Correlating WHO COVID-19 interim guideline 2020.5 and testing capacity, accuracy, and logistical challenges in Africa

Coronavirus disease 2019 (COVID-19), a severe acute respiratory syndrome caused by SARS-CoV-2 was declared a global pandemic by the World Health Organization (WHO) in March 2020. As of 21^st April 2021, the disease had affected more than 143 million people with more than 3 million deaths worldwide. Urgent effective strategies are required to control the scourge of the pandemic. Rapid sample collection and effective testing of appropriate specimens from patients meeting the suspect case definition for COVID-19 is a priority for clinical management and outbreak control. The WHO recommends that suspected cases be screened for SARS-CoV-2 virus with nucleic acid amplification tests such as real-time Reverse Transcription-Polymerase Chain Reaction (rRT-PCR). Other COVID-19 screening techniques such as serological and antigen tests have been developed and are currently being used for testing at ports of entry and for general surveillance of population exposure in some countries. However, there are limited testing options, equipment, and trained personnel in many African countries. Previously, positive patients have been screened more than twice to determine viral clearance prior to discharge after treatment. In a new policy directive, the WHO now recommends direct discharge after treatment of all positive cases without repeated testing. In this review, we discuss COVID-19 testing capacity, various diagnostic methods, test accuracy, as well as logistical challenges in Africa with respect to the WHO early discharge policy.

'Away' is a place: The impact of electronic waste recycling on blood lead levels in Ghana

E-waste recycling remains a major source of livelihood for many urban poor in developing countries, but this economic activity is fraught with significant environmental health risk. Yet, human exposure to the toxic elements associated with e-waste activities remains understudied and not evidently understood. This study investigates the impact of informal e-waste processing on the blood lead levels (BLLs) of e-waste workers and non-e-waste workers (mainly females working in activities that serve the Agbogbloshie e-waste site), and relates their lead exposure to socio-demographic and occupational characteristics. A total of 128 blood samples were analysed for lead levels. Surprisingly, the mean BLL (3.54μg/dL) of non-e-waste workers was slightly higher than that of e-waste workers (3.49μg/dL), although higher BLLs ranges were found among e-waste workers (0.50-18.80μg/dL) than non-e-waste workers (0.30-8.20μg/dL). Workers who engaged in e-waste burning tended to have the highest BLLs. In general, the BLLs are within the ABLES/US CDC reference level of 5μg/dL, although 12.3% of the workers have elevated BLLs, i.e. BLL ≥5μg/dL. The study concludes that the impact of e-waste recycling is not limited to workers alone. Traders and residents within the Agbogbloshie enclave are equally at risk through a range of environmental vectors. This calls for increased public awareness about the effects of human exposure to lead and other toxic elements from e-waste recycling. A key contribution is that government and stakeholder projects for safe e-waste infrastructure should disaggregate the e-waste value chain, recognize differential risk and resist one-size-fits-all strategies.