Search Results (295)

The shift towards the integration of and transition to renewable energy has led to an increase in renewable energy communities (RECs) and smart grids (SGs). The significance of these RECs is mainly energy self-sufficiency, energy independence, and energy autonomy. Despite this, in low- and middle-income countries and regions like Pakistan and the Middle East, SGs and RECs are still in their initial stage. However, they have potential for green energy solutions rooted in their unique geographic and climatic conditions. SGs offer energy monitoring, communication infrastructure, and automation features to help these communities build flexible and efficient energy systems. This work provides an overview of Pakistani and Middle Eastern energy policies, goals, and initiatives while aligning with European comparisons. This work also highlights technical, regulatory, and economic challenges in those regions. The main objectives of the research are to ensure that residential service sizes are optimized to maximize the economic and environmental benefits of green energy. Furthermore, in line with SDG 7, affordable and clean energy, the focus in this study is on the development and transformation of energy systems for sustainability and creating synergies with other SDGs. The paper presents insights on the European Directive, including the amended Renewable Energy Directive (RED II and III), to recommend policy enhancements and regulatory changes that could strengthen the growth of RECs in Asian countries, Pakistan, and the Middle East, paving the way for a more inclusive and sustainable energy future. Additionally, it addresses the main causes that hinder the expansion of RECs and SGs, and offers strategic recommendations to support their development in order to reduce dependency on national electric grids. To perform this, a perspective study of Pakistan’s indicative generation capacity by 2031, along with comparisons of energy capacity in the EU, the Middle East, and Asia, is presented. Pakistan’s solar, wind, and hydro potential is also explored in detail. This study is a baseline and informative resource for policy makers, researchers, industry stakeholders, and energy communities’ promoters, who are committed to the task of promoting sustainable renewable energy solutions. Full article

Background: West Nile Virus (WNV) is a mosquito-borne flavivirus responsible for seasonal outbreaks in temperate and tropical regions, including Europe, the Mediterranean, and the Middle East. Its transmission via mosquitoes, particularly Culex species, poses persistent challenges to public health. Despite ongoing efforts, comprehensive prevention and treatment strategies remain limited. Methods: A comprehensive search of peer-reviewed literature, clinical trials, and government surveillance data from Italy and Iran was conducted using PubMed, Scopus, Web of Science, and supplementary web-based resources. Inclusion criteria focused on molecular studies of WNV, vaccine and antiviral drug development, and regional outbreak reports. Results: WNV transmission is influenced by climatic conditions, as well as vector distribution and ecological patterns. While human vaccines are currently under development, only veterinary vaccines yielded promising but still limited evidence of effectiveness. Notably, therapeutic measures are currently limited to supportive care, whereas investigational antiviral drugs are in early-stage trials. Interestingly, Italy demonstrates robust surveillance with regular reporting of outbreaks, whereas data from Iran indicate that despite a widespread serological footprint, especially in southern and southwestern provinces, the reported clinical impact on humans and animals appears comparatively less severe. Conclusions: Bridging gaps in vaccine availability, therapeutic innovation, and disease monitoring is essential for effective WNV management to prepare for potential severe future outbreaks in Europe and the Middle East. On the other hand, regional differences between Italy and Iran reveal the need not only for tailored public health interventions and enhanced surveillance, but also for sustained investment in research. In our view, collaborative frameworks across Mediterranean and Middle Eastern countries in a “One Health” approach may improve preparedness and response to future WNV outbreaks. Full article

Background/Objectives: Research about the effects of schizophrenia, along with caregiver burden, exists extensively in Western countries. However, research on Middle Eastern societies, especially Saudi Arabia, is limited. We assessed the burden experienced by caregivers of individuals with schizophrenia and identified the associated factors contributing to it. Methods: The current cross-sectional study was conducted in Jeddah, Western Saudi Arabia, from December 2024 to March 2025. We used a validated Arabic data collection tool comprising 22 items that assessed five domains of caregiver burden. The associations between background characteristics and individual domains were determined by the Mann–Whitney U test and the Kruskal–Wallis test. We applied binomial regression analysis to find the factors associated with caregiver burden. Results: Of the 330 participants studied, no burden was observed in 17.9%. The remaining had mild (25.8%), moderate (34.8%), and severe (21.5%) burdens. Among the domains, emotional strain showed the highest mean (11.52 ± 4.32), followed closely by time and social limitations (11.29 ± 5.07) and health and financial impacts (11.08 ± 5.08). The caregiver burden was significantly higher among the adult children caring for their parents (p = 0.034) and lower among the participants working in the government sector (p = 0.022). Conclusions: The findings suggest a policy-relevant support program that includes workplace flexibility and financial help to manage their overall caregiving load and improve their health. Future research should explore the effectiveness of support strategies tailored to caregivers in different sociocultural contexts to enhance both caregiver and patient outcomes. Full article

Multiple sclerosis (MS) affects approximately 2.9 million people in the world, exerting a significant economic and societal burden. The disease is increasingly identified among populations considered as uncommonly affected. MS is reported in all regions of the World Health Organization (WHO) member states in Africa, the Americas, South-East Asia, Europe, the Eastern Mediterranean and the Western Pacific, affecting all ethnicities while exhibiting substantially variable prevalences. Countries with high MS prevalence and some with moderate frequencies generally have economically better structured healthcare systems. Nevertheless, health disparities in these countries are accentuated by suboptimal accessibility of care for their minorities, immigrants and other underserved populations. Social Determinants of Health (SDOH) might have an impact on morbidity and higher rates of disability. Large segments of the world population (i.e., African, Latin American, people from the Middle East and Southeast Asia) do not have access to adequate MS diagnostic procedures, compounded by reduced availability of neurologists. Healthcare disparities exist practically in every country of the world. Active wars and a large number of refugees resulting from conflict augments the challenges to healthcare systems. These global factors constitute obstacles to the adequate management of MS. A collective international path is required to facilitate access to highly effective, albeit onerous treatments, some already approved and being utilized, i.e., monoclonal antibodies and B-lymphocyte depletory agents, and others foreseen in the future as advanced therapeutic molecules continue to develop. Full article

Background: Hypertension is a leading modifiable risk factor for cardiovascular diseases globally, disproportionately affecting low- and middle-income countries (LMICs), including South Africa. Primordial prevention targeting normotensive individuals plays a key role in reducing lifetime risk. Aim: To assess knowledge, attitudes and practices (KAP) and social determinants of health related to primordial hypertension prevention among normotensive adults in OR Tambo District, Eastern Cape province. Methods: A community-based cross-sectional study was conducted among 245 randomly selected normotensive adults. A validated questionnaire captured socio-demographic characteristics and KAP levels. Data analysis included descriptive statistics, Cronbach’s alpha, and chi-square tests (p < 0.05). Results: Participants demonstrated moderate knowledge (53.9%), highly positive attitudes (86.1%), and fair preventive practices (59.6%), highlighting a clear knowledge–practice gap. Higher knowledge was significantly associated with female gender (p < 0.001), older age (p < 0.001), and family history of hypertension (p = 0.001). Positive attitudes correlated with older age (p = 0.018) and higher education (p = 0.008). Knowledge level significantly predicted both positive attitudes (p < 0.001) and preventive practices (p = 0.009). Conclusions: Despite moderate knowledge and positive attitudes, a clear knowledge–practice gap was evident, possibly influenced by social and structural constraints. Strengthening primordial hypertension prevention in rural South Africa requires integrated strategies combining context-specific health education with interventions addressing structural barriers to enable sustainable behaviour change. Full article

Groundwater is one of the main sources of water supply in tropical developing countries; however, its integrated management is often constrained by limited hydrogeological information and increasing anthropogenic pressures on aquifer systems. This study presents the numerical modeling of groundwater flow in the Neogene–Quaternary aquifer system of the Middle Magdalena Valley (Colombia), focusing on the rural area of Puerto Wilches, which is characterized by strong surface–groundwater interactions, particularly with the Yarirí wetland and the Magdalena River. A three-dimensional model was implemented and calibrated in FEFLOW v.8.1 under steady-state and transient conditions, integrating both primary and secondary data. The dataset included piezometric levels measured with water level meters and automatic loggers, hydrometeorological records, 21 physicochemical and microbiological parameters analyzed in 45 samples collected during three field campaigns under contrasting hydrological conditions, 79 pumping tests, detailed lithological columns from drilled wells, and complementary geological and geophysical models. The results indicate a predominant east–west groundwater flow from the Eastern Cordillera toward the Magdalena River, with seasonal recharge and discharge patterns controlled by the bimodal rainfall regime. Microbiological contamination (total coliforms in 69% of groundwater samples) and nitrate concentrations above 10 mg/L in 21% of wells were detected, mainly due to agricultural fertilizers and domestic wastewater infiltration. Particle tracking revealed predominantly horizontal flow paths, with transit times of up to 800 years in intermediate units of the Real Group and around 60 years in shallow Quaternary deposits, highlighting the differential vulnerability of the system to contamination. These findings provide scientific foundations for strengthening integrated groundwater management in tropical regions under agroindustrial and hydrocarbon pressures and emphasize the need to consolidate monitoring networks, promote sustainable agricultural practices, and establish preventive measures to protect groundwater quality. Full article

Improved maternal experiences and outcomes have been widely linked to the presence of birth companions. However, cultural norms, institutional constraints, and privacy concerns frequently restrict women’s choice of birth companions in many Middle Eastern countries, including Jordan. This study investigated Jordanian women’s beliefs and barriers about the presence of companions in the labour room. A qualitative descriptive study design was conducted using Braun and Clarke’s framework for thematic analysis. Thirteen women (ages 21 to 38 years) with prior pregnancy and childbirth experience were chosen from a free health awareness event in Irbid, Northern Jordan in July 2025, to participate in semi-structured interviews. The responses were recorded on audio tapes and subsequently stored in their original format. Data were coded, transcribed, and then thematically analyzed to identify beliefs and perceived barriers. The most significant beliefs were: (i) emotional and psychological support, wherein companionship was thought to alleviate fear and provide reassurance; (ii) strengthening family ties, as women saw shared childbirth experiences as improving family bonds; and (iii) cultural and religious interpretations, wherein female relatives were frequently seen as more acceptable than husbands. Women reported two barriers to allowing companions in the labour room: (i) privacy and modesty issues, where they feared embarrassment, exposure, and judgment, and (ii) institutional and policy restrictions, such as restrictive hospital regulations. Although Jordanian women recognized the emotional and interpersonal benefits of having company during childbirth, they encountered numerous substantial institutional, cultural, and privacy-related barriers. Improving women’s birth experiences and promoting respectful maternity care may be achieved by addressing these issues through culturally sensitive education, privacy-enhancing infrastructure, and regulatory reform. Full article

Tuberculosis (TB) remains a public health threat in low- and middle-income countries (LMICs) of the World Health Organization (WHO) Eastern Mediterranean Region (EMR), driven by a combination of social determinants including undernutrition, fragile health systems, conflict-related disruptions, human mobility and displacement, sub-optimal programmatic implementation, and insufficient domestic investment. These programmatic and governance constraints operate within a broader geopolitical context marked by conflict, sanctions, protracted crises, and large-scale displacement, which further limit countries’ ability to deliver uninterrupted TB services. In 2023, the region’s TB incidence was estimated at 116 per 100,000 population, with Pakistan alone accounting for about 73% of the regional burden. Despite a multitude of efforts, progress in reducing the TB burden in the EMR remains slow, with high case detection and treatment coverage gaps, low uptake of TB preventive treatment (TPT), underutilization of WHO-recommended rapid diagnostics, and only 25% of drug-resistant TB (DR-TB) cases initiated on treatment. Vulnerable populations, including internally displaced persons, migrants, refugees, prisoners, and returnees, continue to face major access barriers, and cross-border TB collaboration remains limited. This commentary reasons that the slow pace of TB burden reduction in the region is not only a biomedical or resource issue but also a reflection of structural and governance shortcomings. It proposes a ten-point strategic vision focused on building a sustainable ecosystem, enhancing primary healthcare systems, adopting people-centered and rights-based approaches, leveraging artificial intelligence, and gradually reducing dependency on external donors where feasible. However, in highly fragile settings such as Yemen or Somalia, domestic financing remains limited, and sustained external support will continue to be indispensable. The commentary calls for stronger national leadership, inclusive stakeholder engagement, and increased domestic financing to deliver integrated and resilient TB services. Ending TB in the EMR is within reach, but it requires boldly committed, coordinated, and country-led action. Full article

Background and Objectives: Adolescent pregnancy remains a major global public-health concern, particularly in low- and middle-income countries. Romania consistently reports the highest teenage birth rate in the European Union, with pronounced regional disparities. This study aimed to assess the incidence, sociodemographic predictors, and obstetric outcomes of adolescent pregnancies over a ten-year period in southeastern Romania. Materials and Methods: A retrospective, population-based study was conducted at the Clinical County Hospital “Saint Andrew the Apostle”, Constanța, from 1 January 2014 to 31 December 2023. All deliveries involving mothers aged ≤19 years were identified from institutional databases. Demographic variables (age, residence, education) and obstetric outcomes (mode of delivery, gestational age, neonatal parameters) were analyzed. Statistical tests included Pearson’s χ², t-tests or Mann–Whitney U tests, and multivariate logistic regression to identify independent predictors of cesarean delivery and preterm birth. Results: Among 13,416 hospital deliveries, 1640 (12.2%) involved adolescent mothers (mean age 16.3 ± 1.4 years). Most originated from rural areas (64.6%) and had only primary education (42.8%). Cesarean section was performed in 58.3% of cases—significantly higher among rural (61.2%) and low-education (62.4%) groups (p < 0.05). The leading indications were cervical dystocia (19.2%) and cephalopelvic disproportion (16.9%). Preterm birth occurred in 30.5% and low birth weight in 27.1% of neonates. Multivariate analysis identified primiparity (OR 2.10; 95% CI 1.45–3.05; p < 0.001) and low education (OR 1.56; 95% CI 1.09–2.21; p = 0.015) as independent predictors of cesarean delivery, while rural residence and low education predicted prematurity (OR 1.84; 95% CI 1.12–3.02; p = 0.016). Conclusions: Adolescent pregnancy in southeastern Romania remains a persistent public-health challenge concentrated among rural and low-education populations. These patterns are consistent with previously described vulnerabilities in adolescent populations, including developmental and healthcare-access challenges, although such factors were not directly measured in this study. Community-based prevention, comprehensive sexual education, and adolescent-friendly obstetric pathways are urgently needed to reduce the burden of teenage pregnancy in Eastern Europe. These associations should be interpreted with caution, as the retrospective design precludes causal inference. Full article

Urban parks improve the overall quality of life (QoL) by reducing CO₂ emissions, depression, anxiety, and fatigue. Urban green spaces shape our lives by influencing our mental and physical well-being. High-income dwellers of low-density urban areas enjoy a wide range of health benefits because they have better access to sustainable logistics urban parks (SLUPs), while the economically disadvantaged sometimes have fewer chances to access parks in their high-density suburbs in Middle Eastern Countries (MECs). The disparity in accessibility to urban parks raises questions about the inclusivity of civic facilities. Therefore, this study seeks to answer the following question: What challenges do MECs face in the successful implementation of SLUPs? This study aimed to analyze and understand the challenges of establishing SLUPs in MECs. To achieve this aim, this study adopted a mixed-method approach, whereby in-depth interviews and questionnaire surveys were utilized to collect and validate the data. The study outcome shows that the gap in stakeholder collaboration and high land prices are the major challenges, whereas sociability issues, lack of awareness, and interest are the minor challenges in establishing SLUPs in MECs. Full article

In the era of climate crisis, the search for places that offer natural climatic comfort has become a crucial element in understanding the interaction between the environment and the overall quality of human life. Although indoor artificial climate control can provide comfort, it has significant environmental impacts and fosters a more artificial human experience. This study explores how climatic comfort varies worldwide, with a particular focus on outdoor environments where natural atmospheric factors directly influence human perception of comfort. We conducted a global survey, integrated with spatial climate databases, to model outdoor climatic comfort based on temperature, humidity, and natural lighting. The most comfortable locations were identified in tropical/equatorial regions at relatively high elevations. We discuss the results of the current global population distribution, along with past, present, and future demographic scenarios, thereby revealing a critical situation for countries in the Sahel and Middle Eastern deserts. Full article

The Middle East Respiratory Syndrome coronavirus (MERS-CoV) remains a highly significant threat to global public health. Dromedary camels are the zoonotic source of human infection. All cases of zoonotic Middle East Respiratory Syndrome (MERS) have occurred in Middle Eastern countries despite MERS-CoV infection of camels being widespread in Africa. This disparity in the geographic burden of the disease may be due to genomic differences between MERS-CoV circulating in Middle Eastern countries (clades A and B) versus those infecting camels in Africa (clade C), although the precise genetic determinants of virulence remain to be elucidated. The objective of the studies reported here was to evaluate differences in the magnitude of virus shedding and in transmissibility of clades A/B and C viruses using alpacas as a surrogate for dromedary camels. We found that two of three African-origin, clade C strains of MERS-CoV induced very reduced levels of virus shedding and were transmitted inefficiently to contact control animals as compared to one other clade C virus and representative viruses from clade A and B. Lower virus titers in the nasopharynx may be associated with lower zoonotic transmission and human disease severity and may explain the observed epidemiology of MERS-CoV in Africa where zoonotic disease appears rare. These results add to our understanding of the transmission of different lineages of MERS CoV in camelids and zoonotic transmission. Full article

This paper examines the impact of country risk on banking sector stability, employing the CAMELS framework, within 13 Middle Eastern and North African (MENA) countries for 1984–2024. The analysis exploits the impact of political, economic, and financial risk dimensions on 102 publicly listed banks using two-way random effects models and one-step dynamic panel data estimations. The findings reflected a significant inverted U-shaped nexus between country risk and the stability of the banking sector, addressing how high-country risk deteriorates banking resilience, whereas low country risk improves it. Political risk has the strongest impact with a similar nonlinear relationship. Conversely, economic and financial risks consistently have reverse linear effects. These findings signify the structural vulnerability of MENA banks to political, economic, and financial turmoil and address the urgent need for robust frames of risk management and fiscal discipline. This investigation extends sovereign risk theory, which explains the ability to maintain financial stability by integrating three core dimensions—political, economic, and financial risk—into a comprehensive empirical model that directly relates them to MENA banking stability and provides crucial insights for banking institutions, policymakers, and regulators in a highly volatile atmosphere. Full article

The COVID-19 pandemic has had a diverse impact worldwide, affecting all strata of society. This article examines the relationship between health system adaptation and socioeconomic inequality in countries and the WHO Eastern Mediterranean Region (WHO-EMR), and we suggest that the dynamics among government response, health system preparedness, and epidemic spread are calibrated by the present socioeconomic inequality. With the use of a panel dataset spanning February 2020 to March 2021 and both linear (PARDL) and nonlinear (PNARDL) estimation techniques, we find that more socioeconomically vulnerable regions were disproportionately hit by the efforts of the pandemic, even in the presence of containment measures. From our findings, we find that health system capacity measures, such as hospital bed density and primary healthcare expenditure, are positively related to long-term economic resilience, while antimicrobial drug resistance is strongly negatively related to it. The study emphasizes the need for selective policy interventions to protect the most disadvantaged groups, a finding of relevance for other high-inequality low- and middle-income countries. Full article

Background/Objectives: Although antimicrobial resistance (AMR) is recognized as a critical global health threat across human, animal, and environmental domains, evidence from AMR economic evaluations remains limited. This study systematically reviewed available studies, emphasizing existing evidence and reported limitations in AMR-related economic evaluations. Methods: A comprehensive review of peer-reviewed empirical studies was conducted, including publications up to July 2023 without temporal restrictions, but limited to English-language articles. Literature searches were undertaken in PubMed and Cochrane using a search strategy centered on the terms “economic evaluations” and “antimicrobial resistance.” Screening and data extraction were performed by two reviewers independently, with disagreements resolved through consensus or consultation with a third reviewer. Findings were synthesized narratively. Results: Of the 3682 records screened, 93 studies were included. Evidence gaps were identified across income and geographic regions, particularly in low- and middle-income countries (LMICs) and the African, Southeast Asian, and Eastern Mediterranean regions. Studies were comparatively more numerous in high-income countries (HICs) and the European and Americas regions. Substantial gaps also existed in one health approach and community-based evaluations. Nine major study limitations were identified, with many interlinked. The most frequent issues included limited generalizability primarily due to inadequate sampling approaches (n = 16), and single-center studies (n = 11), alongside errors in cost estimation (n = 4), and lack of consideration for essential features or information (n = 3). Conclusions: The review highlights persistent evidence gaps and recurring methodological shortcomings in AMR economic evaluations. Addressing these limitations, particularly in LMICs, will strengthen the evidence base and better inform policy implementation to combat AMR effectively. Full article