An update on the access to inpatient rehabilitation facilities across Tunisia in 2023

INTRODUCTION

Considering the growing global need and the complexity of health conditions, an intensive rehabilitation in inpatient departments is fundamental. Yet, in Tunisia, the distribution of Inpatient Rehabilitation Facilities is not illustrated.

AIM

To perform an update concerning the rehabilitation's beds-ratio /1000 Tunisian-inhabitants in 2023.

METHODS

Data were collected from the Tunisian Ministry of Health, the Eastern Mediterranean Regional Office, and the National Institute of Statistics websites.

RESULTS

The findings revealed a total number of rehabilitations' beds 132 among a total of 20000 hospital beds with a rehabilitations' beds-ratio equal to 0.01/1000 inhabitants. Only three Inpatient Rehabilitation Facilities were identified in Tunisia covering the Greater Tunis, North East, and Center east districts. There was inequity of distribution since the beds ratio is 1.07/1000 in the North east, 0.02/1000 in the Greater Tunis and 0 in the North West and the South of Tunisia.

CONCLUSION

This update highlighted the alarmingly low rehabilitation's beds-ratio in Tunisia, coupled to a significant regional disparity. Increasing beds in the existing Inpatient Rehabilitation Facilities and extending outpatient rehabilitation departments with inpatient units might be considered urgent solutions.

Tuberculosis epidemiological trend in Sousse, Tunisia during twenty years (2000-2019)

Describe the epidemiology of tuberculosis in the last two decades (2000-2019) in the East region of Tunisia (city of Sousse). This was a descriptive retrospective analysis of notified incident cases of tuberculosis from 2000 to 2019 in Sousse Governorate, Tunisia. The data collection was done via the regional registry of tuberculosis. Stata software was used to characterize the socio-demographic and clinical profile of tuberculosis, to calculate its incidence, mortality and fatality rates and to determine predictive factors of mortality. R software was used to analyze the chronological trend of tuberculosis incidence and mortality. A total of 2606 incident cases of tuberculosis were declared from 2000 to 2019 in Sousse. The mean age was 39 ± 19 years with a sex ratio (male/female) of 1.19. Only one case was HIV positive among the total 2606 incident cases. Extra-pulmonary tuberculosis was the most recorded (1,534 cases, 58.9%). The mean annual case notification and deaths were 130 and four respectively. After adjusting for confounders, individuals with pulmonary tuberculosis were 1.9 significantly more likely to die from tuberculosis compared to those suffering from extra-pulmonary tuberculosis. There was a trend of increasing mortality with increasing age. The association was statistically significant only for those above 60 years' old who had 12.5 times higher odds of dying compared to those below 60 years. After adjusting for age and gender, with every year there was an increase in the total incidence rate (+0.35 per 100,000) with p = 0.005 and in the extra-pulmonary incidence (+0.27 per 100,000), with p = 0.001. This study demonstrated the increasing trend of tuberculosis in Sousse, Tunisia from 2000 to 2019. The national program against tuberculosis should enhance community knowledge and centralize the national and regional epidemiological information for better epidemiological surveillance.

Epidemiology of dyslipidemia in Tunisia, HSHS 3 study (Hammam Sousse Sahloul Heart Study)

INTRODUCTION

Dyslipidemia is a major cause of morbidity and mortality worldwide because it increases the risk of cardiovascular diseases.

AIM

To determine the prevalence of dyslipidemia and its components in the general population of Hammam Sousse (Tunisia) and to identify its risk factors.

METHODS

This was an analysis of the HSHS database (Hammam Sousse Sahloul Heart Study), a «community-based» cross-sectional study on cardiovascular risk factors including dyslipidemia, with a random sample in two-stages, proportional-probability clusters. All subjects above 20 years underwent a lifestyle interview, clinical examination with anthropometric measurements, and blood sampling. Dyslipidemia was defined by: total cholesterol ≥5.2 mmol/l, hyper LDL (Low Density Lipoprotein) cholesterolemia ≥4.1 mmol/l, hypo HDL (High Density Lipoprotein) cholesterolemia <1.03 mmol/l for men and <1.29 mmol/l for women and hyper-triglyceridaemia: ≥2.26 mmol/l. Multivariate logistic regression analysis was conducted to determine factors independently associated with dyslipidemia.

RESULTS

The study population was composed of 481 males (M) and 960 females (F), with a sex ratio of 0.5. Mean cholesterol was higher in women (5 mmol/l±1.01) than in men (4.8 mmol/l±0.92). Only 24.9% of men and 29.1% of women had normal HDL cholesterol levels. Women had higher levels of hypercholesterolemia and LDL cholesterolemia than men (p<10-6). Multivariate analysis showed that dyslipidemia was independently and statistically significantly associated with age ≥40 years (p<10-3), physical inactivity (p<10-3) and obesity (p=0.025).

CONCLUSION

As a result of the epidemiological situation of dyslipidemia, the promotion of an active lifestyle seems essential. In addition, nutritional education improves the lipid profile by promoting weight loss and balancing lipid consumption.

Perception of Tunisian Public Health Practitioners on the Role of Primary Health Care during the COVID-19 Pandemic

CONTEXT

Primary Health Care is the first level of healthcare delivery services. Its role in the management of epidemics has been documented especially during the SARS and Ebola epidemics, and more recently during the COVID-19 pandemic.

OBJECTIVE

To describe public health experts' perceptions of the implication of Primary Health Care on managing the COVID-19 pandemic in Tunisia.

METHODS

This qualitative study was based on a structured interview covering five domains: 1. Preparedness, 2. Implication, 3. Health delivery, 4. Response and 5. Fight against COVID-19 in Primary Health Care in Tunisia. Convenient sampling was done to include public health practitioners and experts.

RESULTS

A total of 25 experts were included with a sex ratio that was equal to 0.92, including two international experts, and four that were working in the Ministry of Health. The majority of respondents affirmed that the Tunisian PHC was not prepared to fight against the COVID-19 pandemic. Concerning the response role of PHC against COVID-19, some experts stated that PHC played an important role in the early stages of the pandemic. Almost all included participants claimed that PHC was marginalized from the national strategy against COVID-19. In addition, all respondents affirmed that there had been a weakening effect of the delivery of the minimum healthcare package that was dispended by the PHC after the pandemic. However, they all expressed the ability of PHC to manage future epidemics.

CONCLUSION

The Tunisian PHC system did not play an efficient role in the current COVID-19 pandemic. However future lessons should be deduced for further implications in potential upcoming epidemics.

Epidemiology of metabolic syndrome in Tunisia. HSHS 5 study

OBJECTIVE

To measure the prevalence of metabolic syndrome and its components in the HSHS cohort (Hammam Sousse, Tunisia), in 2009, and to identify its determining factors.

METHODS

This was a descriptive epidemiological study of the "community based" type having focused on a random sample of people aged 20 and over. The metabolic syndrome was defined according to the criteria of the "International Diabetes Federation" (IDF 2005) and those of the "National Cholesterol Education Program-Adult Treatment Panel III" (NCEP-ATP III, 2001).

RESULTS

The study involved 1441 people including 960 women (66.6%). The age- and sex-adjusted prevalences of increased waist circumference, blood pressure, blood sugar and triglycerides, and decreased HDL-cholesterol were respectively 63.2%, 95%CI[62.5-63.8]; 47.7%, 95%CI[47.4-48.6]; 25.7%, 95%CI[25.1-26.2]; 11.9%, 95%CI[11.4-12.3] and 65,6%, 95%CI[65.0-66.2], according to IDF thresholds and 37.4%, 95%CI[36.3-37.6]; 45.7%, 95%CI[45.4-46.6]; 13.8%, 95%CI[13.4-14.2]; 8.4%, 95%CI[8.0-8.7] and 61.9%, 95%CI[61.2-62.5], according to those of the NCEP-ATP III. The prevalence of metabolic syndrome adjusted for age and sex was 36.5% 95%CI[33.0%-38.9%] according to the IDF definition and 23.0% 95%CI[20.4%-25.6%] according to that of NCEP-ATP III. The multivariate study by logistic regression made it possible to retain three significant independent determining factors of the metabolic syndrome: age ≥40 years, low level of physical activity and family history of diabetes mellitus with respectively adjusted ORs of 3.77 95%CI[2.70-5.27], 1.39 95%CI[1.01-1.89], 1.62 95%CI[1.21-2.15], according to IDF and 5.87 95%CI[3.88 -8.88], 1.47 95%CI[1.07-2.01] and 1.45 95%CI[1.07-1.96], according to NCEP-ATP III .

CONCLUSION

With this high prevalence rate of the metabolic syndrome, the establishment of an action plan would be essential. This plan should be based on the combination of the promotion of physical activity and screening for the components of the metabolic syndrome, particularly in subjects aged 40 or over, with a family history of diabetes mellitus.

Epidemiology of diabetes mellitus in Tunisia. HSHS 2 study (Hammam Sousse Sahloul Heart Study)

BACKGROUND

National epidemiological studies on diabetes mellitus are rare, ancient and often carried out schools or clinics settings.

OBJECTIVES

To determine the prevalence of diabetes mellitus and identify its risk factors in the adult population of the city of Hammam Sousse (Tunisia) during the year 2009.

METHODS

This study is a part of analysis of the HSHS database (Hammam Sousse Sahloul Heart Study), a «community-based» cross-sectional study on cardiovascular risk factors including diabetes mellitus, with a two-stage proportional probability cluster random sample. All subjects aged 20 years and more underwent a lifestyle interview, clinical examination with anthropometric measurements, and blood sampling. The diagnosis of diabetes mellitus was defined by a fasting blood glucose level ≥7 mmol/l. Overweight was defined by a Body Mass Index (BMI) ≥ 25 kg/m². A multivariate logistic regression analysis was conducted to determine independent risk factors associated with diabetes mellitus.

RESULTS

The population was composed of 481 males (M) and 960 females (F), a sex ratio of 0.5 with mean ages respectively of 49.6±16.35 years and 46.6±16.18 years. The prevalence of diabetes mellitus adjusted by age and sex was 12.1% (95%CI[11.7-12.5]); M: 12.7% (95%CI[12.1-13.3]), F: 11.5% (95%CI[10.9-12.1]). The prevalence rate of patients newly detected with diabetes mellitus was 1.9% (95%CI[1.7-2.1]): M: 1.8% (95%CI[1.6-2.0]), F: 2.1% (95%CI[1.8-2.4]). The multivariate study revealed five independent factors significantly associated with diabetes mellitus. In addition to non-modifiable factors (male gender, age ≥40 years old, low schooling level and family history of diabetes), diabetes mellitus was 2 (95%CI[1.3-3.2]) times more prevalent in overweight cases.

CONCLUSION

In deep trouble of this epidemiological situation of diabetes mellitus, it is urgent to launch a universal intervention strategy based on the promotion of a healthy lifestyle motivating regular physical activity and a low-calorie diet.

Epidemiology of arterial hypertension in Tunisia: Hammam Sousse Sahloul Heart Study (HSHS)

INTRODUCTION

Tunisia is experiencing a double burden of morbidity, characterized by the explosion of cardiovascular diseases and their risk factors including arterial Hypertension. The objective of this study, based on the HSHS cohort (Hammam Sousse Sahloul Heart Study), was to determine the prevalence of hypertension in the general population and to identify its predisposing factors.

METHODS

HSHS is a cardiovascular health promotion initiative in the city of Hammam Sousse (Tunisia). The study was conducted via a random sample of households, using the WHO PEV technique, made up of 33 clusters, of 33 households each. All people aged 20 and over, included, benefited from a questionnaire, a physical examination and a biological assessment. The Systolic Blood Pressure (SBP) and the Diastolic Blood Pressure (DBP) were measured from the average of the last two measurements, by an OMRON type tensiometer, of suitable width. These prevalences were adjusted according to sex and age group, by their weighting coefficients in the general population, and they were accompanied by their 95% CIs. Binary logistic regression was conducted to identify independent factors associated with hypertension.

RESULTS

The study population was composed of 481 men (33.4%) and 960 women (66.6%), with an average age of 49.6±16.35 years in males (M) and 46.6±16.18 in females (F). In addition to the family history of hypertension, the sufficient weekly consumption of vegetables and fruits was low (M: 32.4%, F: 24.9%). The adjusted rate of hypertension in the adult study population was 32.5%, 95%CI[31.9-33.1] (M: 36.4%, 95%CI[35, 5-37.3]; F: 28.4%; 95% CI[27.6-29.2]), reaching in the age group of 60 years and above: M: 74.6% (95%CI[66.9-82.3], F: 82.7% (95%CI[73.8-83.6]) Multivariate analysis identified five independent factors significantly associated with hypertension: male sex (ORa=1.55 [1.18-2.03]), age over 40 years (ORa=6.54[4.70-9.11]), low level of schooling (ORa=1.80 [1.36-2.38]), low physical activity (ORa=1.42[1.07-1.88]) and high socio-economic level (ORa=1 .84 [1.30-2.63]).

CONCLUSION

The HSHS study confirmed the high prevalence of hypertension, and the extent of its low detection and control. Hence the need for a universal approach to health promotion, oriented towards the general population, piloted by its local organizations, based on the adoption of a healthy lifestyle, and centered on physical activity.

Forty-year Tunisian bibliometrics of general surgery theses in the four national faculties of medicine (1980-2019)

The objective of this work was to establish the bibliometric profile of Tunisian theses in ‘general surgery’ and to describe their themes, their study designs, and their writing quality. This is a retrospective descriptive bibliometric study, covering all the theses in medicine in the specialty of ‘general surgery’, defended in the four medical faculties of Tunisia, during the forty last years from 1980 to 2019. During the study period, 739 theses in ‘general surgery’ were discussed in Tunisia, with an average of 19 theses per year. The most studied research topic was emergencies (41%), followed by common surgical pathologies (26%) and digestive oncology (21.5%). Descriptive studies and case studies represented the majority of study designs with respective proportions of 56.9% and 40.6%. Only 20.7% of these theses had a scientific writing quality deemed satisfactory. The least respected elements in writing their summaries were statistical (confidence intervals and standard deviations) and documentary (keywords). Despite the plethora of themes of Tunisian theses in ‘general surgery’, their basic methodology and their editorial non conformity require the educational reform of the dissertations, both doctoral students and supervisors, by strengthening their skills in research methodology and scientific communication written.

Descriptive Statistics in Health Sciences

Le Réseau Maghrébin PRP2S et la Rédaction de la revue «La Tunisie Médicale» ont l’honneur de continuer d’une manière régulière, à partir du numéro de mars 2021, et pour la deuxième année successive, la série des fiches techniques en épidémiologie, en bio statistique et en rédaction médicale scientifique.

Cette série a eu un grand succès au cours de sa première année d’édition en 2020, comme indique le nombre de téléchargements dépassant significativement celui des articles originaux et illustrant un besoin très manifeste des jeunes chercheurs, au renforcement de leurs capacités en méthodologie de recherche scientifique en sciences de santé, selon une pédagogie centrée sur l’acquisition des compétences pratiques de recherche biomédicale.

En effet, nos fiches méthodologiques décrivent, d’une manière standardisée, les modes d’usage des concepts, des outils et des méthodes, utilisés d’une part lors du continuum de la recherche biomédicale scientifique, dès la phase conceptuelle jusqu’à la phase rédactionnelle et d’autre part lors des différentes phases de la rédaction médicale scientifique, depuis l’étape de la recherche documentaire jusqu’à l’étape de la communication médicale scientifique.

Cette série est rédigée par les experts du Réseau Maghrébin PRP2S, en méthodologie de recherche, exerçant dans les universités du Grand Maghreb et les facultés sœurs au Nord de la Méditerranée. Chaque fiche répond à trois questions essentielles (Quoi ? Pourquoi ? Comment) du concept étudié, en se basant sur un article publié dans la revue «La Tunisie Médicale».

Bibliometric profile of the doctoral thesis at the Faculty of Medicine of Sousse (Tunisia)

OBJECTIVE

Describe the bibliometric profile of medical dissertations in Sousse Faculty of Medicine (SOFM) in Tunisia.

METHODS

This is a cross-sectional bibliometric study of all dissertations defended from 2001 to 2005. The data were collected through a reading grid applied to the cover page, conclusion, and summary of the thesis. The specialty of the dissertation has been attributed to its first director. Themes were defined by the "essential descriptor", chosen from the descriptors used for the indexing.

RESULTS

The 670 theses collected, all written in French except one in Arabic, were original, pedagogic or bibliographical works in respectively 93.3%, 6.4%, and 0.3% respectively. "Community and Preventive Medicine" was the discipline that generated the most theses with a proportion of 8.9%. About half (48%) of the dissertations were supervised by two directors. The first director was a University Hospital Professor or an Associate Professor of Conferences, respectively in 34% and 42% of cases. The chairman of the thesis jury belonged to the same specialty as the first director and was from the same department in respectively 54% and 41% of cases. Four "essential descriptors" were frequently cited as indexation of the dissertation: "tumor", "CD-Rom", "trauma", and "diabetes". These dissertations were "clinical" type in 68% of cases, of which around 80% were "case studies".

CONCLUSION

The doctoral dissertation in SOFM was characterized by the orientation towards clinical and epidemiological research and the preference for general medicine and community health themes. It's often recourse to a basic research estimate and its writing in French would be two factors limiting its scientific promotion and its social influence.

Evidence-Based Medecine (EBM)

Le Réseau Maghrébin PRP2S et la Rédaction de la revue «La Tunisie Médicale» ont l’honneur de continuer d’une manière régulière, à partir du numéro de mars 2021, et pour la deuxième année successive, la série des fiches techniques en épidémiologie, en bio statistique et en rédaction médicale scientifique.

Cette série a eu un grand succès au cours de sa première année d’édition en 2020, comme indique le nombre de téléchargements dépassant significativement celui des articles originaux et illustrant un besoin très manifeste des jeunes chercheurs, au renforcement de leurs capacités en méthodologie de recherche scientifique en sciences de santé, selon une pédagogie centrée sur l’acquisition des compétences pratiques de recherche biomédicale.

En effet, nos fiches méthodologiques décrivent, d’une manière standardisée, les modes d’usage des concepts, des outils et des méthodes, utilisés d’une part lors du continuum de la recherche biomédicale scientifique, dès la phase conceptuelle jusqu’à la phase rédactionnelle et d’autre part lors des différentes phases de la rédaction médicale scientifique, depuis l’étape de la recherche documentaire jusqu’à l’étape de la communication médicale scientifique.

Cette série est rédigée par les experts du Réseau Maghrébin PRP2S, en méthodologie de recherche, exerçant dans les universités du Grand Maghreb et les facultés sœurs au Nord de la Méditerranée. Chaque fiche répond à trois questions essentielles (Quoi ? Pourquoi ? Comment) du concept étudié, en se basant sur un article publié dans la revue «La Tunisie Médicale».

Global university performance. Bibliometric analysis of the ARWU platform (2003-2020)

OBJECTIVES

Describe the 2020 report of the ARWU "Academic Ranking World Universities" classification and identify, accordingly, the roadmap of academic excellence, particularly in the countries of the Greater Maghreb.

METHODS

This is an in-depth reading of the 2020 results of the ARWU bibliometric platform (launched in 2003) from top 1000 world-class universities. Six criteria were used in this ranking: 1. Alumni (10%): students who received Nobel / Fields prizes; 2. Award (15%): professors who have won the Nobel / Fields prizes; 3. HiCi (20%): Most cited scientists; 4. PUB (20%): number of publications 5. TOP (20%): proportion of publications in the most influential periodicals; 6. PCP (10%): Per Capita Performance.

RESULTS

The 2020 ARWU ranking was characterized by the domination of the "Top 10" ranking by the United States, particularly the "Harvard University", the Asian boom of 55% of the "Top 1000" ranking (Chinese universities evolved from 16 in 2004 to 81 in 2020 in the "Top 500" list) and finally an African incubation of academic excellence, manifested by the selection of nine South African institutions (including the "University of Cape Town ", world rank between 201-300), and the re-entry for the first time of a Maghreb university in the" Top 1000 "list, Tunis El Manar (rank between 901-1000), with the following scores: N&S: 1 , 4; Pub: 26.1 and PCP: 10.3, for a total score of 37.8 points.

CONCLUSION

This report proves once again, the promising academic perspectives of Asia and Africa in the inclusion of the "Top 1000" list of the ARWU ranking. The roadmap for academic excellence would thus be based on the triad of centering scientific publications, in prestigious journals and by national author networks.

Preparation of the Structured Summary of a Biomedical Scientific article

Le Réseau Maghrébin PRP2S et la Rédaction de la revue «La Tunisie Médicale» ont l’honneur de continuer d’une manière régulière, à partir du numéro de mars 2021, et pour la deuxième année successive, la série des fiches techniques en épidémiologie, en bio statistique et en rédaction médicale scientifique.

Cette série a eu un grand succès au cours de sa première année d’édition en 2020, comme indique le nombre de téléchargements dépassant significativement celui des articles originaux et illustrant un besoin très manifeste des jeunes chercheurs, au renforcement de leurs capacités en méthodologie de recherche scientifique en sciences de santé, selon une pédagogie centrée sur l’acquisition des compétences pratiques de recherche biomédicale.

En effet, nos fiches méthodologiques décrivent, d’une manière standardisée, les modes d’usage des concepts, des outils et des méthodes, utilisés d’une part lors du continuum de la recherche biomédicale scientifique, dès la phase conceptuelle jusqu’à la phase rédactionnelle et d’autre part lors des différentes phases de la rédaction médicale scientifique, depuis l’étape de la recherche documentaire jusqu’à l’étape de la communication médicale scientifique.

Cette série est rédigée par les experts du Réseau Maghrébin PRP2S, en méthodologie de recherche, exerçant dans les universités du Grand Maghreb et les facultés sœurs au Nord de la Méditerranée. Chaque fiche répond à trois questions essentielles (Quoi ? Pourquoi ? Comment) du concept étudié, en se basant sur un article publié dans la revue «La Tunisie Médicale».

The 5x5 approach in scientific biomedical writing

Cette série…

Le Réseau Maghrébin PRP2S et la Rédaction de la revue «La Tunisie Médicale» ont l'honneur de continuer d'une manière régulière, à partir du numéro de mars 2021, et pour la deuxième année successive, la série des fiches techniques en épidémiologie, en bio statistique et en rédaction médicale scientifique.

Cette série a eu un grand succès au cours de sa première année d'édition en 2020, comme indique le nombre de téléchargements dépassant significativement celui des articles originaux et illustrant un besoin très manifeste des jeunes chercheurs, au renforcement de leurs capacités en méthodologie de recherche scientifique en sciences de santé, selon une pédagogie centrée sur l'acquisition des compétences pratiques de recherche biomédicale.

En effet, nos fiches méthodologiques décrivent, d'une manière standardisée, les modes d'usage des concepts, des outils et des méthodes, utilisés d'une part lors du continuum de la recherche biomédicale scientifique, dès la phase conceptuelle jusqu'à la phase rédactionnelle et d'autre part lors des différentes phases de la rédaction médicale scientifique, depuis l'étape de la recherche documentaire jusqu'à l'étape de la communication médicale scientifique.

Cette série est rédigée par les experts du Réseau Maghrébin PRP2S, en méthodologie de recherche, exerçant dans les universités du Grand Maghreb et les facultés sœurs au Nord de la Méditerranée. Chaque fiche répond à trois questions essentielles (Quoi ? Pourquoi ? Comment) du concept étudié, en se basant sur un article publié dans la revue «La Tunisie Médicale».

[Quality of "crisis communication" media during the COVID-19 pandemic in the Great Maghreb countries]

Objectif

Évaluer la qualité des supports de communication de crise, au cours de la pandémie de la COVID-19, dans trois pays du Grand Maghreb (Tunisie, Algérie, Maroc).

Méthodes

Il s’agit d’un audit de la conformité des communiqués de presse et des bulletins épidémiologiques, analysés via un référentiel de qualité, spécialement conçu par les auteurs. Ce référentiel, composé de cinq dimensions et de 50 items, cotés (0/1), a été appliqué par deux chercheurs en médecine préventive. La multiplication des notes par un coefficient de deux, a permis d’avoir un score partiel de 20 points pour chaque dimension et un score total de 100 points pour l’ensemble de la check list. La qualité des supports de communication a été jugée bonne au-delà des seuils de 15/20 pour les dimensions du référentiel et de 75/100 pour la totalité de la grille.

Résultats

Un total de 141 supports de communication a été inclus dans cet audit (Tunisie : 60, Algérie : 60, Maroc : 21). Le score global médian de la qualité de ces supports a été seulement de 56/100 (IIQ : [46–58]), sans variabilité notable entre les pays. La dimension la plus appréciée a été le « maintien de la confiance de la population » avec un score médian global de 14/20 (12/20 pour les bulletins épidémiologiques et 16/20 pour les communiqués de presse). La dimension la moins bien notée a été le « renforcement de la participation communautaire », avec un score médian de seulement 4/20 (6/20 pour les bulletins épidémiologiques et 4/20 pour les communiqués de presse).

Conclusion

La qualité des supports maghrébins de communication de crise, au cours de la COVID-19, a été insuffisante dans la majorité de ses dimensions et de ses items (dont surtout psychosociaux). Le renforcement des capacités des chargés de communication, dans l’élaboration des supports d’information, au cours des crises sanitaires, est indispensable et urgent.

Effectiveness of hand hygiene in an epidemic context. Systematic review

OBJECTIVE

To assess the effectiveness of Hand Hygiene (HH) in preventing infections and the transmission of pathogens, in an epidemic context, in community and hospital settings.

METHOD

It is a systematic review of the literature based on a document request, conducted on PubMed, using the following search equation: "(" Hand Hygiene "[All Fields] OR" Hand Disinfection "[All Fields]) AND ("Epidemics" [All Fields] OR "Pandemics" [All Fields]) ". All publications related to the effectiveness of the preventive intervention for HH in an epidemic setting were Included.

RESULTS

A total of 16 publications were included, of which the majority proved the effectiveness of HH and its promotion in reducing infections during an epidemic. In a clinical trial, promoting HH in an intervention group significantly reduced the prevalence of infections (24.4% vs. 11.1%). Two systematic reviews have shown the effectiveness of HH in preventing the transmission of germs with ORs between 0.52 and 0.62. Four case-control studies and three cross-sectional studies concluded with the protective effect of HH with ORs varying between 0.06 and 0.71. A cohort study showed that low adherence to HH recommendations was associated with a higher infection rate (77.5% vs 95%; p = 0.02). A single systematic review did not conclude that HH was effective in the epidemic setting.

CONCLUSION

The effectiveness of HH in the fight against epidemics has been demonstrated. It is dependent on the engagement and the active participation of the different intervenient. Hence the need to increase accessibility to different methods of HH and to promote the importance of this prevention strategy could be assured through education and awareness.

The satisfaction of patients hospitalized in the surgical departments of a general hospital. Case study of Sahloul hospital in Sousse (Tunisia)

OBJECTIVE

Measure the overall and specific satisfaction rates of patients hospitalized in surgical services in Sahloul University Hospital in Sousse during the year 2018.

METHODS

The study population was recruited by a quota sample of hospitalized patients in the surgical departments of Sahloul University Hospital in Sousse. Data collection was done via a patient satisfaction questionnaire, administered to outgoing patients. The questionnaire was composed of 33 items exploring technical, administrative, logistical and relational dimensions. Overall patient satisfaction, called "reactivity", was defined by a concomitant positive response to the three questions exploring satisfaction, recommendation and loyalty.

RESULTS

A total of 735 patients hospitalized in six surgical departments were included (general surgery, orthopedics, maxillofacial surgery, urology, neurosurgery and cardiovascular surgery). The rates of "satisfaction", "recommendation" and "loyalty" of the patients were 71%, 70% and 69% respectively, equivalent to an "overall positive reactivity" of 62%, 95% CI [58,5%-65.5%], particularly low in the orthopedic department (43%). The logistics dimension was the least appreciated by patients, including room's condition, with almost 23% overall and 17% in the orthopedic department.

CONCLUSION

The responsiveness of patients hospitalized in the surgical services of Sahloul University Hospital was low, particularly for items related to the hotel services in the hospital. Furthermore, plans to improve the quality of care and support the performance of public hospitals should pay close attention to the logistical dimension of patients' hospital stays.

Under 5 Child Mortality in the Maghreb countries

INTRODUCTION

Mortality, particularly at younger ages, is a key measure of population health.

AIM

To describe under 5 children mortality trends and its related factors in the Great Maghreb countries over the last three decades 1994-2019.

METHODS

We conducted an observational descriptive study to clarify the situation in the Maghreb countries with regard to the under-five death rates and the various causes related to them during the last three decades (1990-2019). The data was collected from the Global Burden of Diseases, Injuries, and Risk Factors (GBD).

RESULTS

he overall trend for the five Maghreb countries was towards the decrease in the mortality rates for all age groups and for both sexes. Mauritania remains at the top of the list in term of the number of deaths followed directly by Morocco. The number of deaths of under-5 children is higher among boys in all Maghreb countries and the most affected age group is under 1 year old. Regarding the causes of under-5 mortality in Maghreb countries, the top-5 causes were similar; except in Mauritania where infectious diseases remain the leading under-5 mortality cause, like in other sub-Saharan countries.

CONCLUSION

Despite the big drop in under 5 child Mortality rates, a lot remains to be done in Maghreb countries to improve children health.

Thirty years of Tunisian publication of «case reports» in General Surgery (1989-2018)

OBJECTIVE

To describe the bibliometric profile of Tunisian "case report" publications in general surgery over the last thirty years (1989-2018).

METHODS

This is a descriptive bibliometric study on "case reports", general surgery, Tunisian affiliation, indexed in the Medline database, between January 1, 1989 and December 31, 2018. The themes of Search articles were defined by referring to their major keywords used for their indexing.

RESULTS

During 30 years of study, Medline indexed 188 papers in "General Surgery" type "case reports", signed by 80 authors in first position and 71 authors in last position, belonging to ten academic specialties and 19 professional affiliations. These papers were published by 60 journals, including the Ugandan magazine "Pan African Medical Journal", which published 23% of these "case reports" alone. The number of major indexing keywords was 299 words, mainly "Echinococcosis", "Pancreatic Cancers" and "Echinococcosis of the liver", together accounting for 18.1% of articles.

CONCLUSION

The plethora of "case reports" in Tunisian general surgery publications over the last three decades was accompanied by a preferential edition in the journal "Pan Afr Med J" and a thematic focus on hydatid cysts and cancers pancreatic. Hence the importance of strengthening the capacity of Tunisian surgeons in research methodology and scientific medical writing.

Bibliometrics of Tunisian publications on respiratory tract diseases from 2010 to 2014

AIM

To describe the bibliometric characteristics of Tunisian publications on respiratory tract diseases, during the quinquennium 2010-2014.

METHODS

This is a descriptive bibliometric study of respiratory medicine publications, indexed in "Medline", based on their MSDSs. All included articles were written by Tunisian researchers regardless of their position in the list of co-authors. The topics of the publications were explored through their "major" and "generic" keywords.

RESULTS

A total of 340 publications was captured in Medline. These articles were co- authored by 218 authors in first position and 163 in last position. They were signed by pulmonologists, in first and last position respectively in 21.5% and 22.4% of articles. The A. Mami Hospital was the major affiliation of the first authors in 19.7% of the publications. These articles were published by 138 journals including "La Tunisie Medicale" in 11.8% of cases. They were "case reports" and written in English respectively in 44.4% and 54.1% of cases. Among 639 major keywords indexing, three were dominant: «Lung Neoplasms» (Tumeurs du poumon), «Chronic Obstructive Pulmonary Disease» (Broncho-pneumopathie chronique obstructive) and «Tuberculosis, Pulmonary» (Tuberculose pulmonaire), in 13.5%, 10.3% and 7.4% of articles respectively.

CONCLUSION

Tunisian research on respiratory tract diseases has been thematically concordant with the public health needs. However, it has often been of low-level evidence and published in low-impact factor journals.

Ramadan and Health. Bibliometric study of the biomedical literature indexed in «Medline» database

OBJECTIVE

To describe both editorial and thematic profile of biomedical publications related to the theme «Ramadan and Health», indexed in «Medline» database till December 31th 2018.

METHODS

This is a bibliometric study via «Medline» database using the following documentation query: «Fasting» [Majr] AND («Islam» [Majr] OR Ramadan [All Fields]). Data was collected through the «Medline» Material Safety Data Sheets from the NLM Library. Publications' themes have been defined by major descriptors (Majr). The generic descriptor corresponded to the Majr word hierarchically superior in the «Medline» Mesh descriptor thesaurus.

RESULTS

A total of 508 articles were captured, of which 13% were reviews and 5% were randomized controlled trials. These publications were published by 272 journals belonging to 38 countries, and signed by 108 authors in first position and 398 in last position. The number of major descriptors used to index these publications related to «Ramadan and Health» was 484. Endocrine System Diseases (Diabetes mellitus) and Human Activities (Exercise) were the main major generic keywords, indexing respectively 28% and 20% of this literature.

CONCLUSION

«Ramadan and Health» is increasingly, a theme of scientific and biomedical research of great interest worldwide in order to manage health problems, especially diabetes mellitus. Expanding the scope of its applications to other global burden of disease's areas would be useful.

Disciplinary and thematic mapping of Maghreb publications in "infectiology". Bibliometric study (Tunisia, 2010-2014)

AIM

To describe the essential bibliometric characteristics of Tunisian publications in "infectiology", during the five-year period 2010-2014.

METHODS

This is a descriptive bibliometric study, on the papers of "infectiology", indexed in "«Medline»", based on their data sheets. Were included all the articles written by Tunisian researchers regardless of their position in the list of co-signers. The themes of the publications were explored through the key words "major" and "generic" in the three chapters of the descriptors: "Bacterial Infections and Mycoses", "Parasitic Diseases", and "Viral Diseases".

RESULTS

A total of 846 publications in "Infectiology" were analyzed, of which 66% were written in English and 31% were "case reports". They were signed by 536 authors in first position belonging mainly to microbiology (20.7%), parasitology (20.1%) and virology (7.1%). The 391 co-signatories in last position belonged to 44 specialties, of which pediatrics, internal medicine and infectious diseases respectively occupy the 4th, the 9th and the 10th positions. These publications were edited in 258 journals, mainly "Tunisie Medicale" (9%) and "Pan African Medical Journal" (3.8%). The greatest interest of the Tunisian researchers in infectious diseases have been staphylococcal / tuberculosis infections, chronic viral hepatitis C / human influenza, and echinococcosis / leishmaniasis.

CONCLUSION

In Tunisia, infectious diseases research has been relatively prolific and concordant with the population's health needs. Infectious diseases physicians should build their network of care, research and education with biologists, while focusing their research on multicenter and high-level studies.

Bibliometrics of Tunisian publications in "General Surgery" (Medline, 2009-2018)

OBJECTIVE

To describe the bibliometric characteristics of Tunisian publications in "General Surgery", indexed in "Medline" database from 2009 to 2018.

METHODS

This is a bibliometric study conducted through a comprehensive documentary query applied to the "Pubmed" portal and using the "Medline" database. The essential themes of a publication have been defined by referring to its major keywords.

RESULTS

A total of 173 publications were included in this study, representing a productivity rate of 14 articles / 100 surgeons' teachers-year. These publications were co-authored by 65 authors in first position and published by 55 journals in 15 countries, including mainly the national journal "Tunis Med" during the first five-year period 2009-2013 (27%) and the Ugandan magazine "Pan Afr Med J" during the second five-year period 2014-2018 (33%). Case reports were the most widespread type of publication in Tunisian "General Surgery", during the two periods of the study, respectively in 63% and 51% of cases. English was the major language with 57% of publications. Among the 259 major descriptors used to index the "General Surgery" articles, the occurrence of "Pancreatic Neoplasms" and "Echinococcosis, Hepatic" was respectively 3% and 2%.

CONCLUSION

During the decade 2009-2018, the Tunisian research in "General Surgery" was not very prolific and was mainly "case reports" but it was directed toward population health problems; Hence the interest of a thorough training of surgeons in research methodology and scientific medical writing.

Management crisis of health personnel in the great Maghreb. Mauritania case study

OBJECTIVE

To describe the number and distribution of health personnel in Mauritania during 2017, according to their academic grades and administrative assignments.

METHODS

This is a quantitative study of the number and uses of health human resources in Mauritania, based on the 2017 data from the Personnel Register of the Ministry of Health. The number of doctors, midwives and nurses in the six administrative regions of Mauritania and its "wilayas", were standardized according to the size of the population (health workers /10 000 inhabitants). Interregional inequalities in the allocation of health personnel have been studied through the correlation between the percentages of the health professions and the populations of the regions affected.

RESULTS

In 2017, the number of health workers in all categories was 6608 in Mauritania, a ratio of 17.5 / 10000 health workers / inhabitants, ranging from 8.6 in "Gargot" wilaya to 37.3 in the wilaya of "Inchiri". The densities of specialist physicians, general practitioners, midwives and nurses were respectively 0.9, 0.84, 1.8, and 3.32 per 10,000 inhabitants, respectively. In the Nouakchott region, covering 28.5% of the Mauritanian population, 76.5% of specialist doctors and 56.8% of midwives, had ratios (health workers / 10 000 inhabitants) two and three times higher than national levels.

CONCLUSION

This study documented on the one hand the persistence of the shortage of health personnel in Mauritania in 2017, in all its professional categories, and on the other hand the inequalities of their distribution in its administrative zones, with a relative abundance in the region of Nouakchott.

Cancers in the Central Maghreb: epidemiology from 1990 to 2017 and trends in 2040

OBJECTIVE

To describe the epidemiology of cancers in terms of global burden of disease, incidence, prevalence and typology in the three Central Maghreb countries from 1990 to 2017, as well as their trends from 2017 to 2040.

METHODS

This is a descriptive and predictive study of the epidemiology of cancers in the Central Maghreb (Tunisia, Algeria and Morocco) from 1990 to 2040. The epidemiological data: incidence, prevalence, specific mortality rate and Disability Adjusted Life Years were collected via the Global Burden of Disease Database created by the Institute of Heath Metrics and Evaluation. These parameters were expressed in terms per 100,000 inhabitants.

RESULTS

In 2017 and for the three Central Maghreb countries, cancers represented the second leading cause of death, with an overall specific mortality rate of 69/100,000 and an overall incidence rate of 116/100,000 inhabitants. The Disability Adjusted Life Years rate varied from 1516/100,000 in Algeria to 1992/100,000 in Morocco. In the three Central Maghreb countries and during the year 2017, lung cancer was the first cancer in terms of mortality, regardless of age and sex, followed by colorectal cancer in Tunisia and breast cancer in Algeria and Morocco. These three cancers will remain in 2040 the most important in terms of mortality rate with lung cancer topping the list in Tunisia and Morocco with respective mortality rates of 30 and 16/100,000.

CONCLUSION

Cancers are currently, and in the next two decades, an important component of the GlobalBurden of Disease in Central Maghreb countries. The typology is dominated by lung, breast and colorectal cancers. The establishment of a Maghreb cancer registry would be a fundamental component of the Maghreb cancer plan.

For a honest Maghreb care system. Systematic Review of the International Literature on Corruption in the Health care System

INTRODUCTION

Corruption in the health care system is a universal phenomenon, putting at risk the health of populations. The purpose of this work was to synthesize the international literature on corruption in the health sector.

METHODS

This is a systematic review of literature dealing with articles on health corruption practices, published between July 2008 and June 2018, via two search engines: PubMed and Google Scholar. The extracted data were narratively summarized in three major areas: defining the concept of corruption in health, its typology / manifestations and anti-corruption interventions.

RESULTS

A total of 23 articles were selected for final analysis. The articles that defined health corruption shared two key aspects: "abuse of power" and "benefit". The main types of corruption were "abuse of therapeutic indication", followed by "bribes" and "falsification". The anti-corruption interventions were synthesized into seven types: creation of an independent multi-interventional agency, support for scientific research, law enforcement, awareness raising, detection, reporting and institutional commitment.

CONCLUSION

Based on the use of power, corruption in health is a complex phenomenon whose struggle requires a specific and contextualized strategy integrating information, detection and punishment.

Mortality in the Great Maghreb (1990-2015): causes of death and trends

OBJECTIVES

To describe trends of gross and specific mortality rates for all five countries of the Great Maghreb and to identify the typology and the main causes of death during the period 1990-2015.

METHODS

This is an observational and descriptive study of causes of death in the Great Maghreb (Tunisia, Algeria, Morocco, Mauritania and Libya) using the database Global Burden of Diseases (GBD) of the Institute for Health Metrics and Evaluation (IHME). Causes of death were categorized according to the IHME into three categories: "Communicable Diseases", "Non Communicable Diseases" and "Trauma". These following tracer years (1995, 2005, 2015) were considered in the study of global and specific causes of death by country, disease group, sex and age group.

RESULTS

During the period 1990-2015, the general trend in gross mortality rates was going down, reaching in 2015 rates that varied from 547/100 000 inhabitants in Tunisia to 437/100 000 inhabitants in Algeria. The trend in specific mortality from Communicable Diseases has been declining, particularly in Mauritania. Among the "Top 10" list of causes of death, four to eight were "Non Communicable Diseases" including ischemic heart disease, which was ranked first in the Maghreb except Mauritania. For children under 5 years old, prematurity was the leading cause of death in the five Maghreb countries in 2015.

CONCLUSION

This analysis of causes of death in the Great Maghreb confirmed the similarity of the epidemiological transition and health priorities. Hence the urgency of developing common North African strategies for monitoring, training and intervention in public health.

Profile and evolution of the Global Burden of Morbidity in the Maghreb (Tunisia,Morocco, Algeria). The Triple burden of morbidity

BACKGROUND

The Global Burden of Disease (GBD) is an objective method of measurement of disease disability, allowing the quantification of a population's health status, the identification of its health needs, and the determination of its public health priorities.

OBJECTIVES

To document the epidemiological transition in Maghreb countries (Tunisia, Morocco, Algeria) over the past three decades and to identify their priority health problems, which are responsible for a considerable burden of disability.

METHODS

This is a data synthesis work of the Institute for Health Metrics and Evaluation (IHME) global burden of disease, through its project "GBD Compare Data Visualization". Data covering the period from 1990 to 2016, examined the three major categories of health problems "communicable, maternal, neonatal and nutritional diseases", "noncommunicable diseases" and "injuries", as well as the three types of risk: metabolic, environmental / professional and behavioral.

RESULTS

Since 1990, cardiovascular diseases have consistently been the leading cause of death in the three Maghreb countries. During the period 1990-2016, and at varying speeds, the positions of communicable and neonatal diseases declined, while noncommunicable diseases (particularly cardiovascular diseases, cancers, mental disorders, diabetes and neurological disorders) increased significantly, to be at the top of the list of components of the global burden of disease.In 2016, road accidents have been ranked eighth in the ranking of the main components of the overall burden of morbidity in Tunisia and Morocco and ninth in Algeria. During the same period, the environmental and behavioral risk factors registered an overall decrease in the three Maghreb countries, in contrast to the metabolic risk factors that experienced a gradual and homogeneous increase in the Greater Maghreb.

CONCLUSION

This GBD analysis confirmed the rather old and fairly advanced epidemiological transition in Maghreb countries, leading to a real "triple burden" threatening the stability and sustainability of national health systems. Hence the urgency of supporting the following five projects: the curriculum reform of the faculties of health sciences, the development of the second line of care, the participative management of health services, universal health coverage and the implementation of a comprehensive and integrated strategy for prevention and health promotion.