CENTRAL ASIA: ’WORLD TB DAY’ OBSERVED AMID CONCERNS OF EPIDEMIC
Antoine Blua: 3/28/04
A EurasiaNet Partner Post from RFE/RL

As winds whip tons of polluted dust from the Aral Sea’s dry seabed into the air, tuberculosis (TB) has risen to epidemic proportions in the area.

Poverty, malnutrition, and unemployment are helping the fatal disease to spread throughout the region. Tazhibai Bazylkairov heads the TB clinic in the southern Kazakh city of Qyzyl-Orda, east of the Aral Sea.

"Seventy percent of those infected last year in our region are jobless people. I know of cases where the entire family is infected, from the great-grandfather to his great-grandson."

In Uzbekistan’s autonomous republic of Karakalpakstan, as many as 478 TB cases per 100,000 people were reported.

The Aral Sea region is far from being the only area where TB is prevalent. TB poses a particular threat to many villages in the southern Vose district in Tajikistan’s Khatlon region. Saidjamol Murodov lives in one of these villages.

"In the past two to three years, 12 people died in my family: my brother, my wife, my children, my sister-in-law. All of them died from tuberculosis."

A woman from a nearby village tells a similar tale: "There are 150 families in our village. And I can say that only 50 of them are not affected by tuberculosis. The rest of the villagers are sick. The life expectancy here is 18-25 years."

Inconsistent data collection has made the number of cases hard to pinpoint. For example, in Tajikistan, only 10 percent of confirmed TB cases were reported in 2000.

Besides, Central Asia’s prison data are only variably included in the national TB statistics.

TB is an airborne infectious disease spread by coughing and sneezing. It is curable with a six-month drug regimen that can cost less than $10.

But according to the UN World Health Organization, Central Asia is a "global hot spot" for a new strain of TB that is resistant to drug therapy.

The new strain, called multidrug-resistant TB, means that the virus mutates into a form that does not respond to known treatments -- or requires treatment far more expensive than the ordinary regimen.

One of the world’s worst crisis points is Kazahkstan, with 57 percent of new TB cases being resistant to one drug and 14 percent being multidrug-resistant.

Doctor Paul Nunn is program director for drug-resistant tuberculosis at WHO. He says the WHO places the blame squarely on health authorities in those countries.

"And what this tells us is that the systems, the mechanisms, for controlling tuberculosis in these countries are not up to international standards."

Ineffective treatment occurs when health workers administer smaller-than-proper doses, when drug supplies run out, or when patients share drugs or deliberately stop their treatment.

Low treatment success rates also show the limited coverage and implementation of effective treatments. Karakalpakstan had a treatment success rate of only 68 percent in 2001-2002.

Researchers are therefore urging countries and public-health charities to invest in DOTS (Directly Observed Treatment Short Course), a WHO scheme to standardize the detection, treatment and reporting of TB cases.

Also, there is partial or total lack of coverage within Central Asian prisons, which are considered the epidemiological pump for the TB epidemic in the region.

According to Kazakh Deputy Justice Minister Sabyrzhan Bekbosynov, there were 6,417 TB sufferers as of last November in Kazakh prisons out of a total of 52,000 prisoners.

The Kyrgyz Justice Ministry estimates that approximately 2,000 out of 17,000 prisoners are infected with an easily contractible form of TB. Every year more than 1,000 Kyrgyz inmates reportedly infected with TB are released based on amnesties.

However, Tazhibai Bazylkairov, from the TB clinic in Qyzyl-Orda in Kazakhstan, says the fight against TB is becoming more effective in the country, where 70,000 TB cases have been registered: "Before 1998 there were no TB drugs available, only 22-23 percent of necessary drugs were distributed by the government. Yes, cases of fatal TB illness went down almost [twofold] in recent years. The main reason is that we started to receive those drugs."

Aftandyl Alisherov, director of the TB Institute in the Kyrgyz capital, Bishkek, told a press conference on March 24 -- World Tuberculosis Day -- that the situation is improving in the republic, one of the poorest in the former Soviet Union.

"Today the situation concerning TB is difficult in Kyrgyzstan. In 2003, 123 people out of 100,000 were found to have TB. That is why I can say that the situation is very difficult. But six-seven years ago, it was 129-127. The rate has been decreasing in the last two years."

Alisherov said international organizations and foreign governments are helping to counter TB in Kyrgyzstan. Germany provides medicine and training. The WHO last year gave a 2.5-million-euro subsidy to the country to fight TB and is introducing new methods to detect and cure it.

At the same time, Alisherov added, the Kyrgyz government has increased to 60 percent its share in the financing of TB programs.

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Posted March 28, 2004 © Eurasianet
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