Objectives This scoping review mapped antimicrobial resistance (AMR)-related interventions in WHO African region against the five strategic objectives of the WHO Global Action Plan (GAP) on AMR and identified evidence gaps limiting progress.Design A scoping review using the Arksey and O'Malley framework, enhanced by Levac et al and Joanna Briggs Institute methodology; reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR).Data sources PubMed, CINAHL, Web of Science and Scopus searched on 9 December 2025, with grey literature from Google Scholar and Google (first 100 hits).Eligibility criteria Studies of any design reporting interventions addressing GAP strategic objectives-stewardship, surveillance, infection prevention, education or economic approaches in the WHO African region.Data extraction and synthesis Data were charted using a pilot-tested Excel tool by GAP strategic objective and evidence gaps and research considerations were synthesised thematically.Results Forty-nine studies (2016-2025) were included, with country-specific evidence concentrated in South Africa, Ethiopia, Kenya, Ghana and Nigeria. Most evaluated antimicrobial stewardship or awareness/training interventions in tertiary hospitals, showing improvements in prescribing, knowledge and occasional cost savings but few assessed long-term effects or resistance trends. Surveillance had advanced but remained limited by weak laboratory capacity, diagnostic coverage, data quality and limited use of AMR/antimicrobial use data in practice. Evidence on infection prevention, vaccination and One Health interventions was scarce and no full economic evaluations were identified.Conclusions AMR research in the African region clusters around antimicrobial stewardship and awareness in tertiary hospitals, leaving infection prevention, vaccination, One Health approaches and economic evaluation substantially underrepresented across the GAP framework. Closing these gaps will require longer-term implementation research, context-specific economic analyses and broader geographical coverage to generate the evidence needed to operationalise the global AMR research agenda in Africa.

A common misconception is that Antimicrobial resistance (AMR) stems solely from poor treatment management in hospitals and weak health systems. AMR is, however, driven by a multitude of factors, including environmental stressors such as contamination from industrial, agricultural, domestic, and healthcare waste, use of antibiotics in veterinary medicine and agriculture, inadequate water, sanitation, and poverty. This paper is a synthesis of stakeholder engagement to advocate for a multi-sectoral One Health approach to address the emerging global threat of AMR. The Africa One Health Network for Disease Prevention (ADAPT) led multi-sectoral stakeholder engagement at the 15th CUGH annual conference in San Francisco, USA. Up to 100 in-person attendees included medical clinicians, microbiologists, anthropologists, veterinarians, agriculturalists, crop scientists, data scientists, mathematical modellers, policy makers, and economists, among others. Stakeholders’ views were audio recorded, transcribed, and analyzed manually according to pre-determined themes of (a) key achievements, (b) challenges, and (c) recommendations for multi-and inter-sectoral approaches towards antimicrobial stewardship (AMS) and AMR. Academic research institutions and governments are called to foster multi-sectoral and inter-sectoral collaborative education, research, policy, and community engagement innovations, together with the human and animal health, wildlife, agriculture, trade, tourism, urbanization, and immigration sectors, to prioritize efforts to promote AMS.

Background:Antimicrobial resistance (AMR) is a major global health threat, and African countries are disproportionately affected due to limited diagnostic capacity, weak surveillance and inadequate monitoring of antimicrobial consumption (AMC). This study analysed regional trends using the Tracking Antimicrobial Resistance Country Self-Assessment Survey (TrACSS), a standardised tool for monitoring national progress in AMR response. Methods:We conducted an analysis of the TrACSS database covering 47 African countries (2017-2024). Indicators included national AMC monitoring systems, national AMR surveillance systems and laboratory capacity focusing on public and private bacteriology coverage and antimicrobial susceptibility testing (AST) for WHO-priority bacteria and critical fungi. Descriptive and trend analyses were performed, and the association between AMC and AMR system maturity was examined using logistic regression and correlation tests. Results:Between 2017 and 2024, the proportion of countries with advanced AMC monitoring more than doubled (13%-30%), while advanced AMR surveillance quadrupled (13%-57%). From 2022 to 2024, public-sector bacteriology coverage rose from 80%-94% and private sector coverage from 60%-75%. Nearly all countries (95.7% in 2024) reported at least one reference laboratory performing AST for priority bacteria, though pathogen-specific reporting remained limited, with the lowest capacity for Campylobacter spp. (reported by a maximum of 12.2% of countries annually). Dual Candida and Aspergillus testing increased from 23% to 30%, but nearly half (46.8%) of countries still lacked a national mycology reference laboratory. Countries with advanced AMC systems were significantly more likely to also have advanced AMR surveillance (OR 8.1; p<0.001). Conclusion:The WHO African Region has made measurable progress in AMR response over the past 8 years, though gains remain uneven. Strengthening mycology services, expanding bacteriology coverage and integrating AMC and AMR data systems are critical next steps towards achieving resilient, evidence-driven surveillance networks that can better guide stewardship and investment decisions.

Background:Antimicrobial resistance (AMR) is a global public health crisis affecting human health, animal health, plant health, and the environment. In 2015, all WHO Member States endorsed the Global Action Plan on AMR and committed to develop multi-sectoral national action plans (NAPs) under a 'One Health' approach. To accelerate the implementation of AMR NAPs, the WHO introduced a costing and budgeting tool in 2021 to support prioritization of interventions, identification of activities financed through existing budgets, estimation of implementation costs and assessment of funding gaps. Objectives:To assess the impacts resulting from the use of the costing and budgeting tool at national level in WHO African region (AFRO) Member States. Methods:National AMR focal points from the human, animal, agriculture and environmental sectors in 15 WHO African Region Member States trained on the tool completed a questionnaire using Google Forms via a secure web-based survey link. Results:Eleven countries reported mobilizing funding using costed data generated through the tool. Costed NAPs informed policy decisions in seven countries and improved stakeholder collaboration in funding efforts. However, the use of the tool revealed significant challenges, including insufficient domestic financing and lack of congruence of donor priorities with national needs. Conclusions:Costing One Health AMR NAPs serves as an important catalyst for realistic budgeting and resource planning including resource mobilization to ensure both effective implementation and the long-term sustainability of AMR interventions.

Background Antimicrobial Resistance is a critical health challenge in the African Region. This papefactors and review of evidence generated through WHO-supported monitoring and surveillance tools to describe progress in AMR governance architecture and monitoring uptake in addressing antimicrobial resistance in the WHO African region over the past decade, highlight key enabling factors, and propose actions required to address persisting challenges. We reviewed country reports on the implementation of antimicrobial resistance national action plans using the most recent 2024 Tracking Antimicrobial Resistance Country Self-Assessment Survey with multi-sectoral and human health specific indicators, alongside data from the Global AMR/Use Surveillance System databases. Main Text The number of countries with National Action Plans on antimicrobial resistance under the One Health approach increased from 2 (4.3%) in 2015 to 47 (100%) in 2024. Between 2017 and 2024, the number of countries with national guidelines for appropriate antimicrobial use and antimicrobial stewardship programmes increased from 10 (21.3%) to 20 (42.6%). Multisectoral coordination mechanisms rose from 13 (27.7%) in 2015 to 41 (87.2%) in 2024. During the same period, countries conducting nationwide AMR awareness campaigns grew from 2 (4.3%) to 16 (34%), and participation in Global AMR/Use Surveillance System expanded from 7 (14.9%) to 41 (87.2%). Success factors driving this progress include country endorsement and adaptation of global and regional antimicrobial resistance strategies, stronger collaboration among stakeholders including United Nations agencies, civil society, and partners, and use of platforms like Tracking Antimicrobial Resistance Country Self-Assessment Survey and Global AMR/Use Surveillance System to generate data for decision-making. Conclusion Moving forward, collective efforts from all stakeholders are essential to consolidate progress and contribute to global health security, achieve Universal Health Coverage and Sustainable Development Goals. Additionally, future AMR research agenda should focus on measuring the impact of AMR interventions and developing new AMR prevention and control strategies.

Objectives Antimicrobial resistance (AMR) poses a serious threat across human, animal and environmental health. The One Health approach emphasises multisectoral collaboration and is critical in addressing AMR. While One Health governance has gained recognition from international organisations, there remains limited understanding of how it can be effectively implemented across institutional, social, economic and political contexts. This scoping review aims to explore the design and implementation of One Health governance across contexts.Design Scoping reviewData sources We searched PubMed, Scopus, Web of Science and grey literature sources in December 2024, updating our search in March 2026.Eligibility criteria Eligible sources included empirical and conceptual work on One Health governance.Data extraction and synthesis We searched for and screened documents and extracted data following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. We then applied qualitative analysis to examine governance mechanisms; implementation contexts; conceptualisations of effectiveness; evidence of effectiveness and key barriers and facilitators.Results We included 171 documents from over 50 countries. We explored six dimensions of One Health governance: participation, leadership, coordination, decision-making, resourcing and accountability. Existing governance structures and wider aspects of country context shaped One Health governance. While there was broad agreement on the goals of One Health governance—namely, to support disease prevention, detection and response—empirical evidence on effective approaches was relatively limited. Facilitators included strong political will and crisis-driven momentum, while barriers included siloed systems, sectoral dominance, limited accountability, inadequate funding and lack of institutionalisation.Conclusions This review highlights the range of approaches to One Health governance that exist and outlines how context may shape the design and implementation of One Health governance. Evaluative research should further explore which approaches to One Health governance are most effective in specific contexts. These insights are particularly relevant for AMR, where sustained cross-sectoral governance beyond outbreak-driven responses is essential to counter the ‘silent pandemic’.

Inappropriate antimicrobial use (misuse, overuse, underuse, and abuse), often due to a lack of knowledge, is a major factor driving antimicrobial resistance (AMR). Effective education and awareness programs are crucial for addressing this issue. This paper examines how implementation science can improve AMR education and awareness in the World Health Organization (WHO) African Region. This paper discusses the relevance of implementation science frameworks and practical strategies for adapting AMR initiatives to local contexts. By reviewing the literature and case studies, this paper underscores the need for tailored approaches that reflect the region’s unique socio-cultural and healthcare settings. Integrating implementation science into AMR education can promote sustainable behavior change with regard to antimicrobial use, improve healthcare practices, and help combat AMR.

BACKGROUND:Evidence on HAIs in Africa is fairly common. OBJECTIVES:The main objective was to identify the surveillance tools used for healthcare-associated infections (HAIs) in countries in the WHO African Region. Secondary objectives focused on the organization of surveillance, the pathogens involved, and the frequency of multidrug-resistant species. INCLUSION AND EXCLUSION CRITERIA:Observational or interventional studies on healthcare-associated infections in humans, published between January 2011 and December 2024, in French or English, were included. However, the following publications were not included: animal studies, healthcare-associated infections not related to healthcare, literature reviews, studies outside the period or geographical area, and studies in languages other than French or English. Sources of information and search date: The databases consulted were PubMed, Web of Science, EMBASE, Cochrane, African Index Medicus, Google Scholar, and AJOL. The search was conducted between January and March 2025. Risk of bias assessment: The risk of bias was assessed using a specific grid (eleven criteria), scored from one (low) to three (high). The studies were classified into three levels of methodological quality. The results of the bias assessment showed that the publications were excellent (strong and moderate) with a cumulative rate of 99.9%. Methods of synthesizing results: Data were extracted using a standardized grid and synthesized narratively. No meta-analysis was performed. Number of studies and characteristics: 95 studies were included, mostly cross-sectional studies (82.1%), cohorts (10.4%), and a few case reports. Most were from West Africa (60.0%), particularly Nigeria (16.8%) and South Africa (14.7%). MAIN RESULTS:• Most common pathogens: Staphylococcus aureus (53.7%), Escherichia coli (43.2%), Klebsiella pneumoniae (32.6%). • Resistance profile: ESBL (27.4%), MRSA (21.1%), multidrug resistance (13.7%). • Sources of HAIs: mainly exogenous (83.2%). • Laboratory methods: phenotypic (70.5%), genotypic or genomic rare (3.1%). • Scope of studies: local (96.8%), national (3.2%). Limitations of evidence: Risk of bias due to underreporting of HAIs, methodological heterogeneity, predominance of cross-sectional studies, low use of molecular methods, lack of modeling, and uneven geographical coverage. Overall interpretation and implications: surveillance of HAIs in Africa remains fragmented and poorly standardized. There is a need to strengthen national systems, integrate molecular methods, train professionals, and promote interventional research. The WHO GLASS program can serve as a framework for harmonizing surveillance.

BACKGROUND:The studies on knowledge, attitudes, and practices of Antimicrobial resistance (AMR) and use among adolescents and young people are largely from Europe and the Asia region. All such studies reported a low level of understanding of antibiotic resistance and the rational use of antibiotics among adolescents and young people who are at a formative stage when health behaviours are being shaped. There are limited such studies from West Africa, despite a high AMR burden in the region. We therefore conducted a study to assess the knowledge, attitude, and practice on antibiotic use and resistance among adolescents and young people in Sierra Leone. METHODS:This cross-sectional study was conducted among adolescents and young people (15-29 years) who participated in the National Girls Summit-2024 in Sierra Leone. A validated self-administered questionnaire with 29 questions was used to collect data: demography (4 questions); knowledge (14 questions); attitude (3 questions); and practice (8 questions). Data were analyzed using Stata version 15, with results presented using frequencies and percentages. RESULTS:Of the 235 participants, over half (133, 56.6%) had attained university education, and a smaller proportion (14, 6.0%) had completed vocational training. The majority (144, 61.3%) of the adolescents and young people had used an antibiotic within the last 30 days before the study. Over two-thirds (180, 76.6%) of adolescents and young people had heard about antibiotic resistance, and most of them got the information from their academic institutions (67, 37.2%) and the radio (15.0%). Almost half (110, 46.8%) had poor knowledge about antibiotic use and resistance. The majority (139, 59.1%) had a negative attitude towards antibiotic use and resistance, and most (205, 87.2%) of them demonstrated poor practices in antibiotic use. CONCLUSION:Our study revealed that adolescents and young people in Sierra Leone have a limited understanding of antibiotic resistance. Limited knowledge may drive inappropriate antibiotic use, further increasing the AMR burden in the country. We recommend implementing school and university-based antimicrobial stewardship initiatives to enhance awareness and understanding of antibiotic resistance and promote rational use of antibiotics.

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.

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.

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.

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.

The COVID-19 pandemic has exposed faults in the way we assess preparedness and response capacities for public health emergencies. Existing frameworks are limited in scope, and do not sufficiently consider complex social, economic, political, regulatory, and ecological factors. One Health, through its focus on the links among humans, animals, and ecosystems, is a valuable approach through which existing assessment frameworks can be analysed and new ways forward proposed. Although in the past few years advances have been made in assessment tools such as the International Health Regulations Joint External Evaluation, a rapid and radical increase in ambition is required. To sufficiently account for the range of complex systems in which health emergencies occur, assessments should consider how problems are defined across stakeholders and the wider sociopolitical environments in which structures and institutions operate. Current frameworks do little to consider anthropogenic factors in disease emergence or address the full array of health security hazards across the social-ecological system. A complex and interdependent set of challenges threaten human, animal, and ecosystem health, and we cannot afford to overlook important contextual factors, or the determinants of these shared threats. Health security assessment frameworks should therefore ensure that the process undertaken to prioritise and build capacity adheres to core One Health principles and that interventions and outcomes are assessed in terms of added value, trade-offs, and cobenefits across human, animal, and environmental health systems.

Background: The emergence of the Omicron variant of concern in late 2021 led to a resurgence of SARS-CoV-2 infections globally. By September 2022, Seychelles had experienced two major surges of SARS-CoV-2 infections driven by the Omicron variant. Here, we examine the genomic epidemiology of Omicron in the Seychelles between November 2021 and September 2022. Methods: We analysed 618 SARS-CoV-2 Omicron genomes identified in the Seychelles between November 2021 and September 2022 to infer virus introductions and local transmission patterns using phylogenetics and the ancestral state reconstruction approach. We then evaluated the impact of government coronavirus 2019 (COVID-19) countermeasures on the estimated number of viral introductions during the study period. Results: The genomes classified into 43 distinct Pango lineages. The first surge in Omicron cases (beginning November 2021 and peaking in January 2022) was predominated by the BA.1.1 lineage (59%) co-circulating with 11 other Omicron lineages. In the second surge (between April and June 2022), four lineages (BA.2, BA.2.10, BA.2.65 and BA.2.9) co-circulated and these were swiftly replaced by BA.5 subvariants in July 2022, which remained predominant through to September 2022. In the latter period, sporadic detections of BA.5 subvariants BQ.1, BE and BF were observed. We estimated 109 independent Omicron importations into Seychelles over the 11-month period, most of which occurred between December 2021 and March 2022 when strict government restrictions (SI>50%) were still in force. The districts Anse Royale, and Baie St. Anne Praslin appeared to be the major dispersal points fuelling local transmission. Conclusions: Our results suggest that the waves of Omicron infections in the Seychelles were driven by multiple lineages and multiple virus introductions. The introductions were followed by substantial local spread and successive lineage displacement that mirrored the global patterns.

BackgroundAntimicrobial resistance (AMR) has emerged as a leading global health and economic threat of the 21st century, with Africa bearing the greatest burden of mortality from drug-resistant infections. Optimization of the use of antimicrobials is a core strategic element of the response to AMR, addressing misuse and overuse as primary drivers. Effectively, this requires the whole society comprising not only healthcare professionals but also the public, as well as the government, to engage in a bottom-up and a top-down approach. We determined the progress of African national governments in optimizing antimicrobial drug use.MethodsFrom September 2021 to June 2022, all 47 member states of the World Health Organization African region (WHO AFRO) were invited to participate in a survey determining the implementation of strategies to optimize antimicrobial use (AMU). We used the WHO antimicrobial stewardship (AMS) assessment tool, National core elements—A checklist to guide the country in identifying existing national core elements for the implementation of AMS Programs, to obtain information from national AMR focal persons. The tool consists of four sections—national plans and strategies; regulations and guidelines; awareness, training, and education; and supporting technologies and data—with a total of 33 checklist items, each graded from 0 to 4. The responses were aggregated and analyzed using Microsoft Excel 2020®.ResultsThirty-one (66%) of the 47 countries returned completed forms. Only eight (25.8%) countries have developed a national AMS implementation policy incorporating defined goals, targets, and operational plans. There are no budget lines for AMS activities in 23 (74.2%) countries. The WHO Access, Watch, Reserve (AWaRe) classification of optimizing AMU has been integrated into the national essential medicines list or formulary in 19 (61.3%) countries, while the incorporation of the AMS principles and WHO AWaRe classification into national clinical guidelines for the management of infections is present in only 12 (38.7%) and 11 (34.5%) countries, respectively. Although regulations on the prescription-only sale/dispensing of antibiotics are present in 68% of countries, their enforcement is poor. Systems identifying pathogens and antibiotic susceptibility for optimal use of antibiotics are lacking in 38% of countries.ConclusionIn Africa, wide gaps exist in the governments’ implementation of the core elements of optimizing antimicrobial drug use. Responding to AMR constitutes a long journey, and technical and financial support needs to be deployed to optimize the use of antimicrobials.

Seychelles, an archipelago of 155 islands in the Indian Ocean, had confirmed 24,788 cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by the 31st of December 2021. The first SARS-CoV-2 cases in Seychelles were reported on the 14th of March 2020, but cases remained low until January 2021, when a surge was observed. Here, we investigated the potential drivers of the surge by genomic analysis of 1056 SARS-CoV-2 positive samples collected in Seychelles between 14 March 2020 and 31 December 2021. The Seychelles genomes were classified into 32 Pango lineages, 1042 of which fell within four variants of concern, i.e., Alpha, Beta, Delta and Omicron. Sporadic cases of SARS-CoV-2 detected in Seychelles in 2020 were mainly of lineage B.1 (lineage predominantly observed in Europe) but this lineage was rapidly replaced by Beta variant starting January 2021, and which was also subsequently replaced by the Delta variant in May 2021 that dominated till November 2021 when Omicron cases were identified. Using the ancestral state reconstruction approach, we estimated that at least 78 independent SARS-CoV-2 introduction events occurred in Seychelles during the study period. The majority of viral introductions into Seychelles occurred in 2021, despite substantial COVID-19 restrictions in place during this period. We conclude that the surge of SARS-CoV-2 cases in Seychelles in January 2021 was primarily due to the introduction of more transmissible SARS-CoV-2 variants into the islands.

Background Supervision of healthcare workers improves performance if done in a supportive and objective manner. Regular supervision is a support function of Integrated Disease Surveillance and Response (IDSR) strategy and allows systematic monitoring of IDSR implementation. Starting 2015, WHO and other development partners supported the Ministry of Health and Sanitation (MoHS) to revitalize IDSR in Sierra Leone and to monitor progress through supportive supervision assessments. We report on the findings of these assessments. Methods This was a cross-sectional study where six longitudinal assessments were conducted in randomly selected health facilities. Health facilities assessed were 71 in February 2016, 99 in July 2016, 101 in May 2017, 126 in August 2018, 139 in February 2019 and 156 in August 2021. An electronic checklist based on selected core functions of IDSR was developed and uploaded onto tablets using the Open Data Kit (ODK) platform. Supervision teams interviewed health care workers, reviewed documents and made observations in health facilities. Supervision books were used to record feedback and corrective actions. Data from the supervisory visits was downloaded from ODK platform, cleaned and analysed. Categorical data was summarized using frequencies and proportions while means and medians were used for continuous variables. Z test was used to test for differences in proportions. Results Completeness of IDSR reporting improved from 84.5% in 2016 to 96% in 2021 (11.5% points; 95% CI 3.6, 21.9; P -value 0.003). Timeliness of IDSR reports improved from 80.3 to 92% (11.7% points; 95% CI 2.4, 22.9; P -value 0.01). There was significant improvement in health worker knowledge of IDSR concepts and tools, in availability of IDSR standard case definition posters and reporting tools and in data analysis practices. Availability of vaccines and temperature monitoring tools in health facilities also improved significantly but some indicators dropped such as availability of IDSR technical guidelines and malaria testing kits and drugs. Conclusion Supervision using electronic tool contributed to health systems strengthening through longitudinal tracking of core IDSR indicators and other program indicators such as essential malaria commodities and availability and status of routine vaccines. Supervision using electronic tools should be extended to other programs.

Abstract Background From May 2018 to the end of June 2022, the Democratic Republic of Congo (DRC) experienced six Ebola virus disease outbreaks within its borders. During the 10th EVD outbreak, 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. Burundi, Rwanda, South Sudan and Uganda were classified as priority one countries while Angola, Central African Republic, Congo, Tanzania and Zambia as priority two. 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 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 COVID-19 pandemic. Shortfalls such as lost opportunities in vertical approaches to response pillars such as surveillance, over dependence on external support and duplication of efforts especially in the 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 Ebola virus disease outbreak preparedness and response rather than sustainable investment into strengthening systems for improved health security in alignment with IHR obligations and the Sustainable Development Goals. 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 approaches to emergency preparedness towards achieving global health security is now.

Investment in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing in Africa over the past year has led to a major increase in the number of sequences that have been generated and used to track the pandemic on the continent, a number that now exceeds 100,000 genomes. Our results show an increase in the number of African countries that are able to sequence domestically and highlight that local sequencing enables faster turnaround times and more-regular routine surveillance. Despite limitations of low testing proportions, findings from this genomic surveillance study underscore the heterogeneous nature of the pandemic and illuminate the distinct dispersal dynamics of variants of concern-particularly Alpha, Beta, Delta, and Omicron-on the continent. Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve while the continent faces many emerging and reemerging infectious disease threats. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century.