Transcript Community Health Assessment Maternal and Child Health Republic

Community Health Assessment
Maternal and Child Health
Republic of Kazakhstan
Meruert Rakhimova
Kanat Shakenov
Faina Linkov
Kazakhstan: Introduction
Location: North of Central Asia
Population: 14.9 million (53% women) (1999)
Religion: Islam
Ethnicity:
Kazakh 53.4%, Russian 30%, others 16.6
Political status:
former Soviet Republic,
independent state since 1991
Objective:
To analyze factors influencing maternal
and child health in Kazakhstan.
To identify major health deficiencies in
these areas and to propose
interventions strategies for improving
the current situation.
Conceptual Framework
MANDALA of Health.
We looked at multiple factors influencing
maternal and child health in
Kazakhstan:
 Maternal education
 Women’s role
 Economics
 Environment
And other factors…..
Culture
Community
Lifestyle
Personal
Behaviour Family
Spirit
Human
Biology
Psycho-Socio
Economic
Environment
Physical
Environment
Human-Made Environment
Biosphere
DECLINE IN:
Birth rate per 1000:
 1994 – 18.2
 1999 – 14.0
Fertility rate (No of children per woman):
 1989 – 2.9
 1995 – 2.5
 1999 – 2.1
Maternal and Child health
indicators in Kazakhstan

Infant mortality rate
61.9 / 1,000

Under-five mortality rate 71.4 / 1,000

Maternal mortality
62.5 per 100,000
Comparison Communities
Uzbekistan
Infant
Mortality
80/1,000
Russia
UK
25/1,000
5.86/1,000
Under 5year 105/1,000
mortality
30/1,000
8/1,000
Maternal
mortality
75/100,000
9/100,000
39/100,000
Major causes of infant mortality per 10,000
ALL CAUSES
Respiratory diseases
Incl. pneumonias
perinatal morbidity
(unspecified)
Incl. GI infections
Congenital abnormalities
Accidents, poisoning,
injuries
1994
1995
1996
268.2
80.3
78.0
82.5
265.0
84.6
83.8
73.0
248.1
75.1
74.0
77.9
28.3
32.3
14.8
28.2
35.5
13.2
21.2
30.4
14.3
Access to healthcare (1999)




Obstetricians and gynecologists supply –
14.4 per 1,000 newborns
Pediatricians supply
(incl.neonatologists)- 1.32 per 1,000
children aged 1-14
Antenatal care received – 94%
No of births delivered at health facilities
– 98%
Vaccination coverage among
children 12-23 months (1999):


BCG and first dose of polio and DPT/DP
– 99%
All WHO-recommended vaccinations –
81%
Personal Behavior

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Changes in values
Substance abuse
Lowered average age at first sexual
intercourse
Unsafe sexual practices
Incidence of syphilis in KZ per
100,000 (years 1991 thru 1999)
300
268,9
250
231,2
200
231,4
182,2
150
122,9
100
50
0
32,6
2,1 3,5 8,2
1991 1992 1993 1994 1995 1996 1997 1998 1999
Human biology


DALE - 56.4 years (122 rank)
Average life expectancy is decreasing for
the past decade:
1988 – male – 64.8; female – 74.1
2000 – male – 58.8; female – 70.1
Physical Environment



Proper housing
Fresh water – 59% piped water (1999),
1/3 (30%) use water from an open well,
urban – 90% piped water, rural – 35 %
Sanitation
Urban – 81% flush toilets,
Rural – 5% flush toilets (94 % pit toilets)
Psycho-Social-Economic Status




Female Literacy - over 99%
Muslim society-the role of women is
undermined
Women are underrepresented in the
government
Women have little decision making power
Major Deficiencies





Financial difficulties due to economic crisis
(approx. 2 - 2.5% of GDP goes to
healthcare; GDP itself decreased by 50%
after collapse of Soviet Union)
Access to quality healthcaredisproportionate allocation of health
facilities-all rural areas are underserved
Absence of health insurance
Access to fresh water supply
Sanitation problems
Proposed interventions




Elaboration and implementation of
reproductive health programs ( raise
health awareness among women, family
planning)
Increase access to quality health care for
indigent women and children
Legal restrictions on alcohol and cigarette
sales and consumption
Provision of information to population via
Mass Media on available health resources
Useful Links Related to Maternal and
Child Health in Kazakhstan
Official web site of Kazakhstan (Background)
Republic of Kazakhstan Social Protection
Project, supported by World Bank (targeting
kindergarten age children)
Maternal Health Around the World Maternal
Mortality in Asia