Free Content Tuberculosis deaths averted by implementation of the DOTS strategy in Kazakhstan

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Abstract:

SETTING: Kazakhstan began implementing the DOTS strategy for tuberculosis (TB) in 1998.

OBJECTIVE: Data were analyzed 1) to determine if changes in TB mortality rate (MR) and case fatality rate (CFR) in Kazakhstan for 1998–2003 differed from those of Uzbekistan and four adjacent Russian Federation (RF) oblasts that had not yet implemented DOTS, and 2) to estimate the number of deaths averted in Kazakhstan as a result of DOTS.

DESIGN: Observed MRs were calculated, and predicted MRs for Kazakhstan were approximated by linear regression based on average slope of MRs from 1998 through 2003 in adjacent non-DOTS-implementing territories. Deaths averted were calculated by comparing predicted MRs to actual MRs by converting rate differences to numbers of deaths.

RESULTS: TB MRs in Kazakhstan decreased markedly, but remained stable or increased in the neighboring territories. CFRs decreased markedly in Kazakhstan and marginally in Uzbekistan, and increased in the neighboring RF oblasts. From 1998 to 2004, DOTS appears to have helped avert approximately 17 800 deaths in Kazakhstan.

CONCLUSION: DOTS has contributed markedly to a decrease in TB mortality in Kazakhstan. In settings where mortality data are relatively complete, deaths averted can be another indicator of DOTS effectiveness.

Keywords: DOTS; Kazakhstan; case fatality rate; death rate; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Centers for Disease Control and Prevention, Atlanta, Georgia, USA; International Vaccine Institute, Seoul, Korea; and Centers for Disease Control and Prevention Central Asia Office, Almaty, Kazakhstan 2: Centers for Disease Control and Prevention Central Asia Office, Almaty, Kazakhstan; and World Health Organization Office in the Russian Federation, Moscow, Russian Federation 3: Centers for Disease Control and Prevention Central Asia Office, Almaty, Kazakhstan 4: Kazakhstan National Center for Tuberculosis, Almaty, Kazakhstan 5: Centers for Disease Control and Prevention, Atlanta, Georgia, USA 6: Centers for Disease Control and Prevention, Atlanta, Georgia, USA; and Centers for Disease Control and Prevention Central Asia Office, Almaty, Kazakhstan

Publication date: December 1, 2010

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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