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Drug resistant form of tuberculosis in penitentiary system of Kazakhstan in 2008-2009.

The pick of TB incidence in civil health sector in Kazakhstan occurred in 2002 when it was 165.1 per 100.000 of population, since that time the stable tendency to decrease TB incidence was marked. In 2009 the indicator of TB incidence constituted 105.3 per 100.000 of population. In the penitentiary system the pick of TB incidence was in 2004 when it constituted 1388 per 100.000 and, also, had the tendency to decrease to 643.9 in 2009. The incidence of tuberculosis in the penitentiary system exceeds the incidence in the civilian sector: in 2008 it was 6.1 times higher and in 2009-7.1 times. The main reasons of high rate of TB incidence and TB mortality among convicted persons are the difficult conditions of confinement due to the ventilation absence, overcrowding, stress inducing states, poor nutrition (Zumabaev and Ibraghimov, 1995; Muminov et al., 2002; WHO, 2003). Therefore, persons serving their sentences, have a greater chance of infection or TB disease and, therefore, upon release from prison pose a threat to tuberculosis infection of surrounding people.

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.

Conclusion

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%).

References

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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Article Details
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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
Geographic Code:9KAZA
Date:Apr 1, 2011
Words:1810
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