Qualitative studies on raw materials for Hepaclin-4 prescription / Монголын эм зүй, эм судлал

Background@#In 2021, 5981 of cancer new cases was registered in Mongolian population. Among those cases, liver cancer was commonly registered with a prevalence of 32.7%. Studies on anticancer agents with no-adverse effects and good-preventive efficacy against cancer have been attracted more attention from the researchers in the field of pharmaceutical sciences. Scutellaria baicalensis Georgi, Saussurrea amara.L, Chiazospermum erectum Berh, and Carthamus tinctorius.L are well recognized as effective agent against liver diseases. Using these raw materials, researchers have been invented a traditional prescription and named as Hepaclin-4. In this study, we aimed to investigate the qualitative study of raw materials and some biologically active sub- stances in the compounds.@*Purpose@#To study the qualitative study of raw materials for Hepaclin-4 prescription@*Materials and methods@#Some qualitative properties of raw materials for Hepaclin-4 prescription, including appearance, minerals, some organic compounds, total ash, water-soluble substances and fungi, were investigated according to Mongolian pharmacopeia and total flavonoid was detected by thin layer chromatography.@*Results@#No changes were observed on the appearance of raw materials, and minerals and organic compounds weren’t detected in the prescription. No contamination with fungi and insects were identified. The moist in the raw materials were 5.9 to 8.1%, total ash was 4.7 to 13.3% and the water-soluble substances were detected 33.8 to 42.9%. Number of aerobic bacteria, fungi and E.coli, Salmonella species were detected in normal range, indicating that the prescription was matched with the requirement of pharmacopeia. According to the thin layer chromatography study of the raw materials, a yellow spot on the chromatogram were identified and same as quercetin (Rf=0.9-0.98) and rutin ((Rf=0.18-0.23)) as standard compounds, which indicated that the spot which indicated that the spot was flavonoids in the prescription.@*Conclusions@#These results showed that the appearance, moist, minerals, organic compound, water-soluble substances, ash and biologically active substances of the raw materials for Hepaclin-4 prescription was corresponded with the requirements of pharmacopeia, and flavonoid was detected in raw materials of Hepaclin-4.

Health Impact Assessment of the Mining Industry / Монголын Анагаах Ухаан

@#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.

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.

Evaluation of air pollution prevention consultation, Ulaanbaatar / Монголын Анагаах Ухаан

Introduction@#Mongolia’s capital hosts about half the country’s total population, and its air pollution ranks among the highest in the world during winter. Air pollution is linked to reduced fetal growth, preterm birth, low birth weight, impaired cognitive intra-uterine development, impaired cognitive development, and even spontaneous abortion. Antenatal care includes fetal development monitoring, prevention of anemia, immunization against infectious diseases, prevention of sexually transmitted diseases, and any health risk factors such as environmental pollution. </br>Health care measures for pregnant women and children under one year of age have the potential to be highly effective because they are directly aimed at reducing pneumonia in children. As such, we need to conduct this survey to determine whether pregnant women were satisfied with the information and advice on air pollution prevention provided by health facilities and to take evidence-based measures.@*Materials and Methods @#The survey data were collected using quantitative and qualitative research methods. In this study, a total of 958 pregnant women participated from Songinokhairkhan district, Bayanzurkh district, and Bayankhongor province center. The overall satisfaction of health services is calculated using the three dimensions namely: satisfaction with health service, operation, and environment of the Health Organization. Satisfaction scores were assessed using an even-point scale. These are “Very Dissatisfied-1 point”, “Dissatisfied-2 point”, “Satisfied-3 point”, “Very satisfied-4 point”. The results were calculated after entering the survey data into SPSS-23, creating a database, and performing error control. The research methodology was discussed at the meeting of the Academic Council of the National Center for Public Health on December 25, 2019, and the methodology was approved by the Medical Ethics Committee of the MOH (Stagnant №2).@*Results @#The survey covered 958 pregnant women aged 16-45 in Bayanzurkh district Songinokhairkhan district, and Bayankhongor province. During antenatal care visits, the majority of pregnant women (BZD- 56.9%, SKHD- 68.3%, BKH province - 86.7%) were advised by their health specialists to go outside for fresh air, while women in Ulaanbaatar (BZD- 18.9%, SKHD- 24.7%) received the information and advice at the lowest percentage. Pregnant women in Ulaanbaatar were less involved in air pollution training than in Bayankhongor. Participants in the air pollution prevention training rated it as “satisfied” regardless of location. 37.2% of pregnant women obtained information on protecting their health from air pollution from the board of Family Health Center and 34% from their district health centers. 86.1% of the participants were able to obtain information on air pollution on their own, while 86% of them got information from their family and friends. @*Conclusion @#The percentage of pregnant women getting medical advice, training, and information on air pollution prevention from hospitals during their antenatal care visits was the highest in rural areas. Moreover, their level of satisfaction with counseling had been rated as “satisfied”. Pregnant women often seek information on air pollution prevention from non-professional sources, such as their family and friends.

Evaluation of the 5th National Program on Maternal, Child and reproductive Health / Монголын Анагаах Ухаан

Background@#As a result of the previous programmes implemented by the Government of Mongolia, maternal mortality and under-five mortality rates had declined fourfold from 1990 levels to 2015 The Millennium Development Goals (50.0), shifting from a country with a high maternal mortality rate to a country with a moderate maternal mortality rate [6, 7, 8, 9]. However, as maternal and child mortality have not been steadily declining, regional disparities in care have not been eliminated, unmet needs for family planning have increased, contraception use has reduced, abortions and repeat abortions have not decreased. The quality of antenatal care is low; the continuing challenges have led to the development and implementation of the 5^th National Programme. As the programme was finished in 2016-2020, assessing its impact on Mongolia is significant. @*Objective@#Evaluating the objectives of the National on Maternal, Child and Reproductive Health Programme, the implementation of planned activities, whether the intended results have been achieved according to the criteria was to determine future needs and the main areas of focus. @*Materials and Methods@#Quantitative and qualitative methods were used to analyse the information required for the assessment. The activities of the programme implementation plan were evaluated in the form of activities implemented in 2016-2020 and time spent on implementation, which implemented, who was involved, the budget spent, the type and the number of beneficiaries, and the reasons for nonimplementation. @*Results@#A total of 28 indicators of the National Program was 76.8 percent. In 2016, by the time the programme was launched, the under-five mortality rate was 20.8 per 1000 live births. However, the goal to reach 15 in 2021 was achieved to reach 12.7 by successfully implementing the programme. The program aimed to reduce the maternal mortality rate from 48.6 per 100000 live births to 25 per 100000 live births in 2021, but has not yet been achieved, reaching 30.2 in 2020 and 43 in the first five months of 2021. Initially, the program implementation plan included cooperation with more than 600 organisations, such as 9 ministries, 14 government organizations, 21 provinces, health centers, and maternity hospitals. However, an excessive number of organizations and an unnecessary amount of planned work made it impossible to identify the beneficiaries in addition to the Government of Mongolia, donors such as UNFPA, UNICEF, and WHO made a significant contribution to the implementation of the programme by providing financial and technical assistance. As of 2017-2021, no funds had been found to implement the National Programme on how much has been spent on information, publicity, and advocacy measures. According to the interviews with the programme implementers, a lack of leadership, lack of proper planning, turnover in the civil servants, and the ongoing pandemic had resulted in the lack of a transparent annual implementation plan, the insufficient time and resources for next year’s planning and implementation of the planned work, and the lack of budget resources. @*Conclusion@#As the total of 28 indicators of the National Programme was 76.8 percent, it has been evaluated as having achieved specific results.

Determination of concentrations of indoor air pollutants emitted from briquette combustion / Монголын Анагаах Ухаан

Introduction@#This field assessment was performed to ensure the effective implementation of Order No. A/142 of the Deputy Prime Minister of Mongolia dated 30^th December 2021 and Order No. A/01 of the Head of the National Committee for Reducing Environmental Pollution dated 3^rd January 2022 and to monitor the level of indoor air pollutants emitted from traditional stoves and standard stoves. @*Purpose@#To determine the level of indoor air pollutants emitted from briquette combustion and to develop recommendations by comparing various types of stoves and dwellings. @*Materials and Methods@#Through analytical cross-sectional designs, three households from Songinokhairkhan district and one household from Chingeltei district were selected to participate in this assessment as they use briquettes for heating, vary in their dwelling types (ger (traditional Mongolian tent), house) and their stove types (traditional, standard), stay home during the day and chose to participate in the assessment. 24-hour continuous measurements were conducted for each dwelling and before taking measurements, we calibrated and adjusted the air suction velocity of the measuring instrument at the Central Metrology Laboratory. The monitor was placed at a distance of 0.5m from the stove and a height of 0.5-1.0m from the floor. The results were then compared with the Mongolian National Standard “General air quality and technical requirements MNS4585:2016” and WHO Guidelines for Indoor Air Quality 2021. Statistical analysis was performed using SPSS 24.0 software, mean, ANOVA test, and if the p-value is less than 0.05, our results are statistically significant.@*Results@#The concentration level of SO₂ in houses with “Dul” stoves was within the level specified in the Mongolian standard MNS4585: 2016 and WHO Guidelines for Indoor Air Quality 2021, while 24-hour SO₂ concentration in gers and houses with traditional stoves was 1.3-2.92 times higher than the standards. The 24-hour average concentration of nitrogen dioxide in houses with traditional stoves was 1.73 times higher than the Mongolian air quality standard MNS4585: 2016. There were statistically significant differences in the emission levels of SO₂ and NO₂ depending on dwelling and stove types (df=4, f=4.04, p=0.008 and df=4, f=17.17, p=0.001, respectively.). The 8-hour average (10,000 μg/m3) CO concentration was statistically significant for various types of dwellings and stoves (df=4, f=45.17, p=0.001), whereas there was a statistically significant difference in CO concentrations in gers with traditional stoves and gers with standard stoves in terms of morning, afternoon, and evening hours (df=3, f=33.17, p=0.001). @*Conclusion@#Indoor air pollutants in the households except for houses with “Dul” stoves have been determined to exceed the air quality standards set by the Mongolian air quality standards and WHO Guidelines for Indoor Air Quality 2021.

The comparison of ambient air quality with raw coal and improved fuel consumption, Ulaanbaatar, 2018-2020 / Монголын Анагаах Ухаан

Introduction@#Air pollution is one of the greatest environmental risk to health. Ambient air pollution accounts for an estimated 4.2 million deaths per year due to stroke, heart disease, lung cancer and chronic respiratory diseases. Approximately 46% of the population resides in Ulaanbaatar, and over half of the population living in ger (traditional yurt dwelling) areas consumes raw coal, which leads to an increase in ambient air pollutants. The Government of Mongolia took a series of actions to reduce air pollution; one was the ban on the consumption of raw coal beginning on 15 May 2019. The aim of this study is to describe the Ulaanbaatar air quality related to briquettes usage during cold seasons. @*Material and Methods@#We used ecological research design in this study. Quantitative data about air quality of Ulaanbaatar city during the cold seasons (Oct, Nov, Dec, Jan, Feb, Mar, Apr) in 2018-2020 years were analyzed from Department of air quality. These 5 indicators such as sulfur dioxide, nitrogen dioxide, particles (PM_2.5, PM₁₀) and carbon monoxide were selected for statistical analysis. The SPSS-20 software was used to analyze the data. @*Ethics@#The methodology was approved by the Medical Ethics Sub-Committee of the Ach medical university on 5^th of February, 2021.@*Results@#The average sulfur dioxide, nitrogen dioxide concentrations in the air have increased in October 2019–April 2020 compared to the previous five years. But carbon oxide, particular matter concentrations have decreased in the selected years. Sulfur dioxide (p <0.0001), nitrogen dioxide (p =0.001), PM₁₀(p <0.0001), and PM_2.5 (p <0.0001) are differentiated before and after the use of improved fuels by Wilcoxon signed rank test. However, the CO content did not differ from that of the briquette’s consumption (p =0.412).@*Conclusions@#During the cold seasons, the concentration of sulfur dioxide and nitrogen dioxide has increased in air of Ulaanbaatar after used briquettes, while the concentration of particulate matter has decreased during the cold seasons.

The contribution of field epidemiologists to the public health sector in Mongolia / Монголын Анагаах Ухаан

Introduction@#Field epidemiology training (FET) was first established in 1951, named as Epidemics Intelligence Service, next to the Centres for Disease Control and Prevention of USA. At present, FET is conducted in over 50 countries in the world and the training is based on the main principle of promoting utilization of theories of epidemiology in public health practice and evidence-based decision making. Main goal of FET is to strengthen capacity and infrastructure of the public health system and to improve people’s health as a result of forming a core team of professionals, which will deliver public health services in a particular country, survey any country-specific public health issues, and provide evidence.</br> MFETPs have been implemented in Mongolia since 2009 with support from Ministry of Health (MOH) and World Health Organization (WHO). To ensure structural and organizational sustainability of the training, the programme has been integrated into the National Centre for Communicable Disease (NCCD) under the auspices of MOH and the trainings have been conducted nationwide. MFETPs last for one year, which includes 1-2 months of classroom training and 3-11 months of field internship by trainees. The training graduates should be skilled to use the science of epidemiology in studying public health issues and to deliver evidence-based conclusions and recommendations.@*Goal@#To evaluate of MFETP graduates’ knowledge, skills and their contribution to the public health system@*Method@#We conducted a cross-sectional online survey link between October 2019 and March 2020 through Mongolian field epidemiology alumni networks. Survey questions included demographic details of participants, along with their technical background, level of formal education, topics studied during epidemiology training, and years of experience as an epidemiologist. We specifically targeted FETP alumni, however the survey was open to all people who had studied MFETP.@*Results@#In total, 55 field epidemiologists (77% of all graduates) responded to the survey. Participants had a range of formal public health and epidemiology training backgrounds. Of the total graduates, 19 (30%) are currently working at NCCD, of whom 3 are head of department. A total of 7 (11%) graduates work in rural health centers and health centers, while 6 (10%) graduates work in the tertiary level. In addition, there are 2 graduates working in the Ministry of Health. 80.6% (25/31) were involved in outbreak-response activities and 93.9% (31/33) conducted operational research, 91.4% (32/35) said that the surveillance analysis was conducted and 81.5% (22/27) performed fundamental researches at least one times. One graduate had an average 3.7 study and analysis during the course of the study, and increased to 7.7±12.4 after graduation. Particularly, the operational study (4.1 ± 8.7) and the outbreak study (3.1 ± 4.5) have increased.@*Conclusion@#Our study has demonstrated that applied epidemiology workforce training must evolve to remain relevant to current and future public health challenges.

Relationship between meteorological parameters and some intestinal infectious diseases / Монголын Анагаах Ухаан

Introduction@#Mongolia is one of the most vulnerable countries to climate change due to its geographical location, climate conditions, level of development and lifestyle of the population.</br> The “Impact of Climate Change on Drinking Water, Health and Adaptability” study report has shown that climate change is affecting the quality and composition of drinking water, drying up many rivers and lakes and reducing groundwater levels.</br> There was a strong positive correlation between precipitation and air temperature and dysentery, diarrhea and salmonellosis, while there was a strong negative correlation between precipitation, air temperature and viral hepatitis. @*Goal@#The goal of the study was to reveal correlation between meteorology parameters and some intestinal infectious diseases and human health in Mongolia.@*Material and Methods@#We evaluated climate and certain morbidity (intestinal infections) indicators for the last 15 years (2005-2019) using descriptive survey methods. The methodology of the survey has developed and discussed at the Scientific Council meeting of NCPH, 12th of Oct, 2020. The methodology of the survey has developed and discussed at Medical Ethics Reviews Committee of MOH on 23rd. of June, 2021.@*Results@#On the other hand, the average air temperature has intensively risen for the last three decades since 1990 with the warmest average temperature between 2001-2010, whereas the coldest average temperature has been observed between 1951-1960. In 2005-2009, the prevalence of intestinal infections per 10.000 population was 0.8 cases of salmonellosis, 11.2 cases of dysentery, 0.2 cases of diarrhea, and 39.0 instances of hepatitis A. Throughout 2015 and 2019, the prevalence of salmonellosis fell by 0.1 per 10.000 population, dysentery by 2.9, diarrhea by 0.1, and hepatitis A by 0.1.@*Conclusion@#A seasonal trend in intestinal infections was observed (p<0.001). Strong positive correlation was found between high temperature and some intestinal infections (hepatitis А, dysentery, salmonellosis) respectively.

The result of disinfection of pit latrine with “Gipon” ionized disinfectant solution / Монголын Анагаах Ухаан

Introduction@#Sanitation facility supply and service availability of Mongolia is essential due to the slow process of bacterial decomposition which is getting significant difficulties because of the cold and arid climate. Only 37 percent of Ulaanbaatar’s population is connected to the central sewerage system, and the majority of ger area residents, or 95 percent, use pit latrines in demand of sanitation facility. Numerous studies have shown that the main contaminant of the soil in ger area were pit latrines. It not only pollutes the environment but also affects human health. There is a lack of awareness about the transmission of infectious diseases and options of new sanitation facilities and poor knowledge and bad conditions to introduce new drainage systems. Most pit latrines in ger areas are of poor quality and do not meet relevant standards.@*Goal@#To determine the effect of ”Gipon” ionized disinfectant solution produced by Japanese technology for disinfecting pit latrines@*@#@*Material and Methods@#This study was conducted in December 2019 using a random sampling method. Five households in ger areas were selected and pit latrines were disinfected by ”Gipon” ionized disinfectant solution.@*Results@#The survey covered pit latrines of 5 households in the 21st khoroo of Bayanzurkh district. All owners allowed to participate in the survey. The pit latrines are located approximately 9.8 meters away from the households participated in survey. They have been utilized it for 7.6 years and used by an average of 6 people per day. For inner cover, 60.0 percent are lined with wood, and 40.0 percent are cleaned once a month. Before the use of the disinfectant solution, having taken the swab from door handles, floors and walls of the toilet and were detected Enterobacter spp, E.Coli, and Pseudomonas spp in all samples. </br> However, after one and 24 hours of spreading of the disinfectant solution, the amount of intestinal coliform bacteria and E. coli was reduced dramatically and in some places no bacterial were detected. 72% of the soil near the latrines in the study covered ger areas was contaminated with bacteria. In terms of E.Coli contamination in soil, 60% of them were contaminated in low degree and 32% were medium and 8% were high degree. Anaerobic microorganisms such as Cl.prefrings were accounted for 82% of the total sample, 19% moderate and 81% low contamination.@*Conclusion@#Intestinal coliform bacteria (Enterobacter spp, E.Coli, Pseudomonas spp) and pathogenic bacteria (Serratia spp, Staphylacoccus spp) were not detected and the number of fungi was sharply reduced after 1 and 24 hours using Hypon disinfectant. No intestinal pathogens (Salmonella spp, Citrobacter freundii) were found in the soil near the latrine. The amount of coli titers was reached to the acceptable limits. According to this study, the disinfection activity of “Gipon” solution was ranging from 105 to 104.

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.

Satisfaction of health care and services for parents and guardians with 0–5 years-old children / Монголын Анагаах Ухаан

Introduction@#Within the framework of health sector reform, the development of the organization, the responsibility of doctors and medical professionals, and the improvement of ethics, quality and safety of care and services are top priorities. Customer satisfaction is important for the implementation of this operation based on results and quality. The WHO Recommendation states that health professionals have a key role to play in providing information and advice to citizens and their families on how to prevent, mitigate and address air pollution, and how to inform the general public and decision-makers. ADB, the Ministry of Health, and UNICEF report that information and promotional materials on air pollution prevention are scarce and do not provide advice to clients. Therefore, it is the reason for conducting a survey to determine the level of satisfaction of clients receiving child health care.@*Materials and methods@#The survey data were collected using quantitative and qualitative research methods. In this study, totally 1160 guardians of children aged 0-5 participated from Songinokhairkhan and Bayanzurkh district and Bayankhongor aimag center. The overall satisfaction of health services is calculated using the three dimensions namely: satisfaction with health service, operation and environment of Health Organization. Satisfaction scores were assessed using an even-point scale. These are “Very Dissatisfied-1 point”, “Dissatisfied-2 point”, “Satisfied-3 point”, “Very satisfied-4 point”. The results were calculated after entering the survey data into SPSS-23, creating a database, and performing error control. Research methodology discussed at the meeting of the Academic Council of the National Center for Public Health on December 25, 2019, and the methodology was approved by the Medical Ethics Committee of the MOH (Stagnant №2).@*Results@#84.7 percent of the respondents were parents of children aged 0-5 years. Their average age is 34, most of them have higher education, and 43.0 percent of them have a household income of 500,000-1 million MNT. Guardians of children aged 0-5 years in Bayanzurkh District were “dissatisfied” with the Family Health Center’s dressing room, wardrobe, toilet and parking lot. Guardians of children aged 0-5 years in Songinokhairkhan district were “dissatisfied” in the parking lot and toilet of the health organization. Guardians of children aged 0-5 years in Bayankhongor aimag were satisfied with the services, operation and environment of the health organization. Studies have shown that 76.5 percent of the guardians did not receive air pollution risk training. As for difficulties in preventing air pollution, 31.4 percent of the surveyed population answered that they cannot change their living and working environment to prevent air pollution.@*Conclusion@#It shows the health care organizations need to improve the hospital environment as well as to provide training how to protect children from air pollution risk for guardians.

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.

Usage of blood and blood product / Монголын Анагаах Ухаан

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.

Attitude towards to blood donation among population, Mongolia, 2019 / Монголын Анагаах Ухаан

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.

Correlation between 0-5 year old children’s diarrheal infections and soil bacterial contamination in Ulaanbaatar city / Монголын Анагаах Ухаан

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.