Yaroshenko Z. Medical and Social Reasoning of Delivering Primary Medical Care to the First Generation Offspring Individuals Affected by the Chernobyl Accident

The dissertation focusses on the reasoning for delivering medical care through the primary-tier care to the first-generation offspring (FGO) affected by the Chernobyl accident. The developed health monitoring system is based on the conducted epidemiological analysis of the initially detected non-tumour incidence rate by fourteen ICD-10 classes, from birth to the 18th birthday (1987–2016). The study of the health status of the FGO as a general cohort, and taking into account the birth time of the offspring after the accident, was carried out, subject to individuals’ sex, based on the development of non-tumour morbidity, as follows: health groups, structure and dynamics of disease levels over three-year observation periods (up to 3 years, 4 –6, 7–9, 10–12, 13–15, 16–18 years). The basic data for the formation of the cohort of the studied individuals was the database "State Register of Ukraine of Persons Affected by the Chernobyl Accident" (SRU). The health condition was assessed among 35,893 people under the age of 18 years, of whom 18,138 were male offspring (MO), while 17755 were female offspring (FO) residing in the radioactively contaminated territories (RCT) of Kyiv, Zhytomyr, Rivne and Chernihiv regions of Ukraine. It has been established that the main non-tumour diseases that affect the health condition of the FGO are diseases of the endocrine system, respiratory system, and digestive system. After attaining 18 years of age, 30% of FGO have evidenced to have chronic disease. Disability of children aged from birth to 18 years (0.19% -1.18%) occurred due to diseases associated with the consequences of the Chernobyl accident. The highest incidence was found among the offspring born in the first years after the accident (1987-1990), and the smallest – after 11-13 years (1996-1999), respectively. There have not been established significant differences in the development of non-tumour incidence among FGOs based on gender, while there has been determined an increasing tendency for diseases of the respiratory system, endocrine system, and digestive system during the growth of the offspring. The functional and organizational model of providing the descendants of the first generation of victims of the Chernobyl accident, living in radioactively contaminated areas, aged three to 18 years with medical care in the context of health care reform is presented.