Objectives. Kazakhstan’s live-birth definition—that dates from the former Soviet Union (FSU) era—differs from that used by the World Health Organization (WHO). We studied the impacts of both live-birth definitions on the computations of the infant mortality rate (IMR) and maternal and child health (MCH) planning in Zhambyl Oblast, Kazakhstan.Methods. We interviewed caregivers and abstracted medical records to obtain birth weight and age-at-death information on infant deaths in Zhambyl Oblast from November 1, 1996, through October 31, 1997. Using the 2 indicators of birth weight and age at death, we created a matrix delineating the respective contribution to infant death (maternal health, newborn care, or infant care) for the cells. We then calculated the IMR, birth weight-specific IMR (BWS-IMR), and birth weight-proportionate IMR (BWP-IMR) for each cell.Results. The observed IMR in Zhambyl Oblast, in 1996—using the definition of a live birth from the FSU—was 32 per 1000 live births. The recalculated IMR—using the WHO definition—was 58.7 per 1000 live births. Computed estimates of the contribution to infant death, by the categories of maternal health, newborn care, and infant care, were 10%, 23%, and 67%, respectively, when using the live-birth definition from the Soviet era. These estimates shifted to 24%, 41%, and 35%, respectively, when using the WHO definition, yet only 8% of the Zhambyl Oblast MCH budget was earmarked to maternal health and newborn care, which we estimated accounted for 65% of infant deaths.Conclusions. The live-birth definition commonly used in the FSU underestimated the IMR and undervalued the contributions to infant death by both maternal health and newborn care. We recommend that all republics of the FSU adopt the WHO live-birth definition so that the IMR can serve as a better indicator for MCH planning.
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机译：目标。哈萨克斯坦的活产定义可追溯到前苏联（FSU）时代，与世界卫生组织（WHO）使用的定义不同。我们研究了活产定义对哈萨克斯坦Zhambyl州婴儿死亡率（IMR）和母婴健康（MCH）计划的计算的影响。我们采访了看护者并提取了医疗记录，以获取有关Zhambyl州从1996年11月1日至1997年10月31日婴儿死亡的体重和死亡年龄的信息。我们使用出生体重和死亡年龄这两个指标，创建了一个矩阵，描述了细胞对婴儿死亡（母亲健康，新生儿护理或婴儿护理）的各自贡献。然后我们计算每个细胞的IMR，特定于体重的出生体重IMR（BWS-IMR）和与出生体重成比例的IMR（BWP-IMR）。使用FSU的活产定义，1996年在Zhambyl州观察到的IMR为每1000活产32个。根据WHO的定义，重新计算的IMR为每1000例活产58.7例。当使用苏联时代的活产定义时，按孕产妇保健，新生儿护理和婴儿护理的类别计算的对婴儿死亡的贡献的估算值分别为10％，23％和67％。使用WHO定义时，这些估计分别转移到24％，41％和35％，但Zhambyl Oblast MCH预算中只有8％专门用于孕产妇保健和新生儿护理，我们估计这占婴儿总数的65％死亡。结论。 FSU中常用的活产定义低估了IMR，并低估了孕产妇保健和新生儿保健对婴儿死亡的贡献。我们建议FSU的所有共和国都采用WHO的活产定义，以便IMR可以作为妇幼保健计划的更好指标。
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