СОВЕРШЕНСТВОВАНИЕ ОРГАНИЗАЦИИ И УПРАВЛЕНИЕ КАРДИОЛОГИЧЕСКОЙ ПОМОЩЬЮ НАСЕЛЕНИЯ ЮЖНО-КАЗАХСТАНСКОЙ ОБЛАСТИ

Результаты исследований по области и материалы Минздрава РК свидетельствуют о незначительной эффективности проводимых мероприятий по снижению смертности от кардиоваскулярных, чем от цереброваскулярных болезней. По данным исследования причинами этого служат: 1) недостаточно высокое качество специализированной медицинской помощи, оказываемой больным с ОКС и ОИМ; 2) недостаточная оснащенность и квалификация персонала ФАП, общеврачебных практик (ОВП) и бригад скорой медицинской помощи; 3) отсутствие четких критериев выбора методов лечения и алгоритмов действия медицинского персонала на каждом этапе оказания помощи; 4) нарушение преемственности при оказании медицинской помощи больным на разных этапах; 5) несоответствие оснащения лечебных учреждений требованиям, указанным в Порядках оказания медицинской помощи при БСК.

Ключевые слова: кардиологическая помощь, смертность от болезней системы кровообращения, медико-социальные проблемы, эффективность мероприятий.

 

UDK: 616-053.2: 338.124.4

STATUS OF HEALTH OF CHILDREN GROWN IN THE PERIOD OF SOCIAL AND ECONOMIC CRISIS

¹ Grjibovski A.M.  ² Buleshova A.M., ² Buleshova R.M. ² Abdullaeva G.B., ³ Z h anabayev N.S., ³Z.I.Sultanova.

¹ Norwegian Institute of Public Health, Oslo, Norway

² South Kazakhstan medical academy

³ International Kazakh-Turkish University

ABSTRACT

The total incidence of children in the SKO is 1003.42 cases per 1000 children, and the primary incidence is up to 401.92 cases.

The incidence of children, identified through preventive examinations, is 2772.2% o. With age, there is an increase in its level from 2, 291.7% at the age younger than 11 years to 2829.3% in adolescents. The structure of pathological involvement is dominated by: diseases of the musculoskeletal system and connective tissue (24.3%), mental and behavioral disorders (16.7%), respiratory diseases (15.3%), endocrine system diseases, eating disorders and metabolic disorders (14.5%), diseases of the eye and its adnexa (12.9%). Only 5.7% of those surveyed do not need to be monitored, while 87.4% need to be monitored by narrowly specialized doctors, 2.9% are monitored by a local doctor, 4.0% by a hospital examination or treatment. The first group of health is 6.7%, to III and more groups - 31.2% of children.

Key words: general morbidity, incidence of children, diseases of the musculoskeletal system, mental disorders, eye diseases, socioeconomic situation.

Relevance of the topic. 2015-2017 years in the Republic of Kazakhstan were characterized by a socio-economic crisis associated with the global economic crisis. In the period of any crisis, the least socially protected segments of society, including children, suffer the most. It is the health of children that can serve as an indicator of social well-being, and the attitude of the state towards them determines the degree of its civiliza- tion [1, 2, 3]. The instability of the socioeconomic situation in recent years has significantly worsened the situation of children and the family's ability to provide life support and development. Particular concern is the health of schoolchildren - the most numerous age group of the child population. Modern schoolchildren, according to several authors, have a lower level of health than their peers several decades ago [4].

Negative trends in the health of children are primarily associated with the increased impact of risk factors due to deterioration in family quality of life [2, 3, 5]. The changing conditions of life require from the population an equally rapid adaptive response, with social pressures often becoming excessive [2, 3]. However, medical and social studies that prove the presence of changes in the health status of schoolchildren due to the dynamics of risk factors have not been found in the literature available to us.

Materials and methods.

As an object of research, we chose Shymkent city and Maitalar and Tyulkubas regional polyclinic organizations, which are typical for settlements in the South Kazakhstan region. The number of serviced population is 1342 000 people, of which 52.7% (of which 12.5% are girls) constitute the female population, 47.3% (13.7% male) male population.

Among the served population, 17.2% are industrial workers, 11.6% employees of the education organization, administrative subordination, 16.8% pensioners and disabled citizens, 28.9% employees of commercial organizations and enterprises, and 26.2% children in age from 0 to 14 years inclusive.

The polyclinic has a planned annual load equal to an average of 50, 000 visits. In the study of polyclinics there are 2 departments of general medical practice, surgeon's offices, ENT doctor, neurologist, ophthalmologist, children's physician and physiotherapy rooms. Medical offices are equipped with all necessary medical equipment, and auxiliary cabinets - modern rendgenodiagnostic apparatus, physiotherapy equipment, all offices have computer settings, the attendance of patients is automatically recorded.

To study the characteristics of the medical and social characteristics of outpatients and the respondents of the organizations served by the doctors, a questionnaire was developed for an outpatient patient consisting of two parts. The first part was filled by patients or their parents and was designed to evaluate the medical and social characteristics of sick children. The second part was filled by the leche doctor after filling out part one and included information about the purpose of the visit to the clinic, the diagnosis, the health group and the need for medical supervision of the medical organization. With the purpose of in-depth study of the work of the medical and preventive organization, a map was developed for studying cases of outpatient visits to a doctor.

For a comprehensive study of the doctor's work on preventive examinations, a map of the evaluation of the results of the preventive examination was developed. All necessary information about the results of the preventive examination, further tactics of introduction, information about the patient's follow-up group were recorded in the registration card. To assess the quality of the introduction of dispensary patients, a map was developed for assessing the quality of work of district doctors of pediatricians with a dispensary group of patients. The card was filled by copying the data from the outpatient card to each patient, who was under dispensary supervision. In addition to an objective assessment, patients underwent subjective assessment of the quality of medical care provided by an outpatient and polyclinic organization. To characterize this section, a number of sociological questions were included in the questionnaire of an outpatient patient.

The program and methodology of the present study, which made it possible to carry out a study of the incidence and organization of medical care for children using the system of monitoring the state of health of the child population, is as follows (Figure 1).

 

Scheme 1. The program of the study of morbidity according to the data of preventive examinations and the organization of medical care for children using the system of monitoring the state of health of the child population.

		Development of proposals on improving medical care for children from 1 to 17 years of age and introducing them into practical healthcare in the region

 

The complex nature of this study has determined the need for the correct formation of objects of scientific observation and analysis. Based on the need to ensure the reliability of the received materials, we used the general population, as the conditions for providing medical care in different regions and cities were different.

According to official statistics of the statistical department of the SKO, the total incidence of children from 0-14 years was 1002.18 to 1003.42 cases per 1000 children, the primary incidence of 416.35-421.92 cases per 1000 children from 0 to 14 years old (1 figure).

 

Figure 1 - Level and dynamics of primary and general morbidity in children 0-14 years old for 2017.

 

Preventive examinations made it possible to establish that the level of pathological affliction of children of all age groups is 2772.2 per 1000 people examined. With age, there is an increase in the incidence rate (Fig. 2) - from 2, 291.7% in the younger school age to 2829.3% in the older school groups of children.

 

Figure 2 - Level and dynamics of morbidity according to comprehensive medical examinations 2015-2017

 

In the structure of morbidity with a large margin five leading classes of diseases lead: diseases of the musculoskeletal system and connective tissue (24.3%), mental and behavioral disorders (16.7%), respiratory diseases (15.3%), diseases endocrine system, eating disorders and metabolic disorders (14.5%) and eye disease and its adnexa (12.9%), (Figure 3).

Diseases of the musculoskeletal system and connective tissue occupy the first place in the structure of the incidence of both schoolchildren and children over 10 years old, and they have the second place in junior schoolchildren. This class of diseases is represented mainly by various forms of curvature of the spine (76.6%) and flat feet (22.1%). As children grow up, there is a significant increase in the prevalence of this class of pathology, from 458.3% in younger pupils to 708.2% in adolescents, that is, the frequency of these diseases increases by more than 1.5 times during school.

 

Figure 3 - Structure of the total incidence of children from 0 to 14 years

 

The second place in the structure of pathological affliction of the examined children is occupied by mental disorders and behavioral disorders. The role of this class rises sharply in the period to 15 years, and then stabilizes. So, if in the age group up to 11 years, these diseases belong only to the fifth place in the structure of morbidity and the level of pathological affection is 208.3% o, then during the period of 11-14 years the prevalence rate doubles (417.2% o) and rank rank rises to the third, and in adolescence - even to the second. The greatest proportion of mental disorders and behavioral disorders are violations of physiological functions of psychogenic etiology (71.7%) and neurotic disorders (27.9%).

Diseases of the respiratory organs belong to the third place in the structure of the incidence of schoolchildren. Among the diseases of this class of diseases, the most significant are: chronic diseases of the tonsils and adenoids (33.1%), allergic rhinitis (29.1%) and curvature of the nasal septum (24.7%). The highest prevalence of these diseases and, correspondingly, the ranked place is observed in the age group up to 11 years - 541.7% (the first rank place), then the pathological affection is reduced to 389.2% at the age of 11-14 (the fourth rank place) and stabilizes within these limits.

The fourth place in the structure of the incidence of schoolchildren is occupied by diseases of the endocrine system, eating disorders and metabolic disorders, which are mainly obese (44.2%), eating disorders (34.2%) and thyroid diseases (10.4%). The prevalence of these diseases has a rise in the age of 11-14 years - the second ranked place (419.2% o), in the period up to 11 years and over 15 years their role is less significant (respectively, the third and fifth rank places, 343.8% and 355.5%).

In the fifth place - diseases of the eye and its adnexa. Pathological affection with these diseases is at the age of 11 years - 260.4% o, 11-14 years - 299.4% o, 15 years and older - 362.2% o, respectively 41 but 4, 5 and 4 ranked places. Despite the stability of the ranking place, the level of prevalence of these diseases during the training increases by 1.4 times. Among the diseases of the eye and its adnexa, 88.2% occupy violations of refraction and accommodation. The medical and social characteristics of the conditions and lifestyle of children are very important.

According to a number of authors, the age of parents has a significant effect on the health of children. Adverse is the age of over 35 years and under 18 for the mother and over the age of 45 for the father (at the time of the birth of the child). Among the families surveyed, 4.9% of mothers were over 35 years of age at the time of childbearing, 2.2% were under the age of 18, and 2.1% of fathers were over 45 years old.

Observance of the intergenetic interval of at least 2 years is an important factor determining the health of the child. In the SKO region, 45.5% of children had older siblings, and in 9.2% of cases the intergenetic interval was less than 2 years.

As most pediatricians point out, the natural feeding of a child is the most complete. Milk, obtained directly from the maternal breast, fully meets the needs of the child and fully contributes to its proper development.

REFERENCES:

1.    Mediko-social charter of the Russian Federation / Ed. Komarova GA 2 nd ed., Sr. - M., 2001.

2.    The concept of protection of reproductive health of the population of Russia for the period 2000-2004. And the plan of measures for its implementation // Family planning. 2000. - № 2.

3.    Republican complex target program & laquo-Children of Mordovia& raquo- for 2003-2006. Saransk, 2003. - 117 p.

4.    Recreation and health improvement of children and adolescents: Collection of normative documents. - M., 2002.

5.    Russia in figures. 2004: Brief. stat. Sat. Federal Service of State Statistics. - M, 2004. 99 p.

ТҮ ЙІН

¹ Гржибовский А.М., ²Булешова А.М., ²Булешова Р.М., ² Абдуллаева Г.Б.

³ Жанабаев Н.С. ³Султанова З.И.

¹ Норвегиялық қ оғ амдық денсаулық с ақ тау институты

² Оң тү стік Қ азақ стан облысының медициналық академиясы

³ Х.А. Ясауй атындағ ы Халық аралық Қ азақ -тү рік Университеті

Ә ЛЕУМЕТТІК-ЭКОНОМИКАЛЫҚ ДАҒ ДАРЫС КЕЗІНДЕ Ө СКЕН БАЛАЛАР ДЕНСАУЛЫҒ ЫНЫҢ ЖАҒ ДАЙЫ.

Балалар арасында ОҚ О бойынша 1000 тұ рғ ынғ а шақ қ анда жалпы балалар аурушаң дың дығ ы 1003, 42 жағ дайды қ ұ райды, ал біріншілік аурушаң дық 401, 92 жағ дайғ а дейін жетеді. Профилактикалық тексерулер арқ ылы анық талғ ан балалар аурушаң дығ ы 2772, 2%о қ ұ райды. Жастары ұ лғ ая келе оның дең гейі ө седі, 11 жастан кіші балаларда 2291, 7%о-ден 2829, 3%о ге дейін. Патологиялық зақ ымдану қ ұ рылымында басым кездеседі: тірек-қ имыл аппараты мен дә некер тіндер (24, 3%), психикалық ауытқ улар жә не іс-ә рекет ауытқ улары (16, 7%), тыныс алу жү йесінің аурулары (15, 3%), эндокринді жү йе аурулары, тамақ танудың бұ зылуы жә не зат алмасу бұ зылыстары (14, 5%), кө з аурулары жә не оның қ уыстарының аурулары (12, 9%). Тек 5, 7% зерттеуден ө ткендер ғ ана бақ ылауды қ ажет етпейді, ал 87, 4% жеке мамандар қ адағ алауында болулары қ ажет, 2, 9% - учаскелік дә рігерлер қ арамағ ында, 4, 0% - стационарда емделулері қ ажет. I денсаулық тобына 6, 7% жатады, II жә не одан жоғ ары топтарда - 31, 2% балалар бар.

Кілтті сө здер: жалпы жә не алғ ашқ ы аурушаң дық, балалар, тірек – қ имыл аппаратының аурулары, психикалық ауытқ улар, кө з аурулары, ә леуметтік-экономикалық жағ дай.

РЕЗЮМЕ

¹ Гржибовский А.М., ²Булешова А.М., ²Булешова Р.М., ² Абдуллаева Г.Б. ³Жанабаев Н.С. ³Султанова З.И.

¹ Норвежский институт общественного здравоохранения, Осло, Норвегия

² Южно-Казахстанская медицинская академия, Шымкент

³ Международный Казахско-Турецкий университет имени Х.А. Ясав

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