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UDC 616-007.1-053.2
ANALYSIS OF SOCIAL LOSS DUE TO BIRTH DEFECTS AMONG CHILDREN IN KYZYLORDA REGION
N.K. Dyussembayeva, A.E. Shpakov, B.M. Salimbayeva,
D.H. Rybalkina, E.A. Drobchenko, J. Izmahanov, S.B. Kenzhebekova
National centre of occupational health and disease MoH and SP of RK,
Regional Hospital of Kyzylorda region Karaganda state medical university, Karaganda, Kazakhstan
A comprehensive assessment of medical and social costs of children in deprived regions of Kazakhstan was carried out by YLL-analysis based on classification of congenital malformations in the period from 2009 to 2013 on the basis of demographic indicators and data on the number of deaths. Absolute loss of years for the study region by the birth defects was 2.62% of the total medical and social losses. The work was performed as part of NTP "Integrated approaches to the management of the state of health of the population of the Aral Sea region."
Key words: YLL index, mortality, classification of birth defects
Introduction. Congenital malformations belong to the category of diseases which for decades attracted the attention of the scientific community and public health practitioners. They are among the most serious deviations in the health of children and have significant impact on morbidity, mortality and disability in childhood [1,2]. Currently, for comprehensive evaluation of health of the population DALY and YLL-ana-lysis methods are the most preferred. Advantages of the method are that it provides multidimensional analysis and standardization; reducing the dimension of the description of the object while preserving its information content. It should be noted that for health management YLL index may be a basis for optimizing the economic planning [3,4]. Importance of the evaluation of years of life lost by age and sex in the structure of morbidity and mortality in Kazakhstan is obvious, because researches in this field, analysis of medical and social losses are relatively few [5,6]. Of particular interest to epidemiologists is monitoring congenital malformations in environmentally disadvantaged areas [7,8].
Aim: to define YLL index based on birth defects among children, living in environmentally disadvantaged areas of Aral Sea and its interpretation.
Research methods. According to ICD-10 the congenital anomalies and chromosomal abnormalities were chosen. Based on standard life tables, data from statistical public reports of Kyzylorda region in the number of deaths in the period from 2009 to 2013 was calculated YLL index with absolute and intense indicator loss among children
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of age groups 0-4 and 5-14 years, according to WHO recommendations [9]. YLL index calculation was made on the basis of the formula (1) [10].
YLL = X Dx * ex, (1)
where Dx - number of death at age x, ex - life expectancy at age х (from standard life tables), х - from 0 to 14.
Statistical processing of data was performed on Statistica - 10 software, significance of the difference between the average values detected by the method of statistical parametric Student t-test. Descriptive statistics in the article is presented as relative ratios.
Results. For the child population of the region, average of 212,721 in number, was obtained array of integrated indicators, average and total values of which are shown in Table 1.
Table 1 - Index of medical and social losses due to the class of birth defects in children of Kyzylorda region for 2009-2013
Age category Unit YLL 2009-2013
male female total
0-4 years to 1000 26,8 28,5 27,6 M (av.)
23,3 - 30,3 22,6 - 34,3 22,1 - 33,2 95% ДИ
abs. 1180,6 1177,2 2357,4 M (ср.)
1094,9 - 1266,3 1001,2 - 1353,2 1990,4 - 2724,4 95% ДИ
5903,0 5886,0 10577,0 X
5-14 years to 1000 0,8 0,7 0,6 M (ср.)
0,5 - 1,2 0,4 - 0,9 0,3 - 0,9 95% ДИ
abs. 51,8 39,3 81,0 M (ср.)
27,6 - 75,9 23,6 - 55,1 48,6 - 113,4 95% ДИ
207,0 118,0 294,0 X
Total to 1000 3,5 3,4 3,5 M (ср.)
3,1 - 3,9 2,8 - 4,0 2,9 - 4,0 95% ДИ
abs. 1221,6 1200,8 2422,4 M (ср.)
1111,2 - 1332,0 1006,2 - 1395,4 2034,2 - 2810,6 95% ДИ
6108,0 6004,0 10872,0 X
YLL index in total for 5 years - 10872 absolute value (2,62% of general social and medical loss). Significant differences between male and female values were not detected. For comparison, data on the contribution to the total loss of years considered the loss of years at death and disability for oncological diseases Kyzylorda region, which amounted to 47539 units DALY [11]. Data loss due to congenital malformations acco-
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unted for a quarter of the years lost due to malignant tumors, which are characterized by a high proportion of deaths.
In the dynamics was observed a decrease in the number of years, both among male children and among female, lost due to premature mortality from birth defects (Figure 1).
Figure 1 - Dynamics of YLL index (to 1000 population) for 2009-2013 among children of Kyzylorda region based on birth defects
The share of congenital malformations in the structure of infant and child mortality by Kyzylorda region, which is considered as environmentally disadvantaged in Aral Sea region, for 2009-2013 was in average 14.7%. Among the causes of death by birth defects were present: congenital malformations of the circulatory system (44.1%), other congenital malformations (23.3%), the birth defects of the nervous system (12.5%), digestive disorders (7.5%) and respiratory (4.0%), chromosomal abnormalities (3.8%), the deformation of the musculoskeletal system (3.0), abnormalities of the urinary system (0.75%), cleft lip, palate (0.75%), eye, ear, face and neck abnormalities (0.25%).
In the diagram of an YLL index by age and sex were observed peaks of growth and decline of losses (Figure 2). Since the quantities alternately increasing and decreasing, to approximate, smoothing and prediction for two periods used polynomial trend line, while the prevalence of congenital developmental threshold and damage caused by this disease in the next two years will probably increase, which may be due, to the combined impact of risk factors on the areas of concern and the increase in population.
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Figure 2 - Dynamics of YLL index among children of Kyzylorda region based on birth defects
If YLL index calculated not by standard, but by the model life tables (table 2) -they will be less as the average survival time of Kyzylorda region is smaller than the standard, although it is observed the increase in the dynamics. But if the difference between the standard and actual average life expectancy could also be conditionally accepted, as the years of lost life, the number of lost years of relative population will increase significantly.
Table 2 - The average survival time for children of Kyzylorda region in comparison (difference) with standard data
V! Й 1) !>-. Standard Kyzylorda region
2009 2010 2011 2012 2013
male female male female male female male female male female male female
0 80,0 82,5 63,7/ 72,6/ 64,6/ 73,1/ 65,2/ 73,7/ 65,8/ 74,0/ 66,7/ 75,0/
16,3 9,9 15,4 9,4 14,8 8,8 14,2 8,5 13,3 7,5
1 79,4 81,8 63,7/ 72,6/ 64,5/ 73,0/ 65,0/ 73,4/ 65,6/ 73,7/ 66,3/ 74,6/
15,7 9,3 14,9 8,8 14,4 8,4 13,8 8,2 13,1 7,3
5 75,4 78,0 60,1/ 68,9/ 60,8/ 69,3/ 61,3/ 69,7/ 61,9/ 69,9/ 62,6/ 70,8/
15,3 9 14,6 8,7 14,1 8,3 13,5 8 12,8 7,1
10 70,4 73,0 55,3/ 64,1/ 56,0/ 64,4/ 56,5/ 64,8/ 57,1/ 65,0/ 57,7/ 65,9/
15,1 8,9 14,5 8,6 13,9 8,2 13,3 7,9 12,7 7,1
15 65,4 68,0 50,5/ 59,2/ 51,1/ 59,5/ 51,7/ 59,9/ 52,2/ 60,1/ 52,9/ 61,0/
15 8,9 14,3 8,5 13,8 8,2 13,2 7,9 12,5 7
Based on the above, the problem of congenital malformations and mortality in this area should play an important role in prevention programs of the region.
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Thus, the years loss for the period 2009-2013 years class of congenital malformations in Kyzylorda region totaled 2.62% of the total medical and social losses. The dynamics of the loss of years due to congenital malformations were analyzed by YLL-analysis, was characterized reduction indicators, but with a forecast of their increase. No significant gender differences were found. The average life expectancy of children in ecologically unfavorable Aral Sea region was below the standard indicators.
References
1. WHO fact sheet "Malformations", № 370, January, 2014. - URL: http://www. who. int/ mediacentre/factsheets/fs370/ru/ (date of appeal: 11.02.14)
2. Corsello G., Giuffre M. Congenital malformations // Journal of Maternal-Fetal and Neonatal Medicine. - 2012. - V.25, №1. - P. 25-29.
3. Hannah Blencowe, Theo Vos, Anne CC Lee et all. Estimates of neonatal morbidities and disabilities at regional and global levels for 2010: introduction, methods overview, and relevant fndings from the global Burden of disease study // Pediatric Research. - 2013. - V.74, №1. - P. 4-16.
4. Demikova N.S. Monitoring of congenital malformations and its importance in the study of epidemiology // Russian Bulletin of Perinatology and Pediatrics. - 2003. №4. - P.13-17.
5. Slazhneva T.I., Popova T.V. Using the index DALY In assessing medical and demographic situation in the Republic of Kazakhstan // Journal of Central Asian Health Service Research - 2007. - № 6 (4) - P. 70-72.
6. Tulegaliyeva A.G., Bermagambetova G.N., Kim S.V. Years lost due to premature mortality in Kazakhstan. Methodological approaches to the assessment of individual health services // Clinical Medicine of Kazakhstan - 2012 - №1(24). - P.6-11.
7. Zhalgasbayev G.Sh. On the state of childhood disability in Kyzyl-Orda region based on the pediatric department of Medical and Social Expertise // Materials of VI Congress of Pediatricians of Kazakhstan - Almaty, 2006. - P. 69.
8. Bokonbayeva S.Dj., Aldasheva N.M., Lobzova A.V., Djanibilova G.A. Congenital malformations as an indicator of the quality of the environment // Bulletin KRSU. - 2008. - V.8, №4. - P. 165-170.
9. URL: http: //www.who.int/entity/ health info /bod reference YLL calculation template. xls.
10. Methodology of comprehensive assessment of health loss as a result of morbidity and mortality. Rostovtsev V.N., Lomat L.N., Ryabkova O.I. et al. State "Belarusian Centre for Medical Technologies, Informatics, Management and Health Economics" - Minsk, 2008. - 28 p.
11. Dyussembaeva N.K., Rybalkina D.H., Shpakov A.E. et al. Analysis of the index DALY class neoplasms population Kyzylorda region // Occupational hygiene and medical ecology. - 2014. - №4(45). - P.52-60.
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Тұжырым
Қазақстанның қоршаған орта көрсеткіштері бойынша жағдайы төмен ай-мақтарындағы балалар арасында медициналық-әлеуметтік шығынын кешенді ба-ғалау 2009 - 2013 жылдар аралығында туа біткен даму ақаулары түрлері бойынша демографиялық және өлім көрсеткіштерін сараптау YLL сараптама әдісімен жүр-гізілді. Зерттелетін аймақтағы туа біткен ақаулардан абсолют жылдар шығыны жалпы медициналық-әлеуметтік шығынның 2,62%-н құрайды. Жұмыс «Арал ма-ңы тұрғындарының денсаулығын басқарудағы кешенді тәсілдеме» ҒТП аясында жасалған.
Түйінді сөздер: YLL индексі, өлім көрсеткңштері, туа біткен даму ақаулары
Резюме
Была проведена комплексная оценка медико-социальных потерь у детей неблагополучного региона Казахстана методом YLL-анализа по классу врожденные пороки развития за период с 2009 по 2013 гг. на основании демографических показателей и данных по смертности. Абсолютная утрата лет для исследуемого региона по ВПР составила 2,62% от общих медико-социальных потерь. Работа выполнена в рамках НТП «Комплексные подходы в управлении состоянием здоровья населения Приаралья».
Ключевые слова: индекс YLL, смертность, класс врожденных пороков развития
УДК 613.6:612.15(574.3)
ВЛИЯНИЕ ХИМИЧЕСКИХ ФАКТОРОВ НА БИОХИМИЧЕСКИЕ ПОКАЗАТЕЛИ СПЕРМАТОГЕНЕЗА У МУЖЧИН, ПРОЖИВАЮЩИХ В РЕГИОНАХ ЦЕНТРАЛЬНОГО КАЗАХСТАНА
Б.Ж. Култанов
Карагандинский государственный медицинский университет, г. Караганда
В данной работе дана оценка влияния химических факторов, распространенных на территории Центрального Казахстана, на биохимические показатели сперматогенеза. Объектом исследования послужил эякулят мужчин 6-ти населенных пунктов Карагандинской области. Полученные результаты свидетельствуют о нарушении процессов ПОЛ-АОЗ в сперме у мужчин молодого возраста.
Ключевые слова: перекисное окисление липидов, антиоксидантная защита, сперматогенез, эякулят
ISSN 1727-9712
Гигиена труда и медицинская экология. № 1 (46), 2015
