Programmeon reduction of perinatal mortality in

the Republic of KazakhstanDr. Bekbai KhairulinDr. Bekbai Khairulin

Head of the MCH Department, MoH RKHead of the MCH Department, MoH RKVII CARK MCH ForumVII CARK MCH Forum

Almaty, KazakhstanAlmaty, Kazakhstan5 – 7 November 2003 5 – 7 November 2003

Situation in Perinatal CareSituation in Perinatal Care

(based on findings of the study of the (based on findings of the study of the causes of infant and child mortality in the causes of infant and child mortality in the Republic of Kazakhstan, UNICEF, 2002)Republic of Kazakhstan, UNICEF, 2002)

The analysis of 3,168 child deaths The analysis of 3,168 child deaths at the age of 0-5 years at the age of 0-5 years

demonstrateddemonstrated FirstFirst, most children (62.1%) , most children (62.1%) died in the early died in the early

neonatal period neonatal period and 50% of the losses could have and 50% of the losses could have been prevented. been prevented.

The second important factor The second important factor revealed by analysis is revealed by analysis is the leading role of infections as the cause of death of the leading role of infections as the cause of death of children in all age groups. children in all age groups.

The third factorThe third factor is a lack of access to primary health is a lack of access to primary health care services for population in remote areas and care services for population in remote areas and those living in those living in RayonsRayons without primary health facilities. without primary health facilities.

The fourth factor The fourth factor revealed by this study is a high revealed by this study is a high level of accidental deaths among infants and children. level of accidental deaths among infants and children.

Age Structure of Infant and Child Age Structure of Infant and Child MortalityMortality

Late neonatal periond

8%

Postneonatal period

21%

1 to 5 years9%

Early neonatal period

62%

Major causes of early neonatal Major causes of early neonatal deathsdeaths

20,6%

19,6%

14,4%

13,7%

6,8%

4,0%

0,0% 5,0% 10,0% 15,0% 20,0% 25,0%

Newborn haemolytic

diseaseBirth defects

CongenitalPenumoniaBirth trauma

InfectionsRespiratory DistressSyndrome

Children with normal birth

weight

Children with low birth weight

Structure of Early Neonatal Deaths by birth Structure of Early Neonatal Deaths by birth weightweight

VVLBW (500-999 g)

1%

LNBW (2000-2499 g)66%

VLBW (1000-1499 g)10%

LBW (1500-1999 g)23%

Programme GoalProgramme Goal

To reduce perinatal mortality through overall improvement of health status of reproductive age women, and improvement of newborn care provided by maternal and other concerned health institution of the Republic of Kazakhstan

Programme ObjectivesProgramme Objectives To reduce antinatal losses through To reduce antinatal losses through

improved health of reproductiveage improved health of reproductiveage women, and introduction of modern women, and introduction of modern antenatal technologiesantenatal technologies

To reduce intranatal losses by adoption of To reduce intranatal losses by adoption of evidence based EOC technologiesevidence based EOC technologies

To reduce early neonatal mortality due to To reduce early neonatal mortality due to asphixia, RDS, birty trauma and infections, asphixia, RDS, birty trauma and infections, by means of improvements in perinatal by means of improvements in perinatal carecare

Programme Implementation Programme Implementation MechanismsMechanisms

Development and introduction of package activities aimed at overall improvement of health of reproductive age women

Development of universal principles of perinatal health care

Regionalisation of perinatal care Programme of Continuous Quality

Improvement

Programme ActivitiesProgramme ActivitiesI. Improvement of health status of

women of reproductive age

II. Development of universal principles of perinatal care

III. Regionalisation of perinatal care (staged care)

IV. Continuous quality improvement

Improvement of health status of reproductive age women

Rationalisation of nutrition of reproductive age women including essential use of fortified flour and iodised salt, as well as organisation of ‘Nutrition Couseling’

Prevention of STIs Family planning Information of population on issues

concerning reproductive health

Development of universal principles of perinatal care

Development and introduction of regulations concerning provision of ante-, post-, perinatal and neonatal care based on effective WHO technologies

Review of documents regulating provision of maternal services and bringing them in line with new technologies

Development and introduction of national protocols on intra- and postneonatal care.

Regionalisation of perinatal care (staged care)

Development and approval of standards for levels of maternal (orgnaisations) insitutions

Inventory of maternal organisations Development and approval of

resolution endorsing distribution of maternal organisations by levels of perinatal care

Programme of Continuous Quality Improvement

Improvement of organisation and management of perinatal care

Improving the knowledge and qualification of health workers. This includes the use of BABIES matrix and TQM package

Programme monitoring and evaluation

Expected Outcomes Expected Outcomes of the Programmeof the Programme

Reduction of infant mortality, mainly as a result of reduced perinatal losses

Reduction of proportion of children with low birth weight and especially those with very lowbirth weight (below 1500 g). It is also expected that improvement in overall health of women will result in reduction of maternal mortality

Mapping of activities aimed towards Mapping of activities aimed towards reduction of perinatal and infant reduction of perinatal and infant mortalitymortality

Health ofHealth ofwomen women mothersmothers

Antenatal Antenatal carecare

InfantInfant carecare

Intra-Intra-natalnatalcarecare

Newborn Newborn carecare

7 days 28 days 1 yrPrematurity

5,2 % Antenatal mortality - 6,2 ‰

Perinatal mortality – 15,5 ‰

Infany mortality – 19,4 ‰

Fetal and infant mortality - ? ‰

Still births – 7,9 ‰

Earlyneonatal7,6 ‰

22 wks. 28 wks Delivery

Thank You!Thank You!