1-72 ay çocuklarda görülen yaz ishallerine sosyal faktörleri etkisi

Abstract

ishal yocuk oliimlerinin onde gel en nedenlerinden birisidir. Ozelliklege1i~mekte olan iilkelerde ishale bagh morbidite ve mortalite yiiksektir. Buyah~mamn amaCI 1-72 ay grubu yocuklann yaz ishalleri ile sosyal etkenler arasmdakii1i~kiyi ara~trrmak ve bunlann etkilerini incelemek, ishal olmalanm etkileyen sosyalfaktorleri saptayarak yocuklarm normal biiyiimelerinin saglanmasma ve gereklionlemlerin ahnmasma katktda bulunmaktlr.<;ah~ma kesitsel, prospektif ve kontrollii olarak Haziran-Agustos 2005 veHaziran-Agustos 2006 tarihleri arasmda yaplldl. Saghk Bakan1lg1 Ankara Egitim veAra~tlrma Hastanesi <;ocuk poliklinigine ba~vuran 1-72 ay araSI 450 ishalli yocukyah~maya ahndl. Kontrol grubu son bir aydlr ishal olmayan, 1-72 ay arasmdaki 200yocuktan olu~turuldu. Anket formunda yocuklann ya~l, cinsiyeti, anne-baba egitimdurumu, anne-baba ya~lan, annenin aglzdan SIVI tedavisi (AST) bilgi durumu, kaykez ishal oldugu, sosyo-ekonomik diizeyi, a~llanma durumu, oturulan konut tipi,vitamin preparatl almasl, ailede ya~ayan ki~i saytSI, su kaynaklan, anne siitiinedevam siiresi, inek siiru ahml, ek gtdaya ba~lamasl, annelerin tuvalet kagldl kullanmadurumu, anne1erin tuvalet sonraSI el ytkamasl, annelerin yemek yapmadan once elytkamasl, haftada eve gelen misafir silllgl, annenin yah~maSI, ailede ya~ayan ki~isaytSI, ailede ya~ayan yocuk saytSI, kaymCI yocuk oldugu, evin kanalizasyon durumu,aym evde ya~ayan diger bireylerde ishal goriilme durumu sorgulandl. Elde edilentUm veriler saytsal ~ekilde kodlanarak Statistical Program for Social Sciences (SPSS)siiriim 12 He degerlendirildi.<;ah~maya alman olgulann ya~ ortalamasl hasta grubunda 31.8±20.9 ay,kontrol grubunda 31.4±21.4 ay idi. Hasta grubunun 213'si (%47.2) ktz, 23Tsi(%52.8) erkek; kontrol grubunun 96'Sl (%48) ktz, l04'ii (%52) erkekti. Gruplararasmda AST kullamml ile ilgili bilgi diizeyleri degerlendirildiginde hasta grubundaAST kullamm1ll1 bilmeyen annelerin oramnm daha yiiksek oldugu bulundu(p=O.008). Anne egitim diizeyi arttlkc;a AST kullammlm bilme orammn da anlamholarak arttlgl gozlendi (p=O.OOOl). <;ah~maya alman gruplar arasmda a~tlarmtamamlanmasl aC;lsmdan anlamh fark bulundu (p=O.OOOl). ishal olanlardakontrollere gore yiiksek orand a a~llann tamamlanmadlgl goriildii. Gelir diizeyiaC;lsmdan kar~tla~tmldlgmda gelir diizeyinin hasta grubunda daha dii~iik oldugusaptandl (p=O.04). ishal grubunda (% 67.3) olanlarda kontrollere (%45.5) goregecekonduda oturma oram daha yiiksekti (p=O.OOOl). Gruplar vitamin preparatl almasfueleri aC;lsmdan kar~lla~tmldlgmda hasta grubunda, vitamin preparatl almayaruannoram kontrol grubuna gore anlamh derecede yiiksek saptandl (p=O.OOl).<;ocuk ya~l kiic;iildiikc;e, annenin AST bilgisi yoksa, c;ocuk yetersiza~llanml~sa, yeterli vitamin destegi almaml~sa, ailenin sosyo-ekonomik diizeyidii~iil(se ishal olma oram artmaktadlr. Annelerin yemek yapmadan once el ytkamalanc;ocuklarda ishal goriilme oranlanm azaltmaktadlr. <;ocuklann baktmmdabiiyiimesinde, egitiminde biiyiik rol oynayan annenin egitimi ve ailenin ya~adlglsosyal c;evrenin diizeltilmesi ishallerin oruenmesinde onemlidir. Ya~amlan sosyalc;evrenin iyile~tirilmesi konusunda ilgili kurum ve ki~ilerin iizerlerine dii~en gorevleriyapmalanmn gerekliligini vurgulamak istiyoruz.

Acute gastroenteritis is among the main causes of death of children. Mortalityand morbidity is high especially in developing countries. The aim of this study is todetermine the association between social factors and acute gastroenteritis occurredduring summer, among children aged between land 72 months and to investigate theeffects of these; providing help to normal growth of children and contribution totaking preventive measures, by determining effecting factors.The study was prospectively carried out between 2005 and 2006 June toAugust. 450 children with acute gastroenteritis that admitted to Ministry of HealthAnkara Education and Research Hospital were recruited. Control group wasconstituted with 200 children that did not have acute gastroenteritis in the last onemonth. The questionnaire included the age and gender of the child, education leveland ages of parents, mother's knowledge about ORS, number of acute gastroenteritisthe child experienced, economic level of the family, the type and sewerage system ofhouse, vitamin supplementation, number of people and children in the family, type ofwater source, breast milk duration, feeding with cow's milk, starting tosupplementary foods, the status of mothers about habitude of hand washing andusing toilet paper. The frequency of visitors to home in a week, mother's workingstatus, and acute gastroenteritis experience in members of the family were asked. Thedata were numerically coded and analyses were performed using SPSS (StatisticalProgram for Social Sciences), version 12.The mean age of children in patient group was 31.8±20.9 months, and31.4±21.4 months in control group. In patients 213 (47.2%) were girls, 237 (52.8%)were boys; in controls 96 (48%) were girls, and 104 (52%) were boys. When groupswere compared according to ORS knowledge, amount of mothers with ORSknowledge in patient group was lower (p=0.008). The rate of ORS knowledge of themothers increased with the increase in education level (p=0.0001). Groups hadstatistically significant difference about the complement vaccination (p=0.0001),.Children with acute gastroenteritis had higher rates of incomplete vaccination.Economic level of children in patient group was lower than controls (p=0.04). Inaddition, children in patient group (67.3%) had higher rates of living in shanty thancontrols (45.5%) (p=0.0001). When groups were compared according to duration ofvitamin supplementation patients had lower rates of vitamin supplementationcompared to controls.The rate of acute gastroenteritis increases without ORS knowledge of themother, incomplete vaccination, inadequate rate of vitamin and young age of thechild, and low socioeconomic level of the family. If the mother has the habitudes ofhand washing rate of gastroenteritis decreases.Mother's education considers importance because they have the mostimportant role in nursing, growth, education and training as an individual. hnprovingthe social environment, which they live in and education of the mothers is essential.We think that both individuals and institutions should make their duty concerningthem.