Middle East North Africa Region Research Articles

The impact of institutions' quality and information availability on capital inflows volatility in selected MENA countries

PurposeThis paper aims to discuss the main characteristics of the Middle East North Africa (MENA) region's capital inflows volatility. It also examines the effect of institutional quality and information availability on capital inflows volatility in selected MENA countries (Bahrain, Egypt, Israel, Jordan, Kuwait, Libya, Morocco, Oman, Saudi Arabia and Tunisia) in the period 1996–2017.Design/methodology/approachThe study's assessments are based on the International Country Risk Guide (ICRG) and globalization indices. It also employs an updated data set of balance of payments indicators released by the International Monetary Fund. Moreover, the study uses econometric panel modeling of random effect model, with Driscoll-Kraay robust standard error, to analyze the relationship between capital inflows volatility, institutional quality and information availability.FindingsThe paper finds that both institutional quality and information availability are in an inverse relationship with the total capital inflows volatility in the MENA region. However, the findings vary across the different components of total capital inflows. For example, the volatility of foreign direct investment (FDI) declines, like total capital flows, as the two factors improve. However, the volatility of foreign portfolio investment (FPI) is negatively related to institutional quality but does not have any significant relationship with information availability. While the volatility of foreign other investments (FOI) decreases with the availability of information, but does not have any significant relationship with institutional quality.Originality/valueThis paper expands the limited literature regarding the determinants of capital inflows volatility. Furthermore, it is the first study that investigates the effect of institutional quality and information availability on capital inflows volatility in the MENA region.

Can the Middle East-North Africa region mitigate the rise of its food import dependency under climate change?

The online version contains supplementary material available at 10.1007/s10113-023-02045-y.

Power, politics & resistance: secularism and women’s marital rights in Egypt and Iran

ABSTRACT Family law in the Middle East North Africa region has been critically scrutinized by both adherents to Islam and Western observers. There is consensus between both traditions that secularism has had no meaningful impact on women’s marital rights due to Islam’s continued influence on socio-cultural and legal practices. Building on this, this article examines the effects of the secular nature of Egypt and Iran, between 1900 and 1939, on women’s marital rights. Contributing to the current literature by examining two countries which are rarely exclusively compared in this field, significant insights into the relationship between gender equality, marriage, and secularism emerge through interpretive textual analyses of memoirs and laws. It illustrates how secular identities affect marital laws; the importance of the political environment within the state, and how secularism is a tool for pursuing or challenging power. This article challenges homogenizing assumptions that secularism had limited effects on marital laws.

Multiple Sclerosis in Middle East North Africa (MENA) Region: Challenges, Achievements and Opportunities.

Multiple Sclerosis in Middle East North Africa (MENA) Region: Challenges, Achievements and Opportunities.

The Status of Insulin Access in Middle East-North Africa Region

Background and Objective: The current situation in the Middle East-North Africa (MENA) region makes it very difficult for many countries to have an effective policy to ensure the availability and affordability of different insulin types for many individuals with diabetes mellitus in any individual country. This article comprehensively reviews the possible barriers to insulin access in countries of this region and provides some solutions to mitigate these barriers. Materials and Methods: The framework for understanding the life-cycle of medicines of the World Health Organization (WHO) was adopted for this review with country-specific modifications. PubMed was used as an initial search builder using the country name and insulin as query terms in (title/abstract) for articles written in (English and French) which dealt with humans only between (2000–2022). Out of (578) published articles, only (42) articles were relevant and dealt with insulin access. Additional search through references of these articles and the websites of international health organizations added additional (32) references to have (79) references for the review. Review (Results): The countries in the MENA are lagging in the (Research, Development, and Innovation) and production of insulin and insulin delivery systems. There are some attempts by some countries to develop their national plan with the help of some big insulin manufacturers, with a suboptimal outcome. The local insulin production in some countries did not reach full national coverage. The difficult regional economic and political situations in many countries in the MENA imposed negatively on their citizens’ insulin access, availability, affordability, cost, and insurance plans. Conclusions: There is a suboptimal level of insulin access for individuals with diabetes in the MENA countries, especially in the low-resourced countries. There is an urgent need to adopt country-specific healthcare policies to ensure uninterrupted insulin access and improved availability, with a lower affordable cost for individuals with diabetes from the public and private sectors.

Innovative hybrid waste to energy–parabolic trough plant for power generation and water desalination in the Middle East North Africa region: Jordan as a case study

This research proposes a hybrid system consisting of a parabolic trough solar field coupled with a waste incineration facility to produce power and desalinated water in Jordan. To predict the performance of the proposed system, EBSILON Professional (13.02) was used to simulate the entire system and for a more realistic simulation process, a prime sample of 100 tons of municipal waste from Jordan was obtained, processed, and homogenised, after which 4 kg was brought to Germany for laboratory analysis. The laboratory results were inserted into EBSILON. Solar radiation data were adapted from meteonorms and input to EBSILON. Heat transfer between the receiver wall and the heat transfer fluid was analysed to calculate the time required to increase the temperature of the Heat Transfer Fluid from the influent temperature to the desired effluent temperature. The results show that this system can produce 34 MWe of power and 13,824 m3/d of distilled water. On the 1st January, the temperature of the heat transfer fluid in the solar field was increased by 6 °C for 20 min in an open cycle. After 5h, it reached 390 °C in a closed cycle, assuming a fixed direct normal irradiance. Economically, five scenarios were analysed to assess the impact of the cost of heat harvested to produce this amount of water on the annual cost of handling each ton of garbage which was approximately 57 US$ in the first year of operation and 19.5 US$ in the 15th year of plant operation (for the scenario in which the tariff of power sales was considered to evaluate the cost of heat for water desalination).

S675 Glasgow-Blatchford Score vs Glasgow-Blatchford Score Plus Additional Variables to Predict High-Risk Peptic Ulcers in Acute Nonvariceal Upper Gastrointestinal Bleed in a United Arab Emirates Tertiary Center

Introduction: Acute nonvariceal upper gastrointestinal bleeding (NVUGIB) is a medical emergency and one of the most common reasons for emergency GI care. The Glasgow-Blatchford score (GBS) has been developed for risk stratification. Our group has previously reported that GBS has very limited accuracy in Middle East North Africa (MENA) region. Our aim was to evaluate whether additional clinical variables improved the accuracy of GBS to predict actual high-risk stigmata or active bleeding during emergency endoscopy and to validate this in a large volume tertiary care setting in the MENA region. Methods: Data were collected retrospectively for a cohort of patients over the age of 16 years who attended the emergency department or were inpatients and underwent esophagogastroduodenoscopy (EGD) for acute NVUGIB from January 2020 through September 2021 at a tertiary hospital in the United Arab Emirates. Our predictor variables included GBS and other potential risk factors as listed in Table. GBS included patients' hemoglobin by gender, blood urea, heart rate, and systolic blood pressure from the time of admission as well as presentation with syncope or melena, and evidence of hepatic disease or cardiac failure. After assessing ability of the GBS to predict Forrest I- II classification by estimating the area under the receiver operating characteristic curve (AUROCC), we examined if other patient demographics and clinical characteristics might improve upon the ability of GBS to detect Forrest I-II classification by fitting several logistic regression models and calculating the AUROCC. Results: Among the 153 patients in our cohort, the median age was 58 years (IQR XMR 11 (IQR 7 to 13). In our cohort, 28 (18.3%) patients had Forrest I-II classification identified during endoscopy. The AUROCC for the ability of GBS to detect Forrest I-II classification was 0.49 (95% CI 0.37 to 0.62). AUROCC for the ability of each patient characteristic to detect Forrest I-II classification is shown in Table. Models that contained age, diastolic blood pressure and nationality/immigration status in addition to GBS provided the highest overall AUROC with confidence intervals significantly higher than GBS alone. Conclusion: Our study did not find evidence that GBS by itself was a useful tool at identifying patients with Forrest I-II classification during endoscopy. Our data suggested younger age, nationality / immigration status along with lower DBP may be better predictors of Forrest I-II classification when considered with GBS. Table 1. - Patients Demographics and Clinical Characteristics with Area under the Receiver Operating Characteristic Curve for Detection of Forrest I-II Classification AUC-1 AUC-2 AUROC-3 AUC-4 Predictor variable Unadjusted GBS-adjusted Age-adjusted GBS- and age-adjusted Glasgow-Blatchford score 0.493 0.704 Age 0.695 0.704 Gender 0.590 0.605 0.724 0.731 Nationality 0.630 0.634 0.737 0.745 Diabetes 0.563 0.565 0.697 0.705 Hypertension 0.609 0.627 0.696 0.706 Dyslipidemia 0.523 0.530 0.698 0.707 Chronic kidney disease 0.577 0.602 0.694 0.704 Ischemic heart disease 0.578 0.566 0.695 0.715 Atrial fibrillation 0.568 0.582 0.704 0.718 Congestive heart failure 0.510 0.519 0.696 0.706 Chronic liver disease 0.526 0.530 0.700 0.708 Cerebrovascular accident 0.563 0.575 0.691 0.702 Malignancy 0.508 0.522 0.696 0.705 Antiplatelets 0.533 0.537 0.696 0.706 Anticoagulant 0.527 0.548 0.699 0.709 Proton pump inhibitor 0.524 0.525 0.695 0.703 Steroid 0.506 0.514 0.695 0.702 NSAIDs 0.520 0.537 0.704 0.712 Admission unit 0.515 0.534 0.700 0.706 Admission time 0.538 0.533 0.699 0.711 Prior GI bleeding 0.517 0.513 0.693 0.705 Hematemesis 0.578 0.572 0.711 0.717 Melena 0.587 0.602 0.716 0.719 Drop in haemoglobin 0.519 0.504 0.693 0.706 PR Bleeding 0.528 0.541 0.698 0.705 Syncope 0.502 0.511 0.694 0.705 Urea 0.532 0.518 0.698 0.706 Initial Hgb 0.498 0.516 0.693 0.701 SBP 0.383 0.448 0.698 0.710 DBP 0.599 0.648 0.738 0.738 Heart rate 0.593 0.599 0.700 0.708 Unstable Pulse 0.570 0.607 0.700 0.705 Blood Transfusion 0.505 0.497 0.698 0.705 AUC=area under the receiver operating characteristic curve, GBS=Glasgow-Blatchford score.AUC-1 estimates were obtained from single variable logistic regression models separately for each predictor variable.AUC-2 estimates were obtained from logistic regression models separately for each predictor variable with GBS included as an additional predictor variable.AUC-3 estimates were obtained from logistic regression models separately for each predictor variable with age included as an additional predictor variable.AUC-4 estimates were obtained from logistic regression models separately for each predictor variable with GBS and age included as an additional predictor variables.

Russia under Putin in the Eastern Mediterranean: The Soviet Legacy, Flexibility, and New Dynamics

Abstract Russia has become an important player in the Eastern Mediterranean during the presidency of Vladimir Putin, setting up a military presence in the Crimea, South Caucasus, Syria as well as naval facilities in the Mediterranean. Moscow deepened its bilateral relations with NATO members Greece, France and particularly Turkey and has been able to profit from the new dynamics that have emerged in the Middle East North Africa (MENA) region. Russian policy towards the Eastern Mediterranean has been based on large-scale flexibility and its ability to combine elements of soft and hard power. Dependent on Russian grain and tourists and eager to cooperate with Moscow militarily, most non-EU countries of the Eastern Mediterranean have refused to institute anti-Russian sanctions of the sort imposed by the EU after Russia’s invasion of Ukraine in February 2022.

1603P An evaluation of Cancer Aging Research Group (CARG) score to predict chemotherapy toxicity in Iranian older cancer patients

The Cancer Aging Research Group (CARG) developed a prediction tool for chemotherapy-related toxicity in older cancer patients. Evidence has put forward the crucial impact of a patient's race on the type and extent of chemotherapy toxicity. Therefore, the CARG model requires validation in different populations before its general application. In this study, we aim to evaluate the predictive value of the CARG model in Iranian patients as a representative of the Middle East North Africa (MENA) region population. This prospective longitudinal study involved patients 65 years of age and older starting a new cytotoxic chemotherapy regimen. We did general (including Karnofsky performance status, KPS) and CARG-based assessments before chemotherapy. Chemotherapy toxicities were recorded during chemotherapy courses. The predictive values of CARG and KPS were evaluated using the area under the receiver-operating characteristic curve (AUC-ROC). Chemotherapy toxicities were sub-analyzed per hematologic and nonhematologic types. This study examined 76 patients across 456 chemotherapy cycles. The mean age was 71 years. Treatment was palliative in 46 patients (60.5%). Chemotherapy-related toxicity was reported in 23.6% of patients. There was no correlation between CARG risk groups and total chemotherapy toxicity (15% low-risk, 31% intermediate-risk, 20% high-risk, P = .32). Regarding CARG model, the corresponding AUC-ROC was 0.56 (95% CI, 0.40–0.69) for total toxicity, 0.67 (95% CI, 0.48–0.78) for hematologic toxicity, and 0.39 (95% CI, 0.21–0.66) for nonhematologic toxicity. Regarding physician-rated KPS, the corresponding AUC-ROC was 0.56 (95% CI, 0.40–0.72) for total toxicity, 0.55 (95% CI, 0.37–0.72) for hematologic toxicity, and 0.61 (95% CI, 0.37–0.86) for nonhematologic toxicity. CARG model had an acceptable ability to predict hematologic toxicities; however, its efficacy for total and nonhematologic toxicities was limited.

Development and Validation of an ICP-MS Method for the Detection of Platinum in the Lebanese Aquatic Environment

Lebanon is a Middle Eastern country located on the eastern Mediterranean coast. Compared to other countries in the MENA (Middle East North Africa) region, Lebanon is considered the richest in water resources. However, due to inadequate water management, Lebanese water resources are under stress. Water pollution is one of the main problems causing major concerns. The contamination of Lebanese surface water originates predominantly from the discharge of untreated municipal and industrial wastewater. With only a few studies investigating the level of water contamination in Lebanon, this research is the first to report the level of platinum in numerous rivers, three wastewater treatment plants, and two untreated sewage outfalls in coastal areas across Lebanon. To determine the platinum levels, an Inductively Coupled Plasma-Mass Spectrometry (ICP-MS) method was developed and validated in compliance with the ICH guidelines. The method demonstrated acceptable sensitivity with LOQ and LOD equal to 2.35 and 0.56 ng L−1, respectively. The level of total platinum in the Lebanese water samples ranged between 22.44–53.32 ng L−1. These concentrations were all above the baseline concentration of platinum in tap water indicated by WHO and aligned with previous studies in other countries. Although the baseline concentration of platinum in Lebanese water resources is unknown and the source of the total platinum detected in this study could not be identified, these preliminary findings could serve as a foundation for future research.

Awareness and attitudes of oncology specialists toward dihydropyrimidine dehydrogenase testing in Saudi Arabia.

Fluoropyrimidines (FP) are among the most common class of prescribed anti-neoplastic drugs. This class has severe to moderate toxicity in around 10%-40% of those who take 5-fluorouracil (5-FU) or capecitabine for the treatment of cancer. In practice many patients with severe toxicities from FP use had dihydropyrimidine dehydrogenase (DPD) enzyme deficiency. Several studies have proposed DPD screening before treatment with 5-fluorouracil (5-FU) and capecitabine or other drugs belonging to the FP group. This study aims to assess the level of awareness and attitudes of oncology specialists in Saudi Arabia toward genetic screening for DPD prior to giving FP. This highlights the importance of health guidelines required for implementation in our health care system, as a framework to adopt testing as a regular practice in clinical care. Based on the findings in this study, guidelineshave been suggested for the Middle East North Africa region. A cross-sectional survey study was conducted during 2021 targeting oncologists and clinical pharmacists working in the oncology departments across Saudi Arabia. A total of 130 oncologists and pharmacists completed the questionnaire representing a response rate of 87%. Most of the respondents indicated that they prescribe FP in clinical practice, but 41% of respondents reported that they have never ordered a specific molecular test during their practice. Only 20% of respondents reported that they often screen for DPD deficiency prior to prescribing FP. Significantly higher rates of awareness of potential dihydropyrimidine dehydrogenase gene (DPYD) mutation were observed among respondents in governmental hospitals (81.1% vs. 47.4% in private hospitals), and among those with more years of practice (80.6% if 5 or more years of practice vs. 59.3% if less than 5 years of practice). Also, higher rates of observing the impact of DPD testing were present among respondents with a PharmD (35% vs. 11% for oncologists and 18% for other professions) and among those with 5 or more years of practice (24.6% vs. 7.7% among those with less than 5 years). While in some institutions there is a high level of awareness among oncology specialists in Saudi Arabia regarding the effect of the potentially serious DPD enzyme deficiency as a result of gene mutations, screening for these mutations prior to prescribing FP is not a routine practice in hospitals across the country. The findings of this study should promote personalized medicine with recognition of interpatient variability via DPD testing to manage the risks of FP prescribing more effectively in the Kingdom of Saudi Arabia.

Performance of small businesses in Tangier: the perceptual role of location

PurposeThis study seeks to investigate perceptions of the role of location on the performance of small and medium enterprises (SMEs) in Tangier, as understood by local owner-managers.Design/methodology/approachTo explore perceptions of the performance/location relationship for SMEs in Tangier, 20 in-depth online semi-structured interviews were conducted with selected owner-managers of SMEs. The judgement sample was selected to explore their experiences, beliefs and attitudes with respect to their performance and location.FindingsFindings of the study revealed that “location” is a salient factor that, in the minds of respondents, materially influences the performance of SMEs in Tangier. Location was mentioned extensively in the interviews, in relation to the “free zones”. Findings showed that firms located within the free zones enjoyed favourable economic conditions, in particular those related to taxation and competition, compared to their counterparts located outside the free zones, which were excluded from these benefits. Furthermore, perceived unfair competition (financial and fiscal incentives in the free zones) damages the performance of the SMEs in Tangier. These findings suggest that the placement of the business in relation to the free zones and in respondents' perception thus became an important financial and emotionally significant perspective on equality in relation to success.Research limitations/implicationsThe findings of the study could encourage the government to adopt policies that will assist indigenous firms to benefit from advantages that are comparable to those that are available to those in the free zones. Greater attention to the perceptual effects of location would be advantageous. However, the exploratory nature of the study means that results cannot necessarily be generalised beyond the setting in which the data were collected. Future research should examine the impact of location for SMEs in a broader sample of countries.Originality/valueThis study is among those few studies located in the Middle East North Africa (MENA) region that explore the performance of SMEs from the perceptions of owner-managers themselves and not based on aggregate or economic data. It supports previous findings of several studies and contributes additional evidence that suggests the significance of levelling the playing field and its impact on SME performance in the contemporary African business context.

Pharmaceutical care education at pharmacy colleges in the Middle East and North Africa region: A systematic review.

New pharmacy curricula include content that equip students with a bundle of professional and interpersonal skills that allows the provision of evidence-based patient-centred pharmaceutical care (PC). PC has been adopted as a practise model underpinning these new roles for pharmacists in developed countries. However, anecdotal evidence suggests that countries in the Middle East/North Africa (MENA) region have been relatively slow in including PC in pharmacy education. There seems to be a need to more accurately describe the extent to which PC is included in pharmacy education in the MENA region. The objective of this systematic review was (a) to determine the status of PC education in schools and colleges of pharmacy in the MENA region and (b) to identify pharmacy students' and/or educators' perceptions and attitudes towards PC, preparedness level to PC provision and perceived barriers to implement this practise model in countries of the MENA region. A comprehensive literature search was conducted using MEDLINE, EMBASE, SCOPUS, International Pharmaceutical Abstract and ProQuest databases to identify articles published from 2000 to 2021. Selection of studies for inclusion in the review was based on a pre-determined eligibility criterion to retrieve original research articles addressing the review objectives. Nine articles were eligible for inclusion in the review. The majority of the studies (n= 8) employed a survey-based research method. The studies were conducted in Jordan (n= 4), Kuwait (n= 2), Qatar (n= 2), Saudi Arabia (n= 1) and United Arab Emirates (n= 1). The findings suggest that pharmacy students had overall positive attitude and perception towards PC and some studies reported that students expressed good preparedness levels to implement most of the PC aspects. Several barriers to the implementation of PC were reported such as the slow educational reforms in pharmacy programs and a number of organizational and professional barriers. The studies provided recommendations for improvements in the pharmacy curricula to support pharmacy students' preparation to become competent PC practitioners. The literature describing PC education in the MENA region is limited. Joint efforts among educational institutions and health authorities are needed to support PC implementation. There is a need to conduct further research to explore the status of PC education and practise in the different countries within the MENA region. This can drive future directions of pharmacy education to meet the needs of the pharmacy profession and healthcare systems in these countries.

Incidence of diabetes and its predictors in the Greater Beirut Area: a five-year longitudinal study

BackgroundType 2 Diabetes (T2D) remains a world epidemic. Obtaining accurate estimates of its incidence and their predictors will aid in targeting preventive measures, allocating resources, and strategizing its management. The Middle East North Africa region has high T2D prevalence and rates of rise. Few incidence studies exist for the region, and none from Lebanon. The current study objective was to determine diabetes incidence and diabetes predictors in a community-based Lebanese sample. A secondary objective was to describe the metabolic control over time in adults with preexisting diabetes.MethodsThis is a five-year (2014–2019) follow-up study on a random sample of 501 residents of the Greater Beirut area. Out of 478 people eligible to participate in the follow-up study, 198 returned (response rate 39.5%). Assessment included medical history, anthropometric measures, food frequency, sleep, and lifestyle questionnaires. Laboratory data included glycemic indices (fasting glucose and HbA1C) and other biological markers. The diagnosis of probable diabetes (PD) was based on one abnormal test for either fasting glucose ≥ 126 mg/dL or HbA1C ≥ 6.5% or having history of diabetes.ResultsThe incidence of diabetes was 17.2 (95% CI 9.6–28.7) per 1000 person-years. Cardiometabolic risk factors independently associated with diabetes were: older age, higher BMI, family history of diabetes, metabolic syndrome, higher CRP and triglyceride level; whereas an independent predictor of diabetes was previous BMI.In addition, the 42 participants with preexisting diabetes had worsening of their metabolic profile over a five-year period.ConclusionsThe incidence of diabetes was high as compared to some reported world rates, and in line with the high prevalence in the MENA region. The risk was highest in those with positive family history and the presence of the metabolic syndrome or its components. Preventive measures should particularly target participants with that specific risk profile. This becomes particularly important when observing that metabolic control gets worse over time in individuals with diabetes.

Neutralizing Dromedary-Derived Nanobodies Against BotI-Like Toxin From the Most Hazardous Scorpion Venom in the Middle East and North Africa Region.

Scorpion envenoming is a severe health problem in many regions causing significant clinical toxic effects and fatalities. In the Middle East/North Africa (MENA) region, Buthidae scorpion stings are responsible for devastating toxic outcomes in human. The only available specific immunotherapeutic treatment is based on IgG fragments of animal origin. To overcome the limitations of classical immunotherapy, we have demonstrated the in vivo efficacy of NbF12-10 bispecific nanobody at preclinical level. Nanobodies were developed against BotI analogues belonging to a distinct structural and antigenic group of scorpion toxins, occurring in the MENA region. From Buthus occitanus tunetanus venom, BotI-like toxin was purified. The 41 N-terminal amino acid residues were sequenced, and the LD50 was estimated at 40 ng/mouse. The BotI-like toxin was used for dromedary immunization. An immune VHH library was constructed, and after screening, two nanobodies were selected with nanomolar and sub-nanomolar affinity and recognizing an overlapping epitope. NbBotI-01 was able to neutralize 50% of the lethal effect of 13 LD50 BotI-like toxins in mice when injected by i.c.v route, whereas NbBotI-17 neutralized 50% of the lethal effect of 7 LD50. Interestingly, NbBotI-01 completely reduced the lethal effect of the 2 LD50 of BotG50 when injected at 1:4 molar ratio excess. More interestingly, an equimolar mixture of NbBotI-01 with NbF12-10 neutralized completely the lethal effect of 7 and 5 LD50 of BotG50 or AahG50, at 1:4 and 1:2 molar ratio, respectively. Hence, NbBotI-01 and NbF12-10 display synergic effects, leading to a novel therapeutic candidate for treating Buthus occitanus scorpion stings in the MENA region.

Interests above Influence: China's Security Presence in the Middle East–North Africa Region

Interests above Influence: China's Security Presence in the Middle East–North Africa Region

Projected Air Temperature Extremes and Maximum Heat Conditions Over the Middle-East-North Africa (MENA) Region

This study analyzes projected heat extremes over the Middle-East–North Africa (MENA) region until the end of the twenty-first century with a number of temperature indices based on absolute values and thresholds to describe hot conditions. We use model projected daily near-surface air (2-m) temperature (T_mathrm{{max}} and T_mathrm{{min}}) to derive the indices for the period 1980–2100. The data were taken from 18 CMIP5 models combining historical (1980–2005) and scenario runs (2006–2100 under RCP2.6, RCP4.5, and RCP8.5 pathways). Results show a domain-wide projected warming for all emission scenarios. Our findings for a business-as-usual pathway indicate excessive warming of more than 8 ^circ C in the northern part of the domain (south Europe) for the annual warmest day (TXx) and night (TNx). In the hottest parts of the domain record high temperatures reached 50 ^circ C in the recent past, which could increase to at least 56 ^circ C by the end of the century, while temperatures over 50 ^circ C are expected to occur in a large part of the MENA region. A significant increase is projected in the number of hot days (TX >40^circ C) and nights (TN >30 ^circ C) all over the region. For the period of 2071–2100 excessive hot days and nights will become the normal during summer in large parts of the MENA with some locations expected to exceed 180 and 100 days, respectively. Calculations of the corresponding heat index suggest that several areas across the MENA region may reach temperature levels critical for human survival.

ASSESSMENT OF FUTURE CLIMATE PROJECTIONS IN ALGERIA USING STATISTICAL DOWNSCALING MODEL

In this study, we assess the future changes in minimum temperature (T-min), maximum temperature (T-max), and precipitation (PRCP) for the three periods the 2020s (2011–2040), the 2050s (2041–2070), and the 2080s (2071–2100), with respect to the reference period 1981–2010 over Algeria focusing on a validation of the Statistical DownScaling Model (SDSM). In this approach, to underpin our analysis, we evaluate statistically the SDSM performance by simulating the historical temperatures and precipitation. The NCEP reanalysis data and CanESM2 predictors of three future scenarios, RCP2.6, RCP4.5, and RCP8.5 are used for model calibration and future projection, respectively. The projected climate changes resulting from the application of SDSM show a convincing consistency with those unveiled in previous studies over Algeria based on dynamical regional climate model outputs conducted in the context of Middle East-North Africa region. By the end of the century, the results exhibit strong warming for both extreme temperatures under the worst-case scenario (RCP 8.5), it is more pronounced for the T-max and over the Algerian Sahara region. Under the optimistic scenario (RCP2.6), the strength of the warming is expected to increase for both extreme temperatures. The projected changes of precipitation revealed for all scenarios several discrepancies with significant decrease over the northwest region and central Sahara, while nonsignificant change is projected for the center and eastern coastal regions. Our findings corroborate previous studies using sophisticated tools by demonstrating that Algeria’s climate is expected to warm further in the future. These primary findings could give an overview of the application of the statistical modeling approach using SDSM over a semi-arid and arid vulnerable region like Algeria and would extend our knowledge in the climate-modelling field for the North Africa zone by providing an added value to the existing GCMs and regional climate projections. In addition, reliable information regarding the magnitude of future changes at local scale may be used in impact models to assess changes of other key economic sector variables such as water resources management, energy and agriculture.

POSA287 Transferability of Disease-Related Costs of Chronic Immune-Mediated Diseases within Countries of the Middle East North Africa Region: The Case of Multiple Sclerosis

Financing decisions of innovative health technologies including specialty medicines or biologicals increasingly necessitate health technology assessment (HTA) in the Middle East North Africa (MENA) region. However, lack of cost data hampers health economic evaluations. Therefore, we assessed the possibility of transferring disease-related costs of multiple sclerosis (MS) within countries in the MENA region as a model for chronic-immune mediated disorders (IMIDs).

A review on waste management and compost production in the Middle East-North Africa region.

Over the last two decades, solid waste management in the Middle East-North Africa (MENA) region has been one of the major challenges due to increasing solid waste quantities and poor waste management practices. With the tremendously increasing amounts of organic waste, MENA countries are under great pressure and are facing the threats of acute air pollution, contamination of water bodies and climate change. As a result, these countries are adopting different methods to cope with this rising challenge of waste management, including composting. This review reports on the different MENA countries' organic waste quantities, disposal methods, organic waste management practices and challenges, along with the potential use and demand of compost, where information is available. The reported data are from 2009 to 2021, with the bulk of the papers being from 2014 and onwards. The total amount of municipal waste collected in the 21 countries ranged from 0.56 million tons in Mauritania to 90 million tons in Egypt, with an average of 16.42 million tons, equivalent to 1.08 kg per capita waste generation per day. Around 55% of this material is biogenous. Many treatments and repurposing methods of this material are adopted in the MENA region, mainly through composting, as it presents one of the most sustainable solutions that lead to immediate climate change mitigation. This article also presents the biotic and abiotic stressors faced by this region, which in turn affect the successful implementation of composting solutions, and proposes some solutions based on different studies conducted.