CHANGES IN DEATH RATES FROM LOWER RESPIRATORY INFECTIONS BETWEEN 1991 AND 2019 IN THE REPUBLIC OF KAZAKHSTAN.

From 1991 to 2019, the mortality rate from lower respiratory tract infections has been on a downward trend. Overall, in 1991, 4.42% [4.08% - 4.79%] of the population died from lower respiratory tract infections. Further, over a period of approximately 20 years, mortality has been declining: 1995 - 3.39% [3.16% - 3.64%]; 2000 - 2.99% [2.78% - 3.2%]; 2005 - 2.66% [2.49% - 2.85%]; 2010 - 2.52% [2.37% - 2.7%]. Despite the fact that until 2010 the number of deaths for the group of diseases studied by us decreased, since 2011 the mortality rate began slightly, but increased, and by 2015 the mortality rate from lower respiratory tract infections was 3.02% [2.83% - 3. 22%]. But then, by 2019, the death rate began to decline again and amounted to 2.88% [2.63% - 3.13%]. Since 1991, the Republic of Kazakhstan has maintained a high mortality rate from lower respiratory tract infections in children under 14 years of age. And also, compared with 1991, in 2019 the mortality rate doubled among representatives of older age groups (15-49; 50-69; and over 70 years old). Based on the results of ranking by gender, a relatively high rate of mortality from lower respiratory tract infections among men was determined.

COMPARATIVE ANALYSIS OF MORTALITY FROM TUBERCULOSIS AMONG COUNTRIES OF FORMER SOVIET UNION.

Mortality from tuberculosis has decreased from 11.89 deaths per 100,000 population in 1990 to 4.18 deaths per 100,000 population in Kazakhstan in 2019. Thus, the deviation was (-)35.5%. If Kazakhstan showed the above result over the 29-year period, then how are things with other republics that were part of the Soviet Union and how have the countries' economies changed? Aim - determination of the difference in 15 republics using the mortality rate from tuberculosis per 100,000 population. The study included the following countries: Ukraine, Georgia, Kazakhstan, Kyrgyzstan, Uzbekistan, Russia, Estonia, Lithuania, Latvia, Turkmenistan, Tajikistan, Belarus, Moldova, Azerbaijan, Armenia. The analysis was carried out using the Global burden of diseases database. A relatively high reduction in TB mortality was found in Kazakhstan (-3.61%). In second place is Estonia (-3.25%), in third place is Azerbaijan (-2.39%), in fourth place is Latvia (-2.16%), and the top five is closed by Georgia (-1.98%). Despite the high level of GDP, countries such as Russia (6th place in the world ranking of GDP per capita) and Ukraine (42nd place in the world ranking of GDP per capita) are not in the leading positions in reducing the burden of TB. For example, Russia is in 10th place (-0.81%) in terms of the percentage reduction in mortality from TB, and Ukraine is in last place. According to the Global Burden of Disease, Ukraine has seen an increase in TB mortality (+1.62%). The leader among the former Soviet countries in terms of spending on the healthcare system is Armenia (12.24%). In general, current public spending on health care per capita is 11.6 times lower than in OECD (Organization for Economic Cooperation and Development) member countries: in 2020 in Kazakhstan this indicator was 341.5 USD, in the OECD - on average 3 959 USD. According to WHO recommendations for sustainable development, financing of the health care system should be up to 5% of GDP, while the share of private spending should not exceed 20% of current health care spending. As the experience of developed countries shows, the level of life expectancy directly depends on the financing of the healthcare system.

FEATURES OF THE CLINICAL COURSE OF CORONAVIRUS INFECTION IN NEWBORN CHILDREN.

The article analyzes the prevalence of coronavirus infection in newborns in the Republic of Kazakhstan from the pandemic outbreak till April 2022. The article provides the dynamics of the number of newborns with positive SARS-CoV-2 tests in the reporting period, describes the specifics of the course of coronavirus infection in newborns depending on the neonatal gestational age, and reports the immediate outcomes.

PNEUMONIA AMONG CHILDREN UNDER 1 YEAR OF AGE: ANALYSIS OF INCIDENCE AND HOSPITAL MORTALITY FROM 2010 TO 2020 IN THE REPUBLIC OF KAZAKHSTAN.

Aim - to analyze the dynamics of morbidity and mortality from pneumonia in children under 1 year of age in the Republic of Kazakhstan for 10 years since the introduction of vaccination against pneumococcal infection in the National Immunization Schedule of the Republic of Kazakhstan in 2010. A retrospective cross-sectional study was carried out using the statistical collection of the National Scientific Center for Health Development named after S. Kairbekova from 2010 to 2020. The criterion for the study of epidemiology was the incidence of pneumonia in children under 1 year of age per 1000 children. The indicator compared with 2010 in the year, the incidence decreased by 34.0 cases, and amounted to 20.1 cases. In 2010, it was 54.1 cases. Analyzing the lethality of children from pneumonia by region, we also decided to show the top 5 regions with a high rate. This list in 2010 included Akmola (n=149.7), Turkestan (n=79.7), West Kazakhstan (n=76.9), Kostanay regions (n=66.1) and the city of Nur-Sultan (until 2019, the city of Astana) (n=69.5). The indicator for the republic in 2010 was 54.1 cases per 1,000 children. The incidence per 1000 children in 6 regions and 1 city is higher than the republican indicator. In 2020, in Kazakhstan, the incidence of pneumonia in children under 1-year-old per 1000 children was 20.1 cases. In such regions as Akmola, Turkestan, North Kazakhstan, Kostanay and Zhambyl regions, the indicators are the highest in the country. From 2010 to 2020, the incidence of pneumonia in children under 1 year of age tends to decrease in Kazakhstan, however, the city of Almaty shows a relatively high proportion of the total mortality for all diseases under 1 year of age. This work is analytical, and further work with a study of immunization of children against pneumococcal infection is required for a full study. A curve should be plotted on parental refusals to vaccinate over a given period of time.

[Association between treatment outcome and age in tuberculosis and diabetes patients: a population analysis].

BACKGROUND: The undoubted importance of this work lies in the fact that for the first time in the Republic of Kazakhstan, an analysis is being made of the relationship between age and treatment outcome in patients with a comorbid diagnosis of tuberculosis and diabetes mellitus. PURPOSE OF THE STUDY: Identification of the correlation between the age of patients with tuberculosis with diabetes mellitus and the outcome of treatment. MATERIALS AND METHODS: Cross-sectional retrospective study of 2,125 patients with TB and diabetes mellitus out of a total of 43,807 of all patients diagnosed with TB (2017-2019). The study analyzed the data of patients with comorbidity from all regions of Kazakhstan (data from 14 regions and 3 cities of republican significance) (2017-2019). RESULTS: A high prevalence of tuberculosis morbidity with a concomitant diagnosis of diabetes mellitus in the age group from 45 to 64 years was revealed. This group consisted of 1193 patients out of 2115 (56.4% of the total number of patients with tuberculosis and diabetes mellitus). The average age of all studied patients with DM was 54.7±13.4 years. There is a positive correlation between age and treatment outcome in TB patients. Mortality was higher in the age group over 45 years old - OR95%CI = 0.213 [0.019-2.362], p - 0.0000015 (p < 0.05).

Concordance of three approaches for operationalizing outcome definitions for multidrug-resistant TB.

BACKGROUND: The WHO provides standardized outcome definitions for rifampicin-resistant (RR) and multidrug-resistant (MDR) TB. However, operationalizing these definitions can be challenging in some clinical settings, and incorrect classification may generate bias in reporting and research. Outcomes calculated by algorithms can increase standardization and be adapted to suit the research question. We evaluated concordance between clinician-assigned treatment outcomes and outcomes calculated based on one of two standardized algorithms, one which identified failure at its earliest possible recurrence (i.e., failure-dominant algorithm), and one which calculated the outcome based on culture results at the end of treatment, regardless of early occurrence of failure (i.e., success-dominant algorithm).METHODS: Among 2,525 patients enrolled in the multi-country endTB observational study, we calculated the frequencies of concordance using cross-tabulations of clinician-assigned and algorithm-assigned outcomes. We summarized the common discrepancies.RESULTS: Treatment success calculated by algorithms had high concordance with treatment success assigned by clinicians (95.8 and 97.7% for failure-dominant and success-dominant algorithms, respectively). The frequency and pattern of the most common discrepancies varied by country.CONCLUSION: High concordance was found between clinician-assigned and algorithm-assigned outcomes. Heterogeneity in discrepancies across settings suggests that using algorithms to calculate outcomes may minimize bias.