Prevalence of diabetes in Northern African countries: the case of Tunisia.

BACKGROUND: Although diabetes is recognized as an emerging disease in African and Middle East, few population-based surveys have been conducted in this region. We performed a national survey to estimate the prevalence of type 2 diabetes (T2D) and to evaluate the relationship between this diagnosis, demographic and socioeconomic variables. METHODS: The study was conducted on a random sample of 6580 households (940 in each region). 7700 subjects adults 35-70 years old were included in the analyses. T2D was assessed on the basis of a questionnaire and fasting blood glucose level according to the WHO criteria. Access to health care and diabetes management were also assessed. RESULTS: Overall, the prevalence of T2D was 15.1%. There were sharp urban vs. rural contrasts, the prevalence of diabetes being twice higher in urban area. However, the ratio urban/rural varied from 3 in the less developed region to 1.6 in the most developed ones. A sharp increase of prevalence of T2D with economic level of the household was observed. For both genders those with a family history of T2D were much more at risk of T2D than those without. Awareness increase with age, economic level and were higher amongst those with family history of T2D. Drugs were supplied by primary health care centers for 57.7% with a difference according to gender, 48.9% for men vs. 66.0% women (p < 0.001) and area, 53.3% on urban area vs. 75.2% on rural one (p < 0.001). CONCLUSIONS: Through its capacity to provide the data on the burden of diabetes in the context of the epidemiological transition that North Africa is facing, this survey will not only be valuable source for health care planners in Tunisia, but will also serve as an important research for the study of diabetes in the region where data is scarce. In this context, NCDs emerge as an intersectoral challenge and their social determinants requiring social, food and environmental health policy.

Prevalence and determinants of the metabolic syndrome among Tunisian adults: results of the Transition and Health Impact in North Africa (TAHINA) project.

OBJECTIVE: To determine the prevalence of metabolic syndrome (MetS) and its components and to evaluate the relationship between this diagnosis and cardiovascular risk factors, demographic and socio-economic variables. DESIGN: A cross-sectional study using a questionnaire including information on sociodemographic and CVD risk factors. Blood pressure, anthropometric indices, fasting glucose and lipid profile were measured. MetS was defined according to the criteria of the National Cholesterol Education Program, Adult Treatment Panel III. SETTING: The whole Tunisian territory; Transition and Health Impact in North Africa (TAHINA) project. SUBJECTS: A total of 4654 individuals (1840 men and 2814 women), aged 35 to 74 years, who participated in the Tunisian national survey. RESULTS: The overall prevalence of MetS was 30·0 %, higher in women (36·1 %) than in men (20·6 %; P < 0·001). In both genders MetS prevalence increased significantly with age (P < 0·001), but this increase was more important in women. Multiple regression analyses showed that the odds for MetS increased significantly with urban area for both men and women (P < 0·05 and P < 0·001, respectively). The multivariate models showed also that the odds for MetS increased significantly with increasing level of education and in those with a family history of CVD for men (both P < 0·05) and after the menopausal transition for women (P < 0·05). CONCLUSIONS: The study highlights the MetS problem in a middle-income developing country. There is an urgent need for a comprehensive, integrated, population-based intervention programme to ameliorate the growing problem of MetS in Tunisians.

Blood pressure and associated factors in a North African adolescent population. a national cross-sectional study in Tunisia.

BACKGROUND: In southern and eastern Mediterranean countries, changes in lifestyle and the increasing prevalence of excess weight in childhood are risk factors for high blood pressure (BP) during adolescence and adulthood. The aim of this study was to evaluate the BP status of Tunisian adolescents and to identify associated factors. METHODS: A cross-sectional study in 2005, based on a national, stratified, random cluster sample of 1294 boys and 1576 girls aged 15-19 surveyed in home visits. The socio-economic and behavioral characteristics of the adolescents were recorded. Overweight/obesity were assessed by Body Mass Index (BMI) from measured height and weight (WHO, 2007), abdominal obesity by waist circumference (WC). BP was measured twice during the same visit. Elevated BP was systolic (SBP) or diastolic blood pressure (DBP) ≥ 90th of the international reference or ≥ 120/80 mm Hg for 15-17 y., and SBP/DBP ≥ 120/80 mm Hg for 18-19 y.; hypertension was SBP/DBP ≥ 95th for 15-17 y. and ≥ 140/90 mm Hg for 18-19 y. Adjusted associations were assessed by logistic regression. RESULTS: The prevalence of elevated BP was 35.1%[32.9-37.4]: higher among boys (46.1% vs. 33.3%; P < 0.0001); 4.7%[3.8-5.9] of adolescents had hypertension. Associations adjusted for all covariates showed independent relationships with BMI and WC: - obesity vs. no excess weight increased elevated BP (boys OR = 2.1[1.0-4.2], girls OR = 2.3[1.3-3.9]) and hypertension (boys OR = 3.5[1.4-8.9], girls OR = 5.4[2.2-13.4]), - abdominal obesity (WC) was also associated with elevated BP in both genders (for boys: 2nd vs. 1st tertile OR = 1.7[1.3-2.3], 3rd vs.1st tertile OR = 2.8[1.9-4.2]; for girls: 2nd vs. 1st tertile OR = 1.6[1.2-2.1], 3rd vs.1st tertile OR = 2.1[1.5-3.0]) but only among boys for hypertension. Associations with other covariates were weaker: for boys, hypertension increased somewhat with sedentary lifestyle, while elevated BP was slightly more prevalent among urban girls and those not attending school. CONCLUSION: Within the limits of BP measurement on one visit only, these results suggest that Tunisian adolescents of both genders are likely not spared from early elevated BP. Though further assessment is likely needed, the strong association with overweight/obesity observed suggests that interventions aimed at changing lifestyles to reduce this main risk factor may also be appropriate for the prevention of elevated BP.

[Medical demography in Tunisia: current situation and perspectives]. / Demographie medicale en Tunisie: etat actuel et perspectives.

BACKGROUND: Health human resources management is one of the important determinants of health care access equity. AIMS: To analyse the trend of Tunisian medical density during 2000-2009 and to predict its situation by 2024. METHODS: Current medical density was calculated using Bar Council of Physicians of Tunisia database. Medical density was calculated and analysed for the period 2000-2009 then modelled by 2024 (estimate of needs and supply). RESULTS: The active medical density raised by 36% during the period 2000-2009 with a higher increase for specialists. The proportion of non-active physicians rose from 4.6% to 15.2% in 2009. Increasing feminization of medical density and persistence of its regional disparities. By the year 2024, 217 physicians for 100,000 inhabitants would be required while the supply would correspond to 212/100 000 inhabitants. CONCLUSION: medical human resources have indeed globally improved. However, some lacks remain and adequate measures are required, based on a rational planning directed to satisfy the population needs and to allow health equity.

Nutrition transition among adolescents of a south-Mediterranean country: dietary patterns, association with socio-economic factors, overweight and blood pressure. A cross-sectional study in Tunisia.

BACKGROUND: The increase in the burden of chronic diseases linked to the nutrition transition and associated dietary and lifestyle changes is of growing concern in south and east Mediterranean countries and adolescents are at the forefront of these changes. This study assessed dietary intake and association with socio-economic factors and health outcomes among adolescents in Tunisia. METHODS: Cross-sectional survey (year 2005); 1019 subjects 15-19 y. from a clustered random sample. Dietary intake was assessed by a validated semi-quantitative frequency questionnaire (134 items) as was physical activity; the Diet Quality Index International measured diet quality; dietary patterns were derived by multiple correspondence analysis from intakes of 43 food groups. Body Mass Index (BMI) ≥ 85th and 95th percentile defined overweight and obesity. Waist Circumference (WC) assessed abdominal fat. High blood pressure was systolic (SBP) or diastolic blood pressure (DBP) ≥ 90th of the international reference for 15-17 y., and SBP/DBP ≥ 120/80 mm Hg for 18-19 y. RESULTS: Energy intake levels were quite high, especially for females. The macro-nutrient structure was close to recommendations but only 38% had a satisfactory diet quality. A main traditional to modern dietary gradient, linked to urbanisation and increased economic level, featured an increasing consumption of white bread, dairy products, sugars, added fats and fruits and decreasing consumption of oils, grains, legumes and vegetables; regarding nutrients this modern diet score featured a decreasing relationship with total fat and an increase of calcium intake, but with an increase of energy, sugars and saturated fat, while vitamin C, potassium and fibre decreased. Adjusted for age, energy and physical activity, this modern pattern was associated with increased overweight in males (2nd vs. 1st tertile: Prevalence Odds-Ratio (POR) = 4.0[1.7-9.3], 3rd vs. 1st: POR = 3.3[1.3-8.7]) and a higher WC. Adjusting also for BMI and WC, among females, it was associated with decreased prevalence of high blood pressure (2nd vs. 1st tertile: POR = 0.5[0.3-0.8], 3rd vs. 1st tertile: POR = 0.4[0.2-0.8]). CONCLUSION: The dietary intake contrasts among Tunisian adolescents, linked to socio-economic differentials are characteristic of a nutrition transition situation. The observed gradient of modernisation of dietary intake features associations with several nutrients involving a higher risk of chronic diseases but might have not only negative characteristics regarding health outcomes.

[Mortality from cancer in Tunisia: calculating years of life lost]. / Mortalité par cancer en Tunisie: calcul des années de vies perdues.

This work, conducted in Tunisia, aimed to calculate the number of years of life lost due to premature death caused by cancer. The data were based on mortality statistics (2006) provided by the national surveillance system of causes of death and involved calculations proposed by the World Health Organization. A total of 105,205 deaths due to cancer were recorded, 61,550 for males and 43,655 for females. The cancers were mostly of the lung and upper respiratory-digestive tract for men and breast and cervix for women. These results should prompt the health care system to emphasize tobacco control, the promotion of healthy eating and physical activity, as well as screening for breast and cervical cancer.

[Tobacco use among paramedical students in Tunis]. / Le tabagisme chez les étudiants paramédicaux de Tunis.

AIM: To assess smoking habits among Tunisian paramedical students, and their attitudes and knowledge about smoking. METHODS: During the first quarter of the school year 2002-2003 we investigate 1288 paramedical students of the College of Sciences and Techniques of the Health in Tunis. The smoker was the student who declare to smoke daily or by occasionally at the time of the survey. RESULTS: About three quarters of the students (77,2 %) were female and half of them was less than 20 years old. Smokers were those who smoked daily or occasionally. The prevalence of smoking was weak but it was 10 fold higher in male than in female (35,5% vs 3,5%) The rate of the ex-smokers was 4,1 %. Progress in studies does not affect smoking behaviour. The knowledge of tobacco induced diseases was generally good. However, there was substantial underestimation of tobacco contribution to causing bladder cancer, coronary artery disease and peripheral vascular disease. The study evidences insufficient awareness of medical students about their responsibilities for heath education and prevention. CONCLUSION: It is recommended to improve tobacco control educational programs at the paramedical students with elaboration of practical smoking cessation trainings.

[Vitamins A, E and leptin in obese and non-insulin-dependent diabetes]. / Statut en vitamines a, e et léptinémie chez un groupe d'obèses diabétiques non insulino-dépendant.

BACKGROUND: At the obese ones, there is an imbalance between the free defenses antioxydants and radicals from where the installation of an oxydative stress, responsible for the development of non-insulin-dependent diabetes. AIM: Our objectives was to evaluate the levels of vitamins A, E and of leptin, to search the link witch could exist between vitamins and leptin. METHODOLOGY: We proportioned the rates in vitamins A, E and in leptine at 30 obese subjects diabetic of type 2 including 12 men and 18 women of average age (50.93 +/- 6.13) years not carrying pathologies other than the diabetes and obesity compared to 30 witnesses who theirs are paired according to the age and the sex.. RESULTS: Our results chows that levels of antioxidants did not differ between the two groups but we find a non significant decrease in vitamin E/(TC +TG) ratio (1.86 +/- 0.38 vs. 2.11 +/- 0.74 ; p = 0.08) and significant increase of vitamin A level in women obese with non-insulin-diabetes mellitus compared with control group of women (0.69 +/- 0.16 vs. 0.55 +/- 0.15 ; p = 0.01). Moreover a negative and significative correlation between vitamin E and leptin (r = 0.452 ; p = 0.01), and a negative and no significative correlation between vitamin A and leptin (2 = - 0.221; p > 0.05) were observed. CONCLUSION: The rate of vitamin A, is different for each sex with share. The vitamin E could have a negative control on the secretion of the leptin.

[Estimated cost of managing invasive cervical cancer in Tunisia]. / Estimation du coût de la prise en charge du cancer invasif du col de l'utérus en Tunisie.

In Tunisia, cervical cancer incidence is about 4.8 per 100,000, but the diagnosis is often made too late, with 5-year survival rates of 35% or less. Given the budgetary constraints facing the health system, and taking into account the low incidence of cervical cancer in Tunisia, the comparative cost effectiveness analysis of screening programs must be strongly considered by policy and decision-makers. A retrospective study to estimate the average direct cost of managing cervical cancer during the first year after diagnosis was conducted among patients with cervical cancer diagnosed in 2003 at the Salah Azaiez Cancer Institute in Tunis. The study included 64 patients with cervical cancer. The direct medical cost is equal to the sum of the respective consumable costs related to hospitalization, ambulatory care, diagnostic tests, surgical procedures, chemotherapy and radiation. Regarding the in-patient hospital stay, the overall cost of a hospital day is a macro-cost including the accommodation expenses themselves, as well as staff costs and non-specific drugs. An extrapolation of the cost of care has been done at the national level; the method used consisted in multiplying the mean of the direct medical costs according to the FIGO stage by the number of incident cases at national level, for the corresponding stage. The distribution by FIGO stage was derived from the Cancer Registry of the northern region of the country. This extrapolation is an estimate, It assumes that the costs of care are similar in other health facilities, and secondly, it assumes that the distribution by FIGO stage according to that of the northern region's registrar is approximately the same at the national level. The results showed that the direct medical care cost of cervical cancer ranged from 777 to 7458 DT (431 to 4143 euro) with an average of 3180 +/- 1390 DT (1766 +/- 772 euro). The national cost was estimated at 877,680 DT (486,847 euro). Although, the cost of care for cervical cancer in Tunisia does not represent a considerable burden for health system, cervical cancer screening remains the best intervention to improve cancer survival rates.

Prevalence of obesity and overweight in Tunisia on 2001.

BACKGROUND: Obesity becomes a major problem in our country during the last decades. AIM: Evaluation of the prevalence of obesity and overweight in Tunisia. METHODS: Prospective epidemiological survey concerning a representative sample of Tunisian Population realised on 2001 by the Tunisian National Health Public Institut. Medical visit and anthropometric measurements were performed by medical investigators at subject's home. Statistical analysis using SAS program were performed. WHO body mass index criteria were used to define overweight and obesity. Population investigated included 8576 adults and adolescents 15 years or older, 4232 men and 4344 women. RESULTS: Prevalence of obesity is 12.2% (6.1% in men, 18.3% in women, p<0.001). Prevalences of obesity grade I, II, and III are respectively 8.7%, 2.9% and 0.7%. Prevalence of overweight is 21.8% (8.9% in men, 12.8% in women, p<0.001). Prevalences of obesity and overweight are respectively in rural districts 8.6% and 10.2%, in urban districts 14.8% and 23.6% (p<0.001). Tunisian eastern areas are more affected by obesity and overweight than western areas but there isn't a north-south gradient. CONCLUSION: Our study shows that prevalences of overweight and obesity in Tunisia became quite similar to the prevalence in European countries, but concerned especially women and eastern areas, more industrialised and more urbanised than the western ones. Preventive strategies should be rapidly implemented in Tunisia to stop the growing of this health public problem.

[Knowledge and attitudes of medical students at the end of their curriculum, towards breast and cervical cancer screening]. / Connaissances et attitudes des étudiants en fin d'études médicates vis-à-vis des dépistages des cancers du col utérin et du sein.

This study assesses knowledge and attitudes of medical students of the faculty of medicine of Tunis, at the end of their medical curriculum, towards breast and cervical cancer screening. Among the 644 medical students at the end of their curriculum, 592 answered to anonymous questionnaire (response rate = 92%). Results show that 34.1% have proposed systematic cervical cancer screening. This proportion was 61.0% for clinical breast cancer examination. The majority of students (70.2%) proposed to start this cervical screening since the first sexual activities. As for the periodicity of this screening, 44.2% are favourable for a yearly periodicity, 39.2% for every three years, 7.2% for every five years and 9.4% for a periodicity at least once in life. 94.1% of students declared to have learned clinical breast examination, contrarily to pap smear, for which this proportion was only 55.1%. Breast and cervical cancer control training, in the faculty of medicine of Tunis, is insufficient and should be improved and restructured.

[Cardiovascular disease surveillance in Tunisia]. / Surveillance des facteurs de risque des maladies cardiovasculaires en Tunisie: methodologie et principaux resultats.

OBJECTIVE: To assess the Cardiovascular risk factors trend in community based surveys. METHOD: Two population surveys were conducted in 1996-97 and 2000-01 in the Ariana region among 7608 adults 35-70 years aged. The surveys were based on: 1--a questionnary, 2--an anthropometrical and physical examination, 3--a biological investigation, and 4--an ECG registration for the second cohort. RESULTS: Relative to the first survey, the prevalence of hypertension, diabetes, hypercholesterolemia didn't change significantly while borderline cholesterol increased on both genders, tobacco smoking decreased and ex-smokers increased on men. In both genders, hypertension and diabetes prevalence is low before 50 years but it increased after this age. Risk factors association is common: about 35% have more than two risk factors. This association is more common on women and diabetes-hypertension is the most frequent. CONCLUSION: These two surveys integrated in a global surveillance program has contributed to assess the CVDs burden and to identify priorities and intervention relevant to epidemiological region context.

[Population surveillance of coronary heart disease]. / Prévalence des cardiopathies ischémiques: resultats d'un depistage en population.

OBJECTIVE: A cross-sectional population survey was carried out in the Ariana region in 2000-01. The aim of this study is to report the prevalence of CHD as indicated by ECG Minnesota coding. METHOD: A randomly selected sample included 1837 adults 40-70 years. Data on socio-economic status, demographic, medical history, health behaviour, clinical and biological investigations were recorded. Risk factors (hypertension, dyslipedemia, obesity, diabetes) are defined according to WHO criterias. Standard supine 12 lead ECGs were recorded. All ECGs are red and classified according to the Minnesota codes criteria on CHD probable, CHD possible and on Major abnormalities and minor abnormalities. RESULTS: CHD prevalence was higher on women. Major abnormalities are more common on women (20.6% vs 13%), while minor abnormalities prevalence was higher on men (15.5% vs 7.5%) (p<0.0001). The prevalence increased with age in both genders. CONCLUSION: This study tested how feasible is the population approach on CVDs surveillance. It highlighted the burden of cardiovascular diseases and support that women are at risk as men are. The value of ECG findings must be integrated in the cardiovascular diseases surveillance to identify high risk population.

[Hypertension prevalence, awareness, treatment and control: results from a community based survey]. / Prevalence, connaissance, traitement et controle de l'hypertension arterielle: resultats d'une enquete populationnelle.

The study objective was to assess the prevalence, level of awareness of treatment, and control of hypertension in a general population. We conducted a cross-sectional survey on 1837 adults 40-69 years old. Hypertension and control level are defined according to the WHO/ISH recommendations. HBP is defined as SBP > or = 140 and or DBP > or = 90 mm Hg and the use of blood pressure-lowering medication. Hypertension is controlled by medication if SBP < 140 and DBP < 90 mm Hg. We conduct analysis by socio demographic variable, medical history and CHDs risk factors. 44.3% of adults was hypertensive. The prevalence of hypertension was higher among women (48.2% versus 38.7% on men) and it increases in both genders with age, body mass index. Only 41% of the hypertensive were aware of having hypertension, among them, 74.1% declare that they are treated but only 13.2% were controlled. The study highlights the problem of the hypertension in a developing country. It contributes to identify the huge iceberg of this CVDs risk factor. The national strategy must focus on the population life style and drugs management. The question is how much will be the cost of HBP and CVDs control for a country which has a limited resources.

[Delays in acute myocardial infarction treatment: results of a multicenter study in the district of Tunis (Tunisia)]. / Delai de prise en charge et acces aux soins de l'infarctus du myocarde dans les structures hospitalieres. Résultats d'une étude multicentrique.

OBJECTIVE: We aimed to assess the acute myocardial infarction management in Tunis public hospitals during one year (from March 2000 to February 2001). METHOD: A standard questionnaire was designed to record prospective data on 740 patients with a follow up during 28 days. Multivariate analysis was performed using the logistic regression model with all-factors as well as age, gender, CHD risk factors as predictors of the delay and fatality. 54% of patients were admitted during the first 6 hours after the onset of symptoms. In multivariate analysis, the delay of consultation is significantly correlated with gender (OR = 2.3, p < 0.001), age (OR = 1.02, p < 0.01) and health insurance (OR = 1.5, p < 0.01). 90% of patients consulted in emergency wards. The emergency ambulance transported 19.6% of patients. 48% of patients underwent early revascularisation of thrombolysis, 51% on men vs 31% on women (p < 0.01). The fatality rate was higher on women 14% vs 6.4% on men (p < 0.01) at 5 days and 27.2% vs 13.6% at 28 days. In multivariate analysis, the principal fatality predictive factor was age (RR = 1.08, p < 0.001) and delay (2.56 p < 0.001) and tobacco smoking (RR = 2.83, p < 0.0001). CONCLUSION: This study highlighted the problem of acute myocardial infarction management in public hospitals in Tunisia and it constitutes a baseline to assess different interventions focusing on cardiovascular diseases control and surveillance.

[Management of arterial hypertension: results of a Tunisian general practitioner survey]. / Prise en charge de l'hypertension artérielle: résultats d'une enquête tunisienne aupres des medecins generalistes.

The control of arterial hypertension (HT) is an endlessly hoped objective but usually not reached. Several factors are determinants. The physician role is crucial in the HT prevention. In order to evaluate knowledge, attitudes and behaviours of Tunisian physicians in HT management, we conducted a cross sectional study in 2002 using a self administered questionnaire addressed to physicians working in private and public sectors. 380 generalists participated to this study. 95.5% of them confirmed that HT constitutes a public health problem. 81.1% saw at least 4 patients with HT a week. 95% insisted on the importance of the primary prevention. 90% took care themselves patients. 71.5% confirmed the importance of a training and an entrainement for the measure of the blood pressure (BP). 3.7% made diagnosis after a single visit and 10.9% confirmed it only from described symptoms. 20.4% of the generalists chose the old classification as objective level of BP. Thiazidic Diuretics and beta blockers were most prescribed medicines in first intention. 9.4% stopped the treatment after stabilization of blood pressure. 60% of generalists had inadequate behaviour facing a not stabilized BP. Non observance of treatment by patients was indicated by 31% of the generalists, cost and break of the medicines' stock and disappearance of symptoms were the main causes advanced by the generalists. This study shows the existence of gaps in generalists' practical behaviour treating this disease. Measures aiming the medical practice improvement turn out necessary in particular the sensitization of the generalists by an adequate university training and a continuous medical training, and a regular evaluation of the national program of hypertension prevention and management.

[The cost of acute myocardial infarction management: the Tunisian experience]. / Cout direct medical de la prise en charge de l'infarctus du myocarde en phase aigue.

OBJECTIVE: To assess the medical direct cost of acute myocardial infarction. METHOD: Data are recorded through a prospective study in 7 wards of cardiology of the District of Tunis during one year: from November 2001 to October 2002. Cost of hospital stay, biologic analyses, drugs, functional investigations and possible non surgical cardiologic intervention (IC) was calculated. RESULTS: 632 AMI cases are recorded, the death rate is 7.8%. The average of hospital stay was 13.3 days. 49.1% of patients benefited from thrombolytic therapy, 55.5% benefited from a coronary angiography and 16.1% of an act of IC. The mean of direct cost (CGM) was 2171 Tunisian Dinars and the median was 1731 DT, of whom room costs 31.7%, 22.5% acts of IC, 7.2% drugs, 26.2% functional investigations and 12.4% biological analyses. The mean cost of IC was 3030 +/- 401 DT. CONCLUSION: The methodology of our study remains original in our country and can be used to assess the other aspects of AMI as other diseases cost management.

[Attitude to cervical cancer screening of women residing in two regions of northern Tunisia]. / Recours au depistage du cancer du col utérin chez des femmes residant dans deux regions du Nord de la Tunisie.

The objective of this survey to describe knowledge, attitudes and behaviours of women residing in two regions of the North of Tunisia, towards cervical cancer screening methods. 936 women residing to the Ariana (urbanized region) and 993 women residing to Zaghouan (region to farming predominance) were included; they were chosen according to the method of quotas while taking like criteria's, the of area residence (urban or rural), age and the level of education. Every woman should have answered to a questionnaire. Data collected were related to women perception of the severity of the cervical cancer, of their vulnerability for this cancer, of screening efficiency and the recourse of women to this service. The recourse to the cervical cancer screening was significantly more frequent in Ariana (24,6% vs. 13,8% p <0,001); the half of women is optimistic towards the therapeutic progress recorded in Tunisia in the domain of cancer. A better organization of cervical cancer screening including the individual invitations of women and a better sensitization and implication of physicians of the first line in the two sectors public and private, are indispensable to improve the frequency of recourse to cervical cancer screening.