A Comprehensive Social-Hygienic Study of the Health Status of Premature Children

The dissertation is devoted to a comprehensive social-hygienic study of the health status of premature children and the peculiarities of the lifestyle of their families throughout the first three years of life. The work develops a program and methodology for conducting such a study, encompassing hospitalized morbidity, physical development, social-hygienic factors of health formation, and the organization of medical care. The research was conducted at the base of a children's polyclinic in the city of Moscow and is aimed at substantiating and implementing a program of preventive observation of premature children in outpatient-clinic conditions.

The work analyzes medical and organizational factors influencing the preservation and strengthening of the health of premature children, identifies the role of social-hygienic factors of the family lifestyle in the formation of children's health, and develops principles of monitoring that take into account the social status of the family. The obtained results are directed toward improving medical care for premature children and implementing a system of preventive observation in the outpatient-clinic link of healthcare.

Relevance of the Problem.

The preservation and state of health of the child population currently constitutes one of the priority directions of social policy in our country. This is due, on the one hand, to unfavorable demographic indicators, on the other hand, to the unsatisfactory state of health of the child population. In the Russian Federation, against the background of a sharp decline in birth rate, a decrease in fertility and reproduction indicators, a decrease in the proportion of healthy children among newborns is noted, and the proportion of children with low birth weight increases. Official statistics data confirm that over the past decades the morbidity rate among children has increased from 1404.5‰ to 1871.4‰, and the number of disabled children alone for the period from 1996 to 2001 increased by 93,522 thousand people, while there was an increase in the level of diseases leading to disability from 142.4 to 189.3 diseases per 10,000 children (Makel'skaya N.P., 1977, Zakharova T.G., 1982, Albitsky V.Yu., 1986, Volodin N.N., 1988, Ashabova D.M., 1991, Simonov S.N., 1998, Degtyarev D.N., 1999, Nurgaliev R.I., 1999, Cherdantseva G.A., 1999, Polunina N.V., 2000, Krylova I.V., 2001).

The transition of practical healthcare in our country to international criteria for live birth, the introduction of modern technologies for the management of pregnancy among women in high-risk groups contributed to an increase in the proportion of premature children among newborns. In connection with this, the cost of life and quality of health of newborns are sharply increasing, and the significance of the health of the current generation for the future of the country is growing. It should be taken into account that the care of newborns with various perinatal pathologies is associated with certain difficulties, requires significant resources, and therefore does not always correspond to the developed standards (Kulakov V.I., Barashev Yu.I., 1994, Baranov A.A. et al., 2001, Khersonskaya E.B., Kurzer M.A., 2002). Moreover, the criteria for the success of perinatal medicine should be considered not only the direct care of a premature child, but also the possibility of his further normal development and adaptation in modern society, full participation in public life.

Among the conditions forming the health of the child population, medical and organizational factors play a significant role, since to the greatest extent they are manageable from the side of society, the state, and healthcare. The timely and quality provision of therapeutic and preventive measures to premature children, who are a risk group, largely depends on the preservation and strengthening of the health of the child population. In connection with this arises the necessity of developing measures whose implementation will allow the preservation and strengthening of the health of children, adolescents, and the adult population.

Despite the sufficiently wide study and coverage in the literature of questions concerning the study of the health of children of various age and sex groups, their lifestyle, families raising a premature child have been practically unstudied in a complex with health indicators and lifestyle factors; the peculiarities of the social-hygienic characterization of a premature child and his family have not been shown; the priority of risk factors in the formation of near and distant health indicators of children, including during the first three years of life, has not been established.

In child healthcare, there is no system of monitoring premature children, and medical-technological standards for the provision of specialized medical care to premature children in outpatient-clinic institutions are absent. The volume and effectiveness of the provision of medical care to premature children have not been studied.

The above determined the expediency of conducting the present research, outlined its relevance in modern conditions, and formed the goal of the work.

Goal of the Work.

On the basis of a comprehensive social-hygienic study of the health status of premature children and the peculiarities of the lifestyle of their families, to substantiate and develop medical and organizational recommendations aimed at improving medical care for children in outpatient-clinic conditions and improving their health.

To achieve the set goal, the following tasks were determined:

1. To develop a program and methodology for a comprehensive social-hygienic study of the health status and lifestyle of families raising a premature child.

2. To study and evaluate the hospitalized morbidity of premature children and the peculiarities of morbidity during the first three years of their life.

3. To study and evaluate the physical development of premature children and provide a comprehensive assessment of their health status.

4. To identify medical and social peculiarities of the lifestyle of families raising a premature child, and to determine the factors forming their health.

5. To provide a social-hygienic characterization of the studied children and their families, to identify the role of lifestyle factors in the formation of children's health.

6. To analyze the peculiarities of the organization of medical and social care for premature children in the conditions of a children's polyclinic.

7. To scientifically substantiate, develop, and implement a program of preventive observation of premature children in outpatient-clinic conditions.

Scientific Novelty. The scientific novelty of this research lies in the fact that for the first time:

1. a multi-stage comprehensive social-hygienic study of the health status and lifestyle of premature children was conducted.

2. a comprehensive characterization of the health status of a premature child was given on the basis of morbidity indicators and physical development during the first three years of their life;

3. the proportional participation of social-hygienic factors of the family lifestyle in the formation of the health of a premature child was determined;

4. principles of monitoring the health status of premature children in outpatient-clinic institutions of a large city, taking into account the social status of the family, were developed;

5. a program of preventive observation of premature children in the conditions of outpatient-clinic institutions was substantiated, developed, and implemented.

Practical Significance. On the basis of the results of the conducted research, the main trends in morbidity and physical development of premature children during the first three years of life were determined. A methodology for a comprehensive assessment of the health status of premature children was proposed, allowing district pediatricians to identify priority directions in preventive work with children of early age.

The effectiveness of the organization of therapeutic and preventive care for premature children in the conditions of outpatient-clinic institutions was analyzed. A program of preventive observation of premature children was developed, substantiated, and implemented, based on the formation of a database of their health status, the peculiarities of providing them with therapeutic and preventive care, and the conduct of rehabilitation measures among children.

The principles of the organization of a health school for parents raising a premature child were developed and tested at the base of a children's polyclinic in the city of Moscow.

The materials of the dissertation research were included in the educational process of the departments of public health and healthcare of the Russian State Medical University and the Moscow Institute of Medical and Social Rehabilitation, the department of pediatric diseases of RGMU, and the department of neonatology of the Faculty of Advanced Training of RGMU. Moreover, the obtained results are used in the activities of healthcare institutions in the city of Moscow. The main provisions to be defended:

1. Peculiarities of the health status of premature and full-term children during the first three years of life.

2. Medical and social characterization of families raising premature children during the first three years of life.

3. The role of social-hygienic factors of lifestyle in the formation of the health of premature children.

4. Medical and organizational measures for preventive observation of premature children in the conditions of a children's polyclinic of a large city.