Background: Population of a significant number of countries in the world use drinking water high in arsenic content. Asia is a leading region in the world by the endemic arsenic prevalence and countries such as India, Bangladesh, China and Taiwan have high prevalence of arsenic. The fact that in neighboring China, namely, in Inner Mongolia, the number of cases of neuropathy and skin cancer has been increasing, amplifies the necessity for such studies. It is essential to conduct further research in order to identify arsenic content in drinking water throughout the country.Goal: The survey aims at studying arsenic content in drinking water and mapping arsenic prevalence by aimags and soumsMaterials and Methods: The survey was conducted nationwide –21 aimags and urban areas, in total, arsenic content in drinking water was studied in 291 soums in 867 wells. Arsenic content was identified with a test kit developed by Mahidol University, Thailand. Results: Out of 867 well water samples from 21 aimags and Ulaanbaatar studied for the survey, 91 or 10.5% contained arsenic. Arsenic was found in well water of all aimags except Bulgan, Zavkhan, Orkhon, Selenge and Huvsgul aimags. Nationwide, average arsenic content in drinking water is 0.014+ 0.003mg/l. Highest arsenic content was found in Dornogobi (53.9%), Dundgobi (31%) and Sukhbaatar (27.3%) aimags. Although average arsenic content in drinking water in selected wells in Tuv, Gobisumber, Dornogobi, Gobi-Altai, Dornod, Sukhbaatar and Dundgobi aimags contains 1.2-5 times more arsenic than UST-900-92 standard and WHO recommended content. Out of all studied samples, water from well #3 in Khatanbulag soum, Dornogobi, contained 0.07mg/l arsenic which is the highest – 0.065mg/l more than UST-900-92 standard and WHO recommended content.Concliusions:1. Out of 867 well water samples 10.3% contained arsenic.2. Arsenic content in drinking water nationwide is 0.014+-0.003mg/l. The highest arsenic content is recorded in Khatanbulag soum, Dornogobi – 0.075mg/l.

Live species with selenium deficiency are unable to produce adequate antioxidant selenoprotein to defend themselves, so the virus may turn harmful and cause additional stubborn illness.
The disease associated with selenium deficiency in humans became known as cardiomyopathy or Keshan disease, an area in northeastern China that endemic spread. Some of the study results on the treatment of COVID-19 patients and selenium levels in patients are similar to previous studies indicating the antiviral effects of selenium. Indeed, various cellular and viral mechanisms, including selenium and selenoprotein, affect viral pathogens, including glutathione peroxidase, which depends on selenium encoded by the virus. Such viral mechanisms affect well-operated oxidative stress associated with multiple RNA-virus infections and increase viral replication (resulting in increased mutation frequency); as with SARS-CoV-2, selenium deficiency pathogens or mortality are high.
Inadequate selenium deficiency has been reported in the Mongolian population. According to a 2005 year study report by the University of Otto in New Zealand and the Center for Nutrition, 57% of children aged 06–35 months in Ulaanbaatar and four aimags had low selenium consumption in plasma. In most countries, the most important sources of selenium are meat and wheat products, and the concentration of selenium in the main staples eaten by Mongolians, such as wheat and meat, was remarkably low

The research on the smoking habits among 8th-to-12th grade students of schools was conducted using a random sampling method among the 13-18 years old school students.Materials and MethodsThe research was performed using a combination of both qualitative and quantitative methods. The quantitative part of the research was performed by conducting surveys among randomly selected secondary school students according to prepared and approved questionnaires. The qualitative study was performed by organizing focus groups based on prepared discussion guidelines. Sampling: the survey participants were students in grades 8-12 from both public and private schools in Ulaanbaatar, the capital city of Mongolia. A total of 1190 students from the 12 secondary schools of 6 districts were selected through random sampling.Resultsto the question of whether the participants have tried to smoke once or twice, 36,1% (407) responded positively. Among these respondents, 49.6% (272) are male and 23.2 (135) are female. This confirms the statistical data that male students are more exposed to the habit of smoking than female students (x2=57.8, p<0.01). The percentage of the currently smoking students is 11.2% (77) of whom 17.9% are male and 4.8% are female. Of the current smokers, 6.8% smoke every day (x2=48.3, p<0.01). The average age of taking up smoking was 14.0[±1.8] of which males students began using tobacco at 13.9[±1.8] years and females at 14.3[±1.6]. Among the smoking students, 10[±2.1]% were from public schools and 17.3[±2.8]% were from private schools (x2=8.1, p<0.01).

Various studies conducted worldwide emphasized the importance of identifying gastric cancer risk factors for better prevention and further incidence reduction. A total of 52 identified risk factors for gastric cancer were classified into nine categories in which diet, lifestyle, and infections are leading causes. Gastric cancer morbidity and mortality has an increasing trend annually in our country. In Mongolia, only 1% is diagnosed in the carcinoma stage, 3% in the first stage, 11% in the second stage, 43% in the third stage, 42% in the fourth stage.
The “Gastric cancer risk factors study, 2018” by L.Tulgaa, and D.Ganchimeg confirmed smoking on an empty stomach as a risk factor. B.Gantuya et al`s (2018) study on gastric cancer and helicobacter infection, as well as S.Tsegmed et al`s (2012) gastric cancer prevalence, its risk factors study, had similar results.
B.Gantuya et al (2018) identified the excessive consumption of salt among the gastric cancer diagnosed population in Mongolia. Also, L.Tulgaa and D.Ganchimeg et al`s “Gastric cancer risk factors study, 2018” results reported the daily consumption of salt in tea is a risk for gastric cancer.
L.Tulgaa et al`s (2018) study participants had irregular mealtime such as dinners are at a very late hour, the meals aren`t chewed well, leftover meals, and seasoning consumption. These characteristics were significantly different in two groups with a statistically important result.
Furthermore, the study results suggested a need to provide practical advice on healthy eating to the population as 50% of the participants consumed more than 5 high-risk food products for esophageal and gastric cancer along with combined risk factors.

Background: Mongolia is characterized by restricted sources of drinking water and intensive water pollution due to high rates of urbanization, mining industry development, enormous amount of livestock, and ever-growing attempts in domestic production of cereals and vegetables. Among others, Se is the least studied element in Mongolian water resources. Goal: To assess the selenium content of Mongolia’s drinking water depending on its geographical location and to identify areas of environmental risk associated with the chemical composition of the water. Materials and Methods: In the summer of 2017, water samples were collected from 5 aimags (Dornogovi, Tuv, Selenge, Umnugovi, Arkhangai) and Ulaanbaatar city and sent to Moscow, Russia for analysis. Of the collected samples, 19 were groundwater (wells, wells, springs) and 2 were surface water (Tuul River, Selenge River). Results: Based on fluorimetric method of analysis, the first results on Se levels in drinking water of five aimags, Ulaanbaatar, and Erdenet were obtained. Uneven distribution of Se in Mongolia was manifested, the highest Se concentrations being typical for the southern resources (up to 18,600 μg/L) and the lowest, for the Northern ones (up to 0.022 μg/L). ICP-MS data of Al, As, B, Ca, Cd, Co, Cr, Cu, Fe, Hg, I, K, Li, Mg, Mn, Na, Ni, P, Pb, Si, Sn, Sr, V, and Zn contents indicate poly-microelementosis existence in the South of Mongolia (Dorno-Gobi aimag) where ground water is characterized by elevated levels of As and extremely high levels of Se, Li, Na, F, Cl, B, and nitrates ions, exceeding maximum permissible levels by 1.86; 4.3; 3.1; 3.1; 2.7; 3.4; and 1.8 times respectively. Toxic concentrations of Se in groundwater of Dorno-Gobi aimag contradict with the published low human serum Se and low content of the element in horseflesh that suggests the possible effect of the above pollutants on Se bioavailability. Conclusion Revealed phenomenon and mosaic distribution of heavy metals in areas with high and low Se content in water resources indicate the need of direct search for Se and other pollutant transfer in food chain in various ecological loading conditions, creation of a map of Se distribution in water resources of other Mongolian regions, and large-scale evaluation of the human poly-elemental status.

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.
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.
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.
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.

Introduction: Among the endocrine, nutritional, and metabolic disease and thyroid disorders occupy a significant place. According to the World Health Organization, 8-18% of the world’s population suffer from thyroid disorders. In our country, no research on the prevalence of the disorders has been conducted before, and this research methodology was discussed by the Scientific committee of the National Center for Public Health and was approved by resolution No.156 of the Ethics Committee of the Ministry of Health on 2020. Materials and Methods: In order to determine the prevalence of thyroid disease in the country, we collected the actual number of thyroid disorders registered in 9 districts of the capital city and 330 soums of 21 aimags for a total of 10 years from 2011 to 2020. The prevalence of thyroid disorders was mapped using Arc view and GIS software. Results Endocrine, nutritional and metabolic disease account for 2.3% of all outpatient cases. Endocrine, nutritional, and metabolic disease accounted for an average of 168.3 per 10000 population over the past 10 years, and thyroid disorders accounted for 45 or 26.7% of endocrine, nutritional, and metabolic diseases. Thyroid disorders are highest in people aged 40-49 years.
Thyroid toxicity is the most common type of thyroid disease in Mongolia, accounting for 56.2%, with an average of 17.2 per 10000 population in 2011-2020. However, iodine deficiency-related thyroid disease accounts for 5.5% of all thyroid disorders, with an average of 2.5 per 10000 population in 2011-2020. In 2011, it decreased by 2.2 per 10000 population, and by 2020, it decreased by 0.2 per thousand to 2.0, but in the last 5 years, it has increased by an average of 2.4 per 10,000 population, and in the last 5 years it has increased by 0.2 per thousand, or 2.6 per 10,000 population. Morbidity is high in the Khangai and Central regions.

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.
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.

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.

Introduction: Gastric cancer is still one of the most leading causes of mortality in the world. The highest mortality rate of gastric cancer is estimated in Mongolia. South Korea and Japan, where leading the incidence of gastric cancer, mortality rates are observed in 51th and 31nd rank respectively. In Mongolia, gastric cancer is the second leading site, after liver cancer. Goal: We aimed to determine the cause of late diagnosis of gastric cancer and to evaluate supply of upper endoscopy devices and human resource for gastric cancer in the general hospital of provinces and districts. Materials and Methods: In this study, 84 patients suffering from gastric cancer (42 patients in III, IV TNM stage; 42 patients in I, II TNM stage)were investigated in National Cancer Center, Mongolia. A survey questionnaire which included age, gender, education, income, risk factors and clinical questions was detected from all patients. And we conducted study of supply of upper endoscopy devices and human resource for gastric cancer in general hospitals of from 21 provinces and general hospitals of 6 districts by questionnaire. Results: Seventy three(86.9%) patients were over 50 years old and the highest rates of gastric cancer were in group of 61-70 years (40.5%). From the results, the reason to visiting hospital was significantly different between two groups. 55.1% of patients suffering from early-stage gastric cancer were voluntarily diagnosed by upper endoscopy. In contrary, 55.8% of patients suffering from late-stage gastric cancer have visited the hospital due to worsening symptoms or dysphagia and vomiting. Factors such as age, gender, education, employment status and income had no significant effect on late diagnosis of gastric cancer. In totally 24(89%)general hospitals out of 27 had upper endoscopy devices and 22 (81.5%) hospitals had endoscopist. Although 75% of total general hospitals conduct annual cancer screening, 64% of them do not perform the endoscopy in annual screening. Conclusion In our country, late diagnosis of gastric cancer is related to the attitudes of patients for preventing and screening disease. Therefore, it is important to improve the health education of the population and to develop healthy, right attitudes and practices. And the study revealed that general hospitals have insufficient for upper endoscopy devices and human resource.