East Region Research Articles

Oral health status of inhabitants of Messamena, East Region of Cameroon: A Community Dental Outreach Study

Oral health status of inhabitants of Messamena, East Region of Cameroon: A Community Dental Outreach Study

Six Decades of Rural Landscape Transformation in Five Lebanese Villages

During the last six decades, Lebanon’s landscapes have undergone significant regime shifts whose causes are under-investigated. Using land cover maps from 1962 and satellite imagery from 2014 and 2023 in five randomly selected villages across Lebanon’s major agroecological zones (AEZs), we identified salient trends in the urbanization-driven transformation of land use and land cover (LULC). Household socio-economic characteristics and environmental pressures were analyzed as independent variables influencing land use decisions. Logistic regression (LR) was employed to assess the significance of these variables in shaping farmers’ choices to transition toward “perennialization”—namely fruit tree monocropping or protected agriculture. The LR results indicate that education reduced the likelihood of “perennialization” by 45% (p < 0.001). Farm size positively influenced “perennialization” (p < 0.01), suggesting that land availability encourages this agricultural practice. In contrast, water availability negatively affects “perennialization” (p < 0.01), though farmers may still opt to irrigate by purchasing water during shortages. Our findings underline the complex interplay of socio-economic and environmental dynamics and historical events in shaping Lebanon’s rural landscapes and they offer insights into similar transformations across the Middle East and North Africa (MENA) region.

Residual nitrite and nitrate in processed meats and meat analogues in the United States

Residual nitrite (NO2−) and nitrate (NO3−) have been widely studied in the past few decades for their function to improve processed meat quality and their impact on human health1, 2, 3–4. In this study we examined how the residual nitrite and nitrate (NOx−) content of major classes of processed meats products (n = 1132) produced locally from three regions (East Coast, Midwest and West Coast) and plant protein-based meat analogues (n = 53) available at retail in the United States was influenced by their composition, processing, and geographical attributes. We also conducted time-dependent depletion studies and observed different patterns of NOx− depletion and conversion during processing and storage and correlated them with product quality. Together, our results reveal a comprehensive prospective of NOx− content in processed meats and meat analogues. The NO2− in processed meats and meat analogues averaged (± standard error; minimum and maximum value in parentheses) 13.7 ± 0.62 (0.0-214.5) and 1.7 ± 0.34 (0.0–11.0), respectively, and the NO3− in processed meats and meat analogues averaged 32.6 ± 0.90 (2.0–205.9) and 7.2 ± 0.56 (4.0-25.3) ppm, respectively.

Isolation and Characterization of Naga King Chilli Rhizobacteria

Amongst the many landraces of chilli that are cultivated in the North east region of India, the Naga king chilli (Capsicum chinense Jacq.) is one of the best known worldwide and is widely grown in the state of Nagaland.27 rhizospheric bacteria of Naga king chilli was isolated for their characterization and results suggested that the rhizosphere of Naga king chilli is dominated by smooth, round, either orange or milky white, smooth surface, convex with entire margin and translucent bacteria. The rhizosphere was also observed to be dominated by Gram negative bacteria (21 isolates) while, all the isolates were observed to give positive reaction catalase test and gelatine hydrolysis activity with 18 isolates being able to hydrolyse starch.

Genetic characterization of measles virus circulating in Iran, 2021–2023

BackgroundMeasles, an ongoing public health concern, demands continuous molecular surveillance and virus characterization for elimination. Despite Iran achieving measles elimination status in 2019 through robust molecular testing and vaccination, the COVID-19 pandemic disrupted global vaccination efforts, leading to increased measles-related morbidity and mortality. This study aims to overview measles virus serological and molecular traits in Iran from 1st January 2021 to 30th April 2023.MethodsFollowing World Health Organization and Center for Diseases and Control protocols, serological tests were performed on suspected cases and the nucleoprotein (N) gene of confirmed cases were subsequently amplified using molecular methods and were sequenced afterwards for measles genotyping. Phylogenetic analysis was performed with the obtained sequences.ResultsAnalyzing 17,343 suspected cases from 1st January 2021 to 30th April 2023, 936, 177, and 164 samples were positive using ELISA, quantitative Reverse transcription PCR, and Reverse transcription PCR, respectively. The B3 genotype predominated, notably in Iran’s South East (41%), Central (28%), and South (13%) regions. Provinces bordering countries with measles outbreaks exhibited higher risk of virus importation. Genetic comparisons with measles sequences submitted to NCBI and MeaNS databases revealed direct importation and contact transmission.ConclusionRegular surveillance and genetic analysis are critical for understanding measles transmission and reacting to outbreaks. The COVID-19 pandemic yielded mixed effects on measles cases, enhancing hygiene measures while causing underreporting and vaccination gaps. Vigilance against measles resurgence is crucial, requiring cross-border transmission studies, improving cross-border surveillance and adaptable vaccination strategies.

Associations Between Dietary Factors and Breast Cancer Risk: A Systematic Review of Evidence from the MENA Region

Background: The Middle East and North Africa (MENA) region is witnessing a continuous rise in the incidence of breast cancer (BC). This region is characterized by distinct cultural and lifestyle habits. Despite the importance of diet as a modifiable risk factor for BC, its role in the development of BC within the MENA context has not been extensively studied. This systematic review aims to identify and synthesize existing evidence regarding the effect of different dietary factors on BC risk among women from this region. Methods: We systematically reviewed the scientific literature for observational studies that examined the association between specific dietary factors and the risk of BC in MENA, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Our comprehensive search included databases such as PubMed, Web of Science, ScienceDirect, and Scopus, identified a total of 18,085 records, of which 65 met our inclusion criteria and were assessed for quality using the National Institute of Health Quality Assessment Tool. Results: The findings of the 65 included studies were categorized into food groups, nutrients, and dietary patterns. Studies in the MENA region have consistently shown that the consumption of fruit and vegetables, fish and seafood, and black tea are associated with a reduced BC risk. In contrast, the intake of milk and white bread is linked to an increased risk. Specific dietary patterns such as the Mediterranean diet, a healthy plant-based diet, dietary antioxidant index, and overall healthy dietary patterns have shown a negative association with BC risk. Conversely, the dietary insulin index and load, dietary glycemic index, dietary inflammatory index, and unhealthy dietary patterns are associated with an increased risk of BC. For the remaining dietary factors, research was too limited or inconsistent to draw conclusions. Conclusions: Our findings highlight the significant role of dietary factors in modulating BC risk among women in the MENA region, an area that faces a notable gap in research on this topic. Further studies are essential to deepen our understanding and develop targeted dietary recommendations for BC prevention in this population.

Monitoring the Risk of Corruption in the MENA Region: What Are the Most Reliable Data to Address the Sustainable Development Goals?

ABSTRACTCountering corruption is recognized by the United Nations Sustainable Development Goals (UN SDGs) as crucial for effective and sustainable governance. Sample surveys are often used as the primary tool for monitoring corruption, making the evaluation of their quality essential for building a reliable evidence base strategy and achieving the UN SDGs 16.5. However, there is a lack of studies assessing the quality of corruption surveys in the Middle East and North African (MENA) region. This gap can be attributed to various factors, including low prioritization, insufficient resources for anti‐corruption initiatives, the sensitivity of the topic, and language and cultural barriers. This article aims to assess the quality of corruption surveys in the MENA region by developing an ad‐hoc quality evaluation framework, MENA_QUEST_16.5. This framework includes criteria for assessing survey relevance, validity, accuracy, credibility, periodicity, and comparability to evaluate MENA surveys' effectiveness in capturing corruption events, in line with SDGs' requirement for measuring corruption. The framework is then applied to evaluate the quality of 19 national and cross‐national corruption surveys targeting countries in the MENA region. The study finds that the overall quality of MENA corruption surveys is good, but the number of national initiatives is low. Surveys often lack accuracy in depicting corruption issues, typically operationalizing corruption through only one or two questions. Details about corruption events (e.g., types of officials involved; types of benefits exchanged) are rarely investigated. Also, MENA surveys are not periodically conducted and suffer from a lack of transparency, with raw data generally unavailable or inaccessible. These results point to methodological shortcomings that should be addressed to obtain a reliable overview of corruption in the MENA region. Tackling these issues can improve the monitoring of corruption trends and inform anti‐corruption policy design and evaluation, to ultimately achieve the UN SDGs.

P1260 Demographics and Clinical Characteristics of Inflammatory Bowel Disease in the Middle East and North Africa : A Multi-Nation Cross-sectional (MIRAGE) Study

Abstract Background Although inflammatory bowel disease (IBD) is more prevalent in Western countries, its incidence and prevalence have risen markedly in Asia and the Middle East [1,2]. Data on IBD patients from the Middle East and North Africa (MENA) region remain limited. This study aims to evaluate the demographic, clinical, and treatment patterns of IBD patients in the MENA region through the Middle East and North Africa IBD Research and Geographic Epidemiology (MIRAGE) study. Methods A cross-sectional, multi-national study was conducted at 10 IBD centers across six countries in the MENA region from January 1, 2022, to July 1, 2024. The primary objective was to assess IBD demographics, prevalence, and subtypes according to the Montreal classification. The secondary objective was to evaluate current IBD treatment strategies in the region. Categorical variable differences were analyzed using the Chi-squared test or Fisher’s exact test as appropriate. Results A total of 5,540 patients with inflammatory bowel disease (IBD) were included in the study. Of these, 2,824 (50.9%) were diagnosed with ulcerative colitis (UC), 2,602 (46.9%) with Crohn’s disease (CD), and 114 (2.0%) with IBD unclassified (IBD-U). In terms of gender distribution, 2,663 (48.1%) were male, and 2,877 (51.9%) were female. A total of 481 patients (8.7%) reported being smokers. Among the UC patients, disease extent was categorized as follows: 517 (18.3%) had E1 (proctitis), 1,123 (39.8%) had E2 (left-sided colitis), and 1,190 (42.1%) had E3 (pancolitis). For CD patients, disease location was distributed as: L1 (ileal) in 784 patients (30.13%), L2 (colonic) in 287 patients (11.02%), and L3 (ileocolonic) in 1,210 patients (46.50%). Disease behavior among CD patients included B1 (non-stricturing, non-penetrating) in 1,324 patients (50.9%), B2 (stricturing) in 693 patients (26.6%), and B3 (penetrating) in 647 patients (24.9%). Perianal disease was present in 708 CD patients (27.2%). Across the entire IBD cohort, 1,018 patients (18.38%) had undergone prior IBD-related surgeries, and 1,960 patients (35.38%) had experience with biologic therapies. (Table 1). The highest CD-to-UC ratio was observed in the Kingdom of Saudi Arabia (63% CD/35% UC), while the lowest ratio was seen in Oman (18% CD/80% UC) (Figure 1). Conclusion This study offers valuable insights into the demographic characteristics, clinical profiles, and treatment approaches for IBD patients in the MENA region, highlighting the rising prevalence of IBD in the region and the increasing utilization of advanced therapies.

First Report of HPV Genotyping and Distribution in People Living with and Without HIV from Iran and the Middle East.

In people living with human immune deficiency (PLHIV), the rates of human papillomavirus (HPV) infection, mixed types, and high-risk (HR) strains increase, while the virus clearance is prevented. Here, we report HPV genotyping in PLHIVs from Iran and the Middle East region for the first time. HPV genotyping in referring individuals from different provinces to our laboratory was evaluated over 2023-2024. For this, the HPV types in specimens were detected through the INNO- LiPA HPV genotyping kit. Statistical analysis was conducted with a 95% confidence interval (95%CI) and P < 0.05. Accordingly, 481 subjects from various provinces participated in this study. The rate of HPV infection was 45.7%, of which 14% were HIV-infected women referred from all provinces. The most prevalent types included 6, 51, and 18, but not 16 HR types. Mixed infections in dually infected women were significantly more than in HPV-infected ones. The HPV+/HIV+ subgroup had the lowest median age. The prevalence of HPV types and mixed infection in PLHIVs was congruent with the previous reports, except for the low rate of type 16 infection, perhaps due to the healthy nature of our subjects. Only HIV+/HPV+ cases' age was similar to the previous reports, perhaps because of sample collection and study designs. Among all factors, age and gender affected the HPV type distribution notably. The current study corroborated the results of many prior reports, demonstrating the considerable impact of HIV status on HPV distribution. The authors recommend implementing a national HPV vaccination and more comprehensive reports of HPV genotyping in PLHIVs.

Migrant Health Country Profile tool (MHCP-t) for transforming health data collection and surveillance in the Middle East and North African (MENA) region: tool development protocol with embedded process evaluation

IntroductionThe Middle East and North Africa (MENA) region is characterised by major health disparities and complex migration flows. Yet, because of a lack of epidemiological data, there is an urgent...

Burden and trends of dietary iron deficiency in the Middle East and North Africa region, 1990–2021

Burden and trends of dietary iron deficiency in the Middle East and North Africa region, 1990–2021

Faculty Members’ Views on Digital Journalism as a Source of Information: Educational Issues Perspective

This study aimed to explore the extent to which faculty members at University at the Emirates and Jordan rely on digital journalism as a source of information related to educational issues. The study was conducted using a questionnaire methodology distributed to a sample of 100 Academics in the Emirates and Jordan. The results showed that the majority of faculty members included in the study rely heavily on digital journalism as a primary source of information related to educational issues. More than 75% of the participants indicated that they regularly use digital journalism to obtain the latest news and developments in the field of education, whether locally or globally. In addition, the study showed that reliance on digital journalism has a positive impact on the performance of faculty members in both teaching and research. 65% of the respondents indicated that they use information derived from digital journalism to update their lectures and develop curricula. The study also found that there were no statistically significant differences (α=0.05) attributed to the effect of the gender variable in all dimensions (cognitive effects, affective effects, and behavioral effects) and the total score. This study provides a comprehensive examination of the intersection between digital journalism and educational issues in the context of faculty members, which represents a pioneering contribution to the field of media studies in the Middle East and North Africa region.

Liminality experienced from within: place intensification through self-built dwellings in Montenegro

ABSTRACT Liminal dwellings are self-built units without a predetermined urban planning permit and architectural plans generating ambiguous, reflexive, and change-inducing in-between neighbourhoods. Migrants from the Republic of Kosovo inhabit self-built shelters, which stimulate contextual and communal intensification of cities. Contextual addresses the spatial network established between inhabitants and their destinations in the city, and communal intensification reviles neighbourly connections. Using in-depth semi-structured interviews, diaries, and personal essays during data gathering, participants’ lived experiences were recorded in informal settlements “Bijela Gora” and “Meljine,” located in the east and west periphery of the southern region of Montenegro. Interpretative phenomenological analysis is used as a qualitative research method to survey participants’ experiences of liminalities captured via migrants’ destinations in the city, the neighbourhoods’ organisation, social trust, and repercussions from the alternation of sheds. Rather than comprehending poverty as individual misfortune, these categories are useful for altering future urban and communal developments.

Age Estimation from Teeth among Benghazi Children Using Demirjian’s Method

Background: Age estimation his of great importance in many clinical decisions in pediatrics, legal medicine, forensic sciences, anthropology and orthodontics in the view of increased immigration flow and globalization of economy. Demirjian method of age estimation is one of the widely used methods in determining chronological age of children, youths and young adults in many countries, however, its applicability in Libyan population have not been tested yet. .Aims: This study was aimed to evaluate the accuracy of Demirjian method in Benghazi children esti-mating the chronological age of boys and girls aged 6 to 16 years of age from panoramic radiographs and to establish a new dental age curve if the Demirjian method was not found to be accurate.Materials and Methods: This retrospective cross sectional study consisted of 250 OPGs for 127 boys and 123 girls between the ages of 6–16 years. All children were placed in the age group closest to their chronological age. The dental age was scored on all seven left mandibular teeth by calibrated examiner. Statistical analyses using the t-test and Pearson correlation were performed.Results: There was no significant difference in both boys and girls in all the age groups between their chronological age and dental age except for age group 6, 7, 15. Even though there was a slight overes-timation in boys in some age groups and slight underestimation in girls in some groups, Moreover, correlation analyses for each age group showed a significant correlation between the chronological age and the dental age, using the Demirjian method, in most age groups (P &lt; 0.01). When comparing the maturation score between boys and girls, the Student’s t-test didn’t reveal any statistically signif-icant difference between boys and girls in most age groups.Conclusion: Boys and girls living in the east region of Libya exhibited similar pattern of dental de-velopment when compared by Demirjian method with a reliable estimation of dental age b this method, so Demirjian method can be used as for this propose in children from the eastern region of Libya.

Supports for informal caregivers of people living with dementia in the Middle East and North Africa Region: realist review

In the Middle East and North Africa (MENA) region, the commitment to honour parents and keep private ‘issues’ within the home combine to shape caregiving styles and needs. Evidence on the effectiveness of interventions for informal caregivers for people living with dementia in the MENA region is lacking. This study offers an overview of interventions for caregivers. It also explores informal caregivers’ needs, preferences and views on addressing intervention through online content. A middle-range programme theory is developed to provide insight into the mechanisms underpinning the interventions. A realist review approach was used to explore what intervention types and features support the informal caregivers of people living with dementia throughout the MENA region and to examine in which contexts and how these interventions worked. The realist synthesis included 23 articles and eight interviews with health professionals. Eight context–mechanism–outcome configurations (CMOCs) were extrapolated to build and iteratively refine a middle-range programme theory and finalise it for testing. Contextual conditions that emerged include stigma, long care duration, culture, lack of support and the effect of this on intervention uptake. Mechanisms reported include feeling supported and empowering caregivers with the skills, knowledge and support they need, which led to outcomes such as improved quality of life for people living with dementia and caregivers and reduction in stress for caregivers. This article contributes to the limited literature by addressing an identified gap in knowledge, providing insights into informal caregivers of people living with dementia in the MENA region to understand why particular interventions work or not, and in what contexts.

Agronomic characteristics, mineral nutrient content, antioxidant capacity, biochemical composition, and fatty acid profile of Iranian pistachio (Pistacia vera L.) cultivars

BackgroundPistachio (Pistacia vera L.) nuts are among the most popular nuts. The pistachio cultivars are tolerant to both drought and salinity, which is why they are extensively grown in the arid, saline, and hot regions of the Middle East, Mediterranean countries, and the United States.ResultsThis study evaluated the agronomic and chemical characteristics of 10 pistachio cultivars (‘Abbasiali’, ‘AhmadAghaei’, ‘Akbari’, ‘Chrook’, ‘Fandoghi’, ‘KalehGhoochi’, ‘Momtaz’, ‘Rezaei’, ‘Sefied’, and ‘Shahpasand’). Total phenolic content, antioxidant capacity, fruit mineral elements, soluble protein content, kernel-oil content, and fatty-acid composition were determined in 60 fruits (20 fruits per replication). Leaf mineral elements were determined in 450 leaves (150 leaves per replication). Significant differences were observed (p < 0.05) among the cultivars, with the coefficient of variation (CV) ranging from 1.03 (unsaturated fatty acids) to 115.16% (early nut splitting). Flower buds varied from 4 (‘AhmadAghaei’) to 7 (‘Momtaz’), and fruit per bunch ranged from 11 (‘Abbasiali’) to 21 (‘Momtaz’). Hull percentage ranged from 36.8 (‘KalehGhoochi’) to 43.1% (‘Chrook’), and nut percentage ranged from 56.3 (‘Chrook’) to 62.4% (‘KalehGhoochi’). Iron content in leaves ranged from 267 (‘Chrook’) to 367 mg/kg (‘Rezaei’), while iron in fruits ranged from 65.72 (‘Fandoghi’) to 81.90 mg/kg (‘Sefied’). Total phenolic content varied from 99.9 (‘Rezaei’) to 184.30 mg/g (‘Fandoghi’), and antioxidant activity ranged from 39.14 (‘Shahpasand’) to 82.89% (‘Sefied’). Oil content ranged from 49.26 (‘Rezaei’) to 67.72% (‘AhmadAghaei’), with oleic acid between 48.4 (‘Rezaei’) and 55.55% (‘KalehGhoochi’). Leaf phosphorus positively correlated with split nut percentage (r = 0.669) and negatively with blank nut percentage (r = -0.734). Fruit potassium strongly correlated with total phenolics (r = 0.917) and oleic acid (r = 0.654). Multiple regression analysis showed that blank nut percentage was negatively correlated with leaf zinc (β = -0.77) and positively with antioxidants (β = 0.77). Early nut splitting showed a negative correlation with antioxidants (β = -0.72). The first three principal components (PC1 = 22.48%, PC2 = 18.15%, PC3 = 15.82%) explained 56.45% of the total variation. Heat map analysis using Ward clustering revealed cultivar groupings based on traits like nutrient content and fatty acid composition.ConclusionsThe findings obtained in this study allow producers to select the most suitable cultivars for obtaining more efficient and high-quality products. Additionally, choosing cultivars based on environmental factors and market demands contributes to the development of more effective production strategies. The ultimate goal is to provide insights that guide the selection of pistachio cultivars optimized for both agricultural sustainability and market-specific requirements.

Efficiency analysis of geological exploration, mineral production, and land restoration in China's provinces under natural change

China is one of the world's largest producers of mineral resources and possesses abundant mineral reserves, and its mining industry thus plays a crucial role in the country's economic development. However, most studies overlook the importance of geological exploration activities preceding mineral production and the impact of land restoration on said production under external environmental factors. Therefore, this research utilizes the meta recycle undesirable dynamic three-stage directional distance function (DDF) under exogenous model to investigate geological exploration stage efficiency, mineral production stage efficiency, and land restoration stage efficiency in different regions of China. The research findings are as follows. (a) The overall efficiency in the east region surpasses that of the other regions. (b) The central region exhibits the lowest efficiency in the geological exploration stage and mineral production stage. (c) Land restoration stage efficiency in all regions needs improvement due to the impact of precipitation.

The burden of prostate cancer in the North Africa and Middle East Region from 1990 to 2021

Prostate cancer ranks among the most prevalent malignancies affecting males globally. This study sought to document the incidence, deaths and disability-adjusted life-years (DALYs) that were due to prostate cancer in the Middle East and North Africa (MENA) region, and its 21 countries, from 1990 to 2021. We analysed publicly accessible data from the Global Burden of Disease 2021 study to present findings on the incidence, deaths, and disability-adjusted life years (DALYs) associated with prostate cancer. These metrics were reported as counts and age-standardised rates, each accompanied by 95% uncertainty intervals. In 2021, the age-standardised incidence of prostate cancer in the region was 27.4 per 100,000 population, representing a 125.1% increase from 1990. The age-standardised mortality rate was 10.1, and the age-standardised DALY rate was 173.6, neither of which showed significant increases since 1990. Qatar recorded the highest age-standardised DALY rate in 2021, while Algeria had the lowest. The largest number of incident cases, deaths, and DALYs in 2021 were found in the 65–69, 80–84, and 70–74 age groups, respectively. Additionally, from 1990 to 2021, the burden of prostate cancer largely increased with the socio-demographic index (SDI) at the regional level. The burden of prostate cancer in the MENA region rose markedly between 1990 and 2021. Further studies into the underlying causes of this increasing incidence are essential to devise effective strategies for the early detection and prevention of the disease.

The Effect of Provider-Related Factors on Healthcare Utilization in the Upper East Region of Ghana: The Mediating Role of Marketing Strategies

The Effect of Provider-Related Factors on Healthcare Utilization in the Upper East Region of Ghana: The Mediating Role of Marketing Strategies

THE NEW WORLD ORDER AND THE STRATEGIC SECURITY SITUATION IN THE GREATER MIDDLE EAST AND INDO-PACIFIC REGIONS

The paper addresses the transformation of the world order and the geopolitical and strategic processes taking place within its framework, especially the developments in the Greater Middle East and the Indo-Pacific region, their main actors and political ambitions. In 2020, the Artsakh war and subsequent developments created a new geo-strategic and geo-economic situation for Armenia. In light of this and subsequent events, we see that the system of international relations has entered a highly complex and even chaotic period, which includes a vast region from the Atlantic coast of Europe to the Pacific coast of the Far East. In this context, there are discussed the two geostrategic concepts emerging in the international discourse regarding the Greater Middle East and the Indo-Pacific macro-regions. The paper analyzes the processes, unfolding in those regions, including the US policies and strategies, as well as their implications, the factors of China and India as the main actors, formed and emerging alliances, as well as cooperation formats. The transformation of the global world order and the formation of the new geopolitical regions of the Greater Middle East, Central Asia and the Indo-Pacific portend great dramatic changes. The struggle of great powers or power centers (USA, China, India, Iran, Turkey, Europe, Russia) in the mentioned regions is becoming the core of modern world politics. Thus, it can be confirmed that the Greater Middle East and Indo-Pacific macro-regions are moving towards each other, due to which a completely new situation is emerging, which is significantly different from both the post-Cold War world order and the global order established after September 11, 2001.