East Region Research Articles

A Systematic Review of Knowledge, Attitudes, and Factors Influencing HPV Vaccine Acceptance Among Adolescents, Parents, Teachers, and Healthcare Professionals in the Middle East and North Africa (MENA) Region

A Systematic Review of Knowledge, Attitudes, and Factors Influencing HPV Vaccine Acceptance Among Adolescents, Parents, Teachers, and Healthcare Professionals in the Middle East and North Africa (MENA) Region

Trend of pharmaceuticals 3D printing in the Middle East and North Africa (MENA) region: An overview, regulatory perspective and future outlook

The traditional method of producing medicine using the “one-size fits all” model is becoming a major issue for pharmaceutical manufacturers due to its inability to produce customizable medicines for individuals’ needs. Three-dimensional (3D) printing is a new disruptive technology that offers many benefits to the pharmaceutical industry by revolutionizing the way pharmaceuticals are developed and manufactured. 3D printing technology enables the on-demand production of personalized medicine with tailored dosage, shape and release characteristics. Despite the lack of clear regulatory guidance, there is substantial interest in adopting 3D printing technology in the large-scale manufacturing of medicine. This review aims to evaluate the research efforts of 3D printing technology in the Middle East and North Africa (MENA) region, with a particular emphasis on pharmaceutical research and development. Our analysis indicates an upsurge in the overall research activity of 3D printing technology but there is limited progress in pharmaceuticals research and development. While the MENA region still lags, there is evidence of the regional interest in expanding the 3D printing technology applications in different sectors including pharmaceuticals. 3D printing holds great promise for pharmaceutical development within the MENA region and its advancement will require a strong collaboration between academic researchers and industry partners in parallel with drafting detailed guidelines from regulatory authorities.

An Advanced Quality Assessment and Monitoring of ESA Sentinel-1 SAR Products via the CyCLOPS Infrastructure in the Southeastern Mediterranean Region

The Cyprus Continuously Operating Natural Hazards Monitoring and Prevention System, abbreviated CyCLOPS, is a national strategic research infrastructure devoted to systematically studying geohazards in Cyprus and the Eastern Mediterranean, Middle East, and North Africa (EMMENA) region. Amongst others, CyCLOPS comprises six permanent sites, each housing a Tier-1 GNSS reference station co-located with two calibration-grade corner reflectors (CRs). The latter are strategically positioned to account for both the ascending and descending tracks of SAR satellite missions, including the ESA’s Sentinel-1. As of June 2021, CyCLOPS has reached full operational capacity and plays a crucial role in monitoring the geodynamic regime within the southeastern Mediterranean area. Additionally, it actively tracks landslides occurring in the western part of Cyprus. Although CyCLOPS primarily concentrates on geohazard monitoring, its infrastructure is also configured to facilitate the radiometric calibration and geometric validation of Synthetic Aperture Radar (SAR) imagery. Consequently, this study evaluates the performance of Sentinel-1A SAR by exploiting the CyCLOPS network to determine key parameters including spatial resolution, sidelobe levels, Radar Cross-Section (RCS), Signal-to-Clutter Ratio (SCR), phase stability, and localization accuracy, through Point Target Analysis (PTA). The findings reveal the effectiveness of the CyCLOPS infrastructure to maintain high-quality radiometric parameters in SAR imagery, with consistent spatial resolution, controlled sidelobe levels, and reliable RCS and SCR values that closely adhere to theoretical expectations. With over two years of operational data, these findings enhance the understanding of Sentinel-1 SAR product quality and affirm CyCLOPS infrastructure’s reliability.

Determination of birth prevalence of sickle cell disease using point of care test HemotypeSC™ at Rundu Hospital, Namibia

BackgroundSickle cell disease (SCD), a noncommunicable disease, has the greatest burden in sub-Saharan Africa. The majority of children (50–90%) with SCD die before their 5th birthday, with approximately 150,000–300,000 annual SCD child deaths in Africa. In developed countries, newborn screening (NBS) has been shown to improve the survival of children with sickle cell disease, with under5 childhood mortality reduced tenfold due to interventions performed before the development of complications. Point –of-care tests have been developed for resource limited settings to expand NBS. The aim of this study was to determine the birth prevalence of sickle cell disease in Namibia using the HemoTypeSC™ point-of-care test.MethodsA cross-sectional descriptive study was carried out at Rundu Intermediate Hospital in the Kavango East Region. Two hundred and two (202) well newborns within 72 h of birth were recruited for the study from 22 February to the 23th March 2023. Descriptive statistics were used to compute the haemoglobin types of the study participants.ResultsThe majority of the participants (n = 105, 52%) were females, and (n = 97,48%) were males. The median age of the participants was 23 h (Q1, Q3; 11; 33),) with an age range of 2–98 h. Sickle cell trait was present in 9.4% of the screened newborns, no homozygous disease was detected, and 90.6% had Hb AA.ConclusionsThis study is the first to measure HbS gene carriage at birth using HemotypeSC point-of-care testing in Namibia. There was a moderate prevalence of sickle cell traits but no SCD. This baseline study may provide the foundation for larger epidemiological surveys to map HbS gene carriage in Namibia to provide evidence for policy makers to fashion appropriate SCD newborn screening services.

Perceptions and knowledge of local people toward an endangered armadillo from the Buenos Aires coast, Argentina

ABSTRACT In a large area used for livestock production in the north east of the Pampas region of Buenos Aires, central Argentina, there is a subpopulation of endangered armadillo species (Chaetophractus vellerosus) which is threatened by mining activities. Knowledge and perception of local communities living in the range of the endangered species were evaluated using an anonymous online questionnaire. A total of 618 questionnaires were filled out, with the majority of respondent (82%) not being aware of the existence of this species. The study documented the lack of knowledge and the need to develop strategies to increase local communities’ awareness toward this species.

Assessment of the technological, physicochemical and microbiological characteristics of the fermented dough used to produce <i>O’moabu</i> in the Eastern region of Burkina Faso

O'moabu is a traditional dough made from fermented cereal dough by the Gourmachema tribe in the East Region of Burkina Faso. The technological, physicochemical and microbiological characteristics of this food, have been poorly documented. This study aimed to evaluate the characteristics of the fermented dough used in the production of O'moabu. Data on production technology were collected through a survey. Physicochemical, microbiological and biochemical analyses were conducted using standard methods. The assessment enabled the generation of a typical production diagram for O'moabu. Concerning physicochemical characteristics, pH ranged from 5.57 ± 0.02 to 6.08 ± 0.02, while titratable acidity varied between 0.41 ± 0.01 and 1.04 ± 0.01 g lactic acid/100 g. Regarding microbiological characteristics, total aerobic mesophilic flora ranged from 1.1x105 ± 27 to 4.6x107 ± 10 CFU/g, yeasts from 5x102 ± 37 to 9.5x104 ± 33 CFU/ g and lactic acid bacteria from 1x104 ± 25 to 6.7x105 ± 27 CFU/g. Morphological and biochemical tests showed that the yeast isolates belonged to the genera Saccharomyces sp. (50%), Candida sp. (18.75%), Torulaspora sp. (25%) and Kluyeverommyces sp. (6.25%). The lactic acid bacteria belonged to the genera Lactobacillus sp. (37.5%), Streptococcus sp. (12.5%), Leuconostoc sp. (25%) and others genera (25%). These yeasts and lactic acid bacteria work in symbiosis to ferment O'moabu dough.

Beijing Winter Olympics and China’s Middle East Diplomacy in the Xi Era

ABSTRACT Sports diplomacy, host diplomacy and pandemic diplomacy intertwined in the Beijing Winter Olympics and jointly served China’s overall diplomacy. The Middle East region has a long history of participation in the Winter Olympics. A total of seven Middle East countries, including Turkey, Cyprus, Israel, Lebanon, Saudi Arabia, Morocco and Iran, participated in Beijing Winter Olympics, while Israel and Iran participated in the Beijing Paralympic Winter Games. Middle East countries generally help China break the politicization of the Winter Olympics from other countries. Thanks to the Beijing Winter Olympics, Chinese president and leaders of Middle East countries met offline for the first time since the outbreak of the COVID-19 pandemic, which is also conducive to the new development of relations between China and the Middle East in the post-pandemic era. The leaders of Egypt, the UAE and Qatar also took the opportunity of attending the opening ceremony of the Beijing Winter Olympics to hold their own meetings, which is conducive to the further repair of the relations among these countries since the Qatar diplomatic crisis. The Beijing Winter Olympics objectively set up a platform to promote the easing of crisis issues in the Middle East.

Impact of COVID-19 pandemic on food availability and affordability: an interrupted time series analysis in Ghana

BackgroundIn Africa, approx. 675 million people were at risk of food insecurity. COVID-19 pandemic is likely to have exacerbated this situation, by damaging populations’ access to and affordability of foods. This study is aimed at estimating the impacts of the COVID-19 pandemic on availability and prices of essential food commodities at 20 large markets in Ghana.MethodsData on food availability and food retail prices collected through weekly market-level data during the period from July 2017 to September 2020 were used in this study. We performed interrupted time-series analyses and estimated the percentage increases between the observed and predicted food prices by food group and by region to assess the impact of COVID-19 pandemic on food prices.ResultsAs a result, the impact of COVID-19 on food availability was limited. However, the results of interrupted time-series analyses indicate a significant increase in overall mean food prices in Greater Accra, Eastern and Upper East regions. It was also found that mean price of starchy roots, tubers and plantains significantly increased across regions.DiscussionThe impact of COVID-19 pandemic on food availability and prices was significant but varied by food type and regions in Ghana. Continuous monitoring and responses are critical to maintain food availability and affordability.

Regional perspectives on patient safety policies and initiatives: a focus group study with patient safety leaders in the Middle East and Asian regions

Preventing and reducing risks and harm to patients is of critical importance as unsafe care is a leading cause of death and disability globally. However, the lack of consolidated information...

An empirical analysis of the social contract in the Middle East and North Africa region and the role of digitalization in its transformation

AbstractThis paper presents an empirical analysis of the social contract (SC) in MENA based on a simple model synthesizing three main characteristics of a SC linking governments and citizens: Participation, Protection, and Provision. Using this 3‐P framework, we focus on the role of provision and protection in determining citizen participation, a question that drew much attention following the recent economic and social developments in MENA. We compare our characterization of the SC in MENA and Organisation for Economic Co‐operation and Development (OECD) countries and find robust empirical evidence that, in MENA, the benefits provided to citizens through improved delivery of basic services have come at the cost of impaired participation. We also find that digital transformation, a potential channel through which the SC may improve, has an inversely U‐shaped effect suggesting that institutional changes are called for in MENA countries before their SC is comparable to that of OECD countries.

Recent and projected changes in climate patterns in the Middle East and North Africa (MENA) region

Observational and reanalysis datasets reveal a northward shift of the convective regions over northern Africa in summer and an eastward shift in winter in the last four decades, with the changes in the location and intensity of the thermal lows and subtropical highs also modulating the dust loading and cloud cover over the Middle East and North Africa region. A multi-model ensemble from ten models of the Coupled Model Intercomparison Project—sixth phase gives skillful simulations when compared to in-situ measurements and generally captures the trends in the ERA-5 data over the historical period. For the most extreme climate change scenario and towards the end of the twenty-first century, the subtropical highs are projected to migrate poleward by 1.5°, consistent with the projected expansion of the Hadley Cells, with a weakening of the tropical easterly jet in the summer by up to a third and a strengthening of the subtropical jet in winter typically by 10% except over the eastern Mediterranean where the storm track is projected to shift polewards. The length of the seasons is projected to remain about the same, suggesting the warming is likely to be felt uniformly throughout the year.

Unlocking Economic Resilience: A New Methodological Approach and Empirical Examination under Digital Transformation

Economic resilience is crucial for urban sustainability as it ensures stability and growth in the face of external shocks, promotes social cohesion and inclusivity, fosters environmental sustainability, and enhances cities’ adaptability to future challenges. This study expands the conventional perspective on economic resilience beyond the context of shocks, focusing on the inherent resilience of regional economic systems. A novel method for quantifying economic resilience is introduced, emphasizing system sensitivity and adaptability. Using Chinese prefecture-level city data and an econometric model, we empirically examine how Fintech, a major digital transition in current urban systems, affects economic resilience. The findings reveal that Fintech has a substantial positive effect on economic resilience, primarily through the upgrading of industrial structures and technological innovation. Furthermore, there is significant regional heterogeneity in the impact of Fintech on economic resilience, with more pronounced contributions in the east, central, and western regions of China, as opposed to the northeast. Additionally, the impact of Fintech on economic resilience is more substantial in large-scale cities. The promotion of economic resilience through digital transformation serves as a potent risk prevention measure. Understanding the role of economic resilience in urban systems holds valuable implications for countries worldwide.

Appraisal of groundwater quality and hydrochemistry in three regions of Ghana: Implications for drinking purposes

Groundwater is the most relied upon source of water for rural areas and small communities with no access to national water systems. The Community Water and Sanitation Agency (CWSA) in Ghana is an institution that facilitates the provision of water and sanitation services to small towns and communities, hence it has engineered several boreholes all over the country. However, some of these boreholes have quality challenges. Hence this study was carried out to assess the quality and hydrochemical controls of such boreholes in the Ashanti, Upper East and Central Regions of Ghana. A total of 45 boreholes were sampled across these areas and subjected to physicochemical, microbial, and heavy metal analysis. Analysis of the groundwater in the Ashanti Region indicates that its quality is negatively impacted by its iron, manganese, and arsenic content. Same was observed for the Central Region. While in the Upper East Region, total hardness, fluoride, nitrate, and arsenic are the parameters that impact the groundwater quality greatly. Water quality index was used to assess the suitability of the groundwater for domestic purposes and based on this index, 80 % of the water samples were classified as either having an excellent or good quality, while about 7 % were classified as unsuitable for domestic purposes, across all regions. The suitability of the groundwater for irrigational purposes was assessed using sodium adsorption ratio (SAR), percentage sodium (% Na), and Kelly's index (KI). Based on SAR and % Na, all the water samples were suitable for irrigation, while 9 % were unsuitable based on KI. This study provides a comprehensive information on some of the CWSA boreholes with quality challenges. This kind of information is critical and useful when considering what options and treatment technologies would be suitable to address the challenges that these boreholes have.

Green Revolution and Sustainability Impact in the Indian Economy

This work assesses the Indian economy by evaluating the environment, economy, and society. It determines the Green Revolution’s impact on sustainability. Sustainability analysis is wide-ranging and, in its scope, it exposes uneven sustainability prospects across regions, whereby the South region demonstrates environmental resilience that is higher than the North and East regions. The environmental indicators such as soil management, water management and biodiversity are moderately good or good in case of South region. However, the region of East and North have environmental degradation in varying degrees. On the economic side, different metrics are used to show the discrepancies between smallholders and large-scale farmers which means that the former have a lower standard of living and a lack of access to the market. Social indexes emphasise the concept of inequality and insecurity of the North and East region. So, these policies demand the formulation of inclusive policies and targeted programmes in order to rectify the socioeconomic disparities. Therefore, the research reaffirms the significant role of region-specific solutions along with the adoption of up-to-date technologies and progressive developmental strategies in promoting Indian agriculture's progressive transformation.

Entrepreneurship education, digital literacy and computational thinking insights for business sustainability among housewives

Introduction. Development of digital literacy and computational thinking among housewives lie in its potential to address a critical gap in the understanding of digital education and empowerment. This study seeks to ascertain the viability of family enterprises based on digital marketing. In detail, this study examines the relationship between entrepreneurship education, digital literacy, and business sustainability through computational thinking. Study participants and methods. This research involved a quantitative approach using a self-administered survey method. The population in this study were housewives in several regions in Indonesia and the data will be analyzed using partial least square structural equation modeling (PLS-SEM). Sumatra, Java, and Bali homemakers participated in this study. The three islands represent Indonesia's west, center, and east regions. We offered 350 Google Forms questions sent via WhatsApp. Results. The results indicates that entrepreneurship education has a significant effect on business sustainability (t-value =16.620, p-value =.000), and computational thinking skills (t-value =10.916, p-value =.000). In addition, digital literacy has a significant effect on business sustainability (t-value =4.612, p-value =.000), and computational thinking skills (t-value =3.738, p-value =.000). Later, there is robust link between computational thinking and business sustainability (t-value =3.712, p-value =.000). The mediating estimation indicates that computational thinking can mediate the connectivity between entrepreneurship education and business sustainability (t-value =3.398, p-value =.001), as well as digital literacy and business sustainability (t-value =2.516, p-value =.012). Conclusion. Empowering housewives with entrepreneurship education, digital literacy, and computational thinking holds practical significance in managing their business and community development. This research extends beyond housewives empowerment to potential policy assistance and housewives educational reforms to build inclusive business matters.

Proteomic analysis and lethality of the venom of Aegaeobuthus nigrocinctus, a scorpion of medical significance in the Middle East

The scorpion Aegaeobuthus nigrocinctus inhabits areas in Turkey and the Levant region of the Middle East where severe/lethal envenomings have been reported. Previous research indicated its extreme venom lethality to vertebrates and distinct envenomation syndrome. We report on the composition of A. nigrocinctus venom from Lebanese specimens using nESI-MS/MS, MALDI-TOF MS, SDS-PAGE and RP-HPLC. Venom lethality in mice was also assessed (LD50 = 1.05 (0.19–1.91) mg/kg, i.p), confirming A. nigrocinctus venom toxicity from Levantine populations. Forty-seven peaks were resolved using RP-HPLC, 25 of which eluted between 20 and 40 % acetonitrile. In reducing SDS-PAGE, most predominant components were <10 kDa, with minor components at higher molecular masses of 19.6, 26.1, 46.3 and 57.7 kDa. MALDI-TOF venom fingerprinting detected 20 components within the 1,000–12,000 m/z range. Whole venom ‘shotgun’ bottom-up nLC-MS/MS approach, combined with in-gel tryptic digestion of SDS-PAGE bands, identified at least 67 different components belonging to 15 venom families, with ion channel-active components (K+ toxins (23); Na+ toxins (20); Cl− toxins (2)) being predominant. The sequence of a peptide (named α-KTx9.13) ortholog to Leiurus hebraeus putative α-KTx9.3 toxin was fully determined, which exhibited 81–96 % identity to other members of the α-KTx9 subfamily targeting Kv1.x and Ca2+-activated K+ channels. Chlorotoxin-like peptides were also identified. Our study underscores the medical significance of A. nigrocinctus in the region and reveals the potential value of its venom components as lead templates for biomedical applications. Future work should address whether available antivenoms in the Middle East are effective against A. nigrocinctus envenoming in the Levant area.

Expatriate Academics’ Positive Affectivity and Its Influence on Creativity in the Workforce Indigenization Context: Revealing the Role of Perceived Fairness

Workforce indigenization in Gulf Corporation Council (GCC) countries is under-researched in international business literature, especially among expatriate academics from the Middle East and North Africa regions working in GCC countries. Therefore, drawing from the social exchange and conservation of resources theories, this study examines the moderating effect of perceived fairness on the relationship between positive affectivity (PA) and creativity in the context of enhanced indigenization of human resource (HR) policies in GCC countries. This study collects data from 228 mobile academics working in Saudi universities. Principal least squares structural equation modeling results show that PA positively impacts creativity. Further, perceived fairness is found to reinforce the connection between PA and creativity. This study’s results indicate that host universities must build appealing HR policies to cope with the diverse challenges related to the indigenization of HR policies. Furthermore, this study highlights the role of positive personality traits in enhancing creativity.

Impact of COVID-19 on Management and Outcomes of Oncology Patients: Results of MENA COVID-19 and Cancer Registry (MCCR).

Despite extensive studies of the impact of COVID-19 on patients with cancer, there is a dearth of information from the Middle East and North Africa (MENA) region. Our study aimed to report pertinent MENA COVID-19 and Cancer Registry (MCCR) findings on patient management and outcomes. MCCR was adapted from the American Society of Clinical Oncology COVID-19 Registry to collect data specifically from patients with cancer and SARS-CoV-2 infection from 12 centers in eight countries including Saudi Arabia, Jordan, Lebanon, Turkey, Egypt, Algeria, United Arab Emirates, and Morocco. The Registry included data on patients and disease characteristics, treatment, and patient outcomes. Logistic regression was used to assess associations with mortality. Between November 29, 2020, and June 8, 2021, data were captured on 2008 patients diagnosed with COVID-19 from the beginning of the pandemic. Median age was 56 years (16-98), 56.4% were females, and 26% were current or ex-smokers. Breast cancer (28.5%) was the leading diagnosis and 50.5% had metastatic disease. Delays of planned treatment (>14 days) occurred in 80.3% for surgery, 48.8% for radiation therapy, and 32.9% for systemic therapy. Significant reduction in the delays of all three treatment modalities occurred after June 1, 2020. All-cause mortality rates at 30 and 90 days were 17.1% and 23.4%, respectively. All-cause mortality rates at 30 days did not change significantly after June 1, 2020; however, 90-day mortality increased from 33.4% to 42.9% before and after that date (p = 0.015). Multivariable regression analysis showed the following predictors of higher 30- and 90-day mortality: age older than 70 years, having metastatic disease, disease progression, and being off chemotherapy. Patients with cancer in the MENA region experienced similar risks and outcome of COVID-19 as reported in other populations. Although there were fewer treatment delays after June 1, 2020, 90-day mortality increased, which may be attributed to other risk factors such as disease progression or new patients who presented with more advanced disease.

Achieving environmental sustainability goals through capitalizing on renewable energy channels: Role of green finance, resources productivity and geopolitical situation in the MENA region

Environmental sustainability is essential to the country's financial position and economic growth. Geopolitical situations and green activities significantly contribute to enhancing sustainable development goals. The purpose of this study is to evaluate the impact of green finance, investment in renewable energy sources and geopolitical risk on the environmental sustainability of the Middle East and North America (MENA) region over the period 2000–2021. When using a cross‐sectional dependence autoregressive distributed lag model (CS‐ARDL), it is discovered that a rise in geopolitical risk will decrease environmental performance in the form of carbon dioxide emission. At the same time, the other factors (green finance and investment in renewable energy) have a positive relationship with sustainability. This observation can be ascribed to the association between increased geopolitical risk and the inclination of crude oil consumers, who are most affected by such risk, to contemplate renewable energy as an alternative to conventional energy sources. This finding could also be attributed to the fact that clean energy is becoming more affordable. In addition, the augmented mean group model findings provide more evidence that a negative linkage is found between geopolitical risk and environmental sustainability. The findings have repercussions for regulators as well as investors who are active in the renewable energy markets.

Infective Endocarditis in North Africa and the Middle East, 1990‒2019: Updates from the Global Burden of Disease Study 2019.

Infective endocarditis (IE), a severe and economically impactful condition, lacks substantial epidemiological data in the North Africa and Middle East (NAME) region. This study focused on analyzing the trends and burden of IE in NAME from 1990 to 2019, taking into account factors like age, gender, and socio-demographic index (SDI). The Global Burden of Disease data from 1990 to 2019 was retrieved from the Institute for Health Metrics and Evaluation (IHME) website. Between 1990 and 2019, the age-standardized rates (ASR) for IE incidence increased by 59%, and prevalence and years lived with disability (YLDs) rose by 12% and 9%, respectively, while the ASRs for deaths, disability-adjusted life years (DALYs), and years of life lost (YLLs) saw reductions of 22%, 34%, and 34% in the NAME region. Death rates among children under five declined by 72%. Gender and the SDI did not significantly influence these changes. Saudi Arabia witnessed the most significant increase in ASR of IE incidence since 1990, while Turkey had the highest rates in 2019. The year 2019 also saw the highest death rate among those aged 70 and over, with over 91000 DALYs from IE. DALYs decreased by 71.5% for children under five from 1990 to 2019 but remained stable for individuals in their seventies. Jordan showed the most notable decrease in ASRs for deaths, DALYs, and YLLs among children under five. This study highlights the changing epidemiology of IE in the NAME region, recommending the establishment of multidisciplinary IE registries, antibiotic prophylaxis guidelines for healthcare-associated IE, and strategies to control antimicrobial resistance as key mitigation measures.