The perspectives of politicians on tobacco control in Turkey.

Background: Tobacco use is a leading but preventable cause of non-communicable diseases and premature death. The legislature has a key role in setting tobacco control policies. Smoking trends are decreasing thanks to the introduction of effective tobacco control policies in Turkey and these policies may have been shaped by how politicians' interpreted social problems that were prominent during the development and implementation of tobacco regulations. Aim: This paper explores the long-term national relationship between tobacco consumption, tobacco control policies and the associated political discourse in Turkey, considering the varying influences through national leadership on this important public health agenda. This relationship is studied by comparing a time series analysis of tobacco consumption trends with a policy analysis of the minutes of deliberations at the Grand National Assembly of Turkey (GNAT). Methods: This study uses Bayesian time series analysis in order investigate whether the tobacco control policies and related activities influenced the annual per adult cigarette consumption in Turkey. We used a novel method to identify change points in tobacco trends and whether they correspond with key policy changes intended to alter usage after adjusting for the effect of other non-policy related covariates, such as the purchasing power. The policy analysis included an examination of the minutes of deliberations at the GNAT-which is the Turkish parliament and unicameral Turkish legislature-1 year before and 1 year after the break years associated with an increase or decrease in tobacco consumption. Results and recommendations: Tobacco consumption increased with the encouragement of tobacco production and the entrance of multinational companies in the country in 1976 and 1993, respectively. The National Tobacco Law of 1996 and comprehensive amendments in 2008, including smoke-free public places and tax increases, appear to have helped reduce tobacco consumption in Turkey. The focus of Parliamentary discussions throughout this period changed, becoming less supportive of tobacco over time. However, throughout the period there remained discussions focussing on concerns around the implications for the economy and the privatization agenda, national agriculture and the welfare of farmers. Effective control appears to require certain political ingredients to be implemented: politicians who are well informed on tobacco control measures and understand the range of issues surrounding the policies (not only those directly health-related); and supportive public health information in the community. Evidence-based public health policy should be introduced to the politicians.

Substance Use in Refugee Camps and Local Community: Sanliurfa Sample.

INTRODUCTION: Although substance use has increased in recent years in Turkey, it is still lower than in other European countries. Turkey is home to the largest Syrian refugee population. In this study, it was aimed to evaluate the prevalence of tobacco, alcohol, and substance use among local people living in city centers and refugees living in refugee camps in Sanliurfa. METHODS: The study was based on a cross-sectional epidemiologic survey conducted with a total of 6041 people, 4040 (67%) from camps and 2001 (33%) from districts. Face-to-face interviews were accompanied by local interviewers or interpreters who spoke Arabic, and a survey form used in our country for drug addiction screening was used. According to the number of samples selected, households with proportional distribution were chosen from the districts, which were selected from the address based from Turkish Statistical Institute. In the refugee camps, interviews were conducted in tents selected using a random numbers table according to the number of samples. RESULTS: The lifetime prevalence of tobacco use was 22.3% (n=902) in the camps, whereas in the districts this rate was 33.5% (n=670). The lifetime prevalence of alcohol use was found as 0.2% in the camps and 3.5% in the districts. The lifetime prevalence of substance use was found as 2.6% in the camps and 4.3% in the districts. The most commonly used substance type was cannabis. Some 45.7% of the people who used a substance in the camps were male and 54.3% were female. In districts, these rates were 64.4% and 35.6%, respectively. CONCLUSION: Alcohol and substance use rates are low in Turkey compared with most countries in the world. Substance use in the city center is higher than in refugee camps in Sanliurfa. Substance use is a significant mental health problem that concerns every community including refugees. Identifying characteristics and attitudes related to substance use may help to improve policies regarding protective measures.

A Resilient Health System in Response to Coronavirus Disease 2019: Experiences of Turkey.

Turkey's response experience thus far with the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic affords the globe and the region a unique opportunity for and distinctive insights into combating this novel virus. The country's pandemic response, having one of the lowest case fatality ratio (2.8%; 52.5 infections/million population), particularly among the elderly (the high-risk group), rising to the occasion to shoulder its long-standing role in global solidarity and humanitarian support by providing personal protective equipment (globally scarce) to many countries in their desperate time of fight against the pandemic while also meeting its own critical domestic needs, stands out. This paper aims to highlight key decisions, actions, and partnerships behind Turkey's successful fight against the SARS-CoV-2 pandemic that have enabled the country to turn the corner, as well as the components of its success story.

Substantial decline in hepatitis B virus infections following vaccine introduction in Tajikistan.

BACKGROUND: Tajikistan, considered highly endemic area for hepatitis B virus (HBV) in a pre-vaccine era, introduced hepatitis B vaccine in 2002 and reported ≥80% coverage with three doses of hepatitis B vaccine (HepB3) since 2004. However, the impact of vaccine introduction has not been assessed. METHODS: We tested residual serum specimens from a 2010 national serosurvey for vaccine-preventable diseases in Tajikistan and assessed the prevalence of HBV infection across groups defined based on the birth cohorts' routine infant hepatitis B vaccination program implementation and HepB3 coverage achieved (≥80% versus <80%). Serosurvey participants were selected through stratified multi-stage cluster sampling among residents of all regions of Tajikistan aged 1-24 years. All specimens were tested for antibodies against HBV core antigen (anti-HBc) and those found positive were tested for HBV surface antigen (HBsAg). Seroprevalence and 95% confidence intervals were calculated and compared across subgroups using Satterthwaite-adjusted chi-square tests, accounting for the survey design and sampling weights. RESULTS: A total of 2188 samples were tested. Prevalence of HBV infection markers was lowest among cohorts with ≥80% HepB3 coverage (ages, 1-6 years): 2.1% (95% confidence interval, 1.1-4.3%) for anti-HBc, 0.4% (0.1-1.3%) for HBsAg, followed by 7.2% (4.1-12.4%) for anti-HBc and 2.1% (0.7-6.1%) for HBsAg among cohorts with <80% HepB3 coverage (ages, 7-8 years), by 12.0% (8.7-16.3%) for anti-HBc and 3.5% (2.2-5.6%) for HBsAg among children's cohorts not targeted for vaccination (ages, 9-14 years), and 28.9% (24.5-33.8%) for anti-HBc and 6.8% (4.5-10.1%) for HBsAg among unvaccinated adult cohorts (ages, 15-24 years). Differences across groups were significant (p<0.001, chi-square) for both markers. CONCLUSIONS: The present study demonstrates substantial impact of hepatitis B vaccine introduction on reducing HBV infections in Tajikistan. To achieve further progress in hepatitis B control, Tajikistan should maintain high routine coverage with hepatitis B vaccine, including birth dose.

Seroepidemiology of diphtheria and tetanus among children and young adults in Tajikistan: nationwide population-based survey, 2010.

BACKGROUND: Tajikistan had a major diphtheria outbreak (≈ 10,000 cases) in the 1990 s, which was controlled after nationwide immunization campaigns with diphtheria-tetanus toxoid in 1995 and 1996. Since 2000, only 52 diphtheria cases have been reported. However, in coverage surveys conducted in 2000 and 2005, diphtheria-tetanus-pertussis vaccine coverage was lower than administratively reported estimates raising concerns about potential immunity gaps. To further assess population immunity to diphtheria in Tajikistan, diphtheria antibody testing was included in a large-scale nationwide serosurvey for vaccine-preventable diseases conducted in connection with a poliomyelitis outbreak in 2010. In addition, the serosurvey provided an opportunity to assess population immunity to tetanus. METHODS: Residents of all regions of Tajikistan aged 1-24 years were included in the serosurvey implemented during September-October 2010. Participants were selected through stratified cluster sampling. Specimens were tested for diphtheria antibodies using a Vero cell neutralization assay and for tetanus antibodies using an anti-tetanus IgG ELISA. Antibody concentrations ≥ 0.1 IU/mL were considered seropositive. RESULTS: Overall, 51.4% (95% CI, 47.1%-55.6%) of participants were seropositive for diphtheria and 78.9% (95% CI, 74.7%-82.5%) were seropositive for tetanus. The lowest percentages of seropositivity for both diseases were observed among persons aged 10-19 years: diphtheria seropositivity was 37.1% (95% CI, 31.0%-43.7%) among 10-14 year-olds, and 35.3% (95% CI, 29.9%-41.1%) among 15-19 year-olds; tetanus seropositivity in respective age groups was 65.3% (95% CI, 58.4%-71.6%) and 70.1% (95% CI, 64.5%-75.2%). CONCLUSIONS: Population immunity for diphtheria in Tajikistan is low, particularly among 10-19 year-olds. Population immunity to tetanus is generally higher than for diphtheria, but is suboptimal among 10-19 year-olds. These findings highlight the need to improve routine immunization service delivery, and support a one-time supplementary immunization campaign with diphtheria-tetanus toxoid among birth cohorts aged 1-19 years in 2010 (3-21 years in 2012) to close immunity gaps and prevent diphtheria outbreaks.

Population immunity to polioviruses in the context of a large-scale wild poliovirus type 1 outbreak in Tajikistan, 2010.

BACKGROUND: A serosurvey to evaluate population immunity to polioviruses (PVs) in the context of the importation-related wild PV1 outbreak in Tajikistan in 2010 (461 confirmed cases among children and young adults) was conducted. METHODS: Serum specimens from a nationwide sample of 1-24 year-old persons selected through stratified cluster sampling (n=2447) were tested for neutralizing antibodies to all three PV types. Samples with titers<1:8 were considered seronegative. The serosurvey was conducted during the interval after mOPV1 supplementary immunization activities (SIAs) and before tOPV SIAs (targeting ages ≤ 15 years) implemented to control the outbreak. In the absence of pre-outbreak specimens, results for PV3 were used as a proxy for pre-outbreak PV1 immunity patterns. RESULTS: Overall, PV1 seroprevalence was 98.9%, PV2 seroprevalence was 98.8%, and PV3 seroprevalence was 86.9%. PV1 and PV2 seroprevalence exceeded 95% in all age groups and regions. PV3 seroprevalence was <90% in all age groups and regions, except 15-19 year-olds (91.7%) and Dushanbe (90.0%). PV3 seroprevalence was lowest among 1-4 (82.7%) and 5-9 (84.4%) year-olds, particularly among 1-4 year-olds in Kurgan-Tube (76.3%) and RRS (80.0%) regions. Birth cohorts immunized only through routine services (ages, 1-7 years) had lower PV3 seroprevalence than birth cohorts targeted by the SIAs during 1995-2002 (8-19 years): 82.5% versus 89.3%, p<0.001. CONCLUSIONS: Suboptimal (<90%) PV3 seroprevalence across wide age range suggests the outbreak resulted from accumulation of susceptibles due to suboptimal coverage over a long time period, particularly in the birth cohorts immunized only through routine services and in areas where the outbreak began (Kurgan-Tube and RRS). High PV1 seroprevalence indicates that mOPV1 SIAs with expanded target age (≤ 15 years) succeeded in closing the immunity gap and ongoing WPV1 transmission is unlikely. To accelerate outbreak control in areas which have been polio-free for long time, expanding SIA target age should be considered.

Survey on the health status, services utilization and determinants of health: Syrian refugee population in Turkey

This publication reports the results of a survey on the health status, services utilization and determinants of health of the Syrian refugee population in Turkey. The general goal of the survey is to determine and better understand the health status of Syrian refugees living outside camps. Among the data available in this report are the measurements of the demographic and socioeconomic characteristics of this population, health status including self-reported perceived health in six dimensions and the prevalence of self-reported morbidity for chronic diseases and mental health conditions and the prevalence of chronic diseases risk factors. Moreover, the report shows data concerning the health care service utilization, satisfaction and accessibility with special focus on the geographical variability among Turkish provinces and the health literacy of Syrian refugees. Finally, the report evaluates maternal and child health and health care access, in particular the prevalence of general health conditions among children, the presence of acute conditions among children under 5 years, the vaccination rate (reported by parents) and the antenatal and postnatal care accessibility and utilization by mothers and children.

Multisectoral action on drug dependence in Turkey: applying a whole-of-government approach

The use of substances that produce dependence has become a severe and worldwide health problem. Substancedependence is not only a health issue; it also has public, social, legal and governmental aspects. For this reason, antidrugefforts need to be multidirectional. Protection of people who has not yet met with drugs (particularly teenagers)and people with drug use but not yet dependence can be ensured by developing effective policies. For that purpose,under the leadership of Deputy Prime Minister and under the coordination of Ministry of Health, and with the highlevel participation of other 7 related Ministries a holistic and high level multidisciplinary approach is adopted withinthe scope of Anti-Drug Emergency Action Plan in Turkey. Priority objective of all these efforts is to ensure effectiveimplementation, sustainability of prevention and protection activities. This study summarizes strategies and supply,demand and communication policies developed with high level determination and institutional cooperation within thescope of Anti-Drug Emergency Action Plan.