Hand hygiene reduces healthcare-associated infections. The World Health Organization (WHO) recommends the multimodal hand hygiene strategy to improve hand hygiene. To compare hand hygiene knowledge and compliance of healthcare practitioners (HCPs) before and after the implementation of the WHO multimodal strategy, a before-and-after cross-sectional study was conducted in two Tunisian University Hospitals (2019–2023). Hand hygiene knowledge and compliance were assessed using the WHO questionnaire and observation tool. In 2019, 42 of 246 HCPs (17%) correctly answered ≥80% of 25 questions on hand hygiene knowledge. By 2023, this increased to 47 HCPs (19%). Knowledge on hand hygiene significantly improved for 10 out of 25 questions (12–38% increases) but declined for eight questions (5–40% decreases). Seven questions showed no significant changes in knowledge. Overall hand hygiene compliance increased from 21% in 2019 to 40% in 2023 (p < 0.001). Improvements were observed across the hospital departments (p < 0.001) and staff categories (p < 0.001). In 2023, the lowest hand hygiene compliance was for/before touching a patient (29%), and before clean/aseptic procedures (37%). Hand hygiene compliance was improved, but progress fell short of the WHO’s desired 80% target. Sustained efforts and complementary interventions are needed to accelerate progress and achieve the desired outcomes.

Background: Coronavirusdiseasese 2019 (COVID-19) pandemic has affected the world deeply. Successfully control and minimization of related morbidity and mortality require changing the behavior, which is influenced by knowledge and perceptions. This study aimed to explore the level of knowledge, attitude, and practice of medical students (MS) regarding COVID-19 and to identify their associated factors. Methods: A cross-sectional study involving 431 ungraduated MS was conducted in Sfax Medical School, Southern Tunisia, in November 2020. Results: The global scores of COVID-19 knowledge, attitude and practice among MS were 74.6 +/- 13, 69 +/- 10.2, and 78.8 +/- 13.6/100, respectively. Prevalence of good knowledge, positive attitude and good practice was 47.1%, 19.3%, and 61.3%, respectively. In multivariate analysis, the independent factors of good knowledge were current smoking (adjusted odds ratio [AOR]=1.8; p=0.04), assistance to training sessions (AOR=1.5; p=0.04) and specialized residency education level (AOR=2.4; p=0.02). History of chronic disease was an independant predictor of positive attitude (AOR=2.4; p=0.009), while current smoking (AOR=0.4; p=0.01) wasindependantly associated with negative attitude. Social media used as a main source of information about COVID-19 was independently associated with poor knowledge (AOR=0.5; p=0.01) and negative attitude (AOR=0.4; p=0.008). Independant factors of good practice were specialized residency education level (AOR=2.4; p=0.01), being in close contact exposure with COVID-19 cases (AOR= 2.1; p=0.04) and having good knowledge (AOR=2.2; p < 0.001). Conclusion: Tunisian MS had satisfactory knowledge and practice about COVID-19, butthey had lower positive attitude rates towards this emergent disease. Thus, development of interactive courses on emerging diseases and travel epidemiology are higly recommended.

Introduction. Healthcare professionals (HCPs) play a crucial role in healthcare waste management (HWM). Insufficient knowledge and inadequate management practices are the most important issues in the HWM process. The purpose of the study — the objective was to assess an educational program’s impact on HCP’s knowledge and practices regarding HWM. Materials and Methods. This quasi-experimental study consisted of a pretest evaluation, an intervention, and a post-test re-evaluation conducted in Habib Bourguiba University Hospital during the period of January 2nd to April 30th, 2022. Results. Overall, 134 HCPs provided complete responses. The median age was 40 years (Interquartile range = [32.00–48.75] years) and the sex ratio was 0.44. We found a significant rise in the knowledge score (KS) of participants regarding global HWM knowledge (86.8 ± 6.7 vs 58.5 ± 6.8; p < 0.001) and also in the KS for each waste category: non-infectious waste (89.6 ± 8.7 vs 68.9 ± 15.4; p = 0.005), infectious waste (90.7 ± 4.2 vs 74.3 ± 9.7; p = 0.001), sharps (89 ± 7,3 vs 72.9 ± 7.0; p < 0.001) and cytotoxic waste (80.0 ± 21.7 vs 17.2 ± 5.7; p < 0.001). We noted a significant rise in PS of participants regarding global HWM practices (93 ± 6 vs 73 ± 10; p < 0.001) and also for each item: availability of equipment in the medical treatment cart (100 ± 1 vs 71 ± 23; p < 0.001), healthcare waste segregation (78 ± 20 vs 54 ± 27; p = 0.002), information and training about HWM (100 ± 10 vs 71 ± 46; p = 0.003), and healthcare waste disposal (91 ± 14 vs 45 ± 34; p = 0.001). The KS change was significantly more important for HCPs who had no previous training in HWM during the last 3 years than other HCPs with previous training (29.8 vs 25; p = 0.042). Research limitations. It was a single-center study that could impact the generalization of the results on a national scale. Secondly, as previously noted, the participation rate was low but this fact was not an obstacle to having a positive impact on HCP’s knowledge and practices in the whole hospital. Conclusions. HWM training sessions are a promising and effective intervention to improve knowledge and practices of HCPs. It should not be a one-time activity but it should be a continuous and regular process to ensure a safe care environment and deliver quality care.

Background: Tuberculosis (TB) has become a public health problem among elderly in developing countries with the gradual increase in life expectancy. Aim/Objective: This study aimed to analyze the prognosis factors and chronological trends of TB in elderly in Southern Tunisia. Methods: A retrospective study was conducted. All TB patients aged ≥60 years, recorded in the Center of TB Control between 1995 and 2016, were included. Chronological trends of TB were analyzed by calculating the correlation coefficient of Spearman (Rho). Multivariate analysis was done by binary logistic regression (Adjusted Odds ratio (AOR); CI; p) to determine the independent risk factors associated with unsuccessful outcome in elderly. A p value <0.05 was considered as statistically significant. Results: Overall, 512 new elderly TB cases were notified between 1995 and 2016, with an average of 23.3 new cases/year. The mean TB incidence rate for elderly was 2.31/100,000 population/year. The case-fatality rate of 8.6%. Multivariate analysis showed that factors independently associated with unsuccessful outcome among elderly patients were age between 80 and 89 (AOR = 4.5; [95% CI: 2, 10.2]; p < 0.001), male gender (AOR = 2.2; [95% CI: 1.1, 4.4]; p = 0.026) and neuro-meningeal involvement (AOR = 4.6; [95% CI: 1.4, 14.8]; p = 0.011). The incidence of TB in elderly patients increased significantly from 0.95/100,000 population in 1995 to 2.17/100,000 population in 2016 (Rho = 0.48; p = 0.024). Discussion: A better understanding of TB features in elderly and its chronological trends overtime would facilitate to put in place, in the national TB control program, strategies geared towards this group of people.

Background and aims: Prostate cancer (PCa) is the second most common malignancy among Tunisian men, although screening uptake remains low due to limited awareness and cultural barriers. Thus, this study aimed to assess the levels of knowledge, attitudes, cultural beliefs, views, and screening behaviors related to PCa among men aged 40 and above in the Sfax region of Tunisia and to identify factors influencing these dimensions. Methods: A descriptive and analytical cross-sectional study was conducted in 2025 among 1,520 men using a structured questionnaire covering sociodemographic and clinical factors, knowledge of PCa, attitudes, cultural beliefs, views, and screening practices. The obtained data were entered, verified, and analyzed using SPSS 25. Ultimately, univariate tests and multivariate logistic regression were used for statistical analysis. Results: Based on the results, participants demonstrated low knowledge (n=922; 60.7%), negative attitudes (n=1304, 85.8%), and moderate cultural beliefs (n=869, 57.2%). Only 7.4% had ever undergone PCa screening (n=113), and 68.7% expressed a willingness to perform screening in the future (n=966). Moreover, screening uptake was significantly associated with high knowledge (OR=4.399, P<0.001), positive attitudes (OR=4.579, P<0.001), and weak cultural beliefs (OR=0.251, P<0.001). Finally, barriers included lack of symptoms (55.2%), financial constraints (47.3%), and low perceived risk (46.3%). Conclusion: Overall, PCa screening remains low in the Sfax region, driven by limited knowledge, negative attitudes, and influential cultural beliefs. In general, higher knowledge and positive attitudes increased screening uptake, while strong cultural beliefs reduced it. Accordingly, improving awareness and addressing cultural and financial barriers are essential to enhance early detection.

Introduction: first-line physicians should play a key role in tobacco control. The purpose of this study is to assess the knowledge and attitudes of front-line physicians as well as their practices for smoking cessation, assess their smoking status and determine the barriers to smoking cessation support. Methods: we conducted a cross-sectional study among a representative sample of front-line physicians practising in the governorate of Sfax in November 2020. Results: a total of 115 first-line physicians were included in the study, with a sex ratio (M/F) of 0.91 and an average age of 43 years (interquartile interval= [34-55 years]). Among the respondents, 26 (22.6%) stated that they were smokers; 98 of the physicians surveyed (85.2%) had not had any postgraduate training in smoking cessation. However, 71 (61.7%) had an idea on nicotine replacement therapy. Regarding attitudes,73 respondents (63.5%) were convinced that physicians were responsible for helping their patients quit smoking. Forty five physicians (39.1% ) systematically asked all patients about their smoking habits. The least performed activities of the 5A strategy were the components "help" (14%) and "organize follow-up" (17.4%). Patients' disinterest was considered (53%) to be a significant barrier to smoking cessation assistance by the 61 physicians surveyed. Conclusion: there is a need to evaluate and improve the implementation of the national tobacco control strategy, in particular with regard to the training of front-line physicians.