THE STUDY OF REGIONAL PECULIARITIES OF PARENTERAL VIRAL HEPATITIS INCIDENCE DYNAMICS AMONG CHILDREN AS AN INSTRUMENT OF DEVELOPING COMPLEX REGIONAL SOCIAL PROGRAMS ON THE PREVENTION OF ITS INCREASE
Badanie regionalnych odmienności dynamiki występowania parenteralnego wirusowego zapalenia wątroby u dzieci jako narzędzie służące rozwojowi kompleksowych regionalnych społecznych programów mających na celu zapobieganie wzrostowi tego typu zakażeń
Nataliia V. Medvedovska1, Valeriy I. Bugro2, Ivan I. Kasianenko3
1 SHUPYK NATIONAL MEDICAL ACADEMY OF POSTGRADUATE EDUCATION, KYIV, UKRAINE
2 SHUPYK NATIONAL MEDICAL ACADEMY OF POSTGRADUATE EDUCATION, KYIV, UKRAINE
3 PUBLIC INSTITUTION “UKRAINIAN INSTITUTE OF STRATEGIC RESEARCHES OF MINISTRY OF HEALTH IN UKRAINE”, KYIV, UKRAINE
Introduction: the problem of increase of viral hepatitis incidence which are transmitted in the haemocontact (parenteral) way remains unresolved in the majority countries of the world. The special relevance is acquired lately by a problem of increase of risk of transfer of an infection among children of teenage age, youth, in the main ways of transmission of infection among which there is a risky behavior, addictions (the injection use of narcotic substances) and the unprotected sexual relations due to the lack of informing and awareness of risk of a disease and irreversible losses of health in the future.
The aim: Studying of regional features of incidence of parenteral viral hepatitis among children and teenagers with justification of the priority directions of prevention of its increase in the context of implementation of regional comprehensive programs became a research objective.
Materials and methods: Data from official forms of the statistical reporting on cases of diseases of viral hepatitis (sharp and chronic) in forms No. 1, No. 2 “The report about separate infections and parasitic diseases” (annual) MZ of Ukraine became primary material for a research. For achievement of a goal methods have been used: system approach, medico-statistical, graphic and conceptual modeling, and organizational experiment.
Review: During a research of 2007-2016 it has been established that the majority of viral hepatitis’s in Ukraine (58,79 ± 0,44%) is diagnosed in a chronic stage of a disease, and especially in the Kirovohrad region (80,35 ± 2,14%). Increase of incidence of parenteral viral hepatitis’s B and C in the Kirovohrad region has happened in age group of children of 15-17 years to prevalence in structure of incidence of children of chronic viral hepatitis’s of hepatitis C (52,7 ± 5,8%) that demands search of the medico-organizational reasons of formation of the established incidence tendencies for a solution of the problem of their distribution due to early preventive intervention within complex program social influence.
Conclusions: Accounting of regional features of incidence of parenteral hepatitises became scientific justification for acceptance to execution of the comprehensive regional social program of prevention of their distribution among teenagers and youth of the Kirovohrad region.
Key words: integrated social approach, children’s population of teenage age, parenteral viral hepatitis’s
Wiad Lek 2019, 72, 1, 95-98
According to public data provided by the World Health Organisation (WHO) 3.5% of the world population (in the uncertainty interval 95%: 2.7-5.0%), or 257 million people (199-368 m) have chronic HBV-infection (with positive serology HBsAg for at least 6 months), and 686 thousand people die of HBV-infection every year. World Hepatitis Day has been annually held on July 28 since 2011 on the initiative of World Hepatitis Alliance (WHA) to commemorate the birthday of Nobel Laureate, professor Baruch Samuel Blumber, whose scientific research was dedicated to the fight with HBV-infection, and other parenteral/hemocontact types of viral hepatitis, that indicates the recognition of the global scope of this problem [1-5].
Studied by us dynamics of the viral hepatitis incidence rate among children and teenagers in Ukraine, as well as among the total population demonstrates yearly growing tendencies (from 25.8 in 2007 to 29.67 per 100 thousand of the total population in 2016 and from 11.87 in 2007 to 18.16 per 100 thousand in 2016).
The specific aspect of the spread of parenteral viral hepatitis is its hemocontact transfer mechanism, when the virus is present practically in all the fluids of the infected person (saliva, urine, blood, nasopharyngeal fluids, tears, sperm, cervicovaginal fluids and so on). Infection through the contact of the damaged epithelium of the healthy person with fluids contaminated with parenteral viral hepatitis is plausible, and it should be noted that this virus can be transmitted starting from the middle of the incubation period [6-8].
Parenteral viral hepatitis (especially hepatitis C, the course of which can be accompanied by jaundice at the ratio 1:4, and which can also develop chronic state (up to 80.0% of cases) sometimes can be asymptomatic at early stages. Epidemic spreading also takes place due to the fact that infected people simply are not aware that they have already become the source of infection. The spread of parenteral viral hepatitis among teenagers and youth becomes a pressing problem due to their risky behavior (for example, making tattoo, piercing with violation of aseptic rules), unprotected intercourse and bad habits (use of parenteral narcotics) [9, 10].
The aim of the study: to examine regional peculiarities of the incidence of parenteral viral hepatitis among children and teenagers with the following verification of its key methods of prevention in the context implementation of regional, complex programmes.
MATERIALS AND METHODS
Starting material for research became data from official forms of statistical accounting on viral hepatitis cases (acute and chronic), namely accountability forms # 1 and # 2 “The Report on Definite Infections and Parasitic Diseases” (annual), The Ministry of Health of Ukraine. To successfully reach the research aim the following methods were used: systemic approach, medico-statistical analyses, graphic and conceptual modeling, organizational experiment.
REVIEW AND DISCUSSION
The analysis of viral hepatitis incidence rate among children in Ukraine showed gradual increase of the index from 11.87 in 2011 to 18.16 in 2016, that is 1.53 times more as much (р<0,01). Regional peculiarities of high indicator values in 2016 (Zakarpatska Region (162.45), Zhytomyrska Region (62.15) – by comparison, the average indicator in Ukraine is 18.16 per 100 thousand of the total population) – were caused by high incidence rate of viral hepatitis A (in Zakarpatska Region (161.07), Zhytomyrska region (58.86), by comparison, the average indicator in Ukraine is15.18 per 100 thousand the corresponding population). Viral hepatitis B incidence rate was the highest among children of Vinnytska Region (5.12), Zhytomyrska Region (2.47) and Kirovogradska Region (2.35), by comparison, the average indicator in Ukraine is 1.13 per 100 thousand of the total population. Chronic viral hepatitis occurred in children more often in Vinnytska Region (4.09), Ivano-Frankivska Region (2.86), Khersonska Region (2.84), Poltavska Region (2.55), Zaporizka Region (1.71), Ternopilska Region (1.48), and Kirovogradska region (1.17), the average indicator in Ukraine is 0.97 per 100 thousand of the total population.
The increase in incidence rate is observed with the increase in age. Thus, the highest indicators of disease incidence rate are among early teens (10-14 years) and mid teens (15-17 years). As for acute viral hepatitis B and C, the highest incidence rate was in the age group from 15 to 17 years (3.69 and 0.51 per 100 thousand of the total population) (Fig.1. and 2.).
Chronic hepatitis incidence rate among children from birth up to 17 years was the highest among late teenagers from 15 to 17 years old with negligible fluctuations (1.72 per 100 thousand of the total population ) (Fig. 3).
In the structure of chronic hepatitis incidence rate parenteral viral hepatitis B and C show almost the same prevalence with negligible predominance of chronic viral hepatitis C (52.7 ± 5.8 % and 44.6 ± 5.78 % respectively), with significant predominance among children in the age group from 15 to 17 (369 and 0.51 per 100 thousand persons of the total population respectively).
With the knowledge of the main ways of parenteral viral hepatitis transmission among teenagers, domestic and world’s experience, results of our research, we have suggested complex intersectoral approach to prevention of the parenteral viral hepatitis spread among teenagers as exemplified by Kirovogradska Region. Today’s teenagers, namely peculiarities of their growth, as well as shaping in them health-conscious behavior, are in the center of attention. Enforcement of preventive work, thanks to combined efforts of medical, educational sector and health care services. The latter requires organizational and managemental interventions on all the components of quality health care provision (according to A. Donabedian: structure, process, outcomes). The structural component concerns resource’s provision (staff acquisition, material and technical facilities), organization of work of primary health care professionals, that provide accessibility of health care to the population. It also requires quality management of specialized health care (with the involvement of clinics “Friendly to the Youth”) with the aim of identifying groups of increased risk of parenteral viral hepatitis spread and providing prophylactic observations. The structural component is directly connected to the process component, which implies taking necessary preventive, diagnostic and treatment and rehabilitation measures among teenagers.
The first positive results of scientifically justified innovations were in Kirovogradska Region, where the regional programme was adopted. Regional departments of health care, education and science, physical culture and sport, tourism took part in the implementation of this programme. The first stage of implementation of the suggested approach became the improvement of educational work among teenagers, with the help of mass media, non-governmental organizations, specialists on healthy lifestyle from Health centers, «Clinics Friendly to the Youth», volunteers, medical specialists, educators that are in every day contact with teenagers. Combined educational work and consulting teenagers and their families on psychosocial issues is also practiced. We expect positive medico-psychological results from the safe behavior of teenagers. It can help solve problems, connected to risk factors and ways of transmission of parenteral hepatitis viruses, as well as provide freedom of choice for the people with the maximum awareness. Psychosocial consulting helps teenagers develop certain psychological skills that are necessary for solving conflicts with the peers, resisting group pressure. Detecting conditions for the proper development of teenagers, individual approach to education and prophylactic influence are very important. Programmes on healthy leisure organization were developed, with the involvement of the youth and teenagers into socially useful, creative and sociocultural activities, sports, tourism, art etc. Trainings for parents were also introduced. Not only medical professionals but also cultural and social workers took part in these trainings. Accessible for parents training system ONLINE is planned to be launched. Medical professionals will give consultations on reproduction issues, prevention of the spread of infections including hemocontact (parenteral) way. Social workers, psychologists and lawyers will also take part in the project. In addition “Health Day”, “Family Day”, «Child Health Day» where held. Teenagers and their families got additional knowledge about parenteral viral hepatitis risk factors and ways of transmission. Free of charge possibility to make laboratory test on the presence of parenteral viral hepatitis infection was offered during the event. We must admit that most of the participants used this possibility.
United work of general practitioners and educators targeted at detection of teenagers in the risk group of spreading parenteral viral hepatitis is planned for the next stage. For these teenagers personalized recommendations on the frequency of prophylactic observations will be worked out, quite possibly pediatric gynecologists, urologists, dermatologists and psychologists will be involved.
Prevention of parenteral viral hepatitis spread among teenagers is still the issue of the day in today’s difficult socio-economic situation. The study of the regional problem of the increase in parenteral viral hepatitis incidence among teenagers of Kirovogradska Region, justifying measures directed at improving prevention of its spread starting from teenage years, which were included into the regional social programme adopted on the level of the regional state administration, and resolutions on its implementation with the list of planned measures on the township and district levels in Kirovogradska Region proved to be medically and socially effective. Implementation of justified approaches showed the readiness of the primary health care professionals, educationalists, workers of social and cultural sectors for taking an active part in shaping healthy attitude to personal health among teenagers. We hope it will help to prevent parenteral viral hepatitis in the region. This experience became of immediate interest in light of the local authority reform, when local communities have the right to solve local health care issues. According to the law of Ukraine from 05.02.2015 # 157-VІІІ “On Volunatry Association of Communities”, local communities are responsible for primary health care provision. In such a way, changes in the current rules and regulations promote cooperation between local communities, and local self-government, which includes prevention of spread of parenteral viral hepatitis among teenagers. Identified regional peculiarities of the state of health of the population should be at the core of future cooperation with implementation of early preventive interventions with the aim of prevention irreversible loss, especially among children and teenagers.
Found regional peculiarities of increase in parenteral viral hepatitis case rate among teenagers in Kirovogradska region induced us to work out approaches to improvement of its prevention specifically among teenagers of the region. Suggested steps were approved by the regional state administration; they were taken into account and became a scientific foundation for developing and implementation of the complex regional social programme targeted at prevention of parenteral hepatitis spread among teenagers of Kirovogradska region.
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Research work «Scientific ensuring implementation of the European policy Health for all – 21 in the conditions of optimization of a health care system of Ukraine» (number of the state registration: 0112U002809) was performed in Public institution «Ukrainian institute of strategic researches of the Ministry of Health of Ukraine».
According to the order of the Authorship.
Conflict of interest:
The Authors declare no conflict of interest.
Nataliia V. Medvedovska
Zoologicheskaya St. 6B, apartment 524, Kiev, Ukraine
Fig. 1. Dynamics of viral hepatitis B incidence rate over a period from 2011 to 2016 (per 100 thousand of the total population)
Fig. 2. Dynamics of acute viral hepatitis C incidence rate in children of different age groups over a period from 2011 to 2016 (per 100thousand of the total population)
Fig. 3. Chronic viral hepatitis incidence rate among children of different age groups over the period from 2011 to 2016 (per 100 thousand of the total population)