[Epidemiology of Haemophilus influenzae meningitis in Tunisia]. / Epidémiologie des méningites à Haemophilus influenzae en Tunisie.

The incidence of Haemophilus influenzae b meningitis (Hib) in children < 5 years in Tunisia was studied through a surveillance system set up in June 2000 and followed for 14 months. Population-based surveillance began in 3 governorates and sentinel surveillance in 2. Children < 5 years suspected of meningitis had lumbar puncture, macroscopic exam, blood count, chemical analysis and culture carried out. In the 14 months, 80 cases of meningitis were recorded. From the population-based surveillance most cases were children < 1 year (73.6%) and boys (64%). H. influenzae was isolated in 38% of cases, pneumococci in 13% and meningococci in 7%. The incidence of confirmed Hib was 14.4/100 000 children. The estimated cost of identifying and treating Hib meningitis and its complications was greater than the cost of vaccine introduction. Based this study, the Ministry of Health has decided to introduce Hib vaccination.

[Epidemiology of Haemophilus influenzae b meningitis in Tunisia]

The incidence of Haemophilus influenzae b meningitis [Hib] in children < 5 years in Tunisia was studied through a surveillance system set up in June 2000 and followed for 14 months. Population-based surveillance began in 3 governorates and sentinel surveillance in 2. Children < 5 years suspected of meningitis had lumbar puncture, macroscopic exam, blood count, chemical analysis and culture carried out. In the 14 months, 80 cases of meningitis were recorded. From the population-based surveillance most cases were children < 1 year [73.6%] and boys [64%]. H. influenzae was isolated in 38% of cases, pneumococci in 13% and meningococci in 7%. The incidence of confirmed Hib was 14.4/100 000 children. The estimated cost of identifying and treating Hib meningitis and its complications was greater than the cost of vaccine introduction. Based this study, the Ministry of Health has decided to introduce Hib vaccination

[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.

[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

[Antibiotic therapy in general medicine in Monastir, Tunisia]. / L'antibiothérapie en médecine générale à Monastir, Tunisie.

In order to determine the cost and frequency of antibiotic prescription by general practitioners, we studied 563 outpatients from health centres in Monastir (Tunisia). All patients had acute diseases. Antibiotics were prescribed to 50.4%. Single antibiotics were generally prescribed, but 52.8% of these patients did not have any laboratory tests. The more frequently used antibiotics were penicillin G and A. Antibiotics cost represented 34.7% of medicinal cost borne by patients and 49.7% of the cost borne by the public sector. Rationalization of medicinal prescription would have a positive impact on household and state budgets.

[The antibiotherapy in general medicine in Monastir, Tunisia]

In order to determine the cost and frequency of antibiotic prescription by general practitioners, we studied 563 outpatients from health centres in Monastir [Tunisia]. All patients had acute diseases. Antibiotics were prescribed to 50.4%. Single antibiotics were generally prescribed, but 52.8% of these patients did not have any laboratory tests. The more frequently used antibiotics were penicillin G and A. Antibiotics cost represented 34.7% of medicinal cost borne by patients and 49.7% of the cost borne by the public sector. Rationalization of medicinal prescription would have a positive impact on household and state budgets

[Prenatal surveillance and determinants of prenatal follow-up in the Monastir health district]. / Surveillance prénatale et déterminants du suivi prénatal dans la circonscription sanitaire de Monastir.

Prenatal monitoring is a prime strategy to improve the end of pregnancy. To estimate the prevalence rate and the conditions determining such a monitoring, the authors carried out a survey on 1190 pregnant women in the Monastir district (Tunisia). The rate of satisfactory monitoring (4 check-up and more) is 45.8 p.c. Age and high parity have a negative influence, but instruction, occupation and a bad out come of the last pregnancy favour a satisfactory prenatal monitoring.

PIP: In Tunisia, a survey was conducted of 1190 women who delivered at the maternity ward of the Fattouma Bourguiba University Hospital Center in Monastir during September 1988 to August 1989 to evaluate, in an Arab-Moslem context, the coverage rate of prenatal care and to identify the determinants of correct prenatal follow-up among users of the central maternity ward. 45.8% of the women received adequate prenatal care (i.e., 4 prenatal visits). 14.4% received no prenatal care. The frequency of adequate prenatal care decreased with age (51.78% for 15-24 years, 45.29% for 25-34 years, and 35.51% for 35 and over; relative risk [RR] = 1.34). Based on occupation, mothers who did not work received the least amount of prenatal care (40.47% vs. 55.63% for moderate profession and 51.76% for superior profession; RR = 1.36). Women who received the least amount of prenatal care were illiterate women (39.89% vs. 53.18% for secondary education and 67.69% for higher education; RR = 1.86). Women whose last pregnancy had a poor outcome (fetal death or miscarriage) were more likely to receive adequate prenatal care than those whose last pregnancy had a good outcome (54.7% vs. 33.6%; RR = 1.47). Women who experienced a medical condition during pregnancy were more likely to receive adequate prenatal care than those who had no such problem (53.7% vs. 45.2%). Primiparous women were more likely to receive adequate prenatal care than multiparous women (55.7% vs. 38.7% for parity 2-4 and 21.7% for parity 5; RR = 1.77). The influence of parity continued even when the researchers controlled for age (p 0.0003).

[Cost of hydatidosis surgery at the Sousse University Hospital (Tunisia)]. / Coût de l'hydatidose chirurgicale à l'Hôpital universitaire de Sousse (Tunisie).

Hydatidosis is a very common disease in Tunisia, with a great economical importance for the health care system. In 1983, for Sousse Hospital, the total cost for hydatidosis was 125,000 US $. More than half of these costs were for "hospital days". A more rational in the services administration would make decrease these costs, but the best is a special attention to primary prevention.