Community Health Assessment Maternal and Child Health Republic of Kazakhstan Meruert Rakhimova Kanat Shakenov Faina Linkov MERUERT RAKHIMOVA Is a 2nd year graduate student at GSPH, University of Pittsburgh, Department of Health Service Administration, division of Behavioral and Community Health Sciences . She has her MD from Kazakh State Medical University, Almaty, Kazakhstan (1999). She also worked at the Department of Pharmacology at the same university in Kazakhstan (1999-2000) FAINA LINKOV is a PhD student in the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh. She currently works with Dr. Ronald LaPorte in the Supercourse project. She got her undergraduate degree in Psychology at the University of Pittsburgh in 1999. KANAT SHAKENOV is a 2nd year graduate student at GSPH, University of Pittsburgh, Department of Health Service Administration, division of Behavioral and Community Health Sciences. He graduated from Kazakh State Medical University in 1999 with the degree in dentistry.

For over 70 years, healthcare system in Kazakhstan was government centralized. However, the break down of Soviet Union in 1991 started a complete deterioration of this system and a great decrease in the quality of health care.

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

Objective: To 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. Assessment was based on various literature sources including Kazakhstan Demographic and Health Survey 1999 by Academy of Preventive medicine of Kazakhstan and Macro International, Inc.

Conceptual Framework MANDALA of Health. We looked at multiple factors influencing maternal and child health in Kazakhstan: Maternal education Women’s role Economics Environment And other factors….. According to Mandala model of human health, factors that influence individuals and their families include: human biology, personal behavior, psycho-socio-economic environment, and physical environment. Each of them can individually and/or in conjunction with others affect personal well-being.

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

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

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 Urban: 1.5 children Rural: 2.7 children

Comparison Communities Uzbekistan Russia UK Infant Mortality 80/1,000 25/1,000 5.86/1,000 Under 5year mortality 105/1,000 30/1,000 8/1,000 Maternal mortality 39/100,000 75/100,000 9/100,000

Major causes of infant mortality per 10,000 1994 1995 1996 ALL CAUSES 268.2 265.0 248.1 Respiratory diseases 80.3 84.6 75.1 Incl. pneumonias 78.0 83.8 74.0 perinatal morbidity (unspecified) 82.5 73.0 77.9 Incl. GI infections 28.3 28.2 21.2 Congenital abnormalities 32.3 35.5 30.4 Accidents, poisoning, injuries 14.8 13.2 14.3

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%

Vaccination coverage among children 12-23 months (1999): BCG and first dose of polio and DPT/DP – 99% All WHO-recommended vaccinations – 81%

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

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

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

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)

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

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

Abandoned babies in Children Hospital #1 in Astana, capital of the Republic of Kazakhstan. The number of babies that are getting abandoned is increasing in Kazakhstan as a result of financial difficulties that many single mothers experience.

Group of volunteers is working with abandoned children to stimulate their development.

“Waiting for adoption” Family Adoption Center working under Family Health Council, Inc., Pittsburgh, PA, had established partnering relations with Children’s Hospital #1 in Astana to carry out international adoption program.

Local pediatric clinic, Almaty, Kazakhstan

Dr. Rakhimova is holding one of those orphans, Nelli, 5 y. o Dr. Rakhimova is holding one of those orphans, Nelli, 5 y.o., malnourished and physically immature, who is getting premedicated for her cleaved lip plastic surgery. The surgery would be performed by international team of plastic surgeons within a charity program “Operation Blessing International” / Flying Hospital.

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

Visiting a Family Planning Physician

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