Outcomes of the retinopathy of prematurity screening and treatment in Mongolia Background: Retinopathy of prematurity (ROP) is a disease characterized by abnormal retinal vasculature that can have devastating visual consequences. Despite evidence that early detection and treatment can prevent blindness, ROP remains a leading cause of pediatric blindness worldwide. We aimed at investigating the outcomes of ROP screening, intravitreal anti–vascular endothelial growth factor (VEGF) and laser surgery in the treatment ROP and describe an evidence-based and specific process for identifying birth weight and gestational age screening guidelines in Mongolia utilizing telemedicine. Materials and methods: This was a retrospective of prematurity infants screened ROP from 2012 September to July 2020 and prospective cohort study of premature infants with treatment-requiring ROP who received intravitreal injections, laser surgery and combined therapy from 2015 December 01 to January 31, 2017. Demographic factors, diagnosis and clinical course were recorded in a de-identified manner using REDCap, a secure, web-based platform to collect image and demographic data. The IRB approved the study protocol not requiring parental consent due to the de-identified nature of the data which was used for program monitoring purposes. Indirect ophthalmoscopy and Retinal imaging was performed using RetCam (Natus Medical, Pleasanton, CA) and images were uploaded to the web-based platform which could be accessed by the Mongolian ophthalmologist for reference. Each eye was evaluated by the local Mongolian ophthalmologist for the presence or absence of ROP, zone of vascularization, stage, plus disease, and aggressive posterior ROP (AP-ROP). The diagnosis and classification of ROP for this current study were determined by examination using indirect ophthalmoscopy, and treatment plans were determined according to the International Classification for ROP and the Early Treatment for ROP Study (ET-ROP).2,13 Regression analysis to determine association between BW and GA and the development of ROP. Results: A total of 9126 premature infants with BW ≤ 2500 g and/or GA ≤ 36 weeks were screened for ROP during the study period. 327 (3.5%) of the 9126 infants screened required treatment. The193 infants who received ROP screening had a mean GA of 30.09 ± 1.7 weeks, and mean BW of 1500.3 ± 125.42g. The BW of infants in this study ranged from 750g to 2000g, and the GA at birth ranged from 25 to 35 weeks. The BW of infants in this study ranged from 750g to 2000g, and the GA at birth ranged from 25 to 35 weeks. There were 96 boys (49.7%) and 97 girls (50.3%). Among infants receiving treatment, the highest BW was 2000g (born at 31 weeks GA), and the oldest was 34 weeks (with a BW of 1300g). The distribution of birth weight and gestational age in Mongolia was similar to other low-middle income countries, with higher birth weight and older gestational age. As birth weight and gestational age decreased, relative risk of developing ROP increased. Conclusions: After treatment, resolution of ROP was noted in approximately 90 % of the patients who had treatment-requiring ROP. 10 % of patients treated with IVB, IVR, Laser surgery and combined therapy however, did not respond and progressed to retinal detachment. This prospective study provides information about the development of ROP in preterm infants in the capital city of Mongolia. The distributions of BW and GA among infants developing ROP in Mongolia differ from those found in higher-income countries, and are comparable to other low and middle-income countries. We used a secure, web-based data collection and retrieval system that could be extended to multiple countries, which is now equipped with a telemedicine platform enabling remote grading of fundus images.

Introduction: First family group practices (FGPs) started to function in 1999 and there are 225 FGPs in Mongolia. FGP is a primary health care unit that renders medical assistance for all urban population in the country. Privatized FGPs act as contractors for state responsibility service and this one of the innovations that raises challenges to make primary health care services more accessible improve their quality and strengthen their human resources. Greater equity of service access and provision depends on structure and capacity of human resources of FGPs. Therefore, there is a need to study human resources provision and their specialization profile in FGPs.Objectives: To study human resource provision and its specialization profile in FGPs of Ulaanbaatar city.Design: Cross-sectional study Material and Methods: Developed registration checklists and questionnaire were used for collection data on human resources, their specialization and training needs.Settings: 77 FGPs in Ulaanbaatar were covered by the studyResults: There were 2273 people per one family doctor and 2233 people per one family nurse. This means that a family doctor and a family nurse provide services for population almost twice greater compared to required standards and it was observed in all districts of Ulaanbaatar. Most of family doctors (71.6%) graduated as basic doctors and only 10.5% of them specialized as family doctors or general practitioners. Some 15.5% of all selected family doctors attended an upgrading training in family practice and only 1.6% attended specialization training. There were 180 nurses covered by the study and 143 (79.4%), 24 (13.3%), 4 (2.2%) and only 2 (1.1%) of them were trained as general nurse, midwife, nursing assistant and family practice nurse, respectively. Some 20(11.1%) of nurses participated in the study attended some specialization training. Some 28% of family doctors stressed that they would like to attend upgrading training courses in family practice, 13% of them training on public health, 12% on healthcare management, 11% on imaging diagnostics, 8% on internal medicine, 6% on traditional medicine and 5% on child health. FGP’s nurses preference of training were as follows: 40%, 22%, 11%, and 18% were on general practice nursing, public health, management and physiotherapy, respectively.Conclusions: The FGP’s physicians and nurses have been provided service to population twice greater than in required standards, and there were only 1.6% and 1.1% of doctors and nurses attended family practice training, respectively. Therefore, there is a need to increase number of professionals in FGPs and provide specialization training to strengthen FGPs human resources.

Goal: To conduct mercury-based medical devises used in health care organizations and develop strategy and recommendations on futher activityMaterial and Methods:A cross-sectional study design was used. Totally 578 units of 38 governmental and private health care organizations inUlaanbaatar, Darkhan, Erdenet cities and Uvurkhangai aimags were conducted in the survey. The survey was conductedby means of a questionnaire given to the medical workers and doctors to complete. There were 3 parts of questions. Thefirst part of the questionnaire dealth with the use of mercury-based medical devices, working, transportation and storageconditions, and waste management. The second section was concerned with knowledge, attitude and practice (KAP) ofmedical personals for safety handling, storage and disposal of mercury containing devices. The third part of the questionnairedealth with the dental amalgam.Mercury concentration of dental amalgam samples were detected by portable mercury vapor analyser RP-91, PYRO-915+ in the Poison Information Center of Public Health Institute. Data processing was done by using statistical programSPSS-10.Conclusions:1. Mercury containing devices such as thermometer, blood pressure sphygmomanometer, energy saving fluorescencelamp and termostates were used in urban and rural hospitals. There are not any regulations for safe handling,storage, and transportation and disposal system of mercury containing divices.2. Knowledge on handling, storaging and disposing mercury based devices are not enough among the medical personals.The current situations for inapproiprate disposal system can be posed to increase riskes of environmentalpollution with mercury.3. Knowledge on health impact of spilled mercury from broken mercury based medical devices is not enoughamong the medical workers. Safety manual for handling, storage and disposal of mercury based medical devicesand promotion materials for health adverse effect and prevention methods have not been developed.4. 14.7% of the investigated dental hospitals and cabinets were used dental amalgam for treatment. Of these wasinvolved the fist stage hospitals. Dental amalgams were imported from China and Russia. Any special recommendationsand rules for safe use, storage and disposal of dental amalgam have not developed.