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‘Croatian Health Service Statistical Annual’
is based on the data collected from the whole nation’s
health system. The data gives an insight into the Health
Service’s organization and human resource structure,
operation and utilization of health facilities, as well as
some health status indicators of the population. To present
the health status of Croatia’s population, we have selected
some indicators using both the WHO methodology, and
comparable data on other Central European countries.Since
health care of the population and its health do not solely
depend on the activity of the Health Service, they can not
be considered in isolation from demographic, economic and
ecological indicators.
Therefore, the present report also gives some
demographic and social characteristics of the country.
Demographic
and social characteristics
Data of the population census taken on 31
March 2001 show Croatia to have 4,437,460 people recorded.
Central Institute of Statistics has defined total population
in accordance with the UN Economic Commission on Europe’s
and EUROSTAT’s international recommendations on censuses and
migrations. The criterion involves a year’s or longer
presence or absence of an individual on the national
territory. Because of these changes in the definition,
census data is not comparable with the previous censuses.
Years of decline in the number of births, increase in the
mortality of younger age groups during the war and negative
migration trends of the last decade have influenced the
overall population trends.
According to WHO (Health for All, 2002), life
expectancy at birth in Croatia in 2001 was 74,65 years for
both sexes,for females 78,17 years,and for males 71.03
years.
Long-standing decreases in natality,
fertility, and natural increment have led to the natural
trend in Croatia entering, with 1991, the depopulation
stage. In 2002, the natality, mortality, and general
fertility rates were 9./1,000(9,2 in 2001), 11.4/1,000 (11,2
in 2001), and 37.1(38 in 2001),respectively.In 2002
Croatia’s natural population increase was negative-2,4.
There were 282 infant deaths (7/1,000) in
Croatia in 2002 (315 or 7.7/1,000 in 2001). Equally as in
developed countries, the most common causes of infant deaths
were either linked with premature birth and consequent
immaturity or there was involvement of severe malformation
and malformation syndromes.
In total population, the leading causes of
death in 2002 belonged to circulatory diseases. Of these
26,698 people died (601,7/100,000). They were followed by
malignant neoplasms with 12,157 deaths (274/100,000),
injuries and poisonings (61./100,000), diseases of the
digestive system (54/100,000), respiratory system diseases
(47.4/100,000) and other less common causes.
In 2002, this country recorded 2,707 violent
deaths. Of these, 1,757 were due to accidents: 639 to
traffic accidents (14.4/100,000), 875 to suicides
(19.7/100,000), 67 (1.5/100,000) to murders.Violent deaths
were rare by female( 36%, rate 39.3/100,000) then by male
(7%,rate 84,3/100,000).
The principles and organization of health
care
The basic aim of health policy is not only
extension of life expectancy, but also the endeavor to
improve the quality of life. In addition to Health Service
promotion and development, this includes the promotion of
healthier life styles, reduction or elimination of
preventable health risks, and improvement of the quality of
life of chronic patients and the disabled.
Facilities discharging health activity are in
either state or county ownership; there are also privately
owned health institutions. Teaching hospitals, clinical
hospital centers and state institutes of health are
state-owned. Health centers, polyclinics, general hospitals,
special hospitals, pharmacies, institutions for emergency
medical aid, home care institutions, and county institutes
of public health are county-owned.
In 2002 Croatia had 111 health centers (120
in 2001).Of the 75 hospital institutions and health resorts,
three special hospitals and four health resorts were
privately owned. At the end of 2002, 6,461 private practice
units (doctors’ offices, laboratories, and pharmacies) were
registered. Of these, 2,791 were private physician
practices. Of this figure, 2,060 were practice
rentals.Private dentists’ offices were 2,371, of these 1,139
were private practices
At the end of 2002 Croatia’s health had a
permanent work force of 66,467. Of these 47,814 were health
workers and associates, 4,951 clerical, and 13,702 technical
staff (28% clerical and technical staff)
As there was an extra 6,111 part‑time health
workers and associates.At the end of 2002 worked 6,111
health worker and associate or total was 53,925.
In 2002, by place of primary job 7,537 of the
10,589 permanent‑job physicians worked in state health
institutions, 253 in private health institutions, and 2,799
in private doctors’ offices. Of these last 2,060 worked in
rented doctors’ offices.
Except permanent-job physicians at the end
2002, workid 799 part-time physicians, or total was 11,388.
Lady doctors accounted for 56.4% of the
permanently employed physicians and for 68.3% (7,229) of the
specialists.
Of all physicians in health institutions,
54% worked in hospital. In healt centar worked 11,5%, in
rented doctor`s offices 19,4%, in private doctor`s offices
6,9%, in state health institutions 4,4%.Other physicians
worked in private polyclinic, in emergensy care station,
other institutions and nursing care institutions.
Of the 2,956 stomatologists, 510 worked in
state health institutions, 23 in private health
institutions, and 2,423 in private dentists’ offices. Of
these last, 1,112 worked in rented dentists’ offices.
Except permanent-job stomatologists,at the
end 2002, worked 161 part-time worked stomatologists, or
total was 3,117.
Of the permanently employed stomatologists
62.8% were female and 19% (563) were specialists.
Properly speaking, our
Primary Health Service
consists of Pediatric Service and General/Family Medicine
Service. In 2002, it employed 2,649 physicians. Of these,
1,303 were different specialists (739 in general/family
medicine, 272 in pediatrics, 155 in occupational health, 115
in school health, and 22 in other disciplines). As to other
health workers, 103 had post-secondary and 2,574 secondary
school backgrounds. Compared with 1995, no significant
change either in the number of teams or in the number of
medical specialists was recorded in 2002. While the number
of general medical specialists was 2,5% higher, that of
health workers with post-secondary backgrounds was 70%
lower. The number of secondary school level personnel was 6%
lower.
In 2002, Primary Health Service teams had in
care 4,134,971 insurees. Of these, 3,336,047 used health
care or health services in any form as provided by either
pediatric or family/general medicine teams. Compared with
1995 the number of insured was smaller by 11 and
beneficiaries by 9%.
In 2002, there were 25,657,553 attendances to
doctors’ offices (18% more than in 1995). Office attendances
to other health workers in 2002 numbered 6,540,662 or 3%
more than in 1995. The number of examinations at home by
Primary Health Service units in 2002 was 353,017 or 72%
higher than in 1995. Recorded in 2002 were 6,049,885
referrals by Primary Health Service teams. In comparison
with 1995, the number of referrals to examinations by
specialists has risen by 20%.
In 2002, diseases and conditions diagnosed by
General/Family Medicine units and by Pediatric Service units
numbered 8,192,575 or 2% less than in 1995.
Diseases of the respiratory system with acute
respiratory infections leading ranked first with 1,781,226.
Cardiovascular diseases still ranked second( 820,609 ).
Hypertension accounted for more than 50% (444,738) of the
figure. Diseases of musculoskeletal system and connective
tissue ranked third (708,517), 12% less than in 1995.
Diseases of urinary and sex organs. ranked
fourth(475,250),8% higher than in 1995.
In the Infant and Young Child Care
Service recorded 405,666 attendances for preventative
care. (17% less than in 2001) Of these recorded 189,571
preventive attendances by infants ( 201,555 or 6% higher
than in 2001,) and 216,095 preventive attendances by young
children (216,859 or 0,5% higher than in 2001) Of all
preventive attendances by infants 180,430 related to general
medical examinations and pre-vaccination and 9,141 to
counseling.
According to the morbidity report on ages up
to 7 years, most frequent diseases were respiratory system
diseases (52.4%), infectious and parasitic diseases (8.7%),
diseases of the ear (5.9%), diseases of the skin and
subcutaneos tissue(4,8%)and diseases of the eye and
adnexa(3,2%) The order of leading causes of morbidity was
the same at school age.
The Obstetric Service and the offices of the
General/Family Medical Service, which had charge of young
children, did 298,112 general medical examinations( 306,960
in 2001,). General medical examinations of infants found
undernutrition in 1.7% of the examined and overnutrition in
2.1%. For 58.2% of the infants aged 0-2 months, the records
show that their feeding was with mother’s milk exclusively,
17,7% were breast-fed, receiving formulas (artificial diet)
in addition. Whereas 13.2% of infants were on formulas, the
feeding method in 10,9% was unknown. In 71% of infants,
general medical examinations noted the use of scurvy
prophylaxis. In 13%, there was use of anemia prophylaxis and
signs of scurvy were evident in 0.5 percentage of infants.
Most frequent among the developmental disorders diagnosed at
general medical examinations of infants were registered
retarded psychomotor development in 2.3% of the examined,
with the proportion of other disorders recorded as being
below 1%. General medical examinations showed undernutrition
in 2.2% (1,7% in 2001) of the examined and overnutrition in
2.3% of the examined (2,2 in 2001). Caries (11.5%), dyslalia
(2,9%), musculoskeletal deformities of limbs (2.3%),
strabism (1.6%) and disorders of refraction (1,4%) were the
pathological conditions established with general medical
examinations.
School doctors have been running
preventive and specific medical care of school children and
youths as part of public health institutes’ activity
since 1998. In the school year 2002/03, this service had a
work force of 155 physicians, 103 of who were school health
specialists, 21 medical specialty trainees and 31 general
practitioners. Of pre‑enrollment medical examinations, in
school year 2002/03 there were 51,666 for the first, 42,566
in the fifth (84,2% coverage ) and 45,492 in the eighth
primary grade (87,8% coverage). General medical examination
in the first grade of secondary school covered 33,964
children or 65,6% of the generation.
A screening for disorders of vision covered
all children in the third grade of primary school. In the
sixth grade, a screening for developmental and structural
deformities of the locomotor system covered 72,2% of the
children.
The number of attendances in primary school
counseling centers increased from 59,647 in 1998, to 119,629
in the school year 2002/03. In secondary school and over the
same period, these attendances increased in number from
18,196 to 38,286.
In the same year, 326,332 primary school and
87,918 secondary school pupils received health education in
some form. In addition, 76,009 parents and teachers in
primary schools and 9,143 in secondary schools took part in
health-related lectures, forums, or workshops.
Occupational Health Service
had 146 full-time and 17 part-time teams.
These employed 159 occupational health specialists, 11 other
specialists, and 6 doctor of general medicine. Occupational
Health Service exists in all counties.
According to the Croatian Institute for
Health Insurance, in 2002 Croatia had 1,328,356 active
insurees, 1.7% more than in 2001. A monitoring of preventive
examinations performed in Occupational Health Service showed
a rate of 118.3/1,000 in 2002 (0.2 more than in 2001).
According to the monthly reports of regional
and municipal branch offices of the Croatian Institute for
Health Insurance, in 2002 Croatia recorded 21,184 industrial
injuries. Forty-four of these had fatal outcome. Of the
industrial injury total, 83.4% happened at the workplace and
16,6% in commuting.
Croatia’s injured in 2002 totaled 1,594.8
employed per 100,000 actively insured. The highest specific
rates per 100,000 in the branch of activity (workplace
injuries only) reported agriculture, hunting and forestry
(3,066.0), construction (2,834.1), manufacturing industry
(2,516.1), electricity, gas and water supply utilities
(1,944.1), transport, storage and communications (1,842.2),
mining and extraction (1,662.8) etc.
In 2002, notifications came in of 106
occupational diseases (91 in 2001). The largest number of
occupational diseases recorded was in the manufacturing
industry (55 or 51,9%) agriculture, hunting, and forestry
(21 or 19,8%), and in health service and social welfare (14
or 13,2%). Most commonly diagnosed in 2002 were the
following, occupational diseases: pneumoconiosis (30 cases
or 28.3%), diseases due to the deleterious effects of
vibration (18 cases or 17%), hearing damage caused by the
deleterious effect of noise (13 cases or 12.3%), infectious
diseases (13 cases or 12.3%), diseases of the skin (9 cases
or 8.5%).
In 2002, in Women’s Primary Care 208
teams worked full time under contract to Croatian Institute
for Health Insurance, 47 teams working part time. An extra
60 full-time and 6 part-time teams worked in private
practices with no contract with the Croatian Institute for
Health Insurance.
According to the Women’s Primary Care
records, between 1985 and 1991 a gynecologist of her choice
examined each pregnant woman six times. From 1992 to 1994,
the average was 5.9-5.7 exams to rise above six again from
1995 to 1999. In 2000 and 2001 every pregnant woman in
Croatia had an average of 7.2 exams irrespective of whether
contractual or purely private offices in women’s primary
care made the exams.In 2002 the average was 3.6 exams.
Since its drastic falls in 1991 and 1992, the
total number of preventive examinations in Women’s Primary
Care has been rising continuously, overtaking already in
1995 the prewar level from 1990. While in 1990 the
preventive examinations rate was 163.6/1,000 women of
fertile age, in 2002 it was 285.5/1,000.
Monitoring of the total number of Papa tests
has been in progress since 1995. In 2000 the rate was
353,2/1000 fertile age women, in 2001 365,6/1,000, and the
highest rate was in 2002 (385,1/1,000) fertile age women. In
2002, there were 7,4% of pathological findings.
The most common diseases leading to womens’
attendance at Primary Health Service gynecologist’s offices
were menopausal and perimenopausal disorders (14.5%),
menstrual disorders (10.6%), candidiasis (9.2%), attendance
for supervision of normal pregnancy (7.6%), attendance for
prevention of unwanted pregnancy (7.3%), trichomoniasis
(4.1%), inflamatory disease of cervix uteri (3.5%).
In 2002, Croatia’s Emergency Medical
Service had 389 permanent physicians. Thirty-eight of
these were medical specialists of every specialty. The EMS
(units for emergency medical aid) offices recorded 1,002.312
interventions in 2002. It had 150,568 patient home
interventions and 63,491 field interventions. It carried out
394,822 sanitary transportation. Compared with 1995 the
total of office, patient home, and field interventions was
33%, 22%, and 38% higher, respectively. There was 60% more
sanitary transportation than in 1995.
In 2002, the Stomatological Care
employed 1,674 contractual full-time teams, and 30 part-time
teams. In their care there were 3,560,617 insured, 1,879,960
of who actually used medical care. In addition, teams
without a contract to Croatian Institute for Health
Insurance also provided the above services, 477 doing so
full time and 50 part time. This service employed a total of
4,535 health workers. Most were stomatologists (1,967),
dental assistants (1,820), specialized stomatologists (394),
dental technicians (306) and dentists (48).
During 2002, 4,387.638 patient attendances at
contractual and 433,809 at noncontractual offices were
recorded. Further, 601,404 systematic examinations were
done, filled teeth and extracted teeth accounted for
1,815.036, respectively 643,934. Dental prostheses made in
2002 numbered 189,470. Apart from this, there were 508,295
soft tissue treatments.
During 2002, there were 7,003.784
special-consulting examinations in Croatia, considerably
more than (151%) in 1995, but still much less than in 1990
(9,014,443). Compared with 1995 when there were 3.3
examinations per each special examination, in 2002 the ratio
was one special examination per 2.7 examinations in the
General/Family Medical Service. In relation to the number of
examinations in the Primary Health Service, the proportion
of special-consulting examinations in the Primary Health
Service increased from 30% in 1995 to 37% in 2002.
Infectious diseases and immunization
Being a direct or potential threat to the
country, infectious diseases are one of health priorities.
The state of infectious diseases in Croatia in 2002 was
relatively favorable. This is not due to lucky chance, but
is an outcome of organized activities of the health services
and others concerned who contribute each in his domain to
the health of the population. Vaccine-preventable diseases
have either totally disappeared (diphtheria, poliomyelitis)
or their incidence has been drastically reduced (measles,
mumps, rubella, pertussis, tetanus, tuberculosis).
In recent years the incidence of diseases of
low hygienic and living standards, i.e. typhoid fever,
bacillary dysentery, and hepatitis A, has clearly regressed
to the levels typical of developed countries. Incidents
related to public water supply are rare and brief, and cases
of infectious diseases caused by industrially manufactured
food products are exceptionally rare.
Infectious diseases incidence figures in last
decade (see tables in the chapter. "Infectious diseases and
immunization") show, among other, a very low incidence of
typhoid fever with one case in 2002, stabilized, relatively
high level of salmonellosis morbidity (6.500 cases
annually), rise and declining again of incidence of
hepatitis A, however on levels far below those of the 60s
when up to 14,000 cases would be registered annually. Owing
to systematic immunization, diphtheria (0), tetanus (8),
pertussis (syndrome: 176), measles (6), rubella (10),
epidemic parotitis (101) showed a remarkably favorable
state.
A stress should be given to the complete
disappearance of poliomyelitis. This was officially
announced by the World health organization in 2001, with
special Certificate, declaring the whole European region,
which includes also Croatia, polio - free. This was a crown
and symbolic award for the long - year steady work on polio
control by systematic mass immunization starting here in
1961, resulting now in one more magnificent success of
preventive medicine.
Having stagnated over the past few years (due
to war and its aftermath), since 1999 the incidence of
tuberculosis resumed a favorable trend of continuing decline
(1,770 in 1999, 1,641 in 2000, 1505 in 2001, 1470 in 2002)
Venereal diseases syphilis (11) gonnorrhoea
(26) and AIDS (19) exhibit a favorable, low, sporadic
incidence. Owing to systematic application of all preventive
measures, ranging from surveillance of human blood
preparations to health education, AIDS here staying at a low
level, one of the lowest in Europe, and with no signs of
rising incidence. Total HIV prevalence of 0.04% positives
with AIDS patients included. Analysis of the diseased and
infected by epidemiological categories, shows there to be
the largest proportion of homo/bisexual (males) with a
relatively small proportion of i.v. drug users. Neither in
2002 were there new cases among the hemophiliacs (a total of
eight since 1986). This means that blood preparations are
safe and controlled. The number and percentage of AIDS cases
in the category “unknown” has stayed low and unchanged (2%),
meaning that infection transmission is still within the
bounds of known higher-risk groups, without “penetration”
into the general population.
Under the National Mandatory Immunization
Schedule, about 500,000 people are immunized annually who
receive more than 900,000 individual doses of mostly
polyvalent vaccines (a single application containing two or
three different vaccines). While the legal coverage under
the Schedule for most vaccinations is 90%, against measles
it is 95%. The desired percentage has been achieved in the
primary vaccination (whereby immunity base is formed at the
infant and young age) for all vaccines, except against
measles where it was 94.8%. Revaccinations aimed at
maintaining the immunity and redressing possible omissions
or failures of the previous immunizations take place
periodically through life, under the Schedule. Revaccination
coverage percentages are also satisfactory.
Every year before the onset of the influenza
season, immunization against influenza takes place, designed
primarily for the elderly and individuals with compromised
health. A decision of the Croatian Institute for Health
Insurance made the vaccinating of these categories, and also
of health workers free of charge. In 2002, around 490,000
people in Croatia received the vaccine. The interest for
vaccination is gradually increasing in recent years, also
among active working population for the intended reduction
of sick leaves.
In 2002, the bacteriological diagnosis of
tuberculosis involved testing 80,043 patient
samples for tuberculosis. The declining trend of the number
of samples continued. With 5,280 (96.9%) strains, the
species M. tuberculosis was still dominant. This matches our
epidemiological situation for tuberculosis according to the
number of recorded mycobacterioses. Last year, there were no
isolates of M. bovis either, only 2 M. bovis-BCG strain
being isolated. The drug resistance test was done in 4,982
strains of M. tuberculosis. The strains resistant to one or
more antituberculotics numbered 237 (4.8%) strains. As
evident from our Laboratory Register of Resistant
Tuberculosis, resistant tuberculosis was present in 74
patients. Thirty-one of these had multidrug-resistant
tuberculosis. On comparison with the number of isolates in
countries with a low incidence of tuberculosis,
nontuberculous or “atypical mycobacteria” with 168 (3.1%)
isolates continued to be sporadic and rare findings.
Inpatients care
In 2002, Croatian hospitals treated 696,519
people (700,524 in 2001). The care included hospital stays
for childbirth, abortion, and hospital rehabilitation.
From 7.4 in 1990 the number of beds
(expressed per 1,000 population) in all hospital-type
institutions dropped to 6.0 in 2002. By bed structure per
1,000 population, there were 3.68 acute beds (1.72 in
general hospitals and 1.96 in teaching hospitals). For
chronic patients 2.00 beds per 1,000 population were
available.
In Croatian hospitals, in 2002 there were
7,780,300 days of hospital treatment. In other words, the
average length of treatment per stay was 8.95 days (against
the 1990’s average length of treatment of 15.37 days). The
all-hospital bed-occupancy rate approximated its prewar
values (320 in 1990 and 309 per bed in 2002). In 2002, total
annual‑bed‑utilization rate was 84.66% (87.67% in 1990).
Whereas clinical and teaching hospitals had the highest
utilization rate (91.78%), special hospitals had the lowest
(75.62%).
In 2002, general hospitals, hospital-type
institutions and outpatient maternity clinics had a turnover
interval (average number of days of bed nonuse between two
patients) of 1.19. In teaching hospital centers, teaching
hospitals and clinics it was 0.84, being 9.63 days in
special hospitals.
The leading disease groups in inpatient care
were diseases of the circulatory system, neoplasms, diseases
of the intestinal system, respiratory system diseases, and
diseases of the system of urinary and sex organs.
Overall, female admissions to inpatient care
are more numerous than male (1.06:1). In consequence, some
typically female diseases have a greater share of total
hospital morbidity. In the female admissions of 2002,
neoplasms were most common with malignant neoplasm of the
breast as the leading one, diseases of the circulatory
system (with angina pectoris leading), diseases of the
system of urinary and sex organs, excessive, frequent and
irregular menstruation were the most common causes of female
hospitalization. So were diseases of the digestive system,
with cholelithiasis as the leading one. Diseases of the
circulatory system (with angina pectoris leading), neoplasms,
neoplasm of the bronchus and lungs, and diseases of the
digestive system (with inguinal hernia leading) were the
most common causes of male hospitalization in Croatia. An
equally common cause for treating males in Croatian
hospitals in 2002 was diseases of the respiratory system
(with chronic diseases of tonsils and adenoids).
At patient ages above 65 years, our hospitals
take in care more females than males (1.2:1).
Births and abortions
In 2002, Croatian maternity hospitals
registered 39,408 childbirths with 39,927 liveborn. This is
a 10% decline in comparison with 2000. Reflecting maternity
wards, these figures differ from those of the Central
Institute of Statistics. The latter record children born by
mothers residing in Croatia and not having been absent from
the country for more than a year. However, they also record
children born by mothers with no permanent residence in
Croatia, but present in Croatia for a year or more.
According to this source, in 2002 there were 40,094
livebirths in Croatia.
By age of mother, child deliveries were most
common at 25-29 years. Deliveries at the age of 20-24 years
were next, with those at 30-34 years following.
Most childbirth recorded were first births
(46,5%), second in order accounting for 34,3% and the third
or higher in order for 19,2%. In comparison with 2001,
there is almost no change.
Of 39,408 births, births of a single child
accounted for 38,904 (98.72%). In 489 births twins were
produced (1.24%). There were 15 (0,04%) births of triplets.
Maternal mortality in Croatia was purely
sporadic. Four women died (9.97/100,000 liveborn) in 2002
due to complications of pregnancy, childbirth or puerperium.
Each pregnancy that does not end in
childbirth is considered an abortion and, as required
by law, a notification on a duly completed form is to be
sent to the Croatian National Institute of Public Health.
Counted as pregnancies terminated by abortion are
extrauterine pregnancies, hydatidic mole, other abnormal
products of conception, spontaneous and medically induced
abortions.
During 2002, notifications came in of 12,002
abortions, continued drop compared to the previous years
(6.8% less than in 2001). With 6,191 (51.6%) medically
induced abortions represent the largest part of the
structure.
The proportion of spontaneous abortions was
almost identical as in 2001: 2,313 (19.3%).
Most of the women having had an abortion were
35-39 years old. The proportion of girls up to 19 years old
and having an abortion on demand is slightly increased. In
2002, 482 adolescents (7,8%) had medically induced
abortions. Among the women who demanded abortion most had
already had two children (2,274 or 36.7%). This confirms the
fact of the continued use of abortion as a contraceptive
agent.
Chronic diseases registers
Croatian Cancer Register
was established in 1959 with the aim of collecting, managing
and analyzing cancer incidence data. Since 1994 Croatia’s
Cancer Register has been a full member of the International
Association of Registries on Cancer (IARC) with head office
in Lyon, France, and is also part of the European Network of
Cancer Registries (ENCR).
Cancer is the second major cause of death in
Croatia and responsible for the death of our every fifth
inhabitant. In 1999, it led to the death of 11,540 people
(6,899 male and 4,641 female). In 2000, the cancer death
toll rose to 11,683, reaching 11,725 in 2001, and 12,077 in
2002.
In 2001, 19,630 new cancer cases (10,597
males and 9,033 females) were diagnosed (invasive cancers
without skin cancer). Between 1982 and 2001 the rates of
incidence in Croatia increased by 63.7% and of mortality by
34.3%. Both the incidence and mortality were higher among
males than females.
The most common cancer sites in males, making
up 70% of the incidence, were the bronchus and lungs (23%),
prostate (11%), colon (6%), rectum (7%), stomach (7%),
urinary bladder (6%), larynx (4%), kidney (3%) and pancreas
(3%). Only for bronchus and lungs mortality exhibited the
same order as incidence.
In females, the most common cancer sites were
the breast (24%), colon (7%), bronchus and lungs (6%),
rectum (6%), ovary (6%), stomach (6%), uterine body (5%),
uterine cervix (4%) and pancreas (3%). These nine sites
accounted for 66% of total cancer incidence in females. On
the ladder of mortality the order was the same only where
the breast was concerned. Presented jointly, cancers of the
large intestine (colonic and rectal) in both sexes ranked
second among the most common cancer sites with an incidence
of 13% in males and 12% in females.
Back in 1961, Croatian Psychoses Register
was set up in this Institute. On the scale of causes of
hospitalization in Croatia in 2002, with a proportion of
6.97%. the mental disease and disorder group ranked seventh.
However, by number of hospital treatment days used, it was
the first with a 25.5% share of the hospital treatment day
total. In practical terms, every fourth day of hospital
treatment in Croatia was used to deal with the mental
disease and disorder group.
With 41%, schizophrenia ranks first in the
mental disease and disorder group in the hospital treatment
day total.
According to the Register, until 1990
increases were noted in both the numbers of shizophrenic
patients hospitalized and of hospitalizations. In parallel,
a decline was observed in the number of patients threated
throughout the year and in the ratio of patients receiving
hospital cares throughout the year. From 1990 to 1995 nearly
every indicator has exhibited a declining trend, certainly a
reflection of the war in Croatia when a portion of hospital
facilities was demaged.In addition, however, it reflects the
abstence of reporting from temporarily foreign-occupied
areas. After the introduction in 1995 of the ICD-10, which
has regrouped certain diagnostic groups, the trend had been
declining till 1998 for most indicators, continued. The
psychiatric care of schizophrenics by using the following:
higher-intensity therapeutic programs, rehabilitative
programs, outpatient treatment and monitoring has produced
more frequent but shorter hospitalizations, as well as
reducing the total length of patient stay. This also
constitutes an improvement in patient´s quality of life.
The Croatian National Institute of Public
Health has collected all information in the health system on
individuals treated for psychoactive drug use since 1978.
The Register of Treated Psychoactive Drug Addicts
manages this.
In 2002, Croatian health institutions
registered 5,811 persons treated for psychoactive drug
dependency. Of these, there were 1,486 (25.6%) aged up to 20
years. Most of the treated (1,581 or 27.2%) belonged to the
age group 21-25 years. With 69.9%, morphine type addiction
was most prevalent among the addicts presenting for
treatment. So high a proportion of drug addicts treated for
opiates has partly been the reason to use methadone
maintenance as a method of treatment. During 2002, marijuana
(cannabis) was the leading drug in 23.7% of the cases. The
majority of persons court-committed for treatment on the
grounds of using cannabinoids had been thus referred by
juvenile courts. To avoid criminal action, youths preferably
volunteer for the drug dehabituation measure.
Croatia’s drug addict treatment rate per
100,000 population was 130.4. Most outstanding problems of
psychoactive drug abuse were still reported by counties:
Istria, City of Zagreb, Primorje-Goran, Zadar, Šibenik-Knin,
Varaždin and Zagreb county.
Health Ecology Service
A survey of school children living in
Primorje-Goran county was taken in 2002 as part of a
permanent monitoring of Croatian
population’s nutritional status and quality of diet.
The values and distribution of the
anthropometric height for age index suggested that the
examined school population in Croatia had on average
slightly higher height for age index values. The results
indicate that 23.5% of the school children examined were
higher and 7.5% significantly higher for their age.
According to the measurements of the anthropometric weight
for height index, 69.5% of children in Croatia are normally
nourished. While 13.4% of them belong to the “thin” group,
0.9% are undernourished. Whereas 11% of the children had
increased body weight, 5.2% could be classed into the obese
group.
An analysis of the structure of whole-day
meals of the 6th and 7th grade primary
school pupils in both counties indicated that they had
satisfactory energy intake. It was established that protein,
fat and carbohydrate intake was satisfactory as well as
intake of energy from them. Intake for vitamin C was
satisfactory, but intake for vitamin A and calcium in both
counties was beyond recommended.
The health safety monitoring system for
foods and objects of common use is based on the
obligation of the laboratories certified to examine their
health safety to submit quarterly reports to the Croatian
National Institute of Public Health. These have to specify
the number and type of samples covered and final analytical
results.
Among food samples examined microbiologically
individually or on the aggregate in public health
institutes, of the 31,808 samples of domestic origin 2,651
(8.33%), (8.54% in 2001) were microbiologically unsafe. As
to samples originating from the imports, 339 (2.65%), (8.08%
in 2001) were unsafe. All certified laboratories that have
submitted their reports have examined 44,598 samples of
domestic origin. Of these, 2,990 (6.70%) were unsafe.
Examined samples of imported food numbered 12,790, with 339
(2.65%) found to be unsafe. Of the microbiologically
examined samples’ 47,454 grand total in 2002, there were
3,156 (6.65%) unsafe samples.
The most common causes of microbiological
unfitness were total counts of aerobic mesophilic bacteria,
yeast, molds or enterobacteria more than their respective
allowances, as also the finding of coagulase‑positive
staphylococci or salmonella.
All certified laboratories that have
submitted their reports have chemically examined 13,802
samples of food of domestic origin. Of these, 779 (5.64%)
were unwholesome. At the same time 17,745 samples from the
imports were examined with 998 (5.62%) being rejected. This
adds up to 31,547 examined samples, 1,777 (5.63%)
unwholesome.
As to chemical parameters, the most common
causes of unwholesomeness were incorrect composition,
inappropriate sensory properties, disallowed use of
additives in certain foodstuffs and, very rarely, the levels
of additives, pesticides, heavy metals etc. more than their
allowances.
In 2002, all institutes and other certified
institutions examined microbiologically 2,079 objects of
common use (1,594 domestic and 485 imported). Of these, 163
(7,84%) were unfit. Of that figure, 9,91% were domestic and
1.03% imported. Five thousand six hundred and sixty-six
(2,082 domestic and 3,584 imported) samples of objects of
common use were assayed chemically, with 256 or 4.52% (3.36%
domestic and 5.19% imported) were pronounced unfit.
Data on the period 1990-02 reveal
considerable annual variation in the number of food and
object of common use samples assayed. A minor decrease in
the number of food samples assayed microbiologically and
chemically was registered in 2002. As regards objects of
common use, a decline in the number of chemically assayed
samples, and an decrease of microbiologically assayed
samples took place in 2002.
In 2002, public water supply systems
accounted for about 76% of the national supply with
drinking water. Counties. Bjelovar-Bilogora reported the
lowest (34%), at the same time Istria and Primorje-Goran
counties reported the highest percentage (about 97%) of
water supply.
In addition, in 2002 drinking water was
tested for health safety. Physical properties of water,
presence of nitrogen salts (e.g. in Varaždin), iron or
manganese, and increased levels of total organic matter in
terms of KMnO4 consumption were found to be the
main causes of unfitness in drinking water.
As regards microbiology, the waters were
mainly unsafe because of the total bacterial count in 1-mL
water. Fecal matter or a pathogenic bacterium was a very
rare cause of unfitness of drinking waters.
Considering the technological‑technical
status of our public water supply systems, health safety in
2002 nationally of the drinking water from public water
supply systems can make us pleased overall. There were fewer
than 10% of unsafe samples.
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