STAPP: Swiss Tajik Pediatric Project

10 years of success in Mongolia and 5000 successful treatments of DDH (developmental dysplasia of the hip) have encouraged us to expand our project. In October 2017, the team launched a pilot project in Tajikistan. During our first two-week stay we trained and certified 40 doctors. We equipped two large maternity clinics in the capital Dushanbe with ultrasound equipment and the necessary material for diagnostics and treatment. The project has met with enormous interest from both the doctors and the Ministry of Health, which promises its support. In May 2018, we conducted an intensive theoretical and practical refresher course for the doctors of the National Research Institute and Birth Hospital 1 during one week. Since the beginning of 2019 we employ a project coordinator in Dushanbe. As in many countries in Central Asia, newborns in Tajikistan are traditionally tightly wrapped in cloths with stretched legs during the first months of life and are additionally tied to a rocking cradle "Gahvora". This leads to the fact that unstable hip joints are literally "levered out" by the fixation of the legs. This prevents spontaneous post-ripening or can even lead to a worsening and luxation of a mild DDH. According to our findings, the frequency of DDH is higher than in Switzerland. In a developing country without a social safety net, however, the resulting disability is much more serious. Those affected often see themselves deprived of their professional opportunities and socially discriminated against. Hip joint replacement therapy is unaffordable for the country, and the surgical technique does not meet current standards either. By very early detection of DDH using ultrasound, a hip can be treated without surgery using a hip splint, thus preventing a lifelong disability.
 
Info about Tajikistan:
 
Tajikistan is a high mountain country bordering Uzbekistan, Kyrgyzstan, the People's Republic of China and Afghanistan. More than two thirds of the surface are high mountains. The climate is extremely continental with cold winters and hot summers. 84.3% of the population (2010) are Tajiks. The birth rate in 2016 was 2.7 children per woman. 32.5 % of the population were under 15 years old.
 
In 2004, public health expenditure amounted to 1% of GDP. In the early 2000s there were about 200 doctors per 100 000 inhabitants. In 2005, infant mortality was 5.9% of live births. Life expectancy in the period from 2010 to 2015 was 70.4 years (men: 67.7 years, women: 73.5 years).
 
A relatively large number of births in Tajikistan still take place at home in the hard-to-reach provinces. In the two birth clinics selected for the first phase of the hip sonography pilot project, approximately 16,000-20,000 children are born each year.