Knowledge, Attitudes, and Practices (KAP) Regarding Hepatitis B Vaccination among Healthcare Workers in Mongolia

Background: Mongolia is no exception and experiencing the burden of HBV among the population. In the last decade, the prevalence of HBV among the relatively healthy population of Mongolia has ranged between 11.8 percent and 10.6 percent, and acute cases are between 1.7 and 1.1 per 10,000 people. We aimed to determine healthcare workers (HCWs) knowledge, attitude, and practices regarding HBV prevention compared to vaccination coverage. Methods: This cross-sectional study was conducted among HCWs from the selected sites through multi-stage sampling. The study involved 1135 HCWs, including medical doctors, nurses, clinicians in both surgical and medical specialties, laboratory technicians, and other staff working in all departments from primary and referral levels in 36 healthcare facilities in two urban and four rural provinces of Mongolia. Participants who consented to the study completed a standardized self-administered questionnaire between July and Dec 2019. Results: Most participants (82.0%) were born before 1992 or before starting a birth vaccination against HBV in Mongolia. The mean age of the participants was 38 years and the participants’ median employment year in the health sector was seven years. Most participants were medical doctors (29.1%) and nurses (28.0%). Five questions explored HCWs’ knowledge about hepatitis B virus infection and prevention, and the correct response ranged between 15.6% and 95.4%. 2.8% of the respondents answered five questions correctly. Men, those with higher levels of education, those over the age of 30, soum family health center HCWs, and doctors and senior medical professionals answered many questions correctly, which is statistically significant. 98.9% of respondents believe that HCWs should vaccinate against HBV. The younger the age (%), management professionals, and service staff are confident in vaccines. A significant difference between age groups, perception of HBV infection, and formal attendance to the official training positively relate to vaccination coverage. Specially survey respondents who knew about the adverse effects of overdosing, learning about total doses of the vaccine, and the effectiveness of the hepatitis B vaccine were more tent to have full doses of the HBV vaccine. Knowledge and working conditions are increasing factors in receiving full doses of the HVB vaccine. Conclusion: The overall knowledge of HBV and its vaccination is fair among the HCWs;however, there is a need to intensify the training on some of the details and increase the training frequency at the workplace. Attitude and practice on infection protection and vaccination are still essential to be promoted among the HCWs. The low level of vaccination coverage is relevant to the level of KAP among the HCWs of the country.

Lead Hair Level Impact on Mongolian Children with Attention Deficit Hyperactivity Disorder

Background: High-prevalence disorders among children are attention-deficit/ hyperactivity disorder (ADHD) and lead exposure. The purpose of this study was to find out the relationship between ADHD symptoms and hair lead levels and neurocognitive function among Mongolian children. Methods: This was the case study to investigate the relationship between hair lead and ADHD in Mongolian school kids. We conducted a pair-matching case-control study with 30 ADHD cases and 30 non ADHD controls for 7 - 12 years of age school children, based on the same age, and sex. Recruitment process was conducted from June 2018 to December 2019. The case and control study children were systematically selected by structured diagnostic interviews, including caregiver interviews based on the Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSM-IV). Results: The average level of hair lead of the ADHD group was 1.45 ± 2.93 ppm and the control group’s lead level was 0.7 ± 1.59 ppm. We found ADHD-Combined (ADHD-C) patients showed the highest lead levels (p < 0.05). Hair lead levels were positively linked with the severity of ADHD symptoms, negatively linked with the Full-Scale Emotional Intelligence Quotient, but positively correlated with inattention and hyperactivity/impulsivity symptoms (p < 0.05). A statistically significant difference was discovered regarding the lead levels between the study and the control groups with significantly increased risks among boys and children whose mother had preeclampsia during the pregnancy period. Spearman’s correlation coefficient showed a notable negative connection between children’s hair lead levels with ADHD-Hyperactive (ADHD-H), and EQ (Emotional Quotient) level of children (−0.329 and −0.242, for original and log10 transformed, p < 0.001). The lead was linked with vulnerability to ADHD and symptom severity among those school-age children. Conclusions: The child hair lead exposure is one of the risk factors of the development of ADHD and decreasing FSIQ (Full Scale Intelligent Quotient) and EQ level of children and linked with susceptibility to ADHD and symptom severity in school-age children.

Impact of Ambient Air Pollution and Meteorological Factors on Hospital Admission to the Cardiovascular System Disease on Ulaanbaatar City of Mongolia

Background: Mongolia is situated in northern Central Asia. Landlocked between China and Russia, it is a vast expanse of high attitude grassland steppe, desert, and mountain covering an area of 1,565,000 square kilometers. Air pollution is an increasingly series problem in Mongolia. Materials and Methods: This is a time-series cross over study. All health and air pollution data of 2008-2017 was used for this survey. Results: The mean level of SO2 during the cold season was 35.22 μg/m3 and during the warm season it was 4.65 μg/m3. 24 hours PM10 concentration, during the cold season daily average concentration was 226.77 μg/m3. The 8 hours average daily carbon monoxide concentration (1352.85 μg/m3 [95% CI: 1313.07 - 1396.15]) was high during the cold season, ozone concentration (39.10 μg/m3 [95% CI: 37.95 - 40.35]) was high during the warm season. Air quality depends on metrological parameters. All correlation was statistically significant during the whole year and cold season. In total, 288,832 people get admitted to the hospital due to cardiovascular system disease in Ulaanbaatar during the year of 2008-2017. In general, hospitalization is increasing year by year. Significant associations were found for SO2 with hypertensive diseases (I10 - I15), ischemic heart diseases (I20 - I25), cerebrovascular diseases (I60 - I69), diseases of pulmonary circulation and other forms of heart (I00 - I09, I26 - I52) in all lags. For NO2 was less associated with Ischemic heart diseases (I20 - I25) and diseases of pulmonary circulation and other forms of heart (I00 - I09, I26 - I52). For both PM10 and PM2.5, every disease had observed significant RR in lag 0 - 3. Significant associations were found for air pollutants such as PM10, PM2.5, CO, SO2, and O3 in all lags had a statistically significant association with cold season’s cardiovascular system disease admission. As expected during the warm season significant association was found only lag 1 with PM2.5 and lags (0, 1) CO and O3. Conclusion: As expected this study demonstrated significant correlations between cardiovascular morbidity with PM2.5, PM10, NO2, SO2, CO, O3, and some meteorological parameters.

Short Term Impact of Air Pollution on Asthma Admission in Ulaanbaatar

Background: Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. The air quality is influenced by locations of the air pollution sources, their performance capacity, the technology used, the composition of waste generated and geographical and climate conditions. In this study, a time-series analysis was conducted to estimate the association of short-term exposure to ambient air pollutants and hospitalization due to asthma in Ulaanbaatar. Objectives: We estimate the short-term associations between daily changes in ambient air pollutants and daily asthma in Ulaanbaatar, Mongolia. Methods: This is a time-series cross over study. All asthma hospital admission and air pollution data of 2008-2017 was used for this assessment. Data analyzed by using the program STATA-12. For testing the differences of the results were used appropriate non-parametric tests. Result: The daily mean of sulfur dioxide concentration was 35.22 mg/m3 in the cold season, which was 7.57 times higher than the mean of the hot season. The mean annual PM 10 concentration was 182.73 μg/m3. Most of the cases of asthma were among women, aged between 5 - 64 years old, registered during winter and spring. 3.8 people admitted to the hospital mostly on weekdays. In all Lag of SO2, in Lag of NO2, in all Lag of PM 10, in PM 2.5 and in all Lag except for Lag 2 of CO, Lag 0 - 2 of O3 the incidence is likely to increase by 0.3% - 6.1% per 10 units of pollutants. Conclusion: The air pollution especially PM 10, PM 2.5, and CO are the most harmful air pollutants to asthma in Ulaanbaatar. The correlation mainly between asthma admission cases with meteorological parameters is because of the cold winter condition.