The impact of the COVID-19 pandemic on service delivery for noncommunicable diseases in the Eastern Mediterranean Region

Background: The COVID-19 pandemic has adversely affected the delivery of noncommunicable diseases (NCDs) services globally as health systems are overwhelmed by the response to the pandemic. Aims: The World Health Organization (WHO) Regional Office for the Eastern Mediterranean conducted an assessment to evaluate the impact of COVID-19 on NCD-related services, programmes, funding and consideration of NCDs in COVID-19 response. Methods: Data were collected from countries of the WHO Eastern Mediterranean Region (EMR) in mid-2020 through a web-based questionnaire on NCD services-related infrastructure, policies and plans, staffing, funding, NCD services disruptions and their causes, disruption mitigation strategies, data collection on comorbidity, surveillance, and suggestions for WHO technical guidance. The data were exported into Microsoft Excel and summarized. Countries were grouped according to socioeconomic level. Results: Nineteen of the 22 countries in the EMR responded: 95% had NCD staff reallocated to support their COVID-19 response. Lower-income countries were less likely to include NCDs in their pandemic response plans and more likely to report disruption of services. The most commonly disrupted services were hypertension management (10 countries 53%), dental care (10 countries 53%), rehabilitation (9 countries 47%), palliative care (9 countries 47%) and asthma management (9 countries 47%). Conclusion: The COVID-19 pandemic has disrupted the continuity of NCD-related services in EMR countries. The ability to mitigate service disruptions varied noticeably between countries. The mitigation measures implemented included triaging of patients, novel NCD medicines supply chains and dispensing interventions, and the use of digital health and telemedicine. Guidance and support for systems resilience, preparedness and response to crises are recommended.

Estimated and projected prevalence of tobacco smoking in males, Eastern Mediterranean Region, 2000-2025

Background:Three global reports published by the World Health Organization (WHO) report trends in the prevalence of tobacco smoking from 2000 to 2025 based on data from national surveys.Aims:The is study aimed to: (i) compare current and projected prevalence rates of tobacco smoking presented in these reports for males ≥ 15 years in countries of the Eastern Mediterranean Region; and (ii) assess changes in the prevalence rates in the context of changes in tobacco monitoring and control policies in these countries.Methods:Regional and country-level data on tobacco smoking were extracted from the trend reports. Percentage point differences between the estimated prevalence of tobacco smoking in 2010 and the projected prevalence in 2025 were calculated for countries with available data. Data on implementation of national surveys and policies on tobacco use were obtained from relevant WHO reports.Results:In the latest trend report (2019), the prevalence of male current tobacco smoking is projected to decrease by less than 2 percentage points in the Region (from 33.1% in 2010 to 31.2% in 2025). The projections for male tobacco smoking for 2025 in the 2019 report are more encouraging than in the 2015 report in seven of the eight countries of the Region. For five of these seven countries, implementation of tobacco monitoring and tobacco control policies improved over the same period.Conclusions:Countries of the Region need to conduct additional national tobacco-use surveys to improve the accuracy of prevalence estimates and projections. Such data can help guide policy-makers to implement policies to control tobacco smoking.

Smoking prevalence in the Eastern Mediterranean Region

Background: Three global reports issued by the World Health Organization (WHO) track and report on trends in the prevalence of tobacco smoking from 2000 to 2025 based on data from national surveys. Aims: This review aimed to compare regional and country-level projections for current tobacco smoking as presented in the WHO trend reports. These changes were considered in the context of improved monitoring and tobacco control policies.Methods: Regional and country-level results in the WHO trend reports were considered in terms of the projected percentage point increase of current tobacco smoking between 2000 and 2025. Data on national surveys and policy implementation came from the relevant WHO reports. Results: In the 2019 trend report, the prevalence of current tobacco smoking among males is projected to decrease by less than 2 percentage points by 2025. Eight countries featured in both the 2015 and 2019 WHO trend reports. Seven of these countries indicated a more encouraging projection (a decline in their projected increase between 2000 and 2025)for current male tobacco smoking in the 2019 report than in the 2015 report. For five out of these seven countries, their monitoring and tobacco control policy implementation improved over the same period. Conclusion: Countries in the Region should implement additional national surveys to improve the accuracy of prevalence estimates, allow further projections to be performed and motivate policy-makers to make positive policy changes. Solutions to under-reporting biases during surveys should be considered. Governments should use trend projections to guide effective tobacco control policies to reduce tobacco use in the Region

The status of tobacco control in the Eastern Mediterranean Region: progress in the implementation of the MPOWER measures

Background: The World Health Organization (WHO)MPOWER measures are a set of highly effective tobacco control measures drawn from the WHO Framework Convention on Tobacco Control (FCTC), designed to help countries reduce the prevalence of tobacco use. The WHO Report on the Global Tobacco Epidemic is published biennially to monitor global implementation of these measures. Aims: This review aimed to critically assess the status of MPOWER implementation in the Eastern Mediterranean Region. Methods: Data were collected for WHO Reports on the Global Tobacco Epidemic, focusing on the most recent 2019 edition. Regional population coverage figures were calculated using this data and population figures for the countries of the Region. Results: Between 2007 and 2018, for any MPOWER measure, there were 29 cases of countries progressing to the highest level of achievement; 23 cases of countries progressing to the intermediate levels from the lowest level; 12 cases of countries falling from the highest level; and 18 cases of countries falling to the lowest level.57.7% of people are covered at the highest level for the monitoring measure; 63.7% for the smoke-free policies measure; 6.7% for the cessation measure; 60.7% for the health warnings measure; 37.4% for the mass media measure; 29.4% for the advertising bans measure; and 16.1% for the taxation measure. Conclusions: Countries must work comprehensively to improve tobacco control. Regional priorities should include lifting more people out of lowest level coverage for the health warnings and mass media measures, increasing taxation on tobacco products and improving access to cessation services.

Smoking cessation services in the Eastern Mediterranean Region: highlights and findings from the WHO Report on the Global Tobacco Epidemic 2019

The report aimed to review and assess the status of tobacco cessation services in the Eastern Mediterranean Region (EMR). Nearly 70% of people in the Region have legal access to nicotine-replacement therapy but for 77% of these people the costs of the treatment are not covered. Bupropion and Varenicline are legally available in 10 and 11 EMR countries respectively. Just under 50% of people in the Region have access to at least some cessation support in primary health care facilities. Around 32% of people have access to a national toll-free quit line. Costs for cessation services are fully covered in few EMR countries; however, cessation services in the Region must be improved. Member States should aim to increase the availability of, and financial support for, cessation treatments and support, which should be prioritized in primary health care facilities