1-72 ay çocuklarda görülen yaz ishallerine sosyal faktörleri etkisi
The effect of social factors on gastroenteritis 
during summer among children aged between 1 and 72 
months
Yazar: SEBAHAT GÜCÜK
Danışman: DOÇ. DR. YILDIZ DALLAR
Sağlık Bakanlığı / Ankara Eğitim ve Araştırma Hastanesi / Aile Hekimliği Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2007
Konu: Çocuk Sağlığı ve Hastalıkları = Child Health and Diseases

Özet:
ishal yocuk oliimlerinin onde gel en nedenlerinden birisidir. Ozellikle
ge1i~mekte olan iilkelerde ishale bagh morbidite ve mortalite yiiksektir. Bu
yah~mamn amaCI 1-72 ay grubu yocuklann yaz ishalleri ile sosyal etkenler arasmdaki
i1i~kiyi ara~trrmak ve bunlann etkilerini incelemek, ishal olmalanm etkileyen sosyal
faktorleri saptayarak yocuklarm normal biiyiimelerinin saglanmasma ve gerekli
onlemlerin ahnmasma katktda bulunmaktlr.
<;ah~ma kesitsel, prospektif ve kontrollii olarak Haziran-Agustos 2005 ve
Haziran-Agustos 2006 tarihleri arasmda yaplldl. Saghk Bakan1lg1 Ankara Egitim ve
Ara~tlrma Hastanesi <;ocuk poliklinigine ba~vuran 1-72 ay araSI 450 ishalli yocuk
yah~maya ahndl. Kontrol grubu son bir aydlr ishal olmayan, 1-72 ay arasmdaki 200
yocuktan olu~turuldu. Anket formunda yocuklann ya~l, cinsiyeti, anne-baba egitim
durumu, anne-baba ya~lan, annenin aglzdan SIVI tedavisi (AST) bilgi durumu, kay
kez ishal oldugu, sosyo-ekonomik diizeyi, a~llanma durumu, oturulan konut tipi,
vitamin preparatl almasl, ailede ya~ayan ki~i saytSI, su kaynaklan, anne siitiine
devam siiresi, inek siiru ahml, ek gtdaya ba~lamasl, annelerin tuvalet kagldl kullanma
durumu, anne1erin tuvalet sonraSI el ytkamasl, annelerin yemek yapmadan once el
ytkamasl, haftada eve gelen misafir silllgl, annenin yah~maSI, ailede ya~ayan ki~i
saytSI, ailede ya~ayan yocuk saytSI, kaymCI yocuk oldugu, evin kanalizasyon durumu,
aym evde ya~ayan diger bireylerde ishal goriilme durumu sorgulandl. Elde edilen
tUm 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. Gruplar
arasmda AST kullamml ile ilgili bilgi diizeyleri degerlendirildiginde hasta grubunda
AST kullamm1ll1 bilmeyen annelerin oramnm daha yiiksek oldugu bulundu
(p=O.008). Anne egitim diizeyi arttlkc;a AST kullammlm bilme orammn da anlamh
olarak arttlgl gozlendi (p=O.OOOl). <;ah~maya alman gruplar arasmda a~tlarm
tamamlanmasl aC;lsmdan anlamh fark bulundu (p=O.OOOl). ishal olanlarda
kontrollere gore yiiksek orand a a~llann tamamlanmadlgl goriildii. Gelir diizeyi
aC;lsmdan kar~tla~tmldlgmda gelir diizeyinin hasta grubunda daha dii~iik oldugu
saptandl (p=O.04). ishal grubunda (% 67.3) olanlarda kontrollere (%45.5) gore
gecekonduda oturma oram daha yiiksekti (p=O.OOOl). Gruplar vitamin preparatl alma
sfueleri aC;lsmdan kar~lla~tmldlgmda hasta grubunda, vitamin preparatl almayaruann
oram kontrol grubuna gore anlamh derecede yiiksek saptandl (p=O.OOl).
<;ocuk ya~l kiic;iildiikc;e, annenin AST bilgisi yoksa, c;ocuk yetersiz
a~llanml~sa, yeterli vitamin destegi almaml~sa, ailenin sosyo-ekonomik diizeyi
dii~iil(se ishal olma oram artmaktadlr. Annelerin yemek yapmadan once el ytkamalan
c;ocuklarda ishal goriilme oranlanm azaltmaktadlr. <;ocuklann baktmmda
biiyiimesinde, egitiminde biiyiik rol oynayan annenin egitimi ve ailenin ya~adlgl
sosyal c;evrenin diizeltilmesi ishallerin oruenmesinde onemlidir. Ya~amlan sosyal
c;evrenin iyile~tirilmesi konusunda ilgili kurum ve ki~ilerin iizerlerine dii~en gorevleri
yapmalanmn gerekliligini vurgulamak istiyoruz.

Abstract:
Acute gastroenteritis is among the main causes of death of children. Mortality
and morbidity is high especially in developing countries. The aim of this study is to
determine the association between social factors and acute gastroenteritis occurred
during summer, among children aged between land 72 months and to investigate the
effects of these; providing help to normal growth of children and contribution to
taking preventive measures, by determining effecting factors.
The study was prospectively carried out between 2005 and 2006 June to
August. 450 children with acute gastroenteritis that admitted to Ministry of Health
Ankara Education and Research Hospital were recruited. Control group was
constituted with 200 children that did not have acute gastroenteritis in the last one
month. The questionnaire included the age and gender of the child, education level
and ages of parents, mother's knowledge about ORS, number of acute gastroenteritis
the child experienced, economic level of the family, the type and sewerage system of
house, vitamin supplementation, number of people and children in the family, type of
water source, breast milk duration, feeding with cow's milk, starting to
supplementary foods, the status of mothers about habitude of hand washing and
using toilet paper. The frequency of visitors to home in a week, mother's working
status, and acute gastroenteritis experience in members of the family were asked. The
data were numerically coded and analyses were performed using SPSS (Statistical
Program for Social Sciences), version 12.
The mean age of children in patient group was 31.8±20.9 months, and
31.4±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 groups
were compared according to ORS knowledge, amount of mothers with ORS

knowledge in patient group was lower (p=0.008). The rate of ORS knowledge of the
mothers increased with the increase in education level (p=0.0001). Groups had
statistically 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). In
addition, children in patient group (67.3%) had higher rates of living in shanty than
controls (45.5%) (p=0.0001). When groups were compared according to duration of
vitamin supplementation patients had lower rates of vitamin supplementation
compared to controls.
The rate of acute gastroenteritis increases without ORS knowledge of the
mother, incomplete vaccination, inadequate rate of vitamin and young age of the
child, and low socioeconomic level of the family. If the mother has the habitudes of
hand washing rate of gastroenteritis decreases.
Mother's education considers importance because they have the most
important role in nursing, growth, education and training as an individual. hnproving
the social environment, which they live in and education of the mothers is essential.
We think that both individuals and institutions should make their duty concerning
them.