[Seroprevalence and risk factors of hepatitis E among pregnant women in central Tunisia]. / Séroprévalence et facteurs de risque de l'hépatite virale E chez la femme enceinte dans le centre tunisien.

OBJECTIVES: The study was conducted to investigate the prevalence and risk factors for hepatitis E virus (HEV) infection in Tunisian pregnant women. METHODS: A total of 404 pregnant women were enrolled. Data were collected through a standard questionnaire which covered sociodemographic characteristics and risk factors. Blood samples were collected and were tested for HEV IgM and IgG antibodies, IgG against hepatitis A (anti-HAV IgG), hepatitis B virus surface antigen (HBsAg) and hepatitis C virus antibody (anti-HCV). Risk factors were analyzed using univariate and multivariate logistic regression models. RESULTS: Prevalence of anti-HEV IgG, anti-HEV IgM, anti-HAV IgG, HBs Ag and anti-HCV was 12.1 %, 0 %, 97 %, 3 % and 0,5 %, respectively. In multivariate analysis age (>30 years) and the number of persons per room (>2) in the house were independent factors predicting HEV infection. History of agricultural work, kind of water, sewage treatment, use detergent to wash vegetables, contact with animals and parenteral risk factors were not correlated with the presence of anti-HEV IgG. CONCLUSION: The important seropositive rate among pregnant women is compatible with endemicity of HEV in Tunisia. Hepatitis E should be considered in the diagnosis of acute hepatitis during pregnancy. Our result suggests that infection occurs sporadically by person-to-person transmission route but further investigations are needed to determine the natural reservoir of infection.

[Seroprevalence of rubella virus, varicella zoster virus, cytomegalovirus and parvovirus B19 among pregnant women in the Sousse region, Tunisia]. / Séroépidémiologie de la rubéole, de la varicelle et des infections par le cytomégalovirus et le parvovirus B19 chez les femmes enceintes dans la région de Sousse, Tunisie.

The aim of the study is to evaluate seroprevalence of rubella virus (RV), cytomegalovirus (CMV), varicella zoster virus (VZV), and parvovirus B19 (PB19) in 404 Tunisian pregnant women, and to determine reliability of maternal past history of eruption. Sociodemographic characteristics, risk factors, and past history of eruption were collected through a questionnaire. Serologic tests were performed using enzyme immunoassays. Risk factors were analyzed using univariate and multivariate logistic regression models. Seroprevalences were 79.7% for rubella, 96.3% for CMV, 80.9% for VZV, and 76.2% for PB19. In multivariate analysis, the number of persons per room (> 2) in the house during childhood was associated with CMV infection (P = 0.004), irregular professional husband's activity was correlated with VZV infection (P = 0.04), and an age of more than 30 years was associated with PB19 infection (P = 0.02). History of rubella, varicella, and PB19 infection was unknown for, respectively, 55.8%, 20%, and 100% of women. False history of rubella and varicella were found for 7.4% and 15% of women, respectively. The positive and negative predictive values (PPV and NPV) of rubella history were, respectively, 92.6% and 17.2%, and were, respectively, 84.9% and 20.9% for varicella history. Susceptibility to RV, VZV, and PB19 infection remains high in pregnancy in our population. Preventive strategies against congenital rubella must be reinforced. Vaccination against VZV should be considered in seronegative women. Systemic CMV screening is not warranted in our country where high immunity is acquired probably in childhood. Since maternal history of eruption is not reliable, we recommend serologic testing to determine immune status of women.

The need for capacity building to prevent chronic diseases in North Africa and the Middle East.

Chronic (noncommunicable) diseases, such as cardiovascular disease, stroke, cancer and diabetes mellitus, are a global public health problem that is increasing, particularly in developing countries. According to the World Health Organization, over the period 2006-15, the largest increase in deaths from chronic diseases will occur in the regions of Africa and the Middle East. This article outlines the problems facing theses regions with regard to chronic diseases, and discusses the urgent need for capacity building and community-based programmes in order to enhance regional capability for tackling chronic diseases.

National health research system mapping in 10 Eastern Mediterranean countries.

Health research systems in the Eastern Mediterranean Region are not well developed to generate and use knowledge to improve health, reduce inequity and contribute to economic development. This study aimed to provide core data on National Health Research Systems (NHRS) in 10 Eastern Mediterranean countries in order to inform actions to strengthen health research system governance and management. Whilst there were examples of good practice, few countries had a formal NHRS and many basic building blocks needed for an effective system had not been put in place. Although limited in focus, the study provides useful information for countries to initiate action to strengthen their NHRS.

[Knowledge of patients with type 2 diabetes about their condition in Sousse, Tunisia]. / Connaissances des patients diabétiques de type 2 sur leur maladie à Sousse (Tunisie).

We assessed the knowledge of 404 type 2 diabetic patients about their condition in order to evaluate the quality of diabetes education in primary health care units in Sousse in 2003. We found that knowledge was satisfactory in only 59% of the patients. Their knowledge about the definition of diabetes and its pathophysiology were the 2 main areas where knowledge was lacking: the proportion of correct answers were 62.6% and 50.3% respectively. More attention should be paid to educating diabetic patients within the chronic disease care national programme.

[Predictors of increased cardiovascular risk in hypertensive patients in frontline facilities in Sousse, Tunisia]. / Facteurs prédictifs du haut risque cardio-vasculaire chez les patients hypertendus suivis en premiere ligne à Sousse (Tunisie).

We assessed cardiovascular risk factors among 456 hypertensive patients in 7 health centres in Sousse. Cardiovascular risk was estimated according World Health Organization recommendations. Mean age was 65.6 (SD = 9.8) years, male:female sex ratio was 0.18. Cardiovascular risk was not influenced by sex, age or residence. However, patients with longer duration of hypertension and more frequent co-morbidity had a significantly higher cardiovascular risk. In addition 45.9% of patients on monotherapy had high cardiovascular risk compared with 40.6% of those treated with 2 or more drugs (P = 0.02). Non-compliance was not found to be associated with high risk.

Medical students and tobacco in 2004: a survey in Sousse, Tunisia.

OBJECTIVE: To assess the behaviour, knowledge and attitudes towards smoking among medical students in Sousse, Tunisia. DESIGN: A cross-sectional survey in classroom settings using a self-administered questionnaire was conducted at the School of Medicine during September 2004. RESULTS: The numbers of students who entered the first and the fifth years of medical training at the University of Sousse in 2004 and completed the questionnaire were respectively 120 and 110. The population age ranged from 18 to 21 years (mean 19 +/- 0.62 years) in first year students and from 22 to 30 years (mean 23 +/- 1.38 years) in fifth year students. The prevalence of daily smoking (both sexes combined) was 4.5% among first year students and 16.7% among final year students. The prevalence of daily smoking according to sex was 29.6% among boys and 0.7% among girls. Over 90% of students thought smoking was harmful to health, but there was considerable underestimation of its causal role in a number of diseases, notably coronary heart disease, bladder cancer and peripheral vascular disease. There were important defects in both knowledge and motivation regarding counselling patients to stop smoking. CONCLUSIONS: The results of this study may provide baseline data to develop an anti-smoking programme in the university.

[Predictive factors of glycemic control in patients with type 2 diabetes mellitus in primary health care]. / Facteurs déterminants du contrôle glycémique des patients diabétiques de type 2 suivis en première ligne.

PURPOSE: To determine the factors associated with poor glycemic control in type 2 diabetic patients followed in primary care units in Sousse, Tunisia. METHODS: A cross-sectional study was conducted on a representative sample of type 2 diabetic patients followed at least two years in primary health care units in Sousse, Tunisia. Data were gathered from three sources: a self-administrated questionnaire, analysis of patient files and HbA1c level. HbA1c level was measured with turbidimetric immunoinhibition assay. Patients were considered well-controlled if glycated hemoglobin (HbA1c) was less than 7%, according to the American Diabetics Association (ADA) recommendations. RESULTS: The study enrolled 404 type 2 diabetic patients. The mean age was 60.5+/-10.89 years, sex-ratio was 0.5, and mean disease duration 8.7+/-6.1 years. ADA recommendations were met by 16.7% of patients. Multivariate analysis using variables in relation with the patient, his/her family, the disease, the treatment and the health care unit, showed that only poor geographic access to the care center (adjusted OR: 1.89, p=0.009) and Body Mass Index (BMI) less than 30 kg/m2 (adjusted OR: 2.21, p=0.034) were significantly and independently associated with poor glycemic control. CONCLUSION: Glycemic control in type 2 diabetic patients is poor. It depends strongly on geographic access to health care. Type 2 diabetic patients should be referred, as much as possible, to the nearest health care unit.

[Tobacco use among teachers in a district of the Tunisian Sahel]. / Le tabagisme des enseignants dans une commune du Sahel Tunisien.

INTRODUCTION: The aim of this study was to evaluate the scale of tobacco use among teachers in the district of Kalaa Kebira (a semi-urban region in the Tunisian Sahel). METHODS: The study design was descriptive and cross sectional, employing a self administered questionnaire given to 402 teachers. RESULTS: The response rate was 89%. The average age of respondents was 35.7 7.9 years. The global prevalence of smoking among teachers was 29.3% (men: 51.6%; women: 3.6%). 79% of smokers were addicted to nicotine according to the Fagerstrôm test. Half of the teachers were poorly informed about the hazards of smoking and 77.9% of smoking teachers didn't refrain from smoking in front of their pupils. CONCLUSIONS: The teachers' lack of knowledge limits their effectiveness both as a role model and information relay in the war against tobacco.

Epidemiology of dyslipidemia among schoolchildren in Sousse, Tunisia.

In Tunisia, there is no available data on the CVD risk profile in the children population, although it is well known that risk factor development takes place during childhood. We undertook an epidemiological survey based on a representative sample of 1569 urban school children of Sousse in Tunisia to assess the prevalence of hypercholesterolemia and other lipid disorders. Prevalence of hypercholesterolemia (8.1%), high level of LDL-cholesterol (3.9%), high level of Lp(a) (14.5%), hypertriglyceridemia (1.3%) and hyper Apo B (3.4%) were found. These informations will be useful to set up a regional program of Heart Health promotion in schools.

[The quality of first line management of arterial hypertension in the sanitary region of Sousse]. / La qualité de prise en charge de l'hypertension artérielle en première ligne dans la région sanitaire de Sousse.

The aim of the study is to value determinants of the quality of management of hypertension in structures of primary health care, a medical audit has been achieved on a representative sample of 456 hypertensive patients followed in the sanitary region of Sousse during the year 2002. It takes out again this work that the global quality of management of hypertension in primary health care have been considered satisfactory at only 28,7% of the hypertensive patients. It was statistically differential according to surroundings (farming: 40,5%, urban: 24,9%) and categories of the seniority of follow-up in primary health care (< or = five years: 34,6%, > five years: 23,9%). A survey multi varied by logistical regression controlling the other factors of confusion (kind, seniority of the illness, geographical and financial accessibility) kept these two factors: the farming middle (ORa: 1,97; P = 0,003) and the lower seniority to five years (ORa: 1,64; P = 0,023). So, the hypertensive patients followed in the urban health centres since more that five years should constitute the population targets a program of improvement of the quality of health care dispensed to hypertensive patients in extra hospital structures of health.

Evaluation of clinical diagnosis scores for Boutonneuse fever.

Mediterranean spotted fever (MSF) is endemic in Tunisia. Diagnosis is confirmed retrospectively based on serology. Clinical features are suggestive of diagnosis if the triad (fever, rash, and eschar) is present. Otherwise clinical diagnosis could be difficult. A diagnosis score was already proposed by Raoult et al. The aim of this study was to evaluate this score, considering only clinical parameters, in order to help clinicians in diagnosing MSF before confirmation. We retrospectively analyzed 62 consecutive charts of patients with diagnosis of suspected MSF. Diagnosis confirmation was made by serology (IgG anti-R. conorii exceeding 128 or seroconversion). Epidemiological and clinical features and total score for each patient were reviewed. To validate the clinical score, we calculated sensitivity, specificity and the Youden index for each score in order to establish the ROC curve. SPSS was used for these statistical tests. Area under curve was 0.70 (P = 0.02). The cutoff score with the most predictive value of MSF diagnosis was 18, according to our study (sensitivity 60%, specificity 84,6% and Youden index 0.44). The MSF diagnosis score is a helpful tool to aid the clinician with presumptive management before confirmation. In our study we demonstrated that a score based only on epidemiological and clinical features could be sufficient, but we have to indicate that these results and cutoff score of 18 were from a retrospective study and should be confirmed by a well-designed prospective one.

[Epidemiology of diabetes in a school children population in Tunisia]. / Epidémiologie du diabète chez l'enfant en milieu scolaire à Sousse, Tunisie.

OBJECTIVE: Study the diabetes prevalence on children because, in Tunisia there are not any available data concerning the epidemiological profile of diabetes in the population aged less than 19 years. MATERIAL AND METHODS: We undertook an epidemiological survey on a representative sample of 1,569 pupils from Sousse in Tunisia aged between 13 and 19 years with a global answer rate of 95.4%. Fasting blood glucose was measured by the glucose oxidase method. RESULTS: The main results showed that prevalences of the moderate hyperglycaemia on an empty stomach (2%) and of the mellitus diabetes (0.4%) did not reveal any significant statistical difference between girls and boys. The moderate hyperglycaemia prevalence varied according to the existence of other cardiovascular risk factors such as hypercholesterolemia (3.3%), arterial hypertension (2.1%) and overweight (3.4%). CONCLUSION: Our survey has provided a first evaluation related to a population of youngsters on the diabetes prevalence and other cardiovascular risk factors. This would help to sensitise health authorities on the importance of primary prevention and its setting in health clubs at schools.

[Cardiovascular risk in schoolchildren in rural Sousse, Tunisia]. / Risque cardiovasculaire chez l'enfant en milieu scolaire rural à Sousse, Tunisie.

There is no data available on the cardiovascular risk of children under 18 years of age in Tunisia, although it is well known that these risk factors present themselves in childhood. The authors performed an epidemiological study based on a representative sample of 793 schoolchildren in the rural region of Sousse, in Tunisia, to determine the incidence of the following risk factors: hypertension, hypercholesterolaemia and other lipid disorders, obesity and smoking. The main results show that the prevalence of hypertension is 11.2% with no statistically significant difference between the sexes. The prevalence of hypercholesterolaemia (2.9%), of hyper-LDL cholesterolaemia (0.6%) and hypertriglyceridaemia (1%) were comparable in boys and girls. Obesity (BMI > 30) was observed in 1.8% of the study population and was as common in girls (1.7%) as in boys (1.9%). Smoking was recorded in 4% of the study population and was commoner in boys (7.3%) than in girls (1.2%). This cardiovascular risk profile is encouraging and efforts should be made to maintain these levels until adulthood. This data will form the basis of a regional programme for the promotion of cardiovascular health in schools.

[Diarrheal diseases treated at the health center of Kalaa-Kebira (Sousse-Tunisia)]. / Les maladies diarrhéiques traitées au centre de PMI de Kalaa-Kébira (Sousse-Tunisie).

Diarrheal diseases of children constitute a public health problem in Tunisia because of their frequency as well as their association with malnutrition. A national programme for diarrheal diseases control was instituted in 1980. This study focuses on a local health center (the PMI of Kalaa-Kebira in an effort to assess the magnitude of diarrheal diseases of children in 1985, and to see to what extent goals and recommendations of the national programme have been attained.

[Epidemiological transition and cardiovascular risk factors in Tunisia]. / Transition épidémiologique et facteurs de risque cardiovasculaire en Tunisie.

In Tunisia a growing extension of chronic diseases has resulted from the environmental and behavioral changes such as the adoption of new dietary habits, sedentarity habitat, stress of urbanization and work conditions. To illustrate this trend, we undertook a household epidemiologic survey of a representative sample of the adult urban population of Soussa (n = 957) to assess the main cardiovascular risk factors except the lipid profile distribution. This study showed a high prevalence of hypertension (> 160/95 mm Hg): 18.8% with an adjusted rate of 15.6%. History of diabetes 10.2%, obesity (BMI > 30) 27.7% significantly higher in women (34.4%), android obesity 36%, smoking habits 21.5% significantly higher in men (61.4%). With this risk factor profile, Tunisia has to implement a national strategy of primary prevention and heart health promotion in addition to the efforts recently made in secondary prevention of some chronic diseases such as hypertension and diabetes.

[Risk factors in cardiovascular diseases in a semi-urban community of the Tunisian Sahel]. / Facteurs de risque des maladies cardiovasculaires dans une communauté semiurbaine du Sahel Tunisien.

Cardiovascular diseases are the leading cause of mortality in the western countries at the same time they are beginning to appear with increasing frequency in developing countries. An epidemiologic study was carried out at Kalaa Kebira (Sousse-Tunisia) to determine the prevalence of the different risk factors of cardiovascular diseases. The study was performed on a representative sample of 555 adults of 20 years and more (response rate of 76%). There was a high proportion of adult males smokers (66%). The prevalence of hypertension varied from 15% to 25%, those of diabetes was 6.5%. An hypercholesterolemia greater than 6.2 mmole/l was observed for 12% of the sample and obesity for 20%.

[Circulation of pharmaceutical information among general practitioners in the region of Sousse (Tunisia)]. / Les moyens d'information pharmaceutique des médecins généralistes dans la région sanitaire de Sousse (Tunisie).

The general practitioner plays an essential role in the rational strategy of drug-use by the quality of his prescription which translates the validity and the relevance of his pharmaceutical information. The objective of this work is to study the different means of pharmaceutical information used by general practitioners in the region of Sousse (Tunisia). We conducted a transversal, descriptive, exhaustive survey of 140 general practitioners in private (68) and public (72) practice during 1999. Data were collected through a questionnaire. This study, with a participation rate of 78%, showed that pharmaceutical dictionaries are the major source of information for 86% of general practitioners, that medical delegates have a positive image for 84% of them and that 36% of general practitioners do not subscribe to any medical journal. Thus, general practitioners are exposed to relatively unreliable pharmaceutical information coming generally from the pharmaceutical industry.

[Study of overweight and obesity in a population of urban school children in Sousse, Tunisia]. / Etude de la surcharge pondérale et de l'obésité dans une population d'enfants et d'adolescents scolarisés en milieu urbain à Sousse en Tunisie.

AIM: The aim of this study was to assess the prevalence of obesity and overweight and their relationship with cardiovascular disease risk factors. METHODS: Epidemiological survey based on a representative sample of 1569 urban school children of Sousse, Tunisia. RESULTS: Overweight (BMI > or = 25) was significantly higher in girls (16.1%) than in boys (11.6%); (chi 2 = 8.2; p = 0.004). Obesity (BMI > or = 30) was slightly higher in girls (3.7%) than in boys (2.7%); (chi 2 = 0.89; p = 0.34). Girls had significantly higher BMI, diastolic blood pressure, cholesterol and HDL cholesterol levels than boys who had however significantly higher levels of systolic blood pressure. Overweight was significantly higher in children who did not practice sport at school: 22 versus 13.1% (p < 0.002), in groups of youngsters who were not affiliated to school sport or city associations. Overweight children had a significantly higher levels of cholesterol, HDL cholesterol and means of systolic and diastolic blood pressures. CONCLUSION: These results will serve to set up a regional program of health promotion at schools.