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Abstract
BACKGROUND There is increasing evidence that domestic violence (DV) is an important risk factor for suicidal behaviour. The level of risk and its contribution to the overall burden of suicidal behaviour among men and women has not been quantified in South Asia. We carried out a large case-control study to examine the association between DV and self-poisoning in Sri Lanka. METHODS Cases (N = 291) were patients aged ⩾18 years, admitted to a tertiary hospital in Kandy Sri Lanka for self-poisoning. Sex and age frequency matched controls were recruited from the hospital's outpatient department (N = 490) and local population (N = 450). Exposure to DV was collected through the Humiliation, Afraid, Rape, Kick questionnaire. Multivariable logistic regression models were conducted to estimate the association between DV and self-poisoning, and population attributable fractions were calculated. RESULTS Exposure to at least one type of DV within the previous 12 months was strongly associated with self-poisoning for women [adjusted OR (AOR) 4.08, 95% CI 1.60-4.78] and men (AOR 2.52, 95% CI 1.51-4.21), compared to those reporting no abuse. Among women, the association was strongest for physical violence (AOR 14.07, 95% CI 5.87-33.72), whereas among men, emotional abuse showed the highest risk (AOR 2.75, 95% CI 1.57-4.82). PAF% for exposure to at least one type of DV was 38% (95% CI 32-43) in women and 22% (95% CI 14-29) in men. CONCLUSIONS Multi-sectoral interventions to address DV including enhanced identification in health care settings, community-based strategies, and integration of DV support and psychological services may substantially reduce suicidal behaviour in Sri Lanka.
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Affiliation(s)
- Piumee Bandara
- Translational Health Research Institute, Western Sydney University, New South Wales, Australia
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, New South Wales, Australia
| | - Lalith Senarathna
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Health Promotion, Faculty of Applied Sciences, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
| | - Judi Kidger
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gene Feder
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute of Health Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute of Health Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust
| | - Thilini Rajapakse
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Duleeka Knipe
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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202
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Fernando SU, Udagama P, Fernando SP. Effect of urbanization on zoonotic gastrointestinal parasite prevalence in endemic toque macaque ( Macaca sinica) from different climatic zones in Sri Lanka. Int J Parasitol Parasites Wildl 2022; 17:100-109. [PMID: 35024333 PMCID: PMC8724921 DOI: 10.1016/j.ijppaw.2021.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 01/25/2023]
Abstract
Understanding variations in host-parasite relationships with urbanization is vital for both, public health management and conservation of endemic animals with high anthropogenic interactions. Toque macaques (Macaca sinica) are such endemic old-world monkeys in Sri Lanka. Three macaque sub species inhabit the main climatic zones of the island; M . s. sinica , M . s. aurifrons and M . s. opisthomelas inhabit the dry zone, wet zone, and montane regions of the island, respectively. This study aimed to examine parasite prevalence in this host in association with urbanization. A total of 180 fecal samples were collected from the three sub species of toque macaques inhabiting the main climatic zones (dry, wet, and montane) in Sri Lanka; 20 samples each were collected from urban, suburban, and wild populations representing each climatic zone. Twenty gastrointestinal (GI) parasite genera types i.e. five types of protozoan cysts, two types of trematode ova, four types of cestode ova, eight types of nematode ova, and a single type of acanthocephalan ova were identified. The overall prevalence of parasites was 62% (112/180) with the highest prevalence of Strongyloides infection. In all three sub species, toque macaque populations with proximity to human settlements, including urban and suburban populations, manifested a greater GI parasitic prevalence, mean ova/cyst counts and species richness, compared to their wild counterparts. Importantly, records of five parasite types in toques in Sri Lanka are reported for the first time, while Moniliformis type was reported as a first record in free ranging macaques, globally. This study clearly demonstrated that human contact and habitat modification may influence patterns of parasitic infections in macaques. As most of the parasite types identified manifest zoonotic potential, with public health implications, close associations of macaques may cause a threat to human well-being.
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Affiliation(s)
- Shehani U. Fernando
- Department of Zoology and Environment Sciences, Faculty of Science, University of Colombo, Colombo 03, Sri Lanka
| | - PreethiV. Udagama
- Department of Zoology and Environment Sciences, Faculty of Science, University of Colombo, Colombo 03, Sri Lanka
| | - Saminda P. Fernando
- Department of Zoology, Faculty of Natural Sciences, The Open University of Sri Lanka, Nawala, Nugegoda, Sri Lanka
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Schölin L, Weerasinghe M, Agampodi S, Chathurange U, Rajapaksha S, Holloway A, Norrie J, Mohamed F, Eddleston M, Pearson M. Involvement of alcohol in injury cases in rural Sri Lanka: prevalence and associated factors among in-patients in three primary care hospitals. BMC Public Health 2022; 22:514. [PMID: 35296275 PMCID: PMC8928674 DOI: 10.1186/s12889-022-12958-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 03/09/2022] [Indexed: 11/17/2022] Open
Abstract
Background Injuries account for a major proportion of global morbidity and mortality related to alcohol use. Information on the prevalence of alcohol-related injury in rural Sri Lanka is limited. The aims of this study were to determine the burden of alcohol-related injury in a hospital-based sample in rural Sri Lanka and explore factors associated with an increased risk of alcohol-related injury. Methods Involvement of alcohol in injury amongst in-patients was assessed in three hospitals in the North Central Province of Sri Lanka over 6 months. Adult (≥ 18 years) patients were eligible. Patients were assessed for: injury characteristics, current alcohol use (in the past year) using the Alcohol Use Disorder Identification Test (AUDIT), and acute intoxication. Patients with a blood alcohol concentration (BAC) reading equivalent of 10 mg/dL (2.17 mmol/L) were considered as having an alcohol-related injury. Binary logistic regression was used to explore association between alcohol-related injury and demographic and injury characteristics. Results A total of 883 injured patients were eligible and consented to the study. No alcohol use was reported by 487 (55.2%) of patients (35.6% of men, 95.2% of women). Prevalence of alcohol-related injuries was 14.8% overall and 32.8% among current alcohol users. Almost all patients with an alcohol-related injury were male (122/123; 99.2%); 24 (18.8%) of these patients scored positive for possible alcohol dependence. Patients with an alcohol-related injury had significantly higher AUDIT scores (median = 15 vs 6, p < 0.001), were significantly more likely to be aged 26–40 (OR 2.29, 95% CI:1.11, 4.72) or 41–55 years (OR 2.76, 95% CI: 1.29, 5.90) (compared to 18–25 years), to have a transport-related injury (OR 5.14, 95% CI: 2.30, 11.49) (compared to animal/plant sting/bite), and have intentional injuries (OR 3.47, 95% CI: 1.01, 11.87). Conclusions One in three injuries among people who drank alcohol in this sample were alcohol-related. In addition, problematic alcohol use was higher among those with alcohol-related injury. Further work is needed to explore whether this prevalence of alcohol-related injury is reflected in other rural settings in Sri Lanka. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12958-8.
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Affiliation(s)
- L Schölin
- Centre for Pesticide Suicide Prevention & Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
| | - M Weerasinghe
- Department of Community Medicine, Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - S Agampodi
- Department of Community Medicine, Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - U Chathurange
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - S Rajapaksha
- Department of Community Medicine, Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - A Holloway
- Nursing Studies, School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - J Norrie
- Usher Institute, Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - F Mohamed
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - M Eddleston
- Centre for Pesticide Suicide Prevention & Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - M Pearson
- Centre for Pesticide Suicide Prevention & Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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Burtscher M, Britton E. " There Was Some Kind of Energy Coming into My Heart": Creating Safe Spaces for Sri Lankan Women and Girls to Enjoy the Wellbeing Benefits of the Ocean. Int J Environ Res Public Health 2022; 19:3342. [PMID: 35329026 DOI: 10.3390/ijerph19063342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/25/2022] [Accepted: 03/03/2022] [Indexed: 11/17/2022]
Abstract
Worldwide, there is growing recognition of the wellbeing benefits of accessing and engaging with healthy blue spaces, especially seas, coasts, and beaches. However, vast gender inequalities persist that impact women’s and girls’ ability to safely access these spaces for recreational benefit. This is even more pronounced in the context of emerging surf cultures in regions such as Southeast Asia. Using a qualitative and reflective approach, this paper explored how safe spaces for female surfers are created, using case studies from two female-focused surfing programs in Sri Lanka. To facilitate a safe space, the multi-layered challenges that female surfers face were analysed. The common mediators that enable females to participate in surfing were then investigated and identified, including: seeing surfing as an option, supportive families and communities, the group factor, free lessons, an all-female environment, culturally appropriate surf apparel, and a safe and playful methodology. This study highlights pathways for how unsafe spaces of exclusion and fear may be transformed into safe spaces of inclusion, healing, and empowerment. These findings have implications for how safe spaces may be facilitated for other organisations, as well as the sustainability of female access to surfing, beyond the life of surfing programs.
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Surendran SN, Nagulan R, Sivabalakrishnan K, Arthiyan S, Tharsan A, Jayadas TTP, Raveendran S, Kumanan T, Ramasamy R. Reduced dengue incidence during the COVID-19 movement restrictions in Sri Lanka from March 2020 to April 2021. BMC Public Health 2022; 22:388. [PMID: 35209890 PMCID: PMC8866919 DOI: 10.1186/s12889-022-12726-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 02/07/2022] [Indexed: 02/07/2023] Open
Abstract
Background Dengue is the major mosquito-borne disease in Sri Lanka. After its first detection in January 2020, COVID-19 has become the major health issue in Sri Lanka. The impact of public health measures, notably restrictions on movement of people to curb COVID-19 transmission, on the incidence of dengue during the period March 2020 to April 2021 was investigated. Methods The incidence of dengue and COVID-19, rainfall and the public movement restrictions implemented to contain COVID-19 transmission were obtained from Sri Lanka government sources. A Seasonal Autoregressive Integrated Moving Average (SARIMA) model was used to predict the monthly dengue incidence from March 2020 to April 2021 for each of the country’s 25 districts based on five years of pre-pandemic data, and compared with the actual recorded incidence of dengue during this period. Ovitrap collections of Aedes larvae were performed in Jaffna city in the Jaffna district from August 2020 to April 2021 and the findings compared with similar collections made in the pre-pandemic period from March 2019 to December 2019. Results The recorded numbers of dengue cases for every month from March 2020 to April 2021 in the whole country and for all 25 districts over the same period were lower than the numbers of dengue cases predicted from data for the five years (2015–2019) immediately preceding the COVID-19 pandemic. The number of dengue cases recorded nationwide represented a 74% reduction from the predicted number of dengue cases for the March 2020 to April 2021 period. The numbers of Aedes larvae collected from ovitraps per month were reduced by 88.6% with a lower proportion of Ae. aegypti than Ae. albopictus in Jaffna city from August 2020 until April 2021 compared with March 2019 to December 2019. Conclusion Public health measures that restricted movement of people, closed schools, universities and offices to contain COVID-19 transmission unexpectedly led to a significant reduction in the reported numbers of dengue cases in Sri Lanka. This contrasts with findings reported from Singapore. The differences between the two tropical islands have significant implications for the epidemiology of dengue. Reduced access to blood meals and lower vector densities, particularly of Ae. aegypti, resulting from the restrictions on movement of people, are suggested to have contributed to the lower dengue incidence in Sri Lanka. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12726-8.
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Affiliation(s)
- S N Surendran
- Department of Zoology, Faculty of Science, University of Jaffna, Jaffna, Sri Lanka.
| | - R Nagulan
- Faculty of Applied Science, University of Vavuniya, Vavuniya, Sri Lanka
| | - K Sivabalakrishnan
- Department of Zoology, Faculty of Science, University of Jaffna, Jaffna, Sri Lanka
| | - S Arthiyan
- Department of Zoology, Faculty of Science, University of Jaffna, Jaffna, Sri Lanka
| | - A Tharsan
- Department of Zoology, Faculty of Science, University of Jaffna, Jaffna, Sri Lanka
| | - T T P Jayadas
- Department of Zoology, Faculty of Science, University of Jaffna, Jaffna, Sri Lanka
| | - S Raveendran
- Department of Geography, Faculty of Arts, University of Jaffna, Jaffna, Sri Lanka
| | - T Kumanan
- Department of Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - R Ramasamy
- Department of Zoology, Faculty of Science, University of Jaffna, Jaffna, Sri Lanka.
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Rathnayake S, Gray D, Reid J, Ramilan T. The impacts of the COVID-19 shock on sustainability and farmer livelihoods in Sri Lanka. Curr Res Environ Sustain 2022; 4:100131. [PMID: 35992577 PMCID: PMC9377147 DOI: 10.1016/j.crsust.2022.100131] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 02/10/2022] [Accepted: 02/15/2022] [Indexed: 06/15/2023]
Abstract
The COVID-19 pandemic and its handling in Sri Lanka has affected vegetable farmers in numerous ways and these impacts will constrain the country's move towards sustainable development. A field level study with vegetable farmers and key informants was carried out using exploratory research to understand, describe and analyze the impact of COVID-19 on the livelihoods of vegetable farmers and its relevance in achieving SDG 1. Data were supplemented by an extensive literature review. The analysis showed that the pandemic's impact on vegetable farmers in Sri Lanka is multidimensional and will increase vulnerability among vegetable farmers, for the long run. Adapting alternative inputs and marketing strategies, provision of immediate financial support, promoting innovative technology and service provision, and implementing intervention strategies tailored to farmer heterogeneity will improve farmer livelihoods and the prosperity of the sector.
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Affiliation(s)
- Sanduni Rathnayake
- School of Agriculture and Environment, College of Sciences, Massey University, Private Bag 11 222, Palmerston North 4410, New Zealand
- Department of Agricultural Extension, Faculty of Agriculture, University of Peradeniya, Peradeniya, Sri Lanka
| | - David Gray
- School of Agriculture and Environment, College of Sciences, Massey University, Private Bag 11 222, Palmerston North 4410, New Zealand
| | - Janet Reid
- School of Agriculture and Environment, College of Sciences, Massey University, Private Bag 11 222, Palmerston North 4410, New Zealand
| | - Thiagarajah Ramilan
- School of Agriculture and Environment, College of Sciences, Massey University, Private Bag 11 222, Palmerston North 4410, New Zealand
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Fonseka RW, McDougal L, Raj A, Reed E, Lundgren R, Urada L, Silverman JG. A mediation analysis of the role of girl child marriage in the relationship between proximity to conflict and past-year intimate partner violence in post-conflict Sri Lanka. Confl Health 2022; 16:5. [PMID: 35164806 PMCID: PMC8842814 DOI: 10.1186/s13031-022-00436-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 01/26/2022] [Indexed: 12/02/2022] Open
Abstract
Background Studies from many contexts indicate that proximity to conflict is associated with increased likelihood of intimate partner violence (IPV), and girl child marriage is associated with both proximity to conflict and increased IPV. In this study, we consider whether girl child marriage acts as a mediator of the association between proximity to conflict and IPV in the context of Sri Lanka, which sustained long-term conflict until 2009. Methods We analyzed responses of currently partnered women between ages 18 and 49 in the 2016 Sri Lankan Demographic and Health Survey (N = 13,691). Using logistic regression analyses, we measured associations between proximity to conflict (residence in districts which were central, proximal, or distal to the regions where the war occurred) and the outcomes of IPV and girl child marriage, and secondarily assessed girl child marriage as a possible mediator of the association between proximity to conflict and past year IPV. Results Women residing in districts central to conflict, as compared to districts distal to conflict, had increased odds of past year sexual, physical, and emotional IPV, with the odds of sexual IPV increasing the most (adjusted odds ratio/aOR 4.19, 95% confidence interval/CI 2.08–8.41). Residing in districts proximal to conflict compared to those distal to conflict was associated with lower odds of past year physical and emotional IPV, with the greatest decrease in emotional IPV (aOR 0.31, CI 0.18–0.54). Girl child marriage was more likely in districts central to conflict as opposed to those distal to conflict (aOR 1.89, CI 1.22–2.93), and partially mediated the relationship between centrality to conflict and IPV. Conclusions Our findings demonstrate that residing in districts central to conflict compared to those distal to conflict is associated with greater odds of IPV and girl child marriage in post-conflict Sri Lanka, with girl child marriage partially mediating the association between centrality to conflict and IPV. Residence in districts proximal to conflict appears protective against IPV. Future research should investigate what factors are responsible for decreased IPV in districts proximal to violence, and whether these factors can be reproduced to mitigate the increased prevalence of IPV in districts central to conflict. Supplementary Information The online version contains supplementary material available at 10.1186/s13031-022-00436-2.
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Affiliation(s)
- Ruvani W Fonseka
- Center on Gender Equity and Health (GEH), University of California San Diego School of Medicine, La Jolla, CA, USA. .,Joint Doctoral Program in Public Health, San Diego State University and University of California San Diego, San Diego, CA, USA. .,School of Social Work, San José State University, San Jose, CA, USA.
| | - Lotus McDougal
- Center on Gender Equity and Health (GEH), University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Anita Raj
- Center on Gender Equity and Health (GEH), University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Elizabeth Reed
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Rebecka Lundgren
- Center on Gender Equity and Health (GEH), University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Lianne Urada
- Center on Gender Equity and Health (GEH), University of California San Diego School of Medicine, La Jolla, CA, USA.,School of Social Work, San Diego State University, San Diego, CA, USA
| | - Jay G Silverman
- Center on Gender Equity and Health (GEH), University of California San Diego School of Medicine, La Jolla, CA, USA
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Samarasekara K. e-Learning in Medical Education in Sri Lanka: Survey of Medical Undergraduates and New Graduates. JMIR Med Educ 2022; 8:e22096. [PMID: 35142626 PMCID: PMC8874795 DOI: 10.2196/22096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 01/15/2021] [Accepted: 04/17/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Medical education has undergone drastic changes with the advent of novel technologies that enable e-learning. Medical students are increasingly using e-learning methods, and universities have incorporated them into their curricula. OBJECTIVE This study aimed at delineating the pattern of use of e-learning methods among medical undergraduates and new graduates of the Faculty of Medicine, University of Colombo, and identifying the challenges faced by these students in using e-learning methods. METHODS A cross-sectional descriptive study was conducted in the Faculty of Medicine, University of Colombo, in April 2020, with the participation of current undergraduates and pre-intern medical graduates, using a self-administered questionnaire that collected data on sociodemographic details, pattern of use of learning methods, and challenges faced using e-learning methods. RESULTS There were 778 respondents, with a response rate of 65.1% (778/1195). All the study participants used e-learning resources with varying frequencies, and all of them had at least 1 smart device with access to the internet. Electronic versions of standard textbooks (e-books), nonmedical websites, online lectures, medical websites, and medical phone apps were used by the majority. When comparing the extent of use of different learning methods, it appeared that students preferentially used traditional learning methods. The preference was influenced by the year of study and family income. The 3 most commonly used modalities for learning new study material and revising previously learned content were notes on paper material, textbooks (paper version), and e-books. The majority (98.7% [n=768]) of participants have encountered problems using e-learning resources. The most commonly faced problems were unavailability of free-of-charge access to some e-learning methods, expenses related to internet connection, poor connectivity of mobile internet, distractions while using online resources, and lack of storage space on electronic devices. CONCLUSIONS There is a high uptake of e-learning methods among Sri Lankan medical students. However, when comparing the extent of use of different learning methods, it appeared that students preferentially used traditional learning methods. A majority of the students have encountered problems when using e-learning methods, and most of these problems were related to poor economic status. Universities should take these factors into consideration when developing curricula in medical education.
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Piyawardhana N, Weerathunga V, Chen HS, Guo L, Huang PJ, Ranatunga RRMKP, Hung CC. Occurrence of microplastics in commercial marine dried fish in Asian countries. J Hazard Mater 2022; 423:127093. [PMID: 34536847 DOI: 10.1016/j.jhazmat.2021.127093] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/23/2021] [Accepted: 08/29/2021] [Indexed: 06/13/2023]
Abstract
The major risk of microplastics in marine environments is the bioaccumulation in marine organisms. Plastic ingestion by marine organisms has been investigated and recently more attention has been given to microplastics in seafood. However, it is seldom reported the occurrence of microplastics in marine commercial dried fish products available for human consumption. Here, we report the occurrence of microplastics in 14different marine dried fish products from seven Asian countries. Microplastics were observed in most dried fish, with fibers representing ~80% of the total-microplastics. The major plastic polymers, identified using Micro-Raman spectroscopy, included polyethylene (35%), polyethylene terephthalate (26%), polystyrene (18%), polyvinyl chloride (12%), and polypropylene (9%). The highest count, in either per individual (1.92 ± 0.12) or per gram of dried fish (0.56 ± 0.03), were found in Etrumeus micropus from Japan. Marine dried fish, which are typically eaten whole, may contribute to the ingestion of microplastics by humans, posing potential health risks especially in Asian countries. Further studies are needed to identify the occurrence of smaller sized microplastics and nanoplastics and their potential health impacts.
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Affiliation(s)
- Nathangi Piyawardhana
- Department of Oceanography, National Sun Yat-sen University, 70 Lien-hai Rd., Kaohsiung 80424, Taiwan, ROC
| | - Veran Weerathunga
- Department of Oceanography, National Sun Yat-sen University, 70 Lien-hai Rd., Kaohsiung 80424, Taiwan, ROC
| | - Hsu-Sen Chen
- Department of Oceanography, National Sun Yat-sen University, 70 Lien-hai Rd., Kaohsiung 80424, Taiwan, ROC
| | - Laodong Guo
- School of Freshwater Sciences, University of Wisconsin-Milwaukee, 600 E Greenfield Ave., Milwaukee, WI 53204, USA
| | - Po-Jung Huang
- Institute of Environmental Engineering, National Sun Yat-sen University, 70 Lien-hai Rd., Kaohsiung 80424, Taiwan, ROC
| | - R R M K P Ranatunga
- Center for Marine Science & Technology, University of Sri Jayewardenepura, Nugegoda 10250, Sri Lanka
| | - Chin-Chang Hung
- Department of Oceanography, National Sun Yat-sen University, 70 Lien-hai Rd., Kaohsiung 80424, Taiwan, ROC.
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Senanayake S, Pradhan B, Huete A, Brennan J. Spatial modeling of soil erosion hazards and crop diversity change with rainfall variation in the Central Highlands of Sri Lanka. Sci Total Environ 2022; 806:150405. [PMID: 34582866 DOI: 10.1016/j.scitotenv.2021.150405] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 06/13/2023]
Abstract
The spatial variation of soil erosion is essential for farming system management and resilience development, specifically in the high climate hazard vulnerable tropical countries like Sri Lanka. This study aimed to investigate climate and human-induced soil erosion through spatial modeling. Remote sensing was used for spatial modeling to detect soil erosion, crop diversity, and rainfall variation. The study employed a time-series analysis of several variables such as rainfall, land-use land-cover (LULC) and crop diversity to detect the spatial variability of soil erosion in farming systems. Rain-use efficiency (RUE) and residual trend analysis (RESTREND) combined with a regression approach were applied to partition the soil erosion due to human and climate-induced land degradation. Results showed that soil erosion has increased from 9.08 Mg/ha/yr to 11.08 Mg/ha/yr from 2000 to 2019 in the Central Highlands of Sri Lanka. The average annual rainfall has increased in the western part of the Central Highlands, and soil erosion hazards such as landslides incidence also increased during this period. However, crop diversity has been decreasing in farming systems, namely wet zone low country (WL1a) and wet zone mid-country (WM1a), in the western part of the Central Highlands. The RUE and RESTREND analyses reveal climate-induced soil erosion is responsible for land degradation in these farming systems and is a threat to sustainable food production in the farming systems of the Central Highlands.
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Affiliation(s)
- Sumudu Senanayake
- The Centre for Advanced Modelling and Geospatial Information Systems (CAMGIS), Faculty of Engineering and IT, University of Technology Sydney, Sydney 2007, NSW, Australia; Natural Resources Management Centre, Department of Agriculture, Peradeniya 20400, Sri Lanka
| | - Biswajeet Pradhan
- The Centre for Advanced Modelling and Geospatial Information Systems (CAMGIS), Faculty of Engineering and IT, University of Technology Sydney, Sydney 2007, NSW, Australia; Department of Energy and Mineral Resources Engineering, Sejong University, Choongmu-gwan, 209 Neungdong-ro, Gwangjin-gu, Seoul 05006, Republic of Korea; Earth Observation Center, Institute of Climate Change, University Kebangsaan Malaysia, 43600 UKM Bangi, Selangor, Malaysia.
| | - Alfredo Huete
- The Centre for Advanced Modelling and Geospatial Information Systems (CAMGIS), Faculty of Engineering and IT, University of Technology Sydney, Sydney 2007, NSW, Australia; Faculty of Science, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Jane Brennan
- The Centre for Advanced Modelling and Geospatial Information Systems (CAMGIS), Faculty of Engineering and IT, University of Technology Sydney, Sydney 2007, NSW, Australia
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Goswami P, Guruge KS, Tanoue R, Tamamura YA, Jinadasa KBSN, Nomiyama K, Kunisue T, Tanabe S. Occurrence of Pharmaceutically Active Compounds and Potential Ecological Risks in Wastewater from Hospitals and Receiving Waters in Sri Lanka. Environ Toxicol Chem 2022; 41:298-311. [PMID: 34529856 DOI: 10.1002/etc.5212] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/27/2021] [Accepted: 09/09/2021] [Indexed: 06/13/2023]
Abstract
The presence of pharmaceutically active compounds (PACs) in the environment and their associated hazards is a major global health concern; however, data on these compounds are scarce in developing nations. In the present study, the existence of 39 non-antimicrobial PACs and six of their metabolites in wastewater from hospitals and adjacent surface waters in Sri Lanka was investigated from 2016 to 2018. The highest amounts of the measured chemicals, including the highest concentrations of atorvastatin (14,620 ng/L) and two metabolites, mefenamic acid (12,120 ng/L) and o-desmethyl tramadol (8700 ng/L), were detected in wastewater from the largest facility. Mefenamic acid, gemfibrozil, losartan, cetirizine, carbamazepine, and phenytoin were detected in all the samples. The removal rates in wastewater treatment were 100% for zolpidem, norsertaline, quetiapine, chlorpromazine, and alprazolam. There was substantial variation in removal rates of PACs among facilities, and the overall data suggest that treatment processes in facilities were ineffective and that some PAC concentrations in the effluents were increased. The estimated risk quotients revealed that 14 PACs detected in water samples could pose low to high ecological risk to various aquatic organisms. Compounds such as ibuprofen, tramadol, and chlorpromazine detected in untreated and treated wastewater at these facilities pose a high risk to several aquatic organisms. Our study provides novel monitoring data for non-antimicrobial PAC abundance and the associated potential ecological risk related to hospitals and urban surface waters in Sri Lanka and further offers valuable information on pre-COVID-19 era PAC distribution in the country. Environ Toxicol Chem 2022;41:298-311. © 2021 SETAC.
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Affiliation(s)
- Prasun Goswami
- Atal Centre for Ocean Science and Technology for Islands, ESSO-National Institute of Ocean Technology, Dollygunj, Port Blair, Andaman and Nicobar Islands, India
| | - Keerthi S Guruge
- National Institute of Animal Health, National Agriculture and Food Research Organization, Tsukuba, Ibaraki, Japan
- Graduate School of Life and Environmental Sciences, Osaka Prefecture University, Izumisano, Osaka, Japan
- National Institute of Fundamental Studies, Kandy, Sri Lanka
| | - Rumi Tanoue
- Center for Marine Environmental Studies, Ehime University, Matsuyama, Ehime, Japan
| | - Yukino A Tamamura
- National Institute of Animal Health, National Agriculture and Food Research Organization, Tsukuba, Ibaraki, Japan
| | - K B S N Jinadasa
- Department of Civil Engineering, University of Peradeniya, Peradeniya, Sri Lanka
| | - Kei Nomiyama
- Center for Marine Environmental Studies, Ehime University, Matsuyama, Ehime, Japan
| | - Tatsuya Kunisue
- Center for Marine Environmental Studies, Ehime University, Matsuyama, Ehime, Japan
| | - Shinsuke Tanabe
- Center for Marine Environmental Studies, Ehime University, Matsuyama, Ehime, Japan
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Wyatt S, Ostbye T, De Silva V, Long Q. Antenatal depression in Sri Lanka: a qualitative study of public health midwives' views and practices. Reprod Health 2022; 19:23. [PMID: 35090509 PMCID: PMC8796187 DOI: 10.1186/s12978-022-01330-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 01/08/2022] [Indexed: 11/25/2022] Open
Abstract
Background Almost all pregnant people in Sri Lanka receive antenatal care by public health midwives. While there is strong infrastructure in Sri Lanka for postpartum mental health care, the current practices within antenatal mental health care have not been externally evaluated. The purpose of this study is to investigate the current clinical guidelines and experiences of how public health midwives diagnose and treat antenatal depression. Methods We conducted in-depth interviews with 12 public health midwives from four antenatal clinics in the Bope Poddala division in Galle, Sri Lanka and reviewed and extracted information on antenatal depression from clinical guidelines. Data was collected in Sinhala and translated into English. We used applied thematic analysis and worked closely with our local team to ensure data trustworthiness. Results Midwives (n = 12) reported varying degrees of knowledge on antenatal depression and did not have standardized diagnosis patterns. However, they were very consistent in their clinical practices, following guidelines for referral and follow-up of case management, building strong rapport. In their practice, midwives continue to face challenges of lack of human resources and high stigma around mental illness. They suggested that that care could be improved with use of a standardized diagnostic tool, and easier access to specialist care. We found the clinical guideline on the diagnosis and treatment of antenatal depression is lacking key details on symptoms for appropriate diagnosis, but it clearly guides on how to navigate treatment. Conclusions Public health midwives are following the clinical guideline to refer pregnant women who need intervention for antenatal depression and follow-up for case management. However, there is a need for more specific and context-relevant guidelines, especially for diagnosis of antenatal depression. Formative research is needed to explore intervention strategies to improve antenatal depression management in Sri Lanka. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-022-01330-z. We interviewed 12 midwives at pregnancy clinics in southern Sri Lanka about what happens if a pregnant woman gets depressed. Some midwives knew a lot about depression, while others did not know very much. They all had different ideas of what the signs of depression were, and what percentage of pregnant women are usually depressed. They have a rule book about how to be a midwife, but it is not clear about how they should find out if a pregnant woman has depression. However, all midwives agreed on what they should do if they meet a depressed woman during an antenatal appointment in their clinic, following the rule book closely. They said they need to tell their supervisor, who will tell a psychiatrist who can treat the depression. However, sometimes there are problems. Midwives said that they, their supervisor and the psychiatrist are all very busy and don’t have enough time to spend with pregnant women. Also, a lot of the women in their clinics don’t want to get treated because they feel embarrassed about having depression, and don’t want other people to know. Midwives told us they could do their jobs better if they could give a quick test for depression to every woman visiting their clinic. This would be an easy solution, because they already use a test like this for after women give birth.
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Affiliation(s)
- Sage Wyatt
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, 215316, Jiangsu, China.,University of Bergen, Bergen, Vestland, Norway
| | - Truls Ostbye
- Duke Global Health Institute, Duke University, Durham, NC, USA.,University of Bergen, Bergen, Vestland, Norway
| | - Vijitha De Silva
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Faculty of Medicine, University of Ruhuna, Matara, Southern Province, Sri Lanka
| | - Qian Long
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, 215316, Jiangsu, China.
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213
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Zavos HMS, Zunszain PA, Jayaweera K, Powell TR, Chatzivasileiadou M, Harber-Aschan L, Adikari A, Pannala G, Siribaddana S, Badini I, Pariante CM, Hotopf M, Sumathipala A, Rijsdijk F. Relationship between CRP and depression: A genetically sensitive study in Sri Lanka. J Affect Disord 2022; 297:112-7. [PMID: 34653513 DOI: 10.1016/j.jad.2021.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/30/2021] [Accepted: 10/03/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Previous studies have shown associations between major depression and C-reactive protein (CRP) levels. Few studies have considered the extent to which shared genetic and environmental factors contribute to this association, nor have they considered the relationship outside of European populations. We examined the association between CRP levels and depression and their aetiology in a Sri Lankan population. METHODS Data were collected from 2577 twins and 899 singletons in Colombo, Sri Lanka. Depression symptoms were assessed using the revised Beck Depression Inventory (BDI-II). High-sensitive CRP blood levels were assessed using immunoturbidimetry. Linear regressions were performed to test the association between CRP and depression. The heritability of CRP levels was estimated using Structural Equation Modelling. RESULTS CRP was significantly associated with BMI (p < 0.01) but not depression (p > 0.05). In males, variance in CRP levels was explained by shared environment (51% 95%CIs: 13-62) and non-shared environment (45% 95%CIs: 36-54). In contrast, in females, CRP variance was explained by genetic (41% 95%CIs: 10-52) and non-shared environment (56% 95%CIs: 47-67). A genetic correlation between CRP and BMI was observed in females only. LIMITATIONS CRP level was based on a single data collection point, longer term data collection would give a more accurate picture of an individual's state of inflammation. CONCLUSIONS The lack of association between depression and CRP strengthens the hypothesis that inflammation might contribute to the development of some, but not all types of depression. CRP levels were moderated by the environment, suggesting interventions aimed at reducing CRP levels and risk for inflammatory conditions, particularly in males.
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214
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Amarasekara C, Iyke BN, Narayan PK. The role of R&D and economic policy uncertainty in Sri Lanka's economic growth. Financ Innov 2022; 8:16. [PMID: 35043083 PMCID: PMC8758231 DOI: 10.1186/s40854-021-00322-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 12/09/2021] [Indexed: 05/23/2023]
Abstract
In this paper, we assess the role of investment in research and development (R&D) and economic policy uncertainty (EPU) in Sri Lanka's economic growth experience. We do this by first determining which endogenous growth theories best explain the evolution of total factor productivity (TFP) in the country. Using historical time series data (1980-2018), we find that semi-endogenous growth theories best explain the evolution of TFP in Sri Lanka. This evidence suggests that R&D is critical to the country's TFP expansion. We find that, through R&D, EPU has a crucial detrimental impact on TFP growth, although it is short-lived. Our findings are robust and have important implications for R&D investment and for moderating EPU.
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Affiliation(s)
| | | | - Paresh Kumar Narayan
- Monash Business School, Monash University, Melbourne, Australia Wellington Road
- Monash Business School, Monash University, Wellington Road, Melbourne, Australia
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215
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Warnasekara J, Agampodi S. Neglecting the neglected during the COVID-19 pandemic: the case of leptospirosis in Sri Lanka. Epidemiol Health 2022; 44:e2022015. [PMID: 35038829 PMCID: PMC9117097 DOI: 10.4178/epih.e2022015] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/10/2022] [Indexed: 11/09/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has disrupted global health systems and affected the transmission dynamics as well as the surveillance of other infectious diseases. This study described the probable effect of the COVID-19 pandemic on the surveillance and control of leptospirosis in Sri Lanka. With 8,579 reported cases and more than 800 estimated deaths, the Sri Lankan public health surveillance system documented the largest outbreak of leptospirosis in Sri Lankan history in 2020. This was the worst infectious disease outbreak Sri Lanka experienced in 2020, but it was neglected, primarily due to the COVID-19 pandemic.
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Affiliation(s)
- Janith Warnasekara
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Suneth Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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216
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Prabath IHDS, Mohottala VS, Prasanni WDD, Ranathunga RTR, Mathangasinghe Y. Health-related attitudes, behaviors and burnout in intern medical officers and their effects on self-reported patient care in a developing country. Ir J Med Sci 2022. [PMID: 34993835 DOI: 10.1007/s11845-021-02874-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/29/2021] [Indexed: 11/17/2022]
Abstract
Background Intern Medical Officers (IMOs) in Sri Lanka face significant challenges due to heavy patient load and scarcity of resources. Aims To assess IMOs' level of burnout, associated factors and the effects on self-reported patient care in comparison to post-intern Relief House Officers (RHOs). Methods A descriptive cross-sectional study was conducted among IMOs and RHOs in two leading tertiary care hospitals in Sri Lanka. The level of burnout was assessed using Maslach Burnout Index. The self-reported health-related attitudes, practices, level of burnout, and their associations with patient care were compared between IMOs and RHOs. Results We studied 114 participants (70 (61.4%) IMOs and 44 (38.6%) RHOs). IMOs were not involved in regular exercises (χ2(1) = 19.8, p = 0.000), skipped meals frequently (χ2(1) = 29.3, p = 0.000), and had a poor sleep quality (χ2(1) = 35.7, p = 0.000) compared to RHOs. Overall, 46.5%, 95.5%, and 86.7% of the participants were having moderate-to-high emotional exhaustion, depersonalization, and sense of poor personal achievement. The exhaustion and depersonalization levels were significantly higher among IMOs. Emotional exhaustion was significantly associated with poor sleep (U = 923.0, p = 0.014). Self-reported patient care negatively correlated with exhaustion (rs(112) = − 0.263, p = 0.005) and depersonalization (rs(112) = − 0.491, p = 0.000), while having positive attitudes correlated with better patient care (rs(112) = 0.208, p = 0.027). Conclusions The prevalence of burnout in IMOs in Sri Lanka is high, which, in turn, negatively correlates with patient care. IMOs face significant challenges in self-care, while their poor sleep perturbs daytime activities and conceivably interferes with patient care. Therefore, we recommend introduction of preventive measures to mitigate burnout in early-career physicians, particularly IMOs, to improve both self and patient care. Supplementary information The online version contains supplementary material available at 10.1007/s11845-021-02874-y.
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217
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Amarasinghe GS, Agampodi TC, Mendis V, Malawanage K, Kappagoda C, Agampodi SB. Prevalence and aetiologies of anaemia among first trimester pregnant women in Sri Lanka; the need for revisiting the current control strategies. BMC Pregnancy Childbirth 2022; 22:16. [PMID: 34986796 PMCID: PMC8734253 DOI: 10.1186/s12884-021-04341-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/09/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The Sustainable development goals, which focus strongly on equity, aim to end all forms of malnutrition by 2030. However, a significant cause of intergenerational transfer of malnutrition, anaemia in pregnancy, is still a challenge. It is especially so in the low- and middle-income settings where possible context-specific aetiologies leading to anaemia have been poorly explored. This study explores the prevalence of etiological factors significantly contributing to anaemia in pregnancy in Sri Lanka, a lower-middle-income country with a high prevalence of malnutrition albeit robust public health infrastructure. METHODS All first-trimester pregnant women registered in the public maternal care programme in the Anuradhapura district from July to September 2019 were invited to participate in Rajarata Pregnancy Cohort (RaPCo). After a full blood count analysis, high-performance liquid chromatography, peripheral blood film examination, serum B12 and folate levels were performed in anaemic participants, guided by an algorithm based on the red cell indices in the full blood count. In addition, serum ferritin was tested in a random subsample of 213 participants. Anaemic women in this subsample underwent B12 and folate testing. RESULTS Among 3127 participants, 14.4% (95%CI 13.2-15.7, n = 451) were anaemic. Haemoglobin ranged between 7.4 to 19.6 g/dl. 331(10.6%) had mild anaemia. Haemoglobin ≥13 g/dl was observed in 39(12.7%). Microcytic, normochromic-normocytic, hypochromic-normocytic and macrocytic anaemia was observed in 243(54%), 114(25.3%), 80(17.8%) and two (0.4%) of full blood counts in anaemic women, respectively. Microcytic anaemia with a red cell count ≥5 * 106 /μl demonstrated a 100% positive predictive value for minor haemoglobinopathies. Minor hemoglobinopathies were present in at least 23.3%(n = 105) of anaemic pregnant women. Prevalence of iron deficiency, B12 deficiency and Southeast Asian ovalocytosis among the anaemic was 41.9% (95%CI 26.4-59.2), 23.8% (95%CI 10.6-45.1) and 0.9% (95%CI 0.3-2.3%), respectively. Folate deficiency was not observed. CONCLUSION Even though iron deficiency remains the primary cause, minor hemoglobinopathies, B 12 deficiency and other aetiologies substantially contribute to anaemia in pregnancy in this study population. Public health interventions, including screening for minor hemoglobinopathies and multiple micronutrient supplementation in pregnancy, should be considered in the national programme for areas where these problems have been identified.
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Affiliation(s)
- Gayani Shashikala Amarasinghe
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka.
| | - Thilini Chanchala Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Vasana Mendis
- Department of Pathology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Krishanthi Malawanage
- Regional Director of Health Services Office - Anuradhapura, Ministry of Health, Anuradhapura, Sri Lanka
| | - Chamila Kappagoda
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Suneth Buddhika Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
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Abayalath N, Malshani I, Ariyaratne R, Zhao S, Zhong G, Zhang G, Manipura A, Siribaddana A, Karunaratne P, Kodithuwakku SP. Characterization of airborne PAHs and metals associated with PM10 fractions collected from an urban area of Sri Lanka and the impact on airway epithelial cells. Chemosphere 2022; 286:131741. [PMID: 34358888 DOI: 10.1016/j.chemosphere.2021.131741] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/19/2021] [Accepted: 07/29/2021] [Indexed: 06/13/2023]
Abstract
Airborne particulate matter (PM), polycyclic aromatic hydrocarbons (PAHs) and heavy metals (HMs) are significant contributors leading to many human health issues. Thus, this study was designed to perform chemical analysis and biological impact of airborne particulate matter 10 (PM10) in the World heritage City of Kandy City in Sri Lanka. 12 priority PAHs and 34 metals, including 10 highly toxic HMs were quantified. The biological effects of organic extracts were assayed using an in vitro primary porcine airway epithelial cell culture model. Cytotoxicity, DNA damage, and gene expressions of selected inflammatory and cancer-related genes were also assessed. Results showed that the total PAHs ranged from 3.062 to 36.887 ng/m3. The metals were dominated by Na > Ca > Mg > Al > K > Fe > Ti, while a few toxic HMs were much higher in the air than the existing ambient air quality standards. In the bioassays, a significant cytotoxicity (p < 0.05) was observed at 300 μg/mL treatment, and significant (p < 0.05) DNA damages were noted in all treatment groups. All genes assessed were found to be significantly up-regulated (p < 0.05) after 24 h of exposure and after 48 h, only TGF-β1 and p53 did not significantly up-regulate (p < 0.05). These findings confirm that the Kandy city air contains potential carcinogenic and mutagenic compounds and thus, exposure to Kandy air may increase the health risks and respiratory tract-related anomalies.
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Affiliation(s)
- Nirodha Abayalath
- Department of Animal Science, Faculty of Agriculture, University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | - Indeepa Malshani
- Department of Animal Science, Faculty of Agriculture, University of Peradeniya, Peradeniya, 20400, Sri Lanka; Department of Pharmacy, Faculty of Allied Health Sciences, University of Ruhuna, Galle, 80000, Sri Lanka
| | - Rajitha Ariyaratne
- Department of Chemical and Process Engineering, Faculty of Engineering, University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | - Shizhen Zhao
- State Key Laboratory of Organic Geochemistry (SKLOG), Guangzhou Institute of Geochemistry (GIG), Chinese Academy of Sciences (CAS), Guangzhou, 510640, PR China
| | - Guangcai Zhong
- State Key Laboratory of Organic Geochemistry (SKLOG), Guangzhou Institute of Geochemistry (GIG), Chinese Academy of Sciences (CAS), Guangzhou, 510640, PR China
| | - Gan Zhang
- State Key Laboratory of Organic Geochemistry (SKLOG), Guangzhou Institute of Geochemistry (GIG), Chinese Academy of Sciences (CAS), Guangzhou, 510640, PR China
| | - Aruna Manipura
- Department of Chemical and Process Engineering, Faculty of Engineering, University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | | | - Parakrama Karunaratne
- Department of Chemical and Process Engineering, Faculty of Engineering, University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | - Suranga P Kodithuwakku
- Department of Animal Science, Faculty of Agriculture, University of Peradeniya, Peradeniya, 20400, Sri Lanka; Department of Obstetrics and Gynaecology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, PR China.
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219
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Wijemunige N, Rannan-Eliya RP, Maurer J, O'Donnell O. Cost-Effectiveness and Distributional Impact of Opportunistic Screening for People at High-Risk of Cardiovascular Disease in Sri Lanka: A Modelling Study. Glob Heart 2022; 17:89. [PMID: 36578913 DOI: 10.5334/gh.1174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 11/14/2022] [Indexed: 12/24/2022] Open
Abstract
Background While hypertension, diabetes, hypercholesterolemia and high-risk of cardiovascular disease can be easily diagnosed and treated with cost-effective medicines, a large proportion of people remain undiagnosed. We assessed the potential effectiveness, cost, and distributional impact of opportunistically screening for these chronic conditions at outpatient patient departments in Sri Lanka. Methods We used nationally representative data on biomarkers and healthcare utilization in 2019 to model the screening of people aged 40+ without preexisting CVD and without a reported diagnosis of hypertension, diabetes, or hypercholesterolemia. We modelled an intensive one month program that would screen a proportion of those making an outpatient visit to a public or private clinic and follow-up a proportion of those screened to confirm diagnoses. We also modelled a less intensive one year program. The main outcomes were the new diagnoses of any of the chronic conditions. Program costs were calculated and the socioeconomic distributions of individuals screened, new cases diagnosed, and treatments delivered were estimated. Sensitivity analyses varied the probability of screening and follow-up. Results Using data on 2,380 survey participants who met the inclusion criteria, we estimated that the one month program would diagnose 8.2% (95% CI: 6.8, 9.6) of those with a chronic condition who would remain undiagnosed without the program. The one year program would diagnose 26.9% (95% CI: 26.5, 27.4) of the otherwise undiagnosed and would have a cost per person newly diagnosed of USD 6.82 (95% CI: 6.61, 7.03) in the public sector and USD 16.92 (95% CI: 16.37, 17.47) in the private sector. New diagnoses would be evenly distributed over the socioeconomic distribution, with public (private) clinics diagnosing a higher proportion of poorer (richer) individuals. Both programs would reduce underdiagnosis among males relative to females. Conclusions Opportunistic screening for cardiovascular diseases at outpatient clinics in Sri Lanka could be cost-effective and equitable.
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220
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Premawardhena AP, Madushanka HDP. Thalassemia in Sri Lanka. Hemoglobin 2022; 46:71-73. [PMID: 35950586 DOI: 10.1080/03630269.2022.2025826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The island nation of Sri Lanka with 22 million people (in 2020) has an estimated 2000 patients with severe thalassemia. The majority have β-thalassemia (β-thal) major (β-TM), and Hb E (HBB: c.79G>A)/β-thal accounts for most of the remainder. Carrier rate for α+-thalassemia (α+-thal) trait is 9.9% and β-thal trait is 2.5%, with very similar rates in the three major ethnic groups (Sinhalese, Tamils and Moors). The distribution of thalassemia type reveals a remarkable variation, even in this small island, mirroring historical distribution of malaria. Even though healthcare is provided free by the state including blood transfusions and chelation, the overall survival of patients of β-TM is still not on a par with that of the Mediterranean countries. A national thalassemia prevention program was set up in 2007, but overall success of the exercise based essentially on dissuasion of marriages is not very promising.
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Affiliation(s)
- Anuja P Premawardhena
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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Jayarajah U, Gunawardene M, Willaraarachchi M, Chandrasiri S, Udayakumaran P, Sosai C, Abeygunasekera A. Clinical characteristics and outcome of genitourinary tuberculosis in Sri Lanka: an observational study. BMC Infect Dis 2021; 21:1279. [PMID: 34961480 PMCID: PMC8711141 DOI: 10.1186/s12879-021-06990-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 12/17/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although genitourinary Tuberculosis (GUTB) is the second commonest source of extrapulmonary TB in most countries, the reported rate of GUTB in Sri Lanka remains low. The characteristics of GUTB in Sri Lanka have not been studied and documented so far. We aimed to study the clinical and imaging characteristics, treatment modalities and outcome of GUTB in Sri Lanka. METHODS Data collected from patients treated by a single urological surgeon in two institutes consecutively over a period of 21 years were analysed. All patients with a microbiological and/or histopathological diagnosis of GUTB were included. Median duration of follow-up was 24 months (range: 6-96). RESULTS There were 82 patients and 45 (54.9%) were men. The median age was 51 (range: 26-75) years. Most patients (39%, n = 32) had vague non-specific symptoms at presentation. Common specific symptoms at presentation were haematuria (15.8%, n = 13) and scrotal manifestations (15.8%, n = 13). Mantoux test was done in 70 patients and was > 10 mm in 62 (88.5%). Erythrocyte sedimentation rate was available in 69 patients and was > 30 mm in 54 (78.3%) patients. Chest x-ray and x-ray kidney-ureter-bladder (KUB) abnormalities were detected in 9 (11%) and 6 (7.3%) respectively. CT-urography was performed in 72 patients and abnormalities were detected in 57 (79%) patients. Forty-two patients underwent cystoscopy and 73.8% (n = 31) had abnormal findings. Microbiological diagnosis was feasible in 43 (52.4%) and rest were diagnosed histopathologically. Commonest organs involved were kidney (64.6%, n = 53), ureter (51.2%, n = 42), bladder (43.9%, n = 36) and testis/epididymis (15.8%, n = 13). One patient had TB of the prostate. All were treated primarily with anti-TB drugs however, 50 (61%) required ancillary therapeutic interventions. The majority of interventions were reconstructive surgeries (n = 20, 24.4%) followed by excisional surgeries (n = 19, 23.2%) and drainage procedures (n = 11, 13.4%). Seven patients developed serious adverse reactions to anti-TB drugs. Five patients developed a thimble bladder with disabling storage symptoms. Eight patients had deranged renal functions at diagnosis and three patients developed progressive deterioration of renal function and two patients died of end stage renal disease. CONCLUSIONS The combination of urine for acid-fast bacilli, Mantoux test, CT-Urography, cystoscopy and histopathology is necessary to diagnose GUTB in resource-poor settings. Most ureteric strictures, non-functioning kidneys and epididymal masses need surgical treatment. Long-term follow up is essential to detect progressive deterioration of renal function.
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Affiliation(s)
- Umesh Jayarajah
- Department of Urology, Colombo South Teaching Hospital, No: B229 Hospital Road, Dehiwala, 10350 Sri Lanka
| | - Milan Gunawardene
- Department of Urology, Colombo South Teaching Hospital, No: B229 Hospital Road, Dehiwala, 10350 Sri Lanka
| | - Munipriya Willaraarachchi
- Department of Urology, Colombo South Teaching Hospital, No: B229 Hospital Road, Dehiwala, 10350 Sri Lanka
| | - Shirani Chandrasiri
- Department of Microbiology, Colombo South Teaching Hospital, Dehiwala, Sri Lanka
| | | | - Cherine Sosai
- Department of Pathology, Colombo South Teaching Hospital, Dehiwala, Sri Lanka
| | - Anuruddha Abeygunasekera
- Department of Urology, Colombo South Teaching Hospital, No: B229 Hospital Road, Dehiwala, 10350 Sri Lanka
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222
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Karunaratna S, Weerasinghe MC, Ranasinghe T, Jayasuriya R, Chandraratne N, Herath H, Quaife M. Improving Uptake of Non-Communicable Disease Screening in Sri Lanka: Eliciting Peoples' Preferences using a Discrete Choice Experiment. Health Policy Plan 2021; 37:218-231. [PMID: 34893842 DOI: 10.1093/heapol/czab141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 11/11/2021] [Accepted: 12/10/2021] [Indexed: 11/15/2022] Open
Abstract
A national programme to universally screen the population between 35 - 65 years for non-communicable diseases was established at 'Healthy Lifestyle Centres (HLCs)' in 2011 in Sri Lanka. Despite several efforts by policy makers, the uptake of screening remained below 10% of the target population and with disparities in uptake across districts and among men and women. Considering service beneficiaries as a vital stakeholder, a discrete choice experiment was carried out to estimate people's preference for a NCD screening service delivery model in rural, urban and estate sectors in a district in Sri Lanka. The choice design and the general survey questionnaire was developed through focus group discussions, literature reviews and stakeholder consultations. Data was collected by stratified random sampling, with 187 participants from the urban sector, 253 from the rural sector and 152 from the estate/plantation sector. Peoples' preference was assessed as utility estimates derived using multinomial logistic regression. Reliability was assessed within test among all study participants and with test-retest among 40 participants showed 80% precision. Urban and rural sectors gave the highest priority to workplace screening over screening at HLCs. The estates attributed the highest priority for cost free screening. If cost free screening is offered with having to spend 1-2 hours at the most preferred opening times for each sector with warm and friendly staff, the uptake of screening can predicted to be increased by 65, 29 and 21 times respectively in urban, rural and estate sectors relative to having to attend HLCs from 8am - 4 pm, spending more than 2 hours and Rs. 1000 with unfriendly staff. Thus, peoples' preferences on service delivery aspects seemed to have differed from government priorities. Preferences when ill and apparently healthy differed, as they preferred to spend less time and money when healthy than when ill.
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Affiliation(s)
- Sumudu Karunaratna
- Office of the Deputy Director General/ Public Health Services, Ministry of Health, Sri Lanka
| | - Manuj C Weerasinghe
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Sri Lanka
| | | | - Rohan Jayasuriya
- School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia
| | - Nadeeka Chandraratne
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Sri Lanka
| | | | - Matthew Quaife
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom
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223
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Sadeepa D, Sirisena K, Manage PM. Diversity of microbial communities in hot springs of Sri Lanka as revealed by 16S rRNA gene high-throughput sequencing analysis. Gene 2021; 812:146103. [PMID: 34896522 DOI: 10.1016/j.gene.2021.146103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 11/01/2021] [Accepted: 11/16/2021] [Indexed: 01/16/2023]
Abstract
Characterization of hot spring microbiota is useful as an initial platform for exploring industrially important microbes. The present study focused on characterization of microbiota in four hot springs in Sri Lanka: Maha Oya; Wahava; Madunagala; and Kivlegama using high throughput 16S amplicon sequencing. Temperatures of the selected springs were ranged from 33.7 °C to 52.4 °C, whereas pH ranged from 7.2 to 8.2. Bacteria were found to be the dominant microbial group (>99%) compared to Archaea which represented less than 1% of microbiota. Four hot springs comprised of unique microbial community structures. Proteobacteria, Firmicutes, Bacteroidetes, Cloroflexi, Deinococcus and Actenobacteria were the major bacterial phyla. Moderately thermophilic genera such as Thermodesulfobacteria and Deinococcus-Thermus were detected as major genera that could be used in industrial applications operating at temperatures around 50 °C and alkaline reaction conditions.
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Affiliation(s)
- Dilini Sadeepa
- Centre for Water Quality and Algae Research, Department of Zoology, University of Sri Jayewardenepura, Gangodawila, Nugegoda 10250, Sri Lanka; Faculty of Graduate Studies, University of Sri Jayewardenepura, Nugegoda 10250, Sri Lanka
| | - Kosala Sirisena
- Department of Environmental Technology, Faculty of Technology, University of Colombo, Sri Lanka
| | - Pathmalal M Manage
- Centre for Water Quality and Algae Research, Department of Zoology, University of Sri Jayewardenepura, Gangodawila, Nugegoda 10250, Sri Lanka; Faculty of Graduate Studies, University of Sri Jayewardenepura, Nugegoda 10250, Sri Lanka.
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Herath HMMTB, Wijayawardhana KWSM, Wickramarachchi UI, Rodrigo C. Attitudes on euthanasia among medical students and doctors in Sri Lanka: a cross sectional study. BMC Med Ethics 2021; 22:162. [PMID: 34876119 DOI: 10.1186/s12910-021-00731-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/24/2021] [Indexed: 11/26/2022] Open
Abstract
Background Euthanasia is a topic of intense ethical debate and it is illegal in most countries at present, including Sri Lanka. The aim of this descriptive cross-sectional study of medical students and practicing doctors was to explore the acceptance of euthanasia and physician assisted suicide (PAS), and factors influencing this opinion. Methods A customised online questionnaire which explored opinions on euthanasia was administered to first and final year medical undergraduates in University of Colombo and practicing doctors with more than 5 years of work experience at The National Hospital of Sri Lanka. Attitudes on euthanasia and PAS were also assessed with the attitudes towards euthanasia (ATE) Scale, which is a 10-item questionnaire. Results A total of 425 individuals responded (males: 178, 42%, age: median – 27 years), which included 143 (33.6%) first-year medical undergraduates, 141 (33.2%) final-year medical undergraduates and 141 (33.2%) practicing doctors. More participants (200, 47.1%) favoured legalizing euthanasia than those directly opposing it (110, 25.9%), but a significant proportion (27%) remained undecided. The mean scores of ATE questionnaire from the whole sample were generally unfavourable towards euthanasia/PAS. Accepting euthanasia as an option for oneself (p = < 0.001) was the strongest predictor of favouring euthanasia/PAS or supporting its legalization. Conclusion In this cross-sectional survey, more respondents supported legalisation of euthanasia in Sri Lanka than those openly opposing it. Yet, a significant minority that responded as “undecided” for legalisation, were more likely to have unfavourable ATE. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-021-00731-2.
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225
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De Silva Perera U, Inder BA. Midday meals as an early childhood nutrition intervention: evidence from plantation communities in Sri Lanka. BMC Public Health 2021; 21:2224. [PMID: 34876076 PMCID: PMC8650296 DOI: 10.1186/s12889-021-11843-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 09/23/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND High rates of child malnutrition are a major public health concern in developing countries, particularly among vulnerable communities. Midday meals programs can be effective for combatting childhood malnutrition among older children. However, their use in early childhood is not well documented, particularly within South Asia. Anthropometric measures and other socioeconomic data were collected for children below the age of 5 years living in selected Sri Lankan tea plantations, to assess the effectiveness of midday meals as a nutrition intervention for improving growth among young children. METHODS The study exploits a natural experiment whereby the provision of the midday meals program is exogenously determined at the plantation level, resulting in comparable treatment and control groups. Longitudinal data was collected on heights and weights of children, between 2013 and 2015. Standardized weight-for-age, height-for-age and weight-for-height, and binary variables for stunting, wasting and underweight are constructed, following WHO guidelines. All modelling uses STATA SE 15. Random-effects regression with instrumental variables is used for modelling standardized growth while random-effects logistic regression is used for the binary outcomes. Robustness analysis involves different estimation methods and subsamples. RESULTS The dataset comprises of longitudinal data from a total of 1279 children across three tea plantations in Sri Lanka, with 799 children in the treatment group and 480 in the control group. Results show significant positive effects of access to the midday meals program, on the growth of children. A child with access to the midday meals intervention reports an average standardized weight-for-age 0.03 (±0.01) and height-for-age 0.05 (±0.01) units higher than a similar child without access to the intervention. Importantly, access to the intervention reduces the likelihood of being underweight by 0.45 and the likelihood of wasting by 0.47. The results are robust to different model specifications and across different subsamples by gender, birthweight and birth-year cohort. CONCLUSIONS Midday meals programs targeting early childhood can be an effective intervention to address high rates of child malnutrition, particularly among vulnerable communities in developing countries like Sri Lanka.
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Affiliation(s)
- Udeni De Silva Perera
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Australia
| | - Brett A. Inder
- Research Fellow, Centre for Health Economics, Monash University, 900, Dandenong Road, Caulfield campus, Melbourne, VIC 3145 Australia
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226
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Jeewandara C, Guruge D, Abyrathna IS, Danasekara S, Gunasekera B, Pushpakumara PD, Madhusanka D, Jayathilaka D, Ranasinghe T, Somathilake G, Tanussiya S, Jayadas TT, Kuruppu H, Thashmi N, Harvie M, Wijayamuni R, Schimanski L, Tan TK, Rijal P, Xiao J, Ogg GS, Townsend A, Malavige GN. Seroprevalence of SARS-CoV-2 Infection in the Colombo Municipality Region, Sri Lanka. Front Public Health 2021; 9:724398. [PMID: 34869146 PMCID: PMC8632812 DOI: 10.3389/fpubh.2021.724398] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 09/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background: As the Municipality Council area in Colombo (CMC) experienced the highest number of cases until the end of January 2021, in Sri Lanka, we carried out a serosurvey prior to initiation of the vaccination program to understand the extent of the SARS-CoV-2 outbreak. Methods: SARS-CoV-2 seropositivity was determined in 2,547 individuals between the ages of 10–86 years, by the Wantai total antibody ELISA. We also compared seroprevalence using the haemagglutination test (HAT) to evaluate its usefulness in carrying out serosurveys. Results: The overall seropositivity rate was 24.46%, while seropositivity by HAT was 18.90%. Although The SARS-CoV-2 infection detection rates by PCR were highest in the population between the ages of 20–60 years of age, there was no statistically significant difference in the seropositivity rates in different age groups. For instance, although the seropositivity rate was highest in the 10–20 age group (34.03%), the PCR positivity rate was 9.80%. Differences in the PCR positivity rates and seropositivity rates were also seen in 60–70-year-olds (8.90 vs. 30.4%) and in individuals >70 years (4.10 vs. 1.20%). The seropositivity rate of the females was 29.70% (290/976), which was significantly higher (p < 0.002) than in males 21.2% (333/1,571). Conclusions: A high seroprevalence rate (24.5%) was seen in all age groups in the CMC suggesting that a high level of transmission was seen during this time. The higher PCR positivity rates between the ages of 20–60 are likely to be due to increased testing carried out in the working population. Therefore, the PCR positivity rates, appear to underestimate the true extent of the outbreak and the age groups which were infected.
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Affiliation(s)
- Chandima Jeewandara
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | | | - Inoka Sepali Abyrathna
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Saubhagya Danasekara
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Banuri Gunasekera
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Pradeep Darshana Pushpakumara
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Deshan Madhusanka
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Deshni Jayathilaka
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Thushali Ranasinghe
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Gayasha Somathilake
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Shyrar Tanussiya
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Tibutius Tanesh Jayadas
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Heshan Kuruppu
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Nimasha Thashmi
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Michael Harvie
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | | | - Lisa Schimanski
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom.,Centre for Translational Immunology, Chinese Academy of Medical Sciences Oxford Institute, University of Oxford, Oxford, United Kingdom
| | - T K Tan
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom.,Centre for Translational Immunology, Chinese Academy of Medical Sciences Oxford Institute, University of Oxford, Oxford, United Kingdom
| | - Pramila Rijal
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom.,Centre for Translational Immunology, Chinese Academy of Medical Sciences Oxford Institute, University of Oxford, Oxford, United Kingdom
| | - Julie Xiao
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom.,Centre for Translational Immunology, Chinese Academy of Medical Sciences Oxford Institute, University of Oxford, Oxford, United Kingdom
| | - Graham S Ogg
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Alain Townsend
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom.,Centre for Translational Immunology, Chinese Academy of Medical Sciences Oxford Institute, University of Oxford, Oxford, United Kingdom
| | - Gathsaurie Neelika Malavige
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.,MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
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227
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Bandaranayaka KO, Kularatne SAM, Rajapakse RPVJ, Abeysundara UB, Rajapaksha RMMA, Rajakaruna RS. Human Otoacariasis in Two Climatically Diverse Districts in Sri Lanka: Seasonality, Risk Factors, and Case Notes. Acta Parasitol 2021; 66:1326-1340. [PMID: 33993424 DOI: 10.1007/s11686-021-00372-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/12/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Otoacariasis is a parasitic otopathy reported in many parts of the world. This study presents the seasonal pattern, risk factors, and case notes on human otoacariasis in two climatically different districts: Anuradhapura and Kandy in the Dry and Wet/Intermediate zone of Sri Lanka, respectively. METHODS Ticks removed from the ear canal of patients were collected. Risk factors of otoacarisis were determined by a case/control follow-up study. RESULTS Nymphal Dermacentor auratus (90.8%) was the main tick species associated otoacariasis. In the Kandy District, infestation was year-round, while in the Anuradhapura District, it was seasonal with a peak in December-February. Children < 10 years were a risk group in both districts. Females were a risk group in the Kandy District. Engagement in outdoor activities was a risk factor in both districts. In addition, the presence of wildlife and domesticated animals were risk factors in the Kandy and Anuradhapura districts, respectively. The treatment protocols in the two hospitals were different. An infant with otoacariasis from the Anuradhapura District developed rickettsia. CONCLUSIONS Although the tick species was the same, seasonality, risk groups, and risk factors in the two districts were different which could be due to the establishment and persistence of tick populations influenced by biotic and abiotic factors.
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Affiliation(s)
- K O Bandaranayaka
- Department of Zoology, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka
- Postgraduate Institute of Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - S A M Kularatne
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - R P V J Rajapakse
- Department of Veterinary Pathobiology, Faculty of Veterinary Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | | | - R S Rajakaruna
- Department of Zoology, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka.
- Postgraduate Institute of Science, University of Peradeniya, Peradeniya, Sri Lanka.
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Amarasinghe P, Barve N, Kathriarachchi H, Loiselle B, Cellinese N. Niche dynamics of Memecylon in Sri Lanka: Distribution patterns, climate change effects, and conservation priorities. Ecol Evol 2021; 11:18196-18215. [PMID: 35003667 PMCID: PMC8717329 DOI: 10.1002/ece3.8415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/23/2021] [Accepted: 11/12/2021] [Indexed: 12/02/2022] Open
Abstract
Recent climate projections have shown that the distribution of organisms in island biotas is highly affected by climate change. Here, we present the result of the analysis of niche dynamics of a plant group, Memecylon, in Sri Lanka, an island, using species occurrences and climate data. We aim to determine which climate variables explain current distribution, model how climate change impacts the availability of suitable habitat for Memecylon, and determine conservation priority areas for Sri Lankan Memecylon. We used georeferenced occurrence data of Sri Lankan Memecylon to develop ecological niche models and assess both current and future potential distributions under six climate change scenarios in 2041-2060 and 2061-2080. We also overlaid land cover and protected area maps and performed a gap analysis to understand the impacts of land-cover changes on Memecylon distributions and propose new areas for conservation. Differences among suitable habitats of Memecylon were found to be related to patterns of endemism. Under varying future climate scenarios, endemic groups were predicted to experience habitat shifts, gains, or losses. The narrow endemic Memecylon restricted to the montane zone were predicted to be the most impacted by climate change. Projections also indicated that changes in species' habitats can be expected as early as 2041-2060. Gap analysis showed that while narrow endemic categories are considerably protected as demonstrated by their overlap with protected areas, more conservation efforts in Sri Lankan forests containing wide endemic and nonendemic Memecylon are needed. This research helped clarify general patterns of responses of Sri Lankan Memecylon to global climate change. Data from this study are useful for designing measures aimed at filling the gaps in forest conservation on this island.
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Affiliation(s)
- Prabha Amarasinghe
- Department of BiologyUniversity of FloridaGainesvilleFloridaUSA
- Florida Museum of Natural HistoryUniversity of FloridaGainesvilleFloridaUSA
- Biodiversity InstituteUniversity of FloridaGainesvilleFloridaUSA
- Cooperative Agricultural Research CenterPrairie View A&M UniversityPrairie ViewTexasUSA
| | - Narayani Barve
- Florida Museum of Natural HistoryUniversity of FloridaGainesvilleFloridaUSA
| | | | - Bette Loiselle
- Biodiversity InstituteUniversity of FloridaGainesvilleFloridaUSA
- Department of Wildlife Ecology and ConservationUniversity of FloridaGainesvilleFloridaUSA
- Tropical Conservation and Development ProgramCenter for Latin American StudiesGainesvilleFloridaUSA
| | - Nico Cellinese
- Florida Museum of Natural HistoryUniversity of FloridaGainesvilleFloridaUSA
- Biodiversity InstituteUniversity of FloridaGainesvilleFloridaUSA
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229
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Zhao Y, Diunugala HP, Mombeuil C. Factors affecting household solid waste generation and management in Sri Lanka: an empirical study. Environ Monit Assess 2021; 193:838. [PMID: 34817701 DOI: 10.1007/s10661-021-09633-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 11/12/2021] [Indexed: 06/13/2023]
Abstract
This study examines the effect of "waste management" factors (Knowledge, Motivation, Time, Awareness, Contribution, Attitudes) on household waste generation (HWG), more precisely the measured weight of waste generated at households for a week (MWWGHW) while controlling for the socioeconomic factors such as family size, monthly family income, education level, and occupation. It also examines the moderating effects of the geographic location (urban versus rural areas) on the relationships between waste management factors and MWWGHW while controlling for the aforementioned socioeconomic factors. The overall results show that socioeconomic factors such as Family Size ([Formula: see text] = 0.134; p < 0.001) and Monthly Family Income ([Formula: see text] = 0.301; p < 0.001) significantly and positively influence MWWGHW, whereas the Occupation factor ([Formula: see text] = - 0.106, p < 0.05) significantly and negatively influences MWWGHW. Furthermore, the results show that the Knowledge ([Formula: see text] = - 0.129, p < 0.05), Motivation ([Formula: see text] = - 0.161, p < 0.001), Contribution ([Formula: see text] = - 0.111, p < 0.05), and Awareness ([Formula: see text]= - 0.189, p < 0.001) factors significantly and negatively influence MWWGHW. While the results show that the geographic location Urban Area moderates significantly the relationship between the Motivation factor and MWWGHW ([Formula: see text] = - 0.129, p < 0.05), the same results show, however, that the geographic location Rural Area moderates significantly but negatively the relationships between Knowledge factor and MWWGHW ([Formula: see text] = - 0.187, p < 0.01); Motivation factor and MWWGHW ([Formula: see text] = - 0.390, p < 0.001); Contribution factor and MWWGHW ([Formula: see text] = - 0.154, p < 0.10); and Awareness factor and MWWGHW ([Formula: see text] = - 0.285, p < 0.001). Based on these results, implications for policy orientations and future research are provided.
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Affiliation(s)
- Yuhuan Zhao
- Beijing Institute of Technology, Beijing, China
| | | | - Claudel Mombeuil
- Beijing Institute of Technology, Beijing, China.
- Rezo Inovasyon Edikatif Ayisyen, Mirebalais, Haiti.
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Renzella J, Fernando S, Kalupahana B, Rayner M, Scarborough P, Townsend N. Assessing the social validity of a brief dietary survey for Sri Lankan adults with a focus on gender: a qualitative study. BMC Nutr 2021; 7:79. [PMID: 34802458 PMCID: PMC8607623 DOI: 10.1186/s40795-021-00481-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As the World Health Organization urges countries to strengthen their noncommunicable disease monitoring and surveillance activities, setting-specific innovations are emerging. Diet - a key, modifiable risk factor for chronic diseases - is particularly challenging to capture reliably. By socially validating self-report dietary survey tools, we may be able to increase the accuracy and representativeness of data for improved population health outcomes. The purpose of this study was to explore the factors that impact Sri Lankan Brief Dietary Survey (a newly developed tool) and 24-h Dietary Recall participation, engagement, and social validity among Sri Lankan adults. METHODS We conducted semi-structured interviews with 93 participants (61 women and 32 men) in three Sri Lankan districts (Colombo, Kalutara, and Trincomalee). Interview data were analysed thematically and are presented as non-hierarchical thematic networks. RESULTS Participants identified a number of factors that influenced their survey participation and engagement. These included the time of day interviews occur, recall ease, level of commitment required, perceived survey value, emotional response to surveys, and interviewer positionality. Many of these factors were gendered, however, both female and male participants expressed a preference for engaging with socially valid research that they felt justified their personal investment in data collection. When explicitly asked to share ideas about how to improve the surveys, many participants opted not to provide suggestions as they felt they lacked the appropriate expertise. CONCLUSIONS Our findings have implications for the accuracy and equity of dietary surveillance activities, and ultimately the appropriateness and effectiveness of programmes and policies informed by these data. Only through understanding how and why the target population engages with dietary research can we develop socially valid methods that assess and address the dietary risks of individuals and groups that are underrepresented by current conventions.
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Affiliation(s)
- Jessica Renzella
- Nuffield Department of Population Health, University of Oxford, BDI Building, Old Road Campus, Oxford, OX3 7FZ, UK.
| | - Santhushya Fernando
- Sri Jayewardenepura General Hospital and Post Graduate Training Centre, Colombo, Sri Lanka
| | | | - Mike Rayner
- Nuffield Department of Population Health, University of Oxford, BDI Building, Old Road Campus, Oxford, OX3 7FZ, UK
| | - Peter Scarborough
- NIHR Biomedical Research Centre at Oxford and Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Fernando M, Chandrasiri A, Dayabandara M, Reavley NJ. Cultural adaptation of mental health first aid guidelines for depression for Sri Lanka: a Delphi expert consensus study. BMC Psychiatry 2021; 21:585. [PMID: 34801017 PMCID: PMC8606054 DOI: 10.1186/s12888-021-03598-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Family and friends can play a key role in supporting a person with depression to seek professional help. However, they may lack the knowledge to do so. English-language guidelines for high-income countries have been developed to assist with this. The aim of this study was to adapt the English mental health first aid guidelines for helping a person with depression to the Sri Lankan context. METHODS A Delphi expert consensus study involving mental health professionals and people with lived experience (either their own or as carers) was conducted. Participants were recruited from inpatient, outpatient and community care settings. The English-language questionnaire was translated into Sinhala and participants were asked to rate the importance of each item for inclusion in the guidelines for Sri Lanka. RESULTS Data were collected over two survey rounds. A total of 115 panellists (23% male) consisting of 92 mental health professionals and 23 consumers and carers completed the Round 1 questionnaire. A total of 165 items were included in the final guidelines, with 156 adopted from the guidelines for English-speaking countries and 9 generated from the comments of panellists. CONCLUSIONS The adapted guidelines were similar to the English-language guidelines. However, new items reflecting culturally relevant approaches to autonomy-granting, communication and culture-specific manifestations of depression were reflected in the adapted version. Further research should explore the use of the adapted guidelines, including their incorporation into Mental Health First Aid Training.
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Affiliation(s)
- Madhawee Fernando
- grid.1008.90000 0001 2179 088XCentre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria 3010 Australia
| | - Amila Chandrasiri
- grid.1008.90000 0001 2179 088XCentre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria 3010 Australia ,grid.466905.8Ministry of Health, Colombo, Sri Lanka
| | - Madhubhashinee Dayabandara
- grid.8065.b0000000121828067Department of Psychiatry, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Nicola J. Reavley
- grid.1008.90000 0001 2179 088XCentre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria 3010 Australia
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Handaragama S, Kusakabe K. Participation of women in business associations: A case of small-scale tourism enterprises in Sri Lanka. Heliyon 2021; 7:e08303. [PMID: 34778588 PMCID: PMC8577111 DOI: 10.1016/j.heliyon.2021.e08303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 07/06/2021] [Accepted: 10/28/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose Effective business networks, experienced mentors, and access to financial and business knowledge are crucial for small-scale entrepreneurs to overcome challenges and barriers towards growth. Women entrepreneurs have limited access to information, training, credit, and networks compared to that of men entrepreneurs. Business Associations (BAs) are self-governing bodies designed to meet the needs of entrepreneurs in a specific local, national and regional socio-economic-cultural context. This study investigates firstly the potential of BAs to support and empower women entrepreneurs and the difficulties encountered by women in taking up leadership positions in BAs. Methods Three sub-sectors from among tourism enterprises in Hikkaduwa Urban Council, Galle District, in Sri Lanka were studied. A questionnaire survey among 390 respondents (195 women, 195 men) was conducted aiming to understand the profile of entrepreneurs. Employing 24 in-depth interviews (12 women, 12 men), a further investigation was taken to ascertain the underlying reasons of their decisions in business and family. Findings Determined to overcome the challenges, women entrepreneurs join BAs thus gaining access to business resources such as financial, information and connections. They become members of multiple BAs seeking tenacities to address difficulties they face as women entrepreneurs. However, women's participation is restricted to low-level positions while significant leadership positions in BAs tend to be dominated by male thereby obstructing a great deal of potential benefits yieldable by women. Recommendations We recommend that BAs promote women across the entire hierarchy of organization making BAs more relevant to women members who are in greater need of its services. Research limitations/and future research This study covers three sub-sectors of the tourism industry in one district in Sri Lanka wherein more research is demanded covering larger industries and geographies to develop nuanced theories about the potentially powerful roles that BAs could play to support women entrepreneurs. Business/trade associations hold enormous potential to support women entrepreneurs with critically important resources, i.e., mentoring and networking. Further research is required to further analyze how to promote women's leadership in BAs. Since the study was done before Covid-19 pandemic, gender impact of the pandemic could not be integrated.
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Maduwage K, Karunathilake P, Gutiérrez JM. Web-based snake identification service: A successful model of snake identification in Sri Lanka. Toxicon 2021; 205:24-30. [PMID: 34774917 DOI: 10.1016/j.toxicon.2021.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 11/18/2022]
Abstract
Snakes are reptiles of great biomedical significance. The accurate identification of snakes is particularly important for healthcare workers to diagnose and treat victims of snakebite envenoming. Further, snake identification is vital for the general population, especially to those who live in areas of high snakebite incidence. Owing to the great diversity of snakes and the superficial similarities between some species, the correct identification of these reptiles is often difficult. Therefore, identification of snake species is challenging for healthcare workers, biologists, naturalists, and the general population. To overcome this challenge, we developed a web-based snake identification service (www.snakesidentification.org) in Sri Lanka, which provides rapid and accurate identification by experienced herpetologists. This service received 486 identification requests over a period of 40 months. The majority of requests were from Colombo District [140 (28.8%)], though only 63 (13.0%) of these were identified as medically important snakes. The majority [389 (80.0%)] of the requests related either to feebly venomous colubrid snakes or non-venomous species. The sample included 30 (of 107) snake species in the island, including 8 endemic species. There were 315 (64.8%) requests relating to live snakes. In the majority of cases (285, 90.4%), the snake was released to the closest available habitat after being identified. The median time taken to respond to requests was 70 min (interquartile range 23-299 min). The majority of persons making requests (283, 58.2%) were unable to identify the snakes. For those who attempted identification the snakes, correct identification was made by only 59 (12.1%), whereas 144 (29.6%) identified the snake incorrectly. This web-based snake identification service provides an example of a successful and useful model of rapid snake identification. Similar models could be implemented in other regions and countries to provide accurate information on snake identification both to the healthcare workers and the general public.
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Affiliation(s)
- Kalana Maduwage
- Department of Biochemistry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
| | | | - José María Gutiérrez
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
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Wyatt S, Ostbye T, De Silva V, Lakmali P, Long Q. Predictors and occurrence of antenatal depressive symptoms in Galle, Sri Lanka: a mixed-methods cross-sectional study. BMC Pregnancy Childbirth 2021; 21:758. [PMID: 34758774 PMCID: PMC8578523 DOI: 10.1186/s12884-021-04239-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 10/28/2021] [Indexed: 01/21/2023] Open
Abstract
Background There is a high prevalence of antenatal depression in low-or-middle-income countries, but information about risk factors in these settings is still lacking. The purpose of this study is to measure the prevalence of and explore risk factors associated with antenatal depressive symptoms in Galle, Sri Lanka. Methods This study used a mixed-method approach. The quantitative portion included 505 pregnant women from Galle, Sri Lanka, with health record data, responses to psychometric questionnaires (MSPSS and PRAQ-R2), and antenatal depression screening (EPDS). The qualitative portion included interviews with public health midwives about their experiences and routine clinical practices with women with antenatal depressive symptoms. Results Prevalence of antenatal depressive symptoms was 7.5%, highest in women over the age of 30 (13.0%, OR = 3.88, 95%CI = 1.71 – 9.97), with diabetes (21.9%, OR = 3.99, 95%CI = 1.50 – 9.56), or pre-eclampsia in a previous pregnancy (19.4%, OR = 3.32, 95%CI = 1.17 – 8.21). Lower prevalence was observed in the primiparous (3.3%, OR = 0.29, 95%CI = 0.12 – 0.64) employed outside the home (3.6%, OR = 0.33, 95%CI = 0.13 – 0.72), or upper-middle class (2.3%, OR = 0.17, 95%CI = 0.04 – 0.56). Anxiety levels were elevated in depressed women (OR = 1.13, 95%CI = 1.07 – 1.20), while perceived social support was lower (OR = 0.91, 95%CI = 0.89 – 0.93). After multivariable adjustment, only parity (OR = 0.20, 95%CI 0.05 – 0.74) and social support from a “special person” (OR = 0.94, 95%CI = 0.77 – 0.95) remained significantly associated with depressive symptoms. Qualitative findings also identified antenatal health problems and poor social support as risk factors for depressive symptoms. They also identified different contributing factors to poor mental health based on ethnicity, higher stress levels among women working outside the home, and misinformation about health conditions as a cause of poor mental health. Conclusions Prevalence of antenatal depressive symptoms in Galle is lower than the recorded prevalence in other regions of Sri Lanka. Risk factors for antenatal depressive symptoms were identified on biological, psychological, and social axes. These variables should be considered when developing future guidelines for mental health and obstetric treatment in this context.
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Affiliation(s)
- Sage Wyatt
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu Province, China
| | - Truls Ostbye
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Vijitha De Silva
- Faculty of Medicine, University of Ruhuna, Matara, Southern Province, Sri Lanka
| | - Prabodha Lakmali
- Faculty of Medicine, University of Ruhuna, Matara, Southern Province, Sri Lanka
| | - Qian Long
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu Province, China.
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Jayadas TTP, Kumanan T, Gomes L, Jeewandara C, Malavige GN, Ranasinghe D, Jadi RS, Ramasamy R, Surendran SN. Regional Variation in Dengue Virus Serotypes in Sri Lanka and Its Clinical and Epidemiological Relevance. Diagnostics (Basel) 2021; 11:2084. [PMID: 34829432 PMCID: PMC8618005 DOI: 10.3390/diagnostics11112084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 01/19/2023] Open
Abstract
Dengue is a significant health concern in Sri Lanka, but diagnosis of the infecting dengue virus (DENV) serotype has hitherto been largely restricted to the Colombo district in the western province. Salinity tolerant Aedes vectors are present in the island's northern Jaffna peninsula, which is undergoing rapid groundwater salinization. Virus serotypes were determined by RT-qPCR in 107 and 112 patients diagnosed by NS1 antigen positivity from the Jaffna district in 2018 and 2019, respectively, and related to clinical characteristics. DENV1 and DENV2 were the most common serotypes in both years. Infections with multiple serotypes were not detected. DENV1 was significantly more prevalent in 2019 than 2018, while DENV3 was significantly more prevalent in 2018 than 2019 among the Jaffna patients. Limited genomic sequencing identified DENV1 genotype-I and DENV3 genotype-I in Jaffna patients in 2018. Dengue was more prevalent in working age persons and males among the serotyped Jaffna patients. DENV1 and DENV2 were the predominant serotypes in 2019 in the Colombo district. However, DENV1 and DENV3 were significantly more prevalent in Colombo compared with Jaffna in 2019. The differences in the prevalence of DENV1 and DENV3 between the Jaffna and Colombo districts in 2019 have implications for dengue epidemiology and vaccination. Salinity-tolerant Aedes vector strains, widespread in the Jaffna peninsula, may have contributed to differences in serotype prevalence compared with the Colombo district in 2019. Significant associations were not identified between virus serotypes and clinical characteristics among Jaffna patients.
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Affiliation(s)
| | | | - Laksiri Gomes
- Centre for Dengue Research, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda 10250, Sri Lanka; (L.G.); (C.J.); (G.N.M.); (D.R.)
| | - Chandima Jeewandara
- Centre for Dengue Research, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda 10250, Sri Lanka; (L.G.); (C.J.); (G.N.M.); (D.R.)
| | - Gathsaurie N. Malavige
- Centre for Dengue Research, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda 10250, Sri Lanka; (L.G.); (C.J.); (G.N.M.); (D.R.)
| | - Diyanath Ranasinghe
- Centre for Dengue Research, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda 10250, Sri Lanka; (L.G.); (C.J.); (G.N.M.); (D.R.)
| | - Ramesh S. Jadi
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7290, USA;
| | - Ranjan Ramasamy
- Department of Zoology, University of Jaffna, Jaffna 40000, Sri Lanka;
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Herath HMMTB, Rodrigo C, Alahakoon AMBD, Ambawatte SB, Senanayake S, Senanayake B, Fernando A. Outcomes of stroke patients undergoing thrombolysis in Sri Lanka; an observational prospective study from a low-middle income country. BMC Neurol 2021; 21:434. [PMID: 34753432 PMCID: PMC8576930 DOI: 10.1186/s12883-021-02475-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 10/29/2021] [Indexed: 11/12/2022] Open
Abstract
Background Stroke related deaths are relatively higher in low- and middle-income countries where only a fraction of eligible patients undergo thrombolysis. There is also limited evidence on post-thrombolysis outcomes of patients from Asian countries in these income bands. Methods This is a single center prospective observational study of a patient cohort with acute ischaemic stroke, undergoing thrombolysis with alteplase (low and standard dose), over a 24-month period in 2019/2020. Modified Rankin scale (mRS) for dependency at 3 months (primary outcome), duration of hospital stay, incidence of symptomatic intracranial haemorrhages and all-cause mortality at 3 months (secondary outcomes) were recorded. Demographic, clinical and treatment related factors associated with these outcomes were explored. Results Eighty-nine patients (males – 61, 69%, mean age: 60 years ±12.18) were recruited. Time from symptom onset to reperfusion was 174 min ± 56.50. Fifty-one patients were independent according to mRS, 11 (12.4%) patients died, and 11 (12.5%) developed symptomatic intracranial haemorrhages by 3 months. Functional independence at 3 months was independently associated with National Institutes of Health Stroke Scale (NIHSS) on admission (p < 0.05). Thrombolysis with low dose alteplase did not lead to better or worse outcomes compared to standard dose. Conclusions On admission NIHSS is predictive of functional independence at 3 months post-thrombolysis. Low dose alteplase may be as efficacious as standard dose alteplase with associated cost savings, but this needs to be confirmed by a prospective clinical trial for the Sri Lankan population. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02475-3.
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Affiliation(s)
- H M M T B Herath
- Neurology Department, National Hospital of Sri Lanka, Colombo, Sri Lanka.
| | - Chaturaka Rodrigo
- Department of Pathology, School of Medical Sciences, UNSW Sydney, Sydney, NSW, Australia
| | - A M B D Alahakoon
- Neurology Department, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | | | | | - Bimsara Senanayake
- Neurology Department, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Arjuna Fernando
- Neurology Department, National Hospital of Sri Lanka, Colombo, Sri Lanka
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Mallawarachchi CH, Chandrasena N, Wijerathna T, Dalpadado R, Mallawarachchi MSMNS, Gunarathna DGAM, Gunathilaka N. An investigation of a new cutaneous leishmaniasis endemic area in Western Sri Lanka. Trans R Soc Trop Med Hyg 2021; 115:1288-1297. [PMID: 34532744 DOI: 10.1093/trstmh/trab141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/31/2021] [Accepted: 08/23/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The aim was to investigate an emerging focus of cutaneous leishmaniasis (CL) in Gampaha district, Western Sri Lanka. METHODS Sociodemographics of CL patients in Mirigama, Gampaha district, were compared with controls using a structured questionnaire. Clinical data and geographic positioning system coordinates of patients were recorded. Sandflies collections were performed in four selected sites using indoor hand collection (162 units) and cattle-baited net traps (n=3). RESULTS Of 73 patients (mean age 43.6 y; SD 20), 58.9% were males. Lesions consisted of nodules (52.1%) and ulcers (47.9%). Single lesions were seen in 69.9% of patients, while 30.1% had multiple lesions. Except for one mucosal lesion, all the others were cutaneous. Treatment consisted of sodium stibogluconate and cryotherapy (46.6%), sodium stibogluconate (45.2%) or cryotherapy (8.2%). Multiple lesions were more likely to receive combination therapy (p=0.013). The majority of those employed (81.1%; 27/33) were engaged in outdoor work. Male gender, low education attainment and poor disease awareness were significant risk factors for CL (p<0.05). Four households reported multiple cases. Phlebotomus argentipes was detected in all cattle-baited net traps and 35.3% of indoor hand collection units. CONCLUSIONS CL is emerging in Gamapha district with Mirigama as the epicentre. Case distribution indicates local transmission, with P. argentipes as the probable vector.
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Affiliation(s)
| | - Nilmini Chandrasena
- Department of Parasitology, Faculty of Medicine, University of Kelaniya, Ragama 11010, Sri Lanka
| | - Tharaka Wijerathna
- Department of Parasitology, Faculty of Medicine, University of Kelaniya, Ragama 11010, Sri Lanka
| | - Rasika Dalpadado
- Regional Directoratre of Health Services, Health Services Office, Gampaha District, Gampaha, Sri Lanka
| | | | | | - Nayana Gunathilaka
- Department of Parasitology, Faculty of Medicine, University of Kelaniya, Ragama 11010, Sri Lanka
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Kanda K, Jayasinghe A, Jayasinghe C, Yoshida T. Public health implication towards rabies elimination in Sri Lanka: A systematic review. Acta Trop 2021; 223:106080. [PMID: 34364895 DOI: 10.1016/j.actatropica.2021.106080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND/OBJECTIVES Sri Lanka has been targeted zero rabies by the end of 2025. Towards the elimination, the country needs more effective, evidence-based strategies and efforts to achieve its ultimate goal. Therefore, we conducted a systematic review of scientific literatures and data to assess current human and animal rabies control and prevention strategies in Sri Lanka. METHODS We compiled documents regarding current and previous rabies control and prevention activities implemented in the entire country of Sri Lanka. The documents included published literatures issued between 1946 and 2020 from both online databases and university library in Sri Lanka. All the collected documents were screened based on the PRISMA statement and categorized into several types of rabies control and prevention strategies. Official reports including epidemiological data in Sri Lanka were also filed in order to analyze the current trend of rabies control and prevention in the nation. RESULTS As of end December 2020, we found 119 scientific literatures regarding rabies control and prevention in Sri Lanka. Human rabies deaths in Sri Lanka have been reduced for the last half century by successful implementation of mass dog vaccination, animal birth control and awareness raising activities. However, the country is still facing on sporadic rabies cases, limited dog vaccination coverage and insufficient dog population management in the district level. Despite the nationwide standard of dog to human ratio of 1:8, there are huge disparities or unknown of dog ecology in regions. Awareness raising including has been enhancing for both general public and school children. Surveillance system is poorly operated so that simultaneous data analysis for decision-making is impractical. CONCLUSIONS In order to achieve nationwide rabies elimination, it is highly recommended to implement more effective rabies control and prevention activities and build adequate scientific evidences.
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Rathnayaka RMMKN, Ranathunga PEAN, Kularatne SAM, Abeywardhana KPL. Purpura fulminans following hump-nosed pit viper (Hypnale hypnale) envenoming: A rare complication of snakebites. Toxicon 2021; 202:110-114. [PMID: 34582831 DOI: 10.1016/j.toxicon.2021.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/03/2021] [Accepted: 09/06/2021] [Indexed: 11/18/2022]
Abstract
Hump-nosed pit vipers of the genus Hypnale are highly venomous and reputed for the commonest venomous snakebites in Sri Lanka. They frequently cause local manifestations and less commonly cause systemic effects such as acute kidney injury and coagulopathy. There is no antivenom currently available in Sri Lanka for their envenoming. However, more and more complications of Hypnale bites are being recently described. Purpura fulminans, one of the rare complications of snakebites that we report following authentic Hypnale hypnale bite. A 58-year-old female was bitten by a hump-nosed viper and developed bilateral toe gangrenes, ultimately ended up with amputations. She got recovered with loss of toes in both feet for 46 days treatment at hospital.
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Affiliation(s)
- R M M K Namal Rathnayaka
- Department of Pharmacology, Faculty of Medicine, Sabaragamuwa University of Sri Lanka, Hidellana, Ratnapura, Sri Lanka; Intensive Care Unit, Teaching Hospital, Ratnapura, Sri Lanka; Department of Veterinary Pathobiology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Sri Lanka.
| | | | - S A M Kularatne
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka
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Galappatthy P, Ranasinghe P, Liyanage CK, Wijayabandara MS, Mythily S, Jayakody RL. WHO/INRUD Core drug use indicators and commonly prescribed medicines: a National Survey from Sri Lanka. BMC Pharmacol Toxicol 2021; 22:67. [PMID: 34711271 PMCID: PMC8555184 DOI: 10.1186/s40360-021-00535-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 10/20/2021] [Indexed: 12/02/2022] Open
Abstract
Background Identification of internationally comparable indicators of medicines use are important for a country to implement strategies and regulations to improve usage of medicines. Sri Lanka established a new National Medicines Regulatory Authority in 2015 and this survey evaluated the medication use indicators in Sri Lanka, according to the International Network on Rational Use of Drugs (INRUD), prior to its implementation. Methods This descriptive-cross-sectional study was conducted in 80 pharmacies, representing all 25 districts of the country. Three pharmacy categories were included; privately owned pharmacies, ‘Rajya Osusala’ pharmacies operated by the State Pharmaceuticals Corporation (SPC) of Sri Lanka and SPC Franchisee pharmacy outlets. Selection of pharmacies from respective districts were done proportionate to estimated population. Data were collected to identify WHO/INRUD core drug use indicators and the commonly prescribed medicines. Results Total of 2328 prescriptions were included (‘Rajya Osusala 559; SPC Franchise 711; private pharmacies 1058). Altogether 7,255 medicines were prescribed, and the 3 most commonly prescribed medicines were atorvastatin, losartan and metformin. Average number of medicines per encounter was 3.1±1.9 (Median: 3; range 1-12) Highest average number of medicines per encounter was reported in prescriptions received at ‘Rajya Osusala’ pharmacies (3.6±2.2), significantly higher than in other categories of pharmacies (p<0.001). Percentage of medicines prescribed by generic name was only 35.5%, highest at the ‘Rajya Osusala’ pharmacies (40.6%), significantly higher than other categories of pharmacies. The overall percentage of medicines prescribed from essential medicine list (EML) was 68.8%, without any significant variation between different categories of pharmacies. The percentage of medicines actually dispensed and accurately labelled were 92.4 and 98.5% respectively. Conclusions The average number of medicines per encounter was higher than the WHO recommended value but the usage of antibiotic and injectable drugs were within recommended standards. Generic prescribing, was very much lower. The EML prescribing, labelling and percentage dispensed medicines fared much better although lower than the WHO recommended 100% compliance. This island wide study has provided national wide data before the implementation of key changes in regulation of medicines in Sri Lanka and a repeat survey will be useful to identify impact of the new legislations. Supplementary Information The online version contains supplementary material available at 10.1186/s40360-021-00535-5.
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Affiliation(s)
- P Galappatthy
- Department of Pharmacology, Faculty of Medicine, University of Colombo, No 25, Kynsey Road, Colombo, 08, Sri Lanka
| | - P Ranasinghe
- Department of Pharmacology, Faculty of Medicine, University of Colombo, No 25, Kynsey Road, Colombo, 08, Sri Lanka.
| | - C K Liyanage
- Department of Pharmacology, Faculty of Medicine, University of Colombo, No 25, Kynsey Road, Colombo, 08, Sri Lanka
| | - M S Wijayabandara
- Department of Pharmacology, Faculty of Medicine, University of Colombo, No 25, Kynsey Road, Colombo, 08, Sri Lanka
| | - S Mythily
- Department of Pharmacology, Faculty of Medicine, University of Colombo, No 25, Kynsey Road, Colombo, 08, Sri Lanka
| | - R L Jayakody
- Department of Pharmacology, Faculty of Medicine, University of Colombo, No 25, Kynsey Road, Colombo, 08, Sri Lanka
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Pett J, Mohamed F, Knight J, Linhart C, Osborne NJ, Taylor R. Two decades of chronic kidney disease of unknown aetiology (CKDu) research: Existing evidence and persistent gaps from epidemiological studies in Sri Lanka. Nephrology (Carlton) 2021; 27:238-247. [PMID: 34704321 PMCID: PMC9298898 DOI: 10.1111/nep.13989] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/29/2021] [Accepted: 10/16/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Chronic Kidney Disease of unknown origin (CKDu) excludes known primary renal conditions or systemic disease (such as diabetes mellitus or hypertension). Prominence of CKDu has been noted for some decades in Sri Lanka, especially among men in particular rural areas, prompting many studies directed towards environmental causation. This article critically reviews relevant primary studies. METHODS Articles for this literature review (n = 86) were found by searching Medline, Embase, Global Health and ProQuest databases over 2000-2020 utilizing a standard algorithm. Articles were critiqued according to criteria for diagnosis of CKDu, aetiological agents investigated, analytic methods employed and findings. RESULTS Criteria for diagnosis of CKDu varied significantly, including pre-selection by proteinuria, eGFR and biopsy proven interstitial nephritis. Prevalence studies have been largely conducted in the North Central Province, with recent studies demonstrating the presence of CKDu in other regions. Aetiological factors investigated in primary studies included water source, use of agrochemicals, agricultural work, heavy metals, snake bites, ayurvedic medication, heat stress, infectious diseases and usage of tobacco and betel leaf. There is no conclusive evidence for any one aetiological agent despite consistent evidence of distal factors such as male sex, rural residence and farming. CONCLUSIONS The current body of evidence for any aetiological agent as the cause of CKDu in Sri Lanka is limited. Further research with stronger study designs is necessary to increase knowledge of aetiology of CKDu in Sri Lanka to identify and eliminate exposure to possible causative agent(s) prior to concluding that the disease is multifactorial.
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Affiliation(s)
- Jennifer Pett
- School of Population Health, University of New South Wales, Sydney, NSW, Australia.,The George Institute for Global Health, Sydney, NSW, Australia
| | - Fahim Mohamed
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine University of Peradeniya, Kandy, Sri Lanka.,Department of Pharmacy, Faculty of Allied Health, University of Peradeniya, Peradeniya, Sri Lanka.,Australian Kidney Biomarker Reference Laboratory, Department of Nephrology, Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia.,Faculty of Medicine and Health, Discipline of Biomedical Informatics and Digital Health, Clinical Pharmacology and Toxicology Research Group, The University of Sydney, Sydney, NSW, Australia
| | - John Knight
- School of Population Health, University of New South Wales, Sydney, NSW, Australia.,The George Institute for Global Health, Sydney, NSW, Australia
| | - Christine Linhart
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Nicholas J Osborne
- School of Population Health, University of New South Wales, Sydney, NSW, Australia.,School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Richard Taylor
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
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242
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Hale KL, Zalla LC, Scherer EM, Østbye T, Dinesh Coonghe PA, Surenthirakumaran R, Maselko J. Grandparenting activities and mental health in Northern Sri Lanka. J Intergener Relatsh 2021; 21:194-214. [PMID: 37077924 PMCID: PMC10109061 DOI: 10.1080/15350770.2021.1991869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Grandparenting activities are of increasing interest to researchers seeking to understand reduced social engagement and depression among aging adults. Heterogeneity in the population and caretaking roles complicate its measurement. We piloted a measure of grandparenting activities among 79 grandparents (aged 55+) in Sri Lanka and correlated those activity levels with psychological distress. Second, we explored whether the aforementioned correlation varied by grandparent functional limitations. We found that greater engagement in generative grandparenting activities was correlated with lower distress, and that association was stronger among grandparents with more functional limitations. We discuss possible explanations and implications of these findings.
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Affiliation(s)
- Kathryn L. Hale
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lauren C. Zalla
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elissa M. Scherer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- RTI International, Research Triangle Park, NC, USA
| | - Truls Østbye
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
- Center for Aging Research and Education, Duke-NUS Medical School, Singapore
| | | | | | - Joanna Maselko
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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243
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Wanigasinghe J, Chang T. Autoimmune epilepsy due to N-methyl-D-aspartate receptor antibodies in a child: a case report. J Med Case Rep 2021; 15:516. [PMID: 34666812 PMCID: PMC8527639 DOI: 10.1186/s13256-021-03117-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/18/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Seizures of autoimmune etiology may occur independent of or predate syndromes of encephalitis. We report a child with “pure” autoimmune epilepsy followed up for 7 years to highlight long-term effects of this epilepsy and the importance of early initiation and appropriate escalation of immunosuppression to achieve a good long-term outcome. Case presentation A previously healthy 5-year-old Sri Lankan boy presented with acute, frequent, brief focal seizures of temporal-lobe semiology without clinical and investigatory findings suggestive of central nervous system infection, tumor, structural abnormality, or metabolic causes. His epilepsy showed poor response to increasing doses and combinations of antiseizure medications. Further investigations detected N-methyl-d-aspartate receptor antibodies in serum, but not cerebrospinal fluid. Treatment with intravenous methyl prednisolone and maintenance on mycophenolate resulted in a rapid reduction, with seizure freedom achieved within 5–6 weeks. He relapsed when immunotherapy and anti seizure medications were reduced after seizure freedom for 24 months. This, and subsequent relapses, showed poor response to modification of anti-seizure medications, but treatment with immunotherapy (methyl prednisolone and rituximab) achieved complete seizure freedom. At 7-years of follow-up, he remains free of seizure for over 3 years, and has average academic performance and satisfactory quality of life. Conclusions Autoimmune epilepsy is a recognized independent entity. Diagnostic criteria have been suggested for its early recognition and confirmation of diagnosis. Early diagnosis and initiation of immunosuppression, with prompt escalation of treatment when necessary, remains key to good patient outcome.
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Affiliation(s)
- Jithangi Wanigasinghe
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
| | - Thashi Chang
- Department of Clinical Medicine, University of Colombo, Colombo, Sri Lanka
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244
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Pallegedara A, Kumara AS. Impacts of firewood burning for cooking on respiratory health and healthcare utilisation: Empirical evidence from Sri Lankan micro-data. Int J Health Plann Manage 2021; 37:465-485. [PMID: 34655271 DOI: 10.1002/hpm.3350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 11/07/2022] Open
Abstract
Despite escalating income levels of Sri Lankan households, 70.3% of them still depend on firewood for cooking. This might lead to bad respiratory health and thereby, increased healthcare utilisation. With this backdrop, this paper examines how firewood burning for cooking influences respiratory health and healthcare utilisation of Sri Lankans. The study proposes a theoretical model to explain effects of firewood burning on respiratory health and healthcare utilisation and empirically tests it using nation-wide micro-data of 79,170 individuals belonging to 21,748 households. The data are drawn from the most recent wave of Sri Lankan household income and expenditure survey. After addressing potential endogeneity by applying instrumental variable regression models, the study finds that firewood burning increases households' probability of asthma prevalence by 10.9 percentage points (P < 0.001), out-patient care utilisation by 33.1 percentage points (P < 0.001), and in-patient care utilisation by 17.5 percentage points (P < 0.001), on average. Our individual level analysis demonstrates that females are more vulnerable to bad respiratory health induced by firewood burning (β = 0.055, P < 0.001) compared to males (β = 0.008, P > 0.1). The results imply policies on promoting improved-cooking stoves, separated-kitchen designs, and switching more towards cleaner energy sources, including LP gas and solar power.
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Affiliation(s)
- Asankha Pallegedara
- Department of Industrial Management, Wayamba University of Sri Lanka, Kuliyapitiya, Sri Lanka
| | - Ajantha Sisira Kumara
- Department of Public Administration, University of Sri Jayewardenepura, Gangodawila-Nugegoda, Sri Lanka
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245
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Jayaweera P, Thilakarathne A, Ratnayaka M, Shashikala T, Arachchige R, Galgamuwa LS, Karunathilaka N, Amarasekara T. Evaluation of learning environment among Nursing undergraduates in state universities, Sri Lanka. BMC Nurs 2021; 20:193. [PMID: 34627247 PMCID: PMC8502353 DOI: 10.1186/s12912-021-00714-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/22/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The learning environment is a vital part of the undergraduate curriculum which enable to delivery of quality education in the stipulated time. Therefore, this study aimed to evaluate the learning environment among BSc. Nursing undergraduates in Sri Lankan state universities. METHODS A descriptive cross-sectional study was conducted among 161 final year BSc. Nursing undergraduates in six state universities. Socio-demographic characteristics were collected using a self-administered questionnaire. The Dundee Ready Educational Environment Measure (DREEM) questionnaire was used to evaluate the learning environment in Perception of learning (SPL), Perceptions of teaching (SPT), Academic self-perceptions (SASP), Perceptions of the atmosphere (SPA), and Social self-perceptions (SSP). Based on the SPL, SPT, SASP, SPA, and SSP domains, the overall score of learning environment was ranged from 0 to 200 and then the overall score was classified into four categories such as poor (0-50), many problems (51-100), more positive than negative (101-150) and excellent (151-200). One-way Analysis of Variance (ANOVA) and t-test were used to determine the difference in the subscales and the overall scale. RESULTS The mean age of the students was 24.9 ± 0.9 years. The overall score of the learning environment was 127.1 ± 14.3. Student's Perception of learning showed the highest mean score of 31.1 ± 3.9 while the social self-perception showed the lowest score (mean 16.4 ± 3.1). A significant group effect was observed in SPL and SPT subdomains among state universities while no significant group effect was observed in other subdomains. Furthermore, participating in extracurricular activities, travelling time to the faculty, and gender were observed as associated factors for the learning environment among BSc. Nursing undergraduates in state universities. CONCLUSIONS Although the overall learning environment of BSc. Nursing undergraduates in state universities in Sri Lanka was within more positive than negative category, none of the university reaches to the excellent category. Therefore, each university should have improved their subdomains of learning environment to reach excellent category through addressing the gaps of curricular and extracurricular activities in the future.
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Affiliation(s)
- Patalee Jayaweera
- Department of Nursing and Midwifery, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Colombo, Sri Lanka
| | - Abisheka Thilakarathne
- Department of Nursing and Midwifery, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Colombo, Sri Lanka
| | - Madushanka Ratnayaka
- Department of Nursing and Midwifery, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Colombo, Sri Lanka
| | - Tharangi Shashikala
- Department of Nursing and Midwifery, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Colombo, Sri Lanka
| | - Rushani Arachchige
- Department of Nursing and Midwifery, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Colombo, Sri Lanka
| | - Lahiru Sandaruwan Galgamuwa
- Department of Parasitology, Faculty of Medicine, Sabaragamuwa University of Sri Lanka, Belihuloya, Sri Lanka.
| | - Nimantha Karunathilaka
- Department of Nursing and Midwifery, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Colombo, Sri Lanka
| | - Thamara Amarasekara
- Department of Nursing & Midwifery, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
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van den Broek M, Ponniah P, Jeyakumar PJR, Koppenol-Gonzalez GV, Kommu JVS, Kohrt BA, Jordans MJD. Proactive detection of people in need of mental healthcare: accuracy of the community case detection tool among children, adolescents and families in Sri Lanka. Child Adolesc Psychiatry Ment Health 2021; 15:57. [PMID: 34625116 PMCID: PMC8501662 DOI: 10.1186/s13034-021-00405-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/10/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Most children and adolescents in need of mental healthcare remain untreated even when services are available. This study evaluates the accuracy of a new tool, the Community Case Detection Tool (CCDT). The CCDT uses illustrated vignettes, two questions and a simple decision algorithm to support proactive community-level detection of children, adolescents and families in need of mental healthcare to improve help-seeking. METHODS Trusted and respected community members in the Eastern Province of Sri Lanka used the CCDT in their daily routine. Children and families detected as potentially in need of mental healthcare based on utilizing the CCDT (N = 157, aged 6-18 years) were invited for a clinical interview by a mental health counsellor using the Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). The CCDT results were compared against the results of the clinical interview. The concurrent validity and performance of the CCDT were also evaluated by comparing the CCDT outcomes against the Strengths and Difficulties Questionnaire (SDQ). RESULTS 7 out of 10 children and families detected by community members using the CCDT were confirmed to be in need for treatment (positive predictive value [PPV] = 0.69; 0.75 when compared to the SDQ). Detections based on the family problem vignette were most accurate (PPV = 0.76), followed by the internalising problem vignette (PPV = 0.71) and the externalising problem vignette (PPV = 0.62). CONCLUSIONS The CCDT is a promising low-cost solution to overcome under-detection of children and families in need of mental healthcare. Future research should focus on evaluating the effectiveness, as well as additional strategies to improve help-seeking.
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Affiliation(s)
- Myrthe van den Broek
- Research and Development, War Child Holland, Amsterdam, The Netherlands
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | | | - John Vijay Sagar Kommu
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, USA
| | - Mark J D Jordans
- Research and Development, War Child Holland, Amsterdam, The Netherlands.
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands.
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247
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Kulasooriya PN, Jayasekara KB, Nisansala T, Kannangara S, Karunarathna R, Karunarathne C, Wikramarathne M, Albert SM. Utility of Self-Reported Heat Stress Symptoms and NGAL Biomarker to Screen for Chronic Kidney Disease of Unknown Origin (CKDu) in Sri Lanka. Int J Environ Res Public Health 2021; 18:ijerph181910498. [PMID: 34639798 PMCID: PMC8507708 DOI: 10.3390/ijerph181910498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 12/28/2022]
Abstract
Objective. We examined heat stress symptoms and urine markers of chronic kidney disease (CKDu) in Sri Lanka to assess differences between endemic vs. non-endemic regions and by occupation. Sample and Methods. We assessed a total of 475 villagers. In the endemic region, 293 were agricultural workers and 67 were not working primarily in agriculture. In the non-endemic region, 76 were agricultural workers. Of the residents, 218 were assessed for neutrophil gelatinase-associated lipocalin (NGAL), an early predictor of acute kidney injury, along with urine markers of chronic kidney disease. Results. The mean (sd) age of the sample was 45.2 (12.6), with males comprising 52.7%; 7.2% reported kidney disease (n = 34), and 5.7% reported diabetes (n = 27). The heat stress index (mean (sd)) was highest among agricultural workers in the endemic region (8.05 (5.9)), intermediate in non-agricultural workers in the endemic region (4.61 (4.5)), and lowest among agricultural workers in the non-endemic region (3.85 (3.3)); p < 0.0001. Correlations were higher between NGAL and serum microalbumin in the endemic agricultural worker sample than in the other two samples (Spearman’s r = 0.34 vs. 0.15 and 0.20). Conclusions. Both heat stress symptoms and NGAL values were higher among agricultural workers in endemic CKDu regions. Correlations between NGAL and microalbumin suggested a link between acute kidney injury and chronic kidney disease in the more-exposed sample.
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Affiliation(s)
- Pavithra N. Kulasooriya
- University Hospital, Sir John Kotelawala Defence University, Colombo 10290, Sri Lanka; (P.N.K.); (T.N.)
- Faculty of Allied Health Sciences, University of Peradeniya, Kandy 20400, Sri Lanka;
| | - Kithsiri B. Jayasekara
- Faculty of Allied Health Sciences, Sir John Kotelawala Defence University, Colombo 10290, Sri Lanka; (K.B.J.); (S.K.); (C.K.)
| | - Thilini Nisansala
- University Hospital, Sir John Kotelawala Defence University, Colombo 10290, Sri Lanka; (P.N.K.); (T.N.)
- Faculty of Allied Health Sciences, University of Peradeniya, Kandy 20400, Sri Lanka;
| | - Sajani Kannangara
- Faculty of Allied Health Sciences, Sir John Kotelawala Defence University, Colombo 10290, Sri Lanka; (K.B.J.); (S.K.); (C.K.)
| | | | - Chaminda Karunarathne
- Faculty of Allied Health Sciences, Sir John Kotelawala Defence University, Colombo 10290, Sri Lanka; (K.B.J.); (S.K.); (C.K.)
| | - Mahinda Wikramarathne
- Faculty of Allied Health Sciences, University of Peradeniya, Kandy 20400, Sri Lanka;
| | - Steven M. Albert
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA 15621, USA
- Correspondence:
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248
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Mettananda KCD, Eshani MDP, Wettasinghe LM, Somaratne S, Nanayakkkara YP, Sathkorala W, Upasena A, Sirigampola C, Tilakaratna PMY, Pathmeswaran A, Ranawaka UK. Prevalence and correlates of carotid artery stenosis in a cohort of Sri Lankan ischaemic stroke patients. BMC Neurol 2021; 21:385. [PMID: 34607563 PMCID: PMC8489097 DOI: 10.1186/s12883-021-02415-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 09/21/2021] [Indexed: 01/04/2023] Open
Abstract
Background Large artery atherosclerotic disease is an important cause of stroke, accounting for 15–46% of ischaemic strokes in population-based studies. Therefore, current guidelines from west recommend urgent carotid imaging in all ischaemic strokes or transient ischaemic attacks and referral for carotid endarterectomy. However, the clinical features and epidemiology of stroke in Asians are different from those in Caucasians and therefore the applicability of these recommendations to Asians is controversial. Data on the prevalence of carotid artery stenosis (CAS) among South Asian stroke patients is limited. Therefore, we sought to determine the prevalence and associated factors of significant CAS in a cohort of Sri Lankan patients with ischaemic stroke. Methods We prospectively studied all ischaemic stroke patients who underwent carotid doppler ultrasonography admitted to the stroke unit of a Sri Lankan tertiary care hospital over 5 years. We defined carotid stenosis as low (< 50%), moderate (50–69%) or severe (70–99%) or total-occlusion (100%) by North American Symptomatic Trial Collaborators (NASCET) criteria. We identified the factors associated with CAS ≥ 50% and ≥ 70% by stepwise multiple logistic regression analysis. Results A total of 550 ischaemic stroke patients (326 (59.3%) male, mean age was 58.9 ± 10.2 years) had carotid doppler ultrasonography. Of them, 528 (96.0%) had low-grade, 12 (2.2%) moderate and 7 (1.3%) severe stenosis and 3 (0.5%) had total occlusion. On multivariate logistic regression, age was associated with CAS ≥ 50% (OR 1.12, p = 0.001) and CAS ≥ 70% (OR 1.14, p = 0.016), but none of the other vascular risk factors studied (sex, hypertension, diabetes mellitus, smoking, past history of TIA, stroke or ischemic heart disease) showed significant associations. Conclusions Carotid stenosis is a minor cause of ischemic stroke in Sri Lankans compared to western populations with only 4.0% having CAS ≥ 50 and 3.5% eligible for carotid endarterectomy. Our findings have implications for the management of acute strokes in Sri Lanka.
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Affiliation(s)
- K C D Mettananda
- Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Talagolla Road, Ragama, Sri Lanka. .,Stroke Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka.
| | - M D P Eshani
- Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Talagolla Road, Ragama, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - L M Wettasinghe
- Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Talagolla Road, Ragama, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - S Somaratne
- Stroke Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka
| | | | - W Sathkorala
- Radiology Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka
| | - A Upasena
- Radiology Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka
| | - C Sirigampola
- Stroke Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka
| | - P M Y Tilakaratna
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.,University Medical Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka
| | - A Pathmeswaran
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - U K Ranawaka
- Stroke Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.,University Medical Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka
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249
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Senanayake B, Aravinthan M, Weerasinghe S, De Silva R. Multiple sclerosis in Sri Lanka; epidemiology, demographic patterns and current trends. Mult Scler Relat Disord 2021; 56:103276. [PMID: 34597917 DOI: 10.1016/j.msard.2021.103276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/07/2021] [Accepted: 09/19/2021] [Indexed: 11/18/2022]
Abstract
Cases of Multiple sclerosis are being increasingly recognized in Sri Lanka and South Asia challenging the concept of MS being a disease of the West. Our study estimates a crude prevalence of 7.78 cases per 100,000 population in Sri Lanka. They carry a secure diagnosis satisfying the 2017 McDonalds criteria with sero-negativity for AQP4 and MOG antibodies. Demography and clinical presentations are similar to the western and regional nations. They show excellent visual and mobility outcomes over a long period of follow up. Further studies are necessary to evaluate a possible genetic predisposition contributing to the benign disease course.
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250
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Shinsugi C, Gunasekara D, Takimoto H. Associations of Emotional Behavior with Nutritional Status and Lifestyle Habits among Schoolchildren Aged 5-10 Years in Sri Lanka. Int J Environ Res Public Health 2021; 18:ijerph181910332. [PMID: 34639627 PMCID: PMC8508002 DOI: 10.3390/ijerph181910332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 11/22/2022]
Abstract
We aimed to examine the relationships of lifestyle habits and nutritional status with emotional behavior among schoolchildren in Sri Lanka. Five hundred and eight schoolchildren (195 boys and 313 girls) aged 5–10 years were included. Emotional and behavioral problems were assessed using the Strengths and Difficulties Questionnaire. Nutritional status was used for body mass index-for-age z-score. Breakfast consumption, daily moderate- to vigorous-intensity physical activity (MVPA), wake-up time, and bedtime were considered lifestyle habits. The mean total difficulties score ± standard deviation was 12.0 ± 5.3, and the mean prosocial behavior score was 7.4 ± 1.9. In total, 89.2% children ate breakfast, and 41.3% engaged in at least 60 min of MVPA per day. After adjustment for confounding factors, multiple logistic regression analyses showed that breakfast skipping was associated with high scores on conduct problems (adjusted odds ratio (aOR) = 2.95, 95% confidence interval (CI): 1.50 to 5.77, p < 0.01) and that late bedtime was related to low prosocial behavior scores (aOR = 2.43, 95% CI: 1.17 to 5.03, p < 0.05). Our findings suggest that promoting regular lifestyle habits helps reduce psychological difficulties in schoolchildren. However, further research, including longitudinal studies, are required to identify the mechanism underlying this relationship.
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Affiliation(s)
- Chisa Shinsugi
- Department of Nutritional Epidemiology and Shokuiku, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8636, Japan
| | - Deepa Gunasekara
- Department of Biochemistry and Clinical Chemistry, Faculty of Medicine, University of Kelaniya, Ragama 11010, Sri Lanka
| | - Hidemi Takimoto
- Department of Nutritional Epidemiology and Shokuiku, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8636, Japan
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