Contrasting patterns of hepatitis C virus infection in two regions from Tunisia

This report is a population-based study describing the pattern of hepatitis C virus (HCV) infection in two distinct regions in Tunisia. The study included a total of 11,507 individuals sampled in 1996 from both genders, all age groups, urban and rural settings belonging to 2,973 families. HCV infection was assessed by commercial enzyme immunoassay (EIA) and immunoblot assays and detection of HCV RNA by PCR. HCV genotypes and subtypes were determined by sequencing in the 5'-untranslated region (UTR) viral genomic region and the INNO-LiPA HCVII genotyping kit. Genetic relatedness between HCV strains was assessed by sequencing of a portion of the NS5B region. HCV prevalence was significantly higher in the North-Western region than in the Southern one: 1.7% versus 0.2% (P < 10(-3), chi(2) = 8,506). There was no difference in positivity according to gender or living in rural or urban settings; the only significant risk factor was advanced age. HCV prevalence among household contacts of HCV positives was not significantly higher than the prevalence in the whole study population. These results indicate a heterogeneity in the geographical distribution of HCV in Tunisia. An increased HCV transmission occurs in the North-Western region with large predominance of genotype 1b (88%) and low contribution of intrafamilial transmission.     

Prevalence of Middle East Respiratory Syndrome Coronavirus in Dromedary Camels,Tunisia

Free-roaming camels, especially those crossing national borders, pose a high risk for spreading Middle East respiratory syndrome coronavirus (MERS-CoV). To prevent outbreaks, active surveillance is necessary. We found that a high percentage of dromedaries in Tunisia are MERS-CoV seropositive (80.4%) or actively infected (19.8%), indicating extensive MERS-CoV circulation in Northern Africa.     

Qualité des supports de communication de crise lors de la pandémie de la COVID-19 au Grand Maghreb

ObjectiveTo objectively assess the quality of “crisis communication” media, during the COVID-19 pandemic, in the three Greater Maghreb countries (Tunisia, Algeria, Morocco).MethodsA compliance audit for press releases and epidemiological bulletins was analyzed against a quality benchmark, which had been specifically designed by the authors. This framework, made up of five dimensions and 50 items, graded (0/1), was applied by two researchers in preventive medicine. Multiplying the scores by a coefficient of two resulted in a partial score of 20 points for each dimension and a total score of 100 points for the checklist taken as a whole. The quality of the communication media was considered to be good when exceeding the thresholds of 15/20 for the different dimensions and 75/100 for the entire grid.ResultsA total of 141 information media were included in this audit (Tunisia: 60; Algeria: 60; Morocco: 21). The overall median quality score for these media was only 56/100 (IIQ: [46–58]), without major variability between countries. The most appreciated dimension was “maintaining the confidence of the population”, with an overall median score of 14/20 (12/20 for epidemiological bulletins and 16/20 for press releases). The most poorly rated dimension was “strengthening community participation”, with a median score of only 4/20 (6/20 for epidemiological bulletins and 4/20 for press releases).ConclusionThe quality of the Maghreb crisis communication media during COVID-19 was insufficient in most of its dimensions and items, particularly from a psychosocial standpoint. Reinforcement of the capacities of communication officers to develop information material and supports during health crises is indispensable and should be considered as an urgent matter.     

First Molecular Identification and Genetic Characterization of Theileria lestoquardi in Sheep of the Maghreb Region

Theileria lestoquardi is the most prominent Theileria species in small ruminants that causes malignant theileriosis of sheep in Africa and Asia. In the present survey, blood samples and ticks were collected in Kebili (southern Tunisia) from 166 Queue Fine de l'Ouest sheep. Giemsa‐stained blood smears, immunofluorescent antibody test (IFAT) and PCR were performed. The DNA was extracted from blood and analysed by PCR targeting 18S rRNA gene of Theileria spp. and then sequenced. A total number of 140 ticks were collected from a total number of 166 sheep during the four seasons. The ticks belonged to two genera and 4 species; the most frequent tick was Hyalomma excavatum 84.3% (118/140) and then Rhipicephalus spp. 15.7% (22/140). Only two animals had positive Giemsa‐stained blood smears, and they were also positive by IFAT. The amplicons had 99.3 and 99.6% homology with the BLAST published T. lestoquardi amplicons. To our knowledge, this is the first report of T. lestoquardi in small ruminants within the Maghreb region.     

National cervical cancer prevention program in the Arab States: Strategies and cost-minimization study of the Tunisian case

BackgroundThe Arab states geographic region is marked by a low to moderate cervical cancer screening coverage rates and the absence of national human papillomavirus (HPV) vaccination programs, except for the United Arab Emirates. Knowing that the HPV prevalence among Tunisian woman is estimated to 4.9/100 000 according to the “HPV Center” data, this study aims to estimate the cost of a national cervical cancer prevention program in Tunisia using either the primary prevention method (the two-dose schedule anti-HPV vaccine according to the WHO recommendation for young adolescents) or the secondary prevention method (the Pap smear test according to three time-lapse periodicity).MethodsThe mean incremental cost of one avoided cervical cancer case was calculated for each prevention scenario.ResultsThe ascending incremental costs by avoided cervical cancer case are: 1- the national vaccination program through the GAVI support ($ 1803), 2- the cervical cancer screening according to 10-year periodicity ($ 8219), 3- the cervical cancer screening according to 5-year periodicity ($ 14,567), 4- the cervical cancer screening according to 3-year periodicity ($ 20,479), 5- and finally the national vaccination program according to the manufacturer marketed price ($ 36,854).ConclusionCurrently, the anti-HPV national vaccination program combined with cervical cancer screening according to 5-year periodicity present the best cost-effective strategy for cervical cancer prevention in Tunisia. This study gives Tunisian decision makers a basis for structured planning and cost apportionment to ensure effective roll-out of the cervical cancer prevention strategies.     

First detection and molecular identification of Neospora caninum from naturally infected cattle and sheep in North Africa

Neosporosis, caused by the protozoan Neospora caninum , is a major cause of reproductive failure in ruminants causing enormous economic losses. The objective of this study was to estimate the infection rate and molecular identification of N. caninum in Tunisian cattle and sheep. A total number of 348 meat samples were collected from 150 cows and 198 ewes slaughtered in the regional slaughterhouse of Béja (North‐west Tunisia) and tested for the presence of N. caninum ITS 1 gene using PCR followed by sequencing of some PCR products. A phylogenetic tree was then constructed to compare the partial sequences of the ITS 1 gene with GenBank sequences. The overall molecular infection prevalence of N. caninum was significantly higher in cattle than in sheep (22 and 10.6%, respectively, p  = .003). In sheep, the highest prevalence was observed in the northern Béja locality (31.2 ± 16.1), with the Noire de Thibar breed as the most infected sheep breed (31.7 ± 14.2%) (p  < .001). In cattle, there were no differences in the molecular prevalence of N. caninum according to breeds and localities. The association between age and N. caninum molecular prevalence was statistically significant in both species; the highest prevalence was observed in sheep of more than one year of age (19.4 ± 9.1%), and in cattle between two and eight years of age (28.8 ± 10.9%). Comparison of the partial sequences of the ITS 1 gene revealed 96%–100% similarity among our N. caninum amplicon and those deposited in GenBank. To our knowledge, this is the first detection and molecular identification of N. caninum in sheep and cattle in North Africa. This information is pertinent in designing control programmes that would reduce economic losses in the livestock industry.     

Burn-out chez les jeunes médecins : étude réalisée dans la région de Sousse

ObjectiveTo assess the extent of the burn-out syndrome among interns and residents in health facilities of the governorate of Sousse of Tunisia and identify the contributing factors.MethodsThis study is based on a questionnaire accompanied by two specific scales of burn-out (Maslach) and sleep disorders (Epworth). It covered all the interns and residents doing an internship running in health facilities of the governorate of Sousse.ResultsOur study included 342 interns and residents with a 52.7% response rate. The analysis of the scale of Maslach revealed that 98 young doctors were concerned about burn-out. The prevalence of this syndrome in this population was 28.7% (95% CI [24.0 to 33.6]). Half of the population seems to have sleep disturbances and 29% suffer from insomnia. The main risk factors for burn-out objectified by interns and residents are high workload, poor working conditions, insecurity, lack of supervision and communication with hierarchical superiors, lack of rest compensator guard post and insufficient time devoted to leisure. As for the consequences, our study also suggests that this burn-out is causing medical errors committed by our population of young doctors.ConclusionBurn-out is a reality in our hospitals, particularly among young physicians, with potentially harmful consequences for the individual himself and for the patient. Prevention, based on both personal care, as working conditions, is needed to ensure the socio-professional balance of young doctors.     

Les facteurs liés aux actes d’homicide chez les patients tunisiens atteints de schizophrénie

IntroductionEvaluation of variables correlated to homicide is a fundamental issue for developing preventive and therapeutic strategies to deal with such criminal behavior.ObjectivesThe objectives of this study were to assess the characteristics of homicide in Tunisian patients suffering from schizophrenia and to determine the correlated socio-demographic, clinical and therapeutic variables.MethodsThe study included two groups of male patients with a DSM-IV diagnosis of schizophrenia who attended the “Razi” university psychiatric hospital of Tunis. The first group was composed of 36 patients hospitalized for homicide in the forensic unit between the first of January 2000 and the 30th of May 2012. The second group included 50 patients without any criminal record. Demographic, clinical and therapeutic variables were analyzed and compared between the two groups.ResultsNo differences were found between the two groups regarding the different socio-demographic variables. Significant differences were found with respect to a duration of untreated psychosis equal to or more than one year (p = 0.048), shorter duration of psychiatric care (p = 0.002), lower number of hospitalizations (p = 0.026), antecedent of forced hospitalization (p < 0.001), low degree of insight (p = 0.001), poor medication compliance (p < 0.001) and higher antipsychotic doses (p = 0.001).DiscussionDemographic variables as suggested by other studies are less valuable predictors of homicide in patients with schizophrenia.ConclusionInterventions for reducing such behavior should focus on clinical variables and integrate an early diagnosis of the disease and improvement of insight as well as medication compliance.