Tajikistan

Tajikistan is a landlocked country in Central Asia, bounded on the south by Afghanistan, on the north and northwest by Kyrgyzstan and Uzbekistan, and on the east by China. It is the smallest Central Asian country, at 143,100 kilometers (55,250 miles) and one of the most mountainous, with almost 50 percent of the country laying about 3,000 m (over 9,800 feet). Tajikistan joined the Soviet Union in 1929 and gained independence in 1991. Civil war broke out soon after. Peace was not declared until 1997.

Tajikistan is home to 7 million people and is growing at 1.895 percent annually. The birth rate is 27.33 per 1,000 population and the death rate is 7.05 per 1,000. Like most of the former Soviet states, it is losing citizens to migration, with 1.33 people leaving per 1,000. Median age is 21.3, with 50 percent of the population under 18 years of age. Life expectancy is 61.6 years for males and 67.78 years for females. Gross national income is the lowest in Europe, at $330 per person. Seven percent live on less than $1 a day, and 64 percent live in poverty. The average rate of inflation is 121 percent. Three-fourths of the population lives outside the cities, making it Europe's least urbanized country, and 67 percent of the population works in agriculture.

There is little epidemiological surveillance of communicable disease. Only half the population has clean water or sanitary waste disposal. This leads to a high burden of diseases such as viral hepatitis, typhoid, cholera, malaria, and other gastrointestinal ailments. These illnesses cause a fair amount of misery, but account for only 4 percent of mortality.

Tuberculosis is on the rise, climbing from 55 cases per 100,000 in 2001 to 67 cases per 100,000 in 2003; there is little money for widespread vaccination. Like its Central Asian neighbors, the AIDS rate is low at 0.1 percent, or around 4,900 cases. It has not moved into the general population, and seems to be confined to IV drug users, prisoners, and sex workers. The government has made a good start at containing and preventing the spread of the virus, including the opening of testing and counseling centers among at-risk areas. Drug use has increased as Afghanistan's poppy production has returned to pre-war levels; Tajikistan is on the main smuggling routes out of Afghanistan.

Non-communicable disease accounts for at least 85 percent of mortality in Tajikistan. (Inaccurate medical coding of diseases skew the figures to some degree.) Cardiovascular disease (CVD) is the main killer, accounting for 57 percent of all deaths within the country. Tajikistanis main risk factors for the development of CDV are alcohol abuse, high blood pressure, and obesity for males. For females, high blood pressure, obesity, and exposure to indoor smoke from cooking with solid fuels are the main risks. Tajikistan seems to [Page 1643]have a low rate of cancer, but like its neighbors, heavy alcohol use and viral hepatitis increases the mortality from cirrhosis and chronic liver disease.

Despite attempts to improve care for children, Tajikistan has infant and child mortality rates more in line with Africa than Europe. Ninety-one of every 1,000 infants die before the age of one, and 118 of every 1,000 dying before the age of five. UNICEF believes that this generation of children will be less educated than their parents, as the universal education of the Soviet period has collapsed. About 18 percent of children work to help support their families. Eighty percent of the 11,000 children in Tajikistani orphanages are not orphans at all, but have been put into care by parents who cannot afford to keep them or who have migrated in a search for work.

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