TB on the rise in the north

The number of reported tuberculosis (TB) cases is on the rise in Tajikistan's northern Sughd Province despite the recent introduction by the World Health Organisation (WHO) of a new method of diagnosing and treating disease. "It is very high in some districts, but it does not mean that the epidemic is increasing. It is probably because of the new diagnostic technique," Nazira Artykova, a liaison officer with WHO, told IRIN from the capital, Dushanbe, on Wednesday. Following the introduction of Directly Observed Treatment Short Course (DOTS) in Sughd, Artykova maintained that the number of TB cases in Machoc and Zafarabad districts was 100 per 100,000. Tajikistan officially has a TB rate of 79 per 100,000. Two years earlier, the rate was 44 per 100,000. Experts attribute this increase to improved diagnosis under the DOTS method, which uses microbiological tests instead of the X-rays used under the old Soviet method. DOTS is the WHO-recommended, universally recognised method of TB control. The programme involves hospitalisation for about three months as opposed to one year coupled with heavy reliance on injections in other treatment methods. TB remains one of the major public-health concerns in the Tajikistan. According to Project Hope, the first DOTS programme in the country, 10 out of every 100,000 Tajiks die of TB annually - a very high percentage in global terms. The government and aid agencies estimate the annual new-notification rate for TB at 127 per 100,000. However, some aid workers fear that many cases are never reported. Artykova blamed poor living conditions as one of the main causes of the disease's spread. While Tajikistan continues to use old Soviet methods of diagnosis with X-rays and admission to specialised TB hospitals for lengthy periods of treatment, the combination of expensive drugs, coupled with food and transport costs, renders completion of the TB treatment out of the reach of most patients in the country, where over 80 percent of its 6.2 million inhabitants still live in poverty. In addition to Sughd, the southern Vasaih, Khatlon and Kulyab districts, together with the northeastern Rasht Valley are the areas with the highest prevalence of the infection. Earlier in the year, aid workers believed that with improved stability and security after the end of the country's five-year civil war in 1997, donors were more confidently investing in longer-term and more diverse TB-control programmes. Such programmes are important, as even an uncomplicated case of TB can take up to nine months to treat. However, Artykova maintained that pledges made during a 16-nation donor conference in May on supporting health care in the country had not been fulfilled, and urged for sustained support in the battle against infectious diseases in Tajikistan. "There are lots of empty promises, but nothing is being provided," she said. [For further information on TB see: www.who.int]