African Union Commission

The Fair Priority Model offers a practical way to fulfill pledges to distribute vaccines fairly and equitably

Hypertension has always been regarded as a disease of affluence but this has changed drastically in the last two decades with average blood pressures now higher in Africa than in Europe and USA and the prevalence increasing among poor sections of society. We have conducted a literature search on PubMed on a broad range of topics regarding hypertension in Africa, including data collection from related documents from World Health Organization and other relevant organizations that are available in this field. We have shared the initial results and drafts with international specialists in the context of hypertension in Africa and incorporated their feedback. Hypertension is the number one risk factor for CVD in Africa. Consequently, cardiovascular disease (CVD) has taken over as number one cause of death in Africa and the total numbers will further increase in the next decades reflecting on the growing urbanization and related lifestyle changes. The new epidemic of hypertension and CVD is not only an important public health problem, but it will also have a big economic impact as a significant proportion of the productive population becomes chronically ill or die, leaving their families in poverty. It is essential to develop and share best practices for affordable and effective community-based programs in screening and treatment of hypertension. In order to prevent and control hypertension in the population, Africa needs policies developed and implemented through a multi-sectoral approach involving the Ministries of Health and other sectors including education, agriculture, transport, finance among others.

The novel coronavirus disease 2019, COVID-19, which is caused by severe acute respiratory syndrome
\nvirus 2 (SARS-CoV-2) [1] was first reported in December 2019 by Chinese Health Authorities following an outbreak of pneumonia of unknown origin in Wuhan, Hubei Province [2,3]. SARS-CoV-2 is
\nlikely of zoonotic origin, similar to SARS and Middle East Respiratory Syndrome (MERS), and transmitted between humans through respiratory droplets and fomites. Since its emergence, it has rapidly
\nspread globally [4].

ABSTRACT Between 1952 and 2012, there were a total of 88 successful military coups in Africa. Of those, 63 occurred prior to 1990, and 10 cases since the adoption, by the defunct Organization of African Unity (OAU), of the Lomé Declaration in July 2000, banning military coups and adopting sanctions against regimes born out of this. The article shows that the African Union (AU) has followed in the footsteps of the OAU in this regard. Assisted by some African regional organisations and international partners, the combined effect of this policy of the AU – assisted by other factors – has been a significant reduction in the occurrence of this phenomenon. While not constituting a funeral arrangement for military coups in the immediate future, these developments – if they were to continue – may indeed make this eventuality achievable in the long run. But the article also reveals some challenges the AU is facing in ensuring this.

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain major causes of heart failure, stroke and death among African women and children, despite being preventable and imminently treatable. From 21 to 22 February 2015, the Social Cluster of the Africa Union Commission (AUC) hosted a consultation with RHD experts convened by the Pan-African Society of Cardiology (PASCAR) in Addis Ababa, Ethiopia, to develop a 'roadmap' of key actions that need to be taken by governments to eliminate ARF and eradicate RHD in Africa. Seven priority areas for action were adopted: (1) create prospective disease registers at sentinel sites in affected countries to measure disease burden and track progress towards the reduction of mortality by 25% by the year 2025, (2) ensure an adequate supply of high-quality benzathine penicillin for the primary and secondary prevention of ARF/RHD, (3) improve access to reproductive health services for women with RHD and other non-communicable diseases (NCD), (4) decentralise technical expertise and technology for diagnosing and managing ARF and RHD (including ultrasound of the heart), (5) establish national and regional centres of excellence for essential cardiac surgery for the treatment of affected patients and training of cardiovascular practitioners of the future, (6) initiate national multi-sectoral RHD programmes within NCD control programmes of affected countries, and (7) foster international partnerships with multinational organisations for resource mobilisation, monitoring and evaluation of the programme to end RHD in Africa. This Addis Ababa communiqué has since been endorsed by African Union heads of state, and plans are underway to implement the roadmap in order to end ARF and RHD in Africa in our lifetime.

Seed policies primarily concentrate on the formal seed system, which supplies Sub-Saharan African countries less than 20% of the total seed demand and involves only a limited number of crops and varieties. Seed laws, and the mechanisms and organizations involved in their implementation, are developed with varying degrees of success. We address the limitations of applying a linear model to seed sector development and introduce integrated seed sector development (ISSD). We assess seed systems in Ethiopia, Mali, and Zambia, and demonstrate that one single model cannot address the variations in realities within one country or the continent. ISSD provides opportunities for taking a pluralistic approach in strengthening multiple seed systems, and has the potential to combine objectives targeting food security, agricultural development, promoting entrepreneurship, and contributing to biodiversity management. We elaborate pathways for ISSD-guided policies that include variety release, seed quality management, and plant breeders' rights.

COVID-19: Shining the Light on Africa

BACKGROUND: The impact of food-based interventions on child and maternal anthropometry and anemia has not been adequately studied. OBJECTIVE: This study tested the effect of an enhanced homestead food production (EHFP) program consisting of home garden, poultry raising, and nutrition education implemented over 2.5 years versus control (no intervention) on anthropometry and anemia among children (12-48 months) and their mothers. METHODS: An unblinded cluster-randomized controlled trial involving pre- and post-surveys with independent samples was conducted in rural areas of Baitadi District, Nepal. Data (including weight, height/length, and hemoglobin) were obtained from 2106 and 2614 mother-child pairs at baseline and follow-up, respectively. Changes in outcome variables (stunting, underweight, wasting, and anemia among children and underweight and anemia among mothers) were compared between the study groups using mixed-effects logistic regression models. RESULTS: At follow-up, anemia was significantly lower among children (odds ratio, OR [95% confidence interval, CI]: 0.76 [0.59-0.98]) and mothers (OR [95% CI]: 0.62 [0.48-0.82]) in the treatment group compared to the control. Underweight was lower among mothers in the treatment group compared to the control (OR [95% CI]: 0.61 [0.46-0.82]). There was no impact on child anthropometry. CONCLUSION: The EHFP intervention improved anemia among children aged 12 to 48 months and their mothers in Baitadi District of Nepal. The intervention also reduced underweight among these women, but had no impact on child growth, in this district.

Mycotoxins are major food contaminants affecting global food security, especially in low and middle-income countries. The European Union (EU) funded project, MycoKey, focuses on “Integrated and innovative key actions for mycotoxin management in the food and feed chains” and the right to safe food through mycotoxin management strategies and regulation, which are fundamental to minimizing the unequal access to safe and sufficient food worldwide. As part of the MycoKey project, a Mycotoxin Charter (charter.mycokey.eu) was launched to share the need for global harmonization of mycotoxin legislation and policies and to minimize human and animal exposure worldwide, with particular attention to less developed countries that lack effective legislation. This document is in response to a demand that has built through previous European Framework Projects—MycoGlobe and MycoRed—in the previous decade to control and reduce mycotoxin contamination worldwide. All suppliers, participants and beneficiaries of the food supply chain, for example, farmers, consumers, stakeholders, researchers, members of civil society and government and so forth, are invited to sign this charter and to support this initiative.

Human breast milk is considered as the best and ideal form of nutrition for infants. However, food contaminants such as mycotoxins, which may be transferred from maternal blood to milk, are poorly described. Mycotoxins are a major group of natural toxins frequently detected in foods. Here, we review the current state-of-the-art in the monitoring of mycotoxins in human breast milk, i.e., knowledge on occurrence, metabolism, and analytical assays utilized for their quantification. We highlight that most of the data captured to date have not been verified with the precision now capable utilizing LC-MS/MS and LC-HRMS approaches. One concern is that some studies may overestimate individual measures, and most cannot capture the patterns and levels of mycotoxin mixtures. We propose accurate assessment as a priority, especially for aflatoxins, fumonisins, ochratoxin A, zearalenone, and deoxynivalenol as well as their major metabolites. However, also so-called emerging toxins such as citrinin, the enniatins, beauvericin, aurofusarin, or Alternaria toxins should be considered to evaluate their potential relevance. Key requirements for analytical quality assurance are identified and discussed to guide future developments in this area. Moreover, research needs including investigations of lactational transfer rates, the role of human metabolism for bioactivation or detoxification, and an evaluation of potential combinatory effects of different mycotoxins are pointed out. It is hoped that LC-MS based multianalyte methods will enable more accurate, rapid and affordable human biomonitoring approaches that support informed decisions for maternal and infant health.

Undernutrition among under-five children is a public health concern in developing countries and has been linked with poor water, sanitation, and hygiene (WASH) practices. This study aimed at assessing WASH practices and its association with nutritional status of under-five children in semi-pastoral communities of Arusha. The study was cross-sectional in design. Mother–child pairs from 310 households in four villages of Monduli and Longido were involved. Weight and height of children were measured using weighing scale and length/height board, respectively. Children’s age was recorded using clinic cards. Hemoglobin level of each child was tested using Hemo Cue ® Hb 201 + photometer (HemoCue AB, Ängelholm, Sweden) machine. Structured questionnaire was used to gather information on WASH, child morbidity, demographic, and sociocultural characteristics. Prevalence of stunted, underweight, wasted, anemia, and diarrhea were 31.6%, 15.5%, 4.5% 61.2%, and 15.5%, respectively. Children with diarrhea 2 weeks preceding the survey ( P = 0.004), children using surface water for domestic purposes ( P < 0.001), and those with uneducated mothers ( P = 0.001) had increased risk of being stunted and underweight. Children introduced to complementary foods before 6 months of age ( P = 0.02) or belonging to polygamous families ( P = 0.03) had increased risk of being stunted. Consumption of cow’s milk that is not boiled ( P = 0.05) or being a boy ( P = 0.03) was associated with underweight. Prevalence of undernutrition among under-five children in the population under study was alarming and it could be associated with poor WASH practices and other sociocultural factors. This study underlines the importance of incorporating WASH strategies in formulation of interventions targeting on promotion of nutrition and disease prevention in pastoral communities.

New financing in clean energy technologies plays a progressively important role in increasing energy access in Sub-Saharan Africa (SSA). This research investigates the salient social dimensions of clean electricity access with the view to identify the most suitable SSA countries for funding and implementing decentralised renewable energy systems and sheds light on the opportunities for improving social conditions through clean electrification. Our multi-dimensional analysis of social considerations culminates in the Social Clean Energy Access (Social CEA) Index. The composite indicator structure was empirically tested and improved in terms of accuracy and robustness for 35 SSA countries. The Social CEA index captures the status of social factors on health, education, economic development, gender equality, and quality of life related to electricity access. The Social CEA Index strength is assessed by exploring the synergies between electricity access and social development and its progress over time is evaluated through a dimension's breakdown approach in Ghana.

On Jan 31, 2017, heads of states and governments of the African Union and the leadership of the African Union Commission will officially launch the Africa Centres for Disease Control and Prevention (Africa CDC) in Addis Ababa, Ethiopia. As detailed in the African Union's Africa Agenda 20631African UnionAgenda 2063: the Africa we want.http://agenda2063.au.int/en/documents/agenda-2063-africa-we-want-popular-version-final-editionGoogle Scholar—a roadmap for the development of the continent—some of the concerns that justified the establishment and initiation of an Africa-wide public health agency include rapid population growth; increasing and intensive population movement across Africa, with increased potential for new or re-emerging pathogens to turn into pandemics; existing endemic and emerging infectious diseases, including Ebola;2WHOEbola situation reports.http://apps.who.int/ebola/ebola-situation-reportsGoogle Scholar antimicrobial resistance;3Smith KF Goldberg M Rosenthal S et al.Global rise in human infectious disease outbreaks.J R Soc Interface. 2014; (published online Oct 29, 2014.)http://dx.doi.org/10.1098/rsif.2014.0950Crossref Scopus (295) Google Scholar increasing incidence of non-communicable diseases and injuries;4Marquez P V Farrington JL The challenge of non-communicable diseases and road traffic injuries in sub-Saharan Africa: an overview. World Bank, Washington, DC2013Google Scholar high maternal mortality rates; and threats posed by environmental toxins. In addition to these concerns, African countries are burdened with insufficient public health assets including surveillance, laboratory networks, competent workforce, and research expertise that hinder evidence-based decision-making. Public health institutes are a science-based source of guidance for public health policy formulation and implementation for decision-makers. Accordingly, the guiding values of the Africa CDC include leadership, credibility, ownership, transparency, and accountability. The institution will provide strategic direction and promote public health practice within member states through capacity building, minimisation of health inequalities, and promotion of continuous quality improvement in the delivery of public health services. It will also guide in the prevention of public health emergencies and threats through partnerships, science, policy, and data-driven interventions and programmes in line with international standards and WHO recommendations. In the next 5 years, the Africa CDC will work with member states, WHO, and partners to strengthen their capacity in four strategic priority areas: (1) health-related surveillance and innovative information systems, with a focus on improved capacity for event-based surveillance, disease prediction, and improved public health decision making and action; (2) functional and linked clinical and public health laboratory networks in the five geographic subregions of Africa; (3) support for member states' public health emergency preparedness and response plans; and (4) strengthened public health science for improved decision making and practice. To ensure capacity to implement the strategic priority areas, the Africa CDC will develop innovative programmes in the areas of competency-based workforce development, partnerships, financing of public health activities, and communication among member states. This approach will support African countries to achieve existing international health targets, including the Sustainable Development Goals, the International Health Regulations (IHR), and universal health coverage. The Africa CDC will operate on a decentralised model driven by implementation of operational approaches that enables member states to own and facilitate an increase in the proximity of their response capabilities. Thus, Africa CDC will operate as a network, with a headquarters in Addis Ababa and close linkage with five Regional Collaborating Centres in Egypt, Nigeria, Gabon, Zambia, and Kenya. Each collaborating centre will be equipped with laboratory and advanced diagnostic capacity to rapidly detect known and unknown pathogens. In addition, the Africa CDC will advocate and promote the establishment or strengthening of National Public Health Institutes (NPHIs) in each member state, resulting in an African Public Health Network. NPHIs provide a legal mandate for public health and can enhance public health research. Moreover, functional NPHIs provide a unique opportunity to create effective responses, improve efficiencies and hence reduce cost, and improve IHR core capacities by integrating disease surveillance and laboratory networks into robust and well-coordinated national disease intelligence hubs.5Koplan J Duserbury C Jousillahti P Puska P The role of national public health institutes in health infrastructure development: science based and often relatively apolitical, they deserve 10% of donors' funds.BMJ. 2007; 335: 824-835Crossref PubMed Scopus (15) Google Scholar The Africa CDC is expected to work with member states and WHO's Regional Offices in Africa to develop a framework for establishing and operating NPHIs, based on a stepwise approach aimed at improving capacities for disease surveillance at country level, laboratory networks, emergency operation centres, information systems, and pandemic preparedness and response plans with a surge capability to mobilise the workforce in times of need. NPHIs will be certified biannually through a thorough, quantitative, and transparent process, against clearly defined benchmarks agreed on in the framework. A similar stepwise improvement approach for capacity development has been used very effectively by the WHO Regional Office for Africa and the African Society for Laboratory Medicine in advancing laboratory networks in Africa and moving them towards accreditation: over 1100 facilities are now enrolled in the process. The Africa CDC will also assist member states to strengthen their core NPHI capacity through the development and implementation of competency-based tiered public health workforce programmes with an enabling environment for appropriate career paths in field epidemiology, laboratory management and leadership, and public health informatics. These programmes will be designed to suit needs at different levels of the health systems pyramid, including primary health care and community programmes at the base of the pyramid. NPHIs will also serve as coordinators of the one-health approach to disease control and prevention including coordinating engagements with ministries of agriculture, health, communications, defence, wildlife, and communication. The statute of the Africa CDC clearly requires close collaboration with WHO and other UN health agencies to coordinate and create synergies to better respond to disease threats in Africa. Accordingly, in August, 2016, WHO and the African Union Commission signed a framework for collaboration that will guide both institutions to leverage each other's strengths to improve disease management in Africa. The framework outlines key areas for coordination: enhanced capacity for IHR; improved surveillance (event-based and integrated disease surveillance); development and dissemination of information products for decision making, including health situation and risk analysis; investigation and emergency response, including surge capacity and stockpiles; and management of public health events. In addition, the Africa CDC will seek to strengthen close partnerships with non-governmental organisations including the African Field Epidemiology Network and the African Society for Laboratory Medicine. In summary, the recent Ebola virus disease pandemic clearly calls for greater investment in strengthening national responses.6Moon S Sridhar D Pate MA et al.Will Ebola change the game? Ten essential reforms before the next pandemic. The report of the Harvard-LSHTM Independent Panel on the Global Response to Ebola.Lancet. 2015; 386: 2204-2221Summary Full Text Full Text PDF PubMed Scopus (318) Google Scholar, 7Sands P Mundaca-Shah C Dzau VJ The neglected dimension of global security—a framework for countering infectious-disease crises.N Engl J Med. 2016; 374: 1281-1287Crossref PubMed Scopus (145) Google Scholar How successful the Africa CDC becomes in its mission will be determined by its capacity to develop the right partnerships, including with the private sector to invest in public health as a public good, adopting innovative approaches, and mobilising adequate resources. Through this inclusive approach, the Africa CDC is expected to fill a niche that enables rapid acquisition of critical public health surveillance data linked to joint response capabilities, which would mitigate the gap in response that has characterised public health events of significance in the past. It is now clear that disease outbreaks in Africa constitute national, economic, and health security threats that can quickly evolve into global health crises. We call for a strong commitment at the G20 summit in July, 2017, to championing the Africa CDC's strategic approach and its capacity to strengthen or establish NPHIs—a critical step in enabling countries to identify threats early and respond effectively. We declare no competing interests. Sustainable clinical laboratory capacity for health in AfricaThe 2008 Maputo Declaration on Strengthening of Laboratory Systems and the subsequent 2012 African Society for Laboratory Medicine Ministerial Call for Action1 drew attention to the importance of laboratory services. Most recently, laboratories have gained prominence in the accurate detection of infectious diseases—including emerging public health threats—and monitoring of antimicrobial drug resistance, especially within the context of the Global Health Security Agenda . Equally important, but relatively marginalised, is the role of laboratories in dealing with all diseases, in ensuring quality clinical care towards universal health coverage (UHC), and meeting the targets of Sustainable Development Goal 3. Full-Text PDF Open Access

OBJECTIVE: The COVID-19 pandemic is a biosecurity threat, and many resource-rich countries are stockpiling and/or making plans to secure supplies of vaccine, therapeutics, and diagnostics for their citizens. We review the products that are being investigated for the prevention, diagnosis, and treatment of COVID-19; discuss the challenges that countries in sub-Saharan Africa may face with access to COVID-19 vaccine, therapeutics, and diagnostics due to the limited capacity to manufacture them in Africa; and make recommendations on actions to mitigate these challenges and ensure health security in sub-Saharan Africa during this unprecedented pandemic and future public-health crises. MAIN BODY: Sub-Saharan Africa will not be self-reliant for COVID-19 vaccines when they are developed. It can, however, take advantage of existing initiatives aimed at supporting COVID-19 vaccine access to resource-limited settings such as partnership with AstraZeneca, the Coalition for Epidemic Preparedness and Innovation, the Global Alliance for Vaccine and Immunisation, the Serum Institute of India, and the World Health Organization's COVID-19 Technology Access Pool. Accessing effective COVID-19 therapeutics will also be a major challenge for countries in sub-Saharan Africa, as production of therapeutics is frequently geared towards profitable Western markets and is ill-adapted to sub-Saharan Africa realities. The region can benefit from pooled procurement of COVID-19 therapy by the Africa Centres for Disease Control and Prevention in partnership with the African Union. If the use of convalescent plasma for the treatment of patients who are severely ill is found to be effective, access to the product will be minimally challenging since the region has a pool of recovered patients and human resources that can man supportive laboratories. The region also needs to drive the local development of rapid-test kits and other diagnostics for COVID-19. CONCLUSION: Access to vaccines, therapeutics, and diagnostics for COVID-19 will be a challenge for sub-Saharan Africans. This challenge should be confronted by collaborating with vaccine developers; pooled procurement of COVID-19 therapeutics; and local development of testing and diagnostic materials. The COVID-19 pandemic should be a wake-up call for sub-Saharan Africa to build vaccines, therapeutics, and diagnostics manufacturing capacity as one of the resources needed to address public-health crises.

The period after 9/11 can be characterised as the terrorism moment in world history. Every actor in international relations—the state, regional, continental and international as well as civil society organisations—has been mobilised to combat what, apparently has been conceived as a common security threat to humanity. The transformation of the Organisation of African Unity (OAU) into the African Union (AU) was a divine coincidence at a time when multilateralism and international cooperation were being challenged by the threat of terrorism. In the post-9/11 period, the main concern of the Union has been to reinforce and implement existing counter-terrorism instruments adopted at the continental level in coordination with states and regional organisations. This article discusses and appraises the endeavours undertaken by the AU and its precursor organisation, the OAU, in tackling and dealing with the threat of terrorism despite limitations to its human and financial resources. In recognition of the nature of the states in Africa and the challenges facing the Union, we argue that the role of the AU remains critical in order to fill the gaps where its member states or regional mechanisms are lacking. In this regard, we stress that the role of the AU should be complementary and serve as an interface between the continent and the international community, including the United Nations.

Global leaders at the 2018 UN Climate Change Conference were powerfully reminded by Greta Thunberg that, “You say you love your children above all else. And yet you are stealing their future.”1Thunberg G High-level segment statement COP 24.https://unfccc.int/documents/187780Date accessed: May 10, 2019Google Scholar In less than 7 months, the 16-year-old environmental activist mobilised a global movement of young people in over 120 countries calling for urgent action to address climate change.2Hougaard R The true meaning of leadership—taught by our children.https://www.forbes.com/sites/rasmushougaard/2019/03/15/the-true-meaning-of-leadership-taught-by-our-children/#3cbb028e4c9cDate accessed: May 10, 2019Google Scholar Young people elsewhere are catalysing important conversations on crucial issues, such as Malala Yousafzai on global education and March for Our Lives on reforming gun control in the USA. The potential of youth engagement is striking, but how can their power be effectively amplified to address the most pressing and interconnected challenges in global health? Achieving the ambitions of the 2030 Agenda for Sustainable Development will not be possible without the meaningful engagement of young people.3WHOGlobal accelerated action for the health of adolescents (AA-HA!): guidance to support country implementation. World Health Organization, Geneva2017https://apps.who.int/iris/bitstream/handle/10665/255415/9789241512343eng.pdf;jsessionid=2191E184BC0EDC56D4BB1C42C15A0FF7?sequence=1Date accessed: May 10, 2019Google Scholar, 4Patton GC Sawyer SM Santelli JS et al.Our future: a Lancet commission on adolescent health and wellbeing.Lancet. 2016; 387: 2423-2478Summary Full Text Full Text PDF PubMed Scopus (1511) Google Scholar, 5UN Population FundThe power of 1·8 billion: adolescents, youth and the transformation of the future. United Nations Population Fund, New York, NY2014https://www.unfpa.org/sites/default/files/pub-pdf/EN-SWOP14-Report_FINAL-web.pdfDate accessed: May 10, 2019Google Scholar, 6WHO Joint UN Programme on HIV/AIDSUN Population FundUN Children's FundUN WomenThe World Bank GroupSurvive, thrive, transform. Global strategy for women's, children's and adolescents' health: 2018 report on progress towards 2030 targets. World Health Organization, Geneva2018http://www.unaids.org/sites/default/files/media_asset/EWECGSMonitoringReport2018_en.pdfDate accessed: May 10, 2019Google Scholar The world currently has the largest generation of youth in its history, with more than half the global population younger than 30 years.5UN Population FundThe power of 1·8 billion: adolescents, youth and the transformation of the future. United Nations Population Fund, New York, NY2014https://www.unfpa.org/sites/default/files/pub-pdf/EN-SWOP14-Report_FINAL-web.pdfDate accessed: May 10, 2019Google Scholar Perhaps just as noteworthy, among the 1·8 billion young people aged between 10 and 24 years, close to 90% live in low-income and middle-income countries, where health and social systems are often the most vulnerable.5UN Population FundThe power of 1·8 billion: adolescents, youth and the transformation of the future. United Nations Population Fund, New York, NY2014https://www.unfpa.org/sites/default/files/pub-pdf/EN-SWOP14-Report_FINAL-web.pdfDate accessed: May 10, 2019Google Scholar This cohort represents a magnitude of human potential, with massive unrealised benefits for both socioeconomic growth and health. In fact, the 2016 Lancet Commission on Adolescent Health and Wellbeing4Patton GC Sawyer SM Santelli JS et al.Our future: a Lancet commission on adolescent health and wellbeing.Lancet. 2016; 387: 2423-2478Summary Full Text Full Text PDF PubMed Scopus (1511) Google Scholar concluded that investing in adolescents will yield a triple dividend—in the present day, into their adulthood, and through to the next generation of children. Finally, with young people's unique ability to cut through the status quo and hold leaders accountable, they are today emerging as the most vocal advocates on complex issues in global health, such as gender inequality or sexual and reproductive health and rights. Their unparalleled fluency in social media and digital technology makes this generation the most likely to make solutions a reality. Awareness and efforts by many organisations to engage and enable young people to participate in decision making and policy dialogues in global health are increasing. Examples include the launch of the Global Health Workforce Network Youth Hub, the crowd-sourcing of obesity policy solutions from adolescents through CO-CREATE, the crowd-sourced NCDFREE social movement, or the inaugural African Union Youth Advisory Council. However, governance structures and a silo mentality prevent the creation of opportunities that are effective or fast enough to meaningfully tap into their potential. Quite simply, by failing to include the next generation of young leaders as equal partners in policy and practice, the Sustainable Development Goals will remain just that—important, yet ultimately unrealised, goals. The transformative potential of young people can only be achieved through participatory leadership; development of the necessary partnerships and resources to enable young people to fully engage as leaders are urgently needed.7Marcus R Cunningham A Young people as agents and advocates of development evidence gap map report. Overseas Development Institute, London2016https://www.odi.org/sites/odi.org.uk/files/resource-documents/11187.pdfDate accessed: May 10, 2019Google Scholar Recognising the need to ensure its work reflects the lived reality of young people's experiences and solutions, WHO commissioned the report Engaging Young People for Health and Sustainable Development.8WHOEngaging young people for health and sustainable development. Strategic opportunities for the World Health Organization and partners. World Health Organization, Geneva2018https://apps.who.int/iris/bitstream/handle/10665/274368/9789241514576-eng.pdf?ua=1Date accessed: May 10, 2019Google Scholar Launched in September, 2018, in conjunction with the UN Youth Strategy,9UNYouth2030: the United Nations strategy on youth.https://www.un.org/youthenvoy/youth-un/Date accessed: May 10, 2019Google Scholar the WHO report provides areas of strategic opportunity for WHO and its partners to transform the way it engages with young people in achieving its “triple billion” targets.4Patton GC Sawyer SM Santelli JS et al.Our future: a Lancet commission on adolescent health and wellbeing.Lancet. 2016; 387: 2423-2478Summary Full Text Full Text PDF PubMed Scopus (1511) Google Scholar Furthermore, the WHO Knowledge Action Portal offers an innovative opportunity to bring communities together, including young people, on the prevention and control of non-communicable diseases. In addition, the Partnership for Maternal, Newborn and Child Health, in collaboration with The International Youth Alliance for Family Planning and Family Planning 2020, created the Global Consensus Statement on Meaningful Adolescent and Youth Engagement,10Partnership for MaternalNewborn and Child HealthInternational Youth Alliance for Family Planning, and Family Planning 2020Global consensus statement on meaningful adolescent and youth engagement.https://www.who.int/pmnch/mye-statement.pdf?ua=1Date accessed: May 10, 2019Google Scholar defining it as an inclusive, intentional partnership between youth and adults. Importantly, the consensus notes that power must be shared, respective contributions must be valued, and young people's perspectives and skills must be integrated into both the strategic design and delivery of health and related programmes and policies, particularly when they affect young people's lives and communities. While we applaud this progress, much more must be done to position young people as equal stakeholders in the realisation of global, regional, and national goals in health. Notably, there remains substantial underinvestment of both intellectual and financial resources for the development and implementation of tangible and meaningful youth engagement strategies. The key to achieving meaningful youth engagement is the active investment in youth, particularly by governments, foundations, and the private sector. Furthermore, global institutions, such as WHO (panel), must act as leaders in engaging young people if they are to achieve health for all. To do this, such institutions must first critically reflect on themselves and commit to transforming their own ethos and organisational cultures by placing young people at the core of their strategy.PanelRecommendations for strategic opportunities to transform youth engagement with WHO and partners8WHOEngaging young people for health and sustainable development. Strategic opportunities for the World Health Organization and partners. World Health Organization, Geneva2018https://apps.who.int/iris/bitstream/handle/10665/274368/9789241514576-eng.pdf?ua=1Date accessed: May 10, 2019Google Scholar *Report commissioned by the WHO and led by two of the authors of this Comment (BB and RR). *Report commissioned by the WHO and led by two of the authors of this Comment (BB and RR).Leadership:•Create a fully resourced WHO strategy for engaging with young people•Modernise WHO culture to orient the organisation towards young people, ensuring that none are left behind in the Sustainable Development Goals eraCountry impact:•Engage all young people, taking into account their diverse backgrounds and characteristics, in health and sustainable development planning and implementation•Strengthen the capacity of organisations to engage safely, effectively, and meaningfully to enable young people to augment their knowledge and lead on health and rightsFocusing global public goods on impact:•Engage young people throughout the design and delivery of global public goods, particularly on issues that affect their health and rights•Establish an innovative partnership and technology-driven platform so that young people can share their experiences and ideas to monitor and drive change on health and the Sustainable Development GoalsPartnerships:•Forge innovative partnerships with diverse organisations that engage with young people•Mobilise resources for a comprehensive, coherent global movement that engages the power of young people for health and sustainable development Leadership: •Create a fully resourced WHO strategy for engaging with young people•Modernise WHO culture to orient the organisation towards young people, ensuring that none are left behind in the Sustainable Development Goals era Country impact: •Engage all young people, taking into account their diverse backgrounds and characteristics, in health and sustainable development planning and implementation•Strengthen the capacity of organisations to engage safely, effectively, and meaningfully to enable young people to augment their knowledge and lead on health and rights Focusing global public goods on impact: •Engage young people throughout the design and delivery of global public goods, particularly on issues that affect their health and rights•Establish an innovative partnership and technology-driven platform so that young people can share their experiences and ideas to monitor and drive change on health and the Sustainable Development Goals Partnerships: •Forge innovative partnerships with diverse organisations that engage with young people•Mobilise resources for a comprehensive, coherent global movement that engages the power of young people for health and sustainable development Young people not only want to be involved in actively achieving the Sustainable Development Goals, as evidenced through youth initiatives globally, but they are necessary partners in shaping and implementing effective policies and programmes in their own communities. The exclusion of young people at all levels of health and social systems delays progress at best and costs lives at worst. We are calling on all leaders in global health to actively dedicate resources to youth engagement and to urgently rethink approaches to enable young people to have the space, voice, audience, and influence that they need to shape and implement agendas, particularly on issues that affect their own health and wellbeing. Such a shift in framework and in mindset is necessary and will lead to new forms of powerful partnerships that will profoundly change the direction of health and sustainable development for a shared future. We declare no competing interests. We thank Rachael Hinton, Korane Idarousse, and Sabrina Sarli for their contribution to this manuscript.

BACKGROUND: Tsetse flies occur in much of sub-Saharan Africa where they are vectors of trypanosomes that cause human and animal African trypanosomosis. The sterile insect technique (SIT) is currently used to eliminate tsetse fly populations in an area-wide integrated pest management (AW-IPM) context in Senegal and Ethiopia. Three Glossina palpalis gambiensis strains [originating from Burkina Faso (BKF), Senegal (SEN) and an introgressed strain (SENbkf)] were established and are now available for use in future AW-IPM programmes against trypanosomes in West Africa. For each strain, knowledge of the environmental survival thresholds is essential to determine which of these strains is best suited to a particular environment or ecosystem, and can therefore be used effectively in SIT programmes. METHODS: In this paper, we investigated the survival and fecundity of three G. p. gambiensis strains maintained under various conditions: 25 °C and 40, 50, 60, and 75 % relative humidity (rH), 30 °C and 60 % rH and 35 °C and 60 % rH. RESULTS: The survival of the three strains was dependent on temperature only, and it was unaffected by changing humidity within the tested range. The BKF strain survived temperatures above its optimum better than the SEN strain. The SENbkf showed intermediate resistance to high temperatures. A temperature of about 32 °C was the limit for survival for all strains. A rH ranging from 40 to 76 % had no effect on fecundity at 25-26 °C. CONCLUSIONS: We discuss the implications of these results on tsetse SIT-based control programmes.

BACKGROUND: Healthcare-associated infections (HAIs) are a major global public health problem, increasing the transmission of drug-resistant infections. In Africa, the prevalence of HAIs among all hospital inpatients is estimated to be between 3% and 15%, but outbreaks are infrequently reported. Failure to detect and/or report outbreaks can increase the risk of ongoing infections and recurrent outbreaks. METHODS: A search of the PubMed, Web of Science, Cochrane Library, and other outbreak databases was performed to identify published literature on bacterial HAI outbreaks in Africa (January 2009 to December 2018). Details of the outbreak characteristics, hospital environment, and the control measures implemented were extracted. RESULTS: Twenty-two studies published over the 10-year period were identified. These reported 31 distinct outbreaks and a total of 31 causative pathogens, including Klebsiella pneumoniae (six outbreaks, 19%), Staphylococcus aureus (six outbreaks, 19%), and Enterococcus (five outbreaks, 16%). Most outbreaks were reported from university (n = 8, 26%) and tertiary hospitals (n = 11, 55%), from South Africa (n = 9, 41%) and Tunisia (n = 4, 18%). Interventions to control the outbreaks were described in 27 (90%) outbreaks, and all instituted or recommended enhancing hand hygiene and education. CONCLUSIONS: Few facilities in Africa reported HAI outbreaks over the 10-year period, suggesting substantial under-detection and under-reporting. The quality and timeliness of reporting require improvement to ensure changes in public health practice.

Modernization and expansion require heightened efforts

On July 3, 2017, African heads of state and government issued a declaration and committed to accelerating implementation of the 2005 International Health Regulations (IHR)1The African UnionAfrican Union heads of state and government commit to accelerate the implementation of international health regulations.https://www.au.int/web/en/pressreleases/20170707/african-union-heads-state-and-government-commit-accelerate-implementationDate: July 7, 2017Google Scholar and tasked the Africa Centres for Disease Control and Prevention (Africa CDC), the African Union Commission (AUC), and WHO with supporting the venture.1The African UnionAfrican Union heads of state and government commit to accelerate the implementation of international health regulations.https://www.au.int/web/en/pressreleases/20170707/african-union-heads-state-and-government-commit-accelerate-implementationDate: July 7, 2017Google Scholar The IHR is a global legal agreement that aims to prevent and respond to the spread of diseases to avoid their becoming international crises.2WHOStatement of the 14th IHR Emergency Committee regarding the international spread of poliovirus. World Health Organization, GenevaAug 3, 2017http://www.who.int/mediacentre/news/statements/2017/14th-ihr-polio/en/Google Scholar The Ebola virus disease outbreak that started in March 2014, resulted in an estimated 11 000 deaths3Centers for Disease Control and Prevention2014–2016 Ebola outbreak in west Africa.https://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/index.htmlDate: 2016Google Scholar and US$3 billion in economic losses in west Africa.4The World Bank2014–2015 west Africa Ebola crisis: impact update.www.worldbank.org/en/topic/macroeconomics/publication/2014-2015-west-africa-ebola-crisis-impact-updateGoogle Scholar The declaration is not only a reaffirmation of Africa's determination to scrupulously implement the IHR but should also serve as a new African public health order in addressing health security and inequities on the continent. Here we argue that a new public health order should address two broad categories of barrier that have challenged the implementation of IHR (2005) in Africa: health systems and systems for health. Five key improvements to the health system are necessary. First, public health capabilities should be strengthened, with national public health institutes as the drivers of IHR implementation. There should be improved infrastructure and enhanced capacities for integrated national and regional networks for disease surveillance, including laboratories, emergency operation centres, and innovative information systems. Second, a reward and penalty system should be implemented along with financial incentives to acknowledge whether progress has been made in implementing the core capacities of IHR through rigorous objective external stepwise assessments, such as the joint external evaluation (JEE), creating an IHR aggregate score for each country. Only 64 of 196 signatories to the IHR had developed the necessary core capacities as of 2015.5Kamradt-Scott A Strategic security analysis. Achieving global health security: the implementation of international health regulations. Center for Global Policy, GenevaJanuary, 2016www.gcsp.ch/download/5089/123206Google Scholar Third, implementation of the IHR should be decentralised to the subnational levels of the health service, with a strong community engagement. Fourth, the African public health workforce should be enabled to meet the IHR needs and other commitments at a national level, including by adapting and recognising community health-care worker programmes, field epidemiology training programmes with subspecialties to meet IHR requirements, field laboratory leadership programmes, public health informatics training programmes, and through public health management of hazards and pandemics. Fifth, governance procedures for the management of public health data sharing should be established. The continent's ability to generate, warehouse, and use quality public health data in real time is a challenge. As such, a culture of data sharing must be promoted in the new public health order. Data sharing is not a zero-sum game, so must be seen as a collective public health improvement to stimulate appropriate confidence among member states. Sharing disease data in a timely fashion through recently established public health constructs such as the Africa CDC's Regional Integrated Surveillance and Laboratory Networks will be critical to advance the implementation of IHR and enhance African health security. Not sharing disease data for public health is costly to countries as it can lead to duplicate research efforts to generate data that might already exist and might have enabled a neighbouring country to be better alerted, prepared, and able to respond to a disease threat. To accompany the health system strengthening agenda, a strong commitment to enhancing systems for health must be made. First, political commitment must be translated into action by making available the necessary domestic financing for strengthening health systems. Second, legal instruments to facilitate implementation of the IHR in member states should be issued—all member states should commit to establishing national public health institutes as the driving body for implementing the IHR. Third, country leadership and ownership needs to be encouraged. Partners and donors should commit to cooperating and coordinating their efforts within national plans for the IHR, with a clear and unified matrix for measuring progress—one country, one plan. The JEE tool developed by WHO in partnership with other organisations provides a unique opportunity for partner coordination, information sharing, and avoidance of fragmented efforts that often undercut national health systems. Fourth, there should be a private sector engagement strategy in which commitments to developing financial analogues to support health systems are treated as an investment and not a cost—outbreaks and pandemics constitute serious threats to businesses in Africa, including airlines, the hotel and leisure industry, banking, the food industry, and mining. Fifth, an AUC health diplomacy strategy must be developed to enable and supplement efforts for enhanced health systems and systems for health. The provision of the legal capacity by the appointed oversight institutions to implement corrective action on non-compliant member states will be key to the success of the IHR framework. In summary, the declaration of African heads of state and government offers a momentous opportunity for renewed engagement for strengthening health systems to accelerate implementation of the IHR and other commitments using a broader multisector approach including public–private philanthropic partnerships. We declare no competing interests.