Vaccination coverage and reasons for non-vaccination in a district of Istanbul

BACKGROUND: In order to control and eliminate the vaccine preventable diseases it is important to know the vaccination coverage and reasons for non-vaccination. The primary objective of this study was to determine the complete vaccination rate; the reasons for non-vaccination and the predictors that influence vaccination of children. The other objective was to determine coverage of measles vaccination of the Measles Immunization Days (MID) 2005 for children aged 9 month to 6 years in a region of Umraniye, Istanbul, Turkey. METHODS: A '30 × 7' cluster sampling design was used as the sampling method. Thirty streets were selected at random from study area. Survey data were collected by a questionnaire which was applied face to face to parents of 221 children. A Chi-square test and logistic regression was used for the statistical analyses. Content analysis method was used to evaluate the open-ended questions. RESULTS: The complete vaccination rate for study population was 84.5% and 3.2% of all children were totally non-vaccinated. The siblings of non-vaccinated children were also non-vaccinated. Reasons for non-vaccination were as follows: being in the village and couldn't reach to health care services; having no knowledge about vaccination; the father of child didn't allow vaccination; intercurrent illness of child during vaccination time; missed opportunities like not to shave off a vial for only one child. In logistic regression analysis, paternal and maternal levels of education and immigration time of both parents to Istanbul were found to influence whether children were completely vaccinated or non-vaccinated. Measles vaccination coverage during MID was 79.3%. CONCLUSION: Efforts to increase vaccination coverage should take reasons for non-vaccination into account

Health worker densities and immunization coverage in Turkey: a panel data analysis

<p>Abstract</p> <p>Background</p> <p>Increased immunization coverage is an important step towards fulfilling the Millennium Development Goal of reducing childhood mortality. Recent cross-sectional and cross-national research has indicated that physician, nurse and midwife densities may positively influence immunization coverage. However, little is known about relationships between densities of human resources for health (HRH) and vaccination coverage within developing countries and over time. The present study examines HRH densities and coverage of the Expanded Programme on Immunization (EPI) in Turkey during the period 2000 to 2006.</p> <p>Methods</p> <p>The study is based on provincial-level data on HRH densities, vaccination coverage and provincial socioeconomic and demographic characteristics published by the Turkish government. Panel data regression methodologies (random and fixed effects models) are used to analyse the data.</p> <p>Results</p> <p>Three main findings emerge: (1) combined physician, nurse/midwife and health officer density is significantly associated with vaccination rates – independent of provincial female illiteracy, GDP per capita and land area – although the association was initially positive and turned negative over time; (2) HRH-vaccination rate relationships differ by cadre of health worker, with physician and health officers exhibiting significant relationships that mirror those for aggregate density, while nurse/midwife densities are not consistently significant; (3) HRH densities bear stronger relationships with vaccination coverage among more rural provinces, compared to those with higher population densities.</p> <p>Conclusion</p> <p>We find evidence of relationships between HRH densities and vaccination rates even at Turkey's relatively elevated levels of each. At the same time, variations in results between different empirical models suggest that this relationship is complex, affected by other factors that occurred during the study period, and warrants further investigation to verify our findings. We hypothesize that the introduction of certain health-sector policies governing terms of HRH employment affected incentives to provide vaccinations and therefore relationships between HRH densities and vaccination rates. National-level changes experienced during the study period – such as a severe financial crisis – may also have affected and/or been associated with the HRH-vaccination rate link. While our findings therefore suggest that the size of a health workforce may be associated with service provision at a relatively elevated level of development, they also indicate that focusing on per capita levels of HRH may be of limited value in understanding performance in service provision. In both Turkey and elsewhere, further investigation is needed to corroborate our results as well as gain deeper understanding into relationships between health worker densities and service provision.</p

ON THE PERIOD LENGTH OF CONGRUENTIAL PSEUDORANDOM NUMBER SEQUENCES GENERATED BY INVERSIONS

Congruential pseudorandom number sequences generated by inversions have been studied recently. These sequences do not show the undesirable lattice structure of the linear congruential method. The necessary and sufficient condition for the generated sequence to have the maximal period length was given by Eichenauer (1988) for the case of 2e modulus. Generalization of this result to the case of an arbitrary prime power modulus is obtained

A community-based intervention programme on hormonal contraceptives: The utilisation of social networks

The aim of the study was to determine the effects of an intervention programme based on the utilisation of the social learning concept which is practised through social networks among adult women in a suburban population in Turkey. The study was performed in two disadvantaged neighbourhoods of Umraniye, Istanbul. One of the neighbourhoods served as the intervention while the other as the control group. In order to document the efficacy of the intervention, baseline and evaluation surveys were carried out in both neighbourhoods. The most widely known hormonal contraceptive method was oral contraceptives, while emergency contraceptives were determined as the least known methods. The improvement was higher for the least known methods. Education with peer groups is shown to be effective in improving the knowledge of women about contraception. Information transfer through peer groups should be used more frequently particularly for emergency contraception

A NONLINEAR CONGRUENTIAL PSEUDORANDOM NUMBER GENERATOR WITH POWER OF 2 MODULUS

A nonlinear congruential pseudorandom number generator is studied where the modulus is a power of two. Investigation of this generator was suggested by Knuth [7]. A simple necessary and sufficient condition is given for this generator to have the maximal period length

ON THE LATTICE STRUCTURE OF A NONLINEAR GENERATOR WITH MODULUS 2-ALPHA

Nonlinear congruential pseudorandom number generators based on inversions have been introduced and analysed recently. These generators do not show the simple lattice structure of the widely used linear congruential generators which are too regular for certain simulation purposes. In the present paper a nonlinear congruential generator based on inversions with respect to a power of two modulus is considered. It is shown that the set of points formed by consecutive pseudorandom numbers has a more complicated lattice structure: it forms a superposition of shifted lattices. The corresponding lattice bases are explicitly determined and analysed

Management of postpartum manic episode without cessation of breastfeeding: a longitudinal follow up of drug excretion into breast milk

WOS: 00020947020048

Resistance to vaccination: The attitudes and practices of primary healthcare workers confronting the H1N1 pandemic

During the H1N1 pandemic, most healthcare workers in Turkey were not willing to take up the vaccine. This qualitative study aims to explore the factors that lead to vaccination resistance among a group of primary healthcare workers in Istanbul. Data were collected through focus group discussions. Thematic content analysis was conducted. All participants considered themselves at risk for infection, yet most of them were not vaccinated. Only persons with a poor immune system were considered by the respondents at risk for severe disease and death. Health personnel mostly did not realize their potential role in the transmission of influenza to patients. The decision of vaccination was dependent on the information source. The personnel who depended mainly on the media either did not accept vaccination or was undecided. They believed that the vaccine went through an accelerated authorization procedure. Yet the ones who accepted vaccination relied mostly on evidence-based sources and accessed information from the guidelines of the Ministry of Health, Professional Medical Associations and the World Health Organization. Social networks were also influential factors in the decision-making process. It is important to empower healthcare workers through supporting the skills of acquiring and using evidence-based information. This is particularly important for physicians who also serve as opinion leaders. (c) 2010 Elsevier Ltd. All rights reserved