Turkey is making progress through education and outreach efforts.
By Menekse Tokyay for Southeast European Times in Istanbul -- 25/09/13
The region has made significant improvements in child healthcare. [AFP]
Turkey and its neighbours in the Balkans have made progress in reducing child mortality rates, but a new UNICEF report that tracks statistics for 176 nations warns that continued efforts are needed to keep young children from dying of preventable causes.
The top causes of child deaths globally are pneumonia, diarrhoea, malaria and malnutrition. On average, nearly 6,000 children younger than 5 years old die each day. Government interventions such as medicines, vaccinations, nutritional supplements, and improved access to clean water and sanitation are cited as important factors.
Turkey ranks 120th in the under-5 mortality rate with 14 fatalities per 1,000 live births. That number has been reduced dramatically in the past two decades. In 1990 it was 72 out of 1,000.
In Turkey, the main causes of child deaths are pneumonia, neonatal illness and disease, injuries and diarrhoea.
Bulgaria and Romania rank 129th, each with 12 deaths per 1,000 live births, but both countries have shown dramatic improvement. Romania's rate in 1990 was 38 deaths per 1,000 births, while Bulgaria's was 22 per 1,000.
Bosnia and Herzegovina (BiH), Serbia and Macedonia rank 150th with seven deaths per 1,000 live births. BiH was at 18 per 1,000 in 1990, and Serbia was at 28 per 1,000.
EU countries Croatia and Greece are both at 161st with five deaths per 1,000 live births.
For Balkan countries, the main causes of under-5 deaths are pneumonia and neonatal issues. Injuries are a primary cause of under-5 deaths in Romania, and measles is a factor in Macedonia. According to the report, poor health education, lack of access to maternity healthcare services, the problems in professional empowerment of midwifery as well as insufficient promotion of breastfeeding constitute barriers for further improvement in the region.
Ayla Goksel, vice chairman of the Mother and Child Education Foundation (ACEV), an Istanbul-based early childhood NGO, told SETimes that urbanisation, rising income levels and the strengthening of women's education levels have allowed Turkey to decrease its under-5 mortality rate during the past 15 years.
"However, in some indicators like mortality rates and malnutrition, we are still far behind of countries having the same income levels with Turkey," Goksel said. "Still 10 percent of women, mostly in rural zones, give birth without the assistance of a medical staff in Turkey, while the need for overcoming large regional disparities is also a threshold for Turkey to achieve a nationwide success in this field."
Goksel added that the most important period in a child's life is the first five years, during which the pace of physical and mental development are rapid and dependence on families is high.
"During this period, the awareness raising campaigns targeting mothers and the nationwide health screenings conducted and monitored by local state authorities are of the utmost importance to increase the life quality of children as well as their mothers," Goksel said.
Experts emphasise that mortality rates will decline further as Turkey's three-year-old family practitioner system gets more established. Appointed by the health ministry, family practitioners succeeded in achieving child vaccination rates of 97 percent. They also have computerised follow-up systems and provide new mothers with free information and advice about healthcare requirements.
Dr. Gokhan Mamur, a paediatrician at Istanbul’s Memorial private hospital, told SETimes that most of Turkey's progress has been achieved through the increased emphasis on neonatal resuscitation skills at both state and private hospitals.
"Those skills, which have been taught at each region of Turkey since the late 1990s through a ministerial campaign, are essential for all healthcare providers who are involved in the health of newborns. The underlying aim is to teach them the steps necessary to accurately examine a newborn baby who is not breathing and protect the life," Mamur said.
Mamur added that the increased number of private hospitals in Turkey since the early 2000s and their international accreditation standards have helped to raise the level of care at public hospitals, which have had to improve services to compete. There are nearly 600 private hospitals in Turkey.
Professor Selda Bulbul, an expert on child health at Kırıkkale University and a member of health ministry’s School Milk Scientific Council, said Turkey deserved this record thanks to its efforts made since 1985.
"With the nationwide increase in nutrition programs and promotion of exclusive breastfeeding with state-run campaigns for the first six months of life, the immunity system of newborns has been boosted," Bulbul told SETimes. "The health ministry has succeeded in establishing baby-friendly hospitals in more than 60 provinces in Turkey to ensure that every new mother receives quality advice and support from informed staff."
Bulbul, who has been an adviser for the past decade in many state projects aimed at reducing child mortality, added that Turkey's vaccination programs have become exemplary for many international standardisation agencies.
"During my years as an assistant doctor, I witnessed many tetanus incidents among children, but now my assistants have not witnessed any. Turkey has succeeded in adopting an efficient approach in preventing these diseases, and it will reach more promising results in next reports," she said.
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