Middle East And North Africa Research Articles

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.

COVID-19 policy responses, social norms, and behavior change in MENA

ABSTRACT Inducing behavior change is a missing factor in the face of viral threats. We provide evidence from a natural experiment in 2020 on the effects of containment, closure, and economic policy responses to COVID-19 on change in human mobility behavior in the Middle East and North Africa (MENA) region and worldwide. We also examine how social norms, namely risk taking and patience, and institutional trust, could explain the heterogenous effects of policy responses on behavior change. Our results show that the stringency of containment and closure policies decreased human mobility in MENA and worldwide. Risk-averse populations and populations with low-time preference were more likely to pre act and lower their mobility independent of containment and closure policies. The effectiveness of risk communication in promoting positive mobility change increased by the level of institutional trust. Specifically in MENA, populations were less responsive to the actual disease risk and the public perception of that risk. Familiarity with COVID-19 induced negative behavior change among impatient populations. Economic support policies promoted strong positive mobility change among low-risk and high-time preference populations. Income support seems to be the effective economic policy response in low-income countries and debt relief the effective one in higher-income countries.

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.

Özgür ÖZDAMAR and Sercan CANBOLAT, Leaders in the Middle East and North Africa: How Ideology Shapes Foreign Policy

It is almost always the case that any Introduction to International Relations course teaches the contributions of Kenneth Waltz to the field, firstly through his grandiose formulation of a theory: it should be simple, parsimonious, abstract, and accordingly, one needs to move away from reality as much as possible to increase the theory’s explanatory and predictive capacity. Moving the individual and state level of analyses aside, Waltz simplifies his theory of international politics at the system/structural level and, with his neorealist theory becoming the dominant approach for a large part of the twentieth century, it put the state in a sort of black box, purposefully ignored individual actors, and targeted the maximum degree of abstraction as possible. In Leaders in the Middle East and North Africa: How Ideology Shapes Foreign Policy, which consists of seven chapters (one introduction chapter, four empirical chapters, one theoretical conclusions chapter and one policy implications chapter), Özdamar and Canbolat aim to shed light on foreign policy belief patterns of leaders in the Middle East and North Africa (MENA), highlighting divergences across them and comparing them to the average world leadership. In the process, and in total opposition to Waltz’s claim, the authors argue that advancing “the actor-specific empirical studies zeroing in on agent behaviors and decisions in the future” is “the only way for IR to establish itself as a scientific discipline” (p. 148). In other words, as opposed to the structural approaches, the authors propound that less abstraction and a more actor-specific, nuanced, and tailored approach would provide significant opportunities for the IR discipline to be scientific.

Current and Future Distribution of the Cataglyphis nodus (Brullé, 1833) in the Middle East and North Africa

Climate change is a major threat to the Middle East and North Africa (MENA) region, which can cause significant harm to its plant and animal species. We predicted the habitat distribution of Cataglyphis nodus (Brullé, 1833) in MENA using MaxEnt models under current and future climate conditions. Our analysis indicates that the cooler regions of the MENA are projected to experience temperature increases of 1–2 °C by 2040 and 2–4 °C by the 2070s. Similarly, the warmer regions may anticipate rises of 0.5–2 °C by 2040 and 2–4 °C by the 2070s. MaxEnt model results for the current climate show good agreement with observations (mean area under the curve value of 0.975 and mean true statistical skill value of 0.8), indicating good potential habitat suitability for C. nodus. Significant factors affecting habitat suitability are elevation, mean monthly precipitation of the coldest quarter, temperature seasonality, and precipitation amount of the driest month. The research predicts that under Shared Socioeconomic Pathway (SSP) 1.2.6, the habitat suitability area may increase by 6% in 2040, while SSP 3.7.0 (0.3%) and SSP 5.8.5 (2.6%) predict a decrease. For 2070, SSP 5.8.5 predicts a 2.2% reduction in habitat suitability, while SSP 1.2.6 (0.4%) and SSP 3.7.0 (1.3%) predict slight increases. The results provide insight into the potential impacts of climate change on the species and regional biodiversity changes associated with the projected species distribution.

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.

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.

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.

Measuring progress towards universal health coverage in 22 Middle East and North African countries

PurposeMonitoring progress towards universal health coverage (UHC) has become increasingly important, especially given the centrality of UHC in achieving the sustainable development goals. We sought to estimate the progress towards UHC in the 22 Middle East and North Africa (MENA) countries. MethodsEmploying the Joint World Bank and World Health Organization Framework for Monitoring UHC, we estimated the UHC index for MENA countries using both service coverage and financial protection indicators. We also explored the correlation between the UHC index with government expenditure/investment in health. ResultsThe 2021 UHC index ranged from 48.2 (Somalia) to 90.3 (United Arab Emirates) with a mean, median, and standard deviation of 74.9, 77.4, and 11.1, respectively, with significant differences between low-income and high-income countries. Service coverage lags behind financial protection in most MENA countries. There is a significant positive relationship between UHC and government health spending/investments. ConclusionThe majority of MENA countries are yet to achieve UHC. There is a need to expand healthcare services, especially PHC services, and adopt strategies that address concerns related to financial protection.

Management of massive haemorrhage in transfusion medicine services in the Middle East and North Africa.

Massive transfusion protocols (MTPs) are critical in managing haemorrhage, yet their utilization varies. There is lack of data on the utilization of MTPs in the Middle East and North Africa (MENA) region. This study aims to assess the degree of utilization of MTPs in the region. We conducted a survey to collect data on MTP use, inviting medical directors of transfusion services from various hospitals. Data were analysed to determine the prevalence of MTP utilization, their compositions, challenges in application and areas of future need. Eighteen respondents participated, representing 11 countries in the region. Thirteen hospitals implemented MTP, and eight included paediatrics. Eleven institutions used more than one definition of massive haemorrhage, with the most common being ≥10 red blood cell (RBC) units transfused for adults and replacement of >50% total blood volume in paediatrics. The majority of sites with MTPs utilized 1:1:1 RBCs:platelets:plasma ratio (70%). Variations were observed in the types and blood groups of components used. Two sites utilized whole blood, while six are considering it for future use. Utilization of adjunctive agents and frequency of laboratory testing varied among the sites. Challenges included the lack of medical expertise in protocol development, adherence and paediatric application. The need assessment emphasized the need for developing regional guidelines, standardized protocols and training initiatives. Although several hospitals have adopted MTPs, variations exist in activation criteria, blood product ratios and monitoring. Challenges include the lack of medical expertise, protocol adherence and addressing paediatric needs. Standardizing protocols, enhancing training and paediatric application are crucial for improving massive transfusion management in the region.

Effect of Subcutaneous Semaglutide on Diabetic Retinopathy among Adults with Type 2 Diabetes in Saudi Arabia. A Systematic Review

Diabetic Retinopathy (DR) is one of the leading causes of progressive and irreversible vision loss. The relationship between metabolic control and progression of DR is observed in previous landmark randomized clinical studies. Moreover, a potential association between DR progression and glucagon-like peptide1 receptor agonists (GLP1-RA) is reported in diabetes literature. Objectives: To explore the effect of semaglutide treatment on diabetic retinopathy progression in adults with type 2 diabetes (T2DM) among the Middle East and North Africa (MENA) area. Methods: This is a systematic review of randomized clinical trials, we searched electronic databases including Google Scholars, PubMed, Science Direct, Cochrane, ClinicalTrials.gov, and The Medical Subject Heading (MeSH) terms using the PRISMA flow chart based on our inclusion criteria and used PROSPERO for searching for registered systematic reviews in MENA area. Results: Among 12 studies 11,854 patients were included in the mean follow-up period which was 52.5 weeks on semaglutide therapy with non-significant association with a pooled effect size for retinopathy incidence of 1.12 (95% CI: 1.00, 1.12). Conclusion: The current literature revealed that semaglutide has an uncertain effect on diabetic retinopathy progression. A need for larger randomized clinical trials in MENA area to expose the definitive effect.

Design, development and preclinical assessment of MENAVip-ICP, a new snake antivenom with potential coverage of species in the Middle East and North Africa regions

Snakebite in the Middle East and North Africa (MENA) is a public health problem whose magnitude is not fully known. Several antivenoms are available in these regions, but these formulations are designed for restricted geographical settings. Many countries do not have local production of antivenoms and must access products whose clinical performance has not been demonstrated. We hypothesize that it is possible to unify the treatment for viperid snakebites of MENA in a single antivenom formulation. Hereby we describe the design, development and preclinical evaluation of an antivenom of broad geographical coverage for this region (MENAVip-ICP). We produced this antivenom from the plasma of horses immunized with eight medically important venoms of viperid snake species from MENA. For this, we used a strategy based on two stages: first, immunization of horses with North African (NA) venoms, followed by a second immunization stage, on the same horses, with MENA venoms. We purified antivenoms from both stages: the Anti-NA and the final product Anti-MENA (MENAVip-ICP). Anti-NA was considered as intermediate formulation and was purified with the intention to study the progression of the immunoglobulin immune response of the horses. Antivenoms from both stages neutralized lethal, hemorrhagic, and procoagulant activities of homologous venoms. Compared to Anti-NA, MENAVip-ICP improved the neutralization profile of intravenous lethality and in vitro procoagulant activities of venoms. A notable finding was the difference in the neutralization of lethality when MENAVip-ICP was assessed intraperitoneally versus intravenously in the murine model. Intraperitoneally, MENAVip-ICP appears more effective in neutralizing the lethality of all venoms. Furthermore, MENAVip-ICP neutralized the lethal activity of venoms of species from other regions of MENA, Central/East Asia, and Sub-Saharan Africa that were not included in the immunization protocol. Our results showed that MENAVip-ICP neutralizes the main toxic activities induced by viperid MENA venoms at the preclinical level. Consequently, it is a promising product that could be clinically assessed for the treatment of snakebite envenomings in this 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.

Knowledge gaps related to HIV and condom use for preventing pregnancy: a cross-sectional study among migrants in Sweden

BackgroundInformation and knowledge of sexual and reproductive health and rights (SRHR) plays a crucial role in promoting safe sexual practices among young migrants. We aimed to assess the sociodemographic factors of migrants associated with knowledge of condoms and the prevention, treatment, and transmission of HIV to highlight the need for SRHR information, including comprehensive sexual health education.MethodsA cross-sectional survey was conducted (2018–2019) among migrants at Swedish language schools and high schools across Sweden. The survey included questions about knowledge of condom use for preventing pregnancy and HIV treatment and transmission. Descriptive statistics were calculated, and multivariable logistic regression analyses were performed to assess the responses to the knowledge questions and sociodemographic characteristics.ResultsOut of 3430 respondents (median age: 35, interquartile range: 20), approximately 39% were unaware that condoms can prevent unplanned pregnancies. Only 58% of the respondents knew that condoms reduce the risk of contracting HIV. About 77% were unaware of HIV treatment, and 52% reported not knowing that a woman with HIV could transmit the virus to her baby during pregnancy or breastfeeding. Incorrect knowledge about condom use to prevent unwanted pregnancy was associated with several factors: younger age (15–19 years) adjusted odds ratio (aOR) 1.35; 95% confidence interval (CI), 1.02–1.79); female respondents (aOR: 1.68; 95% CI 1.36–2.07); lack of previous sexual health education (aOR: 2.57; 95% CI 2.11–3.13); low level of education (aOR: 1.30; 95% CI 1.04–1.61). Originating from the Americas, European, or sub-Saharan African regions was associated with a 34–42% decreased likelihood of incorrect knowledge that condoms can reduce the risk of HIV infection compared to respondents from the Middle East and North Africa (MENA). More than half (64%) of respondents reported needing more SRHR information.ConclusionsWe found significant knowledge gaps on HIV and condom use for preventing pregnancy among migrants in Sweden. Comprehensive sexual health education in language schools, along with information to newly arrived migrants from diverse regional backgrounds and targeted sexual health services to younger individuals, women, and those who lack sexual health education, are needed to address these information gaps and provide crucial SRHR education and information.

Scoping review of healthcare professionals’ views on intimate partner violence in the Middle East and North Africa

ObjectivesThis scoping review aims to survey healthcare providers (HCPs) in the Middle East and North Africa (MENA) about their knowledge, attitudes and barriers to working with women who have experienced...

The relationship between lifestyle habits and obesity among students in the Eastern province of Saudi Arabia: using the Arab Teens Lifestyle (ATLS) questionnaire

BackgroundThe Arab Teens Lifestyle (ATLS) questionnaire was an initiative to assess the lifestyle habits influencing obesity rates in the Middle East and North Africa (MENA) region, including physical activity (PA) patterns, sedentary and eating behaviours. Since its implementation, the ATLS questionnaire has been used in several studies among different age groups and populations. This instrument has not previously been administered among the university students of the Eastern Province of Saudi Arabia, where the obesity rates are the highest in the country. This research was the first that aimed to identify lifestyle habits influencing the rates of obesity among 18-25-year-old university students in the Eastern Province of the Kingdom of Saudi Arabia (KSA) using the ATLS questionnaire.MethodsQuantitative cross-sectional research among n = 426 students of the Eastern Province of Saudi Arabia using the ATLS questionnaire.ResultsOut of n = 426 participants, n = 200 (47%) were categorised (using body mass index) as normal weight; n = 113 (26.5%) were overweight, and n = 73 (17.1%) were obese. The findings showed that most of the nutritional, PA, and sedentary behavioural factors (e.g., screen time) in the questionnaire were not associated with obesity status amongst the participants. In the obese group, more of the males that consumed fruits, French fries, cakes, sweets and doughnuts more than three times per week were likely to be obese, which was not the case for females.ConclusionThe reported lifestyles of the students could potentially lead to long-term negative health effects, which is of concern given the rising rates of overweight, obesity, and obesity-related non-communicable diseases (NCDs) among the Kingdom’s adult and ageing population. Further studies are recommended to explore the knowledge, attitudes, and perceptions of Saudi students in the Eastern Province in relation to PA, sedentary behaviours, and dietary habits, along with their views on how these can be improved.

Competency level and determinants among infection prevention and control staff in the Middle East and North Africa region

BackgroundCompetency of the staff working in infection prevention and control (IPC) is the cornerstone of successful IPC programs. The objective was to assess competency level and associated factors among IPC staff working in the Middle East and North Africa (MENA) region.MethodsA cross-sectional study was carried out in 2019 among active IPC staff who were members of the Arab Countries Infection Control Network. The questionnaire covered demographic and professional characteristics of IPC staff and characteristics of work facilities and IPC programs. A competency score was created from self-perceived responses to 8 competency domains. The competency score was then transformed into 100-scale and categorized into two groups (≥ median and < median).ResultsA total of 176 participants completed the survey. Participants were mostly female (65.7%), and the mean age was 40.2 ± 8.3 years. The mean competency score was 61.4%. It was slightly variable between domains, being highest with preventing transmission of infection (65%) and lowest with sterilization and disinfection (59%). Higher (≥ median) competency score was associated with having CBIC certification (p < 0.001). It was also associated with facilities having IPC plan (p = 0.005), IPC committee (p = 0.049), regular meetings of IPC committee (p < 0.001), and IPC plan included communications with healthcare workers (p < 0.001). Domain-specific competency scores were significantly associated with receiving same domain-specific training (p < 0.05 for all).ConclusionsThe competency levels of IPC staff in the MENA region is still suboptimal. The current finding calls for more regional and national investment in IPC staff by providing up-to-date customized educational and training opportunities.

Urban Heat Islands, Heatwaves and Implications for Human Wellbeing: A Comparative Analysis across Middle East and North Africa (MENA)

Urban Heat Islands, Heatwaves and Implications for Human Wellbeing: A Comparative Analysis across Middle East and North Africa (MENA)