Preparations for sustainability and transition from Global Fund support in the Eastern Mediterranean Region.

Background: HIV, tuberculosis and malaria (HTM) services receive financial support from the Global Fund and need to plan for sustainability and transition from external funding. Aim: To recommend actions for addressing key sustainability and transition issues in 15 countries receiving Global Fund grants in the WHO Eastern Mediterranean (EMR) Region. Methods: We reviewed documents, interviewed key informants, and conducted case studies in Sudan and Tunisia to highlight key considerations for sustainability and transition from Global Fund that is tailored to the EMR and the health system building blocks. Sustainability considerations should align with the health system building blocks, including governance, financing, service delivery, workforce and health product management, with the addition of considerations for key and vulnerable populations because of their particular importance for HIV and tuberculosis services. Conclusion: While hoping for economic growth and reduction of the burden of HTM, EMR countries need to prepare for transition from Global Fund support. Proactive steps that are tailored to the health system building blocks and address the needs of key and vulnerable populations should progressively increase national capabilities as well as resources dedicated to HTM.

[Epidemiology of domestic accidents of young children in Tunisia: impact of the training of health professionals on data collection quality]. / Epidémiologie des accidents domestiques du jeune enfant à Tunis : Impact de la formation des professionnels de santé sur la qualité de la collecte d'informations.

BACKGROUND: In Tunisia, several studies on domestic injuries have been carried out on children attending care facilities. Nevertheless,there is a lack of data on incidence and kinds of child domestic injuries amongst general population because of absence of a reliable data collect system. AIM: To estimate the incidence and kinds of domestic injuries through a prospective survey "here-there" within two cohorts of young children attending two mother and child protection centers (MCPC) in Tunis during the three first years of their life and to analyze the importance of health professional training in improving data collect. METHODS: A prospective study "here-there" was carried out on two cohorts of children in two mother and child protection centers (MCPC) between January 2007 and December 2009. Only children aged less than 3 months at their first contact with the centers were included and followed up until age of 3 years. In the MCPC2 (cohort2), health personnel have been trained on data collection importance related to child domestic accident and asked to monitor accidents by calling parents while a phone line got available for this aim. In the MCPC1, health personnel was asked to work as they used to do and to collect data on child domestic injuries when children attend the center. RESULTS: 192/435 domestic accidents were recorded within cohort 2 vs only 1/686 within cohort 1. Annual incidence rate was 14.7% for the cohort 2. The kinds of accidents were: falls 78.2% (falls from high plans 84.6%), injuries15.1% (injury by cutting things 58.6%),burns 5.7% (burns by hot liquid 54.5%), intoxications 1%. In terms of damages, we recorded 4 cases of broken bones (thighbone, elbow,handwrist), stitches in 11 cases, broken teeth in 3 cases and nail pulled out in one case. No death was recorded. Training impact on accident prevention was not studied. CONCLUSION: Child domestic accidents are relatively frequent. Health personnel training allows to improve data. The kinds of recorded accidents indicate the need to educate parents on best practices towards strengthening prevention.

Determinants of neonatal mortality in a Tunisian population.

BACKGROUND: In Tunisia, perinatal mortality remains a public health problem, currently estimated at 28 per thousand, including 15 per thousand of still birth rate and 10 to 15 per thousand of early neonatal mortality rate. The recent investigations show that about half of the deaths at less than five-years-old are of perinatal origin and that neonatal mortality represents two thirds of infant mortality. Published data regarding neonatal mortality and the causes of death are sparse. THE AIM: to evaluate the neonatal mortality rate over a 2 year period in our population study and to present data collected prospectively on the risk factors and the causes of all neonatal deaths. METHODS: A prospective cohort compiling all live births reported between January 2007 and December 2008 at Charles Nicolle hospital (Tunis-Tunisia). All the neonatal deaths that occurred before or after discharge or transferred to other hospitals and subsequently died are included. Births from termination of pregnancy were excluded from all the analyses. Causes of deaths were assigned according the International Classification of Diseases, Tenth Revision (ICD10). RESULTS: 88 neonatal deaths were recorded over 7285 live births (LB) that is a NMR of 12 per thousand LB. Early neonatal death occurred in 79 cases (88.7%), that is an ENMR of 10.8 per thousand LB. Risk factors directly related to neonatal mortality were prematurity (aOR=6.03- 95%CI: [2-18.13] p=0.001), neonatal respiratory distress (aOR=16.12 - 95%CI: [5.67-45.78] p<10(-3)), perinatal asphyxia (aOR=11.49 - 95%CI: [3.68-35.92] p<10(-3)), nosocomial infection aOR=8.71- 95%CI: [1.77-42.70] p=0.008, and small for gestational age aOR=7.11 - 95%CI: [2.23-22.69] p=0.001. 80.6% of underlying causes and 88.6% of immediate causes of death are gathered in the chapter "Certain conditions originating in the perinatal period". Maternal hypertensive disorders and extreme immaturity due to spontaneous prematurity were respectively responsible for 13.6% and 10.2% of underlying causes of neonatal death. CONCLUSION: Neonatal mortality remains high, dominated by the conditions originating in the perinatal period. The multitude of the risk factors implies the need for a multidisciplinary strategy of intervention, engaging the pre and perinatal prevention.

[Bacterial infections in AIDS (mycobacterial infections excluded): study of 100 cases]. / Infections bactériennes au cours du SIDA (mycobactérioses exclues): étude de 106 cas.

We report a retrospective study of 106 patients with bacterial infections from 322 patients infected with the human immunodeficiency virus (HIV) resulting in 33 percent. Epidemiological profile of bacterial infection in HIV patient is the same that observed in tunisian patient with HIV: a young male infected mainly by sexual route. Bacterial infection is located in the lungs in 38.3 percent, in the skin in 16.5 percent, in upper respiratory tract and oral in 12.7 percent, sexually transmitted disease and bacteremia are respectively found in 12 percent, bacterial genito-urinary tract infection in 5.3 percent, bacterial gastro-intestinal tact infection in 2.3 percent and meningitis in 0.8 percent. Bacterial infections occur at all stages in patients with HIV, but mainly in 77.7 percent at AIDS stage. Regardless the infectious site, granulocytes number is normal in 66 percent of cases. Bacterial investigation find a bacterial specie in 14.3 percent and a bacterial positive serology in 11.2 percent. Mortality caused by bacterial infection is found in 11.3 percent.

[AIDS in Tunisian women. Study of 92 cases]. / Le sida chez la femme tunisienne. Etude de 92 cas.

The authors report a retrospective study about 92 cases of HIV-1 infections among adult tunisian women hospitalised or consulting in the department of infectious diseases at Rabta hospital over a period of 15 years and 6 months. The middle age is 33.2 years. 64.1% of patients are married, and the conjoint is HIV-1 positive in 84.1% of cases. The route of transmission is sexual in 75%, parenteral in 22.8% and unknown in 2.2%. According to CD4 level and clinical symptoms, patients are at AIDS stage in 75.5%. The main clinical symptoms are: oral candidiasis in 92.4%, diarrhea in 54.3%, pneumocystis carinii pneumoniae in 11.9%, cerebral toxoplasmosis in 10.9%, septicemia caused particularly by salmonella in 9.7%, tuberculosis in 6.7%, cryptococcal meningitis in 4.3% an Kaposi's sarcoma in 3.2%. Mother to child HIV transmission is found in 33.3%, and the mortality is noted in 43.5% of cases.