Epidemiology of covid-19 in Mongolia: descriptive findings

Background

Mongolia is a landlocked country, and has been divided into 21 provinces plus the capital city Ulaanbaatar. In our country, Covid-19 was the first internal case (15 Nov 2020) and the first wave of pandemic occurred (peak at 14 Jun 2021) ten months later on World’s first case and wave. The second and third waves were also delayed by two months, but the fourth wave occurred just in parallel (peak on 17 Jan 2022).

Methods

This study was a retrospective cross-sectional study. We have compared incidence rate (IR) and case-fatality rates (CFR) in provinces by age groups based on publicly available data reported by MoH from January to December of 2021.

Results

CFR in Mongolia was low (average 0.23%), and had a clear dynamic to drop from beginning to the present time (for I wave-0.49, and II-0.42, III-0.23, IV-0.04 correspondently). At the beginning of the III waves, we vaccinated 68.7% of the total population, and in the fourth wave, CFR significantly decreased. IR had two peaks: in the age group 30-34 (250.6) and over 85 (248.9). There was a strong correlation between age and morbidity. Up to age group 40-44 (0.12 %), there was a deliberate increase of CFR, further up to 65-69 ages (2.7%) gradual increase, and from age group 70-74 CFR rapidly increases reaching 10.5% at age group over 85. IR was higher in men aged 65 years and over. CFR was significantly higher in Ulaanbaatar city and Umnugovi province morbidity due to Covid-19 not being registered.

Conclusions

Vaccination in Mongolia was a key factor in declining fatality. Umnugovi province is crucial for exports to China, so we suppose, government decisions strongly affected in fatality rate in this province, in terms of the evacuation of severely diseased patients to the capital.

Key messages

• Vaccination is played important role in COVID-19 epidemiology.

• Burden of Covid-19 need to be investigated deeply in association with political decisions.

Geospatial characteristics of medical workforce and infrastructure to combat COVID-19 in Kazakhstan

Background

After cessation of initial quarantine in Kazakhstan, the COVID-19 outbreak peaked in July 2020, imposing dramatic stress on the country's healthcare system. This study was focused on calculation of updated epidemiological characteristics, on evaluation of available medical workforce and infrastructure and the impact of workforce density on infected and dead individuals via ArcGIS platform.

Methods

The national and local incidence rate (IR), mortality (M) and case-fatality rates (CFR) were calculated along with the population-weighted densities of beds, physicians, general practitioners, resuscitators, nurses and healthcare budget. Associations between the density of different health workers, infected and dead individuals were investigated using Poisson regression. Finally, we constructed vector maps of country regions clustered by IR and CFR to depict the density of beds and those health workers that were significantly associated with infection and death rates.

Results

There is much heterogeneity between the country regions in terms of CFR (range from 0.28 to 2.57) and IR (range from 1.62 to 12.04), while density of beds was characterized by a relatively greater stability (range from 3.47 to 6.66) and so did density of physicians (range from 0.79 to 2.76) and density of nurses (range from 5.73 to 8.26). Densities of beds, physicians, general practitioners, resuscitators, and nurses have been linked significantly with infection and death rates.

Conclusions

As COVID-19 epidemic is still far from ending, findings of this study could be of interest for policy makers to formulate an appropriate action plan in the view of possible repeated outbreaks.

Key messages

The impact of the COVID-19 pandemic on tuberculosis case reporting in Kazakhstan

Background

The COVID-19 pandemic had a significant impact on economic development, lifestyles and health systems in all countries. Due to the lack of medical interventions, many countries adopted restrictive measures to slow the spread of the virus and reduce the burden on the healthcare system. Quarantine measures have had an impact on the transmission of SARS-CoV-2. However, the unintended consequences of such drastic measures were inevitable. In developing countries, there have been adverse effects of disruptions in health services, including the provision of timely medical services in detecting cases of tuberculosis in the population. The aim of this study was to study the influence of COVID-19 pandemic on the tuberculosis incidence in the Republic of Kazakhstan.

Methods

We analyzed national data on the reported tuberculosis cases and screening results of tuberculosis in Kazakhstan for 2019-2020. The primary data were collected from regular reporting of cases through surveillance.

Results

The number of registered patients identified during screening activities in 2020 were 2,854 cases compared to 4,288 cases in 2019 before COVID-19 era. The proportion of cases with antibiotic-resistant (poly, multi, super) forms of tuberculosis increased up to 6.7% in 2020 in comparison with 2019.

Conclusions

There is a need to conduct an analysis of the reasons for the increase in cases of multidrug-resistant and extensively drug-resistant tuberculosis. The working process should be adapted to epidemics and emergencies to ensure the availability of medical services, as well as to improve the system of preventive examinations and screening for the early detection of TB cases.

The abstract was submitted under the ‘CATINCA - Capacities and infrastructures for health policy development’ project which is coordinated/led by Robert Koch Institute and supported by the WHO Regional Office for Europe.

Key messages

P-513 Quality of life assessment of women undergoing in vitro fertilization treatment in Kazakhstan

Study question

What is the quality of life of Kazakhstani women with infertility and what additional factors can affect it?

Summary answer

The FertiQoL questionnaire showed the low quality of life of Kazakhstani women and a significant affect some factors.

What is known already

Studies showed that infertility problems are among the saddest events in people's lives. It is reported that women undergoing IVF procedures are experiencing various types of psychological burdens like stress, anxiety and depression.

Study design, size, duration

This cross-sectional study involved women of reproductive age undergoing an IVF cycle at a large IVF center in Kazakhstan in the period from September 1, 2020 to September 31, 2021.

Participants/materials, setting, methods

The survey was carried out using the Google Form program and was sent to patients of large IVF clinic of Kazakhstan by the attending physician for an online survey. Out of 500 women who were given questionnaires, 453 women completely filled out. Questionnaire results data were entered into SPSS version 26.0 for aggregation and statistical analysis. Two-sample Student's t-test or one-way analysis of variance (ANOVA) was used to test for differences between groups.

Main results and the role of chance

Total FertiQoL was 59.6±11.3. 292 women with primary infertility and 161 with secondary infertility. According to the main indicators as Total FertiQoL and Core FertiQoL, the results of the scales were significantly higher (p < 0.001). The source of income for infertility treatment affects the level of Treatment FertiQoL. Cronbach's α coefficients of the FertiQoL subscale averaged 0.8. Cronbach's α coefficients of the FertiQoL subscale averaged 0.8.

We examined the satisfaction scores by FertiQoL, dividing them into two groups according to the presence of children (Table 3). FertiQoL scores were statistically significantly higher in the group with children than in the group with primary infertility in all areas (p < 0.05), except for Relation, Tolerability (p = 0.65, p = 0.59).

Limitations, reasons for caution

This study cross-sectional and was conducted in the countries of the Commonwealth of Independent States (CIS) for the first time. We want to continue research in cooperation with other CIS countries.

Wider implications of the findings

The duration of infertility, age and low economic status negatively affect the quality of life of women. The availability of subsidies from the state for infertility treatment improves the quality of life. The health expenditure percentage of GDP may affect the overall level of satisfaction of women.

Trial registration number

IRB-A108

PERINATAL CARE INDICATORS IN ALMATY, KAZAKHSTAN FOR 2013-2017: A CROSS-SECTIONAL STUDY

Protection of maternity and child health is of great medical and social importance. Provision of medical care to women and children in Kazakhstan is the major task for state policy. Still, the data on epidemiological indicators of perinatal care in Kazakhstan are rather limited. This study was aimed at assessment of perinatal care indicators in Almaty, Kazakhstan Republic, over the period from 2013 to 2017. The data on demographic characteristics of study population were obtained from online platform of the Republican Center for Health Development. The analysis of perinatal indicators was carried-out on the basis of statistical reporting form No. 32. We relied on the standard statistical formulas to calculate epidemiological indicators. All statistical tests were performed in SPSS software, Version 17.0 for Windows. The crude birth rate over five years remained stable and was within the range of 25,975-26,289 per 1,000 population. The abortion rate constituted 2.018-2.272 per 1,000 population. The abortion ratio was growing until 2016 and composed 26.387 per 1,000 population. The adolescent fertility rate has dropped significantly over the past period from 4,357 per 1,000 teenage population in 2013 to 3,366 per 1,000 teenage population in 2017. The maternal mortality rate did not exceed 0.02 per 1,000 population. Maternal mortality ratio was within the range of 0.208-0.194 per 1,000 population. Incidence rate of extragenital pathology was very high and peaked in 2016 (1,010.800 per 1,000 population). Only 17.4% of women in labor were recognized as healthy based on the labor results. Effective perinatal technologies that were introduced in the Republic of Kazakhstan have demonstrated their high performance in achieving and maintaining a reasonable level of maternity and child health. This was particularly true for stable rate of general fertility and crude birth rate, and decreasing adolescent fertility rate. However, high rates of extragenital pathology indicate the need to implement national preventive programs aimed at ensuring proper monitoring over maternity health indicators.

[PREVALENCE AND MEDICAL ERROR MANAGEMENT (REVIEW)]

Medical errors are an inevitable part of the professional activity of a medical worker: they were, are and will be, no matter what technological advances are introduced into medicine. For years, experts have recognized that there are medical errors and that society will compromise. But the desire to reduce their number is a real aim that requires serious efforts from both the medical community and government agencies responsible for the country's health. The aim of literature review was to analyze publications devoted to the study of the current state of methods of organizing and managing medical errors in Kazakhstan and some foreign countries. Analyzed full-text publications in English and Russian languages, which were devoted to the study of the prevalence and management of medical errors in Kazakhstan and abroad. According to the literature, there is an active medical and social policy aimed at organizing medical safety and improving the quality of life of patients, which is based on a set of measures of a socio-economic, legal and medical-organizational nature. A legislative and regulatory framework has been created and is being improved, including a number of laws, decrees, orders, standards of ministries and departments. Despite the above, the practice of managing and controlling medical errors as one of the mechanisms of medical safety is not well understood. Thus, all these issues remain relevant in general for world medical practice and initiate research in the interdisciplinary field of medical sciences and jurisprudence.

TREATMENT OF TOXIC THYROID ADENOMA BY THE ETHANOL DESTRUCTION METHOD

The aim of study was to evaluate the long-term results and complications of percutaneous ethanol injection therapy of the thyroid gland toxic adenoma for a 10-year follow-up period. We conducted a 10-year prospective cohort study of the ethanol sclerotherapy results in 43patients with toxic adenomas of the thyroid gland aged in average 62.59 (57.95-65.73) years and a duration of the disease of 17.7 (10.8-22.20) years. As a result of the study, we found that ethanol sclerotherapy can achieve a significant reduction in the volume of adenomas based on the results of ultrasound during the 10-year observation period: the average volume after the procedure was 4.27 cm3 vs. initial - 21.12 cm3, p <0.00, and absence of the disease recurrence. The incidence of complications, including temporary local pain and transient dysphonia was 0.07±0.02% of cases. The patients quality of life during the 12 months of observation was significantly higher than the baseline data (Physical component: 71.96 (71.35-72.84) points after treatment versus 47.47 (47.18-47.82) (Z = -5711, p <0.00 ) Psychic component: 81.35 (78.34-85.49) points after therapy against 53.00 (52.11-54.11) points at the initial examination (Z = -5.711, p<0.00)). According to results we concluded, that the treatment of toxic thyroid adenoma by the ethanol destruction method is an effective, safe, low-cost method of therapy that has a significantly positive effect on the patients' quality of life.