New coumarin from the roots of Prangos pabularia growing wild in Tajikistan.

Dichloromethane and butanol extracts of the roots of Prangos pabularia were analyzed to determine chemical constituents and biological activity. The new coumarin 1, yuganin B ((5-(((2S,3R,4S,5S,6R)-4,5-dihydroxy-6-(hydroxymethyl)-2-((2-oxo-2H-chromen-7-yl)oxy)tetrahydro-2H-pyran-3-yl)oxy)-3,4-dihydroxytetrahydrofuran-3-yl)methyl 4-hydroxy-3-methoxybenzoate) along with three phenolic and twenty-four known coumarins were isolated from the roots of Prangos pabularia, and the structures of these isolated compounds were elucidated by UV, HR-ESIMS, and 1 D and 2 D NMR spectroscopy. In addition, the anti-melanogenic effect of several of the isolated individual compounds and their inhibitory effect on B16 cells were evaluated. Isolating and testing compounds may proof to be useful in the treatment of hyperpigmentation and as a skin-whitening agent in the cosmetics industry.

Оё одамон имконияти молиявии пардохти хизматрасонии тиббиро доранд? Далелҳои нав оид ба ҳимояи молиявӣ дар Тоҷикистон

Дар ин гузориши ҷамъбастӣ арзёбӣ карда мешавад, ки то чӣ андоза мардум дар Тоҷикистон ҳангоми истифода аз хизматрасониҳои тиббӣ ва пардохти нақдӣ аз ҷайби худ ба мушкилоти молиявӣ дучор мешавад. Таҳлили ҳимояи молиявӣ одатан маълумотро дар бораи эҳтиёҷоти қонеънашуда ба кӯмаки тиббӣ дар бар мегирад, аммо ин маълумот барои Тоҷикистон дастрас нест. Дар гузориш маълумоти Тадқиқоти буҷети хонаводаҳо истифода карда шудааст, ки аз ҷониби Агентии омори назди Президенти Ҷумҳурии Тоҷикистон дар давраҳои аз соли 2016 то 2019 ва аз 2021 то 2022 гузаронида шудааст. Хулосаҳои асосии гузориш чунин мебошанд.

В состоянии ли люди платить за услуги здравоохранения? Новые данные о финансовой защите в Таджикистане: Сводный отчет

В этом сводном отчете оценивается степень, в которой население Таджикистана испытывают финансовые трудности при использовании услуг здравоохранения и осуществляют выплаты из кармана (прямые платежи, осуществляемые населением). Анализ финансовой защиты обычно включает данные о неудовлетворенных потребностях в услугах здравоохранения, но эти данные недоступны для Таджикистана. В отчете использованы микроданные обследований бюджетов домашних хозяйств, проведенных Агентством по статистике при Президенте Республики Таджикистан в период с 2016 по 2019 гг. и с 2021 по 2022 гг. Основные выводы отчета заключаются в следующем.

Health labour market analysis in Tajikistan

The Health Labour Market Analysis (HLMA) was undertaken to understand the health workforce situation in Tajikistan to inform the development of a National Health Workforce Action Plan that will contain key policies to improve the availability of health workers to provide quality health care. To guide the analysis, three policy questions were identified through a consultative process led by the Ministry of Health and Social Protection and supported by WHO. The questions related to 1) the availability of health workers in primary health care and ways to attract health workers at primary health care level, 2) the situation and quality of postgraduate medical specialty programme and 3) situation and quality of nursing education. The findings and policy considerations emerging out of the analysis were validated by the Technical Working Group on Health Labour Market Analysis under the Ministry of Health and Social Protection of the Population, Tajikistan. This analysis is being used by the Ministry of Health in evidence-based planning for retention and recruitment of the primary health care workforce, improvements in medical and nursing education, and higher investments in the health workforce.

Household drug-resistant TB contact tracing in Tajikistan.

BACKGROUND: Tajikistan has a high burden of rifampicin-resistant TB (RR-TB), with 2,700 new cases estimated for 2021 (28/100,000 population). TB is spread among household members through close interaction and children exposed through household contact progress to disease rapidly and frequently.METHODS: We retrospectively analysed programmatic data from household contact tracing in Dushanbe over 50 months. We calculated person-years of follow-up, contact tracing yield, number needed to screen (NNS) and number needed to test (NNT) to find one new case, and time to diagnosis.RESULTS: We screened 6,654 household contacts of 830 RR-TB index cases; 47 new RR-TB cases were detected, 43 in Year 1 and 4 in Years 2 or 3. Ten were aged <5 years; 46/47 had TB symptoms, 34/45 had chest radiographs consistent with TB, 11/35 were Xpert Ultra-positive, 29/32 were tuberculin skin test-positive and 28/47 had positive TB culture and phenotypic drug susceptibility results. The NNS to find one RR-TB case was 141.57 and the NNT was 34.49. The yields for different types of contacts were as follows: 0.7% for screened contacts, 2.9% for tested contacts, 17.0% for symptomatic contacts and 12.1% for symptomatic contacts aged below 5 years.CONCLUSION: RR-TB household contact tracing was feasible and productive in Tajikistan, a low middle-income country with an inefficient healthcare delivery system.

Gahvora cradling in Tajikistan: Cultural practices and associations with motor development.

In Tajikistan, infants are bound supine in a "gahvora" cradle that severely restricts movement. Does cradling affect motor development and body growth? In three studies (2013-2018), we investigated associations between time in the gahvora (within days and across age) and motor skills and flattened head dimensions in 8-24-month-old Tajik infants (N = 269, 133 girls, 136 boys)) and 4.3-5.1-year-old children (N = 91, 53 girls, 38 boys). Infants had later motor onset ages relative to World Health Organization standards and pronounced brachycephaly; cradling predicted walk onset age and the proficiency of sitting, crawling, and walking. By 4-5 years, children's motor skills were comparable with US norms. Cultural differences in early experiences offer a unique lens onto developmental processes and equifinality in development.

Unnecessary hospitalisations and polypharmacy practices in Tajikistan: a health system evaluation for strengthening primary healthcare.

BACKGROUND: Children and pregnant women require multiple contacts with the healthcare system. While most conditions can be managed by primary healthcare (PHC) providers, hospitalisations are common. This health system evaluation in Tajikistan quantifies unnecessary and unnecessarily prolonged hospitalisations and assesses antibiotic and polypharmacy practices. METHODS: Data were retrospectively collected from randomly selected medical records from 15 hospitals. Inclusion criteria were children 2-59 months of age with a primary diagnosis of acute respiratory infection or diarrhoea, or pregnant women with threatened preterm labour, threatened miscarriages, premature rupture of membranes or mild pre-eclampsia, hospitalised between January and September 2021. RESULTS: Among 440 children and 422 pregnant women, unnecessary hospitalisations accounted for 40.5% and 69.2% of hospitalisations, respectively, ranging from 0% to 92.7% across the hospitals. Among necessary hospitalisations, 63.0% and 39.2% were unnecessarily prolonged in children and women, respectively.Prior to admission, 36.8% of children had received antibiotics, in which more than half intramuscularly. During hospitalisation, 92.5% of children and 28.9% of women received antibiotics. Children and women received an average of 5 and 6.5 drugs, respectively; most were not indicated or with no evidence of benefits. CONCLUSIONS: The methodology is applicable across all health systems and can provide important insights on health service use and resource waste. Findings of this assessment in Tajikistan have led to evidence-based decisions and actions from stakeholders and policy makers with the goal of strengthening PHC and improving the management of common diseases in children and pregnant women.

Detection of Mycobacterium tuberculosis Complex Using the Xpert MTB/RIF Ultra Assay on the Stool of Pediatric Patients in Dushanbe, Tajikistan.

We report the findings of a prospective laboratory diagnostic accuracy study to evaluate the sensitivity, specificity, and predictive values of the Xpert MTB/RIF Ultra assay for Mycobacterium tuberculosis detection in fresh stool specimens from children under 15 years of age with confirmed tuberculosis (TB) disease from Dushanbe, Tajikistan. Six hundred eighty-eight (688) participants were enrolled from April 2019 to October 2021. We identified 16 participants (2.3%) with confirmed TB disease, defined as ≥1 TB sign/symptom plus microbiologic confirmation. With the Xpert MTB/RIF Ultra assay for stool, we found a sensitivity of 68.8% (95% CI, 46.0 to 91.5) and a specificity of 98.7% (95% CI, 97.8 to 99.5) in confirmed TB disease. Our results are comparable to other published studies; however, our cohort was larger and our confirmed TB disease rate lower than most. We also demonstrated that this assay was feasible to implement in a centralized hospital laboratory in a low-middle-income Central Asian country. However, we encountered obstacles such as lack of staffing, material ruptures, outdated government protocols, and decreased case presentation due to COVID-19. We found eight patients whose only positive test was an Xpert Ultra stool assay. None needed treatment during the study; however, three were treated later, suggesting such cases require close observation. Our report is the first from Central Asia and one of a few from a low-middle-income country. We believe our study demonstrates the generalizability of the Xpert MTB/RIF Ultra assay on fresh stool specimens from children and provides further evidence supporting WHO's approval of this diagnostic strategy. IMPORTANCE The importance of this report is that it provides further support for WHO's recent recommendation that fresh stool is an acceptable sample for GeneXpert TB testing in children, especially small children who often cannot produce an adequate sputum sample. Diagnosing TB in this age group is difficult, and many cases are missed, leading to unacceptable rates of TB illness and death. In our large cohort of children from Dushanbe, Tajikistan, the GeneXpert stool test was positive in 69% of proven cases of TB, and there were very few false-positive tests. We also showed that this diagnostic strategy was feasible to implement in a low-middle-income country with an inefficient health care delivery system. We hope that many more programs will adopt this form of diagnosing TB in children.

Contextual Factors Associated With Women's Attitudes Toward Intimate Partner Violence in Tajikistan: Findings From the 2012 and 2017 Demographic and Health Surveys.

The study employed data from the 2012 and 2017 Tajikistan Demographic and Health Surveys to examine two time periods on media access, interview setting, and sociodemographic predictors of intimate partner violence (IPV) justification attitudes among representative samples of women aged 15-49 years old (9,656 and 10,718 women, respectively) in Tajikistan. The odds of justifying IPV were higher for women who had access to radio and lower for those who had access to newspaper and television. The presence of the husband and other women during the interview was associated with lower justification of IPV. The findings emphasize the importance of contextual factors in developing effective IPV intervention policies.

Can people afford to pay for health care? New evidence on financial protection in Tajikistan: summary

This summary report assesses the extent to which people in Tajikistan experience financial hardship when they use health services and pay out of pocket. Analysis of financial protection usually includes data on unmet need for health care, but these data are not available for Tajikistan. The report draws on microdata from household budget surveys carried out by the Statistical Agency under the President of the Republic of Tajikistan from 2016 to 2019 and 2021 to 2022. Its key findings are as follows.

Ottia, a new ennomine genus of moth from Tajikistan (Lepidoptera: Geometridae).

An ennomine species, described earlier as Plagodis ochraceata Viidalepp, 1988, is transferred from Plagodis Hbner, [1823]1816 to a genus of its own: Ottia ochraceata (Viidalepp, 1988) (gen. nov., comb. nov.). The morphology of the adult moth, of its male and female genitalia, phenology and spatial distribution are described and its taxonomic relationships are analyzed.

New and poorly known species of Palpimanus Dufour, 1820 (Araneae, Palpimanidae) from Uzbekistan and Tajikistan.

Two new species, Palpimanus logunovi sp. n. () and P. rakhimovi sp. n. (), are described from Tajikistan and Uzbekistan respectively. Lectotype has been designated for the poorly known species, P. sogdianus Charitonov, 1946 from Uzbekistan and is redescribed based on type and newly collected material. (Re)descriptions, figures, diagnoses, distribution map and photograps of habitats of all the studied species are provided.

Availability and prices of essential medicines in Tajikistan in 2021

Access to medicines, vaccines and health products is an essential component of universal health coverage. It represents one of the building blocks of a well-functioning health system and is an essential determinant of better health outcomes at individual and population levels. To enable regular monitoring of patient-level indicators of access, in 2016 WHO launched the MedMon mobile application for monitoring price and availability of essential medicines and health products. This report presents results of a facility-based survey conducted in April–May 2021 on the availability and prices of essential medicines in community pharmacies in Tajikistan using MedMon.

Фазои буҷетӣ барои тандурустӣ дар Ҷумҳурии Тоҷикистон: имкониятҳои ҷалби захираҳои давлатии иловагӣ

Барномаи ислоҳоти соҳаи тандурустии Ҷумҳурии Тоҷикистон ҷиҳати ноил шудан ба фарогирии умумӣ бо хизматрасониҳои тандурустӣ (ФУХТ) аз беҳтар намудани дастрасии тамоми аҳолӣ ба хизматрасонии тиббии баландсифат ва истифодаи самараноки захираҳои давлатӣ иборат аст. Стратегияи миллии тандурустии ба наздикӣ қабулшуда (Стратегияи ҳифзи солимии аҳолии Ҷумҳурии Тоҷикистон барои давраи то соли 2030) ба далелҳо ва тавсияҳои глобалӣ пайравӣ намуда, ба тавсеаи кумаки аввалияи тиббию санитарӣ такя мекунад. Барои татбиқи стратегия ба Ҷумҳурии Тоҷикистон лозим аст, ки маблағгузории давлатиро ба соҳаи тандурустӣ ба таври қобили мулоҳиза зиёд намояд ва захираҳоро ба он соҳае ҷудо намояд, ки онҳо самараи бештар доранд. Дар айни замон, захираҳои буҷетӣ барои кӯмаки аввалияи тиббию санитарӣ кофӣ нестанд ва дар саросари кишвар нобаробар тақсим карда мешаванд, ки дар натиҷа камбудиҳои ноодилона дар дастрасии хизматрасонии тиббӣ ба вуҷуд меоянд. Аз ин рӯ, дар истифодаи соҳаи тандурустӣ фарқиятҳои беасос вуҷуд доранд. Дар гузориши мазкур имкониятҳои алтернативии зиёд кардани фазои буҷетӣ барои саломатӣ, аз ҷумла захираҳои кӯмаки аввалияи тиббию санитарӣ тавсиф, таҳлил ва муқоиса шудаанд.

Budgetary space for health in the Republic of Tajikistan: options for more public resources

The Republic of Tajikistan’s health reform agenda to achieve universal health coverage includes improved access to high-quality health care for the entire population and more efficient use of public resources. The recently adopted National Health Strategy (Strategy for the Healthcare of the Population of the Republic of Tajikistan, 2021–2030) follows global evidence and recommendations, and builds on expanding primary health care. To implement the strategy, Tajikistan needs to increase considerably public funding for health and allocate resources to where they will have the most effect. Currently, budget resources for primary health care are lagging behind, and are unevenly distributed across the country, resulting in unjust gaps in health care access. Consequently, there are unjustified differences in health care utilization.This report describes, analyses and compares alternative opportunities to increase budgetary space for health, in particular resources for primary health care.

Наличие основных лекарственных средств и цены на них в Республике Таджикистан в 2021 г.

Доступ к лекарствам, вакцинам и изделиям медицинского назначения является важнейшим компонентом в достижении всеобщего охвата услугами здравоохранения (ВОУЗ). Он представляет собой один из составных элементов эффективно функционирующей системы здравоохранения и является важным фактором, определяющим высокие показатели в области охраны здоровья на индивидуальном и популяционном уровнях. Чтобы обеспечить возможность регулярного мониторинга показателей доступа дляпациентов, в 2016 г. Всемирная организация здравоохранения (ВОЗ) запустила мобильное приложение MedMon для мониторинга цен и наличия основных лекарственных средств и изделий медицинского назначения.В этом отчете представлены результаты исследования, проведенного в учреждениях здравоохранения с использованием инструмента MedMon в течение апреля и мая 2021 г. с целью оценки наличия основных лекарственных средств и цен на них в розничных аптеках Республики Таджикистан.

Quantitative evaluation of Zindagii Shoista (Living with Dignity) intervention to prevent violence against women in Tajikistan.

BACKGROUND: Violence against women and girls (VAWG) is a major problem in Tajikistan, driven by conservative gender norms, the culturally ascribed position of young women, and poverty. OBJECTIVE: We evaluated Zindagii Shoista (Living with Dignity), an intervention developed with the aim of reducing VAWG through a combination of gender norm change, communication skills, and income-generating activities (IGA) over a period of 30 months. METHODS: The evaluation used a mixed-methods approach, combining quantitative and qualitative data collection. Eighty families from four villages were enrolled in the intervention and surveyed at baseline and on three subsequent occasions. From these families, 134 women and 102 men were interviewed at baseline, 153 women and 89 men 8 months later, 153 women and 93 men 15 months later, and 143 women and 82 men, 30 months after the baseline. Generalised random effects regression models were used to assess the trend in proportions or mean score over time. RESULTS: Over the 30 months, the proportion of women and men earning in the past month rose from 17.9% to 56.6% and 44.1% to 72%, respectively. Women and men's gender attitudes became significantly less patriarchal, and they reported less harmful gender norms in the community. Women and men reported less male controlling behaviour and greater woman involvement in decision-making. Women's reports of experience of emotional, physical, and sexual IPV significantly reduced. Depressive symptoms and suicidal thoughts reduced significantly for men and women, and self-rated health improved. CONCLUSIONS: The quantitative findings are confirmed by the findings of the qualitative research and monitoring data. They demonstrate that Zindagii Shoista is a very promising intervention for strengthening gender relations, reducing IPV, and improving mental health and socio-economic circumstances for younger married women and their families in Tajikistan.