Health status and risk factors of seminomadic pastoralists in Mongolia: a geographical approach

A comparative examination of the health status of earthquake-affected and non-earthquake-affected adolescents in Yushu

Background

Yushu, Qinghai Province, which is located in the remote Tibetan Plateau in western China, was struck by a disastrous earthquake in 2010.

Methods

This study aimed to compare the health status of adolescents who had (Exp-Group) and had not (Non-Group) experienced the Yushu earthquake, 7 years after it occurred; additionally, group-specific predictors of health status were identified. A cross-sectional study was adopted among students from two junior schools in Yushu, whereby two groups were compared. Descriptive statistics, t-tests, Wilcoxon rank-sum tests, Kruskal-Wallis H tests, and stepwise linear regression were used to analyze data.

Results

Exp-Group scored higher than Non-Group on Physiological Component Summary (PCS) but not on Mental Component Summary (MCS). Among Exp-Group participants, lower PCS scores were predicted for "house damaged," "injured," "family member injured," and "family member or friend dead." Lower MCS scores were predicted by "family member or friend dead." Among Non-Group participants, PCS scores were predicted by "residence" and "family member or friend dead." Lower MCS scores were predicted by "not living with parents."

Conclusion

Lower PCS and MCS scores of Exp-Group adolescents mainly contributed to earthquake-related injuries, while lower PCS and MCS scores of Non-Group are related to poor living conditions and the fact of the left-behind child.

Hygienic Condition of Different Water Sources in the Kharaa River Basin, Mongolia in the Light of a Rapid Warming Trend

Mongolia is a water-scarce land-locked country, and available water resources are utilized for multiple purposes including irrigation, food preparation, drinking water for livestock and people. Limited data availability on water hygiene means that the related risks to public health are only partially understood. This is particularly problematic due to the widespread use of unimproved water sources such as surface water and water from simple shallow wells. Based on two field surveys in the Kharaa River Basin in spring 2017 and 2018, we assessed the presence and quantity of total coliforms (TC), fecal coliforms (FC), and E. coli bacteria in surface waters and wells and investigated potential linkages between temperature and hygiene. In the Kharaa River and its tributaries, TC concentrations averaged at a most probable number of (MPN) of 754 ± 761 per 100 mL and FC concentrations at an MPN of 31 ± 33. Only small and non-significant correlations between coliform concentrations and temperature were identified. Coliforms concentrations in wells were lower (average MPN for TC: 550 ± 1286, and for FC 58 ± 253). There was considerable variation between wells, with moderate but significant correlations between temperature and bacterial counts. Low water temperatures in April and May (just above freezing to less than 6.5 °C in wells and 7.5 °C to 14.5 °C in the river system) and the positive correlations between temperature and coliform concentrations particularly for well samples indicate that further warming is likely to increase the risks of microbiological water pollution. In the future, this should be complemented by modeling at a watershed scale. This should include the consideration of a trend towards stronger rainfall events, changes in livestock density, and urban sewage treatment and discharge, which are other likely drivers of changes in water hygiene.

Hyperostosis frontalis interna in ancient populations from the Carpathian Basin - A possible relationship between lifestyle and risk of development

OBJECTIVE

The prevalence of hyperostosis frontalis interna (HFI) was examined in different periods of the Carpathian Basin from 4900 BCE to 17th century AD. The study seeks to evaluate temporal changes in HFI and the possible impact of lifestyle on it.

MATERIALS

The studied material consisted of 4668 crania from Hungary and Serbia.

METHODS

The crania were analyzed employing macroscopic and endoscopic examination.

RESULTS

In historic periods, sex and age played a pivotal role in HFI development. Among predominantly pastoralist populations of the 5th-8th and 10th centuries, prevalence of HFI was considerably higher than in the medieval populations of the 9th-17th centuries.

CONCLUSIONS

In addition to age and sex, other factors could be implicated in HFI development. The physiological effects of the pastoralist lifestyle and diet on insulin regulation could explain the increased risk of developing HFI in the 5th-8th and 10th-century populations.

SIGNIFICANCE

The study provides the first comprehensive dataset of HFI from different archaeological periods from the Carpathian Basin. It has implications for lifestyle and risk of HFI development in past populations.

LIMITATIONS

The archaeological periods are not equally represented.

SUGGESTIONS FOR FURTHER RESEARCH

In order to better understand the etiology of HFI, lifestyle factors can be used to elucidate the risk of developing HFI in ancient populations.

Social and environmental determinants of child health in Mongolia across years of rapid economic growth: 2000-2010

BACKGROUND

To understand the effect of economic growth on health, we investigated the trend in socio-economic and regional determinants of child health in Mongolia. This Central Asian country had the fastest economic growth amongst low and middle-income countries (LMICs) from 2000 to 2010 and a healthcare system in transition.

METHODS

Data was from Mongolian multiple indicator cluster surveys (MICS) in 2000, 2005 and 2010. Child nutrition/growth was measured by height-for-age z-score (HAZ), weight-for-age z-score (WAZ), prevalence of stunted (HAZ < -2) and underweight (WAZ < -2) children. Access to health care was measured by prevalence of fully immunised children <5 years. Multivariate multi-level logistic mixed modelling was used to estimate the effect of socio-economic and environmental health determinants on each outcome in each year; 2000, 2005 and 2010. T-tests were used to measure significant change in HAZ and WAZ over the decade.

RESULTS

Overall, from 2000 to 2010, there was a significant improvement (p < 0.001) in all three outcomes, but the effect of socio-economic factors increased on both stunting and weight. In 2000, region was a significant determinant: children living in three provinces were significantly more likely to be stunted and less likely to be immunised than Ulaanbaatar, but this was not significant by 2010. By 2010, none of the factors were significant determinants of immunisation in children. In 2000, economic status had no effect on stunting (OR = 0.91; 95%CI:0.49,1.66), however by 2010, children in the poorest economic quintile were 4 times more likely to be stunted than the richest (OR = 0.24; 95% CI:0.13,0.45; p < 0.001). The effect of maternal education on stunting prevalence continued over the 10 years, in both 2000 and 2010 children were twice as likely to be stunted if their mother had no education compared to university education (2000 OR = 0.45; 95% CI:0.28,0.73, p < 0.01,2010 OR =0.55; 95% CI:0.35,0.87, p < 0.05).

CONCLUSION

Economic growth in Mongolia from 2000 to 2010 resulted in an increase in the effect of social determinants of child health; whilst focused policy improved access to immunisation. Children with less educated mothers and lower household incomes should be targeted in interventions to reduce health inequity.

A cohort study of chronic diseases for Mongolian people: Outline with baseline data of the Moncohort study

Many Mongolian people suffer from non-communicable chronic diseases. In order to plan preventive strategies against such diseases, we designed a community-based prospective cohort study of chronic diseases, called the Moncohort study, in Mongolia. This is the first nationwide large-scale cohort study of chronic diseases. This paper describes the study’s rationale, design and methods with baseline data.

Mongolian residents aged ⩾40 years were selected nationwide from many geographic regions in 2009. Data were collected on demographics, socioeconomic status, lifestyle, and anthropometric and biochemical measurements.

In total, 2280 Mongolian residents were registered in the survey. Socioeconomic, lifestyle, anthropometric and biochemical characteristics were differentiated by gender and geographical area in descriptive data. Aging, low social class, physical inactivity and infrequent fruits intake were positively associated with histories of chronic disease in men, while aging was positively associated with histories of chronic disease in women.

Factors associated with chronic diseases reveal gender-oriented strategies might be needed for their prevention. Detailed prospective analyses will illustrate the impact of risk factors on chronic diseases and lead to evidence for designing programs aimed at preventing chronic diseases and related disorders in Mongolia.

Exploring knowledge, attitudes and practices related to diabetes in Mongolia: a national population-based survey

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Health status and geographic mobility among semi-nomadic pastoralists in Mongolia

This paper sets out to examine the impact on health of a key aspect of the semi-nomadic lifestyle, namely geographic mobility. The relevant literature suggests that seasonal migrations of pastoralists tend to increase the risk of a poor health. Highlighted in this paper is an inverse association between spatial mobility and health status among the herders of rural Mongolia. Two types of mobility are involved in this process. For households, seasonal migration has a significant influence on health. At the level of individuals, however, there is another kind of mobility: that of travelling to meet personal needs. At both of these levels, statistically significant impacts on health were observed.

Assessment of the health status and risk factors of Kham Tibetan pastoralists in the alpine grasslands of the Tibetan plateau

The health status of Tibetan herders in the Sanjiangyuan region of the Tibetan Plateau, in southwest Qinghai Province, is assessed in this paper. The field study was conducted in 2002 in the context of a broader community development and research framework, the ultimate goal of which is to achieve an effective region-specific programme of preventative health care and training for Tibetan pastoralists. Specifically, the authors analysed the impact of a number of potentially health-related environmental and lifestyle risk factors on self-reported health indicators, with a special emphasis on mother and child health. Several health status indicators were used, including a general morbidity index and a measurement of functional incapacity due to illness in the sample households. Maternal and child health findings were alarming with high rates of miscarriage and infant loss, with no traditional midwives to assist in pregnancy and delivery. Preventable childhood illnesses were also common. Other debilitating diseases included hepatitis, tuberculosis, arthritis (gout), gall bladder disease, peptic ulcers and back pain. Finally, binary logistic regression analysis showed a significant link between general morbidity and the time it takes to obtain water. The survey findings, validated by the focus groups, indicate a real need for increased accessibility and quality of health service provision to women and men and effective preventative health strategies.

Health sector reform and sexual and reproductive health services in Mongolia

Since its transition to democracy, Mongolia has undergone a series of reforms, both at national level and in the health sector. This paper examines the pace and scope of these reforms, the ways in which they have impacted on sexual and reproductive health services and their implications for the health workforce. Formerly pro-natalist, Mongolia has made significant advances in contraceptive use, women's education and reductions in maternal mortality. However, rising adolescent pregnancy and sexually transmitted infections, and persisting high levels of abortion, remain challenges. The implementation of the National Reproductive Health Programme has targeted skills development, outreach and the provision of resources. Innovative adolescent-friendly health services have engaged urban youth, and the development of family group practices has created incentives to provide primary medical care for marginalised communities, including sexual and reproductive health services. The Health Sector Strategic Masterplan offers a platform for coordinated development in health, but is threatened by a lack of consensus in both government and donor communities, competing health priorities and the politicisation of emerging debates on fertility and abortion. With previous gains in sexual and reproductive health vulnerable to political change, these tensions risk the exacerbation of existing disparities and the development by default of a two-tiered health care system.

Emerging infectious diseases in Mongolia

Since 1990, Mongolia’s health system has been in transition. Impressive gains have been accomplished through a national immunization program, which was instituted in 1991. Nevertheless, the country continues to confront four major chronic infections: hepatitis B and C, brucellosis, tuberculosis, and sexually transmitted diseases (STDs). As of 2001, only two cases of HIV infections had been detected in Mongolia, but concern grows that the rate will increase along with the rising rates of STDs and increase in tourism. Other infectious diseases of importance in Mongolia include echinococcus, plague, tularemia, anthrax, foot-and-mouth, and rabies.

Networks of nomads: negotiating access to health resources among pastoralist women in Chad

Health resources among pastoralist groups are strongly gendered. While certain types of health resources fall within the female domain (home-based treatment, caring and supportive roles, and knowledge surrounding particular reproductive conditions) access to most outside health practitioners, treatments and knowledge is controlled largely by men. For pastoralist women, this means that actions taken during illness episodes depend largely on the nature and quality of social support systems available, and on their ability to mobilise them effectively. These support systems include husband and other affines, male kin, and networks of female kin and friends. Factors such as position within domestic and wider social units, as well as life cycle, affect women's ability to access and mobilise these different support systems for their health needs. However, seasonal mobility interacts with gender and social support systems in complex ways that profoundly influence women's access to health resources. Most literature on nomadic peoples and health focuses on the physical barriers posed by spatial mobility to accessing health resources. However, it is suggested here that, for pastoralist women in Chad, the spatial fluidity of social networks might be a more important consideration. At certain times of the year women enjoy relatively easy access to a large range of extended kin and other social contacts, while at other times, when people are very dispersed, options become much more limited, often resulting in illness treatment being delayed. Mobility should not, though, be seen purely as a constraint. It can also be an opportunity, increasing the potential geographical and social resource base with regard to health for women.

Risk factors and child mortality among the Miao in Yunnan, Southwest China

Environmental factors and the lifestyle of communities in developing countries as in the industrialized world have a great deal to do with their health status. This study carried out among the Miao people of southeastern Yunnan province in Southwest China has demonstrated important links between child mortality (one indicator of health status) and specific risk factors. These include lifestyle variables such as geographic mobility, the age of weaning and religious belief. In addition, the use of available health care facilities was another explanatory variable. Perhaps surprisingly, a history of tuberculosis seemed also to be empirically related to the presence or absence of child mortality. Although it was impossible to show a significant statistical relationship between traditional practices and child mortality from the study's database, the authors have observed qualitatively that birthing customs play an important role in explaining the perinatal component of child mortality. These various relationships shed some light on potential areas for intervention with a view to reducing the levels of child mortality among minority peoples in China and elsewhere.