{"id":31614,"date":"2026-03-24T11:43:35","date_gmt":"2026-03-24T08:43:35","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=31614"},"modified":"2026-03-24T13:00:45","modified_gmt":"2026-03-24T10:00:45","slug":"2015-2024-arasinda-bilecik-ilinde-asi-reddi-egilimleri-on-yillik-degerlendirme","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2026\/03\/24\/2015-2024-arasinda-bilecik-ilinde-asi-reddi-egilimleri-on-yillik-degerlendirme\/","title":{"rendered":"2015\u20132024 Aras\u0131nda Bilecik \u0130linde A\u015f\u0131 Reddi E\u011filimleri: On Y\u0131ll\u0131k De\u011ferlendirme"},"content":{"rendered":"

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

A\u015f\u0131lar, bula\u015f\u0131c\u0131 hastal\u0131klar\u0131n \u00f6nlenmesi ve toplum ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131n\u0131n sa\u011flanmas\u0131nda en etkili ve ekonomik halk sa\u011fl\u0131\u011f\u0131 ara\u00e7lar\u0131ndan biridir. Ancak, son y\u0131llarda a\u015f\u0131ya y\u00f6nelik teredd\u00fct ve reddin art\u0131\u015f\u0131 hem bireysel hem de toplumsal d\u00fczeyde \u00f6nemli sa\u011fl\u0131k sorunlar\u0131na yol a\u00e7maktad\u0131r. D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6), a\u015f\u0131 karars\u0131zl\u0131\u011f\u0131n\u0131 21. y\u00fczy\u0131l\u0131n en b\u00fcy\u00fck k\u00fcresel sa\u011fl\u0131k tehditlerinden biri olarak tan\u0131mlam\u0131\u015f ve bu durumun salg\u0131n hastal\u0131klar\u0131n yeniden ortaya \u00e7\u0131kmas\u0131na zemin haz\u0131rlad\u0131\u011f\u0131n\u0131 bildirmi\u015ftir (1). K\u0131zam\u0131k, difteri ve bo\u011fmaca gibi uzun y\u0131llard\u0131r kontrol alt\u0131nda tutulan bula\u015f\u0131c\u0131 hastal\u0131klar, a\u015f\u0131lanma oranlar\u0131ndaki d\u00fc\u015f\u00fc\u015fle birlikte yeniden art\u0131\u015f g\u00f6stermektedir (2,3).<\/p>\n

A\u015f\u0131 karars\u0131zl\u0131\u011f\u0131; a\u015f\u0131lara eri\u015fim olmas\u0131na ra\u011fmen bireylerin a\u015f\u0131y\u0131 geciktirmesi veya tamamen reddetmesi olarak tan\u0131mlanmakta ve bir\u00e7ok fakt\u00f6rden etkilenmektedir. Bu fakt\u00f6rler aras\u0131nda sosyoekonomik durum, e\u011fitim d\u00fczeyi, dini inan\u00e7lar, a\u015f\u0131lar\u0131n yan etkilerine ili\u015fkin korkular, sosyal medya kaynakl\u0131 yanl\u0131\u015f bilgi i\u00e7erikleri ve bilimsel otoritelere duyulan g\u00fcven eksikli\u011fi yer almaktad\u0131r (4,5). S\u00f6z konusu etkenler, toplum ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131n\u0131 tehdit ederek a\u015f\u0131yla \u00f6nlenebilir hastal\u0131klar\u0131n yay\u0131l\u0131m\u0131n\u0131 kolayla\u015ft\u0131rmaktad\u0131r (6).<\/p>\n

K\u00fcresel \u00f6l\u00e7ekte her y\u0131l yakla\u015f\u0131k 1.5 milyon \u00e7ocu\u011fun, yaln\u0131zca a\u015f\u0131yla \u00f6nlenebilecek hastal\u0131klar nedeniyle hayat\u0131n\u0131 kaybetti\u011fi tahmin edilmektedir (7). Avrupa\u2019da 2018 y\u0131l\u0131nda bildirilen 80 000\u2019den fazla k\u0131zam\u0131k olgusunun \u00e7o\u011fu, a\u015f\u0131 reddinin yo\u011fun oldu\u011fu topluluklarda g\u00f6r\u00fclm\u00fc\u015f; ABD\u2019de ise 2019 y\u0131l\u0131nda son 25 y\u0131l\u0131n en y\u00fcksek k\u0131zam\u0131k olgu say\u0131s\u0131na ula\u015f\u0131lm\u0131\u015ft\u0131r (3,8). T\u00fcrkiye\u2019de de a\u015f\u0131 reddi son y\u0131llarda art\u0131\u015f g\u00f6stermi\u015ftir. T.C. Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 verilerine g\u00f6re, 2011 y\u0131l\u0131nda yaln\u0131zca 183 olan a\u015f\u0131 reddi say\u0131s\u0131, 2017 y\u0131l\u0131nda 23 600\u2019e ula\u015fm\u0131\u015ft\u0131r (9). Bu art\u0131\u015f, toplum ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131n\u0131n zay\u0131flamas\u0131na neden olmakta ve yerel d\u00fczeyde ciddi halk sa\u011fl\u0131\u011f\u0131 riskleri do\u011furmaktad\u0131r.<\/p>\n

\u00d6zellikle son 10 y\u0131lda (2015 ve sonras\u0131), baz\u0131 k\u00fcresel ve ulusal s\u00fcre\u00e7ler a\u015f\u0131 reddini, halk\u0131n g\u00fcvenini ve uygulama prati\u011fini \u00f6nemli \u00f6l\u00e7\u00fcde etkilemi\u015ftir. \u00d6rne\u011fin, 2020 sonras\u0131 COVID-19 pandemisi, halk\u0131n a\u015f\u0131ya yakla\u015f\u0131m\u0131n\u0131 yeniden \u015fekillendirmi\u015f, risk alg\u0131lar\u0131n\u0131 ve a\u015f\u0131 tart\u0131\u015fmalar\u0131n\u0131 derinle\u015ftirmi\u015ftir. T\u00fcrkiye\u2019de yap\u0131lan \u00e7al\u0131\u015fmalarda \u201ci\u00e7eri\u011fine g\u00fcvenmeme\u201d gerek\u00e7esi pandemi sonras\u0131 a\u015f\u0131 reddi nedenleri aras\u0131nda en s\u0131k bildirilen sebeplerden biri olarak ortaya \u00e7\u0131km\u0131\u015ft\u0131r. \u00d6rne\u011fin D\u00fczce\u2019de yap\u0131lan bir ankette a\u015f\u0131 reddi i\u00e7in %43 oranla i\u00e7eri\u011fe g\u00fcvenmeme ilk s\u0131rada yer alm\u0131\u015ft\u0131r (10). Ayr\u0131ca, sa\u011fl\u0131k sistemine duyulan g\u00fcvensizlik, genel n\u00fcfusta COVID-19 a\u015f\u0131 teredd\u00fcd\u00fcn\u00fc anlaml\u0131 d\u00fczeyde art\u0131ran bir fakt\u00f6r olarak saptanm\u0131\u015ft\u0131r (11).<\/p>\n

Belirli yarg\u0131 kararlar\u0131 ve y\u00f6netsel d\u00fczenlemeler de a\u015f\u0131 reddini etkileyen hukuki \u00e7er\u00e7eveyi \u015fekillendirmi\u015ftir. \u00d6rne\u011fin, 2015 y\u0131l\u0131nda Anayasa Mahkemesi, geni\u015fletilmi\u015f ba\u011f\u0131\u015f\u0131klama program\u0131 kapsam\u0131ndaki bebeklik d\u00f6nemi a\u015f\u0131lar\u0131n\u0131n yaln\u0131zca genelgeye dayan\u0131larak uygulanamayaca\u011f\u0131na karar vermi\u015f; bu karar, a\u015f\u0131 uygulamalar\u0131n\u0131n hukuki dayanak ihtiyac\u0131n\u0131 vurgulam\u0131\u015ft\u0131r (12,13). Yine 2. Hukuk Dairesi\u2019nin bir a\u015f\u0131 reddi davas\u0131na ili\u015fkin karar\u0131, velilerin a\u015f\u0131 i\u00e7eriklerine dair itirazlar\u0131n\u0131 dile getirme hakk\u0131n\u0131 kullanabilece\u011fini g\u00f6stermi\u015ftir (12). Bu t\u00fcr hukuki s\u00fcre\u00e7ler, ebeveynler a\u00e7\u0131s\u0131ndan a\u015f\u0131 reddini rasyonelle\u015ftirme zemini olu\u015fturabilir ve karar alma s\u00fcre\u00e7lerini etkileyebilir.<\/p>\n

T\u00fcrkiye\u2019de \u00e7ocukluk \u00e7a\u011f\u0131 a\u015f\u0131 uygulamalar\u0131, Ulusal A\u015f\u0131 Takvimi kapsam\u0131nda planlanmakta ve \u00fccretsiz olarak uygulanmaktad\u0131r. \u00d6rne\u011fin, bebeklerin do\u011fumda, 2., 4. ve 6. aylarda hepatit B a\u015f\u0131s\u0131, Bacillus Calmette\u2013Gu\u00e9rin (BCG) a\u015f\u0131s\u0131, difteri-asel\u00fcler bo\u011fmaca-tetanoz-inaktif polio a\u015f\u0131s\u0131-Haemophilus influenzae tip b konjuge a\u015f\u0131s\u0131 (DaBT-\u0130PA-Hib) kombinasyonu; 12. ayda k\u0131zam\u0131k-kabakulak-k\u0131zam\u0131k\u00e7\u0131k (KKK) ve su\u00e7i\u00e7e\u011fi a\u015f\u0131lar\u0131; ayr\u0131ca 18. ay ve okul giri\u015finde peki\u015ftirme dozlar\u0131 i\u00e7in programlanm\u0131\u015f a\u015f\u0131lar yer almaktad\u0131r. Bu a\u015f\u0131 takvimi, y\u0131llar i\u00e7inde g\u00fcncellenmi\u015f ve yeni a\u015f\u0131lar takvime eklenmi\u015ftir (14,15). A\u015f\u0131 reddi olgular\u0131n\u0131 bu takvimle kar\u015f\u0131la\u015ft\u0131rmak, reddin hangi dozlarda ve a\u015f\u0131 tiplerinde odakland\u0131\u011f\u0131n\u0131 anlamada \u00f6nemli katk\u0131 sa\u011flayabilir. Bu ba\u011flamda, a\u015f\u0131 reddine ili\u015fkin yerel verilerin analizi, hedefe y\u00f6nelik halk sa\u011fl\u0131\u011f\u0131 politikalar\u0131n\u0131n geli\u015ftirilmesi a\u00e7\u0131s\u0131ndan kritik \u00f6nem ta\u015f\u0131maktad\u0131r. T\u00fcrkiye\u2019de il baz\u0131nda a\u015f\u0131 reddi e\u011filimlerini inceleyen \u00e7al\u0131\u015fmalara duyulan ihtiya\u00e7 giderek artmaktad\u0131r.<\/p>\n

Bu \u00e7al\u0131\u015fman\u0131n amac\u0131, Bilecik ili \u00f6zelinde 2015\u20132024 y\u0131llar\u0131 aras\u0131nda bildirilen a\u015f\u0131 reddi olgular\u0131n\u0131 inceleyerek reddedilen a\u015f\u0131 t\u00fcrlerini, bireylerin a\u015f\u0131lanma durumlar\u0131n\u0131 (hi\u00e7 a\u015f\u0131lanmam\u0131\u015f veya eksik a\u015f\u0131l\u0131), a\u015f\u0131 reddi nedenlerini, cinsiyet ve yerle\u015fim yeri gibi demografik \u00f6zellikleri ile olgular\u0131n il\u00e7e baz\u0131nda co\u011frafi da\u011f\u0131l\u0131m\u0131n\u0131 analiz etmektir. Bu kapsamda elde edilen bulgular\u0131n hem Bilecik \u00f6zelinde hem de ulusal d\u00fczeyde y\u00fcr\u00fct\u00fclecek ba\u011f\u0131\u015f\u0131klama programlar\u0131n\u0131n geli\u015ftirilmesine katk\u0131 sa\u011flamas\u0131 ama\u00e7lanmaktad\u0131r.<\/p>\n

Y\u00d6NTEMLER<\/b><\/h2>\n

Bu ara\u015ft\u0131rma, kesitsel olarak tasarlanm\u0131\u015f bir epidemiyolojik \u00e7al\u0131\u015fmad\u0131r. \u00c7al\u0131\u015fman\u0131n evrenini, 2015\u20132024 y\u0131llar\u0131 aras\u0131nda Bilecik \u0130l Sa\u011fl\u0131k M\u00fcd\u00fcrl\u00fc\u011f\u00fc\u2019ne bildirilen ve Geni\u015fletilmi\u015f Ba\u011f\u0131\u015f\u0131klama Program\u0131 (GBP) kapsam\u0131nda uygulanan a\u015f\u0131lar\u0131 reddeden olgular olu\u015fturdu. Ara\u015ft\u0131rmada \u00f6rneklem se\u00e7imine gidilmedi ve bildirimi yap\u0131lan t\u00fcm a\u015f\u0131 reddi olgular\u0131 \u00e7al\u0131\u015fmaya dahil edildi.<\/p>\n

Marmara B\u00f6lgesi\u2019nde yer alan Bilecik\u2019in 2023 y\u0131l\u0131 itibar\u0131yla n\u00fcfusu yakla\u015f\u0131k 228 495\u2019tir (16). N\u00fcfusun \u00f6nemli bir k\u0131sm\u0131 il\u00e7e ve kasabalarda da\u011f\u0131lm\u0131\u015ft\u0131r. \u0130l genelinde bir devlet hastanesi, il\u00e7e hastaneleri ve bir\u00e7ok aile sa\u011fl\u0131\u011f\u0131 merkezi arac\u0131l\u0131\u011f\u0131yla birinci basamak sa\u011fl\u0131k hizmetleri sunulmaktad\u0131r. A\u015f\u0131 uygulamalar\u0131 aile sa\u011fl\u0131\u011f\u0131 merkezleri arac\u0131l\u0131\u011f\u0131yla y\u00fcr\u00fct\u00fclmekte ve il sa\u011fl\u0131k m\u00fcd\u00fcrl\u00fckleri taraf\u0131ndan koordine edilmektedir.<\/p>\n

Helsinki Bildirgesi\u2019ne uygun olarak y\u00fcr\u00fct\u00fclen \u00e7al\u0131\u015fma i\u00e7in KTO Karatay \u00dcniversitesi T\u0131p Fak\u00fcltesi \u0130la\u00e7 ve T\u0131bbi Cihaz D\u0131\u015f\u0131 Ara\u015ft\u0131rmalar Etik Kurulu\u2019ndan 26 Aral\u0131k 2024 tarih ve 2024\/027 karar numaras\u0131yla onay al\u0131nd\u0131. Ard\u0131ndan Bilecik \u0130l Sa\u011fl\u0131k M\u00fcd\u00fcrl\u00fc\u011f\u00fc de gerekli idari izinleri verdi.<\/p>\n

Veriler, 1\u201328 \u015eubat 2025 tarihleri aras\u0131nda \u0130l Sa\u011fl\u0131k M\u00fcd\u00fcrl\u00fc\u011f\u00fc\u2019nde, aile sa\u011fl\u0131\u011f\u0131 merkezleri taraf\u0131ndan bildirilen a\u015f\u0131 reddi tutanaklar\u0131n\u0131n incelenmesi yoluyla topland\u0131. Her bir olguya ili\u015fkin olarak a\u015f\u0131 reddinin ger\u00e7ekle\u015fti\u011fi y\u0131l, \u00e7ocu\u011fun ya\u015f\u0131 ve cinsiyeti, ikamet edilen il, il\u00e7e ve kasaba bilgileri, reddedilen a\u015f\u0131 t\u00fcr\u00fc, a\u015f\u0131lanma durumu (hi\u00e7 a\u015f\u0131lanmam\u0131\u015f ya da eksik a\u015f\u0131l\u0131) ve a\u015f\u0131 reddi nedeni sistematik bi\u00e7imde kaydedildi. A\u015f\u0131 reddi nedenleri \u00fc\u00e7 kategori alt\u0131nda s\u0131n\u0131fland\u0131r\u0131ld\u0131: Ailenin bilin\u00e7li a\u015f\u0131 reddi, t\u0131bbi nedenler (\u00e7ocu\u011fun sa\u011fl\u0131k durumu nedeniyle), g\u00f6\u00e7 nedeniyle a\u015f\u0131lama yap\u0131lamamas\u0131.<\/p>\n

A\u015f\u0131 reddi prevalans\u0131n\u0131n hesaplanmas\u0131nda iki farkl\u0131 y\u00f6ntem kullan\u0131ld\u0131. Her y\u0131l i\u00e7in canl\u0131 do\u011fum say\u0131lar\u0131 baz al\u0131narak y\u0131ll\u0131k genel prevalans hesapland\u0131. Canl\u0131 do\u011fum verileri T\u00fcrkiye \u0130statistik Kurumu\u2019ndan (T\u00dc\u0130K) al\u0131nd\u0131 (16). Prevalans hesaplamas\u0131 i\u00e7in a\u015fa\u011f\u0131daki form\u00fcl kullan\u0131ld\u0131:<\/p>\n

A\u015f\u0131 Reddi Prevalans\u0131 (%) = (A\u015f\u0131y\u0131 Reddeden Ki\u015fi Say\u0131s\u0131 \/ Toplam Hedef Pop\u00fclasyon) \u00d7 100<\/p>\n

2024 y\u0131l\u0131na ait do\u011fum verileri hen\u00fcz kesinle\u015fmedi\u011fi i\u00e7in bu y\u0131la ili\u015fkin prevalans a\u015fa\u011f\u0131da verilen iki farkl\u0131 projeksiyon y\u00f6ntemiyle tahmini olarak hesapland\u0131.<\/p>\n

Ortalama Y\u00f6ntemi<\/i>: 2015\u20132023 y\u0131llar\u0131 aras\u0131nda kaydedilen canl\u0131 do\u011fum say\u0131lar\u0131n\u0131n aritmetik ortalamas\u0131 al\u0131nd\u0131 ve 2024 y\u0131l\u0131 i\u00e7in tahmini do\u011fum say\u0131s\u0131 2362 olarak belirlendi.<\/p>\n

E\u011filim Analizi<\/i>: 2022\u20132023 aras\u0131ndaki %1.5\u2019lik do\u011fum say\u0131s\u0131 d\u00fc\u015f\u00fc\u015f oran\u0131 temel al\u0131narak, 2024 y\u0131l\u0131 i\u00e7in do\u011fum say\u0131s\u0131 yakla\u015f\u0131k 2182 olarak hesapland\u0131.<\/p>\n

A\u015f\u0131 reddinin ya\u015f gruplar\u0131na g\u00f6re da\u011f\u0131l\u0131m\u0131n\u0131 daha ayr\u0131nt\u0131l\u0131 analiz edebilmek amac\u0131yla, 0\u20134 ya\u015f, 5\u20139 ya\u015f ve 10\u201314 ya\u015f gruplar\u0131na y\u00f6nelik prevalans hesaplamalar\u0131 yap\u0131ld\u0131. Her y\u0131l i\u00e7in bu ya\u015f gruplar\u0131na ait n\u00fcfus verileri kullan\u0131larak ya\u015f grubuna \u00f6zel prevalanslar, ilgili ya\u015f aral\u0131\u011f\u0131ndaki n\u00fcfus i\u00e7indeki a\u015f\u0131 reddi say\u0131s\u0131 dikkate al\u0131narak a\u015fa\u011f\u0131daki form\u00fclle hesapland\u0131:<\/p>\n

Ya\u015f Grubu Prevalans\u0131 (%) = (Ya\u015f Grubundaki A\u015f\u0131 Reddi Say\u0131s\u0131 \/ Ya\u015f Grubundaki Toplam N\u00fcfus) \u00d7 100<\/p>\n

A\u015f\u0131 reddi prevalans\u0131ndaki y\u0131ll\u0131k de\u011fi\u015fim h\u0131z\u0131n\u0131 analiz edebilmek amac\u0131yla, y\u0131llar aras\u0131ndaki prevalans de\u011fi\u015fim oranlar\u0131 da hesapland\u0131. Her y\u0131l i\u00e7in, bir \u00f6nceki y\u0131la k\u0131yasla prevalans\u0131n y\u00fczde olarak art\u0131\u015f veya azal\u0131\u015f oran\u0131 belirlendi. Bu hesaplama a\u015fa\u011f\u0131daki form\u00fcl kullan\u0131larak yap\u0131ld\u0131:<\/p>\n

Art\u0131\u015f Y\u00fczdesi (%) = (Yeni Y\u0131l Prevalans\u0131 \u2212 \u00d6nceki Y\u0131l Prevalans\u0131) \/ \u00d6nceki Y\u0131l Prevalans\u0131 \u00d7 100<\/p>\n

\u0130statistiksel Analizler<\/b><\/h3>\n

Toplanan veriler, SPSS for Windows s\u00fcr\u00fcm 18.0 (IBM Corp., Armonk, NY, ABD) program\u0131 kullan\u0131larak analiz edildi. Verilerin normal da\u011f\u0131l\u0131ma uygunlu\u011fu g\u00f6rsel y\u00f6ntemler (histogramlar ve olas\u0131l\u0131k grafikleri) ve Kolmogorov-Smirnov testi ile de\u011ferlendirildi. Say\u0131sal de\u011fi\u015fkenler i\u00e7in ortanca (1. \u00e7eyreklik \u2013 3. \u00e7eyreklik) de\u011ferleri hesapland\u0131. Kategorik de\u011fi\u015fkenler frekans (n) ve y\u00fczde (%) da\u011f\u0131l\u0131mlar\u0131 ile \u00f6zetlendi. Kategorik de\u011fi\u015fkenlerin kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131nda Pearson \u03c7\u00b2 testi kullan\u0131ld\u0131. \u0130statistiksel anlaml\u0131l\u0131k d\u00fczeyi p<\/i><0.05 olarak kabul edildi.<\/p>\n

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

\u015eekil 1.<\/strong> Y\u0131llar\u0131 G\u00f6re A\u015f\u0131 Reddi Oranlar\u0131<\/p><\/div>\n

\u00c7al\u0131\u015fmaya 2015\u20132024 y\u0131llar\u0131 aras\u0131nda bildirilen toplam 692 a\u015f\u0131 reddi olgusu dahil edildi. Olgular\u0131n %1.2\u2019si 2015\u2019te, %2.3\u2019\u00fc 2016\u2019da, %6.8\u2019i 2017\u2019de, %4.8\u2019i 2018\u2019de, %3.9\u2019u 2019\u2019da, %6.6\u2019s\u0131 2020\u2019de, %15.5\u2019i 2021\u2019de, %11.4\u2019\u00fc 2022\u2019de, %18.4\u2019\u00fc 2023\u2019te ve %29.2\u2019si 2024\u2019te kaydedildi. En y\u00fcksek oran 2024 y\u0131l\u0131nda tespit edildi (\u015eekil 1).\u00a0<\/span><\/p>\n

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Tablo 1.<\/strong> A\u015f\u0131 Reddi Olgular\u0131n\u0131n Demografik \u00d6zellikleri, A\u015f\u0131lanma Durumu ve A\u015f\u0131 Reddi Nedenleri<\/p><\/div>\n

Olgular\u0131n ya\u015f ortancas\u0131 1.0 (0\u20134) y\u0131l olup 350\u2019sini (%50.6) erkek \u00e7ocuklar, 342\u2019sini (%49.4) k\u0131z \u00e7ocuklar olu\u015fturdu. Ya\u015f grubu da\u011f\u0131l\u0131m\u0131 incelendi\u011finde olgular\u0131n 623\u2019\u00fcn\u00fcn (%90.0) 0\u20134 ya\u015f, 8\u2019inin (%1.2) 5\u20139 ya\u015f ve 61\u2019inin (%8.8) 10\u201314 ya\u015f grubunda oldu\u011fu g\u00f6r\u00fcld\u00fc. \u0130kamet yerine g\u00f6re olgular\u0131n 259\u2019unun (%37.4) il merkezinde, 433\u2019\u00fcn\u00fcn (%62.6) il\u00e7elerde ve kasabalarda ya\u015fad\u0131\u011f\u0131 belirlendi. A\u015f\u0131lanma durumu a\u00e7\u0131s\u0131ndan de\u011ferlendirildi\u011finde, 263\u2019\u00fcn\u00fcn (%38.0) hi\u00e7 a\u015f\u0131lanmam\u0131\u015f ve 429\u2019unun (%62.0) eksik a\u015f\u0131l\u0131 oldu\u011fu tespit edildi. A\u015f\u0131 reddi nedenlerine bak\u0131ld\u0131\u011f\u0131nda en s\u0131k neden ailelerin bilin\u00e7li a\u015f\u0131 reddi (n=595; %86.0) idi ve bunu t\u0131bbi nedenler (n=70; %10.1) ve g\u00f6\u00e7 (n=27; %3.9) izledi (Tablo 1).<\/p>\n

A\u015f\u0131 reddi olgular\u0131n\u0131n il merkezi ve il\u00e7elere g\u00f6re da\u011f\u0131l\u0131m\u0131 incelendi\u011finde, oranlar\u0131n y\u0131llar i\u00e7inde de\u011fi\u015fkenlik g\u00f6sterdi\u011fi ancak il\u00e7elerde il merkezine k\u0131yasla belirgin yo\u011funla\u015fma oldu\u011fu g\u00f6r\u00fcld\u00fc. \u00d6rne\u011fin 2015 y\u0131l\u0131nda il ve il\u00e7elerin oranlar\u0131 (%50.0) e\u015fit iken, bu oran il\u00e7elerde 2018 y\u0131l\u0131nda %78.8, 2020 y\u0131l\u0131nda ise %78.3 olarak ger\u00e7ekle\u015fmi\u015ftir. \u0130zleyen y\u0131llarda oranlar k\u0131smen dengelenmi\u015f olmakla birlikte 2022 (%69.6), 2023 (%67.7) ve 2024 (%58.4) y\u0131llar\u0131nda il\u00e7eler yine \u00f6ne \u00e7\u0131km\u0131\u015ft\u0131r. Genel e\u011filim olarak a\u015f\u0131 reddi olgular\u0131n\u0131n \u00f6zellikle 2018 sonras\u0131 d\u00f6nemde a\u011f\u0131rl\u0131kl\u0131 olarak il\u00e7elerde yo\u011funla\u015ft\u0131\u011f\u0131 s\u00f6ylenebilir.<\/p>\n

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Tablo 2.<\/strong> A\u015f\u0131 Reddi Olgular\u0131n\u0131n \u0130kamet Yeri ve Cinsiyete G\u00f6re Y\u0131ll\u0131k Da\u011f\u0131l\u0131m\u0131<\/p><\/div>\n

Cinsiyet da\u011f\u0131l\u0131m\u0131 y\u0131llara g\u00f6re incelendi\u011finde oranlar\u0131n y\u0131llar i\u00e7erisinde de\u011fi\u015fkenlik g\u00f6sterdi\u011fi ancak belirgin bir cinsiyet \u00fcst\u00fcnl\u00fc\u011f\u00fc olmad\u0131\u011f\u0131 tespit edildi. K\u0131z \u00e7ocuk oran\u0131 2015\u2019te %62.5 ile daha y\u00fcksekken, 2016\u2019da %43.8 ve 2017\u2019de %34.0 ile erkekler lehine idi. 2018\u2019de k\u0131z \u00e7ocuk oran\u0131 %57.6\u2019ya y\u00fckselmi\u015fti. Sonraki y\u0131llarda da\u011f\u0131l\u0131m dengelenmi\u015f ve k\u0131z \u00e7ocuk oranlar\u0131 2020\u2019de %47.8, 2021\u2019de %45.8, 2022\u2019de %53.2, 2023\u2019te %51.2 ve 2024\u2019te %51.0 olarak ger\u00e7ekle\u015fmi\u015fti (Tablo 2).<\/p>\n

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Tablo 3.<\/strong> Canl\u0131 Do\u011fumlara G\u00f6re A\u015f\u0131 Reddi Prevalans\u0131 ve Y\u0131ll\u0131k De\u011fi\u015fim Oranlar\u0131<\/p><\/div>\n

Canl\u0131 do\u011fumlara g\u00f6re hesaplanan y\u0131ll\u0131k a\u015f\u0131 reddi prevalanslar\u0131 incelendi\u011finde, 2015 y\u0131l\u0131nda %0.3 olan prevalans\u0131n, 2016 y\u0131l\u0131nda %0.59\u2019a y\u00fckseldi\u011fi, 2017 y\u0131l\u0131nda ise %1.77\u2019ye ula\u015ft\u0131\u011f\u0131 g\u00f6r\u00fcld\u00fc. 2018 (%1.25) ve 2019 (%1.06) y\u0131llar\u0131nda d\u00fc\u015f\u00fc\u015f g\u00f6zlenmekle birlikte 2020 y\u0131l\u0131nda prevalans %1.96\u2019ya y\u00fckselmi\u015fti. 2021 y\u0131l\u0131nda a\u015f\u0131 reddi prevalans\u0131 %4.66 ile \u00f6nceki y\u0131la g\u00f6re yakla\u015f\u0131k %137\u2019lik art\u0131\u015f g\u00f6stermi\u015fti. 2022 y\u0131l\u0131nda prevalans %3.51\u2019e gerilemi\u015f ancak 2023 y\u0131l\u0131nda %5.73\u2019e \u00e7\u0131karak yeniden art\u0131\u015f g\u00f6stermi\u015fti. 2024 y\u0131l\u0131 i\u00e7in yap\u0131lan tahmini hesaplamalarda, ortalama do\u011fum say\u0131s\u0131na g\u00f6re prevalans %8.55, e\u011filim analizine g\u00f6re ise %8.27 olarak hesapland\u0131. 2024 y\u0131l\u0131, her iki hesaplama y\u00f6ntemine g\u00f6re de a\u015f\u0131 reddi prevalans\u0131n\u0131n en y\u00fcksek oldu\u011fu y\u0131l olarak kaydedildi. Y\u0131llar aras\u0131 kar\u015f\u0131la\u015ft\u0131rmalarda, \u00f6zellikle 2016 (%96.67), 2017 (%200), 2020 (%84.91) ve 2021 (%137.75) y\u0131llar\u0131nda belirgin art\u0131\u015flar tespit edildi. Buna kar\u015f\u0131l\u0131k, 2018, 2019 ve 2022 y\u0131llar\u0131nda d\u00fc\u015f\u00fc\u015f e\u011filimi g\u00f6zlendi (Tablo 3).<\/p>\n

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Tablo 4.<\/strong> Ya\u015f Gruplar\u0131na G\u00f6re A\u015f\u0131 Reddi Olgular\u0131 ve Prevalans Oranlar\u0131<\/p><\/div>\n

Ya\u015f gruplar\u0131na g\u00f6re a\u015f\u0131 reddi olgular\u0131 ve prevalans oranlar\u0131 incelendi\u011finde, en y\u00fcksek prevalans 0\u20134 ya\u015f grubunda g\u00f6r\u00fcld\u00fc. Bu ya\u015f grubunda a\u015f\u0131 reddi prevalans\u0131 2015 y\u0131l\u0131nda %0.06 iken, y\u0131llar i\u00e7erisinde art\u0131\u015f g\u00f6stererek 2021 y\u0131l\u0131nda %0.70\u2019e, 2023 y\u0131l\u0131nda %0.87\u2019ye ve 2024 y\u0131l\u0131nda %1.61\u2019e y\u00fckselmi\u015fti. S\u0131n\u0131rl\u0131 veriye ra\u011fmen 5\u20139 ya\u015f grubunda a\u015f\u0131 reddi prevalanslar\u0131 2018\u2019de %0.04, 2021\u2019de %0.02 ve 2024\u2019te %0.00 olarak tespit edildi. \u00d6te yandan 10\u201314 ya\u015f grubunda prevalans 2018 y\u0131l\u0131nda %0.01 ile ba\u015flam\u0131\u015f, 2021\u2019de %0.09\u2019a y\u00fckselmi\u015f, 2023\u2019te %0.14 ile en y\u00fcksek de\u011ferine ula\u015fm\u0131\u015f ve 2024\u2019te %0.09 olarak hesaplanm\u0131\u015ft\u0131r (Tablo 4).\u00a0<\/span><\/p>\n

2015\u20132024 y\u0131llar\u0131 aras\u0131nda bildirilen olgular i\u00e7inde en s\u0131k reddedilen a\u015f\u0131 %41.8 ile DaBT-\u0130PA-Hib olarak tespit edildi; bunu s\u0131ras\u0131yla %36.3 ile KKK ve %35.1 ile pn\u00f6mokok konjuge a\u015f\u0131s\u0131 (PKA) izliyordu. Dozlara g\u00f6re en y\u00fcksek reddedilme oranlar\u0131, KKK hat\u0131rlatma (rapel) dozunda %23.6, hepatit B ikinci dozunda %22.5, PKA birinci dozunda %17.3, hepatit A birinci dozunda %15.8 ve su\u00e7i\u00e7e\u011fi birinci dozunda %15.7 olarak tespit edildi. Cinsiyet da\u011f\u0131l\u0131m\u0131 a\u015f\u0131 t\u00fcrlerine g\u00f6re benzerdi.<\/p>\n

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Tablo 4.<\/strong> A\u015f\u0131 T\u00fcr\u00fc ve Dozuna G\u00f6re A\u015f\u0131 Reddi Olgular\u0131n\u0131n Cinsiyete G\u00f6re Da\u011f\u0131l\u0131m\u0131 ve Ret Nedenleri (Aile Karar\u0131, T\u0131bbi Neden)<\/p><\/div>\n

Ret nedenleri incelendi\u011finde t\u00fcm a\u015f\u0131 dozlar\u0131nda en yayg\u0131n nedenin ailenin bilin\u00e7li a\u015f\u0131 reddi oldu\u011fu tespit edildi. A\u015f\u0131 t\u00fcrlerine g\u00f6re aile reddi oranlar\u0131 genel olarak y\u00fcksekti (Tablo 5).\u00a0<\/span><\/p>\n

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Tablo 6.<\/strong> A\u015f\u0131 Reddi Olgular\u0131n\u0131n A\u015f\u0131 T\u00fcr\u00fc ve Dozlara G\u00f6re Y\u0131ll\u0131k Da\u011f\u0131l\u0131m\u0131<\/p><\/div>\n

A\u015f\u0131 t\u00fcr\u00fc ve dozlara g\u00f6re y\u0131ll\u0131k da\u011f\u0131l\u0131m incelendi\u011finde, \u00f6zellikle primer serilerin ilk dozlar\u0131nda kayda de\u011fer reddin yan\u0131 s\u0131ra, ard\u0131\u015f\u0131k dozlarda ve hat\u0131rlatma dozlar\u0131nda da art\u0131\u015f e\u011filimi dikkat \u00e7ekmektedir. \u00d6rne\u011fin, hepatit B ikinci doz (%22.5), KKK hat\u0131rlatma dozu (%23.6) ve hepatit A ikinci doz (%37.3) y\u00fcksek reddedilme oranlar\u0131 ile \u00f6ne \u00e7\u0131kmaktad\u0131r. Ayr\u0131ca baz\u0131 a\u015f\u0131larda [PKA \u00fc\u00e7\u00fcnc\u00fc doz, OPA (oral polio a\u015f\u0131s\u0131) ikinci doz, Td (tetanoz + d\u00fc\u015f\u00fck doz difteri toksoidi i\u00e7eren a\u015f\u0131) hat\u0131rlatma dozu] belirli y\u0131llarda k\u00fcmelenmeler tespit edildi (Tablo 6).\u00a0<\/span><\/p>\n

\u0130RDELEME<\/b><\/h2>\n

Bu \u00e7al\u0131\u015fmada, 2015\u20132024 y\u0131llar\u0131 aras\u0131nda Bilecik ilinde bildirilen toplam 692 a\u015f\u0131 reddi olgusu analiz edildi ve y\u0131llar i\u00e7inde belirgin bir art\u0131\u015f e\u011filimi oldu\u011fu g\u00f6r\u00fcld\u00fc. 2015 y\u0131l\u0131nda a\u015f\u0131 reddi oran\u0131 %1.2 iken on y\u0131ll\u0131k s\u00fcre\u00e7te belirgin bir art\u0131\u015f meydana gelmi\u015fti. \u00d6zellikle 2024 y\u0131l\u0131nda g\u00f6r\u00fclen %29.2 a\u015f\u0131 reddi oran\u0131 \u00f6nceki y\u0131llara k\u0131yasla \u00f6nemli bir art\u0131\u015f\u0131 i\u015faret etmektedir. Bu d\u00f6nemde yaln\u0131zca a\u015f\u0131lama uygulamalar\u0131 de\u011fil, y\u00f6netsel d\u00fczenlemeler de a\u015f\u0131 reddi e\u011filimini etkileyebilecek bi\u00e7imde de\u011fi\u015fmi\u015ftir. \u00d6rne\u011fin, 2020\u2019de Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 A\u015f\u0131 Dan\u0131\u015fma Kurulu karar\u0131yla, ilk\u00f6\u011fretim 1. ve 8. s\u0131n\u0131f peki\u015ftirme a\u015f\u0131lar\u0131 okullarda de\u011fil aile sa\u011fl\u0131\u011f\u0131 merkezlerinde uygulanmaya ba\u015flanm\u0131\u015ft\u0131r. Ayr\u0131ca, aile sa\u011fl\u0131\u011f\u0131 merkezlerinde hedef bazl\u0131 performans sisteminin uygulanmas\u0131 ve bireylerin bu merkezlere d\u00fczensiz ba\u015fvurmas\u0131 durumunda sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n \u00fccretlerinde kesinti yap\u0131lmas\u0131na ili\u015fkin d\u00fczenlemeler, a\u015f\u0131 takibi ve toplumla ileti\u015fim s\u00fcre\u00e7lerinde bask\u0131y\u0131 art\u0131rarak ret e\u011filimini g\u00fc\u00e7lendirebilecek unsurlar olarak de\u011ferlendirildi.<\/p>\n

A\u015f\u0131 reddindeki bu e\u011filim yaln\u0131zca yerel d\u00fczeyde de\u011fil, ulusal ve k\u00fcresel \u00f6l\u00e7ekte de g\u00f6zlemlenmektedir. D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6), 2019 y\u0131l\u0131nda a\u015f\u0131 teredd\u00fcd\u00fcn\u00fc en \u00f6nemli on k\u00fcresel sa\u011fl\u0131k tehdidinden biri olarak tan\u0131mlam\u0131\u015f ve bu teredd\u00fcd\u00fcn a\u015f\u0131 ile \u00f6nlenebilir hastal\u0131klar\u0131n yeniden ortaya \u00e7\u0131kmas\u0131yla do\u011frudan ili\u015fkili oldu\u011funu bildirmi\u015ftir (1). Benzer \u015fekilde, DS\u00d6 ve Birle\u015fmi\u015f Milletler \u00c7ocuklara Yard\u0131m Fonu (United Nations Children\u2019s Fund, UNICEF) taraf\u0131ndan 2023 y\u0131l\u0131nda yay\u0131mlanan \u201cImmunization Agenda 2030<\/i>\u201d raporunda, COVID-19 pandemisini izleyen s\u00fcre\u00e7te a\u015f\u0131lanma oranlar\u0131nda belirgin bir d\u00fc\u015f\u00fc\u015f ya\u015fand\u0131\u011f\u0131 ve 2021 y\u0131l\u0131 itibar\u0131yla d\u00fcnya genelinde yakla\u015f\u0131k 25 milyon \u00e7ocu\u011fun temel a\u015f\u0131lar\u0131n\u0131 zaman\u0131nda tamamlayamad\u0131\u011f\u0131 bildirilmi\u015ftir (17). Birle\u015fik Krall\u0131k\u2019ta yap\u0131lan bir \u00e7al\u0131\u015fmada, pandemi sonras\u0131nda \u00e7ocukluk \u00e7a\u011f\u0131 a\u015f\u0131 reddinde %25\u2019e varan bir art\u0131\u015f g\u00f6zlenmi\u015ftir (18). Avrupa Hastal\u0131k \u00d6nleme ve Kontrol Merkezi\u2019nin (European Centre for Disease Prevention and Control, ECDC), 2022 tarihli raporunda genel a\u015f\u0131lama oranlar\u0131nda d\u00fc\u015f\u00fc\u015f ve a\u015f\u0131 teredd\u00fcd\u00fcnde art\u0131\u015f oldu\u011fu bildirilmi\u015ftir (19). Kazakistan\u2019da y\u00fcr\u00fct\u00fclen zaman serisi analizinde de benzer bir e\u011filim g\u00f6zlemlenmi\u015f olup 2013\u20132022 y\u0131llar\u0131 aras\u0131nda \u00e7ocukluk \u00e7a\u011f\u0131 a\u015f\u0131 reddinde devam eden bir art\u0131\u015f e\u011filimi tespit edilmi\u015ftir; \u00f6yle ki 2021\u2019de tespit edilen olgu say\u0131s\u0131 42 282 iken bu say\u0131 2022\u2019de 44 180\u2019e y\u00fckselmi\u015ftir (20). T\u00fcrkiye\u2019de ise 2011 y\u0131l\u0131nda yaln\u0131zca 183 olan a\u015f\u0131 reddi say\u0131s\u0131, 2015\u2019te 1370\u2019e, 2016\u2019da 5091\u2019e ve 2017\u2019de 23 000\u2019in \u00fczerine \u00e7\u0131km\u0131\u015ft\u0131r. Bu art\u0131\u015f, a\u015f\u0131lama oranlar\u0131n\u0131n da d\u00fc\u015fmesine yol a\u00e7m\u0131\u015f ve 2016\u2019da %98 olan oran 2017\u2019de %96\u2019ya gerilemi\u015ftir (9).<\/p>\n

Bulgular\u0131m\u0131z, Bilecik\u2019te g\u00f6zlenen a\u015f\u0131 reddi art\u0131\u015f\u0131n\u0131n yaln\u0131zca bireysel veya b\u00f6lgesel nedenlerle a\u00e7\u0131klanamayaca\u011f\u0131n\u0131, bunun k\u00fcresel \u00f6l\u00e7ekte sosyal, k\u00fclt\u00fcrel ve politik dinamiklerden de etkilenebilece\u011fini g\u00f6stermektedir. Literat\u00fcrde, a\u015f\u0131ya y\u00f6nelik tutumlar\u0131n yaln\u0131zca bilgi eksikli\u011finden de\u011fil, ayn\u0131 zamanda toplumdaki kanaat \u00f6nderi ya da rol model olarak g\u00f6r\u00fclen ki\u015filerin etkisiyle de \u015fekillenebildi\u011fi g\u00f6sterilmi\u015ftir. Yucel ve Aydin-Keser\u2019in (21) \u00e7al\u0131\u015fmas\u0131nda kat\u0131l\u0131mc\u0131lar\u0131n yakla\u015f\u0131k \u00fc\u00e7te ikisi, a\u015f\u0131 kar\u015f\u0131t\u0131 g\u00f6r\u00fc\u015flerini en \u00e7ok etkileyen unsurun bu t\u00fcr fig\u00fcrler oldu\u011funu ifade etmi\u015ftir. Ayn\u0131 \u00e7al\u0131\u015fmada dini inan\u00e7lar\u0131n da teredd\u00fctt\u00fc art\u0131r\u0131c\u0131 bir rol oynad\u0131\u011f\u0131 bildirilmi\u015ftir. Bu nedenle, Bilecik\u2019teki a\u015f\u0131 reddindeki art\u0131\u015f yaln\u0131zca niceliksel bir art\u0131\u015f olarak de\u011fil, ba\u011f\u0131\u015f\u0131klama sistemine duyulan g\u00fcvenin zay\u0131flamas\u0131 olarak da de\u011ferlendirilebilir. Bu d\u00fczeydeki yerel oranlar, ba\u011f\u0131\u015f\u0131klama programlar\u0131nda diren\u00e7li topluluklar\u0131n belirlenmesini ve hedefe y\u00f6nelik ileti\u015fim stratejilerinin geli\u015ftirilmesini zorunlu k\u0131lmaktad\u0131r. Bulgular\u0131m\u0131z, a\u015f\u0131 reddi ile m\u00fccadelenin yaln\u0131zca t\u0131bbi yakla\u015f\u0131mlarla s\u0131n\u0131rl\u0131 kalmamas\u0131, sosyok\u00fclt\u00fcrel, ileti\u015fimsel ve politik boyutlar\u0131 da i\u00e7eren b\u00fct\u00fcnc\u00fcl bir yakla\u015f\u0131mla y\u00fcr\u00fct\u00fclmesi gerekti\u011fini g\u00f6stermektedir. Bilimsel bilgiye eri\u015fimin art\u0131r\u0131lmas\u0131, yanl\u0131\u015f bilgi i\u00e7eriklerinin etkili \u015fekilde d\u00fczeltilmesi ve yerel dinamiklere duyarl\u0131 halk sa\u011fl\u0131\u011f\u0131 politikalar\u0131n\u0131n olu\u015fturulmas\u0131, s\u00fcr\u00fc ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131n\u0131n s\u00fcrd\u00fcr\u00fclebilirli\u011fi a\u00e7\u0131s\u0131ndan \u00f6nem ta\u015f\u0131maktad\u0131r.<\/p>\n

Olgular\u0131n ortanca ya\u015f\u0131 1 y\u0131l olup cinsiyet da\u011f\u0131l\u0131m\u0131 %50.6 erkek, %49.4 k\u0131z \u00e7ocu\u011fu \u015feklinde bulundu. Bu da\u011f\u0131l\u0131m, a\u015f\u0131 reddi kararlar\u0131n\u0131n \u00e7ocu\u011fun cinsiyetinden ba\u011f\u0131ms\u0131z oldu\u011funu g\u00f6stermektedir. T\u00fcrkiye\u2019de y\u00fcr\u00fct\u00fclen bir \u00e7al\u0131\u015fman\u0131n bulgular\u0131 da \u00e7al\u0131\u015fmam\u0131zla benzer olup da\u011f\u0131l\u0131m %50.7 erkek ve %49.3 k\u0131z olarak bildirilmi\u015ftir (22). Cinsiyetler aras\u0131nda belirgin farkl\u0131l\u0131k bulunmamas\u0131, a\u015f\u0131lama kararlar\u0131n\u0131n biyolojik \u00f6zelliklerden \u00e7ok sosyok\u00fclt\u00fcrel dinamiklerle ili\u015fkili olabilece\u011fini g\u00f6stermektedir.<\/p>\n

\u00c7al\u0131\u015fmam\u0131zda, \u00e7ocuklar\u0131n %38.0\u2019\u0131 hi\u00e7 a\u015f\u0131lanmam\u0131\u015f, %62.0\u2019\u0131 ise eksik a\u015f\u0131l\u0131 idi. Bu durum, ailelerin a\u015f\u0131ya kar\u015f\u0131 mutlak bir reddetmeden ziyade se\u00e7ici bir yakla\u015f\u0131m benimsediklerini d\u00fc\u015f\u00fcnd\u00fcrmektedir. Literat\u00fcrde, KKK ve hepatit B gibi a\u015f\u0131lar\u0131n toplumda daha s\u0131k tart\u0131\u015f\u0131ld\u0131\u011f\u0131 ve bu nedenle daha fazla reddedildi\u011fi bildirilmi\u015ftir. \u00d6rne\u011fin, Beki\u015f Bozkurt\u2019un (23) \u00e7al\u0131\u015fmas\u0131nda, KKK a\u015f\u0131s\u0131 ile otizm aras\u0131nda kurulan as\u0131ls\u0131z ba\u011flant\u0131lar\u0131n kamuoyundaki g\u00fcveni zedeledi\u011fi ve se\u00e7ici reddi art\u0131rd\u0131\u011f\u0131n\u0131 ifade edilmi\u015ftir. Benzer \u015fekilde, Do\u011fan ve arkada\u015flar\u0131n\u0131n (24) \u00e7al\u0131\u015fmas\u0131nda, baz\u0131 ailelerin yaln\u0131zca okul kayd\u0131 i\u00e7in zorunlu olan a\u015f\u0131lar\u0131 yapt\u0131rd\u0131\u011f\u0131, KKK ve hepatit B gibi a\u015f\u0131lar\u0131 ise sosyal medya kaynakl\u0131 \u015f\u00fcpheler nedeniyle reddetti\u011fi bildirilmi\u015ftir. Bu se\u00e7ici reddetme e\u011filimi, bireylerin tamamen a\u015f\u0131 kar\u015f\u0131t\u0131 olmad\u0131\u011f\u0131n\u0131; ancak yanl\u0131\u015f bilgi, bilgi eksikli\u011fi veya g\u00fcven sorunlar\u0131 nedeniyle ayr\u0131mc\u0131 kararlar ald\u0131\u011f\u0131n\u0131 g\u00f6stermektedir. Bu nedenle, ba\u011f\u0131\u015f\u0131klama hizmetlerinde yaln\u0131zca genel fark\u0131ndal\u0131k kampanyalar\u0131 de\u011fil, ayn\u0131 zamanda a\u015f\u0131ya \u00f6zg\u00fc ve hedefli ileti\u015fim stratejilerinin uygulanmas\u0131 da gereklidir.<\/p>\n

A\u015f\u0131 reddinin nedenleri incelendi\u011finde olgular\u0131n %86.0\u2019s\u0131n\u0131n ebeveyn karar\u0131yla ger\u00e7ekle\u015fti\u011fi, %10.1\u2019inin t\u0131bbi nedenlerle ili\u015fkili oldu\u011fu tespit edildi. Bu durum, a\u015f\u0131 reddinin a\u011f\u0131rl\u0131kl\u0131 olarak bireysel tercihlere ve sosyal etkilere dayand\u0131\u011f\u0131n\u0131 g\u00f6stermektedir. \u015eim\u015fek (25) yapt\u0131\u011f\u0131 \u00e7al\u0131\u015fmada sosyal medya yoluyla yay\u0131lan yanl\u0131\u015f bilgileri, dini inan\u00e7lar\u0131 ve yan etki korkusunu T\u00fcrkiye\u2019de a\u015f\u0131 teredd\u00fcd\u00fcn\u00fcn ba\u015fl\u0131ca nedenleri olarak bildirmi\u015ftir. K\u00fcresel \u00f6l\u00e7ekte a\u015f\u0131 teredd\u00fcd\u00fcn\u00fcn belirleyicilerini inceleyen ve \u201cVaccine Confidence Project<\/i>\u201d verilerine dayanan Larson ve arkada\u015flar\u0131n\u0131n (26) \u00e7al\u0131\u015fmas\u0131nda, a\u015f\u0131 g\u00fcvenli\u011fi kayg\u0131lar\u0131, bilgi eksikli\u011fi ve sa\u011fl\u0131k sistemlerine duyulan g\u00fcvensizli\u011fin yayg\u0131n fakt\u00f6rler oldu\u011fu bildirilmi\u015ftir. Ayn\u0131 \u00e7al\u0131\u015fmada, g\u00f6\u00e7men gruplarda dil engelleri ve sa\u011fl\u0131k hizmetlerine s\u0131n\u0131rl\u0131 eri\u015fim \u00f6nemli sorunlar olarak \u00f6ne \u00e7\u0131kmaktad\u0131r. Ayr\u0131ca bilin\u00e7li a\u015f\u0131 reddinin, a\u015f\u0131lar\u0131n do\u011fal ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bozdu\u011fu veya zararl\u0131 i\u00e7erik ta\u015f\u0131d\u0131\u011f\u0131 y\u00f6n\u00fcndeki yanl\u0131\u015f bilgilerden kaynakland\u0131\u011f\u0131 ve bu g\u00f6r\u00fc\u015flerin \u00e7o\u011funlukla sosyal medya arac\u0131l\u0131\u011f\u0131yla yay\u0131ld\u0131\u011f\u0131 ortaya konulmu\u015ftur. Bu veriler, a\u015f\u0131 reddiyle m\u00fccadelenin yaln\u0131zca bireysel de\u011fil toplumsal d\u00fczeyde \u00e7ok y\u00f6nl\u00fc stratejiler gerektirdi\u011fini g\u00f6stermektedir.<\/p>\n

\u00c7al\u0131\u015fmam\u0131zda canl\u0131 do\u011fum verilerine g\u00f6re hesaplanan a\u015f\u0131 reddi prevalans\u0131nda y\u0131llara g\u00f6re belirgin bir art\u0131\u015f oldu\u011fu g\u00f6zlendi; 2015\u2019te %0.3 olan oran, 2021\u2019de %4.66\u2019ya, 2023\u2019te %5.73\u2019e, 2024\u2019te ise tahmini olarak %8.27\u20138.55 aral\u0131\u011f\u0131na ula\u015fm\u0131\u015ft\u0131. Bu e\u011filim, T\u00fcrkiye genelinde 0\u20134 ya\u015f grubunda bildirilen %10\u2019a varan a\u015f\u0131ya devams\u0131zl\u0131k oran\u0131yla ve Birle\u015fik Krall\u0131k\u2019ta COVID-19 sonras\u0131 g\u00f6zlenen %25\u2019e kadar \u00e7\u0131kan reddetme oran\u0131yla paralellik g\u00f6stermektedir (18,27). Ayn\u0131 \u015fekilde, DS\u00d6\u2019n\u00fcn 2022 tarihli raporunda da pandemiden sonra a\u015f\u0131lama oranlar\u0131nda d\u00fc\u015f\u00fc\u015f ve kamu g\u00fcveninde azalma oldu\u011funu ifade edilmi\u015ftir (28). Kazakistan\u2019da da 2013\u20132022 y\u0131llar\u0131 aras\u0131nda a\u015f\u0131 reddinin s\u00fcrekli artt\u0131\u011f\u0131 ve bu durumun yanl\u0131\u015f bilgi i\u00e7erikleriyle ba\u011flant\u0131l\u0131 oldu\u011fu bildirilmi\u015ftir (20). A\u015f\u0131 reddinden en \u00e7ok etkilenen grubun 0\u20134 ya\u015f aral\u0131\u011f\u0131ndaki \u00e7ocuklar oldu\u011fu ve \u00f6zellikle okul \u00f6ncesi d\u00f6nemin kritik bir zaman dilimi oldu\u011fu g\u00f6r\u00fclmektedir. Konya\u2019da yap\u0131lan bir \u00e7al\u0131\u015fmada da a\u015f\u0131 reddi nedeniyle hi\u00e7 a\u015f\u0131lanmam\u0131\u015f \u00e7ocuklar\u0131n tamam\u0131n\u0131n bu ya\u015f grubunda oldu\u011fu bildirilmi\u015ftir (29). ABD ve Kanada\u2019dan yap\u0131lan epidemiyolojik \u00e7al\u0131\u015fmalar da a\u015f\u0131 reddinin en \u00e7ok erken \u00e7ocukluk d\u00f6neminde yo\u011funla\u015ft\u0131\u011f\u0131n\u0131 g\u00f6stermektedir (30,31). Bilecik \u00f6rne\u011finde, 5\u20139 ve 10\u201314 ya\u015f gruplar\u0131nda daha d\u00fc\u015f\u00fck prevalans oranlar\u0131n\u0131n g\u00f6r\u00fclmesinin, bu ya\u015f d\u00f6nemlerinde uygulanan peki\u015ftirme dozlar\u0131 ile okul kay\u0131t s\u00fcre\u00e7lerinde a\u015f\u0131 belgelerinin sorgulanmas\u0131n\u0131n etkisiyle ili\u015fkili olabilece\u011fi d\u00fc\u015f\u00fcn\u00fclmektedir. Literat\u00fcrde de okul \u00e7a\u011f\u0131ndaki \u00e7ocuklarda a\u015f\u0131lanma durumunun e\u011fitim kurumlar\u0131 ve sa\u011fl\u0131k kontrolleri arac\u0131l\u0131\u011f\u0131yla yeniden de\u011ferlendirilmesinin a\u015f\u0131 kabul\u00fcn\u00fc art\u0131rabilece\u011fi belirtilmektedir (32).\u00a0<\/span><\/p>\n

A\u015f\u0131 t\u00fcrlerine g\u00f6re da\u011f\u0131l\u0131m incelendi\u011finde, en s\u0131k reddedilen a\u015f\u0131lar\u0131n DaBT-\u0130PA-Hib, KKK ve PKA oldu\u011fu tespit edildi. \u00c7ok bile\u015fenli ve birden fazla doz i\u00e7eren a\u015f\u0131lar\u0131n daha s\u0131k reddedilmesi, literat\u00fcrde tan\u0131mlanan a\u015f\u0131 i\u00e7eri\u011fi, g\u00fcvenli\u011fi ve doz say\u0131s\u0131na ili\u015fkin ebeveyn kayg\u0131lar\u0131 ile ili\u015fkili olabilir (33). Benzer bi\u00e7imde, UNICEF\u2019in 2023 verileri de KKK ve HPV gibi \u00e7ok dozlu a\u015f\u0131larda program ba\u015flat\u0131lsa dahi doz s\u00fcreklili\u011finde belirgin d\u00fc\u015f\u00fc\u015f oldu\u011funu g\u00f6stermektedir (34). Amerika Birle\u015fik Devletleri\u2019nde 2019 y\u0131l\u0131nda ya\u015fanan k\u0131zam\u0131k salg\u0131n\u0131nda KKK a\u015f\u0131s\u0131n\u0131n reddinin, salg\u0131n\u0131n yay\u0131lmas\u0131nda kritik bir rol oynad\u0131\u011f\u0131 bildirilmi\u015ftir (35). Benzer \u015fekilde, ECDC (2021) raporunda da KKK a\u015f\u0131s\u0131na y\u00f6nelik yanl\u0131\u015f bilgi i\u00e7eriklerinin sosyal medya platformlar\u0131 arac\u0131l\u0131\u011f\u0131yla h\u0131zla yay\u0131ld\u0131\u011f\u0131n\u0131 g\u00f6stermi\u015ftir (36). Bu ba\u011flamda, \u00e7al\u0131\u015fmam\u0131zda g\u00f6zlenen \u00f6zellikle DaBT-\u0130PA-Hib, KKK ve PKA gibi \u00e7ok dozlu a\u015f\u0131lara y\u00f6nelik reddetme e\u011filimleri, ulusal ve k\u00fcresel bulgularla uyumlu g\u00f6r\u00fcnmektedir.<\/p>\n

Bu \u00e7al\u0131\u015fmada a\u015f\u0131 reddinin yaln\u0131zca primer serilerin ilk dozlar\u0131nda de\u011fil, ard\u0131\u015f\u0131k dozlarda ve hat\u0131rlatma dozlar\u0131nda da belirgin oldu\u011fu tespit edildi. \u0130lk doz reddi, ailelerin a\u015f\u0131lama s\u00fcrecine ba\u015flama a\u015famas\u0131nda yeterince bilgilendirilmedi\u011fi ya da yanl\u0131\u015f inan\u0131\u015flar\u0131n erken d\u00f6nemde etkili olabilmesiyle ili\u015fkili olabilir. Buna kar\u015f\u0131l\u0131k, hat\u0131rlatma dozlar\u0131nda ve ard\u0131\u015f\u0131k dozlarda g\u00f6zlenen y\u00fcksek ret oranlar\u0131, ilk doz sonras\u0131nda geli\u015fen hafif yan etkilerin yanl\u0131\u015f kontrendikasyon olarak alg\u0131lanmas\u0131 veya \u00e7evresel ve sosyal etkilerin ailelerin karar\u0131n\u0131 de\u011fi\u015ftirmesi ile ili\u015fkili olabilir. Bu durum, \u00f6zellikle primer serinin ilk dozlar\u0131nda ailelerin ayr\u0131nt\u0131l\u0131 bilgilendirilmesinin ve hat\u0131rlatma dozlar\u0131 \u00f6ncesinde yan etki kayg\u0131lar\u0131n\u0131n do\u011fru y\u00f6netilmesinin \u00f6nemine i\u015faret etmektedir.<\/p>\n

Bu \u00e7al\u0131\u015fman\u0131n baz\u0131 s\u0131n\u0131rl\u0131l\u0131klar\u0131 bulunmaktad\u0131r. Kesitsel tasar\u0131m nedeniyle nedensel \u00e7\u0131kar\u0131mlar\u0131n yap\u0131lmas\u0131 m\u00fcmk\u00fcn de\u011fildir. Verilerin yaln\u0131zca resmi bildirim kay\u0131tlar\u0131na dayanmas\u0131, eksik veya bildirilmeyen olgular\u0131n bulunabilece\u011fi olas\u0131l\u0131\u011f\u0131n\u0131 d\u0131\u015flamamaktad\u0131r. 2024 y\u0131l\u0131na ait do\u011fum verilerinin kesinle\u015fmemi\u015f olmas\u0131 nedeniyle bu y\u0131la ili\u015fkin prevalans de\u011ferleri tahmini hesaplamalara dayanmaktad\u0131r. Veri setinde sosyoekonomik ve davran\u0131\u015fsal de\u011fi\u015fkenlerin bulunmamas\u0131, a\u015f\u0131 reddine etki eden fakt\u00f6rlerin ayr\u0131nt\u0131l\u0131 analizini s\u0131n\u0131rland\u0131rm\u0131\u015ft\u0131r. Ayr\u0131ca \u00e7al\u0131\u015fma tek bir ile ait verileri i\u00e7erdi\u011fi i\u00e7in bulgular\u0131n genellenebilirli\u011fi s\u0131n\u0131rl\u0131d\u0131r.\u00a0<\/span><\/p>\n

Sonu\u00e7 olarak; Bilecik \u00f6zelinde elde edilen veriler, a\u015f\u0131 reddi davran\u0131\u015f\u0131n\u0131n \u00f6zellikle 0\u20134 ya\u015f grubunda yo\u011funla\u015ft\u0131\u011f\u0131n\u0131 ve \u00e7ok dozlu a\u015f\u0131lara kar\u015f\u0131 daha y\u00fcksek bir ret e\u011filimi oldu\u011funu ortaya koydu. Bu durum, erken \u00e7ocukluk d\u00f6nemine odaklanan hedefli halk sa\u011fl\u0131\u011f\u0131 m\u00fcdahalelerine, bilgi temelli ileti\u015fim kampanyalar\u0131na ve dezenformasyonla m\u00fccadeleye y\u00f6nelik stratejilere duyulan acil ihtiyac\u0131 g\u00f6stermektedir. Bu fakt\u00f6rlerin ele al\u0131nmas\u0131, toplumsal ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131n korunmas\u0131 ve \u00e7ocukluk \u00e7a\u011f\u0131 a\u015f\u0131lama programlar\u0131n\u0131n s\u00fcrd\u00fcr\u00fclebilirli\u011fi a\u00e7\u0131s\u0131ndan son derece \u00f6nemlidir.<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e A\u015f\u0131lar, bula\u015f\u0131c\u0131 hastal\u0131klar\u0131n \u00f6nlenmesi ve toplum ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131n\u0131n sa\u011flanmas\u0131nda en etkili ve ekonomik halk sa\u011fl\u0131\u011f\u0131 ara\u00e7lar\u0131ndan biridir. Ancak, son y\u0131llarda a\u015f\u0131ya y\u00f6nelik teredd\u00fct ve reddin art\u0131\u015f\u0131 hem bireysel hem de toplumsal d\u00fczeyde \u00f6nemli sa\u011fl\u0131k sorunlar\u0131na yol a\u00e7maktad\u0131r. D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6), a\u015f\u0131 karars\u0131zl\u0131\u011f\u0131n\u0131 21. y\u00fczy\u0131l\u0131n en b\u00fcy\u00fck k\u00fcresel sa\u011fl\u0131k tehditlerinden biri olarak tan\u0131mlam\u0131\u015f ve bu […]<\/p>\n","protected":false},"author":5,"featured_media":31944,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[5099,6258,6259,6260,3132],"class_list":["post-31614","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ozgun-arastirma","tag-asi-reddi","tag-bagisiklama-programi","tag-cocuk-sagligi","tag-ebeveyn","tag-prevalans"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/31614","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\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=31614"}],"version-history":[{"count":3,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/31614\/revisions"}],"predecessor-version":[{"id":31907,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/31614\/revisions\/31907"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media\/31944"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=31614"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=31614"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=31614"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}