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Delays in innovative drug registration across countries, or the \"drug approval lag\", can cause inequities in treatment access, thereby worsening patient outcomes. Registration delays hinder the first step in making treatments available, and are often linked to regulatory inefficiencies, constrained healthcare financing, and fragmented decision-making. Since late 2019, Lebanon's health system has faced overlapping socioeconomic and political crises, yet their impact on innovative medication registration remains undocumented. This study aimed to measure this impact by comparing Lebanon's drug approval lag before (2014-2019) and after (2020-2024) the crisis and to develop an interpretive framework exploring the rationale behind an informal policy to delay innovative medication registration. A mixed-methods approach was adopted. Innovative medications approved by the Food and Drug Administration (FDA) or the European Medicines Agency (EMA) between 2014 and 2024 were included and compared to local registration timelines in Lebanon. In-depth interviews with policymakers, industry leaders, and healthcare providers informed the interpretive framework. Findings revealed a dramatic fall in innovative medication registrations post-crisis over these two periods. The proportion of FDA-approved innovative medications registered in Lebanon dropped from 43.6% to 0% and EMA-approved medications dropped from 59.4% to 0%. Pre-crisis, average registration time was under two years; post-crisis, delays are estimated to exceed four years. Our interpretive framework suggests the intermediate effects of delaying innovative medication registration are mainly to control costs and reduce reimbursement pressures on the Ministry of Public Health. However, key stakeholders believe the resulting negative consequences, such as reduced access to life-saving treatments and greater dependence on parallel market importation, outweigh the short-term benefits. Health systems are complex adaptive systems, where policies affecting innovative drug approvals may not only delay access, but also trigger unintended consequences. In Lebanon, the registration of innovative medications should remain independent from reimbursement decisions and grounded in evidence-informed health policies.

Having high levels of e-health literacy has been shown to positively influence health-promoting behaviors by empowering patients with greater self-efficacy and improving their health management. Multiple Sclerosis (MS) in Lebanon presents a unique case for studying e-health literacy due to several socio-economic and healthcare-specific challenges faced by this population. This study aimed to evaluate the e-health literacy levels of MS patients in Lebanon and identify the barriers they face when accessing health-related information online. This study employed a mixed-methods approach, combining an online structured survey with qualitative in-depth interviews. The eHealth Literacy Scale (eHEALS) was incorporated to quantify participants' e-health literacy levels, selected for its well-established reliability and validity, as well as its availability in both English and Arabic. Additionally, the Lily Model was used to guide various phases of the study, providing a conceptual framework for understanding and interpreting e-health literacy. Among participants, 45 (31.5%) had limited eHEALS scores while 98 (68.5%) had sufficient eHEALS scores, indicating an overall sufficient e-health literacy among MS patients. However, qualitative findings revealed previously unidentified challenges, including limited confidence in assessing the credibility of online content, emotional distress triggered by exaggerated MS information online, and high reliance on general search engines and social media platforms. Participants expressed lack of access to trusted disease-specific information and voiced a need for professional guidance and well-established peer support. These findings call for targeted health promotion interventions to enhance this population's e-health literacy levels. It is important to equip MS patients from the point of diagnosis with the necessary skills and self-efficacy to effectively utilize online health resources and enhance their disease management journey. This calls for coordinated efforts from well-established MS patient groups, healthcare providers, academic and private institutions to support and empower this population in navigating the digital health landscape.

Background Disruptions in contraceptive access during crises can have negative effects on women’s reproductive autonomy. Since 2019, Lebanon has experienced a multifaceted political-economic crisis that has severely impacted the healthcare sector and pharmaceutical imports. The objective of this study was to explore access to, use of, and continuation of contraceptives in Lebanon across the range of the contraceptive method mix in the context of the crisis. Methods A longitudinal, mixed-methods study was conducted from May to December 2023. Married, non-pregnant Lebanese and Syrian women aged 18–49 were recruited from three Primary Healthcare Centers (PHCs) and one pharmacy in Beirut. A total of 326 women completed an initial in-person survey and 223 (68.4%) were successfully re-surveyed at four months. In-depth interviews were conducted with a purposive sample of 21 women who experienced a pregnancy or changes in contraceptive use or fertility intentions between the surveys. Quantitative results were analyzed using descriptive statistics and logistic regression models. Qualitative results were analyzed thematically. Results Overall, 67% of Syrian participants and 54% of Lebanese participants were using any contraceptive method. Five methods accounted for almost all contraceptive use: intrauterine devices (34%), withdrawal (19%), pills (14%), rhythm (14%), and condoms (12%). While most users of modern methods faced no challenges accessing their method during the crisis, increasing prices were a challenge for users of short-acting methods. Even in the context of the crisis, the most common reason for method choice was (lack of) side effects. Although PHCs facilitated access to affordable contraceptives, they offered limited method choice, particularly longer-acting methods. Conclusions The limited method mix provided in Lebanon’s PHC system is a barrier to women’s ability to exercise informed choice of method. There are few affordable contraceptive options available, such that some women are unable to switch between modern methods that might better suit their needs and preferences. To meet the diverse needs of women throughout their reproductive lives, healthcare facilities and their partners should prioritize expanding the range of contraceptive methods available while implementing key policy changes to improve the accessibility, availability, and quality of reproductive health services.

ObjectivesWhile adverse childhood experiences (ACEs) have been consistently linked to poorer cognitive outcomes in later life, far less is known about ACEs’ contribution to dementia and cognitive ageing risk in low-income and middle-income countries (LMICs), despite their growing and disproportionate share of global Alzheimer’s disease and related dementias (ADRD) burden. This study aimed to systematically review existing evidence on the association between individual ACEs and cognitive outcomes among adults aged 40 years and older in LMIC settings.DesignSystematic review and narrative synthesis.Data sourceWe searched Medline, Embase, PsycINFO and CINAHL from the inception of each database to January 2026.Eligibility criteriaObservational studies examining the association between individual ACEs and cognitive outcomes among adults aged 40 and older in LMICs.Data extraction and synthesisTwo reviewers independently screened each record, assessed risk of bias using the Joanna Briggs Institute critical appraisal tool and extracted data. Results were illustrated using descriptive forest plots and a narrative synthesis.ResultsOur systematic review included 14 studies, primarily from upper-middle-income countries, that assessed the relationship between individual ACEs and cognitive impairment (n=4) and function (n=10). 10 studies reported significant associations between ACEs and poorer cognitive function and increased risk of cognitive impairment. No study assessed the association between ACEs and ADRD. Parental death, neglect and mental health issues in the family showed consistent associations with cognitive outcomes, whereas experiencing hunger and poor health in childhood showed inconsistent associations.ConclusionsOur review corroborated evidence from high-income countries that exposure to ACEs is associated with a long-term risk of poorer cognitive outcomes among older populations in LMICs. However, the available literature remains limited, with most studies originating from upper-middle-income countries, few examining cognitive impairment and none assessing ADRD. These findings underscore substantial gaps in knowledge and highlight the need for research across diverse LMIC settings to clarify the role of broader psychosocial and contextual childhood experiences in shaping cognitive ageing and dementia risk.PROSPERO registration numberCRD42024501816.

Background Achieving equitable healthcare access for persons with disabilities is vital, as they often face various barriers that impact their health and well-being. Recognizing the importance of gender equity, this study aims to explore the specific barriers faced by women and girls with disabilities in accessing quality healthcare services in Lebanon. Methods A mixed-method sequential explanatory approach was employed. Initially, a retrospective descriptive study analyzed data from the International Committee of the Red Cross (ICRC)-supported physical rehabilitation programme (PRP) database. Subsequently, in-depth interviews were conducted to delve into factors influencing gender-disproportionate service users and to uncover barriers to accessing healthcare. Levesque et al.‘s ‘Conceptual framework on healthcare access’ was used to organize and map the results. Results The quantitative analysis of service utilization at ICRC PRP centers from 2015 to 2022 revealed significant gender disparities, with males comprising 66.6% of service users compared to 33.4% females. This trend was consistent across age categories, nationalities, and clinical conditions. Healthcare access for women and girls with disabilities was found to be inadequate across all five dimensions of the Levesque framework: adequacy, accessibility, affordability, appropriateness, and availability, as well as their corresponding abilities. While certain challenges such as transportation, financial constraints, inadequate infrastructure, and limited information on available services were common to both genders, gender-specific barriers primarily included societal norms, safety concerns during unaccompanied visits to healthcare facilities, limited access to societal information, economic disparities, preferences for female healthcare providers, and the need for privacy during consultations. Conclusion This study underscores key barriers hindering healthcare access for women and girls with disabilities in Lebanon, necessitating tailored interventions. Gender-specific challenges, including societal norms and safety concerns, require targeted solutions for improved access and outcomes. This study serves as a call to action for stakeholders at various levels to collaborate and implement concrete measures to bridge the gap in healthcare access and ensure that no one is left behind.

Background A large body of evidence suggests that adverse childhood experiences (ACEs) are associated with poorer cognitive functioning and cognitive impairment later in life. Yet, most of the evidence comes from high‐income countries, which often have greater social and healthcare resources and infrastructure to mitigate the effects of ACEs. We performed a systematic review and meta‐analysis of studies that examined the association between ACEs and cognitive function/impairment among adults in low and middle‐income countries (LMICs). We also conducted a narrative synthesis of whether and how ACE characteristics, such as frequency, severity, and age at exposure, were included in studies. Method We searched four electronic databases from conception until August 2024 for studies investigating the association between individual ACEs and cognitive function and cognitive impairment among older adults in LMICs. Two authors independently screened and performed data extraction and quality assessment for each study. We calculated the pooled estimate using a random‐effects model. We also conducted a sub‐meta‐analysis using studies reporting on the same ACE. Result Our search yielded 10883 records, of which 13 articles were included in the final meta‐analysis. The most examined ACEs include emotional neglect, parental death, and childhood illness. The pooled effect of ACE on cognitive function was β = ‐0.27 (95% CI ‐0.37, ‐0.16), and on cognitive impairment was OR = 1.12 (95% CI 0.95, 1.32). In sub‐meta‐analyses, parental death (β = ‐0.37; 95% CI ‐0.52, ‐0.22) and emotional neglect (β = ‐0.41; 95% CI ‐0.75, ‐0.08) were associated with poorer cognitive function. We found considerable heterogeneity (I2>75%) in the meta‐analysis for both outcomes. In most studies, ACEs were measured crudely without considering the frequency, severity, or age at exposure. Conclusion ACEs are associated with an increased risk of poor cognitive function and impairment in old age in LMICs, consistent with findings from high‐income countries. However, the evidence from LMICs is scanty, with most of the included studies conducted in China. Consideration of key ACE characteristics like frequency, severity and age at exposure remain largely unexamined despite their potential importance. More research in other LMICs considering contextual ACEs is needed to build the evidence base.

A large body of evidence suggests that adverse childhood experiences (ACEs) are associated with poorer cognitive functioning and cognitive impairment later in life. Yet, most of the evidence comes from high-income countries, which often have greater social and healthcare resources and infrastructure to mitigate the effects of ACEs. We performed a systematic review and meta-analysis of studies that examined the association between ACEs and cognitive function/impairment among adults in low and middle-income countries (LMICs). We also conducted a narrative synthesis of whether and how ACE characteristics, such as frequency, severity, and age at exposure, were included in studies. We searched four electronic databases from conception until August 2024 for studies investigating the association between individual ACEs and cognitive function and cognitive impairment among older adults in LMICs. Two authors independently screened and performed data extraction and quality assessment for each study. We calculated the pooled estimate using a random-effects model. We also conducted a sub-meta-analysis using studies reporting on the same ACE. Our search yielded 10883 records, of which 13 articles were included in the final meta-analysis. The most examined ACEs include emotional neglect, parental death, and childhood illness. The pooled effect of ACE on cognitive function was β = -0.27 (95% CI -0.37, -0.16), and on cognitive impairment was OR = 1.12 (95% CI 0.95, 1.32). In sub-meta-analyses, parental death (β = -0.37; 95% CI -0.52, -0.22) and emotional neglect (β = -0.41; 95% CI -0.75, -0.08) were associated with poorer cognitive function. We found considerable heterogeneity (I >75%) in the meta-analysis for both outcomes. In most studies, ACEs were measured crudely without considering the frequency, severity, or age at exposure. ACEs are associated with an increased risk of poor cognitive function and impairment in old age in LMICs, consistent with findings from high-income countries. However, the evidence from LMICs is scanty, with most of the included studies conducted in China. Consideration of key ACE characteristics like frequency, severity and age at exposure remain largely unexamined despite their potential importance. More research in other LMICs considering contextual ACEs is needed to build the evidence base.