Risk factors for hypertension among the adult Moroccan population.

This study used data from the Moroccan national survey in 2000 to identify the principle risk factors for hypertension in a representative sample of the population age 20+ years. The risk of hypertension increased steadily with age and was higher among rural residents (OR = 1.42) and those with diabetes (OR = 1.72). The risk increased with increased body mass index, waist size and hypercholesterolaemia. The risk of hypertension decreased by 36% and 46% respectively for those who walked 30-60 min and > 60 min daily. Consumption of fish and fresh fruits 1+ times per week was associated with a lower risk. Among those with hypertension, only 21.9% were previously diagnosed and 8.8% were under medical treatment.

Adiposity in women and children from transition countries predicts decreased iron absorption, iron deficiency and a reduced response to iron fortification.

BACKGROUND: Overweight is increasing in transition countries, while iron deficiency remains common. In industrialized countries, greater adiposity increases risk of iron deficiency. Higher hepcidin levels in obesity may reduce dietary iron absorption. Therefore, we investigated the association between body mass index (BMI) and iron absorption, iron status and the response to iron fortification in populations from three transition countries (Thailand, Morocco and India). METHODS: In Thai women (n=92), we examined the relationship between BMI and iron absorption from a reference meal containing approximately 4 mg of isotopically labeled fortification iron. We analyzed data from baseline (n=1688) and intervention (n=727) studies in children in Morocco and India to look for associations between BMI Z-scores and baseline hemoglobin, serum ferritin and transferrin receptor, whole blood zinc protoporphyrin and body iron stores, and changes in these measures after provision of iron. RESULTS: In the Thai women, 20% were iron deficient and 22% were overweight. Independent of iron status, a higher BMI Z-score was associated with decreased iron absorption (P=0.030). In the Indian and Moroccan children, 42% were iron deficient and 6.3% were overweight. A higher BMI Z-score predicted poorer iron status at baseline (P<0.001) and less improvement in iron status during the interventions (P<0.001). CONCLUSIONS: Adiposity in young women predicts lower iron absorption, and pediatric adiposity predicts iron deficiency and a reduced response to iron fortification. These data suggest the current surge in overweight in transition countries may impair efforts to control iron deficiency in these target groups. Interactions of the 'double burden' of malnutrition during the nutrition transition may have adverse consequences.

Results of cohort analysis by category of tuberculosis retreatment cases in Morocco from 1996 to 2003.

OBJECTIVE: To analyse treatment outcomes by subcategory of tuberculosis (TB) retreatment cases. METHODS: All TB patients treated with the Category II regimen from 1996 to 2003 in Morocco were enrolled in this retrospective study. For each cohort, the retreatment outcome data were analysed as a whole and by the following sub-categories: 1) cases who relapsed after one course of anti-tuberculosis treatment; 2) cases who failed the Category I regimen; and 3) cases who interrupted one course of anti-tuberculosis treatment. RESULTS: The study population included 14 635 retreatment patients, among whom 81.7% were TB relapse cases, 5.2% had failed the Category I regimen and 13.1% were defaulters. The average treatment success rates were respectively 74.8% (range 71.8-76.6), 58.0% (range 52.4-74.0) and 51.4% (range 46.4-55.6) among relapse, failure and default cases. Failure and default rates were significantly higher (P < 0.001) among patients who failed Category I treatment and among those who defaulted, respectively. CONCLUSIONS: TB cases who fail the Category I regimen should systematically receive drug susceptibility testing, while defaulters should be given support to improve treatment adherence. Stratified cohort analysis by subcategory of retreatment has been shown to be useful for evaluating the performance of TB control programmes.

Thyroid ultrasound compared with World Health Organization 1960 and 1994 palpation criteria for determination of goiter prevalence in regions of mild and severe iodine deficiency.

OBJECTIVES: In 1994, WHO/International Council for the Control of Iodine Deficiency Disorders recommended replacing the WHO 1960 four-grade goiter classification with a simplified two-grade system. The effect of this change in criteria on the estimation of goiter prevalence in field studies is unclear. In areas of mild iodine deficiency disorders (IDD) where goiters are small, ultrasound is preferable to palpation to estimate goiter prevalence. However, in areas of moderate to severe IDD, goiter screening by palpation may be an acceptable alternative to thyroid ultrasound. To address these two issues, we compared WHO 1960 and 1994 criteria with thyroid ultrasound for determination of goiter prevalence in areas of mild and severe IDD in Morocco. DESIGN: A cross-sectional study of 400 six- to 13-year-old children from two mountain villages (Ait M'hamed and Brikcha) in rural Morocco was carried out. METHODS: Urinary iodine concentration (UI), whole blood TSH and serum thyroxine were measured. Thyroid size was graded by inspection and palpation by two examiners using both WHO 1960 and 1994 criteria. Thyroid volume was determined by ultrasound. Variation between examiners and examination methods was assessed. Sensitivity and specificity of the two classification systems compared with ultrasound were calculated. RESULTS: Median UIs in Aït M'hamed and Brikcha were 183 and 24 microg/l respectively. In Ait M'hamed, using 1960 and 1994 criteria, goiter prevalence was 21 and 26% respectively, compared with 13% by ultrasound. In Brikcha, with 1960 and 1994 criteria, goiter prevalence was 64 and 67% respectively, compared with 64% by ultrasound. Agreement between observers was better with the 1994 criteria than with the 1960 criteria in Ait M'hamed (kappa=0.53 and 0.47 respectively), while in Brikcha observer agreement was similar with the two systems (kappa=0.67). Using either the 1994 or 1960 criteria, agreement with ultrasound was only moderate in Ait M'hamed (kappa=0.41-0.44), but good in Brikcha (kappa=0.55-0.64). Overall, compared with ultrasound, sensitivity increased 3-4% using 1994 criteria, while specificity decreased 4-5%. CONCLUSIONS: The WHO 1994 criteria are simpler to use than the 1960 criteria and provide increased sensitivity with only a small reduction in specificity. Agreement between observers is better with the 1994 criteria than with the 1960 criteria, particularly in areas of mild IDD. Like the 1960 criteria, the 1994 criteria overestimate goiter prevalence in areas of mild IDD, compared with ultrasound. However, the 1994 palpation criteria provide an accurate estimate of goiter prevalence in areas of severe IDD, and may be an acceptable and affordable alternative to thyroid ultrasound in these areas.

[Epidemiological descriptive approach of cancer in Morocco through the activity of the National Institute of Oncology. 1986-7]. / Approche épidémiologique descriptive du cancer au Maroc à travers l'activité de l'Institut national d'oncologie. 1986-1987.

The Hospital registry data of the Moroccan National Oncology Institute--which is the main structure in the field--are presented here. We collected 5,148 files between 1986 and 1987. Descriptive epidemiological aspects of the most frequent cancer sites are given. Cervix uterine neoplasia is the most common carcinoma in females (35%) followed by breast cancer (22.3%). In males, nasopharyngeal cancer accounts for 12.3%, lymphoma 10.1%, larynx cancer 8.2% and lung cancer 6.5%. These data, although, constitute a starting point to a more complete approach of cancer epidemiology in Morocco; Especially since October 1, 1990 when the population--based cancer registry of Rabbat-Sale Wilaya was started.

[Over-estimation of incidence in the Quebec Tumor Registry 1981-1982]. / Surestimation de l'incidence au Fichier des Tumeurs du Québec en 1981-1982.

Since 1981, the Quebec Tumor Registry (FTQ) is using form AH-101P which is filled out for all patients seeking care in Quebec hospitals. From a list of 8,000 names in 1981-82, we have found that 4.8% was constituted of cases reported 2, 3 and 4 times. In two major hospitals, we have checked 71 medical records of patients reported more than once to FTQ using the AH-101P form with what was found in the hospital records. Only 6 multiple cancers (8.5%) were found. All other cases were constituted of invasions, infiltrations or metastasis. It is concluded that, despite the new procedure, cancer incidence is still overestimated in FTQ in 1981-82 but this problem should disappear in the near future.

The viral origin of cervical cancer in Rabat, Morocco.

In Northern Africa, cervical cancer is the second most common cancer among women. The diagnosis is usually made in advanced stages, and mortality is high, yet few studies have investigated the role of human papillomavirus (HPV) and other risk factors in the etiology of cervical cancer. A hospital-based case-control study was completed at the Institut National d'Oncologie (INO) in Rabat, Morocco. The study included 214 cases of invasive cervical cancer and 203 controls. A structured questionnaire was used to investigate known and suspected risk factors for cervical cancer. A GP 5+/6+ polymerase chain reaction system was used to detect the presence of HPV DNA and HPV type distribution. Probes for 30 HPV types were used in one research laboratory. HPV DNA was the central risk factor and accounted for the large majority of the cases. The adjusted odds ratio (ORa) for any HPV was 61.6 (95% CI, 29.2-130) and the corresponding HPV attributable fraction (AF) was 92%. Among cases of cervical cancer, HPV 16 was the most common type (67.7%) followed by HPV 18. The HPV type-specific prevalence was similar for squamous cell carcinomas and adenocarcinomas. In multivariate adjusted or HPV-stratified analyses, in addition to the strong effect of HPV, other risk factors identified were sexual intercourse with multiple partners before the age of 20 and low socio-economic status. Use of oral contraceptives for 5 or more years and high parity were also found to be related to cervical cancer. Screening was rare in this population but offered substantial protection against cervical cancer. In Morocco, cervical cancer is a late sequel of a viral infection with certain HPV types. Developing screening programs for preneoplastic cervical lesions is a public health priority. When available, HPV vaccination would offer a relevant alternative for preventing cervical cancer.

Risk factors for hypertension among the adult Moroccan population

This study used data from the Moroccan national survey in 2000 to identify the principle risk factors for hypertension in a representative sample of the population age 20+ years. The risk of hypertension increased steadily with age and was higher among rural residents [OR = 1.42] and those with diabetes [OR = 1.72]. The risk increased with increased body mass index, waist size and hypercholesterolaemia. The risk of hypertension decreased by 36% and 46% respectively for those who walked 30-60 min and > 60 min daily. Consumption of fish and fresh fruits 1+ times per week was associated with a lower risk. Among those with hypertension, only 21.9% were previously diagnosed and 8.8% were under medical treatment