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Central Asia: Region Struggles To Combat High Rates Of Tuberculosis

  • Farangis Najibullah

Tuberculosis has been on the rise in Central Asia over the past 10 years. The spread of the disease is exacerbated by the region's widespread poverty, shortage of TB drugs, minimal diagnostic equipment, and a lack of trained specialists. Tajikistan recently launched a program to eradicate TB by 2010, but as RFE/RL reports, the challenge is proving to be monumental.

Prague, 26 February 2003 (RFE/RL) -- Tuberculosis kills about 2 million people every year, most of them in Africa, Asia, and the former Soviet Union. The infection rates for tuberculosis (TB) have increased dramatically throughout Central Asia over the past 10 years, with some specialists saying the number of new cases is of epidemic proportions.

In Kazakhstan, tuberculosis has been declared a national emergency, with the government issuing a decree allocating more state money for anti-TB drugs.

In Kyrgyzstan and Turkmenistan, both the number of reported cases and the number of people dying from the disease are on the increase.

The situation is slightly better in Uzbekistan, but the disease is found to be spreading in areas around the shrinking Aral Sea.

The government of Tajikistan recently introduced a program to eradicate tuberculosis by 2010, but it's highly unlikely that Tajikistan or any other Central Asian country will be able to implement such programs without outside help.

Mahbuba Eshanova is the head of a TB clinic in Dehmoy in northern Tajikistan. She said the dispensary receives only 1.5 somoni ($0.50) for each TB patient per day. "We receive [from the government budget] 1 somoni per patient per day for their daily food. We get another 26 to 40 diram [$0.08-$0.13] per patient per day for medication. But the TB patients have to get sufficient meals at least three times a day, and we need 1.6 somoni for each patient's food each day. For medication, sometimes we have to spend at least 8 somoni per patient per day, because some TB-infected people come to the dispensary in the late stages of the illness. Sometimes they need treatment for TB-related anemia, heart problems, and, of course, for TB itself," Eshanova said.

Eshanova said widespread poverty is one of the main reasons behind Central Asia's high rates of tuberculosis. "Since 1995, the number of TB patients is increasing. Mostly those people who have a poor diet and cannot afford sufficient food suffer from the disease, because their weakened bodies have little resistance to the illness," Eshanova said, adding, "People need to get adequate food and vitamins to resist tuberculosis."

Indira Aitmagambetova is a project-management specialist for the United States Agency for International Development's (USAID) mission in Almaty. She told RFE/RL that the situation is not much better in oil- and gas-rich countries like Kazakhstan and Turkmenistan. "In recent years, the case-notification rate has been increasing. For example, in 1990 in Kazakhstan, the case-notification rate was 66 per 100,000 of population. It has increased dramatically. In 2000, there were 165 TB cases for 100,000 population," Aitmagambetova said.

There are still many tuberculosis dispensaries and sanatoriums in the region, relics of Soviet times, when the disease had largely disappeared. Uzbekistan alone contains 20 anti-TB dispensaries, five specialized kindergartens, a specialized boarding school, and a children's sanatorium. All of these facilities today face shortages of medicine, diagnostic equipment, and trained specialists.

The health-care system has declined in quality throughout the region. Recognizing the severity of the problem, a number of international organizations, such as USAID, the World Bank, Doctors Without Borders, are now providing aid and launching anti-TB programs in Central Asia.

USAID has sponsored the Project HOPE Tuberculosis Initiatives Program since 1998. The basis of the program is the implementation of the World Health Organization's strategy for tuberculosis control, which involves a directly observed short-course treatment known as DOTS. DOTS is one of the most effective methods available for controlling the TB epidemic.

International organizations also provide technical assistance, such as microscopes and laboratory supplies. They also help train local TB specialists and health-care workers.

Qurbon-gul Zokirova, head of the national anti-TB center in Tajikistan, told RFE/RL that even the UN World Food Program provides food for first-time TB patients and their families. Zokirova said that she is satisfied with the help the center is receiving both from international organizations and the government. "TB institutions in Tajikistan received several pieces of diagnostic equipment worth 1.5 million euros [$1.61 million], including two stationary and 10 mobile X-ray stations, as well as 50 modern binocular microscopes," Zokirova said, adding that the funding was provided by Germany.

Aitmagambetova said that one of the most important aspects of the anti-TB campaign is raising public awareness about the disease. According to Doctors Without Borders, people infected with TB often do not know they have the disease, do not seek professional help, or receive treatment at home, thereby infecting relatives and neighbors.

Guljahon Pulatova, a TB patient in Dehmoy, said she tries not to infect those around her, but noted that friends and family take few precautions. "In public places, on buses, I am very careful. I try not to infect people. For instance, I cover my mouth when I talk. But in our neighborhood and among our relatives, no one treats me any differently," Pulatova said.

Zokirova said the anti-TB center in Tajikistan runs special advertisements on national television and radio programs and also distributes free calendars that contain important information about measures to prevent TB. "As a part of our nationwide anti-TB campaign," she said, "we want to remind people about the problem every day in order to rid the society of the disease," Zokirova said.