Maternal mortality from cardiac disease in Turkey: a population-based study.

OBJECTIVE: Population-based studies on maternal deaths in Turkey are rare. The aim of the present study was to analyze the cardiac causes of all maternal deaths in Turkey between 2007 and 2009. MATERIALS AND METHODS: In this retrospective study, case files of all pregnancy-associated deaths recorded in Turkey between 2007 and 2009 were reviewed. Records for all pregnancy-associated deaths were reviewed by five authors to identify 129 cases in which a cardiac disease seemed to be the reason. For each of the 129 cases, maternal age, gravidity, parity, antenatal care attendance, district of residence, year of death, mode of delivery, perinatal outcome, and clinical history preceding death were recorded. RESULTS: During the study period, 779 maternal deaths were identified. Our estimate of the maternal mortality ratio (MMR) in 3-year period was 19.7 per 100,000 live births. The report lists 779 deaths, 411 direct and 285 indirect. Indirect obstetric causes of maternal death were primarily cardiac disorders and cerebrovascular diseases. Maternal mortality due to cardiac disease was 15.5% in 2007 and 18.4% in 2008. Valvular heart disease was the leading cause of maternal death from cardiac reasons (25.6%). Maternal mortality due to cardiac disease increased with age. CONCLUSION: The main cause of indirect maternal death has been cardiac disease in 3-year period.

Reproductive health education of conscripts in Turkish Armed Forces: first evaluation of training courses.

BACKGROUND: In the frame of the Reproductive Health Program of Turkish Armed Forces, conscripts have been given 1-day participatory, interactive courses by the field military medical trainers in all military garrisons. METHODS: Pre- and posttest knowledge levels of soldiers were tested by 25 true-false questions. Demographic characteristics and test scores were routinely transferred from the training rooms to the reproductive health database by authorized field trainers using the network of the army. Two hundred forty-eight thousand seven hundred ninety-six soldiers with perfect entrance of data have been selected for descriptive analyses. RESULTS: Of all the soldiers, 39.2% were born in 1984. Primary school graduates have constituted the largest group with 34.4%. Only 7.4% of the soldiers were married. The mean precourse score was 65.7% +/- 15.4%, while the postcourse score was 83.5 +/- 12.73% (SD) (p < 0.001). Those who used to live in the east region of Turkey have obtained significantly lower scores on both pre- and posttests in comparison to scores of those who used to live in other regions (p < 0.001). Groups based on five educational levels have obtained significantly different scores, ascending gradually from uneducated to the higher educational level (p < 0.001). The ratio of increase in knowledge was highest in the groups with the lowest educational level and unmarried (p < 0.001). CONCLUSION: Training courses seem to succeed in increasing the knowledge of conscripts, particularly of those with a low socioeconomic and cultural status. However, it requires time to determine whether this increase in knowledge level with promote behavioral change positively and will improve young males' own and their partners' reproductive health status.