Assessment of Health Status and Risk Factors Among Students Based on Population Morbidity Trends in the Southern Region of Kyrgyzstan

Бюллетень науки и практики / Bulletin of Science and Practice

UDC 614.2:314.1:378(575.2-22)                   

The study of population health status and morbidity patterns is one of the key priorities of modern public health, as it reflects the overall socio-economic development of a country and the effectiveness of its healthcare system. In recent years, significant changes in demographic processes, lifestyle factors, and environmental conditions have been observed in many regions, including the southern part of the Kyrgyz Republic. These changes are accompanied by a growing burden of disease, shifts in morbidity structure, and alterations in the general health profile of different population groups.

Nowadays, one of the global issues of public education and health policy is protecting and improving the younger generation's health. The relationship between the health of individuals and the well-being of society as a whole is a fundamental principle of public health. It is believed that the deterioration of socio-economic conditions in societies, the negative impact of environmental, sanitary, and epidemiological factors, food safety, and lack of good quality drinking water have led to the rapid spread of socially significant both non-infectious and infectious diseases among a vast population, including student youth as one of the vulnerable population groups [1-4]. The reforming of health care in the Kyrgyz Republic in recent years has led to the destruction of the system of dispensary observation of university students and a reduction in the number of preventive examinations of students [5, 6]. In this regard, the study of health and morbidity of the population, including students, is relevant not only for public health but also for the state, which can serve as a basis for policy development and prioritization in the system of protection of public health in general.

The Osh, Jalal-Abad, and Batken regions are characterized by specific demographic and socioeconomic conditions that directly influence public health indicators. In particular, trends such as a decline in birth rates, fluctuations in natural population growth, and a relatively stable mortality rate indicate the need for a detailed and systematic analysis of health dynamics. At the same time, the increasing prevalence of chronic diseases and general morbidity highlights the importance of identifying underlying determinants and risk factors.

Despite the importance of these issues, comprehensive studies combining both population-level medical and demographic indicators with an in-depth assessment of student health in the southern regions of Kyrgyzstan remain limited. Therefore, there is a clear need for an integrated approach that allows for the evaluation of both macro-level demographic trends and micro-level health characteristics.

In this context, the present study aims to provide a descriptive analysis of morbidity and health status in the Osh, Jalal-Abad, and Batken regions, as well as to assess the physical development and health characteristics of students at Osh State University. The findings are expected to contribute to a better understanding of regional health challenges and to support the development of targeted preventive and health-promoting strategies.

The purpose of this study is to analyze the medical and demographic indicators and general morbidity of the population of Osh, Jalal-Abad and Batken regions of the Kyrgyz Republic to assess the health status of students studying at Osh State University as one of the major educational institutions of the country.

Research materials and methods

The materials for the study were the official statistical reports of the Ministry of Health of the Kyrgyz Republic, "Public health and health care in the Kyrgyz Republic" for 2019-2023. Annual reports of Osh city and Osh region medical and preventive care institutions for 2021-2023.The results of preventive medical examinations and assessment of physical development of students of Osh State University. Epidemiological, analytical, and statistical methods of research were used. An in-depth medical examination was carried out to assess the morbidity rate, covering 439 students of 1-3 courses. The physical development of students was evaluated using somatotopic, somatometric, and psychometric methods.

The indicators of general morbidity of the population per 100,0 thousand people, general morbidity of students per 1000 people, and the structure of the most common diseases (in %) were calculated. Processing and analysis of the obtained materials were carried out on a computer using Epi-Info programs.

Results and discussion

More than 6 thousand students’ study at the medical faculty of Osh State University, the majority (85-90%) of whom are residents of Osh, Jalal-Abad, and Batken regions of the Kyrgyz Republic. In this regard, when studying student’s health status, there was a need to analyses the medical and social indicators, structure, and general morbidity of the population of Osh, Jalal-Abad, and Batken regions of the Kyrgyz Republic. Table 1 presents a comparative characterization of medical and demographic indicators of the population of Osh, Jalal-Abad, and Batken region of the Kyrgyz Republic for 2019 and 2023 years.

Table 1 shows that 2023 the total fertility rate averaged 21.5 newborns per 1,000 inhabitants, slightly lower than in 2019 (26.9). The highest rate was observed in Osh City (34.6 registered newborns per 1,000 inhabitants) and Batken regions (24.2).

Table 1

MEDICAL AND DEMOGRAPHIC INDICATORS OF THE POPULATION OF OSH, JALALABAD, AND BATKEN REGIONS OF THE KYRGYZ REPUBLIC FOR 2019 AND 2022 (per 1000 population)

Indicators      By the Kyrgyz                   Name of regions and cities

Republic         Оsh         Оsh       Jalal-Abad     Batken

	2019	2023	2019	2023	2019	2023	2019	2023	2019	2023
Fertility rate	26.9	21.5	44.5	34.6	26.1	20.6	26.3	21.7	29.1	24.1
Natural increase of population	21.7	17.0	39.2	30.3	21.8	16.8	21.7	17.5	21.7	17.0
Mortality rate	5.2	4.5	5.3	4.3	4.3	3.8	4.6	4.2	5.2	4.5

As an essential component of natural reproduction of the population mortality in2023, 31.4 thousand deaths were registered, 8.1 thousand deaths or 20.5% less than in 2021 (39.5 thousand deaths). The indicator of total mortality of the population of Kyrgyzstan in 2023 decreased and amounted to 4.5 deaths per 1,000 population (2019 - 5.2). Every year, the most significant impact on the change in total mortality is caused by circulatory diseases, which account for more than half of deaths. (52.1% of the total number of deaths in 2023). In 2023, there was a decrease in the number of deaths due to this cause by 3.5 thousand people, or 17.7%, compared to 2019. The second-ranked causes of total mortality are neoplasms (12.2% of the total number of deaths in 2023). A significant share in the structure of causes of death is occupied by unnatural causes (injuries, poisoning and some other consequences of external causes — 8.0% of the total number of deaths in 2023).

Respiratory diseases (4.7% of the total number of deaths in 2023) and digestive diseases (4.2% of the total number of deaths in 2023) follow the structure of causes of death. As before, the highest level of total mortality is observed in Jalal-Abad (4.2), Batken (4.5) regions and Osh city (4.3 per 1000 population). There was a slight decrease in the natural population growth rate to 17.0 in 2023, compared to 21.7 in 2019 per 1000 population. against 21.7 in 2019 per 1000 population. The same situation of this indicator in all southern regions of the country.

Morbidity is one of the critical indicators characterising the state of public health. The general morbidity of the population is the result of the interaction of severalfactors. It depends on the availability and quality of medical care, the adequacy of its reflection in accounting and reporting documentation, the population's age structure and medical activity, and the development of theoretical ideas and practical capabilities of medicine, which are presented in Table 2.

Table 2

GENERAL MORBIDITY OF THE POPULATION (ADULTS AND ADOLESCENTS) IN OSH, JALALABAD, AND BATKEN REGION OF THE KYRGYZ REPUBLIC FOR 2019 AND 2023, %

Names of administrative regions	2019		2023
	Abs.number	per 100,000 population	Abs.number	per 100,000 population
Jalal-Abad region	104642	12882.8	125425	15447.6
Batken region	39708	11499.5	49618	14188.4
Osh region	82484	9386.7	93437	10331.6
Total in the Kyrgyz Republic	669817	31666.1	743942	32445.4

The presented table 2 shows that the level of general morbidity of the population in the republic in 2023 increased slightly and amounted to 32445.4 against 31666.1 in 2019 (+2.5%), the increase in the general morbidity of the population in 2023 compared to 2019 is observed in all regions of the country, except city Osh, where a decrease in this indicator by 27.4% was noted. In 2023, compared to 2019, the structure of causes of morbidity of the population has not changed much, Table 3. Thus, in the structure of causes of morbidity of adults and adolescents in the republic, the leading place was occupied by diseases of the respiratory system (28.6%), digestive organs (13.3%), genitourinary system (10.4%), diseases of the eye (7.2%), diseases of the circulatory system (4.5%), nervous system (3.3%), diseases of the endocrine system (1.9%). Injuries account for 6.4%. A similar tendency in the structure of morbidity is observed among the population of the southern regions of the republic. The analysis revealed a negative tendency in the change of the leading medical and demographic indicators. Thus, over the last ten years in the southern regions, the socio-demographic situation has changed significantly in particular, the population has increased, and there has been an overload of the infrastructure of urban settlements due to the growth of migration processes.

Table 3

STRUCTURE OF MORBIDITY BY MAIN CLASSES, ADULTS AND ADOLESCENTS IN OSH, JALAL-ABAD, AND BATKEN REGIONS OF THE KYRGYZ REPUBLIC for 2019 and 2023, %

Disease class ICD-10	By Republic		Name of regions and cities
			Jalal-Abad		Оsh		Batken		Osh city
	2019	2023	2019	2023	2019	2023	2019	2023	2019	2023
Respiratory diseases	22.3	28.6	18.2	24.8	15.8	17.2	17.9	18.4	20.7	23.1
Genitourinary diseases	10.6	9.4	12.5	10.2	12.2	11.8	7.8	12.2	6.9	6.9
Digestive diseases	13.3	11.4	6.3	4.4	7.3	5.3	10.3	8.1	10.3	3.8
Injuries, poisoning and some other consequences of external causes of everything	7.6	6.4	5.9	4.8	4.8	4.3	7.7	6.1	3.1	3.2
Diseases of the eye and its appendages	7.2	7.1	6.7	6.9	10.9	10.7	7.7	12.4	13.7	19.2
Circulatory diseases	6.5	4.5	7.7	5.6	10.9	7.5	12.8	8.1	8.2	7.6
Diseases of the skin and subcutaneous tissue	4.4	4.3	5.5	6.4	4.8	4.3	5.1	8.1	2.4	1.9
Some infectious and parasitic diseases	3.2	3.8	3.8	4.0	3.6	3.7	5.1	6.1	1.9	1.9
Diseases of the nervous system	3.3	3.3	4.8	4.7	4.3	7.5	5.1	4.1	10.4	7.7
Diseases of the ear and mastoid process	3.3	3.0	3.6	3.7	3.6	3.2	5.4	4.1	3.4	3.9
Diseases of the endocrine system	2.2	1.9	1.9	1.6	3.6	2.1	1.8	1.4	3.1	3.4
Diseases of blood, hematopoietic organs	2.0	1.8	2.9	2.9	3.6	3.2	2.7	3.0	2.8	3.1
Others	14.1	14.5	21.1	20.0	11.7	19.2	10.6	7.9	13.1	14.3
Total in the Kyrgyz Republic	100.0	100.0	100.0	100.0	100.0	100.0	100.0	100.0	100.0	100.0

During the observation period, the growth of the presented indicators is probably connected with the introduction of family medicine in the practice of health care, but the increased influence of socio-economic reasons is not excluded. Despite this, the simultaneous growth of mortality rates allows us to think about the presence of undetected morbidity accordingly, the hidden need for medical care.

In order to objectively assess the somatic health of students, we analyzed the morbidity of students based on medical examination. An in-depth analysis of students' health status revealed a significant spread of deviations in the state of health and reduced somatic health indicators. The study of students' morbidity revealed a wide range of diseases in Table 4.

Table 4 INDICATORS OF MORBIDITY OF EXAMINED STUDENTS FOR 2022 PER 1000 EXAMINED, n =439

Disease class ICD-10	Абс. число	Показатель на 1000 осмотренных	Заболеваемость, %
Respiratorydiseases	124	284.7	21.2
Genitourinarydiseases	25	56.9	4.2
Digestivediseases	122	255.5	20.8
Injuries and all poisonings	15	34.2	2.5
Diseases of the eye and its appendages	65	148.1	11.1
Circulatorydiseases	35	79.7	5.9
Diseases of the skin and subcutaneous tissue	59	134.4	10.1
Some infectious and parasitic diseases	64	77.4	10.9
Diseases of the nervous system	26	59.2	4.4
Diseases of the ear and mastoid process	12	27.3	2.0
Diseases of the endocrine system	9	20.5	1.5
Diseases of blood, hematopoietic organs	4	9.1	0.7
Others	26	59.2	4.4

As seen from Table 4, in the structure of morbidity of the surveyed students, the leading place in the structure of morbidity is occupied by respiratory diseases (284.7 per 1000 students) due to acute respiratory viral infections, tonsillitis, adenoids and others. The second place among the indicators of student morbidity is occupied by diseases of digestive organs (255.5). These are most often gastritis, duodenitis, etc. Eye diseases (148.1) and skin diseases (134.4) are essential next.

The increase in the number of students suffering from various pathologies reflects the general tendency to increase this pathology among the population.

The level of physical development is one of the integral indicators of the state of health of the young generation. Based on the obtained indicators, we calculated several indices that allow us to carry out a comparative assessment of students' physical health level in the Table 5.

	Table 5 DISTRIBUTION OF STUDENTS BY BODY TYPE
	'^ Со                     Bodytypes                                          Kettle index ^ ®    Asthenic.      Normostenic   Hyperstenic    retardation      (<23)        (>23) i      n     %    n    %    n    %   n    %   n    %   n.    %
I	137     82      59.9    43    31.4    12     8.7    112   81.8   131   95.6    6    137
II	75      39     52.0    20    26.7    16    21.3   59   78.7   61   81.3    14    75
III	64      17     26.6    28    43.8    19    29.6   38   59.4   46   71.9   18    64
Total	276     38      0.0    91    32.9    47    17.1   209   75.7   238   86.2   38   13.8

Table 5 shows that the predominant number of students have an asthenic type of physique: in first-year students, it was observed in 59.9% of cases; in second-year students - in 52.0%; in third-year students - in 26.6%. It should be noted that a significant number of the examined students have a pronounced deficit of body weight, mainly due to reduced muscle mass. When calculating the Kettle index, it was revealed that 86.2% of students have a body mass deficit. Thus, in 95.6% of first-year students, this index was registered at < 20 units; body mass deficiency in students of 2-3 courses amounted to 81.3% and 71.9%.

Dynamometry indicators obtained during the examination also indicate a decrease and weakening of muscle strength. Extremely low results were obtained in first-year students, 16.1% of cases; second-year students were registered at 11.6%, and third-year students, 5.5% of cases. Below average, dynamometry indicators were found in 66.2% of first-year students, 66.7% of second-year students, and 74.5% of third-year students. Unfortunately, the study's estimation results of the vital capacity of the lungs (VCL) were not high enough. According to spirometry data, the vital capacity of the lungs (up to 2000 ml) was revealed in the first-year students at 11,5%, in the second year at 14,5%, and in the third year at 9,1%. Average indicators of vital capacity of lungs demonstrated: 66,9% of the first-year students, 63,8% of the second-year students, and 70,9% of the third-year students.

Thus, the increase in morbidity among students is undoubtedly dependent on the presence of risk factors for the development of chronic non-communicable diseases, which are quite common among students. Monitoring of risk factors is essential for health promotion programs. It allows us to identify the most significant risk factors and changes in their importance in implementing preventive programs. In implementing preventative measures, there are two main directions of action - the formation of a healthy lifestyle and early diagnosis of non-communicable diseases, as well as risk factors for their development, followed by timely correction.

The implemented dynamic monitoring and control of the main physiological parameters provided objective information about the student's health levels. The assessment of the structure and level of morbidity will allow the development of scientifically-based recommendations for improving and organizing medical and social assistance to students of higher educational institutions.

Выводы

Thus, the medical and demographic situation in the southern regions of the Kyrgyz Republic for the period 2019-2022 is characterized by an increase in the general morbidity of the population, a decrease in the birth rate and natural population growth with stabilization of the general mortality rate of the population. Analysis of the health status of students indicates a significant prevalence of deviations in the state of health and a decrease in the leading indicators of somatic health. The increase in morbidity among students undoubtedly depends on the presence of risk factors for the development of chronic non-infectious diseases, which are quite common among students. In implementing preventive measures, it is necessary to identify two main directions of action - the formation of a healthy lifestyle for students and early diagnosis of chronic diseases, as well as risk factors for their development with the subsequent timely correction. Given the unfavorable health level of student youth, it is essential to create an optimum level of health care for them.