Notre travail traite de la relation santé-contexte socio-environnemental à travers l’analyse des disparités sanitaires de la morbidité liée à l’asthme dans l’agglomération de Sfax. La morbidité liée à l’asthme est exprimée à partir de l’effectif des consultations enregistrées dans les Centres de Santé de Base (CSB) sur la période 2009-2016. Si le diagnostic de la situation épidémiologique montre certaines caractéristiques liées à la variation selon les saisons et les classes d’âge, c’est la spatialisation des consultations pour asthme enregistrées par les CSB qui suscite l’intégration de multiples déterminants socio-environnementaux intrinsèques et généraux. Les facteurs intrinsèques, qui sont liés au contexte de vie et du comportement des individus, justifient la variation spatiale de la morbidité liée à l’asthme, alors que les facteurs dits généraux s’imposent pour expliquer la prédominance de l’asthme allergique extrinsèque. Compte tenu de cette combinaison complexe des déterminants de la santé des asthmatiques dans l’agglomération de Sfax, plusieurs mesures peuvent être suivies afin d’améliorer le bien-être et la santé respiratoire d’une population fortement « pénalisée » sur le plan environnemental.
This work deals with the relationship between health and socio-environmental context through the analysis of health disparities in asthma-related morbidity in the Sfax agglomeration. This analysis is based on data obtained from the Basic Health Sector, which is the first line of recourse offering primary care services to the population in the various delegations in Sfax. The asthma-related morbidity is expressed by the number of consultations recorded in the Basic Health Centers (BHC) over the period 2009-2016. The diagnosis of the epidemiological situation of asthma shows the permanence of the consultations for asthma in the dispensaries of the agglomeration throughout the year. The monthly consultations recorded by the Health Sector Database show two peaks in April and October. This seasonal pattern is influenced by the factors of the environment and specially the climate. From the point of view of individual’s vulnerability, the analysis of the epidemiological data by age shows a notable predominance of the adult category. However, this does not obscure the risk of asthma for other age groups, especially for children. The spatialization of asthma consultations recorded by BHC leads to the integration of multiple intrinsic and general socio-environmental determinants. Factors related to the context of living (accommodation conditions) and behavior (smoking) of individuals as well as others specifying some sectors of the city than others (industrial air pollution) justify the spatial variation of asthma-related morbidity. Other so-called general factors spare people from their effects, such as sand-wind and pollen, and explain the spring and autumnal peaks of asthma-related morbidity in Sfax. These factors are necessary to lead to a predominance of extrinsic allergic asthma. Surveys carried out in BHC in April and October 2015 highlight some specificities of the asthma-related morbidity and its origins in the agglomeration of Sfax. The sand-wind, a fairly frequent phenomenon in Sfax, alters the well-being of individuals and affects their respiratory health by reactivating asthma because of the very fine dust that can penetrate deeply into the lungs. The olive tree is the main species that causes respiratory allergies in Sfax as a plant pollen with a significant allergenic potential and a predominant asthma-related morbidity. Its effects become crucial for the vulnerable population and supported by a moderate wind and an ambient temperature which both favor the dissemination of the pollen. Given this complex combination of determinants of asthma health in the agglomeration of Sfax, several measures can be taken to improve the well-being and respiratory health of an environmentally severely “penalized” population. Health awareness is a cornerstone of all strategies to fight respiratory allergies, which is at the origin of huge public health spending. However, the rehabilitation of respiratory health, which is severely impaired by multiple sources of nuisance, is based on the establishment of a healthy environment. This cannot be achieved without a genuine struggle against air pollution caused by the industrial units located in the south of the city, and in particular the Industrial Company of Phosphoric Acid and Fertilizer. The risks of asthma-related factors, particularly those related to the behavior of individuals such as smoking, can be mitigated by changing personal habits and following good practice leading ultimately to a significant reduction in the morbidity.
