Develop management decisions aimed at preventing the development of diseases in the population of the Republic of Kazakhstan, taking into account local characteristics

Healthcare

In 2020, there were about 773 medical institutions in the republic. In accordance with preliminary data for 2020, the number of health workers in the country was about 262 thousand, including 76,443 doctors and 185,757 mid-level specialists. In 2020, there were 127,464 hospital beds.

Purpose of this study

Conduct an epidemiological cross-sectional study of the impact of socio-economic, psychosocial and behavioral factors on the health of the population of the Republic of Kazakhstan, including major chronic non-communicable diseases (NCDs) and COVID-19, followed by the development of management decisions .

Research Objectives

Collect information at the national and regional levels on major risk factors for noncommunicable diseases to inform NCD prevention and control interventions, provide a basis for further implementation and strengthen effective interventions. Relevance

Today, it is a generally recognized and indisputable fact that social and environmental factors have the greatest impact on human health, that is, diet, bad habits, regular physical activity, environmental pollution environment, occupational exposure, income level, education level, social environment, etc. influence the risk of major diseases (cardiovascular disease, oncology, diabetes mellitus II, respiratory) to a greater extent than all other factors combined. In this context, the Republic of Kazakhstan is still a "blank spot" on the global epidemiological map, especially in terms of NCD epidemiology. In our country, NCD medical statistics are based on non-standardized indicators that do not allow comparison with the indicators of other countries, as well as a correct comparative analysis of regional indicators. At the same time, morbidity rates are not very informative for NCDs, since in our country they are determined by referrals. True incidence rates should be determined as a result of national epidemiological studies, which were not regularly conducted in our country. Thus, as a result of epidemiological studies, not only true indicators of the prevalence of diseases, including COVID-19, will be obtained, but also the awareness of patients about the existing disease, treatment coverage will be studied, and the level of control of ongoing treatment will be established - the achievement of target levels. Increasing the effectiveness of disease treatment is certainly an important component of the process of improving the health of the population. However, today the World Health Organization (WHO) recommends that national health systems pay more attention to the preventive block, since in terms of the effectiveness of measures to improve public health, preventive measures occupy a leading position, due to the fact that preventive measures are less costly, and most importantly, a more effective way to achieve the main indicator of the Ministry of Health of the Republic of Kazakhstan (MZRK) - an increase in the average life expectancy of Kazakhstanis. In this regard, there is a need to make a significant number of management decisions, but given the scale and significance of the proposed activities, they need serious scientific justification through a thorough research at the national level.

Study Design

This is a cross-sectional study of risk factors for noncommunicable diseases in people aged 18 to 69 using the standardized and adapted STEPS tool in the Republic of Kazakhstan. We focus on this age range (18 to 69 years) as this is the standard age range recommended by WHO for noncommunicable disease risk factor surveys using the STEPS tool. The research will consist of three stages: 1. Preparatory stage: study protocol, study documents (informed consent, questionnaire, telephone recruitment form, standard operating procedures manuals - spirometry, glucometer, blood pressure measurement, height, weight, hip and waist circumference, heart rate measurement) will be prepared abbreviations), recruitment strategy, study plan, and obtain the necessary approvals from local authorities, health departments, partner primary care institutions, and approvals from the Local Ethics Committee. This step will take approximately 1 month. 2. Interview and physical examination phase: This phase will consist of two steps: I. Interview: A standardized and adapted STEPS questionnaire will be used, which includes

Relevance

As you know, in the Republic of Kazakhstan there are systemic problems with coding the causes of death, which not only does not allow obtaining true mortality rates and leads to incorrect management decisions, as well as the impossibility of comparability of our indicators with the corresponding international indicators. According to official statistics for the Republic of Kazakhstan, 10,000 people have died due to the COVID-19 pandemic. Also, there is data on excess mortality for this period, as in 2020 excess mortality in Kazakhstan was increased by 21% compared to the previous three years. The excess annual mortality in 2020 compared to 2019 amounted to 29,000 deaths. To obtain a true picture of the prevalence of mortality rates, we propose the use of a post-mortem audit of the causes of death through a retrospective study using the method of verbal autopsy. This methodology was applied in Russia by researchers from the University of Oxford led by the famous epidemiologist Sir Richard Peto. The results and methodology of the research are published in numerous publications in the Lancet. The COVID-19 pandemic has posed a number of important practical questions for researchers and society as a whole, such as what percentage of the population has acquired immunity after an infection, what is the pattern of the true prevalence of this infection by region and in individual population groups, what factors have determined the risk of infection. Thus, as a result of epidemiological studies, not only true indicators of the prevalence of diseases, including COVID-19, will be obtained, but also patient awareness of the existing disease, treatment coverage will be studied, and the level of control of ongoing treatment will be established - achievement of target levels. All this will be analyzed in relation to the resulting mortality rates, which will also allow conclusions to be drawn about the contribution of medical care to population health indicators. The results of the Prospective urban and rural epidemiological study PURE, published last year, completely changed the idea of ​​​​healthy nutrition, showing that it is the consumption of carbohydrates, and not fats (as previously thought), is associated with an increased risk of mortality, including from cardiovascular disease. - vascular diseases. A study conducted in Russia showed that half of the premature deaths in men in this country are due to alcohol consumption.

Purpose of this study

Development of sample design for a cross-sectional study and study of the causes of mortality in the population of the Republic of Kazakhstan.

Research Objectives

Collection of information at the national and regional levels on the main causes of death in a sample of the population of the studied cities.

Study Design

This study will be conducted using a verbal autopsy questionnaire, which was developed and reviewed in collaboration with WHO. Reliable data on levels and causes of death are cornerstones for building a strong evidence base for health policy, planning, monitoring and evaluation. The main purpose of conducting a verbal autopsy is to describe the cause of death at the population level, where civil registration and death certification systems are weak and where most people die at home without contact with the health care system. A verbal autopsy is a technique used to determine the cause of death based on interviews with immediate family members or others. The interview is conducted using a standardized questionnaire that provides information about signs, symptoms, medical history, and circumstances prior to death. The cause of death, or sequence of causes leading to death, is assigned based on the data collected through the verbal autopsy questionnaire and any other information available. Rules and guidelines, algorithms, or computer programs can help interpret the information collected through the verbal autopsy questionnaire to determine the cause of death. The standard verbal autopsy tool includes a verbal autopsy questionnaire, a list of causes of death or a classification system for mortality, and sets of diagnostic criteria (either expert or data-driven algorithms) to determine the causes of death. An interviewer guide that explains the meaning and importance of each indicator and how to ask each question included in the 2016 WHO IA tool is available on the WHO website: www.who.int/healthinfo/statistics/verbalautopsystandards .

Sample size: • randomized representative

Healthcare

According to the Declaration of Alma-Ata, primary health care (hereinafter referred to as PHC) is a central function of national health systems and is an integral part of the ongoing process of health care, which includes prevention, promotion , treatment and rehabilitation, and the overall social and economic development of the community, including collaboration with other sectors to promote social development and address the social determinants of health. Health assessments are typically structured screening and assessment tools used in PHC practice to help the healthcare team and the patient develop a plan of care. Health assessment information can also help the healthcare team understand the needs of its general population and patients. Health assessments may vary by time and volume. High-quality PHC systems can improve health outcomes, improve health equity and optimize the efficient use of resources. Since the formation of the sovereign Republic of Kazakhstan, a significant number of important PHC reforms have taken place. However, all these reforms were aimed at developing uniform national standards for a typical polyclinic. Nevertheless, today it is obvious that when solving certain problems, an approach is needed that takes into account the local characteristics of a particular settlement. Today in the Republic of Kazakhstan, the number of necessary specialists in medical organizations, the number of purchased medicines and medical devices, the number and type of equipment are dictated solely by staff standards based on the number of attached population. Thus, the real (local) need is not taken into account, which depends on many factors such as: logistical features, the level of medical literacy of the population, the level of qualification of medical personnel, the degree of effectiveness of PHC management, gender and age structure and, in general, the incidence pattern. In addition, the COVID-19 epidemic posed a number of new challenges for PHC organizations, including the readiness of the system in terms of infection control, infection prevention, active case detection and provision of medical care to patients with COVID-19, as well as other patients at high epidemiological risk. COVID-19. The essence of this subtask is to determine the real need and develop such management decisions as: adjusting the quantitative and qualitative composition of doctors; adjusting the volumes and types of purchased medicines and medical devices; re-equipment with equipment and transport or their reduction and relocation to other outpatient clinics that are in greater need; systems for classifying patients according to the degree of their epidemiological danger, adjusting the organization's management system; weekly (monthly, semi-annual) advanced training courses for medical personnel; raising public awareness on PHC issues, etc. The purpose of this study

Identification of the real need and development of such managerial decisions as: adjustment of the quantitative and qualitative composition of doctors; adjusting the volumes and types of purchased medicines and medical devices; re-equipment with equipment and transport or their reduction and relocation to other outpatient clinics that are in greater need; systems for classifying patients according to the degree of their epidemiological danger, adjusting the organization's management system; weekly (monthly, semi-annual) advanced training courses for medical personnel; raising awareness of the population on PHC issues, etc.

Research Objectives

1. Develop management decisions aimed at preventing the development of diseases in the population of the Republic of Kazakhstan, taking into account local characteristics; 1.2. Conducting a study of the effectiveness of the work of the primary link at all levels of the provision of medical and preventive care in the Republic of Kazakhstan with the subsequent development of management decisions. 1.2.1. Development, testing of a questionnaire for - patients on dispensary records, as well as their family members, and the population who applied to PHC, - PHC employees (doctors and nurses), - health managers. 1.2.2. Development and testing of evaluation sheets and indicators for the evaluation of PHC. 1.2.3. Training of representatives of the regions on the use and conduct of the survey. 1.2.4. Conducting a survey, collecting data on scorecards and indicators, drawing conclusions and recommendations 1.2.5. Write a research report

Scientific novelty: 1. For the first time, a survey will be conducted on original questionnaires based on met

Relevance

Today, in the Republic of Kazakhstan, the impact of environmental objects on the health of the population is assessed according to hygienic standards (maximum concentration limit, maximum concentration limit, footwear), most of which were developed back in the middle of the 20th century and mainly experimental method on animals. The vast majority of these standards have not been revised since Soviet times, as a result of which today Kazakhstanis drink water and breathe air, the quality of which is normalized by outdated hygienic standards. Today, in OECD countries, the impact of environmental objects on public health is assessed using the health risk assessment methodology. This methodology is fundamentally different from the sanitary and epidemiological surveillance practiced throughout the post-Soviet space. The main difference is an individualized science-based approach to each specific source of pollution based on reference doses and concentrations, regularly reviewed as new information becomes available (results of observational studies, man-made disasters, etc.). The application of this methodology unifies the system of management technologies in the field of assessing the quality of the human environment and will ensure the harmonization of domestic hygiene standards with international safe exposure levels against the backdrop of increasing integration processes around the world. The essence of this subtask is to obtain a real picture of the impact of industrial facilities, vehicles and water supply systems on the health of the population of each specific city and regional center of the Republic of Kazakhstan using the health risk assessment methodology. As part of this work, for the first time, levels of carcinogenic and non-carcinogenic risks to the health of the population living throughout the Republic of Kazakhstan from exposure to priority chemicals contained in the atmospheric air and drinking water will be established. As a result of the research, a real picture of the impact of industrial facilities of the 1st hazard class, vehicles and water supply systems on the health of the population of each specific city and regional center of the Republic of Kazakhstan will be determined. The main factors affecting the health of the population, as well as the degree of influence and causes of these factors will be identified. The territories of all regions of the Republic of Kazakhstan will be ranked according to the degree of acceptability of integral risks to public health using GIS technology (mapping). Further, specific measures will be proposed to eliminate or reduce the impact of the identified factors on the health of the population of each specific city and regional center of the Republic of Kazakhstan, taking into account their local characteristics: including regulatory ones), stimulating specific private industrial facilities for such modernization; a science-based program to combat air pollution of the air basin of settlements of the Republic of Kazakhstan, including a phased strengthening of requirements for vehicles with internal combustion engines, improvement of the system for monitoring such requirements, a system for controlling the entry of vehicles into large cities from satellite cities, measures for point screening of specific areas highways; installation of additional purification systems at specific water intake points or installation of additional filters on specific mains of water supply systems or their replacement.

Purpose of this study

Assessment of the risk to the health of the population of the Republic of Kazakhstan from industrial facilities of hazard class I, vehicles and water supply systems. Research objectives

1. Data collection of 7 industrial facilities of hazard class I. 2. Risk assessment and development of management decisions for 7 industrial facilities of the 1st hazard class. 3. Collection of data on the state of the air basin of 19 cities of the Republic of Kazakhstan. 4. Collection of data on the state of drinking water in 38 cities of the Republic of Kazakhstan. 5. Risk assessment and development of management decisions for 19 cities of the Republic of Kazakhstan in terms of improving the air quality of these settlements 6. Risk assessment and development of management decisions for 38 cities of the Republic of Kazakhstan in terms of improving the quality of drinking water in these settlements

Study Design

Sample size: • 7 industrial facilities of the 1st hazard class for studying air quality; • 3 cities of republican significance, 14 regional centers and 2 cities of regional significance to study air quality; • 38 cities to study water quality. Research methods: • Methodology for public health risk assessment (WHO); • Simulation of scattering you