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 Socio-demographic characteristics and principal cooking fuel type in Sri Lanka: comparison of data from two Demographic and Health Surveys(College of Community Physicians of Sri Lanka, 2009) Nandasena, Y.L.S.; Wickremasinghe, A.R.; Sathiakumar, N.INTRODUCTION: Indoor air pollution is a growing public health concern due to its well documented ill effects. Biomass- cooking fuel is the main source of indoor air pollution in the majority of households in the developing world. OBJECTIVES: To determine the trends of cooking fuel pattern and associated factors in Sri Lanka. METHODS: Determinants and the use of cooking fuel in households in Sri Lanka were abstracted from data collected by the Demographic Health Surveys (DHS) of 2000 and 2007. The DHS was based on a representative sample (multi-stage stratified probability sample) of the whole country except the provinces afflicted by the war. The results are based on a sample of 8,169 households in 2000 and 19,862 households in 2007. RESULTS: Firewood was the principal type of cooking fuel in 78.3%(n=6397) and 78.5%(n=15592) of households in years 2000 and 2007, respectively. In 2007, 96.3%(n=897) of estate sector households used firewood as compared to 84.2%(n=13850) in the rural and 34.6%(n=859) in the urban sector. Similar trends were seen in year 2000 as well. Electricity was the main source of lighting in 68%(n=5571) of households in year 2000 and the corresponding figure for year 2007,was 80%(n=15890). In year 2000, 25.9%(n=1442) of the houses having electricity used clean fuel (electricity/ LP gas) for cooking and the rest relied on biomass or kerosene. The higher the educational level of the respondent, the more likely the household will use a clean fuel (Chi square for trend: p<0.001). CONCLUSION: The shift from firewood to cleaner fuels in Sri Lanka is negligible from 2000 to 2007. Improving the quality of life of the population does not necessarily predict a shift towards the use of cleaner cooking fuels in Sri Lanka.Item Fine particle air pollution due to secondhand smoke in selected public places in Colombo(College of Community Physicians of Sri Lanka, 2009) Nandasena, Y.L.S.; Wickremasinghe, A.R.; Lee, K.; Sathiakumar, N.INTRODUCTION: Globally, about five million deaths per year are attributed to tobacco smoke. Secondhand smoke accounts for a substantial proportion of these deaths. Most countries including Sri Lanka have legislation banning smoking in indoor workplaces and public places. Certain public places such as entertainment venues continue to permit smoking. Particulate matter (PM2.5) is a widely accepted indicator to evaluate secondhand smoke levels. OBJECTIVE: To determine PM2.5 concentrations in selected public places (defined as a space which can be visited without permission) in Colombo, Sri Lanka. METHODS: Using convenient sampling technique, we measured PM2.5 concentration levels in four types of public places (restaurants: n=6; bars: n=6; cafes: n=4; pubs and entertainment venues: n=4) during January to March, 2009. A particulate matter monitor (Model AM510 - SIDEPAK Personal Aerosol Monitor) was used to measure indoor air quality for 40 minutes and the immediate outdoors for 10 minutes before and after the indoor measurement. RESULTS: The mean indoor PM2.5 concentration was 124.9 ug/m3 (SD± 81.0) [range 33 ug/m3 - 299 ug/m3; median, 97.0 ug/m3]. The mean outdoor PM2.5 concentration was 39.7 ug/m3 (±14.3) [range 18 ug/m - 83 ug/m3; median, 37.5 ug/m3]. Indoor to outdoor (I/O) PM2.5 ratio ranged from 1.1 to 14.9. The highest PM2.s concentration was recorded in a bar and the highest I/O ratio in an entertainment venue. Smoking density (number of burning cigarettes divided by volume of the public place) was not correlated with average indoor PM2.5 concentration (Pearson correlation = 0.36, p=0.12) or with I/O PM2.5 ratio (Pearson correlation = 0.07, p=0.76). The reported values are equal or above, compared to such venues in other countries. CONCLUSION: The authorities should take steps in enforcing the smoking ban in public places. Areas where smoking is permitted, proper ventilation should be ensured.Item Environmental noise levels in the city of Colombo, Sri Lanka(Sri Lanka Medical Association, 2013) Nagodawithana, N.S.; Pannila, A.S.; Gurusinghe, R.D.; Kalansuriya, C.; Sathiakumar, N.; Wickremasinghe, A.R.; Pathmeswaran, A.INTRODUCTION AND OBJECTIVES: Noise is a physical pollutant, which causes adverse health effects. Noise levels in most cities are higher than that recommended by environmental regulatory authorities of the relevant countries. Objective of this study was to determine the level of environmental noise at identified locations in the city of Colombo. METHODS: Colombo Municipal Council area is divided into 15 divisions. Sixty places with high traffic density, four from each of the 15 divisions, were purposively selected. At each selected site, equivalent continuous sound pressure level (LAeq) was measured for six hours during day time (three hours each from peak and non-peak traffic hours) using a Class-I Sound Level Meter on week days. LAeq for eight hours (LAeq [8hrs]) was calculated and taken as the average noise level of that place. L10, L50, and L90 measurements were also taken. RESULTS: LAeq (8hrs) within the Colombo city ranged from 76.6dB (at BOC roundabout, Colombo 12) to 84.0dB (at Lipton’s roundabout, Colombo 07), well above the maximum permissible noise level (63dB) for municipal council areas. All recorded LAeq values were more than 80dBs in Colombo 5, 9, 10, 13 and 14. Median LAeq value for the entire city was 81.0dB. Median LAeq value for peak traffic hours was 81.1dB and for off-peak traffic hours 80.4dB. Median values for L10, L50 and L90 for the city were 83.1dB, 76.6dB and 71.9dB respectively. CONCLUSIONS: Environmental noise levels in Colombo city are well above (13.3dB to 21.0dB) the levels recommended in the National Environmental (Noise pollution) Act of Sri Lanka.Item Noise levels of vehicles in the city of Colombo(Sri Lanka Medical Association, 2013) Nagodawithana, N.S.; Pannila, A.S.; Gurusinghe, R.D.; Kalansuriya, C.; Sathiakumar, N.; Wickremasinghe, A.R.; Pathmeswaran, A.INTRODUCTION AND OBJECTIVES: Though there is concern that vehicular traffic contributes to noise pollution in the city of Colombo there is no reliable data on the noise emitted by different types of vehicles. Objective of this study was to determine the noise emitted by vehicles within the city of Colombo. METHODS: Vehicles in the city of Colombo could be classified into sixteen categories based on the type (bus, motor-car, three-wheeler etc), technology (two-stroke, four-stroke, petrol, diesel) and size (light, heavy etc). Nine to 16 vehicles from each category were selected by quota sampling. Sound pressure level (SPL-the magnitude of sound) and maximum sound level (LAmax) of the engine and horn of the selected vehicles were measured according to ISO 5130:2007(E) standards. RESULTS: Diesel three-wheelers recorded the highest SPL (105.2dB) while cars recorded the lowest SPL (80.2dB). SPL of six categories of vehicles were more than 100dB. SPL of four and two stroke petrol three-wheelers and diesel three-wheelers were 97.2, 102.1 and 105.2dB respectively. SPL of large-buses with turbo and normal engines were 95.0dB and 103.6dB respectively. Ranking order of the LAmax level of engines were the same as for SPLs. LAmax of horns ranged from 100.1dB to 113.3dB. Maximum permissible noise level in a municipal council area during day time is 63dB. CONCLUSIONS: Diesel three-wheelers, two stroke petrol three-wheelers and large buses with normal engines are the noisiest vehicles in the city of ColomboItem Noise levels of vehicles in the city of Colombo(College of the Community Physicians of Sri Lanka, 2013) Nagodawithana, N.S.; Pathmeswaran, A.; Pannila, A.S.; Sathiakumar, N.; Wickremasinghe, A.R.INTRODUCTION: Though there is concern that vehicular traffic contributes to noise pollution in the city of Colombo there is no reliable data on the noise emitted by different categories of vehicles. OBJECTIVES: Objective of this study was to determine the noise emitted by different categories of vehicles within the city of Colombo. METHODS: Vehicles in the city of Colombo could be classified into sixteen categories based on the type (bus, motor-car, three-wheeler etc), technology (two-stroke, four-stroke, petrol, diesel) and size (light, heavy etc). Nine to 16 vehicles from each category were selected by quota sampling. Sound pressure level (SPL-the magnitude of sound) and maximum sound level (LAmax) of the engine and horn of the selected vehicles were measured according to ISO 5130:2007(E) standards. RESULTS: Measurements were made on 184 vehicles. Median SPL of vehicles ranged from 80dB in cars to 105dB in diesel three-wheelers. SPL of six categories of vehicles were more than 100dB. SPL of four and two stroke petrol three-wheelers and diesel three-wheelers were 97.2, 102.1 and 105.2dB respectively. SPL of large-buses with turbo and normal engines were 95.0dB and 103.6dB respectively. Rank order of the vehicles according to LAmax level and SPL of engines was the same. LAmax of horns ranged from 100.1dB to 113.3dB. There was no relationship between the category of vehicle and the LAmax of the horn. CONCLUSIONS AND RECOMMENDATIONS: Diesel three-wheelers, two stroke petrol three-wheelers and large buses with normal engines are the noisiest vehicles while cars, jeeps and pickups were the least noisy vehicles in the city of Colombo. Prohibition of importation of diesel three-wheelers and large busses with normal engines will help to make the county less noisy.Item Prevalence and correlates of noise induced hearing loss among traffic policemen in the city of Colombo(College of the Community Physicians of Sri Lanka, 2013) Nagodawithana, N.S.; Pathmeswaran, A.; Pannila, A.S.; Sathiakumar, N.; Wickremasinghe, A.R.INTRODUCTION: Noise induced hearing loss (NIHL) is a high frequency sensory-neural hearing loss in subjects who are exposed to environmental noise, but this diagnosis is made only after excluding other reasons for the hearing. Traffic policemen are exposed to environmental noise due to the nature of their duty and are susceptible to develop NIHL. OBJECTIVE: The objective of this study was to determine the prevalence and correlates of NIHL among traffic policemen in the city of Colombo. METHODS: This was a cross sectional study and traffic policemen working in the city of Colombo were selected for study. Cluster sampling method was adopted to select 350 participants. Pure tone audiometry test was performed to assess the level of NIHL. The test was performed in an audiology laboratory or in a sound treated, air-conditioned conference hall. Hearing levels of participants were classified according to a classification obtained by modifying the Clark’s classification. Correlates of NIHL were assessed using information collected using an Interviewer Administered Questionnaire (IAQ). RESULTS: Pure tone audiometry was performed on 287 policemen. High frequency hearing of, 169 participants (58.9%) was normal. Seventy nine participants (27.5%) had minor NIHL and 39 participants (13.6%) had major NIHL. In bivariate analysis 23 variables showed statistically significant association with mild and major NIHL of traffic policeman in the city of Colombo. However according to multi-variate analysis only age had statistically significant association with major NIHL with odds-ratio (OR) of 1.088 while only “duration of work as a policeman” had statistically significant association with any NIHL (major or minor) with OR of 1.007. CONCLUSIONS AND RECOMMENDATIONS: Prevalence of NIHL among traffic policemen working in the city of Colombo was 41.1% (95% CI=35.5%–46.9%). A third of those having NIHL had major NIHL. Traffic policemen should undergo periodic hearing assessment. The police department should explore the feasibility of reducing the number of hours per day spent on the road by traffic policemen. Traffic policemen with NIHL must be transferred to a different division immediately.Item Effect of indoor air pollution due to solid fuel combustion on childhood respiratory diseases(Sri Lanka Medical Association, 2014) Ranathunga, R.A.N.; Perera, K.P.J.; Nandasena, Y.L.S.; Kasturiratne, A.; Sathiakumar, N.; Wickremasinghe, A.R.Introduction and objectives: To determine the association between indoor air pollution and respiratory symptoms in children under 5 years of age. Methods: A prospective study was conducted over a 22 month period in the Ragarna MOH area. All children under 5 years in the selected households were followed up for 12 months and data on respiratory symptoms were extracted from a symptom diary. Sodoeconomic data of the households and main fuel type used for cooking was recorded. Air quality measurements were made in a sub sample of househords. Results: 262 children were followed up. The incidence of lower respiratory tract infections (RR-1.513, 95% C.t= 1.071-2.158) and infection induced asthma (RR-1.758, 95% C.l= 1.159-2.718) were significantly higher among in children resident in households using biomass fuel compared to children resident in households using LPG and electricity. The incidence of asthma attacks, rhinitis exacerbations and rhino conjunctivitis exacerbations were not associated with exposure to indoor air pollution. Houses which used biomass fuel had significantly higher concentrations of CO (3.27 vs. 1.49) and PM2.5 (1.14 vs. 0.31} compared to houses using LPG and electricity for cooking but CO2 concentration was not higher. Conclusions: CO and PM2.5 concentrations are significantly higher in households which use biomass fuel for cooking. There is a 1.5 times higher risk of lower respiratory tract infections and 1.8 times higher risk of infection induced asthma among children resident in households using biomass fuel for cooking compared to children in households using LPG or electricity.Item Fine particle air quality levels of Sri Lankan households and associated respiratory conditions: preliminary findings of an ongoing longitudinal study(Lippincott Williams & Wilkins, 2011) Nandasena, S.; Wickremasinghe, A.R.; Sathiakumar, N.BACKGROUND/AIMS: Data on fine particle (PM2.5) air pollutant levels in Sir Lankan households are scarce. A high proportion of households are known to use unclean fuels for cooking, without proper ventilation. The aim of the study was to determine the respiratory health status of children and PM2.5 levels in a sample of home environments (indoors and outdoors). METHODS: A total of 612 children (aged 7–10 years) were selected from 2 study settings (setting 1, n = 408; setting 2, n = 204) for a prospective study. Study “setting 1” was selected from a high outdoor air-polluted area of the Colombo Municipal Council, and “setting 2” from a low-polluted area. The study commenced in March 2009. Measurements were made in the main living room using UCB particle monitors for 24 hours with minute logging. The outdoor 24-hour PM2.5 levels were measured using gravimetric air samplers in 3 selected outdoor locations in each setting at monthly intervals. RESULTS: On the basis of the 124 household measurements, the median PM2.5levels in households of settings 1 and 2 were 66.6 μg/m3 (mean = 104.0, range = 25.5–644.8) and 50.0 μg/m3 (mean = 142.0, range = 5.9–749.5), respectively. The highest PM2.5 concentrations were reported from houses using wood as cooking fuel (mean = 145.2, median = 66.8, range = 5.9–749.5 μg/m3). The prevalences of wheezing during the past 12 months (at least one episode during the last 12 months) were 20.8% (n = 85) and 10.8% (n = 22) (odds ratio = 2.2, confidence interval = 1.3–3.6) in setting 1 and 2, respectively. The prevalences of children ever having asthma were 18.9% (n = 77) and 12.7% (n = 26) in settings 1 and 2, respectively. CONCLUSION: Most of the households had PM2.5 levels exceeding the upper limit recommended by the World Health Organization. Children living in setting 1 had a higher risk of experiencing respiratory ill health than children living in setting 2. © 2011 Lippincott Williams & Wilkins, Inc.Item Prevalence and correlates of noise induced hearing loss among traffic policemen in the City of Colombo(Asia-Pacific Academic Consortium for Public Health, 2013) Nagodawithana, N.S.; Pathmeswaran, A.; Pannila, A.S.; Sathiakumar, N.; Wickremasinghe, A.R.BACKGROUND AND OBJECTIVE: Noise induced hearing loss (NIHL) is a high frequency sensory-neural hearing loss in subjects who are exposed to environmental noise, but this diagnosis is made only after excluding other reasons for the hearing. Traffic policemen are exposed-to environmental noise due to the nature of their doty and are susceptible to develop NIHL The objective of this study was to determine the prevalence and correlates of NIHL among traffic policemen in the city of Colombo. METHODS: A cross sectional study was carried out among traffic po icemen in the city of Colombo, 350 participants were selected by cluster sampling. Pure-tone ; udionietry test was performed to assess the level of NIHL. Hearing levels of participants were classified using a classification obtained by modifying the Clark's classification. Correlates of NIHL were assessed using an Interviewer Administered Questionnair (IAQ). RESULTS: High frequency hearing of, 169 (total 287} participants (5->.9%) was normal. Seventy nine participants (27.5%) had minor NIHL and 39 participants (13.6%) lad major NIHL. In bivariate analysis 23 variables showed statistically significant association with mild and major NIHL while multi-variate analysis showed only age had statistically significant association with major NIHL with odds-ratio(OR) of 1.088 and only 'duration of work as a policeman" had statistically significant association with any NIHL (major or minor) with OR of 1.007. Conclusions: Prevalence of NIHL among traffic policcrien working in the city of Colombo was 41.1 %(95% CI=35.5%-46.9%). A third of those having r IHL had major NIHL. Traffic policemen should undergo periodic hearing assessment. The police department should explore the feasibility of reducing the number of HOLTS per day spent on the road by traffic policemen. Traffic policemen with NIHL must be transfe'-red to a different division immediately.