Drug resistant form of tuberculosis in penitentiary system of Kazakhstan in 2008-2009.
Besides, in Kazakhstan situation on TB is being aggravated because of spreading multidrug resistant tuberculosis (Zaleskis, 2007; Ismailov, 2006). MDR-TB prevalence hase not been studied yet in the penitentiary system of the country.
The study aims to determine the main priorities in detection and diagnostics of multidrug resistant tuberculosis in the penitentiary settings. The following objectives were set in the analysis:
1. examining situation on detection of MDR-TB in the anti-TB institutions of the civil
sector and in settings of criminal executive system;
2. studying epidemiology of newly detected tuberculosis on presence of the drug resistance in the penitentiary system;
3. defining recommendations to improve the situation on TB in the country.
In the criminal executive system of the country anti-TB care for convicted persons is provided in three TB hospitals, four specialized anti-TB institutions for in-patient and out-patient treatment of persons suffering from TB. To conduct this study two regions/oblasts were chosen by us: Karagandinskaya and South Kazakhstan oblasts. 2 anti-TB institutions in Karagandinskaya oblast and 1 institution in South Kazakhstan oblast comprise 1350 (57.7%) TB beds equipped for national penitentiary system in the country. These medical institutions receive patients from other oblasts in accordance with their assignment. It is suggested that the results obtained in these two oblasts could be extrapolated all over the country.
For successful and adequate treatment of MDR-TB any country must possess the reliable information on prevalence of drug resistance, implement the system of electronic surveillance after patients with TB (WHO, 2003). In Kazakhstan electronic registration of all population groups filed at TB dispensaries--National Electronic Register of TB patients (NERT)--was implemented since 2003, when maintaining of two separate registers for penitentiary and civil systems was introduced. Further improvement of integrated electronic TB fighting database was conducted to meet international standards. Data on both sectors have being obtained from NERT since 2008 are significantly reliable.
Material and methods
Design of the study: retrospective cohort analysis of data of epidemiological surveillance systems over 2008-2009. Data sources: electronic database on TB control in the Republic of Kazakhstan over 2008-2009.
Results and discussion
Study of sputum culture was made in the contingent of penitentiary and civil systems of Kazakhstan for the period 2009 (data was obtained from NERT).
Persons of 2 groups were chosen for analysis: all newly detected patients during the period of observation; and repeatedly treated cases such as those having disease relapses, patients with failure of previous treatment, patients after break in treatment process, and others.
321 convicted persons from penitentiary system and 1932 persons from civil sector were examined in Karagandinskaya oblast. Correspondingly, 423 and 2507 patients were observed in South Kazakhstan.
In the category "unknown sputum culture" we included the cases which analysis results were absent in the registration system. Absence of those data could be possible in two cases: no regular input of sputum culture results in the electronic database in spots or absence of the related bacteriological sputum investigations.
Comparative analysis of persons from penitentiary system and civil sector showed the low coverage with bacteriological investigations in the penitentiary system--in 62.6% of new cases and 63.2% of repeatedly treated cases in Karagandinskaya oblast. These indexes made 27.6% and 43.6% respectively in South Kazakhstan oblast.
While bacteriological investigations in the civil sector demonstrated high coverage with sputum culturing study: 92% of new cases and 85.2% of repeatedly treated patients in Karagandinskaya oblast; and 86.9% and 86% respectively in South Kazakhstan oblast.
Thus, the obtained data indicate on low coverage of persons from penitentiary system with bacteriological investigations through sputum culturing method. This situation makes important to conduct additional operational, training and monitoring activities among medical staff in settings of criminal executive system in Karagandinskaya oblast and South Kazakhstan oblast.
Timely detection of drug-resistant strains of M. tuberculosis is a priority for the effective treatment of TB patients. In this connection, our study aimed to investigate the spectrum of drug resistance in patients with positive sputum culture in civil and penitentiary sectors of the pilot regions (Tables 1 and 2).
Data of Table 1 indicate on high percentage of MDR-TB among newly detected patients from Karagandinskaya oblast: 31 (41.9%) cases compared with this category of patients from South Kazakhstan oblast: 13 (22.8%) cases. This outcome confirms the high level of the primary resistance among patients with MDR TB in the penitentiary system of Karagandinskaya oblast, and it needs the additional investigation.
Meanwhile, the indicator of primary resistance among patients with MDR-TB in the civil sector of both regions is not significantly different: 60 (17.1%) in Karagandinskaya oblast and 35 (12.8%) in South Kazakhstan oblast (Table 2).
Results of drug sensitivity testing in re-treatment cases with positive culture in persons from penitentiary system in Karagandinskaya region also demonstrate high ratio: of the 113 patients the 91 (81.5%) were established with multidrug-resistant strains of M. tuberculosis strains of M. tuberculosis (Table 1). Whereas in the civilian sector the index made 98 (28.3%) cases (Table 2).
Thus, our study has shown the high drug resistance level in penitentiary system of Karagandinskaya oblast. Analysis of drug resistance prevalence in the penitentiary system of Kazakhstan by age groups has shown that the highest percentage of MDR TB is marked in the age group from 18 to 24 years (40.6%); while in the age group from 65 years or older it is observed the highest remained sensitivity and monoresistance in 75% of patients with TB.
Analysis of independent electronic surveillance data on patients with TB in the penitentiary system and civil sector has shown the low percentage coverage with sputum culture surveillance of patients with TB in the penitentiary system.
In the penitentiary system it is marked the high percentage of MDR TB among convicts from settings of criminal executive system in Karagandinskaya oblast (MDR TB rate among new cases constituted 41.9%, among repeatedly treated cases it made 80.4%); while indicators of primary resistance of MDR TB in the civil sector of both regions are nearly similar: 17.1% in Karagandinskaya oblast and 12.8% in South Kazakhstan oblast.
The high percentage of MDR TB is marked among newly detected patients with TB in age group from 18 to 24 years (40.6%); while in the age group from 65 years or older it is marked the highest proportion of patients with the prevailed sensitivity and monoresistance (75%).
Ismailov, Sh., 2006. "The epidemiological situation of tuberculosis with multidrug resistance in the Republic of Kazakhstan", Journ. of Phthisiopulmonology [Ftiziopulmonologiya], in Russian, No.2, pp.71-73.
Muminov, T., Rakisheva A. et al., 2002. "Clinical and epidemiological peculiarities of tuberculosis in places of confinement," Journ. of Phthisiopulmonology [Ftiziopulmonologiya], in Russian, No.1(1), pp.32-34.
Rakisheva, A., 2002. "The present conception on problem of tuberculosis in the penitentiary settings" [Sovremennoe predstavlenie o probleme tuberkuloza v penitenziarnykh uchrezhdenijakh. Mediko-sotzialnye I kliniko-epidemiologicheskie aspekty v penitentziarnykh uchrezhdenijakh], in Russian, Doctoral disseration.
WHO, 2003. Tuberculosis control in prisons. A Manual for Programme Managers.
Zaleskis, R., 2007. "Tuberculosis in the world and Europe region of WHO [Tuberkuloz v mire i Evropeyskom Reghione VOZ], in Russian, International conference "Global control on tuberculosis in countries of Central Asia", Almaty, pp.17-18.
Zhumabaev, S., Ibraghimov, M., 1995. "New objectives and improvement of certain operational forms in anti-TB service of Ministry of Interior Affairs of the Republic of Kazakhstan," in: Dzhunusbekov, A. (Ed.), Improvement of methods of prevention, diagnostic observation and treatment of Tuberculosis [Sovershenstvovanie metodov profilaktiki, dispansernogo nabludenija i lechenija tuberkuloza], in Russian, Almaty, pp.19-21.
Tleukhan Abildaev, Klara Baimukhanova, Aygul Tursynbaeva, Saule Usembaeva, Alya Kurbanova, Gulnaz Mussabekova
National Center for TB Problems Kazakhstan
Lyubov Kartashova, Bibigul Tayshieva
Medical Service of Criminal Executive System, Kazakhstan
TABLE 1. RESULTS OF DRUG SENSITIVITY TESTING (DST) IN CASES WITH POSITIVE SPUTUM CULTURE IN SETTINGS OF CRIMINAL EXECUTIVE SYSTEM OF KARAGANDINSKAYA AND SOUTH KAZAKHSTAN OBLASTS DURING 2008-2009 Sensitive Monoresistance abs % abs % Karagandinskaya New cases 3 4.1 7 9.5 oblast Repeatedly 1 0.5 4 2.2 treated cases South Kazakhstan New cases 24 42.1 6 10.5 oblast Repeatedly 38 39.6 13 13.5 treated cases Polyresistance MDR-TB abs % abs % Karagandinskaya New cases 29 39.2 31 41.9 oblast Repeatedly 20 10.9 148 80.4 treated cases South Kazakhstan New cases 12 21.1 13 22.8 oblast Repeatedly 18 18.8 21 21.9 treated cases Unknown Total abs % Karagandinskaya New cases 4 5.4 74 oblast Repeatedly 11 6.0 184 treated cases South Kazakhstan New cases 2 3.5 57 oblast Repeatedly 6 6.3 96 treated cases TABLE 2. RESULTS OF DRUG SENSITIVITY TESTING (DST) IN CASES WITH POSITIVE SPUTUM CULTURE IN CIVIL SECTOR OF KARAGANDINSKAYA AND SOUTH KAZAKHSTAN OBLASTS DURING 2008-2009 Sensitive Monoresistance abs % abs % Karagandinskaya New cases 156 44.6 26 7.3 oblast Repeatedly 126 35.2 21 5.9 treated cases South Kazakhstan New cases 117 43.6 22 8 oblast Repeatedly 52 20.9 13 5.3 treated cases Polyresistance MDR-TB abs % Abs % Karagandinskaya New cases 44 12.5 60 17.1 oblast Repeatedly 26 7.3 123 34.3 treated cases South Kazakhstan New cases 27 10.1 35 12.8 oblast Repeatedly 20 7.9 81 32.7 treated cases Unknown Total abs % Karagandinskaya New cases 65 18.5 349 oblast Repeatedly 62 17.3 358 treated cases South Kazakhstan New cases 69 25.5 269 oblast Repeatedly 82 33.3 247 treated cases FIGURE 1. PREVALENCE OF DRUG RESISTANCE BY AGE AMONG NEWLY DETECTED PATIENTS WITH TB IN THE PENITENTIARY SYSTEM OF KAZAKHSTAN DURING 2008-2009 sensitivity monoresistance polyresistance MDR TB age groups 18-24 40,6 25-34 34,9 35-44 36,2 45-49 37,0 50-54 30 55-64 25 65+ 25 Table made from bar graph.
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|Author:||Abildaev, Tleukhan; Baimukhanova, Klara; Tursynbaeva, Aygul; Usembaeva, Saule; Kurbanova, Alya; Muss|
|Publication:||Medical and Health Science Journal|
|Article Type:||Clinical report|
|Date:||Apr 1, 2011|
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