Impacts of the COVID-19 pandemic on subjective wellbeing in the Middle East and North Africa: A gender analysis.

The pathways through which the COVID-19 pandemic has impacted population mental health are potentially gendered. Little research has explored these pathways in low- and middle-income country contexts, such as in the Middle East and North Africa (MENA) region, where socioeconomic roles are highly gendered. To address this gap, we examine the relationships between pandemic-related socioeconomic changes and subjective wellbeing in the MENA region. Our core hypothesis is that the COVID-19 pandemic affected men and women's subjective wellbeing differently in part because these effects were mediated by gendered socioeconomic roles. We exploit multiple waves of longitudinal, nationally-representative phone survey data across Egypt, Jordan, Morocco, Sudan, and Tunisia. The data were collected between November 2020 and August 2021 and include 32,296 observations of 20,256 unique individuals. Mental health is measured through the WHO-5 subjective wellbeing scale. Our key independent variables capture pandemic-related employment loss, income loss, experience of limitations on food access, enrollment of children in alternative schooling modalities, and receipt of formal and informal transfers. We find significantly worse subjective wellbeing for women in Egypt and Morocco during the pandemic, but not the three other countries. There were negative associations between employment and income loss during the pandemic and subjective wellbeing, but not gender-differentiated ones. In contrast, high levels of limitations on food access were associated with worse mental health for men than women. Receipt of transfers generally did not have any association with subjective wellbeing. Further research is needed into how social assistance programs implemented in response to pandemics may be designed so as to address the negative mental health consequences of such events.

COVID-19 vaccine acceptance and COVID-19-induced income disruption among migrant workers in Saudi Arabia.

Background: Neither COVID-19 vaccine acceptance nor income changes among migrant workers during the pandemic has been assessed in Saudi Arabia. Aims: To assess the correlates of willingness to take the COVID-19 vaccine and a decrease in income during the pandemic among migrant workers in Saudi Arabia. Methods: An electronic questionnaire was administered to 2403 migrant workers from the Middle East and South Asia employed in agriculture, auto repair, construction, food service (restaurants), municipality, and poultry farms in Al-Qassim Province, Saudi Arabia. The interviews were conducted in the native languages of the workers in 2021. Chi-square was used to assess the associations, and a multiple logistic regression was used to generate the odds ratio. Data analysis was conducted using SPSS version 27. Results: South Asian workers were 2.30 [95% confidence interval (CI): 1.60-3.32] times more likely to accept the COVID-19 vaccine than those from the Middle East (reference group). Restaurant, agriculture and poultry workers were respectively 2.36 (95% CI: 1.41-3.95), 2.13 (95% CI: 1.29-3.51) and 14.56 (95% CI: 5.64-37.59) times more likely to accept the vaccine than construction workers (reference group). Older (≥ 56 years, reference group ≤ 25 years) workers were 2.23 (95% CI: 0.99-5.03) times, auto repair 6.75 (95% CI: 4.33-10.53) times, and restaurant workers 4.04 (95% CI: 2.61-6.25) times more likely to experience a reduction in income than construction workers. Conclusions: Workers from South Asia were more likely to accept the COVID-19 vaccine and less likely to experience an income reduction than those from the Middle East.

Efficiency, market concentration and bank performance during the COVID-19 outbreak: Evidence from the MENA region.

This study aims to contribute to the existing literature that explores the impact of market concentration on bank efficiency in emerging economies. Using a sample of 225 banks in 18 countries in the Middle East and North Africa (MENA) region over the period 2006-2020, we empirically investigate the significance of this relationship. Since the evidence of concentration effect on efficiency during the COVID-19 outbreak is ambiguous, we test the hypothesis that the efficiency is positively affected by the level of banking market concentration in the MENA region. We adopt fixed effect model specifications and test the robustness of our results with the two-step Generalized Method of Moments (GMM) estimation technique. Our analysis finds a strong positive association between market concentration and bank efficiency. The analysis of different types of banking systems that co-existing in the MENA region (Islamic and conventional) indicates the market concentration effect is more pronounced when the banking institution is Islamic and during the COVID-19 outbreak. Moreover, the better economic performance of Islamic banks during the initial stage of pandemic further increases their efficiency. Our analysis indicated that the impact of market competitive conditions on bank efficiency varies significantly across banks with different ownership structures and is more pronounced for government-owned banks. The results are robust using different model specifications and alternative estimation techniques.

MERS-CoV seroconversion amongst Malaysian Hajj pilgrims returning from the Middle East, 2016-2018: results from the MERCURIAL multiyear prospective cohort study.

Prospective cohort study to investigate the potential exposure to the Middle East Respiratory Syndrome-Coronavirus (MERS-CoV) following Hajj pilgrims is still very limited. Here, we report the antibody seroconversion study results obtained from successive three years cohort studies (2016-2018) involving the Malaysian Hajj pilgrims returning from the Middle East. A cohort study of Hajj pilgrims from Malaysia enrolled 2,863 participants from 2016-2018, all of whom consented to provide paired blood samples for both pre- and post-Hajj travel to the Middle East. ELISAs and micro-neutralization assays were performed to detect the presence of MERS-CoV IgG antibodies. Sociodemographic data, symptoms experienced during Hajj, and history of exposure to camels or camel products were recorded using structured pre- and post-Hajj questionnaires. A 4-fold increase in anti-MERS-CoV IgG between paired pre-Hajj and post-Hajj serum samples in twelve participants was observed. None of the twelve ELISA-positive sera had detectable levels of virus-neutralizing antibodies. All reportedly had mild symptoms of respiratory symptoms at a certain point during the pilgrimage, implying mild or asymptomatic infections. No association between post-Hajj serum positivity and a history of exposure to camels or camel products was obtained. Findings from the study suggest that serologic conversion to MERS-CoV occurred in at least 0.6% of the Hajj pilgrims returning from the Middle East. Since all the seroconvertants had mild to no symptoms during the sampling period, it highlights the likelihood of occurrence of only low infectivity spillover infections among the Hajj pilgrims.

COVID-19 related risk factors and their association with non-syndromic orofacial clefts in five Arab countries: a case-control study.

BACKGROUND: The environmental etiology of non-syndromic orofacial clefts (NSOFCs) is still under research. The aim of this case-control study is to assess COVID-19 associated factors that may be related to the risk of NSOFC in five Arab countries. These factors include COVID-19 infection, COVID-19 symptoms, family member or friends infected with COVID-19, stress, smoking, socioeconomic status and fear of COVID-19. METHODS: The study took place in governmental hospitals in five Arab countries from November 2020 to November 2021. Controls are matched in the month of delivery and site of recruitment. A clinical examination was carried out using LASHAL classification. Maternal exposure to medication, illnesses, supplementation, COVID-19 infection during their pregestation and 1st trimester periods were evaluated using a validated questionnaire. Maternal exposure to stress was assessed using the Life Events scale, fear of covid-19 scale, family member or friend affected with covid-19 infection, pregnancy planning and threatened abortion. RESULTS: The study recruited 1135 infants (386 NSOFC and 749 controls). Living in urban areas, maternal exposure to medications 3-months pregestation, maternal exposure to any of the prenatal life events and maternal fear of COVID-19 significantly increased the risk of having a child with NSOFC. On the other hand, mothers exposed to supplementation 3-months pregestation, mothers suspected of having COVID-19 infection, family members or friends testing positive with COVID-19 significantly decreased the risk of having a child with NSOFC. CONCLUSIONS: This study suggests that NSOFC may be associated with maternal exposure to lifetime stress and COVID-19 fear in particular, with no direct effect of the COVID-19 infection itself. This highlights the importance of providing psychological support for expecting mothers during stressful events that affect populations such as the COVID-19 pandemic, in addition to the usual antenatal care.

THE PREVALENCE OF COVID-19 IN THE COUNTRIES OF THE GULF COOPERATION COUNCIL: AN EXAMINATION AFTER THREE YEARS.

The coronavirus disease (COVID-19) pandemic in the Gulf Cooperation Council (GCC) countries is part of the global pandemic. So, the current study used COVID-19 statistics to examine the COVID-19 prevalence in the GCC countries by the end of 2020, 2021, and 2022 and compare the findings to non-GCC Arab countries and also compare 2022's results globally. COVID-19 data per country, including the vaccination coverage rate, were obtained from well-known publicly online websites (such as Worldometer and Our World in Data). An Independent sample t-test was used to compare the means between the GCC and non-GCC Arab countries. By the end of 2022, most COVID-19 deaths in the GCC countries were recorded in Saudi Arabia but given the number of cases and deaths per million, Bahrain was the most affected. Saudi Arabia was the least testing country per population, while the United Arab of Emirates performed tests nearly 20 times more than its population. Qatar had the lowest case-fatality rate (0.14%). Statistically, the GCC countries had higher median age, higher mean cases per million, higher mean tests per population, and higher mean vaccination coverage (84.56%) than non-GCC Arab countries. Globally, the GCC countries recorded fewer deaths per million, performed more tests relative to the population, and had higher vaccination coverage. Globally, the GCC countries have been less affected by the COVID-19 pandemic. However, statistics vary across the GCC countries. The average vaccination coverage in the Gulf countries was higher than in the global one. Given the natural immunity and the excellent vaccine coverage in the GCC countries, it is essential to reconsider the definition of a suspected case and establish more specific criteria for testing.

Cross-sectional, hospital-based analysis of headache types using ICHD-3 criteria in the Middle East, Asia, and Africa: the Head-MENAA study.

BACKGROUND: Headaches are frequent neurological disorders that are yet to be unveiled and treated comprehensively worldwide. Bearing in mind that the distribution of headache subtypes in neurology clinics (NC) is essential for planning appropriate diagnostic and therapeutic approaches, the primary goals of this multi-centric study are to carry out inter-regional comparisons by using current diagnostic criteria with evaluations of neurologists to delineate headache burden. METHODS: A cross-sectional study between April 1 and May 16, 2022 was conducted with the participation of 13 countries from the Middle East, Asia, and Africa. Patients were included in the study on a specific day each week during five consecutive weeks. All volunteers over the age of 18 and whose primary cause for admission was headache were examined. The patients admitted to NC or referred from emergency services/other services were evaluated by neurologists by means of the International Classification of Headache Disorders (ICHD-3) criteria. RESULTS: Among the 13,794 patients encountered in NC, headache was the primary complaint in 30.04%. The headache patients' mean age was 42.85 ± 14.89 (18-95 years), and 74.3% were female. According to the ICHD-3 criteria, 86.7% of the main group had primary headache disorders, 33.5% had secondary headaches, 4% had painful cranial neuropathies along with other facial and headaches, and 5.2% had headaches included in the appendix part showing some overlapping conditions. While the most common primary headache was migraine without aura (36.8%), the most common secondary headache was medication-overuse headache (MOH) (9.8%). Headaches attributed to COVID-19, its secondary complications, or vaccines continue to occur at rates of 1.2%-3.5% in current neurology practice. Pain severity was significantly lower in Ivory Coast and Sudan than in Türkiye, Turkish Republic of Northern Cyprus, Iran, Egypt, Senegal, Tatarstan, and Azerbaijan (p < 0.001). CONCLUSIONS: The study showed that migraine is still the most common motive for admissions to NC in different regions. Furthermore, MOH, an avoidable disorder, is the most common secondary headache type and appears to be a significant problem in all regions. Remarkably, pain perception differs between regions, and pain intensity is lower in Africa than in other regions.

Middle East respiratory syndrome coronavirus-a 10-year (2012-2022) global analysis of human and camel infections, genomic sequences, lineages, and geographical origins.

OBJECTIVES: The World Health Organization priority zoonotic pathogen Middle East respiratory syndrome (MERS) coronavirus (CoV) has a high case fatality rate in humans and circulates in camels worldwide. METHODS: We performed a global analysis of human and camel MERS-CoV infections, epidemiology, genomic sequences, clades, lineages, and geographical origins for the period January 1, 2012 to August 3, 2022. MERS-CoV Surface gene sequences (4061 bp) were extracted from GenBank, and a phylogenetic maximum likelihood tree was constructed. RESULTS: As of August 2022, 2591 human MERS cases from 26 countries were reported to the World Health Organization (Saudi Arabia, 2184 cases, including 813 deaths [case fatality rate: 37.2%]) Although declining in numbers, MERS cases continue to be reported from the Middle East. A total of 728 MERS-CoV genomes were identified (the largest numbers were from Saudi Arabia [222: human = 146, camels = 76] and the United Arab Emirates [176: human = 21, camels = 155]). A total of 501 'S'-gene sequences were used for phylogenetic tree construction (camels [n = 264], humans [n = 226], bats [n = 8], other [n=3]). Three MERS-CoV clades were identified: clade B, which is the largest, followed by clade A and clade C. Of the 462 clade B lineages, lineage 5 was predominant (n = 177). CONCLUSION: MERS-CoV remains a threat to global health security. MERS-CoV variants continue circulating in humans and camels. The recombination rates indicate co-infections with different MERS-CoV lineages. Proactive surveillance of MERS-CoV infections and variants of concern in camels and humans worldwide, and development of a MERS vaccine, are essential for epidemic preparedness.

The effect of COVID-19 infection on the menstrual cycle: a cross-sectional investigation in the MENA region.

Due to the paucity of literature on COVID-19 and menstrual irregularities, this study aims to investigate the effect of COVID-19 infection on menstrual changes in premenopausal women within the Middle East and North Africa (MENA) region. A cross-sectional investigation utilizing a self-administered online questionnaire was conducted between July and August of 2021. A total of 499 females participated in our survey with a mean age of 35.2 ± 8.4 years. The majority of participants had regular periods (74.1%) and were disease free (81.6%). Mild, moderate, and severe symptoms were documented in 58.9%, 26.7%, and 3.0% of the studied cohort, respectively. Females experienced significantly more menstrual abnormalities after COVID-19 infection than during the pandemic prior to infection (p < 0.001). Those females were significantly older (p = 0.031), had more severe symptoms (p = 0.029), and were more likely to have experienced irregularities during the epidemic (p < 0.001). COVID-19 infection seems to induce menstrual abnormalities in premenopausal females. These abnormalities could manifest as increased frequency or severity and are associated with older women.

Assessment of preparedness for response to COVID-19 by two hospitals in the Gaza Strip.

Background: Hospital preparedness enables the healthcare delivery system to save lives during emergencies that surpass the day-to-day capacity of existing response systems. The COVID-19 pandemic negatively affected all aspects of life worldwide, and in the Gaza Strip particularly. Aims: We assessed the preparedness of 2 hospitals in the Gaza Strip for response to COVID-19. Methods: An observational, analytical, cross-sectional study was conducted among 160 nurses and physicians between July 2020 and October 2021 at the European Gaza Hospital and the Turkish-Palestinian Friendship Hospital, 2 hospitals dedicated to the reception and care of COVID-19 patients in the Gaza Strip. Data were collected using a structured, self-administered questionnaire and a checklist. The data were analysed using SPSS, version 23. Frequencies and descriptive data were used to assess the variables. Inferential statistics such as ANOVA and t-test were used to determine the significance and differences between the variables. Cronbach's alpha was 0.903. Results: The majority of the participants were nurses (77.5%) and they showed a high level of knowledge and training regarding the response to COVID-19 pandemic (73.4 %). Their perception of the preparedness of their hospitals in terms of work environment and availability of resources was average (63.6%). Around 70% perceived COVID-19 to have had a negative effect on their personal lives and work. Conclusion: The preparedness level at the 2 hospitals was unsatisfactory (55.75%). Further research is recommended to assess the level of hospital preparedness from the viewpoint of other healthcare workers.

SARS-CoV-2 chronological genomic evolution and epidemiology in the Middle East and North Africa (MENA) region as affected by vaccination, conflict and socioeconomical disparities: a population-based cohort study.

OBJECTIVE: To describe the chronological genomic evolution of SARS-CoV-2 and its impact on public health in the Middle East and North Africa (MENA) region. METHODS: This study analysed all available SARS-CoV-2 genomic sequences, metadata and rates of COVID-19 infection from the MENA region retrieved from the Global Initiative on Sharing All Influenza Data database from January 2020 to August 2021. Inferential and descriptive statistics were conducted to describe the epidemiology of SARS-CoV-2. RESULTS: Genomic surveillance of SARS-CoV-2 in the MENA region indicated that the variants in January 2020 predominately belonged to the G, GR, GH or O clades and that the most common variant of concern was Alpha. By August 2021, however, the GK clade dominated (57.4% of all sequenced genomes), followed by the G clade (18.7%) and the GR clade (11.6%). In August, the most commonly sequenced variants of concern were Delta in the Middle East region (91%); Alpha (44.3%) followed by Delta (29.7%) and Beta (25.3%) in the North Africa region; and Alpha (88.9%), followed by Delta (10%) in the fragile and conflict-affected regions of MENA. The mean proportion of the variants of concern among the total sequenced samples differed significantly by country (F=1.93, P=0.0112) but not by major MENA region (F=0.14, P=0.27) or by vaccination coverage (F=1.84, P=0.176). CONCLUSION: This analysis of the genomic surveillance of SARS-CoV-2 provides an essential description the virus evolution and its impact on public health safety in the MENA region. As of August 2021, the Delta variant showed a genomic advantage in the MENA region. The MENA region includes several fragile and conflict-affected countries with extremely low levels of vaccination coverage and little genomic surveillance, which may soon exacerbate the existing health crisis within those countries and globally.

The current challenges affecting the quality of care of HIV/AIDS in the Middle East: Perspectives from local experts and future directions.

OBJECTIVE: This report aimed to reflect the experts' views regarding the challenges affecting the quality of care for people living with HIV in the Middle East. Besides, we integrated experts' opinions and recommendations to offer future directions to improve the quality of care and the overall landscape of HIV in the Middle East. METHODS: This review article is based on a comprehensive literature search and the outcomes of several regional meetings that discussed the challenges faced by patients living with HIV in the Middle East. RESULTS: The experts called for actions by various stakeholders to improve the quality of HIV care and implement culturally acceptable programs to face the ongoing stigma and discrimination. Various strategies should also be implemented to improve the HIV awareness among the general population and medical staff, prompt early diagnosis and initiation of ART,and optimize patients' adherence to treatment. Besides, reliable databases, both on national and regional scales, should be implemented to provide reliable data regarding the HIV status in the region. CONCLUSION: All efforts should be directed towards achieving the UNAIDS the "90-90-90" targets, with an acceptable quality of life and minimal complications.

Rheumatology research output in the Arab World: despite the challenges.

Rheumatology is a field in which diagnostic, pathophysiological, and therapeutic advancements occur daily. These developments are the result of research in basic sciences, translational sciences, and clinical sciences. Physical and financial support, provided by individuals and institutions, is essential for all types of research. The political and economic instability in the Arab world has impacted the advancement of healthcare and the output of research. This review seeks to evaluate the quantity and quality of rheumatology-related research conducted in the Arab world. This review examined the number of rheumatological clinical publications produced by Arab countries between 2017 and 2021 and cited by PubMed/MEDLINE. Publications with authors from multiple nations were disqualified. Publications were then categorized by type, including randomized controlled trials (RCTs), cohort studies, cross-sectional studies, systematic reviews, narrative reviews, and case reports. Publications were also organized according to the regions of the Arab world: North and East Africa, the Middle East, and the Arabian Peninsula. The review also used data from the world bank to evaluate the gross domestic product (GDP) and total population of Arabian nations in order to calculate a ratio of publications to GDP and publications to population. Egypt had the highest number of publications among north and east African countries and Arab countries in general, with 261 publications, including the highest number of RCTs, which were 23. With 81 publications, Saudi Arabia had the highest number of publications on the Arabian peninsula. However, no individual country on the Arabian peninsula published an RCT. Lebanon had the most publications in the Middle East, but the majority were reviews and case reports. Tunisia had the highest ratio of publications to GDP. Notably, the number of publications increased during the coronavirus disease 2019 era in some countries. The Arab world is still able to produce clinical rheumatology publications despite its political instability and lack of resources. The influence of such publications on the daily practice of rheumatology is still debatable.

How COVID-19 highlighted the need for infection prevention and control measures to become central to the global conversation: experience from the conflict settings of the Middle East.

Within just a few months, the coronavirus disease 2019 (COVID-19) pandemic managed to bring to the foreground the conversation that infection prevention and control (IPC) experts have been pushing for decades regarding the control of the spread of infections. Implementing the basics of IPC has been a challenge for all affected countries battling with an exponential COVID-19 curve of infection. Preventing nosocomial transmission of the disease has been difficult in highly resourced and stable contexts, but even more so in the conflict context of the Middle East. COVID-19 has added further challenges to the long list of existing ones, hindering the implementation of the optimal IPC measures that are necessary to break the chain of infection of both respiratory and non-respiratory infections in those settings. This paper outlines and gives examples of the challenges faced across the Middle East conflict setting and serves as a call for action for IPC to be prioritized, given the resources needed, and fed with contextualized evidence.

Parental health beliefs, intention, and strategies about covid-19 vaccine for their children: A cross-sectional analysis from five Arab countries in the Middle East.

BACKGROUND: The issue around vaccination of children has brought divergent opinions among the populations across the globe and among the Arab population. There has been a low response rate to the calls for vaccination of children and this is reflective of the sentiments which parents may have towards their children being vaccinated. This study aims to explore the parents' health beliefs, intentions, and strategies towards the COVID-19 vaccine for their children among Arab population. METHODS: A cross-sectional study using an online survey from October to December 2021, was carried out in five Arab countries in the Middle East. A reliable health belief model (HBM) including five domains: severity, susceptibility, benefits, barriers and cues to action, was adopted. Chi-square, Mann-Whitney test, and multivariable logistic regression were performed for data analysis. RESULTS: The survey response rate was 58 % (1154/2000). Only 56 % of Arab parents are intended to vaccinate their children against COVID-19. The mean scores of parental health belief are largely driven by their concern over the vaccine's side effect (p = 0.001) followed by its efficacy, safety (p < 0.001), and scheduling difficulty (p = 0.029). However, strategies that were statistically encouraged parents to vaccinate their children included doctor's recommendation, adequate information being provided, and acceptance of the vaccine by public (p < 0.001). Parents with one child were almost three times most likely to vaccinate their children (OR = 2.660, 95 %CI = 1.572-4.504, p < 0.001). Parents' desire to vaccinate their children is also influenced by other factors such as job loss owing to COVID-19 and the presence of a health worker in the family. CONCLUSION: Intention of Arab parents to vaccinate their children via COVID-19 vaccine is still limited. Thus, it is essential for health care authorities to avail the information which will debunk the erroneous beliefs which some parents have developed towards the vaccination of children against COVID-19.

Assessment of drugs administered in the Middle East as part of the COVID-19 management protocols.

The pandemic spread of coronavirus (COVID-19) has been reported first at the end of 2019. It continues disturbing various human aspects with multiple pandemic waves showing more fatal novel variants. Now Egypt faces the sixth wave of the pandemic with controlled governmental measures. COVID-19 is an infectious respiratory disease-causing mild to moderate illness that can be progressed into life-threatening complications based on patients- and variant type-related factors. The symptoms vary from dry cough, fever to difficulty in breathing that required urgent hospitalization. Most countries have authorized their national protocols for managing manifested symptoms and thus lowering the rate of patients' hospitalization and boosting the healthcare systems. These protocols are still in use even with the development and approval of several vaccines. These protocols were instructed to aid home isolation, bed rest, dietary supplements, and additionally the administration of antipyretic, steroids, and antiviral drugs. The current review aimed to highlight the administered protocols in the Middle East, namely in Egypt and the Kingdom of Saudi Arabia demonstrating how these protocols have shown potential effectiveness in treating patients and saving many soles.

Regional connectivity drove bidirectional transmission of SARS-CoV-2 in the Middle East during travel restrictions.

Regional connectivity and land travel have been identified as important drivers of SARS-CoV-2 transmission. However, the generalizability of this finding is understudied outside of well-sampled, highly connected regions. In this study, we investigated the relative contributions of regional and intercontinental connectivity to the source-sink dynamics of SARS-CoV-2 for Jordan and the Middle East. By integrating genomic, epidemiological and travel data we show that the source of introductions into Jordan was dynamic across 2020, shifting from intercontinental seeding in the early pandemic to more regional seeding for the travel restrictions period. We show that land travel, particularly freight transport, drove introduction risk during the travel restrictions period. High regional connectivity and land travel also drove Jordan's export risk. Our findings emphasize regional connectedness and land travel as drivers of transmission in the Middle East.

Status of the HIV epidemic in key populations in the Middle East and north Africa: knowns and unknowns.

The Middle East and north Africa is one of only two world regions where HIV incidence is on the rise, with most infections occurring among key populations: people who inject drugs, men who have sex with men, and female sex workers. In this Review, we show a trend of increasing HIV prevalence among the three key populations in the Middle East and north Africa. Although the epidemic continues at a low level in some countries or localities within a country, there is evidence for concentrated epidemics, with sustained transmission at considerable HIV prevalence among people who inject drugs and men who have sex with men in over half of countries in the region with data, and among female sex workers in several countries. Most epidemics emerged around 2003 or thereafter. The status of the epidemic among key populations remains unknown in several countries due to persistent data gaps. The HIV response in Middle East and north Africa remains far below global targets for prevention, testing, and treatment. It is hindered by underfunding, poor surveillance, and stigma, all of which are compounded by widespread conflict and humanitarian crises, and most recently, the advent of COVID-19. Investment is needed to put the region on track towards the target of eliminating HIV/AIDS as a global health threat by 2030. Reaching this target will not be possible without tailoring the response to the needs of key populations, while addressing, to the extent possible, the complex structural and operational barriers to success.

Evaluation of the Health Situation among Recovered Cases of COVID-19 in West Bank, Palestine, and Their Onset/Recovery Time.

Background and Aims: COVID-19 emerged at the end of 2019 and was classified as a global pandemic in March 2020. Infected cases of SARS-CoV-2 experience symptoms during initial infection 2-14 days after virus exposure, and some symptoms and complications may persist after recovery. This study evaluated the onset/recovery time, postrecovery symptoms, complications, and factors affecting the health situation of recovered cases of COVID-19 in West Bank, Palestine. Methods: This cross-sectional study was conducted using a questionnaire based on related scientific articles and expert recommendations. It was distributed to recovered COVID-19 patients either face-to-face or online. Chi-square and Fisher's exact tests were used to investigate the significant relationships. The data were analyzed using SPSS version 22. Findings. A total of 686 participants completed the questionnaire; the mean age was 28·1 ± 11·8. SARS-CoV-2 infection recovery time was 1-2 weeks in most participants. A total of 72·4% developed post-COVID-19 symptoms. Fatigue (260, 38.0%), loss of smell (224, 32.7%), headache (207, 30.7%), and joint pain (188, 27.4%) were the most reported postrecovery symptoms. In women, fatigue and headaches were the most common symptoms that persisted after recovery. Diabetic patients endured continuous muscle and joint pain. Interpretation. Patient health situation, recovery time, and symptoms post-COVID-19 infections are affected by many demographic factors and disease status.