Rural Areas Of Mongolia Research Articles

Comparison of quality and interpretation of newborn ultrasound screening examinations for developmental dysplasia of the hip by basically trained nurses and junior physicians with no previous ultrasound experience.

We are obliged to give babies the chance to profit from a nationwide screening of developmental dysplasia of the hip in very rural areas of Mongolia, where trained physicians are scarce. This study aimed to compare the quality and interpretation of hip ultrasound screening examinations performed by nurses and junior physicians. A group of 6 nurses and 6 junior physician volunteers with no previous ultrasound experience underwent Graf's standard training in hands-on practice. Newborns were examined before discharge from the hospital, according to the national guideline. Two standard documentation images of each hip were saved digitally. The groups were compared on the proportion of good quality of sonograms and correct interpretation. Two Swiss supervisors' agreed diagnosis according to Graf was considered the final reference for the study purposes. A total of 201 newborns (402 hips or 804 sonograms) were examined in the study, with a mean age of 1.3±0.8 days at examination. Junior physicians examined 100 newborns (200 hips or 400 sonograms), while nurses examined 101 newborns (202 hips or 404 sonograms). The study subjects of the two groups were well balanced for the distribution of baseline characteristics. The study observed no statistically significant difference in the quality of Graf's standard plane images between the providers. Eventually, 92.0% (92) of the physician group and 89.1% (90) of the nurse group were correctly diagnosed as "Group A" (Graf's Type 1 hip) or "Non-Group A" hips (p = 0.484). The most common errors among the groups were a missing lower limb, wrong measurement lines, and technical problems. Our study provides evidence that while there might be a trend of slightly more technical mistakes in the nurse group, the overall diagnosis accuracy is similar to junior physicians after receiving standard training in Graf's hip ultrasound method. However, after basic training, regular quality control is a must and all participants should receive refresher trainings. More specifically, nurses need training in the identification of anatomical structures.

Stroke in rural areas of Mongolia

Stroke in rural areas of Mongolia

Sociodemographic predictors of flourishing among older adults in rural and urban Mongolia

Flourishing is an eudaimonic dimension of psychological well-being associated with positive social and health outcomes. Determining correlates of health and well-being is critical for the development of evidence-based best practices, policies, and action plans that target older adults, especially in low- and middle-income countries where research on ageing, health and well-being is still scarce. The study aimed to determine the level of flourishing among older adults in Mongolia and to explore demographic and social factors that contribute to their flourishing in urban and rural areas of Mongolia. We used proportional quota sampling to select a non-probability sample of 304 community-dwelling older adults that reflected the national distribution of older age groups and rural/urban residency. We adapted and administered a widely used standardized questionnaire on flourishing and used multiple regression to establish correlates of flourishing. Study participants reported “very high” levels of flourishing; differences in median scores 53 for urban and 50 for rural older adults were significant. Sex (beta =-,2.09, p=0.080), level of education(beta =0.98, p=0.009) and receive help with ADLs (beta =-,2.29, p=0.013) were associated with flourishing in rural areas, as were self-rated health (beta =1.14, p=0.028), number of social activities (beta =0.050, p=0.019),and friends network (beta =0.22, p=0.035) in urban areas. Despite facing many challenges to well-being, older adults in Mongolia reported high levels of flourishing. Those in urban areas had higher scores than those in rural areas and predictors of flourishing differed for these groups.

THE DETERMINANTS OF LIFE SATISFACTION AMONG MONGOLIAN OLDER ADULTS

Abstract Background As the average life expectancy and the proportion of the elderly population increases, approaches that limit their policies, programs, and activities to health issues are changing worldwide. International organizations, such as the WHO, United Nations, have pledged their member countries to update their policies on the elderly population and increase their psychological and social participation over the next 20 years. We determined social demographic factors of life satisfaction among Mongolian older adults. Methods A cross-sectional study recruited three hundred four older adults recruited by geriatric doctors and seniors’ association units in urban and rural areas of Mongolia. The questionnaire included life satisfaction, social network, loneliness, social participation, self-rated health, and demographics. We used multiple linear regression analyses. Result: Life Satisfaction of the older adults living in urban is higher than those living in rural area (β = 0.954, p = 0.001). Good self-rate of health (β = 1.013 p = 0.001), voluntary work (β = 0.847 p = 0.001), and employment increase life satisfaction levels. Life satisfaction scores increased by 0.3 points for male older adults with a 1-point increase in education, 0.9 points for women living in cities (β = 0.929 p = 0.002), and 0.8 points for volunteering (β=0.790 p=0.006) respectively. However, when the loneliness score increases by one, the satisfaction score decreases by 0.3 points (β = -0.353 p = 0.013). Conclusions: The level of satisfaction of the Mongolian older adults is associated with self-rate of health, education level, loneliness, social activities, and living areas.

X and Millennial Employee Job Satisfaction Factor Study of Mongolia

Organizations have different approaches to attract and retain desired employees based on the company values, goals, and capacity. However, the turnover rate is increasing worldwide and Mongolia is not an exception. To succeed we should manage each employee individually. However, in real life companies do not have that capacity and resources. To manage more effectively, companies might need to group employees by their needs. Some research materials show that generations share similar values. Therefore, solution to that issue could be dividing employees by their birth generation. This paper aims to identify differences and similarities of X and Millennial generations job satisfaction factors of Mongolian employees. To effectively manage individual’s need, questionnaire of this work was developed based on previous works on job satisfaction aspect, which distributed to 389 employees from Mongolia working in Mongolia, USA, Canada and Australia. The sorting criterion was affiliation to the generational cohort, Baby Boomers generation 2.8%, Generation X 36%, Generation Y 57.1% and Generation Z 4.1% respectively. Respondents geographical location: Ulaanbaatar (Capital of Mongolia) 68.1%, Aimags (Rural areas of Mongolia) 27.5% and abroad (USA, Canada, Australia) 4.4% respectively. This study reveals that employee engagement factor importance and reward program effectiveness differ by generations. Overall, company reputation, job security, benefits are rated differently by generations in regards to their importance level. Furthermore, generations prefer government award programs significantly different. The research results might serve companies and organizations to customize their program to attract and retain desired Mongolian employees based on their specific needs. To the best of the author’s knowledge, there is no study conducted regards to job satisfaction and employee engagement factors of Mongolian employees by their generation.

The prevalence of headache disorders in children and adolescents in Mongolia: a nationwide schools-based study

BackgroundThe Global Campaign against Headache collects data from children (7–11 years) and adolescents (12–17 years) both to inform health and education policies and to contribute to the Global Burden of Disease (GBD) study. This survey in Mongolia was part of this global enquiry.MethodsFollowing the generic protocol for the global enquiry, this was a schools-based cross-sectional survey. Self-completed structured questionnaires were administered, within classes, in seven schools in four districts of the Capital city and three rural areas of Mongolia, selected to represent the country’s diversities. Headache diagnostic questions were based on ICHD-3 criteria but for the inclusion of undifferentiated headache (UdH).ResultsOf 4515 potential participants, 4266 completed the questionnaire (children 2241 [52.5%], adolescents 2025 [47.5%]; males 2107 [49.4%], females 2159 [50.6%]). Children were therefore slightly over-represented, although overall mean age was 11.3 ± 3.3 years (range: 6–17; median 11). The non-participation proportion was 4.5%. Observed lifetime prevalence of headache was 81.0%. Gender- and age-adjusted 1-year prevalence was 59.4% (migraine: 27.3%; tension-type headache [TTH]: 16.1%; UdH: 6.6%; all headache on ≥15 days/month: 4.2%; probable medication-overuse headache: 0.7%). All headache types except UdH were more prevalent among females than males, and all were more prevalent among adolescents than children, although UdH represented a higher proportion of all headache in children (13.0%) than in adolescents (10.0%). Headache yesterday was reported by 15.9% of the sample, 26.0% of those with headache.ConclusionsAt least in adolescents, headache in Mongolia is no less common than in adults. The clear difference from similar studies in other countries was a lower prevalence of UdH, perhaps a consequence of reporting bias in a non-troublesome headache (mild and short-lasting by definition). This study informs policy in Mongolia and, with no similar study yet from elsewhere in Western Pacific Region, makes an important contribution to the global enquiry.

Distribution of midwives in Mongolia: A secondary data analysis

IntroductionMidwives are at the core of strengthening the health system, especially in the crucial period around pregnancy, childbirth, and the early weeks of life. In 2016, the national-level maternal mortality ratio in Mongolia was 48.6 deaths per 100,000 live births, but this was much higher (up to 212.9 deaths/100,000) in some rural provinces of the country. The wide variation in maternal mortality between urban and rural areas of Mongolia might be related to the distribution of midwives and equity of access to maternity care. ObjectivesIn the present study, we aimed to determine the distribution of midwives in each province of Mongolia and to examine inequality in the distribution of midwives nationwide. DesignA secondary data analysis. MethodsData from the Centre of Health Development and the National Statistical Office of Mongolia were obtained and analysed. First, we assessed the distribution of midwives at provincial and regional levels, along with the association between these distributions and the maternal mortality ratio in 2016. We then calculated the inequality of these distributions using the Gini coefficient and examined trends for the years 2010–2016. We compared results for urban, suburban, and rural provinces. Rural areas are sparsely populated and enormous in size, so it may be difficult access to basic healthcare services. It was considered important, therefore, to assess the number of midwives per 1000 km2 as well as the commonly used indicator of per 10,000 population. ResultsWhen the land area in each province was taken into consideration rather than only the population, wider variations between urban, suburban, and rural provinces became apparent. Provinces varied according to the number of midwives per 10,000 population by a factor of three (range 2.0–6.2/midwives); while provinces varied according to the number of midwives per 1000 km2 by a factor of approximately 300 (range 0.2–61.2/midwives). The Gini coefficient for the number of midwives per 10,000 population in 2016, R = 0.201, revealed "relative" equality. This was slightly reduced from R = 0.305 in 2010 and indicated a shift toward equality. However, the Gini coefficient for the number of midwives per 1000 km2 area indicated "severe" inequality of R = 0.524 in 2016. This was increased from R = 0.466 in 2010, indicating that no improvement has been seen over these years. ConclusionsOur study suggests that two different measures of midwifery distribution should be used as indicators: number of midwives "per 10,000 population" and "per 1000 km2 area". In rural areas such as parts of Mongolia, geographical features and population density are important features of the local context. To deliver healthcare services in a timely manner and within a reasonable distance for pregnant women who need care, the indicator of per 1000 km2 area would be more suitable for rural and sparsely populated areas than the indicator of per 10,000 population, which is commonly used for urban and settled areas. Based on our findings, to reduce the wide gap in MMR between rural and urban areas, we recommend at least one midwife per 1000 km2 area in rural regions of Mongolia.

Living with spinal cord injury in Mongolia: A qualitative study on perceived environmental barriers

Context: Environmental factors play a key role in the lives of individuals with a spinal cord injury (SCI). This study identifies environmental barriers and their impacts on daily lives as perceived by individuals living with SCI in Mongolia. Design: A qualitative study with semi-structured interviews was conducted. A topic guide for the interviews was structured around the components of the International Classification of Functioning, Disability, and Health. Setting: Urban and rural areas of Mongolia. Participants: A purposive sample of 16 persons with traumatic SCI. Interventions: Not applicable. Outcome Measures: Not applicable. Results: Seven categories of environmental barriers were mentioned, such as poor access to the physical environment, absence of wheelchair-friendly transportation, negative societal attitudes, inadequate health and rehabilitation services, lack of access to assistive devices and medicines, limited financial resources for healthcare, and inaccurate categorization of disabilities in laws. These barriers were claimed to have an impact on physical and psychological health, limit activities, and restrict participation in almost all areas of life. Conclusion: This study contributes to the identification of targets for interventions aimed at improving the lived experience of persons with SCI in a low-resource context. The findings reveal that while the Mongolian government already has laws and policies in place to improve access to the physical environment, transportation, assistive devices and employment, much more has to be done in terms of enforcement. Specialized SCI care and rehabilitation services are highly demanded in Mongolia.

The utility of an rTeGM6-4r-based immunochromatographic test for the serological diagnosis of non-tsetse-transmitted equine trypanosomosis in rural areas of Mongolia.

Our previous studies report epidemics of non-tsetse-transmitted equine trypanosomosis in Mongolia. However, the current status of non-tsetse-transmitted equine trypanosomosis endemicity remains to be clarified in some parts of Mongolia. We previously reported the potential application of rTeGM6-4r-based diagnostic tools, an rTeGM6-4r-based immunochromatographic test (ICT) and an enzyme-linked immunosorbent assay (ELISA), in the serological surveillance of equine trypanosomosis in Mongolia. In the present study, the utility of the rTeGM6-4r-based ICT was validated. The rTeGM6-4r-based ICT accurately diagnosed positive reference sera that had been prepared from dourine horses in Mongolia, similarly to the rTeGM6-4r-based ELISA. The diagnostic performance of the rTeGM6-4r-based ICT was maintained when the strips were preserved for at least 2months under dry conditions. The ICT detected 42 positive serum samples from a total of 1701 equine sera that had been collected from all 21 provinces of Mongolia. The κ-value, sensitivity and specificity of rTeGM6-4r-based ICT were 0.58, 50.0% (95% CI, 37.7-62.3%) and 99.3% (95% CI, 98.7-99.6%), respectively, in comparison to the rTeGM6-4r-based ELISA. Our field-friendly rTeGM6-4r-based ICT was found to be useful for the serological diagnosis of non-tsetse-transmitted equine trypanosomosis in rural areas of Mongolia.

Explaining differences in education-related inequalities in health between urban and rural areas in Mongolia.

BackgroundAfter the socioeconomic transition in 1990, Mongolia has been experiencing demographic and epidemiologic transitions; however, there is lack of evidence on socioeconomic-related inequality in health across the country. The aim of this paper is to evaluate the education-related inequalities in adult population health in urban and rural areas of Mongolia in 2007/2008.MethodsThis paper used a nationwide cross-sectional data, the Household Socio-Economic Survey 2007/2008, collected by the National Statistical Office. We employed the Erreygers’ concentration index to assess the degree of education-related inequality in adult health in urban and rural areas.ResultsOur results suggest that a lower education level was associated with poor self-reported health. The concentration indices of physical limitation and chronic disease were significantly less than zero in both areas. On the other hand, ill-health was concentrated among the less educated groups.The decomposition results show education, economic activity status and income were the main contributors to education-related inequalities in physical limitation and chronic disease removing age-sex related contributions.ConclusionsImproving accessibility and quality of education, especially for the lower socioeconomic groups may reduce socioeconomic-related inequality in health in both rural and urban areas of Mongolia.

Lightning incidents in Mongolia

This is one of the first studies that has been conducted in Mongolia on the distribution of lightning incidents. The study covers a 10-year period from 2004 to 2013. The country records a human death rate of 15.4 deaths per 10 million people per year, which is much higher than that of many countries with similar isokeraunic level. The reason may be the low-grown vegetation observed in most rural areas of Mongolia, a surface topography, typical to steppe climate. We suggest modifications to Gomes–Kadir equation for such countries, as it predicts a much lower annual death rate for Mongolia. The lightning incidents spread over the period from May to August with the peak of the number of incidents occurring in July. The worst lightning affected region in the country is the central part. Compared with impacts of other convective disasters such as squalls, thunderstorms and hail, lightning stands as the second highest in the number of incidents, human deaths and animal deaths. Economic losses due to lightning is only about 1% of the total losses due to the four extreme weather phenomena. However, unless precautionary measures are not promoted among the public, this figure of losses may significantly increase with time as the country is undergoing rapid industrialization at present.

Polychlorinated biphenyls in surface soil in urban and background areas of Mongolia

Polychlorinated biphenyls (PCBs) were measured in soil in some industrial towns (Ulaanbaatar, Suhbaatar, Erdenet, Darhan, Tsetserleg, Hovd, Ulaangom, Altay, Bayanhongor, Arvayheer, Saynshand, Choybalsan) and in background and rural areas of Mongolia. The average sum of all investigated PCB congeners in soil of Mongolia comes to 7.4 ng/g dry weight (DW) and varies from 0.53 ng/g DW till 114 ng/g DW. PCB levels in soil from towns are significantly higher than those in soil from background and rural areas. The PCB homological composition in soil sampled in highly-PCB-polluted sites is similar to the PCB homological pattern in Sovol and Aroclor 1254. Significant correlation between soil organic carbon and low chlorinated PCB both for towns and background sites was found. Significant differences in PCB means in soil in different natural zones were found.

Strengthening Surgical Services at the Soum (First‐referral) Hospital: The WHO Emergency and Essential Surgical Care (EESC) Program in Mongolia

Provision of surgical care continues to receive little attention and funding despite the growing burden of surgical disease worldwide. In 2004, The World Health Organization (WHO) established the Emergency and Essential Surgical Care (EESC) program, which was designed to strengthen surgical services at the first-referral hospital. There are limited data documenting the implementation and scale-up of such services. We describe the nationwide implementation of the EESC program in Mongolia over a 6 year period. Surgical services were increased in rural areas of Mongolia using the WHO Integrated Management of Emergency and Essential Surgical Care (IMEESC) toolkit from 2004 to 2010. Fund of knowledge tests and program evaluation was done to measure uptake, response, and perceived importance of the program. Two years after the pilot sites were launched, programmatic impact on short-term process measures was evaluated using the WHO Monitoring and Evaluation form. The program was implemented in 14 aimags/provinces (66.67 %) and 178 soum hospitals (52.66 %). Fund of knowledge scores increased from 47.72 % (95 % confidence interval (CI) 40.7-54.7) to 77.9 % (95 % CI 70.1-85.7, p = 0.0001) after the training program. 1 year post-training, there was a 57.1 % increase in the availability of emergency rooms, 59.1 % increase in the supply of emergency kits, a 73.64 % increase in the recording of emergency care cases, and a 46.66 % increase in the provision of facility and instrument usage instructions at the pilot sites. The EESC program was successfully implemented and scaled up at a national level with improvements in short-term process measures.

Online Medical Diagnosis and Training in Rural Mongolia

This article has two major objectives. Firstly, the need for distance education (DE) in Mongolia's health sector is examined. A project is reported with the general objective of initiating research, development, and experimentation in distance‐based medical diagnosis and consultancy, and in DE for rural medical doctors using Internet‐based applications. The project's specific objectives (2003–2006) were to: 1. Establish distance diagnosis centers at the Health Sciences University of Mongolia in Ulaanbaatar and at medical centers in three selected rural areas; 2. Investigate, assess, and adapt various medical distance diagnosis technologies using the low bandwidth Internet available in rural areas of Mongolia, and to train medical specialists in these methods; 3. Train the project's instructors in web‐based teaching technologies and methodologies; 4. Prepare new web‐based training materials for the continuous education of rural doctors; and 5. Evaluate the project, and formulate recommendations for the continuous training of doctors and the introduction of telemedicine and distance diagnosis methods. In conclusion, recommendations are made for future DE policies and practices in Mongolian medical education.

Scanning the Satellite Signal in Remote Western Australia

Scanning the Satellite Signal in Remote Western Australia

Constructing the Pillars of a Knowledge Society: The Challenge of Providing Access to ICTs in Rural Mongolia

Globalization has resulted in a shift away from the economics of things towards the economics of information, where access to ICTs has reduced the disadvantages of distance and location. Advanced industrialized countries have been at the forefront of this shift and have been able to influence governments to institute policies that have made globalization possible. At the same time, lower income countries have been at a disadvantage in adapting to this new paradigm. Before poor countries can fully benefit from the positive effects of access to ICTs they must first develop a knowledge society. For a society to become a knowledge society and to be part of the economics of information, it must meet four interrelated criteria which we refer to as the four pillars of the knowledge society. These include: ICT and connectivity, usable content, infrastructure and deliverability, and human intellectual capability. In this paper we examine how one developing country, Mongolia, is approaching the challenge of developing a knowledge society. We concentrate on its efforts to construct one of the pillars - ICT and connectivity. The paper looks specifically at the challenges in providing access to ICTs in the vast rural areas of Mongolia where more than half the population still follows a nomadic herding lifestyle. We conclude that despite a positive policy environment for developing ICTs and limited success in extending Internet connectivity into the rural towns, the prospect of integrating these services into the social and business practices of rural communities remains a long way off. Future research needs to go beyond economic and technological factors and focus on the social and cultural implications of incorporating ICTs into traditional societies.

High prevalence of hepatitis delta virus infection detectable by enzyme immunoassay among apparently healthy individuals in Mongolia

A previous study revealed a high prevalence of hepatitis B surface antigen (HBsAg) and hepatitis delta virus (HDV) RNA among 249 apparently healthy individuals (mean+/-standard deviation age, 48.4+/-13.9 years; 126 males and 123 females) in Ulaanbaatar, Mongolia. To investigate further the prevalence of HDV infection there, the same serum samples obtained from the cohort were tested for the presence of immunoglobulin G (IgG) class antibody to HDV (anti-HDV) by a newly developed enzyme-linked immunosorbent assay using recombinant hepatitis delta antigen protein expressed in the pupae of silkworm as the antigen probe. Anti-HDV was detected in 42 persons (16.9%), among whom 22 (52.4%) were positive for HBsAg and 20 (47.6%) had detectable HDV RNA. Among 170 persons with anti-HBc in the absence of HBsAg, 20 (11.8%) tested positive for anti-HDV, and 1 of the 20 subjects was positive for HDV RNA. Of note, none of 55 anti-HBc-negative persons had anti-HDV, supporting the specificity of the anti-HDV assay. The optical density (OD) value of anti-HDV was significantly higher among HDV RNA-positive subjects (n=21) than among HDV RNA-negative subjects (n=21) (2.513+/-0.514 vs. 0.836+/-0.550, P<0.0001). The present study confirmed the extremely high prevalence of HDV infection in Mongolia, and identified a person who was positive for both anti-HDV and HDV RNA despite negativity for HBsAg and HBV DNA probably due to viral interference. The anti-HDV assay may be useful for further epidemiological studies on HDV infection in larger cohorts in urban and rural areas of Mongolia, where elucidation of the transmission route of HDV is required urgently.

Prevalence of sexually transmitted infections (Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and human papillomavirus) in female attendees of a sexually transmitted diseases clinic in Ulaanbaatar, Mongolia.

Background: Epidemiological data suggest that the prevalence of syphilis, gonorrhea and trichomoniasis has increased in both urban and rural areas of Mongolia. These data are primarily substantiated by notifications of cases of clinically apparent disease in both rural and urban areas, plus laboratory diagnoses from the AIDS/STD Reference Center,Ulaanbaatar. In the past 5 years, however, there has been a marked decline in the total number of patients being screened for sexually transmitted infections (STIs). An assessment of true prevalence of STIs in a female population attending an urban sexually transmitted diseases (STD) clinic was therefore commenced. Methods: Consecutivewomen attending an STD clinic in Ulaanbaatar had genital samples collected by the insertion and immediate removal of a tampon, which was then tested for the presence of Neisseria gonorrhoeae , Chlamydia trachomatis, human papillomavirus (HPV) and Trichomonas vaginalis , using polymerase chain reaction (PCR) amplification. Results: A total of 110 women were studied (mean age 26.7 years). Overall, 58 (53%) patients had one or more pathogens identified; 43 (39%) had a single pathogen, while 15 (14%) had mixed pathogens. C. trachomatis was found in 15 (14%), N. gonorrhoeae in 12 (11%), T. vaginalis in nine (8%) and HPV in 39 (36%). Among the 39 HPV-positive patients, oncogenic genotypes (16, 18, 31, 33, 35, 39, 45, 51, 52) were found in 17 (44%) patients. Conclusions: Sexually transmitted infections as defined by PCR were common, and found in 53%of female attendees of an urban STD clinic in Mongolia. As infections with conventional STIs increase the risk of human immunodeficiency virus (HIV) transmission, it is imperative that strategies be introduced to reduce the prevalence of STIs. Furthermore, detection of oncogenic HPV was common, indicating that it is vital that a strategy to reduce cervical cancer such as a pre-cancer cervical cytology screening program also be introduced.

00/02004 The feasibility of solar energy use in rural areas of Mongolia: solar ‘Ger’

00/02004 The feasibility of solar energy use in rural areas of Mongolia: solar ‘Ger’