Abstract The direct agglutination test (DAT) is a simple and economic technique for the diagnosis... more Abstract The direct agglutination test (DAT) is a simple and economic technique for the diagnosis of visceral leishmaniasis. The efficiency of DAT for diagnosing visceral leishmaniasis was evaluated in 41 patients and 58 negative controls from Tunisia. DAT ...
Médecine tropicale : revue du Corps de santé colonial, 2009
Hydatidosis is a major public health problem in Tunisia. The presence of numerous stray dogs, wid... more Hydatidosis is a major public health problem in Tunisia. The presence of numerous stray dogs, widespread practice of sheep rearing and frequent slaughter of animals outside slaughterhouses are the main risk factors for spread of this zoonotic disease. Human behaviour associated with poor understanding of the parasite life cycle also has a negative impact. Health education is crucial for effective control. It should emphasize the damaging effects of uncontrolled slaughter, the exact role of dogs in parasite transmission and above all the need for adequate measures to sterilize infested viscera.
The aim of this study was to assess the efficacy of the national Tuberculosis Control Programme i... more The aim of this study was to assess the efficacy of the national Tuberculosis Control Programme in Tunisia, by applying the 8-stage model proposed by Piot (1967). Two retrospective cohorts of tuberculosis cases, including all new smear-positive cases detected by all laboratories in the study area during the study period, were selected at least 2 years after treatment began. The real number of new active cases during the study period was estimated at 142, the case detection rate at 61%. In all, 70% of patients started tuberculosis treatment, and regular use of the home treatment varied from 87% (including irregular use) to 71% (excluding irregular use). The low global efficacy of the program, which ranged from 26 to 31%, indicates the need for improved application of the strategy by programme managers.
Background It is well known that weather conditions influence the comfort and human health, in pa... more Background It is well known that weather conditions influence the comfort and human health, in particular temperature variations and its extremes. Many studies showed cold and heat-related mortality mainly in infants and the elderly. In Tunisia, the effects of temperatures have never been estimated at a large scale. The objective of this study was to estimate the effect of extreme daily temperatures on the risk of death in 7 different bioclimatic regions. Methods Generalized additive model was applied to assess the exposure-response relation and lag patterns of the association between mean temperature and the daily number of death from 1991 to 2011 in Tunis (North), Siliana and Jendouba (North West), Kairouan (Center West), Monastir (Center East), Gabes (South East) and Tozeur (South West). The analysis was adjusted for sex, age and population size, and controlled for long-term trend, seasonality and holidays. We did not adjust for the confounding effect of road traffic accident. Th...
Background The aim of this study was to characterize the transmission chains and clusters of COVI... more Background The aim of this study was to characterize the transmission chains and clusters of COVID-19 infection in Tunisia. Methods All cases were confirmed by Reverse Transcriptase Polymerase Chain Reaction of a nasopharyngeal specimen. Contact tracing is undertaken for all confirmed cases in order to identify close contacts that will be systematically screened and quarantined. Transmission chains were identified based on field investigation, contact tracing, results of screening tests and by assessing all probable mode of transmission and interactions. Results As of May 18, 2020, 656 cases out of a total of 1043 confirmed cases of Coronavirus disease 2019 belong to 127 transmission chains identified during the epidemic (mean age 42.36 years, Standard deviation 19.56 and sex ratio 0.86). The virus transmission is the most concentrated in the governorate of Tunis (31.5%), Ariana (10.2%) and Ben Arous (10.2%). Virus transmission occurred 50 times (9.72% of secondary transmission even...
Background The outbreak of coronavirus disease (COVID-19) continues to constitute an internationa... more Background The outbreak of coronavirus disease (COVID-19) continues to constitute an international public health concern. Few data are available on the duration and prognostic factors of the disease. We aimed to study the recovery time among a Tunisian cohort of COVID-19 confirmed patients and identify the prognostic factors. Methods A retrospective, nationwide study was conducted from March 2 to May 8, 2020, recruiting all patients who were diagnosed with COVID-19, by RT-PCR methods, in Tunisia. Data were collected via phone call interview. Kaplan-Meir Methods and Cox proportional hazards regression models were, respectively, used to study the recovery time and estimate its prognostic factors. Results One thousand and thirty patients with COVID-19 (aged 43.2 ± 18.2 years, 526 female (51.1%)) were enrolled. Among them 141 (14.8%) were healthcare professionals. Out of 173 patients (17.8%) admitted to the hospital, 47 were admitted in an intensive care unit. Among 827 patients who did...
Background Describing transmission dynamics of the outbreak and impact of intervention measures a... more Background Describing transmission dynamics of the outbreak and impact of intervention measures are critical to planning responses to future outbreaks and providing timely information to guide policy makers decision. We estimate serial interval (SI) and temporal reproduction number (Rt) of SARS-CoV-2 in Tunisia. Methods We collected data of investigations and contact tracing between March 1, 2020 and May 5, 2020 as well as illness onset data during the period February 29-May 5, 2020 from National Observatory of New and Emerging Diseases of Tunisia. Maximum likelihood (ML) approach is used to estimate dynamics of Rt. Results 491 of infector-infectee pairs were involved, with 14.46% reported pre-symptomatic transmission. SI follows Gamma distribution with mean 5.30 days [95% CI 4.66–5.95] and standard deviation 0.26 [95% CI 0.23–0.30]. Also, we estimated large changes in Rt in response to the combined lockdown interventions. The Rt moves from 3.18 [95% CI 2.73–3.69] to 1.77 [95% CI 1....
BackgroundThe world is threatened by the outbreak of coronavirus disease 19 (COVID-19) since Dece... more BackgroundThe world is threatened by the outbreak of coronavirus disease 19 (COVID-19) since December 2019. The number of cases and deaths increased dramatically in some countries from March 2020. The objective of our study was to examine potential associated factors with country-variation in COVID-19 morbidity and mortality in the world.MethodsWe performed a retrospective geographic study including all countries with the most recent available data on free access on the web. We analyzed univariate and multivariable correlation between both the number of reported cases and deaths by country and demographic, socioeconomic characteristics, lockdown as major control measure, average annual temperature and relative humidity. We performed simple linear regression, independent t test and ANOVA test for univariate analyses and negative binomial regression model for multivariable analyses.ResultsWe analyzed data of 186 countries from all world regions. As of 13thApril 2020, a total of 1 804 ...
Background Asthma and Chronic Obstructive Pulmonary Disease (COPD) are the two most common chroni... more Background Asthma and Chronic Obstructive Pulmonary Disease (COPD) are the two most common chronic obstructive pulmonary diseases worldwide. The objective of this study was to analyze the relation between the daily levels of air pollution indicators and the number of emergency department visits (EDV) for asthma and COPD exacerbation in the District of Tunis. Methods We conducted a retrospective ecological study. We collected daily morbidity data from the emergency register of Ariana Mami Hospital from 1 January 2007 to 31 December 2014. We investigated the association between daily EDV for asthma or COPD exacerbation and daily concentrations levels of air pollutants by simple Pearson correlation and by binomial negative regression using generalized linear models (GLM). Results For morbidity data, we recorded 19127 EDV for asthma (10771, 56.3%) and COPD exacerbation (8356, 43.7%) between 2007 and 2014. We observed a rising trend in the number of EDV for COPD since 2007 with winter se...
Introduction Un bon systeme d’information permet de decrire et d’evaluer l’activite hospitaliere ... more Introduction Un bon systeme d’information permet de decrire et d’evaluer l’activite hospitaliere et la performance d’un etablissement hospitalier. L’objectif de notre travail etait de decrire les tendances chronologiques de l’activite hospitaliere de l’hopital A. Mami durant les dix dernieres annees a partir du systeme d’information existant. Methodes Etude descriptive resultant de l’exploitation de la base de donnees administrative existante a l’hopital A. Mami, etablissement public situe a l’Ariana au nord-est de la Tunisie, alimentee par les personnels du bureau d’entree concernant tous les admissions entre le 1er janvier 2006 et le 31 decembre 2015. Resultats L’analyse des donnees a montre que l’hopital A. Mami comporte 14 services et une capacite hospitaliere de 355 lits. Le nombre total d’hospitalisations a double durant la periode allant de 2006 a 2016. Cette evolution etait variable d’un service a l’autre avec une augmentation au fil des annees des hospitalisations provenant de la consultation au depend de celles provenant des urgences. La duree moyenne de sejour hospitalier pour l’ensemble des services de l’hopital a enregistre une baisse durant la periode d’etude en passant de 11,17 jours en 2006 a 5,3 jours en 2015 tandis que le taux d’occupation des lits global etait variable d’une annee a une autre et d’un service a un autre. Il etait de 73,10 % en 2006 et de 75,5 % en 2015 avec un minimum de 72,93 % en 2007 et un maximum de 82,42 % en 2009. Durant cette periode, le taux de mortalite global a diminue de 3,87 % en 2006 a 2,93 % en 2015 (r = −0,754 et p = 0,012) Discussion/Conclusion Le systeme d’information existant, avec ses insuffisances, nous a permis de decrire les principaux indicateurs de l’activite dans notre hopital. Mais une evaluation de la performance de l’hopital necessite la mise en place d’un systeme d’information hospitalier plus performant.
Abstract The direct agglutination test (DAT) is a simple and economic technique for the diagnosis... more Abstract The direct agglutination test (DAT) is a simple and economic technique for the diagnosis of visceral leishmaniasis. The efficiency of DAT for diagnosing visceral leishmaniasis was evaluated in 41 patients and 58 negative controls from Tunisia. DAT ...
Médecine tropicale : revue du Corps de santé colonial, 2009
Hydatidosis is a major public health problem in Tunisia. The presence of numerous stray dogs, wid... more Hydatidosis is a major public health problem in Tunisia. The presence of numerous stray dogs, widespread practice of sheep rearing and frequent slaughter of animals outside slaughterhouses are the main risk factors for spread of this zoonotic disease. Human behaviour associated with poor understanding of the parasite life cycle also has a negative impact. Health education is crucial for effective control. It should emphasize the damaging effects of uncontrolled slaughter, the exact role of dogs in parasite transmission and above all the need for adequate measures to sterilize infested viscera.
The aim of this study was to assess the efficacy of the national Tuberculosis Control Programme i... more The aim of this study was to assess the efficacy of the national Tuberculosis Control Programme in Tunisia, by applying the 8-stage model proposed by Piot (1967). Two retrospective cohorts of tuberculosis cases, including all new smear-positive cases detected by all laboratories in the study area during the study period, were selected at least 2 years after treatment began. The real number of new active cases during the study period was estimated at 142, the case detection rate at 61%. In all, 70% of patients started tuberculosis treatment, and regular use of the home treatment varied from 87% (including irregular use) to 71% (excluding irregular use). The low global efficacy of the program, which ranged from 26 to 31%, indicates the need for improved application of the strategy by programme managers.
Background It is well known that weather conditions influence the comfort and human health, in pa... more Background It is well known that weather conditions influence the comfort and human health, in particular temperature variations and its extremes. Many studies showed cold and heat-related mortality mainly in infants and the elderly. In Tunisia, the effects of temperatures have never been estimated at a large scale. The objective of this study was to estimate the effect of extreme daily temperatures on the risk of death in 7 different bioclimatic regions. Methods Generalized additive model was applied to assess the exposure-response relation and lag patterns of the association between mean temperature and the daily number of death from 1991 to 2011 in Tunis (North), Siliana and Jendouba (North West), Kairouan (Center West), Monastir (Center East), Gabes (South East) and Tozeur (South West). The analysis was adjusted for sex, age and population size, and controlled for long-term trend, seasonality and holidays. We did not adjust for the confounding effect of road traffic accident. Th...
Background The aim of this study was to characterize the transmission chains and clusters of COVI... more Background The aim of this study was to characterize the transmission chains and clusters of COVID-19 infection in Tunisia. Methods All cases were confirmed by Reverse Transcriptase Polymerase Chain Reaction of a nasopharyngeal specimen. Contact tracing is undertaken for all confirmed cases in order to identify close contacts that will be systematically screened and quarantined. Transmission chains were identified based on field investigation, contact tracing, results of screening tests and by assessing all probable mode of transmission and interactions. Results As of May 18, 2020, 656 cases out of a total of 1043 confirmed cases of Coronavirus disease 2019 belong to 127 transmission chains identified during the epidemic (mean age 42.36 years, Standard deviation 19.56 and sex ratio 0.86). The virus transmission is the most concentrated in the governorate of Tunis (31.5%), Ariana (10.2%) and Ben Arous (10.2%). Virus transmission occurred 50 times (9.72% of secondary transmission even...
Background The outbreak of coronavirus disease (COVID-19) continues to constitute an internationa... more Background The outbreak of coronavirus disease (COVID-19) continues to constitute an international public health concern. Few data are available on the duration and prognostic factors of the disease. We aimed to study the recovery time among a Tunisian cohort of COVID-19 confirmed patients and identify the prognostic factors. Methods A retrospective, nationwide study was conducted from March 2 to May 8, 2020, recruiting all patients who were diagnosed with COVID-19, by RT-PCR methods, in Tunisia. Data were collected via phone call interview. Kaplan-Meir Methods and Cox proportional hazards regression models were, respectively, used to study the recovery time and estimate its prognostic factors. Results One thousand and thirty patients with COVID-19 (aged 43.2 ± 18.2 years, 526 female (51.1%)) were enrolled. Among them 141 (14.8%) were healthcare professionals. Out of 173 patients (17.8%) admitted to the hospital, 47 were admitted in an intensive care unit. Among 827 patients who did...
Background Describing transmission dynamics of the outbreak and impact of intervention measures a... more Background Describing transmission dynamics of the outbreak and impact of intervention measures are critical to planning responses to future outbreaks and providing timely information to guide policy makers decision. We estimate serial interval (SI) and temporal reproduction number (Rt) of SARS-CoV-2 in Tunisia. Methods We collected data of investigations and contact tracing between March 1, 2020 and May 5, 2020 as well as illness onset data during the period February 29-May 5, 2020 from National Observatory of New and Emerging Diseases of Tunisia. Maximum likelihood (ML) approach is used to estimate dynamics of Rt. Results 491 of infector-infectee pairs were involved, with 14.46% reported pre-symptomatic transmission. SI follows Gamma distribution with mean 5.30 days [95% CI 4.66–5.95] and standard deviation 0.26 [95% CI 0.23–0.30]. Also, we estimated large changes in Rt in response to the combined lockdown interventions. The Rt moves from 3.18 [95% CI 2.73–3.69] to 1.77 [95% CI 1....
BackgroundThe world is threatened by the outbreak of coronavirus disease 19 (COVID-19) since Dece... more BackgroundThe world is threatened by the outbreak of coronavirus disease 19 (COVID-19) since December 2019. The number of cases and deaths increased dramatically in some countries from March 2020. The objective of our study was to examine potential associated factors with country-variation in COVID-19 morbidity and mortality in the world.MethodsWe performed a retrospective geographic study including all countries with the most recent available data on free access on the web. We analyzed univariate and multivariable correlation between both the number of reported cases and deaths by country and demographic, socioeconomic characteristics, lockdown as major control measure, average annual temperature and relative humidity. We performed simple linear regression, independent t test and ANOVA test for univariate analyses and negative binomial regression model for multivariable analyses.ResultsWe analyzed data of 186 countries from all world regions. As of 13thApril 2020, a total of 1 804 ...
Background Asthma and Chronic Obstructive Pulmonary Disease (COPD) are the two most common chroni... more Background Asthma and Chronic Obstructive Pulmonary Disease (COPD) are the two most common chronic obstructive pulmonary diseases worldwide. The objective of this study was to analyze the relation between the daily levels of air pollution indicators and the number of emergency department visits (EDV) for asthma and COPD exacerbation in the District of Tunis. Methods We conducted a retrospective ecological study. We collected daily morbidity data from the emergency register of Ariana Mami Hospital from 1 January 2007 to 31 December 2014. We investigated the association between daily EDV for asthma or COPD exacerbation and daily concentrations levels of air pollutants by simple Pearson correlation and by binomial negative regression using generalized linear models (GLM). Results For morbidity data, we recorded 19127 EDV for asthma (10771, 56.3%) and COPD exacerbation (8356, 43.7%) between 2007 and 2014. We observed a rising trend in the number of EDV for COPD since 2007 with winter se...
Introduction Un bon systeme d’information permet de decrire et d’evaluer l’activite hospitaliere ... more Introduction Un bon systeme d’information permet de decrire et d’evaluer l’activite hospitaliere et la performance d’un etablissement hospitalier. L’objectif de notre travail etait de decrire les tendances chronologiques de l’activite hospitaliere de l’hopital A. Mami durant les dix dernieres annees a partir du systeme d’information existant. Methodes Etude descriptive resultant de l’exploitation de la base de donnees administrative existante a l’hopital A. Mami, etablissement public situe a l’Ariana au nord-est de la Tunisie, alimentee par les personnels du bureau d’entree concernant tous les admissions entre le 1er janvier 2006 et le 31 decembre 2015. Resultats L’analyse des donnees a montre que l’hopital A. Mami comporte 14 services et une capacite hospitaliere de 355 lits. Le nombre total d’hospitalisations a double durant la periode allant de 2006 a 2016. Cette evolution etait variable d’un service a l’autre avec une augmentation au fil des annees des hospitalisations provenant de la consultation au depend de celles provenant des urgences. La duree moyenne de sejour hospitalier pour l’ensemble des services de l’hopital a enregistre une baisse durant la periode d’etude en passant de 11,17 jours en 2006 a 5,3 jours en 2015 tandis que le taux d’occupation des lits global etait variable d’une annee a une autre et d’un service a un autre. Il etait de 73,10 % en 2006 et de 75,5 % en 2015 avec un minimum de 72,93 % en 2007 et un maximum de 82,42 % en 2009. Durant cette periode, le taux de mortalite global a diminue de 3,87 % en 2006 a 2,93 % en 2015 (r = −0,754 et p = 0,012) Discussion/Conclusion Le systeme d’information existant, avec ses insuffisances, nous a permis de decrire les principaux indicateurs de l’activite dans notre hopital. Mais une evaluation de la performance de l’hopital necessite la mise en place d’un systeme d’information hospitalier plus performant.
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Papers by Mohamed Chahed