Oral Health Research in the WHO Eastern Mediterranean Region between 2014 and 2024: a scoping review protocol

BackgroundMalaria remains a major public health challenge in the WHO Eastern Mediterranean region, transmitted by various Anopheles species. The main objective of this review was to collect the knowledge on the diversity and spatial distribution of malaria vectors in the World Health Organization (WHO) Eastern Mediterranean region.MethodsA comprehensive literature search was conducted in PubMed, Web of Science, and Scopus through August 2024 using the terms “Anopheles”, “malaria vector”, and relevant country names. Eligible field studies documenting captures of adult or larval Anopheles with detailed information about the capture locations (including both rural and urban areas, as well as various breeding sites and feeding behaviours), were systematically included. Out of 3637 identified publications, 276 met the inclusion criteria.ResultsThis systematic review identified 45 species of Anopheles mosquitoes documented across the WHO Eastern Mediterranean region, reflecting substantial ecological diversity. Most research has concentrated on five principal species: Anopheles stephensi (102 studies), Anopheles superpictus (57), Anopheles dthali (49), Anopheles culicifacies (47), and Anopheles maculipennis (45). A total of 18 countries were represented, with Iran contributing the largest share of studies (122 studies), followed by Pakistan (35), Sudan (31), Egypt (30), Morocco (14), Saudi Arabia (14), Iraq (7), Afghanistan (6), while the remaining countries had fewer than five studies each.ConclusionsThis review highlights the critical need for ongoing monitoring and surveillance of Anopheles populations to identify shifts in distribution and abundance. Such information is essential for timely interventions and adapting control measures in response to emerging threats.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12936-025-05697-9.

This detailed and comprehensive study examines nutrition and health in the World Health Organization (WHO) Eastern Mediterranean Region, presenting the six game-changing food systems actions proposed by the WHO and the progress of their implementation in the region. The WHO Eastern Mediterranean Region is a particularly complex place to study: an area of economic contrasts with changing dietary patterns and stark differences between high levels of malnutrition and a prevalence of overweight and obesity. As a result, actions to improve the nutritional situation of the population are urgently sought. The strategies explored in this book offer a unique opportunity to change food systems all over the world, addressing aspects including sustainable food production, the impact of marketing and labelling on behaviour, and the effect of global events such as climate change, war and the COVID-19 pandemic. Reshaping Food Systems is an essential read at a time when malnutrition in all its forms, including undernourishment, micronutrient deficiencies and overweight and obesity, pose a serious threat to global health, and is of particular interest for policymakers working in nutrition and public health.

Suicide Prevention in an International Context.

Background: The healthy city concept has been widely accepted globally and has been established in all six World Health Organization (WHO) Regions. Community involvement, empowerment, and leadership are embedded core principles in the Healthy Cities initiative and pillars to achieve the health and health-related sustainable development goals. This article aimed to present the findings of the recent evaluation of eleven healthy cities in the WHO Eastern Mediterranean Region (EMR). Methods: The descriptive comparative evaluation was based on the WHO/EMRO healthy city 80 indicators. It included eleven cities (Al-Dariyah, Jalajil, Al-Jamoum, Unaiza, Riyadh Alkhubra, Sharoura, Al-Madina, Al-Taif, and Al-Mundaq in Kingdom of Saudi Arabia; Al-Yarmouk in Kuwait, and Manama in Bahrain). Results: The findings revealed that eleven cities were peculiar in demonstrating community involvement, empowerment, and leadership in real terms. All had well mechanisms for communities to voice themselves and participate in decision-making, assessing the needs, setting priorities, planning better for their cities, and monitoring. The community engagement was based on voluntarism with a high sense of loyalty. It has been well demonstrated in community organizations like women and youth groups, health volunteers, community-based organizations, and others. Conclusion: Although community participation and empowerment remain at the heart of the healthy cities initiative, to be meaningful, the government-related sectors must foresee this as an integral part of long-term strategic development. Moreover, a paradigm shift towards a more integrated approach to promote health, well-being, accelerate the achievement of health-related sustainable development goals, and reduce health inequities in urban settings requires multi-stakeholder collaboration, including public, private, and community civil societies.

Prevalence estimates are essential to effectively prioritize, plan, and deliver health care to high-needs populations such as children and youth with fetal alcohol spectrum disorder (FASD). However, most countries do not have population-level prevalence data for FASD. To obtain prevalence estimates of FASD among children and youth in the general population by country, by World Health Organization (WHO) region, and globally. MEDLINE, MEDLINE in process, EMBASE, Education Resource Information Center, Cumulative Index to Nursing and Allied Health Literature, Web of Science, PsychINFO, and Scopus were systematically searched for studies published from November 1, 1973, through June 30, 2015, without geographic or language restrictions. Original quantitative studies that reported the prevalence of FASD among children and youth in the general population, used active case ascertainment or clinic-based methods, and specified the diagnostic guideline or case definition used were included. Individual study characteristics and prevalence of FASD were extracted. Country-specific random-effects meta-analyses were conducted. For countries with 1 or no empirical study on the prevalence of FASD, this indicator was estimated based on the proportion of women who consumed alcohol during pregnancy per 1 case of FASD. Finally, WHO regional and global mean prevalence of FASD weighted by the number of live births in each country was estimated. Prevalence of FASD. A total of 24 unique studies including 1416 unique children and youth diagnosed with FASD (age range, 0-16.4 years) were retained for data extraction. The global prevalence of FASD among children and youth in the general population was estimated to be 7.7 per 1000 population (95% CI, 4.9-11.7 per 1000 population). The WHO European Region had the highest prevalence (19.8 per 1000 population; 95% CI, 14.1-28.0 per 1000 population), and the WHO Eastern Mediterranean Region had the lowest (0.1 per 1000 population; 95% CI, 0.1-0.5 per 1000 population). Of 187 countries, South Africa was estimated to have the highest prevalence of FASD at 111.1 per 1000 population (95% CI, 71.1-158.4 per 1000 population), followed by Croatia at 53.3 per 1000 population (95% CI, 30.9-81.2 per 1000 population) and Ireland at 47.5 per 1000 population (95% CI, 28.0-73.6 per 1000 population). Globally, FASD is a prevalent alcohol-related developmental disability that is largely preventable. The findings highlight the need to establish a universal public health message about the potential harm of prenatal alcohol exposure and a routine screening protocol. Brief interventions should be provided, where appropriate.

In 1997, the 22 countries in the World Health Organization (WHO) Eastern Mediterranean Region (EMR) adopted a goal of measles elimination by 2010. To achieve this goal, the WHO Regional Office for the Eastern Mediterranean Region (EMRO) developed a four-pronged strategy: 1) achieve ≥ 95% vaccination coverage of children with the first dose of measles-containing vaccine (MCV1) in every district of each country through routine immunization services, 2) achieve ≥ 95% vaccination coverage with the second dose of measles-containing vaccine (MCV2) in every district of each country either through a routine 2-dose vaccination schedule or through supplementary immunization activities (SIAs), 3) conduct high-quality, case-based surveillance in all countries, and 4) provide optimal clinical case management, including supplementing diets with vitamin A. Although significant progress was made toward measles elimination in the EMR during 1997-2007, the measles elimination goal was not reached by the target date of 2010, and the date was revised to 2015. This report updates previous reports and summarizes the progress made toward measles elimination in EMR during 2008-2012. From 2008 to 2012, large outbreaks occurred in countries with a high incidence of measles, and reported annual measles cases in EMR increased from 12,186 to 36,456. To achieve measles elimination in EMR, efforts are needed to increase 2-dose vaccination coverage, especially in countries with high incidence of measles and in conflict-affected countries, and to implement innovative strategies to reach populations at high risk in areas with poor access to vaccination services or with civil strife.

The World Health Organization (WHO) Eastern Mediterranean Region (EMR) presently is the arena of the world’s major conflicts and over one-third of its member countries have been in permanent conflict for the last five years or more.

Referral systems represent the structural link between different tiers of health care, ensuring patients receive appropriate, timely, and continuous management. Effective referral mechanisms prevent fragmentation, duplication, and inequity while optimizing limited specialist resources. In the Gulf and Middle East, fast-growing populations, epidemiologic transitions, and significant digital-health investments have reshaped how referrals operate. This review synthesizes evidence from Saudi Arabia, the United Arab Emirates (UAE), Qatar, Oman, Bahrain, Jordan, and Lebanon, examining referral models, common bottlenecks, and emerging innovations. Across the region, digital transformation through national health information exchanges (HIEs) has advanced rapidly, yet persistent challenges remain, particularly in gatekeeping, interoperability, workforce training, and governance. The review concludes with policy and research recommendations aligned with the World Health Organization (WHO) Eastern Mediterranean Region (EMRO) strategy for people-centered integrated health services.

Anopheles stephensi (Diptera: Culicidae), a primary malaria vector native to south Asia and the Arabian peninsula, has recently spread to Sri Lanka and the Horn of Africa (HOA). Its arrival poses a serious challenge to malaria control initiatives, particularly in the rapidly urbanized African settings because it can transmit both Plasmodium falciparum (Haemosporida: Plasmodidae) and Plasmodium vivax (Haemosporida: Plasmodidae). This threat is compounded by the vector's growing resistance to insecticides, particularly pyrethroids, the backbone of indoor residual spraying (IRS) and insecticide-treated nets (ITNs). The use of dichlorodiphenyltrichloroethane (DDT), which exhibits a comparable mode of action to pyrethroids, significantly increases the likelihood of cross-resistance development. This review presents the first regionally integrated synthesis of An. stephensi susceptibility to pyrethroids and DDT. The analysis encompasses phenotypic resistance and underlying molecular mechanisms across the World Health Organization (WHO) Eastern Mediterranean Region, the Indian subcontinent and the HOA regions where the species is either native or invasive. Twenty-one studies published over the past two decades were identified through searches in five electronic databases. The findings revealed confirmed resistance to multiple pyrethroid compounds such as permethrin, deltamethrin, lambdacyhalothrin, alpha-cypermethrin, and cyfluthrin, as well as DDT, while susceptibility to etofenprox varied by location. Geographic variability was observed in intensity of resistance and allele distribution across Iranian sites. Mechanistically, resistance was linked to both target-site knockdown resistance (kdr) mutations (L1014F and L1014S) and metabolic detoxification pathways involving cytochrome P450s, glutathione S-transferases (GSTs), and esterases. These findings underscore the escalating menace that insecticide resistance poses to malaria vector control, particularly in newly invaded regions characterized by inadequate surveillance infrastructure and pronounced reliance on pyrethroid-based interventions. This review advocates for the establishment of comprehensive global monitoring frameworks and the formulation of evidence-based resistance management strategies tailored to local vector ecologies and resistance mechanisms.

Situational analysis of health systems for ear and hearing care in the World Health Organization (WHO) Eastern Mediterranean Region: A systematic review and evidence synthesis to inform national policies and strategies.

Evidence regarding the adverse burden of severe neonatal jaundice (SNJ) in hospitalized neonates in resource-constrained settings is sparse. We attempted to determine the prevalence of SNJ, described using clinical outcome markers, in all World Health Organization (WHO) regions in the world. Data were sourced from Ovid Medline, Ovid Embase, Cochrane Library, African Journals Online, and Global Index Medicus. Hospital-based studies, including the total number of neonatal admissions with at least one clinical outcome marker of SNJ, defined as acute bilirubin encephalopathy (ABE), exchange blood transfusions (EBT), jaundice-related death, or abnormal brainstem audio-evoked response (aBAER), were independently reviewed for inclusion in this meta-analysis. Of 84 articles, 64 (76.19%) were from low- and lower-middle-income countries (LMICs), and 14.26% of the represented neonates with jaundice in these studies had SNJ. The prevelance of SNJ among all admitted neonates varied across WHO regions, ranging from 0.73 to 3.34%. Among all neonatal admissions, SNJ clinical outcome markers for EBT ranged from 0.74 to 3.81%, with the highest percentage observed in the African and South-East Asian regions; ABE ranged from 0.16 to 2.75%, with the highest percentages observed in the African and Eastern Mediterranean regions; and jaundice-related deaths ranged from 0 to 1.49%, with the highest percentage observed in the African and Eastern Mediterranean regions. Among the cohort of neonates with jaundice, the prevalence of SNJ ranged from 8.31 to 31.49%, with the highest percentage observed in the African region; EBT ranged from 9.76 to 28.97%, with the highest percentages reported for the African region; ABE was highest in the Eastern Mediterranean (22.73%) and African regions (14.51%). Jaundice-related deaths were 13.02%, 7.52%, 2.01% and 0.07%, respectively, in the Eastern Mediterranean, African, South-East Asian and European regions, with none reported in the Americas. aBAER numbers were too small, and the Western Pacific region was represented by only one study, limiting the ability to make regional comparisons. The global burden of SNJ in hospitalized neonates remains high, causing substantial, preventable morbidity and mortality especially in LMICs.

The COVID-19 transmission in the Eastern Mediterranean Region (EMR) was influenced by various factors such as conflict, demographics, travel and social restrictions, migrant workers, weak health systems, and mass gatherings. The countries that responded well to COVID-19 had high-level political commitment, multisectoral coordination, and existing infrastructures that could quickly mobilize. However, some EMR countries faced challenges due to political instability and fragile health systems, which hindered their response strategies. The pandemic highlighted the region’s weak health systems and preparedness, fragmented surveillance systems, and lack of trust in information sharing. COVID-19 exposed the disruption of access and delivery of essential health services as a major health system fragility. In 2020, the World Health Organization (WHO) conducted a global pulse survey, which demonstrated that the EMR experienced the highest disruption in health services compared to other WHO regions. However, thanks to prioritization by the WHO and its member states, significant improvement was observed in 2021 during the second round of the WHO’s National Pulse Survey. The pandemic underscored the importance of political leadership, community engagement, and trust and emphasized that investing in health security benefits everyone. Increasing vaccine coverage, building regional capacities, strengthening health systems, and working toward universal health coverage and health security are all priorities in the EMR. Emergency public health plays a key role in preparing for and responding to pandemics and biological threats. Integrating public health into primary care and investing in public health workforce capacity building is essential to reshaping public health and health emergency preparedness.

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.

ObjectivesEvaluation of published research in a region provides insight into relevant aspects of clinical care and research priorities. This study aimed to provide a comprehensive assessment of the type of critical care research published in the World Health Organization Eastern Mediterranean region (EMR) over a 10-year period.ResultsDuring the study period (2007–2016), the search strategy revealed 4303 publications, of which 1537 were included in the analysis; studies were excluded for the following reasons: not critical care, conducted in non-EMR countries, editorials, case reports, in-vitro or animal studies, as well as those conducted in multiple countries and those that evaluated foreign military personal. Countries varied in the number of publications produced, ranging from none in Somalia to 620 in Iran. The majority of the studies were observational (78%), evaluated adults (73%), and the most common areas of research were infectious (29%) and respiratory (10%) diseases. Median sample size was 120 and the mean (SD) impact factor of the journals in which the articles were published was 1.02 (0.7).

This study was carried out to document the implementation status of public-private mix (PPM) in 6 member countries of the World Health Organization Eastern Mediterranean Region, with a particular focus on advocacy, communication and social mobilization (ACSM) specific to PPM. Interviews and focus group discussions were held with staff of national tuberculosis control programmes and partners. Four PPM models were being practised. For all models, ACSM specific to PPM was at the elementary stage. Participants perceived that promoting private partners was difficult, specific policy guidelines were deficient and human resources and capacity for both initiatives were lacking across the region. Building ACSM capacity is required along with the development of guidelines and the implementation of country-specific communication plans to carry out local-level advocacy, strategic communication and effective social mobilization to maximize the benefits of PPM.