Parental attitudes, beliefs and behaviors toward childhood and COVID-19 vaccines: A countrywide survey conducted in Kazakhstan examining vaccine refusal and hesitancy

Background: Vaccination rates worldwide have declined in recent years. This decrease is primarily driven by vaccine hesitancy, which remains understudied in Central Asia, including Kazakhstan. Furthermore, there is great concern about parental hesitancy toward COVID-19 vaccines, as previous studies have focused on adult vaccine hesitancy. The current study was conducted by UNICEF and funded by USAID to explore the drivers of routine and COVID-19 immunization behaviors among parents and caregivers in Kazakhstan. Methods: Using a cross-sectional methodology, researchers conducted 3081 face-to-face interviews with parents and caregivers of children aged 0–17 years across cities and villages in Kazakhstan. A tablet-based questionnaire (CAPI) was utilized, collecting participants’ data on sociodemographic characteristics, childhood and COVID-19 vaccination behaviors, and potential drivers. Results: Total of 239 participants (7.8%) were found to previously refuse vaccination due to their own beliefs. Stronger belief that vaccines are efficacious (AdjOR = 0.47), stronger belief that childhood vaccines are safe and danger of vaccine-preventable diseases is high (AdjOR = 0.73), firmer trust in societal factors (AdjOR = 0.77) and positive attitudes of family members toward immunization (AdjOR = 0.6) were significantly associated with parental refusal of childhood vaccines. The large proportion of respondents (N = 2,634, 85.6%) missed the COVID-19 vaccination of their child or were unwilling to get vaccinated. Stronger belief that COVID-19 vaccines are safe and efficacious (AdjsOR = 0.18), lacking important information about COVID-19 vaccines (AdjOR = 1.25) and parents being unvaccinated against COVID-19 (AdjOR = 2.3) were significant predictors of vaccine hesitancy. Conclusion: This study revealed numerous socio-demographic and behavioral factors significantly associated with parental refusal of childhood vaccines and hesitancy toward COVID-19 vaccines. Many parents not refusing vaccination possessed negative attitudes towards vaccines. Potential changes in their attitudes and beliefs of parents were observed compared to findings from pre-COVID era. Continuous monitoring of parental hesitancy, proper interventions and education of healthcare workers are suggested to reduce parental vaccine hesitancy

Knowledge and attitudes towards ambulatory treatment of tuberculоsis in Kazakhstan

Background Ambulatory based treatment of tuberculosis has been recently introduced in Kazakhstan. We sought to assess the attitudes of the general population, TB patients and their household members towards ambulatory TB treatment and identify how knowledge of TB is associated with these attitudes. Methods New pulmonary TB cases and their household and community controls were recruited from three regions of Kazakhstan in 2012–2014. 1083 participants completed audio computer-assisted self interviews to assess their knowledge of TB and attitudes towards ambulatory care. Mixed effects logistic regression models were used to identify factors associated with attitudes toward ambulatory TB treatment. Results The proportion of people who considered ambulatory TB treatment as appropriate was very low (24.9%). Positive attitudes towards ambulatory TB treatment were significantly associated with region of residence, higher level of education, family support and experience with TB. The association between sufficient tuberculosis knowledge and favorable attitude toward ambulatory treatment was stronger among community controls compared to TB patients and their family members. Conclusions This study provides insight into attitudes toward ambulatory TB treatment among different groups and the specific influence of TB knowledge on these attitudes. Our findings can inform the process of integration of new TB treatment strategies and the development of appropriate education and advocacy programs in the general population

Implications of Mobility Patterns and HIV Risks for HIV Prevention Among Migrant Market Vendors in Kazakhstan

Objectives. We examined the relationships between mobility characteristics and sexual risk behaviors among male and female migrant market vendors in Almaty, Kazakhstan. Methods. Participants completed a structured interview covering sociodemographics, mobility characteristics, sexual behaviors, and biomarkers for HIV, HCV, and syphilis. We used multivariate analyses to examine associations between mobility patterns and HIV risks after adjusting for sociodemographics. Results. Longer duration of a participant's last trip outside Almaty increased the odds of reporting multiple sexual partners. More frequent travel to visit family or friends was associated with multiple sexual partners and unprotected sex with steady partners. More frequent travel to buy goods in the past year was associated with multiple sexual partners. Men who traveled more often to buy goods were more likely to have purchased sex within the previous 90 days. Conclusions. Relationships between mobility patterns and sexual risk behaviors underscore the need for HIV-prevention strategies targeting the specific transmission dynamics that migrant vendors are likely to present

Identifying risk factors associated with smear positivity of pulmonary tuberculosis in Kazakhstan

Background Sputum smear-positive tuberculosis (TB) patients have a high risk of transmission and are of great epidemiological and infection control significance. Little is known about the smearpositive populations in high TB burden regions, such as Kazakhstan. The objective of this study is to characterize the smear-positive population in Kazakhstan and identify associated modifiable risk factors. Methods Data on incident TB cases’ (identified between April 2012 and March 2014) socio-demographic, risk behavior, and comorbidity characteristics were collected in four regions of Kazakhstan through structured survey and medical record review. We used multivariable logistic regression to determine factors associated with smear positivity. Results Of the total sample, 193 (34.3%) of the 562 study participants tested smear-positive. In the final adjusted multivariable logistic regression model, sex (adjusted odds ratio (aOR) = 2.0, 95% CI:1.3–3.1, p < 0.01), incarceration (aOR = 3.6, 95% CI:1.2–11.1, p = 0.03), alcohol dependence (aOR = 2.6, 95% CI:1.2–5.7, p = 0.02), diabetes (aOR = 5.0, 95% CI:2.4–10.7, p < 0.01), and physician access (aOR = 2.7, 95% CI:1.3–5.5p < 0.01) were associated with smear-positivity. Conclusions Incarceration, alcohol dependence, diabetes, and physician access are associated with smear positivity among incident TB cases in Kazakhstan. To stem the TB epidemic, screening, treatment and prevention policies should address these factors

Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

© The Author(s) 2018. Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries(1,2). However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world(3) and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health(4,5). However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular riskchanged from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.Peer reviewe

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

Two Countries, Five Years: Islam in Kazakhstan and Kyrgyzstan through the Lens of Public Opinion Surveys

Drawing on two waves of public opinion surveys conducted in Kazakhstan and Kyrgyzstan, we investigate the rise in religiosity and orthodoxy among Central Asian Muslims. We confirm that a religious revival is underway, with nearly 100 percent of Kazakhstani and Kyrgyzstani Muslims self-identifying as such in 2012—up from 80 percent in Kazakhstan in 2007. If we dig a bit deeper, however, we observe cross-national variations. Religious practice, as measured by daily prayer and weekly mosque attendance, is up in Kyrgyzstan, but has fallen in Kazakhstan. While the share of those who express preferences associated with religious orthodoxy has grown in both, this group has more than doubled in Kazakhstan. We attribute these differences to political context, both in terms of cross-national political variation and, within each country, variation based on regional differences

The effects of COVID-19 severity on health status in Kazakhstan: A prospective cohort study /

On May 5, 2023, the World Health Organization announced the end of the coronavirus pandemic. Nonetheless, there are growing reports indicating that individuals who have contracted COVID-19, especially in its more severe manifestations, may endure medium-to long-term impacts of the condition. The purpose of this study was to investigate the impact of the severity of COVID-19 on the subsequent health outcomes. Methods The prospective cohort study ran from March to October of 2021.482 study participants were divided into two cohorts: the first cohort encompassed 118 individuals who received hospital care, while the second cohort included 364 individuals receiving outpatient care. Propensity Score Analysis was used as the probability of being hospitalized for COVID-19 in logistic regression as a covariate, to account for the influence of intervening factors that were associated with the probability of being hospitalized for COVID-19. The odds ratio (OR) was the association metric that was applied. Results Patients with more severe COVID-19 are more prone to infectious and parasitic diseases ORadj 6.61 (with 95 % CI 1.84–23.75), p = 0.004, more likely to show complications from the respiratory system ORadj 2.37 (with 95 % CI 1.35–4.16), p = 0.003, more frequently diagnosed eye pathologies ORadj 5.60 (with 95 % CI 1.96–15.98), p = 0.001, susceptible to hospitalization, ORadj 3.49 (1.78–6.84), p < 0.001. Conclusion Our study's findings indicate that patient with more severe COVID-19 have a higher requirement for medical attention regardless of other factors that influence the need for medical care