Health screening strategies in Maghreb countries: Situation Analysis and perspectives.

BACKGROUND: The aim of screening is to improve individual health through an early detection of diseases at a stage where the prognosis of disease could be significantly. However, this kind of intervention is costly and it's necessary to respect criteria in selection of targeted diseases and screening tests.

OBJECTIVE: The objective of this study was to describe public health screening policy in the Maghreb countries in order to identify the main barriers to the development of this type of intervention.

METHODOLOGY: This study is a literature review of screening practices and policy in Maghreb countries. For this purpose, we conducted a global search in MEDLINE, as well as in the websites of the Ministries of Health of Maghreb countries; we also asked also key persons in the different countries to provide us useful t information concerning screening in their countries.

RESULTS: Antenatal and neonatal screening is generally limited to a few pilot experiments such as screening for congenital hypothyroidism and phenylketonuria and deafness. Regarding school population, screening of certain diseases such as dental disorders, infectious diseases including tuberculosis, overweight and obesity, visual impairment, is carried out during periodic medical visits. Among adults, screening is often opportunist; it is performed in patients who use primary care health centers; the main targeted diseases are cervical, breast cancer and colorectal cancer, pulmonary tuberculosis. Screening coverage, especially for cancers, remains relatively low; for example, in Tunisia, this coverage was 12.7% for at least one cervical smear in the last five years; while for an annual clinical breast examination, this proportion was 33.2%.

CONCLUSIONS: It is strongly recommended to improve coverage by screening, especially for cancers through educational actions of the population highlighting the high chances of cure in case of early detection, training of care staff and improvement, access to screening benefits.