North Africa Research Articles

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.

Morphological and Taxonomic Analysis of the Quercus faginea and Quercus canariensis (Fagaceae) Complexes in Algeria

The valid deciduous Quercus L. species from North Africa have been largely discussed by many authors. The current species remain yet uncertain. In this study, we compare several populations of presumably Q. canariensis Willd. and Q. faginea Lam. from Algeria with pure populations of these species from the northeast of the Iberian Peninsula. Different morphological characters from leaves have been analyzed. Principal components analysis and a canonical analysis of principal coordinates have been used to observe the relationship between samples, groups and the seven quantitative variables. Distances among centroids have been reported and a SIMPER procedure has also been executed to better explain the different variability within and between groups. PERMANOVA has been applied to test for significant differences between the groups. For the trichomes study, ANOVA models have been used. From our analysis, we conclude that in Algeria, we have a single Q. canariensis Willd. population, different from the Iberian population we examined. It probably corresponds morphologically to Q. mirbeckii Durieu, currently considered a synonymy of Q. canariensis Willd., and for the “Q. faginea” group we have two Algerian populations: Q. faginea Lam. subsp. faginea, found in the northeast Iberian Peninsula, and Q. tlemcenensis (A.DC.) Maire and Weiller ex Greuter and Burdet. Previous results from other authors have also been discussed.

Undernourishment in North and sub-Saharan Africa

Undernourishment has continued to occur globally in recent years; the spread of this phenomenon shows that inequalities, between and within countries, are increasing. After a good period of stability since 2015, the prevalence of undernourishment (PoU) dropped from 8.0 percent to 9.3 percent between 2019 and 2020, then increased at a less sustained rate in 2021, rising to 9.8 percent. The causal factors to eliminate or reduce its severity differ from one country to another. The causes of hunger in the countries of North Africa are: independence from food imports of primary products, loss of marine biodiversity, climate change (projected change in warm periods) and poverty in terms of available water resources cause while malnutrition or moderate food insecurity comes down to the lack of commitments in international conventions on the environment and the respect and enforcement of the law against trafficking in natural resources. The causal variables of these two phenomena in the countries of sub-Saharan Africa are identical.The great pressure that the population exerts on their environment and the enormous consumption of resources without having them protected, also the total deterioration of the agricultural sector and the Emigration to urban areas has greatly worsened the situation of hunger and malnutrition in these countries. The projects implemented to resolve these issues must be designed according to the causes identified in each country. In general, the reorientation of public support must currently be provided to strengthen the primary sector (food and agriculture), by implementing complementary policies relating to agri-food systems, promoting healthy food environments and providing consumers with the means to adopt a healthy diet.

Genomic Landscape of Advanced Solid Tumors in Middle East and North Africa Using Circulating Tumor DNA in Routine Clinical Practice

Introduction: Next-generation sequencing (NGS) of tumor DNA can detect actionable drivers and help guide therapy for patients with advanced-stage cancers. While tissue-based genotyping is considered a standard of care, blood-based genotyping is emerging as a valid alternative. Tumor genomic profiles may vary by region, and data from the Middle East and North Africa (MENA) are not widely available. This study elucidates the genomic landscape of advanced solid cancers in patients from the MENA region by retrospectively analyzing results from NGS circulating tumor DNA (ctDNA) testing. Methods: In routine clinical practice, 926 plasma samples from 767 patients with advanced cancers from the MENA region were profiled using a comprehensive NGS assay (Guardant360®). We conducted a pan-cancer analysis and sub-analyses focusing on lung, breast, and colorectal cancers. Results: In the pan-cancer group, TP53 (58.5%), EGFR (20.4%), and KRAS (18.9%) were the most frequently mutated genes. EGFR (10.2%), FGFR1 (4.9%), and PIK3CA (4.9%) showed the most amplifications, while fusions were observed in 2.7% of patients, including ALK, FGFR2, and RET. For lung adenocarcinoma, EGFR (30.5%), KRAS (19.3%), and ERBB2 (4.6%) were the most frequently identified alterations among the genes recommended for evaluation by the National Comprehensive Cancer Network (NCCN). In patients with breast cancer, PIK3CA (35.3%), ESR1 (21.7%), and BRCA1/2 (13.3%) had the most prevalent alterations among NCCN-recommended genes. In colorectal cancer, KRAS (39.0%), NRAS (8.0%), and BRAF (V600E, 4.0%) were the most observed mutations among genes recommended by the NCCN. Comparing this cohort to publicly available Western and Eastern datasets also indicated similarities (including PIK3CA in breast cancer) and variances (including EGFR in lung adenocarcinoma) in key genes of interest in the analyzed cancer types. Conclusion: Overall, our findings provide insight into the genomic landscape of individuals with advanced solid organ malignancies from the MENA region and support the role of ctDNA in guiding therapeutic decisions.

Parental migration, socioeconomic deprivation and hospital admissions in preschool children in England: national birth cohort study, 2008 to 2014

BackgroundA third of children born in England have at least one parent born outside the United Kingdom (UK), yet family migration history is infrequently studied as a social determinant of child health. We describe rates of hospital admissions in children aged up to 5 years by parental migration and socioeconomic group.MethodsBirth registrations linked to Hospital Episode Statistics were used to derive a cohort of 4,174,596 children born in state-funded hospitals in England between 2008 and 2014, with follow-up until age 5 years. We looked at eight maternal regions of birth, maternal country of birth for the 6 most populous groups and parental migration status for the mother and second parent (UK-born/non-UK-born). We used Index of Multiple Deprivation (IMD) quintiles to indicate socioeconomic deprivation. We fitted negative binomial/Poisson regression models to model associations between parental migration groups and the risk of hospital admissions, including interactions with IMD group.ResultsOverall, children whose parents were both born abroad had lower emergency admission rates than children with parents both born in the UK. Children of UK-born (73.6% of the cohort) mothers had the highest rates of emergency admissions (171.6 per 1000 child-years, 95% confidence interval (CI) 171.4–171.9), followed by South Asia-born mothers (155.9 per 1000, 95% CI 155.1–156.7). The high rates estimated in the South Asia group were driven by children of women born in Pakistan (186.8 per 1000, 95% CI 185.4–188.2). A socioeconomic gradient in emergency admissions was present across all maternal regions of birth groups, but most pronounced among children of UK-born mothers (incidence rate ratio 1.43, 95% CI 1.42–1.44, high vs. low IMD group). Patterns of planned admissions followed a similar socioeconomic gradient and were highest among children with mothers born in Middle East and North Africa, and South Asia.ConclusionsOverall, we found the highest emergency admission rates among children of UK-born parents from the most deprived backgrounds. However, patterns differed when decomposing maternal place of birth and admission reason, highlighting the importance of a nuanced approach to research on migration and health.

The spatial relationship between leishmaniases and sand flies in Europe and neighboring countries

BackgroundLeishmania infantum is endemic in Europe (and elsewhere) while L. donovani s.s., L. tropica and L. major are not but are present in neighboring countries in North Africa, the Middle East, (the Asian part of) Turkey and the Southern Caucasus. Lists of sand fly vector species in the scientific literature vary with the criteria for vector incrimination, and criteria vary because, for some, evidence is difficult to generate. With minimal criteria, about 20 sand fly species are proven or suspected vectors of L. infantum in Europe and neighboring countries, while for L. tropica and L. major, there are seven and four proven or suspected vector species, respectively, in this area. For L. donovani s.s., present in Cyprus, the Middle East and (the Asian part of) Turkey, no local vectors have been incriminated so far. The aim was to assess the degree of spatial agreement between Leishmania spp. and various vectors species and their relative contribution to the explained variation.MethodsWe used multivariate regression modeling to analyze the spatial relationship between autochthonous Leishmania spp. and clinical forms in humans and animals and 14 Phlebotomus spp. in Europe and neighboring countries.ResultsThere was only fair agreement between parasite and vector distributions. The most parsimonious models describing the distribution of Leishmania spp. and clinical forms included three to six sand fly species and explained between 12% (L. infantum) and 37% (L. donovani) of the observed variation. Selected models included confirmed and suspected vector species as well as unexpected species.ConclusionsThe relatively low agreement between Leishmania and vector distributions highlights the need to improve leishmaniasis reporting and vector surveillance in areas where no information is available, both for a better understanding of the epidemiology of infection in endemic areas and to monitor possible spread of infection into non-endemic areas. While some of the unexpected sand fly-Leishmania spp. statistical associations might be spurious, for others, the existence of sporadic or recent reports of infections warrants further vector competence studies that consider strain variation.Graphical

Causes and predictors of premature death in the pars cohort study, Iran: a cohort study

BackgroundWhile death in old age is inevitable, premature death at younger ages is within our control. Premature mortality (death < 70 years) is a crucial indicator of health status and access to healthcare, with variations observed across regions. In North Africa and the Middle East, ischemic heart disease (IHD), road injuries, stroke, and chronic kidney disease are projected to be the main causes of premature mortality. Unfortunately, few studies have been conducted on premature mortality worldwide. This study aimed to analyze the causes of premature death and associated risk factors within the Pars Cohort Study.MethodsThe Pars Cohort Study is a prospective cohort study conducted in Fars Province, Iran, involving 9,264 individuals aged 40–75 years, 53.8% of whom were women. We assessed participants from baseline (2012–2014) to 2021. The data were gathered through interviews, biological samples, and physical examinations. The causes of premature mortality, hazard ratios (HRs), and population attributable fraction (PAF) with 95% confidence intervals (95% CIs) for the variables were calculated.ResultsOut of 388 deaths, 54% were premature. The most common causes of premature death included IHD (40%), stroke (11%), road traffic injuries (6%), lower respiratory infections (5%), and COVID-19 (3%). The predictive factors [adjusted HRs (95% CIs)] associated with premature mortality included age [year, 1.07 (1.04, 1.10)], tobacco [1.43 (0.96, 2.11)], opium [2.12 (1.39, 3.24)], hypertension [1.52 (1.10, 2.12)], waist circumference [cm, 1.03 (1.00, 1.05)], female sex [0.30 (0.19, 0.47)], education [> 8 years vs. no formal schooling, 0.46 (0.24, 0.88)], being married [0.60 (0.37, 0.97)], physical activity [3rd vs. 1st tertile, 0.38 (0.26, 0.57)], hip circumference [cm, 0.96 (0.92, 0.99)], estimated GFR [mL/min/1.73 m², 0.99 (0.978, 0.999)], and wealth score [4th vs. 1st quartile, 0.54 (0.32, 0.90)]. The PAF (95% CI) for all modifiable predictors was 0.83 (0.62, 0.92).ConclusionsThe predominant causes of premature mortality were IHD and stroke. To mitigate premature deaths, it is recommended to address both socioeconomic and behavioral factors simultaneously.

Ablation of Supraventricular Arrhythmias With as Low as Reasonably Achievable X-Ray exposure (AALARA): Results of Prospective, Observational, Multicenter, Multinational, Open-Label Registry Study on Real World Data Using Routine Ensite 3D Mapping During SVT Ablation.

The reduction of fluoroscopic exposure during catheter ablation of supraventricular arrhythmias is widely adopted by experienced electrophysiology physicians with a relatively short learning curve and is becoming the standard of care in many parts of the world. While observational studies in the United States and some parts of Western Europe have evaluated the minimal fluoroscopic approach, there are scarce real-world data for this technique and the generalizability of outcomes in other economic regions. The AALARA study is a prospective, observational, multicenter, and multinational open-label study. Patients were recruited from 13 countries across Central Eastern Europe, North and South Africa, the Middle East, and the CIS (Commonwealth of Independent States), with different levels of operator expertise using minimal fluoroscopic exposure techniques. Data on radiation exposure, procedural success, complications, recurrence, and quality of life changes were collected and analyzed. A total of 680 patients were enrolled and followed for 6 months. The majority were ablation naïve with the commonest arrhythmia ablated being typical AVNRT (58%) followed by Atrial Flutter (23%). Zero fluoroscopy exposure was observed in almost 90% of the cases. Fluoroscopy was most commonly used during the ablation phase of the procedure. We observed a high acute success rate (99%), a low complication rate (0.4%), and a 6-month recurrence rate of 3.8%. There was a significant improvement in the patient's symptoms and quality of life as measured by patient global assessment. The routine use of a 3D mapping system during right-sided ablation was associated with low radiation exposure and associated with high acute success rate, low complications, and recurrence rate along with significant improvement in quality of life. The data confirm the reproducibility of this approach in real-world settings across different healthcare systems, and operator experience supporting this approach to minimize radiation exposure without compromising efficacy and safety. NCT04716270.

A Proteomic Analysis of Nasopharyngeal Carcinoma in a Moroccan Subpopulation.

Nasopharyngeal carcinoma (NPC) is a distinct cancer of the head and neck that is highly prevalent in Southeast Asia and North Africa. Though an extensive analysis of environmental and genetic contributors has been performed, very little is known about the proteome of this disease. A proteomic analysis of formalin-fixed paraffin-embedded (FFPE) tissues can provide valuable information on protein expression and molecular patterns for both increasing our understanding of the disease and for biomarker discovery. To date, very few NPC proteomic studies have been performed, and none focused on patients from Morocco and North Africa. Label-free Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS) was used to perform a proteomic analysis of FFPE tissue samples from a cohort of 41 NPC tumor samples of Morocco and North Africa origins. The LC-MS/MS data from this cohort were analyzed alongside 21 healthy controls using MaxQuant 2.4.2.0. A differential expression analysis was performed using the MSstats package in R. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) functional annotations were carried out using the DAVID bioinformatic tool. 3341 proteins were identified across our NPC cases, revealing three main clusters and five DEPs with prognostic significance. The sex disparity of NPC was investigated from a proteomic perspective in which 59 DEPs were found between males and females, with significantly enriched terms associated with the immune response and gene expression. Furthermore, 26 DEPs were observed between patients with early and advanced stages of NPC with a significant cluster related to the immune response, implicating up-regulated DEPs such as IGHA, IGKC, and VAT1. Across both datasets, 6532 proteins were quantified between NPC patients and healthy controls. Among them, 1507 differentially expressed proteins (DEPs) were observed. GO and KEGG pathway analyses showed enriched terms of DEPs related to increased cellular activity, cell proliferation, and survival. PI3K and MAPK proteins as well as RAC1 BCL2 and PPIA were found to be overexpressed between cancer tissues and healthy controls. EBV infection was also one of the enriched pathways implicating its latent genes like LMP1 and LMP2 that activate several proteins and signaling pathways including NF-Kappa B, MAPK, and JAK-STAT pathways. Our findings unveil the proteomic landscape of NPC for the first time in the Moroccan population. These studies additionally may provide a foundation for identifying potential biomarkers. Further research is still needed to help develop tools for the early diagnosis and treatment of NPC in Moroccan and North African populations.

Predatory midges of the genus Schizohelea Kieffer, 1917 in Europe and North Africa (Diptera: Ceratopogonidae)

Five species of the Holarctic genus Schizohelea occurring in Europe and North Africa are reviewed, diagnosed and illustrated. These are S. leucopeza (Meigen, 1804), S. incerta (Clastrier, 1963), S. algeriana Szadziewski, Dominiak, Rumišek et Rupp, sp. nov., S. clastrieri Szadziewski, Dominiak, Rumišek et Rupp, sp. nov. and S. withersi Szadziewski, Dominiak, Rumišek et Rupp, sp. nov. The male of North African S. incerta is described for the first time. Schizohelea algeriana and S. clastrieri are described from northern Algeria, and S. withersi from southern France. An identification key to all species of the genus is provided.

Integrated solar dryer and distillation system with PCM and injection, powered by PVT panels and solar concentrator

This research introduces a novel hybrid system integrating solar drying, solar distillation, and photovoltaic thermal panels, aimed at drying agricultural products, producing clean drinking water, and conserving energy. The system enhances the drying air temperature using thermal energy storage materials and a solar dish concentrator connected to a hot water storage tank, ensuring continuous operation even after sunset. The solar distiller, equipped with energy storage materials and an air injection system, is integrated with an external condenser to condense water vapor before expulsion, thereby increasing freshwater productivity. The results revealed that the developed system achieved an accumulative freshwater productivity of 87.1 L per day. The rates of water removal from dried potato slices ranged from 0.18 to 0.91 kg/h between 8:00 am and 10:00 pm. Additionally, the system achieved a gain output ratio of 1.38, indicating a significant improvement in energy efficiency. This innovative system offers practical solutions to address energy and freshwater scarcity, especially in remote regions of the Middle East and North Africa (MENA) region, which are characterized by high solar irradiance. The implementation of such hybrid systems could contribute to sustainable development by reducing reliance on conventional energy sources and mitigating environmental pollution.

Zachowując wspólne więzi: dyplomacja publiczna Turcji w Azji Środkowej

This article aims to analyse and assess the effectiveness of activities undertaken by Turkish public diplomacy organisations in Central Asia. Since the Justice and Development Party (AKP) came to power in Turkey in 2002, the state’s foreign policy doctrine has changed profoundly. The new government has adopted a program of active and multifaceted diplomacy, seeking to improve mutual relations with neighbouring regions (i.e. Middle East, North Africa, Balkans, Caucasus, Central Asia). Historical, social and cultural references play an extremely important role in the AKP’s political strategy, and numerous public diplomacy organisations promote Turkish regional cooperation initiatives on behalf of the authorities in Ankara. In Central Asia, institutions such as the Turkish Cooperation and Coordination Agency, the International Organisation of Turkic Culture, the Yunus Emre Institute, the Presidency for Turks Abroad and Related Communities, ensure that ties between Turkey and countries of the region are being preserved. By utilising Turkish soft power potential, these organisations support traditional diplomatic services in implementing Turkey’s foreign policy objectives.

Criminal synergies: Human smuggling and illicit organ removal on the Central Mediterranean route

The externalisation of European border controls in North Africa is represented and justified by European leaders as the antithesis to the business model of human smuggling and human trafficking. Rather than being in an antithetical relationship, I argue that the European Union is in a symbiotic relationship with criminal groups exploiting the (im)mobility of migrants for profit. My analysis is informed by 37 interviews with African migrants, organ brokers, migration brokers and humanitarian organisations. Their experiences reveal how the convergence of crime and immigration controls along the Central Mediterranean route has led to the development of criminal synergies between different illegal markets, i.e. human smuggling and illicit organ removal.

The impact of gynecologic cancer on female sexuality in Europe and MENA (Middle East and North Africa): a literature review.

Gynecologic cancer has a negative impact on the sexuality of women who are or have been affected by this disease. In fact, gynecologic cancers cause negative changes in female sexuality, affecting body image and psychophysical well-being, with serious consequences for women's sex lives. The aim of this study is to analyze the differences in sexuality among women who have or have had gynecologic cancer in Europe and in the Middle East and North Africa (MENA). We also explored possible factors that may influence women's sexuality in the 2 populations compared. The literature search was carried out using PubMed and Google Scholar, considering the 10-year period of 2013 to 2023. Studies were initially selected according to the criterion that the title and abstract were in English. We then reviewed all the articles selected in the first phase and analyzed the following information: author, year of publication, type of gynecologic cancer, country in which the study was conducted, design, and materials used. Finally, we defined the inclusion criteria for the present paper: women 18years of age or older, diagnosed with gynecologic cancer, and who had undergone treatment (surgery, chemotherapy, radiotherapy). The studies reviewed were conducted between 2013 and 2023 in Europe and MENA, and all analyzed sexual function after the disease, understood as a general dimension that includes physiological and psychological aspects. The results of this research show that patients in both geographical areas (Europe and MENA) report changes in sexuality as a result of the cancer. Studies show that cancer reduces, interrupts, and impairs women's sexual activity, resulting in experiences of discomfort, anxiety, guilt, inadequacy, pain, and poorer quality of life. The data analyzed in this review show that cancer causes changes and deterioration in sexuality in both populations studied. No cultural or social factors were found to cause differences between the variables studied in the 2 populations. In the future, it may be interesting to carry out further studies to improve the treatment of women with gynecologic cancer, as sexuality is a very important part of a person's life.

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.

Genetic profile of progressive myoclonic epilepsy in Mali reveals novel findings.

Progressive myoclonic epilepsy (PME) is a group of neurological disorders characterized by recurrent myoclonic seizures with progressive neurological deterioration. We investigated the genetics of three unrelated patients with PME from Mali, a country in sub-Saharan Africa highly underrepresented in genetic and genomic research. Participants were carefully examined and phenotyped. DNA was obtained for genetic analysis including whole exome sequencing (WES). In silico prediction tools and ACMG criteria were used to assess the deleteriousness of putative candidate variants. Pedigree analysis suggests autosomal recessive inheritance patterns for one family and sporadic forms of PME for the two other cases. WES identified novel homozygous missense variants in all the three patients, one each for NHLRC1, EPM2A, and NEU1. The sequence variants segregated with PME in each family and in silico studies including protein 3D structures, CADD scores and ACMG criteria suggested that they were damaging. PME is a group of clinically heterogeneous neurological disorders. Most reported cases in the literature are from European background with only a few cases described in North Africa. We report here novel pathogenic variants in three different genes causing PME phenotypes in three unrelated Malian patients, suggesting that genetic studies of underrepresented populations may expand the genetic epidemiology of PME. These findings also emphasize the need for inclusive genetic research to ensure a more targeted diagnostic and therapeutic approaches for diverse patient populations.

Сравнительный анализ развития Eдиных Информационных Систем Здравоохранения (ЕИСЗ) в странах Африки, Северной Америки и Европы: проблемы и перспективы.

This study presents a comparative analysis of the development of unified healthcare information systems (UHIS) in North America, Europe, and Africa. The research examines key aspects of UHIS implementation, including population coverage by electronic health records, telemedicine development, system interoperability, and regulatory frameworks. The analysis revealed significant regional differences in approaches to healthcare digitalization and UHIS implementation levels. North America is characterized by high digital technology adoption but faces challenges in integrating disparate systems. The European region shows heterogeneity, with Northern European countries leading, while Southern and Eastern Europe lag in UHIS development. The African continent presents the most contrasting picture, with a small group of leading countries and most states in the early stages of digitalization. The study identified common challenges across all regions, including ensuring interoperability, protecting personal data, and overcoming healthcare professionals' resistance to change. Special attention is given to innovative approaches, such as the use of mobile technologies in Africa to overcome infrastructure limitations. The research results emphasize the need for a comprehensive approach to UHIS implementation, considering not only technological but also socio-economic factors. The study concludes that successful UHIS development requires a clear national strategy, adequate funding, and active involvement of all stakeholders.

Need for neurorehabilitation in the Middle East and North Africa from 1990 to 2021: an analysis based on the global burden of disease study

Background: This study will present the burden of diseases needing neurorehabilitation in Middle East and North Africa (MENA) countries and describe their epidemiology across age and gender groups. Materials and Methods: This study was conducted based on the Global Burden of Disease (GBD) 2021 findings. We used years of healthy life lost due to disability (YLD) as a proxy for the need for neurorehabilitation, and extracted the YLD rates and counts for neonatal encephalopathy due to birth asphyxia and trauma, stroke, neural tube defects, Parkinson’s disease (PD), motor neuron disease, multiple sclerosis (MS), tension-type headache, other neurological disorders (except migraine, dementia, and epilepsy), head injuries, spinal injuries, nerve injury, and asphyxiation across age groups, genders, and MENA countries. Results: YLD rates of disorders needing neurorehabilitation in 1990 and 2021 were 408.08 and 496.19 per 100,000 people, respectively, indicating a 21.59% rise in YLD. Stroke had the highest YLD rates in both 1990 (150.19 per 100,000) and 2021 (192.75 per 100,000). Syria, Saudi Arabia, and the United Arab Emirates had the highest YLD rates for conditions needing neurorehabilitation Conclusions: Considering the growing demand for neurorehabilitation with the aging of populations and the historical shortage of rehabilitation services in the region, the gap between the demand and supply may further increase in the coming years, leading to consequences for people living with neurological conditions in the region.

Impact of the Israel–Hamas conflict on financial markets of MENA region – a study on investors’ reaction

PurposeThis study aims to examine market reactions to the Israel–Hamas conflict in neighboring countries, particularly focusing on the Middle East North Africa (MENA) region.Design/methodology/approachThe study adopts an event study methodology, employing average abnormal return (AAR) and cumulative abnormal return as measures to assess market reactions. The sample for this study comprises 1,314 companies, with October 9, 2023, identified as the event day for analysis.FindingsThe results of our study indicate that countries in close proximity to Israel and Palestine encountered detrimental effects on their capital markets, as evidenced by negative responses observed across various sectors. Our analysis also reveals that countries in the midst of conflict, particularly Israel, experienced a decrease in their stock markets across various sectors, with the exception of materials and real estate. In addition, our investigation reveals disparities in market responses according to different categories of company size.Originality/valueThis research is the first to study market reactions to Israel–Hamas in the MENA region at the company level.