Uzbekistan is pursuing a consistent policy in promoting women’s health and preventing cancer in the Aral Sea region

Uzbekistan is pursuing a consistent policy in promoting women’s health and preventing cancer in the Aral Sea region

Strengthening the health of mothers and children has always been a priority area of reforms implemented since the first years of independence of Uzbekistan. The country has introduced a number of government programs in this area aimed at further strengthening the reproductive health of the population, protecting the health of mothers, children and adolescents.

Strengthening maternal and child health has always been a priority of the reforms implemented since the first years of independence of Uzbekistan. А number of State programs in this area have been introduced in the country, aimed at further strengthening the reproductive health of the population and protecting the health of mothers, children and adolescents.

Thanks to the highest level of attention to the health of mothers and children in our country, reproductive health services are now available to the entire population of the country and, as a result, the mortality rate of children and mothers has been reduced.

In particular, in 2017-2023, a 1.5-fold reduction in maternal mortality and a 1.3-fold reduction in infant mortality was achieved.

As a result of the implementation of measures defined by the relevant regulatory and legal documents to improve maternal and child health, as well as to further increase the effectiveness of obstetric and gynecological care services from 2017 to 2023 in the Republic:

in 209 district (urban) multidisciplinary central outpatient clinics, “Women's consultation” units, “Girls' health centers” and “Onko-nazorat” (onco-control) rooms have been set up to ensure joint activities between outpatient clinics and inpatient facilities, maternity hospitals, dispensaries and specialized centers for the prevention of reproductive health, the prevention of unwanted pregnancies and the conduct of prenatal check-ups;

inpatient pediatric gynecology units have been set up in 13 regional children's multidisciplinary medical centers and pediatric gynecology units 20 beds at the clinic of the Tashkent Pediatric Medical Institute;

a vertical structure for the pediatric gynecological service has been established;

annually, an average of 20,000 of the 6.5 million girls surveyed are diagnosed with reproductive system dysfunctions and pathologies, and receive appropriate outpatient and inpatient treatment;

an autonomous electronic database of women of fertile age and pregnant women locally attached to the region has been created in each “Women's Consultation” department;

emergency gynecology departments with 30 beds have been set up in 13 regional branches of the Republican Scientific Center for Emergency Medical Care (RSCEMC);

a universal-progressive model of patronage for pregnant women, women in labor and children has been created based on UNICEF recommendations;

assisted reproductive technologies (IVF) have been introduced in the private health sector;

2 projects are being implemented with the support of international organizations piloting different models of cervical cancer screening.

Currently, there are 15 stationary and 16 mobile offices for mammography screening in the country. In May 2021, for the first time mammographic screening was launched in the republic. Between May 2021 and 2023, 140506 women were screened (70.2% of the target group was covered).

The following were detected: 327 new cases of breast cancer, 2300 benign masses, 7097 precancerous lesions. Among the detected cases of breast cancer, 246 (80.9%) women were diagnosed at stages 1-2, and 81 (19.1%) women were diagnosed at stages 3-4.

In addition, the State has been paying a great deal of attention to improving the health of the child population. Free provision of medicines, medical devices and special food products for children suffering from rare (orphan) and other hereditary genetic diseases has been introduced, and the range of medical and social assistance provided to them has been expanded.

Children's anesthesiology and resuscitation departments and 24-hour pediatric emergency posts have been established in district (city) medical associations, and children's departments have been set up in outpatient clinics.

An additional 8,500 pediatric nurses and midwives have been assigned to more than 17,500 medical teams. Free provision of children, pregnant women and women of childbearing age with the necessary vitamin complexes, iodine, iron and folic acid preparations has been introduced.

Thus, in 2023, 8 million children aged 3 to 15, 2.2 million pregnant and lactating women were provided with iodine preparations free of charge, and 5.9 million women of childbearing age up to the age of 35 - iron and folic acid preparations.

Within the framework of the nationwide movement on proper nutrition, healthy lifestyle and physical activity of the population, the launch of which was announced by the President of the Republic of Uzbekistan at the end of 2022, the health authorities, along with local authorities, civil society institutions, non-governmental organizations and the media, have started to implement the programs “Healthy Nation” and “Healthy Family Planning”.

At the same time, the issues of forming healthy families through prevention of unwanted pregnancies, birth spacing, promotion of breastfeeding and early diagnosis of pregnancy pathologies have been prioritized.

A significant document aimed at further improving the organization of medical care, prevention and early detection of diseases among the population of the Republic of Karakalpakstan, was the decision of the President of the Republic of Uzbekistan “On further strengthening the protection of public health in the Republic of Karakalpakstan in 2022-2024”.

A document that provides for improving the quality and bringing medical services closer to the population, strengthening the material and technical base of medical services to the population, strengthening the material and technical base of the region's medical institutions The document was adopted after an open dialog between the President of the Republic of Uzbekistan and representatives of the health sector on the theme “Reforms in medicine - for the sake of human dignity” in July 2022.

This decision entrusts the Ministry of Health of the Republic of Karakalpakstan with such priority tasks as restoring the gene pool and protecting the health of the population living in the Aral Sea region, promoting a healthy lifestyle, assisting in the introduction of a culture of family health into everyday life, improving the health of the population, especially children and women, providing children, women of childbearing age, pregnant women and nursing mothers with preventive special medicines free of charge, and carrying out the following activities: (a) the development of a healthy lifestyle; (b) the promotion of a healthy lifestyle; (c) the promotion of a culture of family health in everyday life; and (d) the promotion of a culture of family health.

For example, in the Republic of Karakalpakstan in 2023, 59050 children aged 6-23 months of age were provided with micronutrient preparations, 466546 children aged 3-15 years and 68472 pregnant women and nursing mothers were provided with iodine preparations, and 356324 women of childbearing age up to 35 years were provided with iron and folic acid preparations.

Children's departments of multidisciplinary central outpatient clinics regularly conduct preventive and in-depth medical examinations of children aged 1-18 years, helminthic screening of children aged 2-10 years and hematooncological screening of children aged 3-18 years.

On the basis of the schedule of preventive medical examinations of children, a total of 664710 children aged 0 to 18 years were examined in depth during 2023, of whom 228239 were treated in outpatient and inpatient settings.

In the course of health care reforms, cancer among women requires close attention and measures aimed at early detection and prevention of premature mortality. Currently, cervical cancer is the leading cancer in the world.

Cervical cancer is the second most common type of cancer among women in Uzbekistan. In 2021, 1827 new cases were detected. Incidence and mortality rates are steadily increasing, and cervical cancer is projected to cause 2100 new cases and 1300 deaths per year by 2030.

It is necessary to widely implement screening programs for early diagnosis and timely treatment of precancerous diseases of the cervix at the level of primary health care to reduce the incidence of cervical cancer.

One of the large-scale activities was a screening program on early diagnosis and timely treatment of precancerous diseases in the Republic of Karakalpakstan with the support of the United Nations Population Fund (UNFPA) and UNDP in 2021.

The initiated pilot project on cervical cancer screening was conducted in 11 regions of the Republic of Karakalpakstan.

In the Republic of Karakalpakstan, the incidence of cervical cancer ranks second after breast cancer among the female population. In 2020, 117 women with cervical cancer were detected, 69 of them had advanced form (III-IV st.), and the number of registered women amounted to 438. The peak incidence of cervical cancer is between 40 and 44 years of age. Cervical malignancy claimed the lives of 71 women in Karakalpakstan in 2020.

Under the project, about 50000 Karakalpak women were screened free of charge, and some of them received the necessary treatment or continued with it. Detecting cervical cancer at an early stage saves women's lives - and that is why cervical cancer screening is so essential.

According to the World Health Organization, 90% of cases begin with an infection caused by some type of human papillomavirus (HPV). With early detection and proper treatment, precancerous conditions caused by HPV are completely curable; so is cancer in its early stages.

The pilot program for early detection of cervical cancer covered 50000 people in Karakalpakstan aged 30-55 years. 50000 in Karakalpakstan aged 30-55 years. In Karakalpakstan, 49140 tests were performed. 49140 tests, of which 3290 (6.8%) were positive for the presence of the virus in the body. All patients with detected pathology were referred for further consultations and treatment by narrow specialists.

237 HPV-positive women with detected minimal lesions on the cervix were treated (thermoablation or radio wave coagulation) at the outpatient clinic. 769 HPV-positive women were referred to oncology institutions, nine of whom underwent surgical treatment for cervical cancer.

The project trained 45 gynecologists, 150 family physicians, 270 patronage nurses, and 77 primary health care midwives in Karakalpakstan. They were involved in conducting HPV testing.

Handouts (leaflets, brochures) on cervical cancer prevention in Karakalpak, Uzbek and Russian languages were developed and printed to inform the population.

Also in 2021, equipment and test systems for HPV detection were received: 8 test machines and 50 thousand tests purchased by the Government of Japan were installed in 8 district multidisciplinary outpatient clinics of Karakalpakstan.

Also 3 sets of equipment for radio wave surgery were purchased and installed in two districts and Nukus city, specialists were trained to use them.

This equipment made it possible to carry out biopsy and treatment of precancerous conditions of the cervix without the risk of invasion, covering the population of nearby outpatient clinics, as well as to treat precancerous conditions of the cervix at the place of residence of women and relieve the workload of the Oncology Center.

Implementation of screening programs for early diagnosis and timely treatment of precancerous diseases based on HPV testing and timely treatment of precancerous lesions based on HPV testing have shown their effectiveness and allowed to improve the reproductive health of the female population in the Aral Sea region.

During 2023, 1454 cases of cervical cancer were detected in the country, of which 564 (38.8%) were detected as a result of preventive screening. 32804 women aged 35-65 years were screened for cervical cancer, of which 154 (0.06 %) women were diagnosed. Also 178948 women were screened for breast cancer, and 194 cases (0.1%) were diagnosed. All patients with detected pathology were referred to specialized specialists for further treatment.

It should be noted that the State Strategy of the Republic of Uzbekistan for 2030 also provides for expanding the coverage of medical care provided to women of reproductive age by detecting precancerous lesions at early stages and improving treatment results and patient survival rates.

At present, the Ministry of Health has developed a draft national strategy “Population Health - 2030” based on best international practices. One of the main directions of the national strategy “Population Health - 2030” is the protection of motherhood and childhood, meeting the needs of the population in this area, in particular:

1. Reduction in maternal mortality from 13.5 ppm to 7.1 ppm;

2. Reduction in infant mortality from 8.5 ppm to 4.3 ppm;

3. Children under 5 years of age mortality rate reduced from 11.0 ppm to 5.5 ppm;

4. Ensuring proper nutrition of children and creation of appropriate conditions by reducing stunting, underweight, reducing the share of overweight on average 2 times, etc.

The inclusion of maternal and child health issues in the strategic document is unprecedented proof of the state's attention to the issues of improving the reproductive health of the population and women's health care.