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.

INTRODUCTION: Hepatitis B virus (HBV) infection is a highly endemic in Mongolia. Consequently, complications of HBV including livercirrhosis and primary hepatocellular carcinoma, are crucial public health problems in the country. Since 1991, hepatitisB vaccination has been an integrated part of Mongolia’s Expanded Programme of Immunization (EPI). Since the HBVvaccination program has been implemented in Mongolia, there are few studies of HBV prevalence among children, itis essential to assess the effectiveness of HBV vaccination through the prevalence of hepatitis B virus carriage (i.e.,HBsAg) among children in Ulaanbaatar.GoalTo assess prevalence of HBV carriage and vaccination coverage among 4-6 year-old children in UlaanbaatarMATERIAL AND METHODS:∎ A representative, population based cross-sectional study was implemented in Ulaanbaatar.∎ A retrospective descriptive study design was used to estimate the HB vaccination coverage among 4-6 year-oldchildren in Ulaanbaatar.∎ A total of 2200 children, ages 4 to 6 years, were sampled using a stratified conducted, with stratified, multistage,random cluster design from 40 sub districts of 5 districts in Ulaanbaatar.∎ The children, aged 4 to 6 years, (n=1988) were tested for serological marker of HBV HBsAg.∎ All data (dose, species, and date) of the HepB vaccination were collected from the immunization record of thechildren.∎ Closed and open ended questionnaires were asked by parents to assess some social and demographicfactors.RESULT:Of the 2200 children sampled 183 children were not present at their home address and 29 children refused to participatein the study. Thus, 1988 children participated from Ulaanbaatar city (353 of from Khan-Uul district, 440 from Bayanzurkhdistrict, 400 from Bayangol district, 344 from Sukhbaatar district, 451 from Songinokhairhan district) (Response proportion90.3 percent). The mean age of children was 4.97±0.8 years with a range of 4-6 years; 1023(51%) were boys. Rapidtest results are available for all 1988 children; 0.3 percent (n=6) of whom were HBsAg carriers. HBsAg prevalence of4,5 and 6 year-old children were 0.15 percent, 0.43 percent and 0.32 percent, respectively. No association betweengender and HBsAg was identified. The administration of HB vaccine birth dose, HepB2 and HepB3 were 98.2 percent,94 percent, and 91 percent, respectively. Among children with immunization cards, 1089 (81.5 percent) children werecompletely vaccinated, 237 (17.7 percent) incompletely vaccinated and 11(0.8 percent) not vaccinated with hepatitisB vaccine. Prevalence of HBsAg carriage among children with immunization record was 0.18 percent and withoutimmunization records was 0.46 percent.CONCLUSION:Prevalence (0.31 percent) of HBV carriage among the young generation meaningfully declined compared with those ofprevious studies in Ulaanbaatar as a result of Expanded Program of Immunization. There was no significant associationbetween age or sex and HBsAg carriers.

Risk of nephrotith disease increases relating with using high hardened water, not suitable diet, being sensitive for some kind of food products. Then for Mongolia, particularly Bulgan province which is located in basin of the Selenge river is consisted in regions which have high hardened water. Sickness rate of renal diseases especially nephtolith disease is high in population of Selenge soum of Bulgan province. It was main reason of choose this subject and investigate non organic substances in urine of population and determine risks of nephtolith disease for them. To determine оne of the factors affecting the formation of the disease is to study the composition of drinking water and investigate non organic substances in urine. We used cross-sectional methodology for our study. Our study was conducted from June, 2013 to November, 2014. Household water used portable water dissemination and homes with private wells and water samples from the river.Drinking water analyzed of the chemistry parameters (13 substances) in the chemistry and toxicology laboratories in Orkhon aimag. There was 300 urine analyze was done and 62 of them was confirmed nephtolith disease with it. We investigated non-organic substances in their urine. Interviews people in the study, the average age was 43.26±14.7. 64.2% of participants was answered that they use ground water (private groundwater wells), 25.4% use external water (the well water), 8.1% use river water, 2.3 use pure water when asked about their water supply. Composition of samples from drinking water standard was near to the standard assessments by comparing the maximum amount of. We were considered the most important water pH, solids, iron, chlorine analysis compares removable wells and private wells. Hardness for 53.3% of the well of 2.5-3.5 mg/l with hard water, private wells, 60.0% of 4.6-5.5 mg/l solids by of water. Wells chlorides portable 66.7% 14.4-25.3 mg/l, and private wells 13.3% of 4.3-14.3 mg /l. 20.7 percent of survey identified as the kidney and urinary tract diseases. Urat salt (32.1%), compound of urat and sodium (32.1%), oxalate (14.5%), sodium (13.4%), compound of oxalate and sodium (6.4%), phosphate (1.5%) was determined in urine analyze. It was close to the water content of the standard performance. The well water solids of 2.5-3.5 mg/l and private groundwater wells solids of 4.6-5.5 mg/l. And the well chlorides 14.4-25.3 mg/l and private groundwater wells chlorides 4.3-14.3 mg/l.Urat and compound of urat and sodium are dominated in composition of stone during nephrolith disease (p=0.043).

The Western Pacific Region have the highest neonatal mortality rate of any country in the world. It has 37 countries and areas with approximately 1.8 billion people which comprises one-fourth of the total world population. The First Embrace It is care for all mothers and newborn infants. The components of the First Embrace are immediate and thorough dying, appropriately timed clamping and cutting of the cord, skin to skin contact and initiating exclusive breastfeeding for all newborns. Aim: First embrace and Early Essential Neonatal Care the importance of infant seeks to to learn some of the problems faced by identifying the skills of medical personnel. We were conducted in this study by a cross sectional questionnaire in order to assess the knowledge, attitude and practices of healthcare providers about essential newborn care and administrated a structured questionnaire to evaluate instruments and materials of the maternity wards.Skin to skin contact and a mother first embrace is the beginning of a healthy life is to reduce the newborn mortality. And the first embrace is improves the children’s immunity. We determined urgent problems for EENC including a lack of maternal health education, inadequate salaries for health care providers, a lack of essential medicines and commodities for birth preparation and numbers of health care providers delivering neonatal intensive care are increased due to the stillbirth rate has increased dramatically year by year.The first embrace is important to reduce neonatal mortality rate and 92.0% of all participants have the enough experiences for the first embrace care and 80.3% of all participants for the EENC.