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 Reported tobacco industry interference during COVID-19 pandemic in South Asia(Sri Lanka Medical Association, 2023) Perera, N.C.S.; Horadagoda, N.; DineshKumar, P.; Perera, K.M.N.; Rajasuriya, M.INTRODUCTION: Articles 13 and 5.3 of the Framework Convention on Tobacco Control (FCTC) recommend banning sponsorships and restricting Corporate Social Responsibility (CSR) activities of the tobacco industry (TI). It is known that TI uses catastrophic situations to promote its image through CSR activities. OBJECTIVES: This study aimed to explore TI activities during the COVID-19 pandemic in South Asia from March 2020 to February 2022. METHODS: A mixed methods design was used. Investigative research techniques were used to gather data. Media reports, websites, industry reports and social media posts during the pandemic were analysed using content analysis methods. RESULTS: A total of 132 incidents were identified and 122 directly involved 10 tobacco companies. The highest were reported in India (80), Bangladesh (27) and Sri Lanka (18). The majority of incidents (73) were related to ITC Limited India. Influencing media (41), promotion (31), CSR activities (donating money/medical equipment/food/ hygiene goods) (15), and partnering with governments (15) were the commonest incidents. Lobbying governments and officials, increasing accessibility to products, receiving awards, directors/ executive officers featuring in conferences, and sponsorships were other themes identified. These received wide positive media coverage. Media highlighted the drop in revenue and later recovery of sales. Online cigarette sales and home delivery services were initiated in Sri Lanka and Bangladesh. In Bhutan, the trade ban was lifted, and cigarettes were added to the essential goods list and sold in “state-owned duty-free” sales outlets. CONCLUSION: TI used the pandemic to promote its image via CSR activities, sponsorships and partnering with governments violating FCTC and national laws.Item Maternal satisfaction and knowledge of early childhood development (ECD) related public health services(Sri Lanka Medical Association, 2023) Gunathilake, A.M.C.M.; Perera, K.M.N.INTRODUCTION: A good start in life gives rise to better outcomes as adults, hence the provision of quality health care helps children to reach maximum development potential. OBJECTIVES: To determine the level of satisfaction and knowledge on ECD-related public health services, screening, and psychosocial stimulation among mothers in the Medical Officer of Health area Damana. METHODS: Mothers of children attending polyclinics in the Damana MOH area were recruited through a consecutive sampling method to conduct a descriptive cross-sectional study. A structured and pre-tested interviewer-administered questionnaire was used. RESULTS: Satisfaction with ECD services was reported by 98.4% (95%CI[96.0-99.0]; n=306) mothers. A good level of knowledge was reported by the majority (78.5%; 95%CI[74.0-83.0]; n=244) of mothers on child development milestones. Only 56.3% (95%CI[51.0-62.0]; n=175) mothers had a good knowledge level on psychosocial stimulations (CI=0.51-0.62). However, a poor level of knowledge on child developmental screening was noted among 87.1% (95%CI[83.0-90.0]; n=271) mothers. In addition, 58.8% (95%CI[53.0-64.0]; n=183) of mothers reported a poor knowledge level of available child developmental services in the area. A good level of knowledge in psychosocial stimulation has shown a significant association with mothers being educated beyond O/L (X2(1, N=311) =5.69,p =0.017). Working mothers had a significant association with a good level of knowledge on psychosocial stimulation (χ2(1,N=311)=4.62,p=0.03). CONCLUSION: Lack of maternal knowledge in available ECD services needed to be addressed to enhance the quality of care at the field level.Item Community driven tobacco surveillance system: Engaging communities to monitor tobacco industry using a mobile app(EUEP European Publishing, 2021) Perera, C.N.S; Perera, K.M.N.; Wijesuriya, H.; Kandeepan, S.; Periyannan, D.; Lakmal, P.A.C.S.; Fernando, A.B.I.; Rajasuriya, M.INTRODUCTION: Centre for Combating Tobacco (CCT) is the tobacco observatory in Sri Lanka established under the FCTC Article 5.3. CCT has experimented several resource-efficient methods in low-resource settings. Sri Lanka, a developing lower-middle income country, reports user rates closer to 100% for smart mobile device and social media. OBJECTIVES: To effectively engage the public in monitoring tobacco industry interference and activities (TIIA) METHODS: “Tobacco Unmasked HotSpots” (TU-HotSpots) mobile app, was developed and launched in two stages. The preliminary launch (May 2018) was to pilot the app for feasibility and acceptability. A community network to monitor TIIA, Community-Driven Tobacco Surveillance System (CDTSS) using an upgraded app (based on the pilot project findings) was launched in March 2019. Freely downloadable from any mobile app store, TU-HotSpots enables registered users to report TIIA under three categories: “Report a HotSpot” (geographical location of TIIA (Articles 5.3, 6, 12, 13, 15, 16), “Interference through Media” (Article 13) and “Tobacco Industry contacted me” (Article 5.3). Data is fed to the TU-HotSpots Map, a website with an interactive map and a dashboard of interactive graphs and charts after reviewing and approval by the CCT team. RESULTS: Two evaluations done to explore the feasibility and acceptability revealed that 91.4% (n=54) agreed this app would be useful in tobacco control and 82.8% (n=48) stated that it would be accepted by the public. Inadequate technological knowledge and interrupted online connection were the perceived challenges for implementation. Active promotion using organized trainings among youth and field officers were the main suggestions for improvement. As at October 2019, 289 registrants reported 786 incidents; with 315 approved “Report a HotSpot” and 383 approved “Interference through Media” reports. “Tobacco Industry contacted me” category only had a one reporting. CONCLUSION(S):A mobile app coupled with an actively established community network is an effective tool to engage the public in monitoring TIIA.Item Tobacco industry targeting political giants in Sri Lanka: Presidential candidates 2019(EUEP European Publishing, 2021) Kandeepan, S.; Perera, C.; Wijesuriya, H.; Dias, I.S.; Periyannan, D.; Perera, K.M.N.; Rajasuriya, M.INTRODUCTION: The presidential election to elect the 7th Executive President of Sri Lanka was held on November 2019. Ceylon Tobacco Company (CTC), a subsidiary of British American Tobacco (BAT), holds the monopoly of manufacturing and selling cigarettes in Sri Lanka, which has a comprehensive ban on tobacco advertisement, promotion and sponsorship under the National Authority on Tobacco and Alcohol (NATA) Act. OBJECTIVES: To explore tobacco industry (TI) engagements of the 2019 presidential election candidates. METHODS: Investigative research techniques were used. Key informant interviews, news reports, online content, industry reports and community-level documentary evidence were used. A deductive data analysis approach was used based on the themes ‘type of engagement’, ‘TI investment’ and ‘potential impact’. RESULTS: All three top ranked candidates depicted a positive result. Two had a history of direct engagement with the CTC and the other declared support for beedi industry during the election campaign. The engagements of the candidate who was a former Defence Secretary included accepting sponsorships to construct police stations and Army welfare shops. Police are one of the authorized officers of the NATA Act and Sri Lanka Army distributed tax free cigarettes for its soldiers until recent past. The candidate who was a former Agriculture Minister accepted CTC sponsorships for renovation of water reservoirs. CTC cultivates almost all tobacco they need for manufacturing cigarettes and is accused of exploiting the Sri Lankan farmers during the process. One candidate was the guest of honour of the opening ceremony of a pilgrim’s rest in a Buddhist shrine constructed with CTC sponsorship (around 70% of Sri Lankans are Buddhists). All TI engagements of these leading politicians received positive media coverage. CONCLUSION(S): TI engaging main political figures in Sri Lanka has potential to cause serious policy implications, thus, highlights the need for a national policy for implementation of the FCTC Article 5.3.Item Tobacco industry interference against the single stick cigarette sales ban(EUEP European Publishing, 2021) Kandeepan, S.; Perera, K.M.N.; Wijesuriya, H.; Perera, C.S.; Rajasuriya, M.INTRODUCTION: Sri Lanka implemented 80% Pictorial Health Warnings and is planning to implement standardised packaging. However, a considerable proportion of smokers buy cigarettes in the loose form. Sale of cigarettes as single sticks promotes smoking among minors, beginners and poor due to high affordability and accessibility. In September 2018, Health Minister proposed to ban sale of single sticks as recommended by the Framework Convention on Tobacco Control. The proposal failed to gain Cabinet approval preventing its implementation. OBJECTIVES: This study aimed to explore the tobacco industry’s tactics in sabotaging the proposed ban on single stick sale of cigarettes in Sri Lanka. METHODS: Investigative research techniques were used. Content analysis was carried out on identified web posts and documents to determine the tobacco industry’s strategic involvement, their front groups and arguments used. RESULTS: First argument, the ban would reduce government tax revenue due to reduction of cigarette sales, was made by three parties: cigarette industry, media and Minister of Finance (MoF). The strongest advocate against the ban was the Tobacco Retailer’s Association (TRA), backed by the Ceylon Tobacco Company (CTC). TRA’s argued that retail business would be impacted, again because of reduced sales. TRA directly advocated MoF via a meeting. Third argument, used by the MoF was that the ban would increase beedi use. The cabinet rejected the ban as MoF and three other ministers opposed. CONCLUSION(S): CTC successfully interfered in the ban on single sticks cigarette sale through the TRA, media and the MoF, arguing that resulting reduced cigarette sales would generate a negative impact.Item Advocating university undergraduate students on implementing FCTC Article 5.3(EUEP European Publishing, 2021) Kandeepan, S.; Perera, K.M.N.; Wijesuriya, H.; Perera, C.S.; Rajasuriya, M.INTRODUCTION: Tobacco industry uses aggressive strategies to use to make people want to buy their products, especially youths. Therefore It is needed to enhance the knowledge about industry tactics among the youngsters. OBJECTIVES: Establishment of network with university undergraduates to combat tobacco industry interferences in public health in Sri Lanka. METHODS: Centre for Combating Tobacco (CCT) organized a series of advocacy sessions on Tobacco Industry Impact on Public Health and Framework Convention on Tobacco Control (FCTC) Article 5.3 targeting the university undergraduates in Sri Lanka. The first session was held on June 23rd, 2019. It was organized by a group of undergraduates currently working as volunteers with CCT to empower their peers in state university science stream faculties of the Western Province. In this session Industry’s impact on substance use and public health and direct and indirect promotion strategies, Tobacco industry interference in Sri Lanka, FCTC Article 5.3 and current activities by CCT to monitor tobacco industry interference on public health and implementation of FCTC Article 5.3 in Sri Lanka were discussed. Networking and establishment of action committees to support CCT activities with university undergraduate students were discussed. Results Opportunities for best practice strategies for tobacco interference control were identified. Policy adherence and enforcement was improved to raising the awareness with students. CONCLUSION(S): A majority of students supported the advocacy programme. A Network with university students was formed to combat the tobacco industry interference.Item Promotion of tobacco and alcohol on social media: a mixed methods analysis(Sri Lanka Medical Association, 2021) Athauda, L.K.; Jayawardhane, R.; Chandrasekara, B.E.; Kumari, M.I.P.; Perera, K.M.N.; Rajasuriya, M.Introduction and Objectives Promotion of tobacco and alcohol on the internet is banned in Sri Lanka by the NATA Act. However, it appears that tobacco and alcohol related content are rampant on various social media. This study aimed to describe the portrayal of tobacco and alcohol on Facebook and YouTube in 2019 and 2020. Methods YouTube Videos and Facebook posts were analysed by two independent researchers using a pre-defined data extraction sheet. One-minute interval method was used to analyse content regarding actual or implied use, paraphernalia, brand names, dialogue or text. A 16 member- panel provided qualitative interpretations of selected posts and videos. Results A total of 24 YouTube videos and 240 Facebook posts were studied within 2019 and 2020. On YouTube, within 39 oneminute intervals 69 tobacco scenes were reported while 166 alcohol scenes were reported within 87 one-minute intervals for both years. Within the 240 Facebook posts, tobacco content appeared 252 times and alcohol content appeared 204 times. Majority of tobacco content was actual or implied use while the majority of alcohol content focused on brand names or paraphernalia. The messages delivered on both platforms were interpreted as tobacco and alcohol being fun, normal, sophisticated and a part of modern lifestyle. Conclusion This study finds that social media is used as a vehicle to promote tobacco and alcohol among its users. Frequent and positive portrayal leads to creating norms. Such portrayal is not only a violation of the current legal restrictions, but also creates a harmful environment for young people who engage with social media.Item Facilities and challenges for education during COVID-19 pandemic among institutionalized orphans in Gampaha District(College of Community Physicians of Sri Lanka, 2021) Jayarathne, N.P.M.W.; Jayalath, H.B.S.; Jayasooriya, M.G.N.B.; Jayasooriya, Y.T.; Jayasundara, H.P.P.I.; Perera, K.M.N.Background: Orphans are critically underprivileged in receiving and accessing positive learning experiences in general. This may have worsened during a global pandemic with movement restrictions. We aimed to describe the facilities and challenges for education before and during COVID-19 pandemic among institutionalized orphans in Gampaha district. Methods: A descriptive cross-sectional study approached all wardens of Child Development Centers (CDCs) in Gampaha district compatible with the inclusion criteria (N=46) using a telephone interview in February, 2021. Results: The response rate was 56.5% (26/46) as 43.4% declined participation due to legal and administrative issues. More than 60% accommodated fewer than 20 children. All CDCs had at least 2 uniforms per child. Other essentials for schooling and stationeries were adequately available. Only 10 had a separate chair and a table for each child. Only 16 CDCs had computers and 15 had internet connections before the pandemic. Twenty-four (92.3%) reported that they sent their children to extra tuition classes. During COVID-19, roughly equal proportions used printed material sent from school (34%), online learning platforms (32%) and television (30%) to continue education. Only 65% was able to provide equal e-learning facilities for all children. Only 17 (73%) could continue education without any interruption. Majority could not state a cost for education. However, 84% stated they “managed” and 81% claimed that it increased during COVID-19. Most had covered their expenses through private organizations (53%) and individual donations (25%). Conclusions: COVID-19 pandemic had a negative impact on children's education in the studied institutions due to inadequate facilities.Item Is accessibility to centers of disability care in the emerging hub for disability healthcare services of the Western Province truly challenging?(College of Community Physicians of Sri Lanka, 2021) Pathirage, C.K.; Padmasiri, U.G.M.; Nuwarapakshage, N.S.R.P.; Panditharatne, W.D.; Hewawardhane, S.N.; Perera, K.M.N.Background: Ragama Medical Officer of Health (MOH) area is a sanctum of disability care hosting the main teaching hospital in the district, National Center for Children with Disabilities, National Rehabilitation Hospital and a school for disabled children. The objectives were to describe compliance of above institutions with current accessibility regulations and access-related challenges for the disabled community. Methods: A mixed-methods study was performed by qualitative evaluation of accessibility-related challenges and quantitative assessment of the aforementioned institutions and access-points. The qualitative component collected data from 6 service providers 4 disabled individuals and 5 community stakeholders sampled purposively by the research team. In-depth interviews used a semi-structured questionnaire guide. Data was analyzed using thematic analysis method. The quantitative component utilized an observational checklist based on 'disabled persons accessibility regulations act no.1, 2006' under the themes of public institutions, road network and access-points and accessibility for the visually impaired. Data analysis utilized descriptive statistics allocating a score of 1 for compliance and 0 for non-compliance. Results: Financial constraints were identified as the main challenge along with “Dependence”, “Gaps in awareness” and “Negative attitudes”. The highest level of compliance to the imposed regulations was only 61.1% portrayed by the institution specializing in children with disabilities. Accessibility for the visually impaired showed 0% compliance across all institutions. The public road network failed to exceed a compliance of 5%. Conclusions: Failure to meet anticipated excellence of accessibility in a developing hub such as Ragama MOH area emphasizes on the need for prioritization of disabled accessibility in Sri Lanka.Item The effect of a community-based health promotion intervention to improve utilization of healthy lifestyle centers in Sri Lanka(College of Community Physicians of Sri Lanka, 2021) Herath, H.M.T.P.; Perera, K.M.N.; Kasturiratne, A.Background: Healthy lifestyle centers (HLCs) report underutilization by the target population. There is a dearth of evidence on improving HLC utilization through the Health Promotion (HP) approach. This study aims to evaluate of the effectiveness of a HP intervention in improving the utilization of HLCs.Methods: A quasi-experimental study was conducted in six grama niladari divisions from the catchment area of two selected HLCs, one each in Gampaha (intervention) and Kalutara (comparison) districts. Community support groups (CSGs) were developed and empowered as the intervention. Contributory factors for the underutilization were addressed with the CSG.The pre and post intervention assessments were done in a random sample of 498 (aged 35-65 years) from each group. Primary outcome was improvement in the attendance of the HLC and secondary outcomes were changes in contributory factors. Data collected using an interviewer-administered questionnaire and secondary data from the HLCs were used. Results: Utilization of the HLC improved significantly among the sample from the intervention group (Post 35.3% [95% CI: 30.9 - 39.8]; Pre 5.85% [95% CI: 3.74 - 7.95], P < 0.001). The comparison group showed no significant change (Post 3.49% [95% CI: 1.80 -5.17] - Pre 3.25% [95% CI: 1.62 - 4.87], p = 1.00). There was a significant improvement in mean HLC attendance in the intervention group (Mean difference= 91.83, P < 0.05) compared to the comparison group (Mean difference = 2.66, P > 0.05). Conclusions: The utilization of the HLCs can be improved by a HP intervention through developing and empowering CSGs.