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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.

\"A ... history of Western liberal democracy over the last forty years, from the fundamental series of changes in the 1970s to its latest, present incarnation\"-- Provided by publisher.

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.

Background Pacific island countries (PICs), including Fiji, are among the most vulnerable to the health impacts of climate change. In Fiji, acute watery diarrhea (AWD) remains a common communicable disease of public health concern, yet evidence regarding direct meteorological drivers remains equivocal, especially in Pacific settings. This study examined the associations between rainfall, temperature, and humidity and AWD incidence across districts, while also assessing seasonal and autoregressive influences. Methods An ecological time-series analysis was conducted using eight years (2016–2023) of surveillance data from the Early Warning Alert and Response System (EWARS). Meteorological predictors included monthly averages of rainfall, temperature, and humidity. Negative binomial mixed-effects regression models were used to examine associations between AWD incidence and meteorological variables, adjusting for seasonal indicators, autoregressive terms, and district population. The analyses were stratified by age group (under five years [U5] and individual five years and older [O5]) and by division. Results Strong seasonal trends were observed: AWD incidence peaked in Quarter 1 (January–March) for both the U5 (RR 1.20, 95% CI 1.06–1.37) and O5 (RR 1.25, 95% CI 1.12–1.39) populations, compared to Quarter 4 (October–December). Quarter 3 (July–September) showed reduced risk (U5: RR 0.89, 95% CI 0.80–0.99; O5: RR 0.91, 95% CI 0.83–0.99). Prior-month AWD incidence consistently predicted current-month incidence (U5: RR 1.006, 95% CI 1.004–1.007; O5: RR 1.002, 95% CI 1.002–1.003). No significant associations between AWD incidence and average monthly rainfall, temperature, or humidity. Regional heterogeneity emerged: in the Central Division, elevated temperatures increased AWD risk for both age groups (U5: RR 1.03, 95% CI 1.00–1.07; O5: RR 1.05, 95% CI 1.02–1.07) and high humidity increased risk in U5 (RR 1.02, 95% CI 1.01–1.03); In the Western Division, elevated temperature was protective for U5 (RR 0.98, 95% CI 0.96–1). Conclusion AWD incidence in Fiji's Central and Western Divisions is driven primarily by seasonal and autoregressive patterns rather than average monthly meteorological factors. Strong Quarter 1 peaks (20–25% elevated risk) provide a predictable signal for proactive intervention. Context-dependent climate-disease relationships emerged, with Central Division showing temperature and humidity associations absent in Western region. These findings support calendar-based preparedness, with district-specific vulnerability assessments guiding pre-positioned WASH and medical resources in high-risk areas before the annual Quarter 1 surge.

Background Diarrheal disease, including acute watery diarrhea (AWD), remains a persistent global health challenge, particularly in settings with inadequate water and sanitation infrastructure. Understanding the local epidemiological features of AWD is a crucial first step to inform effective public health intervention. This study examines the AWD trends in Fiji and their association with water and sanitation service levels as defined by the WHO/UNICEF Joint Monitoring Programme. Methods This ecological study analysed longitudinal syndromic surveillance data on AWD cases reported in Fiji’s Central and Western Divisions from April 2016 to December 2021, alongside census derived water and sanitation data. Age-specific trends, seasonal patterns, and district-level variations were assessed using descriptive statistics and Pearson’s correlation analyses. The associations between AWD incidence, water and sanitation service levels were evaluated using negative binomial regression, adjusting for district-level population confounders. Additionally, population attributable risk (PAR) was calculated to estimate the proportion of AWD cases linked to unimproved water and sanitation services. Results Children under 5 years old (U5) had the highest incidence of AWD throughout the study period, with both age groups showing a seasonal trend from February to April annually. AWD rates declined during the period when COVID-19 travel restrictions were in place. A strong correlation existed between U5 and O5 cases across all years ( R  = 0.59–0.88; 95% CI: 0.45–0.92; p  < 0.001). Nearly 18% of AWD cases were attributable to unimproved water (PAR 17.46%) and sanitation (PAR 17.80%). Access to safely managed water service reduced AWD risk (reference category), while unimproved water (RR 3.42; 95% CI: 2.66–4.38) and sanitation (RR 7.56; 95% CI: 4.21–13.58) service levels posed the highest risks. Conclusion Advancing access to safely managed water and sanitation is essential to mitigate AWD. Investments in water and sanitation infrastructure particularly in underserved and high-risk areas should be prioritised. The findings underscore the importance of context-specific Water and Sanitation interventions in Pacific Island settings. Highlights • Acute watery diarrhea (AWD) burden disproportionately affects young children. • Seasonal peaks in AWD cases between February and April, with a strong correlation between incidences in under-five (U5) and over-five age group (O5). • Unimproved water supply and unimproved sanitation contribute to increased AWD risk. • Safely managed water and sanitation services demonstrate protective effects against AWD.

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.

Background: Communicable diseases remain a significant global health issue. The increase in refugees and asylum seekers associated with conflicts may alter the burden of communicable diseases in host countries. We conducted a systematic review of the prevalence of TB, HBC, HCV, and HIV among refugees and asylum seekers by regions of asylum and origin. Methods: Four electronic databases were searched from initiation to the 25 December 2022. Prevalence estimates were pooled into a random-effect model and were stratified by the region of origin and asylum. Meta-analysis was conducted to explore the heterogeneity of the included studies. Results: The most-reported asylum region was The Americas, represented by the United States of America. Asia and the Eastern Mediterranean was the region of the most-reported origin. The highest reported prevalence of active TB and HIV was among African refugees and asylum seekers. The highest reported prevalence of latent TB, HBV and HCV was among Asian and Eastern Mediterranean refugees and asylum seekers. High heterogeneity was found regardless of the communicable disease type or stratification. Conclusion: This review provided insights about refugees’ and asylum seekers’ status around the world and attempted to connect refugees’ and asylum seekers’ distribution and the burden of communicable diseases.

Chronic kidney disease of unknown cause is prevalent in a range of communities; however, its etiology remains unclear. We examined the association between pesticide exposures and the risk of kidney function loss using four waves of the National Health and Nutrition Examination Survey (NHANES) to identify a pathological pathway. We pooled data from four cross-sectional waves of NHANES, with 41,847 participants in total. Exposure to malathion increased the risk of low kidney function (aOR = 1.26, 95% CI = 1.01–1.56) in the adjusted model. Increased risk of low kidney function was not found among those exposed to 2,4-D (aOR = 0.88, 95% CI = 0.72–1.09), 3,5,6-trichloropyridinol (aOR = 0.96, 95% CI = 0.83–1.12), and 3-PBA (aOR = 1.03, 95% CI = 0.94–1.13). Our findings provide evidence of altered kidney function in people exposed to malathion, highlighting the potential of organophosphate pesticides’ role in renal injury.

Cognitive cloud computing in space (3CS) describes a new frontier of space innovation powered by Artificial Intelligence, enabling an explosion of new applications in observing our planet and enabling deep space exploration. In this framework, machine learning (ML) payloads—isolated software capable of extracting high level information from onboard sensors—are key to accomplish this vision. In this work we demonstrate, in a satellite deployed in orbit, a ML payload called ‘WorldFloods’ that is able to send compressed flood maps from sensed images. In particular, we perform a set of experiments to: (1) compare different segmentation models on different processing variables critical for onboard deployment, (2) show that we can produce, onboard, vectorised polygons delineating the detected flood water from a full Sentinel-2 tile, (3) retrain the model with few images of the onboard sensor downlinked to Earth and (4) demonstrate that this new model can be uplinked to the satellite and run on new images acquired by its camera. Overall our work demonstrates that ML-based models deployed in orbit can be updated if new information is available, paving the way for agile integration of onboard and onground processing and “on the fly” continuous learning.