BackgroundOver 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.MethodWe 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.ResultsThe 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.DiscussionStudies 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.ConclusionIn 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.

BackgroundThe A1c-derived average glucose examined the link between the glycated haemoglobin and the estimated average glucose, and provided a linear relation between them. Other studies proved that, over a period of 4 months, plasma glucose in the preceding 30 days contribute to about 50 % to the glycated haemoglobin value while the other 50 % is due to the remaining 3 months altogether.Technical details of the methodIn this technical note, we propose a weighted method assuming that the contribution of glucose to glycated haemoglobin over 3 months is chronologically 20 %, 30 % and 50 % respectively. A comparison is made with the linear regression method which uses the same estimated average glucose over the whole period. Results yielded by the weighted method are also compared to those given by the model proposed by Ladyzyński et al.FindingsA simulation is carried out on data assumed to come from a first individual with nearly the same level of glucose over 3 months, a second individual who starts with high levels of glucose and then reaches a stabilised low level by the last month, and finally, a third case who had just been diagnosed with diabetes during the last month whereas he/she had a normal glycaemia during the preceding 2 months. The weighted method gives more realistic values of HbA1c (7.36 %, 6.80 %, 8.49 %) than the linear regression method without weights which gives the same value (7.45 %) for the three cases. Another comparison shows that the three values given by the weighted method are slightly smaller than the corresponding values given by the model of Ladyzynski et al. (7.62 %, 7.02 %, 8.8 %) but the relative variation is nearly the same for the three values (≈3 %).ConclussionWithout regular self-testing and day-to-day insights, a sole HbA1c value can be confusing and misleading. For physicians and patients, a clear understanding of the relationship between the weighted average glucose and HbA1c is necessary in order to set an appropriate daily control depending on whether the glucose is stabilized over the whole period, at the beginning, at the end; or still under recurrent episodes of high and low levels. The measured HbA1c at a biological laboratory gives no indication on glucose variation. Moreover, low values of glucose may cancel high values and lead to a “good” average glucose and ideal glycated haemoglobin.

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Les auteurs présentent une liste détaillée des espèces et sous-espèces endémiques marocaines et maroco-algériennes trouvées dans la région de la chaîne des Horsts et du massif de Debdou (Maroc oriental). Cette liste est accompagnée d'une description succincte de leurs habitats préférés et de leurs répartitions géographiques au Maroc. L'inventaire de ces espèces a montré le fort pourcentage des plantes endémiques maroco-algériennes (87,1% de l'ensemble des endémiques). Il a montré, d'autre part, la distribution restreinte de ces plantes aussi bien à l'échelle de la zone étudiée qu'au niveau du Maroc.

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.