[Show abstract][Hide abstract] ABSTRACT: In Morocco, knowledge of cancer risk factors, a crucial element in the process of behavioral change, has never been evaluated. This study aims to provide information on the level of awareness of cancer risk factors among the Moroccan general population.
BMC Cancer 09/2014; 14(1):695. · 3.32 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction
Au Maroc, le suicide des adolescents est un phénomène rarement étudié. L’objectif de cette étude était d’évaluer les déterminants et la prévalence du risque suicidaire et des tentatives de suicide chez les élèves de la région Centre Nord du Maroc.
Une enquête transversale a été réalisée entre avril 2012 et novembre 2013, au sein des collèges et lycées publiques. Un questionnaire anonyme auto-administré explorant le risque suicidaire selon les critères du MINI DSM-IV a été utilisé.
Au total, 2885 élèves (52,7 % garçons) âgés de 11 à 23 ans ont rempli le questionnaire. Le risque suicidaire global était de 35,3 % (n = 1017) avec des différences significatives entre les garçons et les filles (27 % versus 44,5 % ; p < 0,001). La prévalence du risque suicidaire léger était de 16,9 % (IC-95 % : 15,6–18,4), celle du risque moyen était de 8,1 % (IC-95 % : 7,1–9,1), et celle du risque élevé était de 10,1 % (IC-95 % : 9–11,3). Les tentatives de suicide au cours de la vie ont été déclarées par 10,6 % d’élèves (IC-95 % : 9,4–11,7). L’analyse multivariée a montré que le risque suicidaire est hautement associé au sexe féminin (OR = 2,9 ; IC-95 % [2,4–3,4]), au tabagisme (OR = 2,1 ; IC-95 % : [1,6–2,8]), et à l’usage de toxiques (OR = 2 ; IC-95 % : [1,4–2,8]).
Une telle prévalence élevée du risque suicidaire au milieu scolaire est choquante et inattendue. D’où la nécessité urgente de l’élaboration d’une stratégie nationale de prévention contre le suicide chez les adolescents.
Revue d Épidémiologie et de Santé Publique 09/2014; 62:S182–S183. · 0.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Understanding the effects of cancer on the quality of life of affected patients is critical to clinical research as well as to optimal management and care. The aim of this study was to adapt the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) questionnaire into Moroccan Arabic and to determine its psychometric properties. After translation, back translation and pretesting of the pre-final version, the translated version was submitted to a committee of professionals composed by oncologists and epidemiologists. The psychometric properties were tested in patients with cancer. Internal consistency was tested using Cronbach's alpha and the test-retest reliability using interclass correlation coefficients. Construct validity was assessed by examining item-convergent and divergent validity. It was also tested using Spearman's correlation between QLQ-C30 scales and EQ-5D.
The study was conducted in 125 patients. The Moroccan version was internally reliable, Cronbach's α was 0.87 for the total scale and ranged from 0.34 to 0.97 for the subscales. The intraclass correlation coefficient of the test-retest reliability ranged from 0.64 for "social functioning" to 0.89 for "physical activities" subscales. The instrument demonstrated a good construct and concomitant validity.
We have developed a semantically equivalent translation with cultural adaptation of EORTC QLQ-C30 questionnaire. The assessment of its measurement properties showed that it is quite reliable and a valid measure of the effect of cancer on the quality of life in Moroccan patients.
[Show abstract][Hide abstract] ABSTRACT: H. pylori persistent infection induces chronic gastritis and is associated with peptic ulcer disease and gastric carcinoma development. The severity of these diseases is related to human's genetic diversity, H. pylori genetic variability and environmental factors. To identify the prevalence of histo-pathological damages caused by H. pylori infection in Moroccan population, and to determine their association to H. pylori genotypes, a prospective study has been conducted during 3 years on patients attending the gastroenterology department of Hassan II University Hospital (CHU) of Fez, Morocco. A total of 801 Moroccan adults' patients were recruited; H. pylori was diagnosed and genotyped by PCR in biopsy specimens and histological exam was performed. We found a high rate of glandular atrophy. Chronic inflammation, neutrophil activity and glandular atrophy showed statistically significant association with H. pylori infection. However, intestinal metaplasia was inversely associated to this infection and no association was observed with gastric cancer cases. A statistically significant association was found between intestinal metaplasia and vacAs1 and vac Am1 genotypes in patients aged 50 years and more but not in younger. This last genotype is also associated to gastric cancer. In this study, gastric cancer showed no significant association with H. pylori. Further studies are warranted to determine the role of other etiological agents such as Epstein-Barr virus, human papillomavirus and possibly environmental and dietetic factors in the occurrence of this pathology.
PLoS ONE 12/2013; 8(12):e82646. · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Conventional treatment of anal abscess by a simple drainage continues to be routine in many centers despite retrospective and randomized data showing that primary fistulotomy at the time of abscess drainage is safe and efficient. The purpose of this study is to report the long-term results of fistulotomy in the treatment of anal abscesses. This is a prospective nonrandomized study of 165 consecutive patients treated for anal abscess in University Hospital Hassan II, Fez, Morocco, between January 2005 and December 2010. Altogether 102 patients were eligible to be included in the study. Among them, 52 were treated by a simple drainage and 50 by drainage with fistulotomy. The results were analyzed in terms of recurrence and incontinence after a median follow-up of 3.2 years (range 2-6 years). The groups were comparable in terms of age, gender distribution, type and size of abscess. The recurrence rate after surgery was significantly higher in the group treated by drainage alone (88 %) compared to other group treated by drainage and fistulotomy (4, 8 %) (p < 0.0001). However, there was a tendency to a higher risk of fecal incontinence in the fistulotomy group (5 % vs 1 %), although this difference was not significant (p = 0.27). In the group treated by drainage and fistulotomy, high fistula tract patients are more prone to develop incontinence and recurrence, mainly within the first year. A long-term follow-up seems not to influence the results of fistulotomy group. These findings confirm that fistulotomy is an efficient and safe treatment of anal abscess with good long-term results. An exception is a high fistula, where fistulotomy may be associated with a risk of recurrence and incontinence.
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION: In developed countries, reinfection after successful eradication of Helicobacter pylori appears unusual. High prevalences of H. pylori in developing countries may result in high reinfection rates. In Morocco, published studies regarding the prevalence of H. pylori are limited, and to our knowledge, there are no data regarding the reinfection rate of H. pylori after successful treatment. AIM: The aim of this study was to determine the prevalence of H. pylori in our area, and the reinfection rate at 6 months and 1 year of follow-up after successful eradication. METHODS: Consecutive patients with investigated ulcer or non-ulcer dyspepsia were prospectively enrolled in the Hassan II University Hospital of Fez. Patients with H. pylori infection were treated with a 1-week triple therapy or 10 day sequential therapy. Those tested urea breath test negative after 3 months of treatment were followed prospectively with repeated urea breath test at 6 months and 1 year. H. pylori status at endoscopic examination was determined by rapid urease test, histology, and culture. RESULTS: Four hundred and twenty-nine patients were enrolled in the study, among them 324 patients (75.5%) presented with H. pylori infection. Two hundred and fifty-six (83.3%) patients had successfully eradicated H. pylori following treatment, among them, two patients (0.8%) were reinfected with H. pylori over 12 months. The rate of reinfection was 0.42% in the first 6 months and of 0.45% in the first year of the study. CONCLUSION: The results of the present study demonstrate that firstly, prevalence of H. pylori is high (75.5%) in our area, secondly as in developed countries, there is a low (0.8%) but continuous risk of H. pylori infection in adulthood. A different approach for follow-up after H. pylori eradication is probably needed in patients of developing countries, since reinfection prevalence is different between countries.
Gastroentérologie Clinique et Biologique 04/2013; · 0.80 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Studies have shown an association between smoking and tuberculosis (TB) infection, disease and TB-related mortality. We thus documented the impact of smoking and others factors on TB treatment default.
A cohort of 1039 new TB cases matched on smoking status was followed between 2004 and 2009 in eight Moroccan regions. Treatment default was defined according to international criteria. Univariate analyses were used to assess associations of treatment default with smoking status and demographic characteristics. Multivariate logistic regression was used to adjust for potential confounding.
Patients' mean age was 35.0 ±13.2 years. The rate of treatment default was 30.2%. Default was significantly higher among men, smokers, persons living in urban areas and non-religious Muslims. After adjusting for confounding variables, factors that remained significantly associated with treatment default were: being male (OR = 3.2; 95% CI: 1.2-8.7), being a non-religious Muslim (OR = 2.0; 95% CI: 1.4-2.9) and living in an urban area OR = 3.0; 95% CI: 1.8-4.9).
The high rate found for default suggests important program's inadequacies and an urgent need for change. Therefore continued research of predictors of default and strategies to reinforce adherence is recommended.
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: The aim of this study was to assess and compare the efficacy and safety of sequential treatment with standard triple therapies in a located population in Morocco. METHODS: Consecutive H. pylori-positive patients with endoscopy-proven ulcer or non ulcer dyspepsia were prospectively randomized in the trial into one of three groups: AM and AC group were administered a tri-therapy for 7 days including PPI + amoxicillin + metronidazole (AM group)/clarithromycin (AC group) and SQ group was administered a sequential regimen consisting of PPI + amoxicillin for 5 days followed by PPI + clarithromycin + metronidazole for the remaining 5 days. Eradication was confirmed by 13C-urea breath test 3 months after the end of the treatment. RESULTS: Groups AM, AC and SQ included respectively 104, 115 and 104 patients. They were comparable in terms of age, sex, clinical and endoscopic presentation. The rate of H. pylori eradication with sequential therapy was found at 94.2% (n=98) in ITT and 96% (n=98) in PP. It was higher than those found in the AM group: 70% (n=73) in ITT and 70.8% (n=73) in PP and the AC group: 78.2% (n=90) in ITT and 79.6% (n=90) in PP (0.001). The prevalence of side effects following the sequential treatment was 9.6% (n=10) versus 22% (n=22) and 27.8% (n=32) in the AM and AC groups, respectively, (P=0.006). CONCLUSIONS: Sequential treatment was better tolerated and achieved a significantly higher eradication rate of H. pylori compared with standard triple therapies in this population.
Gastroentérologie Clinique et Biologique 11/2012; · 0.80 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Epidemiological studies have shown the association between risk of developing cervical cancer and the persistence of high-risk papillomavirus types in addition to some co-factors. However, little is known about co-factors associated with human papillomavirus (HPV) infection, especially in developing countries. This study aims to determine HPV status and associated risk factors in women with normal cytology living in the north-central area of Morocco.
From February 2007 to December 2008, a total of 925 women consulting in the gynaecological department of Fez University Hospital were asked about sociodemographic characteristics and reproductive and sexual health. Cervical samples were collected for cytological examination and HPV DNA detection. Data collected from 751 women with normal cytology were used in this study to assess the correlation between HPV infection and potential risk factors.
High prevalence of HPV infection was detected (42.5%). The highest infection rate was observed in women aged > 45 years and in those with history of abortion (OR:3.76; 95%CI[1.77-7.98]) fibroma, polyp or cysts (OR:1.68; 95%CI[1.07-2.65]). No significant association was detected with other reproductive health and risk factors including oral contraception.
In spite of the insignificant association of HPV infection with age, health authorities should seriously consider and implement strategies to increase and maintain a cervical cancer screening programme in women aged 45 and above. More attention must be given to women with gynaecological history (abortion, fibroma, polyp or cysts) since these events may be predictors of HPV infection. Investigations on partner sexual behaviour and some specific hygienic habits, especially public Turkish bath use, are needed to clarify the HPV incidence in this region.
The Journal of Infection in Developing Countries 07/2012; 6(7):543-50. · 1.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Dietary habits in Morocco are changing and the causes are not well understood. This study aimed to analyse socio-demographic factors associated with adherence to the Mediterranean diet (MeDi) in a national random sample of the adult Moroccan population.
The data collected in this cross-sectional survey included socio-demographic factors and a food frequency questionnaire. MeDi adherence was assessed in 2214 individuals with complete dietary data. MeDi adherence was measured according to a simplified MeDi score based on the weekly frequency of intake of eight food groups (vegetables, legumes, fruits, cereal or potatoes, fish, red meat, dairy products and olive oil) with the use of the sex specific medians of the sample as cut-offs. A value of 0 or 1 was assigned to consumption of each component according to its presumed detrimental or beneficial effect on health. Logistic regression was used to estimate the association between MeDi adherence (low score 1-4 vs. high 5-8) and other factors.
Mean age of the sample was 41.4 (standard deviation 15.3) years, 45.4% were men and 29.9% had a low MeDi adherence. Married subjects (adjusted odds ratio ORa=0.68, 95% CI 0.55-0.84) were less likely to have a low MeDi adherence compared to single, divorced or widowed persons. Persons from rural areas (ORa=1.46, 95% CI: 1.02-2.08), were more often low MeDi adherents compared to those from urban areas. Obese persons (ORa=1.56, 95% CI: 1.16-2.11) were more prone to low MeDi adherence than normal weight individuals.
MeDi is far from being a universal pattern in the Moroccan population. Intervention strategies should be implemented in target groups to maintain the traditional MeDi pattern considered as the original diet in Morocco.
BMC Public Health 05/2012; 12:345. · 2.32 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To estimate the prevalence of sunlight exposure and sun protection behaviors and to identify the main determinants of sun protection in a representative sample of the Moroccan population.
Cross-sectional survey was carried out during May 2008 among Moroccan adults aged 18 and over, using stratified cluster sampling in origin and sex.
A total of 2896 subjects were included. More than half (52.1%) of the participants were regularly exposed to the sun during midday hours (11-16 h) for more than 2h per day. Among those exposed to the sun during midday hours, 16.4% didn't use any means of protection. The subjects who were more protected were women (odds ratio=0.47, 95% confidence interval=[0.35-0.64]), rural residents (odds ratio=2.33, 95% confidence interval=[1.97-2.77]) and worker subjects and students (p<0.0001).
This survey has highlighted a high prevalence of sun exposure in the Moroccan population with few protection practices. It is therefore important to promote sun protection in order to maintain the incidence rate of skin cancer at its lower level.
Preventive Medicine 03/2012; 54(6):422-4. · 2.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In Morocco, there are no studies that focused on the hypertension and its associated risk factors through patients with type 2 diabetes. Different findings show that the frequency of type 2 diabetes has risen rapidly in Morocco. The main objective of this study was to assess the prevalence of hypertension and its associated risk factors among a group of patients with type 2 diabetes and to examine the level of control of hypertension among type 2 diabetic patients with hypertension.
A cross-sectional study was carried out on 525 type 2 diabetics in three Moroccan regions. The structured questionnaire was used to gather information on sociodemographic variables, history of hypertension, use of anti-hypertensive medications and duration of diabetes. Anthropometric measurements including weight and height were measured by trained staff. Blood pressure was measured using standardized sphygmomanometers.
The prevalence of hypertension was 70.4%. The logistic regression indicated that hypertension was positively associated with age (p<10-4), BMI (p<0.0002) and duration of diabetes (p)
Hypertension is a common co-morbidity among Moroccan diabetic patients with high rate of ignorance of hypertension among study subjects. The focus must be on patients and family education, counseling and behavioral interventions designed to modify lifestyle such as increasing physical activity and adopting recommended dietary changes, as well as compliance with medications.
[Show abstract][Hide abstract] ABSTRACT: Helicobacter pylori infection is the etiologic agent of various gastric pathologies. The severity of disease outcome has been attributed to some H. pylori genotypes, which varies geographically. In Morocco, there are no data regarding the pattern of H. pylori genotypes; therefore, this is the first prospective study conducted in our country to investigate the genotype profiles (vacA and cagA) of H. pylori in patients with gastric pain. Endoscopic biopsies were obtained in patients attending the gastroenterology department of the Hospital University Hassan II of Fez for gastric pain and were directly used for H. pylori detection and genotyping by polymerase chain reaction (PCR). The SPSS software program was used to study the genotype correlation to different clinical outcomes. A total of 429 patients were included in this study, with an infection rate of 69.9%. cagA was detected in 42.3% of cases. However, vacA genotyping reveal a large predominance of s2m2. Infection with multiple strains was detected in 10.8% of cases and incomplete vacA was observed in 31.5%. In Morocco, vacA s1m1 was significantly associated to peptic ulcer diseases, while s2m2 was associated to gastritis. Moroccan H. pylori vacA genotype profiles differ from the Latin American, European, and South African profiles, with more similarities to the North African profile. Because of the small number of cases with gastric cancer, no correlations with H. pylori have been studied, so, further studies will be required in order to highlight the effects of those genes on this disease.
European Journal of Clinical Microbiology 12/2011; 31(8):1775-81. · 3.02 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The association between smoking and tuberculosis (TB) treatment failure has not yet been assessed in Morocco.
To evaluate the impact of smoking on the failure rate of patients with TB.
A cohort of 727 new TB cases was followed between 2004 and 2009. Socio-demographic measurements and smoking status were collected by questionnaire. Treatment failure was defined according to international guidelines. Univariate analyses were used to assess associations of treatment failure with smoking status and demographic characteristics. Multivariate logistic regression was used to adjust for potential confounding.
The patients' mean age was 35.0 ± 13.2 years. The monthly household income was <€180 for 71.4% of the patients. The rate of treatment failure was 6.9%. Failure was significantly higher among smokers (9.1% vs. 4.5%; P < 0.01), alcohol drinkers (18.5% vs. 4.9%; P < 0.01), and those with a monthly income of <€180 (8.4% vs. 3.3%; P < 0.01). After adjusting for confounding variables, smoking and low income remained significantly associated with treatment failure (adjusted OR 2.25, 95%CI 1.06-4.76, and 3.23, 95%CI 1.12-9.32).
Smoking is associated with TB treatment failure in Morocco. Anti-smoking interventions should be incorporated into current TB case management.
The International Journal of Tuberculosis and Lung Disease 06/2011; 15(6):838-43. · 2.76 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to adapt the knee and hip osteoarthritis quality of life questionnaire (OAKHQoL) into Moroccan Arabic and to determine its psychometric properties. After translation, back-translation and pretesting, the translated version was submitted to an expert committee. The psychometric properties were tested on patients with hip or knee osteoarthritis. Internal consistency was tested using Cronbach's alpha coefficient (α), and the test-retest reliability using intraclass correlation coefficients (ICC). Construct validity was assessed by examining item-convergent and divergent validity and by comparing the average scores between age groups and walk perimeter groups. The study was conducted on 131 patients (115 with osteoarthritis of the knee and 16 with osteoarthritis of the hip). The "physical activities" (α = 0.93), "mental health" (α = 0.84) and "pain" (α = 0.88) dimensions of the Arabic version were internally reliable. The ICC were adequate to good; 0.83 for "physical activities", 0.65 for "mental health" and 0.70 for "pain" dimensions. The instrument demonstrated good construct validity; all items exceeded the 0.4 criterion for convergent validity, except items 13 and 41 and most of the correlations between items and their own scale were significantly higher than their correlations with other scales. A semantically equivalent translation has been developed with cultural adaptation of OAKHQoL. It is quite reliable and a valid measure of the effect of osteoarthritis on the quality of life on Moroccan patients.
Rheumatology International 04/2011; 32(4):1015-23. · 1.63 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To estimate the prevalence of physical activity (PA) and associated variables in the Moroccan adult population.
Population-based, May 2008 survey of a representative sample of Moroccan adults. PA was assessed using the International Physical Activity Questionnaire (IPAQ).
Mean age was 41.4 years (26.2-56.6). Of the 2613 subjects, 48.1% were women and 58% lived in urban areas. The prevalence of the lowest physically active category was 16.5% overall, 24% in women and 9% in men (p < 0.001). Unemployed (18.6%) and retired individuals (17.9%), housewives (28.2%) and married persons (19.7%) reported lower levels of physical activity. Older age, unemployment or retirement, having high income, and being overweight or obese were the main determinants of low PA levels in men. In women, the main determinants of low PA levels were living in an urban area and being a housewife.
This survey has identified that urbanization and having high income are main determinants of low physical activity in Moroccan adults in a country undergoing economic transition.
Preventive Medicine 03/2011; 52(5):355-7. · 2.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Résumé Au Maroc, le cancer du col de l’utérus demeure un véritable problème de santé publique au moment où son incidence diminue
dans les pays développés. Cette diminution est liée au dépistage précoce qui se base sur le frottis et sur le test HPV (human papillomavirus). La prévalence de l’infection par ce pathogène qui est l’agent causal de cette maladie varie suivant les régions géographiques.
L’objectif de cette étude était de déterminer la prévalence de l’infection à HPV dans trois régions différentes du Maroc ainsi
que les facteurs de risque qui lui sont liés. L’amplification génique « PCR » a été utilisée pour le diagnostic de l’HPV.
Résultats Les résultats obtenus montrent que le taux d’infection diffère d’une région à l’autre. Des taux alarmants ont été détectés
dans la ville de Fès et dans ses régions. Quelle que soit la région, deux facteurs de risque semblent être liés à l’infection
à HPV: l’âge de plus de 45 ans et l’antécédent de fausse couche (FC) ou d’avortement naturel. Le taux d’infection était plus
important chez les femmes sexuellement actives et qui n’ont jamais eu d’enfants.
Conclusion Une intention plus particulière doit être prêtée à cette catégorie de femmes et un protocole de dépistage convenable tenant
compte des facteurs de risque spécifiques à ces régions doit être établi.
Journal africain du cancer / African Journal of Cancer 01/2011; 3(2):104-110.