Temporal trends in lower extremity amputation in Middle East and North Africa (MENA) region: analysis of the GBD dataset 1990-2019.

BACKGROUND: Lower extremity amputations (LEAs) significantly contribute to mortality and morbidity, often resulting from peripheral artery disease and diabetes mellitus (DM). Traumatic injuries also account for many LEAs. Despite the global burden, the epidemiology of LEAs, particularly in the Middle East and North Africa (MENA) region, remains underexplored. This study utilizes the Global Burden of Disease (GBD) dataset to analyze temporal trends in LEAs in the MENA region from 1990 to 2019. METHODS: The study utilized the 2019 GBD dataset, which includes estimates for incidence, prevalence, and disability-adjusted life-years (DALYs) across 369 diseases. Age-standardized incidence rates (ASIRs) for LEAs were extracted for 21 MENA countries. Trends were analyzed using percentage change calculations and Joinpoint regression to identify significant shifts in LEA rates over time. RESULTS: From 1990 to 2019, male LEA rates generally decreased, while female rates increased. Significant increases in LEA rates were observed in Syria, Yemen, and Afghanistan, correlating with periods of conflict and instability. Conversely, countries like Iraq, Palestine, Sudan, Lebanon, Iran, and Kuwait saw marked decreases. The study highlighted a complex interplay of socio-political factors, natural disasters, and chronic diseases like DM in shaping LEA trends across the region. CONCLUSION: The study reveals variable LEA trends in the MENA region, influenced by conflicts, natural disasters, and chronic diseases. These findings underscore the need for targeted public health interventions, improved healthcare access, and robust data collection systems to reduce the burden of LEAs and improve patient outcomes in the MENA region.

Waterborne Cryptosporidium species and Giardia duodenalis in resources of MENA: A systematic review and meta-analysis.

This review explores our understanding of Cryptosporidium species and Giardia duodenalis distribution in Middle East and North African (MENA) water resources. Results emphasize that Cryptosporidium species (sp.) and G. duodenalis (oo)cysts are present in distinct categories of water in ten MENA countries. Cryptosporidium sp. proportional prevalence in the MENA region was 24.5% (95% CI 16.3-33.8), while G. duodenalis prevalence was 37.7% (95% CI 21.9-55.1). Raw wastewater and surface water were the water categories most significantly impacted. Both parasites were reported in the various types of MENA drinking waters. The most frequent species/genotypes reported were C. hominis, C. parvum, and G. duodenalis assemblage A. Despite the high prevalence of (oo)cysts reported, we should consider the absence of waterborne outbreaks. This indicates significant underestimation and underreporting of both parasites in MENA. Stakeholders should apply water contamination legislation to eradicate Cryptosporidium sp. and G. duodenalis (oo)cysts from water resources/categories.

Computer aided design/computer aided manufacturing (CAD/CAM) technology in the undergraduate dental programs in the MENA region.

INTRODUCTION: The aim of this study was to understand the trends of teaching Computer Aided Design/Computer Aided Manufacturing (CAD/CAM) in the undergraduate dental curriculum in the MENA region by conducting an online survey among the undergraduate dental colleges in this region. MATERIALS AND METHODS: An online survey was conducted using Google Forms consisting of 20 questions that could be answered by "yes" or "no" responses, multiple-choice answers or in a descriptive, "open" format. A total of 55 participants from the MENA region representing their dental college were requested to participate in this study. RESULTS: The response rate of the survey was 85.5% following the twofold follow-up reminders method. Although the vast majority of professors demonstrated vital knowledge in the practical use of CAD/CAM, the majority of them did not provide theoretical and practical training on CAD/CAM in their institutions. Among the schools with established levels of teaching CAD/CAM, nearly 50% of them provide both pre-clinical and clinical training on CAD/CAM. Despite the availability of extra-curricular training courses on CAD/CAM outside the university setting, there is a lack of advocating for students to enrol in those courses by the institutions. More than 80% of the participants agreed that CAD/CAM has a strong future in chair-side dental clinics and CAD/CAM needs to be incorporated within undergraduate studies. CONCLUSION: Based on the results of the current study, it is understandable that an intervention is required by the dental education providers to cope with the growing demand for CAD/CAM technology for the current and future dental practitioners of the MENA region.

Trend of pharmaceuticals 3D printing in the Middle East and North Africa (MENA) region: An overview, regulatory perspective and future outlook.

The traditional method of producing medicine using the "one-size fits all" model is becoming a major issue for pharmaceutical manufacturers due to its inability to produce customizable medicines for individuals' needs. Three-dimensional (3D) printing is a new disruptive technology that offers many benefits to the pharmaceutical industry by revolutionizing the way pharmaceuticals are developed and manufactured. 3D printing technology enables the on-demand production of personalized medicine with tailored dosage, shape and release characteristics. Despite the lack of clear regulatory guidance, there is substantial interest in adopting 3D printing technology in the large-scale manufacturing of medicine. This review aims to evaluate the research efforts of 3D printing technology in the Middle East and North Africa (MENA) region, with a particular emphasis on pharmaceutical research and development. Our analysis indicates an upsurge in the overall research activity of 3D printing technology but there is limited progress in pharmaceuticals research and development. While the MENA region still lags, there is evidence of the regional interest in expanding the 3D printing technology applications in different sectors including pharmaceuticals. 3D printing holds great promise for pharmaceutical development within the MENA region and its advancement will require a strong collaboration between academic researchers and industry partners in parallel with drafting detailed guidelines from regulatory authorities.

Online Arabic Beverage Frequency Questionnaire (ABFQ): evaluation of validity and reliability.

BACKGROUND: Obesity and chronic diseases are significant public health issues in the Middle East and North Africa region. A robust body of evidence demonstrated the association between beverage consumption, obesity, and chronic diseases. Therefore, the assessment of beverage consumption is gaining more interest in health policy development, food industry partnerships, research expansion and community involvement. Although beverage-consumption assessment tools have been developed for various populations, none were developed for the Arabic population. In this study, we developed and validated an online Arabic Beverage Frequency Questionnaire (ABFQ) to assess the total beverage intake among Arabic speaking population. METHODS: A cross-sectional validation study was conducted among healthy adults aged between 18 and 55 years. Participants (n = 49) completed a 24-item ABFQ on two occasions and provided one 24-h urine sample. For validity, total beverage consumption (ABFQ1) was assessed against a 24-h urine sample using an osmolality test and correlation analysis. Reliability was assessed by comparing the participants' consumption in total and for every 24 individual items from ABFQ1 with the total and individual items in ABFQ2 using correlation and paired sample t-test. RESULTS: The average daily consumption of beverages was 1504 ml/day, while the average urine osmolality/kg was 614. The validity assessment between ABFQ and urine osmolality indicates a negative correlation. However, the correlation was week and not statistically significant (rs = -0.2, p = 0.12). In reliability test, correlation analysis was positive and acceptable in all beverage categories (rs = 0.4 - 0.9; all p < 0.05) except flavored milk (rs = 0.2; p < 0.181) and sweetened coffee (rs = 0.3; p < 0.022). Furthermore, no significant differences were found between the means of total consumption in both ABFQ1 and ABFQ2. CONCLUSIONS: The finding of this study suggest that the ABFQ is a reliable reproducible tool for assessing beverage consumption among Arabic-speaking consumers. However, the survey could not be validated using 24-h urine osmolality only and other methods such as multi dietary records may use in future re-assessment.

The burden of musculoskeletal disorders in the Middle East and North Africa (MENA) region: a longitudinal analysis from the global burden of disease dataset 1990-2019.

BACKGROUND: Musculoskeletal (MSK) disorders are one of the main causes of disability among adults globally. The burden of MSK disorders varies greatly between different regions and is the highest in low- and middle income- countries. This study sought to investigate trends in the burden of MSK disorders across the MENA region, utilizing the GBD 2019 dataset. METHODS: This ecological study utilized data from the Global Burden of Disease (GBD) to report on the burden of musculoskeletal (MSK) disorders in The Middle East and North Africa (MENA) region between 1990 and 2019. Our analysis involved descriptive statistics and sociodemographic trends and did not employ any specific statistical analyses. Using age-standardized rates of prevalence and disability-adjusted life-years (DALYs), we reported trends in the burden of MSK disorders, as well as national variation between different countries. Furthermore, we analyzed trends in risk factors contributing to MSK disorders by age and gender. RESULTS: The longitudinal analysis from 1990 to 2019 showed an increase in the age-standardized rate for prevalence and DALYs of MSK disorders by 5% and 4.80%, respectively. Low back pain continued to be the most prevalent MSK condition, while RA and other MSK disorders had the largest percentage increase for DALYs between 1990 and 2019. The study found that Afghanistan had the lowest age standardized DALYs rate attributed to MSK disorders, while Iran, Turkey, and Jordan had the highest. Further, Syria showed the most dramatic decrease while Saudi Arabia had the most notable increase in age standardized DALY rates from 1990 to 2019. In 2019, occupational risks, high body mass index, and tobacco smoking were the main risk factors for MSK disorders, with occupational risks being the largest contributor, and between 1990 and 2019, there was a decrease in the contribution of occupational risks but an increase in the contribution of high body mass index as a risk factor. CONCLUSION: This study highlights the significant burden of MSK disorders in the MENA region, with various risk factors contributing to its increasing prevalence in recent decades. Further research is needed to better understand the underlying factors and potential interventions that could improve health outcomes. Addressing MSK disorders should be a public health priority in the region, and efforts should be made to develop effective strategies to prevent and manage this debilitating condition.

Bacterial indoor air contaminations in hospitals in MENA region: a systematic review.

Poor indoor air quality in healthcare settings has been tied with the increase in hospital-acquired infections. Thus, this systematic review was conducted to assess the levels and compositions of bacteria in indoor hospital air in the Middle East and North Africa (MENA) region. We examined results provided by different search engines published between 2000 and 2021. Our data showed that most studies were conducted in Iran (80.9%) with a bacterial concentration mean of 172.9 CFU/m3. Comparing sensitive and non-sensitive areas of hospitals, no significant difference was detected in the mean bacterial concentration. The most investigated sensitive hospital areas were operating rooms and intensive care units with mean indoor bacterial concentrations of 180.3 CFU/m3 and 204.6 CFU/m3, respectively. Staphylococcaceae, Enterobacteriaceae, Pseudomonadaceae, and Bacillaceae were commonly identified bacterial families. In conclusion, the mean concentrations of the airborne bacteria were within the acceptable limit compared to WHO standards (300 CFU/m3) for the air in areas occupied by immunosuppressed people.

Coping Strategies, well-being and inequalities during the COVID-19 pandemic period.

As a response to the outbreak of the COVID-19 pandemic, governments around the globe have carried on strict lockdown measures affecting millions of jobs, public life, and the well-being of people. This study examines people's subjective well-being, such as the perception of the economic situation and mental well-being, who made adjustments to cope with the earning losses. We estimate the well-being cost, which is the money required to compensate people because of the reduction in earnings or employment loss and the coping strategy followed to bring their well-being to the levels of those who have not adopted any coping strategy. We examine two outcomes; the perception of the economic situation and a mental well-being index. We employ data from the ERF COVID-19 MENA Monitor Surveys for Egypt, Jordan, Morocco and Tunisia. The results show that coping strategies with earning losses impact well-being and are associated with high costs. In most cases, the coping strategies of borrowing from banks and selling assets present the highest well-being costs. Furthermore, the estimates highlight significant discrepancies across gender and types of workers, such as those employed in the informal sector and temporary contracts. Supplementary information: The online version contains supplementary material available at 10.1007/s12144-023-04710-1.

The differential mental health impact of COVID-19 in Arab countries.

COVID-19 pandemic's mental health impact on Arab countries is under-researched. The goal of this investigation was to study the differential impact of COVID-19 on the mental health of Arab countries. A questionnaire including measures of COVID-19 traumatic stress, PTSD, depression, anxiety, and cumulative stressors and trauma was distributed anonymously online in seven Arab countries (Egypt (N = 255), Kuwait (N = 442), Jordan (N = 216), Saudi Arabia (N = 212, Algeria (N = 110), Iraq and Palestine (N = 139)). We used ANOVA and stepwise regression to analyze the data. For each country, regression, PTSD, depression, and anxiety were dependent variables; we entered in the first-step, gender, age, religion, education, and income. In the second step, we entered "cumulative stressors and traumas." In the third step, we entered COVID-19 traumatic stress. The ANOVA results indicated that the differences in COVID19 traumatic stress, PTSD, depression, and anxiety between the countries were significant. Post-hoc analysis indicated that Egypt is significantly higher than all the other Arab countries in COVID-19 traumatic stress, PTSD, anxiety, and depression. The subsample from Palestine and Iraq had a significantly higher cumulative trauma load than the other Arab countries but did not have higher levels of COVID-19 traumatic stress or PTSD. Stepwise regression indicated that COVID-19 traumatic stress accounted for significant variance above and beyond the variance accounted for by previous cumulative stressors and traumas for anxiety in all countries and PTSD and depression in all countries except for Algeria. We discussed the implications for these results for the urgent mental health needs of Arab countries.

Geriatric Mental Health and COVID-19: An Eye-Opener to the Situation of the Arab Countries in the Middle East and North Africa Region.

While the detrimental ramifications of the COVID-19 outbreak on the mental wellbeing of the general public continue to unravel, older adults seem to be at high risk. As the geriatric population continues to grow in the Middle East and North Africa (MENA) region, it is essential to explore the influence of this outbreak on geriatric mental health, a topic often neglected. In this review, we depict the status of geriatric psychiatry in the Arab countries of the MENA region, exploring the variations from one nation to another. While some have a null exposure to the field, resources and expertise in other countries range from very limited to extensive. Furthermore, we highlight the measures implemented in the Arab region to address mental health during the COVID-19 outbreak; these tend to be insufficient when targeting the geriatric population. Finally, we provide short- and long-term recommendations to stakeholders that aim at enhancing the mental healthcare of older adults in the Arab countries of the MENA region, particularly during this pandemic.

Epilepsy and school in the Middle East and North Africa (MENA) region: The current situation, challenges, and solutions.

Education is a human right that plays a key role in social and economic development. Children having active epilepsy may not be properly schooled in ordinary school structures. Students with epilepsy (SWE) are often faced with academic barriers. The lack of information about the current status of special education for SWE obliged the researchers to try to describe the existing reality of the special education practices in the Middle East and North Africa (MENA) region. We disseminated a simple self-administered questionnaire via email to main healthcare professionals involved in epilepsy care in the MENA region, and we also did a literature search on the PubMed, Google Scholar, and Embase engines. We ranked the countries in terms of their educational system. The 1st group contains the most advanced educational system, including specialized schools for SWE. The 2nd group contains an educational system with specialized but less structured schools. The 3rd group includes countries using integrated classes or classes mixing many children with cognitive disabilities. The 4th group includes countries with ordinary classes for SWE, and finally, the 5th group with no schooling for children with epilepsy (CWE). This study indicates that 60% of the countries in the MENA region belong to the 3rd group; there is only one country in each of the first two groups. This work highlights the need to develop structured environments for schooling for SWE in the MENA region.

Coronavirus Disease 2019 (COVID-19): Potential implications for weak health systems and conflict zones in the Middle East and North Africa region.

This short communication recognizes the underbelly of weak and conflict-prone health systems in the Middle East and North Africa region in the wake of COVID-19 pandemic. The communication highlights how the lack of basic resources, absence of a well-functioning health system and the dearth of well-coordinated communication channels, can bode ill for the successful fight against COVID-19. The article elucidates COVID-19 potential health, social, and economic implications for such countries. The communication cautions that if COVID-19 is left to incubate and makes a home in weak systems, it will have a much better chance of mutating and coming back to infect many people globally. The communication calls on the international institutions in collaboration with developed nations to be prepared to probe up health systems in weak and conflict-prone health systems with much-needed resources in order to nip COVID-19 in the bud.

Explaining the MENA Paradox: Rising Educational Attainment, Yet Stagnant Female Labor Force Participation.

BACKGROUND: Despite rapidly rising female educational attainment and the closing, if not reversal, of the gender gap in education, female labor force participation rates in the Middle East and North Africa (MENA) region remain low and stagnant. This is a phenomenon that has come to be known as the "MENA paradox". Even if increases in participation are observed, they are typically in the form of rising unemployment rather than employment. METHODS: We use multinomial logit models estimated, by country, on annual labor force survey data for four MENA countries - Algeria, Egypt, Jordan and Tunisia - to simulate trends in female participation in different labor market states (public sector, private wage work, non-wage work, unemployment and non-participation) for married and unmarried women and men, of a given educational and age profile. RESULTS: Our results confirm that the decline in the probability of public sector employment for educated women is associated with either an increase in unemployment or a decline in participation. CONCLUSIONS: We argue that failure of employment rates to increase in line with women's rapidly rising educational attainment - the so-called MENA paradox -- can be primarily attributed to the change in opportunity structures facing educated women in the MENA region in the 2000s, rather than the supply-side factors traditionally emphasized in the literature to explain low female participation in MENA. CONTRIBUTION: We argue that female labor force participation among educated women in four MENA countries - Algeria, Egypt, Jordan and Tunisia -- is constrained by adverse developments in the structure of employment opportunities on the demand side. Specifically, the contraction in public sector employment opportunities has not been made up by a commensurate increase in opportunities in the formal private sector, leading to increases in female unemployment or declines in participation.

An investigation into solid waste problem in the Egyptian construction industry: A mini-review.

Solid waste management (SWM) is one of the most critical global challenges nowadays. It has a severe negative effect on the triple bottom line of sustainability. Construction and demolition waste (CDW) contributes about 50% of the total global annual generated SW. In the particular case of the Middle East and North Africa (MENA) region including Egypt, the SW problem has become a major challenge, and the need to find sustainable solutions is overwhelming. However, the region faces several challenges that hinder the development of an effective and efficient SWM system. This has resulted in the predominance of unsustainable SWM practices such as indiscriminate disposals. The aim of this paper is to investigate the escalating problem of SW in the MENA region, while focusing on CDW in Egypt as a part of the total generated SW, by reviewing the most recent research papers, and technical and governmental reports on the SW problem. The main challenges towards effective and efficient SWM systems and recommendations for improvement are gathered in this study based on the explored literature. Findings from this study are expected to be beneficial to local and central governments, academics, construction industry practitioners, and policymakers contending with the problems of SW in the MENA region and especially CDW in Egypt.

Examining the association between educational attainment and life expectancy in MENA region: A panel data analysis.

BACKGROUND: The purpose of this study is to investigate the association between educational attainment and life expectancy in 18 countries in MENA region. METHODS: We used World Bank database for a panel of 18 MENA countries during the years 1995 to 2009. We used Life Expectancy at Birth, as the key health care output measure. Additionally, we used six health care input independent variables. All variables were transformed into natural logarithms. We estimated the production function using Cobb-Douglas function. RESULTS: Results indicate that 1% increase in educational attainment of males 25 to 34 years old, males 25 years and older, females 25 to 34 years old, females 25 years and older, and females aged 15 to 44 years old will increase life expectancy by 0.14%, 0.07%, 0.04%, 0.03%, and 0.04%, respectively, while everything else remains constant. CONCLUSION: Our results suggest that for MENA region countries investing in education to broaden access would improve health outcomes and life expectancy. Boosting educational attainment for both male and female population may close the life expectancy gaps between the MENA region and other developed countries, and males and females within the same country. Education attainment has the potential to be a social remedy for better health outcomes in MENA countries.

Management of prolactinomas: a survey of physicians from the Middle East and North Africa.

BACKGROUND: Prolactinomas are the commonest functional tumors of the pituitary gland. There are still controversies regarding medical therapy in specific clinical situations. Patients may be managed by different specialists in the Middle East and North Africa (MENA) region and no data exist on patterns of clinical management. OBJECTIVES: To ascertain the diagnostic and therapeutic approaches to prolactinomas among relevant professionals from the MENA region. METHODS: An online survey of a large sample of physicians was conducted. The questionnaire covered various aspects of diagnosis and treatment of prolactinomas. 468 respondents were included; 36 % were endocrinologists; 49 % worked in public facilities and 81 % graduated more than 10 years. 40 and 30 % would have seen 1-5 and more than 5 suspected or confirmed prolactinomas over a 6 months period, respectively. RESULTS: Regarding the diagnosis, 30 % of the respondents considered that prolactin levels <100 ng/ml exclude the presence of a prolactinoma. 21 % of respondents considered prolactin levels >250 ng/ml compatible with macroprolactinomas only, whereas others accepted this to be compatible also with microprolactinomas, macroprolactinaemia and drug-induced hyperprolactinemia (50, 42 and 36 % respectively). 71 % of respondents favored the screening for macroprolactin in asymptomatic individuals with hyperprolactinemia. Regarding the treatment, 84 % of respondents would treat microprolactinomas even in the absence of symptoms whereas 72 % of the respondents would treat microprolactinomas only if symptoms exist. 60 and 49 % of the respondents chose cabergoline as the drug of choice to treat macroprolactinomas and microprolactinomas respectively. Similar proportions had no preference of either cabergoline or bromocriptine as the best treatment for macroprolactinoma (27 %) and microprolactinomas (32 %). 46 and 75 % of respondents favored treatment withdrawal 2-3 years after prolactin normalization in patients with macroprolactinomas and microprolactinomas, respectively whereas 10 % of respondents withdraw treatment after menopause in either case. 94 % of respondents considered medical therapy as the primary treatment for microprolactinomas. In case of pregnancy, 49 % considered bromocriptine as the drug of choice for women who wish to become pregnant. 65 and 38 % of respondents advocated discontinuation of treatment with dopamine agonists in patients with microprolactinomas and macroprolactinomas, respectively. Finally, 48 % would allow breast-feeding without restriction, 28 % would restrict it to patients with microprolactinomas and 25 % would not recommend it for women with prolactinomas. CONCLUSIONS: This is the first study of the clinical management of prolactinomas in the MENA region. Some of the practices are not in line with the latest Endocrine and Pituitary Societies guidelines. These warrant further discussions of contemporary guidelines in regional forums.

Health system barriers and enablers to early access to breast cancer screening, detection, and diagnosis: a global analysis applied to the MENA region.

OBJECTIVES: To identify barriers and enablers that impact access to early screening, detection, and diagnosis of breast cancer both globally and more specifically in the Middle East and North Africa (MENA) region (with a specific focus on Egypt, Jordan, Oman, Saudi Arabia, United Arab Emirates [UAE], and Kuwait) with a specific focus on the health system. STUDY DESIGN: A systematic review of literature. METHODS: We conducted a systematic reviewing using the PRISMA methodology. We searched PubMed, Global Index Medicus, and EMBASE for studies on 'breast cancer', 'breast neoplasm,' or 'screening, early detection, and early diagnosis' as well as key words related to the following barriers: religion, culture, health literacy, lack of knowledge/awareness/understanding, attitudes, fatalism/fear, shame/embarrassment, and physician gender from January 1, 2000 until September 1, 2016. Two independent reviewers screened both titles and abstracts. The application of inclusion and exclusion criteria yielded a final list of articles. A conceptual framework was used to guide the thematic analysis and examine health system barriers and enablers to breast cancer screening at the broader macro health system level, at the health provider level, and the individual level. The analysis was conducted globally and in the MENA region. RESULTS: A total of 11,936 references were identified through the initial search strategy, of which 55 were included in the final thematic analysis. The results found the following barriers and enablers to access to breast cancer screening at the health system level, the health provider level, and the individual level: health system structures such as health insurance and care coordination systems, costs, time concerns, provider characteristics including gender of the provider, quality of care issues, medical concerns, and fear. In addition, the following seven barriers and enablers were identified at the health system or provider level as significantly impacting screening for breast cancer: (1) access to insurance, (2) physician recommendation, (3) physician gender, (4) provider characteristics, (5) having a regular provider, (6) fear of the system or procedure, and (7) knowledge of the health system. More specifically, the largest increased odds for having a mammogram was from having insurance, having a physician recommendation, type of provider (mainly gynecologist), and having regular contact with a physician. Clinical breast examinations were increased by having insurance and having regular contact with a physician. The eight studies identified from the MENA region identified barriers to breast cancer screening related to service quality, fear of pain and of cancer itself, female versus male provider, having a physician recommend the screen, cost issues as well as time and convenience of the services. CONCLUSIONS: There are a number of system changes that can be made to remove barriers to breast cancer screening. Some of these system changes apply directly to MENA countries. A larger health system assessment of a country is warranted to determine which health system changes should be made to most efficiently and effectively improve access to breast cancer screening.

Psycho-social Correlates of Condom Use and HIV Testing among MSM Refugees in Beirut, Lebanon.

MSM refugees have to deal with personal challenges and social/structural adversaries based on their refugee status on top of their sexual identity. To better customize interventions beside this population, we explored psycho-social and structural correlates of condom use and HIV testing in Lebanon by surveying and testing 150 participants. 67 % self-identified as gay. 84.6 % reported any unprotected anal intercourse (UAI) with men in the prior 3 months. Those who engaged in UAI, were lest comfortable with a doctor, didn't know where to get free HIV testing, experienced discrimination based on their refugee status and spent more time with their refugee peers, were less inclined to have seen a doctor in the past 12 month or knew where to get free HIV testing. Ever having been HIV tested was associated with being comfortable with medical doctors, knowing where to get HIV testing and spending time with other peer refugees. HIV prevention and testing promotion efforts targeting MSM refugees need to account for structural barriers, while fighting discrimination is crucial for a healthy sexual identity development.

HIV Prevalence and Demographic Determinants of Unprotected Anal Sex and HIV Testing among Male Refugees Who have Sex with Men in Beirut, Lebanon.

Men who have sex with men (MSM), the same as refugees are at higher risk for health issues including HIV infection. With the large influx of refugees to Lebanon, and to better understand HIV transmission in this setting, we explored the socio-demographic correlates of condom use and HIV testing among MSM refugees in Beirut, by surveying and testing 150 participants. 67 % self-identified as gay, 84.6 % of respondents reported unprotected anal intercourse (UAI) in the prior 3 months, and 56.7 % with men of positive or unknown HIV status (UAIPU). 2.7 % tested positive for HIV, and 36 % reported having engaged in sex work. Men in a relationship and men who self-identified as gay had higher odds of UAI, of ever been tested, but lower odds of UAIPU. HIV prevention and testing promotion efforts targeting MSM refugees need to account for how men self-identify in relation to their sexual behavior and relationship status. Such efforts also should place emphasis on MSM of lower socio-economic status.

Hepatitis E virus in the countries of the Middle East and North Africa region: an awareness of an infectious threat to blood safety.

PURPOSE: Hepatitis E virus (HEV) is mainly transmitted through contaminated water supplies which make the virus endemic in developing countries including countries of the Middle East and North Africa (MENA) region. Recent reports suggest potential risk of HEV transmission via blood transfusion. METHODS: Related articles on HEV were collected by searching through the 25 countries of the MENA region using Pubmed and Medline within the past 14 years: January 2000-August 2014. RESULTS: One hundred articles were extracted, of which 25 were not eligible. The articles discussed the seroprevalence of HEV and HEV markers in 12 countries. Eight articles provided data on HEV in blood donors. The seroprevalence of HEV in the general MENA population ranged from 2.0 to 37.5% and was higher in males than in females. Prevalence increased with age, but exposure seems to be in early life. CONCLUSIONS: In the MENA region, the role of HEV as an infectious threat to blood safety is under-investigated. More data are needed to quantify the risk of transmission and to assess clinical outcomes. This requires, at least, surveillance screening of donors and recipients for HEV markers using sensitive and specific serological tests. At the present time, serious consideration should be given to selective screening for certain groups of patients (e.g., immunocompromised, pregnant women and others) who commonly require blood transfusion and are at high risk of hepatic failure or chronicity from HEV infection.