Implementation of Health Impact Assessment in the Healthcare System of the Republic of Kazakhstan.

The Health Impact Assessment (hereinafter referred to as HIA) is an effective method for predicting potential health impacts from decisions. Little is known about the implementation of the HIA in the Republic of Kazakhstan (further, RK). In addition, the Russian language literature has not yet been reviewed in terms of HIA-related knowledge. By conducting a literature review of enabling factors, including Russian language literature, on the implementation of the HIA and studying governance systems in RK, we aim to suggest an implementation process to implement the HIA in RK. After careful analysis of the governance system, we suggest set up of a HIA support unit under the National Scientific Center for Health Development and discuss the possible benefits. The proposed center should guide the implementation of the HIA in RK.

Status and Trends of Physical Activity Surveillance, Policy, and Research in 164 Countries: Findings From the Global Observatory for Physical Activity-GoPA! 2015 and 2020 Surveys.

BACKGROUND: Physical activity (PA) surveillance, policy, and research efforts need to be periodically appraised to gain insight into national and global capacities for PA promotion. The aim of this paper was to assess the status and trends in PA surveillance, policy, and research in 164 countries. METHODS: We used data from the Global Observatory for Physical Activity (GoPA!) 2015 and 2020 surveys. Comprehensive searches were performed for each country to determine the level of development of their PA surveillance, policy, and research, and the findings were verified by the GoPA! Country Contacts. Trends were analyzed based on the data available for both survey years. RESULTS: The global 5-year progress in all 3 indicators was modest, with most countries either improving or staying at the same level. PA surveillance, policy, and research improved or remained at a high level in 48.1%, 40.6%, and 42.1% of the countries, respectively. PA surveillance, policy, and research scores decreased or remained at a low level in 8.3%, 15.8%, and 28.6% of the countries, respectively. The highest capacity for PA promotion was found in Europe, the lowest in Africa and low- and lower-middle-income countries. Although a large percentage of the world's population benefit from at least some PA policy, surveillance, and research efforts in their countries, 49.6 million people are without PA surveillance, 629.4 million people are without PA policy, and 108.7 million live in countries without any PA research output. A total of 6.3 billion people or 88.2% of the world's population live in countries where PA promotion capacity should be significantly improved. CONCLUSION: Despite PA is essential for health, there are large inequalities between countries and world regions in their capacity to promote PA. Coordinated efforts are needed to reduce the inequalities and improve the global capacity for PA promotion.

Clinical characteristics of congenital and developmental cataract in Kazakhstan.

Purpose: To study and describe clinical characteristics of congenital and developmental cataract at a tertiary eye care facility. Methods: In this retrospective study, 942 children (1311 eyes) presenting with congenital/developmental cataract over a 10-year study period were included. Gender, age at surgery, main presenting complaint, morphologic type of cataract, laterality, family history, and associated findings were recorded. Results: The overall proportion of boys and girls undergoing cataract surgery was approximately equal (P = 0.110). However, in the cases of bilateral cataract, the proportion of boys was larger than girls (P = 0.028). More than half (62.3%) of the patients underwent surgery at the age of >3 years. The main presenting complaint was white pupils, accounting for 48.1% of cases. Total cataract was the most common morphologic type in all age groups. In total, 133 children out of 942 (14.1%) had a positive family history of congenital/developmental cataract. Strabismus and nystagmus were seen in 27.2% and 19.3% of the eyes, respectively. Additional ocular dysmorphology was found in 97 (10.3%) of patients. Coexisting systemic disease was found in 149 (15.8%) cases. Among syndrome-associated cataracts, Down syndrome accounted for the majority of cases. Conclusion: High prevalence of total cataracts as well as frequent association with strabismus and nystagmus are likely to be the consequences of delayed presentation.

Age at recognition and age at presentation for surgery for congenital and developmental cataract in Kazakhstan.

PURPOSE: To investigate the age at recognition and presentation for surgery for congenital and developmental cataract at Kazakh Eye Research Institute in Kazakhstan. METHODS: A retrospective review of children aged 0-18 years, who presented with congenital and developmental cataract between January 1, 2010 and December 31, 2020. All medical records were reviewed. Gender, age at recognition, age at surgery, laterality, residential location (rural/urban) were recorded. RESULTS: The study population included 897 patients of children presented with congenital and developmental cataract over a 10-year study period, 58% of them were boys and 44.6% were from rural areas. Cataract was bilateral in 621 (69.2%) and unilateral in 276 (30.8%) of patients. Median age at recognition for patients with congenital/developmental cataract was 12 months. Median age at surgery for congenital/developmental cataract was 51 months. Only 14.7% of children underwent surgery within first year of life. The urban citizens underwent surgery earlier than patients from rural areas. The median delay in presentation for surgery was 15 months. CONCLUSION: The average age at cataract surgery in the population of Kazakhstan is much older than in developed countries. It is essential to study barriers that associated with delayed presentation to build strategies to overcome them.Key messagesIt is known that cataract surgery in children early in life provides favourable visual outcome.Children with congenital and developmental cataract in Kazakhstan experience delay in surgical treatment.Children from rural areas undergo cataract surgery later than urban citizens.

Adaptation of the Health Literacy Survey Questionnaire (HLS19-Q) for Russian-Speaking Populations-International Collaboration across Germany, Israel, Kazakhstan, Russia, and the USA.

The Russian language is the eighth most spoken language in the world. Russian speakers reside in Russia, across the former Soviet Union republics, and comprise one of the largest populations of international migrants. However, little is known about their health literacy (HL) and there is limited research on HL instruments in the Russian language. The purpose of this study was to adapt the Health Literacy Questionnaire (HLS19-Q) developed within the Health Literacy Survey 2019-2021 (HLS19) to the Russian language to study HL in Russian-speaking populations in Germany, Israel, Kazakhstan, Russia, and the USA. The HLS19-Q was translated either from English or from a national language to Russian in four countries first and then critically reviewed by three Russian-speaking experts for consensus. The HLS19 protocol and "team approach" method were used for linguistic and cultural adaptation. The most challenging was the adaptation of HLS19-Q questions to each country's healthcare system while general HL questions were flexible and adaptable to specific contexts across all countries. This study provides recommendations for the linguistic and cultural adaptation of HLS19-Q into different languages and can serve as an example of international collaboration towards this end.

Population Health Status of the Republic of Kazakhstan: Trends and Implications for Public Health Policy.

The Republic of Kazakhstan began undergoing a political, economic, and social transition after 1991. Population health was declared an important element and was backed with a substantial commitment by the central government to health policy. We examine key trends in the population health status of the Republic of Kazakhstan and seek to understand them in relation to the ongoing political, economic, and social changes in society and its aspirations in health policy. We used the Global Burden of Disease database and toolkit to extract and analyze country-specific descriptive data for the Republic of Kazakhstan to assess life expectancy, child mortality, leading causes of mortality, disability-adjusted life years, and causes and number of years lived with disability. Life expectancy declined from 1990 to 1996 but has subsequently recovered. Ischemic heart disease, stroke, and chronic obstructive pulmonary disease remain among the leading causes of death; child mortality for children under 5 years has declined; and cardiovascular risk factors account for the greatest cause of disability. Considering its socioeconomic development over the last two decades, Kazakhstan continues to lag behind OECD countries on leading health indictors despite substantial investments in public health policy. We identify seven strategic priorities to improve the efficiency and effectiveness of the health care system.

Comparative assessment of health-related quality of life with and without anticonvulsant therapy in patients with childhood epilepsy with centrotemporal spikes.

OBJECTIVE: To estimate anti-seizure medication (ASM) treatment burden and its effects on health-related quality of life (HRQOL) in new-onset childhood epilepsy with centrotemporal spikes (CECTS) using different treatment approaches in Kazakhstan. METHODS: Forty-three patients were followed prospectively during 2015 to 2020 for at least 2 years. Patients were divided into three groups: (1) history of ≤3 seizures (n = 32); (2) ≥4 seizures (n = 6); (3) cerebral palsy coexisting with CECTS (n = 5). The first group was subdivided into treated (n = 8) and observed (n = 24) subgroups. The shortened Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55) was completed by parents after 6 months of follow-up. RESULTS: At the end of the study, all children had a sustained remission from seizures for at least 2 years. Differences were identified in emotional, social, and physical subscales between patients in the low seizure frequency group. Signs of low self-esteem, anxiety, depression, limited social interaction owing to pharmacotherapy, painful medical procedures, and stigma were reasons for decreased HRQOL in the treated subgroup. Overall HRQOL in treated (89.2 ± 5.2) patients was significantly decreased compared with observed children with low seizure frequency (98.0 ± 3.0). CONCLUSION: ASM therapy does not necessarily improve and may decrease HRQOL in children with low seizure frequency CECTS.

International Perspective on Health Literacy and Health Equity: Factors That Influence the Former Soviet Union Immigrants.

Among the world's 272 million international migrants, more than 25 million are from the former Soviet Union (FSU), yet there is a paucity of literature available about FSU immigrants' health literacy. Besides linguistic and cultural differences, FSU immigrants often come from a distinct healthcare system affecting their ability to find, evaluate, process, and use health information in the host countries. In this scoping review and commentary, we describe the health literacy issues of FSU immigrants and provide an overview of FSU immigrants' health literacy based on the integrated health literacy model. We purposefully consider the three most common locations where FSU immigrants have settled: the USA, Germany, and Israel. For context, we describe the healthcare systems of the three host countries and the two post-Soviet countries to illustrate the contribution of system-level factors on FSU immigrants' health literacy. We identify research gaps and set a future research agenda to help understand FSU immigrants' health literacy across countries. Amidst the ongoing global population changes related to international migration, this article contributes to a broad-scope understanding of health literacy among FSU immigrants related to the system-level factors that may also apply to other immigrants, migrants, and refugees.

Development and Validation of a New Short-Form Health Literacy Instrument (HLS-SF12) for the General Public in Six Asian Countries.

BACKGROUND: No comprehensive short-form health literacy (HL) survey tool has been available for general use across Asia. OBJECTIVE: This study aimed to develop and validate a short-form HL instrument derived from the 47-item European Health Literacy Questionnaire (HLS-EU-Q47). METHODS: A population survey (N = 10,024) was conducted from 2013 to 2015 using the HLS-EU-Q47 in 1,029 participants from Indonesia, 1,845 from Kazakhstan, 462 from Malaysia, 1,600 from Myanmar, 3,015 from Taiwan, and 2,073 from Vietnam. Validation of the short form was evaluated by principle component analysis, internal consistency, Pearson correlation, and regression analysis. KEY RESULTS: Based on responses from six countries, a 12-item short-form HL questionnaire (HLS-SF12) was developed, retaining the conceptual framework of the HLS-EU-Q47 and accounting for the high variance of the full-form (i.e., 90% in Indonesia, 91% in Myanmar, 93% in Malaysia, 94% in Taiwan, and 95% in both Kazakhstan and Vietnam). The HLS-SF12 was demonstrated to have adequate psychometric properties, including high reliability (Cronbach's alpha = .85), good criterion-related validity, a moderate and high level of item-scale convergent validity, no floor or ceiling effect, and good model-data-fit throughout the populations in these countries. CONCLUSIONS: The HLS-SF12 was shown to be a valid and reliable tool for HL surveys in the general public in six Asian countries. [HLRP: Health Literacy Research and Practice. 2019;3(2):e90-e102.]. PLAIN LANGUAGE SUMMARY: A health literacy survey was conducted from 2013 to 2015 in six Asian countries using the European Health Literacy Questionnaire (HLS-EU-Q47). The collected data were used to develop and validate a comprehensive short-form questionnaire. A health literacy questionnaire with 12 items (HLS-SF12) that retains the original conceptual framework of the HLS-EU-Q47 was demonstrated to be reliable and valid.

Association between antiretroviral therapy and antitubercular drug resistance in TB treatment outcome among Kazakh TB/HIV co-infected patients.

OBJECTIVES: Drug-resistant tuberculosis (TB) poses a serious threat to public health in Kazakhstan. This paper presents findings related to TB treatment outcome and drug resistance status among people co-infected with human immunodeficiency virus (HIV) and TB in Kazakhstan. METHODS: A cohort study using data provided by the Kazakhstan Ministry of Health's National Tuberculosis Program for 2014 and 2015 was performed. The χ2 test and logistical regression were performed to understand factors associated with drug-resistant TB status and TB treatment outcome. RESULTS: In the bivariate analysis, drug-resistant TB status was significantly associated with year of TB diagnosis (P=0.001) and viral load (P=0.03). TB treatment outcome was significantly associated with age at diagnosis (p=0.01), antiretroviral (ARV) treatment (P<0.0001) and drug-resistant TB status (P=0.02). In the adjusted analysis, drug-resistant TB status was associated with an increased likelihood of successful completion of treatment with a successful outcome compared with treatment failure (odds ratio=6.94, 95% confidence interval 1.39-34.44). CONCLUSIONS: These results suggest that having drug-resistant TB is associated with a higher likelihood of completing treatment with successful outcome, even when controlling for receipt of ARV therapy.

Burden of the Cardiovascular Diseases in Central Asia.

Cardiovascular diseases (CVD) are now the number one cause of death in low- and middle-income countries, including those in Central Asia (CA). Low- and middle-income countries (LMICs) bear a disproportionate and growing burden of CVD, which constitutes a challenge to national development. CVD account for more than 43% of cases of disability and 9.0% of cases of temporary disability in many developing countries. The high burden of CVD oftentimes results from insufficient preventive care and a lack of education about the prevention and treatment of these diseases. The rapidly growing burden of CVD and other major non-communicable diseases (NCDs) is a global public health threat, especially in Central Asia. Information on cardiovascular risk factors, including hypertension, diabetes, tobacco use, and alcohol use, is traditionally obtained from studies conducted in Europe and North America, which limits our understanding of these factors in Central Asia. In this review, we collected all published information on CVD in Central Asia from 2000 to 2015, which included the websites of the Ministries of Health, the World Health Organization, PubMed, and other published sources. This narrative review describes CVD burden, stroke incidence, and common CVD risk factors in the five post-Soviet countries of Central Asia (Kazakshstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan).

Measuring health literacy in Asia: Validation of the HLS-EU-Q47 survey tool in six Asian countries.

BACKGROUND: Health literacy has been increasingly recognized as one of the most important social determinants for health. However, an appropriate and comprehensive assessment tool is not available in many Asian countries. This study validates a comprehensive health literacy survey tool European health literacy questionnaire (HLS-EU-Q47) for the general public in several Asian countries. METHODS: A cross-sectional survey based on multistage random sampling in the target countries. A total of 10,024 participants aged ≥15 years were recruited during 2013-2014 in Indonesia, Kazakhstan, Malaysia, Myanmar, Taiwan, and Vietnam. The questionnaire was translated into local languages to measure general health literacy and its three domains. To evaluate the validity of the tool in these countries, data were analyzed by confirmatory factor analysis, internal consistency analysis, and regression analysis. RESULTS: The questionnaire was shown to have good construct validity, satisfactory goodness-of-fit of the data to the hypothetical model in three health literacy domains, high internal consistency (Cronbach's alpha >0.90), satisfactory item-scale convergent validity (item-scale correlation ≥0.40), and no floor/ceiling effects in these countries. General health literacy index score was significantly associated with level of education (P from <0.001 to 0.011) and perceived social status (P from <0.001 to 0.016), with evidence of known-group validity. CONCLUSIONS: The HLS-EU-Q47 was a satisfactory and comprehensive health literacy survey tool for use in Asia.

Screening of Arterial Hypertension in the Republic of Kazakhstan: Advantages, Disadvantages and Ways of Improving.

BACKGROUND: In the Republic of Kazakhstan, the State screening program for early detection of Arterial Hypertension (AH) and other cardiovascular diseases (CVD) for the target age groups was established in 2008. METHODS: The results of cross-sectional survey conducted at 8 primary health care facilities of Almaty city and Almaty region of Kazakhstan from September 2012 until May 2013 was used. A multistage sampling approach was used to select patients with diagnosed arterial hypertension between 18 to 64 years of age residing in a city (n=405, 50.6%) or village (n=395, 49.4%). Data collection was done via face-to-face interviews using a semi-structured questionnaire. RESULTS: Rural residents (62.7%) mainly were "no-screened". These patients get treatment in policlinics only in case of serious health problems. At younger ages of 18 and 39 years, AH is diagnosed less often among rural than among urban residents (P<0.05). In addition, 71% of the rural residents have incomes below the national average, which has a significant impact on their ability to purchase quality medicines and food and to engage in sports; 16.3% of the rural respondents do not follow doctor's prescriptions due to the lack of money to buy medications. CONCLUSION: The screening for AH and the dissemination of information about screening in rural areas needs a lot of improvement, and that it is necessary to reconsider and improve the public policy for the distribution of free medications.

Public Health Challenges and Priorities for Kazakhstan.

The Republic of Kazakhstan is one of the largest and fastest growing post-Soviet economies in Central Asia. Despite recent improvements in health care in response to Kazakhstan 2030 and other state-mandated policy reforms, Kazakhstan still lags behind other members of the Commonwealth of Independent States of the European Region on key indicators of health and economic development. Although cardiovascular diseases are the leading cause of mortality among adults, HIV/AIDS, tuberculosis, and blood-borne infectious diseases are of increasing public health concern. Recent data suggest that while Kazakhstan has improved on some measures of population health status, many environmental and public health challenges remain. These include the need to improve public health infrastructure, address the social determinants of health, and implement better health impact assessments to inform health policies and public health practice. In addition, more than three decades after the Declaration of Alma-Ata, which was adopted at the International Conference on Primary Health Care convened in Kazakhstan in 1978, facilitating population-wide lifestyle and behavioral change to reduce risk factors for chronic and communicable diseases, as well as injuries, remains a high priority for emerging health care reforms and the new public health. This paper reviews the current public health challenges in Kazakhstan and describes five priorities for building public health capacity that are now being developed and undertaken at the Kazakhstan School of Public Health to strengthen population health in the country and the Central Asian Region.

New horizons for public health in Kazakhstan.

This paper, the first ever to review and critique public health developments in Kazakhstan, suggests ways in which public health can be improved strategically. The paper outlines the main threats to health in a dynamic economically developing country, but argues that with a health care reform agenda in place, and the Governments apparent support of public health policy initiatives, the time is right for new opportunities in the promotion of health. The paper utilises the Ottawa Charter, but suggests novel, more appropriate headings for Kazakhstan, to galvanise policy makers and professionals into tackling the growing burden of disease. It concludes by calling for greater transparency in relation to Government policy initiatives, and the need for greater national and international collaboration.