High Prevalence of Multi-Drug Resistant Tuberculosis in Uzbekistan
April 28, 2008
The Uzbek capital city Tashkent ranks
among the top five areas with
alarmingly high rates of multiple-drug
resistant tuberculosis (MDR-TB), the
World Health Organization (WHO)
stated in its latest Anti-Tuberculosis
Drug Resistance in the World report.
Overview of Tuberculosis in
Uzbekistan
Tuberculosis (TB) is an air-borne,
infectious disease. Like the common
cold, TB bacilli are propelled into the
air when infected persons cough,
sneeze, or talk. Those infected do
not necessarily fall sick, however, a
weakened immune system heightens the likelihood of illness caused by active TB.
From 1995 to 2001, TB infection rates in Uzbekistan practically doubled; rising from 43.2 per 100,000 people in 1995 to 77.2 in 2003, according to the U.S. Department of State. TB infection rates have continued rise with a 25 percent increase over the past three years, the independent news Web site Uznews reported.
North-western Uzbekistan was among the hardest hit regions. Poverty, inadequate medical care, and the desertification of the Aral Sea accelerated the growth of TB. Of these causes, the consequences of the ecological disaster may be the most profound. Unemployment in Karakalpakstan, for example, is over 70 percent, according to international press reports. In light of this desperate situation, families are more likely to buy contaminated or spoiled food products which increase their susceptibility to bacteria. In addition to destroying the livelihood of the regions’ inhabitants, desertification of the Aral Sea has created an ideal environment for TB to thrive: wind-borne salt and chemicals from the dried sea bed and rising temperatures have caused respiratory infections and leaving the population vulnerable to TB infection.
Multiple-Drug Resistant Tuberculosis
The recent WHO report illustrated an even more alarming scenario: high rates of MDR-TB in Central Asia’s largest city and the capital of Uzbekistan, Tashkent. According to the World Health Organization, MDR-TB is the disease caused by TB bacilli resistant to at least isoniazid and rifampicin, the two most powerful anti-TB drugs. MDR-TB can develop due to inadequate medical care and shortages of first-line anti-TB drugs. MDR-TB can also be acquired – persons infected with the resistant strain can transmit it to others, even if they have not been infected with common TB already.
While common TB can be cured cheaply by taking several drug for six to twelve months, treatment regimens for MDR-TB are complicated, lengthy and expensive, according to the international humanitarian organization Partners in Health (PIH). The cost of treating common TB costs around US$20 per person but treatment for MDR-TB is much higher, from US$500 to US$3,000, the International Herald Tribune reported in February. Treatment for MDR-TB includes up to two years of extensive chemotherapy with second-line TB drugs, which often cause painful side effects among patients.
The international medical aid agency Medecins Sans Frontieres (MSF) has been treating MDR-TB in Uzbekistan since 2003 by implementing a project which treats patients in the hospital for 12 months and later though out patient services. During their hospitalization, patients take a combination of five to six different drugs and as many as twenty-five pills per day. These drugs take a toll on patients. Yakubpai Urazbyev told MSF staff members the drugs caused terrible headaches which start after taking the drugs in the morning and only subside the next morning. “The worst thing is that I have to begin it all over again,” an MSF press release quoted her as saying.
The physical pain is not the only side effect of MDR-TB treatment. Because patients have to spend long periods in the hospital away from their families, many report severe mental health consequences such as depression and feelings of isolation.
“Prison Stress”
Like in Russia and other areas of the former Soviet Union, prisons and labor camps have contributed to the rise of MDR-TB in Uzbekistan.
In Russia, health authorities coined the termed “prison stress” to describe the experience faced by inmates who are suddenly forced to endure the hardship of prison life, including overcrowding, bad living conditions, and emotional upsets, the Global Fund to Fight AIDS, Tuberculosis and Malaria stated in a March 2008 press release.
The term is applicable to the situation in Uzbekistan. The US Department of State called conditions in Uzbek prisons “poor and life threatening” and acknowledged “tuberculosis [made] even short periods of incarceration potentially life threatening” in its 2007 Human Rights Report released on March 11th. Prison facilities are so overcrowded inmates are forced to sleep in shifts while meals are often limited to a small piece of bread and tea, according to Human Rights Watch. Despite a significant decline in Uzbek prison conditions over the last fifteen years, the number of inmates has risen to catastrophic proportions, a recent report by the independent magazine Transitions Online stated.
As a result, TB is far more prevalent in prisons and other places of detention than in the outside community. Although the Uzbek government has not released figures of the number of those incarcerated or the official estimate of TB-infected prisoners, the International Committee of the Red Cross (ICRC) has said 25 percent of those infected with the disease overall are currently in prison.
Health and human rights activists say rampant TB in prisons is causing the infection rate to rise sharply among the general population. The TB epidemic in prisons affects non-inmates as well. On average, four to six times more non-prisoners such as visitors, health workers, lawyers, and prison staff members pass through prisons during the course of a year, Transitions Online reported. TB is also exported to the general population when detainees are released and returned to their communities, the ICRC stated in a press release on World TB Day, which is observed annually every March 24th. Left untreated, each person with active TB will infect between ten and fifteen people every year, according to the World Health Organization.
HIV/Tuberculosis Co-infection
Human Immunodeficiency Virus (HIV) is a virus that weakens the immune system and causes Acquired Immunodeficiency Syndrome (AIDS). “Uzbekistan, Central Asia’s most populous state, is experiencing a faster growth in its HIV infection rate than sub-Saharan Africa,” the United Nations news agency IRIN reported. According to the Joint United Nations programme on HIV/AIDS (UNAIDS), approximately 31, 000 people are living with HIV/AIDS in Uzbekistan. In UNAIDS’ latest Epidemic Update, the organization reported that Uzbekistan now has the largest epidemic in Central Asia and noted the number of newly reported HIV diagnoses rose exponentially between 1999 and 2003, from 28 to 1836.
HIV forms a lethal combination with TB, which is the leading killer of HIV-positive people worldwide. Research implemented by the Stop TB Partnership, an international network of governmental and nongovernmental organizations, has shown people living with HIV are 50 times more likely to develop TB than those who are HIV-negative. If effective measures are not taken soon, high rates of MDR-TB and an accelerating HIV infection rate could create a catastrophic public health crisis in Uzbekistan.