1. Injection Practices in Mongolia Results and Outcomes of the Rapid Assessment of Injection Practices Dr G. Soyolgerel Dr G. Soyolgerel Ministry of Health of Mongolia Phnom Penh, October 2002

2. Rationale for an Assessment of Injection Practices in Mongolia High prevalence of infection with HBV and HCV –6.4% of children 0-15 years of age HBsAg positive * –10.7% of children 0-15 years of age anti-HCV positive * Anecdotal reports of poor injection practices –Injection overuse –Unsafe practices Political will to engage in a safe and appropriate use of injections policy * 1998-1999 (Davaasuren at al. National Medical University)

3. “Aimags” Selected Urban (33%), semi-urban (26%) and rural (41%) Dornogobi Ovorkhangai Darhan Tov UB N

4. Who Gives Injections in Mongolia in 2001? 0% 20% 40% 60% 80% 100% NursesGPsFamily member Feldshers Nurses Feldshers Others GPs Population reports regarding 62 last injections Injection providers identified by prescribers (n=21)

5. Reported Setting for 62 Last Injections Remembered by the Population, Mongolia 2001 Home Clinic Hospital

6. Reported Patients’ Preference for Injections, Mongolia 2001 0% 10% 20% 30% 40% 50% 60% 70% 80% According to prescribers (n=21) According to the population, in the case of fever(n=65) Proportion (%)

7. 0%20%40%60%80%100% Jaundice HCV HBV HIV Prescribers Inj. Providers Population Awareness Regarding Pathogens Transmitted through Unsafe Injections Mongolia, 2001 Proportion (%)

8. Injection Practices in Mongolia: Strengths Dramatic improvement of injection practices in Mongolia over the last 10 years –Large use of locally produced new, disposable injection equipment –Good awareness of the risks associated with injections among health-care workers Efficient health-care waste management despite a lack of sophisticated waste treatment options

9. Injection Practices in Mongolia: Weaknesses The ratio of injection per capita in Mongolia is the highest ever reported (13 injections / person-year) Most injections are given in high-risk settings –Hospitals (nosocomial infections) –Houses (family providers) Numerous breaks in infection control practices occur, including possible re-use of disposable injection equipment in the absence of sterilization and use of multi-dose vials Health-care workers are exposed to a high risk of needlestick injuries (2.6 needlesticks / year) –Dangerous practices observed : policy requesting to count used syringes before disposal

10. Outcomes of the Rapid Assessment Behaviour change: Development of communication tools Injection safety policy: Organization of a national workshop on injection safety in Mongolia

11. Behaviour changes Development of IEC materials (October 2001) –Promote health-care worker protection –Promote oral drugs in the general population –Engage patients in a consumer demand for safety Printing of posters, leaflets, brochures ( August 2002)

12. Injection safety policy in Mongolia Organisation of a national workshop to institutionalise safe and appropriate use of injections (May 2002) –draft a national injection safety policy –nominate a national injection safety committee Initial cost collection for costing a plan of action (May 2002)

13. Perspectives Develop an injection safety plan of action Organize group discussion for prescribers and consumers on rational use of injection Explore options for technology transfer for AD syringes production in Mongolia Organize universal access to safety boxes (Consider national production) Assess options for sharps waste management