Evolution of acute lower respiratory infection in children aged < 5 years in Morocco from 2005 to 2014.

BACKGROUND: Acute lower respiratory infection is a major cause of death in children aged < 5 years in Morocco. The 13-valent pneumococcal conjugate vaccine (PCV) was introduced to the Moroccan National Immunization Programme in 2010. AIMS: To investigate the trend in the incidence of acute lower respiratory infection in children aged < 5 years during 2005-2014 in Morocco. METHODS: Data on acute lower respiratory infection in children aged < 5 years were obtained from the data published annually by the Moroccan Ministry of Health. We used joinpoint regression analysis to estimate the trend in incidence of acute lower respiratory infection during the study period. RESULTS: The incidence of acute lower respiratory infection increased significantly between 2005 and 2011: by 3.08% annually in children aged < 5 years and by 3.24% annually in children aged 1 to < 5 years. However, the incidence was stable after 2011 as the observed trends were not significant, although the incidence decreased from 2011 to 2014 by 4.26% annually in children aged < 5 years, by 3.57% annually in children aged 1 to < 5 years and by 5.14% annually in urban areas. CONCLUSIONS: Our results suggest a probable influence of the PCV on the trend in incidence of acute lower respiratory infection in Morocco.

Decline in childhood respiratory-related mortality after the introduction of the pneumococcal conjugate vaccine in Morocco.

AIM: The objective of this study was to analyse the effect of the introduction in 2010 of the pneumococcal conjugate vaccine (PCV) on the reduction in mortality from respiratory causes in children under 5 years in Morocco. METHODS: Child mortality rates from respiratory cause were analysed using an interrupted time series analysis. Mortality rates from congenital and chromosomal causes were also analysed for comparative purposes. RESULTS: In the post-vaccination period, child mortality rates from respiratory causes decreased by 28% (Mortality rate ratio (MRR)=0.72, 95% CI: 0.58-0.83) and by 30% in children under 1 year (MRR=0.70, 95% CI: 0.50-0.98). In children aged between 1 and 5 years, the decrease in the child mortality rate was not statistically significant (MRR=0.99, 95% CI: 0.91-1.08). Mortality rates from congenital and chromosomal causes in the post-vaccination period were stable in children under 5 years (MRR=1.19, 95% CI: 0.97-1.48), in children under 1 year (MRR=1.15, 95% CI: 0.94-1.40) and in children aged between 1 and 5 years (MRR=1.19, 95% CI: 0.97-1.48). CONCLUSION: The decrease in child mortality from respiratory causes in the post-vaccination period provides strong evidence of the effectiveness of PCV.

The impact of maternal socio-demographic characteristics on breastfeeding knowledge and practices: An experience from Casablanca, Morocco.

BACKGROUND: Breastfeeding is universally recognized by the World Health Organization as the best way of feeding infants. Therefore, several countries have initiated health promotion interventions to support successful breastfeeding based on the factors influencing breastfeeding outcomes. OBJECTIVE: To examine the association between the knowledge of breastfeeding and maternal socioeconomic and demographic characteristics, and to determine any impact on child nutritional status. METHODS: A cross-sectional study using both qualitative and quantitative methods was conducted with mothers of infants aged six- to twenty-four months. Data was collected by a semi-structured questionnaire and face-to-face, in-depth interviews with mothers to get an insight into their breastfeeding perceptions and experiences. Educational achievement and occupational class were used as indicators of socio-demographic status. Nutritional status was assessed by anthropometric measurements. RESULTS: A significant relationship between exclusive breastfeeding and the mother's education (P < .001) and socio-economic status (P < .001) has been highlighted. A significant link was pointed out between breastfeeding and length-for-age Z score (LAZ) (P < .001), and weight-for-age Z score (WAZ) (P = .005). Moreover, a strong association was found between maternal employment and exclusive breastfeeding (P < .001). CONCLUSIONS: Our findings shed some light on challenges faced by mothers, as well as an association between socio-demographic characteristics and practices for facilitating exclusive breastfeeding to guide the mothers in breastfeeding management.

Risk factors associated with a breast cancer in a population of Moroccan women whose age is less than 40 years: a case control study.

INTRODUCTION: Breast cancer is the most common cancer in morocco women were it occupies the first place in term of incidence and mortality. The aim of the present paper is to evaluate the risk factors associated with a breast cancer in a population of Moroccan women. METHODS: A case-control study was conducted with population women whose age is less than 40 years during 2008-2010 at the National Institute of Oncology of Rabat. These women were interviewed for Epidemiological information and risk factor for breast cancer. RESULTS: Included in this study were 124 cases and 148 age matched controls. No statistically significant case-control difference was found for the early age of menarche (OR = 2.474; CI 95%: 1.354- 4.521), and family antecedents of first degree of breast cancer (OR = 11.556; 95% CI: 2.548-52.411). However physical activity (OR = 0.507; 95% CI: 0.339 -0.757) early maternity age (OR = 0.212; 95% CI: 0.087 - 0.514), multiparity (OR = 0.742; 95% CI: 0.359 -1.539) and breastfeeding than 6 months (OR = 0.739; 95% CI: 0.357 -1.523) appear as significant protective factors. CONCLUSION: This study show the criminalization of only part of the known risk factors of breast cancer in this age group and confirms the probable protective role of physical activity and factors related to life reproductive women in our study (early childbearing, multiparity and lactation).

Fetal outcome in emergency versus elective cesarean sections at Souissi Maternity Hospital, Rabat, Morocco.

INTRODUCTION: Perinatal mortality rates have come down in cesarean sections, but fetal morbidity is still high in comparison to vaginal delivery and the complications are more commonly seen in emergency than in elective cesarean sections. The objective of the study was to compare the fetal outcome and the indications in elective versus emergency cesarean section performed in a tertiary maternity hospital. METHODS: This comparative cross-sectional prospective study of all the cases undergoing elective and emergency cesarean section for any indication at Souissi maternity hospital of Rabat, Morocco, was carried from January 1, to February 28, 2014. Data were analyzed with emphasis on fetal outcome and cesarean sections indications. Mothers who had definite antenatal complications that would adversely affect fetal outcome were excluded from the study. RESULTS: There was 588 (17.83%) cesarean sections among 3297 births of which emergency cesarean section accounted for 446 (75.85%) and elective cesarean section for 142 cases (24.15%). Of the various factors analyzed in relation to the two types of cesarean sections, statistically significant associations were found between emergency cesarean section and younger mothers (P < 0.001), maternal illiteracy (P = 0.049), primiparity (P = 0.005), insufficient prenatal care (P < 0.001), referral from other institution for pregnancy complications or delivery (P < 0.001), cesarean section performed under general anesthesia (P < 0.001), lower birth weight (P < 0.016), neonatal morbidity and early mortality (P < 0.001), and admission in neonatal intensive care unit (P = 0.024). The commonest indication of emergency cesarean section was fetal distress (30.49%), while the most frequent indication in elective cesarean section was previous cesarean delivery (47.18%). CONCLUSION: The overall fetal complications rate was higher in emergency cesarean section than in elective cesarean section. Early recognition and referral of mothers who are likely to undergo cesarean section may reduce the incidence of emergency cesarean sections and thus decrease fetal complications.

[Perinatal morbidity and mortality in twin pregnancies in a Moroccan level-3 maternity ward]. / Morbimortalité périnatale dans les grossesses gémellaires dans une maternité marocaine de niveau 3.

INTRODUCTION: Twin pregnancies are associated with a higher rate of perinatal morbidity and mortality than singleton pregnancies. The aim of the present study was to evaluate perinatal morbidity and mortality in twin pregnancies in a Moroccan level-3 maternity ward. METHODS: This is a comparative cross-sectional study of perinatal morbidity and mortality rates in newborn infants in twin pregnancies versus singleton pregnancies among women who gave birth at Souissi Maternity Hospital in Rabat from January 1 to February 28, 2014. RESULTS: There were 3297 births and, of these, 65 in twin pregnancies and 3167 in singleton pregnancies. Twin pregnancies were associated with higher rates of preeclampsia and eclampsia (P = 0.046), HELLP syndrome (P = 0.030), premature rupture of membranes (P < 0.001), malpresentation (P < 0.001), prematurity (P < 0.001), low birth weight in fullterm neonates (P < 0.001), respiratory distress at birth (P < 0.001), congenital malformations (P = 0.015), hospitalization in the neonatal period (P = 0.001), and perinatal mortality (P = 0.001) than singleton pregnancies. Monochorionic twins showed higher rates of low birth weight in fullterm pregnancies (P = 0.016) and of perinatal mortality (P = 0.017) than dichorionic twins. CONCLUSION: Twin pregnancies showed higher risk of perinatal morbidity and mortality than singleton pregnancies and were more exposed to prematurity. Monochorionic twin pregnancies showed a higher risk because of the significant exposure to low birth weight in fullterm babies.

[Survival rate for breast cancer in Rabat (Morocco) 2005-2008]. / Survie au cancer du sein à Rabat (Maroc) 2005-2008.

INTRODUCTION: Breast cancer is a public health problem in Morocco. This study aims to estimate the survival rate for patients with breast cancer living in Rabat. METHODS: We conducted a prognostic study of female patients with breast cancer diagnosed during 2005-2008, living in Rabat and whose data were recorded in the Rabat Cancer Registry. The date of inclusion in this study corresponded with the date on which cancer was histologically confirmed. Survival rate was estimated using the Kaplan-Meier method and the comparison between the different classes of a variable was made using the log rank test. The study of factors associated with survival was performed using the Cox model. RESULTS: During the study period 628 cases of breast cancer were collected. Mortality rate was 19.9%. Overall 1-year survival rate was 97.1%, 89.2% at 3 years and 80.6% at 5 years. In multivariate analysis, breast cancer survival was statistically lower in patients over 70 years of age (p <0.001) with large tumor size (p < 0.001), advanced-stage adenopathies (p = 0.007), metastases (p < 0.001) and not using hormone therapy (p = 0.002). CONCLUSION: Large tumor size and metastases are poor prognostic factors in breast cancer, hence the need to strengthen screening programs.

Dietery factor obesity microenvironnement and breast cancer.

BACKGROUND: Breast cancer is a multifactorial disease. Factors most often mentioned risks are those related to the environment, genetics, hormones and individual behaviors. Among these include alcohol, smoking, sedentary lifestyle and eating habits. Identification of eating and the role of nutritional factors may be involved in cancer risk have been studied extensively since nearly 40 years. PURPOSE: We conducted a study of breast cancer type case-control with food frequency questionnaire to assess the causal relationship between dietary factor, obesity and breast cancer risk. PATIENTS AND METHODS: female patients with breast cancer were compared to healthy controls at the National Institute of Oncology of Rabat during 2008-2010 and were interviewed for epidemiological information and for their eating habits. RESULTS: A total of 800 women were included in this study (400 cases and 400 controls). Result of univariate analysis showed that significant factors associated with the etiologie of breast cancer: high body mass index (BMI) [odds ratio (OR) =1.30; 95% confidence interval (CI), 1.25-1.37], red meat (OR =1.33; 95% CI, 1.27-1.40), processed meat (OR =1.44; 95% CI, 1.35-1.54), eggs (OR =1.20; 95% CI, 1.14-1.23), poultry (OR =0.70; 95% CI, 0.60-0.80), fish (OR =0.67; 95% CI, 0.61-0.73), fruit (OR =0.67; 95% CI, 0.62-0.72), and vegetable (OR=0.72; 95% CI, 0.67-0.78). Multivariate analysis indicated that a significantly elevated risk of contracting breast cancer was associated with higher BMI (OR =9.61; 95% CI, 6.1-15.15), red meat (OR =4.61; 95% CI, 2.26-9.44) and processed meat (OR =9.78; 95% CI, 4.73-20.24). In contrast consumption of fish (OR =0.07; 95% CI, 0.02-0.24), poultry (OR =0.61; 95% CI, 0.46-0.81), fruit (OR =0.001; 95% CI, 0.00-0.004), and vegetable (OR =0.82; 95% CI, 0.22-3.08) remained as significant beneficial factor associated with breast cancer. CONCLUSIONS: This study is rather in favour of positive association between obesity, consumption of food rich in fatty matter and breast cancer, which is consistent with data from the literature using the same type of investigation. These results encourage increased cohort studies, case-control and experimentation in order to achieve a genuine code of cancer prevention, to define with precision the positive and negative.