Tuberculosis in elderly: Epidemiological profile, prognosis factors and chronological trends in Southern Tunisia, 1995-2016.

Background: Tuberculosis (TB) has become a public health problem among elderly in developing countries with the gradual increase in life expectancy. Aim/Objective: This study aimed to analyze the prognosis factors and chronological trends of TB in elderly in Southern Tunisia. Methods: A retrospective study was conducted. All TB patients aged ≥60 years, recorded in the Center of TB Control between 1995 and 2016, were included. Chronological trends of TB were analyzed by calculating the correlation coefficient of Spearman (Rho). Multivariate analysis was done by binary logistic regression (Adjusted Odds ratio (AOR); CI; p) to determine the independent risk factors associated with unsuccessful outcome in elderly. A p value <0.05 was considered as statistically significant. Results: Overall, 512 new elderly TB cases were notified between 1995 and 2016, with an average of 23.3 new cases/year. The mean TB incidence rate for elderly was 2.31/100,000 population/year. The case-fatality rate of 8.6%. Multivariate analysis showed that factors independently associated with unsuccessful outcome among elderly patients were age between 80 and 89 (AOR = 4.5; [95% CI: 2, 10.2]; p < 0.001), male gender (AOR = 2.2; [95% CI: 1.1, 4.4]; p = 0.026) and neuro-meningeal involvement (AOR = 4.6; [95% CI: 1.4, 14.8]; p = 0.011). The incidence of TB in elderly patients increased significantly from 0.95/100,000 population in 1995 to 2.17/100,000 population in 2016 (Rho = 0.48; p = 0.024). Discussion: A better understanding of TB features in elderly and its chronological trends overtime would facilitate to put in place, in the national TB control program, strategies geared towards this group of people.

[Knowledge, attitudes and practices of front-line physicians in smoking cessation assistance in Sfax, Tunisia, in 2020]. / Connaissances, attitudes et pratiques des médecins de première ligne en matière d'aide au sevrage tabagique à Sfax (Tunisie), 2020.

Introduction: first-line physicians should play a key role in tobacco control. The purpose of this study is to assess the knowledge and attitudes of front-line physicians as well as their practices for smoking cessation, assess their smoking status and determine the barriers to smoking cessation support. Methods: we conducted a cross-sectional study among a representative sample of front-line physicians practising in the governorate of Sfax in November 2020. Results: a total of 115 first-line physicians were included in the study, with a sex ratio (M/F) of 0.91 and an average age of 43 years (interquartile interval= [34-55 years]). Among the respondents, 26 (22.6%) stated that they were smokers; 98 of the physicians surveyed (85.2%) had not had any postgraduate training in smoking cessation. However, 71 (61.7%) had an idea on nicotine replacement therapy. Regarding attitudes,73 respondents (63.5%) were convinced that physicians were responsible for helping their patients quit smoking. Forty five physicians (39.1%) systematically asked all patients about their smoking habits. The least performed activities of the 5A strategy were the components "help" (14%) and "organize follow-up" (17.4%). Patients' disinterest was considered (53%) to be a significant barrier to smoking cessation assistance by the 61 physicians surveyed. Conclusion: there is a need to evaluate and improve the implementation of the national tobacco control strategy, in particular with regard to the training of front-line physicians.

Private public partnership: a solution for the development of health system in Tunisia.

In a context of economic difficulties, the Tunisian government is required to find solutions to meet the expectations of the population. Health sector is one of the critical areas requiring radical reform. The objective of this paper is to find the place of public private partnership project in the harmonious development of both public and private sectors in Tunisia. Indeed, the Tunisian health system consists of two main sectors: the public sector, and the private sector, booming since the 90s. Tunisian infrastructure and staff resources distribution is characterised by a very significant regional disparity, to the detriment of the interior regions, which is more pronounced in the private sector. This area, considered innovative and responsive, captures the local wealthy clientele, and the foreign highly specialized care seekers. It wins over the best healthcare providers, inspite of some reported claims against pricing abuses leading to user's lack of confidence. As for the public sector under funded, handicapped by red tape and some forms of lack of transparency and lobbying, it can not cope with the influx of customers of poor and middle classes. The relationship between the two sectors misses often. The current challenge in the Tunisian health sector is how can public and private sectors combine and harmonize their efforts to achieve common interest objectives. The public-private partnership, is a process helping the state to involve private investors in the realization of public interest projects and develop long term contracts. So, the two sectors will share resources and technical expertise and will access to further advantages. However, it is essential to establish clear and effective legal and institutional frameworks governing private participation in the public sector.

[Adolescent's hospital morbidity in Sfax - Tunisia]. / La Morbidité Hospitalière Des Adolescents à Sfax - Tunisie.

BACKGROUND: Adolescents present specific sanitary needs, linked to the physical and psychological mutations that occur during this vulnerable period of life. These needs remain little known in Tunisia. But : To describe epidemiological profile of morbidity of teenagers hospitalized in Hedi Chaker's hospital center of Sfax, during a period of 5 years, between 2003 and 2007. METHODS: Data exploitation of the descriptive survey of morbidity and mortality of hospitalized adolescents. RESULTS: During the study, 2963 adolescents of 10 to 19 years have been hospitalized (5.1 % of total of hospitalizations). Paediatrics received 36.9 % of adolescents. Paediatrics, haematology and infectious diseases's services received 58.5 % of them. According to the groups of diagnosis, genitourinary and endocrine's diseases, dominate for girls, whereas infectious and parasitic diseases and tumors touched more boys. Diabetes, signs and general symptoms, leukaemia and anaemia, were the most frequent pathologies. CONCLUSION: Taking care of teenagers is often parcelled out on several hospitable services. Therefore, the improvement of the greeting services, in order to answer the teenager's relational needs home a temporary solution, while hoping, the setting up of units or specific services of adolescents that showed evidence of their utility for the development of the medicine of the teenagers in the industrialized countries.

[The six minute walk test: which predictive values to apply for Tunisian subjects aged between 40 and 80 years?]. / Le test de marche de six minutes: quelles valeurs predictives a appliquer pour les sujets ages entre 40 et 80 ans de la population Tunisienne?

AIM: To establish predictive values for the six minutes walk test (6MWT) specific to subjects old more than 40 years from Tunisian population and to compare them with the other pre-established reference equations. METHODS: 155 voluntary Tunisian subjects, including 75 women, from 40 to 80 years old, sedentaries, no smokers, and without acute or chronic pathologies carried 2 TM6m in a hospital corridor on a way of 30 meters length according to the American Thoracic Society recommendations. Covered distance, heart rate and level of dyspnea were given during each 6MWT. RESULTS: The covered distance was better at the second 6MWT and was significantly different from the predicted values from pre-established equations. Age, sex, weight and size contributed in a multiple linear regression model to explain 60% of the variance of the covered distance and to establish the following regression equation: calculated distance (m) = 299.8 - (4.34 * ageyears) + (342.6 * heightm) - (1.46 * weightkg) + (62.5 * sex) with sex=1 for men and 0 for women and the lower Limit of the normal = calculated distance--124.5 m CONCLUSION: The use of the regression equation established in this study would be adapted to the subjects between 40 and 80 years old and pertaining to the Tunisian population, and its use must be limited to these criteria.

[Health indicators of the University Hospital Center Hedi Chaker of Sfax in 2002]. / Les indicateurs sanitaires du CHU Hedi Chaker de Sfax en l'an 2002.

AIM: The objective of this work was to present the main results of this investigation during the year 2002 and to describe the profile of the hospital morbidity. METHODS: In the setting of the epidemiologic supervision, the Community Medicine and Epidemiology service in Sfax leads a continuous descriptive study of the hospital morbidity and mortality. RESULTS: The average age of the hospitalized was 32.10 years. The sex-ratio was estimated at 0.94. The socio-economic level was relatively low. The chronic pathologies come in head and are dominated by: the chronic renal failure, schizophrenia and diabetes. The profile of morbidity reflects an epidemiological transition phenomenon and call to a backing of the ambulatory handling and the development of specific services capable to make decrease the needs of hospitalizations