MCH CARK Forum
VII Annual Meeting
Achievements in
implementation of
VI MCH CARK Forum
recommendations
November 5-7, 2003, Almaty, Kazakhstan
Recommendations of the VI MCH
CARK Forum on reduction of Infant
and Child Mortality
• To adopt international criteria of live birth
in pilot regions, improve registration and
reporting system;
• Early neonatal period – to provide and
ensure safe motherhood and healthy
pregnancy;
• Late neonatal and post-neonatal periods –
to introduce IMCI program, program of
micronutrients disorders prevention;
• Inter-sectoral issues – to conduct a survey
on accessibility and quality of health care
services at primary health care level
The Kyrgyz MOH Decree № 338
as of 27.09.01
«On transition to WHO
recommended criteria of live birth
and stillbirth» is being implemented,
in accordance to which, registration
of the infants born is performed with
the use of official criteria of live birth
in parallel with WHO recommended
criteria
Infant Mortality Rates (IMR) by official statistics and
application of WHO recommended criteria,
Kyrgyz Republic (9 months of 2003)
IMR by official IMR with application
of WHOecommended
statistics
criteria
21,4
Kyrgyz Rep
19,4
21,3
26,5
Bishkek City
14,8
20,1
Chui Oblast
22,7
23,2
Talas oblast
20,7
21,1
Naryn Oblast
Issyk-Kul Oblast
13,7
15,9
Osh Oblast
22,2
22,9
20,3
20,7
Batken oblast
19,1
19,9
Jalal-Abad Obl
The MOH Decree №511 as of 11.12.02 «On
Transition to WHO recommended criteria of
live births and stillbirths in pilot regions» is
implemented; Chui oblast and Bishkek City
are identified as pilot regions;
- 8 seminars were conducted, 200 specialists
were trained, including:
Ob-Gyns, neonatologists, pediatricians, patmorphologists, medical statisticians, health
care system managers;
-the following equipment was provided to
pilot regions: electronic scales, mucus
exhaust devices, Ambu bags, kits for pat
anatomic autopsy of low weight newborns;

Perinatal Mortality Rate in Pilot Regions by official
statistics and application of WHO recommended
criteria of live birth, 8 months 2003
Official
statistics
WHO
criteria
%
Growth
Kyrgyz Republic
24,7
36,0
45,7
Bishkek City
23,8
35,3
48,3
Kyrgyz
Research
Institute of
Obstetrics
43,2
58,5
35,4
Chui oblast
21,9
32,2
47,0
•Nationwide transition to international
definitions, related to perinatal period, is
planned for January 1, 2004.
The following preparatory work is being done:
-Inter-Sectoral Working Group has been
established;
-National Statistics Committee has reviewed
Program of converting of IMR taking into
account WHO recommendations;
-The Ministry of Justice jointly with Ministry of
Interior are implementing activities aimed at
improvement of reliability and accuracy of
registration of children born and died
-The Ministry of Health (MOH) has revised
the registration-reporting system, medical
documentation, related to perinatal period,
taking into account WHO recommendations,
which are introduced in all health care
facilities of the republic; seminars were
conducted to train specialists in their use
in practice;
-Clinical Protocols on Low-Weight Babies
care are being developed;
- National Program on Perinatology is being
initiated
Logistic of maternity health facilities of the
republic is being upgraded:
-with support of WB, ADB, Kyrgyz-Swiss Health
Reforms Support Project, repair works have been
completed in 124 health care facilities, including
maternity ones;
-Under the «Protection of Mother’s and Child’s
Health Project II», the German bank KFW has
supplied medical equipment to maternity
institutions in the south of the country;
-The same project plans to supply medical
equipment to maternity health facilities in the
north of the country in 2003-2004.
•
The draft of the Resolution of the KR
Government «On modification of national
statistics due to transition to international
definitions, related to perinatal period» is being
discussed with ministries and agencies
• On the 5th of November 2003 a Review Meeting is
being held with participation of the KR
Government representatives, interested Ministries
and agencies, international organizations, where
the results of introduction of international
definitions, concerning perinatal period, in pilot
regions will be discussed, as well as perspectives
for their expansion nationwide will be considered
Provision of safe motherhood and healthy
pregnancy is the main objective to reduce the
level of infant mortality in early neonatal period
• The work on introduction of Initiative for
Promoting of Effective Perinatal Care (PEPC) is
continued
• At present, the Program is introduced in Chui
Oblast, Bishkek City (City Perinatal Center,
Maternity House # 1), trainers are trained, training
sessions are conducted
•Monitoring of PEPC at maternity institutions in
Chui Oblast is being conducted
-PEPC Initiative is integrated into USAID/HOPE
«For Survival of Children» program (2003 - 2006),
it is planned to introduce it in 2 rayons of JalalAbad Oblast (Bazar-Korgon and Aksyi);
-Main principles of PEPC Initiative are
incorporated into the curricula of the Kyrgyz
Medical Academy (KMA), Kyrgyz State Medical
Institute of Training and Retraining (KSMIT&R);
- 46 Clinical Protocols on Pregnancy
Management, Physiological Labor and Main
Types of Obstetric Pathologies have been
developed and approved.
•The Program of Initiative Baby Friendly Hospitals
is being implemented (IBFH):
- 14 maternity health institutions were certified in
the republic, 5 more maternity departments are
prepared for internal certification and 1 – for recertification in the year of 2003;
-The issues of Breastfeeding are incorporated into
training and retraining of Family Doctors, Curricula
of the KMA and KSMIT&R;
- 4 Clinical Protocols on Basic Care of Newborns
and Intensive Therapy have been developed on
WHO standards and approved;
• Normative-Legal framework of maternity health
facilities is being reviewed to meet WHO
recommendations
As a result of activities, conducted in the area
of safe motherhood and healthy pregnancy, the
overview of the year 2002 has indicated that in
the republic and especially in Bishkek City and
Chui oblast, almost no purulent-septic cases in
women in childbirth are registered; the rate of
infections among newborns, specific for
perinatal period, has decreased almost by 2
times.
The Maternity Mortality Rate has stabilized in
the republic and for 9 months of 2003 it
comprised – 52,0 (9 months of last year – 52,8)
Maternal Mortality Rate,
Kyrgyz Republic, 9 months of 2003
(per 1000 livebirths)
9 months 2003
9 months 2002
Kyrgyz Republic
52,0
52,8
Bishkek
Chui oblast
Talas Oblast
Naryn Oblast
53,4
54,7
149,6
19,7
102,4
29,7
42,0
51,9
24,0
58,5
117,5
62,0
81,0
35,1
73,7
49,9
Issyk-Kul Oblast
Osh Oblast
Batken Oblast
Jalal-Abad Oblast
• IMCI Program in the republic is recognized as
the main component of the National Policy for
Reduction of Infant Mortality level in neonatal
and post-neonatal periods and Child Mortality:
-Since 2000 the Program has being implemented
3 pilot rayons (Aravan, Jail, Jety-Oguz), results of
implementation were discussed at Review
Meeting in April 2003 with participation of
UNICEF, WHO/EURO. The results of the program
implementation are evaluated as successful and
since 2003 the program has been expanded to 2
more rayons (Moskovskyi and Tyupskyi);
• Coordination Centre under the Research
Institute of Obstetrics and Pediatrics for
Monitoring and Evaluation of IMCI Program
implementation has been established;
• IMCI Coordinators and trainers of pilot rayons
are trained in IMCI master course in Child’s Care;
a Plan of Actions is developed in introduction of
this course in five pilot rayons;
• IMCI Program is integrated in USAID/HOPE
Project «For Children’s Survival» (2003-2006),
introduction of the IMCI program has been
started in Bazar-Korgon and Aksyi Rayons of
Jalal-Abad oblast;
-In pilot IMCI rayons medicines are supplied by
different projects;
-At the national level medicines, used for IMCI,
are included into the Essential Drug List;
-IMCI issues are incorporated into the program
of training and retraining of Family Doctors,
paramedical staff, curricula of Kyrgyz State
Medical Academy, Kyrgyz State Medical Institute of
Training and Retraining;
-Training and retraining of Family Doctors and
Paramedical Staff from pilot rayons is given
priority
IMCI program implementation has
considerably affected the general structure
of IMR in the republic:
- In 2003 Morbidity of Respiratory Organs Diseases
has dropped by 21,4% compared to 2000, and
Infectious and Parasitic diseases – by 40,2%;
-For the given period, mortality of children of the
first year of life of Pneumonia has decreased:
-in Jayil rayon - by 9,3% (2000 -3,2; 2002 – 2,9),
- in Aravan rayon – by 4 times (2000- 7,5;
2002- 1,9);
- in Jety-Oguz – by 41% (2000 – 4,4, 2002 – 2,6)
Causes of Infant Mortality in
Kyrgyz Republic, 2000-2002, (%)
2000
2002
+\-
Respiratory Organs
Diseases
Perinatal Conditions
34,6
27,2
-21,4
33,1
46,4
40,1
Infectious and Parasitic
Diseases
Congenital Anomalies
13,9
8,3
-40,2
8,9
9,7
9,0
Other
9,5
8,4
-11,5
Immunization coverage rate against vaccine
manageable infections has reached the level of
95-98%.
Supply of vaccines from the Republican
(National) budget in 2003 has comprised 18,2%
(2001- only 10,9%).
To achieve the National Vaccine Independence in
future, the Kyrgyz Republic has developed the
Financial Sustainability Plan of the National
Immunization Program (NIP) for the Years of 20032008, which envisages participation of local
budgets, incorporation of part of the NIP funding
into the budget of National Strategy for Poverty
Alleviation, toughening of control of vaccine
stocks and immunization activities.
Iodine Deficiency Prevention:
•The Kyrgyz Government Resolution № 836 as
of 26.12.02 has ratified the National Program
for reduction of Iodine Deficiency Disorders
(IDD) level in population of the Kyrgyz Republic
for the Years of 2003-2007;
•The draft of the Government Resolution on
establishment of Department of Fortified Food
Products is currently being reviewed;
• Association of Salt Producers of the Kyrgyz
republic has been organized;
•Control of content of iodine in imported,
produced and sold salt is conducted:
-The joint MOH and State Custom Inspection
Decree was issued on enforcement of control of
imported salt quality;
- Normative–technical documents concerning
salt production have been standardized; since
2002 a unified standard for Iodine concentration
at the level of 40 mkg/kg for fortified salt is
introduced;
-50 labs of State SES are equipped with one wave
spectrophotometers to do rapid test of
quantitative content of iodine in salt
•
Prevention of Iron Deficiency and
Vitamin A Disorders
- Studies on assessment of spread of Vitamin A
Deficiency (VAD) in the republic were conducted,
which detected the problem of VAD in women and
children under 5;
-The National Program for Prevention of Iron
Deficiency Anemia and VAD among the Kyrgyz
Republic population for the years of 2003-2007 has
been developed and is to be approved soon;
- The issues of prevention of Iron Deficiency
Disorders are incorporated into Curricula and
training programs of KMA, KSMIT&R;
- Clinical Protocols on Prevention and Treatment of
Iron Deficiency Anemias are currently reviewed
With support of ADB and UNICEF, the Kyrgyz
Republic Government has implemented the
following activities in the area of iron
fortification of wheat flour:
-At present, 10 flour-grinding enterprises are
functional in the republic (in all oblasts, except
Naryn and Issyk-Kul), producing iron fortified
flour;
- Due to small production capacity, flour-grinding
enterprises manage to supply only 10% of the
population with fortified flour instead of 33%
planned for the year of 2003;
•
Work with medical community and general
population to increase the level of awareness
about methods of micronutrients disorders
prevention:
-Seminars for Family Doctors and SES Specialists are
being conducted in all regions of the republic on
issues of Iodine and Iron Deficiency Disorders
prevention and Lab control of quality of food salt and
fortified flour;
- In March-April last year, the MOH jointly with ADB,
UNICEF, Kyrgyz-Swiss Health Project and USAID, with
support of the Ministry of Education and Culture, TV
and Radio, has conducted Informational campaign
aimed at increase of the of population’s awareness
level about methods of micronutrients disorders
prevention.
-During the Campaign the following
activities were conducted:
-Sessions and programs on TV and radio;
- Competition for the best session on TV,
radio, and best article in newspaper;
- Theater performances for schoolchildren
population;
- Dictations, expositions for schoolchildren;
- Methodical recommendations for School
teachers were developed;
Huge work is being performed in the area of
social mobilization of population with support of
local authorities and communities;
- The following organizations are involved in
education and training of population in
methods of Micronutrients disorders prevention:
-Health Committees, established at the
community level (experience of the Jumgal
Rayon, Naryn oblast under the Kyrgyz - Swiss
Health Project);
- Initiative Groups in rural areas, organized
under the DFID/Rural Hygiene and Sanitation
Project (Naryn, Issyk-Kul and Talas Oblasts);
-NGOs and Public Organizations (Jalal-Abad,
Chui, Talas Oblasts)
Results of monitoring of the activities,
performed in the area of Micronutrients
Disorders Prevention, have shown:
- Analysis of more than 16 thous. samples of salt
has demonstrated that % of deviation from the
norm has dropped down to 17% (in 2001 – this
indicator was 48%);
- The amount of salt which does not meet GOST
standard and is consumed by the population
dropped down to 30 thous. tons (2001- 150 thous.
tons);
- Thanks to local salt production, the % of supply
of the population with quality salt has increased
up to 35-37% versus 12-17% in 2001;
In June – August 2003 survey on
accessibility and quality of Primary
Health Care (PHC) services for
mothers and children was conducted
in the Kyrgyz Republic.
Findings of the survey will be used
by the MOH when developing
Program for Improvement of PHC
Accessibility and Quality for the
population of the Kyrgyz Republic.
HIV/AIDS spread is a topical issue for the republic.
As of today, 470 infected cases are registered,
there are 3 cases of birth of children to HIV
infected mothers.
However, there are no developed Clinical protocols
in the republic, medications necessary for HIV
infected treatment are not registered in the republic
yet.
Specialists were trained in Vertical transmission in
Odessa City, Ukraine; Working Groups is
established to develop National Program; Clinical
Protocols are being adapted.
Recommendations of the VI annual
meeting of CARK ОЗМиР were taken into
consideration when activities related to
MCH for 2003 were planned and
implemented in the Kyrgyz Republic.
However, such factors as low social –
economic status of the population,
scantiness of financial resources,
inadequate quality of medical care impede
implementation of activities aimed at
protection of mothers and children’s health
to the full extend.