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BackgroundFew studies on spatial patterns or secular trends in human leishmanias have been conducted in Morocco. This study aimed to examine spatial patterns and trends associated with the human leishmaniasis incidence rate (HLIR) at the province/prefecture level between 2003 and 2013 in Morocco.MethodsOnly the available published country data on the HLIR between 2003 and 2013, from the open access files of the Ministry of Health, were used. Secular trends were examined using Kendall’s rank correlation. An exploratory spatial data analysis was also conducted to examine the spatial autocorrelation (Global Moran’s I and local indicator of spatial association [LISA]), and spatial diffusion at the province/prefecture level. The influence of various covariates (poverty rate, vulnerability rate, population density, and urbanization) on the HLIR was tested via spatial regression (ordinary least squares regression).ResultsAt the country level, no secular variation was observed. Poisson annual incidence rate estimates were 13 per 100 000 population (95 % CI = 12.9–13.1) for cutaneous leishmaniasis (CL) and 0.4 per 100 000 population (95 % CI = 0.4–0.5) for visceral leishmaniasis (VL). The available data on HLIR were based on combined CL and VL cases, however, as the CL cases totally outnumbered the VL ones, HLIR may be considered as CL incidence rate. At the provincial level, a secular increase in the incidence rate was observed in Al Hoceima (P = 0.008), Taounate (P = 0.04), Larache (P = 0.002), Tétouan (P = 0.0003), Khenifra (P = 0.008), Meknes (P = 0.03), and El Kelaa (P = 0.0007), whereas a secular decrease was observed only in the Chichaoua province (P = 0.006). Even though increased or decreased rate was evident in these provinces, none of them showed clustering of leishmaniasis incidence. Significant spatial clusters of high leishmaniasis incidence were located in the northeastern part of Morocco, while spatial clusters of low leishmaniasis incidence were seen in some northwestern and southern parts of Morocco; there was spatial randomness in the remaining parts of the country. Significant clustering was seen from 2005 to 2013, during which time the Errachidia province was a permanent ‘hot spot’. Global Moran’s I increased from 0.2844 (P = 0.006) in 2005 to 0.5886 (P = 0.001) in 2011, and decreased to 0.2491 (P = 0.004) in 2013. It was found that only poverty had an effect on the HLIR (P = 0.0003), contributing only 23 % to this (Adjusted R-squared = 0.226).ConclusionLocalities showing either secular increase in human leishmaniasis or significant clustering have been identified, which may guide decision-making as to where to appropriately allocate funding and implement control measures. Researchers are also urged to undertake further studies focusing on these localities.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0135-8) contains supplementary material, which is available to authorized users.

Based on our findings, nonselective beta-blockers should not be routinely withheld in patients with cirrhosis and ascites, even if refractory.

BackgroundTuberculosis (TB) is a major health problem in Morocco. This study aims at examining trends in TB in Morocco and identifying TB spatial clusters and TB-associated predictors.MethodCountry-level surveillance data was exploited. Kendall’s correlation test was used to examine trends and an exploratory spatial data analysis was conducted to assess the global and local patterns of spatial autocorrelation in TB rates (Moran’s I and local indicator of spatial association [LISA]) at the prefecture/province level. Covariates including living in a prefecture versus living in a province, annual rainfall, annual mean temperature, population density, and AIDS incidence were controlled. An ordinary least squares regression was thus performed and both spatial dependence and heteroscedasticity were assessed.ResultsA decrease in TB incidence rate was seen between 1995 and 2014 (Kendall’s tau b = − 0.72; P <  0.0001). However, while the period between 2005 and 2014 (10 last years) was considered, TB rate remained stable and as high as 84 per 100 000 population per year (95% CI: 83.7–84.3). The highest incidence rates were seen in Tanger-Assilah, Fez, Tetouen-M’diq Fnidaq, Inezgane Ait Melleoul, and Casablanca. From 2005 to 2014, while TB incidence rate was stable in Fez (P = 0.500), Tetouen-M’diq Fnidaq (P = 0.300), Casablanca (P = 0.500), Mohammadia (P = 0.146), Al Hoceima (P = 0.364), and Guelmim (P = 0.242), an increase in TB incidence rate was seen in Tanger-Assilah (Kendall’s tau = 0.49; P = 0.023) and a decrease in Salé (Kendall’s tau b = − 0,54; P = 0.014) and Inezgane-Ait Melloul (Kendall’s tau b = − 0,67; P = 0.0023). TB is strongly clustered in space (P-values of Moran’s I <  0.01). Two distinct spatial regimes that affect TB spatial clustering were identified (east and west). In the east, both annual rainfall (P = 0.003) and AIDS (P = 0.0002) exert a statistically significant effect on TB rate. In the west, only the living area (prefecture versus province) was associated with TB rate (P = 0.048).ConclusionsNew information on TB incidence and TB-related predictors was provided to decision-making and to further pertinent research. Association between annual rainfall and TB may be of interest to be explored elsewhere.Electronic supplementary materialThe online version of this article (10.1186/s40249-018-0429-0) contains supplementary material, which is available to authorized users.

BackgroundSince its development in the early 1980s, Hepatitis B virus (HBV) vaccine has been proven to be highly protective. However, its immunogenicity may be ineffective among HIV-infected children. In Morocco, HBV vaccine was introduced in 1999, and since then all infants, including vertically HIV-infected infants, have been following the vaccination schedule, implemented by the Moroccan ministry of health. An assessment of the immunization of these children is important to optimize efforts aimed at tackling Hepatitis B coinfection, within the country.MethodsForty-nine HIV-infected children (HIV group) and 112 HIV uninfected children (control group) were enrolled in this study. Samples were tested by Elisa (Monolisa Anti-HBs, Biorad) to quantify the anti-HBs antibodies. The % of lymphocyte subsets i.e. CD4+ T cells, CD8+ T cells, B cells, and NK, was determined by flow cytometry, using CellQuest Pro software (Becton-Dickinson), and for HIV group, HIV viral load was measured by real time PCR assay (Abbott). All variables were statistically compared in the two groups.ResultsThe median age was 51 ± 35 months for the HIV group and 50 ± 36 months (p > 0.05) for the control group. Female represented 63% and 41% (p = 0.01), among the HIV group and the control group, respectively. Among HIV-infected children, 71.4% (35/49) were under HAART therapy at the enrollment in the study. Seroprotection titer i.e. anti-HBs ≥10mUI/ml among control group was 76% (85/112), and only 29% (14/49) among the perinatally HIV-infected children (p < 0.0001). Lower % of CD4 + T cells was observed in HIV-infected children with a poor anti-HBs response.ConclusionIn this studied group, we have shown that despite the vaccination of HIV-children with HBV vaccine, 71% did not show any seroprotective response. These findings support the need for monitoring HBV vaccine response among HIV-infected children in Morocco, in order to revaccinate non-immunized children.

BackgroundLittle is known about asthma trend in Morocco, particularly in early childhood. Furthermore, when dealing with asthma related environmental risk factors in Morocco, decision-making focus is in one region R9, while 16 regions make up the country. This work aims at studying 9-year trends in consultations for asthma in under-5 children in the 16 individual regions with respect to area and age group.MethodsDirect method use, based on the only available national data from the open access files of the ministry of health, standardizing data for three age groups (0–11 ; 12–23 and 24–59 months). We compared age-adjusted rates, stratified by area (urban and rural areas) within each region (Wilcoxon's signed ranks test), and between all regions emphasizing on R9. Secular trends are examined (Kendall's rank correlation test). We also compared directly standardized rates as a rate ratio for two study populations (that of R9 and any region with highest rates). We finally compared rates by age group in selected regions.ResultsSecular increase in prevalence rates was shown in both urban and rural Morocco, particularly in urban areas of R10, R14, R16 and R5, and in rural areas of R14 and R16. In urban area of R10 (the highest age-adjusted prevalence rates area) the rates showed secular increase from 6.82 at 95 % CI = [6.44 to 7.19] per 1000 childhood population in 2004 to 20.91 at 95 % CI = [20.26 to 21.56] per 1000 childhood population in 2012 (P = 0.001). Rates were higher in urban than rural Morocco, particularly in R8, R9, R10, R14, R15 ; R6 was an exception. Rates in R10 were 1.63 higher than that in R9 in 2004 and rose to be 2.55 higher in 2012 ; rates in urban area of R14, about 3 times lower than that in R9 in 2004, increased to be similar in 2012. The highest-prevalence age group varied according to region and area.DiscussionThe regions that worth decision making attention are the urban areas of R10 (the highest prevalence rates Moroccan area, showing continuous increase), of R9, of R14 and the rural area of R6. The rates in the urban area of R9 (a current continuous decision making focus) remained high but stable within the study period and less important than those in R10. Environmental factors (biological particules, non-biological particules or gazes) are suspected.The potential unavailability of treatment at regular basis at the primary health care centers may reduce frequency of consultations for asthma in early childhood : outpatients may consult only if asthma causes problems in an attempt to get free medicines ; chances of outpatients' follow-up by the primary health care center's physicians are therefore reduced and optimal asthma control is not achieved.ConclusionSocial, health care policy and environmental factors, to which decision-making has to be responsive, are suspected to be affecting both frequency of and time secular trend in consultations for asthma in early childhood in Morocco.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2262-8) contains supp...

BackgroundThe widespread use of an effective and safe vaccine to measles has substantially decreased morbidity and mortality from this epidemic. Nevertheless, HIV-infected children vaccinated against measles may develop an impaired vaccine response and remain susceptible to this disease. In Morocco, infants are routinely vaccinated against measles, regardless of their HIV serostatus. An evaluation of the immunization of these children may be of paramount importance to implement timely measures aimed at preventing measles transmission.MethodsIn this study, we have enrolled 114 children vaccinated against measles, 50 children prenatally infected with HIV and 64 HIV-uninfected children. For all children, blood samples were taken to measure anti-measles IgG by EIA and CD4 count by flow cytometry. Additionally, HIV viral load was determined by automated real time PCR, for HIV-infected children.ResultsThe seroprotective rate of IgG anti-measles antibodies was significantly lower among HIV-infected children (26%) compared with HIV-uninfected children (73%) (p < 0.001). Within HIV-infected children group, the comparison of variables between children without seroprotective seroconversion to measles and those with seroprotective immunity, displayed that sex and age were not statistically different, p > 0.999 and p = 0.730, respectively. However, CD4 count was lower among children with negative serostatus to measles (23% versus 32%, p < 0.001). Furthermore, viral load was higher, with 2.91 log10 ± 2.24 versus 1.7 log10 ± 1.5 (p = 0.042). Finally, 62% of children with a negative vaccine response to measles were under HAART therapy, versus 92% (p = 0.008).ConclusionThe majority of HIV-infected children vaccinated against measles develop a suboptimal seroprotective titer, and therefore remain at risk for this highly infectious disease. These data in combination with international recommendations, including recent WHO guidance on vaccination of HIV-infected children, suggest there is a need for national measures to prevent these children from measles.

Previous studies showed contradictory findings regarding the relationship between nitrate in drinking well-water and abnormal methemoglobin (MetHb) level (>2%) among children. We studied the effect of water chlorination in this relationship in children aged up to 7. 240 subclinical children participated in this cross-sectional study. Water nitrate was analyzed for each participant, and so was blood MetHb. Analysis of two water nitrate exposure levels (<50 and >50 mg/L as 3 )-other extraneous factors (Breslow-Day-Test for interaction), bivariate and multivariate analyses were performed. Abnormal MetHb levels (up to 7.9%) were associated (p-value = 0.020) with exposure to drinking water nitrate. Only water chlorination was an effect modifier. Among those who do not disinfect water, the prevalence of abnormal MetHb for those with nitrate level >50 mg/L was 4.95 (p-value = 0.001, 95% CI = [1.92 -12.79]) times the prevalence for those with nitrate level <50 mg/L. Whereas, among those who do disinfect water, the prevalence for those with high nitrate levels was only ) times the prevalence of those with low nitrate levels. The biological plausibility of a relationship between waterborne microorganisms, drinking water nitrate, drinking water chlorination, and development of an abnormal MetHb level needs to be further explored.