Background: Toxoplasmosis is an infection caused by the parasite Toxoplasma gondii. Cats are the reservoir of the parasite. Humans can become infected either by ingesting the cysts (by direct contact with cats or through food or water contaminated by cat faeces) or by eating poorly cooked meat containing cysts. We aimed to study on knowledge, attitude, risk of Toxoplasmosis among herder in Khovd province. Materials and Methods:
<b>Study methods: b>The study used a descriptive cross-sectional design and included herders from Bulgan, Buyant, Darvi, Zereg, Myangad, Khovd, Erdeneburen, Jargalant soum, which have the largest livestock number in Khovd province. A questionnaire was administered to determine the knowledge, attitudes, and risk factors for toxoplasmosis among herders. Study ethics: Before starting the study, the methodology was discussed at a meeting of the Ethics Committee of “Ach” University of Applied Sciences, and the research (Resolution No. 23/02) was approved. Data processing: The data collected during the study were coded into Microsoft Office Excel and a database (file) was created. Open Epi Info and SPSS 20 were used to statistically process the results of the study (mean, standard deviation, relative risk). Result: In result, 180 herder’s average age was 48.1±17.8 years old, most of them were female. Most of herder were herding their livestock over six years. During their herding period, 31% of herder household has registered rabies, anthrax, brucellosis, swine fever, blood infection, blindness, smallpox, horse pox, scabies, foot and mouth disease among their livestock. By questionnaire, toxoplasmosis has not registered among livestock. When assessing self protection practices when dealing with suspected infected animals, 14-22.3% use masks and aprons when dealing with sick animals, 1.4-3% use goggles, coveralls, and disinfectants, and the lowest percentage is 0.2% of gloves. This indicates a very high risk of transmission of zoonotic diseases among herder of Khovd province. Conclusion In our study, although no cases of toxoplasmosis were recorded among livestock in the soums of the Khovd province by questionarie, the lack of self-protection practices and attitudes against animal-to-human transmission and the high risk of infection indicate the importance of disseminating information and organizing training on zoonotic diseases

Study about caeserean section In nulliparous women Introduction: Cesarean section rates in Mongolia exceed WHO recommendations of 5–15%, reaching 27.6% nationally and 34.1% at the First Maternity Hospital between 2019–2023. C-sections, while life-saving, increase risks of hemorrhage, infection, uterine complications, and reduced maternal quality of life. This study aimed to analyze emergency C-sections by Robson classification and identify associated risk factors in groups 1, 2a, 3, and 4a. Materials and methods: A retrospective case-control study was conducted using 886 medical records (443 emergency C-sections and 443 vaginal deliveries) from 2021–2023. Data were analyzed with IBM SPSS 24.0, and binary logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI). Results: Robson 2a was the most frequent category (43.8%), followed by 4a (25.7%), 1 (20.1%), and 3 (10.4%). Significant risk factors for emergency C-section included maternal age (p<0.001), early cervical dilation (<5 cm) at labor diagnosis (OR 3.54), abnormal CTG, pre-eclampsia, PROM, amniotomy, infertility, and malposition. Multivariate analysis showed PROM (aOR 14.66), amniotomy (aOR 6.85), fetal weight ≥4000 g (aOR 4.07), and maternal age (aOR 1.48) as key predictors. Conclusions: Emergency C-sections were most common in Robson group 2a. Major contributing factors included PROM, amniotomy, maternal age, macrosomia, and abnormal labor patterns. Targeted interventions to manage these risk factors could reduce unnecessary emergency C-sections.

Background: Tick-borne encephalitis is human viral infection involving the nervous system and transmitted by the bite of infected tick. The TBE Virus is distributed in different geographical areas by three widespread subtypes of the virus: The Far East, Europe, and Siberia. The Far East type has a mortality rate was 30-35%, the European type has a mortality rate of 2.2%, and the Siberian type has a mortality rate of 6-8% (A.G. Pletnev, 1998) [2].
In recent years, human cases of tick-borne infections have been reported in 19 European countries and four Asian countries (Mongolia, China, Japan, and South Korea) [3].
Human cases of tick-borne encephalitis, tick-borne rickettsiosis, and tick-borne borreliosis have been registered in Mongolia since 2005. Deaths have been reported year by year [5].
During 2005 to 2021, tick-borne rickettsiosis (71.6%), tick-borne encephalitis (17.3%) and tick-borne borreliosis (52.9%) were confirmed by epidemiological, clinical and laboratory tests at the NCZD.
Tick-borne encephalitis was registered in 63 soums of 15 provinces and 9 districts of the capital city, of which 90% were infected with tick bites in Selenge and Bulgan provinces. The average mortality rate is 4.9% (14), of which 28.6% in Bulgan province and 2.7% in Selenge province.
Tick-borne encephalitis is the leading cause of death in Bugat soum of Bulgan province and more infected men about 40 years of age [7]. Purpose : Collect ticks from selected soums of the provinces, identify tick species, species composition, distribution, tick densities, pathogens of tick-borne diseases, conduct population surveys to assess the risk of tick-borne infections, and identify tick-borne infections. Material and Method: Ticks were collected by flag from birch trees in birch forests and meadows with biotope and overgrown berries, determined morphological analyze and molecular biological investigation for detecting tickborne pathogens.
Questionnaires were collected from selected soum residents according to a specially designed randomized epidemiological and clinical survey card, collected information and forms were submitted to soum hospitals with a history of tick bites (according to clinical criteria). Serological tests were performed to detect IgG-specific antibodies to the collected serum mites. Result and conclusion Collected 121 ticks (120 I. persulcatus and 1 D. nuttalli) and not wound egg, larvae, nymphs. By molecular biological investigation detected 3.5% of I.persulcatus from Khutag-Undur soum of Bulgan province, 3.5% of anaplasmosis, and 14.1% of I.persulcatus mites from Bugat soum. 1.5% borreliosis, 3.1% anaplasmosis.
Detected DNA of 100% tick-borne rickettsiosis from D.nutalli ticks and determined circulation of infection among tick in Bugat and Khutag-Undur soums of Bulgan province.
247 people were surveyed, 56 blood serum from cases. Detected Q fever, erysipelas, and anaplasmosis, tick-borne borreliosis 3 (5.4%), tick-borne rickettsiosis 26 (46.4%), Japanese encephalitis 3 (5.4%), tick-borne encephalitis tick-borne rickettsiosis 6 (13.0%), tick-borne rickettsiosis tick-borne borreliosis 1 (1.8%), tick’s rickettsiosis Japanese encephalitis 1 (1.8%), tick-borne encephalitis tick-borne borreliosis 1 (1.8%).
By investigation, vaccination (88%) and wearing long-sleeved shirts and pants (81%) were the most effective ways to prevent tick bites (81%) [15]. According to our research, the percent of population knowledge in Bulgan province was insufficient (40.9%) which there is a lack of information, training and advertisement among the population in the province.

The microbiologist, who aged 44 man has work with glander DNA extraction between January and March at 2022, was developed sumptoms with fever, headache, muscle pain, weakness, cut throat, cough at 4 March, 2022. On March 7, he had tested Covid-19 and the result was negative. He was given 1gr tefazoline by eight-time interval for two days. Despite completing the therapy, episodes of fever and headache increased. A medical evaluation, which included MRI test was no disorder was developed. On March 12, painful with leg and developed muscle pain. He continued to difficulty to walk and cough, fever and weakness. On March 13, he has admitted hospital with diagnoses pneumonia.
He had continued sign with pneumonia in both lung, fever, infiltration with right leg, cough, headache, and glandule node in hospital. By PCR test, glander DNA was detected in sputum in National Center for Zoonotic Diseases laboratory. He recovered 20 days in hospital.
He has 12 days incubation period and infection route was by worked with glander strain and it was pneumonia form with laboratory-acquired human glanders.
Human glander case is rare in Mongolia. Three human glander cases had registered in 1966, 1972, 1977 among prison’s horse herder in Mongolia.

Background: Medical geography deals with the application of major concepts and theories derived from human and physical geography to issues of health and disease. Between1970-1980, Russian scientists were first figured landscape, geographical distribution of TBE in Mongolia. Since human cases of TBD were registered from 2005, around 2000 cases of TBD were registered. From 15% of diseases and 78% of fatal cases were tick-borne encephalitis. Therefore, were tried to create current geographical distribution of TBE in Mongolia and detect risk areas. Мaterials and Methods: 287 TBE cases data, information of TBE positive tick and human data were analyzed which registered in NCZD between 2005-2017. Arc GIS 9 were used for create map. Mongolian map was divided by 5 landscape range such as forest-taiga, forest-steppe, steppe, steppe-desert, gobi and high mountain. Result: In forest-taiga range, 57% of TBE cases and incidence was 9.51 per 10000 population. 56.4% of I.persulcatus tick, 1.9% of D.nuttalli tick were found and infection rate of tick was Ixodes persulcatus-6.97%, Dermacentor nuttalli-5.2%. Seroprevalence of TBE was 25±12.1 among population.
In forest-steppe range, 40% of TBE cases and incidence was 0.56 per 10000 population. 43.6% of I.persulcatus tick, 44.3% of D.nuttalli, 24.4% of D.silvarum tick tick were found and infection rate of tick was Ixodes persulcatus-3.08%, D.silvarum-1.56% and D.nuttalli-1.56%. Seroprevalence of TBE was 14.5±11 among population.
In steppe range, 0.7% of TBE cases and incidence was 0.12 per 10000 population. 62.2% of D.silvarum tick, 23.9% of D.nuttalli tick were found and infection rate of tick was D.nuttalli-2.81% and D.silvarum-1.2%. Seroprevalence of TBE was 16.3±6.5 among population.
In other range including steppe-desert, gobi and high mountain, 2.8% of TBE cases and incidence was 0.1-0.27 per 10000 population. 62.2% of D.silvarum tick, 47.6% of D.nuttalli tick were found and infection rate of tick was D.nuttalli-0.84%. Seroprevalence of TBE was 2.5-13.1 among population. Conclusion Natural foci of tick-borne encephalitis have been registered in all landscape ranges of Mongolia and higher risk area of those ranges were forest-taiga and forest-steppe. Dermacentor silvarum, Dermacentor nuttalli tick becoming dominant vector of TBE in steppe range.

BACKGROUND. Traditional medicine is the oldest form of health care in the world and is used in the prevention and treatment of physical and mental illnesses3. Traditional medicine is also variously known as complementary and alternative, or ethnic medicine, and it still plays a key role in many countries today11. Plant produces a wide variety of secondary metabolites which are used either directly as precursors or as lead compounds in the pharmaceutical industry. It is expected that plant extracts showing target sites other than those used by antibiotics will be active against drug resistant microbial pathogens7. Antibacterial activities of various extracts, including methanol, ethanol, butanol and ethyl acetate crude extracts from traditional Tiishal medicine and its medicinal plants ingredients were carried out. Staphylococcus aureus, Pseudomonas aeruginosa, Micrococcus luteus, Salmonella enterica. For this purpose extract of drug Tiishal were prepared and tested by “Disc Diffusion Method”. As a result of this study it was found that the extract of Tiishal generally revealed antimicrobial activity against both gram positive bacteria (Staphylococcus aureus, Pseudomonas aeruginosa, Micrococcus luteus) and gram-negative bacteria (Salmonella enterica). The to study found that antibacterial activity of the ethanol extracts of each 6 samples showed little inhibition on Sal. enterica. METHODS. Traditional medicine Tiishal was produced from the Manba Datsan clinic and training center for traditional Mongolian medicine. Tiishal medicine was prepared by the standard MNS 5585:2006, № 0333151207 Tiishal medicine instructional method. The main medicinal herbs of Tiishal include Juniperus pseudosabinaFisch., Gentiana barbata Froel., Cynomorium songaricum Rupr., Sophora alopecuroides L., and Tricholoma mongolicum Imai (1:1:1:1:1) ratio. The antimicrobial activity of the ethanol, methanol, butanol and ethyl acetate extracts was carried by disc diffusion method. RESULTS. A total 4 strains were used for the antibacterial activity test. The extracts of methanol, and ethanol of J. pseudosabina revealed the highest antibacterial activity against Bac. subtilis, Ps. aeruginosa, S. aureus, and S. enteric with the diameters of inhibition zones between 6.0 - 10.0 mm. СONCLUSION. “Tiishal”, ethanol and methanol extracts of 5 different plants showed relatively low inhibition of bacterial growth.

ХУРААНГУЙ. Дутуу төрөлт нь анагаах ухаан төдийгүй нийгэм эдийн засгийн тулгамдсан асуудал юм. Дутуу болон жин багатай төрөх нь нярайн эндэгдэлийн тэргүүлэх шалтгааны нэг болж байна. Шүдний тулгуур эдийн үрэвсэлт өвчний үед зарим нянгийн бүрэлдэхүүн хэсгүүд нь жирэмсэлтийн явц ба ургийн хөгжилд нөлөөлж болдог гэдгийг харуулсан судалгааны үр дүнгүүд байдаг. Иймээс жирэмсэн эмэгтэйчүүдийн тулгуур эдийн өвчин нь нярайн дутуу болон жин багатай төрөх эрсдэлт хүчин зүйл болж байгаа эсэхийг судлахад энэхүү судалгааны зорилго оршино. Уг судалгааг эмнэлэгт суурилсан тохиолдол хяналтын загвараар Нийслэлийн Өргөө Амаржих Газар болон Эх Хүүхдийн Эрүүл Мэндийн Үндэсний Төв (ЭХЭМҮТ)-ийн нийт 90 оролцогчийг хамруулан хийж гүйцэтгэлээ. Тохиолдлын бүлэг 30 (37 долоо хоногоос бага тээлттэй, 2500 гр-aaс бага жинтэй нярай) оролцогч, хяналтын бүлэгт 60 (хэвийн тээлттэй) оролцогч хамрагдсан. Судалгаанд оролцогчдийн шүд цоорох өвчний (ШЦӨ) тархалт хяналтын бүлэгт 99%, эрчим 8.32 ЦЛА/ш, тохиолдолын бүлэгт ШЦӨ тархалт 100%, эрчим 11.33 ЦЛА/ш байв. Амны хөндийн эрүүл ахуйн (АХЭА) үзүүлэлтийг үнэлэхэд хяналтын бүлэгт 2.4 буюу ‘’дунд’’, тохиолдолын бүлэгт 3.2 буюу ‘’муу’’ үнэлгээтэй байлаа. Тулгуур эдийн өвчин, шүдний чулуу (***p<0.008), шүд буйлны эмгэг хөндийн гүн 4-6 мм байх нь (***p<0.006) жин багатай дутуу нярай (ЖБДН) төрөх эрсдэлт хүчин зүйл болж байгаа нь статистик ач холбогдол бүхий үр дүнг үзүүллээ. Буйлны үрэвсэл нь ЖБДН төрөх эрсдэлийг 5.5 дахин нэмэгдүүлж байна. Community Periodontal Index of Treatment Needs (CPITN) үзүүлэлт нь АХЭА үзүүлэлтээс хамааралтай болох нь статистикийн хувьд ач холбогдолтой байлаа (***р<0.000). Тулгуур эдийн өвчин шүдний чулуу, шүд буйлны эмгэг хөндийтэй байх нь ЖБДН төрөх эрсдэлт хүчин зүйл болж байгаа нь судалгааны үр дүнгээс ажиглагдлаа.

Preterm birth is not only health problem but also one of major socioeconomic issues. Preterm Low Birth Weight (PLBW) is leading causative factor of neonatal mortality. Some researches results showed that during periodontal inflammatory disorder some bacterial components could affect pregnancy and fetal development. Therefore aim of our study is to assess and confirm periodontal disease of pregnant females whether or not risk factor of PLBW. We performed our study on the First Maternity Hospital and National Centre for Maternal and Child Health of Mongolia by clinical based case control method on 90 participants. Case group has 30 females (<37 weeks of gestation, and Neonates Birth Weight <2500), control group has 60 females (Normal birth) (ratio was 1:2). Dental caries prevalence on control group was 99%, the mean of DFM/t was 8.32 “average”, prevalence of case group was 100%, and mean of DFM/t was 11.33, which was also “average”. Oral hygiene examination assessment was poor. Study results showed that patients with periodontal disease such as dental calculus (***p<0.008) and periodontal pocket with depth of 4-6mm (***p<0.006) were risk factors for PLBW. Gingivitis is increased to have PLBW baby by 5.5 times. CPITN index was highly associated with dental hygiene index and it was statistically significant. (***p<0.000). Within the limits of this study poor periodontal health status of mothers may be a potential risk factor for a preterm low birth weight.

BACKGROUND. In 1929, Mongolian mental health department established and since then it has been showing qualified professional health care towards population. In code of mental health (7.1.2) it is defined as “mental health care can be carried out by person with professional license that indicated in health law” However, recently people tend to seek help from nonprofessional organizations. Because of psychiatric misconception among population, people usually don’t seek help from professional service that it makes diagnostic delay and people suffer longer from their illness. GOAL. To define diagnoses and pathway of people who seek help first-time from mental health care. MATERIAL AND METHOD. This study was relied upon to NCMH out and inpatient unit. Cross-sectional study method with purposive sampling and questionnaire method wasused in this study. RESULT. In total of 145 patients, 76 males and 69 females, who are aged between 18 to 56 years participated in our study. According to ICD 10, majority of participants (40.7%, n=59) had schizophrenia and schizophrenia spectrum disorders, 21.4%had stress induced disorder, 12.4 % had organic disorder, 11% had affective disorder, and 14.5 % had substance use disorder.According to their help seeking pathway, every patient sought help from professional organization or several nonprofessional organizations and individual person. As we demonstrated the initial help seeking pathway of participants 40% sought help from religious service, 26.2% sought help from psychiatrist, 17.2% sought help from general and 16.6% sought help from other professional doctors. Therefore we demonstrated the amount of participants who sought help from nonprofessional organization and individual person that 60.6% sought help from shaman, 62% sought help from lama. Primary or secondary educated people are tend to seek help from religious service which was statistically significant (p≤0.006).in total of 107 participants sought help from nonprofessional organization and each patient spent about 5,629,122.30±928799 tugrug, but average of total medical fee for per patients in NCMH was 83916±7793 tugrug which costs 7 times lower than nonprofessional organization but improves patients` mental state more, significantly (p≤0.001) Primary or secondary educated patients likely to have diagnostic delay 1 time more than high educated patients, people with nonprofessional initial help seeking likely to have diagnostic delay 2 times more than psychiatric initial help seeking patients and people who imply that religion causes mental illness have diagnostic delay with 2 times more, significantly. (p≤0.001). CONCLUSION. According to study result stress induced disorder and schizophrenia were the majority of total participants. People tend to seek professional help far lately from symptom onset. Psychiatric misconception and inadequate health education among the population are the main reason of diagnostic delay.

Backround: Hematology departments of health laboratories, over capital city and 21 provinces both of governmental and private sectors in this country, have to take responsibilities for providing hematology analysis. A wide range of technology and methods have been implemented among these laboratories. Harmonization of the hematology investigations of different laboratories with standard service all over the country is the major goal to reach. We organized the MEQAS (Mongolian External Quality Assessment Scheme) since 2008 on basis the Cooperation agreement between Ministry of Health and Sysmex Corporation in the establishment of Hematology external quality control and reference laboratory system in Mongolia. This is the report of our 8-year experience of MEQAS as the national project, covering increasing numbers of laboratory members. In 2008-2017 years we set up total 18 MEQAS in Mongolia. Materials and Methods:
Survey Materials
In each survey, the following three different of survey materials were used;
Sample A : Hematology Control Material 1*
Sample B : Hematology Control Material 2*
Sample C : Fresh Whole Blood Sample**
*Hematology Control Material provided by Sysmex Corporation
**Under cooperation of National Center for Transfusiology, a fresh whole blood sample was drawn from a healthy donor and prepared on the same day of sample delivery, according to the procedures reported by Kondo H et. all.
Standard Analyzers
3 units of fully-automated standard analyzers (KX-21, pocH-100i, XS-1000i), installed at the Shastin Central Hospital, were used to assign the target values for the survey materials. These standard analyzers have been calibrated with SCS-1000® before the survey, and monitored with hematology controls, e-CHECK(XS) ® and EIGHTCHECK-3WP® on daily basis.
Instructions & Sample Distribution
On every survey, the workshop was held to give guidance and distribute the survey samples to each participant.
Categorization of Peer Group
Participating data were divided into two peer groups, based on methodology; Group 1: laboratories used automated hematology analyzer (in further Auto’s), Group 2: manually examined group. Each laboratory was given ID number and was asked to analyze these samples 3 times and report the all data and average for CBC 8 parameters.
Statistical Evaluation Method
For individual reports, the results for each participant were evaluated and expressed according to peer group mean and standard deviation index (SDI), Precision index (PI), Absolute evaluation, Scoring system and Target-value evaluation methods (A B C D evaluation). Results:
The Auto’s inter-lab CV% of WBC for fresh whole blood showed decrease from 6.1 to 4.2 comparing with17^th and 18th MEQAS.
The Auto’s Inter-lab CV% of RBC for fresh whole blood showed decrease from 3.7 to 3.4 comparing with 17^th and 18^th MEQAS.
The Auto’s inter-lab CV% of HGB for fresh whole blood were very stable (2.9%, 3.0%), respectively from 17^th to 18^th MEQAS.
The Auto’s inter-lab CV% HCT for the fresh whole blood showed go down from 5.5% to 4.8% comparing with 17^th and 18^th MEQAS.
The Auto’s inter-lab CV% PLT for fresh blood showed go down from 10.2% to 8.2% comparing with 17^th and 18^th MEQAS.
The Auto’s inter-lab CV% of CBC parameter for fresh blood and control Material (Sample A) showed go down from 1^st to 18^th MEQAS.
The Auto’s inter-lab CV% of WBC, RBC, HGB, PLT for Control Material (Sample A) were big difference comparing with Japan’s CV%. Conclusion:
1. The Auto’s inter-lab CV% of WBC, RBC and PLT for fresh whole blood has been decrease respectively 4.2%, 3.4%, 8.2% in the 18^th MEQAS and there was difference in the CV% between manufacturers.
2. The Auto’s inter-lab CV% of WBC, RBC, HGB, PLT for Control Material (Sample A) showed go down from 1^st to 18^th MEQAS but were big difference comparing with Japan’s CV%. Acknowledgements We would like to express our appreciation to the Sysmex Corporation (Japan) for providing financial supports investigate this study.