Feasibility of one-stop antenatal syphilis screening in Ulaanbaatar, Mongolia: women and providers perspectives.

Congenital syphilis can be prevented by antenatal syphilis screening, however, the complexity of delivering prenatal service can result in low screening rates, and thus lower prevention and treatment rates. One-stop antenatal syphilis screening, which includes rapid testing and treatment, is the proposed method to overcome this problem. The feasibility of this type of screening needs to be tested to dertermine its effectiveness. In this study, the opinions and level of satisfaction of women undergoing antenatal care and their health care providers regarding a one-stop syphylis screening and treatment service at two antenatal clinics in Ulaanbaatar, Mongolia were assessed. The majority of the 246 women studied were satisfied with the service. The mean aggregate satisfaction score derived from 12 questions regarding specific aspects of satisfaction was 3.2. Most providers were also satisfied, not reporting any significant problems interfering with routine antenatal care. However, all providers felt the one-stop service is time consuming and leads to high staff workloads and needs good clinical management. The provider preferred instead to treat husbands presumptively to avoid the possibility of diagnosing couples with discordant syphilis, which could lead to possible violence. A one-stop syphilis diagnosis and treatment service during antenatal care is feasible in Ulaanbaatar, Mongolia from both the women's and providers' perspectives.

One-stop service for antenatal syphilis screening and prevention of congenital syphilis in Ulaanbaatar, Mongolia: a cluster randomized trial.

BACKGROUND: This cluster randomized trial was performed to test whether one-stop service could better prevent congenital syphilis than the conventional antenatal screening service in Mongolia. METHODS: Out of 14 antenatal clinics in 6 districts of Ulaanbaatar, 7 were randomly selected for the one-stop service and the remaining for the conventional service. Intervention clinics provided on-site rapid syphilis testing and immediate treatment for positive cases and their partners. In control clinics, syphilis screening services with routine off-site rapid plasma regain testing and case management were followed. Analysis was intention to treat. RESULTS: Of 3850 antenatal women recruited in each group, the proportion of syphilis testing at the first visit and third trimester was over 99% in the intervention group and 79.6% and 61.5% in the control group, respectively (P <0.001 for both periods). Correspondingly, syphilis cases detected in the intervention group were 73 (1.9%) and 20 (0.5%) for the first visit and third trimester, respectively, and 27 (0.9%) and 2 (0.08%) in the control group; and 98.9% (92/93) of the detected cases in the intervention group and 89.6% (26/29) in the control group were adequately treated (P = 0.02). The corresponding treatment rates for sexual partners were 94.6% and 55.2% (P <0.001). One congenital syphilis case out of 3632 deliveries in the intervention group, compared to 15 of 3552 in the control group, was diagnosed, a reduction of 93.5% (95% confidence interval, 66.0%-98.6%). CONCLUSIONS: One-stop services increased the detection rate of syphilis, treated more positive women and their partners, and effectively reduced the rate of congenital syphilis.

Heritability and linkage study on heart rates in a Mongolian population

Elevated heart rate has been proposed as an independent risk factor for cardiovascular diseases, but their interrelationships are not well understood. In this study, we performed a genome-wide linkage scan in 1,026 individuals (mean age 30.6 years, 54.5% women) from 73 extended families of Mongolia and determined quantitative trait loci that influence heart rate. The DNA samples were genotyped using deCODE 1,039 microsatellite markers for 3 cM density genome-wide linkage scan. Correlation analysis was carried out to evaluate the correlation of the covariates and the heart rate. T-tests of the heart rate were also performed on sex, smoking and alcohol intake. Consequently, this model was used in a nonparametric genome-wide linkage analysis using variance component model to create a multipoint logarithm of odds (LOD) score and a corresponding P value. In the adjusted model, the heritability of heart rate was estimated as 0.32 (P<.0001) and a maximum multipoint LOD score of 2.03 was observed in 77 cM region at chromosome 18. The second largest LOD score of 1.52 was seen on chromosome 5 at 216 cM. Genes located on the specified locations in chromosomes 5 and 18 may be involved in the regulation of heart rate.

Intestinal protozoan infections and echinococcosis in the inhabitants of Dornod and Selenge, Mongolia (2003).

The status of intestinal parasitic infections and seroprevalence of cystic echinococcosis in the inhabitants in Dornod and Selenge, Mongolia, was observed with stool and serum samples from 165 and 683 residents from August 9 to August 15, 2003. A total of 10 inhabitants (6.1%) were found to be infected with protozoan cysts or oocysts by stool examinations; 7, 1 and 2 cases with Entamoeba coli, Giardia lamblia and Cryptosporidium parvum, respectively. A total of 62 people (9.1%) revealed significantly high levels of specific antibodies against Echinococcus granulosus by enzyme-linked immunosorbent assay (ELISA). The surveyed areas are rural areas and the sanitized tab water is not available. There is a possibility of endemic transmission of water-borne protozoan diseases in these areas. The clinical echinococcosis is needed to be searched from the seropositive inhabitants.

Coverage of antenatal syphilis screening and predictors for not being screened in Ulaanbaatar, Mongolia.

OBJECTIVES: To measure the coverage of antenatal syphilis screening and identify factors related to women not being screened. GOAL: To assess the syphilis control program in Mongolia. STUDY DESIGN: Antenatal care records of women in 16 antenatal care clinics of 6 districts were reviewed. Additionally, postpartum women were interviewed to identify potential factors for not being screened. RESULTS: Among 3,519 antenatal records, the coverage of syphilis screening was 77.7%. Of 2,735 screened women, 54 (2.0%) had reactive serological results and subsequently received treatment. Four late antenatal care comers delivered infants with congenital syphilis. Being unscreened was significantly associated with late antenatal care (odds ratio OR=2.6), lack of knowledge (OR=5.5), history of previous sexually transmitted infection (OR=3.7), and living far from screening services (OR=4.9). CONCLUSIONS: The coverage of antenatal syphilis screening is still low, with poor contact tracing. More efforts are needed to promote early antenatal care visit and improve syphilis screening systems.

Antenatal care providers' practices and opinions on the services of antenatal syphilis screening in Ulaanbaatar, Mongolia.

The objectives of this study were to review antenatal syphilis screening and to assess antenatal care providers' practices and opinions in Ulaanbaatar, Mongolia. A cross-sectional study on antenatal syphilis screening was conducted. The study settings were all 16 antenatal care clinics, and a random selection of 30 family units from six districts in Ulaanbaatar, Mongolia. Interviews were conducted with 150 antenatal care providers and 27 antenatal care heads/leaders. Antenatal syphilis screening in Ulaanbaatar was complex. Most pregnant women had antenatal care at family units or antenatal clinics, but syphilis blood testing could be performed only in some district general hospitals. Syphilis positive-screening cases were referred to the venereologists for confirmation of results, appropriate treatment, contact tracing, and follow-up. The providers agreed with the need for syphilis screening in pregnant women but identified as constraints the limited time for performing the screening due to late antenatal visit, women's lack of knowledge, poverty, and geographic barriers. The practice of providers varied, and the opinion on a one-stop service was positive. The main conclusions concerning the failure of universal antenatal syphilis screening were limited accessibility and feasibility of the service, and the ignorance of both women and providers on the importance of screening. It was agreed that decentralization of antenatal syphilis screening would improve the system.