Health and ecological sustainability in the Arab world: a matter of survival

Saudi Arabia’s Maternal and Child Health Scenario Interpreted

BACKGROUND

Countries in the Arabian Gulf, especially Saudi Arabia, deserve special attention due to the scarcity of information researched and discussed on Maternal and Child Health (MCH). This report focuses on trends in women of reproductive age, children ever born, live births, child mortality, contraception, age at marriage, and fertility rates.

METHOD

Data from various censuses conducted from 1992 to 2010 and demographic surveys conducted from 2000 to 2017 were used in this analysis.

RESULTS AND DISCUSSION

Over time period, the female population increased in Saudi Arabia. However, the proportion of children, ever-married women, children ever-born, and live births decreased as did child mortality. These changes in maternal and child health dimensions are owing to reforms in the health sector, including health infrastructure, in accordance with the achievements of the Sustainable Development Goals (SDGs).

CONCLUSIONS

A comparatively higher quality of MCH was reported. However, demands and challenges of obstetric, gynecologic, and pediatric care are increasing, thus, strengthening and streamlining in accordance with fertility trends, marital patterns, and child health care is essential, for which primary data collection at regular intervals is a prerequisite.

Understanding the bearable link between ecology and health outcomes: the criticality of human capital development and energy use

The Middle East and North Africa (MENA) countries share a common context of critical ecological issues and trans border conflicts that threaten the quality of life and long-term stability of the region. The lack of water and arable land in particular has been a significant aspect of the region's history, but in more recent times, these pressures have grown in correlation with development patterns. Previous studies in this regard based on MENA countries data have failed to capture the holistic impact of the environmental risk factors on health outcomes. This study examines the bearable link between ecology and health outcomes, accounting for the criticality of human capital and energy use in the MENA region. The study employs second generation econometrics methods - system GMM, panel quantile regression via moments, and Dumitrescu-Hurlin causality test on panel data covering 2008-2017. The empirical results establish a trade-off between the ecological factors and health outcomes. Specifically, ecological footprint as a measure of environmental quality is positively related to health outcomes, while biocapacity is negatively and insignificantly associated with health outcomes. Both effects of the two environmental factors are undesirable. Furthermore, the results show that human capital has the desired positive and significant effect on health outcomes, while the effect of energy use is negative. Based on the findings, the study provides several policy options that would help to deescalate the pressure on the natural resources.

Analysis of the Implementation Effect of College Curriculum Ideological and Political under the Background of Ecological Sustainable Development

Our country is paying more and more attention to ecological issues. How to put ecological sustainable development in real life is a key problem. This article discusses the significance of integrating ecological sustainable development and college ideological political courses. Therefore, an experiment was designed to analyse the model of ecology and other courses. The final experiment showed the following: (1) The ecological sustainable development model can be well integrated into the students in their courses. Students can freely choose to study some quality assurance thought courses and reinforce their spiritual level. The mentality of this model can also self-optimize to solve students' troubles in choosing courses and consider the level of students intimately. (2) According to the experimental data of the figures and tables, it is concluded that the form "other professional courses" at my country is still very serious, and the popularization of ideological and political courses is not common, so it is a little troublesome to carry out work, but our system model is very characteristic. With its help, we have obtained the effect of the integration of ecological sustainable development and students' curriculum. The state has vigorously provided economic support for their development. Under their influence, students have gradually maintained their awareness of protecting the environment. Socioeconomic and environmental conditions are also improving. However, in the future, the times will change, and we will continue to update the system model to adapt to more challenges.

An ecological perspective for understanding regional integration based on ecosystem service budgets, bundles, and flows: A case study of the Jinan metropolitan area in China

Regional integration can contribute to co-occurring benefits of different parts of an urban agglomeration by managing these parts as a whole. However, current regional integration mainly focuses on the socioeconomic rather than the ecological dimension. To interpret regional ecological integration, we firstly selected six typical ecosystem services (ESs) to represent ecological benefits that potentially need to be improved by ecological integration for further analysis. Then we used ES budgets, bundles, and flows to investigate the potential, basic analysis unit, and occurring manners of ecological integration, respectively. Our results show that supply-demand mismatches were observed in all the ES types. Meanwhile, coexisting ES surpluses and deficits on the town scale were found in supporting biodiversity, soil retention, water yield, green space recreation, and crop yield, which indicates that their supply-demand mismatches can be mitigated with ecological integration. Furthermore, all the towns were classified into five spatial clusters with distinct ES budget bundles, which acted as the basic analysis unit of ecological integration. ES flows with three flow characteristic types were observed between different clusters, and all the clusters had ES provider-beneficiary relationships with each other. Based on the ES approach, we provided an ecological perspective for understanding regional integration, which has the potential to promote regional ecological sustainability.

Contextual influences on chronic illness: A multi-level analysis in the twin cities of Ramallah and Al Bireh in the occupied Palestinian Territory

The features of the urban environment can support human health as well as harm it, but less is known about such influences in the context of middle eastern countries. The association between green space and the political classifications of the urban environment and the risk of chronic illness was investigated in a novel setting, the twin cities of Ramallah and Albireh in the occupied Palestinian territory. We used a generalised multi-level regression analysis to link the 2017 census data with Geographic Information System data. We modelled individuals at level one (n = 54693) and areas of residence at level two (n = 228), adjusting for individual demographic and socio-economic characteristics.

The proportions of ‘mixed’ trees in residential areas had a significant inverse association with the risk of chronic illness. On the political dimension, only living in a refugee camp had a significant positive association with chronic illness; however, this was largely explained and rendered non-significant when green space variables were entered into the models. Our ability to differentiate between several types of green space was important, as findings demonstrated that not all types were associated with reduced risk of chronic illness. Our results from a middle eastern setting add to the largely Western existing evidence, that trees in urban settings are important and beneficial to human health. Researchers and policymakers should pay more attention to the health consequences of refugee camps but also the role of trees in benefiting individuals' health in such a disadvantaged context.

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The study explored the urban political and environmental impacts on health in the Palestinian context.

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Living in a refugee camp is positively associated with the risk of chronic illness, over and above individual characteristics.

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Residential areas mixed trees are inversely associated with chronic illness, and explained the association with refugee camps.

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Not all types of green space are associated with a reduced risk of chronic illness.

Mapping environmental impact assessment research landscapes in the Arab world using visualization and bibliometric techniques

Interests and concerns on environmental issues have attracted much attention over the past few decades. This is in harmony with the growing understanding of environmental impacts associated with human activities and their role in degrading ecosystems. In line with these concerns, considerable advances in science and technology to assess, mitigate, or lessen these adverse impacts have emerged (i.e., environmental impact assessment (EIA) methodologies). The involvement of EIA in sustainable development has become a prevalent topic in research in either developed and developing countries. The present work investigated the research status, development trends, and hotspots of EIA in a region with massive environmental challenges; the Arab world. Bibliometric analysis and visualization mapping were utilized with an objective of revealing and evaluating the developments in knowledge on EIA from the Arab world. A sum of 595 documents was the productivity of the Arab world on EIA (2.1% of total global productivity). Most of the studies were performed by scholars in Egypt (143 documents; 24.0%), followed by Saudi Arabia (96 documents; 16.1%), and Tunisia (68 documents; 11.4%). France, the USA, and the UK were, respectively, the most collaborated countries with the Arab world on EIA. Most of the publications on EIA were in prestigious journals in relation to environmental sciences. King Abdulaziz University, Saudi Arabia and University of Kuwait were the most productive institutions (24 documents/institution). Topics in relation to assessing different environmental impacts on the quality and quantity of water will continue to be vital themes of research. While, the utilization of remote sensing, geographic information systems, risk assessment, life cycle assessment, bioaccumulation, and biomarkers techniques in assessing environmental impacts will continue to be dominant as efficient tools in conducting EIA related research. The outcomes displayed, in general, a rapidly and steadily rising interests on EIA. However, the development of regional experience, increasing of funds and advancing of competencies will further promote research activities on EIA.

Mapping of climate change research in the Arab world: a bibliometric analysis

The attendant threats of climate change in the Arab world are accelerating at a high pace. The realization of these risks has promoted scientific research activities in climate change (i.e., modeling of climate change effects and development of mitigation and adaptation measures). A bibliometric analysis was desired to trace the status and trends of these research activities with an origin from the Arab world. The aim was to contribute to a better understanding of the scientific knowledge of climate change and its impacts and survey its evolution. Moreover, it is aimed at enabling recommendations for future research activities in this field. The data of this analysis were retrieved from the Scopus database using the most common terms of climate change to search titles, abstracts, and keywords. The collected data, in the form of documents referring to climate change, enabled to extract and further assess different quantitative and qualitative bibliometric indicators. Productivity of countries, sources, and institutions; collaboration figures; impact of published research; and citation rates were being among the assessed indicators. Subsequently, the data were analyzed using visualization maps and clustering techniques to characterize the hot spots and vital topics of research. A total of 2074 documents (1.2% of the total global research output) were retrieved from the Arab world. Saudi Arabia took the leading positions in terms of the number of publications (473 documents; 22.8%), impact of research (Hirsch index (h-index), 48), collected citations (10,573 citations), and number of documents from collaboration (389 documents). The USA was the most collaborated country with the Arab world (344 documents; 17.0%), followed by France (311 documents; 15.0%). The most productive journal was Plos One (42 documents; 2.0%), followed by the Arabian Journal of Geosciences (38 documents; 1.8%). Three institutions from Saudi Arabia were in the forefront in terms of research productivity (King Abdulaziz University, 124 documents; King Saud University, 117 documents; and King Abdullah University of Science and Technology, 102 documents). The vital climate change-related topics which will continue to be active in the future are climate modeling, physiology, genetics, and animals. The present data indicate a committed scientific research progress. Increasing the fund, capacity building, and development of regional experience with climate change-related disasters are key factors to promote the scientific research in this field.

Maternal mortality and health in the Arab World: A 25-year epidemiological study

AIM

In this work, we aim to assess the maternal health in terms of maternal mortality ratios and lifetime risk of maternal death in of women in the Arab World.

METHODS

Data on maternal mortality rates (MMR) and lifetime risk of maternal death (LTR) were extracted from the official databases of the United Nations Children's Fund. Annual Percentage Change was calculated using Joinpoint regression model. Statistical significance among countries was determined using one-way analysis of variance (anova) on spss version 25.0 (IBM SPSS, 2017).

RESULTS

The MMR and LTR significantly decreased in almost all Arab countries. Somalia was found to be the country with the highest burden of MMR, while Gulf countries had the lowest burden.

CONCLUSION

Our study shows a decrease in the MMR and LTR of maternal death in the Arab world. Although there is a decrease in these rates, but continuous research and efforts must be undergone to better develop the health care system in a great number of Arab countries to decrease the burden of maternal deaths.

The Sustainability of Post-Conflict Development: The Case of Algeria

The Algerian civil war, 1992–2002, affected all aspects of life in the country. Major development efforts were therefore initiated in the post-conflict era. Almost 20 years later, the economy remains fragile, and the country’s large hydrocarbon revenues have not been used to develop the infrastructure for sustainability, support energy transition or reduce structural vulnerabilities. This paper provides an overview of Algerian development strategies before and after the conflict, examining in particular the orientation of major development projects involving foreign financing. Two rural development programmes are described to illustrate the outcomes of such projects. The results show that the conflict stopped or hindered many ongoing and planned development projects in the country, especially in the agriculture sector, while new investments in industry started after the conflict. The review of individual development projects further revealed that many projects between 1980–2017 had doubtful benefits with respect to long-term development goals. Initiatives tended to be discontinued once the funding period closed, and the involvement of the private sector was low. It is therefore concluded that additional attention needs to be devoted to long-term and structural impacts of development projects, including considerations regarding sustainability, demographics, and climate-related future changes.

A Comparison of Neighborhood-Scale Interventions to Alleviate Urban Heat in Doha, Qatar

Recent evidence suggests that many densely populated areas of the world will be uninhabitable in the coming century due to the depletion of resources, climate change, and increasing urbanization. This poses serious questions regarding the actions that require immediate attention, and opportunities to stave off massive losses of infrastructure, populations, and financial investments. The present study utilizes microclimate modeling to examine the role of landscape features as they affect ambient temperatures in one of the fastest growing regions of the world: Doha, Qatar. By modeling three study sites around Doha—one highly urbanized, one newly urbanizing, and one coastal low-density urbanized—the research indicates that at the neighborhood scale, the most effective scenario was that of adding mature trees along the sides of roads. In the coastal study area, the model results estimated a maximum hourly air temperature reduction of 1.35 °C, and in the highly urbanized inland site, surface temperature reductions were up to 15 °C at 12:00. While other scenarios were effective at reducing air and surface temperatures, the mean radiant temperature was also increased or nearly neutral for most of the other scenarios. This result highlights the need to develop improved shading measures for pedestrian pathways and outdoor recreational areas, especially for highly urbanized inland areas in Doha and cities with similar climatic conditions.

Factors Influencing Arab Nursing Students' Attitudes toward Climate Change and Environmental Sustainability and their Inclusion in Nursing Curricula

OBJECTIVE

To assess the factors influencing the attitudes of Bachelor of Science in Nursing students toward climate change and environmental sustainability and the inclusion of these concepts in the nursing curricula of four Arab countries.

METHOD

A convenience sample of 1,059 students from four Arab countries was surveyed using the Environmental Sustainability Attitudes in Nursing Survey-2 (SANS-2) questionnaire in this descriptive-comparative study.

RESULTS

The majority of the respondents exhibited positive attitudes toward the five items of SANS-2, with "Environmental sustainability is an important issue for nursing" receiving the lowest mean score and "Issues about climate change should be included in the nursing curriculum" receiving the highest mean score. Saudi students had more positive attitudes toward environmental sustainability in health care compared with students from Iraq, Egypt, and the Palestinian Territories. Country of residence, type of community, and knowledge about environmental issues and their impact on health in any nursing course were significant factors that influenced attitudes toward environmental sustainability.

CONCLUSION

The inclusion of climate change and environmental sustainability in nursing curricula in the Arab region was emphasized by the findings. Including environmental sustainability practices in nursing education will help student nurses develop critical thinking and skills in the adaptive delivery of health care, especially when resources are scarce.

Mapping genetic research in non-communicable disease publications in selected Arab countries: first step towards a guided research agenda

Background

In the Arab world, intervention and policy response to non-communicable diseases (NCD) has been weak despite extensive epidemiological evidence highlighting the alarmingly increased prevalence of chronic diseases. Generating genetic information is one key component to promote efficient disease management strategies. This study undertook a scoping review to generate the profile of the undertaken research on genetics of NCD publications in selected Arab countries. An analysis of the research produced examined the extent, range, nature, topic and methods of published research. The study aimed at identifying the gaps in genetic NCD research to inform policy action for NCD prevention and control.

Methods

The scoping review was conducted based on the five-stage methodological framework and included countries in Arab region selected to represent various economies and epidemiological transitions.

Results

The search identified 555 articles that focus on genetics-NCD research in the selected Arab countries over the duration of this study (January 2000 to December 2013). The most commonly conducted research was descriptive and clinically focused, rather than etiologically focused. Country-specific carrier and risk screening studies were not among the top research designs. The genetic component of certain highly heritable diseases, as well as diabetes, obesity, hypertension, chronic lung dysfunction and metabolic syndrome were all under investigated.

Conclusions

This scoping review identified gaps for further research in the context of bioinformatics and genome-wide association studies. Genetic research in the Arab region has to be redirected towards NCDs with the highest morbidity, heritability and health burden within each country. A focused research plan to include community genetics is required for its proper integration in the Arab community.

Schools of public health in low and middle-income countries: an imperative investment for improving the health of populations?

BACKGROUND

Public health has multicultural origins. By the close of the nineteenth century, Schools of Public Health (SPHs) began to emerge in western countries in response to major contemporary public health challenges. The Flexner Report (1910) emphasized the centrality of preventive medicine, sanitation, and public health measures in health professional education. The Alma Ata Declaration on Primary Health Care (PHC) in 1978 was a critical milestone, especially for low and middle-income countries (LMICs), conceptualizing a close working relationship between PHC and public health measures. The Commission on Social Determinants of Health (2005-2008) strengthened the case for SPHs in LMICs as key stakeholders in efforts to reduce global health inequities. This scoping review groups text into public health challenges faced by LMICs and the role of SPHs in addressing these challenges.

MAIN TEXT

The challenges faced by LMICs include rapid urbanization, environmental degradation, unfair terms of global trade, limited capacity for equitable growth, mass displacements associated with conflicts and natural disasters, and universal health coverage. Poor governance and externally imposed donor policies and agendas, further strain the fragile health systems of LMICs faced with epidemiological transition. Moreover barriers to education and research imposed by limited resources, political and economic instability, and unbalanced partnerships additionally aggravate the crisis. To address these contextual challenges effectively, SPHs are offering broad based health professional education, conducting multidisciplinary population based research and fostering collaborative partnerships. SPHs are also looked upon as the key drivers to achieve sustainable development goals (SDGs).

CONCLUSION

SPHs in LMICs can contribute to overcoming several public health challenges being faced by LMICs, including achieving SDGs. Most importantly they can develop cadres of competent and well-motivated public health professionals: educators, practitioners and researchers who ask questions that address fundamental health determinants, seek solutions as agents of change within their mandates, provide specific services and serve as advocates for multilevel partnerships. Funding support, human resources, and agency are unfortunately often limited or curtailed in LMICs, and this requires constructive collaboration between LMICs and counterpart institutions from high income countries.

Food system sustainability and vulnerability: food acquisition during the military occupation of Kuwait

OBJECTIVE

To document food acquisition experiences during Iraqi military occupation in Kuwait.

DESIGN

Retrospective cross-sectional study.

SETTING

Urban areas in Kuwait during occupation.

SUBJECTS

Those living in Kuwait during the period of occupation, and aged between 15 to 50 years at the time of occupation, recruited by snowball sampling. A total of 390 completed questionnaires (response rate 78%, 202 female and 188 male) were returned.

RESULTS

During the occupation, food became increasingly difficult to acquire. Two food systems emerged: (i) an underground Kuwaiti network linked to foods recovered from local food cooperatives and (ii) a black market supplied by food imported through Iraq or stolen locally. Food shortages led to reductions in meal size and frequency. Some respondents (47·7%) reported not having sufficient income to purchase food and 22·1% had to sell capital items to purchase food. There was a significant increase (P<0·01) in home production, with 23·1% of people growing vegetables and 39·0% raising animals to supplement food needs. Reduction in food wastage also emerged as a significant self-reported behaviour change. Respondents reported deterioration in the quality and availability of fish, milk, and fruit in particular. Despite a decrease in opportunities for physical activity, most respondents reported that they lost weight during the occupation.

CONCLUSIONS

Although the Kuwaiti population fell by about 90 % and domestic food production increased during the 7-month occupation, the local population continued to rely heavily on imported food to meet population needs. The high prevalence of self-reported weight loss indicates the inadequacies of this food supply. High apparent food security in systems which significantly exceed the ecological carrying capacity of the local environment and rely on mass food importation remains vulnerable.

The state of health in the Arab world, 1990-2010: an analysis of the burden of diseases, injuries, and risk factors

BACKGROUND

The Arab world has a set of historical, geopolitical, social, cultural, and economic characteristics and has been involved in several wars that have affected the burden of disease. Moreover, financial and human resources vary widely across the region. We aimed to examine the burden of diseases and injuries in the Arab world for 1990, 2005, and 2010 using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010).

METHODS

We divided the 22 countries of the Arab League into three categories according to their gross national income: low-income countries (LICs; Comoros, Djibouti, Mauritania, Yemen, and Somalia), middle-income countries (MICs; Algeria, Egypt, Iraq, Jordan, Lebanon, Libya, Morocco, occupied Palestinian territory, Sudan, Syria, and Tunisia), and high-income countries (HICs; Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates). For the whole Arab world, each income group, and each individual country, we estimated causes of death, disability-adjusted life years (DALYs), DALY-attributable risk factors, years of life lived with disability (YLDs), years of life lost due to premature mortality (YLLs), and life expectancy by age and sex for 1990, 2005, and 2010.

FINDINGS

Ischaemic heart disease was the top cause of death in the Arab world in 2010 (contributing to 14·3% of deaths), replacing lower respiratory infections, which were the leading cause of death in 1990 (11·0%). Lower respiratory infections contributed to the highest proportion of DALYs overall (6·0%), and in female indivduals (6·1%), but ischaemic heart disease was the leading cause of DALYs in male individuals (6·0%). DALYs from non-communicable diseases--especially ischaemic heart disease, mental disorders such as depression and anxiety, musculoskeletal disorders including low back pain and neck pain, diabetes, and cirrhosis--increased since 1990. Major depressive disorder was ranked first as a cause of YLDs in 1990, 2005, and 2010, and lower respiratory infections remained the leading cause of YLLs in 2010 (9·2%). The burden from HIV/AIDS also increased substantially, specifically in LICs and MICs, and road injuries continued to rank highly as a cause of death and DALYs, especially in HICs. Deaths due to suboptimal breastfeeding declined from sixth place in 1990 to tenth place in 2010, and childhood underweight declined from fifth to 11th place.

INTERPRETATION

Since 1990, premature death and disability caused by communicable, newborn, nutritional, and maternal disorders (with the exception of HIV/AIDS) has decreased in the Arab world--although these disorders do still persist in LICs--whereas the burden of non-communicable diseases and injuries has increased. The changes in the burden of disease will challenge already stretched human and financial resources because many Arab countries are now dealing with both non-communicable and infectious diseases. A road map for health in the Arab world is urgently needed.

FUNDING

Bill & Melinda Gates Foundation.

Governance and health in the Arab world

Since late 2010, the Arab world has entered a tumultuous period of change, with populations demanding more inclusive and accountable government. The region is characterised by weak political institutions, which exclude large proportions of their populations from political representation and government services. Building on work in political science and economics, we assess the extent to which the quality of governance, or the extent of electoral democracy, relates to adult, infant, and maternal mortality, and to the perceived accessibility and improvement of health services. We compiled a dataset from the World Bank, WHO, Institute for Health Metrics and Evaluation, Arab Barometer Survey, and other sources to measure changes in demographics, health status, and governance in the Arab World from 1980 to 2010. We suggest an association between more effective government and average reductions in mortality in this period; however, there does not seem to be any relation between the extent of democracy and mortality reductions. The movements for changing governance in the region threaten access to services in the short term, forcing migration and increasing the vulnerability of some populations. In view of the patterns observed in the available data, and the published literature, we suggest that efforts to improve government effectiveness and to reduce corruption are more plausibly linked to population health improvements than are efforts to democratise. However, these patterns are based on restricted mortality data, leaving out subjective health metrics, quality of life, and disease-specific data. To better guide efforts to transform political and economic institutions, more data are needed for health-care access, health-care quality, health status, and access to services of marginalised groups.