Ahmet Topuzoğlu

Marmara University, İstanbul, Istanbul, Turkey

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Publications (27)32.82 Total impact

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    ABSTRACT: Abstract Objective: To investigate the relationship between MBD and THOP. Methods: 124 infants, born in Marmara University Hospital with a gestational age ≤ 34 weeks, were enrolled. Clinical features were recorded. Serum TSH, free T4, total T4, calcium, phosphorus and total Alkaline Phosphatase (ALP) levels were determined in the first and third postnatal weeks. MBD was defined as a phosphorus level < 4.5 mg/dl and/or ALP >900 IU/L. THOP was defined as a serum free and/or total thyroxine level lower than -1 SD for gestational age at the 7(th) postnatal day. Result: THOP was diagnosed in nineteen (15,3 %) patients. MBD was diagnosed in 52 (41,9 %) at the 3(rd) month. Low birth weight, low gestational age and prolonged parenteral nutrition were associated with MBD. Multivariate analysis documented a significant relationship solely between MBD and gestational age. Conclusion: The risk of MBD does not increase significantly in babies with THOP.
    The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 05/2013; · 1.36 Impact Factor
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    ABSTRACT: Rabies is an endemic infectious disease and one of the most important causes of human mortality in both underdeveloped and developing countries. In Turkey, 167,000 individuals are believed to be victims of animal bites annually. In this study, we investigated Turkish physicians' knowledge and clinical awareness of rabies caused by animal bites. This was a cross-sectional, analytical study. We used questionnaires that collected demographic information and assessed the physicians' basic knowledge of rabies as well as the management of animal bites suspected of causing rabies. The questionnaires were completed in person with physicians who work in Istanbul. A total of 890 physicians responded to our cross-sectional questionnaires. The maximum possible scores for basic and clinical rabies- related knowledge was 100 points each. The average score for basic rabies knowledge was 64.5 ± 16, while the average score for clinical rabies knowledge was 62.8 ± 12. However, 68% of the physicians in the study were not aware of the proper method for cleaning wounds as a first-line treatment in postexposure prophylaxis. In addition, 38.4% of the physicians in the study did not understand the administration of vaccines together with immunoglobulin as part of postexposure prophylaxis. We also found that 79% of the physicians did not know the correct doses of vaccines, while 37.6% did not know the correct sites and routes of vaccine administration. Finally, 30% of the physicians were not aware of the correct vaccine schedules in postexposure prophylaxis. Our data indicate that Turkish physicians' basic and clinical knowledge of rabies was insufficient. Rabies prophylaxis educational programs should be designed to educate physicians on the guidelines provided by the World Health Organization and the Advisory Committee on Immunization Practices for the treatment of rabies caused by animal bites.
    Japanese journal of infectious diseases. 09/2011; 64(5):382-90.
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    ABSTRACT: In this population-based study, we aimed to determine the total sleep duration (TSD), its association with socio-economic status (SES) and behavioural symptoms among schoolchildren. A cross-sectional study was performed among schoolchildren in Istanbul. A structured questionnaire evaluating the sleep schedule variables was filled out by their parents. SES was determined according to the Turkish SES scale. The mean age of 2669 children was 8.2 ± 2.4 years, and 51% of the students were girls. The mean TSD was 10.20 ± 1.04, and the mean bedtime was 21.57 ± 0.56 (both in hours, minutes ± SD). Boys tended to go bed later (p = 0.004) and slept less than girls (p = 0.02). The duration of sleep disruptions increased (p < 0.001), whereas TSD decreased with age (p < 0.001). Multiple linear regression revealed that waking time and TSD decreased significantly (p < 0.05) with higher SES among both girls and boys. Sleep fragmentation was associated with habitual snoring, parasomnias, daytime sleepiness and conduct symptoms. Decreased total sleep duration is more prominent in boys, older children and children among higher socio-economic status. Insufficient sleep attributed to shortened total sleep duration by age and higher socio-economic status might have a negative effect on both sleep hygiene and psychological well-being in schoolchildren.
    Acta Paediatrica 03/2011; 100(3):420-4. · 1.97 Impact Factor
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    ABSTRACT: The aim of the present study was to asses the accuracy of prediction equations in elderly patients with advanced renal disease (ARD). Twenty-three elderly patients (>60 years) with chronic kidney disease (CKD) stages 3-5 underwent technetium-99 m-diethylenetriaminepentaacetic acid (Tc-99m-DTPA) radionuclide measurement of glomerular filtration rate (GFR). To predict GFR, estimation formulas [Cockcroft-Gault (CG), 6-variable Modification of Diet in Renal Disease (6-var-MDRD) and the corrected 24-hour creatinine clearance (24-h CCL) method] were used. Estimates of bias and precision were obtained to compare prediction equations of GFR with standard radionuclide measurement. In the present study, all the prediction equations overestimated the GFR measured with the radionuclide method. Six-var-MDRD and 24-h CCL methods correlated better with standard radionuclide measurements compared to the CG formula (Rc of 0.53 and 0.50 vs. 0.41, respectively) as for GFR prediction, but they were still insufficiently accurate. Glomerular filtration rate prediction equations correlate poorly with standard radionuclide measurements and their use may lead to late initialization of renal replacement therapy in elderly patients with ARD. Therefore, measurement by standard radionuclide method (Tc-99m-DTPA) is recommended to accurately assess GFR in elderly patients with ARD.
    International Urology and Nephrology 10/2010; 43(1):257-63. · 1.33 Impact Factor
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    ABSTRACT: During the H1N1 pandemic, most healthcare workers in Turkey were not willing to take up the vaccine. This qualitative study aims to explore the factors that lead to vaccination resistance among a group of primary healthcare workers in Istanbul. Data were collected through focus group discussions. Thematic content analysis was conducted. All participants considered themselves at risk for infection, yet most of them were not vaccinated. Only persons with a "poor" immune system were considered by the respondents at risk for severe disease and death. Health personnel mostly did not realize their potential role in the transmission of influenza to patients. The decision of vaccination was dependent on the information source. The personnel who depended mainly on the media either did not accept vaccination or was undecided. They believed that the vaccine went through an accelerated authorization procedure. Yet the ones who accepted vaccination relied mostly on evidence-based sources and accessed information from the guidelines of the Ministry of Health, Professional Medical Associations and the World Health Organization. Social networks were also influential factors in the decision-making process. It is important to empower healthcare workers through supporting the skills of acquiring and using evidence-based information. This is particularly important for physicians who also serve as opinion leaders.
    Vaccine 10/2010; 28(51):8120-4. · 3.77 Impact Factor
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    ABSTRACT: The objective of this study was to assess the urine levels of interleukin-6 (IL-6) and interleukin-8 (IL-8) as noninvasive markers of vesicoureteral reflux (VUR) and renal parenchymal scarring (RPS) in children in the absence of a recent urinary tract infection (UTI) episode. Urine concentrations of IL-6 and IL-8 in 114 children aged 1 month to 16 years were evaluated. The children were divided into four groups: group 1, 26 children with VUR and RPS; group 2, 27 children with VUR without RPS; group 3, 34 children with RPS without VUR, group 4, 27 children without VUR and RPS, as the control group. After the first assessment, the children were divided into four larger groups for comparison purposes: group A (groups 1+2), 53 children with VUR; group B (groups 3+4), 61 children without VUR; group C (groups 1+3), 60 children with RPS; group D (groups 2+4), 54 children without RPS. Urinary IL-6 and IL-8 concentrations were determined. To avoid dilution effects and to the standardize samples, urinary levels of IL-6 and IL-8 were expressed as the ratio of cytokine to urinary creatinine (pg/mg). The median urine IL-6/creatinine was significantly higher in patients with VUR than in those without VUR (5.72 vs. 3.73). In patients with VUR, there was a significant but rather weak correlation between IL-6/creatinine concentrations and there flux grade (p<0.05, R=0.305). The median urine IL-8/creatinine was significantly higher in patients with RPS than in those without RPS (43.12 vs. 16.36). In patients with RPS, there was a significant but rather weak correlation between IL-8/creatinine concentrations and the renal scar grade (p<0.05, R=0.251). The results of this study provide preliminary evidence that children with VUR have a high urine IL-6 concentration, whereas children with RPS have a high urine IL-8 concentration.
    Pediatric Nephrology 05/2010; 25(5):905-12. · 2.94 Impact Factor
  • Fuel and Energy Abstracts 01/2010; 86.
  • Anadolu Psikiyatri Dergisi 01/2010; 11(2):151-160. · 0.18 Impact Factor
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    ABSTRACT: Purpose: Transient hypothyroxinemia is the most common thyroid dysfunction in the preterm. Thyroid hormone is essential for normal bone maturation. The aim of the study is to determine the effect of transient hypothyroxinemia on osteopenia of prematurity. Methods: 113 infants, born at a gestational age of less than or equal to 34 weeks ,were enrolled. Demographic characteristics and clinical features were recorded. Thyroid Function Tests and Calcium, Phosphorus, serum total Alkalene Phosphatase levels were determined in the first and third week of life. An ALP level of 900 IU/L or more at the third week was accepted as an indicator of metabolic bone disease. Free T4 levels < 0,6 ng/dl for the infants born at 25-27 weeks of gestation, < 0,8 ng/dl for 28-30 weeks of gestation and < 1,2 ng/dl for 31-34 weeks of gestation at the seventh postnatal day were accepted as hypothyroxinemia. Cut-off values for free T4 levels were -1 SD of the mean for each gestational subgroup. SPSS 14.0 program was used for statistical analysis. Results: Forty three ( 38% ) babies had ALP values > 900 IU/L at third postnatal week. 22 (19,6%) babies had low free T4 at 1st week. Infants with hypothyroxinemia had lower gestational age than the infants without hypothyroxinemia .The mean gestational ages were 30,2±2,4 weeks and 31,1±2,2 weeks, respectively ( p=0.04). Full enteral feeding was achieved at 19,2±11,7 days in hypothyroxinemic infants, at 11,4±6,9 days in infants without hypothyroxinemia ( p=0,007).Duration of total parenteral nutrition infusion was longer in infants with hypothyroxinemia (17,3±12,3 days and 11,0±10 days respectively p==0.05 ). BPD was more frequent in patients with hypothyroxinemia ( p=0,006 ) The mean ALP levels was not different between the infants with or without hypothyroxinemia. Free T4 level and ALP levels did not have a statistically significant correlation. Conclusion: Both transient hypothyroxinemia and osteopenia are common problems of prematurity. Low free thyroxine levels do not seem to effect osteopenia in premature infants. Mild alterations of free T4 levels may be a minor contributor for normal bone maturation in premature babies. These findings should be explored with a larger sample size.
    2009 American Academy of Pediatrics National Conference and Exhibition; 10/2009
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    ABSTRACT: To explore the impact of gender roles in relation to health seeking behaviour during pregnancy and childbirth. The study was conducted in neighbourhoods with low antenatal care rates in three provinces of Turkey. The study population consisted of pregnant women who never got or discontinued antenatal care and their peers, families and community leaders. Sixteen focus group discussions and 125 in-depth interviews were conducted with a total of 239 participants. Pregnancy and childbirth are interwoven strongly with gender roles. Since the patriarchal system acknowledges women through the means of childbirth, women are expected to have many children. Hence women experience pregnancy as a burden and are not motivated to seek antenatal care. During pregnancy, only 'serious' conditions are considered as legitimate reasons for accessing care. However, the decision regarding whether a pregnant woman is seriously sick or not belongs to the responsibilities of elder women, which delays service use. Providing information regarding the value of antenatal care also to elder women is essential in increasing the demand to the services. Incorporating gender perspectives into daily health practice and maintaining access to high quality reproductive care services are vital in reducing the gender based barriers to care.
    The European Journal of Contraception and Reproductive Health Care 05/2009; 14(4):290-300. · 1.81 Impact Factor
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    ABSTRACT: Objective.— The etiology and pathogenesis of migraine and other types of headache are still under discussion. An interaction of organic, psychological, and psychosocial factors is operative. In this study, we aimed to determine the prevalence of headache and its association with socioeconomic status among schoolchildren.Study Design.— A cross-sectional study was performed on 2669 schoolchildren via a parental questionnaire. Socioeconomic status was determined according to the Turkish socioeconomic status scale.Results.— The mean age of the students was 8.2 ± 2.4 years. The headache prevalence was 46.2% (95% CI: 44.3-48.1). The prevalence of migraine was 3.4% (95% CI: 2.8-4.1), the prevalence of probable migraine was 8.7% (95% CI: 7.6-9.8), and that of non-migraine headache was 34.1% (95% CI: 32.3-35.9). Multivariate analysis revealed that older age, being a girl, having a family history of headache, and exposure to passive smoking at home were independently associated with headache. There was an inverse association between socioeconomic status and all 3 types of headaches after adjusting for age, sex, family history of headache, and presence of passive smoking. When the group with the lowest socioeconomic status was taken as the reference category, the odds ratios for the highest socioeconomic group were 0.33 (95% CI: 0.16-0.69, P = .003) for the migraine, 0.30 (95% CI: 0.11-0.89, P = .029) for the probable migraine, and 0.34 (95% CI: 0.16-0.72, P = 0.005) for the non-migraine headache.Conclusion.— Headache is more common among children with lower socioeconomic groups. Social causation can play a role in the pathogenesis of headache.
    Headache The Journal of Head and Face Pain 04/2009; 49(5):697 - 703. · 2.94 Impact Factor
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    ABSTRACT: The objective of this study is to evaluate and map soil radionuclides' activity concentrations and environmental outdoor gamma dose rates (terrestrial and cosmic) in Kirklareli, Turkey. The excess lifetime cancer risks are also calculated. Outdoor gamma dose rates were determined in 230 sampling stations and soil samples were taken from 177 locations. The coordinates of the readings were determined by the Global Positioning System (GPS). The outdoor gamma dose rates were determined by Eberline smart portable device (ESP-2) and measurements were taken in air for two minutes at 1 m from the ground. The average outdoor gamma dose rate was 118 ± 34 nGy h−1. Annual effective gamma dose of Kirklareli was 144 μSv and the excess lifetime cancer risk of 5.0 × 10−4. Soil samples were analyzed by gamma spectroscopy. The average 226Ra, 238U, 232Th, 137Cs, and 40K activities were 37 ± 18 Bq kg−1, 28 ± 13 Bq kg−1, 40 ± 18 Bq kg−1, 8 ± 5 Bq kg−1 and 667 ± 281 Bq kg−1, respectively. The average soil radionuclides' concentrations of Kirklareli were within the worldwide range although some extreme values had been determined. Annual effective gamma doses and the excess lifetime risks of cancer were higher than the world's average.
    Journal of Environmental Radioactivity 01/2009; · 2.12 Impact Factor
  • Harika Alpay, Nihal Ozdemir, Elke Wühl, Ahmet Topuzoğlu
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    ABSTRACT: The aim of this study was to compare ambulatory blood pressure monitoring (ABPM) parameters in offspring with at least one hypertensive parent (HP) to offspring with normotensive parents (NP) and to determine whether gender of parent or child might influence the association between parental hypertension and blood pressure (BP). Eighty-nine healthy children (mean age 11.1 +/- 3.9 years) with HP and 90 controls (mean age 10.5 +/- 3.1 years) with NP were recruited. Age, gender, and height did not differ between the two groups, whereas children of HP had higher weight, body mass index (BMI), and waist circumference compared with healthy controls. No difference was found in casual BP between the two groups. In contrast, during ABPM daytime and nighttime mean systolic and diastolic BP and mean arterial pressure (MAP) standard deviation scores (SDS) were significantly elevated in children with HP. The mean percentage of nocturnal BP decline (dipping) was not significantly different between the two groups. Children with hypertensive mothers had higher daytime systolic and MAP SDS than controls; no such difference was detected for children with hypertensive fathers. Daytime systolic and MAP SDS were significantly elevated in boys with HP compared with boys with NP but failed to be significant in girls. Multiple linear regression analysis showed that parental history of hypertension (B = 0.29) and BMI (B = 0.03) were independently correlated with increase of daytime MAP SDS. Early changes in ambulatory BP parameters were present in healthy children of HP. BP in HP offspring was influenced by the gender of the affected parent and the offspring.
    Pediatric Nephrology 10/2008; 24(1):155-61. · 2.94 Impact Factor
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    ABSTRACT: The aim of this study was to establish the reference values of preductal oxygen saturation (SpO2) in healthy infants immediately after birth. SpO2 recordings of 200 term neonates (vaginal group;n=150 and cesarean group;n=50) with regular respiratory pattern were evaluated. The median SpO2 values in the first, fifth and tenth minutes were 71, 92, and 98% in vaginal deliveries and 70, 79, and 96% in cesarean deliveries, respectively. SpO2 was significantly lower in the cesarean group at any time after the first minute of life (p<0.0001). The time needed to reach a SpO2>90% was three times longer in cesarean deliveries. Healthy neonates are poorly saturated immediately after birth. The duration to reach a SpO2>90% was longer in infants born by cesarean deliveries.
    European Journal of Pediatrics 07/2008; 167(6):687-8. · 1.98 Impact Factor
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    ABSTRACT: There is no single or widely accepted method to define pain in neonates. The aim of this study was to compare three different neonatal pain scales in the estimation of the pain response to minor painful stimuli in healthy term neonates. Thirty healthy neonates were included in the study. Video recordings of infants during heel prick blood sampling were evaluated by two observers according to the Neonatal Infant Pain Scale (NIPS), the Neonatal Facial Coding System (NFCS), and the Douleur Aiguë du Nouveau-né (DAN). Crying times of infants were recorded, and the correlation between the three pain scales and crying time was calculated. The pain scores and inter-observer variability were analyzed. The highest correlation between the crying time and each of the three different neonatal pain scales was found for NIPS (r = 0.74, p<0.001), while similar results were found for the DAN scale (r = 0.67, p <0.001) and the NFCS (r = 0.67, p<0.001). Inter-observer variability was similar for the three scales (NFCS r = 0.95; DAN r = 0.97; NIPS r = 0.96). NFCS had a coefficient of variation (CV) of 59.8 +/- 32.2%. The DAN scale and NIPS had similar CV values (41.5 +/- 26.1% and 43.2 +/- 31.6%, respectively), but these values were significantly lower than that of NFCS. All three scales provided comparable results, with a slight difference favoring NIPS. Therefore, NIPS can be used to evaluate pain during minor painful procedures in neonates.
    Journal of Maternal-Fetal and Neonatal Medicine 06/2008; 21(5):305-8. · 1.52 Impact Factor
  • Sexologies 04/2008; 17.
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    ABSTRACT: ABSTRACT Objective: Patient satisfaction is very important as a quality criterion in health care services. Patient satisfaction outcomes are important in quality assessments, shaping and managing health care services. The aim of this study was to determine the satisfaction level of hospitalized patients and the associated factors in Marmara University School of Medicine. Method: The study was designed as cross-sectional. Face to face interviews were conducted with 135 patients who were hospitalized during February 2006. The questionnaire included 61 questions which were prepared in the light of the existing literature. Results and Conclusion: Among the 155 hospitalized patients, 135 (87.09%) participated in the study. 64.5% of the participants reported satisfaction regarding the general hospital care. The most frequent factor for preferring this hospital was related to social insurance and consignment (42.2%). 84.6% of the participants reported that they would again prefer this hospital in the future and 70.7 %of them reported that they would recommend this hospital to their relatives and friends. There was a statistically significant relation between the general satisfaction level and the hospital personnels’ attitudes as well as the physical conditions of the hospital (p<0.05). There were also statistically significant relations between the services, the cleaning of the rooms and the doctors’ skills. Keywords: Hospitalized patient, Satisfaction, Quality, Hospital
    Marmara Medical Journal 01/2008;
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    Ahmet Topuzoğlu, Pinar Ay, Seyhan Hidiroglu, Yucel Gurbuz
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    ABSTRACT: The socio-economically disadvantaged populations are among the most vulnerable groups that are under-vaccinated. Therefore, the aim of this qualitative study was to understand the behaviours of mothers concerning the immunization of their children, the decision-making process, the perceived barriers, and the enabling factors to access the services in a suburban population in Istanbul. Eight focus group discussions and two in-depth interviews were carried out with the mothers who have children younger than five years. While the responsibility of immunization was left totally to the mother, the socially subordinate role of women did not provide the means of getting the immunization services. The women were dependent mostly on social networks for getting the immunization services. Another important barrier to the services was related to the economical constraints and accessibility of the services. In addition, the lack of effective communication and information transfer between the health personnel and the mothers formed an important obstacle. This study underlines a need for an effective counselling tailored to the immunization session, which will maintain a positive relationship between the personnel and the mother.
    The European Journal of Public Health 09/2007; 17(4):348-52. · 2.52 Impact Factor
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    ABSTRACT: To evaluate the health concerns and the perceived non-contraceptive benefits of modern contraceptive methods through utilizing qualitative methods. Six focus group discussions were carried out with a total of 53 married women in a socio-economically disadvantaged community in Istanbul, Turkey. Women had a vague knowledge of the mechanism of menstruation. Some women believed that the uterus was filled with blood -- termed 'dirty blood' -- which should be eliminated during menstruation in order to stay healthy. For this reason, amenorrhoea was recognized as the important disadvantage of the progestin-only injectable contraceptives. While the participants mentioned fallacious and exaggerated side effects related to modern methods they did not recognize their non-contraceptive benefits. Most women gained the information concerning side effects through their social networks. Sometimes the information acquired was based on rumours that biased women against the modern contraceptives. Women outweighed the risks, some of which were fallacious and exaggerated, against the benefits of modern contraceptives. It is crucial to address health concerns of women and what they 'heard' from their peers during counselling sessions. Also the non-contraceptive health benefits of modern methods should be well emphasized. Since informal sources are prevalent, the effectiveness of peer education should be studied in this community.
    The European Journal of Contraception and Reproductive Health Care 07/2007; 12(2):154-61. · 1.81 Impact Factor
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    ABSTRACT: The overall objective of the study is to explore and describe the perceptions of, and health-seeking behaviour related to, pregnancy and childbirth, and the responsiveness of Primary Health Care (PHC) and Mother-Child Health/Family Planning (MCH/FP) services to these in selected urban and rural sites in Turkey, in order to inform the design of interventions contributing to increased utilisation of antenatal care (ANC) and skilled birth attendance. The study was conducted in Adana, Afyon, and Van provinces (in parts of these provinces where problems regarding ANC and birth services are observed) with pregnant women who have never attended ANC or have discontinued ANC services, their husbands, family elders, peers as well as with health service personnel and community leaders/key informants using qualitative methods. The sample size was not calculated as the study was of qualitative nature, and purposive sampling and the snowball method was used as the sampling method. In line with the objectives of the study, data collection was done until saturation was reached. Data was collected through in-depth interviews, focus group discussions and interviews with key informants. The in-depth interviews and key informant interviews were conducted by fieldworkers who were selected from the region and given training. The focus group discussions (FGD) were conducted by short-term experts who were experienced in this field. Audio recordings of the interviews were made along with observational notes and these were transcribed and stored digitally. Data analysis was undertaken by experts. The concepts and categories which were coded in detail were grouped under themes and theoretical constructs and interpretations were made. Various utilities of Microsoft Office Word and Microsoft Office Excel programmes were employed during data analysis. Data was collected through in-depth interviews and FGD from a total of 239 participants, of whom 111 were pregnant women, the remainder (128) being comprised of peers, relatives, health care personnel, and community leaders in the selected regions. In this regard, 60.4% of the pregnant women were in the 20-29 age group, 59.1% resided in urban areas and 98.2% was either illiterate or elementary/primary school ‘graduates’. Furthermore, 57.4% were from extended families. In short, the pregnant women covered under this study were in the youngmiddle age group, mostly living in extended families, with low education attainment levels. The women participating in the present study perceive pregnancy as a natural process even as a process giving a sense of happiness and fulfilment in general and that it is unnecessary to go to a health care institution for a check-up in the absence of any severe complaint. Concern and anxiety observed in some pregnant women is more related to childbirth and the health of the unborn offspring than to the pregnancy xii process. Childbirth, and how the baby will be after birth, are important for women and their relatives and all concern is focused on these aspects. The feeling of ‘shame/embarrassment’ is present in almost all women interviewed and this is expressed universally with a smile. It is understood that this feeling negatively affects obtaining information and accessing services. Such symptoms as vaginal haemorrhages, immobility of the unborn offspring, severe aches and pains, nausea during pregnancy, increase risk perceptions as does the occurrence of miscarriages, stillbirths, babies with deformities, and babies with serious diseases, in their proximity. Although pregnant women and their relatives state that attending ANC is a good thing, they cannot give satisfying explanations as to why it is a good thing. The explanations given for the benefit of services remain limited to learning the status of the unborn offspring. According to pregnant women and their relatives who were interviewed, there are many and serious obstacles impeding access to health care services. The most common and highly-rated obstacle is ‘lack of interest and negative behaviour of the health personnel’. Inattentiveness, bad practice, and miscommunication at health care institutions come out as being the most responsible features for underutilization of the provided services. Other common obstacles in this group are the lack of health insurance and economic problems. These emerge along with lack of education, and gender problems. Low education levels, lack of education, and living in an extended family structure where permission of the mother-in-law and husband is required, seriously impede women accessing information and services regarding ANC and childbirth. In some peri-urban areas of Adana and Van provinces and to some extent in the rural areas, prejudice and concern stemming from distrust of health services provided are important obstacles in the utilisation of services. Not providing ANC at primary health care institutions, or inadequate ANC provision, insufficient personnel, and the occurrence of organizational and administrative problems, are important obstacles in the utilization of services. It is possible to group the pregnant women in the study in 4 categories with regards their health seeking behaviour: 1. Women who are uneducated, live in extended families and have never attended ANC although their fertility is encouraged and they are under risk. 2. Women who mostly live in the peri-urban areas and seasonal workers areas in Adana and Van and who have problems in communicating with the health care institutions 3. Women who have previously applied to a health care institution for ANC or childbirth, however due to such negative experiences as inattentiveness and ill treatment at the health care institution have decided against utilising services. xiii 4.Women who mostly reside in urban areas and who do not feel the necessity of attending ANC unless there are serious health problems but who definitely think of giving birth at a hospital and who have previously received services. The information and data gathered from health personnel, community leaders and key informants indicate that the present primary health care services being provided are inadequate and problematic with regards ANC and childbirth services. In light of the findings, recommendations have been formulated to inform policies, strategies and interventions.