Intestinal diseases on the increase

Lack of access to clean drinking water and an unregulated street trade have fuelled a rise in intestinal disease in Kyrgyzstan, according to health officials. Alla Sarkina, deputy head of the Republican Infectious Diseases Hospital in the Kyrgyz capital, Bishkek, said there were many causes of intestinal infections, including consumption of out-of-date food and inadequate personal hygiene. “But of course the main ones are using unclean water from rivers and aryks [irrigation ditches], and street trade,” she added. Villagers from the Aksy district of the southern Kyrgyz province of Jalal-Abad were a case in point. They took water from the river for drinking and cooking and many were frequently sick with intestinal infections. Back in Bishkek, Gulzara and her one-year-old daughter have been treated at the Republican hospital. “It is sad and stupid that the seller at the bazarchik [small bazaar] near our home did not tell me that the yogurt was old,” she said. “Now, as you see, I am in the hospital with my daughter.” Such cases are not unusual in this former Soviet republic, particularly in rural areas. Officials cite a lack of access to clean drinking water and unregulated food and beverage trade on the streets as major causes of the problem. Upwards of 40 percent of the country’s 5.5 million inhabitants live below the national poverty line, according to the World Bank. According to the UN Children’s Fund (UNICEF), 76 percent of the country’s total population used improved drinking water sources in 2002, though there was a disparity between urban and rural areas. In urban areas that figure stood at 98 percent; in rural areas, 66 percent. The intestinal infections included dysentery, typhoid and hepatitis A. Health officials noted children under five accounted for the majority of infections. “If children become sick there is a danger of strong dehydration, which can lead to death if untreated,” Sarkina said. According to government statistics, 10,506 adults and 21,327 children contracted intestinal infections in 2002, while in 2004 the number increased to 11,392 adults and 25,728 children. Meanwhile, in 2004 there were 7,693 cases of acute infection among adults and 19,395 among children. However, these numbers reflected only registered cases; many cases remained unreported in remote areas where people are faced with limited access to medical services. The situation was worse in the south of the country, in Jalal-Abad, Osh and Batken provinces, considered the poorest and most densely populated parts of Kyrgyzstan. “There is a rise [in] intestinal diseases in the south of the country and the main reason is water. But in general, we do not have cholera and there is a decrease in typhoid cases,” said an official from the country’s Republican Centre of Quarantine and Dangerous Infectious Diseases. In the capital, the majority of people at risk are those living in novostroikas, the new residential areas. Those residents are mainly internal migrants who came to the capital in search of a better life. Some live in houses lacking basic amenities such as electricity, water and waste disposal. The World Bank classifies improved water sources as those coming via a household connection, public standpipe, borehole, protected well or spring, or rainwater collected from a source within 1 km of the dwelling. “To get water I have to walk for about two kilometres,” 15-year-old Nurlan, who came from Kochkor in the central province of Naryn, told IRIN in an illegal settlement near the Dordoi bazaar on the outskirts of Bishkek. Unregulated trade on the streets of major cities was another major cause of intestinal diseases, Sarkina said, adding unqualified and unlicensed traders often did not have refrigerators or other facilities to keep food fresh. “You can buy everything, including food, in such places and traders there do not follow elementary norms of hygiene,” she said. “You can wash fruits [but] you cannot do it with cakes or bread. Sometimes they even sell tinned products with expired dates of consumption.” In an effort to tackle the problem, the health ministry has ordered regional, district and city health bodies to conduct frequent bacteria checks and boost sanitary control.