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INTRODUCTION
Health promotion aims to prevent illness and promote good health. Primary care staff, and health visitors in particular, are expected to play a key role in promoting the health of children and parents.
Health promotion calls for three basic prerequisites, which are protection, education and healthy public policy.
Initiatives for protecting infant health may be enlisted as parental education and participatory guidance (growth and development, nutrition, infant and child care, safety, first aid, diseases and complications, child behaviors, employment of health care systems), screenings, immunization, growth and development monitoring and assessing family dynamics. Initiatives for promoting health may differ in each developmental period as they may change in each age group in accordance with the child’s individual development.
OBJECTIVE: This study aimed to bring out the measures that mothers in Southeastern Anatolia take in order to promotion their children’s health.
METHOD: It was conducted in a primary health care center in the town center of a Southeastern city, Mardin. Mothers who brought their children to the center were interviewed over a week in June 2004 (n=46) for which a questionnaire based on Ardell’s model of wellness was utilized. Ardell’s wellness model includes four fundamental prerequisites, which are nutrition, physical exercise, environment and stress management and Ardell emphasized accomplishment of these prerequisites through self- responsibility. Barleben (1987), on the other hand, introduced a guide for infant health protection and promotion by combining Ardell’s health promotion model with initiatives of health protection and nursing procedures. The questionnaire form which was used in this study is based upon Ardell’s model and Barleben’s guide. Data were evaluated using nominal and percentage distribution with statistical packet program.
SAMPLING
Infants who participated in this study are aged between 1 month and 12 months old (average 5.6 months). 54.3% of the infants are girls (n=25) and 45.7% of them are boys (n=21). 50% of the infants are the single child, while 19.6% of these children (n=9) have one sibling. Their mothers are aged between 19 and 38 years old, with an average of 26.4 years, while their fathers are aged between 24 and 54 years old, with an average of 32.1 years. 37% of mothers graduated from primary school and 45.7% (n=21) of fathers graduated from high school. 19.6% of the families who participated in the study have no social security (n=9), family income of 58.6% of these families barely cover their expenses and 30.4% of them (n=14) earn less then their expenses.
Limitations of the study:
There are some limitations that need to be acknowledged and addressed regarding the present study, most important of which is that only one outpatient clinic was chosen for the sampling and data were collected from those who were visiting that particular clinic.
RESULTS
Health Controls: All infants are being monitored by the outpatient clinics where 43.5% of all mothers take their children only when they have got a health problem.
As it is shown in table 1, 47.8% of mothers aged between 19-28 years old and 8.7% of mothers aged between 29-38 years old take their babies to routine health controls, which illustrates that there appears to be a meaningful relationship between mothers’ age and their behavior of taking their babies to routine health controls (X2 = 4,890 p= .027, p<0,05) while the same relationship couldn’t be found between fathers’ age and their behavior of taking their babies to routine health controls (X2
= 4,753, p=,093, p>0,05).
All of the high school graduate mothers and 10.9 of university graduate mothers take their babies to routine health controls. There is a meaningful relationship between mothers’ educational status and their behavior of taking their babies to routine health controls (X2 = 23,194 p= .000) while the same relationship couldn’t be found between fathers’ educational status and their behavior of taking their babies to routine health controls (X2 = 4,221, p=,23, p>0,05).
All well-off families were found to take their children to routine health controls but, on the other hand, 19.6% of low-income families were found not to take their children to controls. There is a meaningful relationship between economic status of the families’ and their behavior of taking their babies to routine health controls (X2 = 6,395, p= ,041, p<0,05).
Among 26 families who take their babies to routine controls, 34.8% of them prefer private doctors, 10.9% of parents (n=5) choose outpatients clinics, 6.5% of these families (n=3) said they favor hospitals and 4.3% of them (n=2) have a preference for both private doctors and outpatients clinics.
A meaningful relationship between mothers’ age and educational status, fathers’ age and educational status and economic status of the family and their behavior of taking their babies to routine health controls couldn’t be found.
Immunization: All infants in the study are vaccinated on a regular base.
Nutrition: 87% of babies are fed with breast milk, while 13% of them (n=6) not. There isn’t a meaningful relationship between breast feeding and mothers’ age and educational status, fathers’
age and educational status and economic status of the family.
While 76.1% of babies (n=35) are not given cow’s milk, 23.9% of babies (n=11) are. 4.3% of high school and university graduate mothers and 19.6% of primary school graduate or unschooled mothers are reported to be feeding their babies with cow’s milk (X2 =,3,765 p= , 052). Mothers’
age, fathers’ age and educational status and economic status of the family are not found to affect such behavior.
37% of babies (n=17) are reported to be given formula milk, while 29% of babies (n=29) are not fed with formula milk. 3% of children who are 4 months old are started to be given additional food.
However, one infant from the 7 months old group hasn’t been given additional food.
Accidents: 80.4% of babies haven’t had an accident, but 19.6% of children (n=9) are reported to have an accident such as falls (13.0% n=6), and foreing object aspirations (%6.5’i n=3). There isn’t a meaningful relationship between mothers’ age and educational status, fathers’ age and educational status, infant’s sex and economic status of the family economic and accidents.
87% of mothers haven’t been given first aid training.
Stress Management: Mothers stated that their children cry, wail and pull their legs up and crawl when they are stressed and 41.3% of mothers consider breast feeding as the best remedy.
DISCUSSION
Health Controls: Routine health controls are confirmed to be highly important for early diagnosis and initiatives. All in all, we have to face a significant shortfall that only 55% of all families have their routine controls done. We found in our study that economic insufficiencies certainly hinder the families from taking their babies to routine health controls. It is obvious that income comes out as one of the important determinants of health condition. According to the recent reports of the World Bank, one fifth of world population lives under the international poverty line, and children suffer disproportionately from such inequalities (Hatun, Etiler ve Gönüllü, 2003). Education emerges as another factor that influences health controls in our study, which suggests that families with low education and income levels apparently need to be educated on infant care.
Immunization: It sounds comforting that all children in the study are vaccinated on a regular base, while only 48% of children who are younger than 12 months old are reported to be vaccinated fully in Turkey (TNSA 2003).
Nutrition: 87% of babies are fed with breast milk, 23.9% of all infants in the study (n=11) are given cow’s milk and 37% of babies (n=17) are fed with formula milk. High rates of breast feeding are considered to be a good progress. Tuncel et al. (2006) found breast feeding rates as 33.0% in babies who are younger than 4 months, and 3.7% in children who are 4 to 6 months old. Findings of our study have shown that mothers with low educational level tend to use cow’s milk more, which implies that education may well shape the nutrition behaviors of mothers. Sanlier and Aytekin (2004) pointed out the fact that university graduate mothers are inclined to use breast milk more than the others.
Dalgic, Hizel and Köse (1997) stated that as mothers’ educational status rises up, their awareness increases accordingly, while initiating additional food and educational levels are in inverse proportion.
It is obvious that mothers need more education on infant feeding.
Accidents: It was found in our study that nearly one fifth of children have had an accident, which is considered to be one of the leading causes of mortality and morbidity. Hampshire et al (2001) noted that avoiding accidents may be a vital prerequisite in promoting health. Although one way of avoiding accidents seems to be educating mothers, it turns out that 87% of mothers haven’t been educated on first aid. Knowledge and awareness of parents about avoiding accidents, maintaining a safe environment and first aid must be increased.
Stress Management: Mothers expressed their belief that their children cry, wail and pull their legs up and crawl when they are stressed, and 41.3% of them consider breast feeding as the best remedy in such occasions. Mothers said that they can recognize the moments when their babies are stressed out. However, using breast feeding as the only solution to control and soothe their babies’ stress entails that they need be provided with more education on other possible solutions.
CONCLUSION:
A geographical and cultural bridge between Asia and Europe, Turkey still needs further studies on infant health. For instance, Mardin, situated in the Northern East part of the country, is in urgent need for the studies on promoting infant health. Despite being conducted with a limited sampling, our study surely mirrors the traumatic conditions of the Southeastern region and depicts that health services in the region is far less sufficient.
BIBLIOGRAPHY:
References
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6.Hatun Ş, Etiler N, Gönüllü E. Yoksulluk ve Çocuklar Üzerine Etkileri, Çocuk Sağl ğ ve Hastal klar Dergisi. 2003; 46 (4): 251-260.
AUTHOR/S:
Candan ÖZTÜRK, Hatice YILDIRIM SARI, Murat BEKTAŞ, Ayfer ELÇİGİL
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