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This project will screen previously untested individuals for viral hepatitis and liver cancer, connecting positive patients to life-saving care and educating negative participants about hepatitis and liver cancer prevention. Thousands of people will be educated through a community awareness event. Community leaders and policy makers will be educated on the hepatitis a liver cancer epidemic as well as their power to direct lasting change. Health care workers will be intensively trained on hepatitis and liver cancer prevention, diagnosis and treatment. This project will reach every community in one province.
This multi-faceted, strategic program will be implemented in Dornod province in eastern Mongolia.
The estimated number of direct beneficiaries is below.
● 5,000 people will be tested for viral hepatitis B and C
● 1,500 people will be tested for liver cancer through a blood test and ultrasound examination
● 1,000 people will be examined by Fibro Scan, assessing their level of cirrhosis
● 3,500 people will be vaccinated against viral hepatitis B
● 10,000 people will be educated through community awareness activities
● 50,000 information pamphlets and posters will be distributed across the province
● 6,000 patient record books, complete with relevant hepatitis and liver cancer prevention and treatment information, will be distributed
● 400 copies of "Physician's Guide to Viral Hepatitis," will be printed and distributed to local doctors
● 50 local doctor will be trained through intensive, hands-on "shadow training" of visiting Mongolian specialists as they examine and counsel participants and in classroom sessions for Continuing Medical Education credits
● 16 health care facilities will be visited (all the public facilities in Dornod)
● 30 government and private sector leaders will attend an advocacy meeting to learn about the urgency of this epidemic and ways they can help support its elimination
● 1,500 individuals (an estimated 30% of the total population screened) will be diagnosed with at least one of a variety of illnesses, giving them the ability to change and save their lives.
● 1,000 people will be given a Knowledge, Attitude and Practice (KAP) survey to test their awareness level of hepatitis. This will provide both important baseline information to help design future policies and measure the effectiveness of this project.
● A variety of information will be collected from all 5,000 participants and entered into the Mongolian Ministry of Health database for hepatitis and liver cancer patients.
This project will be implemented in March - August 2017.
- Screening in the province capital / March
- Screening in the rural counties / May - June
- Hepatitis B vaccination / March - June
- Updating government patient database / March - June
- Capacity building for the rural health care providers / March - June
- Community awareness activities / March - June
- Advocacy with community leaders and policymakers / March - June
- Knowledge attitude and practice survey / March - September
The Problem
This screening and awareness program supports the World Health Organization's Global Health Strategy to eliminate viral hepatitis by 2030.
Globally, viral hepatitis kills 1.4 million people every year, more than HIV, Tuberculosis and Malaria. There are currently nine different types of hepatitis viruses. Hepatitis viruses A, B, C, D, and E can cause acute and chronic infection and inflammation of the liver leading to cirrhosis and liver cancer. Despite this tremendous problem, there is widespread ignorance about these diseases. This ignorance leads people to assume they are not at risk; it prevents people from coming forward for testing and treatment; and it stops people from paying attention to awareness messages. Viral hepatitis infections can be prevented through administering vaccines (hepatitis A, B, and E), screening blood donations, and providing sterile injection equipment and medical waste management supplies. Chronic viral hepatitis B and C can be treated, but most people, especially those living in low and middle income countries, do not have access to treatment because of a lack of screening and clinical services, and the high prices of hepatitis medicines.
Mongolia has the highest rate of liver cancer in the world. It also has one of the highest prevalence rates of hepatitis B and C. In Mongolia, the province of Dornod has the highest rates of liver cancer (hepatocellular carcinoma, HCC), twice the national average. Mongolia has six times the international average of liver cancer, giving Dornod 12 times the international average. Mongolia's high rate of liver cancer is largely due to the late diagnosis of viral hepatitis and other related liver diseases, such as cirrhosis. 82% of liver cancer patients are not diagnosed until the disease has reached stage III or IV. 85% of liver cancer patients die within one year of diagnosis, according to the Center for Health Development in Mongolia, 2014. Additionally, 77% of the population is estimated to have had viral hepatitis B at some point in their life. 10-22% of the population has chronic hepatitis B, C or both. 93% of liver cancer patients also have viral hepatitis.
Rural Mongolia does not have specialized healthcare or services. Many of the services this project provides are not available outside of the capital city. In most cases, rural community members will not know their disease status until it presents with serious symptoms and has progressed to untreatable stages.
Additionally, while Mongolia has very strong health care infrastructure set up during the Soviet era, the health care system lacks adequate training, supplies and funds. Many of the rural health care workers have very limited knowledge of hepatitis and liver related issues, further preventing the availability of necessary care for their patients.
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