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.

Introduction: According to the WHO, being exposed to loud noise for a long time can be very harmful to health. It can lead to heart and blood vessel problems, mental health issues, trouble sleeping, and hearing loss. Noise pollution has a negative effect on the brain and nervous system, and it can cause many problems. High-frequency noise, in particular, can disturb the central nervous system. This can lead to problems like poor concentration, more anxiety, and feeling mentally tired. Many studies around the world have shown that noise levels of ≥85 dB at work increase the risk of noise-induced hearing loss (NIHL) and tinnitus.In Ulaanbaatar, environmental noise pollution continues to grow due to population growth, construction, and urban planning. Therefore, it is important to find out whether environmental noise pollution is linked to mental and behavioral disorders, insomnia, nervous fatigue, high blood pressure, and hearing loss among the population. Goal: The aim of this study is to examine the prevalence of primary hypertension (I10), nervous fatigue (F48.0), sleep disorders (F51.0), and tinnitus (H83.3) caused by environmental noise among the population of Ulaanbaatar. Materials and Methods: A descriptive research design was applied to examine statistical data from the Center for Health Development regarding diseases related to noise pollution. Based on the 10th revision of the International Classification of Diseases (ICD-10), the study focused on conditions such as neurasthenia (F48.0), non-organic sleep disorders (F51), primary hypertension (I10), and hearing disorders (H83.3). The analysis included data recorded between 2014 and 2023 among the population of Ulaanbaatar city. Epidemiological analysis was performed using SPSS-24 software, and the results were calculated per 10,000 population. Ethical Considerations: This study did not receive any external funding or financial support from public or private organizations. It utilizes secondary data from the Health Development Center, which does not contain any personal information. Results: In 2014, the average age of individuals diagnosed with neurasthenia (F48.0) was 40.1±12.6 years; for non-organic sleep disorders (F51.0), it was 48.1±14.5 years; for noise-induced hearing disorders (H83.3), 47.2±12.7 years; and for primary hypertension (I10), the average age was 59.0±11.4 years. By 2023, the average age for primary hypertension had slightly decreased to 58.0±12.9 years. Since 2014, the number of cases of nervous fatigue, non organic sleep disorders, and hearing problems caused by noise has risen in Ulaanbaatar. In 2023, the average age of people with primary hypertension (I10) dropped to 58.0±12.9 years. Noise-related illnesses are common among people aged 40 to 60 in Ulaanbaatar, and this is lowering their quality of life. Conclusion Noise-related illnesses are being recorded among the 40–60 age group in Ulaanbaatar, which is negatively affecting their quality of life. It is urgently necessary to introduce measures for adequate protection of the population from the negative health effects of environmental noise.

Introduction: In 2020, the prevalence of respiratory system diseases in the population of Gobi-Altai province is 1339.5 cases per 10,000 population, which is 4% (52) more than the average of the provinces and 20% (223.8) more than the national average. In 2021, the number of deaths due to respiratory system diseases was 2.9 per 10,000 population, increasing by 1.1 from 2020 (1.8). Pneumonia-related deaths account for 60.7% of all respiratory system-related deaths. As of 2022, there are 7,281 simple stoves, 248 low-pressure and steam boilers, and 18,207 automobiles in the Gobi-Altai province as sources of air pollution. 63.1% of the total coal is consumed by water heating boilers with a capacity of more than 101 kW, 20.5% by households, and 16.4% by small and medium enterprises. Goal: Determining the relationship between the incidence of pneumonia in the population of Gobi-Altai province and the common air pollutants. Material and Method: According to the rotation research model, the common external air pollutants SO₂, NO₂, PM₁₀, climate parameters, temperature, pressure, humidity, and population pneumonia measurements and registration data of Altai Sum, Gobi-Altai Province in 2020-2021 were analyzed using SPSS-24 software. statistical processing was calculated for non-parametric parameters. Result: The annual average value of sulfur dioxide (SO₂ ) measured in 20 minutes in Gobi-Altai province is 25.2 ± 13.7 μg/m³, the annual average value of nitrogen dioxide (NO₂) measured in 20 minutes is 36.329±29 μg/m³, and the annual average concentration of PM₁₀ particles is 35.2 ± 28,264 μg/m³, which is the standard level of MNS4585:2016. But the 20-minute average concentration of SO₂ (r=0.81, p=0.005), the average concentration of NO₂ (r=0.089, p=0.008), and the average concentration of PM₁₀ (r=0.089, p=0.002) is directly related to the incidence of pneumonia. It is also inversely correlated with air temperature (r=-142, p=0,000). Conclusion Common outdoor air pollutants in Yesunbulag sum, Gobi-Altai Province are related to pneumonia in children aged 0-5 years.

Introduction : Water is a vital resource for human existence and is essential for daily food processing, preparation, washing, hygiene, and sanitation. Furthermore, providing the population with safe drinking water is one of the pressing problems of the world and some regions.
In recent years, population density and the scale of commercial and industrial activities, as well as clean and dirty water consumption were increased in the capital city. As a result of these, ground and surface water resources are becoming scarce and polluted.
Therefore, assessment of daily drinking and residential water consumption of Ulaanbaatar should be determined to use drinking water properly in daily life and water loss. This study assessed the actual amount of households’ daily water consumption. Goal: The purpose of this study is to determine the daily consumption of drinking water for households in ger areas and apartments in Ulaanbaatar. Materials and Method: This study covers 30 households in ger areas and 15 apartment households, in Ulaanbaatar. Household members performed 6-10 types of measurements every day, within 7 days. As a result of these measurements, actual consumption of water quantity used for drinking and household purposes was calculated. Statistical analysis was done by SPSS Version 21 to calculate the true probability of difference between parameters. Result: 67.9% of the households in the ger areas were 4-5 family members. The average daily household consumption of drinking and domestic water were 68.3 ± 3.57 L (95% 61.3-75.3), the minimum consumption was 12 L, and the maximum was 227 L. Average of the household water consumption water was 97.6-108.9 liters during the weekends, and water consumption was statistically higher than weekdays (p=0.001; p=0.01).
The water consumption of residential households with 3 family members accounted for the majority (30.8%) in this study. The average daily consumption of drinking and domestic water was 297.67±19.7 liters. There was no statistically significant difference (p=0.96) in week. The average daily water consumption including drinking and residential was 270.3-335.97 L.
The total daily drinking and residential water consumption per person was 15.57 L for households in ger areas and 90 L for apartment households. Calculating the daily water consumption of households in ger areas, 60.3% of it is used for laundry, washing dishes, food preparation, washing face and hands, and clothes, 31% for drinking, and 8.7% for outdoor water use. While apartment households, approximately 94.1%, were used for household and 5.9% for drinking purposes. Research ethics approval : This study was discussed at the meeting of the Academic Council of the National Center for Public Health. In addition, this study was carried out according to the methods and methods discussed and approved at the meeting of the Medical Ethics Control Committee of the Ministry of Health (Resolution No. 08). Conclusion The total daily consumption of drinking and residential water per person were 15.57 litres for the households in the ger areas and 90 litres for the apartment households. It implies that it does not exceed the WHO recommendations

Introduction: This field assessment was performed to ensure the effective implementation of Order No. A/142 of the Deputy Prime Minister of Mongolia dated 30^th December 2021 and Order No. A/01 of the Head of the National Committee for Reducing Environmental Pollution dated 3^rd January 2022 and to monitor the level of indoor air pollutants emitted from traditional stoves and standard stoves. Purpose: To determine the level of indoor air pollutants emitted from briquette combustion and to develop recommendations by comparing various types of stoves and dwellings. Materials and Methods: Through analytical cross-sectional designs, three households from Songinokhairkhan district and one household from Chingeltei district were selected to participate in this assessment as they use briquettes for heating, vary in their dwelling types (ger (traditional Mongolian tent), house) and their stove types (traditional, standard), stay home during the day and chose to participate in the assessment. 24-hour continuous measurements were conducted for each dwelling and before taking measurements, we calibrated and adjusted the air suction velocity of the measuring instrument at the Central Metrology Laboratory. The monitor was placed at a distance of 0.5m from the stove and a height of 0.5-1.0m from the floor. The results were then compared with the Mongolian National Standard “General air quality and technical requirements MNS4585:2016” and WHO Guidelines for Indoor Air Quality 2021. Statistical analysis was performed using SPSS 24.0 software, mean, ANOVA test, and if the p-value is less than 0.05, our results are statistically significant. Results: The concentration level of SO₂ in houses with “Dul” stoves was within the level specified in the Mongolian standard MNS4585: 2016 and WHO Guidelines for Indoor Air Quality 2021, while 24-hour SO₂ concentration in gers and houses with traditional stoves was 1.3-2.92 times higher than the standards. The 24-hour average concentration of nitrogen dioxide in houses with traditional stoves was 1.73 times higher than the Mongolian air quality standard MNS4585: 2016. There were statistically significant differences in the emission levels of SO₂ and NO₂ depending on dwelling and stove types (df=4, f=4.04, p=0.008 and df=4, f=17.17, p=0.001, respectively.). The 8-hour average (10,000 μg/m3) CO concentration was statistically significant for various types of dwellings and stoves (df=4, f=45.17, p=0.001), whereas there was a statistically significant difference in CO concentrations in gers with traditional stoves and gers with standard stoves in terms of morning, afternoon, and evening hours (df=3, f=33.17, p=0.001). Conclusion Indoor air pollutants in the households except for houses with “Dul” stoves have been determined to exceed the air quality standards set by the Mongolian air quality standards and WHO Guidelines for Indoor Air Quality 2021.

Introduction: During this pandemic, overcrowding in classroom caused by a lack of educational facilities and poor indoor air quality are the main causes of respiratory diseases among children and adolescents. Therefore, it is essential to measure and assess the indoor air quality where children spend extended periods of time such as school. Materials and methods: This study covered four schools with old buildings and four schools with new buildings in Bayanzurkh, Sukhbaatar, Khan-Uul, Chingeltei district of Ulaanbaatar. We collected PM10 and PM2.5, carbon dioxide, air temperature, humidity, and microbiological count from chosen classrooms and compared to the MNS4585:2016 standard. SPSS-24 was used to do statistical analysis on the information gathered during the evaluation. Results and Discussion: The 24-hour average PM2.5 concentration was 64.3 (95% CI: 64.1-64.5) mcg/m3, which was 4.3 times higher than the WHO guideline value and 1.3 times higher than the MNS4585:2016 standard. The 24-hour average PM10 concentration was 85.3 (95 % CI: 85.1-85.6) mcg/m3, which is 1.9 times higher than WHO guideline value. In older school buildings, the 24-hour average PM2.5 concentration was 5.6 times higher than the WHO guideline value and 1.7 times higher than the MNS4585:2016; the average PM10 concentration was 2.8 times higher than the WHO guideline value and 1.3 times higher than the MNS4585:2016. The air temperature and carbon dioxide concentration in classroom was met the MNS4585: 2016. The average relative humidity of all schools is 24.2±6.5%, which is 14-16% lower than the MNS4585: 2016. Conclusion The indoor air quality of the school in new and old buildings was similar poor, therefore a variety of steps are needed to improve it.

Rationale: Carbon monoxide (CO) is a colorless, odorless gas produced by carbon-containing substances, most commonly incomplete fuel and biomass combustion. Carbon monoxide deprives the human body of oxygen, leads to severe poisoning and death. In 2017, there were 137 new cases of carbon monoxide poisoning per 1,000,000 people worldwide, and 4.6 deaths per 1,000,000. The global incidence of carbon monoxide poisoning has remained steady over the previous 25 years, while mortality has decreased by 36-40%. Every year in Mongolia, 700-840 persons are hospitalized for carbon monoxide poisoning. Also, there has been a lack of study into the prevalence and causes of carbon monoxide poisoning and death. Goal: Study the dynamics of morbidity and mortality cases caused by carbon monoxide poisoning in Mongolia. Objectives:
To analyze the carbon monoxide poisoning morbidity recorded in Mongolia between 2016-2020.
To analyze the carbon monoxide poisoning mortality reported in Mongolia between 2016-2020. Material and Methods: The survey was conducted utilizing data from outpatient and inpatient poisoning and deaths reported in 2016-2020 with the goal of studying carbon monoxide poisoning and mortality in Mongolia. Workplace exposure poisoning was excluded from quantitative data on carbon monoxide poisoning (fires, suicidal, accidental and domestic explosions, accidents, external effects).The statistics analysis was performed using 23 versions of the SPSS program, to estimate a distribution of new cases and fatalities per 10,000 population depended on age, sex, average number of hospital days, and standard error. ArcGIS version 10.8 was used to map the locations. Results: Acute carbon monoxide poisoning. Carbon monoxide poisoning was 0.01-0.31 cases per 10,000 population during 2016 and 2018. Between 2019 and 2020, it increased to 1.5-1.9 cases per 10,000 population, with up to 37% of those admitted to hospitals. In the last five years, carbon monoxiderelated deaths have been reported in 0.1-0.3 cases per 10,000 population. The amount of hours firing of the households increases every year in September, when the colder season begins. Incidences of death and intentional poisoning were reported in Arkhangai, Uvurkhangai, Khuvsgulaimags, and Ulaanbaatar. The average age of poisoning patients admitted to the hospital was 33 ± 19.5 years old (minimum 2 months, maximum 81). In terms of gender, women registered for 58.4 (734) percent of all cases. The average number of days spent in the hospital was 3.4± 3.7 days.
Carbon monoxide poisoning-related mortality. During the previous five years (2016-2020), 353 people died in Mongolia as a result of carbon monoxide poisoning, although 1.4 percent, or five people, died in hospitals, one case in Bayan-Ulgii, Zavkhan, and Uvs aimags, and two cases in Ulaanbaatar. However, 98.6 percent of them died prematurely at home or in poisoned places due to a lack of access to health care. The average age of carbon monoxide poisoning deaths cases was 35 ± 19.9 years old, and 71.7 (253) percent were male. The Ulaanbaatar, Selenge, Uvs, and Dornod aimags had the lowest death rate of 0.08-0.21 per 10,000 population, while Khuvsgul and Arkhangai aimags had the highest death rate of 0.96-1.57 per 10,000 population. Conclusions Carbon monoxide poisoning among the population rises during the winter season, however, in the previous five years, 96.5 percent of cases have been poisoned accidentally, particularly 82.6 (1035) percent of cases reported in Ulaanbaatar. According to socioeconomic factors, 41.6 (529) of the cases were male, with an average age of 36.5±15.4 years.
During the preceding five years, carbon monoxide-related mortality in Mongolia was between 0.2 per 10,000 people. Without medical attention, 99.2% of cases died at the exposed location or area. The death rate in Khuvsgul aimags was low, whereas it was high in Ulaanbaatar city. The average age of premature deaths was 35±19.9 years, and 71.7 (253) percent were male.

Introduction: According to CDC guideline, common changes in patient admitted due to pneumonia caused by COVID-19 are lymphopenia (63%), leukocytosis (24-30%), leukopenia (19-25%). Neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), thrombocyte-lymphocyte ratio (PLR) are important to evaluate prognosis of infectious diseases as well as cancer.
Hematological tests are important for diagnosis, treatment and monitoring of patient with COVID-19. Our study objective was to determine the changes of leukocyte, lymphocyte, thrombocyte, NLR, LMR, and PLR in imported cases of COVID-19 into Mongolia. Method: The data such as age, gender, and laboratory test of a total of 249 cases who admitted to National Center forCommuncable Diseases (NCCD) from March 11 to July 20, 2020 was collected from information system of clinical laboratory of NCCD. Peripheral blood tests were conducted by XN 550 which is fully automated hematological analizator of Sysmex corporation, Japan. Statistical analysis such as mean, standard deviation, probability range was done by Microsoft Excel SPSS -25 program. Result: Regarding to gender, 163 (66.5%) were male and 86 (34.5%) were female. Mean age was 26 with range age of 11-80. Statistic analysis on leukocyte (mean 6.38 x 10⁹/L; P <0.000), thrombocyte (mean 283 x 10⁹/L P <0.000), neutrophil (mean 3.33 x 10⁹L; P <0.000), lymphocyte {mean 2.3 x 10⁹/L; P <0.000), NLR (mean 1.6, P <0.000), PLR parameter (mean 141.8 P <0.000> were revealed. Leukopenia (<3.98) were in 17 (6.8%), leukocytosis (>10.0) were in 11 (4.4%) cases. Lymphopenia (<1.18) were in 14 (5.6%), lymphocytosis (>3.74) were in 14 (5.6%) cases. Thrombocytosis (>369) were in 21 (8,4%), thrombocytopenia (<163) were in 4(1.6%) cases. Neutropenia (<1.56) were in 14 (5.6%) neutrophilia (>6.13) were in 15 (6%). The rest 220 (88.3%) cases have been determined no changes. PLR were 141.8 ±88.6, NLR were in 1.29 ±1.26 in 249 cases. Increased NLR and decreased PLR were in 10 (4.0%) and 114 (45.7%); increased PLR and decreased PLR in 31 (12.4%) and 28 (11.2%), respectively. Discussion Our result which is leukocytosis in 4.4%, leukopenia in 6.8%, lymphopenia in 5.6% of all imported eases ol"CO\ 1D-W. are similar to other studies. However, percentage of changes were lower than similar studies due to low rate of severe cases. It suggests, further studies clinical stages and severity of the infection need to be conducted.

Introduction: Soum and family health care centers (primary health care centers) provide public health services to reduce the negative effects of air pollution on health. In order to decrease the risk factors due to air pollution, it is crucial for health professionals, who are providing health care services to the public, to have the knowledge, attitude and practice to give an advice for residents on how to protect their health from air pollution. The “Air pollution and child health” report from WHO recommended that responsibility of health professionals must include knowing the latest information on air pollution, doing a research, spreading the knowledge, educating families and community and learning from them as well, proposing solutions, and finding a solution for policy developers and decision makers in other sectors. Therefore, we conducted this survey with purpose to determine the long-term effects of air pollution on population psychology and lifestyle and to evaluate the level of knowledge, attitude, and practice of health professionals on how to protect a health from air pollution. Goal: Evaluate the level of knowledge, attitude, and practice of health professionals on air pollution. Material and Methods: In 2019, this study conducted a cross-sectional design and collected quantitative and qualitative data. 88.4% of (n=532) health professionals from 48 secondary health care centers (SHCC) and 64 family health care centers (FHCC), which are agents that implement UNICEF project, in Bayanzurkh, Songinokhairkhan districts and Bayankhongor aimag were participated in the survey. Results: 97.4% of the participants agreed that air pollution has negative effects on human health. 99.5% of participants did not know the Mongolian standard for the acceptable level of air pollutant particulate matter (PM) and 73.1% of all participants did not receive information about air quality index. 82.1% of participants regularly give prevention advice with the purpose of protecting maternal and child health from air. The participants who worked for more than 21 years and who are older than 51 years old were more likely to give advice (p<0.05). As for the reasons for not giving advice about air pollution for protecting the maternal and child health, 29.2% of participants answered the service time is not enough, and 22.9% mentioned the lack of knowledge and information. 30.5% (162) of participants were not satisfied with their skill to give an advice on how to protect maternal and child health from air pollution. 86.8% of participants indicated that they did not receive proper training on air pollution and prevention from air pollution. Conclusion There is a need to provide training and information on how to protect maternal and child health from air pollution for health professionals.

Introduction: Beginning 15 May 2019, the consumption of raw coal in Ulaanbaatar has been replaced by the consumption of briquette fuel for the improvement of air quality according to Governmental Resolution No.62 adopted in 2018. Since after this resolution has been in placed the number of CO poisoning has been increased as of 18 December 2019, nine persons were died and 1394 people get a health care service due to CO poisoning. However, it has been not been assessed briquette affect to the indoor air quality and its health impact. Thus, it is need urge to define the indoor air quality effect of briquette and its heath impact. Goal: To assess the indoor air quality of the household using the “improved briquette” and identify the causes of the risk. Material and Method: This a cross-sectional survey, conducted from January 31, 2020 to April 31, 2020, data were obtained by quantitative, qualitative (observation, interview) and direct indoor air quality measurement. The survey sampling frame was 40 households in central 6 districts of Ulaanbaatar that used improved fuels (20 households with a history of carbon monoxide poisoning and 20 households that were not affected), and 14 households in the Nalaikh district that used raw coal, in total of 54 households were participated. Indoor air quality was measured by PM2.5, PM10, CO, SO2, NO2, and microclimate per household for 24 hours during a week.
The statistical data analysis was done by the SPSS-23 program and preformed required parametric and non-parametric tests. The normality of the data was checked by the Kolmogorov-Smirnov test. The most of data was not normally distributed. So, thus we used median and used relevant non-parametric tests. The average level of microclimate indicators, and air quality indicators were defined as mean, median and its IQR and standard deviation. The 95% confidence intervals of mean and frequencies were determined and used to differentiate group differences.
The Ethical permission to start the survey was approved by the 2nd meeting of the Ministry of Health on February 4, 2020. The committee was reviewed and approved the research methodology based on whether data collection technique and tools are considered the ethical issues, and whether provided accurate information for make decisions to enroll to the survey for respondents. Results: According to the health statistic, from October 2, 2019 to March 31, 2020, a total of 2,768 people from 837 households were exposed to carbon monoxide poisoning. Of the total reported cases, 10 were drunk, and 2 were due to other disease complications, and a total of 2,756 cases were confirmed diagnosis as carbon monoxide poisoning.
Emissions of CO were recorded every 15 seconds and the results were calculated by conducting continuous measurements per household for 24 hours a week. The level of CO emitted into the indoor environment of households exposed by carbon monoxide had increased during the following time from 7 am to 9 am in the morning, from 13 pm to 15 pm, from 18 pm to 20 pm in the evening, and from 22 pm to 24 pm at night. During this period of time, the indoor air CO level had increased from the WHO mild poisoning recommendation level. Conclusion It has been defined that the carbon monoxide emits to the indoor air households which are using an improved fuel according to measurement the 30 minutes, 31-60 minutes, and 61-120 minutes after burning.