RETROSPECTIVE EPIDEMIOLOGICAL ANALYSIS OF THE INCIDENCE OF ASCARIASIS IN THE REPUBLIC OF UZBEKISTAN AND IMPROVEMENT OF PREVENTIVE MEASURES

ISSN: 2582-4686 SJIF 2021-3.261,SJIF 20222.889, 2024-6.875 ResearchBib IF: 9.948 / 2024 VOLUME-5, ISSUE-11 888 O‘ZBEKISTON RESPUBLIKASIDA ASKARIDOZ KASALLIGINING RETROSPEKTIV EPIDEMIOLOGIK TAHLILI HAMDA PROFILAKTIK CHORA – TADBIRLARNI TAKOMILLASHTIRISH Sh.M. Rasulov, A.Y. Toshpo‘latov Toshkent tibbiyot akademiyasi Termiz filiali Annotatsiya:Ushbu maqolada O‘zbekiston Respublikasida 2011 – 2021 yillardagi askaridoz kasalligining retrospektiv epidemiologiktahlili,ya’ni Respublika bo‘yicha, ma’muriy hududlar bo‘yicha hamda kasallikning yoshlar va jinslar bo‘yicha tahlili natijalaribayon qilingan. Bundan tashqari maqolada askaridoz kasalligining profilaktikasini takomillashtirish bo‘yicha takliflar ishlab chiqilgan. Kalit so‘zlar: epidemiologiya, askaridoz, geogelmint, gelmint, invaziya, retrospektiv epidemiologik tahlil, profilaktika. РЕТРОСПЕКТИВНЫЙ ЭПИДЕМИОЛОГИЧЕСКИЙ АНАЛИЗ ЗАБОЛЕВАЕМОСТИ АСКАРИДОЗОМ В РЕСПУБЛИКЕ УЗБЕКИСТАН И СОВЕРШЕНСТВОВАНИЕ ПРОФИЛАКТИЧЕСКИХ МЕР Ш.М. Расулов, А.Ю.Тошпулатов Термезский филиал Ташкентской медицинской академии Аннотация: В данной статье изложены результаты ретроспективного эпидемиологического анализа заболеваемости аскаридозом в Республике Узбекистан за 2011–2021 годы, то есть по Республике, по административным территориям, а также по возрасту и полу заболевания. Кроме того, в статье разработаны предложения по совершенствованию профилактики аскаридоза. Ключевые слова: эпидемиология, аскаридоз, геогельминт, гельминт, инвазия, ретроспективный эпидемиологический анализ, профилактика. RETROSPECTIVE EPIDEMIOLOGICAL ANALYSIS OF THE INCIDENCE OF ASCARIASIS IN THE REPUBLIC OF UZBEKISTAN AND IMPROVEMENT OF PREVENTIVE MEASURES Sh.M. Rasulov, A.Y. Tashpulatov, Termez branch of the Tashkent Medical Academy Abstract: This article presents the results of a retrospective epidemiological analysis of the incidence of ascariasis in the Republic of Uzbekistan for 2011 – 2021, that is, by Republic, by administrative territories, as well as by age and gender of the disease. In addition, the article has developed proposals to improve the prevention of ascariasis. Key words: epidemiology, ascariasis, geohelminth, helminth, invasion, retrospective epidemiological analysis, prevention. According to WHO data from March 2, 2020, more than 1.5 billion people worldwide — about 24% of the global population — are infected with soil-transmitted helminth infections. Over 267 million preschool-aged children and more than 568 million school-aged children live in areas where these parasites are highly prevalent and are in need of treatment and preventive measures [1,2,5]. Acute ascariasis infections cause nearly 60,000 deaths each year, with most fatalities occurring in children due to intestinal obstruction [6]. ISSN: 2582-4686 SJIF 2021-3.261,SJIF 20222.889, 2024-6.875 ResearchBib IF: 9.948 / 2024 VOLUME-5, ISSUE-11 889 Worldwide, 4.5 billion people are infected with helminthiases [3]. Among them, 1.269 billion have ascariasis, 932 million have ankylostomiasis, 637 million have trichocephalosis, 353 million have enterobiasis, 77 million have taeniasis, 39 million have hymenolepiasis, 15 million have diphyllobothriasis, and 10 million are infected with dracunculiasis [4,7]. Under the influence of helminths, children’s mental and physiological development is delayed, while adults experience a decline in work capacity. Helminth infections can also trigger allergic reactions, weaken the body’s resistance to infectious diseases, and reduce the effectiveness of vaccines in immunized individuals. Some helminth infections, such as echinococcosis and alveococcosis, can lead to disability and even death. The aim of the study: To investigate the modern epidemiological characteristics of ascariasis in Uzbekistan and to improve preventive measures based on these findings. Research materials: Official reports on ascariasis morbidity in Uzbekistan from 2011 to 2021 provided by the Sanitary-Epidemiological Wellbeing and Public Health Service of the Republic of Uzbekistan. Epidemiological and statistical methods were used in the study. The causative agent of ascariasis is the roundworm Ascaris. Ascariasis is a peroral geohelminthiasis and an anthroponosis. The female Ascaris measures 25–40 cm in length, while the male measures 15–25 cm. The female lays oval, membrane-covered eggs in the human intestine. Since ascariasis is a geohelminth, the initial part of the parasite’s life cycle occurs in the soil. It is important to note that the development of Ascaris in the external environment requires favorable natural conditions. Larvae begin to develop from Ascaris eggs when the external temperature is between 13–30°C. This explains why Ascaris is more common in warm and hot countries. Ascaris eggs are excreted with human feces. Using human feces as fertilizer for vegetables and fruits, and consuming them without washing, can lead to infection with ascariasis. When Ascaris eggs enter the digestive system orally, larvae hatch and enter the bloodstream. They travel through the portal vein to the liver, then via the inferior vena cava to the right heart, and from there through the pulmonary artery to the lungs. In the lungs, they reach the bronchioles and bronchi. When the person coughs, the larvae are brought up into the mouth and, if the sputum is swallowed, they re-enter the digestive system. Mature Ascaris worms can survive in the human intestine for 1–2 years, where they continue to parasitize. The epidemiological situation of ascariasis in the country cannot be considered stable. Although current control measures, the WHO-supported “Children Free from Worms” program, and medications provided through the UNICEF humanitarian system show some effectiveness, they are not sufficient. This situation is clearly indicated by the persistent annual incidence of the disease among the population, its tendency to become chronic in most cases, and the complications it causes. Epidemiological analysis methods were employed to reveal epidemiological patterns and to understand the specific characteristics of the epidemic process of a particular disease. According to the data obtained, a decreasing trend in ascariasis incidence was observed in our country between 2011 and 2021. Currently, this situation necessitates the improvement of control measures against the disease, as well as addressing issues related to early detection and treatment of ascariasis, prevention of the disease, and sanitation of its endemic areas in the future. Analysis of ascariasis cases registered in the Republic of Uzbekistan from 2011 to 2021 shows that the incidence rate per 100,000 population ranged from 4.7 to 25.2 in different years (Figure 1). As ISSN: 2582-4686 SJIF 2021-3.261,SJIF 20222.889, 2024-6.875 ResearchBib IF: 9.948 / 2024 VOLUME-5, ISSUE-11 890 seen in the figure, in the initial year of the analysis, 2011, the incidence rate of ascariasis in the country was 18.9 per 100,000 population. Over the subsequent years, the incidence trend fluctuated, reaching its highest level in 2015, with an incidence rate of 25.2 per 100,000 population. The analysis of the subsequent years showed the following incidence rates: in 2012, the rate slightly decreased to 18.6 per 100,000 population; in 2013, the incidence trend gradually increased to 19.3, and in 2014 it reached 24.2. The highest rate during the analyzed period was recorded in 2015 at 25.2 per 100,000 population. From 2016 to 2020, a declining trend in ascariasis incidence among the population was observed. The rates were as follows: 16.3 in 2016, 10.7 in 2017, 9.8 in 2018, 6.4 in 2019, and 4.7 in 2020. In the final year of the study, 2021, the incidence rate showed a slight increase compared to 2020, reaching 5.7 per 100,000 population. 18,9 18,6 19,3 24,2 25,2 16,3 10,7 9,8 6,4 4,7 5,7 0 5 10 15 20 25 30 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 Figure 1. Dynamics of ascariasis incidence in the Republic of Uzbekistan from 2011 to 2021 (100 000 aholiga nisbatan) ISSN: 2582-4686 SJIF 2021-3.261,SJIF 20222.889, 2024-6.875 ResearchBib IF: 9.948 / 2024 VOLUME-5, ISSUE-11 891 Figure 2. Average incidence rates of ascariasis by administrative regions of the Republic of Uzbekistan from 2011 to 2021 (per 100,000 population) As seen in this figure, the incidence rates of ascariasis by region were recorded as follows: Fergana – 83.3, Sirdaryo – 48.6, Surkhandarya – 39.7, Namangan – 33.8, Bukhara – 11.6, Andijan – 6.1, Navoi – 5.1, Tashkent region – 4.8, Jizzakh – 4.6, Kashkadarya – 3.5, Tashkent city – 2.2, Khorezm – 1.5, Samarkand – 1.1, and the lowest in the Republic of Karakalpakstan – 1.0 per 100,000 population. The highest incidence rates were observed in Fergana, Sirdaryo, Surkhandarya, and Namangan regions. The high prevalence in these areas is primarily due to two factors: first, the soil provides sufficient temperature conditions for the maturation of Ascaris eggs; second, a large portion of the population in these regions is engaged in agriculture, which increases direct contact with contaminated soil, the main source of infection. 0,0 10,0 20,0 30,0 40,0 50,0 60,0 70,0 80,0 90,0 2,2 6,1 11,6 4,6 3,5 5,1 33,8 1,1 39,7 48,6 4,8 83,3 1,5 1,0 ISSN: 2582-4686 SJIF 2021-3.261,SJIF 20222.889, 2024-6.875 ResearchBib IF: 9.948 / 2024 VOLUME-5, ISSUE-11 892 Figure 3. Distribution of ascariasis infection by gender in the Republic of Uzbekistan from 2011 to 2021 (in percentages) As shown in this figure, a retrospective analysis of ascariasis incidence in the Republic of Uzbekistan by gender revealed that men accounted for the majority of cases, 60.5%, while women accounted for 39.5%. The incidence among men was 1.5 times higher than among women. This is primarily explained by the fact that men are more frequently in direct contact with soil during their daily activities, such as farming, cultivating vegetables and fruits, tending field crops, and performing household and livestock work—activities that increase exposure to Ascariscontaminated soil, a key source of infection. 39,50% 60,50% Ayollar Erkaklar 77% 23% 14 yoshgacha bo‘lgan bolalar 14 yoshdan kattalar ISSN: 2582-4686 SJIF 2021-3.261,SJIF 20222.889, 2024-6.875 ResearchBib IF: 9.948 / 2024 VOLUME-5, ISSUE-11 893 Figure 4. Analysis of ascariasis infection by age groups in the population of the Republic of Uzbekistan from 2011 to 2021 (in percentages) As shown in the figure above, a retrospective analysis of ascariasis incidence in the Republic of Uzbekistan from 2011 to 2021 by age groups revealed that the majority of cases, 77%, occurred in children under 14 years of age, while the remaining 23% were observed in individuals aged 14 and older. This distribution is naturally explained by the fact that children often do not fully follow personal hygiene rules. However, the occurrence of infection among those aged 14 and above is a serious concern. This situation places a responsibility on healthcare workers not only to conduct effective sanitary and educational campaigns among the population but also to foster medical culture and awareness. Improving the population’s level of hygiene, culture, and living standards plays a crucial role in the successful implementation of preventive measures against ascariasis. To achieve this goal, the following tasks need to be carried out. • Strengthen sanitary and educational campaigns among all segments of the population, especially children; • Involve the wider community and local neighborhood activists to ensure continuous implementation of preventive measures; • Strictly adhere to personal hygiene practices; • Continuously improve the qualifications of doctors and medical personnel, including midlevel and junior staff, in the field of parasitology; • Actively identify and treat patients with ascariasis during scheduled mass screenings; • Detect patients within population groups that play a key role in the spread of the infection; • Prevent contamination of the external environment with patients’ feces and other biological excretions during treatment; • Regularly monitor soil for the risk of contamination with Ascaris eggs; • Improve access to quality drinking water and proper sanitation systems for the population; • Construct toilets in public organizations, parks, recreational areas, and boulevards according to sanitary and hygiene standards; install waste bins in every yard and ensure their regular cleaning; collect waste in special covered concrete containers and ensure timely disposal; • Wash fruits and vegetables thoroughly; maintain regular medical, sanitary, and epidemiological control of public catering facilities and their staff at least once a year. In the prevention of helminthiasis, including ascariasis, three stages are recognized. In the first stage, particular attention is focused on identifying the etiological agent of the disease and preventing its occurrence. Determining the etiological cause of helminthiasis allows for targeted etiotropic and pathogenetic treatment measures, which can achieve positive results. In the prevention of ascariasis, fostering and adhering to a healthy lifestyle is especially important. Its main directions include the health of parents, the family’s material well-being, and the level of cultural awareness. Special attention should be given to the interaction between mother and child. Timely breastfeeding of a newborn is crucial, as breast milk not only supports the child’s harmonious physiological development but also plays a key role in protecting against bacterial, viral, and other infectious diseases. Therefore, proper nutrition is particularly important in the primary prevention of helminthiasis. Achieving this goal requires ensuring that the diet contains sufficient vitamins, antioxidants, and ISSN: 2582-4686 SJIF 2021-3.261,SJIF 20222.889, 2024-6.875 ResearchBib IF: 9.948 / 2024 VOLUME-5, ISSUE-11 894 mineral elements. Proper meal organization and culinary processing of food are also essential. Special attention should be paid to the handling of vegetables, greens, and fruits to ensure safety. To prevent ascariasis and implement planned control measures, improving the quality of drinking water and adhering to sanitary and epidemiological standards is necessary. Neglecting sanitary and hygiene requirements can create favorable conditions for the widespread transmission of helminth infections, similar to infectious diseases. This risk is particularly significant for preschool institutions and other organizations caring for children. Such institutions must provide each child with a separate towel, bedding, and personal hygiene items to maintain proper hygiene standards. It is also necessary to pay attention to domestic animals, especially dogs and cats. These animals can act as hosts (sources of invasion) for helminths. Therefore, it is important to regularly monitor the health of dogs and cats, perform deworming, and vaccinate them according to epidemiological guidelines, as these measures play a crucial role in preventing the spread of helminth infections. Every child’s daily routine should include sufficient time outdoors. This ensures they receive the ultraviolet rays essential for normal growth and development. During the warm months, children spend a lot of time in nature, which increases the risk of helminth infections through contaminated water, soil, plants, and wild fruits. This risk is especially high during trips and long excursions to regions with different climatic and geographical conditions. Foundations of Secondary Prevention of Ascariasis Various methods are used for the timely diagnosis of ascariasis. These methods are applied both to the child and to the child’s family members. During periods of high ascariasis prevalence, children and adults are purposefully screened. In children, this prevalence may be slightly higher (around 6– 7%). When the infection rate exceeds 5%, mass screening of the population for helminth infections is considered appropriate. Every person infected with ascariasis should undergo deworming treatment. Deworming serves two main purposes: on one hand, it allows the treatment of individuals infected with helminths, and on the other, it enables timely implementation of preventive measures among them. Strict adherence to these measures is crucial for preventing contamination of the external environment with helminth eggs. Ascarid eggs accumulate in the environment until they mature, allowing infection foci to persist for long periods. Therefore, environmental sanitation is a critical component of ascariasis prevention. This includes proper disposal and treatment of feces, wastewater, and other waste, as well as largescale soil cleaning to eliminate helminth eggs. Currently, biological, natural, and artificial methods are used to achieve these goals. Humans are the primary source of ascariasis, and non-compliance with personal hygiene rules is the main factor in the spread of these helminth infections. Preventive measures should focus on stopping the emergence and transmission of helminths among the population. Improving personal hygiene and sanitation culture among the population, especially children, is of great importance in helminth prevention. Early diagnosis of ascariasis also requires attention to additional risk factors present in the population, which should be identified and addressed promptly. These risk factors include acute respiratory viral infections (ARVI), secondary immunodeficiency, failure to follow vaccination schedules, living in unsanitary conditions, population migration, and other similar factors. Foundations of Tertiary Prevention of Ascariasis ISSN: 2582-4686 SJIF 2021-3.261,SJIF 20222.889, 2024-6.875 ResearchBib IF: 9.948 / 2024 VOLUME-5, ISSUE-11 895 Tertiary preventive measures for ascariasis are aimed at alleviating the course of the disease, preventing it from progressing to chronic forms, and treating its complications. In this context, tertiary prevention also encompasses primary and secondary preventive measures. The basis of tertiary prevention includes maintaining a healthy lifestyle, proper nutrition, and timely implementation of vaccination programs. If patients exhibit signs of anemia, it is necessary to prescribe iron preparations, multivitamins, probiotics, and cytoprotectors. To manage allergodermatosis symptoms associated with ascariasis, the use of last-generation antihistamine medications is advisable. According to modern epidemiological standards, preventive measures against helminthiasis should be planned and implemented based on the principles of epidemiological surveillance. Observations show that epidemiological monitoring of helminthiasis in the regions where our research was conducted has significant shortcomings. From this perspective, based on our research results and to obtain complete information on helminthiasis prevalence, we propose the following directions for improving the theoretical, methodological, and organizational foundations of helminthiasis epidemiological control, in addition to existing preventive measures: • Maintaining complete registration and reporting of helminthiasis identified during current examinations, including reflecting the data in reports from both institutional and private healthcare facilities. • Continuous monitoring of the treatment and re-examination of patients identified through screening of populations belonging to high-risk groups. • Analyzing the dynamics of key socio-ecological factors that determine the epidemiological situation of helminthiasis (e.g., contamination of water, soil, fruits, and vegetables with helminth eggs, and improving the quality of such examinations). • Identifying high-risk periods, groups, regions, and factors based on analysis of helminthiasis incidence dynamics (through current and retrospective epidemiological analysis). • Evaluating the prevalence and socio-economic significance of certain helminth infections. • Organizing monitoring of implemented measures, assessing their quality and effectiveness. • Periodically predicting infection and disease incidence for certain helminthiases, including ascariasis. In conclusion, based on the results analyzed during our study, it is recommended that, in addition to existing measures for preventing ascariasis, the improved measures we propose, as well as the principles of primary, secondary, and tertiary prevention, should be utilized. It is also advisable to conduct deworming in ascariasis-endemic areas and monitor the process. Furthermore, analyzing the dynamics of key socio-ecological factors determining the epidemiological situation of ascariasis (such as contamination of water, soil, fruits, and vegetables with Ascaris eggs) and improving the quality of these assessments yields better results. References 1. Deka S, Barua D, Bahurupi Y, Kalita D. Assessment of the Prevalence of Soil-Transmitted Helminth Infections and Associated Risk Factors among School-Aged Children in a Flood-Affected Area of Northeast India. Am J Trop Med Hyg. 2021 Jul 6;105(2):480-489. 2. Ghahremani GG, Hahn ME. 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