РЕГИОНАЛЬНЫЕ АСПЕКТЫ МЛАДЕНЧЕСКОЙ И ДЕТСКОЙ СМЕРТНОСТИ НА ДАЛЬНЕМ ВОСТОКЕ

Abstract

The article presents the results of long-term observations of the authors to assess the health of pregnant women, children and adolescents of the Far-Eastern Federal District. In the dynamics of the observation there is an improvement in indicators characterizing the health status of women and children: the reduction of morbidity, infant and child mortality. However, these data are much higher than in European countries. Thus, the infant mortality rate on average in the Far Eastern Federal District decreased from 11.0‰ in 2013 to 5.7‰ in 2017 (on average in Russia it was 5.5‰). At the same time, in the “new” countries of the European Union (EU) that are the closest in socio-economic condition to Russia (Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia, Slovenia), this figure in 2016 amounted to 3.9‰, and in the “old” countries of the EU it was 3.3‰. The child mortality rate (1-17 years old) in some regions of the Far Eastern Federal District ranges from 73.0 in the Khabarovsk territory (per 100 thousand of the corresponding age) to 101.1 in the Jewish Autonomous Region and on average in Russia in 2016 it was 70.9. And in the EU countries, this figure was significantly lower and amounted to 37.6 in the “new” countries and 31.4 in the “old” countries. In the analysis of risk factors affecting health, infant and child mortality, the following biological factors were noted: maternal health, complicated pregnancy, genetic factors, living conditions and, above all, economic and biogeochemical environmental factors. In areas with a tense and critical assessment of the environmental situation, the proportion of spontaneous abortions, stillbirths, premature, congenital malformations is much higher. In the formation of pathology in children, the deficiency or imbalance of essential, i.e. vital trace elements, the nature of nutrition, nutrient deficiency, and the formation of energy deficiency of immunocompetent blood cells can influence a lot. All these environmental factors, in fact, are etiological and determine different variants of pathology, the formation of metabolic imprinting, the manifestation of fetal programming and the birth of immature offspring. Disturbance of embryogenesis under the influence of these factors leads to the development of various pathologies of newborns, long-term consequences in the form of reproductive dysfunction, pathology of immune reactions, mental dysfunction, and reduced adaptability. As a result, we have an increased morbidity, sick offspring, and a decrease in life expectancy. In order to develop specific measures to reduce morbidity, infant and child mortality, it is necessary to solve a number of medical and organizational measures, strengthen the preventive orientation of medical care for pregnant women, and timely correct the deficit conditions. It is necessary to organize the system of active health follow-up (examination based on automated control systems) of pregnant women, a system of data banks for the examination, treatment and rehabilitation of women with a burdened obstetric history and from the risk group for the development of perinatal pathology at the stage of planning pregnancy (the best option) or in the early stages of pregnancy.