[Monitoring of maternal and infantile care activities: experience of Tunisia basic health care services]. / Le monitoring des activites de sante maternelle et infantile. A propos de l'expérience des soins de santé de base de Tunis.

In the feamework of quality assessment, the basic service for health care of Tunis introduced in 1997 a service managing tool for prenatal activity monitoring. This paper aims to present the way this tool should be used its setting up within the basic health structures and its principal effects on the quality process. Prenatal activity monitoring is a process that allows evaluation, control and dysfunction level identification of a health program: it also permits a microplanification in order to compensate for its failings. The first step consists in calculating the 5 following covering determining factors: target population, material or, human resources availability, the service at one's disposal's use rate, the appropriate coverage rate according to a precise way in which the consultations are linked to each other concerning this program and the effective coverage rate including the required quality indicator for the care. A graph permits to visualize these different rates. The second step consists in identifying the bottleneck and the most relevant correcting actions to be conducted in relation with either the available human resources or the material resources or the process of health care by using an "intemal audit". Setting up this tool required many training sessions and supervisions for the Tunis health care services. It proved efficient enough in order to improve the actual coverage of the population especially in the responsibility area of the staff members for certain preventive programs as prenatal services or children's growth follow up. It allowed a better documentation of the consultation activity and the objective analysis of the inherent problems to the recommended program. The solutions were taken locally and dependes on the decision maker's will.

[Children bronchiolitis: multicentric study in Tunis]. / Les bronchiolites du nourrisson: étude multicentrique à Tunis.

This study is made in the general framework of the basic health cares program set up by Tunis regional service to fight child serious respiratory infections. It has an objective to measure bronchiolitis winter frequency for patients aged from 1 to 36 months, serious cases frequency, changing profile, the therapeutic behavior and environmental risk factors. This is a multicentric transversal study in grappa, it has taken place in Tunis between January and march 1999 with a sample size of 1340 patients. Result of the survey has shown a medium frequency of the disease with 10% of the patients, median age group infected at 9 months, aggravating factor in 73% of cases, and a surinfection in 70% of cases. Promiscuity is the only environmental risk factor which is statistically significant. Hospitalization was necessary in 14.2% of cases. With regard to prescriptions, bronchodilators, corticoids and antibiotics were prescribed for respectively 71, 39, and 45.6% of patients. Basic health cares structure is a good alternative during the winter season, provided human expertise's are constantly updated and adequate technical staff is available.