Defining indicators for disease burden, health outcomes, policies and barriers and facilitators to health services for migrant populations in the Middle East and North African region: a protocol for a suite of systematic reviews.

INTRODUCTION: The Middle East and North African (MENA) region is characterised by high and complex migration flows, yet little is known about the health of migrant populations, their levels of underimmunisation and access to healthcare provision. Data are needed to support regional elimination and control targets for key diseases and the design and delivery of programmes to improve health outcomes in these groups. This protocol describes a suite of seven systematic reviews that aim to identify, appraise and synthesise the available evidence on the burden and health outcomes, policies and access (barriers and facilitators) related to these mobile populations in the region. METHODS: Seven systematic reviews will cover three questions to explore the: (1) burden and health outcomes, (2) policies and (3) healthcare barriers and facilitators for the following seven disease areas in migrants in the MENA region: tuberculosis, HIV and hepatitis B and C, malaria and neglected tropical diseases, diabetes, mental health, maternal and neonatal health, and vaccine-preventable diseases. We will search electronic databases for studies in any language (year 2000-2023), reference-check relevant publications and cross-check included studies with experts. We will search for grey literature by hand searching key databases and websites (including regional organisations and MoH websites) for country-specific guidelines and talking to our network of experts for local and regional reports and key datasets. We will assess the studies and policies for their quality using appropriate tools. We will meta-analyse the data by disease outcome if they are of sufficient volume and similarity. Where meta-analysis is not possible and where data are on policy or access, we will narratively synthesise the evidence using summary tables, figures and text. DISSEMINATION: We anticipate disseminating the findings through peer-reviewed publications, conferences and other formats relevant to all stakeholders. We are following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and protocols will be registered on International Prospective Register of Systematic Reviews.

Assessing the Vaccination Status and Barriers to Influenza, Pneumococcal, and COVID-19 Vaccination Among Moroccan Patients With Chronic Inflammatory Rheumatic Disease.

OBJECTIVE: To evaluate the vaccination coverage of patients with chronic inflammatory rheumatic disease (CIRD) against influenza, pneumococcus, and COVID-19 and to determine, per the patients' point of view, the possible factors related to vaccination hesitation and/or refusal. METHODS: A cross-sectional study carried out by the vaccination working group of the Moroccan Society of Rheumatology, including patients with CIRD in Morocco. Information about vaccination coverage and reasons for non-vaccination against influenza, pneumococcal infection, and COVID-19 was collected. RESULTS: This survey included 230 patients (mean age of 46.9 +/-13.89 years; 68.7% females) affected by CIRD (rheumatoid arthritis 53%, spondyloarthritis 39.6%, psoriatic arthritis 7%). The study shows a significant lack of influenza and pneumococcal vaccination in CIRD patients, with vaccination coverage against influenza, pneumococcal infection, and COVID-19 at 2.2%, 0.4%, and 80.9%, respectively. The main reason for non-vaccination against influenza and pneumococcus was related to the absence of recommendations by their doctors (77%, 87%, p = 0.04). Additionally, the primary reason for non-vaccination against COVID-19 was the fear of the vaccine's side effects (51%, p = 0.0001), mainly a flare-up of CIRD (44%, p = 0.001). CONCLUSION: This survey shows a lack of influenza, pneumococcal, and COVID-19 vaccination in CIRD patients. The principal actions to improve vaccination should aim to educate patients and encourage rheumatologists to vaccinate their patients.

Anxiety, Stress, and Depression Among Healthcare Professionals During the COVID-19 Pandemic: A Cross-Sectional Study in Morocco.

The COVID-19 pandemic has caused an enormous psychological impact worldwide. This study aimed to assess anxiety, depression, stress, and compensatory behaviors among Moroccan healthcare workers (HCWs) during COVID-19. This descriptive cross-sectional study was conducted using a snowball sampling strategy. This descriptive cross-sectional study was conducted using a snowball sampling strategy. Online surveys were sent to groups of HCWs working in Casablanca and Fez cities. Post-traumatic stress disorder (PTSD) was measured using the Impact of Event Scale revised (IES-R) scale, and the DASS-21 was used to measure anxiety, depression, and stress among participants. Compensatory behaviors used by HCWs to manage these symptoms were also investigated. The majority of participants (72.5%) experienced moderate to severe distress during the COVID-19 pandemic. The majority of participants (53.1%) reported symptoms of mild to extremely severe depression. Overall, nurses, female, and frontline HCWs experienced more stress, anxiety, and depression (P < .001). Leisure activities (29%), sport (19%), and drinking tea/coffee (19%) were the most common compensatory behaviors. Our findings suggest that psychological support and interventions targeting high-risk HCWs with heavy psychological distress are needed. It is of paramount importance to improve the psychological endurance and safeguard the mental and physical well-being of HCWs, who find themselves on the frontline of health and humanitarian crises, when they are needed the most.

Acceptability of COVID-19 vaccination among health care workers: a cross-sectional survey in Morocco.

INTRODUCTION: This study aimed to evaluate the acceptability of COVID-19 vaccination among health care workers prior to the start of the COVID-19 vaccination campaign in Morocco. METHODS: This cross-sectional study was conducted in the Cheikh Khalifa University Hospital of Casablanca-Morocco. Utilizing a web-based platform surveys were distributed over a 3-week period via professional mailing list and social media. Odds ratios and 95% confidence intervals were estimated by using logistic regression models. RESULTS: A total of 303 health care workers participated in this study. The results showed a relatively high rate of vaccination acceptability (62.0%) among health care workers included in this study. Participants were more likely to accept the COVID-19 vaccine if they were physician, nurse, or technician (OR 1.79; 95% CI: 1.09-2.95), had high score of confidence in the information circulating about COVID-19 (OR 1.91; 95% CI: 1.36-2.69), or had high score of perceived severity of COVID-19 (OR 1.55; 95% CI: 1.11-2.15). Reasons of hesitation/or refusal of COVID-19 vaccine were fear of the likely side effects of the vaccine for 74.8% of participants, and concern about the effectiveness of the vaccine for 47.8%. CONCLUSION: This study showed a relatively high rate of the COVID-19 vaccination acceptance among health care workers in Morocco. Willingness to be vaccinated was significantly associated with job category, confidence in the information circulating about COVID-19, and perceived severity of COVID-19. These results could be useful in the development of educational interventions to increase the acceptance of COVID-19 vaccine among health care workers in Morocco and similar settings.

Facteurs prédictifs de la non-complétude vaccinale chez des enfants migrants de moins de 5 ans, Maroc.

INTRODUCTION: Despite several initiatives by the Moroccan health ministry to protect migrants' rights to health services, the vaccination of migrant children remains a public health issue. AIM OF THE STUDY: The objective of this study was to measure the vaccination coverage and identify the factors associated with the non-completion of vaccination of sub-Saharan migrant children under 5 years of age in the city of Casablanca. METHODS: Based on an analytical cross-sectional study, snow-ball sampling was conducted and a questionnaire was given to sub-Saharan migrant mothers of children under 5. The results of the descriptive analyses and the Chi test led to the elaboration of a predictive model through a multivariate logistic regression. The information collected included socio-demographic characteristics, factors linked to accessibility to vaccination services, the mothers' knowledge and perception of vaccination. RESULTS: Approximately 57% of sub-Saharan migrant children under 5 were incompletely or non-vaccinated. The factors significantly associated with vaccination status after the multivariate analysis were the mothers' educational levels (4.895 [1.907-12.562]), professional status (0.411 |0.206-0.821]), knowledge about the advantage of vaccination (0.035 [0.004-0.309]), the vaccination calendar (6.854 [3.172-14.813]), the waiting period (0.115 [0.051-0.261]), administrative barriers (7.572 |2.004-28.617]) and psychological barriers (0.086 [0.043-0.170]). CONCLUSION: The vaccination status of migrant children under 5 years of age in the city of Casablanca remains a public health issue and requires better healthcare coverage in order to improve the vaccination situation in this vulnerable population.

Level of Knowledge on Stroke and Associated Factors: A Cross-Sectional Study at Primary Health Care Centers in Morocco.

Background: Stroke is increasingly becoming a major cause of disability and mortality. However, it can be prevented by raising awareness about risk factors and early health care management of patients. Objective: The aim of this study is to assess the level of knowledge on stroke, its risk factors, and warning signs in the population attending urban primary health care centers in the city of Agadir, Morocco. Methods: This is a multicentric cross-sectional study with a descriptive and analytical purpose. The study was conducted at five urban primary health care centers in Agadir in centralwest Morocco. All persons over the age of 18 years who consulted the health centers and who agreed to fill in the questionnaire were recruited, except for the foreign population and health workers. An interview questionnaire was used to assess the level of knowledge on stroke. Findings: A total of 469 participants were involved in the study. The median knowledge score was 8 (Interquartile range 4-13). High blood pressure (55.7%), depression and stress (48.8%) were the most well-known risk factors. Sudden weakness of the face, arms or legs (37.3%) was the main warning sign cited by the participants. Multivariate analysis revealed that illiteracy (OR 1.92; CI95%: 1.08-3.44) primary education (OR 3.43; CI95%: 1.63-7.21), rural residential (OR 1.67; CI95%: 1.07-2.59), no history of stroke among respondents (OR 16.41; CI95%: 4.37-61.59) and no history of stroke among relatives, acquaintances, or neighbors (OR 4.42; CI95%: 2.81-6.96), were independently associated with a lower level of knowledge of stroke (Table 4). Conclusions: The low level of knowledge on stroke among this Moroccan population indicates the importance of implementing stroke education initiatives in the community. More specifically, proximity education and awareness programs ought to be considered to anchor lifestyle preventive behaviors along with appropriate and urgent actions regarding the warning signs of stroke.

Evaluation of Vitamin D Status in Rheumatoid Arthritis and Its Association with Disease Activity across 15 Countries: "The COMORA Study".

The aims of this study are to evaluate vitamin D status in 1413 RA patients of COMORA study from 15 countries and to analyze relationship between patients' RA characteristics and low levels of vitamin D. All demographic, clinical, and biological data and RA comorbidities were completed. The results showed that the average of vitamin D serum dosage was 27.3 ng/mL ± 15.1 [0.1-151]. Status of vitamin D was insufficient in 54.6% and deficient in 8.5% of patients. 43% of RA patients were supplemented with vitamin D and absence of supplementation on vitamin D was related to higher prevalence of vitamin D deficiency (p < 0.001). Finally, our study shows that the status of low levels of vitamin D is common in RA in different countries and under different latitudes. Absence of supplementation on vitamin D was related to higher prevalence of vitamin D deficiency. Low levels of vitamin D were associated with patients characteristics (age, BMI, and educational level), RA (disease activity and corticosteroid dosage), and comorbidities (lung disease and osteoporosis therapy). This suggests the need for a particular therapeutic strategy to improve vitamin D status in RA patients.