Bullying victimization among middle school students in el kef governorate (Tunisia)

Background and aim

Bullying is a complex and widespread public health issue that one can be exposed to at any age and at any field, but it is considered particularly frequent during times of transition in children’s and adolescents’ lives. This study aims to investigate the prevalence and various forms of bullying victimization and explore culture of bullying victimization among students.

Methods

A cross-sectional study was conducted during the Academic year 2018/2019 among middle school students in the governorate of El Kef, Tunisia. The sampling method adopted for this research was a cluster sampling technique. Data were collected using self-administered questionnaires. The Students’ involvement in bullying victimization was assessed using a validated Arabic version of the revised Olweus Bully/Victim Questionnaire.

Results

A total of 1111 middle school students were enrolled. The prevalence of bullying victimization behavior in this study was 45.8 % [95% CI: 45.5- 46]. Looking at the forms of bullying experienced by students: “Being called mean names” was the most prevalent form of being bullied with 26.9% (n = 299), followed by 16.9% reported “being kicked in some place”, 16.3% reported “being bullied through false rumors” and 14.3% experienced bullying through messages, calls or images by means of mobile phones or Internet and 8.1% of the students reported being bullied with sexual gestures or comments. Verbal bullying (29.5%) was the most common type of victimization, followed by physical victimization, relational victimization and cyber victimization with 22.5%, 22.2% and 14.3% respectively. More than half of the students (58.5%) were more likely to inform others about incidents of bullying in their schools, mainly their parents (36.6%) or a friend (32.6%).

Conclusions

Bullying is serious and major public health issue that have a negative impact on adolescents’ well-being, and require special attention at the family, school, and community level

Key messages

• High prevalence of bullying victimization with predominace of verbal type.

• Culture of bullying victimization and taking care of victims is still weak.

Polysubstance use among adolescents in Tunisia

Background

Poly-substance use is a global public health problem associated with significant adverse social and health effects. Adolescents are increasingly affected by this risky behaviour. The objective of our study was to describe the poly-substance use and to determine the association between the different types of substance use among middle school students in the Region of Kairouan in Tunisia.

Methods

A cross-sectional study was conducted in 2017 among middle school students in the Region of Kairouan in Tunisia using a self-administered questionnaire for data collection.

Results

A total of 494 students participated in the survey. Tobacco, alcohol, cannabis and psychotropic drug uses were reported respectively by 7.9%, 7.3%, 6.3% and 14.3% of the students. Among the surveyed students, the poly-consumption of the four substances: alcohol, tobacco, cannabis and psychotropic medication without medical prescription was reported by 2.83% of the students. Among these poly-consumers, 57.1% were male. Poly substance use was found to increase with the level of study (21.4%, 28.6% and 50% respectively in grades 7, 8 and 9). In our study, among the smokers, 64.1% reported alcohol use, 69.2% reported cannabis use and 43.6% reported psychotropic drug use. Associations between tobacco use and other substances use were significant (p < 10-3). This association was significant for both boys and girls. In addition, 71% and 26% of alcohol users were respectively cannabis and psychotropic drug users. Alcohol use was significantly associated with cannabis and psychotropic drug use (p < 10-3). This association was significant for both boys and girls.

Conclusions

Adolescents are particularly vulnerable to multiple risky behaviors including substance use. Appropriate prevention and control strategies based on a participatory approach involving parents, teaching and medical staff should be put in place to combat this scourge.

Key messages

Despite a relatively low prevalence of poly-substance use among the surveyed students, a particular attention should be drawn to the phenomenon of psychotropic drug use without medical prescription. There is an urgent need for the implementation of an effective substance use prevention program in school settings in Tunisia where monitoring is one of its core components.

Obstetric referrals to the regional maternity of Kasserine (Tunisia)

Background

A large proportion of maternal deaths are related to the health care system, including the failure of the referral system between maternity wards. The objectives of this study were to determine the frequency and the indications of obstetric referrals in a Tunisian regional care maternity and to assess the conformity of referral mechanisms with the National Perinatality Programme guidelines.

Methods

A descriptive study was carried out at the regional maternity facility of the regional Hospital of Kasserine in 2018, among parturients referred during a period of three months. Data collection was carried out prospectively from medical records, transfer documents, interviews with parturients and with the nursing staff of the reference maternity hospital. The ICD-10 was used to code recorded indications and diagnoses for referrals.

Results

A total of 234 parturients were included. Referrals represented 15.1% of the obstetric activity in this facility. There were 26 reasons for referrals and the most common was Maternal care for pelvic organ abnormalities (19.7%) and premature rupture of membranes (12.8%). 34.4% of the referrals were unclassifiable according to ICD-10. Most of the indications for referrals (71.4%) did not conform to the list of referral indications of the NPP. Twenty-eight diagnoses were retained after referrals: the most common was Maternal care for pelvic organ abnormalities (15.8%). In 42% of women, reasons for referral did not match with diagnoses established at the time of the patients' admission to hospital.

Conclusions

The referral system must be analyzed in order to ensure a maximum level of safety for the mother-child couple through the formalization of the protocols and the promotion of the role of peripheral maternity facilities, which are the structures of first recourse.

Key messages

The current referral system in the region of Kasserine still faces several challenges that need to be addressed in order to make it more effective. Maternal referral systems are an effective measure to help to reduce preventable maternal deaths, they should be continuously assessed and revised.

Tunisian Nurses experiences of their humanitarian mission in the ''Choucha” Refugee Camp

Background

Participation in a humanitarian mission can be considered as a heroic work especially for health professionals. In 2011, a refugee camp was set up in southern Tunisia. The objective of this study was to describe and better understand the experience of Tunisian nurses in the Choucha refugee campbased on the Meleis transition theory.

Methods

We conducted a qualitative, phenomenological study among 14 nurses using an interview guide. Data analysis was carried out according to the method of Giorgi, from which 5 core themes and 28 sub-themes had emerged.

Results

This studydescribed the experience of nurses as a passage between 4 different phases: before, during, after the passage to the refugee camp and the memory.Five core themes emerged from our research:1) Trigger events: 3 sub-themes were evoked for the reason of participation: motivation, commitment and expectations; 2) Professional and interpersonal relationships marked the integration of the interviewees despite some misunderstandings, 3) Coping, 4) The impacts are mostly positive, and 5) Feelings that expressed emotions and nostalgia. For the transition, the last stage, which is the appreciation of the past moments, indicated the passage from an unbalanced state to stability.

Conclusions

Looking at the lived experience of the nurses and the transition experience described by the participants, this study found that the lack of training of the nurses previous to the humanitarian mission was the major barrier to making a healthy transition. These findings can contribute to raise the awareness, preparation and education of nurses to improve the experiences of future caregivers who will participate in humanitarian missions.

Key messages

It seems essential to set up training program focusing on preparation and debriefing of nurses to support them in achieving a healthy transition in their humanitarian mission in refugee camps. Training health care professionals before their participation to humanitarian mission in refugee camps can be among the factors that enhance the quality of care provided to refugee populations.

A picture of the adolescents dietary habits in Tunisia

Background

Adolescence is one of the main growth periods of life during which dietary needs are specific and where diet quality is important for healthy development. Nonetheless, unhealthy eating behaviours are common among adolescents including over consumption of unhealthy fast food, sugar and fat and skipping meals. Exposure to unhealthy eating can lead to chronic conditions such as obesity and diabetes. In this context, we conducted this study to describe the quality of the diet of middle school students in the Region of Kairouan in Tunisia.

Methods

This is a cross-sectional study conducted in 2017 among middle school students in the Region of Kairouan. Data collection was carried out using a self-administered questionnaire.

Results

In this study, 494 students were included. In terms of food type, fast food meals (sandwiches) were the most preferred type of food (52.6%). Daily consumption of vegetables and fruit was reported by 48.8% of students. Among the participants, 46.8% reported daily consumption of olive oil. Daily water consumption was less than one liter for 32% of the college students. Daily coffee and/or tea consumption concerned 53.8% of respondents. In the current study, 39.3% of the students reported that they consume more than three meals per day and 26.7% declared that they often skip the breakfast. In our study, 62.8% of the participants had reported their dissatisfaction with their nutrition education, 54.9% sought to know the food composition and 57.9% reported that they have a willingness to adopt a healthy eating.

Conclusions

A quality and diversified diet can cover the specific nutritional needs of adolescents. A diet inspired by the Mediterranean food is to be encouraged. Further studies should be conducted among adolescents to evaluate the impact of a healthy and balanced diet on health and school achievement.

Key messages

The quality of diet of Tunisian adolescents is to be improved. Effective comprehensive programs for healthy lifestyle promotion are needed to improve the eating behaviour among Tunisian adolescents.

Herbal medicine use and its associated factors in the region of Sousse (Tunisia)

Background

Patients use medicinal plants as the first-line treatment for many chronic and acute medical conditions. The lack of access to conventional health care, historical, cultural and economic considerations contributes to the important use of these plants. The purpose was to identify medicinal plants used by primary Health Care Centers' visitors in the region of Sousse (Tunisia) and to assess its associated factors.

Methods

A cross-sectional descriptive study was conducted among Primary health care centers' visitors of the region of Sousse (Tunisia) in 2018. We randomly selected 18 primary health centers and 50 participants were chosen from each center. Data were collected using a pre-tested questionnaire, filled through a direct interview with participants which explores: socio-demographic variables and medicinal plants' use (name of plants, symptoms, methods of preparation, routes of administration, plant source, tolerance and side effects).

Results

900 persons were included with a female predominance (72.4%). The median age of participants was 48 years ranging from 18 to 93. 65.2% (n = 587) of them report using medicinal plants to heal. The most common sources of information were family (90.5%), beliefs and traditions (56.4%). Fifty-three (53) plants were used to treat different disorders. The most used plants are: verbena (81.6%), rosemary (53.3%), mint (52%) and thyme (45.1%). The most reported treated symptoms were: flu and gastro-intestinal disorders. Plants utilization was associated to: lower age, female gender, marital status, high level of education and social existence of protection coverage.

Conclusions

Plants use should be based on well-conducted scientific results specifying the mechanism of action of plants, the therapeutic and toxic dose through researches on local plants samples and extracts.

Key messages

It seems essential to train health professionals on herbal therapy during their studies and practice. The further step after this picture of the herbal medicine use in the Region of Sousse, is to evaluate the safety and the efficacy of their use.

Adolescent’s substance use and suicidal thoughts in Tunisia

Background

Experimentation with substance use is common during adolescence. Substance use may result in many health-related problems and contribute to adolescent suicidal behavior. We conducted this study to examine the relationship between substance use and suicidal ideation.

Methods

This is a cross sectional study conducted among a representative sample of 2020 adolescents enrolled in Tunisian secondary schools using a self-administered questionnaire.

Results

The prevalence of tobacco, alcohol and cannabis use was respectively 3.7% (95% CI [2.87%-4.52%]), 4.4% (95% CI [3.5%-5.29%]) and 0.8% (95% CI [0.40%-1.18%]) Overall, 17.0% (95% CI [15.3%-18.6%]) reported having suicide ideation during the past 12 months. Tobacco (Odds Ratio = 2.61; 95% CI = 1.59–4.29), alcohol (Odds Ratio = 2.77; 95% CI = 1.76–4.36), and cannabis use (Odds Ratio = 4.98; 95% CI = 1.85–13.96) were significantly associated with suicidal thoughts among adolescents (p < 10-3).

Conclusions

This cross study has shown a significant association between substance use and suicidal ideation. This relationship can be bidirectional and suicidal ideation and substance use may affect each other.

Key messages

In his study, the prevalence of substance use was relatively low and was associated with suicidal ideations. The reciprocal link between the two problems and their co-occurrence should be taken into account when planning preventive substance use and suicide programs.

Obstetrical complications treated in the maternities of the region of Sousse (Tunisia)

Background

About 800 women die each day worldwide due to complications related to pregnancy, childbirth or in the postpartum period. The objective of this study was to describe the activity of the public maternities in the Governorate of Sousse (Tunisia) and to identify obstetrical complications treated in these facilities.

Methods

A cross sectional study of all public health facilities, which performed deliveries in Sousse was conducted in 2017 (Five maternities: one University maternity and four peripheral ones). Data were collected by reviewing clinical records and registers of these maternities for the year 2016.

Results

In total, in the health visited structures, there were 13427 deliveries in 2016, the majority of them (78.8%) took place at the university maternity of Farhat Hached hospital. Of these deliveries, 3397 were performed by caesareans (25.3%). In 2016, there were three maternal deaths and 69 very early neonatal deaths. There were 2036 direct obstetric complications treated in the five maternities visited. The most frequently encountered direct complications were: ’obstructed/prolonged labor’ (41.21%), ’severe pre-eclampsia/eclampsia’ (19.5%) and ’ante and postpartum haemorrhage’ (15.18%). The most encountered indirect obstetrical complications were: gestational diabetes and anaemia.

Conclusions

The reduction of maternal and neonatal mortality requires the existence of a functioning basic health care system that provides all pregnant women and their newborns with timely access to skilled care, particularly when a complication occurs. The provision of this qualified care requires also the presence of qualified personnel working in a suitable professional environment.

Key messages

The majority of obstetrical complications occur in university maternity and this is due to excessive references from peripheral maternities. Peripheral maternities need to be strengthened with material and human resources.

Suicidal ideation among Tunisian adolescents and the association with adverse life experiences

Background

Youth suicidality is a significant public health problem. Understanding the factors leading to suicide is essential to implement effective preventive efforts. In this context, this study was conducted to assess the link between suicidal ideation and adverse life experiences among Tunisian school aged youth.

Methods

A cross-sectional survey was conducted among a sample of 2020 secondary school adolescents in 2016. An anonymous self-administered questionnaire was used to collect data. The adverse life events measured were: domestic violence, parental divorce, physical aggression, sexual abuse and a familial antecedent of suicide.

Results

Overall, 17.0% (95% CI [15.3%-18.6%]) reported having suicide ideation during the past 12 months with no gender difference (16.3% among girls and 17.3% among boys, p = 0.62). Among the participants, 26.7% experienced at least one adverse life experience. Those who reported domestic violence (Odds Ratio = 8.93; 95% CI = 6.84–11.66), parental divorce (Odds Ratio = 3.02; 95% CI = 1.57–5.79), physical aggression (Odds Ratio = 6.97; 95% CI =5.14–9.46), sexual abuse (Odds Ratio = 8.69; 95% CI =3.94–19.15), familial antecedent of suicide (Odds Ratio = 8.17; 95% CI = 5.75–11.60) were associated with increased odds of suicide ideation.

Conclusions

The prevalence of suicidal ideation observed in the survey area was relatively high and associated with all the measured life adverse events. These factors should be included in a suicide screening tool to be integrated in a suicide prevention program.

Key messages

Suicidal ideation among adolescents was associated with all the measured life adverse events. Identifying adolescents at higher risk of suicide and help them to cope with their adverse experiences could be effective to prevent taking action to attempt suicide.

School bullying among Tunisian adolescents: prevalence and psychosocial outcomes

Background

Bullying is a serious public health concern affecting the emotional well-being of pupils. We conducted this study to examine the prevalence of bullying, its psychosocial associated factors and the perceived involvement of parents, teachers, and classmates to counteract this behavior.

Methods

This is a cross-sectional study conducted in 2015 among a representative sample of pupils enrolled in 14 colleges in Sousse using the revised Olweus Bully/Victim Questionnaire.

Results

We included 1584 students aged between 11 and 15 years. The prevalence of bullying and victimization was 16.0% [95% CI: 14.2%, 17.8%] and 11.3% [95% CI: 9.7%, 12.9%] respectively. Four groups of students were identified, 11.7% were classified as pure victims, 7.8% as pure bullies, 3.2% as bully-victims and 75.5% as bystanders. Compared to other groups, the bully-victims were less likely to report a feeling of empathy (38.3%, p < 10-3) and liking school (30.0%, p < 10-3). They were more likely to be aggressive (56.2%, p < 10-3) and disintegrated in the class (30.6%, p = 0.002). Among the victims, 11.1% reported that their parents contacted the school several times to stop their victimization. The majority of the middle school students perceived that their classmates (54.1%) and teachers (39.5%) did nothing to counteract the bullying behavior.

Conclusions

The school institution is expected to be for pupils a highly meaningful space for social, emotional and academic development. Parents, teachers and students should learn effective ways to handle the bullying problem since it has been emphasized that the most effective programs are comprehensive targeting students, schools, families, and the community.

Key messages

This is the first study conducted in Tunisia to highlight the extent of school bullying. Our findings can help to raise awareness of parents, school staff and policy makers about bullying.

Well-differentiated extraskeletal chondrosarcoma: about a new case

Extraskeletal chondrosarcoma is a rare malignant tumor. The well differentiated histological type, which is found primary in soft tissue, is extremely rare. This report  describes the case of a 58-year-old woman presented with a large palpable mass in the right buttock. Imaging studies revealed a well-defined soft tissue mass, with extensive calcification. A histological examination after surgical resection confirmed the diagnosis of well-differentiated extraosseous chondrosarcoma. The outcome was favorable, without recurrence or metastasis.

Mixed stromal and smooth muscle tumours of the uterus: a report of two cases

Mixed stromal and smooth muscle uterine tumours, defined as those containing at least 30% of each component as seen by routine light microscopy, are rare. This report describes the morphological features of two such tumours diagnosed in 44-year-old and 50-year-old females complaining from recurrent uterine bleeding that was unresponsive to medical treatment. Morphological and immunohistochemical evaluations were performed, and a final diagnosis of mixed endometrial stromal nodule and smooth muscle tumour of the uterus was rendered in both cases.

Uterine tumour resembling ovarian sex cord tumours presenting as multiple endometrial and cervical uterine polyps: a case report

BACKGROUND

Uterine tumours resembling ovarian sex-cord tumours (UTROSCT) are very rare, benign uterine tumours, composed solely of sex cord elements. These tumours have a polyphenotypic immunophentype that favours a derivation from uterine mesenchymal stem cells.

CASE REPORT

A 43-year-old female presented with recurrent vaginal bleeding. On hysteroscopy, she had multiple endometrial and cervical polyps that were removed endoscopically. Histologically, the specimen contained epithelioid cells arranged in tubules, trabeculae and anastomosing cords, without significant cellular atypia or mitotic activity. Immunohistochemical studies were performed. The tumour was found to be diffusely positive for vimentin, calretinin and desmin, focally positive for cytokeratin, CD99 and inhibin and negative for chromogranin and CD10. A subsequent total hysterectomy was performed and revealed neoplastic infiltration of the myometrium.

CONCLUSION

A polyphenotypic immunophenotype is a characteristic feature of UTROSCT, and may be helpful in diagnosis and in exclusion of other lesions. Familiarity with this tumour by gynaecologists and pathologists is essential to avoid misdiagnosis:correct diagnosis of this neoplasm is important in patient management.