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PUBLIC HEALTH AND PUBLIC HEALTH SERVICES1320 Орел© V.I.Oryol, A.A.Tsiteladze, 2010 UDC 613.956:616-071.2:378 Orel V.I., Tsiteladze A.A. Problems of physical examination of teenagers entering military educational institutions of the general secondary education // Preventive and clinical medicine. – 2010. - № 1 (34). – Р.7-11. ¹State educational institution for high professional education «Saint-Petersburg State Pediatric Medical Academy by Federal agency for health services and social development»; 194100, Saint-Petersburg, Litovskaya str., 2; tel./fax: (8-812) 554-05-83; e-mail: spb@gpma.ru. ²State general secondary education school «Saint-Petersburg Military Suvorov School»; 194011, Saint-Petersburg, Sadovaya str., 26; tel./fax: 310-18-00, e-mail: spb-svu.nm.ru. Summary: The study conducted the analysis of the medical examination of adolescents to enroll in military schools, a comprehensive assessment of their health status. In reforming the military education system interagency integration is necessary in carrying out the basic stages of a medical examination of young people entering the military school in child health clinics of the Ministry of Health. Key words: military school of general secondary education (college); assessment of adolescent health status; medical examination; interdepartmental integration. References 1. Баранов А.А. Профилактические основы развития приоритетного национального проекта в сфере здравоохранения в интересах детей. / Баранов А.А., Кучма В.Р. // Здравоохранение Российской Федерации.– 2008. – №1. – С. 10-11. 2. Рапопорт И.К. Состояние здоровья школьников и проблемы выбора профессии. / Рапопорт И.К. // Гигиена и санитария. – 2009. – №2. – С. 36-38 3. Varni JW, et al. The Peds QL: Measurement Model for the Pediatric Quality of Life Inventory. Medical Care, 1999; 37(2):126-139 4. Куликов А.А. Оптимизация учебно-воспитательного процесса на основе мониторинга здоровья школьников. / Куликов А.А., Лебедев СБ., Шевченко В.Н. // Регион: Политика. Экономика. Социология. – 2000. – №4. С. 132-135. 5. Пажеский Его Императорского Величества корпус за сто лет: в 2 т. / авт.-сост. Д.М. Левшин. – СПб.; «Т-во Художественной печати», 1902. – с Т.1 – С. 204-216. 6. Постановление Правительства РФ от 25 февраля 2003 г. № 123 «Об утверждении Положения о военно-врачебной экспертизе». / Собрание законодательства РФ. – 2003. – №10. ст. 902. Information about the authors: Oryol V.I. Doctor of Medicine, Professor, Honoured Scientist of FR, head of State educational institution for high professional education «Saint-Petersburg State Pediatric Medical Academy by Federal agency for health services and social development»; 194100, Saint-Petersburg, Litovskaya str. 2; work tel. (812) 554-05-83, mobile phone 8-921-949-41-47; e-mail: spb@gpma.ru. Tsiteladze A.A. Chief Physician of Saint-Petersburg Military Suvorov School; work tel. (812) 310-18-00, mobile phone 8-921-791-20-66; e-mail: tsitalex@mail.ru. Accepted 14.10.2009 г. 1242 Сайед UDC 614.1: 312.2: 616-053.3 (471.331) © К. Sayed, A.G. Ivanov, 2010 The Analysis of Infant Mortality and Factors Lowering its Rate while Implementing Strategic Programs in Tver Region K. Sayed, A.G. Ivanov State Educational Institution of the Higher Professional Education “Tver State Medical Academy of the Federal Agency for Public Health and Social Development” Tver, Russia Sayed K., Ivanov A.G. Analysis of infantile death rate and factors influencing // Preventive and clinical medicine. – 2010. - № 1 (34). – Р.11-14. State Educational Institution of the Higher Professional Education «Tver State Medical Academy of the Federal Agency for Public Health and Social Development». Russia, 170100, Tver, Sovetskay str., 4. Tel. 8 (4822) 32-17-79, fax: 8 (4822) 34-43-09. E-mail: m000293@tversu.ru Summary: The research represents the analysis of infant mortality and factors determining its rate in Tver Region for the period of 1996-2007. It reveals a positive dynamics in the indexes of infant mortality for the last 11 years which is to large extent can be attributed to the implementation of the «Complex Program on Women and Child Care and Child Mortality Reduction» in Tver Region, carried out in 1989-2010. It also proves the effectiveness of developing and launching strategic programs on fighting both the rate and the definite causes of death among the population. Kеy words: infant mortality; manageable, partially manageable and unmanageable factors; strategic regional programs. Infant mortality belongs to the leading index of not only the effectiveness of the State Health Service but the national well-being on the whole. For several decades Tver Region has been among the regions with the highest infant mortality rates both in The Central Federal District and in Russian Federation on the whole. The aim of research was to substantiate the necessity of developing and implementing strategic programs to lower the rate of mortality among the population especially occurring due to definite causes. Material and Methods of Research: The research represents the analysis of statistic data provided by the Local Committee of Federal Statistic Data Service of Tver Region on infant mortality, perinatal mortality including early neonatal one and mortinatality. Multi-factor analysis applied determined quantitatively the importance and share of different factors influencing the rate of infant mortality. Results of the research and their discussion. The rates of infant mortality in Tver Region in 1997-2007 fluctuated between 19.3‰ in 1998 and 9.8‰ in 2007. Since 1999 the positive dynamics of this index might be observed – there has been a gradual decrease in infant mortality. On the whole the index fell down by 46.2% (from 18.2‰ in 1996 to 9.8‰ in 2007). But at the same time it continued exceeding the average rates of child mortality in Russia. By 2007 this difference has amounted 4.3% (9.4‰ throughout Russia and 25.6% throughout the Central Federal District (7.8‰). Similar trend could be observed in urban areas of the Region since 1999 but in the rural area this process started a bit later – in 2002. The comparison of mortality rates among urban and rural infants aged less than 1 year old displayed the exceeding of deaths the latter above the former (except in the years of 1998, 2000 and 2006 when the mortality among rural children was lower than among the urban ones.) At the same time infant mortality in urban settlements fluctuated between 8.3‰ in 2007 and 19.9‰ in 1998, as for the rural ones the figures were 10.2‰ in 2006 and 24.1‰ in 1996. Thus positive dynamics in the rates of infant mortality could be equally observed both in urban and in rural areas. The indexes of 1996 dropped (by 47.8% and 42.7% correspondingly) and the most rapid changes could be observed in rural settlements since 1996 to 2006. In the urban districts of Tver Region the rates of infant mortality in 2007 remained within the boundaries of 5.0‰ and 16.2‰. In comparison to 1996 the indexes decreased by 8.5% that is they became 3.6 times lower. Among the municipal districts the range of infant mortality indexes varied considerably between 2.8‰ and 43‰. At the same time the changes in indexes for the studied period proved diverse in different districts of the region: the increase in infant mortality was reported in 12 districts with the decrease in 14 ones; it remained practically the same in 4 districts and in 6 ones the cases of infant mortality were not registered at all. The biggest drop in the mortality rate of infants aged less than 1 year old was registered among girls (for them it became 2.1 times lower (1.5 lower for the boys)) in comparison to 1996. Thus the share of male infants in the structure of those who died in early child age has increased. So if in 1996 this share slightly exceeded the half of the total number of children who died under 1 year old (54.6%) in 2007 it amounted 62.1%. For the studied period the index of perinatal mortality in Tver Region exceeded the average rates throughout the country (with the exception of 2000) and in 2007 the difference made up 15.4% (10.4‰ against 8.8‰). In 2007 Tver Regin was placed the forth among the regions of the Central Federal District in perinatal mortality following Ryazanskaya (12.8‰), Kostromskaya (11.2‰) and Kaluzskaya (10.6‰) Region, exceeding by 1.3‰ the average rate of the Central Federal District. The coefficient of perinatal mortality in Tver Region was within the limits of 10.4‰ and 19.3‰ (in 2007 and 1998 correspondingly). For 11 years it has fallen by 42.8%. The dynamics of early neonatal mortality and mortinatality, determining the rate of perinatal mortality has remained unstable for the studied period but there has been some progress in it. By 2007 the rate of mortinatality became 3 times smaller and the index of early neonatal mortality dropped by 15.3%. The causes of death among children under 1 year old proved to be different in urban and rural areas. In the former ones perinatal death has been found out to be responsible for 53% of deaths among newborns, in the latter ones this is the cause of 33% of deaths. The second major cause of urban newborn deaths (24% of deaths) is congenital anomalies (22% for the rural newborns). At present the diseases of respiratory system are considered to be a leading cause of newborn deaths in the rural area (25%, while for the urban area it is 13%). For the last 11 years the coefficient of infant mortality that could happen due to definite causes has decreased; namely, the number of deaths due to the congenital anomalies became 2.4 times smaller, mortality due to some causes of perinatal death decreased by 31%, due to accidents, poisoning and traumas – by 40%, due to the diseases of respiratory tract – by 38%. The research has revealed the social character of factors contributing to the presence of a considerable level of infant mortality in cities as well as in the rural area. It was found out that these factors are eliminable and can be eliminated by the collaboration of medical workers and social organizations involved. It is known that a number of these factors fully depends on the level of health service provided for children aged less than 1 year old, pregnant women and women in labour. The problem of medical services available for women in labour is especially critical for the rural settlements of the region. The integrated evaluation of medical and social factors determining the frequency of deaths among infants under 1 year old has revealed the following factors being the most considerable: bad habits of a father, financial well-being of a family, mother’s social status, mother’s marital status, parents’ heredity, living conditions, mother’s bad habits and frequency of prenatal nursing. In the rural areas 8 leading factors of medico-social character determining the rate of infant mortality are as follows: father’s bad habits, mother’s social status, full-term of a newborn by the time of labour, financial well-being of a family, father’s educational background, complications in labor, frequency of prenatal nursing and mother’s marital status. Most of these factors are of social character and refer to the category of eliminable ones. There has also been studied the degree of influence of social, biological and medical factors on the infant mortality rate in the region on the whole, in the district centers and in the rural settlements of the region. As an instrument for measuring the influence of factors on the result a multy-factor analysis has been applied. It provided quantitative estimates of the influence of different factors on the result that is on the rate of infant mortality. On the whole 27 of the manageable factors determining the mortality rate of infants under 1 year old have been studied. They have been grouped into 3 main types: manageable, partially manageable and unmanageable ones. Moreover within each group factors of medical and not medical character have been distinguished. These groups of factors are rather conventional and still they help to determine those ones which are possible to manage in order to bring down the rate of infant mortality and those of them which depend mostly on the quality of medical service. Obviously, manageable factors determined are much of a practical value. The estimates have revealed that irrespective of the type of settlement these are manageable factors that play the major role in building the rate of infant mortality, with factors of medical character (that is depending on the level of health service) predominating. Among manageable factors of medical character the biggest ratio belongs to the complications in labour (7.1% in the rural area and 12.4% in the regional centre) as well as full-term of a newborn at birth (more than 5%). Manageable factors of not medical character also play an important role in building the rate of infant mortality. With their ratio of 22.2% in towns and up to 32.4% in the rural settlements of the region they are being more critical for the rate of infant mortality in the rural area. It must be pointed out that infant mortality depends on the way of life of parents-to-be especially that of a mother (it is responsible for 14.7% of deaths among infants in Tver and for 29.0% of deaths in the rural settlements). Thus cultivating a healthy way of life among parents (fighting with smoking, for instance) is at present primary and the most reasonable way to lower the rate of infant mortality in towns and especially in the rural settlements. Certainly that is the task that must be accomplished not only by medical workers but by every member of the society. Another priority in fighting infant mortality is the prevention of prematurity and complications in labor, as well as carrying out definite tasks on normal physical development of infants aged under 1 year old. The coordinating role in fulfilling these tasks undoubtedly belongs to medical workers. It must be pointed out that such factors as parents’ social status, their educational background, family income and living conditions determine the rate of infant mortality in towns as well as in the rural settlements but to very little extent. The multifactor dispersion analysis applied allowed to determine quantitatively the share of different factors in building the rate of infant mortality. Irrespective of the type of settlement manageable factors proved to have the biggest ration (more than 55%) with the factors of medical character predominating, especially in towns. As for the rural settlements the rate of infant mortality there has been found out to be to large extent determined by the manageable factors of not medical character, connected with parents’ way of life and living conditions. All the above mentioned things considered further steps towards lowering the rate of infant mortality in Tver Region are found to depend on the implementation of such medical and social tasks as:
At the same time positive dynamics of the infant mortality indexes that has been reported for the last 11 years in the region is to large extent due to the implementation of the “Complex Program on Women and Child Care and Child Mortality Reduction” in Tver Region carried out in 1989-2010. Among the key points reflected in 16 chapters of The Program the most important are:
The main part of The Program defines the importance of improving personal health at such stages as: improving the health of parents’-to-be (I); conception (II); pregnancy period (III); labour (IV); postnatal period (V). Considering close connection of the I and V stages one should speak about the closed constantly evolving cycle passing though generations. Conclusion. Thus the main features of the above mentioned program are its being: long-term, complex, permanent and scientific. Being long term enables it to determine to larger extent the character and indexes of obstetrics service. Being complex means its phase structure and multi sided approach to bringing up healthy children (starting with health of parents’-to-be and finishing with child health in postnatal period following the chain: a female child – a young woman – a woman – a pregnant woman – labour – a newborn). Being permanent means constant development of The Program, its improvement with respect to the changing conditions, infrastructure, financial base, staff efficiency and financing, that will enable timely determination of priorities and measures needed, that is this Program represents a complex integrated system, all the levels of which are in the dynamic balance. The implementation of this Program proves the necessity of development and launching strategic regional programs aimed at lowering mortality rate among the population, especially from definite causes. Information about the authors: Sayed Kamruzzaman – PhD in Medicine, assistant-professor of the Department of Public Health and Public Health Services of Tver State Medical Academy, work tel.: 8 (4822) 34-66-4, 32-07-60. E-mail: washim@mail.ru Ivanov Alexander Gennadievich – Doctor of Medical Sciences, Professor of the Department of Public Health and Public Health Services of Tver State Medical Academy, work tel.: 8 (4822) 34-57-14, 32-07-60. Accepted 12.11.2010 г. |
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