Weight excess among high-school students: Relation with mental health and sociodemographic factors.

INTRODUCTION: The escalating prevalence of adolescent obesity represents a complex public health challenge, influenced by interactions of environmental, socio-economic, and behavioral factors. Recent studies reveal a surge in addictive substance use among adolescents, with non-substance addictions. Overweight adolescents are particularly susceptible to risky behaviors. Tunisia is not exempt from this issue, facing a rapidly increasing prevalence. AIM: Our work aimed to assess the prevalence of obesity among adolescents and to explore the connections between sociodemographic factors, mental health, and overweight in this demographic group. METHODS: A cross-sectional study was led among sample of Tunisian high school adolescents from Sousse. We enrolled study participants through proportional stratified sampling. RESULTS: Our study included 1399students, predominantly female, with an average age of 17±1.5 years. The average BMI (Body Mass Index) was 22.7±4.1 kg/m². According to the International Obesity Task Force (IOTF), 20.4% were overweight, and 7% were obese, resulting in an overall weight excess prevalence of 27.4%. Girls exhibited a higher weight excess prevalence compared to boys. Multivariate analysis identified factors associated with overweight and obesity, including maternal self-employment(aOR=2.13,[1.35-3.35];p<0.001), regular physical activity (aOR=0.61,[0.47-0.8];p<0.001), internet usage ≥2 hours (aOR=0.70,[0.50-0.99];p=0.045), daily fruit-vegetable consumption (aOR=1.51,[1.15-1.97]; p=0.003), possible alexithymia (aOR=1.55,[1.07-2.22];p=0.018), probable anxiety (aOR=1.28,[0.87-1.89]; p=0.007), very probable anxiety (aOR=1.61,[1.14-2.2]; p=0.037), and problematic Facebook-use (aOR=0.67,[0.50-0.89]; p=0.006). CONCLUSION: Understanding factors tied to excess weight in our social and cultural context is crucial in shaping effective public health strategies. Interventions should adopt a multisectoral approach specifically targeting working mothers within the adolescent's socio-familial environment. It is fundamental also to address mental health concerns, with a particular focus on alexithymia and anxiety.

Cross-sectional study of co-occurring addiction problems among high school students in Tunisia.

Background: Addictive behaviours are a major public health problem, especially among adolescents, who are susceptible to experiencing multiple co-occurring addictions. Aim: To assess the prevalence of addiction problems and co-occurrences of addictive behaviours (substance abuse, problematic video gaming and social media addiction) and disorders among high school students in Sousse, Tunisia. Methodology: A cross-sectional study was conducted in 2018 in public high schools, in the urban area of Sousse, Tunisia. A structured self-administered questionnaire was used to obtain relevant information from the students. Statistical analysis was performed using SPSS version 10 and confidence intervals of 95% were calculated. Chi-square test was used to compare qualitative variables and multinomial regression was conducted to determine independent factors related to the number of addictive behaviour co-occurrences. Results: Of the 1399 high school students, 60.5% were girls and mean age was 17 ± 2.28 years. Analysis of single addiction problems revealed 20.9% prevalence for all tobacco products, 10.1% for alcohol, 7.0% for all drugs, 36.1% for Facebook, and 35.3% for video games. Analysis of co-occurring addiction problems showed that 46.0% of the study population had 1 addiction problem, 12.2% had 2 addiction problems, 4.5% had 3, and 2.7% had the maximum number of 4 addiction problems. Multinomial regression showed an increase in co-occurrence of addiction problems among boys (aOR = 217.004; P < 0.001), participants who had repeated a school grade (aOR = 0.232; P < 0.001), those who had moderate or severe depression (aOR = 0.232; P < 0.001), and those who were anxious (aOR = 0.335; P = 0.003) and had alexithymia (aOR = 0.361; P = 0.005). Conclusion: The rate of co-occurrent addictions among adolescents in Sousse, Tunisia, is alarming. Problematic use of Facebook, gaming and tobacco use were the most frequent addictive behaviours. There is an urgent need for effective and multisectoral programmes to prevent addictions among children in Tunisia and other countries in the Middle East and North Africa Region.

Risk factors for severe Covid-19 breakthrough infections: an observational longitudinal study.

BACKGROUND: The drive to vaccinate large populations is nowadays the main instrument for combating the pandemic and preventing serious disease and death. However, breakthrough infection (post-vaccination infection) still happens after vaccination among fully vaccinated people. We aimed to assess the severity outcomes and to determine its associated factors among vaccinated COVID-19 cases in the governorate of Sousse, Tunisia. METHODS: We carried out a five-month observational longitudinal study including all the population of Sousse. Confirmed infections of SARS-CoV-2 and the vaccination status are recorded in the daily COVID- 19 database of the Regional Office of the Tunisian Ministry of Health. We included all post-vaccination COVID-19 cases for the analysis of the COVID-19 serious outcomes. Data were collected via 15-min telephonic call interviews conducted by trained interviewers. Descriptive analysis with calculating incidence rates of confirmed COVID-19 cases per 100,000 inhabitants was conducted. In binary logistic regression, adjusted odds ratios along with 95% intervals confidence were performed to determine factors related to severe or critical COVID-19. RESULTS: As of 31 July 2021, 107,545 persons over 19 years old have received at least one dose of COVID-19 vaccination. Among the vaccinated population, we traced and included 765 breakthrough infection cases, and the incidence rate was 711.3 per week. The majority were female (sex-ratio = 0.8), and the average age of the overall cases was 55.7 years. The prevalence of severe or critical cases in vaccinated COVID-19 patients occurs in 10.8% of cases. Patients with a medical history of cardiovascular diseases had more than two times increased odds to have a severe or critical disease. We also found the highest self-estimation of adherence to preventive measures was inversely correlated to serious cases and having an incomplete vaccination schema was strongly associated with complications. CONCLUSIONS: We tried to provide evidence about the breakthrough infections to improve measures of prevention and control of COVID-19. Boosting immunity for vulnerable patients added to maintaining and promoting preventive measures are not only essential to prevent severe cases of breakthrough infections of COVID-19, but also other influenza-like diseases.

Surveillance of tobacco use among young adolescents: trends and predictors across three years in Sousse, Tunisia.

BACKGROUND: In developed countries, there was an overall decrease in tobacco use over the last decades. In Tunisia, a national strategy to reduce tobacco use was set up since 2008. However, this strategy was rarely evaluated. The objective of the current study was to examine the trends in tobacco use among the middle schoolchildren of the governorate of Sousse (Tunisia) between 2014 and 2016 and to determine predictors of its experimentation. METHODS: Three cross-sectional studies were conducted in 2014, 2015 and 2016 school years among middle schoolchildren randomly selected from the governorate of Sousse-Tunisia. The required sample size for each study was 760 participants. Each year, the same procedure was used to recruit pupils from the same middle schools. The same pre-established and pre-tested questionnaire was self-administered anonymously to participants in their classrooms. RESULTS: Lifetime tobacco use rose from 11% in 2014 to 17.3% in 2016 (p = 0.001). Across the 3 years of survey, predictors of lifetime tobacco use were: The male sex (OR, 95% CI: 4.4 [3.2-6.1]), age above 13 (OR, 95% CI: 2.3 [1.7-3.1]), lifetime illicit substances use (OR, 95% CI: 3.9 [1.1- 13.8), lifetime inhalant products use (OR, 95% CI: 2.2 [1.2-4.3]), tobacco use among the father (OR, 95% CI: 2.2 [1.2-4.3]), tobacco use among siblings (OR, 95% CI: 1.7 [1.2-2.4]) and current anxiety symptoms (OR, 95% CI: 1.8 [1.4-2.4]). CONCLUSION: Lifetime tobacco use is in expansion among the young adolescents of Sousse. The current national tobacco prevention program should be strengthened and expanded to cover other substances use issues with emphasis on secondhand smoking and mental health problems.

Screening and health education practices related to cardiovascular risk factors among adults: results of a households survey in Sousse, Tunisia.

In Tunisia, despite the implementation of national strategies to prevent some of cardiovascular risk factors, these diseases still represent the leading cause of death. The current study aimed to determine the prevalence of cardiovascular risk factors and assess the screening and health education practices related to these factors among the adults of Sousse (Tunisia). A cross-sectional study was conducted in 1000 households in Sousse, Tunisia. To collect data, a team of trained medical doctors administered by interview a pre-tested questionnaire and performed blood pressure and anthropometric measures at the participants' homes. In total, 1977 adults participated in the study. Their mean age was 39.8 (± 13.8) years. The Females/Males sex ratio was 1.5. Weight excess and lack of physical activity were found in 65.4% and 60.7% of participants. Screening for obesity and android obesity were reported by 36.6% and 5.7% of health services users. Advices from a healthcare professional to practice the recommended physical activity and eat healthily were reported by less than a third of these latter. Screening and health education practices related to cardiovascular risk factors should be reinforced in the Tunisian healthcare facilities. The implementation of multisectoral actions is necessary at the national level in order to obtain an environment that promotes a healthy lifestyle.

Studying SARS-CoV-2 vaccine hesitancy among health professionals in Tunisia.

BACKGROUND: People's lives were seriously affected by the emergence and the spread of the COVID-19 disease. Several vaccines were developed in record time to overcome this pandemic. However, putting an end to this public health problem requires substantial vaccination coverage rate. This latter depends on the acceptance of these vaccines especially by health professionals; the leaders of the current war against COVID-19. In fact, they have a central role in promoting vaccination against the SARS-CoV-2. In the developed countries, hesitancy rates towards these vaccines among health professionals vary from 4.3% to 72%. In the developing countries, few studies focused on this issue. OBJECTIVE: To estimate the prevalence and the predictors of SARS-CoV-2 vaccine hesitancy among the Tunisian health professionals. METHODS: A cross-sectional study was led online between the 7th and the 21th of January 2021 among Tunisian health professionals. At least 460 participants were required. Snowball sampling method served to recruit participants. Data were collected using a pre-established and pre-tested questionnaire recorded in a free Google form. The link of the questionnaire was disseminated online to be self-administered anonymously to the participants. The generated online Google Sheet was uploaded and exported to SPSS software for analysis. RESULTS: Of the 546 responses, 493 were retained. The mean age of participants was 37.4 (± 9.5) years. Females represented 70.2% of participants. Social media represented the most frequently used source of information about COVID-19. The prevalence of SARS-CoV-2 vaccine hesitancy among participants was 51.9% (95% CI: 47.5-56.3)). Female sex, working far from the capital and having concerns about the vaccines components predicted more hesitancy among participants. In contrast, the use of the national COVID-19 information website predicted less hesitancy among them. CONCLUSIONS: The current Tunisian communication plan about COVID-19 vaccines must be reinforced. Social media represent a cost effective communication channel that can serve to reassure Tunisian health professionals regarding the safety of COVID-19 vaccines. Special interest should be paid to females, paramedical professionals and those working far from the capital.

The prevalence of high blood pressure and its determinants among Tunisian adolescents.

Hypertension can originate in childhood and remain undetected unless special screening is performed. The burden of hypertension in adolescents in Tunisia is unknown. The aim of this study was to investigate the prevalence of blood pressure (BP) within the hypertension range and its association with other risk factors among Tunisian adolescents. A cross-sectional study that included 1385 secondary school students in Sousse, Tunisia, was performed during 2017-2018. A two-stage cluster sampling strategy was used to obtain a representative sample of the study population. BP within the hypertension range (HBP)was classified following the European guideline recommendations for measuring BP in children and adolescents. Anthropometric indices were measured using a standard protocol. A structured questionnaire collected information about sociodemographic characteristics, lifestyle, mental health status, and addictions. Adjusted logistic regression models were used to assess hypertension-related risk factors. Our study included 39.5% boys and 60.5% girls. The mean age of our population was 17 ± 1.5 years. The prevalence of HBP was 15.4% (13.1-18.0%), and it was significantly higher in boys (22.8%) than in girls (10.6%, p value < 0.001). In the multivariate logistic regression model, overweight [OR = 1.72(1.18-2.51)] and obesity [OR = 3.73(2.55-5.41)] were independent risk factors for HBPrange, (p value < 0.001), whereas female sex [OR = 0.41(0.29-0.56), p value < 0.001] and depression [OR = 0.67(0.51-0.88), p value = 0.008] were independent protective factors. Among Tunisian secondary school adolescents, the prevalence of HBP was high and associated with excess body weight. A comprehensive strategy for the prevention of hypertension and its risk factors among youth is urgently needed.

Effectiveness of a 3-year community-based intervention for blood pressure reduction among adults: a repeated cross-sectional study with a comparison area.

Raised blood pressure is the leading risk factor for cardiovascular diseases. We aimed to demonstrate the effectiveness of a 3-year community-based healthy lifestyle promotion intervention at a neighbourhood level for blood pressure reduction among adults in the context of a political transition. We conducted repeated cross-sectional surveys including 1880 (940 from each area) participants at baseline and 1977 (1001 in the intervention area; 976 comparison area) participants at follow-up. Data collection was conducted through home visits. Multiple linear regression models were used to identify the intervention effect and factors associated with blood pressure change in each area. The prevalence of hypertension was 4.4% lower (35.8% vs. 31.4%) in the intervention area after 3 years (p = 0.044). The mean systolic and diastolic blood pressures changed significantly in the intervention area, from 132.4 ± 19.2 mmHg at baseline to 130.6 ± 17.7 mmHg at follow-up (p = 0.035) and from 78.7 ± 11.8 mmHg to 76.9 ± 11.1 mmHg (p < 10-3), respectively. In the control group, the mean systolic blood pressure increased from 129.4 ± 17.8 mmHg to 130.4 ± 17.9 mmHg (p = 0.38). A significant protective effect of the intervention on systolic (ß = -0.4; 95% CI: -0.76; -0.06) and diastolic blood pressures (ß = -0.22; 95% CI: -0.38; -0.07) was found in the intervention area. In the control area, the effect was not significant for systolic blood pressure. Lifestyle intervention at the neighbourhood level, in the context of a sociopolitical transition, was found to be effective for reducing blood pressure in Sousse, Tunisia. This approach could be scaled up and applied in other similar settings. Future research also needs to focus on designing, implementing, and evaluating multisectoral action plans and legislative measures.

Validity and reliability of a modified short version of a stigma scale for use among Tunisian COVID-19 patients after quarantine: A cross-sectional study.

BACKGROUND AND AIM: The COVID-19 is a stigmatizing infectious disease even after healing. Until now, no COVID-19 stigma scale validated in Tunisian Arabic language among the general population is available. Developing such tools is necessary to detect COVID-19 stigma and reduce it effectively. Indeed, stigmatization of COVID-19 patients could increase the spread of this disease and its related mental health issues. We aimed at testing the validity of a translated and modified version of the 12-item HIV stigma scale among Tunisian COVID-19 patients. METHODS: A cross-sectional study was conducted between November and December 2020 among a representative sample of COVID-19 patients in the governorate of Sousse, Tunisia, after quarantine. The 12-item HIV stigma scale was translated in Tunisian Arabic and then modified to be adapted to the Tunisian context. The preliminary modified version was administrated to the participants by pretrained medical doctors during phone calls. It consisted on 20 items covering the four stigma dimensions (personalized stigma, disclosure concerns, concerns with public attitudes, and negative self-image). The psychometric evaluation of this version included internal consistency as well as principal component analysis (PCA). RESULTS: The responses of 346 COVID-19 patients were obtained. Their median age was 40 years (interquartile range: 30-54.5). Females represented 60.4% of them. The PCA resulted in a three factor solution with 14 items. This 14-item scale demonstrated good internal consistency with a global Cronbach's α of 0.91 and values of 0.94, 0.93, and 0.98 for social stigma, negative self-image, and disclosure concerns, respectively. CONCLUSION: This study provides a reliable and valid instrument for stigma measuring among Tunisian COVID-19 patients. The use of this scale would contribute in reducing the spread of this new infectious disease and its related mental health issues.

Effective public health measures to mitigate the spread of COVID-19: a systematic review.

BACKGROUND: In December 2019, a novel coronavirus (2019-nCoV) was recognized in Wuhan, China. It was characterised by rapid spread causing a pandemic. Multiple public health interventions have been implemented worldwide to decrease the transmission of the 2019 novel coronavirus disease (COVID-19). The objective of this systematic review is to evaluate the implemented public health interventions to control the spread of the outbreak of COVID-19. METHODS: We systematically searched PubMed, Science Direct and MedRxiv for relevant articles published in English up to March 16, 2021. We included quasi experimental studies, clinical trials, cohort studies, longitudinal studies, case-control studies and interrupted time series. We included the studies that investigated the effect of the implemented public health measures to prevent and control the outbreak of 2019 novel coronavirus disease (COVID-19). RESULTS: The database search using the predefined combinations of Mesh terms found 13,497 studies of which 3595 in PubMed, 7393 in Science Direct 2509 preprints in MedRxiv. After removal of the duplicates and the critical reading only 18 articles were included in this systematic review and processed for data extraction. CONCLUSIONS: Public health interventions and non-pharmaceutical measurements were effective in decreasing the transmission of COVID-19. The included studies showed that travel restrictions, borders measures, quarantine of travellers arriving from affected countries, city lockdown, restrictions of mass gathering, isolation and quarantine of confirmed cases and close contacts, social distancing measures, compulsory mask wearing, contact tracing and testing, school closures and personal protective equipment use among health workers were effective in mitigating the spread of COVID-19.

The incubation period during the pandemic of COVID-19: a systematic review and meta-analysis.

BACKGROUND: The aim of our study was to determine through a systematic review and meta-analysis the incubation period of COVID-19. It was conducted based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Criteria for eligibility were all published population-based primary literature in PubMed interface and the Science Direct, dealing with incubation period of COVID-19, written in English, since December 2019 to December 2020. We estimated the mean of the incubation period using meta-analysis, taking into account between-study heterogeneity, and the analysis with moderator variables. RESULTS: This review included 42 studies done predominantly in China. The mean and median incubation period were of maximum 8 days and 12 days respectively. In various parametric models, the 95th percentiles were in the range 10.3-16 days. The highest 99th percentile would be as long as 20.4 days. Out of the 10 included studies in the meta-analysis, 8 were conducted in China, 1 in Singapore, and 1 in Argentina. The pooled mean incubation period was 6.2 (95% CI 5.4, 7.0) days. The heterogeneity (I2 77.1%; p < 0.001) was decreased when we included the study quality and the method of calculation used as moderator variables (I2 0%). The mean incubation period ranged from 5.2 (95% CI 4.4 to 5.9) to 6.65 days (95% CI 6.0 to 7.2). CONCLUSIONS: This work provides additional evidence of incubation period for COVID-19 and showed that it is prudent not to dismiss the possibility of incubation periods up to 14 days at this stage of the epidemic.

PASCAR and WHF Cardiovascular Diseases Scorecard project.

Data collected by the Pan-African Society of Cardiology for the World Heart Federation's scorecard project regarding the current state of cardiovascular disease prevention, control and management along with related non-communicable diseases in Tunisia are presented. Furthermore, the strengths, threats, weaknesses and priorities identified from these data are highlighted in concurrence with related sections in the incorporated infographic. Information was collected using open-source data sets available online and relevant government publications.

Effect of a school-based intervention in eating habits among school children: quasi experimental study, Tunisia.

OBJECTIVE: The present study aimed to assess whether six months intervention program with parents' implication in primary schools is able to decrease morning snack consumption among children aged 6-12 years. METHODS: We carried out a quasi-experimental study with two groups of schoolchildren in the region of Sousse (Tunisia) from 2015 to 2016. One primary school in each group was selected. In each school, we randomly selected a sample size of schoolchildren and their parents. The intervention was based on healthy eating habits promotion. RESULTS: The consumption of morning snacks the day before data collection, reported by children, decreased significantly in post-intervention in both intervention and control groups. The decrease of consumption of morning snacks was significantly higher in intervention group (p=0.009). According to parents, the proportion of children who had the habit of eating morning snack decreased significantly from pre to post-intervention in intervention group (p<0.001). CONCLUSION: A healthy environment should be created through effective school policies to prevent obesity.

Validation of the Arabic version of the Bergen Facebook Addiction Scale in Tunisian adolescents.

BACKGROUND: Facebook is by far the most popular social network. Thus, it is important to use a valid measuring tool. This study aimed to validate an Arabic version of the Bergen Facebook Addiction Scale (BFAS). METHODS: It was a cross-sectional study conducted among public secondary schools, within the city of Sousse, Eastern Tunisia over 2 months. Students completed self-administrated questionnaires. The revised test-retest version of the scale was given to a sample of ten pilot students in order to check the readability of the translation. Internal consistency was measured using Cronbach's alpha coefficient in order to assess the extent to which the BFAS items were interrelated. RESULTS: A total of 1399 participants took part in the study (60.5% females). Among 1353 students who are using Facebook, 71.8% had non-problematic use. The median score of addiction was 13 ranging from 6 to 30. The median time spent each day on Facebook was 3 h. The Cronbach's alpha coefficient was 0.87. Students with higher Facebook addiction scores were significantly more addicted to video games (p = 0.001), and more depressed (p < 0.0001). CONCLUSION: The Arabic-BFAS is consistent as a screening test for Facebook addiction among secondary school students due to having good reliability and validity.

Tobacco use: the main predictor of illicit substances use among young adolescents in Sousse, Tunisia.

Introduction Early adolescence is a critical period usually associated with experimentation with illicit substances. In Tunisia few studies explored these risk behaviors among young adolescents. Aims To evaluate the prevalence and the predictors of the use of illicit substances among the young adolescents of Sousse. Methods A cross-sectional study was conducted in the region of Sousse, Tunisia during the 2013/2014 school year among 4272 schoolchildren in 16 public middle schools. Data about psychosocial characteristics and risk behaviors among the schoolchildren, their parents, their siblings and their friends were collected anonymously using a self-administrated questionnaire. Results Females represented 50.5% of participants. The mean age of schoolchildren was 13.3 (±1.2) years. Lifetime illicit substances use prevalence was 2.9% [confidence interval (CI) 95%: (2.4%-3.4%)] and lifetime use of tobacco prevalence was 12.9% [CI 95%: (11.9%-13.9%)]. The age of tobacco onset was significantly younger to the age of experimentation with illicit substances. Insomnia, sadness and illicit substances use among peers were associated with illicit substances use among participants. While the most influential risk factor on illicit substances use was current cigarette smoking with an adjusted odds ratio (OR) of 7.2 [CI 95%: (4.5-11.2)]. Conclusion A national substances use prevention program should be implemented in the schools of Tunisia with an emphasis on tobacco use prevention.

Clustering of chronic diseases risk factors among adolescents: a quasi-experimental study in Sousse, Tunisia.

Background The objective of the study was to evaluate the effectiveness of a school-based physical activity and nutritional behavior intervention, on the reduction of clustering of chronic diseases risk factors among school children. Materials and methods A quasi-experimental school-based intervention was conducted with an intervention group and a control group in the region of Sousse in Tunisia. The intervention was implemented between 2010 and 2013, with data collected at pre and at post intervention. Studied risk factors were: smoking, sedentary behavior, low fruit and vegetable intake and obesity. Odds ratios (ORs) were used to calculate the clustering of two risk factors. We calculated ORs in each group before and after the intervention. Results In the intervention group, the prevalence of adolescents that had no risk factors has significantly increased (p = 0.004). In the control group the prevalence of adolescents carrying two or more risk factors has increased (p = 0.06). The results showed that all risk factors tended to cluster together in both groups. In the intervention group, the calculated OR for smoking and sedentary behavior decreased after assessment (OR = 5.93) as well as the OR for smoking and low fruit and vegetable intake (OR = 3.26). In the control group, all ORs increased, showing an enhancement of the association. Conclusion This study showed the effectiveness of a school-based intervention in reducing the clustering of chronic diseases risk factors.

Challenges and results of a school-based intervention to manage excess weight among school children in Tunisia 2012-2014.

BACKGROUND: Obesity is a serious health issue and predisposes individuals to an increased risk of morbidity and mortality. Its prevalence in children has increased worldwide. OBJECTIVE: To demonstrate the feasibility and effectiveness of a school-based management program based on healthy lifestyle promotion for obese and overweight adolescents in Sousse, Tunisia. METHODS: We conducted a quasi-experimental study among overweight and obese school children enrolled in 7th and 8th grades in Sousse, Tunisia with two groups, intervention and control. The 1-year intervention was based on promoting healthy eating and physical activity through a collective intervention for all recruited children and an individual intervention only for obese children who require intensive managing. Data collection was done before, at the end and at a 4-month follow up of the intervention, both in intervention and control groups. RESULTS: The body mass index Z score decreased significantly from pre-intervention to post-intervention (1.89±0.57 to 1.76±0.63, p<0.001) and from post-intervention to the follow-up (1.76±0.63 to 1.55±0.68, p<0.001) in the intervention group. In the control group, it decreased significantly from pre-intervention to post-intervention but not significantly from post-intervention to follow-up assessment. Calorie intake decreased significantly both in intervention and control groups. CONCLUSION: This project began with introducing a new culture of health management in schools on one side and with increasing awareness of the importance of obesity prevention and treatment. The support of authorities for this type of action is very important to guarantee its sustainability.

Long term effect of a school based intervention to prevent chronic diseases in Tunisia, 2009-2015.

BACKGROUND & OBJECTIVES: We aimed to evaluate the long term effect of school based intervention to prevent non- communicable disease risk factors. METHODS: It was a quasi experimental study conducted during the period of 2009-2015. We involved school children aged from 11 to 16 years old. For the assessment of the program's effectiveness, subjects in both groups were examined at baseline, at the end of the 3-year intervention period and at the follow-up, one year after program's cessation. RESULTS: In the intervention group, the prevalence of school children who reported to be eating 5 fruits and vegetable sdaily increased significantly from 30.0% at pre-assessment to 33.2% at post-assessment, one year after (p=0.02, p=0.41 respectively). For the control group, this prevalence had significantly decreased from 40.2% at baseline to 35.0% at post-intervention, at the follow up, this proportion increased to 44.5%(p=0.001, p<10-3 respectively). Concerning smoking habits, we observed a decreasing trend in the intervention group from 5.7% at pre-assessment, to 4.8% at post-assessment and to 3.4% at the follow-up (p=0.19 and p=0.25 respectively). There was also a significant decrease in school children who did recommended physical activity in the same group. CONCLUSION: The present work showed that interventions promoting healthy lifestyles should be maintained. Developing countries should be encouraged and supported to design, conduct, and evaluate robust preventive interventions.

Sustainability of the results of a non communicable diseases prevention program among youth in the region of Sousse, Tunisia.

INTRODUCTION: Implementation of a healthy lifestyle at an early age is described as a successful intervention to prevent non communicable diseases. However, successful programs are not necessarily sustainable. The purpose of this study was to evaluate a 1-year sustainability of a 3-year comprehensive intervention conducted to promote a healthy lifestyle among schoolchildren. MATERIALS AND METHODS: A cohort study of 204 schoolchildren enrolled in middle schools was conducted after a quasi-experimental study in the region of Sousse, Tunisia. The survey lasted 1 year. An exposed group (n=105) was selected from the intervention group and the not-exposed group (n=99) was selected from the control group. The exposition was the intervention. The same questionnaire used at pre-intervention and post-intervention was self-administered to collect data about tobacco use, physical activity and eating habits. The biometric measurements were taken by trained medical doctors at schools. RESULTS: After 1 year of follow-up, none of participants became smokers in the exposed group. However, in the not-exposed group five (5.1%) participants became smokers. The proportion of schoolchildren who experimented with tobacco for the first time increased insignificantly by 2.9% (p=0.77) in the exposed group versus a significant increase by 11.1% (p=0.001) in the not-exposed group. Concerning the recommended physical activity practice, fast food and fried food consumption and overweight, there were no significant changes in the two groups. CONCLUSION: A 3-year non communicable diseases prevention program has limited sustainable effects among schoolchildren in the short-term. Its repetition or a continued program through multisectoral actions is required.

Global Forum 2015 dialogue on "From evidence to policy - thinking outside the box": perspectives to improve evidence uptake and good practices in the African Region.

BACKGROUND: The Global Forum 2015 panel session dialogue entitled "From evidence to policy - thinking outside the box" was held on 26 August 2015 in the Philippines to debate why evidence was not fully translated into policy and practice and what could be done to increase its uptake. This paper reports the reasons and possible actions for increasing the uptake of evidence, and highlights the actions partners could take to increase the use of evidence in the African Region. DISCUSSION: The Global Forum 2015 debate attributed African Region's low uptake of evidence to the big gap in incentives and interests between research for health researchers and public health policy-makers; limited appreciation on the side of researchers that public health decisions are based on multiple and complex considerations; perception among users that research evidence is not relevant to local contexts; absence of knowledge translation platforms; sub-optimal collaboration and engagement between industry and research institutions; lack of involvement of civil society organizations; lack of engagement of communities in the research process; failure to engage the media; limited awareness and debate in national and local parliaments on the importance of investing in research and innovation; and dearth of research and innovation parks in the African Region. CONCLUSION: The actions needed in the Region to increase the uptake of evidence in policy and practice include strengthening NHRS governance; bridging the motivation gap between researchers and health policy-makers; restoring trust between researchers and decision-makers; ensuring close and continuous intellectual intercourse among researchers, ministry of health policy-makers and technocrats during the life course of research projects or programmes; proactive collaboration between academia and industry; regular briefings of civil society, media, relevant parliamentary committees and development partners; development of vibrant knowledge translation platforms; development of action plans for implementing research recommendations, preferably in the context of the Sustainable Development Goals; and encouragement of competition on NHRS strengthening and research output and uptake among the countries using a barometer or scorecard to review their performance at various regional ministerial forums and taking into account the lessons learned from the MDG period.