Browsing by Author "Ranathunga, N."

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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%.
Behavioral and emotional problems in adolescents with constipation and their association with quality of life
(Public Library of Science, 2020) Rajindrajith, S.; Ranathunga, N.; Jayawickrama, N.; van Dijk, M.; Benninga, M.A.; Devanarayana, N.M.
Objectives: To assess behavioral and emotional problems in children and adolescents with functional constipation and their relationship with psychological maladjustment and health-related quality of life (HRQoL). Design: A school-based cross-sectional survey conducted in 8 randomly selected schools from 4 randomly selected districts in Sri Lanka. A previously validated questionnaire was used for data collection. Behavioral and emotional problems were assessed using the Sinhala version of the Child Behavior Check List (CBCL-S/4-18). Constipation was diagnosed by applying the Rome III criteria. Results: A total of 1000 questionnaires were distributed, and 913 completed questionnaires were included in the analysis. Sixty adolescents (6.5%) had functional constipation. Scores obtained for isolated psychological problems such as withdrawal (3.1 [3.1] vs. 1.9 [2.4], p<0.001), somatic complaints (3.2 [2.8] vs. 2.3 [2.5], p<0.05) anxiety/depression (5.8 [2.5] vs. 3.9 [3.6], p<0.001), social problems (3.0 [2.7] vs. 2.2 [1.9] p<0.001) and attention problems (5.4 [4.1] vs. 3.9 [3.4], p<0.001), and broadband scale of internalization (12.1 [8.4] vs. 8.3 [7.2], p<0.05) and mean total CBCL-S/4-18 score (29.4 [19.5] vs. 23.2 [17.0], p<0.001) were higher in adolescents with functional constipation. Clinical characteristics, socio-demographic and family factors and psychological maladjustment had no relationship with externalization, internalization and total CBCL-S/4-18 score. Internalization (-0.49, p<0.0001), externalization (-0.30, p<0.05), and total CBCL-S/4-18 (-0.44, p<0.001) scores had a negative impact on HRQoL of adolescents with functional constipation. Conclusions: Adolescents with functional constipation are suffering from significant behavioral and emotional problems. These problems negatively affect their HRQoL.
Dental hygiene practices and the pattern of dental caries in preschool children in Ragama
(Sri Lanka Medical Association, 2012) Perera, P.; Abeweera, N.; Fernanado, M.; warnakulasuria, T.W.; Ranathunga, N.
INTRODUCTION: Dental caries is a common problem among preschool children, but often neglected as deciduas teeth are replaced later by permanent teeth. However, for many reasons, protecting deciduas teeth is very important. AIMS: The objectives of this study were to describe the prevalence of dental caries among preschool children and assess the utilization of dental care facilities. METHODS: A descriptive cross sectional study was done between August 2010 and October 2010 at child welfare clinics held in the Ragama MOH area. Consecutive children aged between 2 and 5 years attending the clinics were recruited with the consent of parents. An interviewer administered questionnaire was used to obtain data and the mouth was examined for caries. Total decayed-missing-filled (dmft) score and significant caries index (SIC) were calculated to describe the prevalence of dental caries. Care index was calculated to describe the use of dental services. RESULTS: Out of 410 children recruited, none had routine visits to a dentist. Though practices related to brushing teeth were satisfactory, 37.8% children in the study sample had caries. This increased to 68.8% by 5 years of age. Mean dmft score for the whole sample was 1.41 and SIC index was 4.09. The Care index was 4.72. The dmft score in girls was higher than boys. Incisors of the upper jaw were the mainly affected teeth. CONCLUSIONS: Prevalence of dental carries among this cohort of Sri Lankan preschool children is very high. The level of dental care for preschool children at present appears to be unsatisfactory.
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.
Effect of household air pollution due to solid fuel combustion on childhood respiratory diseases in a semi urban population in Sri Lanka.
(BioMed Central, 2019) Ranathunga, N.; Perera, P.; Nandasena, S.; Sathiakumar, N.; Kasturiratne, A.; Wickremasinghe, R.
BACKGROUND:Household air pollution from combustion of solid fuels for cooking and space heating is one of the most important risk factors of the global burden of disease. This study was aimed to determine the association between household air pollution due to combustion of biomass fuel in Sri Lankan households and self-reported respiratory symptoms in children under 5 years. METHODS: A prospective study was conducted in the Ragama Medical Officer of Health area in Sri Lanka. Children under 5 years were followed up for 12 months. Data on respiratory symptoms were extracted from a symptom diary. Socioeconomic data and the main fuel type used for cooking were recorded. Air quality measurements were taken during the preparation of the lunch meal over a 2-h period in a subsample of households. RESULTS: Two hundred and sixty two children were followed up. The incidence of infection induced asthma (RR = 1.77, 95%CI;1.098-2.949) was significantly higher among children resident in households using biomass fuel and kerosene (considered as the high exposure group) as compared to children resident in households using Liquefied Petroleum Gas (LPG) or electricity for cooking (considered as the low exposure group), after adjusting for confounders. Maternal education was significantly associated with the incidence of infection induced asthma after controlling for other factors including exposure status. The incidence of asthma among male children was significantly higher than in female children (RR = 1.17; 95% CI 1.01-1.37). Having an industry causing air pollution near the home and cooking inside the living area were significant risk factors of rhinitis (RR = 1.39 and 2.67, respectively) while spending less time on cooking was a protective factor (RR = 0.81). Houses which used biomass fuel had significantly higher concentrations of carbon monoxide (CO) (mean 2.77 ppm vs 1.44 ppm) and particulate matter2.5 (PM2.5) (mean 1.09 mg/m3 vs 0.30 mg/m3) as compared to houses using LPG or electricity for cooking. CONCLUSION: The CO and PM2.5 concentrations were significantly higher in households using biomass fuel for cooking. There was a 1.6 times higher risk of infection induced asthma (IIA) among children of the high exposure group as compared to children of the low exposure group, after controlling for other factors. Maternal education was significantly associated with the incidence of IIA after controlling for exposure status and other variables.
Effects of indoor air pollution due to solid fuel combustion on physical growth of children under 5 in Sri Lanka: A descriptive cross sectional study
(Public Library of Science, 2021) Ranathunga, N.; Perera, P.; Nandasena, S.; Sathiakumar, N.; Kasturiratne, A.; Wickremasinghe, A.R.
ABSTRACT: Solid fuel combustion is an important risk factor of morbidity. This study was conducted to determine the effect of indoor air pollution (IAP) due to solid fuel combustion on physical growth in 262 Sri Lankan children under five. Exposure was defined by the type of fuel used for cooking. Pollutant levels were measured in a subsample of households. "High" exposure group (households using biomass fuel/kerosene oil for cooking) comprised 60% of the study population; the prevalence of wasting was 19.7% and underweight was 20.4% in the entire population where 68% were from the high exposure group. Children from the "high" exposure group had significantly lower mean z-scores for weight-for-height (p = 0.047), height-for-age (p = 0.004) and weight-for-age (p = 0.001) as compared to the "low" exposure group (children of households using liquefied petroleum gas and/or electricity) after adjusting for confounders. Z-scores of weight-for-age, height-for-age and weight-for-height were negatively correlated with CO (p = 0.001, 0.018, 0.020, respectively) and PM2.5 concentrations (p<0.001,p = 0.024 p = 0.008, respectively). IAP due to combustion of biomass fuel leads to poor physical growth.
Effects of indoor air pollution on the development of children under five years of age in Sri Lanka
(MDPI, 2022) Ranathunga, N.; Perera, P.; Nandasena, S.; Sathiakumar, N.; Kasturiratne, A.; Wickremasinghe, R.
Air pollution is a multifaceted environmental toxin affecting the Central Nervous System (CNS) through diverse pathways. The CNS of young children is particularly susceptible to the detrimental effects of toxins, as brain development continues postnatally with the formation of interneuronal connections, glial cell proliferation and myelination of axons. Indoor air pollution (IAP) from solid fuel combustion is more harmful than outdoor air pollution. Numerous air pollutants hazardous to health are released during the burning of unprocessed biomass. The primary source of fuel in Sri Lanka for cooking is biomass, mainly wood. In this study, we evaluated the influence of IAP resulting from biomass combustion on the neurodevelopment of children. In a cohort of children under five years living in a semi-urban area of Sri Lanka, neurodevelopment was assessed using Denver II developmental screening test. Air quality levels were measured (Carbon Monoxide (CO) and Particulate Matter 2.5 (PM2.5)) in a subsample. There were significantly high levels of CO and PM2.5 in the ambient air of households using biomass as the primary fuel for cooking. Children living in these households had a significantly higher number of children with ‘suspect’ developmental assessment scores in the language, social behavior and play and gross motor development domains.
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.
Feeding practices of children attending well baby clinics in Ragama MOH area: a descriptive cross sectional study
(Sri Lanka Medical Association, 2011) Perera, K.P.J.; Fernando, M.; Warnakulasuria, T.; Ranathunga, N.
INTRODUCTION AND OBJECTIVES: Feeding during early childhood is important for growth and health. Objectives of this study were to evaluate the current feeding practices during first few years of life among Sri Lankan children. METHODS: A descriptive cross sectional study conducted in Ragama MOH area during the period of 10th august 2010 and 30th October 2010. 410 children between 2 -5 years of age, attending well baby clinics were included in the study. Interviewer administered questionnaire was used to collect data regarding socio-demographic characteristics and feeding practices. Open ended questions were used. SSPS version 16 was used for data analysis. RESULTS: The study population consisted of 208 boys and 202 girls. 62.2% children were exclusively breastfed for 6 months. 351 have received formula milk. 61 had formula milk started before the age of 6 months and 212 by one year. 330 children had sugar added to formula milk. 144 of them had sugar added within first year. 29 children had complementary food started before 4 months. 294 mothers continued to breastfeed beyond 2 years and 41.6% of them were breast feeding at regular intervals. 82.5% children were receiving overnight feeding either as breast milk or formula beyond 2 years. . CONCLUSIONS: Though high rate of exclusive breast feeding is prevalent in Sri Lanka, there seem to be other issues related to feeding. Too early introduction of complementary food, adding sugar to formula, prolonged breast feeding too frequently and prolonged overnight feeding 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
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.
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.
Sequelae of BCG vaccination and effects of cleaning vaccine site with alcohol
(Sri Lanka Medical Association, 2012) Perera, P.; Samaranayaka, G.; Samaranayaka, R.; Ranathunga, N.
INTRODUCTION: In Sri Lanka, BCG vaccine is given during neonatai period. There are many myths regarding BCG vaccine among general public and sequelae of vaccination is not well documented in medical literature. AIMS: Objectives of this study were to describe the sequelae of BCG vaccination when given at neonatal period and to find out whether cleaning the vaccine site with 70% alcohol, affect its potency. METHODS: A prospective observational study was carried out at Ragama teaching hospital and 2 private hospitals in Gampaha district. 125 babies each from government and private sector were recruited for the study with the consent from parents. Vaccine was administered in the morning as well as evening, as required by the patient, by a consultant Paediatrician. Vaccine site was cleaned with 70 % alcohol and allowed to dry before vaccination. All babies were bathed on same day. Babies were followed up periodically until a scar was detected. RESULTS: 182 babies completed the follow up and all babies developed a scar. Time taken for a reaction varied but all babies had a reaction by 8 weeks and a scar by 14 weeks. 6 babies had fever within one week of vaccination but it was due to feeding failure or sepsis. None had adverse reactions attributable to the vaccine. CONCLUSIONS: Cleaning the vaccine site with alcohol does not affect the potency of BCG vaccine. Proper technique of administration is important for successful vaccination. Time of vaccination and bathing had no effect on efficacy or side effects.
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