Alcohol-associated Liver Disease in the MENA Region: A 16-Country Survey of Healthcare Provider Perspectives

Abstract

INTRODUCTION AND OBJECTIVES: Despite low alcohol consumption across most MENA countries, the burden and management challenges of alcohol-associated liver disease (ALD) remain poorly characterized. This study assessed healthcare providers' perceptions, clinical experiences, and barriers to ALD care in the region. PATIENTS AND METHODS: A cross-sectional survey was distributed to clinicians involved in liver disease management in MENA. The survey explored perceived ALD prevalence, diagnosis patterns, clinical practices, access to services, and sociocultural barriers. Selected variables were compared across three subregions (Gulf, North Africa, and Levant & Turkey). RESULTS: A total of 286 providers from 16 MENA countries participated. ALD prevalence was perceived as low or moderate by most respondents, and 52.1% reported an increase in ALD case numbers over the past five years. ALD was commonly diagnosed during routine assessments or at advanced stages. Only 12.9% reported existing national ALD guidelines, and 28.3% had access to specialized clinics. Medical management and nutritional support were widely available, whereas liver transplantation was accessible to 54.5%. Stigma (76.6%) and limited treatment facilities (46.9%) were major barriers. CONCLUSION: This region-wide assessment highlights major gaps in ALD recognition, clinical pathways, and policy infrastructure. Reducing stigma, strengthening provider training, and developing region-specific guidelines are essential to improve ALD care in culturally sensitive settings.