Infant mortality trends in a region of Belarus, 1980–2000

BMC Pediatrics

Natan Khotianov³  Sergey P Chunikhovskiy⁴  Arthur M Michalek¹  Silvana Lawvere²  Martin C Mahoney³  Lauren J Zichittella⁵ 

[1]Educational Affairs, Roswell Park Cancer Institute, Buffalo, NY 14263, USA

[2]Department of Social & Preventive Medicine, School of Public Health & Health Professions, State University of New York at Buffalo, 276 Farber Hall, Buffalo, New York 14214, USA

[3]Department of Family Medicine, State University of New York at Buffalo, ECMC Clinical Center, 462 Grider Street, Buffalo, New York 14215, USA

[4]Mogilev Regional Children's Hospital, Mogilev, Belarus

[5]Division of Cancer Prevention & Population Sciences, Roswell Park Cancer Institute, Buffalo, NY 14263, USA

关键词: Chernobyl;    postneonatal deaths;    neonatal deaths;    public health;    epidemiology;    infant deaths;   

Others  :  1181722
DOI  :  10.1186/1471-2431-4-3

 received in 2003-08-19, accepted in 2004-02-11,  发布年份 2004

【 摘 要 】

Background

The Chernobyl disaster in 1986 and the breakup of the former Soviet Union (FSU) in 1991 challenged the public health infrastructure in the former Soviet republic of Belarus. Because infant mortality is regarded as a sensitive measure of the overall health of a population, patterns of neonatal and postneonatal deaths were examined within the Mogilev region of Belarus between 1980 and 2000.

Methods

Employing administrative death files, this study utilized a regional cohort design that included all infant deaths occurring among persons residing within the Mogilev oblast of Belarus between 1980 and 2000. Patterns of death and death rates were examined across 3 intervals: 1980–1985 (pre-Chernobyl), 1986–1991 (post-Chernobyl & pre-FSU breakup), and 1992–2000 (post-Chernobyl & post-FSU breakup).

Results

Annual infant mortality rates declined during the 1980s, increased during the early 1990s, and have remained stable thereafter. While infant mortality rates in Mogilev have decreased since the period 1980–1985 among both males and females, this decrement appears due to decreases in postneonatal mortality. Rates of postneonatal mortality in Mogilev have decreased since the period 1980–1985 among both males and females. Analyses of trends for infant mortality and neonatal mortality demonstrated continuous decreases between 1990, followed by a bell-shaped excess in the 1990's. Compared to rates of infant mortality for other countries, rates in the Mogilev region are generally higher than rates for the United States, but lower than rates in Russia. During the 1990s, rates for both neonatal and postneonatal mortality in Mogilev were two times the comparable rates for East and West Germany.

Conclusions

While neonatal mortality rates in Mogilev have remained stable, rates for postneonatal mortality have decreased among both males and females during the period examined. Infant mortality rates in the Mogilev region of Belarus remain elevated compared to rates for other western countries, but lower than rates in Russia. The public health infrastructure might attempt to assure that prenatal, maternal, and postnatal care is maximized.

【 授权许可】

   
2004 Zichittella et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.

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【 参考文献 】

• [1]Drozdovitch VV, Goulko GM, Minenko VF, Paretzke HG, Voigt G, Kenigsberg Ya I.: Thyroid dose reconstruction for the population of Belarus after the Chernobyl accident. Radiat Environ Biophys 1997, 36:17-23.
• [2]Tulchinsky TH, Varavikova EA: Addressing the Epidemiologic Transition in the Former Soviet Union: Strategies for Health System and Public Health Reform in Russia. American Journal of Public Health 1996, 86:313-320.
• [3]Shkolnikov V, McKee M, Leon DA: Changes in life expectancy in Russia in the mid-1990s. Lancet 2001, 357:917-921.
• [4]Ciment J: Life expectancy in Russian men falls to 58. BMJ 1999, 319:468.
• [5]Field MG: The health crisis in the Soviet Union: a report from the 'post-war' zone. Social Science and Medicine 1995, 41:1469-1478.
• [6]Cassileth BR, Vlassov VV, Chapman CC: Health Care, Medical Practice, and Medical Ethics in Russia Today. JAMA 1995, 273:1569-1573.
• [7]Wise PH: The anatomy of a disparity in infant mortality. Annu Rev Public Health 2003, 24:341-362.
• [8]Reidpath DD, Allotey P: Infant mortality rate as an indicator of population health. J Epidemiol Community Health 2003, 57:344-346.
• [9]UNICEF Statistics, Childhood Mortality. [http://www.childinfo.org/cmr/revis/db1.htm] webcite
• [10]Notzon FC, Komarov YM, Korotkova AV, Ermakov SP: Maternal and child health statistics: Russian Federation and United States, selected years, 1985-1995. Volume 5 (10). National Center for Health Statistics; 1999.
• [11]Official Site of the Mogilev Region Administratinon (Belarus) [http://region.mogilev.by/eng/] webciteMogilev Region Administration; 2003
• [12]WHO: World Health Organization, International statistical classification of diseases, injuries, and causes of death, 9th Revn. Geneva, World Health Organization; 1975.
• [13]NCHS: Vital and health statistics: Russian Federation and United States, selected years 1980-93. National Center for Health Statistics; 1995.
• [14]Nolte E, Brand A, Koupilova I, McKee M: Neonatal and postneonatal mortality in Germany since unification. J Epidemiol Community Health 2000, 54:84-90.
• [15]Korblein A: Strontium fallout from Chernobyl and perinatal mortality in Ukraine and Belarus. Radiats Biol Radioecol 2003, 43:197-202.
• [16]Wuhib T, McCarthy BJ, Chorba TL, Sinitsina TA, Ivasiv IV, McNabb SJN: Underestimation of Infant Mortality Rates in One Republic of the Former Soviet Union. Pediatrics 2003, 111:e596-e600.
• [17]Andreev EM, Nolte E, Shkolnikov VM, Varavikova EA, McKee M: The evolving pattern of avoidable mortality in Russia. International Journal of Epidemiology 2003, 32:437-446.
• [18]Twigg JL: Health care reform in Russia: a survey of head doctors and insurance administrators. Social Science and Medicine 2002, 55:2253-2265.
• [19]Malloy MH, Kleinman JC, Land GH, Schramm WF: The association of maternal smoking with age and cause of infant death. Am J Epidemiol 1988, 128:46-55.
• [20]Wisborg K, Kesmodel U, Henriksen TB, Olsen SF, Secher NJ: Exposure to Tobacco Smoke in Utero and the Risk of Stillbirth and Death in the First Year of Life. Am J Epidemiol 2001, 154:322-327.
• [21]Newton RW, Webster PA, Binu PS, Maskrey N, Phillips AB: Psychosocial stress in pregnancy and its relation to the onset of premature labour. BMJ 1979, 2:411-413.
• [22]Fikree FF, Azam SI, Berendes HW: Time to focus on child survival programmes on the newborn: assessment of levels and causes of infant mortality in rural Pakistan. Bull World Health Organ 2002, 80:271-276.
• [23]Kleinman JC, Kiely JL: Postneonatal Mortality in the United States: An International Perspective. Pediatrics 1990, 86:1091-1097.
• [24]Shkolnikov VM,, McKee M, Chervyakov VV, Kyrianov NA: Is the link between alcohol and cardiovascular death among young Russian men attributable to misclassification of acute alcohol intoxification? Evidence from the city og Izhevsk. J Epidemiol Community Health 2002, 56:171-175.
• [25]Notzon FC, Komarov YM, Ermakov SP, Sempos CT, Marks JS, Sempos EV: Causes of Declining Life Expectancy in Russia. JAMA 1998, 279:793-800.
• [26]Wegman ME: Infant Mortality: Some International Comparisons. Pediatrics 1996, 98:1020-1027.
• [27]Schultz DS, Rafferty MP: Soviet Health Care and Perestroika. Am J Public Health 1990, 80:193-197.