Assessment of indicators of reproductive health of the population of the Trans-Ural Republic of Bashkortostan in 2000–2020

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Abstract

BACKGROUND: The reproductive health of a population depends on many factors one of which is chemical pollution of the environment caused by both natural conditions and man-made impacts. The population living in geochemical provinces is often subject to pathological conditions caused by a lack, excess or imbalance of macro- and microelements. This study was carried out in the Republic of Bashkortostan in areas of natural and man-made anomalies with excessive content of heavy metals in the environment.

AIM: To analyze the demographic profile and assess the reproductive health of the population of the Trans-Ural zone of the Republic of Bashkortostan.

MATERIALS AND METHODS: A descriptive ecological study of the trend of reproductive health of the population of the Trans-Ural zone of the Republic of Bashkortostan was carried out using average population indicators. Statistical data presented in the open press by the Ministry of Health of the Republic of Bashkortostan for the 2000–2020 period were used. These data included demographic indicators, infant mortality, frequency of congenital malformations, and morbidity of children within the first year of life.

RESULTS: In all the areas studied, there was a tendency for a decrease in the birth rate and an increase in the mortality rate. The highest average birth rate of 19.8 was recorded in the Burzyansky District and the lowest of 13.1 in the Zilairsky District, which was higher than the republican average of 12.4. During the study period, there was a significant decrease in infant mortality both in the republic and in the Trans-Urals regions. Average infant mortality rates relative to congenital malformations among newborns in the Sibay, Baymaksky, and Zianchurinsky Districts as well as the relative risk of blood diseases in children of the first year of life in most of the studied areas was higher than the average republican level.

CONCLUSION: Reproductive health of the population of Sibay for the period 2000–2020 is exposed to a higher risk of congenital malformations and infant mortality than the average republican level. In the Baymaksky, Zianchurinsky, Uchalinsky and Khaibullinsky Districts, the risk of developing blood diseases in children within the first year of life was higher than the average republican level. The results further indicate the need to take measures to reduce risks and improve the safety of reproductive health of the population of the mining region.

Full Text

Introduction
The territory of the Trans-Urals of the Republic of Bashkortostan (RB) covers an area of ​​31,901 km2 and includes the Yuluksko-Tubinsky; Baimak-Buribaevsky and Krasnouralsko-Sibay-Gaisky geochemical provinces, differing in the composition of parent rock metals, as well as a large number of various geochemical anomalies. The largest deposits of polymetallic ores, on the basis of which mining and processing plants operate, are Sibaysky (Sibay), Yubileyny (Khaibullinsky district), Uchalinsky (Uchalinsky district). The development of copper-zinc ore in the Trans-Urals of the RB for half a century has led to a deterioration in the ecological state of the environment. Numerous environmental studies in this area have revealed an increased level of heavy metals (HM) in soil, water, crop and livestock products, as well as an imbalance of microelements in human biosubstrates [1–4]. The specificity of HM accumulation in the biosubstrates of the population of the geochemical province of the RB was studied both in the general population and on the example of individual rural settlements [5–11]. The results of studies indicate that the population of this geochemical province (approximately 260 thousand people) is at risk of developing hyper- and hypoelementoses, which in turn can provoke the development of neoplasms, blood diseases, psychoneurological, neuroendocrine pathologies, as well as reproductive health disorders [12-15].
It is known that environmental pollution has a negative impact on the reproductive state of the population, intrauterine development of the fetus and the health of the newborn [16, 17]. Therefore, such indicators as levels of maternal and child mortality, spontaneous miscarriages, the frequency of birth of children with congenital malformations (CMDs), child morbidity, etc., can be considered as a criterion for assessing the quality of the environment [18, 19].
The purpose of this study is to study the reproductive health of the female population of the Trans-Ural zone of the RB in comparison with the average republican indicators.

Materials and methods
The data of the annual reports of the Ministry of Health of the RB “Health of the population and the activities of medical organizations” for 2000-2020 were used as research materials for the following administrative districts: Abzelilovsky, Baymaksky, Burzyansky, Zilairsky, Zianchurinsky, Uchalinsky, Khaibullinsky and Sibay. The following indicators were analyzed: birth and death rates, birth outcomes for women and fetuses, general morbidity, frequency of congenital malformations and chromosomal disorders, diseases of the blood and blood-forming organs of children in the first year of life, infant mortality. To assess the significance of the differences between the studied parameters from the average national level, Student's t-test was used with a threshold value of 0.05.

Results
Dynamics of birth rates and total mortality for 2000-2020 in the regions of the Trans-Urals of the Republic of Belarus are shown in fig. 1. The presented data show a downward trend in the birth rate in all regions, starting from 2010-2012. At the same time, there is an increase in the mortality rate, especially pronounced in 2020.
The highest birth rate was found in Burzyansky (19.8), the lowest - in Zilairsky district (13.1) with an average republican level of 12.4. The highest mortality (an indicator classified by WHO as an indicator in relation to the habitat) was typical for Zilairsky (14.8), the lowest - for Burzyansky district (10.5) with an average republican indicator of 13.4 (Fig. 1).
Fig. 1 - Dynamics of birth and death rates for 2000-2020 in the regions of the Trans-Urals of the RB: A - Abzelilovsky district, B-Baymaksky, C - Burzyansky, D - Zilairsky, D - Zianchurinsky, E - Uchalinsky , F - Khaibullinsky, G - Sibay, H - RB (solid line - birth rate, dotted line - mortality)

The proportion of premature births in the Trans-Urals ranged from 3.3% (Sibay) to 6.7% (Burzyansky district) and statistically significantly exceeded the national average in Burzyansky and Zilairsky districts (Table 1).

Table 1.
The share of preterm births in the total number of births in the regions of the Trans-Urals of the RB in comparison with the average republican indicators for 2015-2020 (%)

District

Mean

p

Abzelilovsky

4,4±0,6

0,404

Baymaksky

5,6±1,4

0,062

Burzyansky

6,7±1,2

0,006*

Zilairsky

6,4±0,7

0,001*

Zianchurinsky

3,5±1,2

0,440

Uchalinsky

4,6±1,4

0,491

Khaibullinsky

4,6±2,1

0,605

Sibay

3,3±0,5

0,082

RB

4,1±0,5

-



* - statistically significant level

An important indicator of the state of health of the population is infant mortality (the number of dead newborns per 1000 live births). In general, for 2000-2020. there was a significant decrease in this indicator, both in the republic and in the regions of the Trans-Urals (Fig. 2).

Fig. 2– Dynamics of infant mortality in the regions of the Trans-Urals for 2000-2020

Comparison of infant mortality in the RB and in rural areas of the Trans-Urals for 2000-2020. showed no statistically significant difference. At the same time, the average infant mortality rate in the city of Sibay was statistically significantly higher (р=0.020) than in the RB (Table 2).

Table 2.

The indicator of infant mortality in the regions of the Trans-Urals of the Republic of Bashkortostan in comparison with the average republican indicators for 2015-2020 (%)

District

Mean

p

Abzelilovsky

7,6±3,4

0,191

Baymaksky

10,4±4,2

0,258

Burzyansky

8,9±4,4

0,930

Zilairsky

6,6±4,6

0,082

Zianchurinsky

11,1±3,6

0,066

Uchalinsky

9,2±3,8

0,861

Khaibullinsky

8,6±3,4

0,719

Sibay

11,2±2,3

0,020*

RB

7,6±2,5

-

* - statistically significantly below the level of RB
**- statistically significantly higher than the level of RB

Study of congenital malformations and chromosomal disorders for 2000-2020 showed a significant excess (p = 0.000049) of this pathology in the city of Sibay (74.7‰) compared with the national average (28.7‰) (Table 3).

Table 3

The frequency of congenital malformations and chromosomal disorders in the regions of the Trans-Urals of the Republic of Bashkortostan in comparison with the average republican indicators for 2015-2020 (‰)

District

Mean

p

Abzelilovsky

7,3±5,1

0,000*

Baymaksky

15,7±8,7

0,000*

Burzyansky

25,9±15,8

0,633

Zilairsky

7,4±6,3

0,000*

Zianchurinsky

17,4±7,8

0,000*

Uchalinsky

25,2±10,5

0,3165

Khaibullinsky

8,2±5,0

0,000*

Sibay

74,7±35,4

0,000**

RB

28,7±5,1

-

* - statistically significantly below the level of RB
**- statistically significantly higher than the level of RB

The average morbidity rates of children of the first year of life in the Trans-Urals do not exceed the republican level. The exception was the Khaibullinsky district (Table 4).

Table 4

Average incidence rates of children in the first year of life in the regions of the Trans-Urals of the Republic of Belarus in comparison with the average republican indicators for 2015-2020 (‰)

District

Mean

p

Abzelilovsky

1418,3±339,2

0,000*

Baymaksky

2483,9±976,8

0,845

Burzyansky

1717,0±311,4

0,000*

Zilairsky

1739,1±358,5

0,000*

Zianchurinsky

2139,0±857,7

0,277

Uchalinsky

2433,9±332,5

0,372

Khaibullinsky

3178,6±903,2

0,025**

Sibay

2066,2±365,9

0,000*

RB

2545,5±203,2

-

* - statistically significantly below the level of RB
**- statistically significantly higher than the level of RB

 

Comparison of the prevalence of blood diseases in children of the first year of life in the Trans-Urals with the average republican indicators revealed a statistically significant excess in Baimaksky, Zianchurinsky, Uchalinsky and Khaibullinsky districts. The highest average frequency of blood diseases in children of the first year of life for 2000-2020 was observed in Baymaksky and Khaibullinsky districts (Table 5).

Table 5

Average incidence rates of diseases of the blood and hematopoietic organs in children of the first year of life in the regions of the Trans-Urals of the Republic of Bashkortostan in comparison with the average republican indicators for 2015-2020. (‰)

 

District

Mean

p

Abzelilovsky

92,0±25,4

0,000*

Baymaksky

311,6±176,9

0,007**

Burzyansky

218,4±96,7

0,080

Zilairsky

179,0±115,8

0,480

Zianchurinsky

223,4±46,2

0,000**

Uchalinsky

249,5±76,2

0,000**

Khaibullinsky

287,4±150,5

0,004**

Sibay

138,3±30,2

0,051

RB

157,4±19,9

 

* - statistically significantly below the level of RB
**- statistically significantly higher than the level of RB

The discussion of the results
Low birth rates and low life expectancy in recent years in the Russian Federation are a serious problem regarding the country's security. There are various reasons for the current demographic situation, including an unsatisfactory environmental situation that has a negative impact on the reproductive health of the population [20–24]. Living on the territory of a geochemical province leaves its mark on the elemental portrait of the population and creates risks of reproductive health disorders. Thus, it has been shown that in women with reproductive health disorders, a tendency to the predominance of the content of toxic microelements in the biosubstrates of the body was revealed [25]. Experimental studies on animals and in human cell cultures have shown a negative effect of the toxic element cadmium on the reproductive system [26].
The administrative regions of the geochemical province of the Republic of Belarus differ both in terms of the level of technogenesis and the ecological state of the environment. On the territory of the city of Sibay, Uchalinsky and Khaibullinsky districts, large mining and processing plants and other mining enterprises are located, the intensive and long-term activity of which contributed to a significant deterioration of the environmental situation [27]. On the territory of a number of districts, primarily Baimaksky, there are exhausted quarries and mines, which are a source of pollution of the surroundings with HM and other toxic substances [11] . The list of administrative regions under study also included regions where there are practically no large enterprises, for example, Burzyansky and Zilairsky regions. The degree of pollution of environmental objects in these areas can vary greatly [7]. Due to the existence of geochemical anomalies, an increased level of HMs in the environment can take place even in the absence of technogenic impact.
An analysis of the demographic indicators of this subregion revealed the presence of a relatively high birth rate compared to the national average. Particularly distinguished in this regard is the Burzyansky district, the average birth and death rates for 2000-2020. in which they accounted for 150 and 78% of the republican level, respectively. Also in the study area there are areas in which mortality rates exceed birth rates. So, the average birth rate in the Zilair district for 2000-2020. was 13.1, while the death rate is 14.8. In general, the situation in the republic is approximately the same: the average birth rate for the specified period is 12.4, while the death rate is 13.4.
As for the dynamics of the birth rate, then, unfortunately, both in the whole country and in the studied areas, its increase in 2007-2010. as a result of the introduction of the Maternity Capital Program, it has changed in recent years to a steady decline. The sharp increase in overall mortality in 2020 as a result of the coronavirus pandemic also does not leave hope for an increase in the population in the near future.
The presence of a relatively high birth rate in the Trans-Urals of the Republic of Belarus, compared with the average republican values, is accompanied in a number of the studied regions (Burzyansky and Zilairsky) by an increased level of premature births. It is possible that this is facilitated by the difficulty with the timely provision of medical care, since these areas are located far from cities where there are perinatal centers provided with the necessary equipment and having the appropriate human resources.
The average infant mortality rate in Sibay was 11.2, which is statistically significant (p=0.020) higher than the national average (9.0). No significant differences were found for the rest of the studied regions. It is possible that the unfavorable environmental situation in the city of Sibay is one of the reasons for the increased infant mortality in the city. Compared with the background values, the average mass fractions of zinc were 5.4 F, copper - 4.9 F, lead - 2.4 F, cadmium - 1.8 F, nickel - 1.3 F. The maximum mass fractions of copper were observed at the level 22 F, zinc - 10 F, lead - 6.5 F, cadmium - 4.8 F, nickel - 2.3 F [28]. Along with the increased content of HMs and other pollutants in the environment in 2018-2019. As a result of the fire in the Sibai quarry, toxic substances were released into the atmosphere, mainly sulfur dioxide. The average daily concentration of sulfur dioxide varied from 0 to 2.5 mg/m3, which was 50 times higher than the MPC [29].
Along with increased infant mortality, a high incidence of congenital malformations and chromosomal disorders was registered in Sibay, which is statistically significantly higher than the national average.

Conclusion
The study of the state of reproductive health of the population of the Trans-Urals of the Republic of Belarus, located on the territory of the geochemical province, revealed a negative environmental impact on it. In the reproductive health of the population of Sibay for 2000-2020. there is a high frequency of congenital malformations, infant mortality, in Baymaksky, Zianchurinsky, Uchalinsky and Khaibullinsky districts - blood diseases in children of the 1st year of life compared with the national indicators. The results obtained indicate the need to take measures aimed at ensuring the safety of the reproductive health of the population and future offspring.

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About the authors

Irina N. Semenova

Sibay Institute (branch) Ufa University of Science and Technology

Author for correspondence.
Email: alexa-94@mail.ru
ORCID iD: 0000-0001-8213-6275
SPIN-code: 1258-9113
Scopus Author ID: 56326153600

doctor of biological sciences, Leading researcher of Ecology and Environmental Management Laboratory, professor of Natural Sciences Department

Russian Federation, 21, Belova, Sibay, Republic of Bashkortostan

Yuliya S. Rafikova

Central City Hospital of Sibay

Email: shagit67@mail.ru
ORCID iD: 0000-0002-3281-803X
SPIN-code: 9326-0342
Scopus Author ID: 57193392548

научный сотрудник

Russian Federation, Republic of Bashkortostan, Sibay

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Supplementary files

Supplementary Files
Action
1. Fig. 1. Dynamics of birth and death rates for 2000–2020 in the regions of the Trans-Urals of the Republic of Bashkortostan: a — Abzelilovsky district, b — Baymaksky, c — Burzyansky, d — Zilairsky, e — Zianchurinsky, f — Uchalinsky, g — Khaibullinsky, h — Sibay city, i — Republic of Bashkortostan (solid line — birth rate, dotted line — mortality).

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2. Fig. 2. Dynamics of infant mortality in the regions of the Trans-Urals for 2000–2020.

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