Burden of non-communicable diseases in Tunisia, 1990-2017: results from the global burden of disease study

Introduction: non-communicable diseases (NCDs) are the leading cause of mortality and disability worldwide especially in developing countries such as Tunisia. We aimed to describe the national burden of non-communicable diseases in 2017 and to analyze disability-adjusted life year trends from 1990 to 2017 in Tunisia by cause and gender. Methods: we used Joinpoint regression analysis to assess trends of the age standardized disability-adjusted life year rate from 1990 to 2017 and to determine average annual percentage change. Results: non-communicable diseases accounted for 87.7% of total disability-adjusted life year in Tunisia in 2017. The five leading causes of this rate in Tunisia in 2017 were cardiovascular diseases, musculoskeletal disorders, neoplasms, mental disorders and neurological disorders. The trend of disability-adjusted life year rate of non-communicable diseases decreased significantly from 23403.2 per 100.000 (95% CI: 20830.2-26285.8) in 1990 to 18454.6 (95% CI: 15611.3-21555.4) in 2017, with a change of -0.9%; p=0.00. The decrease of the age standardized disability-adjusted life year rate concerned mainly cardiovascular diseases and neoplasms secondly. This decrease was more important in female (change=-1.1, p=0.00) in comparison to males (change=-0.7, p=0.00). On the other hand, the increase of the standardized disability-adjusted life year rate was related to musculoskeletal disorders, diabetes, kidney disorders and substance use disorders with a significant annual percentage change of 0.1%, 0.2% and 1.3% (p=0.00) respectively. Conclusion: the implementation of the national strategy is the key solution to mitigate the impact of non-communicable diseases in Tunisia

Antibiotherapy management in respiratory infections in ambulatory in Tunisia

Acute respiratory tract infections are the commonest acute conditions managed in general practice and the main causes of antibiotic use. In Tunisia, the rates of antibiotic prescriptions remain high in general practice. In order to assess antibiotics prescribing practices of 23 general practitioners when facing an ENT or a respiratory tract infection, we conducted an observational study from February 1st, 2014 to November 25th, 2014. The study involved 374 patients, 45.6 mean age of years, among them 193 men (51.6%) and 174 (51.9%) with comorbidities. Tonsillitis, acute maxillary sinusitis and acute bronchitis are the main diagnosis, accounting for over 90% of ENT and respiratory tract infection. The diagnosis of these infections was based on clinical criteria, additional tests were prescribed for only 75 patients (20%). An antibiotic was prescribed for 360 patients (96.2%). β-lactams were the main prescribed class of antibiotics (58.3%). The antibiotic treatment was considered as inappropriate in 42.5% of prescriptions. The main causes were the prescription of amoxicillin-clavulanic acid during tonsillitis, non-antipneumococcal fluoroquinolones, when streptococci or streptococcus pneumoniae are presumed to be responsible for infection (tonsillitis, acute maxillary sinusitis, pneumonia), and unnecessary combination of antibiotics. A concomitant treatment was prescribed for 365 patients (97.6%). The most prescribed drugs were antipyretics (71.4%), corticosteroids (44.7%) and mucolytic (30.2%). The outcome was favorable in 333 cases (89%) and unfavorable in 26 cases (7.1%). The total average cost of an infectious episode was 79.776 ± 36.988 TND (45 ± 20 USD)., with a minimum and maximum values respectively 19.5 and 315.5 TND (35 to 558 USD). This study highlights the frequency of antibiotics prescription (96.2%) during supposed viral infections such as acute bronchitis, tonsillitis or when antibiotic prescription has to be debatable such as in acute otitis media, sinusitis maxillary or exacerbations of COPD. The over-use of antibiotics is an important concern in many countries of the region leading to emergence of bacterial resistance. National guidelines should be developed in order to promote rational use of antibiotics

Patients’ experiences and satisfaction with health care in the Salah Azaiez Institute of Cancer in Tunisia in 2020

Measurement of patient-centered care is a key step to ensure quality of care improvement. The aims of this study were to evaluate the experience of hospitalized patients of Salah Azaiez Institute (SAI) of Cancer of Tunisia in 2020 and to analyze factors associated to the global satisfaction. It was a cross-sectional study. The used questionnaire was derived from the Picker patient questionnaire. Factors associated to the global satisfaction were assessed using Chi-squared and Fisher’s exact tests. The present study concerned 200 inpatients of the SAI. The Cronbach’s α of the patient experience test (PPE-15) was of 0.82 indicating a good internal consistency. According to results of this study, only 38.5% of the patients were satisfied with their hospitalization. Perception of the quality of the received treatment was good to excellent for 57.0%. Regarding the global organization, 56.5% of the patients found it intermediate and 21.5% perceived it as bad. The highest scores among patient experience dimensions concerned the coordination of healthcare, the respect for patient preference and the physical comfort. However, lowest scores were attributed to the involvement of family and friends, the information and patient education and the emotional support. Unlike socio-demographic factors, patient experience and its dimensions was strongly associated to the global satisfaction. Further studies are recommended to explore patient experience dimensions and other determinants of patient satisfaction in Tunisia. Experience Framework This article is associated with the Policy & Measurement lens of The Beryl Institute Experience Framework. (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

Predictive factors of morbidity after surgical treatment of hepatic hydatid cyst

Introduction Surgery remains the basic treatment of hepatic hydatid cyst (HHC). However, it is associated with significant morbidity. The aim of our study was to evaluate mortality and morbidity of surgery of the HHC and to highlight the risk factors. Methods A retrospective study was conducted from January 1, 1996 to December 31, 2006. 391 patients hospitalized for HHC and operated in the Department of General Surgery “A” of the Rabta Hospital in Tunis, Tunisia. Results The overall mortality rate was 0.7% while the overall morbidity rate was 20.4%. About 16.6% suffered from specific complications, while 3.8% suffered from non-specific complications. Predictors of morbidity in a univariate analysis included cysts larger than 9 cm, dome cysts, cysts with bilious contents, type II, III, IV or V on ultrasound classification, fissured cysts and intrabiliary rupture of hepatic hydatid cyst. The multivariate study consisted of independent predictors of disease at the site of the liver dome, the cysto-biliary fistula and intrabiliary rupture of hepatic hydatid cyst Conclusion The hepatic hydatid cyst of the dome and the existence of preoperative complications in particular intrabiliary rupture of hepatic hydatid cyst are the main factors of morbidity. A better understanding of these factors allows the surgeon to choose the appropiate surgical technique that is associated with less morbidity.Pan African Medical Journal 2012; 13:2

Burden of musculoskeletal disorders in the Eastern Mediterranean Region, 1990–2013: findings from the Global Burden of Disease Study 2013

Moradi-Lakeh M, Forouzanfar MH, Vollset SE, et al. Burden of musculoskeletal disorders in the Eastern Mediterranean Region, 1990–2013: findings from the Global Burden of Disease Study 2013. Annals of the Rheumatic Diseases. 2017;76(8):annrheumdis-2016-210146

The Burden of Mental Disorders in the Eastern Mediterranean Region, 1990-2013

Charara R, Forouzanfar M, Naghavi M, et al. The Burden of Mental Disorders in the Eastern Mediterranean Region, 1990-2013. PLOS ONE. 2017;12(1): e0169575.The Eastern Mediterranean Region (EMR) is witnessing an increase in chronic disorders, including mental illness. With ongoing unrest, this is expected to rise. This is the first study to quantify the burden of mental disorders in the EMR. We used data from the Global Burden of Disease study (GBD) 2013. DALYs (disability-adjusted life years) allow assessment of both premature mortality (years of life lost-YLLs) and nonfatal outcomes (years lived with disability-YLDs). DALYs are computed by adding YLLs and YLDs for each age-sex-country group. In 2013, mental disorders contributed to 5.6% of the total disease burden in the EMR (1894 DALYS/100,000 population): 2519 DALYS/100,000 (2590/100,000 males, 2426/100,000 females) in high-income countries, 1884 DALYS/100,000 (1618/100,000 males, 2157/100,000 females) in middle-income countries, 1607 DALYS/100,000 (1500/100,000 males, 1717/100,000 females) in low-income countries. Females had a greater proportion of burden due to mental disorders than did males of equivalent ages, except for those under 15 years of age. The highest proportion of DALYs occurred in the 25-49 age group, with a peak in the 35-39 years age group (5344 DALYs/100,000). The burden of mental disorders in EMR increased from 1726 DALYs/100,000 in 1990 to 1912 DALYs/100,000 in 2013 (10.8% increase). Within the mental disorders group in EMR, depressive disorders accounted for most DALYs, followed by anxiety disorders. Among EMR countries, Palestine had the largest burden of mental disorders. Nearly all EMR countries had a higher mental disorder burden compared to the global level. Our findings call for EMR ministries of health to increase provision of mental health services and to address the stigma of mental illness. Moreover, our results showing the accelerating burden of mental health are alarming as the region is seeing an increased level of instability. Indeed, mental health problems, if not properly addressed, will lead to an increased burden of diseases in the region

Burden of obesity in the Eastern Mediterranean Region: findings from the Global Burden of Disease 2015 study

Mokdad AH, El Bcheraoui C, Afshin A, et al. Burden of obesity in the Eastern Mediterranean Region: findings from the Global Burden of Disease 2015 study. INTERNATIONAL JOURNAL OF PUBLIC HEALTH. 2018;63(Suppl. 1):165-176.We used the Global Burden of Disease (GBD) 2015 study results to explore the burden of high body mass index (BMI) in the Eastern Mediterranean Region (EMR). We estimated the prevalence of overweight and obesity among children (2-19 years) and adults (20 years) in 1980 and 2015. The burden of disease related to high BMI was calculated using the GBD comparative risk assessment approach. The prevalence of obesity increased for adults from 15.1% (95% UI 13.4-16.9) in 1980 to 20.7% (95% UI 18.8-22.8) in 2015. It increased from 4.1% (95% UI 2.9-5.5) to 4.9% (95% UI 3.6-6.4) for the same period among children. In 2015, there were 417,115 deaths and 14,448,548 disability-adjusted life years (DALYs) attributable to high BMI in EMR, which constitute about 10 and 6.3% of total deaths and DALYs, respectively, for all ages. This is the first study to estimate trends in obesity burden for the EMR from 1980 to 2015. We call for EMR countries to invest more resources in prevention and health promotion efforts to reduce this burden

Maternal mortality and morbidity burden in the Eastern Mediterranean region : findings from the Global Burden of Disease 2015 study

Assessing the burden of maternal mortality is important for tracking progress and identifying public health gaps. This paper provides an overview of the burden of maternal mortality in the Eastern Mediterranean Region (EMR) by underlying cause and age from 1990 to 2015. We used the results of the Global Burden of Disease 2015 study to explore maternal mortality in the EMR countries. The maternal mortality ratio in the EMR decreased 16.3% from 283 (241-328) maternal deaths per 100,000 live births in 1990 to 237 (188-293) in 2015. Maternal mortality ratio was strongly correlated with socio-demographic status, where the lowest-income countries contributed the most to the burden of maternal mortality in the region. Progress in reducing maternal mortality in the EMR has accelerated in the past 15 years, but the burden remains high. Coordinated and rigorous efforts are needed to make sure that adequate and timely services and interventions are available for women at each stage of reproductive life

Burden of cancer in the Eastern Mediterranean Region, 2005-2015: findings from the Global Burden of Disease 2015 Study

Fitzmaurice C, Alsharif U, El Bcheraoui C, et al. Burden of cancer in the Eastern Mediterranean Region, 2005-2015: findings from the Global Burden of Disease 2015 Study. INTERNATIONAL JOURNAL OF PUBLIC HEALTH. 2018;63(Suppl. 1):151-164.To estimate incidence, mortality, and disability-adjusted life years (DALYs) caused by cancer in the Eastern Mediterranean Region (EMR) between 2005 and 2015. Vital registration system and cancer registry data from the EMR region were analyzed for 29 cancer groups in 22 EMR countries using the Global Burden of Disease Study 2015 methodology. In 2015, cancer was responsible for 9.4% of all deaths and 5.1% of all DALYs. It accounted for 722,646 new cases, 379,093 deaths, and 11.7 million DALYs. Between 2005 and 2015, incident cases increased by 46%, deaths by 33%, and DALYs by 31%. The increase in cancer incidence was largely driven by population growth and population aging. Breast cancer, lung cancer, and leukemia were the most common cancers, while lung, breast, and stomach cancers caused most cancer deaths. Cancer is responsible for a substantial disease burden in the EMR, which is increasing. There is an urgent need to expand cancer prevention, screening, and awareness programs in EMR countries as well as to improve diagnosis, treatment, and palliative care services