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Drug utilization pattern of COVID-19 according to clinical severity (A Comparative Study in Two Secondary-Level Hospitals in Ulaanbaatar, Mongolia)

Narangarav ; ; Nina M ; ; Munkhbat S ; Erdenetuya M

Mongolian Journal of Health Sciences.2025;89(5):25-32.

Background: The COVID-19 pandemic has placed an extraordinary strain on healthcare systems worldwide, underscoring the need for evidence-based pharmacotherapy and rational use of medicines. Despite the availability of international and national treatment guidelines, notable variations in drug selection and utilization persist across healthcare institutions. Evaluating medication use according to clinical severity is vital for ensuring therapeutic rationality, improving patient outcomes, and optimizing pharmaceutical resource management. Aim: The aim of this study was to assess medication use and associated costs among inpatients diagnosed with COVID-19 at the Mongolia–Japan Hospital of MNUMS and the National Center for Communicable Diseases through ABC analysis Materials and Methods: : A retrospective, document-based study was conducted at the Mongolia-Japan Hospital (MJH) and the National Center for Communicable Diseases (NCCD) in Ulaanbaatar. Medical and pharmacy records of 1,012 inpatients diagnosed with COVID-19 between April 18 and December 31, 2021, were reviewed. Drug utilization was assessed using the ABC analysis method, classifying medicines based on their proportional contribution to total pharmaceutical expenditure. Comparative analyses were performed to identify differences in utilization patterns between hospitals and across clinical severity levels. Results: Of the total pharmaceutical expenditure for COVID-19 treatment, six medicines (4.5% of all drugs) were categorized as Class A, accounting for 69.7% of total costs. Class B included seven medicines (7.0%, 19.5% of total costs), while Class C comprised twenty-six medicines (88.6%, 10.6% of total costs). Remdesivir 100 mg injection, a Class A drug, represented 18.5% of total drug expenditure at MJH (used in 78 patients) and 36.2% at NCCD (used in 133 patients). Overall, approximately 70% of total expenditure was concentrated in a small number of high-cost medicines, indicating potential inefficiencies in pharmaceutical resource utilization. Conclusion This study demonstrates that a limited number of high-cost medicines, particularly Remdesivir, accounted for the majority of COVID-19 treatment expenditures. Strengthening evidence-based prescribing, rational selection, and monitoring of high-cost drugs is essential to enhance resource efficiency, ensure equitable access, and sustain hospital pharmaceutical care systems during pandemic response and beyond.

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Study of molecular biology analysis for the detection of Helicobacter pylori and clarithromycin resistance

Zoljargal G ; Tsolmon B ; Byambajav Ts ; ; Nymaakhuu D ; Avarzed A ; ; Khosbayar T ;

Mongolian Journal of Health Sciences.2025;89(5):168-175.

Background: Helicobacter pylori (H.pylori) infection is highly prevalent worldwide, with an overall infection rate of 50% of the total population. Effective and accurate eradication treatment for H.pylori is considered one of the most important preventative measures against gastric cancer. However, the increasing prevalence of clarithromycin-resistant H. pylori strains has significantly compromised the success rates of standard eradication regimens. In recent years, many countries have adopted molecular diagnostic methods to detect H.pylori infection and assess clarithromycin resistance. These approaches, which are often non-invasive, enhance both diagnostic accuracy and the ability to tailor treatment strategies. Although numerous studies have investigated methods for detecting H. pylori and clarithromycin resistance using gastric tissue specimens, relatively few have focused on the clinical application of stool-based diagnostics, despite their potential advantages in non-invasive testing. Aim: To detect H.pylori infection and clarithromycin resistance using molecular biological methods from both gastric tissue and stool samples, and to comparatively evaluate the diagnostic outcomes. Materials and Methods: The hospital-based cross-sectional study was conducted at the Gastroenterology department of the Mongolia-Japan Hospital. A total of 125 dyspeptic patients aged 18-80 years were enrolled. Eligibility criteria required the H.pylori infection to be confirmed by at least two diagnostic methods. Each participant underwent both invasive (histological examination, gastric biopsy-based real-time PCR) and non-invasive (urea breath test, stool antigen test, stool-based real-time PCR) methods. Gastric biopsies and stool samples were analyzed by real-time PCR to detect H.pylori and identify clarithromycin resistance-associated 23S rRNA point mutations (A2143G, A2142G, A2142C) Results: Among the study participants, 60.0% (n=75) were female and 40.0% (n=50) were male, with a mean age of 39±1 years. Comparative evaluation of the diagnostic methods for H.pylori infection demonstrated that the stool antigen test, performed in 104 individuals, yielded positive results in 91 cases (87.5%), whereas the urea breath test, performed in 51 individuals, was positive in 45 cases (88.2%). Using real-time polymerase chain reaction (PCR), H.pylori was detected in 76 of 101 stool samples (75.2%) collected in ENAT transport medium, and in 43 of 87 raw stool samples (49.4%). The estimated diagnostic sensitivities were 94% for the urea breath test, 91% for the stool antigen test, 78% for real-time PCR using ENAT-preserved stool, and 49% for real-time PCR using raw stool specimens. Clarithromycin resistance was found in 36 participants (28.8%), while 89 participants (71.2%) carried H.pylori strains susceptible to clarithromycin. Clarithromycin resistance was detected in 27.6% of stool samples and 30.5% of gastric biopsy specimens. Among the clarithromycin-resistant isolates identified from gastric tissue, 35 cases (97.2%) carried the A2143G point mutation, while the A2142G mutation was detected in only 1 case (2.8%). All resistant cases detected from stool samples carried the A2143G mutation, whereas the A2142G mutation was not observed. Conclusion Real-time PCR demonstrated high efficacy for the detection of H.pylori infection and clarithromycin resistance in gastric biopsy specimens. While the sensitivity of stool-based real-time PCR was comparatively lower, detection rates improved with the use of ENAT transport medium. These findings highlight the potential of stool-based real-time PCR as a non-invasive diagnostic tool; however, further investigations are warranted to optimize assay performance through rigorous standardization and refinement of sample processing protocols for the accurate detection of clarithromycin-resistant H.pylori.

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Comparative analysis of household indoor PM2.5 concentrations and prevalence of hypertension between cities

Anujin M ; Myagmarchuluun S ; Erkebulan M ; Ser-Od Kh ; Shatar Sh ; Gantuyаa D ; Enkhjargal G ; Munkh-Erdene L ; Gregory C. Gray ; Jungfeng Zhang ; Damdindorj B ; Ulziimaa D ; Davaalkham D

Mongolian Journal of Health Sciences.2025;89(5):5-10.

Background: According to the World Health Organization (WHO), 6.7 million people die annually due to air pollution caused by solid fuel use, with the majority of deaths resulting from respiratory diseases and cardiovascular conditions. In Mongolia, air pollution ranks as the fourth leading risk factor contributing to mortality, following hypertension, diabetes, and other major health risks. Although there have been numerous studies on outdoor air pollution in Mongolia, research linking indoor air pollution at the household level with the health status of residents remains limited. Aim: To compare indoor PM2.5 concentrations in households of Ulaanbaatar and Darkhan and examine their association with hypertension during the winter season. Materials and Methods: The study was conducted during November and December 2023, and January 2024, involving 240 households in Ulaanbaatar and Darkhan. Indoor PM2.5 concentrations were measured using Purple Air real-time sensors continuously for 24 hours over approximately one month. After measuring indoor air pollution, individuals aged 18–60 years living in the selected households were recruited based on specific inclusion criteria. Blood pressure was measured three times and the average value was recorded. Information on respiratory illnesses was collected through structured questionnaires. Statistical analysis was performed using STATA version 19.0. Results: A total of 241 households participated in the study, with 116 from Ulaanbaatar and 125 from Darkhan. Of the participants, 46.5% were male and 53.5% were female. In terms of housing type, 96 households (39.8%) lived in gers, 97 (40.2%) lived in stove-heated houses, and 48 (19.9%) lived in apartments. Among all participants, 66.0% (n=159) had hypertension and 34.0% (n=79) had normal blood pressure. Among participants aged over 40, 69.9–88.5% had hypertension, which is statistically significantly higher compared to younger individuals (p=0.0001). By body mass index, 75.3% (n=72) of overweight individuals and 78.4% (n=58) of obese participants had hypertension, showing a statistically significant difference compared to participants with normal weight (p=0.0001). The 24-hour average concentration of indoor PM2.5 was measured using the Purple Air device, and the levels in gers and stove-heated houses exceeded the limit set by the MNS 4585:2025 standard (37.5 µg/m³) Conclusion This study identified a relationship between environmental factors, such as air pollution and housing type, and the prevalence of hypertension. The indoor PM2.5 concentration in gers and stove-heated houses was above the standard limit, indicating a negative impact on the health of those residents. Furthermore, the high prevalence of hypertension among participants over the age of 40 and those who are overweight suggests a possible link to lifestyle and environmental conditions.

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The study results on the job satisfaction among employees of primary and referral level hospitals

Buyandelger B ; Erdenebileg N ; Yerkebulan M ; Sarnai Ts ; Davaalkham D ; Khurelbaatar N

Mongolian Journal of Health Sciences.2025;89(5):11-17.

Background: Employee satisfaction in the healthcare sector has a direct impact not only on the quality of medical services, but also on workforce stability and overall organizational performance. High levels of job satisfaction are associated with improved work performance, whereas low satisfaction often leads to negative outcomes such as stress and burnout. Although studies on job satisfaction have been conducted in Mongolia, research specifically targeting healthcare workers—and identifying the key factors influencing their satisfaction—remains relatively limited. This gap provides the rationale for the present study Aim: The objective of this study is to examine job satisfaction among healthcare workers at primary and referral hospitals and to identify key factors influencing it. Materials and Methods: The study was conducted between 2022 and 2024 among 1,883 physicians, nurses, and other healthcare professionals aged 18–65 years from 11 provinces and Ulaanbaatar city, using a quantitative research approach with a cross-sectional design. Job satisfaction was assessed with a questionnaire comprising six subdomains (supportive leadership, opportunities for human resource development, professional ethics, organizational culture, quality of healthcare services, and workplace safety), rated on a three-point Likert scale. Data analysis was performed using IBM SPSS Statistics version 26.0. Results: The overall level of job satisfaction among participants was 77.6%. Among the subdomains, workplace safety and supportive environment scored the lowest at 71.7%, whereas the quality and safety of healthcare services scored the highest at 83.4%. The findings indicated that holding a managerial position in hospitals in Ulaanbaatar and working as a physician in primary-level hospitals were positively associated with job satisfaction (p < 0.05). Age demonstrated a statistically significant association with job satisfaction, while years of work experience showed a negative correlation, with satisfaction decreasing as tenure increased (r = −0.09, p < 0.001). The findings indicate that improving healthcare workers’ job satisfaction requires strengthening and supporting several organizational dimensions, including supportive leadership, opportunities for human resource development, organizational culture, workplace safety, and a supportive work environment Conclusion Workplace safety and support, opportunities for human resource development, and organizational culture were found to be critical determinants of employee job satisfaction. The findings suggest that job satisfaction can be enhanced by optimizing organizational support, ensuring opportunities for professional growth, and strengthening workplace safety

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Study risk factors, genotype and prevalence of HCV infection among the populations in Arkhangai, Mongolia

Amgalan B ; ; Tsolmon Ch ; Myagmarjaltan B ; Naranzul N ; Khurelbaatar N ; Baatarkhuu O

Mongolian Journal of Health Sciences.2025;89(5):18-24.

Background: Hepatitis C virus (HCV) is a blood-borne infectious disease that, if left untreated, can lead to chronic infection, liver cirrhosis, and hepatocellular carcinoma. In Mongolia, the prevalence of HCV is relatively high, posing significant public health concerns. In alignment with the global goal to eliminate hepatitis B and C by 2030, this study aimed to investigate the prevalence, genotype distribution, and associated risk factors of HCV infection among the general population in Arkhangai province, Mongolia. Aim: To determine the prevalence of hepatitis C virus infection among the relatively healthy population of Arkhangai Province and to study its genotypes and risk factors. Materials and Methods: A cross-sectional analytical study was conducted using a two-stage sampling method, enrolling 2,304 individuals aged 0–80 years. Participants completed a structured questionnaire, and blood samples were collected for anti-HCV and HBsAg testing using enzyme-linked immunosorbent assay (ELISA) at the central laboratory of the provincial hospital. Serum from anti-HCV positive individuals was preserved at –80°C and transported to Ulaanbaatar for HCV RNA quantification via real-time polymerase chain reaction (RT-PCR) and genotyping through molecular diagnostics. Statistical analyses were conducted using SPSS version 26.0. Results: A total of 2,304 individuals from the provincial center and 8 soums participated in the study, of whom 57.8% were female. The overall HCV seroprevalence was 12.0%, with chronic HCV infection confirmed in 7.16%. Among patients with chronic HCV, genotype 1b was identified in 98.2% of cases. Risk factor analysis revealed statistically significant associations between HCV infection and undergoing cosmetic procedures, receiving injections in non-medical settings, cupping therapy, and sharing shaving equipment. Conclusion This study HCV seroprevalence of 12.0% among the relatively healthy population in Arkhangai province, with genotype 1b detected in 98.2% of chronic HCV cases. The following risk factors were found to be independently associated with HCV infection: undergoing cosmetic procedures (OR: 2.3), cupping therapy (OR: 1.7), receiving nonmedical injections (OR: 2.4), and sharing shaving tools (OR: 1.5) (p<0.001)

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Study of the stomatal cell in certain saponin containing medicinal plants in mongolia

Nurdana B ; Khulangoо B ; Densmaa L ; Norovnyam R ; Enkhtuul B ; Khuvtavilan B ; Munkhzul B ; Buyanjargal E ; Daariimaa Kh ; Enkhjargal D ; Turtushikh D ; Amarjargal T

Mongolian Journal of Health Sciences.2025;89(5):33-38.

Background: Saponins are secondary metabolites in plants that play an important role in defense mechanisms and physiological processes. Since stomatal cells are crucial for gas exchange and water balance in plant tissues, studying the anatomical and biochemical features of stomatal cells in saponin-rich plant species provides insight into the interactions between these compounds and cellular mechanisms. This serves as the basis of our study. Aim: To determine the structure, types, and functions of stomatal cells in saponin-containing medicinal plants Materials and Methods: During June–September 2024, nine species of saponin-containing medicinal plants were collected from Bulgan, Tuv provinces, and “Gorkhi-Terelj National Park” in Mongolia. Prepared microscopic specimens were examined using macroscopic and microscopic techniques to study the structure, position, number, and epidermal features of stomatal cells. Results: The study revealed that Anemone crinita Juz. exhibited the highest stomatal density (107 stomata/mm²) and epidermal cell density (229 cells/mm²), indicating strong adaptation and protective capacity in arid conditions. Vicia baicalensis (Turcz.) B. Fedtsch. showed the highest stomatal index (39.6), highlighting its significant role in regulating transpiration. Stomatal types varied among species: • Anomocytic stomata were observed in Potentilla multifida and Vicia baicalensis. • Anisocytic stomata were found in Delphinium grandiflorum and Ranunculus borealis. • Paracytic stomata were present in Gentiana algida, Adenophora remotiflora, Helianthemum nummularium, Anemone crinita, and Ranunculus acris. Conclution In the study of the structure, form, and number of stomatal cells in saponin-containing plants growing in Mongolia, Anemone crinita Juz. was found to have the highest number of stomatal and epidermal cells, indicating its high efficiency in gas exchange, water regulation, and protection against external stress. Furthermore, Vicia baicalensis (Turcz.) B.Fedtsch. showed the highest stomatal index, confirming its strong capacity for active regulation of gas exchange. The variation in stomatal cell types among plant species was identified as playing an important role in ecological and biological adaptation as well as protective mechanisms.

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Evaluation of the effectiveness of electroacupuncture in facial nerve palsy

Deng Yu Qi ; ; Oyunbileg Yu ; Nomin-Erdene U ; Enkhtuya V

Mongolian Journal of Health Sciences.2025;89(5):39-44.

Background: : Facial palsy, or facial neuropathy, is a peripheral facial paralysis condition known as Bell’s palsy, characterized by weakened muscles on one side of the face, limited movement in that area, and facial distortion. According to data from the U.S. National Institutes of Health (NIH), this condition occurs in 15-20 per 100.000 people, with 40.000 new cases diagnosed annually. Bell’s palsy can affect people of all ages but is more prevalent among middle-aged individuals, with the average age of onset being 40. It is also more common during the spring and autumn seasons. We conducted this study to clinically validate the efficacy of electroacupuncture treatment for facial neuropathy through experimental research methods. Aim: Evaluation of treating facial nerve paralysis with the electroacupuncture method. Materials and Methods: The study was conducted based at the International School of Mongolian Medicine and The Central Hospital of Mongolian Traditional Medicine of MNUMS, and the Chinese Mongolian United Hospital of Ulanqab City, Inner Mongolia Autonomous Region, China. Participants were randomly allocated into a treatment group and a control group, with 30 participants in each group. Both groups were orally administered Tab. Acyclovir 100 mg at a dosage of 200 mg four times daily at 6-hour intervals for 5 days. Additionally, the 30 participants in the treatment group received electroacupuncture therapy, while the control group received an electrical patch application. The treatment was administered consecutively for 5 days, followed by a 2-day break, over a total of 4 weeks. The outcomes were evaluated using the FDI and House-Brackmann questionnaires before treatment, as well as on the 15th, 30th, and 60th days of the treatment period Results: After administering electroacupuncture treatment to the treatment group, the patients’ clinical symptoms significantly improved. The movement of the facial muscles on the affected side gradually recovered, and pathological signs such as incomplete eyelid closure showed marked improvement. Additionally, in most patients, taste sensation began to recover by the middle phase of the treatment, and symptoms such as drooling and difficulty with cheek puffing completely disappeared. On the 30th day of treatment, a comparison of the treatment outcomes between the two groups using the FDI and House-Brackmann questionnaires reve Conclusions 1. Combining electroacupuncture with antiviral medication for the treatment of facial nerve paralysis (Bell’s Palsy) is effective and reduces the likelihood of sequelae. 2. When evaluating treatment outcomes using the Facial Disability Index (FDI) and House-Brackmann Scale (HBS), electroacupuncture demonstrates superior effectiveness compared to patch therapy.

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Findings on the average age at menarche among girls in selected districts and rural areas

Zolboo B ; ; Shiirevnyamba A ; Mongonnavch E ; Dulamsuren Ya ; ; Nomin-Erdene Ts ; Ankhmaa D ; Myadagmaa J

Mongolian Journal of Health Sciences.2025;89(5):45-47.

Background: The average age at menarche (AAM) among girls is influenced by various factors, including the socioeconomic status of the country, geographical location, and anthropometric characteristics. In Mongolia, limited research has been conducted on this topic Aim: This study aimed to compare the mean age at menarche among girls living in Bayanzürkh District of Ulaanbaatar and those in Uvs Province. Materials and Methods: A cross-sectional study was conducted between April and June 2025. The study participants included schoolgirls aged 8 years and older from general education schools located in Bayanzürkh District and Uvs Province. Statistical analyses were performed using R version 4.5.1 (RStudio 2025.05.1-513) Results: A total of 486 girls participated in the study. The mean age at menarche among the participants was 12.23±1.29 years. The mean age at menarche among girls aged 8–18 years in Bayanzürkh District was 11.84±1.19 years, while that among girls aged 8–18 years in Uvs Province was 12.97±1.15 years. Thus, girls in Bayanzürkh District experienced menarche 1.13 years earlier on average than those in Uvs Province. The difference in mean AAM between urban (Ulaanbaatar) and rural (Uvs Province) girls was statistically significant (p<0.0001). Conclusion The mean age at menarche among girls residing in Bayanzürkh District was significantly lower than that of girls living in Uvs Province, indicating a tendency toward earlier onset of menarche in urban areas.

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Study on the Level of Smoking and Health Risk Behaviors among University Students

Namuuntsetseg B ; Bayartsetseg A ; Davaasuren Ts ; Azjargal B

Mongolian Journal of Health Sciences.2025;89(5):48-54.

Background: In a study conducted in the United States, there is a possibility of negative health effects due to risky behavior. Most smokers (88%) started using tobacco before the age of 18years. In recent years, the use of e-cigarettes has increased in Mongolia, which can be seen by the fact that someone around us is using them. All tobacco products are addictive and involve risky behaviors. Risky behaviors are behaviors that pose a risk of harming one’s own or others’ health, causing morbidity or mortality. Therefore, there is no study on the level of smoking dependence and risky behavior among students, which is the basis of our study. Aim: The study is aimed to evaluate the risky behavior and cigarette smoking among students who are studying the school of university Material and Methods: The study was conducted by using a cross sectional design and a quantitative research method. All students of the School of Nursing, MNUMS were included. First to fourth course students of nursing school were included on a voluntary basis. Results: In the study, 87.8% of participants were female and 12.2% were male student. Furthermore, 50.2% of respondents are smokers. When the physical nicotine dependence test was taken from smoking students, moderate to high levels of dependence were identified, indicating there is behavioral risk. Risk behaviors are associated with factors such as safety, violence, bullying, feelings of sadness, use of tobacco and drugs, consumption of alcoholic beverages, changes in sexual orientation, and body weight. Conclusions 1. The students have limited scientific understanding and explanation regarding tobacco use. 2. Among the study participants, 5.4% had a very low level of dependence, 34% had a low level, 24.3% had a moderate level, 35.6% had a high level, and 0.54% had a very high level of dependence. 3. Risk behaviors related to health include tobacco use, alcohol consumption, marijuana use, bullying and violence, sexual activity, feelings of sadness or suicidal thoughts, screen dependence, and consumption of cola beverages.

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Students’ Nutritional Status and Health Behavior Survey (Example: Inner Mongolia Medical University)

Urga (Wu RI Ya) ; Oyunbileg D ; Gantuya D

Mongolian Journal of Health Sciences.2025;89(5):55-59.

Background: Nutritional status among university students is a critical public health issue. Students often face undernutrition or overeating due to social, cultural, and academic pressures. This study aimed to assess the dietary habits and health behaviors of students at Inner Mongolia Medical University to inform targeted intervention strategies. Aim: To examine the differences in dietary patterns among students and their effects on health outcomes. Materials and Methods: A cross-sectional study was conducted among 218 students (133 males, 85 females; ages 19–24) from the 3rd to 5th year of the Clinical Medicine program. Participants were randomly selected. Data were collected via a structured questionnaire based on the “Chinese Resident Dietary Guidelines (2022)” and relevant domestic and international literature. Variables included demographic information, dietary intake (fruits, vegetables, fats, starches, sugar, salt, water, alcohol, dairy), and physical activity patterns. Data were analyzed using SPSS 26.0, with frequencies and percentages for categorical variables and means ± SD for continuous variables. Results: The 87.61% of students consumed fruits and vegetables daily, but only 73.39% met the recommended five types per day. The main barriers were limited availability (51.38%), high cost (31.65%), and lack of preparation time (16.97%). 67.89% preferred low-fat foods; 47.25% used vegetable oil, 22.94% butter, 22.02% margarine; daily fat consumption averaged 1–2 tablespoons. 77.98% consumed fried or roasted foods. 53.21% consumed sugar-rich products at breakfast; 62–64% added sugar to beverages or consumed sweetened snacks; high salt intake was common through processed foods. The 36.24% exercised once per week, 25.69% twice; only 10.09% exercised four or more times per week. 68.81% consumed alcohol at varying frequencies; beer, red wine, and white wine were common. Over half of students were at risk of high blood pressure due to dietary and lifestyle factors. Conclusion Students at Inner Mongolia Medical University face significant dietary challenges, including unbalanced diets, high sugar and salt intake, irregular meals, and inadequate physical activity. There is an urgent need for personal and institutional interventions to promote healthy dietary and lifestyle habits.

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