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 Knowledge and attitudes on unsafe abortions among the state university undergraduates in Western Province(College of Community Physicians of Sri Lanka, 2018) Perera, U.; Abeysena, C.ABSTRACT OBJECTIVE: To describe the knowledge and attitudes on unsafe abortions among undergraduates in the state universities of the Western Province. METHODS: A descriptive cross sectional study was conducted among 1575 second and third year undergraduates using stratified cluster sampling of the selected universities. Pre-tested self-administered questionnaire was administered to assess socio-demographic factors, knowledge and attitudes on unsafe abortions. The responses to the knowledge and attitude questions were scored and graded. Percentage of knowledge categories and attitudes were calculated. The associations of knowledge categories with selected variables were assessed. RESULTS: A majority (53.3 %, n=839) of respondents had good knowledge on unsafe abortions while 30.5% (n=480) had satisfactory knowledge and minority (16.3%) had poor knowledge. Females (55%, n=509) had more good knowledge than males (51%, n=329, P>0.05). Those who studied in Bio-Science stream (70.2%, n=174, P<0.001) and who had their secondary education at mixed schools (54.4%, n=351, P>0.05) had more good knowledge than the others (P<0.001). The majority (68.5%, n=1074) agreed that the legal restrictions would drive people to unsafe abortions and making abortion services through the government health facilities could increase the inappropriate sexual behaviors (63.7%,n=998). Only a very few (7.1%, n=111) of undergraduates agreed that abortion was a convenient form of contraceptive and 47.7% (n=747) agreed to be restricted to save mother’s life. A majority (53.2%, n=833) agreed that it should be a right of a pregnant woman to decide whether she wants an abortion or not. CONCLUSION: A majority of undergraduates had good knowledge on unsafe abortions. Most of the undergraduates wanted not to fully liberalize abortion policies due to inappropriate usage and merely it is a right of a pregnant mother.Item Comprehensive evaluation of demographic, socio-economic and other associated risk factors affecting the occurrence of dengue incidence among Colombo and Kandy Districts of Sri Lanka: a cross-sectional study(BioMed Central, 2018) Udayanga, L.; Gunathilaka, N.; Iqbal, M.C.M.; Lakmal, K.; Amarasinghe, U.S.; Abeyewickreme, W.BACKGROUND: Comprehensive understanding of risk factors related to socio-economic and demographic status and knowledge, attitudes and practices (KAP) of local communities play a key role in the design and implementation of community-based vector management programmes, along with the identification of gaps in existing control activities. METHODS: A total of 10 Medical Officers of Health (MOH) areas recording high dengue incidence over the last five years were selected from Colombo (n = 5) and Kandy (n = 5) Districts, Sri Lanka. From each MOH area, 200 houses reporting past dengue incidence were selected randomly as test group (n = 1000 for each district) based on the dengue case records available at relevant MOH offices. Information on socio-economic and demographic status and knowledge, attitudes and practices were gathered using an interviewer administered questionnaire. The control group contained 200 households from each MOH area that had not reported any dengue case and the same questionnaire was used for the assessment (n = 1000 for each district). Statistical comparisons between the test and control groups were carried out using the Chi-square test of independence, cluster analysis, analysis of similarities (ANOSIM) and multi-dimensional scaling (MDS) analysis. RESULTS: Significant differences among the test and control groups in terms of basic demographic and socio-economic factors, living standards, knowledge, attitude and practices, were recognized (P < 0.05 at 95% level of confidence). 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 and ANOSIM. Findings of the present study highlight the importance of further improvement in community education, motivation and communication gaps, proper coordination and integration of control programmes with relevant entities. Key infrastructural risk factors such as urbanization and waste collection, should be further improved, while vector controlling entities should focus more on the actual conditions represented by the public on knowledge, attitudes and personal protective practices. CONCLUSIONS: The design of flexible and community friendly intervention programmes to ensure the efficacy and sustainability of controlling dengue vectors through community based integrated vector management strategies, is recommended.Item Socio-economic, Knowledge Attitude Practices (KAP), household related and demographic based appearance of non-dengue infected individuals in high dengue risk areas of Kandy District, Sri Lanka(BioMed Central, 2018) Udayanga, L.; Gunathilaka, N.; Iqubal, M.C.M.; Pahalagedara, K.; Amarasinghe, U.S.; Abeyewickreme, W.BACKGROUND: Socio-economic, demographic factors and Knowledge Attitude Practices (KAPs) have been recognized as critical factors that influence the incidence and transmission of dengue epidemics. However, studies that characterize above features of a risk free or low risk population are rare. Therefore, the present study was conducted to characterize the household related, demographic, socio-economic factors and KAPs status of five selected dengue free communities. METHOD: An analytical cross-sectional survey was conducted on selected demographic, socio-economic, household related and KAPs in five selected dengue free communities living in dengue risk areas within Kandy District, Central Province, Sri Lanka. Household heads of 1000 randomly selected houses were interviewed in this study. Chi-square test for independence, cluster analysis and Principal Coordinates (PCO) analysis were used for data analysis. RESULTS: Knowledge and awareness regarding dengue, (prevention of the vector breeding, bites of mosquitoes, disease symptoms and waste management) and attitudes of the community (towards home gardening, composting, waste management and maintenance of a clean and dengue free environment) are associated with the dengue free status of the study populations. CONCLUSIONS: The vector controlling authorities should focus on socio-economic, demographic and KAPs in stimulating the community to cooperate in the integrated vector management strategies to improve vector control and reduce transmission of dengue within Kandy District.Item Multicomponent intervention versus usual care for management of hypertension in rural Bangladesh, Pakistan and Sri Lanka: study protocol for a cluster randomized controlled trial(BioMed Central, 2017) Jafar, T.H.; Jehan, I.; de Silva, H.A.; Naheed, A.; Gandhi, M.; Assam, P.; Finkelstein, E.A.; Quigley, H.L.; Bilger, M.; Khan, A.H.; Clemens, J.D.; Ebrahim, S.; Turner, E.L.; Kasturiratne, A.; for COBRA-BPS Study GroupBACKGROUND: High blood pressure (BP) is the leading attributable risk for cardiovascular disease (CVD). In rural South Asia, hypertension continues to be a significant public health issue with sub-optimal BP control rates. The goal of the trial is to compare a multicomponent intervention (MCI) to usual care to evaluate the effectiveness and cost-effectiveness of the MCI for lowering BP among adults with hypertension in rural communities in Bangladesh, Pakistan and Sri Lanka. METHODS/DESIGN: This study is a stratified, cluster randomized controlled trial with a qualitative component for evaluation of processes and stakeholder feedback. The MCI has five components: (1) home health education by government community health workers (CHWs), (2) BP monitoring and stepped-up referral to a trained general practitioner using a checklist, (3) training public and private providers in management of hypertension and using a checklist, (4) designating hypertension triage counter and hypertension care coordinators in government clinics and (5) a financing model to compensate for additional health services and provide subsidies to low income individuals with poorly controlled hypertension. Usual care will comprise existing services in the community without any additional training. The trial will be conducted on 2550 individuals aged ≥40 years with hypertension (with systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, based on the mean of the last two of three measurements from two separate days, or on antihypertensive therapy) in 30 rural communities in Bangladesh, Pakistan and Sri Lanka. The primary outcome is change in systolic BP from baseline to follow-up at 24 months post-randomization. The incremental cost of MCI per CVD disability-adjusted life years averted will be computed. Stakeholders including policy makers, provincial- and district-level coordinators of relevant programmes, physicians, CHWs, key community leaders, hypertensive individuals and family members in the identified clusters will be interviewed. DISCUSSION: The study will provide evidence of the effectiveness and cost-effectiveness of MCI strategies for BP control compared to usual care in the rural public health infrastructure in South Asian countries. If shown to be successful, MCI may be a long-term sustainable strategy for tackling the rising rates of CVD in low resourced countries.Item The Knowledge and attitude of primary school teachers in Sri Lanka towards childhood attention deficit hyperactivity disorder(Sri Lanka Medical Association, 2011) Rodrigo, M.D.A.; Perera, D.; Eranga, V.P.; Williams, S.S.; Kuruppuarachchi, K.A.L.A.OBJECTIVE: To assess the knowledge and attitudes towards attention deficit hyperactivity disorder (ADHD) among primary school teachers in the Gampaha District. METHODS: A descriptive cross sectional study was conducted in randomly selected schools of Gampaha district using a stratified sampling method. The knowledge and attitudes on ADHD were assessed by a self-administered questionnaire distributed among all the consenting primary school teachers in the selected schools. RESULTS: Total of 202 completed questionnaires of 210 distributed were returned. The majority showed good understanding about ill effects of ADHD, teachers' role in management and counterproductive effects of punishment. Three-fourths had a positive attitude towards behavioural therapy. However, only a minority had adequate knowledge about the presentation of ADHD and its treatment with medication. More than 80% of teachers believed that the parents were to be blamed for the child's ADHD. The majority of participating teachers also believed that behavioural disturbances caused by ADHD children were deliberate and malicious. Teachers who had training in child psychology recorded a significantly higher knowledge and had a more favourable attitude. CONCLUSIONS: The knowledge of ADHD and its treatment among primary school teachers needs to be improved. Particular focus should be on improving attitudes and disseminating the message that timely interventions can make a difference in the educational and social development of the child.Item Non-alcoholic fatty liver disease: confronting the global epidemic requires better awareness(Wiley-Blackwell, 2009) de Silva, H.J.; Dassanayake, A.S.No Abstract availableItem Coconut fats(Sri Lanka Medical Association, 2006) Amarasiri, W.A.D.L.; Dissanayake, A.S.In many areas of Sri Lanka the coconut tree and its products have for centuries been an integral part of life, and it has come to be called the "Tree of life". However, in the last few decades, the relationship between coconut fats and health has been the subject of much debate and misinformation. Coconut fats account for 80% of the fat intake among Sri Lankans. Around 92% of these fats are saturated fats. This has lead to the belief that coconut fats are 'bad for health', particularly in relation to ischaemic heart disease. Yet most of the saturated fats in coconut are medium chain fatty acids whose properties and metabolism are different to those of animal origin. Medium chain fatty acids do not undergo degradation and re-esterification processes and are directly used in the body to produce energy. They are not as 'bad for health' as saturated fats. There is the need to clarify issues relating to intake of coconut fats and health, more particularly for populations that still depend on coconut fats for much of their fat intake. This paper describes the metabolism of coconut fats and its potential benefits, and attempts to highlight its benefits to remove certain misconceptions regarding its use.Item Knowledge and awareness about gynaecological cancer(Sri Lanka College of Obstetricians and Gynaecologists, 2003) Padumadasa, S.; Goonewardene, M.INTRODUCTION: Gynaecological cancer (excluding breast cancer) accounts for about 10% of new cancer cases in women and 12% of cancer deaths. lack of awareness is a major factor in women with gynaecological cancer presenting to a doctor late. OBJECTIVE: to assess the knowledge and awareness about gynaecological cancer, SETTING, SUBJECTS AND METHOD: a total of 516 conse¬cutive women who attended the university gynaecology clinic at teaching hospital, mahamodera, galle during august and september 2002 were administered a pretested structured questionnaire. RESULTS: the knowledge about gynaecological cancer presenting as abnormal vaginal bleeding was poor. two-hundred and thirty six (45.8%) women thought that as one approaches menopause, irregular vaginal bleeding was normal. only 185 (35.8%) women knew that post-menopausal bleeding was abnormal. only 163 (31.5%) women knew that post-coital bleeding might be a symptom of cancer. two hundred and forty one (46.7%) women had heard about the cervix. only 89 (17.3%) knew that early marriage was a risk factor for cervical cancer while only 143 (27.7%) knew that multiple sexual partners was a risk factor for cervical cancer. only 27 (5.2%) were aware of the cervical smear. although 363 (70.3%) had heard about hormone replacement therapy (hrt), only 38 (7.4%) knew that there was an association with the occurrence of breast cancer and only 63 (12.2%) knew that there was a high risk of endometrial cancer if used inappropriately. only 134 (26.0%) women had heard about ovarian cancer. CONCLUSION: the knowledge about gynaecological cancer in women attending the university gynaecology clinic was poor. educational programmes in schools and community intervention programmes should be considered to increase the awareness about gynaecological cancer.Item Compliance with the mass chemotherapy program for lymphatic filariasis(Sri Lanka Medical Association, 2001) Kasturiratne, K.T.A.A.; Premaratna, B.A.H.R.; Pathmeswaran, A.; de Silva, N.R.; de Silva, H.J.OBJECTIVE: To evaluate compliance with the single dose mass chemotherapy program for control of filariasis, and to determine factors influencing compliance in the Gampaha district. DESIGN: A prospective study employing a pre-tested self-administered questionnaire. METHODS: Four groups comprising individuals over one year old with residence in the Gampaha district for over one year were surveyed. Data collection was started two weeks after the mass chemotherapy program. RESULTS: 2300 questionnaires were distributed, 1983 (86.2 percent) were returned, and 1935 (84.1 percent) were sufficiently complete for analysis (857 males; mean age 39 years, SD equal 19.5). Over 96 percent had heard of filariasis and the mass chemotherapy program, but only 60.3 percent of those over 11 years of age were aware of asymptomatic carriage of the parasite. 1289 (66.6percent) out of the total sample surveyed (1935 individuals) had obtained the diethylcarbamazine tablets, and 1221 (63.1 percent) had taken the drug. Of the possible demographic factors that could have influenced compliance only educational level seemed to play an independent significant role, compliance being lowest at both extremes of educational level. The main problem with compliance was obtaining the drug from distribution centres. CONCLUSIONS: Compliance with the mass chemotherapy program to control filariasis needs improvement. Strategies should include a better system for distributing the drug, and altering the content of the publicity material used by the program to target less compliant groups, and improve aspects of knowledge regarding filariasis that seem inadequate at present.Item Driving and epilepsy in Sri Lanka(Elsevier-W.B. Saunders, 1998) Seneviratne, S.L.; Gunatilake, S.B.; Adhikari, A.A.D.N.W.; de Silva, H.J.Regulations regarding driving for patients with epilepsy vary from country to country. They are well implemented in developed countries, but this is not the case in countries such as Sri Lanka. The aims of this study were to study characteristics of a cohort of patients with epilepsy who were driving or riding a vehicle at present, and study the attitudes of a representative sample of doctors, patients with epilepsy and the general population regarding aspects of driving by patients with epilepsy. Patients with epilepsy attending the medical clinics at the Colombo North General Hospital, Ragama, who were driving, were given a questionnaire and interviewed in order to assess their seizure characteristics. Another questionnaire was administered to epileptic patients visiting the clinics, a sample from the general population (relatives visiting in-patients at the University Medical Unit selected randomly), doctors working at the General Hospital in Ragama and the Base Hospital in Negombo, and general practitioners in the Gampaha district, where these two hospitals are situated, which was designed to assess their views regarding driving by persons with epilepsy. Of the patients with epilepsy interviewed 24.8% were presently driving a vehicle, of them 51% were riding a motorcycle. The attitudes of the general public and patients to driving by epileptic patients were at opposite ends of the spectrum; 97% of the general public being opposed to driving by persons with epilepsy, while epileptics themselves being of the view that the rules should be lax. Doctors thought that there should be some regulations against driving by epileptic patients. These facts must be considered when setting implementable regulations regarding driving by epileptics in developing countries.