Toxicology service readiness across the Middle East and North Africa: a systematic review with narrative synthesis

Introduction Poison centres (PCs) are critical components of toxicology and public health infrastructure. However, the overall readiness of toxicology services across the Middle East and North Africa (MENA), together with the Islamic Republic of Iran and Türkiye, remains unclear. We aimed to describe toxicology system readiness using a standardised framework.Methods We performed a PROSPERO-registered systematic review (CRD420251167720) of studies from MENA countries and the World Health Organisation Eastern Mediterranean Region (WHO/EMRO) reporting on at least two WHO-defined operational toxicology domains: PC operations, antidote availability, laboratory services, toxicovigilance, and workforce. We classified each domain as fully operational, limited, absent, or not reported, and assessed certainty of evidence using GRADE criteria.Results Sixteen studies (10 countries; 2013–2025) met inclusion criteria. Domain adherence was highest for PC operations (15/16; 93.8%) and toxicovigilance (10/16; 62.5%), while fully operational coverage was lowest for laboratory services (4/16; 25.0%) and antidote availability and workforce (6/16; 37.5% each). Methodological and contextual heterogeneity precluded quantitative synthesis; no significant regional or economic moderators were identified.Conclusion Included MENA toxicology systems demonstrated variable readiness, with poison information services most consistently established and persistent deficiencies in antidote access, laboratory capacity, and workforce development. Coordinated investment across all WHO-recommended operational domains is required to strengthen integrated toxicology systems across the region.