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CONTEXT: The perinatal mortality rate (PMR) in Macedonia is among the highest in Europe. The World Bank supported a consultant (HEJ) to collaborate with a Macedonian team to develop a national perinatal strategy with the goal of reducing the PMR. Education was given priority in the form of a hospital-based initiative to develop the capacity of health professionals to introduce evidence-based perinatal practice into 16 participating hospitals. A 'train the teachers' approach was used, with trainees introduced to modern education and clinical practice in Sydney and subsequently supported to train their colleagues in Skopje. OBJECTIVES: To describe the development, implementation and evaluation of the educational intervention. METHODS: A curriculum, based on specific Macedonian needs, was developed in order to integrate teaching in the knowledge, skills and attitudinal domains of learning, using small group, interactive techniques. Twenty-five Macedonian doctors and nurses participated in 4-month (phase 1a) and 6-month (phase 1b) teaching programmes at a tertiary perinatal unit in Sydney. Australian staff conducted 4 2-week modules for 36 trainees in Macedonia (phase 2). The phase 1 trainees conducted 8 modules for 57 colleagues in Skopje (phase 3). The intervention was evaluated by trainee questionnaires, assessments of competence, changes in hospital practice and pre- (1997-99) and post-intervention (2000-01) comparisons of PMR. RESULTS: A total of 115 doctors and nurses graduated from the programme. Positive responses to the education programme exceeded 80%. Evidence-based practice in 16 participating hospitals (covering 91% of all Macedonian births) was verified in 6 key areas of neonatology. The PMR fell significantly from 27.4 to 21.5 per 1000 births (RR 0.79, 95% CI 0.73, 0.85). The early neonatal death rate in babies weighing over 1000 g fell by 36%. CONCLUSIONS: The intervention has increased the capacity of Macedonians to practise best-evidence perinatal medicine and improve outcomes. Sustainability is predicted by the 'train the teachers' approach, with concurrent strengthening of the infrastructure and organisational framework. [ABSTRACT FROM AUTHOR]

The community-based survey was conducted at national level, based on a national estimate of injury prevalence, administered by the Department for injury and violence control and prevention within the National Institute of Public Health. The objective of this paper was to determine the magnitude, scope and characteristics of injuries in children, adolescents and youths from different ethnic background in the Republic of Macedonia at national and community level. Standard methodology was applied as recommended in the WHO Guideline for community-based survey on injuries and violence. Total of 1577 children and youths aged 0–24 have been examined. The survey has recorded injury rate of 6087,5/100 000. Ethnic Albanians were 1.68 times more likely than ethnic Macedonians to sustain injury significantly more injured in the afternoon hours. The most common place of injury in ethnic Albanians was their home, while ethnic Macedonians were most likely to be injured in traffic accidents. Ethnic Macedonians were most likely to be injured during paid and sporting activities while ethnic Albanians were most likely to be injured during unspecified and leisure activities. The most common mechanism for injury in ethnic Macedonians were falls, while ethnic Albanians were most likely to be intentionally injured by other person. Community injury survey has provided more comprehensive data on injuries and violence than data collected through hospital and out-patient based surveillance system. Information obtained is intended to be used for decision-making and conducting preventive activities towards most at-risk population. [ABSTRACT FROM PUBLISHER]

Youth in Macedonia face a number of health problems among which violence and injuries are dominant. The main objective of the paper is to determine the magnitude and characteristics of violence and injuries among youth at national and community level. Data from global student health survey 2007 (GSHS) conducted in Macedonia (sample of 2114 students at age 13–15) and from community-based injury survey 2008 (sample of 1200 households) have been analysed. GSHS showed that 31.3% of students had been seriously injured during the past 12 months (males more often 37.3% than females 24.9%), while 10.0% of students were bullied during the past 30 days. Community injury survey implied that most of the injuries occurred among adolescents and young people with the highest injury incidence at the age group 15–19 years, followed by aged 20–24. Injuries at school were reported by 29.3% at age 10–14 and 27.3% at age 15–19, road traffic injuries by 39.4% at age 15–19, etc. More intentional injuries were reported by males in the community survey, with the highest percentage among 20–24 olds (42.1%) and 21.9% for aged 15–19. There were no self-inflicted injuries reported in community survey, while 8.6% of students seriously considered attempting suicide in GSHS. The need for more attention, prevention and support at all levels in a social context has been highlighted. Adolescent-health joint actions have to be developed and promoted to provide safe environments. [ABSTRACT FROM PUBLISHER]

The aim of this paper is to assess the outcome and postinjury impact, analysing the data collected with the community-based injury survey conducted in Republic of Macedonia in 2008. WHO standard methodology has been applied on a nationally representative sample of 1200 households. The survey has recorded injury incidence rate of 5710/100 000 and mortality of 40/100 000. 75.2% of the reported injuries had not resulted in any physical disability. Most frequent physical disability is walk with a limp or difficulty using hand or arm; few reported inability to use hand or arm, loss of vision or inability to chew food. 46.4% of the victims were affected performing usual activities. 21.4% were not able to return to normal activities. Some of respondents stated losing their employment due to the injury. 31.2% reported losing days of work/school, on average 45 working days had been lost. There were also loss of work/school working days of a household member (7 days on average). 33.6% of injured reported decline in household income, while only one respondent stated a household member loss of employment due to taking care for the victim. This indicates that injuries and violence are serious public health problem that should be seriously considered for policy interventions. Prevention of injury and violence is set as on one of the priorities in the Health Strategy of the Republic of Macedonia 2008–2020. [ABSTRACT FROM PUBLISHER]