High performance of a novel point-of-care blood test for Toxoplasma infection in women from diverse regions of Morocco.

Point-of-care (POC) testing for Toxoplasma infection has the potential to revolutionize diagnosis and management of toxoplasmosis, especially in high-risk populations in areas with significant environmental contamination and poor health infrastructure precluding appropriate follow-up and preventing access to medical care. Toxoplasmosis is a significant public health challenge in Morocco, with a relatively heavy burden of infection and, to this point, minimal investment nationally to address this infection. Herein, we analyse the performance of a novel, low-cost rapid test using fingerstick-derived whole blood from 632 women (82 of whom were pregnant) from slums, educational centres, and from nomad groups across different geographical regions (i.e. oceanic, mountainous) of Morocco. The POC test was highly sensitive and specific from all settings. In the first group of 283 women, sera were tested by Platelia ELISA IgG and IgM along with fingerstick whole blood test. Then a matrix study with 349 women was performed in which fingerstick - POC test results and serum obtained by venipuncture contemporaneously were compared. These results show high POC test performance (Sensitivity: 96.4% [IC95 90.6-98.9%]; Specificity: 99.6% [IC95 97.3-99.9%]) and high prevalence of Toxoplasma infection among women living in rural and mountainous areas, and in urban areas with lower educational levels. The high performance of POC test confirms that it can reduce the need for venipuncture and clinical infrastructure in a low-resource setting. It can be used to efficiently perform seroprevalence determinations in large group settings across a range of demographics, and potentially expands healthcare access, thereby preventing human suffering.

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.

Effect of the Integrated Management of Childhood Illness strategy on health care quality in Morocco.

OBJECTIVE: To evaluate an intervention to promote health workers' use of the World Health Organization's Integrated Management of Childhood Illness clinical guidelines and to identify other factors influencing quality of care received by Moroccan children. SETTING: Public outpatient health facilities. DESIGN: Cross-sectional survey of consultations with sick children under 5 years old at facilities in two intervention and two comparison provinces in April 2000 (6-12 months after intervention). Consultations were observed, children's caretakers and health workers were interviewed, and children were re-examined by a 'gold standard' study clinician. STUDY PARTICIPANTS: Probability sample of 467 consultations (97.9% participation) performed by 101 health workers in 62 facilities. INTERVENTION: Health workers received in-service training with job aids and a follow-up visit with feedback 4-6 weeks after training. MAIN OUTCOME MEASURES: Index of overall guideline adherence (mean percentage of recommended tasks that were done per child) and the percentage of children requiring antibiotics correctly prescribed antibiotics. RESULTS: Quality of care was better in intervention provinces, according to the adherence index (79.7 versus 19.5%, P < 0.0001), correct prescription of antibiotics (60.8 versus 31.3%, P = 0.0013), and other indicators. Multivariate modeling revealed a variety of factors significantly associated with quality, including health worker attributes (pre-service training, residence in government-subsidized housing, sex, and opinions) and child/consultation attributes (child's age and temperature, number of chief complaints, and caretaker type). CONCLUSIONS: Exposure to the intervention was strongly associated with adherence to the guidelines and correct prescribing of antibiotics 6-12 months after exposure. Many other factors may influence health worker performance.