Focus on child health

Dilbar Mirzakarimova, awaits the vaccination of her two-month-old son in the rural health centre of Kibraj District, some 15 km northwest of the Uzbek capital, Tashkent. "The services are fine, we can access vaccination almost at our doorstep," the 26-year-old mother of three told IRIN. Mirzakarimova’s only concern is access to more vaccinations preventing further diseases. "They [the doctors] even come to my home to examine my baby," she said. Sayara Zakirova, another visiting mother to the centre, shared her views, but with some reservations. She is tired of sometimes having to travel to Tashkent for further tests or treatment because the health centres in Kibraj have only limited treatment and diagnostic facilities. Despite the two women's shared satisfaction, the infant mortality rates for the country remain high. According to the Multiple Indicator Cluster Survey carried out by the UN Children's Fund (UNICEF) in 2000, some 52 children out of 1,000 live births die before the age of one year. The rate is even higher in children below the age of five, with 69 children out of 1,000 dying between one and five years. However, the Uzbek government maintains that the mortality rate is just 18 for every 1,000 live births. International media recently reported that child death rates in rural areas such as the southern Kashkadar'inskaya Oblast (province) had doubled over the last five years. UNICEF acknowledges that Uzbekistan has no reliable sources for reviewing the health, nutrition, education and socioeconomic status of the country, which has visibly deteriorated since the country’s independence after the break-up of the Soviet Union 11 years ago. With a population of 25 million people, Uzbekistan is the most populous of the Central Asian republics. Forty-one percent of the population consists of children under the age of 15, and 12 percent of the latter are under five years old. After signing the World Summit on Children declaration, the country committed itself to improving a range of indicators related to children, health and education. While the country has achieved remarkable things in the field of immunisation, with the virtual eradication of killer diseases such as malaria, measles and polio, it lags behind in other areas, such as treatment of HIV/AIDS, management of childhood illness and breast-feeding. Uzbekistan’s health-care system has a network of small and large medical facilities at primary, secondary and tertiary levels. Sometimes this hierarchical division leads to complications. Gulnara Karakuziwa, chief paediatrician at Kibraj hospital maintained that the hospital even lacked necessary diagnostic equipment such as ultrasound machines. "It is difficult to detect some diseases without proper equipment," she told IRIN. Such primary-level health establishments are the main source of health care for children and their mothers, because most deliveries are performed there. Most of the machines in the hospital are decades old, a reminder of a once glorious past. Poverty, a major contributing factor in many diseases, has increased in general because of the decline in production, increased unemployment and high inflation. "Although there is no abject poverty in our locality, people live on meagre incomes, which contribute to deteriorating health conditions," Karakuziwa told IRIN. The collapse of the all-encompassing Soviet social system hit the people hard - especially in rural areas, where more than 60 percent of the population lives, and where sustainable livelihoods are yet to be provided. Unlike Karakuziwa, who earns up to US $30 a month, many trained doctors and other health professionals prefer to work for private employers or run private clinics, thereby depriving public hospitals of vital human resources. There's also a serious rural-urban brain drain in Uzbekistan. "We have good equipment available in rural areas, but we don’t have enough specialised personnel, because most of them want to work in Tashkent," Liutsiya Kim, the head immunologist of Tashkent Oblast told IRIN. Innisa Ashirova, an immunisation officer with UNICEF, maintained that the child health-care system in Uzbekistan was not a complete failure. "It is not too bad, but they lack equipment and expertise," she told IRIN. "Provided with greater assistance in supplies and training they will eventually overcome the difficulties," she said optimistically.