Jihen Maatoug

Prevalence of the metabolic syndrome among urban schoolchildren in Sousse, Tunisia

No evidence exists regarding the prevalence of the metabolic syndrome in adolescents in North African countries. We aimed to estimate the prevalence of the metabolic syndrome in Tunisian adolescents. A representative sample of 1569 adolescents was enrolled. The prevalence of the metabolic syndrome was 0.4% with no statistical difference according to sex (p > 0.05). Overweight/obesity was the most common component of the metabolic syndrome (13.7%). This information will be used to develop prevention programs by promoting healthy lifestyles in schools.

Clustering of risk factors in the smoking habits of schoolchildren in Sousse, Tunisia

Abstract Background: In Tunisia, little is known about the association between tobacco use and other chronic disease risk factors. This is the case for both adults and children. It is important to know the characteristics of young smokers to facilitate the creation and implementation of future programs for tobacco prevention. Aim: The aim of this study was to determine the association between tobacco use and other lifestyle factors among schoolchildren in Tunisia. Methods: We conducted a 2009/2010 cross-sectional questionnaire survey of 4003 randomly selected school children aged 13 years old (7th and 9th grades) to evaluate their knowledge, attitudes towards, and beliefs about the three risk factors for chronic disease (unhealthy diet, physical inactivity, and tobacco use). Written informed consent was obtained from each child’s parents who allowed their child to participate. Results: The mean age of our sample was 13.36±1.28 years. The proportions of daily smokers were 2.2% and 0.1% among boys and girls, respectively. The proportions of irregular smokers were 9.1% and 1.5% among boys and girls, respectively. In our population, 19.1% (n=767) had ever experimented to smoke, with 29.8% among boys and 9% among girls (p<0.001). The proportions of schoolchildren who reported daily participation in physical activity were different between smokers and nonsmokers with 17.7% and 11.5%, respectively (p=0.03). Concerning eating habits, there was no significant difference in the consumption of fruits and vegetables; however, smokers frequently ate more high fat foods and in fast food restaurants. Similar results were found while comparing regular smoking children with those who experimented but who never became hooked on smoking. Conclusion: This study and previous research suggest the importance of early intervention in adolescents on smoking and combing these efforts with interventions focusing on physical activity and dietary habits.

Long term effect of a school based intervention to prevent chronic diseases in Tunisia, 2009-2015

Background & Objectives We aimed to evaluate the long term effect of school based intervention to prevent non- communicable disease risk factors. Methods It was a quasi experimental study conducted during the period of 2009–2015. We involved school children aged from 11 to 16 years old. For the assessment of the programs effectiveness, subjects in both groups were examined at baseline, at the end of the 3-year intervention period and at the follow-up, one year after programs cessation. Results In the intervention group, the prevalence of school children who reported to be eating 5 fruits and vegetable sdaily increased significantly from 30.0% at pre-assessment to 33.2% at post-assessment, one year after (p=0.02, p=0.41 respectively). For the control group, this prevalence had significantly decreased from 40.2% at baseline to 35.0% at post-intervention, at the follow up, this proportion increased to 44.5%(p=0.001, p<10−3 respectively). Concerning smoking habits, we observed a decreasing trend in the intervention group from 5.7% at pre-assessment, to 4.8% at post-assessment and to 3.4% at the follow-up (p=0.19 and p=0.25 respectively). There was also a significant decrease in school children who did recommended physical activity in the same group. Conclusion The present work showed that interventions promoting healthy lifestyles should be maintained. Developing countries should be encouraged and supported to design, conduct, and evaluate robust preventive interventions.

Clustering of lifestyle risk factors in employees: A quasi-experimental study in Sousse, Tunisia

Background:An increased understanding of the prevalence and clustering patterns of multiple lifestyle-related health factors may support efforts to reduce incidence of disease, management of existing chronic disease, and improve overall health outcomes. This study aimed to evaluate the effectiveness of three years based intervention in the workplace on clustering of non communicable diseases’ risk factors.Methods:We based our study on a quasi-experimental intervention study (pre and post assessments with intervention and control groups) in two districts in the governorate of Sousse. The evaluation before and after the intervention focused on attitudes and behaviors of participants. The intervention program team conducted several actions for the employees at workplace days focusing on free physical activity sessions and free smoking cessation consultations.Results:Participants who had no risk factor increased significantly from 5.9% to 10.3% (pl0.001) in intervention group but not significantly in control group. Those who had only one risk factor increased in intervention group but decreased in control group.Conclusion:Intervening on two or more risk behavior simultaneously might be more effective than intervening on them separately.

Challenges and results of a school-based intervention to manage excess weight among school children in Tunisia 2012-2014.

Abstract Background: Obesity is a serious health issue and predisposes individuals to an increased risk of morbidity and mortality. Its prevalence in children has increased worldwide. Objective: To demonstrate the feasibility and effectiveness of a school-based management program based on healthy lifestyle promotion for obese and overweight adolescents in Sousse, Tunisia. Methods: We conducted a quasi-experimental study among overweight and obese school children enrolled in 7th and 8th grades in Sousse, Tunisia with two groups, intervention and control. The 1-year intervention was based on promoting healthy eating and physical activity through a collective intervention for all recruited children and an individual intervention only for obese children who require intensive managing. Data collection was done before, at the end and at a 4-month follow up of the intervention, both in intervention and control groups. Results: The body mass index Z score decreased significantly from pre-intervention to post-intervention (1.89±0.57 to 1.76±0.63, p<0.001) and from post-intervention to the follow-up (1.76±0.63 to 1.55±0.68, p<0.001) in the intervention group. In the control group, it decreased significantly from pre-intervention to post-intervention but not significantly from post-intervention to follow-up assessment. Calorie intake decreased significantly both in intervention and control groups. Conclusion: This project began with introducing a new culture of health management in schools on one side and with increasing awareness of the importance of obesity prevention and treatment. The support of authorities for this type of action is very important to guarantee its sustainability.

Clustering of chronic diseases risk factors among adolescents: a quasi-experimental study in Sousse, Tunisia

Abstract Background The objective of the study was to evaluate the effectiveness of a school-based physical activity and nutritional behavior intervention, on the reduction of clustering of chronic diseases risk factors among school children. Materials and methods A quasi-experimental school-based intervention was conducted with an intervention group and a control group in the region of Sousse in Tunisia. The intervention was implemented between 2010 and 2013, with data collected at pre and at post intervention. Studied risk factors were: smoking, sedentary behavior, low fruit and vegetable intake and obesity. Odds ratios (ORs) were used to calculate the clustering of two risk factors. We calculated ORs in each group before and after the intervention. Results In the intervention group, the prevalence of adolescents that had no risk factors has significantly increased (p = 0.004). In the control group the prevalence of adolescents carrying two or more risk factors has increased (p = 0.06). The results showed that all risk factors tended to cluster together in both groups. In the intervention group, the calculated OR for smoking and sedentary behavior decreased after assessment (OR = 5.93) as well as the OR for smoking and low fruit and vegetable intake (OR = 3.26). In the control group, all ORs increased, showing an enhancement of the association. Conclusion This study showed the effectiveness of a school-based intervention in reducing the clustering of chronic diseases risk factors.