[Cost effectiveness analysis of screening strategies for cervical cancer in Tunisia]. / Analyse coût-efficacité des stratégies de dépistage du cancer du col utérin en Tunisie.

We aimed to identify the most appropriate screening strategy for cervical cancer (periodicity of 3, 5 or 10 years) for Tunisia, taking into consideration the incidence of the disease, costs of screening and economic implications. We simulated follow-up of a fictitious cohort of 1 million women 35-39 years over 30 years. Computation of yearly medical care costs was based on data from medical files of patients diagnosed with cervical cancer in 2004 at the National Institute of Cancer, Tunis. For a 60% coverage level of screening, cervical cancer reduction would be 49.2% for a 3-year periodicity. The reduction would be 40.3% and 33.1% for 5 and 10 years periodicity respectively. Considering cost-effectiveness, 10-year screening gave the lowest annual cost to avoid 1 cervical cancer case.

[Cost-effectiveness analysis of screening strategies for cervical cancer in Tunisia]

We aimed to identify the most appropriate screening strategy for cervical cancer [periodicity of 3, 5 or 10 years] for Tunisia, taking into consideration the incidence of the disease, costs of screening and economic implications. We simulated follow-up of a fictitious cohort of 1 million women 35-39 years over 30 years. Computation of yearly medical care costs was based on data from medical files of patients diagnosed with cervical cancer in 2004 at the National Institute of Cancer, Tunis. For a 60% coverage level of screening, cervical cancer reduction would be 49.2% for a 3-year periodicity. The reduction would be 40.3% and 33.1% for 5 and 10 years periodicity respectively. Considering cost-effectiveness, 10-year screening gave the lowest annual cost to avoid 1 cervical cancer case

Reuse of reclaimed wastewater for golf course irrigation in Tunisia.

In Tunisia, golf courses are irrigated with secondary treated effluent stored in landscape impoundments. The impact of the conveyance and storage steps on the physical-chemical and biological quality of irrigation water was evaluated on three golf courses over two years. It was found that the water quality varies all along the water route, from the wastewater treatment plant up to the irrigation site: nutrient and bacteria contents decreased along the route in the three cases. This variation depends on the wastewater quality, the length of the pipes conveying water, the number of regulation reservoirs and ponds, the water residence time in pipes, reservoirs and ponds, and the operation of the ponds. The bacteriological quality of irrigation water deteriorates during the irrigation period in the three golf courses as the ponds are operated as continuous flow reactors. The results obtained in this study indicate the inability of golf water supplies, as currently managed, to properly sanitize reclaimed wastewater and meet target quality criteria recommended by WHO (1989) for water intended for recreational use. For a safe reuse of reclaimed wastewater for golf course irrigation, changes in the design and operation of the ponds should be planned or additional treatment steps provided.

[Assessment of the quality of management of arterial hypertension in a public health center (Ariana - Tunisia)]. / Evaluation de la qualité de la prise en charge de l'hypertension artérielle dans un centre de santé de base public (Ariana-Tunis).

The management of hypertensive outpatients in a primary health care center raises problems of follow-up and effectiveness. This study attempts to assess the management of high blood pressure, using the Medical Audit method, essentially. For that purpose, 194 medical records of hypertensive outpatients registered between 1980 and 1986 were studied. More than 80% of these patients were women between the ages of 40 and 70 years. The medical records of these patients were compared to a standard management scale including 68 items devised by cardiologists and general practitioners. Globally, 32% of the items were cardiologists and general practitioners. Globally, 32% of the items were respected during management of the outpatients. The initial check-up was the least followed item (6.9%), but afterwards care of patients improved, giving ratings of: 29% for respect of treatment protocol, and 35% for surveillance of treatment. As concerns treatment effectiveness, only 28% of the patients (n = 36) actually completed the five-year follow-up period. In these patients average blood pressure fell from 193 to 143 mmHg (systolic), and from 113 to 93 mmHg (diastolic), between the beginning of monitoring and the end of the fifth year. The insufficiency of high blood pressure management results not only from a shortage of resources, but also from underuse of existing ones, and the practitioners' lack of information.