Epidemiological and chronological profile of preterm birth in the region of Monastir (Tunisia) between 1994 and 2012.

Data about the profile and risk factors of premature births in Tunisia are scarce. The objective of this study was to describe the epidemiological profile of preterm births in Monastir, Tunisia, and to study the chronological trends of associated factors over the years 1994-2012. A population-based study was conducted using data from the regional births database on all deliveries in public maternity units. The overall prevalence of preterm births among the 161 116 deliveries in the 19-year period was 5.60% (95% CI: 5.13%-6.07%). The rate of preterm births and of adequate prenatal care increased significantly over the study period. Extremes of maternal age (≤ 19 and ≥ 35 years), having a twin pregnancy and the occurrence of complications during pregnancy were significant predictors of prematurity in the final regression model. Efforts should be made to improve the quality of health care in the region, especially for high-risk pregnancies.

[Profile and trends of pediatric hospital morbidity in the region of Monastir (Tunisia) for a decade]. / Profil et tendances de la morbidité hospitalière pediatrique au niveau de la region de Monastir (Tunisie) pendant une décennie.

INTRODUCTION: Hospital morbidity studies allow us to draw the hospital pathological profile of a region and to follow its evolution. This study aims to describe the profile and the main trends of pediatric diseases within public structures in the region of Monastir between 2000 and 2010. MATERIEL AND METHODS: A descriptive study which concerns all pediatric hospitalizations of public structures in the region of Monastir between 2000 and 2010. Informations were collected from the regional register of hospital morbidity implanted at the Department of Preventive Medicine and Epidemiology of the University Hospital of Monastir. RESULTS: A total of 52.443 hospitalizations were collected between 2000 and 2010 with a means annual hospitalization rate of 3,9 %. The mean age was 7,2 ± 5,4 years and 15,3 % had not exceeded the first year of life. Major diagnostic categories (MDC) were dominated by diseases of the digestive and respiratory systems with 14,4 and 14 % respectively. Main chronological trends have shown that the rate of childhood asthma rise significantly from 0,2 %. in 2000 to 2,5 %. in 2010 and Hydatid Cyst whose rate increased also from 0,2 %. in 2000 to 1,8 %. in 2010 (P < 0,05). CONCLUSION: This morbidity profile incites managers to focus their efforts to improve the management of most important diseases.

[Integrated management of mother and child health in the region of Monastir (Tunisia)]. / Piese en charge intégrér de la santé de la mere et de L'Enfant dans la région de Monastir (Tunisie).

The programme of integrated management of child health (IMCI) was established in Tunisia in 2002 in some health districts. This study evaluated the management of children under 5 years of age and their mothers using the IMCI programme in Zeramdine, a town 20 km south-west of Monastir. A cross-sectional study was conducted on a convenience sample of 526 medical records of children under 5 years attending the Zeramdine maternal and child health centre. The study evaluated preventive and curative aspects of child health. The mean age was 21.9 (SD 16.7) months. On the curative side, respiratory diseases were the leading reason for consultation (71.2%) followed by diarrhoea (15.4%). For preventive services, physicians systematically checked the child's immunization status and height and weight on the growth charts, and screened for strabismus and anaemia. The contribution to child health of IMCI is undeniable; it allows comprehensive care of the child, develops staff skills, upgrades the health system and improves family and community practices.

Tracking medication pathway as per better securing drugs' use in three clinical departments at the University hospital of Monastir (Tunisia).

BACKGROUND: In Tunisia, few studies have an interest to the assessment of medication errors and the implementation of preventive measures. The aim of this study was to evaluate the barriers existing in hospital pharmacies in order to prevent medication errors and to help institutions to make improvement actions. methods: First step: a clinical audit was conducted by observation against a set of standards that are representing a guideline. Second step: interview with health professionals to identify their perceptions about medication safety. Third step: in this step we develop adverse events scenarios according to results of the clinical audit in order to be investigated by the field practice. Fourth step: organizing a multi-professional feedback meeting to raise health professional's awareness and to make them more conscientious about adverse drug events negative consequences and invite them to contribute in the establishment and implementation of corrective solutions. results: In the participating departments medical prescription did not include patient information's (age, weight medical background). Nurses do not verify systematically duration of prescription and administration route. Health professionals interview revealed that physician's have lack of awareness about prescription rules. Lack of communication was the main nurse's problem that requires improvement. CONCLUSION: This project has led to a first overview of the situation of medication use in Tunisia. Results will be used to create a dynamic process to improve the medication system safety.

Cervical cancer screening: women's knowledge, attitudes, and practices in the region of Monastir (Tunisia).

BACKGROUND: In Tunisia, cervical cancer is considered the second leading cancer in women and causes high morbidity and mortality. This study aimed to investigate women's knowledge, attitudes, and practices of cervical cancer screening in the region of Monastir (Tunisia). METHODS: We conducted a cross-sectional study exploring the cervical cancer screening knowledge, attitudes, and practices of women in the region of Monastir. The study was conducted in health centers in this region from 1st March to 30th June 2009. Data were collected using a structured questionnaire containing 15 items on demographic status, knowledge of risk factors and screening methods, and attitudes toward the relevance and effectiveness of cervical cancer screening. RESULTS: A total of 900 women agreed to take part in the study. Their mean age was 41.6±12.4 years and 64% did not exceed the primary level of education. According to the constructed scores, 22.8% of the participants had good knowledge of cervical cancer risk factors and 38.2% had good knowledge of screening methods. Multiple logistic regression analysis showed that women aged 45 and older, married, with good knowledge of risk factors and screening methods were more likely to undergo cervical cancer screening (P-value<0.01). CONCLUSION: This study provides useful information that could be utilized by both researchers and those involved in public health programs. The results show the need for educational programs to enhance women's adherence to cervical cancer screening programs in Tunisia.

Epidemiological profile of health-care-associated infections in the central-east area of Tunisia.

This study aimed to estimate the prevalence and risk factors for health-care-associated infection (HAl) in all 9 hospitals of the central-east area of Tunisia in 2005. Of 1373 patients admitted for more than 48 hours, 74 developed HAI, a prevalence of 5.4% (95% CI: 4.2%-6.6%). The prevalence was significantly higher in the intensive care units (18.4%) and neonatal departments (12.7%). There were 79 infections and the most frequent sites of infection were respiratory tract and urinary tract. Microbiological examination was performed for 25 cases of HAl and Pseudomonas aeruginosa was identified in 8 cases. Multiple logistic regression analysis indicated that HAl was linked to diabetes (OR = 2.0), immunosuppression (OR = 3.3), length of stay (OR = 4.5), central venous catheter (OR = 2.5) and peripheral venous catheter (OR= 10.2). We conclude that HAls are of concern in this area of Tunisia.

Prevalence and predictors of smoking among adolescent schoolchildren in Monastir, Tunisia.

A study in Monastir, Tunisia estimated the prevalence of smoking and analysed the determinants of tobacco use among adolescents aged 10-19 years. An observational cross-sectional study was performed in the 8 colleges and high schools of Monastir city in 2004. The mean age of the 900 respondents was 15.8 (SD 2.2) years and 47.7% were aged under 16 years. The overall prevalence of cigarette use during the past year was 16.0% (30.2% among males and 4.6% among females). The first smoking experience was initiated by friends in 45.8% of cases, at a mean age of 13.8 (SD 2.3) years. One-fifth of smokers (21.5%) had used other forms of tobacco. In multivariate analysis, male sex, academic failure, poor family management, antisocial behaviour and addictive behaviour were the main predictors of adolescent smoking status. The prevalence of smoking among adolescents in Monastir is high and requires targeted action.

[Epidemiological and chronological profile of the low birth weight in the region of Monastir (Tunisia) between 1994 and 2007]. / Caractéristiques épidémiologiques et chronologiques du faible poids de naissance dans la région de monastir (Tunisie) entre 1994 et 2007.

In Tunisia, despite the activities of national programs of maternal and child health, low birth weight (LBW) remains common. The aim of this study is to draw up the epidemiological profile of the LBW in the region of Monastir and to study the chronological trends of the associated factors during a period of 14 years (1994-2007). We conducted a population study which interest 97.630 live births (from 26 to 43 weeks) in the public maternities of the region of Monastir. The mean's age of pregnant women was 28.7 +/- 5.5 years. Among them 14.2% were aged 35 and older and 40% were primipara. Newborns were in term in 94.7% of cases. Maternal age, prenatal care, twin pregnancies and fetal complications were the factors independently associated with the occurrence of LBW in term newborns. However, only prenatal care and twin pregnancies were independently associated to LBW in preterm newborns. During the fourteenth years of the study the parturient mean age and the frequency of preterm birth increased significantly (P < 0.001) while the frequency of multiparty decreased significantly (P < 0.001). We found that the risk factors of LBW (advanced age, multiparty, etc.) are still common in our country and require targeted interventions.

Cross-validation of the Tunisian version of the National Eye Institute Visual Function Questionnaire 25.

INTRODUCTION: The goal of our study was to create a cross-cultural adaptation of the questionnaire « National Eye Institute Visual Function Questionnaire ¼ (NEI-VFQ-25) for the Tunisian population (Tu-VFQ-25) and to test its psychometric properties in a group of patients with chronic uveitis. PATIENTS AND METHODS: The study consisted of two steps. The first was translation of the NEI-VFQ-25 and its cross-cultural adaptation to the Tunisian dialect (Tu-VFQ-25) according to the guidelines of Beaton et al. The second step consisted of studying the psychometric properties of the Tu-VFQ-25. Enrolled patients, diagnosed with chronic uveitis, were interviewed face-to-face by two different investigators, followed by a telephone interview by the first investigator 48hours later. Feasibility, internal consistency and reproducibility of the Tu-VFQ-25 were then tested using statistical methods. RESULTS: The mean time taken to administrate the questionnaire to each of the 45 patients was 11min 40 s (± 2min 24 s). Internal consistency was acceptable, with Cronbach's alpha coefficients above 0.7 except the "Ocular Pain" and "Driving" subscales (0.645 and 0.559 respectively). Inter-observer reliability was excellent, with intra-class correlation coefficients (ICC) ranging from 0.857 to 0.985 for all subscales. Test-retest reliability, assessed for 43 patients, was good to excellent, with ICC above 0.80 for all subscales except "General Vision," which had a value of 0.786. CONCLUSION: As with previous versions, the Tu-VFQ-25 is an easy and reliable tool for assessing vision-related quality of life of Tunisian patients with chronic uveitis.

Graphic model of birth weight and gestational age in Monastir, Tunisia.

BACKGROUND: Birth weight for gestational age curves provide to clinicians available references to assess fetal growth in individual infants and in populations. In Tunisia, until now, only North American based references were used. The objective of this study was to create national reference curves for birth weight and to compare these to those actually used in our maternities. METHODS: A retrospective population based study was performed over a period of 11 years (from January 1994 to December 2004) using the register of births database of the region of Monastir. We studied a total of 75,751 births. Gestational age of infants ranged from 28 to 43 weeks. Fifth, tenth, 25th, 50th, 75th, 90th and 95th percentiles for weight were calculated by polynomial linear regression of the following general form to construct the clinical curves (Y=a+bX+cX(2)). RESULTS: The database included 38,646 males and 37,105 females (sex ratio: 1.04). The resulting male and female curves provide smoothed percentiles cutoffs for defining small and large for gestational age births. An actual difference does exist between our curves and those routinely used. CONCLUSION: These constructed smoothed gestational curves can be used as a useful tool for assessing birth weight and to evaluate clinical or public health interventions to enhance fetal growth.

[New criteria and quality of health care services in the governorate of Monastir, Tunisia]. / Les nouveaux critères et la qualité des services de soins de santé dans le gouvernorat de Monastir (Tunisie).

In 2005 new quality criteria (7 items) were introduced for services provided to mother and child under the national perinatality programme. We evaluated this new version in a descriptive study conducted among a random sample of 400 parturient women from Monastir governorate. Mean age was 29.3 (SD 5) years and 42% were primipara. Although prenatal care was adequate in terms of number of antenatal visits for 82.5% of women, for only 21% were all 7 quality criteria fulfilled. The rates of caesarean section and premature birth were significantly higher in women who received quality care (P < 0.05). In logistic regression analysis, age and parity were the only factors independently associated with the quality of care. Additional efforts are needed to ensure good maternal and infant quality of care.

Integrated management of mother and child health in the region of Monastir [Tunisia]

The programme of integrated management of child health [IMCI] was established in Tunisia in 2002 in some health districts. This study evaluated the management of children under 5 years of age and their mothers using the IMCI programme in Zeramdine, a town 20 km south-west of Monastir. A cross-sectional study was conducted on a convenience sample of 526 medical records of children under 5 years attending the Zeramdine maternal and child health centre. The study evaluated preventive and curative aspects of child health. The mean age was 21.9 [SD 16.7] months. On the curative side, respiratory diseases were the leading reason for consultation [71.2%] followed by diarrhoea [15.4%]. For preventive services, physicians systematically checked the child’s immunization status and height and weight on the growth charts, and screened for strabismus and anaemia. The contribution to child health of IMCI is undeniable; it allows comprehensive care of the child, develops staff skills, upgrades the health system and improves family and community practices

Le programme de la prise en charge intégrée de la Santé de la mère et de l'enfant [PCIME] a été implanté en Tunisie en 2002 dans quelques circonscriptions sanitaires. La présente étude a évalué la prise en charge des enfants de moins de 5 ans et de leurs mères à travers le programme PCIME à Zeramdine, ville située à 20 km au sud-ouest de Monastir. Une étude transversale a été réalisée sur un échantillon représentatif de 526 dossiers médicaux d'enfants de moins de cinq ans consultant dans le centre de protection maternelle et infantile de Zeramdine. L'étude a évalué tous les aspects curatifs et préventifs de la prise en charge de la santé de l'enfant.La moyenne d'âge était de 21,9 mois [ET 16,7]. Sur le plan curatif, les maladies respiratoires dominaient les motifs de consultation [71,2 %], suivies de la diarrhée [15,4 %]. Sur le plan préventif, les médecins vérifiaient systématiquement l'état vaccinal et le développement staturo-pondéral de l'enfant, et assuraient le dépistage de l'anémie et du strabisme. L'apport de la PCIME est indéniable; elle permet une prise en charge globale de l'enfant, le développement des compétences des ressources humaines, la mise a niveau du système de santé et l'amélioration des pratiques familiales et communautaires

Prevalence and predictors of smoking among adolescent schoolchildren in Monastir, Tunisia

A study in Monastir, Tunisia estlinared the prevalence of smoking and analysed the determinants of tobacco use among adolescents aged 10-19 years. An observational cross-sectional study was performed in the 8 colleges and high schools of Monastir city in 2004. The mean age of the 900 respondents was 15.8 [SD 2.2] years and 47.7% were aged under 16 years. The overall prevalence of cigarette use during the past year was 16.0% [30.2% among males and 4.6% among females]. The first smoking experience was initiated by friends in 45.8% of cases, at a mean age of 13.8 [SD 2.3] years. One-fifth of smokers [21.5%] had used other forms of tobacco. In multivariate analysis, male sex, academic failure, poor family management, antisocial behaviour and addictive behaviour were the main predictors of adolescent smoking status. The prevalence of smoking among adolescents in Monastir is high and requires targeted action

Epidemiological profile of health-care-associated infections in the central-east area of Tunisia

This study aimed to estimate the prevalence and risk factors for health-care-associated infection [HAI] in all 9 hospitals of the central-east area of Tunisia in 2005. Of 1373 patients admitted for more than 48 hours, 74 developed HAI, a prevalence of 5.4% [95% Cl: 4.2%-6.6%]. The prevalence was significantly higher in the intensive care units [18.4%] and neonatal departments [12.7%]. There were 79 infections and the most frequent sites of infection were respiratory tract and urinary tract. Microbiological examination was performed for 25 cases of HAI and Pseudomonas aeruginosa was identified in 8 cases. Multiple logistic regression analysis indicated that HAI was linked to diabetes [OR = 2.0], immunosuppression [OR = 3.3], length of stay [OR = 4.5], central venous catheter [OR = 2.5] and peripheral venous catheter [OR = 10.2]. We conclude that HAI sare of concern in this area of Tunisia

Knowledge and practices of women in Monastir, Tunisia regarding breastfeeding

0We assessed the prevalence of breastfeeding and its determinants and mothers' knowledge and practices towards this issue among 354 women attending primary health centres for their child's 6- month vaccination in the region of Monastir in 2008. The mean age of the women was 30 [SD 5.5] years. Most [90.8%] knew that breastfeeding helped prevent infections in babies but only 38.5% knew that breast milk supplies all infant feeding needs until 6 months of age. While was 94.4% breastfed their babies to start, only 1.9% continued exclusive breastfeeding until 6 months. Main reasons for stopping breastfeeding were perceived breast milk insufficiency followed by return to work. Exclusive breastfeeding over 3 months was associated with skin-to-skin contact [OR = 1.93; 95% CI: 1.016-3.69] and mothers' knowledge about breast milk benefits [OR = 2.8; 95% CI: 1.2-6.6] Early weaning was related to using pacifiers and breast-milk substitutes [OR = 0.17; 95% CI: 0.08-0.36 and OR = 0.14; 95% CI: 0.05-0.38 respectively]

[New criteria and quality of health care services in the governorate of Monastir, Tunisia]

In 2005 new quality criteria [7 items] were introduced for services provided to mother and child under the national perinatality programme. We evaluated this new version in a descriptive study conducted among a random sample of 400 parturient women from Monastir governorate. Mean age was 29.3 [SD 5] years and 42% were primipara. Although prenatal care was adequate in terms of number of antenatal visits for 82.5% of women, for only 21% were all 7 quality criteria fulfilled. The rates of caesarean section and premature birth were significantly higher in women who received quality care [P < 0.05]. In logistic regression analysis, age and parity were the only factors independently associated with the quality of care. Additional efforts are needed to ensure good maternal and infant quality of care