health of children in the czech...

Health of Children in the Czech Republic

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http://www.mzcr.cz/

Content:• Demografy data• Natality, Fertility, Life expectancy, Mortality • Infant mortality• Health care system for children• Children morbidity• Children mortality• Children injuries• Conclusions

THE CZECH REPUBLIC

Population in the Czech Republic by age

inhabitants 10 287 189

children 0-14 14,4 %

adult 71,2 %

old people over 65 14,4 %

Population in the Czech Republic

• Population is ageing:low natality + decreasing mortality + survival of older persons

• Low natality:Natality and fertility are slowly increasing, 1.33 children per 1 woman at fertile age

Population by age to 1.7.

100 000 75 000 50 000 25 000 0 25 000 50 000 75 000 100 0000

5

10

15

20

25

30

35

40

45

50

55

60

65

70

75

80

85

90

95

males females

Source: Czech Statistical Office

Trend of proportion of population aged 0-14 years, 65 and more years and Age preference index, in 1950 - 2006

0

6

12

18

24

30

1950

1955

1960

1965

1970

1975

1980

1985

1990

1995

2000

2005

%

0

20

40

60

80

100

Proportion of age group 0-14 Proportion of age group 65+ Age preference index


Age preference index, in Europe

30

40

50

60

70

80

90

100

110

120

130

Alb

ania

Icel

and

Irela

ndC

ypru

sS

lova

kia

Mal

taN

orw

ayN

ethe

rland

sLu

xem

bour

gP

olan

dLi

thua

nia

Rus

sian

Fed

erat

ion

Uni

ted

Kin

gdom

Fran

ceFi

nlan

dR

oman

iaB

elar

usC

zech

Rep

ublic

Sw

itzer

land

Aus

tria

Sw

eden

Hun

gary

Cro

atia

Est

onia

Ukr

aine

Slo

veni

aP

ortu

gal

Latv

iaS

pain

Bul

garia

Gre

ece

Ger

man

y

Source: databaze Health for All - WHO

Trend of Age preference index in selected european countries, in 1990 - 2006

0

25

50

75

100

12519

90

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

United Kingdom Czech RepublicFrance GermanyHungary PolandSpain


Crude birth rate, in Europe

0

4

8

12

16G

erm

any

Latv

iaLi

thua

nia

Slov

enia

Bulg

aria

Ukr

aine

Bela

rus

Cro

atia

Pola

ndH

unga

ryG

reec

eC

zech

Rep

ublic

Aust

ria Italy

Mal

taSw

itzer

land

Rom

ania

Slov

akia

Esto

nia

Portu

gal

Rus

sian

Fed

erat

ion

Spai

nFi

nlan

dBe

lgiu

mSw

eden

Cyp

rus

Den

mar

kN

ethe

rland

sU

nite

d Ki

ngdo

mLu

xem

bour

gN

orw

ayFr

ance

Icel

and

Irela

nd


Trend of Crude natality rate in selected european countries, in 1990 - 2006

8,0

10,0

12,0

14,0

16,019

90

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

Czech Republic FranceGermany HungaryPoland SpainUnited Kingdom


Total fertility rate

0,9

1,2

1,5

1,8

2,1U

krai

neSl

oven

iaBe

laru

sPo

land

Slov

akia

Lith

uani

aC

zech

Rep

ublic

Gre

ece

Rus

sian

Fed

erat

ion

Bulg

aria

Latv

iaH

unga

ryIta

lyR

oman

iaSp

ain

Ger

man

yM

alta

Portu

gal

Aust

riaC

roat

iaC

ypru

sSw

itzer

land

Esto

nia

Luxe

mbo

urg

Belg

ium

Net

herla

nds

Swed

enAl

bani

aD

enm

ark

Finl

and

Uni

ted

King

dom

Nor

way

Irela

ndFr

ance

Icel

and


Trend of Total fertility rate in selected european countries, in 1990 - 2006

1,0

1,5

2,0

2,519

90

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005



0

0,5

1

1,5

2

2,5

3

1970

1972

1974

1976

1978

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

AustriaCRFranceGermanyHungaryNetherlandsPolandSlovakiaSwedenUK

Fertility in Fertility in thethe CR CR andand selectedselected countriescountries

Source: WHO Euro Velebil 2007

Life expectancy

73.45 for men79.67 for women

Life expectancy at birth

55 60 65 70 75 80 85

ICE (2001)

SWI (2001)

CYP (2001)

NOR (2001)

MAT (2002)

AUT (2002)

NET (2000)

LUX (2002)

IRE (2001)

POR (2002)

CZE (2002)

POL (2002)

BUL (2002)

ROM (2002)

LVA (2002)

RUS (2002)

muži / males

ženy / females

Mortality rate

• Half of all deaths were caused by diseases of the circulatory system, while neoplasm, was the second most frequent, caused 27% deaths (men - MN of respiratory system, women –MN of breast)

Standardized mortality rate - males

0 200 400 600 800 1 000 1 200 1 400 1 600 1 800 2 000 2 200

ICE (2001)

SWE (2001)

GRE (2001)

NOR (2001)

FRA (2000)

DEU (2001)

LUX (2002)

FIN (2002)

IRE (2001)

SVN (2002)

POL (2002)

SVK (2002)

HUN (2002)

LTU (2002)

UKR (2002)

RUS (2002)

zhoubné novotvary

nemoci oběhové soustavy

vnější příčiny

ostatní

Standardized mortality rate - females

0 200 400 600 800 1 000 1 200

SPA (2001)

ITA (2001)

ICE (2001)

NOR (2001)

FIN (2002)

GRE (2001)

MAT (2002)

POR (2002)

SVN (2002)

POL (2002)

CZE (2002)

CRO (2002)

HUN (2002)

BUL (2002)

BLR (2002)

RUS (2002)

malign. neoplasms

dis. of the circulatory system

external causes

other

Infant mortality

• Infant mortality 3,3 per millPer 1000 live born children only 3,3 died in the 1st year of life.(Low neonatal mortality - in the first 6 days of life)

• This level is historically the lowest.

Infant mortality rate by age in days

0 2 4 6 8 10 12 14 16 18

FIN (2003)

SWE (2002)

NOR (2003)

CZE (2003)

GRE (2003)

SVN (2003)

SPA (2002)

DEU (2001)

FRA (2001)

AUT (2003)

SWI (2002)

ITA (2001)

NET (2003)

IRE (2002)

POR (2002)

UNK (2002)

MAT (2003)

CRO (2003)

LTU (2003)

POL (2003)

HUN (2003)

SVK (2002)

LVA (2003)

BUL (2003)

RUS (2003)

ROM (2003)

0-6 dnů / days

7-27 dnů / days

28-364 dnů / days

per 1 000 live births

Infant mortality rate

0

2

4

6

8

10

12Sw

eden

Nor

way

Finl

and

Slov

enia

Cze

ch R

epub

licFr

ance

Portu

gal

Spai

nG

reec

eG

erm

any

Switz

erla

ndN

ethe

rland

sAu

stria

Irela

ndU

nite

d Ki

ngdo

mM

alta

Cro

atia

Esto

nia

Hun

gary

Slov

akia

Pola

ndBe

laru

sAl

bani

aLi

thua

nia

Latv

iaU

krai

neR

ussi

an F

eder

atio

nBu

lgar

ia


Trend of infant mortality rate in selected european countries, in 1990 - 2006

3456789

10111213141516

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004



0

5

10

15

20

25

30

3519

70

1972

1974

1976

1978

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004


Infant deaths per 1000 live birthsInfant deaths per 1000 live births


Trend of infant mortality rate, in 1950 - 2006

0

15

30

45

60

7519

50

1955

1960

1965

1970

1975

1980

1985

1990

1995

2000

2005

Infant mortality rate


Trend of mortality rates of children till 1 year of age in 1960 - 2006

0

5

10

15

20

2519

60

1965

1970

1975

1980

1985

1990

1995

2000

2005

0-364 days0-6 days28-364 days7-27 dnů


84

86

88

90

92

94

96

98

100

1970

1972

1974

1976

1978

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004


Percent Percent ofof normalnormal birthweightbirthweight babiesbabies in in thethe CR CR andand selectedselected countriescountries


0

50

100

150

200

250

300

1970

1972

1974

1976

1978

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004


CesareanCesarean sectionssections in in thethe CR CR andand selectedselectedcountriescountries


1

1,2

1,4

1,6

1,8

2

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

ProportionProportion ofof twintwin deliveriesdeliveriesin in thethe CzechCzech RepublicRepublic

in 1995in 1995--20062006

%No of twindeliveries

2004: 18222005: 19272006: 2074

Source: WHO CC in Perinatal Medicne, Prague Velebil 2007

0

100

200

300

400

500

600

700

800

900

1000

1970

1973

1976

1979

1982

1985

1988

1991

1994

1997

2000

2003


Abortions per 1000 live birthsAbortions per 1000 live births


Low infant mortality - causesThe high quality of prenatal and neonatal care.• Preventive care about pregnant women – paid from public health

insurance– High coverage (98.6% receiving prenatal care). – Early registration (81.8% in Ist trimester)– More than 6 visits– Ultrasound screeening

• Hospital deliveries (99.8% of all births)

• 12 perinatal centres, equipped with top-quality diagnostic and therapeutic technology and highly educated staff.These workplaces are closely connected with specialized intermediary centres of neonatal care for premature newborns or newborns with low birth weight.

• Frequency of LBW 7.2%

Perinatal mortality is at very low level despite of influence of changing conditions:

• Aging population, increasing proportion of older mothers

• increasing proportion of LBW• Increasing proportion of multiple pragnancies• Increasing proportion of woman without

pregnant care

Medical Care in the CR

• Medical care in the CR is mostly paid by public medical insurance, which is obligatory by law.

Medical care for children

• Medical care for children in the CR was and is still at a high level.

• Essential medical care for children is covered by public health insurance. The state pays insurance premiums for children and adolescents until the time of completion of preparation for a profession (maximally to 26 years of age).

• Practically all children are born in maternity hospitals and are (mostly) examined by a pediatrician immediately after birth.

• During their stay in the maternity hospital, all children undergo screening tests for phenylketonuria, hypothyroidism, cararacts, congenital adrenal hyperplasia – and are vaccinated against TBC.

• Screening examinations are also performed on the hip joints and on the hearing in children with congenital hypothyroidism

• Newborn screening is being gradually extended.

• Preventive care for children begins in the prenatal and perinatal period with cooperation between obstetricians, geneticists and pediatricians.

• General practitioners for children and adolescentsprovide primary medical care for children in the CR.

• Chronically ill or handicapped children are included in dispensary groups, in which they are monitored to a greater degree by a pediatrician and the relevant specialists. Roughly every fifth child is examined annually in the dispensary care of pediatricians.

• Contemporary pediatrics has a well-introduced system of preventive examinations and an immunization program based on a vaccination calendar paid from public medical insurance

• The law enables /stipulates 11 preventive examinations up to the age of 18 months and then two-year intervals as the frequency of preventive medical examinations from 3 years of age of the child.

Health of Children of the CR• In spite of the very good level of medical care for the children, the

state of health of the child population of the CR is not improving substantially.

• There is no apparent reduction in sickness rate of children and adolescents. There is an extremely high rate of sickness from acute respiratory diseases, especially amongst children attending preschool facilities.

• There are a lot of serious injuries, increasing number of allergic diseases, diabetes, diseases of the nervous system and behavioural disorders.

• Reduced physical activity and unhealthy eating habits are also leading to greater numbers of obese children and adolescents in the CR.

• There is no reduction in the numbers of neglected, maltreated and abused children – including commercially and sexually abused children.

• An increase has occurred in the syndrome of hazardous behaviour amongst adolescents.

The proportion of diseases followed up in children by chapters of ICD - 10,age group 0 - 14

Nervous system...22,8%

Endocrine...7,2% other

32,8%

Diseases of the skin

11,9%

Respiratory system25,3%

Source: The Institute of Health Information and Statistics of the Czech Republic

The proportion of diseases followed up in children by chapters of ICD - 10,age group 15 - 18


Musculoskeletal system9,7%

other33,6%Endocrine...

9,6%

Nervous system...25,5%


Trend of the number of followed up children for Diabetes mellitus per 100 000 registered pacients in age group 0 - 14 and 15 - 18

0102030405060708090

100110120130140150160170180190200

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

age group 0 - 14age group 15 - 19


Trend of the number of alergic children per 1 000 registered pacients in age group 0 - 14 and 15 - 18

0

25

50

75

100

125

150

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005Source: The Institute of Health Information and Statistics of the Czech Republic

Trend of the number of followed up children for Asthma per 100 000 registered pacients in age group 0 - 14 and 15 - 18

0

800

1 600

2 400

3 200

4 000


Trend of the number of followed up children for Obesity per 100 000 registered pacients in age group 0 - 14 and 15 - 18

0

220

440

660

880

1 100

1 320

1 540

1 760

1 980

2 200


Trend of regular smoking of boys

in the period of 1994 – 2006

Vývoj pravidelného kuřáctví u chlapců v období 1994 až 2006

15,9

22,4

28,6

19,7

7,310,1

13,8

7,8

2,3 1,9 31,6

1994 1998 2002 2006 0

5

10

15

20

25

30

35%

11 let 13 let 15 let

Trend of regular boys‘ beer drinking

in the period of 1994 – 2006

Vývoj pravidelného pití piva u chlapců v období 1994 až 2006

35,4

29,3

36,9 35,8

16,4 15

21,1

14,910,5

14,19,3 9,1

1994 1998 2002 2006 0

10

20

30

40

50%

11 let 13 let 15 let

Beer drinking 6x and more during last 30 days

Girls / Boys

Age structure of first narcotics experience

Beer / Cigarettes / Marihuana / Ecstasy

Zdroj dat: Deaths - CZSO

Othersothers

1.1.1.1.3.Injury, poisoning and certain other consequences of external causesXIX.

8.7.9.10.5.Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classifiedXVIII.

6.6.4.4.2.Congenital malformations, deformations and chromosomal abnormalitiesXVII.

xxxx1.Certain conditions originating in the perinatal periodXVI.

5.4.5.5.6.Diseases of the respiratory systemX.

4.5.6.7.7.Diseases of the circulatory systemIX.

3.2.3.2.4.Diseases of the nervous systemVI.

2.3.2.3.9.NeoplasmsII.

Order of causes of death

15-1910-145-9 1-4 0

ageDeaths

Specific mortality rates - infants

0,02,0

4,06,0

8,010,012,0

14,016,0

18,020,0

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

boysgirlstotal

per 1 000 inhabitants in corresponding age group


Specific mortality rates - boys

0,0

0,2

0,4

0,6

0,8

1,0

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

1-45-910-1415-19



Specific mortality rates - girls

0,0

0,2

0,4

0,6

0,8

1,019

8019

8119

8219

8319

8419

8519

8619

8719

8819

8919

9019

9119

9219

9319

9419

9519

9619

9719

9819

9920

0020

0120

0220

0320

0420

0520

06

1-45-910-1415-19



The proportion of causes of death in children till 1 year of ageby chapters of ICD - 10 Congenital

malformations18,8%

Symptoms, signs...4,0%

Injury, poisoning...5,4%other

9,9%

Nervous system4,0%

Of perinatal period58,0%


The proportion of causes of death in children 1 - 14 years oldby chapters of ICD - 10

Nervous system15,5%

Neoplasms19,3%

Injury, poisoning...36,2%

Congenital malformations

9,7%


Circulatory system7,2%

other6,3%


The proportion of causes of death in children 15 - 19 years oldby chapters of ICD - 10

Circulatory system4,0%


Injury, poisoning...73,8%

other5,6%

Neoplasms9,3%

Nervous system4,4%


Child Injury Mortality in the Czech Republic

• The Czech Republic ranges among countries with high rate of injuries.

• In the Czech Republic accidents are the most common cause of death of children and young adults .

• According to statistics, more than 100 children die each year as a result of accidents.

• Of these - more than 30% die as a result of traffic accidents

Injuries mortality – main causes, 2005

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Children (0-14) Adults (15-64) Seniors (65+)

Falls

Traffic accidents

Suicides

Drawing and notspecified

Other

0 1_4 5_9 10_14 15_19 0 1_4 5_9 10_1415_19Vniknuvší tělesa 14 1 2 1 4 10 1 1 3 3Popáleniny 1 1 0 2 0 0 1 0 1 4Otrava léky aj. 0 0 0 1 7 0 1 0 1 4Toxické účinky 0 1 0 0 11 1 1 0 5 12Syndromy týrání 0 0 0 0 0 1 0 0 0 0Omrzliny aj. nespecif. 3 7 6 10 40 3 7 6 10 31Dopravní nehody 2 6 12 9 100 1 7 15 21 118Pády 1 0 1 1 8 1 3 1 1 4Mechan.síly 0 1 0 0 4 0 1 1 1 1Tonutí 0 6 5 4 5 0 5 4 3 6Život.mechan.silám 0 0 0 0 0 0 1 0 0 0Kontakt s jed.živočichy,rostl. 0 0 0 1 0 0 0 0 0 0El. proud, plamen, kouř 1 3 0 2 2 0 1 0 0 4Úmyslné sebepoškození 0 0 0 8 43 0 0 1 8 43Napadení (útok) 3 0 1 2 3 2 1 0 2 2Komplikace zdravotní péče 0 0 0 0 0 0 0 0 0 0

20032004

0%

01_4Other 20 1 4 7 41 15 8 3 10 32

0% 20% 40% 60% 80% 100%

01_45_9

10_1415_19

01_45_9

10_1415_19

2005

2004

The most frequent causes of death in 2004 and 2005, children and youth people

Foreign bodyenteringPoisonning

Toxic effects

Frostbite andnot specifiedTrafficaccidentsFalls

Drowning

Other

National Action Plan on Child Injury Prevention for 2007-2017 (NAP)

• NAP is a systematic solution of the intentional and unintentional child injury prevention in children aged 0 - 18 years in the Czech Republic.

• NAP maps the current activities of the Czech Republic in the area of child injury prevention, it evaluates these activities in terms of the strengths and weaknesses, the utilisation of opportunities and diversion of threats, and it establishes the most important tasks of individual ministries for the period of 2007-2017.

• NAP was endorced by the Czech government on 22 August 2007

• One of the major tasks of the Ministry of Health is the development of the National Registry of Childhood injuries.

Conclusions• Medical care for children in the CR is at

hight level• Infant mortality is very low thanks of hight

level of perinatal care• The main cause of children deaths are

injuries• In the CR there is increasing trend of some

diseases (diabetes, allergic, asthma, obesity..)

Aimes• To keep a current level of perinatal care• To improve a preventive health care systém• To focus on social aspects of health• To deal with child injuries mortality and

morbidity. – Health of Children / Child Violence and Injury

Prevention will be proposed as one of priorities of the Czech Republic chairmanship of the EU in 2009

Thank you for your kind attention

[email protected]

mailto:[email protected]

This paper was produced for a meeting organized by Health & Consumer Protection DG and represents the views of its author on thesubject. These views have not been adopted or in any way approved by the Commission and should not be relied upon as a statement of the Commission's or Health & Consumer Protection DG's views. The European Commission does not guarantee the accuracy of the dataincluded in this paper, nor does it accept responsibility for any use made thereof.

health of children in the czech...

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