[; PROBLEMS OF MONITORING THE QUALITY OF HOSPITALS IN GEORGIA IN THE CONTEXT OF THE COVID 19 PANDEMIC (REVIEW)].

The purpose of the study - scientific justification, development and implementation of an automated information system for assessing the results of the examination of quality and technology of medical care in hospitals at the regional level.; Based on the developed unified expert map for assessing the quality and technology of medical care, a mathematical model is built and the quantification method is used to form a unified regional system for automated monitoring of the quality of medical care in hospitals. The use of this system of monitoring the quality of medical care allows using the statistical methods to manage the quality of care ; to form homogeneous groups of patients according to specific parameters (nozology, gender, age, severity of condition, etc.) and evaluate the quality of the Health Care provided to them; monitor and conduct a comparative analysis of the quality health care in the work of individual doctors, structural divisions, and for institution as a whole, create a database of results carried out according to a unified.; The quality of the diagnostic and treatment process is characterized by many quantitative indicators. The formation of seven groups of process indicators from the number of questions included in the developed formalized expert map concentrates the attention of experts on the main logical stages of medical activity, optimizes decision-making on eliminating identified defects and objectifies collegial management of the level of professional activity of a medical institution.; Using a mathematical model and a quantification method to create an automated information-analytical system for monitoring the quality of medical care allows us to evaluate the qualitative features in quantitative terms. The unified technology for conducting examinations allows you to coordinate expert work at the intra-departmental and extra-departmental levels, carry out cross-expertise and determine the reliability of the examination.; The introduction of formalization in the work on examination of hospital quality and the use of an automated system for monitoring the quality of medical care, allows using statistical methods to generate specific ones. parameters (nozology, gender, age, severity of condition, etc.) are homogeneous groups of patients and assess the quality of care provided to them to monitor and conduct a comparative analysis of the work of individual doctors, structural divisions, the institution as a whole create a database of the results of the examinations carried out by a single technology in all medical institutions at the regional level.; A dynamic analysis of the quality of medical care in hospitals revealed the presence of a significant reserve for its further improvement. The greatest number of defects in the organization and technology of medical care is noted in two blocks: the quality of medical records and diagnostic measures.

NEURAL TUBE DEFECTS AND MICRONUTRIENTS DEFICIENCY PREVALENCE IN GEORGIA.

Until 2015, systematic statistical data on micronutrient deficiency was not available in Georgia, to provide developing national strategy. In the same year, the National Centre for Disease Control and Public Health of Georgia (NCDC) in collaboration with the USA CDC launched the project "Strengthening surveillance of micronutrient deficiency in Georgia". In 2015 we did choose sentinel surveillance approach. For setting nutrition surveillance system 8 sentinel sites (2 sites in each region/children and pregnant health facilities) in four regions of Georgia (Tbilisi, Kakheti, Achara, and Samegrelo) were selected, using the criteria of geographical, social, ethnical, urban/rural, and religion. Also, existing information about malnutrition and dietary habits from the above mentioned regions. The project protocols was approved by the Institutional review board (IRB) at the NCDC and by the Research Review Committee and Ethical review committee of the US CDC. As a result of surveillance system functioning (2016-2019) we reviled that, about 36% out of 1021 studied children U2 (12-23 months) were anemic, 74% of them were identified as iron deficient. Hemoglobin was tested among 963 pregnant women and about 21% of them were found anemic, 57% were iron deficient, and 28% tested positive for folate deficiency. Neural tube defects (NTDs) prevalence per 1000 live births registered in sentinel sites was high 3.7. Our results show that anemia and iron deficiency are prevalent among both pregnant women and children of the specified age group in Georgia. Additionally, folate deficiency was quite common during the1st trimester of pregnancy. Our findings will inform public health policy decision makers to take relevant decisions on required interventions, such as health education, distribution of relevant supplements, and food fortification.

KNOWLEDGE, ATTITUDES AND PERCEPTION AMONG PATIENTS TOWARDS CROSS-INFECTION CONTROL MEASURES IN DENTAL CLINICS IN GEORGIA BEFORE THE COVID-19 PANDEMIC.

Problem of cross-infection and infection in dental practice has become a matter of public concern. Changing public expectations for cross-infection control could improve safety precautions of dental care. Goal of the study was to determine the level of Knowledge, Attitude and Perception (KAP) of Georgian patients attending dental clinics regarding cross-infections and infection control measures in dentistry. A cross-sectional study was conducted among 570 participants from all 10 regions of Georgia and Tbilisi (the capital city) during 2019. A standardized, confidential, self-administered, close-ended questionnaire was used to assess respondents' knowledge, attitudes, self-reported practices, perception and behaviors toward cross-infection control measures in dental clinics. 71.4% (n 407) of participants were females and 28.6% (n 163) were males. 72.6%, 63.2%, and 62.5% of respondents agreed that they can catch during dental treatment HCV, HBV and AIDS/HIV respectively, while 50.5% and 55.8% mentioned about TB and respiratory infectious (RI) diseases respectively. 80% of participants are concerned about the risk to be infected during the dental treatment. 62.5% of participants responded that they would not receive treatment in dental clinic where HIV and HBV/HCV patients are being treated. Overall, the study suggests that participants' knowledge, attitude and perception regarding cross-infection control in dentistry need some improvements. This study will assist in planning more effective interventions to enhance public awareness about infection control in dentistry in Georgia.

[PROBLEMS OF IMPROVING ANTENATAL MONITORING OF PREGNANT WOMEN IN THE PRIMARY HEALTH CARE SYSTEM IN GEORGIA].

The purpose of the above work is to study the trends of mothers' health condition according to the implementation of antenatal monitoring of primary healthcare programs in 1996 - 2016 in Georgia. The methodology basis of the research is the qualitative investigation, so called Desk Research: collecting statistical data, description, systematization, comparison, analyses and interpretation. Data about mothers' health indicators were derived from National Center for Disease Control and Social Health and National Service of Georgian Statistics. Dynamic of the following indicators were studied: Number of births at home and the share of births at medical institution received by the qualified medical personnel, percentage of pregnant women's timely application, covering 4 antenatal visits, full time pregnancy, timely births, physiologic and pathologic births, Caesarean sections (planned, urgent); Number and indicator of mother's deaths. In order to study the law basis, the Statements of Georgian Government, normative acts of Labour, Health and Social Security of Georgia have been used for studying. In 1996 - 2016, as the result of Healthcare reforms, implemented in Georgia up to now, several parameters of antenatal monitoring were improved. The share of timely application and covering full, 4 antenatal visits increased; Share of births, received by qualified medical personnel increased; Number of mothers' mortality significantly decreased, but it is much higher when compared with the developed countries. Following the improvement in monitoring parameters and financial and geographical availability of antenatal care services, the unfavorable outcome of the pregnancy was revealed: the percentage of pathologic births increased, share of physiologic births decreased. The share of Caesarean sections is increasing and critically high. The share of early deliveries and incomplete period pregnancies increased. The above mentioned conditions indicate that there are systemic problems in the primary healthcare: In the preconception and then antenatal period, the quality of medical service does not meet the international standard. Assessment of pregnancy and fetal risks, prevention and management are inadequate.

Tularemia transmission to humans: a multifaceted surveillance approach.

Tularemia has sustained seroprevalence in Eurasia, with estimates as high as 15% in endemic regions. The purpose of this report is to characterise the current epidemiology of Francisella tularensis subspecies holarctica in Georgia. Three surveillance activities are summarised: (1) acute infections captured in Georgia's notifiable disease surveillance system, (2) infectious disease seroprevalence study of military volunteers, and (3) a study of seroprevalence and risk factors in endemic regions. Descriptive analyses of demographic, exposure and clinical factors were conducted for the surveillance studies; bivariate analyses were computed to identify risk factors of seropositivity using likelihood ratio χ2 tests or Fisher's exact tests. Of the 19 incident cases reported between 2014 and August 2017, 10 were confirmed and nine met the presumptive definition; the estimated annual incidence was 0.12/100 000. The first cases of tularemia in Western Georgia were reported. Seroprevalences of antibodies for F. tularensis were 2.0% for military volunteers and 5.0% for residents in endemic regions. Exposures correlated with seropositivity included work with hay and contact with multiple types of animals. Seroprevalence studies conducted periodically may enhance our understanding of tularemia in countries with dramatically underestimated incidence rates.

HEALTH OF CHILDREN UNDER 12 MONTHS OF AGE IN GEORGIA.

The main goal of this study is to determine trends in the field of health of children under the age of 1 in Georgia. Methodological basis of this research is the qualitative research, method of cabinet research ("Desk Research"), it was used gathering, descriptive, systematization, comparison, analysis, interpretation of statistical dates. The date on child health indicators were taken from the National Center for Disease Control and Public Health, National Statistics Office of Georgia. The following indicators have been studied: the dynamics of birth, Mortality and Morbidity of children under the age of 0-1, neonatal mortality, early neonatal mortality, late neonatal mortality, perinatal mortality, stillbirth. For studying the legal basis, we used Regulations of the Government of Georgia and normative acts of the Ministry of Labor, Health and Social Protection. 0-1 years old Child mortality, perinatal, neonatal, early neonatal mortality rates was decreased. The rate of late neonatal mortality, stillbirth, perinatal mortality and ratio of stillbirth with early neonatal mortality was increased. Incidence of "Infections specific to the perinatal period "and "Bacterial sepsis of newborn" was increased. Among the reasons of 0-1 year's old child mortality was increased "Certain conditions originating in the perinatal period" and "Congenital malformations, deformations and chromosomal abnormalitis". Among the reasons of 0-1 year's child morbidity was increased "Diseases of the respiratory system", "Diseases of the ear and mastoid process", "Certain infectious and parasitic diseases". High rates of late neonatal mortality, perinatal mortality and stillbirth, increasing incidence of "Infections specific to the perinatal period "and "Bacterial sepsis of newborn", indicates that the quality of antenatal care does not fit to the international standard, The risks of fetus and pregnant woman are not identified and prevented timely, Infections are not diagnosed timely. Because of the delayed identification, prevention and treatment is not adequate.

MAIN TRENDS IN ACCESS TO PRIMARY HEALTH CARE FOR ADOLESCENTS IN GEORGIA.

This study identifies barriers to accessing primary health care among youth in Georgia to inform strategies for improving the appropriateness, quality and usage of primary health care services. The quantitative survey was conducted throughout Georgia among 1000 adolescents 11-19 years of age via interview. Multi stage probability sampling was used to administer questionnaires in the schools, universities and in the streets between March-May 2014 and September-October 2014. Young people in Georgia identified a range of problems in accessing primary health services. By far the most important issues were preventive checkups, geographical access, cost of care, and perceptions about the quality of care. The majority of respondents (78.4%) declared that they do not visit family doctor when well, and 81.9% said that no information was provided about reproductive health issues. Most (77.3%) stated that their family doctor had never talked about health promotion or life style risk factors. Access to health care is still problematic in the villages; and in some areas young people must travel more than 30 minutes by public transport. Limited access in rural areas compared to urban areas was statistically significant (p<0.05). As our survey data shows, most adolescents do not visit a health provider annually, obviating opportunities to integrate prevention into clinical encounters. Because repeated contacts with a primary care provider may occur over several years, clinicians should ideally have multiple opportunities to screen and counsel an adolescent patient for risky health behaviors. However, young people report that there is little screening or discussion about healthy lifestyles. The biggest health challenge for young people in Georgia is overcoming barriers (socioeconomic, geographic, trust, and perceived competence) to visit a doctor for regular preventive checkups and to get health behavior advice from health professional. Addressing the health and development needs of adolescents requires a comprehensive and timely response, and interventions can be incorporated in many programs supported young population of Georgia.