Arwa Ben Salah

Obstetric and psychological characteristics of women seeking multiple abortions in the region of Monastir (Tunisia): results of a cross-sectional design

BackgroundRepeat abortion is a public health concern favored by many obstetric and social factors.The purpose of our study was to identify associated factors to repeated abortion in the region of Monastir (Tunisia). Common mental disorders (CMD) such as anxiety and depression were also evaluated in women seeking voluntary repeated abortion.MethodsWe carried out a cross sectional study between January and April 2013 in the Reproductive Health Center (RHC) of the region of Monastir in Tunisia (This study is part of a prospective design on mental disorders and intimate partner violence among women seeking abortions in the RHC).Among women referred to the RHC we selected those seeking voluntary abortion (medical or surgical method). Data on women’s demographic characters, knowledge and practices about contraceptive methods and abortion were collected the abortion day via a structured questionnaire. Data about anxiety and depression status were evaluated during the post-abortal control visit at 3–4 weeks following pregnancy termination.ResultsOf the 500 interviewed women, 211 (42.2 %; CI95% [37.88 – 46.52]) were seeking repeated abortions. Multivariate analysis showed that increased age, lower level of women school education, single status, poor knowledge about birth control methods and history of conflict/abuse by a male partner, were uniquely associated with undergoing repeat compared with initial abortion.CMD were significantly higher in women undergoing second or subsequent abortion (51.1 %) single and lower educated women. Women relating a history of conflicts/abuse report more CMD than others (30.6 % vs 20.8 %).ConclusionHealth facilities providing abortion services need to pay more attention to women seeking repeat abortion. Further studies are needed to well establish the relation between the number of abortion and the occurrence and the severity of CMD.

Gender differences in adverse childhood experiences, collective violence, and the risk for addictive behaviors among university students in Tunisia

Adverse childhood experiences (ACE) have been linked to a variety of addictive behaviors. The recent adaptation of the ACE measure by the World Health Organization (WHO) allows for the assessment of the negative role of additional adverse experiences, such as extra-familial violence. To date, the relationship between extra-familial violence and addictive behaviors has not been assessed. We report the contribution of ACEs, including the new scales for extra-familial violence, on the risk for mental health problems and addictive behaviors by gender in a sample of young adults in Tunisia. We conducted a cross sectional study in Tunisia during 2014, where we recruited 1200 young university adults who completed the validated Arabic version of the WHO ACE questionnaire in a university setting. Results indicated that intra-familial adversities were associated with increased risk for addictive behaviors, particularly in males. ACEs were also associated with increased risk for mental health problems with women showing more difficulties than men. Exposure to peer, community and collective violence was higher in males than in females and logistic regression confirms that exposure to extra-familial violence increased the risk for addictive behaviors both in male and females by two to three-fold. Mental health problems were associated with peer violence and substance abuse in males, but not in females. Results demonstrate for the first time the contribution of exposure to extra-familial violence on risk for addictive behaviors. Results highlight the need for addressing mental health and addiction in a community with high burden of adversity and violence.

Predictors of smoking relapse in a cohort of adolescents and young adults in Monastir (Tunisia)

BackgroundSmoking prevalence in adolescents and young adults is substantially elevated in Tunisia. Moreover, there is a lack of knowledge regarding the effectiveness and associated factors in smoking cessation interventions among adolescents and young adults. This study aims at identifying the major factors leading to smoking relapse among adolescents and young adults in the region of Monastir, Tunisia.MethodsWe carried out a prospective cohort study at the smoking cessation center of the University hospital of Monastir, Tunisia. The population study consisted of all adolescents and young adults (15–30 years) consulted during a period of two years (2009 – 2010). A questionnaire was used to explore the patient’s sociodemographic characteristics, smoking history, nicotine dependence (Fagerstrom test) and anxiety / depression (Hospital Anxiety and Depression Scale). A telephone survey was conducted in July 2011 to assess smoking cessation results. A multivariate Cox regression was used to identify predictors of smoking relapses.ResultsA total of 221 adolescents and young adults were included in this study with a mean age of 25.5 ± 3.9 years. At follow up, 59 study participants (26.7%) were abstinent and the overall median abstinence was 2 months. In the multivariate analysis smoking relapse was associated with being an adolescent patient (HR 2.16; 95% CI: 1.54-3.05), medium or higher nicotine dependence at baseline (HR 2.66, 95% CI: 1.06-7.05 and HR 3.12, 95% CI: 1.20-8.12 respectively), not receiving treatment (HR 1.70, 95% CI: 1.25-2.33) and have friend who is a smoker (HR 1.63; 95% CI: 0.96-2.79).ConclusionThe results of this study provide important information about beneficial effect of smoking cessation support for adolescent and young adults. More efforts must be deployed to deal with contributing factors to smoking relapse.

Rheumatic heart disease in a developing country: Incidence and trend (Monastir; Tunisia: 2000–2013)

BACKGROUND The penicillin therapy of β hemolytic streptococcal pharyngitis has aided in the decrease of rheumatic heart disease (RHD) in developing countries. Tunisia is an endemic area, however, and incidence of RHD is weakly documented. We aimed at establishing the standardized incidence rate (SIR) of RHD in Monastir governorate and at determining RHD prevalence among hospitalized patients in two cardiology departments. METHODS From the regional register of Monastir Hospital morbidity, we have selected newly diagnosed patients with RHD, residents of Monastir, and hospitalized to the 2 cardiology departments between 2000 and 2013 (2001 not included). FINDINGS We studied 676 newly admitted patients. We estimate 1060 to be the number of new annual RHD cases in Tunisia. The SIR per 105 person-years was 10.97, being 9.3 in men and 19.1 in women, respectively. We have notified a negative trend of crude incidence rate/105 Inhabitants (Inh) (CIR) (r=-0.23, p<10-3), and a strong positive correlation between age and CIR/105 Inh (r=0.989, p<10-4). RHD lethality was 1%. We have registered 728 hospitalizations for RHD, representing 2.5% of all cardiology hospitalizations [95% CI: 2.3-2.7%], with a prevalence for 13.3% for women aged 15-29years. The median hospital stay was 9days (IQR: 5-15). CONCLUSION Our results confirm the RHD incidence decrease, consistent with epidemiological transition in Tunisia. We have also emphasized on the close trend of RHD with age and the predominance of RHD among women especially at the procreation age.

Hospitalizations for communicable diseases in a developing country: prevalence and trends—Monastir, Tunisia, 2002–2013

BACKGROUND In spite of the epidemiological transition, communicable diseases remain a public health problem and represent a significant cause of morbidity and mortality worldwide, especially in developing countries. This study aimed to determine the crude and standardized prevalence rates of hospitalizations for communicable disease (HCD) and to assess trends in HCD by age and sex at a university hospital in Tunisia over a period of 12 years (2002-2013). METHODS All cases of HCD from 2002 to 2013 in the university hospital departments were included. Data collected from the regional register of hospital morbidity were used. The discharge diagnoses were coded according to the International Classification of Diseases, 10th revision (ICD-10). RESULTS HCD represented 17.45% of all hospitalizations during the study period (34 289/196 488; 95% confidence interval 17.28-17.62%). The median age at the time of admission was 31 years (interquartile range (IQR) 15-52 years). The median hospital length of stay (LOS) was 5days (IQR 3-9 days). The crude prevalence rate (CPR) was 5.41 per 1000 inhabitants. The CPR was highest among patients aged ≥65 years. The four communicable disease categories that represented 70% of all HCD were abdominal infection, skin infection, genitourinary infection, and lower respiratory tract infection. The majority of HCD decreased over time; however, there was a significant increase in HIV diseases, tuberculosis, and viral hepatitis. CONCLUSION This study provides evidence of the epidemiological transition, showing a decline in communicable diseases, which needs to be sustained and improved.

Epidemiological impact of hepatitis B vaccination in Monastir Tunisia (2000-17)

Background: In 2016, the first global health sector strategy on viral hepatitis was endorsed with the goal of eliminating viral hepatitis as a public health threat by 2030. In Tunisia, effective vaccines for hepatitis B (HBV) have been added to the expanded programme of immunization (EPI) since July 1995 for new borns. We expected to have a decreasing trend in the prevalence rate of reported HBV. Our study aimed to address the epidemiological profile of HBV, to assess trends by age and gender in Monastir governorate over a period of 18 years according to immunization status and to estimate the burden (years lived with disability YLDs) of this pathology. Methods: We performed a descriptive cross sectional study of declared HBV from January 1, 2000 to December 31, 2017 defined as having positive serologic markers for HBs Ag. All declared patients were residents of Monastir’s Governorate. EPI included two periods, the first between 1995 and 2006 following a three-dose schedule (3, 4, 9 months). The second PI cohort after 2006 following a three-dose schedule (0, 2, 6 months). Results: During 18 years, 1526 cases of HBV were declared in Monastir with a mean of 85 cases per year. We estimated a mean of 1699 declared cases per year of HBV in Tunisia. CPR was 16.85/100,000 inh being the higher in age group of 20-39 years and in men .ASR was 15.99/100,000 inh, being 35.5 in men and 8.69 in women. During the study period, declared cases among presumed immunized (PI) person against HBV were 32(2.0%). Among PI cases, 29 were from the first period and 3 were from the second. We established a negative trend over 18 years of hepatitis B. The age group of 20 to 39 was the most common with a sharply decline. Presumed not immunized (PNI) HBV cases are decreasing by years with a prediction of 35 cases in 2024. Reported HBV contributed to 1.26 YLDs per 100,000 inh. The highest rate of YLDs occurred at the age 20-39 (2.73 YLDs per 100,000 inh). During 18 years, YLDs were 114.45 in Monastir with a mean of 2293.65 YLDs of HBV in Tunisia. Conclusion, this study showed a law prevalence rate and a decreasing trend of HBV during 18 years showing an efficacy of immunization and confirming that the universal hepatitis B vaccination in Tunisia has resulted in progress towards the prevention and control of hepatitis B infection. These findings should be demonstrated in other Tunisian regions with a standardized serological profile.

Childhood exposure to violence is associated with risk for mental disorders and adult’s weight status: a community-based study in Tunisia

Background We sought to investigate the relationship between social violence and adult overweight/obesity and the role of common mental disorders (CMD) in mediating this relationship. Methods A cross-sectional study was conducted from January to June 2016 in Tunisia. Participants were selected from randomly selected Primary Health Care Centers. The Arabic version of the Adverse Childhood Experiences-International Questionnaire (ACE-IQ) was used. Results A total of 2120 participants were included. Women exposed to social ACEs had higher rates of overweight/obesity than men (13.5 versus 9.5%; P = 0.004). For women, statistically significant partial mediation effects of CMD were observed for exposure to community violence (% mediated = 17.7%). For men, partial mediation was found for the exposure to peer violence (% mediated = 12.5%). Conclusion Our results provide evidence of the independent increase of overweight/obesity after exposure to social ACEs. Efforts to uncover and address underlying trauma in health care settings may increase the effectiveness of obesity interventions.

Exposure to community and collective violence during childhood and tobacco use patterns among young adults in Tunisia

Accumulating evidence demonstrates that experiencing intrafamilial adversities (abuse, neglect and household dysfunction) during childhood is linked to addictive behaviours. However, the impact of social adversities (peer, community and collective violence) as well as gender, on tobacco initiation and dependence has received much less attention. The aim of this study was to examine the relationships between social childhood adversities and tobacco use patterns by gender among young adults in Tunisia. We performed a cross-sectional study from May to December, 2014 on 1,200 respondents using the validated Arabic version of the World Health Organization Adverse Childhood Experiences-International questionnaire (WHO ACE-IQ). Data on smoking characteristics among current smokers were also collected. Data analysis was performed using logistic and linear regression models. The rate of current tobacco use was significantly higher for males (43.9%) than for females (9.3%). Female and male respondents differed significantly on almost every examined adversity. Males were more likely to have experienced all types of social violence than females. The odds of tobacco use were significantly higher regardless the mental health status and the occurrence of intrafamilial early life adversity for both genders. Smokers exposed to social violence during childhood had a strong association between nicotine dependence and the overall burden of adversity. That is, 74 and 58% of nicotine dependence was explained by the number of childhood social adversities in females and males respectively. The findings underscore the role of community and collective violence in addictive behaviours among young adults. Multisectorial and population-based strategies are needed to minimise the occurrence of social early life adversity and related tobacco patterns.

Audit sur la qualite de la vaccination en milieu scolaire dans la region de Monastir (Tunisie)

We conducted a clinical audit by observing 55 vaccinators in schools in the governorate of Monastir in 2014. We used a set of criteria by referring to the national immunization programme. The cold chain was respected in most cases. Accumulators, the collector of syringes and needles, cotton balls soaked in alcohol and emergency box were available in 85.5%, 76.4%, 98.2% and 41.8% of cases respectively. Hand washing before immunization session was performed in 29.1% of cases. Waste disposal according to the hygiene rules was done by 40 agents. Health education of students regarding the interest of vaccination was done in 67.3% of cases. Therefore, improvements in hand hygiene practice and education are recommended.