New coumarin from the roots of Prangos pabularia growing wild in Tajikistan

Dichloromethane and butanol extracts of the roots of Prangos pabularia were analyzed to determine chemical constituents and biological activity. The new coumarin 1, yuganin B ((5-(((2S,3R,4S,5S,6R)-4,5-dihydroxy-6-(hydroxymethyl)-2-((2-oxo-2H-chromen-7-yl)oxy)tetrahydro-2H-pyran-3-yl)oxy)-3,4-dihydroxytetrahydrofuran-3-yl)methyl 4-hydroxy-3-methoxybenzoate) along with three phenolic and twenty-four known coumarins were isolated from the roots of Prangos pabularia, and the structures of these isolated compounds were elucidated by UV, HR-ESIMS, and 1 D and 2 D NMR spectroscopy. In addition, the anti-melanogenic effect of several of the isolated individual compounds and their inhibitory effect on B16 cells were evaluated. Isolating and testing compounds may proof to be useful in the treatment of hyperpigmentation and as a skin-whitening agent in the cosmetics industry.

Land cover dataset of the China Central-Asia West-Asia Economic Corridor from 1993 to 2018

Land Cover (LC) maps offer vital knowledge for various studies, ranging from sustainable development to climate change. The China Central-Asia West-Asia Economic Corridor region, as a core component of the Belt and Road initiative program, has been experiencing some of the most severe LC change tragedies, such as the Aral Sea crisis and Lake Urmia shrinkage, in recent decades. Therefore, there is a high demand for producing a fine-resolution, spatially-explicit, and long-term LC dataset for this region. However, except China, such dataset for the rest of the region (Kyrgyzstan, Turkmenistan, Kazakhstan, Uzbekistan, Tajikistan, Turkey, and Iran) is currently lacking. Here, we constructed a historical set of six 30-m resolution LC maps between 1993 and 2018 at 5-year time intervals for the seven countries where nearly 200,000 Landsat scenes were classified into nine LC types within Google Earth Engine cloud computing platform. The generated LC maps displayed high accuracies. This publicly available dataset has the potential to be broadly applied in environmental policy and management.

New and poorly known species of Palpimanus Dufour, 1820 (Araneae, Palpimanidae) from Uzbekistan and Tajikistan

Two new species, Palpimanus logunovi sp. n. () and P. rakhimovi sp. n. (), are described from Tajikistan and Uzbekistan respectively. Lectotype has been designated for the poorly known species, P. sogdianus Charitonov, 1946 from Uzbekistan and is redescribed based on type and newly collected material. (Re)descriptions, figures, diagnoses, distribution map and photograps of habitats of all the studied species are provided.

Ottia, a new ennomine genus of moth from Tajikistan (Lepidoptera: Geometridae)

An ennomine species, described earlier as Plagodis ochraceata Viidalepp, 1988, is transferred from Plagodis Hbner, [1823]1816 to a genus of its own: Ottia ochraceata (Viidalepp, 1988) (gen. nov., comb. nov.). The morphology of the adult moth, of its male and female genitalia, phenology and spatial distribution are described and its taxonomic relationships are analyzed.

Gahvora cradling in Tajikistan: Cultural practices and associations with motor development

In Tajikistan, infants are bound supine in a "gahvora" cradle that severely restricts movement. Does cradling affect motor development and body growth? In three studies (2013-2018), we investigated associations between time in the gahvora (within days and across age) and motor skills and flattened head dimensions in 8-24-month-old Tajik infants (N = 269, 133 girls, 136 boys)) and 4.3-5.1-year-old children (N = 91, 53 girls, 38 boys). Infants had later motor onset ages relative to World Health Organization standards and pronounced brachycephaly; cradling predicted walk onset age and the proficiency of sitting, crawling, and walking. By 4-5 years, children's motor skills were comparable with US norms. Cultural differences in early experiences offer a unique lens onto developmental processes and equifinality in development.

Evaluating profitability of beef cattle farming and its determinants among smallholder beef cattle farmers in the Baljovan District of Khatlon region, Tajikistan

In Tajikistan, owning beef cattle is an important survival mechanism for smallholder farmers to alleviate poverty. Therefore, beef cattle farming enterprises should indeed strive to maximize profit to excel and flourish in a free economy. Nevertheless, smallholder beef cattle farmers are known for making little profit. Thus, this study was set to evaluate the profitability of beef cattle farming and its determinants to enhance profit maximization among smallholder beef cattle farmers in the Baljovan District of Khatlon region, Tajikistan. A total of 388 farming households were chosen at random and purposive for the study. The cross-sectional data collected using questionnaires was analyzed by using descriptive, gross margin (GM), and ordinary least squares (OLS) regression models. Based on the descriptive analyses, the mean age of beef cattle farmers was 52.73 years, with a household size of 7.07 members. The beef cattle farmers had an average of 18.23 cattle herd size with 8.54 years of farming experience. The average land area possessed by farmers was 10.59 hectares. Among farmers, men (98.2%) dominated beef cattle farming activities. Around 83.8% of farmers had a college grade (higher literacy). Besides, around 89.4% of farmers had access to farm credits. However, only 71.4% of farmers used farm credit points to produce beef cattle. Most of the farmers (89.7%) had access to accurate market information. Such market information enabled 75.8% of farmers to sell their beef cattle to open market (profitable) outlets rather than middlemen. About 89.4% had access to veterinary services. Additionally, about 82.7% of farmers acknowledged the availability of pasture for grazing, which motivated 87.6% of farmers to be involved in selling contracts. Furthermore, economic investigation results revealed that on average, farmers had a gross margin (GM-profit) of 353.77 US$ per cattle, with feed costs (58.6%) and medications costs (26.1%) accounting for the largest share of total variable costs. Meanwhile, the profitability of beef cattle farming among farmers was significantly influenced by education level, family size, farming experience, pasture availability, land size owned, selling contract, feed costs, medications expenses, access to credits, and sales costs (P < 0.05). This study concluded that beef cattle production is a feasible business. However, the potential for increased profitability is significant if existing resources are efficiently coordinated and production expenses, notably feed and healthcare costs, are minimized. Thus, the government should develop additional measures for addressing concerns such as capacity building, suitable and freely available pasture as well as health management, to boost beef cattle profitability among farmers in Tajikistan.

Organic aerosol compositions and source estimation by molecular tracers in Dushanbe, Tajikistan

To elucidate the molecular composition and sources of organic aerosols in Central Asia, carbonaceous compounds, major ions, and 15 organic molecular tracers of total suspended particulates (TSP) were analyzed from September 2018 to August 2019 in Dushanbe, Tajikistan. Extremely high TSP concentrations (annual mean ± std: 211 ± 131 μg m^-3) were observed, particularly during summer (seasonal mean ± std: 333 ± 183 μg m^-3). Organic carbon (OC: 11.9 ± 7.0 μg m^-3) and elemental carbon (EC: 5.1 ± 2.2 μg m^-3) exhibited distinct seasonal variations from TSP, with the highest values occurring in winter. A high concentration of Ca²⁺ was observed (11.9 ± 9.2 μg m^-3), accounting for 50.8% of the total ions and reflecting the considerable influence of dust on aerosols. Among the measured organic molecular tracers, levoglucosan was the predominant compound (632 ± 770 ng m^-3), and its concentration correlated significantly with OC and EC during the study period. These findings highlight biomass burning (BB) as an important contributor to the particulate air pollution in Dushanbe. High ratios of levoglucosan to mannosan, and syringic acid to vanillic acid suggest that mixed hardwood and herbaceous plants were the main burning materials in the area, with softwood being a minor one. According to the diagnostic tracer ratio, OC derived from BB constituted a large fraction of the primary OC (POC) in ambient aerosols, accounting for an annual mean of nearly 30% and reaching 63% in winter. The annual contribution of fungal spores to POC was 10%, with a maximum of 16% in spring. Measurements of plant debris, accounting for 3% of POC, divulged that these have the same variation as fungal spores.

Pathways of change: qualitative evaluations of intimate partner violence prevention programmes in Ghana, Rwanda, South Africa and Tajikistan

A critical component of evaluations of the effectiveness of intimate partner violence prevention programmes involves understanding pathways of change among individuals who participate in such programmes, and the intervention or contextual elements that support or hinder these. This paper draws on qualitative evaluations of four intimate partner violence prevention programmes in Ghana, Rwanda, South Africa and Tajikistan conducted as part of the What Works to Prevent Violence against Women and Girls Programme. Using a comparative case study approach, a secondary analysis was applied to thematically analysed data to explore how and why men and women change in response to different types of programmes across diverse contexts. Similar pathways of change were identified including the value of learning and applying relationship skills to support equitable, non-violent relationships; the importance of participatory approaches to challenge harmful gender norms and allow for group rapport; and the integration of economic empowerment activities to reduce drivers of intimate partner violence and conflict, and promote participants' self-confidence and status. These findings provide insights regarding intervention design and implementation factors pertinent to bring about changes in intimate partner violence.

Fossil birds from the Roof of the World: The first avian fauna from High Asia and its implications for late Quaternary environments in Eastern Pamir

The Eastern Pamir (eastern Tajikistan) is a high-mountain plateau with elevations up to 7000 m, currently characterized by extremely severe environmental conditions and harboring a specialized montane fauna, which in part is shared with that of the Tibetan Plateau. The modern bird fauna of High Asia comprises a diversity of both ancient and recently diverged endemics, and thus is of general importance for historical biogeography and understanding the origin of modern high mountain ecosystems. However, the past history of the Central Asian highland avian communities remains practically unknown, as no fossil bird assemblages from high elevation areas were previously reported. In particular, it remains completely unexplored how birds responded to late Quaternary climatic fluctuations. Here we report the first fossil bird fauna from the High Asia and the first fossil birds from Tajikistan. An assemblage from the late Pleistocene through middle Holocene of Istykskaya cave (4060 m) in Eastern Pamir surprisingly comprises a remarkable diversity of waterbirds, including a few species that are completely absent from High Asia today and that were not reported globally from such high altitudes. The diversity of waterbirds incudes taxa of various ecological preferences (shorebirds, underwater and surface feeders, both zoophagous and phytophagous), strongly indicating the presence of a productive waterbody at the vicinity of the site in the past. These observations correspond to recent palaeoclimatic data, implying increased water availability in this region, currently occupied by high mountain semi-deserts. Our findings for the first time show that milder environmental conditions of late Quaternary attracted lowland species to the Central Asian highland wetlands. The reported assemblage yet contains several characteristic highland taxa, indicating a long-time persistence of some Central Asian montane faunistic elements. In particular, it includes the Tibetan Sandgrouse (Syrrhaptes tibetanus), a highly-specialized montane dweller, which is for the first time found in the fossil record.

Transboundary spread of peste des petits ruminants virus in western China: A prediction model

In pan Pamir Plateau countries, Peste des petits ruminants (PPR) has brought huge losses to the livestock industry and threaten the endangered wildlife. In unknown regions, revealing PPRV transmission among countries is the premise of effective prevention and control, therefore calls for quantified monitoring on disease communication among countries. In this paper, a MaxEnt model was built for the first time to predict the PPR risk within the research area. The least cost path (LCP) for PPR transboundary communication were calculated and referred to as the maximum available paths (MAP). The results show that there are many places with high-risk in the research area, and the domestic risk in China is lower than that in foreign countries and is mainly determined by human activities. Five LCPs representing corridors among Kazakhstan, Tajikistan, Pakistan, India and China were obtained. This study proves for the first time that there is the possibility of cross-border transmission of diseases by wild and domestic animals. In the future, it will play an important role in monitoring the PPR epidemic and blocking-up its cross-border transmission.

Widespread collapse, glimpses of revival: a scoping review of mental health policy and service development in Central Asia

PURPOSE

We aimed to map evidence on the development of mental health care in Central Asia after 1991.

METHOD

We conducted a scoping review complemented by an expert review. We searched five databases for peer-reviewed journal articles and conducted grey literature searching. The reference lists of included articles were screened for additional relevant publications.

RESULTS

We included 53 articles (Kazakhstan: 13, Kyrgyzstan: 14, Tajikistan: 10, Uzbekistan: 9, Turkmenistan: 2, Multinational: 5). Only 9 were published in internationally recognised journals. In the 1990's mental health services collapsed following a sharp decline in funding, and historically popular folk services re-emerged as an alternative. Currently, modernised mental health policies exist but remain largely unimplemented due to lack of investment and low prioritisation by governments. Psychiatric treatment is still concentrated in hospitals, and community-based and psycho-social services are almost entirely unavailable. Stigma is reportedly high throughout the region, psychiatric myths are widespread, and societal awareness of human rights is low. With the exception of Kyrgyzstan, user involvement is virtually absent. After many years of stagnation, however, political interest in mental health is beginning to show, along with some promising service developments.

CONCLUSIONS

There is a substantial knowledge gap in the region. Informed decision-making and collaboration with stakeholders is necessary to facilitate future reform implementation.

Medical education reform in Tajikistan: comparison of the conventional one-year family medicine residency program and the new two-year residency program for postgraduate medical education

INTRODUCTION

The last two decades have seen a shift in former Soviet countries from highly specialized to more family medicine-focused systems. Medical education has slowly adjusted to these reforms, although the region is still at risk to have a chronic shortage of family doctors. This paper presents the evaluation of a new post-graduate family medicine program in Tajikistan, focused on competency-based training. The findings are relevant for policy makers, international organizations and practitioners participating in similar medical education reform programs.

METHODS

We employed a quasi-experimental control group design and compared intervention residents, control group residents with traditional training, and 1st year residents with no training in two outcomes, clinical knowledge and competencies. We employed two objective measures, a written multiple-choice question test (MCQT) and an Objective Structured Clinical Examination (OSCE), respectively. We report reliability and validity of the measures along with ANOVA, planned contrasts and effect size estimates to examine differences across groups.

RESULTS

We found statistically significant differences in both clinical knowledge and competencies between intervention and control groups. We also detected a large intervention effect size. Participants in the intervention outperformed control group participants in the two measures. Our analysis suggests that intervention and control group participants are comparable in terms of initial knowledge and competencies, strengthening the argument that the intervention caused the improvement in the program outcomes.

DISCUSSION

Receiving tailored training and structured opportunities to practice knowledge and competencies in clinical settings have a positive effect on the education of family medicine doctors in Tajikistan. Our results support curriculum reform and investment in medical education in the form of longer and supervised on-the-job preparation designed to be more in line with international standards. We discuss suggestions for future studies and potential requirements to inform replicability in other countries.

CONCLUSION

Family medicine is well recognized as central to health systems throughout the world, but high quality residency training lags behind in some countries. Our study showed that investing in family medicine residency programs and structured training is effective in increasing critical clinical competencies. We encourage promoting comprehensive post graduate family medicine doctor training so that the goals of a family medicine centered health system are attainable.

Sustainable Wheat Production and Food Security of Domestic Wheat in Tajikistan: Implications of Seed Health and Protein Quality

Staple crop yield, quality and sustainable production are critical for domestic food security in developing countries. In Tajikistan, both seed-borne diseases and protein quality impair the yield and the quality of the major staple crop, wheat. Here, we used a detailed two-year survey of fields on 21 wheat-producing farms in Tajikistan, combined with lab analyses on seed health and protein quality, to investigate the presence of seed-borne diseases and bread-making quality in Tajik wheat. Seed samples were collected for the analysis of: (i) the presence of common bunt (Tilletia spp.) using the centrifuge wash test, (ii) the major pathogenic fungi on/in the seed using the agar plate test and (iii) the protein amount and size distribution using size-exclusion high-performance liquid chromatography (SE-HPLC). Field occurrence of common bunt and loose smut was generally low (3 farms in year one (14%) showed common bunt occurrence), but the presence of fungi was observed microscopically on most seed samples (on seeds from 19 out of 21 farms = 91%). Tilletia laevis was the dominant agent in common bunt (present in 19 farms compared to T. tritici present in 6 farms). Altogether, 18 different fungi were identified from seed samples by microscopy. Protein composition, measured with high-performance liquid chromatography as protein amount and size distribution (known to correlate with bread-making quality), differed significantly between samples from different farms and years, although the farm type and land elevation of the farm were not the determinants of the protein composition. The presence of certain fungi on the seed correlated significantly with the protein quality and could then have an impact on the bread-making quality of the Tajik wheat. The presence of seed-borne diseases, a low protein content and weak gluten were the characteristics of the majority of the grain samples, mostly irrespective of farm type and farmer’s knowledge. For sustainable development of the Tajik farming systems, and to strengthen the food security of the country, the knowledge of Tajik farmers needs to be increased independently of farm type; in general, plant breeding is required and certified seeds need to be made available throughout the country.

Black Carbon in Surface Soil and Its Sources in Three Central Asian Countries

Black carbon (BC) aerosol impacts the air quality, public health, agricultural productivity, weather, monsoon, cryosphere, and climate system from the local to the global scale. However, its distribution over vast Central Asia is poorly known, because it is one of the poorly sampled regions of the world. BC in the soil can be resuspended into the atmosphere and transported to downwind regions with sensitive ecosystems and vulnerable populations, such as from Central Asian countries to the cryospheric regions in the Tianshan Mountain and the Tibetan Plateau, which could accelerate the melting of the snowfields and glaciers. We report the distribution of BC and total organic carbon (TOC) in surface soil with samples collected at multiple sites, for the first time, over three countries in Central Asia (Uzbekistan, Tajikistan, and Kyrgyzstan). The mean BC (TOC) concentrations over three countries were 0.06 ± 0.06 (11.86 ± 4.84) mg g^-1, 0.15 ± 0.21 (20.35 ± 10.96) mg g^-1, and 0.32 ± 0.29 (26.45 ± 20.38) mg g^-1, respectively. They were found to be originated from the same or similar sources, at least over Tajikistan and Kyrgyzstan, as indicated by their high and significant correlation (R² > 0.6, p < 0.001). The char/soot ratio indicated the diesel and gasoline combustion as dominant BC sources over this region. To gain further insights into the soil BC and its implications to air quality, climate, and cryosphere, future studies should include a wider area over Central Asia with different land-use types and other soil parameters combined with atmospheric simulations for this important yet relatively less studied region of the world.

Significant Influence of Carbonates on Determining Organic Carbon and Black Carbon: A Case Study in Tajikistan, Central Asia

Carbonates cause large uncertainties in determining the concentrations of organic carbon (OC) and elemental carbon (EC), as well as EC's light absorption characteristics, in arid locations, such as Central Asia. To investigate this influence, a comparison between acid (HCl)-treated and original total suspended particle (TSP) samples was conducted in Dushanbe, Tajikistan. According to the results, the OC and EC concentrations were overestimated by approximately 22.8 ± 33.8 and 32.5 ± 33.5%, with the actual values being 11.9 ± 3.0 and 5.13 ± 2.24 μg m^-3, respectively. It was found that carbonates had a larger influence from May to October than during the other months, which was significantly correlated with the amount of TSPs on the filter. Furthermore, the mass absorption cross-section of EC (MAC_EC) increased from 4.52 ± 1.32 to 6.02 ± 1.49 m² g^-1; this indicated that carbonates can significantly decrease MAC_EC, thus causing an underestimation of approximately 23.9 ± 16.7%. This is the first study that quantifies the influence of carbonates on the light-absorbing abilities of EC.

First main series of transition elements with atomic numbers from 22 to 29, found in air pollution and detected in the plants from Tajikistan areas

According to several reports, the presence of transition metal elements in the atmosphere was associated with adverse health effects. The purpose of this investigation was to analyze the presence of transition metal particles with atomic numbers 22-29 on some medicinal plants (n = 22) from various regions of the Republic of Tajikistan and their content in the atmosphere. Samples (n = 43) of individual plant organs, such as seeds, flowers, leaves, trunks, and plant roots, were examined for their elemental composition using X-ray fluorescence analysis. Selection of particles contained in the atmosphere was carried out for 24 h/3 days by the aspiration method using fiberglass filters GF 10 in an apparatus installed at an altitude of 864 m on the periphery of the capital. For the analysis of plant samples, measurements were carried out on a SPECTROSCAN MAX-G wave-dispersive X-ray fluorescence spectrometer. For samples containing filtered atmosphere elements, a high-resolution PANanalytical Epsilon 5 high-resolution energy-dispersive spectrometer was used. Eight transition elements from the 1st main series of metals with atomic numbers 22-29, such as titanium, vanadium, chromium, manganese, iron, cobalt nickel, and copper, were found in plant organs, as well as in the atmosphere samples. Our results showed that the distribution of metals on plants varied depending on plants and their organs. We did not find any correlation between the region of plant collection and their absorption of metal elements. The distribution of metals varied in various plant organs. In the atmosphere samples, we found all the metals that were found in plants. In conclusion, medicinal plants can adsorb and accumulate some harmful chemical elements in their organs, are involved in the recirculation of these metals, and contribute air pollution.

Formative research to address vaccine hesitancy in Tajikistan

INTRODUCTION

Incomplete childhood vaccination is associated with caregiver vaccine hesitancy, conceptualized by "3 Cs": high complacency, low confidence, and low convenience. To expand on existing evidence drawn primarily from the Americas and Europe, and develop culturally appropriate interventions, this research explored drivers of vaccine hesitancy in the Central Asian country of Tajikistan.

METHODS

In twelve diverse districts, clinic-based immunization record abstraction identified purposive samples of children who were up-to-date (N = 300) or not (N = 300) on all first year vaccines. Using a modified case-control design, the structured face-to-face in-home survey of 600 caregivers compared knowledge, attitudes and practices regarding childhood vaccination by up-to-date status. Socio-demographic and psychological factors associated with hesitancy were identified, using a 22-item vaccine hesitancy scale, with subscales measuring complacency, confidence, and convenience. Overall contribution of vaccine hesitancy to up-to-date status was modeled, adjusting for other significant covariates.

RESULTS

Caregivers of not up-to-date children were more likely to report their child's health as poor, and report many logistical barriers to vaccination. Knowledge of vaccine-preventable illnesses was low, and complacency regarding vaccination was high among not up-to-date caregivers. In final multivariable models of predisposing, enabling and reinforcing influences on vaccination status, urban children, those with transportation and employed mothers were more likely to be up-to-date, while not up-to-date children included those born at home, seen as having fair or poor health, or reportedly told by clinicians to avoid immunization. Reinforcing factors included having a "vaccine passport", receiving useful information from medical providers, and believing that vaccine-preventable illnesses are serious and that most in their community are vaccinated. Additionally, vaccine hesitancy was negatively associated with up-to-date status (odds ratio 0.15, 95% C.I. 0.08, 0.26).

CONCLUSIONS

Results confirm that in this traditional culture, there is a strong need for tailored communication campaigns to address vaccine hesitancy, while continuing to address systems-level barriers.

Scaling up Business Plans in Tajikistan: a qualitative study of the history, barriers, facilitators and lessons learnt

BACKGROUND

To improve health planning at primary health care (PHC) level, Business Plans were introduced in Tajikistan by the Enhancing Primary Health Care (EPHC) Services Project.

OBJECTIVE

To describe the history and process of implementation of Business Plans and to identify barriers, facilitators and lessons learnt from scaling up Business Plans.

METHODS

Set in a qualitative research design, we conducted a desk review of project and official documents and seventeen semi-structured interviews with key stakeholders at national and sub-national levels between May and July 2020. We used an interview guide informed by the ExpandNet/WHO framework and analyzed the data following a content analysis approach facilitated by MAXQDA.

RESULTS

With the participation of various user organizations and resource teams and through a variety of strategic scale-up choices, Business Plans have been scaled up from a vertical pilot project to institutionalized health management tools covering 45% of Tajikistan's PHC facilities. The most prominent facilitators for scaling up Business Plans were the institutionalization and integration of the tool into the Tajik health system, the close collaboration with Community Health Teams (CHTs), the high acceptance of the tool among the users, the advocacy through champions and policy-makers and the large dissemination network. The most outstanding barriers to scaling up Business Plans were insufficient financial or human resources, general weaknesses in health governance, the lack of a strategic scale-up plan and strategic decisions, the lack of motivation or overall vision to implement Business Plans at a large scale and difficulties in donor coordination.

CONCLUSION

To ensure the continuity of scaling up Business Plans, developing a scale-up strategy, strengthening cross-sectoral collaboration and participation during scaling up, and capacitating the user organizations of Business Plans are important next steps to ensure the sustainability and effectiveness of Business Plans in the future.

Geochemical characteristics of solid particles deposited on experimental plots established for traffic pollution monitoring in different countries

The main aim of this research was to identify the mineralogical, morphological, and chemical characteristics of solid particles emitted by vehicular traffic and deposited on special monitoring plots located on the roadside of five countries with different climatic conditions and traffic structure. Within 24 months of exposure, the composition of the matrix used at the monitoring plots changed. Percentage quartz content decreased in all locations, and due to the input from local sources, the share of other mineral phases increased. In some locations, an increase in the share of mineral phases associated with local parent rock and soil erosion was noted (e.g. Helsinki, Böblingen). In other places, material associated with abrasion of the road surface was characteristic (e.g. Gliwice, Opole). The composition of pollutants accumulated at all the monitoring plots was varied, however the common feature was the presence of technogenic magnetic particles in the matrix after exposure. Analyses showed that numerous irregular, angular particles of iron oxides with porous surface, which are carriers for a number of metals and metalloids were present in the samples. Angular iron oxides containing zinc, chromium, and copper are usually considered as non-exhaust traffic emissions. Another type of iron oxides particles found in the samples were magnetic spherules related to exhaust emissions (smaller spherules, < 20 μm). Study of results confirmed the effectiveness of the testing method for roadside pollution monitoring related to currently emitted solid particles accumulated on matrix of known mineral composition.

Implementing Health Warnings on Alcoholic Beverages: On the Leading Role of Countries of the Commonwealth of Independent States

Despite being a psychoactive substance and having a major impact on health, alcohol has to date escaped the required labeling regulations for either psychoactive substances or food. The vast majority of the countries in the WHO European Region have stricter labeling requirements for bottled water and health warning provisions for over-the-counter medications than for alcoholic beverages. However, more progress in implementing health warnings has been made in the eastern part of the WHO European Region, largely because of the recent technical regulation put in place by the newly formed Eurasian Economic Union. The present contribution provides an overview of the existing legislation regarding the placement of alcohol health warnings on advertisements and labels on alcohol containers in the countries of the Commonwealth of Independent States (CIS; Armenia, Azerbaijan, Belarus, Kazakhstan, Kyrgyzstan, Moldova, Russia, Tajikistan, Turkmenistan, and Uzbekistan) and discusses their potential gaps and shortfalls. It also reviews the evolution of the Eurasian Economic Union Technical Regulation 047/2018, which is, to date, the only international document to impose binding provisions on alcohol labeling. The technical regulation's developmental process demonstrates how the comprehensive messages and strong requirements for health warnings that were suggested initially were watered down during the consultation process.

Columnar aerosol properties and radiative effects over Dushanbe, Tajikistan in Central Asia

This paper presents the results of the study on columnar aerosol optical and physical properties and radiative effects directly observed over Dushanbe, the capital city of Tajikistan, a NASA AERONET site (equipped with a CIMEL sunphotometer) in Central Asia. The average aerosol optical depth (AOD) and Ångström exponent (AE) during the observation period from July 2010 to April 2018 were found to be 0.28 ± 0.20 and 0.82 ± 0.40, respectively. The highest seasonal AOD (0.32 ± 0.24), accompanied by the lowest average AE (0.61 ± 0.25) and fine-mode fraction in AOD (0.39), was observed during summer due to the influence of coarse particles like dust from arid regions. Fine particles were found in significant amounts during winter. The 'mixed aerosol' was identified as the dominant aerosol type with presence of 'dust aerosol' during summer and autumn seasons. Aerosol properties like volume size distribution, single scattering albedo, asymmetry parameter and refractive index suggested the influence of coarse particles (during summer and autumn). Most of the air masses reaching this site transported local and regional emissions, including from beyond Central Asia, explaining the presence of various aerosol types in Dushanbe's atmosphere. The seasonal aerosol radiative forcing efficiency (ARFE) in the atmosphere was found high (>100 Wm^-2) and consistent throughout the year. Consequently, this resulted in similar seasonally coherent high atmospheric solar heating rate (HR) of 1.5 K day^-1 during summer-autumn-winter, and ca. 0.9 K day^-1 during spring season. High ARFE and HR values indicate that atmospheric aerosols could exert significant implications to regional air quality, climate and cryosphere over the central Asian region and downwind Tianshan and Himalaya-Tibetan Plateau mountain regions with sensitive ecosystems.

A problem-oriented systems approach to primary care system development: development and initial testing of the problem-oriented primary care system development record

BACKGROUND

There is significant global policy interest related to enabling a data-driven approach for evidence-based primary care system development. This paper describes the development and initial testing of a prototype tool (the Problem-Oriented Primary Care System Development Record, or PCSDR) that enables a data-driven and contextualized approach to primary care system development.

METHODS

The PCSDR is an electronic record that enables the systematic input, classification, structuring, storage, processing and analysis of different types of data related to the structure, function and performance of primary care systems over time. Data inputted into the PCSDR was coded using the WHO's PHC-IMPACT framework and classification system. The PCSDR's functionalities were tested by using a case study of primary care system development in Tajikistan.

RESULTS

Tajikistan's case study demonstrated that the PCSDR is a potentially effective and conceptually-sound tool for the input, classification, structuring and storage of different data types from myriad sources. The PCSDR is therefore a basic data entry and data management system that enables query and analytics functions for health services research and evidence-based primary care system development functions.

CONCLUSIONS

The PCSDR is a data system that enables a contextualized approach to evidence-based primary care system development. It represents a coherent and effective synthesis of the fields of primary care system development and performance assessment. The PCSDR enables analysts to leverage primary care performance assessment frameworks for a broad range of functions related to health systems analysis, improvement and the development of learning health systems.

Medical education state reform in Tajikistan: Between tradition and modernity

After its post-independence economic and social transformation, the healthcare system of Tajikistan has been shifting from a centrally planned, hospital, and specialist-focused model to a primary oriented care delivery system. Since 2010 the government of the Republic of Tajikistan has been implementing the National Health Strategy aimed at improving the population's health. Significantly reformed medical education is a major prerequisite for changing and defining a new landscape of Tajik medicine that could provide the local population with high-quality health care services. The ongoing medical education state reform involves the restructuring of undergraduate, postgraduate education, and continuing professional development programs in compliance with the recommendations of the World Medical Education Federation. This article gives a brief overview of the history and heritage of Persian-Tajik medicine and helps to retrace its evolution throughout the centuries until modern times. The authors describe the current state of the Tajik medical education system as well as the complexities and controversies, milestones, and the primary outcomes of the medical education reform implemented as part of the National Health Strategy.

Demystifying the factors associated with rural-urban gaps in severe acute malnutrition among under-five children in low- and middle-income countries: a decomposition analysis

What explains the underlying causes of rural-urban differentials in severe acute malnutrition (SAM) among under-five children is poorly exploited, operationalized, studied and understood in low- and middle-income countries (LMIC). We decomposed the rural-urban inequalities in the associated factors of SAM while controlling for individual, household, and neighbourhood factors using datasets from successive demographic and health survey conducted between 2010 and 2018 in 51 LMIC. The data consisted of 532,680 under-five children nested within 55,823 neighbourhoods across the 51 countries. We applied the Blinder-Oaxaca decomposition technique to quantify the contribution of various associated factors to the observed rural-urban disparities in SAM. In all, 69% of the children lived in rural areas, ranging from 16% in Gabon to 81% in Chad. The overall prevalence of SAM among rural children was 4.8% compared with 4.2% among urban children. SAM prevalence in rural areas was highest in Timor-Leste (11.1%) while the highest urban prevalence was in Honduras (8.5%). Nine countries had statistically significant pro-rural (significantly higher odds of SAM in rural areas) inequality while only Tajikistan and Malawi showed statistically significant pro-urban inequality (p < 0.05). Overall, neighbourhood socioeconomic status, wealth index, toilet types and sources of drinking water were the most significant contributors to pro-rural inequalities. Other contributors to the pro-rural inequalities are birth weight, maternal age and maternal education. Pro-urban inequalities were mostly affected by neighbourhood socioeconomic status and wealth index. Having SAM among under-five children was explained by the individual-, household- and neighbourhood-level factors. However, we found variations in the contributions of these factors. The rural-urban dichotomy in the prevalence of SAM was generally significant with higher odds found in the rural areas. Our findings suggest the need for urgent intervention on child nutrition in the rural areas of most LMIC.

Out of pocket expenditures of patients with a chronic condition consulting a primary care provider in Tajikistan: a cross-sectional household survey

BACKGROUND

Within its reform efforts, the Government of Tajikistan is embracing the essential role of primary health care (PHC) in decreasing out of pocket (OOP) expenditures and increasing equity in access to health services. In the light of the increasing burden of disease relating to chronic conditions, we investigated OOP expenditures of patients with chronic conditions within a PHC setting; and if and how those expenditures are impacted by several interventions currently being implemented within Tajikistan.

METHODS

A cross-sectional survey among 1600 adult patients who had visited a PHC facility was conducted. The data obtained through interviews were descriptively analysed, and logistic regressions and gamma generalized linear models were performed.

RESULTS

The total OOP expenditures related to a patient's last visit to the PHC facility were 17.2 USD for those with chronic conditions and 13.9 USD for those visiting due to an acute condition. Adjustment for potential confounders reduced the discrepancy from 3.3 USD to 0.5 USD. This convergence of costs was only observed in districts covered by the Basic Benefit Package (BBP), a governmental pilot project, aiming to standardise exemptions for payment and formal co-payments for health care services. Hence, we found the BBP to have a protective impact for patients with chronic conditions. However, considering the demographics of these patients (older in age, with greater dependency on pensions and social aid, and lower socio-economic status) in combination with the 40% higher utilisation rate of PHC and the high rate of onward referrals to specialists; it is clear that patients with chronic conditions continue to face substantial long-term costs and disadvantages.

CONCLUSIONS

After accounting for confounders, patients with chronic and acute conditions faced similar costs related to a single visit to a PHC facility in districts covered by the BBP. However, greater efforts are required to ensure that citizens are well informed about their rights to health care, the BBP and the services that should be provided at no cost at the point of delivery. Moreover, the needs of patients with chronic conditions warrant a more integrative approach that takes long-term expenditures and services beyond the level of PHC into account.

Plant response to N availability in permafrost-affected alpine wetlands in arid and semi-arid climate zones

Nutrient cycling in alpine permafrost-affected wetlands remains insufficiently studied, as it is influenced by a complex network of interrelated climatic and environmental factors, at both regional and local scale. Therefore, we applied mathematical models to examine relationship between environmental factors and plant functional traits reflecting N availability in wetland communities developed under locally variable conditions in a geographic and climatic gradient of high-altitude habitats. Moreover, we assessed impact of local differences in soil chemistry on plant fractionation of N isotopes as a response to N availability. Based on environmental data and chemistry of biomass from 192 study sites from the Pamir Mountains (Tajikistan) and Khangai and Khentei Mountains (Mongolia), a matrix of rank correlations was prepared for regional and local factors and community level plant functional traits. For the traits that were highly correlated either with regional or with local drivers (that is plant N:P ratio and plant δ¹⁵N), linear models were built, with a limited set of predictors selected according to the Risk Inflation Criterion and the SOS algorithm. The models were fitted for each of the studied regions. Presented regional models indicated significant influence of soil NH₄⁺ and/or PO₄^3- content on plant N:P ratio, which showed increase with altitude and lowering precipitation. Thus, its values clearly distinguished between the Pamir Mountains (high N:P) and the Mongolian ranges (low N:P). Models for plant δ¹⁵N showed its strong positive correlations with soil δ¹⁵N and soil salinity. Average values of plant δ¹⁵N were comparable for both study areas. The studied plant functional traits showed different response to regional and local drivers. Plant N:P ratio was controlled by regional drivers via their influence on soil NH₄⁺ content. Contrastingly, plant δ¹⁵N was significantly affected by local factors, namely soil δ¹⁵N and soil salinity expressed as Na:EC.

Actives, passives and power: heteronormative gender norms and their implications for intimate partner violence among men who have sex with men in Tajikistan

Global research reveals that gender-role norms have a profound effect on socio- and psycho-sexual expression (e.g. sexual positioning) among gay and bisexual men, which in turn may affect mental health and sexual risks. However, little is known about these factors among gay and bisexual men in Muslim-majority countries such as Tajikistan. Using a combination of in-depth individual interviews and focus-group assessments, this exploratory, qualitative study examined how gender roles might function as a social determinant for the practice of sexual positioning, which in turn may influence intimate partner violence (IPV), sexual risk and relational power. Results suggest that being the 'active' partner in sexual relationships closely aligns with the construct of hegemonic masculinity, affording actives more power in male-male relationships which may in some cases result in IPV directed against 'passives'. Despite this imbalance, passives also hold power in some cases, such as easier access to public resources such as the police and gay and bisexual focused services. Further research should examine gender norms and sexual positioning relative to IPV and sexual risks among Muslim men in Tajikistan.

How people with disabilities experience programs to prevent intimate partner violence across four countries

Women with disabilities are more vulnerable to violence, including intimate partner violence (IPV), yet the majority of emerging IPV prevention programs fail to explicitly consider the needs of participants with disabilities. Women and men living with disabilities engaged with IPV prevention programs in four countries were interviewed to explore how disability shaped their experiences of gender, violence, IPV, and whether the programs met their disability related needs. In-depth interviews were conducted with 16 women and 15 men living with disabilities in Ghana, Rwanda, Tajikistan and South Africa. The data were analysed thematically and compared across the settings. Participants described experiencing disability-related stigma, discrimination, exclusion, and for women, increased vulnerability to IPV. Barriers to full participation in programs included limited accessibility, and lack of disability-specific materials, recruitment or outreach. Enablers of inclusion included recruitment and monitoring strategies aimed at people with disabilities, partnering with a local disabled people's organization, training staff in disability inclusion, and raising awareness of disability rights. The data encouragingly suggests that inclusion of women and men with disabilities in IPV prevention programs designed for the general population has beneficial outcomes. Inclusion can prevent violence, promote their wellbeing, support economic empowerment, and challenge disability-related stigma and discrimination.

Standardized framework for evaluating costs of active case-finding programs: An analysis of two programs in Cambodia and Tajikistan

INTRODUCTION

Over the years, technological and process innovations enabled active case finding (ACF) programs to expand their capacities and scope to have evolved to close gaps in missing TB patients globally. However, with increased ACF program's operational complexity and a need for significant resource commitments, a comprehensive, transparent, and standardized approach in evaluating costs of ACF programs is needed to properly determine costs and value of ACF programs.

METHODS

Based on reviews of program activity and financial reports, multiple interviews with program managers of two TB REACH funded ACF programs deployed in Cambodia and Tajikistan, we first identified common program components, which formed the basis of the cost data collection, analysis, reporting framework. Within each program component and sub-activity group, cost data were collected and organized by relevant resource types (human resource, capital, recurrent, and overhead costs). Total shared, indirect and overhead costs were apportioned into each activity category based on direct human resource contribution (e.g. a number of staff and their relative level of effort dedicated to each program component). Capital assets were assessed specific to program components and were annualized based on their expected useful life and a 3% discount rate. All costs were assessed based on the service provider perspective and expressed in 2015 USD.

RESULTS

Over the two program years (April 2013 to December 2015), the Cambodia and Tajikistan ACF programs cumulated a total cost of $336,951 and $771,429 to screen 68,846 and 1,980,516 target population, bacteriologically test 4,589 and 19,764 presumptive TB, diagnose 731 and 2,246 TB patients in the respective programs. Recurrent costs were the largest cost components (54% and 34%) of the total costs for the respective programs and Xpert MTB/RIF (Xpert) testing incurred largest program component/activity cost for both programs. Cost per screening was $0.63 and $0.10 and cost per Xpert test was $25 and $18; Cost per TB case detected (Xpert) was $373 and $343 in Cambodia and Tajikistan.

CONCLUSIONS

Results from two contextually and programmatically different multi-component ACF programs demonstrate that our tool is fully capable of comprehensively and transparently evaluating and comparing costs of various ACF programs.

Investigations of the Atmospheric Deposition of Major and Trace Elements in Western Tajikistan by Using the Hylocomium splendens Moss as Bioindicators

The study was performed in a mountainous area of approximately 7000 sq. km of Western Tajikistan, i.e., Turkestan, Zeravshan, Hissar, and Karateghin ridges that are characterized by complex geological settings. Moss biomonitoring was used to assess the concentration level of trace and major elements in atmospheric deposition of the study area. Hylocomium splendens (Hedw.) Schimp. moss was used as biomonitor in this study. 43 major and trace-elements were determined by Epithermal Neutron Activation (ENAA) and Atomic Absorption Spectrometry (AAS). GIS maps of the 43 elements showed that the distribution of Mo, Cd, REE, Th, and U could be most probably associated with the Odjuk pegmatite field. Zr, Hf, and W contents are significantly increased in the vicinity of the Sarbo River washout while Cr, Co, Ni, and As showed a maximum content near Kanchoch gold field. The global pollution index based on the local content of presumed pollutants Cr, Ni, Cu, Zn, As, Cd, Sb, and Pb in some places exceeded the threshold limits for a pristine, unpolluted environment. At the same time, the distribution of incompatible Sc, La, Yb, and Th suggested for the airborne material deposited on mosses a continental component, enriched in few places in felsic components.

Challenges and opportunities in the continuity of care for hypertension: a mixed-methods study embedded in a primary health care intervention in Tajikistan

BACKGROUND

Hypertension, a significant risk factor for ischemic heart disease and other chronic conditions, is the third-highest cause of death and disability in Tajikistan. Thus, ensuring the early detection and appropriate management of hypertension is a core element of strategies to improve population health in Tajikistan. For a strategy to be successful, it should be informed by the causes of gaps in service delivery and feasible solutions to these challenges. The objective of this study was to undertake a systematic assessment of hypertension case detection and retention in care within Tajikistan's primary health care system, and to identify challenges and appropriate solutions.

METHODS

Our mixed methods study drew on the cascade of care framework to examine patient progression through the recommended stages of hypertension care. We triangulated data from household surveys and facility registries within Tajikistan's Health Services Improvement Project (HSIP) to describe the cascade. Focus group discussions with local HSIP stakeholders identified the barriers to and facilitators for care. Drawing on global empirical evidence on effective interventions and stakeholder judgments on the feasibility of implementation, we developed recommendations to improve hypertension service delivery that were informed by our quantitative and qualitative findings.

RESULTS

We review the results for the case detection stage of the cascade of care, which had the most significant gaps. Of the half a million people with hypertension in Khatlon and Sogd Oblasts (administrative regions), about 10% have been diagnosed in Khatlon and only 5% in Sogd. Barriers to case detection include misinformation about hypertension, ambiguous protocols, and limited delivery capacity. Solutions identified to these challenges were mobilizing faith-based organizations, scaling up screening through health caravans, task-shifting to increase provider supply, and introducing job aids for providers.

CONCLUSIONS

Translating findings on discontinuities in care for hypertension and other chronic diseases to actionable policy insights can be facilitated by collaboration with local stakeholders, triangulation of data sources, and identifying the intersection between the feasible and the effective in defining solutions to service delivery challenges.

Evaluation and pilot implementation of essential interventions for the management of hypertension and prevention of cardiovascular diseases in primary health care in the Republic of Tajikistan

Background: Non-communicable diseases (NCDs) are the leading cause of death worldwide and are a major burden in Tajikistan. The health system of Tajikistan is still shaped by the country's Soviet legacy and the pace of reform has been slow, with high patient out-of-pocket expenditure. The aim of this study is to determine the feasibility of implementing and evaluating essential interventions for the management of hypertension and prevention of cardiovascular disease in primary health care in Tajikistan. Methods and analysis: A pragmatic, sequential mixed methods explanatory design, composed of quantitative and qualitative strands will be used with greater weighting of the quantitative strand. A single geographic district was nominated by the Ministry of Health and chosen for implementation. All primary health care centres in the district that meet inclusion criteria will be included; half will be randomly assigned to the intervention arm and half to the control arm. The overall process is organized into seven steps: (1) refresh clinical decision-making tools including open source WHO PEN and HEARTS resources; (2) update training package for primary health care workers; (3) collection of baseline data; (4) training staff in intervention clinics; (5) implementation of protocols and implementation coaching; (6) collection of follow-up data after 12 months; (7) evaluation of results and sharing experience. Ethics and dissemination: Ethical review and approval have been obtained. Findings will be disseminated at the participant level, national level through a national conference of key stakeholders, and internationally through publication in an open-access peer review journal.

Chromosome Translocations as a Driver of Diversification in Mole Voles Ellobius (Rodentia, Mammalia)

The involvement of chromosome changes in the initial steps of speciation is controversial. Here we examine diversification trends within the mole voles Ellobius, a group of subterranean rodents. The first description of their chromosome variability was published almost 40 years ago. Studying the G-band structure of chromosomes in numerous individuals revealed subsequent homologous, step-by-step, Robertsonian translocations, which changed diploid numbers from 54 to 30. Here we used a molecular cytogenetic strategy which demonstrates that chromosomal translocations are not always homologous; consequently, karyotypes with the same diploid number can carry different combinations of metacentrics. We further showed that at least three chromosomal forms with 2n = 34 and distinct metacentrics inhabit the Pamir-Alay mountains. Each of these forms independently hybridized with E. tancrei, 2n = 54, forming separate hybrid zones. The chromosomal variations correlate slightly with geographic barriers. Additionally, we confirmed that the emergence of partial or monobrachial homology appeared to be a strong barrier for hybridization in nature, in contradistinction to experiments which we reported earlier. We discuss the possibility of whole arm reciprocal translocations for mole voles. Our findings suggest that chromosomal translocations lead to diversification and speciation.

Food taboos, health beliefs, and gender: understanding household food choice and nutrition in rural Tajikistan

Household nutrition is influenced by interactions between food security and local knowledge negotiated along multiple axes of power. Such processes are situated within political and economic systems from which structural inequalities are reproduced at local, national, and global scales. Health beliefs and food taboos are two manifestations that emerge within these processes that may contribute beneficial, benign, or detrimental health outcomes. This study explores the social dimensions of food taboos and health beliefs in rural Khatlon province, Tajikistan and their potential impact on household-level nutrition. Our analysis considers the current and historical and political context of Tajikistan, with particular attention directed towards evolving gender roles in the wake of mass out-migration of men from 1990 to the present. Considering the patrilieneal, patrilocal social system typical to Khatlon, focus group discussions were conducted with the primary decision-making groups of the household: in-married women, mothers-in-law, and men. During focus groups, participants discussed age- and gender-differentiated taboos that call for avoidance of several foods central to the Tajik diet during sensitive periods in the life cycle when micronutrient and energy requirements peak: infancy and early childhood (under 2 years of age), pregnancy, and lactation. Participants described dynamic and complex processes of knowledge sharing and food practices that challenge essentialist depictions of local knowledges. Our findings are useful for exploring entaglements of gender and health that play out across multiple spatial and temporal scales. While this study is situated in the context of nutrition and agriculture extension, we hope researchers and practitioners of diverse epistemologies will draw connections to diverse areas of inquiry and applications.

Implementation experiences and insights from the scale-up of an HIV assisted partner notification intervention in Central Asia

INTRODUCTION

WHO recommends assisted partner notification (APN) for people living with HIV (PLHIV). These services have not been widely scaled in Central Asia. We describe the results from an APN intervention implemented within a programme focused on PLHIV and people who inject drugs in Kazakhstan, the Kyrgyz Republic and Tajikistan.

METHODS

Routine data from index cases and their partners were analysed from equal-length periods before and after APN launch. Prior to APN index cases could recruit partners using passive referral, and under APN, had their choice of passive referral or APN (provider, contract or dual-referral). We compared the demographic characteristics of index cases and their sexual/injecting partners from the pre-APN and APN periods, described the number/proportion of HIV cases found (positivity rate) and evaluated predictors of HIV infection among partners using logistic regression.

RESULTS

Under APN 2676 PLHIV served as index cases and recruited 3735 partners for testing, compared to 4418 index cases and 2240 partners during the pre-APN period. A total of 322 (8.6%) partners were rapid test positive during APN versus 161 (7.2%, p = 0.048) before APN. Women represented 38% of APN index cases (vs. 42% pre-APN), 52% of partners tested (vs. 50% pre-APN) and 56% of all PLHIV identified (vs. 63% pre-APN). Compared to the pre-APN period, the number of partners tested per index case recruited increased (0.5 to 1.4, p < 0.001) and the number of index cases needed to find one HIV-positive partner decreased significantly (27.4 to 8.3, p < 0.001) under APN.

CONCLUSIONS

APN was feasibly integrated within a people who inject drugs and PLHIV-focused HIV programme, and was acceptable to high-risk populations in Central Asia. Under APN, large numbers of sexual and injecting partners of PLHIV - including women and non-marital partners - were tested while maintaining high positivity rates. Relative to the pre-APN period, APN approximately tripled the number of partners recruited per index case and reduced the number of index cases needed to find a positive partner by >3 times.

Informing the medical education reform in Tajikistan: evidence on the learning environment at two nursing colleges

BACKGROUND

The Tajik medical education system is undergoing a complex reform to enhance the transition of the healthcare system from its soviet legacy of emphasizing secondary level care/specialisation to become more family medicine and primary health care oriented. The current study presents the first empirical evaluation of the educational environment for nursing students in Tajikistan using the Dundee Ready Educational Environment Measure (DREEM). The study results contribute to the benchmarking efforts of monitoring and positively steering the educational environment over time.

METHOD

The study was based on a cross-sectional survey involving 630 nursing students at two nursing colleges in Tajikistan. Students' perception of the learning environment was measured using the DREEM. Internal consistency was examined using Cronbach's alpha. General scores were calculated and measured against international benchmarks. Data was further interpreted by comparing DREEM scores between students of different sex, at different colleges and different study years using T tests.

RESULTS

Cronbach's alpha ranged from 0.30 to 0.75 with an overall alpha of 0.89. General DREEM scores were slightly above average compared to similar studies with nursing students in other countries. In particular, results showed that students' academic self-perception and teachers' technical competences were generally favourably rated. Teachers' pedagogical skills were critically perceived by the study participants and teaching was generally viewed as too teacher-centred with an over-emphasis on factual learning.

CONCLUSIONS

Statistical results indicated acceptable levels of reliability of the DREEM tool when applied to the Tajik nursing educational context. Students rated the learning environment as generally satisfactory with average scores similar or slightly higher than comparable scores from similar studies involving nursing students. However, the on-going educational reform could have placed more emphasis on developing faculty pedagogical skills in nursing schools. Teaching approaches would benefit from being more competency based rather than so heavily focused on factual knowledge.

Pastoral Practices and Common Use of Pastureland: The Case of Karakul, North-Eastern Tajik Pamirs

This study describes pastoralism practiced in the Karakul village, Northeast of Tajikistan, and discusses its sustainability. Tajikistan introduced a market economy at independence in 1991, and pastoralism is now practiced on a family-unit basis. The families in Karakul graze livestock in their summer pastureland (jailoo) and move their livestock to winter pastureland around the village (kyshtoo). They make groups for pasturage with several families in jailoo and also in kyshtoo. Each group pastures their livestock every day, using a system called novad. In addition to jailoo and kyshtoo, they also practice pastoralism on two additional kinds of pastureland: küzdöö (spring pastureland) and bäärlöö (autumn pastureland). Still, now, the Karakul villagers use their pastureland as the commons: the Karakul village has not established private possession of pastureland even after a law enabled the division of common pastureland among individual families. Using the pastureland as the commons would be preferred by the local pastoralists. However, the free pasture access as the commons may result in a loss of sustainability as a trade-off. Regardless of privatization or the continued use of the commons, the possible development of the uneven use of the pastureland is inferred and should be avoided, and the introduction of a local management structure is urgently needed.

The ties that bind: Cradling in Tajikistan

A traditional childrearing practice—“gahvora” cradling—in Tajikistan and other parts of Central Asia purportedly restricts movement of infants’ body and limbs. However, the practice has been documented only informally in anecdotal reports. Thus, this study had two research questions: (1) To what extent are infants’ movements restricted in the gahvora? (2) How is time in the gahvora distributed over a 24-hour day in infants from 1–24 months of age? To answer these questions, we video-recorded 146 mothers cradling their infants and interviewed them using 24-hour time diaries to determine the distribution of time infants spent in the gahvora within a day and across age. Infants’ movements were indeed severely restricted. Although mothers showed striking uniformity in how they restricted infants’ movements, they showed large individual differences in amount and distribution of daily use. Machine learning algorithms yielded three patterns of use: day and nighttime cradling, mostly nighttime cradling, and mostly daytime cradling, suggesting multiple functions of the cradling practice. Across age, time in the gahvora decreased, yet 20% of 12- to 24-month-olds spent more than 15 hours bound in the gahvora. We discuss the challenges and benefits of cultural research, and how the discovery of new phenomena may defy Western assumptions about childrearing and development. Future work will determine whether the extent and timing of restriction impacts infants’ physical and psychological development.

Social network methods for HIV case-finding among people who inject drugs in Tajikistan

INTRODUCTION

HIV testing programmes have struggled to reach the most marginalized populations at risk for HIV. Social network methods such as respondent-driven sampling (RDS) and peer-based active case-finding (ACF) may be effective in overcoming barriers to reaching these populations. We compared the client characteristics, proportion testing HIV positive (yield), and number of new cases found through two RDS strategies and an ACF approach to HIV case-finding among people who inject drugs (PWID) in Tajikistan.

METHODS

Routine programme data from adult PWID recruited to testing under the HIV Flagship Project in Tajikistan were analysed to compare client demographic and clinical characteristics across the three approaches. We also compared the number of previously untested clients, the number of new HIV cases found, and the yield across the case-finding strategies, and evaluated predictors of new HIV diagnosis using fixed-effects logistic regression.

RESULTS

From 24 October 2016 to 30 June 2017, Flagship tested 10,300 PWID for HIV, including 2143 under RDS with unrestricted waves (RDS1, yield: 1.5%), 3517 under restricted RDS (RDS2, yield: 2.6%), and 4640 under ACF (yield: 1.5%). Clients recruited under ACF were similar in age (35.8 vs. 36.8) and gender (91% vs. 90% male) to those recruited through RDS, though ACF clients were more likely to report being a first-time tester (85.1% vs. 68.3%, p < 0.001). After controlling for age, sex, previous testing history and accounting for clustering at the site level, we found that clients tested under both RDS1 (aOR: 1.74, 95% CI: 1.04 to 2.90) and RDS2 (aOR: 1.54, 95% CI: 1.11 to 2.15) had higher odds of testing newly positive for HIV relative to clients recruited through ACF. We did not find significant differences in the odds of new HIV infection between those recruited from RDS1 versus RDS2 (aOR: 1.12, 95% CI: 0.67 to 1.86).

CONCLUSIONS

RDS-based interventions resulted in higher yields and overall case-finding, especially when recruitment was restricted. However, ACF identified a higher proportion of first-time testers. To find at least 90% of PWID living with HIV in Tajikistan, it may be necessary to implement multiple case-finding approaches concurrently to maximize testing coverage.

Panel estimation for renewable and non-renewable energy consumption, economic growth, CO2 emissions, the composite trade intensity, and financial openness of the commonwealth of independent states

This article investigates the long-run and causal linkages between economic growth, CO₂ emissions, renewable and non-renewable (fossil fuels) energy consumption, the Composite Trade Intensity (CTI) as a proxy for trade openness, and the Chinn-Ito index as a proxy for financial openness for a panel of the Commonwealth of Independent States (CIS) region including Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, Tajikistan, Turkmenistan, Ukraine, and Uzbekistan over the period of 1992-2015. It is the first time that CTI and the Chinn-Ito indexes are used in an economic-pollution model. Employing three panel unit root tests, panel cointegration estimation methods (DOLS and FMOLS), and two panel causality tests, the main empirical results provided evidence for the bidirectional long-run relationship between all the variables in all 12 sampled countries except for economic growth-renewable energy use linkage. The findings of causality tests indicated that there is a unidirectional short-run panel causality running from economic growth, financial openness, and trade openness to CO₂ emissions and from fossil fuel energy consumption to renewable energy use.

Palliative Care Development in Tajikistan

Tajikistan's health system has undergone a series of complex changes associated with reforms aimed at the transition to a more sophisticated control mechanism, financing, and operation. As in many developing countries, there is an increase in morbidity and mortality from cancer and chronic diseases, including tuberculosis and HIV. Attention is needed by the state for the development of cost-effective palliative care that will be integrated into the existing public health system. A recent palliative care country needs assessment identified the following areas of work that need to be addressed for palliative care to be implemented.

The Sodium and Potassium Content of the Most Commonly Available Street Foods in Tajikistan and Kyrgyzstan in the Context of the FEEDCities Project

This cross-sectional study is aimed at assessing sodium (Na) and potassium (K) content and the molar Na:K ratios of the most commonly available ready-to-eat street foods in Tajikistan and Kyrgyzstan. Four different samples of each of these foods were collected and 62 food categories were evaluated through bromatological analysis. Flame photometry was used to quantify sodium and potassium concentrations. The results show that home-made foods can be important sources of sodium. In particular, main dishes and sandwiches, respectively, contain more than 1400 and nearly 1000 mg Na in an average serving and provide approximately 70% and 50% of the maximum daily recommended values. Wide ranges of sodium content were found between individual samples of the same home-made food collected from different vending sites from both countries. In industrial foods, sodium contents ranged from 1 to 1511 mg/serving in Tajikistan, and from 19 to 658 mg/serving in Kyrgyzstan. Most Na:K ratios exceeded the recommended level of 1.0 and the highest ratios were found in home-made snacks (21.2) from Tajikistan and industrial beverages (16.4) from Kyrgyzstan. These findings not only improve data on the nutritional composition of foods in these countries, but may also serve as baseline information for future policies and interventions.

Monitoring of uranium concentrations in water samples collected near potentially hazardous objects in North-West Tajikistan

The water contamination near ecologically problematic objects was investigated between 2009 and 2014 in North-West Tajikistan as a part of a joint project between Forschungszentrum Jülich and Khujand State University. The main part of this work was the determination of uranium in water samples collected near the Degmay tailings dump, the Taboshar pit lake and the Syr Darya river. More than 130 water samples were collected and analyzed to monitor the uranium concentration near the investigated areas. Two different mass spectrometers and an ion chromatograph were used for element concentration measurements. Based on the results obtained, the uranium influence of the Degmay tailings on the rivers Khoja-Bakyrgan-Say and Syr Darya and surrounding water was not found. The uranium concentration in water samples was monitored for a lengthy period at seven locations Great differences in the uranium concentration in waters collected in 2010, 2011, 2012, 2013 for each location were not observed. Drinking water samples from the region of North-West Tajikistan were analyzed and compared with the World Health Organization's guidelines. Seven out of nine drinking water samples near Taboshar exceeded the WHO guideline value for uranium concentrations (30 μg/L). The average uranium concentration of water samples from Syr Darya for the period from 2009 to 2014 was determined to be 20.1 (±5.2) μg/L. The uranium contamination of the Syr Darya was determined from the western border to the eastern border and the results are shown in this paper.

Features of Pharmaceutical Compounding in the Republic of Tajikistan

Despite the deep assortment of finished pharmaceutical products and the reduction in the number of compounding and hospital pharmacies in the Republic of Tajikistan, the need for extemporal medicinal products is still preserved and remains relevant. This article discusses the practice of compounding in the Republic of Tajikistan. History, laws, limits, regulatory institutions, protocols for compounding pharmacy set up, challenges, equipment, extemporaneous formulations, quality control, and storage within regulatory framework are discussed.

Developing citizen report cards for primary health care in low and middle-income countries: Results from cognitive interviews in rural Tajikistan

Citizen report cards on health care providers have been identified as a potential means to increase citizen engagement, provider accountability and health systems performance. Research in high-income settings indicates that the wording, presentation and display of performance information are critical to achieve these goals. However, there are limited insights on developing effective report card designs for middle- and low-income settings. We conducted cognitive interviews to assess consumers’ understanding, interpretation of and preferences for displaying information for a health care report card in rural Tajikistan. We recruited a convenience sample of 40 citizens (20 women and 20 men aged 18–45) from rural areas of two provinces of Tajikistan (Soghd and Khatlon oblasts). The interview protocol was adapted from the model of cognitive interviews used in social science research to improve survey questionnaires. We used multivariate regression to assess understanding and interpretation of the report card; chi2 tests to assess differences in preferences for displaying information; and tests of proportions to assess the preferred comparison group. Respondents understood the main idea of the report card and are not confused by the indicators or display. However, many respondents had difficulties making comparisons, and when asked to identify worst-performing services. Respondents preferred detailed rankings using school grades, comparisons of their local clinic with the regional or national average performance, and the use of color in the report card. We found some heterogeneity across the two provinces. Overall, our findings are promising regarding the citizens’ comprehension of health care report cards in rural Tajikistan, while underscoring the challenges of effectively providing health care performance information to communities. Cognitive interviews and iterative testing can support an effective implementation of reporting initiatives.

A randomised controlled trial of an intervention delivered by app instant messaging to increase the acceptability of effective contraception among young people in Tajikistan: study protocol

INTRODUCTION

Women in lower income countries experience unintended pregnancies at a higher rate compared with women in higher income countries. Unintended pregnancy is associated with numerous poorer health outcomes for both women and their children. In Tajikistan, an estimated 26% of married individuals aged 15-24 years have an unmet need for contraception. The strong cultural value placed on childbearing and oppositional attitudes towards contraception are major barriers to contraceptive uptake in the country.Mobile phone ownership is widespread in Tajikistan. The option of receiving reproductive health support on your personal phone may be an appealing alternative to attending a clinic, particularly for young people. The London School of Hygiene & Tropical Medicine and the Tajik Family Planning Association have partnered to develop and evaluate a contraceptive behavioural intervention delivered by mobile phone. The intervention was developed in 2015-2016 guided by behavioural science. It consists of short instant messages sent through an app over 4 months, contains information about contraception and behaviour change methods.

METHODS AND ANALYSIS

This randomised controlled trial is designed to evaluate the effect of the intervention on self-reported acceptability of effective contraception at 4 months. 570 men and women aged 16-24 years will be allocated with a ratio of 1:1 to receive the intervention messages or the control messages about trial participation. The messages will be sent through the Tajik Family Planning Association's 'healthy lifestyles' app, which contains basic information about contraception.

ETHICS AND DISSEMINATION

The trial was granted ethical approval by the London School of Hygiene & Tropical Medicine Interventions Research Ethics Committee on 16 May 2016 and by the Tajik National Scientific and Research Centre on Paediatrics and Child Surgery on 15 April 2016. The results of the trial will be submitted for publication in peer-reviewed academic journals and disseminated to study stakeholders.

TRIAL REGISTRATION NUMBER

Clinicaltrial.gov NCT02905513.

DATE OF REGISTRATION

14 September 2016. WHO TRIAL REGISTRATION DATASET: http://apps.who.int/trialsearch/Trial2.aspx?TrialID=NCT02905513.

[POPULATION AND CLUSTER APPROACH TO ASSESSMENT OF REPRODUCTIVE HEALTH OF WOMEN]

The purpose of this study was to explore the possibility of using a population approach to assessing the risk of reproductive health disorders in women of childbearing age. We observed 240 clinically healthy women aged 20 to 43 years, half of them lived in the Middle Black Earth region of Russia, and 120 women lived in Tajikistan. The study identified population differences in women with different ethnic backgrounds and regions of residence according to a set of genetic, hormonal, and immune signs. All women underwent venous blood sampling for the purpose of HLA typing by molecular genetic analysis and determining the range of normative values ​​of hormonal and immune status parameters. DNA samples were obtained from peripheral blood lymphocytes using reagent kits and a protocol for isolating DNA from various biological materials from DLAtomTM DNAPrep 100 (Russia). Hormonal status was studied in terms of follicle-stimulating hormone, luteinizing hormone, prolactin, estradiol, progesterone, 17-OH-progesterone; Thyroid hormones - thyroid-stimulating hormone, total triiodothyronine, total thyroxine; Androgens - testosterone, dihydroepiandrosterone; Steroid hormone-cortisol. In order to exclude the variability of the data, the examination was carried out on the 3-5th days of the menstrual cycle: luteinizing hormone, follicle-stimulating hormone, estradiol, prolactin, testosterone and on the 20-22nd Day of the progesterone cycle. Statistical data processing was carried out on the basis of SPSS programs and included descriptive and comparative nonparametric statistics, discriminant, regression analysis, one - factorial analysis of variance, calculation of 95% confidence intervals, construction of ROC curves. The study included the determination of allelic variants at the three loci of the HLA-D genes (HLA-DRB1, HLA-DQA1, HLA-DQB1) controlling the immune response. Population differences in the locus of the HLA-DRB1 gene were determined. The HLA-DRB1 * 08 and HLA-DRB1 * 12 alleles are found in the Russian women's population, and the HLA-DRB1 * 04 and HLA-DRB1 * 17 alleles are more reliably detected in the Tajik women's population, while the HLA-DRB1 * 04 allele Is associated with a higher incidence of miscarriage. The population characteristics of the HLA-DQA1 gene locus were also established. In the group of women of the Russian population, the incidence of HLA-DQA1 * 0101 and HLA-DQA1 * 0103 alleles is significantly higher, of which the former is associated with protective properties for reproductive pathology, and the latter, on the contrary, with miscarriage. At the same time, the alleles HLA-DQA1 * 0201 and HLA-DQA1 * 0301 were significantly more often detected in the compared with the population of Tajik women. As in the previous case, for the HLA-DQA1 * 0201 allele reproductive health disorders are not characteristic, and in the case of the HLA-DQA1 * 0301 allele they accompany it. Our studies have revealed that there are differences between the populations of Russian and Tajik women in a number of parameters of the hormonal and immune status, as well as at the level of allelic variants of genes that control the immune response. The population approach, based on the use of discriminant analysis, is a highly effective way of grouping women according to their reproductive health status and the risk factors that caused reproductive damage. The risk factors that caused the reproductive failure are different in combination and manifestation in the populations of Russian and Tajik women, except for the adverse allelic variants of the HLA-DRB1 * 04 and HLA-DQA1 * 0103 genes, which are the same in both populations. The obtained data also show that in different populations in the evaluation of reproductive health a differentiated approach is needed both to establish physiological norms in these categories of parameters and to assess the reproductive health of women.

Residues of organochlorine pesticides in surface soil and raw foods from rural areas of the Republic of Tajikistan

The central Asian Republic of Tajikistan has been an area of extensive historical agricultural pesticide use as well as large scale burials of banned chlorinated insecticides. The current investigation was a four year study of legacy organochlorine pesticides in surface soil and raw foods in four rural areas of Tajikistan. Study areas included the pesticide burial sites of Konibodom and Vakhsh, and family farms of Garm and Chimbuloq villages. These areas were selected to represent a diversity of pesticide disposal histories and to allow assessment of local pesticide contamination in Tajikistan. Each site was visited multiple times and over 500 samples of surface soil and raw foods were collected and analyzed for twenty legacy organochlorine pesticides. Various local food products were sampled to represent the range of raw foods potentially containing residues of banned pesticides, including dairy products, meat, edible plant and cotton seed products. The pesticide analytes included DDTs (DDT, DDD, DDE), lindane isomers (α, β, γ, δ BHC), endosulfan isomers (endosulfan I, II, sulfate), other cyclodienes (aldrin, α and γ chlordanes, dieldrin, endrin, endrin aldehyde and ketone, heptachlor, heptachlor epoxide), and methoxychlor. Pesticide analytes were selected based on availability of commercial standards and known or suspected historical pesticide use and burial. Pesticide contamination was highest in soil and generally low in meat, dairy, and plant products. DDT was consistently the highest measured individual pesticide at each of the four sampling areas, along with BHC isomers and endosulfan II. Soil concentrations of pesticides were extremely heterogeneous at the Vakhsh and Konibodam disposal sites with many soil samples greater than 10 ppm. In contrast, samples from farms in Chimbuloq and Garm had low concentrations of pesticides. Pesticide contamination in raw foods was generally low, indicating minimal transfer from the pesticide sites into local food chains.