Comparison of prevalence, incidence and disability from nervous diseases and epilepsy among children of the Kharkiv region and Ukraine

The article presents the results of comparison of prevalence, incidence and disability from nervous diseases and epilepsy among children of the Kharkiv region of Ukraine and Ukraine as a whole and the results are compared with global figures. In 2015 in Ukraine 407 618 cases of diseases of nervous system were registered in children from 0 to 17 years of age, that is 53.53 per 1000 children, the average value for 5 years is 459 300 children (58.354 ‰), in the Kharkiv region 36 494 children (86.28 ‰) were diagnosed with diseases of nervous system, 5-year average is 39 883 children (94.476 ‰). The prevalence of epilepsy in Ukraine amounts to 25 695 children (3.21 ‰), higher than the prevalence of cerebral palsy or neuroinfections, the average value for 5 years is 24 667 children (3.144 ‰). In the Kharkiv region the number is 1 451 children (3.43 ‰), 5-year average is 1 340 children (3.21 ‰). The incidence of diseases of the nervous system in children in Ukraine amounts to 140 494 children (18.45 ‰), an average over 5 years is 159 215 children (20.29 ‰), in the Kharkiv region the number is 11 871 children (28.07 ‰), an average is 13 795 children (33.068 ‰). The incidence of epilepsy in children in Ukraine is 3 306 children (0.43 ‰), the average value for 5 years is 3 569 children (0.454 ‰). In Kharkiv region the incidence is 252 persons (0.53 ‰), an average is 201.2 children (0.468 ‰). In Ukraine, over the past 5 years there has been a tendency to reduce the prevalence and incidence of diseases of the nervous system in children, while in the Kharkiv region in 2014–15 there is an increase of these indicators, which is connected, apparently, with the migration of the population. In the structure of disability of children under the age of 18 in Ukraine diseases of the nervous system come second, amounting to 29 684 children (37.1 per 10 000 children), the proportion is 17.6 %, in the Kharkiv region this number is 1 770 (41.8 per 10 000 children). Thus, the presented results of the work allowed to analyze a group of children under 18 years of age with diseases of the nervous system, to determine a number of epidemiological indicators for the Kharkiv region, to assess first of all, the place and importance of epilepsy, to compare data obtained with all-Ukrainian data for optimization of medical care for children.


Background
The health for all policy framework for the European Region (WHO "Health 21", "Healthy Start in Life") provides for health improvement for all infants, young children and pre-school age children in the region by 2020. 11 medical interventions that WHO has classified the most cost-effective include prevention of noninfectious diseases and disabilities. In 2015 in Ukraine 13 267 123 cases of all diseases were registered in children from 0 to 17 years of age, that is 1742.3 per 1000 children, 407 618 of them were diseases of nervous system, which is 53.53 per 1000 children. However, nervous system diseases is one of the main causes of disability among children and have a share of 17 %. Epilepsy holds the 1st place among the diseases of the nervous system for disability reasons.
The aim of this work is to compare prevalence, incidence and disability from nervous diseases and epilepsy among children of the Kharkiv region of Ukraine and Ukraine as a whole and to compare the results with global figures for optimization of medical care.

Results
The number of the children's population in Kharkiv region from 2011 to 2015 is specified in table 1.
The prevalence of the disease is the number of all registered cases in a certain population. In Ukraine among the children's population (0-17 years) 407 618 children with diseases of the nervous system are registered that makes 53.53 cases per 1000 children's population. Diseases of the nervous system in children occupy the 8 th rank place and have a specific weight of 3.1 among all diseases among children. As the prevalence of diseases of the nervous system in children Kharkiv region ranks the 1 st among 27 territorial units of Ukraine, generally due to functional disorders, vegetative dysfunctions.
Comparative dynamics of diseases prevalence of a nervous system among the children's population (0-17 years) of Kharkiv region and Ukraine is presented in fig. 1.
The prevalence of epilepsy in Ukraine is 25 695 children (3.21 %), exceeding the prevalence of cerebral palsy, neuroinfections. Kharkiv region takes the 14 th place among all regions of Ukraine on prevalence of epilepsy, not exceeding the general indicator

Kharkiv region Ukraine
Comparative dynamics of epilepsy prevalence among the children's population (0-17) of Kharkiv region and Ukraine is presented in fig. 2.

Kharkiv region Ukraine
The research conducted in various countries give an epilepsy prevalence rates from 1.5 in Japan, 2.3 in Norway per 1000 people to 6.0 in Great Britain, 6.7 in the USA.
Disease incidence is a frequency of appearaning new, firstly revealed cases in the population this year. The incidence of diseases of the nervous system in children aged 0-17 years in Ukraine is 140 494 children (18.45 %). Diseases of the nervous system in children occupy 10 th ranking place and have a specific weight of 1.48 among all diseases of the children's population. By the number of nervous system diseases in children Kharkiv region ranks the 1 st in Ukraine.
Comparative dynamics of nervous system incidence among the children's population (0-17 years) of Kharkiv region and Ukraine is presented in fig. 3. There were 2028 children who were recognized as disabled due to diseases of the nervous system in 2014 (the indicator per 10 000 children makes 2.7), specific weight is 12.5.
In 2013 year there were 2439 children who were recognized as disabled due to diseases of the nervous system (the indicator per 10 000 children makes 3.1), specific weight is 13.3. There were 2432 children who were recognized as disabled due to diseases of the nervous system in 2012 (the indicator per 10 000 children makes 3.1), specific weight is 13.4.
In 2011 year there were 2579 children who were recognized as disabled due to diseases of the nervous system (the indicator per 10 000 children makes 3.2), specific weight is 13.8.
Dynamics of primary disability indicators due to diseases of a nervous system and epilepsy among the children's Diseases of the nervous system Epilepsy

Figure 6. The dynamics of disability indicators due to nervous system diseases and epilepsy among children (aged 0-17 years) of Kharkiv region for 2011 to 2015
The incidence of epilepsy in Ukraine among children aged 0-17 years is 0,43 % (3 306 children). As the incidence of epilepsy among children's population (0-17 years), Kharkiv region occupies the 17 th place among all regions of Ukraine.
Comparative dynamics of epilepsy incidence among the children's population (0-17 years) of Kharkiv region and Ukraine is presented in fig. 4. In the structure of children's disability aged up to 18 years the1st place is taken by congenital anomalies (malformations) of 51 195 children (64.1 per 10 000 children) (specific weight of 30.4 %), the 2 nd place is occupied by diseases of the nervous system of 29 684 children (37.1 per 10 000 children) (specific weight of 17.6 %), the 3 rd place is taken by disorders of mentality and behavior of 23 337 children (29.2 on 10 000 children) (the specific weight of 13.9 %). From year to year the growth rate of children's disability has been noted, in particular disability related to congenital anomalies (malformations).

Figure 4. Comparative dynamics of epilepsy incidence among the children's population (0-17 years) of Kharkiv region and Ukraine
The dynamics of disability indicators due to nervous system diseases and epilepsy among children (aged 0-17 years) of Kharkiv region from 2011 to 2015 is presented in the fig. 6.
According to the rate of children's disability Kharkiv region takes the seventh place in Ukraine and the first place in the number of children whose disability is connected with epilepsy.
For the first time in 2015, 2160 children were recognized as disabled due to diseases of the nervous system. The indicator per 10 000 children makes 2.8, specific weight is 12.5. Diseases of the nervous system Epilepsy

Conclusions
Thus, the presented results of the work allowed to analyze a group of children under 18 years of age with diseases of the nervous system, to determine a number of epidemiological indicators for the Kharkiv region, to assess first of all, the place and importance of epilepsy, to compare data obtained with all-Ukrainian data. This will bring in subsequent comparative characteristics and more in-depth study of the problem in Ukraine. However, statistical data do not allow to diagnose a form of the disease, to evaluate age and gender composition of patients. Neither it is possible to evaluate the appointment of anticonvulsant therapy and its effectiveness in epilepsy and determine the type of the disease and its prognosis. Therefore, completion of a register of patients with epilepsy is one of the most important tasks enabling us to improve patient care, patients' medical and social prognosis and helping to prevent severe consequences of the disease and disability of patients.

Conflict of interests.
Not declared.