Browsing by Author "Perera, P.J."

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Actual exclusive breastfeeding rates and determinants among a cohort of children living in Gampaha district Sri Lanka: A prospective observational study
(BioMed Central, 2012) Perera, P.J.; Ranathunga, N.; Fernando, M.P.; Sampath, W.; Samaranayake, G. B.
BACKGROUND: Exclusive breastfeeding (EBF) during the early months of life reduce infant morbidity and mortality. Current recommendation in Sri Lanka is to continue exclusive breastfeeding up to six months of age. Exclusive breastfeeding rates are generally assessed by the 24 recall method which overestimates the actual rates. The objective of this study was to determine actual exclusive breast feeding rates in a cohort of Sri Lankan children and to determine the reasons that lead to cessation of breastfeeding before six months of age. METHODS: From a cohort of 2215 babies born in Gampaha district, 500 were randomly selected and invited for the study. They were followed up at two (n = 404), four (n = 395) and six (n = 286) months. An interviewer administered questionnaire asked about feeding history and socio-demographic characteristics. Child health development record was used to assess the growth. RESULTS: Exclusive breastfeeding rates at two, four and six months were 98.0%, 75.4% and 71.3% respectively. The main reasons to stop exclusive breastfeeding between two to four months was concerns regarding weight gain and between four to six months were mothers starting to work. Majority of the babies that were not exclusively breastfed still continued to have breast milk. Mothers above 30 years had lower exclusive breastfeeding rates compared to younger mothers. Second born babies had higher rates than first borns. There was no significant association between maternal education and exclusive breastfeeding rates. CONCLUSIONS: Exclusive breastfeeding rates were high among this cohort of children. A decrease in EBF was noted between two and four months. EBF up to six months does not cause growth failure. Mothers starting to work and concerns regarding adequacy of breast milk were the major reasons to cease EBF. The actual exclusive breastfeeding rates up to six months was 65.9%.
Antioxidant activity and chemical constituents of methanolic extract of Durio zibethinus Murr. (durian) peels
(MEDICINAL PLANTS - INTERNATIONAL JOURNAL OF PHYTOMEDICINES AND RELATED INDUSTRIES, 2021) Perera, P.J.; Binuwangi, A.K.D.M.; Silva, A.A.G.; Attanayake, R.N.; Wickramarachchi, S.R.; Rajapakse, C.S.K.
This study aimed to determine the DPPH free radical scavenging activity, total phenolic content (TPC) and total flavonoid content (TFC) of methanolic extract of Durio zibethinus Murr. (durian) peels and its fractions. The chemical constituents of durian peels extracted into methanol by soxhlet extraction were sequentially extracted into hexane, dichloromethane and aqueous methanol. Among the fractions, the dichloromethane fraction showed the highest DPPH free radical scavenging activity (IC50 179.9 ± 6.6 μg/ml) with high TPC and TFC (85.82 ± 12.11 mg gallic acid equivalent/g of dried weight of extract and 12.66 ± 1.94 mg of quercetin equivalent/g of dried weight of extract, respectively). A very strong positive correlation (r = 0.9677) was observed between the DPPH free radical scavenging activity and the TPC of fractions and a strong positive correlation (r = 0.7858) was noticed between the DPPH free radical scavenging activity and TFC of the fractions indicating that phenolic compounds in durian peels may contribute to their strong antioxidant activity. As the dichloromethane fraction had constituents with the highest antioxidant activity, it was analyzed by Gas chromatography-Mass spectrophotometry to identify its volatile constituents. The results revealed that the dichloromethane fraction was rich in [1,2-Benzenedicarboxylic acid, bis (2-ethylhexyl) ester], [2,3-diphenylquinoxaline], [2-coumaranone], [4-((1E)-3-hydroxy-1-propenyl)-2-methoxyphenol], [7,9-di-tert-butyl-1-oxaspiro (4,5) deca-6,9-diene-2,8-dione] and [phenol, 2,4-bis(1,1-dimethylethyl)], which are known to exhibit antioxidant activity.
An Atypical case of Kawasaki disease presenting with cholestatic jaundice
(Sri Lanka College of Paediatricians, 2015) Perera, P.J.; Samarasinghe, D.A.; Pathirana, D.; Randeni, S.; Samdamal, L.Y.S.
Case Report, No abstract available.
Benign intracranial hypertension following vitamin A megadose
(Sri Lanka Medical Association, 2014) Perera, P.J.; Sandamal, Y.S.; Randeny, S.
No Abstract available.
Child with Trisomy 13, inherited from paternal translocation, rob(13;14)(q12.1;q11.2)
(World Wide Journals(Ahmedab -India), 2016) Perera, P.J.
Consumption pattern of iodised salt in households and serum TSH levels among 5-9 year old children in the plantation sector of Sri Lanka
(Sri Lanka Medical Association, 2012) Abeysuriya, V.; Wickremasinghe, A.R.; Perera, P.J.; Kasturiratne, A.
INTRODUCTION: Salt is the main source of iodine in areas with high rainfall and iodine deficiency is the main cause of preventable hypothyroidism. Iodisation of salt increases iodine intake, but will depend on how salt is handled. This study was carried out to assess the pattern of salt consumption in the estate population and to ascertain the relationship between household salt iodine concentration and TSH levels in children. METHODS: A descriptive cross sectional study was carried out in 20 randomly selected estates in the Ratnapura district of Sri Lanka, from August to November 2009. 1683 households with at least one child between 5-9 years were surveyed to determine patterns of salt usage. A salt sample from each household was tested for adequacy of iodine (concentration ≥30ppm). In phase two, 519 children were randomly selected from these households and serum TSH levels were assayed. RESULTS: Salt powder (54.5%) was preferred to salt crystals. Salt crystals were washed before use in 20% households. Salt was kept away from the fire-place in 90.4% of households. Salt samples of 88.7% households had an adequate iodine concentration. Salt iodine concentration was significantly lower when salt was stored near a fire-place and washed before use (p<0.001). The median TSH level of children from households with adequate salt iodine concentrations was significantly lower than that of children from households with inadequate salt iodine concentration (p<0.001). CONCLUSIONS: A significant number of households did not have adequate iodine in salt samples probably due to inappropriate handling and storage. Consumption of salt low in iodine is associated with high serum TSH levels
Effect of feeding practices on dental caries among preschool children: a hospital based analytical cross sectional study
(HEC Press, Australia, 2014) Perera, P.J.; Fernando, M.P.; Warnakulasooriya, T.D.; Ranathunga, N.
Feeding practices during early childhood play an important aetiological role in early childhood caries (ECC). The role of feeding practices in causation of ECC is debated. The objective of this study was to assess the aetiological role of feeding practices on ECC. A descriptive cross sectional study was conducted at a paediatric unit in Sri Lanka. Two hundred and eighty-five children between 36 to 60 months, admitted to the unit were randomly selected for the study. An interviewer administered questionnaire asked about socio-demographic characteristics and feeding practices. The mouths of children were examined for dental caries. Out of 285 children, 61% had exclusive breast feeding up to six months, 69% continued breast feeding beyond two years and 82% had overnight feeding after two years of age. One hundred and thirty-six children (47.7%) had dental caries with a mean deft score of 1.81. Overnight feeding with any type of milk beyond two years significantly increased dental caries incidence and severity. Children exclusively breast fed for six months or had breast feeding beyond two years had a higher prevalence of caries than children not exclusively breast fed or who were not breast feed beyond two years, but the difference was not significant. Overnight feeding with any type of milk beyond two years should be discouraged.
Feeding practices among children attending child welfare clinics in Ragama MOH area: a descriptive cross-sectional study
(BioMed Central, 2011) Perera, P.J.; Fernando, M.; Warnakulasuriya, T.; Ranathunga, N.
BACKGROUND: Feeding during early childhood is important for normal physical and mental growth as well as for health in later life. Currently, Sri Lanka has adopted the WHO recommendation of exclusive breastfeeding for six months, followed by addition of complementary feeds thereafter, with continuation of breastfeeding up to or beyond two years. This study was conducted to evaluate the current feeding practices among Sri Lankan children during early childhood. METHODS: This study was a descriptive cross-sectional study conducted in the Ragama Medical Officer of Health (MOH) area. It was conducted between 10 August 2010 and 30 October 2010. Children between the ages of 24 and 60 months, attending child welfare clinics, were included in the study on consecutive basis. An interviewer-administered questionnaire was used to collect data regarding socio-demographic characteristics and feeding practices. RESULTS: There were 208 boys and 202 girls in the study population. Of them, 255 (62.2%) were exclusively breastfed up to 6 months. Younger children had a statistically significant, higher rate of exclusive breastfeeding compared to older children. Three hundred and fifty one (85.6%) children had received infant formula, and it was started before the age of 6 months in 61 children, and in 212 before one year. Sugar was added to infant formula in 330 (80.4%) children, and out of them 144 had sugar added within first year of life. Complementary foods were started before 4 months in 29 (7%) children. Of the 410 children, 294 (71.7%) were breastfed beyond 2 years and 41.6% of them were breastfed at regular intervals throughout the day. Three hundred and thirty eight (82.6%) children were receiving overnight feeding of either breast milk or infant formula even after 2 years. CONCLUSIONS: Though a high rate of exclusive breastfeeding was observed in this study population, there are many other issues related to feeding during the early years of life that need immediate intervention. Too early introduction of complementary food, using infant formula without an indication, adding sugar to infant formula, too frequent breastfeeding and overnight feeding of older children are among them.
Growth parameters at birth of babies born in Gampaha district, Sri Lanka and factors influencing them
(World Health Organization, Regional Office for South-East Asia, 2013) Perera, P.J.; Ranathunga, N.; Fernando, M. P.; Warnakulasuriya, T.D.
Background: Growth parameters at birth are important for clinical decision‑making. In Sri Lanka, the data from the World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) are used to interpret these measurements. Materials and Methods: A descriptive cross‑sectional study was conducted between September and October 2010 in hospitals of Gampaha district, Sri Lanka. The weight, length and head circumference of all normal‑term babies born in the Gampaha district during this period were measured within 8 h of birth using standard techniques. Measurements were taken by medical graduates trained and supervised by a consultant paediatrician. Socio‑demographic data were obtained using an interviewer‑administered questionnaire. Results: Of the 2215 babies recruited, 1127 were males. The mean birth weight, mean length and mean head circumference at birth were 2.92 kg, 49.1 and 33.6 cm, respectively. Boys weighed and measured more than girls in all parameters, but the differences were not statistically significant. Growth parameters of babies included in this study deviated from that in the MGRS data. Mean values of MGRS data were between 75th and 90th centiles of this study population. Birth order, family income and maternal education were significantly (P < 0.01) associated with growth parameters. Contrary to common belief, growth parameters continued to increase progressively up to 41 weeks. Maternal age less than 20 years or more than 35 years was negatively associated with birth weight (P < 0.01). Conclusions: Growth parameters of new‑born babies deviated significantly from the values of the MGRS data. Growth characteristics of one population may not be applicable to another population due to variations in maternal, genetic and socio‑economic factors. Using growth charts not applicable to a population will result in wrong interpretations.
Growth parameters of Sri Lankan children during infancy: A comparison with world health organization Multicentre growth reference study
(Centro de Estudos do Crescimento e do Desenvolvimento do Ser Humano, 2014) Perera, P.J.; Fernanado, M.P.; Ranathunga, N.; Sampath, W.; Samaranayake, R.; Mettananda, S.
OBJECTIVES: growth monitoring (GM) is an important intervention ensuring wellbeing of children. If GM to be meaningful it is essential to have reference standards appropriate for that population. In Sri Lanka growth charts based on WHO multi centre growth reference study (MGRS) are used for GM. This study was carried out to ascertain the appropriateness of MGRS charts for GM in Sri Lankan children. METHODS: out of a birth cohort of 2215 children, 250 from each sex were invited for a followed up. Children were examined at 2, 4, 6, 9 and 12 months, to measure weight and length. Statistical characteristics of weight and length for each sex were calculated and compared with MGRS data. RESULTS: out of babies invited to participate in the study 244 boys and 241 girls responded initially. Out of this 85% of boys and 86% of girls completed the follow up. Weight and length of both sexes deviated significantly at all ages from MGRS data. CONCLUSION: MGRS data seems to be inappropriate for monitoring growth of Sri Lankan children
Head circumference during infancy in a birth cohort of Sri Lankan children: are we using the correct chart?
(Sri Lanka Medical Association, 2014) Perera, P.J.; Fernando, M.P.; Samaranayake, R.
INTRODUCTION: Measuring head circumference and plotting it in centile charts is a routine practice in paediatrics. However if wrong charts are used, serious misinterpretations can ensue. OBJECTIVES: This study was carried out to ascertain the appropriateness of charts used in Sri Lanka. Out of a birth cohort of 2215 children, 250 from each sex were invited for a follow up study. Head circumference was measured at 2, 4, 6, 9 and 12 months. Statistical characteristics of head circumference for each sex, at each age were calculated. RESULTS: At the first follow up 244 boys and 241 girls were assessed. Out of this, 85% of boys and 86% of girls completed the follow up. CONCLUSIONS: Head circumference of both sexes deviated significantly at all ages from the charts available in the Child Health Developmental Record (CHDR). Head circumference charts available in the CHDR are inappropriate for use in Sri Lankan children.
Hypocalcaemia leading to supra ventricular tachycardia in a three-month old Sri Lankan infant with vitamin D deficient rickets: a case report
(Sri Lanka Medical Association, 2017) Fernando, M.P.; Perera, P.J.; Muthukumarana, O.J.; Uyangoda, K.
No Abstract Available
Iodine concentration in common potable water sources in the estates of Ratnapura district and thyroid status of children
(Sri Lanka College of Paediatricians, 2012) Abeysuriya, V.; Wickremasinghe, A.R.; Perera, P.J.; Kasturiratne, A.
INTRODUCTION: Iodine deficiency is the single most important cause of hypothyroidism. Drinking water is an important source of iodine for humans. Objective: To identify the common potable water sources available to the estate population in the Ratnapura District, to determine the iodine concentrations in different water sources and to ascertain the relationship between water iodine concentrations and thyroid status of children 5 to 9 years of age. METHOD: A descriptive cross sectional study was carried out in three phases in 20 randomly selected estates in the Ratnapura district of Sri Lanka from September to November 2009. In phase 1, 1,683 households in the selected estates were surveyed to identify the drinking water sources. In phase 2, blood samples from 519 randomly selected children aged 5-9 years from the same estates were taken to assay TSH levels after obtaining informed written consent from parents. In phase 3, water samples from 23 identified sources (wells, rivers and springs) were analysed for iodine levels by the catalytic reduction method. Water sources were grouped on elevation above mean sea level. The mean TSH levels and water iodine concentrations were correlated. RESULTS: The main source of drinking water was spring water (83.7%). Spring water at low altitudes had significantly higher iodine concentrations than that located at higher altitudes (p<0.01). The mean iodine concentration in spring water was significantly lower than that in other sources (p<0.001). There was no association between the mean TSH levels of children and the altitudes at which they lived (p>0.05). There was no significant association between TSH levels of children and iodine concentration in drinking water (p>0.05). CONCLUSIONS: The main potable water source available to the population in the Ratnapura District was spring water (84%). The mean iodine concentration of spring water was significantly lower as compared to other water sources. There was no significant association between serum TSH levels in children 5 to 9 years of age and iodine concentration in drinking water.
Knowledge and practices related to helminth infections among mothers living in a suburban area of Sri Lanka
(SEAMEO Regional Tropical Medicine and Public Health Project, 2012) Perera, P.J.; Disanayake, D.; Fernando, M.P.; Warnakulasooriya, T.D.; Ranathunga, N.
Intestinal helminth infections are a global problem. We assessed maternal knowledge among Sri Lankans about helminth infections and patterns of anthelmintic use to treat their children. We conducted this cross sectional study at the University Pediatric Unit in Teaching Hospital Ragama, during September 2011 to November 2011. Two hundred children admitted to the Pediatric Unit and their mothers were randomly recruited into the study. An interviewer administered questionnaire asking about socio-demographic factors, availability of sanitary facilities and safe drinking water, knowledge about intestinal infections and anthelmintic use. Nearly all the mothers interviewed reported having a safe toilet and 62% reported having safe drinking water. Eighty-four percent of children were given anthelmintic medication periodically irrespective of symptoms. Of these, 39.3% were treated every 3 months, 55.3% every six months and 5.3% annually. Of the children who received routine anthelmintic treatment, 81% had risk factors for helminth infection and 62.5% had evidence of a helminth infection in the past. There was no statistically significant association between routine anthelmintic medicine use and the presence of risk factors (odds ratio 0.28; confidence interval 0.04-1.31) or having symptoms of helminth infection (odds ratio 1.67; CI 0.73-3.8). Maternal knowledge regarding helminth infection was poor. Health education programs regarding helminth infections and their treatment are indicated.
Knowledge on mother to child transmission of HIV among newly registered antenatal mothers in MOH area Ragama
(Sri Lanka College of Venereologists, 2014) Perera, H.P.; Wickramasuriya, C.D.; Perera, P.J.; Pathmeswaran, A.
Sri Lanka has remained a low prevalent country for HIV for past three decades. One important aspect of maintaining this low prevalence is preventing mother to child transmission (MTCT) of HIV. As highly effective strategies are now available to reduce the risk of MTCT, early diagnosis of HIV in antenatal mother is important. Good knowledge about HIV and MTCT will promote mothers to take up HIV testing. Though mothers in this study population had a reasonably good education their knowledge about MTCT of HIV was poor.
Parent and Teacher Assessment as a Screening Tool for Hearing Loss among School Children.
(The Third International Conference on Linguistics in Sri Lanka, ICLSL 2017. Department of Linguistics, University of Kelaniya, Sri Lanka., 2017) Sakalasuriya, S.; Perera, P.J.
Optimum hearing is vital for speech development and education of a child. Many causes of Hearing Loss (HL) are reversible or correctable with modern technology. Early diagnosis of HL will have a significant positive impact. Due to limited resources, it is unable to screen all children for hearing loss. The main objective of this study was to assess whether parent/ teacher assessment of a child’s hearing can be used as a screening tool for hearing loss among school children. This will reduce the number of children needing a formal hearing assessment. In a descriptive cross–sectional study, 985 schoolchildren studying in grades two to five were recruited. Their assessment about each child’s hearing was questioned from parents and the class teacher. All children were screened for HL with Otoscopy, Pure Tone Audiometry (PTA) and Oto Acoustic Emission (OAE). Children, who failed one or more screening tests, were invited for the confirmatory test, Pure Tone Audiometry.270 (27%),failed at screening. Out of them 193 (71.5%) turned up for diagnostic testing. Out of this 40 (20.7%)children had minimal to moderate hearing loss. Out of this 40 children only four (10%) were suspected of having HL by the teacher. Out of nine children suspected by class teacher, only four (44.4%) had the diagnostic test positive. Therefore, teacher’s assessment of hearing as screening tool for HL has a, Sensitivity of 10% and Specificity of 99.4%. Predictive value of a positive test is 44.4% and a negative test is 96.0%. Out of 51 children suspected by parents 18 (35.3%) were having HL. Out of 40 children with HL only 18 (45%) were identified by parents, thus sensitivity of 45%and specificity of 96.2%. The predictive value of a positive test is 35.3% and of a negative test is 97.4%. Educating parents and teachers to identify warning signs of HL is needed if to were used as a screening tool.
Prevalence of dental caries among a cohort of preschool children living in Gampaha district, Sri Lanka: a descriptive cross sectional study
(BioMed Central, 2012) Perera, P.J.; Abeyweera, N.T.; Fernando, M.P.; Warnakulasuriya, T.D.; Ranathunga, N.
BACKGROUND: Dental caries among young children are a global problem. Scant attention is paid towards primary teeth, leading to high prevalence of dental caries. There are only few studies done in Sri Lanka, addressing oral hygiene among preschool children. Scientific evidence is in need to persuade authorities to establish a programme promoting oral hygiene among preschool children. METHODS: A descriptive cross sectional study was conducted in Ragama Medical officer of Health area. Consecutive children between 2 - 5 years of age, attending child welfare clinics were recruited for the study. Practices related to dental hygiene and socio-economic characteristics were obtained using an interviewer administered questionnaire. Mouth was examined for evidence of dental caries. Data collection and examination were done by two doctors who were trained for this purpose. The data were analysed using SSPS version 16. RESULTS: Total of 410 children were included. None had a routine visits to a dentist. Practices related to tooth brushing were satisfactory. Prevalence of dental caries gradually increased with age to reach 68.8% by 5 years. Mean total decayed-extracted-filled (deft) score for the whole sample was 1.41 and Significant caries index (SIC) was 4.09. Decayed tooth were the main contributor for the deft score and Care index was only 1.55. Girls had a significantly higher prevalence of caries than boys. CONCLUSIONS: Dental care provided for Sri Lankan preschool children appears to be unsatisfactory as prevalence of dental caries among this cohort of preschool children was very high. There is an urgent need to improve dental care facilities for Sri Lankan preschool children.
Prevalence of hearing impairment among school children in the Gampaha District of Sri Lanka
(Sri Lanka College of Paediatricians, 2021) Perera, P.J.; Kasturiratne, A.; Sakalasuriya, S.
Background: Normal hearing in a child is vital for acquisition of language skills, literacy, educational achievements, socialization and overall school performances. Globally, data on prevalence of childhood hearing impairment (HI) is sparse and Sri Lanka is not an exception. Objectives: To describe the prevalence of HI among Sri Lankan school children and to assess the feasibility and effectiveness of a screening programme. Method: A descriptive cross sectional study was conducted in Gampaha district, covering all educational zones. Screening for HI, in randomly selected 984 students was carried out at schools using otoscopy, pure tone audiometry and oto-acoustic emission. Children who failed at least one screening test were invited for a diagnostic testing carried out at the Faculty of Medicine, Ragama. Results: Out of 984 students, 270 (27.4%) failed one or more screening tests. Out of this 199 children 73.7% turned up for the diagnostic testing and 40 (20.1%) were diagnosed to have HI. Minimal or mild HI was present in 32 (80%), three (7.5%) had severe and another three (7.5%) had profound HI. With correction for the children who defaulted the diagnostic test, prevalence of all types HI in this student population was 5.5%. Conclusions: In this student population in the Gampaha district, prevalence of all types HI was 5.5%. The HI was mild in 80%, severe in 7.5% and profound in 7.5%.
Socio-economic impact on Sri Lankan families managing a child with cerebral palsy
(World Wide Journals(Ahmedab -India), 2016) Perera, P.J.; Fernanado, M.D.
Cerebral palsy (CP) is a condition that limits a child’s ability to move, maintain balance and posture. Dependency thus ensues, cause significant detrimental effects on the quality of life of CP children and their families. In a cross sectional descriptive study, socio-economic impact on Sri Lankan families managing a CP child was studied. An interviewer administered questionnaire was used to collect data 300 families with CP children were studied. The majority were from the low to low middle income groups. Significant negative socio-economic impacts on the families were identified in terms of the time spent on the child, economic loss due effects on employment, cost of managing the child, marital disharmony and effects on other siblings. A well structured social welfare system is in need to support Sri Lankan families with CP children to minimize the negative
Statistical characteristics of anterior fontanelle size at birth of term Sri Lankan new borns: a descriptive cross sectional study
(Sri Lanka Medical Association, 2013) Perera, P.J.; Wickremasinghe, A.R.; Ranathunga, N.; Fernando, M.P.; Warnakulasooriya, D.
INTRODUCTION: Assessing the anterior fontanelle size is an important component of routine neonatal examination. For meaningful interpretation of fontanelle size, normal reference values are essential. Normal values for the fontanelle size in Sri Lankan newborns are not available. OBJECTIVES: To investigate characteristics of anterior fontanelle size at birth in Sri Lankan babies. METHODS: A descriptive cross sectional study was carried out between October and November 2010. Horizontal and vertical dimensions of the anterior fontanelle were measured in 2215 normal term babies, between 12 to 24 hours after birth. A practical and simple method was used to measure fontanelle size. Average fontanelle size was calculated by adding horizontal and vertical dimensions and dividing by two. RESULTS: Mean of the average fontanelle size for the total sample was 2.55 cm (for males 2.57 cm and for females 2.52 cm). Longitudinal dimension was significantly higher than the horizontal in both sexes (p<0.001). Frequency distribution curves of fontanelle size followed a normal distribution in both sexes. The ninety seventh centile and third centile for the average fontanelle size were 4.5 cm and 0.9 cm respectively. CONCLUSIONS: Babies with an average anterior fontanelle size more than 4.5 cm or less than 0.9 cm need further follow up. Further studies are needed to evaluate the accuracy of these cut off values