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    Tooth Loss and Nutritional Status in 120,994 Children Aged 6-9 Years in Mongolia: A Population-Based Study
    Background: Tooth loss in childhood reflects cumulative oral disease and may impair dietary intake, potentially influencing nutritional status. Evidence on the association between tooth loss and anthropometric indicators in school-aged children remains limited. Methods: This population-based cross-sectional study used data from a nationwide health screening conducted by the Ministry of Health of Mongolia in 2023-2024. A total of 120,994 children aged 6-9 years were included. Tooth loss was categorized as 0, 1-2, or ≥3 extracted teeth. Nutritional status was assessed using weight-for-height (WHZ), weight-for-age (WAZ), height-for-age (HAZ) Z-scores, and body mass index (BMI). Associations between tooth loss and anthropometric indicators were examined using unadjusted and multivariable linear regression models adjusting for age and sex. Results: Overall, 12.5% of children had experienced tooth loss. Mean WHZ and WAZ decreased progressively with increasing tooth loss. In adjusted analyses, children with 1-2 extracted teeth had lower WHZ (β = -0.025; 95% CI: -0.047 to -0.004), and those with ≥3 extracted teeth had substantially lower WHZ (β = -0.058; 95% CI: -0.084 to -0.032), compared with children without tooth loss. Similar associations were observed for WAZ. No significant associations were found between tooth loss and BMI or HAZ. No interactions with age or sex were detected. Conclusions: Tooth loss was independently associated with lower indicators of current nutritional status among children aged 6-9 years. These findings underscore the importance of integrating oral health and nutrition strategies in childhood health programs.
    Scopus© Citations 1
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    Distribution of 10-year cardiovascular disease risk levels in Mongolia: results from nation-wide health screening program
    INTRODUCTION: The Mongolian government recently initiated the first nationwide health screening program to assess the health status of the entire population using age-group specific health risk assessments related to the major noncommunicable diseases and behavioral risk factors. Based on data collected from nationwide health screening program, we estimated the distribution of 10-year cardiovascular disease (CVD) risks in the general population by using the risk prediction model recently published by the World Health Organization (WHO). METHODS: A representative sample of 35,769 adults aged between 40 and 80 years old participated in nationwide health screening program, which covered all 21 Mongolian provinces and 9 districts in the capital city Ulaanbaatar. Data used in the present study were obtained from the first wave of the screening program, which was held throughout Mongolia between May 2022 and February 2023. To assess the four categories of CVD risk and determine the 10-year risk of a fatal/non-fatal event, we used the WHO CVD risk 2019 laboratory-based cardiovascular disease risk charts. The following key risk factors were used to assess the 10-year CVD risk: gender, age, location, smoking status, body mass index, total cholesterol level, history of diabetes, fasting glucose level, and blood pressure level. The 10-year risk for CVD was divided into four groups: low risk (< 10%), mild risk (10 to 20%), moderate risk (20 to 30%), and high risk (> 30%). RESULTS: Total of 35,769 adults aged between 40 and 80 years old participated in the nationwide health screening program. The mean age of the participants in the screening program was 54.4 ± 9.3 years. According to the CVD charts published by the WHO, about 48% (n = 17,282) of the study population had a low 10-year CVD risk (<10%), 41% (n = 14,554) had a mild risk (10-20%), 12% (n = 3,502) had a moderate risk (20-30%), and 1% (n = 431) had a high risk (>30%). CONCLUSION: More than half of the screening program participants were identified as having a 10-year CVD risk greater than 10%. Effective intervention focusing on the male population living in urban areas, and target on major risk factors like hypertension, smoking and diabetes can be strategic approach to reducing the CVD risk in Mongolia.
    Scopus© Citations 1
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    SARS-CoV-2 seroepidemiology in Mongolia, 2020-2021: a longitudinal national study
    (Elsevier BV, 2023-04) ;
    Bailie, Christopher R
    ;
    ;
    Price, David J
    ;
    BACKGROUND: The COVID-19 pandemic has global impacts but is relatively understudied in developing countries. Mongolia, a lower-middle-income country, instituted strict control measures in early 2020 and avoided widespread transmission until vaccines became available in February, 2021. Mongolia achieved its 60% vaccination coverage goal by July 2021. We investigated the distribution and determinants of SARS-CoV-2 seroprevalence in Mongolia over 2020 and 2021. METHODS: We performed a longitudinal seroepidemiologic study aligned with WHO's Unity Studies protocols. We collected data from a panel of 5000 individuals in four rounds between October 2020 and December 2021. We selected participants through local health centres across Mongolia by age-stratified multi-stage cluster sampling. We tested serum for the presence of total antibodies against SARS-CoV-2 receptor-binding domain, and levels of anti-SARS-CoV-2 spike IgG and neutralising antibodies. We linked participant data with national mortality, COVID-19 case, and vaccination registries. We estimated population seroprevalence and vaccine uptake, as well as unvaccinated population prior-infection prevalence. FINDINGS: At the final round in late 2021, 82% (n = 4088) of participants completed follow-up. Estimated seroprevalence increased from 1.5% (95% CI: 1.2-2.0), to 82.3% (95% CI: 79.5-84.8) between late-2020 and late-2021. At the final round an estimated 62.4% (95% CI: 60.2-64.5) of the population were vaccinated, and of the unvaccinated population 64.5% (95% CI: 59.7-69.0) had been infected. Cumulative case ascertainment in the unvaccinated was 22.8% (95% CI: 19.1%-26.9%) and the overall infection-fatality ratio was 0.100% (95% CI: 0.088-0.124). Health workers had higher odds for being COVID-19 confirmed cases at all rounds. Males (1.72 (95% CI: 1.33-2.22)) and adults aged 20 and above (12.70 (95% CI: 8.14-20.26)) had higher odds for seroconverting by mid-2021. Among the seropositive, 87.1% (95% CI: 82.3%-90.8%) had SARS-CoV-2 neutralising antibodies by late 2021. INTERPRETATION: Our study enabled tracking of SARS-CoV-2 serological markers in the Mongolian population over one year. We found low SARS-CoV-2 seroprevalence in 2020 and early 2021, with seropositivity increasing over a 3-month interval in 2021 due to vaccine roll out and rapid infection of most of the unvaccinated population. Despite high seroprevalence in Mongolia amongst both vaccinated and unvaccinated individuals by end-2021, the SARS-CoV-2 Omicron immune escape variant caused a substantial epidemic. FUNDING: World Health Organization, WHO UNITY Studies initiative, with funding by the COVID-19 Solidarity Response Fund and the German Federal Ministry of Health (BMG) COVID-19 Research and development. The Ministry of Health, Mongolia partially funded this study.
    Scopus© Citations 6
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    SARS-CoV-2 seroprevalence in Mongolia: Results from a national population survey
    (Elsevier BV, 2021-12) ; ;
    Le, Linh-Vi
    ;
    ;
    BACKGROUND: With the global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in early 2020, Mongolia implemented rapid emergency measures and did not report local transmission until November 2020. We conducted a national seroprevalence survey to monitor the burden of SARS-CoV-2 in Mongolia in the months surrounding the first local transmission. METHODS: During October-December 2020, participants were randomly selected using age stratification and invited for interviews and blood samples at local primary health centres. We screened for total SARS-CoV-2 antibodies, followed by two-step quantitative SARS-CoV-2 IgG serology tests for positive samples. Weighted and test-adjusted seroprevalences were estimated. We used chi-square, Fisher's exact and other tests to identify variables associated with seropositivity. FINDINGS: A total of 5000 subjects were enrolled. We detected SARS-CoV-2 IgG antibodies in 72 samples. Crude seroprevalence of SARS-CoV-2 antibodies was 1·44% (95%CI,1·21-1·67). Population weighted and test-adjusted seroprevalences were 1·36% (95%CI,1·11-1·63) and 1·45% (95%CI,1·11-1·63), respectively. Age, sex, geographical, and occupational factors were not associated with seropositivity (p>0·05). Symptoms and signs within past 3 months and seropositivity were not associated at the time of the survey (p>0·05). INTERPRETATION: SARS-CoV-2 seroprevalence in Mongolia was low in the first year of the pandemic potentially due to strong public health measures, including border restrictions, educational facilities closure, earlier adoption of mask-wearing and others. Our findings suggest large-scale community transmission could not have occurred up to November 2020 in Mongolia. Additional serosurveys are needed to monitor the local pandemic dynamic and estimate how far from herd immunity Mongolia will be following-up with vaccination programme in 2021 and 2022. FUNDING: World Health Organisation, WHO UNITY Studies initiative, with funding by the COVID-19 Solidarity Response Fund and the German Federal Ministry of Health (BMG) COVID-19 Research and development. TRANSLATION: Cyrillic and Traditional Mongolian translation of abstract is available on appendix section.
    Scopus© Citations 14
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    Molecular epidemiology of SARS-CoV-2 in Mongolia, first experience with nanopore sequencing in lower- and middle-income countries setting
    (Wiley, 2023-12) ; ; ; ;
    Burged, Natsagdorj
    BACKGROUND: Coronavirus disease (COVID-19) has had a significant impact globally, and extensive genomic research has been conducted on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) lineage patterns and its variants. Mongolia's effective response resulted in low prevalence until vaccinations became available. However, due to the lack of systematically collected data and absence of whole genome sequencing capabilities, we conducted a two-stepped, nationally representative molecular epidemiologic study of SARS-CoV-2 in Mongolia for 2020 and 2021. METHODS: We used retrospective analysis of stored biological samples from November 2020 to October 2021 and a variant-specific real-time reverse transcription polymerase chain reaction (RT-PCR) test to detect SARS-CoV-2 variants, followed by whole genome sequencing by Nanopore technology. Samples were retrieved from different sites and stored at -70°C deep freezer, and tests were performed on samples with cycle threshold <30. RESULTS: Out of 4879 nucleic acid tests, 799 whole genome sequencing had been carried out. Among the stored samples of earlier local transmission, we found the 20B (B.1.1.46) variant predominated in the earlier local transmission period. A slower introduction and circulation of alpha and delta variants were observed compared to global dynamics in 2020 and 2021. Beta or Gamma variants were not detected between November 2020 and September 2021 in Mongolia. CONCLUSIONS: SARS-CoV-2 variants of concerns including alpha and delta were delayed in circulation potentially due to public health stringencies in Mongolia. We are sharing our initial experience with whole genome sequencing of SARS-CoV-2 from Mongolia, where sequencing data is sparse.
    Scopus© Citations 1
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    Examining Age-Adjusted Associations between BMI and Comorbidities in Mongolia: Cross-Sectional Prevalence
    (2024-06) ; ; ;
    Tsedev-Ochir, Tumur-Ochir
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    Enebish, Oyunsuren
    (1) Background: This study investigated the association between body mass index (BMI) categories and comorbidities in the context of a developing country, utilizing data from a nationwide health screening in Mongolia. (2) Methods: The study included 181,080 individuals (mean age 47.0 ± 15.3, 42.0% male) from the population-based general health screening. We counted the number of diseases from participants' medical records based on ICD-10 codes, excluding those categorized under Z00-Z99 and codes indicating acute disorders, as well as individuals classified as underweight. (3) Results: Among study participants, the prevalence of two or more comorbidities was 4.2%. The weight distribution comprised 40.4% normal weight; 37.1% overweight; and 16.9%, 4.4%, and 1.2% in the Class I, II, and III obesity categories, respectively. Comorbidities increased with BMI: normal weight (0.222); overweight (0.255); and Class I (0.290), Class II (0.302), and Class III obesity (0.303), suggesting a dose-dependent likelihood of having multiple diseases. Adjusted linear regression (beta coefficients, 95% CIs) showed increased comorbidity risks in overweight (0.017, 0.013-0.021) and obesity (0.034, 0.030-0.039). Interaction analysis with age revealed a significant effect (p < 0.001). While comorbidities tend to increase with higher BMI categories in all age-tertile groups, this association was notably stronger among younger individuals. (4) Conclusions: Obesity is associated with a twofold increase in the prevalence of multiple comorbidities compared to normal weight. Our findings also highlight the critical role of age in the development of multiple diseases, with BMI remaining a significant factor across various age groups, encompassing both younger and older adults.
    Scopus© Citations 9