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      Infant mortality trends in a region of Belarus, 1980–2000

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          Abstract

          Background

          The Chernobyl disaster in 1986 and the breakup of the former Soviet Union (FSU) in 1991 challenged the public health infrastructure in the former Soviet republic of Belarus. Because infant mortality is regarded as a sensitive measure of the overall health of a population, patterns of neonatal and postneonatal deaths were examined within the Mogilev region of Belarus between 1980 and 2000.

          Methods

          Employing administrative death files, this study utilized a regional cohort design that included all infant deaths occurring among persons residing within the Mogilev oblast of Belarus between 1980 and 2000. Patterns of death and death rates were examined across 3 intervals: 1980–1985 (pre-Chernobyl), 1986–1991 (post-Chernobyl & pre-FSU breakup), and 1992–2000 (post-Chernobyl & post-FSU breakup).

          Results

          Annual infant mortality rates declined during the 1980s, increased during the early 1990s, and have remained stable thereafter. While infant mortality rates in Mogilev have decreased since the period 1980–1985 among both males and females, this decrement appears due to decreases in postneonatal mortality. Rates of postneonatal mortality in Mogilev have decreased since the period 1980–1985 among both males and females. Analyses of trends for infant mortality and neonatal mortality demonstrated continuous decreases between 1990, followed by a bell-shaped excess in the 1990's. Compared to rates of infant mortality for other countries, rates in the Mogilev region are generally higher than rates for the United States, but lower than rates in Russia. During the 1990s, rates for both neonatal and postneonatal mortality in Mogilev were two times the comparable rates for East and West Germany.

          Conclusions

          While neonatal mortality rates in Mogilev have remained stable, rates for postneonatal mortality have decreased among both males and females during the period examined. Infant mortality rates in the Mogilev region of Belarus remain elevated compared to rates for other western countries, but lower than rates in Russia. The public health infrastructure might attempt to assure that prenatal, maternal, and postnatal care is maximized.

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          Most cited references24

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          Infant mortality rate as an indicator of population health.

          D. Reidpath, P Allotey (2003)
          The infant mortality rate (IMR) has been criticised as a measure of population health because it is narrowly based and likely to focus the attention of health policy on a small part of the population to the exclusion of the rest. More comprehensive measures such as disability adjusted life expectancy (DALE) have come into favour as alternatives. These more comprehensive measures of population health, however, are more complex, and for resource poor countries, this added burden could mean diverting funds from much needed programmes. Unfortunately, the conjecture, that DALE is a better measure of population health than IMR, has not been empirically tested. IMR and DALE data for 1997 were obtained from the World Bank and the World Health Organisation, respectively, for 180 countries. There is a strong (generally) linear association between DALE and IMR (r=0.91). Countries with low DALE tend to have a high IMR. The countries with the lowest IMRs had DALEs above that predicted by the regression line. There is little evidence that the use of IMR as a measure of population health has a negative impact on older groups in the population. IMR remains an important indicator of health for whole populations, reflecting the intuition that structural factors affecting the health of entire populations have an impact on the mortality rate of infants. For countries with limited resources that require an easily calculated, pithy measure of population health, IMR may remain a suitable choice.
          Article 0 comments Cited 95 times – based on 0 reviews     Review now
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            Causes of declining life expectancy in Russia.

            F C Notzon, Y M Komarov, S P Ermakov … (1998)
            Russian life expectancy has fallen sharply in the 1990s, but the impact of the major causes of death on that decline has not been measured. To assess the contribution of selected causes of death to the dramatic decline in life expectancy in Russia in the years following the breakup of the Soviet Union. Mortality and natality data from the vital statistics systems of Russia and the United States. Russia, 1990-1994. Entire population of Russia. Mortality rates, life expectancy, and contribution to change in life expectancy. Application of standard life-table methods to calculate life expectancy by year, and a partitioning method to assess the contribution of specific causes of death and age groups to the overall decline in life expectancy. United States data presented for comparative purposes. Age-adjusted mortality in Russia rose by almost 33% between 1990 and 1994. During that period, life expectancy for Russian men and women declined dramatically from 63.8 and 74.4 years to 57.7 and 71.2 years, respectively, while in the United States, life expectancy increased for both men and women from 71.8 and 78.8 years to 72.4 and 79.0 years, respectively. More than 75% of the decline in life expectancy was due to increased mortality rates for ages 25 to 64 years. Overall, cardiovascular diseases (heart disease and stroke) and injuries accounted for 65% of the decline in life expectancy while infectious diseases, including pneumonia and influenza, accounted for 5.8%, chronic liver diseases and cirrhosis for 2.4%, other alcohol-related causes for 9.6%, and cancer for 0.7%. Increases in cardiovascular mortality accounted for 41.6% of the decline in life expectancy for women and 33.4% for men, while increases in mortality from injuries (eg, falls, occupational injuries, motor vehicle crashes, suicides, and homicides) accounted for 32.8% of the decline in life expectancy for men and 21.8% for women. The striking rise in Russian mortality is beyond the peacetime experience of industrialized countries, with a 5-year decline in life expectancy in 4 years' time. Many factors appear to be operating simultaneously, including economic and social instability, high rates of tobacco and alcohol consumption, poor nutrition, depression, and deterioration of the health care system. Problems in data quality and reporting appear unable to account for these findings. These results clearly demonstrate that major declines in health and life expectancy can take place rapidly.
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              The evolving pattern of avoidable mortality in Russia.

              Dmitry E. Andreev, Martin McKee, Elena Varavikova … (2003)
              Life expectancy at birth in Russia is over 12 years less than in western Europe. This study explores the possible role of medical care in explaining this gap by examining the evolving pattern of mortality amenable to timely and effective medical care in Russia compared with Estonia, Latvia, and Lithuania, and the UK. Analysis of standardized death rates from causes amenable to health care (treatable) or inter-sectoral health policies (preventable) in all regions and decomposition of differences in life expectancy between Russia and the UK by age, sex, and cause of death for the period 1965-1999/2000. Death rates from treatable causes remained stable between the mid-1960s and mid-1980s in Russia and the Baltic republics while steadily falling in the UK to less than half the rate in Russia. In the 1990s, rates increased in the former Soviet republics, reaching a peak in 1994 but reversing again in Russia in 1998. Deaths from causes amenable to inter-sectoral health interventions were higher in the UK in 1965 than in the Soviet Union but subsequently fell steadily while they increased in the East. Between 1965 and 1999, the male life expectancy gap between Russia and the UK rose from 3.6 to 15.1 years (women: 1.6 and 7.4 years). Treatable causes became an increasingly important contributor to this gap, accounting for almost 3 years by the end of the 1990s in men and 2 years in women. In Russia, elimination of treatable causes of death would have increased life expectancy by 2.9 years in men in 1995/99 compared with 1.2 years in the UK (women: 3.3 and 1.8 years), suggesting that, were the outcomes of health care achieved in the UK to be obtained in Russia, life expectancy for men might improve by about 1.7 years and for women by about 1.5 years. Our findings suggest that the Soviet health care system has failed to match the achievements of the West over the past three decades, highlighting the need to establish a system that provides effective and equitable care for the Russian population.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMC Pediatr
                Title: BMC Pediatrics
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2431
                Publication date Collection: 2004
                Publication date (Electronic): 11 February 2004
                Volume: 4
                Page: 3
                Affiliations
                [1 ]Department of Epidemiology, School of Public Health, University of Massachusetts at Amherst, Amherst, MA 01002, USA
                [2 ]Division of Cancer Prevention & Population Sciences, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
                [3 ]Department of Social & Preventive Medicine, School of Public Health & Health Professions, State University of New York at Buffalo, 276 Farber Hall, Buffalo, New York 14214, USA
                [4 ]Educational Affairs, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
                [5 ]Mogilev Regional Children's Hospital, Mogilev, Belarus
                [6 ]Department of Family Medicine, State University of New York at Buffalo, ECMC Clinical Center, 462 Grider Street, Buffalo, New York 14215, USA
                Article
                Publisher ID: 1471-2431-4-3
                DOI: 10.1186/1471-2431-4-3
                PMC ID: 362877
                PubMed ID: 15018629
                SO-VID: f661f671-f27d-4408-a032-66e2d77bde30
                Copyright © Copyright © 2004 Zichittella et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.
                History
                Date received : 19 August 2003
                Date accepted : 11 February 2004
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Pediatrics
                Keywords: infant deaths,public health,chernobyl,neonatal deaths,postneonatal deaths,epidemiology
                Data availability:
                ScienceOpen disciplines: Pediatrics
                Keywords: infant deaths, public health, chernobyl, neonatal deaths, postneonatal deaths, epidemiology

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