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TB Epidemic in Tajikistan

TB Epidemic in Tajikistan

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TB Epidemic in Tajikistan

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  1. TB Epidemic in Tajikistan ALI BUZURUKOV BU School of Public Health bjali@bu.edu

  2. Pamir –highest mountains of former USSR

  3. TajikistanCountry Background Former Soviet Union Republic in Central Asia Total population 6.O66 million Approximately the size of Wisconsin: 143,100 km2 Landlocked Mountainous country

  4. Country Socioeconomic Background • GNP $ 360 • 80% below poverty line • Mostly rural population 72% • 44% under age 15 • 98.6% literacy rate • Pop. Growth 1.7%

  5. COUNTRY HEALTH INDICATORS • Infant mortality rate 57/1,000 • Maternal mortality rate 130/100,000 • Life expectancy at birth 68.3 years • 19.4 doctors per 1000 patients

  6. 1991 1995 1997 Allocations for Health % of GDP 4% 1.4 1.6 Per capita expenditures $ 300 $6.2 $ 2.7 Source: State Statistical Agency, HDR 1998

  7. TB services “Free treatment” Two TB centers 59 regional dispensaries Two Republican complex hospitals Four regional hospitals One Children hospital

  8. Factors contributing to TB Epidemic • Collapse of health care system • Civil war and huge migration processes • Poor treatment & diagnosis • “Brain drain” of Medical personal • Drug supply at 10% • No reliable statistics

  9. TB Mortality and Incidence Rates in Tajikistan (MOH) WHO Estimate: 267/100,000 Ahad Fazelad

  10. Reported Cases of TB 1980-1998 (MOH) Notification

  11. “Tajikistan does not even have pilot areas under DOTS- you can be sure they have NO idea of the extent MDR TB “ Quote from Ian Small, Head of Mission, Médecins Sans Frontières, The Aral Sea Program With the collapse of Soviet health care system, infectious diseases outbreaks have become frequent, especially in rural areas.

  12. Children and TB • 20% Extra-pulmonary TB 30% in Children • Only TB Children hospital for 96 beds • Street Children Orphan girl standing in front of her destroyed home http://benevolence.org

  13. Children TB Hospital in Dushanbe financed by poor state budget

  14. What is to be done? • Government commitment to sustain TB control • Sputum smear microscopy to detect infectious cases • Standardized short-course treatment regimen with direct observation • Regular, uninterrupted drug supply • Monitoring and reporting system

  15. Need for International aid • TB drugs • DOTS promotion • Research • Partnership