In Mongolia, Back to School, Back to Sickness?

ERDENET, ORKHON PROVINCE, MONGOLIA — It is 5 p.m. and Nanjidmaa Sandui is bathing her grandchildren, ages 3 and 6, and applying a cream on the small red rashes on their bodies. They are both sick with hand, foot and mouth disease.

“If I bathe them well and put the cream on frequently, they will recover soon. Otherwise, it will get harder and that would be trouble,” she says as she helps them get dressed.

With the end of the coronavirus’s hygiene restrictions and recommendations, cases of dysentery, as well as hand, foot and mouth disease, are increasing sharply in many countries around the world — especially among children.

Both diseases are viral infections that spread through bodily secretions. Hand, foot and mouth disease causes rashes, sores and fever, but tends to be self-limiting and rarely leads to complications. Dysentery, on the other hand, causes severe diarrhea and dehydration, and can be fatal if not treated.

While the prevalence of these common infections declined between 2019 and 2021 in Mongolia, health authorities have registered 68% more cases of dysentery in 2022 compared with the previous year; meanwhile, cases of hand, foot and mouth disease exploded by more than tenfold in the same period, according to government data.

Khorloo Khukhnokhoi, GPJ Mongolia

Nanjidmaa Sandui regularly bathes and applies a prescription cream on the rashes of her two grandsons, who are both sick with hand, foot and mouth disease.

“Hospital workload is increasing,” says Erdenetuya Gankhuu, a nurse at the National Center for Communicable Diseases. “Since we do not have enough beds, we return most children by giving [parents] instructions on treatment at home.”

Experts agree that both diseases can be effectively prevented by regular handwashing. “It is sad that people do not follow these recommendations as a regular habit in their life and forget about it,” says Suvdmaa Nyam, a doctor and head of the Early Warning and Response Unit of the National Center for Communicable Diseases.

For Bilguunee Bayanaa, a specialist in charge of surveillance and prevention of communicable diseases at the Orkhon province health department, current government campaigns for prevention of communicable diseases aren’t as intense as those of the coronavirus era. “It is not as effective,” he says.

During the pandemic, the government sent daily text messages to people’s mobile phones to remind them to wear masks and to wash and disinfect their hands. It also regularly broadcasted hygiene recommendations on all television channels.

“During the coronavirus pandemic, I washed and disinfected the hands of my children a lot. But now it has been reduced. I have not even realized it myself,” says Tsetsegmaa Dambadorj, a mother of three. Her son, who is 4 years old, recently recovered from dysentery.

Khorloo Khukhnokhoi, GPJ Mongolia

Parents and children queue in the waiting room of Ankhnii Och family health center in Erdenet city, Orkhon province.

The increase in communicable diseases at times pits parents against kindergartens and schools.

U. Sarangerel, a kindergarten teacher, says that when children get sick at the kindergarten, management and parents blame the teachers. “It is hard to send children back when their parents bring them to kindergarten while they have not completely recovered from their illness.”

For Altantsatsrag Batsukh, a mother of four children who were recently treated for these infections, the problems lie with the schools. “When they are at home and wash their hands well, they don’t get sick,” she says.

“It is true that communicable diseases among children increase when they go to school and kindergarten,” Suvdmaa says. “But children getting sick has to do with poor nursing and care from their parents.”

When communicable diseases increase, the Ministry of Health advises disinfection and decontamination efforts at kindergartens and schools. When the infection is prevalent to a large extent, they may suspend the school’s operations.

For D. Michidmaa, a kindergarten nurse, the Ministry of Health’s current protocols aren’t enough. While Mongolian children are currently on their summer vacation, an epidemic of communicable diseases looms large over Mongolian schools, she says. “If they don’t take effective measures, this situation will be repeated in autumn when schools start.”