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: Among the endocrine, nutritional, and metabolic disease and thyroid disorders occupy a significant place. According to the World Health Organization, 8-18% of the world’s population suffer from thyroid disorders. In our country, no research on the prevalence of the disorders has been conducted before, and this research methodology was discussed by the Scientific committee of the National Center for Public Health and was approved by resolution No.156 of the Ethics Committee of the Ministry of Health on 2020. Materials and Methods: In order to determine the prevalence of thyroid disease in the country, we collected the actual number of thyroid disorders registered in 9 districts of the capital city and 330 soums of 21 aimags for a total of 10 years from 2011 to 2020. The prevalence of thyroid disorders was mapped using Arc view and GIS software. Results Endocrine, nutritional and metabolic disease account for 2.3% of all outpatient cases. Endocrine, nutritional, and metabolic disease accounted for an average of 168.3 per 10000 population over the past 10 years, and thyroid disorders accounted for 45 or 26.7% of endocrine, nutritional, and metabolic diseases. Thyroid disorders are highest in people aged 40-49 years.
Thyroid toxicity is the most common type of thyroid disease in Mongolia, accounting for 56.2%, with an average of 17.2 per 10000 population in 2011-2020. However, iodine deficiency-related thyroid disease accounts for 5.5% of all thyroid disorders, with an average of 2.5 per 10000 population in 2011-2020. In 2011, it decreased by 2.2 per 10000 population, and by 2020, it decreased by 0.2 per thousand to 2.0, but in the last 5 years, it has increased by an average of 2.4 per 10,000 population, and in the last 5 years it has increased by 0.2 per thousand, or 2.6 per 10,000 population. Morbidity is high in the Khangai and Central regions.

Background: Tick-borne encephalitis is human viral infection involving the nervous system and transmitted by the bite of infected tick. The TBE Virus is distributed in different geographical areas by three widespread subtypes of the virus: The Far East, Europe, and Siberia. The Far East type has a mortality rate was 30-35%, the European type has a mortality rate of 2.2%, and the Siberian type has a mortality rate of 6-8% (A.G. Pletnev, 1998) [2].
In recent years, human cases of tick-borne infections have been reported in 19 European countries and four Asian countries (Mongolia, China, Japan, and South Korea) [3].
Human cases of tick-borne encephalitis, tick-borne rickettsiosis, and tick-borne borreliosis have been registered in Mongolia since 2005. Deaths have been reported year by year [5].
During 2005 to 2021, tick-borne rickettsiosis (71.6%), tick-borne encephalitis (17.3%) and tick-borne borreliosis (52.9%) were confirmed by epidemiological, clinical and laboratory tests at the NCZD.
Tick-borne encephalitis was registered in 63 soums of 15 provinces and 9 districts of the capital city, of which 90% were infected with tick bites in Selenge and Bulgan provinces. The average mortality rate is 4.9% (14), of which 28.6% in Bulgan province and 2.7% in Selenge province.
Tick-borne encephalitis is the leading cause of death in Bugat soum of Bulgan province and more infected men about 40 years of age [7]. Purpose : Collect ticks from selected soums of the provinces, identify tick species, species composition, distribution, tick densities, pathogens of tick-borne diseases, conduct population surveys to assess the risk of tick-borne infections, and identify tick-borne infections. Material and Method: Ticks were collected by flag from birch trees in birch forests and meadows with biotope and overgrown berries, determined morphological analyze and molecular biological investigation for detecting tickborne pathogens.
Questionnaires were collected from selected soum residents according to a specially designed randomized epidemiological and clinical survey card, collected information and forms were submitted to soum hospitals with a history of tick bites (according to clinical criteria). Serological tests were performed to detect IgG-specific antibodies to the collected serum mites. Result and conclusion Collected 121 ticks (120 I. persulcatus and 1 D. nuttalli) and not wound egg, larvae, nymphs. By molecular biological investigation detected 3.5% of I.persulcatus from Khutag-Undur soum of Bulgan province, 3.5% of anaplasmosis, and 14.1% of I.persulcatus mites from Bugat soum. 1.5% borreliosis, 3.1% anaplasmosis.
Detected DNA of 100% tick-borne rickettsiosis from D.nutalli ticks and determined circulation of infection among tick in Bugat and Khutag-Undur soums of Bulgan province.
247 people were surveyed, 56 blood serum from cases. Detected Q fever, erysipelas, and anaplasmosis, tick-borne borreliosis 3 (5.4%), tick-borne rickettsiosis 26 (46.4%), Japanese encephalitis 3 (5.4%), tick-borne encephalitis tick-borne rickettsiosis 6 (13.0%), tick-borne rickettsiosis tick-borne borreliosis 1 (1.8%), tick’s rickettsiosis Japanese encephalitis 1 (1.8%), tick-borne encephalitis tick-borne borreliosis 1 (1.8%).
By investigation, vaccination (88%) and wearing long-sleeved shirts and pants (81%) were the most effective ways to prevent tick bites (81%) [15]. According to our research, the percent of population knowledge in Bulgan province was insufficient (40.9%) which there is a lack of information, training and advertisement among the population in the province.

Introduction: Hepatocellular carcinoma incidence and mortality per 100,000 population in Mongolia is the highest in the world. The individual’s genetic factors and new genetic changes are considered an important effect on the origin and development cancer. We aimed to investigate whether p53R72P polymorphisms were associated with the risk of hepatocellular carcinoma in Mongolian patients. Material and Method: p53R72P polymorphisms were evaluated in 80 controls and 38 HCC cases using a PCRrestriction fragment length polymorphism assay. Results: The mean age was 58.5±13.6 years in the case group and 63.2±8.1 years in the control group. Hepatocellular carcinoma is most common in 50-59 (n=14, 36.8%) and 60-69 (n=14, 36.8%) ages. Of the HCC group, 4 (10.8%) were diagnosed with tumor at stage II, 23 (62.2%) at stage III, and 11 (27%) at stage IV.
The results revealed that the heterozygous (Arg/Pro (PR)) genotype of p53R72P increased statistically significant the risk of hepatocellular carcinoma (OR=4.222, 95% CI 1.669-10.684) compared to the wildtype (R/R) genotype. (p=0.002). Moreover, the homozygous (Pro/Pro (P/P)) genotype of p53R72P increased the risk of carcinoma (OR=1.333, 95% CI 0.414-4.299) but not statistically significant. (p=0.63). Heterozygous (Arg/Pro (PR)) genotype of p53R72P in the tumor tissue was associated with a statistically significant (OR=3.3, 95% CI 1.274-8.57) increase in the risk of HCC (p=0.014). Pro/Pro (PP) genotype increased the risk of the carcinoma by 2.4 times (OR=2.44, 95% CI 0.865-6.908), but it was not significant. (p=0.092). Pro/Pro (PP) genotype of p53R72P in the tumor tissue compared to normal tissue of a case group increased the risk of cancer by 1.8 times (OR=1.833, 95% CI 0.472- 7.126), which was not statistically significant (p=0.382). Conclusion Taken together, Heterozygous (Arg/Pro (PR)) genotype of p53R72P increases the risk of hepatocellular carcinoma in Mongolians. Further studies with larger populations are needed to confirm these results.

Acinetobacter baumannii is considered to be a worldwide threat to public health due to its high antimicrobial resistance rates and the severe infections it can cause. Little is known about this pathogen’s resistance in Mongolia. This report aims to describe the antimicrobial resistance profile of A. baumannii at a tertiary hospital in Mongolia. The cross-sectional analysis was conducted at the tertiary care laboratory hospital in the First Central Hospital of Mongolia from 2013.01 to 2013.12 and from 2020.01 to 2020.12.
A total of 141 in 2013, 227 in 2020 consecutive microbiological reports were analyzed. A. baumannii was isolated. Epidemiological and microbiological data, including the isolation setting and patient information, were recorded. Prevalence of multi-drug and extensive-drug resistance was assessed according to international standards.
The median age of individuals was 22 years (2 – 35 years); female was the predominant gender (53%). The hospital’s intensive care units had the highest number of isolates (n = 226). The most frequent specimen from which A. baumannii was isolated was secretion of respiratory tract (n = 119). Resistance to carbapenems was reported to be 35% among the isolates (n = 115) in 2013 and 74.69% (n=135) respectively. This report reveals the threat of this pathogen to public health in Mongolia and appeals for antibiotic stewardship programs throughout all tertiary hospitals and other hospitals.

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: Mongolia is one of the most vulnerable countries to climate change due to its geographical location, climate conditions, level of development and lifestyle of the population.
The “Impact of Climate Change on Drinking Water, Health and Adaptability” study report has shown that climate change is affecting the quality and composition of drinking water, drying up many rivers and lakes and reducing groundwater levels.
There was a strong positive correlation between precipitation and air temperature and dysentery, diarrhea and salmonellosis, while there was a strong negative correlation between precipitation, air temperature and viral hepatitis. Goal: The goal of the study was to reveal correlation between meteorology parameters and some intestinal infectious diseases and human health in Mongolia. Material and Methods: We evaluated climate and certain morbidity (intestinal infections) indicators for the last 15 years (2005-2019) using descriptive survey methods. The methodology of the survey has developed and discussed at the Scientific Council meeting of NCPH, 12th of Oct, 2020. The methodology of the survey has developed and discussed at Medical Ethics Reviews Committee of MOH on 23rd. of June, 2021. Results: On the other hand, the average air temperature has intensively risen for the last three decades since 1990 with the warmest average temperature between 2001-2010, whereas the coldest average temperature has been observed between 1951-1960. In 2005-2009, the prevalence of intestinal infections per 10.000 population was 0.8 cases of salmonellosis, 11.2 cases of dysentery, 0.2 cases of diarrhea, and 39.0 instances of hepatitis A. Throughout 2015 and 2019, the prevalence of salmonellosis fell by 0.1 per 10.000 population, dysentery by 2.9, diarrhea by 0.1, and hepatitis A by 0.1. Conclusion A seasonal trend in intestinal infections was observed (p<0.001). Strong positive correlation was found between high temperature and some intestinal infections (hepatitis А, dysentery, salmonellosis) respectively.

Introduction: Determining stages of liver fibrosis in chronic liver disease is essential for clinical practice such as decision making on medical treatment, setting the interval of follow-up examination for its complication, screening intervals for hepatocellular carcinoma. Goal: We compared non-invasive fibrosis markers among the patients with chronic hepatitis Delta. Materials and Methods: Totally 70 patients with chronic hepatitis D enrolled into this study. The blood samples were examined for complete blood count, liver function test and serum M2BPGi level. Non-invasive markers such as AAR, APRI, Fib-4 scores were calculated. Those with AAR >1, APRI >0.7, FIB-4 >1.45 were considered with advanced fibrosis. All patients underwent liver stiffness measurement using FibroScan M2 probe. The cutoff values of FibroScan for advanced fibrosis were 9 kPa for patient with normal transaminase level and 11 kPa for patients with elevated transaminase. Results: Advanced fibrosis was observed in 25.7%, 38.6% and 38.6% by AAR, APRI and Fib-4 score, respectively. When cut-off levels of serum M2BPGi for advanced fibrosis was 2.2 COI, 35.7% had advanced fibrosis. FibroScan tests showed 34.4% had advanced fibrosis. The AUROC of M2BPGi were 0.894 and 0.827 for predicting advanced fibrosis and liver cirrhosis. Conclusion Serum M2BPGi and FibroScan would be reliable diagnostic tool for identifying liver fibrosis in Mongolian patients with chronic hepatitis D.

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.

Background: Headache is a common disorder among population. 47% of population of the world suffers from the primary headache. Due to the chronic lasting process of headaches, individuals lose productivity, get depression because of negative impact on people’s quality of life and economic status.
Headache disorders are amongst the top ten causes of disability in Europe [4]. Three of these (migraine, tension-type headache and medication-overuse headache) are important in primary care because they are common and responsible for almost all headache-related burden.
The burden is immense on workers, women and children in terms of missing work and school days. The personal and social burden of primary headache is high. Health, occupational, social, and psychological factors contributing to burden in people with disabling headache have not been fully unraveled. Headache disorders are not perceived by the public as serious since they are mostly episodic, do not cause death, and are not contagious. A large number of people with headache disorders are not diagnosed and treated: worldwide only 40% of those with migraine or tension-type headache (TTH) are professionally diagnosed and only 10% of those with medication-overuse headache (MOH).
There are no studies on the burden and disability assessment in patients with primary headache in our country, therefore a need for conducting this study. Goal: The burden and disability assessment in patients with primary headache in Mongolian adults. Methods and Materials: This cross-sectional study was carried out from June to November of 2017. Participants aged 18-65 years old randomly were selected from four aimags of Mongolia and three districts of Ulaanbaatar city. They were visited by door to door calling and surveyed using the HARDSHIP and Migraine Disability Assessment (MIDAS) questionnaire. The diagnosis of headache was made using the International Classification of Headache Disorders-3 beta. Statistical analysis was performed on SPSS-23 program, and level of depression in headache present patients was determined by odds ratio (OR). Study methodology introduced at Ethical review Committee of “Ach” Medical University and approved in 2017 (№17/3/2). Results: There were 2043 participants 39.7% and 60.3% of them were men and women respectively. The mean age of them was 38.0±13.4 years. 57.4% (n=1173) of participants had headache, and 27.4%, 30.0%, 11.2% and 7.5% of them had migraine, tension-type headache, chronic headache and medication overuse headache respectively. 42% of participants with headache had the median duration of suffering 7 years (IQR=3-13 years). Out of 1173 participants with headache 20.7% had depression. 23% of participants with migraine had depression whereas 68.2 % and 47% of participants with chronic headache and medicine overuse headache had depression respectively. Participants with migraine were 1.85 (OR: 1.85, CI: 95%, 1.39-2.47) times, with chronic headache 3.40 (OR: 3.40, CI: 95%, 2.04-5.67) times and medicine overuse headache 3.31 (OR: 3.31, CI: 95%, 1,50-7.30) times more likely to suffer from depression compare to participants with no headache.
People with migraine loses their productivity 10.6 days/m, with chronic headache 19.7 days/m, with MOH 20.3 days/ m. According the MIDAS (migraine disability assessment) people with migraine has mild disability, while people with chronic headache and MOH had middle score of disability. Conclusion The prevalence of primary headaches is high among Mongolian adults. These headaches cause disability, impair work, study and daily activities, decrease life quality, and brings unrecognized socioeconomic burden.