N.P. Kirbasova, A.M. Magomedova, R.N. Shahsinova
I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation

Summary. Subject of the study: maternal and perinatal mortality in the Republic of Dagestan in 2005-2011. Research topic: maternal and perinatal mortality in the Republic of Dagestan.

The aim of the study was to analyze structure of maternal and perinatal mortality in 2005 - 2011 in the Republic of Dagestan in comparison with the Russian Federation; relationship with the geographic and demographic peculiarities of the region, and impact of the existing structure of the obstetric service on future reduction of maternal and perinatal mortality and quality improvement of obstetric care.

Methodology: review of total population indicators, female population of reproductive age, natural increase, fertility, structure of maternal and perinatal mortality in the region with due regard to levels of medical care delivery in comparison with the Russian Federation.

Results. The Republic of Dagestan is characterized by territorial fragmentation, lack of road connections between regional centers and certain districts during winter time; 11 districts of the Republic are avalanche-prone. Female population of reproductive age accounts for 57% of the total population; 55% of them are rural dwellers. Though the Republic’s rates of growth in births are comparable to ones of the Russian Federation - 19.9% and 22.6%, the rates of decline in infant and perinatal mortality in the Republic are lower. In the Republic of Dagestan, infant mortality dropped by 19%, perinatal mortality - by 10% while in Russia infant mortality dropped twice and perinatal mortality dropped one third. Early neonatal mortality increased by 63% (while in Russia it decreased by 31%) due to reduced share of stillbirths. Despite a unidirectional dynamics, the rates of decline in maternal mortality in the Republic are 1.5 times lower, permanently exceeding the Russian Federation rates 1.5-1.9 times. Maternal mortality in rural areas is 2-5 times higher than in the city. Slower decline in the Republic of Dagestan is due to increased maternal mortality in rural areas by 35% against a decline in the city by 51 %. 26% of births are given at the first level care facilities (mainly in rural areas); rural dwellers account for 68% of maternal deaths. The share of manageable causes in the structure of maternal mortality adds up to 86-68%: toxemia of pregnancy, bleeding, complications due to anesthesia, post-transfusion and purulent-septic complications. 12.5% of women died were not on the antenatal follow up; the share of women with three or more children was high.

Scope of application: Results can be used to evaluate quality of obstetric and neonatal care, to develop programs aimed at improving obstetric and neonatal care.

Conclusions. The organizational structure of the obstetric service that is developed regardless of geographical and demographic peculiarities of the region and regardless of the regional structure of pregnancy and birth failures slowdowns reduction of maternal and perinatal mortality and quality improvement of obstetric care. Bed utilization at obstetric care facilities of the first, second and primarily the third level of care delivery as well as size and composition of workforce should be optimized with due regard to birth rates, births parity, maternal and perinatal mortality, geographical peculiarities of the region with introduction of evidence-based index.

Keywords: maternal mortality; structure of maternal mortality; perinatal mortality; specific characteristics of maternal and perinatal mortality in the Republic of Dagestan.

Refereneces

1. Gridchik AL. Maternal mortality in conditions of health care reforms in Moscow region (current state, tendencies, and prevention). Dr.Med.Sci [thesis]. Moscow. 2002. 38 p. (In Russian).
2. Lazarenko MI. Complex transfusion provision of a large multi-field health facility. Dr.Med.Sci [thesis]. St. Petersburg. 2008. 46 p. (In Russian).
3. Pogorelova EI. Scientific grounds for measures to increase the reliability of population mortality statistics. Cand.Med.Sci [thesis]. Moscow. 2004. 24 p. (In Russian).
4. Sukhanova LP, Yusupova AN, Glushenkova AV. Clinical and statistical analysis of tendencies of maternal mortality in Russia. Zdravookhranenie Rossiyskoy Federatsii 2009; (4): 14-19. (In Russian).
5. Filippov OS, Guseva EV. Assessment of efficiency of the organizational model of obstetric care in the Russian Federation. Akusherstvo, ginekologiya, reproduktsiya 2010; (2): 16-20. (In Russian).
6. Filippov OS, Guseva EV. Modernization of anesthetic intensive service in obstetric care as a way to reduce maternal mortality. Akusherstvo i ginekologiya 2009; (5): 52-55. (In Russian).
7. Sharapova OV, Baklaenko NG, Koroleva LP. On maternal mortality in the Russian Federation in 2007. Information Letter. Moscow. 2008. 62 p. (In Russian).
8. Esedov AM, Shakhsinova RN. Analysis of maternal mortality in Republic of Dagestan during the last 15 years. In: The 5-th Regional Forum “Mother and Child”, Proceedings. Gelendzhik, 2011. p. 348. (In Russian).

Write Comment

Please keep the topic of messages relevant to the subject of the article. Personal verbal attacks will be deleted. Please don't use comments to plug your web site. Such material will be removed. Just ensure to *Refresh* your browser for a new security code to be displayed prior to clicking on the 'Send' button. Keep in mind that the above process only applies if you simply entered the wrong security code.
Name:
E-mail
Comment:
Code:*