Bio-demographic characteristics of children with Down syndrome, their siblings, and their parents in Moroccan population.

OBJECTIVE: In this study, we present the results of bio-demographic characteristics of households and associated factors with Down syndrome (DS) birth in Morocco. METHODS: We conducted a retrospective survey between 2014 and 2017 addressed to 277 families with 925 siblings and at least one child with DS (279 with DS). The data are collected using a standardized questionnaire in Marrakech-Safi region. Data were entered and analyzed using the statistical program SPSS statistics software for Windows (version 20.0). Chi-square (χ2) and student t tests were used for testing statistical significance. Differences were considered significant when the p-value <0.05. RESULTS: The binary logistic regression analysis between DS and non-DS children in their bio-demographic characteristics studied (sex, breastfeeding, duration of exclusive breastfeeding, birth weight, maternal age at birth, paternal age at birth, oral contraceptive use, duration of oral contraceptive use before pregnancy, child age and rank of birth) showed that only maternal age and paternal age at birth, duration of exclusive breastfeeding, birth weight and child age (OR= 1.08; 95%Cl: 1.04-1.13, OR= 1.04; 95%Cl: 1.00-1.08, OR= 0.95; 95%Cl: 0.92-0.98, OR= 0.31; 95%Cl: 0.22-0.44 and OR= 0.90; 95%Cl: 0.87-0.93, respectively). In the other hand, the comparison between some of socio and bio-demographic characteristics of households studied with data from National Population Survey and Family health (2018) showed a higher level of education in women and men in our sample. Similar results were shown in proportion of men and women in paid employment, the proportion of smoking and alcohol consumption among men and the rate of oral contraceptive use before pregnancy among women. CONCLUSION: Highlighting the bio-demographic characteristics of people with DS will help families to take good care of this group. .

The impact of knowledge to optimize attitude and behaviour about infertility: Perspectives from students in Morocco.

The aim of this study is to explore knowledge, attitude and behaviour about infertility among young people, to prevent risk factors which should threaten fertility of young people.455 non-medical and medical students participated to this study, by a simple random sampling method. Knowledge state of non-medical group about infertility management was lower than medical group. Participants of non-medical group (p = 0,041) had low knowledge about definition and causes than participants of medical group. 11,5% of female and 10,9% of male of non-medical group opted for Traditional-healer as first solution if treatment fails , none of medical group suggested this option. The first advice of respondents of non-medical was polygamy, adoption and divorce (P= 0,001). Respondents of medical (p= 0,038) had proposed to try fertility treatments more than once time if treatment fails. Government should increase efforts to improve knowledge about infertility for all scholar programs.

Le but de cette étude est d'explorer les connaissances, les attitudes et les comportements concernant l'infertilité chez les jeunes, afin de prévenir les facteurs de risque qui pourraient menacer la fertilité des jeunes. 455 étudiants non-médecins et en médecine ont participé à cette étude, par une simple méthode d'échantillonnage aléatoire. L'état des connaissances du groupe non médical sur la gestion de l'infertilité était inférieur à celui du groupe médical. Les participants du groupe non médical (p = 0,041) avaient une faible connaissance de la définition et des causes par rapport aux participants du groupe médical. 11,5% des femmes et 10,9% des hommes du groupe non médical ont opté pour le guérisseur traditionnel comme première solution en cas d'échec du traitement, aucun membre du groupe médical n'a suggéré cette option. Le premier conseil des répondants non médicaux était la polygamie, l'adoption et le divorce (P= 0,001). Les répondants médicaux (p= 0,038) avaient proposé d'essayer des traitements de fertilité plus d'une fois en cas d'échec du traitement. Le gouvernement devrait redoubler d'efforts pour améliorer les connaissances sur l'infertilité pour tous les programmes universitaires.

Parents' perceptions of morbidities and some functional abilities in people with down syndrome in Morocco.

Objective: This study aimed to assess parental perceptions of morbidity and certain functional abilities in people with Down syndrome (DS) and their variability according to age and sex in Morocco. Material and Methods: A retrospective and analytical survey was conducted between May 2014 and November 2017, and addressed to the parents of 279 individuals with DS, including 161 boys (57.7%) aged 1-40 years. The sample was subdivised to tree age groups, children under 10 years old, adolescents aged 10-18 years and adults aged ≥ 18 years. Information about the identity of parents, age and sex of people with DS, their morbidity during the two years preceding the survey, and some functional abilities was collected. Data were entered and analyzed using the statistical program SPSS statistics software for Windows (version 20.0). Chi-square (χ2) test was used for testing statistical significance. Differences were considered significant when the p-value < 0.05. The multivariate analysis were used to identify the causes of morbidies independently associated with age and sex of child. Associations were measured in Odds ratio (OR) with 95% confidence intervals (95% Cl). Results: The most common factors of morbidity registered in the study sample with DS, included respiratory infections, visual disturbances, oral pathologies, and cardiac problems (75.4%, 72.1%, 59.3%, and 44.9%, respectively). The hearing deficit, cardiac problems, respiratory infections, and oral pathologies showed statistically significant differences among the three age groups. According to the participants parents' perceptions, half of them (50%) were able to walk at 30 months, talk at 72 months, sit at 16 months, crawl at 16 months and eat alone at 48 months old. Conclusion: People with DS at different ages present a set of potentially treatable diseases that require multidisciplinary medical monitoring. They also need early paramedical care to improve their functional abilities.

Gender norms and access to sexual and reproductive health services among women in the Marrakech-Safi region of Morocco: a qualitative study.

INTRODUCTION: Improving access to sexual and reproductive health remains a public health challenge, especially for women, whose access is affected by several determinants, such as gender inequality, which is the underlying barrier to all other determinants. Many actions have been carried out, but much remains to be done before all women and girls can exercise their rights. This study aimed to explore how gender norms influence access to sexual and reproductive health services. METHOD: A qualitative study was conducted from November 2021 to July 2022. The inclusion criteria were women and men aged over 18 years old, living in the urban and rural areas of the Marrakech-Safi region in Morocco. A purposive sampling method was used to select participants. Data were obtained through semi-structured interviews and focus groups with selected participants. The data were coded and classified using thematic content analysis. RESULTS: The study highlighted inequitable, restrictive gender norms that lead to stigmatization and affect the sexual and reproductive healthcare-seeking behavior and access of girls and women in the Marrakech-Safi region. These most common gender norms for women include parental refusal, stigmatization, and social exclusion of girls from sexual and reproductive health education services; strong decision-making power of family members over contraceptive use and women's adherence to pregnancy monitoring and access to supervised delivery; and culturally constructed role allocation, assigning a reproductive role to women and making them responsible for the health of new-borns. CONCLUSION: Sexual and reproductive health projects must strive to be gender sensitive. Gender-blind projects are missed opportunities to improve health outcomes and advance gender equality.

Bio-demographic characteristics of households and risk factors for Down Syndrome in Morocco.

Background: The most studied risk factors for Down Syndrom (DS) were: region of residence, exposure to chemicals, parents' education level, cigarette and alcohol use by father or mother or both, and oral contraceptive (OC) use. Objective: The aim of this study was to compare certain variables considered as risk factors on DS such as parental age at birth, OC use, child's sex, and rank of birth between children with DS and their siblings without DS as well as to determine the socio-bio-demographic characteristics of the families studied compared with the general Moroccan population. Material and Methods: We conducted a cross-sectional analysis of 277 families with 925 siblings and at least one child with DS (279 with DS) between 2014 and 2017. The data are collected using a standardized questionnaire in MarrakechSafi region. Data were entered and analyzed using the statistical program SPSS statistics software for Windows (version 20.0). Chi-square (χ2) and Student t tests were used for testing statistical significance. Differences were considered significant when the p-value <0.05. Results: The binary logistic regression analysis between DS and non-DS children in their bio-demographic characteristics studied (sex, maternal age at birth, paternal age at birth, oral contraceptive (OC) use, length of oral contraceptive use before pregnancy and rank of birth) showed that only maternal age and paternal age at birth and OC use were associated with DS birth (OR= 1.16; 95% CL: 1.11-1.21, OR= 1.05; 95%CL: 1.01-1.09 and OR= 0.01; 95%CL: 0.00-0.003, respectively). In the other hand, the comparison between socio and bio-demographic characteristics of households studied with data from National Population Survey and Family health (2018) showed a higher level of education in women and men in our sample. Similar results were shown in rate of men and women in paid employment, the rate of smoking and alcohol consumption among men and the rate of OC use before pregnancy among women. Conclusion: These results will help to sensitize the Moroccan population about risk factors for DS.

Self-reported morbidities, nutritional characteristics, and associated factors in institutionalized and non-institutionalized older adults.

BACKGROUND: As the world's population ages and people live longer, it seems important to ensure that older people have a good quality of life and positive subjective well-being. The objective of this study is to determine socio-economic, health and nutritional characteristics of institutionalized and non-institutionalized elders in the province of Marrakech. METHODS: This study was conducted among 368 older adults in the province of Marrakech between March 2017 and June 2019. Of all participants, 180 older adults reside in a public institution and 188 of them live in their own homes. Data on health conditions, nutritional status, functional and socio-economic characteristics were collected. Data was analyzed using SPSS Statistics for Windows, Version 16.0. Statistical significance was set at p < 0.05. RESULTS: Institutionalized elders were illiterate (80.0%), had low incomes (95.5%), and unmarried (73.3%), they reported also no children (56.1%) and no health insurance (98.9%). Institutional residents suffered from malnutrition (22.2%), hearing impairments (35.6%) and severe edentulism (43.3%). There was no significant difference between both groups on daily activities and depression. A multivariate analysis identified a model with three significant variables associated with non-institutionalized elders: health insurance (P = 0.001; OR = 107.49), number of children (P = 0.001; OR = 1.74) and nutritional status (p = 0.001; OR = 3.853). CONCLUSIONS: This study shows that the institutionalization of older adults is considerably induced by various factors such as nutritional problems, lack of health insurance and family structure. To mitigate the effects of this phenomenon, home care strategies and preventive actions should be implemented to delay the institutionalization of older adults and therefore keep them socially active in their own homes.

Determinants of Maternal Health Services Use among Vulnerable Women in a Rural Community in the Moroccan High Atlas.

Several factors affect the use of maternal health care services in developing countries. The aim was to describe the knowledge and attitudes of women in a rural area of the Moroccan High Atlas regarding aspects of maternal health, and to identify the determinants of use of maternal health care services. A cross-sectional study of 87 participants was conducted in a mountainous area near Marrakech utilizing two sampling methods (a door-to-door approach, and a mobile health caravan). Fisher test was used to compare two proportions, and the non-parametric Mann-Whitney test to compare two means (p value was 0.05). Median participants' age was 24 years old [15-60]. Findings indicated that husband's education (p=0.005), woman's age (p=0.011), awareness of warning signs during pregnancy (p=0.01) and use of health center for other purposes other than pregnancy (p=0.007) were important influencing factors for use of prenatal consultation services. Factors that influenced supervised birth outcomes were the age of the woman (p=0.013), her education (p=0.027) and a positive attitude towards monitoring her pregnancy by a health professional (p=0.006). To improve utilization rates for maternal health services, these factors must be considered when designing interventions that aim to improve the quality of these services in the community.

Moderate-to-Severe Iodine Deficiency in the "First 1000 Days" Causes More Thyroid Hypofunction in Infants Than in Pregnant or Lactating Women.

Background: Iodine deficiency early in the life cycle-the "first 1000 days"-can cause hypothyroidism and irreversibly impair neuromotor development. However, the relative vulnerability among women and infants during this critical period is unclear, making it difficult for country-based programs with limited resources to prioritize their iodine interventions.Objective: Our aim was to determine the prevalence of thyroid hypofunction in women and infants living in an area of moderate-to-severe iodine deficiency.Methods: In a cross-sectional survey in Morocco, we measured urinary iodine concentrations (UICs) and concentrations of thyroid-stimulating hormone (TSH) and total or free thyroxine (TT4 or fT4, respectively) in women of reproductive age (n = 156), pregnant women (n = 245), and lactating women (n = 239) and their young infants (n = 239). We calculated daily iodine intakes and measured iodine concentrations in breast milk and household salt. We compared the incidence of hypothyroidism between the 3 groups of women and with the infants.Results: Women of reproductive age, pregnant women, and lactating women had median (IQR) UICs of 41 (29-63), 32 (17-58), and 35 (19-62) µg/L; and estimated iodine intakes were ∼60%, 22%, and 26% of Recommended Nutrient Intakes (RNIs). The infants' median UIC was 73 (28-157) µg/L, which was greater than for all 3 groups of women (P < 0.001), and their dietary intakes were 27% of the RNI. The prevalence of hypothyroidism was not significantly different between the 4 groups, whereas the prevalence of hypothyroxinemia was higher in infants (40%) than in the 3 groups of women (11-14%) (P < 0.001). The median breast-milk iodine concentration was 42 (26-81) µg/L. Only 6% of salt samples were adequately iodized to a concentration of ≥15 ppm; 54% were inadequately iodized and 40% contained no measurable iodine.Conclusions: In an area of moderate-to-severe iodine deficiency, the prevalence of thyroid hypofunction is ∼4-fold higher in young infants compared with the 3 groups of women, suggesting that, in the "first 1000 days," infants are more vulnerable than their mothers and that programs should prioritize iodine prophylaxis for this group.

Breast Milk Iodine Concentration Is a More Accurate Biomarker of Iodine Status Than Urinary Iodine Concentration in Exclusively Breastfeeding Women.

Background: Iodine status in populations is usually assessed by the median urinary iodine concentration (UIC). However, iodine is also excreted in breast milk during lactation; thus, breast milk iodine concentration (BMIC) may be a promising biomarker of iodine nutrition in lactating women. Whether the mammary gland can vary fractional uptake of circulating iodine in response to changes in dietary intake is unclear.Objective: We evaluated UIC and BMIC as biomarkers for iodine status in lactating women with a wide range of iodine intakes.Methods: We recruited 866 pairs of lactating mothers and exclusively breastfed infants from 3 iodine-sufficient study sites: Linfen, China (n = 386); Tuguegarao, Philippines (n = 371); and Zagreb, Croatia (n = 109). We also recruited iodine-deficient lactating women from Amizmiz, Morocco (n = 117). We collected urine and breast milk samples and measured UIC and BMIC.Results: In the 3 iodine-sufficient sites, a pooled regression analysis of the estimated iodine excretion revealed higher fractional iodine excretion in breast milk than in urine at borderline low iodine intakes. In contrast, in the iodine-deficient site in Morocco, a constant proportion (∼33%) of total iodine was excreted into breast milk.Conclusions: In iodine-sufficient populations, when iodine intake in lactating women is low, there is increased partitioning of iodine into breast milk. For this reason, maternal UIC alone may not reflect iodine status, and BMIC should also be measured to assess iodine status in lactating women. Our data suggest a BMIC reference range (2.5th and 97.5th percentiles) of 60-465 µg/kg in exclusively breastfeeding women. This trial was registered at clinicaltrials.gov as NCT02196337.

DIET QUALITY OF MOROCCAN ADOLESCENTS LIVING IN MOROCCO AND IN SPAIN.

Intra-population socioeconomic changes and migration are powerful factors in changing eating habits. Changes in eating habits could affect the nutritional status, growth, development and health of adolescents. The aim of this study was to compare the diet of adolescents of Moroccan origin living in Spain with that of adolescents living in Morocco. The sample comprised 428 Moroccan adolescents aged from 12 to 19 recruited in high schools: 327 living in Ouarzazate (Morocco) and 101 living in Madrid (Spain). The variables studied were energy intake (kcal/day), diet quality indicators (adherence to the Mediterranean Adequacy Index (MAI); cholesterol intake (mg/day); fibre intake (g/day) and energy profile)); and indicators of keeping traditional customs (halal meat consumption, bread made at home). Teenagers from Morocco living in Madrid consumed more calories, proteins, saturated fats and simple sugars (p<0.001) than those living in Morocco. Their diet was of lower quality than that of their peers in Morocco. This difference was more marked in boys than in girls. Changes in eating habits associated with migration from the south to the north Mediterranean basin can benefit young migrants in an immediate way (through greater availability of energy and nutrients), but later in life it could have negative consequences for their health, increasing the risk of overweight, obesity and cardiovascular and metabolic problems.

Iodine Supplementation Decreases Hypercholesterolemia in Iodine-Deficient, Overweight Women: A Randomized Controlled Trial.

BACKGROUND: In iodine deficiency, thyrotropin (TSH) may increase to stimulate thyroidal iodine uptake. In iodine-sufficient populations, higher TSH predicts higher total cholesterol. Whether higher TSH caused by iodine deficiency affects serum lipids is uncertain. OBJECTIVE: Our aim was to determine if iodine repletion decreases serum TSH and improves the lipid profile. METHODS: In this randomized controlled intervention, iodine-deficient, overweight or obese Moroccan women (n = 163) received 200 µg oral iodine or a placebo daily for 6 mo. Main outcomes were serum TSH and plasma total and LDL cholesterol. Secondary outcomes included thyroid hormones and measures of lipid and glucose metabolism and urinary iodine concentration (UIC). Data were compared by using mixed-model analysis. RESULTS: In the intervention group, median UIC increased from 38 (95% CI: 34, 45) µg/L to 77 (95% CI: 59, 89) µg/L (P < 0.001). After 6 mo of intervention, TSH was 33% lower in the treatment group than in the placebo group (P = 0.024). The triiodothyronine (T3) to thyroxine (T4) ratio and thyroglobulin decreased with treatment [-15% (P = 0.002) and -32% (P < 0.001), respectively], whereas T4 concentrations were higher in the treatment group (P < 0.001). Total cholesterol in subjects with elevated baseline cholesterol (>5 mmol/L) was reduced by 11% after the intervention (P = 0.034). At 6 mo, only 21.5% of treated women remained hypercholesterolemic (total cholesterol >5 mmol/L) vs. 34.8% of controls (baseline: 44.2% in the intervention and 36.8% in the control group; P = 0.015). The reduction in the prevalence of elevated LDL cholesterol (>3 mmol/L) in the intervention group (50.6% to 35.4% compared with 47.4% to 44.9% in the control group) was not significant (P-interaction = 0.23). CONCLUSIONS: Our findings suggest that moderate to severe iodine deficiency in overweight women elevates serum TSH and produces a more atherogenic lipid profile and that iodine supplementation in this group reduces the prevalence of hypercholesterolemia. Thus, iodine prophylaxis may reduce cardiovascular disease risk in overweight adults. This trial was registered at clinicaltrials.gov as NCT01985204.

Inadequacy of vitamins and minerals among high-school pupils in Ouarzazate, Morocco.

OBJECTIVE: To assess micronutrient intakes and the prevalence of inadequacy in a sample of high-school pupils in Ouarzazate, Morocco. DESIGN: Food records were compiled over three non-consecutive days by pre-trained pupils. Micronutrient intakes were estimated using the DIAL software, adapted to include foods commonly eaten in Morocco. The prevalence of inadequacy was estimated by the proportion of individuals with intakes below the Estimated Average Requirement (EAR) for vitamins B12, A and K, thiamin, riboflavin, niacin, pyridoxine, folate, ascorbic acid, iodine, Ca, Mg and P; below the Adequate Intake (AI) level for pantothenic acid, biotin, Na and K; and using the probability approach for Fe. Data were adjusted for intra-individual variation with exclusion of under-reporters. SETTING: Ouarzazate, a semi-urban region situated on the southern slopes of the High Atlas with little industrial development but an important tourism sector. SUBJECTS: A self-selected sample of 312 pupils aged 15-19 years from the five public high schools. After exclusion of under-reporters, 293 remained for analysis. RESULTS: The highest proportions of below-EAR/AI intakes were seen for pantothenic acid (girls 85·1 %, boys 78·0 %), biotin (boys 83·1 %, girls 79·4 %), thiamin (boys 66·9 %), folate (girls 93·1 %, boys 74·6 %), iodine (boys 94·9 %, girls 88·0 %) and Ca (girls 83·4 %, boys 74·6 %). Na intake was generally in excess whereas K intake was below the AI level. In general, girls had better-quality diets than boys, who appeared to consume more 'empty calories'. CONCLUSIONS: Our findings suggest that in this population of Moroccan adolescents, nutritional intervention and educational strategies are needed to promote healthy eating habits and correct micronutrient inadequacies. To provide reliable and precise estimates of nutrient intakes, an update of Moroccan food composition databases is urgently needed. We recommend that national authorities address these issues.

Cognitive complaints in older adults in primary care and associated factors.

Cognitive complaints are common in older people. They can progress into a more severe cognitive decline and then deterioration of quality of life. They are associated with several factors. Objective: This study aimed to determine the factors associated with cognitive complaints in older adults in the city of Marrakech, Morocco. Methods: This study was conducted between March and June 2022 among 281 people aged 50 years and older who attended primary health care centers in the city of Marrakech. Cognitive complaints were measured using the McNair-Kahn scale. Data on sociodemographic and clinical characteristics were collected through interviews with the participants and consultation of their medical records. Analysis was done using Statistical Package for Social Sciences (SPSS) version 25, Ink software. Results: Of the total participants, 51.6% had cognitive complaints. Multivariate analysis showed that people aged 75 years and over had a sevenfold higher risk of cognitive complaints than people aged 50-64 years (p=0.033; OR=7.64; 95%CI 1.17-49.72), and that illiteracy (p=0.004; OR=3.39; 95%CI 1.48-7.76), cardiovascular disease (p=0.018; OR=4.30; 95%CI 1.29-14.32), diabetes (p=0.001; OR=3.14; 95%CI 1.64-6.04), visual impairment (p=0.017; OR=2.22; 95%CI 1.15-4.19), depression (p= 0.027; OR=2.36; 95%CI 1.10-5.05) and sleepiness (p=0.034; OR=1.96; 95%CI 1.05-3.66) are associated variables. Conclusions: Cognitive complaints are frequent in older adults and are associated with several sociodemographic and health factors. Some measures could help maintain stable memory performance in old age and prevent severe cognitive declines, such as regular follow-up of at-risk individuals, and cognitive, physical and leisure activities.

Queixas cognitivas são comuns em pessoas idosas. Elas podem evoluir para um declínio cognitivo mais grave e, em seguida, deterioração da qualidade de vida. Elas estão associadas a vários fatores. Objetivo: Este estudo teve como objetivo determinar os fatores associados às queixas cognitivas em idosos da cidade de Marrakech, Marrocos. Métodos: Este estudo foi realizado entre março e junho de 2022 entre 281 pessoas com 50 anos ou mais que se apresentaram em centros de atenção primária à saúde na cidade de Marrakech. As queixas cognitivas foram medidas usando a escala de McNair-Kahn. Os dados sobre características sociodemográficas e clínicas foram coletados por meio de entrevista com os participantes e consulta aos seus prontuários. A análise foi feita usando o software Pacote Estatístico para as Ciências Sociais (SPSS), versão 25. Resultados: Do total de participantes, 51,6% apresentaram queixas cognitivas. A análise multivariada mostrou que pessoas com 75 anos ou mais tiveram risco sete vezes maior de queixas cognitivas do que pessoasentre 50­64 anos (p=0,033; OR=7,64; IC95% 1,17­49,72), e que analfabetismo (p=0,004; OR=3,39; IC95% 1,48­7,76), doenças cardiovasculares (p=0,018; OR=4,30; IC95% 1,29­14,32), diabetes (p=0,001; OR=3,14; IC95% 1,64­6,04), comprometimento visual (p=0,017; OR=2,22; IC95% 1,15­4,19), depressão (p=0,027; OR=2,36; IC95% 1,10­5,05) e sonolência (p=0,034; OR=1,96; IC95% 1,05­3.66) são variáveis associadas. Conclusões: Queixas cognitivas são frequentes em idosos e estão associadas a diversos fatores sociodemográficos e de saúde. Algumas medidas poderiam ajudar a manter o desempenho estável da memória na velhice e prevenir declínios cognitivos graves, como o acompanhamento regular de indivíduos em risco e atividades cognitivas, físicas e de lazer.

Factors influencing older adults' satisfaction with caregivers' communication.

Effective communication skills are crucial for caregivers to provide quality care and meet the unique needs of patients of all ages. However, older patients have specific communication requirements, and their satisfaction depends on several factors. Objective: This study aimed to evaluate the level of satisfaction among older adults in Marrakech, Morocco, regarding the communication skills of their caregivers, and to identify the factors influencing this satisfaction. Methods: This is a cross-sectional study conducted between March and July 2022 among 204 people aged 60 years and older who presented to the Mouhamed VI University Hospital of Marrakech, Morocco, for various care services. The older adults' satisfaction with caregivers' communication was assessed by the American Board of Internal Medicine (ABIM) patient satisfaction questionnaire. Sociodemographic and clinical characteristics of the participants were collected through interview and consultation of medical records. Multiple linear regression was used to determine potential factors influencing the total satisfaction score. Results: The total satisfaction score of older adults with caregiver' communication was 2.55±0.95 and the mean scores of the lowest subscales were answering questions, greeting and listening. Analysis revealed that having visual disorders (B=-0.276±0.12; p=0.029) and receiving affective touch from caregivers (B=0.745±0.12; p=0.001) were the main factors associated with older adults' satisfaction with caregiver' communication. Conclusion: Older people are not sufficiently satisfied with caregivers' communication skills, especially those with vision problems and those who have not received affective touch from caregivers. Caregivers need to be aware of the specific needs of older patients and use appropriate communication techniques.

Habilidades de comunicação eficazes são fundamentais para que os profissionais de saúde ofereçam atendimento de qualidade e atendam às necessidades específicas de pacientes de todas as idades. No entanto, os pacientes mais velhos têm necessidades específicas de comunicação, e sua satisfação depende de vários fatores. Objetivo: Este estudo teve como objetivo avaliar a satisfação da pessoa idosa com a comunicação dos cuidadores e identificar os fatores de influência. Métodos: Este é um estudo transversal realizado entre março e julho de 2022 com 204 pessoas com 60 anos ou mais que se apresentaram ao Hospital Universitário Mouhamed VI de Marrakech para receber diversos cuidados. A satisfação da pessoa idosa com a comunicação dos cu idadores foi avaliada pelo questionário de satisfação do paciente do American Board of Internal Medicine (ABIM). As características sociodemográficas e clínicas dos participantes foram coletadas por meio de entrevista e consulta aos registros médicos. A análise dos dados foi realizada com o software Statistical Package for the Social Sciences (SPSS), versão 25. Resultados: A pontuação total de satisfação da pessoa idosa com a comunicação do cuidador foi de 2,55±0,95, e as pontuações médias das subescalas mais baixas foram responder a perguntas, cumprimentar e ouvir. A análise revelou que ter distúrbios visuais (B=-0,276±0,12; p=0,029) e receber toque afetivo dos cuidadores (B=0,745±0,12; p=0,001) foram os principais fatores associados à satisfação dos pessoa idosa com a comunicação do cuidador. Conclusão: As pessoas idosas não estão suficientemente satisfeitas com as habilidades de comunicação dos cuidadores, especialmente aquelas com problemas de visão e as que não receberam o toque afetivo dos cuidadores. Os cuidadores precisam estar cientes das necessidades específicas dos pacientes mais velhos e usar técnicas de comunicação adequadas.

Nutritional status of adolescents in the context of the Moroccan nutritional transition: the role of parental education.

In Morocco, the beginning of the nutritional transition is closely linked to social and economic transformations and changes in behaviour and traditional lifestyles. The objective of this study is to describe the current pattern of food consumption and the nutritional status of adolescents in the province of Ouarzazate and its association with parents' educational level. The sample comprises 327 high school students from Ouarzazate: 135 (41.3%) boys and 192 (58.7%) girls (age range 15-20 years). For both boys and girls, the results show lower height and BMI z-scores than the WHO reference values. Adolescents whose parents have a low educational level have lower height/age and BMI/age z-scores than those whose fathers have a high educational level. No differences are observed in total daily energy intake depending on fathers' educational level, but the energy provided by lipids is higher in adolescents whose fathers have a high educational background. The quality of fats consumed (MUFA+PUFA/SFA) is better among those boys whose fathers have low education, but no differences are observed for girls. The process of nutritional transition is not uniform in the sample, but depends on the socioeconomic characteristics of population groups, which include, among others, accessibility of certain food, differences in habits and lifestyles related to energy expenditure, and higher prevalence of overweight and obesity in more favoured groups.

Ethnobotanical study on wild edible plants traditionally used by Messiwa people, Morocco.

BACKGROUND: The traditional knowledge on wild edible plants has been shown in many studies a worrying decline throughout the last few decades. Therefore, the first aim of this study was to document the population knowledge on wild edible plants among the Messiwa people. The second objective was to assess the traditional knowledge of our informants according to their socio-economic status. METHODS: The survey was conducted among 149 informants through a semi-structured questionnaire. The relative importance of the plants was obtained by calculating the relative frequency of citation (RFC) for each species. To compare means, we used Student's t test for two-group comparisons and Snedecor's F-test for multi-group comparisons. The multi-range Duncan test was used for multiple mean comparisons. The correspondence factor analysis (CFA) was also used. RESULTS: A set of 64 species belonging to 56 genera from 34 families has been collected and identified. The species used for nutritional and medicinal purposes represent 56%, while 44% were used exclusively as nutritional plants. The most used parts are, respectively, the aerial parts (58%), the fruits (17%), the underground parts (13%), the seeds (8%), and finally the flowers (5%). On the other hand, the higher level of knowledge on wild edible plants was found among women, the elderly, illiterate, married people, and those engaged in agricultural occupations. CONCLUSION: This work could be a basis to be reproduced on other regions in Morocco and to be widened through pharmacological and nutritional studies in order to promote and valorize these wild edible plants.

A Quantitative Study on the Ethnobotanical Knowledge about Wild Edible Plants among the Population of Messiwa.

Background: The preservation of traditional knowledge of wild edible plants (WEPs) is one of the challenges to the sustainability of natural resources. Therefore, it is crucial to assess the traditional knowledge of WEPs in relation to some socio-demographic and economic factors. Methods: The survey was conducted among the Messiwapopulationthrough a semi-structured questionnaire. The first part of the questionnaire concerns socio-demographic and economic information, while the second part concerns the plants recognized and used by the informant. The recognition frequency (RF), the use frequency (UF), the general consumption frequency(CF), the recent consumption frequency (RCF), and the correlation between these frequencies were evaluated. A comparison of means was also used to compare informant's knowledge according to their socio-demographic and economic status. Results: The three species;Foeniculum vulgare, Ziziphus lotus, and Malva sylvestris were the most recognized (FR = 1) and the most used (FU = 1). The consumption frequency (CF) and the recent consumption frequency (RCF) for Foeniculum vulgare were 1 and 0.9, respectively. Taraxacum getulum, Calendula arvensis and Cyperus rotundus were the least recognized (FR= 0.16; 0.16; 0.48) and least used (FU = 0.3; 0.3; 0.4) species, respectively. The informants who showed a high level of traditional knowledge on WEPs were housewives, with a low level of schooling and at least 45 years old. Conclusion: Despite the decline in traditional knowledge about wild edible plants, some populations preserve this knowledge, especially among the elderly. Therefore, documentation of this knowledge is necessary through ethnobotanical and ethnomedicinal studies.

[Reorganization of a third-level maternity ward during the COVID-19 pandemic: maternity ward experience at the University Hospital of Marrakech]. / Expérience de réorganisation d'une maternité de troisième niveau face à la pandémie de la COVID-19: étude du cas de la maternité de l´hôpital universitaire de Marrakech.

Introduction: COVID-19 pandemic has put unprecedented pressures on obstetrics and gynecology care services. Maternity hospitals have needed to rapidly prepare to provide quality care while preventing the transmission of the infection. The purpose of this study is to describe the key elements of the response to COVID-19 within the maternity ward of the Mohammed VI University Hospital in Marrakech. Methods: a case study was conducted. Data were collected using various administrative documents related to activities in the maternity ward of the Mohammed VI University Hospital during the COVID-19 pandemic. We also conducted semi-structured interviews with professionals at the maternity ward. Qualitative thematic analysis approach was used for the analysis of transcribed data and triangulation, with the analysis of documentary data. Results: the study highlighted phases of design and organization of two maternity ward access circuits. A new circuit for suspicious or confirmed cases of COVID-19 ensured access to quality care for patients, by guaranteeing isolation measures. The access circuit that was commonly used remained functional to consolidate the right of access to tertiary obstetrics and gynecology care while applying protective measures against COVID-19. Conclusion: this study highlights the necessity to draw on the experience of other health facilities, to contextualize local activities and to anticipate work organization in the face of health crises.

The Antioxidant Activities of Ethanolic, Methanolic, Ethyl Acetate, and Aqueous Extracts of the Endemic Species, Lavandula mairei Humbert (A Comparative Study between Cold and Hot Extraction).

Background: Medicinal plants have been used for therapeutic purposes and have shown important biological properties. This study aimed to evaluate for the first time the antioxidant activities, total flavonoid, and total phenolic contents of Lavandula mairei Humbert. The ethanol, methanol, ethyl-acetate, and water extracts were used for this purpose. Methods: The antioxidant activities were assessed in vitro by free radical scavenging activity against 2,2-diphenyl-1-picrylhydrzyl (DPPH), ferric reducing antioxidant power (FRAP), and total antioxidant capacity (TAC). The total flavonoid and phenolic contents were determined spectrophotometrically with gallic acid and Quercetin as standards. Results: In either Soxhlet or maceration methods, the flavonoids and the total phenolic contents were significantly higher in the methanolic extract (P<0.05) compared to other extracts. The total flavonoid content of L. mairei ranged between 119 and 224.6 mg QE/g DW for Soxhlet extracts and from 111.8 to 148.51 mg QE/g DW for maceration extracts. While the total phenolic content was between 35.12 and 99.37 mg GAE/g DW for Soxhlet extracts and 27.63 to 58.99 mg GAE/g DW for maceration extracts. In either the Soxhlet or maceration method, the highest total antioxidant capacity (TAC) was obtained using the ethanolic extract, while the aqueous extract had the highest antioxidant activity for DPPH and FRAP assays. Conclusion: These results showed that Lavandula mairei Humbert has great potential to be a promising candidate for natural plant sources of antioxidants.

Characteristics of Menarcheal Age, Menstrual Hygiene and Socio-Demographic Factors in Girls with Down Syndrome in Morocco.

The purpose of this study was to determine the characteristics of menarcheal age, menstrual hygiene and their associated socio-demographic factors in girls with Down syndrome (DS) in Morocco. An analytical cross-sectional study was conducted between May 2014 and November 2017, including 59 parents/guardians of girls with Down syndrome aged 9-32 years. Data were collected through a standardized questionnaire providing information about socio-demographic and cultural conditions of parents, nutritional status and some functional abilities of girls. The median age at menarche was estimated using retrospective and status-quo methods, respectively. Data were entered and analyzed using the statistical program SPSS statistics software for Windows (version 20.0). Chi-square (χ2) and Mann-Whitney tests were used for testing statistical significance. The age at menarche ranged from 9 to 16 years old. The median was 13.0 (IQR, 11.0-14.0) years. The median age of menarche by probit analysis was 12.55 years. The relationship between menarcheal age, menstrual hygiene and the selected parameters showed a significant difference in age at menarche only regarding the parameter of number of siblings (Z = 2.14; p = .03), and in menstrual hygiene regarding mother's level of education, family size and age of talking (χ2 = 5.04, p = .02; χ2 = 3.75, p = .05 and χ2 = 4.99, p = .02, respectively). Most girls with DS attain menarche at the usual age as their counterparts in the general population and do not have enough knowledge about menstruation. Mobilization of all interventionists is urgent to develop adolescent skills about practices related to menstruation and menstrual hygiene.