Trends and Factors Affecting Knowledge of and Stigma and Violence Towards Female Sex Workers in Morocco.

BACKGROUND: We investigate factors affecting HIV knowledge, stigma, and violence among female sex workers (FSW) in Agadir, Rabat, Fes, and Tangier, Morocco, over three rounds of HIV surveillance surveys (2012, 2016, and 2019) conducted using respondent-driven sampling (RDS). Multivariable analyses from RDS studies examining the relationships between variables are under-utilized, particularly analyses that combine multiple locations and years of data together in a principled manner. METHOD: We fit three weighted logistic regression models for HIV transmission knowledge, having been denied service (experienced stigma), and having been hit (experienced violence) in the last 12 months, and perform model selection using 41 possible explanatory variables. RESULTS: Variables significantly associated with higher risk included reasons for sex work, how FSW solicit clients, if female family members are also involved in sex work, ever being forced to have sex, and ever being arrested or jailed. There were also significant differences between cities and in trends over time, with HIV transmission knowledge increasing and having been denied health services and having been hit decreasing. CONCLUSION: We found associations indicating that some particularly vulnerable FSW may be subject to multiple intersecting risks related to HIV knowledge, stigma, and violence which may decrease their agency to receive proper HIV testing, care, and treatment. Although Morocco has made excellent progress in providing HIV services to vulnerable populations, this additional analysis will be useful as Morocco makes programmatic decisions related to ending HIV by 2030.

Assessment of Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis prevalence using a molecular Point of Care: Findings from a respondent driven sampling study among MSM.

Objectives: Due to the limited data available within the Moroccan context, the aim of the study was therefore to estimate the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) infection and co-infection among men who have sex with men (MSM) as well as to update the behavioral indicators for this population. Methods: During the period of November 2020 to January 2021, 275 and 303 MSM in Agadir and Fes respectively, were recruited by using respondent-driven sampling protocol (RDS). Eligibility criteria for participants included men identified as having anal sex with another man in the last 6 months, aged 18 years or older and residing in either Agadir or Fes, regardless of their nationality, for the past 6 months.Anal swabs were collected from 445 respondents for molecular investigation of CT, NG, and TV. GeneXpert (Cepheid, USA) was used to test all samples. A survey on the socio-demographic, and risk behavior was then administered to participants. Results: Most MSM subjects were identified as being young, and homosexual. CT prevalence was 11.3% (95%CI, 7.2 to 15.4) and 12.5% (95%CI, 7.5 to 17.5) in Agadir and Fes respectively; NG was 13.3% (95%CI, 8.5 to 18.1) in Agadir and 5.5% (95%CI, 1.9 to 9.2) in Fes. Meanwhile, TV prevalence was 0.4% (95%CI, 0 to 1.1) in Agadir and 0.2% (95%CI, -0.2 to 0.6) in Fes. A CT/NG co-infection was found in 4.5% (95%CI, 3.5 to 5.9) of cases in Agadir and 2.7% (95%CI, 1.9 to 3.9), in Fes. Conclusion: It follows that a regular risk assessment and Sexually Transmitted Infectious (STIs) screening should be administered in these two cities as part of a global strategy to enhance the sexual health of the key populations in question.

Trend analysis of leprosy in Morocco between 2000 and 2017: Evidence on the single dose rifampicin chemoprophylaxis.

BACKGROUND: Morocco has achieved the goal of leprosy elimination as a public health problem several years ago (less than 1 case/ 10 000 habitant). The aim of this study was to analyze trends of leprosy detection during the last 17 years taking into consideration the implementation of single dose rifampicin chemoprophylaxis (SDRC) started in 2012. METHODOLOGY: Time series of leprosy cases detected at national level between 2000 and 2017. Variable collected for each year were leprosy per 100000 H, age category, gender, origin, regions, grade of disabilities and clinical forms. The detection time series was assessed by Joinpoint Regression Analysis. Annual percentage changes (APCs) were estimated to identify the years (joinpoint) when significant changes occurred in the trend. We therefore examined trends in leprosy detection according to epidemiological variables. FINDINGS: Joinpoint regression showed a reduction in the detection rate between 2000 and 2017. The APC for the period 2012-2017 (-16.83, 95% CI: -29.2 to -2.3, p <0.05) was more pronounced than that of the previous period 2000-2012 (- 4.68, 95% CI: -7.3 to -2.0, p <0.05); with a significant break in the same joinpoint year SDRC implementation. In stratified analysis, case detection decreased, but not significantly, after the joinpoint years in men, children, multi-bacillary cases, grade 0-1 disabilities, rural and urban cases and in ten regions. CONCLUSIONS: Leprosy detection was declining over years with a significant reduction by 16% per year from 2012 to 2017. SDRC may reduce leprosy detection over the years following its administration.

Measuring quality of life in patients with psoriasis using the Arabic version for Morocco of the Dermatology Life Quality Index.

BACKGROUND: Psoriasis has been demonstrated to have substantial impacts on dermatology-related functional limitations and health-related quality of life (HRQL). This study evaluated the HRQL in Moroccan psoriatics using the Arabic version of the Dermatology Life Quality Index (DLQI) and examined the psychometric properties of the questionnaire. MATERIALS AND METHODS: The Moroccan Arabic version of the DLQI was developed and approved by the author of the questionnaire. The DLQI was administered to inpatient and outpatient adult psoriatics. Some participants completed the DLQI for a second time. Demographic and clinical characteristics were collected. Reliability of the DLQI was tested using Cronbach's coefficient alpha and intraclass correlation coefficient (ICC). Factor structure was tested by explanatory and confirmatory factor analysis. Construct validity was tested by known-groups comparison using the generalized linear model to assess factors influencing patients' HRQL. RESULTS: A total of 176 psoriatics completed the questionnaire. The mean age was 36 ± 14 years. The mean Psoriasis Area and Severity Index (PASI) score was 11.8 ± 7.9. The mean DLQI score was 12.7 ± 5.9 (the higher the score the greater the impairment of HRQL). Cronbach's alpha coefficient was 0.84. ICC was 0.97. The principal component analysis confirmed the bidimensional structure of the questionnaire. Factors associated with poorer HRQL were higher PASI (P < 0.001), pustular and erythrodermal clinical forms (P < 0.001), and older age (P = 0.001). CONCLUSIONS: The Arabic version for Morocco of the DLQI is reliable and valid. Severity of the psoriasis, older age, and severe clinical forms influence the HRQL of patients.

Prevalence of hospital-acquired infections in the university medical center of Rabat, Morocco.

BACKGROUND: The aims of this study were to determine the hospital-acquired infections (HAI) prevalence in all institutions of Rabat University Medical Center, to ascertain risk factors, to describe the pathogens associated with HAI and their susceptibility profile to antibiotics. MATERIALS AND METHODS: Point-prevalence survey in January 2010 concerning all patients who had been in the hospital for at least 48 hours. At bedside, 27 investigators filled a standardized questionnaire from medical records, temperature charts, radiographs, laboratory reports and by consultation with the ward's collaborating health professionals. Risk factors were determined using logistic regression. RESULTS: 1195 patients involved, occupancy rate was 51%. The prevalence of HAI was 10.3%. Intensive care units were the most affected wards (34.5%). Urinary tract infection was the most common infected site (35%). Microbiological documentation was available in 61% of HAI. Staphylococcus was the organism most commonly isolated (18.7%) and was methicillin-resistant in 50% of cases. In multivariate analysis, risk factors associated with HAI were advanced age, longer length of hospital stay, presence of comorbidity, invasive devices and use of antibiotic use. CONCLUSION: HAI prevalence was high in this study. Future prevention program should focus on patients with longer length of stay, invasive devices, and overprescribing antibiotics.

Measuring quality of life after intensive care using the Arabic version for Morocco of the EuroQol 5 Dimensions.

BACKGROUND: Health-related quality of life (HRQL) is a relevant outcome measures in intensive care unit (ICU). The aim of this study was to evaluate HRQL of ICU patients 3 months after discharge using the Arabic version for Morocco of the EuroQol-5-Dimension (EQ-5D), and to examine the psychometric properties of the questionnaire. RESULTS: The Arabic version for Morocco of the EQ-5D was approved by the EuroQol group. A prospective cohort study was conducted after medical ICU discharge. At 3-month follow up, the EQ-5D (self classifier and EQ-VAS) was administered in consultation or by telephone. EQ-VAS varies from 0 (better HRQL) to 100 (worst HRQL). An unweighted scoring for EQ5D-index was calculated. EQ5D-index ranges from -0.59 to 1. Test-retest reliability of the EQ-5D was tested using Kappa coefficient and intraclass correlation coefficient (ICC). Criterion validity was assessed by correlating EQ-VAS and EQ5D-index with the Short Form 36 (SF-36). Construct validity was tested using simple and multiple liner regression to assess factors influencing patients'HRQL. 145 survivors answered the EQ-5D. Median EQ5D-index was 0.52 [0.20-1]. Mean EQ-VAS was 62 ± 20. Test-retest reliability was conducted in 83 patients. ICCs of EQ5D-index and EQ-VAS were 0.95 and 0.92 respectively. For EQ-5D self classifier, agreement by kappa was above 0.40. Significant correlations were noted between EQ5D-index, EQ-VAS and SF-36 (p < 0.001). In multivariate analysis, factors associated with poorer HRQL for EQ5D-index were longer ICU length of stay (ß = -0.01; p = 0.017) and higher educational level (ß = -0.2; p = 0.001). For EQ-VAS men were associated with better HRQL (ß = 6.5; p = 0.048). CONCLUSIONS: The Arabic version for Morocco of the EQ-5D is reliable and valid. Women, high educational level and longer ICU length of stay were associated with poorer HRQL.

Incidence of medication errors in a Moroccan medical intensive care unit.

BACKGROUND: Medication errors (ME) are an important problem in all hospitalized populations, especially in intensive care unit (ICU). The aim of the study was to determine incidence, type and consequences of ME. MATERIALS AND METHODS: Prospective observational cohort study during six weeks in a Moroccan ICU. Were included all patients admitted for > 24 hours. ME were collected by two reviewers following three methods: voluntary and verbally report by medical and paramedical staff, chart review and studying prescriptions and transcriptions. Seriousness of events was classified from Category A: circumstances or events that have the capacity to cause error, to Category I: patient's death. RESULTS: 63 patients were eligible with a total of 509 patient-days, and 4942 prescription. We found 492 ME, which incidence was 10 per 100 orders and 967 per 1000 patient-days. There were 113 potential Adverse Drug Events (ADEs) [2.28 per 100 orders and 222 per 1000 patient-days] and 8 ADEs [0.16 per 100 orders and 15.7 per 1000 patient-days]. MEs occurred in transcribing stage in 60%cases. Antibiotics were the drug category in 33%. Two ADEs conducted to death. CONCLUSION: MEs are common in Moroccan medical ICU. These results suggest future targets of prevention strategies to reduce the rate of ME.

Eosinopenia, an early marker of increased mortality in critically ill medical patients.

PURPOSE: Inflammatory markers may have a role in predicting severity of illness of intensive care unit (ICU) patients. The aim of this study is to determine whether low eosinophil count can predict 28-day mortality in medical ICU. METHODS: A prospective study over a 4-month period. To evaluate the prognosis information provided by eosinophil count, we compared the variations in eosinophil count from ICU admission to seventh day between patients who survived and those who died. The best cutoff value was chosen using Younden's index for identification of patients with high risk of mortality. The patient outcome was 28-day mortality. RESULTS: A total of 200 patients were eligible. Overall 28-day ICU mortality was 28% (n = 56). At ICU admission, the median eosinophil count was significantly different in survivors [30 cells/mm³; interquartile range (IQR), 0-100 cells/mm³] and nonsurvivors (0 cells/mm³; IQR, 0-30 cells/mm³; P = 0.004). Absolute eosinophil counts remained significantly lower in nonsurvivors from admission to seventh day. The 28-day mortality was significantly higher in patients with eosinopenia <40 cells/mm(3) (P = 0.011). Multivariate analysis by Cox model with time-dependent covariates demonstrated that eosinophil count <40 cells/mm(3) [hazard ratio (HR), 1.85; 95% confidence interval (CI), 1.01-3.42; P = 0.046], high Acute Physiology and Chronic Health Evaluation (APACHE) II score (HR, 1.08; 95% CI, 1.01-1.14; P = 0.014), high Sequential Organ Failure Assessment (SOFA) score (HR, 1.14; 95% CI, 1.03-1.25; P = 0.008), and use of mechanical ventilation (HR, 27.48; 95% CI, 12.12-62.28; P < 0.001) were independent predictors of 28-day all-cause mortality. CONCLUSION: This study suggests the possibility to use eosinophil cell count at admission and during the first 7 days as a prognosis marker of mortality in medical ICU.

Measuring the satisfaction of intensive care unit patient families in Morocco: a regression tree analysis.

OBJECTIVE: Meeting the needs of patients' family members becomes an essential part of responsibilities of intensive care unit physicians. The aim of this study was to evaluate the satisfaction of patients' family members using the Arabic version of the Society of Critical Care Medicine's Family Needs Assessment questionnaire and to assess the predictors of family satisfaction using the classification and regression tree method. DESIGN: The authors conducted a prospective study. SETTING: This study was conducted at a 12-bed medical intensive care unit in Morocco. PATIENTS: Family representatives (n = 194) of consecutive patients with a length of stay >48 hrs were included in the study. INTERVENTION: Intervention was the Society of Critical Care Medicine's Family Needs Assessment questionnaire. MEASUREMENTS AND MAIN RESULTS: Demographic data for relatives included age, gender, relationship with patients, education level, and intensive care unit commuting time. Clinical data for patients included age, gender, diagnoses, intensive care unit length of stay, Acute Physiology and Chronic Health Evaluation, MacCabe index, Therapeutic Interventioning Scoring System, and mechanical ventilation. The Arabic version of the Society of Critical Care Medicine's Family Needs Assessment questionnaire was administered between the third and fifth days after admission. Of family representatives, 81% declared being satisfied with information provided by physicians, 27% would like more information about the diagnosis, 30% about prognosis, and 45% about treatment. In univariate analysis, family satisfaction (small Society of Critical Care Medicine's Family Needs Assessment questionnaire score) increased with a lower family education level (p = .005), when the information was given by a senior physician (p = .014), and when the Society of Critical Care Medicine's Family Needs Assessment questionnaire was administered by an investigator (p = .002). Multivariate analysis (classification and regression tree) showed that the education level was the predominant factor contributing to the Society of Critical Care Medicine's Family Needs Assessment questionnaire score. Society of Critical Care Medicine's Family Needs Assessment questionnaire increased (greater satisfaction) with a higher education level. Other factors of great satisfaction included the senior physician providing the information, and Acute Physiology and Chronic Health Evaluation <15. CONCLUSIONS: Satisfaction of intensive care unit patients' families in a Moroccan sample using the classification and regression tree was dependent on relatives' education level, communication presented by senior caregiver, and low Acute Physiology and Chronic Health Evaluation score. These data underline cultural specificities of the study and suggest that caregivers should develop structured communication programs considering satisfaction predictors.

Eosinopenia is a reliable marker of sepsis on admission to medical intensive care units.

INTRODUCTION: Eosinopenia is a cheap and forgotten marker of acute infection that has not been evaluated previously in intensive care units (ICUs). The aim of the present study was to test the value of eosinopenia in the diagnosis of sepsis in patients admitted to ICUs. METHODS: A prospective study of consecutive adult patients admitted to a 12-bed medical ICU was performed. Eosinophils were measured at ICU admission. Two intensivists blinded to the eosinophils classified patients as negative or with systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, or septic shock. RESULTS: A total of 177 patients were enrolled. In discriminating noninfected (negative + SIRS) and infected (sepsis + severe sepsis + septic shock) groups, the area under the receiver operating characteristic curve was 0.89 (95% confidence interval (CI), 0.83 to 0.94). Eosinophils at <50 cells/mm3 yielded a sensitivity of 80% (95% CI, 71% to 86%), a specificity of 91% (95% CI, 79% to 96%), a positive likelihood ratio of 9.12 (95% CI, 3.9 to 21), and a negative likelihood ratio of 0.21(95% CI, 0.15 to 0.31). In discriminating SIRS and infected groups, the area under the receiver operating characteristic curve was 0.84 (95% CI, 0.74 to 0.94). Eosinophils at <40 cells/mm3 yielded a sensitivity of 80% (95% CI, 71% to 86%), a specificity of 80% (95% CI, 55% to 93%), a positive likelihood ratio of 4 (95% CI, 1.65 to 9.65), and a negative likelihood ratio of 0.25 (95% CI, 0.17 to 0.36). CONCLUSION: Eosinopenia is a good diagnostic marker in distinguishing between noninfection and infection, but is a moderate marker in discriminating between SIRS and infection in newly admitted critically ill patients. Eosinopenia may become a helpful clinical tool in ICU practices.

Prevalence of hospital-acquired infection in a Moroccan university hospital.

BACKGROUND: Infection control and hospital-acquired infection (HAI) prevalence reports from developing countries are often not well established because of the lack of staff and resources. The aim of this study was to estimate the prevalence of HAI in a Moroccan hospital as well as to identify its predisposing factors. METHODS: A one-day prevalence survey was conducted in April 2005 at Ibn Sina University Hospital which included all inpatients who had been in the hospital for at least 48 hours. RESULTS: Among 658 patients surveyed, the prevalence of HAI was 17.8%. The prevalence was higher in intensive care units (50%). The most frequently infected sites were urinary tract (35%) and surgical wounds (32.5%). Microbiological documentation was available in only 31.6% of HAIs. The most frequently isolated organisms were Staphylococcus aureus (30%) and Proteus mirabilis (25%). Results of multiple logistic regression analysis indicated that HAI is linked to the surgical category, a hospital stay of more than 10 days, and the use of intravascular and urinary devices. CONCLUSIONS: The prevalence of HAI is high at our center. This survey provided the principal information for future surveillance and prevention programs in Morocco.