Browsing by Author "Gunawardena, N."

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Cultural adaptation, translation and validation of the ISPCAN Child Abuse Screening Tool - Retrospective Version (ICAST-R) for young adults in Sri Lanka
(Elsevier Science Inc, 2018) Chandraratne, N.K.; Fernando, A.D.; Gunawardena, N.
The aim of the present study was to adapt and validate the ISPCAN child abuse screening tool-retrospective version (ICAST-R) in Sri Lanka with a view to investigating the experiences of physical, sexual and emotional abuse during childhood. The adaptation was performed using qualitative research methods with young adults, parents, teachers, and a multidisciplinary group of experts. The translation to Sinhala (the local Sri Lankan dialect) was carried out by a nominal group technique. A multidisciplinary team of experts assessed the Sinhala ICAST-R (SICAST-R) for its content validity. Moreover, acceptability, reliability and construct validity were determined by conducting a validation study among 200 schooling young adults. The principal component analysis (PCA) technique was used to assess the construct validity. Response rates for each item were taken as evidence of acceptability. The internal consistency was assessed by Cronbach's alpha, and test-retest reliability after two weeks was assessed using Cohen's kappa coefficient. The adaptation of ICAST-R included the introduction of an objective manner by which to measure severity of abuse and the inclusion of a set of questions regarding help-seeking behavior following physical and emotional abusive experiences. The SICAST-R showed adequate content validity and high acceptability, with response rates ranging from 90.3% to 99.5%. The minimum Cohen's kappa coefficient was 0.76, indicating good test-retest reliability. The internal consistency (Cronbach's alpha) for the total tool was 0.708, with the three constructs being 0.398, 0.844 and 0.637 for physical, sexual and emotional abuse, respectively. The PCA demonstrated good reproducibility for sexual and emotional abuse with the hypothesized structure. Overall, the SICAST-R showed adequate validity for the assessment of experiences of physical, sexual and emotional abuse during childhood among Sri Lankan young adults.
Envenoming Snakebite Risk Map for Sri Lanka
(Faculty of Graduate Studies, University of Kelaniya, Sri Lanka, 2016) Ediriweera, D.; Kasturiratne, A.; Pathmeswaran, A.; Pathmeswaran, A.; Gunawardena, N.; Jayamanne, S.; Wijayawickrama, B.; Isbister, G.; Giorgi, A.D.E.; Diggle, P.; Lalloo, D.; de Silva, J.
Snakebite is a neglected tropical disease. Hospital based statistics often underestimate snakebite incidence because a significant proportion of victims seek traditional treatments. Since geospatial risk assessments of snakebite envenoming are rare, health care resources are distributed based on administrative boundaries rather than on a need analysis. The aim of the study was to develop a snakebite envenoming risk map for Sri Lanka. Epidemiological data was obtained from a community-based island-wide survey. The sample was distributed equally among the nine provinces. 165,665 participants living in 1118 Grama Niladhari divisions were surveyed. Model-based geostatistics was used to determine the geographical distribution of envenoming bite incidence. The Monte Carlo maximum likelihood method was used to obtain parameter estimates and plug-in spatial predictions of risk. A predictive model was developed with natural and social environmental variables to construct an estimated envenoming bite incidence map and a probability contour map (PCM) to demonstrate the spatial variation in the predictive probability that local incidence does or does not exceed national envenoming snakebite incidence (i.e. 151 per 100,000). Envenoming bite incidence had a positive association with elevation up to 195 meters above sea level, with incidence dropping at higher elevations. The incidence of envenoming was higher in the dry zone compared to intermediate and wet climatic zones and decreased with increasing population density. Developed risk maps showed substantial within-country spatial variation in envenoming bites. Conclusion: The risk maps provide useful information for healthcare decision makers to allocate resources to manage snakebite envenoming in Sri Lanka. We used replicable methods which can be adapted to other geographic regions after re-estimating spatial covariance parameters for each region of interest.
Evaluating Spatiotemporal Dynamics of Snakebite in Sri Lanka
(International Postgraduate Research Conference 2019, Faculty of Graduate Studies, University of Kelaniya, Sri Lanka, 2019) Ediriweera, D.; Diggle, P.; Kasturiratne, A.; Pathmeswaran, A.; Gunawardena, N.; Jayamanne, S.; Lalloo, D.; de Silva, J.
Snakebite data has shown spatial and temporal variations in many countries and regions. Yet, no study has evaluated spatiotemporal patterns of snakebites across a country in detail. We used data from the National Snakebite Survey (NSS), which sampled 0.8% of the national population (165665 people) living in 1118 clusters representing all the provinces. Explanatory variables of previously published spatial and temporal models for the NSS data were considered as candidate explanatory variables for our spatiotemporal models. Spatial prediction models for snakebite incidence was a geostatistical binomial logistic model and the temporal prediction model was a Poisson log-linear model, which predicted snakebite incidence at the national level. These spatial and temporal models could not explain locally varying temporal patterns in the country. Therefore, we constructed spatiotemporal models at the provincial levels. The NSS was conducted for 11 consecutive months, and different clusters were surveyed in each month. Therefore, the NSS can be considered as a set of 11 repeated cross-sectional surveys at different locations. NSS captured bite events that occurred in the survey month and in the 12 preceding months. Hence, each individual provided information regarding the number of bites experienced in each of 13 months. In the NSS data, the location of each sampled individual was fixed at the cluster centroid and the data contain the month of each recorded bite, if any, over a 13 month period covering the survey month and each of the preceding 12 months. We modelled the data from each cluster as an inhomogenous Poisson process with cluster-level explanatory variables and estimated the model parameters by maximising the pooled log-likelihood over all. The fitted cluster-level spatiotemporal models were aggregated so as to predict the province-level monthly bite incidence rates in Sri Lanka. Snakebite incidence showed complex spatiotemporal patterns in Sri Lanka. Models fitted for Southern, North Central, Uva and Sabaragamuwa provinces showed both spatial and temporal variation in snakebites. The geographical extent of the high-risk areas (i.e. hotspots) in these provinces dynamically changed over a period of a year. The remaining five models (i.e. Western, Central, North Western, Northern and Eastern) did not show any spatio-temporal interaction, in risk, i.e. the geographical extent of the hotspots persisted throughout the year. Southern, Sabaragamuwa and North Central provinces showed triannual seasonal trends. High snakebite incidences in Southern and Sabaragamuwa provinces were noticed in April followed by December and August to September. Peak incidences in North Central province were seen in November and another two smaller peaks were observed in April and July. Uva province showed a biannual trend with highest incidences in June followed by December. These findings can inform healthcare decision-making at local level, taking account of the seasonal variations in order to prevent and manage snakebites in Sri Lanka
Knowledge on health promotion approach among Public Health Midwives in a district in Sri Lanka
(Postgraduate Institute of Medicine, University of Colombo, 2015) Perera, M.; Guruge, N. D.; Gunawardena, N.
BACKGROUND: The Ottawa Charter defines Health Promotion as the "process of enabling people to increase control over, and to improve, their health". The National Health Promotion Policy recognizes health promotion as an efficient and cost effective approach to promote health in Sri Lanka. The Public Health Midwife (PHM) is the grass root level health worker responsible for promoting the health of communities in Sri Lanka. Their knowledge regarding health promotion has not been assessed. The main aim of this study was to describe their knowledge on health promotion and associated factors. METHODS: A cross sectional descriptive study was conducted among all PHMM (N=364) in the Kandy District who were eligible, using a self-administered questionnaire. Level of knowledge was based on scores obtained for responses to close ended questions and case scenarios. RESULTS: Knowledge on health promotion was „poor‟ among 238 (65.4%). Incorrect labeling of other activities as activities using a health promotion approach was common 257(70.6%). Training programmes 285(73.9%) were the commonest source of knowledge while 95(26%) were never trained on health promotion approach during their career. The factors that were significantly associated with a level of „good‟ knowledge on health promotion in multivariate analysis were; experience in the public health field less than 20 years (p=0.012), participating in training programmes on health promotion (p=0.03) and experience in implementing health promotion programmes (p=0.04). CONCLUSIONS: The study concludes that PHMM in the Kandy District have a "poor" level of knowledge on health promotion and recommends increasing training opportunities and improving opportunities for application to improve the situation.
Neurocognitive skills in children with congenital hypothyroidism attending the endocrine clinic of the Professorial Unit of the Lady Ridgeway Hospital for Children, Colombo
(Sri Lanka College of Paediatricians, 2016) Sumanasena, S.P.; Gunawardena, N.; Dissanayake, B.; Dilanka, S.; de Silva, S.
BACKGROUND: Early thyroxine replacement prevents intellectual impairment due to congenital hypothyroidism (CHT). There is minimal evidence on neurodevelopmental outcome of children commenced on thyroxine during early infancy from countries not screening for CHT. OBJECTIVE: To assess the neurocognitive skills of children with CHT of age group 6-10 years, attending the endocrine clinic of the Professorial Paediatric Unit, LRH compared to age matched controls and to assess the influence of age at diagnosis, initial thyroid stimulating hormone (TSH) levels, thyroxine commencement dose and number of clinic visits in the first year on neurocognitive skills. METHOD: A retrospective study was carried out from 1st January 2010 to 1stJanuary 2011 on children with CHT of age group 6-10 years, followed up in the endocrine clinic of the Professorial Paediatric Unit, LRH. Age matched healthy children aged 6-10 years were selected from similar socioeconomic backgrounds to compare the neurocognitive attainments. Neurocognitive skills were assessed using an age appropriate battery of instruments. Children older than 10 years were excluded as the assessment tools were designed only for the age range 6-10 years. Children with other co-morbidities adversely affecting their neurocognitive development were also excluded. RESULTS: Twenty three children with CHT of age group 6-10 years were followed up in the endocrine clinic of the Professorial Paediatric Unit, LRH during the study period and 2 were excluded. Forty two age matched controls of age group 6-10 years also participated in the study. The mean age of the children was 2.42±2.59 years. The mean TSH levels at diagnosis was 43.17± 34.25mU/L. Starting dose of thyroxine in the majority was less than 10µg/kg/day. Children with CHT performed less than their peers in all age ranges and in all areas of skills. Statistically significant differences were documented in the total performance percentiles at ages of 8 (p=0.0001) and 9 years (p=0.0002). Similarly, they performed less in literacy at 8 (p=0.015) and 9 years (p=0.004), verbal performance at 8 years (p= 0.0002) and numeracy in 9 years (p=0.035). There was no significant correlation between the neurocognitive scores and age at diagnosis, initial TSH levels, thyroxine commencement dose or the number of clinic visits in the first year. CONCLUSIONS: Children with CHT of age group 6-10 years, attending the endocrine clinic of the Professorial Paediatric Unit, LRH had significantly reduced neurocognitive skills compared to age matched controls. There was no significant correlation between the neurocognitive scores and age at diagnosis, initial TSH levels, thyroxine commencement dose or number of clinic visits in the first year.
Neurocognitive skills in children with congenital hypothyroidism attending the endocrine clinic of the Professorial Unit of the Lady Ridgeway Hospital for Children, Colombo.
(Sri Lanka College of Paediatricians, 2017) Sumanasena, S.P.; Gunawardena, N.; Dissanayake, B.; Dilanka, S.; de Silva, S.
This is the correspondence to the article appeared in Sri Lanka Journal of Child Health. 2016; 45 (2):95-102. by same authors,
Physical, sexual and emotional abuse during childhood: Experiences of a sample of Sri Lankan young adults
(Elsevier Science Inc, 2018) Chandraratne, N.K.; Fernando, A.D.; Gunawardena, N.
Abuse during childhood is a human tragedy leading to lifelong adverse health, social, and economic consequences for survivors. This descriptive, cross-sectional study aimed to determine the prevalence of childhood physical, sexual and emotional abusive experiences among students (aged 18-19 years) in a Sri Lankan district. Multistage cluster sampling was used to select a sample of 1500 students. Experiences of physical, sexual and emotional abuse and age at abuse, perpetrators, consequences and severity were assessed using a version of ISPCAN Child Abuse Screening Tool-Retrospective Version (ICAST-R) which was culturally adapted and validated by the authors for use amongst Sinhalese students. The prevalence of the various forms of abuse during childhood was as follows: physical: 45.4% (95% CI: 42.9-7.9); sexual: 9.1% (95% CI: 7.6-10.5); emotional: 27.9% (95% CI: 25.7-30.2). The corresponding percentages of individuals categorized as having experienced severe or very severe abuse were as follows, physical: 0.3% (2/672); sexual: 4.05% (3/135); emotional: 8.8% (36/412). Experience of physical abuse was more prevalent amongst male students (54.8% vs. 38.3%) as was emotional abuse (33.9% vs. 23.2%), whereas experience of sexual abuse was more prevalent amongst female students (11.5% vs. 6.4%). Parents and teachers were the commonest perpetrators of physical and emotional abuse. Most of the sexually abusive acts were committed by neighbors or strangers. Some physically abusive acts were more frequent at earlier ages than emotional and sexual abusive acts, which were more common in late adolescence. The results indicate the necessity of targeted interventions to address this public health issue.