The journey of cancer patients and the quest to equity: findings from Morocco.

OBJECTIVES: Rapid diagnostic and assessment pathways for cancer patients provide timely and effective care. This study took place in Morocco, where the majority of patients treated in the public sector are diagnosed at an advanced stage. The aim of this study was to determine the duration of different time intervals along the cancer patient pathway and to highlight problem areas so that strategies can be implemented to make the process more equitable and effective. STUDY DESIGN: Cross-sectional study. METHODS: Recently diagnosed cancer patients were recruited from four major oncology centres in Morocco; namely, Marrakech, Casablanca, Rabat, and Fez. A questionnaire survey was administered, including sociodemographic and medical information and questions on access to the oncology centre, beliefs, and opinions on the medical staff. The dates of symptom recognition, assessment, diagnosis referral, biopsy, and treatment initiation were collected. Different time intervals (patient, diagnosis, biopsy, and treatment) were estimated and their determinants were investigated. RESULTS: A total of 812 patients were interviewed. The majority of participants were breast cancer patients. In total, 60% of participants were at stage III-IV. The main facilitators of cancer diagnosis confirmation and treatment initiation were easy access to diagnosis and treatment facilities, financial resources, personal history of cancer, time availability, late stage at diagnosis, advanced age, and private health insurance. The patient interval (i.e., time from symptom recognition to initial healthcare assessment) had a median duration of 30 days. The biopsy and treatment intervals were within the current international recommendations (7 and 28 days, respectively). However, the diagnosis interval (52 days) was twice as long as the recommended timeframes from the UK, Australia, and the World Health Organization (<28 days). CONCLUSIONS: Interval targets should be defined to encourage health systems to be more equitable and effective and to ensure that cancer patients are treated within a defined timeframe.

Prevalence of smoking in the Maghreb: a systematic review and meta-analysis.

INTRODUCTION: Tobacco is the leading preventable cause of death in the world and kills up to seven million people each year. Monitoring its prevalence is important for prevention programs. The aim of this work was to summarize the literature on the prevalence of smoking in the Maghreb countries during the past two decades. METHODS: The research was conducted on Medline via Pubmed based on the Mesh terms: «Tobacco Use¼, «Smoking¼ and «Africa, Northern¼. Were included articles reporting the prevalence of current smoking in the general population or a subgroup of the population in one or more Maghreb countries. The extracted data was related to current smoking, its definition, total prevalence and prevalence by sex. RESULTS: About 50 articles were included, the data was mainly from Morocco, Algeria and Tunisia. Two studies reported prevalence among college students in Libya. The highest prevalences in the general population were noted in Tunisia with an overall prevalence, during the period studied, of 25% (95% CI [21% -29%]). This prevalence was 16% (95% CI [14% -18%]) in Morocco and 14% (95% CI [8% -22%]) in Algeria. CONCLUSION: The prevalence reported was generally high, especially in Tunisia, although lower than in developed countries, hence the importance of setting up and strengthening prevention and control measures, mainly among young people.

[Syphilis: 57 observations in Fez, Morocco]. / Syphilis: 57 observations à Fès, Maroc.

A prospective study of syphilis cases over a period of 2 years (January 2008 to September 2009) was carried out in the Department of Dermatology of the Hassan II University Hospital Center in Fes, Morocco. A total of 57 cases were identified. The M/F sex ratio was 0.89. Mean patient age was 40.5 years (range, 22-80). Risk factors included unprotected sex in 96.5% of cases and multiple partners in 42.1%. Nine patients had a history of sexually transmitted infection. No patient had received blood transfusion. Clinical picture was late latent syphilis in 70.2% of cases (n = 41). Only one case was associated with human immunodeficiency virus. The mainstay treatment was intramuscular benzathine benzylpenicillin. Outcome was favorable in 48 cases.