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    EVALUATION OF PURIFIED PROTEIN DERIVATES TEST AT TUBERCULOSIS DISPENSARY IN HATAY, TURKEY, APPLIED TO TURKS AND SYRIAN REFUGEES (2012-2015)
    (Natl Inst Public Health, 2018) Savas, Nazan; Barutcu, Gulnur; Yeniceri, Arif
    Objective: The aim of the study was to evaluate results of purified protein derivates (PPD) test applied at the Tuberculosis Dispensary between 2012-2015 in Hatay, Turkey, where a large number of Syrian refugees have migrated since the Syrian civil war began in 2011. Methods: PPD test records from the Electronic Tuberculosis Management System at the Tuberculosis Dispensary from 2012-2015 were analyzed based on nationality, age groups, BCG scar availability, and PPD reaction. The annual risk of tuberculosis infection (ARTI) was calculated based on years for each age group in Turks and Syrian refugees and the trend was evaluated. Student-t, Chi-square, and Mantel-Haenszel tests were used in statistical analyses, p < 0.05 was considered significant. Results: In total, 5,255 PPD tests were made, 15.5% were Syrian refugees. BCG scar was missing in 48.5% of Turks and 87.3% of refugees (p < 0.001). The 0-5 age group represented the lowest rate (Turks 3.2%, refugees 4.3%) and the 19-64 age group represented the highest rate (Turks 51.1%, refugees 54.1%) of positive PPD reaction among individuals without BCG scar. Among individuals without BCG scar, more positive PPD reactions developed in refugees of the 6-18 group than in Turks (Turks 16.9%, refugees 46.4%, p < 0.001). Among individuals with BCG scar, more positive PPD reactions developed among refugees of the 0-5 (Turks 7.8%, refugees 24.0%, p = 0.049) and 19-64 (Turks 36.6%, refugees 58.8%, p = 0.028) age groups. ARTIs between 2012-2015 were 0.2%, 1.0%, 1.3%, and 1.4% among Turks, (except 2012) 2.3%, 0.3%, 2.4% among refugees in the 0-5 age group, 1.1%, 2.0%, 1.7%, and 1.5% among Turks, and 8.5%, 6.6%, 7.3%, and 2.4% among refugees in the 6-18 age group, respectively. Conclusion: Higher positive PPD reactions and ARTIs were found among Syrian refugees, more specifically in the 6-18 age group.
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    Syrian refugees in Hatay/Turkey and their influence on health care at the university hospital
    (E-Century Publishing Corp, 2016) Savas, Nazan; Arslan, Evrim; Inandi, Tacettin; Yeniceri, Arif; Erdem, Mehmet; Kabacaoglu, Meryem; Peker, Ersin
    Background: Refugees have been exposed to severe health problems due to the influences of negativities they experienced in their countries, migration process and low standards of living. Health care workers are not prepared and educated enough for such circumstances, even though they are the very witnesses of changing circumstances and an essential part of providing required services. Our aim is to investigate how Syrian civil war and refugees in Turkey influenced health care services. Methods: This cross-sectional study was conducted in 2015, involving health care workers in the university hospital in Hatay. The survey was applied to 102 doctors and 108 nurses/health technicians. Chi-square test and Mantel-Haenszel test were used. Results: The highest need concerning refugee patients was intensive care capacity for 65.6%, in patient care for 64.6% and 55.5% stated complications develop more in refugees. This was similar among workers at internal and surgical departments (P>0.05). 85.7% stated that workload, 67.1% stated that working hours and 71.6% stated that patient waiting time had increased. Increase in working hours was higher for doctors; increase in patient waiting time was higher in surgical departments and alloted time to patient s increased more for nurses/health technicians (P<0.05). Regarding what is insufficient; it was intensive care capacity for 76%, the number of beds for 68.3% and medicine/blood/bloodproducts for 34.8%. 37.6% experienced a dangerous situtation, 88.1% do not feel secure and 58.9% of participants' desire to work decreased. The rate of feeling in secure was higher among nurses/health technicians, decrease in the desire to work was higher among doctors (P<0.05). The most common diagnosis was gunshot wounds for 38.4% of internal department workers and 68.8% of surgical department workers (P<0.05). The most common communicable disease was found to be nosocomial infection (45.9%). Conclusion: The university hospital in Hatay had been negatively influenced by Syrian civil war in terms of refugee patients. Peace is a precondition for proper health care.