Quality of parent-child interaction in underserved migrant areas in Kyrgyz Republic: a pilot study.

BACKGROUND: After societal change in Kyrgyz Republic, the pattern of parent-child interaction in the changing parenting culture is an important factor influencing the positive development of Kyrgyz children. This study is aim to assess the quality of parent-child interactions in Kyrgyzstan by analyzing the interaction patterns and playfulness of children during free play at home. METHODS: This was a descriptive pilot study using video-recorded observations to explore parent-child interactions. The Dyadic Parent-Child Interaction Coding System and a playfulness instrument were used to assess the patterns and quality of the interaction. A total of 20 dyads of children aged 24 to 58 months and their parents, living in migrant communities of Kyrgyzstan, participated in this study. RESULTS: Major parent-child interaction patterns included 731 turns of parent-child dyads during 1040 episodes. Verbal as well as nonverbal behaviors of parents were observed while interacting with their children. Parents used direct and indirect commands most frequently, while praise was used the least in interactions. Children frequently used compliance as well as noncompliance when they interacted with their parents. Children had low playfulness scores while interacting with their parents. Cognitive spontaneity was the component with the lowest score among all subdomains of playfulness. CONCLUSION: Future studies are recommended to develop strategies to facilitate parents' active interaction with their children, promote children's playfulness, and improve the quality of their mutual interaction.

Unmet need for contraception among married women in the Kyrgyz Republic using the datasets from the 2006, 2014 and 2018 Multiple Indicator Cluster Survey: a cross-sectional study.

BACKGROUND: Since the beginning of the family program in 1998, the proportion of married women who used contraception has fluctuated. An unmet need for contraception among women in Kyrgyzstan drastically increased from 2006 (1.1%) to 2014 (19.1%), and remained unchanged until 2018 (19.0%). This study aims to re-investigate the prevalence of an unmet need for contraception from 2006 to 2018 in a comprehensive manner, and examine the factors associated with an unmet need for contraception among married women over the course of 12 years in the Kyrgyz Republic. METHODS: This is a cross-sectional study using secondary data that derived from the Multiple Indicator Cluster Survey (MICS). The study employed three datasets from the MICS 2006, 2014, and 2018. The study included a total of 9,229 women aged 15-49 who were married and fecund, and whose status of the met/unmet need for contraception could be identified. Logistic regression was employed to estimate the relationship of an unmet need for contraception with independent factors. A P value < 0.05 was set as statistically significant. RESULTS: The prevalence of an unmet need for contraception was 19.9% in 2006, 20.4% in 2014, and 22.5% in 2018. Across 12 years, all reversible-contraceptive methods for women constantly declined. Although intrauterine devices were the prominent contraceptive method of usage among Kyrgyz women, the trend of usage drastically decreased over time. Factors associated with unmet need for contraception included women's age, area of residence, mother tongue of household head, age of husband, and number of children ever born. CONCLUSION: The unmet need for contraception among married Kyrgyz women slightly increased, and the trend of modern contraceptive usage declined from 2006 to 2018, particularly the use of pills, injections, and intra-uterine devices. Comprehensive sexual health education for young people and youth-friendly services should be promoted. An effective and reliable supply chain of contraceptive commodities should be prioritized and strengthened. Regular supportive supervision visits are essential to improve the knowledge and skills of healthcare providers to be able to provide intrauterine device service as a contraceptive choice for Kyrgyz women.

Implementing two national responsibilities of the revised UNICEF/WHO Baby-Friendly Hospital Initiative: A two-country case study.

The 2018 implementation guidance for the Baby-Friendly Hospital Initiative (BFHI) recommends institutionalising the ten Steps through nine national responsibilities for universal coverage and sustainability. As countries adapt BFHI programmes to this paradigm shift away from traditional designation programmes, documenting and sharing policy and programme experience are critical and currently sparse. This qualitative case study included desk reviews of published and grey literature on BFHI programming, national plans and policy documents specific to the selected national responsibilities for universal coverage and key informant (KI) interviews across a range of actors. In the Kyrgyz Republic, the case study explored responsibility 5, development and implementation of incentives and/or sanctions, and responsibility 6 in Malawi, providing technical assistance (TA). In both countries, the three sustainability responsibilities (national monitoring [7] communication and advocacy [8] and financing [9]) as they relate to the universal coverage of the targeted responsibilities were also explored. Thirty-eight respondents in the Kyrgyz Republic described approaches that were used in the health system, including BFHI designation plaques, performance-based financing and financial sanctions. However, currently, there are no formal incentives and sanctions. In Malawi, TA was utilised for national planning and to introduce quality improvement processes. Forty-seven respondents mostly described provisions of TA in building and strengthening the capacity of providers. More programmatic evidence to demonstrate which types of incentives or sanctions can be effective and sustained and more documentation of how TA is provided across multiple aspects of implementation are needed as countries institutionalise BFHI.

Risk Factors for Severe Cutaneous Anthrax in a Retrospective Case Series and Use of a Clinical Algorithm to Identify Likely Meningitis and Evaluate Treatment Outcomes, Kyrgyz Republic, 2005-2012.

BACKGROUND: US Centers for Disease Control and Prevention guidelines currently recommend triple-therapy antimicrobial treatment for anthrax meningitis. In the Kyrgyz Republic, a country with endemic anthrax, cutaneous anthrax patients are routinely hospitalized and treated successfully with only monotherapy or dual therapy. Clinical algorithms have been developed to identify patients with likely anthrax meningitis based on signs and symptoms alone. We sought to retrospectively identify likely meningitis patients in the Kyrgyz Republic using a clinical algorithm and evaluate risk factors and their outcomes by type of treatment. METHODS: We conducted a retrospective chart review of cutaneous anthrax patients in the Kyrgyz Republic from 2005 through 2012. Using previous methods, we developed a highly specific algorithm to categorize patients by meningitis status. We then evaluated patient risk factors, treatments, and outcomes by disease severity and meningitis status. RESULTS: We categorized 37 of 230 cutaneous anthrax patients as likely having meningitis. All 37 likely meningitis patients survived, receiving only mono- or dual-therapy antimicrobials. We identified underlying medical conditions, such as obesity, hypertension, and chronic obstructive pulmonary disease, and tobacco and alcohol use, as potential risk factors for severe anthrax and anthrax meningitis. CONCLUSIONS: Based on our analyses, treatment of anthrax meningitis may not require 3 antimicrobials, which could impact future anthrax treatment recommendations. In addition, chronic comorbidities may increase risk for severe anthrax and anthrax meningitis. Future research should further investigate potential risk factors for severe anthrax and their impact on laboratory-confirmed meningitis and evaluate mono- and dual-therapy antimicrobial regimens for anthrax meningitis.

Use of Project ECHO in Response to COVID-19 in Countries Supported by US President's Emergency Plan for AIDS Relief.

The US Centers for Disease Control and Prevention, with funding from the US President's Plan for Emergency Relief, implements a virtual model for clinical mentorship, Project Extension for Community Healthcare Outcomes (ECHO), worldwide to connect multidisciplinary teams of healthcare workers (HCWs) with specialists to build capacity to respond to the HIV epidemic. The emergence of and quick evolution of the COVID-19 pandemic created the need and opportunity for the use of the Project ECHO model to help address the knowledge requirements of HCW responding to COVID-19 while maintaining HCW safety through social distancing. We describe the implementation experiences of Project ECHO in 5 Centers for Disease Control and Prevention programs as part of their COVID-19 response, in which existing platforms were used to rapidly disseminate relevant, up-to-date COVID-19-related clinical information to a large, multidisciplinary audience of stakeholders within their healthcare systems.

Association between gender-based violence and hypertension among women in the Kyrgyzstan Republic.

BACKGROUND: Gender-based violence (GBV) is a significant global public health problem and the most prominent human rights violation severely impacting women's health and wellbeing. Therefore, the aim of this study is to evaluate the association between gender-based violence and hypertension in Kyrgyzstan Republic. METHODS: This study was conducted using population-based data of women from the 2018 Kyrgyzstan Demographic and Health Survey. The odds ratio was calculated to measure the association between GBV and hypertension, and p-values < 0.005 was considered statistically significant. RESULT: We included data of 4793 participants, and 621 (13%) of them had hypertension. Participants exposed to GBV were 24% more likely to have hypertension than unexposed participants (OR = 1.24, 95% CI: 1.03-1.48). Of all women with hypertension, 206 (33.0%) were exposed to GBV. Participants with secondary education or higher exposed to GBV were 24% more likely to be hypertensive than GBV unexposed women with the same education levels OR = 1.24, 95% CI: 1.04-1.49). Unemployed participants exposed to GBV were 45% more likely to develop hypertension than their unexposed counterparts (OR = 1.45, 95%CI: 1.15-1.81). Rural residents exposed to GBV were also 29% more likely to have hypertension than those unexposed to GBV (OR = 1.29, 95% CI: 1.04-1.59). The odds of hypertension among those exposed to GBV increase with age. CONCLUSION: The study revealed that GBV is a significant factor of having hypertension among Kyrgyz women.

[Status and prospects of gerontology and geriatrics in the Kyrgyz Republic.]

The article analyzes the situation with the development of gerontology in the Kyrgyz Republic. The long-term process of the formation of the gerontological service in the country and its achievements are described in detail. The positive fact is that not only international organizations, but also the state and society itself began to pay attention to the problem of older people. Despite the certain and achieved successes in the development of the service, problems are indicated that require urgent measures to resolve, especially the development of the geriatric service, which today does not meet the modern challenges of aging. The important role of creating the gerontology institute, as a coordinating body in the training of specialized personnel, in the development and implementation of cooperated scientific research and the implementation of their results in healthcare practice was emphasized.

The connection between social cohesion and personality: A multilevel study in the Kyrgyz Republic.

As the discourse around societal cohesion grows and policy makers increasingly turn their attention towards improving cohesion, understanding its role for the lives of individuals becomes ever more important. Our study examines whether the social cohesion of the immediate living context is related to the strength of Big Five personality traits among individuals. Using data from a community survey of 6252 adults living in 30 rural sub-districts in the Kyrgyz Republic, where social cohesion is a sizable policy concern, we conduct a multilevel analysis of the relationship between sub-district cohesion and individual personality. Results indicate that higher levels of cohesion are significantly related to higher individual levels of agreeableness, conscientiousness and openness. However, no relationship is found with extraversion or neuroticism. Thus, where a social entity has higher cohesion, this entity will also have inhabitants with a greater prosocial and communal orientation towards others, greater conscientiousness and more openness to experience. These findings imply that social cohesion may be one geographical social indicator related to variation in personality traits. Moreover, the findings suggest that understanding social cohesion requires both macro- and micro-perspectives and that its connection to these particular personality traits should be taken into consideration.

Mutations of rpoB, katG, inhA and ahp genes in rifampicin and isoniazid-resistant Mycobacterium tuberculosis in Kyrgyz Republic.

BACKGROUND: The aim of this study was to identify mutations of rpoB, katG, inhA and ahp-genes associated Mycobacterium tuberculosis resistance to rifampicin (RIF) and isoniazid (INH) in Kyrgyz Republic. We studied 633 smear samples from the primary pulmonary tuberculosis (TB) patients. We verified Mycobacterium tuberculosis susceptibility to RIF and INH using culture method of absolute concentrations, and commercially available test named "TB-BIOCHIP" (Biochip-IMB, Moscow, Russian Federation). RESULTS: For RIF-resistance, TB-BIOCHIP's sensitivity and specificity were 88% and 97%, 84% and 95% for INH-resistance, and 90% and 97% for multi-drug resistance (MDR). In RIF-resistant strains, TB-BIOCHIP showed mutations in codons 531 (64.8%), 526 (17.3%), 516 (8.1%), 511 (5.4%), 533 (3.2%), 522 (0.6%) and 513 (0.6%) of rpoB gene. The most prevalent was Ser531 > Leu mutation (63.7%). 91.2% of mutations entailing resistance to INH were in katG gene, 7% in inhA gene, and 1.8% in ahpC gene. Ser315→Thr (88.6%) was the most prevalent mutation leading to resistance to INH. CONCLUSIONS: In Kyrgyz Republic, the most prevalent mutation in RIF-resistant strains was Ser531 → Leu in rpoB gene, as opposed to Ser315 → Thr in katG gene in INH-resistant Mycobacterium tuberculosis. In Kyrgyz Republic, the major reservoir of MDR Mycobacterium tuberculosis were strains with combined mutations Ser531 → Leu in rpoB gene and Ser315 → Thr in katG gene. TB-BIOCHIP has shown moderate sensitivity with the advantage of obtaining results in only two days.

Outbreak of sheeppox in farmed sheep in Kyrgystan: Histological, eletron microscopical and molecular characterization.

INTRODUCTION: On a farm in the Kyrgyz Republic, several dead sheep were found without any history of illness. The sheep showed several ulcerations on lips and bare-skinned areas. At necropsy the lungs showed multiple firm nodules, which were defined as pox nodules histologically. In the rumen hyperkeratotic plaques were visible. With electron microscopy pox viral particles were detected and confirmed with q PCR as Capripoxviruses. Although all members of the Capripoxvirus genus are eradicated in western countries, this study should remind us of the classical lesions observed in poxvirus infections.

A case study on anthrax in an eight-month old infant at Kyrgyz Republic.

Anthrax remains a threat, especially in countries like Kyrgyzstan with developed livestock farming. Despite preventive efforts, sporadic outbreaks endure on an annual basis, transmitted from infected animals to humans. Here, we report a severe anthrax case in an 8-month-old child known to be caused when a sick calf was slaughtered in the neighborhood without proper protocols, resulting in intra-family infection. This underscores the importance of swift diagnosis, treatment, preventive measures, and awareness of zoonotic infections, animal vaccination and adherence to sanitary and veterinary protocols.

Anorexia nervosa through the lens of primary health care practitioners in the Kyrgyz Republic.

BACKGROUND: Anorexia nervosa was investigated in a large number of studies. Several of the studies in our review highlighted how important it is to factor in the opinion of health care practitioners if we want to improve the quality of the medical care provided to patients with anorexia nervosa. Additionally, the dominance of studies focused on anorexia nervosa within the Western culture raised the need for cultural diversity in such research. AIM: The present study endeavored to explore how primary healthcare practitioners in Bishkek, Kyrgyz Republic, perceive anorexia nervosa and people who suffer from it. METHODS: The study used the qualitative approach of Interpretative Phenomenological Analysis. Six semi-structured interviews with six primary health care practitioners from Bishkek were conducted. RESULTS: The analysis of the collected data pointed towards four themes: (1) Anorexia nervosa as a reaction to distressing events in the form of loss of appetite; (2) Attributing blame for developing anorexia nervosa by a patient to family members; (3) Local versus Western socio-cultural standards in the development of anorexia nervosa and seeking treatment; and (4) Denial of mental health disorders by patients. CONCLUSION: The discussion of the interpreted results led us to the conclusion that the perceptions of the health care providers in Bishkek represent the common prism through which anorexia nervosa is viewed in the larger population, which is constructed out of information received from the physical and virtual environments.

Mobile Vaccination Teams for Improving Vaccination Coverage in the Kyrgyz Republic: Results of a National Health System-Strengthening Project during the First Two Years of the COVID-19 Pandemic.

(1) Background: This implementation study reports on the results of the mobile vaccination teams' (MVTs) activities during the first two years of the COVID-19 pandemic in Kyrgyzstan, when other vaccination services were disrupted. (2) Methods: Through a national health system-strengthening project under an order of the Ministry of Health, in 2020, the number of MVTs was increased, focusing on internal immigrant settlements around the cities of Bishkek and Osh and geographically remote areas. MVTs provided free vaccination services. (3) Results: MVTs vaccinated a total of 125,289 and 158,047 children in 2020 and 2021, respectively. The higher contribution of MVTs to vaccination coverage was in children under 5 years of age, with the three top vaccines being IPV (8.9%), MMR (7%), and PCV (6.6%). In 2021, 13,000 children who had not received an IPV vaccination and 8692 children who had not received the Pentavalent vaccine (DPT-HBV-Hib) were reached. The number of cases of vaccine-preventable disease reported in official statistics has reduced over time. (4) Conclusions: MVTs increased vaccination coverage in Kyrgyzstan, in particular in remote regions and migrant settlements, where it accounted for a considerable proportion of the vaccinated. This study adds to previous evidence in the literature of the role of MVTs as a strategy to improve immunization in hard-to-reach populations, particularly children.

"Together against Tuberculosis": Cascade of Care of Patients Referred by the Private Health Care Providers in the Kyrgyz Republic.

Until 2021, in the Kyrgyz Republic, tuberculosis (TB) was diagnosed and treated only in the public sector. With funding support of the STOP-TB partnership, the private providers in four regions of the country and Bishkek city were mapped, trained and incentivized to screen for and identify presumptive TB patients and refer them to the public facilities for diagnosis and treatment. In this study, we describe the cascade of care of such patients. This was a cohort study involving secondary analysis of routine data. Of 79,352 patients screened during February 2021-March 2022, 2511 (3%) had presumptive TB, of whom 903 (36%) were not tested for TB [pre-diagnostic loss to follow-up]. A total of 323 (13%) patients were diagnosed with TB, of whom, 42 (13%) were not started on treatment [pre-treatment loss to follow-up]. Among 257 patients eligible for outcome assessment, 197 (77%) had treatment success, 29 (11%) were lost-to-follow-up, 13 (5%) died, 4 (2%) had treatment failure and 14 (5%) were not evaluated. While this donor-funded, pioneering initiative was successful in engaging the private sector, we recommend that the national TB programme scales up the initiative nationally with dedicated budgets, activities and plans to monitor progress. Qualitative research is urgently needed to understand the reasons for the gaps in the care cascade.

Quality of Electronic TB Register Data Compared with Paper-Based Records in the Kyrgyz Republic.

This study evaluated the effectiveness of an electronic system for managing individuals with drug-sensitive pulmonary tuberculosis in the Kyrgyz Republic. This cohort study used programmatic data. The study included people registered on the paper-based system in 2019 and 302 people registered on both the electronic and the paper-based systems between June 2021 and May 2022. The data from the 302 individuals were used to assess the completeness of each form of record and the concordance of the electronic record with the paper-based system. This study showed that for most variables, the completeness and concordance were 85.3-93.0% and were lowest for nonmandatory fields such as medication side effects (26.8% vs. 13.6%). No significant difference was observed in the time taken from symptom onset to diagnosis and treatment initiation between the two systems. However, the electronic system had a significantly higher percentage of subjects who initiated treatment on the day of diagnosis (80.3% vs. 57.1%). The proportion with successful outcomes was similar in both groups, but the electronic system had a significantly lower proportion of individuals with outcomes that were not evaluated or recorded (4.8% vs. 14.3%, p < 0.001). This study highlights the potential advantages and gaps associated with implementing an electronic TB register system for improving records.

Outpatient Services for People with Mental Disorders in the Kyrgyz Republic: What Is Next?: Состояние внебольничной помощи в Кыргызстане: что дальше?

The outpatient care service for patients with mental disorders in the Kyrgyz Republic is currently experiencing various difficulties. These are largely due to a number of organizational and socio-economic problems at the state level. Treatment of patients with mental disorders is still provided in state mental health centres, while psychosocial services at the community level are only now beginning to be developed. This article describes the directions of mental health care, as well as ongoing efforts to provide outpatient care for people with mental disorders. The actions of a few prolific nongovernmental organizations (NGOs) are proving insufficient to meet the needs of patients. There is currently a gradual and visible movement toward the development of the private sector in the field of mental healthcare. In order to overcome organizational difficulties, support from government structures and certain initiatives to create legislative grounds are needed.

Remittances and Household Spending Strategies: Evidence from the Life in Kyrgyzstan Study, 2011-2013.

Globalized labor migration and remittances can help alleviate household poverty and provide supplemental income in many countries. Kyrgyzstan, like other Central Asian countries, has experienced dramatic geopolitical changes, economic reform, and rapid demographic shifts in the post-Soviet-Union era. Based on measurements of GDP, it is one of the most remittance-dependent countries in the world. This study uses data from the Life in Kyrgyzstan Study collected from 2011 to 2013 to break down household budgets into eight consumption categories as part of a detailed analysis of how varying remittance receipt is related to household spending. We address two methodological concerns: 1) the endogeneity of remittances and 2) population heterogeneity. In so doing, we find remittances have limited effects on household spending-while changes in remittances do yield small changes on the budget shares of food and medical expenses, no effects were found on other consumption shares. These results suggest that households in Kyrgyzstan may take remittances as permanent income and proportionally alter consumption shares along with changes in remittances. By focusing on a country whose GDP relies heavily on remittances, the findings increase our understanding of how remittances affect spending at the household level.

Human anthrax in Kyrgyz Republic: Epidemiology and clinical features.

BACKGROUND: Bacillus anthracis infects both humans and animals which leads to anthrax disease. The disease is still a global issue as it occurs naturally and has a potential use for bioterrorism/bio-weapons agents. This study aimed to investigate the clinical and epidemiologic features of human anthrax that has been seen in Kyrgyzstan. METHODS: This study was carried out at the Osh Regional Hospital that is located in the southern regions of Kyrgyz Republic. Medical records of patient's diagnosed with cutaneous anthrax between 2005 and 2015 were reviewed. Epidemiology and clinical features of the infection and the effectiveness of antibiotic therapy were investigated. RESULTS: Two hundred thirty four anthrax cases were reviewed. Among the patients, men in the 31-50 age group prevailed. Infection episodes that sought medical attention occurred mostly during the summer and autumn. Analysis of epidemiological data shows that anthrax contamination occurred as a result of direct contact with mainly farm animals, slaughtering, butchering and the selling of the meat. Cutaneous lesions were localized mostly in the upper extremities. Among the observed patients, a majority of the cases presented a mild form of the disease. The isolated strains of B. anthracis were mostly susceptible to amoxiclav, ofloxacin, 3rd generation of cephalosporins, doxycycline, ciprofloxacin, rifampicin, penicillin and streptomycin. A majority of the isolates were found to be resistant to ampicillin, gentamicin, chloramphenicol. CONCLUSION: Anthrax is still an endemic disease that has lead to outbreaks in the Kyrgyz Republic. The transmission of human infection is seen by direct contact with ill animals or dead animal products. The common form seen in the clinical setting is cutaneous anthrax. Future studies should focus on the surveillance and infection control measurements associated with the anthrax.

A surrogate FRAX model for the Kyrgyz Republic.

The hip fracture rates from Kazakhstan were used to create a surrogate FRAX® model for the Kyrgyz Republic. INTRODUCTION: The International Society for Clinical Densitometry and International Osteoporosis Foundation recommend utilizing a surrogate FRAX model, based on the country-specific risk of death, and fracture data based on a country where fracture rates are considered to be representative of the index country. OBJECTIVE: This paper describes a surrogate FRAX model for the Kyrgyz Republic. METHODS: The FRAX model used the incidence of hip fracture from the neighbouring country of Kazakhstan and the death risk for the Kyrgyz Republic. RESULTS: Compared with the model for Kazakhstan, the surrogate model gave somewhat higher 10-year fracture probabilities for men between 60 and 80 years of age and lower probabilities for men above the age of 80. For women the probabilities were similar up to the age of 75-80 years and then lower. There were very close correlations in fracture probabilities between the surrogate and authentic models (1.00) so that the use of the Kyrgyz model had little impact on the rank order of risk. It was estimated that 2752 hip fractures arose in 2015 in individuals over the age of 50 years in the Kyrgyz Republic, with a predicted increase by 207% to 8435 in 2050. CONCLUSION: The surrogate FRAX model for the Kyrgyz Republic provides the opportunity to determine fracture probability among the Kyrgyz population and help guide decisions about treatment.

Drivers of stunting reduction in the Kyrgyz Republic: A country case study.

BACKGROUND: Chronic malnutrition among infants and children continues to represent a global public health concern. The Kyrgyz Republic has achieved rapid declines in stunting over the last 20 y, despite modest increases in gross domestic product per capita. OBJECTIVE: This study aimed to conduct a systematic, in-depth assessment of national, community, household, and individual drivers of nutrition change and stunting reduction, as well as nutrition-specific and -sensitive policies and programs, in the Kyrgyz Republic. METHODS: This mixed methods study employed 4 inquiry methods, including: 1) a systematic scoping literature review; 2) retrospective quantitative data analyses, including linear regression multivariable hierarchical modeling, difference-in-difference analysis, and Oaxaca-Blinder decomposition; 3) qualitative data collection and analysis; and 4) analysis of key nutrition-specific and -sensitive policies and programs. RESULTS: Stunting prevalence has decreased in the Kyrgyz Republic, however, subnational variations and inequities persist. Child growth Victora curves show improvements in height-for-age z-scores (HAZ) for children in the Kyrgyz Republic between 1997 and 2014, indicating increased intrauterine growth and population health improvements. The decomposition analysis explained 88.9% (0.637 SD increase) of the predicted change in HAZ for children under 3 y (1997-2012). Key factors included poverty (61%), maternal nutrition (14%), paternal education (6%), fertility (6%), maternal age (3%), and wealth accumulation (2%). Qualitative analysis revealed poverty reduction, increased migration and remittances, food security, and maternal nutrition as key drivers of stunting decline. Systematic scoping literature review findings supported quantitative and qualitative results, and indicated that land reforms and improved food security represented important factors. Key nutrition-specific and -sensitive policies and programs implemented involved breastfeeding promotion, social protection schemes, and land and health sector reforms. CONCLUSIONS: Improvements in stunting were achieved amidst political and economic changes. Multilevel enablers, including poverty reduction, improved food security, and introduction of land and health reforms have contributed to improvements in health, nutrition, and stunting among children in the Kyrgyz Republic.