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The Enhancing Primary Health Care Services project supported the Ministry of Health and Social Protection in nine pilot health districts in Tajikistan to strengthen family medicine-oriented primary health care services. The project actively involved the community in this process by implementing a participatory health business planning process and health promotion approach. This study evaluated the degree of communities' involvement in health planning processes and its effect on the population's health literacy regarding risk factors of cardiovascular disease. The mixed-method longitudinal cross-sectional study design included a repeated community-based survey targeting Community Health Team representatives on their involvement in health business planning and health promotion activities and a health literacy survey on knowledge and behavior related to cardiovascular disease and risk factors among adults. The studies were conducted in four project districts in 2015 (only health literacy survey), 2017 and 2020, whereby rural communities were selected and then repeatedly visited. In each community, three community health team representatives were interviewed and 20 eligible adult women and men from randomly selected households. A total of 121 community health team representatives from 40 communities participated in the health business planning and health promotion surveys in 2017, and 154 from 55 communities in 2020. We analyzed complete data from 1,183 adult women and men from 60 communities participating in the health literacy surveys in 2015, 1,418 from 71 communities in 2017, and 1,111 from 55 communities in 2020. We found that the health business planning and promotion approach fostered the collaboration between the primary health care services, community authorities and the population through actively involving community health team representatives in these processes. The population's overall knowledge of cardiovascular risk factors rated as 'good' increased from 31% in the baseline to 46% in the endline. The respondent's belief that changing their lifestyle affects their health increased from 60% to 86%, respectively. The health business planning and health literacy approaches empowered communities to successfully shape health planning by putting forward their health needs. This contributed to increasing people's trust in primary health care services and enhanced the primary health care team's accountability for progress towards the communities. [ABSTRACT FROM AUTHOR]

Abstract Background Intestinal parasitic infections represent a public health problem in Tajikistan, but epidemiological evidence is scarce. The present study aimed at assessing the extent of helminths and intestinal protozoa infections among children of 10 schools in four districts of Tajikistan, and to make recommendations for control. Methods A cross-sectional survey was carried out in early 2009. All children attending grades 2 and 3 (age: 7-11 years) from 10 randomly selected schools were invited to provide a stool sample and interviewed about sanitary situation and hygiene behaviour. A questionnaire pertaining to demographic and socioeconomic characteristics was addressed to the heads of households. On the spot, stool samples were subjected to duplicate Kato-Katz thick smear examination for helminth diagnosis. Additionally, 1-2 g of stool was fixed in sodium acetate-acetic acid-formalin, transferred to a specialised laboratory in Europe and examined for helminths and intestinal protozoa. The composite results from both methods served as diagnostic 'gold' standard. Results Out of 623 registered children, 602 participated in our survey. The overall prevalence of infection with helminths and pathogenic intestinal protozoa was 32.0% and 47.1%, respectively. There was pronounced spatial heterogeneity. The most common helminth species was Hymenolepis nana (25.8%), whereas the prevalences of Ascaris lumbricoides, hookworm and Enterobius vermicularis were below 5%. The prevalence of pathogenic intestinal protozoa, namely Giardia intestinalis and Entamoeba histolytica/E. dispar was 26.4% and 25.9%, respectively. Almost half of the households draw drinking water from unimproved sources, such as irrigation canals, rivers and unprotected wells. Sanitary facilities were pit latrines, mostly private, and a few shared with neighbours. The use of public tap/standpipe as a source of drinking water emerged as a protective factor for G. intestinalis infection. Protected spring water reduced the risk of infection with E. histolytica/E. dispar and H. nana. Conclusions Our data obtained from the ecological 'lowland' areas in Tajikistan call for school-based deworming (recommended drugs: albendazole and metronidazole), combined with hygiene promotion and improved sanitation. Further investigations are needed to determine whether H. nana represents a public health problem.