1
|
Khemiri H, Mangone I, Gdoura M, Mefteh K, Chouikha A, Fares W, Lorusso A, Ancora M, Pasquale AD, Cammà C, Halima SB, Krichen H, Smaoui H, Boubaker IBB, Bahri O, Touzi H, Sadraoui A, Meddeb Z, Hogga N, Safer M, Alaya NB, Triki H, Haddad-Boubaker S. Dynamic of SARS-CoV-2 variants circulation in Tunisian pediatric population, during successive waves, from March 2020 to September 2022. Virus Res 2024; 344:199353. [PMID: 38490581 PMCID: PMC10966772 DOI: 10.1016/j.virusres.2024.199353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 03/17/2024]
Abstract
The emergence of SARS-CoV-2 variants has led to several cases among children. However, limited information is available from North African countries. This study describes the SARS-CoV-2 strains circulating in Tunisian pediatric population during successive waves. A total of 447 complete sequences were obtained from individuals aged from 13 days to 18 years, between March 2020 and September 2022: 369 sequences generated during this study and 78 ones, available in GISAID, previously obtained from Tunisian pediatric patients. These sequences were compared with 354 and 274 ones obtained from Tunisian adults and a global dataset, respectively. The variant circulation dynamics of predominant variants were investigated during the study period using maximum-likelihood phylogenetic analysis. Among the studied population, adolescents were the predominant age group, comprising 55.26% of cases. Twenty-three lineages were identified; seven of which were not previously reported in Tunisia. Phylogenetic analysis showed a close relationship between the sequences from Tunisian adults and children. The connections of sequences from other countries were variable according to variants: close relationships were observed for Alpha, B1.160 and Omicron variants, while independent Tunisian clusters were observed for Delta and B.1.177 lineages. These findings highlight the pivotal role of children in virus transmission and underscore the impact of vaccination on virus spread. Vaccination of children, with booster doses, may be considered for better management of future emergences.
Collapse
Affiliation(s)
- Haifa Khemiri
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles for the EMR, Institute Pasteur of Tunis, University of Tunis El Manar, 13 Place Pasteur, BP74 1002 le Belvédère, Tunis, Tunisia; Laboratory of Virus, Host and Vectors (LR 20 IPT 02), Institute Pasteur of Tunis, University of Tunis El Manar, Tunis, Tunisia.
| | - Iolanda Mangone
- Istituto Zooprofilattico Sperimentale dell' Abruzzo e del Molise, Teramo 64100, Italy
| | - Mariem Gdoura
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles for the EMR, Institute Pasteur of Tunis, University of Tunis El Manar, 13 Place Pasteur, BP74 1002 le Belvédère, Tunis, Tunisia; Laboratory of Virus, Host and Vectors (LR 20 IPT 02), Institute Pasteur of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Khawla Mefteh
- Laboratory of Microbiology, Bechir Hamza Children's Hospital, Tunis, Tunisia
| | - Anissa Chouikha
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles for the EMR, Institute Pasteur of Tunis, University of Tunis El Manar, 13 Place Pasteur, BP74 1002 le Belvédère, Tunis, Tunisia; Laboratory of Virus, Host and Vectors (LR 20 IPT 02), Institute Pasteur of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Wasfi Fares
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles for the EMR, Institute Pasteur of Tunis, University of Tunis El Manar, 13 Place Pasteur, BP74 1002 le Belvédère, Tunis, Tunisia; Laboratory of Virus, Host and Vectors (LR 20 IPT 02), Institute Pasteur of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Alessio Lorusso
- Istituto Zooprofilattico Sperimentale dell' Abruzzo e del Molise, Teramo 64100, Italy
| | - Massimo Ancora
- Istituto Zooprofilattico Sperimentale dell' Abruzzo e del Molise, Teramo 64100, Italy
| | - Adriano Di Pasquale
- Istituto Zooprofilattico Sperimentale dell' Abruzzo e del Molise, Teramo 64100, Italy
| | - Cesare Cammà
- Istituto Zooprofilattico Sperimentale dell' Abruzzo e del Molise, Teramo 64100, Italy
| | - Samar Ben Halima
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles for the EMR, Institute Pasteur of Tunis, University of Tunis El Manar, 13 Place Pasteur, BP74 1002 le Belvédère, Tunis, Tunisia; Laboratory of Virus, Host and Vectors (LR 20 IPT 02), Institute Pasteur of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Henda Krichen
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles for the EMR, Institute Pasteur of Tunis, University of Tunis El Manar, 13 Place Pasteur, BP74 1002 le Belvédère, Tunis, Tunisia; Laboratory of Virus, Host and Vectors (LR 20 IPT 02), Institute Pasteur of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Hanen Smaoui
- Laboratory of Microbiology, Bechir Hamza Children's Hospital, Tunis, Tunisia
| | - Ilhem Boutiba Ben Boubaker
- Charles Nicolle Hospital, Laboratory of Microbiology, National Reference Lab on AMR Surveillance, Tunis 1006, Tunisia; Faculty of Medicine of Tunis, LR99ES09, Research Laboratory, University of Tunis El Manar, Tunis 1006, Tunisia
| | - Olfa Bahri
- Laboratory of Microbiology and Biochemistry, Aziza Othmana Hospital, Tunis, Tunisia
| | - Henda Touzi
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles for the EMR, Institute Pasteur of Tunis, University of Tunis El Manar, 13 Place Pasteur, BP74 1002 le Belvédère, Tunis, Tunisia; Laboratory of Virus, Host and Vectors (LR 20 IPT 02), Institute Pasteur of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Amel Sadraoui
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles for the EMR, Institute Pasteur of Tunis, University of Tunis El Manar, 13 Place Pasteur, BP74 1002 le Belvédère, Tunis, Tunisia; Laboratory of Virus, Host and Vectors (LR 20 IPT 02), Institute Pasteur of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Zina Meddeb
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles for the EMR, Institute Pasteur of Tunis, University of Tunis El Manar, 13 Place Pasteur, BP74 1002 le Belvédère, Tunis, Tunisia; Laboratory of Virus, Host and Vectors (LR 20 IPT 02), Institute Pasteur of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Nahed Hogga
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles for the EMR, Institute Pasteur of Tunis, University of Tunis El Manar, 13 Place Pasteur, BP74 1002 le Belvédère, Tunis, Tunisia; Laboratory of Virus, Host and Vectors (LR 20 IPT 02), Institute Pasteur of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mouna Safer
- National Observatory of New and Emergent Diseases, Tunis, Tunisia
| | - Nissaf Ben Alaya
- Faculty of Medicine of Tunis, LR99ES09, Research Laboratory, University of Tunis El Manar, Tunis 1006, Tunisia; National Observatory of New and Emergent Diseases, Tunis, Tunisia
| | - Henda Triki
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles for the EMR, Institute Pasteur of Tunis, University of Tunis El Manar, 13 Place Pasteur, BP74 1002 le Belvédère, Tunis, Tunisia; Laboratory of Virus, Host and Vectors (LR 20 IPT 02), Institute Pasteur of Tunis, University of Tunis El Manar, Tunis, Tunisia; Faculty of Medicine of Tunis, LR99ES09, Research Laboratory, University of Tunis El Manar, Tunis 1006, Tunisia
| | - Sondes Haddad-Boubaker
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles for the EMR, Institute Pasteur of Tunis, University of Tunis El Manar, 13 Place Pasteur, BP74 1002 le Belvédère, Tunis, Tunisia; Laboratory of Virus, Host and Vectors (LR 20 IPT 02), Institute Pasteur of Tunis, University of Tunis El Manar, Tunis, Tunisia.
| |
Collapse
|
2
|
Boukthir A, Bouguerra H, Ben Salah A, Erber AC, Chaabene S, Moussa H, Guillemette F, Alaya NB, Bettaieb J. Influenza vaccine uptake in Tunisia from two high-risk groups' perception and attitudes: a qualitative study. Front Public Health 2023; 11:1212431. [PMID: 37655288 PMCID: PMC10466396 DOI: 10.3389/fpubh.2023.1212431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/17/2023] [Indexed: 09/02/2023] Open
Abstract
Background Pregnant women (PW) and older adult with chronic diseases (ECD) are priority groups for the influenza vaccination. This study was designed to have a better insight into the influenza perceptions and barriers of the vaccine uptake from these groups' perspectives. Methods This qualitative study consisted of 20 focus group discussions (FGDs) enrolled from five governorates across the country (north, center, and south) between March 18 and July 10, 2019, in urban and rural areas. FGDs were conducted in Arabic (Tunisian dialect) and following the topic guide. Data were transcribed in the local language then translated into English and analyzed using Nvivo12 Software. This permitted the analysis thematic approach, using codes determined by the focus groups. Results A total of 170 individuals participated in the FGDs (84 ECD and 86 PW). Both groups recognized the weakness of the immune system as key determinant for severity. While PW raised the lack of information about the vaccine, the ECD emphasized accessibility problems. Five main barriers to influenza vaccination were identified: cultural barriers and use of traditional medicine, misleading or lack of information about influenza and the vaccine, advice against its uptake, problems of availability and accessibility of the vaccine as well as mistrust towards the vaccine including adverse effects, vaccine composition and effectiveness. Conclusion The study provided refined information from the perspectives of users to orient the policies regarding the promotion of influenza vaccine by decision makers among these two high risk groups.
Collapse
Affiliation(s)
- Aicha Boukthir
- Department of Medical Epidemiology, Pasteur Institute of Tunis, Tunis, Tunisia
- Département de communication sociale, Laboratoire Interdisciplinaire de Recherche en Enseignement Supérieur (LIRES), Université du Québec à Trois-Rivières, Québec, QC, Canada
| | - Hind Bouguerra
- Observatoire National des Maladies Nouvelles et Emergentes, Tunis, Tunisia
- Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisia
| | - Afif Ben Salah
- Department of Medical Epidemiology, Pasteur Institute of Tunis, Tunis, Tunisia
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Astrid C. Erber
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Sana Chaabene
- Department of Medical Epidemiology, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Hayet Moussa
- Département de Sociologie et d’Anthropologie, Institut Supérieur des Sciences Humaines de Tunis, Université de Tunis El Manar, Tunis, Tunisia
| | - François Guillemette
- Département des Sciences de l’Education, Laboratoire Interdisciplinaire de Recherche en Enseignement Supérieur (LIRES), Université du Québec à Trois-Rivières, Québec, QC, Canada
| | - Nissaf Ben Alaya
- Observatoire National des Maladies Nouvelles et Emergentes, Tunis, Tunisia
- Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisia
| | - Jihene Bettaieb
- Department of Medical Epidemiology, Pasteur Institute of Tunis, Tunis, Tunisia
- Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisia
| |
Collapse
|
3
|
Haddad-Boubaker S, Arbi M, Souiai O, Chouikha A, Fares W, Edington K, Sims S, Camma C, Lorusso A, Diagne MM, Diallo A, Boubaker IBB, Ferjani S, Mastouri M, Mhalla S, Karray H, Gargouri S, Bahri O, Trabelsi A, Kallala O, Hannachi N, Chaabouni Y, Smaoui H, Meftah K, Bouhalila SB, Foughali S, Zribi M, Lamari A, Touzi H, Safer M, Alaya NB, Kahla AB, Gdoura M, Triki H. The Delta variant wave in Tunisia: Genetic diversity, spatio-temporal distribution and evidence of the spread of a divergent AY.122 sub-lineage. Front Public Health 2023; 10:990832. [PMID: 36684874 PMCID: PMC9846204 DOI: 10.3389/fpubh.2022.990832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 12/09/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction The Delta variant posed an increased risk to global public health and rapidly replaced the pre-existent variants worldwide. In this study, the genetic diversity and the spatio-temporal dynamics of 662 SARS-CoV2 genomes obtained during the Delta wave across Tunisia were investigated. Methods Viral whole genome and partial S-segment sequencing was performed using Illumina and Sanger platforms, respectively and lineage assignemnt was assessed using Pangolin version 1.2.4 and scorpio version 3.4.X. Phylogenetic and phylogeographic analyses were achieved using IQ-Tree and Beast programs. Results The age distribution of the infected cases showed a large peak between 25 to 50 years. Twelve Delta sub-lineages were detected nation-wide with AY.122 being the predominant variant representing 94.6% of sequences. AY.122 sequences were highly related and shared the amino-acid change ORF1a:A498V, the synonymous mutations 2746T>C, 3037C>T, 8986C>T, 11332A>G in ORF1a and 23683C>T in the S gene with respect to the Wuhan reference genome (NC_045512.2). Spatio-temporal analysis indicates that the larger cities of Nabeul, Tunis and Kairouan constituted epicenters for the AY.122 sub-lineage and subsequent dispersion to the rest of the country. Discussion This study adds more knowledge about the Delta variant and sub-variants distribution worldwide by documenting genomic and epidemiological data from Tunisia, a North African region. Such results may be helpful to the understanding of future COVID-19 waves and variants.
Collapse
Affiliation(s)
- Sondes Haddad-Boubaker
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles for the EMR, Institute Pasteur de Tunis, University of Tunis El-Manar, Tunis, Tunisia
- Laboratory of Viruses, Hosts and Vectors, Institute Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC), Institute Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Marwa Arbi
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles for the EMR, Institute Pasteur de Tunis, University of Tunis El-Manar, Tunis, Tunisia
- Laboratory of Bioinformatics, Biomathematics and Biostatistics, Institute Pasteur de Tunis, University of Tunis El-Manar, Tunis, Tunisia
| | - Oussema Souiai
- Laboratory of Bioinformatics, Biomathematics and Biostatistics, Institute Pasteur de Tunis, University of Tunis El-Manar, Tunis, Tunisia
| | - Anissa Chouikha
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles for the EMR, Institute Pasteur de Tunis, University of Tunis El-Manar, Tunis, Tunisia
- Laboratory of Viruses, Hosts and Vectors, Institute Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC), Institute Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Wasfi Fares
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles for the EMR, Institute Pasteur de Tunis, University of Tunis El-Manar, Tunis, Tunisia
- Laboratory of Viruses, Hosts and Vectors, Institute Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC), Institute Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Kate Edington
- New Variant Assessment Platform (NVAP), UK Health Security Agency, London, United Kingdom
| | - Sam Sims
- New Variant Assessment Platform (NVAP), UK Health Security Agency, London, United Kingdom
| | - Cesare Camma
- Department of Virology, Instituto Zooprofilattico Sperimentale dell'Abruzzo e del Molise G. Caporale (IZSAM), Teramo, Italy
| | - Alessio Lorusso
- Department of Virology, Instituto Zooprofilattico Sperimentale dell'Abruzzo e del Molise G. Caporale (IZSAM), Teramo, Italy
| | | | - Amadou Diallo
- Department of Virology, Pasteur Institute of Dakar, Dakar, Senegal
| | - Ilhem Boutiba Ben Boubaker
- Laboratory of Microbiology, Charles Nicolle Hospital, Tunis, Tunisia
- Laboratory Research Antimicrobial Resistance, Faculty of Medicine of Tunis, University of Tunis El-Manar, Tunis, Tunisia
| | - Sana Ferjani
- Laboratory of Microbiology, Charles Nicolle Hospital, Tunis, Tunisia
- Laboratory Research Antimicrobial Resistance, Faculty of Medicine of Tunis, University of Tunis El-Manar, Tunis, Tunisia
| | - Maha Mastouri
- Laboratory of Microbiology, Fattouma Bourguiba Hospital, Monastir, Tunisia
- Laboratory Research Laboratoire des Maladies Transmissibles et Substances Biologiquement Actives, Faculty of Pharmacy of Monastir, University of Monastir, Monastir, Tunisia
| | - Salma Mhalla
- Laboratory of Microbiology, Fattouma Bourguiba Hospital, Monastir, Tunisia
- Laboratory Research Laboratoire des Maladies Transmissibles et Substances Biologiquement Actives, Faculty of Pharmacy of Monastir, University of Monastir, Monastir, Tunisia
| | - Hela Karray
- Laboratory of Microbiology, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Saba Gargouri
- Laboratory of Microbiology, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Olfa Bahri
- Laboratory of Microbiology and Biochemistry, Aziza Othmana Hospital, Tunis, Tunisia
| | | | - Ouafa Kallala
- Laboratory of Virology, Sahloul Hospital of Sousse, Sousse, Tunisia
| | - Naila Hannachi
- Laboratory of Microbiology, Farhat Hached Hospital of Sousse, Sousse, Tunisia
| | - Yassine Chaabouni
- Laboratory of Medical Biology, Ibn El Jazzar Hospital, Kairouan, Tunisia
- Department of Microbiology, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Hanen Smaoui
- Department of Microbiology, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Microbiology, Microbiology of Children and Immunocompromised, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Microbiology, Bechir Hamza Children's Hospital, Tunis, Tunisia
| | - Khaoula Meftah
- Department of Microbiology, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Microbiology, Microbiology of Children and Immunocompromised, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Microbiology, Bechir Hamza Children's Hospital, Tunis, Tunisia
| | - Sophia Besbes Bouhalila
- Laboratory of Medical Biology and Blood Bank, Institute Mohamed Kassab d'orthopédie, Manouba, Tunisia
| | - Soumaya Foughali
- Laboratory of Medical Biology, Menzel Bourguiba Hospital, Bizerte, Tunisia
| | - Mariem Zribi
- Laboratory of Microbiology, La Rabta Hospital, Tunis, Tunisia
| | - Asma Lamari
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles for the EMR, Institute Pasteur de Tunis, University of Tunis El-Manar, Tunis, Tunisia
- Laboratory of Viruses, Hosts and Vectors, Institute Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Henda Touzi
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles for the EMR, Institute Pasteur de Tunis, University of Tunis El-Manar, Tunis, Tunisia
- Laboratory of Viruses, Hosts and Vectors, Institute Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC), Institute Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mouna Safer
- National Observatory of New and Emergent Diseases, Tunis, Tunisia
| | - Nissaf Ben Alaya
- Department of Microbiology, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- National Observatory of New and Emergent Diseases, Tunis, Tunisia
| | - Alia Ben Kahla
- Laboratory of Bioinformatics, Biomathematics and Biostatistics, Institute Pasteur de Tunis, University of Tunis El-Manar, Tunis, Tunisia
| | - Mariem Gdoura
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles for the EMR, Institute Pasteur de Tunis, University of Tunis El-Manar, Tunis, Tunisia
- Laboratory of Viruses, Hosts and Vectors, Institute Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC), Institute Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
- Department of Virology, Faculty of Pharmacy of Monastir, University of Monastir, Monastir, Tunisia
| | - Henda Triki
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles for the EMR, Institute Pasteur de Tunis, University of Tunis El-Manar, Tunis, Tunisia
- Laboratory of Viruses, Hosts and Vectors, Institute Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC), Institute Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
- Department of Microbiology, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| |
Collapse
|
4
|
Charaa N, Ghrab R, Ben Othman A, Makhlouf M, Ltaief H, Ben Alaya N, Chahed M. Investigation of a human brucellosis outbreak in Douz, Tunisia, 2018. Epidemiol Health 2022; 44:e2022048. [PMID: 35609880 PMCID: PMC9684011 DOI: 10.4178/epih.e2022048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 05/18/2022] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVES In 2017, the incidence of human brucellosis in Tunisia was 9.8 per 100,000 population. In the Douz district, 2 cases were reported in March 2018. Prior to that date, the last indigenous cases to be reported in Douz had been in 2015. This study aimed to identify the source of this new contamination and recommend control interventions. METHODS This case-control study included residents of Douz who presented with clinical symptoms of brucellosis and had a subsequent Wright test antibody titer ≥ 1/160. The controls were neighbors of the infected cases who had a negative Rose Bengal test. Univariate and multivariate analyses were performed to estimate the odds ratios of risk factors. Goats belonging to the cases and controls were actively screened. RESULTS Twenty-five infected cases and 52 uninfected controls were enrolled. All infected cases had consumed goat milk and 92% had purchased it from the same breeder. Consumption of goat milk from this breeder (adjusted odds ratio [aOR], 30.78; 95% confidence interval [CI], 6.47 to 235.91) and overall consumption of raw goat milk (aOR, 14.84; 95% CI, 2.04 to 310.44) were independent risk factors for brucellosis. The breeder had 18 goats, 5 of which were smuggled from a neighboring country. Three of those goats were diagnosed with brucellosis. CONCLUSIONS Consumption of raw milk from smuggled sick goats was the main risk factor in this outbreak. The sick goats were slaughtered and an education campaign was conducted. Vaccination, control of cross-border animal movements, and control of goat milk sales must be strengthened to prevent the spread of brucellosis in southwestern Tunisia.
Collapse
Affiliation(s)
- Nejib Charaa
- Preventive Health Division, Regional Directorate of Health, Kebili, Tunisia
| | | | | | - Mohamed Makhlouf
- Preventive Health Division, Regional Directorate of Health, Sfax, Tunisia
| | - Hejer Ltaief
- National Observatory of New and Emerging Diseases, Ministry of Health, Tunis, Tunisia
| | - Nissaf Ben Alaya
- National Observatory of New and Emerging Diseases, Ministry of Health, Tunis, Tunisia
- Departement of Preventive Medicine and Epidemiology, Faculty of Medicine of Tunis, Tunis, Tunisia
| | - Mohamed Chahed
- Departement of Preventive Medicine and Epidemiology, Faculty of Medicine of Tunis, Tunis, Tunisia
| |
Collapse
|
5
|
Chouikha A, Fares W, Laamari A, Haddad-Boubaker S, Belaiba Z, Ghedira K, Kammoun Rebai W, Ayouni K, Khedhiri M, Ben Halima S, Krichen H, Touzi H, Ben Dhifallah I, Guerfali FZ, Atri C, Azouz S, Khamessi O, Ardhaoui M, Safer M, Ben Alaya N, Guizani I, Kefi R, Gdoura M, Triki H. Molecular Epidemiology of SARS-CoV-2 in Tunisia (North Africa) through Several Successive Waves of COVID-19. Viruses 2022; 14:624. [PMID: 35337031 PMCID: PMC8956073 DOI: 10.3390/v14030624] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 12/17/2022] Open
Abstract
Documenting the circulation dynamics of SARS-CoV-2 variants in different regions of the world is crucial for monitoring virus transmission worldwide and contributing to global efforts towards combating the pandemic. Tunisia has experienced several waves of COVID-19 with a significant number of infections and deaths. The present study provides genetic information on the different lineages of SARS-CoV-2 that circulated in Tunisia over 17 months. Lineages were assigned for 1359 samples using whole-genome sequencing, partial S gene sequencing and variant-specific real-time RT-PCR tests. Forty-eight different lineages of SARS-CoV-2 were identified, including variants of concern (VOCs), variants of interest (VOIs) and variants under monitoring (VUMs), particularly Alpha, Beta, Delta, A.27, Zeta and Eta. The first wave, limited to imported and import-related cases, was characterized by a small number of positive samples and lineages. During the second wave, a large number of lineages were detected; the third wave was marked by the predominance of the Alpha VOC, and the fourth wave was characterized by the predominance of the Delta VOC. This study adds new genomic data to the global context of COVID-19, particularly from the North African region, and highlights the importance of the timely molecular characterization of circulating strains.
Collapse
Affiliation(s)
- Anissa Chouikha
- Reasearch Laboratory “Virus, Vectors and Hosts: One Health Approach and Technological Innovation for a Better Health”, LR20IPT02, Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (W.F.); (A.L.); (S.H.-B.); (Z.B.); (K.A.); (M.K.); (H.T.); (I.B.D.); (M.G.); (H.T.)
- Laboratory of Clinical Virology, WHO Reference Laboratory for Poliomyelitis and Measles in the Eastern Mediterranean Region, Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (S.B.H.); (H.K.)
- Clinical Investigation Center (CIC), Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (M.A.); (I.G.)
| | - Wasfi Fares
- Reasearch Laboratory “Virus, Vectors and Hosts: One Health Approach and Technological Innovation for a Better Health”, LR20IPT02, Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (W.F.); (A.L.); (S.H.-B.); (Z.B.); (K.A.); (M.K.); (H.T.); (I.B.D.); (M.G.); (H.T.)
- Laboratory of Clinical Virology, WHO Reference Laboratory for Poliomyelitis and Measles in the Eastern Mediterranean Region, Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (S.B.H.); (H.K.)
- Clinical Investigation Center (CIC), Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (M.A.); (I.G.)
| | - Asma Laamari
- Reasearch Laboratory “Virus, Vectors and Hosts: One Health Approach and Technological Innovation for a Better Health”, LR20IPT02, Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (W.F.); (A.L.); (S.H.-B.); (Z.B.); (K.A.); (M.K.); (H.T.); (I.B.D.); (M.G.); (H.T.)
| | - Sondes Haddad-Boubaker
- Reasearch Laboratory “Virus, Vectors and Hosts: One Health Approach and Technological Innovation for a Better Health”, LR20IPT02, Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (W.F.); (A.L.); (S.H.-B.); (Z.B.); (K.A.); (M.K.); (H.T.); (I.B.D.); (M.G.); (H.T.)
- Laboratory of Clinical Virology, WHO Reference Laboratory for Poliomyelitis and Measles in the Eastern Mediterranean Region, Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (S.B.H.); (H.K.)
- Clinical Investigation Center (CIC), Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (M.A.); (I.G.)
| | - Zeineb Belaiba
- Reasearch Laboratory “Virus, Vectors and Hosts: One Health Approach and Technological Innovation for a Better Health”, LR20IPT02, Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (W.F.); (A.L.); (S.H.-B.); (Z.B.); (K.A.); (M.K.); (H.T.); (I.B.D.); (M.G.); (H.T.)
- Laboratory of Clinical Virology, WHO Reference Laboratory for Poliomyelitis and Measles in the Eastern Mediterranean Region, Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (S.B.H.); (H.K.)
- Clinical Investigation Center (CIC), Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (M.A.); (I.G.)
| | - Kais Ghedira
- Laboratory of Bioinformatics, Biomathematics and Biostatistics (BIMS), Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia;
| | - Wafa Kammoun Rebai
- Laboratory of Biomedical Genomics and Oncogenetics (LR16IPT05), Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1068, Tunisia; (W.K.R.); (R.K.)
| | - Kaouther Ayouni
- Reasearch Laboratory “Virus, Vectors and Hosts: One Health Approach and Technological Innovation for a Better Health”, LR20IPT02, Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (W.F.); (A.L.); (S.H.-B.); (Z.B.); (K.A.); (M.K.); (H.T.); (I.B.D.); (M.G.); (H.T.)
- Laboratory of Clinical Virology, WHO Reference Laboratory for Poliomyelitis and Measles in the Eastern Mediterranean Region, Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (S.B.H.); (H.K.)
- Clinical Investigation Center (CIC), Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (M.A.); (I.G.)
| | - Marwa Khedhiri
- Reasearch Laboratory “Virus, Vectors and Hosts: One Health Approach and Technological Innovation for a Better Health”, LR20IPT02, Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (W.F.); (A.L.); (S.H.-B.); (Z.B.); (K.A.); (M.K.); (H.T.); (I.B.D.); (M.G.); (H.T.)
- Laboratory of Clinical Virology, WHO Reference Laboratory for Poliomyelitis and Measles in the Eastern Mediterranean Region, Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (S.B.H.); (H.K.)
- Clinical Investigation Center (CIC), Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (M.A.); (I.G.)
| | - Samar Ben Halima
- Laboratory of Clinical Virology, WHO Reference Laboratory for Poliomyelitis and Measles in the Eastern Mediterranean Region, Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (S.B.H.); (H.K.)
| | - Henda Krichen
- Laboratory of Clinical Virology, WHO Reference Laboratory for Poliomyelitis and Measles in the Eastern Mediterranean Region, Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (S.B.H.); (H.K.)
| | - Henda Touzi
- Reasearch Laboratory “Virus, Vectors and Hosts: One Health Approach and Technological Innovation for a Better Health”, LR20IPT02, Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (W.F.); (A.L.); (S.H.-B.); (Z.B.); (K.A.); (M.K.); (H.T.); (I.B.D.); (M.G.); (H.T.)
- Laboratory of Clinical Virology, WHO Reference Laboratory for Poliomyelitis and Measles in the Eastern Mediterranean Region, Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (S.B.H.); (H.K.)
- Clinical Investigation Center (CIC), Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (M.A.); (I.G.)
| | - Imen Ben Dhifallah
- Reasearch Laboratory “Virus, Vectors and Hosts: One Health Approach and Technological Innovation for a Better Health”, LR20IPT02, Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (W.F.); (A.L.); (S.H.-B.); (Z.B.); (K.A.); (M.K.); (H.T.); (I.B.D.); (M.G.); (H.T.)
- Laboratory of Clinical Virology, WHO Reference Laboratory for Poliomyelitis and Measles in the Eastern Mediterranean Region, Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (S.B.H.); (H.K.)
- Clinical Investigation Center (CIC), Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (M.A.); (I.G.)
| | - Fatma Z. Guerfali
- Laboratory of Transmission, Control and Immunobiology of Infections (LTCII) (LR16IPT02), Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1068, Tunisia; (F.Z.G.); (C.A.)
| | - Chiraz Atri
- Laboratory of Transmission, Control and Immunobiology of Infections (LTCII) (LR16IPT02), Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1068, Tunisia; (F.Z.G.); (C.A.)
| | - Saifeddine Azouz
- Genomics Plateform, Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1068, Tunisia;
| | - Oussema Khamessi
- Laboratoire de Venins et Biomolécules Thérapeutiques (LR16IPT08), Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1068, Tunisia;
| | - Monia Ardhaoui
- Clinical Investigation Center (CIC), Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (M.A.); (I.G.)
- Laboratory of Molecular Epidemiology & Experimental Pathology (LR16IPT04), Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1068, Tunisia
| | - Mouna Safer
- National Observatory of New and Emergent Diseases, Tunis 1002, Tunisia; (M.S.); (N.B.A.)
| | - Nissaf Ben Alaya
- National Observatory of New and Emergent Diseases, Tunis 1002, Tunisia; (M.S.); (N.B.A.)
| | - Ikram Guizani
- Clinical Investigation Center (CIC), Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (M.A.); (I.G.)
- Laboratory of Molecular Epidemiology & Experimental Pathology (LR16IPT04), Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1068, Tunisia
| | - Rym Kefi
- Laboratory of Biomedical Genomics and Oncogenetics (LR16IPT05), Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1068, Tunisia; (W.K.R.); (R.K.)
| | - Mariem Gdoura
- Reasearch Laboratory “Virus, Vectors and Hosts: One Health Approach and Technological Innovation for a Better Health”, LR20IPT02, Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (W.F.); (A.L.); (S.H.-B.); (Z.B.); (K.A.); (M.K.); (H.T.); (I.B.D.); (M.G.); (H.T.)
- Laboratory of Clinical Virology, WHO Reference Laboratory for Poliomyelitis and Measles in the Eastern Mediterranean Region, Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (S.B.H.); (H.K.)
- Clinical Investigation Center (CIC), Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (M.A.); (I.G.)
| | - Henda Triki
- Reasearch Laboratory “Virus, Vectors and Hosts: One Health Approach and Technological Innovation for a Better Health”, LR20IPT02, Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (W.F.); (A.L.); (S.H.-B.); (Z.B.); (K.A.); (M.K.); (H.T.); (I.B.D.); (M.G.); (H.T.)
- Laboratory of Clinical Virology, WHO Reference Laboratory for Poliomyelitis and Measles in the Eastern Mediterranean Region, Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (S.B.H.); (H.K.)
- Clinical Investigation Center (CIC), Institut Pasteur de Tunis, Université Tunis El Manar, Tunis 1002, Tunisia; (M.A.); (I.G.)
| |
Collapse
|
6
|
Kharroubi G, Cherif I, Bouabid L, Gharbi A, Boukthir A, Ben Alaya N, Ben Salah A, Bettaieb J. Influenza vaccination knowledge, attitudes, and practices among Tunisian elderly with chronic diseases. BMC Geriatr 2021; 21:700. [PMID: 34911475 PMCID: PMC8672335 DOI: 10.1186/s12877-021-02667-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 11/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Generally, seasonal influenza does not cause severe infection in healthy adults, but for the elderly, an infection can pose a serious health concern. Although several measures can help prevent influenza, vaccination is considered the most effective. This study aimed to assess influenza vaccine uptake among elderly with chronic diseases in Tunisia during the 2018-2019 influenza season, and to identify knowledge, attitudes and barriers associated with influenza vaccine uptake. METHODS During influenza season of 2018-2019, we conducted a national cross-sectional study among elderly with chronic disease who were attending primary and secondary health care facilities in Tunisia. We collected data regarding practices, general knowledge and attitudes related to influenza and influenza vaccine, using a standardized questionnaire. A multivariate analysis by logistic regression was performed to assess the factors influencing willingness to receive influenza vaccine. RESULTS Among the 1191 surveyed elderly, 19.4% (95%CI 14.1-21.9) were vaccinated during the 2018-2019 influenza season and 64.7% (61.9-67.3) expressed willingness to be vaccinated in the next season regardless of vaccination status in the 2018-2019 season. Previous vaccination in the 2018-2019 influenza season was the most significantly associated factor with willingness to receive influenza vaccine (adjusted OR = 16.5 [3.7-72.4]). Significant associations were also observed between knowledge of influenza severity for the elderly as well as for those with chronic diseases and willingness to be vaccinated (p < 0.01). Likewise, participants who were convinced by flu vaccine effectiveness and those who were not concerned about vaccine side effects were more likely to be vaccinated (p < 0.001). The main reason that may lead to vaccine acceptance was a doctor's recommendation (41.1%), while the two main reasons that may lead to vaccine refusal were concerns about side effects (71.5%) and a belief that vaccine was ineffective in averting influenza illness (33.9%). Doctors were the most trusted source for information about influenza vaccine (91.5%). CONCLUSION Our study revealed low influenza vaccination coverage among Tunisian elderly with chronic diseases believed to be at higher risk for severe acute respiratory infections and death if infected with influenza. Treating physicians' role in promoting influenza vaccination in this high-risk group seems to be crucial.
Collapse
Affiliation(s)
- Ghassen Kharroubi
- Laboratory of Medical Epidemiology, Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, 1002, Belvédère, Tunis, Tunisia.,Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, Tunis, Tunisia
| | - Ines Cherif
- Laboratory of Medical Epidemiology, Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, 1002, Belvédère, Tunis, Tunisia.,Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, Tunis, Tunisia
| | - Leila Bouabid
- National Observatory of New and Emerging Diseases, Tunis, Tunisia
| | - Adel Gharbi
- Laboratory of Medical Epidemiology, Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, 1002, Belvédère, Tunis, Tunisia.,Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, Tunis, Tunisia
| | - Aicha Boukthir
- Laboratory of Medical Epidemiology, Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, 1002, Belvédère, Tunis, Tunisia.,Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, Tunis, Tunisia
| | - Nissaf Ben Alaya
- National Observatory of New and Emerging Diseases, Tunis, Tunisia
| | - Afif Ben Salah
- Laboratory of Medical Epidemiology, Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, 1002, Belvédère, Tunis, Tunisia.,Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, Tunis, Tunisia.,Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Jihene Bettaieb
- Laboratory of Medical Epidemiology, Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, 1002, Belvédère, Tunis, Tunisia. .,Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, Tunis, Tunisia.
| |
Collapse
|
7
|
Samy S, Lami F, Rashak HA, Al Nsour M, Eid A, Khader YS, Afifi S, Elfadul M, Ghaleb Y, Letaief H, Alaya NB, Ikram A, Akhtar H, Barkia A, Taha HA, Adam R, Saeed KMI, Almudarra SS, Hassany M, El Sood HA, ur Rahman F, Saaed FAK, Hlaiwah MS. Public health workers' knowledge, attitude and practice regarding COVID-19: the impact of Field Epidemiology Training Program in the Eastern Mediterranean Region. J Public Health (Oxf) 2021; 43:iii1-iii11. [PMID: 34580723 PMCID: PMC8500047 DOI: 10.1093/pubmed/fdab240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/22/2021] [Accepted: 06/08/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This study aimed to compare knowledge, attitude and practice (KAP) regarding COVID-19 between public health workers (PHWs) attended field epidemiology training program (FETP-trained) and those who did not attend FETP (non-FETP trained). METHODS Multi-country cross-sectional survey was conducted among PHWs who participated in COVID-19 pandemic in 10 countries at EMR. Online questionnaire that included demographic information, KAP regarding COVID-19 pandemic was distributed among HCWs. Scoring system was used to quantify the answers, bivariate and Multivariate analysis performed to compare FETP-trained with non-FETP trained PHWs. RESULTS Overall, 1337 PHWs participated, with 835 (62.4%) < 40 years of age, and 851 (63.6%) males. Of them, 423 (31.6%) had FETP, including that 189 (44.7%) had advanced level, 155 (36.6%) intermediate and 79 (18.7%) basic level training. Compared with non-FETP trained, FETP trained were older, having higher KAP scores. FETP participation was low in infection control, and PH laboratories. KAP mean scores for intermediate level attendees are comparable to advanced level. CONCLUSIONS FETP-trained are having better KAP than non-FETP PHWs. Expanding the intermediate level, maintain the Rapid Response training and introduce the laboratory component are recommended to maximize the benefit from FETP. Infection control, antimicrobial resistance and coordination are areas where training should include.
Collapse
Affiliation(s)
- Sahar Samy
- Communicable Disease Control Department, Preventive sector, Ministry of Health and Population, Cairo, Egypt
| | - Faris Lami
- Community and Family Medicine, University of Baghdad, Iraq
| | | | - Mohannad Al Nsour
- Global Health Development (GHD)|The Eastern Mediterranean Public Health Network (EMPHNET), Amman, Jordan
| | - Alaa Eid
- Preventive sector, Ministry of Health and Population, Cairo, Egypt
| | - Yousef S Khader
- Department of Public Health, Jordan University of Science & Technology
| | - Salma Afifi
- Department of Epidemiology and Surveillance, Preventive sector, Ministry of Health and Population, Cairo, Egypt
| | - Maisa Elfadul
- Public Health Institute, Federal Ministry of Health, Sudan
| | - Yasser Ghaleb
- Field Epidemiology Training Program, Ministry of Public Health and Population, Sana'a, Yemen
| | - Hajer Letaief
- National Observatory of New and Emerging Diseases, Tunis, Tunisia
| | | | - Aamer Ikram
- National Institute of Health, Islamabad, Pakistan
| | - Hashaam Akhtar
- Yusra Institute of Pharmaceutical Sciences, Yusra Medical and Dental Collage, Islamabad, Pakistan
| | | | - Hana Ahmad Taha
- Global Health Development (GHD)|The Eastern Mediterranean Public Health Network (EMPHNET), Amman, Jordan
| | - Reema Adam
- Public Health Institute, Federal Ministry of Health, Sudan
| | | | - Sami S Almudarra
- Field Epidemiology Training Program, Saudi Ministry of Health, Riyadh, Saudi Arabia
| | - Mohamed Hassany
- National Hepatology and Tropical Medicine Research Institute, Ministry of Health and Population, Cairo, Egypt
| | - Hanaa Abu El Sood
- Department of Epidemiology and Surveillance, Preventive sector, Ministry of Health and Population, Cairo, Egypt
| | | | | | | |
Collapse
|
8
|
Fares W, Chouikha A, Ghedira K, Gdoura M, Rezig D, Boubaker SH, Dhifallah IB, Touzi H, Hammami W, Meddeb Z, Sadraoui A, Hogga N, Abouda I, Kwasiborski A, Hourdel V, Mikaty G, Caro V, Manuguerra JC, Alaya NB, Triki H. Whole genome sequencing and phylogenetic analysis of six SARS-CoV-2 strains isolated during COVID-19 pandemic in Tunisia, North Africa. BMC Genomics 2021; 22:540. [PMID: 34261445 PMCID: PMC8278182 DOI: 10.1186/s12864-021-07870-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/05/2021] [Indexed: 12/28/2022] Open
Abstract
Background In Tunisia a first SARS-CoV-2 confirmed case was reported in March 03, 2020. Since then, an increase of cases number was observed from either imported or local cases. The aim of this preliminary study was to better understand the molecular epidemiology and genetic variability of SARS-CoV-2 viruses circulating in Tunisia and worldwide. Methods Whole genome sequencing was performed using NGS approach on six SARS. CoV-2 highly positive samples detected during the early phase of the outbreak. Results Full genomes sequences of six Tunisian SARS-CoV-2 strains were obtained from imported and locally transmission cases during the COVID-19 outbreak. Reported sequences were non-identical with 0.1% nucleotide divergence rate and clustered into 6 different clades with worldwide sequences. SNPs results favor the distribution of the reported Tunisian sequences into 3 major genotypes. These SNP mutations are critical for diagnosis and vaccine development. Conclusions These results indicate multiple introductions of the virus in Tunisia and add new genomic data on SARS-CoV-2 at the international level.
Collapse
Affiliation(s)
- Wasfi Fares
- Laboratory of Clinical Virology, Institut Pasteur, University Tunis-El Manar, Tunis, Tunisia.
| | - Anissa Chouikha
- Laboratory of Clinical Virology, Institut Pasteur, University Tunis-El Manar, Tunis, Tunisia
| | - Kais Ghedira
- Laboratory of Bioinformatics, Biomathematics and Biostatistics (BIMS), Institut Pasteur Tunis, Tunis, Tunisia
| | - Meriam Gdoura
- Laboratory of Clinical Virology, Institut Pasteur, University Tunis-El Manar, Tunis, Tunisia
| | - Dorra Rezig
- Laboratory of Clinical Virology, Institut Pasteur, University Tunis-El Manar, Tunis, Tunisia
| | - Sondes Haddad Boubaker
- Laboratory of Clinical Virology, Institut Pasteur, University Tunis-El Manar, Tunis, Tunisia
| | - Imen Ben Dhifallah
- Laboratory of Clinical Virology, Institut Pasteur, University Tunis-El Manar, Tunis, Tunisia
| | - Henda Touzi
- Laboratory of Clinical Virology, Institut Pasteur, University Tunis-El Manar, Tunis, Tunisia
| | - Walid Hammami
- Laboratory of Clinical Virology, Institut Pasteur, University Tunis-El Manar, Tunis, Tunisia
| | - Zina Meddeb
- Laboratory of Clinical Virology, Institut Pasteur, University Tunis-El Manar, Tunis, Tunisia
| | - Amel Sadraoui
- Laboratory of Clinical Virology, Institut Pasteur, University Tunis-El Manar, Tunis, Tunisia
| | - Nahed Hogga
- Laboratory of Clinical Virology, Institut Pasteur, University Tunis-El Manar, Tunis, Tunisia
| | - Imen Abouda
- Laboratory of Clinical Virology, Institut Pasteur, University Tunis-El Manar, Tunis, Tunisia
| | - Aurélia Kwasiborski
- Laboratory for Urgent Response to Biological Threats (CIBU), Environment and Infectious Risks (ERI) research and expertise unit, Institut Pasteur, Paris, France
| | - Véronique Hourdel
- Laboratory for Urgent Response to Biological Threats (CIBU), Environment and Infectious Risks (ERI) research and expertise unit, Institut Pasteur, Paris, France
| | - Guillain Mikaty
- Laboratory for Urgent Response to Biological Threats (CIBU), Environment and Infectious Risks (ERI) research and expertise unit, Institut Pasteur, Paris, France
| | - Valérie Caro
- Laboratory for Urgent Response to Biological Threats (CIBU), Environment and Infectious Risks (ERI) research and expertise unit, Institut Pasteur, Paris, France
| | - Jean-Claude Manuguerra
- Laboratory for Urgent Response to Biological Threats (CIBU), Environment and Infectious Risks (ERI) research and expertise unit, Institut Pasteur, Paris, France
| | - Nissaf Ben Alaya
- National Observatory for New and Emerging Diseases, Ministry of Health, Tunis, Tunisia.,Faculty of Medicine, University Tunis-El Manar, Tunis, Tunisia
| | - Henda Triki
- Laboratory of Clinical Virology, Institut Pasteur, University Tunis-El Manar, Tunis, Tunisia.,Faculty of Medicine, University Tunis-El Manar, Tunis, Tunisia
| |
Collapse
|
9
|
Haj Amor S, Beaney T, Saidi O, Clarke J, Poulter NR, Ben Alaya N, Ben Romdhane H. May Measurement Month 2019: an analysis of blood pressure screening results from Tunisia. Eur Heart J Suppl 2021; 23:B144-B146. [PMID: 34248439 PMCID: PMC8263087 DOI: 10.1093/eurheartj/suab032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We performed a May Measurement Month (MMM) screening campaign among adult volunteers aged 18 years old and over in Tunisia. The objective was to raise awareness, and to estimate the prevalence, awareness, treatment, and control of hypertension, one of the main cardiovascular risk factors. Following the MMM protocol, three blood pressure (BP) measurements were taken by physicians and standard interviewing procedures were used to record medical history, socio-demographic, and cardiovascular disease risk factors. Hypertension was defined as a systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg or treatment with antihypertensive medication. From 11 271 adults screened, the prevalence of hypertension was 38.1%. Among those with hypertension, 72.5% were aware of their diagnosis, and 67.5% were treated. BP control was achieved in only 38.2% of all those with hypertension. The study highlights the magnitude of hypertension in Tunisia. There is an urgent need for implementing a comprehensive integrated population-based intervention programme to ameliorate the growing problem of hypertension.
Collapse
Affiliation(s)
- Sina Haj Amor
- Regional Directorate of Health of Tunis, Carthage Health District, Rue Ibn El haythem, 2045 Tunis, Tunisia.,Cardiovascual Diseases Epidemiology and Prevention Research Laboratory, Faculty of Medicine of Tunis, University Tunis El Manar, 15 Djebel Lakhdar Street, La Rabta, 1007 Tunis, Tunisia
| | - Thomas Beaney
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK.,Department of Primary Care and Public Health, Imperial College London, St Dunstan's Road, London W6 8RP, UK
| | - Olfa Saidi
- World Health Organization-Tunisia, El Mahrajene, 1082 Tunis, Tunisia
| | - Jonathan Clarke
- Department of Mathematics, Huxley Building, South Kensington Campus, Imperial College London, London SW7 2AZ, UK
| | - Neil R Poulter
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Nissaf Ben Alaya
- Cardiovascual Diseases Epidemiology and Prevention Research Laboratory, Faculty of Medicine of Tunis, University Tunis El Manar, 15 Djebel Lakhdar Street, La Rabta, 1007 Tunis, Tunisia.,National Observatory for New and Emerging Diseases, 5-7 Khartoum Street, Belvedre 1002 Tunis, Tunisia
| | - Habiba Ben Romdhane
- Cardiovascual Diseases Epidemiology and Prevention Research Laboratory, Faculty of Medicine of Tunis, University Tunis El Manar, 15 Djebel Lakhdar Street, La Rabta, 1007 Tunis, Tunisia
| | | |
Collapse
|
10
|
Cherif I, Kharroubi G, Bouabid L, Gharbi A, Boukthir A, Ben Alaya N, Ben Salah A, Bettaieb J. Knowledge, attitudes and uptake related to influenza vaccine among healthcare workers during the 2018-2019 influenza season in Tunisia. BMC Public Health 2021; 21:907. [PMID: 33980192 PMCID: PMC8116062 DOI: 10.1186/s12889-021-10970-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/04/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The influenza vaccine (IV) is considered the most effective strategy to prevent seasonal influenza infection and annual vaccination of healthcare workers (HCWs) is recommended by the World Health Organization given their high mixing with patients. We assessed IV uptake among HCWs in the 2018-2019 season and explored their knowledge and attitudes regarding influenza immunization. METHODS A cross-sectional study was conducted in 150 representative Tunisian health facilities from March to May 2019. We recruited 1231 HCWs with direct patient contact using self-weighted multistage sampling. Univariate and multivariate logistic regression analyses permitted to assess the factors associated with IV uptake in the 2018-2019 influenza season. RESULTS Among 1231 health professionals enrolled in this study, less than half (36.6, 95% confidence interval [CI]: 33.9-39.4) received the IV at least once in their lives and only 15.3% (CI: 13.3-17.4) were vaccinated against influenza in the 2018-2019 influenza season. High confidence regarding IV efficacy, belief about the mandatory character of influenza vaccination for HCWs, and IV uptake in the 4 years preceding the 2018-2019 influenza season were independently associated with higher IV uptake by multivariate analysis. However, participants with high educational level were less likely to receive the IV than those with the lowest educational level. CONCLUSIONS Our study revealed a low vaccination rate among Tunisian HCWs confirming the importance of tailored education programs targeting this population.
Collapse
Affiliation(s)
- Ines Cherif
- Laboratory of Medical Epidemiology, Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, Belvédère, 1002, Tunis, Tunisia.,Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, Belvédère, 1002, Tunis, Tunisia
| | - Ghassen Kharroubi
- Laboratory of Medical Epidemiology, Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, Belvédère, 1002, Tunis, Tunisia.,Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, Belvédère, 1002, Tunis, Tunisia
| | - Leila Bouabid
- National Observatory of New and Emerging Diseases, 5-7, Khartoum Street, Diplomat, 13th floor, Le Belvédère, 1002, Tunis, Tunisia
| | - Adel Gharbi
- Laboratory of Medical Epidemiology, Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, Belvédère, 1002, Tunis, Tunisia.,Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, Belvédère, 1002, Tunis, Tunisia
| | - Aicha Boukthir
- Laboratory of Medical Epidemiology, Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, Belvédère, 1002, Tunis, Tunisia.,Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, Belvédère, 1002, Tunis, Tunisia
| | - Nissaf Ben Alaya
- National Observatory of New and Emerging Diseases, 5-7, Khartoum Street, Diplomat, 13th floor, Le Belvédère, 1002, Tunis, Tunisia
| | - Afif Ben Salah
- Laboratory of Medical Epidemiology, Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, Belvédère, 1002, Tunis, Tunisia.,Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, Belvédère, 1002, Tunis, Tunisia.,Arabian Gulf University, Road 2904 Building 293, Manama, 329, Bahrain
| | - Jihene Bettaieb
- Laboratory of Medical Epidemiology, Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, Belvédère, 1002, Tunis, Tunisia. .,Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, Belvédère, 1002, Tunis, Tunisia.
| |
Collapse
|
11
|
Saidi O, Malouche D, Saksena P, Arfaoui L, Talmoudi K, Hchaichi A, Bouguerra H, Romdhane HB, Hsairi M, Ouhichi R, Souteyrand Y, Alaya NB. Impact of contact tracing, respect of isolation, and lockdown in reducing the number of cases infected with COVID-19. Case study: Tunisia's response from March 22 to May 4, 2020. Int J Infect Dis 2021; 113:26-33. [PMID: 33578008 PMCID: PMC7872851 DOI: 10.1016/j.ijid.2021.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/29/2020] [Accepted: 02/02/2021] [Indexed: 11/21/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) has spread rapidly across the world. Tunisia reacted early to COVID-19, resulting in a low number of infections during the first wave of the pandemic. This study was performed to model the effects of different interventions on the evolution of cases and to compare these with the Tunisian experience. Methods A stochastic transmission model was used to quantify the reduction in number of cases of COVID-19 with the interventions of contact tracing, compliance with isolation, and a general lockdown. Results In the model, increasing contact tracing from 20% to 80% after the first 100 cases reduced the cumulative number of infections (CNI) by 52% in 1 month. Similarly, increased compliance with isolation from 20% to 80% after the first 100 cases reduced the CNI by 45%. These reductions were smaller if the interventions were implemented after 1000 cases. A general lockdown reduced the CNI by 97% after the first 100 cases. Tunisia implemented its general lockdown after 75 cases were confirmed, which reduced the cumulative number of infected cases by 86% among the general population. Conclusions This study shows that the early application of critical interventions contributes significantly to reducing infections and the evolution of COVID-19 in a country. Tunisia’s early success with the control of COVID-19 is explained by its quick response.
Collapse
Affiliation(s)
| | - Dhafer Malouche
- Higher School of Statistics and Data Analysis, University of Carthage, Tunisia
| | | | | | | | - Aicha Hchaichi
- National Observatory for New and Emerging Diseases (NONED), Tunisia
| | - Hend Bouguerra
- National Observatory for New and Emerging Diseases (NONED), Tunisia
| | | | - Mohamed Hsairi
- Tunisian Society of Epidemiologists, Faculty of Medicine Tunis, University El Manar, Tunisia
| | | | | | - Nissaf Ben Alaya
- National Observatory for New and Emerging Diseases (NONED), Tunisia
| | | |
Collapse
|
12
|
Araj R, Odatallah A, Mofleh J, Samy S, Ben Alaya N, Alqasrawi S. Rapid Response Teams' Initiative: Critical Role and Impact on National and Eastern Mediterranean Regional Emergency Management Capacity Building. JMIR Public Health Surveill 2019; 5:e14349. [PMID: 31621636 PMCID: PMC6822060 DOI: 10.2196/14349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/22/2019] [Accepted: 07/13/2019] [Indexed: 11/13/2022] Open
Abstract
Rapid response teams (RRTs) are essential to contain the harmful effects of emergency situations and to coordinate actions in the fragile environment of the Eastern Mediterranean region (EMR). The Global Health Development and the Eastern Mediterranean Public Health Network (EMPHNET) implemented RRTs to fill the human resources gap and to enable the member states to build their capacity in rapid assessment and response to public health events to reduce human suffering. To build the capacity of the member states in the field of rapid response and to build a strong team of rapid response specialists at the regional level, EMPHNET implemented this initiative at two levels. The first was a basic regional RRT course (July 2012). It was an introductory course for the selected candidates to provide insight and to enhance the knowledge and skills needed to be part of an RRT. The training included 32 participants from nine EMR countries. The course was designed to allow the facilitators and selection committee to select 15 to 20 potential candidates for the advanced RRT course. The second was the advanced RRT course (September 2010 to October 2012) for training the trainers and preparing the RRTs for deployment. A series of RRT training workshops were held, with more than 650 health staff from 12 countries trained. In all workshops that were conducted during 2016-2017, the trainees showed significant improvement in their knowledge and skills.
Collapse
Affiliation(s)
- Rawan Araj
- Global Health Development and the Eastern Mediterranean Public Health Network, Amman, Jordan
| | - Ali Odatallah
- Global Health Development and the Eastern Mediterranean Public Health Network, Amman, Jordan
| | | | | | | | - Sultan Alqasrawi
- Directorate of Communicable Diseases, Jordan Ministry of Health, Amman, Jordan
| |
Collapse
|
13
|
Abusrewil S, Algeer A, Aljifri A, Al Slail F, Andrew MK, Awad Tag Eldin M, Al Awaidy S, Ben Alaya N, Ben Khelil J, Dbaibo G, Derrar F, Elahmer O, Ghosn N, Gabriel G, Grasso C, Hassan M, Hirve S, Mirza YK, Rateb YM, Nourlil J, Nunes MC, Omaima I, Malande OO, Saadatian-Elahi M, Sanchez-Picot V, Sk Mamunur Rahman M, Tarraf H, Walaza S. Influenza surveillance in Middle East, North, East and South Africa: Report of the 8th MENA Influenza Stakeholders Network. Influenza Other Respir Viruses 2019; 13:298-304. [PMID: 30801995 PMCID: PMC6468068 DOI: 10.1111/irv.12628] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 12/18/2018] [Indexed: 01/24/2023] Open
Abstract
The Middle‐East and Africa Influenza Surveillance Network (MENA‐ISN), established in 2014, includes 15 countries at present. Country representatives presented their influenza surveillance programmes, vaccine coverage and influenza control actions achieved, and provided a list of country surveillance/control objectives for the upcoming 3 years. This report details the current situation of influenza surveillance and action plans to move forward in MENA‐ISN countries. Data were presented at the 8th MENA‐ISN meeting, organized by the Mérieux Foundation that was held on 10‐11 April 2018 in Cairo, Egypt. The meeting included MENA‐ISN representatives from 12 countries (Algeria, Egypt, Jordan, Kenya, Lebanon, Libya, Morocco, Pakistan, Saudi Arabia, South Africa, Tunisia and United Arab Emirates) and experts from the Canadian Centre for Vaccinology, and the World Health Organization. Meeting participants concluded that influenza remains a significant threat especially in high‐risk groups (children under‐5, elderly, pregnant women and immunosuppressed individuals) in the MENA‐ISN region. Additional funding and planning are required by member countries to contain this threat. Future meetings will need to focus on creative and innovative ways to inform policy and initiatives for vaccination, surveillance and management of influenza‐related morbidity and mortality especially among the most vulnerable groups of the population.
Collapse
Affiliation(s)
| | - Abdulrahman Algeer
- Medical services directorate of the armed forces/Ministry of defense, Riyadh, Saudi Arabia
| | | | | | - Melissa K Andrew
- Dalhousie University and Canadian Centre for Vaccinology, Halifax, Canada
| | | | | | | | | | | | | | - Omar Elahmer
- National Centre for Disease Control, Tripoli, Libya
| | - Nada Ghosn
- Ministry of Public Health, Beirut, Lebanon
| | - Guelsah Gabriel
- Heinrich Pette Institute, Leibniz Institute for Experimental Virology, Hamburg, Germany
| | | | - Mohamed Hassan
- Ministry of Health and Prevention, Abou Dabi, United Arab Emirates
| | | | | | | | | | - Marta C Nunes
- Faculty of Health Science, Department of Science/National Research Foundation: Vaccine Preventable Diseases Unit, Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Idris Omaima
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Oliver Ombeva Malande
- Egerton University, Nakuru, Kenya & East Africa Centre for Vaccines and Immunization (ECAVI), Egerton, Kenya
| | | | | | | | | | - Sibongile Walaza
- National Institute of Communicable Disease (NICD), Johannesburg, South Africa
| |
Collapse
|
14
|
Bellabah A, Benkirane A, Ibrahimi A, Nakhli A, Sair A, Nakhli A, Essaid A, Blel A, Ibrahimi A, Lahchaichi A, Ben Slama A, Ouni A, Amouri A, Jemaa A, Cherif A, Khsiba A, Hssine A, Djobbi A, Guedich A, Laabidi A, Mensi A, Ouakaa A, Sriha A, Choukri A, Green A, Belkhamsa A, Hammami A, Bourigua A, Filali A, Belabeh A, Ouakaa A, Sentissi A, Ait Errami A, Nadi A, Filankembo A, Lamine A, Badre W, Ben Kaab B, Ben Slimane B, S B, Hasnaoui B, Bouchabou B, Bouguerra C, Baccouche C, Ayadi C, Bennasrallah C, Benajah D, Gargouri D, Zehi D, Issaoui D, Cherif D, Ben Ghachem D, Trad D, Bouaiti E, Boutouria E, Bel Hadj Mabrouk E, Chalbi E, Aait E, Bouhamou F, Haddad F, Lairani F, Saffar F, Torjmen F, Haj Kacem F, Hamdane F, Chabib FZ, Elrhaoussi FZ, Moumayez FZ, Loukil F, Ahmed Djouldé Diallo F, Aissaoui F, Ajana F, Chabib F, Hamdoun F, Moumayez F, Hamdane F, Haddad F, Bennani Kella G, Bennani G, Abid H, Cheikhani H, Ouazzani H, Romdhane H, Seddik H, Sghir H, Debbabi H, Ben Jeddi H, Garraoui H, Letaief H, Kchir H, Elloumi H, Hammami H, Jaziri H, Ben Abdallah H, Chaabouni H, Ben Romdhane H, Yacoub H, Ben Jeddi H, Elloumi H, Gdoura H, Kchir H, Sahli H, Loghmari H, Bouguerra H, Maghrebi H, Ben Nejma H, Jlassi H, Elloumi H, Fourati H, Alaoui H, Ismail H, Benelbarhdadi I, Cohen I, Errabih I, Koti I, Doghri I, Cohen I, Elhidaoui I, Haraki I, Cheikh I, Abdelaali I, Jemni I, Bouennene I, Akoch I, H I, Boubaker J, Krati K, Eljery K, Temani K, Bellil K, Chabbouh K, Boughoula K, Ouazzani L, Ben Yaghlene L, Kallel L, A L, Hamzaoui L, Chtourou L, Ben Farhat L, Bouabid L, Mnif L, Mouelhi L, Safer L, Zouiten Mekki L, Bourehma M, El Akbari M, El Khayari M, Elyousfi M, Firwana M, Lahlali M, Tahiri M, Mestouri M, Abdelwahed M, Ben Hamida M, Ben Chaabane M, Moalla M, Yakoubi M, Sabbah M, Serghini M, Amri M, Ben Abbes M, Ben Cheikh M, Ghribi M, Hafi M, El Khayari M, Ben Abdelwahed M, Ksiaa M, Essid M, Zakhama M, Yousfi M, Sabbah M, Ayari M, Belhadj M, Cheickh M, Kacem M, Horma Alaoui M, Abid M, Bennour MA, Ghanem M, Loghmari MH, Douggui MH, Azouz MM, Abdelli MN, Boudabous M, Feki M, Fekih M, Kacem M, Mahmoudi M, Boudabbous M, Figuigui M, Medhioub M, Safer M, Azzouz M, Yakoubi M, Abbes M, Amri M, El Abkari M, Aqodad N, Azib N, Bellil N, Benhoumane N, Benzoubbeir N, Elkhabiz N, Hemdani N, Lahmidani N, Abdelli N, Ben Chaabane N, Tahri N, Azib N, Benhoummane N, Ben Jaafar N, Ben Mustapha N, Maamouri N, Elkhabiz N, Bellil N, Hannachi N, Hemdani N, Ben Alaya N, Bibani N, Trad N, Elleuch N, Lahmidani N, Kharmach O, Bahri O, Bousnina O, Gharbi O, Kharmach O, Benjira R, Ennaifer R, Dabbèche R, Jouini R, Zgolli R, Baklouti R, Bouali Mohamed R, Marouani R, Kallel R, Ennaifer R, Berrag S, El Yazal S, Jiddi S, Mechhour S, Morabit S, Oubaha S, Sentissi S, Bouaziz S, Soua S, Hachicha S, Elaboudi S, Ajmi S, Mallat S, Bouchoucha S, Mrabti S, Ben Slama S, Hamdi S, Laabidi S, Ayadi S, Hidri S, Bizid S, Ben Hamida S, Zertiti S, Ben Amor S, Nsibi S, Bellakhal S, Bahja S, Jomni T, Hliwa W, Rebai W, Ben Mansour W, Ben Othmen W, Dhouib W, Hammoumi W, Zaatour W, Bouhlel W, Feki W, Triki W, Said Y, Zaimi Y, Gorgi Y, Bouhnoun Z, Samlani Z, Hamidi Z, Mnif Z, Ben Safta Z. Oral communication and poster abstracts of the 22nd National Congress of Gastroenterology joint to the 4th Maghrebian Congress of Gastroenterology. December 2018. Tunis Med 2018; 96:932-1007. [PMID: 31131873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
|
15
|
Soussi G, Ben Alaya N, Chaouch N, Racil H. Development and validation of a prognostic index for survival in non-small cell lung cancer: Results from a Tunisian cohort study. Cancer Epidemiol 2018; 53:111-118. [PMID: 29414630 DOI: 10.1016/j.canep.2018.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 01/09/2018] [Accepted: 01/27/2018] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Despite the continuous efforts made with the TNM system, the issue of heterogeneity of prognosis within the stages of non-small cell lung cancer (NSCLC) could not be resolved. Our aim was to identify prognostic factors and develop an index to predict NSCLC survival with greater accuracy. METHODS We conducted a survival study over 5 years on patients with NSCLC. Kaplan-Meier analysis followed by Cox regression modelling were used. Prognostic indices were derived, using either an additive or a multiplicative pattern, and were compared by their receiver operating characteristics (ROC) curves. We then proceeded to a risk stratification and validation of the index on the derivation cohort. RESULTS Two hundred and sixty-two NSCLC patients were included. Two models were constructed, using the following nine variables as prognostic factors: age, performance status, haemoglobin level, leucocyte count, calcium, lactate dehydrogenase, alkaline phosphatase levels, histological type and TNM stage. Four prognostic indices were derived, and the best one was picked and validated on a population of five risk groups. The higher the risk group, the shorter the survival. CONCLUSIONS This novel and simple prognostic tool could predict survival more accurately in patients with NSCLC.
Collapse
Affiliation(s)
- Ghassen Soussi
- Department of Pulmonary Medicine II, Abderrahmen Mami Hospital, 2080 Ariana, Tunisia.
| | - Nissaf Ben Alaya
- National Observatory of New and Emerging Diseases, 5-7, Khartoum Street, Diplomat Complex, Block 4, 13th Floor, Belvedere, 1002 Tunis, Tunisia.
| | - Nawel Chaouch
- Department of Pulmonary Medicine II, Abderrahmen Mami Hospital, 2080 Ariana, Tunisia.
| | - Hajer Racil
- Department of Pulmonary Medicine II, Abderrahmen Mami Hospital, 2080 Ariana, Tunisia.
| |
Collapse
|
16
|
Ennaifer E, Salhi F, Laassili T, Fehri E, Ben Alaya N, Guizani I, Boubaker S. Type-Specific Human Papillomavirus Distribution in Invasive Squamous Cervical Carcinomas in Tunisia and Vaccine Impact. Asian Pac J Cancer Prev 2016; 16:6769-72. [PMID: 26434909 DOI: 10.7314/apjcp.2015.16.15.6769] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High risk human papillomaviruses (HPVs) are the leading cause of cervical cancer (CC) and Pap smear screening has not been successful in preventing CC in Tunisia. HPV vaccination that targets HPV16 and 18 offers a new efficient prevention tool. Identification of HPV types in CC is thus essential to determine the impact of HPV vaccine implementation. The aim of this study is to provide specific data from Tunisia. MATERIALS AND METHODS A total of 89 histological confirmed paraffin embedded samples isolated from patients with CC diagnosed between 2001 and 2011 were collected from five medical centres from Northern and Southern Tunisia. HPV DNA was detected using a nested PCR (MY09/MY11-GP5+/GP6+) and genotyping was assessed using a reverse blot line hybridisation assay that enables the detection of 32 HPV types. RESULTS HPV DNA was detected in all samples. Twelve high risk types were detected; HPV16 and/or 18 were predominant, accounting together for 92.1% of all the CC cases (HPV16: 83.1%). Single infections accounted for 48.8% of the cases and were mostly linked to HPV 16 (32.6%) and less frequently to HPV 18 (2.4%). The other high risk HPV single infections were linked to HPV 35 (4.6%), 45 (4.6%), 58 (2.3%) and 59 (2.3%). Multiple infections with mixing of 2 to 4 genotypes predominately featrued HPV16 and/or 18 with HPV 35 and 45 (96.6 %) and less frequently with HPV 59, 40, 66, 73 and 58. There was no statistically significant variation in the relative distribution of HPV types with age. CONCLUSIONS These results strongly indicate that prophylactic HPV vaccines can have a major impact in preventing CC in Tunisia.
Collapse
Affiliation(s)
- Emna Ennaifer
- HPV Research Unit, Laboratory of Molecular Epidemiology and Experimental Pathology Applied to Infectious Diseases, Pasteur Institute of Tunis, Tunis, Tunisia *E-mail : ,
| | | | | | | | | | | | | |
Collapse
|
17
|
Gzara Zargouni A, Tej Dellagi R, Ben Alaya N, Ben Jemaa N, Gamara D, Ben Salah A, Triki H, Kallel K, Chaker E, Rachdi MT. [Indigenous malaria in Tunisia: 4 cases registered in 2013 in Tunisia]. Tunis Med 2015; 93:543-547. [PMID: 26815521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Malaria has been eliminated in Tunisia since 1979, but the country remains, like all other countries harboring the vector, exposed to the potential risk of resurgence. OBJECTIVES Describe the clinical and epidemiological investigation of 4 cases of autochthonous malaria in July 2013 and report the main actions of regional and national response. METHODS Retrospective descriptive survey of the 4 clinical observations as well as the study of the regional report data of basic health care for the region of Tunis in 2013. RESULTS Febrile table concomitant for 4 Tunisian male patients, aged from 21 to 27 years old ; fortuitous discovery of Plasmodium falciparum when checking thrombocytopenia of patient 1 ; diagnosis in cascade of other cases following the epidemiological investigation and field consultation with clinicians ; 3 simple forms and a neuromalaria of favorable evolution ; negative entomological survey for anopheles ; elimination of imported malaria and blood-borne ; airport malaria highly probable. The response included the establishment of a regional and national monitoring unit, an information program aimed at health professionals concerned and public opinion, the involvement of health and entomology teams for the detection and census of potential larval habitats and the implementation of local mosquito eradication measures. CONCLUSION The clinical vigilance and competent biologist's eye is necessary to prevent the resurgence of this disease. The epidemiological surveillance system should be maintained and kept as well as the food safety standards monitoring at the borders.
Collapse
|
18
|
Bellali H, Zaghouani R, Ben Alaya N, Chahed MK. [Emergency department visits for respiratory symptoms in greater Tunisia, 2007 and 2010]. Tunis Med 2015; 93:465-469. [PMID: 26757505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Asthma and Chronic Obstructive pulmonary Disease (COPD) are considered as a major public health problem worldwide. They are characterized by a progressive evolution with episodes of exacerbations. OBJECTIVE The aim of this work was to describe the emergency department visits for asthma and COPD according to sociodemographic characteristics of patients and to assess trends over time. METHODS We conducted a cross sectional study including all emergency department visits of the Abderrahmane Mami hospital during the period between January, 1st 2007 and the 31th of December 2010. We used a standardized questionnaire to collect age; sex and date of emergency department visits with a primary diagnosis of asthma and COPD exacerbation from the emergency register. Data analyses were performed with SPSS 17.0. RESULTS A total of 9814 emergency department visits were reported over the period of four years, 6499 (66,2%) for asthma and 3315 (33,8%) for COPD exacerbation. The mean age was 52±21 years; it was for asthma and COPD respectively 48±21 and 60±18 years. Aging was associated with a marked decrease in the prevalence of asthma (from 51.0% to 25.6%) and with a marked increase in the prevalence of COPD (from 6.8% to 47.5%). Men visit most frequently the emergency department for both diseases than women and particularly for COPD where the proportion of men was 75%. The number of visits increased steadily between 2007 and 2010, it peaked in January for asthma and in February for COPD and it was most important on the period from December to May. CONCLUSION Asthma was most common among emergency department visits than COPD exacerbation, it affects men and women in a nearly same proportions and it is most frequent in young adults aged between 30 and 65 years. COPD exacerbation is most frequent in men aged over 65 years. Our study suggests that there is significant seasonal variation in the emergency department visits for respiratory illness. These findings suggest that greater attention and most adapted studies should be necessary to explain and to identify factors implied in these variations.
Collapse
|
19
|
Chahed MK, Bellali H, Ben Alaya N, Aoun K, Zouari B. [High risk areas for echinococcosis-hydatidosis in Tunisia]. Tunis Med 2015; 93:33-37. [PMID: 25955367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM The study was conducted in order to identify high risk areas for hydatidosis in Tunisia witch would be eligible for a Hydatidosis control program initiation. METHODS The most recent epidemiological investigation on surgical incidence of hydatidosis was used to classify governorates according to their incidence rate. A "global hydatidosis risk score" was calculated for each governorate, combining some parameters related to the hygiene conditions of the population, the literacy rate, the canine density and livestock census. Spearman correlation coefficient was used to compare scores and surgical incidences. Mapping analysis has been conducted. The surgical incidence rate of hydatidosis classifies each governorate regarding occurrence of human cases. The global hydatidosis risk score, by governorate, pointed out the most exposed areas to the disease. RESULTS The mapping analysis showed a good agreement between the incidence rate of the disease and the global hydatidosis risk score and made it possible to identify the population of the center and the west of the country as a most exposed population for the diseases. CONCLUSION In order to have a chance for implementation, hydatidosis control program should target the three jointed governorates of Kasserine, Siliana and Kef, which have the highest incidence rates and the worst scores.
Collapse
|
20
|
Guettiti H, Ennaifer E, Attia L, Chelly D, Alaya NB, Aissa RB, Laassili T, Boubaker S. Pre-vaccination Prevalence and Genotype Distribution of Human Papillomavirus Infection among Women from Urban Tunis: a Cross-sectional Study. Asian Pac J Cancer Prev 2014; 15:9361-5. [DOI: 10.7314/apjcp.2014.15.21.9361] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
21
|
Dimassi K, Hleili W, Saidi O, Ben Alaya N, Ben Romdhane H. Knowledge and uptake of genital cancer screening methods among Tunisian women. Int J Gynaecol Obstet 2014; 128:268-9. [PMID: 25468051 DOI: 10.1016/j.ijgo.2014.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 09/11/2014] [Accepted: 11/04/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Kaouther Dimassi
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.
| | - Wiem Hleili
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Olfa Saidi
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Nissaf Ben Alaya
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | | |
Collapse
|
22
|
Bettaieb J, Bellali H, Ben Alaya N, Mrabet A, Kouni Chahed M. [Evaluation of the surveillance of invasive meningococcal disease in Tunisia: capture-recapture method]. Sante Publique 2013; 25:609-615. [PMID: 24418423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The objective of this study was to assess the completeness of the epidemiological surveillance system for invasive meningococcal diseases in greater Tunis. PATIENTS AND METHODS A six-year retrospective study (2003-2008) identified all cases of invasive meningococcal disease reported on Mandatory Notification records of the Tunis Regional Department of Health and those reported by the Tunis Children's hospital microbiology laboratory, considered to be the main source of diagnoses of invasive meningococcal disease in Greater Tunis. The "capture-recapture" method was applied. RESULTS Thirty-eight cases of invasive meningococcal disease reported to the Regional Department of Health and 47 cases provided by the children's hospital were analysed during the study period and 25 cases common to both sources were identified. The total number of cases of invasive meningococcal disease was estimated to be 71 (95% CI = [60-82]), using the capture-recapture method. Completeness rates were 53.5% (95% CI = [46.6 to 62.9]) for Mandatory Notification to the Regional Department of Health and 66.2% (95% CI = [57.6 to 77.8]) for children's hospital. Stratified analyses suggest that the two data sources were probably independent. CONCLUSIONS The capture-recapture method applied to the invasive meningococcal disease surveillance system in Greater Tunis showed a poor sensitivity of the Mandatory Notification. Factors influencing under-reporting of cases should be identified to improve this surveillance.
Collapse
|
23
|
Zaraa I, Belghith I, Ben Alaya N, Trojjet S, Mokni M, Ben Osman A. Severity of acne and its impact on quality of life. Skinmed 2013; 11:148-153. [PMID: 23930353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Acne is a chronic disease that is especially common among adolescents. It can have a considerable psychological and social impact that is not always correlated with clinical severity. The aim of this paper was to evaluate clinical severity and alteration of quality of life in acne patients, and to investigate a possible correlation between the two. A total of 82 patients with juvenile acne were included in this study. The clinical severity of acne was evaluated using the Echelle de Cotation des Lésions d'Acné (ECLA) scale. The Cardiff Acne Disability Index (CADI) was used to assess acne-related quality of life. Acne was mild to moderate in 61% of patients (ECLA < or = 12). A considerable alteration of quality of life was present in 51% of cases. There was a positive correlation between overall scores on the ECLA and CADI scales (P = .012) before and after treatment. Additionally, CADI score improved after effective treatment of acne. Acne may have an important impact on teenagers' psychological and social life. An objective assessment of this impact seems to be necessary. ECLA and CADI scores appear to be objective and simple instruments that may be used in acne management.
Collapse
Affiliation(s)
- Inès Zaraa
- Dermatology Department, La Rabta, Hospital, Jabbari, Bab Saadoun, Tunis, 1007 Tunisia.
| | | | | | | | | | | |
Collapse
|
24
|
Ben Salah A, Ben Messaoud N, Guedri E, Zaatour A, Ben Alaya N, Bettaieb J, Gharbi A, Belhadj Hamida N, Boukthir A, Chlif S, Abdelhamid K, El Ahmadi Z, Louzir H, Mokni M, Morizot G, Buffet P, Smith PL, Kopydlowski KM, Kreishman-Deitrick M, Smith KS, Nielsen CJ, Ullman DR, Norwood JA, Thorne GD, McCarthy WF, Adams RC, Rice RM, Tang D, Berman J, Ransom J, Magill AJ, Grogl M. Topical paromomycin with or without gentamicin for cutaneous leishmaniasis. N Engl J Med 2013; 368:524-32. [PMID: 23388004 DOI: 10.1056/nejmoa1202657] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is a need for a simple and efficacious treatment for cutaneous leishmaniasis with an acceptable side-effect profile. METHODS We conducted a randomized, vehicle-controlled phase 3 trial of topical treatments containing 15% paromomycin, with and without 0.5% gentamicin, for cutaneous leishmaniasis caused by Leishmania major in Tunisia. We randomly assigned 375 patients with one to five ulcerative lesions from cutaneous leishmaniasis to receive a cream containing 15% paromomycin-0.5% gentamicin (called WR 279,396), 15% paromomycin alone, or vehicle control (with the same base as the other two creams but containing neither paromomycin nor gentamicin). Each lesion was treated once daily for 20 days. The primary end point was the cure of the index lesion. Cure was defined as at least 50% reduction in the size of the index lesion by 42 days, complete reepithelialization by 98 days, and absence of relapse by the end of the trial (168 days). Any withdrawal from the trial was considered a treatment failure. RESULTS The rate of cure of the index lesion was 81% (95% confidence interval [CI], 73 to 87) for paromomycin-gentamicin, 82% (95% CI, 74 to 87) for paromomycin alone, and 58% (95% CI, 50 to 67) for vehicle control (P<0.001 for each treatment group vs. the vehicle-control group). Cure of the index lesion was accompanied by cure of all other lesions except in five patients, one in each of the paromomycin groups and three in the vehicle-control group. Mild-to-moderate application-site reactions were more frequent in the paromomycin groups than in the vehicle-control group. CONCLUSIONS This trial provides evidence of the efficacy of paromomycin-gentamicin and paromomycin alone for ulcerative L. major disease. (Funded by the Department of the Army; ClinicalTrials.gov number, NCT00606580.).
Collapse
|
25
|
Chahed MK, Bellali H, Alaya NB, Ali M, Mahmoudi B. Auditing the quality of immunization data in Tunisia. Asian Pacific Journal of Tropical Disease 2013. [DOI: 10.1016/s2222-1808(13)60014-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
26
|
Bettaieb J, Bellali H, Ben Alaya N, Mrabet A, Kouni Chahed M. Évaluation de la surveillance des infections invasives à méningocoques à Tunis par la méthode de capture-recapture. Santé Publique 2013. [DOI: 10.3917/spub.135.0609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
27
|
Bouchoucha S, Drissi G, Trifa M, Saied W, Ammar C, Smida M, Nessib MN, Ben Alaya N, Ben Ghachem M. [Epidemiology of acute hematogenous osteomyelitis in children: a prospective study over a 32 months period]. Tunis Med 2012; 90:473-478. [PMID: 22693089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM To determine the demographic, clinical, biological and bacteriological profile of acute community acquired hematogenous osteomyelitis (AHO) in children. METHODS Prospective study including children admitted for AHO. We noted the demographic parameters of patients and the clinical, biological and radiological characteristics of the infection. Blood cultures and local specimen in operated children were systematically performed. RESULTS 70 patients were included. The mean age was 7.7 years. The mean time between onset of symptoms and admission was 3.2 days. Distal tibia was the most frequent localization (18.66%). Fever higher than 38° on admission was found in 92.8% of patients. Creactive protein (CRP) was superior to 20 mg / L in 95.8% and ESR superior to 20 mm in the first hour in 92% of cases. A deep venous thrombosis was found in 7 patients and a pleuropulmonary Staphylococcus infection in 4 patients. A micro organism was isolated in 64.7% of cases. Staphylococcus aureus methicillin susceptible (SAMS) was the predominant germ. Staphylococcus aureus methicillin resistant (SAMR) accounted for 15.7% of staphylococcus aureus infections. The importance of CRP on admission and time to resolution of fever after the start of treatment were significantly higher in SAMR infections. The existence of deep venous thrombosis and a pleuropulmonary Staphylococcus infection and the need for surgical drainage were significantly more frequent in SAMR infections. CONCLUSION The existence of a severe form of AHO should lead to a high suspicion of SAMR infection and prompt the prescription of an appropriate antibiotiotherapy.
Collapse
|
28
|
Sidhom O, Laadhar L, Zitouni M, Ben Alaya N, Rafrafi R, Kallel-Sellami M, Lahmar H, El Hechmi Z, Makni S. Spectrum of Autoantibodies in Tunisian Psychiatric Inpatients. Immunol Invest 2012; 41:538-49. [DOI: 10.3109/08820139.2012.685537] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
29
|
Toumi A, Chlif S, Bettaieb J, Ben Alaya N, Boukthir A, Ahmadi ZE, Ben Salah A. Temporal dynamics and impact of climate factors on the incidence of zoonotic cutaneous leishmaniasis in central Tunisia. PLoS Negl Trop Dis 2012; 6:e1633. [PMID: 22563513 PMCID: PMC3341328 DOI: 10.1371/journal.pntd.0001633] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 03/20/2012] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Old world Zoonotic Cutaneous Leishmaniasis (ZCL) is a vector-borne human disease caused by Leishmania major, a unicellular eukaryotic parasite transmitted by pool blood-feeding sand flies mainly to wild rodents, such as Psammomys obesus. The human beings who share the rodent and sand fly habitats can be subverted as both sand fly blood resource. ZCL is endemic in the Middle East, Central Asia, Subsaharan and North Africa. Like other vector-borne diseases, the incidence of ZCL displayed by humans varies with environmental and climate factors. However, so far no study has addressed the temporal dynamics or the impact of climate factors on the ZCL risk. PRINCIPAL FINDINGS Seasonality during the same epidemiologic year and interval between ZCL epidemics ranging from 4 to 7 years were demonstrated. Models showed that ZCL incidence is raising i) by 1.8% (95% confidence intervals CI:0.0-3.6%) when there is 1 mm increase in the rainfall lagged by 12 to 14 months ii) by 5.0% (95% CI: 0.8-9.4%) when there is a 1% increase in humidity from July to September in the same epidemiologic year. CONCLUSION/SIGNIFICANCE Higher rainfall is expected to result in increased density of chenopods, a halophytic plant that constitutes the exclusive food of Psammomys obesus. Consequently, following a high density of Psammomys obesus, the pool of Leishmania major transmissible from the rodents to blood-feeding female sand flies could lead to a higher probability of transmission to humans over the next season. These findings provide the evidence that ZCL is highly influenced by climate factors that could affect both Psammomys obesus and the sand fly population densities.
Collapse
Affiliation(s)
- Amine Toumi
- Laboratory of Medical Epidemiology, Pasteur Institute of Tunis, Tunis, Tunisia.
| | | | | | | | | | | | | |
Collapse
|
30
|
Zaraa I, Labbene I, El Guellali N, Ben Alaya N, Mokni M, Ben Osman A. [Kaposi's sarcoma: epidemiological, clinical, anatomopathological and therapeutic features in 75 patients]. Tunis Med 2012; 90:116-121. [PMID: 22407622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Kaposi's sarcoma (KS) is a mutifocal angiogenic process characterized by cellular and vascular proliferation. AIM To identify the epidemio-clinical, histological and therapeutic features of KS. METHODS Retrospective study of 75 cases of KS at the dermatology department of Rabta hospital in Tunis during a period of 25 years (1982-2007). RESULTS Three epidemio-clinical forms of KS were observed in our study: the classic KS (70 cases), the AIDS-related KS (4 cases) and the iatrogenic KS (1 case). The mean age of our patients at diagnosis was 69.16 years with a sex ratio of 2.33. Elective site of cutaneous lesions in the classic KS was the limbs (87.1%). The cephalic part was concerned in 17.1% of cases. Mucosal involvement was found in 28.5% of patients. Extra dermatological localizations of KS were observed in 32.9%. CONCLUSION Our study identified some epidemio-clinical features of the classic KS especially the high frequency of mucosal and cephalic involvement as well as extra dermatological localizations. Thus further exploration is required even without alarm signs.
Collapse
|
31
|
Abstract
The aim of this study was to assess the efficacy of the national Tuberculosis Control Programme in Tunisia, by applying the 8-stage model proposed by Piot (1967). Two retrospective cohorts of tuberculosis cases, including all new smear-positive cases detected by all laboratories in the study area during the study period, were selected at least 2 years after treatment began. The real number of new active cases during the study period was estimated at 142, the case detection rate at 61%. In all, 70% of patients started tuberculosis treatment, and regular use of the home treatment varied from 87% (including irregular use) to 71% (excluding irregular use). The low global efficacy of the program, which ranged from 26 to 31%, indicates the need for improved application of the strategy by programme managers.
Collapse
Affiliation(s)
- Mohamed Kouni Chahed
- Département d'épidémiologie et de médecine préventive Faculté de médecine de Tunis 15, rue Djebel-Lakhda La Rabta 1007 Tunis Tunisie.
| | | | | | | | | |
Collapse
|
32
|
Aoun K, Chouihi E, Amri F, Ben Alaya N, Raies A, Mary C, Bouratbine A. Short report: Contribution of quantitative real-time polymerase chain reaction to follow-up of visceral leishmaniasis patients treated with meglumine antimoniate. Am J Trop Med Hyg 2010; 81:1004-6. [PMID: 19996428 DOI: 10.4269/ajtmh.2009.09-0285] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Forty-two patients with visceral leishmaniasis in Tunisia were treated with meglumine antimoniate and followed-up for clinical improvement and blood parasite load determined by quantitative real-time polymerase chain reaction (PCR). Parasite loads before treatment ranged from 27 to 5.3 x 10(7) parasites/mL. At the end of treatment, parasite load decreased significantly in 39 cured patients (P < 0.001). The decrease in parasite load after treatment was greater than 99% for 34 patients and PCR results became negative in 23 of them. Two patients without clinical improvement showed no or slight decreases in parasite load (209 versus 202 parasites/mL and 1,765 versus 146 parasites/mL). One patient showed had a relapse seven months after showing a good response to treatment. His parasitemia remained high despite a sharp decrease (5.2 x 10(5) versus 5.9 x 10(3) parasites/mL).
Collapse
Affiliation(s)
- Karim Aoun
- Research Laboratory of Emerging Parasitic Diseases, Tunis, Tunisia.
| | | | | | | | | | | | | |
Collapse
|
33
|
Benabid M, Galai Y, Nouira R, Ben Alaya N, Bouratbine A, Aoun K. ELISA on saliva samples for the detection of anti-hydatid cyst antibodies. Clin Lab 2010; 56:543-546. [PMID: 21141438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND The detection of antibodies in saliva samples proved to be effective in the diagnosis of several microbial diseases. These antibodies were screened in saliva samples of patients with hydatid cysts. METHODS Anti-hydatid fluid antigen IgG and IgA antibodies were screened in saliva and sera of patients with hydatid cysts (n=37) as well as in healthy controls (n=30) using an in-house developed immunoenzymatic assay. RESULTS Salivary anti-hydatid fluid antigen IgG showed a sensitivity of 86.5% and a specificity of 80%. A positive correlation was observed between anti-hydatid fluid antigen IgG in saliva and in serum (r = 0.364; p = 0.02). CONCLUSIONS The detection of anti-hydatid fluid antigen IgG antibodies in saliva using ELISA promises to be interesting for the diagnosis of cystic echinococcosis.
Collapse
Affiliation(s)
- Meriem Benabid
- LR 05SP03 Parasitoses émergentes, Institut Pasteur de Tunis, Institut Pasteur de Tunis, Tunisia
| | | | | | | | | | | |
Collapse
|
34
|
Arfa I, Abid A, Nouira S, Elloumi-Zghal H, Malouche D, Mannai I, Zorgati MM, Ben Alaya N, Rebai A, Zouari B, Ben Ammar S, Ben Rayana MC, Hmida S, Blousa-Chabchoub S, Abdelhak S. Lack of association between the angiotensin-converting enzyme gene (I/D) polymorphism and diabetic nephropathy in Tunisian type 2 diabetic patients. J Renin Angiotensin Aldosterone Syst 2008; 9:32-6. [DOI: 10.3317/jraas.2008.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Objective. The aim of the present study was to investigate whether the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism is associated with diabetic nephropathy and type 2 diabetes in the Tunisian population.Design. A case-control study was conducted among 141 unrelated type 2 diabetic patients with (90 patients) or without nephropathy (51 patients) and 103 non-diabetic controls with normal fasting blood glucose. Genotyping was performed using a nested polymerase chain reaction amplification in order to identify correctly heterozygous individuals.Results. The distribution of DD, ID and II genotypes did not significantly differ between type 2 diabetic patients with or without nephropathy (DD: 44%; ID: 46%; II: 10% vs. DD: 41%; ID: 47 %; II: 12%, respectively).There was also no significant statistical difference between the genotype distribution and allele frequencies of the (I/D) polymorphism in all type 2 diabetic subjects compared to non-diabetic controls with normal fasting blood glucose (DD: 43%; ID: 46%; II: 11% vs. DD: 37%; ID: 48% ;II: 15%, respectively).Conclusions. In the present preliminary study, the (I/D) polymorphis within the ACE gene is likely not associated with diabetic nephropathy nor with type 2 diabetes in the Tunisian studied population.
Collapse
Affiliation(s)
- Imen Arfa
- Molecular Investigation of Genetic Orphan Diseases Research Unit, Institut Pasteur de Tunis. Tunis, Tunisia
| | | | - Sonia Nouira
- Molecular Investigation of Genetic Orphan Diseases Research Unit, Institut Pasteur de Tunis. Tunis, Tunisia, sonia.abdelhak @pasteur.rns.tn
| | - Houda Elloumi-Zghal
- Molecular Investigation of Genetic Orphan Diseases Research Unit, Institut Pasteur de Tunis. Tunis, Tunisia
| | - Dhafer Malouche
- Engineering school of statistic and information analysis (LEGI-EPT-ESSAIT), University of 7th November at Carthage Tunis, Tunisia
| | - Imen Mannai
- Molecular Investigation of Genetic Orphan Diseases Research Unit, Institut Pasteur de Tunis. Tunis, Tunisia, Engineering school of statistic and information analysis (LEGI-EPT-ESSAIT), University of 7th November at Carthage Tunis, Tunisia
| | - Mohamed Majdi Zorgati
- Molecular Investigation of Genetic Orphan Diseases Research Unit, Institut Pasteur de Tunis. Tunis, Tunisia
| | - Nissaf Ben Alaya
- Laboratory of Epidemiology. Institut Pasteur de Tunis, Tunis, Tunisia
| | | | - Béchir Zouari
- Department of Epidemiology and Statistics, School University of Medicine, Tunis, Tunisia
| | - Slim Ben Ammar
- Molecular Investigation of Genetic Orphan Diseases Research Unit, Institut Pasteur de Tunis. Tunis, Tunisia
| | | | - Slama Hmida
- National Center of Blood Transfusion Tunis, Tunisia
| | | | - Sonia Abdelhak
- Molecular Investigation of Genetic Orphan Diseases Research Unit, Institut Pasteur de Tunis. Tunis, Tunisia
| |
Collapse
|
35
|
Hsairi M, Gobrane HB, Alaya NB, Bellaaj R, Achour N. [Knowledge and attitudes of medical students at the end of their curriculum, towards breast and cervical cancer screening]. Sante Publique 2007; 19:119-32. [PMID: 17561734 DOI: 10.3917/spub.072.0119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study assesses knowledge and attitudes of medical students of the faculty of medicine of Tunis, at the end of their medical curriculum, towards breast and cervical cancer screening. Among the 644 medical students at the end of their curriculum, 592 answered to anonymous questionnaire (response rate = 92%). Results show that 34.1% have proposed systematic cervical cancer screening. This proportion was 61.0% for clinical breast cancer examination. The majority of students (70.2%) proposed to start this cervical screening since the first sexual activities. As for the periodicity of this screening, 44.2% are favourable for a yearly periodicity, 39.2% for every three years, 7.2% for every five years and 9.4% for a periodicity at least once in life. 94.1% of students declared to have learned clinical breast examination, contrarily to pap smear, for which this proportion was only 55.1%. Breast and cervical cancer control training, in the faculty of medicine of Tunis, is insufficient and should be improved and restructured.
Collapse
Affiliation(s)
- Mohamed Hsairi
- Institut National de la Santé Publique 5-7 Rue Khartoum-1002, Tunis, Tunisie
| | | | | | | | | |
Collapse
|
36
|
Salah AB, Kamarianakis Y, Chlif S, Alaya NB, Prastacos P. Zoonotic cutaneous leishmaniasis in central Tunisia: spatio temporal dynamics. Int J Epidemiol 2007; 36:991-1000. [PMID: 17591639 DOI: 10.1093/ije/dym125] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Zoonotic cutaneous leishmaniasis (ZCL) is endemic in many rural areas of the Southern and Eastern Mediterranean region where different transmission patterns of the disease have been described. This study was carried out in a region located in Central Tunisia and aimed to investigate the spatio-temporal dynamics of the disease from 1999 to 2004. METHODS Incident ZCL cases were defined by clinical diagnosis, confirmed by a positive skin test and/or parasitological examination. Annual ZCL rates were calculated for 94 regional sectors that comprise the study region of Sidi-Bouzid. Spatial and temporal homogeneity were initially investigated by chi-squared tests. Next, spatial scan statistics were used to identify spatial, temporal and spatio-temporal clusters that display abnormally high incidence rates. A hierarchical Bayesian Poisson regression model with spatial effects was fitted to signify explanatory socio-geographic factors related to spatial rate variability. Temporal ZCL dynamics for the 94 sectors were described via a linear mixed model. RESULTS A total of 15 897 ZCL cases were reported in the 6-year study period, with an annual incidence rate of 669.7/100 000. An outbreak of the disease was detected in 2004 (1114/100 000). Spatial clustering is evident for the whole time period. The most likely cluster according to the spatial scan statistic, contains seven sectors with abnormally high incidence rates and approximately 5% of the total population. ZCL rates per sector are mostly related to the urban/rural index; sectoral population density and the number of inhabitants per household do not appear to contribute much to the explanation of rate variability. The dynamics of the disease within the study period are satisfactorily described by quadratic curves that differ for urban and rural areas. CONCLUSIONS ZCL rates vary across space and time; rural/urban areas and environmental factors may explain part of this variation. In the study region, the Sidi Saâd dam-constructed in the early eighties and identified by previous studies as a major reason for the first outbreak of the disease-seems to be still related to increased ZCL rates. The most likely spatial cluster of high incidence rates contains regions located close to the dam. Our findings of increased incidences in urban areas support the hypothesis of increased incidences in peri-urban environments due to changes in sandfly/rodent living habits over recent years.
Collapse
Affiliation(s)
- Afif Ben Salah
- Laboratory of Epidemiology and Ecology of Parasitic Diseases, Institut Pasteur de Tunis, Tunis-Belvedere, Tunisia
| | | | | | | | | |
Collapse
|
37
|
Arfa I, Abid A, Malouche D, Ben Alaya N, Azegue TR, Mannai I, Zorgati MM, Ben Rayana MC, Ben Ammar S, Blousa-Chabchoub S, Ben Romdhane H, Zouari B, Dellagi MK, Abdelhak S. Familial aggregation and excess maternal transmission of type 2 diabetes in Tunisia. Postgrad Med J 2007; 83:348-51. [PMID: 17488867 PMCID: PMC2600082 DOI: 10.1136/pgmj.2006.053744] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIM To evaluate the degree of familial aggregation of type 2 diabetes mellitus in Tunisia and to investigate transmission patterns of the disease and their relationships with patients' clinical profiles. METHODS Family history of diabetes and clinical data were collected for 132 unrelated type 2 diabetic Tunisian patients. Diabetes status was recorded for first degree relatives (parents, siblings) and second degree relatives (aunts and uncles from both maternal and paternal sides). Information about family history of diabetes was gathered for a total of 1767 individuals. RESULTS Familial aggregation of type 2 diabetes was prominent and more important among first degree relatives than among second degree relatives (p = 0.01). Among studied subjects, 70% reported at least one relative with diabetes and 34% had at least one parent with diabetes. Diabetes was more frequent among mothers than fathers of probands (p = 0.03). This maternal effect extends to second degree relatives as diabetes was more common among maternal than paternal aunts and uncles (p = 0.01). There is no significant difference in clinical and metabolic profiles between patients according to transmission patterns of the disease. CONCLUSION These results suggest familial aggregation and excess maternal transmission of type 2 diabetes in the Tunisian studied population.
Collapse
Affiliation(s)
- Imen Arfa
- Molecular Investigation of Genetic Orphan Diseases Research Unit, Institut Pasteur de Tunis. Tunis, Tunisia
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Ben Romdhane H, Skhiri H, Bougatef S, Gharbi D, Ben Alaya N, Achour N. [Cardiovascular disease surveillance in Tunisia]. Tunis Med 2005; 83 Suppl 5:8-13. [PMID: 16094844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To assess the Cardiovascular risk factors trend in community based surveys. METHOD Two population surveys were conducted in 1996-97 and 2000-01 in the Ariana region among 7608 adults 35-70 years aged. The surveys were based on: 1--a questionnary, 2--an anthropometrical and physical examination, 3--a biological investigation, and 4--an ECG registration for the second cohort. RESULTS Relative to the first survey, the prevalence of hypertension, diabetes, hypercholesterolemia didn't change significantly while borderline cholesterol increased on both genders, tobacco smoking decreased and ex-smokers increased on men. In both genders, hypertension and diabetes prevalence is low before 50 years but it increased after this age. Risk factors association is common: about 35% have more than two risk factors. This association is more common on women and diabetes-hypertension is the most frequent. CONCLUSION These two surveys integrated in a global surveillance program has contributed to assess the CVDs burden and to identify priorities and intervention relevant to epidemiological region context.
Collapse
Affiliation(s)
- Habiba Ben Romdhane
- Laboratoire de recherche en épidémiologie et prévention des maladies cardiovasculaires en Tunisie, Institut National de Santé Publique
| | | | | | | | | | | |
Collapse
|
39
|
Bouguerra LM, Trabelsi S, Alaya NB, Zouari B. [Determinants of maternal breastfeeding in a suburban area of Tunisia]. Arch Pediatr 2002; 9:1113. [PMID: 12462850 DOI: 10.1016/s0929-693x(02)00056-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
40
|
Bougatef S, Ben Romdhane H, Haouala H, Ben Alaya N, Belhani A, Boujnah R, Ben Slimane L, Kafsi N, Kasri R, Zaouali M, Achour N, Gueddiche M. [Knowledge, treatment and control of hypertension. Results of a multicenter study of patients hospitalized for cardiac ischemia]. Tunis Med 2002; 80:387-94. [PMID: 12611348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The study objective was to assess the prevalence, level of treatment, and control of hypertension in CHDs patients. We conducted a cross-sectional survey on 1109 patients hospitalised for a first episode of MI in the main hospitals of the District of Tunis during the period 1999-2000. Hypertension and control level are defined according to the JNC recommendations. HBP is defined as SBP > = 140 and or DBP > = 90 mm Hg and the use of blood pressure-lowering medication for the indication of hypertension. Hypertension is controlled by medication if SBP < 140 and DBP < 90 mm Hg. We conduct analysis by socio demographic variables, medical history and CHDs risk factors. 54.9% men and 72.1% women were hypertensive. The prevalence of hypertension increases with age in both genders. The logistic regression have shown that the age-adjusted odds ratios were statically significant for diabetes, obesity, high cholestrolemia and cigarettes smoking. Only 68.9% of the hypertensive were aware of having hypertension, women were more aware than men (84.6% versus 61.7%, p < 0.001). Awareness increase with age and education level. Among hypertensive, 94.4% were treated but only 41.3% were controlled. The study highlights the problem of the hypertension, and contributes to identify the iceberg of this CHDs risk factor. An effort must be done to involve the health personnel for educating patients, the population for changing their life style and manager for enhancing the availability of drugs. The question is how much will be the cost of HBP and CVDs control for a country which has a limited resources.
Collapse
Affiliation(s)
- Souha Bougatef
- U.R. Epidémiologie et Prévention des Maladies Cardiovasculaires en Tunisie
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|