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"Prevention", a component of primary health care since Alma Ata's declaration (1978), has been a strategic axis of health policy in Tunisia for four decades. If the Tunisian Revolutionary Constitution (2014) declared in its Article 38 that "the State guarantees prevention", the regulatory texts, organizing preventive structures and its operational programs, have today become ill-suited with the global burden of disease and current scientific evidence. The analysis of current preventive practices in Tunisia, based on the "health continuum", the taxonomy of "preventive strategies" and the identification of "vulnerable populations", has shown the need to implement prevention activities. "Primordial" and "quaternary" (for the management of cardiovascular diseases and cancers), extension of the fields of health education and epidemiological surveillance, towards Therapeutic Education of Patients / Health Promotion, and health monitoring, and coverage of new groups at risk adolescents and the elderly. Faced with the multitude of prevention structures and the fragmentation of health programs, the reform of the national preventive policy and its practices should be based on the principles of integration, relevance and efficiency, through the establishment of a National Health Protection Agency (NHPA). This ANP is called upon to launch new prevention support projects including integrated preventive medicine centers (providing periodic health examinations), hospital patient therapeutic education services and home care units. Such a reform, announcing the birth of a new generation of preventive basic health care activities in Tunisia, should be reinforced by a legal, organizational and educational basis.
The proportion of total Tunisian with Diabetes reached 15.5% in 2016. The objective of this study was to analyze diabetic's management in contrasted health care settings.
Mixed methodology (quantitative and qualitative) with explanatory design was used in contrasted health care structures (a primary health center (PHC) and the National Institute of Nutrition and Food Technologies (INNTA)). Interviews with health providers and patients were than condcuted in both centers to explain quantitative findings.
Quality of care assessement was performed among 100 patients in the PHC and 96 in the hospital. Glycemic control was reached in less than 30 % of the cases in both centers. Although clinical evaluation was better in the PHC, conducting ECGs, measuring of HbA1c and LDL-Ch were far from being optimal. The qualitative study did supply some hypotheses explaining these gaps treatments shortage and lack of laboratory assessments specifically pointed in PHC settings, potentially lower its attractiveness, thus compounding overcrowding and stressful working conditions in hospitals. These last points as well as poor communication and overloaded clinics in hospital were major sources of providers and patient dissatisfaction.
This study made it clear that primary health care is a cornerstone in diabetes management. However, it is crucial to strengthen primary health care centers by operational technical support (laboratory equipements and quality information system) as well building capacities of health professionals in information, education and communication.
This study made it clear that primary health care is a cornerstone in diabetes management. However, it is crucial to strengthen primary health care centers by operational technical support (laboratory equipements and quality information system) as well building capacities of health professionals in information, education and communication.
To assess the distribution of cardiovascular risk factors in Maghreb's countries.
It is a systematic review including articles and reports that applied the WHO "STEPwise" approach, or a similar approach, studying cardiovascular risk factors in the Maghreb countries Tunisia, Morocco, Algeria, Libya and Mauritania between 2004 and 2018.
We selected five articles, a report for each country. The prevalence of smoking was between 13.4% (12.2-14.6) in Morocco and 29.4% (28.3-30.4%) in Tunisia. 50.6% of the population of Mauritania had insufficient physical activity. The prevalence of high blood pressure was highest in Libya (40.6%) The prevalence of obesity was up to 41.1% (37-43.3) for women and 21.4% (19-23.8) in men in Libya. The prevalence of diabetes mellitus was between 10.6% (9.7-11.6) in Morocco and 16.4% (14.7-19.1) in Libya.
The distribution of cardiovascular risk factors in the Maghreb countries shows that the level of cardiovascular risk is high, particularly in the central Maghreb. This attests to the fairly advanced epidemiological transition related to the rapid modernization of the Arab countries, hence the importance of launching an integrated project for the fight against cardiovascular diseases based on the global experience.
The distribution of cardiovascular risk factors in the Maghreb countries shows that the level of cardiovascular risk is high, particularly in the central Maghreb. This attests to the fairly advanced epidemiological transition related to the rapid modernization of the Arab countries, hence the importance of launching an integrated project for the fight against cardiovascular diseases based on the global experience.
Pediatric services are tracer services for the assessment of the integration and performance of the national health system.
Describe the typology of morbidity notified to the Pediatrics department of the Msaken regional hospital (Sousse, Tunisia) and the flow of its patients.
This is a descriptive and exhaustive study, covering all the patients hospitalized in the pediatric ward of Msaken, during the year 2015. The data were collected through medical files and medical registers. admission, based on the Minimum Clinical Summary (RCM) form. The notified diagnoses were coded according to the WHO ICD-10 classification. The main diagnosis was defined by the major pathology that led to the hospitalization. Early readmission was retained before 28 days.
A total of 521 children were hospitalized, with a sex ratio of 1.04 and a mean age of 2 ± 3 years; 70% of the patients came from the administrative center of the governorate and 62% were infants (age <two years). Entry was provided via the emergency room istrengthening primary health care and referral / referral system between the pediatric services of district, regional and university hospitals, for an integrated and efficient national health system.
Internal Medicine is an essential component of the clinical platform of regional hospitals (relay between district hospitals and reference university hospitals).
To describe the morbidity diagnosed at Medicine department of the regional hospital of Msaken (Sousse, Tunisia), taken as a tracer of intermediate hospitals.
This descriptive study covered all of the patients hospitalized, during the year 2015, in the Internal Medicine department of the Msaken regional hospital. The data were disseminated through a "Minimum Clinical Summary". Morbidity was classified according to ICD-10. Hospital readmission was tested with reference to <28 days.
A total of 594 patients were hospitalized in Internal Medicine, with a sex ratio of 0.95 and a median age of 67 years [54-78]. "Diseases of the respiratory system" were the first category of diagnosed morbidity (58%), dominated by acute bronchitis, followed by "endocrine, nutritional and metabolic diseases" in women (including insulin-dependent diabetes) and category of infectious diseases in men (including erysipelas). The former patients of the service (49%) were twice as numerous among people ≥60 years old (57% vs 30% in those under 60 years). The readmission rate was 19% (29% for men versus 8% for women). The mean length of stay was 7 ± 5.7 days. The transfer rates and hospital mortality were 11.3% and 1.2%, respectively.
The morbidity diagnosed at the Internal Medicine department of the Msaken regional hospital was dominated by the triad acute bronchitis, diabetes mellitus and erysipelas, particularly in the elderly. Hence the need to strengthen the training of future family doctors in pulmonology, diabetology and infectious diseases.
The morbidity diagnosed at the Internal Medicine department of the Msaken regional hospital was dominated by the triad acute bronchitis, diabetes mellitus and erysipelas, particularly in the elderly. Hence the need to strengthen the training of future family doctors in pulmonology, diabetology and infectious diseases.
Health system reforms in many countries have shown that the delivery of integrated primary health care services according to family medicine is the most efficient approach to achieve universal health coverage. In Tunisia, the issue is therefore the capacity of our health system to integrate a care approach based on family practice.
To assess the preparedness to implement family medicine in our country Methodology this is a qualitative study carried out over a period of 9 months during the year 2017.Based on a WHO protocol addressing the 13 pillars of family practice, our study explores health policy context, actors (using interviews with key informants at national, regional and local level) and health content.
Family practice model is a strategic priority in Tunisia. However, this political recognition suffers from a lack of operationalization, in relation with continuing medical training, registration of patients and families by doctors, referral system, minimum package of essential care/ essential drugs and quality of care monitoring as well as community involvement..
Our situation analysis reveals that the delivery of integrated care based on family practice model; enforce to adopt a comprehensive and operational health policy that goes beyond the academic aspects.
Our situation analysis reveals that the delivery of integrated care based on family practice model; enforce to adopt a comprehensive and operational health policy that goes beyond the academic aspects.
The Basic Health Care Policy (BHC), the Maghrebian version of WHO's Primary Health Care, is celebrating forty years in Tunisia. The aim of this paper was to contribute to the evaluation of BHCs in Tunisia, by listening to the testimonies of experts / leaders who have led their journey during these four decades.
The experts / leaders included in this testimony were invited via email and throu gh the use of the Delphi technique to report the acquired lessons and the errors. The collected qualitative data was analyzed through a process of categorization which classified them into assets (strengths and opportunities) and handicaps (weaknesses and threats).
Four experts / leaders took part in this call for testimonies, including two consultants to international organizations, a trade union doctor and a professor of Preventive Medicine. SSR128129E The main assets of the BHC in Tunisia, according to the participants, were 1. The medical leadership initiated from the student phase; 2. The political commitment of public auunisia highlighted the perception of its performance "in tune" with WHO and "three years before Alma Ata". The new generation of BHC leaders have an obligation to safeguard their principles and adapt their practices to population expectations and new managerial approaches.
