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Background: This study aimed to indirectly examine whether the implementation of clinical breast examination-based screening program in Morocco has been successful in downstaging and improving survival rates. Breast cancer patients detected through the screening pathway were compared with those detected through self-referral over the same period in terms of cancer stage at diagnosis, tumor characteristics, care delays, and survival., Methods: A prospective observational study was conducted between April 2019 and August 2020 at two major public oncology centers., Results: A total of 896 women with confirmed breast cancer were recruited (483 were program-referred and 413 were self-referred). The authors did not report any significant difference between the two groups in terms of stage at diagnosis, molecular profile, or histopathological grade. Early-stage cancer (stage I-II) was detected in 55.7% of self-referred participants compared to 55.5% of program-referred participants. Median intervals between symptom recognition, pathological diagnosis, and treatment initiation were not significantly different between the two groups. Similarly, survival after treatment showed no significant difference between patients screened by the program and self-referred patients. The 3-year survival rate after treatment was 94.5% for patients referred through the program and 88.6% for patients not referred through the program (p = .16)., Conclusions: This study highlights the importance of equitable and timely access to high-quality diagnosis and treatment facilities, leading to substantial downstaging and enhanced survival rates. Continued efforts to improve quality and expand coverage to include asymptomatic women will consolidate the health infrastructure gains achieved by the Moroccan breast cancer screening program., (© 2024 World Health Organization; licensed by American Cancer Society. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.)

Purpose: The project aimed to implement pilot screening and treatment services for cervical cancer integrated with existing primary health centers (PHCs) in Benin, Cote d'Ivoire, and Senegal and evaluate these services using implementation research outcomes such as reach, effectiveness, adoption, and acceptability., Materials and Methods: The Ministry of Health in each country took the lead in setting up a stakeholder's group that designed a protocol tailored to the local context. The target age was 25-49 years in Benin and Cote d'Ivoire and 30-49 years in Senegal. Visual inspection with acetic acid (VIA) was the screening test, and thermal ablation (TA) was the ablative treatment of choice in all. The Ministry in each country identified 4-5 PHCs to set up screening and ablation services and one higher-level center for colposcopy referral. After a master-trainer led training program, nurses, midwives, or general practitioners screened opportunistically the eligible women attending the clinics. The VIA-positive women eligible for ablation were offered immediate treatment., Results: Between May 2018 and January 2021, 16,530 women were screened opportunistically. VIA positivity was 8.1% with huge variability within and between countries. Sixty-one percent of all VIA-positive cases were eligible for immediate TA, and 88% of them accepted same-day treatment. Compliance to TA at PHCs was 99%. Majority of women treated with TA complained of minor side effects. Significant dropouts occurred as the women were referred to colposcopy clinics., Conclusion: Opportunistic screening provided as part of routine PHC service can screen many women and treat a significant proportion of screen-positive women with TA with minimal side effects. Primary concerns are the hard-to-reach women who remain out of opportunistic screening coverage and noncompliance of the screen-positive women referred to higher-level centers.

Background: Colorectal cancer (CRC) incidence and mortality rates are increasing rapidly in many low-income and middle-income countries. A demonstration project was implemented in Morocco in collaboration with the Ministry of Health to assess the feasibility, acceptability, and challenges of implementing CRC screening through routine primary care facilities., Methods: The objective of the project was to screen 10,000 men and women aged 50 to 75 years through 10 primary health centers (PHCs) in 2 provinces. All eligible men and women attending the selected PHCs were offered the fecal immunochemical test (FIT). Stool specimens brought to the PHCs were tested immediately by trained nurses. FIT-positive individuals were referred to the National Oncology Institute for colonoscopy., Results: In total, 9763 eligible men and women were screened by FIT between June 2017 and May 2019; most (73.3%) were women. The test was positive in 460 participants (4.7%). Among the individuals who had positive FIT results, 62.6% underwent colonoscopy. The main reasons for noncompliance to colonoscopy were competing life priorities (15.4%), other health problems (13%), and fear of getting a cancer diagnosis (12.3%). As the number of referrals to colonoscopy increased, the waiting time for the procedure increased, resulting in a drop in compliance. The detection rates of advanced adenomas and CRC were 4.0 in 1000 and 0.5 in 1000 individuals screened, respectively., Conclusions: An effective strategy to reach the target populations (especially men), a pragmatic assessment of the health system's capacity to deal with large numbers of referrals, and a formal cost-effectiveness analysis are essential before making any decision to introduce CRC screening in Morocco., (© 2021 American Cancer Society.)

Background: Breast cancer is the most common cancer of women in Morocco and its diagnosis is usually made at advanced stages. The aim of this study was to describe the knowledge, practices and attitudes of general practitioners regarding early detection of breast cancer. Methods: A cross-sectional study was carried out during July 2011 on a sample of 140 general practitioners employed in basic health care facilities. Results: The majority (85.7%) of general practitioners were aware of the existence of a ministerial circular which aimed to generalize breast cancer screening. Systematic practice of clinical breast examination was reported by 18.0% of doctors for every woman between 45 and 70 years and a systematic breast self-examination check-up was reported by 59.4% of physicians. Mammography was requested by 54.1% of physicians in the presence of risk factors. Females and physicians practicing in urban areas were less likely to have a knowledge, attitudes and practices score higher than 8 as compared to male physicians and those practicing in rural areas. Discussion and conclusion: Our study showed that the knowledge, attitudes and practices of general practitioners regarding the early detection of breast cancer program were not satisfactory; hence the urgent need for improved implementation of the program in the affected regions., (Creative Commons Attribution License)

Objective: The benefits of screening and early detection of breast cancer, including reduced morbidity and mortality, have been well-reported in the literature. In 2011, a breast cancer screening program was launched in Meknes-Tafilalt region of Morocco. The aim of this study was to evaluate the early performance indicators of this program. Materials and Methods: This retrospective evaluative study was conducted between April 2012 and December 2014, in Meknes-Tafilalt region of Morocco. Several performance indicators of the breast cancer screening program were calculated: the compliance rate, the positivity rate, the referral rate, the cancer detection rate and the organizational indicators. Results: During 2012-2014, a total of 184,951 women participated in the breast cancer screening program. The compliance rate was 26%, the positive rate was 3.3%, the referral rate was 36.7%, and the cancer detection rate was 1.2 per 1,000 women. The median time between the date of clinical breast examination and the date of biopsy (or cyto-puncture) was 36 days. The median time between the date of positive mammography and the date of biopsy (or cyto-puncture) was 6 days. The median time between the date of clinical breast examination and the date of the first received treatment was 61 days. Conclusions: The program needs better monitoring, as well as implementation of quality assurance tools to improve performance in our country., (Creative Commons Attribution License)

In December 1998, a survey was carried out on the quality of trichiasis surgery, based on a random sample of 750 people chosen from the surgical records of 13 health centres of the provinces of Zagora and Errachidia (Kingdom of Morocco). Among those, 740 people were examined (participation ratio: 98.6%). The study population was mainly composed of women (63.8%) and people > 40 years (83.5%). The average age was 51.8 (48.5 for women and 57.4 for men). The most common surgical technique was the bilamellar tarsal rotation procedure. In 98.7% of cases, the operation concerned one of the upper eyelids, and in 58.5% of cases the right eye. At the time of the interviewers' visit, 11.1% of the people examined were blind (vision < 1/20 for the best eye) and 28.9% were visually impaired (vision > 1/20 but < 3/10). In addition, 17.6% of the eyes whose eyelids had been operated on rated as blind and 29% of them as visually impaired. The definition of recurrence was the presence of at least one or more eyelashes in contact with the eyeball. The recurrence rate is estimated to be 15.8%, divided into 2 categories: (1) Severe or total recurrence (2.4%) - At least one eyelash from the median part of the lid margin is in contact with the cornea - and, (2) Partial recurrence "One or more eyelashes affect the corners of the eyelids but never rub against the cornea" (13.4%). 14. 3% of the patients operated on were removing their eyelashes regularly which is a clear indicator of the failure of the operation. The following constitute risk factors for recurrence: being aged over 40, having been operated on in Errachidia province, having been operated on by a general practitioner or by an ophthalmologist. However, "time elapsed since the operation" does not appear to influence the recurrence rate in each of the three cohorts which were subsequently formed using the date of the operation (retrospectively). Most recurrences seem to develop during the first twelve months after the operation. The post-operational complications/sequelae detected were rarely sight-threatening, except in four cases, i.e., three ptoses and one case of tegumental necrosis with permanent exposure of the cornea. The most common complications were excessive rotation of the lid margin (over-correction) (2.3%) and cutaneous necroses with no exposure of the cornea (3.6%). In this series, 15.7% of the eyes examined presented central corneal opacity and 2.1% xerosis. In 1.6% of cases the eyeball was either destroyed (phthisis bulbi) or absent. A majority of patients (51.8%) was affected by persistent lacrimation or secretions.

The lack of sound and recent epidemiological data on the prevalence and causes of blindness has hampered the development and evaluation of the Moroccan Programme for the Prevention of Blindness. For this reason a population-based survey using a stratified (urban/rural) sampling design for random selection of clusters was carried out in the Kingdom of Morocco from May 15 until June 30, 1992. The procedures used for this survey were those proposed by the WHO Programme for the Prevention of Blindness. A total of 10,198 people were recruited and 8878 examined for a participation rate of 87%. The size and representativity of the sample satisfactorily guaranteed the order of magnitude and accuracy of eye health indicators used by health planners. The crude point prevalence of blindness was 0.8%, that of bilateral poor vision was 2.3%, and that of unilateral poor vision was estimated to be 2.8%. Based on these findings 195,000 people would be blind and 1,300,000 would be at risk of becoming so, for a total of approximately 1,500,000 people with serious visual impairment. Age-related cataract was the most important cause of blindness (45.5%) and bilateral poor vision (43.1%). The prevalence of cataract-related visual impairment--operable or inoperable--was estimated to be 2.1% of the survey sample. Applying a realistic algorithm to the survey data, it was estimated that the backlog for cataract surgery in Morocco in 1992 was in the order of 502,000 eyes in approximately 287,000 people. The percentage of patients who had undergone cataract surgery in hospital was 0.8%. Posterior lens dislocation according to the traditional "couching" method was noted in 0.1% of people studied. It was estimated that 25% of the demand for cataract surgery was covered by available facilities and that 40% of people with aphakia could not obtain eye care.