Browsing by Author "Perera, K.M.N."

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Accessibility challenges for the disabled community accessing public health care services and disability care institutions in Ragama Medical Officer of Health area
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2021) Pathirage, C.K.; Padmasiri, U.G.M.; Nuvvarapakshage, N.S.R.P.; Panditharatne, W.D.; Hewawardhane, S.N.; Phuntsho, T.; Perera, K.M.N.
Introduction: Ragama Medical Officer of Health (MOH) area is a developing center for the disabled with the National Rehabilitation Hospital and the specialized disability care institution targeting children. It also hosts the main teaching hospital in the district and a school for disabled children. Visual, walking and audibility impairments account for the highest number of disabled individuals in the country. Ragama MOH area is a developing hub for all these communities. Objectives: The objective of this study is to describe access-related challenges for the disabled community accessing public health care services and disability care institutions in Ragama MOH area. Methods: This is the qualitative study component of a larger study which also quantitatively assessed the compliance of the settings using an observational checklist. This component focused on the qualitative evaluation of accessibility-related challenges. Independent research team members interviewed 15 service providers, disabled and community stakeholders sampled purposively using semi-structured questionnaires. Data was analysed using thematic analysis method. Results: Financial constraints were identified as the main constraint for development of accessibility. “Dependence”, “gaps in awareness” and “negative attitudes” in order of perceived importance, revealed to hinder empowerment of the disabled on demanding for better access. Prioritisation of one disability was identified as a significant determinant for reduced access for individuals with multiple disabilities. Service providers were perceived to have the greatest power to address the challenges in their respective settings. Conclusions: Empowering clients to demand for improvement of accessibility and engaging primary service providers in development processes will lead to improvement of the existent challenges.
Accessibility to disability-care institutions and public health services in Ragama Medical Officer of Health Area
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2021) Pathirage, C.K.; Padmasiri, U.G.M.; Nuwarapakshage, N.S.R.P.; Panditharatne, W.D.; Hewawardhane, S.N.; Phuntsho, T.; Perera, K.M.N.
Introduction: Ragama Medical Officer of Health (MOH) area is a developing centre for the disabled with the National Rehabilitation Hospital and the specialized disability care institution targeting children. It also hosts the main teaching hospital in the district and a school for disabled children. Objectives: The objective was to describe compliance of identified settings related to disability health services in the Ragama MOH Area with current accessibility regulations. Methods: This is the quantitative component of a larger study which explored accessibility challenges and perceptions of service providers and the clients as well. This component assessed identified 16 settings including all disability care institutions, public health care services and selected access-points in Ragama MOH area using an observational checklist based on ‘disabled persons’ accessibility regulations act no. 1, 2006’. Photographic documentation of accessibility was performed. Data analysis utilized descriptive statistics based on a score of 1 for complete compliance and 0 for non-compliance. Results: Accessibility for visually impaired and signage for the disabled reported the lowest compliance with a score of 0% across all assessed settings. Highest compliance was observed related to pathways and corridors which scored 93.3%. Specific shortcomings and strongholds of accessibility in each institution were identified. Only one institution specializing in children with disabilities displayed a total compliance of 61.11%. The road network accessing the institutions portrayed less than 5% compliance with the recommended standards. Conclusions: Failure to meet accessibility regulations as expected in a developing hub such as Ragama MOH area emphasizes the need for greater attention to disabled accessibility in the country.
Advocating university undergraduate students on implementing FCTC Article 5.3
(EUEP European Publishing, 2021) Kandeepan, S.; Perera, K.M.N.; Wijesuriya, H.; Perera, C.S.; Rajasuriya, M.
INTRODUCTION: Tobacco industry uses aggressive strategies to use to make people want to buy their products, especially youths. Therefore It is needed to enhance the knowledge about industry tactics among the youngsters. OBJECTIVES: Establishment of network with university undergraduates to combat tobacco industry interferences in public health in Sri Lanka. METHODS: Centre for Combating Tobacco (CCT) organized a series of advocacy sessions on Tobacco Industry Impact on Public Health and Framework Convention on Tobacco Control (FCTC) Article 5.3 targeting the university undergraduates in Sri Lanka. The first session was held on June 23rd, 2019. It was organized by a group of undergraduates currently working as volunteers with CCT to empower their peers in state university science stream faculties of the Western Province. In this session Industry’s impact on substance use and public health and direct and indirect promotion strategies, Tobacco industry interference in Sri Lanka, FCTC Article 5.3 and current activities by CCT to monitor tobacco industry interference on public health and implementation of FCTC Article 5.3 in Sri Lanka were discussed. Networking and establishment of action committees to support CCT activities with university undergraduate students were discussed. Results Opportunities for best practice strategies for tobacco interference control were identified. Policy adherence and enforcement was improved to raising the awareness with students. CONCLUSION(S): A majority of students supported the advocacy programme. A Network with university students was formed to combat the tobacco industry interference.
Availability of rehabilitation services for communication disorders in Sri Lanka: a cross-sectional survey
(BMJ Publishing Group Ltd, 2023) Caldera, A.V.; Wickremasinghe, R.; Munasinghe, T.U.; Perera, K.M.N.; Muttiah, N.; Tilakarathne, D.; Peiris, M.K.R.R.; Thamilchelvan, E.; Sooriyaarachchi, C.; Nasma, M.N.; Manamperige, R.M.; Ariyasena, A.D.K.; Sumanasena, S.P.
OBJECTIVES: To describe the rehabilitation services available for communication disorders in Sri Lanka and to estimate the adequacy of the services in provinces and districts of the country. SETTING: The study considered government and private institutions, which provide rehabilitation services for communication disorders in Sri Lanka. PARTICIPANTS: Institutions providing services of speech-language pathologists, audiologists and audiology technicians in Sri Lanka. PRIMARY AND SECONDARY OUTCOME MEASURES: We investigated the number of government hospitals and private institutions, which provide speech-language pathology and audiology services in Sri Lanka as the primary outcome measure. A number of speech-language pathologists, audiologists and audiology technicians working in the institutions were obtained from records and institution-based inquiries to identify the adequacy of the services in the country as the secondary outcome measure. RESULTS: Of the 647 government hospitals that provide free healthcare services in the country, 45 and 33 hospitals had speech and language therapy and audiology units, respectively. Government hospitals do not have audiologists but only have audiology technicians. The number of speech and language therapists and audiology technicians in the government sector per 100 000 population in the country was 0.44 and 0.18, respectively. There were wide variations in specialist to population ratio between districts. 77 private centres provide speech therapy services in 15 out of the 25 districts; 36 private centres provide audiological evaluations in 9 districts. CONCLUSIONS: The number of specialist speech and language therapists and audiologists is not sufficient to provide adequate rehabilitation services for communications disorder for the Sri Lankan population. Not recruiting audiologists to the government sector affects the management of hearing impairment in the affected.
Bullying in schools among early adolescents in Galenbindunuweva educational zone: prevalence, types, common responses and effectiveness of a health promotion intervention
(Sri Lanka Medical Association, 2015) Jayasinghe, V.P.K.K.; Perera, K.M.N.; Guruge, G.N.D.
INTRODUCTION AND OBJECTIVES: Bullying is a prevalent behavior of violence and a leading health issue among school going adolescents. Aims were to describe prevalence, types, common responses and factors associated with bullying among early adolescents in Galenbindunuwewa Educational Zone and to evaluate a health promotion intervention to reduce bullying among early adolescents in a school in the same zone. METHOD: The study had two components. A cross sectional study and a participatory action research. The former was conducted in three schools randomly selected from the Galenbindunuwewa Educational Zone. A multi¬stage sampling method recruited 372 participants to obtain data using a self-administered questionnaire. In the second component, all students in grades seven to nine of a randomly selected school participated In an intervention modeled on a health promotion approach. Determinants identified and addressed were poor understanding of bullying, school culture, media promotion of violence and attitudes towards bullying and violence. Evaluation employed participatory methods, and a mixed-method approach was used in collecting data. Quantitative data were analyzed using SPSS. Qualitative data were analyzed manually using thematic analysis. RESULTS: The prevalence of bullying was 57.6% (verbal bullying), 31.1% (physical bullying) and 30.8% {social bullying). The most common responses reported when being bullied were tolerating (67.2%) and walking away (66.4%). Attitudes towards bullying showed significant positive changes after the intervention. Post intervention level of all types of bullying reduced significantly among participants with significant changes in the addressed determinants. Conclusion: Bullying is a prevalent issue in the Galenbindunuwewa Educational Zone. The piloted health promotion intervention proved effective in addressing this problem.
Community driven tobacco surveillance system: Engaging communities to monitor tobacco industry using a mobile app
(EUEP European Publishing, 2021) Perera, C.N.S; Perera, K.M.N.; Wijesuriya, H.; Kandeepan, S.; Periyannan, D.; Lakmal, P.A.C.S.; Fernando, A.B.I.; Rajasuriya, M.
INTRODUCTION: Centre for Combating Tobacco (CCT) is the tobacco observatory in Sri Lanka established under the FCTC Article 5.3. CCT has experimented several resource-efficient methods in low-resource settings. Sri Lanka, a developing lower-middle income country, reports user rates closer to 100% for smart mobile device and social media. OBJECTIVES: To effectively engage the public in monitoring tobacco industry interference and activities (TIIA) METHODS: “Tobacco Unmasked HotSpots” (TU-HotSpots) mobile app, was developed and launched in two stages. The preliminary launch (May 2018) was to pilot the app for feasibility and acceptability. A community network to monitor TIIA, Community-Driven Tobacco Surveillance System (CDTSS) using an upgraded app (based on the pilot project findings) was launched in March 2019. Freely downloadable from any mobile app store, TU-HotSpots enables registered users to report TIIA under three categories: “Report a HotSpot” (geographical location of TIIA (Articles 5.3, 6, 12, 13, 15, 16), “Interference through Media” (Article 13) and “Tobacco Industry contacted me” (Article 5.3). Data is fed to the TU-HotSpots Map, a website with an interactive map and a dashboard of interactive graphs and charts after reviewing and approval by the CCT team. RESULTS: Two evaluations done to explore the feasibility and acceptability revealed that 91.4% (n=54) agreed this app would be useful in tobacco control and 82.8% (n=48) stated that it would be accepted by the public. Inadequate technological knowledge and interrupted online connection were the perceived challenges for implementation. Active promotion using organized trainings among youth and field officers were the main suggestions for improvement. As at October 2019, 289 registrants reported 786 incidents; with 315 approved “Report a HotSpot” and 383 approved “Interference through Media” reports. “Tobacco Industry contacted me” category only had a one reporting. CONCLUSION(S):A mobile app coupled with an actively established community network is an effective tool to engage the public in monitoring TIIA.
Designing a tool to monitor development of 2-5 year old children by preschool teachers in Sri Lanka: A preliminary report
(Sri Lanka Medical Association, 2018) Caldera, A.; Mendis, M.; Muttiah, N.; Wijesinghe, T.M.; Godamunne, P.K.S.; Chathurika, L.K.E.; Jayasena, B.N.; Wickremasinghe, A.R.; Perera, K.M.N.; Tilakarathne, N.; Peiris, M.K.R.R.; Sumanasena, S.P.
INTRODUCTION AND OBJECTIVES: Identifying neurodevelopmental impairments and providing early intervention positively impacts later academic and functional outcomes of children. Globally available child development screening tools are not readily accessible or validated for Sri Lanka. As a large proportion of Sri Lankan children aged 2-5 years attend preschools, teachers can complement developmental monitoring. The aim of this study was to design a tool to monitor the development of 2-5 year old children by preschool teachers. METHODS: Twelve local and global tools including the tool developed by Plan International and the Child Health Development Record (CHOR) were reviewed. All tools were mapped according to the domains and subdomains in the National Early Childhood Developmental Standards for Sri Lankan Children. A Delphi process was carried out by a panel of experts to include culture specific activities that assess all domains and subdomains across age groups. RESULTS: The existing tool developed by Plan International lacked indicators for health, daily living and social and emotional development. The CHOR was deficient in cognitive, receptive language, social and emotional indices. Several activities in some instruments were common to more than one age group. The domains incorporated into the proposed tool included motor, cognitive, language, social and emotional and self- help skills. Approximately 50 items per each age group were included in this tool CONCLUSION: A preliminary play-based tool for monitoring development of children 2-5 years of age across five main domains in natural settings for preschool children was developed. A pilot study is required to assess the validity of the tool.
Developing a tool to screen for disability among pre-school children: preliminary results
(Sri Lanka Medical Association, 2014) Perera, K.M.N.; Wijerathne, L.; Jayasinghe, C.; Kasturiratne, A.; Hettiarachchi, S.; Fonseka, R.; Jayasena, B.N.; Siriwardhena, D.; Godamunne, P.; Dahanayake, W.; Pathmeswaran, A.; Wickremasinghe, A.R.
INTRODUCTION AND OBJECTIVES: To develop and validate a tool that can be used by pre-school teachers to identify disabilities in the pre-school age group. METHODS: A multidisciplinary team was formed and the initial tool was developed^ Consensual validity was achieved by using nominal group technique and the tool was pre-tested in the Ragama MOH area. To assure criterion validity, the tool was used to screen all the children in the pre-school age group (2-5 years) in an MOH area randomly selected from the Anuradhapura District. The screened positives .were referred to an expert panel for confirmation of diagnosis and follow-up if required. RESULTS: Thousand nine hundred children were invited for screening and 1536 participated (478 2-3 years, 495 3-years, 560 > 4 years of age) and 267 (17.4%) were referred to the expert panel. Out of the referrals, majority (38.9%) had multiple disabilities. Hearing and speech difficulties were seen in (29.6%). Psycho social problems (11.6%), disabilities and other diseases (19.8%) accounted for the rest. The response rate for confirmation by experts was 64%. The predictive value of a positive test was 79.5%. The prevalence of disabilities among the screened pre-school age group was 88 per 1000 (95% Cl= 74 to 103). CONCLUSIONS: This tool can be used to screen children in the pre-school age for disabilities.
Developing and validating a tool to assess empowerment for tobacco control
(Sri lanka Medical Association, 2015) Perera, K.M.N.; Guruge, G.N.D.; Jayawardana, P.L.
INTRODUCTION AND OBJECTIVES: Empowerment is defined as the mechanism by which individuals, organizations and communities gain mastery over their lives. Many tobacco control interventions aim to empower individuals but measuring empowerment is a challenge. Study aim was to develop a tool to assess empowerment for tobacco controf at individual level in the Moneragala District. METHOD: indicators were operationalized based on Zimmerman's psychological empowerment definition. Initial interviewer-administered tool was subjected to modified Delphi technique to determine content and consensual validity and a scoring system. Cognitive interviews were conducted to assess applicability to local context. Pre testing (n=30) and validation (n=200) were conducted in the Badulla District. Exploratory factor analysis was performed to assess construct validity. Based on communalities, Scree test and Eigenvalues derived from latter, Delphi technique was used to determine the factor structure which improved interpretability. Internal consistency and test-retest reliability were assessed using Cronbach's alpha and Cohen's kappa coefficient respectively. RESULTS: Components extracted using principle component analysis showed high communalities (0.914 to 0.996). Eigenvalue cut-off taken was 0.3 and six constructs based on the Scree plot converged in 14 iterations in Varimax rotation. Final tool comprised 27 items under seven factors named "Perceived awareness"; "Motivation to involve and perceived mastery"; "Awareness and mobilization of resources"; "Perceived efficacy"; "Perceived competence in society", “perceived competence within network” and “community involvement” for tobacco control. Cronbach’s alpha was 0.91 demonstrating good internal consistency. Cohen’s kappa coefficient was 0.63 indiicating substancial agreement .CONCLUSION: Developed tool can be used in similar contexts to measure empowerment for tobacco control.
Do our Advanced Level students have satisfactory knowledge and attitudes related to contraception?
(Sri Lanka Medical Association., 2019) Weerasinghe, W.M.S.P.S.; Weerakoon, H.P.P.G.; Weerarathna, W.G.M.M.H.; Weerasinghe, W.M.L.J.; Weerasinghe, W.M.A.E.; Weerasooriya, M.P.S.R.; Perera, K.M.N.
INTRODUCTION & OBJECTIVES: Advanced level (AIL) students, shortly leaving school to a new life, are older than 16 years, the legal age to consent for sexual activities. Inadequate knowledge on contraception can lead to unprotected sex and serious negative effects including teenage pregnancies, criminal abortions and sexually transmitted diseases. We aimed to assess knowledge and attitudes on contraception among AIL students in Gampaha educational zone and selected factors associated. METHODS: A cross-sectional analytical study was conducted among 275 A/L students attending Gampaha tuition classes, selected using a multistage sampling method. A self-administered questionnaire was used. Knowledge and attitudes were analyzed using descriptive statistics and knowledge of different sub groups were compared using one-way ANOVA. RESULTS: A total of 277 (Male; 118,42.6%; Female; 159,57.4%) participated in the study. Knowledge was low for all methods; Pills (M=l .4, SD=1.7, Max=7), condoms (M=l.4; SD=1.2; Max=4), injectables (M=0.4;SD=0.8;Max=7), emergency methods (M=0.8;SD=0.9;Max=4), permanent methods (M=1.0; SD=1.0; Max=3). Male students (F=30.34;p<0.001) and Biology streams students (F=130.42;p<0.001) displayed significantly higher knowledge than others. Majority showed positive attitudes towards use, even though 16.7% (n=46; N=275) thought using contraceptives is a sin and 16.2% (n=44;N=272) stated their use would depend on the partner. The majority (76.7%;n=214;N=274) thought contraceptives should be taught in school. For all methods (N=545), social media was the commonest source of knowledge (n=95, 17.4%) and parents were the least common (n=16,2.9%). CONCLUSION: The level of knowledge was unsatisfactory even though majority displayed positive attitudes towards contraception. Social media can be effectively used to address the knowledge gap.
The effect of a community-based health promotion intervention to improve utilization of healthy lifestyle centers in Sri Lanka
(College of Community Physicians of Sri Lanka, 2021) Herath, H.M.T.P.; Perera, K.M.N.; Kasturiratne, A.
Background: Healthy lifestyle centers (HLCs) report underutilization by the target population. There is a dearth of evidence on improving HLC utilization through the Health Promotion (HP) approach. This study aims to evaluate of the effectiveness of a HP intervention in improving the utilization of HLCs.Methods: A quasi-experimental study was conducted in six grama niladari divisions from the catchment area of two selected HLCs, one each in Gampaha (intervention) and Kalutara (comparison) districts. Community support groups (CSGs) were developed and empowered as the intervention. Contributory factors for the underutilization were addressed with the CSG.The pre and post intervention assessments were done in a random sample of 498 (aged 35-65 years) from each group. Primary outcome was improvement in the attendance of the HLC and secondary outcomes were changes in contributory factors. Data collected using an interviewer-administered questionnaire and secondary data from the HLCs were used. Results: Utilization of the HLC improved significantly among the sample from the intervention group (Post 35.3% [95% CI: 30.9 - 39.8]; Pre 5.85% [95% CI: 3.74 - 7.95], P < 0.001). The comparison group showed no significant change (Post 3.49% [95% CI: 1.80 -5.17] - Pre 3.25% [95% CI: 1.62 - 4.87], p = 1.00). There was a significant improvement in mean HLC attendance in the intervention group (Mean difference= 91.83, P < 0.05) compared to the comparison group (Mean difference = 2.66, P > 0.05). Conclusions: The utilization of the HLCs can be improved by a HP intervention through developing and empowering CSGs.
Evaluating the efectiveness of a community based health promotion intervention on knowledge improvement regarding low birth weight and its determinants among antenatal couples in Sri Lanka
(Springer Nature, 2024) Guruge, G.N.D.; Young, S.M.; Perera, K.M.N.; Dharmaratne, S.D.; Gunathunga, M.W.
BACKGROUND Improvement of the knowledge of pregnant mothers and their partners related to low birth weight (LBW) is a vital factor in preventing LBW and reducing its prevalence. OBJECTIVES Implement and evaluate the effectiveness of a community based health promotion intervention on preg nant mothers and their partners to increase knowledge on birth weight and its determinants. The second objective is to determine the difference of the birth weight after implementing the intervention. METHODS A quasi experimental study design was used, and the setting was 806 pregnant mothers, 403 each in two dis tricts. In 26 ANCs, twenty six initial training sessions were conducted as a group, with an average of three hours for each session. Three follow up sessions were conducted in each ANC over 04 months (in total 104 sessions). All sessions were conducted in groups of 10 to 20 antenatal couples. The pregnant mothers and their partners completed interviewer administered questionnaires. Pre and post data were analysed based on four major knowledge categories using statistical methods. The McNemar’s Chi Square test; Chi Square test, Fisher’s Exact test, Paired t test, Student’s independent sample t test, Wilcoxon Signed Ranks test and Mann Whitney U test methods were applied as appropriate. RESULTS Both mothers and their partners in the intervention group (IG) reached significantly higher gains in knowledge than in the comparison group (CG). The participants who got the lowest scores for knowledge, at the pre assessment, in IG, also improved more than the CG {mothers (p = 0.002) and partners (p = 0.007)}. The mean birth weight shows that the IG has significantly improved for both mothers (p < 0.001) and partners (p = 0.013) with low knowledge scores (< 50% of total). CONCLUSIONS Knowledge about birth weight and its determinants among pregnant mothers and their partners improved significantly.
Facilities and challenges for education during COVID-19 pandemic among institutionalized orphans in Gampaha District
(College of Community Physicians of Sri Lanka, 2021) Jayarathne, N.P.M.W.; Jayalath, H.B.S.; Jayasooriya, M.G.N.B.; Jayasooriya, Y.T.; Jayasundara, H.P.P.I.; Perera, K.M.N.
Background: Orphans are critically underprivileged in receiving and accessing positive learning experiences in general. This may have worsened during a global pandemic with movement restrictions. We aimed to describe the facilities and challenges for education before and during COVID-19 pandemic among institutionalized orphans in Gampaha district. Methods: A descriptive cross-sectional study approached all wardens of Child Development Centers (CDCs) in Gampaha district compatible with the inclusion criteria (N=46) using a telephone interview in February, 2021. Results: The response rate was 56.5% (26/46) as 43.4% declined participation due to legal and administrative issues. More than 60% accommodated fewer than 20 children. All CDCs had at least 2 uniforms per child. Other essentials for schooling and stationeries were adequately available. Only 10 had a separate chair and a table for each child. Only 16 CDCs had computers and 15 had internet connections before the pandemic. Twenty-four (92.3%) reported that they sent their children to extra tuition classes. During COVID-19, roughly equal proportions used printed material sent from school (34%), online learning platforms (32%) and television (30%) to continue education. Only 65% was able to provide equal e-learning facilities for all children. Only 17 (73%) could continue education without any interruption. Majority could not state a cost for education. However, 84% stated they “managed” and 81% claimed that it increased during COVID-19. Most had covered their expenses through private organizations (53%) and individual donations (25%). Conclusions: COVID-19 pandemic had a negative impact on children's education in the studied institutions due to inadequate facilities.
Household expenditure on tobacco consumption in a poverty-stricken rural district in Sri Lanka
(SAGE Publications, 2017) Perera, K.M.N.; Guruge, G.N.; Jayawardana, P.L.
Tobacco is a determinant of poverty and a barrier for development. Monaragala, a rural, agricultural district, reports the highest poverty-related indicators in southern Sri Lanka. A cross-sectional study was used to describe the household expenditure on tobacco and its association with food- and education-related expenditures at household level. This study used a 4-stage cluster sampling method to recruit a representative sample of 1160 households. Response rate was 98.6%. Median monthly household income was LKR 20 000 (interquartile range [IQR] = LKR 12 000-30 000). The median monthly expenditure on tobacco was LKR 1000 (IQR = LKR 400-2000) with the highest spending tertile reporting a median of LKR 2700 (IQR = LKR 2000-3600).The proportionate expenditure from the monthly income ranged from 0.0% to 50% with a median of 5.0% (IQR = 2.0-10.0) and a mean of 7.4% (7.6). The poorest reported the highest mean proportionate expenditure (9.8%, SD = 10) from the household income. Household expenditure on tobacco negatively associated with expenditure on education.
Household expenditure on tobacco consumption in Monaragala district
(Sri Lanka Medical Association, 2016) Perera, K.M.N.; Guruge, G.N.D.; Jayawardana, P.L.
INTRODUCTION AND OBJECTIVES: The link between tobacco and poverty is well established. Monaragala is the poorest rural district in the southern parts of Sri Lanka and second poorest in the country. The Central Bank statistics state that 2.7% of household expenditure is spent on “liquor, drugs and tobacco”. This figure is much lower than the global estimates and findings in other countries. This study aimed to describe the expenditure on tobacco and its impact on food and education related expenditures at household level in Monaragala District. METHOD: A cross-sectional study design was used. A representative sample of 1160 households was recruited using a four-stage cluster sampling method. A simple random sampling method was used to select an individual aged between 15 to 59 years from the selected household. Data were obtained by a pre-tested, validated questionnaire was administered by trained interviewers. Recall method was used to obtain expenditure related data. RESULTS: Median monthly household income was LKR 20,000 (IQR=LKR 12,000-30,000). The median monthly expenditure on tobacco was LKR 1000 (IQR: 400-2000) with the highest spending tertile reporting a median of LKR 2700 (IQR 2000-3600). The proportionate expenditure from the monthly income ranged from 0.0% to 50% with a median of 5.0% (IQR=2.0-10.0). The poorest reported the highest mean proportionate expenditure (9.8%, SD=10) from the household income. Medium and high spenders spent significantly less on children’s education compared to others. CONCLUSION: The household expenditure on tobacco products in rural poor communities in Sri Lanka is probably greater than the current estimates.
How do Men who Choose Not to Participate in Healthy Lifestyle Centres Reason About Their Decision?
(Sri Lanka Medical Association, 2020) Herath, H.M.T.P.; Perera, K.M.N.; Kasturiratne, K.T.A.A.
INTRODUCTION AND BJECTIVES: In Sri Lanka, both women and men are expected to visit a cost-free population-based cardio-vascular screening programme held at a specific centre called the Healthy Lifestyle Centre (HLC) at their nearest primary health care institution. However, screened male to female ratio in 2016 first quarter was approximately 3:7 portraying that many men choose not to visit HLC compared to their female counterparts. This study explored how men who declined participation in the healthy lifestyle centre reasoned out their choice. METHODS: This qualitative study was conducted using constructivist grounded theory in Gampaha and Kalutara districts in Sri Lanka. Three focus group discussions (n= 7) and six interviews from men who actively declined participation in the healthy lifestyle centre were analysed using thematic analysis. RESULTS: Factors related to men’s decision not to participate in HLC included masculine perceptions such as male having a lower risk for diseases compared to a female, poor perceived susceptibility due to absence of symptoms, previous negative experiences related to health care services, lack of confidence in the tests conducted at the HLC and barriers due to their employment as HLC is being conducted in a fixed day and a time. CONCLUSION: Men’s decision not to participate in screening at HLC is linked with individual attitudes and influence by masculinity. The existing male-unfriendly nature of the health-care services also had a significant impact on the decision. Thus, targeted interventions are urgently needed to improve utilization of HLCs by men addressing these identified reasons.
Implementation of pictorial health warnings on cigarette packs in Sri Lanka and the tobacco industry interferences
(Sri Lanka Medical Association, 2019) Wijesuriya, H.; Perera, K.M.N.; Perera, C.S.; Dineshkumar, P.; Lakmal, S.C.; Fenando, A.I.B.; Kandeepan, S.; Rajasuriya, M.
INTRODUCTION & OBJECTIVES: Ceylon Tobacco Company (CTC), legally challenged the government's initiative on 80% of the pictorial health warnings (PHW) on cigarette packs. After several rounds of Appeal and Supreme Court hearings, the judgement was given to implement PHWs, but reducing its size to 60%. However, as the then Minister of Health was later elected the President the 80% PHWs got implemented through a parliamentary decision. Our study aims to describe the tobacco industry interference during this process. METHODS: Investigative research techniques were used. Media reports, court reports, web content and research articles collected through snow-ball sampling were reviewed using content analysis. RESULTS: Strategies recognised were: alleged bribery by CTC; alleged interference in the legal and policy process through high-ranking politicians including the Head of State; influencing stakeholders and public via industry favourable academic publications and media reports; and influencing business community via industry favourable discussion forums. Main arguments used were: Minister of Health not possessing the legal power to enforce such a law; PHWs violating the company's intellectual property rights related to trade names and branding; unproven effectiveness of PHWs; and inadequate time availability for implementation. The only front group visible was the media, which repeatedly published arguments against PHWs favouring tobacco industry. The industry ultimately managed to delay the PHW implementation by 23 months and to reduce its extent to 60%. They managed to delay the original 80%-PHW implementation by 29 months. CONCLUSION: The tobacco industry interference misled the policy makers and the public, delaying implementation of PHWs for more than two years.
Is accessibility to centers of disability care in the emerging hub for disability healthcare services of the Western Province truly challenging?
(College of Community Physicians of Sri Lanka, 2021) Pathirage, C.K.; Padmasiri, U.G.M.; Nuwarapakshage, N.S.R.P.; Panditharatne, W.D.; Hewawardhane, S.N.; Perera, K.M.N.
Background: Ragama Medical Officer of Health (MOH) area is a sanctum of disability care hosting the main teaching hospital in the district, National Center for Children with Disabilities, National Rehabilitation Hospital and a school for disabled children. The objectives were to describe compliance of above institutions with current accessibility regulations and access-related challenges for the disabled community. Methods: A mixed-methods study was performed by qualitative evaluation of accessibility-related challenges and quantitative assessment of the aforementioned institutions and access-points. The qualitative component collected data from 6 service providers 4 disabled individuals and 5 community stakeholders sampled purposively by the research team. In-depth interviews used a semi-structured questionnaire guide. Data was analyzed using thematic analysis method. The quantitative component utilized an observational checklist based on 'disabled persons accessibility regulations act no.1, 2006' under the themes of public institutions, road network and access-points and accessibility for the visually impaired. Data analysis utilized descriptive statistics allocating a score of 1 for compliance and 0 for non-compliance. Results: Financial constraints were identified as the main challenge along with “Dependence”, “Gaps in awareness” and “Negative attitudes”. The highest level of compliance to the imposed regulations was only 61.1% portrayed by the institution specializing in children with disabilities. Accessibility for the visually impaired showed 0% compliance across all institutions. The public road network failed to exceed a compliance of 5%. Conclusions: Failure to meet anticipated excellence of accessibility in a developing hub such as Ragama MOH area emphasizes on the need for prioritization of disabled accessibility in Sri Lanka.
Is Facebook used to promote tobacco, alcohol and other illicit drugs in Sri Lanka? A qualitative study
(Sri Lanka Medical Association, 2019) Siriwardhana, M.K.B.S.; Siroj, N.M.; Somarathna, A.D.P.; Thilakarathna, P.H.H.K.; Thisarana, K.P.S.K.; Perera, K.M.N.
INTRODUCTION & OBJECTIVES: Global evidence reveals that tobacco, alcohol and other illicit drugs (TAIDs) are promoted via Facebook and social media targeting youth, influencing their initiation and use. Extensive analysis of Sri Lankan Facebook posts on TAIDs is not carried out to date. Main objectives were to describe the content of TAIDs related Facebook posts circulated in Sri Lanka and explore the techniques used in them to promote TAIDs. METHODS: TAIDs related Facebook posts publicly shared by Sri Lankans during a three-month period were collected using a snowball sampling technique. A pre-tested data extraction sheet was used and content analysis was carried out by two independent investigators based on deductive thematic analysis method. RESULTS: A total of 763 posts were collected and 710 posts were analyzed after excluding duplicates. Of them, 595 (83.8%) were promotive [Alcohol (369,620/0), Tobacco (142,23.9%), Cannabis (103,17.3%) Other (57,9.6%)]. Commonest theme seen was humor (349,49.2%). Sarcasm (273,38.4%) and political themes (101,14.2%) were also common. Product promotion (388,54.5%) was commoner than brand promotion (70,9.9%). In-depth analysis of Sinhala and Tamil language promotive posts (n=359) found that 231 (64.3%) promoted a product, 202 (56.2%) normalized their use and 115 (32%) glamorized use of TAIDs. The commonest tools used for promotion were words (277, 77.1 0/0) and images (175, 48.4%). CONCLUSION: TAIDs related Facebook posts were mostly promotive in nature and alcohol promotion was the commonest. Regulations to ban advertisement and promotion of TAIDs in Sri Lanka should be expanded to cover social media as recommended by the Framework Convention on Tobacco Control.
Knowledge and attitude towards intimate partner violence among ever-married women: A Cross-sectional study from Sri Lanka
(AIJR Publisher, 2020) Reyal, H.P.; Perera, K.M.N.; Guruge, G.N.D.
ABSTRACT: Effective approaches are needed to address high prevalence of intimate partner violence (IPV) against women in developing countries. Among them, addressing the attitudes of women justifying IPV is crucial. Yet, Sri Lankan studies so far have not adequately examined the community members’ knowledge and attitude toward IPV. Hence, this study aimed at i) describing knowledge and attitude towards IPV among women, ii) explore the association of socio-demographic variables with knowledge and attitude towards IPV, and iii) examine the association of knowledge and attitude with the abuse experiences. A cross-sectional survey was conducted with women (n = 600) aged 15-49 years from a selected health administrative area in Sri Lanka. Multistage cluster sampling was used to select participants and data collection was performed using an interviewer-administered questionnaire. Descriptive summaries, cross-tabulations and logistic regression analysis were performed to describe and explore the associations. Most respondents had poor knowledge (64.3%, n=386) on IPV with approximately half of them having attitudes generally justifying IPV (48.7%, n=292). Women with low levels of education and low household income were more likely to justify IPV. Further, employed women had good knowledge on IPV. Poor knowledge on IPV increased the risk of being abuse by 1.5 times and women who had justifying attitudes toward IPV had two times risk of being abuse. The necessity of interventions to be targeted on knowledge and attitudes and the contributory socio-demographic factors such as education, employment and income are emphasized. KEYWORDS: Abuse, women, socio-demographic factors, knowledge, attitude