Trends in cost and consumption of essential medicines for non-communicable diseases in Azerbaijan, Georgia, and Uzbekistan, from 2019 to 2021.

BACKGROUND: Access to medicines is a global priority. Azerbaijan, Georgia, and Uzbekistan have different approaches to pricing policies for pharmaceuticals. The aim of this study was to analyze recent trends in the consumption and prices of non-communicable disease (NCD) medicines in Azerbaijan, Georgia, and Uzbekistan, in the outpatient setting. METHODS: We included medicines for asthma and COPD, cancer, cardiovascular disease, diabetes, epilepsy, and mental disorders. Sales data for pharmaceutical products in community pharmacies were extracted from a commercial database. Changes in consumption and prices were analyzed across all included NCD medicines, by disease category and pharmacological group. RESULTS: Consumption of NCD medicines was highest in Georgia, at twice the levels in Azerbaijan, and four times levels in Uzbekistan. Average prices of NCD medicines, weighted by consumption, increased by 26% in Georgia, but decreased by 3% in Azerbaijan and by 0.1% in Uzbekistan. Prices increased for all disease groups in Georgia (from +13% for epilepsy medicines to +86% for cancer), varied by group in Uzbekistan (from -22% for epilepsy medicines to +47% for cancer), while changes in Azerbaijan were smaller in magnitude (from -4% for medicines for cardiovascular disease to +11% for cancer). Cancer medicines had markedly higher prices in Uzbekistan, and asthma and COPD medicines had markedly higher prices in Azerbaijan and Uzbekistan. CONCLUSIONS: Georgia showed the highest outpatient consumption of NCD medicines, suggesting the broadest access to treatment. However, Georgia also saw marked price increases, greater than in the other countries. In Georgia, where there was no price regulation, widespread price increases and increases in consumption both contribute to increasing pharmaceutical expenditures. In Azerbaijan and Uzbekistan, increases in outpatient pharmaceutical expenditures were primarily driven by increases in consumption, rather than increases in price. Comparing trends in consumption and pricing can identify gaps in access and inform future policy approaches.

Assessment of the Impact of the Rotavirus Vaccine Against Severe Rotaviral Diarrhea in Uzbekistan.

BACKGROUND: This article presents the results of a long-term study of the impact of rotavirus vaccination in Uzbekistan. Uzbekistan is the first country in the Central Asian region to introduce rotavirus vaccination into the national compulsory vaccination calendar. The study aimed to evaluate the impact of rotavirus vaccination on hospitalizations due to all-cause AGE and RVGE in children < 5 years of age in Uzbekistan. METHODS: Detection of rotavirus antigen was performed using Rotavirus-Antigen-IFA-BEST "Vector Best" kit (Novosibirsk, Russia). RESULTS: The total of 20,128 children under 5 years of age were hospitalized in sentinel hospitals with a diagnosis of acute gastroenteritis during the study period (2019-2020). Of this number of children, 4481 children (22.2%) were included in the study. Of 4481 children, 367 (8.2%) children tested positive for rotavirus. In our study, decrease in the rotavirus rate was noted in all age groups. The peak of rotavirus positivity occurred in the months of January and February. CONCLUSION: The average rotavirus-positive rate in the period (2019-2020) was 8.2% and the absolute percentage decrease was 18.1% compared to the pre-vaccination period (2005-2009) where the rotavirus-positive rate was 26.3%. The percentage of prevented cases averaged 68.8%.

Patterns of adult tobacco use in Uzbekistan.

BACKGROUND: Little is known about the prevalence of tobacco use in Uzbekistan, a country targeted intensively by the international tobacco industry. METHODS: A national household survey elicited information about cigarette smoking and nasway use (a form of smokeless tobacco). RESULTS: Prevalence of past-month smoking and nasway use among men (N=1795) was 19.6% and 22.3%, respectively, and 1.6% and 0.5% among women (N=1831). Among men, smoking was independently associated with Uzbek ethnicity, urban residence, age and occupation; nasway use was associated with rural residence, age, being married and occupation. CONCLUSIONS: The smoking rate in Uzbekistan remains low relative to neighbouring countries, perhaps due to widespread use of cheaper nasway. These findings establish a baseline for future surveys and highlight the importance of smokeless tobacco in assessing overall consumption.

[Improvement of the organization of oncological aid under conditions of specific technogenic load on the population].

Social and economic disbenifits due to mortality from malignant neoplasms were estimated taking into account the losses of man-years of work, mean life expectancy for the sick, losses from temporary disablement and invalidization caused by malignancies, and the cost of oncological aid. The study was based at an area in Uzbekistan subjected to pollution by industrial wastes from an uranium-extracting enterprise. A special purpose-oriented program has been elaborated for the correction of oncological aid currently provided to the workers of the Navoi mining and metallurgical works and the local population. Its implementation resulted in a 13% reduction of standardized mortality from malignant neoplasm in 2004 compared with 1999 and another 24% in 2009. The disbenefit prevented by the reduction of mortality at active ages is estimated at 60,6 mln rubles.

Comparative economic evaluation of Haemophilus influenzae type b vaccination in Belarus and Uzbekistan.

BACKGROUND: Hib vaccine has gradually been introduced into more and more countries during the past two decades, partly due to GAVI Alliance support to low-income countries. However, since Hib disease burden is difficult to establish in settings with limited diagnostic capacities and since the vaccine continues to be relatively expensive, some Governments remain doubtful about its value leading to concerns about financial sustainability. Similarly, several middle-income countries have not introduced the vaccine. The aim of this study is to estimate and compare the cost-effectiveness of Hib vaccination in a country relying on self-financing (Belarus) and a country eligible for GAVI Alliance support (Uzbekistan). METHODS AND FINDINGS: A decision analytic model was used to estimate morbidity and mortality from Hib meningitis, Hib pneumonia and other types of Hib disease with and without the vaccine. Treatment costs were attached to each disease event. Data on disease incidence, case fatality ratios and costs were primarily determined from national sources. For the Belarus 2009 birth cohort, Hib vaccine is estimated to prevent 467 invasive disease cases, 4 cases of meningitis sequelae, and 3 deaths, while in Uzbekistan 3,069 invasive cases, 34 sequelae cases and 341 deaths are prevented. Estimated costs per discounted DALY averted are US$ 9,323 in Belarus and US$ 267 in Uzbekistan. CONCLUSION: The primary reason why the cost-effectiveness values are more favourable in Uzbekistan than in Belarus is that relatively more deaths are averted in Uzbekistan due to higher baseline mortality burden. Two other explanations are that the vaccine price is lower in Uzbekistan and that Uzbekistan uses a three dose schedule compared to four doses in Belarus. However, when seen in the context of the relative ability to pay for public health, the vaccine can be considered cost-effective in both countries.

[Monitoring of the malaria situation and the assessment of antimalaria measures in the Republic of Uzbekistan].

In 2008, the major malaria vectors An.superpictus and An. pulcherrimus amounted up to 50 specimens per premise in the Surkhandaryinsk and Kashkadaryinsk Regions. The high density of larvae in the water reservoirs (as many as 30-50 specimens per square meter) and rice fields (8-60 specimens per square meter) was noted in the Surkhandaryinsk, Namangan, Ferghana, and Tashkent Regions. There is a high susceptibility of the territory due to increased migration between Uzbekistan, Kyrgyzstan, and Tajikistan. In 2008, a total of 4,958,685 subjects passed through 68 border checkpoints, among them there were 835 (0.02%) individuals with suspected infectious diseases, including malaria. The foci of irrigation-ditch area and their conjugate foci of the floodplain-river one of the Surkhandaryinsk Region are most dangerous. Analysis of the trend of malaria foci showed a reduction in the number of new active foci from 44 in 2006 to 6 to 2008. The increased number of residual inactive and sanitized foci suggests that the malaria situation has considerably improved.

Drug prescribing practices for tuberculosis in Uzbekistan.

SETTING: Uzbekistan has had 100% DOTS coverage since 2005; however, the treatment success rate has remained at around 80% for the last 4 years. Surveys from the capital city of Tashkent and from western Uzbekistan have shown high levels of primary multidrug resistance. OBJECTIVE: To assess treatment regimens prescribed for new cases of tuberculosis (TB), including the prescription of additional non-TB drugs, and the cost implications for the patient. DESIGN: We randomly sampled 30 clusters of seven new TB patients. Enrolled patients were interviewed and their medical records were reviewed. RESULTS: In general, the treatment regimens prescribed were correct; doses were high rather than low. Second-line anti-tuberculosis drugs were rarely prescribed. In addition to anti-tuberculosis drugs, patients were prescribed on average seven to eight non-TB drugs. The rationale for prescribing the non-TB drugs was, however, questionable. Patients incurred substantial costs for these drugs, some of which were not without risk. CONCLUSION: Prescriptions of anti-tuberculosis drugs for new TB patients are adequate; however, the practice of prescribing additional non-TB drugs needs to be reconsidered.

Rotavirus gastroenteritis in uzbekistan: implications for vaccine policy in central Asia.

BACKGROUND: To determine the value of rotavirus vaccines in Central Asia, we conducted surveillance of rotavirus in Uzbekistan, the country with the largest birth cohort in the region. Uzbekistan is eligible for international funds to introduce new vaccines. METHODS: We screened stool samples for rotavirus that were collected from children aged <5 years with gastroenteritis in 2 hospitals during 2005-2006. Using surveillance information and other data, we estimated national numbers of rotavirus-associated events per year. RESULTS: Of 3537 enrolled children, 1046 (30%) had rotavirus detected in stool specimens. Children aged <2 years accounted for 841 (80%) of all rotavirus infections. The G1P[8] genotype was identified in 27 (52%) of 52 typed samples collected in 2005. Rotavirus is estimated to cause 1174-1857 deaths and 6394-6558 hospitalizations among children aged <5 years annually. The cumulative risk of hospitalization for rotavirus by age 5 years is 1 in 94-96 children, and the risk of rotavirus-related death is 1 in 330-524 children. CONCLUSIONS: One-third of all hospitalizations for gastroenteritis and almost 5% of all deaths among children aged <5 years in Uzbekistan may be attributable to rotavirus. Introduction of rotavirus vaccines into the national immunization program at the current subsidized prices could be cost-effective.

Health reform: the human resource challenges for Central Asian Commonwealth of Independent States (CIS) countries.

This paper examines the key human resource issues for health amongst mid-level workers in Central Asia CIS countries. It focuses on Azerbaijan, Tajikistan and Uzbekistan highlighting the human resource issues that are evident within these countries and illustrating how they differ from those described in the sub-Saharan developing countries. The key human resource issue highlighted by the World Health Organization Report [WHO. (2006). World Health Report: Working together for health. Geneva: WHO] was the scarcity of health workers. Four million health care workers were identified as essential if the health services of the world are able to meet current health needs. The primary area of need highlighted was in Africa. Africa bears the greatest burden of disease but has the lowest number of health care workers. In the CIS countries in Central Asia different human resource issues have emerged. The Soviet health care system was comprehensive but labour intensive it had a primarily acute and a specialist disease focused approach with little investment in primary and community health care. It was unsustainable and the legacy that it left the new Central Asian emerging nations was of a large workforce with poor levels of competence and outdated approaches to providing care along with a crumbling infrastructure. In response to this situation health reform has been introduced which focuses on a family model of primary health care with family doctors supported by Family Health Nurses. This approach is beginning to make a difference to the morbidity and mortality of the populations but still has a long way to go before its full benefits are realised.

[Hygienic assessment of combined action of ambient air pollutions in the localities].

The paper describes the experimental studies dealing with the reflectory and resorptive effects of a gas-vapor-dust-like mixture comprising sulfur dioxide, nitrogen dioxide, hydrogen fluoride, and suspension particles. The combined effect of the mixture when inhaled by animals was ascertained to present as the incomplete summation effect type. In the combined presence in the ambient air, the sum of shares of sulfur dioxide, nitrogen dioxide, hydrogen fluoride, and suspension particles should not be greater than 0.4 MPC of the isolated effect of each agent alone.

The gender gap in primary health care resource utilization in Central Asia.

There is a large gender gap in life expectancy in some countries of the former Soviet Union. Life expectancy of males is as much as 13 years less than that of females, and a significant portion of the excess male mortality is caused by cardiovascular disease. Although effective primary health care is necessary to manage cardiovascular disease and reduce acute episodes and mortality, the primary health care system is under-utilized by adult males in the region. This study combines disaggregated utilization data with cost data to analyze patterns of per capita primary care resource consumption in urban and rural regions of Kazakhstan and Uzbekistan. The results show that both in absolute and per capita terms, the principal users of primary health are women of reproductive age and children under five. Based on a combination of utilization and cost of services, women of reproductive age consume approximately 1.5 times the average per capita primary health care resources, while men in the same age group consume approximately one-half of the average. Children under five consume about three to five times the average per capita primary care resources. Based on the results of the study, regional government health purchasers worked together with providers to develop a new per capita payment system with age/sex adjustments and incentives for outreach to bring adult men into the primary care system.

[Control of parasitic diseases in Uzbekistan]. / Organizatsiia bor'by s parazitarnymi bolezniami v Uzbekistane.

More than 200,000 patients with parasitic diseases (predominantly helminthisms, zoonotic cutaneous leishmaniasis) are annually notified in Uzbekistan. There are imported cases of malaria and sporadic cases of visceral leishmaniasis. The republic eradicated Filaria medinensis infection (dracunculosis) in 1931, town-type cutaneous leishmaniasis in 1950, malaria in 1960, visceral leishmaniasis in 1968, and hookworm diseases in 1974. Much experience has been accumulated in controlling zoonotic cutaneous leishmaniasis, large-scale social helminthisms: ascariasis, taeniarinchiasis, and hymenolepiasis.

[Health status of children and adolescents in the main cotton growing region of Central Asia]. / Sostoianie zdorovía detei i podrostkov vedushchego khlopkovodcheskogo regiona Srednei Azii.

The paper outlines the health status of schoolchildren residing in a rural area of Uzbekistan. It also provides the results of an analysis of the pupils' morbidity rates by age, sex, pattern of chronic diseases and extent of their spread. The high proportion of nervous and mental diseases concurrent with headache is associated with chronic pesticide intoxication. It is concluded that there is a need of a wide range of health promotion measures, removal of some poor exogenous factors, and improvement of socioeconomic living conditions of the Uzbekistan's rural population.