RESUMO
BACKGROUND: Morocco hopes to eliminate leishmaniases by 2030. These diseases exist in cutaneous and visceral forms and constitute a serious public health problem. The fight against these parasitoses is carried out within the framework of a national program to control leishmaniases, which offers free treatment. However, the screening rate in public health structures does not exceed 35%. OBJECTIVE: To determine the knowledge and experience of the social actors directly involved in the fight against leishmaniasis to contribute to analyse and understand the factors of this underreporting and to draw scientific recommendations to improve screening and control activities. METHODS: Using a self-administered questionnaire, we conducted an exploratory survey during April and May 2019 among all health professionals working in public health structures in the province of ELHajeb in central Morocco. RESULTS: We found that most of the health professionals had good knowledge about the clinical signs of each form of leishmaniasis, but they had erroneous information about the true vector of the disease, the reservoirs, and the mode of transmission. 76% recognized the national leishmaniases control program and only 17% received continuing education. 85% of these professionals focused on the curative aspects of the program. 47% stated that patients do not adhere to the antileishmaniasis treatment, and 25% stated that the population uses the concept of "Hboub of Chniwla" to refer to cutaneous leishmaniasis. CONCLUSION: The study concluded that the operationalization of the activities of the leishmaniases control program recognizes some weaknesses which explain the underscreening of cases. Improvement of this situation requires the implementation of continuous training programs for caregivers and awareness-raising programs for citizens which should focus on the mode of transmission, preventive measures against reservoirs, sand flies bites, and recognition of lesions using the popular names of the disease as a starting point.
RESUMO
BACKGROUND: Parasitic diseases, in particular leishmaniasis, are still a public health problem in several countries and in Morocco. METHODS: The data used are those of epidemiological surveillance collected in the registers of the prefectural epidemiology cell (PEC); however, the socioeconomic data were obtained from the High Commissioner for Planning. The Pearson correlation test was used to determine the correlation between the different variables. RESULTS: In total, 70 cases were recorded by the prefectural epidemiology cell (PEC) during the period from 2009 to 2015. 46% of the cases come from rural areas while 54% of the cases come from urban areas. The Pearson test shows the existence of a significant relationship between the number of cases recorded and the type of environment (r = 0.49, p value = 0.02), and population rate (R = 0.849 and p ≤ 0.001). However, in our case, the poverty rate does not influence CL's distribution. CONCLUSION: Our results show that the CL affects the majority of the municipalities with predominance of the urban environment, so the distribution of cases of this pathology is not influenced by the poverty; however, the urbanization and the number of inhabitants have a positive impact on the distribution of this scourge.
RESUMO
Phlebotomine sandflies are bloodsucking insects responsible for the transmission of leishmaniasis. The average annual incidence in Morocco, of this pathology, was approximately estimated in 2014 as 7.8 per 100.000 inhabitants according to the Moroccan health information service records. The study of the composition of the Phlebotomian community and its seasonal dynamics are essential for determining the appropriate and adequate means of control at the prefecture of Meknes in Central Morocco. It is with this in mind that two capture sessions per month using sticky paper traps were conducted at the sites of sandflies. A total of 982 sandflies were captured. The identification of the specimens found via the Moroccan key revealed a percentage of 73.3% belonging to the subgenus Paraphlebotomus, 6.3% to the Phlebotomus subgenus, 16.2% to Larroussius, and 4.2% of Sergentomia subgenus. Phlebotomus sergenti, vector of human cutaneous leishmaniasis, was found as the more abundant with 73.3% followed by Larroussius longicuspis with 8.2%. The largest number of species was harvested in July and September with, respectively, 44.8 ph/m2/night and 48.7 ph/m2/night. This study also unveiled that the two high-risk Leishmanian months are July and September, hence, the need to strengthen efforts to monitor and control this disease during the vector activity period.
Les phlébotomes sont des insectes hématophages vecteurs de la leishmaniose. L'incidence moyenne annuelle de cette affection au Maroc a été approximativement estimée en 2014 à 7,8 pour 100 000 habitants selon les registres du service de l'information sanitaire marocaine. L'étude de la composition du peuplement phlébotomienne et celle de la dynamique saisonnière des espèces locales sont indispensables pour déterminer les moyens de lutte contre cette pathologie. Dans cette optique, deux séances de capture par mois en utilisant des pièges adhésifs ont été effectuées pour déterminer les espèces phlébotomiennes et leurs fluctuations saisonnières dans la préfecture de Meknès au centre du Maroc. Neuf cent quatre-vingt-deux phlébotomes ont été identifiés, dont 73,3 % du sous-genre, Paraphlebotomus, 6,3 % du sous-genre Phlebotomus, 16,2 % du sous-genre Larroussius et 4,2 % du sous-genre de Sergentomia. Phlebotomus sergenti, vecteur de la leishmaniose cutanée humaine, est le plus abondant avec 73,3 % suivi par Larroussius longicuspis avec 8,2 %. Le maximum d'espèces a été récolté aux mois de juillet et septembre avec respectivement 44,8 et 45,8 phlébotomes/m2 par nuit (ph/m2 par nuit). Cette étude montre que les deux mois à haut risque leishmanien se situent en juillet et septembre, d'où la nécessité de renforcer les efforts de lutte contre cette maladie durant ces périodes.