1.Respiratory Symptoms Associated with Household Indoor PM2.5 Exposure
Ulziimaa D ; ; Ulziikhutag B ; Ser-Od Kh ; Shatar Sh ; Myagmarchuluun S ; Enkhjargal G ; Gantuya D ; Munkh-Erdene L ; Khurelbaatar N ; Damdindorj B ; Davaalkham D
Mongolian Journal of Health Sciences 2026;91(1):116-123
Background:
Numerous studies have shown that air pollution is a serious public health threat and risk worldwide. Mongolia is the world leader in outdoor and indoor air pollution, and the morbidity and mortality caused by it are increasing every year. People spend most of their lives indoors, and it is necessary to regularly assess and study indoor air pollution.
Aim:
To study the concentration of PM2.5 particles in the indoor air of households in Ulaanbaatar and Darkhan cities in relation to some symptoms of respiratory diseases.
Materials and Methods:
The study was conducted using an analytical cohort design from October 2023 to July 2025, and the 4 districts of the central Ulaanbaatar city and Darkhan cities were included in the study. A total of 240 households were included in the study, including 48 households living in ger and house, 24 households living in apartments, and 48 households living in ger and house, and 24 households living in apartments from Ulaanbaatar city. A direct measurement device (PurpleAir) was installed in the households for 3-4 weeks to measure PM2.5 particles in the indoor air for 24 hours. After measuring PM2.5 particles in the indoor air of the household, data were collected through questionnaires from the participants aged 18-60 who participated in the study and underwent health examinations. The results were processed using STATA-19.0 and R programs.
Result:
213-239 households were selected for the study, including households living in 17-26 apartments, 42-58 houses, and 38-50 houses. The 24-hour average concentration of PM2.5 particles in the ambient air of households in Ulaanbaatar city was measured relatively higher in winter and summer than in households in Darkhan city. Among the districts of Ulaanbaatar city, the highest concentration of PM2.5 particles was measured in Songinokhairkhan district, and the lowest concentration was measured in Bayanzurkh district. Considering the cities by heating type, households with stoves are more polluted than households with centralized heating. In Darkhan city, the lowest concentration was measured in apartments (22.78-31.53 μg/m³), houses (44.53-68.17 μg/m³), and the highest concentration was measured in traditional felt houses (houses) (63.20-68.25 μg/m³). In Ulaanbaatar, PM2.5 concentrations were relatively high in all types of housing, including apartments (41.61-58.37 μg/m³), houses (79.22-92.50 μg/m³), and traditional felt dwellings (76.69-86.31 μg/m³). In the summer, PM2.5 concentrations in Darkhan were 3.10-10.03 μg/m³ in apartments, 7.67-14.37 μg/m³ in houses, and 7.98-17.90 μg/m³ in traditional felt dwellings (houses). The concentration of PM2.5 particles in the ambient air of the settlement is statistically significantly associated with shortness of breath, fatigue, weakness, muscle pain, nausea, palpitations, sneezing, runny nose, conjunctivitis, pain in the eye socket, tearing of the eyes, headache, fever, nasal congestion, cough, loss of appetite, sore throat, phlegm, wheezing, and chest pain.
Conclusion
The 24-hour average concentration of PM2.5 particles in indoor air in households in Ulaanbaatar and Darkhan cities is higher than the Mongolian standard during winter and is statistically significantly associated with some symptoms of respiratory diseases.
2.Severe Polymyositis with Concomitant Rhabdomyolysis
Demchigmaa N ; ; ; Enkhjargal M ; Ganbayar G ; Saymaa L ; Erdenechimeg Ch ; Anu G ; ; Namuuntuul D ; ; Tsolmon D ; ; Devshil Z ; ;
Mongolian Journal of Health Sciences 2026;96(6):262-266
Background:
Polymyositis (PM) is a rare idiopathic inflammatory myopathy characterized by symmetric proximal muscle weakness, elevated muscle enzyme levels, dysphagia, and respiratory muscle weakness. Rhabdomyolysis is a potentially life-threatening condition caused by extensive skeletal muscle breakdown, resulting in myoglobinuria and an increased risk of acute kidney injury and multiorgan complications. The coexistence of rhabdomyolysis in patients with polymyositis is uncommon and may complicate both diagnosis and management.
Case Presentation:
A 65-year-old man was admitted with fever up to 39°C, generalized skin rash, dysphagia, progressive muscle weakness, dyspnea, decreased urine output, and dark tea-colored urine. Physical examination revealed symmetric proximal muscle weakness, with muscle strength graded 3/5 in both upper extremities and 4/5 in both lower extremities. Neck muscle strength was 4/5. Dysphagia and a generalized skin rash were also present. Laboratory investigations showed markedly elevated creatine kinase (CK) at 9,943.1 U/L, alanine aminotransferase (ALT) at 449.1 U/L, aspartate aminotransferase (AST) at 222.1 U/L, lactate dehydrogenase (LDH) at 1,342.9 U/L, and C-reactive protein (CRP) at 70.6 mg/L. Urinalysis showed blood 3+ and protein 2+, while no erythrocytes were detected on urine sediment microscopy. Electromyography demonstrated myopathic changes, and muscle biopsy revealed inflammatory infiltrates and necrotic muscle fibers.
Conclusion
Comprehensive assessment of clinical manifestations, laboratory findings, autoantibody testing, electrophysiological studies, and muscle biopsy is essential for the diagnosis of polymyositis complicated by rhabdomyolysis. An integrated diagnostic approach facilitates confirmation of the diagnosis, differentiation from clinically similar disorders, and appropriate treatment selection. Early recognition of rhabdomyolysis and other potentially life-threatening complications is crucial for preventing organ damage and improving patient outcomes.
3.Comparative study of outdoor and indoor air pollution in Ulaanbaatar and Darkhan cities
Davaalkham D ; ; Ulziikhutag B ; Batzorig B ; ; Ser-Od Kh ; ; Nyamsuren B ; ; Yerkebulan M ; ; Enkhjargal G ; ; Shatar Sh ; ; Myagmarchuluun S ; ; Gantuya D ; ; Ulziimaa D ; ; Buyantushig B ; ; Jargalsaikhan G ; ; Anujin M ; Maralmaa E ; Khurelbaatar N ; ; Damdindorj B ;
Mongolian Journal of Health Sciences 2026;93(3):107-113
Background:
Ambient and household air pollution remain leading risk factors for global morbidity and mortality. Exposure to fine particulate matter (PM₂.₅) is associated with increased risks of cardiovascular and respiratory diseases, as well as lung cancer, metabolic and neurological disorders, and immune dysfunction. In urban areas of Mongolia, air pollution reaches critical levels during the winter season. Although improved solid fuels have been introduced in recent years, their impact on both outdoor and indoor air quality remains insufficiently characterized.
Aim:
To compare outdoor and household air pollution levels in Ulaanbaatar and Darkhan cities.
Materials and Methods:
Outdoor air pollution data for Ulaanbaatar were obtained from fixed monitoring stations of the National Agency for Meteorology and Environmental Monitoring for the period 2014–2026, with seasonal comparisons performed. For indoor air quality assessment, a longitudinal study was conducted among 240 households (apartments, houses, and traditional gers) in Ulaanbaatar and Darkhan from 2023 to 2026. PM₂.₅ concentrations were measured using real-time sensors (PurpleAir sensor), deployed for 14–21 days per season (winter and summer) in each household, recording data at 10-minute intervals over 24-hour periods.
Result:
Between 2014 and 2026, the 24-hour mean concentrations in Ulaanbaatar were 60.5 µg/m for PM₂.₅, 117.3 µg/m for PM₁₀, 37.3 µg/m for NO₂, 41.8 µg/m for SO₂, and 27.5 µg/m for O₃. While particulate matter levels showed a decreasing trend following the introduction of improved fuels, SO₂ concentrations increased, and overall pollution levels remained higher than those observed in Darkhan. Indoor PM₂.₅ concentrations were higher in Ulaanbaatar compared to Darkhan (60.7±86.1 vs 48.4±96.7 µg/m). Significant differences were observed by housing type (p<0.0001), with higher concentrations in households using solid fuels (houses and gers) and lower levels in apartments. These findings indicate substantial variability in indoor air pollution by city, housing type, and season, with persistently elevated exposure levels.
Conclusion
Outdoor air pollutant concentrations in Ulaanbaatar, including particulate matter, NO₂, and SO₂, exceed national standards and WHO guideline values by 1–4 times. Indoor PM₂.₅ pollution is higher in Ulaanbaatar than in Darkhan and varies significantly by housing type and season, indicating a high and heterogeneous exposure burden among urban populations.
4.Effectiveness of School-Based Health Education Intervention
Munguntuul E ; Buyandelger B ; Khulan G ; Enkhjargal Ya ; Odonjil P ; Baigalmaa D ; Tuya S ; Ganchimeg T
Mongolian Journal of Health Sciences 2026;93(3):144-150
Background:
Respiratory and gastrointestinal infectious diseases are the leading causes of morbidity in children. Numerous international studies have demonstrated that handwashing with soap is one of the most effective and cost-efficient methods for preventing these diseases in children. A previous study conducted in Ulaanbaatar found that only 50.1% of general education school students practiced proper handwashing, which is considered insufficient even in areas with relatively adequate facilities. In Mongolia, 56.1% of the 865 schools lack handwashing facilities and soap, and 25% do not meet the WASH standards. Although knowledge about handwashing increased during the COVID-19 pandemic, sustained behavioral change remained limited, highlighting a gap between knowledge and practice and indicating the need for targeted educational interventions. Furthermore, there is limited research comparing the effectiveness of such interventions across different school environments and urban–rural settings, which provides the rationale for this study.
Aim:
To evaluate the effectiveness of a handwashing educational intervention among primary school students and determine differences in knowledge change across four schools in urban and rural areas.
Materials and Methods:
A quasi-experimental study design was used from December 2024 to June 2025. A total of 1,353 students from grades 3–5 in four general education schools (two in Ulaanbaatar and two in rural areas) were included in the study. Preand post-intervention handwashing knowledge scores were analyzed using paired t-tests and one-way ANOVA (α=0.05) with STATA 14.0. Ethical approval was obtained from the Ethics Committee of the Mongolian National University of Medical Sciences.
Result:
The mean handwashing knowledge score increased significantly from 9.68 (±2.64) before the intervention to 10.30 (±2.74) after the intervention, with a mean difference of +0.63 (p<0.001). The differences in improvement between schools were also statistically significant (ANOVA: F(3,1335)=5.90, p=0.0005). The highest improvement was observed in urban School A (+1.49), while the lowest was observed in School B (+0.16). Rural schools C and D showed moderate and relatively consistent improvements (+0.51 and +0.70, respectively).
Conclusion
School-based handwashing educational interventions effectively improve knowledge among primary school students. However, environmental factors, such as infrastructure and geographic location, significantly influence the effectiveness of the intervention. Therefore, educational interventions should be implemented alongside infrastructure improvements.
5.The perception of illness and quality of life in patients with acute myocardial infarction
Otgonboli B ; Enkhtuul Ch ; Enkhjargal Ya
Mongolian Journal of Health Sciences 2026;93(3):157-164
Background:
The patients’ view, perception, and evaluation of illness as an individual, as well as their emotional and behavioral responses, are among the criteria predicting the QoL. Increased illness perception and adjustment are emphasized to ensure patients to return to their active life after acute myocardial infarction (AMI) continue their lives more healthily, and have higher levels of physical, mental, and social well-being.
Aim:
This study aimed to evaluate the illness perception and quality of life of patients who had an AMI.
Materials and Methods:
This descriptive study included 100 patients diagnosed with AMI at the cardiology department of Third State Central Hospital and Second State Central Hospitals. The data were collected using Illness Perception Questionnaire-Revised and Myocardial Infarction Dimensional Assessment Scale.
Result:
The mean age of the patients with AMI was 52.2±12.01 years, and 51% were male. Among the subscales of the illness perception questionnaire, the highest mean score was observed for Illness Identity (13.99±5.01), while Treatment Control (19.10±3.18) had the lowest. The lowest score was for Illness Coherence (10.31±2.16). The overall Myocardial Infarction Dimensional Assessment Scale score (43.00±13.10) of the patients was observed to be moderate. The Illness Perception Questionnaire-Revised subdimensions were observed to have a positive and significant correlation with Myocardial Infarction Dimensional Assessment Scale total score and subscales mean scores. Regression analysis revealed that Illness Coherence and Emotional Representation were significant predictors of QOL. Patients scoring high in these areas reported better QOL. Patients with recurrent infarctions showed significantly lower scores in quality of life (t=-2.234, (p=0.029) and illness perception (t=-3.809, p=.001).
Conclusion
The study demonstrates that illness perception in AMI patients has a significant positive relationship with their quality of life. Specifically, understanding of the illness and emotional representation were key predictors of better quality of life. This suggests that nursing care and psychosocial support targeting patient understanding and emotional coping can play a crucial role in improving post-infarction quality of life.
6.Effects of School-Based Nursing Interventions on Student Health Outcomes
Enkhjargal Ya ; Tuya S ; Enkhtuul Ch
Mongolian Journal of Health Sciences 2026;92(2):192-195
Background:
School health services play a critical role in protecting and promoting students’ health, thereby contributing to improved academic performance. School nurses provide a wide range of services, including preventive care, health education, and management of chronic conditions among students.
Aim:
This review aimed to synthesize existing evidence on the effectiveness of school-based nursing interventions based on published research.
Materials and Methods:
A literature review was conducted using international databases, including PubMed, Scopus, and Web of Science. Relevant studies on school-based nursing interventions were systematically analyzed. The findings indicate that school nursing interventions positively impact the management of chronic diseases, promotion of mental health, and development of healthy behaviors among students. Additionally, reductions in school absenteeism and emergency incidents were consistently reported.
Results:
The reviewed studies demonstrated that school-based nursing interventions significantly improve students’ health outcomes. These include better chronic disease control, enhanced mental well-being, and increased adoption of healthy lifestyles. Furthermore, students receiving such interventions showed decreased absenteeism and fewer emergency health events at school.
Conclusion
School-based nursing interventions have a positive impact on students’ health and well-being. Strengthening school nursing services and enhancing collaboration between the education and health sectors are essential to promote the health of children and adolescents and to ensure a healthier future generation.
7.Bioactive compound profiling of Rheum undulatum L. root extract and evaluation of its interaction with elastase enzyme
Buyanjargal E ; Otgonbaatar U ; Enkhtuul B ; Norovnyam R ; Enkhjargal D ; Munkhzul B ; Khuvitavilan B ; Amarjargal Ts ; Odtugs O ; Maralgua A ; Daariiimaa Kh
Mongolian Journal of Health Sciences 2026;95(5):82-88
Background:
Bioactive compounds derived from plants have been extensively studied and widely applied in cosmetic and dermatological fields. In particular, plant-derived polyphenols and anthraquinones are known for their antioxidant properties as well as their ability to inhibit elastase enzyme activity. Elastase is a key proteolytic enzyme responsible for degrading elastin, a structural protein essential for maintaining skin elasticity. Excessive elastase activity contributes to skin aging and wrinkle formation. Therefore, the identification of plant-derived compounds capable of interacting with elastase is of significant importance for improving the composition and efficacy of cosmetic products.
Aim:
To identify bioactive compounds in the extract of Rheum undulatum L. and to investigate their interaction with elastase enzyme activity.
Materials and Methods:
The root of Rheum undulatum L. was used as the study material. Sample preparation was performed by grinding the plant root followed by extraction using 50% ethanol assisted by an ultrasonic water bath. The obtained extract was evaporated to dryness using a vacuum centrifugation system to remove the solvent completely. A total of 10 mg of the dried extract was dissolved in 100 µL methanol and 900 µL water, then filtered through a 0.1 µm membrane filter. Subsequently, two sample sets were prepared: a control sample and an elastase-incubated sample at a 1:1 ratio. Both were analyzed using liquid chromatography–mass spectrometry (LC-MS). Data processing was performed using Agilent MassHunter Qualitative Analysis software (version 10.0).
Results:
LC-MS analysis revealed a total of 16 bioactive compounds in the root extract of Rheum undulatum L. Comparative analysis between the control and elastase-treated samples demonstrated a decrease in the peak areas of gluconic acid and citric acid, while an increase in the peak area of emodin was observed. These changes indicate compositional differences between the two sample conditions.
Conclusion
The LC-MS analysis of Rheum undulatum L. root extract identified multiple bioactive compounds belonging to anthraquinone, phenolic, and flavonoid classes. Variations in peak intensities between control and elastase-treated samples suggest potential interactions between certain compounds and the enzyme. These findings indicate that the root extract contains biologically active constituents capable of modulating elastase activity, supporting its potential application in anti-aging and cosmetic formulations.
8.Assessment of health literacy levels among the adult population of Mongolia
Tuya S ; Oyungoo B ; Enkhjargal Ya
Mongolian Journal of Health Sciences 2026;95(5):109-115
Background:
Health literacy is a multidimensional concept encompassing the knowledge, attitudes, and skills required for individuals to obtain, understand, appraise, and apply health-related information. It is essential for accessing quality healthcare services and making informed health decisions in daily life.
Aim:
This study aimed to evaluate the level of health literacy among the adult population of Mongolia.
Materials and Methods:
A cross-sectional quantitative study was conducted involving 1,500 Mongolian adults. Data was collected using the Health Literacy Survey European Questionnaire (HLS-EU-Q47), which evaluates four core competencies: accessing, understanding, appraising, and applying health information. Responses were measured on a 4-point Likert scale ranging from 1 (very difficult) to 4 (very easy). Health literacy levels were categorized based on standardized scores: inadequate (0–25), limited (25–33), sufficient (33–42), and excellent (42–50).
Results:
The mean age of the participants was 34.79±15.04 years, with 42.1% being male and 57.9% female. Socioeconomic data showed that 52.1% were married, 37.7% were single, 43.2% had completed secondary education, and 40.5% held a university degree. Lifestyle assessments revealed that 16.4% were daily smokers, 7.0% consumed alcohol daily, and only 12.5% engaged in regular physical exercise. Regarding education, 50.7% of participants with higher education demonstrated “sufficient or excellent” health literacy, whereas only 27.1% of those with secondary education reached this level. The 18–30 age group exhibited the highest capacity to receive health information (44.0%), with a significant decline in health literacy levels observed as age increased (p=0.014).
Conclusion
Although the overall health literacy level among the adult population of Mongolia is generally sufficient, the capacity to access health information remains limited.
9.Job satisfaction among dentists in Mongolia and its associated factors
Battsetseg S ; Byambasoyol N ; Khongorzul Ts ; Enkhjargal M ; Urjinlham J
Mongolian Journal of Health Sciences 2026;95(5):263-266
Background:
Occupational stress among dentists has both direct and indirect effects on individual mental health and work productivity. Furthermore, it is a critical factor influencing patient satisfaction, quality of care, human resource stability, and the sustainable development of healthcare organizations.
Aim:
To assess job satisfaction among dentists and to identify selected factors associated with it.
Materials and Methods:
This analytical cross-sectional study included a total of 98 dentists providing oral healthcare services in both public and private dental clinics in Mongolia. Data were collected using a structured questionnaire administered via Google Forms. The questionnaire consisted of 30 items across three sections, covering general information, working conditions, and job satisfaction. Data were analyzed using Microsoft Excel and SPSS version 31.0.
Results:
The overall job satisfaction score among participating dentists was above average (3.68±0.77). The findings revealed that workplace comfort (r=0.570), colleague relationships (r=0.560), salary (r=0.501), managerial professional competence (r=0.484), and opportunities for professional advancement (r=0.482) were significantly and positively correlated with job satisfaction (p<0.001). Workload did not show a statistically significant association with job satisfaction (p>0.05). Notably, the level of satisfaction regarding institutional support for professional skill development was relatively low (1.87±0.86).
Conclusions
1. Factors such as workplace comfort, colleague relationships, salary, managerial competence and opportunities for professional advancement showed a statistically significant positive correlation with job satisfaction among dentists (p < 0.001). 2. The level of job satisfaction among dentists was assessed as above average (3.68±0.77).
10.The Impact of Air Pollution on Quality of Life of the Population
Enkhnomin E ; Enkhjargal A ; Burmaajav B
Mongolian Medical Sciences 2026;216(2):51-59
Background:
According to the World Health Organization, quality of life is defined as an individual's
perception of their position in life within the context of the culture and value systems in which
they live, and in relation to their goals, expectations, standards, and concerns. Although
numerous epidemiological studies have been conducted worldwide and in Mongolia to
investigate the health effects of air pollution, studies examining its impact on the quality of
life of the population before and after intervention measures remain limited. Therefore, this
study aims to determine the influence of air pollution on the quality of life of residents.
Objective:
The objective of this study was to assess the quality of life of residents of Chingeltei District,
Ulaanbaatar, and to compare their quality of life before and after the implementation of air
pollution reduction interventions.
Materials and Methods:
A total of 330 residents participated in the study, including 165 participants surveyed in 2016
and 165 participants surveyed in 2026. The general characteristics of participants, including
age, sex, educational level, marital status, and self-rated health status, were comparable
between the 2016 and 2026 surveys. Overall, 47.9% of participants were male and 52.1%
were female. In 2016, males accounted for 47.3% and females for 52.7% of the sample. No
statistically significant difference was observed in the sex distribution between the two study
periods.
Results:
The mean scores for Domain 1 (Physical Health) and Domain 2 (Psychological Well-being)
of quality of life were similar in both survey years, whereas the Social Relationships domain
showed improvement. The overall quality of life score increased slightly in 2026 compared
with 2016. Furthermore, a one-unit increase in ambient PM₁₀ concentration was associated
with an average decrease of 0.123 units in the overall quality of life score. Quality of life
was also associated with age, marital status, educational attainment, and self-rated health
status. In particular, older individuals and those who perceived their health as poor tended
to report lower quality of life scores. These findings indicate that both health-related and
socioeconomic factors play important roles in determining quality of life.
Conclusion
The quality of life of residents of Chingeltei District, Ulaanbaatar, who participated in the study
is expected to improve following the implementation of air pollution reduction interventions.
The quality of life of the study participants was found to be at a moderate level and was
influenced by factors such as age, marital status, and educational attainment.
Ambient air pollution was found to have a direct impact on the quality of life of the participants.
In particular, an increase in PM₁₀ particulate matter concentration was associated with a decline in quality of life.
Result Analysis
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