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Background: Adverse Childhood Experiences (ACEs) have become an alarming phenomenon exposing individuals at a great risk of developing mental health issues. To date, there remains a lack of adequate researches on ACEs especially among adolescents. This survey aimed to describe the prevalence of childhood adversities and to determine their role in developing risky behaviours amongst Tunisian youth. Methods: We conducted a cross sectional study among schooled adolescents in the governorate of Mahdia (Tunisia) from January to February 2020. Exposure to violence was assessed using the validated Arabic version of the WHO ACE questionnaire. The Internet Addiction Test (IAT) and the Hospital Anxiety and Depression scale (HAD) were used as a screening tool for internet addiction, anxiety and depression. Results: A total of 1940 adolescents were recruited. The majority of them (97.5%) reported experiencing at least one ACE. Emotional neglect (83.2%) and witnessing community violence (73.5%) were the most reported ACE categories. According to gender, males had higher rates of exposure to physical abuse and social violence than females. The most common risky behaviour was internet addiction (50%) followed by substance use (16.6%). After adjustment for anxiety and depression, the dose-response association between ACE and risky behaviours was well established. Conclusions: These results among youth have both public health and societal implications. Key messages: The prevalence of exposure to adverse childhood experiences as well as risky behaviors are alarming among Tunisian adolescents. Screening addictive behaviors among youth with a history of childhood adversities is needed. [ABSTRACT FROM AUTHOR]

• The Maghreb has high rates of child institutionalisation. • Fragmented child protection systems prioritise cultural norms over child welfare, with limited resources and transparency. • Limited alternative care such as foster care contributes to high rates of child institutionalisation. • Research is urgently needed to develop evidence-based interventions to reduce child institutionalisation in the region. The Maghreb (Algeria, Libya, Mauritania, Morocco (including Western Sahara), Tunisia) has high rates of child maltreatment and child abandonment, leading to high rates of child institutionalisation. This review aims to provide an estimate of the prevalence of children in institutions in the countries of the Maghreb and to compare and contrast the child protection systems in the region. Using a scoping review approach, we identified 44 relevant studies from databases including Academic Search Premiere, Africa-Wide Information, Policy file Index, Google, and Google Scholar. Estimated children in institutions were as follows: Algeria 550,000, Libya 80–145,000, Mauritania 45,850, Morocco 471,006, and Tunisia 140,000. Common elements included limited child protection resources, lack of transparent databases, limited separation between religion and state, Shariah's influence on social and cultural norms, and a kafala system, an Islamically prescribed from of permanent guardianship for abandoned children. Mauritania and Tunisia had dedicated child protection codes, and all countries except Libya reported to the CRC. The literature indicates that components of the child protection systems in the countries of the Maghreb are fragmented with competing purposes, prioritising existing communitarian cultural mores over child protection. High rates of child abandonment and institutionalisation in the region result from inadequate child safeguarding structures and the stigmatisation of unmarried mothers and their children. Kafala, is a common element of Maghrebian child protection systems, with little alternative care provision, such as foster care. The scoping review highlights the opportunity to develop and adapt existing child safeguarding and alternative care structures and practice between countries of the Maghreb. Intra-regional research is urgently needed to facilitate changes and reduce rates of child abandonment and institutionalisation. [ABSTRACT FROM AUTHOR]