Vaccination coverage of children aged 12-23 months in Gaziantep, Turkey: comparative results of two studies carried out by lot quality technique: what changed after family medicine?

BACKGROUND: Health care systems in many countries are changing for a variety of reasons. Monitoring of community-based services, especially vaccination coverage, is important during transition periods to ensure program effectiveness. In 2005, Turkey began a transformation from a "socialization of health services" system to a "family medicine" system. The family medicine system was implemented in the city of Gaziantep, in December, 2010. METHODS: Two descriptive, cross-sectional studies were conducted in Gaziantep city center; the first study was before the transition to the family medicine system and the second study was one year after the transition. The Lot Quality Technique methodology was used to determine the quality of vaccination services. The population studied was children aged 12-23 months. Data from the two studies were compared in terms of vaccination coverage and lot service quality to determine whether there were any changes in these parameters after the transition to a family service system. RESULTS: A total of 93.7% of children in Gaziantep were fully vaccinated before the transition. Vaccination rates decreased significantly to 84.0% (p<0.005) after the family medicine system was implemented. The number of unacceptable vaccine lots increased from 5 lots before the transition to 21 lots after the establishment of the family medicine system. CONCLUSIONS: The number of first doses of vaccine given was higher after family medicine was implemented; however, the numbers of second, third, and booster doses, and the number of children fully vaccinated were lower than before transition. Acceptable and unacceptable lots were not the same before and after the transition. Different health care personnel were employed at the lots after family medicine was implemented. This result suggests that individual characteristics of the health care personnel working in a geographic area are as important as the socioeconomic and cultural characteristics of the community.

Obesity prevalence in gaziantep, Turkey.

BACKGROUND: Obesity is associated with reduced quality of life, development of serious chronic conditions such as heart disease and diabetes, increased medical care costs, and premature death. Environmental effects, especially feeding habits may cause hyperinsulinemia and obesity. A Healthy People 2010 objective is to reduce the proportion of adults who are obese to 15%. MATERIALS AND METHODS: This cross-sectional study was conducted on 1647 persons in a sample representing Gaziantep, Turkey. Over the selected 329 houses, 310 houses were reached (94.2%) and data about 1315 related persons was collected. The body mass index (BMI) shows the relationship between the weight and the height of people, calculated by the ratio of mass by kg over the square value of height measure. In statistical analyses chi-square, student's t-test and logistic regression analysis were used. RESULTS: The mean BMI increased with time for both sex, whereas decreased for 60+ age group. The fastest increase for both sex was seen while transition from 18 year to 19-29 age groups occurred. Another increase in women was in 30-39 age group; BMI=25.08+/-4.39 in 19-29 ages whilst BMI=29.02+/-5.79 in 30-39 ages. The increases in both sex in other age groups were not as much as in this group. CONCLUSION: Obesity is not only a problem in the Gaziantep but is also a major health concern in Europe and other regions of the world. As an accepted method against obesity, life-style changes should be put into use from childhood supported in school and family life.

[The evaluation of interventions for pain control done by health staff caring the patient]. / Hastaya bakim veren saglik çalisanlarinin agri kontrolünde uyguladiklari girisimlerin degerlendirilmesi.

The study was conducted at Sahinbey Research and Intervention Hospital in order to define the interventions of health staff who were in charge of patient pain care. Those who had been an employee already between February- April 2007 were enrolled in the study. As data collecting tools, a questionnaire prepared by the authors and a scale on pain management methods were used. As far as the total scores obtained from the scale are concerned, 34.7% knows the methods to deal with acute pain very well, 57.8% is good, and 7.5% is fair. In addition, the bullet-in questions of the scale revealed that the participants scored highest for knowledge management, followed by pain evaluation, and the least for the maintenance of physical comfort. The results of the study imply that standardization of education is mandatory to decrease individual differences due to educational status, and that more consideration should be given to pain and pain relief topics in schools providing health education.

The distribution of the intestinal parasitic diseases in the Southeast Anatolian (GAP=SEAP) region of Turkey.

OBJECTIVES: The physical alterations put in place by the Southeastern Anatolia Project will undoubtedly provide a remarkable economical growth and a social development in the area. In addition, the influence that formation of dam ponds, enlargement of irrigation areas, change of product and the way of cultivation, urbanization and industrialization will have an impact on the environment. To minimize the adverse effects of this process on human beings, a Community Health Project was completed by the teams participated by Ege, Dicle, Gaziantep and Harran Universities under the Directorate of Turkish Parasitology Association and by Southeastern Anatolia Project Regional Development Administration between 2001 and 2003. RESULTS: To identify individuals with parasite, feces samples were taken from a total of 4,470 individuals. Parasites were found in feces of 41.8% of men, 44.3% of women and 32.2% of children, 0-59 months old, who were included in the research and gave feces samples for parasites tests. These prevalence values indicate how widespread parasitic diseases are in the region. The high prevalence of parasitic diseases in this area is one of the causes of malnutrition in 40% of children. Parasites were detected in 44.2% of feces samples taken from rural areas and in 39.5% taken from urban areas. When the distribution of parasites detected in feces samples was studied, the most common parasites were Giardia intestinalis (18.1%), Entamoeba coli (11.8%), Ascaris lumbricoides (4.8%), Trichuris trichiura (4.5%) and Hymenolepis nana (3.9%). Distribution of parasites according to cities varied widely. The most frequently seen parasites were T. trichiura in Gaziantep; G. intestinalis in Batman, Mardin, Diyarbakir, Sirnak and Sanliurfa; and E. coli in Siirt, Kilis and Adiyaman. CONCLUSIONS: This study is the first investigation of intestinal parasite prevalence in a large region, specifically, in this GAP region and in Turkey, in general. There is no direct relationship between irrigating the cultivation areas and diffusion of parasitic diseases because the existence of intestinal parasites mentioned above is not related to the range of irrigation of cultivation areas, but is related to factors already discussed.

Patterns of active and passive smoking, and associated factors, in the South-east Anatolian Project (SEAP) region in Turkey.

BACKGROUND: Smoking is an important health threat in Turkey. This study aimed to determine the frequency of and main factors associated with smoking in persons of 15 years and over, and the frequency of passive smoking in homes in the South-east Anatolian Project (SEAP) Region in Turkey. METHODS: A cross sectional design was employed. The sample was chosen by the State Institute of Statistics using a stratified cluster probability sampling method. 1126 houses representing the SEAP Region were visited. Questionnaires about tobacco smoking and related factors were applied to 2166 women and 1906 men (of 15 years old and above) in their homes. Face-to-face interview methods were employed. Participants were classified as current, ex, and non-smokers. The presence of a regular daily smoker in a house was used as an indication of passive smoking. The chi-square and logistic regression analysis methods were used for the statistical analysis. RESULTS: The prevalence of smoking, in those of 15 years and over, was 11.8% in women and 49.7% in men. The prevalence of current smokers was higher in urban (34.5%) than in rural (22.8%) regions. The mean of total cigarette consumption was 6.5 packs/year in women and 17.9 packs/year in men. There was at least one current smoker in 70.1% of the houses. CONCLUSION: Smoking is a serious problem in the South-eastern Anatolian Region. Male gender, middle age, a high level of education and urban residency were most strongly associated with smoking.

Attitudes towards family planning in the Southeast Anatolian Project (SEAP) region of Turkey.

OBJECTIVE: To determine attitudes towards family size and last pregnancies in order to improve family planning services in the Southeast Anatolian Project (SEAP) region. METHODS: A questionnaire survey in the nine SEAP regional provinces was carried out under the auspices of the 'SEAP Public Health Project' from 2001 to 2002. The participants comprised 1756 women and 661 men from 1126 households. RESULTS: For men and women aged 15 years and over the median ideal number of children was three. The rate of unintended last pregnancies (43.1%) in the present study was very high compared to the national average of 18.8%. Some 30.1% of the last pregnancies were unwanted by either partner. CONCLUSIONS: The number of pregnancies and children in this region is approximately twice as high as the ideal number. Families in the region are having more children than they want. Basic education must be given to women, particularly non-Turkish speakers, to improve their knowledge and use of family planning. Family planning education for men in rural areas also needs special attention.

Induced abortion and effecting factors of ever married women in the Southeast Anatolian Project Region, Turkey: a cross sectional study.

BACKGROUND: Nearly 10% of the population of Turkey lives in the Southeast Anatolian Project (SEAP) region. The population growth rate and the rate of unintended pregnancies are high and family planning services are insufficient in this region. Lifetime induced abortion rate is also high in this region. Public health problems of the SEAP region were investigated in the "SEAP Public Health Project" in 2001 and 2002. As it is one of the most important health problems of the women living in this region; induced abortion was also investigated in this project. METHODS: An optimumsample size representing the rural and urban area of the region (n = 1150) was chosen by the State Institute of Statistics by a sampling method proportional to size. 1126 of the area's 1150 houses have been visited and data about induced abortions have been obtained by applying a questionnaire to 1491 ever married women who live in the region. RESULTS: It has been found that 9.0% of these women who had at least one pregnancy in their life had at least one induced abortion. The lifetime induced abortion per 100 pregnancies was found to be 2.45. The primary reason given for induced abortions was "wanting no more children" (64.6%). Lifetime induced abortions were 5.3 times greater with women using a family planning method than women not using family planning methods. Lifetime induced abortions were 4.1 times greater with unemployed women than working women. Most of the women have used private doctors in order to have an induced abortion. Although 32.29% have not yet begun to use a contraceptive method after their last induced abortion, 43.75% of the women have since started to use an effective contraceptive method. 23.96% of them have begun to use an ineffective contraceptive method. CONCLUSIONS: Induced abortion is still an important problem at the SEAP region. The results of the study remind us that unemployed women and women who have more than four children is our target group in the campaign against induced abortions. Most of the women use private doctors in order to have an induced abortion. Thus, priority must be given to educate private gynecologists with respect to induced abortion. After induced abortions, a qualified family planning consultant can be given to women and they can be secured to use a suitable contraceptive method.

Vitamin A and beta-carotene levels during pregnancy in Gaziantep, Turkey.

Vitamin A levels during pregnancy have important influences on the health of pregnant women and the growing fetus. Therefore, plasma vitamin A and beta-carotene concentrations during pregnancy in Turkish women living in Gaziantep city were investigated in a prevalence study. Optimum sample size was determined as 252 for vitamin A deficiency and vitamin A and beta-carotene levels were examined in 427 pregnant women aged 14-44 years. Vitamin A and beta-carotene concentrations were measured spectrophotometrically by Neeld Pearson method. Vitamin A and beta-carotene concentrations in pregnant women were found as 1.14 +/- 0.44 micromol/L, and 1.80 +/- 0.66 micromol/L, respectively. Plasma vitamin A concentrations were found in low levels (<1.05 micromol/L) in 45.5% of pregnant women. Vitamin A deficiency (<0.7 micromol/L) was determined in 16.9% of pregnant women. A mild negative correlation was obtained between the vitamin A concentration and pregnancy period. Vitamin A levels of pregnant women were decreased significantly in the third trimester (p<0.05). The findings of present study suggest that vitamin A levels of pregnant women were poor in the region. Therefore, the intake of vitamin A with foods should be improved. Supplementation of vitamin A might benefit at improving maternal and child health especially in high-risk groups especially in developing countries. Monitoring vitamin A levels in pregnant women is very important for also determining low and high levels.

Plasma copper and zinc levels in pregnant women in Gaziantep, Turkey.

OBJECTIVE: Trace elements such as copper and zinc are important factors on the health of pregnant women, fetus and embryonic development. Since these elements have important influences on health of pregnant women and the growing fetus, this study was designed to evaluate the zinc and copper status of pregnant women in Gaziantep, Turkey. METHODS: This study was designed as a prevalence study. Twenty-two health station region were chosen in 13 health centers in the province of Gaziantep city in 1999, and copper and zinc levels were examined in 415 pregnant women living in these regions. Plasma copper and zinc concentrations were determined spectrophotometrically. Analysis of variance and "t" tests were used in the statistical analysis of means. RESULTS: In the examination, plasma copper and zinc levels were found as 220.67 mg/dl and 124.91 mg/dl. While zinc concentrations were not altered significantly throughout gestation, copper levels of pregnant women increased significantly as duration of pregnancy progressed. CONCLUSION: Plasma copper was higher in all trimesters of gestation when compared to normal range of non-pregnant women. The zinc levels of pregnant women were mostly within normal range. It decreased significantly in the pregnant women >35 years of age and in those whose education was literacy and less. Therefore, zinc supplementation in pregnant women is recommended in these groups.

Association between household conditions and diarrheal diseases among children in Turkey: a cohort study.

BACKGROUND: This aim of the present study was to estimate the frequency of diarrheal diseases among children as well as investigating the relationship between diarrheal diseases and household conditions and other factors. METHODS: The study was performed over 12 month period in Binevler Health Center, Gaziantep, Turkey. Five health stations were selected by using a sampling technique with probability proportional to size, and all households with children under the age of 5 years were visited. A questionnaire on diarrhea, household conditions, socioeconomic status of the family and individual characteristics of the children was applied to the mothers by doctors. Three composite indices, including household conditions, socioeconomic status of the family and individual status of the children, were prepared and a classification was made as good, mild or poor in order to better evaluate the results of the study. Daily recordings of diarrheal disease symptoms were made by the parents and these records were collected every month for 1 year. RESULTS: The annual mean incidence of diarrheal diseases was found to be 1.09 per child per year (median = 1). The mean was higher in children with poor household conditions (1.48 +/- 0.12) and with poor individual status (1.48 +/- 0.14), compared with good household conditions (0.76 +/- 0.07) and good individual status (0.71 +/- 0.08). The mean was also higher in children aged between 6 and 11 months (1.51 +/- 0.18), whose father graduated from primary school or lower (1.34 +/- 0.09) and with parents having no habit of washing their hands before taking care of the child (2.00 +/- 0.33). Person-month and case-month incidence rates of diarrhea were calculated to be 8.56 and 9.12%, respectively. CONCLUSIONS: Household conditions, individual status, age, education level of fathers and parents' habit of washing hands before taking care of the child were major factors affecting the incidence of diarrhea.