[Risk factors of children overweight and obesity]. / Facteurs de risque de l'obésité l'enfant.

BACKGROUND: The increase of the prevalence of children obesity in some countries as Tunisia, necessitate to welling known risk factors for obesity, to prevent and early management. AIMS: To determine the prevalence of overweight and of obesity in a group of 4-6 year-old school children in Monastir and to investigate the association with possible risk factors. METHODS: A descriptive transversal study including 121 children aged 4-6 years old (637 males, 698 females), was conducted in 10 Kindergartens in Monastir, in 2011. Personal data such as age, sex, birth weight, breastfeeding history and parental data including parental weights and heights, parental education level and occupation were collected by questionnaires completed by parents. Height and weight were measured with a weighing-scale and body mass index (BMI; kg/m²) was calculated. The prevalence of overweight and obesity was defined based according to the curves of the french reference of Rolland Cachera. RESULTS: Prevalence of overweight and obesity was 9.1% and 11.6% respectively. Parental factors associated with overweight were: parental obesity: 44% vs 17% (p=0.005) (OR = 3.65: 1.27-10.57), artificial feeding: 68% vs 33% (p=0.0016) (OR= 4.25: 1.51-12.27), and the early diversification of food before the age of 6 months: 88% vs 65% (p=0.029) (OR= 3.84: 0.98 - 17.66). Exclusive breast feeding duration ≥ 6mois is probably protector factor against obesity: 0% vs 21% (p=0. 01) (OR=0: 0.00 < OR < 0.78). We found no significant difference between overweight and non-overweight schoolchildren in frequency of high degree educated mother and father, birth weight, breakfast intake, eating habits and exercise. However overweight children intake high-caloric food, low in fiber, with troubles of nutritional comportment, and a sedentary lifestyle. CONCLUSIONS: Risk factors for obesity, well known in most industrialized countries, necessitate to be more understood in Tunisia, to place a preventive strategy included supervision of children weight, nutritional education and promote physical activity and reducing the time spent watching television.

[Handling the cases of school failure in an educational institute in Zaghouan].

AIM: To assess the main reasons for the school failure in a school in Zaghouan, how to handle these issues, to evaluate the work of the school social office. METHODS: A retrospective study included 86 failure cases in a school in Zaghouan, handled by the school social office for three years (2004 - 2007). He have detected the principals causes of school failure, detected by the educational staff or by the listening office. RESULTS: The causes of failure are mainly social (46%) as family problems and low income. These families received financial aids and free treatment cards. Discussions have been made with the parents in order to make them more conscious. The pedagogical reasons (28%) however are usually relationship' problems between the student and his teacher or the student and the administration, the three subjects were informed so that attitudes could be changed in the purpose of helping the student. Twelve students (14%) have a psychological case, depression and over worrying, led in some cases to addiction.These cases were diagnosed and transferred to specialized clinics.Sense and chronic diseases (12%), are considered as health reasons for school failure and caused several absences in the school. The school physicist took care of these cases by handling them medical guidance cards while observing the diagnose progress. As school results, 56 cases turned satisfaisant which is 65 % of all cases. CONCLUSION: The school failure became a priority of the "School Health" institute. That puss to create the school social program, his aim is protecting the students from all dangers, early school leaving and social disintegration, and delinquency. Thus, all parts must be responsible for the school failure, teachers, parents, students,psychiatrists and physicists, as well as introducing the social school work and listening offices and missions to the parents, students and teachers in order to guarantee the success of the operations.

[Smoker teenagers in colleges of Zaghouan]. / Le tabagisme chez les collegiens de la region de Zaghouan.

UNLABELLED: The aim of this study is to evaluate the rate of smoker adolescents in Zaghouan, to seek for the smoking reasons, the used arguments, recording to them, to stop, and show their knowledge about prevention. METHODS: A prospective study included 266 teenagers scolarised: 194 boys and 72 girls (aged from 12 to 16 years) from 3 colleges located in Zaghouan during 2006. A questionnaire was drawn up on these adolescents. It contains three parts: tabagic habits of smoking teenagers, the reasons of smoking and information about prevention. RESULTS: Twenty six percents of students are smokers, this percentage increases with the scholar level. They have parents' authorization in 18% of cases and have at least one smoker in their environment in 74% of cases. From whose who have tried tobacco, 65% became smokers. The most invoked causes are calming character of cigarettes and the pleasure to smoke. The first cigarette is smoked just for curiosity. The middle age of smoking initiation is 12 years. Twenty three percents of smoking students have tried to stop. The reasons are the dangerous character for health and the cost of tobacco. Adolescents prefer to use shocking pictures to self-sensitize (66%). Some pupils suggest calling smoker persons who are victims of tobacco to talk about their experiences. CONCLUSION: Adolescents' smoking is a Public Health priority in Tunisia. The rate of smoking, its cost and its bad health risks encourage us to make preventions, especially the education and information for children and help adolescents to stop smoking.

[Nutritional practices of young children]. / Les pratiques alimentaires des jeunes enfants.

AIM: To evaluate the nutritional practice in a region of Zaghouan, and to show determinants of inappropriate food behaviors. METHODS: A retrospective study included 160 children (aged from 3 to 5 years), from 4 kindergartens situated in the region of Zaghouan, during 2007. A questionnaire was drawn up, filled by parents or medical staff, concerning food behaviors. They are weight up and height. RESULTS: Sixty nine percents (69%) of children were breast fed, during 6-12 months in 50%. Diversified food is early before 3 months in 52% of children, and before 6 months in 70%. They are essentially flour in 53%. Vegetal food is introduced in a median age of 3.5 months, fruits at the age of 4 months. An overweight was found in 12. 5% of the cases, and an obesity in 9.5%. The majority (85.7%) was never breast fed persons, and have abnormal food habits in 91% of the cases: early diversified food rich in flour and low in essential elements. Later, the evaluation of food practice have many failures, exposing the children to obesity, related to caloric food, rich of sugar (87.5%), lipid (75%), low in fiber (37.5%) and eating in front of the television (75%). CONCLUSION: Children food behaviors depend on parents' habits, the medical board dietetics and the composition of industrial production.

[Protective effect of breast feeding in childhood obesity]. / Place de l'allaitement maternel dans la prevention de l'obesite infantile.

THE AIM: To evaluate the frequency of obesity in children scolarised in Zaghouan, and to show the protective effect of breast feeding. METHODS: A retrospective study, included 162 children (aged 2 to 6 years), from 3 kindergartens situated in Zaghouan, during 2006. A questionnaire was drawn up, filled out by parents, concerning the breast feeding, the duration, the family antecedents of obesity, and the nutritional practices. Obesity is defined by an Body Mass Index (BMI) > or =97 centile referring to curve of the centiles of BMI for the age (Rolland Cachera). RESULTS: 86% of children were breast fed. 85 children (52%) were nursed by breast exclusively 6 months or over (A group). 54 (34%) are exclusively breast-fed lower than 6 months (B group). 23 (14%) were never breast fed (group C). An overweight was found in 20 children (12%). This overweight is noted respectively in 8%, 9% and 8/23 in the groups A, B and C. Our results showed that there is a statistically significant relation between the BMI and the breast feeding (P < 10 -8). Breast feeding has probably a protective effect against obesity of the child (Odds Ratio = 0.17). CONCLUSION: Promotion of the breast-feeding and information on its methods and its control are a public health priority, it protects the child and his mother from certain diseases and prevents from childhood obesity. OMS recommends an exclusive breast feeding until the 6 months age, and to continue if possible until the 2 years.