Browsing by Author "Abeysena, H.T.C.S."

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A complex-intervention to change dengue prevention behaviours of the householders in the Kurunegala District
(Sri Lanka Medical Association, 2021) Rajapaksha, R.M.N.U.; Abeysena, H.T.C.S.; Balasuriya, A.
INTRODUCTION AND OBJECTIVES: Dengue is a leading public health problem in Sri Lanka. Evaluation of community-based intervention on behavioural change is identified as the key functional areas to prevent future outbreaks. The study was aimed to assess the complex intervention package on changing the behaviour of the householders to prevent dengue in Kurunegala district. METHODS: A community-based parallel group cluster randomized trial was conducted to assess the effectiveness of the COMBI based behavioural change intervention (n=167) versus routine standards of dengue control activities (n=166) among the householders in highly dengue endemic area in Kurunegala district from May to September 2019. A pre-tested, validated, interviewer-administered tool was used to collect data. Intention to treat analysis was applied using Logistic Regression with Generalized Estimating Equations. RESULTS: There were significant improvements of the overall dengue prevention behaviour (27.4%, 95% CI: 17.1% - 37.7%), knowledge (12.3%; 95% CI: 1.7% - 22.9%), attitude (7.3%; 95% CI: - 1.77% - 16.4%), practices (29.2%; 95% CI: 18.9% - 39.5%), health seeking behaviour (14.7%; 95% CI: 4.12% - 25.3%), and reduction of Pupal-Index (49.3%; 95% CI: 39.7% - 58.9%), House- Index (30.8%; 95% CI: 28.3 - 47.1%), Container-Index (17.7%; 95% CI: 8.8% - 26.6%) and Breteau-Index (52.2%; 95% CI: 43.5% - 60.9%) in the intervention group in comparison with the control group after three-months of the intervention. CONCLUSION: A COMBI planning process based interventional approach to change the behaviour for sustainable dengue control is effective. Importantly, it contributed to a significant reduction in the density of dengue vectors (Pupal Index and HI, CI, BI) and a number of potentials.
Development of risk prediction model for endometrial carcinoma among postmenopausal women in the Western Province.
(Sri Lanka Medical Association., 2019) Jayawickrama, W.I.U.; Abeysena, H.T.C.S.
INTRODUCTION & OBJECTIVES: Risk prediction model can be used to estimate the probability of developing endometrial carcinoma among postmenopausal women. The aim of the study was to develop a model to predict the risk of endometrial carcinoma among postmenopausal women. METHODS: A case control study was conducted. The cases and the controls were defined as postmenopausal women who had and had not been diagnosed as endometrial carcinoma based on histological confirmation respectively. Variable selection was done considering the objectivity and feasibility of the measurements in addition to the statistical criteria. A scoring system [ 1-9) was designed based on weighted score of each risk predictor. Predictive validity of the model was tested by calibration and discrimination. Receiver Operator Characteristic (ROC) curve was used to determine the cut-off value. RESULTS: The developed model consisted of six predictors: Age >55 years, never conceived, age at menarche ≤11 years, ever experienced postmenopausal bleeding, having family history of any type of cancer among first degree relative, generalized obesity. Discrimination of the model was measured by the area under the ROC curve (0.92, 95% Confidence Interval: 0.88-0.95). Calibration with goodness of fit by Hosmer and Lemeshow test (p=0.72) was satisfactory. The tool demonstrated a good predictive ability with sensitivity of 89.2% (Cl: 79.9%-94.6%) and specificity of 76.2% (CI: 79.8%-80.3%) at the cut-off point of 3.5. CONCLUSION: Model demonstrated good discrimination and calibration. It can be used in screening of high risk women for developing endometrial carcinoma in the community.
Development and validation of the interpersonal communication assessment tool for assessing the interpersonal communication skills of public health midwives
(BioMed Central, 2023) Prasanna, S.A.S.; Abeysena, H.T.C.S.; Alagiyawanna, M.A.A.P.
BACKGROUND: Interpersonal Communication Skills (IPCS) are one of the core clinical skills that should be developed by the Public Health Midwives (PHMs), who are grass-root level public healthcare providers in primary healthcare settings in Sri Lanka. This study aimed to develop and validate the Interpersonal Communication Assessment Tool (IPCAT), an observational rating scale, to assess the IPCS of PHMs. METHODS: Item generation, item reduction, instrument drafting, and development of the tool's rating guide were made by an expert panel. A cross-sectional study was conducted in five randomly selected Medical Officer of Health (MOH) areas, the smallest public health administrative division in the district of Colombo, Sri Lanka, to identify the factor structure, which is the correlational relationship between a number of variables in the tool. A sample of 164 PHMs was recruited. The data on IPCS were collected by video-recording the provider-client interaction using simulated clients. All recorded videos were rated by a rater using the drafted IPCAT, which included a Likert scale of 1(poor) to 5 (excellent). Exploratory factor analysis was conducted using the Principal Axis Factoring extraction method and the Varimax rotation technique to explore the factors. Three independent raters were used to rate ten randomly selected videos to assess the tool's internal consistency and inter-rater reliability. RESULTS: The IPCAT obtained a five-factor model with 22 items, and all five factors explained 65% of the total variance. The resulting factors were "Engaging" (six items on making rapport), "Delivering" (four items on paying respect), "Questioning" (four items on asking questions), "Responding" (four items on empathy), and "Ending" (four items to assess the skills of ending a conversation productively). The internal consistency, Cronbach's Alpha value, for all five factors was above 0.8, and the inter-rater reliability (ICC) was excellent (0.95). CONCLUSIONS: The Interpersonal Communication Assessment Tool is a valid and reliable tool for assessing the interpersonal communication skills of Public Health Midwives.
Development of a communication for behaviour impact plan on dengue prevention in the Kurunegala District
(Sri Lanka Medical Association, 2021) Rajapaksha, R.M.N.U.; Abeysena, H.T.C.S.; Balasuriya, A.; Alagiyawanna, M.A.A.P.; Pannilahetti, N.
INTRODUCTION AND OBJECTIVES: Communication for Behaviour Impact (COMBI) is a methodological process that blends strategically a variety of communication interventions intended to engage individuals and families in adopting healthy behaviours and maintaining those behaviours. The objective was to develop a COMBI plan to change the behaviour to prevent dengue in Kurunegala district, Sri Lanka. METHOD: The plan was developed according to World Health Organization’s COMBI planning 10 steps with the scientific evidence and expert opinion. The situation analysis was conducted using mixed-methodology from January to March 2019 among the adults in the highly dengue-endemic area in Kurunegala District. RESULTS: The overall goal of the plan was to contribute to the reduction in morbidity and mortality from dengue disease in the Kurunegala district by improving the dengue prevention behaviours by three months in 2019. After finalizing Specific Behaviour Objectives (SBOs) by conducting Situational Market Analysis for Communication Keys, the plan was developed. The SBOs for the plan were to improve the proper waste management practices according to ‘Three R concept’ (Reduce, Reuse and Recycling) and to improve the dengue prevention practices 30 minutes weekly cleaning. The strategies were to conduct a community empowerment program to improve household waste management and weekly practices on dengue prevention by conducting the administrative mobilization and public relationship, public advocacy, community mobilization, personal selling, advertising, point of service promotion during follow up. Conclusion: Developing a COMBI plan for an area after identification of specific behavioral objectives would be feasible to implement in order to empower the community to prevent dengue in the area.
Development of cardiovascular disease risk prediction model for Sri Lankans
(Sri Lanka Medical Association, 2021) Mettananda, K.C.D.; Thampoe, R.S.; Batagoda, B.M.S.M.; Arangala, D.M.P.; Abeysena, H.T.C.S.
INTRODUCTION AND OBJECTIVES: There are no Cardiovascular (CV) risk prediction models derived from Sri Lankans. Therefore, we aimed to develop a model to predict the risk of cardiovascular diseases (CVD) among Sri Lankans. METHODS: We developed a model to predict the risk of developing CVDs among Sri Lankans by comparing risk factors of patients who have had and haven’t had acute CVDs. Risk factors were selected depending on the odds ratios of each risk predictor and the feasibility of using those in clinical practice. Two separate models were developed for diabetics and non-diabetics. A scoring system [diabetics; 0-23 and non-diabetics 0-14] was designed based on weighted scores of each risk predictor. Predictive validity of the model was tested by calibration and discrimination. Receiver Operator Characteristic (ROC) curve was used to determine the cut-off value. RESULTS: The model consisted of five predictors; sex, current-smoking status, premorbid systolic blood pressure > 140 mmHg, antihypertensive medication usage and high-density-lipoprotein(HDL) < 45 mg/dL. Discrimination of the model was measured by the area under the ROC curve (diabetics; 0.76, 95% Confidence Interval: 0.68-0.84, non-diabetic; 0.91, 0.86-0.96). Calibration with goodness of fit by Hosmer and Lemeshow test (diabetics; p=0.75, non-diabetics; 0.66) was satisfactory. The tool demonstrated a good predictive ability with sensitivity and specificity of 71.1% (95%CI: 61.3% - 80.8%) and 68.4%(65.3% - 80.5%) in diabetics and 82.2% (95%CI: 72.7% - 91.7%) and 90.9% (95%CI: 84.9% - 96.9%) in non-diabetics. CONCLUSION: The model demonstrated good discrimination and well calibration. It can be used in screening high-risk Sri Lankans for developing cardiovascular diseases.
Evidence update on the use of inhaled corticosteroids in the management of bronchial asthma
(Postgraduate Institute of Medicine University of Colombo, 2014) Perera, M.N.; Abeysena, H.T.C.S.
The Feasibility of new HPV/DNA test as a primary cervical cancer screening method among 35- years- old ever-married women in Kalutara district; a cross-sectional study
(BioMed Central, 2021) Perera, K.C.M.; Mapitigama, N.; Abeysena, H.T.C.S.
BACKGROUND: Cervical cancer is the second commonest female cancer in Sri Lanka. Two major drawbacks of the present cervical cancer screening programme are the suboptimal sensitivity of the pap smear and the low coverage. The objective of the study is to determine the feasibility of a new HPV/DNA test among 35 -years -old ever-married women in a district of Sri Lanka. METHOD: A community based descriptive cross-sectional study was conducted from 1stof July 2018 to 30th November 2018 in the public health divisions called Medical Officer of Health (MOH) areas of Kalutara district. The study population is comprised of ever-married women 35 years of age. Three women from each cluster (n = 413) were selected by consecutive sampling. A total of 918 women were recruited. HPV/DNA cervical specimen collection (n = 822) was carried out. Cervical specimens were tested by two cytoscreeners with the cobas 4800 PCR based screening machine. Clients' perceptions and prevalence were assessed. The follow-up of women with positive HPV/DNA screening results was carried out. The operational and technical feasibility of the screening test were assessed. Data entry was done by using the statistical package IBM SPSS version 20. RESULTS: Overall response rate was 91.1% (n = 836). Clients' perception was highly positive for HPV/DNA screening test procedure (99.9%, n = 821) and 99.6% (n = 819) of clients had mentioned that the HPV/DNA screening test is worthwhile to be incorporated into the National Cervical Cancer Screening program. The prevalence of HPV was 6.2% (95%CI: 6.18-6.22%). The coverage of the HPV/DNA screening was 89.5%(n = 822). Invalid results reported were 0.12% (n = 1). The percentage of HPV/DNA test positive women who underwent pap test within 3 months of the initial screening was 100% (n = 51), while the percentage of women who attempted to get a colposcopy within the 1 month of referral was 86.7% (n = 13). CONCLUSIONS: HPV/DNA test implementation as a primary cervical cancer screening method is feasible among the 35- year age cohort of ever- married women in Kalutara district. It is necessary to further attempt alternative methods of cobas 4800 HPV/DNA test, which would be much suitable for resource-limited settings. KEYWORDS: Cervical cancer; Feasibility; HPV/DNA test; Implementation; Screening.
Knowledge of basic epidemiological and statistical concepts among doctors in selected Sri Lankan hospitals
(College of Community Physicians of Sri Lanka, 2010) Abeysena, H.T.C.S.; Jayawardana, P.L.; Wickremasinghe, A.R.; Wickramasinghe, U.
INTRODUCTION: This study was conducted to describe the ability to comprehend basic epidemiologic and statistical concepts among doctors in selected hospitals in the Western Province. METHODOLOGY: A cross-sectional descriptive study was conducted during January to February, 2008. The study population consisted of 315 doctors - 43 (13.7%) specialists, 50 (16%) postgraduate trainees (PG) and 222 (70.3%) grade medical officers. A self administered questionnaire was used to assess perceived knowledge on selected epidemiologic and statistical concepts/parameters and two problem based questions which tested the ability to apply knowledge were used. Data were analyzed calculating the proportion who perceived to have good knowledge regarding each concept. Logistic regression was applied to test for differences in good knowledge between different groups of subjects. RESULTS: More than 75% of the respondents claimed to have good knowledge on prevalence, sensitivity, specificity and case control studies. Less than 50% of them had good knowledge on risk difference, number needed to treat, systematic reviews, meta-analysis, p-value and 95% confidence intervals. Male doctors had a significantly higher good knowledge than female doctors (p<0.001), and those who read medical journals regularly than those who did not (p<0.05). Specialists and PG trainees had a significantly higher good knowledge (p<0.001) than grade medical officers. Correct answers of the respondents to the two problem based questions were 25% (n=79) and 15.8% (n=50), respectively. CONCLUSION : Even though some doctors claimed to have a good knowledge with regard to selected epidemiologic and statistical concepts, their ability to apply their knowledge was poor.
Musculoskeletal symptoms, skin disorders and visual impairment among fishermen in the Divisional Secretariat Division of Kalpitiya
(Sri Lanka Medical Association, 2015) Harshani, S.R.A.P.; Abeysena, H.T.C.S.
INTRODUCTION: To describe musculoskeletal symptoms, skin disorders and visual impairmentamong fishermen in the Divisional Secretariat Division of Kalpitiya. METHODS: This was a community based descriptive cross sectional study conducted from August to October 2011. The sample consisted of 465 fishermen with ≥ 6 months experience in fishing selected using the cluster sampling technique. An interviewer administered questionnaire and a record sheet were used for data collection. Prevalence of the above conditions with 95% confidence Intervals (CI) were calculated. Chi square test was applied for the investigation of the factors associated with the above conditions. RESULTS: The prevalence of musculoskeletal symptoms was 61% (95% CI: 56.6%-65.4%). The commonest symptom was back pain (37.6%). The prevalence of skin disorders was 24% (95% CI: 20.1-27.8) and visual symptoms were 38.9% (95% CI: 34.5%-43.3%). The prevalence of visualimpairment of either eye was 24.3% (95% CI: 20.3%- 28.3%) low vision of either eye 22.4% (95% CI: 18.6%- 26.2%) and blindness of either eye was 1.9% (95% CI: 1.1-2.7). The prevalence ofvisual impairment of better eye was 16% (95% CI: 12.7-19.3), low vision of better eye 15% (95% CI: 12-18.3) and blindness of better eye were 0.9% (95% CI: 0.05-1.75). The prevalence ofmusculoskeletal symptoms, skin disorders or visual impairment did not vary according to service duration in the fishing industry, number of days spent in the boat for a trip or type of boat. CONCLUSIONS: Prevalence of musculoskeletal and skin disorders and visual impairment were relatively higher among the fishermen.
Perceptions of editorial staff and coverage of reproductive health related newspaper articles and adolescents3 expectations
(Sri Lanka Medical Association, 2009) Kumarendran, B.; Nandasena, Y.L.S.; Abeysena, H.T.C.S.
OBJECTIVE: 1. To describe coverage of selected Sinhalese newspaper articles on reproductive health (RH) and to explore the attitudes of editorial staff related to RH publications. 2. To explore the mpressions and expectations of adolescent school children about reproductive health (RH) information published in Sinhalese newspapers METHODS: Most popular three national and three tabloid newspapers were identified through focus group discussions with adolescent school children in the Gampaha district. The newspapers published during the preceding six months (May to October 2007) to the survey were selected and data extraction was done by two medical officers. In-depth interviews were conducted with ditorial staff (n=ll) of the selected newspapers to explore their attitudes regarding the RH related publications and their constraints. Focus group discussions (FGD) were conducted among advanced level students (n=134) in five schools in the Gampaha district selected by stratified purposive sampling based on subject stream, sex and location (urban/rural). RESULTS: 268 articles were published on RH in national and tabloid papers during the reference period. Pregnancy related issues (n= 67, 25%) were the most commonly discussed topic in both types of newspapers. Other articles were mainly on sexually transmitted diseases (n=38, 14.2%), commercial sex (n=35, 13.1%), and abortion (n= 26, 9.7%). Most of the published articles included photographs. Half (n= 138) of the articles were written with the guidance of qualified medical doctors. Although the spectrum of RH issues was known, the journalists tend to write on topics such as sexually transmitted diseases but not on homosexuality, virginity and family planning. This narrow coverage was due to limited space, cultural restrictions in the selection of topics and inadequate guidance from medical personnel. The majority of the students were not satisfied about the adequacy of various aspects covered and presentation of RH related information by newspapers. CONCLUSION: RH related newspaper information was limited to selected topics. Although journalists knew the spectrum of RH related topics, publications were limited to selected topics. The topics covered on RH by newspapers were not presented in an adolescent friendly manner and were not on areas that they have a quest for.
Perceptions of the cervical cancer screening programme in Sri Lanka, among healthcare workers in Kalutara district
(College of Community Physicians of Sri Lanka, 2021) Perera, K.C.M.; Abeysena, H.T.C.S.; Mapitigama, N.
Background: Even after 20 years of existence of the cervical cancer programme with pap smears, there is no marked reduction in the incidence of cervical cancer in Sri Lanka. Therefore, the cervical cancer screening programme needs to be reviewed again. Objective: To explore the perceptions of cervical cancer screening programme among health care workers. Methods: Focus group Discussion (FGD) sessions among Public Health Midwives (n=4) and Key Informant Interviews (KII) (n=10) among health care workers in the Kalutara district were conducted. A convenient sampling technique was used. Public Health Midwives for each focus group (n=8) were selected according to their seniority and the representation of communities. Triangulation methodology was used. At last summary, results were prepared and analysis was done by manual content. Results: Majority of the participants were Sinhalese (n=41, 97.6%), Buddhist (n=39, n=92.9%) and over 40 years of age (n=31, n=73.8%). Some had >20 years of service in the field (n=14, n=33.3%). Some participants mentioned the low sensitivity of pap smears and therefore the missing of lesions, unsatisfactory smears, and reporting delay due to the work burden of cytoscreeners as disadvantages of the pap smear method. Increase community awareness, supervision of WWC activities, conduction of mobile clinics indicated as pathways to improve the coverage by the participant. HPV/DNA test was well accepted as its sensitivity is high, while the majority stated to improve the coverage by vaginal specimens as the procedure is simple and can be done even by public health midwives. Conclusions: Increase community awareness, supervision, and mobile clinics to cover hard to reach population were mainly stated to improve the coverage. The Vaginal HPV/DNA specimens were mentioned as a new tool to improve the coverage.
Pilot intervention to assess the efficacy of a complex-intervention package to prevent dengue in Kurunegala district, Sri Lanka
(College of Community Physicians of Sri Lanka, 2021) Rajapaksha, R.M.N.U.; Abeysena, H.T.C.S.; Balasuriya, A.
Background: Dengue is a leading public health problem in Sri Lanka. Development and evaluation of community-based intervention on behavioural changes are identified as key functional areas to prevent dengue outbreaks. The research study aimed to assess the complex-intervention package on changing household behaviour to prevent dengue. Method: A community based pre-post pilot-intervention was conducted to assess the efficiency of a COMBI-based complex-intervention among 121 adults, aged between 18 to 70 years in households in highly-endemic area in the Kurunegala district. Improvement of proper waste management practices according to the 3R concept (Reduce, Reuse and Re-cycling) was the finalized specific behavioural objectives of the COMBI plan. The outcomes were compared with paired t-test and McNemar test. Results: The response-rate of the pilot-study was 97.5% (n=118). The result revealed that the adequate post interventional knowledge on dengue prevention of the intervention group, positive atitude towards dengue prevention, adequate health-seeking behaviour and the overall community capacity was significantly improved by 37.3%, 39.9%, 31.3% and 16.3% in the post-interventional assessment than the pre-intervention assessment respectively. Notably, adequate dengue prevention behaviours were improved by 51.7% in the post-intervention assessment than the preintervention assessment. Conclusion: A COMBI planning process based interventional approach to change the behaviour for sustainable dengue control is feasible, implementable and efficient. it was able to achieve the significant improvement of the desired outcome of interest including knowledge, atitudes, practices, health seeking behaviours, community capacity and dengue prevention behavior following the pilot intervention.
Prevalence of visual impairment among adults aged forty years and above in the MOH area Mahara
(Sri Lanka Medical Association, 2010) Hapugoda, H.T.C.J.; Abeysena, H.T.C.S.
OBJECTIVES: Visual impairment is a worldwide health problem. It affects mainly low and middle income countries with a rapid increase in the aging population. Main causes of visual impairment in Asian countries are cataract and refractive errors. Up to 80% of visual impairment can be prevented and treated cost effectively. The study was conducted to determine the prevalence of different types of visual impairment among adults aged forty years and above in the MOH area Mahara. METHODS: This was a community based descriptive cross sectional study, conducted in the MOH area Mahara, during the period between August and October 2009. Study population consisted of 602 adults aged forty years and above selected from applying cluster sampling technique. Study instruments were an interviewer administered questionnaire and a record sheet. Data analysis was done using SPSS 16th version. Prevalence of visual impairment and its 95% confidence intervals (CI) were calculated. RESULTS: Overall prevalence of visual impairment was 21.3% (95% CI: 18.03-24.57). Prevalence of low vision and blindness were 19.6% (95% CI: 16.43-21.77) and 1.7% (95% CI: 0.67-2.73) respectively. Prevalence of visual impairment with best correction was 11% (95% CI: 8.55-13.45). Prevalence of low vision and blindness with best correction was 8.3% (95% CI: 7.12-11.48) and 1.7% (95% CI: 0.67-2.73). Overall prevalence of refractive error and prevalence of cataract were 11.1% (95% CI: 8.59-13.61) and 14.6% (95% CI: 11.78-17.42) respectively. CONCLUSION: VisuaS impairment was a health problem among adults aged 40 years and above in the MOH area Mahara.
Psychological stress and associated factors among adults in the quarantine families following COVID-19 in Kurunegala district, Sri Lanka
(College of Community Physicians of Sri Lanka, 2021) Rajapaksha, R.M.N.U.; Abeysena, H.T.C.S.; Jayasooriya, S.P; Pushpalal, G.C; Dissasnayake, M.; Wijesingha, S.; Athukorala, P.; de Mel, N.
Background: Psychosocial-stress for a newly-emerged contagious-disease of the COVID-19 needs to be evaluated. The aim of the study was to assess the prevalence of psychosocial-stress and associated predictors in the home-quarantine families following the COVID-19 outbreak. Method: A descriptive cross-sectional study was conducted among randomly selected 403 Quarantined adults in Kurunegala district from May to July 2020 during the first wave of the COVID-19 outbreak. The suspected index-cases and known patients with mental-health abnormalities were excluded. The GHQ-30, a validated screening tool, was used to assess psycho-social status. The scores were given as 0-0-1-1 for each item in GHQ30, out of which a score of ≥6 was considered as adults under psychosocial-stress. The binary Probit model and multivariate-regression model were used to assess the associated factors.Results: The response rate was 96.5% (n=389). The prevalence of psychological stress was 37%(n=144; 95% CI = 32.6 – 42.4). The probit model shows the likelihood of influence of the factors affecting the prevalence, and the Odds-Ratio was examined. The multivariate-regression model was 2 significant at F (12, 309) = 3.86, R = 12.95 (n=322). The results of the best fitting regression model th depicted that the associated determinants including arrived in Sri Lanka after 10 of March 2020, within 5 days of exposure to a COVID-19 patient, stayed at a quarantined-centre and male-gender were statistically significant (p<0.05) factors of predicting the psychosocial stress. Conclusion: The prevalence of psychosocial stress among the home-quarantined adults following COVID-19 are significantly high and the factors that determine the stress are likely to occur in the significant predictors.
The Quality of interaction between Public Health Nursing Sister and Public Health Midwife during supervision in maternal and child health care settings in Sri Lanka
(Postgraduate Institute of Medicine, University of Colombo, 2014) Samaraweera, N.Y.; Abeysena, H.T.C.S.; Liyanage, T.; Taft, A. J.
Objective To measure the quality of interaction between the Public Health Nursing Sister (PHNS) and the Public Health Midwife (PHM) during supervision. Methods This was a cross-sectional study, using triangulation of data obtained from structured observations and audio tape records of supervisor-supervisee interactions and written records of all supervision activities. Twenty four PHNS participated in the study. This study was undertaken in the district of Kalutara. Results Supervisors spent less time on supervising client care issues than on supervising facility level issues and interacting with clients. The weakest skills among the PHNS were ‘seeking client input’ and ‘discussing the next visit’ and the strongest skills were ‘giving feedback’, ‘discussing/interpreting data’ and ‘developing rapport’. Skills of supervision increased with the service duration of the PHNS but none were able to achieve the cut-off mark for satisfactory overall quality of interaction. Conclusions This study indicates that the overall quality of interaction between the PHNS and the PHM during supervision was poor. PHNS lacked skills in prioritisation of supervision activities and time management. They also lacked other necessary skills that ensure a higher quality of PHNS-PHM interaction. DOI: http://dx.doi.org/10.4038/jpgim.7607
Retrospective study on the foeto–maternal status of teenage pregnancies in the Dimbulagala MOH area
(Sri Lanka Medical Association, 2017) Liyanage, C.; Abeysena, H.T.C.S.; Ariyarathne, A.M.N.; Liyanage, J.; Senavirathnea, D.P.M.A.; Thilak Udayasiri, A.A.
INTRODUCTION & OBJECTIVES: A pregnancy occurring in a young woman who has not reached her 20th birthday is considered as a teenage pregnancy. The impact of consequences of teenage pregnancies in Sri Lanka is not well described. The objective of the study was to assess the foetal and maternal status of teenage pregnancies in the Dimbulagala MOH area. METHODS: A community based retrospective cohort study was carried out in the Dimbulagala MOH area. A sample of 160 teenage mothers was selected. An interviewer-administered pre–tested questionnaire was used to collect the data during the study period. Data was analyzed using SPSS 17 version. RESULTS: Of this sample of teenage mothers, 75.0% (n=120) were aged between 17 and 19 years and their highest educational level was up to grades 6-11. Out of the total sample, 75% had attained puberty before 13 years of age. From this sample, 30% had ante-natal complications in early pregnancy like anaemia, ante-partum complications and PIH. Low birth weight (less than 2.5kg) was seen in 42.1% (n=67). Only 4.4% (n=7) was admitted to the PBU due to foetal complications. CONCLUSION: Though we had an idea that teenagers encounter several problems in foetal and maternal life, this study showed those parameters were not above the national average. Further studies should be conducted to evaluate the foeto-maternal status in the future.
Secondary preventive measures adopted in the management of patients with Acute Coronary Syndrome admitted to the National Hospital of Sri Lanka
(Postgraduate Institute of Medicine University of Colombo, 2014) Ariyarathna, N.; Abeysena, H.T.C.S.
OBJECTIVE: To describe the secondary preventive measures adopted in the management of patients with Acute Coronary Syndrome (ACS) admitted to the National Hospital of Sri Lanka (NHSL), in comparison with standard guidelines. METHODS: A hospital based, descriptive cross-sectional study was carried out in the Cardiology Unit and medical wards of the NHSL during September to October 2009. A sample of 345 patients diagnosed with ACS was included in the study. Medical records were used as the source of data regarding secondary preventive measures during the in-ward period. RESULTS: Among ACS recruited, 168 (48.7%) were diagnosed with unstable angina, 92 (26.7%) with NSTEMI and 85 (24.6%) with STEMI. Acetyl Salicylic Acid (ASA) was given within 3 hours and documented in only 175 (53.7%). Although a twelve-lead ECG within 20 minutes of arrival at hospital is recommended in the guidelines, ECG was performed after 20 minutes in 203 (59%). In 85 with STEMI 66 (77.6%) received re-perfusion/streptokinase therapy. The time of commencing streptokinase was noted in only 49 (57.6%) and only 9 (18%) received streptokinase within 30 minutes of arrival in hospital. Left ventricular function was assessed in only 53 (15.4%) patients. Continuity of treatment with ACE inhibitors was seen in 298 (86.4%), beta- blockers in 213 (61.7%) and statins in 326 (94.5%). In 337 (97.7%) a maintenance dose of ASA was given during the hospital stay. CONCLUSIONS: Some processes in the management of patients with ACS at NHSL did not meet the standard set by local and international guidelines on secondary preventive measures. DOI: http://dx.doi.org/10.4038/jpgim.7330
Surge capacity of the curative sector healthcare institutions for the management of Dengue in Kurunegala district, Sri Lanka
(College of Community Physicians of Sri Lanka, 2021) Rajapaksha, R.M.N.U.; Abeysena, H.T.C.S.; Balasuriya, A.
Background: Surge capacity is defined as the ability to obtain adequate staff, supplies, structures and systems to provide sufficient care to meet immediate needs of an influx of patients. The aim of the study was to describe surge-capacity of the curative-healthcare institutions for the management of dengue in Kurunegala district. Methods: A descriptive cross-sectional study was conducted among all curative-healthcare institutions with inward-care (n=46), May-September 2019. The data was taken from the medical administrator or designated person using an interview administered tool, which was formulated using 'Science of Surge Theory' and 'CO-S-TR Model'. Results: Response-rate was 93.5% (n=43). The higher proportion had inadequate staff capacity (55.8%; n=24), adjustable beds (69.8%; n=30), infusion-pumps (72.1%; n=31), monitors (51.2%; n=22), oxygen (100%; n=43) and 27.9% (n=12) had Pack-Cell-Volume (PCV) monitors. Of the equipped institutions, 13.3% (n=4), 38.7% (n=12), 40.9% (n=9), 30.2% (n=13) and 66.7% (n=8) had adequate number of adjustable beds, infusion-pumps, monitors, oxygen and PCV-monitors respectively. The majority had designated emergency units (90.7%; n=39) and 11.6% (n=5) X-ray, 9.3% (n=4) USS and 9.3% (n=4) blood bank. The majority had focal-points (76.7%; n=33), written disaster plans (72.1%; n=31) and 34.9% (n=15) had teams with adequate risk-communication capabilities. The higher proportion (69.8%; n=30) had inadequate overall surge capacity. The Provincial General Hospitals and 75% (n=3) of the Base-hospitals had moderate-level and 76.3% (n=29) of the District-Hospitals had basic-level overall surge capacity for dengue outbreak management. Conclusion: There is a need for improvement of surge capacity of the curative-healthcare institutions and capacity development programmes need to be initiated.
Surge-capacity of the preventive healthcare institutions for the management of dengue in the Kurunegala District
(Sri Lanka Medical Association, 2021) Rajapaksha, R.M.N.U.; Abeysena, H.T.C.S.; Balasuriya, A.
INTRODUCTION AND OBJECTIVES: The surge-capacity is defined as the ability to obtain adequate ‘Staff, Supplies, Structures and Systems’ to provide sufficient care to meet the immediate needs of an influx of patients following a large-scale incident or outbreak. The aim of the study was to describe the surge- capacity of the preventive healthcare institutions for the management of dengue in Kurunegala district. METHODS: A descriptive cross-sectional study was conducted among all institutions (n=28) in 2019. An interviewer-administered tool was formulated according to the ‘Science of Surge Theory’ and ‘CO-S-TR Model’. There was basic-level (26 to 50%), moderate-level (51 to 75%) and high- level (>75%) surge-capacities for 10 broad areas of the assessment. RESULTS: The majority of the institutions (69.2%; n=18) had inadequate staff-capacity. Three-fourth (76.0%; n=19) did not have a written plan for preparedness. The higher proportion (n=19; 73.1%) had focal points, Personal Protective Equipment (AE) (65.4%; n=17), chemical for mosquito control (92.3%; n=24), and fogging-instrument (88.5%, n=23). The basic-level capacity existed in the areas of staff mobilization (53.8%; n=14), management of staff (76.9%; n=20), triage of cases (76.9%; n=20), and transportation (46.2%; n=12). The moderate-level capacity was existed in the areas of commanding (42.3%; n=11), controlling (38.5%; n=10), coordinating (61.5%; n=16), supplying of special needs (50.0%; n=13) and tracking of the cases (76.9%; n=20). The higher proportion (84.6%; n=22) had inadequate overall-surge capacity for the management of dengue. CONCLUSION: There is a need for improvement of surge capacity of the preventive healthcare institutions and capacity development programmes need to be initiated.
Validity of the Sinhala version of the general health questionnaires item 12 and 30: Using different sampling strategies and scoring methods
(Ibn Sina Academy of Medieval Medicine & Sciences, 2016) Abeysena, H.T.C.S.; Jayawardana, P.L.; Peiris, M.U.P.K.; Rodrigo, A.
OBJECTIVE: To determine the criterion validity of the Sinhala version of the General Health Questionnaire-12 (GHQ-12) and GHQ-30 employing different sampling designs and scoring methods. METHODS: This was a descriptive cross-sectional study including 374 patients. The GHQ-30 was completed by the participants using likert scale and then converted into standard score. The ‘Clinical Examination’ was done blindly to the GHQ score as the reference standard. Total study sample was considered as a representative sample taken consecutively. Case-reference design included 126 cases and 126 randomly selected controls based on reference standard. Test result-based designs included two groups of positive and negative GHQ, based on the optimal cut-off level. Cut-off levels were determined by using three criteria. In addition stratum specific likelihood (SSLR) ratio also considered. RESULTS: Applying consecutive sampling design, for the GHQ-12, the optimal cut-off levels were 9/10 using likert score and 2/3 using standard score and for the GHQ-30, 25/26 using likert score and 6/7 using standard score. The optimal cut-off level depends on the different sampling designs employed in addition to criteria for determining cut-off levels. The SSLR of>1 was useful for determining optimal cut-off level. Irrespective of the scoring methods, application of case-reference design tends to be overestimation of the specificity with high threshold values and test result-based design tends to be overestimation of the sensitivity, compared to consecutive sampling. Using likert scoring method, the sensitivities were higher than standard scoring method. CONCLUSIONS: The optimal cut-off levels depend on the sampling design and the scoring method employed and criteria to determine cut-off levels.