Maghreb doctors need capacity building in epidemic investigation and control.

OBJECTIVE: Describe the training needs of young Maghreb doctors in epidemic management. METHODS: This is a study to quantify the need for medical training on "epidemic management". The study population was formed by residents and assistant professors of the French-speaking faculties of medicine in the Greater Maghreb, hospital-university professors, who were invited to respond to an online questionnaire. The "need" for learning a skill was defined by the perception of its importance, of its low coverage by the curricula and its poor mastery. A grid with 20 items, coded according to the Likert scale of 1 to 5 points, was specially developed for the measurement of need, retained beyond the thresholds of 45/90 points for the two dimensions "confirmation" and "investigation", 60/120 points for the "control" dimension, and 150/300 for the total sum. RESULTS: A total of 121 young Maghreb doctors answered the questionnaire to assess the needs for learning epidemic management skills. The median overall scores for the chapters "importance", "coverage" and "performance" were 76, 40 and 48 respectively out of 100 points. The median scores for training "needs" were 54/90, 48/90 and 67/120 points, respectively, for the dimensions "confirmation", "investment" and "control", giving a global median score of 168 / 300. CONCLUSION: Capacity building in epidemic management is a need felt by young Maghreb doctors, partially covered by current medical school programs, and consequently altering their professional performance.

Lessons learned from the fight against COVID-19 in the Great Maghreb.Five lessons for better resilience.

OBJECTIVE: To compile the lessons learned in the Greater Maghreb, during the first six months of the fight against the COVID-19 pandemic, in the field of "capacity building" of community resilience. METHODS: An expert consultation was conducted during the first week of May 2020, using the "Delphi" technique. An email was sent requesting the formulation of a lesson, in the form of a "Public Health" good practice recommendation. The final text of the lessons was finalized by the group coordinator and validated by the signatories of the manuscript. RESULTS: A list of five lessons of resilience has been deduced and approved : 1. Elaboration of "white plans" for epidemic management; 2. Training in epidemic management; 3. Uniqueness of the health system command; 4. Mobilization of retirees and volunteers; 5. Revision of the map sanitary. CONCLUSION: Based on the evaluation of the performance of the Maghreb fight against COVID-19, characterized by low resilience, this list of lessons could constitute a roadmap for the reform of Maghreb health systems, towards more performance to manage possible waves of COVID-19 or new emerging diseases with epidemic tendency.

Lessons learned from the fight against COVID-19 in the Great Maghreb. Five lessons for a better response.

OBJECTIVE: Identify the lessons learned in the Greater Maghreb, during the first semester of the fight against the COVID-19 pandemic, in the field of response. METHODS: During the first week of May 2020, a consultation of experts was conducted, using the "Delphi" technique, through an email asking each of them, the drafting of a good practice recommendation for "Public health". The Group coordinator finalized the text of the lessons, later validated by the signatories of the manuscript. RESULTS: Five lessons of good «response¼ against epidemics have been deduced and approved by Maghreb experts, linked to the following aspects: 1. Total reservation of hospital beds for patients; 2. Clinical management of the response; 3. Discreet conflict of interest; 4. Community participation in the response; 5. Contextualization of the global fight strategy. CONCLUSION: Based on the finding of low relevance of the Maghreb response against COVID-19, this list of lessons would help support the performance of Maghreb health systems in the management of epidemics.

Lessons learned from the fight against COVID-19 in the Greater Maghreb. Five lessons for better preparation.

OBJECTIVE: To compile the lessons learned in the Greater Maghreb, during the first six months of the fight against the COVID-19 pandemic, in the field of preparation of health systems. METHODS: An expert consultation was conducted during the first week of May 2020, using the "Delphi" technique. An email was sent to them requesting the formulation of a lesson, in the form of a "Public Health" good practice recommendation. The final text of the lessons was finalized by the group coordinator and validated by the signatories of the manuscript. RESULTS: A list of five lessons for the preparation of the national health systems of the Greater Maghreb for the fight against epidemics, was deduced and approved: 1. Liberal health systems are incapable of managing epidemics; 2. The specialties of "Public Health" are often marginalized; 3. Health personnel in the Maghreb are doubly devalued; 4. Flagrant regional disparities in the field of health care are still observed; 5. A general shortage of preventive equipment and medical devices has been noted. CONCLUSION: Based on the evaluation of the performance of the Maghreb fight against COVID-19, characterized by the vulnerability of the preparation of health systems, this list of lessons could constitute a roadmap for the reform of health systems. Maghrebian health, towards more performance in managing possible waves of COVID-19 or new emerging diseases with epidemic tendency.

Management crisis of health personnel in the great Maghreb. Mauritania case study.

OBJECTIVE: To describe the number and distribution of health personnel in Mauritania during 2017, according to their academic grades and administrative assignments. METHODS: This is a quantitative study of the number and uses of health human resources in Mauritania, based on the 2017 data from the Personnel Register of the Ministry of Health. The number of doctors, midwives and nurses in the six administrative regions of Mauritania and its "wilayas", were standardized according to the size of the population (health workers /10 000 inhabitants). Interregional inequalities in the allocation of health personnel have been studied through the correlation between the percentages of the health professions and the populations of the regions affected. RESULTS: In 2017, the number of health workers in all categories was 6608 in Mauritania, a ratio of 17.5 / 10000 health workers / inhabitants, ranging from 8.6 in "Gargot" wilaya to 37.3 in the wilaya of "Inchiri". The densities of specialist physicians, general practitioners, midwives and nurses were respectively 0.9, 0.84, 1.8, and 3.32 per 10,000 inhabitants, respectively. In the Nouakchott region, covering 28.5% of the Mauritanian population, 76.5% of specialist doctors and 56.8% of midwives, had ratios (health workers / 10 000 inhabitants) two and three times higher than national levels. CONCLUSION: This study documented on the one hand the persistence of the shortage of health personnel in Mauritania in 2017, in all its professional categories, and on the other hand the inequalities of their distribution in its administrative zones, with a relative abundance in the region of Nouakchott.

Mortality in the Great Maghreb (1990-2015): causes of death and trends.

OBJECTIVES: To describe trends of gross and specific mortality rates for all five countries of the Great Maghreb and to identify the typology and the main causes of death during the period 1990-2015. METHODS: This is an observational and descriptive study of causes of death in the Great Maghreb (Tunisia, Algeria, Morocco, Mauritania and Libya) using the database Global Burden of Diseases (GBD) of the Institute for Health Metrics and Evaluation (IHME). Causes of death were categorized according to the IHME into three categories: "Communicable Diseases", "Non Communicable Diseases" and "Trauma". These following tracer years (1995, 2005, 2015) were considered in the study of global and specific causes of death by country, disease group, sex and age group. RESULTS: During the period 1990-2015, the general trend in gross mortality rates was going down, reaching in 2015 rates that varied from 547/100 000 inhabitants in Tunisia to 437/100 000 inhabitants in Algeria. The trend in specific mortality from Communicable Diseases has been declining, particularly in Mauritania. Among the "Top 10" list of causes of death, four to eight were "Non Communicable Diseases" including ischemic heart disease, which was ranked first in the Maghreb except Mauritania. For children under 5 years old, prematurity was the leading cause of death in the five Maghreb countries in 2015. CONCLUSION: This analysis of causes of death in the Great Maghreb confirmed the similarity of the epidemiological transition and health priorities. Hence the urgency of developing common North African strategies for monitoring, training and intervention in public health.

Reduction of hospitalizations with diarrhea among children aged 0-5 years in Nouakchott, Mauritania, following the introduction of rotavirus vaccine.

INTRODUCTION: Rotavirus vaccine was introduced in Mauritania in December 2014. We investigated hospitalizations with diarrhea during pre and post-vaccination periods among children aged 0-5 years in Nouakchott, the capital of Mauritania. METHODS: We conducted a retrospective review of hospital admission registries from November 1st 2012 through October 31th 2017 at all referral hospitals in Nouakchott. We described admissions of children aged 0-5 years by diagnosis, data of admission, age and sex, and compared the proportion of all childhood hospitalizations with diarrhea before and after rotavirus vaccine introduction. RESULTS: In total, 6552 (19%) of all 34,329 hospitalizations in 0-5 year-olds had diarrhea. Of these, 3523/16,952 (20.7%) were recorded during the pre-vaccine period, 1373/6897 (19.9%) during the transition period (November 2014-October 2015), and 1656/10,480 (15.8%) during the post-vaccination period. The proportion of all childhood hospitalizations with diarrhea during the pre-vaccine period was 22.6% among males and 18.7% among females. Approximately one third (32.3%) of hospitalizations with diarrhea occurred in children aged 6-11 months. During the post-vaccination period, the proportion of hospitalizations with diarrhea declined by 24%, and the highest reduction (74%) was observed in children aged 2 to 5 years (P < 0.001). CONCLUSIONS: The proportion of childhood hospitalizations with diarrhea in Nouakchott was reduced by about one fourth after introduction of rotavirus vaccination in Mauritania, indicating a major impact for public health for children in the capital city.

[Seasonal transmission of malaria in the Senegal River Valley: case study of the city of Kaedi-Mauritanie]. / Transmission saisonnière du paludisme au niveau de la vallée du fleuve Sénégal: cas de la ville de Kaédi-Mauritanie.

INTRODUCTION: In the face of environmental and climatic changes both ongoing and planned, the epidemiology of malaria in the city of Kaedi (Mauritania), along the Senegal River Valley, requires special attention. Some cases of malaria have been registered in the health facilities throughout the year, with an average of 150,000 annual suspected cases and climatic and ecological conditions which are now favorable for seasonal transmission. METHODS: We conducted two cross-sectional descriptive surveys in the city of Kaedi in September 2014 (wet season) and in May 2015 (dry season). Our cluster sampling involved 700 households. Microscopic examination was performed in all household members. Furthermore, larval surveys, early morning wildlife spraying and nocturnal traps breaking were performed. RESULTS: During both seasons, 9.313 thick smears were manufactured, 15 were positive, with a plasmodium prevalence rate of 0.16%. Among these, 12 were positive in the dry season and 3 in the rainy season. Plasmodium prevalence rate was 0.26% and 0.06% respectively in the dry season (n = 4642) and in the wet season (n = 4671). In the rainy season, rates were 0.04% (2/4671) and 0.02% (1/4671) respectively for Plasmodium malariae and Plasmodium falciparum. The only species found in the dry season was Plasmodium falciparum. Entomological investigations showed the presence of a single species of Anopheles mosquito, Anopheles gambia (two in the rainy season and six in the dry season). Larval surveys showed that the larval fauna was dominated by Culex larvae (99.6%). Anopheles larvae (0.4%) were collected only during the dry season. CONCLUSION: Despite low malaria transmission in the city of Kaedi, in a context of lack of rainfall, health authorities should implement a strategy for malaria elimination in the wilayas of the Senegal River.

Epidemiology of Malaria in the city of Kaedi (Mauritania, 2014).

BACKGROUND: In the face of ongoing and projected environmental and climate change, the epidemiology of malaria in the city of Kaédi (Mauritania), bordering the Senegal River Valley, requires special attention. OBJECTIVE: To describe the epidemiological situation of malaria in the city of Kaédi, Mauritania, during the wet season of 2014. METHODS: We conducted a descriptive cross-sectional survey in the city of Kaédi in september 2014 (wet season), to assess the prevalence of malaria parasites and vectors. For the choice of households, a cluster sampling was carried out and the city was subdivided into 10 sub-spatial units using a map of the city and the contribution of local populations. All household members were subjected to microscopic examination. In addition, larval surveys, morning wildlife sprays and night trap breaks were conducted. RESULTS: Of the 4671 thick drops made, three were positive, ie an average plasmid index of 0.06%. Prevalence was 0.04% (2/4671) and 0.02% (1/4671) for Plasmodium malariae and Plasmodium falciparum, respectively. In addition, the larval fauna consisted essentially of Culex larvae (100%). Two (2) female Anopheles mosquitoes were collected during the study. CONCLUSION: Even if transmission is low, in a context of absence of rainfall, the health authorities must foresee a strategy of malaria pre-elimination in riparian wilayas of the Senegal River.

Epidemiology of malaria and elimination prospects in Maghreb Countries.

BACKGROUND: Faced with the challenges of immigration, the opening of the Trans-Saharan road and the increase in the volume of trade with sub-Saharan Africa, there is a steady increase in the number of malaria cases. An introduction of the disease in the Maghreb is possible. OBJECTIVE: The general objective is to take stock of the epidemiological situation and the malaria control strategy in the Maghreb countries. METHODS: This is a synthesis of data from a literature search on: PubMed (publications), International and national reports (epidemiology and strategies). RESULTS: In 1979, Tunisia became the second Maghreb country to eliminate malaria after Libya (the last local case in 1973). In 1997, when 76 cases were recorded, Morocco embarked on a new national strategy aimed at the elimination of indigenous malaria by the end of 2005. In Algeria, after a phase of control by existence of P. vivax and P. malaria microspheres, the country is in the maintenance phase and no cases were recorded between 2013 and 2016. In Mauritania, even though malaria transmission is generally low, this parasitosis remains a problem public health. And the strategies of struggle and the contribution of scientific research remain below expectations. CONCLUSION: With the exception of Mauritania, the countries of the Great Arab Maghreb have practically eradicated malaria, even though the maintenance phase is underway in Algeria and cases imported from sub-Saharan Africa continue to be registered.

Profile and evolution of the Global Burden of Morbidity in the Maghreb (Tunisia,Morocco, Algeria). The Triple burden of morbidity.

BACKGROUND: The Global Burden of Disease (GBD) is an objective method of measurement of disease disability, allowing the quantification of a population's health status, the identification of its health needs, and the determination of its public health priorities. OBJECTIVES: To document the epidemiological transition in Maghreb countries (Tunisia, Morocco, Algeria) over the past three decades and to identify their priority health problems, which are responsible for a considerable burden of disability. METHODS: This is a data synthesis work of the Institute for Health Metrics and Evaluation (IHME) global burden of disease, through its project "GBD Compare Data Visualization". Data covering the period from 1990 to 2016, examined the three major categories of health problems "communicable, maternal, neonatal and nutritional diseases", "noncommunicable diseases" and "injuries", as well as the three types of risk: metabolic, environmental / professional and behavioral. RESULTS: Since 1990, cardiovascular diseases have consistently been the leading cause of death in the three Maghreb countries. During the period 1990-2016, and at varying speeds, the positions of communicable and neonatal diseases declined, while noncommunicable diseases (particularly cardiovascular diseases, cancers, mental disorders, diabetes and neurological disorders) increased significantly, to be at the top of the list of components of the global burden of disease.In 2016, road accidents have been ranked eighth in the ranking of the main components of the overall burden of morbidity in Tunisia and Morocco and ninth in Algeria. During the same period, the environmental and behavioral risk factors registered an overall decrease in the three Maghreb countries, in contrast to the metabolic risk factors that experienced a gradual and homogeneous increase in the Greater Maghreb. CONCLUSION: This GBD analysis confirmed the rather old and fairly advanced epidemiological transition in Maghreb countries, leading to a real "triple burden" threatening the stability and sustainability of national health systems. Hence the urgency of supporting the following five projects: the curriculum reform of the faculties of health sciences, the development of the second line of care, the participative management of health services, universal health coverage and the implementation of a comprehensive and integrated strategy for prevention and health promotion.

Comparative study of post-graduate training programs in public health in the great maghreb countries.

BACKGROUND: Training in public health, an essential lever for the success of health programs, mobilizes several disciplines, from the description of health situations to the study of their determinants, and to health management. OBJECTIVE: To compare postgraduate training programs in Public Health, provided in the countries of the Greater Maghreb. METHODS: Through a documentary study, various components of post-graduate training in Public Health in the Maghreb have been identified: offers and methods of training, learning objectives, program content and reference skills. RESULTS: In the Maghreb, and with the exception of Mauritania, Training offers are limited to teaching in Public Health with a medical orientation, integrated in the university system in the form of residency. Other training (masters ...) are provided in the context of continuing professional development. Areas of competence include, in addition to medical and scientific expertise, communication and interdisciplinary collaboration. The programs focus on methodological aspects in relation to related disciplines such as health promotion, anthropology, sociology and health planning. CONCLUSION: The pooling of training experiences in Public Health, in the Maghreb countries, would be essential to launch a quality homogeneous training based on the paradigm of global health.

Bibliometry of biomedical scientific publications in Mauritania (Medline:1992-2016).

BACKGROUND: As part of the preparatory work for the elaboration of a strategic plan for the development of scientific research in Mauritania, an overview of national biomedical research was recommended by the supervisory authorities. AIM: Describe the bibliometric profile of biomedical scientific publications in Mauritania, indexed in Medline database, over the past 25 years. METHODS: A bibliometric study was carried out on Medline Database covering the period from 1 January 1992 to 31 December 2016. Were retained, the scientific papers whose one of the author's address, at least, was a Mauritanian one. The fields of the Medline display format were used to describe the following items: authors, addresses, journal, language, article type, and Mesh terms. The assignment of a publication to an author was limited to the first and last position. Only first institutional affiliation mentioned in the authors' addresses was considered to classify the establishments' productivity. International co-operation has been studied through the compilation of all co-author addresses. RESULTS: Between 1992 and 2016, Medline had indexed 141 Mauritanian articles, 74 of them was published during the previous five-year period (2012-2016). These papers covered essentially the following disciplines: "Infectious diseases", "Community health", "Parasitology", "Veterinary Medicine" and "Marine Sciences" It mainly consist of an original article (79%), written in English (57%) and published without financial support (72%). Mauritanian articles have been published in 72 journals in 12 different countries. Three journals « Bulletin de la Société de Pathologie Exotique ¼, « Pan African Medical Journal ¼ and « Malaria journal ¼ have accounted 23 % of the publications ; 36% of the papers have been published in French journals. The research subjects of the Mauritanian biomedical literature was carried out via 215 major keywords, five of them represented 22% of the publications: «Malaria¼, «HIV infections¼, «Anopheles¼,  «Camels¼, and «Goat diseases ¼". For 112 scientific articles (79%), the first author were Mauritanian, as for the rest (n = 29) the authors were coming from 15 different countries, mainly from France, Senegal and the Arab Maghreb. In 48% of the articles, the affiliation of the first author was one of four following structures: « the National Hospital Centre in Nouakchott¼, «The National Center for Livestock and Veterinary Research¼, « the Faculty of Science and Technology ¼ and «the National Institute for Research in Public Health¼. A partnership with an international team was noted for 40% of publications, particularly with France, Italy, Senegal, Burkina Faso and Tunisia. CONCLUSION: During the last past 25 year, the biomedical publication feature, inconsistently growing since 2012, has been characterizing by the adequacy of research themes with the population's health needs, an international visibility and an extensive networking with many foreign research structures. Strengthening Maghrebian collaboration in the fields of research training and Multi-centric research would be a fine support to the national dynamics of biomedical research.