PRACA POGLĄDOWA

REVIEW ARTICLE

Analysis of morbidity and causes of infant mortality IN Poltava

Tetiana V. Pluzhnikova, Oksana I. Krasnovа, Svitlana S. Kasinets, Svitlana M. Tanyanskaya, Natalia V. Yaroshenko, Iryna A. Kolenko

Ukrainian Medical Stomatological Academy, Poltava, Ukraine

ABSTRACT

Introduction: Providing high-quality health care to the newborn is part of the national health system. The number of healthy children in Ukraine decreases annually. One of the main directions of development of the pediatric service is reduction of indicators of child mortality, increase of birth rate and strengthening of children’s health.

The aim: To analyze the dynamics of morbidity and causes of infant mortality in the city of Poltava.

Materials and methods: Medical and statistical – for collecting, processing and analyzing data, (descriptive and analytical statistics for determining relative indicators, absolute growth indicators), a systems approach and system analysis.

Review: According to a study in the city of Poltava, there is a negative absolute increase in the birth rate of children. In the structure of the causes of death of the child population in the first place are the diseases of the period of birth of the newborn, in the second place – congenital anomalies of development. The third place in the structure of causes of death is occupied by diseases of the central nervous system. There is a clear decrease in the incidence of hemolytic disease, anemia, cardiac disorders, intrauterine hypoxia and asphyxiation. In the structure of birth injuries in newborns occupy closed clavicle fractures, plexitis of the newborn.

Conclusions: Analysis of the incidence and causes of infant mortality in the city of Poltava suggests that in recent years there has been a decrease in fertility rates, an increase in morbidity rates. The reform should be aimed at improving the state of the pediatric service and the prevention of preterm labor.

KEY WORDS: reforming, newborns, mortality, morbidity

Wiad Lek 2019, 72, 5 cz. II, 1136-1139

Introduction

Providing high-quality nursing care is part of the national health system [1,2]. The socio-economic crisis in Ukraine, the prolonged military actions, caused significant irreversible demographic losses. The number of completely healthy children in Ukraine decreases annually [3, 4]. The deterioration of the quantitative and qualitative indicators of population reproduction has become the character of a steady trend [5, 6, 7]. The social situation of mothers and children noticeably deteriorates. Therefore, one of the main directions of the development of the prenatal service is reducing infant mortality rates, increasing fertility rates, improving the condition of newborn babies, preventing maternal and infant mortality (mortality in children of 1 year of life), and strengthening the health of the children population [8, 6].

The aim

The aim our work was to analyze the dynamics of indicators of morbidity and causes of mortality of newborns in the city of Poltava.

Materials and methods

The research was conducted on the basis of state and sectoral statistics. In order to achieve the goal, research methods such as medical statistics were used to collect, process and analyze research materials (descriptive and analytical statistics for the determination of relative indicators and absolute growth rates, growth rates and growth rates), system approach and system analysis.

REVIEW AND DISCUSSION

In 2017, 364,0 thousand children were born in Ukraine, in particular in the Poltava region, the birth rate was 7.8 per 1,000 population (in 2016 it was 8.7 per 1000 inhabitants) [3, 2]. According to the study, in Poltava, a negative absolute increase in births is observed in the maternity hospital in 2015 and 2017 [6]. The proportion of childbirth by Caesarean section increased during 2015-2017 (Table I). The rate of growth of pathological births has increased, the number of women with drug dependence has also increased, and the absolute increase in the number of children with somatic pathology has decreased during this period.

In the structure of the causes of death of the child population in the first place are diseases of the period of newborn birth, in the second place – congenital malformations. Third place in the structure of causes of death in 2014-2017 occupy the diseases of the central nervous system (Table II).

Among the diseases of the period of newborns in the structure of the causes of death in the first place are symptoms of respiratory disorders, the second place is occupied by death from hypoxia, asphyxia and sepsis. Third place among the diseases of the period of newborn birth congenital pneumonia.

The index of morbidity refers to the main demographic indicators that characterize the health of newborns and the quality of medical care for women and children. Studying the causes of morbidity and mortality of newborns, its frequency, analysis of factors influencing these indicators, is an actual problem of modern obstetrics [7]. In the structure of the general morbidity of newborns in Poltava, for the period 2014-2017, the first place is marked by developmental abnormalities, in the second place – cerebral disorders, the third place occupy maternal traumas of newborns (Table III). There is a clear decrease in the incidence of hemolytic disease, anomalies of newborns development, anemia, cardiac violations, intrauterine hypoxia (I / O) and asphyxia and withdrawal syndrome, as well as an increase in incidence of cerebral disorders, birth trauma, jaundice during 2014-2017.

In the structure of childbirth infants newborns in the first place isolate kefalgematomy, in the second place – closed fractures of the collarbone, and in the third place are plexitis of newborns (Table IV). During the period of 2014-2017, there was a decrease in the incidence rate of plexitis and a closed fracture of the collarbone.

Conclusions

The analysis of the morbidity and causes of newborn mortality in Poltava shows that in recent years there has been a decrease in fertility rates, and indicators of morbidity and sex traumatic disease remain at a rather high level. The reform of prenatal care should continue in the direction of improving the state of work of the pediatric service and preventing early childbirth. To do this, it is necessary to provide pregnant women with timely and qualified medical assistance, to equip modern maternity hospitals with modern medical equipment to provide high-tech care to preterm infants, to provide the population with affordable family planning services. All these measures will help reduce the morbidity and mortality of newborns, and as a result, improve the demographic situation in Ukraine.

References

1. Pluzhnikova T.V, Kostrikov A.V. Analiz poshirenosti ta zahvoryuvanosti na osnovni klasi hvorob u naselennya Poltavskoyi oblasti ta v Ukrayini (2006-2015 rr.). [Analysis of the prevalence and incidence of the main classes of diseases among the population of the Poltava region and in Ukraine (2006-2015)]. Actual problems of modern medicine. 2017; 17.3 (59): 153-156. (UA)

2. Slabkyi H. O., Dudina O. O., Haborets Yu. Yu. Rehionalizatsiia perynatalnoi dopomohy – vazhlyvyi chynnyk zabezpechennia natsionalnoi bezpeky krainy. [Regionalization of perinatal care is an important factor in ensuring the national security of the country.]. Ukraine. Health of the nation. 2016; 4(1): 196-204. (UA)

3. State Statistical Service of Ukraine. Statistical Information. 2017. doi: http: //www.ukrstat.gov.ua (UA)

4. Annual report on the state of health of the population, the sanitary-epidemic situation and the results of the health care system of Ukraine. 2017 / Ministry of Health of Ukraine, Medinform, 2018; 458 p. (UA)

5. Holovanova IA, Krasnova OI, Tanianska SM et al. Otsinka efektyvnosti vykorystannia resursiv silskoi medytsyny. [Evaluation of the effectiveness of the use of resources of rural medicine]. Wiad Lek, 2018; 5. cz. II: 1032-1038. (UA)

6. Poltava Regional Information and Analytical Center for Medical Statistics. Directory of indicators of the activities of medical and prophylactic institutions of the region. 2017. Retrieved doi: http://oiacms.poltava.ua. (UA)

7. Pasiieshvili NM. Analiz perynatalnoi zakhvoriuvanosti ta smertnosti v umovakh perynatalnoho tsentru ta shliakhy yii znyzhennia. [Analysis of perinatal morbidity and mortality in the perinatal center and ways of its reduction] ScienceRise. Medical science. 2016; 1(3): 37-43(UA)

8. Znamenska TK, Nikulina LI, Rudenko NH et al. Analiz roboty perynatalnykh tsentriv u vykhodzhuvanni peredchasno narodzhenykh ditei v Ukraini. [Analysis of the work of perinatal centers in the emergence of premature births in Ukraine]. Neonatology, Surgery and Perinatal Medicine. 2017; 7(2)24 : 5-11. (UA)

The work is a fragment of SRR “Medical and social rationale for optimizing approaches to managing and organizing various types of medical care for adults and children in the period of reforming the health care industry” (is registered with UkrISTEI).

Authors’ contributions:

According to the order of the Authorship

Conflict of interest:

The Authors declare no conflict of interest

CORRESPONDING AUTHOR

Oksana I. Krasnovа

Ukrainian Medical Stomatological Academy

Shevchenko 23 str., 36011 Poltava, Ukraine

tel: +380984673750

e-mail: krasnovaoksana197@gmail.com

Received: 26.03.2019

Accepted: 02.05.2019

Table І. Dynamics of fertility rates in Poltava maternity hospital for 2015-2017

2015

2016

2017

Absolute index

Absolute increment

The pace of growth, %

Absolute indicator

Absolute increment

The pace of growth, %

Absolute indicator

Absolute increment

The pace of growth, %

Born in a maternity hospital, of which:

3062

-197

93,9

2959

103

96,6

2799

-160

94,5

finished ones

2933

-169

94,5

2824

109

92,6

2650

-174

93,8

prematurely

129

-28

82,1

135

+6

104,6

149

+14

110,3

Outside the maternity home

4

-3

57,1

2

-2

50

3

+1

150,0

Rejected children

4

+2

5

+1

4

-1

Pathological birth

41

+4,7

112,9

35

-6

85,3

40,2

+5,2

114,8

Specific gravity of labor by caesarean section

17,2

+2,8

119,4

18,4

+1,2

106,9

19,9

+1,5

108,1

Born with drug addiction

6 cases

+1

120,0

4 cases

-2

66,6

4 cases

0

100,0

Breast with somatic pathology

56

+10

121,7

56,8

+0,8

101,4

53,6

-3,2

94,3

Table ІІ. The structure of the causes of death of the children’s population of Poltava in 2014-2017.

Diseases Year

2014

2015

2016

2017

1.

Diseases of the period of newborn, including:

15

20

19

10

hypoxia, asphyxia

3

4

3

1

systems of respiratory disorders

4

5

6

3

sepsis

3

2

4

2

pneumonia

2

5

1

intragastric hemorrhages

1

3

3

neonatal ascorbation with meconium

1

1

1

extreme degree of immaturity

1

1

primary atelectasis of the lungs

1

hemolytic neonatal disease

1

diseases of hyaline membranes

1

2.

Congenital malformations

4

4

3

6

3.

Diseases of the central nervous system

4

5

2

4.

Diseases of the cardiovascular system

1

1

5.

Accidents

1

1

1

1

6.

Infectious diseases

1

1

7.

Diseases of the digestive system

1

2

8.

Diseases of the respiratory organs

1

1

Table ІІІ. The structure of the general morbidity of newborns

Diagnoses

2014

2015

2016

2017

Abs. indicator

%

Abs.

indicator

%

Abs.

indicator

%

Abs.

indicator

%

Developmental anomalies

114

48,0

107

36,6

102

26,2

80

10,3

Cerebral disorders

19

4,7

27

9,2

93

23,9

99

12,8

Maternal injuries

18

3,9

26

8,9

22

5,6

161

20,9

Hemolytic disease

43

12,5

31

10,6

22

5,6

20

2,5

The weight is too short

gestational

32

11,0

24

8,2

14

3,5

11

1,4

Jaundice

4

1,3

6

2,0

11

2,8

23

2,9

Anemia

3

0,9

6

2,0

3

0,7

1

0,1

Heart violations

3

1,2

5

1,7

7

1,7

3

0,3

Intrauteine hypoxia and asphyxia

2

0,8

5

1,7

8

2,0

1

0,1

Abstinent syndrome

7

1,9

5

1,7

4

1,0

3

0,3

Table IV. Structure of maternal traumatism of newborns

Diagnosis

2014

2015

2016

2017

Abs. indicator

%

Abs.indicator

%

Abs.indicator

%

Abs.indicator

%

Maternal injuries, including:

18

3,9

26

0,8

22

0,7

161

5,7

Kefalematomy

30

47,6

11

42,2

10

45,4

125

77,6

Closed fractures

23

36,5

9

34,6

8

36,3

34

21,1

Plexit

10

15,8

6

28,0

4

18,1

2

1,2