Africa's neglected area of human resources for health research - the way forward.

Building the skills for doing, managing and delivering health research is essential for every country's development. Yet, human resources for health research (HRHR) are seldom considered in Africa and elsewhere. Africa's health research capacity has grown considerably, with potential to increase this growth. However, a systemic way of defining, co-ordinating and growing the HRHR needed to support health systems development is missing. Reviewing the status of HRHR in Africa, we assert that it consists of uncoordinated, small-scale activities, primarily driven from outside Africa. We present examples of ongoing HRHR capacity building initiatives in Africa. There is no overarching framework, strategy or body for African countries to optimise research support and capacity in HRHR. A simple model is presented to help countries plan and strategise for a comprehensive approach to research capacity strengthening. Everyone engaged with global, regional and national research for health enterprises must proactively address human resource planning for health research in Africa. Unless this is made explicit in global and national agendas, Africa will remain only an interested spectator in the decisions, prioritisation, funding allocations, conduct and interpretation, and in the institutional, economic and social benefits of health research, rather than owning and driving its own health research agendas.

The need for capacity building to prevent chronic diseases in North Africa and the Middle East.

Chronic (noncommunicable) diseases, such as cardiovascular disease, stroke, cancer and diabetes mellitus, are a global public health problem that is increasing, particularly in developing countries. According to the World Health Organization, over the period 2006-15, the largest increase in deaths from chronic diseases will occur in the regions of Africa and the Middle East. This article outlines the problems facing theses regions with regard to chronic diseases, and discusses the urgent need for capacity building and community-based programmes in order to enhance regional capability for tackling chronic diseases.

[Profile of tobacco use among the teachers of Sousse, Tunisia]. / Les facteurs déterminants le comportement tabagique chez les enseignants de la ville de Sousse, Tunisie.

OBJECTIVE: To examine the prevalence of tobacco use among the teachers in the region of Sousse (Tunisia) and to identify the factors, which determine this behavior. PATIENTS AND METHODS: It is a transactional study; using a self-administered and pre-tested questionnaire to 800 teachers. RESULTS: The population being studied was made up of 739 teachers including 50.6% of professors. The sample was 35.4% male and the average age was of 45.3±8.1 years. The total prevalence of tobacco use was 17.8% (41.4% among men and 4.7% among women). Half of these teachers smoked in their school establishments and in the presence of their pupils. The multivariate analysis had made it possible to identify four factors, which determine the profile of tobacco use in our teachers; these factors were: the sex, the age, knowledge and attitudes. CONCLUSION: It's necessary to intervene with the teachers of the town of Sousse with specific trainings on the topic of the tobacco use and dispose their adapted tools which will be used in the educational programmes of tobacco use prevention in schools.

[Seroprevalence of rubella virus, varicella zoster virus, cytomegalovirus and parvovirus B19 among pregnant women in the Sousse region, Tunisia]. / Séroépidémiologie de la rubéole, de la varicelle et des infections par le cytomégalovirus et le parvovirus B19 chez les femmes enceintes dans la région de Sousse, Tunisie.

The aim of the study is to evaluate seroprevalence of rubella virus (RV), cytomegalovirus (CMV), varicella zoster virus (VZV), and parvovirus B19 (PB19) in 404 Tunisian pregnant women, and to determine reliability of maternal past history of eruption. Sociodemographic characteristics, risk factors, and past history of eruption were collected through a questionnaire. Serologic tests were performed using enzyme immunoassays. Risk factors were analyzed using univariate and multivariate logistic regression models. Seroprevalences were 79.7% for rubella, 96.3% for CMV, 80.9% for VZV, and 76.2% for PB19. In multivariate analysis, the number of persons per room (> 2) in the house during childhood was associated with CMV infection (P = 0.004), irregular professional husband's activity was correlated with VZV infection (P = 0.04), and an age of more than 30 years was associated with PB19 infection (P = 0.02). History of rubella, varicella, and PB19 infection was unknown for, respectively, 55.8%, 20%, and 100% of women. False history of rubella and varicella were found for 7.4% and 15% of women, respectively. The positive and negative predictive values (PPV and NPV) of rubella history were, respectively, 92.6% and 17.2%, and were, respectively, 84.9% and 20.9% for varicella history. Susceptibility to RV, VZV, and PB19 infection remains high in pregnancy in our population. Preventive strategies against congenital rubella must be reinforced. Vaccination against VZV should be considered in seronegative women. Systemic CMV screening is not warranted in our country where high immunity is acquired probably in childhood. Since maternal history of eruption is not reliable, we recommend serologic testing to determine immune status of women.

[Seroprevalence and risk factors of hepatitis E among pregnant women in central Tunisia]. / Séroprévalence et facteurs de risque de l'hépatite virale E chez la femme enceinte dans le centre tunisien.

OBJECTIVES: The study was conducted to investigate the prevalence and risk factors for hepatitis E virus (HEV) infection in Tunisian pregnant women. METHODS: A total of 404 pregnant women were enrolled. Data were collected through a standard questionnaire which covered sociodemographic characteristics and risk factors. Blood samples were collected and were tested for HEV IgM and IgG antibodies, IgG against hepatitis A (anti-HAV IgG), hepatitis B virus surface antigen (HBsAg) and hepatitis C virus antibody (anti-HCV). Risk factors were analyzed using univariate and multivariate logistic regression models. RESULTS: Prevalence of anti-HEV IgG, anti-HEV IgM, anti-HAV IgG, HBs Ag and anti-HCV was 12.1 %, 0 %, 97 %, 3 % and 0,5 %, respectively. In multivariate analysis age (>30 years) and the number of persons per room (>2) in the house were independent factors predicting HEV infection. History of agricultural work, kind of water, sewage treatment, use detergent to wash vegetables, contact with animals and parenteral risk factors were not correlated with the presence of anti-HEV IgG. CONCLUSION: The important seropositive rate among pregnant women is compatible with endemicity of HEV in Tunisia. Hepatitis E should be considered in the diagnosis of acute hepatitis during pregnancy. Our result suggests that infection occurs sporadically by person-to-person transmission route but further investigations are needed to determine the natural reservoir of infection.

[Intervention on smoking in adolescents in Sousse, Tunisia]. / Etude d'intervention sur le tabagisme chez les adolescents dans la région de Sousse, Tunisie.

PURPOSE: To increase knowledge about smoking via a school prevention programme. PATIENTS AND METHODS: This quasi-experimental study included two groups: a control and an intervention group with a pre- and a post-evaluation of knowledge about smoking in each group. The target population consisted of students of 12 to 16 years old in Sousse, Tunisia. To evaluate the intervention, stratified and proportional sampling was used to include 2100 students in the questionnaire. All the students in the intervention group received a standardized program of information about smoking. A pre-tested and self-managed questionnaire in Arabic was used to assess knowledge about smoking, attitudes and behavioural intent before and after the intervention. RESULTS: The intervention group's post-test knowledge and behavioural intent were significantly higher than that of the control group's. No significant differences were found in post-test attitudes between the control and the intervention groups. CONCLUSION: The authors carried out this survey to evaluate the difficulties and resources in order to institute a more complete and durable program.

[Tunisian experience in the treatment of aggressive non Hodgkin's lymphoma in adults: about 337 patients]. / Expérience tunisienne dans la prise en charge des lymphomes agressifs de l'adulte: à propos de 337 patients.

From January 1997 to December 2005, 337 patients with aggressive non Hodgkin's lymphoma were treated with one of the two successive multicentric non randomized protocols established in Tunisia. The mean age was 53 years. Most patients had diffuse large cell lymphoma with B phenotype in 86% and T in 14%. The performance status was 2 or 3 in 34% of cases. The LDH were elevated in 74% of cases. Advanced disease (III or IV stage) was noted in 59% of cases and 10% had a tumoral mass greater than 10 cm. According to the international prognostic index (IPI) adjusted to age, we distinguish four groups: group 1 (0 factor and age < 70 years), group 2 (1-3 factors and age < or = 60 years), group 3 (1-3 factors and age between 61 and 70 years) and group 4 (1-3 factors and age > 70 years). The patients of group 1 (N = 47) received 3 courses of CHOP regimen followed by irradiation. The patients of group 2 (N = 160) received 4 courses of ACVBP regimen (+ rituximab for 21 patients) followed by consolidation (N = 92) or peripheral blood progenitor cell transplantation (N = 20). The patients of group 3 (N = 61) received 8 courses of CHOP regimen (+ rituximab for 20 patients). The patients of group 4 (N = 69) received 6 courses of mini-CEOP regimen (N = 48) or 6 courses CVP regimen (N = 21). The 4-year overall survival was 56% and the 4-year event free survival was 49%.

Tracking of lipids in schoolchildren: a four-year followup, population-based study in Sousse (Tunisia).

OBJECTIVE: Dyslipidaemia, which is now seen as one of the most important cardiovascular risk factors, is becoming more common in the younger population. The aim of this study was to assess the efficacy of tracking serum lipid levels over a four-year period in an urban population of schoolchildren. METHODS: The study began in 1999 with a cohort of 789 schoolchildren. Four years later this group was resurveyed and a further 452 adolescent were recruited to the study. RESULTS: The percentages of boys who were initially in the extreme quartile for total cholesterol (TC), low-density lipoprotein (LDL) cholesterol and triglycerides were 42.5, 54.8 and 40.4%, respectively. Similarly, the percentages of girls in the extreme quartile were 62.7, 53.8 and 38.2%. Four years later, both the boys and girls were still in the extreme quartile for these parameters. Therefore, the best predictor of followup level for each of the serum lipoprotein cholesterol fractions was the corresponding baseline level. Interestingly, the next best predictor in most of the groups was change in body mass index (DeltaBMI) and smoking status. CONCLUSION: Prevention of coronary heart diseases in adults must begin early on in childhood, and should be driven by health education towards achieving a healthy lifestyle.

[Cardiovascular risk factors among shift workers in company of electricity production in the centre of Tunisia]. / Facteurs de risque cardiovasculaire chez les travailleurs postés d'une centrale de production d'électricité au centre tunisien.

THE PURPOSE OF THE STUDY: The aim of the present study was to investigate relationship between shift work and the cardiovascular risk factors. METHODS: A cross-sectional study was included 330 subjects worked in a company of electricity production in the Centre of Tunisia. The collection of data was based on a questionnaire, a clinical exam and biomarkers. RESULTS: A total of 290 workers was participated in our study (128 shift workers and 162 daytime workers). A raised prevalence but not statistically significant of some factors of cardiovascular risks was found in the shift workers: obesity (25.8 % versus 17.9 %), smoking (44.5 % versus 39.5 %), impaired fasting glucose (11.7 % versus 9.9 %), hypertriglyceridemia (28.1 % versus 25.9 %) and hypercholesterolemia (14.8 % versus 12.4 %). Whereas the prevalence of the alcohol consumption (25.8 % versus 16.0 %) was significantly higher in the shift workers (p=0.04). CONCLUSION: The high prevalence of the cardiovascular risk factors, observed in our shift workers, justify the adoption of measures to protect this category of workers.

Predictors of smoking initiation among schoolchildren in Tunisia: a 4 years cohort study.

OBJECTIVE: To identify predictors of smoking initiation among non smoking Tunisian school children; and to propose efficient antismoking strategies in order to prevent smoking initiation. METHODS: It was a cohort study surveying prospectively for four years pupils attending schools in Sousse city in Tunisia. 441 non smoking pupils aged 13-15 years attending secondary schools in Sousse. Data were collected by a self administered questionnaire during class session. Two ways cross tabulation, univariate and multivariate logistic regression analyses were the main analytical methods. RESULTS: 57.1% of the surveyed population were girls, 42.9 % were boys. 63% had at least one of their peers who smoked. Before 1999, 16.6% had already tried to smoke, 29.5% had already experienced alcohol. In 2003, smoking prevalence was 17%. 4.8% were girls; 33.3% of boys; p<0,001). 69.9 % of these smokers declared that they would carry on smoking during the following five years. Predictors which were highly associated with smoking initiation were previous experimentation with alcohol and tobacco, having a smoking best friend, lack of sensitization from the part of the school, believing that smoking makes one feel cool and that tobacco shouldn't be forbidden in public places. CONCLUSION: Intervention programs should target young children to avoid experiencing the first cigarette. Multidisciplinary management including community and school based intervention highlighted by mass media campaigns may provide schoolchildren with skills to resist smoking peers prompts to adopt unhealthy habits such as smoking.

National health research system mapping in 10 Eastern Mediterranean countries.

Health research systems in the Eastern Mediterranean Region are not well developed to generate and use knowledge to improve health, reduce inequity and contribute to economic development. This study aimed to provide core data on National Health Research Systems (NHRS) in 10 Eastern Mediterranean countries in order to inform actions to strengthen health research system governance and management. Whilst there were examples of good practice, few countries had a formal NHRS and many basic building blocks needed for an effective system had not been put in place. Although limited in focus, the study provides useful information for countries to initiate action to strengthen their NHRS.

[Knowledge of patients with type 2 diabetes about their condition in Sousse, Tunisia]. / Connaissances des patients diabétiques de type 2 sur leur maladie à Sousse (Tunisie).

We assessed the knowledge of 404 type 2 diabetic patients about their condition in order to evaluate the quality of diabetes education in primary health care units in Sousse in 2003. We found that knowledge was satisfactory in only 59% of the patients. Their knowledge about the definition of diabetes and its pathophysiology were the 2 main areas where knowledge was lacking: the proportion of correct answers were 62.6% and 50.3% respectively. More attention should be paid to educating diabetic patients within the chronic disease care national programme.

[Predictors of increased cardiovascular risk in hypertensive patients in frontline facilities in Sousse, Tunisia]. / Facteurs prédictifs du haut risque cardio-vasculaire chez les patients hypertendus suivis en premiere ligne à Sousse (Tunisie).

We assessed cardiovascular risk factors among 456 hypertensive patients in 7 health centres in Sousse. Cardiovascular risk was estimated according World Health Organization recommendations. Mean age was 65.6 (SD = 9.8) years, male:female sex ratio was 0.18. Cardiovascular risk was not influenced by sex, age or residence. However, patients with longer duration of hypertension and more frequent co-morbidity had a significantly higher cardiovascular risk. In addition 45.9% of patients on monotherapy had high cardiovascular risk compared with 40.6% of those treated with 2 or more drugs (P = 0.02). Non-compliance was not found to be associated with high risk.

[Predictive factors of glycemic control in patients with type 2 diabetes mellitus in primary health care]. / Facteurs déterminants du contrôle glycémique des patients diabétiques de type 2 suivis en première ligne.

PURPOSE: To determine the factors associated with poor glycemic control in type 2 diabetic patients followed in primary care units in Sousse, Tunisia. METHODS: A cross-sectional study was conducted on a representative sample of type 2 diabetic patients followed at least two years in primary health care units in Sousse, Tunisia. Data were gathered from three sources: a self-administrated questionnaire, analysis of patient files and HbA1c level. HbA1c level was measured with turbidimetric immunoinhibition assay. Patients were considered well-controlled if glycated hemoglobin (HbA1c) was less than 7%, according to the American Diabetics Association (ADA) recommendations. RESULTS: The study enrolled 404 type 2 diabetic patients. The mean age was 60.5+/-10.89 years, sex-ratio was 0.5, and mean disease duration 8.7+/-6.1 years. ADA recommendations were met by 16.7% of patients. Multivariate analysis using variables in relation with the patient, his/her family, the disease, the treatment and the health care unit, showed that only poor geographic access to the care center (adjusted OR: 1.89, p=0.009) and Body Mass Index (BMI) less than 30 kg/m2 (adjusted OR: 2.21, p=0.034) were significantly and independently associated with poor glycemic control. CONCLUSION: Glycemic control in type 2 diabetic patients is poor. It depends strongly on geographic access to health care. Type 2 diabetic patients should be referred, as much as possible, to the nearest health care unit.

[Tobacco use among teachers in a district of the Tunisian Sahel]. / Le tabagisme des enseignants dans une commune du Sahel Tunisien.

INTRODUCTION: The aim of this study was to evaluate the scale of tobacco use among teachers in the district of Kalaa Kebira (a semi-urban region in the Tunisian Sahel). METHODS: The study design was descriptive and cross sectional, employing a self administered questionnaire given to 402 teachers. RESULTS: The response rate was 89%. The average age of respondents was 35.7 7.9 years. The global prevalence of smoking among teachers was 29.3% (men: 51.6%; women: 3.6%). 79% of smokers were addicted to nicotine according to the Fagerstrôm test. Half of the teachers were poorly informed about the hazards of smoking and 77.9% of smoking teachers didn't refrain from smoking in front of their pupils. CONCLUSIONS: The teachers' lack of knowledge limits their effectiveness both as a role model and information relay in the war against tobacco.

Medical students and tobacco in 2004: a survey in Sousse, Tunisia.

OBJECTIVE: To assess the behaviour, knowledge and attitudes towards smoking among medical students in Sousse, Tunisia. DESIGN: A cross-sectional survey in classroom settings using a self-administered questionnaire was conducted at the School of Medicine during September 2004. RESULTS: The numbers of students who entered the first and the fifth years of medical training at the University of Sousse in 2004 and completed the questionnaire were respectively 120 and 110. The population age ranged from 18 to 21 years (mean 19 +/- 0.62 years) in first year students and from 22 to 30 years (mean 23 +/- 1.38 years) in fifth year students. The prevalence of daily smoking (both sexes combined) was 4.5% among first year students and 16.7% among final year students. The prevalence of daily smoking according to sex was 29.6% among boys and 0.7% among girls. Over 90% of students thought smoking was harmful to health, but there was considerable underestimation of its causal role in a number of diseases, notably coronary heart disease, bladder cancer and peripheral vascular disease. There were important defects in both knowledge and motivation regarding counselling patients to stop smoking. CONCLUSIONS: The results of this study may provide baseline data to develop an anti-smoking programme in the university.

Celiac disease in Tunisia: serological screening in healthy blood donors.

BACKGROUND: Recent epidemiological studies in Europe and in USA using antigliadin antibodies and antiendomysium antibodies for initial screening have shown that the overall prevalence of celiac disease (CD) is about 1:200 (0.5%). AIM: To screen for CD in healthy blood donors in Tunisia. PATIENTS AND METHODS: Sera from 2500 healthy blood donors (median age: 21 years, 70% men and 30% women) were screened for IgG-antigliadin antibodies and IgA-antigliadin antibodies with an enzyme-linked immunosorbent assay. All sera with positive antigliadin antibodies were tested for antiendomysium antibodies using human umbilical cord cryosections as substrate. RESULTS: Seven healthy blood donors (median age: 21 years; four men, three women) have antiendomysium antibodies. The prevalence of antiendomysium antibodies in healthy blood donors in Tunisia is 1:355 (0.28%). CONCLUSIONS: On the basis of a high specificity of the antiendomysium antibodies, it is likely that the seven blood donors identified in this study have CD. These data suggest that CD is frequent in Tunisia.

[The quality of first line management of arterial hypertension in the sanitary region of Sousse]. / La qualité de prise en charge de l'hypertension artérielle en première ligne dans la région sanitaire de Sousse.

The aim of the study is to value determinants of the quality of management of hypertension in structures of primary health care, a medical audit has been achieved on a representative sample of 456 hypertensive patients followed in the sanitary region of Sousse during the year 2002. It takes out again this work that the global quality of management of hypertension in primary health care have been considered satisfactory at only 28,7% of the hypertensive patients. It was statistically differential according to surroundings (farming: 40,5%, urban: 24,9%) and categories of the seniority of follow-up in primary health care (< or = five years: 34,6%, > five years: 23,9%). A survey multi varied by logistical regression controlling the other factors of confusion (kind, seniority of the illness, geographical and financial accessibility) kept these two factors: the farming middle (ORa: 1,97; P = 0,003) and the lower seniority to five years (ORa: 1,64; P = 0,023). So, the hypertensive patients followed in the urban health centres since more that five years should constitute the population targets a program of improvement of the quality of health care dispensed to hypertensive patients in extra hospital structures of health.

Epidemiology of dyslipidemia among schoolchildren in Sousse, Tunisia.

In Tunisia, there is no available data on the CVD risk profile in the children population, although it is well known that risk factor development takes place during childhood. We undertook an epidemiological survey based on a representative sample of 1569 urban school children of Sousse in Tunisia to assess the prevalence of hypercholesterolemia and other lipid disorders. Prevalence of hypercholesterolemia (8.1%), high level of LDL-cholesterol (3.9%), high level of Lp(a) (14.5%), hypertriglyceridemia (1.3%) and hyper Apo B (3.4%) were found. These informations will be useful to set up a regional program of Heart Health promotion in schools.