Menopause and metabolic syndrome in tunisian women.

OBJECTIVES: This study aimed to evaluate the effect of menopausal status on the risk of metabolic syndrome (MetS) in Tunisian women. METHODS: We analyzed a total of 2680 women aged between 35 and 70 years. Blood pressure, anthropometric indices, fasting glucose, and lipid profile were measured. The MetS was assessed by the modified NCEP-ATPIII definition. RESULTS: The mean values of waist circumference, blood pressure, plasma lipids, and fasting glucose were significantly higher in postmenopausal than in premenopausal women, a difference that was no longer present when adjusting for age. Except for hypertriglyceridaemia, the frequency of central obesity, hyperglycemia, high blood pressure, and high total cholesterol was significantly higher in postmenopausal than in premenopausal women. After adjusting for age, the significance persisted only for hyperglycemia. The overall prevalence of MetS was 35.9%, higher in postmenopausal (45.7% versus 25.6%) than in premenopausal women. A binary logistic regression analysis showed that menopause was independently associated with MetS (OR = 1.41, 95% CI 1.10-1.82) after adjusting for age, residence area, marital status, family history of cardiovascular disease, education level, and occupation. CONCLUSIONS: The present study provides evidence that the MetS is highly prevalent in this group of women. Menopause can be a predictor of MetS independent of age in Tunisian women.

Prevalence of diabetes in Northern African countries: the case of Tunisia.

BACKGROUND: Although diabetes is recognized as an emerging disease in African and Middle East, few population-based surveys have been conducted in this region. We performed a national survey to estimate the prevalence of type 2 diabetes (T2D) and to evaluate the relationship between this diagnosis, demographic and socioeconomic variables. METHODS: The study was conducted on a random sample of 6580 households (940 in each region). 7700 subjects adults 35-70 years old were included in the analyses. T2D was assessed on the basis of a questionnaire and fasting blood glucose level according to the WHO criteria. Access to health care and diabetes management were also assessed. RESULTS: Overall, the prevalence of T2D was 15.1%. There were sharp urban vs. rural contrasts, the prevalence of diabetes being twice higher in urban area. However, the ratio urban/rural varied from 3 in the less developed region to 1.6 in the most developed ones. A sharp increase of prevalence of T2D with economic level of the household was observed. For both genders those with a family history of T2D were much more at risk of T2D than those without. Awareness increase with age, economic level and were higher amongst those with family history of T2D. Drugs were supplied by primary health care centers for 57.7% with a difference according to gender, 48.9% for men vs. 66.0% women (p < 0.001) and area, 53.3% on urban area vs. 75.2% on rural one (p < 0.001). CONCLUSIONS: Through its capacity to provide the data on the burden of diabetes in the context of the epidemiological transition that North Africa is facing, this survey will not only be valuable source for health care planners in Tunisia, but will also serve as an important research for the study of diabetes in the region where data is scarce. In this context, NCDs emerge as an intersectoral challenge and their social determinants requiring social, food and environmental health policy.

Prevalence and determinants of the metabolic syndrome among Tunisian adults: results of the Transition and Health Impact in North Africa (TAHINA) project.

OBJECTIVE: To determine the prevalence of metabolic syndrome (MetS) and its components and to evaluate the relationship between this diagnosis and cardiovascular risk factors, demographic and socio-economic variables. DESIGN: A cross-sectional study using a questionnaire including information on sociodemographic and CVD risk factors. Blood pressure, anthropometric indices, fasting glucose and lipid profile were measured. MetS was defined according to the criteria of the National Cholesterol Education Program, Adult Treatment Panel III. SETTING: The whole Tunisian territory; Transition and Health Impact in North Africa (TAHINA) project. SUBJECTS: A total of 4654 individuals (1840 men and 2814 women), aged 35 to 74 years, who participated in the Tunisian national survey. RESULTS: The overall prevalence of MetS was 30·0 %, higher in women (36·1 %) than in men (20·6 %; P < 0·001). In both genders MetS prevalence increased significantly with age (P < 0·001), but this increase was more important in women. Multiple regression analyses showed that the odds for MetS increased significantly with urban area for both men and women (P < 0·05 and P < 0·001, respectively). The multivariate models showed also that the odds for MetS increased significantly with increasing level of education and in those with a family history of CVD for men (both P < 0·05) and after the menopausal transition for women (P < 0·05). CONCLUSIONS: The study highlights the MetS problem in a middle-income developing country. There is an urgent need for a comprehensive, integrated, population-based intervention programme to ameliorate the growing problem of MetS in Tunisians.

[Medical demography in Tunisia: current situation and perspectives]. / Demographie medicale en Tunisie: etat actuel et perspectives.

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

Blood pressure and associated factors in a North African adolescent population. a national cross-sectional study in Tunisia.

BACKGROUND: In southern and eastern Mediterranean countries, changes in lifestyle and the increasing prevalence of excess weight in childhood are risk factors for high blood pressure (BP) during adolescence and adulthood. The aim of this study was to evaluate the BP status of Tunisian adolescents and to identify associated factors. METHODS: A cross-sectional study in 2005, based on a national, stratified, random cluster sample of 1294 boys and 1576 girls aged 15-19 surveyed in home visits. The socio-economic and behavioral characteristics of the adolescents were recorded. Overweight/obesity were assessed by Body Mass Index (BMI) from measured height and weight (WHO, 2007), abdominal obesity by waist circumference (WC). BP was measured twice during the same visit. Elevated BP was systolic (SBP) or diastolic blood pressure (DBP) ≥ 90th of the international reference or ≥ 120/80 mm Hg for 15-17 y., and SBP/DBP ≥ 120/80 mm Hg for 18-19 y.; hypertension was SBP/DBP ≥ 95th for 15-17 y. and ≥ 140/90 mm Hg for 18-19 y. Adjusted associations were assessed by logistic regression. RESULTS: The prevalence of elevated BP was 35.1%[32.9-37.4]: higher among boys (46.1% vs. 33.3%; P < 0.0001); 4.7%[3.8-5.9] of adolescents had hypertension. Associations adjusted for all covariates showed independent relationships with BMI and WC: - obesity vs. no excess weight increased elevated BP (boys OR = 2.1[1.0-4.2], girls OR = 2.3[1.3-3.9]) and hypertension (boys OR = 3.5[1.4-8.9], girls OR = 5.4[2.2-13.4]), - abdominal obesity (WC) was also associated with elevated BP in both genders (for boys: 2nd vs. 1st tertile OR = 1.7[1.3-2.3], 3rd vs.1st tertile OR = 2.8[1.9-4.2]; for girls: 2nd vs. 1st tertile OR = 1.6[1.2-2.1], 3rd vs.1st tertile OR = 2.1[1.5-3.0]) but only among boys for hypertension. Associations with other covariates were weaker: for boys, hypertension increased somewhat with sedentary lifestyle, while elevated BP was slightly more prevalent among urban girls and those not attending school. CONCLUSION: Within the limits of BP measurement on one visit only, these results suggest that Tunisian adolescents of both genders are likely not spared from early elevated BP. Though further assessment is likely needed, the strong association with overweight/obesity observed suggests that interventions aimed at changing lifestyles to reduce this main risk factor may also be appropriate for the prevention of elevated BP.

Hypertension among Tunisian adults: results of the TAHINA project.

We performed a national survey to determine the prevalence, awareness, treatment and control of hypertension, one of the main cardiovascular risk factors, among the adult population in Tunisia. A total of 8007 adults aged 35-70 years were included in the study. Blood pressure (BP) measurements were taken by physicians with a mercury sphygmomanometer, and standard interviewing procedures were used to record medical history, socio-demographic and cardiovascular disease (CVD) risk factors. Hypertension was defined as a systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg or current treatment with antihypertensive drugs. The prevalence of hypertension was 30.6%, higher in women (33.5%) than in men (27.3%). Multiple logistic regression analyses identified a higher age, urban area, higher body mass index, type 2 diabetes and family history of CVD as important correlates to the prevalence of hypertension. Only 38.8% of those with hypertension were aware of their diagnosis, of which 84.8% were receiving treatment. BP control was achieved in only 24.1% of treated hypertensive persons. Women were more aware than men (44.8 vs. 28.8%), but the rates of treatment and control of hypertension did not differ between the two genders. Higher age, being female, lower education level and urban area emerged as important correlates of hypertension awareness. The study highlights the hypertension problem in a middle-income developing country. There is an urgent need for a comprehensive integrated population-based intervention program to ameliorate the growing problem of hypertension in Tunisians.

[Mortality from cancer in Tunisia: calculating years of life lost]. / Mortalité par cancer en Tunisie: calcul des années de vies perdues.

This work, conducted in Tunisia, aimed to calculate the number of years of life lost due to premature death caused by cancer. The data were based on mortality statistics (2006) provided by the national surveillance system of causes of death and involved calculations proposed by the World Health Organization. A total of 105,205 deaths due to cancer were recorded, 61,550 for males and 43,655 for females. The cancers were mostly of the lung and upper respiratory-digestive tract for men and breast and cervix for women. These results should prompt the health care system to emphasize tobacco control, the promotion of healthy eating and physical activity, as well as screening for breast and cervical cancer.

Dietary fiber in the diets of urban Tunisian women: association of fiber intake with BMI, waist circumference and blood chemistry: preliminary study.

BACKGROUND: The change of the way of life and the food practices in Tunisia due inter alia to the improvement of the socioeconomic conditions induced low fuel consumption of food with significant nutritional interest such as those rich in food fibres which have positive effects on the reduction and the prevention of some complications of the metabolic diseases such as the obesity whose prevalence among Tunisian women is increasingly high. OBJECTIVE: We assessed the association between the mean daily fiber intake and anthropometric parameters, the serum lipid profile and the serum glucose concentration among urban Tunisian women. METHODS: We conducted a 7-day food weighing method among 260 women of which 60 are obese (BMI > 30 kg/m(2)). The weighing method was done by trained and experienced workers in the National Institute of Nutrition of Tunisia. All the results were treated with the (Bilnut) software (1991 version) to which a list of 235 special Tunisian foods was added. We calculated their mean daily fiber intake and we prospectively evaluated the correlations between it and the BMI, the waist circumference, total plasma cholesterol, HDL-cholesterol, triglyceridemia and glycaemia. RESULTS: Obese women are found to consume less fiber than non-obese women (21.73 ± 3.25 g/day vs 26.25 ± 2.7 g/day; P<0.0001). Very high and significant correlations were observed between dietary fiber intake and the parameters investigated: BMI (r=-0.709, P<0.0001), waist circumference (r=-0.790; P<0.0001), total plasma cholesterol (r=-0.488; P<0.0001), triglyceridemia (r=-0.741; P<0.0001) and glycaemia (r=-0.557, P<0.0001). However, we find a positive but a non significant correlation with the HDL-cholesterol and the mean daily fiber intake (r=0.309; P=0.02). CONCLUSIONS: This study provides additional support to the inverse association between fiber consumption and weight gain, the serum lipid profiles, the glycaemia and the waist circumference. Our findings emphasizes the relevance of increased the intakes of fiber from varied sources that may help avoid weight gain among obese adults.

Nutrition transition among adolescents of a south-Mediterranean country: dietary patterns, association with socio-economic factors, overweight and blood pressure. A cross-sectional study in Tunisia.

BACKGROUND: The increase in the burden of chronic diseases linked to the nutrition transition and associated dietary and lifestyle changes is of growing concern in south and east Mediterranean countries and adolescents are at the forefront of these changes. This study assessed dietary intake and association with socio-economic factors and health outcomes among adolescents in Tunisia. METHODS: Cross-sectional survey (year 2005); 1019 subjects 15-19 y. from a clustered random sample. Dietary intake was assessed by a validated semi-quantitative frequency questionnaire (134 items) as was physical activity; the Diet Quality Index International measured diet quality; dietary patterns were derived by multiple correspondence analysis from intakes of 43 food groups. Body Mass Index (BMI) ≥ 85th and 95th percentile defined overweight and obesity. Waist Circumference (WC) assessed abdominal fat. High blood pressure was systolic (SBP) or diastolic blood pressure (DBP) ≥ 90th of the international reference for 15-17 y., and SBP/DBP ≥ 120/80 mm Hg for 18-19 y. RESULTS: Energy intake levels were quite high, especially for females. The macro-nutrient structure was close to recommendations but only 38% had a satisfactory diet quality. A main traditional to modern dietary gradient, linked to urbanisation and increased economic level, featured an increasing consumption of white bread, dairy products, sugars, added fats and fruits and decreasing consumption of oils, grains, legumes and vegetables; regarding nutrients this modern diet score featured a decreasing relationship with total fat and an increase of calcium intake, but with an increase of energy, sugars and saturated fat, while vitamin C, potassium and fibre decreased. Adjusted for age, energy and physical activity, this modern pattern was associated with increased overweight in males (2nd vs. 1st tertile: Prevalence Odds-Ratio (POR) = 4.0[1.7-9.3], 3rd vs. 1st: POR = 3.3[1.3-8.7]) and a higher WC. Adjusting also for BMI and WC, among females, it was associated with decreased prevalence of high blood pressure (2nd vs. 1st tertile: POR = 0.5[0.3-0.8], 3rd vs. 1st tertile: POR = 0.4[0.2-0.8]). CONCLUSION: The dietary intake contrasts among Tunisian adolescents, linked to socio-economic differentials are characteristic of a nutrition transition situation. The observed gradient of modernisation of dietary intake features associations with several nutrients involving a higher risk of chronic diseases but might have not only negative characteristics regarding health outcomes.

Smoking during pregnancy and postpartum among Tunisian women.

OBJECTIVE: The validity of self-reported smoking in population surveys remains an important question yet to be answered. This has been of particular concern in a situation where there is a strong social pressure against pregnant and postpartum women. An associated question is what would be the value of measuring urinary cotinine concentrations in such surveys to obtain validated smoking data. METHODS: Cross-sectional analysis of data on self-reported smoking and urinary cotinine among a sample of 398 pregnant women and recently pregnant, mothers of infants under the age of 2 months, who came to the Family Planning Clinic in Tunis urban area for either prenatal or newborn care. We used quantitative colorimetric urine test based on the könig reaction, in which pink-red chromophores formed from nicotine and its metabolites condensation with barbituric acid were extracted into acetate buffer. RESULTS: The smoking prevalence among Tunisian pregnant women or mothers of newborn infants was 4%. The validity of self-reported daily smoking was relatively low. Among women reporting no smoking at the interview 16% misreported active smoking. According to urinary cotinine values, the smoking prevalence was 18.8%. CONCLUSIONS: These results substantiate the unreliability of self-report on smoking status among women in prenatal and postnatal period and have implications in clinical and education practice.

[Tobacco use among paramedical students in Tunis]. / Le tabagisme chez les étudiants paramédicaux de Tunis.

AIM: To assess smoking habits among Tunisian paramedical students, and their attitudes and knowledge about smoking. METHODS: During the first quarter of the school year 2002-2003 we investigate 1288 paramedical students of the College of Sciences and Techniques of the Health in Tunis. The smoker was the student who declare to smoke daily or by occasionally at the time of the survey. RESULTS: About three quarters of the students (77,2 %) were female and half of them was less than 20 years old. Smokers were those who smoked daily or occasionally. The prevalence of smoking was weak but it was 10 fold higher in male than in female (35,5% vs 3,5%) The rate of the ex-smokers was 4,1 %. Progress in studies does not affect smoking behaviour. The knowledge of tobacco induced diseases was generally good. However, there was substantial underestimation of tobacco contribution to causing bladder cancer, coronary artery disease and peripheral vascular disease. The study evidences insufficient awareness of medical students about their responsibilities for heath education and prevention. CONCLUSION: It is recommended to improve tobacco control educational programs at the paramedical students with elaboration of practical smoking cessation trainings.

[Vitamins A, E and leptin in obese and non-insulin-dependent diabetes]. / Statut en vitamines a, e et léptinémie chez un groupe d'obèses diabétiques non insulino-dépendant.

BACKGROUND: At the obese ones, there is an imbalance between the free defenses antioxydants and radicals from where the installation of an oxydative stress, responsible for the development of non-insulin-dependent diabetes. AIM: Our objectives was to evaluate the levels of vitamins A, E and of leptin, to search the link witch could exist between vitamins and leptin. METHODOLOGY: We proportioned the rates in vitamins A, E and in leptine at 30 obese subjects diabetic of type 2 including 12 men and 18 women of average age (50.93 +/- 6.13) years not carrying pathologies other than the diabetes and obesity compared to 30 witnesses who theirs are paired according to the age and the sex.. RESULTS: Our results chows that levels of antioxidants did not differ between the two groups but we find a non significant decrease in vitamin E/(TC +TG) ratio (1.86 +/- 0.38 vs. 2.11 +/- 0.74 ; p = 0.08) and significant increase of vitamin A level in women obese with non-insulin-diabetes mellitus compared with control group of women (0.69 +/- 0.16 vs. 0.55 +/- 0.15 ; p = 0.01). Moreover a negative and significative correlation between vitamin E and leptin (r = 0.452 ; p = 0.01), and a negative and no significative correlation between vitamin A and leptin (2 = - 0.221; p > 0.05) were observed. CONCLUSION: The rate of vitamin A, is different for each sex with share. The vitamin E could have a negative control on the secretion of the leptin.

[Estimated cost of managing invasive cervical cancer in Tunisia]. / Estimation du coût de la prise en charge du cancer invasif du col de l'utérus en Tunisie.

In Tunisia, cervical cancer incidence is about 4.8 per 100,000, but the diagnosis is often made too late, with 5-year survival rates of 35% or less. Given the budgetary constraints facing the health system, and taking into account the low incidence of cervical cancer in Tunisia, the comparative cost effectiveness analysis of screening programs must be strongly considered by policy and decision-makers. A retrospective study to estimate the average direct cost of managing cervical cancer during the first year after diagnosis was conducted among patients with cervical cancer diagnosed in 2003 at the Salah Azaiez Cancer Institute in Tunis. The study included 64 patients with cervical cancer. The direct medical cost is equal to the sum of the respective consumable costs related to hospitalization, ambulatory care, diagnostic tests, surgical procedures, chemotherapy and radiation. Regarding the in-patient hospital stay, the overall cost of a hospital day is a macro-cost including the accommodation expenses themselves, as well as staff costs and non-specific drugs. An extrapolation of the cost of care has been done at the national level; the method used consisted in multiplying the mean of the direct medical costs according to the FIGO stage by the number of incident cases at national level, for the corresponding stage. The distribution by FIGO stage was derived from the Cancer Registry of the northern region of the country. This extrapolation is an estimate, It assumes that the costs of care are similar in other health facilities, and secondly, it assumes that the distribution by FIGO stage according to that of the northern region's registrar is approximately the same at the national level. The results showed that the direct medical care cost of cervical cancer ranged from 777 to 7458 DT (431 to 4143 euro) with an average of 3180 +/- 1390 DT (1766 +/- 772 euro). The national cost was estimated at 877,680 DT (486,847 euro). Although, the cost of care for cervical cancer in Tunisia does not represent a considerable burden for health system, cervical cancer screening remains the best intervention to improve cancer survival rates.

Nutritional status of Tunisian adolescents: associated gender, environmental and socio-economic factors.

OBJECTIVE: To assess the nutritional status of Tunisian adolescents and associated factors. DESIGN: A cross-sectional study based on a national stratified random cluster sample. SUBJECTS AND METHODS: In all, 1,295 boys and 1,577 girls aged 15-19 years, of whom 28.4 % had already left school. Socio-economic characteristics of the parents, anthropometric measurements, food behaviours and physical activity of the adolescents were recorded during home visits. RESULTS: Prevalence of underweight, overweight and obesity (WHO/National Center for Health Statistics reference) were, respectively, 8.1 %, 17.4 % and 4.1 % among boys and 1.3 %, 20.7 % and 4.4 % among girls; abdominal obesity was highly prevalent among both sexes. Prevalence of overweight differed by region (from 11.5 % to 22.2 %) and was higher in urban v. rural areas for males (21.7 % v. 10.4 %) but not for females (21.7 % v. 19.2 %). These differences were partially mediated by socio-economic and lifestyle factors for males. For females, influence of cultural factors is hypothesised. In rural areas, overweight was more prevalent among boys of higher economic level households, having a working mother or a sedentary lifestyle; for girls, prevalence increased with the level of education of the mother. In urban areas, prevalence of overweight was related to eating habits: it was higher for boys with irregular snacking habits and for girls skipping daily meals. Urban girls having left school were also more overweight. CONCLUSION: Overweight and abdominal obesity in late adolescence have become a true public health problem in Tunisia with the combined effects of cultural tradition for girls in rural areas, and of rapid economic development for boys and girls in cities.

Prevalence of obesity and overweight in Tunisia on 2001.

BACKGROUND: Obesity becomes a major problem in our country during the last decades. AIM: Evaluation of the prevalence of obesity and overweight in Tunisia. METHODS: Prospective epidemiological survey concerning a representative sample of Tunisian Population realised on 2001 by the Tunisian National Health Public Institut. Medical visit and anthropometric measurements were performed by medical investigators at subject's home. Statistical analysis using SAS program were performed. WHO body mass index criteria were used to define overweight and obesity. Population investigated included 8576 adults and adolescents 15 years or older, 4232 men and 4344 women. RESULTS: Prevalence of obesity is 12.2% (6.1% in men, 18.3% in women, p<0.001). Prevalences of obesity grade I, II, and III are respectively 8.7%, 2.9% and 0.7%. Prevalence of overweight is 21.8% (8.9% in men, 12.8% in women, p<0.001). Prevalences of obesity and overweight are respectively in rural districts 8.6% and 10.2%, in urban districts 14.8% and 23.6% (p<0.001). Tunisian eastern areas are more affected by obesity and overweight than western areas but there isn't a north-south gradient. CONCLUSION: Our study shows that prevalences of overweight and obesity in Tunisia became quite similar to the prevalence in European countries, but concerned especially women and eastern areas, more industrialised and more urbanised than the western ones. Preventive strategies should be rapidly implemented in Tunisia to stop the growing of this health public problem.

[Knowledge and attitudes of medical students at the end of their curriculum, towards breast and cervical cancer screening]. / Connaissances et attitudes des étudiants en fin d'études médicates vis-à-vis des dépistages des cancers du col utérin et du sein.

This study assesses knowledge and attitudes of medical students of the faculty of medicine of Tunis, at the end of their medical curriculum, towards breast and cervical cancer screening. Among the 644 medical students at the end of their curriculum, 592 answered to anonymous questionnaire (response rate = 92%). Results show that 34.1% have proposed systematic cervical cancer screening. This proportion was 61.0% for clinical breast cancer examination. The majority of students (70.2%) proposed to start this cervical screening since the first sexual activities. As for the periodicity of this screening, 44.2% are favourable for a yearly periodicity, 39.2% for every three years, 7.2% for every five years and 9.4% for a periodicity at least once in life. 94.1% of students declared to have learned clinical breast examination, contrarily to pap smear, for which this proportion was only 55.1%. Breast and cervical cancer control training, in the faculty of medicine of Tunis, is insufficient and should be improved and restructured.

[Cardiovascular disease surveillance in Tunisia]. / Surveillance des facteurs de risque des maladies cardiovasculaires en Tunisie: methodologie et principaux resultats.

OBJECTIVE: To assess the Cardiovascular risk factors trend in community based surveys. METHOD: Two population surveys were conducted in 1996-97 and 2000-01 in the Ariana region among 7608 adults 35-70 years aged. The surveys were based on: 1--a questionnary, 2--an anthropometrical and physical examination, 3--a biological investigation, and 4--an ECG registration for the second cohort. RESULTS: Relative to the first survey, the prevalence of hypertension, diabetes, hypercholesterolemia didn't change significantly while borderline cholesterol increased on both genders, tobacco smoking decreased and ex-smokers increased on men. In both genders, hypertension and diabetes prevalence is low before 50 years but it increased after this age. Risk factors association is common: about 35% have more than two risk factors. This association is more common on women and diabetes-hypertension is the most frequent. CONCLUSION: These two surveys integrated in a global surveillance program has contributed to assess the CVDs burden and to identify priorities and intervention relevant to epidemiological region context.

[Population surveillance of coronary heart disease]. / Prévalence des cardiopathies ischémiques: resultats d'un depistage en population.

OBJECTIVE: A cross-sectional population survey was carried out in the Ariana region in 2000-01. The aim of this study is to report the prevalence of CHD as indicated by ECG Minnesota coding. METHOD: A randomly selected sample included 1837 adults 40-70 years. Data on socio-economic status, demographic, medical history, health behaviour, clinical and biological investigations were recorded. Risk factors (hypertension, dyslipedemia, obesity, diabetes) are defined according to WHO criterias. Standard supine 12 lead ECGs were recorded. All ECGs are red and classified according to the Minnesota codes criteria on CHD probable, CHD possible and on Major abnormalities and minor abnormalities. RESULTS: CHD prevalence was higher on women. Major abnormalities are more common on women (20.6% vs 13%), while minor abnormalities prevalence was higher on men (15.5% vs 7.5%) (p<0.0001). The prevalence increased with age in both genders. CONCLUSION: This study tested how feasible is the population approach on CVDs surveillance. It highlighted the burden of cardiovascular diseases and support that women are at risk as men are. The value of ECG findings must be integrated in the cardiovascular diseases surveillance to identify high risk population.