Vulnerabilities of Syrian refugee children in Turkey and actions taken for prevention and management in terms of health and wellbeing.

BACKGROUND: The Syrian crisis, which started in March 2011, has resulted in the displacement of 6.3 million refugees predominantly to neighboring countries in addition to the internal displacement of 6.2 million people. Turkey is the country hosting the largest number of refugees in the world with 3.6 million Syrian refugees 46 % of which are under 18 years old. OBJECTIVE: The purpose of this article is to conduct a narrative review and analyze the vulnerabilities of refugee children in Turkey from the lens of the Sustainable Development Goals (SDG), more specifically SDG Goal 3: Good Health and Wellbeing, with a specific focus on Syrian refugee children. Moreover, this article explores the actions taken to prevent and mitigate issues that arise from these vulnerabilities. METHOD: This narrative review article collected data from various primary and secondary sources on the Turkish refugee framework including national and international legislation, governmental and non-governmental data and reports, and scientific papers. RESULTS: Syrian refugee children in Turkey are facing a variety of risks in terms of their health and wellbeing including communicable and non-communicable diseases, post-traumatic stress disorder, depression, family violence, child labor, and child marriage. The measures taken for prevention and response by governmental and non-governmental entities are multilateral and aim to address issues from multiple perspectives including medical, psychosocial, child protection, and legal. CONCLUSIONS: The interventions and restructuring of the health system in Turkey contribute to the SDG number 3 for refugee children. The existence of a legal system which enables refugee access to health, protection, and other social services is key to achieve this goal. However, the existing system could be improved especially through solidifying the legal basis and centralizing the implementation for child and refugee protection. The engagement of all stakeholders to improve the health and wellbeing of refugee children remains vital.

Quality-of-life Evaluation of Healthy Siblings of Children with Chronic Illness

Background: Chronic disease of children can cause changes in the health-related quality of life (HrQoL) of the family members. Aims: To evaluate the HrQoL of healthy siblings of children with chronic disease. Study Design: Cross-sectional study. Methods: The study included healthy sibling of children with chronic disease (cerebral palsy, epilepsy, diabetes, celiac disease, hematologic/oncologic disease, or asthma) and healthy sibling of healthy children to evaluate the quality of life. We used the Pediatric Quality of Life Inventory questionnaire; the physical health and psychosocial health scores were calculated using the responses of the sibling and parent. The primary endpoint was the comparison of HrQoL scores of healthy siblings of children with chronic disease and that of healthy siblings of healthy children. Results: This study included a respective healthy sibling of 191 children with chronic disease and healthy sibling of 100 healthy children. The physical health, psychosocial health, and total health scores of healthy siblings of children with chronic disease were significantly lower than that of healthy siblings of healthy children (p<0.001). Among the healthy siblings of children with chronic disease, the lowest psychosocial health score was found in the siblings of children with cerebral palsy, hematologic/oncologic disease, and asthma (p<0.001). The global impact on the quality of life for healthy siblings of children with chronic disease was significantly higher in the self-report of the children than that of the parents (30.4% versus 15.1%, p<0.05). Conclusion: Most healthy siblings of children with chronic disease are physically and psychosocially affected and there is low parental awareness of this condition. This can increase the risk of emotional neglect and abuse of these children. Therefore, special support programs are needed for the families of children with chronic diseases.

Evaluation of measles immunity in Turkey: is it still a threat?

Background/aim: Measles is one of the important vaccine-preventable diseases with many complications in childhood. This study presents cross-sectional seroepidemiological data, beginning from neonatal cord blood in infants to children under 6 years of age, about waning of measles antibody and tries to suggest the proper time for measles immunization. Materials and methods: A total of 564 blood samples consisting of neonatal cord blood and samples taken from infants and children at ages of 6, 9, 24­48, and 49­72 months were analyzed for measles seropositivity in a period of 6 months. Results: Measles seropositivity rate was 72.5% in 109 cord blood samples, 2.6% in 117 infants of 6 months of age, and 3.6% in 111 infants of 9 months of age. Seropositivity was determined in 118 children at 24­48 months and in 109 children at 49­72 months and was 80.5% and 66%, respectively (P = 0.001). These children were vaccinated in the 12th month. Conclusion: Though measles immunization coverage is 97% in Turkey, population immunity is somewhat lower than expected. Increases of measles cases in Europe and the refugee problem in the country could easily lead to outbreaks. Implementing the first dose of the immunization at 9 months may be an option.

Measuring awareness about child abuse and neglect: Validity and reliability of a newly developed tool-child abuse and neglect awareness scale.

Altan H, Budakoglu II, Sahin-Dagli F, Oral R. Measuring awareness about child abuse and neglect: Validity and reliability of a newly developed tool-child abuse and neglect awareness scale. Turk J Pediatr 2018; 60: 392-399. In this study, we aimed at determining child abuse and neglect awareness of medical students attending one of the top medical schools in Turkey. The study group comprised 350 third-year medical students at Gazi University, School of Medicine, Ankara. The items in the scale were prepared by two experienced pediatricians and revised according to feedback received from two pilot studies and experts in this field of study. A 20-item `Child Abuse and Neglect Awareness` scale (CANA-S) was developed by an expert panel. Exploratory and confirmatory factor analyses were performed. We also measured test-retest reliability and internal consistency. Conformity for factor analysis of the scale`s construct validity revealed a Kaiser-Meyer-Olkin sample concordance coefficient of 0.799. For the Bartlett Sphericity test, χ2 value was 1157.750 (p < 0.01). Based on these analyses, the scale explains 44.9% of the total variance and consists of 20 items and 4 subscales. Cronbach`s alpha value and correlation coefficient were 0.768 and r=0.204 (p=0.045), respectively. This scale is a valid and reliable measurement tool for evaluating awareness about child abuse and neglect among the medical students.

Media Use by Children, and Parents' Views on Children's Media Usage.

BACKGROUND: New (mobile phones, smartphones, tablets, and social media) and traditional media (television) have come to dominate the lives of many children and adolescents. Despite all of this media time and new technology, many parents seem to have few rules regarding the use of media by their children and adolescents. OBJECTIVES: The aim of this study was to evaluate media access/use of children and to evaluate beliefs and attitudes of parents concerning the use of old and new media in Turkey. METHODS: This is a cross-sectional electronic survey of a national convenience sample in Turkey via SurveyMonkey, including 41 questions regarding topics relevant to television, computers, mobile phones, iPad/tablet use, and social media accounts. RESULTS: The responses of the 333 participants (238 women, 95 men; 27-63 years) were evaluated. The average daily watching alone time was 0 to 2 hours among 53.4% (46/86), and daily coviewing time with parents of children was 0 to 2 hours among 62.7% (54/86) of children below 2 years of age. Regarding parents' monitoring their children's computer use (n=178), 35.4% (63/178) of the parents prefer coviewing, 13.5% of the parents use a family filter (24/178), and 33.1% (59/178) of the parents prefer to check Web history. Approximately 71.2% (237/333) of the participants had an iPad/tablet in the house, 84.3% (200/333) of the parents give their children permission to use the iPad/tablet. Of the parents, 22.5% (45/200) noted that their children used the iPad/tablet at the table during lunch/dinner and 57.9% (26/45) of these children were aged 5 years and below. Of parents, 27.3% (91/333) agreed that the optimal age for owning a mobile phone was 12 years, and 18.0% (60/333) of the parents noted that their children (one-third was below 2 years) used the mobile phone at the table during meals. A total of 33.3% (111/333) children/adolescents have a Facebook profile, and 54.0% (60/111) were below 13 years of age. Approximately 89.2% (297/333) of the parents emphasized that the Internet is essential for their child's education. DISCUSSION: According to our study results, knowledge regarding the use of old and new media is limited among the parents in Turkey. Our study showed that screen time and mobile device use (including during meals) are common in children below 2 years of age, whereas no screen time was recommended for children below 2 years of age. We concluded that there is need for evidence-based guidelines regarding the use of the Internet and social media for parents and parents should ensure that there is a plan in place for the use of children's media.