Cigarette use and exposure to second-hand smoke and tobacco advertising among Tunisian adolescents.

Background: The Global Youth Tobacco Survey was conducted in Tunisia in 2001, 2007, 2010 and 2017. It is the only national survey that examined exposure to second-hand smoke and tobacco advertising among young people, and there has been no description of the trend. Aims: To describe cigarette use trends among Tunisian adolescents and their exposure to second-hand smoke and tobacco advertising from 2001 to 2017. Methods: The Global Youth Tobacco Survey is a school-based cross-sectional survey conducted by the World Health Organization. It uses a two-stage cluster sampling design to obtain a representative sample of students aged 13-15 years. A standardized questionnaire is used for data collection. We compared the prevalence and 95% confidence intervals (CI) of ever and current cigarette use, exposure to second-hand smoke in and outside the home, and exposure to tobacco advertising, over 4 years (2001, 2007, 2010 and 2017). Results: Current cigarette use decreased from 11.1% (95% CI: 10.0-12.3%) in 2001 to 7.7% (95% CI: 6.5-9.0%) in 2017 (P < 0.001). Exposure to second-hand smoke at home decreased from 62.5% (95% CI: 60.7-64.2%) to 46.7% (95% CI: 44.5-49.0%) over the same period (P < 0.001), but exposure outside the home increased from 65.4% (95% CI: 63.7-67.1%) in 2001 to 73.3% (95% CI: 71.2-75.3%) in 2017 (P < 0.001). Exposure to anti-tobacco messages in the media decreased from 87.8% (95% CI: 86.3-89.1%) in 2001 to 64.4% (95% CI: 62.2-66.5%) in 2017 (P < 0.001). Conclusion: While the prevalence of cigarette use and second-hand smoke exposure at home decreased, exposure outside the home increased. Efforts are needed to ensure compliance with smoke-free laws to decrease the prevalence of exposure to second-hand smoke.

A sero-epidemiological investigation of West Nile virus among patients without any records of their symptoms from three different hospitals from Tunisia.

West Nile virus is one of the most known arboviruses around the world, along with Dengue virus, Toscana virus, Chikungunya (CHIK). In Tunisia, many epidemics of WNV had occurred in the past. The last one dated from 2018. The aim of our work was to perform a sero-epidemiological investigation on WNV without any records of their symptoms from three different hospitals from Tunisia. Patients without any records of their symptoms of the infection of West Nile Virus (WNV) infection were included in the period from October 2017 to January 2020 from three different Virology departments in the country (the Military Hospital in Tunis, Fattouma Bourguiba Hospital in Monastir and Sahloul Hospital in Sousse). A venous blood sample was taken from all patients at the bend of the elbow using a sterile syringe under aseptic conditions. Serological investigation for WNV was conducted through ELISA and IFI assays. RT-PCR was used to confirm the infection. The study included 353 patients. Twenty-eighty percent (28.8%) of the population were tested positive for IgM antibodies, males were having less positive antibodies than women (24.6% vs. 36.3%, p<0.05). In the city of Sousse, positive IgM were found more than in the other cities. As for IgG, 19.2% of the patients were having positive antibodies. No significant association was found between genders (p>0.05). One quarter of the IgM antibodies were tested positive using IFI technique, with no difference between genders (p>0.05). Only 9.2% of the samples were positive by PCR. Our results highlight the importance of establishing sustainable entomological systems and effective clinical ones and of promoting appropriate biological control strategies to optimize the limitation of the circulation of WNV as well as other arboviruses to inhibit their harmful effects on health.

Determinants of Health Inequalities in Iran and Saudi Arabia: A Systematic Review of the Sleep Literature.

Sleep health inequalities represent an increasing public health concern. Among multiple determinants affecting sleep health, there is people's socioeconomic status (SES), and no systematic review on the relationship between SES and sleep health has been previously conducted in Iran and Saudi Arabia. Following the Prisma protocol, ten articles were selected. Findings revealed that the combined number of participants was N = 37,455 participants, including 73.23% of children and adolescents (n = 27,670) and 26.77% of adults (n = 10,026). The smallest sample was N = 715 and the larger was N = 13,486. In all these studies, sleep variables were assessed using self-reported questionnaires. The studies conducted in Iran assessed the risk of obstructive sleep apnea (OSA), while those in Saudi Arabia were interested in sleep duration, nap time, bedtime, rise time and insomnia. The studies performed on adult populations in Iran and Saudi Arabia concluded that there is no significant association between SES determinants and sleep components in adult populations. One study in Iran found a significant association between parent's low SES and children and adolescent insomnia; and one study in Saudi Arabia found a significant association between the father's education and the longer sleep duration of their children. More longitudinal studies are necessary to establish a causal relationship between public health policies and sleep health inequalities. An extension of the investigation to more sleep disturbances is required to cover the entirety of sleep health inequalities in Iran and Saudi Arabia.

Linking Global Youth Tobacco Survey (GYTS) data to the WHO Framework Convention on Tobacco Control (FCTC): The case for Tunisia.

INTRODUCTION: The World Health Organization (WHO) had launched the Framework convention on Tobacco Control (FCTC) in 2003 in order to curve the epidemic of tobacco use worldwide. Since most smokers begin to smoke before the age of 18 years, Global Youth Tobacco Survey (GYTS) has been developed in order to monitor tobacco smoking among adolescents. Our aim was to assess smoking among Tunisian youth using GYTS 2017 data. METHODS: GYTS is cross-sectional, two cluster school-based survey to produce a representative sample of students aged 13-15 years. It was conducted in 2017 in 67 secondary schools in Tunisia. The investigation tool was an anonymously answered questionnaire, which contained core questions about six majors tobacco related topics. RESULTS: Lifetime cigarettes and waterpipe prevalence were 7.8% (14.4% of boys, 1.6% of girls, p<0.001) and 7.2% (13% of boys, 2.8% of girls, p<0.001), respectively. Among cigarette smokers, 62.5% were able to buy their own cigarettes. Overall, 23.5% of cigarette smokers and 41.5% of waterpipe smokers were not able to buy their products because of their age. Sixty percent of smokers wanted to quit and 56.4% had already tried to stop. Half of the respondents were exposed to SHS in their homes and 62.1% in indoor public places. CONCLUSIONS: In Tunisia, tobacco prevalence among youth is high. Youth have free access to tobacco products and smoke-free regulations are only partially respected.

Characteristics and prognostic factors of COVID-19 among infected cases: a nationwide Tunisian analysis.

BACKGROUND: The outbreak of coronavirus disease (COVID-19) continues to constitute an international public health concern. Few data are available on the duration and prognostic factors of the disease. We aimed to study the recovery time among a Tunisian cohort of COVID-19 confirmed patients and identify the prognostic factors. METHODS: A retrospective, nationwide study was conducted from March 2 to May 8, 2020, recruiting all patients who were diagnosed with COVID-19, by RT-PCR methods, in Tunisia. Data were collected via phone call interview. Kaplan-Meir Methods and Cox proportional hazards regression models were, respectively, used to study the recovery time and estimate its prognostic factors. RESULTS: One thousand and thirty patients with COVID-19 (aged 43.2 ± 18.2 years, 526 female (51.1%)) were enrolled. Among them 141 (14.8%) were healthcare professionals. Out of 173 patients (17.8%) admitted to the hospital, 47 were admitted in an intensive care unit. Among 827 patients who didn't require specialized care, 55.5% were self-isolated at home, while the rest were in specialized centers. Six hundred and two patients were symptomatic. A total of 634 (61.6%) patients have recovered and 45 (4.4%) patients died. The median duration of illness was estimated to be 31 days (95% CI: [29-32]). Older age (HR = 0.66, CI:[0.46-0.96], P = 0.031) and symptoms (HR = 0.61, CI:[0.43-0.81], P = 0.021) were independently associated with a delay in recovery time. Being a healthcare professional (HR = 1.52, CI: [1.10-2.08], P = 0.011) and patients in home isolation compared to isolation centers (HR = 2.99, CI: [1.85-4.83], P < 10¯3) were independently associated with faster recovery time. CONCLUSION: The duration of illness was estimated to be 1 month. However, this long estimated duration of illness may not equate to infectiousness. A particular attention must to be paid to elderly and symptomatic patients with closer monitoring.

Burden of Healthcare-associated infections in a Tunisian University Hospital in 2019.

BACKGROUND: Healthcare-associated infections (HAI) represent a real threat to patient safety and their prevention should be a priority for any Health system. Prevalence surveys constitute one of the most common methods of HAI epidemiological surveillance to determine the burden of this problem. AIM: The aim of this study is to determine the prevalence of HAI and its associated risk factors. METHODS: It is a cross-sectional survey, carried out at Farhat Hached University Hospital in 2019, over a period of nine days including all patients who had been hospitalized for at least 48 hours, in 21 clinical departments of our hospital. A single passage has been carried out by department. RESULTS: Of 373 patients included, a total of 66 patients experienced HAI, with a mean prevalence of 17.7%. In addition, four patients suffered from two types of HAIs. The overall prevalence of HAI in Farhat Hached University Hospital was 19%. Peripheral venous catheter associated infection (41.5%) was the most common type of infections recorded in this survey. Patients admitted to a surgical ward were 4.6 times more likely to acquire HAIs. Patients admitted for more than 7 days were 4.57 times more at risk of developing HAIs. Exposure to peripheral venous catheter, to central venous catheter and to mechanical ventilation were among significant risk factors responsible for HAI with adjusted OR of 4.90, 10.65 and11.99, respectively. CONCLUSION: Prevalence of HAI is high at our center. National strategy to address HAI should be implemented for better control of HAIs.

Estimating transmission dynamics and serial interval of the first wave of COVID-19 infections under different control measures: a statistical analysis in Tunisia from February 29 to May 5, 2020.

BACKGROUND: Describing transmission dynamics of the outbreak and impact of intervention measures are critical to planning responses to future outbreaks and providing timely information to guide policy makers decision. We estimate serial interval (SI) and temporal reproduction number (Rt) of SARS-CoV-2 in Tunisia. METHODS: We collected data of investigations and contact tracing between March 1, 2020 and May 5, 2020 as well as illness onset data during the period February 29-May 5, 2020 from National Observatory of New and Emerging Diseases of Tunisia. Maximum likelihood (ML) approach is used to estimate dynamics of Rt. RESULTS: Four hundred ninety-one of infector-infectee pairs were involved, with 14.46% reported pre-symptomatic transmission. SI follows Gamma distribution with mean 5.30 days [95% Confidence Interval (CI) 4.66-5.95] and standard deviation 0.26 [95% CI 0.23-0.30]. Also, we estimated large changes in Rt in response to the combined lockdown interventions. The Rt moves from 3.18 [95% Credible Interval (CrI) 2.73-3.69] to 1.77 [95% CrI 1.49-2.08] with curfew prevention measure, and under the epidemic threshold (0.89 [95% CrI 0.84-0.94]) by national lockdown measure. CONCLUSIONS: Overall, our findings highlight contribution of interventions to interrupt transmission of SARS-CoV-2 in Tunisia.