Experts are concerned about the growing incidence of multidrug-resistant tuberculosis in the country.
According to WHO, tuberculosis is on the 13th place among main causes of death and on the second place among infectious diseases after COVID-19. In Central Asia, Kyrgyzstan has the highest rates of tuberculosis incidence per 100 thousand people. The country overtakes Tajikistan by 50 per cent, and Kazakhstan by 76 per cent.
Until 2020, according to the National Statistical Committee, Kyrgyzstan had over five thousand cases of active tuberculosis registered every year. During the coronavirus pandemic, rates fell almost by 1.5 times. According to WHO, it was a worldwide trend. It was due to the fact that access to health services was disrupted during the pandemic, while staff and financial resources were redirected to fight COVID-19. Tuberculosis deaths have risen during this period, while a part of people falling ill with tuberculosis was not covered by official statistics.
Bishkek and Chui region, as well as southern regions of Kyrgyzstan are leading in terms of tuberculosis cases.
According to Natalia Shumskaya, head of AFEW, Kyrgyzstan has had some achievements in fighting tuberculosis in latest years. In particular, reduction of cases of drug-sensitive tuberculosis. Nevertheless, more other problems remain.
“For example, increase in cases of multidrug-resistant tuberculosis. It shows we are missing out on something. Therefore, it is important to have interaction between medical, civil societies and the media so that people do not face stigma and discrimination and could seek help in case of symptoms and complete treatment successfully,” she said.
Multidrug-resistant tuberculosis is the tuberculosis that is resistant to main anti-tuberculosis drugs. It requires more complex and longer treatment. About 38 per cent of cases in the country fall on multidrug-resistant tuberculosis, according to the WHO. Kyrgyzstan, just like other Central Asian states (except for Turkmenistan), are on the list of 30 global states with the highest drug-resistant tuberculosis burden.
Moreover, Kyrgyzstan has strong stereotypes about tuberculosis and stigma about people who fall ill with it. According to specialists, health workers, relatives and colleagues can have negative attitudes. There are cases when people who fell ill with tuberculosis get ousted from home, cannot find work, etc. Therefore, many people hide their illness even from family members or tell wrong addresses, which makes it impossible to identify contacts.
According to experts, there have been cases when people who fell ill with tuberculosis stop treatment or refuse it. The request of CABAR.asia on the number of such cases remained unanswered by the National Tuberculosis Centre of the Ministry of Health of the Kyrgyz Republic. Public Foundation AFEW searches for so-called ‘lost’ patients and according to Bermet Kulbaeva, project coordinator, in most cases these are migrants who have left the country.
“There are those patients who categorically refuse treatment on religious grounds; those patients who feel well and think they do not have a tuberculosis; those patients who prefer to get treated by means of alternative medicine or products of marketing companies. But there are those patients who return and continue treatment. We provide such patients with food packages and top up their phones so that they are always in contact with us and their attending physicians,” she said.
Moreover, a patient becomes non-infectious to others in two weeks after correct and stable treatment, and tuberculosis is fully curable. Together with Nestan Moidunova, representative of the National Tuberculosis Centre, and Bakyt Myrzaliev, representative of KNCV in the Kyrgyz Republic, lecturer at the department of phthisiology of the Kyrgyz State Medical Academy, we will figure out why tuberculosis is dangerous, how to reduce risks of infection, and how to treat it if you fell ill with it.
Tuberculosis is a bacterial infectious disease spread by airborne transmission. People infected with open pulmonary tuberculosis expel mycobacteria tuberculosis, which spread through the air and can infect other people.
Most often, we think of lung damage once we hear the word ‘tuberculosis’. In fact, tuberculosis destroys respiratory system in 90 per cent of cases, but the disease can affect other organs but nails and hair.
In fact, it is not. Any person with weak immune system can fall ill with tuberculosis regardless of social status and living standard. The risk group consists of:
- People with diabetes,
- People on dialysis,
- Migrants,
- Patients with HIV status,
- Socially vulnerable populations,
- Prisoners,
- Military personnel,
- Seniors and children.
People with chronic stress or who have a strict, unbalanced diet have a higher risk of falling ill with tuberculosis.
In any crowded place. However, a prolong exposure is needed to get ill with tuberculosis. It means that you are unlikely to get ill during a ride on public transport from home to work. But, for example, you can get ill during work or a long flight.
Therefore, when a person who fell ill with tuberculosis is identified, all his contacts should be found. These are family members, as well as colleagues and those who have contacted him/her for more than 8 hours straight. They are get tested and if any persons infected with tuberculosis (without active tuberculosis) are found, they are prescribed preventive therapy.
Even if a person is infected, it does not mean that he/she would fall ill with tuberculosis. It can manifest itself within two years. For example, the organism can fight the mycobacterium well for some time, but then, because of the stress, disease or other factors, immune system could decrease and tuberculosis could manifest itself.
However, if a person does not fall ill in two years after being infected, he/she is unlikely to fall ill.
No, they are not. Tuberculosis can be classified as ‘open’ and ‘non-open’. A person with ‘open’ tuberculosis releases mycobacteria into the air. A person with ‘non-open’ tuberculosis is a carrier, yet poses no risk to those surrounding him.
Two weeks after the start of treatment, the ‘open’ tuberculosis becomes ‘non-open’. And the ‘non-open’ tuberculosis can become ‘open’ if untreated.
The main symptoms of tuberculosis are as follows:
- Long-lasting cough (sometimes with bloody mucus);
- Chest pain;
- Weakness;
- High fatigability;
- Weight loss;
- Fever;
- Night sweats.
However, sometimes tuberculosis could show no signs.
Specialists recommend contacting your local doctor if you have any cough. They will take your case history and make an X-ray of your chest. If you have had a lasting cough and it would not go away after antibiotics, the doctor shall prescribe a sputum test.
All polyclinics of Kyrgyzstan have special places where you collect sputum under control of a health worker. Then, the sample is sent for analysis and the following day you would get the result.
Moreover, any medical centre, either private or public, can give you a sputum sample container, which would be then sent for analysis.
It is free of charge.
Yes, it is. Tuberculosis is fully curable if properly treated and tuberculosis medicines are taken regularly.
It depends on the type of tuberculosis. It can be:
- Drug-sensitive tuberculosis – can be treated by any tuberculosis medicines;
- Multidrug-resistant tuberculosis (MDR-TB) – it is resistance to two main tuberculosis medicines – isoniazid and rifampicin;
- Pre-extensively drug resistant tuberculosis (pre-XDR-TB) – it is resistance to isoniazid and rifampicin and to fluoroquinolone;
- Extensively drug resistant tuberculosis (XDR-TB) – it is resistance to at least four main tuberculosis medicines;
- Totally drug resistant tuberculosis (TRD-TB) – it means resistance to all medicines. This type of tuberculosis is non-curable.
Once you get infected with tuberculosis, you get the same type of tuberculosis, which the person that has infected you has. For example, if you get infected from a person with XDR-TB, you will fall ill with that kind of tuberculosis.
If you have a drug-sensitive tuberculosis, Kyrgyzstan can offer you treatment by four medicines for 6 months.
A MDR-TB is treated by the BPaLM regimen, the bedaquiline, pretomanid, linezolid and moxifloxacin. This regimen is provided for 6-9 months.
A pre-XDR-TB and XDR-TB are treated by the BPaL regimen only, i.e. by three medicines only.
If you have intolerance to one of the medicines, you will have an individual regimen that can last for 18-24 months.
Tuberculosis treatment in Kyrgyzstan is fully free of charge for patients.
Unfortunately, it cannot. Tuberculosis may be treated only by special medicines.
According to specialists, people often try to treat themselves with mole crickets, kumis, canine or badger fat. It all could help support the immune system, but it does not kill Mycobacterium tuberculosis.
A few months after the treatment, people falling ill with tuberculosis will begin to feel themselves better. They stop coughing, gain weight and they think that the disease has gone away. According to specialists, patients often stop treatment in this period. They also stop treatment because of migration or adverse effects of medicines.
However, successful treatment requires patients to properly follow the treatment and take all prescribed medicines as scheduled and without omissions.
If treatment is stopped, Mycobacterium tuberculosis becomes resistant to tuberculosis medicines. It means that if you previously had, say, drug-sensitive tuberculosis, you would have multidrug-resistant tuberculosis after you quit treatment.
Yes, there is. All newborns get a BCG vaccine. It protects them from generalised forms of tuberculosis – tuberculosis meningitis, miliary tuberculosis. However, there is still a risk to fall ill in case of massive infection. The vaccine does not protect from other kinds of tuberculosis.
There are no specific preventive measures. Yet, there are general recommendations on supporting the immune system:
- Quitting smoking and limiting alcohol,
- Healthy three meals a day,
- Physical activities,
- Less stress,
Sleep and rest regimen.
If you feel certain difficulties in visiting a medical facility, activists and NGOs can accompany you. In any case, they will refer you to a medical facility.