1. Introduction

Protecting and strengthening reproductive health is one of the tasks of national importance, as reproductive health can be seen as a factor of national security. In addition, several authors have noted negative trends in the reproductive health status of women of all ages. It is a well-known fact that gynecological diseases are on the rise among women and their adverse effects on women's reproductive activity. According to N.V. Mingaleva (2007), the incidence of gynecological disease in women is 30%, with an average of 1.95 diseases per patient.

In the development of targeted measures aimed at optimizing the provision of medical services to women of reproductive age, improving its organizational forms, and improving the efficiency of medical institutions, it is necessary to study the health status of certain age groups of women, the description of pathologies that are dominant in a particular region and the socio-hygienic and medical-biological factors that affect health indicators.

2. Materials and Methods

We studied the specifics of the disease based on an in-depth complex socio-hygienic study at the request of 3474 women of reproductive age living in the arid zone of the republic.

The study was conducted among 3474 women of reproductive age living in cities and districts of the Bukhara region. 8.1% of them are under 19 years old, 13.3% are 20-24 years old, 23.7% are 25-29 years old, 19.2% are 30-34 years old, 15.6% are 35-39 years old, 10.8% are 40-44 years old, 9.4% are Women aged 45-49 years. Of the women of reproductive age surveyed, 81.9% were urban, 18.1% were rural, and the majority (98.0%) were Uzbek, with the remainder being Russian, Tajik, Tatar, Arab, and Turkish. 45.0% of women have secondary education, 36.5% have secondary special education and 18.5% have higher education.

3. Results and Discussion

According to the results of the study, the total incidence rate per thousand women per 57 thousand women living in the arid zone is 577.7%, including the incidence of extragenital diseases is 452.5%, the incidence of gynecological diseases is 125.2% (Table 1). The overall morbidity tends to increase with age. At the same time, the incidence of general (513.0% o), including extragenital and gynecological diseases (396.1% o, 116.9% o) in women aged 20-24 years is higher than in 25-29 years. In our opinion, the high incidence rate in women aged 20-24 years is the result of the fact that most girls undergo a compulsory medical examination due to marriage at this age.

Table 1. Morbidity in women by age (For every 1,000 women)

The maximum incidence is observed in women aged 45-49 years, -1064.2% per thousand women. This is 6.5 times higher than the incidence rate for women under 19 and 2.0 times higher than for women aged 20-24 years. This situation can be explained by the relatively serious approach to age-related natural changes in the body, focusing on their health.

Extra genital diseases have been proven in many scientific studies to have a negative effect on women’s reproductive functions. Various extragenital diseases have been reported in 45.3% of women of reproductive age studied in our study. The tendency of the mentioned general morbidity to increase with age is mainly due to extragenital diseases. The maximum incidence of extragenital diseases is observed in women aged 45-49 years, as in the general incidence, which is -899.1% per thousand women of the same age. The incidence of extrahepatic diseases is 5.3 times higher in women aged 45-49 years than in those under 19 years of age, 2.7 times higher than in women aged 25-29 years, and 2.1 times more than in those aged 35-39 years.

Among the systems, the highest incidence is urinary and genital diseases, with the proportion of systemic diseases accounting for 25.9% of the total morbidity (Table 2) and 149.4% per thousand women (Table 3).

Table 2. Composition of diseases by age and major diseases of women (%)

Table 3. Classes and role of major diseases in women (For every 1,000 women of the same age)

The next places are occupied by disorders of the endocrine system, nutrition, metabolism and immune system (20.9%), digestive system (14.1%), blood and blood production system (11.5%), nervous system (9.1%), circulatory system (7.0 %), respiratory systems (6.1%) and infectious and parasitic diseases (4.2%).

Urinary excretion and diseases of the genital system were not reported in women under 19 years of age, slightly higher in women aged 20-24 years (136.7%), an increasing trend from 25-29 years to 40-44 years (127.7%, 241.9%). In the last years of fertile age (45-49 years) it decreases slightly, reaching -201.8% per thousand women. This is mainly due to gynecological diseases and the fact that most women start having sex after the age of 20-24, as well as diseases that accumulate later.

12.5% of the women surveyed reported having a gynecological disease nowadays. It is noteworthy that infertility is observed in 24.1% of women with gynecological diseases. Of these, 29.0% were diagnosed with cervical erosion, 15.9% with chronic adnexitis, 13.8% with uterine fibroids, and 11.0% with ovarian cysts.

Naturally, no gynecological diseases were reported in women under 19 years of age (Table 4). Among gynecological diseases, the highest rate is due to cervical erosion, which is 36.3% per thousand women. The incidence of this disease increases with age 25-29 years (32.9%), decreases with age 30-34 years (18.0%), tends to increase in later life, and reaches a maximum level of -80.7% in women aged 40-44 years. In our opinion, the decrease in the incidence of this disease in women aged 30-34 years is the result of their medical activity, the desire to have children, intensive care, and the increase in the next age is the result of neglect of their health and excessive use of contraceptives.

Table 4. Indications for urinary incontinence and sexually transmitted diseases in women (for every thousand women of the same age)

In terms of prevalence, infertility is next with 30.2% per thousand women. Infertility increases at the age of 30-34 years (45.1%), decreases slightly at the age of 35-39 years (33.2%), and reaches its maximum at the age of 40-44 years (56.5%). This can be explained by the fact that the last diagnosis was made at this age, before which various treatment procedures were attempted.

In the second place is the prevalence of chronic adnexitis with a high prevalence (19.9%), with a declining trend with age (45.5% 19 years, 9.2% 45-45 years). In contrast, the incidence of uterine fibroids tends to increase with age in women, which is 64.2% in women aged 45-49 years, almost 10 times higher than in women aged 20-24 years. This condition can be explained by the disruption of physiological processes in the body under the influence of various external and internal factors with age, and this requires serious study.

Among the diseases of the urinary tract, cystitis - 13.8%, pyelonephritis - 6.9%, kidney stones - 2.6%. While cystitis is relatively equally prevalent in all ages, pyelonephritis tends to increase with age. Kidney stone disease is mainly observed in young people - women aged 20 to 35 years, which can be seen as a consequence of the deterioration of the ecological situation specific to the arid zone.

Among the diseases of the endocrine system, nutrition, metabolism, and immune system disorders, the highest prevalence is endemic, amounting to 95.0% per thousand women. The incidence of this disease increases between the ages of 30-and 34 years (144.1%) and tends to decrease in later life. The incidence of hypothyroidism tends to increase with age, reaching a maximum of 18.4% in those aged 45-49 years. Diabetes mellitus and obesity are also more common in adults, with both diseases accounting for 45.9% of mothers aged 45-49 years.

According to the study, among the diseases recorded in women of reproductive age living in the arid zone, the prevalence of diseases of the digestive system is the third-highest, at 81.2% per thousand women. The highest incidence of these systemic diseases was observed in women aged 40-44 years - 161.3%, while the incidence increased by 20-24 years (103.9%), decreased in 25-29 years (36.5%), and increased in later years. The relatively high incidence in women aged 20-24 years can be explained by the avoidance of obesity in women of this age, and eating disorders due to shyness, which is characteristic of Uzbek women before and after marriage. The increase in morbidity in later life is the result of the accumulation of disease.

Among diseases of the digestive system, the highest rate corresponds to chronic gastritis (47.5% o). The highest incidence of gastritis was observed in women aged 20–24 years (84.4% o), decreased in 25–29-year-olds (29.2% o), and increased in later life, reaching 73.4% in 45–49-year-olds. The fact that chronic gastritis is the basis of diseases of the digestive system in women suggests that the above reasons also apply to this disease.

The incidence of gastric and duodenal ulcers tends to increase with age in women. This figure increased to 6.5% in women aged 20-24 years, to 27.6% in women aged 35-39 years, and remains around the same level in later years. Pancreatitis and cholecystitis also increased in the age group of 40-45 years and remained at the same level in later years.

In women of reproductive age, diseases of the blood and hematopoietic system rank fourth in terms of prevalence. This is the result of measures taken to treat and prevent anemia among women during independence. The basis of these systemic diseases is anemia. According to the results, the incidence of anemia in women of reproductive age in the arid zone is 66.5%. At the same time, the incidence rate increased to 35-39 years, decreased slightly in later years, and 55.1% in women aged 45-49 years. Anemia has a significantly higher rate among all ages. Its high rate among women between the ages of 20 and 40 can be explained by the fact that there are many pregnancies and childbirth processes in this age range.

Nervous system diseases note an increasing trend among women of reproductive age with increasing age. However, it is more common in women aged 20-24 years than in women aged 25-29 years (32.5 %% and 25.6%, respectively), which is observed in all diseases. The highest rate is in women aged 45-49 years, at 110.1% per thousand women. Among the diseases of the nervous system, the highest rate corresponds to neurosis (26.8% o). The neurosis condition increases with age and reaches its peak at 40-44 years of age (40.3% o). The prevalence of osteochondrosis of the spine is 9.5%, increasing with age, and 27.5% in those aged 45-49 years. Migraine is mainly reported in women over 35 years of age and remains almost the same. Disc herniation has been reported since the age of 20-24 years, with the highest incidence in the age group of 45-49 years - 18.4%.

The incidence of diseases of the circulatory system among women of reproductive age was 40.6%, and the highest among women aged 45-49 years - 238.5%. The incidence of diseases in the circulatory system increases with age, the incidence rate of 45-49 years is 2.7 times higher than that of 40-44 years. The high rate in 20-24-year-olds compared to 25-29-year-olds appears to be mainly due to those with heart disease from a young age. The most common disease among these systemic diseases is arterial hypertension, which accounts for 29.4% per thousand women. Arterial hypertension was noted after the age of 25 and increased with age, with the highest rate recorded in the 45-49 age group, at 183.5%. The prevalence of angina pectoris was 2.5%, mainly after the age of 35 years.

The incidence of respiratory diseases is -35.4% per thousand women and tends to increase with age. The highest rate is in women aged 45-49 years (100.9%). The high incidence in patients aged 20-24 years compared to those aged 25 to 39 years is mainly due to bronchitis, which can be explained by the process of adaptation of young brides to another family environment. Bronchitis is less common in postmenopausal women, increases with age, and has a maximum incidence in 45-49-year-olds (55.1%). Bronchial asthma has been reported mainly in women over 35 years of age and increases with age (45.9% 45-49 years). Allergic rhinitis has been reported in women under 39 years of age and is most common in women aged 30-35 years (13.5%).

Numerous studies have proven that infectious and parasitic diseases, including sexually transmitted diseases, adversely affect women’s reproductive functions. These diseases can lead to inflammation of various genitals, turning into a chronic form if not treated in time, leading to infertility. The incidence of infectious diseases in women of reproductive age is 24.2% per thousand women. The highest incidence of infectious diseases was recorded at the age of 25-29 years (40.2%), then decreased to the age of 35-39 years (11.1%), and increased in later years.

The incidence of hepatitis is highest in 25-29-year-olds - 36.5%, then decreased to 11.1% in 35-39-year-olds and increased in later years to 18.4% in 45-49-year-olds. The incidence of sexually transmitted gonorrhea was 6.5% in those under 19 years of age and 3.5% in those aged 25-29 years. The fact that the majority of people with gonorrhea are women under the age of 19 can be assessed as a result of them having sex before marriage and having their spouses have a shallow sex life.

In addition to the above systems, eye and traumatic diseases in women of reproductive age have also been reported. Of the eye diseases, myopia was mainly reported at different ages, with a total incidence of 2.6%. Among the traumatic diseases, arthritis and coxarthrosis were registered, with a total incidence of 2.6% and 4.3%, respectively.

4. Conclusions

In women of reproductive age living in the arid zone of the republic, the incidence of common registered diseases, including extragenital diseases, tends to increase with age. The maximum incidence was recorded in women aged 45–49 years, in whom the incidence was 6.5 times higher than in those under 19 years of age and 2.0 times higher than in those aged 30–34 years. As a result of the fact that most women get married at the age of 20-24 (...%) and undergo a compulsory medical examination, the incidence rate at this age is 10.0% higher than at the age of 25-29 years. Various extragenital diseases were reported in 45.3% of women.

Within the disease classes, urinary incontinence and genital diseases have the highest rate, accounting for more than ¼ of the total morbidity. The high incidence of these systemic diseases is mainly due to gynecological diseases and has the highest rate in women aged 40-44 years. Among gynecological diseases, cervical erosion has the highest level, accounting for about ¼ of systemic diseases.

It is noteworthy that infertility was reported in more than 3.0% of women, an increase of 4.5% among those aged 30-34 years and 5.6% among those aged 40-44 years. The incidence of chronic adnexitis is highest in the age group of 20-24 years and tends to decrease with age. In fibroids, there is a tendency to increase with age, with 6.5% of women aged 45-49 years. This indicates the need for obstetricians and gynecologists to strengthen measures to prevent these diseases.

In terms of prevalence, the next place is occupied by diseases of the endocrine system, nutrition, metabolism, and immune system disorders. Among them, the highest rate was in endemic goiter, recorded in 9.5% of women. The highest rate was observed in women aged 30.34 years, accounting for 14.4%. Hypothyroidism is noted after the age of 25 and increases with age. Obesity has been reported since the age of 20, with a maximum in 44-49-year-olds. Diabetes mellitus is most common in women aged 44-49 years - 4.5%.

Diseases of the digestive system account for 14.1% of the total morbidity, of which 58.5% of systemic diseases are gastritis. The highest incidence of gastritis is observed in women aged 20-24 years. Decreases in the next age group and then increases with age. Gastric or peptic ulcer disease has been reported from 20 to 24 years of age and tends to increase with age. Occurs at about the same rate between the ages of 35 and 49 years. Pancreatitis and cholecystitis have been reported mainly in women over 30 years of age, with the maximum value observed in 40-44-year-olds.

The incidence of diseases of the blood and hematopoietic system has been declining in recent years among women of reproductive age, largely as a result of state-wide measures to prevent anemia. According to the study, anemia accounts for 11.5% of all cases and 31.25% for women under 19 years of age. In all age groups, the incidence of anemia remains high, increasing relative to 35-39 years of age, and decreasing to 30.0% in later age groups.

The incidence of neurological diseases accounts for 9.1% of all diseases and tends to increase with age. More than half of these systemic diseases account for neurosis, and their rate increases with age. Spinal osteochondrosis and disc herniation are also on the rise. Migraine cases have been reported in people over the age of 30 and are relatively similar.

More than 70.0% of diseases of the circulatory system are arterial hypertension. The disease has been reported in people over 25 years of age, increasing with age and reaching 183.5% per thousand women aged 45-49 years. Angina pectoris is observed in women over the age of 35, and it also tends to increase with age.

The main part of diseases of the respiratory system is chronic bronchitis, bronchial asthma, and allergic rhinitis. Chronic bronchitis accounts for more than 60.0% of systemic diseases, with the highest incidence in women aged 40-44 and 45-49 years. Bronchial asthma is observed in women over 35 years of age and accounts for 45.9% of those aged 45-49 years. Allergic rhinitis is observed in women aged 19 to 39 years and notes a declining trend.

About 2.5% of the women in the study were found to have had a sexually transmitted disease during their lifetime. 91.3% of patients were sexually infected with Hepatitis B and C, while 8.7% had gonorrhea. Hepatitis has been reported in women of all ages, with the incidence increasing from 25 to 29 years of age, with a declining trend in later life. The low incidence of sexually transmitted diseases among women indicates that most of them do not engage in casual sex. Women are more likely to be infected with these diseases, mainly by their spouses.