TUBERCULOSIS SPREADS IN KAZAKHSTAN.

Tuberculosis (TB), the world’s leading infectious killer, has reached "epidemic proportions" in Kazakhstan, according to the republic’s Institute of Tuberculosis. (Itar-Tass, January 27) Addressing a press conference at the institute on January 27, the head of the government’s health committee (within the Ministry of Education, Culture and Health), Vasily Devyatko, stated that the disease in Kazakhstan infects between 13,000 and 14,500 people annually. In 1997 alone, TB deaths in the republic totaled approximately 7,000, double the number three years ago. Today, it is believed that around 53,000 of Kazakhstan’s 15.8 million inhabitants are infected and that more than 13,000 are carriers. (Russian agencies, January 27; Delovaya nedelya, 29 January; Panorama, 30 January)

Medical experts attribute the sharp rise in TB infection primarily to falling living standards and insufficient medical care at a time of social and economic turmoil. Nearly 29 percent of the 7,000 who perished last year died at home, having received no medical treatment. The model of care to treat TB that was used during the Soviet era is no longer affordable for either the state or patient. Local charges for monthly treatments are $100-120, over twice the government-defined monthly individual poverty line of $50. (Reuter, November 12, 1997; Delovaya nedelya, January 29) Kazakhstan now has the highest per capita rate of TB among CIS countries. (Delovaya nedelya, 29 January; Panorama, 30 January)

New TB treatment practices are slowly being implemented. Since last June, a WHO-sponsored traveling clinic has been training local specialists in DOTS (Directly Observed Treatment, Short-course), the linchpin of the WHO Global Tuberculosis Program. DOTS’ 85-percent cure rate results from its stipulation that health services monitor patients’ progress until each is cured. (https://www.who.ch)

One of President Nazarbaev’s eight tasks assigned to the government for 1998 is "to launch a public campaign for a healthy mode of life." (Kazakhstan-2030, p. 247) This month Devyatko outlined the preparation of a bill and the planned adoption of a government decree on TB treatment. A national council will be established to implement the strategy. Meanwhile, Devyatko stated, another 16,000 cases of infection are likely to arise in 1998. Of these, 15 percent will be fatal. The disease is likely to continue to spread over the next five to six years. If the situation is not contained, "hot zones," where people are helpless to protect themselves against drug-resistant strains, may spring up. (See Press Release, WHO/74, October 22, 1997) Such strains have already been discovered in Russia, Latvia and Estonia. There are fears that they may also spread to Kazakhstan.

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