Non-Communicable Diseases (NCDs) are those diseases that have been named by the World Health Organization (WHO) and considered to be chronic and which cannot be passed through humans or which are not acute in nature. They can continue for a very long period of time and in a very slight process. The leading ones are cardiovascular diseases, diabetes, chronic respiratory ailments, and cancers [1, 2]. Although they overlook mental health conditions, injuries, and road-traffic accidents, the academic and policy discourses that are situated in differing health agendas, NCDs are now the greatest burden of infection, with over 70 per cent of global deaths attributed to the condition [1]. The prevalence of NCDs is also high in the Eastern Mediterranean Region (EMR), which is a 22-country region in diverse socioeconomic and cultural milieus, leading to approximately 75 per cent of all deaths in many of the member states [1, 3]. The multifactorial nature of the increased pace of NCDs in this geopolitical territory can be profounded at the following points: rapid urbanisation, the increased consumption of energy-dense, nutrient-poor diets high in sugars and fats, sedentary lifestyles associated with technological advances, and the widespread use of tobacco products [4]. Following the introduction of the Global Action Plan for the Prevention and Control of NCDs 2013-2025, an agenda that stipulates the use of tangible targets in the reduction of untimely deaths caused by the four lead NCDs by 25 percent by 2025, the region has been focusing on such a low-carbon mitigation strategy in four prongs. This plan aims at reducing exposure to key risk factors, that is, tobacco use, poor dietary habits, lack of exercise, and dangerous drinking habits; furthermore, enhancing health systems to identify and deal with the illness at an early stage [5]. At the same time, there are multiple states within EMR that promulgated national frameworks to address the NCDs. These policy action plans have institutionalised tobacco control laws, encouraged physical exercise, introduced healthier eating habits that are healthier, increased clinical quality of early diagnosis and continuous management, and staged campaigns on awareness to the population, among other things [6, 7]. However, significant implementation challenges remain. They include insufficient healthcare systems, lack of medical expertise and training, ineffective funds towards the provision of healthcare to the masses, and unequal provision of care to the diverse population groups [8, 9].

Empirical evidence shows that NCD surveillance has not been adequate in most low- and middle-income countries, despite the increasing morbidity and socio-economic consequences of these diseases [10, 11]. Although developed countries have a higher relative burden of NCDs, the absolute burden is highest in middle-income countries when population size is taken into account [12, 13]. This review, hence, aims at questioning the current situation of the NCD control campaigns in EMR countries by analysing the achievements in relation to WHO targets. It will list the effective interventions that are implemented in different national settings and highlight the unending challenges that hinder the proper management of NCDs. With the understanding of the complexities of the dynamics of NCDs in the context of EMR, the stakeholders will be able to redefine strategic interventions to accommodate the urgent health needs and protect the sustainability of the public-health programmes on a long-term basis. The current assessment critically evaluates the rate of achieving WHO NCD goals by state EMRs, distinguishing between successful approaches to the issue and current obstacles to direct other, more effective and sustained regional actions.

The results of this systematic review highlight the significant progress made by those countries in the Eastern Mediterranean Region (EMR) in their efforts to address Non-Communicable Diseases (NCDs) and the unresolved issues that hinder the appointment of effective disease control in contributing to a successful solution. Three to four years of country-level data synthesised between 2010 and 2020 make this review define not just the policy adoption but also the progress and gaps that can be identified in terms of the major WHO indicators. Due to the rising popularity of NCDs, understanding the implications of these findings takes center stage in the eyes of policymakers, health practitioners, and the general population who are determined to improve health outcomes in the region. The creation of the national action plans and policies that address the NCDs is one of the critical developments in the EMR. Countries like Iran and Turkey have developed strong structures that follow the WHO guidelines, and therefore, portray practical interest to address the rising burden of NCDs. As an example, the high prevalence of tobacco in Turkey has fallen sharply due to the comprehensive tobacco control measures, and this demonstrates the extent to which stringent legislation can lead to positive health effects as a result [22]. The Iranian provincial data, based on twelve years of WHO data, showed that the prevalence of cigarette-smoking among the population dropped significantly; the 2005 statistics stood at approximately 14.65 per cent, whereas in 2016, the prevalence of smoking had decreased significantly to about 10.63 per cent (a drop to 10.63 per cent) [23]. However, in spite of the recorded improvements, there are high rates at which the effectiveness of such policies depends on their execution and enforcement [7]. Political will is critical in many situations, where laws are made and followed. The political instability or conflict faced by countries, e.g., Lebanon and Iraq, is a major hindrance to the implementation of health policies. This variance can be seen in Table 1, whereby the prevalence of the use of tobacco in Lebanon reaches above 40% and is in conspicuous contrast to the slowly decreasing trend in more established environments [24]. These statistics underscore the need to have a sustained political will and system of governance that gives high priority to the health programs despite other socio-political issues that cross the board [8, 25-27].

Public-awareness campaigns have been a useful tool for educating the populations on the risk factors of NCDs and healthier lifestyles. The Saudi Arabian and Lebanese campaigns can be viewed as examples of the possible influence of the targeted communication strategy on changing behaviour. However, to attain success in these endeavours, they have to be culturally sensitive and highly customised to local beliefs and practices. As an illustration, although the benefits of encouraging exercise are universal, approaches towards encouraging exercise can vary significantly depending on cultural perspectives of exercise and leisure. The recent evidence of high prevalence of obesity within the Eastern Mediterranean Region, with prevalence levels exceeding 40 whilst in Qatar they remain high, highlights the fact that structural measures are necessary to stem this vice beyond the witnessing of awareness campaigns [28, 29]. The relevance and effectiveness of health-promotion campaigns can be increased significantly when the local communities are engaged in the planning and execution of the campaign. In addition, social media platforms are also a strategic avenue of targeting younger populations who would be more vulnerable to digital communication [30-32]. Inclusion of NCD in the primary healthcare system is essential in the provision of timely screening, diagnosis, and treatment. Our results suggest that such nations as Jordan have achieved significant advancement in this area due to regular screening of high-risk groups. However, there are still major problems with hospital capacity and its access. The healthcare systems in most of the EMR countries are not well-funded, especially in rural areas, where accessibility to healthcare services is still a problem. There is therefore a need to strengthen the primary healthcare infrastructure in a bid to enable early detection and proper management of NCDs. This involves investing in health care centers, improving health care training programs by the health care workers, and ensuring there are the required drugs. Moreover, the quality of care offered to NCD patients may be improved if a patient-centred approach is adopted. This model focuses on holistic management that takes into account patients' physical, emotional, and social needs and ultimately achieves high health outcomes [33-35]. The disproportionate development facilitation observed in Table 1, like the more successful cases of hypertension identification in Jordan relative to Sudan, depicts the effects of dissimilar primary-disparate care integration in the area [36, 37].

The continuing predicaments of NCDs management in the EMR include the weakness of the healthcare system, lack of data, socioeconomic inequalities, and cultural obstacles, which require an all-encompassing, evidence-based, and multi-faceted strategy towards the effective prevention and management of the condition. Improving healthcare systems is paramount, and it requires significant investments in infrastructure to enhance service provision, such as renovating medical institutions, providing necessary diagnostic devices, and generally increasing access to specialist services for NCDs. At the same time, today clinical competencies and patient outcomes can be enhanced with the help of continuous professional development, learning in the form of simulations, making the provision of training programmes to healthcare professionals, in particular, nurses, more effective, which the existing research confirms by confirming the effects of workforce capacity building [38, 39]. Strong data-collection methods are also essential and require that they have common, interoperable data-gathering systems that can track the trends and risk factors of NCDs as well as the results of their intervention. These systems ought to be in line with WHO guidelines in ensuring that there is consistency and comparability across EMR countries [40, 41]. As we review, the countries that have well-established surveillance networks, e.g., Qatar and the UAE, always have complete trend information on obesity and hypertension. However, in weak states such as Sudan and Yemen, the gap in the available data prevents proper monitoring and hinders effective interventions that can be used by the government and the population in fighting diseases [11, 42]. Socioeconomic inequality is a crucial factor in the healthcare accessibility of all groups, and intervening to provide remedies to this issue through policies like subsidies of care among low-income earners, mobile medical services to rural communities, and social protection interventions to alleviate the financial burden is highly recommended, as demonstrated by effective models in resource-limited environments [43, 44]. In addition, the culturally sensitive interventions by the government in the field of health should be implemented in terms of specific collaboration with the community leaders and the stakeholders to develop the programmes that would respect the beliefs and traditions of the community and practices, resulting in the increase of the level of campaign acceptance and efficacy as the example of the community-based health-promotion activities demonstrates [45]. Such results emphasize the fact that popular, one grounds fit all strategies are not applicable to the region. Multi-sectoral approaches are essential in long-term NCD management in the EMR through multi-sectoral collaboration with the government, healthcare providers, and civil society.

To realize the WHO's aspiration of a 25 per cent reduction in premature mortality from non-communicable diseases by 2025, the nation's EMR users are invited to adopt available initiatives whilst addressing deeply rooted inhibitions with solid, evidence-based approaches. Future directions should focus on strengthening multisectoral cooperation and integrating disciplines such as education, agriculture, and urban development to create conditions conducive to healthy living and thereby align with WHO-based integrated NCD prevention models [46]. As seen in the reviewed literature, the EMR states with active multisectoral programmes, such as the case of the Healthy Cities Initiative in Iran, have a better fit with the WHO goals to address the non-communicable disease compared to those that mostly rely on health-sector interventions [47, 48]. The need to promote research and innovation should remain central, and there should be a focus on developing context-specific interventions, including digital health methods, of which such approaches as telemedicine and mobile health apps have proven effective and can be implemented in resource-limited environments [49, 50]. Increasing the involvedness of the community with participatory, community-based interventions has the potential of promoting ownership and driving towards sustainable behaviour change, as demonstrated with successful health promotion initiatives in a wide cultural milieu [51].

There are a number of constraints that surround this review. The presented studies showed the heterogeneity in terms of design, sample size, and the quality of methodology, thus limiting the generalisability of results. In addition, disparate quality, the assessment tool was used in the appraisal of observational studies and randomised controlled trials, which may have introduced a flaw of variance in evidence assessment. The age, sex, and economic disparities among studies could bring about nonapplicability across the heterogeneous EMR countries. Large gaps in data, especially in the low- and middle-income states, hindered the proper estimation of NCD prevalence, risk factors, and the results of interventions. The lack of cross-country comparability and tracking of the achievement of WHO targets is smothered by the absence of standardised, cross-country interoperable NCD surveillance systems. The 22 member states of the EMR have divergent socioeconomic, cultural, and political vectors, which could imply a mindless, exhaustive capture of the challenges in conflict-laden regions like Iraq and Lebanon, or in rapidly urbanising regions like Qatar and the UAE. Perceptions of diet, physical exercise, and seeking health care were identified as barriers, but their depth within particular communities may have been under-investigated. The scope of the review, which is confined to English and Arabic literature, exposes validity, as well as there might be some positive publication bias that may exaggerate the perceived intervention efficacy. Limiting the period to 2010-2024 might exclude recent data that could indicate a new policy trend or health outcomes. As the policy uptake is recorded, the long-term sustainability and effectiveness of implementation on the ground are questionable because of the political instability, financial limitations, and instability of the healthcare system. The use of qualitative thematic analysis instead of quantitative meta -analysis limits the accuracy of the estimates of the effectiveness of the intervention or the assessment of trends in NCD. The focus on the non-empirical case, including opinion pieces, expert commentaries, etc., might have left crucial contextual information about the impediments and facilitators of NCD containment in the EMR out. All these restrictions emphasise the need to interpret the results cautiously, and the need to promote better standardisation of surveillance, nation-specific implementation statistics, and strict quantitative analysis measures in further scholarly work.

The prevalence of non-communicable conditions in the Eastern Mediterranean Region is a massive public health issue of concern; however, progress has been made through policy development, sensitization programs, and incorporation of NCD into primary care. This review highlights, by synthesising cross-national trends over 2010-2020, the finding that those states, which have a comprehensive national action plan and strong surveillance mechanisms, such as Turkey, Qatar, and the UAE, have achieved more quantifiable progress in achieving the WHO targets on NCDs. Valuable hurdles remain, especially in low and middle-income economies, and they include access to healthcare, political vagaries, and policy implementation inconsistency. Multidimensional, evidence-based interventions, such as primary healthcare infrastructure strengthening, multicultural health promotion, and multisectoral collaboration, to address these dilemmas, will not only be important for controlling NCDs. Clinicians and policymakers are placed at a central position in leading the policy implementation, exploitation of digital health innovations, integration of patient-centred care models, and ensuring even distribution of access to the preventive service. The present review, therefore, highlights the need to institutionalise NCD management as part of primary care, strengthen screening programmes, and gender insensitive approaches towards behavioural and metabolic risk factors. However, the results should be approached with reservations due to the heterogeneity of the studies, the lack of data, and the differences in the health system capacities between the EMR countries. Future studies need to be focused on improving the data collection strategies, investigating the issues of the implementation, and conducting quantitative studies to provide a stronger, country-specific NCD governance evidence.