title: Screening and management of viral hepatitis and hepatocellular carcinoma in Mongolia: results from a survey of Mongolian physicians from all major provinces of Mongolia.
abstract: BACKGROUND
  According to Globocan, Mongolia has the highest worldwide hepatocellular carcinoma (HCC) incidence (78.1/100 000, 3.5× higher than China).
  
  
  OBJECTIVE
  We conducted an anonymous survey of physicians from major provinces who attended an educational liver symposium, analysing their demography, practice, knowledge, perceptions and proposed solutions. Multivariate logistic regression was used to estimate OR relating demography and practice factors with higher provider knowledge and improvement.
  
  
  RESULTS
  Of the 121 attendees, 44-95 (36-79%) responded to each question. Most were female (87%), young (79% age <50), subspecialists (81%), university-affiliated (74%), and practised in urban areas (61%). The mean pretest and post-test scores per physician were 60.4±20.4 and 65.6±21.3, with no observed significant predictors for baseline knowledge or improvement. Most (>80%) noted that <50% of patients who need hepatitis or HCC screening receive it. The main perceived barriers to screening were inability to pay for tests, lack of guidelines and poor patient awareness. Hepatitis treatment rates were low; 83% treated hepatitis C virus in <10 patients in the past year, and 86% treated hepatitis B virus in <10 patients/month. Treatment barriers were multifactorial, with cost as a principal barrier. Proposed solutions were universal screening policies (46%), removal of financial barriers (28%) and provider education (20%).
  
  
  CONCLUSIONS
  Physicians from major regions of Mongolia noted low screening for viral hepatitis, even lower treatment rates, financial barriers and the need for increased educational efforts. We advocate broad-based medical education tailored to local needs and based on needs assessment and outcome measurements.
authors.affiliation: Division of Gastroenterology and Hepatology , Stanford University , Stanford, California , USA.
authors.forename: Yoona A
authors.initials: YA
authors.lastname: Kim
authors.affiliation: Division of Gastroenterology and Hepatology , Stanford University , Stanford, California , USA.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Estevez
authors.affiliation: Division of Gastroenterology and Hepatology , Stanford University , Stanford, California , USA.
authors.forename: An
authors.initials: A
authors.lastname: Le
authors.affiliation: Center for Innovation in Global Health, Stanford University, Stanford, California, USA; Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA.
authors.forename: Dennis
authors.initials: D
authors.lastname: Israelski
authors.affiliation: Department of Infectious Diseases , Mongolian National University of Medical Sciences , Ulaanbaatar , Mongolia.
authors.forename: Oidov
authors.initials: O
authors.lastname: Baatarkhuu
authors.affiliation: Department of Internal Medicine , United Family Intermed Hospital , Ulaanbaatar , Mongolia.
authors.forename: Tserenchimed
authors.initials: T
authors.lastname: Sarantuya
authors.affiliation: Shastin Memorial Third National General Hospital of Mongolia , Ulaanbaatar , Mongolia.
authors.forename: Sonom
authors.initials: S
authors.lastname: Narantsetseg
authors.affiliation: Public Health Branch , Mongolian Academy of Medical Sciences , Ulaanbaatar , Mongolia.
authors.forename: Pagbajabyn
authors.initials: P
authors.lastname: Nymadawa
authors.affiliation: Division of Gastroenterology and Hepatology , Stanford University , Stanford, California , USA.
authors.forename: Richard
authors.initials: R
authors.lastname: H Le
authors.affiliation: Division of Gastroenterology and Hepatology , Queen Mary Hospital, The University of Hong Kong , Hong Kong , Hong Kong.
authors.forename: Man-Fung
authors.initials: MF
authors.lastname: Yuen
authors.affiliation: Kings College Hospital and University College London School of Medicine , London , UK.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Dusheiko
authors.affiliation: Department of Gastroenterology , University of Turin , Turin , Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Rizzetto
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University, Stanford, California, USA; Center for Innovation in Global Health, Stanford University, Stanford, California, USA.
authors.forename: Mindie H
authors.initials: MH
authors.lastname: Nguyen
keywords: CHRONIC VIRAL HEPATITIS; HEPATITIS B; HEPATOCELLULAR CARCINOMA