Epidemiological profile of health-care-associated infections in the central-east area of Tunisia

This study aimed to estimate the prevalence and risk factors for health-care-associated infection [HAI] in all 9 hospitals of the central-east area of Tunisia in 2005. Of 1373 patients admitted for more than 48 hours, 74 developed HAI, a prevalence of 5.4% [95% Cl: 4.2%-6.6%]. The prevalence was significantly higher in the intensive care units [18.4%] and neonatal departments [12.7%]. There were 79 infections and the most frequent sites of infection were respiratory tract and urinary tract. Microbiological examination was performed for 25 cases of HAI and Pseudomonas aeruginosa was identified in 8 cases. Multiple logistic regression analysis indicated that HAI was linked to diabetes [OR = 2.0], immunosuppression [OR = 3.3], length of stay [OR = 4.5], central venous catheter [OR = 2.5] and peripheral venous catheter [OR = 10.2]. We conclude that HAI sare of concern in this area of Tunisia

[New criteria and quality of health care services in the governorate of Monastir, Tunisia]

In 2005 new quality criteria [7 items] were introduced for services provided to mother and child under the national perinatality programme. We evaluated this new version in a descriptive study conducted among a random sample of 400 parturient women from Monastir governorate. Mean age was 29.3 [SD 5] years and 42% were primipara. Although prenatal care was adequate in terms of number of antenatal visits for 82.5% of women, for only 21% were all 7 quality criteria fulfilled. The rates of caesarean section and premature birth were significantly higher in women who received quality care [P < 0.05]. In logistic regression analysis, age and parity were the only factors independently associated with the quality of care. Additional efforts are needed to ensure good maternal and infant quality of care

consultation of anonymous and free tracking of the HIV: attitudes and perception of the risk by the consultants

The infection by human immunodeficiency virus [HIV] is a worldwide public health problem. A Voluntary Anonymous Counseling and Screening Consultation [VASC] give the opportunity to inform high-risk population about the disease transmission its severity and especially the main prevention ways. Our study aims the description of the profile, attitudes and risk perception of consultants in Monastir University Hospital. We performed a descriptive study with a total of 172 consultants who used the services of the VASC during a period of three years [2006-2008]. Information's were gathered from an auto-questionnaire assessing infection risks. Consultant's means age was 26.8 +/- 7.5 years with a female predominance [sex ratio=0.67]. Two patients out of three did not exceed the primary school level and the 3/4 were single. Unprotected sex with multiple partners was the main consultation reason for 84% of patients and 96% knew that HIV is a severe infection. Regarding the practices, 38% had never used condoms and half [562%] had presented past episodes of sexually transmitted infections. According to our study, it is clear that the knowledge of consultants were satisfactory. However efforts should be made to address risk behaviours and attitudes toward infection

Implementing a quality improvement programme in a family planning centre in Monastir, Tunisia

We aimed to improve the quality of family planning and reproductive health services in a family planning centre though implementation of a quality improvement programme. Clients were surveyed to identify quality-related problems. Health care teams then analysed the causes of the problems, developed solutions for 3 selected ones and established a quality assurance framework. The selected issues were: long waiting time at the centre; insufficient integration of family planning and reproductive health services; and lack of a holistic approach. The final phase was aimed at testing and implementing corrective measures

[Anthropometrical parameters in infants in Monastir region, Tunisia]

We evaluated the distribution of anthropometrical parameters in infants in Monastir and compared them with the National Center of Health Statistics reference. Our prospective study included 3033 infants attending primary health care centres for vaccinations who were followed for 18 months. In each visit, we measured weight-for-age, height-for-age and weight-for-height. We found a difference between our distribution curve and the NCHS reference. The prevalence of growth retardation increased with age. The prevalence of under-weight and of wasting were less than 10%. Obesity was seen 6.2% of infants aged 3 months and 11.6% aged 9 months

[Analysis of the appropriateness of hospitalizations in Monastir, Tunisia]

We aimed to measure the extent of inappropriate hospital admissions and to identify factors associated with inappropriate hospital use. A descriptive study was carried out on a r and omized sample of 411 hospitalizations in 3 regional hospitals. The appropriateness of admissions was assessed using the Appropriateness Evaluation Protocol [AEP]. We found 21% [95% CI: 17%-25%] of the admissions were avoidable according to the AEP. Inappropriate admissions were associated with the hospital [P = 0.005], patient age [P = 0.003], length of stay and diagnosis [P < 0.001]. The most frequent reasons for appropriate admissions were parenteral therapy, an acute or progressive sensory motor circulatory or respiratory condition sufficient to incapacitate the patient and severe electrolyte or blood gas abnormality. Our study highlights the need to improve hospital management and to develop alternatives to hospitalization