The convergence of chronic diseases, environmental health challenges, and social determinants of health in the Middle East underscores the urgent need for integrated, culturally tailored public health strategies. The six manuscripts presented in this issue offer valuable insights into diverse healthcare challenges ranging from metabolic and hematological disorders to gynecological malignancies and medication adherence. Together, they highlight systemic gaps but also point to promising, evidence-based pathways for improvement.
The paper by Alghamdi et al. on diabetes outcomes in Saudi primary health centers reveals that only 30% of patients achieve glycemic control, with high rates of complications such as dyslipidemia and retinopathy. These data reinforce the critical importance of strengthening the role of primary healthcare providers in chronic disease monitoring and lifestyle counseling, especially in populations burdened by obesity and hypertension.

In parallel, Abdelmageed and colleagues explore the environmental dimension of healthcare through their quality improvement project on green prescribing. Their findings—that switching from metered-dose to dry powder inhalers maintained disease control in most patients—demonstrate the potential for environmentally sustainable practices to coexist with effective clinical care. This innovation, rooted in global climate responsibility, should inform national respiratory guidelines.

Addressing nutritional determinants of disease, the study on iron deficiency anemia (IDA) among children in Jeddahpaints a concerning picture of inadequate dietary practices and low parental awareness. Given that IDA impairs cognitive development and academic performance, the authors rightly call for intensified maternal education campaigns, aligned with pediatric nutritional surveillance.

The burden of gynecological cancers, as documented in Hadhramout, Yemen, further illustrates the regional disparities in screening and early diagnosis. With ovarian and cervical cancers comprising over 70% of cases and increasing incidence trends, this retrospective study urges policymakers to invest in HPV vaccination, public awareness, and infrastructure for gynecological oncology.

Meanwhile, the study on antihypertensive medication adherence in Saudi patients reveals that non-adherence stems from multifactorial causes—ranging from side effects to poor patient-pharmacist communication. Notably, it elevates the role of pharmacists as educators and support providers in blood pressure control, suggesting a shift toward team-based chronic care models.

Finally, the manuscript by Helvaci et al. challenges conventional transfusion practices in sickle cell disease, advocating for more conservative use of red blood cell transfusions. The authors provide a compelling rationale for prioritizing hydroxyurea therapy and reserving transfusions for acute crises, thereby minimizing alloimmunization risks. This aligns with global calls for more judicious use of transfusion resources.

Collectively, these six studies converge on key themes: the necessity of health system strengthening, the value of prevention, the power of patient education, and the imperative for locally driven research. Whether through technological innovation, nutritional reform, pharmaceutical stewardship, or cancer surveillance, each paper contributes to a vision of primary and public health that is not only responsive but proactive.

Warm regards,

Dr. Abdulrazak Abyad
Editor-in-Chief
Middle East Journal of Family Medicine
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