Tuberculosis in Kazakhstan

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Tuberculosis in Kazakhstan

• Irina Gelmanova
• Boston University School of Public Health

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• Kazakhstan is the ninth biggest country in the
  world,
• Kazakhstan has borders with Russia, China,
  Kyrgyzstan, Uzbekistan, Turkmenistan
• The total area is 2,717,300 sq-km
• The total population is 14,896,100 people
• The density of the population is 5.5 people per
  sq-km.

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Case Notification Rate European region 1998
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Dynamic of TB Morbidity in Kazakhstan
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GNP per capita in Kazakhstan in national currency
Economic crisis resulted in reduction of
expenditures on Health Care first of all,
decreased subsidization of TB drugs and active
TB cases detection by X-ray examination
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Other Reasons for Increasing TB Rate in Kazakhstan

• Breakdown of previous system of active case
  detection by X-ray examination
• The common tactics to hide the real picture of TB
  rate in many regions
• Deterioration of conditions in the prisons. The
  prevalence of TB inside the prisons is more than
  100 times that in general population.

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DECLINING FOOD CONSUMPTION IN KAZAKHSTAN(1994
year is taken as a baseline)
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of pregnant women suffered from anemia during
consequent years in Kazakhstan
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PATTERN OF TB IN 47 NEW CASES (DATA OF
MSF-LUXEMBOURG MISSION, ALMATY)

• 13 patients were MDR
• Additional 25 were resistant to Isoniazid in
  combination with other drugs. They have all
  chances to become MDR after DOTS therapy.
• Resistance to Streptomycin comprised 43

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Results of DST of 48 relapsed cases (Data of
MSF-Luxembourg mission, Almaty)
MDR reached 37 47 additionally had low
chances to recover due to their resistance to
Isoniazid 16 have good chances to recover
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THE REASONS FOR MDR RESISTANCE IN KAZAKHSTAN.

• Mono therapy
• In prisons
• In TB dispensaries due to lack of drugs
• Widespread practice of prophylactic treatment
  (mostly by Isoniazid)
• Use of Streptomycin and Kanamycin for treatment
  of non-TB conditions.

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Results of DOTS Treatment in Kazakhstan

• KNCV (working in Pawlodar Prison)-
• 2nd quarter 199827 were cured,
• 3rd quarter 1998 68 were cured.
• Mobile TB Clinic (Project HOPE)
• 23.6 completed the full course of TB
  successfully.
• MSF (Almaty oblast)
• around 70 cure rate for new cases
• around 50 cure rate for relapsed.

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DOTS for Kazakhstan?

• MDR rate is very high
• Local personnel are not prepared and trained
  enough. There is no incentives for health workers
• Lack of management skills of TB leaders
• Density of population is very low, especially, in
  rural places. It is very difficult to control and
  expensive at the same time.
• Ex-prisoners are returning home to join their
  friends. High rate of unemployment.
• Difficulties to establish good laboratory service

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Conclusion

• Kazakhstan has a serious TB problem. Both MDR and
  non MDR tuberculosis
• Economic, social and political conditions are
  driving this epidemic
• Urgent action is needed to prevent the epidemic
  exploding out of the prisons into the general
  population
• International Assistance is absolutely essential!
• DOTS may not be enough and may aggravate the
  situation!