Original ResearchCardiovascular disease research in the Arab world: a scoping review from seven Arab countries (2000–2018)
Introduction
Cardiovascular diseases (CVDs) are the leading cause of death worldwide. In 2015, 17.7 million people died from these diseases, mainly coronary heart disease and stroke, with more than 70% occurring in low- and middle-income countries (LMICs).1 In 2015, the proportionate mortality rate for CVDs in the Eastern Mediterranean region was 34.1%.2 Most CVD deaths are premature and preventable by targeting behavioural risk factors, including physical inactivity, unhealthy diet, tobacco use and harmful use of alcohol.1 Epidemiological data have shown an increasing trend in the burden of CVD risk factors in LMICs.3
Health research is a tool to improve population health and should be based on health burden and local needs.4, 5 Although evidence is accumulating on the rising burden of non-communicable disease (NCD) in general and CVDs in particular in LMICs, CVD research is not given enough attention from research agencies or funding organisations. This might be due to the simplistic dichotomy between developed and developing nations and between non-communicable and communicable diseases and the perceived belief that NCDs are mainly diseases of the affluent populations.6 While much effort has been invested in improvement of health service delivery in NCDs, less effort has been directed to improving NCD health research. The World Health Organization notes that ‘there is no health without research’ and emphasises the importance of strategic, evidence-informed approaches to health research, particularly for LMICs.7 Investment in research should go in parallel with investment in health to be able to provide high-quality evidence for health interventions.4 In the Arab region, health research is in its infancy and remains largely underutilised, with little evidence that knowledge produced is translated into programmes and policies. Research expenditure in the Arab region does not exceed 0.3% of its average gross domestic product (GDP).8 Several United Nation reports and academic reviews note the low research funding and productivity in the Arab countries (if not the lowest)9 and point to the scarcity of evidence when it comes to implementation.10
From another global perspective, and in a series published in The Lancet reflecting on ‘research value and research waste’, Chalmers et al. highlight the high expenditure spent on health and biomedical research, which does not necessarily address the core health needs of users of research.11 They also note that funders have primary responsibility for reducing waste by demanding that proposals be justified by systematic reviews of existing evidence and by so-called ‘research-on-research'.11 Drawing out data from a large scoping review ‘Mapping of NCD Research in selected Arab Countries’ in the Arab region,12 we take a closer look at CVD research output, assess strengths and gaps in methods used and themes addressed and examine whether the knowledge produced reflects disease burden and meets population needs. Findings from this study have implications on funding allocation and CVD research agenda in the region.
Section snippets
Methods
This study is one of a series of research articles that have been published or are being planned from a 4-year (2012–2016) large scoping review project on NCD research in the Arab region. Arab counties are 22 counties sharing a common language, culture and demographic characteristics but with a wide range of variations and diversity in terms of social characteristics, ethnicities, political contexts and economic resources. These variations are reflected in a number of demographic, social and
Results
Table 1 summarises the number of publications for each country and PPMP and contrasts the findings with country-specific CVD death rate per 100,000 population and proportional mortality ratios.2, 16 Overall, CVD publication rate was 7.3 PPMP in the seven countries combined. Variations were observed between different countries in general as well as between different GDP country groups. Kuwait had the highest rate with around 61.4 PPMP, followed by Lebanon (58.8 PPMP) and Bahrain (41.2 PPMP). The
Discussion
Although study findings revealed a relatively steady increase in CVD research output in Arab counties between 2000 and 2018, this remains modest and did not exceed 7.3 PPMP over the entire 19-year study period. This is important as these are countries where chronic diseases are emerging to constitute the leading causes of morbidity and mortality. In 2010, and according to the Global Burden of Disease Study, ischaemic heart disease and stroke were among the top five leading causes of death in
Acknowledgements
The authors acknowledge the foundational work of the NCD Scoping Review Working Group (2000–2013) at the Faculty of Health Sciences, American University of Beirut (AUB): Sawsan Abdulrahim, Samer Jabbour, Farah Naja, Shadi Saleh, Abla Mehio Sibai (PI) and Soha Yazbek. The authors thank the graduate students and research assistants who contributed to data extraction, noting in particular Anthony Rizk. The authors are also grateful for the voluntary work of Master in Public Health students, Jida
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