1Их Британи, Умард Ирландын Нэгдсэн Вант Улсын Антроложика судалгааны байгууллага, 2ЭМЯ, 3 ЭХЭМҮТ, 4ХӨСҮТ
Background
Successful interventions have been undertaken to advance countries towards their Millennium Development Goal 4 (MDG 4), reducing child mortality. Yet, 6.6 million children under five died in 2012, mostly from preventable diseases, including pneumonia (17%) and diarrhoea (9%). Simple, inexpensive treatments are available for each of these conditions, yet too few children receive appropriate and timely care, particularly in high burden countries and in the most deprived settings due to a range of interrelated factors.
Objectives
To determine for barriers that pneumonia, diarrhoea and newborn complication in Mongolia, to collect basic data to prevent action for the reducing preventable child deaths.
Materials and Methods
Based on composite indexes indicating multiple deprivations and drivers of inequity, government assessment concluded that Khuvsgul Province (rural area) and Nalaikh District of Ulaanbaatar (peri-urban) were amongst the most disadvantaged regions in Mongolia.
Data collection was carried out over ten days in October 2013 through in-depth interviews, semi-structured focus group discussions and technology surveys. In total, there were 162 participants from a number of different communities: Darkhad, Reindeer, Khalkh and Khotgoid in Khuvsgul, and Khalkh, Kazakh (Muslim minority group) and economic migrants in Nalaikh.
The primary investigator was responsible for all thematic analysis. Dominant themes were identified through the systematic review of interviews, focus group discussions and technology surveys. Coding and analysis was done by hand for qualitative data and through Excel statistical analysis for survey data. Computer-assisted qualitative data analysis software (ATLAS.ti) was used to analyse a sub-set of coded textual data to verify emergent themes
Results
Causation, symptom recognition and prevention
Pneumonia
Pneumonia was commonly attributed to cold weather and the progression of a cold or flu to more serious symptoms. The level of knowledge about pneumonia symptoms, progression and prevention was elevated amongst mothers of children who had experienced pneumonia In interviews and focus group discussions, mothers frequently cited the following as symptoms of childhood pneumonia: difficulty breathing/pain in the chest/harsh sounds coming from chest; high temperature; vomiting thick yellowish substance; children crying more than normal; loss of appetite; and coughing. Fathers and bagh feldshers also described the need to support children's immune system with healthy foods and vitamins, and to keep a child warm as priorities for pneumonia prevention.
Diarrhoea
'Improper hand hygiene' was a common response from primary caregivers across all districts who also suggested that diarrhoea was caused by 'wrong food' (for example, contaminated milk or soups high in fat content), store-purchased food that had expired, improper baby formula, or drinking unclean water without boiling it first. Diarrhoea symptoms were varied and included: frequent watery stool; high temperature; weakened body; vomiting; loss of appetite; and thirst or dry mouth. Known methods of prevention included: proper nutrition for children and breastfeeding mothers; clean hands/proper hygiene; protection of children from cold and flu and other common child diseases; keeping children warm; and giving oral rehydration solutions. In discussing the severity of diarrhoea in relation to other child illnesses it was generally perceived that diarrhoea was a common or 'normal' problem.
Caregivers were also questioned about household water sources and storage, sanitation and hygiene practices. Hand-washing practices appeared to be of a generally high standard in both Khuvsgul and Nalaikh regardless of rural or urban location.
Pregnancy and birth complications
Due to facility-based deliveries at these larger hospitals with better equipment and more qualified staff, women commonly stated that their deliveries (if not their pregnancies) were complication free. On further probing women discussed symptoms of high blood pressure during pregnancy as pregnancy poisoning, preeclampsia, eclampsia and hypertension. Bagh feldshers concluded that most alarming from their perspective, was premature birth and children born with hypoxia. Approximately half of the fathers in the focus group discussion listed high blood pressure, swelling and anaemia as common pregnancy compilations experienced by their wives. Health workers in both Khuvsgul and Nalaikh attributed pregnancy complications to missed or infrequent antenatal care visits. One mother in Nalaikh concluded that stillbirths, miscarriages, and congenital impairments were common in her district due to environmental pollution.
Conclusion
The survey shows that take appropriate care in right time, to remove the barriers to habituate right choose to take medical care which is faced in provinces, make convenient conditions, contributing to build local support for the positive motivation and identified factors.
