Defining indicators for disease burden, clinical outcomes, policies, and barriers to health services for migrant populations in the Middle East and North African region: a suite of systematic reviews
Authors: Seedat Farah , Evangelidou Stella , Abdellatifi Moudrick , Bouaddi Oumnia , Cuxart-Graell Alba , Edries Hassan , Elafef Eman , Maatoug Taha , Ouahchi Anissa , Pampiri Liv Mathilde , Deal Anna , Arias Sara , Assarag Bouchra , Hassouni Kenza , Chaoui Aasmaa , Chemao-Elfihri Wafa , Hilali Mahmoud , Ibrahimi Azeddine , Khalis Mohamed , Wejdene Mansour , Mtiraoui Ali , Wickramage Kolitha , Zenner Dominik , Requena-Mendez Ana , Hargreaves Sally 
Published: July 2023

ABSTRACTIntroductionThe Middle East and North Africa (MENA) is characterised by high and complex migration flows, yet little is known about the health of migrant populations, their levels of under-immunisation, and access to healthcare provision. Data are needed to support regional elimination and control targets for key diseases and the design and delivery of programmes to improve health outcomes in these groups. This protocol describes a suite of seven systematic reviews that aim to identify, appraise, and synthesise the available evidence on burden and clinical indicators, policies, and barriers related to these mobile populations in the region.Methods and analysisSeven systematic reviews will cover two questions to explore: 1) the burden and clinical outcomes and 2) the policies, uptake, and the barriers for the following seven disease areas in migrants in the MENA region: tuberculosis, HIV and hepatitis B and C, malaria and neglected tropical diseases, diabetes, mental health, maternal and neonatal health, and vaccine-preventable diseases. We will search electronic databases for studies in any language (year 2000 to 2023), reference-check relevant publications, and cross-check included studies with experts. We will search for grey literature by hand searching key databases and websites (including regional organisations and MoH websites) for country-specific guidelines and talking to our network of experts for local and regional reports and key datasets. We will assess the studies and policies for their quality using appropriate tools. We will meta-analyse the data if they are of sufficient volume and similarity by disease outcome. Where meta-analysis is not possible and where data are on policy, we will narratively synthesise the evidence using summary tables, figures, and text.Ethics and disseminationWe anticipate disseminating the findings through peer-reviewed publications, conferences, and other formats relevant to all stakeholders. We are following PRISMA guidelines and protocols will be registered on PROSPERO.STRENGTHS AND LIMITATIONS OF THE STUDYExplicit, transparent, and recommended systematic review methodology.Comprehensive search strategy with no language restrictions and extensive grey literature searching online and through expert government and non-government support.International team with multidisciplinary expertise on migrant health, diseases, policymaking, and methodology.Data prior to the year 2000 will be excluded.Meta-analysis may not be possible due to heterogeneity, and we anticipate that most of the data will come from grey literature.