Background: The World Health Organization developed the Global Action Plan on Antimicrobial resistance (AMR) as a priority because of the increasing threat posed to human health, animal health and agriculture. Countries around the world have been encouraged to develop their own National Action Plans (NAPs) to help combat AMR. The objective of this review was to assess the content of the NAPs and determine alignment with the Global Action Plan on Antimicrobial Resistance using a policy analysis approach. Body: National Action Plans were accessed from the WHO Library and systematically analysed using a policy analysis approach for actors, process, context and content. Information was assessed using a ‘traffic light’ system to determine agreeance with the five WHO Global Action Plans objectives. A total of 78 NAPs (70 WHO approved, eight not approved) from the five global regions were analysed. National action plans which provided more information regarding the consultative process and the current situation regarding AMR allowed greater insight to capabilities of the country. Despite the availability of guidelines to inform the development of the plans, there were many differences between plans with the content of information provided. High income countries indicated greater progression with objectives achievement while low and middle-income countries presented the need for human and financial resources. Conclusion: The national action plans provide an overview of activities underway to combat AMR globally. This analysis reveals how disconnected the process has been and how little information is being gathered globally.

Leptospirosis is probably the most widespread zoonotic disease in the world especially in tropical countries. There has been an increase in individual studies, which assessed the frequency of leptospirosis in flood conditions. Some studies showed contact with floods was significantly associated with the occurrence of leptospirosis while other studies reported differently. The objective of this meta-analysis was to synthesize the evidence on the risk factors which are associated with human leptospirosis following flooding. We set up the inclusion criteria and searched for the original studies, addressing leptospirosis in human with related to flood in health-related electronic databases including PubMed, Embase, Ovid Medline, google scholar and Scopus sources. We used the terms ‘leptospirosis’, ‘flood’, ‘risk factor’ and terms from the categories were connected with “OR” within each category and by “AND” between categories. The initial search yielded 557 citations. After the title and abstract screening, 49 full-text papers were reviewed and a final of 18 observational studies met the pre-specified inclusion criteria. Overall, the pooled estimates of 14 studies showed that the contact with flooding was a significant factor for the occurrence of leptospirosis (pooled OR: 2.19, 95%CI: 1.48–3.24, I²:86%). On stratification, the strength of association was greater in the case-control studies (pooled OR: 4.01, 95%CI: 1.26–12.72, I²:82%) than other designs (pooled OR:1.77,95%CI:1.18–2.65, I²:87%). Three factors such as ‘being male’(pooled OR:2.06, 95%CI:1.29–2.83), the exposure to livestock animals (pooled OR: 1.95, 95%CI:1.26–2.64), the lacerated wound (pooled OR:4.35, 95%CI:3.07–5.64) were the risk factors significantly associated with the incidence of leptospirosis following flooding in the absence of within-study heterogeneity (I²: 0%). We acknowledge study limitations such as publication bias and type 2 statistical errors. We recommended flood control and other environmental modifications that are expected to reduce the risk of leptospiral infection, and a multi-sectoral effort to this aspect would have long-term benefits.

Background: The pandemic of Coronavirus Disease 2019 (COVID-19) is a timely reminder of the nature and impact of Public Health Emergencies of International Concern. As of 12 January 2022, there were over 314 million cases and over 5.5 million deaths notified since the start of the pandemic. The COVID-19 pandemic takes variable shapes and forms, in terms of cases and deaths, in different regions and countries of the world. The objective of this study is to analyse the variable expression of COVID-19 pandemic so that lessons can be learned towards an effective public health emergency response. Methods: We conducted a mixed-methods study to understand the heterogeneity of cases and deaths due to the COVID-19 pandemic. Correlation analysis and scatter plot were employed for the quantitative data. We used Spearman’s correlation analysis to determine relationship strength between cases and deaths and socio-economic and health systems. We organized qualitative information from the literature and conducted a thematic analysis to recognize patterns of cases and deaths and explain the findings from the quantitative data. Results: We have found that regions and countries with high human development index have higher cases and deaths per million population due to COVID-19. This is due to international connectedness and mobility of their population related to trade and tourism, and their vulnerability related to older populations and higher rates of non-communicable diseases. We have also identified that the burden of the pandemic is also variable among high- and middle-income countries due to differences in the governance of the pandemic, fragmentation of health systems, and socio-economic inequities. Conclusion: The COVID-19 pandemic demonstrates that every country remains vulnerable to public health emergencies. The aspiration towards a healthier and safer society requires that countries develop and implement a coherent and context-specific national strategy, improve governance of public health emergencies, build the capacity of their (public) health systems, minimize fragmentation, and tackle upstream structural issues, including socio-economic inequities. This is possible through a primary health care approach, which ensures provision of universal and equitable promotive, preventive and curative services, through whole-of-government and whole-of-society approaches.