Migrants’ health and Bulgarian health care system performance: experts’ and society point of view

Introduction

Migrants often face serious inequities concerning their state of health and access to good quality health services. The aim of the study is to compare the experts' and society point of view on migrants' health and Bulgarian health care system performance in this field.

Methods

Within the TRAIN4M&H project, founded by EC, in March 2019th a work seminar was organized in Bulgaria. Data were collected through an unstructured interview. The focus group and facilitated discussion with 22 experts intended was performed. To elicit information about significant migrants' health problems the questionnaire among 388 people was applied. Data processing was performed by SPSS v.24.

Results

22 frontline professionals and 388 people of the society were covered. 20% of the surveyed experts completely disagrees with the opinion that migrants are a threat to public health while nearly nine out of ten surveyed members of the public fully (38.0%) or partially agree (51%) with that statement (χ2=37,84;df=3;p<0,001). The majority (47.8%) of the respondents from the public express an opinion for greater needs for health care of migrants compared to the Bulgarian population while according to three quarters of the specialists there is no difference (χ2=24,07;df=2;р<0,001). About 40% of the representatives of the society claim that the health care system in Bulgaria is not prepared to provide adequate health care to migrants. Almost two thirds of the experts share the opinion that health care in the country can provide only some specific health care to migrants (χ2 = 15.11; df = 2; p < 0.001). The point of view of the groups compared coincided on the issues of restricting the access of migrants in the country and provision of health care, regardless of the legal status of migrants.

Conclusions

The society is not familiar with the health problems of the migrants, but accepts their health as worse than that of the Bulgarian population and threatening the public health in the country.

Key messages

The society is not familiar with the health problems of the migrants, but accepts their health as worse than that of the Bulgarian population and threatening the public health in the country. According to the experts working at local level with migrants Bulgarian health system is not well prepared and provides adequate health care for migrants only in some specific cases.

The impact of the COVID-19 epidemic and anti-epidemic measures in the Roma neighborhood in Bulgaria

Introduction

COVID-19 is becoming an indicator of inequality in societies. Due to the difficult socio-economic situation, Roma in Bulgaria face a higher risk of suffering and death due to COVID-19 than general population. The aim of the report is to analyze the impact of the epidemic of COVID-19 and the anti-epidemic measures applied among the Roma community in Sliven district, Bulgaria.

Material and methods

An exploratory qualitative study design was adopted, combining focus group discussion and qualitative interviews. One focus group with 8 representatives of the Roma ethnic group, and 7 in-depth interviews with specialists working with the Roma community were conducted in November 2020. Data were subjected to thematic analysis. 6 priority topics have been formulated and a hierarchical framework of codes has been built through free software. The experts, assessment of 13 university professors of public health was applied. The COREQ - checklist for reporting quality research was used.

Results

A segregated Roma community of about 20 000 people lives in the Nadezhda neighborhood in the town of Sliven. The impressions of the author from the in-depth conducted interviews with the specialists were compared with the summarized view of the experts, reflecting the information received from the Roma population in focus group. Matching the codes of the author and the experts in relation to 5 of the topics such as: work - work; fear - insecurity; healthcare - doctor; ‘closing the neighborhood' - police; despair, pessimistic views, deterioration of the epidemic situation - disease, misery, famine was found. No coincidences were found regarding future measures to reduce the negative effects of the COVID-19 crisis.

Conclusions

The measures taken against the spread of the pandemic further worsen the medical and social situation of the Roma ethnic group in Bulgaria. Our findings pointed to the importance of a multi-sectoral strategy to improve Roma health during and after a COVID-19.

Key messages

Due to the socio-economic situation, Roma in Bulgaria face a higher risk of suffering and death due to COVID-19 than general population and multi-sectoral strategy to improve Roma health is needed.

According Roma ethnic group in Bulgaria the measures taken against the spread of the COVID-19 pandemic further worsen their medical and social situation and lead to disease, misery and famine.

A study on stress factors in ferrous metallurgy in Bulgaria and ways of their minimizing and control

Background

Stress at workplace arises when the requirements for workers don't meet their personal or social capabilities, or differ from the individual's needs and motivation. Occupational stress is observed in a number of both elementary and high-tech occupational fields. In ferrous metallurgy it could be associated with 24/7 operating mode, high work intensity and a variety of unfavorable characteristics of working environment. The aim of the study is to clarify the nature of factors - stressors in ferrous metallurgy and to define ways for reduction of their negative health impact.

Materials and Methods

Study subject are 91 workers in an electric steel-making department of a ferrous metallurgy enterprise in Bulgaria. Data, concerning working conditions, work characteristics, workers satisfaction, presence/absence of stress and chronic diseases, were collected by direct individual self-administered questionnaire and documents review.

Results

Two of three study subjects reported stress related to their work. Noise, varies from 89.2 to 92.2 dB/A (at rate 85 dB/A) in different sections of the workshop, is the biggest stressor according to 77.5% of the investigated people, followed by short deadlines for task performance (46.5%) and ineffective leadership (32.4%). In addition, negative effects of stress is increasing by high dust levels, reaching up to 7 mg/m3 air at a standard of 6 mg/m3 air, and contain manganese, coke, chamotte, free and bound silica, rare metals, increased concentration of CO and more.Nevertheless workers consider that the organization provides measures for stress reduction by strict control on the limit values of noise, dust, temperature and chemicals (49.2%),provision of personal protective equipment establishment (69%) of a rational mode of work and rest (56.3%) and healthy eating (47.9%).

Conclusions

Despite a plenty of environmental and organizational stressors, their negative effects could be decreased by appropriate preventive measures.

Key messages

Factors-stressor in ferrous metallurgy could be associated with a variety of unfavorable characteristics of working environment,non-stop operating mode, high work intensity and poor time management. Noise is the biggest stressor followed by short deadlines for task performance and ineffective leadership. Stressors are modifiable and preventable by strict hygienic control and improved management.

Healthy behavior – a conscious choice or unwanted trouble? Study among active population in Bulgaria

Background

Official statistics in Bulgaria, as well as a number of empirical studies, show wide spreading of behaviour risk factors and their associated diseases in Bulgarian population. Legislative measures and health promotion programs aim to curb the unhealthy behavior and to incite conscious healthy choices. The purpose of this report is to investigate the attitude of active age people to behaviour change and the barriers they encounter in its implementation.

Methods

Data were collected by direct individual self-administered questionnaire, within a larger research project on health of active population in Bulgaria. It includes 326 employees in a study representing different branches, companies and professions. Questions have asked about distribution of risk factors and attitude to potential behavior change. Data processing was performed by SPSS v.24.

Results

Number of people willing, considering or already making a change depends on the factor studied. Respondents ready to make a change in their diet are 44.6%. Over ¼ of them have already started or trying to confirm this change. In the last 12 months 56.3% have made efforts to improve their physical activity, but in 75.7% of cases the activities were irregular, low-intense and don't fully comply with WHO recommendations. The desire to improve physical activity is significantly higher in people performing intellectual work (p < 0.05). Although 47.5% of the study subjects identify themselves as smokers, 64.1% of them don't have a sense of risky behavior and have no intention to eradicate this habit, 9.8% consider that negative effects will not affect them and 26.1% define behavior change as a long, difficult, expensive and inconvenient process they can't cope with.

Conclusions

Study results confirm high distribution of behavior risk factors in Bulgarian active population. A conscious readiness for behavior change is closely related to the factor, professional characteristics of people and their health knowledge.

Key messages

There is a wide spreading of life-style risk factors in active age population in Bulgaria. Behavior change and adoption of healthy behavior is a necessity and a conscious choice for many people. A conscious readiness for adoption of healthy habits depends on the factor, knowledge about its harmful effect, profession, as well as difficulties that people face in the process of behavior change.

Case-control study of risk factors for adolescent fertility and premature birth in Bulgaria

The significant positive correlation between share of Roma population and adolescent live birth in EU member states (r = 0.804, with 2-tailed significance p = 0.000) was found. The highest level of proportion of live births to mothers aged less than 20 years was found in Romania (9.8%) and Bulgaria (9.5%). At the same tame proportion of Roma population in those countries is highest: Bulgaria (4.7%) and Romania (2.5%). The study found that two thirds (66%) of children born to mothers under the age of 19 are born prematurely OR = 2.10 95% CI (1.13-3.91). Among the newborns studied, the proportion of prematurely born children living in rural areas is significantly higher than those living in the city (p = 0.0001; r = 0.26). Later registration (after the first trimester) and monitoring of pregnancy is a significant risk factor and increases more than four times the risk of having a premature baby OR = 4.23 95% CI (1.41-12.69). A holistic approach is needed in which socio-economic development and education of Roma girls leads to further reduction of adolescent childbirth and premature delivery in Bulgaria.

Difficulties in implementation of the National Health Map in Bulgaria

Background

National Health Map (NHM) of Bulgaria determines the required minimum of healthcare facilities, hospital beds and specialists at different levels of Health System to meet population's needs of healthcare. Its main objective is to adapt structure of the healthcare network to the population health needs ensuring for every Bulgarian citizen an equal access to health services. Through it healthcare resources have been planned on a territorial basis and the national health policy has been implemented. The aim of this report is to analyze the actual availability of healthcare facilities and staff, and compare with the minimum necessary according to the NHM.

Methods

Content and critical analysis of statistical data of the Bulgarian Ministry of Health.

Results

Bulgaria is among countries with relatively low number of general practitioners (GPs) among countries of EU where the range is between 42 and 253 per 100 000 inhabitants. According to the NHM, taking into account administrative division, infrastructure and morbidity, optimum GPs/population ratio is about 67/100 000 while an actual availability is 55.9/100 000. The most serious deficiency is in remote areas where the ratio is between 26 and 32 per 100 000. Quality of primary health care is affected by the fact that 23.89% of GPs are without acquired specialty. Number of practicing nurses in Bulgarian health system is 30% lower than the recommended minimum. Nurses/population ratio is unsatisfactory. Physicians/nurses ratio is not consistent with European standards. Hospital beds are 6.3/1000 which range Bulgaria among five European countries with the highest availability of hospital beds but they are unevenly distributed both on a territorial basis and on specialties.

Conclusions

There is a lack of human resources in Bulgarian Health System and unequal availability and accessibility of health facilities in different regions of the country. Distribution of hospital beds on specialties also must be optimized.

Key messages

National Health Map of Bulgaria determines population needs of accessible outpatient and hospital care, distributes health institutions on territorial bases and implements National Health Policy. Difficulties in implementation of National Health Map are insufficient number general practitioners (GPs), a large proportion of GPs without acquired specialty, inadequate ratio physicians/nurses etc.

Health status and regularity of preventive activities among working population in Bulgaria

Background

Prevention is an important instrument for public health improvement and maintaining workability of active age people. National Health Insurance Fund of Bulgaria (NHIF) finances an annual regular check-up for people over 18 years of age. In addition, working people have access to preventive activities at their workplace. The aim of the study is to explore an actual regularity of preventive activities at active population in Bulgaria.

Materials and Methods

Data were collected by documents review and direct individual self-administered questionnaire, within a larger research project on health of active population in Bulgaria. It includes 326 employees in a study representing different branches, companies and professions. The questionnaire consists of questions about: a) distribution of risk factors, b) knowledge and attitude to prevention as a tool for better health c) types and regularity of preventive activities. Data processing was performed by SPSS v.24.

Results

Three of four respondents have been diagnosed with chronic disease, 49.4% of them suffer from more than one disease. One third of observed people take more than one medicine. Despite NHIF offers free of charge and obligatory annual check-ups, only 46% of study subjects have undergone a preventive examination within the last year, 49.7% - between 2 and 5 years and 4.3% have done so more than 5 years ago or never, which decrease the effectiveness of preventive measures. Visiting regular check-ups is significantly lower for younger age groups (below 44 years; p < 0.05). Relatively large part of people measured blood pressure (88.5%), blood glucose (67%) and blood cholesterol (51.5%) during the last year in relation to any symptoms, but not within the regular check-up.

Conclusions

Study results confirm the current tendency for low coverage of annual check-ups of working population in Bulgaria. Potential of preventive activities is not rationally used because recommended regularity is not observed.

Key messages

Phenomena as polymorbidity and polypragmasia are widely distributed in Bulgarian active population. Potential of preventive activities is not fully used because recommended regularity is not observed. Despite Bulgarian NHIF finances obligatory annual check-up for people aged over 18 years, most people become subjects of medical examination in case of disease symptoms, rather than regular check-ups.

Experts’ point of view on migrants’ health and Bulgarian health system performance

Introduction

Migrants often face serious inequities concerning their state of health and their access to good quality health services. The aim of the study is to analyze the experts' point of view on migrants' health and Bulgarian health system performance in this field.

Methods

Within the TRAIN4M&H project, founded by European Commission, work seminar was organized in Bulgaria in March 2019th. Focus group and facilitated discussion with experts intended to elicit information about significant migrants' health problems was performed. Quantitative and qualitative data were collected through an unstructured interview. Data processing was performed by SPSS v.24.

Results

All participants in the seminar: 22 frontline health professionals (5), law enforcement officers (13), social workers (2) and other professionals (2) were covered. According 60% of participants the health of migrants threatens the health of the host population. The leading health issues among migrants are: infectious and parasitic disorders as a result of bad hygiene (9), psychiatric problems and drug abuse (5), children and pregnant women health problems (3) etc. Most of the experts (77.3%) determine that there is no difference between health care needs of the migrants and Bulgarian population. None of the respondents said that migrants need hospital care mainly. On the opposite, according to experts' point of view they need emergency care (31.8%), primary health care (36.4%) and specialized care (22.7%). The Bulgarian health system provides adequate health care only in some specific cases, according to two thirds of the respondents. As positive results of the health system performance experts point “asylum seekers are fully health insured”, “the treatment of migrants in the centers is free of charge” etc.

Conclusions

In order to establish migrant friendly health system in Bulgaria and to improve the quality of services provided develop and enhance skills of professionals working at local level is crucial.

Key messages

Professionals working at local level with migrants have to be well qualified to face problems in relation to migrants’ health and their access to health care. According to the experts working at local level with migrants Bulgarian health system is not well prepared and provides adequate health care for migrants only in some specific cases.

Health impacts of air pollution in Bulgaria

Background

Air pollution is a major cause of premature death and disease, and is the single largest environmental health risk. Heart disease and stroke are the most common reasons for premature death attributable to air pollution, followed by lung diseases and lung cancer. This report aims at investigation and comparative analysis of air pollution and mortality related indicators in Bulgaria.

Methods

Descriptive study design with content analysis is applied on data from accessible national and international databases and publications - Bulgarian National Statistical Institute and The European Environment Agency. To evaluate the health burden attributable to air pollution were used the population-weighted concentration and the estimated number of attributable premature deaths, and the Years of life lost (YLL) per 100 000 inhabitants in 2016. The Ambient Air Quality Directive defines the PM2.5 Average Exposure Indicator which reflects population exposure to PM2.5 and shows the average concentration at urban areas, calculated as a 3-year average.

Results

In 2015, the level of PM2.5 had to be below 20 µg/m3 in any country. In 2017, concentrations were still above that level in three countries - Slovakia 22, Poland and Bulgaria 24. The largest health impacts in terms of premature deaths and YLL, are observed in central and eastern Europe where the highest concentrations are also observed - Kosovo, Serbia, Bulgaria, Albania and North Macedonia.

The premature deaths attributable to PM2.5 exposure in Bulgaria are 13 100, to NO2 - 1 100 and to O3 - 280. The YLL attributable to PM2.5, NO2 and O3 exposure are respectively 1858, 151, 42. All these levels are very high in comparison with other European countries.

Conclusions

Recognition of the full health and economic cost of air pollution and the benefits of pollution reduction should spur increased use of renewable energy, energy efficiency, and clean-fuel vehicles. This is a necessary investment for Bulgaria's future.

Key messages

Responsibility for, and tools to tackle, many environmental determinants of health lie outside the direct control of individuals or the health sector alone. Wider societal, intersectoral and population-based public health approach is needed.

Roma origin as a factor for high level of adolescent fertility and abortion rate in European Union

Background

Adolescence is a vulnerable phase in human development. Adolescent girls from Roma origin, especially younger girls, are particularly vulnerable because they face the risks of premature pregnancy and childbirth. The study aims to evaluate the association between Roma origin of mothers and prevalence of adolescent fertility and abortion rate in EU member states.

Methods

A correlational study was conducted and data on prevalence of adolescent fertility and abortion among adolescent girls (per 1000 live births) were extracted from European database “Health for all”. The means of variables in different countries were compared and Pearson’s correlation coefficients with share of Roma population were calculated. Data processing was performed by SPSS v.24.

Results

Increasing trend in premature childbirth has been observed in parallel with the increase of share of Roma population within countries, significantly more expressed in South-East member states. The mean adolescent live birth rate in the countries with highest proportion of Roma population was 5.6 times higher as compared to the mean for those with lowest proportion of Roma population. The highest level of proportion of live births to mothers aged less than 20 years was found in Romania (9.8%) and Bulgaria (9.5%). At the same tame proportion of Roma population in those countries is highest: Bulgaria (4.7%) and Romania (2.5%). The relation of adolescent fertility rate with share of Roma population shows significant positive correlation (r = 0.804, with 2-tailed significance p = 0.000). As far as the correlation of abortion among adolescent girls with the Roma origin is concerned, it is inverse and not significant.

Conclusions

Our results indicate significant correlation between share of Roma population and adolescent live birth in EU member states. A holistic approach is needed in which socio-economic development and education of Roma girls leads to further reduction of adolescent childbirth and abortions in EU.

Key messages

Adolescent girls from Roma origin in EU face the risks of premature pregnancy and childbirth more expressed in South-East member states and significant positive correlation for it was found. Bulgaria is the country with highest share of Roma population (4.7%) and in the second place according proportion of live births to mothers aged less than 20 years (9.5%) in the EU in 2015.

Unsatisfactory effectiveness of preventive programs for oncogynecological diseases in Bulgaria

Background

Incidence rate and mortality of breast cancer and cancer of the cervix uteri in Bulgaria are higher in comparison with most countries of European Union (EU). Moreover, during the last three decades they have been increasing, even doubled for cervix cancer, although in developed countries there are proven effective prevention programs. The aim of the study is to explore how these programs are being implemented in Bulgaria and what caused their unsatisfactory results.

Methods

Data were collected by documents review and direct individual self-administered questionnaire among 186 women aged 30-69 concerning types and regularity of preventive activities.

Results

National Health Insurance Fund in Bulgaria defines as mandatory and finances a regular check-up annually for health insured people over 18 years of age. Mammography, as a screening of a breast cancer, was included in regular check-up package from the year 2011, once at every two years, for women aged 50-69. Papanicolau test for cancer of the cervix uteri wasn’t provided in the preventive package until the year 2017 when it was included only for women who complete 30 years of age in the current calendar year with intended regularity once at every two years. Women from other age groups currently are not covered with preventive examination for cervical cancer or they should pay for it which restricts accessibility and affordability of prevention activities. Study results indicates that every fifth of the investigated women have never had a prophylactic examination for breast cancer and cervical cancer. In addition, 69.4% of those who have such examination did not comply with the recommended regularity.

Conclusions

Screening programs against breast cancer and cancer of the cervix uteri are consistent with the recommendations of the oncology research societies but they being applied relatively soon in Bulgaria and some age groups are out of their coverage which decreases their effectiveness.

Key messages

Incidence rate and mortality of breast cancer and cancer of the cervix uteri in Bulgaria are higher than in most countries of European Union although there are proven effective prevention programs. Screening programs against breast cancer and cervical cancer are not effective because of their low accessibility and affordability and because they don’t comply with the recommended regularity.

Advocating migrant and minority health in Bulgaria through an innovative education subject

Introduction

Migrants and ethnic minorities often face serious inequities concerning their access to good quality health services. The Statement by the European Public Health Association on migration, ethnicity and health addresses the need of supporting public health policy makers by providing education courses.

The objectives of the teaching course “Migrant and minority health”, established in Medical University-Pleven in Bulgaria as optional additional subject, is to extend the specific knowledge of students (bachelors and masters of public health) and to develop competencies and skills of future public health practitioners and policy makers.

Results

The unique for Bulgaria course consists of 15 academic hours of the curriculum and ends with an electronically based test. Teaching methods include lectures, seminars and individual practical assignment and stresses on practice rather than theory. The training advocates migrant and minority health by presenting: the most important migrant’s social and health problems; impact of migrants’ health status on public health; the organization of healthcare in the recipient countries of migrants. The lecture course provides information for the main challenges facing healthcare professionals and the health system regarding the health of the migrants and main minorities groups, in particular the Roma as a predominantly ethnic minority in Bulgaria and Europe. The result of exam until now is good in 42.8% of students, very good in 14.2% and excellent in 42.8%. The curse enable public health professionals to acquire knowledge regarding to the international situation, critical assessment skills and the ability to implement appropriate strategies to address specific health problems.

Conclusions

The training meets the needs of in-depth knowledge of public health specialists in relation to the medical and social problems of migrants and minorities in Bulgaria. The positive experience gives ground to include it as part of basic curricula.

Key messages

The subject “Migrant and minority health” enhances student’s competencies as public health practitioners. Knowledge and skills are relevant to the EUPHA Statement on migration, ethnicity and health. By the subject “Migrant and minority health” public health practitioners may work to establish friendly health system with good quality of health services for migrants and Roma population in Bulgaria.

Social aspects of occupational diseases in clothing industry in Bulgaria

Background

The clothing industry is traditionally well developed branch of industry in Bulgaria Harmful factors of manufacture are forced posture, monotonous work, noise, vibration, poisons etc. At the beginning of 2016, the persons directly employed in the sector add up to 92 000, representing 6% of the employees in Bulgaria. An impairment of musculoskeletal and peripheral nervous system is frequent among these people in relation with the exposure of their professional experience. The aim of the study is to observe the influence of occupational diseases in clothing industry on social and emotional wellbeing of the employees.

Methods

For the purposes of the study, 103 persons employed in clothing industry, with impairments of the musculoskeletal system and the peripheral nervous system, were investigated. They were admitted to the Department of Occupational Diseases, of the University Hospital in Pleven during the period 2014-2017. Data were collected by interview, documents review and clinical examination.

Results

Analysis of the results revealed a statistically significant inverse association between performance of daily life activities and length of exposure of patients (p < 0.05). This means that increasing length of exposure restrict the abilities of the investigated persons to perform daily life activities. About 62% of the respondents are often and long standing patients, with more than 4 cases of hospitalization and over 30 days of disability per year. In 68% of the subjects the average duration of one illness exceeds 10 days. Long period of disability affect their income, working position and family relationships. More than a half of people surveyed (56%) cannot afford the recommended rehabilitation which retards the process of recovering. All these facts affect their mood and health self-esteem.

Concussion

Occupational diseases in clothing industry affect quality of life, social and professional performance of the employees.

Key messages

In clothing industry many risk factors affect workers’ health. There is a significant association between length of occupational experience in this branch and social aspects of occupational diseases. Occupational diseases in clothing industry affect capability of work and daily routines of employees. They have been associated with long and expensive period treatment and rehabilitation.

[ASSOSSIATION BETWEEN UNEMPLOYMENT, HEAVY PHYSICAL WORK AND PREMATURITY: RESULTS OF CASE-CONTROL STUDY IN PLEVEN]

INTRODUCTION

Many studies confirmed the lower risk of prematurity among working women and established a link between heavy physical work and the prematurity. The aim of the study is to establish the association between unemployment and the heavy physical work of the mother during pregnancy and the birth of a premature baby.

MATERIAL AND METHODS

In 2011 case-control study of two groups of premature (58) and mature (192) children born in 2007 in the University Hospital "George Stransky"--Pleven was conducted. For the aim of the study documentary method and sociological interview were used. The survey data were processed with statistical software packages. The significance of the results, findings and conclusions determined at p < 0.05. Odds ratio (OR) was used for assessment the strength of the association.

RESULTS

In this study we found: more than four times higher risk of giving birth to a premature baby for unemployed mothers (OR = 4.48; 95% C = 2.56-7.83; P = 0.01); more than two times higherrisk of premature child birth among mothers performing heavy physical work during pregnancy (OR = 2.40; 95% CI = 1.03-6.19; P = 0.050) and the protective effect of having a job during pregnancy in association to the birth of a premature baby (OR = 0.26; 95% CI = 0.15-0.45; P = 0.001).

CONCLUSION

We confirm our hypothesis that the unemployment and the heavy physical work during pregnancy increase the risk for birth of a premature baby

[ASSOSSIATION BETWEEN UNEMPLOYMENT, HEAVY PHYSICAL WORK AND PREMATURITY: RESULTS OF CASE-CONTROL STUDY IN PLEVEN]

INTRODUCTION

Many studies confirmed the lower risk of prematurity among working women and established a link between heavy physical work and the prematurity. The aim of the study is to establish the association between unemployment and the heavy physical work of the mother during pregnancy and the birth of a premature baby.

MATERIAL AND METHODS

In 2011 case-control study of two groups of premature (58) and mature (192) children born in 2007 in the University Hospital "George Stransky"-Pleven was conducted. For the aim of the study documentary method and sociological interview were used. The survey data were processed with statistical software packages. The significance of the results, findings and conclusions determined at p < 0.05. Odds ratio (OR) was used for assessment the strength of the association.

RESULTS

In this study we found: more than four times higher risk of giving birth to a premature baby for unemployed mothers (OR = 4.48; 95% CI = 2.56-7.83; P = 0.01); more than two times higher risk of premature child birth among mothers performing heavy physical work during pregnancy (OR = 2.40; 95% CI = 1.03-6.19; P = 0.050) and the protective effect of having a job during pregnancy in association to the birth of a premature baby (OR = 0.26; 95% CI = 0.15-0.45; P = 0.001).

CONCLUSION

We confirm our hypothesis that the unemployment and the heavy physical work during pregnancy increase the risk for birth of a premature baby.