Tuberculosebestrijding in Oost-Europa

- The annual incidence of tuberculosis in Eastern Europe has increased from an average of 40 per 100,000 in 1990 to 60 per 100,000 in 1998. In particular, the increase in multi-drug resistant tuberculosis, which is difficult to treat, is a great cause for concern due to increasing migration. The breakdown in the healthcare infrastructure, which has jeopardised medicine supplies, is largely to blame for this increased incidence. Eastern Europe has a long standing tuberculosis control system which is characterised by extensive and specialised knowledge about the disease, but also by a lack of knowledge concerning its control. A great deal of attention is paid to the number of medical procedures carried out, but the results are ignored. For a few years now, Western aid organisations have been involved in tuberculosis control in Eastern Europe and have introduced the WHO DOTS strategy (‘directly observed treatment, short-course’), with emphasis on case detection by sputum smear microscopy, directly observed uninterrupted treatment with short-course intensive chemotherapy and evaluation of treatment outcome. The Netherlands play a prominent role in these activities. The DOTS strategy is only slowly becoming accepted in Eastern Europe, particularly in Russia. It is in Western Europe's interest to help Eastern Europe rebuild their tuberculosis control system. Education and training are important elements to prepare doctors for their new role, in which public health should be given greater emphasis.