Vaping and e-cigarettes: a new public health concern / Монголын Анагаах Ухаан

@#Electronic cigarettes are handheld electronic vaping devices which produce an aerosol by heating an e-liquid. The e-liquid typically contains humectants and flavorings, with or without nicotine; once vaporized by the atomizer, the aerosol (vapor) provides a sensation like tobacco also smoking the heating process can lead to the generation of new decomposition compounds that may be hazardous. Heavy metals, organic compounds, and particles smaller than PM2.5 were found on the puff of the electronic cigarette, also in 2012 International agency research cancer, introduced PM2.5 human carcinogen substance. Therefore, e-cigarette liquid products should be subjected to regulatory control to ensure consistent nicotine delivery. Global youth tobacco survey Mongolia 2019 asked about e-cigarette use status and 3.5% (95% CI: 2.6-4.6) of students currently used electronic cigarettes while one in ten students (10.1%, 95% CI: 8.3-12.2) had ever used electronic cigarettes. E-cigarette advertising is on television and radio in many countries that have long banned similar advertising for cigarettes and other tobacco products and may be indirectly promoting smoking conventional cigarettes. Smoke-free policies protect nonsmokers from exposure to toxins and encourage smoking cessation. Introducing e-cigarettes into clean air environments may result in population harm if use of the product reinforces the act of smoking as socially acceptable or if use undermines the benefits of smoke-free policies.

Comparison results of the population's COVID-19 preventive behaviours / Монголын Анагаах Ухаан

Background@#As of September 21, 2021, 65.3 percent of Mongolia's population was vaccinated at full dose. However, as of COVID-19 confirmed cases, Mongolia is in the top five countries in the West Pacific. This indicates that there is a lack of practice to prevention from coronavirus infection in the population.@*Goal @#This survey aims to compare the level of knowledge, attitudes, and practices of the population towards coronavirus infection with the results of the baseline survey results @*Material and Methods@#This is a cross-sectional study. A total of 1896 people aged 15-60 years old participated in the study. The survey data were collected using quantitative (questionnaire) and qualitative (observation) methods. The research methodology was approved at the Scientific Committee of the National Center for Public Health on November 9, 2021 (Protocol № 5) and the Medical Ethics Review Committee of the Ministry of Health on January 20, 2022 (Resolution №261) was issued the Ethical permission of the survey. @*Results@#Out of 14 knowledge questions that should be known about coronavirus infection, survey participants had known in an average of 8.27 ± 3.73 (95%CI: 8.12-8.43) correct answers, which was lower than the results of the baseline study. The average knowledge score of the surveyed participants of the follow-up survey (9.23±3.2, 95%CI: 9.09-9.38) was smaller than the baseline survey by 0.96 percent. 54.5 percent of surveyed participants believed that the pandemic is “very dangerous”. However, it has decreased by 25.6 percent compared to the baseline survey. Positive attitudes toward the right place at the onset of symptoms of COVID-19 and non-discrimination against infected people are more prevalent in a population with a high average knowledge score. In the baseline study, the average duration to wear a mask was 29 hours, while in the follow-up survey, it was 4.2 hours, which shows improvement in the correct behavior. @*Conclusions@#As the population’s level of education increased, the average knowledge score on the coronavirus infection has increased, and the statistically significant high of the participant with higher education levels was 8.81±3.53 (p=0.0001). In the baseline survey, 64.9 percent of the participants had an attitude toward a discriminant person infected with COVID-19, whereas it was declined by 41.9 percent in the follow-up survey. The practice of wearing masks in crowded places and outdoors were increased by 6.8 percent from the baseline survey. Compared to the baseline survey results, in the follow-up survey, practices of wearing masks in the workplace or indoor environment (73.0%) had increased.

Assessment of secondary school indoor air quality / Монголын Анагаах Ухаан

Introduction@#During this pandemic, overcrowding in classroom caused by a lack of educational facilities and poor indoor air quality are the main causes of respiratory diseases among children and adolescents. Therefore, it is essential to measure and assess the indoor air quality where children spend extended periods of time such as school. @*Materials and methods@#This study covered four schools with old buildings and four schools with new buildings in Bayanzurkh, Sukhbaatar, Khan-Uul, Chingeltei district of Ulaanbaatar. We collected PM10 and PM2.5, carbon dioxide, air temperature, humidity, and microbiological count from chosen classrooms and compared to the MNS4585:2016 standard. SPSS-24 was used to do statistical analysis on the information gathered during the evaluation.@*Results and Discussion@#The 24-hour average PM2.5 concentration was 64.3 (95% CI: 64.1-64.5) mcg/m3, which was 4.3 times higher than the WHO guideline value and 1.3 times higher than the MNS4585:2016 standard. The 24-hour average PM10 concentration was 85.3 (95 % CI: 85.1-85.6) mcg/m3, which is 1.9 times higher than WHO guideline value. In older school buildings, the 24-hour average PM2.5 concentration was 5.6 times higher than the WHO guideline value and 1.7 times higher than the MNS4585:2016; the average PM10 concentration was 2.8 times higher than the WHO guideline value and 1.3 times higher than the MNS4585:2016. The air temperature and carbon dioxide concentration in classroom was met the MNS4585: 2016. The average relative humidity of all schools is 24.2±6.5%, which is 14-16% lower than the MNS4585: 2016. @*Conclusion@#The indoor air quality of the school in new and old buildings was similar poor, therefore a variety of steps are needed to improve it.

Carbon monoxide poisoning, 2016-2020, Mongolia / Монголын Анагаах Ухаан

Rationale@#Carbon monoxide (CO) is a colorless, odorless gas produced by carbon-containing substances, most commonly incomplete fuel and biomass combustion. Carbon monoxide deprives the human body of oxygen, leads to severe poisoning and death. In 2017, there were 137 new cases of carbon monoxide poisoning per 1,000,000 people worldwide, and 4.6 deaths per 1,000,000. The global incidence of carbon monoxide poisoning has remained steady over the previous 25 years, while mortality has decreased by 36-40%. Every year in Mongolia, 700-840 persons are hospitalized for carbon monoxide poisoning. Also, there has been a lack of study into the prevalence and causes of carbon monoxide poisoning and death.@*Goal@#Study the dynamics of morbidity and mortality cases caused by carbon monoxide poisoning in Mongolia.@*Objectives@#</br> To analyze the carbon monoxide poisoning morbidity recorded in Mongolia between 2016-2020. </br> To analyze the carbon monoxide poisoning mortality reported in Mongolia between 2016-2020.@*Material and Methods@#The survey was conducted utilizing data from outpatient and inpatient poisoning and deaths reported in 2016-2020 with the goal of studying carbon monoxide poisoning and mortality in Mongolia. Workplace exposure poisoning was excluded from quantitative data on carbon monoxide poisoning (fires, suicidal, accidental and domestic explosions, accidents, external effects).The statistics analysis was performed using 23 versions of the SPSS program, to estimate a distribution of new cases and fatalities per 10,000 population depended on age, sex, average number of hospital days, and standard error. ArcGIS version 10.8 was used to map the locations.@*Results@#Acute carbon monoxide poisoning. Carbon monoxide poisoning was 0.01-0.31 cases per 10,000 population during 2016 and 2018. Between 2019 and 2020, it increased to 1.5-1.9 cases per 10,000 population, with up to 37% of those admitted to hospitals. In the last five years, carbon monoxiderelated deaths have been reported in 0.1-0.3 cases per 10,000 population. The amount of hours firing of the households increases every year in September, when the colder season begins. Incidences of death and intentional poisoning were reported in Arkhangai, Uvurkhangai, Khuvsgulaimags, and Ulaanbaatar. The average age of poisoning patients admitted to the hospital was 33 ± 19.5 years old (minimum 2 months, maximum 81). In terms of gender, women registered for 58.4 (734) percent of all cases. The average number of days spent in the hospital was 3.4± 3.7 days.</br> Carbon monoxide poisoning-related mortality. During the previous five years (2016-2020), 353 people died in Mongolia as a result of carbon monoxide poisoning, although 1.4 percent, or five people, died in hospitals, one case in Bayan-Ulgii, Zavkhan, and Uvs aimags, and two cases in Ulaanbaatar. However, 98.6 percent of them died prematurely at home or in poisoned places due to a lack of access to health care. The average age of carbon monoxide poisoning deaths cases was 35 ± 19.9 years old, and 71.7 (253) percent were male. The Ulaanbaatar, Selenge, Uvs, and Dornod aimags had the lowest death rate of 0.08-0.21 per 10,000 population, while Khuvsgul and Arkhangai aimags had the highest death rate of 0.96-1.57 per 10,000 population.@*Conclusions@#Carbon monoxide poisoning among the population rises during the winter season, however, in the previous five years, 96.5 percent of cases have been poisoned accidentally, particularly 82.6 (1035) percent of cases reported in Ulaanbaatar. According to socioeconomic factors, 41.6 (529) of the cases were male, with an average age of 36.5±15.4 years.</br> During the preceding five years, carbon monoxide-related mortality in Mongolia was between 0.2 per 10,000 people. Without medical attention, 99.2% of cases died at the exposed location or area. The death rate in Khuvsgul aimags was low, whereas it was high in Ulaanbaatar city. The average age of premature deaths was 35±19.9 years, and 71.7 (253) percent were male.

The result of measured household indoor air quality, Ulaanbaatar, 2020 / Монголын Анагаах Ухаан

Introduction@#Beginning 15 May 2019, the consumption of raw coal in Ulaanbaatar has been replaced by the consumption of briquette fuel for the improvement of air quality according to Governmental Resolution No.62 adopted in 2018. Since after this resolution has been in placed the number of CO poisoning has been increased as of 18 December 2019, nine persons were died and 1394 people get a health care service due to CO poisoning. However, it has been not been assessed briquette affect to the indoor air quality and its health impact. Thus, it is need urge to define the indoor air quality effect of briquette and its heath impact.@*Goal@#To assess the indoor air quality of the household using the “improved briquette” and identify the causes of the risk.@*Material and Method@#This a cross-sectional survey, conducted from January 31, 2020 to April 31, 2020, data were obtained by quantitative, qualitative (observation, interview) and direct indoor air quality measurement. The survey sampling frame was 40 households in central 6 districts of Ulaanbaatar that used improved fuels (20 households with a history of carbon monoxide poisoning and 20 households that were not affected), and 14 households in the Nalaikh district that used raw coal, in total of 54 households were participated. Indoor air quality was measured by PM2.5, PM10, CO, SO2, NO2, and microclimate per household for 24 hours during a week. </br> The statistical data analysis was done by the SPSS-23 program and preformed required parametric and non-parametric tests. The normality of the data was checked by the Kolmogorov-Smirnov test. The most of data was not normally distributed. So, thus we used median and used relevant non-parametric tests. The average level of microclimate indicators, and air quality indicators were defined as mean, median and its IQR and standard deviation. The 95% confidence intervals of mean and frequencies were determined and used to differentiate group differences. </br> The Ethical permission to start the survey was approved by the 2nd meeting of the Ministry of Health on February 4, 2020. The committee was reviewed and approved the research methodology based on whether data collection technique and tools are considered the ethical issues, and whether provided accurate information for make decisions to enroll to the survey for respondents.@*Results@#According to the health statistic, from October 2, 2019 to March 31, 2020, a total of 2,768 people from 837 households were exposed to carbon monoxide poisoning. Of the total reported cases, 10 were drunk, and 2 were due to other disease complications, and a total of 2,756 cases were confirmed diagnosis as carbon monoxide poisoning.</br> Emissions of CO were recorded every 15 seconds and the results were calculated by conducting continuous measurements per household for 24 hours a week. The level of CO emitted into the indoor environment of households exposed by carbon monoxide had increased during the following time from 7 am to 9 am in the morning, from 13 pm to 15 pm, from 18 pm to 20 pm in the evening, and from 22 pm to 24 pm at night. During this period of time, the indoor air CO level had increased from the WHO mild poisoning recommendation level.@*Conclusion@#It has been defined that the carbon monoxide emits to the indoor air households which are using an improved fuel according to measurement the 30 minutes, 31-60 minutes, and 61-120 minutes after burning.

Practices COVID-19: cross sectional survey among Mongolian residents / Монголын Анагаах Ухаан

Introduction@#In 11 March, 2020 WHO made the assessment that COVID-19 can be characterized as a pandemic. The COVID-19 pandemic demands health care systems and decision-makers around the world to take effective preventive measures, policies, and decisions. The pandemic continues to affect individual and social mental health, well-being, lives, relationships, as well as economic stability. Therefore, we measure individual and social responses in this context 1) by measuring unexpected events and actions being taken accordingly, and 2) by the effectiveness of the organized responses to the pandemic. Prevalence of COVID-19 epidemics has a direct relationship with the general population behavior, therefore preventive measures against the spread of COVID is vital. Estimation of practices towards COVID-19 in the population will greatly assist in intensifying the government's efforts to prevent it. Therefore, there is a need to identify the population’s prevention behaviors, attitudes, and information needs about coronavirus infection (COVID-19), to further improve the responses, risk communications, and to ensure public preparedness.@*Materials and Methods@#This cross-sectional study was conducted among the general population of Mongolia using quantitative and qualitative (II & FGD and observation) cross-sectional survey method. The study was adapted to the specifics of the country, using the research tools and guidelines developed by the WHO Regional Committee for Europe, the COVID-19 readiness and response, and risk information communication planning. </br> Total of 1740 people aged 15-60 years old participated in the study from 3 bordering provinces (Bayan-Ulgii, Selenge and Dornogovi) and 2 districts of Ulaanbaatar (Songinokhairkhan and Chingeltei). Data analysis was conducted using SPSS version 23. Deviation values of 95% confidence interval (95%CI) were used to assess the difference between the measurement of accuracy of the results (distribution rate) and the groups (age, sex, location). @*Results@#According to the results 47.5% (95%CI: 44.9-49.7) participants were from Ulaanbaatar and 56.7% (95%CI: 50.3-55.1) were from rural areas. The participants' average age was 35. Most of the participants were married (72.0%, 1252) and women (60.7%, 1057). As for living conditions 34.8% (95%CI: 32.7-37.1) of the participants live in apartments and 65.2% (95%CI: 62.9-67.3) live in ger areas. Respondents had answered to an average of 9.23 ± 3.2 (95%CI: 9.09-9.38) out of 14 scored questions for required knowledge of COVID-19. Knowledge score was higher among female participants (9.43±3.14) than that among male participants (p=0.0001).The score of participants with incomplete secondary education was 8.13 ± 3.24, however this score has increased to 8.32 ± 3.44 for those with complete secondary education and 10.08 ± 2.71 for those with higher education (p=0.0001). The majority of participants perceived COVID-19 pandemic as very dangerous. 69.8% of the surveyed population has been able to prevent COVID-19 in the last 14 days. This suggests that more than half of the population has a practice of preparedness of COVID-19: wearing a mask, keep distance, and hygiene. 81.6% of the participants said that they use masks when going out, but most of them use them incorrectly, which is reflected in the decrease in the frequency of people wearing masks when shopping, public transportation and public transportation. Half of the respondents said that in places where interpersonal space is regulated, they keeping distance. However, 2 out of 3 people cannot keep distance. According to the survey, 41.6% of the respondents used to wash their hands regularly, 58% cleaned and disinfected, 67.0% avoided touching their eyes, nose and mouth with dirty hands, and 76.6% using napkins and elbows when coughing and sneezing. COVID-19 prevention practices in the population were statistically significant in relation to their knowledge of COVID-19.@*Conclusion@#Despite to 81.4 percent of the surveyed population reported they wear face masks outdoors, quantitative and observational studies have shown that people wear face masks indoors relatively for a long period of time and handle it incorrectly. Two out of three respondents were not following social distancing guidelines at all. According to the survey result, good hygiene practices towards COVID-19 prevention was insufficient such as not washing hands properly (58.4%), not possessing hand sanitizer (42.1%), touching your eyes, nose and mouth with unwashed hands (22.1%), and not covering your mouth and nose when you cough or sneeze (23.4%).

Health professional’s knowledge, attitude and practice (KAP) on air pollution / Монголын Анагаах Ухаан

Introduction@#Soum and family health care centers (primary health care centers) provide public health services to reduce the negative effects of air pollution on health. In order to decrease the risk factors due to air pollution, it is crucial for health professionals, who are providing health care services to the public, to have the knowledge, attitude and practice to give an advice for residents on how to protect their health from air pollution. The “Air pollution and child health” report from WHO recommended that responsibility of health professionals must include knowing the latest information on air pollution, doing a research, spreading the knowledge, educating families and community and learning from them as well, proposing solutions, and finding a solution for policy developers and decision makers in other sectors. Therefore, we conducted this survey with purpose to determine the long-term effects of air pollution on population psychology and lifestyle and to evaluate the level of knowledge, attitude, and practice of health professionals on how to protect a health from air pollution.@*Goal@#Evaluate the level of knowledge, attitude, and practice of health professionals on air pollution.@*Material and Methods@#In 2019, this study conducted a cross-sectional design and collected quantitative and qualitative data. 88.4% of (n=532) health professionals from 48 secondary health care centers (SHCC) and 64 family health care centers (FHCC), which are agents that implement UNICEF project, in Bayanzurkh, Songinokhairkhan districts and Bayankhongor aimag were participated in the survey.@*Results@#97.4% of the participants agreed that air pollution has negative effects on human health. 99.5% of participants did not know the Mongolian standard for the acceptable level of air pollutant particulate matter (PM) and 73.1% of all participants did not receive information about air quality index. 82.1% of participants regularly give prevention advice with the purpose of protecting maternal and child health from air. The participants who worked for more than 21 years and who are older than 51 years old were more likely to give advice (p<0.05). As for the reasons for not giving advice about air pollution for protecting the maternal and child health, 29.2% of participants answered the service time is not enough, and 22.9% mentioned the lack of knowledge and information. 30.5% (162) of participants were not satisfied with their skill to give an advice on how to protect maternal and child health from air pollution. 86.8% of participants indicated that they did not receive proper training on air pollution and prevention from air pollution.@*Conclusion@#There is a need to provide training and information on how to protect maternal and child health from air pollution for health professionals.