TB on the rise, say health officials

The number of tuberculosis cases is on the rise in Tajikistan, with official statistics showing that the country now has more than 12,000 patients suffering from the disease. "The situation with regard to TB in Tajikistan remains a problem. It is still an urgent issue," Sadullo Saydaliev, director of the Tajik TB control centre, confirmed to IRIN from the capital Dushanbe on Monday. "The number of registered cases of the infection is rising." "This disease poses a serious problem, both to the state and society. According to the National TB Control Centre, between 2,800 and 3,500 new cases of TB are registered each year in Tajikistan, and this trend continues to go upward," Nazira Artykova, a liaison officer for the World Health Organization (WHO), told IRIN from Dushanbe. According to the Tajik TB Control Centre, officially registered new cases of TB amounted to 55 per 100,000 of the population in 2001. In 2002 that figure rose to 64, and went up to 67 in 2003. The TB mortality rate stood at 7.1 cases per 100,000 in 2003. The population of Tajikistan is some 6.5 million. The recent rise in the number of cases was related to an increasing number of cases registered in the areas where the Directly Observed Treatment Short course (DOTS) was in place, Saydaliev explained. Medication and treatment are free of charge in areas where DOTS is implemented, with assistance from the WHO, and this has led to better detection and registration, he said. The WHO supplies free of charge all the necessary anti-TB drugs through its global drugs facility. However, the real number of TB-infected in the country could be several times the official figure. "Based on assessment sources, the real number of TB sufferers in the country is much higher than the official data shows, [as much as] five to six times higher, particularly among prisoners and people living in overcrowded places such as hostels," Artykova claimed. The WHO official cited the poor socio-economic situation in the country and its weak health sector as the main causes of the disease. "The main reasons for the spread of TB in Tajikistan are the poor socioeconomic situation in the republic, inadequate nutrition, poverty and unemployment," she said. Furthermore, medical facilities in Tajikistan are not able to carry out a detailed survey due to an inadequate health budget and specialised laboratory equipment, along with a shortage of skilled personnel, she added. Echoing that view, Saydaliev said that one of the issues that required tackling was the lack of training for health personnel dealing with TB, especially in rural areas. "We need more training for our staff dealing with TB...Proper training will pay dividends in the form of better monitoring, detection and treatment," he stressed. Although there is a government programme to fight TB until 2010, the most impoverished of the Central Asian republics simply doesn't have the resources to fight the infection on a large scale. According to the World Bank, some 83 percent of the population lives below the national poverty line, of which 17 percent is considered to be destitute. In an effort to contribute to anti-TB efforts in the country, the WHO and other donors, including the United States Agency for International Development (USAID), World Bank, Swiss Development Agency (SDA) and Project HOPE, an international health NGO, are rendering support to the national TB programme with capacity building through training, laboratory supply, and evaluation and monitoring of DOTS strategy implementation. Meanwhile, WHO experts supported a National Coordination Committee on the development and submission of proposals to the Global Fund to fight AIDS, TB and Malaria, which is set to provide more than US $1.2 million for 2004-05. The German-based KFW development bank is also investing $3 million to support anti-TB activities not covered by technical agencies.