Journal/Magazine Articles
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This collection contains original research articles, review articles and case reports published in local and international peer reviewed journals by the staff members of the Faculty of Medicine
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Item The impact of COVID-19 on health care accessibility and financial risk protection in Sri Lanka(Sri Lanka Medical Association, 2023) Nandasena, S.; Gamage, A.U.; Periyasamy, N.; Rismy, M.; Balachandran, K.; Kasturiratne, A.INTRODUCTION: The COVID-19 pandemic negatively impacted the global economy, disrupted essential health services, and distorted social determinants of health, reducing healthcare accessibility and increasing financial risk. AIM: we aimed to assess the impact of COVID-19 on healthcare accessibility and financial risk protection in Sri Lanka. METHODOLOGY: We conducted a cross-sectional study on a representative sample (multi-stage sampling process) of 3151 households in 105 clusters representing all the districts of Sri Lanka. The data collection was conducted using an interviewer-administered questionnaire in early November 2021. This was important to classify three periods of interest, namely: (1) the pre-lockdown period (2) the nationwide lockdown period, and (3) the new normal period. (After Oct 1 to early November 2021). RESULTS: Among 11,463 household occupants, 12.6% reported having chronic diseases, with 76.5% diagnosed prior to six months. The majority had heart disease, high blood pressure, or diabetes. Of them, 53.7% have been followed up during the lockdown, increasing to 80.8% in the new normal period. Provincial variations in expenses were observed, with the highest food expenses in the Western Province. Catastrophic health expenditures affected 9.5% and 3.4% of households at 10% and 25%, respectively. CONCLUSIONS: A considerable proportion of those having heart disease, high blood pressure, high blood sugar or diabetes mellitus were not followed up in the lockdown period and the first month of the new normal period. Antenatal care and family planning were the least affected. Participants had incurred high out-of-pocket expenditures for healthcare during the entire period.Item Capacity building in environmental and occupational health in Sri Lanka(Wiley-Blackwell, 2013) Wickremasinghe, A.R.; Peiris-John, R.; Nandasena, S.; Delzell, E.; Tipre, M.; Sathiakumar, N.BACKGROUND: Although environmental and occupational health (EOH) research and services in Sri Lanka have a long history, policies related to EOH are outdated. METHODS: We review the International Training and Research in Environmental and Occupational Health (ITREOH) program in Sri Lanka that commenced in 2006 as a collaboration between the University of Alabama at Birmingham and the Faculty of Medicine of the University of Kelaniya, Sri Lanka. RESULTS: The program has trained over 20 scientists in conducting EOH research. New pioneering research in EOH was initiated. The program was instrumental in furthering the training and research in EOH by initiating a MPH degree program, the first in the country .CONCLUSIONS: The program has established North-South, South-South and in-country collaborations between institutions and scientists, increasing the visibility of EOH in the future.Item Biomass fuel use for cooking in Sri Lanka: analysis of data from national demographic health surveys(Wiley-Blackwell, 2012) Nandasena, S.; Wickremasinghe, A.R.; Sathiakumar, N.BACKGROUND: Biomass cooking fuel is the main source of indoor air pollution in the majority of households in the developing world. Sri Lanka is an island of about 20 million population with urban, rural, and estate population of 14.6%, 80.0%, and 5.4%, respectively. This study describes biomass fuel use for cooking in Sri Lanka. METHODS: We analyzed data from two national Demographic Health Surveys (2000 and 2007) to identify the use and determinants of cooking fuels in Sri Lankan households. The results are based on a sample of 8,169 households in 2000 and 19,862 households in 2007. RESULTS: Wood was the principal cooking fuel used in 78.3% and 78.5% of households in 2000 and 2007, respectively. In 2007, 96.3% of estate sector households used firewood as compared to 84.2% in the rural and 34.6% in the urban sectors. Similar trends were noted in 2000 as well. CONCLUSIONS: 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 Air pollution and public health in developing countries: Is Sri Lanka different?(College of Community Physicians of Sri Lanka, 2012) Nandasena, S.; Wickremasinghe, A.R.; Sathiakumar, N.Indoor and outdoor air pollution is a major public health challenge in developing countries and much concern has been raised among policy makers, public health experts, clinicians, and the general public in recent years. A spectrum of health outcomes has been shown to be associated with exposure to air pollution in epidemiological studies and by laboratory investigations. It is estimated that indoor air pollution resulting from exposure to solid fuel accounts for over 1.5 million premature deaths and 38.5 million Disability-Adjusted Life Years. Globally, it is estimated that outdoor air pollution accounts for over 800,000 premature deaths and 6.4 million years of life lost; of these numbers, 65% is from Asia alone. There is emerging evidence that the actual burden is much larger than the estimated values. The World Health Organization has estimated the number of deaths attributable to indoor air pollution and outdoor air pollution in Sri Lanka to be 4200 and 1000 deaths, respectively. Although country information is limited, a few epidemiological studies gives us the opportunity to understand and compare the Sri Lankan situation vis a vis other countries. This includes the 16 epidemiological studies identified by a scientific review in 2010 and several other published studies and preliminary data from ongoing studies.Item Indoor fine particle (PM2.5) pollution exposure due to secondhand smoke in selected public places of Sri Lanka(Wiley-Blackwell, 2012) Nandasena, S.; Wickremasinghe, A.R.; Lee, K.; Sathiakumar, N.BACKGROUND: Secondhand smoke accounts for a considerable proportion of deaths due to tobacco smoke. Although the existing laws ban indoor smoking in public places in Sri Lanka, the level of compliance is unknown. METHODS: Fine particulate matter (PM(2.5)) levels in 20 public places in Colombo, Sri Lanka were measured by a PM monitor (Model AM510-SIDEPAK Personal Aerosol Monitor). Different types of businesses (restaurants, bars, cafés, and entertainment venues) were selected by purposive sampling. Only the places where smoking was permitted were considered. RESULTS: The average indoor PM(2.5) ranged from 33 to 299 µg/m(3). The average outdoor PM(2.5) ranged from 18 to 83 µg/m(3). The indoor to outdoor PM(2.5) ratio ranged from 1.05 to 14.93. In all venues, indoor PM(2.5) levels were higher than the Sri Lankan ambient PM(2.5) standard of 50 µg/m(3). All indoor locations had higher PM(2.5) levels as compared to their immediate outdoor surroundings. CONCLUSION: The study highlights the importance of improving ventilation and enforcing laws to stop smoking in public places.Item Respiratory health status of children from two different air pollution exposure settings of Sri Lanka: a cross-sectional study(Wiley-Blackwell, 2012) Nandasena, S.; Wickremasinghe, A.R.; Sathiakumar, N.BACKGROUND: Health effects due to air pollution is becoming a major public health problem with growing traffic congestion and establishment of small- to medium-scale industries with poor emission controls in urban cities of Sri Lanka. METHODS: Respiratory health status of 7- to 10-year-old children in two settings (urban and semi-urban) was assessed using standard questionnaires. Information on socio-demographic characteristics and potential determinants of both outdoor and indoor air pollutants exposure levels were also obtained. The respiratory health status of children in the two settings was compared. RESULTS: We found that children from the urban setting had a significantly higher prevalence of wheezing within the last 12 months as compared to children from the semi-urban setting (adjusted OR = 2.02; 95% CI = 1.13-3.59). Indoor cooking with unclean fuels was a risk factor for wheezing independent of the area of residence (adjusted OR = 1.57; 95% CI = 1.01-2.46). CONCLUSIONS: Poor indoor air quality was a major determinant of wheezing for the overall study group. Children from urban areas of Sri Lanka have poorer respiratory health status as compared to children from semi-urban areas. Besides poor outdoor air quality, this difference may also be due to other unexplored factors which may differ between urban and semi-urban areas in Sri Lanka.Item Identifying the biting species in snakebite by clinical features: an epidemiological tool for community surveys(Oxford University Press, 2006) Pathmeswaran, A.; Kasturiratne, A.; Fonseka, M.; Nandasena, S.; Lalloo, D.G.; de Silva, H.J.The outcome of snakebite is related to the biting species but it is often difficult to identify the biting snake, particularly in community settings. We have developed a clinical scoring system suitable for use in epidemiological surveys, with the main aim of identifying the presumed biting species in those with systemic envenoming who require treatment. The score took into account ten features relating to bites of the five medically important snakes in Sri Lanka, and an algorithm was developed applying different weightings for each feature for different species. A systematically developed artificial data set was used to fine tune the score and to develop criteria for definitive identification. The score was prospectively validated using 134 species-confirmed snakebites. It correctly differentiated the bites caused by the three snakes that commonly cause major clinical problems (Russell's viper (RV), kraits and cobra) from other snakes (hump-nosed viper (HNV) and saw-scaled viper (SSV)) with 80% sensitivity and 100% specificity. For individual species, sensitivity and specificity were, respectively: cobra 76%, 99%; kraits 85%, 99%; and RV 70%, 99%. As anticipated, the score was insensitive in the identification of bites due to HNV and SSV