Comparison of cigarette and waterpipe smoking among pupils in the urban area of Sousse, Tunisia.

BACKGROUND: Epidemiological and observational evidence suggests that waterpipe use is growing in popularity worldwide. AIM: The purpose of this study was to examine the prevalence of cigarette and water pipe tobacco use among pupils aged 13-17 years in the urban area of Sousse, Tunisia and to identify the factors which predict current cigarette and/or waterpipe smoking in this population. METHODS: Across-sectional study was carried out on a representative sample of schoolchildren aged between 13 and 17 years in colleges and public secondary schools of the urban area of Sousse. We used a pre tested and self administered questionnaire to measure tobacco consumption. The significance level for all analyses was p<0.05. Statistical analysis was conducted with SPSS 10.0 software. RESULTS: Participants were 1569 youth. Fifty two percent of them were male. The mean age of the sample was 15+/-1.5 years. Total cigarette smoking percentage for ever and current use were 33.1% and 7.6% respectively. Total water pipe smoking percentage for ever and current use were 19.3% and 5.2% respectively. Overall, the total percentages of cigarette and water pipe smoking (ever and current) were higher for male and aged pupils. Multivariate regression analyses showed that the two types of tobacco use were related. CONCLUSION: Despite the growing adoption of water-pipe smoking, there remains limited research in this area. Increased surveillance and additional research are necessary to address this growing threat to public health.

Epidemiology of infective endocarditis in Tunisia: a 10-year multicenter retrospective study.

BACKGROUND: Since the first description of infective endocarditis, the profile of the disease has evolved continuously with stable incidence. However, epidemiological features are different in developing countries compared with western countries. OBJECTIVE: To describe epidemiological, microbiological and outcome characteristics of infective endocarditis in Tunisia. PATIENTS AND METHODS: This was a descriptive multicenter retrospective study of inpatients treated for infective endocarditis from 1991 to 2000. Charts of patients with possible or definite infective endocarditis according to the Duke criteria were included in the study. RESULTS: Four hundred and forty episodes of infective endocarditis among 435 patients (242 males, 193 females; mean (SD) age=32.4 (16.8) years, range 1-78 years) were reviewed. The most common predisposing heart disease was rheumatic valvular disease (45.2%). Infective endocarditis occurred on prosthetic valves in 17.3% of cases. Causative microorganisms were identified in 50.2% of cases: streptococci (17.3%), enterococci (3.9%), staphylococci (17.9%), and other pathogens (11.1%). Blood cultures were negative in 53.6% and no microorganism was identified in 49.8%. Early valve surgery was performed in 51.2% of patients. The in-hospital mortality was 20.6%. CONCLUSION: Infective endocarditis is still frequently associated with rheumatic disease among young adults in Tunisia, with a high frequency of negative blood cultures and high in-hospital mortality, given that the population affected is relatively young.

Epidemiology of hypertension among a population of school children in Sousse, Tunisia.

BACKGROUND: Pediatric hypertension is a field of increasing interest and importance. Early identification of children at risk for hypertension is important to prevent the serious, long-term complications associated with the condition. In Tunisia, there are no data available on the cardiovascular disease risk profile, such as hypertension, in the population of children. OBJECTIVE: To establish the prevalence of hypertension, the percentile distribution of blood pressure and the inter-relationships between hypertension and other cardiovascular disease risk factors among school children. METHODS: An epidemiological survey was conducted based on a representative sample of 1569 urban school children in Sousse, Tunisia. RESULTS: The prevalence of arterial hypertension was 9.6%, with no significant difference between boys (9.2%) and girls (9.9%). The prevalence of systolic and diastolic hypertension was 6.4% and 4.5%, respectively. In both boys and girls, systolic pressure had a highly significant positive correlation with height (boys: r=0.33, P<0.001; girls: r=0.08, P=0.02), weight (boys: r=0.47, P < or = 0.001; girls: r=0.35, P<0.001) and triglyceride concentrations (boys: r=0.13, P<0.001; girls: r=0.10, P=0.006). Among boys, a positive correlation was found between systolic blood pressure and age (r=0.12, P=0.001) and, among girls, a negative correlation was found (r=-0.12, P=0.001). CONCLUSION: This information will be used to help launch a regional program of heart health promotion in schools.

[Audit of management of arterial hypertension in primary health care in Sousse]. / Audit de la prise en charge de l'hypertension arterielle dans les structures de sante de premiere ligne a Sousse.

A medical audit has been carried out on a representative sample of 456 hypertensive patients followed in the health care facilities of Sousse during 2002, to evaluate the quality of management of hypertension in primary health care. The study yielded the following results: the patients selected for a first line follow-up did not represent more than 79% of the studied population. The minimal recommended balance was achieved in 8% of cases only. Adequate drug therapy was prescribed in 64% of cases. 59% of patients were considered compliant. Controls of blood pressure was achieved in 5,5% of patients. The quality of management of hypertension in primary health care was considered satis factory in 28,7% of patents with a significant difference between urban and rural areas (24,9% versus 40,5%). These results indicate that increased attention should be paid by the national program of Struggle against the Chronic Diseases to the quality of management of hypertension in primary health care institutions.

Age-specific seroprevalence of hepatitis a among school children in central Tunisia.

Hepatitis A virus (HAV) has different epidemiologic and clinical patterns, depending on the level of endemicity in a given geographic area. Tunisia is considered a region of high endemicity for hepatitis. Improvement of socioeconomic conditions in this country has made a determination of the seroprevalence of this disease advisable. We assessed the seroprevalence of HAV in Sousse in central Tunisia. A total of 2,400 school children 5-20 years of age (mean +/- SD age = 11.7 +/- 3.5 years) were selected by two-stage cluster sampling and tested serologically for IgG antibody to HAV by using an enzyme-linked immunosorbent assay. The overall seroprevalence among this population was 60% (44%, in children < 10 years old, 58% in those 10-15 years of age, and 83% in those > 15 years of age. Seroprevalence also varied according to area of residence. At the age of 10, 21.3% of school children living in the urban areas and 87.7% of those living in rural areas had antibodies to HAV. Other factors that increased seroprevalence included non-potable water, crowding, and a low education level of parents with odds ratios of 4.37, 2.96, and 2.62, respectively. This study has shown an increase of seroprevalence with age, suggesting that transmission among younger children has decreased, particularly in urban areas. Programs to prevent hepatitis A may need to be modified based upon the changing age distribution of the disease and mass vaccination program could be indicated if additional incidence and prevalence data confirm the intermediate endemicity of HAV.

[Quality of medical order writing in general practice facilities (Sousse, Tunisia)]. / Qualité de la rédaction de l'ordonnance médicale dans les structures de médecine générale (Sousse, Tunisie).

BACKGROUND: A medical order is a medical and legal document; careful writing of this document enables the reduction of many therapeutic errors. OBJECTIVE: The objective of this study was to evaluate the quality of order writing in Tunisian primary healthcare centres. METHODS: This was a transversal descriptive survey of 2586 medical orders. The quality of the writing was assessed using two parameters: its legibility and the information delivered in it. RESULTS: Among the main results, 36% of orders contained at least 50% of the items retained, 25% of orders were completely illegible, and the quality of writing was considered good in 14% of cases. DISCUSSION: The study showed that hand-written orders in primary healthcare are far from complying with the medico-legal requirements. The teaching of order-writing technique and its computerisation are needed to improve the quality of medical prescribing.

[Tracking of cardiovascular risk factors among school children: a four-year population surveillance in Susa, Tunisia]. / Phenomene de "tracking" des facteurs de risque cardiovasculaires chez l'enfant en milieu scolaire etude de cohorte sur 4 ans a Sousse en Tunisie.

In order to confirm the phenomenon of tracking of cardiovascular risk factors among school children, we undertook in 2003, a prospective survey of a population of 789 pupils aged 13 to 15 years who had participated in a first investigation on cardiovascular risk factors in 1999. We were able to follow and study 453 pupils (57.4% of the initial population). Prevalences of hypertension and obesity were respectively 11.3% and 6.1% without significant difference between sexes. On the other hand, hypercholesterolemia was significantly more elevated among girls than boys (16.1% versus 9.3%, p = 0.039). Children classified initially as hypertensive, obese or having a hypercholesterolemia were identified 4 years later at a subsequent exam as hypertensive, obese or having a hypercholesterolemia in respectively 25%, 48.9% and 59%. The stability of cardiovascular risk factors among children imposes an early screening for a better management and a policy of cardiovascular health promotion since childhood based essentially on prevention of risk factors in order to reduce the cardiovascular disease burden in adulthood.

[Behaviours and needs for health of secondary-school-adolescents in Sousse (Tunisia)]. / Comportements et besoins de sante des adolescents scolarises dans la ville de Sousse (Tunisie).

It was a descriptive study bearing on a probabilistic sample of one-degree cluster composed of 685 adolescents studying in six secondary state schools in Sousse, during 1998-1999 school year. The facts had been collected through an anonymous and self administrated questionnaire. 23.3% of youngsters had a negative image of themselves. Parent-adolescent communication was inexistent in 30.6% of cases. At school, 24.3% of youngsters had a bad relationship with their teachers. One adolescent on four felted rather alone. One on three was not satisfied by leisure means putted at his disposal. Alimentary behavior was disturbed for one adolescent on three. The prevalence rates of smoking and alcoholism were respectively 14.8% and 9%. At least, one suicide attempt was observed in 7.7%. Among sexually active youngsters, 23.8% did not use a contraceptive mean. This study reveled that adolescent was threatened by a hostile environment which may worsen his identity crisis and exposed him to adopt many risky behaviors.

[Victims of violence in urban secondary schools in Sousse (Tunisia)]. / Les jeunes victimes de violence en milieu scolaire urbain à Sousse (Tunisie).

Most often epidemiologic studies of violence during adolescence focus on aspects related to the perpetrator. The adolescent victims of violence are certainly at least as numerous, but too little is known about them. Our aim was to estimate the extent of this social phenomenon and to identify its various forms, through a descriptive, cross-sectional study of a sample of 685 teenagers (409 girls and 276 boys) from six public high schools in Sousse in 1999. A school physician conducted structured interviews to collect the data, recorded in compliance with the ethical rules of confidentiality and anonymity. The results indicate that 36.9% of the adolescents (54% of the boys and 24% of the girls) reported experiencing violence. Within the group of victims, physical violence was reported by 78% of the boys and 63% of the girls, verbal violence by 51% and 63%, respectively. We conclude that experiencing violence is far from uncommon and that it causes acute suffering for youngsters during an important phase of their emotional development and exposes them to the risk of becoming violent as adults. School medical staff can play a crucial role in the prevention and the management of this mistreatment.

[School retardation in a suburban community of Tunisian Sahel]. / Le retard scolaire dans une commune semi urbaine du Sahel Tunisien.

This study tries to assess the prevalence of the school retardation in a suburban community of the Tunision Sahel, to identify its determinants factors and to propose a preventive strategy. It is a transverse investigation having interested 540 registered pupils at the 6th year in six randomly chosen primary schools of Kalaa Kebira (Sousse-Tunisia). Showed that the prevalence of the school retardation is 29%. It appears therefore that the school retardation is especially a complex problem dominated by the socio-educational factors requiring the orientation of the school health team toward a multi sectorial intervention integrating teachers, social workers and representatives of parents.

[Typology of Tunisian medical research indexed in Medline from 1965 to 1999]. / Typologie de la recherche medicale tunisienne indexee dans Medline de 1965 a 1999.

The medical research is a criteria of a country development and the performance of its health system. This study tried to describe the typology of the Tunisian medical research (themes, journals, types of publication,..). It was a bibliometric and exhaustive survey of Tunisian manuscripts indexed in Medline from 1965 to 1999. Among the 3673 eligible references to the study, 73% have been produced in clinic sciences. The main subjects were: Cancer, hydratic cyst and tuberculosis represented respectively 3.9%, 2.9% and 1.8% of manuscripts. 91% of articles have been published in French. 65% of articles have been published in national journals. This work showed that the medical scientific production remains globally lower in relation to the national human resources, that its social relevance is insufficient in relation to the load of morbidity and that the radiance of the Tunisian medical research would be limited by the choice of no English-writing journals. Thus, the promotion of the national medical research requires the backing of the teaching of: documentary techniques, English and written communication.

[Reasons for consultation in general practice]. / Les motifs de consultation en medecine generale.

It was a descriptive and retrospective study relating to 1514 random consultations of general medicine carried out in a structure of primary care during a year (June 1998-May 1999). The reasons for consultation were defined according to the International Classification of the primary care (CISP). The use of the "Top 20" list of the consultations reasons in the teaching of the general medicine could contribute to the development of competences necessary for an efficient practice of the general medicine.

Predictors of food and physical activity patterns among schoolchildren in the region of Sousse, Tunisia.

AIM: To facilitate the improvement of future interventions, it's important to know the determinants of healthy behaviors. Our aim was to determine the predictors of healthy habits in a school based intervention study to promote healthy diet and physical activity among schoolchildren in the region of Sousse, Tunisia. METHODS: It was a quasi-experimental intervention study with two groups: control and intervention group with pre-post evaluation of nutrition and physical activity intention and behavior in each group. The target population was composed with students aged 12-16 years schooled in colleges of Sousse in Tunisia. To evaluate the intervention, a sampling was used to include 2200 students who participated to the questionnaire. All the students of intervention group received a standardized program with information about healthy nutrition and physical activity. An Arabic pre-tested and auto-administered questionnaire was used to assess nutrition and physical activity intention and behavior before and after the intervention. RESULTS: The intervention group's posttest knowledge and behavioral intention were significantly higher than the control group's posttest. No significant differences occurred in posttest attitudes between the control and intervention groups. A multivariate logistic regression models were used to identify the predictors of students' "healthy behavior". CONCLUSION: This school based intervention improved eating and physical activity intentions and behaviors among schoolchildren. "Healthy behaviors' were determined by age, father's profession and home characteristics. This finding could direct future interventions to disadvantaged categories.

School-based Intervention to Promote Healthy Lifestyles in Sousse, Tunisia.

BACKGROUND: Integrated actions against selected risk factors (i.e. smoking, physical inactivity, and unhealthy diet) can lead to the reduction of major chronic diseases. OBJECTIVE: To implement and evaluate a school-based intervention program to prevent cardiovascular risk factors among children. DESIGN: Pre- test post-test quasi experimental design with a control group. SETTING: Four secondary schools in Sousse, Tunisia. INTERVENTION: The overall intervention program lasted for a school year and incorporated educative actions concerning tobacco use, physical activity, and healthy diet. RESULTS: Globally, knowledge, behaviors, and intentions concerning smoking improved in both groups between baseline and the end of the study, particularly in the intervention group. Nutrition knowledge, behaviors, and intentions improved in both groups between baseline and final stage, particularly in the intervention group. At the final stage, there was an increase in the proportion of children walking to and from school in the intervention group. There was also an increase in the percentage of children with intention of practicing sport in the future particularly in the intervention group. There were no significant differences in BMI after the intervention neither in intervention nor in control groups. At the end of the study, the incidence of overweight and obesity was similar to that at baseline. CONCLUSIONS: This pilot study has demonstrated the potential of school as a suitable setting for the promotion of healthy lifestyles in children. The study resulted in substantial improvements concerning knowledge, behaviors, and intentions in the intervention group.

Prevalence of the metabolic syndrome among urban schoolchildren in Sousse, Tunisia.

No evidence exists regarding the prevalence of the metabolic syndrome in adolescents in North African countries. We aimed to estimate the prevalence of the metabolic syndrome in Tunisian adolescents. A representative sample of 1569 adolescents was enrolled. The prevalence of the metabolic syndrome was 0.4% with no statistical difference according to sex (p > 0.05). Overweight/obesity was the most common component of the metabolic syndrome (13.7%). This information will be used to develop prevention programs by promoting healthy lifestyles in schools.

Association of hepatitis C virus infection and diabetes in central Tunisia.

AIM: To investigate hepatitis C virus (HCV) seroprevalence in Tunisian patients with diabetes mellitus and in a control group. METHODS: A cross-sectional study was conducted to determine the HCV seroprevalence in 1269 patients with diabetes (452 male, 817 female) and 1315 non-diabetic patients, attending health centers in Sousse, Tunisia. HCV screening was performed in both groups using a fourth-generation enzyme immunoassay. RESULTS: In the diabetic group, 17 (1.3%) were found to be HCV-infected compared with eight (0.6%) in the control group, although the difference was not significant (P = 0.057). Quantitative PCR was performed in 20 patients. Eleven patients were positive and showed HCV genotype 1b in all cases. CONCLUSION: Frequency of HCV antibodies was low in patients with diabetes and in the control group in central Tunisia, with no significant difference between the groups.