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 Awareness on Malaria among Public and Healthcare Providers during the Prevention of Re-Introduction Phase in Sri Lanka(Sri Lanka Medical Association, 2020) Hamsananthy, J.; Wickremasinghe, A.R.INTRODUCTION AND OBJECTIVES: Prevention of re-introduction/re-establishment of malaria is a challenge for Sri Lanka due to high receptivity and vulnerability. Imported cases are being reported and an introduced case was reported in 2018. The objective of this study was to assess the awareness on malaria among public and healthcare providers which is essential during the prevention of re-introduction/re-establishment phase. METHODOLOGY: Two national surveys were conducted among 3454 households and 766 healthcare providers in 2016. Household survey was conducted using a multistage cluster sampling method. Healthcare providers’ survey used stratified random sampling and a self-administered questionnaire. RESULTS: The mean awareness score of healthcare providers was 54.7% (SD=10.6). Although 99.1% of healthcare providers (n=759) identified fever as a symptom of malaria, the majority (n=634) had not seen, diagnosed or treated a malaria case during the last 5 years. The mean awareness score of heads of households was 28.6 % (SD = 9.03). 74.4% of heads of households (n=2570) had ever seen/heard messages about malaria; 7.2% (n=249) had seen/heard in the past 6 months. The common media of communication were television (n=2714, 78.6%) and mobile phones (n=2242, 64.9%). The majority knew that malaria is spread by a mosquito bite (92.7%, n=3202) and fever (71.8% n=2479) is a symptom of malaria. CONCLUSIONS: The majority of healthcare providers have not seen a case of malaria; updates on malaria should be regularly given to suspect malaria in the differential diagnosis of fever. Television and mobile phone technology can be used to increase awareness on malaria among the general public.Item The first case of introduced malaria in Sri Lanka after elimination: Approach by the Anti Malaria Campaign to prevent re-establishment of malaria(Sri Lanka Medical Association., 2019) Karunasena, V.M.; Marasinghe, M.M.M.B.; Amarasinghe, S.; Senaratne, P.A.S.; Hasantha, M.B.R.; Hevawitharana, M.INTRODUCTION & OBJECTIVES: Apart from imported malaria infections Sri Lanka has been free of malaria cases for the past six years after elimination until December 26th 2018, when the first introduced case was reported. This manuscript describes the probable index case and the introduced case of malaria, and actions taken to curtail the spread of transmission. METHODS: Detailed case investigations of the probable index and introduced cases were carried out and appropriate responses were mounted by the Anti Malaria Campaign (AMC). Genome sequencing was performed on parasites obtained from the two cases to determine relatedness of the two parasite isolates. RESULTS: An Indian employed at a construction site in Moneragala district, developed a Plasmodium vivax infection 23 days after arriving in Sri Lanka. Thirteen days later a Sri Lankan with no travel history to a malaria endemic country was diagnosed with P.vivax malaria following his visit to the same site. Multi-locus genome sequencing show that P. vivax strains obtained from these cases share 100% genetic identity at five loci of three polymorphic genes (CSP, MSPI and MSP3a genes), suggesting that both patients were infected with the same P.vivax strain. AMC mounted a rapid response including parasitological and entomological surveillance, active case detection, appropriate vector control measures and raising public and clinician awareness at relevant sites. CONCLUSION: An outbreak and the re-introduction of malaria to Sri Lanka from an index and introduced cases were prevented by prompt interventions which illustrate a very effective surveillance and response system.Item Importance of private health sector in malaria surveillance: a case study in Nuwara-Eliya district, Sri Lanka(Sri Lanka College of Microbiologists, 2002) Kusumawathie, P.H.D.; Wickremasinghe, A.R.; Karunaweera, N.OBJECTIVE: To determine the Utilization of public and private health facilities by suspected malaria cases in Divisional Director of Health Services (DDHS) area Hanguranketha in Nuwara-eliya district (from July 2000 to June 2001). DESIGN, SETTING AND METHODS: Two state hospitals, DH Rikillagaskada and RH Gonagantenna were selected as public health facilities. Seven clinics at Rikillagaskada and Gonagantenna in which government medical officers engaged in private practice after duty hours were selected as private health facilities. The number of cases blood filmed for malaria at public facilities was obtained from hospital records. Data for the private sector was obtained using a pre designed form. Reporting from the private sector was done on a monthly basis. RESULTS: Among 572 cases blood filmed at government hospitals, 22 were positive for P.vfvax. In the private sector. 634 cases of suspected malaria were reported and treated on clinical grounds. During the study period, 40 P.vivax and 65 P.falciparum cases were detected by examining 1270 blood films collected by Active Case Detection and Special Malaria Clinics, conducted in the villages with risk of malaria transmission within the study area. Of the microscopically confirmed malaria cases, 15.4% of P.falciparum infections were resistant to chloroquine. Investigation of malaria cases revealed 66.7% of cases were indigenous while 33.3% were imported. If the Slide Positive Rate (SPR) of the government facilities is applied to the data of the private sector, 610 cases would have been given chloroquine without actually having malaria. CONCLUSIONS: According to this study, 52.57% of suspected malaria cases had sought treatment at private health facilities. Incorporating the private health sector in malaria surveillance would be helpful in correct treatment and control of malaria in malarious areas. Unnecessary anti malarial therapy should be reduced by provision of laboratory facilities at private health centers. ACKNOWLEDGEMENTS: Assistance provided by the Provincial Director Health Services, Central Province and Deputy Provincial Director Health Services, Kandy, and the Director Anti-Malaria Campaign is acknowledged.Item Extrathymic T cells in human malaria patients(Elsevier, 1998) Watanabe, W.; Weerasinghe, A.; Miyaji, C.; Sekikawa, H.; de Silva, N.R.; Gunawardena, S.; Ratnayake, H.; Kobayashi, J.; Thoma, H.; Sato, Y.; Abo, T.Item A Mixed infection of Plasmodium falciparum and Plasmodium malariae: the first report of a Plasmodium malariae infection after 37 years of its absence in Sri Lanka(2008) Hapuarachchi, H.A.C.; Abeysundara, S.; Gunawardena, N.K.; Manamperi, A.; Senevirathne, M. P.; Leemingsawat, S.; Chavalitshewinkoon-petmitr, P.; de Silva, N.R.; Abeyewickreme, W.Malaria has been endemic in Sti Lanka for several centuries. Currently, only Plasmodium falciparum and P. vivax are present in the country. P. malariae infections have not .been reported in Sri Lanka since 1969. The objective is to determine the presence of malaria species in a patient returned from Malawi. The clinical history of intermittent high fever for 2 weeks accompanied by severe headache, myalgia, arthralgia, vomitimg, loss of appetite and backache with ictetus and mild hepatosplenomegaly suggested malaria in this 51 year old patient. Apart from the basic biochemical investigations, presence of malarial species was determined by light microscopy and confirmed by Real-Time Polymerase Chain Reaction (PCR) technology. Biochemical investigations showed a high serum bilirubin (4.8 mg/di) and liver enzyme (SGOT = >125 units, SGPT = >250 units) levels. Serum haemoglobin level (12.8 g%) was normal. Except for the presence of ptoteinuria (albumin = ++), bile (+) and red blood corpuscles (RBC) in his urine, renal functions were normal. Microscopical examination of Giemsa stained thin and thick blood smears showed an asexual parasite density of 120,000 per ul of blood. Infected RBCs were not enlarged, The presence of double-chromatin and applique form trophozoites, occasionally invading multiple RBCs suggested P. falciparum infection. In addition, there were characteristic band form trophozoites of P. malariae. Real-Time PCR protocol confirmed the presence of both P. falciparum and P. malariae in this patient. This is the first case of P. malariae reported in Sri Lanka after 4 decades, though the infection had been acquired from Malawi. Clinical and biochemical evidence indicated liver dysfunction and a transient glomerulonephritis, both of which subsided after treatment with quinine. This case report emphasizes the need of physicians to be more vigilant about the presence of malaria among immigrants, despite the drastic reduction of malaria in the country in recent years. Hence, this report highlights the importance of a proper programme in Sri Lanka to screen immigrants for infectious diseases.Item Climatic factors affecting density of Anopheles vector mosquitoes in Ampara District, Sri Lanka(University of Kelaniya, 2014) Kannangara, D.N.; Ranathunge, R.M.T.B.; Abeyewickreme, W.; Hapugoda, M.D.; Subasinghe, S.M.C.U.P.Background: Apart of many vector-borne diseases malaria played a major role during past decades in Sri Lanka. Controlling strategies had effectively addressed this issue so that there were no malaria patients recently. However it has been observed that abundance of vector mosquitoes in districts like Ampara is high, which signifies a potential of spreading of malaria in the area in future. Identification of the relationship between the climatic factors and vector density could be a cost effective way in controlling the mosquito instead of costly strategies currently followed. This study attempts to identify the relationship exists between climatic factors and the vector density in Ampara District.Item Effects of socio-economic and socio-cultural risk factors on low malaria transmission in Mannar and Trincomalee Districts of Sri Lanka(University of Kelaniya, 2014) Gunathilaka, P.A.D.H.N.; Abeyewickreme, W.; Ranathunge, R.M.T.B.; Hapugoda, M.D.; Wickremasinghe, A.R.The socio-economic and socio-cultural practices of the people differ between communities and play an important role in malaria control operations. The present study was conducted to assess the influence of household socio-economic and socio-cultural status on reduction of malaria transmission in the Districts of Mannar and Trincomalee, which are endemic regions for malaria in Sri Lanka.