The danger of tuberculosis (TB) spreading is becoming critical amongst an estimated 180 000 displaced persons in Ingushetia who have fled the fighting in neighbouring Chechnya. In response, WHO is working to strengthen health facilities and laboratories through the provision of supplies, equipment and training.
Many displaced persons are at high risk of developing active TB due to overcrowding, poor health facilities lacking drugs and equipment, and problems of access to healthcare. Moreover, some displaced persons have brought the disease, contracted in Chechnya before the conflict, to Ingushetia. TB rates have been increasing steadily in recent years in the North Caucasus, and are particularly high in Chechnya, where no treatment has been available for some time.
The most recent figures on the incidence of TB in Ingushetia show an increase from 1997 to 1998 in the number of new cases detected from about 65 to over 80 per 100 000 persons. The incidence of TB in Chechnya during recent years is likely to be much higher. Data for 1999 are not yet available, but preliminary estimates show that the situation is deteriorating.
"Precautions must be taken to prevent the unnecessary spread of tuberculosis. An improvement in living conditions for all internally displaced persons in Ingushetia, including lessening the overcrowding, would reduce the risks of contracting many communicable diseases, including TB," said Dr Xavier M. Leus, head of Emergency and Humanitarian Action at the World Health Organization (WHO).
To address this situation, WHO is working to improve the capacity of local health institutions to diagnose and treat TB in co-operation with the United Nations High Commissioner for Refugees (UNHCR), the United Nations Children's Fund (UNICEF) and local health authorities.
After assessing existing capacity, WHO will provide laboratories in Ingushetia with the necessary supplies, such as microscopes and items required for laboratory diagnosis. Training courses for laboratory technicians will be conducted where necessary. A quality laboratory system is essential for the diagnosis and future management of TB. These measures will help lay a solid foundation for the successful treatment of patients.
Training seminars on TB control for 90 medical doctors took place in Stavropol in December 1999; some of these professionals will work in Ingushetia. In addition, a week-long training course on direct microscopy for laboratory personnel working in the North Caucasus will instruct in effective and accurate TB diagnostics.
WHO is working with the Russian Ministry of Health to implement a disease surveillance system in Ingushetia. The system will monitor the burden of TB along with several other priority communicable diseases, including diarrhoeal diseases, respiratory tract infections and measles.
WHO also took part in the United Nations Flash Appeal Review Mission to the Northern Caucasus. Based on its assessment, WHO's recommendations to improve health in the region will form part of an upcoming United Nations Consolidated Inter-Agency Appeal.
In addressing the health situation in the North Caucasus, WHO works closely with its Collaborating Centre for Emergency and Disaster Medicine Management, called "Zaschita", the All Russian Centre for Disaster Medicine, located in Moscow. This institution has sent two TB experts and three mobile units for TB examination to the affected area. A temporary TB dispensary in Chechnya has been established.
DOTS (Directly Observed Treatment, Short course) is the TB treatment strategy recommended by WHO; it lasts six or eight months and absolutely cannot be stopped before completion. If the treatment is cut short, the TB patient will be worse off than if he or she had not had any treatment, as multi-drug resistant TB will develop. Past experience has shown that it is difficult to ensure treatment completion in highly mobile populations.
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