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SICA LLC

HEALTH PROJECT OF MCA

SURVEY REPORT PROJECT NUMBER: 2-11/130-124 PROJECT TITLE: LIVING STANDARD INDICATORS’ IMPACT ON NONCOMMUNICABLE DISEASE RISK EXERCISE

Ulaanbaatar, 2011


SURVEY REPORT CONTENTS

TABLES .......................................................................................................................................... 3 FIGURES ........................................................................................................................................ 3 FOREWORD ................................................................................................................................... 5 SURVEY METHODOLOGY ........................................................................................................... 6 Rationale ..................................................................................................................................... 6 Goal ............................................................................................................................................. 6 Survey scope ............................................................................................................................... 6 General survey principles, arrangements and data collection process ..................................... 7 Data collection period.................................................................................................................. 7 Survey sampling .......................................................................................................................... 7 Questionnaire sheet .................................................................................................................... 8 SURVEY RESULTS...................................................................................................................... 10 General information of households and individuals surveyed .................................................. 10 Living standard level indicators ................................................................................................. 13 Common factor of NCD ............................................................................................................. 14 Mental stress ......................................................................................................................... 14 Physical activity ..................................................................................................................... 14 Vegetable consumption ......................................................................................................... 15 Fruit consumption .................................................................................................................. 17 Alcohol consumption ............................................................................................................. 19 Tobacco use .......................................................................................................................... 21 Intermediate factors of NCD ......................................................................................................... 23 Overweight and obesity ......................................................................................................... 23 High blood pressure .............................................................................................................. 25 Prevalence of diabetes .......................................................................................................... 26 Other factors relevant to traffic accident and NCD ................................................................... 26 Traffic accident ...................................................................................................................... 26 Early detection coverage ....................................................................................................... 27 Information on NCD ............................................................................................................... 28 www.sica.mn, www.e-survey.mn

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SURVEY REPORT TABLES Table 1: Sampling prevalence ....................................................................................................... 8 Table 2: Assess vegetable and fruit consumption – “Serving” .................................................... 9 Table 3: Vegetable consumption, by income .............................................................................. 16 Table 4: Number of days of consuming fruits, by income resource............................................. 18 Table 5: Alcohol consumption, by income .................................................................................... 21 Table 6: Smokers, by income level .............................................................................................. 22

FIGURES Figure 1: Determining target group of the survey .................................................................................. 7  Figure 2: Surveyed households number percentage, by district ....................................................... 10  Figure 3: Surveyed households’ number, by residency ..................................................................... 11  Figure 4: Surveyed households’ number, by family member’s number ........................................... 11  Figure 5: Respondents’ number, by sex ............................................................................................... 11  Figure 6: Respondents’ number, by age .............................................................................................. 12  Figure 7: Marital status of the surveyed people .................................................................................. 12  Figure 8: Education level of the surveyed people ............................................................................... 12  Figure 9: Employment status ................................................................................................................. 13  Figure 10: Unemployed reasons ............................................................................................................ 13  Figure 11: Last month income of people .............................................................................................. 14  Figure 12: Predisposition to mental stress ........................................................................................... 14  Figure 13: Physical activity ..................................................................................................................... 15  Figure 14: Frequency of excises ............................................................................................................ 15  Figure 15: Daily frequency of vegetable consumption ....................................................................... 16  Figure 16: Servings of vegetable consumption and consumer’s number ....................................... 17  Figure 17: Servings of vegetable consumption, by income resource .............................................. 17  Figure 18: Frequency of fruit consumption per day ............................................................................ 18  Figure 19: Number of servings of fruit and number of person ........................................................... 19  Figure 20: Number of servings of fruits, by income resource ............................................................ 19  Figure 21: Alcohol consumption status ................................................................................................. 20  Figure 22: Drinkers, by age .................................................................................................................... 20  Figure 23: Drinkers, by frequency.......................................................................................................... 20  Figure 24: Smoking status ...................................................................................................................... 21  Figure 25: Duration of smoking .............................................................................................................. 22  Figure 26: Smokers’ number, by number of cigarettes ...................................................................... 23  Figure 27: BMI, by risk ............................................................................................................................. 24  Figure 28: BMI, by age and risk group .................................................................................................. 25  Figure 29: Treatment of hypertension ................................................................................................... 25  Figure 30: Ways to know blood sugar amount .................................................................................... 26  Figure 31: Traffic injury ............................................................................................................................ 27  www.sica.mn, www.e-survey.mn

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SURVEY REPORT Figure 32: Coverage frequency of early detection .............................................................................. 27  Figure 33: Communication channels ..................................................................................................... 28 

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SURVEY REPORT FOREWORD   Health project of Millennium Challenge Account (MCA) program funded by USA and Government of Mongolia investment aims to prevent from Noncommunicable Disease (NCD) and traffic injury and to detect early and to introduce best international practices providing health services which are efficient and affordable. It was also intended to improve service quality and access and to change population’s practice and approach and to carry out education and information activities focusing on healthy lifestyle. Main goal of the survey “Living Standard Indicators’ Impact on NCD Risk Exercise” conducted by SICA LLC under second phase of the health project small grant program of the MCA is to assess how person’s living standard indicators affecting risk exercise leading to NCD and their correlation. Since there was no survey has been conducted previously explaining correlation between risk factors leading to NCD and indicators demonstrating living standards such as the person’s education, income and employment, this survey serves as a pioneer. We are pleased to present you the sampling survey results based on household under the project. The survey was conducted using 2 phased, proportional probability and randomly sampling method on total of 751 selected households of 9 districts of Ulaanbaatar. SICA is fully responsible for compatibility of the methods and methodologies used in the survey and quality and accuracy of the collected information, explanation and analysis. Other statistics and evidences, not collected during the survey, used in the report were obtained from the official sources including 2010 Statistics Book, Main Results of 2010 Population and Housing Census and Statistics Bulletin 2011 and Prevalence of NCD and Injury Risk Factors -2009.

“Brightness lays in good health”

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SURVEY REPORT SURVEY METHODOLOGY Rationale The survey conducted with the intention of assessing prevalence level of factors leading to NCD demonstrated that main reasons of the sickness were unhealthy food, physical inactivity, overweight, smoking and binge drinking. However, information with broad range is required to assess risk factors’ correlation such as the person’s responsibility for society, potentials, inactive lifestyle, less consumption of vegetables and fruits, high level of alcohol consumption and smoking in developing a policy and conducting more detailed survey at decision making level. In addition, there is a significant need to conduct a survey on how population’s income level affects health service arrangement such as coverage of early detection. Among people, there is a common assumption stating “unemployment, bad living condition, especially, low levels of education and income increase chances to be covered by NCD and risks to decease due to NCD”. Due to the above mentioned risk factors’ prevalence’s in Mongolia, NCD is increasing expressly. However, ability to protect a health still remains limited. Therefore, it is required to actively search ability with result to fight against the disease and to concentrate more on certain group of the population which has highest potential to be covered by this disease. Goal The main goal of the survey was to assess how living standard indicators of the population such as employment, income and education correlate to risk factors lead to NCD and had the following objectives and assumption basing on the goal. Objective-1: To assess the NCD prevention and examination coverage levels of people coordinating employment and household income; Objective-2: To assess whether there are employment and household income differences in incidents of the NCD Objective-3: To assess how the survey results can be used in health inequality decrease Assumption: Main factor affecting undergoing of NCD and early decease due it, is the population’s lower living standard (low income) or low social-economic status. Survey scope Survey target group was population with NCD risk execise, particularly population group with low income. Therefore, it is required to survey all kinds of people in order to work with the target group and most suitable method for our survey was proportional probability and randomly sampling survey method. The survey scope included households of total 9 districts of Ulaanbaatar (Bayangol, Khan-Uul, Sukhbaatar, Bayanzurkh, Chingeltei, Songinokhairkhan, Bagakhangai, Nalaikh and Baganuur).

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SURVEY REPORT General survey principles, arrangements and data collection process Staffs of SICA LLC have carried out the survey data collection operation, submitted the survey methodology and questions of principle to Education Counsel of the Social Health School of Health Sciences University and Ethics Committee meeting of the Ministry of Health for review and obtained the required approvals. The survey team has complied with the following principles:   

To use a complex methodology which is scientifically well grounded To keep data confidential of the respondents All concepts and definitions should be clear and transparent to all stakeholders (including questionnaire developers, interviewers, survey participants and analysis officers) Collected information should be accurate and compatible Survey results and reports will be transparent, clear and usable for policy development

 

The survey team had the following structures:    

Survey plan and questionnaire development Data collection process Data processing Data analysis

Data collection period The survey data was collected between 11th and 23rd of November, 2011 in 9 districts of Ulaanbaatar. Survey sampling 2 phased, proportional probability and randomly sampling method was used in the survey and sampling main unit was a household. However, number of the households to be surveyed was based on the districts’ 2010 household’s number (NSB Annual book -2010). Figure 1: Determining target group of the survey

Total population

Sampling

Population affected by the risk exercise

The following statistics have been used in the sampling: 

9 districts of Ulaanbaatar have total of 273.2 thousand households.

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SURVEY REPORT 

Permanent population of Ulaanbaatar is 1 112.3 thousand.

In 2010, total 291.8 thousand people which were one third or 30% of the total households, received health services in Ulaanbaatar. Basing on the information, calculated the survey sampling size assuming 95% confidence interval and 5% acceptable margin of error.

n

Z

2

 p)

p(1 D

2

n = 375.4

Which: n – sampling size; p – probability; Z – table mean; D – error level If consider half percent of patients can be covered by the survey, the sampling unit size will be 751 (n = 375.4*2 (50%). Table 1: Sampling prevalence № 1 2 3 4 5 6 7

Districts Khan-Uul BayanZurkh Bayangl Sukhbaatar Chingeltei Songinokhairkhan 3 small districts Ulaanbaatar

Sampling Frame 27 808 63 483 43 545 34 503 31 648 55 600 16 595 273 182

Percentages 10.2 23.2 15.9 12.6 11.6 20.4 6.1 100.0

Sampling Units 76 175 120 94 87 153 46 751

When data is collected from households, heads of the households have been mainly selected and interviewer (survey officer) has interviewed adults who have full information about the household during the head of the household absence. In order to avoid information difference on health services, households have been divided into 2 groups: apartment and ger areas residents. With the intention to fully involve Ulaanbaatar total population representation, we estimated the sampling weight and the weight is reverse variable of the household selection probability. Total family annual income and education level were non relevant indicators. Data processing A sample of the survey data entry collected during the sampling survey was prepared on CSPro 4.1 (Census and Survey Program) developed by Census Bureau, USA. Since prepared data contains very broad information, our company is able to support in all ways in case of requiring assessing various additional indicators. Questionnaire sheet The survey questionnaire consist 43 questions with 2 pages and 4 chapters including: 1. Introduction and general information (8 questions) 2. Socia-economic status of households and family members (10 questions) www.sica.mn, www.e-survey.mn

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SURVEY REPORT 3. Common factor of NCD (12 questions) 4. Intermediate factor of NCD (13 questions) For realistic data, 2 baseline data were required and they have been determined as follows: One: To assess s physical activity. The family member’s physical activity was classified into 3 levels including: 1. High levels of physical activity  Vigorous –intensity activity on at least 3 days achieving a minimum of at least 1,500 MET-minutes/week  7 or more days of any combination of walking, moderate or vigorous intensity activities achieving a minimum of at least 3,00 MET-minutes per week 2. Moderate levels of physical activity  3 or more days of vigorous –intensity activity of at least 20 minutes per day  5 or more days of moderate –intensity activity or walking of at least 30 minutes per day  5 or more days of any combination of walking, moderate or vigorous intensity activity achieving a minimum of at least 600 MET- minutes per week 3. Low levels of physical activity  A person not meeting any of the above mentioned criteria falls into this category. Those individuals achieving at least 600 MET-minutes/weeks are considered to be “physically inactive”. Two: Assess vegetable and fruit consumption. Consumption of fruits and vegetables was assessed in terms of “number of servings”, and a serving was equal to 80 g. Table 2: Assess vegetable and fruit consumption – “Serving” № 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Types Strawberry Watermelon Blackberry Seabacktorn Blueberry Fruit juice Persimmon Cucumber Tomatoe Apple Pear Lemon Orange Banana Pomegranate Small sized apple Peach Plum Small plum Strawberry

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Measurement ½ cup One slice ½ cup ½ cup ½ cup ½ cup ½ cup ½ cup 7.5 sm 7.5 sm 7.5 sm 6 sm 8.5 sm 1 piece 3 pieces 2 pieces 7 sm 2 pieces 9 pieces, ½ cup

Gram 80 g 80 g 80 g 80 g 80 g 80 g 80 g 100 g 150 g 250 g 100 g 180 g 170 g 250 g 135 g 140 g 125 g 140 g 80 g

Serving 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Page 9


SURVEY REPORT 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37

Kiwi Spinach Lettuce Cabbage Yutsai/Chinise vegetable Garlic Peas Duuya/Chinise vegetable Hot pepper Half of the yellow turnip Yellow carrot – 1 Half of the red turnip White carrot Pepper Carrot Pumpkin Mushroom

5.5 sm 1 cup 1 cup 1 cup 1 cup ½ cup ½ cup 1 cup ½ cup ½ cup ½ cup ½ cup ½ cup 1 cup ½ cup ½ cup 1 cup

80 g 40 g 30 g 70 g 50 g 80 g 80 g 70 g 80 g 80 g 90 g 70 g 90 g 80 g 80 g 80 g 80 g

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

SURVEY RESULTS General information of households and individuals surveyed Total 751 households were surveyed and majority of the participants was from Bayanzurkh district (175 households or 23.3% of the total participants (Figure 3). Figure 2: Surveyed households number percentage, by district

2 675 people were surveyed and mean family members number was 3.6. According to the survey mean number of people of a household was consistent to state mean; however, it differs from Ulaanbaatar mean by points. It demonstrates the quality of the survey. It indicated that 57.1% of the total households live in ger areas and 42.9% in apartments (Figure 3) www.sica.mn, www.e-survey.mn

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SURVEY REPORT Figure 3: Surveyed households’ number, by residency 26.5% of the ger area residents which was 57.1% of the surveyed households live in their own ger and 27.7% in their own house and the remaining 2.9% in rented ger or house. 39.7% of the apartment households which was 42.9% of the total households live in their own apartment and the remaining 3.2% in rented apartment. Family members’ number of the ger area residents (58.5% of the survey participants) was more than those who live in apartments (41.5%) Figure 4: Surveyed households’ number, by family member’s number

26.8% of the total surveyed households had 3 family members and 25.8% 4 members. As see, 67.9% of the total households had 3-5 family members; the members of the household and number of the child per a household were small. Figure 5: Respondents’ number, by sex With the regards to the responses to determine the family members dependent, 1 099 children, 1 209 heads of household and 372 other members of the family participated in the survey. One of the basic information to study undergo to common and intermediate risk factors of the NCD was a family structure and as mentioned above, 45% of the www.sica.mn, www.e-survey.mn

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SURVEY REPORT  family members were children, 41% were parents or heads of the households and the remaining 14% is other family members. Figure 6: Respondents’ number, by age The surveyed participants’ age was comparatively young and rate in the total was decreasing as ages. As a result of our survey, 12% were people aged 20-24 which was the maximum and 11% were people aged 25-29. Population priamid, it is able to see that birth was comparatively low from mid of 1990 to mid of 2000 (number of population 5-19) but recent years birth have been increasing (number of children 0-4).

Figure 7: Marital status of the surveyed people 58.8% of the respondents who are above 18 (73.6% of the total respondents) responded as married, 25.5% unmarried and 10.0% widowed. As compares the marital status with predisposition to the risk exercise of the NCD, there was no significant difference.

Figure 8: Education level of the surveyed people

We assumed that people educated highly have much less probability to be affected by the NCD risk exercise and those people have information about methods and opportunities to prevent from risk exercise since they obtain information easily /main part of the report/.

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SURVEY REPORT Living standard level indicators For the surveyed people and households, an essential indicator which may represent the living standard was an employment status and total income of individuals and households. Figure 9: Employment status According to the international labor organization definition, surveyed people aged 15 and above were asked a question about their employment: Were you employed last week? 37.0% responded that they were employed somehow last week. Among them, 76.3% had paid jobs and 21.9% were self-employed. The respondents, who weren’t employed last week, responded as employed since they are employed in general or weren’t employed only during the survey due to various reasons. Unemployed reasons (63%) for the last week were clarified as follows. Figure 10: Unemployed reasons

For unemployed people, 52.4% responded studying in schools or being retired.

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SURVEY REPORT Figure 11: Last month income of people 49.7% of the surveyed people responded not earning income from any employment and their monthly income resource was government assistance program of 21 000 tugrug. 91.0% of the income earners (50.3%) earn up to 550 thousand tugrug. The household monthly average income was 632.34 tugrug. The survey participants’ family monthly income consists of salary (44.7%), pension (15.0%), family business (18.5%) and other income resources (the remaining 8.2%). Common factor of NCD When assessing common factor leading to NCD, used indicators such as physical activity, vegetable and fruit consumption, alcohol consumption, smoking and mental stress. Mental stress

Question like where are you mentally stressed most? was asked from the total survey participants. 71.8% responded not being affected by mental stress. However, 28.2% answered having some extent of mental stress. Figure 12: Predisposition to mental stress 74.0% of the mentally stressed people responded stressing on the street, 12.8% at the workplace, 11.0% at home and 1.2% at friends’ circle. The mental stress affects person’s attention and care and furthermore increases the risk to be injured. In addition, it becomes a base of some illness.

Physical activity

2 main questions: “How is your physical activity?” and “How much do you do physical activity?” were used for assessing physical activity. www.sica.mn, www.e-survey.mn

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SURVEY REPORT Â Figure 13: Physical activity This question was a form how people consider their physical activity and majority or 61.5% of the survey population responded engaging in activity requires less physical power and 15.3% engaged in activity requires more physical power. Majority of the respondents considered themselves as engaged in low levels of physical activity. It was related to the following indicators: sit-in jobs, frequent use of private and public transportation due to cold season and survey covering only Ulaanbaatar. With the intention to assess the physical activity, question regarding frequency of the physical activity was asked.

Figure 14: Frequency of excises 37.7% of the survey participants reported having some extent of exercising including 28% engaged in excising, 30% in activities such as excise daily, walking and running and the remaining 42.2% engaged in activity such as running, walking and playing at least once per week. As see above, one in every 3 people takes care of their health problem well and engages in high level of physical activity. Vegetable consumption

It was intended to estimate a vegetable consumption using 2 indicators: frequency of weekly vegetable consumption and number of servings. 18.8% of the survey population responded not consuming any vegetables per week and 81.2% consume at least one day of the week (Figure 15).

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SURVEY REPORT Figure 15: Daily frequency of vegetable consumption Those who consume vegetables every day of a week were 60% and this was 47.2% of the total participants. In terms of a number of servings of vegetables consumed weekly, 30% had 3-5 servings in average and 3.5% had only 1 serving per week. For those who consume at least 1 serving of vegetables per week, number of days of vegetable consumption per week was 5.6. With regards to sex, there is no difference in mean number of days of vegetable consumption (for females, number of days was 5.6 and for males, 5.5). With regards to residency, ger area residents consumed vegetables 5.5 days and apartment residents – 5.7 days a week. With regards to income level, this indicator was interpreted differently and shown in the following table. Table 3: Vegetable consumption, by income Үзүүлэлт Percentage of without vegetable consumption households Average day using vegetable

Income 550.001750.000

Up to 150.000

150.001350.000

350.001550.000

750.001- 1.000.001Above 1.000.000 2.000.000 2.000.001

20.4%

15.7%

19.8%

11.5%

6.7%

17.4%

0.0%

5.5

5.6

5.7

5.8

6.2

4.6

4.7

As income resource increases, number of households without vegetable consumption decreases. However, average daily vegetable consumption tends to increase. Another indicator assessing vegetables consumption was servings of the consumption.

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SURVEY REPORT Figure 16: Servings of vegetable consumption and consumer’s number 16 groups of vegetables other than potatoes were included for selection. 66.7% consume up to 5 servings of vegetables per week and it was 33.2% of the total servings. However, number of person consumes 5-10 servings per week was 23.6% and it was 34.5% of the servings. For a person, vegetable consumption was 4.80 servings per week, males had 4.75 servings and females had 4.84. Ger area residents’ servings were less than apartment residents by 0.1 points.

Figure 17: Servings of vegetable consumption, by income resource As income resource increases, servings of vegetable consumption increases as well and population group with 1-2 million income per month had 5.7 servings, which was higher than general mean by 0.9 servings.

Fruit consumption

Just like vegetable consumption, fruit consumption was estimated using 2 indicators: frequency of fruit consumption per week and servings of the consumption. 48.2% of the survey population responded not consuming any fruits per week and 51.8% consume at least one day of the week (Figure 18).

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SURVEY REPORT Figure 18: Frequency of fruit consumption per day In terms of frequency of fruits consumption per week, 11.0% consumed fruits every day of the week and it is 6.0% of the total survey population. It demonstrates that fruits consumption is not being enough. 70% of the respondents reported consuming fruits 1-3 days per week and 18.6% consumes only once a week. For the participants consume at least once per week, days of fruits consumption was 3.1 per week. For females, daily fruit consumption was 2.96 and for males, 3.17. Comparing to vegetable consumption, fruits consumption was comparatibilty less which shows one of in every 2 Ulaanbaatar residents did not consume any fruits at all per week. With regards to residency, ger area residents consumed fruits 3.05 days and apartment residents – 3.06 days a week. For income level, the following table shows that this indicator also was interpreted differently.

Table 4: Number of days of consuming fruits, by income resource Үзүүлэлт Percentage of without fruit consumption households Average day using fruits

Орлогын бүлэг 350.001550.001750.001550.000 750.000 1.000.000

Up to 150.000

150.001350.000

50.4%

51.0%

35.0%

49.2%

1.4

1.4

2.3

1.6

1.000.0012.000.000

Above 2.000.001

53.3%

21.7%

28.6%

2.1

3.2

1.6

Compared to vegetables consumption, rate of non-fruit consumers was quite high and daily fruit consumption was much less. Although one of the factors to reduce a risk to NCD was to have high level of vegetables and fruits consumption, vegetables and fruits consumption have been much less for the households. Fruits consumption (same as vegetables consumption) was assessed by asking for number of servings used in (Figure 19).

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SURVEY REPORT Â Figure 19: Number of servings of fruit and number of person Popular 21 groups of fruits were included for selection. Number of households consume up to 5 servings of fruits per week was 76.0% which was 38.7% of the total consumption. For people consume 5-10 servings of fruits per week, the number was 17.1% which was 27.6% of the consumption. Average fruit consumption per a person was 4.2 servings per week, or 4.5 servings for males and 4.0 servings for females. For ger area residents, servings of fruits per week were less (by 0.1 servings) than in apartment residents.

Figure 20: Number of servings of fruits, by income resource

As income resources increase, number of fruit servings increases as well. For family earn 1-2 million tugrug per month, they had the highest level of consumption or 4.6 servings and this was higher than general mean by 0.4 servings.

Alcohol consumption

Questions according to alcohol consumption were used as follows: Do you drink any alcoholic beverages in general? How is frequency of your alcohol consumption? Vodka, beer, wine, home brewed alcohol and mare’s milk are considered as an alcoholic beverages. www.sica.mn, www.e-survey.mn

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SURVEY REPORT  Figure 21: Alcohol consumption status In overall, the survey population responded concluding their alcohol consumption whether it was high or low level. 25.6% of people aged 15 and above reported consuming alcohol and 74.0% said “No�. 0.4% was those who used to drink. For the respondents reported consuming alcoholic beverages to some extent, 67.9% were males and 32.1% were females and there was age difference between them (Figure 22).

Figure 22: Drinkers, by age

Among alcohol users, 30.3% were 25-35 in ages and 75% were 2555 in ages. In terms of frequency of alcohol use, consumers (25.6%) and non-consumers (0.4%) who used to drink were asked about.

Figure 23: Drinkers, by frequency In terms of the frequency of alcohol use, 70.9% responded drinking less than twice per month and 22.8% drank 3-4 times per month. However, the alcohol consumption was more frequent as 5.3% responded drinking 1-6 times a week and 6.2% daily. 20.8% of the ger area residents and 17.9% of the apartment residents responded drinking alcoholic beverages to some

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SURVEY REPORT Â extent. Table 5: Alcohol consumption, by income Income

Percentage of drinkers

Up to 150.000 150.001-350.000 350.001-550.000 550.001-750.000 750.001-1.000.000 1.000.001-2.000.000 Above 2.000.001 Total

34.4% 36.1% 22.0% 3.1% 3.1% 0.6% 0.8% 100.0%

Percentage of former drinkers 25.0% 37.5% 25.0% 12.5% 0.0% 0.0% 0.0% 100.0%

Percentage of the drinkers in number of population in income range 11.3% 29.7% 36.1% 26.2% 39.0% 13.0% 57.1% -

7 respondents with income of above 2 million tugrug participated in the survey. Since 4 out of 7 replied consuming alcohol beverages, their rate in total was 0.8%. However, it demonstrates that it was 57.1% in total rate of the group. Tobacco use

3 questions were used for tobacco use. Do you smoke? How long have you been smoking? Or how long have you smoked? and how many tobaccos do you smoke per day?

Figure 24: Smoking status In order to know whether they smoke or not, neither any laboratory analysis nor any equipment was used. Only asked about how people consider themselves. 16.4% of people aged 15 and above reported smoking and 80.3% replied “No�. Rate for former smoker who quit was 3.3% in total rate. Exposure to second hand smoke at home and work reported by 18.6%. In regard to exposure to second hand smoke, 35.5% of children aged up to 15 and 64.6% of females were exposed. Although there is a need to control smoking somehow, this issue can be related to human rights. Therefore, bringing consumption culture to highest level is essential.

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SURVEY REPORT In terms of smokers’ sex, 13.9% were females and 86.1% were males.13.9% of females used to smoke and 86.1% of males were the same. 37.0% of the smokers live in apartments and 63.0% in ger areas. 16.3% of the apartment residents and 13.4% of the ger area residents responded smoking. Table 6: Smokers, by income level Income

Percentage of smokers

Up to 150.000 150.001-350.000 350.001-550.000 550.001-750.000 750.001-1.000.000 1.000.001-2.000.000 2.000.001 дээш Total

31.6% 38.5% 20.6% 4.8% 3.0% 1.2% 0.3% 100.0%

Percentage of former smokers

Percentage of the smokers in number of population in income range

30.9% 42.6% 17.6% 2.9% 2.9% 2.9% 0.0% 100.0%

6.7% 20.5% 19.8% 26.2% 33.3% 17.4% 14.3% -

When distinguishinged smokers by their income level, majority of the smokers were people with low level of income. Those, who smoke the most, had income level of 750 thousand to a million and the lowest level of income was 150 thousand tugrug per month. We concluded that smoking is not relevant to the person’s income level. Figure 25: Duration of smoking 21.6% of the respondents who reported smoking have been smoking for maximum or 5-10 years and 56.6% or more than half have been smoking for up to 15 years. 49.0% of males and 39.3% of females reported smoking more than 10 years and 51.0% of males and 60.7% of females smoking up to 10 years. Analysis of above smoking revealed that females increased number of smokers and this number had intensified in last 5 years.

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SURVEY REPORT Figure 26: Smokers’ number, by number of cigarettes Out of the smokers, 26.1% smoke 1-5 cigarettes, 45.9% 6-10 cigarettes, and 28% smoke more than half or 10 or more cigarettes per day. 2.2% of the smokers smoke more than one pack per day which meant they smoke one cigarette in every 30 minutes when they are awake. 30% of males and 16.1% of females smoke more than 10 cigarettes daily. 37.5% of females and 24.2% of males smoke up to 5 cigarettes daily and there was no difference in 5-10 cigarettes smoked daily between genders (males 45.8% and females 46.4%) As number of cigarettes smoked daily increases, a number of female decreases according to it. In addition, one in every 5 of the surveyed participants aged 15 and above reported smoking to some extent and one in every 5 of the smokers smoked a pack of cigarettes per day (19.6% smoke 15< cigarettes ≤20) Intermediate factors of NCD Overweight and obesity, blood pressure and blood glucose were considered in determining of intermediate factors leading to NCD. Overweight and obesity

With the intention to estimate overweight and obesity, we did not perform any measurement. Instead the survey participants were asked about their height and body weight. Mean weight of the population aged 15 and above covered by the survey was 65.8 kg and height was 165.3 cm. Mean weight of males is 70.9 kg and weight was 170.1 cm and females’ mean weight was 61.6 kg and height was 161.2 cm. Since the survey only covered Ulaanbaatar, there was a possibility to differ the body weight and height as apartment and ger area residents not urban and rural. Mean weight of the ger area residents aged 15 and above was 65.3 kg and height was 164.8 cm. However, for apartment residents, 66.5 kg were their mean weight and 166.0 cm were their mean height.

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SURVEY REPORT Mean weight and height of the apartment residents aged 15 and above were higher than the ger area residents by 1.22 cm and 1.28 kg. Calculated BMI as follows: (1) Mean BMI is 24.09 kg/m2 for population aged 15 and above, for men, 24.48kg/m2 and for women 23.69kg/m2. Men’s mean BMI was higher than women by 0.79. Definition of the body weight risk assessment: -

BMI < 18.4 - underweight BMI 18.5 – 24.9 - normal BMI 25.0 – 29.9 - overweight BMI > 30.0 - obese.

Note: This assessment was taken from the survey “Prevalence of NCD and Inquiry Risk Factors-2009”. According to the survey, BMI for Ulaanbaatar city population and male and female considered as normal. However, was classified as high level. Figure 27: BMI, by risk

8.2% of the respondents were fat, 22.3% overweighed, 54.5% normal and 15.0% underweighted. With regards to BMI of ger area and apartment residents, there was no significant difference (23.33 and 23.26) in residency and was classified into normal category as a risk group.

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SURVEY REPORT Â Figure 28: BMI, by age and risk group

In terms of age group, rate for overweight prevalence was a higher among middle aged or aged 30-50 people and underweight prevalence was higher among 15-25. The surveyed participants who aged above 30 had overweight. This falls into normal and overweighed category for BMI and they are almost same. High blood pressure

Defined it using questionnaire not measurement method. 2 questions regarding blood pressure were used: Is your blood pressure normal? and if you have high blood pressure, what treatment do you use? 82.4% of the total survey population reported not having any changes to their blood pressure and 17.6% had abnormal blood pressure. With a regard of age group, 22.3% of the population aged 15 and above had abnormal blood pressure. Figure 29: Treatment of hypertension Of those with hypertension, 50% reported being on medication sometimes and 36.7% on medication constantly when had high blood pressure. 2.3% of the participants reported controlling their hypertension with healthy food and excises since constant drug use has second hand negative impacts.

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SURVEY REPORT Â Out of those with hypertension, 61.5% were females and 38.5% were males and this rate was increasing as ages. Among those, 51.5% lived in ger areas and 41.5% in apartments. 7.2% of the population aged 15-40 had high blood pressure and in population aged above 40, it was 45.4%. Prevalence of diabetes

Same questions used for high blood pressure, were used for determining diabetes prevalence: Do you know your blood sugar amount? How do you know your blood sugar amount? 94.1% of the survey participants reported not knowing their blood sugar amount and 5.9% reported knowing it. In terms of age group, 7.5% of the population aged 15 and above responded knowing their blood sugar amount. Figure 30: Ways to know blood sugar amount 76.6% of the respondents, who reported knowing their blood sugar amount, replied that they were told by a doctor or other health worker, 17.7% by their own measuring instrument and 5.7% by other signs affecting their body. 43.7% of the people, who have information regarding their blood sugar, were males and 56.3% were females. Out of them, 54.5% live in apartments and 45.9% in ger areas. Although apartment residents were less covered by the survey, the above data demonstrates that they had sufficient information about it. Other factors relevant to traffic accident and NCD Traffic accident

With the purpose of clarifying information related to traffic accidents, 2 questions were asked as follows: Have you been involved in traffic injury in last 12 months? and Do you use a seatbelt every time when you drive? 1.4% of the survey participants reported being involved in traffic injury in last 12 months somehow. By sex, 55.3% of the people who involved in the traffic injury were male and 44.7% female. 1.6% of the apartment residents were involved in the traffic injury and 1.3% of the ger area residents.

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SURVEY REPORT Â Figure 31: Traffic injury 52.2% of the injured people were involved in injuries while riding in a car, 34.2% driving and 13.2% walking or riding a bicycle. 83.9% of the surveyed drivers use seatbelts regularly and 16.1% sometimes. With regards to the passengers, 25.4% uses seatbelts regularly and 74.6% uses sometimes. The study demonstrates that there is a misunderstanding among people stating seatbelts use is only the driverâ&#x20AC;&#x2122;s responsibility and it leads to risk of passengers instead of drivers caused by traffic injury. The surveyed male drivers of 87.4% and female drivers of 76.9% use seatbelts regularly and 23.6% of the male and 26.6% of the female passengers use seatbelts. Early detection coverage

One of the main factors to prevent from NCD and not to worsen any circumstances risk was to be covered by early detection regularly. Figure 32: Coverage frequency of early detection 80.8% of the study participants reported covered by early detection only when required or sick instead of being covered by early detection regularly. With respect to certain period of frequency of coverage by early detection, 41.5% of the respondents were covered by in annual, 48.1% were in less than year and 10.3% responded being covered in 2 or more years. 51.7% of females and 48.3% of males covered by early detection in certain frequency. In terms of residency, 18.9% of ger area and 19.6% of apartment residents covered by.

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SURVEY REPORT Regarding the above, females and apartment residents take care of their health very well and covered by early detection in certain frequency. In addition, as income and age group increases, coverage by early detection increased as well. Information on NCD

As mentioned before, people’s information and approach to NCD reduce a risk when illness occurs and assessed the people’s information on NCD and mostly used communication channels. This aimed to assess information access and effiency of communication channels. 68.3% of the survey population had some kind of information on NCD and 31.7% had no information on this. Figure 33: Communication channels

Most efficient communication channels for obtaining information on NCD were radio and television. 81.8% of the respondents confirmed it by choosing. Since 7.0% of the total survey population obtains information from a doctor or health service worker and 5.0% from newspapers and magazines, those were ranked as second and third efficient communication channels.

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SURVEY REPORT DISCUSSION 

Хүн ам, орон сууцны 2010 оны тооллогоор манай улсын өрхийн ам бүлийн дундаж тоо 3.6 (2000 оны тооллогоор өрхийн ам бүлийн дундаж тоо 4.3 байсан), харин Улаанбаатар хотын өрхийн ам бүлийн дундаж тоо 3.7 гарчээ.

Хүн ам, орон сууцны 2010 оны тооллогоор Улаанбаатар хотын нийт 302.2 мянган өрх тоологдсоны 61.1 хувь нь гэр хороололд, 38.9 хувь нь байшин хороолол буюу орон сууцны хороололд амьдарч байгаа үзүүлэлт гарчээ.

Findings of Population and Housing Census of 2010 demonstrate that gender proportion of Mongolian population is 98.1%. / 49.5% of total population is male, 50.5% is female. /.

This had the same structure as Mongolian population’s age and sex pyramid of 2010. As see from age and sex structure, rate of the population aged 10-15 was high in the total population in 2000. However, 10 years later or in 2010, rate of the population aged 2024 was the highest among the population.

Findings of Population and Housing Census of 2010 demonstrate that 7.5% of the population aged 10 and above were not educated at state level of Mongolia. For our survey, this rate was 0.8% because our survey only covered Ulaanbaatar.

For Population and Housing Census of 2010, this question was asked by population aged 15 and above and 1.9 million people answered to this question. 47.8% or 911.7 thousand people answered that who was employed somehow last week.

According to official statistics, average monthly monetary income of a household of Mongolia is 387 thousand tugrug as of 2010.

For our survey, household income was a little bit less than official statistics data because monthly government assistant program allowance was not included and only one question was asked about income (there are many other questions to assess household income)

Although neither terrorist nor fear on streets in Mongolia is comparably low, this high percentage can be explained referring to air pollution and road traffic.

Recent years because of stress in the street, number of accident have been increasing. If we solve some problems of stress such as air pollution and road traffic it is able to decrease road accident.

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SURVEY REPORT 

Those reported having monthly household income of more than 2 million tugrug, were less covered by the survey and it directly connected to mean number of days of vegetables consumption is 3.2 days in income high level.

Those reported having monthly household income of more than 2 million tugrug, less participated in the survey and caused variation. This directly relates to having mean number of days of fruits consumption is 2.2 days in income high level.

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SURVEY REPORT CONCLUSION 

Main goal of the survey is to assess how person’s living standard indicators affecting risk exercise leading to NCD and their correlation.

The survey was conducted using 2 phased, proportional probability and randomly sampling method on total of 751 selected households of 9 districts of Ulaanbaatar.

According to the study, mean number of family members was consistent to the State mean number. However, it was differed by one point from Ulaanbaatar mean number. This demonstrates the quality of survey.

The total percentage of the rural households is lower than 14.2 percentage point from total percentage of apartment households in case of households included in the survey.

The surveyed population age structure was comparably young and rate in total was decreased as ages. As shown in age pyramid, birth rate was comparably less in 1990 2000 and increased in 2006 or after. 58.8% of the respondents who are above 18 (73.6% of the total respondents) responded as married, 25.5% unmarried and 10.0% widowed.

37.0% responded that they were employed somehow last week. Among them, 76.3% had paid jobs and 21.9% were self-employed.

28.2% of total respondents answered that who affects mental stress somehow and 74.0% of them responded stressing on the street.

Majority or 61.5% of the survey population responded engaging in activity requires less physical power.

37.7% of the survey participants reported having some extent of exercising including 28% engaged in excising, 30% in activities such as excise daily, walking and running and the remaining 42.2% engaged in activity such as running, walking and playing at least once per week.

As income resource increases, number of households without vegetable consumption decreases. However, average daily vegetable consumption tends to increase.

For a person, vegetable consumption was 4.80 servings per week, males had 4.75 servings and females had 4.84. Ger area residents’ servings were less than apartment residents by 0.1 points.

As income resources increase, number of fruit servings increases as well.

Average fruit consumption per a person was 4.2 servings per week, or 4.5 servings for males and 4.0 servings for females. For ger area residents, servings of fruits per week were less (by 0.1 servings) than in apartment residents.

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SURVEY REPORT 

The survey population responded concluding their alcohol consumption whether it was high or low level. 25.6% of people aged 15 and above reported consuming alcohol. For the respondents reported consuming alcoholic beverages to some extent, 67.9% were males and 32.1% were females and there was age difference between them.

70.9% responded drinking less than twice per month and 22.8% drank 3-4 times per month. However, the alcohol consumption was more frequent as 5.3% responded drinking 1-6 times a week and 6.2% daily.

20.8% of the ger area residents and 17.9% of the apartment residents responded drinking alcoholic beverages to some extent.

16.4% of people aged 15 and above reported smoking. In terms of smokers’ sex, 13.9% were females and 86.1% were males..

37.0% of the smokers live in apartments and 63.0% in ger areas. 16.3% of the apartment residents and 13.4% of the ger area residents responded smoking.

Smoking is not relevant to the person’s income level.

21.6% of the respondents who reported smoking have been smoking for maximum or 510 years and 56.6% or more than half have been smoking for up to 15 years.

Out of the smokers, 26.1% smoke 1-5 cigarettes, 45.9% 6-10 cigarettes, and 28% smoke more than half or 10 or more cigarettes per day.

2.2% of the smokers smoke more than one pack per day which meant they smoke one cigarette in every 30 minutes when they are awake.

30% of males and 16.1% of females smoke more than 10 cigarettes daily. 37.5% of females and 24.2% of males smoke up to 5 cigarettes daily and there was no difference in 5-10 cigarettes smoked daily between genders (males 45.8% and females 46.4%)

As number of cigarettes smoked daily increases, a number of female decreases according to it. In addition, one in every 5 of the surveyed participants aged 15 and above reported smoking to some extent and one in every 5 of the smokers smoked a pack of cigarettes per day (19.6% smoke 15< cigarettes ≤20)

Mean weight of the population aged 15 and above covered by the survey was 65.8 kg and height was 165.3 cm. Mean weight of males is 70.9 kg and weight was 170.1 cm and females’ mean weight was 61.6 kg and height was 161.2 cm.

Mean weight of the ger area residents aged 15 and above was 65.3 kg and height was 164.8 cm. However, for apartment residents, 66.5 kg were their mean weight and 166.0 cm were their mean height.

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SURVEY REPORT 

8.2% of the respondents were fat, 22.3% overweighed, 54.5% normal and 15.0% underweighted.

17.6% of the total survey population reported had abnormal blood pressure. Out of those with hypertension, 61.5% were females and 38.5% were males and this rate was increasing as ages.

Of those with hypertension, 50% reported being on medication sometimes and 36.7% on medication constantly when had high blood pressure.

94.1% of the survey participants reported not knowing their blood sugar amount and 5.9% reported knowing it.

76.6% of the respondents, who reported knowing their blood sugar amount, replied that they were told by a doctor or other health worker, 17.7% by their own measuring instrument and 5.7% by other signs affecting their body.

43.7% of the people, who have information regarding their blood sugar, were males and 56.3% were females. Out of them, 54.5% live in apartments and 45.9% in ger areas.

1.4% of the survey participants reported being involved in traffic injury in last 12 months somehow. By sex, 55.3% of the people who involved in the traffic injury were male and 44.7% female. 1.6% of the apartment residents were involved in the traffic injury and 1.3% of the ger area residents.

52.2% of the injured people were involved in injuries while riding in a car, 34.2% driving and 13.2% walking or riding a bicycle.

80.8% of the study participants reported covered by early detection only when required or sick instead of being covered by early detection regularly.

With respect to certain period of frequency of coverage by early detection, 41.5% of the respondents were covered by in annual, 48.1% were in less than year and 10.3% responded being covered in 2 or more years.

51.7% of females and 48.3% of males covered by early detection in certain frequency. In terms of residency, 18.9% of ger area and 19.6% of apartment residents covered by.

68.3% of the survey population had some kind of information on NCD and 31.7% had no information on this.

Most efficient communication channels for obtaining information on NCD were radio and television. 81.8% of the respondents confirmed it by choosing.

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SURVEY REPORT RECOMMENDATION The followings are being recommended basing on the survey results, discussion and conclusion: 

Out of the surveyed participants, 49.7% reported that government support program of 21 000 tugrug was their income resource. Although allowance provides necessary needs to some extent, it can reduce motivation to seek employment and be employed. Therefore, there is no need to make it common.

In last year, increased percentage of people involved in traffic injury might be correlated to mental stress of people on the streets. By settling factors such as road traffic and air pollution, which cause mental stress, number of traffic injury can be reduced.

With regards to the physical inactivity, it was relevant to sit-in jobs and frequent use of public and private transportation due to cold season and Ulaanbaatar population has low level of physical activity.

Although number of households consume vegetables and fruits was comparably high and their average consumption day number and servings were not sufficient. Therefore, it is required to provide information on vegetables and fruits consumption significance.

In terms of people consume alcohol to some extent, young people were the majority. This is one of sensitive problems and it is required to organize anti-alcohol campaign among young generation.

Frequency of alcohol consumption was closer or 1-6 times per week (5.3%) and for daily drinkers (0.9%), its rate in total was comparably low or 6.2%. Although this rate was less, having this kind of people is one of the dramatic problems.

In last 20 years, smoking has been comparatibility increased and there is a need to find out its cause and to control tobacco use and trade.

In regard to the middle aged people, the prevalence of overweight was high among them. Taking it into consideration, it is required to increase physical activity and to promote healthy eating.

In terms of treatment of hypertension, about 50% reported taking drugs sometimes and 36.7% take drugs regularly. Since taking drugs regularly might have a second hand impact, there is a need to introduce practices of people belong to 2.3%.

Although apartment residents were comparatibility less participated in the study, the above data demonstrates that they had much more information on this. Otherwise, ger area residents were required to know about their blood sugar (had early signs or required to see a doctor) more than apartment residents.

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SURVEY REPORT 

According to the results of the survey, there is a misunderstanding stating using seatbelts is only drivers’ responsibility (74.6% of drivers use seatbelts sometimes) and it leads to the risk having passengers involved in traffic injury more than drivers. Making use seatbelts regularly is not traffic officer’s sole responsibility and there is a need to involve media with the intention of making people to realize.

The surveyed females and apartment residents take care of their health very well and covered by early detection in certain frequency. In addition, as income increases and ages, early detection coverage of people increases as well.

The most efficient communication channels for obtaining information on NCD was radio and television, which was confirmed by 81.8% of the study participants. Out of the total survey respondents, 7.0% obtain information from a doctor or health service worker and 5.0% from newspapers and magazines. Those sources were ranked as second and third efficient communication channels for NCD. In order to deliver information on NCD more efficiently, it is required to involve radio and television.

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