Polish Pregnancy-related Assessment Monitoring System (Pol-PrAMS): research on lifestyle health behaviours of Polish women during gestation – study design

Introduction

There has been a marked decline in infant mortality during the first year of life observed within the last century in Poland. After regaining independence in 1918, Poland was a country where epidemiological transformations were substantially delayed as was reflected, amongst other things, by the infant mortality rate. In the inter-war period, this rate was estimated at 150/1000 live births, with 40% of children not surviving beyond the age of five years [1, 2]. This contrasts with an infant mortality rate of 15% in Sweden in 1920 [1]. The Second World War and the resulting health collapse were hardly conducive to the Polish health situation. After the war a centralised healthcare system in the Eastern bloc countries was introduced (the so-called Siemaszko model), leading to health improvements in Poland. An important feature of this system was to create an effective programme of mother and child healthcare [1]. A new staff intake of paediatricians, nurses, and midwives were educated. Such changes brought about impressive declines of infant mortality [1, 3]. Whilst in 1950 the infant mortality rate was 109/1000 live births, already in 1960 this had fallen by a half to 55/1000 live births [1]. Subsequent years showed further improvements for infant mortality, but it was not until the 21st century observed, rates are comparable to other European countries. In 2014, Poland achieved an infant mortality rate of 4.22/1000 live births, while those in Germany, Spain, and Sweden were, respectively, 3.19, 2.89, and 2.18/1000 live births (Fig. 1) [1, 4, 5]. In fact, since the year 2000 the rate has fallen by over 50% [6].
More than half of all infant deaths usually happen in the first week of life, and another 30% after the age of four weeks [7]. In Poland, the main causes of infant deaths are diseases during the perinatal period. Over the last decade the mortality rate due to such reasons has constantly risen. In 2001 this was responsible for 49.9% of child deaths in the first year of life, whilst in 2010 it reached 51.5%. This rise was mainly due to a significant increase in infant mortality due to premature birth and low birth weight. In 2001 the percentage of infant deaths because of prematurity and low birth weight reached 19.8% and in 2010 it was 33.1%. Infant deaths due to congenital anomalies have persisted at a comparable level of 34% [7].
The neonatal mortality rate, especially the early one (of up to seven days old),...


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