Habiba Ben Romdhane

Prevalence of obesity and associated socioeconomic factors among Tunisian women from different living environments.

Adult Tunisian women aged 20–59 (national random sample, nu2003=u20031849), were assessed with respect to environmental and socioeconomic factors associated with obesity (body mass indexu2003≥30u2003kgu2003m−2) and abdominal obesity (waist circumferenceu2003≥88u2003cm). At the national level, prevalence of obesity and abdominal obesity were, respectively, 22.6% and 29.2%, but varied markedly (both Pu2003<u20030.0001) among living environments classified as big cities (30.2% and 36.6%), other cities (25.9% and 32.4%), rural clustered (19.4% and 24.8%) and rural dispersed (9.5% and 16.5%). Adjusted prevalences of both types of obesity increased with age, parity and economic level of the household, while educationally, the risk was greatest in women with intermediate schooling. Differences between the four environments were accounted for by socioeconomic factors, mostly household wealth, except for most rural environment; socio‐cultural factors were possibly influential. Observed differences between rural areas confirmed that finer measures of urbanization are necessary for the drivers of obesity prevalence at the national level. Obesity was still more prevalent in wealthy than in poor women, but given the high prevalence in all the environments, actions are needed at the national level before highly prevalent obesity extends into those of lower socioeconomic status and thereby increases health inequities.

Appraising financial protection in health: the case of Tunisia.

Despite the remarkable progress in expanding the coverage of social protection mechanisms in health, the Tunisian healthcare system is still largely funded through direct out-of-pocket payments. This paper seeks to assess financial protection in health in the particular policy and epidemiological transition of Tunisia using nationally representative survey data on healthcare expenditure, utilization and morbidity. The extent to which the healthcare system protects people against the financial repercussions of ill-health is assessed using the catastrophic and impoverishing payment approaches. The characteristics associated with the likelihood of vulnerability to catastrophic health expenditure (CHE) are examined using multivariate logistic regression technique. Results revealed that non-negligible proportions of the Tunisian population (ranging from 4.5xa0% at the conservative 40xa0% threshold of discretionary nonfood expenditure to 12xa0% at the 10xa0% threshold of total expenditure) incurred CHE. In terms of impoverishment, results showed that health expenditure can be held responsible for about 18xa0% of the rise in the poverty gap. These results appeared to be relatively higher when compared with those obtained for other countries with similar level of development. Nonetheless, although households belonging to richer quintiles reported more illness episodes and received more treatment than the poor households, the latter households were more likely to incur CHE at any threshold. Amongst the correlates of CHE, health insurance coverage was significantly related to CHE regardless of the threshold used. Some implications and policy recommendations, which might also be useful for other similar countries, are advanced to enhance the financial protection capacity of the Tunisian healthcare system.