Primary healthcare played a crucial role during the COVID-19 pandemic by preventing, timely diagnosing, and referring severe cases to hospitals, as well as monitoring and counseling patients via telemedicine. We used a cross-sectional approach to analyze the severity outcomes of 174,540 COVID-19 cases treated in primary care in Almaty between 2021 and 2022, by age, sex, disease severity, and comorbidities. Outpatients with COVID-19 were mainly aged 30–39 (20.3%) with a mild course (88.9%). Among adults, females predominated (≥ 60–25.5% vs. 19.2%, < 0.001), and among children (0–17), boys − 21.2% vs. 12.1% (p < 0.001). A higher risk for moderate to severe COVID-19 and adverse outcomes was assessed among older adults, particularly those aged 60 and older compared with younger groups (OR = 9.01, 95% CI: 7.72–10.51). Pregnant women had a low risk of severe disease (OR = 0.5, 95% CI: 0.38–0.65). Patients with concomitant disease were at higher likelihood of severe COVID-19 (p < 0.001, OR = 2.51, 95% CI: 1.9–3.15 for obesity, p < 0.001, OR = 1.43, 95% CI: 1.27–1.6 for diabetes mellitus, OR = 1.16, 95% CI: 1.07–1.26 for arterial hypertension, and p < 0.001, OR = 2.5, 95% CI: 2.13–3.02 for chronic obstructive pulmonary disease). The study emphasizes an often-overlooked impact of COVID-19 on primary care, which is essential for improving outpatient care.

Background: In 2023, tuberculosis (TB) caused 1.25 million deaths globally, remaining a leading infectious killer. Central Asia and Southern Caucasus face high TB burdens, particularly Mongolia. This review synthesizes TB prevalence data and diagnostic capabilities in these regions to support public health strategies. Methods: This systematic review aimed to synthesize current data on TB prevalence in Central Asia, Southern Caucasus, and Mongolia to support public health strategies and research priorities. A comprehensive search of PubMed and Google Scholar was conducted for English-language articles published up to 2023. Studies were assessed using a modified Newcastle–Ottawa Scale. Nine studies met the inclusion criteria, covering Kazakhstan, Kyrgyzstan, Uzbekistan, Tajikistan, Turkmenistan, Mongolia, Georgia, Armenia, and Azerbaijan. Results: TB incidence ranged from 67 per 100,000 in Kazakhstan to 190 per 100,000 in Kyrgyzstan, with the highest prevalence of 68.5% in Mongolia. TB affected men more frequently (65.3%), and the key risk factors included HIV (30.5%), comorbidities, and undernutrition. Diagnostic performance varied significantly (microscopy sensitivity, 45–65%; GeneXpert MTB/RIF, 89–96% sensitivity and 98% specificity for rifampicin resistance). Diagnostic turnaround times ranged from hours (molecular) to weeks (conventional). Only 58% of TB facilities had GeneXpert technology, with urban–rural disparities in diagnostic access. Drug-resistant TB imposed a significant economic burden, with treatment costs ranging from USD 106 to USD 3125. Conclusions: Strengthening surveillance, improving data collection, and conducting longitudinal studies are essential for designing effective TB control strategies in these regions. Significant diagnostic gaps persist across these regions, especially with regard to drug-resistant strains. Point-of-care molecular diagnostics, improved algorithms, and expanded laboratory training show promise. Future research should focus on rapid biomarker-based diagnostics, field-deployable technologies for settings with limited resources, and AI integration to enhance diagnostic accuracy and efficiency.

Background/objectives: During the COVID-19 pandemic, primary health care systems worldwide adapted to manage cases in outpatient settings, including those involving children. The aim of this study was to investigate the epidemiological characteristics of 27,205 outpatient COVID-19 cases among children (0–17 years) in Almaty, Kazakhstan, from 1 January 2021 to 31 December 2022, compared with major epidemiological events and public health measures.Methods: A cross-sectional analysis was conducted to assess the likelihood of hospitalization regarding demographic characteristics, concomitant diseases, the severity of COVID-19 course, as well as the dynamic of cases.Results: The majority of children (99.3%) were asymptomatic or mild. Children in the younger age group (0–4) had a higher risk of severe course and hospitalization compared with adolescents aged 15–17 years. Sex and chronic diseases (diabetes mellitus, obesity and chronic obstructive pulmonary disease) did not demonstrate statistical significance. The longest spike in outpatient COVID-19 cases in children coincided with the circulation of Delta and Eta strains, the highest with Omicron.Conclusion: Among outpatient COVID-19 cases in children, the likelihood of severe forms and hospitalization is higher if the child is under 5 years of age.

Background and Objectives: The study aimed at identification and analysis of adverse COVID-19 outcomes (admission to intensive care units due to COVID-19, acute respiratory distress syndrome, mechanical ventilation, and death) among hospitalized pregnant and nonpregnant women, which are critical for informed decision-making in obstetric diagnostics and healthcare. Materials and Methods: This was a retrospective observational study conducted on a series of inpatient pregnant women comparatively followed up with nonpregnant women hospitalized between 15 July 2020 to 20 January 2022 across multidisciplinary hospitals in three cities of Kazakhstan. Following group matching with propensity score for COVID-19 disease severity, residence status, and age, the study ultimately included 156 participants, of whom 50% were pregnant, from an initial sample of 314 female inpatients diagnosed with COVID-19. All findings were considered statistically significant at a p-value < 0.05. Results: Laboratory investigations revealed significantly elevated levels of erythrocyte sedimentation rate, creatinine, neutrophils, platelet count, alanine aminotransferase, aspartate aminotransferase, lymphocyte count, and C-reactive protein in pregnant inpatients compared to nonpregnant inpatients. Furthermore, pregnant women exhibited significantly higher levels of D-dimer (2402.97 ng/mL vs. 793.91 ng/mL) and procalcitonin (0.398 ng/mL vs. 0.134 ng/mL) compared to their nonpregnant counterparts. Overall, 16.88% of the pregnant women were admitted to the intensive care unit, whereas among the nonpregnant women, only 2.6% were hospitalized. The most lethal outcomes (8.3%) occurred among pregnant women, while for nonpregnant women, there were two cases (1.3%). Conclusions: Pregnant women diagnosed with COVID-19 may exhibit more severe clinical symptoms and encounter more adverse outcomes compared to their nonpregnant counterparts. Future research should incorporate larger matched samples to comprehensively explore the association between additional factors and clinical conditions.

In 2023, tuberculosis (TB) caused an estimated 1.25 million deaths globally, including 161,000 among people with HIV. After being temporarily surpassed by COVID-19, TB has likely returned as the leading cause of death from a single infectious agent. Central Asia and the Southern Caucasus remain high-burden regions, with Mongolia showing the highest TB prevalence. This systematic review aimed to synthesize current data on TB prevalence in Central Asia, Southern Caucasus, and Mongolia to support public health strategies and research priorities. A comprehensive search of PubMed and Google Scholar was conducted for English-language articles published up to 2023. Studies were assessed using a modified Newcastle-Ottawa Scale. Nine studies met inclusion criteria, covering Kazakhstan, Kyrgyzstan, Uzbekistan, Tajikistan, Turkmenistan, Mongolia, Georgia, Armenia, and Azerbaijan. TB incidence ranged from 67 per 100,000 in Kazakhstan to 190 per 100,000 in Kyrgyzstan, with a prevalence of 68.5% in Mongolia. TB affected men more frequently (65.3%), with key risk factors including HIV (30.5%), comorbidities, and undernutrition. Drug-resistant TB imposed a significant economic burden, with treatment costs ranging from $106 to $3,125. Strengthening surveillance, improving data collection, and conducting longitudinal studies are essential for designing effective TB control strategies in these regions.

Background: The global pandemic COVID-19 presented a serious burden on primary health care. We analyzed the association between the age, sex, and comorbidity on the severity and outcomes of COVID-19 in outpatient care in Almaty, Kazakhstan, between 1.1.2021 to 31.12.2022. Methods: We assessed Odds ratio and 95% Confidence interval (OR, 95% CI) in a retrospective analysis of data on 174.540 COVID-19 patients on outpatient follow-up collected from an primary care electronic database (108,234 women and 66,306 man). Among outpatients 88.9% (n = 155,127) had mild disease, 8.3% (n = 14,537) asymptomatic; and moderate/severe disease was observed in 2.8% of cases. Results: Among the COVID-19 outpatients, the incidence of diabetes mellitus was significantly higher in women (3.1%) then man (2.4%) (p < 0.001), obesity was more common in women (0.6%) than in men (0.4) (p < 0.05), and arterial hypertension was more common in men (10%) versus women (6.2%) (p < 0.001). The probability of developing moderate/severe disease increased significantly with age, especially in those 60 years and older, where it was 9 times higher (p < 0.001, OR = 9.01, 95% CI: 7.7-10.5), and where the probability of lethal outcome was very high (OR = 61.8, 95% CI: 8.5-446.2, p < 0.001) too. The odds of developing moderate/severe COVID-19 were 1.4 times higher in patients with diabetes mellitus (p < 0.001, OR = 1.43, 95% CI: 1.27-1.6), 2.5 times higher in obese patients (p < 0.001, OR = 2.51, 95% CI: 1.9-3.15), and in patients with chronic obstructive pulmonary disease (p < 0.001, OR = 2.5, 95% CI: 2.13-3.02), and the presence of arterial hypertension increased the risk 1.2-fold (p < 0.001, OR = 1.16, 95% CI: 1.07-1.26). Conclusions: In Almaty outpatients, an association between the moderate and severe COVID-19 and age and comorbidity (diabetes mellitus, obesity, arterial hypertension, and COPD) was found, which underscores the necessity of more research on primary care organization and delivery in health emergencies. Key messages: • An increase of severe COVID-19 in elder outpatients and with comorbidity emphasizes the need for their effective protection. • The research on the impact of various factors on the disease severity and outcomes in outpatients can assist in optimizing primary care.