1. POCT diffusion project M Ben Hariz. Tunisia MEDICEL. Palermo 2014

2. Main objective Diffusion of POCT in schools Children with growth fairlure: « small » children

3. Why schools First Because we have a good experience working in school envirenment!

4. First Study : Region of Ariana Ben Hariz M, et al. Prevalence of celiac disease in Tunisia: mass-screening study in schoolchidren. Eur J Gastroenterol hepatol 2007; 19: 687-694. Actual proposed study : Ben Arous Second study : Djerba Ben Hariz M et al. Celiac disease in Tunisian children: A second screening study using a “new generation” rapid test. Immunol Invest 2013; 42: 356–368

5. Second The school is a good choice to start and succeed in our efforts to diffuse POCT enrollment between 6 -14 years: 100% Large number of school doctors generally these same doctors are also primary care physicians lines

6. why “small“ child? Frequent situation in Tunisia (5% in our school previous study) The small height often motivates parents looking for a reason (little refusal to search for celiac disease) If celiac disease is the cause of the small height, the gluten-free diet is often followed well (unlike asymptomatic child)

7. selected region Governorate of Ben Arous Général population: 700000 Area: 761 Km2 Number of schools Number of pupills: 50000

8. DESIGN

9. Selected population: 50000 Mesure of height Selection of children with height < 2SD (2500) Acceptance. Inclusion refusal Exclusion POCT Positive Negative Suspicion of IgA deficiency Determination of IgA ConfirmationNo IgA deficency IgG anti endomysium PositiveNegative ELISA Endoscopy

10. Steps planned May-June 2014: get the final approval from the Ministry of Health, Department of School Medicine and Ethics Committee September 2014: training meeting for school doctors September-November 2014: obtaining and filing the anthropometric measurements of children (only height?) December 2013: sending mail for parental consent for the selected population (Height <-2SD, n=2500). January 2015: POCT for all and samples for ELISA for positive or IgA deficiency children February and March 2015: endoscopy for positives April 2015: analysis of results

11. Estimated budget POCT: 7500 euro Training (meeting): 3000- euro equipment to measure the size? Secretariat (Secretary contract, mail...): 3000 euro Displacement: 4000 euro other: 3000 euro “Gift for schooldoctors”!!: 5000 euro? Total: 25500 euro Budget available for study in 2014: 14000 Euro

12. expected difficulties Mostly administrative: Net decrease in administrative efficiency since the revolution (extreme slow, iterative change managers...) for example, we introduced three times the project at the Ministry!! enthusiasm school doctors! need to expand the team of the research unit (now, only me and Nadia Siala!!)