1. Programme on reduction of perinatal mortality in the Republic of Kazakhstan Dr. Bekbai Khairulin Head of the MCH Department, MoH RK VII CARK MCH Forum Almaty, Kazakhstan 5 – 7 November 2003

2. Situation in Perinatal Care (based on findings of the study of the causes of infant and child mortality in the Republic of Kazakhstan, UNICEF, 2002)

3. The analysis of 3,168 child deaths at the age of 0-5 years demonstrated First, most children (62.1%) died in the early neonatal period and 50% of the losses could have been prevented. First, most children (62.1%) died in the early neonatal period and 50% of the losses could have been prevented. The second important factor revealed by analysis is the leading role of infections as the cause of death of children in all age groups. The second important factor revealed by analysis is the leading role of infections as the cause of death of children in all age groups. The third factor is a lack of access to primary health care services for population in remote areas and those living in Rayons without primary health facilities. The third factor is a lack of access to primary health care services for population in remote areas and those living in Rayons without primary health facilities. The fourth factor revealed by this study is a high level of accidental deaths among infants and children. The fourth factor revealed by this study is a high level of accidental deaths among infants and children.

4. Age Structure of Infant and Child Mortality Late neonatal periond 8% Postneonatal period 21% 1 to 5 years 9% Early neonatal period 62%

5. Major causes of early neonatal deaths 20,6% 19,6% 14,4% 13,7% 6,8% 4,0% 0,0%5,0%10,0%15,0%20,0%25,0% Newborn haemolytic disease Birth defects Congenital Penumonia Birth trauma Infections Respiratory Distress Syndrome

6. Children with normal birth weight Children with low birth weight Structure of Early Neonatal Deaths by birth weight VVLBW (500-999 g) 1% LNBW (2000-2499 g) 66% VLBW (1000-1499 g) 10% LBW (1500-1999 g) 23%

7. Programme Goal To reduce perinatal mortality through overall improvement of health status of reproductive age women, and improvement of newborn care provided by maternal and other concerned health institution of the Republic of Kazakhstan

8. Programme Objectives To reduce antinatal losses through improved health of reproductiveage women, and introduction of modern antenatal technologies To reduce antinatal losses through improved health of reproductiveage women, and introduction of modern antenatal technologies To reduce intranatal losses by adoption of evidence based EOC technologies To reduce intranatal losses by adoption of evidence based EOC technologies To reduce early neonatal mortality due to asphixia, RDS, birty trauma and infections, by means of improvements in perinatal care To reduce early neonatal mortality due to asphixia, RDS, birty trauma and infections, by means of improvements in perinatal care

9. Programme Implementation Mechanisms Development and introduction of package activities aimed at overall improvement of health of reproductive age women Development of universal principles of perinatal health care Regionalisation of perinatal care Programme of Continuous Quality Improvement

10. Programme Activities I.Improvement of health status of women of reproductive age II.Development of universal principles of perinatal care III.Regionalisation of perinatal care (staged care) IV.Continuous quality improvement

11. Improvement of health status of reproductive age women Rationalisation of nutrition of reproductive age women including essential use of fortified flour and iodised salt, as well as organisation of ‘Nutrition Couseling’ Prevention of STIs Family planning Information of population on issues concerning reproductive health

12. Development of universal principles of perinatal care Development and introduction of regulations concerning provision of ante-, post-, perinatal and neonatal care based on effective WHO technologies Review of documents regulating provision of maternal services and bringing them in line with new technologies Development and introduction of national protocols on intra- and postneonatal care.

13. Regionalisation of perinatal care (staged care) Development and approval of standards for levels of maternal (orgnaisations) insitutions Inventory of maternal organisations Development and approval of resolution endorsing distribution of maternal organisations by levels of perinatal care

14. Programme of Continuous Quality Improvement Improvement of organisation and management of perinatal care Improving the knowledge and qualification of health workers. This includes the use of BABIES matrix and TQM package Programme monitoring and evaluation

15. Expected Outcomes of the Programme Reduction of infant mortality, mainly as a result of reduced perinatal losses Reduction of proportion of children with low birth weight and especially those with very lowbirth weight (below 1500 g). It is also expected that improvement in overall health of women will result in reduction of maternal mortality

16. Mapping of activities aimed towards reduction of perinatal and infant mortality Health of women mothers mothersAntenatalcareInfant care careIntra-natalcareNewborncare 7 days 28 days1 yr Prematurity 5,2 % Antenatal mortality - 6,2 ‰ Perinatal mortality – 15,5 ‰ Infany mortality – 19,4 ‰ Fetal and infant mortality - ? ‰ Still births – 7,9 ‰ Early neonatal 7,6 ‰ 22 wks.28 wks Delivery

17. Thank You!