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.

Epidemiology of type 2 diabetes in the Middle East and North Africa:Challenges and call for action

Type 2 diabetes continues to be a serious and highly prevalent public health problem worldwide.In 2019,the highest prevalence of diabetes in the world at 12.2%,with its associated morbidity and mortality,was found in the Middle East and North Africa region.In addition to a genetic predisposition in its population,evidence suggests that obesity,physical inactivity,urbanization,and poor nutritional habits have contributed to the high prevalence of diabetes and prediabetes in the region.These risk factors have also led to an earlier onset of type 2 diabetes among children and adolescents,negatively affecting the productive years of the youth and their quality of life.Furthermore,efforts to control the rising prevalence of diabetes and its complications have been challenged and complicated by the political instability and armed conflict in some countries of the region and the recent coronavirus disease 2019.Broad strategies,coupled with targeted interventions at the regional,national,and community levels are needed to address and curb the spread of this public health crisis.

Potential for human immunodeficiency virus parenteral transmission in the Middle East and North Africa: An analysis using hepatitis C virus as a proxy biomarker

The Middle East and North Africa(MENA) region has endured several major events of infection parenteral transmission. Recent work has established the utility of using hepatitis C virus(HCV) as a proxy biomarker for assessing the epidemic potential for human immunodeficiency virus(HIV) parenteral transmission. In this review, we use data on the prevalence of HCV infection antibody(seroprevalence) among general population and high risk population groups to assess the potential for HIV parenteral transmission in MENA. Relatively low prevalence of HCV infection in the general population groups was reported in most MENA countries indicating that parenteral HIV transmission at endemic levels does not appear to be a cause for concern. Nonetheless, there could be opportunities for localized HIV outbreaks and transmission of other blood-borne infections in some settings such as healthcare facilities. Though there have been steady improvements in safety measures related to parenteral modes of transmission in the region, these improvements have not been uniform across all countries. More precautions, including infection control training programs, surveillance systems for nosocomial infections and wider coverage and evaluation of hepatitis B virus immunization programs need to be implemented to avoid the unnecessary spread of HIV, HCV, and other blood-borne pathogens along the parenteral modes of transmission.

Hepatitis C virus among blood donors and general population in Middle East and North Africa:Meta-analyses and meta-regressions

BACKGROUND Despite the Middle East and North Africa(MENA)Region reported to have the highest prevalence of hepatitis C virus(HCV)globally,HCV infection levels in the majority of MENA countries remain inadequately characterized.Blood donor data have been previously used as a proxy to assess levels and trends of HCV in the general population,however,it is unclear how comparable these populations are in MENA and whether blood donors provide an appropriate proxy.AIM To delineate HCV epidemiology among blood donors and the general population in the MENA.METHODS The data source was the systematically gathered MENA HCV Epidemiology Synthesis Project Database.Random-effects meta-analyses and meta-regressions were conducted.For comparison,analyses were conducted for Europe,utilizing the Hepatitis C Prevalence Database of the European Centre for Disease Prevention and Control.RESULTS One thousand two hundred and thirteen HCV antibody prevalence measures and 84 viremic rate measures were analyzed for MENA.Three hundred and seventyseven antibody prevalence measures were analyzed for Europe.In MENA,pooled mean prevalence was 1.58%[95%confidence interval(CI):1.48%–1.69%]among blood donors and 4.49%(95%CI:4.10%–4.90%)in the general population.In Europe,pooled prevalence was 0.11%(95%CI:0.10%–0.13%)among blood donors and 1.59%(95%CI:1.25%–1.97%)in the general population.Prevalence in the general population was 1.72-fold(95%CI:1.50–1.97)higher than that in blood donors in MENA,but it was 15.10-fold(95%CI:11.48–19.86)higher in Europe.Prevalence was declining at a rate of 4%per year in both MENA and Europe[adjusted risk ratio:0.96(95%CI:0.95–0.97)in MENA and 0.96(95%CI:0.92–0.99)in Europe].Pooled mean viremic rate in MENA was 76.29%(95%CI:67.64%–84.02%)among blood donors and 65.73%(95%CI:61.03%–70.29%)in the general population.CONCLUSION Blood donor data provide a useful proxy for HCV infection in the wider population in MENA,but not Europe,and could improve HCV burden estimations and assess progress toward HCV elimination by 2030.

The Middle East and North Africa （MENA） Oil Exporters After the Global Crisis

Our research topic is about the economic situation in the Middle East and North Africa （MENA） oil exporters after the global crisis in 2008. The authors tried to find the answers to the questions such as ＂How bad or good is the situation there？＂ and ＂what is the expectation about the future of the region？＂ Like other countries around the world, the MENA oil exporters, comprised of Algeria, Bahrain, Iran, Iraq, Kuwait, Libya, Oman, Qatar, Saudi Arabia, Sudan, United Arab Emirates, Yemen were adversely affected by the global crisis. The MENA oil exporters are recently recovering from their recession in 2009 when the global crisis was felt intensively there. GDP in the region has grown by 3.5 percent in 2010 after a low growth of 0.7 percent in 2009. The average real GDP growth excluding Libya is projected to reach 4.9 percent in 2011. Two developments mark the outlook： the unrest in the region and the surge in global fuel and food prices. For most oil exporters, the expected increase in oil prices and production volumes will lead to higher growth in 2011 and stronger fiscal and external balances, notwithstanding recent increases in government spending. The oil exporters＇ combined external current account surplus is estimated to increase. The effects of the political events in Tunisia and Egypt have spread in varying degrees to the MENA oil exporters in the region, and many of these countries are responding with public spending and job-creation measures to alleviate social tensions. The social unrest also highlights the need to pursue fundamental economic reforms--social policy, fiscal management, governance, business environment, labor markets, and financial sector access to facilitate more inclusive economic growth. While the MENA countries are generally divided into two sub-regions such as ＂oil exporters＂ and ＂oil importers＂ in the economic literature, the authors will deal with only the MENA oil exporters in this work. The negative effects of the global crisis in these countries on growth, inflation, current account balance, budget balance, and finally financial sector will be reviewed in this work and the expectations and the developments which occurred after the crisis in these countries will be dealt with especially in the context of the IMF reports.

Economic development and diabetes prevalence in MENA countries: Egypt and Saudi Arabia comparison

Diabetes is increasing in epidemic proportions globally, exhibiting the most striking increase in third world countries with emerging economies. This phenomena is particularly evident in the Middle East and North Africa(MENA) region, which has the highest prevalence of diabetes in adults. The most concerning indirect cost of diabetes is the missed work by the adult population coupled with the economic burden of loss of productivity. The major drivers of this epidemic are the demographic changes with increased life expectancy and lifestyle changes due to rapid urbanization and industrialization. Our focus is to compare MENA region countries, particularly Egypt and Saudi Arabia, in terms of their economic development, labor force diversity and the prevalence of diabetes.

Nationwide seroprevalence, spatial distribution and risk factors of Leishmania in Jordan

Objective:To explore the seroprevalence,spatial distribution and risk factors for Leishmania seropositivity in Jordan.Methods:Blood samples from 872 apparently healthy participants were randomly selected from 11 governorates in Jordan and tested for anti-Leishmania K39 IgG.Risk factors(animal ownership and agriculture practices)and demographic data were also collected using pre-tested and validated questionnaire.Results:Overall,2.52% of participants were seropositive for Leishmania spp.Participants living in the Jordan Valley plateau had significantly greater odds(adjusted odds ratio= 3.70,95% CI 1.37-9.93)of seropositivity than those living in the Highlands after adjustment for age.Conclusions:This study supports the intermittent reports of cutaneous leishmaniasis outbreaks in the Jordan Valley.Vector control measures in the Jordan Valley should be considered,including insecticide treated bed nets,sugar baits and using flowering plants to attract and trap Phlebotomus papatasi sand flies.Active surveillance in the Jordan Valley is also recommended in light of this and other reports.

Distribution and variability of deformed wing virus of honeybees （Apis mellifera） in the Middle East and North Africa

Three hundred and eleven honeybee samples from 12 countries in the Middle East and North Africa （MENA） （Jordan, Lebanon, Syria, Iraq, Egypt, Libya, Tunisia, Algeria, Morocco, Yemen, Palestine, and Sudan） were analyzed for the presence of deformed wing virus （DWV）. The prevalence of DWV throughout the MENA region was pervasive, but variable. The highest prevalence was found in Lebanon and Syria, with prevalence dropping in Palestine, Jordan, and Egypt before increasing slightly moving westwards to Algeria and Morocco Phylogenetic analysis of a 194 nucleotide section of the DWV Lp gene did not identify any significant phylogenetic resolution among the samples, although the sequences did show consistent regional clustering, including an interesting geographic gradient from Morocco through North Africa to Jordan and Syria. The sequences revealed several clear variability hotspots in the deduced amino acid sequence, which furthermore showed some patterns of regional identity. Furthermore, the sequence variants from the Middle East and North Africa appear more numerous and diverse than those from Europe.

The Relative Deprivation Theory and Yemen＇s Uprising

The political upheavals in the Arab world during 2011 challenged the political status quo and have irrevocably paved the way toward transformation in the Middle East and North Africa （MENA）, The longstanding structural impediments to equitable growth and social justice afflicting the Arab world came to a head through a combination of persistently poverty, high unemployment, particularly among educated youth, rampant corruption, deficit of democratic governance, and essential freedoms. Yemen is the third country of the Middle Eastern countries which turmoil sparked in. All the uprisings connote of social, political and economic discontent and frustration. The main question and issue of this paper is to answer： What conditions breed change to Yemen？ The paper spotlights ＂relative deprivation＂ of Ted Robert Gurr as the most relevant theory to illustrate roots of the Yemen uprising. Relative deprivation theory holds that instead of an absolute standard deprivation, a gap between expectations and reality leads men to political violence. Therefore, this study is to utilize relative deprivation theory to explain how socio-economic shortages （such as high unemployment and education, along with poverty） and political inefficiencies of the Yemen＇s authoritarian regime led to public and collective discontent and upheaval. The intervened variables such as ＂ethnicity, race, religion, and sexuality＂ and international parameters have not been considered,

Is a correlation‑based investment strategy beneficial for long‑term international portfolio investors?

Using negative to low-correlated assets to manage short-term portfolio risk is not uncommon among investors,although the long-term benefits of this strategy remain unclear.This study examines the long-term benefits of the correlation strategy for portfolios based on the stock market in Asia,Central and Eastern Europe,the Middle East and North Africa,and Latin America from 2000 to 2016.Our strategy is as follows.We develop five portfolios based on the average unconditional correlation between domestic and foreign assets from 2000 to 2016.This yields five regional portfolios based on low to high correlations.In the presence of selected economic and financial conditions,long-term diversification gains for each regional portfolio are evaluated using a panel cointegration-based testing method.Consistent across all portfolios and regions,our key cointegration results suggest that selecting a low-correlated portfolio to maximize diversification gains does not necessarily result in long-term diversification gains.Our empirical method,which also permits the estimation of cointegrating regressions,provides the opportunity to evaluate the impact of oil prices,U.S.stock market fluctuations,and investor sentiments on regional portfolios,as well as to hedge against these fluctuations.Finally,we extend our data to cover the years 2017–2022 and find that our main findings are robust.

Youth Role in the Arab Spring

Middle East and North Africa （MENA） has been experiencing a unique demographic transition in the world especially after September 11, whilst, its social, political and economic structures have considerably remained inflexible and can hardly meet the increasing demands of employment among the youth whose expectations are raised through expansion in education. In spite of various common causes for the Arab uprisings, the paper spotlights the ＂Youth role＂ and its regarded issues of ＂Youth Bulge＂, ＂Education＂ and ＂Unemployment＂ with a glimpse to the overturned regimes of ＂Tunisia, Egypt, Libya, and Yemen＂. According to published statistics these countries are among the countries with the highest rate of youth as working age population in MENA. Therefore, the paper is to present the importance and impact of youth as a social parameter in challenging political structure of the countries in the MENA and leading to topple their political systems. Thus, the paper reasons the MENA political upheavals, in general, and the mentioned countries＇ uprisings, in particular, can not be well understood disregarding to natural tensions between economic, population structures, and political demographic challenges. This is to be done drawing on data from different international institutions. The intervened variables such as ＂ethnicity, race, religion and sexuality＂ and international parameters have not been considered.

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 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.

Change in the Middle East: A Case of Egypt

The change in Egypt is a result of three factors:the autocratic rule of the Mubarak regime being challenged by globalization;the imbalance between economic growth and social development which created severe unemployment and poverty problems,worsened by imported inflation resulting from the global financial crisis;and,the pro-US and pro-Israel foreign policy pursued by the Mubarak regime which caused resentment among the Egyptian people and stimulated protests.To realize the socioeconomic development,establish a comprehensive development model,and create a stable and sustainable political structure will be formidable tasks for Egyptians in the post-Mubarak era.Thus,change will be a long-run process.Egypt would implement a more independent and neutral foreign policy,and will form with some other countries like Turkey a third group,i.e.a group in the middle.A new strategic structure in the Middle East would emerge through the change,with pro-US group,anti-US group,and a group in the middle as three main groups,based on competition between the Iranian model and the Turkish model,and US hegemonic power in the region would be weakened correspondingly.

从埃及看中东变局

埃及局势变化的原因,包括政治、经济社会和外交三个方面。穆巴拉克时期的专制统治受到全球化的挑战;经济增长与社会发展脱节导致的严重失业和贫困问题,因为全球金融危机引发的输入型通货膨胀而加剧;长期的亲美、亲以外交引发民众不满和街头抗议。埃及要实现经济社会发展、探索综合发展模式、建立稳定持久的政治体制,这意味着变局将持续相当长的一段时期。埃及在外交上将采取更为独立自主和中立的立场,与土耳其等国组成中立阵营。亲美、反美、中立三个阵营并立,伊朗模式和土耳其模式相互竞争,美国的霸权地位受到削弱,中东变局将催生新的战略格局。

中国对北非阿拉伯国家直接投资动因分析及策略选择

本文以北非阿拉伯国家为例,首先描述了中国对其投资概况,进而运用国际经济学的基本原理对其投资动因进行了分析,最后提出我国对其直接投资应采取的类型及产业选择。本文认为,国内产业结构调整、国家的能源、资源战略多元化及规避贸易摩擦和贸易壁垒是中国对非洲直接投资的中国因素。而稳步的经济发展、相对良好的商业环境及较强的国家竞争力使得北非阿拉伯国家成为中国对非直接投资主要流入地区的根本原因。我国应对北非进行资源导向型投资、出口导向和市场导向型投资和产业导向型投资。投资产业应主要集中于能源、农业、机械制造业及通信产业。

中国与中东北非国家可持续能源合作关系探析

世界最大的石油进口国中国和最大的石油出口地区中东北非,两者间的能源合作主要集中在原油贸易、石化、能源基础设施建设等传统领域,且存在贸易结构不平衡,投资领域单一等问题,存在脆弱性、敏感性和不可持续性。中国与中东北非国家的能源合作在清洁能源和可再生能源领域还存在很大空间,尤其是在天然气、可再生能源和氢能领域。需要探索中国与中东北非国家能源关系的合作潜力和合作路径——包括完善石油全产业链合作、构建全球天然气供应链、扩大可再生能源合作,从而构建更加稳定且可持续的能源合作关系。

南苏丹独立的背景与前景

世界最年轻的国家南苏丹共和国诞生了。苏丹问题集种族、民族、宗教、文化、经济、政治和地缘于一体,集中微缩了非洲问题的复杂性。黑奴贩卖的历史记忆,殖民主义的人为隔离,近40年内战结下的恩恩怨怨,使分离成为无奈的选择。南苏丹百废待兴,但新国家面临老问题,遗留问题未能解决,核心问题是石油资源分配,潜在的隐患威胁南苏丹和平发展的立国之路。

中东北非变局对我国海外油气资源战略实施的几点启示

中东北非变局引起世界的巨大关注,其丰富的石油资源是重要因素之一。动荡对我国在该地区的石油工程投资项目造成的损失较大,对石油供应产生的影响有限。由于该地区是我国最重要的海外石油供应渠道,长期看动荡会对我国的石油供应和能源安全产生牵制和威胁。变局反映出我国进口严重依赖该地区、缺乏应对变局的经验,开展国际合作评价需要兼顾资源和投资环境;对全球油气资源状况掌握不够,缺乏有效的基础地质理论指导和有力的基础资料支撑,削弱了我国石油公司国际竞争能力等问题。鉴于我国在油气资源勘探开发国际合作中出现的问题,本文提出了积极参与油气资源国际竞争与合作,不断拓展境外资源利用空间和能力;加强全球矿产资源包括油气资源战略研究,开展基础性地质研究工作;提高技术,资金,整体运作的水平,增强国际竞争力;建立国内石油储备,应对突发事件的对策和建议。

再论2010年中东剧变的历史背景、特征和影响

中东剧变的历史背景包括以下方面(1)本地区的现代化进展迟缓,社会经济方面的发展成效不明显;(2)政治民主化进展迟缓;(3)伊斯兰主义组织的发展;(4)促进舆论开放和政治经济演变的国内外的压力增长。从宏观层面看,剧变的基本特征可以大致归纳为明显的广泛性、自发性、草根性、时代性、非宗教性、不确定性和综合性,尤其是初期。整体来看,中东剧变产生了如下重要影响。第一,对中东自第一次世界大战以来形成的现有国家体系产生了重大威胁。第二,内部政治力量对比的变化,对一些中东国家的政治体制和中央集权产生了程度不同的影响。第三,宗教极端势力的崛起,产生了严重的地缘政治影响。第四,中东国家的经济呈现波动状态,饱受内战折磨的国家则经历了明显的衰退。第五,中东社会受到冲击。第六,中东的地缘格局发生重大变化。第七,中东剧变造成大量的人员伤亡和严重的人道主义危机。