Problems of Diagnosing Hip Joint Dysplasia in Kyrgyzstan. Archival Interview with Kasymbek Tazabekov
In light of this situation, the AKIpress news agency referred to an archived interview with Kasymbek Tazabekov, who is considered the founder of pediatric orthopedics in Kyrgyzstan, as well as a distinguished physician and the founder of the "Healthy Children" Foundation. This conversation took place in 2005, and despite the years that have passed, its content remains relevant.
Kasymbek Tazabekov is the author of more than 70 scientific works and 10 books, as well as the founder of the Kyrgyz school of traumatology and orthopedics. In the interview, he emphasizes the importance of early diagnosis of hip dysplasia, which, if left untreated, can lead to hip dislocation and disability. In 2025, a conference titled "Current Issues in Pediatric Traumatology and Orthopedics" was held, gathering specialists from various countries to discuss modern methods of diagnosis and treatment.
Tazabekov highlights that when the disease is diagnosed in the first weeks of life, treatment shows successful results in more than 90% of cases, often without the need for surgical intervention. Important aspects include training medical personnel and parents' attention to the early symptoms of the disease.
Material from the 2005 archive:
According to data from the information center of the Ministry of Health of the Kyrgyz Republic (2005), among 299,000 children born over three years, 3,218 have congenital anomalies, of which 1,496, or 46%, are cases of congenital hip dislocation. This diagnosis is made for 5 newborns per 1,000. This severe condition, accompanied by impaired musculoskeletal function, is often a consequence of the more common hip dysplasia, which can be considered an initial and easily treatable stage.
Hip dysplasia ranks first among pediatric orthopedic diseases, with an incidence of 16-18 cases per 1,000 newborns.
If dysplasia is not diagnosed and treated in a timely manner, it can progress to hip dislocation, which will subsequently lead to disability.
Treatment of this disease is complex and lengthy, often requiring surgical intervention, which is not always successful.
Sometimes even major surgeries do not yield the expected results.
Parents of children suffering from such diseases face immense stress. The words of doctors stating that "your child is disabled" become a heavy burden. In such situations, many lose hope, and life seems hopeless. When we see a mother with a disabled child on the street, we often look away and feel relieved that it hasn't affected us.
Meeting Kasymbek Tazabekov, a well-known orthopedic surgeon in Kyrgyzstan and an associate professor at the KGMI, instills hope that the number of parents hearing such a diagnosis will decrease, as dysplasia can be effectively treated. It is not necessary to implement large-scale government programs or conduct major reforms in healthcare, which require a lot of time and resources. Can anything be changed, and how can this be done?
Surprisingly, it requires very little. The main thing is that one person sincerely wants to help, has knowledge, experience, and organizational skills, as well as minimal financial resources. In 2002, Kasymbek Tazabekov founded the "Healthy Children" foundation with the support of DFID, local companies, and NGOs, starting a project for the early detection of hip dysplasia and training maternity hospital doctors to recognize the signs of the disease. The results were impressive — the cure rate exceeded 90%. We met with Kasymbek Tazabekov and asked him to talk about the causes of the disease, its symptoms and treatment, as well as the project that allowed such results to be achieved in a short time.
- Kasymbek Tazabekovich, please tell us about the disease itself. When does it manifest, and what are its dangers?
- Children are often born not so much with hip dislocation as with hip dysplasia, which is not critical if the disease is detected in time. Otherwise, it can progress to hip dislocation, requiring prolonged and complex treatment. Treatment of the advanced stage of the disease may not always be successful. Often, due to the ignorance of doctors and the inattention of parents, children with congenital hip dislocation are admitted to clinics at an age when conservative treatment is no longer possible. Therefore, it is critically important to identify such cases in the maternity hospital in the first days or weeks of life.
Starting treatment even at the age of two does not guarantee success, as anatomical changes in the joint can progress and lead to severe disability. If the disease is diagnosed at early stages, there is almost a 100% recovery rate in the first days of life. Of course, there may be rare exceptions, but in 90% of cases, the outcome is positive, often without surgical intervention and plaster casts.
- When did you establish the foundation?
- In 2002, I created the "Healthy Children" Foundation to identify disease hotspots and find new approaches to treatment. I traveled to problematic areas and examined 8,442 children from 6 maternity hospitals in one year. These are the Kochkor, Kemin, Suzak, and Aksu districts, as well as maternity hospitals in Jalalabad and Karakol. Of these, 564 children were identified with suspected dysplasia, among which dysplasia (this is not yet dislocation, but an early stage) was present in 428 cases, and hip dislocation in 136 cases. Over that year, 449 out of 564 children were successfully treated.
- Did you identify these children in maternity hospitals, in the first days after birth?
- Yes, precisely in the first days. This is extremely important, as early diagnosis prevents the development of dysplasia into dislocation. Of the 564 children, 65 needed ongoing treatment. The task is to train medical specialists in the maternity hospital to recognize the disease and its signs.
- Are there specialists in maternity hospitals who can determine if a child is suspected of having dysplasia?
- Unfortunately, there are no such specialists in maternity hospitals. Most regional and district clinics and hospitals do not even have orthopedic surgeons. As you know, family doctor groups have been created in clinics, which include general practitioners who are not familiar with the early clinical diagnosis of hip dysplasia. Often, they do not pay attention to this pathology. My task was to train micro-pediatricians, neonatologists, obstetricians, and even nurses in maternity hospitals so that they know what to pay attention to and what the signs of the disease are.
We posted descriptions of the clinical manifestations of the disease in doctors' offices and delivery rooms so that not only medical professionals but also mothers themselves could carefully monitor the symptoms of the disease. It is important that no child leaves the maternity hospital without a preliminary orthopedic examination.
In each maternity hospital, it is necessary to train 3 neonatologists and 1 orthopedic surgeon from among the pediatric surgeons. I considered it my duty to pass on knowledge to these doctors, conducting lectures and practical classes on proper treatment. Treatment at an early stage is not complicated. The first step is proper swaddling of the child; we call this wide swaddling or "envelope" swaddling, where the child's legs are spread apart. Swaddling should be done for 3-4 months, and after that, the child is completely cured. Children with clinical signs of the disease should not be discharged from the maternity hospital without an envelope or without training the mother in wide swaddling. After discharge, they need to be monitored to track the recovery process.
Therefore, every two months, I not only identified new patients but also checked how treatment was progressing for already identified children.
- What are the results of your work?
- As a result of the treatment, no cases of hip dysplasia in the specified maternity hospitals progressed to hip dislocation. Even in 136 cases of clinically and radiologically identified hip dislocation, 70 children recovered and were removed from the register. The remaining 65 children continue treatment, and the results will be known in 1-1.5 years. Difficulties in treatment are often related to parental negligence. In rural areas, especially during seasonal work, treatment may be interrupted because parents simply do not come for follow-up consultations, and the children's condition worsens.
- This seems to be some Kyrgyz specificity — the hope that it will pass on its own. Parents begin to worry only after 1 year when the child starts walking?
- Yes, before 1 year, the disease is not noticeable. When the child starts walking, then parents begin to notice problems, and often it is too late.
- What could be the cause of the pathology?
- Causes can include consanguineous marriages, which often lead to such pathologies. For example, in the Aksu district, there is a family that enters into consanguineous marriages to preserve their lineage.
- What about nutrition and living conditions?
- Yes, this is particularly important for the health of the mother. Harmful factors such as smoking and alcohol also play a role. For example, in the Issyk-Kul region, women may abuse alcohol, which in a state of intoxication can lead to pathology in the child.
Poor nutrition, lack of vitamins, poverty, and poor living conditions all negatively affect the health of the future child. In Kyrgyz families, there are often many children — 10-12 in a family. I know a person who lives in Bishkek and has 24 children from two marriages. Frequent births, when the female body does not have time to recover, lead to pathologies.
- Are the consequences of the disease only limping?
- Not only limping; later, such children become disabled. From the third year of life, such children are recognized as disabled by government decree.
Our goal is to prevent disability, to treat diseases before the age of one, while the child does not know what limping is. Recently, there has been an increase in cases of the disease among Dungans and Tajiks. If the disease is not detected in time, then at the age of 1.5-2 years, complex surgical intervention is required, and children may spend a long time in the hospital. And surgery for a child means anesthesia, instruments, fixation, and a long recovery. Of course, we perform surgeries that are on par with Russian doctors, but the results are not always satisfactory, not because we operate poorly, but because treatment of advanced cases is much more complicated.
- If a well-trained doctor diagnoses the disease in time, can severe consequences be avoided? Is it just a matter of training doctors?
- Not only training but also materially motivating them. I trained micro-pediatricians, district doctors, and surgeons. We paid an additional 500 soms per month to encourage doctors to thoroughly examine children. If a child with such a diagnosis appears in their area after a year, I will ask where the results are? The funding for these doctors was provided by the foundation with the participation of major businessmen. However, now that funding has run out, I cannot continue my work in these areas. There is still interest from doctors. It is also important for parents to be actively involved so as not to let the situation reach the point of needing complex treatment in Bishkek. Much depends on the conscientiousness of the doctor and his attentiveness to the examination of the child. Many excuses can be found, and as a result, the child may remain lame for life.
- Where in Kyrgyzstan is this disease most common?
- In studying this problem, I concluded that congenital hip dislocation in Kyrgyzstan is unevenly distributed, with several endemic areas where it occurs most frequently. There are places where this disease is almost not observed.
Unfortunately, this issue has not received due attention. 10-12 years ago, I traveled around Kyrgyzstan and examined areas with the highest prevalence of this pathology. It turned out that it is prevalent in the Suzak district of the Jalal-Abad region, as well as in the Kochkor and Atbashy districts of the Naryn region and some areas of the Issyk-Kul region. In Suzak, for example, according to our data, the incidence is from 12 to 15 cases per 1,000 newborns, while the national average is 5 cases per 1,000.
I became interested in why the Suzak district is so heavily affected by this disease. It turned out that the Kogart River in this area has low iodine content, which may be the cause not only of goiter but also of dysplasia, which I am studying.
- What is the situation in other countries?
- Statistics for Kyrgyzstan and the CIS countries show that among 1,000 births, 3-5 children suffer from this pathology, which amounts to 0.3-0.5%. In the Suzak district (Kogart zone), this figure reaches 1%, which equals 10-12 patients per 1,000 children. In the Kochkor and Atbashy districts, this percentage is 0.7-0.8%, or 8-9 cases per 1,000. In the Chui and Issyk-Kul valleys, the figures are within average values. There are areas where the disease has been virtually unrecorded.
For example, in Talas. In the CIS, the highest prevalence is observed in North Ossetia — up to 17 per 1,000 newborns. These are also mountainous areas. They care for newborns in national cradles, similar to our beshik, where the child is tightly swaddled in the specified position of the legs for 6-7 months. In northern areas, such as tundra, there is also a high pathology rate — 70-80 lame children per 1,000 examined. This is because these peoples lived in isolation, resulting in blood mixing. The heredity of the disease is often passed down through the maternal line. If both parents have problems, then the child will suffer from them as well. As a result of vitamin deficiencies and inadequate nutrition, plus blood mixing, this pathology becomes common.
- Is the Ministry of Health aware of your project?
- Yes, the Ministry of Health is informed, the chief surgeon is aware, our institute is also informed, and articles have been published. This is a new method of early detection and treatment. We discuss this issue in the media, but the shift in addressing the problem is very slight. Work needs to continue. Neonatologists acknowledge that until recently, they had very superficial knowledge of the pathology and did not engage in early detection and treatment. We have covered the Jalalabad region, some areas of Naryn and Issyk-Kul regions, but cases where the disease remains undetected still occur. Even in the prosperous Chui region and in Bishkek. Any disease is easier to treat at the very early stage. The main thing is to diagnose the disease correctly and on time and to start treatment as quickly as possible.
This will help avoid complications and surgical intervention, which is also economically advantageous.
- Do you plan to continue your work?
- I have devoted my entire life to this and will work as long as I have the strength. Every cured child is a reward for my labor. Currently, I have found a way to continue the work of the foundation. Six district maternity hospitals already have experience in diagnosis and can really help mothers in treating their children.
I would like to spread this successful experience to other maternity hospitals.
- Thank you for the interesting interview, and we wish you success!
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