Chronic respiratory disease (CRD) is a silent, ongoing pandemic. It disproportionally affects low-resource settings. Tobacco smoke and kitchen smoke (caused by the use of solid fuels and... Show moreChronic respiratory disease (CRD) is a silent, ongoing pandemic. It disproportionally affects low-resource settings. Tobacco smoke and kitchen smoke (caused by the use of solid fuels and inefficient stoves) are major risk factors. Evidence-based solutions to CRD often fail to be effective, as they misalign with local needs and then fail to be implemented. This thesis focused on how lung health solutions can be implemented successfully by capitalising on the local needs.Within the Horizon2020 FRESH AIR implementation research project, we first studied local settings in Kyrgyzstan, Uganda, Greece, and Vietnam. For example, we found that COPD in the highlands of Kyrgyzstan occurred three times more frequently than in the lowlands, partly due to higher levels of kitchen smoke. We discovered the high indirect burden of asthma and COPD, by their impact on work- and daily activities. We also found that many communities and their health workers mistook CRD for infectious disease like tuberculosis. Based on these findings and on implementation literature, we then designed several practical tools addressing critical factors for implementation success of lung health interventions. These evidence-based tools can facilitate implementation success, thereby optimising the use of already scarce resources and benefitting health outcomes. Show less
Tabyshova, A.; Estebesova, B.; Beishenbekova, A.; Sooronbaev, T.; Brakema, E.A.; Chavannes, N.H.; ... ; J.F.M. van boven 2021
Background: COPD prevalence and mortality in Kyrgyzstan are high. Data on clinical and economic impact of COPD in Kyrgyzstan are scarce. This study was part of the FRESH AIR research project that... Show moreBackground: COPD prevalence and mortality in Kyrgyzstan are high. Data on clinical and economic impact of COPD in Kyrgyzstan are scarce. This study was part of the FRESH AIR research project that focused on prevention, diagnosis and treatment of chronic lung diseases in low-resource settings.Aim: We aimed to evaluate the clinical characteristics, treatment patterns and economic burden of COPD in Kyrgyzstan.Methods: A representative sample of patients with a spirometry-confirmed diagnosis of COPD was included. All patients were registered in one of the five major hospitals in Kyrgyzstan. Patients were surveyed on COPD risk factors, health-care utilization and patient reported outcomes (CCQ, MRC). Associations with high symptom burden (MRC score >= 4) and cost were assessed using logistic regression analyses.Results: A total of 306 patients were included with mean age 62.1 (SD: 11.2), 61.4% being male, mean BMI 26.9 (SD: 5.2) and mean monthly income $85.1 (SD: 75.4). Biomass was used for heating and cooking by 71.2% and 52.0%. Current and ex-smokers accounted 14.1% and 32%. Mean FEV1 was 46% (SD: 12.8), 71.9% had COPD GOLD III-IV and most frequent co-morbidities were hypertension (25.2%), diabetes (5.6%) and heart diseases (4.6%). Mean CCQ score was 2.0 (SD: 0.9) and MRC score 3.7 (SD: 0.9). Yearly mean number of hospital days due to COPD was 10.1 (SD: 3.9). Total annual per-patient costs of reimbursed health-care utilization ($107) and co-payments ($224, ie, 22% of patients' annual income) were $331. We found that only GOLD IV and hypertension were significantly associated with high symptom burden. Exacerbations and hypertension were significantly associated with high cost.Conclusion: The clinical and economic burden of COPD on patients and the government in Kyrgyzstan is considerable. Notably, almost half of interviewed patients were current or exsmokers and biomass exposure was high. Show less
Soap operas draw at least part of their success from their clever use of platitudes that may or may not be taken seriously by viewers. In this article, the author focuses on Clone, a Brazilian show... Show moreSoap operas draw at least part of their success from their clever use of platitudes that may or may not be taken seriously by viewers. In this article, the author focuses on Clone, a Brazilian show in which Muslims are depicted in classic, and blunt, stereotypical fashion. While travelling from its intended audience in Brazil to unanticipated, but equally excited, audiences in Kyrgyzstan the soap opera obtained interesting new meanings. Ironically, the stereotypical images contributed positively to local debates on what it means to be Muslim. Show less
Who of you is fasting?', I asked the thirteen students who took my course 'Introduction to Islam'. One single hand at the back of the classroom was raised. This course was part of an exchange... Show moreWho of you is fasting?', I asked the thirteen students who took my course 'Introduction to Islam'. One single hand at the back of the classroom was raised. This course was part of an exchange programme that sends European teachers to post-Soviet republics, and I had come to Kyrgyzstan's capital, Bishkek, in order to teach some courses in social anthropology for one semester. This particular course was attended by students of sociology, political science, and ethnology, who referred to themselves as Muslims. And yet, their formal knowledge of Islam was minimal. I suppose nobody can blame them for this, as they have grown up in a society that has previously been declared 'atheist' and is nowadays considered to be secular. For me, as their teacher - from Europe and a Christian - realizing that I knew a lot more about 'their' religion than they did was extremely awkward. Show less
