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творческие проекты, диспуты. Отрадно то, что эти методы обучения развивают студента как в профессиональном, так и в коммуникативном отношении. Обязательным компонентом должна стать обратная связь со студентами. Эффективная обратная связь - один из краеугольных камней в основе эффективного обучения коммуникативным навыкам [3,5]. Основные требования к обратной связи: ясное изложение, регулярность, сбалансированность и конструктивность, индивидуальная направленность, объективность. Таким образом, владение коммуникативными навыками в совершенстве, то есть, фактически наличие коммуникативной компетентности - одно из условий успешной профессиональной деятельности, устойчивости к эмоциональному выгоранию.
Литература
1. Асимов М.А., Нурмагамабетова С.А., Игнатьев Ю.В. Коммуникативные навыки: Учебник.-Алматы.-2008.- 212 с.
2. Телеуов М.К., Досмагамбетова Р.С., Молотов-Лучанский В.Б., Мациевская Л.Л. Сферы компетентности выпускника медицинского вуза. Компетентность: Коммуникативные навыки: - Методические рекомендации. - Караганда. - 2010 г. - 46 с.
3. Дернер К. Хороший врач. Учебник основной позиции врача. // Пер. с нем. И.Я.Сапожниковой, Э.Л.Гушанского. - М.:Алтейя, 2006.- 544с.
4. Чусовлянова С.В. Автореф. дис.к.п.н. Коммуникативная культура студентов медицинского вуза в контексте их жизненных и профессиональных ценностей в Российском обществе начала 21 века. М., 2009.- 38с.
5. Герасименко С.Л. Совершенствование коммуникативной культуры студентов в условиях медицинского вуза. // Электронный педагогический журнал. - 2007. - №1
ANALYSIS OF PERINATAL AND NEONATAL MORTALITY CAUSES IN ALMATY IN 2008-2010
N.S. Bozhbanbayeva, A.A. Berikbayeva, A.I. Amanbekova, A.S. Kurbanova
Neonatology Department Kazakhstan National Medical University named after S.D. Asfendiyarov
Abstract Analysis of mortality and juvenile neonatal mortality in Almaty for the period 2008-2010 was carried out. Among the causes of juvenile neomortality the leading position belongs to infections. 82.6% of neomortality cases fall within premature infants. Keywords perinatal period, infant, prematurity.
2008-2010 ЖЫЛДАР АРАЛЫГЫНДА АЛМАТЫ КАЛАСЫ БОЙЫНША ПЕРИНАТАЛЬДЫ ЖЭНЕ НЕОНАТАЛЬДЫ еЛ1МШ1ЛД1КТ1Н СЕБЕПТЕРШ1И САРАПТАМАСЫ
2008-2010 жылдар аралыГында Алматы Каласы бойынша перинатальды жэце неонатальды eлiмшiлдiк сараптамасы жYрпзiлдi. Ерте неонатальды eлiмшiлдiк себептер^ц штде жетекшi орынды инфекционды фактор алатыны аны^талды. Неонатальды eлiмшiлдiк Курылымында шала туылгандар 82,6% Курайды.
Анализ перинатальной и неонатальной смертности по городу Алматы за период 2008-2010 гг
Проведен анализ перинатальной и неонатальной смертности по городу Алматы за период 2008-2010 гг. Выявлено (определено?) что среди причин ранней неанатальной смертности ведущее место занимает инфекционный фактор. В структуре неонатальной смертности недоношенные составляют 82,6%.
Immediate problem of modern pediatry is still the prevention of exigent conditions and reduction of infant mortality, including neomortality (juvenile and late). Neomortality rate is one of the key indicators of healthcare system and it is used for political, administrative and managerial decisions. Proper and on-time analysis of infant mortality enables to develop a series of specific measures focused on improvement of pregnant women and children's health, to evaluate effectiveness of preventive measures,
work of local healthcare authorities related to protection of motherhood and childhood.
The aim of the study was to conduct a perinatal audit with regards to the rate level and causes as a basis for the development of measures focused on reduction of perinatal and neonatal mortality. Material and methods of study
We conducted a retrospective analysis of 2760 mortality cases in Almaty during the period of 2008-2010. Study results and discussion
During the study of direct neonatal mortality cases (anatomopathological diagnosis) it was found that the leading position belongs to asphyxia (31.1%), second position to intrauterine pneumonia (27.5%), respiratory distress syndrome, (20.5%), congenital malformations (14.9%), other (6.1%). The studies revealed that 1139 newborns died in the juvenile neonatal period and it amounted to 41.3% out of the whole number of mortality cases of 0-27 days old infants and stillborns. Out of the total number of stillborns and infants who died within the first 27 days, 605 newborns died within the late neonatal period which amounts to 21.9%. 1016 cases (36.8%) of stillbirths were registered. As for the place of death, most mortality cases occurred in maternity hospitals (32.7%), perinatal center (54.7%), infectious hospitals (3.5%) and children's hospitals (9.1%). Of all cases of mortality in neonatal period there were 82.6% of preterm infants, 15.5% of full-term infants and 1.9% of post-term infants.
Only 32.1% of infants with birth weight between 500 and 999 and 24.4% of infants with birth weight between 1000 and 1499 grams died. Consequently there were 56.5% of small premature infants. There were 26.1% of newborns with birth weight between 1500 and 2499 grams and 17.4% of newborns who weighted more than 2500 grams (see Table 1 below).
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Table 1. Information on stillbirths and infants who died within first 27 days of their life (including those born at 22 weeks of pregnancy and more)
2008-2010 in Almaty
of which Died in juvenile neonatal period (0-6 days) Died in late neonatal period (7-27 days)
Birth weight (in Stillbirths
grams) death occurred in antenatal period death occurred in intrapartum period
500-999 332 189 143 446 108
1000-1499 210 171 39 297 168
1500-2499 278 256 22 252 189
2500 and more 196 143 53 144 140
Total 1016 759 257 1139 605
2760
Among all stillbirths the majority of infants (74.4%) died in antenatal period, and 25.3 died in intranatal period.
In the structure of mothers' illnesses infections are leading: cold-related diseases (72.1%), chronic tonsillitis (46.3%), chronic pyelonephritis - (74.5%), chronic adnexitis - (31.8%), sexually transmitted infections (53.2%). The high frequency of anemia (92.6%) indicates to abnormal conditions, nutrition, lifestyle and is an unfavorable factor for gestational process. Among social and domestic factors it should be noted that 38% of women were not in a registered marriage, so most pregnancies were not planned and wanted, 17.8% live in inadequate housing conditions. If distributed by Almaty districts, the highest percentage of cases was noted in Turksib, Auezov and Zhetysu districts. According to data received, an important risk factor of perinatal and neonatal mortality is gestational toxicosis of pregnant women (88.3%), severe preeclampsia (17.8%). A threat of pregnancy termination was observed in 44% of women. Young mothers amounted to 2.6%, primiparas of older age - 22.9%. It was found out that 85.7% of children were born prematurely and among them 52.5% had severe conditions at birth with Apgar score of 1-5 points. Most (45.5%) children died within the first two days, 17.1% - on 3-4 day, 23.4% on 5-6 day, 8.1% on the 7th day. We noted that among the causes of juvenile neonatal mortality the frequency of asphyxia and birth trauma decreases from the 1st day of newborn's life and the frequency of fetal infection increases to the 3rd-4th day of life.
Fast and rapid labors resulted in the death of 37.5% of newborn children, prolonged labor of 21.3% of women resulted adversely. Thus, the analysis of postnatal deaths causes and risk factors (social and domestic conditions, woman's health, peculiarities of pregnancy and labors) has shown that all these factors in varying degree influence the state of a newborn child, however the major importance among the reasons of juvenile neonatal mortality has infectious factor. In this regard, prevention of juvenile neonatal mortality for mothers should include sanitation of infection focal points and pregnancy planning. Conclusions
1. Among the causes of newborn children morbidity and mortality the "leading" factors occurring in perinatal period are the following: growth retardation and malnutrition, neonatal icterus, fetal hypoxia, birth asphyxia, birth trauma.
2. Within the years analyzed the frequency of "fetal hypoxia, asphyxia at birth" significantly decreased, and the frequency of "birth trauma" decreased too but to a lesser extent.
3. In the dynamics of most indicators shown by the official statistics that characterize basic obstetric practice there are distinct positive trends that prove the effectiveness of events carried out in accordance with clinical guidelines being introduced.
Литература
1. Котова Е.Г. Роль акушерского консультативного центра в снижении перинатальной смертности / Котова Е.Г., Мурашко М.А. //Материалы симпозиума «Здоровье человека на Севере» в рамках Третьего Северного социально-экологического конгресса «Социальные перспективы и экологическая безопасность». Сыктывкар, 2006. - С. 34.
2. Вартапетова Н.В. Показатели смертности доношенных детей и мертворождаемость - как факторы качества организации работы учреждений родовспоможения // Социальные аспекты здоровья населения - электронный научный журнал. - Институт здоровья семьи, Москва, 2010.
3. Кудайбергенов Т. Пути снижения материнской и младенческой смертности. Казахстанский опыт. // Москва, октябрь, 2011.
4. РК АГИУВ ЗАО «Казахская академия питания». Причины младенческой и детской смертности в Казахстане // Министерство здравоохранения Алматы, 2002
5. Байрашева В.К., Дудниченко Т.А. Анализ ранней неонатальной смертности у юных матерей // Санкт-Петербургская государственная медицинская академия имени И.И. Мечникова Санкт-Петербург, Россия. 459 с.
