Browsing by Author "Samarawickrema, N."

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Awareness of human papillomavirus, cervical cancer and its prevention among primigravid antenatal clinic attendees in a tertiary care hospital in Sri Lanka: a cross-sectional study
(Collingwood, Vic. Australia : CSIRO Publisher, 2019) de Silva, A.H.W.; Samarawickrema, N.; Kasturiratne, A.; Skinner, S. R.; Wickremasinghe, A.R.; Garland, S. M.
ABSTRACT: Background Cervical cancer is the second commonest cancer amongst Sri Lankan women. With introduction of the human papillomavirus (HPV) vaccine to the national immunisation schedule, awareness and prevention of disease underpins vaccine uptake. Knowledge of HPV, HPV-related diseases and attitudes towards prevention and screening among urban women was assessed. METHODS: Primigravids attending Colombo North Teaching Hospital antenatal clinics were recruited over 8 months as surrogates for women who have recently become sexually active. Data through a self-administered questionnaire on three domains were collected (cervical cancer, Pap testing, HPV and vaccine). RESULTS: Of 667 participants (mean age 23.9 (s.d. = 4.4) years, 68.0% (n = 454) had >11 years of schooling), only 1.5% (n = 10) were aware of all three domains: 55.0% (370/667) had heard of cervical cancer, 19.0% of whom (70/370) knew it was sexually acquired, 9.0% (60/667) were aware of Pap screening, while 5.4% (36/665) had heard about HPV and <1.0% (5/667) knew it caused cancer. The total knowledge score ranged from zero (379/665) to nine (2/665), with a mean of 0.9 (s.d. - 1.4), with awareness increasing with level of education (χ2 = 18.6; P <0.001). Of those aware of Pap testing, 8.0% (5/60) were reluctant to undergo testing, while 46.6% (28/60) had no apprehension. CONCLUSIONS: Knowledge of cervical cancer, Pap testing, HPV and vaccine was low, especially in terms of HPV. Among those aware of Pap screening, generally there were favourable attitudes to having a test. These data have implications for acceptance of the vaccine and any future expansion of cervical screening with newer, more cost-effective technologies.
Fetal effects of environmental exposure of pregnant women to organophosphorus compounds in a rural farming community in Sri Lanka
(Informa Healthcare, 2008) Samarawickrema, N.; Pathmeswaran, A.; Wickremasinghe, R.; Peiris-John, R.; Karunaratna, M.; Buckley, N.A.; Dawson, A.; de Silva, J.
BACKGROUND: The possible deleterious effects of low-grade, chronic environmental and occupational exposure to organophosphorus compounds (OPCs) are not well documented. OBJECTIVE: To investigate the possible effects of low-level, chronic exposure of pregnant mothers to OPCs on the fetus by measuring OPC levels, and using markers of OPC exposure, oxidative stress and oxidative tissue damage. METHODS: Toxicity was assessed by measuring (i) OPC levels in breast milk and plasma from maternal and cord blood using gas chromatography, (ii) maternal and fetal butyrylcholinesterase (BChE) activity using inhibition assays, (iii) antioxidant status of the fetus using superoxide dismutase activity assays, (iv) oxidative stress in the fetus by determining malondialdehyde (MDA) concentrations, and (v) examining for fetal DNA fragmentation using electrophoresis. Samples were obtained from consenting mothers living in a farming community in southern Sri Lanka at the end of the pesticide spray season (study group) and just before the commencement of the spray season (in-between spray season; control group). RESULTS: Organophosphate residues were detected in only two subjects (chlorpyrifos in maternal and cord blood of one during the spray season and dimethoate in breast milk of another during the in between spray season), but the test employed was capable of only detecting concentrations above 0.05 mg/l. However, cord blood obtained during the spray season showed significant inhibition of BChE activity, increased oxidative stress and more DNA fragmentation when compared with cord blood obtained during the in-between spray season. CONCLUSIONS: Inhibition of cord blood BChE activity indicates fetal exposure to organophosphorus compounds during times when there is a high probability of environmental drift. This provides a plausible explanation for the increased oxidative stress and high DNA fragmentation in the fetus. Long-term outcomes of such exposures are unknown.
Knowledge and attitudes on Cervical Cancer and Its prevention amongst primigravid women
(Sri Lanka Medical Association, 2014) de Silva, A.H.W.; Kasturiratne, A.; Subasinghe, V.; Samarawickrema, N.; Garland, S.M.; Wickremasinghe, A.R.
INTRODUCTION AND OBJECTIVES: To describe knowledge and attitudes on cervical cancer and its prevention amongst primigravid women METHODS: A descriptive cross-sectional study was conducted amongst primigravid women aged 18-35 years attending the antenatal clinics of Colombo North Teaching Hospital in 2013. Data were collected using a pretested self-administered questionnaire on their booking visit. RESULTS: 667 participated in the study. Mean age (SD) was 23.9 (4.4) years. Majority (67.5%) had passed G.C.E. Ordinary Level. 30% had heard about cervical cancer but only 11% knew of its viral aetiology.40% identified cervical cancer as a common cancer in Sri Lanka. 8% considered it to be familial and only 15% knew its transmissibility through sex. Knowledge on human papilloma virus (HPV) was very low. 9% had heard about the Papanicolaou test while only 50% of them knew that it could detect cervical cancer at a treatable stage. Only 5.4% had heard about HPV and 5.8% about a vaccine against HPV. Of the respondents who have heard about HPV 70% (21/39) knew that the infection can be prevented by a vaccine.10.5% strongly accepted undergoing periodical Papanicolaou tests as a good health practice while 45% did not know to comment. 21% had no fear but 5% felt embarrassed to participate in testing. Oniy 21% accepted it as a safe test. The association between the level of education and the knowledge of public health importance of cervical cancer was statistically significant (p=0.02). CONCLUSIONS: Knowledge on cervical cancer and preventive methods are low amongst primigravid women. Attitude towards the Papanicolaou test is poor.
Prevalence of Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae and human papillomavirus in a sexual health clinic setting in urban Sri Lanka
(Sage Publications, 2015) Samarawickrema, N.; Tabrizi, S.; Young, E.; Gunawardena, P.; Garland, S.
The prevalences of Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae, and human papillomavirus (HPV) in Sri Lanka are not well reported; the objective of this study is to describe the prevalences of these four sexually transmitted infections among attendees of sexual health clinic in an urban setting. Vaginal swabs were collected from consenting women attending a sexual health clinic and tested for the presence of the above sexually transmitted infections using nucleic acid amplification techniques. Basic demographic details were sought from each participant (483 women of age range 14-61, median 30 years, IQR 12 years) via a research assistant-administered questionnaire. Overall, a prevalence of T. vaginalis, C. trachomatis, N. gonorrhoeae and HPV was 2.3%, (95% CI: 1.2-4.1%), 8.2% (95% CI: 5.6-11.4%), 7.6% (95% CI: 5.2-10.8%), and 44.4% (95% CI: 39.8-49.1%), respectively. Among the 197 positive for HPV, HPV6 accounted for 23.1%, HPV16 (12.5%), then HPV11, HPV66 and HPV58 were the commonest. Vaccine-related types (6/11/16/18) were detected in 59.9% of cases (95%CI: 52.7-66.8%). The high prevalence of sexually transmitted infections (45.2%) is a potential risk factor for an increase in HIV infections in the country and the high carriage of HPV supports the need for cervical cancer screening and prevention programmes. © The Author(s) 2014.