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A Comparison of Comprehensive HIV/AIDS Knowledge Among Women Across Seven Post-Soviet Countries
Get PDFIntroduction: Post-Soviet countries of Eastern Europe and Central Asia have witnessed a recent growth of HIV infection through heterosexual transmission. Women’s low levels of knowledge about HIV prevention and transmission methods have been found to account for the higher female-to-male ratio among cases infected through the heterosexual route. This cross national comparison study assessed comprehensive HIV/AIDS knowledge and its key determinants among women of seven post-Soviet countries and identified which countries face the highest levels of risk due to the low levels of HIV/AIDS awareness.Methods: Study data were obtained from the third wave of the Multiple Indicator Cluster Surveys (MICS3) (conducted in 2005 and 2006), nationally representative samples of women aged 15-49 years. Data on HIV/AIDS knowledge were analyzed for women in Kazakhstan (N=14,310), Kyrgyzstan (N=6,493), Tajikistan (N=4,676), Uzbekistan (N=13,376), Belarus (N=5,884), Ukraine (N=6,066), and Georgia (N=7,727) using descriptive statistics and ordinary least squares (OLS) regressions.Results: We found that the percentage of women who could correctly identify all five modes of HIV/AIDS transmission and prevention was highest in Eastern European countries of Belarus (34.98%) and Ukraine (31.67%). Across all countries, the strongest predictors of comprehensive HIV/AIDS knowledge were age, education, and region of residence. Marital status, area of residence (urban vs. rural), and household wealth were significant predictors for several countries.Conclusion: High rates of comprehensive HIV/AIDS knowledge were found among women of Belarus and Ukraine. To reduce the spread of HIV in the region, programs promoting comprehensive HIV/AIDS knowledge for women of younger ages and with lower education are recommended
Detection of Hepatitis E Antibodies in Kazakhstan: A Pilot Study
Get PDFIntroduction. Hepatitis E virus exposure is associated with sporadic cases of acute hepatitis and outbreaks in many countries worldwide. It is particularly dangerous for pregnant women, in whom the mortality rate is high. There are no previously published data reporting circulation of this virus in Kazakhstan.Methods. We tested blood samples for IgG anti-hepatitis E virus antibodies in 199 Kazakh participants; of these 119 were workers at the EXPO 2017 building site in Astana, 35 were volunteers who got tested at the Astana City Hall on the World Hepatitis Day 2017, and 45 were volunteers who presented for screening at the Hepatogastroenterology Outpatient Clinic of the Republican Diagnostic Center, University Medical Center.Results. 11 (5.5%) individuals were positive for IgG anti-HEV antibodies, with a higher seroprevalence in males (7; 6.8%) vs females (4; 4.5%). The highest number of positive samples was in the 32-46 years age group.Conclusions. This pilot study suggests that Hepatitis E virus has been circulating in Kazakhstan. Studies are needed to determine whether it continues to be present, which viral genotypes are involved and what are the best methodologies for preventing its spread
Burden of the Cardiovascular Diseases in Central Asia
Get PDFCardiovascular 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)
Discovery of Actinomycetes from Extreme Environments with Potential to Produce Novel Antibiotics
Get PDFIntroduction: Antimicrobial-resistant pathogens pose serious challenges to healthcare institutions and health of the public. Thus, there is an urgent need for the discovery of new and effective antimicrobial agents. Microorganisms that exist in extreme environments such as those with high salinity or alkalinity, are known as extremophiles, and include various species of actinomycetes. The goal of this study is to discover novel antibiotics from extremophiles found in Kazakhstan that are effective against drug resistant pathogens.Methods: Soil from extreme environments of Kazakhstan was collected, and pure cultures of actinomycetes were isolated and cultured in modified Bennett’s broth with either high concentrations of salt or high pH to mimic extreme environments. Extracts obtained from selected actinomycetes strains were used to test for antimicrobial activity against Staphylococcus aureus, Escherichia coli and Aspergillus niger.Results: A total of 5936 strains of extremophile actinomycetes were isolated; from these, 2019 strains were further isolated into pure cultures. Of these, 415 actinomycetes strains that demonstrated antagonistic antibacterial activities were selected. These actinomycetes were further classified into groups and subgroups based on their responses to different culture conditions. Antimicrobial antagonism activity for some of the actinomycetes strains was dependent on culture conditions and development of aerial mycelia under extreme conditions.Conclusion: We identified several interesting candidate extracts with putative antimicrobial activities against several strains of drug resistant pathogens. Our research of the actinomycetes’ ability to produce antibiotics in the near-natural conditions provides a great opportunity to assess their biodiversity and distribution in the Central Asian region and to develop new methodological approaches to the screening of new antimicrobial agents
Social Determinants of Maternal Health in Afghanistan: A Review
Get PDFIntroduction: Afghanistan has a high maternal mortality rate of 400 per 100,000 live births. Although direct causes of maternal morbidity and mortality in Afghanistan include hemorrhage, obstructed labor, infection, high blood pressure, and unsafe abortion, the high burden of diseases responsible for maternal mortality arises in large part due to social determinants of health. The focus of this literature review is to examine the impact of various social determinants of health on maternal health in Afghanistan, filling an important gap in the existing literature.Methods: This narrative review was conducted using Arksey and O’Malley’s framework of (1) defining the question, (2) searching the literature, (3) assessing the studies, (4) synthesizing selected evidence in context, and (5) summarizing potential programmatic implication of the context. We searched Medline, CABI global health database, and Google Scholar for relevant publications. Results: A total of 38 articles/reports were included in this review. We found that social determinants such as maternal education, sociocultural practices, and social infrastructure have a significant impact on maternal health. Health care may be the immediate determinant, but it is influenced by other determinants that must be addressed in order to alleviate the burden on health care, as well as to achieve long-term reduction in maternal mortality. Conclusion: Because of the importance of social factors for maternal health outcomes, committed involvement of multiple government sectors (i.e. education, labor and social affairs, information and culture, transport and rural development among others, alongside health care) is the long-term solution to the maternal health problems in Afghanistan. National and international organizations’ long-term commitment to social investment such as education, local economy, cultural change, and social infrastructure is recommended for Afghanstan and globally
Challenges to Global Implementation of Infrared Thermography Technology: Current Perspective
Get PDFMedical infrared thermography (IT) produces an image of the infrared waves emitted by the human body as part of the thermoregulation process that can vary in intensity based on the health of the person. This review analyzes recent developments in the use of infrared thermography as a screening and diagnostic tool in clinical and nonclinical settings, and identifies possible future routes for improvement of the method. Currently, infrared thermography is not considered to be a fully reliable diagnostic method. If standard infrared protocol is established and a normative database is available, infrared thermography may become a reliable method for detecting inflammatory processes
Diabetes Mellitus Among Adults in Herat, Afghanistan: A Cross-Sectional Study
Get PDFIntroduction: Diabetes is reaching epidemic levels in Afghanistan. This study identifies the risk factors associated with diabetes in Herat City, Afghanistan, and explores the prevalence of previously undiagnosed diabetes.Methods: A cross-sectional study was conducted using multistage cluster sampling by adopting the World Health Organization’s (WHO) STEPwise approach to Surveillance (STEPS). We enrolled 1129 participants aged 25-70 years between May and June of 2015 (47.4% males, 52.6% females). A structured questionnaire was used for data collection of demographic, socioeconomic, and behavioral factors. Investigators collected anthropometric measurements and blood samples from study participants. A multivariable logistic regression model was used to identify factors associated with diabetes prevalence.Results: We found that the prevalence of diabetes in Herat City was 9.9% (9.8% in males and 10.1% in females). Of the 1129 respondents, only 3.3% were previously diagnosed with diabetes or were under treatment, whereas 6.6% of respondents were previously undiagnosed. The multivariable analyses showed that age, frequency of rice consumption, type of cooking oil, and systolic blood pressure were associated with diabetes. Conclusions: This is one of the first studies to discuss the high prevalence of undiagnosed diabetes in Herat, Afghanistan. This study found several modifiable factors that were associated with diabetes in Herat, Afghanistan. Future reduction of disease burden should focus on these factors in the development of the most optimal diabetes prevention programs
Hysterectomy Pathway as the Global Engine of Practice Change: Implications for Value in Care
Get PDFIntroduction: In 2012, University of Pittsburgh Medical Center (UPMC) introduced a hysterectomy clinical pathway to reduce the number of total abdominal hysterectomies performed for benign gynecological indications. This study focused on exploring physician and patient factors impacting the utilization of hysterectomy clinical pathways.Methods: An online survey with 24 questions was implemented to explore physicians’ attitudes and perceived barriers toward implementing the pathway. A survey consisting of 27 questions was developed for patients to determine the utility of a pathway-based educational tool for making surgery decisions and to measure satisfaction with the information provided. Descriptive statistics were used to describe survey results, while thematic analysis was performed on verbal feedback submitted by respondents. Results: Physician respondents found the clinical pathway to be practical, beneficial to patients, and up-to-date with the latest evidence-based literature. Key barriers to the use of the pathway that were identified by physicians included perceived waste of time, inappropriateness for some of the patient groups, improper incentive structure, and excessive bureaucracy surrounding the process. Overall, patient respondents were satisfied with the tool and found it to be helpful with the decision-making process of choosing a hysterectomy route. Conclusions: Physicians and patients found the developed tools to be practical and beneficial. Findings of this study will help to use pathways as a unifying framework to shape future care of patients needing hysterectomy and add value to their care
The Euclid Statistical Matrix Tool
Get PDFStataphobia, a term used to describe the fear of statistics and research methods, can result from a lack of improper training in statistical methods. Poor statistical methods training can have an effect on health policy decision making and may play a role in the low research productivity seen in developing countries. One way to reduce Stataphobia is to intervene in the teaching of statistics in the classroom; however, such an intervention must tackle several obstacles, including student interest in the material, multiple ways of learning materials, and language barriers.We present here the Euclid Statistical Matrix, a tool for combatting Stataphobia on a global scale. This free tool is comprised of popular statistical YouTube channels and web sources that teach and demonstrate statistical concepts in a variety of presentation methods. Working with international teams in Iran, Japan, Egypt, Russia, and the United States, we have also developed the Statistical Matrix in multiple languages to address language barriers to learning statistics. By utilizing already-established large networks, we are able to disseminate our tool to thousands of Farsi-speaking university faculty and students in Iran and the United States. Future dissemination of the Euclid Statistical Matrix throughout the Central Asia and support from local universities may help to combat low research productivity in this region
Pediatric Pulmonary Hemorrhage vs. Extrapulmonary Bleeding in the Differential Diagnosis of Hemoptysis
Get PDFIntroduction: Hemoptysis is an important symptom which causes a major concern, and warrants immediate diagnostic attention. The authors compared a group of patients with pediatric pulmonary hemorrhage with pediatric patients diagnosed with extrapulmonary bleeding focusing on differences in etiology, outcome and differential diagnosis of hemoptysis.Methods: We performed the retrospective analysis of medical charts of 134 pediatric patients admitted to the Emergency Department because of pulmonary and extrapulmonary hemorrhage and were diagnosed with suspected hemoptysis or developed hemoptysis (ICD10-CM code R04.2). The cases with pulmonary hemorrhage (Group 1) were compared with cases of extrapulmonary bleeding (Group 2) using the Fisher Exact test or Pearson’s ?2 test for categorical variables. The t-test was used to assess differences between continuous variables of the patients in the two groups.Results: Bloody cough was the presenting symptom in 73.9% of cases. 30 patients had pulmonary hemorrhage (Group 1), while 104 patients had extrapulmonary bleeding (Group 2). The underlying causes of bleeding in Group 2 included epistaxis, inflammatory diseases of nasopharynx and larynx, foreign bodies, gingivitis, and hypertrophy of adenoids. Mortality rate was 10% in Group 1, whereas Group 2 did not have any mortality outcomes during the observation period. Etiologycal factors were significantly different between hemoptysis and extrapulmonary bleeding in childrenConclusions: Our research suggested that pulmonary and extrapulmonary bleeding are two conditions that differ significantly and cannot be unified under one diagnostic code. It is important to differentiate between focal and diffuse cases, and between pulmonary and extrapulmonary hemorrhage due to the diversity of clinical courses and outcomes