Aim. Analysis of the main tendencies in the state of health of children in Russia in 2011-2016 and representation of priorities in its preservation. Methods. The official statistical data characterizing the state of health of the children’s population aged 0-17 years were used: birth rate, population of this age, physical development, incidence, disability, mortality. Results. In general, positive tendencies in the state of health of children and teenagers are observed. The high ratio of children with normal level of physical development was noted. According to routine medical examinations, more than one third of the examined children are healthy. Growth of the general and primary incidence among children of all age groups has stopped. The incidence of socially important diseases (tuberculosis, syphilis, gonococcal infection, alcoholism, drug addiction and inhalant abuse) among children and teenagers is reducing, level of newly diagnosed human immunodeficiency virus infection has stabilized. Mortality from the majority of main causes among children of all age groups, especially during the first year of life, has significantly decreased. However, the level of primary and general disability of children aged 0-17 years remains stable. Conclusion. The current priorities of children’s health care are health problems of teenagers, children’s disability, implementation of preventive medical care for children in primary care setting, improvement of medical rehabilitation, optimization of the system of medical social care to children’s population.
Creation of system of early prophylaxis of children disability and support of the families bringing up disabled children and children with limited opportunities are among the main priorities of the Russian Federation state social policy. There are a number of problems requiring immediate solutions. Dynamics of children’s disability in our country is characterized by process stagnation. The age and gender structure of children’s disability practically doesn’t change. The analysis of its nosological structure shows that alienations and disorders of behavior, illness of a nervous system and congenital anomalies of development steadily occupy more than 60% among the illnesses which caused disability of children of all age groups. There was a decrease in the prevalence of total disability in most classes of diseases, such as injuries, diseases of the genitourinary system, respiratory system, musculoskeletal system, digestive system and growth of disability caused by neoplasms and diseases of the endocrine system. The underestimation of children’s disability bound to various reasons is supposed: social motivation of a family, complexity of legal veneering, strict requirements of service of medico-social examination, insufficient medical experts awareness on criteria of disability. Among disability formations risk factors the most discussed are the achievements of perinatology leading to improvement of nursing of prematurely born and small newborns, and wide uses of auxiliary genesial technologies. An important part of all preventive measures aimed at reducing the genetic load of population is prenatal and preimplantation diagnosis. It seems appropriate to extend the screening to congenital and hereditary metabolic diseases in neonatal period, including the most common nosological forms of infrequent illnesses. In solving problems of childhood disability prevention a priority should be given to development of services of family planning; improving antenatal and perinatal care; preventive work with healthy but having deviations in development children; development of medical genetic services; implementation of programs of different types of pathology screening.
Development of maternity and childhood protection service is one of the priorities of the Ministry of Health of the Russian Federation. The strategy for its development is included in the National plan of action for the benefit of children formulated according to the international documents on the rights of a child. The preservation of life and health of children under 5 years has been identified as an important strategic task for preserving life and health of the population as a whole. Tendencies of mortality in children under 5 years and infant mortality as a part of the data had been studied basing on the analysis of Federal State Statistics Service of the Russian Federation and World Bank data bases. It is shown that the reduction in mortality of children under 5 years occurred in all age periods. The level of infant mortality decreased significantly to the same extent due to neonatal and post-neonatal mortality. The leading causes for mortality in children under 5 years in general and infant mortality in particular are certain conditions originating in the perinatal period and congenital malformations which slow further reduction of the mortality in children in this age group. Significant reasons for death in children aged 1−4 years are injuries, poisonings, and oncologic diseases. The reserves of infant and child mortality reduction are found in implementation of prenatal and preimplantation diagnostics and «Prenatal consultation» organizational model; broader screening for congenital and hereditary metabolic diseases in the neonatal period including the most common nosological forms of rare (orphan) diseases; expansion of the National Vaccination Calendar; improvement of quality of prehospital medical care to children under the age of 1 year; further development of specialized, rehabilitative, and medical-social support.
The work aims to analyze and present the contribution of scientists from Kazan medical universities and their pupils to the success of combat child mortality in Russia in the twentieth century using the historical and medical method. The most important results of the works of Kazan scientists can be considered the following: (1) the finding of underestimation of infant mortality; (2) development of methods for its statistical analysis; (3) identification of medical-statistical and social hygienic patterns of child mortality; (4) scientific substantiation of the methodology and strategy for reducing infant mortality in the USSR; (5) a comprehensive study of the problems of child mortality and substantiation of ways to reduce it in the Russian Federation in the late 20th early 21st centuries. Measures are proposed to further reduce child mortality, including a regional approach, reduction of the population's genetic load, priority implementation of antenatal and neonatal prophylaxis, prompt and full provision of treatment by the state for children with rare diseases, further development of specialized and rehabilitation assistance provided to children, intensive development of medical and social assistance.
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