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At least 19 recordsLinked to original sources
PubMed2006

Frequency of malaria and glucose-6-phosphate dehydrogenase deficiency in Tajikistan.

BACKGROUND: During the Soviet era, malaria was close to eradication in Tajikistan. Since the early 1990s, the disease has been on the rise and has become endemic in large areas of southern and western Tajikistan. The standard national treatment for Plasmodium vivax is based on primaquine. This entails the risk of severe haemolysis for patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Seasonal and geographical distribution patterns as well as G6PD deficiency frequency were analysed with a view to improve understanding of the current malaria situation in Tajikistan. METHODS: Spatial and seasonal distribution was analysed, applying a risk model that included key environmental factors such as temperature and the availability of mosquito breeding sites. The frequency of G6PD deficiency was studied at the health service level, including a cross-sectional sample of 382 adult men. RESULTS: Analysis revealed high rates of malaria transmission in most districts of the southern province of Khatlon, as well as in some zones in the northern province of Sughd. Three categories of risk areas were identified: (i) zones at relatively high malaria risk with high current incidence rates, where malaria control and prevention measures should be taken at all stages of the transmission cycle; (ii) zones at relatively high malaria risk with low current incidence rates, where malaria prevention measures are recommended; and (iii) zones at intermediate or low malaria risk with low current incidence rates where no particular measures appear necessary. The average prevalence of G6PD deficiency was 2.1% with apparent differences between ethnic groups and geographical regions. CONCLUSION: The study clearly indicates that malaria is a serious health issue in specific regions of Tajikistan. Transmission is mainly determined by temperature. Consequently, locations at lower altitude are more malaria-prone. G6PD deficiency frequency is too moderate to require fundamental changes in standard national treatment of cases of P. vivax.

Adult↗
PubMed1998

Epidemic typhoid fever--Dushanbe, Tajikistan, 1997.

Typhoid fever, a severe systemic illness transmitted through food or water, is caused by the bacterium Salmonella serotype Typhi. This report describes a major epidemic of typhoid fever in Dushanbe, Tajikistan, that resulted from contamination of the municipal water system. In Tajikistan, the Sanitary Epidemiologic Service (SES) maintains records for reportable diseases. Dushanbe (1997 population: 600,000) residents receive health care through assigned polyclinics; surveillance for reportable diseases is based on polyclinic records. A case of typhoid fever is defined as physician diagnosis or isolation of S. Typhi from stool, blood, or urine cultures. In February 1997, a sudden increase in the number of typhoid fever cases was identified by SES in Dushanbe, with approximately 2000 cases registered during a 2-week period. In March, the Ministry of Health of Tajikistan requested assistance from CDC. In collaboration with local authorities and nongovernmental partners, CDC reviewed epidemiologic and laboratory surveillance; conducted a case-control study to identify risk factors for infection; and evaluated municipal drinking water quality, water wastage, and health-education campaigns.

Adolescent↗
PubMed2004

Poverty, out-of-pocket payments and access to health care: evidence from Tajikistan.

Most countries of the Former Soviet Union (FSU) have either initiated or are contemplating reform of the health sector. With negative real income growth and falling government revenues, a key concern of many governments is to secure additional finance through non-budgetary sources such as hypothecated payroll taxes, voluntary insurance, and increased private finance through patient cost-sharing. However, before such reforms can be considered, information is needed both on the current levels and distribution of household expenditures on health care, and the extent to which increased charges may affect access to health services, especially amongst the poor. This paper uses the Tajikistan Livings Standard Survey to investigate the level and distribution of out-of-pocket payments for health care in Tajikistan and to examine the extent to which such payments act as barriers to health-care access. The data show that there are significant differences in health-care utilisation rates across socio-economic groups and that these differences are related to ability to pay. Official and informal payments are acting both to deter people from seeking medical assistance and once advice has been sought, from receiving the most appropriate treatment. Despite informal exemptions, out-of-pocket payments for health care are exacting a high toll on household welfare with households being forced to sell assets or go into debt to meet the costs of care. Urgent action is needed to ensure equity in access to health care.

Adolescent↗
PubMed2000

Going beyond triage in Tajikistan. Health reform in the former Soviet Union.

Tajikistan is among the few countries where life expectancy diminished during the 1990's. To rebuild a health system fractured by economic collapse, political disintegration and civil war, the Essential Hospital Services Project was initiated to restore essential hospital services, encourage structural reform and build the health system's capacity to sustain itself. The article provides an overview of these reform efforts, outlines some of the challenges of health reform in Tajikistan and illustrates the benefits global partnerships can achieve when sharing creative new approaches to health reform.

Canada↗
PubMed2004

Genetic characterization of the M RNA segment of Crimean-Congo hemorrhagic fever virus strains isolated in Russia and Tajikistan.

The data on the structure of the M genome segment of CCHF virus strains from Russia and Central Asia (Tajikistan) are presented. Data obtained have been compared with other available published sequences of the middle segment of strains from China, Nigeria, and Pakistan. It has been found that all the known strains can be divided into four genetic groups, based on the nucleotide sequence of the M genome segment and an amino acid sequence of the glycoprotein precursor it encodes, whereas VLG/TI29414 and STV/HU29223 strains from Russia form a separate group. The CCHF virus strain from Tajikistan, TADJ/HU8966, was genetically related to strains 7803 and 75024 from China, and together with these and the Nigerian IbAr 10200 strain, it forms another group.

Base Sequence↗
PubMed2003

Inequality and changes in women's use of maternal health-care services in Tajikistan.

Using recently available survey data for Tajikistan, this study explores changes in the pattern of maternal health care during the last decade and the extent to which inequalities in access to that care have emerged. In particular, the links between poverty and women's educational status and the use of maternal health-care services are investigated. The survey findings demonstrate a significant decline in the use of maternal health-care services in Tajikistan since the country gained independence from the Soviet Union in 1991. They show changes in the location of delivery and the person providing assistance, with a clear shift away from giving birth in a medical facility toward giving birth at home. More than two-fifths of all women who gave birth in the year prior to the survey delivered their baby at home. Women from the poorest quintile are three times more likely than women from the richest quintile to undergo a home delivery without a trained assistant.

Adolescent↗
PubMed1999

Considerations regarding mass vaccination against typhoid fever as an adjunct to sanitation and public health measures: potential use in an epidemic in Tajikistan.

We report on the ongoing epidemic of typhoid fever in Tajikistan that started in 1996. It has involved more than 24,000 cases to date, and is characterized by multiple point sources, overflow of sewage, contaminated municipal water, and person-to-person spread. Of the Salmonella typhi isolates available for testing in western laboratories, more than 90% are multidrug-resistant (MDR). Most recently, 28 (82%) of 34 isolates are resistant to ciprofloxacin, representing the first reported epidemic of quinolone-resistant typhoid fever. In the past, mass immunization during typhoid fever epidemics has been discouraged. A review of this policy is recommended in light of the alarming emergence of quinolone-resistant strains of S. typhi, the availability of improved vaccines, and the ongoing epidemic in Tajikistan. Mass immunization may be a useful measure for the control of prolonged MDR typhoid fever epidemics, as an adjunct to correction of municipal infrastructure and public health intervention.

Anti-Infective Agents↗
PubMedDate not supplied

[The etiological structure of acute intestinal infections in children in the Republic of Tajikistan].

The Republic of Tajikistan belongs to the territories, traditionally hyperendemic with respect to acute enteric diseases (AED). The problem of AED still remains topical in recent years, especially among child population. The study of the etiological structure of AED in children has made it possible to establish that more than 70% of these diseases are of infectious nature. The leading role in the etiological structure of these diseases belongs to Shigella infections (32.4%), enterovirus diarrhea (12.1%) and Escherichia infections (8.9%). No significant differences in the character of the etiological structure of AED in children of urban and rural areas have been detected with the exception of enterovirus diarrhea, found to occur 2.7 times more frequently on children of urban areas (15.9%) than in those of rural areas (5.8%). The ascertaining of the etiological structure of AED in Tajikistan will make it possible to essentially increase epidemiological surveillance on AED and render it more concrete.

Acute Disease↗
PubMedDate not supplied

[ELISA and RT-PCR-based research of viruses in the ticks collected in the foci of Crimean-Congo fever in Kazakhstan and Tajikistan in 2001-2002].

Different species of ticks were found, in the territories of Kazakhstan and Tajikistan, to be infected with the virus of Crimean-Congo hemorrhagic fever (CKHF). The virologic evaluation included determination of antigen and RNA of the CKHF virus by ELISA and RT-PCR, respectively. The below tick species were found to be involved in the epidemic process: Hyalomma asiaticum, Dermacentor niveus (Kazakhastan) and Hyalomma anatolicum (Tajikistan). The results testify to the fact that Hyalomma ticks are the main carrier of the above virus in the Middle Asia. At the same time, Dermacentor niveus ticks are infection carriers in Kazakhstan.

Animals↗
PubMedDate not supplied

[Study of virus contamination of Ixodes ticks in the foci of Crimean-Congo hemorrhagic fever in Kazakhstan and Tajikistan].

The data on the contamination of different of ticks with Crimean-Congo hemorrhagic fever (CCHF) virus on the territory of Kazakhstan and Tajikistan were obtained. The methods of the evaluation of the virus contamination of ticks included the determination of the antigen and CCHF virus RNA by the methods of the enzyme immunoassay and the reverse transcription PCR respectively. Different tick species were found to be involved in the epidemic process: Hyalomma asiaticum, Dermatocentor niveus (Kazakhstan) and Hyalomma anatolicum (Tajikistan). The results obtained in this study confirmed that the main vector of CCHF virus in Central Asia were ticks of the genus Hyalomma, and in Kazakhstan the vectors of this virus also included ticks Dermatocentor niveus.

Animals↗
PubMed2006

[Genetic monitoring of the Crimean-Congo Hemorrhagic Fever virus in Kazakhstan and Tajikistan in 2001-2003].

Blood specimens obtained from 32 CCHF patients were tested for the presence of CCHF virus markers. In addition, 3210 ticks of the genera Hyalomma asiaticum, Hyalomma anatolicum, and Dermacentor niveus were examined to identify the CCHF virus antigen and RNA. This material was obtained during the 2001-2003 local outbreaks of CCHF in Kazakhstan and Tajikistan. The nucleotide sequence in the region 983-1282 of S segment of the CCHF virus for 12 wild type strains was determined. The phylogenetic relationships among the established biovariants of CCHF virus, and also between these biovariants and those from other regions of the world were identified. We were the first to demonstrate the presence of an African-like genotype of CCHF virus in the territory of Kazakhstan. The conclusion was made that two genotypes of CCHF virus were in circulation in Kazakhstan. It was also demonstrated that CCHF virus, circulating in the territories of Kazakhstan and Tajikistan, was genetically heterogeneous.

Animals↗
PubMedDate not supplied

[An outbreak of poliomyelitis in Tajikistan in 1991 caused by the poliomyelitis virus type 1 in concomitant echovirus 19 infection].

In 1991 in Tajikistan 36 cases of acute poliomyelitis were recorded (spinal form 27, bulbospinal 3, pontospinal 6 cases) in children ranging in ages from 6 months to 6 years. The outcome of the disease was fatal in 4 cases and with crude residual effects in 32 children. Out of 23 children examined, poliomyelitis virus type I was isolated from 13, antibodies to poliovirus type I in titres 1:16 to 1:1024 were detected in 21 children, ECHO 19 virus was isolated from 5 children and antibodies to this virus in titres 1:16 to 1:8192 were demonstrated in 13 children. The fresh isolates of poliomyelitis virus type I had rct+, DS+ and N+ markers. The strains of ECHO 19 virus were highly pathogenic for monkeys causing deaths of the animals within 3-4 days. It is assumed that the main causative agent of the Tajikistan outbreak of poliomyelitis was a virulent "wild" variant of poliovirus type I. The preceding or concomitant infection with ECHO 19 virus (considering the data from the literature and the demonstrated high virulence of this agent for monkeys) could exert an aggravating effect on the course of poliomyelitis or, in some cases, be an independent cause of the disease and, possibly, death of the children.

Acute Disease↗
PubMed1996

[Deletion analysis of the dystrophin gene in patients with Duchenne's muscular dystrophy in Tajikistan].

The deletion spectrum of the dystrophin gene was studied in 25 patients with Duchenne's muscular dystrophy (DMD) from 23 families in Tajikistan. To detect deletions, 17 various regions of the dystrophin gene were amplified by means of polymerase chain reaction (PCR). Deletions were revealed in 13 patients from 12 families (52%). The deletion frequency differed in different gene exons, but deletions in the distal part of the gene prevailed (in 91% of cases). Deletions from exons 47 and 48 were detected in 22% of patients; deletions from exon 50 were detected in 35% of patients (73% of patients with deletions). This showed the significance of analyzing the distal part of the gene for DMD diagnostics in Tajikistan. Studying the location of deletion breakpoints revealed a "hot spot" within the dystrophin gene: right (distal) deletion breakpoints occurred between exons 50 and 52 in 73% of deletions.

Dystrophin↗
PubMedDate not supplied

Health human resource reform in Tajikistan: part of a masterplan for change.

Like many countries of the former Soviet Union, the Republic of Tajikistan inherited a poorly paid physician workforce dominated by specialists. This Central Asian republic has been forced to move slowly to change the physician workforce and to implement primary health care. Several years of civil war following independence in 1991 made reform of the struggling health system politically and economically difficult. The civil war also resulted in a loss of health personnel, with significant numbers of physicians leaving the country. The low pay of health professionals caused others to move to higher paying jobs in non-health related professions. A comprehensive masterplan for the reform of the health care system that has been developed through a participatory process is in the process of formal approval. The human resources component of the health care reform masterplan calls for a shift to emphasize the role of primary health care and the introduction of family physicians (FPs) as the cornerstone of the primary health care. With only 90 family practice physicians trained in 2000, the country faces a massive task in retraining existing physicians and training new FPs. The first 40 medical students to enter training as FPs are scheduled for 2001. Retraining at the Post Graduate Institute will be supplemented in 2002 by programs in the three oblasts. To overcome the shortage of FPs a comprehensive job analysis and workload assessment will be conducted to redefine the role of health professionals and involve others in the provision of care. Historically nurses have not been allowed to perform to their full capability and physicians have performed tasks more suitable for mid-level personnel. A strategy to solve maldistribution problems and to develop incentives to stem the loss of physicians will be also implemented. While circumstances have forced the Republic of Tajikistan to move slower than other countries to reform the inefficient health system inherited from the Soviet Union, the current masterplan for the entire system shows a commitment to change. The Masterplan, along with lessons from what has occurred in other countries, provide an opportunity for a well-ordered reform of health human resources within the overall context of health system reform.

Family Practice↗
PubMed2000

Middle paleolithic human deciduous incisor from Khudji, Tajikistan.

In 1997 a human mandibular second deciduous incisor was discovered during excavations at the central Asian Middle Paleolithic site of Khudji, Tajikistan. The specimen was associated with a late Middle Paleolithic assemblage in a minimally disturbed cultural layer. The specimen is average in size for Late Pleistocene archaic human di(2)s and differs from many late archaic human di(2)s in having minimal marginal ridges and tapering markedly distally. In these features it resembles a minority of specimens from the later Pleistocene.

Animals↗
PubMed2005

Complete L segment coding-region sequences of Crimean Congo hemorrhagic fever virus strains from the Russian Federation and Tajikistan.

The large (L) RNA segment of Crimean Congo hemorrhagic fever (CCHF) virus strain AST/TI30908, isolated from pooled Hyalomma marginatum ticks collected in 2002 from the Astrakhan region of European Russia, was amplified piecemeal using reverse-transcription/polymerase chain reaction, followed by direct sequencing of gel-purified amplicons. After removal of 5' and 3' primer-generated termini, the assembled AST/TI30908 L segment sequence is 12112 nucleotides long, with 41.3% G + C content, and is greater than 87% and 96% identical at the nucleotide and translated amino acid levels, respectively, to partial or full-length CCHF virus L segment sequences deposited in GenBank. A complete L segment coding-region sequence for CCHF virus strain TAJ/HU8966, isolated from a patient in Tajikistan in 1990, was determined in a similar fashion. This L segment (12133 nucleotides long, 41.1% G + C content) shares 88% nucleotide identity with the full-length strain Matin from Pakistan, and 97% nucleotide identity with a partial L segment sequence of strain Khodzha from Uzbekistan. Strain TAJ/HU8966 shares at least 96% identity at the translated amino acid level with all other CCHF virus L segment sequences. Although, for the most part, CCHF virus L polyprotein primary sequences are uniformly well conserved, a region of marked variability was identified in the N-terminal half of the RNA-dependent RNA polymerase. This region, approximately 50 amino acids in length, is flanked by previously-reported arenavirus and bunyavirus-conserved regions, and may prove useful in CCHF diagnosis and viral taxonomy.

Amino Acid Sequence↗
PubMed2006

Marked ethnic differences in HIV prevalence and risk behaviors among injection drug users in Dushanbe, Tajikistan, 2004.

OBJECTIVE: To examine differences by ethnicity of HIV prevalence and correlates among injection drug users (IDUs) in Dushanbe, Tajikistan. METHODS: The researchers enrolled 489 active adult IDUs in a cross-sectional risk factor study of HIV infection. Participants were provided HIV pre-and posttest counseling and risk reduction counseling and answered an interviewer-administered questionnaire. HIV-1 status was determined with rapid tests and confirmed with ELISA. RESULTS: Participants included four ethnicities: 204 Tajiks (49.1%), 145 Russians (29.7%), 58 Uzbeks (11.9%), and 46 participants of other nationalities (9.4%). Overall prevalence of HIV-1 infection was 12% and varied significantly by ethnicity: it was highest among ethnic Tajiks, at 19.2%; lowest among Russians and Uzbeks, at 3.4%; and 13% among other nationalities. Ethnic groups differed significantly in years injecting, receiving a needle from a needle exchange program (NEP), injecting in groups, having undergone drug treatment, reported condom use, and arrest history. Among Tajiks, HIV infection was significantly associated with daily injecting (OR 2.16); reporting that narcotics were very easy to obtain (OR 2.46); having undergone drug treatment (OR 2.75), and injecting "alone" (OR 3.12). CONCLUSIONS: Ethnic differences were strongly associated with HIV prevalence and risk behaviors in this multiethnic study, and prevention efforts might need to be targeted by ethnicity.

Adult↗
PubMed1999

A massive epidemic of multidrug-resistant typhoid fever in Tajikistan associated with consumption of municipal water.

From 1 January through 30 June 1997, 8901 cases of typhoid fever and 95 associated deaths were reported in Dushanbe, Tajikistan. Of 29 Salmonella serotype Typhi isolates tested, 27 (93%) were resistant to ampicillin, chloramphenicol, nalidixic acid, streptomycin, sulfisoxazole, tetracycline, and trimethoprim-sulfamethoxazole. In a case-control study of 45 patients and 123 controls, Salmonella Typhi infection was associated with drinking unboiled water (matched odds ratio, 7; 95% confidence interval, 3-24; P<.001). Of tap water samples, 97% showed fecal coliform contamination (mean level, 175 cfu/100 mL). Samples taken from water treatment plants revealed that fecal coliform contamination occurred both before and after treatment. Lack of chlorination, equipment failure, and back-siphonage in the water distribution system led to contamination of drinking water. After chlorination and coagulation were begun at the treatment plants and a water conservation campaign was initiated to improve water pressure, the incidence of typhoid fever declined dramatically.

Case-Control Studies↗