Mapping Metabolic Dysfunction-associated Steatotic Liver Disease Models of Care across 17 Middle East and North Africa Countries: Insights into Guidelines, Infrastructure, and Referral Systems
Year: 2025
Type: article
Study design: Observational Study
Abstract: Background and Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) represents an escalating healthcare burden across the Middle East and North Africa (MENA) region; however, system-level preparedness remains largely undefined. This study aimed to assess existing models of care, clinical infrastructure, policy frameworks, and provider perspectives across 17 MENA countries. Methods: A cross-sectional, mixed-methods survey was distributed to clinicians from MASLD-related specialties across the region. A total of 130 experts (87.2% response rate) from academic, public, and private sectors in 17 countries participated. The questionnaire addressed national policies, diagnostic and therapeutic practices, referral pathways, multidisciplinary team (MDT) integration, and patient/public engagement. Quantitative responses were analyzed descriptively, while qualitative inputs underwent thematic analysis. Results: Only 35.4% of respondents confirmed the presence of national clinical guidelines for MASLD, and 73.1% reported the absence of a national strategy. Structured referral pathways were reported by 39.2% of participants, and only 31.5% believed the current model adequately addresses MASLD. While 60% supported MDT approaches, implementation remained inconsistent. Limited access to transient elastography was reported by 26.2% of providers. Public education efforts were minimal: 22.3% reported no available tools, and 87.7% indicated the absence of patient-reported outcomes data. Nearly half (47.7%) cited poor patient adherence, attributed to low awareness, financial barriers, and lack of follow-up. Conclusions: Significant policy, structural, and educational gaps persist in MASLD care across the MENA region. To address this rising burden, countries must adopt integrated national strategies, expand access to non-invasive diagnostic tests, institutionalize MDT care, and invest in both public and provider education as essential pillars of system-wide preparedness.
Authors: Mohamed El-Kassas, Khalid M. AlNaamani, Rofida Khalifa, Yusuf Yilmaz, Asma Labidi, Maen Almattooq, Faisal M. Sanai, Maisam W.I. Akroush Nabil Debzi, Mohammed A. Medhat, Imam Waked, Ali Tumi, Mohamed Elbadry, Mohammed Omer Mohammed, Ala I. Sharara, Ali El Houni, Mohamed Alsenbesy, Hisham El-Khayat, Mina Tharwat, Abdel-Naser Elzouki, Khalid A. Alswat, Zobair M. Younossi
Institutions: Helwan University, Minia University, Recep Tayyip Erdoğan University, Hôpital La Rabta, King Abdullah International Medical Research Center, National Guard Health Affairs, Hôpital Mustapha Pacha, Assiut University, National Liver Institute, Menoufia University, Tripoli Central Hospital, University of Sulaimani, American University of Beirut Medical Center, American University of Beirut, Arabian Gulf University, Theodor Bilharz Research Institute, Aswan University, Hamad Medical Corporation, Qatar University, King Saud University, Inova Health System
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4413867351