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 Quality of care in the management of asthmatic children with regard to compliance with the guidelines in in-ward setting in a district of Sri Lanka: a descriptive study(College of Community Physicians of Sri Lanka, 2020) Abeysena, C.; Perera, N.INTRODUCTION: The quality of paediatric asthma management in the in-ward settings has not been assessed in Sri Lanka. OBJECTIVES: To describe the quality of care in the management of asthmatic children with regard to compliance with the guidelines. METHODS: A descriptive cross-sectional study was carried out in state hospitals with paediatric units in a district of Sri Lanka. A sample of 577 children diagnosed by a consultant paediatrician was selected. Eleven indicators were chosen by modified Delphi technique. Data collection instruments were an interviewer-administered questionnaire and a record sheet. Compliance with guidelines according to 11 indicators was expressed in percentages. RESULTS: The assessment of acute severity was 100%. The use of systemic corticosteroid at first prescription was 88.9% (n=513), whereas it was 69% (n=398) with oral steroid therapy and 54.5% (n=315) with long-term use of steroid inhaler. Assessment of chronic asthma severity was 31.2% (n=180). Caregivers who had received health education on triggering factors of asthma, on what to do during an asthma attack, and how to use the inhaler were 62.0% (n=358), 37.1% (214) and 68.8% (n=217), respectively. All patients have been issued a diagnosis card on discharge and among them, 74.4% (n=429)received a complete discharge summary and 90.6% (n=523) were scheduled for follow up appointments. CONCLUSIONS: Assessment of acute severity of asthma and the provision of diagnosis card on discharge were exceptional. Assessment of the severity of chronic asthma and providing health education for caregivers should be improved. Prescribing long term use of a steroid inhaler is to be revised. KEYWORDS: Children, Clinical, Indicators, Medication, PerformanceItem Knowledge on primary and secondary prevention of asthma among caregivers of asthmatic children admitted to paediatric wards in Gampaha District.(College of Community Physicians of Sri Lanka., 2019) Perera, N.; Abeysena, C.INTRODUCTION: Asthma is considered to be one of the major public health problems. The accurate knowledge of caregiver on asthma is important for the management. OBJECTIVES: To describe the knowledge on primary and secondary prevention of asthma among caregivers of asthmatic children admitted to the paediatric wards in the district of Gampaha. METHODS: A descriptive cross-sectional study was carried out among 577 caregivers of inward asthmatic children. Pre-tested interviewer- and self-administered questionnaires were used to assess the knowledge on asthma. The grand score of knowledge on asthma was calculated out of 34. The 75th percentile value was considered to differentiate ‘good’ knowledge from ‘poor’ knowledge. Multiple logistic regression was applied to determine the factors associated with poor knowledge on asthma. Results were expressed in adjusted odds ratio (aOR) and 95% confidence interval (CI). RESULTS: The mean score for knowledge on asthma was 20.6 (SD=4.42) ranging from 7 to 30. Among the caregivers, 369 (64%) had poor knowledge on asthma. Low educational level of the caregiver (aOR=2.48; 95% CI=1.59, 3.86) and being under prophylaxis treatment for less than one year (aOR=2.49; 95% CI=1.50, 4.13) were the determinants of poor knowledge on asthma. CONCLUSIONS: Majority of the caregivers’ knowledge on asthma was poor. The caregivers’ low educational level and shorter duration of prophylaxis treatment for the children were associated with poor knowledge on asthma.Item Effectiveness of providing health education to caregivers of hospitalized children with asthma for the prevention of recurrent attacks: a quasi-randomized trial(Informa Healthcare, 2020) Perera, N.; Abeysena, C.OBJECTIVE: To determine the effectiveness of health education intervention for caregivers of children with asthma, focused on preventing recurrent attacks and improving knowledge. METHODS: A quasi-randomized trial of 177 caregivers of asthmatic children was conducted in government hospitals in a district of Sri Lanka. At the time of discharge from the hospital, a health education booklet was prepared and given to the caregivers in the intervention group, along with individual explanation and discussion. The caregivers' knowledge of asthma and preventive practices was assessed. The primary outcome was the proportion of children with recurrent attacks of asthma who needed doctor visits during the three month post discharge period. The intention-to-treat principle was applied for data analysis.RESULTS: In comparison to the control group, the intervention group had a 76% significant reduction in visits to the doctor for recurrent attacks (95% CI:45%-90%) and a 75% significant reduction in hospital admissions required for asthmatic children (95% CI:16%-93%) at the end of three months of intervention. The mean score of knowledge of asthma in the intervention group was 1.73 units higher at three months (p < 0.01) and 1.47 units higher at six months (p < 0.01) than the control group. The mean score of preventive practices for asthma in the intervention group was 1.25 units higher at three months (p = 0.02) and 1.15 units higher at six months (p < 0.01) versus the control group.CONCLUSION: Health education intervention significantly decreased doctor and hospital visits at three months. In addition, caregiver knowledge of asthma and preventive practices also improved. TRIAL REGISTRATION NUMBER: SLCTR/2010/007.Item Association between functional abdominal pain disorders and asthma in adolescents: A cross-sectional study(Baishideng Publishing Group, 2018) Kumari, M.V.; Devanarayana, N.M.; Amarasiri, L.; Rajindrajith, S.AIM: To find the association between asthma and different types of functional abdominal pain disorders (FAPDs) among teenagers. METHOD : A cross-sectional study was conducted among 13 to 15-year-old children from six randomly selected schools in Anuradhapura district of Sri Lanka. Data were collected using translated and validated self-administered questionnaires (Rome III questionnaire, International Study on Asthma and Allergies in Childhood questionnaire, and Pediatric Quality of Life Inventory 4.0) and administered under an examination setting after obtaining parental consent and assent. RESULTS: Of the 1101 children included in the analysis, 157 (14.3%) had asthma and 101 (9.2%) had at least one FAPDs. Of children with asthma, 19.1% had at least one type of FAPDs. Prevalence rates of functional abdominal pain (FAP)(8.9% vs 3.3% in non-asthmatics), functional dyspepsia (FD) (2.5% vs 0.7%), and abdominal migraine (AM) (3.2% vs 0.4%) were higher in those with asthma (P < 0.05, multiple logistic regression analysis), but not in those with irritable bowel syndrome (4.5% vs 3.1%, P = 0.2). Severe abdominal pain (10.8% vs 4.6%), bloating (16.6% vs 9.6%), nausea (6.4% vs 2.9%), and anorexia (24.2% vs 16.2%) were more prevalent among asthmatics (P < 0.05). Lower gastrointestinal symptoms did not show a significant difference. Scores obtained for health related quality of life (HRQoL) were lower in those with asthma and FAPDs (P < 0.05, unpaired t-test). CONCLUSION: Asthma is associated with three different types of FAPDs, namely, FD, AM, and FAP. HRQoL is significantly impaired in teenagers with asthma and FAPDs.Item Prevalence and correlates of asthma among selected garment factory workers at the Free Trade Zone, Ekala(College of Community Physicians of Sri Lanka, 2015) Jayawardana, P.; Abeysena, C.Objective To determine prevalence of bronchial asthma (BA) and its correlates and respiratory functions among selected garment factory workers (GFW) at the Free Trade Zone, Ekala. Methods This consisted of a cross sectional descriptive and an analytical study. It was conducted at three selected garment factories and a clinic setting in Ekala. Study group for first component included 674 GFW who have worked for 1 or more years at the current garment factories. Control group for second component included 100 participants who have never worked in garment factories. Study instruments consisted of an interviewer administered questionnaire and spirometry. Bivariate analysis was followed by multiple logistic regressions. Results were expressed as odds ratios (OR) and 95% Confidence intervals (CI). Results Overall prevalence of BA among GFW was 32.3% (95% CI:28.8-36.0%). Prevalence of “probable occupational asthma” among asthmatic GFW was 49.5% (95% CI:42.7-56.4%). Being a GFW (OR=3.5, 95% CI:1.9-7.2) and age >30 years (OR=1.5; 95% CI:1.1-2.1) were significantly associated with prevalence of BA. Among GFW, FEV1.0 and PEFR were significantly lower among asthmatics compared to non asthmatics, and FVC, FEV1.0, and PEFR among those exposed to dust for >3 years compared to ≤3 years. Conclusions Prevalence of bronchial asthma was higher among Garment Factory Workers. However, respiratory functions were lower only among those who were asthmatics.Item Rhinitis and asthma: it's one airway after all(Medicine Today Pty Limited, 2006) Amarasiri, D.L.; Douglass, J.The concept of `united airways disease - that allergic asthma and rhinitis are manifestations of a single inflammatory airways disease - is supported by laboratory and epidemiological studies and by treatment responsesItem Prevalence of asthma and atopic symptoms in children aged 5-11 years(Sri Lanka College of Paediatricians, 2003) Karunasekera, K.A.W.; Perera, K.P.J.; Perera, M.T.P.R.; Abeynarayana, J.OBJECTIVE: To assess prevalence of asthma and atopic symptoms in a group of school children aged 5-11years and to look at prevalence of usage of asthma medications. SETTING: Three schools in Gampaha District in August 1998. METHOD: A questionnaire translated into Sinhala was distributed to parents/guardians of 2195 children aged 5-11 years in Grades 1-5 of the schools and the filled questionnaires were collected through class teachers. Asthma, allergic rhinitis and eczema were defined using the clinical criteria of the International Study of Asthma and Allergic Conditions (ISAAC). Data was analysed using Epi Info version 6. Chi squared test and Chi squared test for trend were used for significance testing. RESULTS: Return rate of questionnaire was 93%. Sixty six percent were completed by mother, 30% by father and rest by guardian. Prevalence of asthma was 23% and of exercise induced asthma 11%. Prevalence rate of allergic rhinitis was 10% and eczema 3%. Within the specific group of asthma, in response to leading question "Has your child had asthma" only 19% of parents gave a positive answer. Prevalence of asthma in males did not significantly differ from that in females (p=0.5). A decreasing trend of asthma was observed with increasing age in girls (p less than 0.05). Eighty four percent of asthmatic children were using salbutamol orally and 9% without asthma in study population were also using salbutamol. CONCLUSIONS: One in 5 children aged 5-11 years in study population had asthma but parental perception about asthma was poor. More than 80% of asthmatics had some medications for the disease.Item Risk factors of childhood asthma: a Sri lankan study(Oxford University Press, 2001) Karunasekera, K.A.W.; Jayasinghe, J.A.C.T.; Alwis, L.W.G.R.A case-control study was carried out to evaluate the genetic and environmental risk factors of childhood asthma in a group of Sri Lankan children. Three hundred cases (admitted with symptoms of asthma) and 300 age-matched controls were compared over a period of 23 months commencing in January 1996. Family history of atopy, feeding habits in infancy, bronchiolitis in infancy, passive smoking, exposure to dust and dampness, and exposure to pet animals were studied as risk factors for asthma. The risks associated with social factors were also studied. The risk associated with variables were calculated using the chi-squared test in the bivariate analysis and the forward logistic regression model in the multivariate analysis. Parental asthma, asthma in a sibling and in a relative, parental allergic rhinitis, discontinuation of breastfeeding after 6 months in infancy, bronchiolitis in infancy, living in a dusty environment, and a father with primary education compared to secondary education were independently associated with an increased risk of asthma (p 0.05). This study reinforces the view that asthma has a multifactorial aetiology. Influence of paternal asthma is more than that of maternal asthma. As a preventive measure continuation of breastfeeding beyond 6 months is important.