Estimation of body weight using anthropometric parameters in Sri Lankan hospitalized adult patients

Body weight is an important clinical parameter for accurate dosing of drugs with a narrow therapeutic window, However, it is difficult to measure the body weight of a patient if they cannot stand on a scale. There are several anthropometrics-based equations to estimate the body weight, but most of these are derived from white Caucasian populations and are not validated for South Asians. This study aimed to validate existing anthropometrics-based weight estimation equations and develop a new equation for the same purpose for Sri Lankan adults. This prospective study was conducted at the National Hospital of Sri Lanka over a 6-month period, split into a development and a validation phase. During the development phase, estimated body weight of patients by doctors and nurses and patients themselves were noted and compared against their actual body weight. In addition, 13 anthropometric measurements were taken, which were used to validate 12 anthropometrics-based equations to estimate body weight described in literature previously. Two new gender specific regression models to estimate the body weight in the local population was also derived and validated. A total of 502 (males = 249) and 217 (males = 108) patients were recruited for the development and validation phases respectively. Both doctors and patients had comparable accuracy in predicting body weight (p>0.05). All anthropometric based equations were significantly correlated with actual body weight (correlation coefficients: 0.741-0.869), and the new equations derived from the local data performed similarly to the best performing equation identified from the literature during validation phase. However, even the best of these equations could not outperform patient/physician estimates. When the patient weight cannot be measured, an estimate by the patient or the doctor may be the best substitute.

Retrospective analysis of factors affecting rate of skeletonization within a tropical climate

Estimating the post mortem interval (PMI) in skeletonized cases is an extremely challenging exercise. Sri Lanka lacks adequate taphonomic research which is a serious limitation when assessing PMI in forensic death investigations. Methods that have been proposed to estimate PMI using the total body score (TBS) and accumulated degree days (ADD) are mainly based on data from continental and temperate climates and have shown less reliability in tropical climates. With the intention of developing a region-specific, evidence-based guide which would be applicable to tropical climates like Sri Lanka, we selected thirteen skeletonized remains with known PMIs from forensic case records and analysed their taphonomy in relation to selected weather data. We also compared the ADD values within our dataset with reference ranges calculated using published formula. All except one were found from outdoor locations. The TBS ranged from 24 to 32 and had a weak positive correlation with the PMI. The earliest appearance of skeletonization was 15 days in a body found indoors. The highest rate of skeletonization was seen in a body with a TBS of 32 and a PMI of 23 days. The average daily temperature and relative humidity were similar across all the cases however, the amount of rainfall varied. Bodies exposed to monsoon rains (n = 6) had a lower mean rate of skeletonization compared to those that were not exposed (n = 4) suggesting lower rates of decomposition during periods of heavy rainfall. No correlation was found between ADD and TBS. In 9 (69.2%) cases, the actual ADD was much lower than reference ADD ranges for TBS values, indicating poor applicability of TBS and ADD based formulae in estimating PMI within the Sri Lankan climate. Our study shows a strong need for taphonomic and entomological research in tropical climates to further explore the impact of monsoons on biotic and abiotic factors affecting skeletonization.

Use of elemental profiles determined by energy-dispersive X-ray fluorescence and multivariate analyses to detect adulteration in Ceylon cinnamon

The price of Cinnamomum verum (Ceylon cinnamon) is around twice as high as that of the other cinnamon varieties commonly grouped under the name cassia cinnamon, making the former spice an attractive target for fraudsters. This work demonstrates that elemental profiles obtained by energy-dispersive X-ray fluorescence in combination with multivariate analyses can be used as a screening method to detect Ceylon cinnamon adulteration. Thirty-six elements were analysed in 52 commercially available cinnamon samples, 29 Ceylon, 8 cassia, and 15 for which no indication about variety was provided. Fifty-eight percent of the samples were either adulterated or did not meet international quality criteria. Four of the ground cinnamon samples labelled as Ceylon cinnamon were found to be pure cassia or a mixture with a high cassia content, and 26 samples were suspected of other types of adulteration including replacement of bark with other parts of the cinnamon tree. Headspace gas chromatography-mass spectrometry and ash determination by thermogravimetric analysis confirmed the conclusions reached by elemental analysis. Only one sample labelled as Ceylon cinnamon and that according to its volatile composition was cassia cinnamon was not flagged as suspicious by elemental analysis.

Contamination of microplastics in tropical coral reef ecosystems of Sri Lanka

Microplastics (MPs) in different marine compartments are a global concern. This study investigated the abundance, distribution, and characteristics of microplastics from ten coral reef ecosystems in Sri Lanka, a non-quantified threat for some context. Microplastics were isolated and quantified in terms of abundance, shape, size, color, and polymer type with average abundances 546.7 ± 170.3 items kg-1, 9.8 ± 7.6 items m-3, and 46.3 ± 29.7 items kg-1 in corals, water, and sediments respectively. The most dominant microplastic type was blue, LDPE fibres. Acropora exhibited the highest amount. The significant differences in average microplastic abundances among corals suggest that they are capable of enriching microplastics depending on species-specific characteristics. Similar microplastic characteristics in corals and reef environment indicate that corals may have enriched microplastics from surface water and surface sediments. Microplastics being ubiquitous in selected reefs highlights the importance of coral reefs as a long-term microplastic sink in the ocean, contributing to the missing plastic phenomena.

Consensus on an assessment protocol for children with speech sound disorders in Sri Lanka

BACKGROUND

Speech sound disorders (SSDs) are the most common form of communication disorders in children. SSD have an impact on children's abilities to make themselves understood to their listeners and can influence a child's social and emotional well-being as well as their academic achievements. Therefore, it is important to identify children with an SSD early, in order to provide appropriate intervention. A wealth of information on best practice in the assessment of children with SSD is available in countries where the speech and language therapy profession is well established. In Sri Lanka, there is a paucity of research evidence supporting assessment practices that are culturally and linguistically appropriate in SSDs. Therefore, clinicians rely on informal assessment methods. There is a need to understand more about how clinicians in Sri Lanka assess this caseload in order to get general agreement regarding comprehensive and consistent procedures for assessment of paediatric SSD in Sri Lanka. This would support speech and language therapists' (SLTs') clinical decision-making in relation to choice of appropriate goals and intervention for this caseload.

AIM

To develop and gain consensus on an assessment protocol for Sri Lankan children with SSD that is culturally appropriate and based on existing research.

METHOD

A modified Delphi method was utilised to gather data from clinicians currently working in Sri Lanka. The research involved three rounds of data collection, exploring current assessment practices in Sri Lanka, ranking these in order of priority and establishing consensus on a proposed assessment protocol. The proposed assessment protocol was based on the results of the first and second rounds as well as previously published best practice guidelines.

OUTCOME AND RESULTS

The proposed assessment protocol achieved consensus in relation to content, format and cultural appropriateness. SLTs affirmed the usefulness of the protocol within the Sri Lankan context. Further research is required to assess the feasibility and effectiveness of this protocol in practice.

CONCLUSIONS & IMPLICATIONS

The assessment protocol supports practicing SLTs with a general guide to assessing children with suspected SSDs in Sri Lanka. The application of this protocol built upon consensus enables clinicians to improve their individual practice patterns based on best practice recommendations in the literature and the evidence on culturally and linguistically appropriate practices. This study has identified the need for further research in this area, including the development of culturally and linguistically specific assessment tools that would complement the use of this protocol.

WHAT THIS PAPER ADDS

What is already known on the subject The assessment of children with speech sound disorders (SSDs) requires a comprehensive and holistic approach due to their heterogeneous nature. Although there is evidence to support the assessment of paediatric SSDs in many countries where the profession of speech and language therapy is established, there is limited evidence to support the assessment of children with SSDs in Sri Lanka. What this study adds This study provides information about current assessment practices in Sri Lanka and consensus on a proposed culturally appropriate protocol for the assessment of children with SSDs in this country. What are the clinical implications of this work? The proposed assessment protocol provides speech and language therapists in Sri Lanka with a guide for assessment of paediatric SSDs to support more consistent practice in this area. Future evaluation of this preliminary protocol is required; however, the methodology used in this research could be applied to the development of assessment protocols for other range of practice areas in this country.

GIS-based weighted overlay model for wind and solar farm locating in Sri Lanka

With regard to wind and solar energy, research has shown a clear discrepancy between the amount of energy currently being used with the existing potential. The present research has attempted to develop a geographic information systems (GIS) based weighted overlay model to identify potential locations for the development of wind and solar farms in Sri Lanka, which are rapidly advancing renewable energy resources globally. Four major land-use types were considered for the model development as least productive land areas to establish wind and solar farms, namely, barren lands, sand areas, open forests, and scrublands. Nine and seven criteria were identified for the wind and solar farm siting respectively, and the relative weights for each criterion were obtained through focused group discussions. The weighted overlay model was used to locate suitable areas and higher the values generally indicate that a location is more suitable. The outcome of the weighted overlay model shows that for the wind farm locating, 141 km2 of highly suitable lands available accounts for 3% of the total land area of Sri Lanka. Furthermore, the model results indicated a total area of 99 km2 as highly suitable for solar power generation. Central, Sabaragamuwa, Uva, and Northern provinces were found to be the most suitable for wind farm locating and Eastern, Southern, and Northern provinces we identified as highly suitable for the solar farm locating. The model validation performed by overlaying the results with the existing solar and wind farm map of Sri Lanka indicated that the highly suitable, moderately suitable, and marginally suitable lands identified by the weighted overlay lied within 1 km radius of the existing wind and solar power plants. Thus, it can be concluded that GIS-based weighted overlay model can serve as a primary screening tool to shortlist the optimum land areas to locate future solar and wind farms in any selected geographical location.

Mother-daughter communication of sexual and reproductive health (SRH) matters and associated factors among sinhalese adolescent girls aged 14-19 years, in Sri Lanka

INTRODUCTION

School-based and community-based sexuality education has not shown a significant impact on the sexual and reproductive health (SRH) outcomes of Sri Lankan adolescents. Parents, as the primary educators of adolescents, could potentially serve as better sources for providing individualized sexuality education to their children.

OBJECTIVE

To assess the sexual and reproductive health (SRH) topics discussed between mothers and daughters, barriers to communication, and associations of SRH communication among Sinhala adolescent girls aged 14-19 years in Sri Lanka.

METHODS

A descriptive cross-sectional study was conducted among a sample of 810 Sinhala adolescent girls using a pre-tested, self-administered questionnaire. Descriptive statistics pertaining to mother-daughter communication in SRH matters were presented using frequencies and percentages. Bivariate analysis was performed to evaluate the association of selected socio-demographic factors with mother-daughter SRH communication, while binary logistic analysis was used to assess the independent association of chosen demographic factors with mother-daughter SRH communication.

RESULTS

The majority of the respondents (67.1%, n = 540) indicated a willingness to discuss SRH matters with their mothers. For 78.2% (n = 632) of the respondents, the mother was the preferred source of SRH information. Common topics discussed between the mothers and daughters included issues related to menstruation (88.4%, n = 701) and maintaining personal boundaries (94%, n = 718), whereas less discussed topics included homosexuality (21%, n = 166), and preventing unwanted pregnancy (38.6%, n = 305). Cultural barriers, fear of mothers' reactions, and mothers' lack of confidence in responding to their daughter's SRH matters were the main barriers to discussing SRH topics with mothers. Adolescent girls' age, and family income level were significantly associated with mother-daughter SRH communication.

CONCLUSIONS AND RECOMMENDATIONS

Although a majority of adolescent girls preferred to share their sexual health concerns with their mothers, a notable barrier was the lack of confidence from the mother's side. Furthermore, the scope of mother-daughter sexual communication in this study was largely limited to less sensitive topics. In light of these findings, it is suggested that interventions targeted at parents be developed alongside school-based sex education for adolescents. These interventions should aim to enhance parents' knowledge and skills in discussing sexual health matters with their adolescent children.

Maternal Health in Sri Lanka: 75 years of national commitment towards excellence

Sri Lanka has a legacy of religious and cultural practices promoting health, and its rulers have been responsive to health needs of the populace. The healthcare milieu that prevailed in the pre-colonial and colonial periods favorably influenced the evolution of maternal health in the last 75 years. Since independence, maternal health in the country improved in many dimensions and directions, in the backdrop of multiple sociodemographic changes and geopolitical fluxes, while far-reaching advances in the medico-technological and communication fields were taking place at global level. By 1948, maternal health services were extensive with maternity hospitals, midwifery training school and functional health units in place. The establishment of a cadre of government-trained midwives instead of training traditional birth attendants (TBAs) was a key policy decision that brought long-term dividends. The WHO supported training primary health care workers even before opening their country office in 1952. In the early days, obstetricians relied mostly on their skills to conduct dexterous maneuvers with the generous use of rotational forceps rather than resorting to abdominal deliveries. The Family Planning Association was founded in 1953, which introduced family planning services to the country till the government took over the subject in 1958. A rigorous campaign (punchi pawla raththaran), promoting sterilization was conducted for population control in 1974 ,which resulted in the total fertility rate coming down significantly. Maternal Death Surveillance and Response system (MDSR) was established in 1981 which has been recognized globally as a success and is being upscaled to a confidential Inquiry status. Commitment and untiring efforts of the Ministry of health: Family Health Bureau, professional organizations, development partners including the WHO, have contributed for the achievements in the area of women's health.

A malaria death due to an imported Plasmodium falciparum infection in Sri Lanka during the prevention of re-establishment phase of malaria

BACKGROUND

Sri Lanka has maintained a rigorous programme to prevent the re-establishment of malaria ever since the disease was eliminated in October 2012. It includes efforts to sustain case surveillance to ensure early diagnosis and management of malaria. Yet, in April of 2023 the death occurred of an individual with imported malaria.

CASE PRESENTATION

The deceased was a 37-year-old Sri Lankan male who returned to Sri Lanka on the 10th of April after a business trip to several countries including Tanzania. He was febrile on arrival and consulted three Allopathic Medical Practitioners in succession in his home town in the Western Province of Sri Lanka, over a period of 5 days starting from the very day that he arrived in the country. Malaria was not tested for at any of these consultations and his clinical condition deteriorated. On the evening of 14th of April he was admitted to the medical intensive care unit of a major private hospital in the capital city of Colombo with multiple organ failure. There, on a request by the treating physician blood was tested for malaria and reported early the next morning as Plasmodium falciparum malaria with a high parasitaemia (> 10%). The patient died shortly after on the 15th of April before any anti-malarial medication was administered. The deceased had been a frequent business traveller to Africa, but with no past history of malaria. He had not taken chemoprophylaxis for malaria on this or previous travels to Africa.

DISCUSSION

The patient's P. falciparum infection progressed rapidly over 5 days of arriving in Sri Lanka leading to severe malaria without being diagnosed, despite him seeking healthcare from three different Medical Practitioners. Finally, a diagnosis of malaria was made on admission to an intensive care unit; the patient died before anti-malarial medicines were administered.

CONCLUSIONS

This first death due to severe P. falciparum malaria reported in Sri Lanka after elimination of the disease was due to the delay in diagnosing malaria.

Sri Lanka has been a success story for WHO's engagement in global public health

No abstract available

Health Financing Options for Sri Lanka: What, and Why?

The purpose of this paper is to renew and stimulate the national discourse on how to further Sri Lanka's aspirational goal of achieving Universal Health Coverage (UHC [1]) in line with the global sustainable development goals (SDG) to which Sri Lanka is a signatory. After a brief status update about UHC in Sri Lanka, the paper focuses on the financing function, justified on the basis of its central role in addressing the problems confronting the health system, in terms of its inherent inefficiencies as well as the specific context of the economic crisis which the country is currently facing. The paper argues for a well-managed prepaid, pooled health financing mechanism (such as the current tax-based system or social health insurance schemes), incorporating strategic purchasing approaches, leveraging the private sector (both for-profit and non-profit), in order to increase efficiency, equity and accountability by separating the financing and purchasing functions from service delivery.

Genetic diversity, phylogenetic and phylogeographic analysis of Anopheles culicifacies species complex using ITS2 and COI sequences

Anopheles culicifacies is the major vector of malaria in Sri Lanka and the Indian subcontinent which is characterized as a species complex with five sibling species provisionally designated as A, B, C, D and E. The current study was carried out to understand the phylogenetic and phylogeographic relationships between the sibling species of the species complex while observing their genetic diversity and genetic differentiation. Thirty-five ITS2 and seventy-seven COI sequences of An. culicifacies species complex reported from different geographical locations of Asia and China at the NCBI public database were used for the analysis. Bayesian likelihood trees were generated for the phylogenetic analysis. The divergence of the species complex was obtained from the Bayesian phylogeographic model in BEAST. There were two clades of the sibling species of An. culicifacies species complex as A, D and B, C and E in both phylogenetic and phylogeographic analysis using ITS2 sequences. Based on the highly divergent COI sequences and the high mutation rate of the mitochondrial genome, there were four and three clades in both phylogenetic and phylogeographic analysis using COI sequences. The diversification of An. culicifacies species complex was obtained as ranging from 20.25 to 24.12 Mya and 22.37 to 26.22 Mya based on ITS2 and COI phylogeographic analysis respectively. There was a recent diversification of the sibling species A and D than the sibling species B, C and E. Low haplotype diversity was observed in the sequences reported from Sri Lanka in both ITS2 and COI analysis that can be due to bottlenecks resulting from the intense malaria control efforts. A high genetic differentiation was achieved for some populations due to the large geographical distance. The high genetic diversity based on the five sibling species implies the possibility of maintaining a relatively high effective population size despite the vector control efforts.

A. B. D. A, Abbas K, Hussain T, Ramasamy S, Manomohan V, Tapsoba ASR, Pichler R, Babar ME, Periasamy K. Indigenous cattle of Sri Lanka: Genetic and phylogeographic relationship with Zebu of Indus Valley and South Indian origin

The present study reports the population structure, genetic admixture and phylogeography of cattle breeds of Sri Lanka viz. Batu Harak, Thawalam and White cattle. Moderately high level of genetic diversity was observed in all the three Sri Lankan zebu cattle breeds. Estimates of inbreeding for Thawalam and White cattle breeds were relatively high with 6.1% and 7.2% respectively. Genetic differentiation of Sri Lankan Zebu (Batu Harak and White cattle) was lowest with Red Sindhi among Indus Valley Zebu while it was lowest with Hallikar among the South Indian cattle. Global F statistics showed 6.5% differences among all the investigated Zebu cattle breeds and 1.9% differences among Sri Lankan Zebu breeds. The Sri Lankan Zebu cattle breeds showed strong genetic relationships with Hallikar cattle, an ancient breed considered to be ancestor for most of the Mysore type draught cattle breeds of South India. Genetic admixture analysis revealed high levels of breed purity in Lanka White cattle with >97% Zebu ancestry. However, significant taurine admixture was observed in Batu Harak and Thawalam cattle. Two major Zebu haplogroups, I1 and I2 were observed in Sri Lankan Zebu with the former predominating the later in all the three breeds. A total of 112 haplotypes were observed in the studied breeds, of which 50 haplotypes were found in Sri Lankan Zebu cattle. Mismatch analysis revealed unimodal distribution in all the three breeds indicating population expansion. The sum of squared deviations (SSD) and raggedness index were non-significant in both the lineages of all the three breeds except for I1 lineage of Thawalam cattle (P<0.01) and I2 lineage of Batu Harak cattle (P<0.05). The results of neutrality tests revealed negative Tajima's D values for both the lineages of Batu Harak (P>0.05) and White cattle (P>0.05) indicating an excess of low frequency polymorphisms and demographic expansion. Genetic dilution of native Zebu cattle germplasm observed in the study is a cause for concern. Hence, it is imperative that national breeding organizations consider establishing conservation units for the three native cattle breeds to maintain breed purity and initiate genetic improvement programs.

Determinants of early cessation of exclusive breastfeeding practices among rural mothers from Jaffna District of Sri Lanka

BACKGROUND

Sri Lanka is an upper-middle-income country with excellent health statistics. However, 2016 Demographic and Health Survey data have shown 82% and 64% of mothers exclusively breastfed infants aged 0-6 months and 4-5 months, respectively. The short duration of exclusive breastfeeding (EBF) has an impact on the growth and development of babies. Since no studies have been reported on EBF practices of the rural mothers in Jaffna District, an administrative district among 25 districts of Sri Lanka, this study aimed to assess the factors influencing the early cessation of EBF.

METHODS

For this community-based cross-sectional study, 338 mother-child pairs were selected from 2013-14. EBF was defined as children not receiving any food or drink, including complementary foods, formula milk or milk products except for medicines and vitamins or mineral drops, other than breast milk since birth. Socio-economic and demographic factors, the influence of the mode of delivery, and knowledge on EBF were obtained using an interviewer-administered questionnaire. The details of EBF and reasons for the cessation of breastfeeding before six months were obtained from a subgroup of mothers (n = 208). Multivariate analysis was performed to explore the correlates of breastfeeding.

RESULTS

In this study, 71.2% (95% CI 64.5, 77.2) had practiced EBF for six months. Early discontinuation of EBF was practiced by employed mothers (AOR 4.3; 95% CI 1.3, 13.9), mothers of low birth weight babies (AOR 3.6; 95% CI 1.6, 8.2) and those who experienced Cesarean section birth (AOR 2.9; 95% CI 1.2, 6.9). The EBF practiced by mothers of rural Jaffna was not associated with the gender of the babies, type of family, number of children in a family, religion of the household, knowledge on EBF, or family income.

CONCLUSION

The prevalence of EBF up to six months was low in rural Jaffna, and it was influenced by employment, birthweight of the babies, and the mode of delivery. To enhance EBF, the Regional Directorate of Health Service, Jaffna, should take necessary action with policymakers to increase maternity leave for at least six months, reduce the Cesarean section rate, and provide nutritional support to pregnant mothers.

Comparative virome analysis of individual shedding routes of Miniopterus phillipsi bats inhabiting the Wavul Galge cave, Sri Lanka

Bats are described as the natural reservoir host for a wide range of viruses. Although an increasing number of bat-associated, potentially human pathogenic viruses were discovered in the past, the full picture of the bat viromes is not explored yet. In this study, the virome composition of Miniopterus phillipsi bats (formerly known as Miniopterus fuliginosus bats in Sri Lanka) inhabiting the Wavul Galge cave, Sri Lanka, was analyzed. To assess different possible excretion routes, oral swabs, feces and urine were collected and analyzed individually by using metagenomic NGS. The data obtained was further evaluated by using phylogenetic reconstructions, whereby a special focus was set on RNA viruses that are typically associated with bats. Two different alphacoronavirus strains were detected in feces and urine samples. Furthermore, a paramyxovirus was detected in urine samples. Sequences related to Picornaviridae, Iflaviridae, unclassified Riboviria and Astroviridae were identified in feces samples and further sequences related to Astroviridae in urine samples. No viruses were detected in oral swab samples. The comparative virome analysis in this study revealed a diversity in the virome composition between the collected sample types which also represent different potential shedding routes for the detected viruses. At the same time, several novel viruses represent first reports of these pathogens from bats in Sri Lanka. The detection of two different coronaviruses in the samples indicates the potential general persistence of this virus species in M. phillipsi bats. Based on phylogenetics, the identified viruses are closely related to bat-associated viruses with comparably low estimation of human pathogenic potential. In further studies, the seasonal variation of the virome will be analyzed to identify possible shedding patterns for particular viruses.

Characterization of Uromyces appendiculatus First Races in Sri Lanka and Identification of Genes for the Development of Rust-Resistant Snap Beans

Bean rust is a devastating disease of snap beans in Sri Lanka. Our study endeavored to develop snap beans with resistance to Uromyces appendiculatus, the bean rust pathogen reported to have numerous virulent races. Accordingly, we needed a detailed understanding of the virulence of U. appendiculatus and to identify genes conferring effective rust resistance. To investigate the virulence, we collected leaves of snap bean with rust symptoms from four snap bean producing districts of Sri Lanka. From these samples we established 57 single pustule isolates. Each isolate was inoculated on a set of 12 differential cultivars, six from the Andean and six from the Middle American gene pools of common bean. The virulence of the isolates segregated into four distinct groups that comprised the first four reported races of U. appendiculatus in Sri Lanka, 23-5, 31-1, 31-11, and 63-21. All races were significantly more virulent on the Andean than on the Middle American differential cultivars. PI 1819966, a Middle American differential cultivar containing the Ur-11 gene, conferred resistance to all four races. Three other Middle American cultivars were resistant to three races. Conversely, five Andean differential cultivars were susceptible to all four races. PI 160418 was the only Andean differential cultivar with resistance to three races. The results suggested that rust resistance genes from the Middle American differential cultivars could be combined in different ways with the resistance of Andean PI 260418 to develop snap bean varieties with broad resistance to all races of U. appendiculatus in Sri Lanka.

Global, regional, and country-level cost of leptospirosis due to loss of productivity in humans

BACKGROUND

Leptospirosis, a prevalent zoonotic disease with One Health priority and a disease of poverty, lacks global economic burden estimates. This study aims to determine the global, regional, and country-level cost of leptospirosis due to loss of productivity.

METHODOLOGY/PRINCIPAL FINDINGS

The cost of leptospirosis due to loss of productivity (referred to as productivity cost hereafter) was estimated by converting the disability-adjusted life years (DALYs) lost due to leptospirosis to a monetary value using the per capita gross domestic product (GDP). The country-specific DALYs lost were obtained from the global burden of leptospirosis study published previously. Non-health GDP per capita (GDP- per capita health expenditure) was used for the cost conversion of DALYs. Country-specific GDP and health expenditure data were obtained from the World Bank data repositories. Estimates were done using both nominal and international dollars. The estimated global productivity cost of leptospirosis in 2019 was Int$ 29.3 billion, with low and high estimates ranging from Int$ 11.6 billion to 52.3 billion. China (Int$ 4.8 billion), India (Int$ 4.6 billion), Indonesia (Int$ 2.8 billion), Sri Lanka (Int$ 2.1 billion), and the United States (Int$ 1.3 billion) had the highest productivity cost due to leptospirosis. Eight out of 10 countries with the highest burden were in the Asia-Pacific region. In addition, lower-middle-income countries had an annual productivity cost of Int$ 13.8 billion, indicating that the disease is poverty-related.

CONCLUSION

Although significant, the cost estimate due to loss of productivity is merely a fraction of the overall economic burden of this disease, which also includes other direct, indirect, and intangible costs. The existing partial estimates of the different components of economic cost suggest a profound economic burden that demands the inclusion of leptospirosis in the global health agenda for comprehensive disease control and prevention efforts, including vaccine development.

A study on GHG emission assessment in agricultural areas in Sri Lanka: the case of Mahaweli H agricultural region

Agricultural activities contribute 7% to Sri Lanka's economy and account for 20% of the national greenhouse gas (GHG) emissions. The country aims to achieve zero net emissions by 2060. This study was aimed at assessing the present state of agricultural emissions and identifying mitigation strategies. The assessment involved estimating agricultural net GHG emissions from non-mechanical sources in the Mahaweli H region, Sri Lanka, in 2018 using the Intergovernmental Panel on Climate Change (IPCC 2019) guidelines. New indicators were developed to measure emissions for major crops and livestock and used to show the flow of carbon and nitrogen. The region's agricultural emissions were estimated to be 162,318 t CO2eq y-1, of which 48% was from rice field methane (CH4) emissions, 32% from soil nitrogen oxide emissions, and 11% from livestock enteric CH4 emissions. Biomass carbon accumulation offset 16% of the total emissions. Rice crops exhibited the highest emission intensity of 4.77 t CO2eq ha-1 y-1, while coconut crop had the highest abatement potential of 15.58 t CO2eq ha-1 y-1. Approximately 1.86% of the carbon input to the agricultural system was released as carbon-containing GHG (CO2 and CH4), whereas 1.18% of the nitrogen input was released as nitrous oxide. The findings of this study suggest extensive adaptations of agricultural carbon sequestration strategies and increased nitrogen use efficiency to achieve GHG mitigation targets. The emission intensity indicators derived from this study can be used for regional agricultural land use planning to maintain designated levels of emissions and implement low-emission farms.

A unique single nucleotide polymorphism in Agouti Signalling Protein (ASIP) gene changes coat colour of Sri Lankan leopard (Panthera pardus kotiya) to dark black

The Sri Lankan leopard (Panthera pardus kotiya) is an endangered subspecies restricted to isolated and fragmented populations in Sri Lanka. Among them, melanistic leopards have been recorded on a few occasions. Literature suggests the evolution of melanism several times in the Felidae family, with three species having distinct mutations. Nevertheless, the mutations or other variations in the remaining species, including Sri Lankan melanistic leopard, are unknown. We used reference-based assembled nuclear genomes of Sri Lankan wild type and melanistic leopards and de novo assembled mitogenomes of the same to investigate the genetic basis, adaptive significance, and evolutionary history of the Sri Lankan melanistic leopard. Interestingly, we identified a single nucleotide polymorphism in exon-4 Sri Lankan melanistic leopard, which may completely ablate Agouti Signalling Protein (ASIP) function. The wild type leopards in Sri Lanka did not carry this mutation, suggesting the cause for the occurrence of melanistic leopords in the population. Comparative analysis of existing genomic data in the literature suggests it as a P. p. kotiya specific mutation and a novel mutation in the ASIP-gene of the Felidae family, contributing to naturally occurring colour polymorphism. Our data suggested the coalescence time of Sri Lankan leopards at ~0.5 million years, sisters to the Panthera pardus lineage. The genetic diversity was low in Sri Lankan leopards. Further, the P. p. kotiya melanistic leopard is a different morphotype of the P. p. kotiya wildtype leopard resulting from the mutation in the ASIP-gene. The ability of black leopards to camouflage, along with the likelihood of recurrence and transfer to future generations, suggests that this rare mutation could be environment-adaptable.

Direct out-of-pocket expenditure of tuberculosis treatment in intensive phase in Kalutara District, Sri Lanka

BACKGROUND

Tuberculosis (TB) is a communicable disease. Financial risk protection is a key target to achieve in end TB strategy. Out-Of-Pocket Expenditure (OOPE) consisted of expenses bore by patients for their illnesses after subtracting third-party payments such as insurance. Despite the free health care in Sri Lanka, TB patients have to pay for various expenses (e.g., expenses for travel, food, drugs, medical investigations, and cost of accompanied person/bystander).

OBJECTIVES

The main objective of this study was to estimate direct OOPE and find the association between direct OOPE and noncompliance to TB treatment in intensive phase.

METHODS

A cross-sectional study was conducted with TB patients who were registered in Kalutara-district chest clinic for period of six months (n = 267). Interviewer-administered questionnaire (consisted of sections on socio-demographic characteristics, treatment compliance, sources and amount of OOPE, etc.) was used to collect data. Mean median, minimum, maximum and interquartile range were calculated in each component of OOPE.

RESULTS

Questionnaire were administered for 252 patients (male = 160, 63.5%). Mean total direct non-medical cost for one DOTS visit (without accompanied person) was 435.40 (IQR = 420.00) Sri Lankan Rupees (SLR) (i.e., 2.45 United State Dollars (USD)). A patient without an accompanying person spent 26124.00 SLR (435.40 per day into 60 days) (i.e., 146.76 USD) for transport and food during the intensive phase. During the intensive phase, the mean medical cost for one patient was 6444.66 LKR (IQR = 6400) (i.e., 36.21 USD). OOPE was not associated with noncompliance to TB treatment in intensive phase (p = 0.29).

CONCLUSIONS

There was no association between OOPE and noncompliance. The direct OOPE for TB treatment in the intensive phase was high. Therefore, it is necessary to develop strategies to reduce OOPE during TB treatment especially in intensive phase.

Taxonomic status of the Lesser Woolly Horseshoe bats (Chiroptera, Rhinolophidae, Rhinolophus beddomei) in peninsular India and Sri Lanka

Insularity provides ample opportunities for species diversification. Sri Lanka is home to a large diversity of species, many of which are endemic but morphologically similar to species found in southern India, due to recent speciation events, suggesting a complex evolutionary history. However, in some taxa although morphological diversity has been noted, the genetic level variations are minimal. Among the wide-ranging horseshoe bats such a phenomenon is noted. In this study, we used bioacoustics, morphometric and molecular data to evaluate the relationships between the taxa of lesser woolly horseshoe bats in the India and Sri Lanka. Our study reveals that the two taxa-Rhinolophus beddomei Andersen, 1905 and here we have validated the existing subspecies from peninsular India and R. sobrinus Andersen, 1918 from Sri Lanka are genetically very close to R. perniger Hodgson, 1843. Currently the taxa-beddomei and sobrinus are recognized as subspecies of Rhinolophus beddomei Andersen, 1905. We provide a detailed description of the taxa beddomei and sobrinus as the original descriptions are limited in nature.

Fairy moths of the genus Nemophora Hoffmannsegg, 1798 (Lepidoptera: Adelidae) of India and Sri Lanka

This study provides a comprehensive account of 40 species of the genus Nemophora Hoffmannsegg, 1798 described or recorded from India and Sri Lanka. A key to the species based on external characters and on male genitalia is provided; twelve new species are described: Nemophora angustialata Kozlov, sp. nov., N. ceylonella Kozlov, sp. nov., N. costimaculella Kozlov, sp. nov., N. ferruginea Kozlov, sp. nov., N. fletcherella Kozlov, sp. nov., N. fuscomaculella Kozlov, sp. nov., N. kashmirella Kozlov, sp. nov., N. manipurella Kozlov, sp. nov., N. nitidulella Kozlov, sp. nov., N. ornamentella Kozlov, sp. nov., N. phryganeella Kozlov, sp. nov. and N. tenuitella Kozlov, sp. nov. Lectotypes are designated for 19 species, including four junior synonyms. The following new synonyms of seven species are proposed: Nemotois pollinaris (Meyrick, 1907), syn. nov. of Nemophora engraptes (Meyrick, 1907); Adela suavis Caradja, 1938, syn. nov. of Nemophora fluorites (Meyrick, 1907); Adela latifasciella Warren, 1888, syn. nov. of Nemophora gemmella (Walsingham, 1880); Nemotois chrysogona Meyrick, 1922, syn. nov. of Nemophora indica (Walker, 1863); Nemotois xanthargyra Meyrick, 1922, syn. nov. of Nemophora scitulella (Walker, 1864); Nemotois zonoreas Meyrick, 1924, syn. nov. of Nemophora solstitiella (Walsingham in Walsingham & Durrant, 1900); and Nemotois xanthophracta Meyrick, 1930, syn. nov. of Nemophora athlophora (Meyrick, 1912). Eleven new combinations are introduced: Nemophora sporodesma (Meyrick, 1928), comb. nov., N. engraptes (Meyrick, 1907), comb. nov., N. chalcomis (Meyrick, 1907), comb. nov., N. neurias (Meyrick, 1922), comb. nov., N. gemmella (Walsingham, 1880), comb. nov., N. indica (Walker, 1863), comb. nov., N. scitulella (Walker, 1864), comb. nov., N. amphimetalla (Meyrick, 1912), comb. nov., N. pyrotechna (Meyrick, 1912), comb. nov., N. chrysidias (Meyrick, 1928), comb. nov., and N. athlophora (Meyrick, 1912), comb. nov. Nemophora chalcomis (Meyrick, 1907) and N. mediseorsa Sun et Li, 2023 are for the first time reported from India; N. smaragdaspis (Meyrick, 1924) is for the first time reported from Nepal; N. chrysoprasias (Meyrick, 1922) is for the first time reported from Myanmar; N. solstitiella (Walsingham in Walsingham & Durrant, 1900) is for the first time reported from Pakistan and China (Taiwan); and N. augantha (Meyrick, 1907) is for the first time reported from Vietnam. The previous records of Adela croesella (Scopoli, 1763), N. satrapodes (Meyrick, 1894) and N. degeerella (Linnaeus, 1758) from India are dismissed as based on misidentifications. Currently, the fairy moth faunas of India and Sri Lanka include 38 and four species, respectively.

Quantification of impact of COVID-19 pandemic on cancer screening programmes - a case study from Argentina, Bangladesh, Colombia, Morocco, Sri Lanka, and Thailand

It is quite well documented that the COVID-19 pandemic disrupted cancer screening services in all countries, irrespective of their resources and healthcare settings. While quantitative estimates on reduction in volume of screening tests or diagnostic evaluation are readily available from the high-income countries, very little data are available from the low- and middle-income countries (LMICs). From the CanScreen5 global cancer screening data repository we identified six LMICs through purposive sampling based on the availability of cancer screening data at least for the years 2019 and 2020. These countries represented those in high human development index (HDI) categories (Argentina, Colombia, Sri Lanka, and Thailand) and medium HDI categories (Bangladesh and Morocco). No data were available from low HDI countries to perform similar analysis. The reduction in the volume of tests in 2020 compared to the previous year ranged from 14.1% in Bangladesh to 72.9% in Argentina (regional programme) for cervical screening, from 14.2% in Bangladesh to 49.4% in Morocco for breast cancer screening and 30.7% in Thailand for colorectal cancer screening. Number of colposcopies was reduced in 2020 compared to previous year by 88.9% in Argentina, 38.2% in Colombia, 27.4% in Bangladesh, and 52.2% in Morocco. The reduction in detection rates of CIN 2 or worse lesions ranged from 20.7% in Morocco to 45.4% in Argentina. Reduction of breast cancer detection by 19.1% was reported from Morocco. No association of the impact of pandemic could be seen with HDI categories. Quantifying the impact of service disruptions in screening and diagnostic tests will allow the programmes to strategize how to ramp up services to clear the backlogs in screening and more crucially in further evaluation of screen positives. The data can be used to estimate the impact on stage distribution and avoidable mortality from these common cancers.