# A National Forecast and Clinical Analysis of Pediatric Acute Mastoiditis in Kazakhstan

## TL;DR

This study shows that pediatric acute mastoiditis in Kazakhstan reflects growing gaps in healthcare resources and workforce, calling for better planning and policy.

## Contribution

The paper introduces acute mastoiditis as a sentinel condition for evaluating systemic issues in pediatric ENT healthcare in Kazakhstan.

## Key findings

- Pediatricians and ENT beds have declined, while ENT surgeries have increased, creating a mismatch in healthcare capacity.
- 40% of pediatric mastoiditis cases involved complications like subperiosteal and zygomatic abscesses.
- Projections to 2030 suggest continued workforce and inpatient capacity constraints despite rising surgical demand.

## Abstract

What are the main findings?
•Pediatric acute mastoiditis reveals a growing mismatch between healthcare demand and workforce and between healthcare demand and inpatient capacity in Kazakhstan.•Declining numbers of pediatricians and ENT beds coexist with stable ENT workforce density and a rising volume of ENT surgeries.

Pediatric acute mastoiditis reveals a growing mismatch between healthcare demand and workforce and between healthcare demand and inpatient capacity in Kazakhstan.

Declining numbers of pediatricians and ENT beds coexist with stable ENT workforce density and a rising volume of ENT surgeries.

What are the implications of the main findings?
•Acute mastoiditis can serve as a sentinel condition for assessing systemic constraints in pediatric otorhinolaryngology.•Integrated health policies addressing workforce planning, inpatient capacity, and referral pathways are essential to prevent further growth of complicated pediatric ENT conditions.

Acute mastoiditis can serve as a sentinel condition for assessing systemic constraints in pediatric otorhinolaryngology.

Integrated health policies addressing workforce planning, inpatient capacity, and referral pathways are essential to prevent further growth of complicated pediatric ENT conditions.

Background: Ongoing healthcare and medical education reforms in Kazakhstan have been accompanied by persistent workforce shortages and reduced inpatient capacity in pediatric care. Therefore, this study aimed to assess and forecast selected healthcare system indicators using acute mastoiditis (AM) as a sentinel condition while also describing its clinical and epidemiological characteristics. Materials and Methods: This study combined an analysis of national healthcare and demographic statistics in Kazakhstan from 1998 to 2024 with a retrospective review of pediatric AM patients treated at a tertiary referral center. Long-term trends in healthcare resources were assessed, and future needs were projected via average annual percentage change (AAPC) and time series forecasting methods. Clinical, laboratory, and radiological data were extracted from medical records. Statistical analyses were performed via SPSS version 24.0 (IBM Corp., Armonk, NY, USA). Results: From 1998 to 2024, the number of pediatricians and ENT hospital beds declined, whereas the density of ENT physicians remained relatively stable, and the proportion of ENT surgical procedures increased. Projections to 2030 suggest continued constraints in pediatric and ENT workforce capacity and further reductions in inpatient beds despite sustained growth in surgical demand. Among 95 pediatric AM cases, complications, most commonly subperiosteal abscess and zygomatic abscess, were identified in 40% of patients. Conclusions: AM may be considered a contextual indicator of pressures within specialized pediatric ENT services rather than a direct measure of healthcare system performance. These findings highlight the need for further studies to validate these observations and better inform healthcare planning.