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Kyrgyzstan consolidates efforts soil-transmitted helminth

© UNICEF, Kyrgyzstan

At the end of April 2009 in the biggest province of Kyrgyzstan – Osh Oblast – about 1 million people, which is one fifth of the total the Republic’s population will receive pills against helminthes.  It is national response to a high level of parasites prevalence among the population.
 
Two yeast ago such a campaign started in the neighbouring Batken  Oblast where more than 70 percent of the population had been found affected with one or more kinds of parasites. The indicators were higher among children: three out of four pupils.

The campaign entered every village of the province and turned into festivities. Ak-Suu village of Leilek district became the first. Literally all the villagers were affected by the shared jubilant mood. An ambulance car with a loudspeaker came to the village. It drove around all day long. Once it got stuck on a bad rural road and people had to help push the car out. Loud music was heard everywhere; colored posters were hanging. The electricity wasn’t turned off for the entire day which itself seemed like a holiday. That hadn’t happened for the first time in many years. It felt unusual. The villagers were accustomed to having power only for a few hours a day.

“I remember how that campaign started.” Kanybek Myrzaev one of the oldest inhabitants of Ak-Suu village, recalled. “Two days before it, the school director himself had asked for my help. My wife and myself were boiling water all night. No, we weren’t able to sleep that night. But who slept? Kids were drawing posters until morning. Teachers were preparing classrooms,” said the old man. “My wife ironed my best suit. I went there as if to a wedding. My wedding!” laughed Kanybek. “We were the first to arrive. They said they were going to show a movie.”

Public assemblies for villagers were organized at schools. A video about the prevalence of parasites was shown. The doctor explained the ways of parasite contraction and preventive measures. Then each villager starting with 2-year-old children was given a pill. There were glasses with boiled water at the tables. Kanybek was telling everybody with pride about how he had been bringing and boiling water with his old wife all night long.

The organizers event found incentives for every age. Young children were enticed with candies. Anticipating the tempting bait, they swallowed the bitter medicine and received the deserved reward. Candies were provided by the non-governmental organization “Hope.” Schoolchildren took pills by counting “one, two, three.” The first child to swallow was given an “A” mark. For adults, this process was facilitated by the festive atmosphere of the occasion and the joy from the awareness that someone cared about them and wanted to help.

Nobody could ever remember such a large celebration. But not everything was so smooth in the beginning. Many people had believed that the presence of worms (helminthes) was a common occurrence. “Everybody has them,” stated one of the elders. “Yes, we know that some people have worms. So what? Our ancestors also had them. Nobody died. They managed to live somehow.” Although mothers were unwilling to speak about that unpleasant topic, still most of them saw worms in their children’s cribs before. Some even considered that to be a positive sign. “It’s good that they were coming out,” said young Salima before the campaign.

A month later, the results exceeded all expectations. The progress in studies and school attendance had improved by 30 percent. Malika from the 5th grade said, “Sometimes I missed classes before because I had itching all the time. I was ashamed. Now it’s better. And it’s easier to study. I can memorize poetry better.” The school self-administration developed an action plan to improve hygiene and sanitation. The toilet at school was repaired and painted with whitewash. It was agreed that every pupil had to bring a bottle with boiled water and drink solely from it. Also, everyone was expected to have two handkerchiefs – one for their nose and one to dry their hands after washing. Representatives of the school ministry of health were the most active. Children with a red cross on their sleeves examined every pupil on personal hygiene issues and graded them. By the end of the week, the best pupils received awards. The exhibition of children’s drawings and essays on this topic was arranged.

Parents were also active. Many of them began improving household outhouses and setting up washstands after the campaign. The rural educational group conducted outreach to all households. Action plans were developed for each family. The campaign involved everyone. Local street vendors also benefited. “Now soap and toilet paper are in a big demand,” said Meerim, an owner of a small merchandise stand. “We barely manage to deliver them on time. Business is getting better,” she bragged. The change was obvious. According to survey conducted by the Parasitological Department, more than 90 percent of respondents provided correct answers to questions on sanitation. A month earlier, only 12 percent admitted to washing their hands before having a meal.

After the campaign the villagers were visited by representatives of the Rostropovich Foundation that provided the pills. Having returned to Bishkek, Soltan Mammadov, an executive director of the foundation, emphasized, “While traveling across villages we saw what maestro Rostropovich valued so much – the recognition of simple people. This is the main criterion for obtaining assistance from our foundation.”

Immediately after their visit to Batken, the Foundation of Rostropovich-Vishnevskaya announced their intention to provide another one million albentazon pills for conducting a similar campaign in another southern region of Kyrgyzstan – Osh  province.

The struggle against helminthic infections has always had a national importance. During the Soviet times, it included a mass treatment with medication and cleansing of the surrounding environment from intestinal worms. The most affected areas were identified and separate measures were undertaken after the completion of nationwide treatment. During the period of Kyrgyz independence, however, this problem has drawn considerably less attention due to the shortage of the government funding. Vera Toigonbaeva, an associate professor of the Epidemiology Department, pointed out the significant decrease of parasitological specialists, as well as the reduction of teaching hours on this subject in courses at higher education medical institutions. For all specialists, the de-worming campaign became a catalyst for reviving a complex work and gave hope for improving the general situation in the republic.

The situation in Kyrgyzstan still remains critical. Recently specialists of the Swiss Institute of Tropical Diseases piloted a new method of laboratory analysis in Kyrgyzstan which allows not only detecting the eggs of parasites but also determining the level of contamination. In the course of the work, some cases of the parasite dicroceliasis – previously unknown in Kyrgyzstan and transmitted by ants – were revealed. The contamination with this parasite reached 3 percent in “Kalys-Ordo,” one of the residential districts of Bishkek city. Besides, the general contamination of various parasites comprised 72.4 percent in this area, which again demonstrates that this problem is equally pressing for both the southern and northern regions in Kyrgyzstan as well as for both rural and urban settlements.

The situation is aggravated by the ongoing crisis in Kyrgyzstan. More people use water from open sources which are often used by domestic animals as well. Helminth eggs can remain intact up to twenty years in the ground and are not susceptible to the frosts of Kyrgyz winters. Hence, the sanitary-epidemiology service sounds the alarm.

The initiated campaigns are a good sign. Things have started moving to a large extent thanks to the efforts of UNICEF, the International Red Cross Society and other organizations, which invited international consultants, helped with implementing the campaign, and most importantly, contributed in pulling together the multiple efforts of the Kyrgyz Government and international partners toward a common goal. At the beginning of 2009, at the round table organized with UNICEF support on discussing the campaign results and studies of international experts, Mr. Abdikarimov, a deputy minister of health, emphasized, “We face an important task – to develop a sound State programme on eradicating parasites. The demand for the programme is obvious by the scope of the population’s contamination and the need of shifting from pilot projects to a sustainable development model and strategic plan on overseeing parasitological diseases.”

 

 
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