Ischemic stroke in Morocco: Prehospital delay and associated factors.

OBJECTIVES: This study aimed to estimate prehospital delay and to identify the factors associated with the late arrival of patients with ischemic stroke at the Souss Massa Regional Hospital Center in Morocco. PATIENTS AND METHODS: An observational, prospective, cross-sectional study was conducted from March 2019 to September 2019 in the Souss Massa regional hospital center, which is a public hospital structure. A questionnaire was administered to patients with ischemic stroke and to bystanders (family or others), while clinical and paraclinical data were collected from medical records. Univariate and multivariate logistic regression analyses were used to identify the factors associated with delayed arrival at emergency department. RESULTS: A total of 197 patients and 197 bystanders who fulfilled the criteria for the study were included. The median time from symptom onset to hospital arrival was 6hours (IQR, 4-16). Multiple regression analysis showed that illiteracy (OR 38.58; CI95%: 3.40-437.27), waiting for symptoms to disappear (patient behavior) (OR 11.24; CI95%: 1.57-80.45), deciding to go directly to the hospital (patient behavior) (OR 0.07; CI95%: 0.01-0.57), bystander's knowledge that stroke is a disease requiring urgent care within a limited therapeutic window (OR 0.005; CI95%: 0.00-0.36), and direct admission without reference (OR 0.005; CI95%: 0.00-0.07), were independently associated with late arrival (>4.5hours) of patients with acute ischemic stroke. In addition, illiteracy (OR 24.62; CI95%: 4.37-138.69), vertigo and disturbance of balance or coordination (OR 0.14; CI95%: 0.03-0.73), the relative's knowledge that stroke is a disease requiring urgent care and within a limited therapeutic window (OR 0.03; CI95%: 0.00-0.22), calling for an ambulance (relative's behavior) (OR 0.16; CI95%: 0.03-0.80), distance between 50 and 100km (OR 10.16; CI95%: 1.16-89.33), and direct admission without reference (OR 0.03; CI95%: 0.00-0.14), were independently associated with late arrival (>6hours) of patients with acute ischemic stroke. CONCLUSION: Patient behavior, bystander knowledge and direct admission to the competent hospital for stroke care are modifiable factors potentially useful for reducing onset-to-door time, and thereby increasing the implementation rates of acute stroke therapies.

[Moroccan pharmacy students' knowledge and perceptions about pharmacovigilance]. / Connaissances et perception de la pharmacovigilance par les futurs pharmaciens marocains.

OBJECTIVE: The aim of this study was to evaluate the impact of an educational work groups on the knowledge and perception of 2nd year pharmacist students towards pharmacovigilance in a moroccan faculty of medicine and pharmacy. METHOD: A descriptive study conducted in pharmacology laboratory of the faculty of medicine and pharmacy of Rabat on 2nd year pharmacist students, to assess their knowledge and perception towards PV via questionnaire before and after an educational work groups. RESULTS: Among the 122 invited students, 108 responded to the questionnaire distributed before working group with a participation rate of 88,5 %. This rate increased to 95,9 % (n=117) after work groups sessions. Pre-work groups, students showed an overall low knowledge, where only 27.7 % knew the ADRs reporting sheet. In addition, most students were not well prepared to report ADR in their future practice (n=82, 75.92 %). Work groups partially offsetting this deficit, and helped to better explain to the students the reporting system. Resulting in only 28 participants maintained their declaration of inability to report ADR in their future practice (25.92 %). On the other hand, students showed a favorable perception. CONCLUSION: In this study, students expressed the desire to learn more about PV during their university education. This result led to the introduction of a system of PV working groups for 3rd and 4th year pharmacy students for the 2018-2019 academic year.

Estimating attributable fraction of lung cancer linked to smoking in Morocco.

The objective of this research was to estimate the attributable fraction (AF) of lung cancer linked to smoking in Morocco. The estimation was based on the SAMMEC (Adult Smoking-Attributable Mortality, Morbidity and Economic Costs) method based on the Levin formula to calculate AF linked to tobacco. Data about frequencies, association measures and relative risks were taken from available sources. The AF of lung cancer linked to smoking was about 87%, and around 3049 cases of this cancer in men could be avoided if tobacco use could be prevented. About a 10% reduction in smoking prevalence would result in a reduction of 346 lung cancer cases. Our study provides additional important elements for further advocacy to policy-makers to implement a tobacco control strategy based on a prevention policy in line with the epidemiological situation which could avoid a huge burden on the country.

Using surveillance data to understand cancer trends: an overview in Morocco.

BACKGROUND: The aim was to use the existing surveillance data sources of cancer in Morocco that could be used to better describe cancer mortality and incidence trends in Morocco. METHODS: National incidence data were derived from population-based cancer registries. Mortality data were collected from the international GLOBOCAN database. RESULTS: An overview of the main results was presented. In general, the most commonly diagnosed cancers in men are lung and prostates whereas in women, breast and cervical cancers are the pre-dominant cancers. Fifty nine percent and of breast and 65.7 % of cervical cancers in women are diagnosed at stages II and III. Cancer remains the second highest cause of mortality in Morocco. CONCLUSION: The data provides a description of the cancer incidence and trends in the Moroccan population. The Moroccan national cancer program should aim for more coherent, consistent and comparable incidence data between different cancer registries in the country, and develop uniform datasets with respect to quality.

INTRODUCTION: L'objectif était d'utiliser les sources de données existantes de surveillance du cancer qui pourraient être utiles pour décrire les tendances d'incidence et de mortalité du cancer au Maroc. MÉTHODES: Les données de morbidité et mortalité nationales et internationales disponibles ont été explorées. Les registres populationnels de cancer couvrent les données d'incidence régionale. Les données de mortalité sont disponibles par les données internationales de Globocan. RÉSULTATS: Un aperçu des principaux résultats a été présenté. Globalement, les cancers les plus fréquents sont le poumon et la prostate chez les hommes; le sein et le col utérin chez les femmes; ces deux cancers représentant 56,3 % de cancers féminins. Les cancers de sein et du col sont diagnostiqués dans 59 % et 65,7 % aux stades II et III. Le cancer est la deuxième cause de mortalité au Maroc. CONCLUSION: Les données fournissent une description de l'incidence des cancers et leurs tendances dans la population marocaine. Le programme national du cancer marocaine devrait viser pour les données d'incidence cohérents et comparables entre les différents registres du cancer dans le pays, et de développer des ensembles de données uniformes par rapport à la qualité.

Factors associated with treatment default by tuberculosis patients in Fez, Morocco.

Interruption in tuberculosis (TB) treatment still remains the most important challenge for control of the disease. This study aimed to identify the determinants of TB treatment default in Fez, Morocco. A 1:2 pair-matched case-control study was carried out in the TB control units in Fez. Cases were defaulters to TB treatment and were matched by age and sex to non-defaulters (controls). Of the 320 patients (108 defaulters, 212 controls), 80.6% were male. The main reason for defaulting reported by patients was the sensation of being cured. Predictive factors for treatment default in the multivariate conditional logistic regression analysis, were: relapsed case (adjusted OR = 4.49; 95% Cl: 1.87-10.8), current smoking (aOR= 2.10; 95% Cl: 1.07-4.14), alcohol use (aOR = 2.92; 95% Cl: 1.04-8.19), being more than 30 minutes away from the health centre (aOR = 3.34; 95% Cl: 1.06-10.5) and perception of having received insufficient explanation about the disease (aOR = 2.87; 95% CI: 1.53-5.36). The rate of defaulting in Fez can be lowered through targeted and realistic measures.

Factors associated with treatment default by tuberculosis patients in Fez, Morocco

Interruption in tuberculosis [TB] treatment still remains the most important challenge for control of the disease. This study aimed to identify the determinants of TB treatment default in Fez, Morocco. A 1:2 pair-matched case-control study was carried out in the TB control units in Fez. Cases were defaulters to TB treatment and were matched by age and sex to non-defaulters [controls]. Of the 320 patients [108 defaulters, 212 controls], 80.6% were male. The main reason for defaulting reported by patients was the sensation of being cured. Predictive factors for treatment default in the multivariate conditional logistic regression analysis, were: relapsed case [adjusted OR = 4.49; 95% CI: 1.87-10.8], current smoking [aOR = 2.10; 95% CI: 1.07-4.14], alcohol use [aOR = 2.92; 95% CI: 1.04-8.19], being more than 30 minutes away from the health centre [aOR = 3.34; 95% CI: 1.06-10.5] and perception of having received insufficient explanation about the disease [aOR = 2.87; 95% CI: 1.53-5.36]. The rate of defaulting in Fez can be lowered through targeted and realistic measures