To date, no study on smoking behavior of medical students in Inner Mongolia has been reported. The aim of the present study was to determine the 1-month prevalence of and factors associated with daily smoking among medical students in Inner Mongolia of China, to assist interventions designed to reduce the smoking behavior of medical college students in this region.
During December 2010 and January 2011 a cross-sectional survey was conducted among medical students at the Inner Mongolia Medical College using a self-administered questionnaire. The questionnaire consisted of three sections: students’ basic information, attitude on smoking behavior, and smoking status of the student daily smokers. Students who smoked every day in the last 30 days were regarded as daily smokers. Factors associated with smoking were identified using binary logistic regression analysis.
A total of 6044 valid surveys were returned. The overall prevalence of daily smoking was 9.8% while the prevalence of daily smoking among males and females were 29.4% and 1.7%, respectively. Males in the Faculty of Medicine Information Management had the highest daily smoking rate (48.9%). Logistic regression models found that the main factors associated with daily smoking among male medical students were highest year of study (OR = 3.62; CI: 1.18–11.05); attitude towards smoking behavior Do not care about people smoking around you (OR = 2.75; CI: 2.08–3.64); and Smoking is harmful to their health (OR = 4.40; CI: 2.21–8.75). The main factor associated with daily smoking among female medical students was attitude towards smoking behavior Eliminate smoking on campus (OR = 0.11; CI: 0.06–0.23). Both for male and female medical students, there was no association between ethnicity and cigarette daily smoking. In regard to smoking status, more than 60% of daily smokers began smoking in high school, 61.3% smoked less than 5 cigarettes per day, 62.9% of the daily smokers’ families opposed their smoking behavior, and after an hour of not smoking 74.6% daily smokers did not feel uncomfortable.
Antismoking education should be further promoted in Inner Mongolia medical students, with consideration given to the factors associated with daily smoking behavior found in the present study.
Daily smoking; Behavior; Medical students; Prevalence
Hyperuricemia (HUA) is a potential risk factor for developing insulin resistance, hypertension, dyslipidemia and cardiovascular disease. Therefore, we studied the prevalence of HUA and associated risk factors in the population of two provinces in northern China.
Based on the research of Chinese Physiological Constant and Health Conditions conducted in 2008–2010, we enrolled 29,639 subjects in a randomized, stratified study in four sampling areas in Heilongjiang Province and the Inner Mongolia Autonomous Region. We collected 13,140 serum samples to determine biochemical indicators including uric acid(UA), glucose, blood lipids, liver function, and renal function, and finally a representative sample of 8439 aged 18 years and older was determined. We also defined and stratified HUA, hypertension, diabetes, obesity and lipid abnormalities according to international guidelines.
There were significant differences in the UA levels between different genders and regions. The total prevalence of HUA is 13.7%. Men had a higher prevalence of HUA than women (21% vs. 7.9%; P < 0.0001). As age increased, HUA prevalence decreased in men but rose in women. The suburbs of big cities had the highest HUA prevalence (18.7%), and in high-prevalence areas the proportion of women with HUA also increased. A stepwise logistic regression model was used to filter out twelve HUA risk factors, including age, gender, residence, hypercholesterolemia, hypertriglyceridemia, impaired fasting glucose, hypertension, obesity, abdominal obesity, CKD, drinking and sleeping. After adjusting for these factors, the odds ratio of HUA was 1.92 times higher in men than in women. Compared with agricultural and pastoral areas, the odds ratio of having HUA was 2.14 for participants in the suburbs of big cities and 1.57 in the center of big cities.
The prevalence of HUA is high in northern China. The differences in HUA prevalence by geographic region suggested that unbalanced economic development and health education, therefore HUA prevention measures should be strengthened to improve quality of life and reduce health care costs.
Prevalence; Hyperuricemia; Risk factors
The study aimed to examine the effect of household and community characteristics on financial catastrophe and impoverishment due to health payment in Western and Central Rural China.
A household survey was conducted in 2008 in Hebei and Shaanxi provinces and the Inner Mongolia Autonomous Region using a multi-stage sampling technique. Independent variables included village characteristics, household income, chronic illness status, health care use and health spending. A composite contextual variable, named village deprivation, was derived from socio-economic status and availability of health care facilities in each village using factor analysis. Dependent variables were whether household health payment was more than 40% of household's capacity to pay (catastrophic health payment) and whether household per capita income was put under Chinese national poverty line (1067 Yuan income per year) after health spending (impoverishment). Mixed effects logistic regression was used to assess the effect of the independent variables on the two outcomes.
Households with low per capita income, having elderly, hospitalized or chronically ill members, and whose head was unemployed were more likely to incur financial catastrophe and impoverishment due to health expenditure. Both catastrophic and impoverishing health payments increased with increased village deprivation. However, the presence of a village health clinic had no effect on the two outcomes, nor did household enrollment in the New Rural Cooperative Medical Scheme (national health insurance).
Village deprivation independently increases the risk for financial hardship due to health payment after adjusting for known household-level factors. This suggests that policy makers need to view the individual, household and village as separate units for policy targeting.
Few studies on the breakfast consumption habits of medical students in China have been carried out. The aim of the present study was to determine the prevalence of skipping breakfast and factors associated with skipping breakfast among medical students in Inner Mongolia of China, and to assist in the design of interventions to improve breakfast consumption habits of medical college students in this region.
From December 2010 to January 2011 a cross-sectional survey was conducted among medical students in the Inner Mongolia Medical College using a self-administered questionnaire. The prevalence of skipping breakfast in relation to lifestyle habits was described and factors associated with breakfast consumption were identified using multiple logistic regression analysis.
The overall prevalence of skipping breakfast was 41.7% and 23.5% for males and females, respectively. The Faculty of Medicine Information Management had the highest breakfast skipping prevalence. Logistic regression models found that the main factors associated with breakfast consumption habits among medical students were gender, class years of education, monthly expenses, faculty, appetite, sleeping quality, and the learning process; monthly expenses, sleeping quality, and the learning process showed a dose-dependent relationship.
Breakfast consumption was associated with many factors, most importantly monthly expenses, sleeping quality and the learning process. The prevalence of skipping breakfast is significantly higher compared recently reported figures for medical students in western countries and other areas of China. Improvement of breakfast education should be considered for students in which higher monthly expenses, poor sleeping quality, or a laborious learning process have been identified.
Breakfast; Behavior; Medical students; Prevalence
Birth defects are the leading cause of infant mortality and are responsible for substantial child and adult morbidity. Documenting the variation in prevalence of birth defects among racial/ethnic subpopulations is critical for assessing possible variations in diagnosis, case ascertainment, or risk factors among such groups.
We used data from the Metropolitan Atlanta Congenital Defects Program, a population-based birth defects registry with active case ascertainment. We estimated the racial/ethnic variation in prevalence of 46 selected major birth defects among live births, stillbirths, and pregnancy terminations at >20 weeks gestation among mothers residing in the five central counties of metropolitan Atlanta between 1994 and 2005, adjusting for infant sex, maternal age, gravidity, and socioeconomic status (SES). We also explored SES as a potential effect measure modifier.
Compared with births to non-Hispanic white women, births to non-Hispanic black women had a significantly higher prevalence of five birth defects and a significantly lower prevalence of 10 birth defects, while births to Hispanic women had a significantly higher prevalence of four birth defects and a significantly lower prevalence of six birth defects. The racial/ethnic disparities in the prevalence of some defects varied by SES, but no clear pattern emerged.
Racial/ethnic disparities were suggested in 57% of included birth defects. Disparities in the prevalence of birth defects may result from different underlying genetic susceptibilities; exposure to risk factors; or variability in case diagnosis, ascertainment, or reporting among the subpopulations examined. Policies that improve early diagnosis of birth defects could reduce associated morbidity and mortality.
Vigilance is needed to prevent hemorrhagic fever renal syndrome caused by Hantaan
and Seoul viruses in this region.
Surveys were carried out in 2003–2006 to better understand the
epidemiology of hantaviruses in the Inner Mongolia Autonomous Region of China
(Inner Mongolia). Hemorrhagic fever with renal syndrome (HFRS) was first
reported in this region in 1955 and has been an important public health problem
here since then. During 1955–2006, 8,309 persons with HFRS were
reported in Inner Mongolia (average incidence rate 0.89/100,000), and 261
(3.14%) died. Before the 1990s, all HFRS cases occurred in northeastern Inner
Mongolia. Subsequently, HFRS cases were registered in central (1995) and western
(1999) Inner Mongolia. In this study, hantaviral antigens were identified in
striped field mice (Apodemus agrarius) from northeastern Inner
Mongolia and in Norway rats (Rattus norvegicus) from middle and
western Inner Mongolia. Phylogenetic analysis of hantaviral genome sequences
suggests that HFRS has been caused mainly by Hantaan virus in northeastern Inner
Mongolia and by Seoul virus in central and western Inner Mongolia.
Viruses; zoonoses; hemorrhagic fever with renal syndrome; hantavirus; Hantaan virus; Seoul virus; China; Mongolia; research
The leading cause of mortality in Mongolia is Non-Communicable Disease. Alcohol is recognised by the World Health Organization as one of the four major disease drivers and so, in order to better understand and triangulate recent national burden-of-disease surveys and to inform policy responses to alcohol consumption in Mongolia, a national Knowledge, Attitudes and Practices survey was conducted. Focusing on Non-Communicable Diseases and their risk factors, this publication explores the alcohol-related findings of this national survey.
A door-to-door, household-based questionnaire was conducted on 3450 people from across Mongolia. Participants were recruited using a multi-stage random cluster sampling technique, and eligibility was granted to permanent residents of households who were aged between 15 and 64 years. A nationally representative sample size was calculated, based on methodologies aligned with the WHO STEPwise approach to Surveillance.
Approximately 50% of males and 30% of females were found to be current drinkers of alcohol. Moreover, nine in ten respondents agreed that heavy episodic drinking of alcohol is common among Mongolians, and the harms of daily alcohol consumption were generally perceived to be high. Indeed, 90% of respondents regarded daily alcohol consumption as either ‘harmful’ or ‘very harmful’. Interestingly, morning drinking, suggestive of problematic drinking, was highest in rural men and was associated with lower-levels of education and unemployment.
This research suggests that Mongolia faces an epidemiological challenge in addressing the burden of alcohol use and related problems. Males, rural populations and those aged 25-34 years exhibited the highest levels of risky drinking practices, while urban populations exhibit higher levels of general alcohol consumption. These findings suggest a focus and context for public health measures addressing alcohol-related harm in Mongolia.
Alcohol; Epidemiology; Mongolia; Asia; KAP survey; Policy; Health
1) To understand the current prevalence and main types of birth defects, 2) assess the periconceptional exposure of factors associated with birth defects in Shaanxi Province, and 3) provide scientific evidence for local governments to formulate services for the primary prevention of birth defects.
We sampled 16,541 households from 128 townships in 16 counties/districts in Shaanxi province using a multi-stage random sampling method. Among them, 10,544 women who had live born or stillborn infants with gestational age ≥28 weeks between 2008 and 2009 were interviewed using a structured questionnaire designed to collect information about periconceptional risk factor exposure, health care service utilization, and micronutrient supplements. Logistic regression was performed to assess the risk factors associated with birth defects and adjustments were made for imbalanced social-demographic characteristics between case and control groups.
The prevalence of congenital birth defect in Shaanxi province was 14.3/1000 births. The environment risk factors associated with birth defects include unhealthy lifestyle (Alcohol, odds ratio (OR): 3.60, 95% confidence interval (CI) 1.64−7.91; Smoking, OR: 1.32, 95% CI: 0.99−1.75; Drink strong tea, OR: 1.81, 95% CI: 1.27−2.59), exposure to heavy pollution (OR: 1.53, 95% CI: 1.01−2.30), maternal diseases (OR: 1.77, 95% CI: 1.35−2.33), drug use (OR: 2.11, 95% CI: 1.51−2.95), maternal chemical pesticide exposure (OR: 2.30, 95% CI: 1.16−4.57), and adverse pregnancy history (OR: 10.10, 95% CI: 7.55−13.53). Periconceptional folic acid or multiple micronutrients including folic acid supplementation, was associated with a reduced rate of birth defects (OR: 0.54, 95% CI: 0.29−0.998).
Health care service utilization, unhealthy lifestyle factors, and environment risk factors seem to be associated with birth defects in Shaanxi province. Governmental agencies should focus on effective primary preventative methods, such as the delivery of periconceptional health education for minimizing potential risk factor exposures, periconceptional folic acid or micronutrient supplementation, environment monitoring, and assessment of factories with high levels of pollution.
The New Rural Cooperative Medical Scheme (NRCMS, voluntary health insurance) and the Medical Financial Assistance (MFA, financial relief program) were established in 2003 for rural China. The aim of this study was to document their coverage, assess their effectiveness on access to in-patient care and protection against financial catastrophe and household impoverishment due to health spending, and identify the factors predicting impoverishment with and without these schemes.
A cross-sectional household survey was conducted in 2008 in Hebei and Shaanxi provinces and the Inner Mongolia Autonomous Region using a multi-stage sampling technique. Information on personal demographic characteristics, chronic illness status, health care use, household expenditure, and household health spending were collected by interview.
NRCMS covered 90.8% of the studied individuals and among the designated poor, 7.6% had their premiums paid by MFA. Of those referred for hospitalization in the year prior to the interview, 34.3% failed to comply, mostly (80.2%) owing to financial constraints. There was no significant difference in the unmet need for admission between the insured with NRCMS and the uninsured. Before reimbursement, the incidence of catastrophic health payment (household health spending more than 40% of household's capacity to pay) and medical impoverishment (household per capita income falling below the poverty line due to medical expense) was 14.3% and 8.2%, respectively. NRCMS prevented 9.9% of the households from financial catastrophe and 7.7% from impoverishment, whereas MFA kept just one household from impoverishment and had no effect on financial catastrophe. Household per capita expenditure and household chronic disease proportion (proportion of members of a household with chronic illness) were the most important determinants of the unmet need for admission, risk of being impoverished and the chance of not being saved from impoverishment.
The coverage of NRCMS among the rural population was high but not adequate to improve access to in-patient care and protect against financial catastrophe and household impoverishment due to health payment, especially for the poor and the chronically ill. Furthermore, MFA played almost no such role; therefore, the current schemes need to be improved.
To assess the coverage of individual-based primary prevention strategies for cardiovascular disease (CVD) in Cambodia and Mongolia: specifically the early identification of hypertension and diabetes mellitus, major proximate physiological CVD risk factors, and management with pharmaceutical and lifestyle advice interventions.
Analysis of data collected in national cross-sectional STEPS surveys in 2009 (Mongolia) and 2010 (Cambodia) involving participants aged 25-64 years: 5433 in Cambodia and 4539 in Mongolia.
Mongolia has higher prevalence of CVD risk factors than Cambodia --hypertension (36.5% versus 12.3%), diabetes (6.3% versus 3.1%), hypercholesterolemia (8.5% versus 3.2%), and overweight (52.5% versus 15.5%). The difference in tobacco smoking was less notable (32.1% versus 29.4%).
Coverage with prior testing for blood glucose in the priority age group 35-64 years remains limited (16.5% in Cambodia and 21.7% in Mongolia). Coverage is higher for hypertension. A large burden of both hypertension and diabetes remains unidentified at current strategies for early identification: only 45.4% (Cambodia) to 65.8% (Mongolia) of all hypertensives and 22.8% (Mongolia) to 50.3% (Cambodia) of all diabetics in the age group 35-64 years had been previously diagnosed.
Approximately half of all hypertensives and of all diabetics in both countries were untreated. 7.2% and 12.2% of total hypertensive population and 5.9% and 16.1% of total diabetic population in Cambodia and Mongolia, respectively, were untreated despite being previously diagnosed.
Only 24.1% and 28.6% of all hypertensives and 15.9% and 23.9% of all diabetics in Mongolia and Cambodia, respectively were adequately controlled. Estimates suggest deficits in delivery of important advice for lifestyle interventions.
Multifaceted strategies are required to improve early identification, initiation of treatment and improving quality of treatment for common CVD risk factors. Periodic population-based surveys including questions on medical and treatment history and the context of testing and treatment can facilitate monitoring of individual-based prevention strategies.
Mongolia has a high and increasing burden of hypertension and related disease, with cardiovascular diseases among the leading causes of death. Yet little is known about the knowledge, attitudes and practices of the Mongolian population with regards to blood pressure. With this in mind, a national Non-Communicable Diseases knowledge, attitudes and practices survey on blood pressure was implemented in late 2010. This paper reports on the findings of this research.
Using a multi-stage, random cluster sampling method 3450 participant households were selected from across Mongolia. This survey was interviewer-administered and included demographic and socio-economic questions. Sample size was calculated using methods aligned with the World Health Organization STEPS surveys.
One fifth of participants reported having never heard the term ‘blood pressure’. This absence of health knowledge was significantly higher in men, and particularly younger men. The majority of participants recognised high blood pressure to be a threat to health, with a higher level of risk awareness among urban individuals. Education level and older age were generally associated with a heightened knowledge and risk perception. Roughly seven in ten participants were aware of the relationship between salt and blood pressure. Exploring barriers to screening, participants rated a ‘lack of perceived importance’ as the main deterring factor among fellow Mongolians and overall, participants perceived medication and exercise as the only interventions to be moderately effective at preventing high blood pressure.
Rural populations; younger populations; men; and less educated populations, all with lower levels of knowledge and risk perception regarding hypertension, present those most vulnerable to it and the related health outcomes. This research intimates major health knowledge gaps in sub-populations within Mongolia, regarding health-risks related to hypertension.
Hypertension; Blood-pressure; Non-communicable disease; Epidemiology; KAP; Mongolia; Asia
Arsenic is one of the most important toxicants in the environment. In Inner Mongolia of China, 300,000 residents are believed to be drinking water containing >50μg/liter. Skin lesions have been known as the most common consequences resulting from chronic exposure to arsenic. To clarify the prevalence of arsenic-induced skin lesions, it is important to assess the impact of this problem among the target population, and to make future planning. We evaluated the association between multi-levels inorganic arsenic exposure from drinking water and skin lesions in an arsenic-affected area in Inner Mongolia, China. One hundred nine and 32 subjects in high (>50μg/liter) and low (<50μg/liter) arsenic-affected villages were recruited and had the detailed physical examination with special emphasis on arsenic-related skin lesions. Arsenic exposure was measured for each participant with respect to iAs concentration of primary well and the duration using the well. Arsenic-induced skin lesions including keratosis, pigmentation, and/or depigmentation were diagnosed in 56 and 3 subjects in the two villages, respectively. Logistic regression was conducted to calculate odd ratios of skin lesions associated with arsenic exposure with adjustments for sex, age group, smoking and duration of exposure. A consistent dose-response relationship between arsenic exposure level and skin lesion risk was observed. Compared to those with iAs concentration <50μg/liter, the adjusted odds ratios of skin lesions for the subjects with 51–99, 100–149 and >150μg/liter were 33.3% (OR =15.50, 95% CI: 1.53–248.70), 46.7% (OR =16.10, 95% CI: 3.73–69.63) and 55.7% (OR= 25.70, 95% CI: 6.43–102.87), respectively. Duration of using well was not associated with increased risk of skin lesions in this population; (OR =1.68, 95% CI: 0.40–6.91 for 6–15 years, OR = 2.30, 95% CI: 0.58–9.14 for over 15 years) compared with the duration of less than 5 years.
Inorganic arsenic; Arsenic exposure; Skin lesions; Dose-response relationship
Older mothers are becoming more common in Japan. One reason for this is the widespread use of assisted reproductive technology (ART). This study assesses the relationship between maternal age and the risk of birth defects after ART.
Nationwide data on ART between 2004 and 2010 in Japan were analyzed. Diseases that were classified as code Q00-Q99 (ie, congenital malformations, deformations, and chromosomal abnormalities) in the International Classification of Diseases, tenth edition, were selected. There were 219,185 pregnancies and 153,791 live births in total ART. Of these, 1943 abortions, stillbirths, or live births with birth defects were recorded. Percentage of multiple birth defects in total birth defects, the prevalence, crude relative risk and 95% confidence interval per 10,000 pregnancies and per 10,000 live births were analyzed according to the maternal age class (ie, 25–29, 30–34 (reference), 35–39, and 40+ years).
Multiple birth defects were observed among 14% of the 25–29 year old class, and 8% among other classes when chromosomal abnormalities were excluded. The prevalence of chromosomal abnormalities per pregnancy and per live birth became significantly and rapidly higher in mothers in the age classes of 30–35 and 40+ years. Nonchromosomal birth defects per pregnancy decreased linearly with advanced maternal age, while the number of nonchromosomal birth defects per live birth formed a gradual U-shaped distribution. The prevalence per pregnancy of congenital malformations of the nervous system was significantly lower with advanced maternal age. The relative risk per live birth was significant regarding congenital malformations of the circulatory system for a maternal age of 40+ years. Some other significant associations between maternal age and birth defects were observed.
Maternal age is associated with several birth defects; however, older maternal age in itself does not produce noticeable extra risk for nonchromosomal birth defects overall.
birth defects; assisted reproductive technology; maternal age; pregnancy; live births; epidemiologic prevalence study
To estimate the prevalence of radiographic and symptomatic knee osteoarthritis (OA) in a remote rural region of northern China and compare these with those reported in Beijing and data from the Framingham (Massachusetts, USA) cohort.
A population-based cross-sectional survey was conducted among 1030 residents of Wuchuan County, Inner Mongolia, aged 50 years and over. Survey participants, mostly farmers reporting heavy physical occupational activity, completed an interviewer-based questionnaire and obtained bilateral weight-bearing posterior-anterior semi-flexed knee radiographs.
While the overall prevalence of radiographic knee OA was similar to that demonstrated in the Beijing OA study, men in Wuchuan had about double the prevalence of severe radiographic [prevalence ratio (PR) 2.5, 95% CI 1.6 to 3.8] and symptomatic knee OA (PR 1.9, 95% CI 1.3 to 2.9). Women in Wuchuan also had a higher prevalence of both severe radiographic (PR 1.4, 95% CI 1.0 to 2.0) and symptomatic knee OA (PR 1.6, 95% CI 1.2 to 2.1) compared with their Beijing counterparts. The prevalence of bilateral OA and lateral compartment disease were two to three times higher in both Chinese cohorts compared with estimates from the Framingham OA Study.
The prevalence of symptomatic knee OA in rural areas of China is much higher than reported from urban regions of China or in the Framingham cohort. The higher representation of bilateral and lateral compartment disease in China suggests a unique phenotype to OA. The findings will be useful to guide the distribution of future health care resources and preventive strategies.
Osteoarthritis knee; disease prevalence; rural China; physical activity
Non-communicable diseases (NCDs) are now the leading causes of mortality in Mongolia, and diabetes, in particular, is a growing public health threat. Mongolia is a nation undergoing rapid and widespread epidemiological transition and urbanisation: a process that is expected to continue in coming decades and is likely to increase the diabetes burden. To better inform policy and public-health responses to the impact of the growth in NCDs, a national NCD Knowledge, Attitudes and Practices survey was implemented in Mongolia in 2010; a section of which focused on diabetes.
This survey was a nationally-representative, household-based questionnaire conducted by field-workers. Households were selected using a multi-stage, cluster sampling technique, with one participant (aged 15–64) selected from each of the 3540 households. Questions explored demographic and administrative parameters, as well as knowledge attitudes and practices around NCDs and their risk factors.
This research suggests low levels of diabetes-related health knowledge in Mongolia. Up to fifty percent of Mongolian sub-populations, and one in five of the total population, had never heard the term diabetes prior to surveying. This research also highlights a high level of misunderstanding around the symptomatology and natural progression of diabetes; for example, one-third of Mongolians were unaware that the disease could be prevented through lifestyle changes. Further, this study suggests that a low proportion of Mongolians have received counseling or health education about diabetes, with lowest access to such services for the urban poor and least educated sub-populations.
This research suggests a low prevalence of diabetes-related health-knowledge among Mongolians. In this light, health-education should be part of any national strategy on diabetes.
Diabetes; Epidemiology; Gealth policy; Mongolia; Asia; KAP; Knowledge; Population
We tested whether the abundance of C4 vegetation in grasslands of the Mongolian plateau is influenced by grazing conditions. The analysis exploited the politically originated contrast that exists between Mongolia (low stocking rate, transhumant system) and the district of Inner Mongolia, China (high stocking rate, sedentary system). We estimated the proportion of C4 carbon (PC4) in grazed vegetation from the relative carbon isotope ratio (δ13C) of sheep wool sampled from 298 annual shearings originating from 1996 to 2007. Annual stocking rates varying over time and between the districts of both countries were taken from regional statistics. The PC4 pattern within the 0.7 million km2 sampling area was geostatistically analyzed and related to stocking rates and temperature gradients. For similar climatic conditions, PC4 was the same in both countries. Further, a unique relationship was found between PC4 and July temperature on both sides of the border, which explained 71% of the pattern. Stocking rate and grazing system had no significant influences on present-day C3/C4 abundance ratio. This finding suggests that recent changes in the C3/C4 ratio of these grasslands are mainly a consequence of regional warming, not overgrazing.
Recent research has used cardiovascular risk scores intended to estimate “total cardiovascular disease (CVD) risk” in individuals to assess the distribution of risk within populations. The research suggested that the adoption of the total risk approach, in comparison to treatment decisions being based on the level of a single risk factor, could lead to reductions in expenditure on preventive cardiovascular drug treatment in low- and middle-income countries. So that the patient benefit associated with savings is highlighted.
This study used data from national STEPS surveys (STEPwise Approach to Surveillance) conducted between 2005 and 2010 in Cambodia, Malaysia and Mongolia of men and women aged 40–64 years. The study compared the differences and implications of various approaches to risk estimation at a population level using the World Health Organization/International Society of Hypertension (WHO/ISH) risk score charts. To aid interpretation and adjustment of scores and inform treatment in individuals, the charts are accompanied by practice notes about risk factors not included in the risk score calculations. Total risk was calculated amongst the populations using the charts alone and also adjusted according to these notes. Prevalence of traditional single risk factors was also calculated.
The prevalence of WHO/ISH “high CVD risk” (≥20% chance of developing a cardiovascular event over 10 years) of 6%, 2.3% and 1.3% in Mongolia, Malaysia and Cambodia, respectively, is in line with recent research when charts alone are used. However, these proportions rise to 33.3%, 20.8% and 10.4%, respectively when individuals with blood pressure > = 160/100 mm/Hg and/or hypertension medication are attributed to “high risk”. Of those at “moderate risk” (10- < 20% chance of developing a cardio vascular event over 10 years), 100%, 94.3% and 30.1%, respectively are affected by at least one risk-increasing factor. Of all individuals, 44.6%, 29.0% and 15.0% are affected by hypertension as a single risk factor (systolic ≥ 140 mmHg or diastolic ≥ 90 mmHg or medication).
Used on a population level, cardiovascular risk scores may offer useful insights that can assist health service delivery planning. An approach based on overall risk without adjustment of specific risk factors however, may underestimate treatment needs.
At the individual level, the total risk approach offers important clinical benefits. However, countries need to develop appropriate clinical guidelines and operational guidance for detection and management of CVD risk using total CVD-risk approach at different levels of health system. Operational research is needed to assess implementation issues.
Mongolia is undergoing rapid epidemiological transition with increasing urbanisation and economic development. The lifestyle and health of Mongolians are changing as a result, shown by the 2005 and 2009 STEPS surveys (World Health Organization's STEPwise Approach to Chronic Disease Risk Factor Surveillance) that described a growing burden of Non-Communicable Diseases and injuries (NCDs).
This study aimed to assess, describe and explore the knowledge, attitudes and practices of the Mongolian adult population around NCDs in order to better understand the drivers and therefore develop more appropriate solutions to this growing disease burden. In addition, it aimed to provide data for the evaluation of current public health programs and to assist in building effective, evidence-based health policy.
This national survey consisted of both quantitative and qualitative methods. A quantitative household-based questionnaire was conducted using a nationally representative sample of 3854 rural and urban households. Participants were selected using a multi-stage cluster sampling technique in 42 regions across Mongolia, including rural and urban sites. Permanent residents of sampled households were eligible for recruitment, if aged between 15-64 years. This quantitative arm was then complemented and triangulated with a qualitative component: twelve focus group discussions focusing on diet, exercise and alcohol consumption. Discussions took place in six sites across the country, facilitated by local, trained health workers. These six sites were chosen to reflect major Mongolian cultural and social groups.
KAP surveys are well represented in the literature, but studies that aim to explore the knowledge, attitudes and practices of a population around NCDs remain scarce. This is despite the growing number of national epidemiological surveys, such as STEPS, which aim to quantify the burden of these diseases but do not explore the level of population-based awareness, understanding, risk-perception and possible motivation for change. Therefore this paper will contribute to building a knowledge base of NCD KAP survey methodology for future use in epidemiology and research worldwide.
Non-Communicable Diseases; KAP survey; Knowledge; Attitudes; Mongolia; Injuries
Whilst the prevalence and correlates of postpartum depression are well established, far less is known about postpartum anxiety. Studies have described the association between socio-demographic factors and postpartum depression, yet few have explored the association between stressors in women's lives around the time of having a baby and maternal psychological morbidity. This study aimed to describe the population prevalence of postpartum depression, anxiety, co-morbid anxiety and depression and social health issues; and to examine the association between postpartum psychological and social health issues experienced in the six months following birth.
Population-based survey of all women who gave birth in Victoria and South Australia in September/October 2007. Women were mailed the survey questionnaire six months following birth. Anxiety and depression were measured using the Depression Anxiety Stress Scales (DASS-21).
Questionnaires were completed by 4,366 women. At six months postpartum the proportion of women scoring above the 'normal' range on the DASS-21 was 12.7% for anxiety,17.4% for depression, and 8.1% for co-morbid depression and anxiety. Nearly half the sample reported experiencing stressful life events or social health issues in the six months following birth, with 38.3% reporting one to two and 8.8% reporting three or more social health issues. Women reporting three or more social health issues were significantly more likely to experience postnatal anxiety (Adj OR = 4.12, 95% CI 3.0-5.5) or depression (Adj OR = 5.11, 95% CI = 3.9-6.7) and co-morbid anxiety and depression (Adj OR = 5.41, 95% CI 3.8-7.6) than women who did not report social health issues.
Health care providers including midwives, nurses, medical practitioners and community health workers need to be alert to women's social circumstances and life events experienced in the perinatal period and the interplay between social and emotional health. Usual management for postpartum mental health issues including Cognitive Behavioural Therapy and pharmacological approaches may not be effective if social health issues are not addressed. Coordinated and integrated perinatal care that is responsive to women's social health may lead to improvements in women's emotional wellbeing following birth.
This paper was based on ethnobotanical investigations conducted from 2004-2006 in Inner Mongolian Autonomous Region of northern China. Today, due to their nutritious and relatively pollution-free characteristics, wild vegetables are playing an increasingly important role in peoples' health and well-being. This paper aims to provide scientific clues for the selection of special and high quality wild vegetables species.
An ethnobotanical study, consisting of a literature survey, open-ended and semi-structured interviews, and collection and identification of voucher specimens was carried out to gather information on wild vegetables in Inner Mongolia. Next, an integrated assessment of 90 species of wild vegetables was performed using the linearity weighted integrative mathematical analysis method.
According to an integrated assessment of 90 species of wild vegetables in Inner Mongolia, there are 5 species with the highest integrated value, 40 species of high-integrated value, 43 species of general integrated value, and 2 species of low value. The results indicate that the vast majority of wild vegetables have high value in Inner Mongolia.
Inner Mongolia is rich in wild vegetable resources. A comprehensive assessment indicates that the vast majority of wild vegetables are of high value. However, these wild vegetables are seldom collected or cultivated by local people. Most of the collected species require further research and investigation into their nutrient content, toxicity and ethnobotany to illuminate their potential as new cultivars or products.
Short birth intervals and unintended pregnancies pose serious health risks to mothers and their infants by causing unnecessary high risk of pregnancy related complications and self induced abortions. The objective of the study was to assess the child spacing and fertility planning behavior of women in Mana district, Jimma zone.
A cross-sectional survey was conducted from July 18 – August 17, 2008 on 645 women who had a live birth in the three years prior to the survey. A simple random sampling technique was used to identify eligible women. A pre-tested structured questionnaire was used for data collection. Data were analyzed using SPSS for windows version 15. Frequency distributions, cross-tabulation, and logistic regression analysis were performed.
Analysis of birth intervals for women with non first births showed that 27% of births occurred within less than 24 months after a previous birth, showing that a considerable proportion of births were not adequately spaced to promote maternal and child health. About 39% of women reported that their recent pregnancy was unintended. Women with unintended pregnancy are more likely to be illiterate (OR=1.85,95%CI,1.23–2.79), have four or more living children(OR=2.77,95% CI,1.77–4.33), had a previous birth interval of less than 24 months(OR=1.78,95% CI(1.19–2.69), have never used contraception (OR=4.53, 95% CI, 3.05–6.75) and did not desire any more children (OR=1.84, 95% CI, 1.23–2.76).
The study showed that an inadequate child spacing and high level of unintended pregnancy among considerable proportion of the study population. Unintended pregnancy and short birth intervals can pose serious health risks to mothers and their infants by causing unnecessary high risk of pregnancy related complications. Thus, improving access to safe and voluntary family planning counseling and services is essential to reduce the high level of unintended pregnancy and short birth intervals.
unintended pregnancy; child spacing; Mana; high risk
It is critical to monitor the incidence and clinical characteristics of influenza and its associated hospitalization to understand influenza disease burden. A disease burden study can inform the prioritization of a public health response. However, little is known about the epidemiology and disease burden of influenza in developing countries, including Mongolia. Thus we performed prospective data and sample collection from patients who visited outpatient clinics with influenza-like illness (ILI) and hospitalized patients with severe acute respiratory infections (SARI) in two sites of Mongolia, Baganuur District of Ulaanbaatar and Selenghe Province, from 2008 to 2010. In total, we examined 350 ILI cases during the 2008–2009 influenza epidemic period and 1723 ILI cases during the 2009–2010 influenza epidemic period.
We observed the highest ILI incidence per 1000 population in the one to four year age group in Baganuur and in the under one year age group in Selenghe during both periods. Thirteen SARI cases were positive for seasonal influenza A(H1N1) during the 2008–2009 season and 17 SARI cases were positive for pandemic influenza A(H1N1) 2009 during the 2009–2010 season. Among these cases, 84.6% and 58.8% were children under five years of age, respectively, during the 2008–2009 and 2009–2010 seasons. Taken together, children, especially children under five years, had higher influenza infection incidence and hospitalization rate in Mongolia. Although mortality impact also should be considered, we believe that our findings can be useful in formulating an influenza control strategy during influenza epidemic periods in Mongolia.
In 2003, the Omani Ministry of Health Child Health Care Program initiated a national Birth Defects (BD) Register. This paper reviews the magnitude and risk factors of birth defects in children born and registered in 2005 using data from the BD Register.
Pediatricians and neonatologists examined children with BDs found either during screening at birth or when attending clinics in their first year of their life. Clinical examination, laboratory, sonographic and radiological investigations were carried out. A pre-tested form was used to note personal details, type of birth defect including International Classification of Diseases-10 (ICD-10) codes of BD and selected risk factors. The incidence rates per 100 live births were calculated.
The annual incidence of BD in Oman was 2.53% (95% CI 2.38–2.68). Males had a significantly higher risk of BD than females (relative risk (RR) = 2.0). The regional variation of BD was also significant (χ2 = 363). The incidence of anaemia due to enzyme disorders was 1.4%. BD of urogenital organs, hands and feet and Down’s syndrome were the main types of anatomical defects. Consanguinity among parents (RR = 0.85) and low birth weight (RR = 0.28) was negatively associated to birth defects. Mothers giving birth at gestational age of <37 weeks (RR = 1.89) had a higher risk of having children with BD. Maternal and paternal age were not associated to BD.
The national Register for BD is an important evaluation tool. Both genetic and acquired risk factors seem to affect BD rates and types in Oman.
Birth defects; Congenital anomalies; Oman
The Stillbirth Collaborative Research Network (SCRN) has conducted a multisite, population-based, case-control study, with prospective enrollment of stillbirths and live births at the time of delivery. This paper describes the general design, methods, and recruitment experience. The SCRN attempted to enroll all stillbirths and a representative sample of live births occurring to residents of pre-defined geographic catchment areas delivering at 59 hospitals associated with five clinical sites. Live births <32 weeks gestation and women of African descent were oversampled. The recruitment hospitals were chosen to ensure access to at least 90% of all stillbirths and live births to residents of the catchment areas. Participants underwent a standardized protocol including maternal interview, medical record abstraction, placental pathology, biospecimen testing, and, in stillbirths, postmortem examination. Recruitment began in March 2006 and was completed in September 2008 with 663 women with a stillbirth and 1932 women with a live birth enrolled, representing 69% and 63%, respectively, of the women identified. Additional surveillance for stillbirth continued through June 2009 and a follow-up of the case-control study participants was completed in December 2009.
Among consenting women, there were high consent rates for the various study components. For the women with stillbirth, 95% agreed to maternal interview, chart abstraction, and placental pathologic examination; 91% of the women with live birth agreed to all of these components. Additionally, 84% of the women with stillbirth agreed to a fetal postmortem examination. This comprehensive study is poised to systematically study a wide range of potential causes of, and risk factors for, stillbirth and to better understand the scope and incidence of the problem.
Universal hepatitis B (HB) immunisation is the most effective means for prevention of hepatitis B virus (HBV) infection worldwide. Maintaining the vaccine cold chain is an essential part of a successful immunisation programme. Our recent nationwide survey in Mongolia has observed significant urban–rural differences in the prevalence of HBV infection among vaccinated cohorts.
To examine whether the administration of HB vaccine in winter contributes to these residential discrepancies on the effectiveness of vaccination.
Design and setting
In 2004, a nationwide serosurvey was carried out covering both urban and rural areas of Mongolia. Sampling was multistage, with random probability from all public schools in the country.
A random sample of 1145 children (51.7% boys; aged 7–12 years), representative of Mongolian elementary school children.
Multivariate logistic regression analysis identified that total (past and current) HBV infection (OR 2.31, 95% CI 1.20 to 4.42; p = 0.012) was independently associated with the administration of all HB vaccines in winter. An increased OR for current HBV infection was also observed (OR 2.58, 95% CI 0.87 to 7.68; p = 0.089), but without significance. Interestingly, after stratifying by residence, the association between winter vaccination and total HBV infection was evident for rural (p = 0.008) but not for urban areas (p = 0.294). The frequency of vaccine‐induced immunity was significantly (p = 0.007) lower for those who received HB vaccine at birth during winter in rural areas.
Administration of HB vaccine during winter is an important predictor of the low effectiveness of vaccination in rural Mongolia. To improve the effectiveness of HB vaccination in remote areas, cold chain control should be addressed with particular attention to the winter season.