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Purpose Due to the shortage in the healthcare workforce, insufficient qualifications, a lack of infrastructure and limited resources in Mongolia, it is not always possible for healthcare workers in rural areas who wish to attend continuous training and retraining courses to do so. However, in order to provide high-quality care, the demand for distance learning and the upgrading of knowledge and practice of many medical topics (especially related to morbidity and mortality) are necessary for the rural population. This study aimed to assess the needs of e-learning medical education, of graduates in Mongolia. Methods A cross-sectional research design was implemented. We collected data from 1,221 healthcare professionals (nursing professionals, physicians, midwives, and feldshers) who were randomly selected from 69 government hospitals in Mongolia. Data were collected using self-assessment questionnaires which captured the needs assessment in a survey for online continuous medical education in Mongolia. Data were analyzed using descriptive statistics and Kruskal-Wallis statistical test. Results Ninety percent of the respondents reported that they plan on attending online continuous medical education with the most preferred specialty area being emergency medicine. Results using the Kruskal-Wallis statistical technique suggested the preferred specialty area, educational content, appropriate time schedule, available devices, and tools were statistically significant and were different between the nursing professionals, physicians, midwives, and feldshers (p

Objectives: To evaluate multiple-choice questions of the Medical Licensing Examination. Methods: The study design was a cross sectional descriptive and item analysis method was used. This study was conducted in Health Development Center of the Ministry of Health. An item analysis was done on 1500 multiple-choice questions for the internal medicine licensing exam and of 2077 subjects from 2014 to 2016. The item analysis involved identifying reliability coefficient, difficulty index, and discrimination index for each question in relation to the doctors’ exam performance. Microsoft Excel 2010, and SPSS were used for the statistical analyses. Results: Reliability coefficient (KR20) of Mongolia’s medical licensing examination in 2014-2016 ranged from 0.79 - 0.92. The frequency of multiple-choice questions with a negative or zero discrimination index was 11.6 percent and a high difficulty index was 21.9 percent. Conclusion: Even though reliability of Mongolia’s medical licensing examinations were good, one-third of the multiple-choice questions used in the exams fail to evaluate examinee’s knowledge.

Objectives: Purpose of this study was to determine the current attitudes of the faculty who are responsible for training of future healthcare professionals. Methods: A descriptive, cross-sectional design was used to survey participants from a convenience sample of faculty at a large public health sciences university located the capital city of Mongolia. The colleges represented were medicine, dentistry, nursing, pharmacy, public health, biomedicine and traditional medicine. Attitudes towards the various aspects of interprofessional education and learning were measured using surveys. Results: The attitude towards interprofessional health care teams was determined by the responses to 14 statements. The score for interprofessional health care teams for all respondents was 4.1±0.10 (mean±SD). The attitude towards interprofessional education was determined by summing the responses to 15 statements and the score for all respondents was 3.83±0.10. The attitude towards interprofessional learning was determined by summing the responses to 13 statements, yielding a score of 3.41±0.10 for all respondents. The barriers identified included problems with schedule/calendar, classroom size, turf battles, faculty attitudes, rigid curricula and lack of administrative support, faculty incentives, perceived value, students’ acceptance, and financial resources. Conclusion: Analysis of the perceived barriers to IPE revealed a number of similarities in Mongolia compared to Japan and the need to organize IPE training and to make IPE curriculum.

Congenital hypothyroidism (CH) is among the most common conditions leading to intellectual disability, which can be prevented by early detection through newborn screening (NBS). In Mongolia, a regional screening program for CH was launched in 2000, which was supported by the International Atomic Energy Agency (IAEA) for the Asia Pacific Region. In our present study, a total of 23,002 newborns from nine districts in Ulaanbaatar were screened between 2012 and 2020, by the measurement of the thyroid-stimulating hormone (TSH) from dried blood spots, sampled 24 to 72 h after birth. The level of TSH was measured by the DELFIA assay. The overall CH prevalence confirmed at birth was 1/2091. The female-to-male ratio for CH cases was 1.8:1. The majority of patients were asymptomatic (72.7% of CH cases); umbilical hernia and cold or mottled skin were reported symptoms in patients with CH (27.3%). Thyroid dysgenesis (hypoplasia and agenesis) was the most common etiology, with a total of nine cases (81.8%) out of the eleven patients. The lapse between the birth date and the initiation of L-thyroxine treatment in CH-positive children was lower than 15 days in 63.64% of cases or 15 to 30 days in 36.36% of children. Further research is required to expand the screening coverage for CH in Mongolia.

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Background: Symptomatic vitamin D deficiency is associated with slowed growth in children. It is unknown whether vitamin D repletion in children with asymptomatic serum vitamin D deficiency can restore normal growth., Objective: We tested the impact of vitamin D-supplementation on serum concentrations of 25-hydroxyvitamin D [25(OH)D] and short-term growth in Mongol children, with very low serum vitamin D levels in winter., Design: We conducted two randomized, double-blind, placebo-controlled trials in urban school age children without clinical signs of rickets. The Supplementation Study was a 6-month intervention with an 800 IU vitamin D3 supplement daily, compared with placebo, in 113 children aged 12-15 years. A second study, the Fortification Study, was a 7-week intervention with 710 ml of whole milk fortified with 300 IU vitamin D3 daily, compared with unfortified milk, in 235 children aged 9-11 years., Results: At winter baseline, children had low vitamin D levels, with a mean (±SD) serum 25-hydroxyvitamin D [25(OH)D] concentration of 7.3 (±3.9) ng/ml in the Supplementation Study and 7.5 (±3.8) ng/ml in the Fortification Study. The serum levels increased in both vitamin D groups-by 19.8 (±5.1) ng/ml in the Supplementation Study, and 19.7 (±6.1) ng/ml in the Fortification Study. Multivariable analysis showed a 0.9 (±0.3 SE) cm greater increase in height in the vitamin-D treated children, compared to placebo treated children, in the 6-month Supplementation Study (p = 0.003). Although the children in the 7-week Fortification Study intervention arm grew 0.2 (±0.1) cm more, on average, than placebo children this difference was not statistically significant (p = 0.2). There were no significant effects of vitamin D supplements on differences in changes in weight or body mass index in either trial. For the Fortification Study, girls gained more weight than boys while taking vitamin D 3 (p-value for interaction = 0.03), but sex was not an effect modifier of the relationship between vitamin D3 and change in either height or BMI in either trial., Conclusions: Correcting vitamin D deficiency in children with very low serum vitamin D levels using 800 IU of vitamin D3 daily for six months increased growth, at least in the short-term, whereas, in a shorter trial of 300 IU of D fortified milk daily for 7 weeks did not.

Objective: Observational studies suggest that serum levels of 25-hydroxyvitamin D (25[OH]D) are inversely associated with acute respiratory infections (ARIs). We hypothesized that vitamin D supplementation of children with vitamin D deficiency would lower the risk of ARIs., Methods: By using cluster randomization, classrooms of 744 Mongolian schoolchildren were randomly assigned to different treatments in winter (January-March). This analysis focused on a subset of 247 children who were assigned to daily ingestion of unfortified regular milk (control; n = 104) or milk fortified with 300 IU of vitamin D(3) (n = 143). This comparison was double-blinded. The primary outcome was the number of parent-reported ARIs over the past 3 months., Results: At baseline, the median serum 25(OH)D level was 7 ng/mL (interquartile range: 5-10 ng/mL). At the end of the trial, follow-up was 99% (n = 244), and the median 25(OH)D levels of children in the control versus vitamin D groups was significantly different (7 vs 19 ng/mL; P < .001). Compared with controls, children receiving vitamin D reported significantly fewer ARIs during the study period (mean: 0.80 vs 0.45; P = .047), with a rate ratio of 0.52 (95% confidence interval: 0.31-0.89). Adjusting for age, gender, and history of wheezing, vitamin D continued to halve the risk of ARI (rate ratio: 0.50 [95% confidence interval: 0.28-0.88]). Similar results were found among children either below or above the median 25(OH)D level at baseline (rate ratio: 0.41 vs 0.57; P(interaction) = .27)., Conclusions: Vitamin D supplementation significantly reduced the risk of ARIs in winter among Mongolian children with vitamin D deficiency.

Background: By modulating immune function, vitamin D might increase innate immunity and inhibit the growth of initial bacterial invasion and protect against tuberculosis infection., Objective: We examined the effect of vitamin D supplementation on tuberculin skin test (TST) conversion., Design: A double-blind, placebo-controlled study was conducted in 120 Mongol schoolchildren. We estimated the prevalence of latent tuberculosis infection at baseline and examined the effect of vitamin D (800 IU/d) on serum concentrations of 25-hydroxyvitamin D [25(OH)D] and TST conversion., Results: At baseline, the mean (±SD) 25(OH)D concentration was 7 ± 4 ng/mL, and all concentrations were <20 ng/mL. Vitamin D supplementation increased serum 25(OH)D by a mean of 12.7 ng/mL compared with placebo (P < 0.0001). At baseline, 16 children in the vitamin D group and 18 in the placebo group were TST positive (P = 0.7). Over 6 mo, TSTs converted to positive in 5 (11%) children receiving vitamin D compared with 11 (27%) receiving placebo (RR: 0.41; 95% CI: 0.16, 1.09; P = 0.06). Only one TST conversion occurred among those whose serum 25(OH)D concentration increased to >20 ng/mL, whereas 8 TST conversions occurred in those whose final 25(OH)D concentration remained <10 ng/mL (P = 0.05). The mean increase in stature was 2.9 ± 1.6 cm in the vitamin D group and 2.0 ± 1.7 cm in the placebo group (95% CI: 2.16, 2.81; P < 0.003)., Conclusions: Vitamin D supplementation for 6 mo had significant favorable effects on serum 25(OH)D concentrations and on growth in stature. A trend was seen toward fewer TST conversions in the vitamin D group. This trial was registered at clinicaltrials.gov as NCT01244204.

Background: The optimal public health strategy for maintaining 25-hydroxyvitamin D [25(OH)D] concentrations in schoolchildren in Mongolia is unknown., Objective: The objective was to compare the effectiveness of different supplement and fortified milk regimens to increase 25(OH)D concentrations in Mongolian schoolchildren., Design: Twenty-one classrooms of 579 children aged 9-11 y were randomized to interventions with an equivalent content of vitamin D(3): 1) a one-time seasonal supplement of 13,700 IU, 2) 300 IU/d from supplements, 3) 300 IU/d from fortified ultra-high-temperature pasteurized milk from the United States, 4) 300 IU/d from fortified pasteurized Mongolian milk, or 5) unfortified pasteurized Mongolian milk (control)., Results: In January, the mean (±SD) serum 25(OH)D concentration was 8 ± 4 ng/mL (20 ± 10 nmol/L), and 98% of the children had a concentration <20 ng/mL (50 nmol/L). In March, concentrations were 8 ± 4 ng/mL after unfortified milk, 20 ± 6 ng/mL after fortified Mongolian milk, 29 ± 10 ng/mL after fortified US milk, 21 ± 6 ng/mL after daily supplements, and 12 ± 4 ng/mL after seasonal supplements (each greater than unfortified milk, P < 0.01). Seasonal supplementation was less effective than was daily supplementation (P < 0.0001). Despite consuming daily supplements or fortified milk, 41% of the children still had concentrations <20 ng/mL (50 nmol/L). Children with lower baseline 25(OH)D concentrations experienced slightly larger 25(OH)D responses to intervention than did children with higher concentrations (P = 0.002)., Conclusions: In this population with extremely low vitamin D concentrations, delivery of 300 IU vitamin D/d via supplements or in fortified milk improved 25(OH)D concentrations but failed to raise concentrations uniformly to >20 ng/mL (50 nmol/L). The daily low-dose intervention was superior to the seasonal larger-dose intervention. Higher doses may be needed to prevent deficiency in schoolchildren in Mongolia and at other northern latitudes. This trial is registered at clinicaltrials.gov as NCT00886379.

Objective: To estimate the life expectancy (LE), quality-adjusted life expectancy (QALE), and their losses, in patients with pneumoconiosis in Mongolia., Methods and Materials: All patients (n = 432) diagnosed with occupational pneumoconiosis during 1986-2006 were recruited from the registry of the National Research Center of Occupational Diseases, which was linked to the National Mortality Registry of Mongolia to obtain the survival function. We simulated age and gender matched referents group based on the life table in 2000. The survival ratio between patients and referents was used to extrapolate and calculate the LE. The average expected years of life loss (EYLL) of pneumoconiosis were calculated as the mean survival difference between patients and referents. We adopted utility values for workers with pneumoconiosis and multiplied them with the survival function to estimate the QALE, which was then used to calculate the loss of QALE., Results: The life expectancy and EYLL of a patient with pneumoconiosis were 18.1 and 9.5 years respectively. QALE and loss of QALE were 15.1 and 12.5 QALYs (quality-adjusted life years), respectively, indicating a health gap of 45%., Conclusion: The health inequality suffered by miners in Mongolia must be addressed through prevention, including exposure monitoring and control, early diagnosis and case management and rehabilitation of pneumoconiosis., (Copyright © 2011 Wiley-Liss, Inc.)

Background: Kawasaki disease (KD) has been reported in many countries. However, the incidence of KD in Mongolia is not known. This is the first report of incident cases of KD in Mongolia, which were identified using data from 2 nationwide surveys., Methods: Two nationwide retrospective surveys were conducted: medical histories were collected from patients aged 0 to 16 years who were hospitalized countrywide between 1996 and 2008. Hospital records for these patients were also reviewed. Nationwide training seminars on KD were conducted before each survey., Results: For the nationwide surveys, the participation rates among all hospitals with pediatric wards were 97% and 94%. Inpatient medical histories from 1996 through 2008 were reviewed, and, among children younger than 16 years, 9 patients with KD were investigated. The age of KD patients ranged from 1.4 to 14 years; 7 of 9 patients were male. Six (67%) patients fulfilled all 6 clinical diagnostic criteria; the other 3 (33%) were defined as having KD based on the presence of 5 such criteria. Fever persisting 5 or more days, bilateral conjunctival congestion, and changes of the lips and oral cavity were the most common symptoms, and cervical lymphadenopathy was the least common symptom. Cardiac sequelae developed in 5 of the patients, 4 of whom were older than 10 years., Conclusions: The results of these nationwide surveys reveal that KD cases do exist in Mongolia. However, knowledge of KD among Mongolian pediatricians is likely to be poor. Thus, there is a need to augment their understanding to improve management of KD patients. Further studies are crucial to clarify the epidemiologic characteristics of KD in Mongolia.

The purpose of this study was to determine incidence rates and time trends of major occupational diseases in Mongolia. We retrieved information about all 4598 patients from 1986 to 2006 who were diagnosed and registered with occupational diseases by the National Center of Workplace Conditions and Occupational Diseases. There was an increasing trend for new cases as well as for incidence rates of reported occupational respiratory diseases (ORD), musculoskeletal disorders (MSD), cardiovascular diseases, skin diseases, toxic hepatitis, and noise-induced hearing loss. Such a trend may result from both rapid industrialization in Mongolia and increased recognition of occupational disease. Actions must be taken immediately to allocate more resources for prevention and early recognition of occupational diseases, establishment of a comprehensive hazard communication system, and enforcement of all regulations. Key words: occupational diseases, incidence rate, epidemiology, Mongolia.

Aims: The purpose of this study was to investigate the prevalence and determinants of domestic violence in Mongolian women., Methods: The survey was administered to 5500 people in 1000 households randomly selected from two districts of Ulaanbaatar, Mongolia., Results: The response rate was 90.3% (total of 4967, and 3338 were women.). About 37.7% of respondents reported that they were affected by some type of domestic violence during the previous 6 months; 17.9% of all respondents reported physical violence, 21.9% reported emotional violence, 10% reported sexual abuse, and 6.9% reported financial violence. Major risk factors for violence against women included having only a primary education or less, low income, living in a rented house, and living with an unemployed partner who uses alcohol., Conclusions: Domestic or intimate partner violence (IPV) is widespread in Mongolia and is usually committed in family circles, often away from public view. This study suggests that increasing employment for men may help reduce poverty and alcohol abuse and, thus, IPV.