PRACA POGLĄDOWA

REVIEW ARTICLE

CALCULATION OF LOSS OF CHILD MORTALITY IN UKRAINE AS AN INSTRUMENT FOR ESTIMATION OF ACHIEVEMENTS OF SUSTAINABLE DEVELOPMENT GOALS IN UKRAINE

Natalia O. Rynhach1, Raisa O. Moiseenko2

1PTUKHA INSTITUTE OF DEMOGRAPHY AND SOCIAL RESEARCH OF NATIONAL ACADEMY OF SCIENCES OF UKRAINE, KYIV, UKRAINE

2SHUPYK NATIONAL MEDICAL ACADEMY OF POSTGRADUATE EDUCATION, KYIV, UKRAINE

ABSTRACT

Introduction: Ukraine has made a commitment to reduce preventable deaths of newborns and children under 5 years of age, within the framework of the relevant task of the Sustainable Development Goals. For a purposeful and effective struggle, it is necessary to realize the scope and structure of losses.

The aim: Identify differences in child mortality rates in Ukraine compared to other countries, to calculate and estimate the number of years of potential life lost (YPLL) due to infant mortality.

Materials and methods: The information base of the study was official data of the State Statistics Service of Ukraine on the distribution of the deceased by age and causes of death in 2017 and World Health Statistics 2016 data. The method of potential demography was used to estimate demographic losses.

Review: In Ukraine, in 2017 the absolute number of years of potential life lost (YPLL) was estimated to be almost 217,000 person-years due to under-five mortality, most of them – more than 179,000 person-years – due to infant mortality. The rest were losses due to mortality within the interval of 1-4 years – almost 40 thousand person-years. 55.6% of all potential life losses due to infant mortality determined Certain conditions occurring in the perinatal period, Congenital malformations, deformities and chromosomal anomalies – 23.4%.

Conclusions: Ukraine has significant reserves for reducing under five mortality rates, primarily through minimization of preventable mortality.

KEY WORDS: Sustainable Development Goals: Ukraine, child mortality; years of potential life lost, person-years, health-related goals, targets, and SDG indicators

Wiad Lek 2019, 72, 5 cz. II, 1145-1149

INTRODUCTION

A recognized indicator of the health and well-being of children – child mortality is one of the most important indicators of progress towards achieving the Sustainable Development Goals (SDG). The Agenda for Sustainable Development for the period up to 2030, adopted by 193 countries (including Ukraine) under the auspices of the United Nations entered into force in January 2016. An estimated 5.9 million children under 5 years of age died in 2015, with a global under-five mortality rate of 42.5 per 1000 live births [1]. Globally, under-five morality rate has declined by 58 % since 1990, and the number of under-five deaths dropped from 12.6 million in 1990 to 5.4 million in 2017 [2]. Target 3.2: By 2030, end preventable deaths of newborns and children younger than 5 years, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1000 livebirths and under-5 mortality to at least as low as 25 per 1000 livebirths. Under-5 mortality and neonatal mortality rate had the most countries with at least 95% probability of target attainment [3].

The death of a child causes the greatest number of years of potential life lost. On a global scale, neonatal disorders are among the top five causes of death leading to the greatest number of years of potential life lost (YPLL). Globally, the five leading causes of total years of potential life lost in 2016 were cardiovascular diseases; diarrhea, lower respiratory infections, and other common infectious diseases; neoplasms; neonatal disorders; and HIV/AIDS and tuberculosis [4].

The extent of the harm caused, the volume and structure of the losses should be clearly understood for a effective activities to achieve the reduction of infant mortality in Ukraine.

THE AIM

Identify differences in child mortality rates in Ukraine compared to other countries, to calculate and estimate the number of years of potential life lost (YPLL) due to infant mortality.

MATERIALS AND METHODS

The information base of the study was the official data of the State Statistics Service of Ukraine on the distribution of the deceased by age and causes of death in 2011, 2017 and World Health Statistics 2017 data.

The method of potential demography was used to estimate demographic losses. The number of YPLL is calculated as the sum of the differences of years between the threshold values of the death age and the actual mortality age (before 65) of all persons who died during the year at the younger than the threshold age intervals (under 5).

REVIEW AND DISCUSSION

In Ukraine, in 2017, the absolute number of years of potential life lost (YPLL) was estimated to be almost 217,000 person-years due to under-five premature mortality, most of them – more than 179,000 person-years – due to infant mortality. The rest were losses due to mortality within the interval of 1- 4 years – almost 40 thousand person-years.

Compared to 2011, a decrease in the absolute number of YPLL due to the mortality of children under one year can be noted (Table I). This is primarily due to the significant decrease in the registered number of infant deaths (up to 2786) owing to the lack of information from the territories of the Autonomous Republic of Crimea annexed by the Russian Federation and part of the Donbass territory outside the control of the government of Ukraine. Given the inaccuracy of statistical information on population size, we did not calculate the per capita YPLL index, but focused on structural changes.

The major part in the structure of losses accounted for the Class “Certain conditions occurring in the perinatal period.”

Despite the fact that the majority of losses due to under five infant mortality are under one year deaths, 188 infants aged 1-4 of out 598 died due to external causes. Accordingly, out of all 37,674 person-years of life lost, 11844 occurred due to precisely unnatural causes. This should focus attention of the Ukrainian society on the urgent need to clarify and eliminate the circumstances and conditions that enable such deaths.

Decrease in mortality rates among children under five years of age will illustrate the progress in preventing the loss of life of children from a number of diseases and conditions that can be prevented or treated. Although Ukraine has relatively low infant mortality rate, and since 2000 it has been decreasing1, however, its level still does not meet the European average values. (Fig. 1, 2, 3) [5]. For example, almost one-third of deaths between one and five years of age are due to external causes (injuries, poisoning, accidents), that is, those ones deaths from which can be avoided with proper child care.

According to the Institute for Health Metrics and Evaluation, the highest proportion (about 40%) of all years of potential life lost due to under-5 mortality in Ukraine was determined by various conditions of the neonatal period (Table II). Congenital malformations accounted for the next largest contribution (about 22%). It should be noted that in neighboring Poland the significance in the formation of the congenital pathology losses is relatively higher [6]. A certain part of these deaths could have been avoided or prevented in case of proper preparation for conception, adequate supervision during pregnancy and timely diagnosis of pathologies, effective skilled care during childbirth and in the postpartum period.

Measures aimed at creating behavioral changes at the community level have been recognized as essential for empowering individuals, families and communities in order to promote the health of women and children. Scientifically-based map is the starting point to study the effectiveness of such measures and will allow to identify areas where investments yield better results [7] which is extremely relevant in the context of decentralization in Ukraine. Policy aimed at reducing the risk of premature death is one of the priorities of the Sustainable Development Goals [8,9].

CONCLUSIONS

Certain conditions, occurring in the perinatal period determined 55.6% of all potential life lost in Ukraine in 2017 due to infant mortality. Along with congenital malformations, deformations and chromosomal anomalies, they formed nearly 80% of all losses. A significant part of these deaths could have been avoided or prevented in case of proper preparation for conception, adequate supervision and timely diagnosis during pregnancy, effective skilled care during childbirth and in the postpartum period.

Particular attention should be paid to the prevention of high mortality due to the external causes that can be prevented under proper child care. Upbringing of conscious parenthood is of great importance not only for reducing child mortality, but also for preventing social orphanhood.

Estimation of child mortality losses will help managers and policy makers, scientists and the general public to describe the real situation in the area of mortality, to realize the scope of potential losses of short-lived life, to evaluate the effectiveness of the measures and programs being implemented. At the same time, this is the basis for prognostic conclusions and further strategic planning.

Quantitative estimation of losses is a tool for substantiation of political decisions which provides arguments for prioritizing certain actions towards achieving the Sustainable Development Goals.

REFERENCES

1. Levels and trends in child mortality report 2017. Estimates Developed by the UN Inter-Agency Group for Child Mortality Estimation http://childmortality.org/files_v21/download/IGME%20report%202017%20child%20mortality%20final.pdf

2. Transforming our world: the 2030 agenda for sustainable development. United Nations, New York, NY; 2015

3. GBD 2017 SDG Collaborators. Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017.  The Lancet. 8 Nov 2018; 392:2091–138. doi: http://dx.doi.org/10.1016/S0140-6736(18)32281-5.

4. GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet. 14 Sept 2017: 390;1151–210.

5. Rynhach N.O. millennium development goals (MDGS) in Ukraine: reducing child mortality progress assessment. Demography and social economy, 2013;2(20):28-39. DOI 10.15407/dse2013.02.028

6. Institute for Health Metrics and Evaluation (IHME). GBD Compare Data Visualization. Seattle, WA: IHME, University of Washington, 2018. Available from http://vizhub.healthdata.org/gbd-compare. (Accessed [18.03.2019)

7. An evidence map of social, behavioural and community engagement interventions for reproductive, maternal, newborn and child health 6.02.2017 http://apps.who.int/iris/bitstream/10665/259399/1/9789240697263-eng.pdf

8. Health in 2015: from MDGs to SDGs. – Geneva: World Health Organization; 2015 (http://www.who.int/gho/publications/mdgs-sdgs/en/)

9. Sustainable Development Goals: Ukraine’ national report 2017,p.176.

Authors’ contributions:

According to the order of the Authorship

Conflict of interest:

The Authors declare no conflict of interest

CORRESPONDING AUTHOR

Natalia O. Rynhach

Ptukha Institute of Demography and Social Research

of National Academy of Sciences of Ukraine

Blvd. Taras Shevchenko, 60, 01032 Kyiv, Ukraine

e-mail: n_ryngach@ukr.net

Received: 20.03.2019

Accepted: 30.04.2019

Table I. The distribution of the number of years of potential life lost due to deaths of up to one year, the main causes of death, Ukraine, 2011, 2017

Causes

Number of deaths

Number YPLL, person-years

% total YPLL

2011

2017*

2011

2017*

2011

2017*

I Certain infectious

and parasitic diseases

141

70

9094,5

4515

3,1

2,5

ІІ. Neoplasms

26

24

1677

1548

0,6

0,9

ІХ. Diseases of the circulatory system  

81

38

5224,5

2451

1,8

1,4

Х. Diseases of the respiratory system

133

99

8578,5

6385,5

2,9

3,6

ХVІ. Certain conditions originating in the perinatal period  

2339

1550

150866

99975

51,9

55,6

ХVІІ. Congenital malformations, deformations and chromosomal abnormalities

1100

653

70950

42118,5

24,4

23,4

ХХ. External causes of morbidity and mortality

262

140

16899

9030

5,8

5

All causes

4511

2786

290960

179697

100

100

Note: * author’s calculations based on the State Statistics Service data

Table II. Years of potential life lost as a result of Under-five mortality, person-years per 100 000, Ukraine, both sexes, 1990, 2017

rank

1990

rank

2017

1

Congenital heart anomalies

1

Other neonatal disorders

2

Neonatal preterm birth

2

Neonatal preterm birth

3

Lower respiratory infections

3

Congenital heart anomalies

4

Other neonatal disorders

4

Neonatal encephalopathy due by birth asphyxia and trauma

5

Neonatal encephalopathy due by birth asphyxia and trauma

5

Other congenital birth defects

6

Other congenital birth defects

6

Neonatal sepsis and other infections

7

Neonatal sepsis and other infections

7

Lower respiratory infections

Note: Institute for Health Metrics and Evaluation (IHME). GBD Compare Data Visualization. Seattle, WA: IHME, University of Washington, 2018. Available from http://vizhub.healthdata.org/gbd-compare. (Accessed [18.03.2019])

1 We emphasize that the data from Donetsk and Luhansk regions are incomplete, and namely Donetsk Region is one of the leaders in the regional ranking with the highest under 1-year child mortality rate.

Fig. 2. Under-five mortality, neonatal mortality rates in regions of the world, per 1000 live births

Source: World Health Statistics 2016: http://who.int/entity/gho/publications/world_health_statistics/2016/en/index.html

Fig. 3. Child Mortality in Ukraine in 2000-2017 per 1000 live births

Source: State Statistics Service of Ukraine