ABSTRACT
Background: Malaria has been eliminated in Tunisia since 1979, but the country remains, like all other countries harboring the vector, exposed to the potential risk of resurgence
Objectives: Describe the clinical and epidemiological investigation of 4 cases of autochthonous malaria in July 2013 and report the main actions of regional and national response
Methods: Retrospective descriptive survey of the 4 clinical observations as well as the study of the regional report data of basic health care for the region of Tunis in 2013
Results: Febrile table concomitant for 4 Tunisian male patients, aged from 21 to 27 years old ; fortuitous discovery of Plasmodium falciparum when checking thrombocytopenia of patient 1 ; diagnosis in cascade of other cases following the epidemiological investigation and field consultation with clinicians ; 3 simple forms and a neuromalaria of favorable evolution ; negative entomological survey for anopheles ; elimination of imported malaria and blood-borne ; airport malaria highly probable. The response included the establishment of a regional and national monitoring unit, an information program aimed at health professionals concerned and public opinion, the involvement of health and entomology teams for the detection and census of potential larval habitats and the implementation of local mosquito eradication measures
Conclusion: The clinical vigilance and competent biologist's eye is necessary to prevent the resurgence of this disease. The epidemiological surveillance system should be maintained and kept as well as the food safety standards monitoring at the borders
ABSTRACT
Background: The acute bronchiolitis in infants [ABI] constitutes a health problem, responsible for a congestion of the care system, particularly emergencies
Objectives: This study aims to assess the knowledge, attitudes, and the frontline general practitioners' behavior, and describe the availability of the base pediatric equipment in health centers, in Tunis
Methods: Cross-sectional descriptive survey was conducted in 2013 at 50 health centers in the region with physicians, conducted by selfadministered anonymous questionnaire and a data sheet detailing the equipment at the health center. Seizure and data analysis is made by Epi Info 6
Results: The responder doctors have over 20 years of seniority for 64% of them and have all received training in ABI. In knowledge 75 to 80% master the definition of the ABI and the main criteria of severity, but only 35% identified less than 3 months of age as a risk factor and less than half provide prevention tips. Regarding the physicians behavior, chest X-ray and kinesitherapy continues to be prescribed in respectively 23 and 37% of cases, the same applies for corticoid [25%]. Nasopharyngeal desobstruction is only recommended in 60% of cases. In regard to the health centers equipment, they were judged satisfactory overall, except for the absence of oxygen sources in 66% of them
Conclusion: Acute Bronchiolitis in infants remains over-medicated at the level of frontline medical consultation in Tunis. It is necessary to revise the terms of skills updating of the general practitioners in care and prevention, conduct and disseminate easy and attractive communication tools [brochures and posters] and implement seasonal data collection of this disease in sentinel sites
ABSTRACT
Tunisia has investigated maternal mortality in 2010 to determine maternal mortality ratio [MMR] nationally and regionally, in addition to the identifying main causes of this mortality. Describe methodology of this study and its principal findings in the region of Tunis and discuss the national maternal mortality strategy. This is a Ramos study [Reproductive Ag Mortality Studies] that consists on identifying maternal deaths from reproductive age group [RAG] women deaths. We started by the a rehearsal and targeting of [RAG] women deaths, then we investigated a next of kin person of the decedent women by verbal autopsy, thereafter we identified maternal deaths to be confidentially investigated to judge the potential avoidability of the death. The study took place in 2010, it was carried out by 5 couples of investigators supervised by a coordinator doctor. A total of 200 deaths of [RAG] women were found in Tunis, 7 deaths among them were maternal deaths, that corresponds to an MMR of 41/100000 live births. The mean age of the deceased women was 35 years. The main causes of maternal deaths were hemorrhage [3/7], thrombo-embolic diseases [2 times for7] and HELLP syndrome [1/7]. Four of a total of 4 deaths [3 deaths were not marked], were avoidable. The majority of late women had a satisfying educational level, 4 of 7 had financial autonomy. All of them had pregnancy monitoring, 5 times of 7 in university hospital. All the childbirth were medically assisted, Caesarean section was carried in 6 of 7 cases. Nationally, the MMR was estimated to 44.8/100 000 LB, that to say a decrease of 35% compared to 1993. The decrease was significant for all the regions of the country, except the great Tunis where opposite trend was recorded. This could be more likely related to quality of care rather than socio-economic conditions seeing that social determinants in Tunis are favorable. In fact, the Tunisian maternal mortality strategy had essentially focused on the monitoring system of maternal deaths rather than the quality of care improvement interventions, results were disappointing due to the lack of institutional engagement. The achievement of the OMD5 objectives is compromised, due to socio-economic constraint especially in certain regions, poor governance and lack of engagement of ministry of health in reducing maternal mortality. Tunisian maternal mortality strategy should be revised and adapted to regional context, also should include multisectoral interventions. Priority would be given to quality of care improvement, by launching the experience of care setting accreditation in one hand, and in the other improving partnership between different levels of care
ABSTRACT
This study aims at evaluating the morbidity of Tunis city inhabitants during the last 6 months preceding the date of the study [June 1998] and at locating the medical care points. It has been led with home interviews. The sample has been selected in a random way and is supposed to give a fair view of the whole districts of Tunis city; it includes 374 families and 1747 individuals. The socioeconomic indicators of the selected families are genuine with those of the Statistics National Institute and 88.8% of the interviewed families benefit of the welfare coverage. The mean of morbidity is of 2.6 yearly by individual and the health care is 3 yearly by individual: this includes an abstention of medical care up to 1.6% and self medication for 26.0% of individuals. The structure involved in the cares appeared respectively to be of public type in 37.5% of the cases, private in 26.5% and of a par public in 10.0%. For the urgency diseases [4.4%]. patients go to the hospitals in 31% of the cases; for the less urgent diseases [23.8%] patients go to the basic welfare structures in 23% of the cases. For the needs of prevention [8.5%], patients go to the basic structures in more than half of the cases. The study indicated clear trend towards more medication of Tunis city inhabitants though it represents the 1/5 of European people. The increasing demand of Tunis city inhabitants for medical care together with the growth of the private medical structures lead to a necessary new organization of the whole medical system in Tunisia
Subject(s)
Humans , MorbidityABSTRACT
This study is made in the general framework of the basic health cares program set up by Tunis regional service to fight child serious respiratory infections. It has an objective to measure bronchiolitis winter frequency for patients aged from 1 to 36 months, serious cases frequency, changing profile, the therapeutic behavior and environmental risk factors. This is a multicentric transversal study in grappa, it has taken place in Tunis between January and march 1999 with a sample size of 1340 patients. Result of the survey has shown a medium frequency of the disease with 10% of the patients, median age group infected at 9 months, aggravating factor in 73% of cases, and a surinfection in 70% of cases. Promiscuity is the only environmental risk factor which is statistically significant. Hospitalization was necessary in 14.2% of cases. With regard to prescriptions, bronchodilators, corticoids and antibiotics were prescribed for respectively 71, 39, and 45.6% of patients. Basic health cares structure is a good alternative during the winter season, provided human expertise s are constantly updated and adequate technical staff is available