6 курс / Неонатология / Научное_обоснование_механизмов_управления_младенческой
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The incidence rate of the genitourinary system in female mothers decreased from 138,9‰ to 114,0‰. The correlation coefficient was 0,79, characterizing a close relationship, the determination coefficient (0,63) confirmed the decrease in the indicator, the regression coefficient showed a decrease in the incidence rate by 7,6, however, the probability of an error-free forecast was 0,1, which is higher than 0,05 (figure 5.39).
Figure 5.39. Diseases of the genitourinary system in mothers who gave birth to children in the
Republic of Ingushetia in 2016-2020. (‰).
The fetal pathology score in women mothers who gave birth in 2016-2020 steadily decreased from 126.1 ‰ to 84.6 ‰, which was confirmed by the coefficients of correlation (0.95), determination (0.9), regression (-11.34), significance (validity) (0.01) (Fig. 5.40).
Figure 5.40. Pathological conditions of the fetus in women mothers who gave birth to children in
the Republic of Ingushetia in 2016-2020. (‰).
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Venous complications insignificantly and unreliably increased from 58,8‰ to 66,9‰: coefficients of correlation (0,55), determination (0,3), regression (1,5), significance (significance) (0,03) (figure 5.41).
Figure 5.41. Venous complications in mothers who gave birth to children in the Republic of
Ingushetia in 2016-2020 (‰).
The indicator of diseases of the circulatory system significantly and significantly decreased from 66.1 to 41.7‰, which was confirmed by the values of the coefficients of correlation (0.9), determination (0.814), regression (-5.7), significance (significance) (0, 03) (Figure 5.42).
Figure 5.42. Diseases of the circulatory system in mothers who gave birth to children in the Republic of Ingushetia in 2016-2020. (‰).
The indicator of diseases of the endocrine system significantly and significantly
decreased from 53,1‰ to 36.6‰, which was confirmed by the values of the
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coefficients of correlation (0,79), determination (0,62), regression (-3,17), significance
(significance) (0,05) (figure 5.43).
Figure 5.43. Diseases of the endocrine system in mothers who gave birth in the Republic of
Ingushetia in 2016-2020 (‰).
The index of hypertension slightly unreliably decreased from 20,3‰ to 18,4‰: coefficients of correlation (0,7), determination (0,49), regression (-3,17), significance (significance) (p ≥ 0,05) (figure 5.44).
Figure 5.44. Hypertension of mothers who gave birth in the Republic of Ingushetia in 2016-2020
(‰).
The indicator of moderate preeclampsia changed insignificantly and unreliably from 7,3‰ in 2016, increased to 11,1‰ by 2017 and decreased to 7,1‰ by 2020. The coefficients of correlation (0,23), determination (0,05), regression (-2,3), significance (significance) (p ≥ 0,05) confirmed the presence of insignificant differences (figure 5.45).
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Figure 5.45. Moderate preeclampsia of mothers who gave birth in the Republic of Ingushetia in 2016-2020 (‰).
The rate of severe preeclampsia decreased significantly from 3,8‰ to 1,1‰. The correlation coefficient (0,7) characterizing the close connection, determination (0,6) confirmed the decrease in the indicator, regression (-0,5) characterizing the value of the change in the incidence rate on average over 5 years, significance (significance) (p
≥0,05) confirmed the presence of insignificant differences (Figure 5.46).
Figure 5.46. Severe preeclampsia of mothers who gave birth in the Republic of Ingushetia in 2016-
2020. (‰).
The Rh immunization index decreased significantly from 23,4‰ to 7,1‰. Correlation coefficient (0,84) characterizing the close connection, determination (0,72) confirmed the decrease in the indicator, regression (3,99) characterizing the value of
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the change in the incidence rate on average over 5 years, significance (significance) (p
≤ 0,05) confirmed the fact of the presence of insignificant differences (figure 5.47).
Figure 5.47. Rh immunization of mothers who gave birth in the Republic of Ingushetia in 2016-
2020 (‰).
The indicator of diabetes mellitus significantly and significantly increased by 3 times: from 1,2 to 2,9‰. The coefficients of correlation (0,97), determination (0,6), regression (-0,39), significance (significance) (p ≤ 0,05) confirmed the presence of significant differences (figure 5.48).
Figure 5.48. Diabetes mellitus of mothers who gave birth to children in the Republic of Ingushetia
in 2016-2020. (‰).
5.2. Medico-social determinants
The medical and social determinants of infant mortality included the conditions of women's stay in the perinatal center. Women assessed the organization of the work
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of the perinatal center, 81,7% of whom noted a high assessment, 13,6% of women rated the work of the perinatal center at 4 points, 4,7% - at 3 points (figure 5.49).
The evaluation of the work of doctors of the perinatal center was predominantly high: 81,2% of women were rated at 5 points, 15,0% - at 4 points, and only 3,8% - at 3 points (figure 5.50).
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Figure 5.49. Scoring of the organization of the |
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Figure 5.50. Point assessment of the |
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work of the perinatal center by women - |
work of doctors of the perinatal center by |
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puerperas (%). |
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women - puerperas (%). |
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The work of nursing staff was rated by 81,2% of women as "Excellent", 13,2% - as "Good", 5,2% - as "Satisfactory", 0,5% - as "Unsatisfactory" (figure 5.51).
The state of the wards was assessed by 81,7% of women as "Excellent", 15,5% - as "Good", 2,8% - as "Satisfactory" (figure 5.52).
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Figure 5.51. Scoring of the organization of the |
Figure 5.52. Point assessment of the state of the |
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work of the nursing staff of the perinatal center |
chambers of the perinatal center by women - |
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by women - puerperas (%). |
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puerperas (%). |
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The quality of nutrition organized in the perinatal center was highly rated by 80,3% of women, "Good" - by 17,4% of women, "Satisfactory" - by 2,4% (figure 5.53).
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A high assessment of the level of drug provision in the perinatal center was given by 81,7% of women, good - by 15,0%, satisfactory - by 3,3% (figure 5.54).
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Figure 5.53. Scoring of the quality of nutrition |
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Figure 5.54. Scoring of the drug supply |
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organized in the perinatal center by women - |
of the perinatal center by women - puerperas |
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puerperas (%). |
(%). |
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High assessment of newborn care was given by 81,2% of women, good – by 16,0%, satisfactory – by 2,8% (figure 5.55).
Comfort in the departments was also highly rated: 82,2% - "Excellent", 15,0% - "Good" and 2,8% - "Satisfactory" (figure 5.56).
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Figure 5.55. Scoring of quality care for |
Figure 5.56. Point assessment of the comfort |
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newborns of the perinatal center by women - |
of the perinatal center by women - puerperas |
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puerperas (%). |
(%). |
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Thus, the current demographic trend of declining birth rates in the Republic of Ingushetia also contributed to some reduction in infant mortality. The increase in agespecific fertility (fertility) in women of young ages (up to 20 years old) and older than 30-34 and 35-39 years old as risky women-mothers for health reasons was alarming:
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the immaturity of the young mother's body in the first case and the load of chronic pathology of the age-related organism - in second.
An analysis of the incidence of puerperas testified to the presence of predominantly positive medical and demographic trends. The incidence of puerperas who gave birth to children in the Republic of Ingushetia in 2016-2020 was a steady downward trend in indicators. in general, and for individual nosological forms: anemia, threatened miscarriage, diseases of the genitourinary system, pathological conditions of the fetus, venous complications, diseases of the circulatory system, diseases of the endocrine system in puerperas. Hypertension, preeclampsia, and Rh immunization did not show significant dynamic differences, and diabetes mellitus increased significantly and significantly.
The medical and social determinants of infant mortality included the following groups: unmarried (5,2%), living separately from parents (70,9%), in rural areas (36,2%), third and subsequent births (41,8%), with complications in childbirth (9,4%), with malnutrition during pregnancy (13,6%), with increased physical activity during pregnancy (31,5%), the presence of infectious diseases in the family (12,2%), the presence of sexually transmitted diseases in the anamnesis of pregnancy (11,3%), the lack of recovery after the transfer of these diseases (7,7%), the presence of diseases of the female genital area (in less than 20%), the presence of bad habits in mother (9,86%), father (36,6%), genetic diseases (21,1%), failure to undergo genetic counseling to identify the risks of miscarriage (60,7%), high risk of developing genetic diseases (11,2 %), gestational age of the newborn up to 37 weeks (6,6%), the presence of somatic diseases (in 60,6% of women in labor), lack of preparation for childbirth (56,3%), artificial feeding of the newborn (9,4%), the presence of complications in childbirth (in 54% of women), insufficient comfort level of stay in the perinatal center, care, drug provision (3%).
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CHAPTER 6. TECHNOLOGY OF BUILDING ORGANIZATIONAL MODEL
OF INFANT MORTALITY MANAGEMENT.
A systematic dynamic assessment of the medical-demographic and medicalsocial determinants of infant mortality against the backdrop of the National Health and Demography projects made it possible not only to determine the trends of the studied values, to predict the prospective values of these indicators under the so-called other things being equal - the extension of targeted support for motherhood and childhood within the framework of National and Federal projects, as well as to determine the most significant factors influencing infant mortality.
Thus, in the cohort of infants who formed the infant mortality rate, the dynamics in the period 2017-2021 showed a 2% absolute increase in the proportion of children whose primary medical patronage was carried out later than a day. The absence of dynamics in vaccination levels was revealed, the maintenance of a low level of 15% in the interval from 2017 to 2021, the maintenance of a high (75%) proportion of children whose dispensary observation was not carried out in accordance with the decreed terms and volume, a low (30%) proportion of applications of parents to the doctor in connection with the last illness of the child, low (35%) level of compliance with clinical protocols of patient management tactics at the outpatient stage in the group of children who died under 1 year old, insufficient (50%) level of quality in diagnosing diseases in children who died at the age of up to a year at the stage of providing inpatient medical care, an increase in the proportion of mothers who gave birth to children in 2017 - 2021, under the age of 20 years: from 16,5% to 26,2% and older age groups: from 40,1% to 42, 5% (Table 6.1).
Along with the presence of negative organizational, medical and medical and social conditions for infant mortality, positive trends in the health indicators of mothers and newborns from 2017 to 2021 were also noted: a statistically significant decrease in the level of the pathological condition of the fetus from 126,1‰ to 84,6‰, maternal morbidity from 1180,4‰ to 921,1‰, growth in staffing rates: the level of medical personnel from 24,0 to 25,2 per 10,000 people, the level of pediatricians from 9,0 to
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10,2 per 10,000 children, the level of provision with nursing staff from 85,9 to 89,9 per 10,000 people, an increase in the prenatal medical activity of mothers from 71,6% to 76,0% (Table 6.1).
Table 6.1 - Dynamics of actual organizational-medical, medical-demographic and medical-social determinants of infant mortality for 2017-2021.
Years |
2017 |
2018 |
2019 |
2020 |
2021 |
Indicators |
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Proportion of children, primary |
50,0 |
51,0 |
49,0 |
48,0 |
52,0 |
Medical patronage for which was carried out later |
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than 3 days, % |
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Level of vaccination of newborns, % |
15,0 |
15,0 |
18,0 |
12,0 |
15,0 |
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The proportion of children whose dispensary |
75,0 |
76,0 |
74,0 |
75,0 |
75,0 |
observation was not carried out in accordance with |
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the decreed terms and volume, % |
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The share of parents' visits to the doctor in |
30,0 |
29,0 |
31,0 |
30,0 |
30,0 |
connection with the child's last illness, % |
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The level of compliance with clinical protocols of |
35,0 |
35,0 |
32,0 |
38,0 |
35,0 |
patient management tactics at the outpatient stage |
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in the group of children who died before 1 year, % |
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The level of quality of diagnosis of diseases in |
50, |
60,0 |
50, |
50,0 |
50,0 |
children who died under the age of one year at the |
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stage of provision of inpatient medical care, % |
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Pathological condition of the fetus, ‰ |
126,1 |
117,2 |
93,2 |
86,8 |
84,6 |
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Morbidity of mothers, ‰ |
1180,4 |
067,7 |
829,1 |
729,2 |
921,1 |
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The level of provision with medical personnel, per |
24,0 |
24,4 |
24,8 |
15,1 |
25,2 |
10,000 people |
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The level of provision with pediatricians, per |
9,0 |
9,3 |
9,9 |
9,8 |
10,2 |
10,000 people |
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The level of provision with nursing staff, per |
85,9 |
82,6 |
82,6 |
86,5 |
89,9 |
10,000 people |
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Birth rate among mothers under the age of 20, ‰ |
16,5 |
12,55 |
15,27 |
26,1 |
26,2 |
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Birth rate among mothers of older age groups, ‰ |
40,1 |
40,9 |
40,8 |
41,3 |
42,5 |
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Prenatal medical activity of mothers, % |
71,6 |
72,0 |
72,0 |
75,0 |
76,0 |
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Measures taken within the framework of the implementation of the National Health and Demography projects to improve the quality of medical care for mothers and children, aimed at achieving the target indicators of the National Health and Demography projects, were reflected in the predicted values of indicators-determinants
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