L.P. Sukhanova1, N.N. Bushmelyova2, Z.Kh. Sorokina3
1Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation, Moscow
2State Medical Academy of the city of Izhevsk, city of Izhevsk
3Academician V.Yi.Kulakov Memorial Research Center for obstetrics, gynecology and perinatal studies
Summary. Evaluation of recent two decades tendencies in
infantile mortality shows rather a favorable situation when based on
indicators from official statistics: the rates of overall infantile
mortality has decreased from 17.8 deaths upon 1000 newborns in 1991 to
7.4 (that is 2.4-foldly) in 2011, neonatal mortality has decreased from
11.0 ‰ in 1991 to 4.2 ‰ in 2011 (61.8% less in 2011), the mortality of
infants of first week after birth has decreased from 8.9‰ to 2.8‰ (68.5%
less in 2011‰) – mainly contributing to neonatal mortality improved
rates, post-neonatal mortality has decreased from 6.8 in 1991 to 3.3 in
2011 (51.5% less in 2011). Interestingly enough, the fastest rates of
diminishment of the infantile mortality were pertaining to the second
decade of the period studied – from 15.3 in 2000 to 7.4 in 2011.
Noteworthy, infantile mortality is generally considered to be a rather
steady and persistent demographic indicator not quite susceptible to
drastic or just rapid changes, thus, a strong doubt arises as to the
verified nature of these statistical data. Analysis of the dynamics of
these changes, of the age structure of dead-borns and the structure of
newborns’ deaths along body (at-birth) weight categories only but gave
growth to these doubts.
A peculiar feature of infantile mortality age structure in Russia
presented in official statistics was the steady diminishment of the
proportion of neonatal mortality with simultaneous growth of
post-neonatal mortality (the so called ageing of infantile mortality),
while in the EU, for instance, the tendencies are quite opposite to
these ones: more late fatalities are not so prominent in comparison,
and the overall decreased infantile mortality here comes mainly from the
decreased post-neonatal mortality.
The whole nuisance with Russian peculiar features in the dynamics of the
statistically presented infantile mortality could be accounted for
merely by factual under-registration of dead infants.
Two evasion pathways involved in under-calculated indicators of
infantile mortality in Russia were identified in this study: first, the
statistical transfer of a infant dead in early neonatal period to the
category of stillborn, which was quite possible before the new
regulations for the official statistics on this point; secondly,
entering the fact of dead infant (or stillborn) into the pool of fetus
phenomena specifically including miscarriage with no official
registration (on the ground that it was a fetus phenomenon) which was
also quite possible before the new regulations of 2011 for the official
statistics on that point. Peculiar enough was that before these new
regulations, the very discontinuation of pregnancy prior to 27 full
weeks of gestation had been often considered as a miscarriage only.
First, the structural discrepancies in the statistical pool between the
number of life-born and still-born infants are quite obvious from the
official statistics presentations, and these discrepancies were due to
unjustified transfer of infants dead in early neonatal period to a
stillborn category. Secondly, a mythical ablation of a whole category of
newborns (and that was the category with the weight-at-birth of
1000-1499 g) not rarely occurring in statistics of registered infantile
mortality, indicated the existence of great lacunae in this respect.
These insufficiencies to a great extent were due to referring dead
infants to unborn fetes not intended for official registration as
dead-borns.
The first evasion pathway when a life-born, then dead infant was entered
into the category of a stillborn was being very clearly identified
judging from not rare statistical absence or unrealistically small
numbers of the infants dead in the primary 24 hours after birth.
Conclusions: Infantile mortality, or more specifically neonatal
mortality, was artificially under-estimated and under-calculated in
Russia in the past two decades, mainly due to sharp under-registration -
through various evasion pathways - of the infants dead in the PB
(post-birth) neonatal period (0-6 days after birth). Post-neonatal
losses has proved to be of more verified character compared to neonatal
mortality presented by official statistics. Moreover, numerical
relationship between neonatal and post-neonatal losses in the official
statistics of the EU has proved to be much more appropriate, presuming
the possible implementation of the established there proportion for the
correction of the biased statistics in our country - for the indicators
of early neonatal (1st day) and post-birth (0-6 days) neonatal mortality, in particular.
This presumed correction could be done on the way of artificially
reconstructed infantile mortality rates with specified consideration to
the officially registered post-neonatal mortality as much more reliable
in this context – with due correction - on this basis - of early
neonatal figures that were, most probably, unreliable ones.
Keywords. Infantile mortality, neonatal mortality, verification of registered newborns mortality, infants of 1st year after birth.
References
- Albitskiy V.Yu., Nikolskaya L.A., Abrosimova M.Yu. Fetoinfantilnyye poteri [Fetoinfant losses]. Kazan. 1997. 168 p.
- Baranov A.A., Albitskiy V.Yu. Smertnost detskogo naseleniya Rossii
[Mortality of children population in Russia]. Moscow: Literra; 2007. 328
p.
- Baranov A.A., Ignatyeva R.K. Problema nedoucheta perinatalnykh
poter [The problem of undercount of perinatal losses]. In: Smertnost
detskogo naseleniya Rossii. Seriya "Sotsialnaya pediatriya". Vypusk 1.
Moscow: Literra; 2007. P. 45-59.
- Goryainova I.L. Mediko-sotsialnyye problemy mladencheskoy
smertnosti, puti eye snizheniya i profilaktiki [Health and social
problems of infant mortality, the ways for its reduction and
prevention]. [PhD. Thesis]. Moscow. 2010. 24 p.
- Prikaz Minzdravsotsrazvitiya Rossii №1687 ot 27 dekabrya 2011g.
(zaregistrirovan v Minyuste RF 15 marta 2012 g. №23490) "O meditsinskikh
kriteriyakh rozhdeniya, forme dokumenta o rozhdenii i poryadke eye
vydachi" ["On health criteria of the childbirth, the form of the birth
certificate and the order of its registration", the Regulation of the
MoH&SD of the RF №1687 of December 27 2011]. [Internet]. 2011 [cited
2012 Nov 12]. Available from:
http://www.minzdravsoc.ru/docs/mzsr/orders/1245
- Prikaz Ministerstva zdravookhraneniya RF ot 04 dekabrya 1992 g.
№318 "O perekhode na rekomendovannyye Vsemirnoy Organizatsiyey
Zdravookhraneniya kriterii zhivorozhdeniya i mertvorozhdeniya". [On
implementation of the live birth and dead birth criteria recommended by
the World Health Organization”, the Regulation of the MoH&SD of the
RF of December 04 1992 №318] [Internet]. 1992 [cited 2012 Nov 12].
Available from:
http://base.consultant.ru/cons/cgi/online.cgi?req=doc;base=MED;n=1971
- Sorokina Z.Kh. Problemy perekhoda otechestvennogo zdravookhraneniya
na mezhdunarodnyye kriterii registratsii detey ekstremalnoy massy tela
[The problem of implementation of international criteria for
registration of newborns with an extreme birth weight in domestic
healthcare]. Problemy upravleniya zdravookhraneniyem 2010;(5):35-40.
- Starodubov V.I., Sukhanova L.P., Sychenkov Yu.G. Reproduktivnyye
poteri kak mediko-sotsialnaya problema demograficheskogo razvitiya
Rossii [Reproductive losses as a health and social problem of the
demographic development of Russia]. Sotsialnyye aspekty zdorovya
naseleniya [Online Scientific Journal]. 2011;(6). [cited 2012 Oct 22].
Available from: http://vestnik.mednet.ru/content/view/367/27/lang,ru/
- Starodubov V.I., Tsybulskaya I.S., Sukhanova L.P. Okhrana zdorovya
materi i rebenka kak prioritetnaya problema sovremennoy Rossii [Maternal
and child’s health protection as a priority problem of the present-day
Russia]. Sovremennyye meditsinskiye tekhnologii 2009;(2):11-16.
- Sukhanova L.P. Optimizatsiya perinatalnoy pomoshchi kak vazhneyshiy
faktor sokhraneniya zdorovya naseleniya Rossii [Optimization of the
perinatal care as an important factor for protection of the Russian
population health. [PhD. Dissertation]. Moscow. 2006. 335 p.
- Sukhanova L.P., Sklyar M.S. Detskaya i perinatalnaya smertnost v
Rossii: tendentsii, struktura, faktory riska [Infant and perinatal
mortality in Russia: tendencies, structure, and risk factors].
Sotsialnyye aspekty zdorovya naseleniya [Online Scientific Journal].
2007;(4) [cited 2012 Nov 12]. Available from:
http://vestnik.mednet.ru/content/view/46/30/
- Ukaz Prezidenta RF № 825 ot 28 iyunya 2007g. (v redaktsii ot
28.04.2008 i 13.05.2010-№579) "Ob otsenke effektivnosti deyatelnosti
organov ispolnitelnoy vlasti subyektov RF" ["On assessment of efficiency
of executive bodies activity in the subjects of the Russian
Federation", the Regulation of the President of the RF № 825 of June 28,
2007]. [Internet]. 2007 [cited 2012 Nov 12]. Available from:
http://www.referent.ru/1/120081
- Blondel B., Breart G. Mortalite foeto-infantile. Evolution, causes et methods d’analise. Encycl. Med. Chir. (Paris-Franct). Pediatrie 1990;(12):34-56.
- Ewerbeck H. Neue Definition bei der Saulingssterblichkeit. Monatsschrift fur Kinderheilkunde 1977;125(6):674.
- Dellaportas G. J. Correlation-based estimation of early infant mortality. Health Services Reports 1972;87(3):275-281.
- Mathews TJ, MacDorman MF. Infant mortality statistics from the 2007
period linked birth/infant death data set. National vital statistics
reports. [Internet]. 2011;59(6). [cited 2012 Nov 12]. Available from:
www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_06.pdf.
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