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Abstract Background From May 2018 to September 2022, the Democratic Republic of Congo (DRC) experienced seven Ebola virus disease (EVD) outbreaks within its borders. During the 10th EVD outbreak (2018–2020), the largest experienced in the DRC and the second largest and most prolonged EVD outbreak recorded globally, a WHO risk assessment identified nine countries bordering the DRC as moderate to high risk from cross border importation. These countries implemented varying levels of Ebola virus disease preparedness interventions. This case study highlights the gains and shortfalls with the Ebola virus disease preparedness interventions within the various contexts of these countries against the background of a renewed and growing commitment for global epidemic preparedness highlighted during recent World Health Assembly events. Main text Several positive impacts from preparedness support to countries bordering the affected provinces in the DRC were identified, including development of sustained capacities which were leveraged upon to respond to the subsequent coronavirus disease 2019 (COVID-19) pandemic. Shortfalls such as lost opportunities for operationalizing cross-border regional preparedness collaboration and better integration of multidisciplinary perspectives, vertical approaches to response pillars such as surveillance, over dependence on external support and duplication of efforts especially in areas of capacity building were also identified. A recurrent theme that emerged from this case study is the propensity towards implementing short-term interventions during active Ebola virus disease outbreaks for preparedness rather than sustainable investment into strengthening systems for improved health security in alignment with IHR obligations, the Sustainable Development Goals and advocating global policy for addressing the larger structural determinants underscoring these outbreaks. Conclusions Despite several international frameworks established at the global level for emergency preparedness, a shortfall exists between global policy and practice in countries at high risk of cross border transmission from persistent Ebola virus disease outbreaks in the Democratic Republic of Congo. With renewed global health commitment for country emergency preparedness resulting from the COVID-19 pandemic and cumulating in a resolution for a pandemic preparedness treaty, the time to review and address these gaps and provide recommendations for more sustainable and integrative approaches to emergency preparedness towards achieving global health security is now.

This review documents the status of AMR education and awareness in the WHO African region, as well as specific initiatives by its member states in implementing education and awareness interventions, as a strategic objective of the Global Action Plan on AMR, i.e., improve knowledge and understanding on AMR through effective communication, education, and training. A systematic search was conducted in Google Scholar, PubMed, and African Journals Online Library according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, for articles published in English. Retrieval and screening of articles was performed using a structured search protocol following a pre-set inclusion/exclusion criterion. Eighty-five published articles reporting 92 different studies from 19 Member States met inclusion criteria and were included in the final qualitative synthesis. Nigeria (21) and Ethiopia (16) had most of the studies, while the rest were distributed across the remaining 17 Member States. The majority of the articles were on knowledge, attitude, and practices with regard to AMR and antimicrobial use and most of them documented a general lack and suboptimal knowledge, poor attitude and practices, and widespread self-medication. This review shows low levels of knowledge of AMR coupled with extensive misuse of antimicrobial medicines by different target audiences. These findings underscore the urgent need for enhanced and context-specific educational and positive behavioural change interventions.

Background: The WHO Regional Office for Africa developed a Member States (MS)-endorsed regional strategy to fast-track the implementation of MS' national action plans (NAP) on Antimicrobial resistance (AMR). This study explored the perspectives of AMR's national focal points in MS on the implementation of the priority interventions of the regional strategy in their countries. Methods: An online survey consisting of ratings and discussions covering the implementation of the six priority interventions was conducted. Sums of the scores per priority intervention were obtained, and their percentage to the total possible scores were calculated to categorize the implementation as inadequate (0–25%), basic (26–50%), intermediate (51–75%), or advanced (76–100%). Results: Thirty-six of the forty-seven national AMR focal points responded to the survey between 12 November 2023 and 8 January 2024. The implementations were rated as 37–62% (basic-to-intermediate), with the multisectoral coordination and collaboration committee receiving the highest overall rating (62%, 421/684), while the promotion of sustainable investment for the NAP on AMR received the least overall rating (37%, 257/700). The focal points mainly recommended awareness campaigns, capacity building, and regulations and guidelines to improve the implementation of the AMR strategy. Conclusions: The survey revealed a need to enhance awareness campaigns, support the establishment and functioning of AMR evaluation and monitoring systems, and build the capacity of AMR staff with cost-benefit analysis and budgeting skills. It also showed the necessity to improve awareness and conduct education on AMR, streamline evidence generation through One Health Surveillance systems, integrate initiatives to reduce hospital-acquired infections in the antimicrobial stewardship programs, and enhance regulations and guidelines to optimize the use of antimicrobials. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) is a significant global public health threat. This review presents the most recent in-depth review of the situation of the main AMR types in relation to the most commonly prescribed antibiotics in the World Health Organization (WHO) African Region. Underlying genes of resistance have been analyzed where possible. A search to capture published research data on AMR from articles published between 2016 and 2020 was done using PubMed and Google Scholar, with rigorous inclusion/exclusion criteria. Out of 48003 articles, only 167 were included. Among the tested gram-negative bacteria species, Klebsiella spp. remain the most tested, and generally the most resistant. The highest overall phenotypic resistance for imipenem was reported in E. coli, whereas for meropenem, E. coli and Haemophilus spp. showed an equal resistance proportion at 2.5%. For gram-positive bacteria, Streptococcus pneumoniae displayed high resistance percentages to trimethoprim/sulfamethoxazole (64.3%), oxacillin (32.2%), penicillin (23.2%), and tetracycline (28.3%), whereas Staphylococcus aureus contributed to 22.8% and 10% resistance to penicillin and oxacillin, respectively. This review shows that AMR remains a major public health threat. The present findings will help public health decision-makers in developing efficient preventive strategies and adequate policies for antibiotic stewardship and surveillance in line with the global action plan for AMR. [ABSTRACT FROM AUTHOR]

The WHO Regional Office for Africa (AFRO) continues to address many outbreaks and health emergencies, with high morbidity and mortality and major socioeconomic disruptions leading to loss of productivity and [...]

The formulation of accurate clinical case definitions is an integral part of an effective process of public health surveillance. Although such definitions should, ideally, be based on a standardized and fixed collection of defining criteria, they often require revision to reflect new knowledge of the condition involved and improvements in diagnostic testing. Optimal case definitions also need to have a balance of sensitivity and specificity that reflects their intended use. After the 2009- 2010 H1N1 influenza pandemic, the World Health Organization (WHO) initiated a technical consultation on global influenza surveillance. This prompted improvements in the sensitivity and specificity of the case definition for influenza--i.e. a respiratory disease that lacks uniquely defining symptomology. The revision process not only modified the definition of influenza-like illness, to Include a simplified list of the criteria shown to be most predictive of influenza infection, but also clarified the language used for the definition, to enhance interpretability. To capture severe cases of influenza that required hospitalization, a new case definition was also developed for severe acute respiratory infection in all age groups. The new definitions have been found to capture more cases without compromising specificity. Despite the challenge still posed In the clinical separation of influenza from other respiratory infections, the global use of the new WHO case definitions should help determine global trends in the characteristics and transmission of influenza viruses and the associated disease burden. La formulation de definitions precises de cas cliniques fait partie integrente d'un processus efncace de surveillance de la sante publique. Alors que ees definitions devraient, dans l'ideal, s'appuyer sur un ensemble standardise et fixe de criteres de definition, elles necessitent souvent une revision pour tenir compte des nouvelles connaissances relatives a la maladie concernee et des ameliorations apportees aux tests diagnostiques. Pour etre optimales, les definitions de cas doivent aussi etablir un equilibre entre sensibilite et specificite qui reflete leur utilisation aux fins prevues. A la suite de la pandemie de grippe H1N1 de 2009-2010, l'Organisation mondiale de la Sante (OMS) a lance une consultation technique sur la surveillance mondiale de la grippe. Cela a conduit a des ameliorations concernant la sensibilite et la specificite de la definition de cas pour la grippe--c'est-a-dire une maladie respiratoire dont seule la symptomatologie reste a definir. Le processus de revision n'a pas seulement modifie la definition du syndrome de type grippal pour indure une liste simplifiee des criteres le mieux a meme de predire une infection grippale, il a egalement permis de clarifier le langage utilise dans la definition pour en ameliorer Interpretation. Par ailleurs, afin de tenir compte des cas severes de grippe qui necessitaient une hospitalisation, une nouvelle definition de cas a ete introduite concernant l'infection aigue severe des voies respiratoires dans tous les groupes d'age. Il a ete constate que les nouvelles definitions refletaient davantage de cas, sans pour autant compromettre la specificite. S'il est vral que la distinction clinique de la grippe des autres infections respiratoires continue de poser probleme, l'utilisation mondiale des nouvelles definitions de cas de l'OMS devralt permettre de degager des tendances mondiales concernant les caracteristiques et la transmission des virus grippaux ainsi que la charge de morbidite qui leur est associee. La elaboracion de definiciones precisas de los casos clinicos es una parte fundamental de un proceso efectivo de la vigilancia de la salud publica. Aunque tales definiciones deberian, idealmente, estar basadas en una recopilacion estandarizada y fija de criterios de definicion, a menudo necesitan una revision para reflejar el nuevo conocimiento de la enfermedad existente y las mejoras en las pruebas de diagnostico. Las definiciones optimas de los casos tambien deben tener un equilibrio entre sensibilidad y especificidad que refleje su uso previsto. Despues de la pandemia de gripe H1N1 en 2009-2010, la Organizacion Mundial de la Salud (OMS) inicio una consulta tecnica para la vigilancia mundial de la gripe. Esto dio lugar a mejoras en la sensibilidad y la especificidad de las definiciones de los casos de gripe, es decir, una enfermedad respiratoria que carece de una sintomatologia definitoria singular. El proceso de revision no solo modifico la definicion de las enfermedades similares a la gripe para incluir una lista simplificada de los criterios que demostraron ser mas predictivos de la infeccion por gripe, sino que tambien aclaro el lenguaje utilizado para la definicion, con el fin de mejorar su interpretacion. Para englobar los casos graves de gripe que requirieron hospitalizacion, tambien se desarrollo una nueva definicion de los casos de la infeccion respiratoria aguda grave en todos los grupos de edad. Se ha descubierto que las nuevas definiciones engloban mas casos sin comprometer la especificidad. A pesar del desafio que todavia plantea la separacion clinica de la gripe de otras infecciones respiratorias, el uso global de las nuevas definiciones de los casos de la OMS deberia ayudar a determinar las tendencias mundiales en las caracteristicas y transmision de los virus de la gripe y la carga de la enfermedad asociada., Introduction Case definitions form an important part of standardized systems for public health surveillance. They can be used in the reporting of the conditions under surveillance, the monitoring of geographical [...]

The coronavirus disease (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) has become a pandemic. There is currently no vaccine or effective treatment for COVID-19. Early diagnosis and management is key to favourable outcomes. In order to prevent more widespread transmission of the virus, rapid detection and isolation of confirmed cases is of utmost importance. Real time reverse transcriptase polymerase chain reaction (RT-PCR) is currently the "gold standard" for the detection of SARS-COV-2. There are several challenges associated with this test from sample collection to processing and the longer turnaround time for the results to be available. More rapid and faster diagnostic tests that may produce results within minutes to a few hours will be instrumental in controlling the disease. Serological tests that detect specific antibodies to the virus may be such options. In this review, we extensively searched for studies that compared RT-PCR with serological tests for the diagnosis of COVID-19. We extracted the data from the various selected studies that compared the different tests and summarised the available evidence to determine which test is more appropriate especially in Africa. We also reviewed the current evidence and the challenges for the genome sequencing of SARS-COV-2 in Africa. Finally, we discuss the relevance of the different diagnostic tests and the importance of genome sequencing in identifying potential therapeutic options for the control of COVID-19 in Africa. [ABSTRACT FROM AUTHOR]

The Comoros Islands are situated off the coast of East Africa, at the northern entrance of the channel of Mozambique. Contemporary Comoros society displays linguistic, cultural and religious features that are indicators of interactions between African, Middle Eastern and Southeast Asian (SEA) populations. Influences came from the north, brought by the Arab and Persian traders whose maritime routes extended to Madagascar by 700-900 AD. Influences also came from the Far East, with the long-distance colonisation by Austronesian seafarers that reached Madagascar 1500 years ago. Indeed, strong genetic evidence for a SEA, but not a Middle Eastern, contribution has been found on Madagascar, but no genetic trace of either migration has been shown to exist in mainland Africa. Studying genetic diversity on the Comoros Islands could therefore provide new insights into human movement in the Indian Ocean. Here, we describe Y chromosomal and mitochondrial genetic variation in 577 Comorian islanders. We have defined 28 Y chromosomal and 9 mitochondrial lineages. We show the Comoros population to be a genetic mosaic, the result of tripartite gene flow from Africa, the Middle East and Southeast Asia. A distinctive profile of African haplogroups, shared with Madagascar, may be characteristic of coastal sub-Saharan East Africa. Finally, the absence of any maternal contribution from Western Eurasia strongly implicates male-dominated trade and religion as the drivers of gene flow from the North. The Comoros provides a first view of the genetic makeup of coastal East Africa. [ABSTRACT FROM AUTHOR]

Following the West Africa Ebola virus disease outbreak (2013-2016), the Joint External Evaluation (JEE) is one of the three voluntary components recommended by the WHO for evaluating the International Health Regulations (2005) capacities in countries. Here, we share experience implementing JEEs in all 47 countries in the WHO African region. In February 2016, the United Republic of Tanzania (Mainland) was the first country globally to conduct a JEE. By April 2022, JEEs had been conducted in all 47 countries plus in the island of Zanzibar. A total of 360 subject matter experts (SMEs) from 88 organisations were deployed 607 times. Despite availability of guidelines, the process had to be contextualised while avoiding jeopardising the quality and integrity of the findings. Key challenges were: inadequate understanding of the process by in-country counterparts; competing country priorities; limited time for validating subnational capacities; insufficient availability of SMEs for biosafety and biosecurity, antimicrobial resistance, points of entry, chemical events and radio-nuclear emergencies; and inadequate financing to fill gaps identified. Key points learnt were: importance of country leadership and ownership; conducting orientation workshops before the self-assessment; availability of an external JEE expert to support the self-assessment; the skills, attitudes and leadership competencies of the team lead; identifying national experts as SMEs for future JEEs to promote capacity building and experience sharing; the centrality of involving One Health stakeholders from the beginning to the end of the process; and the need for dedicated staff for planning, coordination, implementation and timely report writing. Moving forward, it is essential to draw from this learning to plan future JEEs. Finally, predictable financing is needed immediately to fill gaps identified., Competing Interests: Competing interests: None declared., (© World Health Organization 2023. Licensee BMJ.)