Ambient Air Quality and Health Impact of Exposure to Outdoor Air Pollution in the Moroccan Population: A Systematic Review

Document Type : Review Paper

Authors

1 Geosciences, Environment and Geomatic Laboratory, Department of Earth Sciences, Faculty of Sciences, Ibn Zohr University, P.O. Box 8106 Dakhla Street, 80000, Agadir, Morocco

2 Moroccan Ministry of Health and Social Protection, High Institute of Nursing Professions and Technical Health, Agadir, Morocco

3 Laboratory of Cell Biology and Molecular Genetics, Department of Biology, Faculty of Sciences, Ibn Zohr University, P.O. Box 8106 Dakhla Street, 80000, Agadir, Morocco

4 Clinical Research and Epidemiology (LBRCE), Department of Public Health, Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco

5 Health Sciences Research Laboratory, National School of Applied Sciences, Ibn Zohr University, Agadir, Morocco

6 Medical Biology, Human and Experimental Pathology and Environment, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco

10.22059/poll.2022.348613.1626

Abstract

Evidence of the health impact of air pollution in Morocco is scarce. We aimed to test our hypothesis that exposure to air pollutants has a significant impact on the health of Moroccans. For this systematic review, we searched PubMed, ScienceDirect, LILACS, and ProQuest databases, Google Scholar, and forward and backward citations for studies published between the database inception and August 16, 2022. All studies and reports that measure air quality in Morocco and its health impact were included, without language restrictions. This study is registered on PROSPERO under number CRD42020163948. Studies were selected based on inclusion and exclusion criteria rather than their methods. The data was extracted, coded, and prepared for future examination. After that, descriptive and thematic analyses were carried out. Of 1230 records identified, 31 were eligible, all of which had annual air pollutant concentrations in excess of WHO Air Quality Guidelines. The health impact was demonstrated in five studies. The most studied pathologies were asthma, respiratory and cardiac infections in children under 12 years and adults. In addition to heavy metals, the most investigated pollutants were PM10, O3, SO2, and NOx. The significant association between exposure to air pollutants and health in the Moroccan population has been demonstrated, even if it is not causal. Future research should quantify the health impact of pollution in other Moroccan cities.

Keywords


Abrouki, Y., Anouzla, A., Azzallou, R., Jioui, I., Kastali, M., Hatib, A., ... and Riadi, Y. (2021). Effects of Environmental Air Pollution on pediatric asthma in Morocco. Green Appl. Chem., 12; 31-39.
Agbo, K. E., Walgraeve, C., Eze, J. I., Ugwoke, P. E., Ukoha, P. O. and Van Langenhove, H. (2021). A review on ambient and indoor air pollution status in Africa. Atmospheric Pollut. Res., 12(2); 243-260.
Ait Bouh, H., Benyaich, F., Bounakhla, M., Noack, Y., Tahri, M. and Zahry, F. (2013). Seasonal variations of the atmospheric particles and its chemical components in Meknes city, Morocco. J. Mater. Environ. Sci., 4(1); 49-62.
Ajdour, A., Leghrib, R., Chaoufi, J., Chirmata, A., Menut, L. and Mailler, S. (2020). Towards air quality modeling in Agadir City (Morocco). Mater. Today Proc., 24; 17-23.
Arfala, Y., Douch, J., Assabbane, A., Kaaouachi, K., Tian, H. and Hamdani, M. (2018). Assessment of heavy metals released into the air from the cement kilns co-burning waste: Case of Oujda cement manufacturing (Northeast Morocco). Sustain. Environ. Res., 28(6); 363-373.
Asif, N., Malik, M. and Chaudhry, F. N. (2018). A Review of on Environmental Pollution Bioindicators. Pollution., 4(1); 111-118.
Ballester, F., Rodriguez, P., Iniguez, C., Saez, M., Daponte, A., Galan, I., ... and Toro, S. (2006). Air pollution and cardiovascular admissions association in Spain: results within the EMECAS project. J. Epidemiol. Community Health., 60(4); 328-336.
Beelen, R., Hoek, G., van Den Brandt, P. A., Goldbohm, R. A., Fischer, P., Schouten, L. J., ... and Brunekreef, B. (2008). Long-Term Effects of Traffic-Related Air Pollution on Mortality in a Dutch Cohort (NLCS-AIR Study). Environ. Health Perspect., 116(2); 196-202.
Bell, M. L., McDermott, A., Zeger, S. L, Samet, J. M. and Dominici, F. (2004). Ozone and Short-term Mortality in 95 US Urban Communities, 1987-2000. JAMA., 292(19); 2372-2378. 
Biggeri, A., Baccini, M., Bellini, P. and Terracini, B. (2005). Meta-analysis of the Italian Studies of Short-term Effects of Air Pollution (MISA), 1990-1999. Int. J. Occup. Environ. Health., 11(1); 107-122.
Bouchriti, Y., Elghazali, O., Kharbach, A., Gougueni, H., Haddou, M. A. and Achbani, A. (2021). Characteristics of Patients with Asthma and Asthma Control: A Retrospective Analysis of Reported Data from Primary Healthcare Centers in Agadir city, Morocco (2013 - 2019). J. Clin. Exp. Investig. 12(2); em00766, 1-7.
Bouchriti, Y., Kababchi, K., Ait Haddou, M., Achbani, A., Amiha, R. and Gougueni, H. (2022). Household Dust from a City in Morocco: Characterization by Scanning Electron Microscopy. Pollution., 8(2); 513-527.
Bouchriti, Y., Kabbachi, B., Achbani, A., Elghazali, O., Kharbach, A. and Ait Haddou, M. (2021). Association between housing characteristics and population health. Ann. Clin. Anal. Med., 12(Suppl 3); 290-295. 
Boularab, I., Elghazi, I., Mouhaddach, O., Kestemont, M.-P. and El Jaafari, S. (2015). Spatial Analysis of Particulate Air Pollution in Meknes City (Morocco). Int. J. Innov. Appl. Stud., 13(4); 781-788.
Bounakhla, M. and Azami, R. (2006). Heavy metals and gas emissions assessment in Safi’s city (Morocco). Recherphos Covaphos II, 4; 252-261.
Brook, R. D., Franklin, B., Cascio, W., Hong, Y., Howard, G., Lipsett, M., ... and Tager, I. (2004). Air Pollution and Cardiovascular Disease: A Statement for Healthcare Professionals from the Expert Panel on Population and Prevention Science of the American Heart Association. Circulation., 109(21); 2655-2671.
Brunekreef, B. and Holgate, S. T. (2002). Air pollution and health. The Lancet.,360(9341); 1233-1242.
Butt, E. W., Rap, A., Schmidt, A., Scott, C. E., Pringle, K. J., Reddington, C. L., ... and Spracklen, D. V.  (2016). The impact of residential combustion emissions on atmospheric aerosol, human health, and climate. Atmospheric Chem. Phys., 16(2); 873-905.
Croitoru, L. and Sarraf, M. (2017). Estimating the Health Cost of Air Pollution: The Case of Morocco. J. Environ. Prot., 08(10); 1087-1099.
Dominski, F. H., Lorenzetti Branco, J. H., Buonanno, G., Stabile, L., Gameiro da Silva, M. and Andrade, A. (2021). Effects of air pollution on health: A mapping review of systematic reviews and meta-analyses. Environ. Res., 201; 111487.
El Morabet, R., Aneflouss, M. and Mouak, S. (2017, November). Air Pollution Effects on Health in Kenitra, Northern Morocco. (Paper presented at the Recent Advances in Environmental Science from the Euro-Mediterranean and Surrounding Regions Advances in Science, Technology & Innovation, Tunisia).
El Morabet, R., El Ouadrhiri, A. A., Khan, R. A., Mouak, S. and Aneflouss, M. (2019, November). Effects of Outdoor Air Pollution on Human Health in Mohammedia, Morocco. (Paper presented at the Recent Advances in Environmental Science from the Euro-Mediterranean and Surrounding Regions (2nd Edition), Tunisia).
El Rhzaoui, G., Divakar, P. K., Crespo, A. and Tahiri, H. (2015). Biomonitoring of air pollutants by using lichens (Evernia prunastri) in areas between Kenitra and Mohammedia cities in Morocco. Lazaroa., 36; 21-30.
El Rhzaoui, G., Divakar, P. K., Crespo, A., Tahiri, H. and El Alaoui-Faris, F. E. (2015). Xanthoria parietina as a biomonitor of airborne heavy metal pollution in forest sites in the North East of Morocco. Lazaroa., 36; 31-41.
Elhaddaj, H., Chkara, L., Rangognio, J., Yahyaoui, A., Hanoune, B. and Maimouni, L. E. (2019). SIRANE modeling of oxides nitrogen (NOx) and ozone (O3) in the area of Agadir city, southwestern Morocco. Moroc. J. Chem., 7(4); 7-672.
Farrow, A., Miller, K.A. and Myllyvirta, L. (2021). Toxic air: The price of fossil fuels. Seoul: Greenpeace Southeast Asia., 1-44. Retrieved September 29, 2021, from https://www.greenpeace.to/greenpeace/wp-content.html.
Gourgue, H., Aharoune, A. and Ihlal, A. (2015). Dispersion of the NOx Emissions from Chimneys Around Industrial Area: Case Study of the Company CIBEL II. Mater. Today Proc., 2(9); 4689-4693.
Gryparis, A., Forsberg, B., Katsouyanni, K., Analitis, A., Touloumi, G., Schwartz, J., ... and DoĢˆrtbudak, Z. (2004). Acute Effects of Ozone on Mortality from the “Air Pollution and Health: A European Approach” Project. Am. J. Respir. Crit. Care Med., 170(10); 1080-1087.
Holstius, D. M., Pillarisetti, A., Smith, K. R. and Seto, E. (2014). Field calibrations of a low-cost aerosol sensor at a regulatory monitoring site in California. Atmospheric Meas. Tech., 7(4);1121-1131.
Houssaini, A. S. S., Messaouri, H., Nasri, I., Roth, M. P., Nejjari, C. and Benchekroun, M. N. (2007). Air pollution as a determinant of asthma among schoolchildren in Mohammedia, Morocco. Int. J. Environ. Health Res. 17(4); 243-257.
Inchaouh, M., Tahiri, M., El Johra, B. and Abboubi, R. (2017). State of ambient air quality in Marrakech city (Morocco) over the period 2009-2012. Int. J. GEOMATE., 12(29) ; 99-106.
Inchaouh, M., Khomsi, K. and Tahiri, Pr. M. (2018). Ambient Air Quality Assessment in the Grand Casablanca Area (Morocco): Impact of Road Traffic Emissions for the 2013-2016 Period. Energy Earth Sci., 1(1); 1-7.
Ito, K., De Leon, S. F. and Lippmann, M. (2005). Associations between Ozone and Daily Mortality: Analysis and Meta-Analysis. Epidemiology., 16(4); 446-457.
Kakosimos, K. E., Hertel, O., Ketzel, M. and Berkowicz, R. (2010). Operational Street Pollution Model (OSPM) - a review of performed application and validation studies, and future prospects. Environ. Chem., 7(6); 485-503.
Kerckhoffs, J., Wang, M., Meliefste, K., Malmqvist, E., Fischer, P., Janssen, N. A., ... and Hoek, G.  (2015). A national fine spatial scale land-use regression model for ozone. Environ. Res., 140; 440-448.
Khatami, A., Ponche, J.-L., Jabry, E. and Mirabel, Ph. (1998). The air quality management of the region of Great Casablanca (Morocco). Part 1: atmospheric emission inventory for the year 1992. Sci. Total Environ., 209(2-3); 201-216.
Khomsi, K., Najmi, H., Amghar, H., Chelhaoui, Y. and Souhaili, Z. (2020a). COVID-19 national lockdown in morocco: Impacts on air quality and public health. One Health., 11; 100200.
Khomsi, K., Najmi, H., Chelhaoui, Y. and Souhaili, Z. (2020b). The Contribution of Large-scale Atmospheric Patterns to PM10 Pollution: The New Saharan Oscillation Index. Aerosol Air Qual. Res., 20(5); 1038-1047.
Klimont, Z., Kupiainen, K., Heyes, C., Purohit, P., Cofala, J., Rafaj, P., ... and Schöpp, W. (2017). Global anthropogenic emissions of particulate matter including black carbon. Atmospheric Chem. Phys., 17(14); 8681-8723.
Knibbs, L. D., Hewson, M. G., Bechle, M. J., Marshall, J. D. and Barnett, A. G. (2014). A national satellite-based land-use regression model for air pollution exposure assessment in Australia. Environ. Res., 135; 204-211.
Kouddane, N., Mouhir, L., Fekhaoui, M., Elabidi, A. and Benaakame, R. (2016). Monitoring air pollution at Mohammedia (Morocco): Pb, Cd and Zn in the blood of pigeons (Columba livia). Ecotoxicology., 25(4); 720-726.
Kumar, A., Dixit, S., Varadarajan, C., Vijayan, A. and Masuraha, A. (2006). Evaluation of the AERMOD dispersion model as a function of atmospheric stability for an urban area. Environ. Prog., 25(2); 141-151.
Landrigan, P. J. (2017). Air pollution and health. Lancet Public Health., 2; e4-e5.
Larrieu, S., Jusot, J. F., Blanchard, M., Prouvost, H., Declercq, C., Fabre, P., ... and Lefranc, A. (2007). Short term effects of air pollution on hospitalizations for cardiovascular diseases in eight French cities: The PSAS program. Sci. Total Environ., 387(1-3); 105-112.
Marais, E. A., Silvern, R. F., Vodonos, A., Dupin, E., Bockarie, A. S., Mickley, L. J., and Schwartz, J. (2019). Air Quality and Health Impact of Future Fossil Fuel Use for Electricity Generation and Transport in Africa. Environ. Sci. Technol., 53(22); 13524-13534.
Martin, M., Tritscher, T., Juranyi, Z., Heringa, M. F., Sierau, B., Weingartner, E., ... and Lohmann, U. (2013). Hygroscopic properties of fresh and aged wood burning particles. J. Aerosol Sci., 56; 15-29.
Nejjari, C., Filleul, L., Zidouni, N., Laid, Y., Atek, M., El Meziane, A., and Tessier, J. F. (2003). Air pollution: a new respiratory risk for cities in low-income countries. Int. J. Tuberc. Lung Dis., 7(3); 223-231.
Nejjari, C., Marfak, A., Rguig, A., Maaroufi, A., El Marouani, I., El Haloui, A., ... and El Achhab, Y. (2021). Ambient air pollution and emergency department visits among children and adults in Casablanca, Morocco. AIMS Public Health., 8(2); 285-302.
Otmani, A., Benchrif, A., Tahri, M., Bounakhla, M., El Bouch, M. and Krombi, M. H. (2020). Impact of Covid-19 lockdown on PM10, SO2 and NO2 concentrations in Salé City (Morocco). Sci. Total Environ., 735; 139541.
Ourzazi, J., Bouhafid, A., Terhzaz, M., Abdellaoui, A., Nollet, V. and Dechaux, J. C. (2003). A descriptive study of atmospheric pollutants measurement in the Marrakech conurbation. Pollut. Atmos., 177; 137-151.
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., ... and Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ., 372(n71); 1-9. 
Pope III, C. A., Burnett, R. T., Thurston, G. D., Thun, M. J., Calle, E. E., Krewski, D., & Godleski, J. J.  (2004). Cardiovascular Mortality and TLong-Term Exposure to Particulate Air Pollution: Epidemiological Evidence of General Pathophysiological Pathways of Disease. Circulation., 109(1); 71-77.
Pope III, C. A., Burnett, R.T., Thun, M.J., Calle, E.E., Krewski, D., Ito, K. and Thurston, G.D. (2002). Lung Cancer, Cardiopulmonary Mortality, and Long-term Exposure to Fine Particulate Air Pollution. JAMA., 287(9); 1132-1141.
Rida, J., Moubachir, H. and Bouchriti, Y. (2021). Asthma in Morocco: Retrospective Analysis of Case Characteristics reported by Hospital Units. J. Med. Health Stud., 2(2); 124-129. 
Righi, S., Lucialli, P., and Pollini, E. (2009). Statistical and diagnostic evaluation of the ADMS-Urban model compared with an urban air quality monitoring network. Atmos. Environ., 43(25), 3850-3857.
Saez, M., Ballester, F., Barceló, M. A., Pérez-Hoyos, S., Bellido, J., Tenías, J. M., ... and EMECAM. (2002). A combined analysis of the short-term effects of photochemical air pollutants on mortality within the EMECAM project. Environ. Health Perspect. 110, 221–228.
Sekmoudi, I., Khomsi, K., Faieq, S. and Idrissi, L. (2021). Assessment of global and regional PM10 CAMSRA data: comparison to observed data in Morocco. Environ. Sci. Pollut. Res., 28(23); 29984-29997.
Snyder, E. G., Watkins, T. H., Solomon, P. A., Thoma, E. D., Williams, R. W., Hagler, G. S., ... and Preuss, P. W. (2013). The Changing Paradigm of Air Pollution Monitoring. Environ. Sci. Technol., 47(20); 11369-11377.
Soulhac, L., Salizzoni, P., Cierco, F.-X. and Perkins, R. (2011). The model SIRANE for atmospheric urban pollutant dispersion; part I, presentation of the model. Atmos. Environ., 45(39); 7379-7395.
Stafoggia, M., Faustini, A., Rognoni, M., Tessari, R., Cadum, E., Pacelli, B., ... and Forastiere, F. (2009). Air pollution and mortality in ten Italian cities. Results of the EpiAir Project. Epidemiol. Prev., 33(6 Suppl 1); 65-76.
Sun, Z., and Zhu, D. (2019). Exposure to outdoor air pollution and its human health outcomes: A scoping review. PLOS ONE 14, e0216550. doi: 10.1371/journal.pone.0216550.
Tahri, M., Benchrif, A., Bounakhla, M., Benyaich, F., and Noack, Y. (2017). Seasonal variation and risk assessment of PM2.5 and PM2.5–10 in the ambient air of Kenitra, Morocco. Environ. Sci. Process. Impacts 19, 1427–1436. doi: 10.1039/C7EM00286F.
Tahri, M., Bounakhla, M., Zghaïd, M., Noack, Y., Benyaïch, F., and Benchrif, A. (2013). Evaluation of airborne particulate matter pollution in Kenitra City, Morocco. Ambiente E Agua - Interdiscip. J. Appl. Sci. 8, 38–47. doi: 10.4136/ambi-agua.1042.
Wallace, H. W., Sanchez, N. P., Flynn, J. H., Erickson, M. H., Lefer, B. L., and Griffin, R. J. (2018). Source apportionment of particulate matter and trace gases near a major refinery near the Houston Ship Channel. Atmos. Environ. 173, 16–29. doi: 10.1016/j.atmosenv.2017.10.049.
Zaoui, S., Berrabah, M., Azzaoui, K., and Mejdoubi, E. (2014). Monitoring of troposphere ozone in the peri- urban area of Oujda city in the east of Morocco. J. Mater. Environ. Sci. 5, 6.
Zghaid, M., Noack, Y., Bounakla, M., and Benyaich, F. (2009). Atmospheric particulate pollution in Kenitra, Morocco. 12.
Zhang, K., and Batterman, S. (2010). Near-road air pollutant concentrations of CO and PM2.5: A comparison of MOBILE6.2/CALINE4 and generalized additive models. Atmos. Environ. 44, 1740–1748. doi: 10.1016/j.atmosenv.2010.02.008.