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The domestic dog has been previously demonstrated to be the reservoir of Leishmania infantum, the etiologic agent of human visceral leishmaniasis around the Mediterranean Basin. It can also be infected with L. tropica, the etiologic agent of anthroponotic cutaneous leishmaniasis in Morocco. We report a canine L. tropica visceral infection for the first time in Morocco.
OBJECTIVE: To determine where and with what symptoms women seek care for reproductive tract infections (RTI) in Morocco and to guide allocation of resources for training and treatment for RTIs. METHODS: A primary healthcare centre (PHC), a family planning centre (FPC), and a specialty dermatovenereology clinic (SC) were selected in each of three urban areas. Women with symptoms of vaginal discharge, lower abdominal or pelvic pain, or genital lesions (genital ulcer or warts) underwent interviews, physical examinations, serological testing for human immunodeficiency virus (HIV) and syphilis, and collection of vaginal fluid for microscopic examination, and urine for detection of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) by ligase chain reaction (LCR). RESULTS: Over 8 months, 1238 women enrolled, including 61.8% at PHCs, 34.8% at FPCs, and 3.4% at SCs. Overall, 54% complained of vaginal discharge, of whom 8.8% had GC or CT infection and 30.1% had trichomoniasis (TV) or bacterial vaginosis (BV); 24.9% complained of lower abdominal pain with or without vaginal discharge, of whom 7.3% had GC or CT and 22.6% had TV or BV. GC or CT infections were found in 10.1% of PHC and 5.4% of FPC patients; while TV and/or BV infections were found in 28.7% and 22.8%, respectively. GC or CT infection was associated with perceived risk behaviours of the male partner (for example, belief partner is unfaithful) more often than with reported risk behaviours of the women themselves. For vaginal infections, a modified World Health Organisation (WHO) test algorithm for vaginal discharge involving risk assessment plus speculum and bimanual examination was 98.0% sensitive at PHCs and 90.8% at FPCs, with positive predictive value (PPV) of 33.4% at PHCs and 26.8% at FPCs. For GC or CT infections this algorithm was 60.6% sensitive at PHCs and 85.7% sensitive at FPCs; but PPV was only 9.9% and 9.0% respectively, little higher than the background prevalence of these infections. An RTI algorithm (Morocco specific) had comparable sensitivity and PPV for vaginal infection, and for cervical infection was less sensitive but had much higher PPV (26.9% for PHCs and 26.7% for FPCs). CONCLUSION: Women with complaints of vaginal discharge and/or lower abdominal pain presented to PHC and FP clinics, not to SCs. PHCs and FPCs should therefore receive resources for management of vaginal discharge. Both the test algorithm and the new RTI algorithm were useful in allocating treatment for vaginal infection, but only the RTI algorithm discriminated in selecting women with cervical infection. Even with the RTI algorithm, which limited treatment for cervical infection to risk assessment positive patients with signs of cervical infection or PID, the PPV for cervical infection was low, potentially resulting in frequent overtreatment and problems of partner notification.
INTRODUCTION: Leishmania tropica cutaneous leishmaniasis is usually described as dry, small and self-healing lesions, mainly located on the face and occurring in stable endemic foci. In 1989, similar aspects were observed in a rural hypoendemic focus in center Morocco where about 60 cases were diagnosed. In contrast, an epidemic urban focus in Taza-North Morocco--was identified in 1995 with peculiar clinical aspects. Our objectives is to describe these clinical characteristics. PATIENTS AND METHODS: From October 1995 to November 1996, 132 cases were diagnosed from this new focus during a monthly active survey. Age, sex, duration of lesions, clinical aspects and therapeutic regimen were detailed for each patient. RESULTS: Among the patients, 56.8 p. 100 were women. Mean age was 24.6 +/- 21.5 years (range: 8 months to 85 years). The mean duration of lesions was 6.9 +/- 6.5 months and 91.4 p. 100 evoluted for less than one year. Impetiginized, ulcerocrusted and noduloulcerative forms were predominant (61 p. 100). Furthermore, severe, vegetant inflammatory and multiple lesions were observed in infants and elderly patients. Limbs were involved in 30 p. 100 of cases. Eighty-six patients were treated with intralesional glucantime regimen and cured in 72 p. 100 of cases. Intramuscular treatment by glucantime was required in case of multiple lesions and failure of local therapy. DISCUSSION: In this study, the high frequency of severe lesions in infants and elderly patients suggests that the introduction of the parasite occurred recently in this area. The brief duration of lesions confirms the acute character for cutaneous leishmaniasis related to L. tropica in this epidemic focus. The host immune status associated with parasite intrinsic factors probably plays a role in these perculiar clinical manifestations.
Occupational health and safety in Morocco remain the poor link in our health system despite the existence since several decades of regulations concerning the protection of workers. This legislation is interesting but unfortunately not implemented and not updated. Our study shows failures at all levels: three occupational medical inspectorates with nine occupational inspection physicians for the whole of Morocco; 1,322 occupational medical services for 4,600 firms required to have such services. Occupational medical services cover only 7% of the urban working population; more than 9 workers out of 10 do not benefit from any medical protection. Only one occupational medical service out of four submits its annual medical report to the occupational medical inspectorate; 683 physicians practice occupational medicine while our theoretical needs are for about 3,000; among the 300 doctors holding a diploma of occupational medicine, only 100 practice in their speciality; of the 1,200 nurses employed in work environments, few hold state diplomas as provided for by legislation; safety engineers, prevention experts and ergonomists are rare; several exposed sectors do not have occupational safety and health services: civil servants, handicraft workers, small firms, rural areas, temporary and occasional workers, etc.; no serious study on occupational hazards (occupational accidents and diseases) has been undertaken. A reorganization of occupational safety and health is required: at the level of the Council of physicians and occupational medical inspectorate; a commission should control "who does what"; at the national level: extension of occupational safety and health services to all the working population (political will); meeting of the Consultative Medical Council and the establishment of a National Institute of Occupational Health; at the international level: the fight against the introduction of dangerous substances and technologies, originating in industrialized countries. Only correct and generalized occupational safety and medicine can ensure a true health protection of the population, particularly those working.
The mining sector is one of the pillars of our national economy. Our paper concerns safety and occupational health in the mining sector in Morocco. This sector employs 60,000 persons, more than half of them working in the phosphate sectors. There are 36 occupational medical services, with 83 practitioners 395 nurses and 91 agents, protecting 43,926 workers (73% of all personnel). The task of labour inspection in this sector is entrusted to mining engineers. The statistics of the central department of industrial inspection in mines from 1975 to 1995 show a fall in occupational injuries and a progressive increase reported in occupational diseases, 96% of which are silicosis. The improvement of prevention and health at work in the mining sector in Morocco has led to a reduction in occupational hazards and specially occupational injuries. However, an effort seems required so as to generalize occupational medical and safety services in all the mining enterprises and in the craft mining sector in particular.
The lack of sound and recent epidemiological data on the prevalence and causes of blindness has hampered the development and evaluation of the Moroccan Programme for the Prevention of Blindness. For this reason a population-based survey using a stratified (urban/rural) sampling design for random selection of clusters was carried out in the Kingdom of Morocco from May 15 until June 30, 1992. The procedures used for this survey were those proposed by the WHO Programme for the Prevention of Blindness. A total of 10,198 people were recruited and 8878 examined for a participation rate of 87%. The size and representativity of the sample satisfactorily guaranteed the order of magnitude and accuracy of eye health indicators used by health planners. The crude point prevalence of blindness was 0.8%, that of bilateral poor vision was 2.3%, and that of unilateral poor vision was estimated to be 2.8%. Based on these findings 195,000 people would be blind and 1,300,000 would be at risk of becoming so, for a total of approximately 1,500,000 people with serious visual impairment. Age-related cataract was the most important cause of blindness (45.5%) and bilateral poor vision (43.1%). The prevalence of cataract-related visual impairment--operable or inoperable--was estimated to be 2.1% of the survey sample. Applying a realistic algorithm to the survey data, it was estimated that the backlog for cataract surgery in Morocco in 1992 was in the order of 502,000 eyes in approximately 287,000 people. The percentage of patients who had undergone cataract surgery in hospital was 0.8%. Posterior lens dislocation according to the traditional "couching" method was noted in 0.1% of people studied. It was estimated that 25% of the demand for cataract surgery was covered by available facilities and that 40% of people with aphakia could not obtain eye care.
Smoking is a serious public health problem. In Morocco, the number of smokers varies from 24% to 52% depending on different social categories (school children, university students, public health workers, industrial workers, civil servants). The aim of our descriptive study was to analyze knowledge about smoking and smoking habits in patients hospitalized or followed by two units in the Ibn Rochd Hospital, cardiology and respiratory diseases. A questionnaire was given to a consecutive series of 200 patients between January and March 1997 (100 patients in each unit). Twenty percent of the patients were smokers and 23% were former smokers. The most well known health risks of smoking in the two groups of patients were respiratory and cardiovascular risks (88% and 71% respectively). Smokers and former smokers were more aware of these health risks. 86% of the smokers and former smokers had attempted to stop smoking at least once, mainly for a "health" reasons. 60% of smokers and former smokers decided to never smoke or never take a cigarette again. 66% of the patients said they had not been advised at the hospital about the risk of smoking. Our study provides a basis for further studies. It points out the importance of the smoking phenomena and the minimal role played by health personnel in advising patients. Health care workers should participate in antismoking activities during their consultation activities at the hospital in order to help patients stop smoking and also help implement rigorous antismoking laws in Morocco.
Morocco is famous for its potteries, the largest of which are located at Rabat, Safi, Marrakech and Fes. This cross-sectional, descriptive epidemiological survey was carried out over an eight-month period, from January to August 1997. The study population consisted of 290 male workers from 36 workshops. The study involved a social and medical survey (a questionnaire and medical examination for all workers, with biological assessment for a representative sample of 95 craftsmen) and an analysis of the working conditions in which atmospheric pollution at the pottery was evaluated. Atmospheric concentrations of zinc, copper, iron, chrome and lead were determined. Only lead levels were found to be significantly high and were analyzed on three occasions. This study demonstrates poor working conditions and a lack of respect for the regulations concerning specific prevention measures and the health rules applicable to establishments where personnel are routinely exposed to the risk of lead poisoning. Various pathological conditions were observed, with the following prevalences: skeletal muscle 67.6%, dermatological 8.3%, digestive 58%, respiratory 28% and neurological 35.5%. Several nonspecific, often minor, clinical signs were recorded for most of the potters but the toxicological analysis confirmed lead contamination in 74% of the exposed subjects (plasma lead concentration, CPU, ALAU). The potteries of Morocco are not subject to any protection. Special technical and medical surveillance should be introduced and the laws concerning exposure to lead should be applied.
The objective of this study was to determine the prevalence of skin sensitization to certain pollens in some regions of Morocco. This multicentric study involving 10 centres included a consecutive series of 640 patients consulting for the first time between february and april 1998 for asthma and/or rhinitis and/or conjunctivitis. Skin prick tests (SPT) were performed with stallerpointes (Stallergenes) and interpreted according to standard procedures. Pollinosis was ascertained when SPT was positive to one or more pollens. Epi-Info was used to analyze the data. SPT were positive in 75.9% and prevalence of sensitization to pollens was equal to 28% (179 cases). It ranked second after house dust mites (63%), olive, 5 grass, cupressus, parietaria and corylus sensitization were encountered in 19.8%, 10.9%, 3.8%, 1.7% and 1.3% respectively. Prevalence of sensitization to pollens didn't vary significatively according to age: 25.4% in females versus 31.1% in males (p = 0.13). Prevalence of pollen sensitization was 26.6% in case of asthma versus 30.9% in non asthmatics patients (p = 0.30), 30.1% in case of rhinitis versus 16.9% in non rhinitics (p = 0.009), 36.4% in case of conjunctivitis versus 22.7% in case without conjunctivitis (p < 0.0002). According to the regions, prevalence was significatively high in areas like Meknes (56%), Beni-Mellal (48.1%), Marrakech (43.5%) where olive is abundant in comparison with Oujda (30.8%), Agadir (30.8%), Tanger (27.3%), Rabat (21.8%), Safi (21.3%), Casablanca (11.6%) and El Jadida (10%). The prevalence was up to 84.3% when symptoms were predominant in spring versus 16.8% in other seasons (p < 0.0001). Thus, although SPT did not include numerous other pollens, olive pollinosis seems to be prevalent in Morocco, followed by allergy to grass pollen. Such studies need to be carried out in line with pollen count.
Autosomal dominant polycystic kidney disease (ADPKD) has aroused great interest these last years, especially after the discovery of the genes responsible for this disease. It remains a frequent cause of chronic renal failure (CRF). In this work we report the results of a multi-centre retrospective study. The data relates to 41 centres of nephrology and dialysis in Morocco, 308 Moroccan families and 420 observations. We have tried to determine the frequency of this pathology in Morocco, its complications and difficulties in taking care of it. The average age of the discovery of ADPKD was 46 +/- 3 years and the sex ratio was of 1.08. The ADPKD frequency among Moroccans who undergo dialysis was 6.5%. Pain was the most frequent symptom which revealed the disease (21%); while renal failure at different stages was found in 17% of the patients and high blood pressure (HBP) in 11%. The clinic diagnosis was confirmed by echography in 95% of cases. The association with a hepatic cysts was found in 17.8% of the cases. In addition, to HBR and urinary tract infection, the complications were largely dominated by renal chronic failure and the difficulties in taking care of it because of economic problems. Through this the authors discuss and report the profile and the prognostics of this infection in our society, with a special focus on the evolution of the renal function, the delay in the diagnosis and the management.
Screening 579 sera specimens obtained in Casablanca (Morocco) we have performed a retrospective seroepidemiological survey with regard to the prevalence of Chlamydia trachomatis involved in genital tract infections. The surveyed populations are divided into 3 groups: 177 patients affected with sexually transmitted diseases (STD), 319 reference patients, 83 maghrebian patients affected with STD but living in France. The study was performed by the indirect microimmunofluorescence technique. The prevalence of Chlamydia trachomatis ranging from 50% in the moroccan reference groupe to about 70% among patients with STD both in Morocco and Bordeaux indicates that Chlamydia trachomatis takes a significant part in STD observed in moroccan populations.
A retrospective study of 404 cases of rheumatoid arthritis seen in a department of internal medicine in Casablanca highlights a number of specific features of the disease in Morocco. Onset occurred early and mean age of patients was 34.4 years. Analysis of joint manifestations showed that the disease tended to be mild in the hips and perhaps in the cervical spine. Thirty-five percent of patients were Steinbrocker's class II and 25.5% had carpal bone fusion. Only 20 patients had severely erosive disease, which manifested as giant geodes in 8 cases and as main en lorgnette deformity in one case. Subcutaneous nodules (7.9%) and systemic visceral disorders were fairly infrequent. Only three cases of malignant rheumatoid arthritis were found. Gougerot-Sjögren syndrome was present in 13.6% of patients. Among comorbid conditions, thyroid gland diseases and tuberculosis were fairly common. Serologic tests were positive in 61.14% of cases, often in low titres. Gold salt therapy was well tolerated. No patients in this group had surgical treatment. These data suggest that in Morocco rheumatoid arthritis may be less aggressive than in Europe.
The history of the Culicidae of Morocco was related from bibliographical data. A synthesis of the almost entire works carried out on these Insects (Diptera) since 1916 allowed to bring out the main stages of research of which they were the subject, while emphasizing the important periods of large malaria epidemics in Morocco. A short list of species is also given.
The domestic wastewaters of the city of Kenitra (North-East of Morocco) are rejected without preliminary processing by six emissaries into the Sebou river, the Atlantic Ocean and the Fouarate lake. The present study is based on a qualitative and quantitative analysis of the wastewater parasites load of the "Ville Haute" urban district of Maamora (Kenitra, Morocco). Untreated wastewater samples taken at the exit of the urban emissary are pretreated and analysed by the modified Bailenger method at the parasitological and hydrobiological laboratory of the Sciences Faculty of Kenitra (Ibn Tofail University). For diagnostic confirmation purposes, other complementary analysis were made at the parasitological laboratory of the National Institute of Hygiene (Rabat) The results obtained pointed to the existence of the helminths parasites eggs of Ascaris spp., Toxocara spp., Trichuris spp., Hymenolepis spp., Taenia spp and Fasciola hepatica species with respective concentrations of 3 eggs/L, 17 eggs/L, 7 eggs/L, 2 eggs/L, 1 eggs/L and 1 egg/L. The mean concentration is about 31 eggs/L of untreated wastewater. Furthermore, on the samples examined, the percentages of positives tests is 86% for nematodes, 10% for cestodes, and 4% for trematodes. At the end of this preliminary study we insist on the very high level of parasitic helminths transported by untreated wastewater and we recommend that those wastewater be processed before there are recycled in the Sebou river.
HIV sentinel surveillance was performed in five provinces of Morocco in 1993, expanded to 10 provinces in 1996. The activity was done by unlinked anonymous testing procedures. We analysed the data from 1993 to 1999. The groups studied were sexually transmitted infections, clinic attendees, pregnant women and patients with pulmonary tuberculosis. The results show that overall HIV prevalence rate over the whole period in 10 cities was 0.10% (45/44,233). Casablanca had a significantly high rate with 0.39% (10/2567). The patients with pulmonary tuberculosis displayed the highest prevalence with 0.36% (9/2530). These data confirm the assumption that the HIV epidemic is low in Morocco. However, the increase of HIV prevalence lately calls for reinforcing preventive measures to limit its spread.
Neurosyphilis accounts for 56%-70% of all visceral syphilis and is a complication in 5%-10% of cases of untreated syphilis. The aim of this study was to evaluate the epidemiological aspects and clinical presentations of neurosyphilis in Morocco through a series of 201 patients attending the Centre for Neurological Services at the university hospital in Rabat between 1986 and 1997. The mean age of the patients was 41.26 (SD 9.23) years (range: 17-70 years); the majority (91%) were male. The incidence of neurosyphilis in Morocco is high. From 31 cases per year in 1985, it has fallen since 1990 to reach 10 cases in 1997. Among the different clinical presentations recorded, chronic meningoencepahalitis was the commonest, followed by meningovasculitis, tabes dorsalis and optic atrophy.
Late blight caused by Phytophthora infestans, is the most important disease of potato in Morocco. Use of partially resistant cultivars should be an essential component of a sustainable management strategy of potato late blight, provided the durability of this form of resistance. It is therefore important to determine the nature of P. infestans Moroccan populations. Mating types were determined for 91 strains of P. infestans collected in the northern (Larache-northern plain), north western (Kénitra) and north eastern (Méknès, Middle Atlas) potato cropping areas of Morocco in 1999-2000, 2000-2001 and 2003-2004. They showed a clear regional structure of these populations, with the presence of both mating types (A1 and A2). Of all isolates collected since 1999, A2 mating type constituted 56% (54 isolates), following by A1 mating type (40.7%, 31 isolates) and A1-A2 (self-fertile) mating type (3.30%, 3 isolates). Populations from Méknès and Kénitra consisted mainly of A2 mating type, whereas populations from Larache predominantly included A1 mating type. Physiological race study revealed the presence of 19 races of P. infestans in the first collection of 25 isolates tested between 1999 and 2001. All known virulence genes were detected in western and northern Moroccan isolates, except virulence for resistance genes R2, R5, and R6 which were absent. All isolates were able to overcome two or more R genes except one isolate (5-1) corresponding to race 1.
SETTING: Chronic obstructive pulmonary disease (COPD) and asthma are a public health problem in Morocco. Their evaluation should be supplemented by quality of life measurement, but there is no specific instrument available in local Moroccan Arabic. OBJECTIVE: To validate a Moroccan Arabic version of the St George's Respiratory Questionnaire (SGRQ) in patients with COPD or asthma in Morocco. DESIGN: After a rigorous translation process of the SGRQ into local Moroccan Arabic (SGRQm), the SGRQm, spirometry, Fletcher scale and a visual analogical scale (VAS) were administered to each patient at recruitment. Data were used to examine the construct validity and reliability of the SGRQm. To examine the test-retest reliability, patients completed the SGRQm a second time 10 days later. RESULTS: A total of 131 patients with a mean age of 52 years were recruited into the study. Patients had a mean forced expiratory volume in one second (FEV1) of 1.70 1 and a mean VAS of 51.5 mm. Internal consistency of symptoms, activity and impact components was assessed using Cronbach's alpha (a) reliability coefficient; they were 0.94, 0.91 and 0.90, respectively. The test-retest reliability of components scores ranged from 0.70 to 0.87. The Fletcher scale correlated with all SGRQm scores, while the VAS had a similar correlation except with symptoms (P > 0.05). FEV1 values were negatively correlated with all SGRQm scores. CONCLUSION: The SGRQm yielded satisfactory psychometric properties.