Assessment of safe injection practices in health facilities in Oman

Background: Unsafe injection practices put patients and providers at risk of infectious and noninfectious adverse events. A 2001 Ministry of Health survey on injection practices in Oman indicated that, while overall standards were good, in some areas there was a need for improvement.

Aim: We aimed to evaluate injection safety practices to determine whether facilities meet the requirements for practices, equipment, supplies and waste disposal, and to identify unsafe practices.

Methods: We conducted a national cross-sectional survey in 2007 using the World Health Organization tool to evaluate injection safety practices. Using 2-stage cluster sampling, 80 government and 61 private health facilities were randomly selected and evaluated.

Results: There was no shortage of injection equipment nor evidence of attempts to sterilize disposable devices. Care providers immediately disposed of the used needle/syringe in sharps containers. Phlebotomy devices were taken from sealed packets in 96% of facilities. In private facilities, 66.3% of the care providers were fully immunized against hepatitis B. Wearing a new pair of gloves for phlebotomy was observed in only 46% of government and 38% of private health facilities. Many health facilities lacked alcohol-based handrub.

Conclusions: Many injection safety aspects were satisfactory. However there are still opportunities for improvement. Actions are required to make alcohol-based handrub and appropriate sharps containers available and to provide hepatitis B vaccine and training to health care workers in all facilities

[Validity and reliability of the Tunisian version of section G of the composite international diagnostic interview, relative to Schizophrenia]

Early diagnosis of schizophrenia can improve its outcome. Hence, screening policies should be held and suitable tools must be available for general practitioners. To translate the section G [about schizophrenia] of the Composite International Diagnostic Interview to the Tunisian dialect and to check its validity and reliability. The Arabic version of section G of the Composite International Diagnostic Interview has been translated to the Tunisian dialect by psychiatrists speaking fluently both languages. Metric features of the instrument [sensitivity, specificity and predictive values] were assessed by checking its results against those of the gold standard i.e. the expert's opinion owing to the criteria of the Diagnostical and Statistical Manual of mental disorders 3rd revised edition. Reliability has been measured by the index of observer agreement. The instrument showed a low sensitivity of 45% [32% - 58%] and a high specificity of 96% [93% - 99%]. It looked as a diagnostical test that can avoid wrong diagnoses of such a serious and stigmatizing illness. These values are similar or even better than those of literature. The observer agreement index was 0.83 showing a very good reliability. The interviews mean duration was 20 minutes. The instrument showed no variability towards the sex, the age or the educational level of interviewees. Even though section G of the Composite International Diagnostic Interview failed to detect most cases with schizophrenia and showed a poor sensitivity, this instrument can be useful for screening strategies carried out by lay interviewers in the general population

[Medical demography in Tunisia: current situation and perspectives]

Health human resources management is one of the important determinants of health care access equity.To analyse the trend of Tunisian medical density during 2000-2009 and to predict its situation by 2024. 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]. 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. 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]

The image of the Tunisian doctor seems to have lost some of its aura and social value. 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. 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% [1[st] rank]. 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. 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

Mortalite attribuable au tabac en Tunisie 1997

In Tunisia, in spite of the high prevalence of the cigarette smoking among males, there consequences in term of mortality were not until evaluated. These last can be estimated from tobacco consumption data, mortality statistics and estimates of risks observed among populations of smokers in cohort studies. Numbers of deaths by causes have been estimated from WHO for 1998 year. Smoking prevalence have been estimated from a national survey conducted in 1996 by 1'Institut National de Sante Publique and the National League against the Tuberculosis and the Respiratory Illness. Mortality attributable to tobacco in Tunisia has been estimated 6430 deaths. The effect of smoking are a lot more important at the man [5580 deaths], contributing to 22% of male deaths, that at the woman [850 deaths] contributing at 4% of the female deaths. The present mortality to tobacco is similar to certain developed countries as France or Canada. The consumption of cigarettes even though it recorded a light decrease during these last years, remain even elevated notably at the young. Then it is waited to see an increase of tobacco related deaths during the future decades. It is urgent to conduct an efficient politics against this tobacco epidemic by helping the smoker to stop smoking and preventing teenagers to begin to smoke

[Cost effectiveness of cervical cancer screening strategies in Tunisia]

Cervical cancer is a public health problem in developing countries and is the first cancer among women in several of these countries. Screening using the Pap test is the principle control strategy for this cancer. The aim of this study is to identify the highest cost-effectiveness strategy of Pap test screening, according to age group [20 - 64 years, 35 - 64 years and 40 - 64 years] and the frequency of this test [every 3 years or every 5 years]. Number of cases avoid by screening and mean cost to prevent one case were used to compare these screening strategies. The principles results showed that the number of cervical cancer cases avoid increase with the coverage level of the screening and age group size, and decrease with the frequency of the Pap tests. The screening strategy interesting age group "40 - 64 years" every 5 years observed the highest cost-effectiveness ratio [19MD]; however cost is 23MD for age grovy 35 - 64 years. These results lead to choice a frequency of Pap tests every 5 years. However, for determination of age group, other factors, as psycho-social ones, should be taken into account besides economic criterias