VZCZCXRO2528
RR RUEHCN RUEHGH RUEHVC
DE RUEHUM #0128/01 0840814
ZNR UUUUU ZZH
R 240814Z MAR 08
FM AMEMBASSY ULAANBAATAR
TO RUEHC/SECSTATE WASHDC 1997
INFO RUEHOO/CHINA POSTS COLLECTIVE
RUEHTA/AMEMBASSY ASTANA 0003
RUEHMO/AMEMBASSY MOSCOW 2149
RUEHVK/AMCONSUL VLADIVOSTOK 0249
RUEHNT/AMEMBASSY TASHKENT 0051
RUEHBK/AMEMBASSY BANGKOK 1746
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEHPH/CDC ATLANTA GA
RUEHC/DEPT OF LABOR WASHINGTON DC
RUCPDOC/DEPT OF COMMERCE WASHINGTON DC
RUEHRC/DEPT OF AGRICULTURE WASHINGTON DC
RUEKJCS/SECDEF WASHINGTON DC
RHHMUNA/CDR USPACOM HONOLULU HI
RUEHLMC/MILLENNIUM CHALLENGE CORP WASHINGTON DC

UNCLAS SECTION 01 OF 03 ULAANBAATAR 000128 
 
SIPDIS 
 
SIPDIS 
 
STATE PASS TO PEACE CORPS 
DEPT FOR S/GAC, EAP/CM, EAP/EX, MED, OES, AND DRL 
BANGKOK FOR REGIONAL ENVIRONMENTAL AFFAIRS OFFICE 
 
E.O. 12958: N/A 
TAGS: KHIV EAID SOCI PGOV PHUM PINR PREL MG
SUBJECT: TB Rates Climbing in Mongolia 
 
Ref: 07 ULAANBAATAR 0670 
 
ULAANBAATA 00000128  001.2 OF 003 
 
 
¶1. SUMMARY: Mongolia's tuberculosis rate has steadily risen since 
the early 1990s, in spite of government efforts to contain its 
spread. Statistics show an increase of 177% since 1991.  Health 
officials concede that a steady climb in case numbers make meeting 
Millennium Development Goals to reverse the spread of TB by 2015 
difficult but caution that dramatic growth rates may be artificially 
inflated as detection and diagnosis techniques continue to improve 
and testing becomes more widespread. Incidence rates should start to 
trend downward after 2010 as obligatory BCG vaccinations for 
children (begun in 1997) bear fruit and testing, treatment 
standards, and living conditions improve. Better detection and 
treatment practices have already succeeded in reducing the mortality 
rate of TB, but the emergence of drug-resistant strains of TB in 
neighboring countries represents a new danger. The Mongolian 
government looks to engage local governments, law enforcement, and 
health care institutions more fully as well as improve financial and 
legal environment to combat the spread of tuberculosis more 
effectively. END SUMMARY 
 
TB Rising Steadily Since Early 1990s 
------------------------------------ 
 
¶2. Along with sexually transmitted diseases and brucellosis, 
tuberculosis (TB) is among Mongolia's most pressing public health 
problems and most prevalent infectious diseases. Detected incidents 
of TB have risen steadily in Mongolia since the early 1990s. 
According to a recent WHO survey, Mongolia ranks third among seven 
South-East Asia and Western Pacific region countries with the 
highest rate of tuberculosis. Worldwide TB is the leading cause of 
death among HIV/AIDS patients, according to the WHO. To date only 41 
HIV/AIDS cases have been officially recorded in Mongolia (reftel) 
but experts believe the real number could be 20 to 30 times higher. 
(Four persons have so far died as a result of AIDS, none from 
tuberculosis). The growth of HIV/AIDS could provide fertile ground 
for the further spread of TB among Mongolia's population. 
 
¶3. Mongolia's post-Soviet economic turmoil and social dislocations 
exacerbated the spread of TB throughout the 1990s. Despite the 
establishment of a national program for combating tuberculosis in 
1994, authorities still cannot properly contain the disease. In 
1990, the incidence of TB in Mongolia stood at just 79 cases per 
100,000, but leapt to 185 during the 2000-2006 period. In the 15 
years since Mongolia's democratic revolution, actual TB cases have 
jumped 177%, from 1, 569 from 1991 and 1994 to 4,419 from 2003 to 
¶2006. On average, half of all TB patients are unemployed, 70% are 
poor and 70% are of working age (16-44).  52% of the reported TB 
cases were men, while 48% were women. 12.2% were of the TB cases 
were children. 
 
Improved Detection and Testing Account 
For Some, But Not All, of the Increase 
--------------------------------------- 
 
¶4. Although spiking rates cause concern, health experts caution that 
improved detection and diagnosis techniques, as well as better and 
more widespread testing in both urban and rural areas has 
exaggerated the problem.  In any case health officials expect  TB 
incidence to trend downward after 2010 as an obligatory BCG 
vaccination program for children, implemented in 1997 bares fruit, 
detection and treatment become more effective, and western standard 
practices are more widely implemented. 
 
TB Mortality Rates Falling 
--------------------------- 
 
¶5. Continued improvements in detection and treatment have already 
helped lower the mortality rate.%%126 persons died of tuberculosis 
between 1991 and 1994, 83 between 1999 and 2002, and 80 between 2003 
and 2006. Furthermore, the recovery rate for TB patients increased 
from 31.3% in 1993 to 79% by the end of 2005. 
 
TB Prominent in UB, Eastern and Central Regions 
 
ULAANBAATA 00000128  002.2 OF 003 
 
 
--------------------------------------------- --- 
 
¶6. Of 2,308 new TB cases registered in 2006, Selenge, Dornod, 
Darkhan-Uul, Govi-Sumber, Khentii aimags and Ulaanbaatar city had 
higher incident rates than national average of 18.5 per 10,000, 
indicating higher prevalence in eastern and central regions. Selenge 
aimag in north central Mongolia had the highest TB incidence per 
10,000 (33.6) and the lowest was Govi-Altai aimag in the southwest 
(4.4). 55.9% of registered cases in 2006 were in Ulaanbaatar city 
(with 43% of the population) compared to 40.2% in 2000. 3.2% of all 
new cases registered in Ulaanbaatar were temporary residents from 
rural areas and 2.4% were homeless. Scientists expect TB cases in 
Ulaanbaatar to remain high until 2010. 
 
Cross-Border Transmissions Hamper Fight 
---------------------------------------- 
 
¶7. High rates of TB in Mongolia's two next-door neighbors, China and 
the Russian Federation (which have the world's second- and 
twelfth-highest rates of TB, respectively) hamper efforts to contain 
the disease as an estimated one million migrant workers cross the 
country's borders every year. 
 
Emergence of Drug-Resistant Strains 
------------------------------------ 
 
¶8. Compounding the danger, the World Health Organization (WHO) this 
month announced that drug-resistant tuberculosis has spread 
throughout countries bordering Mongolia at a rate higher than any 
time previously.  In China's Inner Mongolia region, for example, 
some 7.25% of new tuberculosis cases are the drug-resistant strain. 
Drug-resistant tuberculosis cases in parts of the former Soviet 
Union have reached the highest rates ever recorded globally with 
serious rises in the disease found in neighboring Kazakhstan and 
Uzbekistan. About 5% of new TB cases reported in Mongolia came from 
drug-resistant strains. 
%%%%% 
GOM Unlikely To Reach Millennium Development Goal 
--------------------------------------------- ----- 
 
¶9. As part of its Millennium Development Goals (MDG), the GOM has 
vowed to reverse the spread of TB by 2015.  In recently published 
MDG progress report, the GOM acknowledged that its performance in 
lowering incident rates of TB per 100,000 had regressed, and it was 
unlikely Mongolia could meet its goals in this area.  However, the 
GOM had been able to meet official targets for reducing death rates 
associated with TB and increasing the percentage of TB cases 
diagnosed and treated with international standards, both of which 
the GOM said it was likely to achieve. 
 
Improving Social Conditions Key to Fighting TB 
--------------------------------------------- -- 
 
¶10. The GOM has recognized that efforts to combat TB need to be 
closely aligned with poverty reduction and improvements in housing 
availability and living conditions. Early detection of poor and 
high-risk groups and full coverage by the DOTs (Directly Observed 
Treatments) need to be priority for all levels of healthcare 
institutions. With the improvement in technology to deal with TB, 
the proportion of TB cases detected and cured under Directly 
Observed Treatment short cases (DOTS) in Mongolia increased from 
31.4% in 1994 to 80.9% in 2000 and 82.1% in 2006. 
 
Greater Coordination, Engagement Needed 
---------------------------------------- 
 
¶11. Experts say that to reduce the spread of TB, a comprehensive 
approach, with well-coordinated treatment regimens, will play a key, 
particularly reducing poverty, improving housing and environmental 
conditions, establishing a nationwide surveillance system for early 
detection and ensuring full coverage by DOTs. 
The GOM must also engage and enhance the efforts of local 
governments, law enforcement and detention organizations, medical 
doctors and mid-level personnel of local heath care institutions, as 
 
ULAANBAATA 00000128  003.2 OF 003 
 
 
well as improve financial and legal environment for the activities 
aimed at combating tuberculosis. Improved capacity and professional 
skills of TB related personnel and laboratory diagnostic services 
are also essential. 
 
¶12. Mid-to-long-term GOM priorities include: Improved access to and 
quality of living (housing and healthy environment) conditions, food 
security and healthcare services for poor and vulnerable population 
groups and detainees, reduce poverty, improve housing and 
environment conditions, ensure early detection and effective 
treatment of tuberculosis among poor and vulnerable population 
groups. 
 
Minton