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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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