Professor Mohamed Soussi Soltani: Leader, Innovator and Researcher in Public Health.

Mohamed Soussi SOLTANI (June 27, 1953 - March 2, 2016) is Professor of Preventive and Community Medicine at the Faculty of Medicine of Monastir (Tunisia). The objective of this paper is to present, to new generations of the specialty in the Greater Maghreb, this leading teacher from the Center-East of Tunisia (Monastir), through the testimonies of his companions, and his indexed publications. All the colleagues of the late SOLTANI testified to his high human and professional qualities, particularly perseverance, commitment, forward thinking, integrity and professionalism. The scientific life of the late Professor Soltani was oriented towards two major themes: Public Health and Family Medicine. Indeed, the deceased has developed several new preventive activities in first-line structures such as anonymous and free HIV screening, family planning, rational use of drugs, breast cancer screening, smoking cessation, prevention of rheumatic heart disease. Pr SOLTANI welcomed general practitioners from the Monastir region to the Faculty's Community Medicine Department, creating with them a movement to advocate for the academic and professional development of general medicine into an authentic specialty of family medicine. Out of the 34 publications of Professor SOLTANI, indexed on PubMed, 11 were signed by himself in first position, mainly relating to maternal health (prenatal surveillance, education for maternal health, pregnancy referral system) and infant (low birth weight, vaccination, mother-to-child transmission of hepatitis B, meningitis due to Haemophilus influenzae). Thus, with a life prospering by innovations and research in public health, Professor SOLTANI will always remain a model for young people in the specialty of Preventive and Community Medicine. His followers have an obligation to write his complete biography, to safeguard it and pass it on to new generations of public health.

[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.

[Opinion of the Population of Tunis about the physician social image]. / La Place du médecin dans la société selon la perception de la population résidant dans le gouvernorat de Tunis.

BACKGROUND: The image of the Tunisian doctor seems to have lost some of its aura and social value. AIM: To evaluate the medical profession's social image and to identify the reasons of a possible dissatisfaction by interviewing a sample of 200 adults in the District of Tunis. METHODS: Population was selected according to the method of quotas depending of sex, age and instruction degree. One hundred and ninety nine persons aged 20 years and above were included. Collection of data was made by an interview and included 4 items: identification of respondent, expected qualities of medical doctor, satisfaction level regarding health services, comparison between general medicine and specialists. Chi-2 test was done for comparison of proportions. In order to classify professions according to income and prestige a score was calculated. It ranged from 10% (10th rank) to 100% (1st rank). RESULTS: Patience and availability were quoted as particularly essential requirements in a doctor. Yet only 35.7% of the interviewees reported being satisfied by their doctor's qualities. A general dissatisfaction regarding health services was also noted. Our sample's perception of professional prestige rated industrials over doctors by placing them in first position. With regards to the perception of best-paid jobs, doctors were classed third after industrials and important traders. CONCLUSION: In order to counter these deficiencies and to preserve doctors' social image and their place in society, it is imperative to change our understanding of their training and recycling and also to improve their purchasing power as it is the unquestionable guarantee of the preservation and durability of their public image.

[Analysis of antibiotics as a curative measure in four hospital units]. / Analyse de la prescription antibiotique a visee curative en milieu chirurgical et en reanimation.

In order to analyse the methods of curative prescription of antibiotics in four units of hospitalization of the hospital Charles Nicolle of Tunis, a descriptive study of prescriptions was carried out during the first five months of year 2001. On the whole, 165 prescriptions delivered to patients were included in the study. The average age of the patients was 44 years, the sex ratio of 1.45 and the average duration of 15.1 days. Approximately two thirds of the initially probabilist prescriptions were not documented secondarily. Those secondarily documented (n = 51) were essentially related to nosocomial pneumonias and septicaemias (29 and 10 prescriptions). The two germs most frequently isolated during nosocomial pneumonias were Acinetobacter baumannii and, Pseudomonas aeruginosa (17 and 8 strains). Only imipenem, netilmicin and colistin remain active on A. baumannii. The bitherapy was the most used treatment (87.5%). It was generally an association beta-lactamin-aminosid (52.9%). The average cost of a documented prescription varied from 943,6 to 1184,9 TD (Tunisian Dinars) according as the prescription were secondarily documented or not.

[Epidemiological transition and health impact of cardiovascular disease in Tunisia]. / La transition epidémiologique ses determinants et son impact sur les systemes de sante a travers l'analyse de la tendance des maladies cardiovasculaires en Tunisie.

OBJECTIVE: We aim at analysing the increase of CVDs in the Tunisian hospitals in order to assess the burden of NCDs in the transitional context. METHODS: Data are recorded through the Tunisian National Morbidity and Mortality Survey (TNMMS). In order to assess the CVDs (CHDs vs RHDs) trend, two representative samples of Cardiology Departements patients were compared one is selected from the TNMMS and the second from the hospitalisations recorded in 1992. Causes, stay duration, status at the end of the hospitalisation, transfer to another hospital and patients socio-demographic characteristics are recorded and compared for the two periods. All the diagnosis are coded referring to the DMC 10. To analyze the determinant of the epidemiological transition, we have elaborated the CVD causal pattern and we have documented all their determinants. RESULTS: CHD rate has dramatically increased, while RHD has decreased especially on men. In 1992, 39.2% of men and 11.8% of women were admitted for CHD. In 2002, these rate are respectivly 58.8% and 38.2% while RHD rates were, in 1992, 11.8% on men and 25.3% on women vs 4.4% and 11.7% respectively. CONCLUSION: This study has confirmed that so far controlling transmitted diseases seems to be successful, Tunisian people are about to face a new problems as hypertension, obesity, diabetes and tobacco smoking. The new challenge with the burden of diseases requires the implementation of a national strategy relevant to the epidemiological, social and economical transition. Population needs and cost effectiveness of interventions assessment is crucial to set the national priorities.

[Assessment of cancer incidence in Tunisia 1993-1997]. / Estimation a l'echelle nationale de l'incidence des cancers en Tunisie 1993-1997.

The objective of this study is to estimate in Tunisia on a national scale the incidence of the main cancerous localizations for the period 1993-1997 while taking results of registers of the cancer of the region of the North, Sousse and Sfax as a basis. After having verified the relation of exponential type between the incidence of cancers and the life expectancy at the birth (Evo) in a certain number of country we extrapolated levels of governorates incidence included in registers of the North, Sousse and Sfax to the other governorates while taking the similarity of the Evo level as a basis. The incidence rate of in all localizations are 100.11/100.000 for male and 86.4/100.000 for female. The main cancerous localizations for male are the lung (20.8/100.000) the bladder (10.7/100.000), the cutaneous cancers (7.2/100.000) and the prostate (6.1/100.000). For female the main localization are the breast (19.7/100.000), skin (5.8/100.000) and the cervix uteri (4.8,100.000). These results illustrate the interest of tobacco control, screening of the breast cancer of and cervix uteri cancer, as components fundamental of the cancer control.

Tobacco use in Tunisia: behaviour and awareness.

OBJECTIVE: To assess tobacco use and the awareness of and attitudes towards tobacco and its control in the adult population of Tunisia. METHODS: A cross-sectional study was conducted in 1996 of a representative national sample of 5696 subjects aged 25 and over. Data were collected by means of a questionnaire in Arabic. FINDINGS: Tobacco use was reported by 30.4% of the respondents, of whom 24.6% smoked cigarettes and 5.8% consumed traditional tobacco, i.e. snuff, chewing tobacco and/or water pipe tobacco. Whereas 55.6% of men used tobacco, only 5.2% of women did so. Among men the proportion of tobacco users diminished with age as the rate of cessation increased. Among women, smoking peaked in the 35-54 age group. The proportion of men consuming traditional tobacco alone increased from 2.4% in the 25-34 age group to 20.4% in the 55+ age group; the corresponding values for women were 0.1% and 14.3%. Tobacco use was more widespread in rural than in urban areas and was relatively high among poorly educated men from economically deprived backgrounds. The use of tobacco was believed to be harmful to health by 98.6% of the respondents. Over 90% of the interviewees were aware that tobacco played a part in the development of heart disease. However, there were some gaps in awareness. A fear of cancer was expressed by 85% of the respondents, whereas only 5.6% were fearful of accidents. CONCLUSIONS: Informational and educational campaigns relating to tobacco control should be directed at individuals and communities, taking into account the gaps in awareness of the effects of tobacco on health.