TB still problematic in Karakalpakstan, experts say

Health experts say that cases of TB remain high in Uzbekistan, particularly in Karakalpakstan autonomous republic in the northwest of the country. "Karakalpakstan is probably the region with the most difficult situation with regard to TB, with the highest morbidity and mortality rates," Zakir Khodjaev, head of the World Health Organisation (WHO) mission in Uzbekistan, told IRIN in the capital, Tashkent. "It is too early to say that the situation has stabilised because the DOTS [Directly Observed Treatment Short-course] programme being implemented has not covered all the districts of Karakalpakstan yet." However, Khodjaev said the number of registered cases was rising due to the improving rate of detection. He said non-controlled use of medical preparations had led to the emergence of drug resistant forms of TB. Moreover, the transition period had created difficult socio-economic conditions coupled with poorer access to basic health services, so that people were likely to see a doctor only in cases of dire necessity. As a result there were many newly-detected cases with destructive forms of the disease, he said. According to Khodjaev, sanitary measures and education played an important role in informing people of the indications of TB. It would take time to yield results, but the population was now more aware of the issue than two years ago. People were likely to conceal their infection because it was considered a stigma, he warned, and education activities could explain that TB was curable, especially in its early stages of development. Regarding the government's efforts to address the issue, Khodjaev said it was now reacting more promptly and statistics were fairly reliable, objectively reflecting the situation. Detection was on the basis of the applications of patients themselves, rather than on total coverage of the population. Khodjaev also said that the government had applied to the Global Fund to Fight AIDS, Tuberculosis and Malaria for assistance. The WHO official also urged international organisations to contribute to the eradication of the problem with training in the DOTS principles, adopted as the main strategy for fighting TB in the country. Money was no substitute for the knowledge, expertise and experience of the staff involved, he said. "If international organisations are interested in conducting training and come to the country to help in monitoring the project, it would be greatly appreciated," he said. Meanwhile, Médicins Sans Frontières (MSF), an international humanitarian aid organisation providing emergency medical assistance to populations in danger, also said that TB was still prevalent in the area. "We have a higher ratio of TB incidences [in Karakalpakstan] than the average in the country," Muriel Ramirez Santana, medical coordinator for MSF told IRIN from the capital, Tashkent. "The rates are increasing not only because we are improving coverage, but also because we are training doctors to diagnose better and improving the registration system," she said. The data showed that the area of the Aral Sea had one of the highest rates in the world - 120 to 190 new cases per year per 100,000 population, Santana said. The main causes of TB in the Aral Sea area were ecological degradation, poverty, lack of local food production, malnutrition and unemployment. She said the government had agreed a national policy in April to cover the whole country with the DOTS programme by the end of 2005, noting that there was strong political commitment to tackling the issue. She said there was some improvement in the results of current treatment of TB cases in the region. MSF was focusing its activities on areas of high incidence of TB, and was continuing to research links between the degraded environment and human health. It has implemented the DOTS strategy to fight TB in a total of 30 districts in the autonomous republics of Karakalpakstan and Khorezm in Uzbekistan, and Dashkhovuz in Turkmenistan.