Conference Papers
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This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine
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Item Development of size charts of symphysis pubis height measurement for Sri Lankan Population(Wiley-Blackwell, 2015) Dias, T.; Pathmeswaran, A.; Abeykoon, S.; Gunawardena, C.; Pragasan, G.; Padeniya, T.INTRODUCTION Fetal growth restriction is responsible for majority of explained and unexplained intrauterine deaths. Screening and diagnosis of fetal growth restriction is one of the main objectives of the antenatal care. Symphysis pubis height measurement (SFH) is routinely measured to assess the fetal growth during antenatal period. Use of SFH charts made elsewhere may either under or overestimate the fetal size in our population. The aim of this study was to construct new size charts for SFH for Sri Lankan population. METHODS This was a prospective, cross-sectional study carried out at the District General Hospital Ampara. In order to increase generalisability 1220 women with normal nutritional and health status and minimal environmental constraints on fetal growth were enrolled during first trimester. Fetal crown–rump length measurement between 11+0 and 13+6 was considered for gestational age assessment in all patients. Each mother considered only once for measurement of SFH for the purpose of this study at gestations between 24 and 41 weeks. SFH was measured using non-elastic, blinded tape using standard technique. For SFH measurement separate regression model was fitted to estimate the mean and standard deviation at each gestational age. Centiles were derived from this mean and standard deviation, assuming that the measurements have a normal distribution at each gestational age. RESULTS A total of 387 mothers had their SFH measured directly. New charts were created for SFH. 10th, 50th and 90th centile values for SFH at 40 weeks are 34, 37 and 41 cm. CONCLUSIONS We have constructed new size chart for SFH. This chart can now be used to assess the fetal size of Sri Lankan population.Item Development and validation of a reintegration index to assess the status of reintegration among returnee Middle-East Migrant workers in Kurunegala District(College of Community Physicians of Sri Lanka, 2021) Wijeratne, P.D.; Pathmeswaran, A.Background: Reintegration is the least explored phase of the migration cycle. Yet, the reintegration process has a strong influence on the socio-economic and health-related outcomes of returnee migrant workers. The objective of this study was to develop and validate an Index of Reintegration to assess the status of reintegration among returnee Middle-East migrant workers in the Kurunegala District. Methods: A mixed-method consist of qualitative and quantitative approaches were followed for the tool development. In the first-phase primary pool of items was generated following a comprehensive literature review. Further, key informant interviews and Focus Group Discussions were conducted with experts, returnee migrant workers, and their family members to validate and to compliment the developing index. In the second phase, principal component analysis was performed on the collected dataset from a survey involving returnee Middle-East migrant workers(n=232). In the third phase, the constructed tool was evaluated and validated using multiple methods. The tool was tested for reliability. Results: The items and domains of the index demonstrated acceptable validity and reliability (25items, α=0.7). The finalized tool consisted of 25 items distinguished under eight (08) factors: economic self-sufficiency, belongingness, support networks, social adaptation, cultural acceptance, access to health services, physical-psychological distress, etc. and explained 60.1% of the total variance during the factor analysis. Conclusions: Reintegration Index is a reliable and valid tool to measure the status of reintegration of returnee migrant-workers. This tool could be applied for different occupational context returnees in determining socio-economic, migration-related, and health-related factors influencing their reintegration into the home-country.Item Deficiencies in the provision and the barriers in accessing family planning services for women working in Avissawella export processing zone(Sri Lanka Medical Association., 2019) Pathirana, V.P.S.D.; Pathmeswaran, A.; Jayaratna, A.INTRODUCTION & OBJECTIVES: Women working in export processing zones (EPZs) are reported to have risky sexual behaviors leading to unwanted pregnancies. The purpose of this study was to describe the deficiencies in the provision and the barriers in accessing family planning (FP) services for reproductive age women working in Avissawella EPZ. METHODS: Deficiencies in provision and barriers in accessing FP services were explored and described by individual interviews and focus group discussions conducted with a purposively selected sample of 55 comprised of EPZ workers, factory managers and healthcare workers. A semi-structured interviewer guide was used. Thematic analysis of data was done using inductive method. RESULTS: Non-availability of FP services after working hours was the main perceived deficiency in service provision and high opportunity cost for visiting clinics for FP services was the main barrier in accessing FP services among women working in Avissawella EPZ. No major bad comments on the staff, availability of contraceptive items of infrastructure facilities were given although overcrowding and need for improvement of privacy of clients and punctuality of the staff were highlighted by some women. They had more trust on government services than the private sector. Myths and misconceptions were not enormously highlighted as barriers to use of contraceptives. Side effects were seemed to be having a higher impact on non-use of contraceptives. Importance of use of social media to disseminate to be having a higher impact on reproductive health and FP among workers in EPZs was highlighted. CONCLUSION: There is a need for workplace based client friendly FP service integrated with other health services.Item Predictors of mortality in a cohort of adult Sri Lankans(Sri Lanka Medical Association., 2019) Kasturiratne, A.; Beddage, T.; de Silva, S.T.; Niriella, M.A.; Pathmeswaran, A.; Kato, N.; Wickremasinghe, A.R.; de Silva, H.J.INTRODUCTION & OBJECTIVES: There is limited knowledge on early predictors of mortality among Sri Lankans. We investigated predictors of mortality in the Ragama Health Study cohort 10 years after recruitment. METHODS: The study population (35-64-year-olds selected by age-stratified random sampling from the Ragama Medical Officer of Health area) was initially screened in 2007 for socio-demographic, lifestyle, anthropometric and clinical risk factors with informed written consent. Their vital status was assessed in 2017 and the causes of death of the deceased were retrieved from death certificates available with the next-of-kin or declaration of death records from the hospital where the death occurred. RESULTS: Of the 2986 enrolled in 2007, 169 [Males: 107 (63.3%)] had died over the 10-year period, giving an overall mortality rate of 5.7% (95% CI: 5.0 % - 6.4%). The number of deaths due to cardiovascular and cancer related causes were 73/169 and 31/169, respectively. On multivariate analysis using Cox's proportional hazards model, advancing age, male sex, lower educational level, unsafe alcohol consumption and the presence of metabolic syndrome at baseline were independent predictors of all-cause mortality. Advancing age, male sex, unsafe alcohol consumption and the presence of metabolic syndrome at baseline were independent predictors of cardiovascular mortality, while advancing age and unsafe alcohol consumption were the only independent predictors of cancer-related mortality. CONCLUSION: Unsafe alcohol consumption and the presence of metabolic syndrome were important modifiable risks for mortality in this population. Addressing these risks in early adulthood will help to improve longevity.Item Awareness and usage patterns of substances among pre-clinical phase students at a Medical Faculty in Sri Lanka(Sri Lanka Medical Association., 2019) Hapangama, A.; Fernando, R.; Pathmeswaran, A.; Kuruppuarachchi, K.A.L.A.INTRODUCTION AND OBJECTIVES: Availability and usage patterns of psychoactive substances have changed worldwide. Knowledge about new trends of substance use is important for future generation of medical professionals to deliver appropriate treatment. Objective of the study was to determine the awareness and prevalence of substance use among pre- clinical phase medical students in a university in the Western Province, Sri Lanka. METHODS: A cross-sectional descriptive study was carried out using a self-administered questionnaire. RESULTS: Out of 162 students, 61.7% were female, 97.5% were between 20-25 years. 99% were aware of alcohol being a substance of abuse. 34% and 30% were not aware that heroin and cannabis were substances of abuse. Less than half of participants were aware of corex-D (44.4%), volatile substances (39.5%), and methamphetamines (32.7%). Figures for awareness about Psilocybin (9.9%), MDMA (8.6%), LSD (8%), GHB (4.3%), DXM (2.5%). Main sources of information regarding substances were peers and internet. 21% and 18 % of participants had used alcohol and betel respectively at least once while tobacco and corex-D was used among 7.4% and 6.2% respectively. 69% of substance users were male. Use of substances was significantly associated with male gender. CONCLUSION: Alarmingly majority of the participating pre-clinical phase students were not aware of the abuse potential of heroin and cannabis as well as of newer generation recreational drugs. Awareness regarding current trends and misuse potential of psychoactive substances and their consequences should be enhanced among medical students.Item Review of the cervical cancer screening programme in the Puttalam district(Sri Lanka Medical Association., 2019) Fernando, Y.K.J.; Pathmeswaran, A.INTRODUCTION & OBJECTIVES: A well implemented screening programme is effective in preventing cervical cancer. ln order to improve programme effectiveness all programmes need to be reviewed periodically. The objective of this study was to review the cervical cancer screening program in Puttalam District. METHODS: Cross sectional descriptive study was done in 2015. Primary and secondary data was collected using data collection sheets, self-administered questionnaires and structured interviews from all stake holders involved in cervical cancer screening program in Puttalam District. RESULTS: Adequate number of clinics were available considering clinic to population ratio of 1: 15000 as the norm, but vacant positions existed in all staff categories. Colposcopes were unavailable and zero stock episodes of consumables were noted at MOH level. Target age group (35 years) Pap smear coverage, number of cervical visualizations, pap smears taken and positive pap smears were indicators used to monitor the programme. Positive cervical cytology reporting time was more than 10 weeks (mean was 72 days, range 2-334). Guidelines relating to quality control; obtaining a pap smear & cytology process and documentation regarding process of follow up care were not available. Coverage of target age group women (35 years) increased from 28.4% (2013) to 32.4 % (2015). Number of cervical cancers prevented could not be calculated as follow-up information was not available. CONCLUSION: Human resources and equipment relating to pap smear screening need improvement. Indicators sensitive to target population; cytology report turn-around time, and quality indicators need to be built in to program, guidelines developed and evaluated. Outcome of screened positives should be followed up and documented.Item Knowledge on family planning and use of contraceptives among women working in Avissawella export processing zone(Sri Lanka Medical Association., 2019) Pathirana, V.P.S.D.; Pathmeswaran, A.; Jayaratna, I.L.K.INTRODUCTION & OBJECTIVES: Women working in export processing zones (EPZs) are reported to have risky sexual behaviors leading to unwanted pregnancies.The purpose of this study was to describe the level of knowledge on family planning (FP) and prevalence of contraceptive use among reproductive-age women workers of Avissawella EPZ. METHODS: Descriptive cross-sectional study was conducted to assess knowledge on FP and use of contraceptives among 515 unmarried and 515 married women selected by stratified random sampling from factories in Avissawella EPZ. Pretested, self-administered questionnaire was used. RESULTS: Forty two percent (CI37.7-46.3) of married and 7% (CI4.8-9.3) of unmarried women had "Satisfactory Overall Knowledge" on FP. Asignificantly higher knowledge was observed among married women (OR=8.3; CI=5.5-12.5),who were over 35 years (OR=2.2;CI=1.5-3.3), having passed GCE (0/L) examination (OR=1.7) and having a monthly income of more than Rs.30,000/- (OR=2.2). Contraceptive prevalence rate (CPR) for married women for any method and any modem method were 47.8% (CI43.4% -52.2%) and 40.9% (CI 36.6%-45.2%) respectively. Oral contraceptive pill (11%), intrauterine device (8%) and injectable (6%) were the most commonly used methods by married women. Having "Satisfactory Overall Knowledge" on FP (OR= 1.6; Cl=1.7-3.9), age below 35 years (OR=2.2;CI=1.3-3.9) and having two or more children (OR=2.7;CI=1.6-4.5) were in dependently associated with higher CPR. CONCLUSION: Knowledge on FP and use of contraceptives were low among women of Avissawella EPZ.Item Workplacebased intervention to improve knowledge on family planning and use of contraceptives among reproductive-age women workers of Avissawella export processing zone(Sri Lanka Medical Association., 2019) Pathirana, V.P.S.D.; Pathmeswaran, A.; Jayaratna, I.L.K.INTRODUCTION & OBJECTIVES: Women working in export processing zones(EPZs) are reported to be involved in risky sexual behaviors leading to unwanted pregnancies which are associated with high maternal morbidity, mortality and many psychosocial issues. The purpose of this study was to develop and assess the effectiveness of a workplace-based intervention to improve knowledge on family planning (FP) and prevalence of contraceptive use among reproductive-age (15 to 49 years) women workers of Avissawella EPZ. METHODS: Quasi-experimental study was conducted to assess the effectiveness of a workplace-based intervention to improve knowledge on FP and use of contraceptives. Two factories, each for the intervention and control groups were selected purposively. Samples of 100 married and l00 unmarried women were randomly selected from each factory; the total sample size was 800. The intervention that was developed following a baseline assessment included lectures, video presentations, distribution of leaflets, and the establishment of peer groups for the promotion of FP and provision of modem FP methods. Baseline and follow-up evaluations were done using pretested self-administered questionnaire. Chi-square test and Mann Whitney U test were used to assess statistical significance and P<0.05 was considered significant. RESULTS: At follow up, the overall percentage knowledge score (mean; SD) was higher (85.9; 7.1) among women in the intervention arm (IA) compared to women in the control arm (CA) (49.5; 18.4) (P<0.001)and the contraceptive prevalence rate of married women was higher( P<0.001) in IA (79%) than in CA (42.5%). CONCLUSION: This workplace-based intervention was effective in improving knowledge on FP and use of contraceptives.Item Incidence and predictors of Diabetes Mellitus: A 7- year community cohort follow-up of urban, adult Sri Lankans(Sri Lanka Medical Association., 2019) de Silva, S.T.; Ediriweera, D.; Beddage, T.; Kasturiratne, A.; Niriella, M.A.; de Silva, A.P.; Dassanayake, A.S.; Pathmeswaran, A.; Kato, N.; Wickremasinghe, A.R.INTRODUCTION & OBJECTIVES: There is limited data on incidence of type 2 diabetes mellitus (T2DM) from South Asia. We investigated incidence and predictors ofT2DM in an urban, adult population after seven-years of follow-up. METHODS: The study population (42-71 year-olds in 2014, selected by age-stratified random sampling from the Ragama MOH area) was initially screened in 2007 and re-evaluated in 2014 with informed written consent. On both occasions they were assessed by structured interview, anthropometric measurements, liver ultrasound, biochemical and serological tests. RESULTS: Of the 2986 enrolled in 2007, 737 had established T2DM giving a baseline prevalence of 24.7% (95% CI: 23.1%-26.2%). 2148/2984 (71.6%) of the original cohort attended follow-up [1237 (57.5%) women; median (IQR) 60 (54-66) years]. 1650 participants who did not have T2DM in 2007 presented for follow up; 436 (27.6%) of them had developed new T2DM by 2014, giving an annual incidence of 3.9% (95% CI: 3.0%-4.9%). Of 525 participants with pre-diabetes (HbA1c 5.7-6.4%) in 2007, 364 attended follow up and 201/364 (55.1%) had developed T2DM by 2014, giving an annual conversion rate of pre-diabetes to T2DM of 7.9%. On logistic regression, pre-diabetes (OR:4.4;95%CI:3.3%-6.0%), central obesity (OR: 1.8;95%CI: 1.3%-2.4%), dyslipidemia (OR: l.5;95%CI: 1.1 %-2.1 %) and non-alcoholic fatty liver disease (NAFLD) (OR:1.5;95%CI: 1.1 %-2.1%) showed significant association with incident T2DM. CONCLUSION: In this urban cohort, the annual incidence of T2DM was 3.9% and the annual conversion rate of pre-diabetes to T2DM was 7.9%. Our findings emphasize the need for targeted and intensive lifestyle interventions for individuals with high metabolic risk to prevent T2DM.Item Development of a model for a resource limited setting, to predict the presence of oesophageal varices among newly diagnosed patients with cirrhosis.(Sri Lanka Medical Association., 2019) Perera, K.; Kodisinghe, S.K.; Ediriweera, D.; Moratuwagama, H.M.D.; Williams, S.; Pathmeswaran, A.; Niriella, M.A.; de Silva, H.J.INTRODUCTION & OBJECTIVES: In cirrhosis upper-gastrointestinal-endoscopy (UGIE) identifies oesophageal varices (OV). UGIE is unavailable in most resource-limited settings. Therefore, we assessed prediction of presence OV using hematological parameters (HP) and Child-Turcott-Pugh (CTP) class. METHODS: A prospective study was carried out on consecutive, consenting, newly-diagnosed patients with cirrhosis, in the University Medical Unit, Colombo North Teaching Hospital, Ragama, from April 20 I 4-April 2016. All patients had UGIE to evaluate presence and degree of OV, prior to appropriate therapy. HP (FBC with indices using automated analyzer and peripheral blood smear using Leishmann stain) and CTP class were assessed. Linear logistic regression model was developed to predict OV using HP and CTP class. RESULTS: 54-patients with cirrhosis were included [14(26%), 24(44%) and 16(30%) belonged to CTP class A, B and C respectively]. 37 had varices [CTP-A 4/14(26.6%), CTP-B 19/24(79.2%), CTP-C 14/16(87.5%)] on UGIE. Generalized linear model fitting showed decreasing percentage of small platelets (%SP) (P=0.002), CTP-B (P=0.003) and CTP-C (P=0.003) compared to CTP-A had higher probability of having OV. The model predicts the log odds for having OV = - 0.189 - (0.046*%SP) + 2.9 [if CTP-B] + 3.7 [if CTP-C]. Based on ROC analysis, a model value >-0.19 was selected as the cutoff point to predict OV with 89%-sensitivity, 76%-specificity, 89% positive predictive value and 76%-negative predictive value. CONCLUSION: We constructed a model using %SP on peripheral blood smear and CTP class. This model can be used to predict the presence of OV, in newly diagnosed patients with cirrhosis, with high sensitivity and specificity, avoiding the need for initial UGIE.