BACKGROUND: The prescriptions of multi-component have been the subject of chemical study fora long time. Therefore, when compounding the preparations of multi-component in traditionalmedicine, their taste is cautiously relied on, as the power of the medicine should not be subduedwith the power of another. Our research group has been carrying out tests on the raw materials,which are contained in multi-component prescriptions. However, research on multiple prescriptionsis relatively less being carried out.The traditional medicine naro-3 is used in traditionalmedical practicefor the treatment of inflammationand as a pain relieving remedy. Naro-3 is composed of 3 medicinal herbs including AconitumKuznezoffii Reichb, Terminalia chebula Retz, Piper longum L.GOAL: The aim of the study is to investigate some phytochemical compounds of traditional prescriptionNaro-3.OBJECTIVES:1. To reveal biological active substances of naro-3;2. The sum of the quantitative chemical study by spectrophotometry;3. To establish main criteria of standardMATERIALS AND METHODS: Traditional medicine narî-3 was produced from the Traditional Medicinefactoryof TMSTPC. In the phytochemical research, biological active substances were determinedby thin layer chromatography (TLC), on silica gel plats. The total contents of alkaloid and tannincompounds were determined by titrimetric method. TheMongolian pharmacopoeia was used fordetermination of quality parameters of traditional medicine Naro-3.RESULTS: TLC measurements of biological active substances of naro-3 showed that contains gallicacid and alkaloids respectively. The result of our research it was determined that the total tannin10.4 percent, total alkaloid 2.47 percent and organic acid 2.67 percent in drug Naro-3.CONCLUSION: The results of the study indicate that naro-3 contains a large amount of biologicalactive substances such as tannins, alkaloids and organic acids, which are connected with its painrelieving and anti-inflammatory effects.

Prevalence of diabetes mellitus is increasing in Mongolia in last years. Diabetes mellitus is a chronic disease which need longterm treatment and its implication is covering many organ and systems. There are rare studies on type 1 diabetes mellitus in our country. We have read several international and local literature sources on relationship of between type 1 diabetes mellitus and enteroviruses and explained the current situation of what is a role of enteroviruses for development of type 1 diabetes mellitus.

Background: Diabetes mellitus prevalence increased year to years in Mongolia similar to other countries. Prevalence of Type 1 and type 2 diabetes is increasing showed many literature sorces (M. Lönnrot et al, 2000; H.Viskari et al, 2005; Francesco Dotta et al, 2007; Shoichiro Tanaka et al, 2009; Lars C. Stene et al, 2010; Wing-ChiG Yeung et, 2011; Maarit Oikarinen Sisko Tauriainen et, 2012; Teresa Rodriguez-Calvo et, 2015).
Several studies on prevalence, risk factors and complications of type 2 diabetes have been conducted in Mongolia (J.Suvdaa, 1988; Kh.Altaisaikhan, 2002; Bayarchimeg B, 2004; U.Tsolmon, 2005; Myagmartseren D., 2009; Sainbileg S., 2011; Erdenechimeg D., 2012; Enkhjaragal Ya., 2012; Otgonbayar D., 2015).
Currently, there is no conducted study on incidence of type 1 and type 2 diabetes among children and youth in Mongolia. Goal : To study of incidence of type 1 and type 2 diabetes among children and youth Material and Method: We used to data from Health Development Center and calculated incidence of 1 and type 2 diabetes among children 0-19 years of age per 10000 populations. This study methodology approved Research ethics committee of “Ach” Medical University (2019-6-24, Decision #19/02/04). Result : Incidence in aimag level were in 2014-2020 0-4 year age group 0,00 (2016, 2017)-0.20 (2020); 5-9 age group 0,00 (2015, 2016)-0.32 (2017), 10-14 age group 0,22 (2015, 2016)-0,83 (2020); and 15-19 age group 0,13 (2015)-1,02 (2019).
In Ulaanbaatar 2014-2020: 0-4 age group 0,00(2015, 2016)-0.33 (2019); 5-9 age group 0,00(2015)- 0.74 (2019); 10-14 age group 0,00 (2015, 2016)-1,91(2019); and 15-19 age group 0,34(2017)- 1.41(2019). Type 2 diabetes in 2014-2020: In aimag level (rural): 0-4 age group 0,0 (2014, 2015, 2016, 2017, 2018, 2020)-0.05 (2019); 5-9 age group 0.00 (2016, 2018, 2020)-0.16 (2017); 10-14 age group 0.00(2019)-0.12(2020); 15-19 age group 0.07 (2015)-0.43(2019).
In Ulaanbaatar (Urban): 0-4 age group 0,0 (2014, 2015, 2016, 2017, 2019, 2020)-0.11 (2018); 5-9 age group 0.00 (2014, 2015, 2016, 2018, 2020)-0.07 (2017); 10-14 age group 0.00(2014, 2016, 2018)-0.58(2019) and 15-19 age group 0.11 (2015)-1,52(2019) per 10000 pop. Conclusion Type 1 diabetes incidence in l increased in regard to age of children, there is little differences between rural and urban area but in last 2 years there is noted increasing. Type 1 diabetes incidence in 2014- 2018 more than the incidence of type 2 diabetes, in 2019-2020 among 15-19 age group increased especially in Ulaanbaatar.

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.
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%).

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.
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.

Introduction: Major outbreaks of infectious diseases caused by enteroviruses (EV) have been reported in recent years. As of 2017, in Mongolia, hand, foot and mouth disease, or HFMD, accounts for 13.7% of all infectious diseases. The purpose of this study was to investigate the circulation of EV among healthy children, and clinical characteristics of infection. Materials and Methods : The analysis of EV circulation was conducted on Polio Laboratory data of 1172 specimens, collected in 2013-2018, from 9 districts of UB and 21 provinces of Mongolia. Also specimens of 239 patients, who underwent outpatient and inpatient treatment at the NCCD in 2014-2018, were randomly selected and stool samples were collected. Clinical symptoms of patients were analyzed and virus isolation analysis was performed in order to confirm the diagnosis. Results: Children from 1 month of age to 5 years have participated in the study and the average age was 2 years and 5 months. The enterovirus rate among healthy children was 20.1%. Virus circulation rate was highest in 2013 (37.2%), lowest in 2014 (11.8%). The peak of circulation is observed in May and October, while the minimum rate is in July.
Out of selected patients 52.7% (n=126) were diagnosed with HFMD, rash infection occurred in 28.5% (n=68), acute flaccid paralysis-18.8% (n=45). EV was detected in 56.4% (n=135) of the collected stool samples.
Children from 1 month of age to 5 years have participated in the study and the average age was 2 years and 5 months (95% CI:2.5 ±0.1). 49% (n=578) of participants were female, 50.7% (n=594) were male. The enterovirus rate among healthy children were 20.1% (n=236; 95% CI: 20.1 ± 0.55). Virus circulation rate was highest in 2013 (37.2%), lowest in 2014 (11.8%). The peak of circulation is observed in May and October, while the minimum rate is in July. Although the enterovirus isolation rate was relatively high among children under 3, there was no statistically significant difference (p>0.05), as well as there was no difference in gender (p>0.05). As for the EV circulation by region, the highest prevalence rate is found in Central region (27.5%), while the lowest is in the Eastern region (12.7%) with no statistical significance by regions (p>0.05). Conclusions Among children, HFMD is a common disease, that caused by EV. Enterovirus infection can often cause fever, flu like symptoms as well as spotted, maculopapular rash. The EV isolation rate of 20.1% indicates that the incidence of enterovirus is characterized by symptoms of influenza-like illness or is asymptomatic.

Introduction: Vaccination is a cost-effective intervention to prevent major illnesses that contribute to child mortality in the country. Increase in parental knowledge abour vaccination will lead to increase in vaccination rates of children. The main aim of our study was to assess the knowledge, attitudes and perceptions of vaccination. People’s knowledge about immunization and their attitudes toward them are likely influence uptake. Goal: The main purpose of the study is to evaluate the knowledge and attitude of the population towards measles and to clarify their satisfaction and understanding of the measles immunization program. Materials and Methods: We conducted cross-sectional study, involved participants from 3 aimags and 6 districts covered voluntarily. Total participants were 509. We used to online model and with the participant’s self-answer closed questionnaire. Results: 76% of the respondents were female and 24% were male. 64.1% of respondents who have children of 0 to 5 years of age, had little or bad knowledge towards immunization schedules against measles. Overall, the general attitude towards vaccines was positive, but the knowledge about significance of vaccines was weak. Further, district and province family doctors need to pay particular attention to increasing awareness and knowledge on importance of vaccines among families with young children. It is necessary to conduct extensive, long-term research and training among population to evaluate their knowledge and attitude towards measles, its vaccine and prevention, and to identify causes of lack of knowledge. Conclusion Our study shows the importance of good physician–patient communication in improving knowledge attitude and practice of parents towards their children’s vaccination.

Background: Globally the incidence of stroke is not decreasing, and the deaths and disabilities caused by stroke is increasing every year, especially in low and low-middle income countries.
Long-term trends in stroke incidence in different populations have not been well characterized, largely as a result of the complexities associated with population-based stroke surveillance.
Having reliable data on stroke morbidity and mortality, as well as periodic identification of long-term trends will be important information for proper prevention planning in the population, monitoring the disease and further improving the quality of health care. Material and Method: A prospective cohort study has been conducted in adult citizens (972409 in 2019, 925367 in 2020) of 6 districts of Ulaanbaatar from the 1st of January, 2019 to 31st of December, 2020. All first-ever and recurrent stroke cases were included using special software, developed for stroke registry, based on the WHO STEPS approach from participating radiology departments of state hospitals, district hospitals, and some private hospitals. Information of stroke death was obtained from forensic institute and state registration office of the capital city.
The trends of stroke incidence and mortality was compared to data between 1998-1999 and 2019- 2020 in UB. Results: The age-standardized crude incidence rate per 100.000 person-years of stroke were 209.0/100.000 (n=1934) in 2019 and 194.0/100.000 (n=1821) in 2020 among adults of UB city. The above results were compared to 1998-1999 studies and the incidence rate declined by 94.0/100.000 in 2019-2020, whereas mortality rate increased by 10.0/100.000 in women aged 16-34. Stroke mortality was 11.6% in 1998 and 26.5% in 1999, while in our study it was 33.87% in 2019 and 29.71% in 2020. Although the incidence of stroke rates has decreased in 1998-1999, the mortality rate has not decreased significantly. Conclusion Morbidity and mortality rates among the population of Ulaanbaatar citizen remain highest in the world, compared to 20 years ago with overall morbidity declining but mortality has not decreased.
In recent years, the Government of Mongolia has been focused on reducing non-communicable diseases, but the primary and secondary prevention and control of stroke in the general population, as well as the acquisition of knowledge attitudes, practices and access to health care still need to be improved.

Background: Stroke is one of the leading causes of mortality and disability worldwide. Understanding sex differences in risk factors, clinical characteristics and death after stroke might provide valuable evidence for prevention and management of stroke. Aim: We aimed to describe sex differences in risk factors, clinical characteristics and death after intracerebral hemorrhage (ICH) and ischemic stroke (IS) using hospital-based registry in 6 districts of Ulaanbaatar, Mongolia. Materials and methods: We used hospital-based stroke registry in Ulaanbaatar Mongolia. From 2019 to 2020, total of 974 patients with acute ICH and 1612 patients with acute IS were enrolled in this study. The severity of stroke was measured by National Institutes of Health Stroke Scale (NIHSS) and Glasgow Coma Scale (GCS). Risk factors for stroke were defined as patient’s history and their medical record. Death after stroke was registered at 28 days and 90 days by follow-up study. A comparison of categorical and continuous variables was analyzed using chi-squared test, Student’s t-test and Mann Whitney U test. Univariable and multivariable logistic regression analyses were also performed. Results: The mean age of ICH patients was 58.41±11.56. There was significant difference in age (59 vs 57, p=0.009) between women and men. Men with ICH were more likely to drink alcohol (35.4% vs 5.2%, p=0.000) and to smoke (37.0% vs 8.4%, p=0.000) and to have arterial hypertension (72.7% vs 58.6%, p=0.000). However, there were no significant differences in other risk factors including atrial fibrillation, diabetes mellitus, prior stroke and other cardiac diseases. There were no sex differences in clinical characteristics including systole and diastole blood pressure, NIHSS scores and GCS. In our study, case fatality rate was 23.8% at 28 days and 1.9% at 90 days after ICH. By multivariable regression analyses, there were no significant association between sex and death at 28 days and at 90 days (OR:0.74; 95% CI:0.52-1.06, OR: 0.80; 95% CI:0.29-2.21).
The mean age of IS patients was 61.07±12.88. The women were older (63 vs 59, p=0.000) than men. Men with IS also were more likely to be current smokers (37.6% vs 9.0%, p=0.000), current drinkers (33.2% vs 3.4%, p=0.000) and to have arterial hypertension (74.7% vs 65.9%, p=0.000). There were no significant differences in other risk factors. For IS patients, there also was no sex difference in clinical characteristics. Case fatality rate was 13.3% at 28 days and 1.1% at 90 days after IS. By multivariable regression analyses, there were no significant association between sex and death at 28 days and at 90 days (OR:0.90; 95%CI: 0.64-1.26, OR:5.16; 95%CI: 0.99-23.9). Conclusion Our study showed sex differences in some vascular factors of both stroke subtypes which emphasized that we need to implement stroke prevention targeting sex-specific risk factors. While clinical characteristics and early mortality of intracerebral hemorrhage and ischemic stroke were not differed by gender.

Background: Stroke is still one of the leading causes of morbidity and mortality worldwide. Registry-based data of stroke are scarce in low and middle-income countries such as Mongolia. We aimed to investigate the incidence and mortality of stroke in adult population of UB Mongolia by stroke registration method. Material and Method: Covering 611265 (≥15 years old) adult citizens of three districts of Ulaanbaatar, a population-based prospective study was done from the first, January of 2019 to 31st, December of 2019. All first-ever and recurrent stroke cases were included using special software, developed for stroke registry, based on the WHO STEPS approach from participating radiology departments of state hospitals, district hospitals, and family clinics. Information of stroke death was obtained from forensic institute and state registration office of the capital city. Results : In a 1-year study period, 1068 (women 39.1%) stroke cases were registered in people with 60.16±13.66 years old. Stroke incidence rate was 169.81/100000 including first-ever and recurrent events. Stroke incidence rate was higher in men and people with 80 and above years old. The ratio between IS and ICH was 1.14:1.0. Stroke mortality was 27.1% and mortality rate was 45.94/100000. The highest rate mortality was in ICH subtype, male population and older people. Conclusion We identified relatively high incidence and mortality rate of stroke in ICH indicating an urgent need for improvement of arterial hypertension control, health education and primary prevention mainly among men.