Incidence and risk factors of post COVID-19 syndrome: a Tunisian cohort study

BACKGROUND

It has become increasingly clear that SARS-CoV-2 infection can lead to persistent physical and mental health problems lasting weeks or months, requiring prolonged periods of clinical care and increasing the burden on the healthcare system. This phenomenon, known as post COVID-19 syndrome (PCS), is a relatively new condition, its incidence is still unclear and differs between studies.

OBJECTIVES

In this cohort study, we aimed to estimate the incidence of PCS and to identify its risk factors in the Tunisian population.

METHODS

This is a prospective cohort study that enrolled patients diagnosed with COVID-19 from the triage unit of the University Hospital of Monastir, Tunisia. between April 2021 and June 2022. Patients were contacted by phone for a follow-up evaluation of PCS 12- weeks after the diagnosis date.

RESULTS

A total of 1451 individuals diagnosed with COVID-19 during the study period, responded to the follow-up evaluation after 3 months. The incidence of PCS was found to be 44.03% (95% CI [41.47; 46.58]), with fatigue being the most common symptom (21.5%), followed by cognitive impairment (10.3%), including memory loss and difficulty concentrating. Multivariate analysis revealed that the main associated factors to PCS were female gender (RR = 1.54; CI95% [1.30 - 1.82]), pre-existing comorbidities (RR = 1.30; CI95% [1.10 - 1.52]), duration of acute COVID-19 illness (days) (RR = 1.02; CI95% [1.01 - 1.03]), hospitalization (RR = 1.27; CI95% [1.05 - 1.53]), number of COVID-19 episodes (RR = 1.46; CI 95% [1.28 - 1.67]) and patients having receive two or more doses of vaccine prior to COVID-19 infection (RR = 0.82; CI95% [0.70 - 0.96]).

CONCLUSION

Our study allowed to estimate the incidence and identify risk factors of PCS. Recognizing these factors could help to better understand the underlying mechanisms and guide interventions for prevention and management of this condition.

Comparison of time to negative conversion of SARS-CoV-2 between young and elderly among asymptomatic and mild COVID-19 patients: a cohort study from a national containment center

Objective

We aimed to study the relationship between age and time to negative conversion of SARS-CoV-2 in patients with asymptomatic and mild forms of COVID-19.

Methods

We conducted a cohort study including all patients diagnosed with COVID-19 from the national COVID-19 containment center of Tunisia. Patients were subdivided into two cohorts: (under 60 years) and (over 60 years) and were followed up until PCR negativization. Log rank test and Cox regression were applied to compare time to negative conversion between the old group and the young group.

Results

The study included 289 patients with non-severe forms of COVID-19. Age over 60 was significantly associated with delayed negative conversion in male sex (Hazard ratio (HR): 1.9; 95% CI: 1.2-3.07) and among patients with morbid conditions (HR:1.68; 95% CI: 1.02-2.75) especially diabetics (HR: 2.06; 95% CI: 1.01-4.21). This association increased to (HR:2.3; 95% CI: 1.13-4.66) when male sex and comorbidities were concomitantly present and rose to (HR: 2.63; 95% CI: 1.02-6.80) for men with diabetes. Cox regression analysis revealed a significantly delayed negative conversion in symptomatic patients. Significant interaction was observed between gender and age and between age and chronic conditions.

Conclusion

Age is associated with delayed negative conversion of viral RNA in certain subgroups. Identifying these subgroups is crucial to know how prioritize preventive strategies in elderly.

The SBAR tool for communication and patient safety in gynaecology and obstetrics: a Tunisian pilot study

BACKGROUND

In healthcare, inadequate communication among providers and insufficient information transmission represent primary contributors to adverse events, particularly in medical specialties such as obstetrics and gynecology. The implementation of SBAR (Situation-Background-Assessment-Recommendation) has been proposed as a standardized communication tool to enhance patient safety. This study aims to evaluate the knowledge, attitudes, and practices related to SBAR communication through a pilot study conducted in a middle-income country.

METHODS

This prospective longitudinal study took place in the gynecology-obstetrics department of a Tunisian university hospital from May to June 2019. All medical and paramedical staff underwent comprehensive theoretical and practical training through a 4-hour SBAR simulation. To gauge participants' knowledge, anonymous multiple-choice questionnaires were administered before the training initiation, with a second assessment conducted at the end of the training to measure satisfaction levels. Two months later, the evaluation utilized questionnaires validated by the French National Authority for Health (HAS).

RESULTS

Among the 62 care staff participants in this study, a majority (89%) demonstrated a low level of knowledge regarding the SBAR tool. The majority (75.8%) expressed enjoyment with the training and indicated their intention to implement changes in their practice by incorporating the SBAR tool in the future (80.7%). Notably, over half of the participants (79%) expressed satisfaction with the training objectives, and 74% reported acquiring new information. Evaluation of the practice revealed positive feedback, particularly in terms of clarity, the relevance of communication, and the time spent on the call.

CONCLUSION

Our pilot study showed that the majority of professionals on the ward had little knowledge of the SBAR tool, a good attitude and a willingness to put it into practice. It is essential that healthcare managers and professionals from all disciplines work together to ensure that good communication practice is developed and maintained. Organisations, including universities and hospitals, need to invest in the education and training of students and health professionals to ensure good quality standardised communication.

Burden and predictions of hospitalized injuries in a low-middle income country: results from a Tunisian university hospital

Injuries are responsible for a high premature mortality and disability. They are poorly explored in low and middle income-countries. We aimed to estimate the burden of hospitalized injuries in the Monastir governorate (Tunisia) according to the nature of the injury, trends and projections of hospitalizations for injuries up until 2024, and to identify the distribution of this disease burden based on age and sex. We performed a descriptive study from 2002 to 2012 including all hospitalizations for injuries. Data were collected from morbidity and mortality register of the University Hospital of Monastir (Tunisia). We estimated the burden of injuries using the Disability Adjusted Life Years (DALYs). We described injuries (crude prevalence rate (CPR) and age standardized prevalence rate (ASR)), related mortality (lethality and standardized mortality ratio (SMR)), trends and prediction for 2024. A total of 18,632 hospitalizations for injuries representing 10% of all hospitalizations during study period were recorded. Per 1000 inhabitants per year, CPR was 3.36 and the ASR was 3.44. The lethality was of 17.5 deaths per 1000 injured inpatients per year and the SMR was of 2.95 (Confidence Interval of 95%: 2.64-3.29). Burden related to injuries was 2.36 DALYs per 1000 population per year, caused mainly by Years of Life Lost (83.4%), most frequent among men aged under 40 years. The predicted ASR for 2024 was 4.46 (3.81-5.23) per 1000 person-years. Injuries to the head was the most prevalent (20.7%) causing 67.7% of DALYs; and increasing by 226% through 2024. Injuries had a high prevalence and an important burden in a Tunisian university hospital. Prediction showed increased prevalence for 2024. Preventive measures and a trauma surveillance register should be implemented soon.

Quality indicators of public maternity units in the governorate of Monastir (Tunisia)

INTRODUCTION

Increasing access to healthcare for expectant mothers is a national goal. In Monastir, Tunisia, some Peripheral Maternity Units (PMUs) required assessment. Our goals were to describe the delivery activities in MUs (maternity units) and to assess whether some of PMUs need to have their activities replaced.

METHOD

We analyzed aggregate data of deliveries in Monastir from 2015 to 2020. The gouvernorate's seven public MUs were included. Only the morning activity was allotted for obstetricians and gynecologists, in RMUs 1 and 2, whereas they were not available in all PMUs. Data was gathered from the reports of the National Perinatal Program. Both the availability of Comprehensive Essential Obstetric Care (CEOC) and Basic Essential Obstetric Care (BEOC) were calculated. Trends were calculated using Joinpoint software. The Annual Percent Change (APC) was calculated.

RESULTS

The number of births decreased from 2015 to 2020 (APC= -4.3%: 95%CI : -6; -2.4; p = 0.003). The largest significant decreases in APCs of deliveries were reported in PMU 2 (APC = -12.6% (95%CI : -20; -4.4; p = 0.014), in PMU 3 (APC = -29.3% (95%CI : -36.5; -21.4; p = 0.001), and in PMU 4 (APC = -32.9% (95%CI: -49.1; -11.5); p = 0.016). If PMU 3 and 4 were no longer operating as maternity facilities, BEOC and CEOC standards would still be adequat. For accessibility, both PMU 3 and PMU 2 are accessible from PMU 4 and PMU 1, respectively.

CONCLUSIONS

Pregnant women prefer to give birth in obstetric services with ability to perform emergency caesarean at the expense of PMU. Nowadays, it appears that accessibility is less important than the presence of qualified human resources when a pregnant woman choose a maternity hospital.

The effectiveness of a health education intervention to reduce anxiety in quarantined COVID-19 patients: a randomized controlled trial

INTRODUCTION

The COVID-19 pandemic is regarded as a serious public health concern that boosts levels of stress and anxiety which could be explained by several reasons, including social isolation. In this regard, we aimed to assess the impact of health education on the anxiety level of COVID-19 patients during the isolation period.

METHODS

This is a randomized controlled trial conducted between February 2021 and June 2021. Patients tested positive for Covid-19 with mild to moderate forms were randomized to Education (n = 267) or control (n = 269). The education group received a phone health education session on day 1 (D1) following the diagnosis. The three components of the health education intervention were an explanation of the coronavirus disease, what to do in the event of complications, and the recommended preventive measures. The two groups received a telephone evaluation of their Hospital Anxiety and Depression scores on D1 and day seven D7 following the positive diagnosis. The primary outcome was the rate of anxiety reduction in each group on D7 based on a HAD-A score ≥ 8. Secondary outcomes were the rate of anxiety reduction on D7 based on a HAD-A score ≥ 11, the percentage of people complying with isolation and the scores of adherences to preventive measures during the isolation in each group.

RESULTS

Hundred and ninety-six patients in the intervention group and 206 patients in the control group completed the study. The sociodemographic, clinical, and initial anxiety level features of the intervention and control groups were comparable at baseline (p ≥ 0.05). On D7, the education group's anxiety level (HAD-A ≥ 8) decreased from 26 to 16.3% (p = 0.013) while in the control group it increased from 19.4 to 22.8% (p = 0.37). Thus, the percentage change in anxiety between D1 and D7 (delta D7 - D1) was - 9.7% in the Education group and + 3.4% in the Control group. Using the HAD-A ≥ 11 thresholds, the percentage of anxiety decreased from 15.3 to 11.2% (p = 0.26) between D1 and D7, while it increased in the control group from 9.7 to 15.7% (p = 0.045). Thus, the education group's change in anxiety (delta D7 - D1) was - 4.1%, while the control group's change was + 6%.

CONCLUSION

During an outbreak, providing health education to quarantined patients may be beneficial to reduce the psychological impact of the disease.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Identifier: NCT05715593, retrospectively registered on 8/02/2023 https://clinicaltrials.gov/ct2/results?term=NCT05715593&Search=Search .

Associations of psychological factors, parental involvement, and adverse health behaviors with bullying among tunisian middle school students

BACKGROUND

Bullying is a serious problem that significantly affect adolescent well-being and health, needing the attention of teachers, school administrators, parents and public health professionals. In this study, we aimed at estimating the prevalence of bullying, from the perspective of victims in middle school students in the region of Monastir Tunisia, as well as analyzing its association with individual and family context variables.

METHODS

This is a cross-sectional study conducted in December 2017 and January 2018 among a sample of students from two middle schools in the region of Monastir (Tunisia), using the Global School-based Student Health Survey (GSHS) self-answered questionnaire. We defined bullying victimization as being bullied in at least one day in the previous 30 days. Binary logistic regression model was used to identify factors associated with being bullied.

RESULTS

Out of 802 students included in this study, nearly half (43.4%) reported having been bullied in the past month with CI _95%: 38.9-48.2. Gender did not interact with this behavior: (44.5%; CI _95%: 38.1-51.7) in boys versus (43.4% ; CI _95%: 37.2-50.2) in girls. Univariate analysis indicated significant differences regarding some individual factors such as physical fight, cigarette smoking, feeling lonely and being worried, in terms of prevalence of being bully victims. There were no significant differences in parental factors between the two groups (being bullied or not). Multivariate analysis showed the following factors as independently associated with bullying: being involved in physical fight (OR = 2.4; CI_95%:1.77-3.25), feeling lonely (OR = 3.38; CI_95% :2.04-5.57) and being worried (OR = 2.23; CI _95%:1.44-3.43).

CONCLUSION

Bullying victimization was common among school-going adolescents and was linked with physical fight and psychosocial distress. This study highlights the need for school-based violence prevention programs to address this problem among the students.

COVID-19 during pregnancy: case report and literature review

The current coronavirus disease 2019 (COVID-19) pneumonia pandemic, caused by the newly discovered coronavirus is a serious public health emergency and a highly infectious disease. Evidence to date suggests that there are groups of people who are at a higher risk of getting severe COVID-19 disease such as pregnant women and their fetuses. We reported 4 cases of pregnant women with COVID-19 admitted in the national containment center, Tunisia (3 imported cases and one local case). The age range of the patients was 27-35 years and the range of gestational weeks at admission was 16 weeks to 32 weeks. None of the patients had underlying diseases. All four cases were totally asymptomatic and presented no complications. Two of them gave birth one by vaginal and the other by cesarean delivery, neonates presented no symptoms and no adverse outcomes. The current report does not present significant differences in the disease prognosis in the pregnant women´s group compared with the general women´s population. Careful observation, data collection and consecutive research are necessary.

Effect of vitamin D supplementation versus placebo on recovery delay among COVID-19 Tunisian patients: a randomized-controlled clinical trial

INTRODUCTION

The present study aimed to determine the impact of vitamin D supplementation (VDs) on recovery delay among COVID-19 patients.

METHODS

We performed a randomized controlled clinical trial at the national COVID-19 containment center in Monastir (Tunisia), from May to August 2020. Simple randomization was done in a 1:1 allocation ratio. We included patients aged more than 18 years who had confirmed reverse transcription-polymerase chain reaction (RT-PCR) and who remained positive on the 14th day. The intervention group received VDs (200,000 IU/1 ml of cholecalciferol); the control group received a placebo treatment (physiological saline (1 ml)). We measured the recovery delay and the cycle threshold (Ct) values in RT-PCR for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The log-rank test and hazard ratios (HR) were calculated.

RESULTS

A total of 117 patients were enrolled. The mean age was 42.7 years (SD 14). Males represented 55.6%. The median duration of viral RNA conversion was 37 days (95% confidence interval (CI): 29-45.50) in the intervention group and 28 days (95% CI: 23-39) in the placebo group (p=0.010). HR was 1.58 (95% CI: 1.09-2.29, p=0.015). Ct values revealed a stable trend over time in both groups.

CONCLUSION

VDs was not associated with a shortened recovery delay when given to patients for whom the RT-PCR remained positive on the 14th day.

TRIAL REGISTRATION

This study was approved by the Human Subjects Protection Tunisia center (TN2020-NAT-INS-40) on April 28, 2020, and by ClinicalTrial.gov on May 12, 2021 with approval number ClinicalTrials.gov ID: NCT04883203 .

Associated factors with adherence to preventive behaviors related to COVID-19 among medical students in the university of Monastir, Tunisia

INTRODUCTION

Medical students should act as a model for the community in terms of compliance with preventive practices toward COVID-19. The aim of this study was to assess adherence to preventive behaviors related to COVID-19 among medical students and to identify its associated factors.

POPULATION AND METHODS

We conducted a cross-sectional survey in October 2020 in the faculty of medicine of Monastir. We included a representative sample of medical students during registration days for the 2020-2021 academic year. The data were collected through a self-administered anonymous questionnaire. Eleven items related to preventive practices against COVID-19 were assessed (respiratory hygiene practices (Six Item), hand hygiene practices (Three Items) and social distancing (two items)). Items were evaluated using a Likert scale of five points (from 0: (Never) to 4: (Always)). The score obtained from the sum of these items allowed to classify students into two categories: "Good compliance" if the score was ≥ 80% and "Poor compliance" if the score was less than 80%. Scores were compared according to the study population characteristics. Multivariate analysis was used to identify associated factors with good practices. The threshold of statistical significance was set at p < 0.05.

RESULTS

We included 678 medical students. The average age was 21.76 (SD = 1.89 years) with a sex ratio of 0.40. The protection measures most respected by the participants were related to the respiratory hygiene: correct coverage of the nose and mouth with the mask (80%), wearing masks regardless of the presence of symptoms (73.3%) and coverage of the mouth during coughing or sneezing (76.6%). Adherence to hand hygiene measures ranged from 51.4% to 66.3%. The least respected measures were related to social distancing: distancing of at least one meter from others (31.2%) and avoiding crowded places (42.5%). An overall score ≥ 80% was obtained among 61.5% of students. Referring to multivariate analysis, variables that positively affected the overall score of preventive measures related to COVID-19 were the female sex and living alone, with Beta coefficients of 3.82 and 1.37 respectively. The perceived level of stress, E-cigarette and Chicha consumption negatively affected the score with Beta coefficients of (-0.13), (-5.11) and (-2.33) respectively.

CONCLUSION

The level of adherence to good practice among medical students was overall moderate. Awareness programs would be needed in this population, especially for men and those who smoke and vape.

Burnout syndrome among health care workers during the COVID-19 pandemic. A cross sectional study in Monastir, Tunisia

BACKGROUND

Burnout syndrome may affect the safety of frontline healthcare care workers (HCW) and patients. We aimed to measure the prevalence of burnout among HCW in care facilities in Tunisia during the Covid-19 pandemic and to identify its associated factors.

METHODS

We conducted a cross-sectional study among HCW practicing during the covid-19 pandemic in health care facilities in the governorate of Monastir. Data collection was carried out using an anonymous self-administered questionnaire composed by three sections: epidemiological and clinical characteristics, professional conditions and the Maslach Burn out Inventory (MBI-HSS).

RESULTS

This study included 371 HCW. The prevalence of burnout was 77.9% (CI 95%: 73.6% - 82.1%). The severe level was found in 71 participants (19.1%), the moderate level in 115 (31%) and the low level in 103 (27.8%). The distribution of the levels of the burnout dimensions among the participants was as follows: high emotional exhaustion (EE) (57.4%), high depersonalization (DP) (39.4%) and low personal accomplishment (22.6%). The main determinants of burnout among healthcare professionals during COVID 19 pandemic were: working more than 6 hours per day (OR = 1.19; CI95% [1.06; 1.34]), physician function (OR = 1.17; CI 95% [1.05; 1.31]), feeling a negative impact of work on family life (OR = 1.40; 95% CI [1.13; 1.73]), and high personal estimation of COVID 19 exposure (OR = 1.15; CI95% [1.02; 1.29]).

CONCLUSION

During the COVID19 pandemic, the prevalence of burnout among health professionals was high. It was related to hard implication in COVID 19 management. Interventions like adjusting working hours, reducing workload, and providing psychological support should be taken.

Surveillance of tobacco use among young adolescents: trends and predictors across three years in Sousse, Tunisia

Background

In developed countries, there was an overall decrease in tobacco use over the last decades. In Tunisia, a national strategy to reduce tobacco use was set up since 2008. However, this strategy was rarely evaluated. The objective of the current study was to examine the trends in tobacco use among the middle schoolchildren of the governorate of Sousse (Tunisia) between 2014 and 2016 and to determine predictors of its experimentation.

Methods

Three cross-sectional studies were conducted in 2014, 2015 and 2016 school years among middle schoolchildren randomly selected from the governorate of Sousse-Tunisia. The required sample size for each study was 760 participants. Each year, the same procedure was used to recruit pupils from the same middle schools. The same pre-established and pre-tested questionnaire was self-administered anonymously to participants in their classrooms.

Results

Lifetime tobacco use rose from 11% in 2014 to 17.3% in 2016 (p = 0.001). Across the 3 years of survey, predictors of lifetime tobacco use were: The male sex (OR, 95% CI: 4.4 [3.2-6.1]), age above 13 (OR, 95% CI: 2.3 [1.7-3.1]), lifetime illicit substances use (OR, 95% CI: 3.9 [1.1- 13.8), lifetime inhalant products use (OR, 95% CI: 2.2 [1.2-4.3]), tobacco use among the father (OR, 95% CI: 2.2 [1.2-4.3]), tobacco use among siblings (OR, 95% CI: 1.7 [1.2-2.4]) and current anxiety symptoms (OR, 95% CI: 1.8 [1.4-2.4]).

Conclusion

Lifetime tobacco use is in expansion among the young adolescents of Sousse. The current national tobacco prevention program should be strengthened and expanded to cover other substances use issues with emphasis on secondhand smoking and mental health problems.

Breast cancer incidence and predictions (Monastir, Tunisia: 2002–2030): A registry-based study

Introduction

Breast cancer is a major public health problem worldwide. It is the leading cause of cancer deaths in females. In developing countries like Tunisia, the frequency of this cancer is still growing. The aim of this study was to determine the crude and standardized incidence rates, trends and predictions until 2030 of breast cancer incidence rates in a Tunisian governorate.

Methods

This is a descriptive study including all female patients diagnosed with breast cancer in Monastir between 2002 and 2013. The data were collected from the cancer register of the center. Tumors were coded according to the 10^th version of international classification of disease (ICD-10). Trends and predictions until 2030 were calculated using Poisson linear regression.

Results

A total of 1028 cases of female breast cancer were recorded. The median age of patients was 49 years (IQR: 41–59 years) with a minimum of 16 years and a maximum of 93 years. The age-standardized incidence rate (ASR) was of 39.12 per 100000 inhabitants. It increased significantly between 2002 and 2013 with APC of 8.4% (95% CI: 4.9; 11.9). Prediction until 2030 showed that ASR would reach 108.77 (95% CI: 57.13–209.10) per 100000 inhabitants.

Conclusion

The incidence and the chronological trends of breast cancer highlighted that this disease is of a serious concern in Tunisia. Strengthening preventive measures is a primary step to restrain its burden.

Complicated COVID-19 in pregnancy, maternal and neonatal outcomes: a case report

The novel coronavirus disease 2019 (COVID-19) has exposed vulnerable populations, including pregnant women, to an unprecedented public health crisis. According to recent data, pregnancy in COVID-19 patients is associated with increased hospitalization, admission to the intensive care unit (ICU) and intubation. It has been suggested that pregnancy induced immune responses and cardiorespiratory changes can exaggerate the course of the COVID-19. The present is a case of a pregnant woman who presented with critical respiratory failure secondary to COVID-19 resulted in her admission to the ICU and mechanical ventilator support. After childbirth, maternal outcomes were marked by disseminated intravascular coagulopathy and cardiopulmonary arrest on day thirty-four of admission. As to the neonatal outcome, a preterm female baby was transferred to the neonatal intensive care unit (NICU) and intubated immediately due to progressive respiratory distress. She was diagnosed with bacterial pneumonia with no evidence of COVID-19 and recovered after twenty-one days after NICU stay. This case showed that the maternal COVID-19 may lead to acute respiratory distress syndrome, coagulation dysfunction and preterm delivery. The risk of vertical transmission by SARS-CoV-2 is probably very low.

Caractéristiques évolutives et facteurs pronostiques du pneumothorax et du pneumomédiastin chez les patients atteints de COVID-19

Introduction

La survenue d’un pneumomédiastin (PM) ou d’un pneumothorax (PNO) est une complication rare au cours du COVID-19 dont les mécanismes physiopathologiques exacts restent mal connus. Toutefois, il s’agit d’une complication grave qui doit être évoqué devant toute aggravation rapide de l’état respiratoire chez ces patients. L’objectif de notre travail est d’étudier les caractéristiques évolutives et les facteurs pronostiques du PM et du PNO associés à une infection à COVID-19.

Méthodes

Il s’agit d’une étude rétrospective réalisée, entre mars et juillet 2021, à l’hôpital militaire de campagne de Sfax, incluant des patients hospitalisés atteints du COVID-19 et qui ont présenté au cours de leurs évolutions un PM ou PNO.

Résultats

Trente-trois patients ont été inclus dans notre étude. Le PM était spontané chez 41,4 % des cas (prévalence à 1,2 %) et secondaire ou iatrogène dans 58,6 % des cas (prévalence à 1,71 %). Un PNO a été associé au PM dans 7 cas (21,2 %). Un PNO isolé spontané a été noté dans 4 cas (12,1 %). Le délai moyen de survenue d’un PM était de 20 jours. La prise en charge du pneumomédiastin était une surveillance clinique et radiologique dans 30,3 % des cas (PM spontané : 66,7 %, PM secondaire ou iatrogène 11,8 %, p = 0,03), le drainage thoracique 21,2 % (40 % pour le PNO spontané, 83,3 % pour le PNO secondaire ou iatrogène, p = 0,1). Quatorze patients (42,4 %) étaient intubés et nécessitaient une ventilation mécanique et 15,2 % ayant nécessités le recours à la ventilation non invasive. La durée moyenne de l’hospitalisation était de 30 jours (27 jours pour le PM spontané, 34 jours pour le PM secondaire ou iatrogène, p = 0,3). L’évolution était favorable dans 42,4 % des cas (83,3 % pour le PM spontané, 17,6 % pour le PM secondaire ou iatrogène, p = 0,001). Une corrélation significative a été trouvé entre la mortalité et la survenue d’un PM (p = 0,01), l’âge (p = 0), la sévérité de l’atteinte radiologique (p = 0,03), la gravité du tableau clinique (l’aggravation de l’état respiratoire p = 0,01 et la présence des signes de compression p = 0,03) et le recours à la ventilation mécanique (p = 0,03).

Conclusion

Le pneumothorax et le pneumomédiastin sont des complications rares mais grave de l’infection pulmonaire par le SARS-CoV-2. Il semble que l’âge, la survenue d’un PM, la sévérité de l’atteinte radiologique, la gravité du tableau clinique et le recours à la ventilation mécanique sont des facteurs de mauvais pronostic.

The burden of Alzheimer’s caregivers and social support in the Tunisian family

Background

Alzheimer is a pathology that concers the patient and his family having a physical, social, economic and psychological impact. Research on family caregivers is still lacking and little is known about caregivers burden and ist associated factors in Tunisia. The aim of this study were to describe caregiver burden among Tunisian family caregivers of patients with alzheimeŕs disease, its associated factors and ist relationship to social support.

Methods

We conducted a cross-sectional study among 118 family caregivers during three months at the neurology outpatient departments of two university hospitals. Sahloul, Sousse and Taher Sfar, Mahdia. Using the Zarit Burden Interview-22 (ZBI)items and the Medical Outcome Study-Social Support Survey to assess burden and social support among the caregivers.

Results

We included 118 caregivers of patients with Alzheimeŕs disease,with an average age of 45±15 years. Women were more predominant with a sex ratio of 0.57.Half of caregivers were the descent of patients. The Mean years of caregiving was 5±3 years with an average of 13 hours ±3 of care assistance per day. The mean ZBI Score was 38.4±18.5 and 16.1% of caregivers percived a severe burden. The mean ZBI Score was higher in female, retired, lowmsocio economic status and in rural area with a statistically significance difference. We found that caregiver burden and social support were highly correlated (p &lt; 0.001,r=-0.41)indicating that a high level of caregiver burden was asoociated with a less level of social support.

Conclusions

The level of burden in family caregivers who are caring for a patient with alzheimeŕs disease is high. A considerate help and support from helth care and social institutions is required by taking into account the factors that contribute to caregivers burden and considering the importance of social support in alleviating caregiver burden.

Key messages

The level of burden in family caregivers who are caring for a patient with alzheimeŕs disease is high. High level of caregiver burden was asoociated with a less level of social support.

Evidence-based practice among health students: attitudes, knowledge, skills and perceived barriers

Introduction

Evidence-based practice (EBP) is a worldwide approach in optimizing quality of healthcare. As healthcare providers are increasingly more involved in clinical decision making, it is becoming important for them to use the best evidence to make effective and justifiable decisions. EBP is an important competency of undergraduate healthcare students that remains little known among Tunisian future healthcare professionals. This study aimed to describe health sciences students' attitudes. Knowledge and skills in EBP; to determine factors associated with these competencies and to identify perceived barriers regarding EBP.

Materials and Methods

A descriptive cross-sectional study was conducted at the Higher School of Health Sciences and Techniques of Sousse among 365 health sciences students enrolled during the second semester of the academic year 2017-2018. Data was collected using a self administrated questionnaire including a validated EBP-COQ questionnaire and focusing on identifying the perceived barriers to the usage of EBP.

Results

The response rate was 93.11%. Approximately, 61.6% of students were familiar with the term ‘EBP'. The overall score of EBP-COQ questionnaire was 3.26 ±0.53 out of 5. The mean scores of attitude, skills and knowledge subscales were 4.04 ±0.41; 3.05 ±0.77 and 2.70 ±0.74 respectively. A significant statistical association was found between the competencies in EBP and age; gender, academic degree, year of study for license degree, students' English-language reading skills, students' education in research methodology and statistics (p &lt; 10-3). The top reported barriers hindering their adoption of EBP were: lack of training in EBP, difficulty in obtaining full-text papers and lack of time.

Conclusions

The strategic position of healthcare students may influence the adoption of EBP. It is necessary to understand students' attitudes, knowledge and skills in the subject to be able to develop effective strategies for EBP curricula.

Key messages

Evidence-based practice is a worldwide approach in optimizing quality of healthcare. It is necessary to understand students' attitudes, knowledge and skills to develop effective learning strategies.

The association between face mask use and SARS-CoV-2 RNA viral clearance: A cohort study in Tunisia

Background

The outbreak of coronavirus disease (COVID-19) continues to constitute an international public health concern. Scientific evidence showed that community mask wearing is an effective nonpharmacologic intervention to reduce the spread of this infection. However, few data are available about the effect of face masking on the duration of the disease. We aimed to study the association between recovery time among a Tunisian cohort of COVID-19 confirmed patients and mask wearing.

Methods

A prospective cohort study was conducted from March to July 2020 including patients with COVID-19 admitted to the Tunisian national containment center. Data were collected via phone call interview. Kaplan-Meir Methods and Cox proportional hazards regression models were, respectively, used to study the association between recovery time and face masks use.

Results

Among the 264 patients included, the median duration of viral clearance was 20 days (interquartile range (IQR 17-32days)). The median time to RNA viral conversion was 18 days (IQR 16-21 days) when using masks versus 23 days (IQR17-36 days) without wearing masks. Face masks use was significantly associated with an accelerated RNA clearance of SARS-CoV-2 (HR 2.006, 95% CI 1.247-3.228) (p = 0.004).

Conclusions

With the emergence of new variants, it is important to adopt widespread mask wearing to avoid SARS-CoV-2 infection and accelerate RNA negative conversion, until effective levels of vaccination are achieved nationally.

Key messages

Face masking was associated with accelerated RNA clearance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Promoting community mask wearing during COVID-19 pandemic is crucial.

Rabies surveillance in the central region of Tunisia: A 15-year observational study

Background

Rabies remains a major public health threat in many parts of the world and is responsible for an estimated 55,000 human deaths annually. In Tunisia, the National Rabies Control Program was initiated in 1982 based on dog's annual vaccination campaign. The aim of our study was to describe the epidemiological profile and management of rabies exposure in the Monastir governorate, Tunisia.

Methods

We included in our study all cases of animal aggression reported between 2004 and 2018 in the Monastir governorate. The source of the data was the directorate of primary health care in Monastir.

Results

A total of 27,277 bites were reported with an annual average of 1,817 cases per year. Most of victims were in the 5-14 age group (25%, n = 6,902). The culprit animal was the dog in 64% of cases followed by rats and cats. Only 42% of attacking dogs were vaccinated. A significant increase in dog bites was noted from 2004 to 2018 (β = 16.5; p = &lt;10-3). The number of bites increased significantly (β = 23.2; p = &lt;10-3) by vaccinated dogs and decreased significantly by unvaccinated dogs (β = -12; p = &lt;10-3). During our study period, a total of 146 cases of animal rabies was confirmed. Only one case of human rabies was reported, the aggressor animal was a cat and post-exposure prophylaxis was not received.

Conclusions

In Tunisia, human exposure to rabies by a dog has been on the rise. Future interventions should focus on mass dog vaccination campaigns and contraception in order to eliminate this disease.

Key messages

A significant increase in dog bites was noted from 2004 to 2018. It is crucial to reinforce appropriate preventive strategies, such as mass dog vaccination programs.

Social support and health-related quality of life among patients with chronic heart failure

Introduction

Heart failure (HF) represents a major public health issue in Tunisia due to its frequency and its consequences in terms of morbidity and mortality. Despite improved treatment, HF is still associated with high mortality and impaired quality of life. Therefore, improvement or maintenance of health-related quality of life (HRQoL) is important when caring for these patients. The aim of this study was to evaluate the health-related quality of life (HRQoL) and explore its associated factors and its relationship with social support.

Material and methods

A cross sectional study was conducted over a period of two months in the cardiology departments in the following university hospitals: Sahloul and Farhat Hached in Sousse, Fattouma Bourguiba in Monastir and Taher Sfar in Mandia. Overall, 92 participants were included. Data was collected using an interview administrated questionnaire in the Tunisian dialect. This questionnaire used the Tunisian version of the SF-36 and MSPSS.

Results

The mean age of the participants was 63.1 ± 10.4 with female predominance (53.3%). The overall score of the SF-36 was 45.1 ± 26.5. The physical component was more impaired than the mental component ((41.2 ± 29.1 VS51.3 ± 27). The two dimensions mental health and social functioning had obtained the highest averages (63.6 ± 22.4 and 51.4 ± 33.1; respectively). The MSPSS score was 52.5 ± 21. The ‘family' subscale had the highest mean (21 ± 8). HRQoL was positively associated with social support (p = 0.013; r = 0.257). The predictors of good HRQoL were: young age, university level of education, cohabitation with family, high socioeconomic level and one-sided HF.

Conclusions

Therapeutic education sessions should be implemented in order to improve the functional symptoms of HF, reduce the rate of readmissions and subsequently improve HRQOL. We also stress the importance of giving priority to strengthening social ties between the patient and their social circles.

Key messages

Heart failure is still associated with high mortality and impaired quality of life. Therapeutic education sessions should be implemented in order to improve the Quality of life of HF patients.

Viral shedding in asymptomatic versus symptomatic patients with COVID-19

Background

An outbreak of coronavirus disease 2019 (COVID-19) is becoming a public health emergency. Data are limited on the association between a prolonged viral shedding in patients with COVID-19 and having symptoms. We aimed to study the association between the presence of symptoms and recovery time of COVID-19 confirmed patients.

Methods

We conducted a prospective cohort study of COVID-19 patients admitted to the designated national COVID-19 center in Monastir, Tunisia from March to July 2020. Kaplan-Meier survival curve and Cox proportional hazards regression models were used to assess viral shedding in asymptomatic versus symptomatic patients with COVID-19.

Results

Among the 264 patients included in the study, symptoms such as anosmia, dry cough, and fatigue were reported by 34.4% (n = 75) of cases. The median time to RNA viral conversion was 24 days (IQR 18-36 days) for symptomatic patients versus 20 days (IQR 16-30 days) for asymptomatic patients. Having symptoms was significantly associated with a prolonged viral shedding (HR 0.600, 95% CI 0.401-0.897) (p = 0.013).

Conclusions

Our findings revealed that having symptoms delayed viral clearance among COVID-19 patients. Therefore, symptomatology should be taken into consideration in isolation strategy for infected patients.

Key messages

Having symptoms was associated with a delay in SARS-CoV-2 RNA clearance.

The presence of symptoms should be taken into consideration for patient’s isolation strategy.

Health system saturation in managing COVID-19 patients in Monastir, Tunisia

Background

COVID-19 emerged in late 2019 and quickly became a serious public health problem worldwide. This study aimed to determine the average length of stay, occupancy bed rate and bed turnover rate for COVID-19 patients in Monastir university hospital between the 1st October 2020 and 28th february 2021.

Methods

This is a cross-sectional study that enrolled all hospitalizations for COVID19 in Monastir University hospital, the unique third level healthcare in this region, between the 1st October 2020 and 28th february 2021. The following indicators: the average length of stay, the occupancy bed rate and the bed turnover rate were calculated during the study period.

Results

We included 762 hospitalizations for COVID-19 during the study period. The average age of our population was 64,22 years (standard deviation= 14,17). Male predominance was noted with sex ratio=1,63. The median length of stay was significantly longer in the intensive care unit (ICU) than in the other departments (11 (7;16) days, versus 7(2;14) days), p = 0.008. The average number of beds available for COVID-19 patients during the study period was 13 in the ICU and 65 in the other wards. The bed turnover rate and the bed occupancy rate per month were respectively 2,66 patient/bed/month and 96,26% in the ICU versus 1,74 patient/bed/month and 62,26% in the other wards. The occupancy bed rate in the ICU exceeded the 100% during the outbreak of January and February 2021 (129,72% and 120,66% respectively).

Conclusions

Despite the efforts by the health services and social isolation measures in Tunisia, this study highlighted the saturation of our health system with an overload in intensive care units.

Key messages

Length of stay for patients with Covid-19 was significantly the longest in ICU. The occupancy bed rate, exceeding 100% in ICU, highlighted the health system collapse in managing COVID-19 patients.

Spirometry feedback as a motivational tool for tobacco cessation

Background

Tobacco use remains a major public health problem especially in developing countries and emerging economies. The evidence about the effect of spirometry on smoking cessation is still controversial. The aim of this study was to determine whether a spirometry and lung age announcement were a motivator for smoking cessation.

Methods

We conducted a randomized controlled trial among patients who attended the smoking cessation clinic (SCC) at Fattouma Bourguiba University Hospital in Monastir, from June 2017 to February 2020. Participants were assigned into two groups, a control arm receiving standard program and intervention arm receiving standard program and lung age announcement. The primary outcome was the smoking cessation rates after one year of follow-up between the intervention arm and the control arm.

Results

A total of 500 patients were recruited and randomized with 250 patients in each group. At one-year endpoint, a total of 456 patients were reachable for assessment, 236 in control group and 220 in spirometry group. The loss rate was equal to 8.8% (54/500). Six months smoking rate was 78 (33.1%) in control group and 106 (48.0%) in intervention group (p = 0.002). One-year smoking cessation rate was higher in the intervention group than the control group (25.5% versus 16.5%), with a considerable statistical significance (p = 0.019). Spirometric lung age was significantly higher at paired comparison with chronologic age (58.81vs 46.54; p&lt;.001); the mean difference was 10.24 years but with considerable inter-individual variability.

Conclusions

Smoking cessation is still a challenging procedure with a high risk of relapse. This study is an additional evidence for spirometry and lung age announcement as motivators for cessation.

Key messages

Spirometry increased the motivation of smoking cessation. The equipment of smoking cessation centers by spirometry may contribute on tobacco control.

Comparison of SARS-CoV-2 RNA clearance between elderly and young patients with COVID-19

Background

The SARS-CoV-2 outbreak in 2020 caused a highly transmissible disease with a significant impact on the elderly. Understanding viral clearance duration of COVID-19 is important to tailor prevention strategies to this vulnerable category. We aimed to investigate the SARS-CoV-2 infection duration and associated factors to prolonged viral clearance among elderly people comparatively to young people.

Methods

We conducted a cohort study of asymptomatic and mild forms of COVID-19 patients admitted to the designated national COVID-19 center in Monastir, Tunisia. Patients included in the study were divided into two cohorts: (elderly group: ≥ 60 years old) and (young group: < 60 years old) and were followed up to their RNA viral conversion. Stratified cox regression was performed to determine associated factors with prolonged viral SARS-CoV-2 RNA clearance in elderly subgroups.

Results

The study included a total of 289 patients with asymptomatic and mild forms of COVID-19. The median term of viral shedding was 20 days (IQR; 16 - 32 days) for the young group, and 21 days (IQR; 17 - 33 days) for the elderly group. The stratified cox regression showed that Age ≥ 60 was an associated factor to prolonged viral shedding in male sex (HR (Hazard Ratio): 1.91; 95% CI: 1.19 - 3.07) and patients with comorbidities (HR:1.68; 95% CI: 1.02 - 2.75) especially diabetics (HR: 2.06; 95% CI: 1.01 - 4.21).

Conclusions

This study, focused on the factors associated with a prolonged duration of viral RNA clearance in elderly with COVID-19. These Potential factors will help planners to chalk out effective strategies among this vulnerable category.

Key messages

Old age is associated with a prolonged duration of viral RNA clearance in specific subgroups.

Identifying these subgroups is important to know how prioritize preventive strategies in elderly.

Impact of Haemophilus influenza immunization on hospitalized acute respiratory infections

Background

Immunization is the most cost-effective measure to combat communicable diseases in childhood. Haemophilus influenza (Hib) vaccine was included in the Tunisian expanded program of immunization for the first time in 2002 (Hib Vaccine monovalent) and is currently combined with the pneumococcal vaccine(Hib vaccine pentavalent combination) since April 2019. We aimed to assess impact of Hib vaccine on Respiratory Infection(RI) admissions in children aged up to 3 years.

Methods

It was a cohort study from January 1, 2002 to December 31, 2013. All Respiratory Infection (RI) admissions in children aged up to 3 years in the university hospital of Monastir(Tunisia) were enrolled.

Results

Admissions for RI represented 17.6% (CI95%: 17.3-18.1) of all communicable diseases hospitalizations (n = 6 061/34 289). The median age was 22 years (IQR: 3-52). Admission for Pneumonia with Streptococcus Pneumoniae (SP) increased significantly during study period (b = 25.9 (p &lt; 0.0001)) especially in children up to 5 years old (b = 10.6) and in elderly (b = 6.0). Among children up to 3 years old, the Crude incidence rate per 100,000 for Hib pneumonia admission were 11.6 in Non-Vaccinated Cohort (NVC), 10.6 in Vaccinated Cohort (VC) by protocol 1 (Hib Vaccine monovalent) and 0.80 in VC by protocol 2 (Hib vaccine pentavalent combination).The relative risk reduction was 99% for protocol 2 (p &lt; 0.001).

Conclusions

Admissions for RI in a tertiary level hospital were common with an increasing trend. The Hib immunization program, in particular the second protocol (pentavalent combination), has had a positive impact on the reduction of related acute diseases.

Key messages

The Hib immunization program, has had a positive impact on the reduction of related acute diseases. The “Hib vaccine pentavalent combination “is more efficient than “Hib Vaccine monovalent”.

Quality of life in adult patients with open-angle glaucoma:a systematic review

Background

Assessment of the quality of life of glaucoma is an essential basis for their management in order to prevent deterioration of the disease. The aim of the study was to describe through a systematic review the quality of life of patients with open angle glaucoma and identify its associated factors.

Methods

It was a systematic review conducted based on the preferred reporting items for Systematic Reviews and Meta-analyses (PRISMA).Criteria for eligibility were all published population-based primary literature in Pubmed and Embase interface, written in English, since January 2014 to 31 December 2019. Electronic research was done through the following documentary query ((((‘glaucoma'[MeSH Terms]) AND (‘quality of life'[MeSH Terms])) AND (‘open angle glaucoma'[Title/Abstract])) AND (‘adult'[MeSH Terms])) AND (‘risk factors'[MeSH Terms]).Level of evidence and grades of recommendation was assessed according to the Scottish Intercollegiate Guidelines Network (SIGN).

Results

Among 139 articles, 15 were selected. Most of them were descriptive cross-sectional studies using different measuring instruments. We found that the quality of life of glaucoma patients varies according to the regions in Asia, Europe, America and Africa. The highest scores were recorded in Asia, followed by North America and Europe, which have very close scores. The risk factors associated with the quality of life of glaucoma patients were: Age, sex, level of education, professional status, marital status, visual acuity and disability, anxiety and depression.

Conclusions

The level of quality of life in this type of patient varies considerably between regions and countries and even in the same country. Associated factors are predominantly socio-demographic.

Key messages

The level of quality of life in patients with glaucoma varies considerably between regions and countries. Associated factors are predominantly socio-demographic.

Animal bites and post-exposure prophylaxis in Central-West Tunisia: a 15-year surveillance data

BACKGROUND

Rabies is a disease that still exists in developing countries and leads to more fatalities than other zoonotic diseases. Our study aimed to describe the profile of human exposures to animals over fifteen years and to assess the post-exposure prophylaxis (PEP) practices in the governorate of Kasserine (Tunisia) on pre- and post-revolution (2011).

METHODS

We carried out a descriptive study using surveillance data from a region in Central-West Tunisia. All humans exposed to animals, residents in Kasserine Governorate and declared to the regional directorate of primary health care (RDPH) from January 1st, 2004 to December 31st, 2018 were included.

RESULTS

A total of 45,564 cases of human exposures to animals were reported over the fifteen-year period of the study with an annual average of 3089.2 ± 403.1. The standardized incidence rate (SIR) of human exposures to animals was 694 per year per 100,000 inhabitants (inh). The most listed offending animal was the dog (91.3%) and the most reported type of exposure was bites (63.7%). The trend in human exposures to animals increased significantly over time. The number of exposures by vaccinated dogs decreased significantly and by unvaccinated and stray dogs increased steeply. When comparing pre-and post-revolution periods, the yearly average of animal exposures post-2011 was significantly greater than the average prior to 2011 (3200 ± 278.5 vs 2952.8 ± 483) (p < 0.001). The yearly average of animal bites post-2011 was significantly greater than the average prior to 2011 (2260.5 ± 372.1 vs 1609.8 ± 217.9) (p < 0.001). The average number of vaccine doses per animal exposure was 2.4. Concerning PEP protocols, protocol A (2 and 3 doses) was indicated in 79% of animal exposures cases. From 2004 to 2018, a downward trend was noted for protocol A (r = - 0.29, p < 0.001) and an upward trend for protocol B (3 and 5 doses) (r = 0.687, p < 0.001). During our study period, 5 fatal cases of human rabies were declared.

CONCLUSION

Rabies remains a major public health problem in Tunisia. The political dynamics had an impact on the health care system and rabies control. Preventive measures should be applied adequately to decrease the burden of this disease.

Syndromic surveillance of female sexually transmitted infections in primary care: a descriptive study in Monastir, Tunisia, 2007─2017

BACKGROUND

Sexually Transmitted Infections (STIs) are a public health problem, especially for reproductive-age women. The aim of this study was to determine the incidence and trend of STIs during 11 years in Tunisia (2007-17).

METHODS

We conducted a descriptive study including all women with curable STIs (chlamydia, gonorrhea, syphilis and trichomoniasis) diagnosed with the syndromic approach in all basic health care centers of the Governorate of Monastir (Tunisia) from 2007 to 2017. Syndromes included, Pelvic Pain (PP), Vaginal Discharge (VD) and Genital Ulceration (GU).

RESULTS

We analyzed 40,388 episodes of curable STIs with a crude incidence rate and age standardized incidence rate of 1393 (95% Confidence Interval (CI); 1348-1438) / 100,000 Person Year (PY) and 1328 (95%CI; 1284-1372) /100,000 PY respectively. The incidence rate showed a positive trend over 11 years for all age groups and syndromes. VD was the most common syndrome with a crude incidence rate of 1170/100,000 PY. For all syndromes, women aged 20 to 39 were the most affected age group (p < 0.001).

CONCLUSION

In conclusion, the incidence rate of STIs episodes among women diagnosed with the syndromic approach was high, consistent with the global evidence. Focusing on reviewing STIs surveillance system in low and middle-income countries could allow the achievement of the ending of STIs epidemics by 2030.

Effective public health measures to mitigate the spread of COVID-19: a systematic review

BACKGROUND

In December 2019, a novel coronavirus (2019-nCoV) was recognized in Wuhan, China. It was characterised by rapid spread causing a pandemic. Multiple public health interventions have been implemented worldwide to decrease the transmission of the 2019 novel coronavirus disease (COVID-19). The objective of this systematic review is to evaluate the implemented public health interventions to control the spread of the outbreak of COVID-19.

METHODS

We systematically searched PubMed, Science Direct and MedRxiv for relevant articles published in English up to March 16, 2021. We included quasi experimental studies, clinical trials, cohort studies, longitudinal studies, case-control studies and interrupted time series. We included the studies that investigated the effect of the implemented public health measures to prevent and control the outbreak of 2019 novel coronavirus disease (COVID-19).

RESULTS

The database search using the predefined combinations of Mesh terms found 13,497 studies of which 3595 in PubMed, 7393 in Science Direct 2509 preprints in MedRxiv. After removal of the duplicates and the critical reading only 18 articles were included in this systematic review and processed for data extraction.

CONCLUSIONS

Public health interventions and non-pharmaceutical measurements were effective in decreasing the transmission of COVID-19. The included studies showed that travel restrictions, borders measures, quarantine of travellers arriving from affected countries, city lockdown, restrictions of mass gathering, isolation and quarantine of confirmed cases and close contacts, social distancing measures, compulsory mask wearing, contact tracing and testing, school closures and personal protective equipment use among health workers were effective in mitigating the spread of COVID-19.

The incubation period during the pandemic of COVID-19: a systematic review and meta-analysis

BACKGROUND

The aim of our study was to determine through a systematic review and meta-analysis the incubation period of COVID-19. It was conducted based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Criteria for eligibility were all published population-based primary literature in PubMed interface and the Science Direct, dealing with incubation period of COVID-19, written in English, since December 2019 to December 2020. We estimated the mean of the incubation period using meta-analysis, taking into account between-study heterogeneity, and the analysis with moderator variables.

RESULTS

This review included 42 studies done predominantly in China. The mean and median incubation period were of maximum 8 days and 12 days respectively. In various parametric models, the 95th percentiles were in the range 10.3-16 days. The highest 99th percentile would be as long as 20.4 days. Out of the 10 included studies in the meta-analysis, 8 were conducted in China, 1 in Singapore, and 1 in Argentina. The pooled mean incubation period was 6.2 (95% CI 5.4, 7.0) days. The heterogeneity (I² 77.1%; p < 0.001) was decreased when we included the study quality and the method of calculation used as moderator variables (I² 0%). The mean incubation period ranged from 5.2 (95% CI 4.4 to 5.9) to 6.65 days (95% CI 6.0 to 7.2).

CONCLUSIONS

This work provides additional evidence of incubation period for COVID-19 and showed that it is prudent not to dismiss the possibility of incubation periods up to 14 days at this stage of the epidemic.

Factors associated with a prolonged negative conversion of viral RNA in patients with COVID-19

Objectives

The aim of this study was to identify the factors influencing the delay in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA negative conversion.

Methods

A cohort study was conducted that included patients with coronavirus disease 2019 (COVID-19) admitted to the Tunisian national containment center. Follow-up consisted of a weekly RT-PCR test. Multivariate Cox regression analysis was performed to determine independent predictors associated with negative RNA conversion.

Results

Among the 264 patients included, the median duration of viral clearance was 20 days (interquartile range (IQR) 17–32 days). The shortest duration was 9 days and the longest was 58 days. Factors associated with negative conversion of viral RNA were symptoms such as fatigue, fever, and shortness of breath (hazard ratio (HR) 0.600, 95% confidence interval (CI) 0.401–0.897) and face mask use when exposed to COVID-19 cases (HR 2.006, 95% CI 1.247–3.228). The median time to RNA viral conversion was 18 days (IQR 16–21 days) when using masks versus 23 days (IQR 17–36 days) without wearing masks, and 24 days (IQR 18–36 days) for symptomatic patients versus 20 days (IQR 16–30 days) for asymptomatic patients.

Conclusions

The results of this study revealed that during SARS-CoV-2 infection, having symptoms delayed viral clearance, while wearing masks accelerated this conversion. These factors should be taken into consideration for the strategy of isolating infected patients.

Hepatitis B birth vaccination, cohort study, Tunisia 2000-2017

We aimed to compare the efficiency of the first dose of Hepatitis B (HB) vaccine: at Birth versus at 3 months and to evaluate the efficacy of HB vaccine. We conducted a cohort study in the governorate of Monastir. Vaccinated Cohort (VC) included populations receiving the first dose at 3 months (Protocol 1), and at birth (HepB-BD) (Protocol 2). First dose was followed by at least two doses. We collected, from January 2000 to December 2017, cases diagnosed by serological markers (hepatitis B surface antigen (HBsAg) and anti-HBc). We calculated Absolute Risk (AR) per 100,000 PY and the Relative risk reduction (RRR). Twenty-five cases were notified among VC and 1501 cases among not vaccinated cohort (NVC). Twenty-three cases were notified among the cohort receiving the first dose at 3 months and two cases in Protocol 2. The AR per 100,000 PY was 5.67 (CI95%: 3.36-7.99) in Protocol 1 and 0.11 (CI95%: 0.001-0.26) in Protocol 2. The RRR was 77% (95% CI: 66; 85) in Protocol 1 and 99.4% (95% CI: 97.8; 99.9) in Protocol 2. We identified 4 HB cases for children aged between 5 and 11 who benefited from protocol 1 (born between 2000 and 2006) and zero cases for children of the same age group benefiting from protocol 2 (born between 2011 and 2017). The annual number of HB has decreased from 112 in 2000 to 48 in 2017. We predicted 40 new cases of HB in 2030. HepB-BD was 99.4% effective at preventing HB. The continuity of HepB-BD worldwide would achieve WHO's goal of eliminating HB as a threat to health by 2050.

ABBREVIATIONS

AR: Absolute Risk; ARR: Absolute Risk Reduction; G1: Group1; G2: Group2; HB: Hepatitis B; HepB-BD: Hepatitis B Birth Dose; MENA: Middle East and North Africa; NNV: Number Needed to Vaccine; HIV: Human Immunodeficiency Virus; NVC: Not Vaccinated Cohort; PY: Person Year; RRR: Relative Risk Reduction; RR: Relative Risk; VC: Vaccinated Cohort; WHO: World Health Organization.

Trends and health burden of hospitalized acute respiratory infections and impact of Haemophilus influenza immunization in a Tunisian university hospital: a twelve-year study

BACKGROUND

We aimed to describe the episodes and trends of admissions for community-acquired Respiratory Infections (RI) over a 12-year period and to assess the impact of Haemophilus influenza type b (Hib) vaccine on RI admissions in children aged up to 3 years.

METHODS

We conducted a twelve-year retrospective observational study on all community-acquired RI admitted to Fattouma Bourguiba Hospital in Monastir Governorate (Tunisia) from 1 January 2002 to 31 December 2013. RI cases were selected from the Regional Registry of Hospital Morbidity. Data were coded according to ICD-10. To assess the impact of the Hib vaccine, three cohorts were defined based on vaccine status (unvaccinated cohort, first vaccinated cohort (VC) by monovalent form and second VC by pentavalent combination).

RESULTS

Admissions for RI represented 17.6% (CI95%: 17.3-18.1) of all communicable diseases hospitalizations (n = 6 061/34 289). The crude incidence rates (CIR) per 100,000 inh were 24.2 for upper RI (URI) and 77.5 and for Lower RI (LRI) (p < 0.0001). Pneumonias represented 53.9% of LRI. Sex-ratio (male/female) was 1.12 for URI and 1.64 for LRI (p < 0.0001). At admission, the median age was 22 years (IQR: 3-52). Admission for Pneumonia increased significantly during study period (slope 'b' = 5.16; p < 0.0001) especially in children up to 5 years old (slope 'b' = 5.53) and in elderly (slope 'b' = 2.13). Among children up to 3 years old, the CIRs per 100,000 for Hib pneumonia admission were 11.6 in Non-Vaccinated Cohort (NVC), 10.6 in Vaccinated Cohort (VC) by protocol 1 (Hib Vaccine monovalent) and 0.80 in VC by protocol 2 (pentavalent vaccine combination).The relative risk reduction was 99% for protocol 2 (p < 0.001).

CONCLUSION

Admissions for RI in a  tertiary level hospital were common with an increasing trend. The Hib immunization program, in particular the pentavalent combination, has had a positive impact on the reduction of related acute diseases.

Extra-pulmonary tuberculosis incidence, trends and predictions in Monastir, Tunisia (2000-2030)

Background

Tuberculosis (TB) is global public health problem and up to 25% of TB cases present extrapulmonary involvement. The incidence of extrapulmonary tuberculosis (EPTB) is increased worldwide. Our study aimed to give an update on the epidemiology, current trends of EPTB from 2000 to 2017 and to predict future trajectories of EPTB up to 2030 in Monastir, Tunisia.

Methods

We performed an observational study from 2000 to 2017. Data were collected by the regional direction of primary health care. Incidence was estimated by the crude incidence rate (CIR). Poisson regression model was used to calculate the slope 'b' in order to describe trends and was performed to estimate incidence projection for 2030. Data were verified and analyzed using IBM SPSS Statistics version 22.0 software.

Results

During 18 years, 997 cases of TB were declared in Monastir. Almost 51% (n = 509) were EPTB. Sex ratio was 1.68. The main EPTB forms were lymph nodes in 234 (23.5%) cases, followed by pleural TB in 35 (3.5%) cases and bone and joints in 31 (3.1%) cases. CIR was 5.62/100,000 inhabitants (inh) for EPTB with a highest incidence in patients aged 60 years and above. A positive trend was showed for EPTB with a (b = 0.05; p &lt; 0.0001) especially for lymph node localization. Up to 2030, EPTB would be increasing with an estimated incidence rate of 9.11/100,000 inh. Regarding lymph node TB, cases may continue to rise with an estimated incidence rate of 7.96 /100,000 inh.

Conclusions

Despite the availability of a treatment and knowledge on prevention measures, EPTB remains a public health problem. Thus, investigating and identifying patients at higher risk is needed in order to improve its management.

Key messages

Updated epidemiology is important for healthcare experts to improve planning policies attributed to EPTB. Our results are a tool for decision-makers to assess the efficiency of TB control programs.

Trends in cardiovascular disease in the region of Monastir (Tunisia) over 12 years

Background

Cardiovascular diseases (CVDs) are the major cause of morbidity and mortality worldwide. However, CVD prevalence trends is still weakly documented in Tunisia. The objective of this study is to examine trends in the prevalence of CVDs in the Monastir region between 2002 and 2013.

Methods

Data were collected from the regional register of hospital morbidity. The register refers to the WHO International Classification of Diseases, 10th revision (ICD-10). Data were verified and analyzed using IBM SPSS Statistics version 22.0 software. Linear regression was used to calculate the slope 'b' of the least-squares line to estimate admission trends for each CVD category according to sex and age group. A p-value of 5% was considered statically significant.

Results

From 2002 to 2013, cardiovascular diseases accounted for 21,240 hospital admission in the region of Monastir, representing more than a quarter (28.7%; CI 95%: 28.1-29.3%) of all Non Communicable Disease admissions in adults. Males represented 55.9%. The median age at admission was 64 years (IQR 54-71 years). The CVD crude prevalence rate (CPR) was 3.60 /1,000 inh. The age-standardised CVD rate (ASR) was 4.56 per 1000 PY and it was higher in men than in women (5.41 vs. 3.72, respectively, p &lt; 0.001). CVD prevalence rate increased over time (b = 17.78; p&lt;.001). This increase was significant in men (b = 33.69; p &lt; 0.001) and in age groups over 40-years-old (b = 15.30; p &lt; 0.001). However, it declined significantly in women (b= -16.32; p &lt; 0.001). Coronary heart diseases (CHD) were the most prevalent CVD categories (47.7%).

Conclusions

Hospital admissions for CVD increased over the study period, in particular in men and in age groups over 40-years-old. CHDs were the prevalent disease. A comprehensive prevention strategies focused on lifestyle habits such as unhealthy diets, physical inactivity and tobacco consumption are greatly recommended to improve this prevalence trends.

Key messages

Over a 12-year period, CVD prevalence increased in men but not in women at the university hospital of Monastir. A comprehensive prevention strategies focused on lifestyle habits such as unhealthy diets, physical inactivity and tobacco consumption are greatly recommended to improve this prevalence trends.

Epidemiological aspects of human exposure cases to rabies by in the central west region of Tunisia

Introduction

Rabies is a major public health problem in several countries in the South and East of the Mediterranean and in the Middle East. The objectives of this study were to describe the epidemiological profile of human exposures to rabies by a dog, as well as the profile of aggressive dogs during a period of 15 years in a region in the central west region of Tunisia.

Methods

We have included all cases of human exposure to a dog, reported between 2004 and 2018 in the Kasserine area. The source of the data was the directorate of primary health care in Kasserine.

Results

A total of 41,850 human exposure cases to a dog have been reported over the fifteen year study period with an annual average of 1937.5 cases. Among them, 29,062 cases (69.4%) were attacked by a bite. The crude incidence of dog bite cases was 441 per 100,000 population. The vaccination status of attacking dogs was unknown in 15.4% of the cases (n = 6423). Among all attacking dogs with a known vaccination status (n = 35427), 45.2% were vaccinated (n = 16017) and 54.7% (n = 19392) were unvaccinated. A significant increase in human exposure cases to dogs was noted from 2004 to 2018 (β = 11.7, p = &lt;10-3). The number of exposures by an unknown dog or a known unvaccinated dog increased significantly (β = 28.02; p = &lt;10-3 and b = 69.9, p = &lt;10-3; respectively). However, the number of cases attacked by a known vaccinated dog decreased significantly (β = -86.4, p = &lt;10-3). During the study period, five cases of human rabies were identified in the study area.

Conclusions

In Tunisia, human exposure to rabies by a dog has been on the rise. It could be linked to the period of popular and political movement that the country is going through.

Key messages

In this study, human exposures cases to rabies by unvaccinated dog is significantly increasing. It is crucial to strengthen appropriate preventive measures, such as mass vaccination and dog castration programs.

Bladder cancer incidence and predictions: Observational Study (Monastir, Tunisia: (2002-2030)

Background

Bladder cancer is a highly prevalent disease and is associated with substantial morbidity, mortality if not treated optimally. We aimed to describe bladder cancer incidence and trends from 2002 to 2013 and to estimate predictions up to 2030.

Methods

We performed an observational study from 2002 to 2013. Incidence was estimated by the crude incidence rate (CIR) and standardized incidence rate (SIR). Poisson regression model was used to calculate the slope 'b' in order to describe trends and was performed to estimate incidence projection for 2030. Data were verified and analyzed using IBM SPSS Statistics version 22.0 software.

Results

A total of 1024 cases of bladder cancer was declared from 2002 to 2013 predominately among males with a rate of 90.4%. CIR was 16.79/100,000 inhabitants (inh) and SIR was 21.38/100,000 inh. By gender, SIR was 41.3/100,000 inh and 7.73/100,000 inh for males and females respectively. During our study period a significant positive trend was noted with a (b = 0.042, p &lt; 10-4). In 2030, the predicted incidence rate would increase to 28.4/100,000 inh.

Conclusions

The findings have highlighted the positive trend and the increased predicted incidence of bladder cancer in 2030. Thus, developing primary prevention strategies is crucial.

Key messages

Our results are important for health-care professionals to improve planning policies related to bladder cancer. Identifying associated factors is crucial to guide preventive strategies measures.

Prostate cancer incidence and predictions: Observational Study (Monastir, Tunisia: 2002-2030)

Introduction

Cancer is an eminent public health issue in the developing countries. The risk factors incriminated in cancer higher incidence are multiple such as the growing population rates, increasing tobacco consumption, the changes of diet and lifestyle. In Tunisia, there are three population-based cancer registries at the present time providing data on cancer incidence and survival. According to the data published by WHO International Agency for Research on Cancer (IACR) (GLOBOCAN 2018), prostate cancer in Tunisia ranks fifth among cancers with almost 819 new cases per year. The aim of this study was to we report trends in the cancer incidence during the span of time between 2002 and 2013 from the population-based cancer registry of the centre of Tunisia, and to predict the future number of cancer cases by 2030.

Methods

The cancer incidence data were collected from the Center cancer registries from 2003 to 2012.The data were stratified by cancer site, sex and age. We used SPSS software in order to calculate the crude incidence rates and age-standardized incidence rates. SPSS software was used in order to estimate the future number of cancer cases by 2030.

Results

A total of 725 cases of prostate cancer were enregistrated. The mean age of patients was 71.6 ±10.61years. The crude incidence rates were estimated 23.537. The standardized incidence rate was 33.92. A significant positive trend was noted with a b = 0133 and p &lt; 10-3. 1033 new cases are predicted by 2030

Conclusions

The data of the cancer register of the center shows that the incidence of cancer is rising, and it is consistent with the National cancer intelligence, but some cancer incidence showed slightly higher, such as thyroid cancer and prostate cancer. In order to face this alarming situation, many preventive steps should be done such as strengthening early screening and diagnosis of cancer, improving clinical research in order to better control the risks factors.

Key messages

Prediction of the future number of cancer cases is of great interest to society. Prostate cancer in Tunisia ranks fifth among cancers.

Lifestyle habits among a sample of middle school adolescents in Tunisia

Introduction

Adolescent health is a major global concern today. In fact, adolescence is the period of life where different risky behaviors can take hold and is therefore the best prevention phase to guarantee healthy lifestule in adulthood. We aimed to assess the lifestyle of middle school adolescents and to highlight the main behaviors such as the eating habits, the physical activity and the personal hygiene.

Methods

We carried out a cross sectional study among a sample of adolescents from December 2017 to January 2018 and we involved two middle school schools in the region of Monastir in Tunisia. The questionnaire GSHS (the Global school-based student health survey) was used.

Results

In total, 802 participants were enrolled with a mean age of 13.6 ±1.9 years, ranged from 11 to 16 years old. Females represented 51.9% of the study population. More than one third of the students (36%) reported rarely or never eating breakfast with a significant difference in girls more than in boys (62.8% vs 37.2%, p &lt; 10-3). Almost half of students (46.2%) reported drinking sugary sodas at least once a day and 86.3% of them reported consuming fast food more than two times per week. In addition, 59.4% of middle school students reported eating fruit more than twice a day and 24.3% eating vegetables at least three times a day. Regarding physical activity, our results showed that 24.4% of middle school students were physically active (1 hour minimum during the day) every day for the last 7 days, boys more than girls (56.5% vs 43.5%, p = 0.02). In addition, 39.7% of students declared they sit at least three hours a day. As for personal hygiene, our study found that 9.3% of students never, or rarely, washed or brushed their teeth; boys more than girls (69.3% vs 30.7%, p = &lt;0.001).

Conclusions

Our results provide additional evidence on the need to combat sedentary lifestyle and encourage healthy nutrition and physical activity among adolescents.

Key messages

Understanding the health needs and concerns of young people contribute to implement effective health programs. Interventions in young people should act on various aspects of the lifestyle to ensure an optimal effect.

Factors associated with diabetic foot among type 2 diabetes in the region of Monastir (Tunisia)

Background

The diabetic foot (DF) has actually a high rate of disability leading to impaired quality of life and even mortality. Glycemic control among Tunisian adults with diabetes mellitus remains poor. However the relationship between glycemic control and foot complication have not been clearly established. The aim of the present study was to assess the relationship between diabetic foot lesions and glycemic control and the diabetic duration in the people with DT2.

Methods

A cross-sectional survey was conducted in five Primary Health care Centers (PHC) in the region of Monastir (Tunisia) from March 2016 to April 2017. Data were collected using interviewer administered structured questionnaire. Validated questionnaire was used to assess diabetic foot diseases.nA multivariate logistic regression analysis was conducted to assess the relationship between glycemic control, diabetic duration and the DF lesions. A p-value of &lt; 0.05 was considered statistically significant.

Results

In total 383 patients were recruited, of whom 258 (67.9%) were men. The mean age of participants was 60.7±11.3. Poor glycemic control (HbA1c ≥ 7.0%) increased the risk of abnormal patellar reflex (aOR=7.07; CI95% 1.65-30.1; p = 0.03) and calf claudication (aOR=7.07; CI95% 1.65-30.1). The long duration of diabetes (10 years and more) was a significant factor associated with an abnormal Achill reflex (aOR=2.31; CI95% 1.12-4.76; p = 0.02), a needle-stick perceptual disorder(aOR=2.08; CI95% 1.14-3.78; p = 0.01), a vibration sensibility perceptual disorder (aOR=2.02; CI95% 1.01-4.08; p = 0.04), a negative monofilament test (aOR=2.69; CI95% 1.04-5.16; p = 0.003), an absent dorsalis pedis artery pulsation(aOR=2.35; CI95% 1.09-5.05;p=0.02) and an absent posterior tibial artery pulsation (aOR=3.06; CI95% 1.28-7.28; p = 0.01).

Conclusions

This study identified that disease duration and poor glycemic control are significant risk factors related to DF development in the current T2DM population.

Key messages

Disease duration and poor glycemic control are significant risk factors related to DF development in the T2DM population in the region of Monastir. Prevention programs should be focused on patient education about modifiable risk factors in particular glycemic control and adequate and regular foot care.

Hand hygiene and standard hygiene precautions in healthcare settings Monastir Tunisia 2019

To ensure adherence to standard hygiene precautions in healthcare settings, the World Health Organization (WHO) recommends that compliance with these precautions be assessed in any care setting through periodic audits to improve the quality and safety of care procedures

This was a cross-sectional descriptive study that was conducted in the University Hospital of Monastir during the month of July 2019.It was a self-administered questionnaire that explored the knowledge and attitudes in terms of standard precautions in hospital hygiene and administred to the various occupational categories involved in each department. The data was entered and analyzed by the SPSS 20 software.

A total of 440 health professionals responded to the questionnaire with a Sex-ratio of 0.55.The median age was 30 years with an IQR [26,36]. The median length of professional service was 5 years IQR[2,9]. In terms of training on standard precautions, 69.3% were trained, of which 64.5% had training of less than 5 years.

More than half, 54.6% of professionals knew where to find a procedure or sign “what to do if exposed to blood”. Concerning the attitudes of professionals, the majority applied the standard precautions of the various topics and more specifically hand hygiene.

Our results showed acceptable adherence to standard precautions (glove hygiene, etc.) except for accidents during blood exposure which encourage us to follow an action plan with corrective actions.

Key messages

Acceptable adherence to standard precautions. Accident at exposure to blood need to be controlled.

Pulmonary tuberculosis incidence, trends and predictions in Monastir, Tunisia (2000-2030)

Background

Tuberculosis (TB) continues to be one of the infectious diseases with the highest morbidity worldwide. The lung is the most commonly involved organ, but lesions can occur in other body systems. This study aimed to describe incidence and trends of pulmonary tuberculosis (PTB) over a period of 18 years in Monastir and to estimate predictions for 2030.

Methods

We carried out an observational study from 2000 to 2017. Data were collected by the regional direction of primary health care. Incidence was estimated by the crude incidence rate (CIR) and the age standardized rate (ASR). Poisson regression model was used to calculate the slope 'b' in order to describe trends and was performed to estimate incidence projection for 2030. Data were verified and analyzed using IBM SPSS Statistics version 22.0 software.

Results

A total of 997 patients were recorded with 486 cases of PTB (48.95%). Sex ratio was 2.85. The median age was 40.5 [IQR 28-56] years old. PTB ASR was 5.71/100,000 inhabitants (inh). CIR was the highest among the eldest cohort aged more than 60 years (12.65/100,000 inh) and the lowest among youth aged less than 19 years (1.01/100,000 inh). We established a negative trend of PTB over 18 years (b= -0.032; p &lt; 10-4) in all age cohorts. PTB would be decreasing by 2030 with an estimate incidence rate of 1.83/100,000 inh.

Conclusions

The decline of PTB may be a sign of TB control program effectiveness in Monastir. Thus, the challenges for the future are to maintain PTB towards decreasing.

Key messages

Our study highlighted the impact of TB control strategies in Tunisia. Our findings play a key role in estimating whether the WHO’s End TB strategy targets can be achieved by 2030.

Burden of cardiovascular diseases in the region of Monastir (Tunisia)

Background

Cardiovascular disease (CVD) is the leading cause of death in Tunisia. The aim of this study was to analyze CVD burden from 2002 to 2013 in the region of Monastir.

Methods

Using the Global Burden of Disease methodology, cardiovascular disease mortality and disability-adjusted life years (DALYs) were analyzed by age group and sex for all admissions at the university hospital of Monastir, using standardized approaches for data processing and statistical modeling. Data were retrieved from the regional register of hospital morbidity in Monastir and were analyzed from January 2002 to December 2013.

Results

CVDs caused 519 in-hospital deaths during the study period, accounting for 43.3 % (CI 95%: 40.6-46.1%) of all in-hospital non-communicable diseases-related mortality (n = 1197). The crude mortality rate of CVDs was 8.81 per 100,000 inh. The highest rate was recorded among patients aged ≥ 60 years-old. The age-standardized mortality rate was 11/100,000 PY (14 in men and 8 in women). CVD DALY per 100,000 was 176.4 (199.4 in men and 152.7 in women). The highest CVD DALY was in the age groupe of 60 years and older (929.7/100,000). The leading causes of DALYs for both sexes are coronary heart diseases and stroke with DALY rate of 112.6 and 47.4 per 100,000 inh, respectively.

Conclusions

The CVD burden was heavy in the study population, in particular in the elderly and in men. Prevention and control of modifiable risk factors should be taken actively to improve health for Tunisian adults.

Key messages

CVD burden was heavy in the region of Monastir. More efforts are needed to improve cardiovascular health in Tunisian adults.

Being bullied and associated factors among middle school students in the region of Monastir, Tunisia

Introduction

The phenomenon of bullying among adolescents is a worldwide issue. The trend of this behavior is increasing in developed countries as well as in developing countries, with the creation of new forms such as cyberbullying. This study aimed to determine the prevalence of being bullied and to analyze the association between being bullied and some individual and familial factors.

Methods

This is a cross-sectional study conducted in two middle schools belonging to the region of Monastir in Tunisia in December 2017 and January 2018. The Global School-based Student Health Survey (GSHS) was administered for students. All present students from the two recruited schools were included.

Results

A total of 802 students were enrolled in the study. Just under half of the study group (44.0%) reported having been bullied in the past month with 95% CI [40.66%-47.57%]. The predominant type of bullying was being made fun of with sexual jokes, comments or gestures (9.1%), followed by being kicked, pushed, shoved or locked indoors (3.6%). In multivariate analysis, physical fight was an independent associated factor with being bullied (OR [CI]95%: 2.04[1,77-3,25]), p = 0.001. Lonely students had nearly 3.38 higher risk of undergoing bullying (OR [CI]95%: 3.38 [2.05-5.57]), p = 0.001). In addition, being worried was also an independent factor associated with being bullied (OR [CI]95%: 2,23 [1,45-3,43]), p = 0.001.

Conclusions

Our results support an association between existing mental health problems and bullying. Additional studies are needed to understand the factors associated with school bullying and to

Key messages

In this study, the prevalence of bullying was relatively high. Program education in schools should focus on life skills education in order to develop the self-confidence and the self-esteem of students.

Occupational exposures to blood and body fluids among health care workers in Tunisia

Background

Occupational exposures to blood and body fluid are among the most frequent occupational accidents in healthcare. They put healthcare workers (HCWs) at high risk of transmission of many blood borne pathogens mainly hepatitis B virus (HBV), hepatitis C virus HCV and HIV. The aim of this study was to determine the prevalence of occupational exposures to blood and body fluids and its associated factors among HCWs at the university hospital of Monastir (Tunisia) in 2017.

Methods

An exhaustive cross-sectional study was conducted from 01 June 2017 to 31 August 2017 at the university hospital in Monastir Governorate (Tunisia). An anonymous self-administered questionnaire was used to collect data on demographic characteristics, self-reported exposures and their circumstances. We performed a multivariate analysis to determine the associated factors to these occupational exposures.

Results

A total of 1493 HCWs (34.6% nurses 22% technicians and 21.6% doctors) were included corresponding to a response rate of 74%. The median age of the participants was of 36 years (IQR: 31- 46 years). The sex ratio was of 0.36. Responders from medical and surgical departments represented respectively 40.5% and 39%. Among interviewed HCWs, 56.7% reported having at least one exposure to blood or body fluid with 35.4% of them exposed twice or more. Almost half (48.3%) of the respondents had a history of needle stick injury and 32.1% had a history of blood or body fluid splash into the face.The multivariate analysis showed that doctors had the highest risk of exposure comparing to other HCWs with (AOR = 12.425; 95% CI: 05.310 - 29.075) and participants working at surgical departments were at higher risk of exposure than those at others departments (AOR=7.440; 95% CI: 4.461 - 12.408).

Conclusions

Health occupational exposures to blood and body fluids are a serious problem at the university hospital of Monastir. Preventive measures should be strengthened to alleviate this problem.

Key messages

Doctors had the highest risk of exposure to blood and body fluids comparing to other HCWs at the university hospital of Monastir. Preventive measures should be strengthened to alleviate this problem.

Prediction of cardiovascular events in primary Health care: a cross sectional study (Monastir-Tunisia)

INTRODUCTION

We aimed to determine the prediction of cardiovascular events in patients with hypertension and diabetes using the 10-year Framingham score.

METHODS

We conducted a cross sectional study in two primary health care centers in Monastir. We included patients with at least one conventional cardiovascular factors. Prediction of cardiovascular event were expressed by median and inter quartile range.

RESULTS

We included 409 patients. Age mean was 64 years (SD: 12.3), the sex ratio was 0.44. Patients with type 2 Diabetes were 278 (68%) and 295 had hypertension (72.1%). The global risk prediction at 10 years for cardiovascular diseases was 26.3%, It was 36.6% (26.4-46.8) for tobacco users, 29.7% (18.2-42.5) for patients with hypertension and 29.1 % (18.8-43.3) for those with diabetes. It increased significantly with the number of cardiovascular risk factors. The risk prediction for cardiovascular events, were significantly higher in men than in women (p < 0.01) and in non-controlled patients than in controlled patients (p <0.001). The risk prediction for cardiovascular diseases death was 3.6% (1.3-8.6).

CONCLUSION

Thirty percent of patients with hypertension or diabetes will develop cardiovascular diseases in 10 years. We suggest renforcing preventive actions to balance cardiovascular risk factors, including hypertension and diabetes.

BCG vaccination and tuberculosis prevention: A forty years cohort study, Monastir, Tunisia

We aimed to describe incidence, trends of tuberculosis (TB) over 18 years and to evaluate the impact of the BCG vaccine after four decades of immunization program according to three protocols. We performed a cohort study including declared cases in Monastir from January 1, 2000 to December 31, 2017. We reported 997 cases of TB. The predominant site was pulmonarylocalization (n = 486). The age standardized incidence of pulmonary and lymph node TB per 100,000 inh were 5.71 and 2.57 respectively. Trends were negative for pulmonary TB (PTB) (b = - 0.82; r = -0.67; p<10⁻³) and positive for lymph node localization (b = 1.31; r = 0.63; p<10⁻³). We had not notified cases of HIV associated with TB. Crude incidence rate (CIR) of PTB per 100,000 inh was 8.17 in Non-Vaccinated Cohort (NVC) and 2.85 in Vaccinated Cohort (VC) (p < 0.0001). Relative risk reduction (RRR) of BCG vaccination was 65.1% (95%CI:57.5;71.4) for pulmonary localization and 65% (95%CI:55; 73) for other localizations. We have not established a significant RRR of BCG vaccination on lymph node TB. Protocol 3 (at birth) had the highest effectiveness with a RRR of 96.7% (95%CI: 86.6%; 99.2%) and 86% (95%CI:71%;91%) in patients with PTB and other localizations TB respectively. In Cox regression model the HR was 0.061 (95% CI 0.015–0.247) for PTB and 0.395 (95% CI 0.185–0.844) for other localizations TB in patients receiving protocol 3 compared to NVC. For lymph-node TB, HR was 1.390 (95% CI 1.043–1.851) for protocol 1 and 1.849 (95% CI 1.232–2.774) for protocol 2 compared to NVC. Depending on the three protocols, the BCG vaccine had a positive impact on PTB and other TB localizations that must be kept and improved. However, protocols 1 and 2 had a reverse effect on lymph node TB.