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.

[Obstetric care: Supply and demand care in three valleys of the western High Atlas region of Morocco (Anougal, Azgour and Imnane)]. / Demande et offre de soins obstétricaux dans le Haut Atlas occidental.

This article analyses the data of an exhaustive retrospective survey of maternal morbidity among 656 women from 3 valleys of the Western High Atlas mountains of Morocco who gave birth within the previous 5 years and from the obstetric register of the hospital providing obstetric care in the study area. This analysis reveals a very large gap between the prevalence of symptoms of maternal morbidity recorded in the High Atlas valleys we studied and those measured on a regional and national scale. Only a minority of women have either prenatal or postnatal care, and delivery in a medically monitored environment is uncommon. Although morbidity during pregnancy should lead women to give birth in such a setting, only one third of the women with morbidity during pregnancy gave birth in a medical facility. This situation increases the risk of complications and morbidity during pregnancy, delivery and the postpartum period. This inadequate utilisation of preventive and curative healthcare appears to be related not only to sociocultural representations and socio-economic conditions but also to inadequate provision of obstetric care by the health-care system for complications and the poor quality of pre- and postnatal consultations. The proportion of serious complications of pregnancy or delivery complications requiring emergency obstetric care admitted to the hospital does not exceed 4.5%, while the acceptable level is 15%. Among these cases, nearly half were subsequently referred to Marrakech, to a second-level referral centre.