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CNAA / Theses / 2009 / June /

Management of care and development of a child under-5 years old


Author: Ferdohleb Alina
Degree:doctor of medicine
Speciality: 14.00.33 - Social Medicine and Management
Year:2009
Scientific adviser: Constantin Eţco
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 24 June, 2009
Approved by NCAA on the 1 October, 2009

Abstract

Adobe PDF document0.74 Mb / in romanian

Keywords

service of first medical assistance, indicators of health state, factors of risk of health, health workers, children under 5 years old, mortality, morbidity, often ill children, practically healthy children, indicatory “for service”.

Summary

For the first time was performed a scientific research to evaluate the particularly primary medical services in domain of care and development for the child under-5 years old, in order to elaborate some management measures to improve this service in Republic of Moldova.

The results of thesis were done on the basis of integral research investigation, selective-representative and case-test. According to official statistical information’s during 2003-2007, was analyzed the level and the structure of: 1) mortality under-5 years old, 2) morbidity under-5 years old, 3) disability of pediatric population and the results of prophylactic examinations of preschool child with physical retard. The result was elaborated the “Identification account” - a level of mortality under-5 years old and a level of morbidity under-5 years old; the “Atlas of indicatory state of children’s early-age period health”. The selective investigation was given after administrative-territorial distribution, which analyzed: medical-social aspects of families with children under-5 years old. The group of “often ill children” was structured in: 1) diseases of breathing system 74,5±2,16% cases (p�,60;0,01); 2) diseases of digestive system 36,5±2,48% cases (p<0,001); 3) diseases of renal-urinary system 23,1±2,17% cases (p<0,001). The “social-familial” health factors of risk for “often ill children” were determined in comparison with “practically healthy children”. After the analysis of case-test on the parents’ perception of primary medical care, from the point of access and training/informing process; parents priorities of service were established, taking into account: 1) consultation/explanations about children care (t=5,78; p�.60;0,001); 2) sufficient time for consultation (t=4,38; p<0,001); 3) movement to the cabinet of family doctor (t=4,03; p<0,001); 4) sufficient explanations about risks for a health (t=3,49; p<0,001). The selectively-representative research set the following: municipal doctor services on average 61 children, but family doctor from district locality services on average 80–96 children under-5 years. According to the SWOT method and on the basis of analysis, the service’s “weak points” were described, providing for: the supply of health workers at heterogeneity of service depending on locality; the program of work-load and insufficiency of time for parents' teaching; the non-optimal terms of work; the absence of indicatory “for service” - “supervision of child first 5 years of life” and the “ratio families training with children first 5 years of life in Center of Family Doctors”. The “themes recommended for meeting with parents” in the Consulting Room of Healthy Child was elaborated.