RESUMO
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. 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. 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. 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. 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
RESUMO
In Tunisia, perinatal mortality remains a public health problem, currently estimated at 28%, including 15% of still birth rate and 10 to 15% 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. 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. 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]. 88 neonatal deaths were recorded over 7285 live births [LB] that is a NMR of 12%o LB. Early neonatal death occurred in 79 cases [88.7%], that is an ENMR of 10.8%o 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. 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