[Quality of life of silicotic former miners]. / Qualité de vie des anciens mineurs silicotiques.

BACKGROUND: The aim of this study was to assess the respiration-related quality of life (QoL) of former miners with silicosis and to determine the factors that could affect QoL (socio-demographic and professional parameters, toxic habits, co-morbidities, and degree of respiratory disability). METHODS: This cross-sectional study involved 104 people who came for routine periodic consultation and included the medical records file and a questionnaire. RESULTS: The average age was 66.3±5.4 years. Functional respiratory symptoms were exertional dyspnoea (97.2%), cough (73.1%), sputum (59.6%) and wheezing (25%). Associated respiratory illnesses were asthma (29.8%), COPD (18.3%), persistent rhinitis (13.5%) and tuberculosis (5.8%). 3/4 of the miners had at least one comorbidity. The most common were cardiovascular (43.3%), metabolic (27.9%) and musculo-skeletal (25%). The ventilatory defects were mild in 27.9%, moderate in 57.7% and severe in 14.4%. The radiological lesions exceeded four zones of the pulmonary parenchyma in 81.8%. The average scores for "symptoms", "activities ¼, « impacts" and "total" were 49.1±14%, 77.8±12%, 66.5±16% and 67±16%, respectively. Age, duration of exposure, comorbidities, moderate to severe ventilatory defects, and significant to severe impairment were correlated with altered QoL. CONCLUSION: Improvement of QoL requires comprehensive care with the management of complications, co-morbidities, better patient awareness, and better consideration of the feelings of patients.

[Assessing knowledge, attitude, and practice on occupational blood exposure in caregiving facilities, in Morocco]. / Evaluation des connaissances, attitudes et pratiques sur les accidents d'exposition au sang en milieu de soins au Maroc.

OBJECTIVE: This study had for aim to evaluate practices and knowledge of infectious hazards, to determine the prevalence of viral infections related to occupational blood exposure among health care workers, and to propose a preventive policy. DESIGN: This descriptive multicentric and transversal epidemiological survey was carried out from 2003 to 2004 in 10 Moroccan cities. Two thousand eight hundred and forty four persons were contacted and 2086 accepted to answer the questionnaire (73.3 %). RESULTS: The mean age was 40.8+/-7.8 years and seniority 15.6+/-7.4 years. Blood was the most incriminated product (96.1%), followed by dirty linen and hospital waste. Instruments most often mentioned as dangerous were hollow needles (80.3%). The most feared infections were viral hepatitis (77.5%) and HIV (89.3%). Only 40.6% of the personnel were adequately vaccinated against hepatitis B. Post-vaccine serology was performed on only 1.8% of the vaccinated staff. During the last 12 months, 58.9% of the personnel underwent at least one occupational blood exposure 5.8% of which was reported. Universal precautions appeared poorly used as only 65.6% wore gloves for invasive acts and 61.5% correctly disinfected their hands. Re-sheathing used needles was frequent (51.2%). CONCLUSIONS: Infectious hazards in healthcare facilities are not sufficiently taken into account: the recent creation of occupational health services in hospital facilities should contribute to improve working conditions, make hepatitis B vaccination available and mandatory, and lead to more information and education on hazards related to occupational blood exposure for healthcare personnel.

[Infectious risks associated with blood exposure for traditional barbers and their customers in Morocco]. / Risque infectieux lié au sang chez les coiffeurs-barbiers traditionnels et leurs clients au Maroc.

The trade of traditional barber has continued to expose its practitioners and their customers to multiple infectious diseases. The objective of this work was to study the infectious risk associated with blood exposure in this population and to assess its knowledge of this occupational risk. A cross-sectional epidemiologic survey was conducted in the Casablanca region during 2001 among 150 barbers, all men. It included a medical-social questionnaire and a serology work-up (HIV, HCV, HBV, TPHA, VDRL). The subjects' mean age was 36.5 years +/- 14.7, they had worked in the trade for an average of 17.8 years +/- 8.7, and the socioeconomic status of most was low. Hygiene conditions were deficient. The concept of infectious risk associated with blood was generally not well known, especially for hepatitis B and C; most were not vaccinated. HIV serology was negative for all barbers. On the other hand, syphilis serology was positive for 7% by TPHA and for 4% by VDRL. HBV was positive in 2% and HCV in 5%. It is essential and urgent to promote awareness of these risks among all, especially the public authorities, and to formally ban barbers from the illegal practice of medicine for their own protection. All means of prevention must be used to protect the health of these workers and of the general population.

[The prevalence of respiratory symptomes and immediate hypersensitivity reactions in a population exposed to flour and cereal dust in five flour mills in Morocco]. / Prevalence des symptômes respiratoires et de sensibilisation de type immédiat dans un echantillon de minotiers au Maroc.

OBJECTIVE: To evaluate the prevalence of respiratory symptoms, ventilatory function disorder and immediate hypersensitivity reactions in a population exposed to flour and cereal dusts in five flour mills in Morocco. METHODS: The study of 373 exposed and 301 non-exposed subjects consisted of an analysis of working conditions and a medical survey. RESULTS AND CONCLUSION: The prevalence of clinical respiratory symptoms was 64.1% among exposed subjects and 41.2% among non-exposed subjects. Cough, expectoration, rhinitis, conjunctivitis, dermatitis, asthma and chronic bronchitis were more frequent among mill-workers. Spirometry was abnormal in 31.6% of those exposed: anomalies were found in both flow and volume. Among exposed subjects with a ventilatory disorder, 77.9% had only small airways syndrome or a light deficit. Smoking was the cause of excess morbidity. Skin prick tests were positive for at least one allergen in 65.4% of exposed compared to 27.2% non-exposed subjects. The prevalence of positive skin tests to occupational allergens alone was higher among those exposed (42.4%) than among the non-exposed (9.9%). The implementation of adequate medical and technical prevention may reduce this risk.

[Prevalence of respiratory problems in workers at two manufacturing centers of ready-made concrete in Morocco]. / Prévalences des troubles respiratoires chez les travailleurs de deux centrales de fabrication de béton prêt à l'emploi au Maroc.

SETTING: Employees at factories for ready-made concrete are exposed to the dust emanating from the products (such as sand, gravel and cement); however, there have been few studies on the subject. METHODS: A retrospective cohort analysis was conducted in a male population: 120 employees working in cement production and 120 non-exposed civil servants working at the Casa-Anfa prefecture. Each employee underwent interview by standardised questionnaire, spirometry test and standard chest radiography. RESULTS: Statistical analysis of the results revealed an increase in the prevalence of exposed symptomatic subjects compared to non-exposed subjects (57.5% vs. 24.2%) and increased prevalence of all of the symptoms: cough (15.8% vs. 15%), dyspnea (21.6% vs. 5%), chronic bronchitis (11.7% vs. 6.7%), asthma (14.2% vs. 7.5%), rhinitis (40% vs. 19.2%), conjunctivitis (48.3% vs. 10%) and dermatitis (22.5% vs. 6.7%). This increase is only statistically significant for dyspnea, rhinitis, conjunctivitis and dermatitis. Changes in lung function parametres were much more frequent among the workers at the two factories than among the non-exposed workers (40.8% vs. 11.7%). Tobacco also seemed to have an effect on respiratory deficit. Analysis of the chest radiographs of the exposed subjects, using the ILO international classification, revealed 19 (15.8%) abnormal films. CONCLUSIONS: Working conditions in cement factories must be improved rapidly (particularly collective technical prevention) and a medical service should be set up for regular management and follow-up of the workers.

[Study of tuberculosis in health care workers in the public sector of Morocco]. / Etude de la tuberculose chez les professionnels de santé du secteur public au Maroc.

SETTING: Tuberculosis is one of the most important causes of disease in Morocco, with an annual incidence of 100 cases per 100,000 population. There is a permanent risk of tuberculosis for health care workers in contact with bacillary positive tuberculosis patients. OBJECTIVE: To evaluate the risk and incidence of tuberculosis in health care workers and to study its distribution by cohort analysis. METHODS: A questionnaire was sent to all of the provinces and prefectures of the kingdom to gather information on tuberculosis cases notified between 1994 and 1997 in health care workers. RESULTS: Over the 4-year period, 130 new cases of tuberculosis were notified among health care workers in 30 provinces and prefectures: 73 men (56%) and 57 women (44%), with a mean age of 41.3 +/- 8.9 and 38.6 +/- 8.4 years, respectively (P = 0.093). The mean cumulative incidence was 85.3/100 000 health care workers; for doctors in specialist diagnostic centres for tuberculosis it was 1,094.8/100,000. The survey showed no significant difference between the mean annual cumulative incidences for doctors (83.4), nurses (78.5) and administrative staff (94.3). The cohort analysis indicated a mean annual success rate of 89.2%, failure rate of 0.9%, lost to follow-up 0.8%, death 3.8% and transfer out 3.1%. Several studies have shown weaknesses in the conditions of hygiene and security in the health centres (such as lack of gloves and masks, and meals taken within the workplace). CONCLUSION: The risk of tuberculosis is not much higher in health care workers in general than in the general population; however, it is significantly higher in the specialist diagnostic centres for tuberculosis. The recent creation of health units for personnel working in the health centres should result in improvements in working conditions if the recommended preventive measures are respected.

Organization and education in occupational safety and health in Maghreb countries.

The Maghreb consists of five countries of North Africa (Mauritania, Morocco, Algeria, Tunisia and Libya) which are members of a socio-economical community called the Union of Arab Maghreb. This paper discusses the organisation of occupational health, medical protection of workers and training in occupational safety and health in these countries. After a review of socio-economic and demographic data and legislative aspects, we report epidemiological and analytic data specific to each country concerning organisation and training in occupational health. Occupational medicine in Algeria, Morocco and Tunisia has progressed but some deficiencies are still observed at several levels. Like countries of the European Union, cooperation between the Maghreb countries in occupational health and safety seems indispensable.

[Health risks study in a pottery environment in Morocco]. / Etude des risques professionnels chez les potiers au Maroc.

Morocco is famous for its potteries, the largest of which are located at Rabat, Safi, Marrakech and Fes. This cross-sectional, descriptive epidemiological survey was carried out over an eight-month period, from January to August 1997. The study population consisted of 290 male workers from 36 workshops. The study involved a social and medical survey (a questionnaire and medical examination for all workers, with biological assessment for a representative sample of 95 craftsmen) and an analysis of the working conditions in which atmospheric pollution at the pottery was evaluated. Atmospheric concentrations of zinc, copper, iron, chrome and lead were determined. Only lead levels were found to be significantly high and were analyzed on three occasions. This study demonstrates poor working conditions and a lack of respect for the regulations concerning specific prevention measures and the health rules applicable to establishments where personnel are routinely exposed to the risk of lead poisoning. Various pathological conditions were observed, with the following prevalences: skeletal muscle 67.6%, dermatological 8.3%, digestive 58%, respiratory 28% and neurological 35.5%. Several nonspecific, often minor, clinical signs were recorded for most of the potters but the toxicological analysis confirmed lead contamination in 74% of the exposed subjects (plasma lead concentration, CPU, ALAU). The potteries of Morocco are not subject to any protection. Special technical and medical surveillance should be introduced and the laws concerning exposure to lead should be applied.

[Prevalence of respiratory systems and evaluation of sensitization levels in traditional grain market workers in Casablanca]. / Prévalence des symptômes respiratoires et évaluation du degré de sensibilisation chez les ouvriers du souk de céréales de Casablanca.

Our study proposes to evaluate the prevalence of clinical respiratory symptoms, spirometric abnormalities and allergy skin test sensitivities in two groups: on exposed to grain dust in a big traditional grain market in Casablanca and the other unexposed. The inquiry which concerned 277 exposed workers and 230 non exposed consisted of a questionnaire, spirometric examinations and skin prick testings. Exposed and no exposed groups are statically similar as far as physical data (sex, age, weight, heignt) and smoking habits. The atopy was found among 18% of the exposed. The prevalence of clinical respiratory symptomatology among exposed is 64.3% against 24.8% among non exposed. Respiratory symptoms (cough, expectoration), rhinitis, asthma, conjonctivitis, dermatitis, chronic bronchitis were significantly more frequent in those exposed than in the non exposed. Smoking is at the origin of additional morbidity. Atopy seems to be a potentiating factor as all the atopic people exposed are symptomatic. Respiratory function was altered in 37.1% of those exposed versus 12.8% of those no exposed. Among exposed workers with decline of lung function parameters 68.9% have only light anomalies. Tabacco interferes significantly in the alteration of respiratory function parameters. Work exposure to grain associated with smoking resulted in a reduction in respiratory function values. In grain workers, the prevalence of allergy skin test sensitivities of occupational allergens is 30.3% versus 6.9% among those no exposed. The enquiry in the workplace shows complete absence of means of protection for the work force and elevated levels of dust. It is imperative to implement an occupational health service and to develop means for collective and individual prevention to maximally reduce the risk.

[Child labor in the artisan sector of Morocco: determinants and health effects]. / Le travail de l'enfant dans l'artisanat marocain: déterminants et effets sur la santé.

Despite the fact that child labour is regulated through the work code, and the convention on child rights adopted by the General Assembly of the United Nations in 1989 and ratified by Morocco in 1993, multiple surveys have shown that children are often put to work at a very early age and few employers respect the work conditions laid out in the texts. The aim of this study was to assess the different situations of child labour in the handicraft sector, the reasons and the problems surrounding it, to study its repercussions on health and to propose several preventive measures. From March to July 1997, a retrospective cohort study of working children and children in school was carried out in a small neighbourhood of Casablanca. We interviewed and examined a random sample of two hundred children working in the handicraft sector. The health status of these children was compared to that of the same sample size of children in school, from the same age group and socio-economic status. Each subject was given a standardized questionnaire that was translated into dialectal Arabic and administered by a occupational health doctor and a communications specialist. The results of the study have pointed out the small school network of the working children, the painful conditions of work and the important consequences on their health state with a wide prevalence of pathologies higher than for the children attending school. The misery in addition of the rural exodus, the no-adapted educative and socio-economic systems, the splitting of the family unit often go to generate a submissive childhood without defense and "ready to be used".

Occupational health and safety in the mining industry in Morocco.

The mining sector is one of the pillars of our national economy. Our paper concerns safety and occupational health in the mining sector in Morocco. This sector employs 60,000 persons, more than half of them working in the phosphate sectors. There are 36 occupational medical services, with 83 practitioners 395 nurses and 91 agents, protecting 43,926 workers (73% of all personnel). The task of labour inspection in this sector is entrusted to mining engineers. The statistics of the central department of industrial inspection in mines from 1975 to 1995 show a fall in occupational injuries and a progressive increase reported in occupational diseases, 96% of which are silicosis. The improvement of prevention and health at work in the mining sector in Morocco has led to a reduction in occupational hazards and specially occupational injuries. However, an effort seems required so as to generalize occupational medical and safety services in all the mining enterprises and in the craft mining sector in particular.

Occupational health and safety in Morocco: present and future.

Occupational health and safety in Morocco remain the poor link in our health system despite the existence since several decades of regulations concerning the protection of workers. This legislation is interesting but unfortunately not implemented and not updated. Our study shows failures at all levels: three occupational medical inspectorates with nine occupational inspection physicians for the whole of Morocco; 1,322 occupational medical services for 4,600 firms required to have such services. Occupational medical services cover only 7% of the urban working population; more than 9 workers out of 10 do not benefit from any medical protection. Only one occupational medical service out of four submits its annual medical report to the occupational medical inspectorate; 683 physicians practice occupational medicine while our theoretical needs are for about 3,000; among the 300 doctors holding a diploma of occupational medicine, only 100 practice in their speciality; of the 1,200 nurses employed in work environments, few hold state diplomas as provided for by legislation; safety engineers, prevention experts and ergonomists are rare; several exposed sectors do not have occupational safety and health services: civil servants, handicraft workers, small firms, rural areas, temporary and occasional workers, etc.; no serious study on occupational hazards (occupational accidents and diseases) has been undertaken. A reorganization of occupational safety and health is required: at the level of the Council of physicians and occupational medical inspectorate; a commission should control "who does what"; at the national level: extension of occupational safety and health services to all the working population (political will); meeting of the Consultative Medical Council and the establishment of a National Institute of Occupational Health; at the international level: the fight against the introduction of dangerous substances and technologies, originating in industrialized countries. Only correct and generalized occupational safety and medicine can ensure a true health protection of the population, particularly those working.

[Occupational hazards in the Moroccan craft sector and proposal for occupational health services]. / Risques professionnels dans le secteur artisanal marocain et proposition d'une couverture médicale du travail.

The absence of occupational health services, the numerous occupational hazards and the high number of people working in the handicraft sector have sparked this study. Descriptive, cross-sectional epidemiological studies were carried out throughout 1996 for different artisan activities: iron-work, jewellery making, rug making, tannery, "zellige", pottery, and woodworking. The study included 449 artisans and consisted of an analysis of work conditions, a medico-social questionnaire, a clinical examination and among certain artisans, a biological check-up, a respiratory check-up (thoracic x-ray and lung function testing), and a toxicological check-up. Poor work conditions and the absence of any technical protection (collective or individual) are common to all the workshops visited. Multiple risks as well as various and frequent pathologies were observed for all the artisan activities. The most common ailments are those linked to posture and musculo-skeletal problems (67.6%), oral (58.2%), ocular (46.9%), dermatological (35.7%), ear/nose/throat (35.3%), respiratory (31.1%), digestive (21.1%) and neurological (20.7%). Often the same artisan showed several simultaneous conditions linked to work. The legislative texts related to occupational health and safety are many and dispersed, and would profit by being updated and regrouped within a work code which would make them easier to consult and would allow all partners in the social sector to get to know them. In addition, this legislation which has been strengthened, is unfortunately not enforced. We should support every initiative focused on developing the prevention of occupational hazards and the spirit of safety within artisan workshops. The concern for occupational risks within the artisan milieu owes its importance to their abundance, the diversity of the professions involved, and the number of different risks to which artisans are exposed. The role of a worksite doctor is therefore considerable, and his field of intervention in this milieu is vast. The broader goal of occupational health services is to protect and improve the physical, mental, and social well-being of its workers; it is natural that these services should give more attention to general health promotion (vaccinations, health education...). Given that the artisan sector is organised around its structures of production, it seems urgent to introduce medical coverage and to improve health and safety conditions within the sector.

[Occupational medicine in Morocco: analysis of practices and proposition of action]. / La médecine du travail au Maroc: analyse des pratiques et proposition d'action.

With the aim of a better knowledge of their activities of training and information of workers, a survey has been conducted through questionnaires sent to 582 occupational health physicians in Morocco. Among the 48% of physicians who accepted to answer the questionnaire, over half was effectively working in companies. This study revealed many problems in prevention of professional hazards. Workers information about professional risks and measures of prevention was systematically given by 56% of physicians during pre-employment examination and 51% during systematic visit. During "third time", 49% of physicians were informing workers of professional risks and 54% of measures of prevention. With regards to meetings of information, only 26% of physicians were organising such meetings and teaching workers first aid. Consequently, we propose the implementation of protocols "Safety in companies". Informing and teaching the workers about safety, are the mandatory first steps to reduce and prevent professional diseases and accidents; occupational medicine, despite various obstacles should promote it.

[Catamenial hemoptysis caused by bronchopulmonary endometriosis]. / Hémoptysie cataméniale par endométriose broncho-pulmonaire.

The thoracic localization of endometriosis may involve the pulmonary pleura and the diaphragm, or the bronchopulmonary parenchyma, according to mechanisms which appear to be quite different. The principal clinical manifestations express themselves depending on their localization, a pneumothorax in the first case and hemoptysis in the second. One clinical characteristic, however, applies to them all, a rhythm strictly related to periods. The current methods of visualization of the pleura enable a macroscopic diagnosis to occur in the former cases in 64% and the body scanner now localizes the second in all cases. Treatment by Danatrol is often strikingly effective in a few months, notably in the cases with parenchymal localization.