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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 In Côte d’Ivoire, an estimated 767,000 disability-adjusted life years are due to malaria, placing the country at position number 14 with regard to the global burden of malaria. Risk maps are important to guide control interventions, and hence, the aim of this study was to predict the geographical distribution of malaria infection risk in children aged Methods Using different data sources, a systematic review was carried out to compile and geo-reference survey data on Plasmodium spp. infection prevalence in Côte d’Ivoire, focusing on children aged Plasmodium spp. infection risk for entire Côte d’Ivoire, including uncertainty. Results Overall, 235 data points at 170 unique survey locations with malaria prevalence data for individuals aged Conclusion The malaria risk map at high spatial resolution gives an important overview of the geographical distribution of the disease in Côte d’Ivoire. It is a useful tool for the national malaria control programme and can be utilized for spatial targeting of control interventions and rational resource allocation.

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.

Abstract Background Reported malaria cases in rice growing areas in western Tajikistan were at the root of a rapid appraisal of the local malaria situation in a selected agro-ecological setting where only scarce information was available. The rapid appraisal was complemented by a review of the epidemiology and control of malaria in Tajikistan and Central Asia from 1920 until today. Following a resurgence in the 1990s, malaria transmission has been reduced considerably in Tajikistan as a result of concerted efforts by the government and international agencies. The goal for 2015 is transmission interruption, with control interventions and surveillance currently concentrated in the South, where foci of Plasmodium vivax and Plasmodium falciparum persist. Methods The rapid malaria appraisal was carried out in six communities of irrigated rice cultivation during the peak of malaria transmission (August/September 2007) in western Tajikistan. In a cross-sectional survey, blood samples were taken from 363 schoolchildren and examined for Plasmodium under a light microscope. A total of 56 farmers were interviewed about agricultural activities and malaria. Potential Anopheles breeding sites were characterized using standardized procedures. A literature review on the epidemiology and control of malaria in Tajikistan was conducted. Results One case of P. vivax was detected among the 363 schoolchildren examined (0.28%). The interviewees reported to protect themselves against mosquito bites and used their own concepts on fever conditions, which do not distinguish between malaria and other diseases. Three potential malaria vectors were identified, i.e. Anopheles superpictus, Anopheles pulcherrimus and Anopheles hyrcanus in 58 of the 73 breeding sites examined (79.5%). Rice paddies, natural creeks and man-made ponds were the most important Anopheles habitats. Conclusion The presence of malaria vectors and parasite reservoirs, low awareness of, and protection against malaria in the face of population movements and inadequate surveillance may render local communities vulnerable to potential epidemics. To attain malaria transmission interruption in Tajikistan by 2015, there is a need for rigorous surveillance along with strengthening of primary health care facilities for effective case management, and possibly a more differentiated vector control strategy based on additional local evidence.

The overall aim of the Women's Wealth and Influence (WW&I) project was to improve the economic situation and empowerment of women through the formation of groups as a platform for joint activities, savings and solidarity. In 17 districts of Khatlon Province in South Tajikistan, active female community members were trained as 'coaches' and mobilised women to form some 3,000 groups with a total membership of approximately 65,000. Using mixed methods, a study was undertaken to monitor processes of change initiated by this approach. This study set out to determine the extent of change associated with the implementation over two years of the WW&I model on the lives of participating women. In particular, it examines changes and stasis in women's income and prosperity, access to and control over assets, personal empowerment as well a broader interpersonal and household change. Findings revealed that WW&I group members engaged in paid labour more frequently (20%) than non-members (12%), although the overall proportion of women involved in waged labour remained low throughout the project's lifespan. Nonetheless, savings accumulated by the women's groups provided a new means for women to access and control cash. Although there is no indication of group funds contributing to improved household wealth, there is evidence that it provided a buffer in times of acute financial stress, thereby strengthening the economic resilience of group members and their families. Group members also became more able to move freely outside their households: as only 8% had to be accompanied by a family member, compared with 15% of women who were not members of a group. Members of women's groups also reported greater decision-making power in their daily lives compared to nonmembers. Moreover, through their group actions, women exercised leadership and decision-making in two arenas: organising social events and improving community infrastructure and amenities. This, in turn, raised their reputation for solving community challenges and marks an important step towards broader female empowerment. This indicates that the WW& I approach has potential for adaptation to address broader issues of female social and economic development in rural Tajikistan. [ABSTRACT FROM AUTHOR]

Background: An estimated 2% of all deaths in Tajikistan can be attributed to diabetes but reliable data are scarce for the country and across Central Asia. We assessed the prevalence of impaired glucose tolerance and diabetes and associated predictors among residents aged ≥ 45 years in two districts in southern Tajikistan., Methods: A population-representative survey following the WHO STEPwise approach to surveillance and including a two-stage cluster sampling was conducted. Enrolled participants were asked about risk factors for diabetes, and blood pressure, height and weight were measured. The blood glucose level was determined after overnight fasting, and the 2 h oral glucose tolerance test was performed if indicated., Results: Complete datasets were available for 584 out of 672 study participants. One third of the cohort was male and half were 45-54 years old. Overall, 21.2% of the participants were found to be diabetic, 5.1% had impaired glucose tolerance and 4.3% impaired fasting glucose. An elevated body mass index ≥ 25 was observed in 61.5% of the cohort and an elevated blood pressure in 45.6% (systolic, cut-off 140 mm Hg) and 52.3% (diastolic, cut-off 90 mm Hg) respectively. Half of the participants classified as diabetic were aware of their status., Conclusions: Impaired glucose tolerance and overweight are common among elderly residents of southern Tajikistan. Primary health care services should be strengthened to improve early detection and ensure adequate treatment of diabetes and quality of care. Community-based awareness rising about available peripheral services is crucial., (© 2014 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.)