Tunisia
Algeria
Area (km2)
154,630
238,174
10,326
34,800
25
28
Under 5 mortality (per 1,000 live births) 2007 (UNICEF 2009)
21
37
18.7
26.2
Neonatal mortality (per 1,000 live births) 2004 (UNICEF 2009)
13
22
Life expectancy at birth 2007 (UNICEF 2009)
74
72
GNI per capita US$ 2007 (UNICEF 2009)
3,200
3,620
Total expenditure on health (% of GDP) 2006 (WHO 2009)
5.1
4.2
Physicians density per 10,000 peoples 2000–2007 (WHO 2009)
13
11
Tunisia and Algeria are middle income and developing countries. Tunisia is North Africa’s smallest country but, probably, the most socially advanced. Algeria, by contrast, is the largest North African country and the second largest country on the African continent.
Total population in the two countries is 44 million people, 27 % of whom are under 15 years of age (National Office of Statistics Algeria 2009; National Statistics Institute 2009). In the region, there are 11–13 physicians per 10 000 inhabitants compared with 2 per 10,000 in the rest of Africa and 32 per 10,000 in Europe (WHO 2009).
According to UNICEF’s latest State of the World’s Children report, under five and infant mortality rates, while low when compared with other African countries, are still relatively high, especially in Algeria (UNICEF 2009). Most of the child deaths occur during the neonatal period, as neonatal mortality represents 70–80 % of infant mortality and almost half of under five mortality (UNICEF 2009). In older children, the most common causes of death are diarrhea (13 %) and pneumonia (11–13 %) (UNICEF 2009).
Nevertheless, the region has achieved notable improvements in child health, over the last decades, particularly through reduction in mortality rates among infants and children. These improvements have been achieved through the control of communicable childhood diseases and promotion of maternal and child health programs. However, there is a real need to deal with life-threatening illnesses and injuries and to develop and/or strengthen the capability to provide higher levels of care, to greatly influence patients’ survival, and to reduce avoidable death.
68.2 Development of Pediatric Intensive Care in the Region
The ability to provide neonates and pediatric patients with prolonged mechanical ventilation for respiratory failure is relatively new in North African countries. Thus, neonatal and pediatric intensive care are still in their early development and are yet rudimentary.
In Tunisia, the year 1993 saw the establishment of the first 4-bed PICU within a general pediatric ward in the Children’s Hospital of Tunis. The first 12-bed PICU, with an independent department status within the hospital, was created in 1997. In order to achieve the United Nations’ Millennium Development Goal 4 which is to reduce the under five mortality rate (United Nations 2008), national strategies are being implemented to reduce neonatal mortality which represents the vast majority of child deaths. As a result, the tertiary referral levels of newborn care are being strengthened by upgrading neonatology services of major university centers, enabling them to offer neonatal mechanical ventilation. In Algeria, the first PICU with a capacity of ten beds was established in 1996.
68.3 Pediatric Critical Care Resources
Material and human pediatric critical care resources are as yet extremely limited, and there is still great variation between cities, in the capability to provide critical care and mechanical ventilation. So, large number of neonates and pediatric patients requiring ventilation support do not have access to appropriate services. We can identify formal ICUs and informal pediatric acute and critical care beds.
68.3.1 Formal ICUs
There are only five NICUs and four PICUs, offering less than 100 beds in the two countries. All PICUs are mixed neonatal and pediatric ICUs, and most of them are mixed-function medical/surgical ICUs. For an under 15 years population of 2.5 million and 173,000 births annually (National Statistics Institute 2009), only four neonatal ICUs and one PICU, ranging in size from 4 to 12 beds, are available in Tunisia, three of which are located within the capital. In Algeria, which has an under 15 years population quadruple that of Tunisia and 704,000 births annually (National Office of Statistics Algeria 2009), there are one NICU and three PICUs, ranging in size from 8 to 16 beds, three of which are located within the capital.
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