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Open Access Molecular epidemiological analysis for the suppression of risk factors in rheumatic fever.

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Professor Toshihiro Nakajima is co-leader of an ambitious six-year project between Japan and Kyrgyzstan, aimed at the eradication of the debilitating diseases of rheumatic fever (RF) and rheumatic heart disease (RHD) in the ex-Soviet republic. Nakajima's team is collaborating with specialists from the National Centre of Cardiology and Internal Medicine in Bishkek, led by Doctor Nazgul Omurzakova, who is also secretary to the Minister of Health of Kyrgyzstan. The working partnership has been developed over a decade and previously resulted in the opening of the Kyrgyz-Japan Research Centre, which Nakajima notes: 'is proving indispensable for researching these diseases on the ground in Kyrgyzstan.'

In terms of the prevalence of RF and RHD in Kyrgyzstan, Nakajima has speculated on the reasons for its continued increase. He notes that one cause could be: 'uncontrolled use of antibiotics and the instability of antibiotics circulating in the country following the demise of the Soviet Union, leading to resistance in local strains of streptococci'. He explains that: 'half of all deaths in Kyrgyzstan are due to cardiac failure and we estimate that 37 per cent of these deaths are due to heart damage from untreated RHD.' Therefore, the size of the challenge is substantial, particularly given that healthcare in Kyrgyzstan is itself a difficult prospect given the countries' six million people are spread throughout a highly mountainous region which is only slightly smaller than the UK, and which has a population 10 times greater. In addition, Kyrgystan is only one of many countries in Central Asia which is similarly affected by this epidemic.

Epidemiological studies The project has six main streams, which will be run in parallel from 2018 through to and including 2023. These include: a major epidemiological study; the identification of disease risk factors; construction of a 256-person rehabilitation hospital; and educational programmes for families and medical personnel. Data has shown that there are pockets where there is a high incidence of disease and other areas where there are far fewer cases. The first work package (WP) will make a detailed comparison between sites of high and low incidence, taking into account a wide range of factors such as climate, living conditions, diet and lifestyle choices (extent of cigarette smoking for example), ethnicity and socioeconomic profiles. In particular, air pollution levels will be measured in peoples' homes. In total, four regions will be studied in detail.
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Keywords: AIR POLLUTION LEVELS; CARDIOLOGY; DIET AND LIFESTYLE CHOICES; DISEASE RISK FACTORS; EPIDEMIOLOGICAL STUDY; GROUP A STREPTOCOCCUS; INSTABILITY OF ANTIBIOTICS; KYRGYZSTAN; LIVING CONDITIONS; RHEUMATIC FEVER; RHEUMATIC HEART DISEASE; STREP BACTERIA; STREPTOCOCCI; UNCONTROLLED USE OF ANTIBIOTICS

Document Type: Research Article

Publication date: March 1, 2018

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