Country Stories

Scaling-up action on suicide prevention and iodine deficiency disorders reduction in Tunisia: Lessons from the COVID-19 pandemic

Tunisia

World Health Organization. Regional Office for the Eastern Mediterranean | 04 Sep 2023

Tunisia has taken a range of measures to reduce noncommunicable disease (NCD) risk factors, including ratifying the WHO Framework Convention on Tobacco Control (WHO FCTC) in 2010, and banning waterpipe use in public places during the COVID-19 pandemic. However, the focus of this publication is Tunisia’s policy to eliminate iodine deficiency disorders, and the country’s suicide prevention strategy. These areas reflect the importance of surveillance when addressing public health matters.

Salt iodization to tackle iodine deficiency disorders

To reduce the incidence of iodine deficiency disorders, Tunisia implemented a universal salt iodization programme in 1996. This programme was a success, with 97% of households reportedly using iodized salt by the year 2000. Tunisia was the second country in the Eastern Mediterranean Region to be declared “iodine deficiency disorder-free”.

However, by 2017 this progress had stalled, with only half of households using adequately iodized salt. Furthermore, research showed large variability in the iodine content of salt used in Tunisian households, with around 6% using non-iodized salt and around 34% using excessively iodized salt. While urinary iodine concentrations were acceptable at the population level, there were regional disparities.

This shows that even though it is possible to make progress on addressing specific NCDs through effective action, ongoing surveillance is also needed to ensure that progress continues.

This issue can be improved by strengthening the regular monitoring of iodized salt production and working with salt producers to eliminate the variability of iodine content in salt. Authorities can promote iodized salt production and conservation procedures through awareness campaigns that engage the public, producers and retailers.

Efforts for reducing incidence of suicide

Tunisia began its Suicide Prevention Project in 2015 to reduce the incidence of suicide and suicidal behaviours. It also aimed to gain a better understanding of the causes of suicidal behaviour in the country.

The project used a multisectoral strategy and a participatory approach with partners including WHO, the National Institute of Public Health, Tunisia’s Institute of Press and Information Science, civil society, university hospitals and others.

Actions included:

Setting up a training programme for health professionals on screening and intervention for people experiencing suicidal thoughts. The programme included training for trainers and the development of training guidelines.
Making media professionals aware of the complexity of suicide and how it should be covered, and forging partnerships with key players.
Establishing a National Registry of Suicide in partnership with the ten forensic services in Tunisia, the National Institute of Public Health and the Centre Informatique du Ministère de la Sante.
Promoting research, such as a project on the causes of suicide, focusing on young people. This was undertaken in partnership with the McGill Group for Suicide Studies.

To date, training on suicide intervention and screening has been given to 367 general practitioners, 41 psychologists, 21 nurses, 9 psychiatrists and various other health professionals. The project has also delivered five training workshops to media professionals in order to improve media coverage of suicides. One of these workshops was aimed at future journalists.

These are all important steps, as suicide has not traditionally been a subject for discussion in Tunisia. Future aims include:

Forming a dedicated team within the Ministry of Health to ensure the implementation of actions that have been initiated.
Developing a comprehensive information system to provide reliable data on suicide in Tunisia.
Gaining a better understanding of the complex and specific causes of suicide in Tunisia.

This country story is part of a series on sharing successful strategies from the Eastern Mediterranean Region mitigating noncommunicable diseases and mental health disorders during the COVID-19 pandemic and beyond. Discover additional stories and insights in the full report published by the World Health Organization Regional Office for the Eastern Mediterranean.