Epidemiology and medical cost of hospitalization due to rotavirus gastroenteritis among children under 5 years of age in the central-east of Tunisia

Data on the economic burden of rotavirus infection in Tunisia are needed to inform the decision to include rotavirus in routine childhood immunizations. This study aimed to describe the epidemiological profile of rotavirus disease in central-east Tunisia and to estimate its hospital cost. In the first stage - the prospective collection of epidemiological data - we enrolled all patients < 5 years old who were hospitalized for acute diarrhoea at 5 university paediatric departments in central-east Tunisia during the period 2009-2011. Rotavirus was responsible for 65 [23.3%] of the 279 cases enrolled. In the second stage, cost data were collected retrospectively using an activity-based costing method from the medical records of the children who were positively diagnosed with rotavirus. The average cost of care per child was TD 433 [SD 134]. This is a significant economic burden in Tunisia, where a safe and effective vaccine is available but not yet introduced to the immunization schedule

Epidemiological and chronological profile of preterm birth in the region of Monastir [Tunisia] between 1994 and 2012

Data about the profile and risk factors of premature births in Tunisia are scarce. The objective of this study was to describe the epidemiological profile of preterm births in Monastir, Tunisia, and to study the chronological trends of associated factors over the years 1994-2012. A population-based study was conducted using data from the regional births database on all deliveries in public maternity units. The overall prevalence of preterm births among the 161 116 deliveries in the 19-year period was 5.60% [95% CI: 5.13%-6.07%]. The rate of preterm births and of adequate prenatal care increased significantly over the study period. Extremes of maternal age [/= 35 years], having a twin pregnancy and the occurrence of complications during pregnancy were significant predictors of prematurity in the final regression model. Efforts should be made to improve the quality of health care in the region, especially for high-risk pregnancies

[Integrated management of mother and child health in the region of Monastir [Tunisia]]

The programme of integrated management of child health [IMCI] was established in Tunisia in 2002 in some health districts. This study evaluated the management of children under 5 years of age and their mothers using the IMCI programme in Zeramdine, a town 20 km south-west of Monastir. A cross-sectional study was conducted on a convenience sample of 526 medical records of children under 5 years attending the Zeramdine maternal and child health centre. The study evaluated preventive and curative aspects of child health. The mean age was 21.9 [SD 16.7] months. On the curative side, respiratory diseases were the leading reason for consultation [71.2%] followed by diarrhoea [15.4%]. For preventive services, physicians systematically checked the child's immunization status and height and weight on the growth charts, and screened for strabismus and anaemia. The contribution to child health of IMCI is undeniable; it allows comprehensive care of the child, develops staff skills, upgrades the health system and improves family and community practices

[Frequency of aphasia resulting from stroke at hospitals affiliated to Tehran university of medical sciences]

Aphasia is common symptom after acute stroke with a prevalence in earlier studies between 21-38%. In Iran; unfortunately no investigation has been reported on the prevalence of aphasia. So the main aim of this study was to investigate the frequency of aphasia after stroke at hospitals affiliated to Tehran University of medical sciences [TUMS]. This study is a cross-sectional design and has been done on 30 patients with brain injury who admitted to TUMS hospitals during three months. The Mississippi Aphasia Screening Test [MAST] was used to screening aphasia patients. The descriptive results indicated, from 22 patients with CVA five cases [22.7%] were aphasic. Mean age of aphasic patients [69.6 years] was more than non-aphasic patients [49.24 years] and of five aphasic patients, three cases [60%] were male and two of them [40%] were female. Also, regarding background diseases, four of five [80%] aphasic patients had history of high blood pressure and diabetes. Results of this study was consistent with prevalence of aphasia in last studies. Also results of this study confirmed other studies based on that etiology of lesion, age, and high blood pressure and diabetes history of the patients plays an important role in prevalence of aphasia

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

Mother's knowledge and practices in the region of Monastir [Tunisia] in front of childhood fever

Fever is a frequent infant symptom it is among the primary causes of infants morbidity in developing countries. ln Tunisia, fever constitutes a frequent motive for ambulatory consultation and hospitalization Knowledge and practices of mother to face fever conditioning party its issue. In this regard this survey aims at studying knowledge; attitudes and practices of mother facing fever in order to set up educational strategy adapted to the concerned population it is a descriptive cross study of 491 mothers who have consulted the centres of primary healthcare and centres of maternal and infantile protection of 9 delegations in the district of Monastir from 1[st] July up to 15 September 2006. Results have demonstrated that the average age of mothers was 28,5 +/- 5 years with a medium level c instruction and socio-professional. Among the questioned mothers, 80% define fever at a temperature of 38°C and 97.35% know at list one sign of gravity [convulsion is recognized by 56.2% of mothers]. 82.7% know how to measure the rectal temperature, 91.6% use physical means and 88.2% resort substances available at home to reduce temperature 34.3% of mothers have recourse to doctor temperature is diminished Principals determining knowledge and practices of mothers are the instruction and profession of the parents [p<0.01], the number of lived infants and health care education [p<0.05], We can deduce from the study that the knowledge of mothers is quite good. However many efforts are still required to promote the saint practices of mothers

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

[Comparison of pulmonary function in diabetic patients with and without retinopathy compared with control group]

All pulmonary complications of diabetes have not yet been identified completely and results of limited studies available show controversial results. This study aims to determine lung involvement in diabetic patients with and without retinopathy and compare them with healthy subjects. This cross-sectional study was conducted on three groups, 33 diabetic patients with, and 33 patients without retinopathy and 33 healthy subjects as the control group. Diabetic patients were matched with the control group in terms of weight, height, age and sex. Spirometry was performed using a portable spirometer and the results compared with the appropriate statistical software. Diabetic patients did not show significant reduction in FEV1 and FVC compared to the control group [p>0.05] but PEFR showed significant reduction [p<0.001]. Mean PEFR values were lower in patients with retinopathy compared to subjects without retinopathy, difference not statistically significant [p >0.05]. FEV1/FVC was significantly higher in diabetics than nondiabetics, and also in patients with retinopathy in comparison to patients without retinopathy [p<0.001]. PEFR and FEV1/FVC values, in regard to duration of diabetes [>/= 10 Yrs], had significantly reduced and increased respectively [p=0.039, p = 0.049]. Type of diabetes control [Insulin Vs Oral agents] did not show significant changes in spirometeric parameters between patients with and without diabetes [p >0. 05]. This study showed that the pulmonary function is impaired in diabetes mellitus. Increased FEV1/FVC and decreased PEFR present a restrictive pattern in diabetic patient. And the severity of pulmonary complications seems to be correlated with other complication of diabetes [retinopathy]. Duration of diabetes has a significant association with pulmonary complications, whereas the type of treatment has no effect on pulmonary function. To design screening tests for lung involvement in diabetic patients, we need more precise and extensive studies

[Validation of a school children addictive behaviors questionnaire]

The aim was to develop and validate an addictive behaviors screening tool in school children

Methodology: A cross sectional study including a self administrated 223 item questionnaire developed in Arabic language. The questionnaire included identification of the student and seven life domains: school, family, addiction, relationships with peers, leisure and well being. risky behaviors and personality traits. N = 854 high school children. of Monastir City

Results: the questionnaire Alpha Cronbach's Coefficient ranged between 0.3 and 0.8. Only items with a coefficient higher than 0.6 were maintained in the final version. The time reliability by using the Bland and Altman method 15 days after the first measure showed a Pearson's coefficient of 0.81. Validity evaluated by principal components analysis led to 3 independent factors consisting respectively in 20, 4 and 3 well correlated items: family, school and risky behaviors

Conclusion: validated version of the questionnaire consisted in 102 items, easy to, read and understand. This version doesn't require much time to be filled in and takes into consideration cultural particularities of the school children of Monastir. It could be considered as an interesting tool for both the assessment and the prevention of addictive behaviors in school

[Epidemiology of Haemophilus influenzae b meningitis in Tunisia]

The incidence of Haemophilus influenzae b meningitis [Hib] in children < 5 years in Tunisia was studied through a surveillance system set up in June 2000 and followed for 14 months. Population-based surveillance began in 3 governorates and sentinel surveillance in 2. Children < 5 years suspected of meningitis had lumbar puncture, macroscopic exam, blood count, chemical analysis and culture carried out. In the 14 months, 80 cases of meningitis were recorded. From the population-based surveillance most cases were children < 1 year [73.6%] and boys [64%]. H. influenzae was isolated in 38% of cases, pneumococci in 13% and meningococci in 7%. The incidence of confirmed Hib was 14.4/100 000 children. The estimated cost of identifying and treating Hib meningitis and its complications was greater than the cost of vaccine introduction. Based this study, the Ministry of Health has decided to introduce Hib vaccination

[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

[Effects of clove oil [Eugenia caryophyllata] anesthesia on haematological parameters, certain serum enzymes and some tissues in common carp [Cyprinus carpio]]

Objectives: side effects of 100 and 200ppm clove oil, were studied on some haematological parameters, serum enzymes and brain, liver, kidney, spleen and gill of common carp [Cyprinus carpio]

Animals: common carp [Cyprinus carpio]

Procedure: anaesthesia in common carp was induced by 100 and 200ppm clove oil under acceptable water quality conditions at 20+/-2 degree c and hematological and biochemical parameters and histopathology of hematopoietic tissues [kidney and spleen], liver, brain and gills were studied

Statistical analysis: SPSS and SX software one way ANOVA and student t-test

Results: no significant differences were found in levels of WBC, RBC, haematocrit, haemoglobin, MCH, MCHC, alanintransarninase [ALT], aspartatetransaminase [AST], alkalinphosphatase [ALP] and lactatedehydrogenase [LDH] between the anaesthetized fish and control groups [0.3>P>0.1]. Also, there was not any histological abnormality observable in liver, kidney, spleen and gills of anaesthetized groups. However, only hyperemia was seen in brain of both groups

Conclusion: according to the results administration of clove oil, up to 200ppm in aquaculture is safe and recommended

[Drugs in primary health care centres: availability and prescription in health district, Monastir, Tunisia]

Shortages in the availability of some drugs are sometimes noted in primary health care [PHC] centres in spite of the steady increase in the drug budgets in Tunisia. We conducted a survey therefore in 1998 in the health district of Monastir to study the availability of certain essential drugs [n = 15] in PHC centres and the main features of the drug prescription. We found that the drugs lacking were generally those prescribed for chronic diseases and as well as oral antibiotics. Antibiotic treatment constituted 71.8% of public prescriptions and 32.3% of these prescriptions were for an injectable treatment

[ antibiotherapy in general medicine in Monastir, Tunisia]

In order to determine the cost and frequency of antibiotic prescription by general practitioners, we studied 563 outpatients from health centres in Monastir [Tunisia]. All patients had acute diseases. Antibiotics were prescribed to 50.4%. Single antibiotics were generally prescribed, but 52.8% of these patients did not have any laboratory tests. The more frequently used antibiotics were penicillin G and A. Antibiotics cost represented 34.7% of medicinal cost borne by patients and 49.7% of the cost borne by the public sector. Rationalization of medicinal prescription would have a positive impact on household and state budgets

[Interest of the analysis of vaccination across the district]

This study aimed to demonstrate the importance of analysing local immunization data to improve performance of national prevention programmes. From the immunization registers kept in basic health centres, we identified 1271 children receiving their first vaccine at 3 months. Examination of the age at the subsequent vaccinations and time intervals between vaccinations showed that 81.9% had received all the vaccines required by the Ministry of Health but only 48.5% had received immunization meeting the requirements for age and time interval. The analysis also helped identify health centres with best performance [fewer children lost to follow-up and better implementation of immunization schedule] and those vaccinations needing the greatest attention from health professionals