The importance of insufficient national data on sexual and reproductive health and rights in international databases

Looking at SRHR as an isolated set of elements, as is the current practice, does not do justice to the needs and rights of people and communities and may be one of the reasons why challenges remain in the attainment of SRHR for all. SRHR Infographic snapshots were developed for all 194 WHO Member States and included 120 indicators covering a broad range of policy, health systems and service delivery interventions. The snapshots were created using data less than 10 years old publicly available in data repositories maintained by international and global agencies. Data availability was not consistent across countries with low and lower-middle income countries having higher data availability (71%) compared to high income countries (40%). SRHR data that is easily accessible and consistently reported can improve accountability and opportunities for learning to improve people-centred approaches to accelerate the attainment of SRHR for all.

Preparing ethical review systems for emergencies: next steps

Ethical review systems need to build on their experiences of COVID-19 research to enhance their preparedness for future pandemics. Recommendations from representatives from over twenty countries include: improving relationships across the research ecosystem; demonstrating willingness to reform and adapt systems and processes; and making the case robustly for better resourcing.

Assessing the impact of small-research grants supported by WHO in the Eastern Mediterranean Region 2010-2018

Background

For decades, WHO has been providing targeted funding for health research on priority areas of public health in the Eastern Mediterranean Region through different grant schemes.

Aims

This paper investigated the impact of WHO/EMRO's funding schemes and factors facilitating or hindering such impact.

Methods

We assessed the impact of health research funded by WHO/EMRO during 2010-2018 from the health, economic, decision-making, and knowledge translation perspectives, emphasizing accountability and analysis, using the Payback framework, mixed-method approach (quantitative, qualitative), and triangulation.

Results

Principal investigators of 45 (45.9%) out of the 98 funded projects responded to the questionnaire. Almost all (88.0%) the 45 projects reported developing at least one decision-making document. Less than half reported producing peer-reviewed documents and conducting target group empowerment, while 24.0% said they secured research funds from other organizations. For 23 projects (51.0%), research results could have had a direct impact on health and on economy, and 25 (56.0%) projects conducted at least one active knowledge translation activity. Using multiple logistic regression, there was no significant association between the country of research and impact on decision-making and implementation of result if health or economic impact was expected.

Conclusion

To strengthen the impact of research, WHO/EMRO should embark on a series of interventions to guide and empower countries in the use of research results. Discrepancies between health research systems in the Eastern Mediterranean Region and differences in individual and organizational capacities in the different countries require targeted interventions.

Integrating locally-attuned palliative care into health care systems in the Eastern Mediterranean Region

At the 2014 World Health Assembly (WHA), the ministers of health of all 194 World Health Organization (WHO) Member States affirmed that palliative care, the prevention and alleviation of pain and suffering of any kind associated with serious illness, "is an ethical responsibility of health systems". The Assembly acknowledged "the urgent need to include palliation across the continuum of care, especially at the primary care level," and emphasized that "inadequate integration of palliative care into health and social care systems is a major contributing factor to the lack of equitable access to such care." This WHA Resolution (WHA 67.19) differs from other resolutions regarding specific diseases, interventions, populations, or other aspects of health care. It differs not only because palliative care is essential to the care of adults and children affected by serious illness or humanitarian crisis of any type, but also because the Resolution draws attention to the essence of medicine and nursing, the prevention and relief of human suffering. It does so by amplifying the too-often unheard call of the suffering, the poorest, sickest, and most vulnerable.

WHO's support for COVID-19 research and knowledge management in the Eastern Mediterranean Region

Health research, innovation and knowledge management remain major priorities of the WHO’s response to the COVID-19 pandemic. WHO’s Eastern Mediterranean Regional Office (EMRO) supports priority research initiatives that address gaps in current knowledge regarding the COVID-19 pandemic. Through a specific call for proposals, 122 research proposals were received and reviewed in 2020, of which 17 were recommended for funding from eight countries. Ten countries in the region participated in the global solidarity trial to assess potential therapies for COVID-19. In addition, WHO advocated for early serological and epidemiological investigations (‘COVID-19 Unity Studies’) on the general population, healthcare workers, pregnant women and neonates, and extending technical, financial and material support for them.

Starting in early 2020, scholarly articles on COVID-19 have been published in every issue of the Eastern Mediterranean Health Journal. More than 6300 publications on COVID-19 were made available on the WHO knowledge management portal in the last year alone. WHO is also supporting countries in conducting studies to assess the field effectiveness of vaccines deployed nationally. To build and strengthen country capacities, regional webinars and intercountry meetings were conducted on research ethics, national health information systems and evidence-based health policy making. With support from WHO EMRO’s new research and knowledge management pillar, countries in the region were well equipped to contribute to a global understanding of the novel virus’s characteristics, as well as employ a national response based on informed evidence.

Mapping of health innovations in response to the COVID-19 pandemic in Eastern Mediterranean and selected Arab Countries

Background: COVID-19 is the first pandemic during which innovative technologies are being used to keep people connected, safe, and productive while being physically and socially apart. Aims: This study aimed to map health innovations in response to the pandemic in the Eastern Mediterranean Region. Methods: Health innovations are defined as novel methods, models, processes, products, services, or a combination that produce notable public health impact in people, families, and communities at large. We used two approaches: an online survey using a specially designed data collection tool and a review of publicly available literature using PubMed, IMEMR, Google Scholar, Google, and INSERM search engines. Data collection was conducted between September 2020 and February 2021. Results: We describe 80 innovations in this region, of which 13 were identified through the online survey and 76 via literature review. For the purposes of this paper, we subclassified two-thirds of these innovations (n = 52; 65%) as “digital health innovations”, including telehealth and telemedicine, surveillance, and contact tracing. The rest were classified as “non-digital health innovations”, including prevention and clinical management. Conclusion: This mapping exercise provides baseline information on response to the pandemic by the public and private sectors, innovation hubs within and outside the region, as well as by entrepreneurs and innovators. In-depth studies measuring the impact of health innovations will likely only become available when the pandemic is under better control and experts are able to assess the replicability, sustainability and scalability of the health innovations introduced.

Enhancing capacity and use of digital health in the Eastern Mediterranean Region: an urgent priority for action

The Eastern Mediterranean Region (EMR) faces massive challenges that threaten people's livelihood and health due to multiple factors, including socioeconomic disparities, conflicts and emergencies in many countries of the Region. The COVID-19 pandemic has further exacerbated these challenges and significantly disrupted access to essential health services. As highlighted in recent flagship reports, the region is unlikely to achieve health-related Sustainable Development Goals, unless crucial changes are made in the way the goals are pursued. Effective implementation of digital health technologies could provide opportunities to enhance the response to the pandemic, as well as improve the access to health services and develop stronger and more resilient health systems.

A Public Health Research Agenda for Managing Infodemics: Methods and Results of the First WHO Infodemiology Conference

Background

An infodemic is an overflow of information of varying quality that surges across digital and physical environments during an acute public health event. It leads to confusion, risk-taking, and behaviors that can harm health and lead to erosion of trust in health authorities and public health responses. Owing to the global scale and high stakes of the health emergency, responding to the infodemic related to the pandemic is particularly urgent. Building on diverse research disciplines and expanding the discipline of infodemiology, more evidence-based interventions are needed to design infodemic management interventions and tools and implement them by health emergency responders.

Objective

The World Health Organization organized the first global infodemiology conference, entirely online, during June and July 2020, with a follow-up process from August to October 2020, to review current multidisciplinary evidence, interventions, and practices that can be applied to the COVID-19 infodemic response. This resulted in the creation of a public health research agenda for managing infodemics.

Methods

As part of the conference, a structured expert judgment synthesis method was used to formulate a public health research agenda. A total of 110 participants represented diverse scientific disciplines from over 35 countries and global public health implementing partners. The conference used a laddered discussion sprint methodology by rotating participant teams, and a managed follow-up process was used to assemble a research agenda based on the discussion and structured expert feedback. This resulted in a five-workstream frame of the research agenda for infodemic management and 166 suggested research questions. The participants then ranked the questions for feasibility and expected public health impact. The expert consensus was summarized in a public health research agenda that included a list of priority research questions.

Results

The public health research agenda for infodemic management has five workstreams: (1) measuring and continuously monitoring the impact of infodemics during health emergencies; (2) detecting signals and understanding the spread and risk of infodemics; (3) responding and deploying interventions that mitigate and protect against infodemics and their harmful effects; (4) evaluating infodemic interventions and strengthening the resilience of individuals and communities to infodemics; and (5) promoting the development, adaptation, and application of interventions and toolkits for infodemic management. Each workstream identifies research questions and highlights 49 high priority research questions.

Conclusions

Public health authorities need to develop, validate, implement, and adapt tools and interventions for managing infodemics in acute public health events in ways that are appropriate for their countries and contexts. Infodemiology provides a scientific foundation to make this possible. This research agenda proposes a structured framework for targeted investment for the scientific community, policy makers, implementing organizations, and other stakeholders to consider.

Promoting family practice-based model of care: the role of WHO's professional diploma in family medicine in the Eastern Mediterranean Region

Strengthening Primary Health Care (PHC) through family practice-based model of care is an essential bedrock in achieving Universal Health Coverage (UHC), as called for in Sustainable Development Goal (SDG) 3, target 3.8. However, the shortage of family practitioners worldwide and in most countries of the Eastern Mediterranean Region (EMR) is a daunting challenge. The current production rate of family physicians in the EMR is around 700 annually, against the needed estimate of 21 000 physicians per year based on one family physician/1300 population and the current EMR population growth rate, which reflects the huge shortage of family physicians in the Region.

Research on health priorities: a regional agenda and its implementation in Jordan and Pakistan

The Eastern Mediterranean Region (EMR) is facing extraordinary social and health challenges, aggravated by epidemiologic variations, high morbidity and mortality burden (communicable, noncommunicable, injuries), consequences of emergencies (including current COVID-19 pandemic), conflicts and massive migrant population movements. Research for health is essential for generating necessary evidence, which contributes to sustainable development, economic growth and sound health policy-making. Moreover, research for health that addresses national public health priorities is essential for developing required evidence for explanations that contribute towards health improvement and can assist in best utilization of available resources towards issues that maximize the research impact on population health.

Air quality and health impacts in the Eastern Mediterranean Region: an eye on COVID-19

Air quality is intimately linked to human activities, climate, atmosphere and ecosystems. Many of the anthropogenic contributors to air pollution are also sources of greenhouse gases including CO2 and other short-lived climate pollutants, such as Ozone and black carbon, which greatly contribute to the climate change phenomenon and its adverse effects on human health. Unfortunately, fragile and dry ecosystems prevailing in most of our countries in the Eastern Mediterranean Region may be implicated for exacerbation of this air pollution and climate change dilemma even more severely.

Health research prioritization: global and regional perspectives

The Eastern Mediterranean Region (EMR) confronts unprecedented health challenges, exacerbated by demographic and epidemiologic changes, triple burden of disease, increasing healthcare costs, as well as the effects of contracted emergencies, social conflicts and massive population movements. Such challenges have repercussions on health care delivery and health research systems. Research for health is essential for developing solutions that contribute to health improvements. Investment in research for health contributes to health, economic growth and equity.

Biomedical and health research geography in the Eastern Mediterranean Region

Background

Measuring scientific outputs allows for objective evaluation of established health research systems and ranking countries according to scientific achievements. To our knowledge, attempts for systematic mapping health research output in the Eastern Mediterranean Region (EMR) are limited.

Aims

We aimed to conduct a detailed bibliometric analysis of EMR biomedical and health research productivity during the period 2004-2013, considering country of first author.

Methods

We applied an improved PubMed search strategy to obtain precise data on EMR research productivity, limiting articles to reviews, original research and case reports. Data were normalized to global research output, represented by total articles indexed in PubMed per year from 2004-2013, according to population size of each country. Second order polynomial trend lines were calculated and comparing 5-year periods: 2004-2008 with 2009-2013.

Results

Inspecting overall raw data, a clear increasing trend is observed. Regional share of global health related research ranged from 0.85-2.36% of total PubMed indexed publications during the study period. Five countries contributed to 80% of all published articles during study period; i.e., Islamic Republic of Iran (39%), Egypt (14%), Saudi Arabia (11%), Tunisia, and Pakistan (8% each). Overall, 2.35 articles are published per 100 000 population per year. While Kuwait maintained the highest per capita publication (followed by Tunisia, Lebanon, Qatar and Islamic Republic of Iran), Qatar, Islamic Republic of Iran and Saudi Arabia demonstrated the highest "per capita" population growth in publications. Three academic institutions accounted for over 10% of all publications that were led by an investigator from the Region. Collectively, most prolific 25 EMR institutions published 44% of all published biomedical and health research in the EMR.

Conclusions

The overall global share of EMR health research publication is smaller than its global share of population or wealth. Biomedical and health research needs greater encouragement and supporting many EMR countries and/or institutions, especially those found to be least prolific in our analysis. The increase in academic publication on health has been more prominent in a few countries only. It is anticipated that the concentration of biomedical and health research in EMR academic institutions would help in translating knowledge into public health outcomes, if more suitable conditions are provided.

Healthy Cities Programme in the Eastern Mediterranean Region: concurrent progress and future prospects

Urbanization has been rapidly increasing during the past two decades and it is estimated that by 2030, two thirds of the world's population would be living in urban areas, exposing the population to a large number of environmental, social, cultural, economic and behavioural factors that impact population health and wellbeing.

In response to such challenges, the Healthy Cities concept was instigated in 1977 that, along with the Alma Ata Declaration and commitment of countries at the Thirtieth World Health Assembly in Geneva, Switzerland, would empower communities to lead socially and economically productive lives. A number of policy documents from the World Health Organization (WHO) and other bodies suggested introducing new approaches to managing cities and addressing health challenges, focusing more on health determinants and prevention than medical interventions.

Developing the Eastern Mediterranean Health Journal to support public health research in the Region (Editorial)

Since 1995, the Eastern Mediterranean Health Journal (EMHJ) has sought to publish public health research, regionally and globally, in accordance with the mandate and goals of the World Health Organization (WHO). As part of a family of WHO journals, the EMHJ is an open access public health journal and makes no charge for review or publication of accepted papers, allowing research manuscripts as well as policy-related works from institutions with different financial status an opportunity to be published and remain freely accessible to all. Supporting countries that are developing their health research base remains an important focus for the EMHJ, in line with the WHO Thirteenth General Programme of Work 2019-2023 (GPW13), and its mandate to strengthen research on public health priorities.

Health research institutional mapping: an Eastern Mediterranean Regional perspective

BACKGROUND

Research-conducive environments are mandatory for planning, implementing and translating research findings into evidence-informed health policies.

AIM

This study aimed at comprehensive situation analysis of health research institutions in the Region.

METHODS

We collected data on: institutional characteristics, research scope, capacity building, ethics, governance and resources.

RESULTS

We contacted 575 institutions, of which, 223 (38.8%) responded, indicating that they conducted population research (82%). Reported studies were mostly in medicine, public health and epidemiology, while reported capacity building mainly focused on scientific writing (20.6%), research proposal writing (18%) and quantitative research methods (17%). Most institutions reported having collaborating partners (82%) - predominantly national (77%). Sixty-four percent of institutions received their own funding, with 48% reporting always having access to national databases.

CONCLUSION

Governments in the Eastern Mediterranean Region and international funding agencies are called upon to support health research production through increasing allocated support and capacity building in health research.

The integration and management of noncommunicable diseases in primary health care (Guest Editorial)

Noncommunicable diseases (NCDs) are a great burden in the Eastern Mediterranean Region (EMR) and, if no strategic intervention is taken, the burden is forecast to become even heavier, particularly with the additional impact of ageing populations. Currently, 62% of deaths in the EMR are due to NCDs. However, by 2030 this proportion is projected to increase to nearly 70%. The EMR is disproportionately affected by NCDs as a result of the Region's rapid urbanization and the globalization of unhealthy behaviours. Moreover, many of the EMR countries have health systems whose structures are not designed for the prevention, early detection and management of NCDs.

Improving evidence informed policy-making for health in the Eastern Mediterranean Region (Editorial)

Health policies should be based on a sound understanding of the problems, issues and context in which they operate, for which they require reliable data and information for action. The policies should also be informed by the best available research evidence, which also helps in better capturing the problem, understanding existing trends and patterns, and setting reasonable objectives that can be achieved using effective interventions. More importantly, research can provide evidence of comparative effectiveness of alternative interventions for a given public health issue; the costs and feasibility of implementing each intervention; and efficiency of the proposed interventions (policies) in comparison with alternative interventions.

Assessment of World Health Organization Collaborating Centres in the Eastern Mediterranean Region

Following in-house training, there was a need for assessing perceived performance of World Health Organization (WHO) collaborating centres in the Eastern Mediterranean Region, with special relevance to WHO's programme of work. Thus, a questionnaire was shared with responsible officers covering: selection process, frequency of communication, monitoring mechanisms, key delivered activities, and identified gaps during implementation. These included: tendency to implement regular activities, weak technical capacity and communication, and discrepancies between planned activities and actual implementation. Recommendations for centres included: establishing communication plan/modalities, selecting activities of global/regional nature, and mobilizing resources for work plan implementation. Recommendations for responsible officers included: carefully explaining updated WHO rules and regulations; ensuring that specific terms of reference are set as per WHO's global/regional mandates; setting up regular communication mechanisms; agreeing on regular monitoring and coordination modalities; and ensuring that redesignation planning takes place during the 4th year of prior designation period.

Development of an Eastern Mediterranean Region search strategy for biomedical citations indexed in PubMed

PubMed, a 'barrier-free' bibliographic database covering biomedical and health disciplines, has been successfully used to identify a multitude of indicators that assist in analyzing global trends for biomedical research productivity. The current study represents an original attempt to develop and optimize an Eastern Mediterranean Region (EMR) search strategy in PubMed to pave the way for subsequent descriptive analyses. The refined EMR search strategy contains elaborate syntaxes which facilitate controlling the search process and maintaining a proper balance between sensitivity and precision of the obtained results. Country-specific citation data were manually scanned for false positive publications. Our results indicate that publication productivity increased nearly five-fold in the EMR from 2004 to 2013. Five countries (Islamic Republic of Iran, Egypt, Saudi Arabia, Tunisia and Pakistan; in order of total publications) contributed to 80% of all EMR publications during this period. Each of the remaining 17 EMR countries contributed less than 4%. We believe that the methodology presented in this study can be used in conjunction with other metrics to extract invaluable indicators to describe EMR health research systems.

Promoting bioethics in the Eastern Mediterranean Region (Editorial)

Bioethics addresses a broad swathe of human enquiry, ranging from the allocation of scarce health resources to cultural sensitivities over reproductive health. Historically an increasing number of nations have created official bodies to provide advice to their executive and legislative branches, and often to the general public, about bioethics. Termed "National Ethics / Bioethics Committees", such bodies are appointed by ministries of health, education, science and technology, or legislatures to synthesize available evidence and offer recommendations about concurrent issues in bioethics, especially as such issues bear on potential needs to develop national policies and to adopt legislations. Health research has grown substantially in the low- and middle-income countries, including the Eastern Mediterranean Region (EMR), with clinical trial activity in some of its nations tripling between 2008 and 2011. However, indigenous scholarship and expertise are essential when examining the complex debates over how health research is conducted and whether effective oversight can be promoted in resource-limited Member States. Moreover, the notion of ethics in any capacity draws in sensitive matters pertaining to cultural and religious values, and applying western concepts of bioethics in their entirety, may not always be an appropriate course to take.

Substance use prevention: evidence-based intervention

The global substance use problem is a serious public health concern that affects not only health, safety and well-being of communities, but also social and economic development. It particularly affects children, young people and their families. All Member States should set substance use prevention measures and programmes as a priority in order to promote health and reduce social harm. During the past few decades there has been a significant advance in prevention science that has led to the development of international prevention standards and globally accepted evidence-based interventions. This review looks into the key requirements, components and strategic interventions needed for a public health approach to prevention of substance use and disorders, and its health and social consequences. It aims at supporting Member States and civil society to identify the key elements that support countries and local communities to increase the number of substance use protective approaches in relation to risk factors across all relevant domains.

Non-Communicable Disease Risk Factors among Employees and Their Families of a Saudi University: An Epidemiological Study

Objectives

To assess the prevalence of noncommunicable disease (NCD) risk factors among Saudi university employees and their families; to estimate the cardiovascular risk (CVR) amongst the study population in the following 10years.

Methods

The NCD risk factors prevalence was estimated using a cross-sectional approach for a sample of employees and their families aged ≥ 18 years old, in a Saudi university (Riyadh in Kingdom of Saudi Arabia; KSA). WHO STEPwise standardized tools were used to estimate NCD risk factors and the Framingham Coronary Heart Risk Score calculator was used to calculate the CVR.

Results

Five thousand and two hundred subjects were invited, of whom 4,500 participated in the study, providing a response rate of 87%. The mean age of participants was 39.3±13.4 years. The majority of participants reported low fruit/vegetables consumption (88%), and physically inactive (77%). More than two thirds of the cohort was found to be either overweight or obese (72%), where 36% were obese, and 59% had abdominal obesity. Of the total cohort, 22–37% were found to suffer from dyslipidaemia, 22% either diabetes or hypertension, with rather low reported current tobacco use (12%). One quarter of participants was estimated to have >10% risk to develop cardiovascular disease within the following 10-years.

Conclusion

The prevalence of NCD risk factors was found to be substantially high among the university employees and their families in this study.

Eastern Mediterranean Health Journal (EMHJ): a 20-year overview (1995-2014)

The EMHJ was established in 1995 to provide a peer-reviewed platform for health professionals to share their research with the scientific community. The objective of this review was to examine EMR public health research trends, as reflected by EMHJ publications in 20 years (1995-2014), through secondary data analysis. Published articles were categorized according to EMR strategic priority areas (93%), i.e. health systems strengthening (25%); reproductive and child health (22%); communicable diseases (26%); noncommunicable diseases (25%); emergency preparedness (1.5%). Most papers were original research articles (85 %), published in English (94 %), but just over half (52 %) mentioned obtaining a form of ethical clearance in the text. Six countries had each over 100 papers published during the study period, i.e. Iran, Egypt, Saudi Arabia, Jordan, Iraq, Pakistan. Half EMHJ publications during this period came from 4 countries only (Iran, Egypt, Saudi Arabia, Jordan), which calls for further study to evaluate why other EMR nations are less well represented and how to encourage greater contribution from them over the coming years.

Research agenda on persistent and unpredictable threat of influenza and emerging respiratory infections: a public health necessity in the Eastern Mediterranean Region (Guest Editorial)

Infectious diseases continue to represent a significant threat to global health security, particularly in the context of increasing globalization, interconnectedness and interdependence. Chief among such threats are influenza viruses and other respiratory pathogens, such as Middle East Respiratory Syndrome coronavirus (MERS-CoV), because of their risk of high transmissibility and acuity of illness. Annual epidemics of seasonal influenza cause an estimated 3-5 million cases of severe illness and more than 500 000 deaths, with the prospect of pandemic influenza viruses causing far greater impact. In addition, the appearance of severe acute respiratory syndrome (SARS) in 2003, widespread and continued outbreaks of avian influenza A (H5N1) since 2004, the H1N1 pandemic in 2009 and emergence of MERS CoV in 2012 reflect the seriousness of public health challenges posed by influenza and emerging respiratory infections.