Moroccan Children Research Articles

Effects of Health Policy on Children’s Physical Well-being in Morocco

Several international studies published by the authors and global bodies have highlighted the important role of child health policies in achieving Sustainable Development Goals (SDGs). In this article, we examine the impact of health policy on child well-being in Morocco. To evaluate child health progress, the Millennium Development Goals, indicators, and goals have been adopted. Moroccan children have been the focus of several health strategies, programs, and plans developed by the Ministry of Health within the framework of the five-year and three-year development plans. Other government departments have also developed plans for children and young people. However, these strategies, programs, and plans have been subject to many structural dysfunctions and have therefore not been able to achieve their intended objectives. Accordingly, the findings are consistent with the indicators and determinants of Moroccan children's health, which show that certain aspects of their health have gaps due to inadequate governance. In conclusion, and in view of the results of these strategies, programs, and plans, it appears that Morocco does not yet have a genuine, comprehensive, effective, and efficient child health policy.

Differences in Anxiety and Depression Among Migrant and Non-Migrant Primary School Children in The Netherlands.

This is the first Dutch study investigating symptoms of five DSM-IV-classified anxiety disorders and depression in a large sample of pre-adolescent children with and without a migration background, adjusting for socioeconomic position (SEP) and social preference. Both are potential explanatory factors for differences in mental health among migrant children. We measured anxiety and depression scores with the self-report Revised Child Anxiety and Depression Scale (RCADS) in 2063 children (aged 8-13 years, 55% girls) in the Netherlands. Surinamese/Antillean, Turkish, and Moroccan children reported significantly higher anxiety scores than Dutch children. SEP and peer rejection partly explained higher anxiety scores. Surinamese/Antillean and Turkish children reported comparable depression scores to Dutch children, but Moroccan children reported lower depression scores after adjusting for SEP and peer rejection. Girls reported higher anxiety and depression levels across all four subgroups. Although differences between children with or without a migration background were small, these may increase in later life as the prevalence of anxiety and depression increases with age.

COVID19 AND BREASTFEEDING: WHAT WOMEN SAID WHAT HEALTH WORKERS PRACTICES IN MOROCCO?

Objective: The benefits of early initiation of breastfeeding and exclusive breastfeeding for a period of six months for the newborn are well documented. Despite this scientific evidence, only 35% of Moroccan children are exclusively breastfed at 6 months. The COVID-19 pandemic has seriously impacted the health of women and newborns. The aim of our study isto contribute to the improvement of breastfeeding practices in the context of health crises. Method: We conducted a descriptive cross-sectional study in the prefecture of Meknes between December 2020 and March 2021. Two tools for data collection were used:a questionnaire dedicated to mothers of children aged 0-12 months (breastfeeding and non-breastfeeding) and an online questionnaire distributed to health professionals. Three hundred and eighty-five mothers and 52 health professionals participated in this study. Results: During the covid19 pandemic, 250 (64.9%) of the 385 mothers surveyed reported holding their babies for the first time within one hour of birth. Twenty-seven moms (7%) had Covid-19 either during pregnancy (57.2%), delivery (7.1%) or while breastfeeding (28.6%). Twelve mothers (42.9%) of those with Covid-19 breastfed their babies and took preventive measures during breastfeeding by wearing masks and washing their hands regularly. Five babies (1.3%) had Covid-19. Although the majority of health professionals surveyed agreed that they should promote breastfeeding, only half of them reported discussing about breastfeeding in a Covid-19 context with mothers. Conclusion:Recognizing the benefits of breastfeeding, if the health of the mother and her newborn allows, direct breastfeeding or pumping of breast milk should be encouraged by health care providers and must form the basis of interventions to improve breastfeeding during a health crisis.

The high sensitivity and specificity of rapid urease test in diagnosis of Helicobacter pylori infection in Moroccan children.

Infesting nearly 50% of the world's population, Helicobacter pylori are thought to cause peptic ulcers, as well as gastric adenocarcinoma. Several diagnostic methods are available to detect this bacterium; however, at least two must be used together for an accurate diagnosis. This study evaluated the use of rapid urease test for diagnosis of H. pylori infection in a pediatric population. Five gastric biopsies were taken from children during a 2-year period for the purpose of histological, molecular, bacteriological culture, and rapid urease testing. Among 83 children, 38 were male, and 45 were female with an age ranging of 2 to 15 years. The infected group represented 31%. The rapid urease test had a sensitivity of 88.5%, a negative predictive value of 94%, a specificity of 84.2%, and a positive predictive value of 72%. A rapid urease test may be appropriate for ruling out H. pylori infection after a negative result. The positive results however, may be confirmed by a second invasive test.

Post-vaccine immunity against hepatitis B in Moroccan children

Background: Hepatitis B is a major public health issue worldwide. Immunization of infants against this disease has been effective in Morocco since 1999. However, evaluation of post-vaccination response is rarely performed in our setting. The purpose of this study was to evaluate immunity against HBV in fully vaccinated children in the city of Marrakech in Morocco and to investigate the factors influencing the level of post-vaccination immunity. Methods: A descriptive cross-sectional study was conducted on fully vaccinated children who have medical and vaccination records, from three primary healthcare centers in Marrakech. Children with anti-HBs antibody levels between 10 and 100 IU/L were considered moderately immune, and those with antibody levels above 100 IU/L as highly immune, while those with antibody levels below 10 IU/L were considered non-immune. Results: Of the 123 children recruited, 114 (92.7%) had protective anti-HBs antibody titers, of which 37 (30%) were moderately immunized and 77 (62.7%) were highly immunized, and nine (7.3%) were non-immune. Age, birth weight, vaccine type, and time since the previous dose have all been significantly associated with the degree of post-vaccination immunity. Anti-HBs antibody levels were not significantly related to factors potentially linked to post-vaccination non-response, such as chronic disease, immunosuppressive medication and others. Conclusion: Our findings denote that the HBV vaccine used in The Moroccan Expanded Program on Immunization (EPI) is effective against HBV. Nevertheless, in non-responders, corrective actions such as re-vaccination and monitoring of post-vaccination anti-HBs antibody levels should be implemented.

The type Ic morphology of urinary calculi: an alert to primary hyperoxaluria? Experience with 43 Moroccan children

Primary hyperoxaluria is the most severe stone disease responsible for multiple stone recurrence and impairment of kidney function. It is a rare inherited disease with an autosomal transmission. Due to the high proportion of consanguineous marriages by comparison to other areas in the world, this pathology is more frequent in North Africa. Stones are made of calcium oxalate monohydrate, which is not unique to the disease and cannot help physicians for the diagnosis. By contrast, stone morphology may be a useful marker of the pathology. We report our experience based on 614 stones from Moroccan children analyzed by infrared spectroscopy and examined by stereomicroscopy for the determination of their morphological type. Our results show that 85 stones (13.8%) exhibit a type Ic morphology, strongly suggestive of the disease in children patients. It was confirmed in all subjects of a subgroup of 43 patients who benefited from urinary biochemical explorations revealing whewellite crystalluria and a very high oxalate to creatinine ratio.

P09-04 Sedentary time measured by GT3X+ accelerometry and its variation with grade level and gender among children and adolescents in Morocco

BackgroundSedentary behavior (SB) in children is related to different health outcomes such as overweight and cardio-metabolic diseases. These negative effects have been widely supported by evidence. However, no data on sedentary time (ST) among Moroccan children has been available, yet. Therefore, the present study examined gender and grade differences in objectively measured sedentary behavior in a sample of Moroccan primary school children and adolescents.MethodsIn total, 172 Moroccan children/adolescents aged between 8 to 14 years old (mean age = 10.92 ± 1.55 years; 49.4% were boys) completed the survey. School grade, gender, height, and weight were collected by questionnaires and ST objectively measured using a tri-axial accelerometer (GTX3+). Study required at least 3 valid weekdays and 1 weekend day with? 600 min/day total wear time. Two-way analysis of covariance and logistic regression analyses, adjusted for BMI z-score and accelerometer wear time, were used to examine gender and grade differences in ST.ResultsMean time spent in SB was 535.93 ± 87.15 min/day or ∼ 62.94% of the average daily accelerometer wear time of 851.45 ±51.35.min/day with statistical differences between weekend and week days (471.357 ± 127.73 minutes/day vs. 559.7661± 90.75 minutes/day; p > 0.001). Adolescents (11-14y) were more involved in sitting tasks when compared to the early grades (8-10y). 550.011±88.827 vs. 521.845±83.602 respectively; p > 0.001.ConclusionST increases between ages 11 and 14 years. On week days children and adolescents spent sitting longer than at weekends. Girls and adolescents were identified as potential risk groups. This report on ST presents valuable information for designing and implementing interventions to decrease time spent in SB among children during class time. Acknowledgements This study was performed with the support of the International Atomic Energy Agency (CRP E4.30.24; RAF 6042).

Hair Trace Elements and Mineral Content in Moroccan Children with Autism Spectrum Disorder: a Case-Control Study.

The prevalence of autism spectrum disorder (ASD) around the world continues to increase while the pathophysiology remains insufficiently elucidated. Genetics, environment, and epigenetic changes are often implicated. Abnormal level in trace elements and minerals is among environmental factors assumed to be involved. The purpose of this article is to assess hair concentrations of toxic and essential elements in children with ASD and children with neurotypical development in the city of Marrakech. Two hundred and twenty-seven children (107 with ASD and 120 controls) aged 3 to 14years old were recruited. The results of analysis by ICP-MS showed a significant decrease in hair levels of copper, zinc, iron, and selenium (25%, 13%, 17%, 11%) of children with ASD. The most significantly reduced concentrations in children with ASD are that of manganese by 34%. Hair aluminum level was significantly elevated by 29% in ASD compared to controls. Multiple linear regression analysis revealed that copper, selenium, and iron content in hair were significantly inversely associated with ASD, similarly, hair aluminum content was significantly associated with ASD. Adjusted model for demographic parameters increased the predictive ability of the model, father's age was a significant predictor. In addition, ASD and gender were significant predictors of hair levels of aluminum, selenium, and manganese.These results support the hypothesis of the disparity of trace elements and minerals levels in children with ASD and highlight the potential interest of micronutrient supplementation in the eventual improvement of ASD symptoms. Future research should explore the pathophysiology of these micronutrient deficiencies.

Early Adiposity Rebond in Moroccan Children: Prevalence and Determinants

Background: Childhood obesity is a real public health problem Q, Its incidence is rapidly increasing in developing countries. According to the literature review, early rebound fat is associated with obesity and non-communicable diseases, our objective is therefore to determine the risk factors for early rebound fat in a population of Moroccan children. Material and methods: This retrospective epidemiological study lasted 12 months in 2018. The study involved 200 mother-child couples seen for consultation in an urban health centre at Salé city. Data were collected from a survey on the living conditions of the first 1000 days of life of the children studied and completed by anthropometric measurements, as well as information from mothers and children health books. Results: The average age of the children is 42.3±18.9 months with a sex ratio towards females (46% male versus 54% female). In terms of the internal reliability of the survey, the value of the calculated Cronbach index is acceptable (α = 0.7). We have established that mothers who have practiced artificial breastfeeding or gave birth by cesarean and nursing mothers who took oral contraceptives are of a higher-risk of having a child with an early adiposity rebond compared to other categories, with an odds-ration respectively [Odds-Ratio = 4; IC 95% [2,15-7,45]; P-value = 0,000]; [Odds-Ratio =4. 7; 95% CI [2.46-9.08]; P-value=0.000] and ERA [Odds-Ratio =2.3; 95% CI [1.46-4.34]; P-value=0.000]. Conclusion: Early rebound of adiposity is apredictor of obesity with a whole range of possible cardiovascular and metabolic complications.

Association of TP53 gene polymorphisms with the risk of acute lymphoblastic leukemia in Moroccan children.

TP53 gene plays a pivotal role in maintaining genetic stability and prevention of malignancies. Alterations of this gene are implicated in more than half of human cancers. To the best of our knowledge, this study is the first to explore TP53 polymorphisms in Moroccan childhood acute lymphoblastic leukemia (ALL). DNA samples of 45 ALL children were obtained from peripheral blood. A total of 333 healthy Moroccans were used as controls. Polymerase chain reaction and Sanger sequencing were performed to analyze TP53 hotspot exons in cases. We identified a significant protective effect of the TP53-Arg variant at rs1042522 [OR 0.4593 (0.249-0.8472), p = 0.0127] and the Pro/Arg genotype [OR 0.0350 (0.0047-0.2583), p = 0.0010]. Additionally, we found a novel association between the C-allele of Arg213Arg 1800372 [OR 2.7736 (1.3821-5.5664), p = 0.0041] and the risk of childhood ALL. Importantly, TC/CC genotypes of this polymorphism were revealed to enhance the risk of ALL among females [OR 9.0 (3.1555-25.6693), p < 0.0001]. Arg213Arg was also noticed to be associated with the hemoglobin count of patients at diagnosis by linear regression (p = 0.0318). The analysis of penetrance showed a significant association of the CG/GG genotypes at rs1042522 and TC/CC genotypes at rs1800372 to childhood ALL via dominant model [OR 0.2090 (0.09074-0.4814), p = 0.0002 and OR 3.4205 (1.6084-7.2742), p = 0.0014 for rs1042522 and rs1800372 respectively]. No association was found between TP53 polymorphisms and patients survival. Altogether, our findings indicated that TP53 polymorphisms are significantly involved in the genetic susceptibility to childhood ALL in Morocco.

Epidemiology, clinical features, and mortality rate of Wilson disease in Moroccan children: A pediatric case series

Background and study aimsWilsonʼs disease is an autosomal recessive disorder, that affects copper metabolism, leading to copper accumulation in the liver, nervous system, and cornea. Data are lacking on the epidemiology, the clinical and laboratory characteristics, treatment, and survival of Wilsonʼs disease in Morocco. The aim of this study was to examine these features and the cause of death in a Moroccan pediatric population. Patients and methodsThe study was carried out at the University Hospital Center of Marrakesh, Morocco; 46 children were diagnosed with Wilsonʼs disease from 2008 to 2019. The diagnosis was based on low serum ceruloplasmin, increased urinary copper concentrations, the presence of Kayser–Fleischer rings, a family history of Wilsonʼs disease, and a Leipzig score of ≥ 4. ResultsA total of 42 patients were referred to the center for hepatic or neurological manifestations; four patients were asymptomatic. Consanguineous marriage was found in 67.4% of the cases. The mean duration of illness (42 patients) was 4.9 ± 3.9 years. Kayser–Fleischer rings were found in 60.9% of 46 patients. Of the 42 symptomatic patients: 28 of 30 (93.3%) patients had low serum ceruloplasmin (<0.2 g/L), and 24 h urinary copper >100 μg/day was found in 34 of 35 (97.1%) cases. The treatment was established with D-penicillamine for 43 of the 46 patients, with zinc acetate for one patient and with zinc sulfate in for one patient, while one patient was not treated. D-penicillamine was discontinued in nine patients because of adverse effects such as thrombocytopenia, neurological deterioration, pancytopenia, severe vomiting and severe hypersensitivity. In total 28 patients were clinically and biologically stabilized, two patients experienced vision loss, and 16 patients died (38%). The main cause of death was diagnosis made at an advanced stage of disease and stopping treatment. ConclusionWilsonʼs disease is a rare condition associated with treatement efficacy, but late diagnosis and stopping treatment can lead to a high mortality rate.

Development of inhibition and working memory in school-age Moroccan children

ABSTRACT Studies regarding executive functions (EFs) in children rarely focus on populations of North Africa countries. In this context, this research aimed to adapt EFs tests to the Moroccan context and provide preliminary normative data on the development of inhibitory control and working memory (WM). In addition, the executive performance of school-age Moroccan children was examined, as well as the effects of gender, parents’ education level and multilingualism. The sample included 115 children at age 7 to 12 from Fes city. Results showed that the translation and adaptation steps were sufficient for the cross-cultural adaptation of the tasks. In addition, an overall effect of age on inhibition and WM performances was found, whereas gender and parents’ education level showed non-significant effects. Multilingualism effects had a partial positive influence on EFs, with improved scores on a few executive tasks for multilingual children compared to their bilingual peers. Overall, results suggest that EFs in school-age Moroccan children operate on relatively homogeneous development trajectories, marked by improvements that differ according to tasks. As neuropsychological tools and normative data are still lacking in Morocco, this study helps better understand EFs development of children in this country.

Paediatric osteoarticular infections caused by staphylococcus aureus producing panton-valentine leucocidin in morocco: Risk factors and clinical features.

Objective:We aimed to estimate the prevalence of Staphylococcus aureus producing Panton–Valentine leucocidin (PVL) isolated from children diagnosed with osteoarticular infections (OAIs), and to examine risk factors and clinical features.Methods:This prospective study was conducted from January 2017 to December 2018. All hospitalised children diagnosed with S. aureus OAI are included. Blood cultures, articular fluids, synovial tissues and/or bone fragments were collected for bacteriological culture. Antimicrobial susceptibility tests were determined by disk diffusion method. Genes encoding methicillin resistance (mecA) and PVL virulence factors (luk-S-PV and luk-F-PV) were detected by multiplex polymerase chain reaction. The demographic, clinical, laboratory, radiographic and clinical features were reviewed prospectively from medical records.Results:A total of 37 children with S. aureus OAIs were included, 46% of them have PVL-positive infection and 70.6% were male. The mean age was 8.12 years (±4.57), and almost were from rural settings (76.5%). Children with Staphylococcus aureus producing Panton–Valentine leucocidin (SA-PVL) were significantly associated with type of infection (P = 0.005), location of infection (P = 0.037) and abnormal X-ray (P = 0.029). All strains SA-PVL+ are sensitive to methicillin, but one strain SA-PVL negative was methicillin-resistant S. aureus, confirmed by gene mecA positive.Conclusion:The prevalence of S. aureus infections producing PVL toxin was high in OAIs amongst Moroccan children, mainly due to methicillin-susceptible S. aureus. Type and location of infections and abnormal X-ray were significantly associated with SA-PVL. Routine diagnostic testing of PVL-SA, continuous epidemiological surveillance and multidisciplinary management of OAI is essential to prevent serious complications.

Psychological Effects Caused by COVID-19 on Moroccan Children

Coronavirus disease 2019 is declared as a Public Health Emergency of International Concern by the World Health Organization. On March 22, 2020, the Moroccan government declared a health emergency and also confinement. This study aimed to clarify the adverse effects of confinement on children and to analyze the factors influencing these effects. Our study concerns 495 families with 973 children specifying their activities during confinement, we find that 35% of children spend more than 3 hours on the TV, 29% engaged with their smartphones and 14% playing video games. 76% also had the opportunity to be involved in distance learning. Among consequences of home confinement, there is an increase in behavioral problems from 14% to 31% at the end of the 2nd week of confinement. Overall 77% experienced difficulties such as emotional disturbance, behavioral problems as well as sleep and eating disturbance. The under 6 aged children appeared to be more vulnerable to confinement. 75% of parents, however, noted that confinement also afforded the opportunity to improve relationship with their children. This is an important study that contributes to discussion and further studies on adverse effects of home confinement for children during epidemics. This should lead to further identification of activities that may lead to minimizing the adverse consequences of the experience. Examples might be family outings into places that do not involve meeting other people with close contacts. Distance learning might also be enriched with virtual meetings and discussions of schoolmates that may also involve teachers and parents.

Comparison of genovars and Chlamydia trachomatis infection loads in ocular samples from children in two distinct cohorts in Sudan and Morocco.

Trachoma is a blinding disease caused by repeated conjunctival infection with different Chlamydia trachomatis (Ct) genovars. Ct B genovars have been associated with more severe trachoma symptoms. Here, we investigated associations between Ct genovars and bacterial loads in ocular samples from two distinct geographical locations in Africa, which are currently unclear. We tested ocular swabs from 77 Moroccan children (28 with trachomatous inflammation-follicular (TF) and 49 healthy controls), and 96 Sudanese children (54 with TF and 42 healthy controls) with a Ct-specific real-time polymerase chain reaction (PCR) assay. To estimate bacterial loads, Ct-positive samples were further processed by multiplex real-time qPCR to amplify the chromosomal outer membrane complex B and plasmid open reading frame 2 of Ct. Genotyping was performed by PCR-based amplification of the outer membrane protein A gene (~1120 base pairs) of Ct and Sanger sequencing. Ct-positivities among the Moroccan and Sudanese patient groups were 60·7% and 31·5%, respectively. Significantly more Sudanese patients than Moroccan patients were genovar A-positive. In contrast, B genovars were significantly more prevalent in Moroccan patients than in Sudanese patients. Significantly higher Ct loads were found in samples positive for B genovars (598596) than A genovar (51005). Geographical differences contributed to the distributions of different ocular Ct genovars. B genovars may induce a higher bacterial load than A genovars in trachoma patients. Our findings emphasize the importance of conducting broader studies to elucidate if the noted difference in multiplication abilities are genovar and/or endemicity level dependent.

First report of Kingella kingae diagnosed in pediatric bone and joint infections in Morocco

BackgroundThe progress of diagnostic strategies and molecular methods improved the detection of Kingella kingae in bone and joint infections, and now, Kingella kingae is being increasingly recognized as the most frequent cause of bone and joint infection BJI in early childhood. The main objective of this prospective study is to report the frequency of Kingella Kingae in negative culture bone and joint pediatric infections, and to describe the clinical and biologic features of these children.MethodsFrom December 2016 to June 2019, we selected all hospitalized patients with suspected BJI. When culture was negative on the fifth day, children under 10 years were subsequently included in the study, and PCR assay was performed systematically for researching K. kingae specific gene cpn60. Microbial culture and identification were made using standard bacteriological methods. The demographics, clinical, laboratory, radiographic and clinical features were reviewed from medical records.ResultsWe enrolled 65 children with culture negative BJI, 46 of them having under 10 years old have been screened for the cpn60 gene. Thus, the gene encoding Kingella kingae was positive for 27 BJI cases (58.7%). The mean age of children was 3.02 years, 55.6% were aged 6 months-4 years and 29.6% of them were aged 5–10 years. The male to female ratio was 1.7 and 16 cases (59.26%) occurred during the fall-winter period. The most frequent BJI type was septic arthritis (77.8%) and the most affected sites were knee (51.9%) and hip (37.0%). We recorded a mild clinical picture with normal to mildly raised inflammatory markers. All patients had good clinical and functional outcomes, with no serious orthopedic sequelae..ConclusionK kingae is an important pathogen of culture-negative BJI in Moroccan children. PCR testing should be performed in culture-negative cases of children not only in the typical age range of 6 months to 4 years. When implemented in the routine clinical microbiology laboratory, a specific K. kingae PCR assay can provide a better diagnostic performance of BJI.

The Place of Group A Streptococci in Moroccan Children with Pharyngitis and Emm Type Distribution

Background: Streptococcus pyogenes is responsible for a wide variety of diseases, including noninvasive and severe invasive infections. The emm gene encodes the M protein that is the virulence factor and immunological determinant of group A streptococci. Emm typing is the group A Streptococci (GAS) standard molecular typing method based on the amplification of the N terminal hypervariable region of the emm gene. Objectives: The aim of the present study was to determine the prevalence of GAS in children with pharyngitis and determine different types of emm gene in the GAS isolates using emm typing. Methods: The study was carried out over a period of 14 months (from February 2017 to March 2018). Throat samples were collected from cases aged ≤ 18 years with pharyngitis referring to a primary health care center in Fez, Morocco. GAS isolates were subjected to conventional tests to confirm species identification. Antimicrobial susceptibility testing was performed using the standard disk diffusion method. We researched emm gene by a polymerase chain reaction (PCR). Emm types were determined by a sequence-based protocol. Demographic and clinical data were recorded from each patient. Results: From a total of 177 throat samples, 11 isolates (6.2%) were identified as GAS in children with pharyngitis. Antibiotic sensitivity testing revealed that all the GAS isolates were sensitive to penicillin. The sequencing of the PCR products of the emm gene revealed that emm90 was the most obtained emm type (30,77%); while emm75 was the least type observed (7.7%). Conclusions: The emm90 is the most prevalent type detected from patients with tonsillitis. Penicillin and erythromycin are still the foremost effective antibiotics to treat GAS pharyngitis.

Child In 2020: Reduced Physical Activity What Are the Repercussions?

Objective: to describe physical activity and assess the occurrence of inappropriate behaviors in Moroccan children during the confinement period.

Quality of life of Moroccan children with celiac disease: Arabic translation and validation of a specific celiac disease instrument

PurposeGluten-free diet (GFD) is a lonely lifelong management for patients with celiac disease (CD), which may affect their quality of life (QoL). This can be evaluated by generic or specific instruments. We aimed to translate, validate and cross-culturally adapt a specific-CD instrument to Moroccan-Arabic version (M-CD-DUX), and then apply it to evaluate the QoL of Moroccan celiac children. Design and methodsCD-DUX instrument was translated and culturally adapted, and preliminarily evaluated on 15 children and their proxies. The reproducibility and internal consistency of M-CD-DUX were measured by intra-class coefficient (ICC) and Cronbach α tests respectively. The statistical analysis of data consisted was conducted using SPSS, and the Goodness-of-Fit test was measured by SPSS AMOS. ResultsThe reliability of M-CD-DUX instrument showed a good internal consistency and reproducibility. The psychometric properties of M-CD-DUX were acceptable, and the instrument's Model fit was good [(Root Mean Square Error of Approximation = 0.062; χ2 = 603.08, p < 0.001]. M-CD-DUX was completed by 52 celiac children and their proxies. It showed a worse QoL for all items and subscales, and no difference was observed between the QoL of celiac children already under GFD and those recently diagnosed. ConclusionM-CD-DUX was the first reliable and adapted instrument used to evaluate the QoL of celiac children in an Arab country, emphasizing a negative impact of CD on their QoL. Practice implicationsTherefore, improving their QoL requires to make gluten-free products available to them at an appropriate price as well as a good integration into society.

Age-related changes of cognitive flexibility and planning skills in school-age Moroccan children

North African countries such as Morocco are scarcely the focus of neuropsychological studies, although the role of culture in cognition processes is widely recognized. Currently, studies on flexibility and planning skills in the Moroccan context are still lacking and there are no adapted tools to assess these functions in the country. In this scenario, this study aimed to adapt the Child Executive Functions Battery (CEF-B) tasks and the playing cards task of the Behavioral Assessment of the Dysexecutive Syndrome for Children (BADS-C) to Morocco and provide preliminary normative data on the development of flexibility and planning. In addition, this study proposed to examine the effects of gender, parents’ education level and multilingualism on executive development. To this end, six tasks of the CEF-B were adapted through a translation and back-translation process and administered to 115 children aged 7–12 years. Results showed that the adopted procedure was sufficient for the cross-cultural adaptation of the tasks. Analyses showed a continuous increase with age on executive performance in most of the variables. However, gender and parents' level of education showed mostly non-significant effects. On the other hand, a significant effect of multilingualism was found on the two analyzed functions, with better results for multilingual children if compared to their bilingual peers. In general, results suggest that the identified pattern of development is consistent with international studies. Although normative data on executive functions are still lacking in Morocco, this unprecedented study will help better understand their development in this context.