410 Promoting public–private mix for TB-DOTS: a multicountry study from the WHO Eastern Mediterranean Region

Hepatitis E virus seroprevalence rate among Eastern Mediterranean and middle eastern countries; A systematic review and pooled analysis

The WHO Eastern Mediterranean Region (EMR) is characterised by a large range in routine immunisation coverage. We reviewed progress in access, deployment efforts, and use of COVID-19 vaccines in the...

BackgroundThe COVID-19 pandemic has escalated the use of telemedicine in both high and low resource settings however its use has preceded this, particularly in conflict-affected settings. Several countries in the WHO Eastern Mediterranean (EMR) region are affected by complex, protracted crises. Though telemedicine has been used in such settings, there has been no comprehensive assessment of what interventions are used, their efficacy, barriers, or current research gaps.Main bodyA systematic search of ten academic databases and 3 grey literature sources from January 1st 2000 to December 31st 2020 was completed, identifying telemedicine interventions in select EMR conflict-affected settings and relevant enablers and barriers to their implementation. Included articles reported on telemedicine use in six conflict-affected EMR countries (or territories) graded as WHO Health Emergencies: Afghanistan, Gaza, Iraq, Libya, Syria and Yemen. Data were extracted and narratively synthesised due to heterogeneity in study design and outcomes. Of 3419 articles identified, twenty-one peer-reviewed and three grey literature sources met the inclusion criteria. We analysed these by context, intervention, and evaluation. Context: eight related to Afghanistan, eight to Syria and seven to Iraq with one each in Yemen and Gaza. Most were implemented by humanitarian or academic organisations with projects mostly initiated in the United States or Europe and mostly by physicians. The in-country links were mostly health professionals rather than patients seeking specialist inputs for specialities not locally available. Interventions: these included both SAF (store and forward) and RT (real-time) with a range of specialities represented including radiology, histopathology, dermatology, mental health, and intensive care. Evaluation: most papers were observational or descriptive with few describing quality measures of interventions.ConclusionsTelemedicine interventions are feasible in conflict-affected settings in EMR using low-cost, accessible technologies. However, few implemented interventions reported on evaluation strategies or had these built in. The ad hoc nature of some of the interventions, which relied on volunteers without sustained financial or academic investment, could pose challenges to quality and sustainability. There was little exploration of confidentiality, ethical standards, data storage or local healthcare worker and patient acceptability.

Context: Hepatitis A virus (HAV) infection is the most common type of acute viral hepatitis that has been proposed as an important public health issue. Most of the countries in WHO Eastern Mediterranean region (EMR) and Middle East (ME) have a high endemicity of HAV infection. To provide a comprehensive estimation of the epidemiology of HAV in this region, we carried out a systematic review on the literature reporting the prevalence of HAV infection in the EMR and ME. Evidence Acquisition: We conducted a systematic search in the databases including PubMed, Scopus, Science Direct, and Web of science using appropriate search strategies. Observational studies published between January 1990 and July 2016 with clearly stated data regarding HAV Ab (IgG) in non-high-risk groups from countries of EMR and ME were examined. We estimated the prevalence of HAV infection and 95% confidence interval based on the pooled data from all included studies for each country, and the regions were weighted according to the population size of each country in that region. Results: The HAV prevalence in ME, WHO EMR, and in total was 61.60 (61.31 - 61.89), 65.74 (65.39 - 66.09), and 62.60 (62.32 - 62.89), respectively. We found no eligible study for Bahrain, Djibouti, Libya, Oman, Qatar, and Sudan. Cyprus had the lowest prevalence rate of HAV (2.61% (1.53 - 4.17)) that along with UAE and Kuwait, it had a prevalence rate below 50%. The most HAV prevalence rates were related to Afghanistan (99.01 (95.51 - 99.89)), Iraq (96.35 (95.97 - 96.70)), Somalia (96.00 (94.16 - 97.33)), and Palestine (93.70 (90.96 - 95.77)), in sequence. Conclusions: The countries of EMR and ME need more and constant programs for prevention and control of HAV infection. Also, further primary original epidemiological studies are needed in some countries of the region.

Tackling COVID-19 in the Eastern Mediterranean Region

This paper presents the findings of a 1999 survey of 19 countries of the World Health Organization Eastern Mediterranean Region on the family planning services and programmes in the Region. Data were collected using a questionnaire which explored the following areas: the presence of population or family planning policies and family planning activities, the family planning services available, promotional and educational activities on family planning, quality assurance, family planning data collection, analysis and dissemination, and the use of such information. The results indicate that 13 of the countries have national policies on population and family planning but even in those that do not, family planning services are widely available. The scope of the services provided varied. There is still a need to implement or strengthen family planning programmes in the Region, a need which is recognized by the countries themselves.

Roots of Iraq's maternal and child health crisis run deep

Implementation of GLASS-AMR: An assessment in WHO’s Eastern Mediterranean Region

The WHO Eastern Mediterranean Region (EMR), encompassing nearly 745 million people across 22 countries, faces significant environmental health challenges [1, 2]. Every year, environmental health risks cause more than one million premature deaths across the Region. Air pollution alone accounts for more than 560,000 premature deaths, with 370,000 attributed to ambient air pollution [3]. These deaths are due to five main health outcomes, including ischemic heart disease (IHD), stroke, chronic obstructive pulmonary diseases (COPD), lung cancer (LC), and acute lower respiratory infections (ALRI) [4]. There is a strong belief that these figures are underestimated due to insufficient epidemiological studies on other health outcomes, for which the causality and evidence are still evolving.

The Beijing genotype is a distinct genetic lineage of Mycobacterium tuberculosis, which is distributed worldwide, and may cause large outbreaks of multidrug resistance-tuberculosis (MDR-TB). The distribution of such strains in the Eastern Mediterranean region (EMR) is unclear, and clarifying the data is our purpose apart from the presence of Beijing TB in Iran. We searched Published literature from CINAHL Cochrane Library, Current Contents, Database of Abstracts of Reviews of Effects (DARE), ProQuest Google Scholar PubMed, PsycINFO, Thomson Reuters, (SID), and Medical Library (MedLib) to detect relevant studies from the year 2000 to July 2015 with the following keywords: M. tuberculosis, Beijing genotype, EMR, and drug resistance. Random-effect models were used to estimate the proportion of Beijing strains in STATA 14. Heterogeneity was investigated by subgroup analysis and meta-regression. The meta-prevalence of Beijing strains was 4% (CI 95% = 3-5). The prevalence was different based on types of detection techniques (spoligotyping = 4% vs. other techniques = 6%; p = 0.003) and years of study (before the year 2000 = 2% vs. after year 2000 = 4%, p = 0.004). The Beijing family was most prevalent in Iran and Pakistan. A strong relationship with drug resistance was reported in Pakistan and Iran, and an increasing trend was seen in Pakistan. Additional studies of drug-resistant TB distribution among Beijing strains in EMR countries are needed as well as a time-trend analysis of the Beijing strain infection in the region.

BackgroundAntimicrobial stewardship program (ASP) interventions are designed to optimize antimicrobial use, reduce adverse effects, and address antimicrobial resistance (AMR). In WHO Eastern Mediterranean Office (EMRO) countries, these efforts are important due to high antibiotic use, evolving resistance patterns, and developing regulatory frameworks.ObjectivesThis scoping review evaluates ASP interventions in EMRO countries by systematically mapping their strategies, clinical, economic, and consumption outcomes, as well as identifying their barriers/limitations to effective implementation.MethodsThis scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A systematic literature search was performed without a time limitation to the end of December 2024 across four major databases—PubMed, Embase, Web of Science, and Scopus—to identify relevant peer-reviewed studies. The search was limited to English-language publications originating from EMRO countries. Eligible studies were required to evaluate ASP interventions and report comparative pre- and post-intervention outcomes. Eligible studies involved healthcare workers or patients. A qualitative color intensity classification system was applied within a thematic matrix to visually represent the relative impact of antimicrobial stewardship interventions. Intensity levels (Dark, Medium, Light) reflected the clinical and managerial relevance of outcomes across economic, clinical, and adherence-related domains.ResultsA total of 77 studies with 199 interventions from 11 EMRO countries were included, with the majority originating from Saudi Arabia (n = 50, 25.12%), the United Arab Emirates (n = 33, 16.58%), and Iran (n = 28, 14.07%). Audit and feedback were the most frequent interventions (n = 50, 25.12%), followed by restrictive, educational, and protocol-driven strategies (each n = 26, 13.06%). Most interventions targeted adults (n = 52, 26.13%) and were implemented in hospital settings (n = 160, 82.05%), primarily at the tertiary level of care. High-impact outcomes—mainly for audit and feedback—included reduced antibiotic use, AMR, and costs. Common limitations were single-center design (n = 40, 18.26%) and poor documentation (n = 33, 15.06%).ConclusionsASP interventions in the EMRO region show varying effectiveness, with audit and feedback proving most successful. Regional cooperation and continued efforts are essential to overcome challenges and strengthen these programs. Future efforts should focus on standardized implementation, improved reporting, and further research to effectively scale successful ASP strategies across the EMRO region. To the authors’ best knowledge, this is the first scoping review of ASP interventions in EMRO countries summarizing their strategies, outcomes, and challenges.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13756-025-01627-1.

In recent years, a number of global commitments have been made in the area of noncommunicable diseases (NCD). These include the UN NCD Political Declaration in 2011, and the UN Comprehensive Review on NCDs and Outcome Document in 2014. Nine global targets have been agreed in the area of NCDs, and NCDs have been addressed in the Sustainable Development Goals (SDG). Another UN high-level meeting will take place in September 2018 to assess country progress across the globe.At the regional level, a number of initiates have taken place to deliver on these global commitments. One of the guiding documents is the Regional Framework for Action on Noncommunicable Diseases. This framework was endorsed at the WHO EM Regional Committee in 2012, and includes 17 strategic interventions and 10 monitoring indicators, covering the areas of NCD governance, prevention, surveillance and healthcare.Progress is being monitored on an annual basis through the development of country progress factsheets and biennial WHO Country Capacity Survey on NCDs. To date however, progress has been insufficient and uneven. Moreover, is has been slowest in the areas of planning and surveillance, and tobacco control.No uniform approach or model exists for all EMR countries, but a number of countries have advanced their national NCD agenda through original and innovative initiatives.Perceived challenges include the uneven progress and needs across the WHO EM region, humanitarian emergencies and political instability, vertical approaches, a lack of human and financial resources and other health systems weaknesses.Opportunities however exist through the global SDG and universal health coverage (UHC) agendas offering an opportunity to revisit essential health services package until 2030.Overall, there has been political commitment to NCD governance, as evidenced by the EM Regional Committee’s endorsement of the regional framework for action. However, despite the clear roadmap, progress has been slow and scattered, differing vastly by country and by topic.We recommend that countries urgently scale up their efforts in all four areas of the EM Regional Framework of Action to be able to achieve their national and international targets.

Legal priorities for prevention of non-communicable diseases: innovations from WHO's Eastern Mediterranean region

The Eastern Mediterranean Region (EMR) faces ongoing challenges in its public health system due to limited resources, logistical issues, and political disruptions. The COVID‐19 pandemic accelerated the need for stronger laboratory capacities to handle the increased demand for testing. In a phased response, EMR countries utilized the National Influenza Centers to rapidly establish and scale molecular testing for SARS‐CoV‐2, the causative agent of COVID‐19. The expansion of capacity included strong collaborations between public health bodies and private and academic sectors to decentralize and expand testing to the subnational level. To ensure that the quality of testing was not impacted by rapid expansion, national and subnational laboratories were enrolled in external quality assurance programs for the duration of the response. Implementation of genomic surveillance was prioritized for variant tracking, leading to the establishment of regional sequencing reference laboratories and the distribution of MinION sequencing platforms to complex emergency countries who previously had limited experience with pathogen sequencing. Challenges included a lack of technical expertise, including in implementing novel diagnostic assays and sequencing, a lack of bioinformatics expertise in the region, and significant logistical and procurement challenges. The collaborative approach, coordinated through the WHO Eastern Mediterranean Regional Office, enabled all 22 countries to achieve SARS‐CoV‐2 diagnostic capabilities, highlighting the pivotal role of laboratories in global health security.

Cholera, an age-old disease driven by poverty, poor sanitation and insufficient access to clean water, remains a major public health concern in the WHO Eastern Mediterranean Region (EMR). In January 2023, WHO declared cholera a Grade 3 global public health emergency, requiring organization-wide support and response. In 2024, 8 EMR countries reported 597 026 cholera cases and 2403 deaths, including acute watery diarrhoea (AWD) cases reported in Afghanistan, contributing to almost 74% of the global cholera burden.