Mohamed Bayari pdf

Paediatric Health Assistance in Morocco

Mohamed BAYARI, MD

Casablanca, Morocco

Morocco strongly challenged by social development issues

• Access to basic education & quality primary health care

• Fight against illetracy

• Reduction of poverty & social inequities

• Increase training & employment

National Program = ↓ Mortality

• Life Expectancy or Healthy Life Expectancy (HALE) at birth

Ö

• Infantile Mortality

Ö

• Maternal Mortality

Ö

<14 years: 9,2M (2005) ~31%

Pop. growth rate stable: 1,7% (1996) -1,4% (2006) Total fertility rate: 2,7 per woman (2004)

↑ urbanization rate

51,6 49,4

53,9 55,9

59,7 62,7 65,1 65,6

69,2

25,1 23,6 29,6 26,9

33,1 37

45,9 42,2 44,4

0 10 20 30 40 50 60 70 80

1960 1971 1982 1994 1999 2004 2009 2014 2019

15-59 years 60 years+

0-14 years

Poverty and health are intimately related.

Poverty is both a cause & consequence of ill health

world bank, 2001

21

16,3

9 15,3 14,2

1985 1999 2001 2004 2007

Rate %

4,8 7

55,4

39,5

Morocco Tunisia Italy Belgium

Medical Density per 10000 habitants

359

228 220

170 180

150

Mor occo (

81) Moroc

co (95 ) Moroc

co (00 ) Tuni

sia/E gypt

Syria Jor dani

a Maternal Mortality per 100000 Live Births

-37%

- 4%

Antenatal Care 74,4

17,7

33,2

60,3

2,9 8 14,1

54,5

31 16,8

8,6

5,1 8,2

21,3 13,3

0 20 40 60 80

1 2 3 4 5

Quintiles Percent of women receinving care

care from a medically trained person care from a doctor care from a nurse or midwife

Maine Infantile's mortaliy causes, ECCD 1998 6%

37% 50%

1% 1%

3% 2%

Infectious Diseases Perinatal causes Congenital abnormalities Undernutrition

Other NTD Injuries

Unknown

203

168

74,9 118,2

108,4

59,2 51,5

33,8 27,4 41,7

45,8

33,8 29,1 39,4

58,1

47,6

33,6 27,5

22,1 19,8 24,6

1962-66 1972-76 1987-91 1997-2001 2001-06 2007-11 2012-16

Mortality per 1000 libve births

Neonatal Mortality Infantile Mortality Childhood Mortality

Source: DRPF, Health Ministry

Rapport Politique Santé Enfant 2005

Evolution of Paediatric Mortality

(1962-66 & 1997-2001)

-2,1

-3,2 -2,6

-9,8

Neonatal Post-neonatal Infantile Child

Morocco: Bad student

• Morocco (1997) 36,6

• Tunisia 26,2

• Jordania 31,3

• Egypt 29,1

• Syria 24

• Lebanon 25,4

Global morbidity rate

• Perinatal affections 15,64%

• Infectious diseases 14,57%

• Neuro-psy diseases 13,47%

• CV diseases 11,3%

55,9%

Moderate to severe stunting in children under 5 years (-2Z-score)

8,1 39,2

28,4

13,7 21,6

1 2 3 4 5

< 20% = Low degree of malnutrition;

20–29% = Medium degree of malnutrition;

30–39% = High degree of malnutrition;

40% = Very high degree of malnutrition.

What Are Government Clues Solving Problems?

• Population’s social coverage & protection

• Compulsory Medical Insurance AMO/ RAMED

• Decentralization & Regionalization

• National programs

• Maternal & Infantile Health Pogram (SMI)

• Integrated Managment of Childhood Illness (IMCI)

• National Immunization Program

• ARI National Program

• Anti-Diarrheal Program

90 87 90 91

91 90 93 92

87 88 80 81

82 79 82

73

0 5000 10000 15000 20000 25000 30000

1987 1988

1989 1990

1991 1992

1993 1994

1995 1996

1997 1998

1999 2000

2001 2002

2003 Years

Measles cases % coverage

Source: National Immunisation Program, Health Ministry

Immunization Coverage in Children Aged 12-23 months

83

58

70 94

67

76 93

85 89

94

84 90

Urban Rural Total

ENPS 87 ENPS 92 PAPCHILD 97 EPSF 03-04

Fighting Against Diarrheal Diseases Program [PLMD]

• Ê use of oral rehydration solutions

• Promoting maternal breast-feeding

• Nutritional support

Ì post-neonatal (1-11mo) mortality: 47%

Ì infantile mortality (12-59mo): 69%

• Use of ATB remains high: 32,9% (urban, 1995)

• Vit A deficiency

• Impaired erythropoeisis+++

• Repletion Î redistribution of Fe from stores to BM

• Systematic supplementation (National Program)

• Riboflavin

• Cooper:

• Rare Î unlikely of public Health importance

• Zinc

• May impair iron efficacy