Eastern Mediterranean Region Research Articles

Global epidemiology of early-onset upper gastrointestinal cancer: trend from the Global Burden of Disease Study 2019.

In recent years, there has been a growing incidence of gastrointestinal cancer in young individuals. Despite its significant morbidity and mortality, research on upper gastrointestinal (UGI) cancer in young populations has been relatively limited. Therefore, studies on the epidemiological changes of this cancer are needed. Using data from the Global Burden of Disease Study 2019, we examined the incidence, death, and disability-adjusted life years (DALYs) from UGI cancers in the young, namely, early-onset esophageal cancer (EOEC) and early-onset gastric cancer (EOGC). These results were stratified by sex, geographical region, country, and sociodemographic index. There was a total of 185 140 cases, 120 289 deaths, and 5.70 million DALYs attributable to early-onset UGI cancers globally. From 2010 to 2019, the global incidence, death, and DALYs rates of early-onset UGI cancers decreased. In contrast, the incidence rates increased in both EOEC (+1.15%) and EOGC (+0.21%) in the Eastern Mediterranean region. Over the past decade, the burden of UGI cancer in the young has decreased. However, it has increased in the Eastern Mediterranean region. Further research to elucidate the attributable risk factors in this population is warranted.

International Legal Regulation of Activities of States in the Great Mediterranean Region

INTRODUCTION. In modern international and domestic maritime law, regional fragmentation of legal regulation is becoming more and more noticeable, which, in turn, objectifies and actualizes the formation of complex arrays of legal norms, united by the consistency of the political and legal positions of the contracting states that have national interests in the relevant water area, primarily-coastal states extending their state sovereignty to certain areas of maritime space. In this context, the Greater Mediterranean region should be considered as one of the most important in the world merchant shipping and naval support of international peace and security, as a basin that optimally connects the Atlantic and Indian Oceans from the point of view of logistics, which requires the formation of an appropriate scientific and methodological basis for full implementation of the fundamental principle of international cooperation in the maritime policy of the states of the region.MATERIALS AND METHODS. To substantiate the expediency of singling out the Greater Mediterranean as an independent object of legal regulation, general and special international legal treaties, the domestic legislation of the Mediterranean states, as well as political and legal documents indicating the existence of certain disputes and situations around certain zones of the Mediterranean water area, primarily – in the Eastern Mediterranean region. To obtain reliable and substantiated results of the study, methods of scientific knowledge were used: formal-legal, logical, historical-legal, system-structural analysis. Thus, the formal legal method made it possible to clarify the content and meaning of international legal treaties concluded at different times and aimed at regulating public relations in the maritime sphere. The logical method made it possible to substantiate the need for comprehensive international cooperation of the coastal states of the Greater Mediterranean. With the help of the historical and legal method, an overview was made of both the world, Soviet and Russian practice of applying the norms of domestic and international law on issues related to ensuring international law and order in the Greater Mediterranean region. The logical method made it possible to build the necessary connections and patterns of development of international legal regulation in the Greater Mediterranean region in the general context of ongoing universal and regional political and legal processes and transformations. Using the method of system-structural analysis, it was possible to display a holistic picture of law-making and law enforcement of the Mediterranean states, aimed at the formation of unified principles and norms for the exercise of the sovereign rights of coastal states.RESEARCH RESULTS. International maritime merchant shipping seems to be a very complex area of public relations with a large number of entities that have different legal status and, accordingly, are related to each other in a very different way.DISCUSSION AND CONCLUSIONS. This work is devoted to the study of the main trends in the development of the Greater Mediterranean region in terms of formulating key international legal guidelines and rules of conduct for its constituent states. The object of the study is the legal relations carried out in the maritime spaces of the Greater Mediterranean as one of the key regions, which, along with its economic and political significance, is an integral zone for the implementation of the national interests of the Russian Federation, extending to the entire World Ocean.

Systematic review and meta-analysis of the prevalence of myopia among school-age children in the Eastern Mediterranean Region.

The recent increase in myopia is a major public health concern worldwide, including in the Eastern Mediterranean Region (EMR). To provide data on the prevalence of myopia among school-age children in the EMR. This study was conducted using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) protocol. We searched the Web of Sciences, Scopus, Index Medicus for the Eastern Mediterranean Region, ProQuest, PubMed, and Medline for studies on the prevalence of myopia in the EMR published from January 2000 to May 2022. The data were analysed using MedCalc version 19.6.1 and myopia was defined as refractive error ≥ 0.50 D. The overall pooled prevalence of myopia was estimated using a random-effects model and its associated 95% confidence intervals. The meta-analysis included 27 quality-assessed studies from 13 countries among 51 111 school-age children. The overall pooled prevalence of childhood myopia from 2000 to 2022 was 5.23%, which was significantly higher among females than males (4.90% vs 3.94%). The prevalence of myopia was significantly higher among children aged 11-17 years than among those aged 5-10 years (7.50% vs 3.90%). There was a higher prevalence of myopia with cycloplegic refraction than noncycloplegic refraction (5.95% vs 3.73%). There was highly significant heterogeneity between the studies. Prevalence of myopia among school-age children in the EMR was high, particularly among older children, and it was more common among females. Early intervention to slow myopia progression is essential in the EMR to protect children from irreversible vision loss.

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

Violence against children constitutes a significant public health problem globally. To document and compare media reports of violence against children before and during COVID-19, and measures taken by countries to address such violence. 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. 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. 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.

Resistance of Phyllocoptruta oleivora (Acari: Eriophyidae) to acaricides in Turkey

Phyllocoptruta oleivora (Ashmead) (Acari: Eriophyidae) is a significant pest. The use of pesticides is the main strategy for its control and it has increased year by year. However, citrus growers stated that the effects of the acaricides have decreased in recent years. In order to determine whether this is due to resistance, P. oleivora populations were collected from Erdemli (Mersin), Karataş, Kozan, Yüreğir (Adana), and Balcalı (as a susceptible) in Turkey. Adults were bioassayed with abamectin, sulfur, spirodiclofen, and pyridaben, which are widely used and have different modes of action. Based on the bioassay experiments, the most resistant population to abamectin was found to be that from Kozan with 25.31-fold, and the population with the lowest resistance was determined to be that from Yüreğir with 8.13-fold both compared to susceptible population. All populations showed low resistance against sulfur, the highest resistance ratio to sulfur was found in Yüreğir with 2.53-fold. The highest resistance population against spirodiclofen was detected in Erdemli with 24.00-fold, followed by Karataş, Yüreğir, and Kozan populations with 15.39, 14.05, and 9.21-fold, respectively. The resistance ratios of P. oleivora populations against pyridaben were found to be 30.30, 15.85, 10.10, and 7.55-fold in Erdemli, Kozan, Yüreğir, and Karataş, respectively. The detected status of acaricide resistance indicates that this phenomenon takes place and should be a concern in the Eastern Mediterranean Region of Turkish populations of P. oleivora requiring monitoring and planning of resistance management strategies. The use of acaricides with different modes of action in sequential spraying is essential to prevent the development of resistance.

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.

Cryptic diversity and phylogeographic patterns of Mediodactylus species in the Eastern Mediterranean region

Cryptic diversity poses a great obstacle in our attempts to assess the current biodiversity crisis and may hamper conservation efforts. The gekkonid genus Mediodactylus, a well-known case of hidden species and genetic diversity, has been taxonomically reclassified several times during the last decade. Focusing on the Mediterranean populations, a recent study within the M. kotschyi species complex using classic mtDNA/nuDNA markers suggested the existence of five distinct species, some being endemic and some possibly threatened, yet their relationships have not been fully resolved. Here, we generated genome-wide SNPs (using ddRADseq) and applied molecular species delimitation approaches and population genomic analyses to further disentangle these relationships. Τhe most extensive nuclear dataset, so far, encompassing 2,360 loci and ∼ 699,000 bp from across the genome of Mediodactylus gecko, enabled us to resolve previously obscure phylogenetic relationships among the five, recently elevated, Mediodactylus species and to support the hypothesis that the taxon includes several new, undescribed species. Population genomic analyses within each of the proposed species showed strong genetic structure and high levels of genetic differentiation among populations.

Antimicrobial resistance, virulence potential and genomic epidemiology of global genomes of the rare Salmonella enterica serovar Orion.

Our aim is to characterize through whole-genome sequencing (WGS) the antimicrobial resistance (AMR) and heavy metal tolerance (HMT) genes content, plasmid presence, virulence potential and genomic diversity of the rare non-typhoid Salmonella enterica serovar Orion (S. Orion) from 19 countries of the African, American, Eastern Mediterranean, European, Southeastern Asia and Western Pacific regions. Totally 324 S. Orion genomes were screened for AMR, HMT and virulence genes, plasmids and Salmonella Pathogenicity Islands (SPIs). Genomic diversity was investigated using Multi-Locus Sequence Typing (MLST) and core-genome MLST (cgMLST). Efflux pump encoding genes mdsA and mdsB were present in all genomes analysed, while quinolone chromosomal point mutations and aminoglycoside, beta-lactam, colistin, lincosamide, macrolide, phenicol, sulphonamide, trimethoprim, tetracycline and disinfectant resistance genes were found in 0.3%-5.9%. A total of 17 genomes (5.2%) from Canada, the United Kingdom, the USA and Tanzania showed a potential multi-drug resistance profile. Gold tolerance genes golS and golT were detected in all genomes analysed, while arsenic, copper, mercury, silver and tellurium tolerance genes were found in 0.3%-35.5%. Col(MGD2) was the most frequently detected plasmid, in 15.4% of the genomes. Virulence genes related to adherence, macrophage induction, magnesium uptake, regulation, serum resistance, stress adaptation, type III secretion systems and six SPIs (1, 2, 3, 4, 5, 9, 12, 13, 14 and C63PI) were detected. ST639 was assigned to 89.2% of the S. Orion genomes, while cgMLST showed core-genome STs and clusters of strains specific by countries. The high virulence factor frequencies, the genomic similarity among some non-clinical and clinical strains circulating worldwide and the presence of a strain carrying a resistance gene against a last resource antimicrobial like colistin, highlight the potential risk of S. Orion strains for public health and food safety and reinforce the importance to not underestimate the potential hazard of rare non-typhoid Salmonella serovars.

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.

1092: Call for action: The need for an incident learning system in Eastern Mediterranean Region and Turkey

1092: Call for action: The need for an incident learning system in Eastern Mediterranean Region and Turkey

Effect of plant density on total oil quality and fatty acid compositions in peanut (Arachis hypogaea L.) cultivars

Research in the Eastern Mediterranean Transition Region of Türkiye has demonstrated that plant density impact yield of peanut (Arachis hypogaea L.) cultivars differentially. It is suspected that interactions of plant density and cultivar could also impact oil quality and fatty acid composition when grown in this region. This topic has not been addressed in the country; therefore, the objective of this research was to determine if plant density can affect those variables. The study was conducted in 2020 and 2021 in the zone of Osmaniye to determine total oil content of kernels, and contents of oleic acid, palmitic acid, arachidonic acid, linoleic acid, stearic acid, and lignoceric acid, as well as iodine value and oleic/linoleic ratio for the cultivars Halisbey, Rigel, Aysehanım, NC 7, and Masal. Plant response was in most instances different regardless of plant populations made up of a single row planting pattern with rows spaced 70 cm apart (95.000 plants ha-1) compared with a twin row planting pattern with rows spaced 20 cm apart on 90 cm centers with an intra-row distance of 15 cm (148.000 plants ha-1). It is concluded that no differences in oil quality and fatty acid composition were noted when comparing cultivars established at various combinations of planting pattern and plant population, but there were notable differences among the cultivars.

Rainfall forecasting in arid regions in response to climate change using ARIMA and remote sensing

Climate changes in increasing at alarming rates which caused outward changes in the hydrological cycle parameters such as temperature and precipitation. The spatial and temporal distribution of rainfall has changed all over the world. Rainfall forecasting is considered an important tool that could help decisionmakers for managing water resources. Syria is facing several drought events that may affect its water resources. Due to the lack of available rainfall data from land stations in Syria after the civil war started in 2010 till now, one of the aims of this study is to depend on rainfall data from satellite images after correcting these data using the available land stations data. This study also aims to assess rainfall trends in Syria due to climate change and forecasting rainfall. The rainfall data were collected from 71 land stations from 1991 to 2009. Satellite images from Climate Data Record (CDR) were downloaded from 1983 to 2020 and ArcMap was used to extract rainfall data at locations of land stations. The extracted rainfall data from satellite images were corrected by land stations data from 1991 to 2009. Then Statistical Package for the Social Sciences (SPSS) program with Auto-Regressive Integrated Moving Average (ARIMA) models are used to fit and forecasting rainfall in Syria. The rainfall trends at the studied stations were analyzed for 40 years (1983–2022) and a forecast of one year is conducted. The results showed decreasing trends at all the stations that lead to a decrease the quantity of water received every year which could affect the water resources in Syria and agriculture and food security will be also affected. The results are consistent with Intergovernmental Panel on Climate Change (IPCC) reports that concluded a decrease in rainfall at southern and eastern Mediterranean regions. The results of the current study could help in the management of water resources in Syria and forecasting using ARIMA is recommended for rainfall predictions.

Infection-related severe maternal outcomes and case fatality rates in 43 low and middle-income countries across the WHO regions: Results from the Global Maternal Sepsis Study (GLOSS).

The highest toll of maternal mortality due to infections is reported in low and middle-income countries (LMICs). However, more evidence is needed to understand the differences in infection-related severe maternal outcomes (SMO) and fatality rates across the WHO regions. This study aimed to compare the burden of infection-related SMO and case fatality rates across the WHO regions using the Global Maternal Sepsis Study (GLOSS) data. GLOSS was a hospital-based one-week inception prospective cohort study of pregnant or recently pregnant women admitted with suspected or confirmed infection in 2017. Four hundred and eight (408) hospitals from 43 LMICs in the six WHO regions were considered in this analysis. We used a logistic regression model to compare the odds of infection-related SMOs by region. We then calculated the fatality rate as the proportion of deaths over the total number of SMOs, defined as maternal deaths and near-misses. The proportion of SMO was 19.6% (n = 141) in Africa, compared to 18%(n = 22), 15.9%(n = 50), 14.7%(n = 48), 12.1%(n = 95), and 10.8%(n = 21) in the Western Pacific, European, Eastern Meditteranean, Americas, and South-Eastern Asian regions, respectively. Women in Africa were more likely to experience SMO than those in the Americas (aOR = 2.41, 95%CI: [1.78 to 2.83]), in South-East Asia (aOR = 2.60, 95%CI: [1.57 to 4.32]), and the Eastern Mediterranean region (aOR = 1.58, 95%CI: [1.08 to 2.32]). The case fatality rate was 14.3%[3.05% to 36.34%] (n/N = 3/21) and 11.4%[6.63% to 17.77%] (n/N = 16/141) in the South-East Asia and Africa, respectively. Infection-related SMOs and case fatality rates were highest in Africa and Southeast Asia. Specific attention and actions are needed to prevent infection-related maternal deaths and severe morbidity in these two regions.

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.

Healers that hurt: a scoping review of media reports of cases of rape in healthcare settings

BackgroundSexual assault occurring within healthcare settings represents a significant breach of public trust. This scoping review aimed to highlight the profile of people raped, those who committed the rape within the health facilities, and the legal actions taken to resolved cases.MethodsMedia-reported data on incidents of rape in healthcare settings were collected. The search was conducted in May and June 2023, focusing on English-language publications with accessible full texts. Reports that lacked information on the survivors or incidents that occurred outside of healthcare settings were excluded. Descriptive statistics were used to summarize the categories of the collected publications, and graphical representations were employed for visualization purposes.ResultsA total of 62 cases were retrieved, originating from Africa (n = 17; 27.4%), Europe (n = 14; 22.6%), Southeast Asia (n = 14; 22.6%), the Americas (n = 11; 17.7%), the Western Pacific Region (n = 5; 8.1%) and Eastern Mediterranean region (n = 1; 1.6%). In addition, 69 individuals were implicated in 59 cases. They were 31 doctors (44.9%), 17 (24.6%) nurses, four (5.8%) nurse/healthcare assistants, three (4.3%) cleaners/ward boy, two (2.9%) traditional medical doctors, and two (2.9%) security guards. Others included six (8.7%) staff members without designations and one (1.4%) ambulance driver. All perpetrators were male, ranging in age from 22 to 67 years. There were 66 victims identified in the 62 cases with age ranging from 2 to 92 years. Except for one case, all victims were female, and all but one case were patients. Most assaults occurred in consulting rooms/clinics (n = 21; 31.8%), 16 (24.2%) happened under sedation, and six (9.1%) were repeatedly raped, Survivors typically reported the cases the police (n = 12; 19.4%), family/friends (n = 11; 17.7%) or to hospital authorities (n = 10; 16.1%). Out of the 69 perpetrators, 19 (30.6%) were imprisoned with sentences ranging from 12 months to an indefinite period and one (1.6%) received a death sentence.ConclusionThe raping of patients by healthcare providers within healthcare settings calls for urgent and extensive measures. Stakeholders in healthcare management need to prioritize raising awareness about the problem, implement robust prevention and reporting strategies, and create healthcare environments that are safe, respectful, and supportive for all individuals seeking care.

Text mining of hypertension researches in the west Asia region: a 12-year trend analysis

More than half of the world population lives in Asia and hypertension (HTN) is the most prevalent risk factor found in Asia. There are numerous articles published about HTN in Eastern Mediterranean Region (EMRO) and artificial intelligence (AI) methods can analyze articles and extract top trends in each country. Present analysis uses Latent Dirichlet allocation (LDA) as an algorithm of topic modeling (TM) in text mining, to obtain subjective topic-word distribution from the 2790 studies over the EMRO. The period of checked studied is last 12 years and results of LDA analyses show that HTN researches published in EMRO discuss on changes in BP and the factors affecting it. Among the countries in the region, most of these articles are related to I.R Iran and Egypt, which have an increasing trend from 2017 to 2018 and reached the highest level in 2021. Meanwhile, Iraq and Lebanon have been conducting research since 2010. The EMRO word cloud illustrates ‘BMI’, ‘mortality’, ‘age’, and ‘meal’, which represent important indicators, dangerous outcomes of high BP, and gender of HTN patients in EMRO, respectively.

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.

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

Using social media surveys and interventions to address vaccine hesitancy in Saudi Arabia

Background: Countering COVID-19 vaccine hesitancy has been a challenge in Saudi Arabia, one of the countries affected most by the pandemic in the Eastern Mediterranean Region. Aims: To identify information needs, perceived benefits, concerns, trusted information sources, social norms, and predictors for COVID-19 vaccine uptake in Saudi Arabia and identify effective messaging strategies to increase vaccination intentions among the unvaccinated. Method: Between March and April 2021, we conducted an online cross-sectional survey (N = 2883), and in part, a randomized experiment for unvaccinated participants (n = 675) in Saudi Arabia using Facebook Ads and Messenger. Unvaccinated participants were randomly assigned to 1 of 5 message conditions and after message exposure, participants were asked if they planned to take the COVID-19 vaccine. Results: In total, 2883 adults participated in the survey. All message framings worked equally well, with no statistically significant difference between the arms. Approximately 80% of the participants across all message conditions said they intended to vaccinate. However, participants wanted to know more about the vaccines; about 35% wanted to know more about vaccine efficacy, 31.5% about safety, 26.8% about health authority’s recommendation, and 3.7% about where to get the vaccines. Health workers (61.4%) and scientists and epidemiologists (25.7%) were the most trusted sources. Others were family members (7.5%), community leaders (2.2%), religious leaders (1.6%), friends (1.4%), and celebrities and social media influencers (0.2%). Conclusion: Vaccine hesitancy can be overcome by understanding individuals’ decision-making processes and using effective risk communication targeted to their needs.

Investing in a healthier future for women in the Eastern Mediterranean Region

Investing in a healthier future for women in the Eastern Mediterranean Region