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high prevalence of pregnancy and abortion in adolescent girls can be a serious problem for reproductive health, subsequently affecting fertile health and quality of life.
Purpose of the study. To assess the state of teenage pregnancy and abortion among girls 15-17 years old, Almaty, 2013-2018.
Materials and methods. Statistical data on teenage pregnancy and abortion among girls 15-17 years old in Almaty for 2013-2018.
Results and discussion. Analysis of the data of the RTEC in Almaty for 2013-2018. according to the prevalence of abortions among girls 15-17 years old, revealed that in 2013 this indicator was 1.6 per 1000 girls. In subsequent years, this indicator declined, amounting to 0.7 per 1000 girls in 2017 and 2018.
Data on teenage pregnancy among teenage girls aged 15-17 in Almaty, 2013-2018. showed that during the analyzed period there is a positive trend in reducing the number of teenage pregnancies. The highest rate of teenage pregnancy was in 2015, with an indicator of 9.9 per 1000 girls. In subsequent years, this indicator decreased, amounting to 2018 - 5.6 per 1000 girls.
Conclusions. An analysis of the data of the Almaty Regional Center for the Study of Relativity and Economic Development showed that in the presence of dynamics of a decrease in teenage pregnancy, the rate of abortion among teenage girls did not have a pronounced tendency to decrease.
Key words: teenage girls, teenage pregnancy, abortion of minors.
UCD: 618.172 DOI: 10.24411/1995-5871-2020-10111
STATE OF REPRODUCTIVE HEALTH OF MODERN GIRLS-TEENAGERS
*1 D.N. Makhanbetkulova, 1 A.M. Auyezova, 2 Zhilvinas Padaiga, *1 A.N. Nurbakyt
1 Kazakhstan's medical university «KSPH», Almaty 2 Lithuanian University of Health Sciences (LSMU), Lithuania
SUMMARY
A healthy generation is the key for the future of the country, the gene pool of the nation, the economic and scientific potential of society. One of the factors negatively affecting the demographic situation of numerous countries is the deterioration of the reproductive health of young people. Therefore, the protection of the health and well-being of the younger generation is an essential component of the social policy of states.
Key words: reproductive health, adolescent girls, reproductive potential.
Introduction. The social significance of adolescent health is caused by the fact that youth represents fact that they represent the closest reproductive, intellectual, economic, social, political and cultural reserve of society
[1-4]. Currently, 1.8 billion young people aged 10-24 live in the world, this generation includes 600 million teenage girls with their special needs, problems and aspirations for the future [5]. The reproductive health
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of adolescents is a kind of indicator that is sensitive to changes in factors of the external and internal environment. Numerous domestic and foreign researchers indicate a deterioration in the reproductive and somatic health of adolescent girls, the problem of the prevalence of gynecological diseases [6-12].
Material and methods. This review is based on the analysis of international and domestic data on the protection and assessment of the reproductive health of girls, adolescents and youth.
Results and discussion. Participants of the International Conference on Population and Development (ICPD) held in Cairo, Egypt, 1994, in their speeches and the Program of Action, adopted at the conference, recognized that reproductive health, including sexual as well as reproductive rights, gender equality and the empowerment of women are important goals and play a key role in improving the quality of life of every person [13].
Adolescence is a critical stage of life, characterized by rapid biological, emotional and social development. It the time when each person develops the abilities necessary for a productive, healthy and fulfilling life. In order to make the transition to adulthood healthy, adolescents should have access to medical education, including sexual and reproductive education [14].
A number of studies claim that sexually active adolescents have the highest incidence rates of human papillomavirus (HPV), with 50-80% of cases of infection occurring within three years after the onset of sexual activity [15].
According to WHO, adolescents, especially adolescent girls, are one of the population groups in which AIDS mortality does not decrease [16]. UNAIDS experts believe that the population of adolescent girls is disproportionately vulnerable and is at high risk of becoming infected with HIV [17].
Studies among young women in developing countries have revealed a high level (ranging from 52% to 92%) of the prevalence of sexually transmitted infections. In Egypt, the incidence of vaginitis associated with infection of the genital tract infections in
teenage girls is at the level of 10-25% [18].
Research of M.A. Parker et. al. (2009) in Australia states that typical menstruation in adolescence includes: pain (93%), cramps (71%), premenstrual symptoms (96%), and mood disturbance (73%) [19]. The authors found that 25% of the examined group had pronounced menstrual irregularities: 21% experienced severe pain; 26% had five or more symptoms; 10% of adolescent girls reported atypical symptoms associated with menstruation.
I. Goicolea et. al. (2010) found that 20% of women in Ecuador become pregnant in their teens, and in most cases, pregnancy is associated with the level of education, the socio-economic status of the family, and the geographical location of the region [20].
A survey of 456 teenage girls aged 1419 years in Ghana (2012) showed that the average age at the menarche was 12.5 years. The duration of the menstrual cycle ranged from 21 to 35 days, the average duration of the menstrual cycle was 27.9 days. About 24% of the examined adolescent girls had irregular menstruation, 59.6% had menstruation with blood clots [21]. Similar results on menstrual irregularities were obtained in 2014 by researchers in Turkey [22].
L. Soderman et. al. (2018), studying the prevalence of dysmenorrhea in teenage girls in Sweden, showed that 36% had severe dysmenorrhea, fatigue was reported by 83%, headache was observed in 82% of teenage girls, dyshesia in 37% and dysuria in 35 % of girls examined [23].
Every day, 20,000 teenage girls under the age of 18 give birth in developing countries. It is noted that out of 7.3 million teenage mothers, 2 million are teenage girls under 15 years old. Researchers believe that, If this tendency does not change, the number of women in childbirth under the age of 15 years may increase to 3 million by 2030 [24]. Young mothers are more likely to have complications associated with an unfavorable course of pregnancy, in which there is a higher risk of mortality [25-28].
We would like to one more point: gaps in ensuring sexual and reproductive health of adolescents undermine the achievement of
gender equality, deplete household incomes and state budgets, lead to poor results in public health and education, lower productivity and participation in the labor force, and lead to missed opportunities of the state for economic growth [29].
Thus, the reproductive health problems of adolescent girl s over the worl d are confirmed by the data of numerous researchers and are estimated by WHO experts [30, 31]. So, in 2016, 12 million births were registered among girls aged 15-19 years and at least 77 thousand births among teenage girls under 15 years old [32,33]. Pregnancy among adolescent girls is a serious problem in low- and middle-income countries, with the highest levels of unwanted pregnancies in sub-Saharan Africa, Latin America, the Caribbean and China. Pregnancy among unmarried teenage mothers is more often unintentional and ends with an artificial abortion. Most often the victims of violence, including forced sex, are teenage girls.
Assessing the reproductive health of adolescent girls in different countries over the world, it should be noted that the sharp socioeconomic shocks of recent years have also been unfavorable for the health of adolescents in the countries of the former USSR. Adverse trends in the health status of Russian adolescents are noted by L.I. Levina, A.M. Kulikova (2006) [2]. The authors noted that over the past ten years there has been a decrease in the proportion of healthy children from 45.0% to 33.8%, with a simultaneous increase in the proportion of children with chronic pathology and disability. The annual increase in the incidence of Russian adolescents was 5.7%. According to the majority of Russian researchers, the health status of adolescents in the Russian Federation is significantly worse than that of their peers in other countries [2-4,10].
Thus, it can be stated that in modern conditions the problem of reproductive health of adolescent girls remains one of the significant problems of society.
There is reason to believe that it is caused not only with the demographic situation in the region and social reasons, but also with the low reproductive capacities of modern young men and women.Therefor has been formed
the concept of "reproductive potential" , which includes indicators of gynecological, mental, somatic health and social conditions , taking into account their possible impact on reproductive function in the future. Thus, Yu.A. Gurkin (2006), studying the prevalence of the population of teenage girls from 0 to 18 years of age with gynecological diseases, revealed that the structure of gynecological diseases of high school students was as follows:
- menstrual dysfunction - 46-65%;
- violation of puberty - 19-25%;
- inflammatory processes of the genital organs - 8-17%;
- genital injury - 2-5%;
- developmental anomalies - 0.7-1.2%;
- tumors and tumor formations - 1.311%;
- other - 2.8-9.7% [34].
Similar data on the structure of gynecological pathology in adolescent girls are also given by other Russian researchers [35 - 40]. Thus, E.A. Matejkovich (2018) during the analysis of gynecological diseases in the puberty of teenage girls in Tyumen, noted that various disorders of menstrual function (60.7%) are in the lead, including: algodismenorea (19.4%), oligomenorrhea (13.6%), irregular menstruation (10.3%), amenorrhea (8.7%), hyperpolymenorrhea (6.2%), juvenile uterine bleeding (2.5%). Only 2.9% of girls were recognized as gynecologically healthy [41].
Indicative data on the characteristics of gynecological disorders of adolescent girls in different regions of Russia was stated by I.I. Ivanov et al. (2018) [42]. The authors noted that urban teenage girls showed a higher percentage of gynecological diseases comparing with girls from rural areas. According to researchers, teenage girls living in rural areas have more harmonious physiological puberty than their peers from the city. The authors believe that teenage girls in villages live and are brought up in more favorable environmental conditions with no lack of physical activity.
In the structure of the gynecological morbidity of adolescent girls, number of Russian authors note the predominance of menstrual irregularities and a benign change
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in the cervix and ovaries [43-45]. According to S.M. Siemyatova (2009) teenage girls living in Moscow have a high frequency of gynecological diseases (from 13% to 35.4%). In the structure of reproductive disorders, menstrual irregularities, benign changes in the ovaries and cervix do predominate. According to the author, it is caused due to the lengthening of the formation of menstrual function (more than a year - 28.6%) and impaired reproductive behavior of adolescents [46]. N.V. Artymuk and N.A. Atykhtina (2017), monitoring the reproductive health of adolescent girls in the Kemerovo region, showed the following deviations in reproductive health among the 378 examined at the age of 14-17: 54.0% suffered from dysmenorrhea, 45.0% had irregular menstruation, almost every fifth later menarche (older than 15 years), 17.0% - mastalgia and 12.0% - abnormal uterine bleeding [47]. The authors recommended that all possible efforts should be directed to raising the awareness of adolescent girls about the physiology of the reproductive system, hygiene and the prevention of reproductive health disorders.
In modern conditions, primary amenorrhea is determined by the absence of menstruation in girls against the background of formed secondary sexual characteristics at the age of 16 years, or the absence of menstruation in girls without the manifestation of secondary sexual characteristics at the age of 14 years. So, K.R. Akperli et al. (2014) in Baku (Azerbaijan), when examining 150 girls of early reproductive age, detected 130 amenorrhea cases, while 14.8% were primary amenorrhea, 89.2% were secondary amenorrhea [48]. The authors found that girls with amenorrhea in the early reproductive period had lags in physical development, it was most pronounced in cases of girls with primary amenorrhea.
Study conducted by I.S. Lyalina et al. A (2014) showed that in Cheboksary, adolescent girls mainly complained of discomfort in the perineum when visiting a gynecologist, and, when they were examined, in 43.7% cases they were diagnosed with Vulvovaginitis [49]. The authors believe that on the one hand, the reproductive health of girls is a consequence of the implementation of risk factors for
living conditions, professional activities and the health status of their mothers, and on the other hand, it is a consequence of risk factors in the upbringing and upkeep of girls of preschool age. Delayed sexual development was observed in 19.8% of cases, pelvic pain - 5.6% of cases, cervical erosion in 4.7% of cases, synechia in the uterus - 4.2% of cases.
Representative studies of A.E. Samigullina, N.V. Poltava (2016) in the Kyrgyz Republic for the period from 20102014. among adolescent girls aged 15-17 years, showed that a 2.4-fold increase in the rates of gynecological morbidity was detected with a simultaneous decrease in the coverage rate by preventive examinations by 1.5 times [50]. The authors noted that in the Republic the number of births in the studied population increased by 1.8 times, abortion by 1.2 times, and the contraception rate per 1000 teenage girls decreased by 2.1 times. Similar studies conducted in the Kyrgyz Republic, Bishkek, showed that inflammatory diseases of the vulva and vagina and menstrual dysfunction prevailed in the structure of the gynecological pathology of adolescent girls. 5% of the examined girls had inflammatory processes, mainly in the form of inflammation of the vulva and vagina (82.5%). Out of the total number of the examined adolescent girls, in 18.2% cases there were various disorders of menstrual function, the structure of which was dominated by algodismenorea (52%) and dysfunctional uterine (juvenile) bleeding (18%) [51].
The problem of studying various aspects of reproductive health in Kazakhstan remains topi cal. Theinci denceoftheyoungergenerati on causes particular concern in the medical community of Kazakhstan, since more than 60% of adolescent girls have different kinds of deviation in reproductive health [11]. Recent work of Kazakhstani researchers, performed on clinical materials, indicates that among the disorders of the reproductive system during puberty, juvenile uterine bleeding is one of the most common forms, which subsequently often leads to persistent violations of menstrual and generative functions, hormone-related diseases. D.D. Mirzakhmetova et al. (2015) according to the analysis of 82 case histories of teenage girls in Almaty aged 10-17 years,
founded that the majority of the examined - 59 (71.9%) - were admitted to the hospital for the first time and only 23 (28.1%) - repeatedly. In 26 cases (31.7% of patients), bleeding lasted up to 10 days, in 48 (58.5%) the duration of bleeding was 11-30 days, and in 8 (9.8%) bleeding lasted more than 31 days. The average duration of bleeding was 21 days [52].
G.B. Bapaev et al. (2015) when examining Kazakhstan teenage girls living in cotton-growing regions, noted that the frequency of gynecological morbidity was 14.6%. In the structure of morbidity, the first place was occupied by violations of menstrual function, the second place - by inflammatory diseases, the third place - by premenstrual syndrome. Juvenile uterine bleeding (56.3%) prevailed among menstrual irregularities [53]. Vulvovaginitis had the largest share among inflammatory diseases (82.3%), in the history of which there were urinary tract diseases (33.3%), diseases of the gastrointestinal tract (25.0%), anemia (20.8%), viral infections (54.2%). The examined girls complained of the presence of pus (12.5%) and curdled (45.8%) discharge, itching in the vagina (16.7%). The results of bacterioscopic examination of the smear showed the presence of fungi of the genus Candida (58.3%), gardnerella (8.3%), cocci (33.3%). 16.7% of girls who had sex expierence were diagnosed with Trichomonas.
G.N. Alimbaeva (2018) in an analytical review on the features of reproductive health of modern adolescent girls in Kazakhstan
showed that only 19% of adolescents use contraceptives, every year 20 out of 1000 1519 years old girls committed abortions, that not always was registered [54].
N.M. Petukhova (2013), Member of the Committee on Social and Cultural Development of the Mazhilis of the Parliament of the Republic of Kazakhstan, in her speech at the Central Asian Conference of Parliamentarians on Youth Policy (Almaty, June 6-7, 2013), noted that the number of abortions among 15-19 years old girls is growing annually, HIV and other infections are widespread and this facts are not always recorded. Since 2000, the birth rate among adolescents has not tendency to decrease. In the country about 3% of teenage girls aged 15-19 give birth every year. It is two-three times higher level than in Western Europe, Japan, and Australia. Complications during pregnancy and childbirth are the leading cause of death among teenage girls [55].
Discussion. Thus, an analysis of the literature shows that the population of modern adolescent girls can be characterized with a high frequency of gynecological diseases of the reproductive sphere, an increase in the number of unwanted pregnancies, an increase in the number of abortions, an increase in the number of cases of HIV infection and sexually transmitted infections. This trend causes concern of medical professionals and society, as adolescents determine the future reproductive potential of the nation.
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D.N. Makhanbetkulova https: //orcid.org/0000-0001 -9524-2675
^ СОСТОЯНИЕ РЕПРОДУКТИВНОГО ЗДОРОВЬЯ СОВРЕМЕННЫХ
^ ДЕВОЧЕК - ПОДРОСТКОВ
§ *1 Д.Н. Маханбеткулова, 1А.М.Ауезова, 2 Жильвинас Падайга, *1 А.Н. Нурбакыт
о
^ 1 Кaзaхстaнский медицинский университет «ВШОЗ», г. AnMara
s 2 Литовский университет наук здоровья, Литва
«
| АННОТАЦИЯ
55
^ Здоровое поколение определяет будущее страны, генофонд нации, экономический
¡jj и научный потенциал общества. Одним из факторов, негативно влияющих на демогра -
фическую ситуацию многочисленных стран, является ухудшение репродуктивного здо -ровья молодежи. Поэтому, охрана здоровья и благополучия подрастающего поколения является важнейшей составной частью социальной политики государств.
Ключевые слова: репродуктивное здоровье, девочки-подростки, репродуктивный потенциал.
КАЗ1РГ1 ЖАС6СП1Р1М КЫЗДАРДЬЩ РЕПРОДУКТИВТ1 ДЕНСАУЛЫ^Ы
41 Д. Н. Маханбеткулова, 1 А.М.Ауезова, 2 Жильвинас Падайга,*1 А.Н. Нурбакыт
1 «^ДСЖМ» ^азакстандык медицина университетi, Алматы к-сы 2 Литва денсаулык гылымдары университетi, Литва
ТYЙIНДI
Денi сау урпак елдщ болашагын, улттыц гендш корын, когамныц экономикалык жэне гылыми элеуетiн аныктайды. Кептеген елдердщ демографиялык жагдайына терiс эсер ететiн факторлардьщ бiрi - жастардыц репродуктивтi денсаулыгыньщ нашарлауы. Сондыктан жас урпактыц денсаулыгын коргау кептеген мемлекеттердщ элеуметтiк саясатыныц мацызды к¥рамдас белiгi болып табылады.
Ктт свздер: репродуктивт1 денсаулыц, жасостр1м цыздар, репродуктивт1, репродуктивт1 потенциал.
ЭОЖ: 614.86:614.271.8-004.463.4 БОГ 10.24411/1995-5871-2020-10112
^АЛАЛЫЩ ЕМХАНАЛАРДАГЫ ЖYКТI ЭЙЕЛДЕРГЕ МЕДИЦИНАЛЫЩ К6МЕКТЩ
САПАСЫН ТАЛДАУ
*Ж.К. Ахметова, Т.П. Павлович, Ш.К. Сармулдаева, Р. Кажигаликызы, С.Белпбаев, Н. Сайранбек, К. Кемалладинова, А. Кенжебаева, Ж. Кадир
^азак медициналык Yздiксiз бiлiм беру университетi, Алматы к-сы
ТYЙIНДI ^
>е в
Макалада калалык емханаларда жYктi эйелдерге медициналык -элеуметпк кемектщ ^ сапасын зерттеу нэтижелерiне талдау жасалган, 2/3 (78,5%) артык жагдайларда жYктi эйелдерге карталарды жYргiзу кезiнде кемшiлiктер болган. Атап айтканда, перинаталдык кауiп факторлары-20,1%-да керсетiлмеген, 16,3%
— да усынымдар мен кецестер жок, титул парагыныц сапасыз рэсiмделуi-14,2%-да, гравидограмманыц болмауы немесе ша -блонмен жYргiзiлуi-67,2% - да, акушерлiк анамнездщ жеткшказ сипаттамасы-11,4% -
г
да, бакылау талдауларыныц болмауы -9,8% - да, баска мамандардыц кайта тексерушщ болмауы-7,3% - да. Сондай-ак, эрбiр Yшiншi (36,5%) жYктi эйелде толык емес тексе- ^
* аккте(оуа1кайуга_ 777@mail.ru
