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[Sex education in Tunisia: students' expectations and teachers' conceptions] Education a la sexualite en Tunisie, attentes des eleves et conceptions des enseignants.
Sante Publique. 2017 Jul 10; 29(3):405-414.Health education, as defined by the World Health Organization (WHO 1983), includes sex education. In Tunisia, there is a growing interest in sexuality issues, in contrast with the reigning conservative culture, challenging the taboos and restrictions imposed by religion. A global sex education strategy is therefore required in Tunisian in schools to help students understand their body and its biological functions, construct a real sexual identity and adopt behaviours that promote a healthy and low-risk lifestyle. In this study, we wonder whether the objectives defined by official programmes and conveyed by biology teachers are consistent with the expectations of their students in terms of sex education. This questionnaire-based survey, conducted among 95 biology teachers and 735 students, with an average age of 18 years, shows to what extent the objectives of biology teachers differ from the expectations of students, illustrating to what extent sex education needs to be adapted.
[Knowledge, attitudes and condom use skills among youth in Burkina Faso] Utilisation du preservatif masculin : connaissances, attitudes et competences de jeunes burkinabè.
Sante Publique. 2017 Mar 06; 29(1):95-103.Introduction: Condom use is recognized by the WHO as the only contraceptive that protects against both HIV / AIDS and unwanted pregnancies. But to be effective, condoms must be used consistently and correctly. The objective of this study was to assess young people's skills in male condom used, to identify the challenges faced by them when using condoms to better guide future interventions.Methods: Based on a two-level sampling representing 94,947 households within Bobo-Dioulasso municipality, 573 youth aged between 15 and 24 were interviewed. This data collection was conducted from December 2014 to January 2015 in the three districts of the municipality. A questionnaire was used to assess the knowledge and attitudes of the youth.Results: Only 24% of surveyed know how to accurately use condoms despite their knowledge of condom effectiveness and although some of them are exposed to awareness-raising and information campaigns. Indeed, various handling errors and usage problems (breakage, slippage, leakage and loss of erection) had been identified during the oral demonstration performed by the surveyed. The older youth and with the highest level of education were the most likely to demonstrate increased skills in condom use. Moreover, girls were less competent than boys in terms of condom use.Conclusion: It is important to increase awareness-raising and information campaigns, adapting the content to the real needs of young people so as to transmit the skills required for effective prevention particularly in regard to condom use.
Validation of maternal and neonatal tetanus elimination in Equatorial Guinea, 2016. alidation de l'elimination du tetanos maternel et neonatal en Guinee equatoriale, 2016.
Releve Epidemiologique Hebdomadaire. 2017 Jun 16; 92(24):333-44.Add to my documents.
Progress towards measles elimination - African Region, 2013-2016. Progres realises en vue d'eliminer la rougeole - Region africaine, 2013-2016.
Releve Epidemiologique Hebdomadaire. 2017 May 05; 92(18):229-39.Add to my documents.
Zika virus infection: global update on epidemiology and potentially associated clinical manifestations.
Releve Epidemiologique Hebdomadaire. 2016 Feb 19; 91(7):73-81.Add to my documents.
Releve Epidemiologique Hebdomadaire / Section D'hygiene Du Secretariat De La Societe Des Nations. 2014 Oct 31; 89(44):493-9.Add to my documents.
Releve Epidemiologique Hebdomadaire / Section D'hygiene Du Secretariat De La Societe Des Nations. 2014 Oct 31; 89(44):500-4.Add to my documents.
Releve Epidemiologique Hebdomadaire. 2013 Jul 12; 88(28):285-96.This epidemiologic record discusses recent data about yellow fever outbreaks and cases in Africa and South America between 2011 and 2012. During this period, major outbreaks were reported in Sudan and Uganda while significant clusters of cases were reported in Cameroon, Chad and Cote d’Ivoire, necessitating an extended vaccination response. In addition, some isolated cases occurred in districts reporting high yellow fever vaccination coverage (Burkina Faso, Central African Republic, Togo), for which no vaccination response was undertaken. In South America, the World Health Organization American Region reported 32 cases (2011-2012), including 9 deaths, in Brazil, Ecuador, Plurinational State of Bolivia and Peru. As of 2012, most countries in the Caribbean and Latin America with enzootic areas had introduced the yellow fever vaccine into their national routine immunization schedules. The 2008 outbreaks in the Southern Cone expanded the area considered at risk to include northern Argentina and Paraguay. Building upon the yellow fever investment case strategy, which has reduced the frequency and size of disruptive outbreaks, the Yellow Fever Strategic Framework 2012-2020 prioritizes endemic countries according to their epidemic risk. This framework will enable WHO and partners to identify the populations’ high priority needs through a systematic approach so that limited resources can be allocated most effective to reduce the burden of yellow fever in Africa. Following a request from the countries, a form of yellow fever experts met in Panama to discuss how countries can make scientific evidence-based risk assessments and suggested that endemic countries should strive to enhance yellow fever surveillance systems.
Releve Epidemiologique Hebdomadaire. 2013 Jun 14; 88(24):241-2.In May 2013, eight total cases of wild poliovirus type 1 (WPV1) were isolated in Mogadishu and Bay Region, becoming the first polio cases reported in Somalia since March 2007. That same month, the Kenyan Ministry of Public Health and Sanitation confirmed a WPV1 case in an infant girl from the Dadaab refugee camps near the Somalia border. Genetic sequence analysis of WPV1 from both countries shows that they are closely related, with evidence of the virus’ single introduction into the region and subsequent local transmission. In Somalia and Kenya, rapid response polio supplementary immunization activities (SIA) were conducted. Preventive SIAs are being conducted in areas of Ethiopia and Yemen, and surveillance for acute flaccid paralysis (AFP) is being strengthened in all countries in the Horn of Africa.
Releve Epidemiologique Hebdomadaire. 2013 Apr 26; 88(17):173-80.Add to my documents.
Meeting of the Strategic Advisory Group of Experts on immunization, April 2013 - conclusions and recommendations.
Releve Epidemiologique Hebdomadaire. 2013 May 17; 88(20):201-6.Add to my documents.
[Prevalence of HIV infection and associated factors in the Central African Republic in 2010] Prévalence de l’infection VIH et facteurs associés en République Centrafricaine en 2010.
Calverton, Maryland, ICF International, 2012 Apr.  p.Nearly 68 percent of all HIV-positive individuals worldwide live in Sub-Saharan Africa. The region remains the most severely affected in the world, even though only 12 percent of the world's population lives there. Central Africa, which is less afflicted than Southern and Eastern Africa, nevertheless has a high enough level of infection for it to be characterized as a generalized epidemic. This is the case in the Central African Republic. The Central African Republic has long lacked reliable data on the epidemic, which has slowed the national response that otherwise would have occurred with more factual data. In response to the perceived need, the United Nations Population Fund (UNFPA), World Bank, World Health Organization (WHO), and Joint United Nations Program on HIV/AIDS (UNAIDS) have financed HIV testing in two multiple indicator cluster surveys--the 2006 MICS and 2010 MICS. This partnership has led to collection of reliable data to monitor trends in HIV prevalence and distribution among the population age 15 to 49. Also monitored are distribution of the epidemic by geographic region and population group. Because the decrease in HIV prevalence between 2006 and 2010 will be interpreted as an encouraging sign of progress, it is important to remain vigilant. The disaggregated results show that the epidemic continues to grow in scope and provokes disastrous consequences in certain groups. For the first time since 2006, the Central African Republic has reliable data to inform decision-making and intervention planning. These data have permitted the pandemic areas in the Central African Republic to emerge from the shadows. For the future, we wish to put in place systematic HIV testing similar to that of the Demographic and Health Surveys (DHS) and the Multiple Indicator Cluster Surveys (MICS). The UNFPA office in the Central African Republic is committed to improving knowledge about HIV and reinforcing the availability of information for planning, implementation, and follow-up of the country's National Strategic Plan for the Fight against AIDS.
Measles outbreaks and progress towards meeting measles pre-elimination goals: WHO African Region, 2009-2010. Flambees de rougeole et progres accomplis en vue d'atteindre les objectifs de preelimination de la rougeole: Region africaine de l'OMS, 2009-2010.
Releve Epidemiologique Hebdomadaire. 2011 Apr 1; 86(14):129-36.This report summarizes the progress made during 2009-2010 towards meeting the pre-elimination goals after a historically low incidence of measles cases was reported in 2008. In addition, it provides information on measles outbreaks occurring during the same period which highlights the urgent need for renewed political will from governments and their partners to ensure that national multiyear vaccination plans, budgetary line-items and financial commitments exist for routine immunization services and measles-control activities. To assist countries in resonding to measles outbreaks, WHO guidelines were published in 2009.
Gynecologie, Obstetrique and Fertilite. 2003 Sep; 31(9):774-777.Recent studies from WHO indicated that a large proportion of human contraceptive needs cannot be covered by the already existing means for different reasons (medical, economical, political, and cultural). Therefore, development of new effective methods targeting birth control methods affordable by under-privileged populations turns out to be necessary. Over the last 20 years, a large number of strategies have been used for contraceptive vaccines and thus multiple antigens have been identified as potential targets for immunocontraception. Nowadays, the most acute researches are based on suppression of the secretion and the activity of gonadotropic hormones (GnRH, LH/hCG, FSH) or the targeting of antibodies specific to sperm surface (RSA-1, SP10, SP17, TCLe-1, PH-20) and oocyte antigens (ZP1, ZP2, ZP3).We developed a contraceptive vaccine against FSH receptor. Adult male monkeys (Macaca radiata) were immunized with filamentous phages displaying at their surface N-terminal peptides of the FSH receptor. Long term male contraception has been achieved without any alteration of circulating testosterone levels, sexual behaviour or of any other discernable metabolic changes. Interruption of vaccination resulted in full recovery of sperm production and male fertility. Contraceptive vaccines are aimed to block an essential step in the reproductive process. From this point of view, efforts have to be focused on the challenge to raise is to ally our knowledge on reproductive physiology and protein biochemistry for a better understanding of the target antigen's function. (author's)
Coping with crises. How providers can meet reproductive health needs in crisis situations. Face aux crises. Comment les prestataires peuvent répondre aux besoins de santé dans des situations de crises.
Population Reports. Series J: Family Planning Programs. 2005 Dec; (53):1-19.Know what to do. The materials that guide international humanitarian relief providers-- particularly the Inter-Agency Field Manual and its Minimum Initial Service Package (MISP)-- can inform local providers of the reproductive health care needs of refugees. Kits of supplies that are part of the MISP can be ordered. Disaster preparedness training courses can help providers and government officials respond effectively when crises occur. Plan ahead. Make emergency preparedness plans that consider staffing, logistics, supplies, infrastructure, establishing relationships with news media, and coordination with other organizations. Plan for contingencies. Offer care immediately if a crisis occurs. Coordination is desirable but takes time, while health needs are urgent and great. (excerpt)
The silent war against Africa: AIDS. Report of AACC Church Leaders' Consultation on the Approach to the HIV / AIDS Crisis, 23rd - 25th April 2001, Dakar - Senegal. Une guerre silensieuse contre l'Afrique: SIDA. Rapport de la Consultation des Chefs d'Eglises de la CETA sur l'Approche à la Crise de VIH / SIDA, 23-25 Avril, 2001, Dakar, Sénégal.
Dakar, Senegal, AACC, 2001.  p.The general goal of the AACC HIV/AIDS programme was to facilitate ways the churches in Africa especially the leadership can be better informed to enable them respond more positively to the HIV/AIDS pandemic. The specific objectives: By the end of the two Consultations it was hoped that participants should be able to: Create means/fora for sharing of accurate information on HIV/AIDS; Facilitate means/ways of sharing best practices; Identify the root causes of HIV/AIDS and suggest the ways of responding to the crisis more effectively; Develop ways/means to break the silence on HIV/AIDS; Commit themselves to practical ways of responding to the pandemic; Share the message of HIV/AIDS in Africa and among churches and partners outside of Africa. (excerpt)
In: WHO updates medical eligibility criteria for contraceptives, by Ward Rinehart. Baltimore, Maryland, Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Information and Knowledge for Optimal Health Project [INFO], 2004 Aug. 1. (INFO Reports No. 1; USAID Grant No. GPH-A-00-02-00003-00)The World Health Organization (WHO) has issued new family planning guidance, including the following: Most women with HIV infection generally can use IUDs; Women generally can take hormonal contraceptives while on antiretroviral (ARV) therapy for HIV infection, although there are interactions between contraceptive hormones and certain ARV drugs; Women with clinical depression usually can take hormonal contraceptives. More than 35 experts met at WHO headquarters in Geneva, Switzerland, in October 2003 and developed this and other new guidance. The new guidance updates the Medical Eligibility Criteria (MEC) for Contraceptive Use. This was the third expert meeting to consider medical eligibility criteria. WHO first issued the MEC in 1996; they were first updated in 2000. (excerpt)
Cahiers du Médecin. 2002 Dec; 6(58):45-46.This article presents a report from the macroeconomic and health committee to determine the place of health in economic and social development created by the WHO in the year 2000. The main conclusions for all aspects were presented when the report was submitted to the WHO general assembly in 2002. The observations thus raised indicated that economic losses linked to poor health have been underestimated, especially in developing countries and that the role of health in economic growth has been strongly undervalued. Because of this several pathologies are still responsible for a high percentage of avoidable deaths, particularly maternal and perinatal pathologies and infectious diseases in children. It is also noted that the level of health expenses is insufficient and that the recommended financing strategy is based on growth in budgetary credits consecrated to health and to an increase in donor subsidies. The report emphasizes the different essential actions capable of reaching disadvantaged populations and on the correct steering by the public authorities of contributions from donors in the public and private sectors. Other remarks were collected about the various financing mechanisms on the global scale to combat certain endemic infections, specifically AIDS, tuberculosis, and malaria. Efforts to improve access by the populations to essential and indispensable drugs are also being made. The report underlines the need for the signing of a health pact between governments and development agencies in order to increase resources allocated to health. For the development of health in Morocco, the author emphasizes all aspects raised in this report and suggests the creation of a "Health and development" commission as advised by the WHO.
[Project-generated organizational learning: El-Haouz province and Essaouira province cases] L'Apprentissage organisationnel généré par les projets: "cas des provinces d'El Haouz et d'Essaouira".
[Rabat], Maroc, Institut National d'Administration Sanitaire [INAS], 2002 Jul. , 64,  pMoroccan healthcare structures, both at the central and peripheral levels have traditional organization and management centered on a certain fragmentation in management and vertical integration of programs and healthcare activities. It is for this reason that Morocco maintains cooperative relationships with several countries or international bodies in all domains, including that of health, for purposes of exchanging with them and benefiting from their technical and financial assistance via projects likely to improve the health of the population. Of course, each project results in learning in terms of mastering the technical tools of management by health professionals. It is in this sense that this study from the INAS (National Institute for Health Administration) was undertaken. The goal is to evaluate organizational learning generated in the context of projects initiated in the El Haouz and Essaouira provinces, and to determine its conditions, obstacles, and limits. This study should be taken as qualitative evaluative research, based on a questionnaire given to delegates of the provinces that were the study sites and to members of the local team involved in project management who had responsibilities in this area; on a focus group, and on semi-directed interviews with provincial managers. Analysis of the results led to the following syntheses: The mode of management by project offers the opportunity for health professionals to improve their abilities. But they should make an effort to adapt to conditions in the field, and show that they are committed in this process; the domain of organizational learning should revolve around three components: technical, behavioral, and managerial, provided the last is better integrated since it seems to lag behind the other two. Also, the ability to learn in the context of projects is certainly conditioned by a certain number of factors that must be considered to better master the constraints and work for the implementation of favorable conditions for organizational learning. At the end of this work, recommendations were made in order to enhance and improve the quality of implementing the project management mode in sanitary structures across which develops organizational learning for the purpose of better meeting the needs of the population and strengthening capacities in health professionals.
Bulletin Économique et Social du Maroc. 2000; (159):21-24.According to the 1998 World Human Development Report (HDR), Morocco ranks 125th with a human development indicator (HDI) of 0.557 points. The indicator elements pertaining to life expectancy, adult literacy and schooling levels remain unchanged in the HDI, but the revenue indicator has improved. These important changes have armed this HDI with a more solid methodological base. With an average per capita revenue of 3,310 dollars (PPP), Morocco finds itself in the revenue segment that has undergone the most significant revision of the standardized value. In effect, although it is not found among the principal Arab countries which have successfully reduced deficits in terms of human development during the last two decades, Morocco has, however, successfully reduced them by 27%. The progress made by this country in terms of human development in the last decade can be seen in the struggle against poverty and is reinforced and consolidated by the commitment of the Head of State for the purpose of improving the living conditions of the poor. The struggle against poverty constitutes the fundamental goal of the UNDP, around which are centered most of the programs and projects whose implementation should contribute to promoting the necessary environment for poverty reduction and consequently, to improved human development. The strategy chosen for the UNDP's intervention is broken into two parts: one is to support strategies and policies in the struggle against poverty, and the other lies in local initiatives for validating these same policies. It targets the socio-geographic aspect of action, on the one hand, benefiting the most vulnerable social groups such as women, children, and girls in the poorest areas, and on the other hand, is directed at those geographic areas that are the most ill-favored in the rural world as well as urban outskirts. The process of integrating Morocco into a free trade zone with the European Union has required the implementation of reforms at the legal and institutional level to manage ever stiffer competition in the world market.
[UN assistance in reinforcing African capacities in the area of human rights: the case of legislative reform and support for judicial power] L'Assistance de l'ONU pour le renforcement des capacités africaines dans le domaine des droits de l'homme: cas de la réforme législative et de l'appui au pouvoir judiciaire.
In: La protection des droits de l'Homme entre la législation interne et le droit international. Actes du colloque organisé par le Centre de Recherches sur la Coopération Internationale pour le Développement de la Faculté de Droit de Marrakech avec le concours de la Fondation Hanns-Seidel, les 21 et 22 janvier 2000. Rabat, Morocco, Revue Marocaine d'Administration Locale et de Developpement, 2001. 11-16. (Thèmes Actuels No. 26)In order to respect the main conventions currently in force, and the African Charter of Human and People Rights, the member countries must submit a report on the way they implement the tools supporting human rights, and on the obstacles they encounter. But for reasons linked to a lack of expertise and/or financial resources, many countries are lead to solicit assistance from foreign countries or international organizations such as the UN. This statement is particularly true for African countries. The assistance is mainly technical and is aimed at reinforcing the capacity of these states, and at integrating the norms pertinent to human rights in their judicial and legislative systems. The action of the UN is based on a normative, institutional and operational system, and for that purpose, African countries benefited from the Technical Cooperation Program (Programme de Coopération Technique). The consultative services program, once established, provides technical aid to help with obtaining grants, training through the organization of regional or national seminars, and the consultative services of experts for constitutional or legislative reforms. This program evolved; on one hand it opened up to embrace other domains; and, on the other hand, it opened technical cooperation offices on the field. As for the reinforcement of judicial power, the UN has proposed several strategies such as: constitutional and legislative reforms to reinforce the independence of the judicial power from other bodies of the State, judicial reforms, rehabilitation of the social status of judges and representatives of the law, and reinforcement of training. Furthermore, the Vienna Action Program, (Programme d'action de Vienne), adopted by the World Human Rights Conference of 1993, highlighted the financing of projects devoted to judicial protection and to the reinforcement of the independence of the judicial system of a few African countries.
Psychologie de l'Éducation. 2000; (3):163-169.This article sheds light on the role of breastfeeding in child development and on the psychological aspects of breastfeeding. Indeed, in addition to bringing to infants the nutrients necessary for their growth, and some elements necessary to the maturity and to the integrity maintenance of several physiologic systems, breastfeeding also brings them affection and love. For the newborn, the first contact with the world is through its mother's skin, and assuming the leading role in this primary function, the breast is associated with the first gestures of love. Between the mother and the child, a double relation takes place: the first is the feeding properly speaking, and the other consists of the ensemble of little gestures of care that accompany breastfeeding. Indeed, the infant feels the need to communicate with its mother and to exchange affection with her; the affection is communicated through the breast and the bottle cannot communicate affection. The changes experienced by the pregnant woman's body include preparation for milk production. This milk is rich in sugars, proteins, lipids, vitamins and minerals. For a proper growth of the newborn, the mother must mobilize her own reserves in order to let them pass into the milk. In line with these ideas, the author of this article mentions several studies that have been conducted on maternal milk versus artificial milk with the intention of encouraging mothers to diversify their diet and sensitizing the pharmaceutical industry to the importance and the quality of the relation to the growth of infants. International health organizations have developed several study programs in various countries in order to draw up an inventory of the problems and to establish recommendations on the benefits. From a medical standpoint it is clear and obvious that breastfed children are less likely to contract infectious and digestive diseases in comparison to those fed with artificial milk. This fact is explained by the bacteriological purity of maternal milk. In addition it contains antibodies, immune cells, and bacteriostatic molecules inhibiting bacterial proliferation, while bottles prepared even with the greatest care are not able to prevent some infections. Consequently, WHO and UNICEF recommend breastfeeding children until they are at least two years old, given that the immune system does not reach full maturity before age five. And, in fact, the Koran recommended the same thing, long before them.
[Toward a new international penal law: some general reflections at the end of the century] Vers un nouveau droit international pénal: quelques réflexions générales à la fin du siècle.
In: La protection des droits de l'Homme entre la législation interne et le droit international. Actes du colloque organisé par le Centre de Recherches sur la Coopération Internationale pour le Développement de la Faculté de Droit de Marrakech avec le concours de la Fondation Hanns-Seidel, les 21 et 22 janvier 2000. Rabat, Morocco, Revue Marocaine d'Administration Locale et de Developpement, 2001. 33-56. (Thèmes Actuels No. 26)In classic international law, since the individual is separated from the international sphere by the legal fiction of the State, while international law at the dawn of the twenty-first century no longer governs only co-existence among States or the pursuit of their common goals, but also collective interests proper to the international community as a whole, the protection of human rights today is no longer part of the domain reserved to States. At the present time, we find that the individual is the subject of rights and the State is the subject of new duty, namely the respect of human rights. It is possible to identify, through the practice of diplomacy and international jurisprudence, a few general rules, divided into those relating to substance and those relating to procedure. Among the rules relating to substance, it is possible to identify the principles of sovereignty and cooperation, the elementary rules of humaneness and the rule of individual criminal liability. In the area of international sanction mechanisms in international law, the first image we see is that of the courts of Nuremberg and Tokyo. The classic approach to the sanctioning of individuals has really changed only since the end of the 1980's. These sanctions had long been in the hands of the State. In all cases, at least on the normative level, they left in their hands the obligation to obey and to enforce international criminal law, which at the present time is conveyed, among other ways, through the action of international tribunals, bilateral cooperation through international criminal judiciary assistance and multilateral cooperation. Several humanitarian tragedies, such as those in the former Yugoslavia, Iraq and Rwanda, have called into question the effectiveness of these new enforcement and sanction procedures; however the participation of public opinion and non-governmental organizations (NGO's), the political and judicial action of the United Nations have reinforced it.
[Family Planning and Maternal and Child Health Project in Morocco. Phase V. Consultation report. Childhood illness in Morocco: practical representations and therapy] Projet de Planification Familiale et Sante Maternelle et Infantile au Maroc. Phase V. Rapport de consultation. Les maladies de l'enfant au Maroc: representations pratiques et recours therapeutiques.
Rabat, Morocco, John Snow [JSI], 1999 Dec 3. 49 p. (USAID Contract No. 608-C-00-94-00006)Findings are presented from a field study conducted to explore the sociocultural context related to the possibility of implementing the Integrated Management of Childhood Illnesses approach in Morocco. The author reviews local terminology used to describe infant morbidity in Meknes and Agadir regions, routinely employed therapies, the relatively greater dependence upon biomedical therapeutic approaches, factors inducing child caregivers to seek biomedical practitioner assistance for therapy, and the functioning of the biomedical care system, with particular note of nurses' generally negative attitudes toward patients.
[Family Planning and Maternal and Child Health Project. Phase V. Consultation report. Pilot phase: April 1998 - July 2000. Community component of the integrated management of childhood illness strategy] Projet de Planification Familiale et Sante Maternelle et Infantile. Phase V. Rapport de consultation. Phase pilote: avril 1998 - juillet 2000. La composante communautaire de la strategie de la prise en charge integree des maladies de l'enfant.
Rabat, Morocco, John Snow [JSI], 2000 Aug 3. 36 p. (USAID Contract No. 608-C-00-94-00006)This paper explores the community and familial practices improvement aspect of the WHO/UNICEF Integrated Management of Childhood Illnesses Strategy. Sections explore the key prerequisite steps to implementing the community approach; examine the Community Assessment and Planning (CAP) concept and methodology, as well as their suitability to the Moroccan context; and explore the feasibility of expanding the strategy to the national level, including healthcare personnel training methodology.