Addressing the effectiveness of health literacy programs within the Gulf Corporation Council: an integrative review.

Health literacy is an increasingly required need to help individuals, families and communities manage their health and health conditions. It is linked with better self-adherence to treatments, use of resources, access to care and overall reduced costs in healthcare. In the Gulf Cooperation Council (GCC), which comprises Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates, various health literacy programs are implemented across states to address people's unique and complex healthcare needs. This article aims to examine the current literature and assess the factors that influence the outcomes of health literacy programs within the GCC. An integrative review methodology has been conducted to pursue a comprehensive understanding of health literacy interventions in the GCC. This investigative approach was shaped by Whittemore and Knafl's framework (2005), which includes problem identification, literature search, data evaluation, data analysis and presentation. The literature on the effectiveness of health literacy interventions and the factors that shape them are notably limited worldwide and within the GCC region. This integrative review addresses this knowledge gap and highlights the significance of key themes such as sessions, evaluation and improvement in shaping health literacy outcomes within the GCC region. Through this integrative review, the three main themes of sessions, evaluation and improvement were identified as influencing the outcomes of health literacy programs within the GCC.

Breast Cancer in Women in Gaza: A Review of Clinical Characteristics and Short-Term Survival.

PURPOSE: To understand how breast cancer is diagnosed in Gaza, and disease stage distribution, treatment, and survival. MATERIALS AND METHODS: A clinical record case series study of women diagnosed in 2017 and 2018 was conducted with follow-up until December 31, 2020. Breast cancer crude incidence rates and age-specific incidence rates were calculated. Clinical characteristics, including investigation, diagnosis, and treatment methods by year of diagnosis, were compared using the chi-square test. The 2-year cumulative risk of death from any cause was estimated using the Kaplan-Meier method, and univariate and multivariate Cox proportional hazard regressions estimated hazard ratios and their 95% CIs. RESULTS: Five hundred twenty-four new diagnoses (mean age, 53 years; range, 23-100) were recorded, giving a crude annual incidence rate of 27 per 100,000 population. Six percent (32/524) were diagnosed at stage I, 35% (185/524) at stage II, 33% (171/524) at stage III, and 19% (99/524) at stage IV. More than one half (52%, 271/524) underwent modified radical mastectomy. Seventy-seven percent (405/524) received chemotherapy, 70% (368/524) hormone therapy, and 39% (204/524) radiotherapy. Data on key prognostic factors were mostly available-stage (93%), estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2; 82%), tumor grade (77%), and tumor size (70%). The overall survival was 95.4% at 1 year and 86.6% at 2 years. CONCLUSION: Women with breast cancer in Gaza have a high short-term survival after diagnosis. However, one half were diagnosed with advanced disease, and their investigations were incomplete. Better reporting on family history, tumor grade, size, and ER, PR, and HER2 receptor status is needed for future studies.

Prostate Cancer Awareness in the Middle East: A Cross-Sectional International Study.

PURPOSE: Prostate cancer has emerged as a significant public health challenge in the Middle East, characterized by rising incidence rates and a concerning mortality-to-incidence ratio. Yet, despite these alarming trends, data regarding prostate cancer awareness in the region remain limited. To address this critical knowledge gap, this study investigates prostate cancer awareness within the Middle East. MATERIALS AND METHODS: A cross-sectional survey was performed among 5,913 men age 40 years and older across 14 Middle Eastern countries between January 1, 2022, and July 31, 2023. Excluding those with a history of prostate cancer, a validated questionnaire assessed prostate cancer awareness. Data were analyzed using frequencies and percentages for categorical variables, medians and ranges for continuous variables, and Pearson chi-square analysis for relationships between education levels and awareness of prostate cancer. RESULTS: The survey achieved a 74.9% response rate, with 4,431 male participants. Regarding prostate cancer awareness, 83.8% of participants had heard of the disease. However, only 31.0% correctly identified it as the most common malignancy in men, and 21.8% believed it affects both sex. Awareness of screening was limited, with just 19.1% recognizing the prostate-specific antigen test's role. Additionally, participants had a pessimistic view, with a mean perception that 75% of patients with prostate cancer die from the disease, rather than from other causes. Higher education levels were associated with significantly increased awareness of prostate cancer (P < .001). CONCLUSION: This study reveals that while general awareness of the disease exists, crucial knowledge deficits regarding risk factors, screening, and prognosis are evident. Addressing these knowledge gaps through culturally tailored education may improve early detection rates, treatment outcomes, and ultimately reduce the burden of prostate cancer in the Middle East.

Atherosclerotic Cardiovascular Disease Novel and Traditional Risk Factors in Middle Eastern Young Women. The ANCORS-YW Study.

Background: There is paucity of data on the prevalence of novel and traditional cardiovascular risk factors in young women with atherosclerotic cardiovascular disease (ASCVD) in the Middle East. We sought to evaluate clinical profiles and prevalence of novel and traditional risk factors in Middle Eastern young women with ASCVD compared with age-matched controls. Methods: Women 18-50 years of age who have ASCVD were enrolled and each was aged-matched with two women with no ASCVD. Prevalence of novel and traditional risk factors was compared in the two groups. Multivariable analyzes examined the independent association of 16 factors with ASCVD. Results: Of 627 young women enrolled mean age 44.1 ± 5.2 years; 209 had ASCVD and 418 served as controls. Women with ASCVD had significantly higher prevalence of five of the studied traditional risk factors (hypertension, type 2 diabetes [T2D], smoking, low-density lipoprotein cholesterol serum levels, and family history of premature ASCVD [FHx]) than women with no ASCVD. Additionally, of the 11 novel and psychosocial risk factors studied, four showed significantly higher prevalence in young women with ASCVD (preterm delivery, hypertensive disease of pregnancy gestational diabetes, and low level of education). Multivariable analyzes showed hypertension, T2D, smoking, FHx, persistent weight gain after pregnancy and low level of education were independently associated with ASCVD. Conclusions: In this study of young Middle Eastern women; traditional risk factors as well as persistent weight gain after pregnancy were more prevalent in women with ASCVD compared with controls.The study is registered with ClinicalTrials.gov, unique identifier number NCT04975503.

Factors associated with patient activation among patients with diabetes on hemodialysis: a multicenter cross-sectional study from a developing country.

BACKGROUND: Diabetes mellitus (DM) is a major public health concern with considerable morbidity and mortality. DM affects patients' quality of life and can lead to multiple complications, including chronic kidney disease (CKD) and the need for dialysis. Higher patient activation can improve health outcomes in hemodialysis patients with DM. This study aimed to explore the factors associated with higher patient activation and health-related quality of life (HRQoL) among hemodialysis patients with DM. METHODS: This was a cross-sectional, questionnaire-based study conducted on hemodialysis patients with DM in Palestine. The quota sampling method was utilized to draw samples from six dialysis centers. The questionnaire consists of three sections. The first section includes demographic, socioeconomic and clinical questions. The second section utilizes the patient activation measure-13 (PAM-13) to measure patient activation, while the third section assesses HRQoL using the EQ-5D-5 L tool and the visual analog scale (VAS). Mann‒Whitney and Kruskal‒Wallis tests were employed to examine the relationships between variables at the bivariate level, and multiple regression analysis was employed at the multivariate level. RESULTS: Of the 200 patients who were approached, 158 were included. The median PAM, EQ-5D index, and VAS score were low at 51.0, 0.58, and 60.0, respectively. A higher PAM score was independently associated with a higher household income level and taking medications independently. A higher EQ-5D index was associated with taking more than eight medications, taking medications independently, living with fewer than three comorbid conditions, and having a higher PAM. A higher VAS score was associated with being married, and receiving less than 3.5 hours of hemodialysis. CONCLUSIONS: A higher patient activation level was associated with a higher income level and independence in taking medications. Interventions designed to improve patient activation, such as medication management programs, should address these factors among the target population. Longitudinal studies are needed to assess the time effect and direction of causation between health status and patient activation.

Peace between Israel and Palestine?

Talking to a relative of mine who lives in Israel, we exchanged by email about the Hamas terrorist attack and the brutal re-sponse of the Israeli Armed Forces that affected the entire Pal-estinian population of Gaza. He spoke to me about the moral right of the Jewish people to exist and I replied that the Pales-tinian people also had the moral right to exist. That ended the respectful dialogue we had. The Palestinian people's right to ex-ist remained unanswered.

Comparative analysis and evolution of civilian versus combatant mortality ratios in Israel-Gaza conflicts, 2008-2023.

Background: There is a need for statistical methodologies that scrutinize civilian casualties in conflicts, evaluating the degree to which the conduct of war affects civilians and breaches the laws of war. Employing an epidemiological method, this study introduced, developed, and applied a novel approach for investigating mortality of civilians versus combatants in conflicts. Methods: A deterministic mathematical model, structured by age and sex, was developed to describe the process of conflict-related deaths among both combatants and civilians. The model was calibrated using demographic and conflict-related data from different Israel-Gaza conflicts. To quantify the extent of the impact on civilians and determine whether they are the primary focus of a conflict, a statistical metric, the index of killing civilians, along with associated criteria, was devised. Results: The model-estimated proportion of deaths in Gaza categorized as combatants was 62.1% (95% uncertainty interval (UI): 57.6-66.2%), 51.1% (95% UI: 47.1-54.9%), and 12.7% (95% UI: 9.7-15.4%) in the 2008-2009, 2014, and 2023 Israel-Gaza conflicts, respectively. The index of killing civilians was 0.61 (95% UI: 0.51-0.74), 0.96 (95% UI: 0.82-1.12), and 7.01 (95% UI: 5.50-9.29) in the 2008-2009, 2014, and 2023 conflicts, respectively. These index values indicate strong evidence for civilians being an object of war in the 2008-2009 and 2014 conflicts, but combatants were still identified as the primary focus of the conflict. In the 2023 conflict, there is robust evidence for civilians being an object of war, with civilians identified as the primary focus of the conflict. Conclusion: Findings imply a progressive shift in Israel's rules of engagement over time, with a trend towards higher acceptance of casualties among civilians. The 2023 conflict stands apart from preceding Israel-Gaza conflicts, with civilians identified as the primary focus of the conflict.

Too few epidemiologists in humanitarian crises: a critical gap that needs addressing. A new course organised by the Italian Association of Epidemiology

The current humanitarian crises in Ukraine and Gaza, along with the chronic crises, and the climate-related disasters, have exposed the limitations of the humanitarian system. Within these contexts, humanitarian organisations frequently struggle with collecting, analysing, interpreting, and utilising health data, due to the challenging environments in which they operate and funding constraints. It is precisely in these contexts that field epidemiology plays a crucial, but often overlooked role.Field epidemiologists face unique challenges, including rapidly changing conditions, poor-quality data, and biases. Despite these difficulties, accurate epidemiological data are essential for needs assessment, guidance on interventions, and advocacy. Conventional methods often need adaptation for crisis settings, and there are still gaps in measurement.This article discusses the role of epidemiology in such contexts, noting a shortage of trained 'humanitarian epidemiologists' and specialised training as major issues.To address these needs, the Italian Association of Epidemiology organised a course in early 2024 to enhance the epidemiological skills of staff working in humanitarian crises and introduce traditional epidemiologists to crisis-specific challenges. The course covered key concepts and methods of field epidemiology, emphasising the use of secondary health data. Its positive reception underscored the demand for such specialised training.Improving public health information collection and use in humanitarian crises is an ethical and practical necessity. Indeed, investing in field epidemiology and recognising its importance can enhance humanitarian interventions and better serve vulnerable populations.

Coexistence of Standard Modifiable, Other Classical, and Novel and Classical Atherosclerotic Cardiovascular Disease Risk Factors in Middle Eastern Young Women.

Background: The coexistence of multiple standard modifiable risk factors (SMuRFs),classical and novel risk factors (RFs) for atherosclerotic cardiovascular disease (ASCVD) is common in the Middle East (ME). There is a paucity of data on the coexistence of these RFs in ME young women. Aim: Comparing the prevalence and the statistical patterns of the SMuRFs, classical and novel RFs in target population. Methods: In this case-control (1:2) study, consecutive young women aged 18-50 years were enrolled in 12 centers (July 2021 to October 2023). Prevalence and coexistence of 19 RFs were compared between cases with ASCVD and their controls. The RFs included SMuRFs (hypertension, type 2 diabetes, dyslipidemia, and cigarette smoking), other classical RF (obesity, family history of premature ASCVD, and physical inactivity), novel RFs and social determinants of health (health insurance, place of residence, depression, and level of education). Results: The study included 627 subjects; 209 had ASCVD (median age 46 years, IQR 49-42 years) and 418 controls (median age 45 years, IQR 48-41 years). The presence of 1-2 RFs; (ASCVD: 63.2%, Control: 54.1%, p=0.037) and 3-4 RFs; (ASCVD: 27.8%, Control: 3.3%, p < 0.001) SMuRFs was more prevalent in women with ASCVD. Similarly, the presence of 4-5 RFs; (ASCVD: 40.7%, Control: 14.6%, p<0.001), and 6-7 (ASCVD: 10.5%, Control: 1%, p < 0.001). The classical RF were also significantly common in these women. The distribution of multiple novel RF was not statistically significant across both groups. Finally, regarding the socioeconomic RFs in women with ASCVDs, the presence of 1-2 RFs (ASCVD: 59.8%, Control: 76.1%, p < 0.001) was significantly less common while the presence of 3-4 RFs (ASCVD: 39.2%, Control: 21.8%, p < 0.001) was vastly more common. Conclusion: An elevated rate of coexistence of classical RF in the case group, mainly socioeconomic and SMuRFs. By managing them primary and secondary ASCVDs prevention attained.

The burden of atrial fibrillation/flutter in the Middle East and North Africa region and its associated risk factors from 1990 to 2019.

BACKGROUND: Atrial fibrillation and flutter (AFF) are the most common cardiac arrhythmias globally, contributing to substantial morbidity and mortality. The Middle East and North Africa (MENA) region face unique challenges in managing cardiovascular diseases, including AFF, due to diverse sociodemographic factors and healthcare infrastructure variability. This study aims to comprehensively evaluate the burden of AFF in MENA from 1990 to 2019. METHODS: Data were obtained from the Global Burden of Diseases Study 2019, a comprehensive source incorporating diverse data inputs. The study collected global, regional, and national Age-Standardized Incidence Rate (ASIR), Age-Standardized Mortality Rate (ASMR), and Age-Standardized Disability-Adjusted Rate (ASDR), Mortality across sex, age groups, and years. LOESS regression was employed to determine the relationship between age-standardized rates attributed to AFF and Socio-Demographic Index (SDI). RESULTS: The study found minimal change in ASIR of AFF in MENA from 1990 to 2019, with a slight increase observed in ASMR and ASDR during the same period. Notably, AFF burden was consistently higher in females compared to males, with age showing a direct positive relationship with AFF burden. Iraq, Iran, and Turkey exhibited the highest ASIR, while Qatar, Bahrain, and Oman had the highest ASMR and ASDR in 2019. Conversely, Kuwait, Libya, and Turkey displayed the lowest ASMR and ASDR rates. CONCLUSION: This study underscores the persistent burden of AFF in MENA and identifies significant disparities across countries. High systolic blood pressure emerged as a prominent risk factor for mortality in AFF patients. Findings provide crucial insights for policy-making efforts, resource allocation, and intervention strategies aimed at reducing the burden of cardiovascular diseases in the MENA region.

Barriers faced by primary healthcare providers in addressing emergencies in the Northern region of Palestine before and during the Gaza war.

INTRODUCTION: Physicians working in primary health care (PHC) centers are the first contact for patients and expected to deal with emergencies. Emergency care training in PHC settings has been neglected globally, especially in low to middle income countries. Adequate preparation becomes especially important during periods of conflict. The study objectives are to identify the barriers facing PHC physicians when dealing with emergency cases in the northern region of Palestine during the current conflict. METHODS: A cross-sectional study was conducted with 179 physicians working in the 10 PHC centers distributed among 5 northern governances in Palestine. The study period was from July through December 2023. Data were collected electronically using a self-administered questionnaire, which was adapted from a comprehensive literature review. The questionnaire's internal validity was confirmed by a Cronbach's alpha coefficient of [0.85], indicating high reliability. RESULTS: The ages of the physicians ranged from 25 to 60 years, with a mean ± SD of 35.3 ± 8.15 years. A significant majority (91.6%) were not boarded in any specialty. Most physicians (85.5%) had attended Basic Life Support (BLS) courses, whereas 45.2% and 72% had never attended Advanced Cardiovascular Life Support (ACLS) or Advanced Trauma Life Support (ATLS) courses, respectively. Physicians with emergency department experience (P = 0.002) and those who had attended ACLS courses (P < 0.001) reported significantly higher perceived competence in managing emergency cases. CONCLUSION: Emergency services at PHC centers in northern Palestine are operational but require significant enhancements. There is a critical need for increased availability of essential equipment, supplies, and medications. Additionally, implementing comprehensive training programs in emergency management, particularly ACLS, is essential to improve the competence and performance of PHC physicians in emergency situations.

High bar for famine declaration delays food aid.

Lack of humanitarian action during early stages of acute food insecurity takes a heavy toll.

Defining indicators for disease burden, health outcomes, policies and barriers and facilitators to health services for migrant populations in the Middle East and North African region: a protocol for a suite of systematic reviews.

INTRODUCTION: The Middle East and North African (MENA) region is characterised by high and complex migration flows, yet little is known about the health of migrant populations, their levels of underimmunisation and access to healthcare provision. Data are needed to support regional elimination and control targets for key diseases and the design and delivery of programmes to improve health outcomes in these groups. This protocol describes a suite of seven systematic reviews that aim to identify, appraise and synthesise the available evidence on the burden and health outcomes, policies and access (barriers and facilitators) related to these mobile populations in the region. METHODS: Seven systematic reviews will cover three questions to explore the: (1) burden and health outcomes, (2) policies and (3) healthcare barriers and facilitators for the following seven disease areas in migrants in the MENA region: tuberculosis, HIV and hepatitis B and C, malaria and neglected tropical diseases, diabetes, mental health, maternal and neonatal health, and vaccine-preventable diseases. We will search electronic databases for studies in any language (year 2000-2023), reference-check relevant publications and cross-check included studies with experts. We will search for grey literature by hand searching key databases and websites (including regional organisations and MoH websites) for country-specific guidelines and talking to our network of experts for local and regional reports and key datasets. We will assess the studies and policies for their quality using appropriate tools. We will meta-analyse the data by disease outcome if they are of sufficient volume and similarity. Where meta-analysis is not possible and where data are on policy or access, we will narratively synthesise the evidence using summary tables, figures and text. DISSEMINATION: We anticipate disseminating the findings through peer-reviewed publications, conferences and other formats relevant to all stakeholders. We are following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and protocols will be registered on International Prospective Register of Systematic Reviews.

Perceived barriers and opportunities of providing quality family planning services among Palestinian midwives, physicians and nurses in the West Bank: a qualitative study.

BACKGROUND: Despite advancements in family planning (FP) services, several barriers persist in the Occupied Palestinian territory (oPt), blocking women's access to suitable, high-quality and equitable FP services. The aim of this study was to understand how healthcare providers perceive their abilities, barriers and opportunities in providing good quality FP services. Furthermore, it seeks to explore knowledge and training regarding FP among healthcare providers engaged in providing FP services. METHODS: A qualitative study was undertaken from August to September 2022 in seven Primary Health Care (PHC) clinics distributed in three governorates and operating under the Palestinian Ministry of Health (MoH) in the West Bank. Semi-structured, in-depth face-to-face interviews were conducted with 13 health providers (Physicians, midwives and nurses), using an interview guide in Arabic language. Transcripts were subsequently analyzed using the six phases of reflexive thematic analysis. RESULTS: FP services face various challenges, including shortages in resources such as staff, supplies, infrastructures and FP methods. Midwives possess significant potentials to offer accessible, high-quality, efficient and equitable FP services, yet, their capacities remain underutilized, representing a missed opportunity for a country like Palestine. The study provided a current overview of FP services while illustrating the need for quality FP services and the need for an updated continuous education and training, updated standardized guidelines and protocols and supportive supervision are needed across all levels of healthcare providers. Finally, providers reported a wide range of structural barriers to FP services. CONCLUSIONS: It is crucial to meticulously address both community-related and health system factors to enhance the fulfillment of FP needs and reduce unintended and closely spaced pregnancies. Policymakers should invest in the development of laws and regulations regarding FP services, promoting a comprehensive and holistic approach to FP services. This includes formulating supportive policies, capacity building of human resources and maintaining security of FP commodities.

A review of oral health promotion programmes in Eastern Mediterranean Region.

Background: Oral health conditions, such as dental caries, periodontal disease, tooth loss, dental fluorosis, dental trauma, and oral cancer, are prevalent in the WHO Eastern Mediterranean Region. However, there has been no systematic review of oral health promotion interventions in the region. Aims: To review existing literature on oral health promotion programmes in the Eastern Mediterranean Region and recommend improvements for the future. Method: We reviewed on PubMed and Google Scholar 61 articles published in the Eastern Mediterranean Region between 2010 and 2023. Quality assessment of included studies was performed using established criteria. We used the content analysis approach to create appropriate themes from the studies and to document meaningful conclusions about oral health promotion. Results: Majority of the studies were cross-sectional, a few were randomized controlled, quasi-experimental, longitudinal studies, or reviews. Oral health problems identified included poor oral health knowledge, dental caries, periodontal disease, tooth loss, dental fluorosis, and oral cancer. Although oral disorders were common in most of the countries, very few have implemented oral health promotion programmes. Conclusion: We recommend prioritization of oral health promotion programmes in the Eastern Mediterranean Region to tackle the diverse oral health challenges. To be effective, such programmes should be region- and context-specific. More studies on oral health promotion are needed in the region.

Kidney cancer in the Middle East and North Africa region: a 30-year analysis (1990-2019).

Kidney cancer, a type of urogenital cancer, imposes a high burden on patients. Despite this, no recent research has evaluated the burden of this type of cancer in the Middle East and North Africa (MENA) region. This study explored the burden of kidney cancer from 1990 to 2019 according to age, sex and socio-demographic index (SDI). The Global Burden of Disease (GBD) 2019 data was utilized to estimate the incidence, death, and disability-adjusted life-years (DALYs) caused by kidney cancer. These estimates were reported as counts and as age-standardised rates with 95% uncertainty intervals (UIs). The estimated age-standardised incidence, mortality, and DALY rates of kidney cancer in 2019 were 3.2 (2.8-3.6), 1.4 (1.2-1.6), and 37.2 (32.0-42.6) per 100,000, respectively. Over the period from 1990 to 2019, these rates have increased by 98.0%, 48.9%, and 37.7%, respectively. In 2019, the United Arab Emirates, Qatar, and Lebanon had the largest age-standardised incidence, mortality, and DALY rates. The smallest age-standardised incidence rates were seen in Yemen, Afghanistan, and the Syrian Arab Republic. Additionally, the smallest age-standardised mortality and DALY rates were observed in the Syrian Arab Republic, Yemen, and Morocco. The highest incidence rates were found among individuals aged 75-79 in both males and females. In 2019, the MENA/Global DALY ratio exceeded one for females aged 5-19 age and males aged 5-14, compared to 1990age groups in males. The burden of kidney cancer consistently rose with increasing SDI levels from 1990 to 2019. The increasing burden of kidney cancer highlights the urgent need for interventions aimed at improving early diagnosis and treatment in the region.

Exploring perceived challenges, adoption, and assessment of Western values of democracy and human rights in Palestine in the 2023 War on Gaza.

This study delved into the dynamics of perceived challenges, adoption, and assessment of Western values of democracy and human rights among university students in Palestine, particularly in the aftermath of the 2023 War on Gaza. A mixed-methods strategy was used in the research, with a participant pool of 384 students representing a range of demographics. By exploring the impact of geopolitical events, the results revealed a positive link between perceived challenges and the assessment of Western values. Although there is a notable gender and geographic difference in the assessment and adoption of Western values, females and those living in cities and villages are shown to have greater perceived challenges with these values. The qualitative component, including interviews with 12 students, provided valuable insights into the postwar evolution of Palestinian perspectives, highlighting a notable shift in attitudes, initially characterized by belief in the superiority of Western values, followed by a decline in faith during the war. This decline is attributed to traumatic events, biased media narratives, and the contradiction between idealized standards and harsh realities. In conclusion, the study emphasizes the need for a comprehensive understanding of the multifaceted influences on Palestinian perceptions of Western values.

Pollen metabarcoding reveals the origin and multigenerational migratory pathway of an intercontinental-scale butterfly outbreak.

Migratory insects may move in large numbers, even surpassing migratory vertebrates in biomass. Long-distance migratory insects complete annual cycles through multiple generations, with each generation's reproductive success linked to the resources available at different breeding grounds. Climatic anomalies in these grounds are presumed to trigger rapid population outbreaks. Here, we infer the origin and track the multigenerational path of a remarkable outbreak of painted lady (Vanessa cardui) butterflies that took place at an intercontinental scale in Europe, the Middle East, and Africa from March 2019 to November 2019. Using metabarcoding, we identified pollen transported by 264 butterflies captured in 10 countries over 7 months and modeled the distribution of the 398 plants detected. The analysis showed that swarms collected in Eastern Europe in early spring originated in Arabia and the Middle East, coinciding with a positive anomaly in vegetation growth in the region from November 2018 to April 2019. From there, the swarms advanced to Northern Europe during late spring, followed by an early reversal toward southwestern Europe in summer. The pollen-based evidence matched spatiotemporal abundance peaks revealed by citizen science, which also suggested an echo effect of the outbreak in West Africa during September-November. Our results show that population outbreaks in a part of species' migratory ranges may disseminate demographic effects across multiple generations in a wide geographic area. This study represents an unprecedented effort to track a continuous multigenerational insect migration on an intercontinental scale.