Theses - Faculty of Medicine
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Item The association between asthma and functional abdominal pain disorders in paediatric population: common pathophysiological mechanisms causing this association(University of Kelaniya, 2019) Kumari, A.M.M.V.Asthma and functional abdominal pain disorders (FAPDs) are common paediatric disorders affecting quality of life. Though the association of asthma with irritable bowel syndrome has been reported, association with other FAPDs and possible underlying pathophysiological mechanisms have not been well described. This thesis describes the association between asthma and FAPDs (Phase I) and investigation of a possible pathophysiological mechanism using gastric motility and lung function tests (Phase II) in a cohort of children. In phase I, a cross-sectional survey was conducted among randomly selected adolescents. The validated Rome HI, and International Study on Asthma and Allergies in Childhood (ISAAC) questionnaires were utilized to identify adolescents with FAPDs and asthma respectively. Health-related quality of life (HRQoL) was evaluated using the Paediatric Quality of Life Inventory. Logistic regression showed independent association between asthma and functional abdominal pain [odds ratio (OR) 3.1, 95% confidence interval (CI) 1.6-6.0], functional dyspepsia (OR 3.9, 95% CI 1.1-13.5) and abdominal migraine (OR 10.2, 95% CI 2.6-39.5). HRQoL was significantly impaired among adolescents with both disorders. In phase II, an extensive review identified shared pathophysiological mechanisms; smooth muscle dysfunction, immune dysfunction, hypersensitivity, mucosal inflammation and barrier dysfunction, followed by a laboratory-based study involving 100 children (age 7-12 years), recruited into 4 groups of 25 each; asthma only, FAPDs only, asthma and FAPDs, and healthy controls. Asthma was diagnosed using clinical history and spirometry, and FAPDs by Rome III criteria. All subjects underwent real-time ultrasonography and spirometry. Gastric emptying rate, amplitude of antral contractions and antral motility index were significantly impaired in children with either disorder or both compared to controls (p<0.05). Antral motility index correlated with FEVi/FVC ratio (r=0.60, p=0.002) and FEF25%-75% (r=0.49,p=0.01) in children with both disorders. In conclusion, a strong independent association was noted between asthma and FAPDs. Gastric motility was significantly impaired in children with either disorder or both. Motility index measuring overall gastric motor function, shov/ed significant positive correlation with lung function parameters that measured airflow limitation. Primary disturbance of smooth muscle activity in airways and the gastrointestinal wall could be a possible pathophysiological mechanism for this association between asthma and FAPDs.Item Assessment of background radiation and frequency of micronuclei formation in two selected populations in Sri Lanka.(University of Kelaniya, 2019) Weerakkody, W.A.T.L.This study assessed background radiation and frequency of micronuclei formation in persons living in Norochcholai and Ragama. Ninety-six healthy individuals (20-59 years of age) from both sexes were selected for the study, comprising 50 from Norochcholai (area closest to the power plant) and 46 from Ragama (control). Ten milliliters of venous blood was drawn and the cytokinesis—block micronuclei assay was performed. Thousand binucleate cells were assessed; the median spontaneous micronuclei formation was estimated. Background radiation was measured using an Automess dose rate meter 6150AD. There was no significant difference in the median micronuclei (MN) frequency between the two sexes (p= 0.538) and the two study areas (p=0.539). There was no correlation between background radiation and MN frequency. Fifty-four water samples (26 from Norochcholai and 28 from Ragama) were analyzed by gamma spectrometry and radioactivity was not detected in any of the water samples. Fifty-one soil samples (25 from Norochcholai and 26 from Ragama) were analyzed by gamma spectrometry. The median radioactivity concentration (IQ range) of 232 Th, 40 K, 226Ra and 210Pb in Norochcholai were 50.0Bqkg-l (31.3-91.2), 99Bqkg-1 (84.0-111.3), 22Bqkg-l (14.3-40.3Bqkg-l) and 27Bqkg-l (23-44Bqkg-l) respectively; in Ragama, the median radioactivity concentrations (IQ range) of were significantly higher in Norochcholai than that of Ragama area exceþt for 40K.The gamma ray absorbed dose rates in soil samples of Norochcholai varied between 32.1 nGyh-l and 81.1 nGyh-l with an average of 51.2nGy h-l which is lower than the global average of 57 nGyh-l; in Ragama, this varied between 27.8-40. lnGyh-1. The mean Raeq of Norochcholai was 149.7 Bqkg-l. A radium equivalent activity above 370, the limit set by the Nuclear Energy Agency group of experts as safe to be used in building materials, was observed in 2 soil samples from Norochcholai. All the soil samples from Ragama had a Raeq below 370Bq/kg. The median Raeq was 73.7 Bq/kg. The median annual effective dose in Norochcholai was 0.062 mSv.y-l and in Ragama it was 0.040mSvy-l. They were within the safe limit of ImSv/y. Hex of all the samples were below I. Thus the soil from both the study areas are safe for human health. Pb were 38.4Bq/kg (26.4-52.1), 100.7Bq/kg (93.1-163.9), 11.7Bq/kg (10.1-16.3) and 25.9 Bq/kg (19.8-47.5) respectively. 232Th activity concentration in both were higher than the world average. Activity concentrations of all the radionuclides. The results of this study can be used as baseline data to monitor exposure to radiation in the selected population in the future. This is important for monitoring radiation hazards and will be useful in case of a nuclear accident. KEYWORDS: Background radiation, micronuclei, Nuclear accident, baseline data, gamma spectrometryItem Establishment of a geographic information system (GIS) based mathematical model for prediction of dengue epidemics within Colombo and Kandy districts of Sri Lanka.(University of Kelaniya, 2019) Udayanga, N.W.B.A.L.Dengue fever, which is primarily transmitted by Aedes aegypti and Aedes albopictus, is responsible for approximately 390 million infections globally per annum. The current study was conducted to characterize the dengue risk within the districts of Colombo and Kandy. Information on socio-economic and demographic status, and knowledge, attitudes and practices (KAP) were gathered from 1000 randomly selected patients and 1000 non-dengue reported households within each district using an interviewer administered questionnaire. Routine entomological surveillance was conducted from February 2016 to July 2018 at monthly intervals within 10 high risk Medical Officer of Health (MOH) areas in both districts. Monthly vector indices, [Premise Index (PI), Container Index (CI) and Breteau Index (BI)], meteorological parameters (monthly total rainfall, minimum and maximum temperature and relative humidity), landuse practices and socio-demographic data from all the 39 MOH areas relevant to the period of January, 2012 to December, 2018 were collected as secondary data. The socio-economic attribute. were statistically analysed by using the Chi-square test of independence and cluster analysis. Receiver Operating Characteristic (ROC) curves analysis was used to develop thresholds for dengue epidemic management. Principal Component based Linear Regression (PCLR) and Principal Component based Poisson Regression (PCPR) approaches were used to develop a spatial risk characterization model for dengue, while Seasonal Autoregressive Integrated Moving Average (SARIMA) approach was used to develop a temporal dengue prediction model. The climate change vulnerability of the local communities to dengue was evaluated by using the composite index method. Significant differences were identified among the test and control groups for basic demographic factors, living standards, knowledge, attitude and practices. The test group indicated similar risk factors, while the control group also shared more or less similar characteristics as depicted by the findings of cluster analysis. Further, improvement in key infrastructural facilities such as urbanization and waste collection, community education, public motivation, coordination and integration of control programmes, were recognized to be vital. Only PI and BI for Ae. aeopti (Blagp) were significantly associated with dengue epidemics at lag periods of one and two months. Based on Ae. aegypti, average threshold values were defined for Colombo as Low Risk (Blagp ≤2.4), Moderate Risk (3.8 ≤ Blagp ≥5), High Risk (Blagp ≥ 5), along with Blagp ≤ 3.0 (Low Risk), 4.2 ≤ Blagp < 5.3 (Moderate Risk) and Blagp ≥ 5.3 (High Risk) for Kandy. Further, PI ≤ 5.5, 8.9 ≤ PI ≥ 11.9 and PI ≥11.9 were defined as Low Risk, Moderate Risk and High Risk average thresholds for PI in Colombo, while PI ≤ 6.9 (Low Risk), 9.1≤ PI ≥ 11.8 (Moderate Risk) and PI ≥ 11.8 (High Risk) were defined for Kandy. The best fitting model converged by PCPR was the best risk characterization model, with higher levels of goodness of fit indicators such as R2 and Adjusted R2 values of 90.08% and 89.88%, with an AIC value of 205.86. The best fitting forecasting models fitted for Colombo and Kandy are SARIMA (0,1,0) (3,0,0) and SARIMA (2,1,2) (1,0,0)12 respectively. Colombo Municipal Council MOH area had the highest vulnerability (0.49: moderate vulnerability) to dengue, while the Galaha MOH showed the lowest (0.15; very low vulnerability). KEYWORDS: Dengue, Risk prediction, GIS, Spatial model, threshold.Item Determination of risk factors and development of mathematical models to forecast case incidence of dengue in Gampaha District, Sri Lanka.(University of Kelaniya, 2019) Withanage, G. P. W. K.ABSTRACT: Dengue is one of the most important mosquito-borne viral infection in Sri Lanka and the disease is caused by any of the four antigenically distinct Dengue Viruses (DENV). Aedes aegypti (Linnaeus) and Ae. albopictus (Skuse) are considered as vectors transmitting the virus in the country. The second highest number of dengue incidences are reported from the District of Gampaha, next to Colombo, since 2010. Overall objective of the current study was identification of risk factors, development of risk maps and prediction models for transmission of dengue and identification of efficacy of lethal ovitraps to control dengue vectors in the District of Gampaha. During the COMPONENT 1 of the study, identification of risk factors affecting transmission of dengue in selected sites in the District of Gampaha was performed. Based on epidemiological situation during the period of 2005-2014, four Medical Officer of Health (MOH) areas with highest number of dengue incidences reported, namely Kelaniya, Mahara, Negombo and Wattala, were selected as study areas. Mirigama MOH area, which had a very low level of dengue incidence, was selected as the control area. Differences in entomological indices were observed in study areas during the analysis of studied risk factors, however the study variables in high risk study areas were clustered together when compared to the control area. Broadly, socio-economic factors viz. size of the homestead, years of living in the same area, number of persons in household, monthly family income and type of premise, Entomological factors, viz. surrounding cleanliness, vegetation coverage and source of water and Knowledge, Attitude and Practices (KAP) measures, viz. waste disposal method, mosquito control measures, effects of previous dengue control projects and role of Public Health Inspector (PHI) play significant role in transmission of dengue in the high risk study areas. Transmission of DENV serotype/s and genotype/s by field-caught dengue vector mosquitoes was detected using molecular-based assays. Phylogenetic analysis of the positive mosquito pools, collected during the dengue epidemic in 2017, revealed that the causative agent for the epidemic is a migrated virus belongs to DENV-2 Cosmopolitan Clade lb strain. Under the COMPONENT 2 of the study, development of mathematical and Geographic Information System (GlS)-based models to forecast impending dengue epidemics and GIS-based risk maps to study on transmission of dengue in the District of Gampaha were performed. During mathematical modelling, rainfall, rainy days, temperature and Relative Humidity (RH) were identified as significant climatic factors affecting for the transmission of dengue. Further, number of dengue incidence in the previous month exponentially contributed to the dengue incidence in the current month. The best time series regression model developed forecasted correctly with mean absolute errors of 95.65 and 532.39 for training and validation periods, respectively. The Pierce skill score of the model was 0.49. Receiver operating characteristic of the selected model was 86% and the sensitivity was 92%. The developed random forest model forecasted dengue incidences correctly with mean absolute errors of 90.73 and 1308.56 for training and validation periods and the model demonstrated the increase of dengue incidences since March, 2017 which lead to the epidemic peak in July. GIS-based risk maps were developed to identify dengue risks in each MOH area in the district and models were developed to identify risk localities in the studied dengue high-risk areas. Positive correlations were observed with breeding containers, roads and land use during spatial correlation analysis in the high risk study areas. During COMPONENT 3 of the study, identification of dengue vector mosquito species and other mosquito species was performed. Different mosquito species were collected from the field and complete 'Folmer region' Cytochrome c Oxidase (COI) DNA barcodes were developed for 21 species of mosquitoes belong to six genera in Sri Lanka. When COI barcodes analyses utilizing distance and phylogenetic methods compared with morphological identification revealed that the mean inter-species Kimura-2-parameter pairwise divergence ranged from 7.0% to 25.4%, while that for intra-species ranged from 0.0% to 1.4%. The developed COI-based DNA barcoding approach can be used to discriminate mosquito species in the district and the study reported the presence of Culex pipiens mosquito for the first time in Sri Lanka. During COMPONENT 4 of the study, development of an Autocidal Gravid Ovitraps (AGO) with an Insect Growth Regulator (IGR) to control dengue vector mosquitoes was performed. The optimum field dosage of Novaluron in the developed Autocidal Gravid Ovitraps (AGO) was 2 ppm and the residual effect was 28 days. In the field experiments, significantly higher mortality counts of mosquito larvae were recorded in the treated area in both indoor and outdoor ovitraps. Two factor repeated measures Analysis of Variation (ANOVA) followed by the Tukey’s test confirmed that the mean mortality count is high for the developed AGOs in both indoor and outdoor settings. - Even though the mode of action of Novaluron is 100% clear, molecular docking experiments indicated that Novaluron shows greater affinity towards chitin synthase and interacts with tryptophan (try) residue at 872 position. KEYWORDS: Dengue, District of Gampaha, Phylogeny and phylogeography, Mathematical and GIS modelling, DNA barcoding, Autocidal Gravid Ovitrap, Molecular modellingItem Hysterectomy for benign uterine conditions: Cost evaluation, post procedural quality of life and pelvic organ function.(University of Kelaniya, 2019) Ekanayake, C. D.OBJECTIVE: The Objective was to assess costing, quality of life and pelvic organ function in women undergoing total abdominal hysterectomy (TAH), non-descent vaginal hysterectomy (ND VH) and total laparoscopic hysterectomy (TLH) for benign uterine indications. METHODS: A randomized controlled trial* was done in two public sector hospitals. Eligible participants were patients requiring hysterectomy for non-malignant uterine causes. The exclusion criteria were; uterus>14 weeks, previous pelvic surgery, those requiring incontinence surgery or pelvic floor surgery, any medical illness which cautioned/contraindicated laparoscopic surgery. A societal perspective with micro-costing for direct hospital costs was used to calculate costs. Time to recover and the difference in utility scores (EQ-5D-3L questionnaire) were used to assess quality of life. Pelvic organ function was assessed using validated ICIQ-VS, ICIQ-FLUTS questionnaires and an interviewer based questionnaire for bowel symptoms. RESULTS: The operative time was significantly more in TLH (93 (80-111) compared to TAH 45 (36.5-60) and ND VH 50 (35-65) (p<0.01). The post-operative hospital stay was shorter in the TLH 2 (1-3) compared to TAH 3 (2-3) and NDVH 3 (2-3). The total cost [(interquartile range), number] of TAH was USD 338 [(310-408), n=49] versus USD 334 [(297-414), 11=49] for NDVH and USD 412 [(364-460), 11=49] for TLH (pItem Potential use of a combined sterile insect technique(SIT) and Wolbachia- based approach for the control of the dengue vector Aedes albopictus in Sri Lanka.(University of Kelaniya, 2018) Wijegunawardana, N. D. A. D.The overall work involved in this thesis was an assessment of the density and species abundance of wild mosquito populations, genotyping of Wolbachia strains naturally present in insect hosts, Microinjection of Wolbachia for artificial infection, introgression and characterization of Wolbachia triply infected Ae. albopictus line in a Sri Lankan genetic background and determination of minimum sterility dose for the males and females of the introgressed line. Results revealed that Ae. albopictus mosquito was the dominant vector species in the Narangodapaluwa Public Health Inspector area with an average ovitrap index of 75.25% (range; 56.9% - 94.7%) over the study year. The frequency of Wolbachia infection among the mosquito population was 17% (13/78) and among other insect species (five different orders) was 25% (18/72). The most prominent Wolbachia supergroup infecting the wild insect species was the B group 58% (18/31). Ae. albopictus was naturally infected with both strains A and B (double infected) while Ae. aegypti was infected with strain A with sample infection frequency of 2.5%. This is the second report of such an infection in Ae. aegypti mosqu ito in the world. Forty-three new alleles and 15 complete allelic profiles were submitted to the Wolbachia Multilocus sequence typing (MLST) data base and all sequencing data were deposited in the Gene bank. The application of direct maternal micro-injection techniques of Wolbachia (purified from infected mosquitoes) to Ae. albopictus mosquitoes resulted in the development of a common protocol for bio manipulation of mosquito vectors with enhanced survivability. Successful transfer of Wolbachia triple infection into Ae. albopictus with Sri Lankan genetic background was achieved through an introgression experiment. Characterization of the introgressed Wolbachia triply infected Ae. albopictus Sri Lankan line expressed partial Cytoplasmic incompatibility and revealed competitive fitness cost for fecundity, fertility and longevity compared with wild type while there was no cost for pupation rate, adult emergence and sex ratio. Therefore, integration of an irradiation (dose; 30Gy) is recommended to achieve complete male and female sterility prior to mosquito release. This minimum sterility dose is lower than the irradiation dose applied for SIT and had not resulted in a significant effect for male competitiveness. Key words: SIT, IIT, Wolbachia, population suppression, Ae. albopictusItem Identification of social and bio-ecological changes on distribution of malaria vector in the Districts of Ampara and Batticaloa.(University of Kelaniya, 2018) Kannangara, D. N.Identification of social and bio-ecological changes on distribution of malaria vector in the Districts of Ampara and Batticaloa Malaria is a widespread vector-borne disease in the world, endemic throughout the tropical and subtropical regions. In Sri Lanka, Ampara and Batticaloa Districts were considered as endemic malaria prevailing areas. This research was to incorporate Geographical Information System (GIS) to investigate the relationship between the vector densities with socio and bio-ecological changes in seven malaria sensitive areas (sentinel sites) in Districts of Ampara and Batticaloa. Each sentinel site contained four Grama Niladhari Divisions (GND) (localities) with a radius of 5-20 km. An in-depth locality and house-hold surveys were conducted to collect information on environment and house-holds. Entomologic l surveillance was conducted during the period from April, 2013 to July, 2014 for 15 months. All selected localties, households and entomological surveillance points were mapped. Data on mean temperature, total rainfall, wind speed and humidity were also collected and incoporated into GIS. Pearson's correlation coefficients (r), Arc GIS modeling and time series analysis were carried out to investigate the associations among anopheline densities with climatic variables, sociological and other parameters. 51000 anopheline mosquitoes were collected. Most abundant species were An. nigerrimus, An. peditaeniatus and An. subpictus. Out of which, An. subpictus showed endophilic behavior while An. nigerrimus appeared to be exophlic in nature. Maximum temperature with 2 months lag period and minimum temperature and rain fall of the current month were the most influential meteorological parameters affecting density of Anophelines. Further, use of Long Lasting Insecticide Nets (LLIN), household parameters (house, roof and wall types) and sociological parameters are affecting vector density. Arc GIS model developed showed majority of the houses were within the highly threatened area. Risk maps developed in the study areas revealed that the densities of vector mosquitoes are rising in Dehiattakndiya and Mahaoya (Ampara District) and Thirukkovil and Vakarei (Batticaloa Distict) areas. Despite the fact there had not been An. culicifacies found as well as Sri Lanka being certified as a malaria free country in 2016, prediction of the prevalence of malaria vector is important for a country like Sri Lanka as it was found that the densities of secondary vector still exist. Key Words: Risk map, Model builder, Models, PredictionItem Study on immunity against Hepatitis (Hep) B in children after vaccination during infancy and assessment of knowledge about Hep B infection among mothers of Gampaha District(University of Kelaniya, 2019) Fernando, K. M. D.Study on immunity against Hepatitis (Hep) B in children after vaccination during infancy and assessment of knowledge about Hep B infection among mothers of Gampaha District Fernando, K.M.D., Molecular Medicine Unit, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka Hepatitis (Hep) B is a potentially life threatening liver infection caused by a virus. It is important to know whether immunity produced by vaccination during infancy last up to adolescence. Sound knowledge about Hep B infection would promote mothers to vaccinate their children against Hep B. Objective of this study was to assess the Hep B surface Antibody (anti-HBs) status in children aged ten years after Hep B vaccination during infancy and knowledge about Hep B infection among mothers in the District of Gampaha, Sri Lanka. In the PART 1 of the study, assessment of anti-HBs status after Hep B vaccination during infancy was conducted with 150 children (10 years old) with evidence of Hep B vaccination at 2, 4 and 6 months during infancy. After quantitative detection of anti-HBs using Enzyme-Linked lmmunosorbent Assay (ELISA), majority of children 85.33% (128/150) showed protection level of anti-HBs .C::.10 mIU/ml). In the PART 2 of the study, assessment of efficacy of a booster dose of Hep B vaccine in children who had Ab levels below protective level (< 10 mlU/ml) in the PART 1 was conducted with 22 children. They were offered a free booster dose and retested one month after the . booster . All children showed Ab response above 10 mIU/ml, while 81.81% ( 18/22) had a titre > 100 mlU/ml. In the PART 3 of the study, assessment of knowledge about Hep B infection among mothers in the District of Gampaha, Sri Lanka was assessed with 800 mothers. Overall knowledge of Hep B, educated population had a high score, while not educated population had the minimum score. Even though the mothers in all groups had notable levels of knowledge on transmission of Hep B, their awareness on complications and prevention were relatively low. Therefore, the awareness programs conducted by the relevant sector should focus more on the above aspects to improve the overall knowledge of mothers on Hep B. Vaccination against Hep B during infancy appears to produce protective level of Ab at 10 years of age. Even the children with Ab titres below protective level produced a sharp rise in titres with a booster dose. Though we have a good immunization coverage mothers seem to have a very poor knowledge about Hep B.Item Determination of the quality of coconut oil and the effects of selected coconut products on serum metabolic parameters of Wistar Rats.(University of Kelaniya, 2018) Samaranayake, H. A. E.Although a large number of studies have. been conducted on the health effects of coconut, findings remain inconclusive. This study investigated the quality of commercially available coconut oil (CNO) and the effects of CNO and grated coconut on serum metabolic parameters in Wistar rats. The quality of 52 CNO samples obtained from retail and wholesale outlets in three districts were investigated. Most of the samples were adulterated with palm or coconut paring oil and were of inferior quality. White coconut oil (WCO) had a significantly higher total phenol content and antioxidant activity (p<0.05) as compared to virgin coconut oil (VCO). Effects of WCO and VCO on body weight, fasting blood glucose (FBG), serum lipids and hepatic antioxidant status were investigated using normocholesterolaemic (NC) and hypercholesterolaemic (HC) rats. Seven groups of rats (n=8) were maintained on diets containing WCO or VCO at a concentration of 2% or 4% for 36 weeks. No significant differences were observed in the body weights and FBG levels in any rat group after 36 weeks. In NC rats, no significant changes (p>0.05) were observed in serum lipid parameters including HDL. In HC rats, a significant increase in total cholesterol (TC) was observed in 2%WCO group (p<0.05) while no significant change was observed in 2%VCO comparing with baseline indicating a potential therapeutic effect of VCO in controlling serum TC in HC states. Similar findings were observed in the TC/HDL ratio. HC rats on 2% VCO diets had higher HDL and lower serum triglyceride levels than HC rats fed on 2% WCO, though the differences were not statistically significant (p>0.05). In NC rats, WCO diets resulted in higher hepatic lipid peroxidation (p<0.05) and hepatosteatosis (p<0.05) as compared to VCO diets. Incorporation of grated coconut into diets resulted in a significant hypoglycaemic effect (p<0.05) and lower serum triglyceride levels (p>0.05) as compared to diets ·containing oil only. Key words: WCO, VCO, Quality, Serum lipids, Antioxidant activityItem Effectiveness of early stretching exercises for range of motion of the shoulder joint,state of axillary scar and quality of recovery in burnt patients admitted to burns unit of the national hospital of Sri Lanka(University of Kelaniya, 2016) Perera, G. A. D.;BACKGROUND: Burn injuries can result in long term impairment, limitation and restriction in participation in various activities in a patient’s life. The majority of burns occur in low- and middle-income countries and almost half occur in the Asian and south-east Asian regions. Axillary or shoulder burns often develop scar contracture with subsequent loss of shoulder movements and function. PURPOSE: This study was done to evaluate the effects of early stretching exercises programme on the range of' motion of the shoulder joint, state of axillary scar and quality of recovery in burnt patients in comparison to a control group. METHODS: A randomized controlled study was conducted in National hospital of Sri Lanka. Patient, from 15 to 55 years of age admitted to the burns unit with a total burn injury surface area (TBSA) of 10% to 45% involving the shoulder joint with axilla were selected. The subjects were randomized into two groups; intervention and a usual care control group. There were 110 patients in each group. A Study protocol was used in the management of intervention group for 14 days. The control group was subjected to usual protocol currently used in the unit.Range of Motion (ROM) was measured with a Universal Goniometer. Functional recovery (FR) was assessed with the Quick DASH questionnaire and the Abduction ladder. State of the axillary scar was assessed with the Vancouver Scar Scale (VSS). Data were obtained before and after the intervention phase on 3, 6 and 12 months of post burn period.RESULTS: The mean (SD) age of intervention group and control group were 29.76 [9. 81] and 30.3 l [9.45] respectively. The mean (SD) TBSA% of intervention group and control group were 26.15[9.45] and 24.60[9.56] respectively. There is a significant beneficial difference (p=0.000) in ROM, FR and the state of the axillary scar between the Intervention group and the control group. After 12 months of post burn, all the ROM which had been measured was h igher in subjects who were in the intervention group than in the control group. Mean scores of Quick DASH and the VSS values were less in the intervention group Compared to the control group. CONCLUSION: This study demonstrated that early sustained stretching exercise regime Significantly improved the ROM and functional recovery of the shoulder joint and scar condition of the axil1a after a severe axillary burn.