Community Health Assessment Maternal and Child Health Republic of Kazakhstan Meruert Rakhimova Kanat

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Community Health Assessment Maternal and
Child Health Republic of Kazakhstan
Meruert RakhimovaKanat ShakenovFaina Linkov
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Kazakhstan Introduction

• Location North of Central Asia
• Population 14.9 million (53 women) (1999)
• Religion Islam
• Ethnicity
• Kazakh 53.4, Russian 30, others 16.6
• Political status
• former Soviet Republic,
• independent state since 1991

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ObjectiveTo analyze factors influencing
maternal and child health in Kazakhstan. To
identify major health deficiencies in these areas
and to propose interventions strategies for
improving the current situation.
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Conceptual Framework

• MANDALA of Health.
• We looked at multiple factors influencing
  maternal and child health in Kazakhstan
  
• Maternal education
• Womens role
• Economics
• Environment
• And other factors..

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Culture
Community
Lifestyle
Personal Behaviour
Psycho-Socio Economic Environment
Family
Spirit
Sick Care System
Work
Mind
Body
Human Biology
Physical Environment
Human-Made Environment
Biosphere
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DECLINE IN

• Birth rate per 1000
• 1994 18.2
• 1999 14.0
• Fertility rate (No of children per woman)
• 1989 2.9
• 1995 2.5
• 1999 2.1

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Maternal and Child health indicators in Kazakhstan

• Infant mortality rate 61.9 / 1,000
• Under-five mortality rate 71.4 / 1,000
• Maternal mortality 62.5 per 100,000

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Comparison Communities
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Major causes of infant mortality per 10,000
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Access to healthcare (1999)

• Obstetricians and gynecologists supply 14.4 per
  1,000 newborns
  
• Pediatricians supply (incl.neonatologists)- 1.32
  per 1,000 children aged 1-14
  
• Antenatal care received 94
• No of births delivered at health facilities 98

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Vaccination coverage among children 12-23 months
(1999)

• BCG and first dose of polio and DPT/DP 99
• All WHO-recommended vaccinations 81

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Personal Behavior

• Changes in values
• Substance abuse
• Lowered average age at first sexual intercourse
• Unsafe sexual practices

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Incidence of syphilis in KZ per 100,000 (years
1991 thru 1999)
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Human biology

• DALE - 56.4 years (122 rank)
• Average life expectancy is decreasing for the
  past decade
  
• 1988 male 64.8 female 74.1
• 2000 male 58.8 female 70.1

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Physical Environment

• Proper housing
• Fresh water 59 piped water (1999),
• 1/3 (30) use water from an open well,
• urban 90 piped water, rural 35
• Sanitation
• Urban 81 flush toilets,
• Rural 5 flush toilets (94 pit toilets)

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Psycho-Social-Economic Status

• Female Literacy - over 99
• Muslim society-the role of women is undermined
• Women are underrepresented in the government
• Women have little decision making power

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Major Deficiencies

• Financial difficulties due to economic crisis
  (approx. 2 - 2.5 of GDP goes to healthcare GDP
  itself decreased by 50 after collapse of Soviet
  Union)
• Access to quality healthcare-disproportionate
  allocation of health facilities-all rural areas
  are underserved
  
• Absence of health insurance
• Access to fresh water supply
• Sanitation problems

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Proposed interventions

• Elaboration and implementation of reproductive
  health programs ( raise health awareness among
  women, family planning)
  
• Increase access to quality health care for
  indigent women and children
  
• Legal restrictions on alcohol and cigarette sales
  and consumption
  
• Provision of information to population via Mass
  Media on available health resources

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Useful Links Related to Maternal and Child Health
in Kazakhstan

• Official web site of Kazakhstan (Background)
• Republic of Kazakhstan Social Protection
  
  
• Project, supported by World Bank (targeting
• kindergarten age children)
• Maternal Health Around the World Maternal
• Mortality in Asia