“Arsenic was also analyzed in hair and nails of people living in NCP including CKDu patients. In about 90% arsenic levels in hair were higher than those observed in developed countries (0.02 ug/g).In about 94% arsenic levels in nails were higher than those observed in developed countries (>0.03 ug/g) ”

I cant understand why the control population are citizens of developed countries. Shouldnt we be comparing those afflicted people from the NCP with those unaflicted people from the NCP using the same water sources? And also those afflicted with others in Sri Lanka where there is no CKDu?

We should also compare symptoms with Bangladesh where groundwater Arsenic is a much bigger problem. As far as I know the groundwater Arsenic in Bangladesh results in cancer among the consumers and not Kidney Failure.

Often decisions are made even where reliable and valid database is available without reference to the available data. Gut feelings and biased observations that suits the politicians are what is common.

It is time the Medical Faculties and Teaching hospitals have well funded professional Research Units.

As another observer mentioned above there are enough research methodology, statistical packages and competent professional medical researchers available in Sri Lanka to determine and predict the cause of CKD with an acceptable level of probability.

http://water.epa.gov/drink/standardsriskmanagement.cfm

What is lacking is a common sense approach to tackle the problem. Our Scientist are engaged in an academic debate whilst the poor farmers wither and die away. We dont have to reinvent the wheel when such know how is available. the problem appears to be the number of govt agencies involved and lack of a cohesive strategy.

In my honest opinion, it is data that can provide most of the answers. This is the key element that is missing in the health sector. Our epidemiologist are comfortable spending time and money to simply report on a hand full of 25 infectious disease, called notifiable diseases. These diseases are seldom; no more than 66,000 patients per annum. The last (2007) Ministry of Health Annual Health Bulletin reports that their are over 48 million patient visitations at the Government hospitals. This means the Epidemiology Unit is only reporting monitoring less than 0.1% (zero point one percent) of the reported cases. Those are simply district aggregates and not granular with time and specific location information.

How these numbers are achieved is questionable but the Medical Statistics Unit confirms that these numbers are obtained through paper registries, where nurses are asked to supply the numbers for the 660+ hospitals each year but there has not been any numbers since 2007. Absence of this rich set of data in digital form is unfortunate.

Syndromic surveillance has proven to be effective in the early detection of potential outbreaks. Instead of waiting for the disease to be confirmed, which may take several days with laboratory tests, etc, a recording of the symptoms the patient complaints of at the Outpatient department is of greater utility in nipping escalating diseases in the bud. Moreover, the accumulation of geo-spatial information along with the syndromic data can aid medical statisticians with them drilling in to the data to find alarming patterns.

If such data had been available then medical statisticians could have analyses the data looking at all different correlations to zone in on a meaningful data sample. Moreover, other data sets such as agriculture information and water supply information can be layered on top of the medical data (which we call multi-variate statistical analyses) to verify the hypotheses.

This is exactly what the Real-Time Biosurveillance Pilot achieved; here’s a Lakbima news article that tells the story: http://www.lakbimanews.lk/archvi/lakbimanews_10_09_26/feb/feb6.htm

It is a heart stopping struggle trying to scale such a project that has proven it’s capabilities to better serve the health information needs of the country. Not just with identifying infection diseases or reportable diseases but also contributing information on life-style chronic diseases. A key emphasis of this biosurveillance program was enabling syndromic surveillance or at least create a comprehensive rich data set of disease, symptoms, location, date, gender, and age specific clinical information. We don’t need patients’ names and private information. Moreover, the pilot tested biosurveillance program was estimated to be ~40% (forty percent) cheaper with much higher efficiency gains and incremental benefits, relative to the present day paper and laborious practices that have no utility. A national implementation of such a system would cost less than 1.0% (one percent) of the total annual national health expenditure.

With the pilot data we found alarming trends of Respiratory Tract Infection, Urinary Tract Infection, Hypertension to be twice as more common among above 40 women than men in Kurunegala District. The system was capable of detecting the escalation of any disease with a day opposed to the present day practice that takes weeks or for several deaths reported to raise some eyebrows. All these adveres events affect household productivity and our quality adjusted life years. I suppose absence of such granular information might be better for the institutions because then there is less work and less blame to take.

The most visible problem, in trying to introduce such innovations with proven utility, is breaking the fear within the institutional silos of the health ministry that like to safeguard their territory. Because they don’t want to share resources and don’t see eye-to-eye, a one stone kill all birds kind of solution that benefits all is hard to pass their acceptance. They all want to do their own thing.

Doctors (not all) have superiority complexes that they know it all, including ICT. If anyone from outside tries to introduce something then that is not good enough. I recently, had a meeting with set of Epidemiologist, before they could even hear out the utility of the field tested biosurveillance solution they had already judged it as useless, yelling away like hooligans. It is very immature and unscientific behavior that I experienced; especially, coming from a scientific community. The author also points to other unscientific behavior, with the lacking of peer reviewed publications; moreover, sharing of the raw data for other researchers to verify the conclusions.

Until such time government institutions open up their data, learn to share, drop their inferiority/silo-ish structure, and those responsible institutions are forced to perform based on outcomes, they will simply not solve CKDu or any other problem for that matter and would continue to dwell within their safeguarded cradles, lavishly spending Government money.