Primary health care revitalization in Azerbaijan.
Of Azerbaijan's 7,564,800 inhabitants, 52.2% live in urban and 47.8% in rural areas. With the transition to market-oriented economy, health problems have worsened. Expenditures for health care fell from 2.9% of GDP in 1990 to 1.2% in 1997. In case of illness, 37% of population prefer self-treatment, and 68% of treatment refusals are due to the inability of patients to pay for the treatment. Maternal mortality rate increased from 10.5 deaths per 100,000 live births in 1991 to 52 deaths per 100,000 live births in 1996. However, diphteria has been reduced to sporadic cases, whereas polio has not been reported since 1996. A pilot reform of primary health care was initiated in one of the districts, and soon expanded to four more districts. The aims were the improvement of health management, rationalization/optimization through development of traditional services, organization of preventative activities, rational use of drugs, institution of sustainable financial mechanisms through affordable fees for services, drug sales within health facilities with corresponding management and the accounting systems for the revenues, development of the exemption system, and community participation in district health. Increased patient attendance to health facilities, improved access to the vulnerable population health services, empowered health system management, better quality of care, and reduced overall individual expenditures were observed. (+info)
Epidemic diphtheria in the 1990s: Azerbaijan.
The diphtheria epidemic in the former Soviet Union reached Azerbaijan in 1991, when 66 cases of diphtheria were reported, a number that compared with 4 cases in 1990. From 1990-1996, 2182 cases of diphtheria and 286 diphtheria fatalities (case fatality rate: 13.1%) were reported in Azerbaijan, primarily among persons 5-39 years of age. Almost 45% of cases and 61% of deaths occurred among children 5-14 years of age. The high burden of severe disease among children and young adults suggested a different pattern of preexisting immunity against diphtheria in the Azerbaijani population than was observed in the concurrent diphtheria epidemic in Russia. Because resources were limited in Azerbaijan, mass immunization of the population was carried out in stages, focusing initially on school-aged children. Mass immunization campaigns targeting children were moderately successful in stabilizing the epidemic; mass immunization campaigns targeting both adults and children were eventually needed to fully stop the epidemic. (+info)
Multidrug-resistant tuberculosis in prison inmates, Azerbaijan.
In a tuberculosis (TB) program in the Central Penitentiary Hospital of Azerbaijan, we analyzed 65 isolates of Mycobacterium tuberculosis by IS6110-based restriction fragment-length polymorphism (RFLP) and spoligotyping. From 11 clusters associated with 33 patients, 31 isolates had an IS6110-based banding pattern characteristic of the Beijing genotype of M. tuberculosis. In addition, 15 M. tuberculosis isolates with similar RFLP patterns constituted a single group by spoligotyping, matching the Beijing genotype. Multidrug resistance, always involving isoniazid and rifampin, was seen in 34 (52.3%) of 65 isolates, with 28 belonging to the Beijing genotype. (+info)
Fast-track surgical referral in a population displaced by war and conflict.
After the 1988-1994 conflict between Armenia and Azerbaijan, fought over the territory of Nagorno-Karabakh, large numbers of people were resettled in camps in southern Azerbaijan. Healthcare in the camps was generally good but there was no access to hospitals. The Leonard Cheshire Centre of Conflict Recovery (LCC) organized a 'fast-track' system of surgical care in the southern camps by securing the help of still-functioning hospitals in the distant capital, Baku. Regular clinics were held in the camps for visiting specialists; and, by arrangement with the Government of Azerbaijan and various non-governmental organizations, treatment was offered to those who fell within strict selection criteria. After a pilot study yielded clear benefits, the scheme was transferred to a local non-governmental organization, which successfully operated an expanded version. The hidden cost of war often includes the neglect of chronic medical conditions that require secondary and tertiary care. The 'fast-track' system illustrates the potential of existing facilities to meet these needs at modest cost, given sufficient support. (+info)
Prevalence of anemia among displaced and nondisplaced mothers and children--Azerbaijan, 2001.
In the early 1990s, the war between Armenia and Azerbaijan over the Azeri region of Nagorno-Karabakh resulted in approximately 600,000 internally displaced persons and 200,000 refugees in Azerbaijan. After years of displacement and despite sustained humanitarian assistance, these internally displaced persons and refugees (IDP/Rs) are still coping with unfavorable living conditions and limited employment opportunities. Results of a 1996 CDC survey in Azerbaijan revealed high rates of malnutrition and anemia among both the IDP/R and resident populations and prompted further study of the nutritional status of these populations. This report summarizes results of a 2001 survey of IDP/R and non-IDP/R mothers and children with anemia in Azerbaijan. Findings indicated that more than one third of mothers and children were anemic, with no significant difference in the overall prevalence between IDP/R and non-IDP/R populations; however, among the IDP/R population, anemia was associated with various socioeconomic factors such as education, socioeconomic status (SES), and area of residence. Future studies should focus on identifying causes for the high rates of anemia in Azerbaijan and developing effective interventions such as iron supplementation and behavior modification. (+info)
Genetic diversity of Plasmodium vivax isolates from Azerbaijan.
BACKGROUND: Plasmodium vivax, although causing a less serious disease than Plasmodium falciparum, is the most widespread of the four human malarial species. Further to the recent recrudescence of P. vivax cases in the Newly Independent States (NIS) of central Asia, a survey on the genetic diversity and dissemination in Azerbaijan was undertaken. Azerbaijan is at the crossroads of Asia and, as such, could see a rise in the number of cases, although an effective malaria control programme has been established in the country. METHODS: Thirty-six P. vivax isolates from Central Azerbaijan were characterized by analysing the genetic polymorphism of the circumsporozoite protein (CSP) and the merozoite surface protein 1 (MSP-1) genes, using PCR amplifications and amplicons sequencing. RESULTS: Analysis of CSP sequences showed that all the processed isolates belong to the VK 210 type, with variations in the alternation of alanine residue (A) or aspartic acid residue (D) in the repeat motif GDRA(A/D)GQPA along the sequence. As far as MSP-1 genotyping is concerned, it was found that the majority of isolates analysed belong to Belem and Sal I types. Five recombinant isolates were also identified. Combined analysis with the two genetic markers allowed the identification of 19 plasmodial sub-types. CONCLUSION: The results obtained in the present study indicate that there are several P. vivax clones circulating in Azerbaijan and, consequently, a careful malaria surveillance could be of paramount importance to identify, at early stage, the occurrence of possible P. vivax malaria outbreaks. (+info)
Evolutionary toxicology: population-level effects of chronic contaminant exposure on the marsh frogs (Rana ridibunda) of Azerbaijan.
We used molecular methods and population genetic analyses to study the effects of chronic contaminant exposure in marsh frogs from Sumgayit, Azerbaijan. Marsh frogs inhabiting wetlands in Sumgayit are exposed to complex mixtures of chemical contaminants, including petroleum products, pesticides, heavy metals, and many other industrial chemicals. Previous results documented elevated estimates of genetic damage in marsh frogs from the two most heavily contaminated sites. Based on mitochondrial DNA (mtDNA) control region sequence data, the Sumgayit region has reduced levels of genetic diversity, likely due to environmental degradation. The Sumgayit region also acts as an ecological sink, with levels of gene flow into the region exceeding gene flow out of the region. Additionally, localized mtDNA heteroplasmy and diversity patterns suggest that one of the most severely contaminated sites in Sumgayit is acting as a source of new mutations resulting from an increased mutation rate. This study provides an integrated method for assessing the cumulative population impacts of chronic contaminant exposure by studying both population genetic and evolutionary effects. (+info)
The 2000 canine distemper epidemic in Caspian seals (Phoca caspica): pathology and analysis of contributory factors.
More than 10,000 Caspian seals (Phoca caspica) were reported dead in the Caspian Sea during spring and summer 2000. We performed necropsies and extensive laboratory analyses on 18 seals, as well as examination of the pattern of strandings and variation in weather in recent years, to identify the cause of mortality and potential contributory factors. The monthly stranding rate in 2000 was up to 2.8 times the historic mean. It was preceded by an unusually mild winter, as observed before in mass mortality events of pinnipeds. The primary diagnosis in 11 of 13 seals was canine distemper, characterized by broncho-interstitial pneumonia, lymphocytic necrosis and depletion in lymphoid organs, and the presence of typical intracytoplasmic inclusion bodies in multiple epithelia. Canine distemper virus infection was confirmed by phylogenetic analysis of reverse transcriptase-polymerase chain reaction products. Organochlorine and zinc concentrations in tissues of seals with canine distemper were comparable to those of Caspian seals in previous years. Concurrent bacterial infections that may have contributed to the mortality of the seals included Bordetella bronchiseptica (4/8 seals), Streptococcus phocae (3/8), Salmonella dublin (1/8), and S. choleraesuis (1/8). A newly identified bacterium, Corynebacterium caspium, was associated with balanoposthitis in one seal. Several infectious and parasitic organisms, including poxvirus, Atopobacter phocae, Eimeria- and Sarcocystis-like organisms, and Halarachne sp. were identified in Caspian seals for the first time. (+info)