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COUNTRY PRESENTATIONCOUNTRY PRESENTATIONMONGOLIAMONGOLIA
Meeting of TB managers and TBMeeting of TB managers and TBlaboratory managers in the WPRlaboratory managers in the WPR
Hangzhou, ChinaHangzhou, China29 June29 June 2 July 20042 July 2004
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Country presentationCountry presentation
PopulationPopulation 2,475,000 (2002)2,475,000 (2002)APGRAPGR 1.3%1.3%
WomenWomen 50.4%50.4%
Reproductive age (15Reproductive age (15--49)49) 56.5%56.5%
Average life expectancy 60.4 (male), 66.1 (female)Average life expectancy 60.4 (male), 66.1 (female)Case notification rateCase notification rate
--New casesNew cases 3772 per 100.0003772 per 100.000 153 (2003)153 (2003)
MDR rateMDR rate
--1% in general population1% in general population--16% in prison population16% in prison population
--No data on MDRNo data on MDR--TB chronic cases category I and IITB chronic cases category I and II
--HIVHIV 4 cases4 cases
**Source:Source: Health sector 2002, Reducing Mortality, Ministry of HealthHealth sector 2002, Reducing Mortality, Ministry of Health
Mongolia, 2003Mongolia, 2003
Annual Statistic Report, National Center for CommuAnnual Statistic Report, National Center for Communicable Diseases, 2003nicable Diseases, 2003
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Country PresentationCountry Presentation
87%87%
(2002)(2002)
86.8%86.8%
(2001)(2001)
Success rateSuccess rate
85%85%85%85%83%83%
(2002)(2002)
83%83%
(2001)(2001)
58%58%
moremore
thanthan
Cure rateCure rate
70%70%70%70%67.5%67.5%67.7%67.7%70%70%DOTS DetectionDOTS Detection
rate new smearrate new smear(+)(+)veve
100%100%100%100%100%100%100%100%100%100%DOTS expansionDOTS expansion
20052005
PlannedPlanned
20042004
PlannedPlanned
20032003
ActualActual
20022002
ActualActual
20052005
OverallOverall
targettarget
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Action Plan 2003Action Plan 2003 --20042004Develop mechanism to ensure effectiveDevelop mechanism to ensure effective
implementation of Global Fund projectimplementation of Global Fund project
1. Approved Accelerating DOTS in Mongolia project, Two year wo1. Approved Accelerating DOTS in Mongolia project, Two year work planrk plan
with budget submitted to the GFATM, Grant Agreementwith budget submitted to the GFATM, Grant Agreementwith PR signedwith PR signed
Accelerating DOTS in Mongolia project implementedAccelerating DOTS in Mongolia project implementedin 9 districts ofin 9 districts of
Ulaanbaatar city and 6 selected provincesUlaanbaatar city and 6 selected provinces
2. Monitoring and Evaluation Plan for two years submitted and ap2. Monitoring and Evaluation Plan for two years submitted and approved byproved bythe Global Fundthe Global Fund
3.3. Organized targeted case detection and treatment activities amongOrganized targeted case detection and treatment activities amongthethe
vulnerable groups. Homeless people receiving free medical care avulnerable groups. Homeless people receiving free medical care at thet theMercy Hospital. New TB section established at the Mercy HospMercy Hospital. New TB section established at the Mercy Hospital whereital where
TB doctors providing consulting to TB patients. International orTB doctors providing consulting to TB patients. International organizationganization
World Vision provide free nutrition and supplement vitaminizatioWorld Vision provide free nutrition and supplement vitaminization ton to
vulnerable TB patient. By the WHO support there was commenced thvulnerable TB patient. By the WHO support there was commenced thee
Study on diagnosis delay of TB patients in Sept 2003. CoverageStudy on diagnosis delay of TB patients in Sept 2003. Coverage size of thesize of thestudy: 4 provinces and 8 districts of Ulaanbaatar. Designed andstudy: 4 provinces and 8 districts of Ulaanbaatar. Designed anddistributeddistributed
500 checklists 160 filled checklist data.500 checklists 160 filled checklist data.
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Action Plan 2003Action Plan 2003 --20042004
Improve quality of DOTS implementation in ruralImprove quality of DOTS implementation in rural
areasareas1. With purpose of improvement the participation of govern1. With purpose of improvement the participation of governors in TB activitiesors in TB activities
there was organized a training among 150 governors frothere was organized a training among 150 governors from 6 selectedm 6 selected
provinces and 9 districts of UB city.provinces and 9 districts of UB city.22.. NTP organizedNTP organized
--Training for 400 family and soum doctors of 15 provinces and diTraining for 400 family and soum doctors of 15 provinces and districtsstricts
supported by the Global Fundsupported by the Global Fund
--Training for 120 doctors from 2 selected provinces supported bTraining for 120 doctors from 2 selected provinces supported by the WHOy the WHO
--Training for 250 volunteers and the health workers on TB treatmTraining for 250 volunteers and the health workers on TB treatment andent and
treatment followtreatment follow--upup
3. Training on supervision and inspection in soum level (3. Training on supervision and inspection in soum level (30 TB coordinators30 TB coordinators
fromfrom
30 TB units)30 TB units)
4. MNTV and Radio broadcasting carried out 13 times4. MNTV and Radio broadcasting carried out 13 times
--Publication, interview by 4 newspapersPublication, interview by 4 newspapers --14times14times
-- Research conferenceResearch conference 2 times2 times
-- Press conference for launch the projectPress conference for launch the project
--Designed, published and distributed IEC materials: posters, leaDesigned, published and distributed IEC materials: posters, leaflets,flets,
stickers (2600 pc)stickers (2600 pc)
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Action Plan 2003Action Plan 2003 --20042004
Strengthen the system to maintain quality ofStrengthen the system to maintain quality of
laboratory serviceslaboratory services
1. Developed new guideline on EQA of smear microscopy in Mongoli1. Developed new guideline on EQA of smear microscopy in Mongolianan
2. 16 Lab. Technicians trained on microscopic examination2. 16 Lab. Technicians trained on microscopic examination
3. Conducted refresher training for 40 lab. Technicians3. Conducted refresher training for 40 lab. Technicians
4. Established new TB laboratory in remote area4. Established new TB laboratory in remote area
5. Supervision visits carried out in 8 district of Ulaanbaa5. Supervision visits carried out in 8 district of Ulaanbaatar and 9tar and 9
aimagaimag
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Access to DOTS for poor and vulnerableAccess to DOTS for poor and vulnerable
populationspopulations
123 vulnerable people (unemployed, homeless TB patient) with123 vulnerable people (unemployed, homeless TB patient) with
improved access to DOTS receiving supplementary food in 9improved access to DOTS receiving supplementary food in 9district of Ulaanbaatardistrict of Ulaanbaatar
40 vulnerable people (unemployed, homeless TB patient) with40 vulnerable people (unemployed, homeless TB patient) with
improved access to DOTS receiving supplementary food in 6improved access to DOTS receiving supplementary food in 6
provincesprovinces
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Activities will be implemented in 2004Activities will be implemented in 2004 --20052005
in address of TB/HIVin address of TB/HIV
2 Quarter 20052 Quarter 2005Conduct workshop on TB diagnosis, treatmentConduct workshop on TB diagnosis, treatment
and prevention for STI doctors from urban areaand prevention for STI doctors from urban area55
3 Quarter 20053 Quarter 2005Conduct peer education on TB/HIV patientConduct peer education on TB/HIV patient
home care and nursing for health workers fromhome care and nursing for health workers fromurban areaurban area
66
3 Quarter 20043 Quarter 2004Conducting HIV routine surveillance for newConducting HIV routine surveillance for newserious TB cases in urban areaserious TB cases in urban area
33
1 Quarter 20051 Quarter 2005Develop and distribute the guideline on TBDevelop and distribute the guideline on TB
/HIV prevention and diagnosis for patients and/HIV prevention and diagnosis for patients and
health workershealth workers
44
2 Quarter 20042 Quarter 2004Active TB and HIV case finding amongActive TB and HIV case finding among
prisoners in detention centerprisoners in detention center22
1 Quarter 20041 Quarter 2004Conduct workshop on HIV/AIDS diagnosis,Conduct workshop on HIV/AIDS diagnosis,
treatment and prevention for TB coordinatorstreatment and prevention for TB coordinatorsof all aimag and district hospitalsof all aimag and district hospitals
11
TimingTimingActivitiesActivitiesNoNo
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TB LaboratoryTB Laboratory
Assessment of the implementation of Quality Assurance:Assessment of the implementation of Quality Assurance:-- Developed National Quality Assurance Manual based on theDeveloped National Quality Assurance Manual based on the
recommendation ofrecommendation of
WHO and WPRWHO and WPR
--TB Laboratory NetworkTB Laboratory Network
TB suspectTB suspect
cases send tocases send to
TB laboratoriesTB laboratories00
(Soum hospital, Health(Soum hospital, Health
Center)Center)PeripheralPeripheral
LevelLevel
SmearSmear
microscopymicroscopy
2121
88
11
Aimags TB laboratoryAimags TB laboratory
Districts TB laboratoryDistricts TB laboratory
Prisons TB laboratoryPrisons TB laboratory
IntermediateIntermediate
LevelLevel
EQA and othersEQA and others
11
National ReferenceNational Reference
LaboratoryLaboratoryCentralCentral
LevelLevel
DutyDutyQuantityQuantityLaboratoryLaboratoryLevelLevel
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TB LaboratoryTB Laboratory
External Quality AssessmentExternal Quality Assessment
--OnOn--site evaluation of peripheral laboratorysite evaluation of peripheral laboratory
using standard checklistusing standard checklist
--Blinding rechecking ( 923 slides selectedBlinding rechecking ( 923 slides selected
by LQAS , checked 861 (93.3%)by LQAS , checked 861 (93.3%)
false positivity rate 0.9% (8 slides)false positivity rate 0.9% (8 slides)
false negativity rate 1.2% (11 slides)false negativity rate 1.2% (11 slides)
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Current problems in the implementation ofCurrent problems in the implementation of
Quality AssuranceQuality Assurance
Delayed cases registration with the false negativeDelayed cases registration with the false negative
results by EQA in sputum microscopyresults by EQA in sputum microscopy
Lack of laboratory supply and reagents (destroyingLack of laboratory supply and reagents (destroying
smears, broken smear, long storage of smears)smears, broken smear, long storage of smears)
QA Programme in sputum smear microscopy noQA Programme in sputum smear microscopy no
immediately influence in case detection andimmediately influence in case detection anddiagnosis due to the QA unavailable for checking alldiagnosis due to the QA unavailable for checking all
smear (+) cases.smear (+) cases.