Vaccination coverage in the South-East Anatolian Project (SEAP) region and factors influencing low coverage.

OBJECTIVES: To determine the vaccination coverage of children living in the South-east Anatolian Project (SEAP) region; whether the vaccination coverage was similar to formal reports, other studies and other countries; and which factors influence vaccination, in order to indicate how vaccination coverage can be improved. STUDY DESIGN: A descriptive cross-sectional study conducted in nine provinces of the SEAP region in order to determine public health problems and their causes. METHODS: A population-based sample of 1150 houses was selected from rural and urban areas of the SEAP region and visited by the researchers. Questionnaires were applied in 2001 and 2002. RESULTS: In the SEAP region, only 30% of children had received a complete set of vaccines. The vaccination coverage was 76.7% for Bacille Calmette-Guérin; 62.0% for the third doses of diphtheria, tetanus toxoid, pertussis and polio vaccine; 62.7% for measles; 44% for the third dose of hepatitis B vaccine in children aged 12-23 months; and 13.3% for the second dose of tetanus toxoid in women who gave birth in the last 5 years. In logistic regression analysis, residence type, number of siblings, birth interval, follow-up visits of midwives, and maternal level of education were found to influence whether children were completely vaccinated. CONCLUSIONS: The findings of this study indicate that vaccination coverage is not acceptable in the SEAP region. Efforts must focus on family planning services, education of women, follow-up visits and strengthening health facilities, especially in rural regions, to improve vaccination.

Family planning in the Southeast Anatolian Project Region.

OBJECTIVES: The aim of this study was to evaluate contraceptive use by women of reproductive age in the Southeast Anatolian Project Region and the promotion of the use of family planning services. METHODS: An optimum sample size to represent the rural and urban area of the region was determined and the sample was chosen by sampling method proportional to the size. A total of 1126 houses were visited and questions about reproductive health were asked of 1019 ever-married (currently married, widows and divorced) women. RESULTS: The study showed that 48.2% of the ever-married women of reproductive age had never used any method of family planning; 37.4% were currently using a family planning method, and 14.4% had used a family planning method in the past. Of the women who were currently using a family planning method, 73.1% were using an effective method. The result of the logistic regression analysis showed that educational level, knowledge of Turkish, type of residence, and total number of living children were the main variables that affected the use of family planning methods. CONCLUSIONS: Use of family planning methods in the region was not at the expected level. In order to decrease the barriers to family planning in developing countries, we must provide obtainable, acceptable, integrated health services.

Adrenomedullin and nitrite levels in children with dilated cardiomyopathy.

Dilated cardiomyopathy (DCM) is an important cause of chronic congestive cardiac failure in children. In patients with idiopathic DCM, endothelium vasomotor function is disturbed. There are many studies on the roles of nitric oxide (NO) and adrenomedullin (AM) in adult patients with DCM. However, to our knowledge, no studies have investigated the level of AM and NO in children with idiopathic DCM. We determined plasma and urinary AM and total nitrite concentrations in children with idiopathic DCM and investigated the correlation between these and other clinical and laboratory findings. Eleven patients with DCM, ranging in age from 5 month to 14 years, were compared to 10 healthy age- and sex-matched controls. Plasma (pmol/ml) and urinary (pmol/mg creatinine) AM levels were significantly lower than in the healthy controls (19.55 +/- 2.36 vs 51.61 +/- 7.22 and 28.29 +/- 20.66 vs 68.87 +/- 40.23, respectively; p <0.001). Plasma and urinary AM levels were negatively correlated with ejection fraction (EF) and fractional shortening (FS). The plasma (Mmol/L) and urinary nitrite levels (Mmol/mg creatinine) were not different between patients and controls [50.90 +/- 17.50 VS 53.40 +/- 26.05 (P > 0.05) and 1.98 +/- 1.24 vs 2.75 +/- 1.68 (p > 0.05), respectively]. In our study, the first to analyze AM and nitrite levels in children with DCM, plasma and urinary AM levels were found to be decreased. A possible explanation for this reduction could be depletion of the viable myocyte population. However, this hypothesis must be clarified by further studies.