Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit最新文献

Background: Diabetes poses an increasing public health and economic challenge in the Eastern Mediterranean Region (EMR), yet its full financial impact across the region remains poorly quantified.

Aim: To estimate the economic burden of diabetes, including direct and indirect costs, in the 22 EMR countries and territories.

Methods: A prevalence-based approach was used to estimate the annual direct and indirect costs of diabetes in the EMR from 2023 to 2050. Data were sourced from international, open-access databases. Mortality costs were estimated using the value of a statistical life-year approach.

Results: In 2023, diabetes affected more than 74 million people in the EMR and caused approximately 833 000 deaths. By 2050, diabetes cases are projected to reach 150 million, with associated deaths rising to 2 million. The economic burden in 2023 was estimated at 639 billion international dollars (Int$), 89% of which was attributable to indirect costs. By 2050, the burden is expected to reach Int$ 1.5 trillion.

Conclusion: Without urgent intervention, diabetes will place increasing strain on healthcare systems, hinder economic growth and widen health inequalities. Implementing cost-effective public health strategies can significantly reduce its societal and economic burden.

Background: The effects of the COVID-19 pandemic on other aspects of public health and social life are still being studied globally.

Aim: To determine the relationship between COVID-19 and suicide deaths in Türkiye.

Methods: This retrospective, descriptive study collected and analysed suicide data for 2019-2023 from the Turkish Statistical Institute to evaluate the causes of the suicide deaths. Chi-square test was used to evaluate the statistical significance of the observed differences. P < 0.05 was considered statistically significant.

Results: Between 2019 and 2023, a total of 19 659 suicide deaths were documented in Türkiye. The number of suicides increased during the period, with the highest increases recorded in 2019/2020 and 2020/2021. The majority of the cases (76.4% of all cases, P < 0.001) were men. Reasons given for the suicide were illness, family incompatibility, economic problems, business failure, emotional relationship and not marrying the desired person, educational failure, and others.

Conclusion: Fear, social isolation, the prevailing situation, and measures taken to control COVID-19 may have contributed to the increases in suicide deaths during the peak pandemic period in Türkiye. There is a need for strategies to help prevent suicide deaths during health emergencies and pandemics.

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.

Background: Socioeconomic inequalities can affect vaccine acceptability and the effectiveness of vaccination programmes.

Aim: To investigate income inequality in willingness to vaccinate and identify its determinants in the Islamic Republic of Iran.

Method: This cross-sectional study was conducted in Hamadan City, Islamic Republic of Iran, in February and March 2021. It collected data from 864 respondents using a structured questionnaire and analysed them using Stata version 14. Logistic regression was used to assess the effects of covariates on willingness to vaccinate within income groups and a multivariate decomposition technique was applied to evaluate the factors influencing willingness to vaccinate across groups.

Results: We found that 39.2% of the participants were willing to accept the COVID-19 vaccination. Fewer participants in the low-income group than those in high-income group (33.5% vs 49.1%; P < 0.001) were willing to accept the vaccination. Female sex, having elderly family members and witnessing COVID-19-related deaths among relatives were primary contributors to the willingness to accept vaccination. In contrast, being employed, previous COVID-19 infection and holding a bachelor's degree had the main contradictory effects on the inequality of willingness to vaccinate.

Conclusion: The differences in income level among the participants affected their willingness to vaccinate. There is therefore a need for targeted interventions to increase COVID-19 vaccine acceptance and vaccination effectiveness among the different income groups within the study population.

Background: Mortality due to cardiovascular disease in Morocco is estimated at 38%, making it a significant burden on public health.

Aim: To provide updated estimates of the prevalence of major modifiable cardiovascular disease risk factors among adults in Morocco.

Methods: This descriptive, cross-sectional study collected and analysed sociodemographic, lifestyle, medical and anthropometric data from 731 adults aged ≥18 years in Casablanca, Morocco, in 2018.

Results: Of the participants, 81.1% reported physical inactivity, with higher prevalence among women than men (P = 0.031). Prevalence of smoking was 18.2% and of alcohol consumption 6.8%, with stronger male predominance (P < 0.0001), while prevalence of obesity was 20.7% and of overweight 30.8%. Central obesity affected 8.7% of men and 61.1% of women. Diabetes prevalence was 6.6% (10.3% among women, 3.2% among men; P < 0.001), while arterial hypertension affected 9.6% (14.8% of women, 4.8% of men; P < 0.001) of the participants.

Conclusion: The significant high levels of modifiable cardiovascular disease risk factors found by this study among adults in Casablanca, Morocco, highlight the need for more effective and more sustainable cardiovascular disease prevention strategies and policies among the population.

Background: Orofacial cleft can occur as an isolated birth defect, a nonsyndromic abnormality, or as part of a syndrome with multiple congenital anomalies, and its prevalence can vary by ethnicity, sex and geographic location.

Aim: To review literature on the prevalence of orofacial cleft in Arab countries.

Methods: A search of relevant publications, in English, on the prevalence of orofacial cleft in Arab countries was performed on Web of Science, PubMed, Google Scholar and Scopus using several keywords, including the name of each Arab country.

Results: Our findings show an average prevalence of orofacial cleft of 1.1 per 1000 livebirths, with a range of 0.3-2.6 per 1000 livebirths in the Arab countries. There were inconsistencies in reporting for the different countries and in the methodologies used. Various publications from the same countries reported different prevalence figures.

Conclusions: The inconsistency in the findings from this study indicate an urgent need for Arab countries to establish comprehensive national birth defect surveillance systems or expand existing systems to provide reliable and up-to-date evidence for policy, practice and interventions.

Background: Cervical cancer remains a global health concern, particularly in low- and middle-income countries, including Bahrain, where human papillomavirus (HPV) infection is the leading cause.

Aim: To compare the diagnostic accuracy of cervical cytology (pap smear) and molecular HPV detection using polymerase chain reaction (PCR) in identifying cervical abnormalities among women in Bahrain.

Methods: We retrospectively analysed 320 pap smear samples from the Salmaniya Medical Complex laboratory. Cytological findings were compared with HPV PCR results, using PCR testing as the gold standard. Sensitivity, specificity, positive predictive value and negative predictive value were calculated. Statistical analyses included chi-square and Fisher's exact tests.

Results: Among the 320 samples, 56 (17.5%) were HPV-positive and 264 (82.5%) were HPV-negative. PCR showed higher sensitivity (95.5%) but had reduced moderate specificity (67.4%), with a positive predictive value for detecting histopathological lesions of 94.6% and a negative predictive value of 96.9%. Pap smears identified 57.5% as negative for intraepithelial lesion or malignancy and 42.5% with abnormalities. HPV-positive cases had higher abnormal cytology rates, and histopathology confirmed lesions in some HPV-positive cases despite normal cytology results.

Conclusion: Combining HPV PCR with pap smear enhances cervical cancer detection. Tailored screening programmes based on individual risk factors are recommended to reduce the disease burden.

Background: Studies have shown that diabetes negatively affects mental health, and that depression is twice as common among individuals with diabetes.

Aim: To evaluate diabetes-related distress and its association with complications, treatment adherence and clinical outcomes in Saudi Arabia.

Methods: This cross-sectional study collected data from 269 patients with type 1 and type 2 diabetes mellitus at a tertiary hospital in Riyadh, Saudi Arabia, using the Diabetes Distress Scale (DDS). The data were analysed using SPSS version 25.

Results: Overall, 12.3% of the participants reported diabetes-related high distress (DDS-17 score > 3), 38.7% moderate distress (> 2) and 49.0% little or no distress. The most reported type of distress was regimen-related distress (22.7%), followed by emotional burden (15.6%), physician-related distress (14.9%), and interpersonal distress (10.4%). Treatment adherence was significantly associated with lower distress levels across all domains (P < 0.05). Higher diabetes-related distress scores correlated with elevated haemoglobin A1c levels and diabetes-related complications. Females had significantly more neurologic and more visual complications than males (P < 0.001).

Conclusion: Our findings show that diabetes-related distress, particularly regimen-related and physician-related distresses, has significant effects on clinical outcomes for type 1 and type 2 diabetes mellitus patients. There is therefore a need for physicians to integrate diabetes-related distress assessment and management into routine diabetes care, including providing guidance on daily disease management and lifestyle changes as preventive measures for diabetesrelated distress.

Background: Incidence of invasive cervical cancer is low in Saudi Arabia, and it varies by nationality, region and stage. Understanding the trends is essential for designing interventions that align with global elimination goals.

Aim: To estimate cervical cancer incidence trends by nationality, region and stage in Saudi Arabia.

Methods: In this retrospective study, we analysed data obtained from the Saudi Cancer Registry on all women (N = 3038) diagnosed with cervical cancer in Saudi Arabia from 2005 to 2019. We calculated the age-standardised incidence rates by nationality, region and stage at diagnosis using the world standard population.

Results: Incidence of cervical cancer varied by nationality, region and stage. Non-Saudi women had higher rates than Saudi women, while Makkah Region consistently had the highest rates, followed by Riyadh and Eastern regions. The proportion of localised-stage diagnoses increased from 24.2% in 2005 to over 40.0% in 2019, while cases with unknown stage decreased from 19.6% to 6.3%.

Conclusion: In alignment with the global priority of eliminating cervical cancer, Saudi Arabia should intensify efforts to reduce its disease burden by ensuring equitable access to services across the cervical cancer continuum and raising awareness of the early signs and symptoms to increase early stage detection. There is a need to continuously monitor completeness and validity of cancer registry data to ensure that they are of high quality, relevant and suitable for policymaking.