ENVIRONMENTAL HEALTH ISSUES Demographic process and population morbidity in the city of Kyiv

A special demographic situation rather different from that in rest of the state, has developed in the city of Kyiv due to a number of ecological and socio-economic factors.

The public health in Kyiv is steadily getting worse. In 1998, 18,304 babies were born, i.e. the birth rate index (7.0 per 1,000 people) has decreased by 6.7% against 1997 (7.5 per 1,000 people). These indices in Kyiv are rather lower than in Ukraine as a whole, where the birth rate is 8.3 and for the urban population 7.6 babies per 1,000 people.

Despite a certain decrease of the general death rate index in the city (9.8 per 1,000 in 1998 against 10.0 per 1,000 in 1997) the natural population increase in Kyiv remains negative and makes up 2.8% (against 2.5% in 1997).

Since the death rate indices in Kyiv are lower than total state indices (14.3 for Ukraine and 12.5 for its urban population), the index of negative natural increase (-2.8%) also remains lower than the state average index (-6.0%) and that calculated for the urban population (-4.9%). As compared to 1997 mortality from infectious and parasitic diseases has decreased in the city (-20.6%); one can also mention tuberculosis (-22.2%), diseases of endocrine system (-14.3%), diseases of the blood and homopoietic organs (-16.0%), diseases of the nervous system and sense organs (-24.0%), respiratory organs (-9.5%), digestive organs (-6.3%), the urogenital system (-5.6%), pregnancy and delivery complications (-78.5%), diseases of the skin and subcutaneous tissue (-55.1%); the osteomuscular system (-36.5%) and congenital anomalies (-31.6%).

At the same time the number of deaths from malignant tumours has increased (168.73 cases per 100,000 people in 1998 against 162.87 in 1997). The greatest actual increase of cases of deaths from tumours of respiratory organs (+6.9%) and digestive organs (+4.7%) which can be connected with the environmental pollution. A certain increase of the death rate from blood circulation diseases (+0.12%) can be observed. The said changes do no differ from those registered throughout Ukraine.

As a result of measures taken the indices of infant mortality in Kyiv have increased (13.3 per 100 alive newborns in 1998 against 19.0 in 1997), but they remain higher than those in Ukraine (12.8 in the country and 12.9 for its urban population). The perinatal mortality index has decreased to 12.0 (1998) against 17.8 (1997). Infant mortality has decreased considerably: from 296 (1997) to 193 (1998) as well as maternal mortality – 4 cases in 1998 against 9 in 1997. The indices of hospital aid rendered to people (including children) by medical-prophylactic institutions in Kyiv and Ukraine are presented in Table 6.4

As to population morbidity, special anxiety is caused by changes in the dynamics of socially significant diseases. The level of spreading of primary sickness with tumours is rather higher in Kyiv than in Ukraine: spreading in Kyiv is 2,937.18 cases per 100,000 people, in Ukraine 2,866.59; primary morbidity is 774.98 and 740.69, respectively. The number of cases of malignant tumours continues to increase: as compared with 1985 the primary oncological morbidity has decreased by 27.2% as compared with 1997 (by 0.85%). The highest increase is observed for following localizations: skin (+8.4%), thyroid gland (+25.6%) and rectum (+4.5%). But the localization level (307.36 cases per 100,000 people) is rather lower than the state average (312.36), which is mainly determined by high indices in Kyiv, Kirovograd, Odesa, Poltava and Cherkasy regions as well as in the city of Sevastopol.

Primary morbidity of the adult population in 1998 is 5,824.6 cases per 100,000 people, which is 12.4% less than in 1991. At the same time one can observe an increase of primary morbidity during the last year from the following classes of diseases: diseases of the endocrine system, nervous system and sense organs, respiratory organs, urogenital diseases, pregnancy and delivery complications, diseases of the skin and subcutaneous tissue and the osteomuscular system. The indices of spreading of such diseases as diabetes mellitus and urogenital diseases,  diseases of the nervous system and sense organs, blood circulation system and digestive organs, are higher in Kyiv in comparison with the data on Ukraine as a whole.

Special attention should be paid to the high indices of pathology of the respiratory organs, as that may be connected with the influence of contaminated atmospheric air. The level of spreading of these diseases exceeds the data of Ukraine by 36.2%, and primary morbidity is 43.5% higher.

The indices of the level of total (1,810.19 cases per 1,000 children) and primary (1,498.53) morbidity of children in the city of Kyiv are higher than the corresponding indices in Ukraine (1,444.17 and 1,119.36). One can observe a further increase of the above indices: the spreading of diseases in 1998 against 1997 has increased by 6.4%, and primary morbidity by 8.3%. Special anxiety is caused by the continuous growth of socially-significant diseases among children. The number of cases of pulmonary tuberculosis has increased twice against 1995 and 10 times against 1986. During the last 6 years the number of neoplasms in children was 4.39 cases per 1,000 (state average level 4.02). The number of different cases of respiratory diseases are higher than the state average indices by 45.2%, digestive system diseases by 29.4%, skin and subcutaneous tissue 11.9% and congenital anomalies by 13.5%.

The state of health in pregnant women is also a cause of concern. The index of postnatal complications frequency is 5.2% higher in Kyiv than in Ukraine as a whole. Cases of anaemia among pregnant women are becoming more and more frequent (140.3 in 1998 against 100.8 in 1997), which considerably affects the babies. This circumstance causes special anxiety in view of the fact that the girls born in 1979-1986, i.e. those who suffered from the Chernobyl disaster are now entering the reproductive period. Even now a rather high share of newborns with intrauterine hypoxia are registered in the city and taking into consideration the substantial spreading of anaemia  in future mothers, a further rise of these indices can be expected.

The complicated medical-biological anamnesis, i.e. existence of pathologies in the ante-, intra- and early postnatal periods of ontogenesis, has an essential influence on the development of deviations in the health of children. The risk of development of chronic diseases, the above risk factors being present, increases 25.9 times; while the risk of development of disturbances of the organism’s functional state increases 14.1 times.

The environmental pollution is one of the components of the unsatisfactory health state of the population, side by side with the complex economic situation. Calculations show that in children living in micro-districts adjacent to big industrial enterprises the risk of developing chronic pathology and appearance of frequent acute diseases increases 1.5 times as compared with relatively clean regions; in children living in micro-districts adjacent to the sites of meteorological locators, this risk increases 2.0 and 2.6 times, respectively.

Calculation of health losses in children (complex health index) has demonstrated that the level of health can be conditionally raised in 192 children (in relatively clean districts) and in 157 children (from micro-districts adjacent to weather stations) of each thousand if medical, socio-economic and other measures are taken.

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