347 



organs of the blood circulatory system (in 1980, 268.5; in 1990, 231.3 per 100,000 people). 

 It should be mentioned that mortality from ischemic cardiac disease is 324.5 per 100,000 

 people, which places Yakutia third in the CIS after Latvia (520.2) and Estonia (492.8). 

 Accidents and traumas take second place in the general hierarchy of mortality (in 1980, 

 251.7; in 1990, 166.3 per 100,000 people), malignant tumors are in third place (in 1980, 

 101.8; in 1990, 121.9 per 100,000 people), respiratory diseases are in fourth place (in 

 1980, 98.5; in 1990, 41.2 per 100,000 people), and in fifth place are diseases of the 

 digestive organs (in 1980, 31.3; in 1990, 26.4 per 100,000 people). The state of children's 

 heetlth in the Republic of Sakha (Yakutia) is indicated by the indices of mortality among 

 children (Figure 2). The high mortality rate of children is caused mainly by many social 

 factors, not to mention purely medical problems of public health. 



Currently in this republic, the number of hospital beds for children lags behind 

 the increase in their population. As a result, the availability of children's hospital beds 

 (75.7) is less than that in the Russian Federati )n (92.2). Altogether the republic has 

 16,581 beds, including 1,521 allocated for pediatric patients (9.1%). 



In the hierarchy of causes of infant mortality, diseases of the perinatal period are 

 in first place (49%), and mortality from these causes increases consistently. In second 

 place are congenital anomalies and deformities - 23.6%. One in two children who 

 passed on during the first year of life in 1991 died from diseases of the perinatal period, 

 one in four died fi"om congenital anomalies and developmental malformations. 

 Congenital respiratory diseases are in third place (10.0%), and mortality from respiratory 

 disorders shows a consistently declining trend. 



The high level and increase of perinatal affliction (every second child) is mainly 

 due to the unfavorable state of the health of pregnant women and poor prenatal fetus 

 protection, which includes low-quality monitoring of pregnancies with an increased risk 

 for the fetus, untimely diagnostics of extragenital hypoxia of the fetus, and lack of 

 prevention of the latter. 



A 12.3% increase in infant mortality in the neonatal period (11.1% in the Russian 

 Federation) indicates poor therapeutic and preventive care in maternity institutions, and 

 absence of second-stage care for premature infants. Every year, more than 1,000 infants 

 are bom prematurely, and no specialized help is given to them. 



In the hierarchy of causes of infant mortality during the neonatal period, ' 

 congenital anomalies and deformities are in first place (29.6%), atelectases in second 

 (28.9%), and birth injuries in third (17.3%). 



The poor protection of children's health in the republic is related mainly to the 

 low level of development of health care institutions in rural areas. The central, rayon, 

 and local hospitals in rural areas are very poorly equipped. Out of 862 health care 

 facilities, 77.3% (662 facilities) are buildings adapted for medical use. The average area 



