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).

INTRODUCTION:Waterborne diseases, especially diarrhea, related to water quality and safety, personal sanitation and hygienehave been still reported very high in developing countries. Globally, there are an estimated 1.4 million casesof hepatitis A every year. The hepatitis A virus is transmitted through ingestion of contaminated food and wateror through direct contact with an infectious person. Hepatitis A is associated with a lack of safe water and poorsanitation [2].Dysentery is bloody diarrhea, i.e. any diarrheal episode in which the loose or watery stools contain visiblered blood. Dysentery is most often caused byShigella species (bacillary dysentery) or Entamoeba histolytica(amoebic dysentery) [3].Kharaa and Orkhon River are tributaries of the Selenge River-basin, in which many mining and other industries,agriculture, and residential areas reside. It has become a one pollutant factor for water of the Kharaa andOrkhon rivers. As a result, water of the Tuul, Kharaa and Orkhon River was reported to be highly contaminated(Mongolian Human Development Report 2010: Water and Development report) [4].GOAL:The aim of the research was to study incidence of gastrointestinal infectious diseases among population ofsoums are located in Selenge River Basin.MATERIALS AND METHODS:Data on health statistics 2009-2013 years of gastrointestinal infectious diseases, including dysentery, diarrhea,hepatitis A virus and others, were collected and analyzed.RESULTS:Incidence of dysentery was registered highly among people who live in Mandal soums in 2009-2013 years. Butincidence of dysentery (per 10 000 population 2.82) among population ofMandal soum lower than the Selengeprovince and National average. Incidence of hepatitis A virus was registered highly among people who livein Orkhon (74.46), Orkhontuul (48.86) soums and it was greater than 1.3-2 times than the Selenge provinceaverage. Incidence of diarrhea was registered highly among people who live in Khushaat soum and it wasgreater than 2.18-3.8 times the than Selenge province averageCONCLUSION:Incidences of diarrhea and hepatitis A virus were registered highly in Orkhon, Orkhotuul and Khushaat soumscompared to other target soums and it was greater than 1.3-3.8 times than the Selenge province average.Especially, these diseases were registered highly among 0-16 aged children.

BackgroundClimate change, as defined by the United Nations Convention on Climate Change, is a “Change of climate which is attributed directly or indirectly to human activity that alters the composition of the global atmosphere and is observed over time”. In 2001 an Initial Communication on Climate Change was prepared by the Government as part of its obligations under the UNFCCC. One of its recommendations was for “creating public awareness among a wide range of stakeholders including public, private and community sector organizations”. GoalThe main goal of the study was to develop recommendations and measures on prevention from diseases and adaptation to climate change by assessing knowledge, attitude and practice (KAP) of population towards climate change. Based on the main goal the following objectives were setup. Therefore addressing the different levels of knowledge and types of attitudes and practices people have towards climate change must initially be dealt with at the local level where site specific variations can be accounted for. Once research has been undertaken at the local level it can later inform decisions and policy at the regional, continental and global levels on how to incorporate site specific variations with in the greater context of the global threat.Objectives:1. To determine knowledge and attitude of population towards climate change;2. To determine practice of population on some adverse consequences of climate change;3. To develop recommendations and measures on prevention from and adaptation to climate change;Materials and MethodsThe study was at once carried out by means of questionnaire. In order to assess KAP of population, the data was collected using a card with 38 questions in three chapters which previously produced and ratified. The questionnaire was structured into 4 sections; demographics, knowledge, attitudes and practices. Two sums in an aimag from each climate zone of Mongolia were selected. In total, 2258 respondents aged 15 to 64 were involved from eight sums in four aimags (Zavkhan, Selenge, Dornod and Umnugovi), and two districts in Ulaanbaatar. The study data was input to computer using EPIDATA-3.6 software and statistically analyzed using SPSS-18.0 software.ResultsA total of 2258 individuals were interviewed. 44.1% 44.1% (995) of the participants was residents of Ulaanbaatar city and remained percentages accounted for residents living in the center of aimags and soums. 56.7% (1281) of participants were women and 43.3% (977) were men aged with 35.2±15.1 in average. Most of the study participants had educated with medium level (34.8%) and high level (30.0%). Employment percentage is 47.5% (1073). However, most respondents interpreted the meaning of climate change as “a change in weather,” “a change in normal climate conditions,” or “a change in temperature” – answers that requires more common sense than climate change savvy. Global warming is one of the evident of climate change. To know study participants awareness about climate change we used terminology of global warming. 25.3% (571) of the total participants answered that climate change revealed by the overheating or warming earth surface. 42.4% of the respondents answered the climate change could affect to health, 33.2% to environment and 16.3% to economy. 84.5% (1908) of the study participants agreed with that climate change has been started. Most of them (71.3%, 1824) allowed that people’s improper use of nature tend to global warming. When ranging the protection practices during the strong storm means of timbering the houses or gers accounted for 42.5% (960). Study participants supported the following activities; 41.2% (931) agreed that is it necessary to increase health services and 34.1% (769) suggested that it is better to enhance training and propagation for increasing awareness of population about climate change adaptation procedures and some information on climate changes and protection events. 85.2% (1923) of the study participants answered that they want to get the information on climate change from public TV.ConclusionsAlthough knowledge on global warming as the climate change was poor among the respondents, they agreed the climate change has already been started worldwide as well as in Mongolia. Only half of the respondents have had practice to prevent themselves from natural disaster.

In recent years, many researches that is related to waterborne diseases, especially diarrhea and water quality, safety, personal sanitation, hygiene have been conducting in developing country. Kharaa and Orkhon river are tributaries of the Selenge river basin and the many industries,agriculture, mining, provinces, soums are located in the near of Selenge river basin. Also Tuul,Kharaa and Orkhon river water is very polluted (Mongolian human Development Report 2010: Water and Development report).The aim of the research is to study correlation between to Kharaa and Orkhon river’s water pollution level and rate of gastrointestinal infectious diseases of people who live in the near of Selenge river basin.We analysed Kharaa and Orkhon river’s water quality and statistical data of gastrointestinal infectious diseases (such as dysentery, diarrhea, hepatitis A virus and others). Then we conducted correlation analysis between to river water pollution level and rate of intestinal infectious diseases. Kharaa and Orkhon river’s water was determined “less polluted” by physical, chemical andorganic indicators. But total number of bacteria was determined highly and Proteus vulgaris,Citrobacter freundi, Enterobacter agglomerans pathogens were detected in these river’s water. There were significant positive correlations between level of nitrit in river water and incidence of dysentery and diarrhea. (r=0.38, p=0.022; r=0.291, p=0.005).

Introduction: According to CDC guideline, common changes in patient admitted due to pneumonia caused by COVID-19 are lymphopenia (63%), leukocytosis (24-30%), leukopenia (19-25%). Neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), thrombocyte-lymphocyte ratio (PLR) are important to evaluate prognosis of infectious diseases as well as cancer.
Hematological tests are important for diagnosis, treatment and monitoring of patient with COVID-19. Our study objective was to determine the changes of leukocyte, lymphocyte, thrombocyte, NLR, LMR, and PLR in imported cases of COVID-19 into Mongolia. Method: The data such as age, gender, and laboratory test of a total of 249 cases who admitted to National Center forCommuncable Diseases (NCCD) from March 11 to July 20, 2020 was collected from information system of clinical laboratory of NCCD. Peripheral blood tests were conducted by XN 550 which is fully automated hematological analizator of Sysmex corporation, Japan. Statistical analysis such as mean, standard deviation, probability range was done by Microsoft Excel SPSS -25 program. Result: Regarding to gender, 163 (66.5%) were male and 86 (34.5%) were female. Mean age was 26 with range age of 11-80. Statistic analysis on leukocyte (mean 6.38 x 10⁹/L; P <0.000), thrombocyte (mean 283 x 10⁹/L P <0.000), neutrophil (mean 3.33 x 10⁹L; P <0.000), lymphocyte {mean 2.3 x 10⁹/L; P <0.000), NLR (mean 1.6, P <0.000), PLR parameter (mean 141.8 P <0.000> were revealed. Leukopenia (<3.98) were in 17 (6.8%), leukocytosis (>10.0) were in 11 (4.4%) cases. Lymphopenia (<1.18) were in 14 (5.6%), lymphocytosis (>3.74) were in 14 (5.6%) cases. Thrombocytosis (>369) were in 21 (8,4%), thrombocytopenia (<163) were in 4(1.6%) cases. Neutropenia (<1.56) were in 14 (5.6%) neutrophilia (>6.13) were in 15 (6%). The rest 220 (88.3%) cases have been determined no changes. PLR were 141.8 ±88.6, NLR were in 1.29 ±1.26 in 249 cases. Increased NLR and decreased PLR were in 10 (4.0%) and 114 (45.7%); increased PLR and decreased PLR in 31 (12.4%) and 28 (11.2%), respectively. Discussion Our result which is leukocytosis in 4.4%, leukopenia in 6.8%, lymphopenia in 5.6% of all imported eases ol"CO\ 1D-W. are similar to other studies. However, percentage of changes were lower than similar studies due to low rate of severe cases. It suggests, further studies clinical stages and severity of the infection need to be conducted.

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:
To analyze the carbon monoxide poisoning morbidity recorded in Mongolia between 2016-2020.
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.
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.
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.

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: 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.

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.

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.