/* Written 3:10 AM Mar 23, 1995 by nphhi in igc:aiha.med-pol */ From: National Public Health and Hospital InstituteFrom the NISHEALTH Clearinghouse (nphhi@igc.apc.org) ********************************************************* International Federation of Red Cross and Red Crescent Societies Moscow Regional Delegation Medical Assessment Republic of Azerbaijan 17-21 June 1992 Version 1.1 Jean Mireault, M.D. ********************************************************* [Reproduced through the NISHEALTH Clearinghouse with the permission of Dr. Lawrence Probes.] The population of Azerbaijan is 7,000,000 people. The capital city is Baku, which has a population of more than 2 million. The country covers an area of 86,000 square kilometers. There are two autonomous regions: Nakhichevan is the capital city of the autonomous republic of the same name with a population of 285,000 persons; the autonomous region of Nagorno-Karabakh was composed of 75.9% Armenians before the actual conflict. In 1989, Azerbaijanis constituted 83% of the population of the country. Azerbaijan has two significant minority groups: Armenian (5.6%) and Russian (5.6%). Politically speaking, since February 1988, tension between Azerbaijanis and Armenians has become stronger. After the declaration of independence from USSR on August 30, 1991, the situation increased. On November 1991, Azerbaijan launched a massive military operation against the Armenian enclave of Nagorno-Karabakh. Life for these peoples began to deteriorate (food supplies, medications and water) in that region. As a result of all this political conflict the number of displaced persons is increasing daily. There are now approximately 200,000 persons from or close to Nagorno-Karabakh whose have been displaced. The country is very rich in mineral resources. The most important industry is the oil industry. By the way, the original name of Azerbaijan means the land of fire. It is also an important cotton-growing and sub-tropical base. THE RED CRESCENT SOCIETY OF AZERBAIJAN REPUBLIC CENTRAL COMMITTEE CHAIRMAN: Abdulhalim Shamsaddin oglu Ahmadov DEPUTY: Ariz Asiev ADDRESS: Baku, pr. Azerbaijan, 19 Tel. (8922) 93-19-12 Fax (8922) 93-15-78 Thirty-five persons work for the Society in seven different departments: General, Immigrants, Humanitarian, Editorial, Finance, International and Commercial departments. The Humanitarian Department is responsible for the nurse's, youth, and blood donor programs. All financing comes from the government. The annual budget was unavailable to me. 1. HUMANITARIAN DEPARTMENT A. NURSES' PROGRAM The Red Crescent has a staff of 308 nurses. The program has been in existance for more than 30 years. They receive 460 roubles per month, but the Red Crescent would like to raise the salary to 1,200 roubles. Some of them have left their jobs because the salary was too low. By way of comparison, a nurse working in a hospital earns 3,000 roubles. Basically, two types of nurses work for the Red Crescent: medical nurses (208) and social nurses (100). In Baku alone, ther are 60 social nurses and 150 medical nurses. Actually, at least 18 regions are not covered by the Red Cross's nurses due to the war. The medical nurses are trained at a special institute for nurses. They are trained for different jobs: giving injections, administering first aid, changing dressings, measuring blood pressure and conducting medical evaluations of patients. Social nurses (normally younger women) receive a two-day training orientation by the Red Crescent Society in which they are instructed on how to clean the patient, go to the bazaar for shopping, stay at night to observe some patients, etc. Normally, nurses work in pairs. When a patient needs some medical services, the medical nurse takes care of him while the other nurse does the social work. When medical care is no longer required, the social nurse continues her work for the patient until she or he dies or goes to a home for the aged (which are not very popular). At least every two days, each patient is seen by a doctor. Every day, the team follows 16 patients. In the Republic, more than 6000 patients are under the Red Crescent umbrella. Daily, the medical nurse goes to the regional hospital and talks to the doctor in charge of a certain number of patients and discuss each case separately. In the health system, each doctor takes care of 800 patients. The doctor keeps a list of those patients; invalids and elderly persons without any relatives are identified. The nurses of the Red Crescent take care of these most needy groups of the population. Until recent years, the Red Crescent Society provided the equipment, including syringes and medication, for each nurses. Now, it is impossible. Each nurses takes her syringes or medicine from the polyclinic. With the situation at the moment, it is difficult to obtain medical supplies. If a patient is not satisfied, she or he can lodge a complaint with the Red Crescent. The head nurses give their telephone numbers to each patient. It seems that there are not too many complaints. The nurses love their jobs, and they do them properly. Twice a year, the social nurse takes an educational or refreshment course. The salary is the same for the both types of nurses. Questions from the head nurse? 1. Is it possible to have different salary levels? 2. Is it possible to pay 1,000 roubles per month for her transportation costs? RESPONSE TO THE CONTENTS OF THE BASIC UNIT FOR A SISTER OF CHARITY They like the idea of being independent from the hospital and feel that the quality of care will increase. Nothing on the list was needless. PLANS FOR THE FUTURE They plan for November 1992, a nurse's school with a two year program. I have no more details concerning the cost or the curriculum. There is a possibility that the chairman, Mr. Akhmedov, will request money from the Federation to implement this project. Also in October of this year, under the responsability of the Minister of Health, they are planning a refresher session of two months for 30 medical nurses. Using a rotation system each medical will receive this refresher session. B. YOUTH PROGRAM DIRECTOR: Asim Agaleviv This is a very new program which was only started one month ago. In this program, young volunteers help elderly to do house repairs, painting, and shopping, they also help in distributing clothes. The Red Crescent Society teaches all the necessary skills for such work, as well as some medical techniques to help the medical nurses. Presently, there are 25 very active volunteers who finance their activities by selling artistic creations. C. BLOOD DONOR PROGRAM It is not a problem here to recruit donors. The people are patriotic and give blood without any financial incentives unlike in the other Former Soviet Republics. 2. INTERNATIONAL DEPARTMENT DIRECTOR: Elchin Bagirov Tel. office: (8922) 93-84-81 home: (8922) 94-12-80 At the moment, he is involved with displaced persons from Nagorno-Karabakh and other places where there is military action. He works with the ICRC in different aspects such as prisoner and researching missing people. The department is very busy because there is only one other person working with him. In addition, they are currently being faced with a new problem of an increasing number of Azerbaijanis coming into the country from different places such as Central Asia and Russia. At the moment there are more than 250,000 of them. 3. COMMERCIAL DEPARTMENT This department is working on some potential joint-venture project (hygienic utilities, tent, hotel). No agreements have actually been concluded. MEETING WITH THE MINISTER OF HEALTH OF THE AZERBAIJAN REPUBLIC: MR Ragim Mamed oglu GUSEINOV PRESENT: A. Ahmadov: Chairman of the Red Crescent Society Daniel Prewitt: Deputy of the IFRC Moscow Delegation The minister has held this position for two months only. He explains that he faces the problem of reorganizing the system. Reorganization means nearly starting form scratch. Under the FSU the decision was dictated from Moscow, all the budget planning, all the delivery of medicines and equipment was under the control of the central committee in Moscow. Now they want to organize themselves with their owns views. The economic crisis plus the war situation complicate in many ways the difficulties. The budget for the last six months was 1,134 million rubles and it represents only one third of the real needs. Due to the inflation rate, they only budget for this short period. They also face another problem. They do not have a specialized institute in the country. Before independence, patients who needed specialized treatment were transferred to Moscow. Now Moscow demands hard currency. They plan for the future, but without precision, a system with health plan insurance. It is possible also that private practice would be accepted, but under the government regulation. The doctors will not use the government facilities (hospital, equipment, staff). At the moment, there are no pharmaceutical companies in the country. The Minister said that some discussions are in progress, but it is a secret at the moment. They have received from Medecins sans Frontieres (MSF), ICRC, AMOCO (corporation from USA) and other countries (Pakistan, Turkey,France,Belgium) a total of 175 tons of medicine and basic medical supplies. They received from Turkey some autoclaves, gloves and sutures materiel. Sometimes, there are significant problems with international assistance; they receive different medicines which they do not know how to use, creating a problem of identification and loss of energy and money. I have attached some examples and the list of the requirements for the country (annexes A, B). It is very difficult to buy drugs and equipment at the moment because of the shortage of hard currency. The political situation (i.e. fighting in Nagorno-Karabakh) increases pressure on the health system. There are approximately 200-300 wounded per day. The need for treament is increased and the turnover of different medicine and medical supplies is by extension expanded. There is a lack of water in different regions, and displaced persons are placed in different locations: schools, barns, tents and hospitals, sometimes with minimal sanitary service. The Health Minister said that there is the potential risk of an increasing incidence of gastroenteritis. At the moment, there are no outbreaks of communicable diseases (i.e., measles, hepatitis, dysentery). One thing was very clear also during the discussion, he is frustrated answering a lot of question and getting no humanitarian aid from those different organizations. The question concerning the refugees or the displaced persons is covered by Mr. Daniel Prewitt. We interrupted the discussion after 45 minutes and I went to the discussion with other officials from the Health Ministry. We had left an extensible questionnaire. The goverment was very kind to answer. You will find annexed (C) a compilation of different data. MEETING WITH OTHER OFFICIALS OF THE HEALTH MINISTRY PRESENT: Velibekov Abbas Sultan-ogly: Deputy of the Sanitary's Department Guseynova Zemfita Gadgi-kizi: Children's Department Mamedov Nazim Mamed-Aly ogly: Mother's department Efendiyeva Tahira Ziyad-kizi: deputy of the department of child and mother After the formal presentation, we started to discuss more specifically the children's situation. There is a high-risk problem for the future. At the moment the vaccination program faces a dramatic situation: they have no vaccine for the coming years. With all the displaced children and refugees, the vaccination profile of this group is unknown. Normally each child in the country is supervised by a doctor. Now a lot of children travel without a vaccination certificate. It causes two critical problems; firstly there is a lack of vaccine, and secondly there is need for more vaccine because we don't know the medical records of some children. Presently, there is no evidence of any outbreak. The vaccines needed are for measles, diphteria, poliomyelitis, pertussis. Another point was discussed concerning the cases of displaced children arriving from Armenia. These groups represent more than one-third of all displaced persons. They suffer from physical illnesses and post-traumatic stress disorders. These children increase the charge of the children's hospital. We discussed a normal diet for children. It is difficult to have diary product because they are very expensive. They eat every two days. Less than 40% of the population can afford to buy fruits and vegetables. There is no problem for bread. They buy potatoes (30 R\kg) and tomatoes (50R\kg) on a more regular basis. I asked one man who earned 2 000 roubles per month what is a regular daily diet for his two children: the day starts with bread, tea, butter and rarely jam; the lunch is a soup; for dinner, they eat soup or meat and potato. We also had a discussion about their Blood Institute. In the country, because of marriage between close relatives, there is a significant number of thallassemias and hemophilia. The thalassemias are a diverse group of congenital disorders in which there is a defect in the synthesis of one (or more) of the subunits of hemoglobin molecules. Hemophilia is a congenital plasma coagulation defect that causes bleeding into muscles, joints, and body cavities, hours or days after an injury. I was not able to obtain more official data to figure out the exact importance of the problem in the country. At the moment they do not have modern equipment to make the diagnosis. The diagnosis is based on the symptoms. They do electrophoresis but no plasmapheresis. The ministery is ready to discuss with pharmaceutical companies. Presently, there is no official contact in this particular medical field. They do not have a problem of recruiting blood donors in the country. This confirms what the Red Crescent said to me. They fractionate the whole blood in each components (platelets, plasma, coagulation factors, red cells). I have shown our proposed medical list for children hospital. The contents of the list causes no problem. In addition of this list, they want other things: vaccines, gamma globulins, immunoglobulin, disinfectant and chloramine. They request different prepared forms of baby formula. They especially ask for a form resistant to warm temperature like in Africa. They have received some from Finland but resitant just for a "cold" country. The preservation quality was not good because it was not adapted for the climate of Azerbaijan. I explained that it is impossible at this point to take a decision but I took note of their demands. The environmental problem was discussed. At the moment, they complained about the bad quality of their soils caused by the extended use under the FSU rules of a large quantities of pesticides. They are starting to realize the problem of chemical pollution in Baku. There is a concentration of chemical, petrochemical and metallurgic industries. They said that the health situation is aggraved with all the toxic substances used to increase the production of their different industries when they were under the FSU. VISIT TO DIFFERENT HOSPITALS We went to Sabunga located 20 kilometers east of Baku where we visited the city hospital #3. This hospital was built by Nobel, one hundred years ago. PRESENT AT MEETING: Chief physician: Dr Kadynova Nabat Department of nursery and gynecology: Dr Sultanova Svetlana Shizouna First deputy: Yabloneva Natalia Dmitrievna Total number of beds: 1200 Number of children's beds:120 Bed occupancy: 60 % Average length of stay: 17-18 days Number of admissions per year: 33 000 Number of physicians of staff: 180 Number of nurses on staff: 600 This hospital's catchment area covers three raions (districts) which together have a population of 400,000. Thirty percent are children under fourteen. The hospital is a complex of 17 buildings and some at the moment are functioning without water. The water in these buildings is carried by hand. Some of the buildings are under repair which has been heavily delayed by a shortage of money. There are 20 departments including: reanimation: 15 beds nursery: 110 beds surgery: 120 beds therapy: 300 beds infectious diseases: 60 beds gynecology: 100 beds two children's department: orthopedic\surgery (50 beds) and somatic (70 beds). Currently several departments are under repair. In the last four years, the ordered supplies received from Moscow have decreased by 80%, and in the last 2 years, they have a maximun of 30% of what they need to run the hospital. It is the responsibility of the chief doctor to make priorities in terms of requests, and the decision so far has been to focus on the children's and nursing departments. The lack of medications forces them to use old remedies. For example, they prepare the active element and add purified liquid to recreate the medicine. The equipment, especially surgical instruments, is old and in small numbers. However, they stated that currently no delays in surgery occur as a result of the lack of equipment. In this way, they again differ from other regions of the former Soviet Union. The most desperate needs at the moment are very basic surgical gloves, syringes and baby formula. As a result they are sometimes forced to operate without gloves and to re-use disposable syringes. More than 3,000 injections are given daily, although annually, they receive only 15,000 syringes. Surprisingly, even though there are more cases of hepatitis, no case of transmission (needle or blood) had been reported in the hospital. The nursing department takes care of 3,000 - 4,000 newborn babies annually; 30% are premature. Each normal new born stays in the hospital for 5 days. There is a great need for oxytocin or prostaglandins because those two particular drugs are very important during the delivery period. They help to regulate the contractions and to stop abnormal postpartum bleeding. More specifically, there is a great need for different drugs which are useful for various diseases: asthma (prednisolone, aminophylin), diabetes (insulin), cardiac (lasix, tonic). We visited the pharmacy and spoke with some people there. It seems there is a lack of each medicine, although the counter was not empty. I saw a lot of aminophylin, prednisolone, etc. Compared to other hospitals, the condition of the pharmacy was not so bad. The sterilization room included 4 autoclaves and was modest but very clean. They showed me the water purifier where they reconstitute their own drugs. During the discussion, the chief doctor said that the humanitarian aid which had already been received was for the hospital treating the wounded from the military struggle. In general, Dr. Kadynova feels that the situation here is not so bad compared to other places, and I personally agree with her. AMIRJAN'S CHILDREN HOSPITAL No 8 Chief physician : Dr. Manedova Sophia This is a 50 year old hospital for infectious diseases with a department for hepatitis and a department for gastric diseases. Each of these departments has 40 beds. Bed occupany is 75%, and the average length of stay per child is 14-21 days. There are 800-1,000 admissions per year. Ten doctors and seventy nurses work in this hospital, which is divided into two wards depending on age: 0-3 and 3-14 years. This hospital also treats children from the neighboring raion. This children's hospital treats basically only two kinds of pathology: hepatitis and infections of the digestive system. The three leading causes of admission are dysentery (salmonellosis), food poisoning and hepatitis. The equipment to diagnose hepatitis was rudimentary, but they said that they were able to diagnose different forms of hepatitis. I asked how they monitor each case after discharge and how they monitor carrier states. The answer was vague except that every 6 months, they make a blood test. As a result of the low standard of living in this petrol workers region, the incidence of large numbers of people sharing one house is quite high and there are significantly more cases of transmitted disease. Dr. Manedova confirmed that the war has created a budget crisis, because more money is going to the war hospital. Another cause for financial hardship is the long delays which occur between their requests for money and government responses. At the moment, there is a lack of syringes and medicines but as yet, no deaths have been attributed to a lack of drugs. The same conclusion has been reached with regard to the nutritional status of the children's population. They badly need syringes, needles, multivitamins, bandages, gloves and and hypoallergenic desinfectant. Actually they reuse nondisposable syringes and gloves. During our visit I saw six childrens with their mothers, all living in the same room. The crowding was conspicuous. I asked who paid for the mothers' meals, and the answer was that the hopital would take care of that. There are also some rooms within which there are several small rooms, closed off from each other by glass and just large enough for a bed (less than 7 square meters) in which both the mother and her small child live. During our visit, a very nice little boy was eating soup with piece of meat and vegetables. The pharmacy was very small. The medicine for the hospital was in one cabinet. There were some drugs from different countries (Finland, Yougoslavia, Austria), although the number of different kinds was less than 30 and the quantities were small (15 boxes). They had some disposable syringes in this cabinet. VISIT TO A GENERAL HOSPITAL IN BAKU Chief physician: Guligeva Minaya chief pediatrician: Professor Karagev. This hospital has 500 beds and 13 departments; reanimation (infectious-general), gastric infections, hepatitis, meningitis, respiratory disease, rheumatic disease, ENT (Ear-Nose-Throat), pathology, stomatology, pulmonology and newborns. There are 40 beds for children in this hospital. There are between 11,000 and 12,000 admissions annually, including 600 pediatric. The average length of stay per patient is 13 days and 3 days for a newborn. The polyclinic received more than 18,000 patients per year. Each pediatrician takes care of 800 children. One important duty is the vaccination program which is easy to follow. I visited the vaccination room in the polyclinic and I saw a chart with the specific period when each child is supposed to receive each specific vaccine. There were no children during my visit. I saw few disposable syringes. There was a refrigerator in the room. Each "family physician" takes care of 1,500 to 1,800 adults. They had received aid from Iran, Turkey and United Nation, but it insufficient. There is still a great need for medical supplies and drugs. They badly need injectable and oral antibiotics, cardiovascular medicines (digitalis, cardiotonic) and prednisolone. They asked for catheters (peripheral, central). There is a problem with diabetes. The lack of insulin is a critical issue. At the moment, they order drugs from the central state pharmacy every two weeks. The stock is very low, and the future in uncertain. We visited certain portions of the hospital. The reanimation unit had no children at the moment. They asked for more incubators. They have one modern incubator from an American company (Air-shield Vickers) for 40 children. They want to upgrade their equipment (children's pediatric table, endotracheal tube for children and adults, cardiac monitor, ventilatory apparatus). I saw some empty incubators, heating table for new born and electronic perfusor for intravenous drugs. VISIT TO THE OBLAST CHILDREN HOSPITAL No. 12 OF MARDAKEN Chief physician: Raginova Sahubar Khananovna For three years now, this old dacha has been converted into a hospital. Different old datchas are used as hospitals, as well as some other buildings specifically built for this purpose. The hospital consists of a group of one-story buildings. The outpatient clinic forms part of the hospital. There are 100 somatic beds in the hospital, wich beds are divided into two groups: the first group for children under 3 years of age and the latter group of beds for children of 3 and up. A total of 8,600 patients come to the clinic each year. The clinic serves fifteen refugee settlements (38,500 children). These children including a large number from Armenia suffer from physical and psychological stress. They arrived without any medical records, so doctors are unaware of their vaccination history or if they suffer from any health problems. The average number of admissions per year at the hospital is 2,461. The average stay per person is between 14 to 20 days. Every bed is occupied 295 days each year. Children between the age of 2 months to 14 years are treated at the hospital. The principal pathologies are pneumonia, rheumatism and bronchitis. There are 32 doctors and 60 nurses working in the hospital. Due to the war, it is obvious that the drugs and medical supplies have diminished. There are no cases of malnutrition at the hospital, except for few displaced children from Armenia. After discussion concerning the content of the medical supplies list, they have asked for, in priority: blood giving sets, scalp vein infusion sets, prednisolone, disinfectant, antibiotics (gentamycin, claforan, kefzol), diazepam, cocarboxylase, antihistamines and immunoglobulins. We have visited a couple a hospital buildings. There are 6 or 7 children sharing the same room with their mothers. Surprisingly, the walls in different rooms were quite dirty. Our visit attracted much attention in the hospital, actually more than usual. I think that the mothers with their children were following us. They talked about missing persons and the atrocity of the war. It was very touching. CONCLUSION AND RECOMMENDATION It is clear that this new independant state is undergoing at the moment some difficult organizationnal problems. The conflict with Armenia raises problems at higher levels. The country has rich natural resources. The possibility of improving the health situation of the country is better here compared to the other new independant states. Medically speaking, because of the political reorganization, armed conflict and displaced persons, there is a potential risk for a degradation of the health profile for children. Even if there is no outbreak of epidemic disease, the risk is there. Also, very strangely, they asked spontaneously for medical supplies used to treat wounded persons. My recommendation is to inform other international organizations of the potential risk of an outbreak of disease and to bring only basic medical kits. I am afraid that if we send specialized kits, they will channel some of our supplies in the "war- hospital" The nurses program like the other one in CIS has to be supported by the Federation with salary and the kits. Public Health Statistics All figures are for 1991 unless otherwise specified. 1. Total population of the republic: 7,297,000 2. Average population density: 78.6 persons per square kilometer (area of the republic: 86,600 square kilometers) 3. Urban population: 54% 4. Capital city: Baku Overall population: 1,758,000 (not including including refugees from Nagorno-Karabakh and adjoining areas) Children up to age 14 years inclusive: 28% 5. Population distribution by age (thousands) Ages 1981 1991 1981 1991 % growth % growth 0 - 4 728.1 875.0 11.0 12.4 5 - 14 1,389.9 1,490.7 24.5 20.6 15 - 59 3,740.5 4,178.6 57.0 59.0 60+ 444.1 575.5 7.5 8.0 6. Ethnic composition (1989 census, in percentages) Azeris 82.7 Russians 5.6 Armenians 5.6 Lezgins 2.4 Avartsi 0.6 Ukrainians 0.5 Jews 0.5 Tatars 0.4 Talysh 0.3 Turks 0.3 Georgians 0.2 Tsakhuri 0.2 Kurds 0.2 Udins 0.1 Others 0.4 7. Birth rate: 27.0 per 1,000 (26.4 in 1990) 8. Crude death rate: 6.8 per 1,000 (6.1 in 1990) 9. Age-standardized (European standard) mortality rate (per 1,000) Age Percent Mortality 0 - 14 3.1 15 - 59 3.5 60 & older ? Total 88 10. Average life expectancy at birth (years): Total 71.1 Males 67.0 Females 74.8 11. Infant mortality: 25.3 deaths per 1,000 live births (note: in some regions the rate is as high as 50 - 60) 12. Total fertility rate: 23.6% 13. Marriages: 10.6 per 1,000 population 14. Divorces: 1.5 per 1,000 population 15. Marital status (percentage of all persons aged 16 and older) Males Females Never married 30.9 22.7 Married 64.4 59.4 Widowed 1.9 13.2 Divorced & separated 0.9 2.8 16. Level of education (percentage of persons aged 15 years and older) Higher 10.5 Higher (incomplete) 2.0 Middle (specialized) 14.4 Middle (general) 41.7 *Note: Middle education encompasses the first 11 years of schooling, and is nearly equivalent to a combination of primary and secondary education in the United States) 17. Ratio of physicians to population: 88.9 physicians per 10,000 population) 18. Number of hospital beds: 99.4 per 10,000 population Total beds: 72,700 (approx. 50,828 adults, 18,431 child.) Russia: 137.4 per 10,000 Europe (average) 94.0 per 10,000 19. Literacy rate: 99.0% 20. Life expectancy at birth: 71.1 years Female: 73 years Male: 66 years 21. All causes of death: Overall mortality 638.7 per 100,000 Total deaths All Neoplasms Organs of Accidents Both sexes Causes Respiration Poison By age Trauma 0 - 1 2,629.8 2.8 1,180.6 44.8 1 - 4 528.8 8.8 270.5 58.1 5 - 9 63.7 5.2 14.9 20.8 10 - 14 41.9 3.5 5.6 16.0 15 - 19 53.8 6.6 3.2 19.6 20 - 24 85.5 8.5 5.6 34.1 25 - 29 120.5 12.5 5.0 48.4 30 - 34 149.5 21.1 5.5 54.7 35 - 39 217.9 39.5 9.5 64.7 40 - 44 330.8 66.9 19.2 62.7 45 - 49 530.0 131.2 18.6 65.2 50 - 54 825.6 194.2 38.6 64.1 55 - 59 1,297.7 295.2 66.4 65.3 60 - 64 1,972.8 418.1 119.6 54.8 65 - 69 2,790.0 496.8 185.6 63.7 70 - 75 4,196.9 565.5 284.2 80.0 75 - 79 6,676.1 654.4 - - 80 - 85 - - - - 85 & older 13,624.2 546.8 1,280.5 74.2 22. Diseases of the circulatory system; mortality per 100,000: 633.7 23. Ischemic heart disease; mortality per 100,00: 311.9 24. Cerebrovascular diseases; mortality per 100,000: 62.5 25. Malignant neoplasms; mortality per 100,000: 68.2 26. Cancer of trachea, bronchus, lungs; mortality per 100,000: 11.5 (13.13 in 1990) 27. Diseases of the respiratory system; mortality per 100,000: 89.6 28. Diseases of the digestive system; mortality per 100,000: 27.4 29. External causes of death; mortality per 100,000: 47.1 30. Infant mortality (per 1,000 live births) 1981 34.4 1982 30.4 1983 31.2 1984 30.3 1985 29.4 1986 30.5 1987 28.6 1988 27.0 1989 - 1990 23.0 1991 25.3 31. Infectious and parasitic diseases; mortality per 100,000: 21.8 32. Suicide and self-inflicted injury; mortality per 100,000: 1.9 33. Birth weight less than 2,500 grams: 5.3% 34. Maternal mortality: ? 35. Causes of maternal mortality: (deaths per 100,000) Extrauterine pregnancy 1.1 Artificial medical abortion 0.5 Other complications of pregnancy and labor 8.9 36. Abortions: 19.9 per 100 births 37. Abortions: 18.8 per 1,000 women of childbearing age 38. Annual prevalence of diseases registered at health care institutions Main categories of diseases (ICD-9) 0-14 age 15+ (no. per (no. per 100,000) 100,000) Infections & parasitic 6,358.0 2,300.9 Neoplasms 40.8 714.7 Endocrine & metabolic 1,839.5 1,649.9 Blood & blood forming organs - - Mental disorders 562.6 2,114.0 Nervous system & sense organs 4,644.6 3,741.0 Circulatory 1,137.8 8,804.8 Respiratory 24,518.1 12,982.8 Digestive 2,537.4 5,791.7 Genitourinary - - Complications of pregnancy - 543.9 Skin & subcutaneous tissue 1,858.9 1,521.8 Musculoskeletal 601.1 1,195.8 Congenital anomalies 321.1 32.7 Injury & poisoning 3764.8 3,450.1 39. Temporary disability: 57.85 cases per 100 workers 40. Temporary disability: 649.8 calender days (626.4 working days) lost per year per 100 workers, comprising 27% of all workers 41. Mortality from intestinal infectious diseases: 8.3 deaths per year per 100,000 42. Measles morbidity: 84.9 cases per 100,000 43. Pertussis morbidity: 2.1 cases per 100,000 44. Diptheria morbidity: 0.9 cases per 100,000 45. Morbidity from viral hepatitis: 191.7 cases per 100,000 46. Tuberculosis morbidity: 37.3 cases per 100,000 47. Morbidity from bacterial dysentery: 21.9 cases per 100,000 48. Alcohol and drug abuse morbidity (new cases of alcoholism and new cases of drug abuse per 100,000): 21.4 49. Proportion of water samples from water supply system not meeting national standards by chemical indicators: 67.3% 50. Proportion of water samples from water supply system not meeting national standards by bacteriological indicators: 22.7% 51. Expenditures on health and physical training from state budgets (roubles per person): 1986 - 43.0 1990 - 61.3 52. Number of hospitals and public health care (PHC) units: Hospitals 733 Ambulatory polyclincs 1,678 53. Number of physicians and dentists per 10,000: 38.9 54. Visits to PHC units per person per year: 9.1 55. Number of hospital beds per 10,000: 99.4 56. Number of hospital admissions per 100 population: 13.6 57. Syphillis morbidity: 3.9 new cases per year per 100,000 58. Gonorrhea morbidity: 8.1 new cases per year per 100,000 59. Breast feeding rates: up to 3 months 37.9% up to 6 months 39 % 60. Pollutants: Solids 111.889 Liquids 1,387.131 Sulfuric anhydrides 92.89 Carbon monoxide 65.39 Nitrogen oxide 48.162 Carbohydrates 15,556.617 Organic airborne compounds 37,291.191 Other 7.221 61. Economic base (leading industries): oil, cotton, chemicals, tobacco