TB remains problematic in rural areas and prisons

While there have been some signs of improvement, tuberculosis (TB) continues to remain a major health concern in Kyrgyzstan. Of the country's five million inhabitants, those in rural areas and the state's overcrowded prisons are most at risk. "The situation with TB in rural areas is stabilising", Oscon Moldokulov, a liaison officer with the World Health Organisation (WHO), told IRIN from the Kyrgyz capital, Bishkek, noting, however, that case detection for the disease still fell short of the WHO's target of 70 percent. Poverty, close interaction within the community, as well as a low level of water supply and sanitation were the main causes of TB incidence in rural communities, he said. According to the Moldokulov, whereas there had been 116.1 incidences of the disease per 100,000 in 1997, that rate stabilised at 127.3 cases in 2001. He noted that the WHO-recommended strategy for detection and treatment of TB, commonly referred to as DOTS (Directly Observed Treatment Short Course], and implemented throughout the country since 1998, was now virtually comprehensive. "DOTS coverage is 98 percent," he said. The treatment method combines five elements: political commitment, diagnosis by means of microscopy services, regular drug supplies, surveillance and monitoring systems and direct observation of treatment. Once patients with infectious TB (bacilli visible in a sputum smear) have been identified by microscopy services, health and community workers and trained volunteers observe patients to ensure they ingest the full six- to eight-month course of the correct dosage of anti-TB medicines. The most common anti-TB drugs are isoniazid, rifampicin, pyrazinamide, streptomycin and ethambutol; a six-month supply of drugs for DOTS costs as little as US $10 per patient in some parts of the world. Sputum smear-testing is repeated after two months to check progress, and again at the end of treatment. A recording and reporting system documents patients' progress throughout, and the final outcome of treatment. However, Avtandil Alisherov, the director at the Kyrgyz National TB Institute, was less optimistic. "The current situation with TB in the Kyrgyz Republic is not good. TB incidence among the population continues to increase every year," he told IRIN, citing economic instability and lack of medical awareness and TB education among the population as contributory factors. And with almost 70 percent of the Kyrgyz population living in rural areas, it was vital to pay that group a greater degree of attention. Meanwhile, both experts conceded that the situation within the prison system was even worse. "While there were 2,964 cases in 1997 per 100,000 people, there were 7,854 incidences in 2001," Moldokulov said. In short, in just five years, the number of cases in the system had increased by over 170 percent. "Prisons have become the reservoirs of TB, including its drug-resistant forms," Alisherov commented. Moldokulov blamed a lack of state financing for the system - lack of equipment, supplies and training of medical staff on the application of DOTS, coupled with poor nutrition, sanitation, ventilation and overcrowding, as the root causes. Whereas DOTS was being applied in the rural areas, he said, access to and the quality of health services remained far from adequate, and stronger budgetary support was required to rectify the situation. According to the WHO, TB kills about two million people worldwide each year, making it a leading killer of young people. Over one-third of the world's population is now infected with the TB bacillus, and at risk of developing the disease. Despite that, prevention of TB is one of the most cost-effective, with medicines being over 95 percent effective. However, strains of TB bacteria resistant to one or more TB drugs are increasing worldwide, threatening to render TB more expensive to treat and potentially even incurable for future generations. [For further information on TB see: www.who.int]