Introduction The rate of global warming has accelerated over the past 50 years, with 2014 and 2015 being the earth’s warmest years on record. The prevailing scientific view is that increased ambient temperatures are changing rainfall patterns and cause extreme weather conditions. Increasing surface temperature is melting glaciers and raising the sea level. More flooding, droughts, hurricanes, and heat waves are being reported. Accelerated changes in climate are already affecting human health, in part by altering the epidemiology of climate-sensitive pathogens.
Annually, one out of every four deaths worldwide is due to environmental pollution and climate change-related diseases.
Greenhouse gases from human activities are the most significant driver of observed climate change since the mid-20th century.
These warming trends may have profound effects not only on the environment but also on human health directly and indirectly. In fact, climate change has been considered the biggest threat to global health in the 21st century.

Introduction: Sanitation facility supply and service availability of Mongolia is essential due to the slow process of bacterial decomposition which is getting significant difficulties because of the cold and arid climate. Only 37 percent of Ulaanbaatar’s population is connected to the central sewerage system, and the majority of ger area residents, or 95 percent, use pit latrines in demand of sanitation facility. Numerous studies have shown that the main contaminant of the soil in ger area were pit latrines. It not only pollutes the environment but also affects human health. There is a lack of awareness about the transmission of infectious diseases and options of new sanitation facilities and poor knowledge and bad conditions to introduce new drainage systems. Most pit latrines in ger areas are of poor quality and do not meet relevant standards. Goal: To determine the effect of ”Gipon” ionized disinfectant solution produced by Japanese technology for disinfecting pit latrines Material and Methods: This study was conducted in December 2019 using a random sampling method. Five households in ger areas were selected and pit latrines were disinfected by ”Gipon” ionized disinfectant solution. Results: The survey covered pit latrines of 5 households in the 21st khoroo of Bayanzurkh district. All owners allowed to participate in the survey. The pit latrines are located approximately 9.8 meters away from the households participated in survey. They have been utilized it for 7.6 years and used by an average of 6 people per day. For inner cover, 60.0 percent are lined with wood, and 40.0 percent are cleaned once a month. Before the use of the disinfectant solution, having taken the swab from door handles, floors and walls of the toilet and were detected Enterobacter spp, E.Coli, and Pseudomonas spp in all samples.
However, after one and 24 hours of spreading of the disinfectant solution, the amount of intestinal coliform bacteria and E. coli was reduced dramatically and in some places no bacterial were detected. 72% of the soil near the latrines in the study covered ger areas was contaminated with bacteria. In terms of E.Coli contamination in soil, 60% of them were contaminated in low degree and 32% were medium and 8% were high degree. Anaerobic microorganisms such as Cl.prefrings were accounted for 82% of the total sample, 19% moderate and 81% low contamination. Conclusion Intestinal coliform bacteria (Enterobacter spp, E.Coli, Pseudomonas spp) and pathogenic bacteria (Serratia spp, Staphylacoccus spp) were not detected and the number of fungi was sharply reduced after 1 and 24 hours using Hypon disinfectant. No intestinal pathogens (Salmonella spp, Citrobacter freundii) were found in the soil near the latrine. The amount of coli titers was reached to the acceptable limits. According to this study, the disinfection activity of “Gipon” solution was ranging from 105 to 104.

Introduction: Vaccination is a cost-effective intervention to prevent major illnesses that contribute to child mortality in the country. Increase in parental knowledge abour vaccination will lead to increase in vaccination rates of children. The main aim of our study was to assess the knowledge, attitudes and perceptions of vaccination. People’s knowledge about immunization and their attitudes toward them are likely influence uptake. Goal: The main purpose of the study is to evaluate the knowledge and attitude of the population towards measles and to clarify their satisfaction and understanding of the measles immunization program. Materials and Methods: We conducted cross-sectional study, involved participants from 3 aimags and 6 districts covered voluntarily. Total participants were 509. We used to online model and with the participant’s self-answer closed questionnaire. Results: 76% of the respondents were female and 24% were male. 64.1% of respondents who have children of 0 to 5 years of age, had little or bad knowledge towards immunization schedules against measles. Overall, the general attitude towards vaccines was positive, but the knowledge about significance of vaccines was weak. Further, district and province family doctors need to pay particular attention to increasing awareness and knowledge on importance of vaccines among families with young children. It is necessary to conduct extensive, long-term research and training among population to evaluate their knowledge and attitude towards measles, its vaccine and prevention, and to identify causes of lack of knowledge. Conclusion Our study shows the importance of good physician–patient communication in improving knowledge attitude and practice of parents towards their children’s vaccination.

Background: Diabetes mellitus prevalence increased year to years in Mongolia similar to other countries. Prevalence of Type 1 and type 2 diabetes is increasing showed many literature sorces (M. Lönnrot et al, 2000; H.Viskari et al, 2005; Francesco Dotta et al, 2007; Shoichiro Tanaka et al, 2009; Lars C. Stene et al, 2010; Wing-ChiG Yeung et, 2011; Maarit Oikarinen Sisko Tauriainen et, 2012; Teresa Rodriguez-Calvo et, 2015).
Several studies on prevalence, risk factors and complications of type 2 diabetes have been conducted in Mongolia (J.Suvdaa, 1988; Kh.Altaisaikhan, 2002; Bayarchimeg B, 2004; U.Tsolmon, 2005; Myagmartseren D., 2009; Sainbileg S., 2011; Erdenechimeg D., 2012; Enkhjaragal Ya., 2012; Otgonbayar D., 2015).
Currently, there is no conducted study on incidence of type 1 and type 2 diabetes among children and youth in Mongolia. Goal : To study of incidence of type 1 and type 2 diabetes among children and youth Material and Method: We used to data from Health Development Center and calculated incidence of 1 and type 2 diabetes among children 0-19 years of age per 10000 populations. This study methodology approved Research ethics committee of “Ach” Medical University (2019-6-24, Decision #19/02/04). Result : Incidence in aimag level were in 2014-2020 0-4 year age group 0,00 (2016, 2017)-0.20 (2020); 5-9 age group 0,00 (2015, 2016)-0.32 (2017), 10-14 age group 0,22 (2015, 2016)-0,83 (2020); and 15-19 age group 0,13 (2015)-1,02 (2019).
In Ulaanbaatar 2014-2020: 0-4 age group 0,00(2015, 2016)-0.33 (2019); 5-9 age group 0,00(2015)- 0.74 (2019); 10-14 age group 0,00 (2015, 2016)-1,91(2019); and 15-19 age group 0,34(2017)- 1.41(2019). Type 2 diabetes in 2014-2020: In aimag level (rural): 0-4 age group 0,0 (2014, 2015, 2016, 2017, 2018, 2020)-0.05 (2019); 5-9 age group 0.00 (2016, 2018, 2020)-0.16 (2017); 10-14 age group 0.00(2019)-0.12(2020); 15-19 age group 0.07 (2015)-0.43(2019).
In Ulaanbaatar (Urban): 0-4 age group 0,0 (2014, 2015, 2016, 2017, 2019, 2020)-0.11 (2018); 5-9 age group 0.00 (2014, 2015, 2016, 2018, 2020)-0.07 (2017); 10-14 age group 0.00(2014, 2016, 2018)-0.58(2019) and 15-19 age group 0.11 (2015)-1,52(2019) per 10000 pop. Conclusion Type 1 diabetes incidence in l increased in regard to age of children, there is little differences between rural and urban area but in last 2 years there is noted increasing. Type 1 diabetes incidence in 2014- 2018 more than the incidence of type 2 diabetes, in 2019-2020 among 15-19 age group increased especially in Ulaanbaatar.

Introduction: Major outbreaks of infectious diseases caused by enteroviruses (EV) have been reported in recent years. As of 2017, in Mongolia, hand, foot and mouth disease, or HFMD, accounts for 13.7% of all infectious diseases. The purpose of this study was to investigate the circulation of EV among healthy children, and clinical characteristics of infection. Materials and Methods : The analysis of EV circulation was conducted on Polio Laboratory data of 1172 specimens, collected in 2013-2018, from 9 districts of UB and 21 provinces of Mongolia. Also specimens of 239 patients, who underwent outpatient and inpatient treatment at the NCCD in 2014-2018, were randomly selected and stool samples were collected. Clinical symptoms of patients were analyzed and virus isolation analysis was performed in order to confirm the diagnosis. Results: Children from 1 month of age to 5 years have participated in the study and the average age was 2 years and 5 months. The enterovirus rate among healthy children was 20.1%. Virus circulation rate was highest in 2013 (37.2%), lowest in 2014 (11.8%). The peak of circulation is observed in May and October, while the minimum rate is in July.
Out of selected patients 52.7% (n=126) were diagnosed with HFMD, rash infection occurred in 28.5% (n=68), acute flaccid paralysis-18.8% (n=45). EV was detected in 56.4% (n=135) of the collected stool samples.
Children from 1 month of age to 5 years have participated in the study and the average age was 2 years and 5 months (95% CI:2.5 ±0.1). 49% (n=578) of participants were female, 50.7% (n=594) were male. The enterovirus rate among healthy children were 20.1% (n=236; 95% CI: 20.1 ± 0.55). Virus circulation rate was highest in 2013 (37.2%), lowest in 2014 (11.8%). The peak of circulation is observed in May and October, while the minimum rate is in July. Although the enterovirus isolation rate was relatively high among children under 3, there was no statistically significant difference (p>0.05), as well as there was no difference in gender (p>0.05). As for the EV circulation by region, the highest prevalence rate is found in Central region (27.5%), while the lowest is in the Eastern region (12.7%) with no statistical significance by regions (p>0.05). Conclusions Among children, HFMD is a common disease, that caused by EV. Enterovirus infection can often cause fever, flu like symptoms as well as spotted, maculopapular rash. The EV isolation rate of 20.1% indicates that the incidence of enterovirus is characterized by symptoms of influenza-like illness or is asymptomatic.

BACKGROUND. Hypertension is an increasingly important medical and public-health issue. Recent years complementary and alternative medicine therapies are getting popular and frequently than medical treatment used by patients with hypertension and cardiovascular disease. Aiming to analyze the efficacy of bloodletting to treat impure blood and hypertension and to implement to the clinical practice. METHODS. 14 day before and after loodletting treatment, triglycerides, cholesterol, high- density lipoprotein were analyzed and compared to body type for 30 patients (30- 60 years old ) who have 1st stage arterial hypertension. The LDL was calculated with Fridvalid formula. The participants took traditional prescription ( formula of three seeds) 2gr twice per day for 5 days after bloodletting vena. ( jinshug) RESULTS. The study showed that triglycerides are decreased by 0,4mml/l (P value 0.0047), cholesterol was decreased by 1,54 mml/l (P value 0.00001), LDL was decreased by 1,68 mml/ l (P value 0.00001), and HDL was increased by 0,22 mml/ l (P value 0.0001) after bloodletting treatment. After treatment we observed decreasing hypertension when measured the systolic and diastolic blood pressure for three months. LDL and cholesterol increasing in the blood is risk for cardiovascular disease. But in this study LDL and cholesterol were decreasing after bloodletting treatment which means it is possible to prevent from cardiovascular disease. As well after treatment HDL was increased in the blood that showed prevention from arteriosclerosis. СONCLUSION. Most of patients were shar and badgan type. The badgan type with patients had obesity and high cholesterol compared to other body types. After treatment cholestrol was decreased in all patients, LDL was decreased and HDL was significantly increased in the badgan type patients with hypertension. Systolic and diastolic blood pressure were decreased and stable and kept for long time after bloodletting treatment.

Prevalence of diabetes mellitus is increasing in Mongolia in last years. Diabetes mellitus is a chronic disease which need longterm treatment and its implication is covering many organ and systems. There are rare studies on type 1 diabetes mellitus in our country. We have read several international and local literature sources on relationship of between type 1 diabetes mellitus and enteroviruses and explained the current situation of what is a role of enteroviruses for development of type 1 diabetes mellitus.

BackgroundIn 1988, the Forty-first World Health Assembly adopted a resolution for the Global Polio Eradication.Since the initiative was launched, number of polio cases has fallen by over 99%. Today, only threecountries in the world, Afghanistan, Pakistan and Nigeria - remain polio-endemic. The Polio Eradicationand Endgame Strategic Plan of 2013-2018 calls for the gradual eradication of wild virus strain and thevaccine virus strain at the same time. In order to prevent the border transmission of wild type poliovirus,virus leakage from laboratories, it is required to conduct inventory of laboratories handling poliovirus andpotential infectious materials every 2 year.GoalTo identify laboratories handling poliovirus and potential infectious materialsMethodsSurvey of laboratories handling poliovirus and potential infectious materials was conducted amongstate, private, clinical, biomedical and environmental testing in total of 127 laboratories operating in21 provinces and 9 districts of Ulaanbaatar city by questionnaire. Survey questionnaire consists of 6sections (general, sample storage, laboratory biosafety, staff knowledge, information source, trainingand etc.). Study results were processed using SPSS-19 statistical programme.Results34.7% of 96 biomedical laboratories were analyzed stool samples. These laboratories were analyzedrotavirus (17.0%), intestinal bacteria (67.0%), Helicobacter (14.3%), parasite and other indicators (1.7%)in stool samples. 43.8% of laboratories were stored stool samples for one day and 3.1% up to oneyear. From 31 environmental testing laboratories 73.3% were bacterialdetection test on environmentalsamples. 60% of wastewater samples were collected from rivers, 16% on entrance to wastewatertreatment plant and after biological treatment combined, and 24% from other sources. Soil sampleswere collected near waste disposal and other sources (46.4%), and from unknown sources (53.6%).24.1% of all laboratories were stored environmental samples for 3 days, 3.4% for 45 days. Accordingto results, surveyed laboratories did not store samples for more than 1 year. Also, none of surveyedlaboratories (100%) were not stored poliovirus and potential infectious materials.Conclusion· The investigated laboratories were not stored poliovirus and potential infectious materials.· The biosafety and biosecurity status of laboratories should be improved in near future throughenhancing knowledge of laboratory workers and organizing training related to biosafetyandbiosecurity.

Background Concentrations of lead, chromium, cadmium, mercury, arsenic and boron in waste water treatment sample and soil sample of Mich Company in Khongor, Darkhan-Uul province were detected with high concentration by WHO, UNEP and FAO study in 1998. Therefore, the conclusion was required to conduct environmental audit and to determine pollution frame and risks [1, 2]. According to recommendation of WHO, UNEP and FAO study, it is required to conduct re-survey study of environ¬mental pollution in Khongor, Darkhan-Uul province. Goal Study was aimed to conduct re-survey study of environmental pollution and human health exposure assessment in Khongor, Darkhan-Uul province. Objectives: 1. To determine environmental pollution by questionnaire study and chemical analysis for mercury, chromium, arsenic, lead, cadmium and boron in hair, blood, urine and environment. 2. To develop guidance for next actions. Results Average concentration of arsenic in soil sample of Mich Co, Ltd was 8.458 mg/kg or 1.4 fold higher (95%CI 5.472- 11.444) than reference value (6.0 mg/kg) in “MNS 5850:2008 -Soil quality. Reference value for soil pollutants and elements” standard and mercury and cadmium were not detected (Table 1). Chromium and boron were detected with acceptable level in water samples and average concentration of arsenic (0.0014 mg/l) was lower than reference value (0.01mg/l) in “MNS 900:2005 Drinking water, Hygiene requirements and control” standard. This result shows that there was not arsenic migration from soil to water. Concentrations of lead, cadmium, chromium, arsenic, boron and mercury in soil and water samples were detected with acceptable level (Table 1). Conclusions: 1. Lead, mercury, cadmium, chromium and boron levels in environmental samples of Khongor, Darkhan-Uul province were at subordinate level from reference values in national standards. 2. Arsenic concentrations in biological samples were determined as a higher level, but in environmental samples its amounts were corresponded with acceptable level. Thus there was not environmental pollution exposure to human health. Because of detoxication processes of contaminated moulds by mercury and cyanides in MICH company area, it is possible to this area polluted by arsenic or gold associated elements. Thus it is necessary to decrease arsenic pollution in soil. 3. Concentrations of cadmium, arsenic, lead and mercury in hair, urine and blood samples were less than refer¬ence value of Human biomonitoring commission of Germany (HBM), PHI of USA, Clinical chemist’s agency of Russia and Canadian medical research center. So, in Khongor soum had not those of toxic elements ex¬posure to human health. 4. The boron and chromium concentrations of hair, urine and blood samples exceeded the maximum admissible limits in half of all cases, while their amounts in environmental samples were at permissible level according to national standards. And there was no statistical significance correlation (p=0.735) between chromium and boron concentrations in biological and environmental samples.

Goal: To make mercury exposure assessment among private gold miners, who live in Jargalant and Bornuur soums ofTuv province.Objectives:1. To collect human bio-samples, including hair, urine and blood, then determine mercury concentrations.2. To asess the mercury exposure situation for those of two soum civilizationsMaterials and MethodsThe MoH-lead investigations were undertaken in collaboration with the Institute of Public Health from UMIT University in Hall, Austria as well as national Mongolian partners from the National Emergency Management Agency (NEMA), the National Public Health Institute , the and other institutions. The Mongolian WHO office supported the mission. The urine samples were analyzed by the Department of Forensic Toxicology, Institute of Forensic Medicine, University of Munich, (LMU) Germany and the National Institute for Minamata Disease, Japan. The blood samples were analyzed by the Chemical Hazards and Poisons Division, Centre for Radiation, Chemical and Environmental Hazards, HPA, Chilton, Didcot, Oxon, UK through the Health and Safety Laboratory, Harpur Hill, Buxton, Derbyshire, UK.Results and Conclusions• The median level of mercury in urine for the control area is 0.10 μg/l, compared to 2.88 μg/l for the group exposed by living in the area and 4.37 μg/l for the group working with mercury. The blood results do differ significantly as well (median 0.24 μg/l for control group, median 0.33 μg/l for the group living in an exposed area, median 0.55 μg/l for the group working with mercury).• The hair results do differ significantly as well (median 0.11/0.08 (root/tip) μg/l for control group, median 0.0.25/0.19 (root/tip) μg/l for the group living in an exposed area, median 0.31/0.26 (root/tip) μg/l for the group working with mercury).• Laboratory tests performed on urine, blood and hair samples collected in Bornuur and Jargalant Soum indicate that the population is very likely to have been recently exposed to mercury. The participants from Bornuur soum and Jargalant soum show results above HBM I to a high percentage and even above HBM II, indicating a much higher exposure to mercury compared to Khushaat soum.