Further reduction of TB requires poverty alleviation, observers say

Most observers equate the persistence of tuberculosis (TB) in Kyrgyzstan with high levels of poverty. "TB, by its nature, is a social disease, and its the reduction depends not only on medical treatment but also on how well poverty is alleviated," the deputy director of the National Centre of Physiology (NCP), the institute responsible for the fight against TB, Myrzahat Imanaliev, told IRIN. While there have been some signs of a reduction in the number of new TB cases in recent years, the disease continues to remain a major health concern in the country. Of its five million inhabitants, those in rural areas and the state's overcrowded prisons are most at risk. TB is primarily an illness of the respiratory system, and is spread by coughing and sneezing. Each year about two million people worldwide die from the curable disease, according to the World Health Organisation (WHO). "The situation with TB in rural areas is stabilising," Oscon Moldokulov, a liaison officer with the 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. After the collapse of the Soviet Union in 1991, TB afflicted many more Kyrgyz people, growing from a rate of 54 per 100,000 people to reach 127 per 100,000 in 2001. At present, nearly 7,000 people in the country are registered as having the disease. Poverty, close interactions within the community, as well as poor water supplies and sanitation remain the main causes of high TB incidences in rural communities. "More than a third of the patients are poor people. They are vagabonds, prisoners, migrants from other regions, soldiers and students. The reason why they caught TB is clear - they have no income", Kurmanbek Palavanov, a doctor at Bishkek's TB hospital, told IRIN. Akylbek Agibetov is a typical sufferer. He hangs around on street corners waiting to be hired for building or labouring work. Agibetov told IRIN he caught the disease after coming to work in the capital from Naryn province. "I don't quite know why I got TB but the doctors said it was due to not eating properly. But I have no choice. I have to send what little money I earn back to my family." Kyrgyzstan was one of the first Central Asian countries to introduce the WHO-approved DOTS strategy to tackle the disease. It includes political commitments, short-course therapy for those sick with TB and access to drugs to control the condition. Since 1996, Bishkek has implemented two five-year programmed based on the DOTS strategy, and they are having an impact on TB mortality figures. The TB death rate has dropped from 16 per 100,000 in 1997, to 11.8 per 100,000 in 2003. "Kyrgyzstan has shown good progress with TB, but has not yet been able to reduce the disease to under epidemic proportions," Timur Aptekary, a TB specialist with the HOPE Project that conducts training on the DOTS strategy for health workers, said. According to WHO standards, a TB prevalence rate above 100 per 100,000 for developing countries means the disease has reached epidemic proportions.