{"id":24891,"date":"2022-06-27T09:00:17","date_gmt":"2022-06-27T06:00:17","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=24891"},"modified":"2022-06-27T13:01:48","modified_gmt":"2022-06-27T10:01:48","slug":"gebelerin-tetanos-asisina-yaklasimlari-2","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2022\/06\/27\/gebelerin-tetanos-asisina-yaklasimlari-2\/","title":{"rendered":"Gebelerin Tetanos A\u015f\u0131s\u0131yla \u0130lgili Bilgi, Tutum ve Davran\u0131\u015flar\u0131n\u0131n De\u011ferlendirilmesi"},"content":{"rendered":"

G\u0130R\u0130\u015e<\/h2>\n

A\u015f\u0131 ile korunulabilen bir hastal\u0131k olmas\u0131na ra\u011fmen tetanosun hala insan sa\u011fl\u0131\u011f\u0131n\u0131 tehdit etmeye devam etti\u011fi g\u00f6r\u00fclmektedir. Tetanos; yetersiz hijyen ko\u015fullar\u0131na sahip, ekonomik olarak yoksul ve yeterli sa\u011fl\u0131k hizmetine eri\u015fimin olmad\u0131\u011f\u0131 b\u00f6lgelerde \u00f6zellikle yayg\u0131n olarak g\u00f6r\u00fclmektedir (1).\u00a0<\/span><\/span><\/p>\n

Kaynaklar\u0131n s\u0131n\u0131rl\u0131 oldu\u011fu b\u00f6lgelerde tetanostan \u00f6l\u00fcm oranlar\u0131 %100\u2019e kadar \u00e7\u0131kabilmektedir; ancak do\u011fru yakla\u015f\u0131mlarla bu oran %10-20\u2019ye kadar d\u00fc\u015f\u00fcr\u00fclebilir (2). T\u00fcm ya\u015f gruplar\u0131nda ortaya \u00e7\u0131kmakla birlikte \u00f6zellikle hijyenik olmayan ko\u015fullarda do\u011fum durumunda, yenido\u011fanlar ve gebe kad\u0131nlar en fazla risk alt\u0131nda olan grubu olu\u015fturmaktad\u0131r (3). Maternal ve neonatal tetanosun \u00f6nlenmesi, do\u011fumda basit hijyenik uygulamalar ve \u00f6zellikle gebe kad\u0131nlar\u0131n tetanosa kar\u015f\u0131 ba\u011f\u0131\u015f\u0131klanmas\u0131yla sa\u011flanabilir (4). Bir meta-analitik \u00e7al\u0131\u015fmada, gebe kad\u0131nlar\u0131n en az iki doz tetanos toksoidi ile ba\u011f\u0131\u015f\u0131klanmas\u0131n\u0131n tetanosa ba\u011fl\u0131 neonatal mortaliteyi %94 oran\u0131nda azaltabilece\u011fi g\u00f6sterilmi\u015ftir (5). Bu nedenle, D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6), tetanos a\u015f\u0131s\u0131 \u00f6yk\u00fcs\u00fc olmayan kad\u0131nlara toplam be\u015f doz tetanos a\u015f\u0131s\u0131 \u00f6nermektedir (6). Gebe kad\u0131nlar aras\u0131nda tetanos toksoidi ile ba\u011f\u0131\u015f\u0131klanma oranlar\u0131n\u0131 de\u011ferlendiren bir yay\u0131nda ise ba\u011f\u0131\u015f\u0131klanman\u0131n G\u00fcneydo\u011fu Asya\u2019da %95, Do\u011fu Akdeniz\u2019de %53, Afrika\u2019da %63\u2019e kadar de\u011fi\u015fen oranlarda oldu\u011fu g\u00f6r\u00fclm\u00fc\u015f; d\u00fcnya \u00e7ap\u0131nda ise ortalaman\u0131n %75 oldu\u011fu belirlenmi\u015ftir (7).\u00a0<\/span><\/p>\n

Banglade\u015f\u2019te yap\u0131lan bir \u00e7al\u0131\u015fmada, ba\u011f\u0131\u015f\u0131klanman\u0131n d\u00fc\u015f\u00fck oranda olmas\u0131n\u0131n ba\u015fl\u0131ca nedenleri, a\u015f\u0131lara yetersiz eri\u015fim ve bilgi eksikli\u011fi olarak tespit edilmi\u015ftir (8).\u00a0 <\/span>Bir ba\u015fka yay\u0131nda ise d\u00fc\u015f\u00fck oranda ba\u011f\u0131\u015f\u0131klanman\u0131n nedenleri olarak, tetanos a\u015f\u0131lamas\u0131n\u0131n nerede ve ne zaman yap\u0131laca\u011f\u0131n\u0131n bilgisine sahip olunmamas\u0131n\u0131n yan\u0131 s\u0131ra a\u015f\u0131lara ili\u015fkin yanl\u0131\u015f anlamalar\u0131n ve inan\u0131\u015flar\u0131n (k\u00fcrtaja neden olmas\u0131, k\u0131s\u0131rl\u0131k, vb.) oldu\u011fu bildirilmi\u015ftir (9).\u00a0<\/span><\/p>\n

Maternal ve neonatal tetanos eliminasyon giri\u015fimleri ile anne ve yenido\u011fan \u00f6l\u00fcmlerinin azalt\u0131lmas\u0131nda b\u00fcy\u00fck bir ilerleme kaydedilmesine ra\u011fmen, tetanos ba\u011f\u0131\u015f\u0131klanmas\u0131yla ilgili sorunlar halen ya\u015fanmaya devam etmektedir (10). Bu \u00e7al\u0131\u015fmada, gebelerin tetanos ba\u011f\u0131\u015f\u0131klanma durumlar\u0131n\u0131n, ba\u011f\u0131\u015f\u0131klanma s\u0131kl\u0131\u011f\u0131n\u0131n, tetanos a\u015f\u0131s\u0131na yakla\u015f\u0131mlar\u0131n\u0131n ve bunlar\u0131 etkileyen fakt\u00f6rlerin incelenmesi ama\u00e7lanm\u0131\u015ft\u0131r.<\/p>\n

Y\u00d6NTEMLER \u00a0<\/span><\/h2>\n

T\u00fcrkiye\u2019nin farkl\u0131 \u015fehirlerinden, gebeliklerinin farkl\u0131 a\u015famalar\u0131nda olan ve de\u011fi\u015fik nedenlerle hastaneye ba\u015fvuran 5000 gebe kad\u0131n \u00e7al\u0131\u015fmaya kat\u0131lmay\u0131 kabul etmi\u015ftir. Kat\u0131l\u0131mc\u0131lara, her bir merkezde tek bir hekim taraf\u0131ndan tetanos ile ilgili 19 soruluk bir anket y\u00fcz y\u00fcze uygulanm\u0131\u015ft\u0131r. Gebe kad\u0131nlara; ya\u015flar\u0131, gebelik say\u0131lar\u0131, mevcut gebeliklerinde tetanos a\u015f\u0131s\u0131 olup olmad\u0131klar\u0131 ile ilgili sorular sorulmu\u015ftur. Gebeli\u011fi s\u0131ras\u0131nda a\u015f\u0131lanmam\u0131\u015f olanlar\u0131n ba\u015fl\u0131ca a\u015f\u0131 olmama nedenleri incelenmi\u015ftir. Mevcut gebeliklerinde 2 doz a\u015f\u0131 olmu\u015f olanlar tam a\u015f\u0131l\u0131 olarak kabul edilmi\u015ftir. Ayr\u0131ca \u00f6nceki gebeliklerinde 2 doz a\u015f\u0131 yapt\u0131rd\u0131\u011f\u0131n\u0131 belirten ve mevcut gebeli\u011finde tek doz a\u015f\u0131 yapt\u0131ranlar da tam a\u015f\u0131l\u0131 olarak kabul edilmi\u015ftir. \u0130statistiksel analizlerde, Stata 9.0 program\u0131 (StataCorp, Teksas, ABD) kullan\u0131larak, kategorik de\u011fi\u015fkenler ki kare testi ile, s\u00fcrekli de\u011fi\u015fkenler Student-t test ile kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131. A\u015f\u0131lanman\u0131n; de\u011ferlendirilen durumlardan etkilenip etkilenmedi\u011fi Pearson ki kare testi ile, a\u015f\u0131lanmay\u0131 etkileyen ba\u011f\u0131ms\u0131z fakt\u00f6rler ise lojistik regresyon analizi testi ile belirlenmi\u015ftir. \u00c7al\u0131\u015fma protokol\u00fc, Batman B\u00f6lge Devlet Hastanesi Etik Kurulu taraf\u0131ndan 7.04.2018-89 karar numaras\u0131yla Helsinki Deklarasyonu\u2019na uygun olarak onaylanm\u0131\u015ft\u0131r. \u00a0<\/span><\/p>\n

BULGULAR<\/h2>\n
\"\"<\/a>

Tablo 1.<\/strong> Gebelerin Demografik \u00d6zellikleri ve A\u015f\u0131ya Kar\u015f\u0131 Tutumlar\u0131<\/p><\/div>\n

\"\"<\/a>

Tablo 2.<\/strong> Mevcut Gebelikte Tetanos A\u015f\u0131s\u0131 Yapt\u0131rma Oran\u0131n\u0131 Etkileyen Fakt\u00f6rler (Tek De\u011fi\u015fkenli Analiz)<\/p><\/div>\n

\"\"<\/a>

Tablo 3.<\/strong> Tetanos A\u015f\u0131s\u0131 Yapt\u0131rmay\u0131 Etkileyen Fakt\u00f6rler (\u00c7ok De\u011fi\u015fkenli Lojistik Regresyon Analizi)<\/p><\/div>\n

\u00c7al\u0131\u015fmaya; ya\u015flar\u0131 15 ile 44 (ortalama 28.5\u00b15.7) aras\u0131nda de\u011fi\u015fen, gestasyonel haftalar\u0131 8 ile 40 (ortalama 22.07\u00b18.5) aras\u0131nda olan, %20.5\u2019i Do\u011fu Anadolu, %14.6\u2019s\u0131 G\u00fcney Do\u011fu Anadolu, %14.3\u2019\u00fc \u0130\u00e7 Anadolu, %13\u2019\u00fc Karadeniz, %12.6\u2019s\u0131 Ege, %12.6\u2019s\u0131 Marmara ve %12.3\u2019\u00fc Akdeniz b\u00f6lgesinden olmak \u00fczere toplam 5000 gebe kat\u0131lm\u0131\u015ft\u0131r. Ankete cevap veren 108 (%2.1) gebe okur-yazar olmad\u0131\u011f\u0131n\u0131, 2414 (%48.2) gebe ilk\u00f6\u011fretim, 1381 (%27.6) gebe lise ve 1097 (%21.9) gebe y\u00fcksekokul veya \u00fcniversite mezunu oldu\u011funu belirtmi\u015ftir. B\u00f6lgeler aras\u0131nda e\u011fitim a\u00e7\u0131s\u0131ndan istatistiksel olarak anlaml\u0131 fark bulunmam\u0131\u015ft\u0131r (p<\/i><\/span>>0.05). Mevcut gebeli\u011fi ilk gebelik olanlar\u0131n say\u0131s\u0131 1752 (%35)\u2019dir. Daha \u00f6nce do\u011fumla sonu\u00e7lanan gebelik say\u0131lar\u0131 a\u00e7\u0131s\u0131ndan de\u011ferlendirildiklerinde, gebelik say\u0131lar\u0131n\u0131n 1 ile 8 aras\u0131nda de\u011fi\u015fti\u011fi g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Mevcut gebeli\u011fi hari\u00e7 do\u011fumla sonu\u00e7lanan \u00fc\u00e7ten fazla gebeli\u011fi bulunanlar\u0131n say\u0131s\u0131 354 (%7.08)\u2019t\u00fcr. Gebelerin 91 (%2.8)\u2019i daha \u00f6nceki gebeliklerinde hi\u00e7bir sa\u011fl\u0131k kurulu\u015funda takip edilmedi\u011fini ifade ederken 2164 (%66.6)\u2019\u00fc devlet hastanesinde, 135 (%4.6)\u2019i ise aile hekimi taraf\u0131ndan takip edildi\u011fini bildirmi\u015ftir. Mevcut gebeli\u011fi devlet hastanesinde takip edilen gebe say\u0131s\u0131 3876 (%77.5) olup 199 (%3.9) gebe aile hekimi taraf\u0131ndan takip edilmektedir. \u00d6nceki gebeliklerinde tetanos a\u015f\u0131s\u0131 yapt\u0131rmayan gebe say\u0131s\u0131 1069 (%32.2)\u2019dur. Tetanos a\u015f\u0131s\u0131n\u0131 kimin \u00f6nerdi\u011fi sorguland\u0131\u011f\u0131nda; 1052 (%46.6) gebeye aile hekiminin, 588 (%26) gebeye gebe takip hem\u015firesinin ya da ebesinin, 298 (%13.2) gebeye ise kad\u0131n hastal\u0131klar\u0131 ve do\u011fum uzman\u0131n\u0131n a\u015f\u0131 yapt\u0131rmas\u0131 \u00f6nerisinde bulundu\u011fu tespit edilmi\u015ftir. Kendi iste\u011fi ile a\u015f\u0131 olan gebe say\u0131s\u0131 316 (%14)\u2019d\u0131r. Gebelerin %27.3\u2019\u00fcnde gebelik d\u0131\u015f\u0131 bir nedenle tetanos a\u015f\u0131s\u0131 yapt\u0131rma \u00f6yk\u00fcs\u00fc mevcutken, %72.6\u2019s\u0131nda her hangi bir \u00f6yk\u00fc bildirilmemi\u015ftir. Gebelik d\u0131\u015f\u0131nda a\u015f\u0131 yapt\u0131rman\u0131n en s\u0131k (%64.2) nedeninin travma oldu\u011fu g\u00f6zlenmi\u015ftir. Gebelerin 4412 (%88.2)\u2019si mevcut gebeli\u011finde a\u015f\u0131 olmam\u0131\u015f olup 1024 (%23.2)\u2019\u00fc gebeli\u011finin ilerleyen zamanlar\u0131nda da a\u015f\u0131 yapt\u0131rmayaca\u011f\u0131n\u0131 bildirmi\u015ftir. A\u015f\u0131 yapt\u0131rmama nedenleri sorguland\u0131\u011f\u0131nda sadece 18 (%1.7) gebe a\u015f\u0131 takvimi tamamland\u0131\u011f\u0131 i\u00e7in a\u015f\u0131 yapt\u0131rmayaca\u011f\u0131n\u0131 belirtirken; 293 (%28.6) gebe yan etki geli\u015fmesi endi\u015fesiyle, 154 (%15.4) gebe bebe\u011fe zarar vermesinden ve 36 (%3.5) gebe d\u00fc\u015f\u00fck riskinden korktu\u011fu i\u00e7in a\u015f\u0131 yapt\u0131rmayaca\u011f\u0131n\u0131 belirtmi\u015ftir. \u0130ki y\u00fcz k\u0131rk be\u015f (%23.9) gebe a\u015f\u0131 yapt\u0131rmaya gerek duymad\u0131\u011f\u0131n\u0131, 205 (%20) gebe a\u015f\u0131 yapt\u0131rmas\u0131n\u0131n \u00f6nerilmedi\u011fini, 73 (%7.13) gebe de a\u015f\u0131n\u0131n koruyuculu\u011funun olmad\u0131\u011f\u0131n\u0131 d\u00fc\u015f\u00fcnd\u00fc\u011f\u00fcn\u00fc ifade etmi\u015ftir. Tetanos a\u015f\u0131s\u0131n\u0131n ne gibi yan etkileri oldu\u011funu d\u00fc\u015f\u00fcnd\u00fckleri soruldu\u011funda, 2819 (%56.3) gebe herhangi bir yan etkisi olmad\u0131\u011f\u0131n\u0131 d\u00fc\u015f\u00fcnd\u00fc\u011f\u00fcn\u00fc ve 159 (%3.1) gebe bu konuda bilgisi olmad\u0131\u011f\u0131n\u0131 s\u00f6ylerken; 690 (%13.8) gebe lokal, 357 (%7.1) gebe fel\u00e7 veya n\u00f6bet gibi n\u00f6rolojik,\u00a0 <\/span>324 (%6.4) gebe bebek \u00f6l\u00fcm\u00fc veya d\u00fc\u015f\u00fck gibi bebek kayb\u0131na neden olma, 254 (%5) gebe erken do\u011fum, 212 (%4.2) gebe sistemik (\u00f6rne\u011fin ate\u015f), 115 (%2.3) gebe grip ve grip benzeri, 41 (%0.8) gebe kanser, 29 (%0.5) gebe otizm yan etkilerinin oldu\u011funu belirtmi\u015ftir. Tetanos a\u015f\u0131s\u0131 yapt\u0131rma \u00f6yk\u00fcs\u00fc varsa herhangi bir yan etki geli\u015fip geli\u015fmedi\u011fi soruldu\u011funda 599 (%15.4) gebe yan etki geli\u015fti\u011fini s\u00f6ylemi\u015f ancak bu yan etkiler sorguland\u0131\u011f\u0131nda hepsinin lokal yan etkiler oldu\u011fu saptanm\u0131\u015ft\u0131r (Tablo 1). \u00a0<\/span><\/p>\n

Mevcut gebeli\u011finde a\u015f\u0131 yapt\u0131r\u0131p yapt\u0131rmayacak olman\u0131n; b\u00f6lgeler aras\u0131nda ve liseye kadar e\u011fitim almaya, gebelik haftas\u0131na, ilk gebelik olmas\u0131na, do\u011fumla sonu\u00e7lanan gebelik say\u0131s\u0131na, aile hekiminde takipli olmaya ve gebelik d\u0131\u015f\u0131nda a\u015f\u0131 olmaya g\u00f6re istatistiksel olarak anlaml\u0131 \u015fekilde farkl\u0131 oldu\u011fu belirlenmi\u015ftir (Tablo 2).<\/p>\n

Lojistik regresyon analizinde; gebelik haftas\u0131n\u0131n, liseye kadar e\u011fitim alm\u0131\u015f olman\u0131n, aile hekiminde takipli olman\u0131n, do\u011fumla sonu\u00e7lanan \u00fc\u00e7ten fazla gebelik \u00f6yk\u00fcs\u00fcn\u00fcn ve \u00f6nceki gebelikte ya da gebeliklerde a\u015f\u0131 yapt\u0131rm\u0131\u015f olman\u0131n mevcut gebelikte a\u015f\u0131 yapt\u0131rma karar\u0131n\u0131 istatistiksel olarak anlaml\u0131 \u015fekilde etkileyen ba\u011f\u0131ms\u0131z fakt\u00f6rler oldu\u011fu bulunmu\u015ftur (Tablo 3).<\/p>\n

\u0130RDELEME<\/h2>\n

Neonatal tetanos sadece y\u00fcksek mortalitesinden dolay\u0131 de\u011fil sa\u011f kalanlarda b\u0131rakt\u0131\u011f\u0131 sekellerden dolay\u0131 da \u00f6nlenmesi gereken bir hastal\u0131kt\u0131r. \u00d6nlenebilen bir hastal\u0131k olan neonatal tetanos gebelerin a\u015f\u0131lanmas\u0131 ile en aza indirebilir ve hatta tamamen eradike edilebilir. Ancak \u00fclkemizde yap\u0131lan az say\u0131da \u00e7al\u0131\u015fmada g\u00f6rd\u00fc\u011f\u00fcm\u00fcz \u00fczere gebelerin tam doz tetanos a\u015f\u0131s\u0131 yapt\u0131rma oranlar\u0131 endi\u015fe verici oranda d\u00fc\u015f\u00fckt\u00fcr. Maral ve arkada\u015flar\u0131n\u0131n (11) 2001 y\u0131l\u0131nda yapt\u0131klar\u0131 \u00e7al\u0131\u015fmada, Ankara\u2019da gebelerin son gebeliklerinde en az bir doz a\u015f\u0131 yapt\u0131rma oran\u0131 %46.7 olarak; Kala\u00e7a ve arkada\u015flar\u0131n\u0131n (12) 2004 y\u0131l\u0131nda yapt\u0131klar\u0131 \u00e7al\u0131\u015fmada ise bu oran \u0130stanbul\u2019da %21.6 olarak saptanm\u0131\u015ft\u0131r. Bizim \u00e7al\u0131\u015fmam\u0131zda da T\u00fcrkiye\u2019nin yedi farkl\u0131 co\u011frafi b\u00f6lgesinden \u00e7al\u0131\u015fmaya kat\u0131lan 5000 gebenin %32.2\u2019sinin \u00f6nceki gebeliklerinde tetanos a\u015f\u0131s\u0131 yapt\u0131rmad\u0131\u011f\u0131 tespit edilmi\u015ftir. Gebelerin %18.6\u2019s\u0131 mevcut gebeli\u011finde de tetanos a\u015f\u0131s\u0131 yapt\u0131rmam\u0131\u015f ve %5.6\u2019s\u0131n\u0131n da mevcut gebeli\u011finde tetanos a\u015f\u0131s\u0131 yapt\u0131rmay\u0131 d\u00fc\u015f\u00fcnmedi\u011fi saptanm\u0131\u015ft\u0131r. \u00d6nceki gebeliklerinde ve mevcut gebeli\u011finde tetanos a\u015f\u0131s\u0131 yapt\u0131rmam\u0131\u015f olan gebelerin 221 (%82.4)\u2019i gebelik d\u0131\u015f\u0131 bir nedenle de tetanos a\u015f\u0131s\u0131 yapt\u0131rmad\u0131\u011f\u0131n\u0131 bildirmi\u015ftir.\u00a0<\/span><\/p>\n

2019 y\u0131l\u0131nda yay\u0131nlanan D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6) verilerine g\u00f6re T\u00fcrkiye\u2019de \u00e7ocukluk \u00e7a\u011f\u0131nda tetanos a\u015f\u0131s\u0131 uygulanma oran\u0131 %96\u2019d\u0131r; bu oran gebelik s\u00fcrecinde %50\u2019ye d\u00fc\u015fmektedir (10). Ne yaz\u0131k ki bu oranlar DS\u00d6 taraf\u0131ndan istenilen %80 a\u015f\u0131lanma oran\u0131ndan uzak olup bu kapsamda gerekli \u00f6nlemleri almak \u00f6nemlidir. \u00dclkemizden Maral ve arkada\u015flar\u0131n\u0131n (11) yapt\u0131\u011f\u0131 \u00e7al\u0131\u015fmada, gebeli\u011fi s\u0131ras\u0131nda bir doz tetanos a\u015f\u0131s\u0131 yapt\u0131ran gebelerde tespit edilen koruyuculuk d\u00fczeyi %93.5\u2019tir; iki doz tetanos a\u015f\u0131s\u0131 yapt\u0131ranlarda bu oran\u0131n %95.6\u2019ya ula\u015ft\u0131\u011f\u0131 belirlenmi\u015ftir. Dolay\u0131s\u0131yla gebelerin tetanos a\u015f\u0131s\u0131 ile a\u015f\u0131lanmalar\u0131 koruyuculuk oranlar\u0131n\u0131 art\u0131rmak a\u00e7\u0131s\u0131ndan da ayr\u0131ca \u00f6nemlidir.<\/p>\n

\u00c7al\u0131\u015fmam\u0131zda, a\u015f\u0131 yapt\u0131rmayaca\u011f\u0131n\u0131 bildiren gebelerin %20\u2019si a\u015f\u0131 yapt\u0131rmas\u0131n\u0131 herhangi bir ki\u015fi \u00f6nermedi\u011fi i\u00e7in a\u015f\u0131 yapt\u0131rmayaca\u011f\u0131n\u0131 ifade etmi\u015ftir. Daha \u00f6nce Kala\u00e7a ve arkada\u015flar\u0131n\u0131n \u00fclkemizde yapt\u0131\u011f\u0131 \u00e7al\u0131\u015fmada a\u015f\u0131 yapt\u0131rmam\u0131\u015f olan gebelerin \u00f6nemli bir k\u0131sm\u0131n\u0131n tetanos a\u015f\u0131s\u0131 yapt\u0131rmalar\u0131 gerekti\u011fini bilmedikleri saptanm\u0131\u015ft\u0131r (12). Hindistan\u2019da yap\u0131lan bir \u00e7al\u0131\u015fmada ise tetanos a\u015f\u0131s\u0131 yapt\u0131rmayan gebelerin %44\u2019\u00fcn\u00fcn tetanos a\u015f\u0131s\u0131n\u0131n gereklili\u011fini, %29\u2019unun ise tetanos a\u015f\u0131s\u0131n\u0131n nerede ve ne zaman yap\u0131lmas\u0131 gerekti\u011fini bilmedikleri belirlenmi\u015ftir (13).\u00a0 <\/span>Gebelerin tetanos a\u015f\u0131s\u0131n\u0131n gereklili\u011fi konusunda bilgilendirilmeleri olduk\u00e7a \u00f6nemlidir.<\/p>\n

D\u00fcnyada ve T\u00fcrkiye\u2019de son y\u0131llarda a\u015f\u0131 karars\u0131zl\u0131\u011f\u0131 ve kar\u015f\u0131tl\u0131\u011f\u0131, bunlara ba\u011fl\u0131 olarak da a\u015f\u0131 reddi giderek artmaktad\u0131r. \u00dclkemizde 2011 y\u0131l\u0131nda 183 a\u015f\u0131 reddi mevcutken takip eden sekiz y\u0131l i\u00e7inde bu say\u0131n\u0131n 20 000\u2019in \u00fczerine \u00e7\u0131kt\u0131\u011f\u0131 g\u00f6r\u00fclm\u00fc\u015ft\u00fcr (14). A\u015f\u0131 kar\u015f\u0131tl\u0131\u011f\u0131 ve karars\u0131zl\u0131\u011f\u0131 kavramlar\u0131n\u0131n g\u00fcndeme gelmesi, toplumda daha \u00e7ok kar\u015f\u0131m\u0131za \u00e7\u0131kmas\u0131 ve bu durumun gebeleri de etkileyebilecek olmas\u0131 gebelerin a\u015f\u0131 yapt\u0131rmama nedenlerinin anla\u015f\u0131lmas\u0131n\u0131 son derece \u00f6nemli k\u0131lmaktad\u0131r. \u00c7al\u0131\u015fmam\u0131za kat\u0131lan gebelerin tetanos a\u015f\u0131s\u0131 yapt\u0131rmama nedenleri incelendi\u011finde; %28.6\u2019s\u0131n\u0131n yan etki geli\u015fmesinden, %15.4\u2019\u00fcn\u00fcn a\u015f\u0131n\u0131n bebe\u011fe zarar vermesinden, %3.5\u2019unun ise d\u00fc\u015f\u00fck riskinden korktu\u011fu i\u00e7in a\u015f\u0131 yapt\u0131rmad\u0131\u011f\u0131 tespit edilmi\u015ftir. Korkunun \u00f6nde gelen bir a\u015f\u0131 yapt\u0131rmama nedeni olarak kar\u015f\u0131m\u0131za \u00e7\u0131kmas\u0131yla birlikte; gebelerin %23.9\u2019unun a\u015f\u0131 yapt\u0131rmaya gerek duymad\u0131\u011f\u0131n\u0131, %20\u2019sinin a\u015f\u0131 yapt\u0131rmas\u0131n\u0131n \u00f6nerilmedi\u011fini ve %7.13\u2019\u00fcn\u00fcn de a\u015f\u0131n\u0131n koruyuculu\u011funun olmad\u0131\u011f\u0131n\u0131 d\u00fc\u015f\u00fcnd\u00fc\u011f\u00fcn\u00fc belirtmesi dikkat \u00e7ekici bulunmu\u015ftur. Da\u011fdeviren ve arkada\u015flar\u0131n\u0131n (15) yapt\u0131\u011f\u0131 \u00e7al\u0131\u015fmada, tetanos a\u015f\u0131s\u0131 yapt\u0131rmam\u0131\u015f olan 252 gebenin a\u015f\u0131 yapt\u0131rmama nedenleri sorguland\u0131\u011f\u0131nda; %46\u2019s\u0131n\u0131n a\u015f\u0131 yapt\u0131rmas\u0131 gerekti\u011fini bilmedi\u011fi ve %12.5\u2019inin ise a\u015f\u0131n\u0131n koruyucu olmad\u0131\u011f\u0131n\u0131 d\u00fc\u015f\u00fcnd\u00fc\u011f\u00fc g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Ayn\u0131 \u00e7al\u0131\u015fmada gebelerin %2.3\u2019\u00fc a\u015f\u0131n\u0131n i\u00e7eri\u011fiyle ilgili endi\u015feleri oldu\u011funu belirtmi\u015ftir. Yak\u0131n zamanda, T\u00fcrkiye\u2019de \u00fclke \u00e7ap\u0131nda yap\u0131lan ve aile hekimlerinin a\u015f\u0131 reddine yakla\u015f\u0131mlar\u0131n\u0131n de\u011ferlendirildi\u011fi bir \u00e7al\u0131\u015fmada, \u00e7al\u0131\u015fmaya kat\u0131lan hekimlerin %69\u2019unun en az bir defa hasta taraf\u0131ndan a\u015f\u0131n\u0131n reddedilmesi durumuyla kar\u015f\u0131la\u015ft\u0131\u011f\u0131 belirlenmi\u015f; en \u00e7ok reddedilen a\u015f\u0131n\u0131n ise tetanos a\u015f\u0131s\u0131n\u0131n da yer ald\u0131\u011f\u0131 be\u015fli karma a\u015f\u0131 oldu\u011fu tespit edilmi\u015ftir. Ayn\u0131 \u00e7al\u0131\u015fmada, a\u015f\u0131lar\u0131 en yayg\u0131n reddetme nedeninin, a\u015f\u0131lardaki maddelerin neden olabilece\u011fi yan etkiler oldu\u011fu saptanm\u0131\u015ft\u0131r (16).<\/p>\n

\u00c7al\u0131\u015fmam\u0131zda, beklenen yan etkiler sorguland\u0131\u011f\u0131nda; gebelerin %7.1\u2019i a\u015f\u0131n\u0131n fel\u00e7 veya n\u00f6bete, %6.4\u2019\u00fc \u00f6l\u00fcm veya d\u00fc\u015f\u00fck nedeniyle bebek kayb\u0131na, %5\u2019i erken do\u011fuma, %2.3\u2019\u00fc gribe, %0.5\u2019i ise otizme neden olabilece\u011fini d\u00fc\u015f\u00fcnd\u00fc\u011f\u00fcn\u00fc ifade etmi\u015ftir. Gebelerin %0.8\u2019i ise a\u015f\u0131n\u0131n kansere yol a\u00e7abilece\u011fini d\u00fc\u015f\u00fcnmektedir. Tetanos a\u015f\u0131s\u0131 yapt\u0131ranlarda geli\u015fen yan etkiler sorguland\u0131\u011f\u0131nda, sadece %15.4 oran\u0131nda lokal yan etki g\u00f6r\u00fcld\u00fc\u011f\u00fc saptanm\u0131\u015ft\u0131r. Gebelerin geli\u015fmesini bekledikleri yan etkiler ile ortaya \u00e7\u0131kanlar aras\u0131ndaki fark e\u011fitimin \u00f6nemini g\u00f6stermi\u015ftir.<\/p>\n

\u00c7al\u0131\u015fmam\u0131zda, tek de\u011fi\u015fkenli analiz sonucunda;\u00a0 <\/span>Ege b\u00f6lgesinde ya\u015fayanlar\u0131n, lise \u00fczerinde e\u011fitim e\u011fitim alm\u0131\u015f olanlar\u0131n, 24 hafta ve \u00fczerinde gebelik haftas\u0131nda olanlar\u0131n, ilk gebeli\u011fini ya\u015fayanlar\u0131n, do\u011fumla sonu\u00e7lanan en az 3 gebeli\u011fi olanlar\u0131n, aile hekiminde takip edilen gebelerin ve \u00f6nceki gebeliklerinde tetanos a\u015f\u0131s\u0131 yapt\u0131rmam\u0131\u015f olanlar\u0131n bu gebeliklerinde tetanos a\u015f\u0131s\u0131 yapt\u0131rma\u00a0 <\/span>isteklerinin istatistiksel olarak anlaml\u0131 d\u00fczeyde y\u00fcksek oldu\u011fu belirlenmi\u015ftir. Bunun birlikte, lojistik regresyon analizinde; gebelik haftas\u0131n\u0131n, liseye ve \u00fczerinde e\u011fitim alm\u0131\u015f olman\u0131n, aile hekiminde takipli olman\u0131n, do\u011fumla sonu\u00e7lanan \u00fc\u00e7ten fazla gebelik \u00f6yk\u00fcs\u00fc olmas\u0131n\u0131n ve \u00f6nceki gebelik ya da gebeliklerinde a\u015f\u0131 yapt\u0131rmam\u0131\u015f olman\u0131n mevcut gebelikte a\u015f\u0131 yapt\u0131racak olmay\u0131 istatistiksel olarak anlaml\u0131 d\u00fczeyde art\u0131ran ba\u011f\u0131ms\u0131z fakt\u00f6rler oldu\u011fu tespit edilmi\u015ftir.\u00a0<\/span><\/p>\n

S\u00f6nmez ve arkada\u015flar\u0131n\u0131n (17) yapt\u0131\u011f\u0131 \u00e7al\u0131\u015fmada da ya\u015f ile tetanos a\u015f\u0131s\u0131 olma aras\u0131nda anlaml\u0131 bir ili\u015fki saptanmazken; Maral ve arkada\u015flar\u0131n\u0131n (11) yapt\u0131\u011f\u0131 \u00e7al\u0131\u015fmada gen\u00e7 ya\u015f\u0131n anlaml\u0131 olarak a\u015f\u0131lanmay\u0131 art\u0131rd\u0131\u011f\u0131 belirlenmi\u015ftir. Her iki \u00e7al\u0131\u015fmada da \u00f6\u011frenim durumu ile a\u015f\u0131lanma aras\u0131nda bir ili\u015fki bulunmam\u0131\u015ft\u0131r. Hindistan ve Pakistan\u2019da yap\u0131lan iki farkl\u0131 \u00e7al\u0131\u015fmada ise \u00f6\u011frenim durumunun tetanos a\u015f\u0131lanmas\u0131n\u0131 do\u011fru orant\u0131l\u0131 olarak anlaml\u0131 \u015fekilde art\u0131rd\u0131\u011f\u0131 saptanm\u0131\u015ft\u0131r (18, 19).<\/p>\n

Bir\u00e7ok \u00fclkede, aile hekimleri a\u015f\u0131 uygulamas\u0131n\u0131n ana unsurudur ve hastalar\u0131n tutum ve bilgileri \u00fczerinde \u00f6nemli etkileri vard\u0131r. Bu nedenle aile hekimlerinin a\u015f\u0131lar\u0131n yararlar\u0131 ve etkinlikleri hakk\u0131nda hastalar\u0131n\u0131 do\u011fru bilgilendirmesi \u00e7ok de\u011ferlidir. Bir\u00e7ok \u00e7al\u0131\u015fmada da aile hekimlerinin mesleki yeterlili\u011finin a\u015f\u0131lanma programlar\u0131na ciddi katk\u0131 sa\u011flad\u0131\u011f\u0131 belirtilmi\u015ftir (20-22). Bizim \u00e7al\u0131\u015fmam\u0131zda da aile hekimi taraf\u0131ndan takipli olman\u0131n tetanos a\u015f\u0131lanma oranlar\u0131n\u0131 istatistiksel olarak anlaml\u0131 \u015fekilde art\u0131rm\u0131\u015f olmas\u0131, aile hekimlerinin toplum sa\u011fl\u0131\u011f\u0131 ve koruyucu hekimlik a\u00e7\u0131s\u0131ndan ne kadar \u00f6nemli oldu\u011funu bir kez daha g\u00f6stermi\u015ftir. Co\u011frafi b\u00f6lgelerin tamam\u0131n\u0131 temsil etmesi \u00e7al\u0131\u015fmam\u0131z\u0131n g\u00fc\u00e7l\u00fc y\u00f6n\u00fcn\u00fc olu\u015fturmakla birlikte t\u00fcm T\u00fcrkiye\u2019yi temsil edecek veriyi i\u00e7ermemektedir. Ancak 5000 gebelik bir kohortun de\u011ferlendirilmesiyle elde edilen sonu\u00e7lar \u00fclkemizdeki gebe kad\u0131nlar\u0131n tetanos a\u015f\u0131s\u0131na yakla\u015f\u0131mlar\u0131n\u0131 anlamak i\u00e7in yol g\u00f6sterici niteliktedir. <\/span>\u00a0<\/span><\/span><\/p>\n

Elde etti\u011fimiz veriler; a\u015f\u0131 karars\u0131zl\u0131\u011f\u0131 ve kar\u015f\u0131tl\u0131\u011f\u0131n\u0131n \u00f6nemli bir halk sa\u011fl\u0131\u011f\u0131 sorununa d\u00f6n\u00fc\u015fmemesi ve do\u011fru bilgi ile koruyucu sa\u011fl\u0131k hizmetlerinin daha etkin yap\u0131labilmesi i\u00e7in son derece \u00f6nemlidir. \u00c7al\u0131\u015fmam\u0131z; gebe kad\u0131nlar\u0131n, tetanos a\u015f\u0131s\u0131n\u0131n \u00f6nemi ve gereklili\u011fiyle ilgili mutlaka ayr\u0131nt\u0131l\u0131 bir \u015fekilde bilgilendirilmeleri, yanl\u0131\u015f bilgilerinin d\u00fczeltilmesi ve e\u011fitim ve dan\u0131\u015fmanl\u0131k deste\u011fi verilmesi gerekti\u011fine dikkat \u00e7ekmektedir.<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e A\u015f\u0131 ile korunulabilen bir hastal\u0131k olmas\u0131na ra\u011fmen tetanosun hala insan sa\u011fl\u0131\u011f\u0131n\u0131 tehdit etmeye devam etti\u011fi g\u00f6r\u00fclmektedir. Tetanos; yetersiz hijyen ko\u015fullar\u0131na sahip, ekonomik olarak yoksul ve yeterli sa\u011fl\u0131k hizmetine eri\u015fimin olmad\u0131\u011f\u0131 b\u00f6lgelerde \u00f6zellikle yayg\u0131n olarak g\u00f6r\u00fclmektedir (1).\u00a0 Kaynaklar\u0131n s\u0131n\u0131rl\u0131 oldu\u011fu b\u00f6lgelerde tetanostan \u00f6l\u00fcm oranlar\u0131 %100\u2019e kadar \u00e7\u0131kabilmektedir; ancak do\u011fru yakla\u015f\u0131mlarla bu oran %10-20\u2019ye kadar d\u00fc\u015f\u00fcr\u00fclebilir […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[5419,5418,5417,2799],"class_list":["post-24891","post","type-post","status-publish","format-standard","hentry","category-ozgun-arastirma","tag-asi-kararsizligi","tag-asi-karsitligi","tag-gebe","tag-tetanos"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/24891","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=24891"}],"version-history":[{"count":3,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/24891\/revisions"}],"predecessor-version":[{"id":24954,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/24891\/revisions\/24954"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=24891"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=24891"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=24891"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}