The Mediterranean monk seal Monachus monachus is the most endangered seal species. In this review we summarize the status, ecology, and behaviour of the Mediterranean monk seal, and identify the main threats that currently affect the species and the conservation priorities for securing its survival. Once abundant throughout the Black Sea and Mediterranean, as well as off the Atlantic coasts of northwestern Africa and Macaronesia, the Mediterranean monk seal has recently suffered dramatic declines, both in abundance and geographical range. It is now estimated that fewer than 700 individuals survive in three or four isolated subpopulations in the eastern and western Mediterranean, the archipelago of Madeira and the Cabo Blanco area in the northeastern Atlantic Ocean. Mediterranean monk seals are coastal marine mammals. When resting and pupping on land, individuals generally seek refuge in inaccessible marine caves; this behaviour is, in part, believed to be an adaptation to increased disturbance by humans. Larger aggregations or colonies of the species can now be found only at Cabo Blanco in the Atlantic Ocean and on the island of Gyaros in the eastern Mediterranean. The main threats to the survival of the Mediterranean monk seal are habitat deterioration; deliberate killing, mainly by fishermen; and accidental entanglement and drowning in fishing gear. Limited availability of food sources and stochastic and unusual events have occasionally also contributed to Mediterranean monk seal mortality. Based on a common consensus among scientists and conservationists, the main conservation priorities for the monk seal are: habitat protection; mitigating negative interactions between seals and fisheries; scientific research and monitoring of local seal populations; education and public awareness campaigns; and rescue and rehabilitation of wounded, sick, and orphaned seals.

No abstract

The Mediterranean monk seal is categorized as Critically Endangered on the IUCN Red List and is in urgent need of effective conservation measures. Following a steep decline in the 20th century, the National Park Service of Madeira initiated efforts to protect the species in the archipelago of Madeira, including habitat protection, scientific research and public awareness. The aim of this study was to analyse data collected during a monitoring project (1988À2005) to assess the conservation status of the species and identify priority conservation actions for the future. The study recorded the presence of the species at key pupping sites in a strictly protected area at the Desertas Islands, increased sightings in recent years around the main island of Madeira, an increase in the number of pups born, and low mortality. The population in the archipelago of Madeira is currently estimated to be 20-30 adults. These findings suggest that the species remains Critically Endangered in the area but that its conservation situation has improved because of the implementation of effective conservation actions. Conservation priorities identified include protecting suitable monk seal habitat at Madeira, investigating sealÀfisheries interactions, increasing environmental education, and strengthening regional legislation for the protection of the species.

The Mediterranean monk seal Monachus monachus is the most endangered seal in the world with < 600 ind. currently surviving. The species faces a number of threats to its survival: accidental entanglement has been identified as one of the most important amongst them. Here we made the first attempt to systematically describe the nature of this threat and assess its impact on Mediterranean monk seal populations. We based our study on information from an extensive literature review, questionnaires carried out in various locations in Greece and necropsies performed in Greece and in the Madeira Islands, Portugal. Our results indicate that accidental entanglement has been, and still is, a major threat to the species in its main distribution area in the northeastern Mediterranean, and that this threat may increase throughout the seal's range. Accidental entanglement occurs mainly with fishing nets, and affects mostly sub-adult seals. Short-term conservation actions should include the identification of critical pupping sites and their protection through the establishment and enforcement of protective measures. A long-term course of action will require detailed knowledge of the causes of accidental entanglement of Mediterranean monk seals in fishing gear.KEY WORDS: Endangered species · Mediterranean monk seal · Accidental entanglement · Conservation · Seal-fishery interactions · Greece · Madeira

Summary Background To overcome the three delays in triage, transport and treatment that underlie adverse pregnancy outcomes, we aimed to reduce all-cause adverse outcomes with community-level interventions targeting women with pregnancy hypertension in three low-income countries. Methods In this individual participant-level meta-analysis, we de-identified and pooled data from the Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised controlled trials in Mozambique, Pakistan, and India, which were run in 2014–17. Consenting pregnant women, aged 12–49 years, were recruited in their homes. Clusters, defined by local administrative units, were randomly assigned (1:1) to intervention or control groups. The control groups continued local standard of care. The intervention comprised community engagement and existing community health worker-led mobile health-supported early detection, initial treatment, and hospital referral of women with hypertension. For this meta-analysis, as for the original studies, the primary outcome was a composite of maternal or perinatal outcome (either maternal, fetal, or neonatal death, or severe morbidity for the mother or baby), assessed by unmasked trial surveillance personnel. For this analysis, we included all consenting participants who were followed up with completed pregnancies at trial end. We analysed the outcome data with multilevel modelling and present data with the summary statistic of adjusted odds ratios (ORs) with 95% CIs (fixed effects for maternal age, parity, maternal education, and random effects for country and cluster). This meta-analysis is registered with PROSPERO, CRD42018102564. Findings Overall, 44 clusters (69 330 pregnant women) were randomly assigned to intervention (22 clusters [36 008 pregnancies]) or control (22 clusters [33 322 pregnancies]) groups. 32 290 (89·7%) pregnancies in the intervention group and 29 698 (89·1%) in the control group were followed up successfully. Median maternal age of included women was 26 years (IQR 22–30). In the intervention clusters, 6990 group and 16 691 home-based community engagement sessions and 138 347 community health worker-led visits to 20 819 (57·8%) of 36 008 women (of whom 11 095 [53·3%] had a visit every 4 weeks) occurred. Blood pressure and dipstick proteinuria were assessed per protocol. Few women were eligible for methyldopa for severe hypertension (181 [1%] of 20 819) or intramuscular magnesium sulfate for pre-eclampsia (198 [1%]), of whom most accepted treatment (162 [89·5%] of 181 for severe hypertension and 133 [67·2%] of 198 for pre-eclampsia). 1255 (6%) were referred to a comprehensive emergency obstetric care facility, of whom 864 (82%) accepted the referral. The primary outcome was similar in the intervention (7871 [24%] of 32 290 pregnancies) and control clusters (6516 [22%] of 29 698; adjusted OR 1·17, 95% CI 0·90–1·51; p=0·24). No intervention-related serious adverse events occurred, and few adver...