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Abstract Background Healthcare waste (HCW) poses a global hazard, particularly in developing country hospitals where mismanagement is common due to poor practices among staff. Training healthcare workers has shown promise in enhancing practices and behaviors. The aim of this study was to assessHCW management at Sahloul University Hospital (2019–2021) before and after training sessions. Methods This study was conducted at Sahloul University in Sousse, Tunisia, spanned two years (2019–2021) and consisted of three distinct stages. Two audits of Healthcare Waste Management (HCWM) were conducted using a predetermined assessment framework derived from ANGED’s guidelines, with an educational session separating the two audits. Results In terms of sorting practicesthere was a substantial improvement in sorting practices following training. Specifically, the overall compliance rate for sorting sharps increased from 60.3 to 77.6% (p

Background Muscle injuries are the most frequent in football and may lead to the end of a player’s career. Many studies have evaluated the effectiveness of prevention programs for all injury types. Few studies have evaluated the effects of exercise on muscle injuries. The aim of this study is to report, through a systematic review of research of high level of proof (randomized controlled trial) the efficacy of preventive programs for muscle injuries for football players. Methods A documentary search was conducted in October 2022 from three databases: Medline via its PubMed interface, Google Scholar, and COCHRANE databases. We only included original articles published between October 2012 and October 2022 with a high level of evidence. The research was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. The target population consisted of professional and semi-professional footballers. The intervention in question was structured injury preventive protocols, including specific training or pre-established protocols such as the FIFA 11+ program, compared to each other or with regular training sessions. The main outcomes were the incidence rates of muscle injuries and severe injury in each group, as well as the time loss to injury. Results Seven randomized controlled trials with a high level of evidence confirmed using the PEDRO scale were included. There were 3815 male professional football players. There was heterogeneity in the age, hours of exposure, and duration of the intervention. The prevention protocols used were FIFA 11+, bounding exercises, NHE, and stretching exercises. Structured exercises significantly reduce the severity of muscle injury and, consequently, time loss to injury. Discussion Despite the diversity of prevention programs, teams still lack standardized programs. Structured exercises, such as FIFA 11+ and bounding exercises, which combine strengthening, body kinesthesic awareness, and neuromuscular control, reduce the incidence and severity of muscle injury. FIFA 11+ is the first and most complete structured program, but lacks some exercises, such as adductor strengthening. Conclusion This review showed the interest in structured exercises in reducing severity and time loss to injury in professional football players. It shows that effective MI prevention program should combine variable structured programs taking into consideration risk evaluation. Registration This review was registered on 8/17/2023 in the International Prospective Register of Systematic Reviews under the reference code CRD42023452202.

Introduction: Healthcare activities are generally associated with the production of healthcare waste, a large part of which is assimilated to household waste (packaging, kitchen waste, green waste, etc.) and another category of waste which may have a risk to health and the environment given its nature and typology. This category of waste at risk includes waste at risk of infection such as stinging, sharp waste (needles, blade, scalpel, etc.), and waste at chemical risk. Poor management of hospital waste is a problem in most countries and especially in developing countries. We aimed to determine the health and environmental impacts of the poor management of healthcare waste. Methods: We carried out a systematic review of the French and English literature on the scientific research sites Medline/PubMed and Embase. This research was carried out over 3 months (April–June 2020). The search strategy was used by combining keywords and Boolean operators: Health, Health impact assessment, Hospitals, Medical waste, Waste disposal facilities, Environment, Environment/Epidemiology, Hospital waste, impact, workplace, Environment hazards, Healthcare works, Waste management. Results: It has been clear that the current management of healthcare waste is not capable of adequately preserving human health and environmental contamination from infection. The surveys analyzed showed that if incineration is properly treated, it would be an appropriate treatment method to deal with healthcare waste. However, exposure to pollutants produced by the incineration is still a public health problem. If incineration is seen as a practical solution for dealing with healthcare waste, low-temperature incinerators should be banned and replaced by modern incinerators equipped with air pollution control units. These problems are typical for any developing country which does not have the means to purchase incinerators which are more protective for the environment and equipped with the latest technologies. Conclusions: Thus, autoclaving and microwaves are considered better alternatives for treating healthcare waste. However, these methods are generally not adequate for the disposal of pathological, radioactive, laboratory, and chemotherapy wastes. Therefore, the specific management of healthcare waste is a major concern due to the potentially high risks for human health and the environment.

Abstract Background Hand hygiene (HH) is considered the most important measure to tackle the transmission of healthcare-associated pathogens. However, compliance with recommendations is usually low and effective improvement strategies are needed. We aimed to assess the effectiveness of an intervention targeting hand hygiene promotion among healthcare workers (HCWs). Methods We conducted a pre-post interventional study design in the university hospital Sahloul, Sousse, Tunisia, from January 2015 to December 2016. The intervention program consisted of training sessions and distribution of posters of hand hygiene guidelines. To assess the evolution of HH observance at pre- and post-intervention, the same observation form was distributed and collected at healthcare workers’ workplace. Results Of the 1201 and 1057 opportunities for hand hygiene observed among all categories of HCWs, overall compliance enhanced significantly from 32.1 to 39.4% (p < 0.001) respectively at pre- and post-intervention. Nurses were the most compliant with a significant improvement from 34.1 to 45.7% (p < 0.001) respectively at pre- and post-intervention. Furthermore, analysis by department showed significant improvement of compliance in orthopedic department (p < 0.001), maxillofacial-surgery department (p < 0.001), pediatrics department (p = 0.013), and emergencies (p = 0.038). Conclusion This study showed the feasibility and effectiveness of a health-setting-based intervention to enhance hand hygiene observance in the context of a developing country.

Background Although efforts to manage coronavirus disease 2019 (COVID-19) pandemic have understandably taken immediate priority, the impacts on traditional healthcare-associated infection (HAI) surveillance and prevention efforts remain concerning. Aim To describe trends in HAIs in a Tunisian university hospital through repeated point prevalence surveys over 9 years, assess the impact of measures implemented for COVID-19 pandemic, and to identify associated factors of HAI. Methods The current study focused on data collected from annual point prevalence surveys conducted from 2012 to 2020. All types of HAIs as defined by the Centers for Disease Control and Prevention (CDC) were included. Data collection was carried out using NosoTun plug. Univariate and multivariate logistic analysis were used to identify HAI risk factors. Results Overall, 2729 patients were observed in the 9 surveys; the mean age was 48.3 ± 23.3 years and 57.5% were male. We identified 267 infected patients (9.8%) and 296 HAIs (10.8%). Pneumonia/lower respiratory tract infections were the most frequent HAI (24%), followed by urinary tract infection (20.9%).The prevalence of infected patients increased from 10.6% in 2012 to 14.9% in 2020. However, this increase was not statistically significant. The prevalence of HAIs increased significantly from 12.3% to 15.5% ( P =.003). The only decrease involved is bloodstream infections (from 2% to 1%). Independent risk factors significantly associated with HAI were undergoing surgical intervention (aOR = 1.7), the use of antibiotic treatment in previous 6 months (aOR = 1.8), peripheral line (aOR=2), parenteral nutrition (aOR=2.4), urinary tract within 7 days (aOR=2.4), central line (aOR = 6.3), and prosthesis (aOR = 12.8), length of stay (aOR = 3), and the year of the survey. Young age was found as protective factor (aOR = .98). Conclusion Contrary to what was expected, we noticed an increase in the HAIs rates despite the preventive measures put in place to control the COVID-19 pandemic. This was partly explained by the vulnerability of hospitalized patients during this period.

Background: In spite of the epidemiological transition, communicable diseases remain a public health problem and represent a significant cause of morbidity and mortality worldwide, especially in developing countries. This study aimed to determine the crude and standardized prevalence rates of hospitalizations for communicable disease (HCD) and to assess trends in HCD by age and sex at a university hospital in Tunisia over a period of 12 years (2002–2013). Methods: All cases of HCD from 2002 to 2013 in the university hospital departments were included. Data collected from the regional register of hospital morbidity were used. The discharge diagnoses were coded according to the International Classification of Diseases, 10th revision (ICD-10). Results: HCD represented 17.45% of all hospitalizations during the study period (34 289/196 488; 95% confidence interval 17.28–17.62%). The median age at the time of admission was 31 years (interquartile range (IQR) 15–52 years). The median hospital length of stay (LOS) was 5 days (IQR 3–9 days). The crude prevalence rate (CPR) was 5.41 per 1000 inhabitants. The CPR was highest among patients aged ≥65 years. The four communicable disease categories that represented 70% of all HCD were abdominal infection, skin infection, genitourinary infection, and lower respiratory tract infection. The majority of HCD decreased over time; however, there was a significant increase in HIV diseases, tuberculosis, and viral hepatitis. Conclusion: This study provides evidence of the epidemiological transition, showing a decline in communicable diseases, which needs to be sustained and improved.

Background Early adolescence is a critical period usually associated with substances experimentation. In Tunisia, some studies were carried out recently to evaluate tobacco and cannabis use in the colleges and high schools. However, few studies were led in the middle schools. While onset of substances use usually occur during early adolescence. Aims: To evaluate the prevalence of tobacco and cannabis use and to determine if there is an association between their use among the young adolescents of Sousse. Methods A cross-sectional study was conducted in the region of Sousse, Tunisia during the 2013/2014 school year among a proportional and stratified sample of 4272 schoolchildren randomly selected in 16 public middle schools from the region of Sousse. Data about sociodemographic characteristics, tobacco products and cannabis use among the schoolchildren, their parents, their siblings and their friends were collected using a self administrated questionnaire. Results Females represented 50.5% (2157) of participants. The mean age of schoolchildren was 13.3 ±1.2 years. Among participants, 12.9% (CI 95% : 11.9%-13.9%) reported lifetime tobacco use, 4.5% (CI 95% : 3.9%-5.1%) were current cigarette smokers, 3.2% (CI 95% : 2.7%-3.7%) were current water pipe users and 1.9% (CI 95% : 1.5%-2.3%) reported lifetime cannabis use. The age of tobacco use onset (11.2 ±2.7 years) was significantly inferior to the age of cannabis use onset (13.1±2 years) (p< 0.001). The most influential risk factor on cannabis use was current cigarette smoking with an adjusted odds ratio of 7.3 (CI 95% : 4.2-12.5). Conclusions National school-based substances use prevention program is required in Tunisia. Tobacco use prevention deserves more efforts as it is a gateway to other substances use such cannabis.

Background Tobacco use has become the leading preventable cause of death worldwide. Therefore, Tunisia has ratified the WHO Framework Convention on Tobacco Control in 2010. Objectve: We aimed to outline an experience of implementing a workplace based program of tobacco control in Sousse, Tunisia (2009-2014) in order to identify barriers and recommendations for future interventions in low and middle income countries. Methods We conducted a quasi-experimental study among a representative sample of employees in Sousse, Tunisia with two groups, intervention and control. Our three years workplace program consisted of a collective intervention (Smoking free workplace, open sensitization day : films and workshops on tobacco harmful effects) and an individual one (Free clinics for tobacco cessation offering free nicotine replacement therapy products). Participants enrolled at the pre intervention and post intervention assessments belonged to two independant samples in each group. Results Overall, the intervention showed positive effets in improving the knowledge of the participants on the harmful effects of active and passive smoking and on light cigarettes. The intervention was associated to a significant increase of the employers involvment in tobacco control efforts. Regarding the smoking behaviors, in the intervention group, the prevalence of tobacco use decreased from 39.2% at the pre-assessment to 37.5% at the post assessment (p=0.43) with no substantial difference in the number of cigarettes consumed. Conclusions Despite the absence of positive effect of this project on smoking behavior, severall lessons may be deducted and it would be therefore considered as a corner stone. The fight against tobacco use is dependent on deep environmental changes. The role the employer is crucial but not sufficient. A multisectoral approach garanteeing an actual involvement of all the stakeholders and topped by a political will is strongly needed.

Background Secondhand smoke (SHS) contains an estimated 4000 toxic chemicals and is a serious health hazard to non-smokers. Exposure to tobacco smoke causes extremely serious damages, placing exposed persons at increased risk of a number of adverse health outcomes, such as asthma, lung cancer and cardiovascular diseases. In this context, this work was carried out in order to evaluate exposure to smoking among schoolchildren in the region of Sousse. Methods We conducted a cross sectional design study among a representative sample of students from all colleges in the delegation of Sousse Jawhra and Sousse Erriadh. We used an Arabic, pre tested and self administered questionnaire to collect data about Socio -demographic characteristics and student's smoking behavior. Results Our population was composed of 2170 students. Girls accounted for 1100 (51.3%) and 1070 (48.7%) boys. The mean age of our population was 13.23±(1,19). The prevalence of smoking in our population was 4.8%. In the month preceding our study 75% of our population was exposed to a second-hand smoking. 36.7 % was exposed at home and almost one third (27.3%) at school. But second hand smoking was affecting smoking and non smoking students. We noticed that 74.5% of non smoker were exposed to secondhand smoking despite the that the majority (92.0 %) knew that second hand smoking is dangerous . We highlighted also that non-smokers were significantly more in favor of implementing tobacco control laws (94.6% vs 94% of smokers ; p=0.02). Conclusions Exposure to an involuntary smoke is an urgent issue, because there is no safe level of SHS exposure, even minimal exposure is harmful. And as we noticed the Second hand smoking is very high among students in the Sousse region. Therefore there is an urgent need for a program to prevent and control this scourge of active and passive smoking among schoolchildren.

Background Tobacco use is one of the biggest public health threats the world has ever faced. Tunisia is one of the countries suffering from the heavy burden of tobacco use. It is in this context that the Chronic Disease Prevention Research Center in Sousse established a school based intervention for tobacco control and prevention. Our objective was to evaluate the feasibility and effectiveness of our intervention in tobacco control and prevention by the evaluation of smoking behavior among schoolchildren at pre and post assessment in both intervention and control groups. Methods We conducted a three years school based quasi-experimental study with an intervention and a control groups. We enrolled a representative sample of schoolchildren from all colleges of intervention and control areas. We have carried out a pre-assessment before the intervention in 2009-2010 and a post assessment of the same parameters at the end of the intervention in both groups in 2013-2014. We used a pre tested self administered questionnaire to assess tobacco use. Results Overall, 4003 schoolchildren were included: 1929 in the intervention group and 2074 in the control group. After the intervention, 4275 schoolchildren participated in the evaluation with respectively 2170 and 2105 in each group. The age of the schoolchildren varied between 11 and 16 years. There was a decrease in tobacco use in the intervention group from 5.7% to 4.8% contrary to an increase in the control group from 7.5% to 9.2%. Among boys, the prevalence of tobacco use decreased in both groups. However, among girls, in the intervention group a decrease was noticed in the contrary to the control group where a significant increase was observed from 1.1% to 5.2%. Conclusions Tobacco prevention needs multi-sectored approach and an extended intervention to be effective. That's why a political will is important for such interventions.

Background Muscle injuries are the most frequent in football and may lead to the end of a player’s career. Many studies have evaluated the effectiveness of prevention programs for all injury types. Few studies have evaluated the effects of exercise on muscle injuries. The aim of this study is to report, through a systematic review of research of high level of proof (randomized controlled trial) the efficacy of preventive programs for muscle injuries for football players. Methods A documentary search was conducted in October 2022 from three databases: Medline via its PubMed interface, Google Scholar, and COCHRANE databases. We only included original articles published between October 2012 and October 2022 with a high level of evidence. The research was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. The target population consisted of professional and semi-professional footballers. The intervention in question was structured injury preventive protocols, including specific training or pre-established protocols such as the FIFA 11+ program, compared to each other or with regular training sessions. The main outcomes were the incidence rates of muscle injuries and severe injury in each group, as well as the time loss to injury. Results Seven randomized controlled trials with a high level of evidence confirmed using the PEDRO scale were included. There were 3815 male professional football players. There was heterogeneity in the age, hours of exposure, and duration of the intervention. The prevention protocols used were FIFA 11+, bounding exercises, NHE, and stretching exercises. Structured exercises significantly reduce the severity of muscle injury and, consequently, time loss to injury. Discussion Despite the diversity of prevention programs, teams still lack standardized programs. Structured exercises, such as FIFA 11+ and bounding exercises, which combine strengthening, body kinesthesic awareness, and neuromuscular control, reduce the incidence and severity of muscle injury. FIFA 11+ is the first and most complete structured program, but lacks some exercises, such as adductor strengthening. Conclusion This review showed the interest in structured exercises in reducing severity and time loss to injury in professional football players. It shows that effective MI prevention program should combine variable structured programs taking into consideration risk evaluation. Registration This review was registered on 8/17/2023 in the International Prospective Register of Systematic Reviews under the reference code CRD42023452202.

Background Tunisia was one of the most affected nations with COVID-19 disease. The clinical features of this illness range from asymptomatic illness to death. Aim To analyse the survival of patients admitted to a Tunisian tertiary care center (Sahloul University Hospital) and identify independent predictive factors for hospital COVID-19 mortality. Methods A longitudinal study was conducted among confirmed COVID-19 patients hospitalized in Sahloul University Hospital between September 2020 and September 2022. Cox univariate regression was used to calculate the Hazard Ratio (HR) of death for patient characteristics regarding the time at risk. Risk factors with a p value of 0.2 or less in the univariate analysis were initially included in the multivariate Cox regression models. Results During the study at Sahloul Hospital, 1978 patients were hospitalized, averaging 55.65 years in age (± 21.39). Among them, 417 deaths occurred, with a median survival of 30 days (± 3.11) [23.904-36.096]. Factors significantly affecting the survival curve were: Age, male gender, comorbidities, diabetes, hypertension, endocrine diseases, obesity, intubation, and ICU admission Multilevel survival analyses revealed that hypertension (aHR 1.24; CI [1.02-1.52]; p=0.028), ICU admission (aHR 12.20- CI [9.56-15.57]; p Conclusion Our study concluded the importance of the early identification of high-risk COVID-19 patients to decrease this virus mortality. A good understanding of the possible clinical factors associated with COVID-19 severity is helpful for clinicians in identifying patients who are at high risk and require prioritized treatment to minimize death.

Background Muscle injuries are the most frequent in football and may lead to the end of a player’s career. Many studies have evaluated the effectiveness of prevention programs for all injury types. Few studies have evaluated the effects of exercise on muscle injuries. Methods A documentary search was conducted in October 2022 from three databases: Medline via its PubMed interface, Google Scholar, and COCHRANE databases. We only included original articles published between October 2012 and October 2022 with a high level of evidence. The research was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. The target population consisted of professional and semi-professional footballers. The intervention in question was structured injury preventive protocols, including specific training or pre-established protocols such as the FIFA 11+ program, compared to each other or with regular training sessions. The main outcomes were the incidence rates of muscle injuries and severe injury in each group, as well as the time loss to injury. Results Seven randomized controlled trials with a high level of evidence confirmed using the PEDRO scale were included. There were 3815 male professional football players. There was heterogeneity in the age, hours of exposure, and duration of the intervention. The prevention protocols used were FIFA 11+, bounding exercises, NHE, and stretching exercises. Structured exercises significantly reduce the severity of muscle injury and, consequently, time loss to injury. Discussion Despite the diversity of prevention programs, teams still lack standardized programs. Structured exercises, such as FIFA 11+ and bounding exercises, which combine strengthening, body kinesthesic awareness, and neuromuscular control, reduce the incidence and severity of muscle injury. FIFA 11+ is the first and most complete structured program, but lacks some exercises, such as adductor strengthening. Conclusion This review showed the interest in structured exercises in reducing severity and time loss to injury in professional football players. Registration This review was registered on 8/17/2023 in the International Prospective Register of Systematic Reviews under the reference code CRD42023452202.

Introduction: A better understanding of socio-demographic characteristics of subgroups, which have a high risk to develop chronic diseases, is essential to develop more efficient interventional programs especially for youth. This study aimed to determine the association between clusters of non communicable diseases (NCDs') risk factors and the socio-demographic characteristics among a sample of Tunisian school children.Materials and Methods: We conducted, in 2013/2014, a cross-sectional study among a proportional and stratified school children sample, selected in 17 elementary public schools in Sousse (Tunisia). A cluster analysis was used to identify different NCDs risk factors clusters, based on tobacco use, physical inactivity, unhealthy diet, and excess weight. Subsequent χ2-tests were used to identify differences between the NCDs risk factors clusters in regards to socio-demographic characteristics.Results: Four clusters of NCDs risk factors were found: 1) Cluster 1: physical inactivity behavior with normal weight, 2) Cluster 2: physical inactivity behavior associated to excess weight, 3) Cluster 3: unhealthy diet associated to excess weight and low practice of physical activity, and 4) Cluster 4: smoking behavior with physical activity behavior. The pattern of cluster membership differed across sex (<10-3), school level, and socioeconomic level (<10-3) but there was no significant difference between clusters for mother's education levels and household tenure.Conclusion: This study can have important implications for health policy and practice. Indeed, it found that many subjects have simultaneous multiple NCDs risk factors which leads to identify groups at risk and implement integrated intervention program. [ABSTRACT FROM AUTHOR]