The contribution of field epidemiologists to the public health sector in Mongolia / Монголын Анагаах Ухаан

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.

Gene mutation associated with drug resistance in M.tuberculosis strains isolated from national TB prevalence survey in Mongolia / Монголын Анагаах Ухаан

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.

The effect of household poverty on tuberculosis.

pSETTING: Households in Malawi, Mongolia, Myanmar, the Philippines, Rwanda, Tanzania, Viet Nam and Zambia.OBJECTIVE To assess the relationship between household socio-economic level, both relative and absolute, and individual tuberculosis (TB) disease. DESIGN: We analysed national TB prevalence surveys from eight countries individually and in pooled multicountry models. Socio-economic level (SEL) was measured in terms of both relative household position and absolute wealth. The outcome of interest was whether or not an individual had TB disease. Logistic regression models were used to control for putative risk factors for TB disease such as age, sex and previous treatment history. RESULTS: Overall, a strong and consistent association between household SEL and individual TB disease was not found. Significant results were found in four individual country models, with the lowest socio-economic quintile being associated with higher TB risk in Mongolia, Myanmar, Tanzania and Viet Nam. CONCLUSIONS: TB prevalence surveys are designed to assess prevalence of disease and, due to the small numbers of cases usually detected, may not be the most efficient means of investigating TB risk factors. Different designs are needed, including measuring the SEL of individuals in nested case-control studies within TB prevalence surveys or among TB patients seeking treatment in health care facilities.

Success of community-based directly observed anti-tuberculosis treatment in Mongolia.

BACKGROUND: Many countries restrict access to directly observed therapy (DOT) for tuberculosis (TB) to government health facilities. More innovative approaches are required to reduce non-adherence, improve patient outcomes and limit the risk of selecting drug-resistant strains. METHODS: We performed a retrospective cohort study in sputum smear-positive patients treated with community-based DOT (home-based DOT or 'lunch' DOT, whereby DOT is provided with a free daily meal once sputum smear conversion has been documented), and conventional clinic-based DOT in Ulaanbaatar, the capital of Mongolia, in 2010-2011. We compared treatment success using community-based home DOT vs. conventional clinic DOT and describe treatment completion rates using lunch DOT. RESULTS: The overall treatment success among new sputum smear-positive TB patients was 85.1% (1505/1768). Patients receiving community DOT had higher cure rates (294/327, 89.9% vs. 1112/1441, 77.2%; aOR 2.66, 95%CI 1.81-3.90) and higher treatment success (306/327, 93.6% vs. 1199/1441, 83.2%; aOR 2.95, 95%CI 1.85-4.71, P < 0.001) than those treated with clinic DOT. Apart from one death, treatment completion was 100% among patients who received lunch DOT after sputum smear conversion. CONCLUSIONS: Community DOT improved treatment success in Ulaanbaatar, Mongolia. It should now be scaled up to be made available for more patients and in all regions of the country.

One Health in Mongolia.

The Asia Pacific Strategy for Emerging Diseases (APSED) requires collaboration, consensus, and partnership across all the different actors and sectors involved in different aspects of emerging disease. Guided by APSED, Mongolia has established a functional coordination mechanism between the animal and human health sectors. Surveillance, information exchange and risk assessment, risk reduction, and coordinated response capacity and collaborative research have been identified as the four pillars of the zoonoses framework. Intersectoral collaboration has been clearly shown to be a crucial tool in the prevention and control of emerging zoonotic diseases. A "One Health" strategy has been implemented under the concept of 'Healthy animal-Healthy food-Healthy people'. An intersectoral coordination mechanism established between the veterinary and public health sectors has expanded its function to incorporate more work on food safety, emergency management, and effects of climate change on zoonotic diseases. Its membership includes the human health sector, the veterinary sector, the national emergency management agency, the environment sector, emergency management and inspection authorities, and the World Health Organization (WHO). The main outputs of the coordination mechanism have been strengthened surveillance and response activities and laboratory capacities. The coordination mechanism has also strengthened the surveillance and response capacity of neglected zoonotic diseases, such as brucellosis, anthrax, and tick-borne diseases. Through regular meetings and brainstorming sessions, both sectors have developed joint operational plans, a long-term risk reduction plan 2011-2015, initiated a prioritization exercise and risk assessment for 29 zoonotic diseases, and reviewed and revised standards, procedures, and communication strategies. In 2011, a list of experts on major zoonoses were identified from different sectors and formed into a taskforce to identify the focal points for rabies, brucellosis, and vector-borne diseases. As a result, disease control strategies are now linked to scientific research and epidemiological expertise.