CC BY
19Received by the Editor 02.12.2020
IRSTI 76.75.29
UDC 614.2
Children's health as a medical and social problem
S. Tuktibayeva1, Zh. Zhumabekov2, S. Ashurova1, K.S. Kemelbekov1
1Khoja Ahmet Yassawi Kazakh-Turkish International University, Kazakhstan, 161200, Turkestan region, Turkestan city, B. Sattarkhanov Avenue, building 29B
2South Kazakhstan Medical Academy, Republic of Kazakhstan 160019, Shymkent, pl. Al-Farabi, 1/1.
The purpose of the literature review was to identify important issues in the study of health status and health reform in children. Analysis of the literature on risk factors affecting children's health.
Key words: children, health, risk group, mother's health.
Здоровье детей как медико-социальный вопрос
Туктибаева С.А.1, Жумабеков Ж.К.2, Ашурова С.И.1, Кемельбеков К.С.1
Международный казахско-турецкий университет имени Ходжа Ахмета Ясави, Казахстан, 161200, Туркестанская область, город Туркестан, Проспект Б. Саттарханов, строение 29В
2Южно-Казахстанская Медицинская Академия, Республика Казахстан 160019, Шымкент, пл. Аль-Фараби, 1/1.
Целью обзора литературы было выявление важных вопросов в изучении состояния здоровья детей и реформировании здоровья детей. Анализ литературы предоставляет факторы риска, влияющие на здоровье детей.
Ключевые слова: дети, здоровье, группа риска, здоровье матери.
Балалардыц денсаульны медико-элеуметтж мэселе ретшде
Тукт1баева С.А.1, Жумабеков Ж.^.2, Ашурова С.И.1, Кемелбеков ^.С.1
1^ожа Ахмет Ясауи атындагы Хальщаралык; казак^р^ университет^ ^азакстан, 161200, ТYркiстан облысы, ТYркiстан каласы, Б.Саттарханов дацгылы, 29Б гимарат
2Ощуспк ^азакстан медицина Академиясы, ^азакстан Республикасы 160019, Шымкент к. Эл-Фараби, 1/1
Эдебиеттердi талдаудын максаты балалардыц денсаулыгыныц жай-кушн жэне балалар денсаулыгын коргауды реформалау мэселелерш зерттеудiц мацызды мэселелерiн айкындау болды. Эдебиеттердi талдауда балалардыц денсаулыгына эсер ететiн кауш-катер факторлары бершдг
ТYЙiндi сездер: балалар, денсаулык, кауш-катер тобы, ана денсаулыгы.
After gaining independence, the Republic of Kazakhstan has undergone political, social and economic changes in all spheres of life of the state and society, and the children belong to that part of the population, which is most sensitive to any changes in society. At the turn of the XX and XXI centuries the demographic situation in the Republic and increasing in the total population was characterized by an increasing in the birth rate, a decreasing in the death rate, and indicators of natural population growth.
Information about children's health plays a special role in the study of public health. The level of one's own health reflects not only the diversity of natural, socio-economic, medical and organizational factors affecting a person, but also indirectly the health of parents. In recent years, many works have been published on topical issues of children's health. Trends in the state of health were analyzed, health problems were identified, and ways to solve them were identified in the work of many pediatricians [1].
Many authors emphasize concerns about children's health. The health of the nation, healthy individuals of fertile age, is largely determined by their ability to reproduce the quality of the population and offspring. Parts of the elements of reproductive health include preserving the reproductive health of children and adolescents, safe sex, effective acceptable and affordable methods of birth, safe pregnancy and the birth of a healthy child [2].
These references indicate that the issue of reproductive health is relevant to all countries of the world, but the priorities are different in each country, depending on the current state of the nation's reproductive health, the degree of solution of medical and social problems of a particular state. In developed countries with low maternal, perinatal and infant mortality, and with a high proportion of women covered by modern substances regulating the birth rate, reproductive behavior, sexual culture, unplanned pregnancy and sexually transmitted diseases are the most important priority areas [3].
In the modern state of Kazakhstan, the components of reproductive health are Prevention of unwanted pregnancies, childbirth and safe motherhood [4], reduction of extragenital diseases and pregnancies, especially associated with social, economic and industrial factors, reduction of maternal, perinatal and infant mortality and improvement of the quality of offspring [5].
According to experts, the health of children depends on the state of somatic and reproductive health of parents, which significantly worsened through the social and economic crisis in the 90s of the twentieth century in the country. Extragenital diseases of women (especially anemia, diseases of the genitourinary organs, thyroid dysfunction), dysfunctional disorders and inflammatory diseases of the genitals, endometriosis, and female infertility have increased. During this period, there was a rapid growth of socially significant diseases-syphilis, tuberculosis, drug addiction, alcoholism. The deterioration of women's health is facilitated by a decrease in living standards and nutrition, violations of Occupational Safety and health requirements,and a decrease in the level of preventive and curative measures against working women [6].
Numerous studies confirm the direct impact of socio-economic crisis factors on children's health indicators. Thus, according to some authors, a number of large industrial regions showed a high incidence of various types of acute and chronic diseases when conducting an in-depth examination of children. It is particularly evident among the children of mothers in the working environment who have had an adverse negative impact on the profession. In almost half of babies born to mothers who were in contact with professionally harmful substances during pregnancy, there are clinical signs of intrauterine hypoxia, delayed intrauterine development, morphological and functional immaturity of organs and systems. Perinatal brain damage is diagnosed with a frequency of 14.4%, prenatal hypotrophy - 11.2%. According to some authors, 25-40% of mothers whose children died in the first year of life, whose work depended on the influence of harmful factors in various industries on them during pregnancy [7].
The relationship between the mother's work during pregnancy and the health of the unborn child, especially her early birth, is evidence of the impact of unfavorable social conditions and poverty. In the literature, unfortunately, often the results of pregnancy among working and unemployed women are simply compared. Such comparisons often do not take into account those who work at home and care for children [8], do not distinguish between first-time births (mostly everyone works) and many births (most of them are not at paid work), and unite women who work tirelessly, without physical effort, and women who work tirelessly in a cold, hot or humid environment, who live for several hours near a conveyor [9].
The analysis of sources of Occupational fatigue revealed a number of factors that significantly increase the risk of giving birth to a sick child. Some scientists believe that a pregnant woman working in a standing position, as well as working on conveyor industrial or industrial mechanisms, or requiring energy, or under the influence of vibration, has a risk of premature birth by 1.6 times; those weighing more than 10 kg or with constant physical exertion - by 1.8 times; performing routine work or tasks that do not attract much attention without stimulating interest -by 2 times; he noted that the combination of cold or wet noise, as well as working with chemicals, increases by 1.9 times [10].
The whole complex of negative trends leads to an increase in the pathological course and complications of pregnancy in women in childbirth and the postpartum period, manifested by an increase in the specific weight of immature and sick babies, a deterioration in the indicators of physical development, a difficult course of transition processes from the womb to the external environment [11].
Some authors emphasize that in absolute terms, the increase in the number of sick offspring is mainly due to babies born on time. Pathological conditions in newborns born in full-term conditions increase at the maximum rate, which is due to hypoxic - ischemic processes and morphofunctional immaturity, - respiratory disorders syndrome and other respiratory conditions; hematological disorders, due to intra-ventricular and subarachnoid hemorrhages [12].
Toxicosis of pregnancy has a significant impact on the development of the fetus, the health of the newborn and the health of the child under one year of age, it is often the cause of congenital lag in development, affects the compensatory and adaptive reactions of the child, leads to functional instability of heart activity, poor adaptation to external conditions, increased likelihood of convulsive syndrome [13].
There are no reliable studies in sufficiently large materials on the relative effect of maternal age, but in many studies, a group of mothers over the age of 35 is distinguished, which varies from 4% to 22% among those born in different countries [40]. According to domestic scientists, the increase in the share of first-time births over the age of 35 corresponds to global trends due to the high social activity of women aged 25-35. In our country, late birth is often associated with the need for education, often due to a stable social situation [14].
In more than half of cases of late birth, the cause is a relatively late onset of sexual intercourse (after 30 years). In older births for the first time, appropriate pathologies accumulate: surgical intervention, extragenital and gynecological diseases. Pregnancy only in older first-time births without complications in 18% of cases, two-thirds of births occur pathologically. According to individual scientists, the risk of getting an unfavorable outcome of pregnancy in women under 16 years of age and over 35 years of age is 2-3 times higher than in people aged 16-35 years [15].
The risk of having children with chromosomal disorders increases to 1:526 in 20-year-old women and 1 in 45-year-old women in 18 cases. Features of maternal age not only change the genotype in the child, but also indirectly change embryogenesis, slowing down the development of the fetus.
Depending on the age of the woman, the number of diseases, complications during pregnancy and the frequency of its premature termination increases [16]. Foreign scientists have studied the risk factors for congenital malformations in children when there is a risk of pregnancy. Among the reasons that complicate the course of pregnancy, the most important were identified. Genetic disorders: detection of deaths of children under one year of age with unknown etiology, congenital diseases, mental illnesses, risk of termination of pregnancy, cardiovascular diseases, as well as children born in cases of repeated pregnancy. Kazakh scientists studied the condition of children associated with drug therapy during pregnancy and childbirth, came to the conclusion that 2-3% of the development of fetal malformations, sterilization of the child's urinary system is highly sensitive to the vast majority of drugs [17].
The influence of the transition period of pregnancy and childbirth on the general morbidity character, in particular, the incidence of acute pneumonia in children under the first three years, has been established by a number of authors [18]. The pathological course of pregnancy and childbirth determines and continues to affect the prevalence of high morbidity in children at the age of 6,leading to functional disorders of the digestive system in children even at school age [19].
In general, physiological pregnancy and childbirth occur in 20% of women, the most common anemia, toxicosis, diseases of the genitourinary system and circulatory system caused complications of pregnancy, childbirth and the postpartum period in about half of the total number of women who gave birth in 1993. Among all obstetric complications, the most significant were sudden termination of pregnancy: 65.7% of women had abortions that led to the birth of a child with congenital malformations; 16% had a risk of miscarriage; the analysis showed that the risk of abnormal birth depends on the serial number of pregnancy, and about more than 17% of the third
birth is children with serial numbers [20].
The most important factor determining the health of children is the type of family. The researchers found that children's health is much worse in single-parent families, children born out of wedlock, than in children from full-fledged families. The incidence is 2.4 times higher in children born out of wedlock, 1.7 times higher in children living in single-parent families than in full families among children under three years of age [21].
Bad habits of parents have a significant impact on the health of children. High perinatal mortality was found in infants born to smoking mothers. Children of smoking mothers belong to the group of frequent and long - term patients (mothers of frequently ill children smoke 32.7%, 41.3% - smoke and drink alcohol, 23.9% of women suffer from chronic alcoholism.), compared to the control group, respectively, 57.0% and 35.3% lag behind their peers in physical and mental development [22].
Insemination of a child by parents under the influence of alcohol and Alcoholism of a pregnant woman leads to an increase in perinatal mortality, the incidence of congenital abnormalities, dementia and other diseases. In addition, Smoking during pregnancy increases the birth rate of a low-weight child by half, by 1/3 of fetal mortality. Alcohol and nicotine negatively affect the cells of the parent sex before the onset of pregnancy [23].
According to American researchers [24], about 40% of children with congenital developmental disabilities were born to parents who suffer from alcoholism, and the parameters of physical development differ significantly from the children of mothers who avoid harmful habits.
The influence of the social and hygienic living conditions of the family on the health of the child begins from the first days of his life. At the same time, the influence of the family on the physical development and the level of illness in the first years of a child's life is clearly visible.
In particular, children of all age groups in a favorable family have lower rates of morbidity than children from families exposed to socially dangerous factors. In the group of children from well-off families, in well-off families, the number of children who are not often ill is 60%, and 9% who are often ill respectively, and in the group of children from families with social risk factors, the number of children who are not often ill -17.8% and -38.8% who are often ill [25].
In recent years, significant experience has been accumulated in the formation of risk groups depending on factors affecting the health of children. Clearly defined criteria have been identified that allow us to classify children as a "risk" group. Risk factors have been identified, and medical and organizational measures have been developed to conduct dispensary monitoring of such children [26]. Health-improving measures have been developed and widely implemented for certain groups of children: often ill; large births by body weight; premature births; children from large families; children whose mothers study; children born in the first 7 years of life in young families; children from single-parent families; children of displaced residents [27].
The study of children's health and the role of individual medical and social factors in its formation was carried out in the United States, Germany, Great Britain and other foreign countries. A number of foreign authors have studied the effects of socio-hygienic factors on the disease of children [28]. In recent years, many studies have focused on individual risk factors that lead to pathology of the fetus and newborns: maternal smoking, drug use by pregnant women, clinical and obstetric risk factors before birth [29].
A number of works are devoted to the study of physical development and medical and social factors: overweight in younger schoolchildren in Japan and the United Kingdom, physical exercise of nine-year-olds in England, the relationship between children's health and physical activity in the United Kingdom), etc [30].
In the UK, children with high social status have a lower mortality rate, their body weight at birth, and overall physical performance are higher. The influence of a social group on the health of children and the survival of early childhood is characterized by I. Douglas L. The monograph by Kohler et al summarizes Sweden's experience in reducing infant mortality and achieving high health indicators in children. The health of children attending kindergarten is studied [31].
When we examined more than 17 thousand children from low-income families living in the United States, we found that they are more likely to suffer from chronic diseases than their peers with a much better condition. A list of 6 medical and social risk factors known at birth that affect a child's future performance decline has been compiled: late delivery or lack of care for the mother during pregnancy, low weight gain during pregnancy, small intergenetic intervals, children aged three and older in the Family, Smoking by the mother, as well as alcohol use during pregnancy [32].
The data provided in the literature on the health of the population is very comprehensive and difficult to compare. Often, different age groups, different types of pathologies, data obtained during examination or preventive examinations, sociological studies and etc. are described.
It is important to study its features and patterns in different regions of the country, justifying the system of measures to improve the level of health of the population in the context of deterioration of health, including children's health. In recent years, studies have been conducted on the regional characteristics of children's health and medical care for children. These works were devoted to the health of children and their problems; in the northern regions of the country and the territories equated to them; in the regions affected by the Semipalatinsk test site.
Of considerable interest is the dissertation work, which studied a complex of medical, social and environmental factors that determine the health status of children, providing a comprehensive medical and social assessment of the health of children attending preschool institutions.
During the period of political and economic changes in the Republic of Kazakhstan, a number of serious problems arose about the situation of children in families and society, as well as their health status. This poses a serious threat to the national security of the country as a whole, requires the adoption of appropriate measures aimed at radically changing the current situation, implementing the most effective, first of all, state policy in the field of Health Protection of the younger generation [33].
The child's health is managed as a dynamic process and Biosocial category. Many materials of scientific research have made it possible to identify certain patterns in the formation of the health of children and adolescents, which in modern conditions serve as the basis for the development of effective measures aimed at protecting and promoting health for the management of specific health care.
The analysis of the situation in dynamics is the basis for applying a program-targeted method of planning and managing healthcare, which allows us to solve the problems of the industry as a whole and its pediatric services as quickly as possible. This approach justifies the optimal use of material, financial and human resources, the formation of specific priorities, and the optimal ways to solve them step-by-step in the near future.
In modern conditions, it is important to organize, finance, and implement the integration of all structural divisions, services, and structures that can provide program-targeted measures in the interests of protecting the health of motherhood and childhood.
The dangerous increase in morbidity and disability of children and adolescents in order to combat these trends, to prevent diseases and disability of children and adolescents, creates the need to mobilize all the forces of society, as well as to increase the functional capabilities and reserves of the body for their health.
In this case, it is not enough to understand the laws of formation and development of children's health as an objective phenomenon. Determining the characteristics of children's health in regions, territories, and different groups of children is possible only if there is a clear picture of the social uniformity of this phenomenon.
Conclusion
Thus, the analysis of the literature made it possible to identify the most important issues of studying the state of children's health and issues of reforming children's Health Protection. Comprehensive medical and social studies of these key issues are still insufficient.
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The Author for correspondence: Tuktibaeva Saule Aktleuovna Head of the Department of Human Morphology and Physiology, MKTU named after Kh.A. Yasavi +77026512379 saule79s@mail.ru
Information about the authors:
Tastanbekova Asem Arysbekovna - Master's student, Al-Farabi Kazakh National University.
Kurmanbaeva Meruert Sakenovna - Head of the Department of Biodiversity and Bioresources, Al-Farabi Kazakh National University.
Ylymbet Kanat Kairatuly - Junior Researcher, Kazakh Research Institute of Soil Science and Agrochemistry named after U.U. Uspanov.
Saduakhas Amandy Bolatuly - Analytical Engineer, U. U. Uspanov Kazakh Research Institute of Soil Science and Agrochemistry.
