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@#Health impact assessment is a means of evidence-based policy-making for improvement in health. It is a combination of methods whose aim is to assess the health consequences to a population of a policy, project, or program that does not necessarily have health as its primary objective. It is described as being “the leading global network on best practice in the use of impact assessment for informed decision-making regarding policies, programs, plans and projects”. In recent years, much evidence was revealed that the mining, metal mining, and processing industry has a greatly impact on humans. Residing population has affected directly and indirectly influenced to the health and wellbeing of human. </br>The mining, metal mining and processing industries play an important role in the economic and social development of Mongolia. With the rapid development of the mining industry in Mongolia, environmental protection and environmental rehabilitation have become a priority. Currently, there are 27 laws governing environmental legal acts in our country, and chapter 3 of the Hygiene Law covers environmental and health impact assessment. As stated the implementation of the law shall be financed from the state and local budgets, the central state administrative organization and the Governor at the appropriate level shall order the relevant professional organizations to carry out environmental research and analysis work and to develop projects, and in addition to financing with budget funds, as well as conducting research with their funds for interested citizens, enterprises, and organizations were are arrangements to support the implementation of the laws and its regulation. </br>However, Within the scope of the Law on Environmental Protection and Detailed Environmental Impact Assessment Procedures, the negative impact on the environment is identified but in the area of health impact, it is a lack of information on how the activities are conducted, and health impact assessments are not conducted according to procedures and methods. Thus, there are need to conduct health impact assessments of the mining area and its affected population.
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@#Lung cancer has the highest mortality rate in the world and is the most common cancer type in Asiancountries. In developed countries, new cases and lung cancer among women tend to increase, while in less developed countries, the death rate of this cancer is high and its prevalence is higher among males. </br>Moreover, in many studies conducted in recent years worldwide, a sample of the studies containing early detection, diagnosis, and treatment that can be implemented at the national level was translated and compiled. </br>Improvement of public health education, availability of health care services, an increase of human resource capacity, implementation of early detection programs among the public, and early detection with a reduced dose of KTG among the target group are expectations of the public health sector. </br>Special attention should be paid to issues such as reducing smoking among the people of Mongolia, immediately solving the problem of air pollution in central areas, assessing and reducing the risk factors of occupational diseases of mining workers, and introducing modern methods of treatment and diagnosis in health care services. The time has come to take multifaceted measures to prevent lung cancer, which has a high global disease burden and economic burden, with public participation.
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Background@#A blood product is any therapeutic substance derived from human blood, including whole blood and other blood components for transfusion, and plasma-derived medicinal products. Medicinal (medical therapeutic) products derived from human donations of blood and plasma play a critical role in health care. Safe, effective and quality-assured blood products contribute to improving and saving millions of lives every year, as they: address child mortality and maternal health, dramatically improve the life expectancy and quality of life of patients suffering from life-threatening inherited disorders, such as haemophilia, thalassaemia and immune deficiency, and acquired conditions such as cancer and traumatic haemorrhage and support complex medical and surgical procedures, including transplantation. An insufficient or unsafe blood supply for transfusion has a negative impact on the effectiveness of key health services and programmes to provide appropriate patient care in numerous acute and chronic conditions. Ensuring access of all patients who require transfusion to safe, effective and quality-assured blood products is a key component of an effective health system and vital for patient safety.</br> Although the number of blood donors is increasing, there are still insufficient human and financial resources for encouraging the growing demand of blood and blood products and new blood donors. @*Material and Methods@#We collected secondary data by using using the order forms of hospitals that used blood and blood products registered in the National Center for Blood Transfusion Research in 2017-2019 in accordance with the retrospective survey method. </br> In total 34,119 hospital order information sheet was entered into computer in excel program, and converted into SPSS 23 software, descriptive parameters were calculated and analyzed. @*Results@#Compare to the 2017 (n=9076), the demand of blood product was increased by 21.8%, and 54.8% in 2019. There are 51.9% (95%CI: 51.2-52.5) of total users are male, which is statistically significant. The mean age of blood product users were aged 48.58±21.32, the youngest user was aged 1 and the oldest age was 99. The demand of blood products were increased by growing of the age of users. The product usage of age group of 46-55 was 17.8% and has trend to increase year by year. In total, 11.3% of total blood product was utilized for children and 72.3% of them were aged less than 5 years old. 73.0% of total blood products were utilized in specialized hospitals, 14.6 % of them were used in aimag and district level hospitals and 11.3% of them were used in private clinics. 24.4% of blood products utilization was used for diseases of digestive system (К00-К93), 22.1% of them were used for diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism, and 19.5% of them were used for the cancer (C00-C97) disease patient’s treatment. @*Conclusion@#Since after new treatment guidance was introduced the blood and blood products usage had been increased.
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@#Hepatitis B (HBV) and C (HCV) are viral infections which can cause acute and chronic hepatitis and are the leading causes for hepatic cirrhosis and cancer, thus creating a significant burden to healthcare systems due to the high morbidity/mortality and costs of treatment. The risk of HBV infection in an unvaccinated person from a single HBV-infected needle stick injury ranges from 6–30. The prevention of HBV infection among HCWs has become a crucial issue. HBV can effectively be prevented by vaccination. A safe and effective HBV vaccine has been available since the 1980s and can prevent acute and chronic infection with an estimated effectivity of 95%. In 2017, the São Paulo Declaration on Hepatitis was launched at the World Hepatitis Summit 2017, calling upon governments to include hepatitis B vaccines for HCWs in national immunization programs. The vaccine is 95% effective in preventing infection and its chronic consequences and has an outstanding record of safety and effectiveness. Data on current hepatitis B vaccine coverage among HCWs in Mongolia is scarce. According to Azzaya et al, the protection level of the subjects was 67.2% >100 mIU/ml, 18.8%, 11-100 mIU/mL and 14.1%, 0-10 mIU/mL based on antibody titer level respectively among the vaccinated HCWs at the 2nd Central hospital. Thus, the HBV vaccination among public and private sector HCWs in Mongolia to inform the health authorities about the HCWs HBV vaccination status along with associated problems and challenges for further improving vaccination strategy among HCWs.
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@#The atmosphere is a mixture of gaseous substance produced over the Earth’s long history by biogenic, geogenic, and atmosphere processes. By definition, air pollution is a mixture of solid, liquid and gaseous substances as well as biological objects emitted to the atmosphere caused by natural and anthropogenic activities that has detrimental effects on the animals, human health and economics. </br> Nowadays, the anthropogenic impact on the atmosphere has been increasing with the enormous growth of human population, the use of mineral resources, and the advanced technology and continues to be significant. </br> Compared to children in low-pollution urban areas, children living in high air pollution city have higher levels of acute pharyngeal disease. The fact that children aged 0-1 years are more prone to such diseases shows that the younger the child, the more susceptible he/she is. </br> As a result of conducting in-depth review of recent scientific studies, researchers have confirmed, based on evidence that ambient air pollution leads to the formation of lung cancer. Also many other researchers were stated adverse health impact of each air pollutants are different. For instance, particle matter, one of the indicators of air pollution has been studied separately and classified as a carcinogen. The research of the International Agency of Cancer Study has revealed that the more the impact of air pollution and the level of particle in the air increases, the higher the risk of lung cancer becomes. Every air pollutants has different hazardous impact to human health. </br> Thus, we would like to emphasize adverse health impact of main air pollutants in this paper.
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@#Tuberculosis remains a major global health problem with 10.4 million incident cases in 2016. Although Mycobacterium tuberculosis is the causative agent, many environmental factors play a role in disease progression. Several respiratory hazards including smoking and indoor air pollution were suggested to increase the risk of tuberculosis, but only fewer studies has been conducted on the association between ambient air pollution and tuberculosis. </br> Mongolia is a one of the seven TB high burden countries in the WHO Western Pacific Region. In 2017, there were 3779 TB cases in Mongolia. Most of them were smear positive pulmonary cases. Mongolia achieved the regional WHO targets for finding and curing TB. Currently, case detection and treatment success rates have reached 72% and 84.0%, respectively.</br> Air pollution is hard to escape no matter how rich an area you live in, it is all around us. Also, air pillution is incerasingly serious problem in Mongolia. Globally it is estimated that 9 out of 10 breathe polluted air and about 7 million deaths are attributed to air pollution. It is estimated that 91% of the world’s population lives in area where the World Health Organization (WHO) Air Quality Guidelines are not met. </br> In addition, children are highly affected by air pollution because their lungs are still developing and the air pollution can interfere with this biological process, their bodies are less able to metabolize, detoxify and excrete the toxins contained in the air pollution. Many epidemiological and ecological studies were done in Mongolia toward to air pollution and health. However, it is still not clear how much indoor and ambient air pollution can cause to TB incidence in Mongolia.
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Background@#Blood is an important resource, both for planned treatments and urgent interventions. It can help patients suffering from life-threatening conditions live longer and with a higher quality of life, and supports complex medical and surgical procedures. According to WHO recommendation at least 1% of the population of any country needs to donate their blood to accommodate the basic clinical needs of the country. Accordingly, we aimed to assess existing attitudes of the general population towards on blood donors. @*Materials and Methods@#The survey identified attitude of the population on blood donation and factors influencing them, using quantitative and qualitative methods. The survey covered a population aged 18-60 years. SPSS software version 21 was used for data analysis of the survey. The survey protocol and methodology were reviewed and approved by the Scientific Committee at the NCPH. The Medical Ethical Committee at the MOH reviewed the survey materials and issued an approval (2015/3). @*Results@#The survey covered in total 3,782 people and there are 59.2% of surveyed respondents said they have never thought of becoming a voluntary blood donor. Positive attitude on blood donation is higher with statistical significance among women (59.0%), 18-25 years old (43.7%) and UB residents citizens with higher education. As education level increases the number of respondents who thought about donating blood is also increases. 16.1% of them had a history of blood donation before and 38.2% said they never thought about it. Twenty point four percent of respondents thought blood donation brings some kind of risk. Nevertheless of the education level of surveyed respondents, the percentage of answer blood donation is not risky for a person was the most common answer. But respondent who is only literal and uneducated were don’t know about whether it has a risk or not (385.37=2א, p=0.000001). Also, respondents failed to donate their blood because the family not allowed, afraid, risk of infection, doesn’t want and had a busy schedule.@*Conclusion@#There is a high tendency to donate blood populations of young people aged 20-29, women, residents of Ulaanbaatar, and uneducated and highly educated. The majority of respondents agreed that blood donating is charity and a good deed. The leading causes of blood donation is the education, gender, the desire of doing a good deed, peer influence and health condition.
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Background@#Air pollution has been increasing intensively during last decade in big cities of Mongolia especially in Ulaanbaatar due to urbanization, poor urban plan, migration from rural areas to urban areas, poverty, unemployment, economic crises, exercise with unclean technology mainly coal for heating and cooking, raise of number of motor vehicle and other air pollution sources; as result of this phenomena population health has been worsening. The Global burden of disease concept, first published in 1996, constituted the most comprehensive and consistent set of estimates of mortality and morbidity and WHO now regularly develops GBD estimates at regional and global level. The goal of this study is to define DALY of air pollution related diseases in Ulaanbaatar. @*Materials and Methods@#This is retrospective study which used air pollution and mortality secondary data 2008-2017. The DALY extends the concept of potential years of life lost due to premature death (YLL) to include equivalent years of ‘healthy’ life lost by virtue of being in states other than good health. DALYs for a disease or health condition are calculated as the sum of the years of life lost due to premature mortality (YLL) in the population and the equivalent ‘healthy’ years lost due to disability (YLD) for incident cases of the health condition. We used WHO recommended estimation methodology and selected 2 disease category of mortality of each RSD (pneumonia, COPD) and CVD (ischemic heart disease, cerebrovascular disease).@*Results@#According to the age group, most of children 0-4 due to RSD and most of adults were died due to CVD. In general, hospitalization is increasing year by year and differing by season. Significant associations were found for all air pollutants such as PM10, PM2.5, CO, SO<sub>2</sub>, and O<sub>3</sub> had a statistically significant association with cold season’s mortality of RSD and CVD. The most common mortality cases were ischemic heart disease, cerebrovascular disease, pneumonia and COPD. In Ulaanbaatar in 2008-2017, 2205 people were died due to RSD and CVD. Hospital admission and mortality has an increasing trend. @*Conclusion@#Residents of Ulaanbaatar were lost in total 249854 years due to pneumonia, COPD, ischemic heart disease, and cerebrovascular disease during 2008-2017. The most vulnerable group of people on air pollution was children and elders of Ulaanbaatar city.
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Background@#The 2030 Agenda for Sustainable Development offers an historic opportunity to set a new course for the next era for significant changes for children and their families, with water, sanitation and hygiene (WASH) is at the centre of this ambitious new agenda, with a distinct water sector goal (SDG 6) that aims for universal, sustainable, affordable and equitable access to safe drinking water and adequate sanitation and hygiene, as well as the elimination of open defecation by 2030. According to the data of the National Statistics Office of Mongolia, the total population of the country is 3,036,988 of which 1.3 million inhabit in Ulaanbaatar with over 60 percent of them living in the ger districts. Sanitation facilities which fail to meet the hygiene requirements are used by 97.3 percent of the ger-district households.@*Materials and Methods@#The research was implemented using laboratory test methods following the cross-sectional model. In the ger communities of the 9 districts of Ulaanbaatar, 111 sites were selected for soil sampling in July, August and September of 2016 with 3 repetitions. The samples were tested in the reference laboratory of the Public Health Institute, titres of E.Coli and quantities of Protei were defined and assessed in comparison against the normative levels provided in the Standard MNS 3297:91 “Environmental protection. Soil. The indicators of norm sanitation condition for soil communities.@*Results@#The findings of the study show that the most or 79.2 percent (225) of the sites where E.Coli was detected had low level of contamination, 18.3 percent (52) had moderate contamination and 2.1 percent (7) had high level of contamination. By locations of soil sampling for E.Coli detection, 588.74 titres were counted in the samples from near the ger-district service centres which was the highest among other locations and 5.88 times exceeded the mean contamination category of MNS3291:91 Standard as much as 5.88 times. The E.Coli contamination in the samples taken from near the main roads and gas stations were higher than the Submitted abstract International expert consultation on sanitation in cold climate 148 mean standard category (100-1000) by 16 points, but still lower than at the other locations (p=0.22). The mean value of the Proteus titres from July, August and September in the soil samples from the proximities of the car and tyre repair shops and car wash centres was higher than at other locations and would fall within the high contamination category according to the Standard. The 1.0 percent of the causes of diarrhea in small children in ger areas in UB is E.Coli in the topsoil. But the total number of bacteria in soil accounts for the 2.1 percent of the causes of diarrhea in small children.@*Conclusions@#</br> 1. Thesurficial soil of the ger-districts in city Ulaanbaatar are getting contaminated due to human and animal excreta and pit latrines which do not meet the hygiene requirements.</br> 2. Pollution of soil pathogenic microorganisms affects the diarrheal infection in children from ger areas in Ulaanbaatar.
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IntroductionThe metabolic syndrome is a cluster of the most dangerous heart attack risk factors: diabetes andprediabetes, abdominal obesity, high cholesterol and high blood pressure. Also it is known as acluster of changes associated with resistance to insulin.There is a convincing evidence of important ethnic differences in the prevalence of metabolic syndrome,its components and sequelae. Estimates vary by country, but generally they show higher prevalenceof metabolic syndrome in non-European groups. Based on these findings, we were convinced inthe importance of studying the prevalence of metabolic syndrome and insulin resistance among thepopulation of Mongolia.Materials and MethodsThe main goal of our study was the determination of insulin level and insulin resistance in metabolicsyndrome exposed and non-exposed groups. We included 194 randomly selected people aged 20-60 years old; among them 51 had metabolic syndrome which was identified by the criteria of theInternational Diabetes Federation. All participants underwent general medical examinations andsigned a written consent paper. Fasting blood glucose, triglyceride, HDL, insulin levels were measuredin fasting blood serum and insulin resistance was calculated as a HOMA-IR model.ResultsAverage age of participants was 44,26±8,66 years, of whom 46,4% (n=90) were male, 53,6%(n=104)were female. By IDF criteria, 26,2% (n=51) of the participants had metabolic syndrome. Insulin levelwas 17,23±14,91μIu/mL in MS exposed group which was much higher than in the control group.Insulin, HOMA-IR, had direct correlation with the body mass, BMI and waist circumference andinverse correlation between HDL.Conclusions26.2% of the study participants had metabolic syndrome which was defined by IDF criteria. Insulin levelin the MS exposed group was 17,23±14,91μIu/mL, higher than in the control group by 7,53±2,21μIU/mL. Insulin, HOMA-IR, showed a direct correlation with the body mass, BMI and waist circumferenceand inverse correlation between HDL.
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Air pollution is an increasingly serious problem in Mongolia, especially in the capital city of Ulaanbaatar, Darkhan and several other urban areas.The goal:The goal of this study is to determine the relationships between air pollutants (PM10, PM2.5, NO2 and SO2) and meteorological parameters (average temperature, humidity, and wind speed) and respiratory and cardiovascular morbidity and mortality of all secondary level and tertiary level hospitals of Ulaanbaatar and 8 primary level hospitals. This is a cross sectional study using secondary air quality and hospital morbidity and mortality data.Material and Methods:Sampling unit is a total number morbidity of respiratory and cardiovascular diseases at the selected study hospitals, number of mortality of the selected II and III level hospitals. Data were collected during 1 year and 5 days or 370 days from 1 June 2008 to 5 of June 2009. Hospital morbidity and mortality admission data were obtained from each hospitals statistic department. Daily data of FGPs were collected manually by data collectors in accordance with scheduled date. Emergency data was also been obtained from the City emergency center.Results:The daily concentrations of PM10, PM2.5, SO2 and NO2 had exceeded the MNAAQS mainly in the winter months from November to February. The correlation mainly between respiratory and cardiovascular disease case admissions with meteorological parameters is because the cold winter conditions in Ulaanbaatar result in the accumulation of pollutants in the atmosphere. Thus, population exposure to air pollution is increase significantly during winter months. Based on recent study result, during winter 1 out of 2 diseases admission case of respiratory system disease caused due to average temperature, relative humidity, NO2, and PM10 and cardiovascular disease also caused due to relative humidity, NO2, and PM10 level. So thus, not only fuel based pollutants but also vehicle related pollutants and meteorological conditions also causing onset of cardiovascular and respiratory system disease. Children under 15 years old are more likely get admitted to the hospital due to respiratory system disease cases whereas cardiovascular disease admission more registered among older age group of people. In addition, residents of ger area are more visited to the FGPs than the residents of apartment area.Conclusions:1. The correlation mainly between respiratory and cardiovascular disease case admissions with meteorological parameters is because the cold winter conditions in Ulaanbaatar result in the accumulation of pollutants in the atmosphere.2. Population exposure to air pollution is increase significantly during winter months.3. During winter 1 out of 2 diseases of respiratory system disease caused due to average temperature, relative humidity, NO2, and PM10 and cardiovascular disease also caused due to relative humidity, NO2, and PM10 level.
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This survey had conducted for determining respiratory system disease and mortality trend of Ulaanbaatar city population and for developing evidence based recommendations. In accordance with the methodology we had done meta-analysis and statistical analysis on data 2004-2008. For the data analysis we used SPSS and parametric and non-parametric tests were used for determining disease changes and differences of seasonal, age and gender. In recent 5 years, in Ulaanbaatar, respiratory system disease cases are continuously leading 5 leading causes of disease. In 2008, respiratory system disease cases were 865.0 per 10000 populations and it is compare to 2004 increased by 10-30 percent. Children and women are more tend to attend to hospitals due to diseases cases. The survey also revealed that incidence of pneumonia (116.7-145.8 per 10000 populations) was the most visited case from other ICD10 causes of diseases.The mean age of mortality of respiratory system disease was 36.6±31.8 and the oldest age was 101 and the youngest was under 1 year old during 2004-2008 in Ulaanbaatar. During spring season, acute respiratory system disease, chronic bronchitis pneumonia and others respiratory system disease cases were more admitted from the respiratory system disease. Whereas, during autumn season, emphysema, during winter season bronchitis were the leading causes of respiratory system disease admission (x2=33.779, p=0.013).CONCLUSION: The statistics, 2004-2008 in Ulaanbaatar, were showing respiratory system disease trend constantly and continuously increasing. Age, gender and seasonal characteristics were signifi cantly correlated with the respiratory system disease. During these 5 years, 932 deaths were recorded and mean age of dying was 36.6±31.8.