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PubMed1997

The spatial and seasonal distribution of African horse sickness and its potential Culicoides vectors in Morocco.

African horse sickness (AHS) is a vector-borne, infectious disease of equines that is caused by African horse sickness virus (AHSV). The only proven field vector is the biting midge Culicoides imicola, although C. obsoletus and C. pulicaris are suspected vectors. There was a recent epizootic of AHS in Iberia (1987-90) and Morocco (1989-91). In 1994-45 a total of 3887 light trap samples were taken from twenty-two sites distributed over most of Morocco. Culicoides imicola was found to be very widely dispersed, with the greatest catches in the low-lying northwestern areas (between Tangier and Rabat) and at Marrakech. Culicoides imicola was absent at one site only, near Settat. Culicoides imicola was found at altitudes ranging from 4 to 1275 m and in climatic conditions ranging from subhumid to saharan. In general, the catch of C.imicola peaked in late summer and autumn, with a smaller peak in spring. In areas where the insect appears most abundant at least one adult C.imicola per night may be caught in a light trap at all times of year, thus providing a possible means of viral overwintering. Culicoides obsoletus and C.pulicaris are also widely distributed in Morocco but trap catches were much lower than for C.imicola. Peak catches occurred in spring, and late summer and autumn. Other frequently caught species were C.circumscriptus, C.newsteadi, C.puncticollis and members of the odibilis subgenus. In general, the findings for C.imicola correspond well with the distribution of disease outbreaks during the epizootic. Although disease outbreaks were widespread in the country, the greatest number of reported cases was in the northwest (1989-90); in 1991 there were also significant numbers in Marrakech province. No cases were reported in a large area to the west of the Atlas mountains (including Settat) despite the presence of a large equine population. It is likely that during the epizootic the virus overwintered in the northwest (1989) and in Marrakech province (1990). Disease outbreaks occurred from July to December, with a peak from September to November. An unexplained phenomenon is the large number of reported cases of AHS in mules in Chefchaouen province in 1990, despite the apparent low abundance of C.imicola at a site at Chefchaouen. It is argued that C.obsoletus and C.pulicaris were probably of little significance to the epidemiology of AHS in Morocco in 1989-91.

African Horse Sickness↗
PubMed2025

First surveillance study of avian orthoavulavirus type 1 in wild birds in Morocco: Insights and implications for future monitoring.

BACKGROUND: Wild birds, particularly migratory species, can act as natural reservoirs and vectors of avian orthoavulavirus type 1 (AOAV-1) or Newcastle disease virus (NDV), contributing to its spread across regions and potentially threatening domestic poultry populations. AOAV-1, also known as NDV, is a major pathogen affecting avian species and poses a global threat to poultry production. It belongs to the Paramyxoviridae family and is an RNA virus encoding six key proteins, including the fusion (F) protein, which determines pathogenicity. AOAV-1 is classified into three pathotypes based on virulence: velogenic (highly pathogenic), mesogenic (moderately pathogenic), and lentogenic (mild or asymptomatic). In Morocco, AOAV-1 is endemic in poultry production systems, as evidenced by recent studies reporting a 52.1% seroprevalence and active viral RNA detection in backyard chickens in the Khemisset and Skhirat-Temara provinces; however, effective vaccination strategies have contributed to controlling the clinical signs and widespread dissemination of the virus. AIM: The main objective of this study was to investigate the presence of AOAV-1 in wild bird populations across Morocco, providing insights into possible transmission of infection affecting domestic poultry. METHODS: From November 2016 to April 2022, a total of 1984 samples were collected from 840 individual birds, encompassing 79 species, 25 families, and 12 orders. The majority of the samples belonged to Charadriiformes, Anseriformes, Pelecaniformes, and Passeriformes. Sampling was conducted at 17 wetlands and six additional locations throughout Morocco. Viral detection was performed using real-time reverse transcriptase PCR (RT-qPCR) targeting Matrix (M) and RNA polymerase (L) genes to confirm the presence of AOAV-1. RESULTS: Although the study spanned 6 years and included a large number of samples from bird orders considered primary AOAV-1 reservoirs, all samples tested negative for NDV RNA using both M and L gene targets. CONCLUSION: This study represents the first effort in Morocco to monitor wild birds for AOAV-1. The samples analyzed were initially collected for avian influenza surveillance, which shares epidemiological similarities with Newcastle's disease. However, to improve future surveillance efforts, sample collection should be optimized to target scenarios with the highest probability of virus detection.

Animals↗
PubMed2002

[Health care services in the Kingdom of Morocco].

Kingdom of Morocco is located in Northwestern Africa on the Atlantic Ocean and the Mediterranean Sea. Its surface area is 710,850 km2. In 2001 the estimated population of Morocco was 29,800,000 people who are not equally distributed over the territory. Population growth rate is changing with a tendency toward levels similar to those in developed countries. The health care system created in 1959 has undergone several reorganizations including the most recent reform now in progress. At the present time the health care system is organized into approximately 60 medical districts. It is subdivided into two networks, i.e., an ambulatory action network and a hospital action network. The ambulatory action network provides basic health care services. It includes 2128 basic care units. Most of these units have medical equipment designed mainly for preventive medicine. The hospital action network comprises 112 hospitals classified as zone hospitals, provincial hospitals, regional hospitals, and university hospitals. Both networks receive technical and scientific support from a network of institutes, laboratories, and specialized centers. Training for health care professionals in Morocco is provided by four medical schools and two health care institutes for paramedical care specialists. Morocco is in a period of epidemiological transition characterized by the coexistence of patients with developed and developing country diseases.

Delivery of Health Care↗
PubMed2006

Prevalence and trend of self-reported asthma and other allergic disease symptoms in Morocco: ISAAC phase I and III.

BACKGROUND: The prevalence of asthma and other allergic diseases is increasing in many parts of the world. OBJECTIVE: To determine the prevalence of asthma, rhinoconjunctivitis and skin allergy symptoms in Morocco as part of the International Study of Asthma and Allergic Diseases in Children (ISAAC). METHODS: The survey was conducted using the standardised method of ISAAC Phase III in four centres in Morocco-Casablanca, Marrakech, Ben Slimane and Boulmane-with respectively 1777, 1689, 1008 and 1254 13-14-year-old schoolchildren participating. A comparison of the results with ISAAC Phase I was carried out in two centres. RESULTS: The prevalence of self-reported symptoms of wheeze in the last 12 months (6.4-16.2%), nasal symptoms (27.9-52.8%), rhinoconjonctivitis (8.8-28%) and eczema (13.3-20.2%) varied between centres, and were highest in Casablanca, the largest city in Morocco. Significant increases in almost all symptoms were found in the two centres of Casablanca and Marrakech between ISAAC Phase I and Phase III. CONCLUSION: Morocco could be classified as a country with an intermediate burden of asthma (between 10% and 15%) and other allergic disorders. The prevalence of these symptoms has increased in the past 5 years.

Adolescent↗
PubMed1993

[Comparison of patients evaluated for spondylarthropathy in France and Morocco].

The authors compared demographic and clinical data in patients with spondylarthropathy residing in Morocco or in France and searched for factors associated with increased disease severity, with special attention to course of the disease, life style, clinical findings and roentgenographic changes. They carried out univariate analyses (chi-square test, Student's t test) to look for factors associated with hip involvement. Evaluation of the relative risk associated with each factor by determination of the odds ratio and corresponding 95% confidence interval. Statistically significant differences were found between the two groups concerning socioeconomic status and disease characteristics. Patients seen in Morocco had more severe disease, with roentgenographic hip involvement in 48% of cases versus only 16% of patients seen in France (p < 0.0001). Several factors were associated with the presence of hip disease, including residence in Morocco, Maghrebine ethnic origin, patient characteristics (male sex, low body mass index), disease characteristics (high erythrocyte sedimentation rate, young age at onset), and environmental factors (no running water in the home). Patients with spondylarthropathy residing in Morocco had more severe disease than their counterparts living in France; both genetic and environmental factors may explain this difference.

Adolescent↗
PubMed1999

Primary structure of open reading frame 2 and 3 of the hepatitis E virus isolated from Morocco.

The nucleotide sequence from position 5,014 to 7,186 of the hepatitis E virus (HEV) genome was determined using a set of 10 polymerase chain reaction (PCR) fragments amplified directly from a pool of fecal specimens obtained from patients with well-documented epidemic HEV infection in Morocco. This sequence contains the 3'-terminal region of open reading frame 1 (ORF1), full length ORF2 and ORF3, and a portion of the 3'-noncoding region. The HEV Morocco nucleotide sequence was compared with the corresponding sequences of 13 HEV strains. A region of ORF2 that overlaps with ORF3 was found to be the most conserved region of ORF2, whereas a protein segment encoded by this region was found to be the most variable. Theoretical RNA secondary structure analysis predicted that this region may be folded into a strong secondary structure that may constrain nucleotide sequence variability. In addition, the nucleotide sequence comparison revealed that the HEV Morocco sequence is most homologous to the sequences of the HEV Asian strains compared with the HEV Mexico, swine, and US strains. Phylogenetic analysis performed on the entire ORF2 and ORF3 sequences and on a small fragment of ORF2 allowed classification of the HEV Morocco strain together with a few other known African strains as a separate subtype within the Asian-African genotype.

Base Sequence↗
PubMed2006

Study of GM immunoglobulin allotypic system in Berbers and Arabs from Morocco.

The GM immunoglobulin allotype polymorphism was investigated in four Moroccan populations: three Berber groups from Khenifra (Middle Atlas), Amizmiz (High Atlas), and Bouhria (Beni Snassen) and one Arabic-speaking sample from the Doukkala area (Abda, Chaouia, Doukkali, and Tadla districts in south-central Morocco). In order to characterize the genetic relationships between the populations, our results were compared with those obtained for other North African groups (from Morocco, Algeria, Tunisia, and Niger) and for Middle-East Africans, sub-Saharans, and Southwest Europeans. Based on GM haplotype frequencies, Factorial Correspondence Analyses, F(ST) significance testing, and hierarchical analyses of variance were performed. Our results reveal that Moroccan populations have heterogeneous GM profiles with high frequencies of GM haplotypes in Europeans (from 76% for Doukkala to 88% for Bouhria) and relatively high frequencies of GM haplotypes in sub-Saharans (from 11% for Bouhria to 23% for Amizmiz). The genetic diversity observed among Moroccans is not significantly correlated with either geographic or linguistic differentiation. In spite of their cultural and historical differentiation, we did not discover any significant genetic differences between Berbers and Arabic-speakers from Morocco. However, when large geographical areas are considered, our population samples are integrated in the North African GM variation, significantly distant from sub-Saharan groups but with a close relationship with Southwest European populations.

Analysis of Variance↗
PubMed2002

Genetic analysis of measles viruses isolated in Morocco.

Sequence analysis was conducted on the hemagglutinin (H) and nucleoprotein (N) genes from nine wild-type measles viruses (MV) isolated during an outbreak that occurred in Morocco during 1998 and 1999. The sequence data showed that all the viruses were closely related to each other and were members of genotype C2. Genotype C2 has been shown to be circulating in Europe, and the sequences of the Moroccan isolates were most closely related to the sequences of recent viral isolates from western Europe. This report presents the first molecular epidemiological study of circulating wild-type measles viruses in Morocco. Knowledge of the indigenous strain of measles virus circulating in Morocco will help to describe viral transmission pathways and should contribute to efforts to evaluate the effectiveness of future vaccination campaigns.

Adolescent↗
PubMed2006

Rapid diversification of measles virus genotypes circulating in Morocco during 2004-2005 epidemics.

Measles virus strains circulating in six different regions in Morocco during 2004-2005 were analysed. They were genotyped using two different methods: the recently developed method based on real-time PCR amplification and melting curve analyses, and the conventional method based on nucleic acid sequencing and phylogenetic analysis of 456 nucleotides of the 3'-region of the nucleoprotein (N) gene sequence. Five genotypes (A, B3.2, C2, D7 and D8) were shown to be circulating during this period. Previous studies on measles virus genotypes in Morocco (1998-2003) showed that only the genotype C2 was present and was considered to be endemic. Sequence comparison of the 2004-2005 viruses with other measles strains suggests that measles strains belonging to genotype B3.2 were probably imported from West Africa, whereas those belonging to genotypes D7 and D8 were imported from Europe. These studies which identify the route of importation of measles are important for developing strategies for measles elimination in Morocco.

Disease Outbreaks↗
PubMed1998

Studies of the mortality rate of Culicoides imicola in Morocco.

Daily mortality rates of female Culicoides imicola were found for eight sites in Morocco in 1994 and for six sites in 1995. The mortality rates were found by operating Pirbright-type light traps for a number of consecutive nights in late summer or autumn and finding the parous rate assuming a feeding interval of 3 to 5 days. The mortality rates were calculated according to established methods. In Morocco the daily mortality rates were found to vary from about 5% per day (Arbaoua, 1994, 1995 and Sidi Moussa 1995) up to 20-25% per day (Berkane, Marrakech, Tangier). In general, estimates of daily mortality rate were consistent between the two years of study. Among sites, daily mortality rate was significantly correlated with the average night-time minimum wind speed but not mean or maximum night-time wind speeds, or with temperature, humidity or saturation deficit. The observed mortality rates suggest that at Arbaoua, were 1,000 flies to become infected with African horse sickness virus, at least 330 would live long enough to take 3 or more infective blood meals on hosts. At Berkane, the survival rate per 1,000 is less than 10. In general, the pattern observed for daily mortality rate, combined with the relative population sizes of C. imicola in Morocco, agree well with the observed distribution of African horse sickness in the country during the 1989-1991 epizootic.

Animals↗
PubMed1998

Modelling the distribution and abundance of Culicoides imicola in Morocco and Iberia using climatic data and satellite imagery.

Relative abundances of Culicoides imicola at 22 sites in Morocco were compared with climatic variables, altitude and the NDVI (Normalised Difference Vegetation Index, a satellite derived measure of photosynthetic activity) of the same sites. Abundances were negatively correlated with wind speed and positively correlated with the average and minimum NDVI (NDVImin). There were no significant correlations with air or soil temperatures, relative humidity, saturation deficit, rainfall, altitude or mean annual maximum or range of NDVI. The best 2-variable model, which combined wind speed and NDVImin as predictors, explained over 50% of the variance in abundance. It is suggested that wind speed affects the abundance of C. imicola by causing adult mortality while NDVImin provides a measure of the availability of C. imicola breeding sites. Data from 27 sites in Iberia yielded broadly similar results to those found in Morocco although the great abundance of C. imicola at Milfontes (Portugal) could not be accounted for. Several northern sites where the NDVImin is sufficiently high to suggest the presence of C. imicola but where it appears to be absent indicate that there may be a northern limit to the distribution of C. imicola in Iberia that is independent of NDVImin. The potential use of NDVImin to predict the distribution of outbreaks of African horse sickness was investigated using data from the 1989-1990 epizootic in northern Morocco. Within the cluster of outbreaks in Larache province is a corridor of very low NDVImin in which few or no outbreaks were reported.

African Horse Sickness↗
PubMed2004

Epidemiology of hip fractures in 2002 in Rabat, Morocco.

Hip fracture has never been studied before, either in Morocco or in the adjacent countries of the south bank of the Mediterranean Sea. The aim of this study was to investigate the incidence rate of hip fracture in 2002 in Rabat Province, a large area in the northwest of The Kingdom of Morocco, by the use of register information and medical records collected from the five public hospitals of the region. The hip fracture data were restricted to cervical or trochanteric types. There was a total of 150 hip fractures (83 in women and 67 in men) in the over-50-year-old population in the Province of Rabat during 2002. The age-adjusted 1-year cumulative incidence of hip fracture was 52.1/100,000 [95% confidence interval (CI) 40.9-63.3/100,000] in women and 43.7/100,000 (95% CI 33.3-52.2/100,000) in men. The standardized incidence rate against the 1985 US population was 80.7/100,000 (95% CI 78.5-93.0/100,000) for women and 58.5/100,000 (95% CI 47.9-68.1/100,000) for men. The mean (standard deviation) age of patients with a hip fracture was 70.7 (9.4) years for women and 70.4 (10.0) years for men. The overall female-to-male ratio of hip fracture was 1.19 for age-adjusted hip fracture incidence and 1.30 for standardized incidence. A marked increase in incidence rate was found for both men and women with increasing age, becoming exponential after the age of 50 years. The mean age for hip fracture was 70.7 (9.4) years in women and 70.4 (10.0) years in men (P > 0.05). Women had a cervical-to-trochanteric ratio of 0.97 compared to men, at 1.03. The characteristics of hip fractures described in this study suggest that fragility fractures occur in North Africa, although substantially less frequently than in most European, North American and Asian countries but more frequently than sub-Saharan African countries, in agreement with the north-south gradient observed in the epidemiology of osteoporosis. The low incidence of hip fragility fracture rate is most likely the result of reduced longevity in Morocco.

Age Distribution↗
PubMed2002

Sequence-Based analysis of the HLA-DRB1 polymorphism in Metalsa Berber and Chaouya Arabic-speaking groups from Morocco.

To examine the genetic diversity in Morocco, the polymorphism at the HLA-DRB1 locus was investigated in two populations: the Metalsa group consisting of Berbers from north Morocco (who speak the Tarifit language and live in the Nador area), and the Chaouya group who are Arabic-speaking people from west Morocco (Atlantic coast) living in the Settat area. The DRB1 alleles of 197 healthy unrelated individuals were identified by direct DNA sequencing of exon 2 using fluorescently-labeled primers. A total of 28 and 29 alleles at DRB1 locus were identified in the Metalsa and Chaouya groups, respectively. The most frequent alleles in the Metalsa group are DRB1*03011 (20.2%), DRB1*0701 (12.12%), and DRB1*1302 (11.11%). In the Chaouya group, DRB1*0701 (16.33%), DRB1*15011 (12.76%), and DRB1*03011 (11.73%) are most common. Each population exhibits some specific variants and some uncommon alleles. The frequency of the DRB1*03011 allele differs significantly between the two populations (p = 0.0311). The DRB1 frequency distributions in the two groups suggest the effects of balancing selection. The interpopulation analysis highlighted a strong relatedness, based on genetic distances, between the two Moroccan groups and the other north Africans (the Moroccans from El Jadida area, Moroccan Souss Berbers, Algerians, and Tunisians), and to a lesser extent with the Iberians, French, and Ethiopians.

Gene Frequency↗
PubMed2006

Peritoneal tuberculosis in the Fes University Hospital (Morocco). Report of 123 cases.

AIMS: Peritoneal tuberculosis is an important public health issue in Morocco. Our aim was to describe the clinical, biological, and therapeutic features of peritoneal tuberculosis treated in a University Hospital in Morocco. PATIENTS AND METHODS: We retrospectively included 123 patients with peritoneal tuberculosis diagnosed at the gastroenterology unit of the Fes University Hospital between January 2001 and August 2003. RESULTS: The mean age was 28 years with a clear female predominance (sex ratio 2.61). Ascites associated with fever were the most frequent signs found in 80.5% of patients. The ascitic fluid was exsudative in 90% of cases and lymphocytic in 88%. The diagnosis was based on laparoscopy or laparotomy with peritoneal biopsy demonstrating caseating granulomatous lesions in 92.4% of patients. Patients were given antituberculous therapy for 6 months, and the outcome was favourable in 90%. CONCLUSION: Peritoneal tuberculosis is very frequent in Morocco, where the diagnosis is based exclusively on peritoneal biopsies obtained during laparoscopy. With an adapted treatment, the course of the disease is favourable in most cases.

Adolescent↗
PubMed2002

Nutrition transition in Morocco.

OBJECTIVE: To analyse the nutritional transition in Morocco. DESIGN: Examination of Moroccan national survey data. RESULTS: Morocco is undergoing a demographic, epidemiological and social transition. The urban population increased from 29% in 1960 to 53% in 1997. Per capita gross domestic product increased steadily from 1972 to 1999. Life expectancy at birth increased to 70 years in 1999 from 47 years in 1962. Both infant and juvenile mortalities have decreased, from 92/1000 and 69/1000 in 1982-87 to 46/1000 and 37/1000 in 1992-97, respectively. In parallel, the diet changed considerably: the intake of animal products increased while that of cereals and sugar remained relatively high, reflecting the specificity of Moroccan dietary habits. The rise in the consumption of meats and vegetables was accompanied by a steady consumption of bread, used to eat the sauce in which the meat and vegetables are cooked. Sugar is mainly used in tea, the very sweet, national drink consumed throughout the day. Under-nourishment persists among children under five (23% stunting and 10% underweight in 1997) while overweight is rising (9% in 1997 compared with 3% in 1987 for children under three). Among adults, overweight (body mass index (BMI) > 25 kg m(-2)) increased from 26% in 1984 to 36% in 1998. It is higher among women (32% in 1984 and 45% in 1998) than among males (19% in 1984 and 25% in 1998). It is also higher among urban populations (30% in 1984 and 40% in 1998) than rural populations (20% in 1984 and 29% in 1998). Obesity (BMI > 30kg m(-2)) increased from 4% in 1984 to 10% in 1998. Overweight seems to be positively associated with economic status but negatively with education level. CONCLUSION: Overweight and obesity constitute major health problems in Morocco.

Adolescent↗
PubMed2001

Pattern of cerebral aneurysms in Morocco: review of the concept of their rarity in developing countries: report of 200 cases.

OBJECTIVE: Many neurosurgeons consider cerebral aneurysms to be rare in Africa and the Middle East. In this report, we describe the pattern of cerebral aneurysms in Morocco and call into question the idea of their rarity in developing countries. Our objective is to urge neurosurgeons in these areas to track them and to treat them under better conditions. METHODS: We report a retrospective study of 200 patients with cerebral aneurysms admitted to our department between 1983 and 1999. The results of this study are supported by pertinent epidemiological surveys, anatomic studies on the incidence of cerebral aneurysms in Morocco, and analysis of the literature related to the epidemiology of aneurysms in developing countries. RESULTS: The patients in our series ranged in age from 7 to 70 years (mean age, 52 yr), with a slight female predominance (52%). They presented with subarachnoid hemorrhage (173 patients), cranial nerve palsy (18 patients), or mass symptoms (9 patients). The delay between subarachnoid hemorrhage and admission ranged from 1 to 30 days (mean, 14 d). The aneurysm was located in the internal carotid artery in 42%, in the anterior communicating and anterior cerebral arteries in 28%, in the middle cerebral artery in 19%, and in the vertebrobasilar artery in 10%. Multiple aneurysms were encountered in 9% and giant aneurysms in 15.5%. Seventeen patients died before surgery (with vasospasm in 13 cases and rebleeding in 4 cases), and 19 died after surgery. Follow-up, ranging between 1 and 10 years, revealed good outcomes with complete recovery in 64.5% and recovery with major sequelae in 7%. Pre- and postoperative mortality represented 18%; there was no operative treatment and no follow-up in 11.5%. CONCLUSION: Some data in this study (the delay between subarachnoid hemorrhage and admission, the high incidence of urban patients [80%], and the high rate of giant aneurysms) explain why many cases of ruptured aneurysms are not diagnosed. The analysis of our clinical series and the results of the epidemiological surveys show that the incidence has doubled every 5 years. These findings confirm that cerebral aneurysms are not rare in Morocco. A critical reading of the published articles claiming a low incidence of cerebral aneurysms in Africa, the Middle East, and Asia shows that this conclusion is not based on accurate and reliable statistical studies. Neurosurgeons in these regions should abandon this idea of rarity, and they should search for arterial cerebral aneurysms and develop the optimum conditions for the treatment of patients with aneurysms.

Adolescent↗
PubMed1999

The impact of family planning service provision on contraceptive-use dynamics in Morocco.

This article uses linked data from the 1995 Morocco DHS calendar and the 1992 Morocco DHS service-availability module to study the effect of service environment on contraceptive discontinuation, switching, and adoption of a modern method following a birth. The 1995 Morocco DHS also collected information on the source of supply for each episode of use of a modern method recorded in the calendar, allowing study of the association between the source of supply and discontinuation and switching rates. Multilevel event-history models are used to evaluate the impact of individual-level sociodemographic characteristics and community-level indicators of family planning service provision. The findings show that the presence of a nearby public health center is associated with higher modern-method adoption after a birth and lower method-failure rates; the presence of a pharmacy is associated with lower discontinuation due to side effects or health concerns. The degree of method-choice potential has a positive impact on both the rate of switching from the pill to another modern method and on modern-method adoption after a birth.

Adolescent↗
PubMed2000

[A socio-anthropological study of birth in Morocco].

BACKGROUND: To understand the role of beliefs, notions of risk and local practices in explaining the low utilization of maternal health services in Morocco. METHODS: Ethnographic research in three sites in Morocco, including interviews with 126 women and observation of medical encounters at health facilities. RESULTS: Local practices are not incompatible a priori with the use of health services, and women manifest a relatively pragmatic and flexible attitude towards the decisions they make regarding birth. The different factors that influence women's choices are analyzed, in particular those related to obstacles of accessibility and quality of services. CONCLUSION: The pluralism and eclecticism that characterize beliefs and behaviors related to birth in Morocco suggest that an improvement in the quality of care would encourage more women to seek care from health facilities.

Adult↗