Focus on brucellosis in south

Health officials in southern Kyrgyzstan have expressed concern over the growing number of people infected with brucellosis, an infectious bacterial disease of human beings transmitted by contact with infected animals, infected meat or milk products and characterised by fever and headache. "My bones are aching so bad that I am about to climb up the wall. I can neither sleep nor rest," 45-year-old Abidilla from the mountainous Chong Alay District of the southern province of Osh told IRIN. He was sent to the Osh provincial hospital earlier this month after being diagnosed with an acute form of the disease. For Abidilla, however, his greatest concern remains his daughter-in-law, who also underwent treatment for brucellosis in the hospital's infectious disease unit recently. The disease can reportedly can wreak devastating effects on young women's bodies, resulting in miscarriages and even sterility. According to local doctors, Abidillah contracted the disease after consuming undercooked meat, which is quite a common dietary habit in mountainous areas where it is difficult to fully cook meat and other foods at a high altitude. "Brucellosis is a painful, exhausting disease of an infectious and allergic type, which proceeds for years and affects various body parts and often results in their collapse," Adakhamjan Abdumomunov, the head of the infectious diseases unit the Osh provincial hospital, told IRIN, noting the malady often affected bone and joints, the urinary and nervous systems, as well as the liver and spleen. STEEP RISE IN CASES Taken from a broader viewpoint, however, brucellosis had rapidly assumed the proportion of one of the most serious health threats in the region, undermining the nation's genetic fund, said the Kyrgyz health ministry, following a recent meeting of its senior officials in Osh. Health officials have expressed concern over the rapid increase in the number of cases occurring. In the first six months of 2003, some 1,170 cases were registered, 270 more compared to the same period last year. Every fifth person infected was either a child or an adolescent. Indeed, some Kyrgyz health persons claim that Kyrgyzstan, a nation of just 5 million, has the highest prevalence of the disease in Central Asia. According to regional authorities, brucellosis is also becoming a burden on the country's already under-resourced health system. Standard treatment for a patient with the acute form of the disease costs US $150, whereas the average monthly salary stands at just $25. Health specialists are particularly concerned over the situation in the southwestern Batken Province, where the morbidity was three times the average in the country, and southern Jalal-Abad Province. Local health officials cited grinding poverty of the rural population, a low hygiene culture, coupled with the collapse of the system which had been capable of fighting livestock diseases during the Soviet era. "The epizootic situation in the region is getting worse year by year. Stock farming rural people don't often have money to buy working clothes and hygiene products," a sanitary inspector told IRIN in Batken. Brucellosis cannot be contracted between human beings. Infection comes while slaughtering or contacting the meat of an infected animal. Also, the other way of contracting the disease is consuming poor meat and diary products, or even while swimming in or drinking water from water reservoirs where cattle are watered. INADEQUATE VETERINARY SUPERVISION Alexandra Vasilyeva, a retired resident in Osh, complained to IRIN that neither veterinary nor sanitary inspection agencies were addressing issue effectively. "Meat, milk and other dairy products are sold on every corner without any sanitary certificate or quality certificate, and nobody cares," she complained. Meanwhile, some health ministry officials admitted that while veterinary services had been reporting almost 100 percent surveillance of animals, they were under-stating the number of sick animals. "Before, if several sick animals were found in a flock, the whole herd would have been sent to a meat factory to be slaughtered," Ahmad Ergeshev, an experienced food industry expert, told IRIN in Osh, adding that after a thorough heat treatment the product was used for sausages or canned. "Now livestock is totally in the hands of private farmers and those poorer ones do not know to whom to sell the meat of an infected animal. It is forbidden to sell it and there is no a meat-packing factory around, so he continues to keep the sick animal, hoping for the best," Ergeshev added. CONCERTED EFFORT NEEDED Mitalip Mamytov, the health minister, told IRIN that the problem was not only a medical, but also a social one. "It demands the joint efforts of various bodies and the society," he said, offering to create an inter-organisational commission for coordinating the fight against brucellosis, which should comprise health, agriculture, science and education experts. Mamytov also said that international organisations could help. "Various expensive reagents are necessary for conducting analyses on brucellosis," he said, noting, however, that due to lack of resources they were conducting only simple and easy laboratory tests, which could result in low-quality diagnosis and treatment. He also gave a good example of the cooperation between Swiss Development Fund and the mountainous province of Naryn, resulting in a noticeable decrease in the number of brucellosis cases there. Foreign partners were helping in the training of specialists and also the population, as well as providing necessary equipment and medicines. Directors of the Batken and Jalal-Abad provincial hospitals reportedly said they were ready to learn from the experience of their colleagues in Naryn, especially within the framework of an ongoing Kyrgyz-Swiss hygiene project there. Officials at the hospitals in Batken Province noted a severe lack of qualified doctors, namely infectious diseases specialists. Moreover, most of the local doctors had undergone no recent specialisation tests nor received any professional training skills on such issues for a long time. "Authorities do have to tighten veterinary and sanitary control," said Abdumomunov. There are also some other ideas on how to deal with the issue. "It would be good if the government could buy the infected animals from farmers for their further processing for meat products, or it could reimburse farmers' expenses for [infected] animals they had to slaughter," Vakhit Aliev, a prominent zootechnician who used to head a huge cattle-breeding facility, told IRIN in Osh. He also emphasised the importance of reviving and developing the veterinary service as there remained a lack of experienced and well-trained specialists on the ground. According to local media reports, scientists at the Kyrgyz livestock, veterinary and pastures research institute have developed an inexpensive and simple method of diagnosing brucellosis, thereby providing a means of identifying the source of the infection at its earlier stages. However, the method had failed to become widespread, the scientists complained, with only farmers in three northern districts having expressed an interest in it. "Provincial authorities raise the issue periodically at the meetings of emergency counter-epidemic commissions. However there is a need for comprehensive social, veterinary, medical and educational measures, which would be able to eradicate the problem," Kamil Atakhanov, a prominent and experienced health specialist in Osh, concluded.