Patients' perception of the quality of care at the Ibn Al Jazzar University Hospital in Kairouan, Tunisia.

AIM: This study aims to evaluate the level of satisfaction of patients hospitalized at Ibn Al Jazzar University Hospital of Kairouan in 2018. METHODS: It's a descriptive cross-sectional study including all patients hospitalized at Ibn Al Jazzar University Hospital in Kairouan over a period of three months, from January 1 to March 31, 2018. The survey was conducted using a questionnaire made up of 27 items to explore seven specific dimensions of satisfaction. RESULTS: A total of 640 patients was included in the study. The overall satisfaction rate was 41.7%. The dimensions of globality and hospital stay were the least appreciated by hospitalized patients with respective satisfaction rates of 14.4% and 18.3%. Access to care was the most appreciated area with a satisfaction rate of 58.9%. the lowest satisfaction rates, among the items studied at the Kairouan University Hospital in 2018 were: «the places of visits¼ (9%), «the quality of the catering¼ (20%), « tranquillity" (23%), and "attentiveness of staff to patient needs" (23%). CONCLUSION: At Ibn Al Jazzar University hospital of Kairouan, patient satisfaction was low regarding the quality of the services provided, particularly for areas related to the conditions of stay and the globality of care. Intervention measures based on these shortcomings should be undertaken.

Family Medicine (General Medicine): What academic and professional specificities?

Family Medicine, a true scientific and academic discipline, has been defined by the World Organization of National Colleges, Academies and academic associations of general practitioners / family physicians (WONCA) since 2002, as being a "clinical specialty oriented towards primary care". This paper details the specificities of Family Medicine: a horizontal specialty, primary care, providing comprehensive and continuous care, patient-centered and community-oriented. The promotion of Family Medicine in the Maghreb countries requires a multi-axial strategy based on the social marketing of Family Medicine, the recognition of Family Medicine as a medical specialty and of Family Medicine as a gateway to national health system, the establishment of a quality approach in basic health centers and free practice offices (centers of health centers) and regular validation of the Family Medicine diploma.

Attitudes of health professionals towards the response to the COVID-19 pandemic in Maghreb.

OBJECTIVE: Measuring the attitudes of health professionals in two Maghreb countries (Tunisia and Algeria) with regard to the response to COVID-19 during the first quarter of 2020. METHODS: This scoping study was based on a "Google Form" covering three constituents of the response plan against COVID-19: responders, activities and crisis communication. The attitudes of health professionals who are working in Tunisia and Algeria were measured through the Likert scale with four propositions, grouped in pairs, during the analysis. RESULTS: The study population consisted of 280 health professionals, 170 of whom are Tunisians along with 110 Algerians. The medians of age and that of professional seniority are, respectively, 37 and 10 years. The role of "health workers", "Mass Media" and "civil society associations" was found to be satisfactory according, respectively, to 92%, 71%, and 55% of the respondents. As far as 72% of health professionals are concerned, the "barrier measures" were respected by the population. Approximately, seven in ten respondents were satisfied with the quality of communication occuring between the Ministries of Health and its epidemiological structures. CONCLUSION: Health professionals of the Maghreb working in Tunisia and Algeria had a generally positive perception of the role of population responders, community engagement, and the quality of official communication in regards to the response plan against COVID- 19. This perception would be a prerequisite for the success of community participation and multisectoral action as well as essential in the strategy of prevention and control of this pandemic and of possible other health emergencies.

Counter-COVID- 19 pandemic strategy in the Maghreb Central. Qualitative study of the perceptions of health professionals.

CONTEXT: The Maghreb Central, like all the countries of the world, was strongly mobilized (governments, ministries of health, population, civil society) in the response against COVID-19, immediately after the registration of the first cases on its territory (end of February, beginning of March) and according to pre-established control strategies. OBJECTIVES: Describe the perceptions of health professionals in the Central Maghreb (Tunisia, Algeria and Morocco) as to the Strengths/Opportunities and Weaknesses/Threats of the national response plans against COVID-19, during the first weeks of their execution, and report their proposals for optimizing the performance of control strategies. METHODS: This is a qualitative study of the perceptions of health professionals in the Maghreb Central regarding their experience of the first six weeks of fighting the COVID-19 pandemic. The data was collected using the "Delphi" technique in one turn, based on an electronic form such as "Google Form", developed according to SWOT analysis. The respondents' verbatim was grouped into homogeneous groups of items, the occurrence of which was subsequently measured. RESULTS: A total of 382 health professionals from the Maghreb Central participated in this study, with a median age of 37 years and a median professional tenure of 10 years. The major force of the Maghreb response strategies, the most shared by the respondents, was the performance of the human resources mobilized (doctors, biologists, nurses, etc.) who succeeded in quickly learning from the international epidemiological expertise accumulated in Asia and in Europe. The fight against COVID-19 in the Central Maghreb was confronted with the general and chronic fragility of the national health systems and the low support of the general population for the recommendations of the steering committees of response, threatening the capacity of the Maghreb to confront new epidemics. CONCLUSION: The success of the national response plans against COVID-19 and of possible epidemics or pandemics in the Central Maghreb, is strongly attributed to the commitment of health professionals and to community participation, necessitating the launch of assistant motivation programs. and development of health personnel and mobilization and loyalty of civil society.

[Evaluation of surgical antibiotic prophylaxis in a Tunisian University Hospital]. / Evaluation des pratiques d'antibioprophylaxie chirurgicale dans un Hopital Universitaire du Centre Tunisien.

Antibiotic prophylaxis (ATBP) is one of the specific measures for the prevention of surgical site infections, whose impact has been quantified in clean or clean-contaminated surgery. Our study aims to evaluate the conformity of ATBP practices and the adherence to the prescribing protocols adopted in our Hospital. We conducted a clinical audit retrospective observational study, evaluating antibiotic prophylaxis practices in our Hospital in the month of March 2015. The primary study endpoint was the overall compliance of the observed practices with the 5 major criteria defined by the French National Authority for Health (FNAH). We followed the guidelines of the French Society of Anesthesia and Intensive Care published in 2010. The study included 150 patients who had undergone surgery in the Department of General Surgery, Orthopaedics and Urology. The overall compliance rate was 33.3%. The compliance with each of the 5 major criteria defined by the FNAH was 74% for the indication; 84% for the time between injection and incision; 60% for the choice of ATB; 89.3% for the dose of the first injection and 72% for the duration of ATBP. The compliance was variable depending on the Department; better compliance was reported in the Department of Urology, in scheduled surgery and when the prescriber was an anesthetist-resuscitator. A global strategy including organization, education and restriction, could lead to a real improvement in the rate of compliance with ATBP practices. Successive audits should be carried out regularly in order to evaluate the impact of the undertaken actions.

[Nosocomial infections in the Intensive Care Unit: annual incidence rate and clinical aspects]. / Les infections nosocomiales en milieu de réanimation: incidence annuelle et aspects cliniques au Service de Réanimation Polyvalente, Kairouan, Tunisie, 2014.

Although the number of ICU beds is generally limited, the incidence rates of nosocomial infections is high. Managing infectious risk in ICU is a priority today; one of the strategic aims is the establishment of systems for epidemiological control. The aim of our study is to determine the incidence and the clinical aspects in order to identify the risk factors. We conducted a longitudinal descriptive impact assessment study enrolling patients hospedalized for more than 48 hours in general purpose Intensive Care Unit at the Ibn El JAZZAR Hospital, Kairouan over a period of 1 year, from 01/03/2013 to 28/02/2014. The study focused on 265 patients whose average age was 39±20 years (18-93 years) with a sex ratio(M/F) of 2.48. We identified 125 episodes of nosocomial infections in 81 patients corresponding to a total incidence of 30.6%. The incidence density rate was 55 infections per 1000 days of hospitalization. There was a clear predominance of pneumopathies, with an incidence of 27.73%, followed by urinary tract infections (9,73%), infections associated with central venous catheter (6.25%) and surgical site infections (2.34%). Mortality rate of patients was 28.7%, with a significant difference between infected patients (44.7% of cases) and non-infected patients (29.07%) (p < 10-3). Gram-negative bacteria were found in 80% of cases. Prevention must involve a global and multidisciplinary action.

Tunisian documentation of «Public Health¼ in post revolution, with a taste of freedom. For a fair, participatory and efficient National Health System.

CONTEXT: Following the Tunisian revolution of 2010/2011, a new Public Health literature emerged, by the ministerial departments as well as the civil society, which was marked by the transparency and the comprehensiveness of the approach. OBJECTIVE: To identify the key ideas of the new Tunisian Public Health discourse, reconciling the principles of a globalizing paradigm with the health problems of a country in transition. METHODS: During this qualitative research, a selected series of three Tunisian reports of Public Health, published in the first quinquennium of the revolution, was read by an independent team of experts in Public Health, not having contributed to their elaboration, to identify the consensual foundations of the new Public Health discourse. These documents were: the "2011 Health Map" of the Department of Studies and Planning of the Ministry of Health, the "Societal Dialogue Report on Health Policies, Strategies and Plans" (2014), and the "Report on the right to health in Tunisia" (2016). RESULTS: The reading of this sample of the Tunisian Public Health literature of the post-revolution brought out three consensual ideas: 1. The constitutional principle of the "right to health" (article 38 of the constitution) with its corollary the State's obligation to ensure access to comprehensive, quality and secure care; 2. The challenge of social "inequalities" of access to care, reinforced by a regional disparity in the distribution of resources, particularly high-tech (specialist doctors, university structures); 3. Advocacy for a National Health System, based on a universal health coverage for its funding and citizen participation in its governance. CONCLUSION: The new Tunisian Public Health literature, in post-revolution, calls on all stakeholders in Preventive and Community Medicine to replace their segmental, technical and hospital practices with a new approach, centered on the implementation of a National Health System that is based on a socialized financing of care and citizen participation in its management.

[Evaluation of the compliance rate of partograph use in a Tunisian Maternity ward: a targeted clinical audit]. / Évaluation de la conformité de la tenue du Partogramme dans une maternité Tunisienne: audit clinique ciblé.

Partograph is an essential tool in routine delivery room practices. It is a written reflection of the quality of mother and child health management during delivery and in the immediate post-partum period. Our study aims to assess compliance rate of partograph use within our maternity ward and to propose areas for improvement of its quality. We conducted a retrospective clinical audit of 400 patients? medical records who gave birth on the labour ward at University of Kairouan from 1 January to 31 December 2014. The reference guidelines used were those from the French Health High Authority (2006) containing 29 criteria divided into 3 categories (PARTOten, PARTOobs, PARTOeve). The overall compliance rate (OCR) of partograph use in our audit was 55.9%. With regard to the first area, such as « La tenue du partogramme ¼ (partograph use, PARTOten) the overall compliance rate was 88, 9%. With regard to the second area, such as « la traçabilité du déroulement du travail ¼ (track labor progression, PARTOobs) the overall compliance rate was 51, 4%. With regard to the third area, such as « la traçabilité des actes, des évènements et des traitements au cours du travail ¼ (the tracing of actions, events and treatments during labor, PARTOeve) the overall compliance rate was 27.4%. Our study has helped identify several areas for improvement. The ultimate goal of this clinical audit was the improvement of professional practices. Therefore, we implemented an action plan (training, awareness raising?) followed by a review aimed to verify the continuity of the corrective actions.

[Acute organophosphorus intoxications in pregnant women]. / Intoxications aigues aux organophosphores chez la femme enceinte.

Acute organophosphorus pesticides (OPs) poisoning during pregnancy are rare events, not well documented in the literature. We conducted a retrospective analysis of outcomes in seven cases of suicidal ingestion of OP in pregnant women. This intoxication was most often serious. Indeed, five of seven parturients had an initial Glasgow score < 9 and the POP score was ≥ 3 in all parturients. Five patients required mechanical ventilation for a mean duration of 3,4 days. All patients reported favorable outcomes but in more than half of the cases fetuses had unfavorable outcomes (fetal death in utero). Two mechanisms can explain these fetal complications. The first mechanism is fetal hypoxia, associated or not with a state of shock, which can be reflected in the Fetal Heart Rate (FHR) by tachycardia or decelerations and result in intrauterine fetal death. The second mechanism is the passage of these pesticides through the placental barrier representing a potential risk to the fetus due to the alteration of the microsomal enzyme systems.