Middle East And North Africa Region Research Articles

The burden of cirrhosis and other chronic liver disease in the middle east and North Africa (MENA) region over three decades

BackgroundCirrhosis comprises a significant health challenge in the Middle East and North African (MENA) region impacting healthcare systems and communities. This study sought to investigate trends in the burden of cirrhosis and other chronic liver disease, different etiologies, deaths, and the disability burden utilizing data from the Global Burden of Disease (GBD) database.MethodsAnalyzing epidemiological trends from 1990 to 2021 across 21 MENA countries, this research utilized data on age-standardized incidence rates (ASIR), age-standardized death rates, and age-standardized disability-adjusted life years (DALYs) to evaluate the burden of cirrhosis and other chronic liver disease. The study also examined national variations and sociodemographic relationships.ResultsThe study identified a 114.9% increase in cirrhosis and other chronic liver disease incidence within the MENA region between 1990 and 2021, with 7,344,030 incident cases reported in 2021. The ASIR showed a steeper rise in females (9.6%) compared to males (7.0%). Etiology-specific analysis revealed an increase in the ASIR for MASLD related cirrhosis and other chronic liver disease by 22.2%, while those due to alcohol as well as hepatitis B and C decreased by 28.1%, 59.3%, and 30%, respectively. Despite the rising incidence, overall age-standardized death rates across all etiologies decreased by 54.3%, with DALYs showing a 51.4% decrease during the same period. Country-specific trends varied significantly, with Oman recording the highest annual ASIR increase (0.64%), and Qatar observing the most substantial annual reduction in age-standardized death rates (-2.88%).ConclusionThe study highlights evolving trends in cirrhosis and other chronic liver disease within the MENA region, emphasizing the necessity for comprehensive, etiology, and gender-specific interventions. Despite an increasing incidence, the observed improvements in mortality rates and age-standardized disability burden indicate progress in public health efforts to mitigate cirrhosis’s impact. These findings point to the complex nature of cirrhosis outcomes and the urgent need for tailored strategies to manage its increasing burden effectively.

Clinico-demographic profile of burns in the Middle-East and North-Africa (MENA) region: a systematic review and meta-analysis

Burn injuries remain a public health issue with risk of mortality and multiple post-burn morbidities. This article aims to systematically review and meta-analyse data about burns in the Middle-East and North-Africa (MENA) region. Methods Pubmed, Web of Science, Scopus, Global Index Medicus, Cochrane Library and Google scholar data were searched from their dates of inception till April 2024. Results One hundred and one studies were included in this review, representing data from twelve countries in the region. Data was sub-grouped into two groups: pediatric group and emergency room (ER) group. The pooled random-effect estimates were male gender 58.6% [95% CI 56.9–60.2%], accidental injury 91.1% [95% CI 85.9–94.5%], scald burn 50% [95% CI 46.7–53.4%], at home injury 79.9% [95% CI 76.7–82.8%], upper limbs involvement 51.7% [95% CI 46.8–56.6%], mean body surface area burned (BSAB) 17.2% [95% CI 14.69–19.84%], second-degree burns 56.5% [95% CI 49–63.8%], length of stay 11.18 days [95% CI 9.68–12.68%] and mortality rate 9.1% [95% CI 7.5–11%]. All included studies were of good quality. Conclusion This review shows scarcity of studies from many countries in the MENA region. These data will inform policy makers and burn specialists about the extent of this public issue in the region.

Factors in the Decline of U.S. Agricultural Imports in the MENA Region

The Middle East and North Africa (MENA) region stands on a global pivot point, impacting the world through its diverse political and economic dynamics. While often recognized for its complex challenges, the region's food security remains surprisingly under-considered, even though it carries significant global repercussions. This research focuses on a concerning trend: the decline of U.S. agricultural exports to MENA, potentially jeopardizing regional stability and impacting global food systems. While EU competitiveness is acknowledged, this research delves deeper than mere identification of competitors such as the EU, dissecting the interplay of their advantages – superior pricing and yields – against the U.S. approach from a policy-perspective. The paper’s ultimate goal is to highlight how the US has suffered from out-competition from the EU, not simply MENA countries’ diversification, leading to the latter’s collapse as a source of staple crop importations, in order to prevent such drastic changes in the future as the same trend in other industries could provide much more devastating for the US. This analysis can impact US policy and inspire a shift towards more sensible and outcome-oriented spending policies.

Liver Cancer in the Middle East and North Africa: Epidemiology, Trends, and Risk Factors

Objectives: Considering the growing concerns about the rising incidence of this cancer in the Middle East and North Africa (MENA), this literature review presents the local epidemiology and trends of liver cancer, along with a practical estimation of its epidemiology and contributing risk factors. Design: Review Article. Setting(s): Middle East and North Africa. Outcome Measures: MEDLINE (via PubMed), Scopus, and Web of Science databases, as well as Google Scholar, were searched up to September 2024 using representative keywords and MeSH terms. Studies reporting the epidemiology of liver and intrahepatic cholangiocarcinoma in the region or an analysis of the contributing infectious diseases, non-communicable disorders, genetic predispositions, behavioral aspects, and environmental factors were included. A qualitative synthesis was performed, and the results were presented using thematic narrative synthesis. Results: Liver cancer, particularly hepatocellular carcinoma (HCC), is rapidly growing in the MENA region, driven by a combination of viral hepatitis, underlying metabolic disorders, and environmental exposures. Liver cancer epidemiology varies across the region, with countries like Egypt historically burdened by hepatitis C, while Gulf states experience rising cases linked to metabolic disorders. Projections indicate a continued increase in the incidence of liver cancer due to the ongoing obesity and diabetes epidemics. Conclusions: Despite the success of viral hepatitis management campaigns in some countries, the region faces significant challenges in controlling the rising burden of liver cancer related to metabolic disorders. Prevention strategies should focus on lifestyle and dietary interventions, alongside the need for improved cancer registries, better data collection, and policy reforms. A multidisciplinary approach, combining public health initiatives and targeted healthcare improvements, is essential to reduce regional liver cancer incidence and improve outcomes.

Technological Innovation, Trade Openness, Natural Resources, and Environmental Sustainability in Egypt and Turkey: Evidence from Load Capacity Factor and Inverted Load Capacity Factor with Fourier Functions

The environmental degradation in the Middle East and North Africa (MENA) region leads to significant challenges regarding economic sustainability and the attainment of sustainable development goals (SDGs). The extensive use of fossil fuels in the region, as well as rapid urbanization and economic growth, has led to significant carbon emissions, together with unprecedented ecological footprints compromising environmental sustainability. The study aims to elucidate the influence exerted by technological innovation, trade openness, and natural resources on environmental sustainability in Turkey and Egypt for the period 1990–2022. In assessing the empirical relations, the study employed the Fourier function incorporate estimation techniques, that is, Fourier ADF for unit root test, Fourier ARDL, and Fourier NARDL for long-run and short-run elasticities of technological innovation (TI), trade openness (TO,) and natural resources rent (NRR) on load capacity factor (LCF) and inverted LCF (ILCF); finally, the directional causality evaluate through Fourier TY causality test. The results revealed that both Turkey and Egypt have severe environmental problems due to their high carbon emissions and ecological footprints. Technological change and international trade separately negatively affect environmental sustainability; however, these negative impacts have mixed character. On the one hand, technology can improve efficiency and reduce ecological footprints by obviating the use of high-impact processes or allowing cleaner production systems. In the same vein, trade openness helps transfer green technologies more quickly, but it can also lead to unsustainable resource extraction and pollution. The findings of the paper propose that in order to move forward, Turkey and Egypt need strategic policy shifts to ensure environmental sustainability, including transitioning towards renewable energy from fossil fuels while bolstering their capacity for energy efficiency. Policymakers must balance economic development with environmental conservation to reduce the harmful effects of climate degradation and help safeguard continued economic survival in the face of increasing climatic instability. This research helps to inform policy and investment decisions about how the SDGs can be achieved and how they are relevant for sustainable development in the MENA region.

Estimating The Prevalence of Non-Communicable Diseases and Adherence to Dietary Habits And Physical Activity Among Healthcare Professionals in The Middle East And North Africa Regions

The rising number of fatalities linked to food, exercise, and non-communicable illnesses has sparked interest in studying their effects. In society, Healthcare Professionals (HCPs) symbolize health and wellbeing. However, the incidence of chronic illness and healthy habits among Middle East and North Africa (MENA) HCPs remains unclear. To determine the prevalence of chronic diseases and adherence to healthy dietary habits and physical activity among HCPs in the MENA region. Algeria, Egypt, El Yemen, Iraq, Jordan, Kuwait, Libya, Palestine, Saudi Arabia, Sudan, and Syria HCPs (physicians, dentists, nurses, pharmacists, and nutritionists) participated in multicenter cross-sectional research. April to June 2022 data on diet and exercise habits was collected using a pre-tested self-administered questionnaire. Demographics, risk factors, medical history, and nutrition and exercise were included in the questionnaire. HCP diet and exercise were examined using multivariable regression models. A study of 7130 HCPs (mean age 28.6 ± 7.8 years, 57.5% females) was conducted. Physicians held 56.8% of the sample population, followed by pharmacists, nurses, dentists, and nutritionists. Cardiovascular disease (CVD) affected 33.1% of individuals. Alcohol, pork, soda, sugar, and smoking raised the risk of non-communicable diseases. Nutritionists were the most active HCPs. About half of dietitians (45.3%) walked 150 minutes or more per week, while 14.7% and 25.9% did 150 minutes or more of moderate and 75 minutes or more of intense exercise, respectively. HCPs in MENA had high rates of CVD and risk factors such smoking, alcohol, pork, soda, sugar, and less exercise. MENA HCPs must be aware of the significant incidence of these risk factors to enhance health behavior.

The Landscape of Cutaneous T-Cell Lymphoma (CTCL) in the Middle East and North Africa (MENA) and the Establishment of the MENA CTCL Working Group

The high cancer burden in the Middle East and North Africa (MENA region) is coupled with an increasing cancer incidence. While the MENA region constitutes 6% of the world’s population, it remains underrepresented in clinical trials. Cutaneous T-cell lymphomas (CTCLs) represent a heterogeneous group of rare extranodal non-Hodgkin lymphomas with variable clinical presentation. In the MENA region, where darker skin colors are more common than in the West, CTCL generally presents at a younger age and with distinct clinical features that necessitate special expertise and management across disciplines: rare forms of CTCL are more common (hypo- and hyperpigmented MF) and a higher prevalence of pediatric MF is noticed. The multidisciplinary approach to cancer management is growing worldwide and is necessary for the comprehensive management of CTCL. The MENA CTCL group was established with the aim of creating a collaborative environment for the diagnosis and treatment of CTCL in the region. Its first meeting was held in May 2023. The group plans to increase the global representation of the MENA region and establish CTCL registries and patient advocacy groups in the region.

The Effect of ICT Usage on Economic Growth in the MENA Region: Does the Level of Education Matter?

This paper examines the effect of information and communication technology (ICT) usage on economic growth in the Middle East and North Africa (MENA) region, with a focus on how education levels modulate this relationship. Covering data from 2000 to 2020 and employing a panel ARDL model for analysis, this research finds that, while ICT is prevalent across MENA, its impact on economic growth is negative. Furthermore, it reveals that education plays a crucial role in determining ICT’s effectiveness on economic growth. However, the positive impact of education is overshadowed by the adverse effects of brain drain, which negates the potential benefits ICT could have on the economy. This study highlights the importance for MENA policymakers to address the brain drain issue to enhance the positive impact of ICT on economic growth, suggesting the need for strategies that leverage both ICT and education to effectively foster economic development.

Renewable energy, energy efficiency, and economic complexity in the middle East and North Africa: A panel data analysis

This paper aims to investigate how economic complexity and structural transformation affect energy security. This study differs from previous research by focusing on energy efficiency and renewable energy transition as indicators of energy security. The employed methods include econometric techniques such as Panel-Corrected Standard Errors, Driscoll and Kraay's Spatial Correlation Consistent (SCC) method, and Generalized Least Squares, covering data from the Middle East and North Africa (MENA) countries between 1990 and 2017. The results show that economic complexity has a negative effect on energy efficiency but a positive impact on renewable energy. However, economic growth positively affects energy efficiency but negatively influences renewable energy. These results imply that economic complexity is energy-intensive but green, whereas economic growth is energy-saving but brown. The comparative analysis reveals that the negative effects of economic complexity and growth are larger than their positive effects, highlighting the necessity of restructuring economic activities and sectors. Accordingly, decision-makers should encourage the utilization of more energy-efficient technologies in economic activities and production, while promoting renewable energy consumption to enhance energy security in the MENA region.

Creating a Responsible Renewable Energy Investment Model for the MENA Region's Low-Carbon Transition

Addressing climate change presents specific challenges for the countries of the Middle East and North Africa (MENA), particularly concerning oil production and water scarcity, but it also offers opportunities for new paths toward sustainability. The transition to low-carbon energy raises significant concerns for oil and gas producers in the MENA region, especially regarding their dependence on hydrocarbon revenues. Without proper adjustments, this transition could worsen macroeconomic imbalances and potentially threaten existing social contracts. Policymakers are working to promote various renewable energy sources and implementation strategies to mitigate the adverse effects of climate change. As a result, the development of an index capable of accurately measuring and benchmarking a country's overall sustainability and economic performance becomes essential. This index should provide a comprehensive assessment of both the current and future state of renewable energy. Additionally, it must highlight key environmental, social, governance (ESG), and economic factors within the renewable energy sector. This proposal aims to establish a composite index, referred to as the Renewable Energy Responsible Investment Index (RERII), covering 19 countries and utilizing 22 distinct metrics. The RERII trend is calculated from 2010 to 2019. The proposed index can serve as a screening tool, decision-making aid, benchmarking instrument, and guide for sustainable development.

FDI, defense spending, and economic prosperity

AbstractThe relationship between foreign direct investment (FDI) and military spending in the Middle East and North Africa (MENA) region is complex and multifaceted. High levels of military spending can deter foreign investors, as it creates an uncertain and potentially volatile investment climate. However, countries that invest in their military infrastructure and capabilities may be seen as more stable and secure, which can attract foreign investors. Taking into account several factors that can influence this relationship, including political stability, security concerns, and economic factors, this work analyzes whether military spending attracts foreign capital into the region. Using a dynamic panel data methodology along with other relevant macroeconomic variables, results show that the military expenditure has a positive and significant impact on FDI inflows into the MENA region. The paper highlights the fact that policymakers in the region must carefully balance military spending with investments in other areas of the economy in order to create a stable and favorable investment climate that attracts foreign investors and contributes to long‐term economic growth and development achieving both security and welfare.

Key Challenges to Understanding the Burden of Respiratory Syncytial Virus in Older Adults in Southeast Asia, the Middle East, and North Africa: An Expert Perspective.

Respiratory syncytial virus (RSV) is a common, highly contagious pathogen and a leading cause of serious illness among infants and older adults. While existing scientific evidence has predominantly focused on the epidemiology and disease burden of RSV in infants, data in older adults remain limited in some countries, including those in Southeast Asia (SEA) and the Middle East and North Africa (MENA) region. Here, we outline the key challenges for understanding the burden of RSV in older adults in SEA and the MENA region and we propose opportunities for improving understanding and eventually reducing the impact of RSV. A key challenge identified by the expert group, particularly in older adults, is a lack of awareness (among healthcare professionals, policy makers, and the public) of RSV burden and the associated risks for severe outcomes. This is often confounded by the complexities of underdiagnosis, surveillance limitations, and comorbidities. To address these issues, we suggest medical education initiatives for physicians in SEA and the MENA region to better understand the need to protect older adults from RSV, and encourage more widespread routine testing to better understand the burden of RSV. We also recommend surveillance studies in these regions to provide comprehensive and accurate epidemiological data on RSV inolder adults. Finally, in the absence of current surveillance data in these regions, we propose extrapolating existing global data and local pediatric data to inform the likely burden of RSV in older adults. A graphical abstract is available with this article.

Navigating crisis: marketing dynamics and resilience in the MENA’s dual-banking system amidst the SAR-COV-2 pandemic

In this paper, we investigate how market concentration and efficiency impact banks’ performance and stability during the SAR-COV-2 pandemic. There is a research gap in the empirical literature in understanding the specific impact of market concentration and efficiency on the profitability and risk-taking behavior of banks, particularly in the developing context of the Middle East and North Africa (MENA) region. To address this gap, we examine the relationship between market concentration, efficiency, and bank performance using a comprehensive dataset encompassing 575 banks across 20 MENA countries from 2006 to 2021. Specifically, we examine the market dynamics and performance of different banking systems co-existing in the MENA region. Our findings indicate that prior to the pandemic, both conventional and Islamic banks benefited from enhanced financial stability as a result of the increased market concentration and efficiency. However, during the pandemic, the positive effects of efficiency and concentration were primarily observed within the group of Islamic banks. Furthermore, we provide new evidence for the moderating effect of market concentration, with a significant negative impact suggesting that increased market competition reinforces the efficiency effect during the pandemic. Our findings are important for policymakers and regulatory authorities in the MENA region as they indicate the need for new policies that assign a more significant role to Islamic banking in the post-SAR-COV-2 recovery.

Do public governance and financial shocks effect public health? Empirical evidence from MENA region

Financial shocks have an incredible socioeconomic effect on both developed and developing countries. Various recent studies demonstrated that bad public governance impacted public health across all nations. In fact, this study aims to use panel data for 21 countries from the Middle East and North Africa (MENA) region over the period 2000–2020 to scrutinize the effect of both governance and financial crises on public health. We use the generalized method of moments (GMM) approach to carry out the empirical analysis. The objective of using this method is to deal with the issue of endogeneity between exogen variables. Results outline that there is a significant positive association between public governance indicators and public health. Moreover, we found a strong negative association between financial shocks and public health. Thus, the direct negative impact of financial crisis on public health could be mitigated by the indirect positive impacts via institutions and good public governance. This study gives insights to policymakers to take appropriate measures to decrease the severity of the financial shocks and improve healthcare services.

Economic Growth through Rent Streams, Financial Development and Institutional Quality in Mena

This study examines the relationships between natural rent streams, financial development, institutional quality, and economic growth in the Middle East and North Africa (MENA) region and is the development of fixed effects panel models during 1990–2020. The analysis of the MENA region sheds light on the complex, dynamic nature of the region’s economies and societies, as this region is an interesting case study where economic, political and cultural dynamics are diverse. The region faces economic diversification needs, conflicts, migration, and climate change, making this study timely and relevant. To this end, fixed effects regressions and scenario approaches were applied to the collected panel data. The findings reveal natural resource rents as the primary driver of economic growth, their effectiveness dependent on financial development and institutional quality levels. A well-developed financial sector facilitates efficient channeling of rents into productive investments, while strong institutions mitigate resource curse effects. In contrast, while remittances and foreign aid do not directly impact growth, their effectiveness is enhanced by financial development and institutional frameworks. The results highlight the critical roles of financial sector development, institutional quality, and robust governance in shaping the impacts of resource rents in this resource-rich region. The policy recommendations emphasize strategies for managing resource wealth, strengthening financial systems, promoting inclusion, improving institutions, and fostering an enabling environment for remittances and foreign aid to promote sustainable economic growth.

Advancing green education in MENA region: Challenges, opportunities and best practices

AbstractThis paper explores Green Education in the Middle East and North Africa (MENA), addressing shared environmental challenges across its 21 diverse countries. Despite differing economic structures, economies and politics, the need for green education, also known as environmental education (EE) or education for sustainable development (ESD), is evident. MENA encounters obstacles like centralised education structures, governance issues, curriculum gaps, limited funding, environmental awareness and gender disparities. Overcoming these challenges necessitates a comprehensive strategy involving curriculum integration, policy support, collaboration with non‐governmental organisations and international organisations, sufficient funding and effective monitoring. Engaging in global initiatives like the Paris Agreement and the Middle East Green Initiative provides opportunities to enhance EE. Adopting a holistic approach empowers the MENA region to address environmental concerns, promote sustainable development and align with global conservation efforts.

Epidemiological Aspects of Road Accidents in the Middle East and North Africa (MENA) Countries from 1990 to 2019

Background: Road accidents are a major public health concern globally and are expected to become the fifth leading cause of death worldwide by 2030. Objectives: This study aimed to compare the consequences of road accidents in the Middle East and North Africa (MENA) region by analyzing data from 21 countries and approximately 400 million people Methods: The data used was from the Global Burden of Diseases (GBD) in 2019, which defines traffic accidents as deaths resulting from external injury causes based on the international classification of diseases (ICD). Results: Road traffic injuries (RTIs) in the MENA region have decreased from 1990 to 2019. Motor vehicles have the highest death rate from RTIs at 15.32 per 100,000, followed by pedestrians at 8.37 per 100,000, motorcyclists at 2.16 per 100,000, and cyclists at 0.35 per 100,000. Saudi Arabia (46.7 per 100,000) and Oman (25.5 per 100,000) have the highest death rates for motor vehicle-related road injuries, while Oman (17.7 per 100,000) and Yemen (12.95 per 100,000) have the highest rates for pedestrian-related road injuries. Conclusions: Given the significant impact of road accidents in the countries of the region, it is crucial to address this issue through various measures. These should include training initiatives, preventive measures, and a review of traffic laws and regulations.

Spotlight on the epidemiology and antimicrobial susceptibility profiles of Vibrio species in the MENA region, 2000-2023.

Recent cholera outbreaks in many countries in the Middle East and North Africa (MENA) region have raised public health concerns and focused attention on the genus Vibrio. However, the epidemiology of Vibrio species in humans, water, and seafood is often anecdotal in this region. In this review, we screened the literature and provided a comprehensive assessment of the distribution and antibiotic resistance properties of Vibrio species in different clinical and environmental samples in the region. This review will contribute to understanding closely the real burden of Vibrio species and the spread of antibiotic-resistant strains in the MENA region. The overall objective is to engage epidemiologists, sanitarians and public health stakeholders to address this problem under the One-health ethos.

Temporal trends in lower extremity amputation in Middle East and North Africa (MENA) region: analysis of the GBD dataset 1990–2019

BackgroundLower extremity amputations (LEAs) significantly contribute to mortality and morbidity, often resulting from peripheral artery disease and diabetes mellitus (DM). Traumatic injuries also account for many LEAs. Despite the global burden, the epidemiology of LEAs, particularly in the Middle East and North Africa (MENA) region, remains underexplored. This study utilizes the Global Burden of Disease (GBD) dataset to analyze temporal trends in LEAs in the MENA region from 1990 to 2019.MethodsThe study utilized the 2019 GBD dataset, which includes estimates for incidence, prevalence, and disability-adjusted life-years (DALYs) across 369 diseases. Age-standardized incidence rates (ASIRs) for LEAs were extracted for 21 MENA countries. Trends were analyzed using percentage change calculations and Joinpoint regression to identify significant shifts in LEA rates over time.ResultsFrom 1990 to 2019, male LEA rates generally decreased, while female rates increased. Significant increases in LEA rates were observed in Syria, Yemen, and Afghanistan, correlating with periods of conflict and instability. Conversely, countries like Iraq, Palestine, Sudan, Lebanon, Iran, and Kuwait saw marked decreases. The study highlighted a complex interplay of socio-political factors, natural disasters, and chronic diseases like DM in shaping LEA trends across the region.ConclusionThe study reveals variable LEA trends in the MENA region, influenced by conflicts, natural disasters, and chronic diseases. These findings underscore the need for targeted public health interventions, improved healthcare access, and robust data collection systems to reduce the burden of LEAs and improve patient outcomes in the MENA region.

IMF Conditionality and Government Education Spending: The Case of 10 MENA Countries

This study explores the impact of International Monetary Fund (IMF)-linked conditionality on government education expenditures in the Middle East and North Africa (MENA) region. Understanding the impact of conditional lending by international financial institutions on education spending is important due to the pivotal role education plays in fostering social and economic development. We use country-level panel data encompassing a representative set of 10 MENA countries from 1990 to 2020 and employ a cross-national fixed effects regression model. Our findings suggest that IMF conditionality demonstrates a positive relationship with government education expenditures in the MENA region. The proposed explanation is that the application of IMF policy advice can have a catalytic effect on donor financing, including for education. This indicates that the Fund’s financing arrangements in the region can free up fiscal space for social spending, which, in turn, signals a sort of departure of the IMF from the reputation that typically precedes it—its traditional bias for macroeconomic stability irrespective of social costs. We argue that our findings are instructive for policy, especially if one shares the idea that education is a necessary prerequisite for achieving Sustainable Development Goal (SDG) 4: guaranteeing inclusive and equitable quality education and promoting enduring learning opportunities for all.