Browsing by Author "Vithana, P.V.S.C."

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Effectiveness of an educational intervention on early detection of breast cancer in the district of Gampaha
(Sri Lanka Medical Association, 2012) Vithana, P.V.S.C.; Ariyarathne, M.A.Y.; Jayawardena, P.L.
INTRODUCTION AND AIMS: To assess the effectiveness of an educational intervention on improving knowledge, attitudes and practices (KAP) on early detection of breast cancer among Public Health Midwives (PHMs) and target group women (TGW) in the district of Gampaha. METHODS: A community-based intervention was conducted in Gampaha district using two Medical Officer of Health areas selected by random sampling as intervention (IA) and control (CA). The study participants were all PHMs in IA (n=38) and CA (n=47J and 260 TGW from each area. PHMs who were exposed to the educational intervention first, conducted the same among the TGW. For PHMs, post-intervention survey was conducted at one and six months and for TGW at six months after intervention. RESULTS: The overall median scores for KAP respectively were as follows: PHMs: Pre-intervention: IA: 58%[IQR: 53- 69%), 90%(IQR: 70-100%) and 62%(IQR: 57-70%). CA: 64%(IQR: 56-69%), 90%{IQR: 70-90%) and 62%( IQR: 50-77%). Post-intervention; six months IA: 93% (IQR: 91-93%), 100%(IQR: 90-100%), and 81%(IQR: 77-89%). CA: 67%(IQR: 58- 71%), 90%(IQR: 90-100%), and 62%( IQR: 58-73%). TGW: Pre-intervention: IA: 54%(IQR: 46-59%), 50%(IQR: 41-59%), and 0%(IQR: 0-20%). CA: 54%(IQR: 44- 59%), 50%(IQR: 36-59%), and 0%( IQR: 0-20%). Post-intervention: six months IA: 77%(IQR: 72-82%), 68%(IQR: 59- 76 %) and 40%(IQR: 20-60%). CA: 54%(1QR: 46- 59%), 50%(IQR: 36-64%), and 0%( IQR: 0-20%). All the post-intervention scores of PHMs and TGW in the IA were significantly higher in comparison to CA (p<0.001). CONCLUSIONS: This planned educational intervention had a significant impact on improving KAP of PHMs and TGW in the Gampaha district
Public health midwives’ perception on breast cancer early detection services provided through well woman clinics in the Gampaha District, Sri Lanka
(College of the Community Physicians of Sri Lanka, 2013) Vithana, P.V.S.C.; Hemachandra, D.K.N.N.; Ariyarathne, M.A.Y.; Jayawardana, P.L.
INTRODUCTION: Being most common cancer diagnosed in Sri Lanka, breast cancer accounts for 27% of female cancer-mortality. Early-detection of breast cancer is conducted using clinical breast examination (CBE) and increasing awareness on breast self-examination through well woman clinics (WWCs). OBJECTIVE: To identify Public health midwives' (PHMs') perception on the importance and deficiencies of the breast cancer early-detection services provided through WWCs, and their suggestions on improving the breast cancer early-detection services. METHODS: A qualitative study using four focus group discussions (FGDs) consisting of 8-10 participants per each FGD were conducted among 38 PHMs in the Gampaha District during July to September 2008. FGD guide included discussion points on availability of guidelines and protocols, training received, time for clinic-sessions, adequacy of resources, support from other sectors, and reasons for low-participation and their recommendations for improving utilization of services. Two experts conducted FGDs as moderator and data recorder. FGDs were audio-recorded, transcribed and analyzed using constant comparison and identifying themes and categories. Results were presented in narrative form. RESULTS: All the PHMs had a firm realization on the need of breast cancer early-detection. FGDs revealed non-availability of guidelines, lack of training, lack of skills and material to provide health education, inability to provide privacy during CBE, shortage of stationery and lack of community awareness and motivation. The suggestions for the improvements identified in FGDs were capacity building of PHMs, making availability of guidelines, rescheduling clinics, improving the supervision, strengthening the monitoring, improving coordination between clinical and preventive sectors, and improving community awareness. CONCLUSIONS AND RECOMMENDATIONS: The components to be improved in breast cancer early-detection services were identified. Study recommends training programmes at basic and post basic levels on a regular basis and supervision for the sustenance of the program.
Quality of breast cancer early detection services in the well women clinics in the district of Gampaha
(Sri Lanka Medical Association, 2012) Vithana, P.V.S.C.; Ariyarathne, M.A.Y.; Jayawardena, P.L.
AIMS: To evaluate selected aspects of breast cancer early detection services implemented through well woman clinics (WWCs) in the Gampaha District. METHODS: Clinical breast-examination(CBE) coverage of target age group women(TGW) of 35-59 years was assessed in all the WWCs in Gampaha district from 2003-2007. Quality assessment of breast cancer early detection services was done using Lot Quality Assurance Sampling. The lot size and threshold value computed were twenty and six clinics respectively. Checklists were used in assessing coverage, physical facilities and clinic activities. Client-satisfaction on WWC services was assessed among 200 TGW attending 20 WWCs using an interviewer-administered questionnaires. RESULTS: CBE coverage in the Gampaha district increased from 1.1% (3389/318711) to 2.2% (7248/326271) from 2003-2007. With regard to physical facilities, the number of clinics that were rated substandard varied between 7-18 (35% - 90%). Adequacy in relation to notice boards, stationery, furniture and linen, and cleanliness outside premises and toilets were identified as substandard. With regard to services, punctuality of staff arrival and in commencement of clinics, provision of healtheducation, availability of supervision and CBE and breast self-examination (BSE) services were observed as substandard in 7-20 clinics (35%-100%). Median satisfaction score among TGW was 45.2% (IQR: 38.7 - 54.8%). Only 11% had a score of >70%; the threshold for satisfaction. CONCLUSIONS: Coverage of breast cancer early detection service in the Gampaha district in 2007,11 years after commencing WWC services, was still very low (2.2%). All 20 clinics were substandard for overallCBEand BSE services.