A study of the prevalence and risk factors of ischemic heart disease / Эрүүл мэндийн лаборатори

Аbstract@#Ischemic heart disease (IHD) remains one of the most important disorders associated with disability and mortality worldwide, and is one of the major causes of cardiovascular diseases in Mongolia. The objective of the current study was to determine the prevalence of IHD and its related factors in a general population in Mongolia.</br> We conducted a nationwide cross-sectional survey between March and September, 2009. General participants were recruited from urban to rural regions in a multistage random cluster sampling method. The diagnosis of IHD was based on the Rose questionnaire and electrocardiographic findings. A total of 369 (16.2%) subjects with IHD were diagnosed among 2280 participants. The prevalence of subjects with IHD was significantly increased by age: from 9.9% in individuals age 40-44 years compared to 17.7% in those over 60 years. Smoking habits (former and current) and non-frequent intake of fruits and vegetables were significantly positively associated with IHD in men, while heavy alcohol drinking habits and lower education period of time were significantly positively associated with IHD in women. </br> IHD was found to be prevalent, especially among people aged over 40 years, in Mongolia. Statistical factors related to IHD were found to be significantly different based on sex. The current data may provide relevant information to prevent IHD in the Mongolian population.

Epidemiologic features of metabolic syndrome in a general Mongolian population / Эрүүл мэндийн лаборатори

Background@#Although cardiovascular health is a crucial problem for Mongolian people, little information about metabolic syndrome (MetS), associated with the development of cardiovascular disease, is available in Mongolia. @*Aim@#The aim of this study was to observe the epidemiological features of MetS in a general Mongolian population.@*Material and Methods@#This cross-sectional study was performed in 1911 general Mongolian subjects (men=717, women=1194), who were aged ≥ 40 years and free of ischemic heart disease. The prevalence of MetS, as defined by International Diabetes Federation criteria, was determined.@*Result@#The prevalence of MetS was significantly higher in women (n=488, 40.9%) than in men (n=138, 19.2%). The prevalence of MetS was high, especially in the Khangai region. A moderateto-high alcohol consumption was a significantly positively associated factor of MetS in men (odds ratio [OR] =2.01; 95% confidential interval [CI]: 1.15-3.51; adjusted odds ratio [AOR] =2.41; 95% CI: 1.31-4.44) and widowed status was a significantly positively associated factor of MetS in women (OR=1.61, 95% CI: 1.18-2.18; AOR=1.49, 95% CI: 1.07-2.08). @*Conclusion @#MetS was prevalent in women compared with men among Mongolian adults. Preventive strategies aimed at men with higher alcohol consumption and women of widowed status may help reduce MetS, thereby improving cardiovascular health conditions in Mongolia.

Epidemiologic features of metabolic syndrome in a general Mongolian population / Монголын Анагаах Ухаан

Background Although cardiovascular health is a crucial problem for Mongolian people, little information about metabolic syndrome (MetS), associated with the development of cardiovascular disease, is available in Mongolia. Aim The aim of this study was to observe the epidemiological features of MetS in a general Mongolian population. Material and Methods This cross-sectional study was performed in 1911 general Mongolian subjects (men=717, women=1194), who were aged ≥ 40 years and free of ischemic heart disease. The prevalence of MetS, as defined by International Diabetes Federation criteria, was determined. Results The prevalence of MetS was significantly higher in women (n=488, 40.9%) than in men (n=138, 19.2%). The prevalence of MetS was high, especially in the Khangai region. A moderate-to-high alcohol consumption was a significantly positively associated factor of MetS in men (odds ratio [OR] =2.01; 95% confidential interval [CI]: 1.15-3.51; adjusted odds ratio [AOR] =2.41; 95% CI: 1.31-4.44) and widowed status was a significantly positively associated factor of MetS in women (OR=1.61, 95% CI: 1.18-2.18; AOR=1.49, 95% CI: 1.07-2.08). Conclusion MetS was prevalent in women compared with men among Mongolian adults. Preventive strategies aimed at men with higher alcohol consumption and women of widowed status may help reduce MetS, thereby improving cardiovascular health conditions in Mongolia.

EVALUATION OF THE SECONDARY SCHOOL EXTERNAL ENVIRONMENT SOLID WASTE MANAGEMENT IN ULAANBAATAR MONGOLIA / Шинэ санаа Шинэ нээлт

A school environment may cause positive effect upon health and healthy behavior, but also representmain factor for transfer of non-infectious diseases. Therefore, the issue of maintaining an appropriate environment in operations of training and educational institution would be considered as vital in every country of the world. In our country the solid waste hygienic conditions around children organizations represent one of actual problems. Through the research work was aimed to evaluate the state of solid waste at external environment of general educational institutions by the momentum model of analytical research and involving 103 state proprietary Educational Institutions of 9 districts. At developing estimation list of solid waste at external environment of schools were used current effective standards, resolutions and regulations. 88.3 percent of schools involved into research work had special solid waste-points and 11.7 percent had no special solid waste-points. 38.8 percent of solid waste-points were fenced from all sidesand 44.7 percent fenced from some sides and 16.5 percent had no fence in whole. The research of material from which was made a solid waste-keeping facility showed that 44.2 percent were made from metal, 2.3 percent from wood and 52.3 percent from brick. When we studied whether the solid waste-keeping facility is placed in distance of 25 meters from school according to standard,was determined that 71.8 percent were built according to the standard, 28.2 percent were allocated within 25 meters showing inconformity with the standard. During the research it has been detected that among schools 27.2 percent had too much solid waste-heap, 25.5 percent had placed no special recycle-bins on the school site and 13.6 percent conducted wrong activity by incinerating solid waste on the territory of school.2/3 or total 63 schools among Metropolitan state proprietary educational institutions has non- standard solid waste-keeping facility, 1/3 or 29 schools has located their solid waste-points in non- standard distance, there exists much solid waste-heap because of insufficient recycle-bins, absence of solid waste-points results in collection of solid waste in a special room inside of school and later its transportation with scavenger. Also, 13.6 percent or 14 schools are incinerating their solid waste within school site. This breeches effective hygienic norms and normative.

DEPRESSIVE STATE IN NEWLY DIAGNOSED PATIENTS WITH TYPE 2 DIABETES / Шинэ санаа Шинэ нээлт

Diabetes is known to be directly and indirectly associated with stress. Many researchers havereported that diabetes is actually induced by stress and several hormones includ¬ing cortisolare known to be involved.14 Though tight glycemic control is viewed as a primary indicator offavorable diabetes outcomes metabolic control , medication, and physical activity, contribute toa patient’s success in achieving desirable glycemic control. Our study aimed to evaluate improvesdepressive state in newly diagnosed patients with type 2 diabetes(T2DM) by education. The cohort survey was conducted in Ulaanbaatar. For the study we 150 patients newly diagnosed T2DM, who have met the inclusion criteria and agreed with informed consent. We have evaluated self-management control, beliefs about illness, depression. We measured anthropometric measurements, blood pressure (BP), levels of HbA1C, lipids and fasting blood glucose (FBG) at the baseline, in 3 and up to 6 months in educated and noneducated groups. Statistical analyses was performed using SPSS 16 software.The study involved newly diagnosed Type 2 diabetes 49,4±8,9 years men 65 (43,6%), women 85(56,7%) and 39,3% of the participants had a family history of diabetes. After 6 months self- control of blood glucose (p=0.046) significantly improved in educated newly diagnosed patients with T2DM. Problem areas in diabetes (PAID) score reduced in educated group -2.86 (95% CI-1.61 -3.23); (p=0.004) and illness perception questionnaire (IPQ) score increased 8.95 (95% CI 5.31-10.1); (p=0.001). Outcome shows positive improvements statistically increased diabetes self-management control IPQ score and decreased score PAID in the educated newly diagnosed patients T2DM.

DEPRESSIVE STATE IN NEWLY DIAGNOSED PATIENTS WITH TYPE 2 DIABETES / Шинэ санаа Шинэ нээлт

Diabetes is known to be directly and indirectly associated with stress. Many researchers have reported that diabetes is actually induced by stress and several hormones includ¬ing cortisol are known to be involved.14 Though tight glycemic control is viewed as a primary indicator of favorable diabetes outcomes metabolic control , medication, and physical activity, contribute to a patient’s success in achieving desirable glycemic control. Our study aimed to evaluate improves depressive state in newly diagnosed patients with type 2 diabetes(T2DM) by education. The cohort survey was conducted in Ulaanbaatar. For the study we 150 patients newly diagnosed T2DM, who have met the inclusion criteria and agreed with informed consent. We have evaluated self-management control, beliefs about illness, depression. We measured anthropometric measurements, blood pressure (BP), levels of HbA1C, lipids and fasting blood glucose (FBG) at the baseline, in 3 and up to 6 months in educated and noneducated groups. Statistical analyses was performed using SPSS 16 software.The study involved newly diagnosed Type 2 diabetes 49,4±8,9 years men 65 (43,6%), women 85(56,7%) and 39,3% of the participants had a family history of diabetes. After 6 months self- control of blood glucose (p=0.046) significantly improved in educated newly diagnosed patients with T2DM. Problem areas in diabetes (PAID) score reduced in educated group -2.86 (95% CI -1.61 -3.23); (p=0.004) and illness perception questionnaire (IPQ) score increased 8.95 (95% CI 5.31-10.1); (p=0.001). Outcome shows positive improvements statistically increased diabetes self-management control IPQ score and decreased score PAID in the educated newly diagnosed patients T2DM.

Prevalence of underweight among children under five years in Mongolia / Монголын Анагаах Ухаан

IntroductionOne key target of the United Nations Millennium Development goals is to reduce the prevalence of underweight among children younger than 5 years by half between 1990 and 2015. Child malnutrition is internationally recognized as an important public health indicator for monitoring nutritional status and health in populations. World Health Organization estimated the malnutrition was associated with 54% of child deaths in developing countries. The devastating effects of malnutrition on human performance, health, and survival are well-established and a recent global analysis demonstrated that child malnutrition is the leading cause of the global burden of disease. The importance of assessing population nutritional status every 5 years is widely recognized, and three rounds of National Nutrition Survey were carried out in Mongolia since 1992 with support from UNICEF. The most recent Third National Nutrition Survey was carried out with the purpose of assessing nutritional status of Mongolian children and women six years ago in 2004.ObjectiveTo describe the national prevalence of underweight in children under five.Materials and MethodsThe current cross-sectional survey was conducted in 21 provinces of 4 economic regions of the country and capital Ulaanbaatar city. Household was randomly selected based on local administrative and soum/family hospital registry and enrolled a total of 706 children aged 0-59 months were selected from sampled households. Interviews, anthropometric measurements and clinical examinations were used in the survey. Child growth was assessed based on z-scores calculated using the WHO Child Growth Standard. Low weight-for-age (underweight) can result from either long-term or short-term nutritional deficit.Results4.7% of the surveyed children were underweight. According to the WHO criteria the prevalence of underweight in Mongolian children less than 5 years of age was include “low prevalence rate”. The prevalence of the underweight among children less than 5 years was significantly higher in Rural area than the Urban.Conclusions:1. The national prevalence of underweight remains at “low” level according to WHO classification. 2. Child malnutrition reduction is needed to successfully meet the Millennium Development Goals.3. In rural area the prevalence of underweight among in 0-59 months old children was highest than urban area’s children.4. The prevalence of nutrition deficiencies varies between different regions calling for implementation of interventions specific for local conditions and needs.

Knowledge of rural herdsmen on non-communicable diseases and their needs in and availability of information / Монголын Анагаах Ухаан

IntroductionAs prevalence of morbidity and mortality due to the non-communicable diseases is high, educationand communication are crucial in terms of reduction of the risk factors of these diseases amongstthe population. However, the sources and needs for information regarding NCDs among the generalpopulation, especially among the rural herdsmen, are still unknown.Materials and MethodsThe study used a population based cross sectional design selecting 500 herders in total by themultistage random cluster sampling method from 4 provinces and 12 soums of 4 the geographicalregions of Mongolia. Data collection methods included both quantitative and qualitative methodsfollowed by an analysis of the data using the by SPSS 17.0 software.ResultsA total of 228 herding families participated in the study and 78.5% of them were use television, 37.3%--radio and 10.1% -- newsletters. As for sources of health information, 53.4% of participants receiveinformation on NCDs from the television, 32.2% - from health care facilities, and 18.6% -- from radio.More than 65% of the participants state that the information on NCDs is “insufficient”, whereas 92%have never participated in trainings on NCDs, and 84.4% were have had no access to NCD-relatedbrochures and handouts. These results indicate that the NCD related information available to theherders and rural population is insufficient. In terms of demand for information on non-communicablediseases, 82.2% of the respondents answered that information is necessary, 60.4% of the herdersprefer to have information through television, 42.2%-- through soum doctors and bag feldschers,35.8%-- from health care facilities, and 31.4% -- from the radio.ConclusionInformation on NCDs available to rural herders and households is insufficient, thus more appropriatemethods for delivery NCD information should be used meeting their demands and their preferenceof the sources of health information.

Study of effectiveness of the diabetes education for patients with type 2 diabetes mellitus / Монголын Анагаах Ухаан

Background Educating diabetic patients about their diseases encourages their families to learn as much as possible about the latest medical management and approaches, as well as informing healthy lifestyle choices, and supports their responsibility in improving their condition and quality of life through well-managed self-control. Goal To evaluate the outcomes of diabetes education in patients with T2DM. Materials and Methods The cohort survey was conducted at the Diabetes center of the State Central Clinical Hospital (SCCH) and District Health centers in Ulaanbaatar. Participants included 150 newly diagnosed patients with T2DM. Data collection was done by using internationally accepted questionnaire and anthropometric measurements and biomedical outcome measures such as Haemoglobin A1c levels, high density lipid (HDL), low density lipid (LDL), total cholesterol (TCh), triglyceride (TG), fasting blood glucose (FBG), blood pressure (BP), body weight (BW) at baseline and 3rd and 6th months of the follow ups. Statistical analyses were performed with the SPSS16 software. Results Diabetic patient’s knowledge (p=0.029) and self control of blood glucose (5.35±1.81 days in the last week) of newly diagnosed patients with T2DM improved statistically significantly (p=0.046) after 6 months diabetes education. Psychological problem areas in diabetes (PAID) score reduced in educated group 2.86% (95%CI 1.61 to 3.23) p=0.004 and points in illness perception questionnaire (IPQ) increased 8.95% (95%CI 5.31 to 10.1) p=0.001. After 6 months, the group of the newly diagnosed patients receiving diabetes education had decreased numbers in biomedical measurements: Systolic BP decreased 8mmHg (p=0.001), diastolic BP 2 mmHg (p=0.035), some anthropometric measurements including waist circumference (WC) decreased 2cm (p=0.014). Levels of HbA1C were 1.5% lower (p=0.001) in the diabetes educated group, LDL decreased 0.7 mmol/l (p=0.0001), and HDL increased 0.2% (p=0.036). Conclusion: 1. The data on the educated patients’ knowledge about diabetes, self control, psychosocial status, and illness perception are comparatively higher than those in the non-educated group. 2. The decrease in not only the levels of systolic and diastolic BP and WC of newly diagnosed patients with T2DM, but also levels of HbA1C and LDL together with the increase in levels of HDL indicates that the self control improves among educated patients.

Isolated systolic hypertension and physical activity / Монголын Анагаах Ухаан

IntroductionIsolated systolic hypertension (ISH) has been found to increase the risk of stroke and coronary heart disease significantly among both middle-aged and elderly men and women. ISH is a higher risk factor for cardiovascular diseases (CVDs) than isolated diastolic hypertension. Because of this it is important to determine the prevalence of ISH and its associated risk factors in order to reduce CVD mortality and morbidity in Mongolia.ObjectivesThe aim of the study was to compare the physical activity of people with ISH to it of people with normal blood pressure (BP).Мaterials and MethodsWe examined the physical activity using the data of “Mongolian STEPS Survey on the Prevalence of Noncommunicable Disease and Injury Risk Factors-2009”. ISH was defined as systolic BP≥140 mmHg and diastolic BP<90 mmHg. The Control (normotensive) group comprised subjects whose systolic BP<140 mmHg and diastolic BP<90 mmHg. Using to approach of WHO “STEPS” Survey, physical activity was assessed on intensity, duration and frequency of physical activity at work, in recreational settings and during transportation using complex set of 16 questions.ResultsAccording to the survey results, 74% of people who had normal BP and 48.7% of people with ISH engaged in moderate levels of physical activity in recreational settings daily a week. It was statistically difference in two groups. Males with ISH were more likely to engage in high levels of physical activity at work and in recreational settings compared to females. In terms of age differences, moderate and high levels of physical activity at work decreased steadily with age. Mean duration and frequency of physical activity a week weren”t difference in two groups.ConclusionFrequency of physical activity decreased with age in respondents with Isolated systolic hypertension. Males engaged more in high levels of physical activity at work and in recreational settings more than females. Moderate levels of physical activity in recreational settings was lower in respondents with ISH compared to respondents who had normal blood pressure (p<0.05).

Knowledge, attitude, practice of mothers and caregivers regarding infant and young child feeding in Mongolia / Монголын Анагаах Ухаан

Introduction. More than 3.5 million mothers and children under five die unnecessarily each year due to the underlying cause of under nutrition, and millions more are permanently disabled by the physical and mental effects of a poor dietary intake in the earliest months of life. Malnutrition has a negative impact on the physical and intellectual development which can further affect health, living potentials and the quality of life. It has been established that to reduce child mortality and to prevent illnesses related to malnutrition the most effective actions are to breastfeed, feed with proper complementary foods, enrich child’s diet with vitamin A, zinc and other necessary vitamins and mineral supplements, and to treat chronic malnutrition. This can be achieved by implementing internationally reputed projects and programs. Goal. To assess the knowledge, attitude and practice of mothers in the project areas towards, infant and young child feeding.Materials and Methods. This survey conducted in each of 5 soums of Gobi-Altai, Sukhbaatar, Dundgobi, Tuv, and Arkhangai aimags and each of 5 khoroos of Chingeltei and Songinokhairkhan districts of Ulaanbaatar city. Survey recruited a total of 1077 mothers and caregivers of children aged 0-35 months.Results. 7 in 10 mothers participating in the study have “insufficient” level of knowledge of feeding young children and this is related to the mother’s education level. 2. 21.8% of mothers and caregivers were aware of the recommendations of breastfeeding the child within an hour after birth and 38.6% were not aware of exclusive breastfeeding until 6 months of age. 1 in 4 mothers participating in the survey (25.2%) had the wrong understanding of feeding a child 1-2 times a day while complementary feeding: 43.6% of mothers in Sukhbaatar aimag, and 33.8% in Gobi-Altai aimag had this insufficient knowledge of frequency of breast feeding while giving complementary food to the baby. Half (50.3%) of mothers and caregivers did not know the correct amount of food to be given at one time to feed a child and this knowledge was insufficient across all aimags and districts. Knowledge of illnesses caused by nutrition and their preventions was insufficient among mothers in all aimags and districts.Conclusions:1. 65, 7% of mothers exclusively breastfed their children until the age of 6 months. The percentage of exclusively breastfeeding in districts is similar to the national average; however, in rural aimags it is twice higher.2. Only 41, 5% of children up to 3 years of age were fed with complementary food at right time, while 42, 8% - too early and 15%- too late.3. Only 8, 7% of mothers and caretakers have correct practice of feeding children of 12-23 months old more than 5 times per day, which is not sufficient indicator.

Coverage of hepatitis b vaccination of children in age of 4-6 year old in Mongolia / Монголын Анагаах Ухаан

Hepatitis B virus (HBV) infection is highly prevalent in Mongolia and its sequelae including liver cirrhosis and liver cancer are crucial public health problems in Mongolia. HBV infection is preventable through the vaccination. Universal hepatitis B vaccination has been introduced in 1991 after the 3 years field trial, making our country the 20th country with obligatory immunization against hepaitis B of all eligible population. In addition a penta vaccine (DTP+HipB+HBV) was introduced since 2005 in urban and rural areas. Although statistical information is available regarding the coverage of these hepatitis B vaccines, no study has been conducted on the coverage of hepatitis B vaccination based on the immunization cards of children that is important to reveal the current situation in the country. Objective: To study the coverage of Hepatitis B vaccination among children born after more than 10 years since its implementation in Mongolia. Materials and Methods: Nationwide cross-sectional survey was conducted during 2009-2010. A total of 5894 children was enrolled in this survey selected from Ulaanbaatar, Darkhan, Erdenet as well as 11 provinces and 50 soums. Iimmunization data of each child was abstracted from the health records or immunization cards at the actual Health Center, Local or Family hospital. The hepatitis B vaccination coverage was assessed by measuring HepB-birth dose, second and third dose. The vaccination status of the child was determined by counting the immunizations that were recorded by health/immunization registry or card. Data analyses was performed using SPSS 17.0 software. Results: A total of 5894 children were participated in the survey out of 6380 selected children (response rate 92.38%). Vaccination cards or registrations were available for 4944 (83.9%) children that was higher in rural areas compared to cities (Ulaanbaatar, Darkhan, Erdenet 75.5%, province centers 87.3%, soums 90.5%, p<0.001). In addition, the proportion of children with vaccination card was significantly decreased by age from age of 4 years to 6 years (p<0.0001). Vaccination coverage rate of those who received at least one dose of hepatitis B or penta vaccine was 98.6% [(95% confidence interval: 98.36-98.98) and 81.9% of them were fully vaccinated whereas 16.7% were partially vaccinated. Vaccination rate was 97.8% in Ulaanbaatar, Darkhan and Erdenet cities, 99.2% in province centers and 99.1% in rural soums. According to the results of 11 provinces and, coverage rate in provinces was 98.3%-100% where Umnugovi and Khentii provinces had highest rate (100%) and Selenge and Zavkhan provinces had lower rates (98.7%). Around 95% of the children were received the first dose of hepatitis B vaccine, of whom 3413 (76.5%) received within 24 hours while 1274 (27.8%) had received later than the schedule. Among study population 13.1% were vaccinated with penta vaccine that was introduced in 1995 in Mongolia. Conclusion: 1. Vaccination cards were available for 4944 (83.9%) children that was significantly higher in rural areas compared to cities. 2. Vaccination coverage rate of those who received at least one dose of hepatitis B or penta vaccine was 98.6% [(95% confidence interval: 98.36-98.98) and 81.9% of them were fully vaccinated whereas 16.7% were partially vaccinated. 3. Around 95% of the children were received the first dose of hepatitis B vaccine, of whom 3413 (72.8%) received within 24 hours while 1274 (27.8%) had received later than the schedule.

Analysis of hepatitis B surface antigen mutations in Mongolia: molecular epidemiology and implications for mass vaccination.

Although the potential significance of hepatitis B surface antigen (HBsAg) mutants for failure of immunization has been studied in some endemic countries, whether the "a" determinant variants are responsible for vaccine failure in Mongolia remains unknown. Fifty-nine HBsAg-positive children (age: 8.8 +/- 0.9 years) who had been observed during the nationwide survey of vaccinated cohorts conducted in 2004 were subjected to molecular analyses of hepatitis B virus (HBV). Partial S gene sequences encoding amino acids (aa) 40-171 of HBsAg were determined in 57 children (96.6%) who had detectable HBV DNA. Phylogenetic analysis of the S gene sequences revealed that genotype D accounted for 93.0% and genotype A for 5.3%. Only one child (1.7%) had HBVs of genotypes A and D. HBsAg mutations were found in 17 (29.8%) children ranging from 1 to 4 aa per subject (mean +/- SD, 1.6 +/- 0.9 aa). Pro127Thr and Thr118Ala were the most common substitutions, which occurred in 6 (10.5%) and 3 (5.3%) subjects, respectively; none had Gly145Arg. There were no significant associations in the prevalence of HBsAg mutations with age, sex, residential area, or vaccination status against hepatitis B. Analysis of the deduced amino acid sequence of the entire preS1/preS2/S gene revealed that eight genotype D isolates and one genotype A isolate were quite similar to previously-reported wild-type isolates, suggesting that they are essentially wild-type, but not vaccine-induced mutants. In conclusion, the results demonstrate that hepatitis B surface gene mutants do not play a significant role in vaccination failure in Mongolia.