title: [The first Tunisian cardiovascular diseases register: processes and results].
abstract: BACKGROUND
  In Tunisia, cardiovascular diseases are the leading causes of death (30%) and a few studies conducted in the population have demonstrated that the level of their risk factors is increasing. For policy makers, the health system impact of these diseases is currently a crucial issue. The National Public Health Institute has identified the implementation of a morbidity register as a priority.
  
  
  METHODS
  A CVD morbidity register is implemented since 2001, in 3 different geographical populations having contrasted levels of health status (Tunis, Ariana and Ben Arous). The 3 regions are covering about 2 millions inhabitants which is the fifth of the overall Tunisian population. All coronary heart events occurring among adults 25 years old and above in the 3 populations are recorded. The diagnosis of events, case fatality and classification are defined according to MONICA criteria. The data are recorded from public and private hospitals, death certificates and autopsies.
  
  
  RESULTS
  During the year 2001, the total number of myocardial infarction events was estimated at 942: in men, the age-standardized rates were 163.8/100000 in Tunis population vs. 161.9 in Ariana and 170.5 in Ben Arous. In women, the rates were respectively 43.4, 61.1 and 44.6. Medical causes of death registration was the most crucial problem in spite of the implementation of the death certificate designed according to WHO model. Specific surveys for clinical assessment and surveillance of risk factors were conducted in the register populations.
  
  
  CONCLUSIONS
  It is the first time that data on coronary heart disease incidence and fatality are available in Tunisia through this experience which highlights the practical difficulties experienced in registering and coding coronary events in a developing country. The data source quality should be improved and the register should be integrated in the local health system.
authors.affiliation: Laboratoire de Recherche en Epidémiologie et Prévention des Maladies Cardiovasculaires en Tunisie, Institut National de Santé Publique, Le Diplomate (10e étage), 5-7, rue Khartoum, Belvédère, 1002 Tunis, Tunisie. habiba.benromd-hane@rns.tn
authors.forename: H
authors.initials: H
authors.lastname: Ben Romdhane
authors.forename: S
authors.initials: S
authors.lastname: Bougatef
authors.forename: H
authors.initials: H
authors.lastname: Skhiri
authors.forename: D
authors.initials: D
authors.lastname: Gharbi
authors.forename: M N
authors.initials: MN
authors.lastname: Kafsi
authors.forename: A
authors.initials: A
authors.lastname: Belhani
authors.forename: R
authors.initials: R
authors.lastname: Mechmèche
authors.forename: H
authors.initials: H
authors.lastname: Haoula
authors.forename: R
authors.initials: R
authors.lastname: Boujnah
authors.forename: S
authors.initials: S
authors.lastname: Kachboura
authors.forename: M
authors.initials: M
authors.lastname: Hamdoun
authors.forename: N
authors.initials: N
authors.lastname: Achour
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D003327:Coronary Disease / Q000453:epidemiology*; D003906:Developing Countries; D005260:Female; D006304:Health Status; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors; D014416:Tunisia / Q000453:epidemiology