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

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.