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Caldera A, Wickremasinghe R, Newby G, Perera R, Mendis K, Fernando D. Initial response to SARS-CoV-2 (COVID-19) outbreak in Sri Lanka; views of public health specialists through an International Health Regulations lens. PLoS One 2023; 18:e0293521. [PMID: 37948434 PMCID: PMC10637679 DOI: 10.1371/journal.pone.0293521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 10/13/2023] [Indexed: 11/12/2023] Open
Abstract
The COVID-19 pandemic affected Sri Lanka despite having developed an International Health Regulations (IHR) steering committee in 2016 and a national action plan for health security following the Joint External Evaluation in 2018. Many steps were taken to improve the disaster management skills of healthcare workers even before the COVID-19 outbreak. We interviewed seven public health specialists to obtain their views on the country's response to the pandemic. A thematic analysis was conducted, leading to the emergence of three major themes and seven subthemes. The major themes included health security preparedness; COVID-19 management; and effects of COVID-19. The subthemes were; preparedness prior to pandemic and gaps in the preparedness (under health security preparedness); dual burden for the curative sector, strategies to reduce transmission and barriers to managing COVID-19 (under COVID-19 management) and negative and positive effects of COVID-19 (under effects of COVID-19). When COVID-19 reached Sri Lanka, healthcare workers, border control authorities and those involved with infectious disease control were overwhelmed by the magnitude of the pandemic. Healthcare workers' hesitation to work amidst the pandemic due to fear of infection and possible transmission of infection to their families was a major issue; the demand for personal protective equipment by health workers when stocks were low was also a contributory factor. Lockdowns with curfew and quarantine at government regulated centers were implemented as necessary. Perceptions of the public including permitting healthcare workers to perform field public health services, logistical barriers and lack of human resources were a few of the barriers that were expressed. Some persons did not declare their symptoms, fearing that they would have to be quarantined. The pandemic severely affected the economy and Sri Lanka relied on donations and loans to overcome the situation. Pandemic also brought about innovative methods to maintain and upgrade health service provision. Individuals with non-communicable diseases received their regular medications through the post which reduced their risk of being infected by visiting hospitals. Improvement of laboratory services and quarantine services, a reduction of acute respiratory infections and diarrhoeal diseases, improved intersectoral coordination and public philanthropic response were other positive effects.
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Affiliation(s)
- Amandhi Caldera
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Gretchen Newby
- Malaria Elimination Initiative, Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States of America
| | - Ruwanthi Perera
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Kamini Mendis
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Deepika Fernando
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Somasundaram D, Jayasuriya R, Perera R, Thamotharampillai U, Wickremasinghe R, Tay AK. Effect of daily stressors and collective efficacy on post-traumatic stress symptoms among internally displaced persons in post-war northern Sri Lanka. BJPsych Open 2023; 9:e180. [PMID: 37818719 PMCID: PMC10594160 DOI: 10.1192/bjo.2023.563] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 08/15/2023] [Accepted: 08/15/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Daily stressors have been shown to mediate the relationship of war trauma and trauma-related distress among refugees and internally displaced persons exposed to war and conflict. AIMS To examine the extent to which the relationship between war-related trauma and mental distress was mediated by daily stressors and collective efficacy among internally displaced communities a decade after exposure to war. METHOD In a cross-sectional study, we recruited a random sample of residents in villages severely affected by conflict in five districts in the Northern Province of Sri Lanka. Measures of war trauma, daily stressors, collective efficacy and post-traumatic stress symptoms (PTSS) were examined. Statistical analyses of the mediating and moderating effects of daily stressors were conducted using regression based methods. RESULTS Daily stressors mediated the association of war trauma and PTSS, as both paths of the indirect effect, war trauma to daily stressors and daily stressors to PTSS, were significant. The predictive effect of war trauma on PTSS was positive and significant at moderate and high levels of daily stressors but not at low levels. Higher levels of neighbourhood informal social control, a component of collective efficacy, function as a protective factor to reduce effects of war trauma and daily stressors on mental distress in this population. CONCLUSIONS Daily stressors are an important mediator in the well-established relationship between war exposure and traumatic stress among internally displaced persons, even a decade after the conflict. Mental health and psychosocial support programmes that aim to address mental distress among war-affected communities could reduce daily stressors and enhance collective efficacy in this context.
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Affiliation(s)
| | - Rohan Jayasuriya
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Ruwanthi Perera
- Department of Rogavijnana, Faculty of Indigenous Medicine, Gampaha Wickramarachchi University of Indigenous Medicine, Yakkala, Sri Lanka
| | | | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Alvin Kuowei Tay
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
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Baminiwatta A, Fernando R, Gadambanathan T, Jiyatha F, Sasala R, Kuruppuarachchi L, Wickremasinghe R, Hapangama A. Measuring Resilience Among Sri Lankan Healthcare Workers: Validation of the Brief Resilience Scale in Sinhalese and Tamil Languages. Indian J Psychol Med 2023; 45:542-543. [PMID: 37772141 PMCID: PMC10523521 DOI: 10.1177/02537176231174185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Affiliation(s)
- Anuradha Baminiwatta
- Dept. of Psychiatry, Faculty of Medicine,
University of Kelaniya, Ragama, Sri Lanka
| | - Roshan Fernando
- Dept. of Psychiatry, Faculty of Medicine,
University of Kelaniya, Ragama, Sri Lanka
| | | | - Fathima Jiyatha
- Dept. of Clinical Science, Faculty of Health
Sciences, Eastern University, Chenkaladi, Sri Lanka
| | - Rashmi Sasala
- Dept. of Psychiatry, Faculty of Medicine,
University of Kelaniya, Ragama, Sri Lanka
| | | | | | - Aruni Hapangama
- Dept. of Psychiatry, Faculty of Medicine,
University of Kelaniya, Ragama, Sri Lanka
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Seneviratne S, Fernando D, Chulasiri P, Gunasekera K, Thenuwara N, Aluthweera C, Wijesundara A, Fernandopulle R, Mendis K, Wickremasinghe R. A malaria death due to an imported Plasmodium falciparum infection in Sri Lanka during the prevention of re-establishment phase of malaria. Malar J 2023; 22:243. [PMID: 37620890 PMCID: PMC10463374 DOI: 10.1186/s12936-023-04681-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/19/2023] [Indexed: 08/26/2023] Open
Abstract
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.
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Affiliation(s)
| | - Deepika Fernando
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
| | | | | | | | | | | | - Rohini Fernandopulle
- Faculty of Medicine, General Sir John Kotelawala Defense University, Ratmalana, Sri Lanka
| | - Kamini Mendis
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Caldera AV, Wickremasinghe R, Munasinghe TU, Perera KMN, Muttiah N, Tilakarathne D, Peiris MKRR, Thamilchelvan E, Sooriyaarachchi C, Nasma MN, Manamperige RM, Ariyasena ADK, Sumanasena SP. Availability of rehabilitation services for communication disorders in Sri Lanka: a cross-sectional survey. BMJ Open 2023; 13:e071620. [PMID: 37041045 PMCID: PMC10106016 DOI: 10.1136/bmjopen-2023-071620] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
OBJECTIVES To describe the rehabilitation services available for communication disorders in Sri Lanka and to estimate the adequacy of the services in provinces and districts of the country. SETTING The study considered government and private institutions, which provide rehabilitation services for communication disorders in Sri Lanka. PARTICIPANTS Institutions providing services of speech-language pathologists, audiologists and audiology technicians in Sri Lanka. PRIMARY AND SECONDARY OUTCOME MEASURES We investigated the number of government hospitals and private institutions, which provide speech-language pathology and audiology services in Sri Lanka as the primary outcome measure. A number of speech-language pathologists, audiologists and audiology technicians working in the institutions were obtained from records and institution-based inquiries to identify the adequacy of the services in the country as the secondary outcome measure. RESULTS Of the 647 government hospitals that provide free healthcare services in the country, 45 and 33 hospitals had speech and language therapy and audiology units, respectively. Government hospitals do not have audiologists but only have audiology technicians. The number of speech and language therapists and audiology technicians in the government sector per 100 000 population in the country was 0.44 and 0.18, respectively. There were wide variations in specialist to population ratio between districts. 77 private centres provide speech therapy services in 15 out of the 25 districts; 36 private centres provide audiological evaluations in 9 districts. CONCLUSIONS The number of specialist speech and language therapists and audiologists is not sufficient to provide adequate rehabilitation services for communications disorder for the Sri Lankan population. Not recruiting audiologists to the government sector affects the management of hearing impairment in the affected.
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Affiliation(s)
- A V Caldera
- Public Health, University of Kelaniya Faculty of Medicine, Ragama, Western Province, Sri Lanka
| | - Rajitha Wickremasinghe
- Public Health, University of Kelaniya Faculty of Medicine, Ragama, Western Province, Sri Lanka
| | - T U Munasinghe
- Public Health, University of Kelaniya Faculty of Medicine, Ragama, Western Province, Sri Lanka
| | - K M N Perera
- Public Health, University of Kelaniya Faculty of Medicine, Ragama, Western Province, Sri Lanka
| | - Nimisha Muttiah
- Department of Disability Studies, University of Kelaniya Faculty of Medicine, Ragama, Western Province, Sri Lanka
| | | | | | - E Thamilchelvan
- Public Health, University of Kelaniya Faculty of Medicine, Ragama, Western Province, Sri Lanka
| | | | - Mohamed Naseem Nasma
- Public Health, University of Kelaniya Faculty of Medicine, Ragama, Western Province, Sri Lanka
| | - R M Manamperige
- Public Health, University of Kelaniya Faculty of Medicine, Ragama, Western Province, Sri Lanka
| | - A D K Ariyasena
- Public Health, University of Kelaniya Faculty of Medicine, Ragama, Western Province, Sri Lanka
| | - Samanmali P Sumanasena
- Department of Disability Studies, University of Kelaniya Faculty of Medicine, Ragama, Western Province, Sri Lanka
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Jude J, Gunathilaka N, Udayanaga L, Fernando D, Premarathne P, Wickremasinghe R, Abeyewickreme W. Biology, bionomics and life-table studies of Anopheles stephensi (Diptera: Culicidae) in Sri Lanka and estimating the vectorial potential using mathematical approximations. Parasitol Int 2023; 93:102715. [PMID: 36470340 DOI: 10.1016/j.parint.2022.102715] [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: 04/22/2022] [Revised: 10/20/2022] [Accepted: 11/29/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Anopheles stephensi is an invasive mosquito in Sri Lanka that can potentially transmit malaria. The transmission intensity is linked with biology, bionomic and behavioral aspects of a vector that are associated with the Vectorial Capacity (VC). However, the influence of larval conditions eventually affects the vectorial potential of An. stephensi are not well understood. METHODS A colony of An. stephensi was established at the Regional Centre of the Open University of Sri Lanka, Jaffna District. The colony was maintained under confined conditions according to standard protocols. Biotypes of An. stephensi were characterized by referring to the number of egg ridges. Information on (a) biological aspects of eggs (duration for egg hatching, egg development and hatchability), (b) larval development time, larval survivorship pupation success, resting depth of larvae), (c) pupae (adult emergence rate, average time for adult emergence) and (d) adults (biting frequency, mating success gonotrophic cycle, fecundity, duration for egg-laying, percentage of sexes, adult survival/longevity) were evaluated under life-table analysis. Further, selected morphometric characters of each life cycle stage were recorded from the eggs (length and breadth), larvae (head length, width of head, length of thorax, width of thorax, length of abdomen, width of abdomen, and the total length of larvae), pupae (cephalothoracic length and width) and adults (length & width of wing, thorax and abdomen). The VC was calculated using a mathematical-based approach. Descriptive statistics, General Linear Model (GLM) and independent-sample t-test were used for the statistical analysis. RESULTS All three biotypes were identified based on egg morphology. Mysorensis biotype (47%; n = 470) was predominant followed by type (38.1%; n = 381) and intermediate (14.9%; n = 149). The mean egg length (F(2,997) = 3.56; P = 0.029) and breadth (F(2,997) = 4.57; P = 0.011) denoted significant differences among the three biotypes. The mating success of females observed was 80.7 ± 4.45%. The mean hatching period was 1.9 ± 0.03 days, with a hatching rate of 86.2 ± 0.77%. Overall, 8.0 ± 0.14 days were required for larval development and 30.3 ± 0.14 h were spent in the pupal stage. The pupation success was 94.5 ± 0.37%, and the majority were males (53.1 ± 0.73%). The mean fecundity was 106.5 ± 6.38 eggs and a gonotrophic cycle of 3.4 ± 0.06 days. The female survival rate was 43.2 ± 2.4%, with a mean biting frequency of 66.6 ± 3.5%. The average VC of adult An. stephensi was estimated to be 18.7. CONCLUSIONS The type biotype, which is an effective vector in the Indian subcontinent is present in Sri Lanka. According to the mathematical approximation, An. stephensi found locally has a vectorial capacity of over 18. Therefore, this study warrants the health authorities and vector control programmes to continue the entomological surveys, monitoring of vector densities and implementing appropriate vector control interventions based on biology and bionomic information of vectors.
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Affiliation(s)
- Justin Jude
- Department of Parasitology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka; Deparment of Zoology, Faculty of Natural Sciences, Open University, Nawala, Nugegoda, Sri Lanka.
| | - Nayana Gunathilaka
- Department of Parasitology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
| | - Lahiru Udayanaga
- Department of Biosystems Engineering, Faculty of Agriculture & Plantation Management, Wayamba University of Sri Lanka, Makadura, Sri Lanka
| | - Deepika Fernando
- Department of Parasitology, Faculty of Medicine, University of Colombo, Sri Lanka.
| | - Prasad Premarathne
- Department of Paraclinical Sciences, Faculty of Medicine, Kotelawala Defence University, Rathmalana, Sri Lanka.
| | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Wimaladharma Abeyewickreme
- Department of Parasitology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka; Department of Paraclinical Sciences, Faculty of Medicine, Kotelawala Defence University, Rathmalana, Sri Lanka
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Dabare P, Wickramasinghe P, Waidyatilaka I, Devi S, Kurpad AV, Samaranayake D, de Lanerolle-Dias M, Wickremasinghe R, Hills AP, Lanerolle P. Prediction Equation for Physical Activity Energy Expenditure in 11-13-Year-Old Sri Lankan Children. Nutrients 2023; 15:nu15040906. [PMID: 36839264 PMCID: PMC9965962 DOI: 10.3390/nu15040906] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/28/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023] Open
Abstract
This study aimed to develop a regression equation to predict physical activity energy expenditure (PAEE) using accelerometry. Children aged 11-13 years were recruited and randomly assigned to validation (n = 54) and cross-validation (n = 25) groups. The doubly labelled water (DLW) technique was used to assess energy expenditure and accelerometers were worn by participants across the same period. A preliminary equation was developed using stepwise multiple regression analysis with sex, height, weight, body mass index, fat-free mass, fat mass and counts per minute (CPM) as independent variables. Goodness-of-fit statistics were used to select the best prediction variables. The PRESS (predicted residual error sum of squares) statistical method was used to validate the final prediction equation. The preliminary equation was cross-validated on an independent group and no significant (p > 0.05) difference was observed in the PAEE estimated from the two methods. Independent variables of the final prediction equation (PAEE = [0.001CPM] - 0.112) accounted for 70.6% of the variance. The new equation developed to predict PAEE from accelerometry was found to be valid for use in Sri Lankan children.
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Affiliation(s)
- Prasangi Dabare
- Department of Physiotherapy, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Dehiwala-Mount Lavinia 10390, Sri Lanka
| | - Pujitha Wickramasinghe
- Department of Pediatrics, Faculty of Medicine, University of Colombo, Colombo 00800, Sri Lanka
| | - Indu Waidyatilaka
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Colombo, Colombo 00800, Sri Lanka
| | - Sarita Devi
- Division of Nutrition, St. John’s Research Institute, Sarjapur Road, Bengaluru 560034, India
| | - Anura V. Kurpad
- Department of Physiology, St. John’s Medical College, Sarjapur Road, Bengaluru 560034, India
| | - Dulani Samaranayake
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo 00800, Sri Lanka
| | - Maduka de Lanerolle-Dias
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Colombo, Colombo 00800, Sri Lanka
| | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya 11010, Sri Lanka
| | - Andrew P. Hills
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Hobart, TAS 7005, Australia
- Correspondence:
| | - Pulani Lanerolle
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Colombo, Colombo 00800, Sri Lanka
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Pilapitiya S, Jayasinghe S, Silva A, Wickremasinghe R, Paranagama P, De Silva J, Lekamwasam S, Kularatne SAM, Wanigasuriya K, Kaluthota S, Sumathipala S, Rathnnasooriya C, Siribaddana S. Approach to Study the Efficacy and Safety of New Complementary and Alternative Medicine Formulations: Lesson during COVID-19 from Sri Lanka. WHO South East Asia J Public Health 2023; 12:57-62. [PMID: 37843182 DOI: 10.4103/who-seajph.who-seajph_67_22] [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] [Indexed: 10/17/2023]
Abstract
COVID-19 affected Sri Lanka from early 2020, a time of considerable ignorance accompanied by wide media coverage of a devastating epidemic in Italy and Europe. Many were attracted to complementary and alternative medicine (CAM) or traditional medicine (TM) in this desperate situation. Several preparations were claimed to be effective against COVID-19 globally. Dammika Bandara Syrup© was one such preparation promoted for preventing and treating SARS-CoV-2 infection. It was based on bees' honey, pericarp and mace of Myristica fragrans (nutmeg), the seed of Foeniculum vulgare and fresh rhizome of Zingiber officinale, all believed to have anti-viral properties. Following an unpublished clinical study claiming efficacy, Dammika Bandara Syrup© gained wide media publicity and political patronage. The producer claimed of Goddess Kali revealing the formula added an anthropological, cultural, and religious complexity to the issue. The demand for the product increased rapidly as a debate raged both in public and in the parliament on utilizing such products in combating COVID-19. The Department of Ayurveda, which is statutorily responsible for regulating CAM/TM had to respond to the situation. The legislation to regulate such indigenous medicinal products was weak, and the crisis deepened as thousands converged to the production facility, defying mobility restrictions introduced to control COVID-19. This led to the Ministry of Health requesting academics to form a team and conduct a clinical trial to prove its efficacy. This paper outlines the process and issues faced during the regulatory approval for the trial in a polarized political environment. Some health professionals accused the researchers of bowing to political pressure and questioned the scientific justification for the trial. However, the team considered this as an opportunity to streamline a path for research into CAM/TM therapies in situations such as COVID-19. Several processes were identified and addressed, such as the provisional registration of CAM preparations, assessing the potential efficacy of a CAM product, confirmation of authenticity and safety, standardization and supervision of production respecting cultural identities, obtaining approval for human use, choice of comparators, and ethical issues. We believe the study has helped set standards and a benchmark for CAM and TM research in Sri Lanka.
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Affiliation(s)
- Senaka Pilapitiya
- Department of Medicine, Rajarata University of Sri Lanka, Mihintale, Anuradhapura, Sri Lanka
| | - Saroj Jayasinghe
- Department of Clinical Medicine, University of Colombo; Department of Medicine, Sabaragamuwa University of Sri Lanka, Colombo, Sri Lanka
| | - Anjana Silva
- Department of Parasitology, Rajarata University of Sri Lanka, Mihintale, Anuradhapura, Sri Lanka
| | | | - Priyani Paranagama
- Department of Chemistry University of Kelaniya; Director, Institute of Indigenous Medicine, University of Colombo, Kelaniya, Anuradhapura, Sri Lanka
| | - Janaka De Silva
- Department of Medicine University of Kelaniya, Kelaniya, Anuradhapura, Sri Lanka
| | | | - S A M Kularatne
- Department of Medicine University of Peradeniya, Peradeniya, Sri Lanka
| | | | - Swarna Kaluthota
- Acting Director, Bandaranaike Memorial Ayurveda Research Institute, Nawinna, Sri Lanka
| | | | - Chinthaka Rathnnasooriya
- Methsiri Sewana COVID-19 Tertiary Care Centre; Teaching Hospital Anuradhapura, Anuradhapura, Sri Lanka
| | - Sisira Siribaddana
- Department of Medicine, Rajarata University of Sri Lanka, Mihintale, Anuradhapura, Sri Lanka
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Perera R, Wickremasinghe R, Newby G, Caldera A, Fernando D, Mendis K. Malaria Control, Elimination, and Prevention as Components of Health Security: A Review. Am J Trop Med Hyg 2022; 107:747-753. [PMID: 36067989 DOI: 10.4269/ajtmh.22-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/23/2022] [Indexed: 11/07/2022] Open
Abstract
International travel, a major risk factor for imported malaria, has emerged as an important challenge in sustaining malaria elimination and prevention of its reestablishment. To make travel and trade safe, the WHO adopted the International Health Regulations (IHR) which provides a legal framework for the prevention, detection, and containment of public health risks at source. We conducted a systematic review to assess the relevance and the extent of implementation of IHR practices that can play a role in reducing malaria transmission. Selected studies addressed control, elimination, and prevention of reestablishment of malaria. Study themes focused on appraisal of surveillance and response, updating national policies to facilitate malaria control and elimination, travel as a risk factor for malaria and risk mitigation methods, vector control, transfusion malaria, competing interests, malaria in border areas, and other challenges posed by emerging communicable diseases on malaria control and elimination efforts. Review results indicate that malaria has not been prioritized as part of the IHR nor has the IHR focused on vector-borne diseases such as malaria. The IHR framework in its current format can be applied to malaria and other vector-borne diseases to strengthen surveillance and response, overcome challenges at borders, and improve data sharing-especially among countries moving toward elimination-but additional guidelines are required. Application of the IHR in countries in the malaria control phase may not be effective until the disease burden is brought down to elimination levels. Considering existing global elimination goals, the application of IHR for malaria should be urgently reviewed and included as part of the IHR.
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Affiliation(s)
- Ruwanthi Perera
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Gretchen Newby
- Malaria Elimination Initiative, Institute for Global Health Sciences, University of California-San Francisco, San Francisco, California
| | - Amandhi Caldera
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Deepika Fernando
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Kamini Mendis
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Athauda L, Peiris‐John R, McCool J, Wickremasinghe R, Ameratunga S. The alcohol marketing policy environment and adolescent drinking in Sri Lanka: A qualitative exploration of stakeholder perspectives. World Med & Health Policy 2022. [DOI: 10.1002/wmh3.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Lathika Athauda
- School of Population Health University of Auckland Auckland New Zealand
- Department of Public Health, Faculty of Medicine University of Kelaniya Colombo Sri Lanka
| | | | - Judith McCool
- School of Population Health University of Auckland Auckland New Zealand
| | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine University of Kelaniya Colombo Sri Lanka
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Mendis K, Wickremasinghe R, Premaratne R. Malaria elimination does not cost more than malaria control: Sri Lanka a case in point. Malar J 2022; 21:231. [PMID: 35915503 PMCID: PMC9344692 DOI: 10.1186/s12936-022-04249-9] [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: 05/26/2022] [Accepted: 07/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background Malaria was endemic in Sri Lanka for centuries and was eliminated in 2012. It is widely assumed that the costs of elimination are generally greater than that of control. The costs of malaria elimination in Sri Lanka with that of malaria control in the past using periods in which starting transmission dynamics were similar were compared. Methods The expenditure of the Anti-Malaria Campaign (AMC), total and by budget category, during 2002–2010 is compared with that of malaria control during the period 1980–1989, using regression analyses and the Mann Whitney U statistic. Results The expenditure on malaria control and malaria elimination was similar ranging from 21 to 45 million USD per year when adjusted for inflation. In both periods, external funding for the malaria progamme constituted around 24% of the total budget; during the control phase in the 1980s, external funds came from bilateral agencies and were disbursed in accordance with government budget guidelines. In the elimination phase in the 2000s, most of external funding was from the Global Fund and had flexibility of disbursement. In the 1980s, most funds were expended on commodities—insecticides, diagnostics and medicines and their delivery; in the elimination phase, they were spent on programme management, human resources, technical assistance and monitoring and evaluation; monitoring and evaluation was not a budget line in the 1980s. Although the cost per case of malaria was considerably higher during the elimination phase than in the control phase, expenditure was not on individual cases but on general systems strengthening. Conclusion Malaria elimination in Southeast Asia may not require more funding than malaria control. But sustained funding for an agile programme with flexibility in fund utilization and improved efficiencies in programme management with stringent monitoring and evaluation appears to be critically important.
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Affiliation(s)
- Kamini Mendis
- Department of Parasitology, Faculty of Medicine, University of Colombo, 25 Kynsey Road, Colombo, Sri Lanka
| | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, P.O. Box 6, Thalagolla Road, Ragama, 11010, Sri Lanka.
| | - Risintha Premaratne
- Anti Malaria Campaign, 555/5 Public Health Building, Narahenpita, Sri Lanka.,World Health Organization Regional Office for South East Asia, New Delhi, India
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Hapangama A, Premaratne I, Thilaxshan T, Gadambanathan T, Wickremasinghe R. Cross-cultural adaptation and validation of the Liebowitz Social Anxiety Scale (LSAS-SR) Tamil Version. Ceylon Med J 2022; 67:5-10. [PMID: 37607887 DOI: 10.4038/cmj.v67i1.9552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Background Despite being the third most prevalent psychiatric disorder, social anxiety disorder remains under-diagnosed due to multiple reasons. Although many screening instruments are available in the English language, to date no instrument has been translated into Tamil. Objective To translate and validate the Liebowitz Social Anxiety Scale (LSAS-SR) into Tamil among a group of Sri Lankan university students whose mother tongue is Tamil. Method The process of translation and validation involved standard procedures. DSM- 5 was used as the gold standard to diagnose social anxiety disorder. As part of the psychometric study, test-retest reliability and analysis of items for internal consistency of the instrument were assessed. Results A cut off of55.5had the optimum sensitivity and specificity for the Tamil version of the LSAS-SR. The Cronbach's alpha between the avoidance subscale, total and the fear subscale total was 0.860 while the figures for Cronbach's alpha between the total score and fear subscale total score and the avoidance subscale total score were 0.880 and 0.855, respectively. The test- retest reliability correlation coefficients for the fear subscale, avoidance subscale and the total score were 0.890, 0.925 and 0.918, respectively (p<0.001 for all). Conclusions The cut off score of 55.5had the optimum sensitivity and specificity for the LSAS-SR Tamil version. It had good internal consistency and test-retest reliability. Further studies will enable the assessment of the prevalence of social phobia and investigation of cultural and environmental factors associated with social phobia in Sri Lanka.
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Affiliation(s)
- Aruni Hapangama
- Department of Psychiatry, Faculty of Medicine, University of Kelaniya, Sri Lanka,
| | - Imalsha Premaratne
- Department of Psychiatry, Faculty of Medicine, University of Kelaniya, Sri Lanka,
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Jayasena Kaluarachchi TD, Campbell PM, Wickremasinghe R, Ranasinghe S, Wickremasinghe R, Yasawardene S, De Silva H, Menike C, Jayarathne MCK, Jayathilake S, Dilhari A, McBain AJ, Weerasekera MM. Distinct microbiome profiles and biofilms in Leishmania donovani-driven cutaneous leishmaniasis wounds. Sci Rep 2021; 11:23181. [PMID: 34848752 PMCID: PMC8633208 DOI: 10.1038/s41598-021-02388-8] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/15/2021] [Indexed: 11/09/2022] Open
Abstract
The endemic strain of Leishmania donovani in Sri Lanka causes cutaneous leishmaniasis (CL) rather than more common visceral form. We have visualized biofilms and profiled the microbiome of lesions and unaffected skin in thirty-nine CL patients. Twenty-four lesions (61.5%) were biofilm-positive according to fluorescence in situ hybridization. Biopsies of biofilm-positive lesions were dominated by Pseudomonas, class Bacilli and Enterobacteriaceae and distinguished by significantly lower community evenness. Higher relative abundance of a class Bacilli OTU was detected in wound swabs versus contralateral skin. Wound swabs and biopsies had significantly distinct microbiome profiles and lower diversity compared to unaffected skin. Greater abundances of potentially pathogenic organisms were observed in wet ulcers, lesions with high parasite loads and large wounds. In summary, more than half of L. donovani associated CL wounds harboured biofilms and the wounds exhibited a distinct, less diverse, microbiome than unaffected skin.
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Affiliation(s)
- T D Jayasena Kaluarachchi
- Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka.
| | - Paul M Campbell
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Shalindra Ranasinghe
- Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Renu Wickremasinghe
- Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Surangi Yasawardene
- Department of Anatomy, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | | | - Chandrani Menike
- Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - M C K Jayarathne
- Department of Family Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Subodha Jayathilake
- Department of Pathology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Ayomi Dilhari
- Department of Basic Sciences, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Andrew J McBain
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Manjula M Weerasekera
- Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
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14
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Muilwijk M, Loh M, Siddiqui S, Mahmood S, Palaniswamy S, Shahzad K, Athauda LK, Jayawardena R, Batool T, Burney S, Glover M, Bamunuarachchi V, Panda M, Madawanarachchi M, Rai B, Sattar I, Silva W, Waghdhare S, Jarvelin MR, Rannan-Eliya RP, Wijemunige N, Gage HM, Valabhji J, Frost GS, Wickremasinghe R, Kasturiratne A, Khawaja KI, Ahmad S, van Valkengoed IG, Katulanda P, Jha S, Kooner JS, Chambers JC. Effects of a lifestyle intervention programme after 1 year of follow-up among South Asians at high risk of type 2 diabetes: a cluster randomised controlled trial. BMJ Glob Health 2021; 6:e006479. [PMID: 34725039 PMCID: PMC8562508 DOI: 10.1136/bmjgh-2021-006479] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/30/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION South Asians are at high risk of type 2 diabetes (T2D). We assessed whether intensive family-based lifestyle intervention leads to significant weight loss, improved glycaemia and blood pressure in adults at elevated risk for T2D. METHODS This cluster randomised controlled trial (iHealth-T2D) was conducted at 120 locations across India, Pakistan, Sri Lanka and the UK. We included 3684 South Asian men and women, aged 40-70 years, without T2D but with raised haemoglobin A1c (HbA1c) and/or waist circumference. Participants were randomly allocated either to the family-based lifestyle intervention or control group by location clusters. Participants in the intervention received 9 visits and 13 telephone contacts by community health workers over 1-year period, and the control group received usual care. Reductions in weight (aim >7% reduction), waist circumference (aim ≥5 cm reduction), blood pressure and HbA1C at 12 months of follow-up were assessed. Our linear mixed-effects regression analysis was based on intention-to-treat principle and adjusted for age, sex and baseline values. RESULTS There were 1846 participants in the control and 1838 in the intervention group. Between baseline and 12 months, mean weight of participants in the intervention group reduced by 1.8 kg compared with 0.4 kg in the control group (adjusted mean difference -1.10 kg (95% CI -1.70 to -1.06), p<0.001). The adjusted mean difference for waist circumference was -1.9 cm (95% CI -2.5; to 1.3), p<0.001). No overall difference was observed for blood pressure or HbA1c. People who attended multiple intervention sessions had a dose-dependent effect on waist circumference, blood pressure and HbA1c, but not on weight. CONCLUSION An intensive family-based lifestyle intervention adopting low-resource strategies led to effective reduction in weight and waist circumference at 12 months, which has potential long-term benefits for preventing T2D. A higher number of attended sessions increased the effect on waist circumference, blood pressure and HbA1c. TRIAL REGISTRATION NUMBER EudraCT: 2016-001350-18; ClinicalTrials.gov: NCT02949739.
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Affiliation(s)
- Mirthe Muilwijk
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Marie Loh
- Lee Kon Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Samreen Siddiqui
- Institute of Endocrinology Diabetes and Metabolism, Max Healthcare, New Delhi, Delhi, India
| | - Sara Mahmood
- Department of Endocrinology & Metabolism, Services Institute of Medical Sciences, Lahore, Punjab, Pakistan
| | - Saranya Palaniswamy
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | | | - Lathika K Athauda
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Ranil Jayawardena
- Department of Physiology, Faculty of Medicine, University of Colombo, Colombo, Western, Sri Lanka
| | - Tayyaba Batool
- Department of Endocrinology and Metabolism, Services Institute of Medical Sciences, Lahore, Punjab, Pakistan
| | - Saira Burney
- Department of Endocrinology & Metabolism, Services Institute of Medical Sciences, Lahore, Punjab, Pakistan
| | - Matthew Glover
- School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | - Vodathi Bamunuarachchi
- Diabetes Research Unit, Faculty of Medicine, University of Colombo, Colombo, Western, Sri Lanka
| | - Manju Panda
- Institute of Endocrinology Diabetes and Metabolism, Max Healthcare, New Delhi, Delhi, India
| | - Madawa Madawanarachchi
- Diabetes Research Unit, Faculty of Medicine, University of Colombo, Colombo, Western, Sri Lanka
| | - Baldeesh Rai
- School of Public Health, Imperial College London, London, UK
| | - Iqra Sattar
- Punjab Institute of Cardiology, Lahore, Punjab, Pakistan
| | - Wnurinham Silva
- School of Public Health, Imperial College London, London, UK
| | - Swati Waghdhare
- Institute of Endocrinology Diabetes and Metabolism, Max Healthcare, New Delhi, Delhi, India
| | - Marjo-Riitta Jarvelin
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
- School of Public Health, Imperial College London, London, UK
- Department of Life Sciences, College of Health and Life Sciences, Brunel University, London, UK
- Unit of Primary Care, Oulu University Hospital, Oulu, Finland
| | | | | | - Heather M Gage
- Surrey Health Economics Centre, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, Surrey, UK
| | - Jonathan Valabhji
- Department of Diabetes and Endocrinology, Imperial College London, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Gary S Frost
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Anuradhani Kasturiratne
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Khadija I Khawaja
- Department of Endocrinology & Metabolism, Services Institute of Medical Sciences, Lahore, Punjab, Pakistan
| | - Sajjad Ahmad
- Punjab Institute of Cardiology, Lahore, Punjab, Pakistan
| | - Irene Gm van Valkengoed
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Prasad Katulanda
- Department of Clinical Medicine, University of Colombo, Colombo, Sri Lanka
| | - Sujeet Jha
- Institute of Endocrinology Diabetes and Metabolism, Max Healthcare, New Delhi, Delhi, India
| | - Jaspal S Kooner
- London North West University Healthcare NHS Trust, Harrow, London, UK
- National Heart & Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - John C Chambers
- Lee Kon Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
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15
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Dharmawardena P, Premaratne R, Wickremasinghe R, Mendis K, Fernando D. Epidemiological profile of imported malaria cases in the prevention of reestablishment phase in Sri Lanka. Pathog Glob Health 2021; 116:38-46. [PMID: 34263705 DOI: 10.1080/20477724.2021.1951556] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Sri Lanka reported the last case of indigenous malaria in October 2012, and received malaria-free certification from WHO in September 2016. Malaria cases have since, shifted from indigenous to imported, and the country remains receptive and vulnerable to malaria. A case-based epidemiological study was conducted on all imported malaria cases reported in the country in 2015 and 2016 with the aim of profiling imported malaria to improve the effectiveness of the surveillance and case management system for malaria. Data were obtained from case reports of the Anti Malaria Campaign, hospital records and laboratory registers. Over the 2 years, 77 imported malaria infections were diagnosed in 54 Sri Lankans and 23 foreign nationals. A majority of the infections were reported among males (93%) in the age group of 21-50 years (85.8%), and all were recent travelers overseas. Most patients were detected by passive case detection, but 10% of cases were detected by Active Case Detection. Only 25% of patients were diagnosed within 3 days of the onset of symptoms. In 32% of patients, the diagnosis was delayed by more than 10 days after the onset of symptoms. Plasmodium falciparum infections manifested significantly earlier after arrival in Sri Lanka than did P.vivax infections. The majority of patients (74%) were diagnosed in the Western Province, which was not endemic for malaria. A third of patients were diagnosed in the private sector. The shift in the epidemiology of malaria infection from before to after elimination has implications for preventing the reestablishment of malaria.
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Affiliation(s)
- Priyani Dharmawardena
- Regional Malaria Officer, Provincial Directorate of Health Services Ministry of Health Anti Malaria Campaign, Sri Lanka, Colombo, Sri Lanka
| | - Risintha Premaratne
- Department of Communicable Diseases, World Health Organization Regional Office for South-East Asia, New Delhi, India
| | - Rajitha Wickremasinghe
- Professor of Public Health Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Kamini Mendis
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo 5, Sri Lanka
| | - Deepika Fernando
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo 5, Sri Lanka
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16
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Jayasena Kaluarachchi T, Wickremasinghe R, Weerasekera M, Yasawardene S, McBain AJ, Yapa B, De Silva H, Menike C, Jayathilake S, Munasinghe A, Wickremasinghe R, Ranasinghe S. Diagnosing human cutaneous leishmaniasis using fluorescence in situ hybridization. Pathog Glob Health 2021; 115:307-314. [PMID: 33686909 PMCID: PMC8547812 DOI: 10.1080/20477724.2021.1896265] [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] [Indexed: 10/22/2022] Open
Abstract
Cutaneous leishmaniasis (CL) is endemic in Sri Lanka. Giemsa-stained slit-skin-smears (SSS-Giemsa) and histology are routinely used in diagnosis with a sensitivity of 40-70%. PCR currently has limited accessibility. Therefore, we assessed the sensitivity and specificity of a previously described fluorescence in situ hybridization assay, on skin smears and biopsy samples to overcome the limitations encountered with routine diagnostic methods.Samples from a total of 123 suspected CL patients were collected and subjected to SSS-Giemsa, fluorescence in situ hybridization (FISH) on slit skin smears (SSS-FISH), formalin-fixed-paraffin-embedded-tissues stained with Hematoxylin & Eosin staining (FFPE-H&E) and FISH on formalin-fixed-paraffin-embedded-tissues (FFPE-FISH). Negative controls of 61 patient samples were collected from a CL non-endemic area and subjected to the same procedures. The gold standard PCR was used as a comparator. For FISH, two previously described cyanine 3 tagged Leihsmania genus-specific probes were used.Compared to PCR, SSS-Giemsa, SSS-FISH, FFPE-H&E, and FFPE-FISH had sensitivities of 76.5%, 79.1%, 50.4% and 80.9%, respectively. Routine diagnostic tests (SSS-Giemsa and FFPE-H&E) had a specificity of 100%. SSS-FISH and FFPE-FISH had specificities of 96.7% and 93.4%, respectively. FFPE-FISH had a statistically significant higher diagnostic performance than FFPE-H&E (p < 0.001). The relative performance of SSS-Giemsa, SSS-FISH and FFPE-FISH was similar (p > 0.05 for all comparisons).We conclude that FFPE-FISH is a more accurate diagnostic tool than FFPE-H&E. SSS-FISH did not have an additional advantage over SSS-Giemsa in diagnosis. However, SSS-FISH could be recommended as a minimally invasive method in studies assessing wound healing where immunological probes are used.
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Affiliation(s)
- Thilini Jayasena Kaluarachchi
- Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | | | - Manjula Weerasekera
- Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Surangi Yasawardene
- Department of Anatomy, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Andrew J McBain
- Division of Pharmacy & Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, UK
| | - Bandujith Yapa
- Dermatology Unit, District General Hospital, Matara, Sri Lanka
| | | | - Chandranie Menike
- Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Subodha Jayathilake
- Department of Pathology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Anuradha Munasinghe
- Department of Transport and Logistics Management, University of Moratuwa, Katubedda, Moratuwa, Sri Lanka
| | - Renu Wickremasinghe
- Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Shalindra Ranasinghe
- Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
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Gunasekera WMKTDAW, Premaratne R, Fernando D, Munaz M, Piyasena MGY, Perera D, Wickremasinghe R, Ranaweera KDNP, Mendis K. A comparative analysis of the outcome of malaria case surveillance strategies in Sri Lanka in the prevention of re-establishment phase. Malar J 2021; 20:80. [PMID: 33563273 PMCID: PMC7871399 DOI: 10.1186/s12936-021-03621-5] [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: 12/10/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 11/30/2022] Open
Abstract
Background Sri Lanka sustained its malaria-free status by implementing, among other interventions, three core case detection strategies namely Passive Case Detection (PCD), Reactive Case Detection (RACD) and Proactive Case Detection (PACD). The outcomes of these strategies were analysed in terms of their effectiveness in detecting malaria infections for the period from 2017 to 2019. Methods Comparisons were made between the surveillance methods and between years, based on data obtained from the national malaria database and individual case reports of malaria patients. The number of blood smears examined microscopically was used as the measure of the volume of tests conducted. The yield from each case detection method was calculated as the proportion of blood smears which were positive for malaria. Within RACD and PACD, the yield of sub categories of travel cohorts and spatial cohorts was ascertained for 2019. Results A total of 158 malaria cases were reported in 2017–2019. During this period between 666,325 and 725,149 blood smears were examined annually. PCD detected 95.6 %, with a yield of 16.1 cases per 100,000 blood smears examined. RACD and PACD produced a yield of 11.2 and 0.3, respectively. The yield of screening the sub category of travel cohorts was very high for RACD and PACD being 806.5 and 44.9 malaria cases per 100,000 smears, respectively. Despite over half of the blood smears examined being obtained by screening spatial cohorts within RACD and PACD, the yield of both was zero over all three years. Conclusions The PCD arm of case surveillance is the most effective and, therefore, has to continue and be further strengthened as the mainstay of malaria surveillance. Focus on travel cohorts within RACD and PACD should be even greater. Screening of spatial cohorts, on a routine basis and solely because people are resident in previously malarious areas, may be wasteful, except in situations where the risk of local transmission is very high, or is imminent. These findings may apply more broadly to most countries in the post-elimination phase.
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Affiliation(s)
| | - Risintha Premaratne
- World Health Organization Regional Office for South-East Asia, New Delhi, India
| | - Deepika Fernando
- Department of Parasitology, Faculty of Medicine, University of Colombo, 25 Kynsey Road, Colombo, Sri Lanka
| | - Muzrif Munaz
- Anti Malaria Campaign, 555/5 Public Health Building, Narahenpita, Sri Lanka
| | - M G Y Piyasena
- Anti Malaria Campaign, 555/5 Public Health Building, Narahenpita, Sri Lanka
| | - Devika Perera
- Anti Malaria Campaign, 555/5 Public Health Building, Narahenpita, Sri Lanka
| | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, P.O. Box 6, Thalagolla Road, 11010, Ragama, Sri Lanka
| | | | - Kamini Mendis
- Department of Parasitology, Faculty of Medicine, University of Colombo, 25 Kynsey Road, Colombo, Sri Lanka.
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Datta R, Mendis K, Wickremasinghe R, Premaratne R, Fernando D, Parry J, Rolfe B. Role of a dedicated support group in retaining Sri Lanka's malaria-free status. J Vector Borne Dis 2021. [DOI: 10.4103/0972-9062.311783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ranaweera P, Wickremasinghe R, Mendis K. Preventing the re-establishment of malaria in Sri Lanka amidst the COVID-19 pandemic. Malar J 2020; 19:386. [PMID: 33138814 PMCID: PMC7605332 DOI: 10.1186/s12936-020-03465-5] [Citation(s) in RCA: 8] [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: 09/23/2020] [Accepted: 10/26/2020] [Indexed: 11/15/2022] Open
Abstract
The COVID-19 pandemic has had a considerable impact on other health programmes in countries, including on malaria, and is currently under much discussion. As many countries are accelerating efforts to eliminate malaria or to prevent the re-establishment of malaria from recently eliminated countries, the COVID-19 pandemic has the potential to cause major interruptions to ongoing anti-malaria operations and risk jeopardizing the gains that have been made so far. Sri Lanka, having eliminated malaria in 2012, was certified by the World Health Organization as a malaria-free country in 2016 and now implements a rigorous programme to prevent its re-establishment owing to the high receptivity and vulnerability of the country to malaria. Sri Lanka has also dealt with the COVID-19 epidemic quite successfully limiting the cumulative number of infections and deaths through co-ordinated efforts between the health sector and other relevant sectors, namely the military, the Police Department, Departments of Airport and Aviation and Foreign Affairs, all of which have been deployed for the COVID-19 epidemic under the umbrella of a Presidential Task Force. The relevance of imported infections and the need for a multi-sectoral response are features common to both the control of the COVID-19 epidemic and the Prevention of Re-establishment (POR) programme for malaria. Sri Lanka’s malaria POR programme has, therefore, creatively integrated its activities with those of the COVID-19 control programme. Through highly coordinated operations the return to the country of Sri Lankan nationals stranded overseas by the COVID-19 pandemic, many from malaria endemic countries, are being monitored for malaria as well as COVID-19 in an integrated case surveillance system under quarantine conditions, to the success of both programmes. Twenty-three imported malaria cases were detected from February to October through 2773 microscopic blood examinations performed for malaria in quarantine centres, this number being not much different to the incidence of imported malaria during the same period last year. This experience highlights the importance of integrated case surveillance and the need for a highly coordinated multi-sectoral approach in dealing with emerging new infections. It also suggests that synergies between the COVID-19 epidemic control programme and other health programmes may be found and developed to the advantage of both.
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Affiliation(s)
- Prasad Ranaweera
- Anti Malaria Campaign, 555/5 Public Health Building, Narahenpita, Colombo, Sri Lanka
| | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Thalagolla Road, P.O. Box 6, Ragama, 11010, Sri Lanka
| | - Kamini Mendis
- Faculty of Medicine, University of Colombo, Kynsey Road, Colombo, Sri Lanka.
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Marasinghe MM, Karunasena VM, Seneratne AS, Herath HDB, Fernando D, Wickremasinghe R, Mendis KN, Ranaweera D. Mass radical treatment of a group of foreign workers to mitigate the risk of re-establishment of malaria in Sri Lanka. Malar J 2020; 19:346. [PMID: 32977809 PMCID: PMC7517794 DOI: 10.1186/s12936-020-03419-x] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 09/17/2020] [Indexed: 11/29/2022] Open
Abstract
Background Following malaria elimination, Sri Lanka was free from indigenous transmission for six consecutive years, until the first introduced case was reported in December 2018. The source of transmission (index case) was a member of a group of 32 migrant workers from India and the location of transmission was their residence reporting a high prevalence of the primary vector for malaria. Despite extensive vector control the situation was highly susceptible to onward transmission if another of the group developed malaria. Therefore, Mass Radical Treatment (MRT) of the group of workers for Plasmodium vivax malaria was undertaken to mitigate this risk. Method The workers were screened for malaria by microscopy and RDT, their haemoglobin level assessed, and tested for Glucose 6 phosphate dehydrogenase deficiency (G6PD) using the Care Start RDT and Brewers test prior to treatment with chloroquine (CQ) 25 mg/kg body weight (over three days) and primaquine (PQ) (0.25 mg/kg/day bodyweight for 14 days) following informed consent. All were monitored for adverse events. Results None of the foreign workers were parasitaemic at baseline screening and their haemoglobin levels ranged from 9.7–14.7 g/dl. All 31 individuals (excluding the index case treated previously) were treated with the recommended dose of CQ. The G6PD test results were inconclusive in 45% of the RDT results and were discrepant between the two tests in 31% of the remaining test events. Seven workers who tested G6PD deficient in either test were excluded from PQ and the rest, 24 workers, received PQ. No serious adverse events occurred. Conclusions Mass treatment may be an option in prevention of reintroduction settings for groups of migrants who are likely to be carrying latent malaria infections, and resident in areas of high receptivity. However, in the case of Plasmodium vivax and Plasmodium ovale, a more reliable and affordable point-of-care test for G6PD activity would be required. Most countries which are eliminating malaria now are in the tropical zone and face considerable and similar risks of malaria re-introduction due to massive labour migration between them and neighbouring countries. Regional elimination of malaria should be the focus of global strategy if malaria elimination from countries is to be worthwhile and sustainable.
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Affiliation(s)
| | | | | | | | - Deepika Fernando
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
| | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka
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Athauda LK, Peiris-John R, Ameratunga S, McCool J, Wickremasinghe R. Factors Influencing Alcohol Use Among Adolescents in South Asia: A Systematic Review. J Stud Alcohol Drugs 2020; 81:529-542. [PMID: 33028463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Abstract
OBJECTIVE Alcohol is the leading cause of disability-adjusted life years among 15- to 19-year-olds globally; yet, social and structural determinants of alcohol use among adolescents in low- and middle-income countries are largely unknown. Given that a quarter of the global adolescent population lives in South Asia, this systematic review aims to identify factors influencing alcohol use among 10- to 19-year-olds living in South Asia (Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka). METHOD We systematically searched eight databases (SCOPUS, MEDLINE, EMBASE, CINAHL Plus, Cochrane Library, PsycINFO, AMED, EBSCO Host), gray literature, and relevant websites for studies reporting influences at psycho-individual, family, school, peer, neighborhood, or country levels. QATSDD (Quality Assessment Tool for Studies with Diverse Designs) was used for quality assessment. The study protocol was registered with PROSPERO (CRD42017084773). RESULTS Twenty-three studies were eligible for inclusion. Male gender, age greater than 14 years, depression, religious belief, parental/family members' drinking, reduced parental attention, peer-drinking/pressure/approval, and urban neighborhood were associated with increased risks of adolescent drinking. No information was available from Afghanistan, Bhutan, Bangladesh, Pakistan, and Maldives. There is little evidence available on the determinants at a national (legislature, industry, and media), school, and personality level. CONCLUSIONS The distal determinants of alcohol use among adolescents living in South Asia are largely unknown. As adolescent drinking behaviors change in response to social media and industry influence, more evidence is needed to reflect the South Asia context.
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Affiliation(s)
- Lathika K Athauda
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Roshini Peiris-John
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Shanthi Ameratunga
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Judith McCool
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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22
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Athauda LK, Peiris-John R, Ameratunga S, McCool J, Wickremasinghe R. Factors Influencing Alcohol Use Among Adolescents in South Asia: A Systematic Review. J Stud Alcohol Drugs 2020. [DOI: 10.15288/jsad.2020.81.529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Lathika K. Athauda
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Roshini Peiris-John
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Shanthi Ameratunga
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Judith McCool
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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Warnakulasuriya T, Williams S, Weerakkody T, Dabarera M, Rodrigo K, Waduge VA, Ediriweera D, Siriwardena N, Wickremasinghe R. BACKGROUND RADIATION LEVELS NEAR A MINERAL SAND MINING FACTORY IN SRI LANKA: CORRELATION OF RADIATION MEASUREMENTS WITH MICRONUCLEI FREQUENCY. Radiat Prot Dosimetry 2020; 189:114-126. [PMID: 32090241 DOI: 10.1093/rpd/ncaa022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 01/11/2020] [Accepted: 01/31/2020] [Indexed: 06/10/2023]
Abstract
Lanka Mineral Sands Ltd (LMS) is a company operating in Pulmoddai, Sri Lanka, mining for rare earth minerals along with monazite which contains thorium that emits ionizing gamma and alpha radiation on decay. The objective of the study was to determine the background radiation levels and selected radionuclides and then to correlate these levels with the frequency of micronuclei (MN) among persons residing in the vicinity of LMS. A cross-sectional study was conducted among persons of both sexes between 35 and 45 years of age residing in the vicinity of LMS. Background radiation measurements were obtained by a survey metre, and gamma spectrometry was done on soil samples. Five millilitres of venous blood was drawn for cytokinesis-blocked MN assay. Background radiation levels measured by the survey metre; 232Th, 226Ra and 210Pb mass activities in soil were highest in the samples collected from the LMS. The background radiation measurements positively correlated with MN frequency although the magnitude of the correlation was small (r = 0.176, p = 0.04). This implies that chronic long-term exposure to low-dose radiation may result in genotoxicity. Prospective large-scale studies are recommended to evaluate the long-term effect of exposure to low-dose radiation at Pulmoddai.
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Affiliation(s)
- Tania Warnakulasuriya
- Department of Physiology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Senani Williams
- Department of Pathology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Thiwanka Weerakkody
- Department of Pathology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Mangala Dabarera
- Department of Pathology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Kusum Rodrigo
- Department of Pathology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | | | - Dileepa Ediriweera
- Faculty of Medicine, Centre for Health Informatics, Biostatistics and Epidemiology, University of Kelaniya, Ragama, Sri Lanka
| | | | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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Manel Yapabandara AMG, do Rosario de Fatima Mota M, Sarmento R, Bosco JD, Wickremasinghe R. From malaria control to elimination within a decade: lessons learned from Timor Leste, a newly independent country. Malar J 2020; 19:104. [PMID: 32127001 PMCID: PMC7055025 DOI: 10.1186/s12936-020-03162-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/17/2019] [Accepted: 02/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Timor Leste has made remarkable progress from malaria control to malaria elimination in a span of 10 years during which organized malaria control efforts were instituted. The good practices and possible factors that have contributed to the remarkable transition from malaria control to elimination in a newly independent country devastated by civil unrest which left the entire administrative structure including the health sector in a disrupted non-functional state are highlighted. METHODS Data from the National Malaria Control Programme were reviewed. A literature search was carried out using the key words "malaria", "Timor Leste", "East Timor", and "malaria control" and "malaria elimination". All relevant manuscripts and reports that were identified in the search were reviewed. Key personnel of the NMCP, WHO and the GFATM involved in the project were interviewed. RESULTS With the setting up of the National Malaria Control Programme just after independence in 2003 with two officers, the programme expanded over the years and strategic malaria control activities in an organized manner commenced in 2009 with funding from the Global Fund to fight AIDS, Tuberculosis and Malaria. The incidence of malaria declined dramatically from 223,002 cases in 2006 with the last indigenous case being reported in June 2017. The decline in malaria was associated with strategic application of key evidence-based interventions taking into account the burden of disease, characteristics of vectors, and stratification of risk areas ensuring universal access to malaria prevention, and quality assured diagnostic tools and effective anti-malarial medicines at point of care, intensified surveillance, monitoring and evaluation, and capacity building, including training of staff, with adequate programme funding. The programme was provided with technical expertise and sustained political commitment that ensured uninterrupted implementation of interventions based on national strategic plans. The incorporation of the malaria control programme within an evolving health system helped the transition from malaria control to malaria elimination. CONCLUSION Universal access to quality assured malaria diagnosis and treatment and focussed vector control, implemented throughout the country in an organized manner with adequate funding and political commitment were key to the successful interruption of malaria transmission in the country. All the practices or factors listed did not work in isolation but rather synergistically in an integrated manner. Malaria elimination is possible even in tropical areas of South and Southeast Asia.
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Affiliation(s)
| | | | | | | | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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25
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Herath HP, Herath RP, Wickremasinghe R. Hyperglycaemia in Pregnancy and Anthropometric Parameters in the Offspring at 10 Years: A Community-Based Retrospective Cohort Study in Sri Lanka. J Obes 2020; 2020:2735148. [PMID: 32670637 PMCID: PMC7350072 DOI: 10.1155/2020/2735148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 05/02/2020] [Accepted: 06/01/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Studies of developmental origins of health and disease have highlighted the possible role of intrauterine hyperglycaemia, increasing the future risk of obesity, diabetes, and cardiovascular diseases in the offspring. There is limited evidence from South Asian populations for risk estimates for childhood obesity that are attributable to maternal diabetes in utero. OBJECTIVE The aim of this study was to determine the association between hyperglycaemia in pregnancy (HIP) and anthropometric parameters in the offspring at 10-11 years of age. METHODS A community-based retrospective cohort study was conducted in Colombo district, Sri Lanka. In the first stage, children born in 2005 were identified, and the availability of antenatal records was assessed. In the second stage, the exposure status of participants was ascertained based on antenatal records and predefined criteria. In the third stage, height, weight, waist circumference, and triceps skinfold thickness (TSFT) of eligible participants were measured to ascertain the outcome status. Background characteristics were collected by interviewing mothers. A 24-hour dietary recall and a 3-day diet diary were recorded. RESULTS 159 children of mothers with HIP (exposed) and 253 children of mothers with no HIP (nonexposed) participated. Mean ages (SD) of exposed and unexposed groups were 10.9 (0.3) and 10.8 (0.3) years, respectively. The median BMI (17.6 vs 16.1, p < 0.001), waist circumference (63 cm vs 59.3 cm, p < 0.001), and triceps skinfold thickness (13.7 mm vs 11.2 mm, p < 0.001) were significantly higher in the exposed group. Offspring of women with HIP were more likely to be overweight (aOR = 2.6, 95% CI 1.4-4.9) and have abdominal obesity (aOR = 2.7, 95% CI 1.1-6.5) and high TSFT (aOR = 2.2, 95% CI 1.06-4.7) at 10-11 years than children who were not exposed after adjusting for maternal BMI, maternal age at delivery, and birth order. CONCLUSIONS Intrauterine exposure to HIP is a significant determinant of overweight, high TSFT, and abdominal obesity in the offspring.
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Affiliation(s)
- Himali P. Herath
- Department of Nutrition, Medical Research Institute, Colombo 00800, Sri Lanka
| | - Rasika P. Herath
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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Ranathunga N, Perera P, Nandasena S, Sathiakumar N, Kasturiratne A, Wickremasinghe R. Effect of household air pollution due to solid fuel combustion on childhood respiratory diseases in a semi urban population in Sri Lanka. BMC Pediatr 2019; 19:306. [PMID: 31477087 PMCID: PMC6720872 DOI: 10.1186/s12887-019-1674-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 08/19/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Household air pollution from combustion of solid fuels for cooking and space heating is one of the most important risk factors of the global burden of disease. This study was aimed to determine the association between household air pollution due to combustion of biomass fuel in Sri Lankan households and self-reported respiratory symptoms in children under 5 years. METHODS A prospective study was conducted in the Ragama Medical Officer of Health area in Sri Lanka. Children under 5 years were followed up for 12 months. Data on respiratory symptoms were extracted from a symptom diary. Socioeconomic data and the main fuel type used for cooking were recorded. Air quality measurements were taken during the preparation of the lunch meal over a 2-h period in a subsample of households. RESULTS Two hundred and sixty two children were followed up. The incidence of infection induced asthma (RR = 1.77, 95%CI;1.098-2.949) was significantly higher among children resident in households using biomass fuel and kerosene (considered as the high exposure group) as compared to children resident in households using Liquefied Petroleum Gas (LPG) or electricity for cooking (considered as the low exposure group), after adjusting for confounders. Maternal education was significantly associated with the incidence of infection induced asthma after controlling for other factors including exposure status. The incidence of asthma among male children was significantly higher than in female children (RR = 1.17; 95% CI 1.01-1.37). Having an industry causing air pollution near the home and cooking inside the living area were significant risk factors of rhinitis (RR = 1.39 and 2.67, respectively) while spending less time on cooking was a protective factor (RR = 0.81). Houses which used biomass fuel had significantly higher concentrations of carbon monoxide (CO) (mean 2.77 ppm vs 1.44 ppm) and particulate matter2.5 (PM2.5) (mean 1.09 mg/m3 vs 0.30 mg/m3) as compared to houses using LPG or electricity for cooking. CONCLUSION The CO and PM2.5 concentrations were significantly higher in households using biomass fuel for cooking. There was a 1.6 times higher risk of infection induced asthma (IIA) among children of the high exposure group as compared to children of the low exposure group, after controlling for other factors. Maternal education was significantly associated with the incidence of IIA after controlling for exposure status and other variables.
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Affiliation(s)
- Nayomi Ranathunga
- Faculty of Medicine, University of Kelaniya, P.O. Box 6, Thalagolla Road, Ragama, 11010, Sri Lanka.
| | - Priyantha Perera
- Faculty of Medicine, University of Kelaniya, P.O. Box 6, Thalagolla Road, Ragama, 11010, Sri Lanka
| | | | - Nalini Sathiakumar
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, USA
| | - Anuradhani Kasturiratne
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, 11010, Sri Lanka
| | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, 11010, Sri Lanka
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27
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Jayasena Kaluarachchi TD, Weerasekera MM, McBain AJ, Ranasinghe S, Wickremasinghe R, Yasawardene S, Jayanetti N, Wickremasinghe R. Diagnosing Cutaneous leishmaniasis using Fluorescence in Situ Hybridization: the Sri Lankan Perspective. Pathog Glob Health 2019; 113:180-190. [PMID: 31429388 DOI: 10.1080/20477724.2019.1650228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 01/19/2023] Open
Abstract
Cutaneous leishmaniasis (CL) caused by Leishmania donovani MON-37 is becoming a major public health problem in Sri Lanka, with 100 new cases per month being reported in endemic regions. Diagnosis of CL is challenging for several reasons. Due to relative specificity and rapidity we propose Fluorescence in Situ Hybridization as a diagnostic tool for CL. The objective was to evaluate the potential of Fluorescence in Situ Hybridization as a diagnostic method for Cutaneous leishmaniasis in Sri Lanka. Literature on current laboratory tests used to diagnose Cutaneous leishmaniasis in Sri Lanka and globally was reviewed. Sri Lankan data were reviewed systematically following the PRISMA guidelines. A narrative of the results is presented. There is currently no gold standard diagnostic method for Cutaneous leishmaniasis. Fluorescence in Situ Hybridization has been previously applied to detect dermal pathologies including those involving infectious agents, and its use to detect the Leishmania parasite in human cutaneous lesions reported in small number of studies, generally with limited numbers of subjects. Advantages of FISH has been specificity, cost and ease-of-use compared to the alternatives. Based on the available literature and our current work, FISH has potential for diagnosing CL and should now be evaluated in larger cohorts in endemic regions. FISH for CL diagnosis could find application in countries such as Sri Lanka, where laboratory facilities may be limited in rural areas where the disease burden is highest.
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Affiliation(s)
| | - Manjula Manoji Weerasekera
- Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura , Nugegoda , Sri Lanka
| | - Andrew J McBain
- Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura , Nugegoda , Sri Lanka.,Division of Pharmacy & Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester , Manchester
| | - Shalindra Ranasinghe
- Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura , Colombo , Sri Lanka
| | - Renu Wickremasinghe
- Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura , Colombo , Sri Lanka
| | - Surangi Yasawardene
- Department of Anatomy, Faculty of Medical Sciences, University of Sri Jayewardenepura , Colombo , Sri Lanka
| | - Nisal Jayanetti
- Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura , Colombo , Sri Lanka
| | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya , Kelaniya , Sri Lanka
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Premaratne R, Wickremasinghe R, Ranaweera D, Gunasekera WMKTDAW, Hevawitharana M, Pieris L, Fernando D, Mendis K. Technical and operational underpinnings of malaria elimination from Sri Lanka. Malar J 2019; 18:256. [PMID: 31358007 PMCID: PMC6664748 DOI: 10.1186/s12936-019-2886-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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: 05/20/2019] [Accepted: 07/20/2019] [Indexed: 11/25/2022] Open
Abstract
Malaria was eliminated from Sri Lanka in 2012, and the country received WHO-certification in 2016. The objective of this paper is to describe the epidemiology of malaria elimination in Sri Lanka, and the key technical and operational features of the elimination effort, which may have been central to achieving the goal, even prior to schedule, and despite an ongoing war in parts of the country. Analysis of information and data from the Anti Malaria Campaign (AMC) of Sri Lanka during and before the elimination phase, and the experiences of the author(s) who directed and/or implemented the elimination programme or supported it form the basis of this paper. The key epidemiological features of malaria on the path to elimination included a steady reduction of case incidence from 1999 onwards, and the simultaneous elimination of both Plasmodium falciparum and Plasmodium vivax. Against the backdrop of a good health infrastructure the AMC, a specialized programme within the Ministry of Health operated through a decentralized provincial health system to implement accepted strategies for the elimination of malaria. Careful planning combined with expertise on malaria control at the Central level with dedicated staff at all levels at the Centre and on the ground in all districts, for several years, was the foundation of this success. The stringent implementation of anti-relapse treatment for P. vivax through a strong collaboration with the military in whose cadres most of the malaria cases were clustered in the last few years of transmission would have supported the relatively rapid elimination of P. vivax. A robust case and entomological surveillance and investigation system described here enabled a highly focused approach to delivering interventions leading to the interruption of transmission.
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Affiliation(s)
- Risintha Premaratne
- Anti Malaria Campaign, 555/5 Public Health Building, Narahenpita, Sri Lanka.,World Health Organization Regional Office for South East Asia, New Delhi, India
| | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, P.O. Box 6, Thalagolla Road, Ragama, Sri Lanka
| | - Dewanee Ranaweera
- Anti Malaria Campaign, 555/5 Public Health Building, Narahenpita, Sri Lanka
| | | | | | | | - Deepika Fernando
- Department of Parasitology, Faculty of Medicine, University of Colombo, 25 Kynsey Road, Colombo, Sri Lanka.
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Karunasena VM, Marasinghe M, Koo C, Amarasinghe S, Senaratne AS, Hasantha R, Hewavitharana M, Hapuarachchi HC, Herath HDB, Wickremasinghe R, Mendis KN, Fernando D, Ranaweera D. The first introduced malaria case reported from Sri Lanka after elimination: implications for preventing the re-introduction of malaria in recently eliminated countries. Malar J 2019; 18:210. [PMID: 31234941 PMCID: PMC6591994 DOI: 10.1186/s12936-019-2843-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [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: 04/15/2019] [Accepted: 06/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There has been no local transmission of malaria in Sri Lanka for 6 years following elimination of the disease in 2012. Malaria vectors are prevalent in parts of the country, and imported malaria cases continue to be reported. The country is therefore at risk of malaria being re-established. The first case of introduced vivax malaria in the country is reported here, and the surveillance and response system that contained the further spread of this infection is described. METHODS Diagnosis of malaria was based on microscopy and rapid diagnostic tests. Entomological surveillance for anophelines used standard techniques for larval and adult surveys. Genotyping of parasite isolates was done using a multi-locus direct sequencing approach, combined with cloning and restriction fragment length polymorphism analyses. Treatment of vivax malaria infections was according to the national malaria treatment guidelines. RESULTS An imported vivax malaria case was detected in a foreign migrant followed by a Plasmodium vivax infection in a Sri Lankan national who visited the residence of the former. The link between the two cases was established by tracing the occurrence of events and by demonstrating genetic identity between the parasite isolates. Effective surveillance was conducted, and a prompt response was mounted by the Anti Malaria Campaign. No further transmission occurred as a result. CONCLUSIONS Evidence points to the case of malaria in the Sri Lankan national being an introduced malaria case transmitted locally from an infection in the foreign migrant labourer, which was the index case. Case detection, treatment and investigation, followed by prompt action prevented further transmission of these infections. Entomological surveillance and vector control at the site of transmission were critically important to prevent further transmission. The case is a reminder that the risk of re-establishment of the disease in the country is high, and that the surveillance and response system needs to be sustained in this form at least until the Southeast Asian region is free of malaria. Several countries that are on track to eliminate malaria in the coming years are in a similar situation of receptivity and vulnerability. Regional elimination of malaria must therefore be considered a priority if the gains of global malaria elimination are to be sustained.
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Affiliation(s)
| | - Manonath Marasinghe
- Anti Malaria Campaign Headquarters, 555/5 Public Health Building, Narehenpita, Colombo 5, Sri Lanka
| | - Carmen Koo
- Environmental Health Institute, National Environment Agency, Singapore, Singapore
| | | | - Arundika S Senaratne
- Anti Malaria Campaign Headquarters, 555/5 Public Health Building, Narehenpita, Colombo 5, Sri Lanka
| | | | - Mihirini Hewavitharana
- Anti Malaria Campaign Headquarters, 555/5 Public Health Building, Narehenpita, Colombo 5, Sri Lanka
| | | | - Hema D B Herath
- Anti Malaria Campaign Headquarters, 555/5 Public Health Building, Narehenpita, Colombo 5, Sri Lanka
| | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | | | - Deepika Fernando
- Department of Parasitology, Faculty of Medicine, Colombo, Sri Lanka.
| | - Dewanee Ranaweera
- Anti Malaria Campaign Headquarters, 555/5 Public Health Building, Narehenpita, Colombo 5, Sri Lanka
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30
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Sathiakumar N, Tipre M, Wickremasinghe R, Bhat V, Kadir MM, Coggon D, Pathemeswaran A, Kamath R, Arunkumar G, Fatmi Z, Smith TL, Pattanshetty SM, Delzell E. Building global partnerships through shared curricula for an MPH programme in India and Sri Lanka. Glob Public Health 2019; 14:1360-1371. [PMID: 30773110 DOI: 10.1080/17441692.2019.1579850] [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: 10/27/2022]
Abstract
OBJECTIVE To design and implement a locally relevant competency- based MPH programme. METHODS The demand for trained public health professionals in South Asia is enormous and growing, which created a unique opportunity for a Fogarty International Center-funded University of Alabama at Birmingham-South Asia [Aga Khan University, Pakistan; Manipal Academy of Higher Education, India; and University of Kelaniya, Sri Lanka] international research training in environmental and occupational health (ITREOH) programme. In 2009, a Master of Public Health (MPH) degree programme was designed using a combination of competencies developed by the Association of School of Public Health, the World Health Organization and the Centers for Disease Control and Prevention. RESULTS A competency- based curriculum was developed with two specialty tracks in applied epidemiology and environmental and occupational health, emphasising applied practice and research. CONCLUSIONS This is the most comprehensive skill-based MPH programme in the region, which positions each institution as a regional leader in public health training. The success of the programme has been amply demonstrated by placements of graduated MPH students in leadership roles in public, private and academic sectors within their countries.
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Affiliation(s)
- Nalini Sathiakumar
- a Department of Epidemiology, University of Alabama at Birmingham , Birmingham , USA
| | - Meghan Tipre
- a Department of Epidemiology, University of Alabama at Birmingham , Birmingham , USA
| | | | - Vinod Bhat
- c Department of Community Medicine, Manipal Academy of Higher Education University , Manipal , India
| | | | - David Coggon
- e Faculty of Medicine, University of Southampton , Southampton , UK
| | | | | | - G Arunkumar
- c Department of Community Medicine, Manipal Academy of Higher Education University , Manipal , India
| | - Zafar Fatmi
- d Department of Community Health Science, Aga Khan University , Karachi , Pakistan
| | - Tamika L Smith
- a Department of Epidemiology, University of Alabama at Birmingham , Birmingham , USA
| | - Sanjay M Pattanshetty
- c Department of Community Medicine, Manipal Academy of Higher Education University , Manipal , India
| | - Elizabeth Delzell
- a Department of Epidemiology, University of Alabama at Birmingham , Birmingham , USA
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Fernando D, Wijeyaratne P, Wickremasinghe R, Abeyasinghe RR, Galappaththy GNL, Wickremasinghe R, Hapugoda M, Abeywickrema WA, Rodrigo C. Use of a public-private partnership in malaria elimination efforts in Sri Lanka; a case study. BMC Health Serv Res 2018; 18:202. [PMID: 29566691 PMCID: PMC5865373 DOI: 10.1186/s12913-018-3008-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 05/08/2016] [Accepted: 03/15/2018] [Indexed: 12/24/2022] Open
Abstract
Background In special circumstances, establishing public private partnerships for malaria elimination may achieve targets faster than the state sector acting by itself. Following the end of the separatist war in Sri Lanka in 2009, the Anti Malaria Campaign (AMC) of Sri Lanka intensified malaria surveillance jointly with a private sector partner, Tropical and Environmental Diseases and Health Associates Private Limited (TEDHA) with a view to achieving malaria elimination targets by 2014. Methods This is a case study on how public private partnerships can be effectively utilized to achieve malaria elimination goals. TEDHA established 50 Malaria Diagnostic Laboratories and 17 entomology surveillance sentinel sites in consultation with the AMC in areas difficult to access by government officials (five districts in two provinces affected by war). Results TEDHA screened 994,448 individuals for malaria, of which 243,867 were screened at mobile malaria clinics as compared to 1,102,054 screened by the AMC. Nine malaria positives were diagnosed by TEDHA, while the AMC diagnosed 103 malaria cases in the same districts in parallel. Over 13,000 entomological activity days were completed. Relevant information was shared with AMC and the data recorded in the health information system. Conclusions A successful public-private partnership model for malaria elimination was initiated at a time when the health system was in disarray in war ravaged areas of Sri Lanka. This ensured a high annual blood examination rate and screening of vulnerable people in receptive areas. These were important for certification of malaria-free status which Sri Lanka eventually received in 2016.
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Affiliation(s)
- Deepika Fernando
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
| | - Pandu Wijeyaratne
- Tropical and Environmental Diseases and Health Associates, No. 3 Elibank Road, Colombo, Sri Lanka
| | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | | | | | - Renu Wickremasinghe
- Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - M Hapugoda
- Department of Parasitology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - W A Abeywickrema
- Department of Parasitology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Chaturaka Rodrigo
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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De Silva G, Somaratne V, Senaratne S, Vipuladasa M, Wickremasinghe R, Wickremasinghe R, Ranasinghe S. Efficacy of a new rapid diagnostic test kit to diagnose Sri Lankan cutaneous leishmaniasis caused by Leishmania donovani. PLoS One 2017; 12:e0187024. [PMID: 29135995 PMCID: PMC5685575 DOI: 10.1371/journal.pone.0187024] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 10/11/2017] [Indexed: 12/21/2022] Open
Abstract
Background Cutaneous leishmaniasis (CL) in Sri Lanka is caused by Leishmania donovani. This study assessed the diagnostic value of a new rapid diagnostic immunochromatographic strip (CL-Detect™ IC-RDT), that captures the peroxidoxin antigen of Leishmania amastigotes. Methodology/Principal findings We sampled 74 clinically suspected CL lesions, of which 59 (79.7%) were positive by PCR, 43 (58.1%) by Giemsa stained slit skin smear (SSS) and 21 (28.4%) by the new IC-RDT. All samples which were positive either by SSS or IC-RDT or both were positive by PCR. The sensitivities of the IC-RDT and SSS compared to PCR were 36% and 73%, respectively. Fifteen patients from this endemic region were negative by all three tests. Twenty two clinically non-CL skin lesions from a CL non-endemic region were also negative by all three methods. Specificity and PPV of both IC-RDT and SSS compared to PCR were 100%; the NPVs of IC-RDT and SSS were 37% and 58%, respectively. The median parasite grading of the 59 PCR positive samples was 2+ (1–10 parasites/100 HPFs) and IC-RDT positive lesions was 3+ (1–10 parasites /10HPFs). The duration of the lesion was not associated with IC-RDT positivity. Conclusions/Significance The median parasite grade of Sri Lankan CL lesions is low. The low sensitivities of SSS and CL Detect™ IC-RDT may be due to low parasite counts or low expression of peroxidoxin antigen in amastigotes of the Sri Lankan L. donovani strain. Our results indicate that negative SSS has to be combined with PCR for confirmation of CL in Sri Lanka. The current commercially available IC-RDT is not suitable to diagnose CL in Sri Lanka; an IC-RDT with improved sensitivity to detect L. donovani would be a valuable addition in the diagnostic tool kit for Sri Lanka.
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Affiliation(s)
- Gayani De Silva
- Department of Parasitology, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | | | - Sujai Senaratne
- Department of Parasitology, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | | | | | - Renu Wickremasinghe
- Department of Parasitology, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Shalindra Ranasinghe
- Department of Parasitology, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
- * E-mail:
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Warnakulasuriya T, Williams S, Dabarera M, Rodrigo K, Weerakkody T, Wickremasinghe R. Frequency of micronuclei among persons resident in the vicinity of a mineral sand processing factory in Pulmoddai, Sri Lanka. Mutagenesis 2017; 32:511-516. [DOI: 10.1093/mutage/gex019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Herath H, Herath R, Wickremasinghe R. Gestational diabetes mellitus and risk of type 2 diabetes 10 years after the index pregnancy in Sri Lankan women-A community based retrospective cohort study. PLoS One 2017. [PMID: 28644881 PMCID: PMC5482451 DOI: 10.1371/journal.pone.0179647] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Women with a history of gestational diabetes mellitus (GDM) have an increased risk of type 2 diabetes mellitus (T2DM) later in life compared to women with no GDM. This study was aimed to determine the risk of developing T2DM 10 years after GDM in Sri Lankan women. METHODS A retrospective cohort study was conducted in the Colombo district, Sri Lanka. 7205 women who delivered a child in 2005 were identified through Public Health Midwives in the field. Women with antenatal records were interviewed and relevant data were extracted from medical records to identify potential participants. One hundred and nineteen women who had GDM and 240 women who did not have GDM were recruited. Current diagnosis of diabetes was based on history, relevant medical records and blood reports within the past 1 year. RESULTS The mean duration of follow up was 10.9 (SD = 0.35) years in the GDM group and 10.8 (SD = 0.31) years in the non-GDM group. The incidence density of diabetes in the GDM group was 56.3 per 1000 person years compared to 5.4 per 1000 person years in non GDM group giving a rate ratio of 10.42 (95% CI: 6.01-19.12). A woman having GDM in the index pregnancy was 10.6 times more likely to develop diabetes within 10 years compared to women with no GDM after controlling for other confounding variables. Delivering a child after 30 years, being treated with insulin during the pregnancy and delivering a baby weighing more than 3.5 Kg were significant predictors of development of T2DM after controlling for family history of diabetes mellitus (DM), GDM in previous pregnancies, parity and gestational age at delivery. CONCLUSIONS Women with GDM had a 10-fold higher risk of developing T2DM during a 10-year follow up period as compared to women with no GDM after controlling for other confounding variables.
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Affiliation(s)
- Himali Herath
- Department of Nutrition, Medical Research Institute, Colombo, Sri Lanka
- * E-mail:
| | - Rasika Herath
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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Fernando SD, Booso R, Dharmawardena P, Harintheran A, Raviraj K, Rodrigo C, Danansuriya M, Wickremasinghe R. The need for preventive and curative services for malaria when the military is deployed in endemic overseas territories: a case study and lessons learned. Mil Med Res 2017; 4:19. [PMID: 28593051 PMCID: PMC5460350 DOI: 10.1186/s40779-017-0128-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/31/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Sri Lanka has been free from indigenous malaria since November 2012 and received the WHO certificate for malaria-free status in September 2016. Due to increased global travel, imported malaria cases continue to be reported in the country. Military personnel returning home from international peace-keeping missions in malaria endemic countries represent a key risk group in terms of imported malaria. The present study intended to characterize the potential causes of a malaria outbreak among the Sri Lankan security forces personnel deployed in the Central African Republic (CAR). METHODS Data were collected from a cross-sectional survey distributed among Sri Lankan Air Force personnel who had returned from United Nations peace-keeping missions in the CAR region. A pre-tested questionnaire was used for the data collection, and focus group discussions were also conducted. RESULTS One hundred twenty male Air Force personnel were interviewed (out of a group of 122 officers and airmen). All participants were deployed in the CAR for 14 months and were aware of the existence of chemoprophylaxis against malaria. The majority of the subjects (92.5%, 111/120) also knew that prophylaxis should be started prior to departure. However, the regular use of chemoprophylaxis was reported by only 61.7% (74/120) of the sample. Overall, 30.8% of the participants (37/120) had 44 symptomatic episodes of malaria during deployment, and one person succumbed to severe malaria. All cases were associated with noncompliance with chemoprophylaxis. CONCLUSION Better coordination with overseas healthcare services and the establishment of directly observed chemoprophylaxis may help to avoid similar outbreaks in the future.
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Affiliation(s)
| | - Rahuman Booso
- Directorate of Health Services, Sri Lanka Air Force, Colombo, Sri Lanka
| | - Priyani Dharmawardena
- Anti-Malaria Campaign, Ministry of Health, 555/5 Public Health Complex, Narahenpita, Colombo, 5 Sri Lanka
| | | | - Kugapiriyan Raviraj
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Chaturaka Rodrigo
- Department of Pathology, School of Medical Sciences, University of New South Wales, Sydney, NSW 2052 Australia
| | - Manjula Danansuriya
- Anti-Malaria Campaign, Ministry of Health, 555/5 Public Health Complex, Narahenpita, Colombo, 5 Sri Lanka
| | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
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Levine KE, Redmon JH, Elledge MF, Wanigasuriya KP, Smith K, Munoz B, Waduge VA, Periris-John RJ, Sathiakumar N, Harrington JM, Womack DS, Wickremasinghe R. Quest to identify geochemical risk factors associated with chronic kidney disease of unknown etiology (CKDu) in an endemic region of Sri Lanka-a multimedia laboratory analysis of biological, food, and environmental samples. Environ Monit Assess 2016; 188:548. [PMID: 27591985 DOI: 10.1007/s10661-016-5524-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 04/26/2016] [Accepted: 08/01/2016] [Indexed: 05/09/2023]
Abstract
The emergence of a new form of chronic kidney disease of unknown etiology (CKDu) in Sri Lanka's North Central Province (NCP) has become a catastrophic health crisis. CKDu is characterized as slowly progressing, irreversible, and asymptomatic until late stages and, importantly, not attributed to diabetes, hypertension, or other known risk factors. It is postulated that the etiology of CKDu is multifactorial, involving genetic predisposition, nutritional and dehydration status, exposure to one or more environmental nephrotoxins, and lifestyle factors. The objective of this limited geochemical laboratory analysis was to determine the concentration of a suite of heavy metals and trace element nutrients in biological samples (human whole blood and hair) and environmental samples (drinking water, rice, soil, and freshwater fish) collected from two towns within the endemic NCP region in 2012 and 2013. This broad panel, metallomics/mineralomics approach was used to shed light on potential geochemical risk factors associated with CKDu. Based on prior literature documentation of potential nephrotoxins that may play a role in the genesis and progression of CKDu, heavy metals and fluoride were selected for analysis. The geochemical concentrations in biological and environmental media areas were quantified. Basic statistical measurements were subsequently used to compare media against applicable benchmark values, such as US soil screening levels. Cadmium, lead, and mercury were detected at concentrations exceeding US reference values in many of the biological samples, suggesting that study participants are subjected to chronic, low-level exposure to these elements. Within the limited number of environmental media samples, arsenic was determined to exceed initial risk screening and background concentration values in soil, while data collected from drinking water samples reflected the unique hydrogeochemistry of the region, including the prevalence of hard or very hard water, and fluoride, iron, manganese, sodium, and lead exceeding applicable drinking water standards in some instances. Current literature suggests that the etiology of CKDu is likely multifactorial, with no single biological or hydrogeochemical parameter directly related to disease genesis and progression. This preliminary screening identified that specific constituents may be present above levels of concern, but does not compare results against specific kidney toxicity values or cumulative risk related to a multifactorial disease process. The data collected from this limited investigation are intended to be used in the subsequent study design of a comprehensive and multifactorial etiological study of CKDu risk factors that includes sample collection, individual surveys, and laboratory analyses to more fully evaluate the potential environmental, behavioral, genetic, and lifestyle risk factors associated with CKDu.
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Affiliation(s)
- Keith E Levine
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA.
| | | | - Myles F Elledge
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | | | - Kristin Smith
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | - Breda Munoz
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | | | - Roshini J Periris-John
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Nalini Sathiakumar
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James M Harrington
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | - Donna S Womack
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
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Levine KE, Redmon JH, Elledge MF, Wanigasuriya KP, Smith K, Munoz B, Waduge VA, Periris-John RJ, Sathiakumar N, Harrington JM, Womack DS, Wickremasinghe R. Quest to identify geochemical risk factors associated with chronic kidney disease of unknown etiology (CKDu) in an endemic region of Sri Lanka-a multimedia laboratory analysis of biological, food, and environmental samples. Environ Monit Assess 2016; 188:548. [PMID: 27591985 DOI: 10.3768/rtipress.2014.rb.0007.1405] [Citation(s) in RCA: 12] [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: 04/26/2016] [Accepted: 08/01/2016] [Indexed: 05/24/2023]
Abstract
The emergence of a new form of chronic kidney disease of unknown etiology (CKDu) in Sri Lanka's North Central Province (NCP) has become a catastrophic health crisis. CKDu is characterized as slowly progressing, irreversible, and asymptomatic until late stages and, importantly, not attributed to diabetes, hypertension, or other known risk factors. It is postulated that the etiology of CKDu is multifactorial, involving genetic predisposition, nutritional and dehydration status, exposure to one or more environmental nephrotoxins, and lifestyle factors. The objective of this limited geochemical laboratory analysis was to determine the concentration of a suite of heavy metals and trace element nutrients in biological samples (human whole blood and hair) and environmental samples (drinking water, rice, soil, and freshwater fish) collected from two towns within the endemic NCP region in 2012 and 2013. This broad panel, metallomics/mineralomics approach was used to shed light on potential geochemical risk factors associated with CKDu. Based on prior literature documentation of potential nephrotoxins that may play a role in the genesis and progression of CKDu, heavy metals and fluoride were selected for analysis. The geochemical concentrations in biological and environmental media areas were quantified. Basic statistical measurements were subsequently used to compare media against applicable benchmark values, such as US soil screening levels. Cadmium, lead, and mercury were detected at concentrations exceeding US reference values in many of the biological samples, suggesting that study participants are subjected to chronic, low-level exposure to these elements. Within the limited number of environmental media samples, arsenic was determined to exceed initial risk screening and background concentration values in soil, while data collected from drinking water samples reflected the unique hydrogeochemistry of the region, including the prevalence of hard or very hard water, and fluoride, iron, manganese, sodium, and lead exceeding applicable drinking water standards in some instances. Current literature suggests that the etiology of CKDu is likely multifactorial, with no single biological or hydrogeochemical parameter directly related to disease genesis and progression. This preliminary screening identified that specific constituents may be present above levels of concern, but does not compare results against specific kidney toxicity values or cumulative risk related to a multifactorial disease process. The data collected from this limited investigation are intended to be used in the subsequent study design of a comprehensive and multifactorial etiological study of CKDu risk factors that includes sample collection, individual surveys, and laboratory analyses to more fully evaluate the potential environmental, behavioral, genetic, and lifestyle risk factors associated with CKDu.
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Affiliation(s)
- Keith E Levine
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA.
| | | | - Myles F Elledge
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | | | - Kristin Smith
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | - Breda Munoz
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | | | - Roshini J Periris-John
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Nalini Sathiakumar
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James M Harrington
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | - Donna S Womack
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
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Gunathilaka N, Abeyewickreme W, Hapugoda M, Wickremasinghe R. Determination of demographic, epidemiological, and socio-economic determinants and their potential impact on malaria transmission in Mannar and Trincomalee districts of Sri Lanka. Malar J 2016; 15:330. [PMID: 27334969 PMCID: PMC4918081 DOI: 10.1186/s12936-016-1390-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 04/17/2016] [Accepted: 06/15/2016] [Indexed: 11/23/2022] Open
Abstract
Background Malaria was an endemic problem in Mannar and Trincomalee districts of Sri Lanka until the recent past. Currently, no local case has been found since October 2012. Therefore, the present study was conducted to identify existing demographic, epidemiological and socio-cultural factors in Mannar and Trincomalee districts of Sri Lanka, since there is limited information available on the potential influence of above variables responsible for low malaria transmission. Methods An analytical cross-sectional survey was carried out on selected demographic, epidemiological and socio-economic variables in 32 localities under eight sentinel sites (Each sentinel with four localities) using a pre-defined questionnaire during June–September 2012. Household heads of 45 houses from each locality were selected randomly to participate in the present study. Data were analysed using the Paired Chi Square test and Bray–Curtis method. Results A total of 1440 household heads were interviewed. Both districts indicated statistically acceptable similarities (p > 0.05) in age structure, gender, family size and presence of animals. The knowledge on malaria was observed under “Poor” category. The protective measures against mosquito bites, spraying status of houses and occupation pattern were varied significantly in both districts (p < 0.05). Educational level was statistically similar (p > 0.05) in both districts. Majority of the families were identified as living in “Moderate” house type under low economic condition. Both populations were indicated 85 % similarity according to Bray–Curtis analysis. Conclusion Lack of awareness in these communities about the disease may facilitate to the re-emerge of malaria.
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Affiliation(s)
- Nayana Gunathilaka
- Department of Parasitology, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka.
| | | | - Menaka Hapugoda
- Molecular Medicine Unit, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka
| | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka
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Gunathilaka N, Denipitiya T, Hapugoda M, Abeyewickreme W, Wickremasinghe R. Determination of the foraging behaviour and blood meal source of malaria vector mosquitoes in Trincomalee District of Sri Lanka using a multiplex real time polymerase chain reaction assay. Malar J 2016; 15:242. [PMID: 27118141 PMCID: PMC4845499 DOI: 10.1186/s12936-016-1279-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 12/09/2015] [Accepted: 04/12/2016] [Indexed: 11/11/2022] Open
Abstract
Background Studies of host preference patterns in blood-feeding anopheline mosquitoes are crucial to incriminating malaria vectors. However, little information is available on host preferences of Anopheles mosquitoes in Sri Lanka. Methods Adult Anopheles mosquitoes were collected from five selected sentinel sites in Trincomalee District during June–September 2011. Each blood-fed mosquito was processed on filter papers. DNA was extracted using the dried blood meal protocol of the QIAmp DNA mini kit. A multiplexed, real-time PCR assay targeting eight animals was developed for two panels to identify the host meal of Anopheles. Human blood index (HBI), forage ratio (FR) and host feeding index (HFI) were calculated. Results A total of 280 field-caught, freshly engorged female mosquitoes belonging to 12 anopheline species were analysed. The overall HBI and HFI in the present study were low indicating that humans were not the preferred host for the tested anopheline species. Nevertheless, a small proportion engorged Anopheles aconitus, Anopheles culicifacies, Anopheles barbirostris, Anopheles annularis, Anopheles subpictus, Anopheles peditaeniatus, Anopheles pseudojamesi, and Anopheles barbumbrosus contained human blood. Conclusion The presence of human blood in mosquito species indicates the possibility of them transmitting malaria. Further studies on vector competence are needed to determine the role of each of the above anopheline species as efficient vectors of malaria.
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Affiliation(s)
- Nayana Gunathilaka
- Department of Parasitology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka. .,Tropical & Environmental Diseases & Health Associates, No 3 Elibank Rd, Colombo 5, Sri Lanka.
| | - Thanuja Denipitiya
- Molecular Medicine Unit, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Menaka Hapugoda
- Molecular Medicine Unit, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | | | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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Banneheke H, Fernandopulle R, Gunasekara U, Barua A, Fernando N, Wickremasinghe R. Validation of wet mount microscopy against Trichomonas culture among women of reproductive age group in Western province, Sri Lanka. Trop Biomed 2015; 32:192-197. [PMID: 26691246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Wet mount microscopy is the most commonly used diagnostic method for trichomoniasis in clinical diagnostic services all over the world including Sri Lanka due to its availability, simplicity and is relatively inexpensive. However, Trichomonas culture and PCR are the gold standard tests. Unfortunately, neither the culture nor PCR is available for the diagnosis of trichomoniasis in Sri Lanka. Thus, it is important to validate the wet mount microscopy as it is the only available diagnostic test and has not been validated to date in Sri Lanka. The objective was to evaluate the validity and reliability of wet mount microscopy against gold standard Trichomonas culture among clinic based population of reproductive age group women in Western province, Sri Lanka. Women attending hospital and institutional based clinics were enrolled. They were interviewed and high vaginal swabs were taken for laboratory diagnosis by culture and wet mount microscopy. There were 601 participants in the age group of 15-45 years. Wet mount microscopy showed 68% sensitivity, 100% specificity, 100% positive (PPV) and 98% negative predictive values (NPV) (P=0.001, kappa=0.803) respectively against the gold standard culture. The area under the ROC curve was 0.840. Sensitivity of wet mount microscopy is low. However it has high validity and reliability as a specific diagnostic test for trichomoniasis. If it is to be used among women of reproductive age group in Western province, Sri Lanka, a culture method could be adopted as a second test to confirm the negative wet mount for symptomatic patients.
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Affiliation(s)
- H Banneheke
- Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - R Fernandopulle
- Department of Gynaecology and Obstetrics, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - U Gunasekara
- Medical Officer of Health Office, Nugegoda, Sri Lanka
| | - A Barua
- Department of Community Medicine, School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - N Fernando
- Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - R Wickremasinghe
- Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
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Gunathilaka N, Fernando T, Hapugoda M, Abeyewickreme W, Wickremasinghe R. Revised morphological identification key to the larval anopheline (Diptera: Culicidae) of Sri Lanka. Asian Pac J Trop Biomed 2014; 4:S222-7. [PMID: 25183086 DOI: 10.12980/apjtb.4.2014c941] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 02/20/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To revise morphological identification keys to the anophelines in Sri Lanka. METHOD Samples were collected from selected entomological sites in different districts in the country. Stage III and IV larvae were identified under a light microscope with an objective (×10) using standard larval keys developed for Sri Lankan anophelines. Key larval characters were recorded for each species based on original observations and previous usage in literature. RESULTS This manuscript describes an illustrated key for the identification of 22 of 23 mosquitoes which are currently recognized as local anopheline species in Sri Lanka, as a guide to workers engaged in malaria surveillance and control in the country. CONCLUSIONS Revised morphological keys to the larval of these species may be helpful in easy and accurate identification at the field level.
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Affiliation(s)
- Nayana Gunathilaka
- Molecular Medicine Unit, Faculty of Medicine, University of Kelaniya, Sri Lanka
| | - Thilan Fernando
- Molecular Medicine Unit, Faculty of Medicine, University of Kelaniya, Sri Lanka
| | - Menaka Hapugoda
- Molecular Medicine Unit, Faculty of Medicine, University of Kelaniya, Sri Lanka
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Gunathilaka N, Fernando T, Hapugoda M, Wickremasinghe R, Wijeyerathne P, Abeyewickreme W. Anopheles culicifacies breeding in polluted water bodies in Trincomalee District of Sri Lanka. Malar J 2013; 12:285. [PMID: 23958454 PMCID: PMC3765073 DOI: 10.1186/1475-2875-12-285] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 08/18/2013] [Indexed: 11/29/2022] Open
Abstract
Background Anopheles culicifacies, the major vector of malaria in Sri Lanka, is known to breed in clean and clear water. The main objective of the study was to detect the breeding habitat diversity of An. culicifacies. Methods Potential larval habitats for Anopheles mosquitoes were surveyed on a monthly basis for 17 months (January 2011–June 2012) in four different selected sampling sites (Murthankulam, Kommnaimottai, Paranamadawachchiya and Kokmotawewa) in Trincomalee District of Sri Lanka. Results A total of 2,996 larval specimens representing 13 Anopheles species were reported from 16 different breeding habitats. According to density criterion, An. culicifacies, Anopheles subpictus, Anopheles barbirostris, Anopheles peditaeniatus and Anopheles nigerrimus were dominant. Anopheles nigerrimus, An. subpictus and An. peditaeniatus were observed as constant in relation to their distribution. The most productive breeding site for An. culicifacies was drains filled with waste water in remote areas; the second highest productivity was found in built wells. Conclusions These results indicate that An. culicifacies has adapted to breed in a wide range of water bodies including waste water collections although they were earlier considered to breed only in clean and clear water.
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Ranasinghe S, Wickremasinghe R, Munasinghe A, Hulangamuwa S, Sivanantharajah S, Seneviratne K, Bandara S, Athauda I, Navaratne C, Silva O, Wackwella H, Matlashewski G, Wickremasinghe R. Cross-sectional study to assess risk factors for leishmaniasis in an endemic region in Sri Lanka. Am J Trop Med Hyg 2013; 89:742-9. [PMID: 23918217 DOI: 10.4269/ajtmh.12-0640] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Sri Lanka reports significantly more cutaneous leishmaniasis (CL) cases than visceral leishmaniasis (VL) cases, both of which are caused by Leishmania donovani MON-37. A cross-sectional study conducted in an area with a high prevalence of CL prevalent included 954 participants of an estimated population of 61,674 to estimate the number of CL cases, ascertain whether there is a pool of asymptomatic VL cases, and identify risk factors for transmission. A total of 31 cases of CL were identified, of whom 21 were previously diagnosed and 10 were new cases. Using rK39 rapid diagnostic test to detect antibodies against Leishmania spp., we found that only one person was seropositive but did not have clinical symptoms of CL or VL, which indicated low transmission of VL in this area. χ(2) test, independent sample t-test, and multivariate analysis of sociodemographic and spatial distribution of environmental risk factors showed that living near paddy fields is associated with increased risk for transmission of CL (P ≤ 0.01).
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Affiliation(s)
- Shalindra Ranasinghe
- Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka; Department of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka; Regional Epidemiology Unit, Regional Director of Health Services Office, Anuradhapura, Sri Lanka; Dermatology Unit, Teaching Hospital, Anuradhapura, Sri Lanka; Geographic Information System Branch, Department of Surveys, Colombo, Sri Lanka; Office of the Medical Officer of Health, Thalawa, Sri Lanka; Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada; Special Program for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland
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Waidyatilaka I, Lanerolle P, Wickremasinghe R, Atukorala S, Somasundaram N, de Silva A. Sedentary behaviour and physical activity in South Asian women: time to review current recommendations? PLoS One 2013; 8:e58328. [PMID: 23472180 PMCID: PMC3589267 DOI: 10.1371/journal.pone.0058328] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 02/01/2013] [Indexed: 11/18/2022] Open
Abstract
Objective Our aims were to describe activity and sedentary behaviours in urban Asian women, with dysglycaemia (diagnosed at recruitment), and without dysglycaemia and examine the relative contribution of these parameters to their glycaemic status. Methods 2800 urban women (30–45 years) were selected by random cluster sampling and screened for dysglycaemia for a final sample of 272 newly diagnosed, drug naive dysglycaemic and 345 normoglycaemic women. Physical activity and sedentary behaviours were assessed by the International Physical Activity Questionnaire (IPAQ). Demographic data, diet and anthropometry were recorded. Logistic regression analysis assessed contribution of all parameters to dysglycaemia and exposure attributable fractions were calculated. Results The mean energy expenditure on walking (2648.5±1023.7 MET-min/week) and on moderate and vigorous physical activity (4342.3±1768.1 MET-min/week) for normoglycemic women and dysglycaemic women (walking;1046.4±728.4 MET-min/week, moderate and vigorous physical activity; 1086.7±1184.4 MET-min/week) was above the recommended amount of physical activity per week. 94.3% of women spent >1000 MET-minutes/week on activity. Mean sitting and TV time for normoglycaemic and dysglycaemic women were 154.3±62.8, 38.4±31.9, 312.6±116.7 and 140.2±56.5 minutes per day respectively. Physical activity and sedentary behaviour contributed to dysglycaemia after adjustment for family history, diet, systolic blood pressure and Body Mass Index. Exposure attributable fractions for dysglycaemia were; lower physical activity: 78%, higher waist circumference: 94%, and TV viewing time: 85%. Conclusions Urban South Asian women are at risk of dysglycaemia at lower levels of sedentary behaviour and greater physical activity than western populations, indicating the need for re-visiting current physical activity guidelines for South Asians.
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Affiliation(s)
- Indu Waidyatilaka
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Pulani Lanerolle
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Sunethra Atukorala
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Noel Somasundaram
- Endocrine Unit, National Hospital of Colombo, University of Colombo, Sri Lanka
| | - Angela de Silva
- Department of Physiology, Faculty of Medicine, University of Colombo, Sri Lanka
- * E-mail:
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Silva N, Peiris-John R, Wickremasinghe R, Senanayake H, Sathiakumar N. Cadmium a metalloestrogen: are we convinced? J Appl Toxicol 2011; 32:318-32. [DOI: 10.1002/jat.1771] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 09/16/2011] [Accepted: 10/12/2011] [Indexed: 01/08/2023]
Affiliation(s)
- Nalinda Silva
- Faculty of Medical Sciences; University of Sri Jayewardenepura; Sri Lanka
| | | | | | | | - Nalini Sathiakumar
- Faculty of Public Health; University of Alabama at Birmingham; Birmingham; AL; USA
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Kasturiratne A, Warnakulasuriya T, Pinidiyapathirage J, Kato N, Wickremasinghe R, Pathmeswaran A. P2-130 Epidemiology of hypertension in an urban Sri Lankan population. Journal of Epidemiology & Community Health 2011. [DOI: 10.1136/jech.2011.142976i.65] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wanigasuriya KP, Peiris-John RJ, Wickremasinghe R. Chronic kidney disease of unknown aetiology in Sri Lanka: is cadmium a likely cause? BMC Nephrol 2011; 12:32. [PMID: 21726464 PMCID: PMC3143923 DOI: 10.1186/1471-2369-12-32] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 07/05/2011] [Indexed: 11/26/2022] Open
Abstract
Background The rising prevalence of chronic kidney disease (CKD) and subsequent end stage renal failure necessitating renal replacement therapy has profound consequences for affected individuals and health care resources. This community based study was conducted to identify potential predictors of microalbuminuria in a randomly selected sample of adults from the North Central Province (NCP) of Sri Lanka, where the burden of CKD is pronounced and the underlying cause still unknown. Methods Exposures to possible risk factors were determined in randomly recruited subjects (425 females and 461 males) from selected areas of the NCP of Sri Lanka using an interviewer administered questionnaire. Sulphosalicylic acid and the Light Dependent Resister microalbumin gel filtration method was used for initial screening for microalbuminuria and reconfirmed by the Micral strip test. Results Microalbumnuria was detected in 6.1% of the females and 8.5% of the males. Smoking (p < 0.001), alcohol use (p = 0.003), hypertension (p < 0.001), diabetes (p < 0.001), urinary tract infection (UTI) (p = 0.034) and consumption of water from wells in the fields (p = 0.025) were associated with microalbuminuria. In the binary logistic regression analysis, hypertension, diabetes mellitus, UTI, drinking well water in the fields, smoking and pesticide spraying were found to be significant predictors of microalbuminuria. Conclusions Hypertension, diabetes mellitus, UTI, and smoking are known risk factors for microalbuminuria. The association between microalbuminuria and consumption of well water suggests an environmental aetiology to CKD in NCP. The causative agent is yet to be identified. Investigations for cadmium as a potential causative agent needs to be initiated.
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Wanigasuriya KP, Peiris-John RJ, Wickremasinghe R. Chronic kidney disease of unknown aetiology in Sri Lanka: is cadmium a likely cause? BMC Nephrol 2011. [PMID: 21726464 DOI: 10.1186/1471‐2369‐12‐32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The rising prevalence of chronic kidney disease (CKD) and subsequent end stage renal failure necessitating renal replacement therapy has profound consequences for affected individuals and health care resources. This community based study was conducted to identify potential predictors of microalbuminuria in a randomly selected sample of adults from the North Central Province (NCP) of Sri Lanka, where the burden of CKD is pronounced and the underlying cause still unknown. METHODS Exposures to possible risk factors were determined in randomly recruited subjects (425 females and 461 males) from selected areas of the NCP of Sri Lanka using an interviewer administered questionnaire. Sulphosalicylic acid and the Light Dependent Resister microalbumin gel filtration method was used for initial screening for microalbuminuria and reconfirmed by the Micral strip test. RESULTS Microalbumnuria was detected in 6.1% of the females and 8.5% of the males. Smoking (p < 0.001), alcohol use (p = 0.003), hypertension (p < 0.001), diabetes (p < 0.001), urinary tract infection (UTI) (p = 0.034) and consumption of water from wells in the fields (p = 0.025) were associated with microalbuminuria. In the binary logistic regression analysis, hypertension, diabetes mellitus, UTI, drinking well water in the fields, smoking and pesticide spraying were found to be significant predictors of microalbuminuria. CONCLUSIONS Hypertension, diabetes mellitus, UTI, and smoking are known risk factors for microalbuminuria. The association between microalbuminuria and consumption of well water suggests an environmental aetiology to CKD in NCP. The causative agent is yet to be identified. Investigations for cadmium as a potential causative agent needs to be initiated.
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Abstract
OBJECTIVE To assess knowledge, attitudes, and practices on evidence-based medicine (EBM) among doctors in selected hospitals in Sri Lanka. METHODS A cross-sectional descriptive study was conducted among 315 doctors in five government hospitals in Sri Lanka between December 2007 and January 2008. A pre-tested self-administered questionnaire was used to gather information on knowledge, attitudes, and practices. RESULTS Of the 407 invited, 315 doctors participated, among whom, 87% (271) had heard the term EBM, 30% (n= 94) were aware of the Cochrane Library, and 8.5% (n= 27) were current users of it. Forty-seven per cent (n= 148) claimed to understand the terms systematic review and 37% (n= 115) meta-analysis. Twenty-four per cent (n= 77) had been exposed to some form of EBM training. All three components of EBM were known by 18% (n= 56) of participants. Attitudes toward EBM were positive among 76% (n= 239), 80% (n= 251) believed the practice of EBM would lead to improved patient care, and 77% (n= 243) considered EBM to be fundamental to professional practice. Just 3% (n= 13) considered it unimportant. EBM was used in clinical practice by 54% (n= 169) of participants. Thirty-six per cent (n= 114) referred to EBM sources when relevant. Available clinical guidelines were referred to by 56% (n= 176), and 34% (n= 107) thought that available guidelines provide sufficient support for the practice of EBM. The main barriers to practicing EBM were insufficient resources, overwork, lack of exposure to EBM, and lack of time and lack of endorsement of the need to practice EBM. CONCLUSIONS Knowledge and practices of EBM among Sri Lanka doctors were poor. However, attitudes toward EBM were relatively good.
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Affiliation(s)
- Chrishantha Abeysena
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
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Takeuchi F, Katsuya T, Chakrewarthy S, Yamamoto K, Fujioka A, Serizawa M, Fujisawa T, Nakashima E, Ohnaka K, Ikegami H, Sugiyama T, Nabika T, Kasturiratne A, Yamaguchi S, Kono S, Takayanagi R, Yamori Y, Kobayashi S, Ogihara T, de Silva A, Wickremasinghe R, Kato N. Common variants at the GCK, GCKR, G6PC2-ABCB11 and MTNR1B loci are associated with fasting glucose in two Asian populations. Diabetologia 2010; 53:299-308. [PMID: 19937311 DOI: 10.1007/s00125-009-1595-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Accepted: 10/06/2009] [Indexed: 12/22/2022]
Abstract
AIMS/HYPOTHESIS To test fasting glucose association at four loci recently identified or verified by genome-wide association (GWA) studies of European populations, we performed a replication study in two Asian populations. METHODS We genotyped five common variants previously reported in Europeans: rs1799884 (GCK), rs780094 (GCKR), rs560887 (G6PC2-ABCB11) and both rs1387153 and rs10830963 (MTNR1B) in the general Japanese (n = 4,813) and Sri Lankan (n = 2,319) populations. To identify novel variants, we further examined genetic associations near each locus by using GWA scan data on 776 non-diabetic Japanese samples. RESULTS Fasting glucose association was replicated for the five single nucleotide polymorphisms (SNPs) at p < 0.05 (one-tailed test) in South Asians (Sri Lankan) as well as in East Asians (Japanese). In fine-mapping by GWA scan data, we identified in the G6PC2-ABCB11 region a novel SNP, rs3755157, with significant association in Japanese (p = 2.6 x 10(-8)) and Sri Lankan (p = 0.001) populations. The strength of association was more prominent at rs3755157 than that of the original SNP rs560887, with allelic heterogeneity detected between the SNPs. On analysing the cumulative effect of associated SNPs, we found the per-allele gradients (beta = 0.055 and 0.069 mmol/l in Japanese and Sri Lankans, respectively) to be almost equivalent to those reported in Europeans. CONCLUSIONS/INTERPRETATION Fasting glucose association at four tested loci was proven to be replicable across ethnic groups. Despite this overall consistency, ethnic diversity in the pattern and strength of linkage disequilibrium certainly exists and can help to appreciably reduce potential causal variants after GWA studies.
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Affiliation(s)
- F Takeuchi
- Department of Gene Diagnostics and Therapeutics, Research Institute, International Medical Center of Japan, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
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