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ORDER OF THE GOVERNMENT OF THE REPUBLIC OF MOLDOVA

of December 6, 2013 No. 988

About approval of the National program for prevention, decrease in incidence and death rate from congenital malformations and heritable pathology of children in the Republic of Moldova for 2013 - 2017

(as amended of the Order of the Government of the Republic of Moldova of 24.07.2017 No. 592)

Based on provisions of the Law on health protection No. 411-XIII of March 28, 1995 (The official monitor of the Republic of Moldova, 1995, No. 34, the Art. 373), with subsequent changes and amendments, the Law about reproductive health No. 138 of June 15, 2012 (The official monitor of the Republic of Moldova, 2012, Art. No. 205-207, 673), for the purpose of decrease in incidence and death rate from congenital malformations and heritable pathology of children in the Republic of Moldova the Government DECIDES:

1. Approve:

The national program for prevention, decrease in incidence and death rate from congenital malformations and heritable pathology of children for 2013 - 2017, according to appendix No. 1;

The action plan on implementation of the National program for prevention, decrease in incidence and death rate from congenital malformations and heritable pathology of children for 2013 - 2017, according to appendix No. 2.

2. Ministry of Health:

within bilateral and multilateral agreements will cooperate with the World Health Organization, the United Nations Children's Fund, other international organizations and non-governmental organizations for implementation of the above-named Program;

will provide to the Government annually till March 15 information on realization specified in the action program.

3. Determine that financing of the National program for prevention, decrease in incidence and death rate from congenital malformations and heritable pathology of children for 2013 - 2017 will be performed for the account and within means of the national public budget, and also from other means, according to the current legislation.

4. To impose control over the implementation of this Resolution on the Ministry of Health.

Prime Minister

Iurie Leanca

Countersign:

Minister of Health

 

Andrey Usaty

Minister of Finance

Anatol Arapu

Appendix No. 1

to the Order of the Government of the Republic of Moldova of December 6, 2013 No. 988

The national program for prevention, decrease in incidence and death rate from congenital malformations and heritable pathology of children in the Republic of Moldova for 2013 - 2017

I. Introduction

1. The national program for prevention, decrease in incidence and death rate from congenital defects and heritable pathology of children for 2013 - 2017 (further - the Program) is part of the social and economic policy of the state directed to improvement of quality of medical services and increase in chances of survival of children.

2. The program determines the main actions according to the priorities stated in the Program of activities of the Government "The European integration: Freedom, Democracy, the Welfare" for 2013 - 2014, National policy of health of the Republic of Moldova for 2007 - 2021 and Strategies of development for health care system during 2008 - 2017.

3. The program is the instrument of accomplishment of the obligations of the Republic of Moldova in the context of goal achievement of development of the millennium approved by the Order of the Government No. 288 of March 15, 2005.

II. Importance of problem

4. The problem of medical care is especially distinguished to mothers and children from the state problems of the medico-social importance. It is the multilateral problem including the whole complex of tasks which determine quality of health of this contingent.

5. The big share of anomalies of development in structure of child mortality, incidence and restriction of opportunities allows to carry them to the major medico-social problems in health sector. According to the World Health Organization, about 5% of newborns have congenital pathology, 40% of cases of child mortality and restriction of opportunities are caused by congenital factors. Patients with this pathology occupy about 30% of beds in children's hospitals of all profiles. Treatment and care of this contingent of patients require considerable financial resources.

6. In the last decade in Moldova infantile death rate steadily decreases, however the frequency of congenital defects remains steadily high and takes the II place in structure of infantile death rate, constituting in 2009 27%, in 2010 - % 29,4, in 2011 - % 27,1, in 2012 - % 36,4.

7. Frequency of congenital defects and chromosomal anomalies in Moldova for the period increased 1985 - 2006 with 11, to 17, on 1000 live-birth and now remains at the same level: in 2011 - case 17,7 on 1000 live-birth, in 2012 - case 16,0. Annually in the republic about 700 cases of congenital malformations are registered.

8. According to official statistics, for 2011 from 14851 handicapped children aged from 0 up to 17 years 11 months 29 days registered in the republic (% 20,2), 4236 (% 5,75) - children with congenital malformations and chromosomal anomalies that in general structure of restriction of opportunities constitutes % 28,5.

9. In the Republic of Moldova during 2011-2012 in structure of congenital anomalies multiple congenital defects (25%), malformations of the musculoskeletal device (19%) and cardiovascular system (15%) dominated. Growth tendency during this period of anomalies of the central nervous system (from % 6,7 in 2011 to % 17,1 in 2012), digestive tract (with % 4,5 in 2011 to % 10,2 in 2012) and kidney system is noted (with % 4,5 in 2011 to % 9,4 in 2012). However these indicators do not correspond to the real situation as the system of registration of cases works inefficiently now.

10. Frequency of the birth of children with Down syndrome in the Republic of Moldova is higher, than in other countries. So, in 2007-2011 on 10000 live-birth case 12,23 was prenatalno diagnosed; in EUROCAT countries (The European supervising committee of congenital anomalies) for the same period - case 9,33 on 10000 children.

11. Dynamics of the birth of children of co spina bifida during 2011-2012 demonstrates increase in quantity of cases in recent years: in 2011 - case 3,32 on 10000 live-birth; in 2012 - case 3,00. While in 2007-2011 this indicator averaged case 2,06 on 10000, and in the countries of EUROCAT case 2,13 on 10000 live-birth is registered on average.

12. Now more than 6000 rare inherited metabolic disorders are known. From all scale of congenital "errors" of metabolism in the Republic of Moldova only the fenilketonuriya (FKU) thanks to the neonatal screening initiated in 1989, however for the financial reasons carried out with some breaks can be identified. Fenilketonuriya is registered in Moldova on average with frequency of 1:7 325 of live-birth. Despite success achieved in control over this disease in developed countries in our country expenses on providing this group of patients with amino-acid mixes are not covered by the state.

13. In 1994 neonatal screening of congenital hypothyroidism was suspended (which in 1990-1994 was registered with frequency of 1: 3 876 newborns). Considering weight of violations of development in case of this pathology and arrangement of the Republic of Moldova in endemic zone of deficit of iodine, it is necessary to resume neonatal screening of this disease urgently.

14. Now in the public medical institutions of the Republic of Moldova prenatal biochemical screening in the first two trimesters of pregnancy is widely not implemented. Since 2011 only the insignificant number of tests (the plasma protein connected with pregnancy, free B-subedinitsa of horionichesky gonadotrophin, a-fetoprotein, free estriol, horionichesky gonadotrophin), capable to reveal pregnant women with high risk of development of fetalny defects and chromosomal aberrations at fruit is carried out.

15. Fetalny ultrasonic screening in the I trimester of pregnancy on the term of 11-14 weeks for determination of predictive ekhografichesky markers of congenital malformations and chromosomal aberrations (cervical skin fold, nasal bones, venous channel, etc.) is not implemented in broad practice of maintaining pregnant women and is carried out at qualitatively low level as specialists of ultrasonography do not own sufficient knowledge in the field of phytology.

16. On holding multidisciplinary actions for rehabilitation of children with congenital defects and heritable pathology the state and society incur huge material and moral costs. Despite it, only the few congenital malformations give in to surgical adjustment. However the material and technical resources of divisions of genetic, perinatal, surgical, rehabilitation profile do not conform to the modern requirements necessary for high-quality ensuring services.

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