Cartography of Suicide-Related Health Indicators and Suicide Attempts in Morocco
European Scientific Journal May 2018 edition Vol.14
Cartography of Suicide-Related Health Indicators and Suicide Attempts in Morocco
Latifa Amiar Faculty of Science 0
Technology of Tangier 0
0 Poison Control and Pharmacovigilance Center of Morocco , Lamfedel Cherkaoui Street , Rabat Instituts Rabat (Morocco) Faculty of Medicine and Pharmacy, Mohammed V University , Av Mohamed Belarbi El Alaoui , Rabat Institutes, Rabat (Morocco) Faical El Hattimy Hinde Hami Laboratory of Genetics and Biometry, Project: PPR-B-Mokhtari-FS-UIT Kenitra.Faculty of Sciences, University Ibn Tofail, Kenitra (Morocco) Ahmed Aarab Faculty of Science and Technology of Tangier, Abdelmalek Essaadi University Abderrazak Khadmaoui Abdelmajid Soulaymani Laboratory of Genetics and Biometry, Project: PPR-B-Mokhtari-FS-UIT Kenitra.Faculty of Sciences, University Ibn Tofail , Kenitra , Morocco
The present work consists of a retrospective study of suicidal intoxication during a period stretching from January 1980 to December 2013, reported to the Poison Control and Pharmaco-vigilance Center of Morocco through two systems of data collection: Toxicological Information and Toxico-vigilance. The objective is to determine the spatio-temporal evolution of the incidence, lethality and mortality related to suicides and suicide attempts through intoxication in Morocco. During the study period, the average annual number of suicidal intoxications was 707 cases. All regions of Morocco have been affected but at variable rates. The average age of the victims is 24.39 ± 0.08 years, with a sex ratio of 2.41 in favor of the female sex. In the space of 34 years, the incidence is 2.4 per 100,000 inhabitants, the mortality is 0.67 per million inhabitants and the lethality is 0.08%. The annual increase in
biological indicators makes suicides and suicide attempts a public health
problem, through hospital care and the resulting socio-economic and
psychological consequences. This problem seems much more common in
urban areas and particularly in the big cities of Morocco.
Recently, the Geographic Information System (GIS) is increasingly
applied in epidemiology. This system is an excellent way to visualize, manage
and analyze epidemiological surveillance data, highlighting trends,
interrelationships and interrelationships that remain much more difficult to
demonstrate in other ways. However, suicides and suicide attempts have
particularly serious consequences for the deliberately intoxicated patient, his
family and his entourage. In recent years, morocco has experienced an
exponential increase in suicides, although there is no national suicide registry
. this is probably attributed to the evolution of our society, the
increase of stress, the distress and socio-economic conditions more and more
unfavorable, unemployment, rape and sexual abuse ... etc. It is therefore
essential to monitor the spatio-temporal evolution of this behavior, in order to
establish an adequate and specific control strategy.
Since 1980, the declaration of all cases of intoxication in Morocco has
become mandatory following Ministerial Circular No. 19 829DR / BF / MM.
(1980), the MAPPC became the public utility institution mandated by the
Ministry of Health responsible for the management of poisoning at the
individual and collective level in morocco, it ensures a function of vigilance
and health alert.
The present work therefore aims to evaluate health indicators related
to the epidemiology of suicidal intoxication in Morocco during the period
from 1980 to 2013, with a view to reducing the morbidity and mortality that
results, in the various administrative regions of Morocco.
Patients and methods
The system of sanitary vigilance undertaken by the Moroccan
AntiPoison and Pharmacovigilance Center (MAPPC) is based on the collection,
management, analysis and interpretation of declarations of poisoning cases.
This system relies on the systematic and centralized collection of data from
the victims' files declared to the MAPPC by mail received from the various
medical delegations throughout the Moroccan territory (toxicovigilance
system) and a system based on the medical records completed by the doctor
on call for every call to the Toxicological Information of MAPPC
(Toxicological Information). This system is used to deliver toxicology
information 24 hours a day, 7 days a week (telephone response). Each
statement is the subject of a creation of a medical file in which are designated
all the information relating to the call, the source, the patient, the suspected
toxic and intoxication.
Records and medical records undergo treatment in three important
The preliminary analysis (sorting, numbering, classification and
coding according to the thesaurus adopted by the MAPPC).
data entry on a computer medium allowing the development of a
Secure archiving of data to establish action plans that can reduce
morbidity and mortality.
This information is part of the epidemiological investigation and will
be helpful in understanding the problem in order to design an action plan and
establish a control strategy. The temporal and spatial analysis of the incidence,
lethality and mortality of suicide-related intoxications and suicides is carried
out by analyzing the data collected. These different basic indicators are :
The population used is based on the 2004 census, overhead projections
and population projections, and the 2009-2010 National Population
Demographic Survey prepared by the Office of the High Commissioner for
Planning of Morocco (Haut-Commissariat au Plan du Maroc, 2009)
The manipulation, the processing of geographic data and the
production of thematic maps of the distribution of incidence, lethality and
global mortality were carried out thanks to the Geographical Information
Results and discussion
The demographic explosion, in several regions of Morocco, the
important evolution of the behavior "stress", the difficult conditions of the
current life and the social injustice, represent major risk factors to the
voluntary suicidal intoxications.
The figure below shows the temporal evolution of suicides according
to the years of the studied period. the results of this analysis show that the
tendency to report suicide attempts is increasing, with a coefficient of
determination of 0.80. however, the maximum values are displayed during the
years 2003, 2012 and 2013, with a frequency that exceeds 1400 declarations.
Gharb-Chrarda-Beni Hssen 290
Grand Casablanca 1753
Guelmim-Es Semara 95
Laayoune-Boujdour-Sakia El Hamra 66
Marrakech-Tensift-Al Haouz 1166
Oued Ed-Dahab-Lagouira 3
Taza-Al Hoceima Taounate 148
The following table shows the distribution of suicide attempts by
region during the study period. In addition, 8782 suicide attempts are recorded
during this period. The maximum number of declarations is displayed in the
regions of Greater Casablanca and Rabat Salé Zemmour Zaer, with a
percentage approaching 15%, followed by the Eastern region with a
percentage of 10.5%.
Figure 2 summarizes the distribution of the declarations of the suicide
attempts according to the regions of the kingdom.
Figure 3 represents the geographical distribution of the incidence of
attempted suicide from 1980 to 2013. This analysis shows that the average
incidence of suicide attempts is 80 cases per 100 000 inhabitants. In fact, the
Tadla Azilal and Rabat salé Zemmour Zaer regions occupy the first position
with an incidence of around 150 cases per 100,000 inhabitants. 100,000
inhabitants followed the Eastern region with 131 cases per 100,000
inhabitants. In addition, the Greater Casablanca region is in fourth position
despite the large number of declarations (Figure 3).
Figures 5 and 6 show respectively lethality and mortality by region.
During the 34 years of study, 675 deaths were reported, this corresponds to a
lethality of 2.81% and a mortality of 22.6 deaths per 100 000 inhabitants
(table). However, the Souss Massa Draa region has the highest number of
deaths (92 cases). the maximum of letality is recorded in the region of Taza
Al Hoceima Taounate (6.6%) (Figure 5). About mortality, the Tadla azilal
region had 41 deaths per 100,000 inhabitants, followed by the eastern region
and Rabat Salé Zemmour region with about 35 deaths per 100,000 inhabitants
In Morocco, suicide attempts currently represent a real public health
problem as well as a frequent reason for admission to emergency and medical
(Hami, 2009; Echahbi, 2011 ; Achour, 2011)
, even if they are a
taboo subject, difficult to address and perceived as a shame for the families
affected (Bernard, 2014).
Suicide attempts represent 24.5% of all cases of acute poisoning
collected at the MAPPC except scorpion poisoning
. With an
annual incidence rate of 2.4 cases per 100,000 populations, this rate remains
relatively low compared to another neighboring country, such as France,
which recorded a rate of 17.8 per 100,000 inhabitants in 2002
The geographical distribution of cases of suicide attempts made it
possible to place the regions of Greater Casablanca,
Rabat-Sale-ZemmourZaer and the Eastern region in first position. this situation may be explained
by the high rate of urbanization in these regions. This is consistent with the
results reported by the High Commission to the plan, which confirms that the
number of urban suicide attempts is 7 times higher than in rural areas
. These three regions still occupy the first positions in the incidence of
(Mahir, 2013; Diallo, 2013)
During the study period, suicide attempts resulted in 675 deaths, with
a lethality of about 3%. this lethality is explained by the choice of the manner
of suicide which generally remains self-poisoning. This technique according
to Platt in 1988 is classified as the least frequent (Platt, 1988). the Taza
AlHoceima Taounate region recorded the highest case fatality rate with a
percentage of 7.4%. This can be explained by the low rate of reporting since
the rate of urbanization does not exceed 27% according to the High
Commission for Planning.
Despite the efforts undertaken by the sector, the problem still remains
especially in the urban environment where risk factors are numerous. The
reduction of the suicide rate in Morocco represents a challenge and a record to
beat, but this in collaboration of all the instances.
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