Hepatitis in Mongolia

In April 2011, an article published in The Lancet, concluded; “Mongolia has the world’s highest rate of liver cancer (deaths) – six times the global average – and the number is increasing… According to the World Health Organization (WHO), one of e

very ten deaths in the country is due to HCC (hepatocellular carcinoma or liver cancer) or its frequent precursor, cirrhosis. Dr. Tsiiregzen Enkhamgala…, asserts… ‘We expect 40 more years to face the same condition’.”

No doubt, this is a serious challenge to the people of Mongolia whose health care system “is ill-equipped to handle” the problem.

Additionally, Mongolia has the 3rd highest rate of hepatitis B (HBV) and C (HCV) in the world. Studies have shown that 10 to 15% of the general population is infected with HBV or HCV. Health care facilities are a leading form of transmission for hepatitis. Multiple studies conducted in Mongolia from 1992 – 2007 have shown that over 50% of health care workers are co-infected with both hepatitis B and C. Industrialized countries have been successful in reducing hepatitis B rates below 10% in health care workers through aggressive vaccination, safety & health education, as well as monitoring and reporting strategies. With less than 7% of health care workers vaccinated for hepatitis B. These figures in Mongolia are unacceptably high and demand similar action for control.

Due to a shortage of regulation sharps containers (biohazard boxes for sharp medical waste) health care workers re-use sub-standard boxes, transferring sharps to other boxes or even plastic bags for transport to the disposal area. Health care workers admit to being frequently stuck with contaminated needles during this transfer process. In 2008, needle stick injuries occurred among 82.6% of Mongolian health care workers. Most of these injuries went unreported. Hospitals do not have a mechanism in place for health care workers to report and treat their injury.

Health and safety practices and medical waste management procedures in the majority of Mongolian clinics and hospitals are regarded as substandard, compounding the risk of further disease transmission to doctors and nurses, and eventually to the general public. There is no systematic training program provided for health care workers at any level of the health care system, including health care workers responsible for waste collection, transportation and disposal. Insufficient training prohibits proper medical waste management and health and safety practices in Mongolia, putting the entire population at risk.