Epidemiology of high risk pregnancy in Sousse, Tunisia

This descriptive study assessed the frequency of selected risk factors for high risk pregnancy [HRP] among women in Sousse region. All pregnant women [beyond 28 weeks gestation] giving birth in 4 public maternity hospitals between 15 February 2005 and 15 August 2005 and who had at least 1 risk factor were enrolled. Data were collected within 24 hours of birth from obstetric and antenatal records and by interview. Of 4660 pregnant women, 1194 [25.6%] had at least 1 risk factor and were considered at-risk pregnancies. Mean age of the at-risk women was 31.3 [SD 5.4] years, 73% were urban residents, 38% had secondary education or higher and 75% were housewives. The mean number of risk factors was 1.5 per woman. The majority of women [59.3%] had 1 risk factor and 30.4% had 2. The mean number of prenatal visits was 4, 68.6% were seen by an obstetrician and 43% used the private sector. Certain factors were inadequately screened: age > 35 years, parity > 4, previous low birth weight and neonatal death, excessive fundal height and anaemia

[Hands hygiene in health care workers: the frequency but also the quality]

Hand washing has been recognized for more than one century as an effective measure in the prevention of hospital acquired infections. The objective of our work is to evaluate the adhesion of health care professionals to hand washing as well as the observance and the relevance of this practice and to consider its conformity to the recommendations. It is a prospective study carried out at the university hospital FARHAT HACHED in Sousse on health care professionals in 4 departments which were randomly selected among the high-risk infections classified wards. We performed a direct observation of the professional practices aiming at measuring the adhesion and the relevance of the hand washing. Two hundred and fifty four observations were carried out during the two weeks of the study. 18.9% of the professionals complied with washing their hands before and after an act of health care, whereas 24% of the audited people washed their hands only before nursing care. Conformity to recommendations in hand washing before and after care was only 16.1%. This work enabled us to give a global report on the practice of hand washing. But it appears important to determine the obstacles to hand washing and the means to improve health manpower observance

[Costs of basic health services in a health district in Tunisia]

Information on the cost of health services is essential for good planning and management and the efficient use of resources. We calculated the total costs incurred in running primary health services for one year [1995] in the health district of Enfidha [Tunisia]. The yearly operating expenditure for the health district was 1 219 099 Tunisian dinars and the cost per inhabitant was 17.494 dinars [US dollar 1 = Tunisian dinar 0.950 in 1995]; 65.37% of total costs went on staff and 17.03% on drugs. Looked at another way, 84,96% went on curative services and 14.04% on preventive services.The cost of a consultation for curative care was 6.847dinars, for perinatal care was 2.764 dinars, for immunization was 3.680 and for school visit was 6.680 dinars. The study helps to identify ways in which cost analysis can be used to explore efficiency and resource adequacy in the district

Pratiques et attitudes transfusionnelles

During last years, blood transfusion and transfusion security were domains which have preoccupied health authorities, the population and health professionals. Beginning with the principle that blood transfusion is a care that must be under medical responsibilities, authors analyse physician's implication in this field. To reach this objective, a study interested 199 young physicians, working in two university hositals in Tunisia. Results indicate that physician's knowledge about blood transfusion is insufficient to guarantee quality of this medical act. In terms of attitudes and practices, physicians are not really always implicated in the different stages of blood transfusion process. Intervention is limited to prescription and blood transfusion record card writing. Transfusion herself and monitoring were, in particular, delegated to nurses. So transfusion incidents were under declared. Transfusion medicine must occupy important place in physicians curriculum. At hospital level, quality insurance process, based on audit, have to be implemented to obtain transfusion good practices, in a domain were risk are unfortunately not yet totally circumscribed

Pratiques de prevention et de promotion de la sante en medecine liberale

In view of the "holistic" or global approach to resolve new health problems created by socio- demographie transition in Tunisia, we questionned a group of practitioners [private sector] about preventive and health promotion attitudes and behaviors. For physicians, prevention and health promotion activities are not valuable. So medical pratice are still essentially curative. Inadequate medical education and communication problems are probably the most important factors that explain this situation. Multiple needs are identified by our practitioners and adjustment are necessary to meet the real needs of the population in matter of health