Systematic overview of hepatitis C infection in the Middle East and North Africa

AIM To assess the quality of and to critically synthesize the available data on hepatitis C infections in the Middle East and North Africa(MENA) region to map evidence gaps.METHODS We conducted an overview of systematic reviews(SRs) following an a priori developed protocol(CRD42017076736). Our overview followed the preferred reporting items for systematic reviews and metaanalyses guidelines for reporting SRs and abstracts and did not receive any funding. Two independent reviewers systematically searched MEDLINE and conducted a multistage screening of the identified articles. Out of 5758 identified articles, 37 SRs of hepatitis C virus(HCV) infection in populations living in 20 countries in the MENA region published between 2008 and 2016 were included in our overview. The nine primary outcomes of interest were HCV antibody(anti-) prevalences and incidences in different at-risk populations; the HCV viremic(RNA positive) rate in HCV-positive individuals; HCV viremic prevalence in the general population(GP); the prevalence of HCV co-infection with the hepatitis B virus, human immunodeficiency virus, or schistosomiasis; the HCV genotype/subtype distribution; and the risk factors for HCV transmission. The conflicts of interest declared by the authors of the SRs were also extracted. Good quality outcomes reported by the SRs were defined as having the population, outcome, study time and setting defined as recommended by the PICOTS framework and a sample size > 100.RESULTS We included SRs reporting HCV outcomes with different levels of quality and precision. A substantial proportion of them synthesized data from mixed populations at differing levels of risk for acquiring HCV or at different HCV infection stages(recent and prior HCV transmissions). They also synthesized the data over long periods of time(e.g., two decades). Anti-HCV prevalence in the GP varied widely in the MENA region from 0.1%(study dates not reported) in the United Arab Emirates to 2.1%-13.5%(2003-2006) in Pakistan and 14.7%(2008) in Egypt. Data were not identified for Bahrain, Jordan, or Palestine. Good quality estimates of anti-HCV prevalence in the GP were reported for Algeria, Djibouti, Egypt, Iraq, Morocco, Pakistan, Syria, Sudan, Tunisia, and Yemen. Anti-HCV incidence estimates in the GP were reported only for Egypt(0.8-6.8 per 1000 person-year, 1997-2003). In Egypt, Morocco, and the United Arab Emirates, viremic rates in anti-HCV-positive individuals from the GP were approximately 70%. In the GP, the viremic prevalence varied from 0.7%(2011) in Saudi Arabia to 5.8%(2007-2008) in Pakistan and 10.0%(2008) in Egypt. Anti-HCV prevalence was lower in blood donors than in the GP, ranging from 0.2%(1992-1993) in Algeria to 1.7%(2005) in Yemen. The reporting quality of the outcomes in blood donors was good in the MENA countries, except in Qatar where no time framework was reported for the outcome. Some countries had anti-HCV prevalence estimates for children, transfused patients, contacts of HCV-infected patients, prisoners, sex workers, and men who have sex with men.CONCLUSION A substantial proportion of the reported outcomes may not help policymakers to develop micro-elimination strategies with precise HCV infection prevention and treatment programs in the region, as nowcasting HCV epidemiology using these data is potentially difficult. In addition to providing accurate information on HCV epidemiology, outcomes should also demonstrate practical and clinical significance and relevance. Based on the available data, most countries in the region have low to moderate anti-HCV prevalence. To achieve HCV elimination by 2030, up-to-date, good quality data on HCV epidemiology are required for the GP and key populations such as people who inject drugs and men who have sex with men.

China-Middle East Cooperation in the Field of Infrastructure under the Framework of the“Belt and Road”Initiative

Infrastructure is not only a priority of the“Belt and Road”Initiative,but also an important component of the productivity cooperation between China and Middle East.The Middle East was one of the regions that had been working with China in the early stage after China’s reform and opening up to the outside world,and since China was integrated into the world economic system and carried out international cooperation.China has a good foundation and experience in the cooperation with the Middle East in the field of infrastructure.Based on the analysis of basic problems of the Middle East infrastructure,this article sorts out the main mode of China’s cooperation with the Middle East in infrastructure,and points out the main problems in China’s expansion in the Middle East infrastructure market.According to the characteristics and future scale of infrastructure market in the Middle East countries,this articles puts forward some countermeasures and suggestions for future development of Chinese enterprises in the Middle East market in the field of infrastructure as well as the proposals to increase market share.

The Strategic Docking between China and Middle East Countries under the“Belt and Road”Framework

The Middle East is the region bringing together the land and maritime Silk Road,coupled with its unique geographical location and diverse and complex humanitarian,religious and ethnic factors,notably with an increasingly significant role of the energy sector.As an energy-rich zone,it plays a decisive role in the position of international political and economic arena.In the process of building the“Belt and Road”,Chinese government should pay close attention to the role of the Middle East region.This region will also play its rightful role in security coordination,economic cooperation,and cultural exchanges under the“Belt and Road”framework,thus,achieving the strategic docking and win-win cooperation between China and Middle Eastern countries.

The Turbulent Middle East: Analysing Security Issues facing China’s Belt and Road Initiative towards the Region

Since the announcement of the‘Belt and Road Initiative’(BRI)in 2013,China has yet to unveil the greatest challenge facing the implementation of this initiative.The Middle East offers both strategic as well as resource opportunities for China but the region remains fluid and unstable security wise.Shaky regional alliances,a dissatisfied labour force,pressures from non-state actors,gender discrimination and human rights abuses and sustained external intervention are just some of the security issues facing the Middle East.How would China navigate itself in such a volatile region without jeopardizing its interests and without breaking the principles of non-intervention and sovereignty?More importantly,what type of power does China want to project vis-a-vis the region?This paper argues that the Middle East region,among all the world’s regions,is the most critical for the success of the BRI.China’s ability to maximize gains amidst regional security challenges will determine the future of its global political and economic influences.The region is a test for China’s diplomacy and credibility,which are crucial for its status as a future global power.

“Understanding between Peoples”of China and the Middle East Countries

The Middle East is a natural ally of China in the“One Belt and One Road”construction.The“understanding between the peoples”of China and the Middle East countries not only has the profound historical basis,but also has strong realistic motives.The great blueprint of the“One Belt and One Road”will link the pursuit of the Middle East people in peaceful development with Chinese people’s dream in national rejuvenation,bringing new opportunities and endowing new connotation for mutual“understanding between peoples”on both sides.However,there is a large gap between the actual demand of the“One Belt and One Road”construction and the existing state of affairs in the understanding between the Chinese and Middle Eastern people.There are not only a lot of problems,but also many interferences and blocking factors.In the context of the“One Belt and One Road”,to further promote the“understanding between peoples”of China and the Middle East countries is a huge and systematic civilizational project,which needs in-depth research and understanding.

The New Development of China-Middle East Relations since the Arab Upheaval

Since the upheaval,the Middle East region has been suffering from persisting conflicts and rising tension.China is facing a changing situation in the Middle East,along with increasingly mutual strategic reliance between China and the Middle East countries:on the one hand,the presence of Chinese interests in the Middle East is continuing to expand;on the other hand,since the 9/11,Middle Eastern countries have been generally in discord with the United States.As a result,Israel,Saudi Arabia and other countries are becoming increasingly willing to enhance relations with China,and significantly level up their expectation towards China accordingly.Within this context,China has actively promoted relations with Middle Eastern countries,with an image of a responsible,positive,and fair-minded actor in Middle East affairs.Accordingly,China’s interaction with the Middle East countries has stepped into a new stage.

China and the Middle East:A Global Strategy Where the Middle East has a Significant but Limited Place

China’s growing importance in the global order,and the increasing assertiveness with which it pursues its global objectives,raise questions as to how the Middle East fits within China’s global strategy.There has been much speculation,in particular,as to whether China is seeking to replace the United States as a key guarantor of security for some Middle Eastern states and regimes.This no doubt is partly dependent on whether the United States will draw back its commitment to the region,and whether Middle Eastern states will seek an alternative guarantor.But it also depends critically on whether China has any interest in playing,and capacity to play,such a role.An understanding of the dynamics of China’s global strategy,and of how the Middle East relates to the parameters around which the strategy is conceived,needs to be the starting point in such an assessment.The aim of this article is to provide a realistic appraisal of the strategy,and then to draw conclusions relative to the present and future role of China in the Middle Eastern region.The analysis concludes that the relationship with Middle Eastern countries is indeed significant to China,but is nonetheless secondary to the interests which are most critical for the Chinese state.

China and the Middle East:Venturing into the Maelstrom

China’s increasingly significant economic and security interests in the Middle East have several impacts.It affects not only its energy security but also its regional posture,relations with regional powers as well as the US,and efforts to pacify its north-western region of Xinjiang.Those interests are considerably enhanced by China’s“One Belt,One Road Initiative”that seeks to patch together a Eurasian land mass through inter-linked infrastructure,investment and expanded trade relations.Protecting its mushrooming interests is forcing China to realign its policies and relationships in the region.

The Middle East in China-Japan Relations: Shared Interests, Competition, and Rivalry Spillover

Since the early twenty-first century,interaction between East Asia and the Middle East has grown considerably.An expected,though understudied,consequence of this development is a gradual spillover of the intra-East Asian political process to the Middle East.Attempting to enhance the understanding of this understudied aspect of East-West Asia relations,as well as new aspects of the China-Japan dynamic,this article explores the competition and possible expansion of the Sino-Japanese rivalry into the Middle East.To examine more concretely we focus on two areas of activities that exceed China’s and Japan’s traditional interests in the Middle East:the utilisation of Middle East events by Japan to loosen its half-century restrictions on the use of military force,and China’s respective response;and Japan’s reaction to China’s Belt and Road Initiative.

The Economic Adjustment of Saudi Arabia and the Docking of Bilateral Economy and Trade between China and Saudi Arabia under the“One Belt and One Road”Initiative

The fall in international oil prices,which began in the second half of 2014,had a severe impact on the economy of Saudi Arabia,and the country began to adjust its economic development policy.The main contents include:changes in the allocation of resources from reliance on government intervention to reliance on the dominance of market;government revenue shifts from dependence on oil revenues to expansion of non-oil revenues;industrial structural changes from excessive dependence on oil economy to diversification in the field of new energy and mining;enterprise ownership structure changes from nationalization to privatization;source of investment funds shifting from basically relying on domestic investment to paying attention to foreign investment;labor and employment change from relying on foreign workers to a trend of localization in Saudi Arabia.Combining priorities in the economic development if Saudi Arabia with the key areas of the“One Belt and One Road”Initiative,energy security,cooperation capacity,infrastructure and finance are the most promising fields in bilateral economic cooperation.

The Multiple Roles of Egypt in China’s‘Belt and Road’Initiative

Egypt was the first country in Africa and the Arab World to establish diplomatic relations with the People’s Republic of China.In 2016,the official visit of President Xi Jinping to Egypt began a new chapter in the two countries’relations and will open a brand-new page in their foreign affairs.This paper,based on the changes that have taken place in Egypt’s diplomacy,highlights the core concepts of Egypt’s diplomatic strategy towards China and focuses on how these outlooks can be compatible with China’s‘Belt and Road’Initiative(BRI).Egypt boasts many important features:a unique geographic location which makes Egypt the meeting point of the Arab World,Africa,Asia,and Europe through the Mediterranean Sea and Red Sea;a unique civilisation and culture,with a longstanding history and interactions throughout millennia with the empires of Greece,Persia,Rome,Turkey,and more.Egypt is also considered a converging point of Islam and Christianity,boasting a relatively stable political and social order,and a fully-fledged economic system.All these features help Egypt to have global outreach;it contributes great value to China’s BRI and enables Egypt to play a key role in the world with China as a strategic partner.This paper also analyses the characteristics of Egypt’s new diplomacy and how they lay a solid foundation for the development of Sino-Egyptian relations.The strategic vision between Egypt and China is not limited to trade and investments,but there are still missing pieces to fill in which depend on the regional and global arenas,such as the Palestinian-Israeli conflict,Middle East security governance,national defense,and counterterrorism.

Analysis on the Potential of Strategic Cooperation between China and OIC under the“Silk Road Strategy”Framework

The Organization of Islamic Cooperation has a unique influence in the global governance,such as Middle East issues and International Islamic development,and has become the most active international multilateral platform for Islam.Based on the context of the establishment of the organization and its development process,particularly,the agenda items and resolutions of the organization since 2000,this study clarifies the path of the OIC to advance agenda items and exert political influence on Islamic countries;this study also tracks the history of both official and civil exchanges between China and the OIC,proposes to seize the historic opportunity of the“Silk Road strategy”,and build a model of cooperation between China and the Arab-Islamic countries as the“natural partners of the Silk Road”and the“Silk Road Community”.

Opportunities and Challenges of China-Middle East Countries’Production Capacity Cooperation

The Middle East is a region where China has more advantages in production capacity cooperation.China started early and has a good reputation in the area of engineering contracting,which has laid good foundations.At present,the Middle East countries are in an important stage of economic transformation.In order to accelerate industrialization,they have developed long-term economic development plan,which provides an important historical opportunity for Chinese enterprises to establish business there.The production capacity cooperation between China and the Middle East countries will utilize the complementary advantages and adhere to mutually beneficial and win-win spirit,and thus has been welcomed by the Middle East countries.At present,the two sides are carrying out fruitful cooperation in infrastructure,high technology and labor-intensive industries,and have achieved significant results.The production capacity cooperation between China and the Middle East countries are facing both opportunities and challenges.We should make good use of opportunities,prevent and resolve risks,and effectively do a good job in production capacity cooperation between China and the Middle East countries.

Belt and Road Initiative:China’s Diplomatic-Security Tool in the Gulf?

The focus of the first five years of the Belt and Road Initiative(BRI)was on the economic dimensions,laced with a tinge of politics.It is likely that the next five years of this ambitious project-whilst making headway in the economic domain and acquiring a greater political flavour-would also attain a security dynamic that could become the basis of a future global security system,with ramifications for the Gulf region.This paper focuses on two interconnected issues:one,the already-evident traces of the BRI’s economic-political-security linkages;and two,how this security feature expands to fit into China’s wider diplomatic and defence policy,which includes a naval plan extending into the Indian Ocean,and how this could impact Gulf security.

China’s Economic Restructuring and Extension of China’s Middle East Strategy

Joint construction of“the Silk Road Economic Belt”and“the Maritime Silk Road of the 21st Century”is not only the objective requirement of China’s further economic development and its deepening reform and opening policy,especially its national strategy of“opening to the west”,but also a major historical opportunity for the development of the Asia-Europe countries particularly the Middle East countries.While Chinese economy achieved remarkable development,the economy of the Middle Eastern countries ploughed through the turmoil and fighting.From the point of view of the global economy,the economies of China and of the Middle East countries are at different stages of historical development.This kind of difference just reflected the complementarity in their economic cooperation.The two sides ought to grasp this historical opportunity,use complementary advantages and achieve win-win cooperation.With the status of the Middle East in China’s diplomacy being definitely rising,China’s Middle East strategy should grasp four points of emphasis,such as expansion of the international political space,strengthening of national security,promotion of trade and economic cooperation,and enhancing soft power.

The New Silk Road in West Asia under“the Belt and Road”Initiative

From the perspective of energy,the construction of a shortcut,through which the oil pipeline can be directly extended to the Persian Gulf through Pakistan,is very beneficial to China's energy supply security.With“the Belt and road”Initiative,if China is able to build China-Pakistan Economic Corridor and Gulf Pearl chain,China would play an influential role in the Arabia Peninsula,as well as in Africa.Pakistan and the Six Gulf Countries are located in the western intersection zone of the belt and road,which makes them important partners of China in promoting“the Belt and Road”Initiative.Once the New Silk Road is built,not only China and its partners can mutually benefit,but also West Asia,East Asia,and Southeast Asian economies can be more closely integrated,an occurrence which will continue to enhance and enrich cooperation in“the Belt and Road”Initiative,and to broaden and extend the building space in it.

“Development First”:China’s Investment in Seaport Constructions and Operations along the Maritime Silk Road

Seaports are crucial pivots connecting a state’s national economy with the world economy.As the largest developing country and one of the largest seaport constructors and operators in the world,China insists on the importance of improving people’s livelihood by building key seaports infrastructure,airports,power plants,highways,and railways.Invited by the host countries,China has participated broadly in the construction and operations of commercial seaports along the Maritime Silk Road,which stretches from Southwest Asia to Eastern Africa and to the Mediterranean Sea and the Maghreb.Officials in Beijing argue that the fundamental task facing the majority of developing countries along the Maritime Silk Road is development,and suggest that“bread is more important than the ballot box”.One can anticipate that when the project is executed,the threats to China’s seaport construction will range from financial burdens,ethnic conflicts,attacks carried out by extremists,and cultural misunderstandings with the host nations to great power rivalries.

“一带一路”战略的支点:中国与中东能源合作

中东是全球主要的能源供应基地,在国际能源体系中扮演着重要的角色。随着习主席提出建设"一带一路"战略构想,中国与中东国家的能源关系发展迅速,已成为中国"一带一路"框架的战略支点。本文考察改革开放以来,中国与中东的能源关系的历程,通过分析中国与中东能源合作的主要机制,即中阿能源合作大会、中海战略对话以及中国与中东能源合作面临的主要问题和挑战,即中东地缘政治风险、西方国家对中国在中东的指责,指出中国在中东面临的竞争加剧,并对中国中东能源合作提出了几点思考。

中东国家基础设施建设与“一带一路”合作前景

第二次世界大战后,中东国家纷纷摆脱殖民统治获得独立,各国基础设施建设逐渐取得较大发展,为本国和地区经济增长发挥了重要作用。然而,中东国家基础设施发展很不均衡,有些国家建立了相对现代化的基础设施,有力地促进了经济增长;有些国家基础设施建设仍很滞后,成为经济增长的瓶颈;还有些国家的基础设施建设受到战乱和冲突破坏,亟需重建。由于中东地区很多国家正处在工业化、城市化的起步或加速阶段,加上年轻化的人口结构,对交通、通信、电力等基础设施的需求量巨大,这成为中国与中东国家共建"一带一路"、实现基础设施领域互联互通和互利共赢的重要契机。