title: Secular trends in consultations for asthma in early childhood, the 16 administrative regions of Morocco, 2004-2012.
abstract: BACKGROUND
  Little is known about asthma trend in Morocco, particularly in early childhood. Furthermore, when dealing with asthma related environmental risk factors in Morocco, decision-making focus is in one region R9, while 16 regions make up the country. This work aims at studying 9-year trends in consultations for asthma in under-5 children in the 16 individual regions with respect to area and age group.
  
  
  METHODS
  Direct method use, based on the only available national data from the open access files of the ministry of health, standardizing data for three age groups (0-11 ; 12-23 and 24-59 months). We compared age-adjusted rates, stratified by area (urban and rural areas) within each region (Wilcoxon's signed ranks test), and between all regions emphasizing on R9. Secular trends are examined (Kendall's rank correlation test). We also compared directly standardized rates as a rate ratio for two study populations (that of R9 and any region with highest rates). We finally compared rates by age group in selected regions.
  
  
  RESULTS
  Secular increase in prevalence rates was shown in both urban and rural Morocco, particularly in urban areas of R10, R14, R16 and R5, and in rural areas of R14 and R16. In urban area of R10 (the highest age-adjusted prevalence rates area) the rates showed secular increase from 6.82 at 95 % CI = [6.44 to 7.19] per 1000 childhood population in 2004 to 20.91 at 95 % CI = [20.26 to 21.56] per 1000 childhood population in 2012 (P = 0.001). Rates were higher in urban than rural Morocco, particularly in R8, R9, R10, R14, R15 ; R6 was an exception. Rates in R10 were 1.63 higher than that in R9 in 2004 and rose to be 2.55 higher in 2012 ; rates in urban area of R14, about 3 times lower than that in R9 in 2004, increased to be similar in 2012. The highest-prevalence age group varied according to region and area.
  
  
  CONCLUSIONS
  The regions that worth decision making attention are the urban areas of R10 (the highest prevalence rates Moroccan area, showing continuous increase), of R9, of R14 and the rural area of R6. The rates in the urban area of R9 (a current continuous decision making focus) remained high but stable within the study period and less important than those in R10. Environmental factors (biological particules, non-biological particules or gazes) are suspected.The potential unavailability of treatment at regular basis at the primary health care centers may reduce frequency of consultations for asthma in early childhood : outpatients may consult only if asthma causes problems in an attempt to get free medicines ; chances of outpatients' follow-up by the primary health care center's physicians are therefore reduced and optimal asthma control is not achieved.
  
  
  CONCLUSIONS
  Social, health care policy and environmental factors, to which decision-making has to be responsive, are suspected to be affecting both frequency of and time secular trend in consultations for asthma in early childhood in Morocco.
authors.affiliation: Environmental Epidemiology Unit, National Institute of Hygiene, Ministry of Health, 27 Avenue Ibn Battota, BP 769, Rabat, Morocco. mina.sadeq@gmail.com.
authors.forename: Mina
authors.initials: M
authors.lastname: Sadeq
authors.affiliation: Laboratory of Biostatistiques, Clinical Research and Epidemiology, Faculty of Medicine and Pharmacy, University Mohammed V. Rabat, Rabat, Morocco. rabouqal@gmail.com.
authors.forename: Redouane
authors.initials: R
authors.lastname: Abouqal
authors.affiliation: Service of Studies and Health Information, Direction of Planning and Financial Ressources, Ministry of Health, Rabat, Morocco. a.elmarnissi@hotmail.fr.
authors.forename: Abdelilah
authors.initials: A
authors.lastname: ElMarnissi
mesh_terms: D001249:Asthma / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D004777:Environment; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009018:Morocco / Q000453:epidemiology; D015995:Prevalence; D011320:Primary Health Care; D012017:Referral and Consultation / Q000639:trends*; D012307:Risk Factors; D012424:Rural Population; D014505:Urban Population