Browsing by Author "Mettananda, S."

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20 year follow up and survival analysis in a cohort of patients with Haemoglobin E beta Thalassaemia.
(Sri Lanka Medical Association., 2019) Olivieri, N.F.; Premawardhena, A.P.; Amir-Arsalan, S.; Ediriweera, D.; Mettananda, S.; Bandara, W.D.; Arambepola, M.; de Silva, S.; Refai, M.A.C.M.; Allen, A.
INTRODUCTION & OBJECTIVES: Haemoglobin E beta thalassaemia (EBT) is the commonest beta thalassaemia syndrome in the world and is extremely phenotypically variable. Unlike for transfusion dependent thalassaemia (TDT) there are no clear guidelines for the management of this disease. We have followed up a cohort of 109 patients with EBT for 20 years. Objective of the study was to study the 20-year survival and factors that affect survival. METHODS: Study was conducted at Kurunegala Thalassaemia centre. Transfusions were stopped in 1997 in all 109 patients. Since then they were assessed every three months by the clinical team for the next 20 years. Relevant haematological, biochemical, radiological assessments were done periodically. RESULTS: 32 (30%) of patients were dead at 20 years. Kaplan Meir survival curve identified the median survival to be 51 years. Splenectomy had been done in 73/109 (67%) patients. Splenectomy allowed 66% to be off transfusions even 9.7± 1.3 years post- surgery. However, 33% had to return to transfusions. The commonest cause of death in the cohort was infections (34.3%). Most (72%) infective deaths happened in those who were splenectomised. Transfusions needed to be restarted in 60%, of whom 33% went back to (>8 per year) regular transfusions at a mean 8.4 ±0.8 years after stopping transfusions. CONCLUSION: In this first ever long term follow up study of EBT, significantly shortened survival is observed. Though splenectomy allows prolonged transfusion free phases in many it increases risk of infective deaths. Overall the disease is far less benign than previously thought with a high prevalence of morbidity and mortality.
24 h activity guidelines in children and adolescents: A prevalence survey in Asia-Pacific cities
(MDPI, 2023) Quah, P.L.; Loo, B.K.G.; Mettananda, S.; Dassanayake, S.; Chia, M.Y.H.; Chua, T.B.K.; Tan, T.S.Z.; Chan, P.C.; But, B.W.; Fu, A.C.; Wong, S.M.; Nagano, N.; Morioka, I.; Kumar, S.; Nair, M.K.C.; Tan, K.H.
This study aimed to examine the prevalence of adherence to 24 h activity guidelines in children and adolescents from Asia-Pacific cities. In 1139 children aged 5-18 years, moderate-to-vigorous physical activity (MVPA), screen viewing time (SVT), sleep duration, child weight, height, sex, and age were parent-reported. Descriptive statistics were used to assess the number of guidelines met, and prevalence of adherence to activity guidelines by city and child sex. Prevalence of meeting all three 24 h activity guidelines was low across all countries (1.8-10.3%) (p < 0.05). Children from Thiruvananthapuram, India had the highest [10.3% (95% CI: 6.0-17.0)], while those from Tokyo, Japan had the lowest prevalence [1.8% (95% CI: 0.5-7.0)] of meeting all three guidelines. The highest prevalence of meeting individual MVPA, SVT and sleep guidelines was found in India [67.5% (95% CI: 58.8-75.1)], Kelaniya, Sri Lanka [63.2% (95% CI: 58.7-67.4)] and Kowloon, Hong Kong [59.4% (95% CI: 51.1-65.3)], respectively. Overall, a higher prevalence of boys met all three guidelines, compared to girls [5.9% (95% CI: 4.1-8.1) vs. 4.7% (3.1-6.6), p = 0.32]. The prevalence of adhering to all three activity guidelines was low in all five participating cities, with a higher proportion of boys meeting all guidelines.
6379 Pre-admission management of children presenting with febrile illness in a tertiary hospital of Sri Lanka
(BMJ, 2024) Arunath, V.; Mettananda, S.
OBJECTIVES To describe the symptoms and pre-admission management of children presenting with febrile illness to the Colombo North Teaching Hospital, Ragama, Sri Lanka.METHODS A retrospective descriptive study was conducted at University Paediatric Unit of Colombo North Teaching Hospital, Ragama, Sri Lanka. Data on pre-admission management of all children admitted with febrile illness from July to December 2019 were extracted from patient records. Children who were transferred from other units, children with chronic illnesses and children developed fever following vaccinations were excluded. Ethical approval was obtained from Ethics Review Committee of Sri Lanka College of Paediatricians and data was analysed using SPSS version 22.RESULTS A total of 366 children were admitted; 56% were males. Mean age was 53.5 ± 41.7 months and the majority were from Gampaha district. Mean duration of illness on admission was 3.6 ± 2.5 days. 236 (65.6%) patients had recorded fever spikes at home while 150 (60.7%) reported a contact history of fever. Common associated symptoms were cough (62.3%), cold (56%) and vomiting (39.6%). 199 (54.5%) underwent investigations prior to admission and full blood count was the commonest (47.5%) investigation. Although 357 (97.8%) had taken medication prior to admission, only 87.3% had consulted a doctor. 356 (97.3%) received paracetamol at home of which 24 (7.9%) and 123 (40.6%) received sub-therapeutic and supra-therapeutic doses respectively. Significantly higher proportion (44.9%) of children who consulted a doctor received appropriate dose of paracetamol compared to others (3.7%), (c2=11.9, p=0.003, p<001). Higher proportion children who had recorded fever spikes consulted a doctor (c2=3.99, p=0.046, p<0.05) and received therapeutic doses of paracetamol prior to admission (c2=4.94, p=0.026, p<0.05).CONCLUSION Use of sub- and supra-therapeutic doses of paracetamol was common before admission to the hospital. Recording temperature at home and medical consultation prior to admission were associated with appropriate dose paracetamol usage (p<005).
A novel mutation in the SLCO2A1 gene presenting as persistent hypoproteinaemia and refractory iron deficiency anaemia due to chronic enteropathy: A case report
(BioMed Central, 2024-11) Mettananda, S.; Bandara, P.; Rajeindran, M.; Padeniya, P.
BACKGROUND The SLCO2A1 gene encodes a prostaglandin transporter and we report a novel mutation causing hypoproteinaemia and refractory anaemia due to chronic enteropathy.Case PRESENTATION An 18-year-old boy of consanguineous parents was investigated for hypoproteinaemia and anaemia. He was short, pale and had generalised oedema. Investigations revealed haemoglobin 5.8 g/dL; hypochromic microcytic anaemia; low serum protein, albumin, globulin, ferritin and iron. Bone marrow aspiration revealed low iron stores. Upper and lower gastrointestinal endoscopies showed moderate gastritis, duodenitis, and non-specific patchy inflammation in the rectum. The whole exome sequencing revealed a homozygous missense mutation in SCLO2A1 gene (NP_005621.2:p.Arg97Cys; rs761212094). Sanger sequencing of the sibling with milder phenotype revealed same homozygous mutation, and carrier father was heterozygous.CONCLUSION We report a novel mutation of SLCO2A1 gene causing severe persistent hypoproteinaemia and refractory iron deficiency anaemia due to chronic enteropathy helping to delineate genotype-phenotype correlation of SLCO2A1 variants.
Abdominal pain predominant functional gastrointestinal diseases in children and adolescents: prevalence, symptomatology and association with emotional stress
(Sri Lanka Medical Association, 2011) Devanarayana, N.M.; Mettananda, S.; Rajindrajith, S.
INTRODUCTION AND OBJECTIVES: To assess the prevalence of abdominal pain predominant functional gastrointestinal diseases (FGD) in Sri Lankan children, their symptomatology, and predisposing factors. METHODS: A cross sectional survey was conducted among a randomly selected group of 10-16 year olds, in 8 randomly selected schools, in 4 provinces in Sri Lanka. A validated, self-administered questionnaire was distributed in an examination setting. Research assistants were present while filling the questionnaire and explanations were given. FGD Were Diagnosed using Rome III criteria. RESULTS: A total of 2180 questionnaires were distributed and 2163 (99.2%) were included in the analysis [1189 (55%) males, mean age 13.4 years, SD 1.8 years]. Seventeen incompletely filled questionnaires were excluded. Two hundred and seventy (12.5%) had at least one abdominal pain predominant FGD. Irritable bowel syndrome (IBS) was seen in 107 (4.9%), functional dyspepsia (FD) in 54 (2.5%), functional abdominal pain in 96 (4.4%) and abdominal migraine (AM) in 21 (1.0%) (2 had AM and FD, 6 had AM and IBS). Extraintestinal somatic symptoms (headache, limb pain, sleeping difficulty) were more common among affected children (p<0.05). Abdominal pain predominant FGD were significantly higher in girls and those exposed to stressful events (p<0.05). Prevalence negatively correlated with age. CONCLUSION: Abdominal pain predominant FGD were a significant health problem in Sri Lankan children affecting 12.5%. IBS was the commonest FGD diagnosed. Abdominal pain predominant FGD were higher in girls and those exposed to emotional stress. Prevalence of FGD decreased with age. Somatic symptoms were more frequent in affected children.
Abdominal pain-predominant functional gastrointestinal diseases in children and adolescents: prevalence, symptomatology, and association with emotional stress
(Lippincott Williams and Wilkins, 2011) Devanarayana, N.M.; Mettananda, S.; Liyanarachchi, C.; Nanayakkara, N.; Mendis, N.; Perera, N.; Rajindrajith, S.
BACKGROUND AND OBJECTIVE: Functional gastrointestinal disorders (FGD) are common among children, but little is known regarding their prevalence in developing countries. We assessed the prevalence of abdominal pain-predominant FGD, in addition to the predisposing factors and symptomatology, in Sri Lankan children. PATIENTS AND METHODS: A cross-sectional survey was conducted among a randomly selected group of 10- to 16-year-olds in 8 randomly selected schools in 4 provinces in Sri Lanka. A validated, self-administered questionnaire was completed by children independently in an examination setting. FGD were diagnosed using Rome III criteria. RESULTS: A total of 2180 questionnaires were distributed and 2163 (99.2%) were included in the analysis (1189 [55%] boys, mean age 13.4 years, standard deviation 1.8 years). Of them, 270 (12.5%) had at least 1 abdominal pain-predominant FGD. Irritable bowel syndrome (IBS) was seen in 107 (4.9%), functional dyspepsia in 54 (2.5%), functional abdominal pain in 96 (4.4%), and abdominal migraine (AM) in 21 (1.0%) (2 had AM and functional dyspepsia, 6 had AM and IBS). Extra intestinal symptoms were more common among affected children (P < 0.05). Abdominal pain-predominant FGD were higher in girls and those exposed to stressful events (P < 0.05). Prevalence negatively correlated with age (r = -0.05, P = 0.02). CONCLUSIONS: Abdominal pain-predominant FGD affects 12.5% of children ages 10 to 16 years and constitutes a significant health problem in Sri Lanka. IBS is the most common FGD subtype present. Abdominal pain-predominant FGD are higher in girls and those exposed to emotional stress. Prevalence of FGD decreased with age. Extra intestinal symptoms are more frequent in affected children.
Accuracy of measuring axillary temperature using mercury in glass thermometers in children under five years: a cross sectional observational study
(Scientific Research Publishing Inc, 2014) Perera, P.; Fernando, M.; Mettananda, S.; Samaranayake, R.
BACKGROUND: Measuring axillary temperature with mercury in glass thermometers is continued in clinical practice though there are many limitations. This is mainly due to convenience and cost. This study was conducted to ascertain the accuracy of measuring axillary temperature with mercury thermometers in preschool children. METHODS: Axillary temperature was measured in 250 preschool children using standardized mercury thermometers. Time taken to record the final temperature and its correlates were assessed. RESULTS: Time taken to record the final temperature extended up to six minutes. This duration varied according to age, body mass index and body temperature, but a significant variation was noted only with age. CONCLUSIONS: Measuring axillary temperature with mercury thermometers is subjected to error. They need to be replaced with suitable alternatives.
Achieving millennium development goal 4 in 2015: are we really on track?
(Sri Lanka College of Paediatricians, 2011) Mettananda, S.; Rajindrajith, S.; Warnakulasuriya, T.; Fernando, M.; Devanarayana, N.M.; Gunawardena, N.K.
INTRODUCTION: Millennium development goal (MDG) 4 aims to reduce under 5 mortality by two thirds from 1990 (22.2 per 1000 live births) to 2015 (7.4 per 1000 live births). In achieving this, proper and accurate description of the causes of deaths is crucial. OBJECTIVES: To describe the timing, causes and distribution of under 5 child deaths in Sri Lanka and to predict the likelihood of achieving MDG 4. DESIGN, SETTING AND METHOD: Information regarding all under 5 child deaths between 2002-2006 was obtained from the Registrar Generals' Department. Place, sex and age at death were retrieved. Causes of deaths documented accordingly to the ICD-10 classification were reclassified into clinically relevant and user-friendly categories. Mortality rates and predictions for 2015 were calculated using Microsoft Excel. RESULTS: A total of 26,273 deaths have occurred during 2002-2006 [55% neonatal, 21% post-neonatal infant and 24% child (l-5year)]. Tsunami wave in 2004 had caused 2,868 (11%) deaths and they were excluded from further analysis. Prematurity had caused 4,603 (31.8%) neonatal deaths; 2389 (16.5%) were due to infections and 1149 (7.9%) were due to birth asphyxia. Congenital anomalies have contributed to 1830 (12.6%) neonatal deaths, of which, the majority [1389 (9.6%)] were heart diseases. Leading causes for post-neonatal infant deaths include congenital anomalies [1772 (35%)], infections [1516 (29.9%)] and trauma [393 (7.7%)]. in children, 910 (23.4%) deaths were due to infections (10.2% respiratory, 2.0% gastroenteritis and 0.9% dengue). One fifth of deaths were due to congenital anomalies of which half were due to heart defects. Trauma/ accidents and malignancies had contributed to 731 (18.8%) and 279 (7.1%) deaths respectively. Colombo district reported the highest number of deaths (24%). More males (54.7%) have died compared to females. Reduction in mortality rates were observed from 2002-2006; neonatal mortality from 8.3 to 7.6, infant mortality from 11.4 to 10.4 and under 5 mortality from 13.7 to 12.3. Projections of data showed that the neonatal, infant and under 5 mortality rates in 2015 would be 4.6, 6.7 and 7.7 per 1000 live births respectively. CONCLUSIONS: Prematurity was the leading cause of neonatal mortality. Congenital heart diseases are an important cause of death throughout childhood. Trauma and accidents contribute to a significant proportion of child deaths. Predictions from data suggest that Sri Lanka may fall marginally short of achieving MDG 4.
Acute disseminated encephalomyelitis presenting as bilateral ptosis in a Sri Lankan Child
(Hindawi Pub. Corp., 2022) Kumarasiri, I.; Samararathna, R.; Sandakelum, U.; Muthukumarana, O.; Balasubramaniam, R.; Mettananda, S.
Introduction: Acute disseminated encephalomyelitis is a rare inflammatory demyelinating disease characterized by acute onset polyfocal neurological deficits associated with encephalopathy. It commonly presents with fever, meningism, seizures, ataxia, motor deficits, and bladder dysfunction. Although cranial neuropathies, including optic neuritis and facial nerve palsies, have previously been reported, children presenting with bilateral ptosis is extremely rare. Here, we report a 3-year-old child with acute disseminated encephalomyelitis presenting with acute onset bilateral ptosis due to involvement of the single central levator subnucleus of the oculomotor nerve. Case Presentation. A 3-year-old Sri Lankan boy presented with drooping of the upper eyelids for three days and unsteady gait for two days. He did not have seizures, blurring of vision, limb weakness, swallowing or breathing difficulties, or bladder dysfunction. On examination, he had bilateral ptosis, gait ataxia, and dysmetria. His vision, eye movements, and examination of other cranial nerves were normal. MRI brain revealed high signal intensities involving the subcortical white matter of parietal and occipital lobes, midbrain in the area of single central levator subnucleus of the oculomotor nerve, cerebellar vermis, and right cerebellar hemisphere. Based on the clinical features suggesting polyfocal neurological involvement of the midbrain and cerebellum and characteristic MRI findings, the diagnosis of acute disseminated encephalomyelitis was made. He responded well and rapidly to high-dose intravenous methylprednisolone and showed a complete clinical and radiological recovery. Conclusion: This case report describes a rare presentation of acute disseminated encephalomyelitis, bilateral ptosis due to involvement of the single central levator subnucleus of the oculomotor nerve. It highlights that the presenting manifestations of acute disseminated encephalomyelitis can be subtle and vary; however, timely diagnosis and treatment result in complete recovery.
Acute on chronic osteomyelitis due to coliforms in a Sri Lankan child with homozygous sickle cell disease
(Sri Lanka College of Paediatricians, 2021) Hoole, T.J.; Arunath, V.; de Silva, M.H.A.D.; Muthukumarana, O.G.W.; Kumarasiri, I.M.; Rathnasiri, G.B.A.M.R.; Mahendra, G.; Premawardhena, A.; Mettananda, S.
No Abstract Available
Alpha-globin as a molecular target in treatment of beta-thalassemia
(American Society of Hematology, 2015) Mettananda, S.; Gibbons, R. J.; Higgs, D. R.
The thalassemias together with sickle cell anemia and its variants are the world's most common form of inherited anemia and in economically undeveloped countries still account for tens of thousands of premature deaths every year. In developed countries, treatment of thalassemia is still far from ideal, requiring lifelong transfusion or allogeneic bone marrow transplantation. Clinical and molecular genetic studies over the past 50 years have demonstrated how co-inheritance of modifier genes, which alter the balance of α-like and β-like globin gene expression, may transform severe, transfusion dependent thalassemia into mild forms of anemia. Most attention has been paid to pathways that increase γ-globin expression and hence the production of fetal hemoglobin. Here we review the evidence that reduction of α-globin expression may provide an equally plausible approach to ameliorate clinically severe forms of β-thalassemia, in particular, the very common subgroup of patients with HbE β-thalassemia which make up approximately half of all patients born each year with severe β-thalassemia.
An unusual presentation of caudothalamic haemorrhage as fever in a term neonate
(Perinatal Society of Sri Lanka, 2024-11) Wickramaarachchi, W.M.S.K.K.; Jayalath, A.G.I.U.; Randeny, S.; Mettananda, S.
No abstract available
Anaemia among females in child-bearing age: Relative contributions, effects and interactions of α- and β-thalassaemia.
(Public Library of Science, 2018) Mettananda, S.; Suranjan, M.; Fernando, R.; Dias, T.; Mettananda, C.; Rodrigo, R.; Perera, L.; Gibbons, R.; Premawardhena, A.; Higgs, D.
INTRODUCTION: Anaemia in women during pregnancy and child bearing age is one of the most common global health problems. Reasons are numerous, but in many cases only minimal attempts are made to elucidate the underlying causes. In this study we aim to identify aetiology of anaemia in women of child bearing age and to determine the relative contributions, effects and interactions of α- and β-thalassaemia in a region of the world where thalassaemia is endemic. METHODS: A cross sectional study was conducted at the Colombo North Teaching Hospital of Sri Lanka. The patient database of deliveries between January 2015 and September 2016 at University Obstetrics Unit was screened to identify women with anaemia during pregnancy and 253 anaemic females were randomly re-called for the study. Data were collected using an interviewer-administered questionnaire and haematological investigations were done to identify aetiologies. RESULTS: Out of the 253 females who were anaemic during pregnancy and were re-called, 8 were excluded due to being currently pregnant. Of the remaining 245 females, 117(47.8%) remained anaemic and another 22(9.0%) had non-anaemic microcytosis. Of anaemic females, 28(24.8%) were iron deficient, 40(35.4%) had low-normal serum ferritin without fulfilling the criteria for iron deficiency,18(15.3%) had β-haemoglobinopathy trait and 20(17.0%) had α-thalassaemia trait. Of females who had non-anaemic microcytosis, 14(66.0%) had α-thalassaemia trait. In 4 females, both α- and β-thalassaemia trait coexist. These females had higher levels of haemoglobin (p = 0.06), MCV (p<0.05) and MCH (p<0.01) compared to individuals with only β-thalassaemia trait. A significantly higher proportion of premature births (p<0.01) and lower mean birth weights (p<0.05) were observed in patients with α-thalassaemia trait. CONCLUSIONS: Nearly one third of anaemic females in child bearing age had thalassaemia trait of which α-thalassemia contributes to a majority. Both α- and β-thalassaemia trait can co-exist and have ameliorating effects on red cell indices in heterozygous states. α-Thalassaemia trait was significantly associated with premature births and low birth weight. It is of paramount importance to investigate the causes of anaemia in women of child bearing age and during pregnancy in addition to providing universal iron supplementation.
Anaemia among women of child-bearing age: Contributions of alpha and beta-thalassaemia
(Sri Lanka Medical Association, 2018) Mettananda, S.; Suranjan, P.D.M.; Fernando, V.R.; Dias, T.D.; Rodrigo, R.; Perera, L.; Mettananda, K.C.D.; Gibbons, R. J.; Premawardhena, A.; Higgs, D. R.
INTRODUCTION AND OBJECTIVES: Anaemia during pregnancy is attributed to iron deficiency and pregnant women prescribed iron supplements without investigating for a cause. However, aetiology can be diverse and iron efficiency may contribute only partly. We aimed to describe the aetiology of anaemia among women of child bearing age. METHODS: This descriptive study was conducted at Teaching Hospital, Ragama from June-December 2017. Patient database of deliveries between January 2015 and September 2016 at University Obstetrics Unit was screened (n=3636) to identify women with anaemia (haemoglobin
Anaemia in children: are we using the correct prevention strategies?
(Sri Lanka Medical Association, 2017) Mettananda, S.; de Silva, D.G.H.
Analysis of effects of meteorological factors on dengue incidence in Sri Lanka using time series data
(Public Library of Science, 2013) Goto, K.; Kumarendran, B.; Mettananda, S.; Gunasekara, D.; Fujii, Y.; Kaneko, S.
In tropical and subtropical regions of eastern and South-eastern Asia, dengue fever (DF) and dengue hemorrhagic fever (DHF) outbreaks occur frequently. Previous studies indicate an association between meteorological variables and dengue incidence using time series analyses. The impacts of meteorological changes can affect dengue outbreak. However, difficulties in collecting detailed time series data in developing countries have led to common use of monthly data in most previous studies. In addition, time series analyses are often limited to one area because of the difficulty in collecting meteorological and dengue incidence data in multiple areas. To gain better understanding, we examined the effects of meteorological factors on dengue incidence in three geographically distinct areas (Ratnapura, Colombo, and Anuradhapura) of Sri Lanka by time series analysis of weekly data. The weekly average maximum temperature and total rainfall and the total number of dengue cases from 2005 to 2011 (7 years) were used as time series data in this study. Subsequently, time series analyses were performed on the basis of ordinary least squares regression analysis followed by the vector autoregressive model (VAR). In conclusion, weekly average maximum temperatures and the weekly total rainfall did not significantly affect dengue incidence in three geographically different areas of Sri Lanka. However, the weekly total rainfall slightly influenced dengue incidence in the cities of Colombo and Anuradhapura. Copyright: 2013 Goto et al.
Analysis of neonatal deaths in Sri Lanka from 2002 to 2006
(Sri Lanka Medical Association, 2011) Mettananda, S.; Warnakulasuriya, T.; Fernando, M.; Devanarayana, N.M.; Rajindrajith, S.
INTRODUCTION AND OBJECTIVES: To describe the causes, timing and distribution of neonatal deaths in Sri Lanka from 2002 to 2006. METHODS: Information on all neonatal deaths occurred from 2002 to 2006 (5 calendar years) in the entire country was obtained from the Registrar Generals' Department. Place of death and age at death were retrieved. Causes of death documented as 429 different diagnoses according to the ICD-10 classification were reclassified into clinically relevant and meaningful categories. Results: A total of 14,487 neonatal deaths occurred during the 5-year period with a mean of 2897.4 deaths per year; of which 8159 (56.32%) were males. One third of them (4904) died within 24 hours of life and 11,318 (78.12%) were early neonatal deaths. Number of deaths gradually decreased with increasing age. Colombo district reported 3334 (23.0%) deaths. Prematurity and related complications were the cause for 4603 (31.77%) deaths whereas 2389 (16.49%) deaths were due to infections. Proportion of deaths due to infections has gradually decreased from 20.23% in 2002 to 11.84% in 2006. Congenital anomalies contributed to 12.63% (1830) deaths and the majority of those deaths (1389-9.59%) were due to congenital heart diseases. Birth asphyxia had caused 1349 (7.93%) neonatal deaths. Tsunami wave in 2004 has led to 36 (0.25%) neonatal deaths. CONCLUSIONS: Preventable causes such as prematurity, infections and congenital heart diseases are still leading causes of neonatal deaths in Sri Lanka. Targeted healthcare reforms are urgently needed to address these issues.
Analysis of nutritional status and factors associated with undernutrition in children aged 6-59 months in a rural area of Sri Lanka
(Sri Lanka College of Paediatricians, 2019) Samarasekara, G.S.; Mettananda, S.; Punchihewa, P.
OBJECTIVE: To describe the prevalence and factors associated with undernutrition in children aged 6-59 months in a rural area of Sri Lanka. METHOD: A community-based, cross-sectional study was carried out among children aged 6-59 months attending well baby clinics in Dehiattakandiya Medical Officer of Health area from November 2016 to January 2017. Data collection was done using an interviewer-administered questionnaire. Weight and height measurements were taken with calibrated instruments. Data analysis was done using logistic regression by SPSS 16.0. RESULTS: Four hundred and sixty four children were recruited having a mean age of 29.3 ±14.6 months; 53% were females. Prevalence of stunting, underweight and wasting was 36.4%, 42.9% and 19.0% respectively. The following independent associations were identified: for stunting- low birth weight, breastfeeding beyond 2 years, lower maternal education and paternal smoking; for underweight- birth order more than 2, low birth weight, breastfeeding beyond 2 years, lower maternal education and paternal smoking and alcohol use; for wasting- male sex, low birth weight and paternal smoking. CONCLUSIONS: Low birth weight, prolonged breastfeeding, lower maternal education level and paternal smoking had a significant association with stunting and underweight whilst male sex, low birth weight, and paternal smoking had a significant association with wasting in children aged 6-59 months.
Analysis of nutritional status and factors associated with undernutrition in children aged 6-59 months in a rural area of Sri Lanka
(Sri Lanka Medical Association, 2017) Samarasekera, G.S.; Punchihewa, P.M.G.; Mettananda, S.
INTRODUCTION & OBJECTIVES: This study aims to describe the prevalence and factors associated with undernutrition among children aged 6-59 months in a selected rural area of Sri Lanka. METHODS: A community-based cross-sectional analytical study was conducted among randomly selected children aged 6-59 months attending well baby clinics in Dehiattakandiya Medical Officer of Health area from November2016 to January2017. Data were collected using an intervieweradministered questionnaire and weight and height were measured using calibrated equipment. Ethical clearance was obtained from the ethical committee of the Sri Lanka College of Paediatricians. Data were analyzed using logistic regression by IBM SPSS statistics 22. RESULTS: A total of 464 children were recruited; mean age was 29.3(SD±14.6) months; 53% were females. Prevalence of stunting, being underweight and wasting were 36.4%, 42.9% and 19.0% respectively. Following independently associated factors were identified: for stunting – low birth weight [OR=1.94 (95% CI 1.44-2.61), p=0.025], prolonged breast feeding beyond 2 years [OR=1.89 (95% CI 1.43-2.50), p=0.022], lower maternal educational level [OR=2.24 (95% CI 1.78-2.81), p<0.001] and paternal smoking [OR=2.30 (95% CI 1.81-2.94), p=0.001]; for being underweight – birth order>2 [OR=1.80 (95% CI 1.37-2.38), p=0.032], low birth weight [OR=2.22 (95% CI 1.64-3.00), p=0.008], prolonged breast feeding beyond 2 years [OR=1.80 (95% CI 1.36-2.38), p=0.036], lower maternal educational level [OR=2.60 (95% CI 2.06-3.27), p<0.001] and paternal smoking [OR=2.58 (95% CI 2.04-3.27), p<0.001] and alcohol use [OR=1.89 (95% CI 1.47-2.44), p=0.011]; For wasting – male sex [OR=2.11 (95% CI 1.62-2.74), p=0.005], low birth weight [OR=2.52 (95% CI 1.85-3.44), p=0.003] and paternal smoking [OR=1.85 (95% CI 1.38-2.48), p=0.35]. CONCLUSION: Low birth weight, prolonged breast feeding, lower maternal educational level and paternal smoking were significantly associated with stunting and being underweight whereas male sex, low birth weight and paternal smoking were associated with wasting in children aged 6-59 months.
Assessment of knowledge on neonatal danger signs among postnatal mothers in Base Hospital Kinniya
(Sri Lanka Medical Association, 2017) Kumara, W.M.A.R.; Naleem, K.M.; Izzana, S.F.; Mettananda, S.
INTRODUCTION & OBJECTIVES: Maternal knowledge on neonatal danger signs is crucial for timely identification of serious health problems in neonates. This study aims to describe the knowledge on neonatal danger signs among post-natal mothers at Base Hospital Kinniya. METHODS: Cross-sectional descriptive study was conducted at Base Hospital Kinniya from October to December 2016. All mothers in postnatal wards were recruited at discharge after obtaining informed consent. Data were collected using an interviewer-administered questionnaire and analysed using SPSS for windows. Ethical approval was obtained from the Sri Lanka College of Paediatricians. RESULTS: A total of 384 mothers were recruited; majority (95.8%) were Muslims. Most (50.5%) were aged between 18-25 years, 6.8% were employed and 90.9% had secondary education. Majority (88.3%) were planned pregnancies, 33.6% were primigravida and all attended antenatal clinics. Nearly 80% had received health education during the antenatal period. Only 2.3% of mothers could identify all neonatal danger signs accurately. Only 83.1% identified hypothermia as a danger sign while only 14.1% identified posseting as normal. Significantly higher proportion of mothers aged below 35 years (54.6%) had a good knowledge on danger signs compared to elderly mothers (33.3%) [χ2=5.91, p<0.05]. Higher proportion with uncomplicated pregnancies (54.7%) had a good knowledge compared to complicated pregnancies (37.0%) [χ2=5.13, p<0.05]. Age at marriage, maternal education level, parity or antenatal health education were not associated with better knowledge on neonatal danger signs. CONCLUSION: Overall knowledge on neonatal danger signs is unsatisfactory among postnatal mothers at Base Hospital Kinniya. Elderly mothers and mothers with antenatal complications have significantly poor knowledge on neonatal danger signs.