Vol.4, No.8, 549-553 (2012) Health http://dx.doi.org/10.4236/health.2012.48086 Maternal and infant health in urban and rural areas in Morocco: Analysis of the preliminary results of the National Survey on Population and Family Health (EPSF 2011) Abdesslam Boutayeb*, Wiam Boutayeb, Mohamed E. N. Lamlili Laboratory of Stochastic and Deterministic Modelling, Research Unit Associated to CNRST, Faculty of Sciences, University Mo- hamed Ier, Oujda, Morocco; *Corresponding Author: [email protected] Received 11 May 2012; revised 7 June 2012; accepted 18 June 2012 ABSTRACT to 2.5 in 2011. The mean age of first marriage went from 24 years for men and 17.5 years for Background: The last Moroccan population and women in 1960 to 31.5 years and 26.3 in 2011 for family health survey (EPSF 2011) was carried out men and women respectively. The age structure between November 2010 and March 2011. The is showing a trend of ageing population. Gene- final report and the whole database are not yet rally, health indicators related to reproductive accessible while a preliminary report was re- and women’s health improved noticeably and leased early March 2012. The information given consequently, maternal and infant mortality also so far does not allow for a complete evaluation of the present health situation in Morocco. decreased. However, while these achievements However, a partial equity analysis can be de- are praiseworthy as national averages, they re- voted to the comparison of health indicators in main insufficient in terms of equitable health- terms of gender and urban-rural gaps. Method: 1) care and access to health services since there is Questionnaires: a household questionnaire dealt still a long way to go in order to reduce the huge with household characteristics, general health, gender gaps and rural-urban disparities. Con- housing condition and anthropometric data for clusion: In this short report, we showed that, as children less than six years of age. A second averages, health indicators improved noticeably questionnaire was devoted specifically to ever during the last decade but gender inequality and married women and dealt with their resources, urban-rural disparities are still challenging marriage, reproductive health, family planning, health decision makers. Moroccan health deci- AIDS/SIDA, healthcare and nutrition. 2) Data sion makers are urged to adopt an equitable collection: data were collected through the na- health strategy, starting by giving access to data tional survey using a three-stage stratified sam- for analysis, monitoring and evaluation. pling design to select 640 clusters covering the 16 Moroccan regions. A total of 15,577 house- Keywords: Health Equity; Gender; Rural; Urban; holds were randomly drawn, providing a sample Indicators; Maternal; Infant of 75,061 individuals (51.1% females and 48.9% males) for investigation. 3) Analysis: in this 1. INTRODUCTION short report, we relied only on partial data re- leased by the Ministry of Health in a preliminary The Moroccan Ministry of Health carries out regular report. We used absolute differences and rela- surveys on population and family health. The last Na- tive ratios to study the evolution of gender and tional Survey (EPSF 2011) was carried out from No- urban-rural gaps on the basis of socioeconomic vember 2010 to March 2011. The final report and the indicators. Results and Discussion: The Moroc- whole database are not yet accessible while a preliminary can population seems to be in the last phase of report was released early March 2012 [1]. The informa- its demographic transition. The total fertility rate tion given so far does not allow for a complete analysis decreased from 5.6 children per woman in 1980 and evaluation of the present health situation in Morocco, Copyright © 2012 SciRes. OPEN ACCESS 550 A. Boutayeb et al. / Health 4 (2012) 549-553 compared to data yielded by the previous surveys. How- household questionnaire dealt with household character- ever, the available data is sufficient for a partial equity istics, general health, housing condition and anthropome- analysis in terms of gender and rural-urban gaps. Data of tric data for children less than six years of age. A second previous demographic health surveys [2] and censuses [3] questionnaire was devoted specifically to women and constitute a valuable capital for the comparison of trends dealt with their resources, marriage, reproductive health, and health indicators. Since the last report released by family planning, AIDS/SIDA, healthcare and nutrition. the WHO commission on social determinants of health in 2008 [4], followed by the Rio political declaration on 2.2. Data Collection social determinants of health adopted by head of gov- Data were collected through the national survey using ernments, ministers and government representatives in a three-stage stratified sampling design to select 640 October 2011 [5], health equity has been put on all clusters (400 in urban areas and 240 in rural areas) cov- agendas and it is supposed to be a shared responsibility ering the 16 Moroccan regions (Figure 1). Then 25 requiring the engagement of all sectors of governments households were randomly drawn from each cluster, pro- and all segments of national and international society in viding a total of 15,577 households for investigation. The “an all for equity” global action. This preliminary analy- sample was thus formed of 75,061 people with females sis will constitute a cornerstone for a more advanced representing 51.1%. The second questionnaire concerned equity analysis that will allow Moroccan health authori- 11,069 ever married women aged 15 to 49. ties to evaluate the current health situation in order to adopt cost-effective strategies that improve “health for 2.3. Analysis all” and reduce the gaps between advantaged and disad- vantaged populations. In this short report, we relied only on partial data re- leased by the Ministry of Health in a preliminary report 2. MEHTOD because the whole data is not yet accessible. We used absolute differences and relative ratios to study the evo- 2.1. Questionnaires lution of gender and urban-rural gaps on the basis of so- Following the standards questionnaires of PAPFAM, a cioeconomic indicators. Unfortunately, with the limited Figure 1. A Moroccan map with regions and numbers of households forming the survey sample. Copyright © 2012 SciRes. OPEN ACCESS A. Boutayeb et al. / Health 4 (2012) 549-553 551 data at hand, we were not able to do a complete statisti- Moroccan population. Illiteracy among women (54.7%) cal analysis, using tests confidence intervals and elabo- is nearly the double of that of men (30.8%). Rural popu- rated data analysis. lations are more adversely affected by illiteracy (60.5%) than their urban counterparts (29.4%). A rural woman is 3. RESULTS AND DISCUSSION 4.27 more likely to be illiterate than an urban man (for the age category (15 - 24) the ratio reaches 9.27 in 2011). 3.1. Demographic Transition Last but not least, the comparison between 2004 and Beside the economic and political transitions, Mo- 2011 data shows that the gender gap as well as the rela- rocco is also undergoing epidemiological and demo- tive ratio between urban and rural areas are persisting or graphic transitions. The geographical distribution shifted even increasing (Table 3). from a rural to an urban dominance and the annual During the last years, unemployment has become a growth rate decreased from 2.8% during the decade major concern worldwide. In Morocco, the 2011 survey 1960-1970 to 1.4% between 1994 and 2004. The mean indicates that among women aged 15 years and over, the age of first marriage has been constantly delayed, post- unemployment rate reaches 81% in cities and 94% in poned from 24 years for men and 17.5 years for women rural areas, compared to respectively 37% and 24% for in 1960 to 31.4 years and 26.6 in 2011 for men and men. women respectively (Table 1). The delay of first mar- riage can be explained by a multitude of cultural and 3.3. Maternal Health: Towards Further socioeconomic factors such as the access of young girls Reduction of Urban-Rural Gaps to higher education, unemployment, housing problems, During the last decade, noticeable efforts were devoted unaffordable expenses of marriage for men (dowry, by Moroccan health authorities to maternal and infant ceremony, festivity) and high cost of child bringing up [6]. health in order to achieve the millennium development The total fertility rate decreased from 5.6 children per goals MDG4 and MDG5, stipulating the reduction of woman in 1980 to 2.5 in 2004 but it remained at the child mortality rate and maternal mortality ratio respec- same level during the last decade according the 2011 tively by two thirds and three quarters between 1990 and survey. Consequently, the age structure is indicating a 2015. In 2011, four years ahead of the deadlines, the re- trend of an ageing population. Indeed, the percentage sults obtained are satisfactory and Morocco is on the represented by the youngest class (0 - 14) decreased from track to achieve these two MDGs. 43.6% in 1980 to 29% in 2011 while the middle and eld- The recent survey shows that 77% of Moroccan erly categories increased respectively from 52.7% to women had prenatal care, compared to 68% in 2004. The 64.2% and from 3.7% to 6.8% during the same period of difference is quite significant between urban (91.6%) and time (Table 2). rural (77.1%). The percentage of assisted deliveries (61%) and deliveries happening in health structures (63%) are 3.2. Illiteracy and Unemployment: Persistent nearly the same and show similar differences between rural Challenges and urban areas. Finally, the proportion of women having Illiteracy is still challenging decision makers in Mo- postnatal care remains very low (21.9%) especially in rocco though it decreased from 43% in 2004 to 37.6% in rural areas (13.3%) (Table 4).