Human papillomavirus genotypes and HPV-16 variants distribution among Tunisian women with normal cytology and squamous intraepithelial lesions.

BACKGROUND: Little is known about the epidemiological characteristics of papillomavirus (HPV) infection among North African countries. Herein, we conducted a molecular epidemiological study to investigate prevalence of HPV type and HPV-16 variants among cervical-screened unvaccinated Tunisian women. METHODS: Cross-sectional study was performed on 494 Tunisian women visiting Women's Healthcare Centers. HPV-DNA detection was carried out on cervical samples using real-time polymerase chain reaction. HPV genotyping and HPV-16 variants were characterized by direct sequencing of L1 viral capsid gene. RESULTS: The overall HPV prevalence was 34% (95% CI: 30-38%) with significantly higher prevalence among women with squamous intraepithelial lesions (SIL) than those with no intraepithelial lesions (NIL) 84% (95% CI: 76-92%) and 24.5% (95% CI: 20-29%) respectively. The distribution of HPV prevalence according to women's age shows a U-shaped curve and the highest HPV prevalence rates were observed among the youngest (≤25 years; 51.2%, 95% CI: 37-67%) and the oldest women (>55 years; 41.7%, 95% The HPV-16 prevalence was 32.8% (95% CI: 22-45%) among women with SIL and 9.2% (95% CI: 6-12%) among women with NIL. Whereas, the HPV-18 prevalence was 1.3% (95% CI: 0-5%) among women with SIL and 0.3% (95% CI: 0-1%) among women with NIL. Among HPV-16 positive women, European lineage (E) was identified as the predominant HPV-16 variant (85.7%, 95% CI: 76-95%). The frequency of E variant was lower among SIL than among NIL women (81%, 95% CI: 64-99%, and 88%, 95% CI: 77-100%, respectively). Conversely, the African-2 variant frequency was higher among SIL than among NIL women (18%, 95% CI: 1-36% and 6%, 95% CI: 2-14%, respectively). In multivariate analysis, young age was the only risk factor that is independently associated with HPV infection. Moreover, HPV infection and menopause were both found to be independently associated with SIL and HSIL. CONCLUSION: HPV DNA testing should be proposed to young and menopausal Tunisian women. Considering HPV prevalence, only 13% of the Tunisian women could be protected by the bivalent HPV vaccine. These results may be helpful for designing an adapted HPV testing and vaccination program in Tunisia.

[Evaluation of the measurement of capillary glucose concentration versus plasma glucose in the newborn]. / Fiabilité de la mesure de la glycémie capillaire par rapport à la glycémie plasmatique chez le nouveau-né.

BACKGROUND: The reliability of blood glucose monitoring in neonatology is not always confirmed. The aim of this study was to evaluate the reliability of blood glucose measurements made with three different devices in newborns. PATIENTS AND METHODS: The study was prospective, conducted in a medical and neonatal intensive care department over a period of 4 months. Capillary glucose level was measured with three different glucometers and compared with venous glucose level determined using the hexokinase method. An ANOVA and Scheffe test were used for the correlation analysis. RESULTS: Three hundred and nine infants were included, with a mean age of 55h and a mean term of 39 weeks of gestation. Mean blood glucose in the laboratory was 0.62±0.15g/L, 0.71±0.17g/L for Accu-Chek(®) Active, 0.80±0.17g/L for Accu-Chek(®) Performa, and 0.83±0.12g/L for Bionime. An ANOVA showed statistically significant differences between the measurements made by glucometers compared to the reference blood glucose levels, and the Scheffé method showed that glucometers overestimated the real plasma glucose levels. CONCLUSION: None of the devices used in this study was satisfactory. However, an estimation of blood glucose taking into consideration this numerical overestimation would allow early detection of hypoglycemia.

Epidemiology and medical cost of hospitalization due to rotavirus gastroenteritis among children under 5 years of age in the central-east of Tunisia.

Data on the economic burden of rotavirus infection in Tunisia are needed to inform the decision to include rotavirus in routine childhood immunizations. This study aimed to describe the epidemiological profile of rotavirus disease in central-east Tunisia and to estimate its hospital cost. In the first stage - the prospective collection of epidemiological data - we enrolled all patients < 5 years old who were hospitalized for acute diarrhoea at 5 university paediatric departments in central-east Tunisia during the period 2009-2011. Rotavirus was responsible for 65 (23.3%) of the 279 cases enrolled. In the second stage, cost data were collected retrospectively using an activity-based costing method from the medical records of the children who were positively diagnosed with rotavirus. The average cost of care per child was TD 433 (SD 134). This is a significant economic burden in Tunisia, where a safe and effective vaccine is available but not yet introduced to the immunization schedule.

Epidemiological and chronological profile of preterm birth in the region of Monastir (Tunisia) between 1994 and 2012.

Data about the profile and risk factors of premature births in Tunisia are scarce. The objective of this study was to describe the epidemiological profile of preterm births in Monastir, Tunisia, and to study the chronological trends of associated factors over the years 1994-2012. A population-based study was conducted using data from the regional births database on all deliveries in public maternity units. The overall prevalence of preterm births among the 161 116 deliveries in the 19-year period was 5.60% (95% CI: 5.13%-6.07%). The rate of preterm births and of adequate prenatal care increased significantly over the study period. Extremes of maternal age (≤ 19 and ≥ 35 years), having a twin pregnancy and the occurrence of complications during pregnancy were significant predictors of prematurity in the final regression model. Efforts should be made to improve the quality of health care in the region, especially for high-risk pregnancies.

[Profile and trends of pediatric hospital morbidity in the region of Monastir (Tunisia) for a decade]. / Profil et tendances de la morbidité hospitalière pediatrique au niveau de la region de Monastir (Tunisie) pendant une décennie.

INTRODUCTION: Hospital morbidity studies allow us to draw the hospital pathological profile of a region and to follow its evolution. This study aims to describe the profile and the main trends of pediatric diseases within public structures in the region of Monastir between 2000 and 2010. MATERIEL AND METHODS: A descriptive study which concerns all pediatric hospitalizations of public structures in the region of Monastir between 2000 and 2010. Informations were collected from the regional register of hospital morbidity implanted at the Department of Preventive Medicine and Epidemiology of the University Hospital of Monastir. RESULTS: A total of 52.443 hospitalizations were collected between 2000 and 2010 with a means annual hospitalization rate of 3,9 %. The mean age was 7,2 ± 5,4 years and 15,3 % had not exceeded the first year of life. Major diagnostic categories (MDC) were dominated by diseases of the digestive and respiratory systems with 14,4 and 14 % respectively. Main chronological trends have shown that the rate of childhood asthma rise significantly from 0,2 %. in 2000 to 2,5 %. in 2010 and Hydatid Cyst whose rate increased also from 0,2 %. in 2000 to 1,8 %. in 2010 (P < 0,05). CONCLUSION: This morbidity profile incites managers to focus their efforts to improve the management of most important diseases.

Epidemiology and medical cost of hospitalization due to rotavirus gastroenteritis among children under 5 years of age in the central-east of Tunisia

Data on the economic burden of rotavirus infection in Tunisia are needed to inform the decision to include rotavirus in routine childhood immunizations. This study aimed to describe the epidemiological profile of rotavirus disease in central-east Tunisia and to estimate its hospital cost.In the first stage - the prospective collection of epidemiological data - we enrolled all patients < 5 years old who were hospitalized for acute diarrhoea at 5 university paediatric departments in central-east Tunisia during the period 2009-2011. Rotavirus was responsible for 65 [23.3%] of the 279 cases enrolled. In the second stage, cost data were collected retrospectively using an activity-based costing method from the medical records of the children who were positively diagnosed with rotavirus. The average cost of care per child was TD 433 [SD 134]. This is a significant economic burden in Tunisia, where a safe and effective vaccine is available but not yet introduced to the immunization schedule

Des données sur le fardeau économique de l'infection à rotavirus en Tunisie sont nécessaires pour décider ou non d'inclure le rotavirus dans les vaccinations infantiles systématiques. La présente étude visait à décrire le profil épidémiologique de l'infection à rotavirus dans le centre-est de la Tunisie et l'estimation de son coût hospitalier. Lors de la première phase, à savoir le recueil prospectif de données épidémiologiques, nous avons recruté tous les patients de moins de cinq ans ayant été hospitalisés pour une diarrhée aiguë dans cinq services pédiatriques universitaires du centre-est de la Tunisie entre 2009 et 2011. Le rotavirus était responsable de 65 cas sur 279 recrutés [23,3 %]. Lors de la deuxième phase, des données sur les coûts ont été recueillies rétrospectivement à partir des dossiers médicaux des enfants qui étaient positifs au rotavirus, en utilisant une méthodologie de gestion des coûts par activité.Le coût moyen des soins par enfant était de 433 dinars tunisiens [ET 134]. Ce montant représente un fardeau économique important en Tunisie, où un vaccin sûr et efficace existe mais n'est pas encore intégré dans le programme de vaccination

[Integrated management of mother and child health in the region of Monastir (Tunisia)]. / Piese en charge intégrér de la santé de la mere et de L'Enfant dans la région de Monastir (Tunisie).

The programme of integrated management of child health (IMCI) was established in Tunisia in 2002 in some health districts. This study evaluated the management of children under 5 years of age and their mothers using the IMCI programme in Zeramdine, a town 20 km south-west of Monastir. A cross-sectional study was conducted on a convenience sample of 526 medical records of children under 5 years attending the Zeramdine maternal and child health centre. The study evaluated preventive and curative aspects of child health. The mean age was 21.9 (SD 16.7) months. On the curative side, respiratory diseases were the leading reason for consultation (71.2%) followed by diarrhoea (15.4%). For preventive services, physicians systematically checked the child's immunization status and height and weight on the growth charts, and screened for strabismus and anaemia. The contribution to child health of IMCI is undeniable; it allows comprehensive care of the child, develops staff skills, upgrades the health system and improves family and community practices.

Integrated management of mother and child health in the region of Monastir [Tunisia]

The programme of integrated management of child health [IMCI] was established in Tunisia in 2002 in some health districts. This study evaluated the management of children under 5 years of age and their mothers using the IMCI programme in Zeramdine, a town 20 km south-west of Monastir. A cross-sectional study was conducted on a convenience sample of 526 medical records of children under 5 years attending the Zeramdine maternal and child health centre. The study evaluated preventive and curative aspects of child health. The mean age was 21.9 [SD 16.7] months. On the curative side, respiratory diseases were the leading reason for consultation [71.2%] followed by diarrhoea [15.4%]. For preventive services, physicians systematically checked the child’s immunization status and height and weight on the growth charts, and screened for strabismus and anaemia. The contribution to child health of IMCI is undeniable; it allows comprehensive care of the child, develops staff skills, upgrades the health system and improves family and community practices

Le programme de la prise en charge intégrée de la Santé de la mère et de l'enfant [PCIME] a été implanté en Tunisie en 2002 dans quelques circonscriptions sanitaires. La présente étude a évalué la prise en charge des enfants de moins de 5 ans et de leurs mères à travers le programme PCIME à Zeramdine, ville située à 20 km au sud-ouest de Monastir. Une étude transversale a été réalisée sur un échantillon représentatif de 526 dossiers médicaux d'enfants de moins de cinq ans consultant dans le centre de protection maternelle et infantile de Zeramdine. L'étude a évalué tous les aspects curatifs et préventifs de la prise en charge de la santé de l'enfant.La moyenne d'âge était de 21,9 mois [ET 16,7]. Sur le plan curatif, les maladies respiratoires dominaient les motifs de consultation [71,2 %], suivies de la diarrhée [15,4 %]. Sur le plan préventif, les médecins vérifiaient systématiquement l'état vaccinal et le développement staturo-pondéral de l'enfant, et assuraient le dépistage de l'anémie et du strabisme. L'apport de la PCIME est indéniable; elle permet une prise en charge globale de l'enfant, le développement des compétences des ressources humaines, la mise a niveau du système de santé et l'amélioration des pratiques familiales et communautaires

[Epidemiology of rotavirus gastroenteritis among children under 5 years of age in Tunisia - results of sentinel hospital surveillance 2009 to 2011]. / Épidémiologie des gastroentérites à rotavirus chez les enfants âgés de moins de cinq ans en Tunisie - Résultats de la surveillance sentinelle hospitalière 2009 à 2011.

BACKGROUND: Rotavirus is the major cause of severe acute gastroenteritis among young children. The objectives of this study were to assess the epidemiology, clinical and virological features of community-acquired rotavirus acute gastroenteritis, in children under 5 years of age, hospitalized in Tunisia. METHODS: A multicenter prospective observational study was conducted from April 2009 to March 2011, in 11 sentinel pediatric departments. Clinical data and stool samples were collected for all children under 5 years, admitted for acute gastroenteritis. Rotavirus was detected by Elisa immunoassay test and genotyped for G and P by semi-nested multiplex RT-PCR. RESULT: A total of 621 children were enrolled in this study. Rotavirus was detected in 30.3% of cases (95% CI [26.7-33.9]). The estimated incidence rate of rotavirus acute gastroenteritis was 11 cases/100,000 child-years (95% CI [9.43-12.57]). This infection affected predominantly children aged under 24 months, and occurred mainly in winter (55.3%). Vomiting, fever and dehydration were observed in 79.6%, 69.5% and 57% respectively. Genotype analysis identified four G types (G1, G2, G3 and G4) and 4 P types (P[4], P[6], P[8] and P[9]). The most common G/P combination was G3P[8] (24.4%), followed by G4P[8] (13.3%) and G1P[8] (6.5%). CONCLUSION: These results highlight the frequency and potential severity of rotavirus acute gastroenteritis in pediatric hospital settings. The present study could provide a sufficient database to make a decision related to the introduction of rotavirus vaccine in Tunisian national immunization program.

Cervical cancer screening: women's knowledge, attitudes, and practices in the region of Monastir (Tunisia).

BACKGROUND: In Tunisia, cervical cancer is considered the second leading cancer in women and causes high morbidity and mortality. This study aimed to investigate women's knowledge, attitudes, and practices of cervical cancer screening in the region of Monastir (Tunisia). METHODS: We conducted a cross-sectional study exploring the cervical cancer screening knowledge, attitudes, and practices of women in the region of Monastir. The study was conducted in health centers in this region from 1st March to 30th June 2009. Data were collected using a structured questionnaire containing 15 items on demographic status, knowledge of risk factors and screening methods, and attitudes toward the relevance and effectiveness of cervical cancer screening. RESULTS: A total of 900 women agreed to take part in the study. Their mean age was 41.6±12.4 years and 64% did not exceed the primary level of education. According to the constructed scores, 22.8% of the participants had good knowledge of cervical cancer risk factors and 38.2% had good knowledge of screening methods. Multiple logistic regression analysis showed that women aged 45 and older, married, with good knowledge of risk factors and screening methods were more likely to undergo cervical cancer screening (P-value<0.01). CONCLUSION: This study provides useful information that could be utilized by both researchers and those involved in public health programs. The results show the need for educational programs to enhance women's adherence to cervical cancer screening programs in Tunisia.

Trends in hospital morbidity among adults in the region of Monastir (Tunisia) between 1996 and 2007.

AIM: To study trends of hospital morbidity among adults in the region of Monastir during a period of 12 years (1996 - 2007). METHODS: We analyzed data from the morbidity database of the university hospital of Monastir (Tunisia) between 01/01/1996 and 31/12/2007. Data were drawn from the register of hospital morbidity implemented in the Department of Preventive Medicine and Epidemiology since 1995. The International Classification of Diseases (tenth revision) was used to identify and classify morbid conditions. RESULTS: During the study period, we collected 150749 admissions with male tendency (sex-ratio = 1.27). Among these admissions 24.4% were over than 64 years. Morbid conditions were dominated by Ischemic Heart diseases (4.24%) followed by cancers and diabetes mellitus (3.3% and 2.52% respectively). Chronological trends, using Spearman correlation rank test, showed that overall rate of chronic conditions increased significantly from 4.4% in 1996 to 9.1% in 2007 (r'= |0.88|, p-value < 0.001). In contrast, the rate of infectious and parasitic diseases decreased from 4.3% to 2.9% (r'= |0.98|, p-value < 0.001). CONCLUSION: Morbidity trends reflect the epidemiological transition of our country and call to a backing of the ambulatory system and the development of specific services able to decrease the needs of hospitalizations.

[Epidemiological and chronological profile of the low birth weight in the region of Monastir (Tunisia) between 1994 and 2007]. / Caractéristiques épidémiologiques et chronologiques du faible poids de naissance dans la région de monastir (Tunisie) entre 1994 et 2007.

In Tunisia, despite the activities of national programs of maternal and child health, low birth weight (LBW) remains common. The aim of this study is to draw up the epidemiological profile of the LBW in the region of Monastir and to study the chronological trends of the associated factors during a period of 14 years (1994-2007). We conducted a population study which interest 97.630 live births (from 26 to 43 weeks) in the public maternities of the region of Monastir. The mean's age of pregnant women was 28.7 +/- 5.5 years. Among them 14.2% were aged 35 and older and 40% were primipara. Newborns were in term in 94.7% of cases. Maternal age, prenatal care, twin pregnancies and fetal complications were the factors independently associated with the occurrence of LBW in term newborns. However, only prenatal care and twin pregnancies were independently associated to LBW in preterm newborns. During the fourteenth years of the study the parturient mean age and the frequency of preterm birth increased significantly (P < 0.001) while the frequency of multiparty decreased significantly (P < 0.001). We found that the risk factors of LBW (advanced age, multiparty, etc.) are still common in our country and require targeted interventions.

[Knowledge and practices of women in Monastir, Tunisia regarding breastfeeding]. / Connaissances et pratiques des femmes de la région de Monastir (Tunisie) concernant l'allaitement maternel.

We assessed the prevalence of breastfeeding and its determinants and mothers' knowledge and practices towards this issue among 354 women attending primary health centres for their child's 6- month vaccination in the region of Monastir in 2008. The mean age of the women was 30 (SD 5.5) years. Most (90.8%) knew that breastfeeding helped prevent infections in babies but only 38.5% knew that breast milk supplies all infant feeding needs until 6 months of age. While was 94.4% breastfed their babies to start, only 1.9% continued exclusive breastfeeding until 6 months. Main reasons for stopping breastfeeding were perceived breast milk insufficiency followed by return to work. Exclusive breastfeeding over 3 months was associated with skin-to-skin contact (OR = 1.93; 95% CI: 1.016-3.69) and mothers' knowledge about breast milk benefits (OR = 2.8; 95% CI: 1.2-6.6). Early weaning was related to using pacifiers and breast-milk substitutes (OR = 0.17; 95% CI: 0.08-0.36 and OR = 0.14; 95% CI: 0.05-0.38 respectively).

Knowledge and practices of women in Monastir, Tunisia regarding breastfeeding

0We assessed the prevalence of breastfeeding and its determinants and mothers' knowledge and practices towards this issue among 354 women attending primary health centres for their child's 6- month vaccination in the region of Monastir in 2008. The mean age of the women was 30 [SD 5.5] years. Most [90.8%] knew that breastfeeding helped prevent infections in babies but only 38.5% knew that breast milk supplies all infant feeding needs until 6 months of age. While was 94.4% breastfed their babies to start, only 1.9% continued exclusive breastfeeding until 6 months. Main reasons for stopping breastfeeding were perceived breast milk insufficiency followed by return to work. Exclusive breastfeeding over 3 months was associated with skin-to-skin contact [OR = 1.93; 95% CI: 1.016-3.69] and mothers' knowledge about breast milk benefits [OR = 2.8; 95% CI: 1.2-6.6] Early weaning was related to using pacifiers and breast-milk substitutes [OR = 0.17; 95% CI: 0.08-0.36 and OR = 0.14; 95% CI: 0.05-0.38 respectively]