Climate change strongly impacts the agricultural sector in West Africa, threatening food security and nutrition, particularly for populations with the least adaptive capacity. Little is known about national climate change policies in the region. This systematic review identifies and analyses climate change policy documents in all 16 West African countries: (1) What are the existing climate change adaptation policies publicly available? (2) Which topics are addressed? (3) How are agriculture and food security framed and addressed? Following PRISMA guidelines, PubMed and Google scholar as key databases were searched with an extensive grey literature search. Keywords for searches were combinations of “Africa”, “Climate Change”, and “National Policy/Plan/Strategy/Guideline”. Fifteen countries have at least one national policy document on climate change in the frame of our study. Nineteen policy documents covered seven key sectors (energy, agriculture, water resources, health, forestry, infrastructure, and education), and eight thematic areas (community resilience, disaster risk management, institutional development, industry development, research and development, policy making, economic investment, and partnerships/collaboration). At the intersection of these sectors/areas, effects of changing climate on countries/populations were evaluated and described. Climate change adaptation strategies emerged including development of local risk/disaster plans, micro-financing and insurance schemes (public or private), green energy, and development of community groups/farmers organizations. No clear trend emerged when analysing the adaptation options, however, climate change adaptation in the agriculture sector was almost always included. Analysing agriculture, nutrition, and food security, seven agricultural challenges were identified: The small scale of West African farming, information gaps, missing infrastructure, poor financing, weak farmer/community organizations, a shifting agricultural calendar, and deteriorating environmental ecology. They reflect barriers to adaptation especially for small-scale subsistence farmers with increased climate change vulnerabilities. The study has shown that most West African countries have climate change policies. Nevertheless, key questions remain unanswered, and demand for further research, e.g., on evaluating the implementation in the respective countries, persists.

Resilient health systems can reduce the negative health and social effects of climate change. However, health systems are themselves threatened by climate change through climate hazards increasing the demand for services, threatening health infrastructure and supply chains, and stressing the workforce. While there is significant research on the environmental sustainability of health facilities in high-income countries, less attention has been paid to building climate resilience (sustainably), especially in low- and middle-income countries (LMICs). This scoping review aims to connect top-down guidelines with concrete bottom-up activities to accelerate transformational change in the health sector. We systematically and comprehensively searched the academic and grey literature to identify case studies of climate-resilient health facilities in LMICs and describe the activities that build resilience to climate-related health risks. We used scoping review methodology (Arksey and O’Malley 2005 Int. J. Soc. Res. Methodol. 8 19–32; Levac et al 2010 Implement. Sci. 5 69) and employed a two-phase, double-blinded, screening approach to search the academic and grey literature (from 2015 to 2022). We searched four academic databases (Scopus, PubMed, CINAHL, Lilacs), Google Scholar and key websites from the World Health Organisation (WHO), Green Climate Fund, Global Adaptation Mapping Initiative, Health Care Without Harm, and the Global Environmental Facility. A coding framework guided data extraction and data were analysed quantitatively and qualitatively. We identified 26 case studies in 46 countries outlining planned and implemented activities to develop the climate resilience of health facilities in LMICs. We focussed on activities targeting health care facilities rather than broader health systems level planning and present a narrative synthesis of these activities using the WHO Operational Framework for Climate-Resilient and Low Carbon Health Systems. As a result, we developed a conceptual theory of change model that can be applied to various health settings to guide vulnerability assessments and improvement plans to build climate resilience. The research sought to identify successful efforts to build climate resilience at the facility level in LMICs, yet we found very little evidence of actual implementation and no evaluations. Of the case studies that were identified, the activities mapped neatly onto the WHO Operational Framework with some novelties and nuances. Key enablers to building climate resilience include supportive policies, strong information systems, stakeholder coordination, adequate funding, and technical expertise. Community engagement emerges as an important consideration and is recommended for inclusion in climate resilience frameworks, action plans, and strategies. Bridging the knowledge-action gap can be helped by collating experiences, standardized reporting of initiatives, and increased investment in implementation science. Lessons learned and good practices should be shared among health decision-makers within and between countries, allowing for mutual learning. There is also an urgent need to ensure climate finance reaches the health facilities and populations most at risk.

Because the evidence for the role of structural housing and combinations of interventions (domestic or peri-domestic) against Aedes mosquitoes or dengue is still lacking, this systematic review and meta-analysis aimed to analyse and synthesize research focusing on the household as the unit of allocation. We searched MEDLINE, LILACS, and Web of Science databases until February 2023 using three general keyword categories: (1) "Aedes" or "dengue"; (2) structural housing interventions including "house", "water", or "drainage"; and (3) vector control interventions of potential relevance and their combinations. We performed a qualitative content analysis and a meta-analysis for 13 entries on dengue seroconversion data. 14,272 articles were screened by titles, 615 by abstracts, 79 by full-text. 61 were selected. Satisfactory data quality allowed for detailed content analysis. Interventions at the household level against the immature mosquito stages (21 studies, 34%) showed positive or mixed results in entomological and epidemiological outcomes (86% and 75% respectively). Combined interventions against immature and adult stages (11 studies, 18%) performed similarly (91% and 67%) while those against the adult mosquitoes (29 studies, 48%) performed less well (79%, 22%). A meta-analysis on seroconversion outcomes showed a not-statistically significant reduction for interventions (log odds-ratio: -0.18 [-0.51, 0.14 95% CI]). No basic research on housing structure or modification was eligible for this systematic review but many interventions with clear impact on vector indices and, to a lesser extent, on dengue were described. The small and not-statistically significant effect size of the meta-analysis highlights the difficulty of proving effectiveness against this highly-clustered disease and of overcoming practical implementation obstacles (e.g. efficacy loss, compliance). The long-term success of interventions depends on suitability, community commitment and official support and promotion. The choice of a specific vector control package needs to take all these context-specific aspects into consideration. This work was funded by a grant from the World Health Organization (2021/1121668-0, PO 202678425, NTD/VVE).

Dengue fever, a mosquito-borne viral illness transmitted by Aedes mosquitoes, continues to be a significant public health burden in tropical and subtropical regions. Traditional vector control methods, primarily reliant on insecticides and larvicides, face challenges because of emerging insecticide resistance and limited community engagement. This narrative review explores co-creation as a collaborative approach to dengue control, where communities actively participate in designing and implementing solutions. Through an examination of existing literature, we discuss the rationale for co-creation, the various methods employed, evidence for effectiveness, challenges, and other items. Findings from previous studies suggest that co-creation can empower communities by fostering a sense of ownership and responsibility for dengue control efforts. Using local knowledge and insights, co-creation approaches have also been shown to identify and address specific community needs and preferences, leading to more contextually relevant interventions. Additionally, co-creation initiatives have demonstrated success in promoting behavior change within communities, leading to increased uptakes of preventive measures such as proper waste management and use of personal protective measures. However, challenges such as building trust and collaboration, addressing power dynamics, and ensuring long-term sustainability remain critical factors that are essential to foster collaboration, empower communities, and develop sustainable strategies for dengue control in affected regions.

Elimination of visceral leishmaniasis (VL) in Southeast Asia and global control of cutaneous leishmaniasis (CL) and VL are priorities of the World Health Organization (WHO). But is the existing evidence good enough for public health recommendations? This meta-review summarises the available and new evidence for vector control with the aims of establishing what is known about the value of vector control for the control of CL and VL, establishing gaps in knowledge, and particularly focusing on key recommendations for further scientific work. This meta-review follows the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) criteria, including (1) systematic reviews and meta-analyses (SRs/MAs) for (2) vector control methods and strategies and (3) for the control of CL and/or VL. Nine SRs/MAs were included, with different research questions and inclusion/exclusion criteria. The methods analysed for vector control can be broadly classified into (1) indoor residual spraying (IRS); (2) insecticide-treated nets (ITNs; including insecticide-impregnated bednets); (3) insecticide-treated curtains (ITCs; including insecticide-treated house screening); (4) insecticide-treated bedsheets (ITSs) and insecticide-treated fabrics (ITFs; including insecticide-treated clothing) and (5) durable wall lining (treated with insecticides) and other environmental measures to protect the house; (6) control of the reservoir host; and (7) strengthening vector control operations through health education. The existing SRs/MAs include a large variation of different primary studies, even for the same specific research sub-question. Also, the SRs/MAs are outdated, using available information until earlier than 2018 only. Assessing the quality of the SRs/MAs, there is a considerable degree of variation. It is therefore very difficult to summarise the results of the available SRs/MAs, with contradictory results for both vector indices and—if available—human transmission data. Conclusions of this meta-review are that (1) existing SRs/MAs and their results make policy recommendations for evidence-based vector control difficult; (2) further work is needed to establish efficacy and community effectiveness of key vector control methods with specific SRs and MAs (3) including vector and human transmission parameters; and (4) attempting to conclude with recommendations in different transmission scenarios.

Introduction: Dengue has emerged as a major public health problem in Sri Lanka. Vector control at community level is a frequent and widespread strategy for dengue control. The aim of the study was to assess Aedes mosquito breeding sites and the prevention practices of community members in a heavily urbanized part of Colombo. Methods: A cross-sectional entomological survey was conducted from April to June 2013 in 1469 premises located in a subdistrict of the City of Colombo. Types of breeding sites and, where found, their infestation with larvae or pupae were recorded. Furthermore, a questionnaire was administered to the occupants of these premises to record current practices of dengue vector control. Results: The surveyed premises consisted of 1341 residential premises and 110 non-residential premises (11 schools, 99 work or public sites), 5 open lands, and 13 non-specified. In these 1469 premises, 15447 potential breeding sites suitable to host larvae of pupae were found; of these sites18.0% contained water. Among the 2775 potential breeding sites that contained water, 452 (16.3%) were positive for larvae and/or pupae. Schools were associated with the proportionally highest number of breeding sites; 85 out of 133 (63.9%) breeding sites were positive for larvae and/or pupae in schools compared with 338 out of 2288 (14.8%) in residential premises. The odds ratio (OR) for schools and work or public sites for being infested with larvae and/or pupae was 2.77 (95% CI 1.58, 4.86), when compared to residential premises. Occupants of 80.8% of the residential premises, 54.5% of the schools and 67.7% of the work or public sites reported using preventive measures. The main prevention practices were coverage of containers and elimination of mosquito breeding places. Occupants of residential premises were much more likely to practice preventive measures than were those of non-residential premises (OR 2.23; 1.49, 3.36). Conclusion: Schools and working sites were associated with the highest numbers of breeding sites and lacked preventive measures for vector control. In addition to pursuing vector control measures at residential level, public health strategies should be expanded in schools and work places.