Unité de dépistage et de suivi . Cadre pour la surveillance des enfants et adolescents. Cas du Khroub (Constantine , Algerie) -1996/97-1999/00-2001/02.

Abstract

Algeria presents all the characteristics of a country in nutritional transition like other countries such as Tunisia, Morocco, Brazil, China and India. The country see appearing the signs of a society in transition which are problems for them the health systems are not yet prepared (MHPHR, 2003). The treatment of these diseases being very expensive, it is urgent to put prevention adapted to these consequences of the nutritional transition. The main stake is to use the nutritional surveillance activities in order to do an obligatory inventory of fixtures before setting a system. In this part, the unities of screening and the follow-up structures of the school health, do they can constitute an observatory of the nutritional transition for a preventive approach? The aim of this thesis is the analysis of anthropometric data of UDS of Khroub in order to know the nutritional state of examined pupils for their surveillance. The qualitative evaluation of these data and the functioning of UDS are also realized. The analyzed anthropometric data concern school children in 1996/97 and 1999/00 in fundamental and secondary schools. It concerns sex, age, weight and height, noted by the staff in registers at the time of screening and the follow-up visit. As a comparison, the same anthropometric measures of pupils of four schools in Khroub have been realized in 2002 by our care. The studied population is constituted of 14 878 pupils in 1996/97, 9 084 in 1999/00 and 3 174 in 2001/02. We have compared the mean values of weight, height and BMI and W/A, W/A and H/A indices of pupils between the three school years. These values have also been compared with the data of international and national population (Chamla et al, 1976; Dekkar, 1986). The nutritional state of pupils is valuated by the estimation of overweight, obesity, thinness and stunting, according to age, sex and for each of the three cited school years. The qualitative aspect is determined by an analysis of anthropometric data (statistic analysis, validity control of WHO, 1995). Activities and functioning of UDS aim at observations. We have distributed an autoadministrated questionnary to staff. The weight, the height and the BMI means of all pupils, children (5-9 years) and adolescents (10-18 years) are different between the three school years (p=0,000). Comparatively to Bouzina and Arris, children in 1974 (Chamla et al, 1976) and Algerian pupils in 1983 (Dekkar, 1986), the values of weight and height of pupils of Khroub are higher. The curves of weight and height are similar to international populations. The difference of the BMI values is probably due to the data of height, methodological differences and age estimation. During the three school years, the estimations of the overweight frequency including the obesity of pupils of the two sexes vary from 10.2% according to CDC (CDC/NCHS, 2000) to 21.6% according to French references (Rolland-Cachera et al, 1991). The obesity in our population varies from 2.5% according the IOTF references (Cole et al, 2000) to 6.4% according to CDC. For all school boys of the three school years, the thinness frequency varies from 3.6% according to French references to 11.3% according to WHO (WHO, 1995); the one of the stunting (H/A < -2 SD) is of 3.3% for all pupils. The qualitative analysis of anthropometric data allows saying that school tendencies is biased because of samples height and great numbers law. That despite a collection of measures by the UDS not true to recommendations. Our results emphasize on emergence of an unrecognized problem and a little bit studied the overweight among the school population in Algeria. Thus, it is very probable that stunting, thinness and obesity coexist. These results concern only 65% of pupils in 1996/97 and 1999/00 and 11.5% in 2001/02 of the commune of Khroub, the adolescents being large, but they are comforted by observed transition tendencies (urbanization and modification of modes of life which are very rapid) and the socio-economic situation which is known by Algeria. Anthropometric data collected by health structures notably the UDS, can be used in order to analyze, to evalue and to follow the nutritional situation of the school population since there aren’t studies on nutritional state of this crosssection of age in our country. The school health can have activities more efficacious, a profitable functioning and constitute information basis and reliable data in order to formulate or to tend nutritional policies. The UDS must constitute an observatory of the nutritional transition and to participle at the mastery of its evolution. In Algeria, the rates of sanitary cover of the young population allow to consider it. The UDS data must contribute at levels by the lack of information and to establish the indicators appropriated to the decision taking. The UDS can, by integrating into their actions the nutritional follow-up of children and adolescents, constitute an observatory of the sanitary situation of pupils but also in order to formulate nutritional policies and to guide decisions. The aims will be operational, of research and valuation of programs, by integrating with national programs.