Eastern Mediterranean Region Countries Research Articles

Media reporting of violence against children in the Eastern Mediterranean Region during the early days of COVID-19 pandemic

Background: Violence against children constitutes a significant public health problem globally. Aim: To document and compare media reports of violence against children before and during COVID-19, and measures taken by countries to address such violence. Methods: This comparative review covered news reports of violence against children from 1 January to 30 June of 2019 and 2020 in the WHO Eastern Mediterranean Region countries. A total of 823 articles published in Arabic and English, covering incidents, initiatives, opinions and views on all types of violence among children under 18 years of age were sourced using search engines and platforms and reviewed. News on incidents was analysed quantitatively while news on initiatives and opinions was analysed qualitatively. Results: Some 40.3% of the news reports was on incidents, followed by interviews or opinions (31.5%) and initiatives (28.2%). There were 1129 reports of violence against children from 1 January to 30 June of 2019 and 1880 for the same period in 2020. Reports of physical violence increased from 34% in 2019 to 40% in 2020, while reports of sexual violence decreased from 45% in 2019 to 37% in 2020. Views and opinion reports showed 0.4–1.1% alignment with the 7 INSPIRE strategies. Conclusion: The COVID-19 pandemic affected the incidence and reporting of violence against children across the region. It is essential to provide accurate and sensitive media coverage for incidences of violence against children so that survivors and at-risk children can receive adequate support and ensure that communities can tackle it appropriately

A systematic review and meta-analysis of extra-intestinal manifestation of inflammatory bowel disease in the Eastern Mediterranean Region (EMRO) countries.

Inflammatory bowel disease which is subgrouped mainly to ulcerative colitis and Crohn's disease is thought to be a multi-organ disease. Most organs can be involved in the disease course in addition to gastrointestinal tract involvement. In this systematic review we aimed to assess the prevalence of these manifestations in Eastern Mediterranean Regional Office (EMRO) countries. The present systematic review and meta-analysis study was performed according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guideline. Joanna Briggs Institute (JBI) Critical Appraisal Checklist was admired for the quality evaluation of the included studies. For determining the heterogeneity, we used Cochran test and I2 statistics. Finally, 12 studies were included in our study. Based on the results of our study the prevalence of arthritis in ulcerative colitis and Crohn's disease patients was 7.1% (95% CI: 2.6-18.2%) and 13.5% (95% CI: 2.6-47.3%), respectively. Prevalence of arthralgia in ulcerative colitis patients was 18.4% (95% CI: 14.3-23.3%). skin involvement prevalence was 9.9% (95% CI 4.7-19.6%) in inflammatory bowel disease (IBD) patients. ocular involvement prevalence was 7.2% (95% CI 17-25.8%) in IBD patients. PSC prevalence in ulcerative colitis and Crohn's disease patients was 3.5% (95% CI: 1.7-7.3%) and 2.7% (95% CI: 1.3-5.5%), respectively. Based on the results of this study arthralgia and arthritis were the most common extra-intestinal manifestation of IBD followed by dermatologic and ocular involvements. This extra-intestinal manifestation can challenge the patients' management and identifying their pattern is important during the disease course.

A scoping review of road traffic data systems in the Eastern Mediterranean Region

Background: Road traffic injury is a major global health risk, however, under-reporting of road traffic crashes data and the use of different reporting systems have made it difficult to compare data across countries. Aim: To examine published and grey literature for better understanding of available health and non-health road traffic data systems in the Eastern Mediterranean Region (EMR) countries. Methods: We conducted a systematic search of databases to identify studies reporting road traffic data systems in the EMR countries between 2011 and January 2022. We also searched grey literature on the websites of government, WHO, World Bank, UNICEF, regional economic commissions and other relevant institutions. We assembled the data in Microsoft Excel and presented the counts of data sources, data types and data quality. Results: We included 84 of 2238 studies accessed in this review. One-third of the publications was from the Islamic Republic of Iran while 10% was from Pakistan. Police databases were the primary sources of data in most of the studies (79%) while hospital and death registration systems together accounted for one-quarter of the databases. The most common indicators reported in the publications were deaths (61%), crashes (48%) and injuries (35%). Only 40% of the studies disaggregated their analyses by gender and 44% by age. No papers identified permanently linked data sources, although more than a quarter of the papers reviewed used some form of modelling or data mining. Conclusion: This scoping review highlights an over-reliance on police data, poor quality traffic data systems, and multiple stakeholders collecting similar data, leading to redundancy. EMR countries need to establish robust road safety data systems to provide data for relevant policies and interventions

Experiences and lessons from using digital technology for noncommunicable disease services during the COVID-19 pandemic in the Eastern Mediterranean Region

Background: Harnessing digital technology for health service provision is inevitable, especially after the dramatic increase in demand during the COVID-19 pandemic and the observed global disruption of health services especially for People Living with Noncommunicable Diseases (PLWNCDs). Aims: To document and share experiences, challenges and lessons learned from the use of digital health interventions (DHIs) for noncommunicable disease (NCD) service delivery during the COVID-19 pandemic in the Eastern Mediterranean Region (EMR). Methods: We conducted a documentary research on the use of DHIs for continuity of NCD services during the COVID-19 pandemic in EMR. We collected our data using a questionnaire that was developed and administered by email to WHO NCD focal persons at the ministries of health of all EMR countries. Using the WHO classification of DHIs we then mapped the various interventions and the stakeholders involved. Results: Seven countries – Islamic Republic of Iran, Jordan, Oman, Qatar, Saudi Arabia, Sudan, and United Arab Emirates – shared their documentations. Documented DHIs used by countries to overcome the disruption of services during the pandemic were mostly on the use of client-to-provider telemedicine for NCD services. The level of implementation varied between countries. NCD and mental health helplines and COVID-19 prevention awareness campaigns for PLWNCDs were the most mentioned interventions. Conclusions: DHIs for NCD service provision were implemented during the COVID-19 pandemic in all settings: highmiddle- and low-income countries in the EMR. There is a high potential for incorporating DHIs within health systems to increase access to health services beyond the pandemic. Documentation, regulation and national capacity-building for mainstreaming DHIs in public health services in the EMR are strongly encouraged, based on each country’s needs.

National public health institutes in the Eastern Mediterranean Region: Insights from experts in the field

National public health institutes (NPHIs) are crucial to the effectiveness of public health systems, including delivering essential public health functions and generating evidence for national health policies, strategies and plans....

Antimicrobial Resistance: Stewardship and One Health in the Eastern Mediterranean Region.

Antimicrobial resistance (AMR) is a major threat in the Eastern Mediterranean region (EMR) due to factors such as the high prevalence of infectious diseases, weak health systems, and the misuse of antimicrobials. This paper aims to discuss how interdisciplinary action and collaboration, specifically through antimicrobial stewardship (AMS) and the One Health approach, can effectively address AMR in the EMR. The review focuses on successful AMS initiatives and the adoption of the One Health approach in countries within the EMR, including the Gulf Cooperation Countries (GCC), Egypt, Iran, Jordan, and Pakistan. The goal is to highlight the potential for progress in combating AMR and identify challenges and opportunities for strengthening interdisciplinary collaboration. The results showcase successful AMS programs and One Health initiatives in various EMR countries, demonstrating their potential to address AMR challenges. The paper also discusses the challenges faced by these nations, such as limited resources, fragmented health systems, and knowledge gaps. Additionally, opportunities for enhancing interdisciplinary action through regional cooperation, international partnerships, and research and innovation are outlined. In conclusion, this paper emphasizes the importance of a comprehensive and collaborative response to combat AMR in the EMR. It advocates for the One Health approach as a crucial framework to guide these efforts, promoting coordinated action, improved surveillance, responsible antimicrobial use, and enhanced interdisciplinary collaboration to effectively mitigate the threat of AMR.

Nutritional Data on Selected Food Products Consumed in Oman: An Update of the Food Composition Table and Use for Future Food Consumption Surveys.

Food composition data in the Eastern Mediterranean Region countries are often lacking, obsolete, or unreliable. The study aims to provide reliable nutrient data on food products consumed in Oman in order to evaluate their nutritional quality, the consistency of the nutrition labeling and claims, and, ultimately, the use for food consumption surveys and update the current food composition database. Contents of fat, fatty acids, carbohydrates, protein, sugars, and sodium were chemically analyzed in 221 foods and beverages. Products were classified according to their nutritional composition and the extent of processing and coded according to the FoodEx2 system. Labels and laboratory values were compared using the tolerance levels of the European Union. Results indicate that the nutrition labeling aligns with the values obtained in the laboratory, with the exception of 6.3% discrepancies in TFA content, where the reported values are higher than the appropriate reference values. The most frequent category (71.5%) was ultra-processed foods. In terms of inconsistencies in the nutritional claims, 5.1% of food products with claims did not comply with the statement "sugar-free" or "low salt". Our study provides evidence to support the necessity of comprehensive recommendations for consumers and food industries, which are aimed at enhancing the nutritional quality of products and augmenting consumer awareness.

Region-wide assessment of National Immunization Technical Advisory Groups (NITAGs) using the NITAG Maturity Assessment Tool (NMAT) – Experience from the Eastern Mediterranean Region of the World Health Organization, 2023

National Immunization Technical Advisory Groups (NITAGs) are independent bodies that help improve national immunization programmes in decision making on immunization policy. The new NITAG Maturity Assessment Tool (NMAT) provided an opportunity to conduct a region-wide assessment to improve NITAG capacity and foster institutional growth. We share experience of the Eastern Mediterranean Region (EMR) of the World Health Organization (WHO) in using NMAT and the use of findings to develop improvement plans. NITAG chairs and secretariats from 22 EMR countries attended a virtual NMAT training in 2023. They self-assessed their NITAGs using the tool and developed improvement plans. An algorithm used the data to determine maturity levels for seven indicators. We consolidated results for the region by income groups. Of 22 countries (or NITAGs), 20 (91%) submitted NITAG assessment findings and 19 an improvement plan. The proportion of criteria met per indicator varied from 36% for independence and non-bias to 74% for establishment and composition. Maturity level varied by indicator. Of 20 NITAGs, less than half had an intermediate or higher-level maturity for the indicators of independence and non-bias 1 (5%), operations 3 (15%), making recommendations 4 (20%), stakeholder recognition 6 (30%), and resources and secretariat support 7 (35%). Meanwhile 11 (55%) NITAGs had an intermediate or higher maturity level for the indicators of establishment and composition and for integration into policy making process. Participants described NMAT as a concise, useful, user-friendly tool. NMAT is a practical tool that can be used by NITAGs to provide insights and strategic direction for individual countries and regionally. Prevention and management of conflict of interest is the domain that requires the most improvement in EMR. Planned activities should be implemented, monitored and a follow up assessment conducted in 2025.

Progress Toward Measles Elimination - World Health Organization Eastern Mediterranean Region, 2019-2022.

In 2015, all 22 World Health Organization Eastern Mediterranean Region (EMR) countries and areas (countries) pledged to achieve measles elimination by 2020. Despite success in several countries, most countries in the region still have not eliminated measles. This report updates a previous report and describes progress toward measles elimination in EMR during 2019-2022. During that period, estimated regional coverage with the first and second doses of a measles-containing vaccine (MCV) was 82%-83% and 76%-78%, respectively. During 2019-2022, approximately 160 million children were vaccinated during national or subnational supplementary immunization activities. Reported confirmed regional measles incidence decreased from 29.8 cases per 1 million population in 2019 to 7.4 in 2020, but then increased 68%, to 50.0 in 2022 because of challenges providing immunization services and conducting surveillance during the COVID-19 pandemic. Surveillance indicators deteriorated in 11 (50%) of the 22 EMR countries. During 2019-2022, four countries in the region were verified as having achieved measles elimination, but other countries reported immunity gaps and increased measles incidence in 2022. To achieve measles elimination in EMR, national immunization programs, especially in those countries with high measles incidence, will need to continue to recover from the COVID-19 pandemic, increase overall vaccination coverage to close immunity gaps, and maintain high-quality disease surveillance.

A quantitative analysis of publication trends in Iranian medical ethics and a comparison with EMRO countries.

Evaluating publication trends in a research area helps assess organised scientific efforts in the particular academic field. This study aims to evaluate and compare trends in medical ethics publications in the Eastern Mediterranean Region (EMRO) countries. A scoping review was conducted to identify publication trends of Iranian and EMRO medical ethicists. Databases were searched, including Web of Sciences, Scopus, and PubMed for English language articles, which were published by countries in the World Health Organization EMRO regions. Iranian articles were searched in Persian and English language databases. The search strategy for the bioethics filter created by the Kennedy Institute of Ethics. Duplicate entries, tertiary publications and grey literature were excluded. All retrieved articles were categorised into ten main groups. Citavi software® was used for categorising and extracting articles' information. A total of 1835 English and Persian articles were obtained. Most (1211, 66%) Iranian publications in medical ethics were in Persian, and the rest (624, 34%) were in English. Most (306, 64.42%) of the published English articles in the EMRO region were authored by Iranian scholars, followed by those from Saudi Arabia (52, 10.95%), Oman (40, 8.42%), Pakistan (28, 5.89%), Lebanon (13, 2.74%), and Egypt (12, 2.53%). The results of this study show that the trend of publication of EMRO countries, especially Iranian publications, is insufficient to respond to national demands in medical ethics. A concept map has been presented to determine research needs in medical ethics. Focusing on national and regional research potentials could synergistically affect medical ethics progress in the EMRO region.

A Systematic Review of the Economic Burden of Diabetes in Eastern Mediterranean Region Countries.

Diabetes Mellitus (DM) is a highly prevalent non-communicable disease with high mortality and morbidity, which imposes a significant financial impact on individuals and the healthcare system. The identification of various cost components through cost of illness analysis could be helpful in health-care policymaking. The current systematic review aims to summarize the economic burden of DM in the Eastern Mediterranean Region (EMR) countries. The original studies published in the English language between January 2010 and June 2023 reported the cost of DM was identified by searching four different databases (Google Scholar, PubMed, Science Direct, and Cochrane Central). Two reviewers independently screened the search results and extracted the data according to a predefined format, whereas the third reviewer's opinion was sought to resolve any discrepancies. The costs of DM reported in the included studies were converted to USD dates reported in the studies. After the systematic search and screening process, only 10 articles from EMR countries met the eligibility criteria to be included in the study. There are substantial variations in the reported costs of DM and the methodologies used in the included studies. The mean annual cost per patient of DM (both direct and indirect cost) ranged from 555.20 USD to 1707.40 USD. The average annual direct cost ranged from 155.8 USD to 5200 USD and indirect cost ranged from 93.65 USD to 864.8 USD per patient. The studies included in the review obtained a median score of 8.65 (6.5 ─ 11.5) on the quality assessment tool based on Alison's checklist for evaluation of cost of illness studies. There is a significant economic burden associated with DM, which directly affects the patients and healthcare system. Future research should focus on refining cost estimation methodologies, improving the understanding of study findings, and making it easier to compare studies.

A phased strengthening of laboratory capacity in the Eastern Mediterranean Region during the COVID-19 pandemic.

The Eastern Mediterranean Region (EMR) faces ongoing challenges in its public health system due to limited resources, logistical issues, and political disruptions. The COVID-19 pandemic accelerated the need for stronger laboratory capacities to handle the increased demand for testing. In a phased response, EMR countries utilized the National Influenza Centers to rapidly establish and scale molecular testing for SARS-CoV-2, the causative agent of COVID-19. The expansion of capacity included strong collaborations between public health bodies and private and academic sectors to decentralize and expand testing to the subnational level. To ensure that the quality of testing was not impacted by rapid expansion, national and subnational laboratories were enrolled in external quality assurance programs for the duration of the response. Implementation of genomic surveillance was prioritized for variant tracking, leading to the establishment of regional sequencing reference laboratories and the distribution of MinION sequencing platforms to complex emergency countries who previously had limited experience with pathogen sequencing. Challenges included a lack of technical expertise, including in implementing novel diagnostic assays and sequencing, a lack of bioinformatics expertise in the region, and significant logistical and procurement challenges. The collaborative approach, coordinated through the WHO Eastern Mediterranean Regional Office, enabled all 22 countries to achieve SARS-CoV-2 diagnostic capabilities, highlighting the pivotal role of laboratories in global health security.

Prevalence of hospital-acquired pressure injuries in intensive care units of the Eastern Mediterranean region: a systematic review and meta-analysis

BackgroundHospital-acquired pressure injuries are a major patient safety concern in intensive care units that are considered largely preventable adverse events by adherence to nursing standards of care. The hypothesis of this research was to investigate the prevalence of hospital-acquired pressure injuries in intensive care units (ICUs) of the Eastern Mediterranean Region.MethodsThis study was designed as a systematic review and meta-analysis. All articles published on Pressure ulcer prevalence in the ICUs of hospitals in Eastern Mediterranean Region countries, identified by searching PubMed through MEDLINE, Web of Science, Scopus, and Google Scholar from January 1, 2011, until September 22, 2023. The reference lists of these articles were checked for additional relevant studies. Data were analyzed using the Comprehensive Meta-Analysis Software (v.2.2.064).ResultsA total of 15 articles met the inclusion criteria. Based on the random-effects model, the overall Pressure ulcer prevalence rate was 16.6% (95% CI (8.6-29.6)). Both the highest and lowest prevalence was observed in Jordan in 2011 at 83.1% (95% CI (71.2- 90.7)) and in 2012 at 0.9% (95% CI (0.5- 1.5)), respectively. The results showed that publication year, average age, and sample size were the main causes of heterogeneity between the reviewed studies (p < 0.05).ConclusionThis systematic review and meta-analysis of the pertinent peer-reviewed literature revealed a high prevalence of hospital-acquired pressure injuries of 16% in intensive care units of Eastern Mediterranean region. Therefore, it is necessary for health policymakers and managers in Eastern Mediterranean Region to take necessary measures to prevent the incidence of Pressure ulcers in hospitals, especially in ICUs.

Prevalence of hospital-acquired pressure injuries in intensive care units of the Eastern Mediterranean region: a systematic review and meta-analysis

BackgroundHospital-acquired pressure injuries are a major patient safety concern in intensive care units that are considered largely preventable adverse events by adherence to nursing standards of care. The hypothesis of this research was to investigate the prevalence of hospital-acquired pressure injuries in intensive care units (ICUs) of the Eastern Mediterranean Region.MethodsThis study was designed as a systematic review and meta-analysis. All articles published on Pressure ulcer prevalence in the ICUs of hospitals in Eastern Mediterranean Region countries, identified by searching PubMed through MEDLINE, Web of Science, Scopus, and Google Scholar from January 1, 2011, until September 22, 2023. The reference lists of these articles were checked for additional relevant studies. Data were analyzed using the Comprehensive Meta-Analysis Software (v.2.2.064).ResultsA total of 15 articles met the inclusion criteria. Based on the random-effects model, the overall Pressure ulcer prevalence rate was 16.6% (95% CI (8.6–29.6)). Both the highest and lowest prevalence was observed in Jordan in 2011 at 83.1% (95% CI (71.2- 90.7)) and in 2012 at 0.9% (95% CI (0.5- 1.5)), respectively. The results showed that publication year, average age, and sample size were the main causes of heterogeneity between the reviewed studies (p < 0.05).ConclusionThis systematic review and meta-analysis of the pertinent peer-reviewed literature revealed a high prevalence of hospital-acquired pressure injuries of 16% in intensive care units of Eastern Mediterranean region. Therefore, it is necessary for health policymakers and managers in Eastern Mediterranean Region to take necessary measures to prevent the incidence of Pressure ulcers in hospitals, especially in ICUs.

Commitment, partnerships and operational research: three priorities for 11 EMR countries to achieve TB elimination

BACKGROUND: In 2022, 11 of 22 Member States of the WHO Eastern Mediterranean Region (EMR) had an estimated TB incidence of &lt;20 cases per 100,000 population. We assessed preparedness for elimination and provided recommendations to pursue the process.METHODS: We surveyed 11 EMR national TB programme managers and collected information on eight TB elimination framework domains using a close-ended data collection tool. We compiled, consolidated and validated data, including a virtual consultation before triangulating data with other sources.RESULTS: Implementation was sufficient (≥74%) for 5 of 8 domains, highest for TB infection management, TB preventive treatment, laboratory service, drug management, drug-resistant TB and TB-HIV collaboration (89%, 83% and 78%, respectively). Countries ranked lowest for commitment (73%), operational research and infection control (63%), and partnership/collaborations (41%). Five countries reached &gt;80% when consolidating the responses, reaching sufficient from all domains. Two reached &lt;50%.CONCLUSION: Key identified obstacles to TB elimination in EMR were insufficient commitment/financing, suboptimal partnerships/collaborations and operational research calling for 1) all-stakeholder-inclusive, sustainably funded TB elimination plans, 2) cost-effective tools to exchange strategic information and build operational research capacity, and 3) improved collaboration.

A review on hospital food waste quantification, management and assessment strategies in the eastern Mediterranean region

BackgroundHospital food wastage has been identified as a significant issue within the foodservice sector. Numerous studies have shed the light on the amount of food waste in hospitals, along with its financial and environmental implications. Consequently, reducing food waste in hospitals has become a priority for the foodservice management sector in the Eastern Mediterranean Region (EMR). AimsThis review aims to examine studies on food waste in the hospitals of the EMR countries, and highlight research gaps in quantification, management, and assessment strategies in this region. MethodsPubMed and Google Scholar databases were searched between January 6 and September 1, 2023, to identify relevant articles published up to 2023 in the EMR. ResultsSix studies were included in this review. Among EMR countries, only Iran, Saudi Arabia, and Qatar have assessed food waste at hospitals. The average food waste in the EMR represents 25.4 % of total food served. Factors contributing to food waste include clinical issues, food preferences, meal timing, and ward sections. Patient's plate waste reduce dietary intake, affects patient's nutritional status and predispose to malnutrition. While some strategies to reduce plate waste have been proposed in many countries, there is a notable lack of food and food-related waste management policies and programs in hospitals food services in the EMR. ConclusionThis review summarizes the hospital's food-related waste assessment, quantifications, and management used by hospitals in the EMR. This review is a benchmark for the EMR's hospitals to work on adopting proactive measures as a general strategy to move toward food and food-related waste reduction.

National immunization technical advisory groups (NITAGs) in the WHO Eastern Mediterranean Region (EMR): A decade of shaping immunization policies, 2010–2021

In the Eastern Mediterranean Region (EMR) of the World Health Organization (WHO), little is known on National Immunization Technical Advisory Groups’ (NITAGs) outputs, including recommendations and their outcomes. We abstracted information from the WHO/UNICEF joint reporting forms and extracted implemented immunization policy decisions from the WHO immunization portal. We describe trends in establishments and functionality of NITAGs and immunization policies implemented in EMR from 2010 to 2021. In 2013, all 22 EMR countries had a NITAG, although only 20 remained active in 2021. The number of countries meeting six NITAG process indicators increased from 7 in 2010, to 14 in 2019, then reduced to 12 in 2021. In 2021, the proportion of countries with a functional NITAG decreased with income level, from 83% in high-income countries, to 55% in middle-income countries and 20% in low-income countries. From 2010 to 2021, there were 103 new vaccine introductions, 31 vaccine switches, and 28 schedule changes implemented across all 22 countries, irrespective of income groups. While NITAGs are established and making recommendations in countries, their functionality decreases with income level. Governments should continue to invest in NITAGs, including on strengthening processes and ensuring that recommendations made are based on evidence to decision frameworks.

Translating political commitments into actions to enhance Universal Health Coverage in the Eastern Mediterranean Region.

Many countries in the Eastern Mediterranean Region (EMR) have developed packages of services for achieving Universal Health Coverage (UHC), however, policymakers, especially in resource-constrained countries, still face challenges in delivering equitable, efficient and sustainable health services. To provide guidance for EMR countries and develop packages of services for UHC. We used information gathered from narrative reviews, national experiences and expert consultations to develop step-by-step guidance for the development of national packages of services for the achievement of UHC by countries in the EMR. The processes used to develop packages of services varied between EMR countries and these processes may not have involved all relevant stakeholders. We highlight in this paper the iterative processes, including several phases and steps, to be used by EMR countries for developing packages of services for UHC. These processes also make provision for continuous monitoring and revision to make necessary improvements as morbidity patterns evolve. Developing a package of services for the achievement of UHC is a significant milestone for EMR countries and it is central to shaping the healthcare system for effective delivery of services.

Combining COVID-19 and seasonal influenza vaccines together to increase the acceptance of newly developed vaccines in the Eastern Mediterranean Region: a cross-sectional study

Background and aim The World Health Organization (WHO) recommended the concomitant administration (co-administration) of inactivated seasonal influenza and coronavirus disease 2019 (COVID-19) vaccines, encouraging the practice for the 2021–2022 flu season. This study aimed to assess the acceptance of simultaneously receiving the seasonal influenza vaccine (SIV) and the COVID-19 vaccine in a single administration to reduce vaccine rejection towards the COVID-19 vaccination. Methods An online-based cross-section survey was conducted from 1 September to 9 November 2022, in the Eastern Mediterranean Region (EMR) through distributing the survey on different social media platforms, including Facebook, Twitter, LinkedIn and WhatsApp. We used the multi-level model to assess the variation of vaccine countries across EMR countries. Results In total, 3300 participants were included in this survey from 11 countries distributed in the EMR. More than one-third (40.7%) were aged 18–25 years, 60.6% were females, 54.0% had a university degree, 43.1% had previous COVID-19, and 41.9% had relatives or friends who died from COVID-19. In total, 43.3% accepted this combination because it is less costly (9%), safer (18%), more effective (17%), and has fewer doses (19%). Rejection of this combination was due to fear of side effects (31%), and no studies have been published on their effects (31%). There was a significant difference across countries, which accounted for 6% of the variance in the log-odds of accepting the combined vaccination. Multi-level analysis revealed that being male, African and losing a family member or friend from COVID-19 increased the acceptance of the theoretical combined vaccines. Additionally, the number of doses taken of the COVID-19 and influenza vaccines separately significantly affected the combined vaccine acceptance. However, previous COVID-19 infection and older age reduced the odds of accepting the combined vaccines. Occupational level, social status and educational level didn’t significantly affect the acceptance odds. Conclusions We can conclude that combining SIV and COVID-19 vaccines in one shot increased the overall acceptance of COVID-19 vaccines among vaccine rejectors.

Operationalizing One Health: strategic guidance for prevention and control of emerging and re-emerging vector-borne and zoonotic diseases in the Eastern Mediterranean Region

Operationalizing global One Health strategies at the field level to prevent and control vector-borne and zoonotic diseases (VBZDs) is of significant public health importance. Such strategies should be coordinated at the human–animal–ecosystems interface and applied at the national, regional, and global levels through the enforcement of effective policies. We aimed to develop a regional framework that can aid countries of the World Health Organization Eastern Mediterranean region to better prevent, detect, and respond to VBZDs events. This strategic guidance is a twelve-element framework drafted using various guidance documents and peer-reviewed scientific literatures, incorporating recommendations made through expert consultations. The framework elements were then integrated within a logical framework designed for practical implementation of One Health at regional and country level.