MEDICEL : where we go ? M editerranean N etwork for Coeliac Disease
POCT diffusion project M Ben Hariz. Tunisia MEDICEL. Palermo 2014.
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Transcript of POCT diffusion project M Ben Hariz. Tunisia MEDICEL. Palermo 2014.
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POCT diffusion project
M Ben Hariz. TunisiaMEDICEL. Palermo 2014
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Main objective
Diffusion of POCT in schoolsChildren with growth fairlure: « small » children
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Why schools
First• Because we have a good experience working
in school envirenment!
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First Study : Region of Ariana
Ben Hariz M, et al. Prevalence of celiac disease in Tunisia: mass-screening study in schoolchidren. Eur J Gastroenterol hepatol 2007; 19: 687-694.
Actual proposed study : Ben Arous
Second study : Djerba
Ben Hariz M et al. Celiac disease in Tunisian children: A second screening study using a “new generation” rapid test. Immunol Invest 2013; 42: 356–368
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Second
• The school is a good choice to start and succeed in our efforts to diffuse POCT
• enrollment between 6 -14 years: 100%• Large number of school doctors • generally these same doctors are also primary
care physicians lines
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why “small“ child?
• Frequent situation in Tunisia (5% in our school previous study)
• The small height often motivates parents looking for a reason (little refusal to search for celiac disease)
• If celiac disease is the cause of the small height, the gluten-free diet is often followed well (unlike asymptomatic child)
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selected regionGovernorate of Ben Arous
Général population: 700000Area: 761 Km2Number of schoolsNumber of pupills: 50000
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DESIGN
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Selected population: 50000
Mesure of height
Selection of children with height < 2SD (2500)
Acceptance. Inclusion refusal
Exclusion POCT
PositiveNegative
Suspicion of IgA deficiency
Determination of IgA
Confirmation No IgA deficency
IgG anti endomysium
PositiveNegative
ELISAEndoscopy
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Steps planned• May-June 2014: get the final approval from the Ministry of
Health, Department of School Medicine and Ethics Committee • September 2014: training meeting for school doctors • September-November 2014: obtaining and filing the
anthropometric measurements of children (only height?)• December 2013: sending mail for parental consent for the
selected population (Height <-2SD, n=2500). • January 2015: POCT for all and samples for ELISA for positive or
IgA deficiency children• February and March 2015: endoscopy for positives • April 2015: analysis of results
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Estimated budget• POCT: 7500 euro • Training (meeting): 3000- euro• equipment to measure the size? • Secretariat (Secretary contract, mail ...): 3000 euro • Displacement: 4000 euro • other: 3000 euro • “Gift for schooldoctors”!!: 5000 euro? • Total: 25500 euro• Budget available for study in 2014: 14000 Euro
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expected difficulties
• Mostly administrative: Net decrease in administrative efficiency since the revolution (extreme slow, iterative change managers ...) for example, we introduced three times the project at the Ministry!!
• enthusiasm school doctors! • need to expand the team of the research unit
(now, only me and Nadia Siala!!)