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JUBA, Aug. 30 (Xinhua) -- South Sudan's Ministry of Health backed by the World Health Organization (WHO) said Tuesday it has trained more than 200 healthcare workers to help bolster disease surveillance and response in the country.

The healthcare workers were trained on how to use an early warning, alert and response system (EWARS) in more than 20 counties in South Sudan to optimize its use to support surveillance, alert management, outbreak response, and laboratory data and management.

John Rumunu, director-general for Preventive Health Services at the Ministry of Health, said the aim of the training was to improve real-time detection and prompt response to disease outbreaks and other health emergencies.

"Given the current humanitarian setting in the country, an effective disease surveillance system is essential to detecting disease outbreaks quickly before they spread," Rumunu said in a joint statement issued in Juba, the capital of South Sudan.

EWARS is a web-based system designed to improve disease outbreak detection in emergency settings.

The East African nation is experiencing multiple disease outbreaks and floods, thus increasing the risk of transmission of infectious diseases and other health conditions such as severe malnutrition.

Fabian Ndenzako, acting WHO representative for South Sudan, said infectious diseases can cost lives and become difficult to control if they are not detected and responded timely. "With generous World Bank funding, we are strengthening EWARS reporting by training healthcare workers countrywide," Ndenzako added.

The EWARS project was rolled out in 2017 to all 80 counties of South Sudan, with the second phase of the rollout further decentralizing data collection and alert management down to the health facility level from 2019 to early 2020.

According to WHO, before the rollout of EWARS in South Sudan, the integrated disease surveillance and response (IDSR) weekly reporting rates were as low as 30 percent, far below the target of 80 percent. Following the completion of the EWARS rollout to the health facilities, however, the reporting rates have improved and surpassed the target of 80 percent on completeness and timeliness of weekly IDSR reporting. - Xinhua


A new clinical trial researching treatment for patients with sight loss as a result of diabetes has shown a type of laser treatment to be both cost effective and non-invasive, offering the best option for patients and healthcare providers. 
There are currently several treatment options offered to people with Diabetic Macular Oedema (DMO), including two types of laser treatment and eye injections. DMO is the most common sight-threatening complication of diabetes, affecting over 27 million adults. This new research provides much-needed evidence to enable patients and healthcare professionals to be better informed on treatment options.
DMO happens when blood vessels in the retina at the back of the eye leak, causing fluid build-up at the macula, which provides central vision. The leakage occurs when high blood sugar levels damage blood vessels.
The severity of DMO is most often determined by measuring the thickness of the macula, which in-turn will determine the treatment offered. Patients with more severe DMO (with thickness of 400 microns or more) are treated with injections into the eye of drugs, known as anti-VEGFs. Patients with mild DMO (with thickness of less than 400 microns) can be treated with macular lase, which can be standard threshold laser or subthreshold micropulse laser. The former produces a burn or scar on the retina.  The latter, which is a more recent technology, works without leaving a burn or scar or any type of visible change or mark on the retina.
The research,  published in Ophthalmology, found that subthreshold micropulse laser, which does not create a burn on the retina, was effective in maintaining a patient’s vision. This also requires much less frequent visits to the clinic and is much more cost effective than treatment via eye injections, with eye injections costing almost ten times more than laser treatments.
Professor Noemi Lois, Clinical Professor of Ophthalmology at Queens University and Honorary Consultant Vitreoretinal Surgeon at the Belfast Health and Social Care Trust and lead author on the study, explains: “The absence of a scar or burn following subthreshold micropulse laser led to some healthcare professionals to doubt its effectiveness compared to the standard threshold laser.”
“However, our research addressed this by demonstrating that subthreshold micropulse laser is as good as standard threshold laser for helping people’s vision, reducing macula thickness, allowing people to meet driving standards, and maintaining their quality of life, both in general terms and for vision in particular.”
The research team set out to compare both types of available laser treatment through a large randomised clinical trial, known as DIAMONDS (DIAbetic Macular Oedema aNd Diode Subthreshold micropulse laser SML). They recruited 266 patients across 16 NHS hospitals around the UK, with half receiving standard threshold laser and the other half receiving subthreshold micropulse laser. Unique to this trial, patients were involved in selecting the outcomes, including how driving standards would be met following treatment. At the end of the two-year trial, DIAMONDS found both laser treatments to offer equivalent benefits.
The total cost of the care of patients enrolled in the trial (including the laser treatment and any other treatments required as well as the costs of the follow-up visits) over two years was similar for both patient’s groups. Over the two-year period, the cost per patient was just under £900 (£897.83) for patients in the subthreshold micropulse laser arm of the trial compared to £1125.66 for those in the standard laser arm. 
Professor Lois adds: “Some ophthalmologists advise patients with milder forms of DMO to have injections of anti-VEGFs, rather than laser, despite laser being less invasive and requiring less visits to the clinic. Laser treatment costs significantly less than eye-injections of anti-VEGFs. With an average of ten injections required over two years, the total cost of eye injections per patient amounts to approximately £8,500 for the drug alone. This is almost ten times the cost of subthreshold micopulse laser without taking into account additional costings such as staff time.
“Until we published these findings, there was no robust evidence comparing these types of laser treatments. A lack of information led some healthcare professionals to favour standard laser over subthreshold micropulse laser. We now have robust evidence to show that both laser treatments are not only effective in clearing the fluid from the retina and maintaining vision for at least two years, but both are also cost-effective.” 
“Armed with this knowledge, it’s likely that patients will opt for micropulse subthreshold laser, which doesn’t burn the retina and is comparable to standard laser. Whilst we didn’t directly compare laser treatments to treatment via eye injections of anti-VEGFs, hopefully we have shown that laser is an effective treatment, while remaining much less invasive to the patient and much less costly to the NHS.” 
The research was funded by the Health Technology Assessment (HTA) of the National Institute for Health and Care Research (NIHR).


Acrid smoke billows from the mountain of waste at the Dandora rubbish dump in Nairobi.

Plastic, glass, even medical waste - it's fresh pickings for the Marabou stalks and the people scavenging through the dump looking for recyclable materials.

The women sift through the waste - most with bare hands - for their livelihood.

A kilo of recyclable plastic waste goes for 17 shilling (0.14 USD) per kilogram at the dumpsite.

A bag of recyclable plastic ranges from 5 to 50 shilling (0.042 - 0.42 USD), depending on the size.

"We usually look for plastic bottles, carton boxes, gunny bags, bones and pig food. Yet we do this without protective gloves or gumboots so we sometimes get cuts from glass. We are really suffering," says Mariam Makeba, an informal waste picker.

But cuts from glass are the least concern for these women who feel they have option other than to work at the dump.

The United Nations Environment Program (UNEP) warned that the Dandora dump has posed a serious health threat to those working and living nearby as far back as 2007.

And according to a report by The Endocrine Society and IPEN ((International Pollutants Elimination Network) in December 2020, there is evidence of human health impacts from many chemicals in common plastics including alterations to both male and female reproductive development and infertility.

Mother of six, Winfred Wanjira, spends her working days filling her sack with recyclable plastics to make enough money to feed her children.

"Sometimes you might unexpectedly lose your pregnancy. But when you change your environment, you can have a successful pregnancy. However, when you try to change your environment you may lack work opportunities and your children become hungry - you have no other option but to come back," she says.

"Medical professionals have advised us to stop working at the dumpsite. But where would I go if I stopped working here?"

24-year-old waste picker, Joyce Wangari says she is also experiencing issues with her reproductive health.

"I usually receive my period after every three months and yet I am not on contraceptives. However, at one point, I had a head injury, and had to change my environment for three months - I also got my period in those three months," says Joyce Wangari, informal waste picker.

The Dandora dumpsite is an informal workplace to about 10,000 women, children and a few men who scavenge through the piles of rubbish daily, according to a Concern Worldwide report from 2012.

The site was deemed full in 1996, but still scores of pickers roam.

And despite an Environment and Land court ordering the closure of the dumpsite in July 2021, they continue to operate.

The UNEP warn that air pollution created by the Dandora landfill poses a wide range of health risks for both workers and the community nearby.

Many materials that end up as waste contain toxic substances and people end up inhaling the noxious fumes from routine waste burning and methane fires, says the organisation.

A UNEP report titled 'Implications of the Dandora Municipal Dumping Site in Nairobi, Kenya' - states that skin disorders, cancers, respiratory abnormalities and blood disorders are just some of the public health effects that can be brought about by environmental pollution emanating from the dump site.

Heavy metals at high concentrations, as is the case in contaminated environments, can result in public health impacts, it goes on to say.

"Lead and mercury are heavy metals and most of the time the women who are working at the dumpsite, they are actually inhaling and at the same time ingesting this particular heavy metals. It is not only affecting reproductive health but it is also affecting the women and most women are actually ending up with cancer. Remember, mercury is one of the major metals associated with cancer. Lead the same," explains public health nurse at Maasai Mara University, Jacqueline Naulikha.

For mercury, samples collected from the waste dump exhibited a value of 46.7 ppm while those collected along the river bank registered a value of 18.6 ppm. Both of these values greatly exceeded the WHO acceptable exposure level of 2 ppm.

The concentration of lead in the soil samples ranged from 50-590 ppm. Soil samples from within the waste dump manifested a value of 13,500 ppm. This is a clear indication that the dumpsite is the major source of high lead levels found in the surrounding environment, according to UNEP.

The United States Environmental Protection Agency has set the maximum contaminant level goal for lead in drinking water at zero because lead can be harmful to human health even at low exposure levels.

"So, if a woman gets cancer and she is not aware that she has cancer, most of the time the first thing that is affected is her menstrual cycle. This could be one of the first signs, heavy bleeding. When she has heavy bleeding and that is irregular, it could be an early warning sign that this particular woman is actually having cancer, especially cancer of the reproductive parts," says Naulikha.

"It may affect the fertile period. When a woman is ovulating and ready to get pregnant, this is going to be affected and you may get that most women who work in Dandora, most of them may end up being childless because of the effect of mercury and lead," she adds.

In a bid to improve waste management, Kenya's 2021 Sustainable Waste Management Bill outlined objectives for county governments - to establish waste management infrastructure to promote source segregation, collection, reuse and provide central collection centres for materials that can be recycled

And on March 2nd this year (2022), the United Nations Environment Assembly decided to initiate negotiations for a global agreement to end plastic pollution at its meeting in Nairobi.

Dorothy Otieno, project officer for programs on plastics and waste management at the Centre for Environmental Justice and Development (CEJAD), explains the changes this could bring.

"The resolution that was passed by UNEA to end plastic pollution, one of the key benefits that we have been able to see from that is waste pickers being recognised. So the Intergovernmental negotiating committees are required to learn from the experiences of waste pickers because they have so much information just by working in the dumpsites," she says.

"And they are also recognised as people who play an integral part in the formal waste management system. So with this, we are hoping that countries like Kenya to be among this (inaudible) championing for the rights of waste pickers and formalised and included in all policy and waste management processes."

A glimmer of hope for the future, but today even knowing the severe health impacts coming to this dump poses, the women, the children and the men keep coming. For them it is the only way to feed their families. - Africanews

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