title: The epidemiology and aetiology of infections in children admitted with clinical severe pneumonia to a university hospital in Rabat, Morocco.
abstract: OBJECTIVE
  Scarce and limited epidemiological, clinical and microbiological data are available regarding paediatric respiratory tract infections in the Kingdom of Morocco, a middle-income country in northwestern Africa. The results of hospital-based surveillance aiming at describing the aetiology and epidemiology of respiratory distress among children <5 years of age are presented.
  
  
  METHODS
  Children admitted to the Hôpital d'Enfants de Rabat, Morocco, and meeting the World Health Organization clinical criteria for severe pneumonia were recruited over a period of 14 months and were thoroughly investigated to ascertain a definitive diagnosis.
  
  
  RESULTS
  In total, 700 children were recruited for the study. Most frequent clinical diagnoses included wheezing-related conditions (bronchitis/asthma, 46%; bronchiolitis, 15%), while typical bacterial pneumonia was infrequent (only 19% of the cases). Invasive bacterial disease detected by classical microbiology or molecular methods was also uncommon, affecting only 3.5% of the patients, and with an overall low detection of pneumococcal or Haemophilus influenzae type b disease. Conversely, coverage of respiratory viral detection in the nasopharynx was almost universal among cases (92%), with the three most frequent viruses detected being rhinovirus (53%), respiratory syncytial virus (18%) and adenovirus (17%). The overall case fatality rate (CFR) among recruited patients with a known outcome was 4.1% (28/690).
  
  
  CONCLUSIONS
  In Morocco, the epidemiological profile of paediatric acute respiratory infections is markedly shifted towards wheezing-related diseases and thus resembles that of high-income countries. However, the high associated CFRs found in this study call for an improvement in preventive and clinical management strategies.
authors.affiliation: Barcelona Centre for International Health Research (CRESIB, Hospital Clinic-Universitat de Barcelona), Barcelona, SpainÉcole Nationale de Santé Publique (ENSP), Ministère de la Santé, Rabat, Morocco.
authors.forename: Imane
authors.initials: I
authors.lastname: Jroundi
authors.affiliation: Hôpital d'Enfants de Rabat (HER), Centre Hospitalier Universitaire Ibn Sina, Rabat, Morocco.
authors.forename: Chafiq
authors.initials: C
authors.lastname: Mahraoui
authors.affiliation: Barcelona Centre for International Health Research (CRESIB, Hospital Clinic-Universitat de Barcelona), Barcelona, Spain.
authors.forename: Rachid
authors.initials: R
authors.lastname: Benmessaoud
authors.affiliation: Barcelona Centre for International Health Research (CRESIB, Hospital Clinic-Universitat de Barcelona), Barcelona, Spain.
authors.forename: Cinta
authors.initials: C
authors.lastname: Moraleda
authors.affiliation: Hôpital d'Enfants de Rabat (HER), Centre Hospitalier Universitaire Ibn Sina, Rabat, Morocco.
authors.forename: Houssain
authors.initials: H
authors.lastname: Tligui
authors.affiliation: Hôpital d'Enfants de Rabat (HER), Centre Hospitalier Universitaire Ibn Sina, Rabat, Morocco.
authors.forename: Myriam
authors.initials: M
authors.lastname: Seffar
authors.affiliation: Hôpital d'Enfants de Rabat (HER), Centre Hospitalier Universitaire Ibn Sina, Rabat, Morocco.
authors.forename: Selma Cherif
authors.initials: SC
authors.lastname: Kettani
authors.affiliation: Hôpital d'Enfants de Rabat (HER), Centre Hospitalier Universitaire Ibn Sina, Rabat, Morocco.
authors.forename: Badr Sououd
authors.initials: BS
authors.lastname: Benjelloun
authors.affiliation: Barcelona Centre for International Health Research (CRESIB, Hospital Clinic-Universitat de Barcelona), Barcelona, SpainCentre Hôpitalier Universitaire (CHU) Ibn Sina, Rabat, Morocco.
authors.forename: Saad
authors.initials: S
authors.lastname: Chaacho
authors.affiliation: École Nationale de Santé Publique (ENSP), Ministère de la Santé, Rabat, Morocco.
authors.forename: Abderrahman
authors.initials: A
authors.lastname: Maaroufi
authors.affiliation: Barcelona Centre for International Health Research (CRESIB, Hospital Clinic-Universitat de Barcelona), Barcelona, Spain.
authors.forename: Edward B
authors.initials: EB
authors.lastname: Hayes
authors.affiliation: Barcelona Centre for International Health Research (CRESIB, Hospital Clinic-Universitat de Barcelona), Barcelona, Spain.
authors.forename: Míriam J
authors.initials: MJ
authors.lastname: Álvarez-Martínez
authors.affiliation: University Hospital Sant Joan de Déu, Esplugues, Barcelona, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Muñoz-Almagro
authors.affiliation: Barcelona Centre for International Health Research (CRESIB, Hospital Clinic-Universitat de Barcelona), Barcelona, Spain.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Ruiz
authors.affiliation: Barcelona Centre for International Health Research (CRESIB, Hospital Clinic-Universitat de Barcelona), Barcelona, Spain.
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Alonso
authors.affiliation: Barcelona Centre for International Health Research (CRESIB, Hospital Clinic-Universitat de Barcelona), Barcelona, Spain quique.bassat@cresib.cat.
authors.forename: Quique
authors.initials: Q
authors.lastname: Bassat
mesh_terms: D000208:Acute Disease; D000256:Adenoviridae / Q000302:isolation & purification; D001988:Bronchiolitis / Q000453:epidemiology / Q000821:virology; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D008297:Male; D009018:Morocco / Q000453:epidemiology; D009305:Nasopharynx / Q000821:virology*; D011014:Pneumonia / Q000453:epidemiology* / Q000209:etiology*; D011159:Population Surveillance; D012135:Respiratory Sounds / Q000209:etiology; D012136:Respiratory Syncytial Viruses / Q000302:isolation & purification; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000209:etiology*; D012229:Rhinovirus / Q000302:isolation & purification; D012720:Severity of Illness Index
keywords: acute respiratory infections; bacterial diseases; diagnostics; epidemiology; paediatrics; respiratory viruses