Availability and quality of primary health care in the compulsory health insurance system in Kazakhstan.

Aim To evaluate patient satisfaction with primary healthcare services and determine effectiveness indicators within Kazakhstan's compulsory health insurance system. Methods An analytical observational study with cross-examination was conducted in Kazakhstan's primary healthcare (PHC) organizations. Patient satisfaction was assessed through a 35-item closed-question questionnaire. An analysis of stimulating component result indicators for per capital standard financing in PHC organizations based on their achieved outcomes was performed. Results Among surveyed patients, 54.0% (1.80±1.108) expressed complete satisfaction with medical care, while 59.4% (1.82±1.269) perceived laboratory tests as readily accessible. Notably, males exhibited higher satisfaction levels with medical care and the availability of laboratory tests compared to females. The city polyclinics № 3 and № 14 in Almaty, Kazakhstan, achieved significant performance indicators, resulting in a 1.1-fold increase in the incentive component of per capital funding. Conclusion Within the framework of compulsory health insurance, primary healthcare organizations in Kazakhstan offer affordable and effective medical care, as attested by surveyed patients and the final result indicators of the polyclinics.

Prevalence of chronic kidney disease in Kazakhstan: evidence from a national cross-sectional study.

To date, there have been no large-scale national studies of the prevalence of chronic kidney disease in Kazakhstan. It includes the research based on the analysis of the estimated glomerular filtration rate (eGFR). The aim of this study was to investigate the population prevalence of CKD and associated risk factors in Kazakhstan. The cross-sectional study consisted of a nationally representative sample of n = 6 720 adults aged 18 to 69 from 14 regions and 3 major cities in Kazakhstan. The study covered the period from October 2021 to May 2022. The WHO STEPS questionnaire was used for the survey. For the diagnosis of CKD, creatinine levels in collected blood samples were measured to assess eGFR. Demographic characteristics were collected and studied. The total and adjusted prevalence of factors associated with the presence of CKD were calculated and analysed using logistic regression. 73.5% (n = 4940) of participants had normal eGFR, while 25.2% (n = 1695) had mild CKD (eGFR = 60-89 mL/min/1.7 m2). The overall prevalence of CKD with eGFR < 60 ml/min/1.7 m2 was 1.3% (n = 85), of which 0.2% (n = 15) had eGFR < 45 ml/min/1.7 m2. A mild degree of CKD was most often determined in residents of the East Kazakhstan region in 10.4%, and in 7.8-8.0% of cases. The majority of CKD patients was detected in the East Kazakhstan region and Almaty city, 15.3% and 10.6% of cases respectively. In mild and CKD with GFR < 60 ml/min/1.7 m2, the age of participants was 50-69 years in 61.5% and 78.8% of cases, respectively (p < 0.001). In addition to the association with the place of residence, a statistically significant relationship was found between the risk of developing CKD and underweight (OR 1.43, 95% CI (1.09-1.88), p < 0.001), as well as the presence of obesity (OR 1.24, 95% CI (0.99-1.53), p = 0.04). We observed the prevalence of CKD with eGFR < 60 ml/min/1.7 m2 at the level of 1.3%. However, a fairly large part of study participants had a mild CKD (25.2%). The results of this study can be used for the optimization of the doctors workload and the timely provision of care to patients with CKD.

Improving multidisciplinary hospital care for acute cerebral circulation disorders in Kazakhstan.

Background: According to the World Stroke Organization, there was a significant increase in stroke cases, stroke deaths, and the DALY rate in low- and middle-income countries in 2022. The number of stroke cases rose by 70.0%, stroke deaths reached 86.0%, and the DALY rate reached 89.0%. Among cerebrovascular diseases, ischemic stroke accounts for 62.0% of all strokes, with more than 7.6 million cases reported annually.Kazakhstan, with a population of 19,832,737, is the largest country in Central Asia in terms of territory. In Kazakhstan, the incidence of cerebrovascular disease has risen from 258.4 cases per 100,000 population in 2015 to 433.7 cases per 100,000 population in 2020. Official statistics indicate that the average inpatient mortality rate from stroke in the country is 16.2%, and the average time for patients to be delivered to the hospital after an ambulance call is 40 min (83.2%).Our study findings reveal that in the regions of Kazakhstan, the main contributors to the high morbidity and mortality rates in stroke are a shortage of doctors, inadequate primary healthcare, insufficient follow-up and treatment, and delayed hospitalization. Consequently, this study has helped fill knowledge gaps regarding the epidemiological situation in these regions and underscores the need for training doctors in managing high-risk patients, establishing multidisciplinary home visit teams, and establishing "Stroke Schools" to enhance public awareness of early stroke signs and the fundamentals of a healthy lifestyle. Future research endeavors should consider these study results as valuable contributions towards addressing the existing problems. Aim: To study the prevalence and mortality of acute cerebral circulation impairment in the population within multidisciplinary hospitals in the cities of Nur-Sultan and Almaty, Republic of Kazakhstan, for the period of 2018-2020.This retrospective study was conducted in two stages. In the first stage, an analysis of morbidity, prevalence, and mortality was conducted for the population of Nur-Sultan and Almaty cities, as well as for the overall population of Kazakhstan. This analysis was based on data from the "Electronic Register of Discharged Patients" (IS ERDB) and the annual collection "Health of the Population of the Republic of Kazakhstan and the Activities of Health Organizations in 2015-2020". In the second stage, we examined the care provided to patients with acute impaired cerebral circulation in a multidisciplinary hospital in these two cities. The analysis was based on data regarding the sex and age composition of treated patients in hospitals across the Republic of Kazakhstan, categorized according to the ICD-10 code "Acute Impaired Cerebral Circulation" (I60-I64). We investigated the methods of patients' delivery to medical organizations, types of hospitalization, and outcomes of treated patients. The sample of patients was selected using data from the "Electronic Register of Dispensary Patients" of the Ministry of Health of the Republic of Kazakhstan, along with the statistical collection "Health of the Population of the Republic of Kazakhstan and the Activities of Healthcare Organizations". Between January 1, 2018, and December 31, 2020, a total of 5965 patients were diagnosed with a cerebrovascular event and admitted to a general hospital in Nur-Sultan city, while 13,498 patients were diagnosed and admitted in Almaty city.

Evaluation of the Effectiveness of the Mobile Application on Adherence of Patients With Arterial Hypertension.

Background: An assessment of the level of adherence of patients diagnosed with hypertension to therapy has not been conducted in Central Asia yet. It includes the lack the information on the impact of digital technologies on hypertension management. Objective: The study aimed at the evaluation of the effect of using a mobile application on adherence to therapy in patients with diagnosed arterial hypertension. Methods: A multi-centre randomized controlled study was conducted on 517 patients with diagnosed arterial hypertension (in the out-patient clinic, Almaty, Kazakhstan). Patients were randomly assigned to intervention (IG) and control (CG) groups. IG patients used a mobile application, which allowed creating an individual schedule for taking medications, including visual and audio notifications. The assessment of adherence to antihypertensive treatment was carried out using the Lebanese Medication Adherence Scale-14 (LMAS-14), consisting of 14 items. Data were collected before therapy (T1), 3 months (T2), 6 months (T3) and 12 months (T4) followed the first dose. Adherence was assessed on 101 patients in the CG group and 165 respondents in the IG group. Results: In the period T1 in both groups CG and IG, a moderate adherence to treatment was recorded with indices equal to 35.9 ± 1.2 and 35.9 ± 1.3, respectively (p ≤ 0.05). A decrease in adherence in the CG group was determined after 3 months (35.9 ± 1.2) (p ≤ 0.05) and six months later (36.5 ± 3.2) in comparison with relatively high adherence among respondents in the IG group in periods T2 (39.5 ± 1.2) and T3 (40.5 ± 1.2) (p ≤ 0.001). After 12 months (T4) on the adherence scale in patients who used the mobile application "MyTherapy" (IG), despite a slight decrease in scores, the results were relatively higher (40.3 ± 1.3) compared with the CG group (33.6 ± 1.9) (p ≤ 0.001). Conclusion: The analysis of adherence of patients with primary health care in Almaty (Kazakhstan) with chronic arterial hypertension showed the effectiveness of using the 'MyTherapy' mobile application in increasing patient adherence. The obtained data on the positive effect of the use of digital technologies require further research to assess the possibility of wider implementation in healthcare.

Comparative Results of Treatment and Complications: Pedea in Open Ductus Arteriosus in Premature Infants.

ABSTRACT: The open ductus arteriosus (ODA) is the vessel through which the pathological communication between the aorta and the pulmonary artery persists after birth. Clinical manifestations depend on the size of the duct and the stage of hemodynamic disorders. The course of the defect varies from asymptomatic to extremely severe. With large duct sizes, the latter manifests itself from the first week of life with signs of heart failure. The current research is devoted to the choice of the optimal method of medical and surgical treatment in premature newborns with an unaffected ductus arteriosus. Drug therapy for pulmonary hypertension is recommended only for those patients who have irreversible pulmonary hypertension. Surgical closure of the ODA is recommended for overloads of the left heart or signs of pulmonary hypertension in the presence of blood discharge from left to right and after previously suffered endocarditis. The article analyzes current information about the treatment of premature infants with ODA.

The Life Quality and Sexual Function of Women Underwent Radical Hysterectomy.

BACKGROUND: Up to date, there no studies were conducted on the quality of life (QL) and sexual function (SF) of women from Kazakhstan treated for cervical cancer. The study was aimed at the assessment of the QL and SF of women of the Kazakh population who underwent radical hysterectomy compared with chemo-radiotherapy group. METHODS: The study was conducted prospectively on 157 women of the Kazakh population. 92 women underwent radical hysterectomy (RH) and 65 underwent chemo-radiotherapy (CRT). The information was collected before treatment (T1), 6 months (T2) and 12 months (T3) after treatment. RESULTS: The women's average age was 41.12 ± 5.4 in the RH group and 47.24 ± 6.1 in the CRT group (p = 0.2). We did not detect significant differences between both groups according to the QLQ C-30 questionnaire (T1). The differences between the RH and CRT groups (p≤0,05) were observed in terms of physical functioning, fatigue, nausea and vomiting, pain during the T2 period. High rates of emotional functioning (p = 0.03), global health and QL (p = 0.02), and symptoms of fatigue (p = 0.04) were detected in the RH group compared to the CRT group during T3. However, pain symptoms (p = 0.001), nausea and vomiting and loss of appetite (p = 0.03) were dominated the CRT group. According to the results of FSFI-6 in the RH group, indicators for the domains "desire" (p = 0.02), "excitement" (p = 0.03), and "orgasm" (p = 0.05) were high, unlike in the CRT group during the T3 period. Nevertheless, the number of complains on the 'pain during intercourse' in the CRT group was higher than in the RH group (p = 0.001). CONCLUSION: Women who underwent RH had better health scores, global health status, and SF compared with patients treated with CRT.

Comparative analysis of primary health care indicators security standing in Belgium and Norway: Lessons from readiness to COVID-19.

The research aims to suggest the most enabling indicator of COVID-19 resistance in Belgium and Norway by studying the dynamics of staff and bed security indicators of the primary health care sector. The research methodology comprises Organization for Economic Cooperation and Development (OECD) statistical analysis of staff and bed security indicators. The reason for choosing Belgium and Norway for comparative analysis regarding the readiness to face the COVID-19 pandemic in terms of staff and bed security is because Belgium is leading by the highest level and Norway is leading by the lowest level of morbidity and mortality per 1 million population. The study revealed that the greatest enabler of the primary health care system efficiency in terms of resistance to COVID-19 is primary health care staff security. The analysis clearly shows that the number of beds is not paramount for the effectiveness of the healthcare system and primary health care. The COVID-19 pandemic has exposed the deficiencies and weaknesses of primary health care systems of all countries of the world. The research results suggest that Belgium and other countries focus on the education of nurses and therapists. The significance of the research results is that they prove that the main factor of the effectiveness of the primary health care system is its human resources. This information is useful for improving health systems in many countries around the world.