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9MEDICAL SCIENCES
BIRTH RATE AND ROLE OF THE MEDICAL-SOCIAL CARE HOMES FOR CHILDREN IN THE REPUBLIC OF BULGARIA
Shopov D.G.
MD, PhD, Chief Assistant Prof. Department of Social Medicine and Public Health Medical University-Plovdiv, Bulgaria
Stoev T.S.
PhD, Assoc.Prof.Department of Health management and Economy of healthcare, Faculty of Public Health,
Medical University-Plovdiv, Bulgaria Mihaylova V.K.
PhD,Assoc.Prof. Department of Preventive Medicine, Faculty of Public Health, Sofia; Chief Assistant Prof.
Department of Healthcare Management, Faculty of Public Health, Medical University-Plovdiv, Bulgaria
Alakidi A.
Medical Student in sixth year, Medicine Faculty, Medical University
Sofia, Bulgaria
ABSTRACT
The present article reviews some quantitative and qualitative indices related to birth rate, analysis of the situation in MSCHC (Medical-Social Care Homes for Children), the tendencies in the process of adoption in the Republic of Bulgaria for a 5-year period from 2012 to 2016 inclusive.
Demographic, social and economic factors precondition the reduced number of marriages and birth rate, the increased urbanization and intensive migration.
Some of the reasons for placement of children deprived of parental care in MSCHC (Medical-Social Care Homes for Children) are outlined.
There is reduction in the number of MSCHC and the accommodation capacities. There is a permanent tendency for decrease in the number of children raised in medical-social care homes.
The tendencies in the process of adoption of children from MSCHC are reported.
Keywords: birth rate, fertility, MSCHC (Medical-Social Care Homes for Children), parental care, migration, adoption
Material and methods:
The study is retrospective over a 5-year period -from 2012 to 2016 inclusive. Quantitative and qualitative indices have been used for the analysis. The primary information has been collected from the annual reports of the National Statistical Institute (NSI), Ministry of Health, National Centre of Public Health and Analyses. The statistical processing of the collected primary information has been performed using a variation, alternative and non-parametrical analysis. The computer processing of the collected database has been performed using the statistical pack SPSS version 19 and Microsoft Excel.
Introduction:
The economic conditions in the past years in Bulgaria are the reasons for the young people to refrain from giving birth to children.[2;3] There are some who „take the risk" and a significant number of them abandon their babies after giving birth. And how many girls have suffered sexual violation, helpless to cope with the hardships of life?! Their alternative is to leave their children in state homes. They do this with grief, torture and pain in their hearts but the common sense, and sometimes the parents and relatives encourage them to do so. And they do it. It is the best solution in their opinion.
For those young residents of Bulgaria, abandoned by their families, there are State homes for their raising.
The establishment of MSCHC (Medical-Social Care Homes for Children) within the system of the Ministry of Health is one of the main units in the struggle for reduction of the children's sick and death rate. [4]
The medical-social care homes for children are health institutions where children with increased medical-social risk aged 0-3 years are raised. Those children are deprived of parental care due to severe illnesses or death of one or both parents, their deprivation of liberty, etc. Initially «Mother and Baby» homes (MBH) have mostly been created to counteract the high death rate of children. Therefore it is natural that they strongly resemble hospitals. Over the years, however, the type of children accepted therein has changed and from hospitals they have turned into social institutions. They still accept children at high medical risk but the children reside there for a longer period of time, i.e. the children need a special establishment resembling a home, their home, and not a hospital.
Therefore, the main objective of the reform carried out by the Ministry of Health is to modify the «Mother and Child» Homes and from hospital institutions turns them into structures for bringing up children at medical and social risk. In 1997 the Ministry of Health started a structural reform at the «Mother and Child' Homes. In June 1998 the Ministry of Health carried out an accreditation of the 31 «Mother and Child» Homes existing in
the country for the purpose of optimization of the facilities and equipment, accommodation and staff-related issues. From closed hospital institutions, «Mother and Child» Homes became children"s medical and social care homes with an open strategy, providing an opportunity for mobility in the structure of the Homes.[1;5;6]
The change in the age (0-7 years) gives an opportunity for children who cannot be adopted or return to their biological families, to stay and grow up in a familiar setting with the people they knew and became fond of.
The establishment of MSCHC within the system of the Ministry of Health is one of the main units in the struggle for reduction of the children's sick and death rate.[7;8]
Funding of DMSCHC is carried out by the Republican budget, the relevant municipal budget, donations from local and foreign natural persons and legal entities.
Results and discussions:
The demographic development of Bulgaria is influenced by the general demographic processes typical of the developed countries, i.e. reduced marriage and
In the analyzed period of time the total number of newborn decreases: from 69678 in 2012 to 65446 in 2016. The boys slightly prevail. Bulgaria occupies one of the first places among the European countries according to the relative share of illegitimate births from
birth rate, increased urbanization as well as the increased death rate and intensive migration, specific for the developing countries and the countries in transition. The decrease in the birth rate is objectively preconditioned by the influence of a number of demographic, social and economic factors. From a demographic point of view, the reduced birth rate in the country is due to reduced fertility of the women at a birth-giving age and the decrease in their number.
The total fertility rate (average number of children born by a woman throughout her whole life) during the observed 5-year period from 2012 to 2016 inclusive is relatively constant, varying from 1.5 in 2012 to 1.54 in 2016. The theoretically determined minimum for the procurement of simple reproduction of the population is 2.1 live births (Chart 1).
During those years displacement of the births to higher age from 27.8 in 2012 to 28.5 in 2016.
The average age of the mother for her first child has an upward tendency: 26.3 years in 2012 - 27 years in 2016. The change is due to the modifications of the social and economic conditions and from there - in the women's value system - such values as education and employment come to the front.
Chart 1
all babies born in a given year: for 2012 - 57.53%, 2013 - 59.23%, 2014 - 58.96%, 2015 - 58.68%, 2016 -58.93% (Table 1):
Birth ratio
30 25 20 15 10 5 0
I Total fertility ratio(average number of children
JJJJJ
2012 Year 2013 Year 2014 Year 2015 Year 2016 Year 1,5 1,48 1,52 1,53 1,54
I Average age of the
motherwhen giving birth 27,8 27,9 28,1 28,3 28,5 (years)
I Average age of the
motherwhen giving birth to 26,3 26,5 26,7 26,9 27
1 child (years)
Table 1
Births by sex and marital status
Boys Girls
2012 Total 35976 33702
Year Legitimate 15186 14405
Illegitimate 20790 19297
2013 Total 34311 32750
Year Legitimate 14072 13267
Illegitimate 20239 19483
2014 Total 35006 33077
Year Legitimate 14300 13638
Illegitimate 20706 19439
2015 Total 34307 32063
Year Legitimate 14217 13206
Illegitimate 20090 18857
2016 Total 33612 31834
Year Legitimate 13934 13072
Illegitimate 19678 18762
We can outline some of the reasons for accommodating children deprived of parental care in MSCHC (Medical-social care homes for children):
• Inability to ensure suitable health care in the family for a child with disability or illness;
• Unwillingness of the parents to accept in the family a child with disability or illness;
• Unwillingness of the parents to accept the child in the family (the child is from another partner, care for many children in the family (over 3);
• Bad hygienic conditions in the family;
• Lack of home;
• Parent's unemployment;
• Negligence or another form of violence in the family environment;
• Lack of support from a partner, relatives and community;
• Health problem of the mother (mental or another disease);
• Alcohol abuse and other dependencies;
• Lack of skills for adequate parental care.
The analysis of the situation in MSCHC during the
period 2012-2016 inclusive shows that as a result of the active processes of removal of the children from the institutions and their placement in a family or alternative environment reduces the number of MSCHC - from 30 to 17. There is a permanent tendency of reduction in the number of children raised in medical-social care homes. In 2012 there were 2087 children in MSCHC and at the end of 2016 their number amounted to 609. The established and actually maintained accommodation capacity in the homes is also reduced: 3624 in 2012 and 1114 in 2016 (Chart 2).
Chart 2
Establishments, places and children in Medica social care homes
4000
I-
3500 3000 2500 2000 1500 1000 500 O
I Establishments I Places I Boys Girls
Lll
30 3624 1169 918
29 2258 670 534
29 2199 537 438
1
2015 Year 2016 Year
18 17
1429 1114
438 341
319 268
Accoridng to their age structure, the largest number belongs to infants below 1 year followed by those at the age of one (Chart 3).
The total number of the staff in the medical-social care homes (MSCHC) - medical institutions funded by the budget, with specific functions, secondary administrators of budget credits to the Minister of health, is reduced. The changes in the number would lead to reaching an adequate corelation between the available staff and the capacity of each establishment.
A comparative analysis of experts from the Social Assistance Agency reports the tendencies in the process of adoptions in the analyzed 5 years. The total number of adopted children out of the children with permanent residence in the country for 2012 is 738. In 2013 - 737, in 2014 - 676, in 2015 - 618, and for 2016 they are 556.
During each of the above years the number of children eligible for adoption is usually double the number of the candidate adopters. A significant part of the applicants entered in the register of adopters under conditions of full adoption have categorical requirements and preferences for the desired child - low age 0-3 years; good health condition; Bulgarian or mixed origin. The listed circumstances are a precondition for extension of the process of adoption.
From the data administered by the Social Assistance Agency it can be concluded that from the total number of 4277 adopted children for the period from 2011 to 2016, only 53 are the adopted children with disabilities.
The ratio between the number of candidate adopters and the number of children entered in the Register for adoption, has the following parameters in the studied period:
- as of 31.12.2012 - 1490 candidate applicants, 2835 children for adoption (1402 of them with disabilities) - the children for adoption exceed the number of candidate adopters by 90%);
- as of 31.12.2013 - 1470 candidate adopters, 3188 children (1411 with disabilities) - the total number of children exceeds the number of candidate adopters by 117%;
Chart 3
- as of 31.12.2014 r. - the candidate adopters are 1500 and the children entered in the Register for adoption are 2863 (1325 of them with disabilities), or by 91% more than the entered candidate applicants;
- as of 31.12.2015 the candidate applicants are 1542 and the children entered into the Register for adoption are 2611 (1206 of them with disabilities), or by 69% more than the entered candidate adopters;
- as of 31.12.2016 the candidate adopters are 1524 and the children entered into the Register for adoption are 2355, or by 55% more than the entered candidate adopters;
Conclusion:
The decrease in the birth rate is objectively preconditioned by the influence of a number of demographic, social and economic factors. From a demographic point of view the decrease in the birth rate in the country is due to the decreased fertility of the women at birth-giving age and the decrease in their number. There is an increasing relative share of illegitimate births.
The establishment of MSCHC within the system of the Ministry of health is one of the main units in the struggle for reduction of children's sick and death rate. Today the contemporary homes have much wider functions and responsible tasks related to the care for the most threatened groups of the population - children with an increased risk, low weight, inborn, hereditary anomalies, hypotrophy. Such children are deprived of parental care and the warmth of the family home due to serious diseases or death of one or both of the parents. It is possible that the parents are deprived of liberty or just unwilling to take care of their child. A significant part of the residents of MSCHC come from socially dis-advantaged families or families living in bad conditions. MSCHC has a mission to bring the children back to the family environment by making their adoption possible. The most important condition is the adopted
Age structure of the children in MSCHC
1600 1400 1200 1000 800 600 400 200 0
Up to 1 year
1 year old
2 years old
3 and more years old
2012 Year 1561 405 217 302
2013 Year 983 98 49 60
2014 2015 2016
Year Year Year
924 719 636
63 50 20
36 37 15
18 41 18
child to find good parents who would give him love, care and affection.
References
1. REGULATIONS FOR THE STRUCTURE AND ACTIVITY OF THE MEDICAL-SOCIAL CARE HOMES FOR CHILDREN, SG 49/16 June 2000
2. Kostadinova, K. Deinstitutionalization of children from medical-social care homes. Prakt. pediatriia, 14, 2013, N 9, p. 18-20.
3. Encheva, D. Preparation for providing a family and love as an alternative to the children from the medical-social care homes. Prakt. pediatriia,14,2013,9, p. 12-13.
4. Antonova, Ts Influence of conditions and organization of bringing up at "Mother and child" homes on the health state and mental development of the children. Pediatriia, 35, 1996, No 2, p.9-11
5. Dimitrov Tz. CONCEPT FOR MEDICO-SOCIAL POLITICS AMONG CHIDREN AT RISK AND INSTITUTIONS IN THE REPUBLIC OF BULGARIA. ASKLEPIOS, V , 2011, p.80-84
6. Dimitrov Tz.. THE EMERGENCE AND DEVELOPMENT OF THE PROBLEMS OF THE
INSTITUTIONS FOR CHILDREN AT RISK. ASKLEPIOS, V, 2011, 85-90
7. Andersson, G. (2005) Family relations, adjustment and well-being in a longitudinal study of children in care. Child & Family Social Work, 10: p. 43-56
8. Brand, A. and Brinich, P. (1999). Behavior problems and mental health contacts in
9. adopted, foster, and non-adopted children. Journal of Child Psychology and Psychiatry, 40,p.1221-1229.
10. Browne, K.D., Hamilton-Giachritis, C.E., Johnson, R. and Ostergren, M. (2006). Overuse of institutional care for children in Europe. British Medical Journal. 332, p. 485-487
11. Browne, K.D., Hamilton-Giacritsis, C.E., Johnson, R., Chou, S. (2005).Young children in institutional care in Europe. Early Childhood Matters, 105:p. 15-18.
12. Johnson R., Browne K.D. and Hamilton-Giachritsis C.E. (2006). Young children in institutional care at risk of harm. Trauma Violence and Abuse, 7(1): p.1-26.
ХАРАКТЕРИСТИКА ОБЩИХ ЗАКОНОМЕРНОСТЕЙ ИЗМЕНЕНИЙ МАРКЕРОВ МЕТАБОЛИЧЕСКОГО СИНДРОМА У ПАЦИЕНТОВ С МОРБИДНЫМ ОЖИРЕНИЕМ ПОСЛЕ ОПЕРАТИВНОГО ЛЕЧЕНИЯ НА ФОНЕ СНИЖЕНИЯ МАССЫ ТЕЛА
Дука Р.В.
Державний заклад «Днтропетровська медична академiя МОЗ Укра'ши», доцент кафедри хiрургii№1
CHARACTERISTIC OF GENERAL LAWS OF CHANGES OF MARKERS OF METABOLIC SYNDROME IN PATIENTS WITH MORBIDIAN OBESITY AFTER OPERATIONAL TREATMENT ON THE BACKGROUND OF BODY MASS
Duka R. W.
State Institution "Dnepropetrovsk Medical Academy of the Ministry of Health of Ukraine", Associate Professor of Surgery Department No. 1
АНОТАЦ1Я
Метою роботи було встановлення поширеносп метаболiчного синдрому у хворих з морбвдним ожи-ршням i оцшка в тсляоперацшному перiодi впливу хiрургiчних методiв л^вання, а саме бшопанкреать ческой шунтування в модифшацп Hess-Marceau i поздовжньо! резекци шлунка, на стутнь корекцп цих порушень. Були поглиблено обстежеш 57 пащенпв (36 (63,2%) жток i 21 (36,8%) чоловiк) з морбщним ожирiнням, вiком вiд 21 до 62 рошв (середнiй вiк 40,0 ± 1,38 рокiв), якi перебували пiд наглядом на кафедрi мрурги №1 ДЗ «ДМА МОЗ Украши».
ABSTRACT
The aim of the study was to establish the prevalence of the metabolic syndrome in patients with morbid obesity and the evaluation in the postoperative period of the influence of surgical methods of treatment, namely biliopancreatic shunting in the Hess-Marceau modification and longitudinal gastrectomy, on the degree of correction of these disorders. A total of 57 patients (36 (63.2%) women and 21 (36.8%) men) with morbid obesity, ages 21 to 62 (mean age 40.0 ± 1.38 years) who were under observation at the Department of Surgery No1 State institution "Dnepropetrovsk Medical Academy of the Ministry of Public Health of Ukraine".
