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[Evolution of the vaccination timetable in Morocco].

Morocco has always been aware of the importance of vaccination and has been implementing an ambitious vaccination policy for several decades. The first vaccination campaigns started in the sixties. The Extended Vaccination Program (EVP) was launched in 1981 and restructured six years later, being renamed the National Immunization Program (NIP). Regular follow-up of vaccine efficacy has led to several changes in the national vaccination timetable, including new antigens and boosters. Protection against tuberculosis, diphtheria, tetanus, whooping cough, poliomyelitis, etc. has considerably improved in Morocco. Neonatal tetanus and diphtheria have been eliminated, along with poliomyelitis (certified by WHO in 2001). Future efforts will focus on reducing urban-rural disparities, and on implementing the WHO program for eliminating measles and congenital rubella.

Adult↗

[Smoking in Morocco: an outline of the anti-smoking campaign].

In Morocco, as in many developing countries, tobacco use has become a plague which aggravates the many already existing problems. A coordinated prevention programme which included research and a variety of educational efforts, has been underway for the past five years. The preliminary stage of the non-smoking campaign consisted of research through use of a variety of standardized questionnaires. The research results showed tobacco use in Morocco to be the following: 23.8% of secondary students are smokers with variation according to family, culture, environment and sex (33% male vs. 8.6% female); 33.8% of university students smoke, including those in Medical Schools; 52.1% of adults in the work environment smoke, including doctors. The rate declines drastically among practicing muslims (between the ages of 14 and 65) to 9.8%. The use of other drugs is significantly higher in students who use tobacco (25%) than those who do not (1.5%). A common factor appeared regardless of age, sex, or occupation: there was insufficient information available concerning the harmful effects of smoking. An educational campaign was therefore launched. As the youth were considered to be the most vulnerable target group, a major part of the educational efforts was concentrated on them. A variety of activities was implemented including conference-debates using audiovisual supports; radio and T.V. broadcasts; contests run with the assistance of the CIPADED (International Committee for the Prevention of Alcohol/Drug Dependence). Information of the harmful effects of tobacco use was diffused in workplaces, government offices, and at public assemblies. Efforts were also implemented to promote adoption of legislation which would limit tobacco consumption.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

[Low occurrence of delta agent infections in Morocco].

The incidence of delta infections in Morocco has been investigated to explain the high rate of severe hepatitis B (HB) observed in this country. The presence of delta antigen (D Ag) and antibodies to delta agent (D Ab) was tested by radio-immuno-assay in the sera from 85 HBs Ag positive patients, hospitalized in Casablanca: among them 57 suffered from acute or fulminant HB (12 deceased), 10 from chronic hepatitis and 18 from cirrhosis. Neither D Ag nor D Ab were found, excepted once in a patient with cirrhosis having shown the presence of D Ab. In contrast with the high endemicity of delta agent reported in other countries of North Africa, the incidence of delta infections seems to be very low in Morocco.

Hepatitis B↗

[Prevalence of markers of the HBs system of hepatitis B among hospital personnel in Morocco: evaluation of the risk of hepatitis B infection].

The prevalences of HBs Ag and HBs Ab were investigated among 221 hospital or laboratory staffs in Casablanca (Morocco) to estimate the importance of risks of infection by HBV at which they were exposed with regard to a control group including 195 blood givers from the city. Staff originated from following departments: infectious diseases, emergency, blood center, haemodialysis and a laboratory associated to this one. HBs Ag has been investigated by inhibition of haemagglutination and HBs Ab by passive haemagglutination. X2 test, with Yates correction if need, was used as statistical. method. HBs Ag and Ab prevalences, higher among hospital staff than in controls (p less than 0.05), showed an increased risk of HBV infection in the formers. Among staff, whatever one's occupation may be, HBs Ab prevalence did not shown appreciable changes. In contrast, the HBs Ag one varied significantly from one department to the other, depending on factors such as hygiene and asepsis, reducing the risk, and contagiousness of some hospitalized patients or more or less frequent exposures to infectious blood, increasing the risk. The influence of these factors was illustrated and discussed by comparison of HBs Ag prevalence with frequency or importance of infectious exposures among staff from each studied department. As reported in various countries, in Morocco hospital and laboratory staff is exposed to a high risk of infection by HBV and the interest to vaccine such persons against hepatitis B is underlined.

Hepatitis B↗

[Epidemiology of tubal sterility in Morocco. Apropos of 386 cases].

In Morocco 11.7% of couples are sterile. Even after 3 years the figure is as high as 6%. We have studied in this work 386 cases of tubal sterility which constitute 58.22% of 663 couples who were fully investigated. The mean age of the patients was 29 years. Patients come for assessment late-75% of them after 5 years of sterility. Most of these (54.15%) suffer from primary sterility due to infections acquired before marriage. One-third of all patients have been married more than once, having been divorced because of their sterility. Although tuberculosis is still very frequent in Morocco, not many of our cases were suffering from pelvic tuberculosis. 11% of the patients had had pelvic surgery.

Adolescent↗

[Arbovirus infections in Morocco: serosurvey in small wild mammals in the northern part of the country].

Sera of 128 small wild mammals (rodents, insectivora) trapped in Northern Morocco in March 1979, were studied for antibody against 15 arboviruses. In inhibition-haemagglutination tests, positive reactions were found against West Nile (0.8%), Tahyna (21 %), Arumowot (14 %) and Sicilian Sandfly fever (9.4 %) viruses. In complement fixation tests, an unique serum from Apodemus sylvaticus was simultaneously positive for Quaranfil virus and for a Kemerovo group virus, Brest/Ar/T222, previously isolated from Ornithodoros (A.) maritimus ticks caught in Morocco. These results are discussed according to the bioclimatic profile of the station where the mammals originated and to the potential vectors known to occur here.

Animal Population Groups↗

[The health care system in Morocco].

At present, Morocco is looking into ways and means for the setting up of a health system liable to satisfy the requirements of the end of this century while taking into account the socio-economic constraints. The current health system comprises three sectors: a public sector consisting of the structures of the ministry of public Health together with those of the Health services of the Royal Armed Forces, a semipublic sector, and a private sector. The health system has been undeniably instrumental in the improvement of the health standards in independent Morocco. One figure is evidence enough of that: mortality rate dropped from 160% in 1956 to 57.4% in 1993. This score, however, does not make up for the inadequacies of the system: insufficient human and material means, uneven geographic distribution of health cover and a very limited health insurance. In order to remedy this situation, a health system development program is to be elaborated in the next few months. With the aim of improving the quality and the geographic expansion of the health cover, this program rests upon a number of fundamental principles: progressively generalized compulsory health insurance, improved health cover in the rural area, and a greater commitment to health matters on the part of local elected councils. The financing of the program will rely on health insurance revenues and the budget of the public Health ministry. The latter item will be devoted to the development of health infrastructures and, prior to generalized compulsory health insurance, to the financing of health-care for the poorest.

Health Care Reform↗

[Alarming admission rates for schizophrenia in migrants from Surinam, the Netherlands Antilles and Morocco].

OBJECTIVE: To compare first admission rates for schizophrenia in the four largest immigrant groups to the Netherlands (from Surinam, the Netherlands Antilles, Turkey and Morocco) with those of the Dutch population. DESIGN: Analysis of data from the national psychiatric register. METHOD: The frequencies of first admission (compulsory or not) for schizophrenia in 1990 were subdivided according to age, sex and country of birth. The figures were plotted against the numbers of immigrants living in the Netherlands on January 1st, 1990. The frequencies were compared with the chi2 test. RESULTS: Rates for immigrants from Surinam and the Netherlands Antilles were 2-5 times higher than those for Turkish immigrants and for the native-born population. Rates of first admissions for young male immigrants from Morocco were also increased but rates for female Moroccan immigrants and for immigrants from Turkey were not. Proportions of compulsory first admissions for young male immigrants were not increased. For young Surinam-born females, however, this proportion was increased. CONCLUSION: These results agree with those of British studies reporting an increased incidence of schizophrenia among Afro-Caribbean immigrants to the UK.

Adolescent↗

Ethnopharmacological survey of plants used in the traditional treatment of hypertension and diabetes in south-eastern Morocco (Errachidia province).

This survey was undertaken in the Errachidia province in south-eastern Morocco in order to inventory the main medicinal plants used in folk medicine to treat arterial hypertension and diabetes mellitus. Four hundred individuals who knew about and/or had used the medicinal plants for the indicated diseases, including some herbal healers, were interviewed throughout different regions of the province. The inventory of medicinal plants is summarized in a synoptic table, which contains the scientific, vernacular and common name of the plant, its ecological distribution, the part of the plant and the preparation used and the therapeutic indication. Extensive investigations have brought to light 64 medicinal plants belonging to 33 families; of these, 45 are used for diabetes, 36 for hypertension, and 18 for both diseases. Of these plants, 34% grow in the wild, 44% are cultivated, and 22% are not indigenous to the area and are brought from other parts of Morocco or from outside the country. The survey shows that 78% of the patients regularly use these medicinal plants. In this region, the most frequently used plants to treat diabetes include Ajuga iva, Allium cepa, Artemisia herba-alba, Carum carvi, Lepidium sativum, Nigella sativa, Olea europaea, Peganum harmala, Phoenix dactylifera, Rosmarinus officinalis, and Zygophyllum gaetulum, and those to treat hypertension include Ajuga iva, Allium cepa, Allium sativum, Artemisia herba-alba Asso, Carum carvi, Nigella sativa, Olea europea, Rosmarinus officinalis, Origanum majorana, Peganum harmala, and Phoenix dactylifera. The local people recognize the toxic plants and are very careful in using such plants, which are Citrullus colocynthis, Datura stramonium, Nerium oleander, Nigella sativa, Peganum harmala and Zygophyllum gaetulum. Our survey shows that traditional medicine in the south-eastern Moroccan population has not only survived but has thrived in the transcultural environment and intermixture of many ethnic traditions and beliefs.

Anti-Infective Agents↗

Phytotherapy of hypertension and diabetes in oriental Morocco.

In order to select the main medicinal plants used in folk medicine to treat arterial hypertension and/or diabetes, a survey was undertaken in different areas of oriental Morocco. The patients (370 women and 256 men) were divided into three groups: diabetics (61%), hypertensives (23%) and hypertensive diabetic persons (16%). On average, 67.51% of patients regularly use medicinal plants. This proportion is perceptibly the same in all groups and does not depend on sex, age and socio-cultural level. This result shows that phytotherapy is widely adopted in northeastern Morocco. For diabetes, 41 plants were cited, of which the most used were Trigonella foenum-graecum L. (Leguminosae), Globularia alypum L. (Globulariaceae), Artemisia herba-alba Asso. (Compositae), Citrullus colocynthis (L.) Schrad. (Cucurbitaceae) and Tetraclinis articulata Benth. (Cupressaceae). In the hypertension's therapy 18 vegetal species were reported, of which the most used were Allium sativum L. (Liliaceae), Olea europea L. (Oleaceae), Arbutus unedo L. (Ericaceae), Urtica dioica L. (Urticaceae) and Petroselinum crispum A.W. Hill (Apiaceae). Among the 18 species used for hypertension, 14 were also employed for diabetes. Moreover, these two diseases were associated in 41% of hypertensives. These findings suggest that hypertension observed in this region would be in a large part related to diabetes.

Africa, Northern↗

Detection and identification of Ehrlichia spp. in ticks collected in Tunisia and Morocco.

A broad-range 16S rRNA gene PCR assay followed by partial sequencing of the 16S rRNA gene was used for the detection of members of the family Anaplasmataceae in ticks in North Africa. A total of 418 questing Ixodes ricinus ticks collected in Tunisia and Morocco, as well as 188 Rhipicephalus ticks from dogs and 52 Hyalomma ticks from bovines in Tunisia, were included in this study. Of 324 adult I. ricinus ticks, 16.3% were positive for Ehrlichia spp., whereas only 3.4 and 2.8% of nymphs and larvae, respectively, were positive. A large heterogeneity was observed in the nucleotide sequences. Partial sequences identical to that of the agent of human granulocytic ehrlichiosis (HGE) were detected in I. ricinus and Hyalomma detritum, whereas partial sequences identical to that of Anaplasma platys were detected in Rhipicephalus sanguineus. However, variants of Anaplasma, provisionally designated Anaplasma-like, were predominant in the I. ricinus tick population in Maghreb. Otherwise, two variants of the genus Ehrlichia were detected in I. ricinus and H. detritum. Surprisingly, a variant of Wolbachia pipientis was evidenced from I. ricinus in Morocco. These results emphasized the potential risk of tick bites for human and animal populations in North Africa.

Anaplasmataceae↗

Validation of a competitive enzyme-linked immunosorbent assay for diagnosing Babesia equi infections of Moroccan origin and its use in determining the seroprevalence of B. equi in Morocco.

A highly specific and sensitive competitive enzyme-linked immunosorbent assay for detection of specific antibody to Babesia equi in serum from equids was validated for use in Morocco. The assay is based on the specific inhibition of binding of a monoclonal antibody to a conserved epitope within a recombinant parasite peptide by serum from infected animals. The assay was compared to an established indirect immunofluorescence assay, with a concordance of 91%. The assay was used to determine seroprevalence for B. equi infections in donkeys and horses throughout Morocco. A total of 578 sera (163 horses and 415 donkeys) from 6 locations representing different bioclimatic regions were assayed. An analysis of variance, indicated no significant effect of location; however, donkeys were significantly more likely than horses to be seropositive. Management conditions contribute to greater tick infestations and thus Babesia exposure in donkeys than in horses.

Animals↗

Social inequalities and health inequity in Morocco.

BACKGROUND: According to the last census, Morocco has a population approaching 30 million people. The country has made good progress in the control of preventable childhood diseases but social inequalities and health inequities remain major problems for the third millennium. Despite the progress achieved during the last decade, the country still ranks at the 125th place according to the Human Development Index. This unpleasant position is mainly explained by illiteracy, education and health indicators. METHOD: Our study was based mainly on annual reports and regular publications released by the United Nations (UN), United Nations Development Programme (UNDP), World Health Organisation (WHO), The Moroccan Health Ministry and related papers published in international journals. RESULTS AND DISCUSSION: As indicated by the last Arab Human Development Reports (AHDR 2002, AHDR 2003, AHDR 2004) and implicitly confirmed by the "National Initiative for Human Development" (NIHD) launched in May 2005 by the King of Morocco, many districts and shanty towns, urban or peri-urban, and a multitude of rural communes live in situations characterized by difficult access to basic social services of which education and health are examples. CONCLUSION: Recent evidence showed that improved health is more than a consequence of development. It is a central input into economic and social development and poverty reduction. Serious initiatives for human development should consider the reduction of social inequalities and health inequities as a first priority. Otherwise, the eventual development achieved cannot be sustained.

Journal Article↗

Reexamination of the immature hominid maxilla from Tangier, Morocco.

Reexamination of the immature Upper Pleistocene hominid maxilla from Mugharet el-'Aliya (Tangier), Morocco is undertaken in light of new evidence on the growth and development of Upper Pleistocene hominids. Metric and qualitative comparisons were made with 17 immature Upper Pleistocene maxillae, and with a recent Homo sapiens sapiens sample. No unambiguous criteria for aligning the maxilla with Neandertals were found, although one character, the degree of maxillary flexion on the zygoma, strongly suggests that this child could be a representative of H.s. sapiens. The probable lack of a canine fossa in Mugharet el-'Aliya 1, the primary criterion used previously to align it with Neandertals, cannot be accurately extrapolated to its adult form from this juvenile. The present evidence suggests that it is inappropriate to refer to this fossil as "Neandertal-like" or as a North African "neandertaloid." Thus, the Tangier maxilla should not be cited as evidence for the presence of Neandertal facial features in North Africa during the Upper Pleistocene.

Age Determination by Teeth↗

The bacterial quality of red meat and offal in Casablanca (Morocco).

The present study aimed to evaluate the bacteriological quality of beef (n = 52), lamb (n = 52) and beef offal (n = 52) marketed in Casablanca, Morocco. Meat and offal samples (n = 156), were collected randomly from butcheries, supermarkets, and slaughterhouses. Two sampling periods were considered, one during the hot season and the second one during the cold season. The samples were analyzed for the presence of the following bacteria: Escherichia coli, coagulase-positive Staphylococcus, Clostridium perfringens, Salmonella, and Listeria monocytogenes. Results indicated that counts of the aerobic plate count, and fecal coliforms were particularly high in all the samples analyzed. E. coli, coagulase-positive Staphylococcus and C. perfringens were detected in 37.8, 16, and 4.5% of the meat samples, respectively. Neither Salmonella nor L. monocytogenes were isolated from meat samples. Approximately 26.9% of beef, 34.6% of lamb and 28.8% of beef offal samples contained bacteria above the maximum limits established by the Moroccan regulatory standards for meat and meat products. Seasonality and the distribution location significantly (p < 0.05) affected bacterial populations: the hot season and butcheries appeared to be cases where the highest populations of bacteria in meat were observed. These high levels of microbiological contamination attest the poor hygienic quality of meat and offal, possibly due to uncontrolled processing, storage, and handling of these products.

Animals↗

Treatment of Wilms tumor according to SIOP 9 protocol in Casablanca, Morocco.

BACKGROUND: Childhood Wilms tumor represents one of the challenge for pediatric oncologists in developing countries. We report the characteristics and treatment results of patients with Wilms tumor according to SIOP 9 protocol in Morocco. PROCEDURE: From January 1989 to December 2000, 86 children with Wilms tumor were admitted. The diagnosis was based on physical exam and abdominal ultrasound. The metastatic work-up was based on abdominal ultrasound and chest X-ray. RESULTS: The mean age was 36 months (3-120 months). The sex-ratio was 1. Abdominal mass was the main symptom at presentation (84 cases). There were 13 metastatic cases. Treatment applied was according to SIOP 9 Protocol without randomization. Local deases was present in 75 patients with stage I in 38 cases (50%), IIN0 in 4 cases (6%), IIN1 in 9 cases, and III in 24 cases (44%). The distribution of pathologic groups was: favorable in 4 cases, standard in 69 cases, and unfavorable anaplastic type in 2 cases. Sixty-nine patients were evaluable for therapeutic evaluation. Other patients were lost to follow-up. Three patients died of treatment related toxicity and 13 patients relapsed. With a median follow-up of 70 months, the 5-year EFS and 5 years overall survival for evaluable patients are 77.4% and 79%, respectively while the 5-year EFS for all patients was 56%. CONCLUSION: These results are encouraging for a developing country but special efforts should be done to reduce the rate of abandonment.

Antineoplastic Combined Chemotherapy Protocols↗

Theropithecus atlanticus (Thomas, 1884) (Primates: Cercopithecidae) from the late Pliocene of Ahl al Oughlam, Casablanca, Morocco.

The site of Ahl al Oughlam near Casablanca, Morocco, dated to ca. 2.5 Ma, has yielded a good sample of Theropithecus atlanticus (Thomas, 1884), a North African late Pliocene species previously known only by its holotype, a lower molar from Algeria. Theropithecus atlanticus, which can now be much better defined, is clearly distinct from other species of the genus, which is thus more diverse than previously thought. The mandible of T. atlanticus has a very characteristic deep and long post-molar sulcus and a deep and well excavated supra-lateral triangular depression of the ramus, with a sharp postero-inferior ridge. The upper and lower canines are rather large but low. The male P3 is very wide, with well developed posterior crests; the P4 is rounded, with a large talonid and weak notches and clefts. Median lingual notches of the lower molars form an acute angle. Although our incomplete knowledge of T. atlanticus precludes a detailed phylogenetic analysis, we suggest that it arose by cladogenesis from the T. darti-T. oswaldi lineage; it is replaced by the latter species in the Pleistocene.

Animals↗

Epidemiological observations on stomach worms of donkeys in Morocco.

Over two consecutive years, weekly examinations for the presence of nematodes were conducted on 185 stomachs from donkeys originating mainly from the Rabat, Casablanca and Settat regions of Morocco. All the animals, except one, were infected by at least one of four helminth species. Trichostrongylus axei was found in 93.5%, Habronema muscae in 89.7%, H. majus in 85.4% and Draschia megastoma in 1.1% of donkeys. Most animals were infected by two (23.8%) or three (71.9%) species. High burdens of T. axei were observed in the winter of both years and in the mid-summer of the second year. Peak burdens of Habronema were found at various times throughout both years. There were more adult H. majus than H. muscae. The periods of peak levels of infection by these parasites were related to environmental conditions suitable for the development and survival of infective larvae of T. axei and for the build-up of muscid fly vectors of Habronema and Draschia spp.

Animals↗