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Budbazar E.,National Center for Communicable Diseases | Vanchinkhuu S.,UNICEF | Blanc D.C.,Regional Immunization Specialist | Grundy J.,University of Melbourne
International Journal for Equity in Health | Year: 2012

Introduction. In recent years, the country of Mongolia (population 2.8 million) has experienced rapid social changes associated with economic growth, persisting socio-economic inequities and internal migration. In order to improve health access for the urban poor, the Ministry of Health developed a "Reaching Every District" strategy (RED strategy) to deliver an integrated package of key health and social services. The aim of this article is to present findings of an assessment of the implementation of the RED strategy, and, on the basis of this assessment, articulate lessons learned for equitable urban health planning. Methods. Principal methods for data collection and analysis included literature review, barrier analysis of health access and in-depth interviews and group discussions with health managers and providers. Findings. The main barriers to health access for the urban poor relate to interacting effects of poverty, unhealthy daily living environments, social vulnerability and isolation. Implementation of the RED strategy has resulted in increased health access for the urban poor, as demonstrated by health staff having reached new clients with immunization, family planning and ante-natal care services, and increased civil registrations which enable social service provision. Organizational effects have included improved partnerships for health and increased motivation of the health workforce. Important lessons learned from the early implementation of the RED strategy include the need to form strong partnerships among stakeholders at each level of the health system and in the community, as well as the need to develop a specific financing strategy to address the needs of the very poor. The diverse social context for health in an urban poor setting calls for a decentralized planning and partnership strategy, but with central level commitment towards policy guidance and financing of pro-poor urban health strategies. Conclusions: Lessons from Mongolia mirror other international studies which point to the need to measure and take action on the social determinants of health at the local area level in order to adequately reduce persistent inequities in health care access for the urban poor. © 2012 Lhamsuren et al; licensee BioMed Central Ltd.

Dondog B.,International Agency for Research on Cancer | Lise M.,Aviano Cancer Center | Baldandorj B.,National Center for Communicable Diseases | Franceschi S.,International Agency for Research on Cancer
European Journal of Cancer Prevention | Year: 2011

The incidence of hepatocellular carcinoma (HCC) in Mongolia is far higher than that of any other cancer in the country, and among the highest worldwide. The relative importance of infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) is unclear. We reviewed (i) medical records for 963 patients with HCC and 941 patients with cirrhosis admitted for the first time to the National Cancer Center of Mongolia and the National Center for Communicable Diseases, respectively, from 2000 to 2009, and (ii) articles published from 1990 to 2010 on the seroprevalence of hepatitis B surface antigen (HBsAg) and antibodies against hepatitis C virus (anti-HCV) among individuals with and without liver disease. Among those with HCC, the seroprevalence of HBsAg, anti-HCV and dual infections was 50, 27 and 21%, respectively. Corresponding percentages among the patients with cirrhosis were 40, 39, and 20%. In both diseases, HCV infection was relatively more prevalent in women than in men and, in cirrhosis, in patients older than 45 years of age. In healthy individuals, from published articles, anti-HCV seroprevalence steadily increased with age (from 3% at age 0-5 years to 34% at age =50 years), whereas HBsAg seroprevalence stayed constant at about 8%. The future benefit of childhood vaccination against HBV in Mongolia will be undermined by the consequences of a severe HCV epidemic and a uniquely high burden of dual infections. © 2010 Wolters Kluwer Health.

Yanjindulam P.,National Center for Communicable Diseases | Oyuntsetseg P.,Ministry of Health | Sarantsetseg B.,General Executive Agency of Court Decision | Ganzaya S.,The Global Fund | And 4 more authors.
International Journal of Tuberculosis and Lung Disease | Year: 2012

Documentation on the TB situation in prisons in developing countries is limited, and very few studies have quantitatively evaluated TB control programmes in prisons. This study aimed to evaluate TB control in Mongolian prisons by analysing routine programmatic data. The TB caseload in prisons has significantly diminished in the last decade, synchronised with policy and programmatic development, including systematic entry screening on detention and after conviction, and improved living conditions. Improved case detection during entry screening may have contributed to the significant reduction of the TB caseload in prisons. © 2012 The Union.

Buyankhishig B.,National Center for Communicable Diseases | Naranbat N.,National Center for Communicable Diseases | Mitarai S.,Research Institute for Tuberculosis | Rieder H.L.,International Union Against Tuberculosis and Lung Disease | Rieder H.L.,University of Zurich
International Journal of Tuberculosis and Lung Disease | Year: 2011

BACKGROUND: Drug-resistant tuberculosis (TB) has emerged as an obstacle to effective TB control. SETTING: The eight district and 21 province TB dispensaries and the two TB hospitals comprising the diagnostic centers for TB in Mongolia. METHODS: To investigate drug resistance levels among new and retreated TB cases. Specifi cally, we determined the prevalence of resistance to rifampin, streptomycin, isoniazid and ethambutol among TB patients with and without prior anti-tuberculosis treatment. RESULTS: A total of 850 patients (74.1% of eligible and 78.0% of patients with a specimen) had Mycobacterium tuberculosis isolated and are the subject of this analysis. Of these, 200 had a history of prior treatment and 650 did not. Any multidrug resistance was found in 7.5% (95%CI 5.9-9.5), with respectively 27.5% (95%CI 21.8-34.1) and 1.4% (95%CI 0.7-1.6) of patients with and without prior history of treatment. CONCLUSIONS: The most conspicuous fi nding in our survey was the relatively low prevalence of multidrug resistance among patients without a history of prior treatment, as compared to very high prevalence among previously treated patients. This suggests that retreatment is defi cient and poses a threat to continued transmission, which has not yet manifested itself among new patients. © 2011 The Union.

Dobler C.C.,University of New South Wales | Dobler C.C.,University of Sydney | Korver S.,National Center for Communicable Diseases | Batbayar O.,National Center for Communicable Diseases | And 7 more authors.
Emerging Infectious Diseases | Year: 2015

In Ulaanbaatar, Mongolia, multidrug-resistant tuberculosis (MDR TB) was diagnosed for more than a third of new sputum smear–positive tuberculosis patients for whom treatment had failed. This finding suggests a significant risk for community-acquired MDR TB and a need to make rapid molecular drug susceptibility testing available to more people. © 2015, Centers for Disease Control and Prevention (CDC). All rights reserved.

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