Hand hygiene and biomedical waste management among medical students: a quasi-experimental study evaluating two training methods.

BACKGROUND: Several studies revealed that medical students have low performance levels of hand hygiene (HH) and biomedical waste management (BMWM). However, there have been limited interventions directed at young students targeting HH and BMWM enhancement. Given these data, we aimed at assessing HH and BMWM among medical students after two training methods. METHODS: We performed a quasi-experimental study from September 2021 to May 2022, which included fifth-year medical students enrolled in the faculty of Medicine of Monastir (Tunisia). We relied on a conventional training based on presentations and simulations guided by the teacher and a student-centred training method based on courses and simulated exercises prepared by students. We used the WHO HH Knowledge Questionnaire and the "BMWM audit" validated by The Nosocomial Infection Control Committee in France. RESULTS: A total of 203 medical students were included (105 in the control group and 98 in the experimental group) with a mean age of 23 ± 0.7 years. Regarding HH, we found a statistically significant increase in post-test scores for both training methods. A higher post-test mean score was noted for student-centred method (14.1 ± 1.9 vs. 13.9 ± 2.3). The overall improvement in good HH knowledge rates was greater after student-centred method compared to conventional training (40.5% vs. 25%). Concerning infectious waste, mean scores were higher after student-centred learning in all hazardous waste management steps (25 ± 3.3 vs. 23.6 ± 5.5). RESULTS: Coupling student-centred teaching and continuous supervision could improve HH and BMWM knowledge and practices among medical students.

Childhood exposure to violence is associated with risk for mental disorders and adult's weight status: a community-based study in Tunisia.

BACKGROUND: We sought to investigate the relationship between social violence and adult overweight/obesity and the role of common mental disorders (CMD) in mediating this relationship. METHODS: A cross-sectional study was conducted from January to June 2016 in Tunisia. Participants were selected from randomly selected Primary Health Care Centers. The Arabic version of the Adverse Childhood Experiences-International Questionnaire (ACE-IQ) was used. RESULTS: A total of 2120 participants were included. Women exposed to social ACEs had higher rates of overweight/obesity than men (13.5 versus 9.5%; P = 0.004). For women, statistically significant partial mediation effects of CMD were observed for exposure to community violence (% mediated = 17.7%). For men, partial mediation was found for the exposure to peer violence (% mediated = 12.5%). CONCLUSION: Our results provide evidence of the independent increase of overweight/obesity after exposure to social ACEs. Efforts to uncover and address underlying trauma in health care settings may increase the effectiveness of obesity interventions.

Script concordance test as a sanctionnal evaluation in cardiology.

INTRODUCTION: Sanctioning evaluation in cardiology is carried out using multiple choice questions, short-answer questions, clinical cases and editorial questions. However, these methods do not assess clinical reasoning in a context of uncertainty in contrast with script concordance tests (SCT). AIM: To compare the scores obtained by the students in the 3rd year of medicine with the SCT versus the sanctioning test of cardiology and to study the correlation between these two evaluation methods. METHODS: This is a prospective study including 31 3rd year students who completed their cardiology clerckship in the Cardiology Department of the HabibThameur Hospital during the first half of 2016. We compared the scores obtained in the 13 SCT test (39 items) with those of the cardiology normative test. RESULTS: Students 'mean score at SCT was significantly lower than that of experts (66.6 ± 10.2 vs 86 ± 6.7%, p <0.0001). The mean score obtained by students at the SCT was significantly higher than that of the cardiology sanctioning test (p <0.001). Cronbach alpha coefficient was 0.71. There was no correlation between the two tests (r = 0.329; p= 0.07). CONCLUSION: The evaluation of our students by the SCT showed mean score statistically higher than the questions of a classic test, without correlation between them. This should encourage us to incorporate SCT into our assessment methods to promote clinical reasoning.

Gender differences in adverse childhood experiences, collective violence, and the risk for addictive behaviors among university students in Tunisia.

Adverse childhood experiences (ACE) have been linked to a variety of addictive behaviors. The recent adaptation of the ACE measure by the World Health Organization (WHO) allows for the assessment of the negative role of additional adverse experiences, such as extra-familial violence. To date, the relationship between extra-familial violence and addictive behaviors has not been assessed. We report the contribution of ACEs, including the new scales for extra-familial violence, on the risk for mental health problems and addictive behaviors by gender in a sample of young adults in Tunisia. We conducted a cross sectional study in Tunisia during 2014, where we recruited 1200 young university adults who completed the validated Arabic version of the WHO ACE questionnaire in a university setting. Results indicated that intra-familial adversities were associated with increased risk for addictive behaviors, particularly in males. ACEs were also associated with increased risk for mental health problems with women showing more difficulties than men. Exposure to peer, community and collective violence was higher in males than in females and logistic regression confirms that exposure to extra-familial violence increased the risk for addictive behaviors both in male and females by two to three-fold. Mental health problems were associated with peer violence and substance abuse in males, but not in females. Results demonstrate for the first time the contribution of exposure to extra-familial violence on risk for addictive behaviors. Results highlight the need for addressing mental health and addiction in a community with high burden of adversity and violence.

Audit sur la qualité de la vaccination en milieu scolaire dans la région de Monastir (Tunisie).

We conducted a clinical audit by observing 55 vaccinators in schools in the governorate of Monastir in 2014. We used a set of criteria by referring to the national immunization programme. The cold chain was respected in most cases. Accumulators, the collector of syringes and needles, cotton balls soaked in alcohol and emergency box were available in 85.5%, 76.4%, 98.2% and 41.8% of cases respectively. Hand washing before immunization session was performed in 29.1% of cases. Waste disposal according to the hygiene rules was done by 40 agents. Health education of students regarding the interest of vaccination was done in 67.3% of cases. Therefore, improvements in hand hygiene practice and education are recommended.

Obstetric and psychological characteristics of women seeking multiple abortions in the region of Monastir (Tunisia): results of a cross-sectional design.

BACKGROUND: Repeat abortion is a public health concern favored by many obstetric and social factors. The purpose of our study was to identify associated factors to repeated abortion in the region of Monastir (Tunisia). Common mental disorders (CMD) such as anxiety and depression were also evaluated in women seeking voluntary repeated abortion. METHODS: We carried out a cross sectional study between January and April 2013 in the Reproductive Health Center (RHC) of the region of Monastir in Tunisia (This study is part of a prospective design on mental disorders and intimate partner violence among women seeking abortions in the RHC). Among women referred to the RHC we selected those seeking voluntary abortion (medical or surgical method). Data on women's demographic characters, knowledge and practices about contraceptive methods and abortion were collected the abortion day via a structured questionnaire. Data about anxiety and depression status were evaluated during the post-abortal control visit at 3-4 weeks following pregnancy termination. RESULTS: Of the 500 interviewed women, 211 (42.2 %; CI95% [37.88 - 46.52]) were seeking repeated abortions. Multivariate analysis showed that increased age, lower level of women school education, single status, poor knowledge about birth control methods and history of conflict/abuse by a male partner, were uniquely associated with undergoing repeat compared with initial abortion. CMD were significantly higher in women undergoing second or subsequent abortion (51.1 %) single and lower educated women. Women relating a history of conflicts/abuse report more CMD than others (30.6 % vs 20.8 %). CONCLUSION: Health facilities providing abortion services need to pay more attention to women seeking repeat abortion. Further studies are needed to well establish the relation between the number of abortion and the occurrence and the severity of CMD.

[Implementation of the safe surgery checklist of the World Health Organization at the University Hospital of Monastir (Tunisia)]. / Implémentation de la liste de contrôle chirurgical de l'Organisation Mondiale de la Santé au niveau de l'hôpital universitaire de Monastir (Tunisie).

OBJECTIVE: To evaluate the impact of introduction of the WHO safe surgery checklist in the university hospital of Monastir over a period of five months. METHODS: We conducted a longitudinal study (before - after) with evaluation of five result indicators which were: percentage of surgical site infections, not prescribed antibioprophylaxis, unplanned return to the operating room, postoperative length of stay and postoperatively death. RESULTS: We identified 185 patients during the period and 323 patients after the introduction of the WHO checklist. The proportion of surgical site infection decreased significantly from 13.5% in the reference period to 1.3% after the introduction of the checklist (p < 0.001). The proportion of unplanned return to the operative room was 10.3% before the introduction of the checklist and deceased significantly to 1.3% at the intervention period (p = 0.003). The proportion of not prescribed antibioprophylaxis and median post-operative length of stay deceased also significantly during the study period (p < 0.001). CONCLUSION: The surgical checklist control contributes to the development of a safety culture in the operating room. Maintaining its use should be supported by incentives such as certification and accreditation.

Gender differences in adverse childhood experiences, resilience and internet addiction among Tunisian students: Exploring the mediation effect.

Adverse Childhood Experiences (ACEs) are a common public health issue with a variety of consequences, including behavioral addiction such as Internet Addiction (IA). Despite widespread recognition of this issue, the underlying mechanisms are not well studied in recent literature. Additionally, studies have indicated gender disparities in the prevalence and manifestation of ACEs and IA. The objective of this study was to investigate the mediating effect of resilience on the link between ACEs and IA among high-school students according to gender in Mahdia city (Tunisia). We conducted a cross-sectional survey for two months (January- February 2020), among 2520 schooled youth in Mahdia city (Tunisia). The Arabic-language edition of the World Health Organisation ACE questionnaire was used. The validated Arabic versions of the Adolescent Psychological Resilience Scale and the Internet Addiction Test were the screening tools for resilience and IA. Data were analyzed according to gender. The majority of youth (97.5%) were exposed to at least one ACE with the most prevalent being emotional neglect (83.2%). Exposure to extra-familial ACEs was also high reaching 86.9% with higher rates among boys for all types of social violence. Internet addiction was common among students (50%) with higher prevalence for boys (54.4% vs 47.7%for girls, p = 0.006). Resilience scores were86.43 ± 9.7 for girls vs 85.54 ± 9.79 for boys. The current study showed that resilience mediated the link between ACEs, especially intrafamilial violence, and internet addiction (%mediated = 15.1). According to gender, resilience had a significant mediating role on internet addiction for girls (%mediated = 17) and no significant role for boys. The mediating effect of resilience in the relationship between ACEs and cyberaddiction among schooled adolescents in the region of Mahdia (Tunisia) has been identified.

Women's knowledge, attitudes and practice about breast cancer screening in the region of Monastir (Tunisia).

Breast cancer remains a worldwide public health problem. In Tunisia, it is considered to be the primary women's cancer and causes high morbidity and mortality. This study aimed to investigate female knowledge, attitudes and practice of breast cancer screening in the region of Monastir (Tunisia). We conducted a descriptive cross-sectional design exploring knowledge, attitudes and practices of women in the region of Monastir on breast cancer screening. The study was conducted in health centres of this region from 1 March 2009 to 30 June 2009. Data were collected via a structured questionnaire containing 15 items on demographic status, knowledge of risk factors and screening methods and attitudes towards the relevance and effectiveness of breast cancer screening. A scoring scheme was used to score women's responses. 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, 92% of participants had poor knowledge of the specific risk factors for breast cancer and 63.2% had poor knowledge of the screening methods. Proper practice of breast cancer screening was observed in 14.3% of cases. Multiple logistic regression analysis showed that good knowledge of risk factors and screening methods, higher level of education and positive family history of breast cancer were independently correlated with breast cancer screening practice. This study revealed poor knowledge of breast cancer and the screening methods as well as low levels of practice of breast cancer screening among women in the region of Monastir. Results justify educational programs to raise women's adherence to breast cancer screening programs in Tunisia.

[Determinants of risky sex practices among consultants of a Voluntary HIV counseling and testing Centre]. / Déterminants des pratiques sexuelles à risque chez les consultants d'un Centre de Conseils et de Dépistage Anonyme et Gratuit du VIH

BACKGROUND: Thirty years after the discovery of human immunodeficiency virus (HIV), knowledge and practices must be improved. AIM: Contribute to reducing the risk of virus transmission. METHODS: A study about the determinants of risky practices was conducted among the consultants of the Voluntary HIV Counseling and Testing Centre (VCTC) in Monastir University Hospital. RESULTS: We performed a cross sectional descriptive study with a total of 241 consultants who used the services of the VCTC during the period from January 1, 2008 to December 31, 2011. Data gathering was based on a self-administered questionnaire. Consultant's mean age was 27.4 ± 8 years with a male predominance. Three patients out of four were single and 65% have at least secondary-level education. Knowledge about the risk of HIV infection after an unprotected sex and drug use by injection were reported by 94.3% and 76.7% of the participants respectively. Risky sex practices were adopted by 89.3% of the subjects. At least secondary school level, knowledge of risk factors of contamination and fear of the virus transmission were identified as determinants of safe sexual practices (0,004 ≤ p ≤ 0,032). CONCLUSION: Improving knowledge of populations at risk for HIV is a privileged axis to lead to a reduction of infectious risk in our country.

Adverse childhood experiences and sleep disorders among Tunisian adolescents: The mediating role of internet addiction.

BACKGROUND: Adverse childhood experiences (ACEs) are a prevalent health problem worldwide. Different side effects have been linked to this issue such as sleep disorders. This matter is well known. However, its influencing mechanisms are not well investigated in literature. OBJECTIVE: To investigate the mediating role of internet addiction in the relation between adverse childhood experiences (ACEs) and sleep disorders among a population of high-school students in the region of Gafsa (Tunisia). PARTICIPANTS AND SETTING: We performed a cross-sectional study, in February 2020, including adolescents registered in all secondary schools of Gafsa city. METHODS: Sleep disorders were evaluated via the Pittsburgh Sleep Quality Index, internet addiction via the Internet Addiction Test and adverse childhood experiences via the Adverse Childhood Experiences-International Questionnaire. RESULTS: A total of 414 students were enrolled in our study with a mean age of 17.18 ± 1.5 years. Exposure to intra-familial violence was more reported than social adversities with 99.1 % and 84 % respectively. Males showed higher rates of internet addiction (82.9 % vs 78.3 %, p < 0.001). Sleep disorders were reported in 94 % of students, predominantly among females (95.4 % vs 91 %, p < 0.001). Our results revealed that ACEs predict sleep disturbances through internet addiction (% mediation =18.3 %, p = 0.005). More particularly, an important mediation effect of internet addiction on the relationship between ACEs and sleep disorders was found among females (% mediation =30 %). CONCLUSION: Internet addiction was found to be a mediating factor in the relation between ACEs and sleep disturbances among Gafsa high school students.

Parental self-medication with antibiotics in a Tunisian pediatric center.

INTRODUCTION: Self-medication of antibiotics among children is a very common problem in Tunisia. Its prevalence isn't well established. The aims of this study are to evaluate parents' knowledge concerning antibiotic use, and identify the factors associated with this problem. PATIENTS AND METHODS: We conducted a cross-sectional study over a one year period (between August 2019 and July 2020). Data collection was performed using a questionnaire guided interview. We included parents of children consulting or hospitalized in the pediatric department of the university hospital Taher Sfar in Mahdia. RESULTS: A total of 354 parents were included with an average age of 36.4±9.2 years. The average knowledge score was 2±1.3 points. In fact, 61.6% of the parents had poor knowledge about antibiotics. The frequency of non-prescription antibiotics use among children was 20.6%. Amoxicillin was the most used antibiotic (72.6%). Sore throat, important fever and flu-like symptoms were the main symptoms justifying non-prescription antibiotic use among our pediatric population in 60.3%, 34.2% and 23.3% of cases respectively. The main reason of self-medication was the fact that the same antibiotic was once prescribed to treat the same symptoms (58.9%). The used antibiotic came from an old prescription for the same child in 57.5% of the cases and was recommended by the pharmacist in 39.7% of the cases. After multivariate analysis, the factors associated with parental self-medication with antibiotics were: the advanced parent's age, the ability to name an antibiotic and knowledge's score>2. CONCLUSION: Our study confirmed that parental knowledge about antibiotic use is low. In fact, the government should from one hand, organize antibiotic delivery and prohibit off the counter sells and in the other hand promote the education of the public through different procedures to stop this major health problem.

Trends in hospital morbidity among adults in the region of Monastir (Tunisia) between 1996 and 2007.

AIM: To study trends of hospital morbidity among adults in the region of Monastir during a period of 12 years (1996 - 2007). METHODS: We analyzed data from the morbidity database of the university hospital of Monastir (Tunisia) between 01/01/1996 and 31/12/2007. Data were drawn from the register of hospital morbidity implemented in the Department of Preventive Medicine and Epidemiology since 1995. The International Classification of Diseases (tenth revision) was used to identify and classify morbid conditions. RESULTS: During the study period, we collected 150749 admissions with male tendency (sex-ratio = 1.27). Among these admissions 24.4% were over than 64 years. Morbid conditions were dominated by Ischemic Heart diseases (4.24%) followed by cancers and diabetes mellitus (3.3% and 2.52% respectively). Chronological trends, using Spearman correlation rank test, showed that overall rate of chronic conditions increased significantly from 4.4% in 1996 to 9.1% in 2007 (r'= |0.88|, p-value < 0.001). In contrast, the rate of infectious and parasitic diseases decreased from 4.3% to 2.9% (r'= |0.98|, p-value < 0.001). CONCLUSION: Morbidity trends reflect the epidemiological transition of our country and call to a backing of the ambulatory system and the development of specific services able to decrease the needs of hospitalizations.

[Chronological observation of the epidemiological characteristics of perinatal indicators in the Monastir health region (Tunisia) between 1994 and 2008]. / Caractéristiques épidémiologiques chronologiques des indicateurs de périnatalité dans la région sanitaire de Monastir (Tunisie) entre 1994-2008.

In the Tunisian healthcare system, the mother-child pair is a key target of the national perinatal program established in 1990. The purpose of this study is to define the epidemiological profile and to study the chronological tendencies of the main perinatal care indicators in the region of Monastir. The paper is based on a population study involving all parturients who gave birth in Monastir public maternities over a period of 15 years (1 January 1994 to 31 December 2008). Data were drawn from the register of births of all public maternities located in the region. The study examined 121,046 parturients. The mean age of parturients was 28.8 ± 5.5 years. 17.2% of parturients were aged 35 and over. Two thirds of deliveries were performed in the 2nd and 3rd level care maternities. Over the course of the fifteen years, absent prenatal care decreased significantly, from 11% in 1994 to 1% in 2008 (p<0.001). The percentage of parturients aged 35 and over increased significantly, from 14% in 1994 to 18% in 2008 (p< 0.001). Prematurity also increased significantly, from 4.2% in 1994 to 7% in 2008. These results are a reflection of the demographic and social transition of the country. The Tunisian healthcare system will need to show greater vigilance and to promote a greater focus on prenatal care quality.

Impulsivity mediates the impact of early life adversity on high risk behaviors among Tunisian adolescents.

Adverse childhood experience (ACE) has become an alarming phenomenon exposing youth at a great risk of developing mental health issues. Several studies have examined the mechanism by which ACE affects adolescent's engagement in risky behaviors. However, little is known about these associations in the Tunisian/African context. We investigated the role of impulsivity in the link between ACE and health risk behaviors among schooled adolescents in Tunisia. We performed a cross sectional study among 1940 schooled adolescents in the city of Mahdia (Tunisia) from January to February 2020. To measure ACE, we used the validated Arabic version of the World Health Organization ACE questionnaire. The Barratt Impulsivity Scale and the Internet Addiction Test were used as screening tools for impulsivity and internet addiction. A total of 2520 adolescents were recruited. Of those, 1940 returned the questionnaires with an overall response rate of 77%. The majority (97.5%) reported experiencing at least one ACE. Emotional neglect (83.2%) and witnessing community violence (73.5%) were the most reported intra-familial ACEs. Males had higher rates of exposure to social violence than females. The most common risky behavior was internet addiction (50%, 95%CI = [47.9-52.3%]). Our survey revealed that ACEs score predict problematic behaviors through impulsiveness (% mediated = 16.7%). Specifically, we found a major mediating role of impulsivity between the exposure to ACE and the risk of internet addiction (% mediated = 37.5%). Our results indicate the role of impulsivity in translating the risk associated with ACE leading to engagement in high risk behaviors.

Cardiovascular risk factors in the Maghreb. A systematic review.

OBJECTIVE: To assess the distribution of cardiovascular risk factors in Maghreb's countries. METHODS: It is a systematic review including articles and reports that applied the WHO "STEPwise" approach, or a similar approach, studying cardiovascular risk factors in the Maghreb countries: Tunisia, Morocco, Algeria, Libya and Mauritania between 2004 and 2018. RESULTS: We selected five articles, a report for each country. The prevalence of smoking was between 13.4% (12.2-14.6) in Morocco and 29.4% (28.3-30.4%) in Tunisia. 50.6% of the population of Mauritania had insufficient physical activity. The prevalence of high blood pressure was highest in Libya (40.6%) The prevalence of obesity was up to 41.1% (37-43.3) for women and 21.4% (19-23.8) in men in Libya. The prevalence of diabetes mellitus was between 10.6% (9.7-11.6) in Morocco and 16.4% (14.7-19.1) in Libya. CONCLUSION: The distribution of cardiovascular risk factors in the Maghreb countries shows that the level of cardiovascular risk is high, particularly in the central Maghreb. This attests to the fairly advanced epidemiological transition related to the rapid modernization of the Arab countries, hence the importance of launching an integrated project for the fight against cardiovascular diseases based on the global experience.

Impact of an Original Methodological Tool on the Identification of Corrective and Preventive Actions After Root Cause Analysis of Adverse Events in Health Care Facilities: Results of a Randomized Controlled Trial.

OBJECTIVE: The aim of the study was to assess the effectiveness of a new methodological tool for the identification of corrective and preventive actions (CAPAs) after root cause analysis of health care-related adverse events. METHODS: From January to June 2010, we conducted a randomized controlled trial involving risk managers from 111 health care facilities of the Aquitaine Regional Center for Quality and Safety in Health Care (France). Fifty-six risk managers, randomly assigned to two groups (intervention and control), identified CAPAs in response to two sequentially presented adverse event scenarios. For the baseline measure, both groups used their usual adverse event management tools to identify CAPAs in each scenario. For the experimental measure, the control group continued using their usual tools, whereas the intervention group used a new tool involving a systemic approach for CAPA identification. The main outcome measure was the number of CAPAs the participants identified that matched a criterion standard established by eight experts. RESULTS: Baseline mean number of identified CAPAs did not differ between the two groups (P = 0.83). For the experimental measure, significantly more CAPAs (P = 0.001) were identified by the intervention group (mean [SD] = 4.6 [1.7]) than by the control group (mean [SD] = 2.8 [1.2]). CONCLUSIONS: For the two scenarios tested, more relevant CAPAs were identified with the new tool than with usual tools. Further research is needed to assess the effectiveness of the new tool for other types of adverse events and its impact on patient safety.

Adverse events in a Tunisian hospital: results of a retrospective cohort study.

BACKGROUND: Despite the worldwide growing attention to patient safety, Tunisia has no data on the magnitude and consequences of hospital adverse events (AEs). OBJECTIVE: To estimate the incidence, nature and consequences of AEs and preventable AEs in a university hospital in Tunisia. DESIGN AND SETTING: We opted for a two-stage retrospective medical record review of 620 inpatients admitted during 2005 based on the use of 18 screening criteria. Records were reviewed by a trained medical student, then by an expert physician when one or more criteria were identified. Main outcomes measures We determine the incidence, preventability and consequences of the AEs. Patients and admissions characteristics were also recorded. RESULTS: Among 620 inpatients, 62 inpatients experienced an AE with an incidence of 10% (95% CI [7.6-12.3]). Surgical/invasive procedures and therapeutic errors were the most common AEs (55 and 21%, respectively). Among the confirmed events 60% were judged to be highly preventable and 21% led to patient death. All ages and both genders experienced equal rates of AEs. However, patients who experienced these events were significantly more exposed to extrinsic risk factors (all surgical interventions and invasive procedures that were listed in the revue form 2 of the questionnaire). Physician reviewers estimated that a total of 570 additional hospital days were associated with AEs. CONCLUSION: This study confirms that preventable AEs were not rare in our context. They caused human harm and consumed a significant part of hospital resources. Thus, targeted interventions are needed.

[Epidemiological and chronological profile of the parturientes in the extreme ages in the monastir region between 1994 and 2003]. / Caracteristiques epidemiologiques et chronologiques des parturientes aux ages extremes dans la région de monastir entre 1994-2003.

BACKGROUND: Pregnancy outside 19 - 34 years interval is risk factors of the maternal and fetal morbidity and mortality. Tunisia, witch known an epidemiological transition, implanted the national program of perinatality since 1990 and one of its objectives is the surveillance of the high risk pregnancies. AIM: The aim of this study is to draw up the epidemiological profile of the parturient in extreme ages in the region of Monastir and to study the chronological tendencies of the associated factors during a decade (1994 - 2003). METHOD: In all, the study interest 13225 extreme ages parturient, representing 22.5% of all women admitted for delivery in the public maternities of the district. RESULTS: The means age was 18.6 ± 0.6 years for the parturient less than 20 years and 37 ± 2 years for the older than 35 years and more, among them 40% were older primipara. The prenatal care was inadequate for 35.4% of younger women and 47.6% of aged women. During the decade, we notice a significant decrease of the frequency of pregnancy for teenager parturient (from 3 in 1994 to 1.99% in 2003), and increase for the aged parturient (from 14.7 in 1994 to 17.7% in 2003) (p < 0.001). Adequate prenatal care increased and the frequency of parturient without any follow-up decreased (from 17.2 to 2%) (p < 0.001). CONCLUSION: Given to this demographic and social transition, our healthcare system is called for greater vigilance and a more rigorous application of the recommendations of the national program of perinatality.