Öz
Amaç: Bebek ve çocuk ölüm oranları ülkelerin gelişmişliğinin, sağlık politikalarının ve sağlık müdahalelerinin etkinliğinin hassas bir göstergesidir. Beş yaş altındaki çocuklar arasındaki ölümlerin önemli kısmı basit ve kanıtlanmış tedbirlerle önlenebilir veya tedavi edilebilir hastalıklardan kaynaklanmaktadır. Bu çalışmada beş yaş altı çocuk ölümlerinin nedenleri ve aşılanma durumlarının değerlendirilmesi amaçlanmıştır.
Metod: Çalışma kesitsel tipte tanımlayıcı bir çalışmadır. Çalışmanın evrenini 3 yıllık sürede Samsun ilinde 5 yaş altında ve 1 yaşını tamamlamış toplam 97 çocuk ölümü oluşturmaktadır. Örneklem seçimi yapılmayıp bütün çocuk ölümlerine ait veriler retrospektif olarak incelenerek elde edilmiştir. Ölen çocukların yaş, cinsiyet ve ölüm nedenleri not edilmiştir. Düşme, trafik kazası, ateşli silah yaralanması ve suda boğulma gibi nedenler travma; sepsis, pnömoni, bronkopnömoni, gastroenterit ve ensefalit gibi nedenler enfeksiyon; doğuma bağlı ve kalıtsal hastalıklar doğumsal anomali ve son olarak metabolik ve kronik hastalıklar da kronik hastalıklar başlığında toplanarak sınıflandırılmıştır.
Bulgular: 3 yıllık dönemde Samsun ilinde toplam 97 çocuk ölümü olmuştur. En sık ölüm nedeni enfeksiyon hastalıkları olduğu görülmüştür. Enfeksiyon nedeniyle ölenlerin en sık tanısı bronkopnömonidir. Ölen çocukların aşılanma durumları ölüm nedenlerine göre incelendiğinde; en düşük aşılanma oranlarının sırasıyla kalıtsal hastalık nedenli ölümler, enfeksiyon kaynaklı ölümler ve kronik hastalık nedenli ölümler olduğu görülmüştür. Ölen çocukların annelerinin doğum öncesi birinci basamak sağlık hizmetlerindeki takip sıklığı 3,26 defa, ikinci basamakta takip sıklığı ortalaması 2,41 defa olduğu görülmüştür. Gebelik süresince toplam izlem sayı ortalaması 5,67 defa olduğu bulunmuştur. Gebelerin %77,3’ü DSÖ’nün önerisine uygun şekilde en az 4 kez gebelik izlemi yaptırmıştır.
Sonuç: Ölen çocukların aşılanma oranı ulusal aşılanma oranının çok altındadır. Aşılanma oranı en düşük kalıtsal hastalık enfeksiyon kaynaklı ölümlerdedir. En sık ölüm nedeni enfeksiyon kaynaklı ölümlerdir. Enfeksiyon kaynaklı ölümlerin fazla olması enfeksiyonla mücadele ve koruyucu hekimlik uygulamaları gibi birinci basamak sağlık hizmetlerine ağırlık verilmesine işaret etmektedir
Anahtar Kelimeler
Aşılar Aşılama Aşıyla önlenebilir hastalıklar Çocuk ölümü Ölüm nedeni
Kaynakça
- 1. Kagabo DM, Kirk CM, Bakundukize B, Hedt-Gauthier BL, Gupta N, Hirschhorn LR, et al. Care-seeking patterns among families that experienced under-five child mortality in rural Rwanda. PLoS ONE 2018;13(1):1–18.
- 2. Mishra K, Mohapatra I, Kumar A. A study on the health seeking behavior among caregivers of under-five children in an urban slum of Bhubaneswar, Odisha. J Family Med Prim Care 2019 Feb;8(2):498–503.
- 3. Ingole A, Yadav S, Gotorkar S, Choudhari S. Treatment-seeking behaviors of families for under five children in field practice area of Jawaharlal Nehru Medical College, Wardha. J Datta Meghe Inst Med Sci Univ 2021;16:36–41.
- 4. Singh BP, Das UD, Singh S, Singh G. Development of a Discrete Probability Distribution and its application to the pattern of child deaths. J Sci Res 2021;65(5):186–90.
- 5. Ali A, Şenturk İ. Justifying the impact of economic deprivation, maternal status and health infrastructure on under-five child mortality in Pakistan: an empirical analysis Amjad. BBE 2019;8(3):140–54.
- 6. Numaguchi A, Mizoguchi F, Aoki Y, An B, Ishikura A, Ichikawa K, et al. Epidemiology of child mortality and challenges in child death review in Japan. Pediatrics International 2022;64(1):1736–50.
- 7. Kizilirmak A, Başer M. The effect of education given to primigravida women on fear of childbirth. Appl Nurs Res 2016;29:19–24.
- 8. Children and adolescents in the WHO European Region [Internet]. [Erişim Tarihi: 5 Nisan 2022]. Erişim adresi: https://www.euro.who.int/en/health-topics/Life-stages/child-and-adolescent-health/children-and-adolescents-in-the-who-european-region
- 9. Hernández-Prado B, Rodríguez-Angulo EM, Palmisano EB, Ojeda-Rodríguez R, Ojeda-Baranda RJ, Andueza-Pecha MG, et al. Factors associated with delays in the search for care in under-5 deaths in Yucatán, Mexico. Salud Publ Mex 2021;63(4):498–508.
- 10. Greenslade L, Ahmar S, Inyang E, Warren S, Oluseyi O. Every breath counts in Nigeria: A coalition to accelerate reductions in child pneumonia deaths. Pediatr Pulmonol 2020;55(S1):S22–4.
- 11. Burstein R, Henry NJ, Collison ML, Marczak LB, Sligar A, Watson S, et al. Mapping 123 million neonatal, infant and child deaths between 2000 and 2017. Nature 2019;574(7778):353–8.
- 12. Children at home and in primary health care [Internet]. [Erişim Tarihi: 5 Nisan 2022]. Erişim adresi: https://www.euro.who.int/en/health-topics/Life-stages/child-and-adolescent-health/children-and-adolescents-in-the-who-european-region/children-at-home-and-in-primary-health-care
- 13. Doctor HV, Nkhana-Salimu S, Abdulsalam-Anibilowo M. Health facility delivery in sub-Saharan Africa: Successes, challenges, and implications for the 2030 development agenda. BMC Public Health 2018;18(1):1–12.
- 14. Bamford LJ, Sa F, Mckerrow NH, Sa F, Paed M, Barron P, et al. Child Mortality. S Afr Med J 2018;108(March):S25–32.
- 15. Nozaki I, Hachiya M, Kitamura T. Factors influencing basic vaccination coverage in Myanmar: Secondary analysis of 2015 Myanmar demographic and health survey data. BMC Public Health 2019;19(1):1–8.
- 16. Greenwood B. The contribution of vaccination to global health: past, present and future. Philos Trans R Soc Lond B Biol Sci 2014;369(1645):20130433.
- 17. Pezzotti P, Bellino S, Prestinaci F, Iacchini S, Lucaroni F, Camoni L, et al. The impact of immunization programs on 10 vaccine preventable diseases in Italy: 1900–2015. Vaccine 2018;36(11):1435–43.
- 18. Scavone C, Sessa M, Clementi E, Rossi F, Capuano A. Italian immunization goals: A political or scientific heated debate? Front Pharmacol 2018;9:574.
- 19. Hotez P. America and Europe’s new normal: the return of vaccine-preventable diseases. Pediatr Res 2019;85(7):912–4.
- 20. Andersen A, Fisker AB, Rodrigues A, Martins C, Ravn H, Lund N, et al. National immunization campaigns with Oral Polio Vaccine reduce all-cause mortality: A natural experiment within seven randomized trials. Front Public Health 2018;8(13):1–10.
- 21. De Bree LCJ, Koeken VACM, Joosten LAB, Aaby P, Benn CS, van Crevel R, et al. Non-specific effects of vaccines: Current evidence and potential implications. Semin Immunol 2018;39:35–43.
- 22. TUIK-Türkiye İstatistik Kurumu [Internet]. [Erişim Tarihi: 23 Nisan 2022]. Erişim adresi: https://data.tuik.gov.tr/Bulten/Index?p=Olum-ve-Olum-Nedeni-Istatistikleri-2021-45715
- 23. Perin J, Mulick A, Yeung D, Villavicencio F, Lopez G, Strong KL, et al. Global, regional, and national causes of under-5 mortality in 2000–19: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet Child Adolesc Health 2022;6(2):106–15.
- 24. Liu L, Chu Y, Oza S, Hogan D, Perin J, Bassani DG, et al. National, regional, and state-level all-cause and cause-specific under-5 mortality in India in 2000–15: a systematic analysis with implications for the Sustainable Development Goals. Lancet Glob Health 2019;7(6):e721–34.
- 25. Ali Y, Mekonnen FA, Molla Lakew A, Wolde HF. Poor maternal health service utilization associated with incomplete vaccination among children aged 12-23 months in Ethiopia. Hum Vaccin Immunother 2020;16(5):1202–7.
- 26. Ekholuenetale M, Wegbom AI, Tudeme G, Onikan A. Household factors associated with infant and under-five mortality in sub-Saharan Africa countries. Int J Child Care Educ Policy 2020;14(1):10.
Öz
Aim: Infant and child mortality rates; it is a sensitive indicator of development in countries, the effectiveness of health policies and health interventions. A significant proportion of deaths among children under the age of five are due to diseases that can be prevented or treated with simple and proven measures. It was aimed to evaluate the causes of death and vaccination status of children under the age of five.
Method: The study is a cross-sectional descriptive study. The population of the study consists of a total of 97 child deaths under the age of 5 and completed the age of 1 in Samsun in a 3-year period. Sample selection was not made, and the data of all child deaths were obtained by retrospectively examining. Age, gender and causes of death of the deceased children were noted. Causes such as falling, traffic accident, firearm injury and drowning are traumas; causes such as sepsis, pneumonia, bronchopneumonia, gastroenteritis and encephalitis as infections; Congenital and hereditary diseases were classified as congenital anomalies, and metabolic and chronic diseases were classified under the title of chronic diseases.
Results: A total of 97 child deaths occurred in Samsun in the 3-year period. The most common cause of death was found to be infectious diseases. The most common diagnosis of those who die due to infection is bronchopneumonia. When the vaccination status of the deceased children is examined according to the causes of death; the lowest vaccination rates were found to be deaths from hereditary disease, deaths from infection, and deaths from chronic disease, respectively. It was observed that the frequency of follow-up in the prenatal primary health care services of the mothers of the deceased children was 3.26 times, and the average frequency of follow-up in the secondary care was 2.41 times. The mean number of total follow-ups during pregnancy was found to be 5.67 times. The rate of pregnant women who had pregnancy follow-up at least 4 times in accordance with WHO's recommendation is 77.3%.
Conclusion: The immunization rate of children who die is well below the national immunization rate. The lowest rate of vaccination is in the deaths caused by the inherited disease infection. The most common cause of death is death due to infection. The high number of infections-related deaths indicates that primary health care services such as infection control and preventive medicine should be focused on.
Anahtar Kelimeler
Vaccines Vaccination Vaccine-preventable diseases Child mortality Cause of death
Kaynakça
- 1. Kagabo DM, Kirk CM, Bakundukize B, Hedt-Gauthier BL, Gupta N, Hirschhorn LR, et al. Care-seeking patterns among families that experienced under-five child mortality in rural Rwanda. PLoS ONE 2018;13(1):1–18.
- 2. Mishra K, Mohapatra I, Kumar A. A study on the health seeking behavior among caregivers of under-five children in an urban slum of Bhubaneswar, Odisha. J Family Med Prim Care 2019 Feb;8(2):498–503.
- 3. Ingole A, Yadav S, Gotorkar S, Choudhari S. Treatment-seeking behaviors of families for under five children in field practice area of Jawaharlal Nehru Medical College, Wardha. J Datta Meghe Inst Med Sci Univ 2021;16:36–41.
- 4. Singh BP, Das UD, Singh S, Singh G. Development of a Discrete Probability Distribution and its application to the pattern of child deaths. J Sci Res 2021;65(5):186–90.
- 5. Ali A, Şenturk İ. Justifying the impact of economic deprivation, maternal status and health infrastructure on under-five child mortality in Pakistan: an empirical analysis Amjad. BBE 2019;8(3):140–54.
- 6. Numaguchi A, Mizoguchi F, Aoki Y, An B, Ishikura A, Ichikawa K, et al. Epidemiology of child mortality and challenges in child death review in Japan. Pediatrics International 2022;64(1):1736–50.
- 7. Kizilirmak A, Başer M. The effect of education given to primigravida women on fear of childbirth. Appl Nurs Res 2016;29:19–24.
- 8. Children and adolescents in the WHO European Region [Internet]. [Erişim Tarihi: 5 Nisan 2022]. Erişim adresi: https://www.euro.who.int/en/health-topics/Life-stages/child-and-adolescent-health/children-and-adolescents-in-the-who-european-region
- 9. Hernández-Prado B, Rodríguez-Angulo EM, Palmisano EB, Ojeda-Rodríguez R, Ojeda-Baranda RJ, Andueza-Pecha MG, et al. Factors associated with delays in the search for care in under-5 deaths in Yucatán, Mexico. Salud Publ Mex 2021;63(4):498–508.
- 10. Greenslade L, Ahmar S, Inyang E, Warren S, Oluseyi O. Every breath counts in Nigeria: A coalition to accelerate reductions in child pneumonia deaths. Pediatr Pulmonol 2020;55(S1):S22–4.
- 11. Burstein R, Henry NJ, Collison ML, Marczak LB, Sligar A, Watson S, et al. Mapping 123 million neonatal, infant and child deaths between 2000 and 2017. Nature 2019;574(7778):353–8.
- 12. Children at home and in primary health care [Internet]. [Erişim Tarihi: 5 Nisan 2022]. Erişim adresi: https://www.euro.who.int/en/health-topics/Life-stages/child-and-adolescent-health/children-and-adolescents-in-the-who-european-region/children-at-home-and-in-primary-health-care
- 13. Doctor HV, Nkhana-Salimu S, Abdulsalam-Anibilowo M. Health facility delivery in sub-Saharan Africa: Successes, challenges, and implications for the 2030 development agenda. BMC Public Health 2018;18(1):1–12.
- 14. Bamford LJ, Sa F, Mckerrow NH, Sa F, Paed M, Barron P, et al. Child Mortality. S Afr Med J 2018;108(March):S25–32.
- 15. Nozaki I, Hachiya M, Kitamura T. Factors influencing basic vaccination coverage in Myanmar: Secondary analysis of 2015 Myanmar demographic and health survey data. BMC Public Health 2019;19(1):1–8.
- 16. Greenwood B. The contribution of vaccination to global health: past, present and future. Philos Trans R Soc Lond B Biol Sci 2014;369(1645):20130433.
- 17. Pezzotti P, Bellino S, Prestinaci F, Iacchini S, Lucaroni F, Camoni L, et al. The impact of immunization programs on 10 vaccine preventable diseases in Italy: 1900–2015. Vaccine 2018;36(11):1435–43.
- 18. Scavone C, Sessa M, Clementi E, Rossi F, Capuano A. Italian immunization goals: A political or scientific heated debate? Front Pharmacol 2018;9:574.
- 19. Hotez P. America and Europe’s new normal: the return of vaccine-preventable diseases. Pediatr Res 2019;85(7):912–4.
- 20. Andersen A, Fisker AB, Rodrigues A, Martins C, Ravn H, Lund N, et al. National immunization campaigns with Oral Polio Vaccine reduce all-cause mortality: A natural experiment within seven randomized trials. Front Public Health 2018;8(13):1–10.
- 21. De Bree LCJ, Koeken VACM, Joosten LAB, Aaby P, Benn CS, van Crevel R, et al. Non-specific effects of vaccines: Current evidence and potential implications. Semin Immunol 2018;39:35–43.
- 22. TUIK-Türkiye İstatistik Kurumu [Internet]. [Erişim Tarihi: 23 Nisan 2022]. Erişim adresi: https://data.tuik.gov.tr/Bulten/Index?p=Olum-ve-Olum-Nedeni-Istatistikleri-2021-45715
- 23. Perin J, Mulick A, Yeung D, Villavicencio F, Lopez G, Strong KL, et al. Global, regional, and national causes of under-5 mortality in 2000–19: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet Child Adolesc Health 2022;6(2):106–15.
- 24. Liu L, Chu Y, Oza S, Hogan D, Perin J, Bassani DG, et al. National, regional, and state-level all-cause and cause-specific under-5 mortality in India in 2000–15: a systematic analysis with implications for the Sustainable Development Goals. Lancet Glob Health 2019;7(6):e721–34.
- 25. Ali Y, Mekonnen FA, Molla Lakew A, Wolde HF. Poor maternal health service utilization associated with incomplete vaccination among children aged 12-23 months in Ethiopia. Hum Vaccin Immunother 2020;16(5):1202–7.
- 26. Ekholuenetale M, Wegbom AI, Tudeme G, Onikan A. Household factors associated with infant and under-five mortality in sub-Saharan Africa countries. Int J Child Care Educ Policy 2020;14(1):10.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | İç Hastalıkları, Halk Sağlığı, Çevre Sağlığı, Birinci Basamak Sağlık Hizmetleri, Sağlık Kurumları Yönetimi |
| Bölüm | Orijinal Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 20 Haziran 2023 |
| Gönderilme Tarihi | 20 Aralık 2022 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 17 Sayı: 2 - Turkish Journal of Family Medicine and Primary Care |
- Makale Dosyaları
Sağlığın ve birinci basamak bakımın anlaşılmasına ve geliştirilmesine katkıda bulunacak yeni bilgilere sahip yazarların İngilizce veya Türkçe makaleleri memnuniyetle karşılanmaktadır.