[Epidemiology of high risk pregnancy in Sousse, Tunisia]. / Profil épidémiologique des grossesses à risque à Sousse (Tunisie).

This descriptive study assessed the frequency of selected risk factors for high risk pregnancy (HRP) among women in Sousse region. All pregnant women (beyond 28 weeks gestation) giving birth in 4 public maternity hospitals between 15 February 2005 and 15 August 2005 and who had at least 1 risk factorwere enrolled. Data were collected within 24 hours of birth from obstetric and antenatal records and by interview. Of 4660 pregnant women, 1194 (25.6%) had at least 1 risk factor and were considered at-risk pregnancies. Mean age of the at-risk women was 31.3 (SD 5.4) years, 73% were urban residents, 38% had secondary education or higher and 75% were housewives. The mean number of risk factors was 1.5 per woman. The majority of women (59.3%) had 1 risk factor and 30.4% had 2. The mean number of prenatal visits was 4, 68.6% were seen by an obstetrician and 43% used the private sector. Certain factors were inadequately screened: age >35 years, parity >4, previous low birth weight and neonatal death, excessive fundal height and anaemia.

Assessment of soil erosion rates in a Mediterranean cultivated and uncultivated soils using fallout 137Cs.

Fallout radionuclides, such as 137Cs, have been recognized as a valuable means for studying soil erosion processes. In this study, the 137Cs technique was used to assess soil erosion magnitude and to investigate the effectiveness of terrace cultivations in the High Atlas of Morocco, particularly, the Ourika watershed. 137Cs depth distribution profiles were established along slope gradients associated with land use considering cereal crop, arboriculture and native forests. Along the slope gradient, depth distribution profiles highlight dissimilarities reflecting differences in land use, topographic roughness, soil particle distribution and stoniness. 137Cs inventory decreases exponentially with depth and its penetration increases along the slope. It becomes higher at the bottom of the slope, with penetration reaching 30 cm. 137Cs mass activity and inventory significantly decrease in cultivated terraces, compared to native forest. Although the pattern of 137Cs gain/loss varied according to topography, soil properties and vegetation cover, showing eroding and aggrading profiles, most samples had 137Cs values lower than the reference value, suggesting net-loss of soil as a consequence of erosion processes. The net erosion rates were estimated about 8.5 and 6.0 t ha-1 yr-1 in cereal crop and arboriculture agrosystems, respectively, whereas in the forest, the net erosion rate was lower at about 4.2 t ha-1 yr-1. Soil loss on agricultural terraces is not significantly above tolerable erosion rates for Morocco (<7 t ha-1 yr-1), particularly for arboriculture terraces. A strong correlation was observed between 137Cs and both soil organic carbon and slope gradient, in uncultivated area, whereas, there was no correlation for cultivated terraces. Terraced arboriculture systems should be encouraged for better soil preservation against water erosion in the Ourika watershed.

Use of (137)Cs technique for soil erosion study in the agricultural region of Casablanca in Morocco.

Accelerated erosion and soil degradation currently cause serious problems to the Oued El Maleh basin (Morocco). Furthermore, there is still only limited information on rates of soil loss for optimising strategies for soil conservation. In the present study we have used the (137)Cs technique to assess the soil erosion rates on an agricultural land in Oued el Maleh basin near Casablanca (Morocco). A small representative agricultural field was selected to investigate the soil degradation required by soil managers in this region. The transect approach was applied for sampling to identify the spatial redistribution of (137)Cs. The spatial variability of (137)Cs inventory has provided evidence of the importance of tillage process and the human effects on the redistribution of (137)Cs. The mean (137)Cs inventory was found about 842 Bq m(-2), this value corresponds to an erosion rate of 82 tha(-1) yr(-1) by applying simplified mass balance model in a preliminary estimation. When data on site characteristics were available, the refined mass balance model was applied to highlight the contribution of tillage effect in soil redistribution. The erosion rate was estimated about 50 tha(-1) yr(-1). The aspects related to the sampling procedures and the models for calculation of erosion rates are discussed.

[Costs of basic health services in a health district in Tunisia]. / Coût des soins de santé de base dans une circonscription sanitaire en Tunisie.

Information on the cost of health services is essential for good planning and management and the efficient use of resources. We calculated the total costs incurred in running primary health services for one year (1995) in the health district of Enfidha (Tunisia). The yearly operating expenditure for the health district was 1 219 099 Tunisian dinars and the cost per inhabitant was 17.494 dinars (US dollar 1 = Tunisian dinar 0.950 in 1995); 65.37% of total costs went on staff and 17.03% on drugs. Looked at another way, 84,96% went on curative services and 14.04% on preventive services. The cost of a consultation for curative care was 6.847dinars, for perinatal care was 2.764 dinars, for immunization was 3.680 and for school visit was 6.680 dinars. The study helps to identify ways in which cost analysis can be used to explore efficiency and resource adequacy in the district.

[Transfusion practice and attitudes]. / Pratiques et attitudes transfusionnelles.

During last years, blood transfusion and transfusion security were domains which have preoccupied health authorities, the population and health professionals. Beginning with the principle that blood transfusion is a care that must be under medical responsibilities, authors analyse physician's implication in this field. To reach this objective, a study interested 199 young physicians, working in two university hospitals in Tunisia. Results indicate that physician's knowledge about blood transfusion is insufficient to guarantee quality of this medical act. In terms of attitudes and practices, physicians are not really always implicated in the different stages of blood transfusion process. Intervention is limited to prescription and blood transfusion record card writing. Transfusion herself and monitoring were, in particular, delegated to nurses. So transfusion incidents were under--declared. Transfusion medicine must occupy important place in physicians curriculum. At hospital level, quality insurance process, based on audit, have to be implemented to obtain transfusion good practices, in a domain were risks are unfortunately not yet totally circumscribed.

Assessment of soil erosion and deposition rates in a Moroccan agricultural field using fallout 137Cs and 210Pbex.

In Morocco land degradation - mainly caused by soil erosion - is one of the most serious agroenvironmental threats encountered. However, only limited data are available on the actual magnitude of soil erosion. The study site investigated was an agricultural field located in Marchouch (6°42' W, 33° 47' N) at 68 km south east from Rabat. This work demonstrates the potential of the combined use of (137)Cs, (210)Pb(ex) as radioisotopic soil tracers to estimate mid and long term erosion and deposition rates under Mediterranean agricultural areas. The net soil erosion rates obtained were comparable, 14.3 t ha(-1) yr(-1) and 12.1 ha(-1) yr(-1) for (137)Cs and (210)Pb(ex) respectively, resulting in a similar sediment delivery ratio of about 92%. Soil redistribution patterns of the study field were established using a simple spatialisation approach. The resulting maps generated by the use of both radionuclides were similar, indicating that the soil erosion processes has not changed significantly over the last 100 years. Over the previous 10 year period, the additional results provided by the test of the prediction model RUSLE 2 provided results of the same order of magnitude. Based on the (137)Cs dataset established, the contribution of the tillage erosion impact has been evaluated with the Mass Balance Model 3 and compared to the result obtained with the Mass Balance Model 2. The findings highlighted that water erosion is the leading process in this Moroccan cultivated field, tillage erosion under the experimental condition being the main translocation process within the site without a significant and major impact on the net erosion.

Epidemiology of high risk pregnancy in Sousse, Tunisia

This descriptive study assessed the frequency of selected risk factors for high risk pregnancy [HRP] among women in Sousse region. All pregnant women [beyond 28 weeks gestation] giving birth in 4 public maternity hospitals between 15 February 2005 and 15 August 2005 and who had at least 1 risk factor were enrolled. Data were collected within 24 hours of birth from obstetric and antenatal records and by interview. Of 4660 pregnant women, 1194 [25.6%] had at least 1 risk factor and were considered at-risk pregnancies. Mean age of the at-risk women was 31.3 [SD 5.4] years, 73% were urban residents, 38% had secondary education or higher and 75% were housewives. The mean number of risk factors was 1.5 per woman. The majority of women [59.3%] had 1 risk factor and 30.4% had 2. The mean number of prenatal visits was 4, 68.6% were seen by an obstetrician and 43% used the private sector. Certain factors were inadequately screened: age > 35 years, parity > 4, previous low birth weight and neonatal death, excessive fundal height and anaemia

[Costs of basic health services in a health district in Tunisia]

Information on the cost of health services is essential for good planning and management and the efficient use of resources. We calculated the total costs incurred in running primary health services for one year [1995] in the health district of Enfidha [Tunisia]. The yearly operating expenditure for the health district was 1 219 099 Tunisian dinars and the cost per inhabitant was 17.494 dinars [US dollar 1 = Tunisian dinar 0.950 in 1995]; 65.37% of total costs went on staff and 17.03% on drugs. Looked at another way, 84,96% went on curative services and 14.04% on preventive services.The cost of a consultation for curative care was 6.847dinars, for perinatal care was 2.764 dinars, for immunization was 3.680 and for school visit was 6.680 dinars. The study helps to identify ways in which cost analysis can be used to explore efficiency and resource adequacy in the district