Original Research Deaths among homeless in northern Tunisia: a 10-year study (2005e2014) M. Ben Khelil a,b,* , A. Zgarni a , M. Bellali a,b , W. Thaljaoui c , M. Zhioua a,b , M. Hamdoun a,b a Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia b Department of Legal Medicine, Charles Nicolle Hospital, Tunis, Tunisia c Department of Legal Medicine, Regional Hospital of Sidi Bouzid, Tunisia article info Article history: Received 20 February 2018 Received in revised form 13 April 2018 Accepted 30 April 2018 Keywords: Homeless persons Mortality Death Epidemiology Developing countries abstract Objective: To analyze the victims profile related to death among homeless people. Study design: A descriptive, retrospective, and cross-sectional study. Methods: We included all deaths among homeless people that occurred during a 10-year period (2005e2014) that were autopsied in the Department of Legal Medicine of the Charles Nicolle Hospital of Tunis. Causes of death were classified according to the Inter- national Statistical Classification of Diseases and Related Health Problems 10th Revision. Data were classified in three sections: sociodemographic data, circumstances of death, and autopsy findings. A univariate data analysis was performed. Results: The sex ratio (M/F) was of 7.45. The average age was of 59 years. The majority of deaths (80.9%) occurred in the metropolis of Tunis with a significant occurrence of cases in other governorates after the 2011 revolution (P ¼ 0.002). Deaths occurred more often during winter (34.8%). The bodies were frequently discovered in public places (36.0%) and private locations (34.0%). The deaths of 55.3% of cases were attributed to natural causes, signifi- cantly affecting the elderly, whereas the accidental causes (25.7%) were more frequent before the age of 49 years, followed by suicides (3.9%) and homicides (3.3%). Conclusions: Our study highlighted a phenomenon not yet studied in Tunisia. Our results highlight an urgent need for preventive measures focused on the improvement of healthcare measures among homeless people. © 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved. Introduction In spite of the higher mortality rate among homeless people than among the general population in developed countries, little information is available about the mortality of the homeless in the developing countries. Most previous studies were carried out in Europe and North America. Homeless mortality in a broader range of cultures should be explored. Busch-Geertsemam 1 defined homelessness as an exclu- sion from three domains: (i) inadequate dwelling to live and fit * Corresponding author. 20 Rue Ahmed Khairedine, Le Bardo, 2000 Tunisia. Tel.: þ216 97 402919; fax: þ216 71 561365. E-mail address: benkhelilmehdi@yahoo.fr (M. Ben Khelil). Available online at www.sciencedirect.com Public Health journal homepage: www.elsevier.com/puhe public health 162 (2018) 41 e47 https://doi.org/10.1016/j.puhe.2018.04.016 0033-3506/© 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.