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  1. Article ; Online: Comparison of quality and interpretation of newborn ultrasound screening examinations for developmental dysplasia of the hip by basically trained nurses and junior physicians with no previous ultrasound experience.

    Ulziibat, Munkhtulga / Munkhuu, Bayalag / Schmid, Raoul / Wyder, Corinne / Baumann, Thomas / Essig, Stefan

    PloS one

    2024  Volume 19, Issue 4, Page(s) e0300753

    Abstract: Background: We are obliged to give babies the chance to profit from a nationwide screening of developmental dysplasia of the hip in very rural areas of Mongolia, where trained physicians are scarce. This study aimed to compare the quality and ... ...

    Abstract Background: We are obliged to give babies the chance to profit from a nationwide screening of developmental dysplasia of the hip in very rural areas of Mongolia, where trained physicians are scarce. This study aimed to compare the quality and interpretation of hip ultrasound screening examinations performed by nurses and junior physicians.
    Methods: A group of 6 nurses and 6 junior physician volunteers with no previous ultrasound experience underwent Graf's standard training in hands-on practice. Newborns were examined before discharge from the hospital, according to the national guideline. Two standard documentation images of each hip were saved digitally. The groups were compared on the proportion of good quality of sonograms and correct interpretation. Two Swiss supervisors' agreed diagnosis according to Graf was considered the final reference for the study purposes.
    Results: A total of 201 newborns (402 hips or 804 sonograms) were examined in the study, with a mean age of 1.3±0.8 days at examination. Junior physicians examined 100 newborns (200 hips or 400 sonograms), while nurses examined 101 newborns (202 hips or 404 sonograms). The study subjects of the two groups were well balanced for the distribution of baseline characteristics. The study observed no statistically significant difference in the quality of Graf's standard plane images between the providers. Eventually, 92.0% (92) of the physician group and 89.1% (90) of the nurse group were correctly diagnosed as "Group A" (Graf's Type 1 hip) or "Non-Group A" hips (p = 0.484). The most common errors among the groups were a missing lower limb, wrong measurement lines, and technical problems.
    Conclusion: Our study provides evidence that while there might be a trend of slightly more technical mistakes in the nurse group, the overall diagnosis accuracy is similar to junior physicians after receiving standard training in Graf's hip ultrasound method. However, after basic training, regular quality control is a must and all participants should receive refresher trainings. More specifically, nurses need training in the identification of anatomical structures.
    MeSH term(s) Infant ; Humans ; Infant, Newborn ; Hip Dislocation, Congenital/diagnostic imaging ; Developmental Dysplasia of the Hip ; Ultrasonography/methods ; Neonatal Screening/methods ; Hip Joint/diagnostic imaging
    Language English
    Publishing date 2024-04-18
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0300753
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Implementation of a nationwide universal ultrasound screening programme for developmental dysplasia of the neonatal hip in Mongolia.

    Ulziibat, Munkhtulga / Munkhuu, Bayalag / Schmid, Raoul / Baumann, Thomas / Essig, Stefan

    Journal of children's orthopaedics

    2020  Volume 14, Issue 4, Page(s) 273–280

    Abstract: Purpose: Mongolia is the first Asian country to launch universal ultrasound screening for newborns with developmental dysplasia of the hip (DDH). The aims of this study were to determine the coverage and treatment rate of this programme.: Methods: ... ...

    Abstract Purpose: Mongolia is the first Asian country to launch universal ultrasound screening for newborns with developmental dysplasia of the hip (DDH). The aims of this study were to determine the coverage and treatment rate of this programme.
    Methods: Data from birth statistics and ultrasound hip screening from 29 hospitals were retrospectively reviewed (2010 to 2016, pre-nationwide phase; and 2017 to 2019, nationwide programme). DDH was diagnosed using the Graf-technique and treated according to 'ABCD', a modified Graf classification (Group A: Graf Type 1, mature; B: 2a, physiologically immature; C: 2c to 3, early DDH; D: 4, dislocated). Group B children were followed with monthly ultrasound. Group C and D children were treated with a flexion and abduction orthosis (Tübingen). Screeners used a web-based platform to upload images for quality surveillance.
    Results: Between 2017 and 2019, 230 079 live births were registered and 176 388 newborns screened. The nationwide screening coverage rate in newborns increased from 73.6% in 2017 to 82.1% in 2019. Group A (148 510 children, 84.2%) was discharged, while Group B (25 820, 14.6%) was followed. Among children in Group B, 284 cases worsened to Group C and were, therefore, treated with a Tübingen orthosis. The remaining 2058 (1.2%) of newborns with DDH were treated with a Tübingen orthosis, including 1999 newborns in Group C and 59 in Group D. Since 2017, a total of 142 860 (81.0%) hip sonograms were uploaded to the platform.
    Conclusion: A simplified diagnostic and therapeutic framework for ultrasound DDH screening for newborns was successfully deployed in Mongolia, a developing country, providing high surveillance coverage and appropriate treatment.Level of evidence: IV.
    Language English
    Publishing date 2020-08-17
    Publishing country England
    Document type Journal Article
    ZDB-ID 2279410-4
    ISSN 1863-2548 ; 1863-2521
    ISSN (online) 1863-2548
    ISSN 1863-2521
    DOI 10.1302/1863-2548.14.200029
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Traditional Mongolian swaddling and developmental dysplasia of the hip: a randomized controlled trial.

    Ulziibat, Munkhtulga / Munkhuu, Bayalag / Bataa, Ariun-Erdene / Schmid, Raoul / Baumann, Thomas / Essig, Stefan

    BMC pediatrics

    2021  Volume 21, Issue 1, Page(s) 450

    Abstract: Background: Mongolian traditional swaddling of infants, where arms and legs are extended with a tight wrapping and hips are in adduction position, may lead to abnormal maturation and formation of the hip joint; and is a contributing factor for ... ...

    Abstract Background: Mongolian traditional swaddling of infants, where arms and legs are extended with a tight wrapping and hips are in adduction position, may lead to abnormal maturation and formation of the hip joint; and is a contributing factor for developmental dysplasia of the hip (DDH). This hypothesis was tested in this randomized controlled trial.
    Methods: Eighty newborns with one or two hips at risk of worsening to DDH (Graf Type 2a; physiologically immature hips) at birth were randomized into 2 groups at a tertiary hospital in Ulaanbaatar. The "swaddling" group (n = 40) was swaddled in the common traditional Mongolian method for a month while the "non-swaddling" group (n = 40) was instructed not to swaddle at all. All enrollees were followed up on monthly basis by hip ultrasound and treated with an abduction-flexion splint if necessary. The groups were compared on the rate of Graf's "non-Type 1" hips at follow-up controls as the primary outcome. Secondary outcomes were rate of DDH and time to discharge (Graf Type 1; healthy hips). In addition, correlation between the primary outcome and swaddling length in days and frequency of swaddling in hours per day were calculated.
    Results: Recruitment continued from September 2019 to March 2020 and follow-up data were completed in June 2020. We collected final outcome data in all 80 enrollees. Percentages of cases with non-Type 1 hip at any follow-up examination were 7.5% (3/40) in the non-swaddling group and 40% (16/40) in the swaddling group (p = 0.001). There was no DDH case in the non-swaddling group while there were 8 cases of DDH in the swaddling group. The mean time to discharge was 5.1 ± 0.3 weeks in the non-swaddling group and 8.4 ± 0.89 weeks in the swaddling group (p = 0.001). There is a correlation between the primary outcome and the swaddling frequency in hours per day (r = 0.81) and swaddling length in days (r = 0.43).
    Conclusions: Mongolian traditional swaddling where legs are extended and hips are in extension and adduction position increases the risk for DDH.
    Trial registration: Retrospectively registered, ISRCTN11228572 .
    MeSH term(s) Developmental Dysplasia of the Hip ; Hip Dislocation, Congenital/diagnostic imaging ; Hip Dislocation, Congenital/etiology ; Hip Joint/diagnostic imaging ; Humans ; Infant ; Infant, Newborn ; Range of Motion, Articular ; Ultrasonography
    Language English
    Publishing date 2021-10-13
    Publishing country England
    Document type Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 2041342-7
    ISSN 1471-2431 ; 1471-2431
    ISSN (online) 1471-2431
    ISSN 1471-2431
    DOI 10.1186/s12887-021-02910-x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Accuracy of Trained Physicians is Inferior to Deep Learning-Based Algorithm for Determining Angles in Ultrasound of the Newborn Hip.

    Oelen, David / Kaiser, Pascal / Baumann, Thomas / Schmid, Raoul / Bühler, Christof / Munkhuu, Bayalag / Essig, Stefan

    Ultraschall in der Medizin (Stuttgart, Germany : 1980)

    2020  Volume 43, Issue 5, Page(s) e49–e55

    Abstract: Purpose:  Sonographic diagnosis of developmental dysplasia of the hip allows treatment with a flexion-abduction orthosis preventing hip luxation. Accurate determination of alpha and beta angles according to Graf is crucial for correct diagnosis. It is ... ...

    Title translation Genauigkeit von geschulten Ärzten unterliegt einem Deep-Learning-basierten Algorithmus beim Bestimmen von Winkeln im Ultraschall der Säuglingshüfte.
    Abstract Purpose:  Sonographic diagnosis of developmental dysplasia of the hip allows treatment with a flexion-abduction orthosis preventing hip luxation. Accurate determination of alpha and beta angles according to Graf is crucial for correct diagnosis. It is unclear if algorithms could predict the angles. We aimed to compare the accuracy for users and automation reporting root mean squared errors (RMSE).
    Materials and methods:  We used 303 306 ultrasound images of newborn hips collected between 2009 and 2016 in screening consultations. Trained physicians labelled every second image with alpha and beta angles during the consultations. A random subset of images was labeled with time and precision under lab conditions as ground truth. Automation predicted the two angles using a convolutional neural network (CNN). The analysis was focused on the alpha angle.
    Results:  Three methods were implemented, each with a different abstraction of the problem: (1) CNNs that directly learn the angles without any post-processing steps; (2) CNNs that return the relevant landmarks in the image to identify the angles; (3) CNNs that return the base line, bony roof line, and the cartilage roof line which are necessary to calculate the angles. The RMSE between physicians and ground truth were found to be 7.1° for alpha. The best CNN architecture was (2) landmark detection. The RMSE between landmark detection and ground truth was 3.9° for alpha.
    Conclusion:  The accuracy of physicians in their daily routine is inferior to deep learning-based algorithms for determining angles in ultrasound of the newborn hip. Similar methods could be used to support physicians.
    MeSH term(s) Automation ; Deep Learning ; Hip Dislocation, Congenital/diagnostic imaging ; Humans ; Infant, Newborn ; Physicians ; Ultrasonography
    Language English
    Publishing date 2020-08-06
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 801064-x
    ISSN 1438-8782 ; 1439-0914 ; 1431-4894 ; 0172-4614
    ISSN (online) 1438-8782
    ISSN 1439-0914 ; 1431-4894 ; 0172-4614
    DOI 10.1055/a-1177-0480
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Accuracy of Trained Physicians is Inferior to Deep Learning-Based Algorithm for Determining Angles in Ultrasound of the Newborn Hip

    Oelen, David / Kaiser, Pascal / Baumann, Thomas / Schmid, Raoul / Bühler, Christof / Munkhuu, Bayalag / Essig, Stefan

    Ultraschall in der Medizin - European Journal of Ultrasound

    2020  Volume 43, Issue 05, Page(s) e49–e55

    Abstract: Purpose: Sonographic diagnosis of developmental dysplasia of the hip allows treatment with a flexion-abduction orthosis preventing hip luxation. Accurate determination of alpha and beta angles according to Graf is crucial for correct diagnosis. It is ... ...

    Abstract Purpose: Sonographic diagnosis of developmental dysplasia of the hip allows treatment with a flexion-abduction orthosis preventing hip luxation. Accurate determination of alpha and beta angles according to Graf is crucial for correct diagnosis. It is unclear if algorithms could predict the angles. We aimed to compare the accuracy for users and automation reporting root mean squared errors (RMSE).
    Materials and Methods: We used 303 306 ultrasound images of newborn hips collected between 2009 and 2016 in screening consultations. Trained physicians labelled every second image with alpha and beta angles during the consultations. A random subset of images was labeled with time and precision under lab conditions as ground truth. Automation predicted the two angles using a convolutional neural network (CNN). The analysis was focused on the alpha angle.
    Results: Three methods were implemented, each with a different abstraction of the problem: (1) CNNs that directly learn the angles without any post-processing steps; (2) CNNs that return the relevant landmarks in the image to identify the angles; (3) CNNs that return the base line, bony roof line, and the cartilage roof line which are necessary to calculate the angles. The RMSE between physicians and ground truth were found to be 7.1° for alpha. The best CNN architecture was (2) landmark detection. The RMSE between landmark detection and ground truth was 3.9° for alpha.
    Conclusion: The accuracy of physicians in their daily routine is inferior to deep learning-based algorithms for determining angles in ultrasound of the newborn hip. Similar methods could be used to support physicians.
    Keywords accuracy ; automation ; deep learning ; feedback ; developmental dysplasia of the hip
    Language English
    Publishing date 2020-08-06
    Publisher Georg Thieme Verlag KG
    Publishing place Stuttgart ; New York
    Document type Article
    ZDB-ID 801064-x
    ISSN 1438-8782 ; 0172-4614 ; 1439-0914 ; 1431-4894
    ISSN (online) 1438-8782
    ISSN 0172-4614 ; 1439-0914 ; 1431-4894
    DOI 10.1055/a-1177-0480
    Database Thieme publisher's database

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  6. Article ; Online: External Validation of a Retinopathy of Prematurity Screening Model Using Artificial Intelligence in 3 Low- and Middle-Income Populations.

    Coyner, Aaron S / Oh, Minn A / Shah, Parag K / Singh, Praveer / Ostmo, Susan / Valikodath, Nita G / Cole, Emily / Al-Khaled, Tala / Bajimaya, Sanyam / K C, Sagun / Chuluunbat, Tsengelmaa / Munkhuu, Bayalag / Subramanian, Prema / Venkatapathy, Narendran / Jonas, Karyn E / Hallak, Joelle A / Chan, R V Paul / Chiang, Michael F / Kalpathy-Cramer, Jayashree /
    Campbell, J Peter

    JAMA ophthalmology

    2022  Volume 140, Issue 8, Page(s) 791–798

    Abstract: Importance: Retinopathy of prematurity (ROP) is a leading cause of preventable blindness that disproportionately affects children born in low- and middle-income countries (LMICs). In-person and telemedical screening examinations can reduce this risk but ...

    Abstract Importance: Retinopathy of prematurity (ROP) is a leading cause of preventable blindness that disproportionately affects children born in low- and middle-income countries (LMICs). In-person and telemedical screening examinations can reduce this risk but are challenging to implement in LMICs owing to the multitude of at-risk infants and lack of trained ophthalmologists.
    Objective: To implement an ROP risk model using retinal images from a single baseline examination to identify infants who will develop treatment-requiring (TR)-ROP in LMIC telemedicine programs.
    Design, setting, and participants: In this diagnostic study conducted from February 1, 2019, to June 30, 2021, retinal fundus images were collected from infants as part of an Indian ROP telemedicine screening program. An artificial intelligence (AI)-derived vascular severity score (VSS) was obtained from images from the first examination after 30 weeks' postmenstrual age. Using 5-fold cross-validation, logistic regression models were trained on 2 variables (gestational age and VSS) for prediction of TR-ROP. The model was externally validated on test data sets from India, Nepal, and Mongolia. Data were analyzed from October 20, 2021, to April 20, 2022.
    Main outcomes and measures: Primary outcome measures included sensitivity, specificity, positive predictive value, and negative predictive value for predictions of future occurrences of TR-ROP; the number of weeks before clinical diagnosis when a prediction was made; and the potential reduction in number of examinations required.
    Results: A total of 3760 infants (median [IQR] postmenstrual age, 37 [5] weeks; 1950 male infants [51.9%]) were included in the study. The diagnostic model had a sensitivity and specificity, respectively, for each of the data sets as follows: India, 100.0% (95% CI, 87.2%-100.0%) and 63.3% (95% CI, 59.7%-66.8%); Nepal, 100.0% (95% CI, 54.1%-100.0%) and 77.8% (95% CI, 72.9%-82.2%); and Mongolia, 100.0% (95% CI, 93.3%-100.0%) and 45.8% (95% CI, 39.7%-52.1%). With the AI model, infants with TR-ROP were identified a median (IQR) of 2.0 (0-11) weeks before TR-ROP diagnosis in India, 0.5 (0-2.0) weeks before TR-ROP diagnosis in Nepal, and 0 (0-5.0) weeks before TR-ROP diagnosis in Mongolia. If low-risk infants were never screened again, the population could be effectively screened with 45.0% (India, 664/1476), 38.4% (Nepal, 151/393), and 51.3% (Mongolia, 266/519) fewer examinations required.
    Conclusions and relevance: Results of this diagnostic study suggest that there were 2 advantages to implementation of this risk model: (1) the number of examinations for low-risk infants could be reduced without missing cases of TR-ROP, and (2) high-risk infants could be identified and closely monitored before development of TR-ROP.
    MeSH term(s) Adult ; Artificial Intelligence ; Child ; Gestational Age ; Humans ; Infant ; Infant, Newborn ; Male ; Neonatal Screening/methods ; Retinopathy of Prematurity/diagnosis ; Retinopathy of Prematurity/epidemiology ; Retrospective Studies ; Risk Factors ; Sensitivity and Specificity
    Language English
    Publishing date 2022-06-21
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
    ZDB-ID 2701705-9
    ISSN 2168-6173 ; 2168-6165
    ISSN (online) 2168-6173
    ISSN 2168-6165
    DOI 10.1001/jamaophthalmol.2022.2135
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article: Feasibility of one-stop antenatal syphilis screening in Ulaanbaatar, Mongolia: women and providers perspectives.

    Munkhuu, Bayalag / Liabsuetrakul, Tippawan / McNeil, Edward / Janchiv, Radnaabazar

    The Southeast Asian journal of tropical medicine and public health

    2009  Volume 40, Issue 4, Page(s) 861–870

    Abstract: Congenital syphilis can be prevented by antenatal syphilis screening, however, the complexity of delivering prenatal service can result in low screening rates, and thus lower prevention and treatment rates. One-stop antenatal syphilis screening, which ... ...

    Abstract Congenital syphilis can be prevented by antenatal syphilis screening, however, the complexity of delivering prenatal service can result in low screening rates, and thus lower prevention and treatment rates. One-stop antenatal syphilis screening, which includes rapid testing and treatment, is the proposed method to overcome this problem. The feasibility of this type of screening needs to be tested to dertermine its effectiveness. In this study, the opinions and level of satisfaction of women undergoing antenatal care and their health care providers regarding a one-stop syphylis screening and treatment service at two antenatal clinics in Ulaanbaatar, Mongolia were assessed. The majority of the 246 women studied were satisfied with the service. The mean aggregate satisfaction score derived from 12 questions regarding specific aspects of satisfaction was 3.2. Most providers were also satisfied, not reporting any significant problems interfering with routine antenatal care. However, all providers felt the one-stop service is time consuming and leads to high staff workloads and needs good clinical management. The provider preferred instead to treat husbands presumptively to avoid the possibility of diagnosing couples with discordant syphilis, which could lead to possible violence. A one-stop syphilis diagnosis and treatment service during antenatal care is feasible in Ulaanbaatar, Mongolia from both the women's and providers' perspectives.
    MeSH term(s) Adolescent ; Adult ; Ambulatory Care Facilities ; Anti-Bacterial Agents/therapeutic use ; Attitude of Health Personnel ; Feasibility Studies ; Female ; Humans ; Male ; Maternal Health Services ; Mongolia ; Patient Satisfaction ; Penicillins/therapeutic use ; Pregnancy ; Prenatal Diagnosis ; Spouses ; Syphilis/diagnosis ; Syphilis/drug therapy ; Syphilis Serodiagnosis ; Young Adult
    Chemical Substances Anti-Bacterial Agents ; Penicillins
    Language English
    Publishing date 2009-07
    Publishing country Thailand
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 800646-5
    ISSN 0125-1562 ; 0038-3619
    ISSN 0125-1562 ; 0038-3619
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Incidence and treatment of developmental hip dysplasia in Mongolia: a prospective cohort study.

    Munkhuu, Bayalag / Essig, Stefan / Renchinnyam, Erdenesuvd / Schmid, Raoul / Wilhelm, Corina / Bohlius, Julia / Chuluunbaatar, Battulga / Shonkhuuz, Enkhtur / Baumann, Thomas

    PloS one

    2013  Volume 8, Issue 10, Page(s) e79427

    Abstract: Background: In Mongolia, adequate early diagnosis and treatment of developmental hip dysplasia (DDH) have been unavailable and its incidence was unknown. We determined the incidence of ultrasonographic DDH in newborns and established adequate procedures ...

    Abstract Background: In Mongolia, adequate early diagnosis and treatment of developmental hip dysplasia (DDH) have been unavailable and its incidence was unknown. We determined the incidence of ultrasonographic DDH in newborns and established adequate procedures for diagnosis and treatment of DDH at the largest maternity hospital in Ulaanbaatar, Mongolia.
    Methodology/principal findings: During one year (Sept 2010 - Aug 2011) we assessed the hips newborns using ultrasound and Graf's classification of DDH. 8,356 newborns were screened; median age at screening was 1 day. We identified 14,873 Type 1 (89.0%), 1715 Type 2a (10.3%), 36 Type 2c (0.2%), 70 Type D (0.4%), 14 Type 3 (0.08%), and 4 Type 4 hips (0.02%). Children with Type 1 hips (normal) were discharged. Children with Type 2a hips (physiologically immature) received follow-up ultrasounds at monthly intervals. Children with Type 2c to 4 (DDH; deformed or misaligned hip joint) hips were treated with a Tubingen hip flexion splint and also followed up. The hip abnormalities resolved to mature hips in all children who were followed up. There was no evidence for severe treatment related complications.
    Conclusion/significance: This study suggests that the incidence of DDH in Mongolian neonates is comparable to that in neonates in Europe. Early ultrasound-based assessment and splinting treatment of DDH led to mature hips in all children followed up. Procedures are feasible and will be continued.
    MeSH term(s) Hip Dislocation/diagnostic imaging ; Hip Dislocation/epidemiology ; Hip Dislocation/therapy ; Humans ; Incidence ; Infant, Newborn ; Mass Screening ; Mongolia/epidemiology ; Prospective Studies ; Risk Factors ; Splints ; Ultrasonography
    Language English
    Publishing date 2013-10-24
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0079427
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article: Antenatal care providers' practices and opinions on the services of antenatal syphilis screening in Ulaanbaatar, Mongolia.

    Munkhuu, Bayalag / Liabsuetrakul, Tippawan / Chongsuvivatwong, Virasakdi / Geater, Alan / Janchiv, Radnaabazar

    The Southeast Asian journal of tropical medicine and public health

    2006  Volume 37, Issue 5, Page(s) 975–982

    Abstract: The objectives of this study were to review antenatal syphilis screening and to assess antenatal care providers' practices and opinions in Ulaanbaatar, Mongolia. A cross-sectional study on antenatal syphilis screening was conducted. The study settings ... ...

    Abstract The objectives of this study were to review antenatal syphilis screening and to assess antenatal care providers' practices and opinions in Ulaanbaatar, Mongolia. A cross-sectional study on antenatal syphilis screening was conducted. The study settings were all 16 antenatal care clinics, and a random selection of 30 family units from six districts in Ulaanbaatar, Mongolia. Interviews were conducted with 150 antenatal care providers and 27 antenatal care heads/leaders. Antenatal syphilis screening in Ulaanbaatar was complex. Most pregnant women had antenatal care at family units or antenatal clinics, but syphilis blood testing could be performed only in some district general hospitals. Syphilis positive-screening cases were referred to the venereologists for confirmation of results, appropriate treatment, contact tracing, and follow-up. The providers agreed with the need for syphilis screening in pregnant women but identified as constraints the limited time for performing the screening due to late antenatal visit, women's lack of knowledge, poverty, and geographic barriers. The practice of providers varied, and the opinion on a one-stop service was positive. The main conclusions concerning the failure of universal antenatal syphilis screening were limited accessibility and feasibility of the service, and the ignorance of both women and providers on the importance of screening. It was agreed that decentralization of antenatal syphilis screening would improve the system.
    MeSH term(s) Adult ; Cross-Sectional Studies ; Female ; Health Knowledge, Attitudes, Practice ; Health Services Accessibility/organization & administration ; Humans ; Mongolia/epidemiology ; Practice Patterns, Physicians'/organization & administration ; Pregnancy ; Prenatal Care/organization & administration ; Syphilis Serodiagnosis
    Language English
    Publishing date 2006-09
    Publishing country Thailand
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 800646-5
    ISSN 0125-1562 ; 0038-3619
    ISSN 0125-1562 ; 0038-3619
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article: Coverage of antenatal syphilis screening and predictors for not being screened in Ulaanbaatar, Mongolia.

    Munkhuu, Bayalag / Liabsuetrakul, Tippawan / Chongsuvivatwong, Virasakdi / Geater, Alan / Janchiv, Radnaabazar

    Sexually transmitted diseases

    2006  Volume 33, Issue 5, Page(s) 284–288

    Abstract: Objectives: To measure the coverage of antenatal syphilis screening and identify factors related to women not being screened.: Goal: To assess the syphilis control program in Mongolia.: Study design: Antenatal care records of women in 16 antenatal ...

    Abstract Objectives: To measure the coverage of antenatal syphilis screening and identify factors related to women not being screened.
    Goal: To assess the syphilis control program in Mongolia.
    Study design: Antenatal care records of women in 16 antenatal care clinics of 6 districts were reviewed. Additionally, postpartum women were interviewed to identify potential factors for not being screened.
    Results: Among 3,519 antenatal records, the coverage of syphilis screening was 77.7%. Of 2,735 screened women, 54 (2.0%) had reactive serological results and subsequently received treatment. Four late antenatal care comers delivered infants with congenital syphilis. Being unscreened was significantly associated with late antenatal care (odds ratio OR=2.6), lack of knowledge (OR=5.5), history of previous sexually transmitted infection (OR=3.7), and living far from screening services (OR=4.9).
    Conclusions: The coverage of antenatal syphilis screening is still low, with poor contact tracing. More efforts are needed to promote early antenatal care visit and improve syphilis screening systems.
    MeSH term(s) Adolescent ; Adult ; Cross-Sectional Studies ; Female ; Humans ; Mass Screening/standards ; Medical Records ; Mongolia/epidemiology ; Outcome Assessment (Health Care) ; Pregnancy ; Pregnancy Complications, Infectious/epidemiology ; Pregnancy Complications, Infectious/etiology ; Pregnancy Complications, Infectious/prevention & control ; Prenatal Care/standards ; Retrospective Studies ; Syphilis/epidemiology ; Syphilis/etiology ; Syphilis/prevention & control ; Syphilis, Congenital/prevention & control ; Women's Health Services
    Language English
    Publishing date 2006-05
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 435191-5
    ISSN 1537-4521 ; 0148-5717
    ISSN (online) 1537-4521
    ISSN 0148-5717
    DOI 10.1097/01.olq.0000194577.71693.c7
    Database MEDical Literature Analysis and Retrieval System OnLINE

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