Clinical Supervision of Medical Students in Primary Health Care Services: General Practitioners' Perspectives in Morocco

Introduction

Clinical supervision is crucial to establish a learning climate in which the supervisor guides the supervised. Clinical supervisors might have numerous barriers and motivations. Our study aimed to explore the clinical supervision practices among general practitioners and to describe their motivations, barriers, and needs.

Methods

A qualitative study was conducted using purposive sampling which is a non-probabilistic sampling method. The population was the general practitioners who were working at the primary health care centers either in the public or the private sectors (N=16). Individual semi-structured interviews were conducted by two authors, using an interview guide. All interviews were recorded, transcribed, and coded. A thematic content analysis was done manually based on an inductive approach.

Results

Sixteen general practitioners participated. Three main themes emerged from the study: 1) General practitioners' practices in clinical supervision, 2) the enablers to adequate clinical supervision in general practice, and 3) the general practitioners' fundamental barriers and needs in clinical supervision. Despite their lack of clinical supervision training, they could describe the different clinical supervision steps without giving their exact names. We found that their teaching skills must be reinforced. General practitioners were mainly motivated by personal and professional interests as well as moral obligations. Numerous barriers and needs were identified at the organizational, relational, and financial levels. The principles barriers and needs were the lack of clinical supervision training, lack of equipment, and remuneration.

Conclusion

The current study highlighted the motivations and challenges of general practitioners concerning clinical supervision. These results are helpful for all responsible institutions involved in clinical supervision and upcoming programs in Morocco.

Cross-cultural adaptation of the Moroccan Arabic dialect version of the Primary Care Assessment Tool

OBJECTIVE

To adapt the Primary Primary Care Assessment Tool-Adult Edition into the Moroccan Arabic dialect and to assess its reliability and validity from the perspective of Moroccan adult patients.

METHOD

A committee of experts carried out the cross-cultural adaptation of the Primary Care Assessment Tool. The adapted questionnaire was subject to forward and backward translation and a pilot study. Exploratory factor analysis assessed the internal consistency, reliability, and construct validity of items and scales. Finally, descriptive statistics were performed on the final factor structure.

RESULTS

A 43-item Moroccan Arabic dialect version of the Primary Care Assessment Tool-Adult Edition was developed. It consisted of six multi-item scales that represented the four main dimensions of primary care: first contact, continuity, comprehensiveness, and coordination. Four derived dimensions were included: cultural competence, communication, advice, and community orientation. All six scales demonstrated robust internal consistency, item-total solid correlations, and construct validity. The calculated Cronbach's alpha coefficients ranged from 0.78 to 0.90.

CONCLUSIONS

Comprehensive metric analyses supported the reliability and validity of the Moroccan Arabic dialect version of the Primary Care Assessment Tool-Adult Edition in assessing core primary care domains from the patients' experience. This tool could be used for future research on primary care in Morocco.

Job satisfaction of primary healthcare professionals (public sector): A cross-sectional study in Morocco

Healthcare professionals (HCPs) are indispensable for improving the availability and quality of healthcare services. Therefore, the present cross-sectional study aimed to measure the job satisfaction of HCPs working in primary care (PC) centers in Marrakech, according to the job satisfaction scale. Using census sampling, this study involved HCPs working in PC centers. Data were collected using an electronic questionnaire and analyzes were performed using Jamovi (version 1.6). The Warr-Cook-Wall scale was used to assess the satisfaction of these professionals. Student's t-test, Kruskal-Wallis test and Mann-Whitney non-parametric tests were used for group comparisons (p < 0.05). The lowest satisfaction scores were recorded for general practitioners (GPs) and nurses. These were work safety (1.54 ± 0.85 vs. 1.51 ± 0.82), salary (1.58 ± 0.79 vs. 1.72 ± 0.87), chance of promotion (1.68 ± 0.87 vs. 1.80 ± 0.93), possibility of using its capacities (1.90 ± 1.04 vs. 2.01 ± 1.08), and workload (1.88 ± 1.10 vs. 2.05 ± 1.06). A statistically significant difference was observed between different professional statuses regarding facility management (p = 0.049). The overall job satisfaction of HCPs was low, especially among GPs and nurses: the scores for intrinsic job satisfaction with respect to sociodemographic characteristics were low, whereas they were medium for extrinsic job satisfaction. Further research is warranted to clarify the intrinsic and extrinsic factors of job satisfaction in Morocco's healthcare sector.

General practitioners' knowledge, attitudes and practices towards health promotion in Morocco

Background

Health promotion (HP) is a part of the general practitioners' (GPs) competencies defined by the World Organization of Family Doctors. The implementation of HP in their practice is unsatisfactory.

Aims

The aim of this study was to explore GPs knowledge, attitudes and practices in Morocco about HP at the primary healthcare services.

Methods

A cross-sectional study was conducted using an online self-administrated questionnaire including, knowledge, attitudes and practices of GPs toward HP. Descriptive and bivariate analyses were conducted.

Results

Two hundred and forty GPs responded to our questionnaires, the sex ratio was 1.12 with an average age of 40.46 ± 9.05 years. More than half of our participants perceived HP as a concept indistinct from prevention, 70.4% believed that HP refers to the biomedical model. On a Likert scale of 1-5, the level of HP knowledge was 2.71 ± 1.13. The most discussed topics with the population were tobacco, alcohol, overweight and obesity. Statistically significant association was found between the competencies of GPs in lifestyle behaviours and the practice of this competence.

Conclusion

The knowledge of GPs remains insufficient, and their practices focus more on the areas in which they feel competent, which requires the implementation of specific training for the development of GPs skills in HP.

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.

Perceptions de la santé publique par les étudiants et les enseignants de la faculté de médecine de Marrakech

BACKGROUND

The COVID-19 pandemic has highlighted the pivotal role of public health. The aim of this study was to explore the perception of public health among medical students and faculty members (teachers).

METHODS

A cross-sectional study was conducted at the medical school of Marrakech (FMPM) in May 2020. Data collection regarding the place of public health (during the training and in the practice) was done by electronic questionnaire. The analysis was descriptive and bivariate.

RESULTS

259 responses were received (78.4% were students). The female / male sex ratio = 1.27. Almost 98.5% believed that public health knowledge and experiences were relevant for clinical practice. The main activities that reflect public health were prevention and health promotion (81%), epidemiological surveillance and epidemic management (89.6%) (98.2% among teachers versus 87.2% among students, p = 0.009). During the pandemic, 85.7% of teachers and 77% of students developed an interest in public health (p = 0.196). Only 6.6% were interested in a career in public health. Compared to teachers, students had a positive perception during the pandemic (p = 0.001).

CONCLUSION

The results highlight the lack of knowledge about the fields of application despite heightened sensitivity at the onset of the pandemic. Lessons can be learned in terms of improving public health training, raising awareness of the choice of this specialty and actions in favor of better visibility.

Well-being assessment in medical students since the COVID-19 pandemic: a mixed method study

INTRODUCTION

Since the COVID-19, changes have occurred for the Moroccan medical students, which represent a vulnerable population. Coping with this situation could be difficult. Our objective was to estimate and understand the psychosocial barriers to the medical students' well-being at the Faculty of Medicine and Pharmacy of Marrakesh (FMPM) by evaluating their coping strategies, difficulties and needs.

METHODS

We conducted a mixed method study among pre-graduate medical students. For the quantitative part, we did a cross-sectional study using an online four-part self-administered questionnaire. We compared Likert scales of perceived well-being before and one year after the lockdown. The scales ranged from 0 (very low state of well-being) to 10 (complete state of well-being). Coping strategies were assessed by the Brief-COPE questionnaire. The qualitative perspective was a case-study with semi-structured interviews using an interview guide based on the literature review. Finally, a one-phase triangulation analysis, underlined by a convergence model, was done.

RESULTS

We had 355 participants for the quantitative part (participation rate of 16.6%). The mean age was 19.2±1.6. The female/male sex ratio was 1.8. The first cycle students represented 76%. The well-being mean state was better before than after the pandemic (7.8 vs 5.4; p<0.001). The main coping strategy was the acceptance of the situation (5.8±1.7). According to the students, their principal need for promoting their well-being at the faculty was having courses about technologies for studies (89.3%). For the qualitative part, we interviewed 16 students. Thirteen had a decline of their well-being after the lockdown. Isolation and adaptation to e-learning were the principal difficulties. However, mainly, they adopted engaging in coping strategies.

CONCLUSION

The medical students' well-being decreased since the COVID-19 pandemic. Students adopting coping strategies were in the best well-being state. Psychosocial and solution-based measures should be put in place at the FMPM to foster the students' well-being.

Perceptions and stress factors among physicians in pre-graduate and post-graduate training in Morocco: COVID-19 pandemic context

Context: On 30 January, 2020, WHO stated that the global COVID-19 epidemic is a public health emergency. Facing this critical situation, health-care workers were at risk of developing psychological distress and other mental health problems. Aims: This study seeks to explore the feelings, attitudes and perceptions of the COVID-19 pandemic among physicians in pre-graduate and post-graduate training from Marrakesh University Hospital Centre. Methods and Material:We conducted a cross-sectional study with internal and resident-physicians in May 2020. Data collection was based on a self-administered electronic questionnaire. The sociodemographic informations, pandemic impact on the occupational and social fields and stress factors were evaluated. Statistical significance was set at p < 0.05. Results: The number of participants was 74. The sex ratio was 1.4 with an average age of 26.1 ± 3.6 years. Two-thirds were directly involved in the management of patients with SARS-CoV2. The majority reported that their work puts them at high-risk of exposure to SARS-CoV2 and 66% felt stressed at work, female physicians were more stressed than men (p = 0.028). Not knowing when the pandemic will be under control and the risk of developing an infection with SARS-CoV2 were the main sources of stress. About motivators for similar situations, respondents emphasized family support (91.9%) and recognition by management and supervisors for the additional efforts they provide (83.8%). Conclusions: The protection of health-care workers is an important component of public health measures to combat this pandemic. Special interventions to promote health-care workers mental well-being must be implemented immediately.

The social accountability of nursing training institutes in Morocco: The knowledge, perceptions and realization of its aspects

INTRODUCTION

The social accountability (SA) challenges health professional training institutes to reorient their missions to train the graduates aligned with the society's priority needs and produce quality, population centered care. The objective was to assess the knowledge, perceptions, and implementation of SA by nursing education institutions.

METHOD

The cross-sectional observational survey was conducted at the Higher Institute of Health Professions and Techniques of Marrakech (ISPITS-M) and its annexes between May 17 and June 4, 2020, using a mixed methodology. The data were collected through an online questionnaire, which was tested with 11 students and teachers. It was completed by 50 teachers and 213 students, recruited on a voluntary basis and was developed based on the literature review, aspects and principles of social accountability. In addition, eight semi-structured interviews were performed with administrative staff recruited by purposive sampling.

RESULTS

Out of a total of 924 students and 75 teachers, 213 students and 50 teachers participated in the survey, with a response rate of 23% and 67% simultaneously. The average age was 40.2±8.9 years for the teachers and 19.7±1.3 years for the students. 36% of the students had no knowledge of SA; teachers and leaders had different perceptions and the concreteness of the aspects of SA was low. The students felt they were less prepared in social determinants of health (85%), community lifestyles to be served (85%), outreach care, and frontline work (83%).

CONCLUSION

The knowledge of SA is average; there is a need to raise awareness of SA in addition to strengthening training programs and the concretization of actions in this direction.

POS0269-HPR CONTENT VALIDITY OF A MULTIPLE LANGUAGES QUESTIONNAIRE FOR MEASURING FLARE IN KNEE AND HIP OA: DEVELOPMENT OF THE FLARE-OA

Background:

Flare in osteoarthritis (OA) of the knee and hip (KHOA) is an important outcome for patients’ daily life and clinical research. A definition of a flare was set, and a core set of domains was recently endorsed by OMERACT/OARSI. No patient reported outcome (PRO) yet focusses on flare in OA specifically.

Objectives:

To develop a self-reporting instrument measuring flare in 5 languages, using qualitative methods and international Delphi consensus.

Methods:

We generated items using a dual-language (English and French) approach involving patients with OA from Australia, France and the United States and health care professionals (HCP) from international societies (OARSI, SFR, OMERACT). Item generation relied on semi-structured individual interviews conducted with OA patients and HCP and one focus group with patients. Content analysis allowed for identifying verbatim statements that were meaningful for patients and HCP. A Delphi consensus method was used to select the most relevant items, according to core domains set (OMERACT). A cross-cultural approach using current guidelines (1) was applied to produce Spanish (in Spain), Turkish and classical Arabic (in Morocco) versions using independent translation and expert committee to preserve its content validity.

Results:

From semi-structured interviews with 29 patients and 16 HCPs and one focus group with 10 patients, 180 statements in French (106) and English (77) were generated. Based on similarity or redundancy, 50 items with equivalent meaning in both languages were retained by an expert committee. After two Delphi rounds involving 50 patients and 116 HCPs from 17 countries on four continents, it was reduced to 33 items (response 0=not at all, to 10=absolutely) in five domains (pain, swelling, stiffness, consequences of symptoms and psychological aspects). This questionnaire was cross-culturally adapted into Spanish, Turkish and classical Arabic. The Spanish version uncovered one inappropriate item in the original questionnaire that was amended accordingly in all 5 languages.

Conclusion:

Flare is more than just an exacerbation of pain. The Flare-OA questionnaire includes all OMERACT recommended core domains. High content validity was seen in 2 original and 3 cross-culturally adapted languages. The Flare-OA should be considered as fit for purpose and evaluation of responsiveness in clinical studies in 5 languages.

Disclosure of Interests:

None declared

Impact of the COVID-19 pandemic on the activity of private medical practices in Morocco

INTRODUCTION

The aim of this study was to assess the impact of the COVID-19 pandemic on the activity of private medical practices in Morocco.

METHODS

An online survey was carried out in June 2020. The study population consisted of physicians (General practitioners and specialists) who run private practices in different regions of Morocco. The questionnaire comprised three sections: demographic and professional data, the impact noticed by the physicians and the strategies they adopted to tackle this impact.

RESULTS

We analysed 225 responses. Specialists represented 71.6% of the respondents. The majority (94.2%) of the private practices were located in urban areas. Almost all respondents have noticed a change in the demand for medical services, mainly a decrease (96.4%). There was an increase in urgent consultations (30.7%) and consultations for acute motives (39.1%). Respondents also reported less (69.3%) or no (23.1%) regular follow-up visits for patients with chronic diseases. Decreased incomes concerned 97.3% of the practices. Practitioners reacted by working less hours (87.6%), delaying some procedures (78.2%) and applying recommended safety measures (100%). Telemedicine was used in an informal way to facilitate the communication with patients.

DISCUSSION AND CONCLUSION

During this pandemic, private practices were challenged to contribute to the continuity of healthcare services while ensuring the safety of the staff and the patients. Several strategies were adopted to cope with the new situation and to survive its many challenges.

Social accountability: Attitudes and awareness among undergraduate medical students in Morocco

INTRODUCTION

As future health professionals, medical students should be aware of their social accountability and their role in the society. The aim was to assess the attitudes and awareness of medical students regarding the social accountability and to identify the factors determining their attitudes and possible levers for action.

METHODS

Online survey among undergraduate students at the medical school in 2019 (N = 2128). The data collection tool was developed based on the literature review, the principles of social accountability SR and the toolkit (The development of the Students' Toolkit on Social Accountability of Medical Schools was a collaboration between the International Federation of Medical Students' Associations (IFMSA) and the Training for Health Equity Network (THEnet). The data were collected in December by LimeSurvey software version 1.90 and analyzed by SPSS version 16 according to the usual descriptive and bivariate. The Fisher test was used to compare two percentages and the Student t-test to compare two means on two independent samples (significance level was 0.05). The verbatims were grouped and analyzed.

RESULTS

271 students participated (response rate = 12.7%). The mean age was 20.6±2.6 years (N = 257). The Female/Male ratio was 1.85. Only 33.5% had heard of social accountability. It was linked to "commitment to the community" in 75.1% of cases, "to be a good citizen" in 66.1% and "to be responsible for one's actions" in 56.4%. Nearly 79% thought that students did not really have a role in society and that they should focus on their studies. Being a member of an association was a factor determining the positive attitude towards the SA (82.1% versus 65.2%, p=0.031). Students believed that the school had some strategies of social accountability. The results of the verbatim emphasize the need to multiply the practices and opportunities for interaction with the social environment for students.

CONCLUSION

The level of knowledge of the concepts by the students seems to be average. It would be necessary to look for the means to plead in favor of reinforcing our school strategies to concretize the principles of SR while training the students.

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.

[Community mobilization for the improvement of monitoring in pregnant women living in rural areas in Morocco]

Introduction

The improvement of maternal health is a health priority in many developing countries. The purpose of this study was to describe the contribution of a community project in the improvement of monitoring during pregnancy in a vulnerable rural commune in the Moroccan High Atlas.

Methods

We conducted an action-research project incorporating an approach for community mobilization conducted in 2014. The project involving several participants such as social actors, local authorities, health professionals and students in medicine helped to ensure the monitoring of a cohort of 283 pregnant women. In the course of antenatal consultations, women were interviewed, assessed and participated in information sessions and education. The interviewers speaking berber were trained to data collection. Bivariate and descriptive statistical analyzes were carried out, with a threshold for significance of 5%.

Results

The average age of patients was 27.1± 6.7 years. The majority of them was illiterate, without health coverage and with no career. Nearly 73.4% had no previous contact with the health care system (N = 252). Among 500 planned pregnancies, 56.6% of women were monitored, 30.4% consulted twice and 6.7% underwent three consultations out of a total of 407 antenatal consultations performed. Follow-up compliance by undergoing at least two consultations was 60.3%. Abnormality detection during pregnancy was significantly associated with monitoring (p = 0.04).

Conclusion

The results reflect the importance of community engagement in the approach to complex health problems as maternal health.

The Prevalence of Celiac Disease-Specific Auto-Antibodies in Type 1 Diabetes in a Moroccan Population

OBJECTIVE

We aimed to determine the prevalence of specific auto-antibodies to celiac disease (CD) in Moroccan type 1 diabetic (T1D) patients and compare the clinical and biological characteristics of seropositive and seronegative cases.

PATIENTS AND METHODS

A cross-sectional study was carried out on 276 T1D patients including 109 adults and 167 pediatric cases. The screening for CD was performed by an Elisa IgA anti-tissue transglutaminase antibody (tTGA) testing, combined with IgA quantification by nephelometry. Positive-IgA-tTGA cases were secondly tested for anti-endomysial antibodies (EMA) using an immunofluorescence technique, and the IgA deficiency cases were screened for IgG-tTGA. Patients with low positive tTGA titers underwent HLA-DQ2/DQ8 typing. Sociodemographic and clinical data of the patients were collected using a hetero-administered questionnaire. The comparison of clinical and biological data between seropositive and seronegative diabetics was done using independent T, Mann-Whitney U, chi-squared, and Fisher tests, which were considered significant if p value <0.05.

RESULTS

The prevalence of CD-specific auto-antibodies was estimated to be 9.1% (IC = 95%), with 25 positive cases in tTGA and EMA testing. Eight cases displayed low titers of IgA-tTGA, among which 4 were positive for HLA-DQ2, 1 for HLA-DQ8, and 1 for both DQ2 and DQ8. The other 2 cases had a biopsy-proven CD. Compared to seronegative patients, seropositive cases had a higher percentage of associated autoimmune disorders (16% vs. 2.4%, p=0.008), with a significant lower height Z-scores (median: -0.90 (-3.93 to 0.95) vs. -0.51 (-4.54 to 2.18), p=0.029) and a higher HbA1c level (median: 11.30% (7.31 to 16.00) vs. 9.30% (4.40 to17.31), p=0.022).

CONCLUSION

The current study gave evidence of a high prevalence of CD specific auto-antibodies in T1D population. The co-existence of these two conditions was associated with a poor glycemic control, a lower height, and other autoimmune diseases. These findings may suggest the necessity of a systematic screening of CD in T1D patients.

Short-term effectiveness of a culturally tailored educational intervention on foot self-care among type 2 diabetes patients in Morocco

BACKGROUND

Self-management education (SME) is an important yet unacknowledged aspect of diabetes care. Despite the raise of diabetes and its complications with significant burden in developing countries, research on SME interventions in Morocco is lacking.

AIMS

To assess the effectiveness of a culturally tailored SME intervention on foot-care self-management practices among type 2 diabetes patients and to identify factors associated with practices variation.

METHODS

We designed a pre-post prospective quasi-experimental study and recruited patients with type 2 diabetes aged 30 years old or above. The intervention consisted of an interactive group discussion using different materials: a narrative video, a PowerPoint presentation and a printed guide. Foot-care practices were assessed prior to the session and one month later using 2 items from the Summary of Diabetes Self-Care Activities (SDSCA). Binary logistic regression was performed to identify factors associated with a favorable variation, defined as an increase in the mean frequency score of foot-care by a minimum of 1 day/week.

RESULTS

A total of 199 participants were recruited and 133 completed the second assessment. Mean age was 55.2 ± 11.2 years old. Women represented 67% and 72% of participants was illiterate. The foot-care score mean increased from 3.5 ± 2.9 days to 5.9 ± 1.8 days one month after the intervention (mean variation was 2.4 ± 3.1 days; p < 0.001). A favorable variation was found among 75 (37.7%) participants. In multivariate analysis, literacy was associated with higher likelihood of a favorable variation of foot-care practices (OR = 2.82; 95%CI: 1.09-7.31) while previous education about diabetic foot was associated with lower likelihood of a favorable variation (OR = 0.26; 95%CI: 0.08-0.78).

CONCLUSIONS

There was a general improvement in foot-care practices after the intervention. Our findings suggest the role of literacy and previous patient education in shaping the observed variation. Culturally tailored interventions targeting other disease management domains are needed in our context.

[Knowledge and attitudes towards reproductive health: survey among moroccans living in rural areas]

INTRODUCTION

The objective is to describe the knowledge, attitudes and practices (KAP) of men living in a landlocked area towards reproductive health.

METHODS

We conducted a mixed methods study (focus group and KAP survey ) in a mountainous region near Marrakech. This descriptive survey involved 74 men ; we used two sampling methods (souk visitors on a weekly basis and persons accompanying the expectant mothers to their antenatal visits as part of an antenatal clinic caravan campaign). Data collection (March - April 2014) was made using a questionnaire translated into respondents' dialect and administered by trained Amazigh-speaking investigators. Quantitative data analysis was descriptive and bivariate (statistical significance level at 5%). Focus group data were analyzed after recording and transcription.

RESULTS

The median age was 38 years (19-80 years). Of the 64 men living together (86.5%), half (55.4%) opted for the pill. Two thirds recognized the importance of importance of pregnancy monitoring, while 37% of husbands were unaware of the frequency of follow-up visits. The non-use of services was 56.9% (N = 58) of which 42.4% without any reason. Educational attainment was associated with spouse's pregnancy screening (p = 0.015) and with a positive attitude toward the importance of pregnancy monitoring (p = 0.011). The lack of awareness regarding possible complications (35.1% of respondents) was a factor associated with lack of postnatal care among spouses (p = 0.021). The barriers identified in focus group analysis were cultural, geographic and socio-economic.

CONCLUSION

Information, education, communication programmes should mostly aim to involve male participants in similar contexts.

Measurement of visual function among patients undergoing corneal transplantation using the VF-14 index in Morocco

OBJECTIVE

To validate the Moroccan version of the VF-14 in candidates for keratoplasty and to assess their quality of life using this tool before and after transplantation.

METHODS

This is a longitudinal prospective study that assessed 57 patients who underwent penetrating keratoplasty, recruited in the ophthalmology service in Marrakech over 5 years. The original VF-14 questionnaire was adapted into Moroccan dialect. The questionnaire was administered before and 2 years after transplantation. The VF-12 questionnaire was also used, deleting the last two items. Data analysis was performed using SPSS 16.0 software. Comparisons of VF-14 scores before and after transplantation used the Wilcoxon test for paired samples.

RESULTS

In total, 57 patients participated in the study. The most frequent indication for surgery was keratoconus (44%). All patients underwent penetrating keratoplasty. Chronbach's alpha value was 0.989 for VF-14 and 0.990 for VF-12. The two scores were negatively correlated with logMAR visual acuity. The strongest correlation was found with VA in the fellow eye. The average best-corrected visual acuity of the eye scheduled for keratoplasty was 1.1±0.16 logMAR. The average of VF-14 was 53±3. After keratoplasty, the average best-corrected visual acuity of operated eye was 0.34±0.31. The average postoperative astigmatism was 3 D. After keratoplasty, an increase in VF-14 score was observed from 53.5 to 81.92 (P<0.001). In postoperative follow-up, graft rejection was noted in two patients and maculopathy in a single patient.

DISCUSSION

Graft transparency, absence of complications, minimal astigmatism, and good visual acuity have long been indicators of a successful corneal transplant. However, this does not provide information on visual quality and its impact on everyday life. It is in this sense that the VF-14 was adapted into several languages, as reliable, valid and sensitive as the original Anglo-American version, to assess objectively and subjectively the quality of life of patients after keratoplasty.

CONCLUSION

With advances in techniques and availability of better materials, surgical success in performing keratoplasty is increasing. At the same time, vision-related quality of life of corneal graft recipients deserves more attention from ophthalmologists.

Psychometric Properties of a Moroccan Version of the Summary of Diabetes Self-Care Activities Measure

BACKGROUND

The Summary of Diabetes Self-Care Activities (SDSCA) is a widely used self-report measure for diabetes self-management. It is an interesting tool for practice and research.

OBJECTIVES

To translate and culturally adapt the SDSCA to the Moroccan context and to assess psychometric properties of the adapted version among type 2 diabetic patients.

METHODS

The Moroccan version was obtained following forward and backward translations. An expert panel issued a final version. The adapted version was administered to patients aged 30 years and older who have type 2 diabetes. Psychometric evaluation consisted of assessing validity through internal consistency (Cronbach's alpha, item-to-scale and interitem correlations) and exploratory factor analysis and reproducibility (test-retest reliability).

RESULTS

Seventy-five participants were included. Cronbach's alpha ranged from 0.20 (diet) to 0.99 (exercise). Moderate to good interitem and item-to-scale correlations were found. Factor analysis resulted in a Moroccan SDSCA version consisting of 8 items, organized in four subscales that explained 89.6% of the variance: diet, exercise, blood sugar testing, and foot-care. Intraclass correlations ranged from 0.27 to 0.52 for subscales.

CONCLUSION

This study provides preliminary evidence for suitability of use of the Moroccan SDSCA among type 2 diabetic patients in order to assess diabetes self-management.

[What agents incriminated in athlete's foot? Survey of consulting diabetic patients in CHU Mohammed VI Marrakech]

Les infections mycosiques du pied constituent un motif fréquent de consultation chez les diabétiques, le diabète constituant à la fois un facteur favorisant et aggravant les lésions cutanéomuqueuses. L'objectif de ce travail était d'identifier la flore mycologique locale responsable des lésions du pied chez le diabétique et déterminer les facteurs favorisant la survenue de mycoses. Il s'agissait d'une étude transversale intéressant des diabétiques suivis en consultation; un prélèvement mycologique, avec examen direct et culture, a été réalisé devant toute suspicion clinique de lésion mycosique. Quatre-vingt-deux patients ont été inclus. L'hémoglobine glycosylée moyenne a été de9,2% ± 2,23. Un intertrigo inter orteil a été noté dans 90,2% des cas; l'examen mycologique était positif dans 64,8% des cas, avec 18 cas de Trichophyton rubrum et 11 cas de Candida albicans. Une atteinte unguéale a été suspectée chez 65,9% patients; la culture a mis en évidence un Trichosporon pathogène chez sept patients, un Candida albicansdans six cas, un Trichophyton rubrum dans quatre cas, avec trois cas de Trichophyton mentagrophytes et deux cas de Scytalidium dimidiatum. L’étude analytique, après confirmation mycologique, en fonction des principales caractéristiques des patients a montré que l'atteinte mycosique du pied est significativement corrélée au déséquilibre glycémique. Ce travail a montré la prédominance du Trichophyton rubrum dans les lésions d'intertrigo inter orteil et du Trichosporon dans les onychomycoses, avec une prédominance globale plus globale plus élevée du TR.

[Prevalence of obesity and overweight among children in primary schools in Marrakech, Morocco]

BACKGROUND

Childhood obesity is a phenomenon of growing concern today because of its rapid growth worldwide. The aim of our study was to estimate the prevalence of overweight and obesity among school age children in Marrakech.

METHODS

We conducted a cross-sectional study of a random sample of 1418 schoolchildren aged 8-15 years in the public sector in Marrakech in May 2011. Trained physicians measured the weight and size of respondents. The body mass index (BMI) was calculated for each child. Overweight was assessed by comparing BMI with World Health Organization (WHO) and International Obesity Task Force (IOTF) references. Statistical analysis was performed using SPSS version 16.0 and using a macro of WHO Anthro for SPSS.

RESULTS

The mean age was 10.8 ± 1.6 years. The sex ratio (girl/boy) was 1. The prevalence of overweight and obesity were 8 % (95 % CI [6.7, 9.6]) and 3 % (95 % CI [2.2, 4.1] based on WHO reference. This prevalence were respectively 12.2 % (95 % IC [10.5; 14.0]) and 5.4 % (95 % IC [4.3; 6.7]) using the IOTF reference.

CONCLUSION

In the absence of national data, our results reflect the importance of the phenomenon in our context, hence the importance of monitoring the nutritional status on both individual and collective levels and the need to develop strategies for prevention, diagnosis and early treatment before the problem becomes more widespread.

[Weaning before the age of 6 months in Marrakech: associated factors and prevalence]

BACKGROUND

In Morocco breastfeeding has become a declining practice. The objectives of this study were to estimate the prevalence of weaning before the age of 6 months and to identify associated factors.

METHODS

A cross-sectional survey was conducted among 400 mothers of infants aged 0 to 24 months. Participants were recruited from patients attending 40 randomly selected general practices in Marrakech. A trained interviewer administered a questionnaire to collect data on breastfeeding practice and factors associated with it. Early weaning was defined as a cessation of breastfeeding before the age of 6 months and was studied in mother-child couples whose infants were aged 6 months and older. Three binary logistic regression models were used to model the probability that an infant aged 6 months or more is weaned early.

RESULTS

Breastfeeding was initiated by the majority of respondents (97.5%). Early weaning was observed in 75 infants (28% of registered weaning). Factors associated with early weaning were: mother having an occupational activity (Odds Ratio [OR]=2.09; 95% confidence interval [CI]: [1.07-4.06]), caesarean delivery (OR=4.15; 95% CI: [1.74-9.88]) and the fact that the pregnancy was desired (OR=0.19; 95% CI: [0.05-0.68]).

CONCLUSION

Weaning before 6 months of age is a common practice in our context. Identifying factors associated with early weaning is critical to promote breastfeeding.

[An audit of type 2 diabetes management in a diabetes center in Marrakech]

AIM

The purpose of this study was to examine current practices among endocrinologists at the University Hospital of Marrakech (Morocco), focusing on the management of type 2 diabetes in adults.

METHODS

A clinical audit of diabetic patient care was performed. The audit was based on a retrospective analysis of 46 medical records during 2011 (including monitoring examinations and non-drug prescriptions during the previous year). 27 medical visits during March 2012 were also observed. Data on physicians' perceptions and proposals for improvement were collected through semi-structured interviews. Quality of care was assessed based on current recommendations.

RESULTS

Data analysis revealed a gap between theory and practice. Glycated hemoglobin levels (measured every six months) were recorded in 59% of cases, while patients' hemodynamic status, weight and height were recorded in 30% of cases. The results of complication screening were recorded in half of the cases. Observations of consultations showed that patient adherence was assessed in 97% of the consultations while foot examinations were performed in just 18% of cases.

CONCLUSION

The audit was both a challenge for the diabetes unit and an opportunity to promote self-assessment. This new approach may help to improve the quality of care provided to diabetic patients in our hospital.

[Food intake during the month of Ramadan in Moroccan patients with type 2 diabetes]

This cross-sectional study aimed to assess the daily dietary intake of type 2 diabetes patients attending Mohamed VI hospital in Marrakech during Ramadan 2010. Sociodemographic and clinical data were collected by interview, and qualitative and quantitative food intake, based on French nutritional tables, was assessed by a dietician. Of the 71 patients recruited, 55% were fasting. The average age of participants was 56.3 (SD 11,2) years. There were no statistically significant clinical differences between the fasting and nonfasting groups except for overweight/obesity and insulin dependence, which were more prevalent in the nonfasting group. The mean total daily caloric intake was significantly lower in the fasting than nonfasting group [1447.5 (SD 756.3) versus 1919.0 (SD 823.4) Kcal/d], as was the carbohydrate, lipid and protein intake. Carbohydrate intake was 57% and 56% of total calories. Overall during Ramadan the diet of the fasting group was calorie deficient and inadequate while for non-fasters it was excessive, which put them at risk of complications. Nutritional education may be needed for diabetic patients for Ramadan.