An ethnoveterinary study of wild medicinal plants used by the Kyrgyz farmers.

ETHNOPHARMACOLOGICAL RELEVANCE: In their centuries-old nomadic life, since their livestock was the backbone of their lives, the Kyrgyz people used a variety of wild medicinal plants for ethnoveterinary practices. However, the plants used for the treatment of livestock ailments never have been recorded, except rarely in local publications. In this study, we present the HSHR (homemade single species herbal remedy reports), their methods of preparation and application, and the livestock ailments for which these remedies were used. AIMS: The collect data from the five different high-altitude valleys of the Kyrgyz Republic on common HSHR used for the treatment of the livestock ailments and describe their preparation procedure, administration, and target animal species. MATERIALS AND METHODS: The plant species mentioned for ethnoveterinary use were collected from five different high-altitude valleys (pastures) in the Kyrgyz Republic during 2016 and 2018. Data were gathered with the help of dialog partners (experienced local shepherds, farmers and veterinarians) through semi-structured interviews. In total, 166 dialog partners were interviewed. The special characteristics of HSHR mentioned for ethnoveterinary use and practices were documented. Plant samples and voucher specimens were collected for taxonomic identification, and preserved for future reference. RESULTS: A total of 2388 HSHR referred to 66 plant species mentioned for ethnoveterinary use belonging to 27 families and 49 genera. According to the data, species of the family Asteraceae were most frequently used HSHRs in the Kyrgyz ethnoveterinary practice (599 HSHR, 25%), followed by Polygonaceae (166 HSHR, 7%), Lamiaceae (141 HSHR, 6%), Ranunculaceae (121 HSHR, 5%), Nitrariaceae (119 HSHR, 4.9%), Apiaceae (113 HSHR, 4.7%), Cupressaceae (111 HSHR, 4.6%), Urticaceae (100 HSHR, 4.2%), Gentianaceae (92 HSHR, 3.8%), Amaranthaceae (87 HSHR, 3.6%). A total of 2785 UR (use reports) were collected for the 2388 HSHR. Infection diseases (572 UR, 20.5%), parasitic diseases (531 UR, 19%), gastrointestinal disorders (523 UR, 18.77%) and wounds (522 UR, 18.74%) were almost evenly reported indications. The largest number use reports (UR) were for cattle (967 UR, 34.7%) and horses (919 UR, 33%), followed by 607 UR (21.8%) for sheep and 292 UR (10.48%) for other domestic animals, including dogs (106 UR, 3.8%), goats (103 UR, 3.69%) and donkeys (83 UR, 2.98%). CONCLUSION: In this study, we identified the folk ethnoveterinary knowledge of the HSHR used by the Kyrgyz farmers in their daily veterinary practice. All the characterized HSHR are of value to the local animal breeders. This knowledge has previously been limited to local shepherds, farmers and vets. Many of these need scientific confirmation using modern methods of phytochemistry and pharmacology.

Evidence for early dispersal of domestic sheep into Central Asia.

The development and dispersal of agropastoralism transformed the cultural and ecological landscapes of the Old World, but little is known about when or how this process first impacted Central Asia. Here, we present archaeological and biomolecular evidence from Obishir V in southern Kyrgyzstan, establishing the presence of domesticated sheep by ca. 6,000 BCE. Zooarchaeological and collagen peptide mass fingerprinting show exploitation of Ovis and Capra, while cementum analysis of intact teeth implicates possible pastoral slaughter during the fall season. Most significantly, ancient DNA reveals these directly dated specimens as the domestic O. aries, within the genetic diversity of domesticated sheep lineages. Together, these results provide the earliest evidence for the use of livestock in the mountains of the Ferghana Valley, predating previous evidence by 3,000 years and suggesting that domestic animal economies reached the mountains of interior Central Asia far earlier than previously recognized.

Widespread collapse, glimpses of revival: a scoping review of mental health policy and service development in Central Asia.

PURPOSE: We aimed to map evidence on the development of mental health care in Central Asia after 1991. METHOD: We conducted a scoping review complemented by an expert review. We searched five databases for peer-reviewed journal articles and conducted grey literature searching. The reference lists of included articles were screened for additional relevant publications. RESULTS: We included 53 articles (Kazakhstan: 13, Kyrgyzstan: 14, Tajikistan: 10, Uzbekistan: 9, Turkmenistan: 2, Multinational: 5). Only 9 were published in internationally recognised journals. In the 1990's mental health services collapsed following a sharp decline in funding, and historically popular folk services re-emerged as an alternative. Currently, modernised mental health policies exist but remain largely unimplemented due to lack of investment and low prioritisation by governments. Psychiatric treatment is still concentrated in hospitals, and community-based and psycho-social services are almost entirely unavailable. Stigma is reportedly high throughout the region, psychiatric myths are widespread, and societal awareness of human rights is low. With the exception of Kyrgyzstan, user involvement is virtually absent. After many years of stagnation, however, political interest in mental health is beginning to show, along with some promising service developments. CONCLUSIONS: There is a substantial knowledge gap in the region. Informed decision-making and collaboration with stakeholders is necessary to facilitate future reform implementation.

A Triassic stem-salamander from Kyrgyzstan and the origin of salamanders.

The origin of extant amphibians remains largely obscure, with only a few early Mesozoic stem taxa known, as opposed to a much better fossil record from the mid-Jurassic on. In recent time, anurans have been traced back to Early Triassic forms and caecilians have been traced back to the Late Jurassic Eocaecilia, both of which exemplify the stepwise acquisition of apomorphies. Yet the most ancient stem-salamanders, known from mid-Jurassic rocks, shed little light on the origin of the clade. The gap between salamanders and other lissamphibians, as well as Paleozoic tetrapods, remains considerable. Here we report a new specimen of Triassurus sixtelae, a hitherto enigmatic tetrapod from the Middle/Late Triassic of Kyrgyzstan, which we identify as the geologically oldest stem-group salamander. This sheds light not only on the early evolution of the salamander body plan, but also on the origin of the group as a whole. The new, second specimen is derived from the same beds as the holotype, the Madygen Formation of southwestern Kyrgyzstan. It reveals a range of salamander characters in this taxon, pushing back the rock record of urodeles by at least 60 to 74 Ma (Carnian-Bathonian). In addition, this stem-salamander shares plesiomorphic characters with temnospondyls, especially branchiosaurids and amphibamiforms.

Trace elements and ALAD gene polymorphisms in general population from three uranium legacy sites - A case study in Kyrgyzstan.

At three uranium (U) legacy sites in Kyrgyzstan, namely, Kadji Sai, Mailuu-Suu and Sumsar, an initial human bio-monitoring programme was introduced as a complementary activity to environmental impact studies in these areas. The aim was to assess trace element (TE) contents in blood and genetic susceptibility for Pb as one of the contaminants. The programme included the determination of 9 TE in blood samples from 123 residents living permanently in this environment. The analyses included U and the potentially toxic TE, lead (Pb), cadmium, mercury (Hg), and arsenic (As), together with essential elements iron (Fe), copper, selenium (Se) and manganese (Mn). TE were analysed by inductively coupled plasma mass spectrometry (ICPMS) and genetic background effect by three single nucleotide polymorphisms (SNPs) of delta-aminolevulinic acid dehydratase (ALAD; rs1805313, rs818708, rs1800435) genotyped by quantitative polymerase chain reaction (qPCR). The obtained results were generally similar to literature reference values obtained from the U non-exposed environments. However, some significant findings indicated elevated levels of certain contaminants typical of the studied environment (U, Pb). Several essential (Se, Mn) and toxic TE (Pb, Hg, As, U) in blood showed statistically significant differences among the studied areas. All areas showed diminished Fe blood levels. Altogether, this indicated specific and different environmental conditions at three industrial legacy sites for U milling and processing along with the accompanying chemical (pollutant) elements. Blood U concentrations were slightly higher at Mailuu-Suu, known for elevated technogenic and naturally occurring U. At Sumsar, the distribution of elevated blood Pb concentrations indicated an airborne source of pollution that was different from the anticipated aqueous exposure pathway. Pb blood variability was found associated with ALAD polymorphisms (SNPs rs1805313, rs1800435). Results are confirming that human data will be a useful and scientifically important additional tool for environmental impact assessment studies at industrial legacy sites in Kyrgyzstan.

Four years after implementation of a national micronutrient powder program in Kyrgyzstan, prevalence of iron deficiency and iron deficiency anemia is lower, but prevalence of vitamin A deficiency is higher.

BACKGROUND/OBJECTIVES: In 2009, the Ministry of Health of Kyrgyzstan launched a national Infant and Young Child Nutrition (IYCN) program which included point-of-use fortification of foods with micronutrient powders (MNP) containing iron, vitamin A, and other micronutrients. Caretakers of children aged 6-23 months were given 30 sachets of MNP every 2 months. Micronutrient surveys were conducted in 2009 and 2013. The objective of the study was to compare the prevalence of anemia and deficiencies of iron and vitamin A among children aged 6-29 months prior to the MNP program (2009) with those after full implementation (2013). SUBJECTS/METHODS: Cross-sectional national surveys were conducted in 2009 (n = 666) and 2013 (n = 2150). Capillary blood samples were collected to measure hemoglobin, iron (ferritin and soluble transferrin receptor [sTfR]) and vitamin A (retinol binding protein [RBP]) status, and inflammation status (C-reactive protein [CRP] and α-1-acid glycoprotein [AGP]). Ferritin, sTfR, and RBP were adjusted for inflammation; hemoglobin was adjusted for altitude. RESULTS: The prevalence of anemia was non-significantly lower in 2013 compared to 2009 (32.7% vs. 39.0%, p = 0.076). Prevalence of inflammation-adjusted iron deficiency (54.8% vs. 74.2%, p<0.001) and iron deficiency anemia (IDA, 25.5% vs. 35.1%, p = 0.003) were lower and the prevalence of inflammation-adjusted vitamin A deficiency was higher (4.3% vs. 2.0%, p = 0.013) in 2013 compared to 2009. CONCLUSIONS: Four years after the initiation of a national Infant and Young Child Nutrition program including the introduction of point-of-use fortification with MNP, the prevalence of iron deficiency and IDA is lower, but the prevalence of vitamin A deficiency is higher.

Evaluation of a Community-based Child (Infants and Toddlers) Health Promotion Pilot Project in a Migrant Village in Kyrgyzstan

PURPOSE: Children in migrant villages in Kyrgyzstan have a high incidence of anemia and need effective health promotion programs. The purpose of this study was to evaluate a pilot study of a health promotion project for infants and toddlers based on community participation.METHODS: This was a retrospective study conducted to evaluate the effectiveness of the project. The project was carried out by nurses at a public health center, community health workers, and local residents in a migrant village. After the operational system of the project was established, health assessments, child-care education, provision of vouchers for iron supplements, and activities to improve residents' awareness were conducted during 6 months among 100 children, of whom 85 were finally analyzed.RESULTS: In international health projects, close cooperation of the project team with community residents and health workers is important. Access to the community-based program was feasible in the socially and economically poor migrant village, and improvements were shown in children's anemia and awareness of health care.CONCLUSION: By focusing on the effective aspects of this preliminary project, plans to utilize community health workers and promotion strategies can be added to the main project to improve health promotion among children in this area.

Early pastoral economies along the Ancient Silk Road: Biomolecular evidence from the Alay Valley, Kyrgyzstan.

The Silk Road was an important trade route that channeled trade goods, people, plants, animals, and ideas across the continental interior of Eurasia, fueling biotic exchange and key social developments across the Old World. Nestled between the Pamir and Alay ranges at a baseline elevation of nearly 3000m, Kyrgyzstan's high Alay Valley forms a wide geographic corridor that comprised one of the primary channels of the ancient Silk Road. Recent archaeological survey reveals a millennia-long history of pastoral occupation of Alay from the early Bronze Age through the Medieval period, and a stratified Holocene sequence at the site of Chegirtke Cave. Faunal remains were recovered from test excavations as well as surface collection of material from recent marmot activity. Although recovered specimens were highly fragmented and mostly unidentifiable using traditional zooarchaeological methods, species identification via collagen mass fingerprinting (ZooMS) coupled with sex and first-generation hybrid identification through ancient DNA enabled preliminary characterization of the animal economy of Alay herders. Our new results indicate primary reliance on sheep at Chegirtke Cave (ca. 2200 BCE), with cattle and goat also present. The discovery of a large grinding stone at a spatially associated Bronze or Iron Age habitation structure suggests a mixed agropastoral economic strategy, rather than a unique reliance on domestic animals. Radiocarbon-dated faunal assemblages from habitation structures at nearby localities in the Alay Valley demonstrate the presence of domestic horse, as well as Bactrian camel during later periods. The current study reveals that agropastoral occupation of the high-mountain Alay corridor started millennia before the formal establishment of the Silk Road, and posits that ZooMS, when paired with radiocarbon dates and ancient DNA, is a powerful and cost-effective tool for investigating shifts in the use of animal domesticates in early pastoral economies.

The Midwifery Services Framework: Lessons learned from the initial stages of implementation in six countries.

In 2015, the International Confederation of Midwives (ICM) launched the Midwifery Services Framework (MSF): an evidence-based tool to guide countries through the process of improving their sexual, reproductive, maternal and newborn health services through strengthening and developing the midwifery workforce. The MSF is aligned with key global architecture for sexual, reproductive, maternal and newborn health and human resources for health. This third in a series of three papers describes the experience of starting to implement the MSF in the first six countries that requested ICM support to adopt the tool, and the lessons learned during these early stages of implementation. The early adopting countries selected a variety of priority work areas, but nearly all highlighted the importance of improving the attractiveness of midwifery as a career so as to improve attraction and retention, and several saw the need for improvements to midwifery regulation, pre-service education, availability and/or accessibility of midwives. Key lessons from the early stages of implementation include the need to ensure a broad range of stakeholder involvement from the outset and the need for an in-country lead organisation to maintain the momentum of implementation even when there are changes in political leadership, security concerns or other barriers to progress.

Provision of medical abortion by midlevel healthcare providers in Kyrgyzstan: testing an intervention to expand safe abortion services to underserved rural and periurban areas.

OBJECTIVE: To demonstrate the feasibility and safety of training midlevel healthcare providers (midwives and family nurses) to provide medical abortion and postabortion contraception in underserved areas in Kyrgyzstan. STUDY DESIGN: This was an implementation study at four referral facilities and 28 Felsher Obstetric Points in two districts to train their midwives and family nurses to deliver safe and effective abortion care with co-packaged mifepristone-misoprostol and provide contraceptives postabortion. The outcome of abortion - complete abortion, incomplete abortion or o-going pregnancy - was the primary end point measured. An international consultant trained 18 midwives and 14 family nurses (with midwifery diplomas) to provide medical abortion care. Supervising gynecologists based in the referral centers and study investigators based in Bishkek provided monthly monitoring of services and collection of patient management forms. A voluntary self-administered questionnaire at the follow-up visit documented women's acceptability of medical abortion services. All study data were cross-checked and entered into an online data management system for descriptive analysis. RESULTS: Between August 2014 and September 2015, midwives provided medical abortion to 554 women with a complete abortion rate of 97.8%, of whom 62% chose to use misoprostol at home. No women were lost to follow-up. Nearly all women (99.5%) chose a contraceptive method postabortion; 61% of women receiving services completed the acceptability form, of whom more than 99% indicated a high level of satisfaction with the service and would recommend it to a friend. CONCLUSION: This study demonstrates that trained Kyrgyz midwives and nurses can provide medical abortion safely and effectively. This locally generated evidence can be used by the Kyrgyz Ministry of Health to reduce unintended pregnancy and expand safe abortion care to women in underserved periurban and rural settings. IMPLICATIONS: Success in scaling up midwife/nurse provision of medical abortion in Kyrgyzstan will require registration of mifepristone-misoprostol, regulations permanently allowing midwife/nurse provision, strengthened procurement and distribution systems to prevent stockouts of supplies, preservice training of midwives/nurses and their involvement in district level supervision, monitoring and reporting, and support from supervisors.

Review of Integrated Management of Childhood Illness (IMCI) in Europe

In 1995, WHO and the United Nations Children’s Fund launched the Integrated Management of Childhood Illness (IMCI) as a global strategy to end preventable child mortality and promote child health and development. A global review of IMCI implementation was carried out in 2016. To complement the global review, the WHO Regional Office for Europe conducted an in-depth review of the status of IMCI implementation in the WHO European Region, where IMCI was introduced in the late 1990s. This report sets out findings of the review of IMCI implementation in 16 countries and territories of the European Region, highlighting strengths, weaknesses, opportunities and threats. It also presents vignettes describing review findings at individual country/territory level.

Risky encounters with doctors? Medical diversity and health-related strategies of the inhabitants of Bishkek, Kyrgyzstan.

This paper introduces the notion of 'risky encounters', referring to the way in which contacts with doctors are commonly perceived by the inhabitants of Bishkek, the capital city of Kyrgyzstan. The author's research conducted between 2011 and 2013 revealed that most people were extremely critical of biomedical personnel, despite positive assessments of healthcare reforms expressed by experts. Owing to the prevailing distrust of doctors, their interventions are often considered risky to one's health, which strongly influences people's health-related strategies in the context of medical diversity. This perception of risk is deeply embedded in feelings of uncertainty and anxiety, which should be viewed from the more general perspective of the political, economic and social uncertainties resulting from the difficulties of the period of post-Soviet transformation. It is evident that medical diversity in Bishkek provides people in need with many non-biomedical treatment options, and a distrust of doctors significantly contributes to the popularity of complementary medicine. Economic constraints and local concepts of health, illness and efficacy are among the many other factors that play a role in therapeutic choices. However, the current paper focuses on risk, uncertainty and trust, as emotions that are central to an understanding of the health-related strategies and tactics used by the inhabitants of present-day Bishkek.

Comparative ethnobotany of the Wakhi agropastoralist and the Kyrgyz nomads of Afghanistan.

BACKGROUND: The mountainous Wakhan and Pamir in northeastern Afghanistan is one of the most isolated yet inhabited places in Asia. It is home to the agropastoralist Wakhi and the last Afghan semi-nomadic Kyrgyz. We present a study of plant names and uses, along with comparisons of plant name etymology, origins of plant resources, intra- and intercultural exchanges and relations, and the relative availability of the known and used plants. METHODS: The fieldwork was conducted as an expedition in the summer of 2010, and visited settlements and pastures in Upper Wakhan and Big and Little Pamir. Semi-structured group interviews, talks and observations gave initial data on names, uses and the relative availability of used plants, and provided foundation for individual interviews using an interview-herbarium containing vouchers of the 72 most frequently used plants or plant groups. RESULTS: Wakhi and Kyrgyz plant names are recorded in western transcription, the new Wakhi alphabet, phonetically and in Cyrillic. The present study documents a large body of endemic, indigenous plant knowledge; on crops, fuel, fodder, cosmetics, dyes, vegetables, veterinary medicine, traditional medicines and other plant uses which sustain life in Wakhan and Pamir. Overall, the Wakhi use considerably more plants than the Kyrgyz, and their materia medica and use thereof is more complex. Although the Wakhi and Kyrgyz are close neighbours, there are few indications of direct knowledge transfer between them. Most shared plant uses are strictly necessary for survival in the mountains. While there are few differences between genders and cultural subgroups within the two cultures, the Wakhi and Kyrgyz exhibit great differences both in their total number of use-plants and the distance from which they obtain them. The agropastoralist Wakhi appear to have their basic needs for wild natural resources covered within half a days travel, while the relatively plant-derived environment of the high Pamir appears to have necessitated the nomadic Kyrgyz to adapt by developing uses and obtaining plants that are comparatively remote. CONCLUSION: The comparative differences in plant uses between the agropastoralist Wakhi and nomadic Kyrgyz appear to be accentuated by an environment at the extreme of what is humanly possible.

Music as Illness; Music as Healing.

Throughout the Soviet Union, the arts became tied to ethnicity through the project of Socialist Realism. When, in 1991, the Kyrgyz Republic became independent from the Soviet Union, its national narrative continued to be built upon tropes of Kyrgyz ethnicity. Through their engagement with images of the ethno-national self, the arts provide a great source of beauty. Defining beauty as a representation of the self that is pure whole, and stable, Julia Kristeva asserts that beauty and suffering are part of the same phenomena. Arthur Kleinman argues that suffering is best understood as existing within the triangulated relationship of cultural representation, collective experience, and subjectivity. Music too is part of this triangulated relationship, and therefore, a part of suffering. Drawing upon ten months of ethnographic fieldwork in Kyrgyzstan, this article explores the illness experience of a single Kyrgyz musician. In doing so, it illustrates music's role in self-formation and the development of social, economic, and political ties and the shifts that occur in these during illness. In drawing forth the role of music in the construction of racialized ethnicities, this article demonstrates how the experience of transformative beauty can coexist with turmoil, marginalization, and violence.

Efficacy and safety of moxifloxacin in community acquired pneumonia: a prospective, multicenter, observational study (CAPRIVI).

BACKGROUND: Community acquired pneumonia (CAP) is a major cause of morbidity, hospitalization, and mortality worldwide. Management of CAP for many patients requires rapid initiation of empirical antibiotic treatment, based on the spectrum of activity of available antimicrobial agents and evidence on local antibiotic resistance. Few data exist on the severity profile and treatment of hospitalized CAP patients in Eastern and Central Europe and the Middle East, in particular on use of moxifloxacin (Avelox®), which is approved in these regions. METHODS: CAPRIVI (Community Acquired Pneumonia: tReatment wIth AVelox® in hospItalized patients) was a prospective observational study in 12 countries: Croatia, France, Hungary, Kazakhstan, Jordan, Kyrgyzstan, Lebanon, Republic of Moldova, Romania, Russia, Ukraine, and Macedonia. Patients aged >18 years were treated with moxifloxacin 400 mg daily following hospitalization with a CAP diagnosis. In addition to efficacy and safety outcomes, data were collected on patient history and disease severity measured by CRB-65 score. RESULTS: 2733 patients were enrolled. A low severity index (i.e., CRB-65 score <2) was reported in 87.5% of CAP patients assessed (n=1847), an unexpectedly high proportion for hospitalized patients. Moxifloxacin administered for a mean of 10.0 days (range: 2.0 to 39.0 days) was highly effective: 96.7% of patients in the efficacy population (n=2152) improved and 93.2% were cured of infection during the study. Severity of infection changed from "moderate" or "severe" in 91.8% of patients at baseline to "no infection" or "mild" in 95.5% at last visit. In the safety population (n=2595), 127 (4.9%) patients had treatment-emergent adverse events (TEAEs) and 40 (1.54%) patients had serious TEAEs; none of these 40 patients died. The safety results were consistent with the known profile of moxifloxacin. CONCLUSIONS: The efficacy and safety profiles of moxifloxacin at the recommended dose of 400 mg daily are characterized in this large observational study of hospitalized CAP patients from Eastern and Central Europe and the Middle East. The high response rate in this study, which included patients with a range of disease severities, suggests that treatment with broader-spectrum drugs such as moxifloxacin is appropriate for patients with CAP who are managed in hospital. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00987792.

[Introduction of traditional medicinal plants in Kyrgyzstan].

Kyrgyzstan is a mountainous country in the northeastern part of Central Asia which shares borders to the southeast with China. Due to their extreme environment and climate, there are a diverse range of species of plants. Many of the plants used in Kyrgyz folk medicine have not been studied using modern scientific techniques. This paper introduced the basic situation of medicinal herbs in Kyrgyzstan by comparing the differences traditional use between China and Kyrgyzstan, and looked for traditional medicinal plant research to provide basis for the development and cooperation of China and Kyrgyzstan.

Advancing the nutrition and early childhood development agenda: indicators and guidance.

The importance of early childhood development (ECD) is scientifically established and is increasingly recognized by governments and international organizations. However, progress in protecting and improving ECD is constrained by multisectoral influences on ECD, the multiple sectors and venues for delivering services, the lack of a common fiscal and policy space, and weak or fragmented data and monitoring systems. This paper describes two tools and strategies to strengthen multisectoral, system-wide policy environments for ECD. One is the Systems Approach for Better Education Results (SABER)-ECD framework for tracking progress toward an integrated ECD system. Developed by the World Bank, SABER-ECD assists governments and their partners to take stock of their existing ECD policies and programs, analyze strengths and areas for improvement using common metrics, and learn from international examples. The other tool is an Agenda-Setting and Commitments framework, based on research in global health and nutrition that can guide national-level actors in their advocacy and strategic efforts to strengthen the integrated ECD system. These represent practical and research-based tools to translate scientific evidence concerning ECD into effective and large-scale actions.