Introduction: Safe and accessible WASH services in healthcare facilities are crucial for maintaining high quality care, especially for maternal and newborn health. The WHO-UNICEF JMP on Water Supply, Sanitation, and Hygiene provides reports on progress in water supply, sanitation, and hygiene services at global, regional, and national levels, covering populations, schools, and healthcare facilities. This assessment was conducted to address the insufficient data on the level of hand hygiene services in healthcare facilities, following the methodology of the JMP. Materials and Methods: A cross-sectional study was conducted in 319 healthcare facilities. Availability of hand hygiene services in the study healthcare facilities was assessed using questionnaire of methodology of the JMP. Data were analyzed using SPSS 25.0 software. Relevant parametric and non parametric statistical analysis were conducted. Results: Overall, 72% and 28% of healthcare facilities had basic and limited hand hygiene service respectively. About 18% of private healthcare facilities had limited hand hygiene service compared to 34% of state healthcare facilities. While 20% of urban healthcare facilities had limited hand hygiene service, 56% of rural healthcare facilities do. When examining the level of hand hygiene services by type of medical care, specialty hospitals have 100% basic services. Among primary care facilities, 83% of family health centers provide basic services, while 41% of soum and village health centers meet these standards. Conclusion The basic hand hygiene services in urban healthcare facilities and specialty hospitals were generally sufficient. There need to enhance basic hand hygiene service at the soum and village level. Among the assessed facilities, 81.0% met four out of the five key hand hygiene requirements outlined in the national standard. However, additional budget allocation for maintenance and operational costs for keeping soap and sustaining water running remains crucial to ensure sustained compliance and quality.

Climate change and child malnutrition Introductions: Globally, one billion children are living in areas at high risk of climate change exposure. Among them, over 200 million children under the age of five suffer from severe malnutrition, and 148 million experience growth and developmental stunting. Climate change affects key determinants of child health such as the nutritional value of food, environmental conditions, and living standards. Mongolia is classified among countries with a high climate vulnerability index. Therefore, it is essential to study the impact of climate change on children's health in the Mongolian context. We aimed at determining the prevalence and trends of nutritional deficiencies among children under five years of age and to assess the impact of climate change on these deficiencies. Materials and methods: This study was conducted using international databases. Climate change was evaluated using indicators such as the Climate Change Index, average annual land surface temperature, air quality, soil contamination, and precipitation levels. Data on child nutrition were collected from the Institute for Health Metrics and Evaluation (IHME) database and the Mongolian National Statistical Information Service for the period 2000–2019. Nutritional deficiencies were measured using indicators including wasting and overweight among children under five. Trends in the prevalence of nutritional deficiencies were analyzed using the AR(I)MA model to forecast changes between 2020 and 2030. Regional variations were assessed using panel regression models, and the impact of regional climate variables on child nutrition was estimated. Results: The climate vulnerability index in Mongolia has been increasing, with trends indicating further rises in temperature variability. From 2000 to 2019, the prevalence of wasting and stunting among children under five showed a decreasing trend, with annual reductions projected at 0.5% and 1.8%, respectively. In contrast, overweight and obesity among children under five are projected to increase until 2030, with Ulaanbaatar showing statistically significant high values. A correlation was found between climate change indicators and childhood overweight. Conclusions: There is a rising trend in overweight and obesity among young children. Climate change has both direct and indirect impacts on child nutrition, food safety, and nutritional deficiencies. These associations must be taken into serious consideration in public health planning and policy.

COVID-19 and pregnancy: a national registry based study Background: According to a cohort study involving 2,130 pregnant women from 16 countries, the impact of COVID-19 on maternal morbidity and mortality was higher in low- and middle-income countries. Other one study found that the coronavirus pandemic increased maternal mortality by 1.37 times. The COVID-19-related mortality risk is 3 times higher in pregnant women than in the general population. In our country, there is a lack of evidence that determine the impact of COVID-19 on maternal mortality based on the national registration system. We aimed to study the relationship between COVID-19 and maternal mortality and complications based on national registry data Materials and methods: The study was conducted between February 20, 2022 and March 1, 2022 based NCMCH. The impact of the coronavirus pandemic on maternal mortality was performed based on the 2020-2021 maternal mortality data of Mongolia through a retrospective and time series analysis. In order to estimated factors that affect the complications of a pregnant women’s COVID-19 infection, it was conducted a retrospective study design based on the database of pregnant women diagnosed with a COVID-19 infection. The study data was collected through a prepared questionnaire. Results: According to analysis, the maternal mortality rate in Mongolia in 2021 was 1.9 times higher than the predicted rate. In 2021, 67.6% of maternal deaths are due to COVID-19. In 2021, the maternal mortality rate due to Covid-19 was 64.2 per 100,000 live births, which is twice as high as maternal mortality due to other diseases. In 2020-2022, 17,789 pregnant women between the ages of 14 and 46 who were infected with the coronavirus were included in the study to determine the factors affecting the complications of COVID-19. The mean age of the participants was 30 ± 5.8 (95% CI 29.7 – 29.9) and their gestational age was 24 ± 10 weeks. Of all participants, 71.6% was diagnosed and treated in Ulaanbaatar. 52.7% of pregnant mothers diagnosed with coronavirus and presenting with complications have not been vaccinated, which is a relatively high rate compared to the group of pregnant mothers without complications. Not being vaccinated against coronavirus had a 70% increased risk of complications (OR = 1.7, 95.0% CI: 1.4–2.0). However, the probability of hospitalization increased by 20% (OR = 1.2, 95.0% CI: 1.0 – 1.4). The COVID-19 severity depends on the age of the maternal and the length of the pregnancy. Conclusion: The COVID-19 pandemic has had a significant impact on maternal mortality, has increased. The maternal mortality rate in Mongolia is low compared to other countries, but it is higher than the recommended level for reducing maternal mortality. COVID-19 vaccination, on the other hand, reduced the complications of pregnant women and had a protective effect. It is important to build evidence by examining the effects of COVID-19 and vaccines on pregnant women.

Assessing children with disabilities using who international classification of functioning (ICF) Background: In 2021, according to the World Health Organization (WHO), over 1 billion people are estimated to experience disability. The number of children with disabilities globally is estimated at almost 240 million, according to a new UNICEF report. There are approximately 43 million children with disabilities in East Asia and the Pacific. In the 2020 population and housing census of Mongolia, a total of 106.4 thousand people with disabilities were counted, of which 7.6 percent or 8.1 thousand children aged 0-14 were counted. People with disabilities lose some of their ability to labor. WHO recommended that assessment of children with disabilities using both ICD and ICF. Thus, we aim to assess children with disabilities who have neurological disease using International Classification of Functioning and evaluate the validity of this classification. Materials and methods: This was a cross sectional analytical study based on NCMCH. Study materials were collected from children and guardians through standard questionnaires. The questionnaire consisted of 2 groups: general information of the participant and indicators of the scope of the D code of the "ICF" to assess the childhood disability. According to the indicators of the D code range, activity limitations and participation restriction, disabilities were evaluated. Each question in the questionnaire was measured on a 5-point Likert scale from 0 to 4. The statistical analysis was performed using R 3.5.1 program. Validity was assessed using the Rasch model for each question. Questionnaire reliability was assessed by Cronbach's alpha test. Results: The study included 32 children aged 2-15 years. Male children were 62.5% of participants, the mean age was 8±3.1 years. Correlation between questions was high (r = 0.79) and reliability was adequate (α=0.94). As a result of Rasch analysis, the mean and standard deviation of the 36 selected parameters were not significantly different from the standardized mean. 3 indicators that did not meet the analysis criteria were removed, and a total of 33 indicators were used to measure childhood disabilities. Mean infit MNSQ was 1.06, mean outfit MNSQ was 0.93. MNSQ of all participants were 1.0 – 2.0. As a result of Rasch analysis, the mean of 33 indicators of disability is -1.6, the standard deviation is 1.2, the upper limit of the mean is 3.6, and the lower limit is -3.4, and the indicator of D code was stable enough to measure disability. The mean code scores were 2.45±1.3. The mean score of disability level of children diagnosed with cerebral palsy was 2.9±1.09, and children hospitalized with seizures and meningitis was 0.5±0.3. Also, the total mean score was 2.61±1.2 in the group with disability and receiving care, and 1.8±0.21 in the group not receiving care, which was a statistically significant difference. Conclusions: Inter-indicator correlation was good and reliability of the questionnaire was adequate in field use of the 38 indicators of the activity limitations and participation restriction of the International Classification of Functioning, Children's Version (ICF-CY) code range “D”. When evaluated by Rasch analysis, 33 questions were evaluated as structural and stable. The International Classification of Functioning can be used to assess children's disabilities. Discussions: Niels Ove Illum et al. (2015) found that The World Health Organization International Classification of Functioning, Disability and Health child and youth version d code data can provide a coherent measure of severity of disability in children across various diagnoses, ages, and genders. Results were similar to our study.

Effects of COVID-19 on pregnancy and delivery outcome: systematic review with meta-analysis Introduction: The impact of Coronavirus infection disease (COVID-19) on during pregnancy, maternal outcome, and neonatal health is unclear. We aimed to measure about effect of Coronavirus infection to pregnancy, maternal outcome, and newborn health in systematic review with meta-analysis. Materials and methods: The systematic review and meta-analysis conducted PRISMA guidelines, recommended from Cochrane, based on database of studies and a hypothesis to determine the impact of COVID-19 on pregnancy, maternal, and neonatal outcome. We searched for eligible studies of databases from December 2019 to April 2021. Our dependent variables were preeclampsia, preterm birth and stillbirth. Independent variables were infection of COVID during pregnancy, and outcomes. We measured for primary outcome that are preeclampsia, preterm birth, and secondary stillbirth. The meta-analysis evaluated the quality of the observational study (Newcastle – Ottawa Scale) and included the results. Statistical analysis was performed using Rev Man 5.0 software. The ratio (OR) in meta-analysis was calculated using a meta-regression model (Random effect meta-analysis). The mean difference was measured and weighed 95.0% confidence interval. Results: We included 46 studies involving 459,789 participants. Coronavirus infection maybe associated with increase the risks of preeclampsia in pregnancy (B: 1.21, 95.0% CI: 1.01 - 1.25), premature birth (B: 1.91, 95.0% CI: 1.62–2.15), stillbirth (B: 2.2, 95.0% CI: 2.12–2.31. Conclusions: Coronavirus infection increases the risk of preeclampsia, premature birth and stillbirth. Furthermore, the studies are needed to collect more robust data to validate or substantiate these findings, better understand the impact of COVID on pregnancy in experiment, intervention, and cohort studies with Meta-Analysis.

Correlation between delay time of surgery of congenital cataract and postoperative visual acuity Introduction: Worldwide, child cataract is 1 to 15 cases per 100,000 children are diagnosed. In the International Classification of Diseases, pediatric cataracts are classified as congenital (Q12) and developmental (H26.0). Congenital cataract occurs in 1–3 out of 10,000 children, and if diagnosed, surgery is required without delay. International researchers report that congenital cataracts require semi-emergency surgery. It is also recommended that children with congenital cataracts be diagnosed after 3 months of age without surgery. Congenital cataracts are recommended for surgery in one eye within 6 weeks and in both eyes within 10 weeks. Early detection of congenital cataracts and emergency surgical treatment are important to improve postoperative visual outcome and quality of life. To investigate the correlation between the surgical delay time and postoperative visual acuity in children diagnosed with congenital cataracts. Material and methods: This study conduct based on the ophthalmic surgery department of the National Center for Maternal and Child Health, performed for a retrospective longitudinal study design. The study examined cases of congenital cataracts in both eyes and retrospectively follow patients who had congenital cataract surgery in 2018-2020 from the onset of symptoms to the postoperative period. The sample size was calculated using open.epi. We sampled participants for non-probabilistic purposes. The study included children 1 year of age and younger or with nystagmus, cataract with nuclear and polar morphology , and bilateral cataracts Statistical analysis was performed using STATA 16.0 software. The risk of delay time to visual acuity was determined by an ordinal regression model. Results: The study included 46 cases of congenital cataracts, under the age of 16. 61 percent of the children were male and 58.7 percent were from rural areas. The postoperative visual acuity of the children in the study was <0.09 in 52.2% (n = 24) and 0.1

BACKGROUND. HCV-infected and obesity related liver diseases are leading to increases in the prevalence of advanced liver disease. So, studying liver disease, especially liver fibrosis is crucial issue of today. In Mongolia digestive system disease is second causation of non-communicable disease. Therefrom in last years hepatocellular carcinoma is most common malignancy, first of all cancers in Mongolia. In response to acute or chronic liver injury, hepatic fibrosis is the accumulation of extracellular matrix and ultimately leads to cirrhosis. Cirrhosis is the end-stage of fibrosis, resulting in nodule formation that may lead to altered hepatic function and blood flow. Defining the phase of liver fibrosis is crucial for therapeutic choice prognosis, important role in monitoring treatment. At the present time, use of direct and undirect biomarkers methods could be recommended for liver fibrosis stage. The aim of this study is to determine liver fibrosis stage and to compare undirect biomarkers in chronic viral hepatitis, cirrhosis. METHODS: 630 cases by chronic viral hepatitis and cirrhosis at third central hospital in Mongolia from retrospectively reviewed and analysed. The clinical data including AST, ALT, platelet count and INR were recorded. APRI, FIB-4, AAR and FibroQ were calculated. RESULT: From all, males 42.06% and females 57.94%, with mean age of 55.35±24.0, in 130 cases with chronic viral hepatitis and 500 cases with cirrhosis. In cases of cirrhosis, mean value of platelet count, ALT, AST, INR was 120.54±73.53, 104.55±500.22, 111.68±279.97, 2.19±10.45, respectively. And in cases of chronic viral hepatitis platelet count mean value was 211.18±6.42. APRI was detected <0.5 cutoff value (F0-F1) 11.7% non-fibrosis, 0.5-1.5 score (F2-F3) 27.5% fibrosis, >1.5 cutoff value (F4) 60.8% cirrhosis. FIB-4 was determined <1.45 cutoff value (F0-F1) 14.8% non-fibrosis, 1.45-3.25 score (F2-F3) 15.7% fibrosis, >3.25 cutoff value (F4) 69.5%, AAR was showed <0.4 cutoff value (F0-F1) 2.3% non-fibrosis, 0.4-1 score (F2-F3) 30.2% fibrosis, >1 cutoff value (F4) 67.5%. And FibroQ was detected <0.6 cutoff value (F0- F1) 0.5% non-fibrosis, 0.6-2.6 score (F2-F3) 6% fibrosis, cutoff value 2.6< (F4) 93.5 cirrhosis. In study liver fibrosis staging by APRI, AAR, FIB-4 and FibroQ score system, AAR was determined fibrosis in 190 cases. CONCLUSION: Recorded data ALT, AST, INR in cases of cirrhosis were detected 104.55±500.22, 111.68±279.97, 2.19±10.45, respectively. And in cases of chronic hepatitis platelet count mean value was 211.18±6.42. APRI, AAR, FIB-4, FibroQ was determined fibrosis 27.5%,30.16%,15.71% and 6.03%, respectively.