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.

Risk factors for severe postpartum hemorrhage: a case-control study Introduction: Postpartum hemorrhage (PPH) is an obstetric emergency. It is one of the top five causes of maternal mortality in both resource-abundant and resource-limited countries. PPH occurs in approximately 1% to 3% of all deliveries and is the leading cause of obstetric morbidity and mortality worldwide, accounting for approximately 8% of maternal deaths in developing countries and 20% of maternal deaths in developed countries. The United States has one of the highest maternal mortality rates at 11% and continues to rise, increasing from 8 to 40 cases per 10,000 deliveries. In Europe, PPH occurs in approximately 13% of deliveries. Uterine atony, the primary cause of PPH, accounts for 70% to 80% of all hemorrhages.Traditionally, PPH is defined as more than 500 mL of estimated blood loss in a vaginal delivery or more than 1000 mL of estimated blood loss during Cesarean delivery. These parameters were redefined in 2017 by the American College of Obstetrics and Gynecology as a cumulative blood loss of more than 1000 mL with signs and symptoms of hypovolemia within 24 hours of the birth process, regardless of the mode of delivery. A loss of an approximate total blood volume of more than 1500 mL will typically cause clinical features of hypovolemia. Materials and methods: The study was conducted using a retrospective, case-control research design. The study population consisted of women who gave birth between January 1 and August 1, 2024 at the Department of Obstetrics and Gynecology at the National Center for Maternal and Child Health and were diagnosed with hemorrhage. The study participants were divided into 2 groups according to the amount of blood loss in the early postpartum period: the control group was less than 1500 ml (n=72), and the case group was women with blood loss of 1500 ml or more (n=26). Research data were collected through a questionnaire with 60 questions in 3 groups pre-designed from medical history. Statistical analysis was performed using IBM SPSS 26 software. Results: The study included 98 women, maternal age was 17-44 which average 30.2±6.7 years. There were no significant differences in age, marital status, mode of delivery, and drug dosage in the case-control group. The risk of major bleeding in the early postpartum period was associated with Preeclampsia, 1.9 (OR: 1.99; 0.71-5.57), cardiovascular disease 11.2 (OR=11.2; 1.1-18.5), placenta accrete spectrum 6.5 (OR=6.5; 2.01- 21.1), increasing anemia during pregnancy 8.05 (OR=8.5; 1.08-12.5). Also, pregnancy with twins and the weight of the fetus increased the amount of postpartum hemorrhage. Also, the amount of blood lost in mothers with other births was positively correlated with the duration of labor (r=0.348). There is a risk of increased bleeding in case of co-occurring causes of bleeding (p=0.042). Conclusions: The risk of major bleeding in the early postpartum period was associated with Preeclampsia, cardiovascular disease, placenta accrete spectrum, increasing anemia during pregnancy. Also, pregnancy with twins and the weight of the fetus increased the amount of postpartum hemorrhage. Also, the amount of blood lost in mothers with other births was positively correlated with the duration of labor. There is a risk of increased bleeding in case of co-occurring causes of bleeding.

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.

Relationship between quality of life, depression and burden of mothers with child withсerebral palsy Background: Regular care and treatment of children diagnosed with cerebral palsy can be time-consuming and costly, increasing the risk of burden and depression, and adversely affecting quality of life. So there are many reasons why mothers' quality of life is poor socio-economic status and support related to the family, cerebral palsy from child care techniques and understanding of the disease the quality of life of mothers with sick children depends. There are few studies in Mongolia that assess the quality of life and other factors of mothers with cerebral palsy. We aimed assessing the relationship between quality of life, stress and depression in mothers with children with cerebral palsy. Materials and methods: The survey was conducted to the cross-sectional design of the analytical study based on the NCMCH. The study included 70 mothers with children with cerebral palsy. The survey data were collected using a general demographic questionnaire and three groups of questionnaires (WHOQOL-BREF, Stephen Zarit, Beck’s ). Quality of life and burden were measured as minimum <5, maximum 95 and minimum >20, maximum <88 respectively. Depression score measured as minimum >10, maximum <40. Results: The average quality of life of all mothers was 52.43 ± 11.95, environment was 44.8 ± 15.8. Maternal depression rates were 21 (30%), 90.0% of mothers had burden, and quality of life was statistically likely to be inversely related to depression and stress. Conclusion: The poor quality of life of mothers with children with cerebral palsy, high levels of depression and stress indicate the need for policies to reduce the quality of life.

Safety and effectiveness of COVID 19 vaccine among pregnant woman Introduction: Major International Organizations such as the World Health Organization (WHO), Centers for Disease and Prevention (CDC), American College of Obstetrics and Gynecology (ACOG) recommend that use of COVID 19 vaccine for people who are pregnant, breastfeeding and trying to get pregnant. Objective: To determine the safety and effectiveness of COVID 19 vaccine among pregnant woman. Materials and methods: In this prospective study, we collected data from pregnant woman who are receiving their antenatal care at the general hospitals of Ulaanbaatar city and National Center for Maternal and Child Health of Mongolia between July 1, 2021 and August 20, 2021. The survey data were collected four categories of questionnaires. An ultrasound scan performed to screening of fetal anomalies and to assess fetal growth at 12, 20, 28, 36 weeks of pregnancy. Results: Among the total of 420 pregnant woman, 193 (46.0%) have received COVID 19 vaccine and 227 (54.0%) were not. (1:1) The most commonly reported adverse events in pregnant participants were injection site pain (63.2%), myalgia (45.2%), headache (44.9%) and fatigue (40%). Furthermore, complications of pregnancy were 11.5% of vaccinated group and 7.8% of the other group and it has shown that pregnancy complications was not statistically significant in differentiating to the study groups (x^2 = 1.62, p = 0.205) Pregnant woman with COVID 19 infections were 73.6% (n=39) of unvaccinated group and 26.4% (n=14) of vaccinated group. Whether to relate between COVID 19 vaccination and COVID 19 infections were statistically significant in differentiating to the study groups. According to the result, COVID 19 vaccine has an effectiveness of 91% for the pregnant woman if they continue to administer the prevention method of COVID 19 infections (same as before the vaccination: wearing a mask, keep a safe distance). The risk of fetal anomalies at first trimester and 20 weeks gestation were not statistically significant in differentiating to the study groups. These results demonstrate that the COVID 19 vaccine does not affects fetus by now. Conclusions: In this study, COVID 19 vaccine does not increase a risk of pregnancy and medical complications. The prevalence of COVID 19 infection was statistically significant in differentiating to the both vaccinated and unvaccinated groups. It shows that COVID19 vaccines have became a crucial tools for reducing the incidence of COVID 19 infection in pregnancy.

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

BI-RADS assessment using for diagnosis of invasive ductal carcinoma Introduction: Scientific evidence is needed to introduce non-invasive and effective diagnostic methods for early detection of breast cancer. One of these methods is the BI-RADS (Breast Imaging Reporting and Data System) assessment, which has entered the field of imaging. However, in the United States, 58% of all cases diagnosed negatively by ultrasound (BI-RADS1-3) were diagnosed by breast biopsy. The significance of BI-RADS assessment in Invasive Ductal Carcinoma will be investigated in the National Cancer Center of Mongolia Materials and methods: The study was conducted using the descriptive design from January 2021 to August 2021, based on the National Cancer Center of Mongolia. The study data were initially collected using a database of tissue and immunohistochemical analyzes and breast ultrasound. Of the 75 women aged 23-86, 81.3% were diagnosed with breast cancer. Results: The study found that 75.4% of women diagnosed with breast cancer by biopsy had a suspected BI-RADS cancer (4a-5). In addition, a woman's age is a statistically significant predictor variable in the diagnosis of peritoneal breast cancer (ROC = ROC = 0.736, p = 0.006). Conclusions: BI-RADS assessment can be used for invasive ductal carcinoma. Our study retrospectively included only women with cancer and other breast disease. In the future, it is necessary to study in detail the relationship between BI-RADS evaluation indicators and invasive ductal carcinoma.

Early detection of bronchial asthma in children and establishment of a national continuous monitoring system Introduction: Bronchial asthma - a chronic inflammatory disease with recurrent allergic reactions characterized by increased sensitivity of the bronchi to various factors, swelling of the bronchial mucosa, excessive mucus secretion, and narrowing of the airways due to severe muscle contraction. Early detection of bronchial asthma in childhood, its prevalence, and the establishment of a continuous monitoring system to assess the effectiveness of follow-up treatment Materials and methods: It is mild in children, but is ready to be severe. If left untreated for a long time, the structure of the bronchi changes irreversibly and becomes ineffective. There are cases of death due to risk factors for irritability and asthma. In the first objective of the study, the National Center for Maternal and Child Health (NCMCH) Children's Counseling Polyclinic, Respiratory Pathology Department, and the Children's Department of the General Hospital of 21 aimags and 9 districts were used to determine the prevalence of Acute respiratory infections, implemented outpatient (2019-2021). Within the scope of objectives 2 and 3 of the study, a self-controlled case-control study model was used to assess the diagnosis of asthma in the case group based on the GINA-2018 guideline evaluation and clinical and laboratory tests based on the GINA protocol treatment. The parameters were taken, the pre-treatment parameters were recorded and compared in the control group, and the results were calculated. Results: When the prevalence was determined by the Acute respiratory infections level, there were 11 cases per 1,000 children. 80.8% of cases of asthma were caused by asthma 1-5 times a year, and the majority or 96.5% were aged 0-9 years. Allergies include plant (42.9%), food (25.4%), and pet (14.3%) allergies under the age of 4, all types of allergies between the ages of 5-14, and plant allergies 15-19 years, (9%), food (21.4%), pet (14.3%), environmental moisture and mold allergies (14.3%). Among the 89 children treated according to GINA guidelines, 64.0% used spices or allergenic foods, 13.5% used antibiotics, 6.7% used paracetamol, and 13.5% used other drugs. Children with asthma were assessed according to GINA guidelines and monitored and treated for 1 year (0.0001), the number of cases of asthma (p = 0.035) and the number of people receiving emergency care (p = 0.042) decreased statistically. There was a statistically significant difference of 2%, nocturnal cough decreased by 15.2%, and whooping cough decreased by 1.4%. Conclusions: The prevalence of asthma was 11 cases per 1,000 children. The main causes of allergies are plants, food and pets. The number of coughs, hospitalizations and emergency room visits decreased with GINA treatment.