Malaria vectors in a traditional dry zone village in Sri Lanka

Malaria transmission by anopheline mosquitoes was studied in a traditional tank-irrigation-based rice-producing village in the malaria-endemic low country dry zone of northcentral Sri Lanka during the period August 1994-February 1997. Adult mosquitoes were collected from human and bovid bait catches, bovid-baited trap huts, indoor catches, and pit traps. Mosquito head-thoraces were tested for the presence of Plasmodium falciparum and P. vivax, and blood-engorged abdomens for the presence of human blood by ELISAs. House surveys were done at two-day intervals to record cases of blood film-confirmed malaria among the villagers. A total of 7,823 female anophelines representing 14 species were collected. Trends in anopheline abundance were significantly correlated with rainfall of the preceding month in An. annularis, An. barbirostris, An. subpictus, An. vagus, and An. varuna, but were not significant in An. culicifacies and An. peditaeniatus. Malaria parasite infections were seen in seven mosquito species, with 75% of the positive mosquitoes containing P. falciparum and 25% P. vivax. Polymorph PV247 was recorded from a vector (i.e., An. varuna) for the first time in Sri Lanka. Computations of mean number of infective vector (MIV) rates using abundance, circumsporozoite (CS) protein rate, and human blood index (HBI) showed the highest rate in An. culicifacies. A malaria outbreak occurred from October 1994 to January 1995 in which 45.5% of village residents experienced at least a single disease episode. Thereafter, malaria incidence remained low. Anopheles culicifacies abundance lagged by one month correlated positively with monthly malaria incidence during the outbreak period, and although this species ranked fifth in terms of abundance, infection was associated with a high MIV rate due to a high CS protein rate and HBI. Abundance trends in other species did not correlate significantly with malaria. It was concluded that An. culicifacies was epidemiologically the most important vector in the study area.

Pattern of use of medical information made available via an Internet website

INTRODUCTION

The Internet is probably the fastest growing means of public communication. Those who seek health and medical information are using it increasingly. We decided to study the pattern of use of information made available via an Internet website.

METHOD

Retrospective analysis of the entries made on the guest book and direct inquiries made to the webmaster of an established and well known Sri Lankan medical website from 1 February 1997 to 20 November 1998.

RESULTS

During this period 23,373 web surfers visited the site. There were 222 guest book entries and 12 direct inquiries to the webmaster. The analysis of these entries and inquiries show that there is a wide gap in use of the information available at this website between web surfers from the developed and the developing countries.

CONCLUSION

Governments in developing countries must plan to make computers and information technology as well as telecommunication services affordable and widely available.

A study of air particulate pollution in Colombo using a nuclear-related analytical technique

Air particulate matter of two size fractions (coarse [2.5-10 microns] and fine [less than 2.5 microns]) were collected at an urban residential site (Colombo University ground) over a period of 12 mo during 1996 using a Gent PM10 stacked filter unit. Seventy-five sets of samples collected during this period were analyzed for 10 elements: Al, Si, K, S, Ca, Ti, Fe, Zn, Br, and Pb by energy-dispersive X-ray fluorescence, which is a multielement analysis. This is a highly sensitive technique enabling quantitative analysis of very low masses. The average concentrations of lead, sulfur, and bromine, which are generally associated with combustion products of automotive exhausts, dominate the fine fraction in this study. The minimum and maximum concentration of lead resulting in an annual average of 0.09 microgram/m3 was found to be 0.0042 and 0.441 microgram/m3 in particulate matter with less than 10 microns equivalent aerodynamic diameter. The maximum concentration determined is well below the limits set by the World Health Organization (0.5-1.0 microgram/m3). The recommended value for Pb in Sri Lanka is 0.5 microgram/m3. Al, Si, Ca, Ti, and Fe exhibited enhanced concentrations in the coarse fraction, which probably originate from disturbed soil as a result of wind and traffic.

Street children--a preliminary study

OBJECTIVE

To study the background, life styles, health and prevalence of abuse of street children in Colombo.

STUDY SAMPLE

50 street children receiving temporary day care or night shelter from community service centres were serially recruited.

DESIGN

A retrospective descriptive survey. Demographic, experiential and clinical data were collected by an interviewer, based on a semistructured questionnaire, followed by physical examination and laboratory investigation.

RESULTS

The children were aged between 4 and 17 years. (Mean 10.5 years.) 64% were males and 18% belonged to ethnic minorities. The majority (84%) had family ties. Family disintegration was mentioned as the cause for life on the streets by 36%. Child labour was reported in 38%. 16% admitted to being sexually abused. 20% were tobacco smokers. Respiratory and skin infections, and injuries incurred in road traffic accidents were the main causes of morbidity.

CONCLUSION

Street children in Colombo are an abused and exploited group. Road traffic accidents, and physical and sexual abuse are the main hazards of the street they are exposed to.

Heart attacks: exploring new preventive strategies

Ischaemic heart disease is an emerging public health problem in Sri Lanka. Implementation of programs for lifetime control and prevention of established coronary risk factors such as smoking, hyperlipidaemia, hypertension, diabetes and hereditary risk are costly and unaffordable in countries such as Sri Lanka with limited resources for health care. Other potential risk factors which are less expensive with regard to prevention require investigation. This paper summarises several studies done over the past decade at Peradeniya, to investigate three such potential coronary risk factors of IHD, namely homocysteine, vitamin C and dietary fat.

A single pathological grading system for breast carcinoma should be adopted in Sri Lanka

INTRODUCTION

Histologic grading of breast cancer is related to prognosis and management of patients. The grading systems used are the initially formulated subjective methods, and the more recently described objective Nottingham system. In Sri Lanka there is lack of uniformity in histopathology reporting of breast cancer. All methods used employ 3 grades. If histologic grading is to be of clinical relevance, it is important that the grades of different systems correlate with one another.

OBJECTIVE

To determine if the three grades of the Nottingham system correlate with those of the other systems.

SETTING

Department of Pathology, Faculty of Medicine, Colombo.

METHOD

54 breast carcinomas were graded using the Nottingham system by reviewing histology slides. The Nottingham grading was compared with the original grading mentioned in the histology report.

RESULTS

The original reports included 35 tumours graded with systems other than Nottingham. 45.7% of these tumours did not correspond with the subsequent Nottingham grade. 40% had to be upgraded from grade II to III. When the 19 tumours originally graded using the Nottingham system were re-evaluated using the same system, there was concurrence in 89.5% of the cases.

CONCLUSION

Our results indicate a failure of other grading systems to correlate with the corresponding Nottingham grade in a high proportion of cases. We recommend the adoption of a single, objective grading system such as the Nottingham method by all clinicians in Sri Lanka.

User satisfaction with child psychiatry outpatient care: implications for practice

INTRODUCTION

Satisfaction with outpatient care is determined by the extent to which the expectations of users are met. Obtaining the opinion of users is considered a reliable method of assessing the quality of service. The objective of our study was to assess the degree of satisfaction expressed by users of a child psychiatry outpatient service and to match degree of satisfaction with the dropout rate.

METHOD

A questionnaire was used to assess the users' expectation of the service and degree of satisfaction. Dropout rate was determined from the clinical records.

RESULTS

165 new referrals to the outpatient service were recruited for the study. 41.2% expected a cure for the child's mental health problem. 65.5% expressed satisfaction with the treatment intervention and time provided at the first consultation. Positive free text comments supported this opinion, but were incongruent with the 32.8% dropout rate after the first and second visits to the clinic. Behaviour problems in children and serious social problems in the families increased the risk of dropout from treatment.

CONCLUSIONS

Initial expression of satisfaction with the service by the users does not guarantee continued co-operation with follow up care. Sensitivity in the approach to treatment is needed where there is a higher risk of dropout.

Chromoblastomycosis simulating rhinosporidiosis in a patient from Ceylon

A case of chromoblastomycosis confined to the mucous membrane of one side of the nasal septum is reported. The organism was not cultivated, but its characteristics in histological preparations were typical of those of the organisms in sections of cutaneous lesions known to be caused by Phialophora pedrosoi and related fungi. The diagnosis is considered to have been justified in spite of the great rarity of mucosal involvement in chromoblastomycosis and of the complete absence of lesions in the skin. The patient was a Sinhalese student working in London. He had first noticed the lesion before he left Ceylon, but the symptoms of nasal obstruction and bleeding were not sufficient to make him seek medical advice until two years later. If it is correct to assume that he contracted the infection in Ceylon his case is only the second on record in which there has been reason to suggest that Ceylon has been the geographical source of chromoblastomycosis. The lesion was excised and its site cauterized. There has been no sign of recurrence of the infection during the two years that have passed since the operation.

The Center for Epidemiological Studies Depression Scale in older community samples in Indonesia, North Korea, Myanmar, Sri Lanka, and Thailand

Cultural differences in the reporting of depressive symptoms among older people were examined using the Center for Epidemiological Studies Depression (CES-D) scale in five Southeast Asian countries: Indonesia, Korea, Myanmar, Sri Lanka, and Thailand. Previous work in Asian samples--principally North American immigrants--suggested differential functioning of the CES-D. The four-factor solution established in the original studies of the CES-D was replicated for all countries using a confirmatory factor analytic approach. It was, however, demonstrated that little information was lost in considering full-scale scores rather than the four subscales separately. The behavior of the CES-D in older Asian populations was found to be comparable to results obtained in North American and European cultures. Significant somatization of depression in these Asian samples was not found. There appears to be a general factor measuring depressed mood across older populations. The results support the validity of comparing responses on the CES-D across cultures.

On Brugia (Brugiella subgen. nov.) buckelyi n.sp., from the heart and blood vessels of the Ceylon hare

1. A new species of Brugia (Brugiella subgen. nov.) buckleyi is described from the heart and blood vessels of the Ceylon Hare (Lepus nigricollis singhala).

2. This worm is much larger than the other species of Brugia. It lacks a distinct head bulb and has a relatively much shorter oesophagus. The vulva in the female is close to the posterior extremity of the oesophagus. In the male the caudal papillae differ in their number and arrangement and the spicule ratio is much smaller.