Outbreak investigation around extensive environmental contamination in an artisanal area of Morocco: a teaching case-study
Asmae Khattabi, Alj Loubna, Hanan Chaoui, Meski Fatima Zahra, Sanae Achour, Youef Khader, Malak A Shaheen
Corresponding author: Asmae Khattabi, Ecole Nationale de Santé Publique, Rabat, Morocco Field Epidemiology Training Program, Morocco 
Received: 04 Mar 2019 - Accepted: 09 Mar 2019 - Published: 14 May 2019
Domain: Epidemiology
Keywords: Outbreak, lead, Morocco
This article is published as part of the supplement Case Studies for Public Health in the Eastern Mediterranean Region - 2019, commissioned by Yousef S Khader (yskhader@just.edu.jo).
©Asmae Khattabi et al. Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cite this article: Asmae Khattabi et al. Outbreak investigation around extensive environmental contamination in an artisanal area of Morocco: a teaching case-study. Pan African Medical Journal. 2019;33(1):3. [doi: 10.11604/pamj.supp.2019.33.1.18612]
Available online at: https://www.panafrican-med-journal.com/content/series/33/1/3/full
Supplement 
Outbreak investigation around extensive environmental contamination in an artisanal area of Morocco: a teaching case-study
Outbreak investigation around extensive environmental contamination in an artisanal area of Morocco: a teaching case-study
Asmae Khattabi1,2,&, Alj Loubna1,2, Hanan Chaoui3, Meski Fatima Zahra1,2, Sanae Achour4, Yousef Khader5, Malak A Shaheen6
1Ecole Nationale de Santé Publique, Rabat, Morocco, 2Morocco Field Epidemiology Training Program, Morocco, 3Centre Anti Poison et de Pharmacovigilance du Maroc, Maroc, 4Laboratory of Medical Analysis, Toxicology Unit, Faculty of Medicine, University Hospital of Fez and Medical Centre of Biomedical and Translational Research, University Sidi Mohamed Ben Abdellah (USMBA), Fez, Morocco, 5Jordan University of Science and Technology, 6Ain Shams University, Cairo, Egypt
&Corresponding author
Asmae Khattabi, Ecole Nationale de Santé Publique, Rabat, Morocco Field Epidemiology Training Program, Morocco
Environmental lead exposure has a proven risk to human health, especially for children. It causes a nervous system effects with irreversible consequences which generate important and entirely avoidable health expenses. This chronic exposure poses problems in clinical diagnosis, identifying sources of contamination, and detection at the laboratory level because of the lack of awareness and training of health professionals. This case study simulates an outbreak investigation including laboratory confirmation, active case finding, etiological study and implementation of control measures. After completing this case study, the participant will be competent to apply epidemiological principles to respond to the outbreaks as they occurred and suggest steps toward development of policy recommendations based on the context of environmental lead exposure. This case study is designed for the training of basic level field epidemiology trainees or any other health care workers working in public health-related fields. It can be administered in 3-4 hours. Used as adjunct training material, the case study provides the trainees with competencies in investigating an outbreak in preparation for the actual real-life experience of such outbreak Investigation around extensive lead environmental contamination.
General instructions: this case study should be used as adjunct training material for novice epidemiology trainees to reinforce the concepts taught in prior lectures. The case study is ideally taught by a facilitator in groups of about 20 participants. Participants are to take turns reading the case study, usually a paragraph per student. The facilitator guides the discussion on possible responses to questions. The facilitator may make use of flip charts to illustrate certain points. Additional instructor’s notes for facilitation are coupled with each question in the instructor’s guide to aid facilitation.
Audience: this case study was developed for novice field epidemiology students. These participants are commonly health care workers working in the county departments of health whose background may be as medical doctors, nurses, environmental health officers or laboratory scientists who work in public health-related fields. Most have a health science or biology background.
Prerequisites: before using this case study, participants should have received lectures on disease surveillance and outbreak investigation.
Materials needed: Flash drive, flip charts, markers, computers with MS Excel
Level of training and associated public health activity: Novice – Outbreak Investigation around extensive environmental lead contamination in an artisanal place of Morocco
Time required: 3-4 hours
Language: English
- Download the case study student guide
- Request the case study facilitator guide
The authors declare no competing interests.
Authors would like to acknowledge The Eastern Mediterranean Public Health Network (EMPHNET) for their technical support. We wish to acknowledge residents of the field epidemiology training program who conducted the outbreak investigation on which this case study is based. We also wish to appreciate the contributions of the representative of the Health Delegation, the animator of the Provincial Cell of Epidemiology, the Toxicology laboratories of National Institute of Hygiene (INH), Ministry of Environment and Morocco Poison Control Centre.
Annex 1: Lead Cohort Data
- World Health Organization. Exposure to lead: a major public health concern. WHO, Geneva, Switzerland. 2010. Accessed on 04 March 2019.
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