Browsing by Author "Kasturiratne, A."

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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.
Aetiological factors of oral cancer in Sri Lanka
(Sri Lanka Medical Association, 2008) Kasturiratne, A.; Ariyaratne, M.A.Y.; Wickremasinghe, A.R.
OBJECTIVE: To determine aetiological factors of oral cancer in three provinces in Sri Lanka DESIGN, SETTING AND METHODS: A matched case-control study on incident cases of oral cancer and age-sex matched neighbourhood controls was conducted in three provinces of Sri Lanka. Risk factors were analysed using matched pair analyses and conditional logistic regression. RESULTS: Among 658 subjects (329 pairs) [males= 82.1%, mean age = 61.6 (30=12.2) years], a higher monthly income, regular betel chewing, age at starting chewing, duration of a chew, retaining the quid in the mouth at night, regular smoking, duration of smoking, amount smoked daily, type of smoke used, regular alcohol consumption and amount of illicit liquor consumed daily were significantly associated with oral cancer on bivariate analysis. Past history of cancer, family history of cancer and family history of cancer of head and neck were also associated with oral cancer. A higher income (OR=0.65; 95% CI 0.44-0.96) and high consumption of raw fruits (OR=0.64; 95% CI 0.46-0.89) were protective. Regular betel chewing (OR=1.94; 95% CI 1.23-3.07), retaining the quid in the mouth at night (OR=20.45; 95% CI 7.23-57.89), consumption of illicit liquor (OR=4,65; 95% CI 2.49-8.71) and the amount smoked per day (OR=1.04 95% CI 1.01-1.07) were significantly associated with oral cancer on multivariate analysis. CONCLUSIONS: Betel chewing is the most important determinant of oral cancer. Retaining the quid in the mouth should be discouraged. The importance of family history demands for preventive programmes for family members of patients.
Age, sex and hyperlipidemia: Is it a simple association?
(College of Community Physicians of Sri Lanka, 2009) Pathmeswaran, A.; Pinidiyapathirage, J.; Kasturiratne, A.; Wickremasinghe, A.R.
INTRODUCTION: Hyperlipidemia is a known cardiovascular disease risk factor. There are effective lifestyle, dietary and pharmacological interventions to treat hyperlipidemia. It is important to target testing for hyperlidemia for the most appropriate age sex groups to optimize resource utilization. Identifying such groups is not easy when there is an interaction between age and sex. OBJECTIVE: To describe the association between age, sex and hyperlipidemia among 35 to 64 year old residents of Ragama. METHODS: Residents aged 35-64 years in the Ragama MOH area were randomly sampled from the voters list after stratification into 10 year age groups. Blood for lipid profile was collected after a 14 hour overnight fast for analysis. Bivariate and multiple logistic regression were performed using Stata 8.2. Results are expressed as odds ratios and relevant 95% confidence intervals (OR; 95% Cl). RESULTS: Total sample analysed was 2987; 45% (n=1338) were males, 17% (n=515), 38% (n=1140) and 45% (n=1332) were in the age groups of 35-44, 45-54 and 55-64 years respectively. The prevalence of hyperlipidemia was 36%. In bivariate analysis, females (OR 1.3; 95% Cl 1.1-1.5) and the age groups of 45-54 (OR 1.7; 95% Cl 1.3-2.1) and 55-64 years (OR 1.5; 95% Cl 1.2-1.9) when compared to 35-44 years were at a higher risk of hyperl[pidaemia . In multiple logistic regression too females (OR 1.2; 95% Cl 1.1-1.4) and the same age groups ( 45-55 [OR 1.7; 95% Cl: 1.3-2.1] and 55 to 64 years OR 1.5; 95%CI: 1.2-1.9) respectively) had higher risk of hyperlipideamia. When an age sex interaction term was added to the above model, 35-44 year old females had the lowest risk. In comparison to the latter, the OR (95%CI) of females of 45-54 and 55-64 years were 2.4(1.8-3.4) and 2.8(2.1-3.9) respectively. The same for males of 35-44, 45-54, and 55-64 years were 2.0(1.3-2.9), 2.3(1.6-3.2) and 1.5(1.1-2.1) respectively. CONCLUSION: The risk of hyperlipidemia increased with increasing age among females but among males the lowest risk was in the 55-64 year age group. Attempts to portray a simple picture are likely to obscure important details and may even be misleading.
Age, sex variation among patients treated with percutaneous transluminal coronary angioplasty (PICA) in Sri Lanka: a retrospective study
(Sri Lanka Medical Association, 2014) Abeysuriya, V.; Chandrasena, L.G.; Kasturiratne, A.; Hettiarachchi, V.S.; Wickremasinghe, A.R.
INTRODUCTION AND OBJECTIVES: Coronary heart diseases (CHD) remain a major cause of death worldwide, ft is a growing burden for the Sri Lankan health sector. Age and sex has been identified as risk factors for CHD. The private health sector contributes significantly to curative care of CHD. The aim of this study was to determine the variation of age and sex of patients who have been treated with PTCA during the last decade at a private hospital in Colombo. METHODS: A retrospective study was conducted on patients treated with PTCA in a private hospital in Colombo from 2003 to 2013. Details of patients were extracted from medical records and age and sex variations were analyzed. RESULTS: 4578 patients (3315 men; 72.4%) were included. There was significant reduction in mean age at PTCA from 2003 to 2013 (p<0.01). Overall it had declined from 56.4 years (SD=10.5) in 2003 to 50.9 years (SD=12.4) in 2013. From 2003 to 2013 the mean ages of men had reduced by 7 years (p<0.01), while in females the mean age had reduced by 2.2 years (p<0.01) Male to female ratio was 2.58 in 2003 and 2.45 in 2013- Linear regression analysis showed that with each increment year the age at PTCA reduced by 0.54 years (95%Ci =0.64 to -0.44). CONCLUSIONS: Higher proportions of patients were men. Age at PTCA had decreased in both males and females. But sex ratio of patients had not significantly changed during the last decade.
Alcohol consumption and tobacco smoking in an urban adult Sri Lankan population
(Sri Lanka Medical Association, 2008) Kasturiratne, A.; Pinidiyapathirage, M.J.; Perera, H.K.K.; Fernando, E.D.P.S.; Ranasinha, C.D.; Edirisinghe, P.A.S.; Makaya, M.; Kato, N.
BACKGROUND: Data on the prevalence and patterns of alcohol consumption and smoking in the general population in Sri Lanka are scarce. Objective: To describe patterns of alcohol use and smoking in an urban adult population in Sri Lanka. DESIGN, SETTING AND METHODS: A random sample of the general population aged between 35-65 years, resident in the Ragama Medical Officer of Health area was interviewed to obtain drinking and smoking habits. RESULTS: Among 2985 subjects [males 45.5%; mean age 52.7 years (SD7.8)], 1156(39.7%) reported ever use of alcohol, and 892(29.7%) reported current use. 58.8% of males and 5.7% of females were current drinkers. 190(14%) males and 12(0.7%) females consumed alcohol above the weekly safe limit (>14 units for males, >7 units for females). The median duration of alcohol use among ever users was 18 years (interquartile range 10-25), and current users was 20 years (interquartile range 1,0-25). The commonest type of alcohol consumed was arrack (n=492), followed by beer (n=217). 60.2% of males and 2.1% of females reported ever smoking, 483(16.2%) were current smokers. 35.1% of males and 0.5% of females were current smokers. The median duration of smoking was 20 years among both ever smokers (interquartile range 10-27.3), and current smokers (interquartile range 15-30). Most (55.3%) smoked cigarettes, only 36(4.2%) smoked beedi. The median pack years of current smokers was 4,5 (interquartile range 2-10). CONCLUSION: Lifetime and current use of alcohol and smoking are high among males. Focused interventions are required to reduce current rates among males and to maintain low rates reported by females.
Alcohol use and alcoholic fatty liver disease: a prospective, communitybased study among adults in an urban community in Sri Lanka
(The Sri Lanka Medical Association, 2022) Niriella, M.A.; Kasturiratne, A.; Beddage, T.; de Silva, S.T.; Dassanayake, A.S.; Pathmeswaran, A.; Wickremasinghe, A.R.; Kato, N.; de Silva, H.J.
Background: Data on alcoholic fatty liver (AFL) is limited. Therefore, we investigated alcohol use and AFL in a cohort of adults in an urban community in Sri Lanka. Methods: The study population (selected by age-stratified random sampling) was screened in 2007 (35-64 years) and re-evaluated in 2014. They were assessed by structured interviews, anthropometric measurements, liver-ultrasound, and biochemical and serological tests. AFL was diagnosed on ultrasound criteria, ‘unsafe’ alcohol consumption (Asian standards: males>14 units, females >7 units per week) and absence of hepatitis B/C markers. Controls were unsafe alcohol consumers who had no fatty liver on ultrasound. Results: 2985/3012 (99%) had complete data for analysis. 272/2985 (9.1%) were unsafe-drinkers in 2007 [males-270; mean-age-51.9, SD-8.0 years]. 86/272 (31.6%) had AFL [males-85; mean-age-50.2, SD-8.6 years]. Male gender [p<0.001], increased waist circumference (WC) [OR 4.9, p<0.01], BMI>23kg/m2 [OR 3.5, p<0.01] and raised alanine aminotransferase (ALT) [OR 2.8, p<0.01] were independently associated with AFL. 173/272 (63.6%) unsafe alcohol consumers from 2007 were re-evaluated in 2014. 134/173 had either had AFL or had changed to ‘safe’ or no alcohol consumption. 21/39 (53.8%) [males-21 (100%), meanage- 57.9, SD-7.9 years] who remained ‘unsafe’ alcohol users who had no fatty liver in 2007 developed AFL after 7-years (annual incidence 7.7%). On bivariate analysis, only male gender was associated with new-onset AFL. Of the 42 who had AFL at baseline but changed their drinking status from unsafe to safe or no alcohol, 6 had resolution of fatty liver in 2014. Conclusion: In this community-based study among adults from an urban community, unsafe alcohol use was found in 9.1%. Among unsafe alcohol users, the prevalence of AFL was 31.6% and the annual incidence of AFL was 7.7%. New-onset AFL was independently associated with male gender.
Ambulatory blood pressure levels in individuals with uncontrolled clinic hypertension across Bangladesh, Pakistan, and Sri Lanka
(Wiley, 2024) Zhu, A.; Ostbye, T.; Naheed, A.; de Silva, H.A.; Jehan, I.; Gandhi, M.; Chakma, N.; Kasturiratne, A.; Samad, Z.; Jafar, T.H.
Hypertension is a leading risk factor for cardiovascular disease in South Asia. The authors aimed to assess the cross-country differences in 24-h ambulatory, daytime, and nighttime systolic blood pressure (SBP) among rural population with uncontrolled clinic hypertension in Bangladesh, Pakistan, and Sri Lanka. The authors studied patients with uncontrolled clinic hypertension (clinic BP ≥ 140/90 mmHg) who underwent ambulatory blood pressure monitoring (ABPM) during the baseline assessment as part of a community-based trial. The authors compared the distribution of ABPM profiles of patients across the three countries, specifically evaluating ambulatory SBP levels with multivariable models that adjusted for patient characteristics. Among the 382 patients (mean age, 58.3 years; 64.7% women), 56.5% exhibited ambulatory hypertension (24-h ambulatory BP ≥ 130/80 mmHg), with wide variation across countries: 72.6% (Bangladesh), 50.0% (Pakistan), and 51.0% (Sri Lanka; P < .05). Compared to Sri Lanka, adjusted mean 24-h ambulatory, daytime, and nighttime SBP were higher by 12.24 mmHg (95% CI 4.28-20.20), 11.96 mmHg (3.87-20.06), and 12.76 mmHg (4.51-21.01) in Bangladesh, separately. However, no significant differences were observed between Pakistan and Sri Lanka (P > .05). Additionally, clinic SBP was significantly associated with 24-h ambulatory (mean 0.38, 95% CI 0.28-0.47), daytime (0.37, 0.27-0.47), and nighttime SBP (0.40, 0.29-0.50) per 1 mmHg increase. The authors observed substantial cross-country differences in the distribution of ABPM profiles among patients with uncontrolled clinic hypertension in rural South Asia. The authors findings indicated the need to incorporate 24-h BP monitoring to mitigate cardiovascular risk, particularly in Bangladesh.
Anthropometric correlates of total body fat, visceral adiposity and cardio-metabolic health risk: a community cohort study of urban, adult Sri Lankans
(Sri Lanka Medical Association, 2016) Niriella, M.A.; de Silva, S.T.; Kasturiratne, A.; Kottachchi, D.; Ranawaka, U.K.; Dassanayake, A.S.; de Silva, A.P.; Pathmeswaran, A.; de Silva, H.J.
INTRODUCTION: Anthropometric measurements (AM) are used as proxies for more direct measurements of body fat (BF) and its distribution. Several studies have examined the association between AM, BF and health outcomes such as cardiovascular risk (CVR). However, correlation of such simple AM and advanced measures of BF and the ability of these to predict CVR has not been studied in community follow up studies. OBJECTIVES: To examine the relationship between simple and advanced anthropometric measurements and their ability to predict cardiovascular risk factors in an urban adult Sri Lankan population. METHOD: The data was collected from a community cohort of adults (aged 42-71 years) selected by age-stratified random sampling from electoral lists of the Medical Officer of Health area, Ragama. Individual simple measurements [body weight, height, waist circumference (WC), hip circumference (HC)], advanced measurements [total body fat (TBF), visceral fat percentage (VFP) by Omron® body fat monitor] and cardiovascular risk factors [blood pressure, HbA1c, triglycerides, low-density (LDL-C), high-density-lipoprotein cholesterol (HDL-C) level, cardio-metabloic risk (CMR) (2 or more risk factors)] were assessed and their relationships were examined. RESULTS: 2155 individuals [1244 (57.7%) women, mean age 59.2 years (SD, 7.7)] participated. Complete data were available for 2000 (92.8%) [1147 (57.4%) women, mean age 59.2 years (SD, 7.7)]. Mean (SD) for anthropometric measurements were: males WC-85.9 (10.8) cm, HC-93.4 (8.0) cm, WHpR (waist-to-hip ratio) -0.92 (0.06), WhtR (waist-to-height ratio) -0.52 (0.06), BMI (body mass index) -23.5 (3.8) kg/m2, TBF -27.0 (5.7)%, VFP -10.7 (5.2)%; females WC -84.8 (10.7) cm, HC-97.2 (9.5) cm, WHpR-0.87(0.08), WhtR-0.52 (0.07), BMI -25.4 (4.4) kg/m2, TBF -38.2 (4.2)%, VFP-9.6 (4.9)%. BMI and WC correlated well with VFP (Pearson’s r for males: 0.94 and 0.85, females: 0.96 and 0.78, respectively). In both sexes, increasing BMI, WC, WHtR, TBF and VFP, were significantly associated with higher risks of hypertension, diabetes, dyslipidemia and combined CMR (ROC area under the curve>0.6). CONCLUSIONS: In this cohort of urban, adult Sri Lanka, simple anthropometric measurements correlated strongly with VFP, and were equally good in predicting cardiovascular risk factors.
Assessment of teamwork skills of medical students using absolute and relative criteria
(Sri Lanka Medical Association, 2014) Chandratilake, M.; Kasturiratne, A.; Pathmeswaran, A.
INTRODUCTION AND OBJECTIVES: Teamwork is an essential professional attribute of medical professionals which has demonstrated to be directly contributing to improve patient care and safety. The assessment of teamwork ability of medical undergraduates is vital to foster this skill. Peers appear to be an effective source for the assessment. METHODS: This study attempted to develop a peer assessment for assessing teamwork ability of students validly and reliably using the team-based research projects adopted by the Faculty of Medicine, University of Kelaniya. In complying with the literature, the assessment focused on communication, participation, involvement, support, commitment and leadership. Each student scored self and peers (5 or 6) in their group on two scoring systems; absolute (allocation of absolute mark for each peer in the group), and relative (marking the peers relative to self). RESULTS: Out of 164 recruits, 128 completed the assessment accurately. The following observations were statistically significant: poor correlation (Pearson < 0.4) between self and peer scores for both domain and overall assessment levels with either absolute or relative marking; and high correlation (Pearson > 0.6) between absolute and relative scores given by peers. The variability of relative scores, however, was higher than the absolute scores. CONCLUSIONS: A peer assessment tool with a limited number of items and assessment of peers relative to oneself produced credible and discriminatory information about the teamwork skills of medical students. Its use for summative purposes is yet to be determined.
Association of genetic variants with non-alcoholic fatty liver disease in an urban Sri Lankan community
(Wiley-Blackwell, 2015) Kasturiratne, A.; Akiyama, K.; Niriella, M.A.; Takeuchi, F.; Isono, M.; Dassanayake, A.S.; de Silva, A.P.; Wickremasinghe, A.R.; Kato, N.; de Silva, H.J.
Availability and cost of medicines for treatment of non-communicable diseases in private sector drug outlets in Sri Lanka
(Sri Lanka Medical Association, 2006) Kasturiratne, A.; Chandratilake, M.N.; Pinidipathirage, M.J.; Jayaratne, G.S.; Mahawithanage, S.T.; Subhashini, K.A.P.; Jayasekara, D.P.A.R.N.; Wickremasinghe, A.R.
BACKGROUND: Non-communicable diseases (NCDs) are the leading cause of morbidity and mortality in Sri Lanka. Availability and affordability of medicines to treat them determine patient outcomes. OBJECTIVES: To determine the availability and affordability of common medicines for the management of NCDs in private sector drug outlets in four districts in Sri Lanka. METHODS: A descriptive cross-sectional study was conducted in randomly selected private pharmacies in Anuradhapura, Colombo, Matara and Monaragala districts. A pre-tested questionnaire administered to pharmacists/dispensers and direct observations were used to obtain availability and prices of drugs for treatment of ischaemic heart diseases, hypertensive diseases, diabetes mellitus, asthma and cancer by trained data collectors
Availability of drugs for the treatment of non-communicable diseases in the government health care institutions in Sri Lanka
(Sri Lanka Medical Association, 2006) Pinidiyapathirage, M.J.; Chandratilake, M.N.; Kasturiratne, A.; Jayaratna, G.S.; Jayasekera, D.P.A.R.N.; Subhasini, K.A.P.; Mahawithanage, S.T.; Wickremasinghe, A.R.
OBJECTIVE: To assess the availability of commonly used drugs in the treatment of non-communicable diseases in government health care institutions. METHODS: Forty four government health care institutions, representing the 3 levels of health care institutions (level 1 - CD & MH, level 2 - PU, DH, RH, level 3 - BH, GH, PH, TH) were randomly selected from the districts of Colombo, Anuradhapura, Moneragala and Matara. Each of the selected institutions was visited and the availability of a selected list of drugs was ascertained on the day of the visit. Availability was considered satisfactory if the drug was available in at least 75% of institutions of a particular level. RESULTS: Of the drugs that should be available at each level the following results were obtained: Level I -Availability of thiazides, beta-blockers, aspirin and nitrates were satisfactory. Availability of benzathine benzylpenicillin, glibenclamide andprednisolone were unsatisfactory. LevelII- Furosemide, thiazides, nitrates, glibenclamide, metformin andprednisolone were available in all and the availability of methyldopa, nifedipine, beta-blockers and aspirin was satisfactory. Availability of benzathine benzylpenicillin, insulin (isophane/so ruble) and spironolactone were unsatisfactory. Level III - Furosemide, thiazides, metformin, aspirin, beta-blockers, nitrates, nifedipine and prednisolone were available in all while the availability of benzathine benzylpenicillin, captopril, spironolactone, methyldopa, glibenclamide, insulin (isophane/soluble) and timolol eye-drops were satisfactory. Availability of steptokinase, inhalation steroids and salbutamol, ipratropium bromide, losartan, and tamoxifen were unsatisfactory. CONCLUSIONS: Availability of some essential drugs for non-communicable diseases was unsatisfactory at all 3 levels of health care institutions. This may be a reason for patients bypassing smaller institutions and the back referral system not functioning properly in the country. Inadequacy of national stocks cannot by itself explain the non-availability of these drugs as the survey was carried out in July/August.
Awareness of human papillomavirus, cervical cancer and its prevention among primigravid antenatal clinic attendees in a tertiary care hospital in Sri Lanka: a cross-sectional study
(Collingwood, Vic. Australia : CSIRO Publisher, 2019) de Silva, A.H.W.; Samarawickrema, N.; Kasturiratne, A.; Skinner, S. R.; Wickremasinghe, A.R.; Garland, S. M.
ABSTRACT: Background Cervical cancer is the second commonest cancer amongst Sri Lankan women. With introduction of the human papillomavirus (HPV) vaccine to the national immunisation schedule, awareness and prevention of disease underpins vaccine uptake. Knowledge of HPV, HPV-related diseases and attitudes towards prevention and screening among urban women was assessed. METHODS: Primigravids attending Colombo North Teaching Hospital antenatal clinics were recruited over 8 months as surrogates for women who have recently become sexually active. Data through a self-administered questionnaire on three domains were collected (cervical cancer, Pap testing, HPV and vaccine). RESULTS: Of 667 participants (mean age 23.9 (s.d. = 4.4) years, 68.0% (n = 454) had >11 years of schooling), only 1.5% (n = 10) were aware of all three domains: 55.0% (370/667) had heard of cervical cancer, 19.0% of whom (70/370) knew it was sexually acquired, 9.0% (60/667) were aware of Pap screening, while 5.4% (36/665) had heard about HPV and <1.0% (5/667) knew it caused cancer. The total knowledge score ranged from zero (379/665) to nine (2/665), with a mean of 0.9 (s.d. - 1.4), with awareness increasing with level of education (χ2 = 18.6; P <0.001). Of those aware of Pap testing, 8.0% (5/60) were reluctant to undergo testing, while 46.6% (28/60) had no apprehension. CONCLUSIONS: Knowledge of cervical cancer, Pap testing, HPV and vaccine was low, especially in terms of HPV. Among those aware of Pap screening, generally there were favourable attitudes to having a test. These data have implications for acceptance of the vaccine and any future expansion of cervical screening with newer, more cost-effective technologies.
Awareness of stroke among patients with stroke in a tertiary care hospital
(Sri Lanka Medical Association, 2014) Ranawaka, U.K.; Peiris, K.A.; Perera, W.M.N.; Kasturiratne, A.
INTRODUCTION AND OBJECTIVES: Stroke awareness is known to affect health seeking and risk reduction behavior. We assessed stroke awareness among patients with stroke. DESIGN: CASE CONTROL STUDY. Setting: University Medical Unit-Colombo North Teaching Hospital, Ragama. METHODS: All consenting patients admitted with stroke over a one-year period, and age and sex matched controls, were assessed for awareness of disease mechanisms, symptomatology, risk factors, treatment, emergency response and prevention. Awareness of stroke was categorized using a composite score- Statistical analysis was done using chi square and t-tests. RESULTS: Eighty patients and 78 controls were studied. Awareness was inadequate ('poor' or 'very poor') in 63.8% of patients and 56.4% of controls, and was rated 'very good' in only two patients and none of the controls. Awareness was inadequate especially regarding risk factors, available treatment options and preventive methods. Mean awareness score was not different between patients and controls (18.38 vs. 18.91; p>0.05). Awareness was better in the younger patients. Doctors (73.6%) and television (36.5%) were the main sources ol knowledge, and other health care workers (15.1%), radio (8.8%) and health educational materials (12.6%) had little impact. CONCLUSIONS: Stroke awareness was inadequate among patients with stroke, and was not better than controls.
Behaviour of Cytokines IL10, IL6 and IFy during late febrile and immediate defervercent phases of Dengue
(Sri Lanka Medical Association, 2014) Weerasinghe, O.M.S.; Premaratna, R.; Gomes, L.; Perera, J.; Silva, S.; Abeyratna, C.; Kasturiratne, A.; Malavige, N.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: Cytokines have been implicated in dengue (DF) pathogenesis. Behaviour of cytokines during the late febrile phase (LFP) and immediate defeversence have not been studied, but may be useful to understand the pathophysiology of disease progression and effect of interventions. METHODS: A preliminary prospective study was performed to investigate 1L-10, IL6 and IFy (pg/ml) responses during the late febrile phase (around fifth day) and immediate defervestence in confirmed (NSlAg positive} dengue patients. Demographic, clinical and laboratory data were collected. Two samples of 1 m! serum were obtained during the above stages of the illness and stored at -80°C to assess cytokine levels. Cytokine levels were compared between phases (LFP and afebrile) and stages (DF, precritical and critical dengue shock syndrome (DSS)). LFP cytokine levels were compared for disease stages using one-way Anova test. RESULTS: 18 patients (11 males, mean age 26 years (SD 10.6)) were studied. There were 3 DF, 9 precritical and 6 criticaj DSS based on national guidelines. Mean temperature during LFP and defervescent phases were 102.07°F (SD 0.98) and 98.53°F (SD 0.26). Median (interquartile range) of IL10, IL6 and IFy in LFP were 164.3 (90.8 - 259.5), 26 (12.7-54.6), 246.5 (117.5-511.8) and during defervescent phase were 17.4 (6A-112.2), 11.9 (4.9-28.2), 2.58 (0.0-58.4) respectively. LFP IL10 significantly correlated with disease stages (F-3.99, P-0.041), IL6 and IFy had no correlation. CONCLUSIONS: All three cytokines rapidly declined with defervecence. IL10 in febrile phase showed significant correlation with disease severity.
Beliefs and knowledge regarding snakebite in rural Sri Lanka: a qualitative survey
(Sri Lanka Medical Association, 2003) Makita, L.S.; Nandasena, S.; Costa, M.R.A.; Kasturiratne, A.; Pathmeswaran, A.; Lalloo, D.G.; de Silva, H.J.
OBJECTIVES: To identify common beliefs and assess knowledge regarding snakebite in rural Sri Lanka, and their influence on health-seeking behaviour. METHODS: Qualitative methods (focus group discussions and key informant interviews) were used to obtain data in five rural locations in wet, intermediate and dry zones. Data was subjected to "framework analysis" involving familiarisation, identification of thematic frame, indexing and coding, charting, mapping, and interpretation. RESULTS: People are aware of risk-behaviour associated with snakebite, and have reasonable knowledge regarding venomous and non-venomous snakes. However, differences in nomenclature sometimes lead to confusion in identifying species. Beliefs and legends, which are linked to religion, have lead people to respect the cobra. Traditional healers claim they can determine the snake species, clinical manifestations that may occur, and prognosis, based on phenomena, such as, day of the week and phase of the moon when the bite took place. They still employ treatment methods, such as wound incision with broken glass and scalp incision for applying potions. Although there is respect for traditional healing, there is acceptance of the efficacy of western medicine. Beliefs, such as, anti-venom though effective is toxic, long-term effects of snake venom can be completely neutralised only by traditional medicine, and producing the dead snake is essential for treatment in hospitals, lead people to seek treatment by traditional healers rather than in hospitals. CONCLUSIONS: Beliefs and misconceptions influence health-seeking behaviour following snakebite. There seems to be a growing acceptance of western medicine. However, traditional healing methods are still popular, but include harmful^rjractices. This information could form a basis for. educational intervention.
Budget impact and cost-effectiveness analyses of the COBRA-BPS multicomponent hypertension management programme in rural communities in Bangladesh, Pakistan, and Sri Lanka
(Elsevier, 2021) Finkelstein, E.A.; Krishnan, A.; Naheed, A.; Jehan, I.; de Silva, H.A.; Gandhi, M.; Lim, C.W.; Chakma, N.; Ediriweera, D.S.; Khan, J.; Kasturiratne, A.; Hirani, S.; Solayman, A.K.M.; Jafar, T.H.; COBRA-BPS study group.
BACKGROUND: COBRA-BPS (Control of Blood Pressure and Risk Attenuation-Bangladesh, Pakistan, Sri Lanka), a multi-component hypertension management programme that is led by community health workers, has been shown to be efficacious at reducing systolic blood pressure in rural communities in Bangladesh, Pakistan, and Sri Lanka. In this study, we aimed to assess the budget required to scale up the programme and the incremental cost-effectiveness ratios. METHODS: In a cluster-randomised trial of COBRA-BPS, individuals aged 40 years or older with hypertension who lived in 30 rural communities in Bangladesh, Pakistan, and Sri Lanka were deemed eligible for inclusion. Costs were quantified prospectively at baseline and during 2 years of the trial. All costs, including labour, rental, materials and supplies, and contracted services were recorded, stratified by programme activity. Incremental costs of scaling up COBRA-BPS to all eligible adults in areas covered by community health workers were estimated from the health ministry (public payer) perspective. FINDINGS: Between April 1, 2016, and Feb 28, 2017, 11 510 individuals were screened and 2645 were enrolled and included in the study. Participants were examined between May 8, 2016, and March 31, 2019. The first-year per-participant costs for COBRA-BPS were US$10•65 for Bangladesh, $10•25 for Pakistan, and $6•42 for Sri Lanka. Per-capita costs were $0•63 for Bangladesh, $0•29 for Pakistan, and $1•03 for Sri Lanka. Incremental cost-effectiveness ratios were $3430 for Bangladesh, $2270 for Pakistan, and $4080 for Sri Lanka, per cardiovascular disability-adjusted life year averted, which showed COBRA-BPS to be cost-effective in all three countries relative to the WHO-CHOICE threshold of three times gross domestic product per capita in each country. Using this threshold, the cost-effectiveness acceptability curves predicted that the probability of COBRA-BPS being cost-effective is 79•3% in Bangladesh, 85•2% in Pakistan, and 99•8% in Sri Lanka. INTERPRETATION: The low cost of scale-up and the cost-effectiveness of COBRA-BPS suggest that this programme is a viable strategy for responding to the growing cardiovascular disease epidemic in rural communities in low-income and middle-income countries where community health workers are present, and that it should qualify as a priority intervention across rural settings in south Asia and in other countries with similar demographics and health systems to those examined in this study. FUNDING: The UK Department of Health and Social Care, the UK Department for International Development, the Global Challenges Research Fund, the UK Medical Research Council, Wellcome Trust.
The Burden of diabetes mellitus and impaired fasting glucose in an urban population of Sri Lanka
(Wiley-Blackwell, 2013) Pinidiyapathirage, M.J.; Kasturiratne, A.; Ranawaka, U.K.; Gunasekara, D.; Wijekoon, N.; Medagoda, K.; Perera, S.; Takeuchi, F.; Kato, N.; Warnakulasuriya, T.; Wickremasinghe, A.R.
AIMS: To describe the burden of diabetes mellitus and impaired fasting glucose in middle-aged residents (35-64 years) in an urban area of Sri Lanka. METHODS: A cross-sectional survey was conducted in the Ragama Medical Officer of Health area, from which 2986 participants (1349 men and 1637 women) were randomly selected from the electoral registry between January and December 2007. The participants underwent a physical examination and had their height, weight, waist and hip circumferences and blood pressure measured by trained personnel. Fasting blood samples were taken for measurement of glucose, HbA(1c) and lipids. The prevalence of diabetes (fasting plasma glucose > 7 mmol/l) and impaired fasting glycaemia (fasting plasma glucose 5.6-6.9 mmol/l) and major predictors of diabetes in Sri Lanka were estimated from the population-based data. RESULTS: Age-adjusted prevalence of diabetes mellitus in this urban population was 20.3% in men and 19.8% in women. Through the present screening, 263 patients with diabetes and 1262 with impaired fasting glucose levels were identified. The prevalence of newly detected diabetes was 35.7% of all patients with diabetes. Among patients with diabetes, only 23.8% were optimally controlled. In the regression models, high BMI, high waist circumference, high blood pressure and hypercholesterolaemia increased the fasting plasma glucose concentration, independent of age, sex and a family history of diabetes. CONCLUSIONS: Our data demonstrate the heavy burden of diabetes in this urban population. Short- and long-term control strategies are required, not only for optimal therapy among those affected, but also for nationwide primary prevention of diabetes
The burden of diabetes mellitus in an urban population of Sri Lanka
(Sri Lanka Medical Association, 2011) Pinidiyapathirage, M.J.; Kasturiratne, A.; Williams, S.; Wijekoon, N.; Pathmeswaran, A.; Ranawaka, U.K.; Warnakulasuriya, T.; Takeuchi, F.; Kato, N.; Wickremasinghe, A.R.
INTRODUCTION AND OBJECTIVES: To describe the burden of diabetes in middle and old aged residents (35-64 years) in an urban area of Sri Lanka. METHODS: A cross-sectional survey was conducted in the Ragama Medical Officer of Health area, in which 2986 participants (1349 men and 1637 women) were randomly selected from the electoral registry between January and December 2007. The participants underwent a physical examination and had their height, weight, waist and hip circumferences and 51ood pressure measured by trained personnel. Blood samples were taken after a 14 hour fast for measurement of glucose, HbAlc and lipids. The prevalence of diabetes (fasting plasma glucose [FPG] >7mmol/L) and impaired fasting glycaemia [IFG] (FPG=5.6-6.9mmol/L) and major predictors of diabetes in Sri Lanka were estimated from the population based data. RESULTS: In the whole sample two thirds of the participants were diagnosed as either people with diabetes (20%) or IFG (45%). Among the diabetics only 23.8% were optimally controlled. Through the present screening, 235 diabetics (7.9%) and 1257 (42.1%) participants with impaired fasting glucose levels were newly identified. Old age (OR=5.1, 55-64 years vs. 35-44 years), male sex (OR=3.1), family history (OR- 2.7), central obesity (OR-1.8), and reduced physical activity (OR=1.3) were significantly associated with increased risk of diabetes. CONCLUSIONS: Our data demonstrate the heavy burden of diabetes in the general population. Short and long term control strategies are required not only for optimal-therapy among those affected but also for nationwide primary prevention of pre-diabetes.
Cervical cancer screening in Sri Lanka
(Sri Lanka Medical Association, 2014) Gunaratne, A.V.C.; Aberathne, H.G.C.R.; Kasturiratne, A.; Wickremasinghe, A.R.
INTRODUCTION AND OBJECTIVES: To review the performance of the current screening programme for cervical cancer in Sri Lanka. METHODS: The estimated female population over 35 years of age for 2004 to 2009 was obtained from the Department of Census and Statistics. Assuming that 20% of the expected number of women make two visits based on current recommendations, the expected number of visits per year was calculated. The treatment gap was calculated for two scenarios assuming that 10% and 25% of women will seek treatment in the private sector. Assuming that 1% of cervical smears wili be reported as positive, the number of females with changes being missed was calculated. RESULTS: The number of females screened at government institutions has increased from 61,707 in 2004 to 116,415 in 2009. The number of clinics conducted throughout the country increased from 379 to 791. Of the 116,415 females seen for the first time in 2009, cervical visualisation was done in 93,356 (80.2%); among these women pap smears were taken in 85,927 (92.0%) and reports were received for 58,195 (67.7%) women. The treatment gap for cervical cancer screening was over 90% from 2004 to 2009 for both assumptions (10% and 25% of women will receive care in the private sector). The number of women with cytological changes who may be missed by the system is estimated to be almost 10,000 per year. CONCLUSIONS: Based on our simulatio ns, the current screening services for cervical carcinoma are inadequate and needs to be scaled up.