[Diagnoses in children seen in general practice in the region of Sousse (Tunisie)]. / La morbidité diagnostiquée chez les enfants en médecine générale dans la région de Sousse (Tunisie).

The objectives of this study were to identify the diseases diagnosed in children under the age of nineteen years old in primary health care centers, and to determine those that have required referral to a specialist for treatment. It is a descriptive study conducted in 92.5% of primary health care centers in the region, and the survey was conducted from two perspectives and levels of analysis. The first focused on a timescale of study, three weeks per season per district. The second focused on assessing medical records. The statistical unit used was the medical consultation. The coding of diagnosis and referrals was done according to the International Classification of Primary Car (ICPC2). The consultations of children under the age of 19 years old accounted for 6629, which is equal to 42.5% of the total number of consultations (including all ages and gender combined). Respiratory disease was by far pre-dominant with 62.5%, followed by digestive and skin disorders respectively in 10.4% and 9.1% of cases. Among the 6629 consultations, 270 of them (representing 4.1%) have needed a reference for specialist treatment or care. More referrals were made for males (57.4%) than females (42.6%) (p=0.015). In most of the cases referred (83%), they could be divided and categorized according to the ICPC2 chapters of classification; 21.9% for respiratory, 16.7% for digestive, 12.6% for both eye and skin, 10.4% for musculoskeletal, 4.8% for urology and 4.1% for ear. The interest of this study is not only epidemiological, but also it has interest as a pedagogical contribution to support and guide the choice of themes for medical training and to provide comparable types of data to be shared between regions and countries.

Morbidity patterns in general practice settings of the province of Sousse, Tunisia.

BACKGROUND: Primary health care is one of the most important pillars of the Tunisian health care system. However, very little information is available regarding the specificities of general practice and the patterns of morbidity encountered. METHODS: We conducted a descriptive study from June 2002 to May 2003 in 85 primary health centres in Sousse during 12 randomly selected weeks in order to describe the variability of the morbidity in all seasons; (3 weeks were randomly selected in each season). Each working day of selected weeks, a systematic sample of patients was identified in each health centre by taking every fifth registered patient. There were 16,271 consultations. The International Classification of Primary Care (ICPC-2) was used to code recorded data of the consultation. RESULTS: There were 24,882 reasons for encounter, a total of 18,097 problems managed by general practitioners (GPs), and 40,190 interventions. There was a predominance of females (62%) and a relatively young population attending the primary health care settings as 50% was aged less than 25 years. According to ICPC-2 chapters, we found that respiratory diseases were the main problems managed in primary health care (43%), followed by digestive (10.1%), locomotive (8.9%), cardiovascular affections (8.7%) and skin diseases (8.4%). These five conditions alone constituted about 80% of the total cases. However, genital conditions for both males and females (1%) as well as psychological and social problems (0.85%) were rarely managed in primary care. CONCLUSION: The findings will be useful in helping to revise the educational curriculum of medical studies as required in general practice and to plan relevant vocational training for GPs. They will also be important for health policy makers in Tunisia.