ABSTRACT
Introduction@#Field epidemiology training (FET) was first established in 1951, named as Epidemics Intelligence Service, next to the Centres for Disease Control and Prevention of USA. At present, FET is conducted in over 50 countries in the world and the training is based on the main principle of promoting utilization of theories of epidemiology in public health practice and evidence-based decision making. Main goal of FET is to strengthen capacity and infrastructure of the public health system and to improve people’s health as a result of forming a core team of professionals, which will deliver public health services in a particular country, survey any country-specific public health issues, and provide evidence.</br> MFETPs have been implemented in Mongolia since 2009 with support from Ministry of Health (MOH) and World Health Organization (WHO). To ensure structural and organizational sustainability of the training, the programme has been integrated into the National Centre for Communicable Disease (NCCD) under the auspices of MOH and the trainings have been conducted nationwide. MFETPs last for one year, which includes 1-2 months of classroom training and 3-11 months of field internship by trainees. The training graduates should be skilled to use the science of epidemiology in studying public health issues and to deliver evidence-based conclusions and recommendations.@*Goal@#To evaluate of MFETP graduates’ knowledge, skills and their contribution to the public health system@*Method@#We conducted a cross-sectional online survey link between October 2019 and March 2020 through Mongolian field epidemiology alumni networks. Survey questions included demographic details of participants, along with their technical background, level of formal education, topics studied during epidemiology training, and years of experience as an epidemiologist. We specifically targeted FETP alumni, however the survey was open to all people who had studied MFETP.@*Results@#In total, 55 field epidemiologists (77% of all graduates) responded to the survey. Participants had a range of formal public health and epidemiology training backgrounds. Of the total graduates, 19 (30%) are currently working at NCCD, of whom 3 are head of department. A total of 7 (11%) graduates work in rural health centers and health centers, while 6 (10%) graduates work in the tertiary level. In addition, there are 2 graduates working in the Ministry of Health. 80.6% (25/31) were involved in outbreak-response activities and 93.9% (31/33) conducted operational research, 91.4% (32/35) said that the surveillance analysis was conducted and 81.5% (22/27) performed fundamental researches at least one times. One graduate had an average 3.7 study and analysis during the course of the study, and increased to 7.7±12.4 after graduation. Particularly, the operational study (4.1 ± 8.7) and the outbreak study (3.1 ± 4.5) have increased.@*Conclusion@#Our study has demonstrated that applied epidemiology workforce training must evolve to remain relevant to current and future public health challenges.
ABSTRACT
Background@#According to the First National Tuberculosis (TB) Prevalence Survey in Mongolia the prevalence of bacteriologically-confirmed pulmonary TB among adults was 559.6 (95% CI: 454.5–664.7) per 100000 population in 2014–2015. This was three times as high as previously estimated. Nationwide anti-tuberculosis (TB) drug resistance survey was conducted in 1999 and 2007 in Mongolia. Share of multidrug resistant TB (MDR-TB) cases among newly notified TB cases increased from 1.0% in 1999 to 1.4% in 2007. Accordingly, we aimed to perform drug susceptibility test on strains isolated from TB Prevalence Survey and to determine the prevalence of drug resistant TB.@*Material and Methods@#All 242 MTB strains isolated from the survey TB cases were tested GenoTypeMTBDRplus test and conventional 1st line DST on solid medium. @*Result@#Conventional DST and GenoTypeMTBDRplus tests done for 93.8% (227/242) of them and 6.2% (15/242) were tested by GenoTypeMTBDRplus only. A 61.6% (95%CI 55.3-67.4) of all cases were susceptible to first line anti-TB drugs, any drug resistance and MDR-TBdetected as 38.4% (95% CI 32.5-44.7)and 9.5% (95% CI 6.4-13.9), respectively. Prevalence of MDR-TB was7.8% (95% CI 4.9-12.4) among new and 17.9% (95% CI 9.0-32.7) among previously treated cases. The 64 strains were identified as a resistant to isoniazid, 32.8% (42/64) and 65.6% (21/64) were katG, and inhAmutation, respectively. One isolate (1.6%) was mutations in both the inhAand katGgenes.The predominant mutations detected in therpoB were S531L (91.3%) among rifampicin resistant isolates and the mutation in inhAwas C–15T (100%) and katG mutation was S315T1 (100%) among isoniazid-resistant isolates. @*Conclusion@#Prevalence of cases with DR-TB is high among prevalent TB cases, especially prevalence of MDR-TB among new cases. In comparison to previous studies, DR-TB cases seem to be increased. Rifampicin resistant strains have a mutation of the rpoBand resistance to isoniazid is predominantly associated with the inhA mutation.