6 курс / Неонатология / Научное_обоснование_механизмов_управления_младенческой

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CHAPTER 3. INFANT MORTALITY IN THE REPUBLIC OF INGUSHETIA.

STRUCTURE. DETERMINANTS. TRENDS

3.1. Analysis of infant mortality rates

The indicator of infant mortality is extremely important for assessing the socioeconomic well-being of the territory, as it is included in the system of 12 indicators of the level and quality of life of the population established by the WHO. It accumulates the results of the impact of socio-economic, organizational, medical, and managerial factors, reveals the share of participation in it of exogenous and endogenous causes. That is why the dynamics of the indicator itself, and the structure of its causes, and the indicators, its components, and the assessment of the conditions for its formation are also important. The characteristics obtained, their assessment, and the dynamics of indicators will provide an opportunity to plan preventive measures, strategies to reduce infant mortality, increase the role of responsibility centers, and develop criteria for evaluating the work of maternal and child health services in the direction of reducing infant mortality.

The dynamics of infant mortality in the Republic of Ingushetia reflected a positive downward trend in the indicator, decreasing from 10,9‰ in 2017 to 6,2‰ in 2018, 5,9‰ in 2019, 5.6‰ in 2020, 5.5‰ - in 2021. The downward trend was steady. The correlation coefficient was 0,7, the determination coefficient was 0,95, the probability of an error-free forecast was p < 0,05 (figure 3.1).

Figure 3.1 - Dynamics of infant mortality in the Republic of Ingushetia in 20172021 (‰).

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The neonatal mortality rate declined unevenly, from 6,8‰ in 2017 to 4,4‰ in 2021. The downward trend was steady. The correlation coefficient was 0.67, the determination coefficient was 0,95, the probability of an error-free forecast was p < 0,05 (figure 3.2).

Figure 3.2 - Dynamics of neonatal mortality in the Republic of Ingushetia in 2017-2021 (‰).

Early neonatal mortality accounted for more than 70% in the structure of neonatal mortality, decreasing dynamically and unevenly from 4,8‰ in 2017 to 3,2‰ in 2021. The correlation coefficient was 0.67, the determination coefficient was 0,95, the probability of an error-free forecast was p < 0.05 (figure 3.3).

Figure 3.3 - Dynamics of early neonatal mortality in the Republic of Ingushetia in 2017-2021 (‰).

The indicator of late neonatal mortality was up to 30% of neonatal mortality and decreased dynamically and unevenly from 2,1‰ in 2017 to 1,1‰ in 2021. The

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The dynamics of late neonatal mortality was positive, characterizing a decrease in levels from 2,1‰ in 2017 to 1,1‰ in 2021. The correlation coefficient was 0,67, the determination coefficient was 0,95, the probability of an error-free forecast was p < 0,05 (figure 3.5).

Figure 3.5 - Dynamics of late neonatal mortality in the Republic of Ingushetia in 2017-2021 (‰).

The quality management of pregnancy and childbirth, the level of medical activity, the effectiveness of measures of state support for motherhood and childhood were indirectly evidenced by the stillbirth rate, which reflected the health status of mothers, the impact of perinatal risk factors for newborns, and the quality of care for a pregnant woman and a woman in labor. In the period before the National Projects "Healthcare" and "Demography", the stillbirth rate was 14‰, and 3 years after the start of financing the healthcare system under the National Projects "Healthcare" and "Demography", the value of the indicator significantly decreased to 1,2‰, and the downward trend was stable, and the coefficients of correlation (0,9), determination (0,85) and the probability of an error-free forecast (p <0,05) confirmed this fact (figure 3.6).

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girls (30,4%), the third ranking place fell on boys (9,1%) and girls (4,4%) born in the interval from 42 to 44 weeks ) (Table 3.2).

Table 3.2 - Gestational structure of infant mortality, (%).

The distribution of children who died under the age of one year by gestational groups corresponded to the occupancy of the newborn groups themselves: the largest share was in the group born at 37-41 weeks of pregnancy, the smallest - at 42-44 weeks.

3.3. Structure of causes of infant mortality

Causes of infant mortality in the Republic of Ingushetia were assigned to class XVI "Certain conditions arising in the perinatal period" and class XVII "Congenital anomalies [malformations], deformities and chromosomal disorders." In 2017, the first place in the structure of causes of infant mortality was occupied by Birth trauma, accounting for 33,4%, the second place - Slow growth and malnutrition of the fetus and Congenital anomalies [malformations], deformities and chromosomal disorders, 22,2% each, respectively, the third place - Disorders associated with shortened pregnancy and low birth weight and Infectious diseases specific to the perinatal period by 11,1%, respectively (Table 3.3).

In 2018, the first place was shared by Congenital anomalies [malformations], deformities and chromosomal disorders (28,6%) and Infectious diseases specific to the perinatal period (28,6%), the second place - Disorders associated with shortened pregnancy and small birth weight, birth trauma, stunted growth and malnutrition of the fetus by 14,3%, respectively (Table 3.3).

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3.4. Exogenous factors of infant mortality

The analysis of infant mortality from the standpoint of exogenous causes was

carried out taking into account the following criteria:

-sex structure

-place of residence

-state of dispensary observation,

-patronage work for children,

-type of feeding

-infant vaccinations

-timing of treatment in an outpatient facility,

-outpatient treatment and diagnostic process since the last illness,

-compliance with its clinical protocols of the treatment and diagnostic process,

-timing of patients' admission to the hospital from the moment of the onset of the disease,

-hospitalization denials.

An analysis of the sex structure among deceased infants indicated that more than 60% of those who died under the age of 1 year were boys and up to 40% were girls (Table 5).

Table 3.4 - Distribution of infant mortality by gender (%).

This reflected the general trend in the human population: the predominance of males at birth, their more intense decrease in the course of life due to greater vulnerability, the excess of male mortality over female, which led to the predominance of women in the population from the age of 30 by 2 -7%.

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among the population, distrust of the local pediatrician and violation of patient routing, congestion in hospitals (Table 3.10).

Table 3.6 - Primary medical patronage (after 3 days) in the group of children who died under the age of 1 year in the Republic of Ingushetia, (%).

Table 3.7 - Dispensary observation carried out not in accordance with the decreed terms and volumes in the group of children who died under the age of 1 year in the Republic of Ingushetia, (%).

Table 3.8 - Breastfeeding in the group of children who died under the age of 1 year in the Republic of Ingushetia, (%).

Table 3.9 - Vaccination level in the group of children who died under the age of 1 year in the Republic of Ingushetia, (%).

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