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Background In Morocco, the treatment of type 2 diabetes (T2D) is mainly focused on medication and only 2% of patients are coached towards a healthier lifestyle. In Oujda, Eastern Morocco the prevalence of T2D is 10.2%, and the current trend is alarming, especially for women. Therefore, the aim of this study is to explore healthcare professionals (HCP) views on the perceived barriers and benefits of an integrated care approach in primary healthcare centers (PHCCs) to T2D management in Oujda. Methods A qualitative descriptive study using focus groups in 8 PHCCs. This resulted in a sample of 5 doctors and 25 nurses caring for diabetes patients. The transcripts of all conversations were coded to allow for thematic analysis. Results The participants mentioned different barriers to an integrated approach to DM management:: excessive workload; poor reimbursement policy; lack of staff and equipment; interrupted drug supply; poor working environment; limited referral; gap in the knowledge of general practitioners; health beliefs; poverty; advanced age; gender; the use of psychotropic drugs. An integrated approach could be facilitated by simplified electronic records and referrals; uninterrupted free care; staff recruitment; continuous professional development; internships. Benefits: structured care; promotion of care in PHCCs; empowerment of self-management. Conclusion HCP views reflect the urge to strengthen the management of T2D in PHCCs. There is a need for HCP with expertise in physical activity and nutrition to solve the current gap in the multidisciplinary integrated care approach. The specific local context in this Eastern Moroccan region, with limited resources and remote hard-to-reach rural areas, can contribute to patients’ reluctance to change their lifestyles, and is a challenge to provide care in an efficient and sustainable manner. More research is needed to see how a patient-centered multidisciplinary approach to T2D management can help motivate patients in Morocco to change to a healthier lifestyle.

Type 2 Diabetes and Hypertension are the most emerging chronic diseases in the world and in Morocco. This study aimed to assess the influence of lifestyle risk factors (RF) on the occurrence of Hypertension and Type 2 Diabetes (T2DM) in an urban and rural community in northeast Morocco (Nador). This is a cross-sectional study, which took place from 1 June to 30 September 2019 in the frontline health centers. Patients over 18 years of age, consulting during the study period, and consenting were included lifestyle and other variables were studied in a structured questionnaire. A total of 397 adults were included. Among them, 61% were from rural areas and 39% from urban areas. The average age was 40.19 ± 15.68 years. The prevalence of diabetes was 27%, of which 72% were T2DM, and that of hypertension was 18%. The RF listed in this community were ranked in descending order as follows: disturbed sleep (46%), abdominal obesity (35%), eating less than 5 fruits and vegetables (25%) and stress (20%). According to the regression test, T2DM was significantly associated with abdominal obesity (p=0.000), sleep deprivation (p=0.000), blood pressure imbalance and hyperglycemia (p=0.000). While hypertension seems to be more related to stress (p=0.041), and physical inactivity (p=0.000). The influence of lifestyle on the occurrence of hypertension and T2D is not negligible in this community, so it is necessary to act on harmful behaviors (such as sleep deprivation and overweight) to better prevent them. Keywords: chronic diseases, HT, T2DM, lifestyle, risk factors, Nador, North-East Morocco

Background:: The need for a multidisciplinary team approach to provide physical exercise, diet, behavioral change, and insulin therapy in type 2 diabetes mellitus (T2DM) treatment has long been recognized. However, often patients with T2DM do not have access to a multidisciplinary team. Introduction:: In developing countries, most patients with T2DM receive their diabetes care in the office of an internist or family practice physician or in a primary level health center with a general practitioner. Knowledge of healthcare professionals regarding the perceived barriers, attitudes, facilitators, and benefits of a multidisciplinary team approach in T2DM treatment can help facilitate the implementation of multidisciplinary care in T2DM. Methods:: A systematic search strategy was performed in six databases (PubMed, Web of Science, CINAHL, EMBASE, MEDLINE, and Cochrane) using different keyword combinations to identify studies describing the healthcare professionals’ views of multidisciplinary team care in T2DM. A textual narrative synthesis was used to analyze data. The Critical Appraisals Skills Programme (CASP) tool for qualitative studies was used to assess the risk of bias and transferability. Results:: The views of health professionals about multidisciplinary team care in T2DM were categorized into six major factors, namely working collaboratively to foster supportive relationships; strong committed organizational and team leadership; diversity in expertise, with team members tailored to local circumstances; shared goals and approaches to ensure consistency of message; clear and open communication with the team and with patients; and the patient at the center of decision- making. Conclusions:: There is a huge gap in shared roles among health professionals in T2DM therapy. Hence, there is a need for allied health professionals such as physiotherapists, dieticians, and psychologists with expertise in diabetes to explore primary healthcare, barriers and facilitators to the successful integration of multidisciplinary team, seamlessly distributedinto three hierarchal levels, namely health management, health professionals, and diabetic patients.

Unregulated supply of medicines compromises quality assurance and risks patient safety. The emergence of illegal medicines trafficking in Morocco presents a major health threat, which highlights the need for region-wide alignment in policies to drive stringent regulatory enforcement and robust health systems that ensure population- wide access to safe medicines. Herein, we draw on insights from a situational analysis in Morocco, as a lower- middle income setting, to present access to medicines through regulated supply procedures as a vital prerequisite for quality assurance and patient safety.L'approvisionnement non réglementé en médicaments compromet l'assurance qualité et la sécurité des patients. L’émergence du trafic illégal de médicaments au Maroc constitue une menace majeure pour la santé, ce qui souligne la nécessité d'un alignement régional des politiques pour une application stricte de la réglementation et des systèmes de santé robustes garantissant l'accès de la population à des médicaments sûrs. Nous nous inspirons d'une analyse situationnelle menée au Maroc, en tant que pays à revenu moyen-inférieur, pour présenter l'accès aux médicaments par le biais de procédures d'approvisionnement réglementées, prérequis indispensable à l'assurance qualité et à la sécurité des patients.

The fight against noncommunicable diseases (NCDs) and their risk factors is one of the major challenges of sustainable development in the twenty-first century. These diseases are emerging more and more in low- and middle-income countries, including Morocco. This study examines the role of environmental health in reducing noncommunicable diseases through a literature review of epidemiological profiles of certain diseases such as type 2 diabetes and hypertension; and identifying environmental risks. The results show that 80% of premature deaths due to noncommunicable diseases could have been largely prevented by effective interventions aimed at reducing the level of exposure of individuals and populations to risk factors, namely smoking, malnutrition, inactivity and the harmful consumption of alcohol. In addition, strengthening health systems so that they can provide more effective and equitable care to people affected by noncommunicable diseases will reduce morbidity, disability and mortality by contributing to better health outcomes. The 2018–2030 Montevideo NCD Roadmap, as a priority for sustainable development, is the cornerstone of achieving Goal 3 of the SDGs on NCDs at the level of the Sustainable Development Goals. Morocco, through its national multisectoral strategy for the prevention and control of noncommunicable diseases, is participating to this global effort to combat noncommunicable diseases, the results of which will be predictable in the coming years.

Phytotherapy as a branch of traditional medicine is one of the most popular remedies in developing countries. Many pharmacological studies have shown the effective effects of some plants in curing or preventing some diseases, such as diabetes and high blood pressure. Herbal medicine is appreciated for several reasons related to the region. In Morocco, it is adopted by a large segment of the population, dominated by women, illiterates and rural residents who are geographically isolated and where poverty is more pronounced. In the absence of political commitment, inappropriate use of plants can lead to serious or even fatal adverse reactions. Efforts have to be made to regulate the sale of these products, qualify service providers and raise consumer awareness.

This framework is designed to encourage transdisciplinary research that will integrate social determinants in cancer research. This framework is designed to help conceptualize how the social determinants interact with other factors in the etiology of cancer. The factors influencing the populations of cancer in Morocco and other countries of the world can be classified into seven groups: 1) Political and institutional factors, 2) Socio-cultural factors, 3) Socio-economic factors, 4) Environmental factors, 5) Biological factors, 6) Factors related to lifestyle, and 7) Those related to the health system.

Background Over the last two decades, Moroccan authorities launched a number of actions and strategies to enhance access to health services and improve health outcomes for the whole population in general and for mother and child in particular. The Ministry of Health launched the action plans 2008–2012 and 2012–2016 and created the maternal mortality surveillance system. The Moroccan government opted for national health coverage through a mandatory health insurance and a scheme of health assistance to the poorest households. Other initiatives were devoted indirectly to health by acting on social determinants of health and poverty reduction. In this paper, we present results of an evaluation of interventions and programmes and their impact on health inequity in Morocco. Method We used data provided by national surveys over the last decades, information released on the website of the Ministry of Health, documentation published by the Moroccan government and international reports and studies related to Morocco and published by international bodies like the World Health Organisation, United Nations Development Programme, United Nations Population Fund, UNICEF, UNESCO and the World Bank. A short review of scientific publications was also carried out in order to select papers published on health equity, social determinants, health system and interventions in primary health in Morocco. Inferential and descriptive statistics (including principal component analysis) were carried out using software SPSS version 18. Results The findings indicate that substantial achievements were obtained in terms of access to health care and health outcomes for the whole Moroccan population in general and for mothers and children in particular. However, achievements are unfairly distributed between advantaged and less advantaged regions, literate and illiterate women, rural and urban areas, and rich and poor segments of the Moroccan population. Discussion Studies have shown that it is difficult to trace the effect of a primary health intervention on the access to health care due to synergetic and overlapping effect of interventions and initiatives aiming to improve the wellbeing of the Moroccan population. Descriptive and inferential statistics were used to illustrate the correlation existing between different variables measuring access to health and health outcomes on one side and variables like income, education, employment and health staff on the other side. Conclusion In Morocco, average access to health care and services as well as health outcomes have improved during the last decades. However, socio-economic inequalities and health inequity are persistent. The present study indicates that urgent and efficient actions on social determinants of health are needed in order to sustain average achievements and improve health equity for the whole Moroccan population.

This study was carried out on six-years cancer data from the Regional Cancer Centre of Oujda to determinate type of cancer and frequency in eastern Morocco through a screening study of 681 women in 2008 in the prefecture of Oujda Angads and also to estimate the frequencies of two major cervical and breast cancers and their prevalence.

Introduction: Arab populations have many similarities and dissimilarities. They share culture, language and religion but they are also subject to economic, political and social differences. The purpose of this study is to understand the causes of the rising trend of diabetes prevalence in order to suggest efficient actions susceptible to reduce the burden of diabetes in the Arab world. Method: We use principal component analysis to illustrate similarities and differences between Arab countries according to four variables: 1) the prevalence of diabetes, 2) impaired glucose tolerance (IGT), 3) diabetes related deaths and 4) diabetes related expenditure per person. A linear regression is also used to study the correlation between human development index and diabetes prevalence. Results: Arab countries are mainly classified into three groups according to the diabetes comparative prevalence (high, medium and low) but other differences are seen in terms of diabetes-related mortality and diabetes related expenditure per person. We also investigate the correlation between the human development index (HDI) and diabetes comparative prevalence (R = 0.81). Conclusion: The alarming rising trend of diabetes prevalence in the Arab region constitutes a real challenge for heath decision makers. In order to alleviate the burden of diabetes, preventive strategies are needed, based essentially on sensitization for a more healthy diet with regular exercise but health authorities are also asked to provide populations with heath- care and early diagnosis to avoid the high burden caused by complications of diabetes.

Purpose: To evaluate the effective dose received per radiological examination per patient and the additional cancer risk factor in the Radiological Service of Al Faraby Hospital in 2012. Methods: From the number of radiological procedures (NX) made in 2012 in the radiology service of Al Faraby Hospital and the average effective dose DEX associated with each type of act exam X, it is possible to calculate the effective dose collective [S =∑ DEX * NX]. The additional cancer risk factor is calculated by the X-ray risk software promoting responsible imaging through patient and provider education. It is function of the effective dose received, the age at the time of exam, and gender of patient. Results: The radiological average effective dose received per act exam is 1 millisievert (mSv), whereas it is 4.45 mSv and 0.21 mSv for the computed tomography (CT) scan and conventional radiological examinations, respectively. As for the average number of acts per patient 2.66, the effective dose is 1.16 mSv and 3.8 mSv for CT scan and conventional radiological examinations, respectively. As for the average effective dose per patient 2.69 mSv, it is 5.16 mSv and 0.81 mSv for CT scan and conventional radiological examinations, respectively. As for the additional cancer risk in 40 years at the time of exam, the average additional cancer risk is equal to 2.17 × 10-4, wheras the risk is 4.17 × 10-4 and 6.54 × 10-5 for CT scan and conventional radiological examinations, respectively. Conclusion: Medical exposure related to the diagnosis of patients in the radiology service in 2012 can be characterized by: (a) 2.66 Act exams on average per patient diagnosis corresponding to a mean effective dose equal to 2.69 mSv per patient, (b)frequency of conventional radiology and CT scan was 81% and 19%, respectively. These act exams contribute to the collective effective dose by 17% and 83%, respectively, and (c) radiological acts can be divided into three levels of exposures: 0 to 5 mSv, 5 to 10 mSv, and > 5 mSv, and the proportion of each level is 90.12%, 9.84%, and 0.05%, respectively.

The breakdown of fresh willow, Salix pedicellata, and oleander, Nerium oleander, leaves in mesh bags was investigated over one year in Oued Cherraa, a temporary river. The three investigation stations were: a permanent pool, and, in the temporary river, a more sheltered upstream station with a sharper gradient and a more open downstream station with a lower gradient. The water was stagnant in the permanent pool, except during high water in March and April when it flowed with the rest of the river. The two river stations were dry for the first 4 months, they were submerged for 7 and 5 months, and dry again for 1 and 3 months, respectively. Leaf breakdown over the whole investigation period was faster in the pool (exponential breakdown coefficient k.day -1 = -0.009 for willow and -0.007 for oleander) than in the intermittently-flowing river (k between -0.003 and -0.005). Breakdown was much faster during submersion than during emersion; at each station it was faster in flowing than in standing water. The terrestrial fauna in the bags was scarce and consisted mostly of predators. During submersion in the river, scrapers and collectors developed in the bags, but shredders were scarce. They were more numerous in the pool and this may explain the faster breakdown.

International audience; Monthly variations of fungal biomass and assemblages on leaves exposed to the air and submerged, of sporulation and specific richness in the water, and of cel- lulolytic activity in the leaves were investigated in a warm temporary river. The bio- mass of terrestrial fungi was relatively low in the dry air and cellulolytic activity also was low . During submersion, biomass and activity of the aquatic hyphomycetes were greater. The fungi were most active in spring when the water was flowing and when breakdown was fast. Complete exclusion of one fungal species on one leaf species, presumably by competition, was observed twice. From June onwards, though fungal biomass remained high, fungal diversity and activity decreased, and further decay was presumably due to other microorganisms. No major difference to the same processes in temperate permanent streams appeared except that initiation of the sequence was the onset of the aquatic phase and not deciduous leaf fall.

Seasonal variations of bacterial abundance on dead leaves decaying both in air and water, as well as microbial Electron Transport System (ETS) activity, were investigated in a Northeastern Moroccan temporary river, Oued Cherraa. Bacteria were counted using epifluorescence microscopy after sonication, and DAPI and acridine orange staining. ETS activity was measured with a spectrophotometer by the reduction of INT to INT-formazan. The results point out the overwhelming influence of water on bacterial distribution: bacteria were most abundant and larger during the flowing phase of the river and in a permanent pool. ETS activity on leaves was higher in water than in air, and during submersion it was higher in the permanent than in the temporary sites. Some temporal correlations were found with temperature and dissolved organic matter. Bacterial density peaked in May, and ETS activity in June. These trends explain a great part of the breakdown rates described from the same leaf packs in a former paper.