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Estimation of malaria transmission in high-risk provinces of Morocco.

The malaria transmission level of Plasmodium vivax was monitored in four high-risk provinces in Morocco. Intensive mosquito collection by light traps and manual catches resulted in the capture of four species: Anopheles labranchiae, An. sergenti, An. cinereus, and An. claviger. All An. sergenti and An. labranchiae females collected were tested for the presence of two phenotypes of P. vivax (PVK210 and PVK247) antigen by enzyme-linked immunosorbent assay (ELISA). No P. vivax antigen was detected in 1347 mosquitoes analysed. A parallel parasitological investigation was conducted. Of 2665 slides examined from a population of 4343 people for detection of P. vivax, no slide was positive. The results confirm the break in malaria transmission in residual foci. The use of ELISA is recommended in future epidemiological studies of human malaria.

Altitude↗

[Implementation and assessment of an HIV treatment training program (2000-2001) for patients in Casablanca (Morocco)].

An educational program to improve the management of HIV patients was introduced in the department of infectious diseases of Ibn Rochd hospital, Casablanca, Morocco in January 2000. The project, funded by the GlaxoSmithKline Foundation, began by training ward physicians as well as volunteers from the ALLOCS (Association de lutte contre le sida) in pedagogy and patient education techniques (four-day course). Other sessions reviewed HIV management and treatment. Treatment training sessions were offered to all patients receiving antiretroviral treatment when the program began. All had been taking medication for at least two months and gave their informed consent to participation in the project. Each patient's sessions took place just after his or her medical consultation, in a room set aside for this purpose in the hospital. During the first session the educator established an educational diagnosis and defined educational objectives according to the individual patient's needs. Objectives were related to patients' knowledge about HIV transmission prevention and treatment management (including problem-solving for mild adverse events, delays, forgetting, vacations etc.). Trainers used several educational tools, including therapeutic planning (planning card with self-adhesive stickers showing the treatment medication); a folder of drawings depicting HIV transmission, prevention, and natural history, as well as the aims of antiretroviral therapy; decks of cards illustrating symptoms and psycho-sociological problems. Each patient had to attend at least 3 educational sessions. The program was evaluated at the end of one year. Patients' attendance, treatment adherence, laboratory test results (CD4 count, viral load), satisfaction about patient-staff relationships and knowledge about HIV disease and treatment were assessed on an on-going basis with various questionnaires and data collection systems. In all, 96 patients attended classes, with a mean of 14 sessions per patient per year. After 6 and 12 months of training, patients' CD4 cell counts increased, and the proportion with viral loads below the detection level rose, as did adherence scores. Patients' knowledge appeared to have improved at 6 months but regressed somewhat at 12 months. This may be explained by program timing: most educational sessions take place during the first 6 months of patient enrolment in the program. Patient satisfaction about the program and their care reveals that they acquired autonomy in managing their disease and treatment. Their satisfaction at 12 months, however, was lower than it was at 6 months. One explanation may be that more educated patients are more demanding, but another is the staff turnover in the program. New staff may have required more support and training than was then available. This pilot program allowed us to draft guidelines for setting up educational programs for HIV patients in relatively poor countries.

Adult↗

[Serious gastrointestinal effects of nonsteroidal anti-inflammatory drugs (NSAIDS) in a prospective study in Morocco].

In Morocco, the need for post-marketing surveillance of selective Cox2 inhibitors (coxibs) prompted a study to assess the serious gastrointestinal effects of NSAIDs and to compare gastrointestinal tolerance of conventional NSAIDs and coxibs. A prospective study was conducted from April 2001 through May 2002 among hospital-staff gastroenterologists in the public and private sector as well as emergency surgical units. Over this period, 123 patients were reported to have serious NSAID-related gastrointestinal effects, and 63% of them were admitted for bleeding or perforated ulcers. Endoscopy most often identified the lesion as a gastric ulcer (45%). Emergency rooms reported that aspirin was the most common causal agent and that NSAIDs accounted for 8.7% of bleeding and 9.3% of the perforated ulcers. Our findings indicate that men and youth are most vulnerable to serious gastrointestinal effects from these drugs. Several risk factors from the literature were confirmed in our population: history of gastrointestinal disorders and joint disease, occurrence within less than 1 month of beginning the drug; association of NSAIDs and aspirin, diabetes and hypertension. No conclusion could be drawn about the comparative gastrointestinal tolerance of conventional NSAIDs and coxibs, however, since the latter account for only 3% of the NSAID market.

Adolescent↗

IS6110 restriction fragment length polymorphism of Mycobacterium tuberculosis isolates from an area of Casablanca, Morocco.

Using IS6110 RFLP, 61 isolates recovered from new cases of pulmonary tuberculosis (TB) were compared from September to December 1999 in Casablanca, Morocco, a city with a high incidence of TB. The majority of the isolates (92%) harboured 6-14 copies of IS6110. The minimal fraction of patients in groups of recently acquired infection is 13.1%. This preliminary study showed that IS6110 RFLP is a suitable method for finger-printing Mycobacterium tuberculosis in Casablanca. The unexpectedly low level of recent transmission of TB found in this study deserves further studies involving higher numbers of isolates recovered during a longer recruitment period.

Humans↗

[Multinodular diving goiters: 100 cases in Morocco].

OBJECTIVE: To assess 100 cases of multinodular diving goiters, the authors review the literature to compare the epidemiology, clinical pictures, additional required work-up, treatments, complications, and sequelae. METHOD: Records of 100 cases of multinodular diving goiters were collected in the surgical department of the Military Hospital of Marrakesh in Morocco from 1991 through 2004. They accounted for 6% of all goiters. The sex ratio was clearly female, and the mean age 50 years. The clinical symptoms of diving goiters involves mainly signs of compression, with dyspnea seen in 50% of cases. Thyroid dysfunction was found in only 25% of our patients. A diagnosis of diving goiter must be suspected when there are signs of mediastinal compression and a palpable cervical goiter, as seen in all our patients. The diagnosis can often be confirmed with thoracic radiography and thyroid scintigraphy. Treatment is mainly surgical and depends on disease course. Cervicotomy was performed in 97% of our patients and was sufficient to extract even most voluminous goiters and those deepest in the mediastinum. RESULTS: Immediate operative results were satisfactory. More long-term results were also generally satisfactory, except for 4 cases of recurrent paralysis and 5 cases of hypoparathyroidism. Both have been reported by several authors. CONCLUSION: Surgical management of multinodular diving goiters is necessary. In general, cervicotomy is sufficient, and the results generally satisfactory, except some complications and neoplasms.

Adult↗

Results of cohort analysis by category of tuberculosis retreatment cases in Morocco from 1996 to 2003.

OBJECTIVE: To analyse treatment outcomes by subcategory of tuberculosis (TB) retreatment cases. METHODS: All TB patients treated with the Category II regimen from 1996 to 2003 in Morocco were enrolled in this retrospective study. For each cohort, the retreatment outcome data were analysed as a whole and by the following sub-categories: 1) cases who relapsed after one course of anti-tuberculosis treatment; 2) cases who failed the Category I regimen; and 3) cases who interrupted one course of anti-tuberculosis treatment. RESULTS: The study population included 14 635 retreatment patients, among whom 81.7% were TB relapse cases, 5.2% had failed the Category I regimen and 13.1% were defaulters. The average treatment success rates were respectively 74.8% (range 71.8-76.6), 58.0% (range 52.4-74.0) and 51.4% (range 46.4-55.6) among relapse, failure and default cases. Failure and default rates were significantly higher (P < 0.001) among patients who failed Category I treatment and among those who defaulted, respectively. CONCLUSIONS: TB cases who fail the Category I regimen should systematically receive drug susceptibility testing, while defaulters should be given support to improve treatment adherence. Stratified cohort analysis by subcategory of retreatment has been shown to be useful for evaluating the performance of TB control programmes.

Antitubercular Agents↗

Raw wastewater agricultural re-use and risk of protozoal infection in Beni-Mellal, Morocco.

This study was carried out to determine the potential risk of protozoal infection associated with raw wastewater use for agricultural purposes, among children of Beni-Mellal, Morocco. In a randomly-selected sample of 1343 children 740 from 5 regions which use raw wastewater for agriculture (exposed), while 603 were from 4 control regions that do not practice wastewater irrigation (unexposed). A questionnaire-interview with children and parents was used to collect data on demographic, hygienic, and risky water contact risk factors One or more protozoal infection was identified among 276(37.2%) of children living in the wastewater re-use regions, versus only among 22 (3.6%) living in control regions. The overall prevalence of 40.1% was observed among boys, and 33.3% among girls residing in exposed areas. The two identified protozoa were Entaemoeba histolytica and Giardia intestinalis, which infected 34.3% and 5.1% in the exposed population compared to only 3.3% and 0.3% in the control population, respectively. We also noted that the G. intestinalis prevalence was more than 40% among the children under 9 years, but less than 17% for those who were more than 12 years. Also, a significant excess of protozoal infection was observed among children who had risky contact with agricultural lands (p<0.001). In conclusion, raw wastewater use in Beni-Mellal can lead to a high risk of protozoal infections. Adequate treatment of wastewater prior to re-use, as well as public health education are highly recommended.

Age Distribution↗

[Epidemiological descriptive approach of cancer in Morocco through the activity of the National Institute of Oncology. 1986-7].

The Hospital registry data of the Moroccan National Oncology Institute--which is the main structure in the field--are presented here. We collected 5,148 files between 1986 and 1987. Descriptive epidemiological aspects of the most frequent cancer sites are given. Cervix uterine neoplasia is the most common carcinoma in females (35%) followed by breast cancer (22.3%). In males, nasopharyngeal cancer accounts for 12.3%, lymphoma 10.1%, larynx cancer 8.2% and lung cancer 6.5%. These data, although, constitute a starting point to a more complete approach of cancer epidemiology in Morocco; Especially since October 1, 1990 when the population--based cancer registry of Rabbat-Sale Wilaya was started.

Academies and Institutes↗

[The impact of National Vaccination Days in the Agadir province of Morocco].

In many countries the realization of the vaccination programmes is prevented by the lack of motivation of the population. We report herewith the positive results of a programme of social mobilisation observed in the Agadir province following the organization of National Vaccination Days in Morocco.

Health Planning↗

Epidemiology of gastrointestinal helminths of sheep in the Rabat area of Morocco.

The epidemiology of gastrointestinal helminths of sheep on permanent pastures in Morocco was studied by monthly examination of faeces of ewes for helminth eggs and by use of batches of 3 tracer lambs each month from December 1979 to November 1980. The main helminth genera encountered were Teladorsagia, Haemonchus, Trichostrongylus and Moniezia, with Nematodirus, Cooperia, Oesophagostomum and Trichuris occasionally recorded. The faecal egg counts of ewes showed 2 peaks; the first in March due to the acquisition of larvae during the rainy season and periparturient rise, the second in October probably due to maturation of inhibited larvae. The worm burdens of tracer lambs showed that there was a gradual accumulation of nematodes from December, reaching a peak in May; an absence of infection in July and August during the dry period, and a second peak in November. Infection by Moniezia was higher during the dry season.

Animals↗

The evaluation of selenium status of sheep from the major production areas of Morocco.

In order to evaluate the selenium status of sheep in the major raising areas of Morocco, blood selenium concentration, erythrocyte glutathione peroxidase activity and feed selenium levels were determined. A total of 843 blood samples from sheep and 118 feed samples were analyzed. Results showed that 73% of sheep sampled had blood selenium concentrations below 100 ng/ml, and were deficient or marginal. Erythrocyte glutathione peroxidase activity was below 19 IU/g hemoglobin and feed selenium levels below 0.1 mg/kg on a dry matter basis. The erythrocyte glutathione peroxidase activity was highly correlated with blood selenium concentration over a wide range of selenium levels (r = 0.88, P less than 0.001, N = 622), indicating that the enzyme can be used as an indicator of the selenium status of grazing sheep.

Animal Feed↗

A new look at traditional medicine in Morocco.

Traditional medicine is still popular in Morocco since it is an important form of health care for many people. Its positive aspects could be encouraged if it were officially recognized and given a place in the health system.

Attitude to Health↗

Dental caries and fluorosis in children from high and low fluoride areas of Morocco.

The purpose of this study was to estimate the prevalence and the severity of dental caries and dental fluorosis in primary and permanent teeth of 582 subjects, aged 7 to 16 years, from the fluorosis area of Khouribga and the non-fluorosis area of Beni Mellal, Morocco. At age-group 7-10, where 67.8 percent of primary teeth were present, about 35 percent of the children were affected in the high-fluoride area and the community fluorosis index was 0.86. The percentage and average number of erupted permanent teeth were higher in Beni Mellal than in Khouribga for 11-12 and 13-14-year-old age-groups. Significant differences in caries prevalence were observed between the high- and low-fluoride areas. In both regions, high and low prevalence of dental caries was observed in the primary and permanent teeth, respectively.

Adolescent↗

[Diagnostic and therapeutic aspects of peritoneal tuberculosis in Morocco. Apropos of 300 cases].

We describe 300 cases of peritoneal tuberculosis observed in the space of 11 years in Morocco. The most usual terrain presented is the young woman in precarious socio-economic conditions. The febrile ascitic form was observed in 229 cases. The ulcero-caseous was observed in 51 cases, and the fibro-adhesive form in 14 cases. Diagnostic was based on laparoscopy with peritoneal biopsy. A controlled prospective study done randomly on 100 patients showed that corticotherapy associated with tuberculous antibiotherapy did not speed up clinical recovery but tended, rather, to slow down the disappearance of granulations and indeed facilitate the constitution of peritoneal adherence phenomena.

Adolescent↗

[Mycoplasma bovis infection: epidemiological and clinical survey of dairy cattle farms in Morocco].

An epidemiological survey of M bovis infection in dairy cattle was performed in 10 herds of the Gharb's region, by sampling the animals three times with a two-month interval, between November 1985 and May 1986. M bovis was isolated in six herds with calf enzootic bronchopneumonia with a total frequency of 39% during the first visit, then 25 and 13% after two and four months, respectively. The severity of the symptoms seems closely related to the age of the animals: the youngest being the most susceptible. On the other hand, M bovis was isolated in two herds from 11% of cows suffering from clinical and subclinical mastitis. The isolation occurs at any lactation stage and the infection lasted more than four months in 40% of the animals. These results suggest that mycoplasma are important bovine pathogens in Morocco.

Animals↗

Cognitive consequences of contrasting pedagogies: the effects of Quranic preschooling in Morocco.

A study was conducted in Morocco to assess the cognitive consequences of Quranic preschooling. 350 6-7-year-old children were selected in a way which allowed contrasts in terms of preschool experience (none vs. Quranic vs. modern), environment (urban vs. rural), maternal language (Arabic vs. Berber), and gender. 6 different memory tests were employed, as well as other cognitive, reading, and math tests. Results indicated specific and positive effects of Quranic schooling on serial memory but not on other memory or cognitive tasks. These findings replicate earlier reports by Scribner and Cole that Quranic schooling affects specific (and not general) memory skills. The reading measures indicated superior performance among those children with urban background, Arabic maternal language, and, to a lesser extent, Quranic schooling. It was concluded that the corpus of research from this and similar studies supports a "practice theory" of culture and cognition.

Child Development↗

Velogenic viscerotropic Newcastle disease virus strains in Morocco.

Isolates of Newcastle disease virus (NDV) in Morocco were characterized as velogenic. Two isolates were from tracheal swabs taken at a Moroccan live poultry market, and four isolates were from field cases. Infection of 8-week-old chickens showed that these isolates and previously characterized Moroccan isolates were of the viscerotropic pathotype. Based on hemagglutinin thermostability and the capacity to agglutinate equine erythrocytes, the Moroccan velogenic viscerotropic NDV isolates were classified as belonging to at least three distinct strains.

Animals↗