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Spatial Distribution and Trends of 
Waterborne Diseases in Tashkent 
Province 

 
Veluswami Saravanan 
Subramanian1, Min Jung Cho1, 
Siwei Zoe Tan1, Dilorom 
Fayzieva2, Christian Sebaly1 
 
1Department of political and cultural 
change, Center for Development 
Research, University of Bonn, Germany; 
2Research Institute of Irrigation and 
Water Problems, Tashkent, Uzbekistan  
 
 
 
 

 
Vol. 6, No. 1 (2017)   |   ISSN 2166-7403 (online)  
DOI 10.5195/cajgh.2017.277 |   http://cajgh.pitt.edu 

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of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 
 

Central Asian Journal of Global Health 
Volume 6, No. 1 (2017) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2017.277|http://cajgh.pitt.edu 

 
 

Abstract 

Introduction: The cumulative effect of limited investment in public water systems, inadequate public health infrastructure, and 
gaps in infectious disease prevention increased the incidence of waterborne diseases in Uzbekistan. The objectives of this study 
were: (1) to spatially analyze the distribution of the diseases in Tashkent Province, (2) to identify the intensity of spatial trends in 
the province, (3) to identify urban-rural characteristics of the disease distribution, and (4) to identify the differences in disease 
incidence between pediatric and adult populations of the province.  
Methods: Data on four major waterborne diseases and socio-demographics factors were collected in Tashkent Province from 2011 
to 2014. Descriptive epidemiological methods and spatial-temporal methods were used to investigate the distribution and trends, 
and to identify waterborne diseases hotspots and vulnerable population groups in the province.  
Results: Hepatitis A and enterobiasis had a high incidence in most of Tashkent Province, with higher incidences in the eastern and 
western districts. Residents of rural areas, including children, were found to be more vulnerable to the waterborne diseases 
compared to other populations living in the province. 
Conclusions: This pilot study calls for more scientific investigations of waterborne diseases and their effect on public health in the 
region, which could facilitate targeted public health interventions in vulnerable regions of Uzbekistan.  

Keywords: Spatiotemporal analysis; Environmental health; Tashkent Province; Uzbekistan; Central Asia 

 
Spatial Distribution and Trends of 
Waterborne Diseases in Tashkent 
Province 

 
Veluswami Subramanian 
Saravanan1, Minjung Cho1, Siwei Zoe 
Tan1, Dilorom Fayzieva2, Christian 
Sebaly1 
 
1Center for Development Research,  
University of Bonn, Bonn, Germany; 
2Research Institute of Irrigation and Water 
Problems, Tashkent, Uzbekistan 

 
 
 
 

 

Research 

Developing countries with inefficient public 
health infrastructure, such as those in Central Asia, 
struggle to address public health challenges1. One of the 
major challenges in the region is access to clean drinking 
water and sanitation with the urban population having 
better access to drinking water and sanitation compared 
to their rural counterparts2. Due to a lack of funds 
dedicated to public health programs, insufficient 
institutional infrastructure, and inadequate technical 
expertise, the water utility companies are primarily 
carrying out emergency repairs rather than renovations, 
placing the health of Central Asian people at risk. 
Waterborne diseases caused by microbiological 
contaminants and pathogens – such as intestinal 
infections, typhoid3, intestinal parasites4, 5, and viral 
hepatitis6 – are commonly reported health problems in 
Central Asian countries7.  

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CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH 
 

 

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While waterborne diseases are an established 
health threat in the region, there is a lack of studies that 
examine the spatial-temporal variation of these 
conditions8. Several published reports suggested the 
importance of access to safe water supply, environment, 
and sanitation for children’s health in Central Asian 
countries4, 9, 10. The WHO reports that diarrhea is the 
leading cause of death among children under 5 in this 
region9, 11, 12, and this figure ranges from 4-5% in 
Kazakhstan and Kyrgyzstan to 9-10% in Tajikistan, 
Turkmenistan, and Uzbekistan13-17. Rotavirus infections, 
which cause severe gastroenteritis in children, lead to the 
death of 886 children annually in Kazakhstan, 
Kyrgyzstan, and Uzbekistan, suggesting that 1 in 1153 
children in these Central Asian states is vulnerable to 
rotavirus-related death before the age of 510. Intestinal 

parasitic infections (including helminths and intestinal 
protozoa) are also a public health problem that appears to 
disproportionately affect school-age children4.  These 
studies have highlighted issues at the national level8, 18, 19, 
but there have been few investigations at the sub-national 
level, and in particular at the provincial level.  

Water quality is a concern in Uzbekistan20 as 
over half of the population does not have access to a 
piped water supply21 and relies on various sources of 
water, including outside taps, water pumps in the yard, 
and public standpipes19. The quality of water is further 
degraded by pollution from domestic waste, organic 
matter, mineral fertilizers, pesticides, and industrial 
waste, which has a considerable effect on human health19

, 
22.  Furthermore, the industrial sector in Uzbekistan 
withdraws about 1.2 km3 of water annually, and almost 

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half of this volume is returned as industrial wastewater 
that poses a serious threat to the quality of drinking water 
sources23.  

Tashkent Province is in the north-eastern part of 
the country, between the Syr Darya River and the Tian 
Shan Mountains. It has an area of 15,300 km², and as of 
2014, has a population of 2,644,400 people, which is 
about 10 % of the total population of Uzbekistan. The 
province includes five towns (Figure 1) and, excluding 
Tashkent City, which is governed as an independent 
administrative unit, is divided into fifteen administrative 
units called districts. Despite proximity to the capital, 
only about 82% of the population in the province had 
access to a piped water supply as of 200524, which is a 
marginal increase from 79% in 2000. Only about 70% of 
the population had access to sewage systems, septic 
tanks, or other hygienic sanitation and sewage disposal 
systems.  

This exploratory study utilizes the available 
social and demographic information to identify hotspots 
in the distribution of waterborne diseases in Tashkent 
Province, Uzbekistan. This province was selected for the 
study due to its proximity to the capital city and due to 
the accessibility of information. We examined four of the 
most prevalent waterborne diseases (enterobiasis, acute 
intestinal infections, hepatitis A, and dysentery) and 
explored their spatial distributions and trends, focusing 
on identifying patterns in rural vs. urban populations as 
well as in pediatric vs. adult cases.  

 

Methods 

This paper uses statistical information for Tashkent 
Province for 2011-2014 to carry out spatial distributions 
of four waterborne diseases (thematic maps) and to 
analyze their spatial-temporal trends. The socio-
demographic information for the country was based on a 
sampling of 10% of the population, rather than the 
traditional census data due to absence of recent census 
data. The last census was undertaken in 1989 under the 

Soviet period and results were published in 199025. A 
census was planned for 2000 but has been postponed due 
to financial constraints. 

The health-related statistical data was obtained 
from the Republican Centre for Sanitary-
Epidemiological Surveillance (CSES) in Tashkent 
Province. The CSES is a surveillance system that has 
been in operation since the Soviet period26, and collects 
cases of infectious diseases with the help of physicians 
and healthcare workers in a standardized format that 
includes basic information about the patients, such as 
name, age, birthdate, sex, address, primary diagnosis, 
date of diagnosis, and date of hospitalization27. Within 12 
hours of diagnosis, all suspected or confirmed cases are 
reported via telephone (followed up by a written report) 
to the district (smallest administrative unit, called 
Tuman) CSES, which is then forwarded to the provincial 
(called Viloyat) CSES27.  

The district-level socio-demographic information 
was available for the following categories: total 
population, children under 14 years of age, and urban and 
rural classification. These were used to calculate the 
incidence rates in the province and its urban-rural 
divisions. The total population of children under 14 years 
of age was available only for 2014; therefore, the year 
2014 was used as a basis to calculate the incidence rates 
among children.  

The district-level CSES obtains additional cases of 
infectious diseases from clinical, laboratory, and 
epidemiological information within 24 hours in order to 
properly respond to a potential outbreak27. A separate 
case report form was prepared by Tuman CSES to 
summarize the epidemiological work as well as the 
information collected27, 28. The district pools monthly 
data from both the provincial and national levels27.  The 
incidence rates for the urban, rural, and total population 
were calculated for the districts in Tashkent Province for 
the years 2011, 2012, 2013, and 2014, and spatially 
mapped. Pediatric population data were not available for 
urban and rural populations as separate categories27.  

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CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH 
 

 

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The base map for Tashkent Province was created 
using the Open-Street Map29 and Esri/DeLorme30. Using 
this base map, thematic maps were prepared for each 
disease to identify spatial-temporal characteristics in 
their distribution. The districts’ yearly incidence rates for 
2011 to 2014 were displayed as grouped bar charts, while 
the average incidence rates of the individual infections 
are symbolized by the red-color gradation. Those values 
were generated using the equal interval classification 
scheme of ArcMap, which divides the given range of 
attribute values into equal-sized subranges. In order to 
emphasize the amount of an attribute value relative to 
other values, four equal-sized classes were created to 
derive the data from.  These four classes were categorized 
as very high, high, moderate, and low incidences of 
diseases, with decreasing red intensity indicating lower 
incidence. The range for these classes varies depending 
on the attribute values for each specific disease. 

Trend surface analysis models the geographic 
distribution of the average incidence rates throughout 
space and identifies general tendencies of the sample 
data31. The average incidence rates (Z-axis) were 
projected as sticks on the coordinate system (X = West to 

East, Y = South to North) reflecting the location and 
value (height) of each incidence rate. Two coordinate 
systems with specific geographic alignments (West-East 
and South-North, Southwest-Northeast and Southeast-
Northwest) were created to identify trends. The 
polynomial lines drawn through the projected points 
display the trends in specific directions. 

 

Results 

Spatio-temporal trends in waterborne diseases 

Of the four waterborne diseases, the incidence 
rates for enterobiasis were found to be the highest, with a 
four-year average of about 1084 cases per 100,000 
population; and the lowest for dysentery with an average 
of 28 cases per 100,000 population (Table 1). The spatial-
temporal trend revealed a marginal increase in 
enterobiasis and hepatitis A from 2011 to 2014. Although 
hepatitis A and enterobiasis incidence rates dropped in 
2012, they sharply increased thereafter. Acute intestinal 
infections decreased since 2011 but increased in 2014. 
Dysentery was the exception, and its incidence rates have 
been steadily decreasing since 2011.

 

 2011 2012 2013 2014 

Dysentery 38.23 27.56 23.38 22.30 

Hepatitis A 124.34 103.98 147.33 189.68 

Acute intestinal infections 201.57 174.31 167.62 173.77 

Enterobiasis 1110.22 1018.55 1055.54 1152.01 

Source: Republican Center for Epidemiology and Sanitary System (CESS) 

Table 1: Average incidence rates (cases per 100,000) of the four major waterborne diseases in Tashkent 

Province (2011–2014) 

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Spatial distribution of the diseases 

The overall spatial distribution of the diseases 
revealed high incidence rates of enterobiasis and hepatitis 
A in the central and eastern districts, and of acute 
intestinal infections and dysentery in the central and 
western districts of the province (Figure 2). Enterobiasis 
appeared to be spatially focused in the eastern and 
southern parts of the province (Figure 2a). Bekabad City 
had the highest average incidence rates, about six times 
higher than the district and twice that of the total average 
for Tashkent Province. A high incidence of hepatitis A 
(more than 185 cases) was reported in Yangiyul District 
and Olmalik City (Figure 2b). A moderate incidence (62 
to 124 incidence rates) of hepatitis A was reported in the 
central districts of the province. Acute intestinal 
infections were reported to be high in Angren City and 
Olmalik City (Figure 2c). Dysentery showed a decreasing 
trend across the province and has the lowest incidence 
rates of the four diseases in this study (Figure 2d). The 
highest average incidence rates for the 2011–2014 period 
were found in Olmalik City and Angren City, while the 
lowest rates were found in Urtachirchik, Bustanlik, and 
Bekabad City. 

Spatio-temporal trends in the incidence  

Spatio-temporal trends in the incidence of 
diseases revealed increasing trends of enterobiasis in the 
east (Figure 2). Hepatitis A revealed an increasing trend 
among eastern and western districts. Acute intestinal 
infections remained stable, while dysentery showed a 
decreasing trend across the province. An increasing trend 
in the incidence of enterobiasis was found in Ohangaron 
District, and in Buka, Chirchik City, and Olmalik City 
(Figure 2a). Hepatitis A incidence rates were increasing 
across the province (Figure 2b), but spatially focused in 
the southern and eastern parts of Tashkent Province. 
Olmalik City and Yangiyul District could be considered 
as hotspots, as the trend of increasing incidence was 
strongest there, along with Bekabad District. Only 

districts Parkent and Kuyichirchik and two cities, 
Bekabad and Chirchik showed a decreasing trend. For 
acute intestinal infections, a decreasing trend was 
observed in the majority of the districts (Figure 2c). 
However, an increasing trend was observed in Angren 
City, Olmalik City, and Bekabad District, and in the two 
northwestern districts of Yangiyul and Zangiota. The 
spatial trends for dysentery were closely related to those 
for acute intestinal infections, although its incidence rates 
were much lower (Figure 2d). There was an overall 
decreasing trend; however, several districts in the 
western part of the province registered a slight increase 
in total incidence rates. The trend surface analysis for 
2011–2014 demonstrated two sets of diseases presenting 
two different geographical trends (Appendix 2). The 
disease that showed strongest spatial variation was 
enterobiasis, which was concentrated towards the east, 
southeast, and southwest. Hepatitis A incidence also 
showed a spatial concentration towards the center and 
east, and tends towards southeast and southwest. Overall, 
the trend surface analyses revealed the east, southeast, 
and southwest as hotspots vulnerable to enterobiasis and 
hepatitis A. In contrast, the center and southeast regions 
were vulnerable to dysentery and acute intestinal 
infections. 

Urban and rural distribution 

All four major waterborne diseases had higher 
incidence rates in the rural areas of the province 
compared to the urban areas during 2011–2014. The 
urban-rural gap was more than 50% for enterobiasis and 
hepatitis A, followed by acute intestinal infections. 
Dysentery was reported to have the lowest urban-rural 
gap in its incidence rates. Enterobiasis had higher 
average incidence (rates of more than 1500 per 100,000) 
in rural regions and in Bekabad City during the four-year 
period (Figure 3a). A higher incidence rate (more than 
150 per 100,000) of hepatitis A was reported across ten 
districts and in two cities (Olmalik and Angren) in the 
province (Figure 3b).

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While acute intestinal infections were more dominant in 
the rural areas, the urban areas were comparable in terms 
of incidence rates (Figure 3c). Dysentery was more 
common (more than 40 cases) in the districts where 
higher rates of acute intestinal infections were reported 
(Figure 3d). 

Distribution of disease among children 

Children were found to be more vulnerable to 
these diseases compared to the adult population. The 
average incidence rates among children under 14 years of 
age were more than double the incidence rates among the 
adult population in the province in 2014, with 
enterobiasis more than three times more common than in 
the adult population. In a few selected districts the spatial 
distribution revealed a wider gap between children under 
14 years of age and the adult population in the incidence 
of enterobiasis (Figure 4a). For hepatitis A, a persistent 
and large gap between incidence in the adult population 
and among children was found across the province 
(Figure 4b).  A higher incidence in acute intestinal 
infections among children under 14 years of age was 
reported in Angren and Olmalik cities, and in Kibray and 
Zangiota districts (Figure 4c). In the case of dysentery, a 
reduced difference was observable across the province, 
except in Angren and Olmalik cities, and Parkent district 
(Figure 4d). The temporal trends among children under 
14 years of age for 2011–2014 were higher in Angren and 
Olmalik cities, and Ohangaron, Bekabad, and Zangiota 
districts. The incidence rates of enterobiasis among 
children significantly increased in Ohangaron and Buka 
districts, while Bekabad City reported a stable high 
incidence rate across the four years. Hepatitis A showed 
an increasing trend in Olmalik and Angren cities, and 
Yangiyul, Bekabad, and Ohangaron districts. 
Interestingly, a decrease was seen in Bustanlik district. 
There was an increasing trend of acute intestinal 
infections in Zangiota, Bekabad, and Kuyichirchik 
districts, while Angren and Olmalik cities and Kibray and 
Zangiota districts reported high but stable incidence 

across the four years. Dysentery showed a decreasing 
trend across the province, except in Akkurgan district. 
 
Discussion 

The findings of this analysis revealed that 
hepatitis A and enterobiasis had high incidence rate in 
most of Tashkent Province, with both diseases sharing 
similar characteristics: they were transmitted through the 
fecal-oral route and were more prevalent in the younger 
populations. People living in rural areas, including 
children, were found to be more vulnerable to the 
waterborne diseases compared to the more urban 
population. A persistent rural bias was reported for all 
four of the waterborne diseases.  

Among the districts, Akkurgan and Zangiota 
were vulnerable to all four diseases in rural areas. The 
districts of Bekabad, Ohangaron, Kuyichirchik, and 
Urtachirchik had vulnerability to enterobiasis and 
hepatitis A, and the Kibray and Parkent districts were 
vulnerable to acute intestinal infections and dysentery. 
The average rural incidence rates of enterobiasis and 
hepatitis A were twice as high as in urban areas. Among 
the cities, Olmalik and Angren could be considered as 
hotspots for increased incidence rates of the waterborne 
diseases. Bustanlik and Bekabad showed considerable 
difference in the distribution of enterobiasis incidence 
rates between urban and rural sectors, but it is unclear if 
the low urban incidence rates reflected the level of urban 
population density or whether the urban areas in these 
two districts had better access to healthcare. Another 
example were the districts that reported higher rural 
incidence rates, such as Yangiyul. Interestingly, Piskent 
and Buka both showed higher urban incidence rates for 
enterobiasis and hepatitis A compared rural incidence 
rates. There are several plausible explanations of why the 
disease incidence is higher in rural areas worthy of 
further investigation. One explanation could be a 
growing gap in healthcare access between the urban and 
rural areas, with a growing population residing in rural 
areas. 

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This study demonstrated that children are more 
vulnerable in the province. This is consistent with other 
studies32, which reported over 70% of observed cases 
involving children under 14 years of age, and also with 
the reports from Fayzieva33 and Alimova and Fayzieva24 
which also identified the districts of Yangiyul, Akkurgan, 
Kuyichirchik, and Urtachirchik in Tashkent Province as 
being at high risk for waterborne diseases. These hotspots 
require further investigation to understand the causes and 
epidemiological characteristics of the diseases.  

Bekabad District is an area with a significant 
industrial presence, where mining, pulp mills, and 
tanneries discharge toxic waste24.  Yangiyul District is at 
the receiving end of the wastewater discharged from 
Tashkent City. In many cases, wastewater from these 
industries not only drains directly into rivers but also 
seeps into the ground, contaminating aquifers and 
wells34. Improper treatment of industrial and municipal 
wastewater may explain adverse health events among 
residents of Olmalik and Angren cities, as well as 
Bekabad and Yangiyul districts. While these studies 
suggest poor quality of water in the water systems, it is 
difficult to establish a link without appropriate 
information on water quality and adequate information 
on the socio-demographic and health parameters.  

This study may suggest that existing water 
quality monitoring system and its analysis of microbial 
indices are potentially insufficient to prevent infectious 
disease outbreaks. These are complex issues requiring a 
resolution35. In most low-income countries, the problem 
arises from the lack of separation of water sources used 
in agriculture irrigation and industrial wastewater 
management 35. This also applies to Uzbekistan, as its 
insufficient regulations of industrial pollution control and 
wastewater agricultural usage increased the risk of 
microbiological contamination of surface water and 
groundwater, and the transfer of chemical and biological 
contaminants to crops, ultimately affecting public health 
35.   

The CSES plays a major role in environmental 
health, food safety, and control of communicable 
diseases in the Central Asian region. In the case of 
Uzbekistan, CSES plays a crucial role in health 
protection with its extensive infrastructure and network 
within the nation. Yet, the effectiveness of this system is 
not well known due to lack of external evaluation36, 34. 
There is a potential for low reliability of the data 
collected through this system due to several factors such 
as lack of qualified medical personnel and lack of 
inadequate laboratory resources as pointed out by other 
studies done in the Central Asian region27, 28, 37. Gradual 
steps need to be taken to improve ways of administration 
and management of CSES, which would open 
possibilities to focus on learning international methods 
and practices. Another option to help evaluating its 
adequacy and relevance for policy making is to make 
public information such as socio-demographic statistics 
accessible to general population.  

The findings of this study can help to underline 
the potential of CSES’s existing capacities and 
recommend ways for advancing practice. While national 
and international studies have highlighted the importance 
of investigating environmental health issues at the 
national level18, 19, 33, 34, little has been done on the local 
level. This study helps to fill this gap. Across the 
province, these diseases were more prevalent in rural 
areas compared to urban regions. The most vulnerable 
districts were Ohangaron, Urtachirchik, Bekabad, 
Kibray, and Zangiota, while among the cities, Olmalik 
and Angren reported high incidence rates. Children under 
14 years of age were found to be twice as vulnerable to 
waterborne diseases as compared to the adult population. 
These findings are only exploratory, but highlight the 
importance of improving our scientific understanding of 
public health challenges in the region. Given the scarcity 
of literature and the lack of accurate etiological data on 
the four diseases in Tashkent Province, this paper can 
serve as a foundation for developing more in-depth 
epidemiological studies and providing targeted 

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of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 
 

Central Asian Journal of Global Health 
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interventions for vulnerable regions and populations 27, 38. 
Corroborating previous studies37, 39, our findings suggest 
the need for a long term commitment, collaborative 
efforts with international partners, as well as political will 
from the local authorities, in order to advance the 
development of a modern infectious disease surveillance 
system in Uzbekistan.  

  

References  

1. UNFCC. Climate Change: Impacts, 
Vulnerabilities and Adaptation in Developing 
Countries. Bonn: United Nations Framework 
for Climate Convention (1), 2007. 
https://unfccc.int/resource/docs/publications/im
pacts.pdf. Accessed 4 July 2017. 

2. GWP. Central Asia and Caucasus- Regional 
Review, Water Supply and Sanitation in the 
Countries of Central Asia and Southern 
Caucasus. Global Water Partnership, 2009. 
http://www.gwp.org/en/learn/KNOWLEDGE_
RESOURCES/Case_Studies/Asia/Central_Asi
a_and_Caucasus_Regional_Review_of_Water
_Supply_and_Sanitation_in_the_Countries_of_
Central_Asia_and_Caucasus/. Accessed 4 July 
2017. 

3. Mermin J, Villar R, Carpenter J, Roberts L, 
Samaridden A, Gasanova L, et al. A massive 
epidemic of multidrug-resistant typhoid fever in 
Tajikistan associated with consumption of 
municipal water. The Journal of Infectious 
Diseases. 1999;179(6):1416-22. 

4. Matthys B, Bobieva M, Karimova G, 
Mengliboeva Z, Jean-Richard V, Hoimnazarova 
M, et al. Prevalence and risk factors of 
helminths and intestinal protozoa infections 
among children from primary schools in 
western Tajikistan. Parasites Vectors. 
2011;4(195):13. 

5. Steinmann P, Usubalieva J, Imanalieva C, 
Minbaeva G, Stefiuk K, Jeandron A, et al. Rapid 
appraisal of human intestinal helminth 
infections among schoolchildren in Osh Oblast, 
Kyrgyzstan. Acta Tropica. 2010;116(3):178-84. 

6. Small I, Falzon D, LBW vdM, Ford N. Safe 
water for the Aral Sea area. Could it get any 
worse? European Journal of Public Health. 
2003;13(1): 87-89. 

7. FAO. Irrigation in Central Asia in Figures. 
Geneva: FAO Land and Water Division, 2013. 
www.fao.org/3/a-i3289e.pdf. Accessed 4 July 
2017. 

8. Bekturganov Z, Tussupova K, Berndstsson R, 
Sharapatova N, Aryngazin K, Zhanasova M. 
Water-related health problems in Central Asia – 
A review. Water. 2016;8(6-219):13. 

9. Crighton E, Barwin L, Small I, Upshur R. What 
have we learned? A review of the literature on 
children's health and the environment in the 
Aral Sea area. International Journal of Public 
Health. 2011;56:126-38. 

10. Latipov R, Utegenova E, Kuatbayeva A, 
Kasymbekova K, Anbdykarimov S, Juraev R, et 
al. Epidemiology and burden of rotavirus 
disease in Central Asia. International Journal of 
Infectious Diseases. 2011;15:e464-e9. 

11. Herbst S, Fayzieva D, Kistemann T. Risk factor 
analysis of diarrhoeal diseases in the Aral Sea 
area (Khorzem, Uzbekistan). International 
Journal of Environmental Health Research. 
2008;18(5). 

12. Semenza J, Roberts L, Henderson A, Bogan J, 
Rubin C. Water distribution system and 
diarrheal disease transmission: A case study in 
Uzbekistan. The American Journal of Tropical 
Medicine and Hygiene. 1998;59(6):941-6. 

http://www.library.pitt.edu/
http://www.pitt.edu/
http://www.library.pitt.edu/articles/digpubtype/index.html
http://www.upress.pitt.edu/upressIndex.aspx
https://unfccc.int/resource/docs/publications/impacts.pdf
https://unfccc.int/resource/docs/publications/impacts.pdf
http://www.gwp.org/en/learn/KNOWLEDGE_RESOURCES/Case_Studies/Asia/Central_Asia_and_Caucasus_Regional_Review_of_Water_Supply_and_Sanitation_in_the_Countries_of_Central_Asia_and_Caucasus/
http://www.gwp.org/en/learn/KNOWLEDGE_RESOURCES/Case_Studies/Asia/Central_Asia_and_Caucasus_Regional_Review_of_Water_Supply_and_Sanitation_in_the_Countries_of_Central_Asia_and_Caucasus/
http://www.gwp.org/en/learn/KNOWLEDGE_RESOURCES/Case_Studies/Asia/Central_Asia_and_Caucasus_Regional_Review_of_Water_Supply_and_Sanitation_in_the_Countries_of_Central_Asia_and_Caucasus/
http://www.gwp.org/en/learn/KNOWLEDGE_RESOURCES/Case_Studies/Asia/Central_Asia_and_Caucasus_Regional_Review_of_Water_Supply_and_Sanitation_in_the_Countries_of_Central_Asia_and_Caucasus/
http://www.gwp.org/en/learn/KNOWLEDGE_RESOURCES/Case_Studies/Asia/Central_Asia_and_Caucasus_Regional_Review_of_Water_Supply_and_Sanitation_in_the_Countries_of_Central_Asia_and_Caucasus/
http://www.fao.org/3/a-i3289e.pdf


 
 

CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH 
 

 

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Volume 6, No. 1 (2017) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2017.277|http://cajgh.pitt.edu 

 
 

13. Global Health Observatory, Kazakhstan. 2015 
http://www.who.int/gho/countries/kaz/country_
profiles/en/ . Accessed 4 July 2017. 

14. Global Health Observatory Kyrgyzstan. 2015. 
http://www.who.int/gho/countries/kgz.pdf?ua=
1.  Accessed 4 July 2017. 

15. Global Health Observatory Tajikistan 2015. 
http://www.who.int/gho/countries/tjk.pdf?ua=1 
Accessed 4 July 2017. 

16. Global Health Observatory Turkmenistan 2015. 
http://www.who.int/gho/countries/tkm.pdf?ua=
1. Accessed 4 July 2017. 

17. Global Health Observatory Uzbekistan 2015.  
http://www.who.int/gho/countries/uzb.pdf?ua=
1. Accessed 4 July 2017. 

18. UNECE. Environmental Performance Reviews: 
Uzbekistan - Second Review. 2010 
Environmental Performance Reviews Series 
No. 29. 
http://www.unece.org/fileadmin/DAM/env/epr/
epr_studies/uzbekistan%20II%20e.pdf 
Accessed 4 July 2017. 

19. Mirshina O. Water and hygiene in Uzbekistan: 
An overview.  Global Environmental Change 
and Water-related Diseases: Improving Risk 
Assessment Strategies for Public Health Care in 
Uzbekistan; 2-6 May 2011; Tashkent, 
Uzbekistan 2011. 

20. WHO. Public health risk assessment and 
interventions: Kyrgystan and Uzbekistan. Bonn: 
World Health Organization (WHO) Regional 
Office for Europe, 2010. 

21. WHO/UNICEF. Joint Monitoring Program for 
Water Supply and Sanitation - Estimates on the 
use of water sources and sanitation facilities. 
World Health Organization, UNICEF, 2015. 
https://www.wssinfo.org/documents/?tx_displa

ycontroller[type]=country_files. Accessed 4 
July 2017. 

22. World Bank. Social Impact Analysis of Water 
Supply and Sanitation Services in Central Asia: 
The Case of Uzbekistan. World Bank, 2015. 
http://documents.worldbank.org/curated/en/860
101467994584583/Social-impact-analysis-of-
water-supply-and-sanitation-services-in-
Central-Asia-the-case-of-Uzbekistan. Accessed 
4 July 2017. 

23. UNDP. Water: Crtical Resource for 
Uzbekistan's Future. Tashkent, Uzbekistan: 
United Nations Development Program, 2007. 
http://wash.earthforever.org/lib/uz/water_critic
al%20resource_Uzbekistan_en_ru_uz/English/
Water_EN.pdf. Accessed 4 July 2017. 

24. Alimova F, Fayzieva D. Spatial pattens of 
water-borne diseases in relation with climatic 
conditions in Tashkent Province, Uzbekistan.  
Conference paper presented at the ‘Water and 
Health’ Conference; University of North 
Carolina: Water Institute; 2013. 

25. Republic of Uzbekistan. Uzbekistan Health 
Examination Survey 2002. Tashkent: Analytical 
and Information Center, Ministry of Health, 
Republic of Uzbekistan, ORC macro Calverton, 
Maryland USA, 2002. 
http://dhsprogram.com/pubs/pdf/fr143/fr143.pd
f . Accessed 4 July 2017. 

26. Ahmedov M, Azimov R, Mutalov Z, Huseynov 
S, Tsoyi E, Rechel B. Uzbekistan: Health 
System Review. 2014. Health Syst Transit. 
2014;16(5):1-137, xiii. 

27. Sharapov M, Favorov M, Yashina T, Brown M, 
Onischenko G, Margolis H, et al. Acute viral 
hepatitis morbidity and mortality associated 
with hepatitis E virus infection: Uzbekistan 

http://www.library.pitt.edu/
http://www.pitt.edu/
http://www.library.pitt.edu/articles/digpubtype/index.html
http://www.upress.pitt.edu/upressIndex.aspx
http://www.who.int/gho/countries/kaz/country_profiles/en/
http://www.who.int/gho/countries/kaz/country_profiles/en/
http://www.who.int/gho/countries/kgz.pdf?ua=1.%20
http://www.who.int/gho/countries/kgz.pdf?ua=1.%20
http://www.who.int/gho/countries/tjk.pdf?ua=1
http://www.who.int/gho/countries/tkm.pdf?ua=1
http://www.who.int/gho/countries/tkm.pdf?ua=1
http://www.who.int/gho/countries/uzb.pdf?ua=1
http://www.who.int/gho/countries/uzb.pdf?ua=1
http://www.unece.org/fileadmin/DAM/env/epr/epr_studies/uzbekistan%20II%20e.pdf
http://www.unece.org/fileadmin/DAM/env/epr/epr_studies/uzbekistan%20II%20e.pdf
https://www.wssinfo.org/documents/?tx_displaycontroller%5btype%5d=country_files
https://www.wssinfo.org/documents/?tx_displaycontroller%5btype%5d=country_files
http://documents.worldbank.org/curated/en/860101467994584583/Social-impact-analysis-of-water-supply-and-sanitation-services-in-Central-Asia-the-case-of-Uzbekistan
http://documents.worldbank.org/curated/en/860101467994584583/Social-impact-analysis-of-water-supply-and-sanitation-services-in-Central-Asia-the-case-of-Uzbekistan
http://documents.worldbank.org/curated/en/860101467994584583/Social-impact-analysis-of-water-supply-and-sanitation-services-in-Central-Asia-the-case-of-Uzbekistan
http://documents.worldbank.org/curated/en/860101467994584583/Social-impact-analysis-of-water-supply-and-sanitation-services-in-Central-Asia-the-case-of-Uzbekistan
http://wash.earthforever.org/lib/uz/water_critical%20resource_Uzbekistan_en_ru_uz/English/Water_EN.pdf
http://wash.earthforever.org/lib/uz/water_critical%20resource_Uzbekistan_en_ru_uz/English/Water_EN.pdf
http://wash.earthforever.org/lib/uz/water_critical%20resource_Uzbekistan_en_ru_uz/English/Water_EN.pdf
http://dhsprogram.com/pubs/pdf/fr143/fr143.pdf
http://dhsprogram.com/pubs/pdf/fr143/fr143.pdf


 
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Volume 6, No. 1 (2017) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2017.277|http://cajgh.pitt.edu 

 
 

surveillance data. BMC Infectious Diseases. 
2009;9:35. 

28. Niyazmatov B, Shefer A, Grabowsky M, Vitek 
C. Diphtheria epidemic in the Republic of 
Uzbekistan-1993-196. Journal of Infectious 
Diseases. 2000;181(Supplement 1):S104-9. 

29.     Open Street Map. Available from: 
https://osm.wno-edv-service.de/boundaries/. 
Accessed 4 July 2017. 

30. DeLorme World Basemap. 
http://www.arcgis.com/home/item.html?id=b1
65c3df453e4be6b5ac4fdb241effbe. Accessed 4 
July 2017. 

31. Hota T. Trend Surface Analysis of Spatial Data. 
Gondwana Geological Magazine. 2014;29:39-
44. 

32. Ibadov G, Akhmedova M, Kasymbekova K, 
Khodjaev N, Shirinova N, Baltabaeva M. 
Environment and Infectious Diseases. In: 
Fayzieva D, editor. Environmental Health in 
Central Asia: The Present and the Future. 
Southhampton, Boston: WIT Press; 2004. p. 
129-55. 

33. Fayzieva D. Environmental Health in Central 
Asia: The Past and Future. Southampton, 
Boston: WIT Press; 2004. 257 p. 

34. Corcoran E, Nellemann C, Baker E, Bos R, 
Osborn D, Savelli H, editors. Sick Water? The 
Central Role of Wastewater Management in 
Sustainable Development. A Rapid Response 
Asessment: United Nations Environment Pro- 
gramme, UN-HABITAT, GRID-Arendal. 2010. 
http://gridarendal-

website.s3.amazonaws.com/production/docum
ents/:s_document/208/original/SickWater_scre
en.pdf?1486721310 Accessed 4 July 2017. 

35. Raschid-Sally L, Jayakodi P. Drivers and 
characteristics of wastewater agriculture in 
developing countries: Results from a global 
assessment. Colombo, Sri Lanka: International 
Water Management Institute, 2008. Research 
Report 127. 
http://www.iwmi.cgiar.org/Publications/IWMI
_Research_Reports/PDF/PUB127/RR127.pdf 
Accessed 4 July 2017. 

36. Maier C, Martin-Moreno J. Quo Vadis 
SANEPID? A Cross country analysis of public 
health reforms in 10 post-soviet states. Health 
Policy. 2011;102(1):18-25. 

37. Usmanov I, Favorov MO, Chorba T. Universal 
immunization: The Diphtheria Control Strategy 
of Choice in the Republic of Tajikistan-1993-
1997. Journal of Infectious Diseases. 2000;181 
(Supplement -1):S86-S93. 

38. Gungoren B, Latipov R, Regallet G, Musabaev 
E. Effect of hygiene promotion on the risk of 
reinfection rate of intestinal parasites in children 
in rural Uzbekistan. Transactions of the Royal 
Society of Tropical Medicine and Hygiene. 
2007;101(6):564-9. 

39. Hay J, Yeh K, Dasgupta D, Shapieva Z, 
Omasheva G, Deryabin P, et al. Biosurveillance 
in Central Asia: Successes and challenges of 
tick-borne disease research in Kazakhstan and 
Kyrgyzstan. Frontiers in Public Health. 2016; 
4(4). 

 

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http://www.pitt.edu/
http://www.library.pitt.edu/articles/digpubtype/index.html
http://www.upress.pitt.edu/upressIndex.aspx
https://osm.wno-edv-service.de/boundaries/
http://www.arcgis.com/home/item.html?id=b165c3df453e4be6b5ac4fdb241effbe
http://www.arcgis.com/home/item.html?id=b165c3df453e4be6b5ac4fdb241effbe
http://gridarendal-website.s3.amazonaws.com/production/documents/:s_document/208/original/SickWater_screen.pdf?1486721310
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http://gridarendal-website.s3.amazonaws.com/production/documents/:s_document/208/original/SickWater_screen.pdf?1486721310
http://www.iwmi.cgiar.org/Publications/IWMI_Research_Reports/PDF/PUB127/RR127.pdf
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	Spatial Distribution and Trends of Waterborne Diseases in Tashkent Province
	Abstract
	Keywords: Spatiotemporal analysis; Environmental health; Tashkent Province; Uzbekistan; Central Asia
	Spatial Distribution and Trends of Waterborne Diseases in Tashkent Province
	Research

