Evolution of quality of life in patients with breast cancer during the first year of follow-up in Morocco.

BACKGROUND: Quality of life has an important place in the future of patients with breast cancer. The objective of this study is to assess the evolution of the patient's quality of life with breast cancer in Morocco after a year of follow-up. METHODS: This study involved the patients with breast cancer with all types of treatment as determined by their physicians. Patient's quality of life was assessed with the Moroccan Arabic version of QLQ- EORTC QLQ C30 and EORTC-BR23 questionnaires. Data were analyzed using SPSS Version 20 software. RESULTS: Regarding EOTRC questionnaires QLQ C-30, there was a significant improvement in global health status and all scales of the functional dimension except the social functional where there was a trend towards improvement and the financial impact of the disease where the situation has deteriorated. Quality of life was improved for most symptom-sized scales dimension of EORTC QLQ- C30 with the exception of diarrhea where it was observed degradation. Most of the EORTC QLQ-scales BR23 questionnaires showed a favorable trend in the quality of life except those of sexual functioning, sexual enjoyment, hair loss and the side effects of systemic therapy. CONCLUSION: The quality of life of the patient is significantly improved after 1 year of follow up. Quality of life instruments can be useful in the early identification of patients whose score low on functional scales and symptoms.

Acceptability of the human papilloma virus vaccine among Moroccan parents: a population-based crosssectional study.

Data about the public's awareness and acceptability of the human papilloma virus (HPV) vaccine are lacking in the Eastern Mediterranean Region. This study aimed to explore parental acceptability of HPV vaccination for their daughters in Morocco. A cross-sectional survey was carried out among mothers and fathers of girls aged 12-15 years at 12 middle schools from 6 regions of Morocco. Despite weak knowledge of genital warts and HPV infection, acceptability of the HPV vaccine was 76.8% (95% CI: 73.3-79.9%) among mothers and 68.9% (95% CI: 65.2-72.5%) among fathers. Only 8.8% of mothers and 7.0% of fathers were against administration of the HPV vaccine to their daughters. Predictors of parents' acceptance of the HPV vaccine were living in precarious housing/slums and low household income (for mothers) and living in urban areas (for fathers). These results will be useful for preparing the introduction of the HPV vaccine in health ministry programmes.

Prevalence of obesity and associated sociodemographic and lifestyle factors in Morocco.

OBJECTIVE: In Morocco, the association between obesity/overweight and socio-demographic and lifestyle factors is poorly understood. The present study aimed to investigate this association in a representative sample of the Moroccan population aged 18 years and above. DESIGN: This is a cross-sectional study using a questionnaire including demographic, socio-economic and physical activity items. Height and weight were measured and BMI was computed. The association between obesity (BMI ≥ 30.0 kg/m2) or overweight (25.0 ≤ BMI < 29.9 kg/m2) and the other variables was analysed using multiple binomial logistic regression, separately in men and women. SETTING: The whole Moroccan territory. SUBJECTS: A total of 2891 subjects took part in the survey (1430 men and 1461 women). RESULTS: The prevalence of obesity was 20.9 % in women and 6.0 % in men (P < 0.0001). The prevalence of overweight was 32.9 % in women v. 26.8 % in men (P < 0.0001). In women, the risk of obesity and overweight increased with age, with the highest risk being in individuals aged 45-54 years (OR = 3.02, 95 % CI 2.06, 4.44) compared to individuals <35 years old. Married women were more prone to obesity and overweight (OR = 2.42, 95 % CI 1.50, 3.91) than single women. In men, the risk of obesity and overweight increased with average family income (OR = 2.62, 95 % CI 1.40, 4.87 for family income ≥5000 MAD/month compared to <2000 MAD/month) and in married persons (OR = 3.75, 95 % CI 1.78, 7.81) compared to single individuals. CONCLUSIONS: These results contribute to target groups in whom prevention programmes could be implemented.

[Identification of alloantibodies and their associations: Balance sheet of 3 years at the Regional Center of Blood Transfusion in Rabat/Morocco and difficult in transfusion management]. / Identification des allo-anticorps seuls et associés : bilan de trois années au centre régional de transfusion sanguine de Rabat/Maroc et difficultés de prise en charge transfusionnelle.

Red blood cell immunization can lead to delays or even an impasse in a transfusion. OBJECTIVES: Determine the specificities of the most common of alloantibodies and their associations to correct management of red blood cell transfused. METHODS AND MATERIALS: A retrospective study between 2013 and 2015 in immunohematology laboratories at the Blood Transfusion Center of Rabat in Morocco. The following data were studied: frequency, specificities of alloantibodies, blood group involved in alloimmunization and difficult of management of transfusion in case with association of alloantibodies. RESULTS: Five hundred of alloantibodies were identified in 425 people (372 patients/pregnant women and 53 blood donors). The alloantibodies were directed against the following antigen: RH1 (50.8 %), RH3 (11.4 %), KEL 1 (8.2 %), RH2 (7.6 %), RH4 (4.6 %), MNS1 (4 %), MNS3 (2.6 %), Jka (2.4 %) and Fya (2.2 %). Only one alloantibody was identified in 85 % of cases. In 15 %, at least, two alloantibodies were found. The most common associations were directed against: anti-(D+C) (25), anti-(E+K) (4), anti-(E+c) (3) and anti-(D+C+E) (3). The rhesus system is the most involved in alloimmunization. Frequency of specific associations of alloantibodies was identified: Fya-/Jkb- (18.23 %), Fyb-/Jkb- (11.7 %), Jka-/S- (8.70 %), Jka-/Fyb- (5.20 %), Fyb-/s- (3.40 %) and Fyb-/Jkb-/s- (0.85 %). CONCLUSIONS: Red blood cell immunization is a serious problem in transfused patients. This study proves the data of literature, the interest of using RH-Kel1 red cell units compatibles among women in age to procreate and for the transfused patients to reduce the rate of immunization. Associations of antibodies with low frequency suggest a promotion of donation.

Hospital epidemiologic surveillance for invasive aspergillosis: patient demographics and the utility of antigen detection.

OBJECTIVE: To monitor the epidemiology of invasive aspergillosis at a university hospital during a period of hospital construction. To compare the efficacy of active epidemiologic surveillance for invasive aspergillosis using Aspergillus cultures with the efficacy of surveillance using Aspergillus antigen detection. DESIGN: A prospective surveillance study. SETTING: An 850-bed, tertiary-care, university-based hospital. PATIENTS: A convenience sample of 153 patients with Aspergillus antigen testing and culture. RESULTS: 24 cases were identified over a 12-month period; 7 were nosocomial, and 17 were community-acquired. Cases occurred primarily in patients with hematologic malignancy, but also occurred in patients with solid tumor, steroid treatment, cardiac transplant, and acquired immunodeficiency syndrome. Culture techniques identified only 14 (58%) of 24 cases, whereas Aspergillus antigen was positive in 19 (79%) of 24 cases tested. Epidemiological surveillance using either antigen or culture positivity detected 22 (92%) of 24 cases. In addition, antigen detection was 98% specific for the detection of aspergillosis, as compared to 91% for culture and 88% for antigen and culture combined. CONCLUSIONS: Hospital surveillance for aspergillosis should include determination of whether cases are nosocomial or community-acquired, because many may be the latter. Patients at risk for aspergillosis include patients without hematologic malignancies. Enhanced case detection occurred with active surveillance of patients considered to be at risk using both fungal serology and traditional microbiological techniques. Antigen detection was more sensitive and specific for the detection of invasive aspergillosis and may improve epidemiological surveillance for aspergillosis.

Antibiotic resistance of Moroccan strains of Salmonella enteritidis isolated between 1996 and 1997.

Antimicrobial resistance is a worldwide problem. The antibiotic resistance of Moroccan strains of Salmonella enteritidis was investigated from 1996 to 1997. A total of 51 strains were collected within this period, 31 derived from human sources and 20 from food. Of the 31 human strains, 10 were resistant to antibiotics; 4 were resistant to two or more antibiotics. Of the 20 food strains, 11 were resistant to antibiotics; 6 were resistant to two or more antibiotics. The results are similar to those obtained from strains isolated from other Mediterranean countries.

Monitoring HIV through sentinel surveillance in Morocco.

HIV sentinel surveillance was performed in five provinces of Morocco in 1993, expanded to 10 provinces in 1996. The activity was done by unlinked anonymous testing procedures. We analysed the data from 1993 to 1999. The groups studied were sexually transmitted infections, clinic attendees, pregnant women and patients with pulmonary tuberculosis. The results show that overall HIV prevalence rate over the whole period in 10 cities was 0.10% (45/44,233). Casablanca had a significantly high rate with 0.39% (10/2567). The patients with pulmonary tuberculosis displayed the highest prevalence with 0.36% (9/2530). These data confirm the assumption that the HIV epidemic is low in Morocco. However, the increase of HIV prevalence lately calls for reinforcing preventive measures to limit its spread.

Some characteristics of the HIV epidemic in Morocco.

The first case of AIDS in Morocco was declared in 1986 and since then the number of AIDS cases has steadily increased. According to the Ministry of Health, the cumulative number of AIDS cases in December 2002 was 1085. HIV in Morocco is acquired mainly through heterosexual intercourse. Individuals aged between 30 and 39 years and in the regions of Marrakech and Agadir have been the most affected. Monitoring of the trend of the epidemic by sentinel surveillance surveys indicates that Morocco is still a low prevalence zone, since prevalence among pregnant women is less than 1%. The estimated number of HIV-infected people in Morocco is around 15 000. It is not clear why the epidemic here has not evolved as it has in the sub-Saharan countries where it is spreading at an alarming rate. Late introduction of HIV-1 subtype B in Morocco, which is relatively less transmissible, circumcision and reduced risk behaviours of Muslims may explain this. Nonetheless, because prevalence has increased in recent years, unless preventive measures are strengthened, the HIV epidemic will worsen in Morocco.

The epidemiology of HIV infection in Morocco: systematic review and data synthesis.

Morocco has made significant strides in building its HIV research capacity. Based on a wealth of empirical data, the objective of this study was to conduct a comprehensive and systematic literature review and analytical synthesis of HIV epidemiological evidence in this country. Data were retrieved using three major sources of literature and data. HIV transmission dynamics were found to be focused in high-risk populations, with female sex workers (FSWs) and clients contributing the largest share of new HIV infections. There is a pattern of emerging epidemics among some high-risk populations, and some epidemics, particularly among FSWs, appear to be established and stable. The scale of the local HIV epidemics and populations affected show highly heterogeneous geographical distribution. To optimize the national HIV response, surveillance and prevention efforts need to be expanded among high-risk populations and in geographic settings where low intensity and possibly concentrated HIV epidemics are emerging or are already endemic.

Acceptability of the human papilloma virus vaccine among Moroccan parents: a population-based crosssectional study

Data about the public's awareness and acceptability of the human papilloma virus [HPV]vaccine are lacking in the Eastern Mediterranean Region. This study aimed to explore parental acceptability of HPV vaccination for their daughters in Morocco. A cross-sectional survey was carried out among mothers and fathers of girls aged 12-15 years at 12 middle schools from 6 regions of Morocco. Despite weak knowledge of genital warts and HPV infection, acceptability of the HPV vaccine was 76.8% [95% CI:73.3-79.9%] among mothers and 68.9% [95% CI:65.2-72.5%] among fathers. Only 8.8% of mothers and 7.0% of fathers were against administration of the HPV vaccine to their daughters. Predictors of parents' acceptance of the HPV vaccine were living in precarious housing/slums and low household income [for mothers] and living in urban areas [for fathers]. These results will be useful for preparing the introduction of the HPV vaccine in health ministry programme

Les données sur les connaissances relatives au vaccin contre le papillomavirus humain et son acceptabilité par le public sont rares dans la Région de la Méditerranée orientale. La présente étude visait à évaluer l'acceptabilité de la vaccination des filles contre le papillomavirus humain pour leurs parents au Maroc. Une étude transversale a été menée chez les mères et les pères de filles âgées de 12 à 15 ans dans 12 collèges situés dans six régions du Maroc.En dépit de faibles connaissances concernant les verrues génitales et l'infection par le papillomavirus humain,l'acceptabilité du vaccin contre le papillomavirus humain était de 76,8 % [IC à 95 % : 73,3 - 79,9 %] chez les mères et de 68,9 % [IC à 95 % : 65,2 - 72,5 %] chez les pères. Seuls 8,8 % des mères et 7,0 % des pères étaient opposés à l'administration du vaccin contre le papillomavirus humain à leur[s]fille[s]. Vivre dans des logements insalubres/des bidonvilles et avoir un revenu du ménage faible pour les mères, et vivre en zone urbaine pour les pères étaient des facteurs prédictifs de l'acceptation du vaccin contre le papillomavirus humain. Ces résultats seront utiles pour préparer l'introduction du vaccin contre le papillomavirus humain dans les programmes du ministère de la santé

Implications of the International Health Regulations (2005) for communicable disease surveillance systems: Tunisia's experience.

BACKGROUND: In May 2005, the revised International Health Regulations, known as IHR (2005), were adopted in response to the evolving nature of communicable diseases (CD) and the rapid increase in global trade and travel. CD surveillance is an integral part of a country's core requirements under the regulations. METHODS: The implications of these requirements were assessed as part of a review of the national CD surveillance system of Tunisia using a qualitative methodology of strengths, weaknesses, opportunities and threats (SWOT). RESULTS: Tunisia is some way towards meeting the requirements of IHR (2005) while some specific areas that need to be addressed are highlighted for improvement: standardization of surveillance documents, strengthening the role of the laboratory in surveillance, increased human resources and training. CONCLUSIONS: Tunisia's experience can offer some lessons to other countries in this process. While meeting the capacity obligations of IHR (2005) requires investment and commitment, this investment will enable countries to better protect themselves against public health emergencies arising within their borders and threatening from elsewhere in the world.

Reproductive tract infections in primary healthcare, family planning, and dermatovenereology clinics: evaluation of syndromic management in Morocco.

OBJECTIVE: To determine where and with what symptoms women seek care for reproductive tract infections (RTI) in Morocco and to guide allocation of resources for training and treatment for RTIs. METHODS: A primary healthcare centre (PHC), a family planning centre (FPC), and a specialty dermatovenereology clinic (SC) were selected in each of three urban areas. Women with symptoms of vaginal discharge, lower abdominal or pelvic pain, or genital lesions (genital ulcer or warts) underwent interviews, physical examinations, serological testing for human immunodeficiency virus (HIV) and syphilis, and collection of vaginal fluid for microscopic examination, and urine for detection of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) by ligase chain reaction (LCR). RESULTS: Over 8 months, 1238 women enrolled, including 61.8% at PHCs, 34.8% at FPCs, and 3.4% at SCs. Overall, 54% complained of vaginal discharge, of whom 8.8% had GC or CT infection and 30.1% had trichomoniasis (TV) or bacterial vaginosis (BV); 24.9% complained of lower abdominal pain with or without vaginal discharge, of whom 7.3% had GC or CT and 22.6% had TV or BV. GC or CT infections were found in 10.1% of PHC and 5.4% of FPC patients; while TV and/or BV infections were found in 28.7% and 22.8%, respectively. GC or CT infection was associated with perceived risk behaviours of the male partner (for example, belief partner is unfaithful) more often than with reported risk behaviours of the women themselves. For vaginal infections, a modified World Health Organisation (WHO) test algorithm for vaginal discharge involving risk assessment plus speculum and bimanual examination was 98.0% sensitive at PHCs and 90.8% at FPCs, with positive predictive value (PPV) of 33.4% at PHCs and 26.8% at FPCs. For GC or CT infections this algorithm was 60.6% sensitive at PHCs and 85.7% sensitive at FPCs; but PPV was only 9.9% and 9.0% respectively, little higher than the background prevalence of these infections. An RTI algorithm (Morocco specific) had comparable sensitivity and PPV for vaginal infection, and for cervical infection was less sensitive but had much higher PPV (26.9% for PHCs and 26.7% for FPCs). CONCLUSION: Women with complaints of vaginal discharge and/or lower abdominal pain presented to PHC and FP clinics, not to SCs. PHCs and FPCs should therefore receive resources for management of vaginal discharge. Both the test algorithm and the new RTI algorithm were useful in allocating treatment for vaginal infection, but only the RTI algorithm discriminated in selecting women with cervical infection. Even with the RTI algorithm, which limited treatment for cervical infection to risk assessment positive patients with signs of cervical infection or PID, the PPV for cervical infection was low, potentially resulting in frequent overtreatment and problems of partner notification.

[Investigation of a measles epidemic in Kouf, Tetouan Province, Morocco]

The investigation of a measles epidemic that occurred in May 1995 in the locality of Kouf [Province of Tetouan] detected 64 cases of measles among 281 children below 15 years of age. The attack rate was 22.8%. The most affected age group was 1-3 years. Age, sex, sublocality, school attendance and number of brothers and sisters did not seem to be risk factors for measles in this epidemic. The vaccine coverage among children aged 9 to 59 months was 83.8% with or without vaccination document and 92.7% with document. The vaccine efficacy in children 9 months to 3 years of age was 40%. Further investigations would be needed in order to clarify the reasons for this low percentage

Monitoring HIV through sentinel surveillance in Morocco

HIV sentinel surveillance was performed in five provinces of Morocco in 1993, expanded to 10 provinces in 1996. The activity was done by unlinked anonymous testing procedures. We analysed the data from 1993 to 1999. The groups studied were sexually transmitted infections, clinic attendees, pregnant women and patients with pulmonary tuberculosis. The results show that overall HIV prevalence rate over the whole period in 10 cities was 0.10% [45/44,233]. Casablanca had a significantly high rate with 0.39% [10/2567]. The patients with pulmonary tuberculosis displayed the highest prevalence with 0.36% [9/2530]. These data confirm the assumption that the HIV epidemic is low in Morocco. However, the increase of HIV prevalence lately calls for reinforcing preventive measures to limit its spread

Some characteristics of the HIV epidemic in Morocco

The first case of AIDS in Morocco was declared in 1986 and since then the number of AIDS cases has steadily increased. According to the Ministry of Health, the cumulative number of AIDS cases in December 2002 was 1085. HIV in Morocco is acquired mainly through heterosexual intercourse. Individuals aged between 30 and 39 years and in the regions of Marrakech and Agadir have been the most affected. Monitoring of the trend of the epidemic by sentinel surveillance surveys indicates that Morocco is still a low prevalence zone, since prevalence among pregnant women is less than 1%. The estimated number of HIV-infected people in Morocco is around 15 000. It is not clear why the epidemic here has not evolved as it has in the sub-Saharan countries where it is spreading at an alarming rate. Late introduction of HIV-1 subtype B in Morocco, which is relatively less transmissible, circumcision and reduced risk behaviours of Muslims may explain this. Nonetheless, because prevalence has increased in recent years, unless preventive measures are strengthened, the HIV epidemic will worsen in Morocco