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 Comparison of urban diabetics with optimal and suboptimal control(British Medical Association, London, 2011) Pinidiyapathirage, M.; Warnakulasuriya, T.; Kasturiratne, A.; Ranawaka, U.; Gunasekera, D.; Wijekoon, N.; Medagoda, K.; Perera, S.; Takeuchi, F.; Kato, N.; Wickremasinghe, A.R.Introduction The prevalence of Diabetes Mellitus in Sri Lanka is increasing. We describe the characteristics of patients with optimal and suboptimal control of diabetes among known diabetics in a 35–64-year-old urban population resident in the Ragama Medical Officer of Health (Ragama MOH) area of Sri Lanka. Methods A cross sectional study was conducted among 2986 randomly selected 35–64 year olds in the Ragama MOH area from January to September 2007. A detailed history was taken and participants were subjected to a physical examination and assay of fasting blood glucose and HbA1C. A HBA1C <6.5 was taken as evidence of optimal control. Results There were 474 persons (194 males and 280 females) who gave a past history of diabetes. 9 males and 9 females were not on any treatment. 27 persons (9 males and 18 females) were on insulin. Of the 474 diabetics, 113 (48 males and 65 females) had a HbA1c <6.5. The average fasting blood glucose of diabetics with optimal control was 120+21 mg/dl. The mean fasting blood glucose level of the 361 subjects with sub optimal control was 190+70 mg/dl. Optimal glycaemic control was not associated with alcohol intake, smoking, obesity, central obesity and low physical activity levels. Conclusions Most known diabetics had access to treatment but only approximately 25% were optimally treated. The need to optimally manage these patients is highlighted.Item Introduction of a Safe Water System (SWS) In a tsunami attuned community In Hikkaduwa, Sri Lanka(College of the Community Physicians of Sri Lanka, 2007) Pinidiyapathirage, M.J.; Wijeyaratnez, P.; Wickremasinghe, A.R.; Kalluri, P.INTRODUCTION: The SWS is an intervention that employs simple, robust, and inexpensive technologies to make drinking water safe at the point oi use through disinfection and safe storage. OBJECTIVE: To introduce a sale water system using household chlorination and washing of hands with soap in the community. METHODS: A commercially prepared solution of 0.9% sodium hypochlorite ('Chlovathura') in 130ml plastic bottles and a 20-liter plastic container with a narrow mouth and a lid was provided tree 01 charge. Trained community assistants distributed and promoted the use of the SWS using interpersonal communication methods. Hand washing using soap was promoted simultaneously. Surveys were conducted at baseline (n=452). six months (n=100) and 18 months (n=200) post- intervention to assess use. RESULTS: All were aware of the product ’Chlovathura' by six months of its introduction. 0t those who were aware oi the product, 49% (n=98) correctly described how it should be used at baseline and this percentage improved to 75% (n=149) post-intervention. When stored water at household level was tested for chlorine, it was present in the specified concentration in 6% 01:26), 27% (n=27) and 34% (n=67) at baseline, six months and 18 months respectively. The incidence of a diarrhoeal episode within the past two weeks among children under 5 years in the sample reduced to 4.8% (n=4) at 18 months from 5.4% (n=8) at baseline (p>0.05). CONCLUSION: The SWS was accepted and correctly practiced by more than one third of the target population. The SWS can be promoted in other areas with remote access to safe drinking water and may be a solution to reduce the morbidity due to diarrhoeal diseases in the country.Item Adaptation of "Medical Interview Satisfaction Scale" (MISS-21) for Sri Lankan general practice(Sri Lanka Medical Association, 2019) de Silva, A.H.W.; Kasturiratne, K.T.A.A.; Seneviratne, A.L.P.; Wickremasinghe, A.R.INTRODUCTION & OBJECTIVES: Patient satisfaction is an important clinical outcome and a validated Sinhalese tool to measure it is essential. MISS 21 is a tool validated in the British general practice. Objective was to translate, cross-culturally adapt and validate the MISS 21 to for the Sri Lankan Sinhala speaking general practice setting. METHODS: The suitability and relevance of items in MISS-21 were assessed and unacceptable items revised. Translation process involved back translations and synthesis. Conceptual and linguistic equivalence was considered. Accuracy in rephrasing-and semantic adjustments was made following pretest. Operational equivalence was evaluated. A sample size of 300 was estimated and 480 recruited to account for non-respondents. Tool was self-administered amongst literate Sinhala patients of ≥18 years from six general practices. Exploratory factor analysis (EFA) extracted potential components associated with satisfaction. Internal consistency was assessed using Cronbach's alpha. RESULTS: Sixteen items fulfilled 80% acceptance. Four items were retained unchanged on consensus while one item was changed. Operational equivalence was accepted. Only 381 were complete enabling EFA. EFA extracted two components. This model explained 56% of the variability of total patient satisfaction scores. Items exploring communication and distress releasing aspects loaded on component 1 ("communication and comfort"). Items related to unmet expectations of patients and the doctor's regard loaded on component 2 ("regard and clarity"). All items in components 1 and 2 (Cronbach's alpha >0.9 and >0.7) demonstrated good internal consistency. CONCLUSION: The Sinhala version of MISS 21 exhibited high content validity, satisfactory construct validity with an acceptable factor structure, internal consistency and high response rates.Item Location and causes of road traffic accidents related to motorcycle riders and three-wheeler drivers brought to Colombo North Teaching Hospital, Ragama(Sri Lanka Medical Association., 2019) Williams, H.S.A.; Amarasekara, P.P.K.; Anthony, K.L.J.M.; Ariyawansha, A.B.M.; Aththanayaka, A.M.A.U.; Alwis, D.N.; Wickremasinghe, A.R.INTRODUCTION & OBJECTIVES: Road traffic accidents (RTAs) is a leading cause of morbidity and mortality in low and middle income countries. Human, vehicle and environmental factors are identified as causative agents. The objective was to identify location and causes of RTA related to motorcycle and three-wheeler drivers brought to Colombo North Teaching Hospital (CNN). METHODS: A descriptive cross sectional study was conducted from 15/12/2018 to 10/12/2019 at the CNTH. 104 motorcycle riders and 49 three-wheeler drivers following an accident were included. Data related to human, vehicle, road factors and demographic details were collected using an interviewer administered questionnaire. The location of accident was mapped using Google earth with colour coding for category of hurt, to identify geographical distribution. RESULTS: Motorcycle Accidents: 17.3% were under the influence of alcohol at the time of accident. Mean speed of vehicle at the time of accident was 42.2 kmph. 42.3% of riders who did not wear the helmet properly sustained grievous injuries. 42.5% of employed riders experienced an income loss. Three-wheeler Accidents: 22.4% were under the influence of alcohol at time of accident. Mean speed of vehicle at the time of accident was 46.94 kmph. 49% of accidents took place at a turn. 63.6% of employed drivers experienced an income loss. Mean income loss for motorcycle and three-wheeler drivers were Rs. 2326 and Rs.2816, respectively. CONCLUSION: Human and environmental factors have been responsible for majority of accidents. There are areas in Ragama where drivers should be cautious.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 Exposure to alcohol marketing among adolescents in Colombo district: A mixed methods study(Sri Lanka Medical Association., 2019) Athauda, L.K.; Wickremasinghe, A.R.; Peiris- John, R.INTRODUCTION & OBJECTIVES: Alcohol initiation age is reported as 14 years in Sri Lanka. Despite regulations to control alcohol marketing, it is accessible, affordable and advertised to adolescents. This study aimed to describe the exposure to alcohol marketing environment among 16 to 18-year old in the Colombo District. METHODS: Eight focus group discussions (5 males,3 female) were conducted with 4-10 participants in each and an online pilot survey among 48 adolescents (16-18 years). The mixed methods approach assessed exposure to alcohol marketing, drinking behaviours and perceptions about alcohol related policy. Focus group transcripts were analysed using NVivo 12 and the survey data was analysed using SPSS 22. RESULTS: Of the males (54.2%, n=26) and females (45.8%, n=22) who participated, 26.5% had drunk alcohol at least once. International school attendees (37.5%, n=18) who consumed alcohol at least once (61 0/0) were higher than the proportion of their government school peers (6%). The minimum age of initiation of drinking was 12 to 13 years. Adolescents identified alcohol drinking as "normal" and found it "affordable"(43.7%) and "accessible"(80%). Adolescents have been exposed to alcohol marketing on social media, mass media, at sports events or restaurants/pubs. Alcohol related content was being shared heavily on social media among those who use it, while adolescents with lower alcohol access experimented with alcohol and other related substances at every opportunity despite their awareness of consequences and regulations. CONCLUSION: Adolescents consider drinking a normal phenomenon which is translated to them through their environment. Their drinking behaviours are fuelled by easy access and affordability despite the current control policies.Item Hyperglycaemia in pregnancy and cardio metabolic risk parameters in the offspring at 10-11 years(Sri Lanka Medical Association., 2019) Herath, K.K.W.H.P.; Herath, H.M.R.P.; Wickremasinghe, A.R.INTRODUCTION & OBJECTIVES: Studies of developmental origins of health and disease have highlighted the possible role of hyperglycaemic intrauterine environment mediating and accelerating the current epidemic of diabetes and non-communicable diseases through foetal programming and epigenetic changes. While the perinatal and neonatal risks of hyperglycaemia in pregnancy (HIP) are well established, the long-term risks for the offspring are less explored. This study aimed to determine the association between HIP and cardiometabolic risk parameters in the offspring at 10-11 years. METHODS: A community based retrospective cohort study was conducted in the Colombo district. In the first stage, children born in 2005 were identified and the availability of antenatal records were assessed. In the second stage, exposure status of participants was ascertained based on antenatal records. In the third stage, eligible children were examined with blood pressure (BP), fasting blood sugar (FBS) and lipid profile to ascertain outcome status. RESULTS: 159 children of mothers with HIP (exposed) and 253 children of mothers with no HIP (non-exposed) participated. Mean ages (SD) of exposed and non-exposed groups were 10.9(0.3) and 10.8(0.3) years, respectively. Exposed children had a significantly higher risk of developing impaired fasting glycaemia (OR=5.6; 95% CI: 1.2-28.9), elevated total cholesterol (OR=2.1; 95% Cl: 1.3- 3.4), elevated low-density lipoprotein cholesterol (OR=1.9; 95% CI: 1.2-3.3) and elevated triglycerides (OR=2.5; 95% CI: 1.4-4.3). There was no significant difference in the BP and elevated high-density lipoprotein cholesterol between the exposed and non-exposed groups. CONCLUSION: Exposure to HIP increases the cardiometabolic risk in the offspring and these children need long-term follow upItem Ecology of healthcare: Symptom prevalence and health care seeking behaviour in Gampaha District, Sri Lanka(Sri Lanka Medical Association., 2019) Withana, S. S.; Mendis, K.; Nandasena, S.; Wickremasinghe, A.R.INTRODUCTION & OBJECTIVES: In 20 J 5, the Ministry of Health reported that 55 million outpatient visits were made to government OPDs and estimates 100 million visits by 2027. We studied the community symptom prevalence, associated factors and the trends in healthcare seeking behaviour in the Gampaha district. METHODS: A community-based prospective study, using a participant held symptom diary and interviews was conducted from May to June 20 J 8 in three Public Health Midwife areas each from Raga ma (urban) and Mirigama (rural) MOH areas. RESULTS: We invited 2330 individuals from 557 households and 2046 participated. Majority were: females. (n=l 127, 55.1%). Highest recruitment was from Mirigama area (n=1207, 59%). Of the study population 1919 (93.8%) reported at least one symptom. Phlegm (n=4871, 7.2%) had the highest frequency, musculoskeletal symptoms were the highest (26.8%) as a group. Females had a higher symptom prevalence (p = 0.001). Employment, income, having a chronic disease and distance to healthcare institution were significantly (p < 0.05) associated with both symptom prevalence and healthcare seeking behaviour. How the symptoms were managed: Ignored symptoms (n=l53, 8%), Self-care (n=560, 29.2%) and Seeking healthcare (n=924, 48.1%). Majority (n=763,82.6%) sought allopathic treatment, of whom 515 (55.7%) chose private sector ambulatory care. Of the 43 (2.2%) hospital admissions, 28 (65%) were to government hospitals. CONCLUSION: People in Gampaha District have a high symptom prevalence (93.8%) and healthcare seeking behaviour (48.1%) compared to USA which was (80%) and (32.7%) respectively. Gender did not influence the healthcare seeking behaviour. Majority (55%) preferred private allopathic ambulatory care.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 Socioeconomic inequality and determinants of postnatal home visits made by public health midwives: An analysis of the Sri Lanka Demographic and Health Survey(2019) Siriwardhana, D.D.; Pathmeswaran, A.; Wickremasinghe, A.R.