Browsing by Author "Jayamanne, S.F."

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Acute poisoning in the paediatric age group in North-Central province of Sri Lanka
(Sri Lanka Medical Association, 2013) Dayasiri, M.B.K.C.; Jayamanne, S.F.; Jayasinghe, Y.C.
INTRODUCTION AND OBJECTIVES: There is little data on poisoning in the paediatric age group in the North Central Province (NCP) of Sri Lanka. Objective of this study was to identify characteristics, risk factors and outcome of poisoning in the paediatric age group in the NCP. METHODS: All children presenting with either accidental or deliberate poisoning, to all paediatric casualty units at the Anuradhapura and Polonnaruwa Teaching Hospitals, over a period of 8 months from March 2012 were studied. Information was obtained from clinical interviews, focus group discussions, clinical observation and clinical records. RESULTS: Of the 167 children, 53% were male and 91% were below six years of age. Parents were agricultural workers in 25% and 51% had been educated up to GCE O' Level. Poisoning was mainly accidental (97%). Commonest poison was kerosene oil (24.9%). Reasons for delay in seeking medical help included lack of transport (14%), poor knowledge (12%), lack of awareness regarding urgency (12%) and financial constraints (8%). Complications included acute liver injury (4.2%), chemical pneumonitis (3.6%), and convulsions (1.8%). There were no deaths. Inadequate supervision by parents 87.5%, improper storage of household chemicals 52% and medicines 40% were common risk factors. CONCLUSIONS: Acute poisoning in children mostly occurred due to inadequate supervision by parents and improper storage of chemicals and medicines. Community education and safe storage of chemicals and medicines will reduce the incidence of poisoning in the paediatric age group.
Adjusting for spatial variation when assessing individual-level risk: A case-study in the epidemiology of snake-bite in Sri Lanka
(Public Library of Science, 2019) Ediriweera, D.S.; Kasturiratne, A.; Pathmeswaran, A.; Gunawardena, N.K.; Jayamanne, S.F.; Murray, K.; Iwamura, T.; Lalloo, D.G.; de Silva, H.J.; Diggle, P.J.
BACKGROUND:Health outcomes and causality are usually assessed with individual level sociodemographic variables. Studies that consider only individual-level variables can suffer from residual confounding. This can result in individual variables that are unrelated to risk behaving as proxies for uncaptured information. There is a scarcity of literature on risk factors for snakebite. In this study, we evaluate the individual-level risk factors of snakebite in Sri Lanka and highlight the impact of spatial confounding on determining the individual-level risk effects.METHODS:Data was obtained from the National Snakebite Survey of Sri Lanka. This was an Island-wide community-based survey. The survey sampled 165,665 individuals from all 25 districts of the country. We used generalized linear models to identify individual-level factors that contribute to an individual's risk of experiencing a snakebite event. We fitted separate models to assess risk factors with and without considering spatial variation in snakebite incidence in the country.RESULTS:Both spatially adjusted and non-adjusted models revealed that middle-aged people, males, field workers and individuals with low level of education have high risk of snakebites. The model without spatial adjustment showed an interaction between ethnicity and income levels. When the model included a spatial adjustment for the overall snakebite incidence, this interaction disappeared and income level appeared as an independent risk factor. Both models showed similar effect sizes for gender and age. HEmployment and education showed lower effect sizes in the spatially adjusted model.CONCLUSIONS:Both individual-level characteristics and local snakebite incidence are important to determine snakebite risk at a given location. Individual level variables could act as proxies for underling residual spatial variation when environmental information is not considered. This can lead to misinterpretation of risk factors and biased estimates of effect sizes. Both individual-level and environmental variables are important in assessing causality in epidemiological studies.
A case series of duplication errors due to brand name confusion - experience from a Sri Lankan teaching hospital
(Sri lanka Medical Association, 2015) Mamunuwa, A.M.V.G.N.; Jayamanne, S.F.; Coombes, J.; Lynch, C.B.; Perera, D.M.P.; Pathiraja, V.M.; Shanika, L.G.T.; Mohamed, F.; Dawson, A.H.
INTRODUCTION AND OBJECTIVES: Confusion with drug names has been identified as a leading cause of medication errors. The majority of these errors result from look-alike or sound-alike drugs. This case series aims to provide examples of duplication errors due to brand confusion where there are no similarities in the names. METHOD: Information for this case series was extracted from a database prospectively collected from Colombo North Teaching Hospital as part of a study conducted to evaluate the impact of the addition of a clinical pharmacist to the standard inpatient care. RESULTS: Of 800 patients reviewed during the study period of 7 months, clinical pharmacist identified 8 cases of duplication errors due to prescribing both generic and brand names of the same drug, but with no similarities in names. Cases identified include a duplication of frusemide caused by the lack of awareness that 'Amifru' {a combination of frusemide and amiloride) contains frusemide. Similarly, a patient was prescribed 'H. Pylori Kit' plus the three individual drugs included in the 'Kif prescribed using their generic names. A patient was found to be taking two different brands of carbidopa plus levodopa not knowing the two contained the same drugs. CONCLUSION: Brand confusion does not necessarily arise from look-alike or sound-alike drug names. It can be due to numerous brands of generic ingredients and lack of awareness of drug names among the patients. Employing trained clinical pharmacists in the wards, educating patients on discharge drugs and appropriate labeling of medicines may prevent these errors.
Changes in biochemical markers of outcomes in haemodialysis patients following a clinical pharmacy intervention.
(Ceylon College of Physicians, 2021) Kalpani, A.G.S.; Mohamed, F.; Hough, J.E.; de Silva, D.N.N.; Chandrasena, W.M.H.N.M.; Jayamanne, S.F.
Introduction and Objectives Common complications of End-Stage Renal Disease (ESRD) include cardiovascular disease, diabetes, anaemia and mineral and bone disease. Achieving an optimum level of biochemical markers of outcomes is crucial in managing ESRD. This study was conducted to assess the changes in selected biochemical parameters following a clinical pharmacy intervention (CPI) in this population. Method A randomized controlled trial was conducted at outpatient haemodialysis units in North Central Province, Sri Lanka. Serum phosphate, serum calcium, haemoglobin, lipid profile, eGFR and 'adequacy of dialysis* (AoD) (determined by urea reduction ratio (URR); calculated based on pre-post blood urea nitrogen measurements and Kt/V measurements) were measured in patients at baseline (BL) and after one year (PI). The Intervention Group (IG), n=143 patients received comprehensive pharmaceutical care by the clinical pharmacist on four consecutive occasions at recruitment, and 2, 6 and 10 months after recruitment. While the Control Group (CG), n=140, received standard care. Results At the baseline, there was no significant difference in the biochemical markers of outcomes between the two groups and AoD was within the acceptable range. However, there was a significant improvement in the mean serum phosphate levels (IG 4.04±1.19 vs CG 5.00±1.67, p<0.0001), mean serum calcium levels (IG 8.90±1.35 vs CG 7.11±2.07, p<0.0001), and mean haemoglobin levels (IG 10.5±1.25 vs CG 9.4±1.87, p<0.0001) in the IG compared to the CG at the end of one year. However, eGFR, lipid profiles did not change significantly (p>0.05). AoD was within the acceptable range in both groups at baseline and post intervention and did not change significantly (p>0.05) Conclusions Improvement in the selected biochemical markers of outcomes resulting from CPI suggests better patient management outcomes in the ESRD population.
Clinical management of agrochemical poisoning – promising outcome with evidence based practice
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Jayamanne, S.F.
Pesticide self-poisoning is an important clinical problem in rural regions of the developing world, and kills an estimated 200 000 people every year. It is a major problem in countries like ours where highly toxic organophosphate pesticides and paraquat are available. Medical management is difficult, with case fatality more than 15%. In the early part of this century, little clinical research and evidence existed with which to determine best therapy. Research conducted in Sri Lanka over the last fifteen years has changed the overall management and outcomes. Our main concern is still organophosphates and carbamates. We still do not know how the core treatments—atropine, oximes, should best be given. However, consensus suggests that early resuscitation with atropine, oxygen, respiratory support, and fluids, improve oxygen delivery to tissues, and therefore the final outcome. The role of oximes is not completely clear. Small studies suggest benefit from new treatments such as clonidine, but much larger trials are needed. Gastric lavage could have a role but should only be undertaken once the patient is stable. Some pesticides might prove very difficult to treat with current therapies, such that bans on particular pesticides could be the only method to substantially reduce the case fatality and we have successfully achieved this.
Clinical Pharmacists‟ Interventions to Improve Inhaler Use among Chronic Kidney Disease (CKD) Patients.
(In: Proceedings of the International Postgraduate Research Conference 2017 (IPRC – 2017), Faculty of Graduate Studies, University of Kelaniya, Sri Lanka., 2017) Wickramasinghe, N.D.D.; Lynch, C.B.; Coombes, J.; Jayamanne, S.F.; De Silva, S.T.
Inappropriate use of asthma inhalers can lead to increased hospitalizations, reduced quality of life (QOL), loss of productivity and increased health related costs. Pharmacist-led interventions have shown an improvement of inhaler technique and use. The following cases describe opportunities for clinical pharmacist-led interventions to resolve problems associated with inhaler use identified from an ongoing study in renal clinic, Teaching Hospital, Anuradhapura.
Community incidence of snakebite and envenoming in Sri Lanka; results of a national survey
(Sri Lanka Medical Association, 2014) Pathmeswaran, A.; Kasturiratne, A.; Gunawardena, N.K.; Wijayawickrama, B.A.; Jayamanne, S.F.; Ediriweera, D.S.; Isbister, G.; Dawson, A.; Lalloo, D.G.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: We undertook the first ever country-wide community-based survey to determine the incidence of snakebite in Sri Lanka. METHODS: Data were collected through household interviews by trained data collectors.125 clusters were allocated to each of the 9 provinces of the country. Within each province the clusters were divided among the districts in proportion to their population. A Grama Niladhari (GN) division was defined as a cluster for data collection. The clusters were selected using simple random sampling, and in each cluster 40 households were sampled consecutively from a random starting point. RESULTS: Data relating to 165,665 individuals (0.8% of the population of Sri Lanka) living in 44,136 households in 1,118 clusters was collected from June 2012 to May 2013. 695 (males 418) snakebites and 323 (males!93) significant envenomings (local tissue necrosis or systemic envenoming) were reported during the 12 months preceding the interview. The overall community incidence of snakebites and significant envenoming were 398 and 151 per 100,000 population, respectively. 446 (64.2%) bites and 208 (64.4%) envenomings were in people aged 30 to 59 years. There was wide variation between districts, the worst affected being Mullaitivu, Anuradhapura, Batticaloa, and Poionnaruwa, ali in the dry zone, mainly agricultural areas of the country. CONCLUSIONS: Sri Lanka has a high community incidence of snakebite and envenoming with a marked geographical variation.This variation underlines both the inaccuracy of extrapolating data of localised surveys to national or regional levels and the need to prioritise distribution of resources for treatment of snakebite even in small countries.
Community incidence of snakebite in the Amiradhapura district
(Sri Lanka Medical Association, 2013) Kasturiratne, A.; Gunawardena, N.K.; Wijayawickrama, B.A.; Jayamanne, S.F.; Pathmeswaran, A.; Isbister, G.; Dawson, A.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: The community incidence of snakebite in Sri Lanka is unknown. To investigate incidence of snakebite, we undertook a community study in the Anuradhapura district as part of an ongoing countrywide survey on snakebite. METHODS: The survey was designed to sample at least 1% of the population in each district Within the district, a Grama Niladhari (GN) division, was defined as a cluster for data collection. The number of clusters required to sample at least 1 % of the population was first determined, and clusters were then selected using simple random sampling. In each selected cluster 40 households were sampled consecutively from a random starting point. Population estimates of snakebite were constructed for the district. RESULTS: The Anuradhapura district has a total of 694 GN divisions, and 84 were surveyed. This included 3357 households and a population of 13,428 (1.6% of the district's population). Eightysix snakebites were reported within the last 12 months. Extrapolating this to the district (mid-year population=855,373), the estimated snakebites in Anuradhapura district was 5478. The crude community incidence of snakebite in the Anuradhapura district was 640.5 per 100, 000 population. CONCLUSIONS: The incidence of snakebite in the community is high in the Anuradhapura district, with one in 156 persons bitten annually.
Delayed psychological morbidity associated with snakebite envenoming
(Public Library of Science, 2011) Williams, S.S.; Wijesinghe, C.A.; Jayamanne, S.F.; Buckley, N.A.; Dawson, A.H.; Lalloo, D.G.; de Silva, H.J.
INTRODUCTION: The psychological impact of snakebite on its victims, especially possible late effects, has not been systematically studied. OBJECTIVES: To assess delayed somatic symptoms, depressive disorder, post-traumatic stress disorder (PTSD), and impairment in functioning, among snakebite victims. METHODS: The study had qualitative and quantitative arms. In the quantitative arm, 88 persons who had systemic envenoming following snakebite from the North Central Province of Sri Lanka were randomly identified from an established research database and interviewed 12 to 48 months (mean 30) after the incident. Persons with no history of snakebite, matched for age, sex, geograpical location and occupation, acted as controls. A modified version of the Beck Depression Inventory, Post-Traumatic Stress Symptom Scale, Hopkins Somatic Symptoms Checklist, Sheehan Disability Inventory and a structured questionnaire were administered. In the qualitative arm, focus group discussions among snakebite victims explored common somatic symptoms attributed to envenoming. RESULTS: Previous snakebite victims (cases) had more symptoms than controls as measured by the modified Beck Depression Scale (mean 19.1 Vs 14.4; p<0.001) and Hopkins Symptoms Checklist (38.9 vs. 28.2; p<0.001). 48 (54%) cases met criteria for depressive disorder compared to 13 (15%) controls. 19 (21.6%) cases also met criteria for PTSD. 24 (27%) claimed that the snakebite caused a negative change in their employment; nine (10.2%) had stopped working and 15 (17%) claimed residual physical disability. The themes identified in the qualitative arm included blindness, tooth decay, body aches, headaches, tiredness and weakness. CONCLUSIONS: Snakebite causes significant ongoing psychological morbidity, a complication not previously documented. The economic and social impacts of this problem need further investigation
Delayed psychological morbidity in victims of snakebite envenoming
(Sri Lanka Medical Association, 2010) Williams, S.S.; Wijesinghe, C.A.; Jayamanne, S.F.; Buckley, N.; Dawson, A.; Lalloo, D.G.; de Silva, H.J.
OBJECTIVES: We assessed delayed somatic symptoms, depressive disorder, post-traumatic stress disorder (PTSD) and impairment in functioning among snakebite victims. The psychological impact of snakebite on its victims has not been systematically studied. METHODS: The study had qualitative and quantitative arms. In the quantitative arm, 88 persons who had systemic envenoming following snakebite from the Polonnaruwa District were randomly identified from an established research database and interviewed 12 to 48 months (mean 30) after the incident. 88 persons with no history of snakebite, matched for age, sex, geograpical location and occupation acted as controls. A modified version of the Beck Depression Inventory, Post-Traumatic Stress Symptom Scale, Hopkins Somatic Symptoms Checklist and Sheehan Disability Inventory, together with a structured questionnaire were administered. In the qualitative arm, focus group discussions among snakebite victims explored common somatic symptoms attributed to envenoming. Results: Snakebite victims had more symptoms as measured by the modified Beck Depression Scale (mean 19.1 vs 14.4) and Hopkins Symptoms Checklist (38.9 vs. 28.2) compared to controls (p<0.001). 48(54%) victims met criteria for depressive disorder compared to 13(15%) controls. 11(12.5%) victims also met criteria for PTSD. 24(27%) claimed that the snakebite caused a negative change in their employment; 9(10.2%) had stopped working. 15(17%) victims claimed residual physical disability, and themes identified in the qualitative arm included blindness, tooth decay, body aches, tiredness and weakness. CONCLUSIONS: Snakebite causes delayed psychological morbidity, a complication not previously documented.
Development and assessment of a psychological intervention for snakebite victims
(Sri Lanka Medical Association, 2014) Wiiesinahe, C.A.; Williams, S.S.; Dolawatta, N.; Wimalaratne, A.K.G.P.; Kasturiratne, A.; Wijewickrema, B.; Jayamanne, S.F.; Lalloo, D.G.; Isbister, G.K.; Dawson, A.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: There is significant delayed psychological morbidity and negative psycho-social impact following snakebite. However, no psychological support is provided to victims. We aimed to develop and assess the effectiveness of a brief intervention which can be provided by non-specialist medical officers aimed at reducing psychological morbidity. METHODS: In a single blind clinical trial at Polonnaruwa Hospital, 187 snakebite victims were randomised into three arms. One arm received no psychological intervention (Group A; n=59; control). Group B (n=60) received psychoeducation at discharge from hospital. Group C (n=68) received psychoeducation and a.second intervention one month later based on cognitive behavioural principles. All patients were assessed six months after discharge from hospital using standardised tools for presence of psychological symptoms and level of functioning. RESULTS: Compared with Group A, there was a significant reduction in anxiety symptoms measured by the Hopkins Psychiatric Symptom check list (16.9% vs. 5.9%, p=0.047, Chi-Squared test) and a non-significant trend towards improvement in the level of functioning measured by the Sheehan Disability inventory (6.47 vs. 4.69) in Group C, but not in Group B. There was no difference in rates of depression and post-traumatic stress disorder (PTSD) between the three groups. CONCLUSIONS: Our preliminary findings suggest that brief psychological interventions which include psychoeducation plus cognitive behavioural therapy given by non-specialist doctors, but not psychoeducation alone seem to reduce anxiety and facilitate a trend towards improved function in snakebite victims. However, these interventions had no effect on depression or PTSD.
Development of a Snakebite risk map for Sri Lanka
(Sri Lanka Medical Association, 2016) Ediriweera, D.S.; Kasturiratne, A.; Pathmeswaran, A.; Gunawardena, N.K.; Wijayawickrama, B.A.; Jayamanne, S.F.; Isbister, G.K.; Dawson, A.; Giorgi, E.; Diggle, P.J.; Lalloo, D.G.; de Silva, H.J.
INTRODUCTION: Snakebite is a public health problem in Sri Lanka and about 37,000 patients are treated in government hospitals annually. At present, health care resources which are required to manage snakebite are distributed based on the administrative boundaries, rather than based on scientific risk assessment. OBJECTIVES: The aim of the study is to develop a snakebite risk map for Sri Lanka. METHOD: Epidemiological data was obtained from a community-based island-wide survey. The sample was distributed equally among the nine provinces. 165,665 participants (0.8%of the country’s population) living in 1118 Grama Niladhari divisions were surveyed. Generalized linear and generalized additive models were used for exploratory data analysis. Model-based geostatistics was used to determine the geographical distribution of snakebites. Monte Carlo maximum likelihood method was used to obtain parameter estimates and plug-in spatial predictions were obtained. Probability contour maps (PCM) were developed to demonstrate the spatial variation in the probability that local incidence does or does not exceed national snakebite incidence. RESULTS: Individual point estimate snakebite incidence map and PCM were developed to demonstrate the national incidence of snakebite in Sri Lanka. Snakebite hotspots and cold spots were identified in relation to the national snakebite incidence rate. Risk maps showed a within-country spatial variation in snakebites. CONCLUSIONS: The developed risk maps provide useful information for healthcare decision makers to allocate resources to manage snakebite in Sri Lanka.
Evaluating spatiotemporal dynamics of snakebite in Sri Lanka: Monthly incidence mapping from a national representative survey sample
(Public Library of Science, 2021) Ediriweera, D.S.; Kasturiratne, A.; Pathmeswaran, A.; Gunawardena, N.K.; Jayamanne, S.F.; Murray, K.; Iwamura, T.; Isbister, G.; Dawson, A.; Lalloo, D.G.; de Silva, H.J.; Diggle, P.J.
BACKGROUND: Snakebite incidence shows both spatial and temporal variation. However, no study has evaluated spatiotemporal patterns of snakebites across a country or region in detail. We used a nationally representative population sample to evaluate spatiotemporal patterns of snakebite in Sri Lanka. METHODOLOGY: We conducted a community-based cross-sectional survey representing all nine provinces of Sri Lanka. We interviewed 165 665 people (0.8% of the national population), and snakebite events reported by the respondents were recorded. Sri Lanka is an agricultural country; its central, southern and western parts receive rain mainly from Southwest monsoon (May to September) and northern and eastern parts receive rain mainly from Northeast monsoon (November to February). We developed spatiotemporal models using multivariate Poisson process modelling to explain monthly snakebite and envenoming incidences in the country. These models were developed at the provincial level to explain local spatiotemporal patterns. PRINCIPAL FINDINGS: Snakebites and envenomings showed clear spatiotemporal patterns. Snakebite hotspots were found in North-Central, North-West, South-West and Eastern Sri Lanka. They exhibited biannual seasonal patterns except in South-Western inlands, which showed triannual seasonality. Envenoming hotspots were confined to North-Central, East and South-West parts of the country. Hotspots in North-Central regions showed triannual seasonal patterns and South-West regions had annual patterns. Hotspots remained persistent throughout the year in Eastern regions. The overall monthly snakebite and envenoming incidences in Sri Lanka were 39 (95%CI: 38-40) and 19 (95%CI: 13-30) per 100 000, respectively, translating into 110 000 (95%CI: 107 500-112 500) snakebites and 45 000 (95%CI: 32 000-73 000) envenomings in a calendar year. CONCLUSIONS/SIGNIFICANCE: This study provides information on community-based monthly incidence of snakebites and envenomings over the whole country. Thus, it provides useful insights into healthcare decision-making, such as, prioritizing locations to establish specialized centres for snakebite management and allocating resources based on risk assessments which take into account both location and season.
Evaluating temporal patterns of snakebite in Sri Lanka: The potential for higher snakebite burdens with climate change
(Sri Lanka Medical Association, 2018) Ediriweera, D.S.; Diggle, P.J.; Kasturiratne, A.; Pathmeswaran, A.; Gunawardena, N.K.; Jayamanne, S.F.; Isbister, J.K.; Dawson, A.; Lalloo, D.G.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: Snakebite is a neglected tropical disease that has been overlooked by healthcare decision makers in many countries. Previous studies have reported seasonal variation in hospital admission rates due to snakebites in endemic countries including Sri Lanka, but seasonal patterns have not been investigated in detail. METHODS: A national community-based survey was conducted during the period of August 2012 to June 2013. The survey used a multistage cluster design, sampled 165,665 individuals living in 44,136 households and recorded all recalled snakebite events that had occurred during the preceding year Log-linear models were fitted to describe the expected number of snakebites occurring in each month taking into account seasonal trends and weather conditions, and addressing the effects of variation in survey effort during the study and due to recall bias amongst survey respondents RESULTS: Snakebite events showed a clear seasonal variation. Typically, snakebite incidence was highest during November to December followed by March to May and August, but this varied between years due to variations in relative humidity, which is also a risk-factor. Low relative humidity levels was associated with high snakebite incidence. If current climate change projections are correct, this could lead to an increase in the annual snakebite of burden of 35,086 (95% CI: 4 202 a€" 69,232) during the next 25 to 50 years. CONCLUSION: Snakebite in Sri Lanka shows seasonal variation Additionally, more snakebites can be expected during periods of lower than expected humidity. Global climate change is likely to increase the incidence of snakebite in Sri Lanka.
Health seeking behavior following snakebites in Sri Lanka: Results of an island wide community based survey
(Public Library of Science, 2017) Ediriweera, D.S.; Kasturiratne, A.; Pathmeswaran, A.; Gunawardena, N.K.; Jayamanne, S.F.; Lalloo, D.G.; de Silva, H.J.
INTRODUCTION: Sri Lanka has a population of 21 million and about 80,000 snakebites occur annually. However, there are limited data on health seeking behavior following bites. We investigated the effects of snakebite and envenoming on health seeking behavior in Sri Lanka. METHODS: In a community-based island-wide survey conducted in Sri Lanka 44,136 households were sampled using a multistage cluster sampling method. An individual who reported experiencing a snakebite within the preceding 12 months was considered a case. An interviewer-administered questionnaire was used to obtain details of the bite and health seeking behavior among cases. RESULTS: Among 165,665 individuals surveyed, there were 695 snakebite victims. 682 (98.1%) had sought health care after the bite; 381 (54.8%) sought allopathic treatment and 301 (43.3%) sought traditional treatment. 323 (46.5%) had evidence of probable envenoming, among them 227 (70.3%) sought allopathic treatment, 94 (29.1%) sought traditional treatment and 2 did not seek treatment. There was wide geographic variation in the proportion of seeking allopathic treatment from <20% in the Western province to > 90% in the Northern province. Multiple logistic regression analysis showed that seeking allopathic treatment was independently associated with being systemically envenomed (Odds Ratio = 1.99, 95% CI: 1.36-2.90, P < 0.001), distance to the healthcare facility (OR = 1.13 per kilometer, 95% CI: 1.09 to 1.17, P < 0.001), time duration from the bite (OR = 0.49 per day, 95% CI: 0.29-0.74, P = 0.002), and the local incidence of envenoming (OR = 1.31 for each 50 per 100,000, 95% CI: 1.19-1.46, P < 0.001) and snakebite (OR = 0.90 for each 50 per 100,000, 95% CI: 0.85-0.94, P < 0.001) in the relevant geographic area. CONCLUSIONS: In Sri Lanka, both allopathic and traditional treatments are sought following snakebite. The presence of probable envenoming was a major contribution to seeking allopathic treatment.
Health seeking behavior of snakebite victims in Sri Lanka: findings from an island-wide community-based study
(Sri Lanka Medical Association, 2014) Kasturiratne, A.; Pathmeswaran, A.; Gunawardena, N.K.; Ediriweera, E.P.D.S.; Wijayawickrama, B.A.; Jayamanne, S.F.; Isbister, G.; Dawson, A.; Lalloo, D.G.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: Health seeking behaviour of snakebite victims in the community has rarely been described and we investigated this as part of a community-based island-wide study on snakebite in Sri Lanka. METHODS: The national snakebite study was conducted in a!! 25 districts, in SriJ_anka in 2012/2013. 44,136 households were sampled in randomly selected clusters. In these households, any member reported to have experienced a snake bite within the preceding 12 months was considered a case. Data related to the health seeking behavior of snakebite were obtained using an interviewer-administered questionnaire. RESULTS: Among 165,665 individuals surveyed, 695 (60% males; median age 43 years) snakebite victims were identified. 323 (46.5%) had evidence of envenoming. 682 (98.2%) had sought health services after the bite. 381 (54.8%) sought allopathic medicine and 99.7% of them obtained this service from the state health sector, while 43.3% sought alternative medicine. The lowest rates of seeking allopathic medicine were seen in the Kalutara (8.7%) and Kegalie (10.7%) districts while highest rates were seen in the districts Mannar, Mullativu and Kilinochchi (100%). Puttalam (92.9%), Vavuniya (92.3%},) Ampara (89.5%), Jaffna (88.9%) and Anuradhapura (86.0%) also had high rates. 70.1% of the victims with envenoming sought allopathic medicine. Victims who had envenoming were significantly more likely to seek allopathic medicine (OR=3.35; 95% confidence interval 2.44-4.59) than those without envenoming. CONCLUSIONS: A considerable proportion of snake bite victims still seek alternative medicines in Sri Lanka.'A wide variation of practices exists across the country. Victims with envenoming are more likely to seek allopathic medicine.
Importance of communicating medication changes to patients at discharge -a prospective case study
(Sri lanka Medical Association, 2015) Pathiraja, V.M.; Jayamanne, S.F.; Lynch, C.B.; Coombes, J.; Perera, D.M.P.; Mamunuwa, A.M.V.G.N.; Shanika, L.G.T.; Mohamed, F.; Dawson, A.H.
INTRODUCTION AND OBJECTIVES: Patients may inadvertently continue their previous medication regimen without understanding changes made by prescribers as part of in-patient care. Inadequate patient education at discharge can lead in some instances to readmission and increased morbidity. The objective of this study is to identify the importance of patient education with regard to changes to their medications. METHOD: This study was part of a prospective study carried out in two medical wards of Ragama teaching hospital to evaluate the effect of a clinical pharmacist's interventions on quality use of medicines. We identified cases from the control group of this study to illustrate the importance of patient education at discharge. RESULTS: From telephone follow-up (six days post discharge), only 89 of 337 patients in the control group reported being informed of changes to their pre-admission medications by a doctor or nurse. There were!24 cases where we have identified patients continuing at least one pre-admission medication which was stopped or changed while they were in hospital. A particular instance is a patient who continued to take sodium valproate post-discharge as per previous drug regimen after being diagnosed with valproate induced hepatitis. He was discharged on phenytoin. CONCLUSION: This study highlights the importance of ensuring patient education about changes made to existing medications whilst in hospital to ensure improved outcomes and reduce the risk of adverse events. The clinical pharmacist is well placed to assist medical teams by providing patients with appropriate education about medication changes and to provide appropriate educational material.
Individual risk factors of snakebites in Sri Lankan community
(Faculty of Graduate Studies, University of Kelaniya, 2015) Ediriweera, E.P.D.S.; Pathmeswaran, A.; Kasturiratne, A.; Gunawardana, N.K.; Jayamanne, S.F.; de Silva, H.J.; Diggle, P.J.
Sri Lanka has 92 identified snake species, and one of the highest snakebite incidence (SBI) rates in the world. According to hospital statistics about 37,000 patients are admitted to government hospitals annually as a result of snakebite. The aim of the present study is to identify individual risk factors for snakebite in Sri Lanka. Methodology A community-based island-wide study (―National Snakebite Study‖) was conducted in all nine provinces of Sri Lanka, with 5,000 households sampled in each province. All the residents of the selected households were included. One-year recall data for all permanent residents of that particular household was obtained regarding the experience of snakebite. Generalized linear models were used to model SBI. Individual-level gender, age, ethnicity, religion, income, education and employment were included as explanatory variables. Statistical analysis used the R programming language. Statistical significance was assessed at the 0.01 level. Results and conclusions Out of 125,391 participants, 63,604 (50.7%) were males. There was no SBI difference amongst 10-year interval age groups from 30 to 59, hence these three age groups were collapsed. High SBI was observed in the age 30-59 year group compared to age less than 20 (P<0.001), 20 to 29 (P<0.001), 60 to 69 (P<0.003) and over 70 (P<0.007), with lower SBI in the two extreme age groups. Males had higher SBI compared to females (P<0.001). Field workers had higher SBI compared to non-field workers (P<0.001). Ethnicity and income showed a significant interaction. Low income non-Sinhalese had high SBI compared to middle income (Rs. 5000-19,999, P<0.001) and high income (Rs.>20,000, P=0.001) non- Sinhalese, whereas Sinhalese had high SBI irrespective of their income status. In summary, the high risk categories for snakebites are males, field workers, 30 – 60 year individuals, Sinhalese and low income non-Sinhalese.
Is hyperkalaemia associated with the development of heart blocks in patients with acute yellow oleander poisoning?
(Sri Lanka Medical Association, 2023) Eriyawa, W.M.A.B.W.; Jayamanne, S.F.; Lokunarangoda, N.; Francis, G.R.; andakumari, G.V.N.; Jayawardane, P.
INTRODUCTION: Yellow oleander (Thevetia peruviana) contains cardiac glycosides which result in arrhythmias, heart blocks and electrolyte imbalances. OBJECTIVES: The objective of the study was to find whether the development of hyperkalaemia within the first 24 hours of admission predicts the development of heart blocks. METHODS: A prospective cohort study was carried out at Teaching Hospital Batticaloa, Sri Lanka, from 1st July 2022 to 28th February 2023 among patients admitted with acute yellow oleander poisoning. Patients were recruited if any of the following signs were present: bradycardia (<60bpm), systolic blood pressure <80mmHg, nausea, vomiting, abdominal pain, diarrhoea, xanthopsia, within 2 hours of admission. Serum potassium level was assessed at recruitment and 6 hourly, serial electrocardiograms were done at recruitment and 4 hourly, for 24 hours. The association between hyperkalemia (serum potassium >5.5mmol/L) and the development of heart blocks were calculated using the chi-squared test. Ethical Clearance was granted by the Ethics Review Committee of the Faculty of Medical Sciences, University of Sri Jayewardenepura. RESULTS: Among 120 consenting symptomatic patients recruited, 26.67%(n=32) patients developed hyperkalemia while 7.5%(n=9), 10.0%(n=12) and 3.33%(n=4) patients developed 1st, 2nd, and 3rd degree heart blocks respectively. Temporary cardiac pacing (TCP) was done in 9.16%(n=11) patients and 2.5%(n=3) died due to cardiac arrest. Hyperkalemia within 24 hours of admission was associated with the development of heart block (X2(1, N=120)=12.9689, p=0.0003). CONCLUSION: Patients who developed hyperkalemia within 24 hours of admission following acute yellow oleander poisoning should be closely monitored for the development of heart blocks and managed at centres where facilities for TCP are available.
Kerosene Oil Poisoning among Children in Rural Sri Lanka
(Hindawi Pub. Corp., 2017) Dayasiri, M.B.K.C.; Jayamanne, S.F.; Jayasinghe, C.Y.
INTRODUCTION: Kerosene oil poisoning is one of common presentations to emergency departments among children in rural territories of developing countries. This study aimed to describe clinical manifestations, reasons for delayed presentations, harmful first aid practices, complications, and risk factors related to kerosene oil poisoning among children in rural Sri Lanka. METHODS: This multicenter study was conducted in North-Central province of Sri Lanka involving all in-patient children with acute kerosene oil poisoning. Data were collected over seven years from thirty-six hospitals in the province. Data collection was done by pretested, multistructured questionnaires and a qualitative study. RESULTS: Male children accounted for 189 (60.4%) while 283 (93%) children were below five years. The majority of parents belonged to farming community. Most children ingested kerosene oil in home kitchen. Mortality rate was 0.3%. Lack of transport facilities and financial resources were common reasons for delayed management. Hospital transfer rate was 65.5%. Thirty percent of caregivers practiced harmful first aid measures. Commonest complication was chemical pneumonitis. Strongest risk factors for kerosene oil poisoning were unsafe storage, inadequate supervision, and inadequate house space. CONCLUSIONS: Effect of safe storage and community education in reducing the burden of kerosene oil poisoning should be evaluated. Since many risk factors interact to bring about the event of poisoning in a child, holistic approaches to community education in rural settings are recommended.