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Objectives Cholera has a long history in India and Bangladesh, the region where six out of the past seven global pandemics have been seeded. The changing climate and growing population have led to global cholera cases remaining high despite a consistent improvement in the access to clean water and sanitation. We aim to provide a holistic overview of variables influencing environmental cholera transmission within the context of India and Bangladesh, with a focus on the mechanisms by which they act. Content We identified 56 relevant texts (Bangladesh n = 40, India n = 7, Other n = 5). The results of the review found that cholera transmission is associated with several socio-economic and environmental factors, each associated variable is suggested to have at least one mediating mechanism. Increases in ambient temperature and coastal sea surface temperature support cholera transmission via increases in plankton and a preference of Vibrio cholerae for warmer waters. Increased rainfall can potentially support or reduce transmission via several mechanisms. Summary and outlook Common issues in the literature are co-variance of seasonal factors, limited access to high quality cholera data, high research bias towards research in Dhaka and Matlab (Bangladesh). A specific and detailed understanding of the relationship between SST and cholera incidence remains unclear.

Schools represent a unique setting for promoting lifelong physical activity during critical development stages of life. Opportunities for in-school physical activity largely depend upon school-level policies, practices, and administrative support. A significant information gap exists on the factors influencing adolescents' participation in school-based physical activity programs in Nigeria. This study aimed to identify and explore the barriers and facilitators of physical activity in school-attending adolescents in Lagos State, Nigeria.A qualitative study, using semistructured interviews, was conducted to explore the views and experiences of 21 decision-makers who were responsible for planning the physical and health education curriculum in secondary schools in Lagos State, Nigeria. Data were analyzed using the thematic analysis framework.Eight themes were identified and explored. The barriers were (i) students' characteristics, (ii) parental objections, (iii) no prioritization of physical activity, (iv) insufficient resources, and (v) challenges with schools' initiatives. The facilitators were (vi) students' interests, (vii) students' awareness of benefits, and (viii) schools' initiatives.Our study findings can help in designing interventions to increase physical activity among school-attending adolescents in Lagos, Nigeria.

ObjectivesThis systematic review aims to identify the secondary attack rates (SAR) to adults and other children when children are the index cases within household settings.MethodsThis literature review assessed European-based studies published in Medline and Embase between January 2020 and January 2022 that assessed the secondary transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within household settings. The inclusion criteria were based on the PEO framework (P-Population, E-Exposure, O-Outcome) for systematic reviews. Thus, the study population was restricted to humans within the household setting in Europe (population), in contact with pediatric index cases 1–17 years old (exposure) that led to the transmission of SARS-CoV-2 reported as either a SAR or the probability of onward infection (outcome).ResultsOf 1,819 studies originally identified, 25 met the inclusion criteria. Overall, the SAR ranged from 13% to 75% in 23 studies, while there was no evidence of secondary transmission from children to other household members in two studies. Evidence indicated that asymptomatic SARS-CoV-2 index cases also have a lower SAR than those with symptoms and that younger children may have a lower SAR than adolescents (>12 years old) within household settings.ConclusionsSARS-CoV-2 secondary transmission from paediatric index cases ranged from 0% to 75%, within household settings between January 2020 and January 2022, with differences noted by age and by symptomatic/asymptomatic status of the index case. Given the anticipated endemic circulation of SARS-CoV-2, continued monitoring and assessment of household transmission is necessary.

Objective: The objective of this review was to synthesize the association between built environment constructs and physical activity among children and adolescents in Africa.Introduction: Previous reviews have found that several built environment constructs, such as residential density, crime safety, and availability of physical activity facilities and infrastructure, are associated with physical activity in children and adolescents; however, these reviews have tended to focus on non-African countries. Therefore, this systematic review synthesized the association between the built environment and physical activity among children and adolescents in Africa.Inclusion criteria: This systematic review included comparative observational studies that assessed the relationship between built environmental constructs on physical activity among children and adolescents (between the ages of five and 19 years) in Africa.Methods: Comprehensive electronic searches of MEDLINE, Embase, Web of Science, CINAHL, Web of Science, PsycINFO, Scopus, SPORTDiscus, EThOS, and ProQuest Dissertations and Theses from inception to 22 October 2021 were conducted to identify relevant published and unpublished studies. Two reviewers independently screened papers, assessed the quality of the included studies using the JBI standard critical appraisal tool, and extracted data using a pre-piloted form. Where possible, data were synthesized using random effects meta-analyses, with effect sizes reported as mean differences (MD) with 95% confidence intervals (CI). The Grading of Recommendations Assessment, Development and Evaluations (GRADE) was used to assess the certainty of the findings.Results: Of the 10,706 identified records, six cross-sectional studies were included which comprised 4628 children and adolescents. Three of the studies had a high-quality score of ?7 out of 8. Seven built environment constructs were reported within the included studies namely, residential density, street connectivity, crime safety, availability of physical activity facilities and infrastructure, walkability, esthetics, and traffic safety. Three of the constructs were assessed with objective measures. Results from individual studies found significant associations between physical activity and objective measure of traffic safety (MD 2.63 minutes; 95% CI 0.16 to 5.1; one study) and an objective measure of crime safety (MD 2.72 minutes; 95% CI 0.07 to 5.37; one study). No significant associations were found between active transportation and any of the built environment constructs. The GRADE evidence for all of the assessed constructs was either low (the built environment constructs may lead to little or no difference in physical activity or active transportation) or very low (it was uncertain whether the built environment constructs affect physical activity).Conclusion: In African settings, the evidence base for the association between built environment constructs and physical activity is limited, with no consistent evidence of an association. Therefore, further high-quality studies should be conducted before firm conclusions can be drawn.Systematic review registration number: PROSPERO CRD42019133324.

BACKGROUND Epidemiological literature on the health risks associated with non-optimal temperature has mostly reported average estimates across large areas or specific population groups. However, the heterogeneous distribution of drivers of vulnerability can result in local differences in health risks associated with heat and cold. We aimed to analyse the association between ambient air temperature and all-cause mortality across England and Wales and characterise small scale patterns in temperature-related mortality risks and impacts. METHODS We performed a country-wide small-area analysis using data on all-cause mortality and air temperature for 34 753 lower super output areas (LSOAs) within 348 local authority districts (LADs) across England and Wales between Jan 1, 2000, and Dec 31, 2019. We first performed a case time series analysis of LSOA-specific and age-specific mortality series matched with 1 × 1 km gridded temperature data using distributed lag non-linear models, and then a repeated-measure multivariate meta-regression to pool LAD-specific estimates using area-level climatological, socioeconomic, and topographical predictors. FINDINGS The final analysis included 10 716 879 deaths from all causes. The small-area assessment estimated that each year in England and Wales, there was on average 791 excess deaths (empirical 95% CI 611-957) attributable to heat and 60 573 (55 796-65 145) attributable to cold, corresponding to standardised excess mortality rates of 1·57 deaths (empirical 95% CI 1·21-1·90) per 100 000 person-years for heat and 122·34 deaths (112·90-131·52) per 100 000 person-years for cold. The risks increased with age and were highly heterogeneous geographically, with the minimum mortality temperature ranging from 14·9°C to 22·6°C. Heat-related mortality was higher in urban areas, whereas cold-related mortality showed a more nuanced geographical pattern and increased risk in areas with greater socioeconomic deprivation. INTERPRETATION This study provides a comprehensive assessment of excess mortality related to non-optimal outdoor temperature, with several risk indicators reported by age and multiple geographical levels. The analysis provides detailed risk maps that are useful for designing effective public health and climate policies at both local and national levels. FUNDING Medical Research Council, Natural Environment Research Council, EU Horizon 2020 Programme, National Institute of Health Research.

Climate change is the greatest threat to global public health, although the impacts on mental health are relatively understudied. Furthermore, there is a lack of consensus about the effects of climate change on individuals with pre-existing mental health problems. This review aimed to identify the health impacts of climate change on people with pre-existing mental health problems. The search was conducted across three databases; studies were included if they involved participants who had mental health problem(s) before a climate-driven event and reported on health outcomes post-event. A total of thirty-one studies met the full inclusion criteria. The study characteristics included 6 climate-driven events: heat events, floods, wildfires, wildfire and flood, hurricanes, and droughts, and 16 categories of pre-existing mental health problems, with depression, and non-specified mental health problems being the most common. The majority of the studies (90%, n = 28) suggest an association between the presence of pre-existing mental health problems and the likelihood of adverse health impacts (e.g., increased mortality risk, new symptom presentation, and an exacerbation of symptoms). To mitigate the exacerbation of health inequalities, people with pre-existing mental health problems should be included in adaption guidance and/or plans that mitigate the health impacts of climate change, future policy, reports, and frameworks.

ObjectivesCOVID-19 poses a threat of loss of life, economic instability, and social disruption. We conducted a systematic review of published economic analyses to assess the direct and indirect costs of the SARS-CoV-2 pandemic, and to contrast these with the costs and the cost-benefit of public health surveillance, preparedness, and response measures in averting and/or responding to SARS-CoV-2 pandemic.SettingA systematic literature review was conducted to identify peer-reviewed articles estimating the cost of the COVID-19 pandemic and the cost-effectiveness of pharmaceutical or non-pharmaceutical interventions in EU/EEA/UK and OECD countries, published from the 1st of January 2020 through 22nd April 2021 in Ovid Medline and EMBASE. The cost-effectiveness of interventions was assessed through a dominance ranking matrix approach. All cost data were adjusted to the 2021 Euro, with interventions compared with the null.Primary and secondary outcome measuresDirect and indirect costs for SARS-CoV-2 and preparedness and/or response or cost-benefit and cost-effectiveness were measured.ResultsWe included data from 41 economic studies. Ten studies evaluated the cost of COVID-19 pandemic, while 31 assessed the cost-benefit of public health surveillance, preparedness, and response measures. Overall, the economic burden of SARS-CoV-2 was found to be substantial for both the general population and within specific population subgroups. Community screening, bed provision policies, investing in personal protective equipment and vaccination strategies were cost-effective, in most cases due to the representative economic value of below acceptable cost-effectiveness thresholds. Physical distancing measures were associated with health benefits; however, their cost-effectiveness was dependent on the duration, compliance and the phase of the epidemic in which it was implemented.ConclusionsSARS-CoV-2 is associated with substantial economic costs to healthcare systems, payers, and societies, both short term and long term, while interventions including testing and screening policies, vaccination and physical distancing policies were identified as those presenting cost-effective options to deal with the pandemic, dependent on population vaccination and the Re at the stage of the pandemic.

ObjectivesSchool closures have been used as a core non-pharmaceutical intervention (NPI) during the COVID-19 pandemic. This review aims at identifying SARS-CoV-2 transmission in educational settings during the first waves of the pandemic.MethodsThis literature review assessed studies published between December 2019 and 1 April 2021 in Medline and Embase, which included studies that assessed educational settings from approximately January 2020 to January 2021. The inclusion criteria were based on the PCC framework (P-Population, C-Concept, C-Context). The studyPopulationwas restricted to people 1–17 years old (excluding neonatal transmission), theConceptwas to assess child-to-child and child-to-adult transmission, while theContextwas to assess specifically educational setting transmission.ResultsFifteen studies met inclusion criteria, ranging from daycare centres to high schools and summer camps, while eight studies assessed the re-opening of schools in the 2020–2021 school year. In principle, although there is sufficient evidence that children can both be infected by and transmit SARS-CoV-2 in school settings, the SAR remain relatively low—when NPI measures are implemented in parallel. Moreover, although the evidence was limited, there was an indication that younger children may have a lower SAR than adolescents.ConclusionsTransmission in educational settings in 2020 was minimal—when NPI measures were implemented in parallel. However, with an upsurge of cases related to variants of concern, continuous surveillance and assessment of the evidence is warranted to ensure the maximum protection of the health of students and the educational workforce, while also minimising the numerous negative impacts that school closures may have on children.

Objective The objective of this systematic review is to summarize the association between the built environment and physical activity in children and adolescents in Africa. Introduction Physical activity offers immense benefits to children and adolescents. Some built environment constructs, such as street connectivity and the availability of parks, have been identified to facilitate physical activity in children and adolescents; however, this evidence has come from developed countries. This review will present evidence from Africa on the built environment constructs that facilitate physical activity in children and adolescents. Inclusion criteria This review will consider quantitative studies that have built environment constructs as one of their exposure variables and physical activity as one of their outcomes and were conducted in children and adolescents aged five to 19 years residing in Africa. Methods A systematic search of MEDLINE, Embase, Web of Science and other sources will be conducted to locate both published and unpublished studies. There will be no date or language restrictions. Titles, abstracts, and full text of articles retrieved from the search will be screened and read by two reviewers independently for eligibility. Included articles will be critically appraised independently by two reviewers. Data extraction will be performed in two phases, first for information regarding the study characteristics and then to extract specific study findings. Meta-analysis will be used to synthesize the findings from the studies; however, where this is not possible, a narrative synthesis will be performed. Systematic review registration number PROSPERO CRD42019133324.

BackgroundAs mortality from COVID-19 is strongly age-dependent, we aimed to identify population subgroups at an elevated risk for adverse outcomes from COVID-19 using age/gender-adjusted data from European cohort studies with the aim to identify populations that could potentially benefit from booster vaccinations.MethodsWe performed a systematic literature review and meta-analysis to investigate the role of underlying medical conditions as prognostic factors for adverse outcomes due to SARS-CoV-2, including death, hospitalisation, Intensive Care Unit (ICU) admission, and mechanical ventilation within three separate settings (community, hospital and ICU). Cohort studies that reported at least age and gender-adjusted data from Europe were identified through a search of peer-reviewed articles published until 11th June 2021 in Ovid Medline and Embase. Results are presented as Odds Ratios (ORs) with 95% confidence intervals (95%C.I.) and absolute risk differences (RD) in deaths per 1,000 COVID-19 patients.FindingsWe included 88 cohort studies with age/gender adjusted data from 6,653,207 SARS-CoV-2 patients from Europe. Hospital-based mortality was associated with high and moderate certainty evidence for solid organ tumours, diabetes mellitus, renal disease, arrhythmia, ischemic heart disease, liver disease, and obesity, while a higher risk, albeit with low certainty, was noted for chronic obstructive pulmonary disease and heart failure. Community-based mortality was associated with a history of heart failure, stroke, diabetes, and end-stage renal disease. Evidence of high/moderate certainty revealed a strong association between hospitalisation for COVID-19 and solid organ transplant recipients, sleep apnoea, diabetes, stroke, and liver disease.InterpretationThe results confirmed the strong association between specific prognostic factors and mortality and hospital admission. Prioritisation of booster vaccinations and the implementation of non-pharmaceutical protective measures for these populations may contribute to a reduction in COVID-19 mortality, ICU and hospital admissions.FundingEuropean Centre for Disease Prevention and Control (ECDC) under specific contract No. 10 ECD.11843 within Framework contract ECDC/2019/001 Lot 1B.

High NO2 concentrations (long term average of 383 µg/m3 in 2016/2017) recorded at Birmingham New Street railway station have resulted in the upgrade of the bi-directional fan system to aid wind dispersion within the enclosed platform environment. This paper attempts to examine how successful this intervention has been in improving air quality for both passengers and workers within the station. New air pollution data in 2020 has enabled comparisons to the 2016/2017 monitoring campaign revealing a 23–42% decrease in measured NO2 concentrations. The new levels of NO2 are below the Occupational Health standards but still well above the EU Public Health Standards. This reduction, together with a substantial decrease (up to 81%) in measured Particulate Matter (PM) concentrations, can most likely be attributed to the new fan system effectiveness. Carbon Monoxide levels were well below Occupational and Public Health Standards at all times. The COVID19 pandemic “initial lockdown” period has also allowed an insight into the resultant air quality at lower rail-traffic intensities, which produced a further reduction in air pollutants, to roughly half the pre-lockdown concentrations. This study shows the scope of improvement that can be achieved through an engineering solution implemented to improve the ventilation system of an enclosed railway station. Further reduction in air pollution would require additional approaches, such as the removal of diesel engine exhaust emissions via the adoption of electric or diesel-electric hybrid powered services.

Climate change requires urgent action; however, it can be challenging to identify individual-level behaviours that should be prioritised for maximum impact. The study aimed to prioritise climate change mitigation behaviours according to their impacts on climate change and public health, and to identify associated barriers and facilitators—exploring the impact of observed behaviour shifts associated with COVID-19 in the UK. A three-round Delphi study and expert workshop were conducted: An expert panel rated mitigation behaviours impacted by COVID-19 in relation to their importance regarding health impacts and climate change mitigation using a five-point Likert scale. Consensus on the importance of target behaviours was determined by interquartile ranges. In total, seven target behaviours were prioritised: installing double/triple glazing; installing cavity wall insulation; installing solid wall insulation; moving away from meat/emission heavy diets; reducing the number of cars per household; walking shorter journeys; and reducing day/weekend leisure car journeys. Barriers related to the costs associated with performing behaviours and a lack of complementary policy-regulated subsidies. The target behaviours are consistent with recommendations from previous research. To ensure public uptake, interventions should address behavioural facilitators and barriers, dovetail climate change mitigation with health co-benefits and account for the long-term impacts of COVID-19 on these behaviours.

ObjectivesThis systematic review aims to identify the secondary attack rates (SAR) to adults and other children when children are the index cases within household settings.MethodsThis literature review assessed European-based studies published in Medline and Embase between January 2020 and January 2022 that assessed the secondary transmission of SARS-CoV-2 within household settings. The inclusion criteria were based on the Population, Exposure, Outcome framework for systematic reviews. Thus, the study population was restricted to humans within the household setting in Europe (population), in contact with paediatric index cases 1–17 years old (exposure) that led to the transmission of SARS-CoV-2 reported as either an SAR or the probability of onward infection (outcome).ResultsOf 1819 studies originally identified, 19 met the inclusion criteria. Overall, the SAR ranged from 13% to 75% in 15 studies, while there was no evidence of secondary transmission from children to other household members in one study. Evidence indicated that asymptomatic SARS-CoV-2 index cases also have a lower SAR than those with symptoms and that younger children may have a lower SAR than adolescents (>12 years old) within household settings.ConclusionsSARS-CoV-2 secondary transmission from paediatric index cases ranged from 0% to 75%, within household settings between January 2020 and January 2022, with differences noted by age and by symptomatic/asymptomatic status of the index case. Given the anticipated endemic circulation of SARS-CoV-2, continued monitoring and assessment of household transmission is necessary.

BackgroundThe study objective was to conduct a systematic review to assess the effectiveness of non-pharmaceutical interventions (NPIs) to reduce the transmission of SARS-CoV-2 in Europe during the first wave of the pandemic.MethodsWe searched OVID Medline, EMBASE, and the Cochrane and Campbell Databases for Systematic Reviews published up to April 15th 2021. Focusing on community (meso-level) and society (macro-level) level NPIs, we included all study designs, while a geographic restriction was limited to the EU, UK and European Economic Area (EEA) countries. Using the PICO framework, two reviewers independently extracted data and assessed quality using appropriate quality appraisal tools. A qualitative synthesis was performed, with NPIs grouped initially by a) Physical Distancing measures, b) Case detection and management measures, and c) hygiene measures and subsequently by country.ResultsOf 17,692 studies initially assessed, 45 met all inclusion criteria. Most studies (n=30) had a modelling study design, while 13 were observational, one quasi-experimental and one experimental. Evidence from across the European continent, presented by country, indicates that the implementations of physical distancing measures (i.e., lockdowns/quarantines), preferably earlier in the pandemic, reduce the number of cases and hospitalisation across settings and for which the timing and duration are essential parameters. Case detection and management measures were also identified as effective measures at certain levels of testing and incidence, while hygiene and safety measures complemented the implementation of physical distancing measures.ConclusionsThis literature review represents a comprehensive assessment of the effectiveness of NPIs in Europe up to April 2021. Despite heterogeneity across studies, NPIs, as assessed within the context of this systematic review at the macro and meso level, are effective in reducing SARS-CoV-2 transmission rates and COVID-19 hospitalisation rates and deaths in the European Region and may be applied as response strategies to reduce the burden of COVID-19 in forthcoming waves.

Background The survival of coronaviruses are influenced by weather conditions and seasonal coronaviruses are more common in winter months. We examine the seasonality of respiratory infections in England and Wales and the associations between weather parameters and seasonal coronavirus cases. Methods Respiratory virus disease data for England and Wales between 1989 and 2019 was extracted from the Second-Generation Surveillance System (SGSS) database used for routine surveillance. Seasonal coronaviruses from 2012 to 2019 were compared to daily average weather parameters for the period before the patient’s specimen date with a range of lag periods. Results The seasonal distribution of 985,524 viral infections in England and Wales (1989–2019) showed coronavirus infections had a similar seasonal distribution to influenza A and bocavirus, with a winter peak between weeks 2 to 8. Ninety percent of infections occurred where the daily mean ambient temperatures were below 10 °C; where daily average global radiation exceeded 500 kJ/m2/h; where sunshine was less than 5 h per day; or where relative humidity was above 80%. Coronavirus infections were significantly more common where daily average global radiation was under 300 kJ/m2/h (OR 4.3; CI 3.9–4.6; p Conclusions The dynamics of seasonal coronaviruses reflect immunological, weather, social and travel drivers of infection. Evidence from studies on different coronaviruses suggest that low temperature and low radiation/sunlight favour survival. This implies a seasonal increase in SARS-CoV-2 may occur in the UK and countries with a similar climate as a result of an increase in the R0 associated with reduced temperatures and solar radiation. Increased measures to reduce transmission will need to be introduced in winter months for COVID-19.

BackgroundSchool closures have been used as a core Non pharmaceutical intervention during the COVID-19 pandemic, however the role of educational settings in COVID-19 transmission is still unclear.MethodsThis systematic literature review assessed studies published between December 2019 and April 1, 2021 in Medline and Embase, which included studies that assessed educational settings from approximately January 2020 to January 2021. The inclusion criteria were based on the PCC framework (P-Population, C-Concept, C-Context). The studyPopulationwas restricted to people 1-17 years old (excluding neonatal transmission), theConceptwas to assess child-to-child and child-to-adult transmission, while theContextwas to assess specifically educational setting transmission clusters.ResultsFifteen studies met inclusion criteria, ranging from daycare centers to high schools and summer camps, while eight studies assessed the re-opening of schools in the 2020-2021 school year. In principle although there is sufficient evidence that children can both be infected by and transmit SARS-CoV-2 in school settings, the SAR remain relatively low -when NPI measures are implemented in parallel. Moreover, although the evidence was limited there was an indication that younger children may have a lower SAR than adolescents.ConclusionsTransmission in educational settings in 2020 was minimal -when NPI measures were implemented in parallel. However, with an upsurge of cases related to variants of concern, continuous surveillance and assessment of the evidence is warranted to ensure the maximum protection of the health of students and the educational workforce, while also minimising the numerous negative impacts that school closures may have on children.Strengths and limitations of this studyThis study provides a rapid review of the peer-reviewed literature pertaining to SARS-CoV-2 transmission by children within educational settings.The review reflects the status quo of the previous school years (January 2020 -January 2021) due to the lag time between study implementation, peer review and publication.The included studies represent child-to-child transmission within the context of previous SARS-CoV-2 strains and are not directly applicable to newer variants.

Human parasitic infections-including malaria, and many neglected tropical diseases (NTDs)-have long represented a Gordian knot in global public health: ancient, persistent, and exceedingly difficult to control. With the coronavirus disease (Covid-19) pandemic substantially interrupting control programmes worldwide, there are now mounting fears that decades of progress in controlling global parasitic infections will be undone. With Covid-19 moreover exposing deep vulnerabilities in the global health system, the current moment presents a watershed opportunity to plan future efforts to reduce the global morbidity and mortality associated with human parasitic infections. In this chapter, we first provide a brief epidemiologic overview of the progress that has been made towards the control of parasitic diseases between 1990 and 2019, contrasting these fragile gains with the anticipated losses as a result of Covid-19. We then argue that the complementary aspirations of the United Nations Sustainable Development Goals (SDGs) and the World Health Organization (WHO)'s 2030 targets for parasitic disease control may be achieved by aligning programme objectives within the One Health paradigm, recognizing the interdependence between humans, animals, and the environment. In so doing, we note that while the WHO remains the preeminent international institution to address some of these transdisciplinary concerns, its underlying challenges with funding, authority, and capacity are likely to reverberate if left unaddressed. To this end, we conclude by reimagining how models of multisectoral global health governance-combining the WHO's normative and technical leadership with greater support in allied policy-making areas-can help sustain future malaria and NTD elimination efforts.

We aimed to assess the proportion of school attending adolescents who reached the recommended moderate-to-vigorous physical activity (MVPA) level in Lagos State, Nigeria, as well as the predictors associated with it. A cross-sectional study was conducted among 720 adolescents aged 12–19 years from 20 schools in Lagos State in 2020. MVPA level was assessed using the Activity Questionnaire for Adults and Adolescents. Predictors assessed were socio-demographic variables, anthropometric measurements, sedentary behaviour, self-efficacy, perceived benefits, and perceived barriers. Complete data was provided by 528 adolescents for the study (73% response rate). The recommended MVPA level was reached by 82.8% (95% CI 79.3–85.7) of the participants. Participants spent a median time of 44 (IQR 12.9, 110) minutes of MVPA per day on household-based activities, followed by school-based activities (21.4, 4.3, 50.4), active transportation (14.3, 0, 35), sport-based activities (8.6, 0, 58.9) and leisure-based activities (8.6, 1.1, 34.3). Participants in public schools were four times more likely to meet the recommended MVPA level compared to those in private schools (OR 3.97, 95% CI 2.46–6.42). A high proportion of school adolescents met the recommended MVPA level in Lagos State, Nigeria. Our study suggests that interventions for promoting MVPA should be targeted to private schools.

Tick-borne encephalitis (TBE) is an infection caused by the Tick-borne encephalitis virus (TBEv) and it is common in Europe. The virus is predominantly transmitted by ticks, but other non-vectorial modes of transmission are possible. This systematic review synthesises the epidemiological impact of non-vectorial modes of TBEv transmission in Europe. 41 studies were included comprising of 1308 TBE cases. Alimentary (36 studies), handling infected material (3 studies), blood-borne (1 study), solid organ transplant (1 study) were identified as potential routes of TBEv transmission; however, no evidence of vertical transmission from mother to offspring was reported (2 studies). Consumption of unpasteurised milk/milk products was the most common vehicle of transmission and significantly increased the risk of TBE by three-fold (pooled RR 3.05, 95% CI 1.53 to 6.11; 4 studies). This review also confirms handling infected material, blood-borne and solid organ transplant as potential routes of TBEv transmission. It is important to tracing back to find the vehicle of the viral infection and to promote vaccination as it remains a mainstay for the prevention of TBE.

Human parasitic infections-including malaria, and many neglected tropical diseases (NTDs)-have long represented a Gordian knot in global public health: ancient, persistent, and exceedingly difficult to control. With the coronavirus disease (Covid-19) pandemic substantially interrupting control programmes worldwide, there are now mounting fears that decades of progress in controlling global parasitic infections will be undone. With Covid-19 moreover exposing deep vulnerabilities in the global health system, the current moment presents a watershed opportunity to plan future efforts to reduce the global morbidity and mortality associated with human parasitic infections. In this chapter, we first provide a brief epidemiologic overview of the progress that has been made towards the control of parasitic diseases between 1990 and 2019, contrasting these fragile gains with the anticipated losses as a result of Covid-19. We then argue that the complementary aspirations of the United Nations Sustainable Development Goals (SDGs) and the World Health Organization (WHO)'s 2030 targets for parasitic disease control may be achieved by aligning programme objectives within the One Health paradigm, recognizing the interdependence between humans, animals, and the environment. In so doing, we note that while the WHO remains the preeminent international institution to address some of these transdisciplinary concerns, its underlying challenges with funding, authority, and capacity are likely to reverberate if left unaddressed. To this end, we conclude by reimagining how models of multisectoral global health governance-combining the WHO's normative and technical leadership with greater support in allied policy-making areas-can help sustain future malaria and NTD elimination efforts.

Decisions on school closures and on safe schooling during the COVID-19 pandemic should be evidence-based. We conducted a systematic literature review to assess child-to-child and child-to-adult SARS-CoV-2 transmission and to characterise the potential role of school closures on community transmission. 1337 peer-reviewed articles published through August 31, 2020 were screened; 22 were included in this review. The literature appraised provides sufficient evidence that children can both be infected by and transmit SARS-CoV-2 in community, household and school settings. Transmission by children was most frequently documented in household settings, while examples of children as index cases in school settings were rare. Included studies suggested that school closures may help to reduce SARS- CoV-2 transmission, but the societal, economic, and educational impacts of prolonged school closures must be considered. In-school mitigation measures, alongside continuous surveillance and assessment of emerging evidence, will promote the protection and educational attainment of students and support the educational workforce.

Background: Pneumonia causes most death in children under five globally. Indoor air pollution has been reported to increase the risk of children to pneumonia. ObjectiveTo investigate the association between specific indoor air pollutants and pneumonia episodes in children under five.MethodsUsing a case-control study design, we compared exposure of cases and controls to specific pollutants (PM2.5, CO, BC and PM1), using battery operated aerosol monitors. Data was analysed using Wilcoxon signed-rank test.ResultsThe mean PM2.5 was higher in controls compared to cases. PM2.5 highest mean recorded for controls was 177 µg/m3. There was a significant difference between cases and controls for 10 hours (p-value 0.0147), 15 hours (p-value 0.0111) and 20-24 hours (p-value 0.0296) for PM2.5. No significant difference in CO concentration between cases and controls, the highest CO mean concentration recorded being 2930 µg/m3. Similarly, PM1 was consistently higher in controls compared to cases. However, this difference was not significant from exposure to PM1 between cases and controls (P-value>0.05), with the highest PM1 mean concentration recorded being 91 µg/m3. There was a significant difference (p-value 0.0260) in exposure to Black Carbon between cases and controls. BC was higher in households of cases compared to controls, with the mean average of BC for cases 4350 µg/m3 and controls 4126 µg/m3. In this study, BC is positively associated with a pneumonia episode. We also report the importance of unmodifiable and behaviourally modifiable factors on pneumonia episode in children.Discussion: In conclusion, we show that children present during cooking, number of available windows and MUAC increased the likelihood of a pneumonia episode. We recommend household level behaviour changes and targeted IMCI including early effective detection and treatment of childhood pneumonia particularly in high pollution areas in Nigeria.