Medicine

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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty

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Development and validation of the interpersonal communication assessment tool for assessing the interpersonal communication skills of public health midwives
(BioMed Central, 2023) Prasanna, S.A.S.; Abeysena, H.T.C.S.; Alagiyawanna, M.A.A.P.
BACKGROUND: Interpersonal Communication Skills (IPCS) are one of the core clinical skills that should be developed by the Public Health Midwives (PHMs), who are grass-root level public healthcare providers in primary healthcare settings in Sri Lanka. This study aimed to develop and validate the Interpersonal Communication Assessment Tool (IPCAT), an observational rating scale, to assess the IPCS of PHMs. METHODS: Item generation, item reduction, instrument drafting, and development of the tool's rating guide were made by an expert panel. A cross-sectional study was conducted in five randomly selected Medical Officer of Health (MOH) areas, the smallest public health administrative division in the district of Colombo, Sri Lanka, to identify the factor structure, which is the correlational relationship between a number of variables in the tool. A sample of 164 PHMs was recruited. The data on IPCS were collected by video-recording the provider-client interaction using simulated clients. All recorded videos were rated by a rater using the drafted IPCAT, which included a Likert scale of 1(poor) to 5 (excellent). Exploratory factor analysis was conducted using the Principal Axis Factoring extraction method and the Varimax rotation technique to explore the factors. Three independent raters were used to rate ten randomly selected videos to assess the tool's internal consistency and inter-rater reliability. RESULTS: The IPCAT obtained a five-factor model with 22 items, and all five factors explained 65% of the total variance. The resulting factors were "Engaging" (six items on making rapport), "Delivering" (four items on paying respect), "Questioning" (four items on asking questions), "Responding" (four items on empathy), and "Ending" (four items to assess the skills of ending a conversation productively). The internal consistency, Cronbach's Alpha value, for all five factors was above 0.8, and the inter-rater reliability (ICC) was excellent (0.95). CONCLUSIONS: The Interpersonal Communication Assessment Tool is a valid and reliable tool for assessing the interpersonal communication skills of Public Health Midwives.
A complex-intervention to change dengue prevention behaviours of the householders in the Kurunegala District
(Sri Lanka Medical Association, 2021) Rajapaksha, R.M.N.U.; Abeysena, H.T.C.S.; Balasuriya, A.
INTRODUCTION AND OBJECTIVES: Dengue is a leading public health problem in Sri Lanka. Evaluation of community-based intervention on behavioural change is identified as the key functional areas to prevent future outbreaks. The study was aimed to assess the complex intervention package on changing the behaviour of the householders to prevent dengue in Kurunegala district. METHODS: A community-based parallel group cluster randomized trial was conducted to assess the effectiveness of the COMBI based behavioural change intervention (n=167) versus routine standards of dengue control activities (n=166) among the householders in highly dengue endemic area in Kurunegala district from May to September 2019. A pre-tested, validated, interviewer-administered tool was used to collect data. Intention to treat analysis was applied using Logistic Regression with Generalized Estimating Equations. RESULTS: There were significant improvements of the overall dengue prevention behaviour (27.4%, 95% CI: 17.1% - 37.7%), knowledge (12.3%; 95% CI: 1.7% - 22.9%), attitude (7.3%; 95% CI: - 1.77% - 16.4%), practices (29.2%; 95% CI: 18.9% - 39.5%), health seeking behaviour (14.7%; 95% CI: 4.12% - 25.3%), and reduction of Pupal-Index (49.3%; 95% CI: 39.7% - 58.9%), House- Index (30.8%; 95% CI: 28.3 - 47.1%), Container-Index (17.7%; 95% CI: 8.8% - 26.6%) and Breteau-Index (52.2%; 95% CI: 43.5% - 60.9%) in the intervention group in comparison with the control group after three-months of the intervention. CONCLUSION: A COMBI planning process based interventional approach to change the behaviour for sustainable dengue control is effective. Importantly, it contributed to a significant reduction in the density of dengue vectors (Pupal Index and HI, CI, BI) and a number of potentials.
Development of a communication for behaviour impact plan on dengue prevention in the Kurunegala District
(Sri Lanka Medical Association, 2021) Rajapaksha, R.M.N.U.; Abeysena, H.T.C.S.; Balasuriya, A.; Alagiyawanna, M.A.A.P.; Pannilahetti, N.
INTRODUCTION AND OBJECTIVES: Communication for Behaviour Impact (COMBI) is a methodological process that blends strategically a variety of communication interventions intended to engage individuals and families in adopting healthy behaviours and maintaining those behaviours. The objective was to develop a COMBI plan to change the behaviour to prevent dengue in Kurunegala district, Sri Lanka. METHOD: The plan was developed according to World Health Organization’s COMBI planning 10 steps with the scientific evidence and expert opinion. The situation analysis was conducted using mixed-methodology from January to March 2019 among the adults in the highly dengue-endemic area in Kurunegala District. RESULTS: The overall goal of the plan was to contribute to the reduction in morbidity and mortality from dengue disease in the Kurunegala district by improving the dengue prevention behaviours by three months in 2019. After finalizing Specific Behaviour Objectives (SBOs) by conducting Situational Market Analysis for Communication Keys, the plan was developed. The SBOs for the plan were to improve the proper waste management practices according to ‘Three R concept’ (Reduce, Reuse and Recycling) and to improve the dengue prevention practices 30 minutes weekly cleaning. The strategies were to conduct a community empowerment program to improve household waste management and weekly practices on dengue prevention by conducting the administrative mobilization and public relationship, public advocacy, community mobilization, personal selling, advertising, point of service promotion during follow up. Conclusion: Developing a COMBI plan for an area after identification of specific behavioral objectives would be feasible to implement in order to empower the community to prevent dengue in the area.
Surge-capacity of the preventive healthcare institutions for the management of dengue in the Kurunegala District
(Sri Lanka Medical Association, 2021) Rajapaksha, R.M.N.U.; Abeysena, H.T.C.S.; Balasuriya, A.
INTRODUCTION AND OBJECTIVES: The surge-capacity is defined as the ability to obtain adequate ‘Staff, Supplies, Structures and Systems’ to provide sufficient care to meet the immediate needs of an influx of patients following a large-scale incident or outbreak. The aim of the study was to describe the surge- capacity of the preventive healthcare institutions for the management of dengue in Kurunegala district. METHODS: A descriptive cross-sectional study was conducted among all institutions (n=28) in 2019. An interviewer-administered tool was formulated according to the ‘Science of Surge Theory’ and ‘CO-S-TR Model’. There was basic-level (26 to 50%), moderate-level (51 to 75%) and high- level (>75%) surge-capacities for 10 broad areas of the assessment. RESULTS: The majority of the institutions (69.2%; n=18) had inadequate staff-capacity. Three-fourth (76.0%; n=19) did not have a written plan for preparedness. The higher proportion (n=19; 73.1%) had focal points, Personal Protective Equipment (AE) (65.4%; n=17), chemical for mosquito control (92.3%; n=24), and fogging-instrument (88.5%, n=23). The basic-level capacity existed in the areas of staff mobilization (53.8%; n=14), management of staff (76.9%; n=20), triage of cases (76.9%; n=20), and transportation (46.2%; n=12). The moderate-level capacity was existed in the areas of commanding (42.3%; n=11), controlling (38.5%; n=10), coordinating (61.5%; n=16), supplying of special needs (50.0%; n=13) and tracking of the cases (76.9%; n=20). The higher proportion (84.6%; n=22) had inadequate overall-surge capacity for the management of dengue. CONCLUSION: There is a need for improvement of surge capacity of the preventive healthcare institutions and capacity development programmes need to be initiated.
Development of cardiovascular disease risk prediction model for Sri Lankans
(Sri Lanka Medical Association, 2021) Mettananda, K.C.D.; Thampoe, R.S.; Batagoda, B.M.S.M.; Arangala, D.M.P.; Abeysena, H.T.C.S.
INTRODUCTION AND OBJECTIVES: There are no Cardiovascular (CV) risk prediction models derived from Sri Lankans. Therefore, we aimed to develop a model to predict the risk of cardiovascular diseases (CVD) among Sri Lankans. METHODS: We developed a model to predict the risk of developing CVDs among Sri Lankans by comparing risk factors of patients who have had and haven’t had acute CVDs. Risk factors were selected depending on the odds ratios of each risk predictor and the feasibility of using those in clinical practice. Two separate models were developed for diabetics and non-diabetics. A scoring system [diabetics; 0-23 and non-diabetics 0-14] was designed based on weighted scores of each risk predictor. Predictive validity of the model was tested by calibration and discrimination. Receiver Operator Characteristic (ROC) curve was used to determine the cut-off value. RESULTS: The model consisted of five predictors; sex, current-smoking status, premorbid systolic blood pressure > 140 mmHg, antihypertensive medication usage and high-density-lipoprotein(HDL) < 45 mg/dL. Discrimination of the model was measured by the area under the ROC curve (diabetics; 0.76, 95% Confidence Interval: 0.68-0.84, non-diabetic; 0.91, 0.86-0.96). Calibration with goodness of fit by Hosmer and Lemeshow test (diabetics; p=0.75, non-diabetics; 0.66) was satisfactory. The tool demonstrated a good predictive ability with sensitivity and specificity of 71.1% (95%CI: 61.3% - 80.8%) and 68.4%(65.3% - 80.5%) in diabetics and 82.2% (95%CI: 72.7% - 91.7%) and 90.9% (95%CI: 84.9% - 96.9%) in non-diabetics. CONCLUSION: The model demonstrated good discrimination and well calibration. It can be used in screening high-risk Sri Lankans for developing cardiovascular diseases.
Surge capacity of the curative sector healthcare institutions for the management of Dengue in Kurunegala district, Sri Lanka
(College of Community Physicians of Sri Lanka, 2021) Rajapaksha, R.M.N.U.; Abeysena, H.T.C.S.; Balasuriya, A.
Background: Surge capacity is defined as the ability to obtain adequate staff, supplies, structures and systems to provide sufficient care to meet immediate needs of an influx of patients. The aim of the study was to describe surge-capacity of the curative-healthcare institutions for the management of dengue in Kurunegala district. Methods: A descriptive cross-sectional study was conducted among all curative-healthcare institutions with inward-care (n=46), May-September 2019. The data was taken from the medical administrator or designated person using an interview administered tool, which was formulated using 'Science of Surge Theory' and 'CO-S-TR Model'. Results: Response-rate was 93.5% (n=43). The higher proportion had inadequate staff capacity (55.8%; n=24), adjustable beds (69.8%; n=30), infusion-pumps (72.1%; n=31), monitors (51.2%; n=22), oxygen (100%; n=43) and 27.9% (n=12) had Pack-Cell-Volume (PCV) monitors. Of the equipped institutions, 13.3% (n=4), 38.7% (n=12), 40.9% (n=9), 30.2% (n=13) and 66.7% (n=8) had adequate number of adjustable beds, infusion-pumps, monitors, oxygen and PCV-monitors respectively. The majority had designated emergency units (90.7%; n=39) and 11.6% (n=5) X-ray, 9.3% (n=4) USS and 9.3% (n=4) blood bank. The majority had focal-points (76.7%; n=33), written disaster plans (72.1%; n=31) and 34.9% (n=15) had teams with adequate risk-communication capabilities. The higher proportion (69.8%; n=30) had inadequate overall surge capacity. The Provincial General Hospitals and 75% (n=3) of the Base-hospitals had moderate-level and 76.3% (n=29) of the District-Hospitals had basic-level overall surge capacity for dengue outbreak management. Conclusion: There is a need for improvement of surge capacity of the curative-healthcare institutions and capacity development programmes need to be initiated.
Psychological stress and associated factors among adults in the quarantine families following COVID-19 in Kurunegala district, Sri Lanka
(College of Community Physicians of Sri Lanka, 2021) Rajapaksha, R.M.N.U.; Abeysena, H.T.C.S.; Jayasooriya, S.P; Pushpalal, G.C; Dissasnayake, M.; Wijesingha, S.; Athukorala, P.; de Mel, N.
Background: Psychosocial-stress for a newly-emerged contagious-disease of the COVID-19 needs to be evaluated. The aim of the study was to assess the prevalence of psychosocial-stress and associated predictors in the home-quarantine families following the COVID-19 outbreak. Method: A descriptive cross-sectional study was conducted among randomly selected 403 Quarantined adults in Kurunegala district from May to July 2020 during the first wave of the COVID-19 outbreak. The suspected index-cases and known patients with mental-health abnormalities were excluded. The GHQ-30, a validated screening tool, was used to assess psycho-social status. The scores were given as 0-0-1-1 for each item in GHQ30, out of which a score of ≥6 was considered as adults under psychosocial-stress. The binary Probit model and multivariate-regression model were used to assess the associated factors.Results: The response rate was 96.5% (n=389). The prevalence of psychological stress was 37%(n=144; 95% CI = 32.6 – 42.4). The probit model shows the likelihood of influence of the factors affecting the prevalence, and the Odds-Ratio was examined. The multivariate-regression model was 2 significant at F (12, 309) = 3.86, R = 12.95 (n=322). The results of the best fitting regression model th depicted that the associated determinants including arrived in Sri Lanka after 10 of March 2020, within 5 days of exposure to a COVID-19 patient, stayed at a quarantined-centre and male-gender were statistically significant (p<0.05) factors of predicting the psychosocial stress. Conclusion: The prevalence of psychosocial stress among the home-quarantined adults following COVID-19 are significantly high and the factors that determine the stress are likely to occur in the significant predictors.
Perceptions of the cervical cancer screening programme in Sri Lanka, among healthcare workers in Kalutara district
(College of Community Physicians of Sri Lanka, 2021) Perera, K.C.M.; Abeysena, H.T.C.S.; Mapitigama, N.
Background: Even after 20 years of existence of the cervical cancer programme with pap smears, there is no marked reduction in the incidence of cervical cancer in Sri Lanka. Therefore, the cervical cancer screening programme needs to be reviewed again. Objective: To explore the perceptions of cervical cancer screening programme among health care workers. Methods: Focus group Discussion (FGD) sessions among Public Health Midwives (n=4) and Key Informant Interviews (KII) (n=10) among health care workers in the Kalutara district were conducted. A convenient sampling technique was used. Public Health Midwives for each focus group (n=8) were selected according to their seniority and the representation of communities. Triangulation methodology was used. At last summary, results were prepared and analysis was done by manual content. Results: Majority of the participants were Sinhalese (n=41, 97.6%), Buddhist (n=39, n=92.9%) and over 40 years of age (n=31, n=73.8%). Some had >20 years of service in the field (n=14, n=33.3%). Some participants mentioned the low sensitivity of pap smears and therefore the missing of lesions, unsatisfactory smears, and reporting delay due to the work burden of cytoscreeners as disadvantages of the pap smear method. Increase community awareness, supervision of WWC activities, conduction of mobile clinics indicated as pathways to improve the coverage by the participant. HPV/DNA test was well accepted as its sensitivity is high, while the majority stated to improve the coverage by vaginal specimens as the procedure is simple and can be done even by public health midwives. Conclusions: Increase community awareness, supervision, and mobile clinics to cover hard to reach population were mainly stated to improve the coverage. The Vaginal HPV/DNA specimens were mentioned as a new tool to improve the coverage.
Pilot intervention to assess the efficacy of a complex-intervention package to prevent dengue in Kurunegala district, Sri Lanka
(College of Community Physicians of Sri Lanka, 2021) Rajapaksha, R.M.N.U.; Abeysena, H.T.C.S.; Balasuriya, A.
Background: Dengue is a leading public health problem in Sri Lanka. Development and evaluation of community-based intervention on behavioural changes are identified as key functional areas to prevent dengue outbreaks. The research study aimed to assess the complex-intervention package on changing household behaviour to prevent dengue. Method: A community based pre-post pilot-intervention was conducted to assess the efficiency of a COMBI-based complex-intervention among 121 adults, aged between 18 to 70 years in households in highly-endemic area in the Kurunegala district. Improvement of proper waste management practices according to the 3R concept (Reduce, Reuse and Re-cycling) was the finalized specific behavioural objectives of the COMBI plan. The outcomes were compared with paired t-test and McNemar test. Results: The response-rate of the pilot-study was 97.5% (n=118). The result revealed that the adequate post interventional knowledge on dengue prevention of the intervention group, positive atitude towards dengue prevention, adequate health-seeking behaviour and the overall community capacity was significantly improved by 37.3%, 39.9%, 31.3% and 16.3% in the post-interventional assessment than the pre-intervention assessment respectively. Notably, adequate dengue prevention behaviours were improved by 51.7% in the post-intervention assessment than the preintervention assessment. Conclusion: A COMBI planning process based interventional approach to change the behaviour for sustainable dengue control is feasible, implementable and efficient. it was able to achieve the significant improvement of the desired outcome of interest including knowledge, atitudes, practices, health seeking behaviours, community capacity and dengue prevention behavior following the pilot intervention.
The Feasibility of new HPV/DNA test as a primary cervical cancer screening method among 35- years- old ever-married women in Kalutara district; a cross-sectional study
(BioMed Central, 2021) Perera, K.C.M.; Mapitigama, N.; Abeysena, H.T.C.S.
BACKGROUND: Cervical cancer is the second commonest female cancer in Sri Lanka. Two major drawbacks of the present cervical cancer screening programme are the suboptimal sensitivity of the pap smear and the low coverage. The objective of the study is to determine the feasibility of a new HPV/DNA test among 35 -years -old ever-married women in a district of Sri Lanka. METHOD: A community based descriptive cross-sectional study was conducted from 1stof July 2018 to 30th November 2018 in the public health divisions called Medical Officer of Health (MOH) areas of Kalutara district. The study population is comprised of ever-married women 35 years of age. Three women from each cluster (n = 413) were selected by consecutive sampling. A total of 918 women were recruited. HPV/DNA cervical specimen collection (n = 822) was carried out. Cervical specimens were tested by two cytoscreeners with the cobas 4800 PCR based screening machine. Clients' perceptions and prevalence were assessed. The follow-up of women with positive HPV/DNA screening results was carried out. The operational and technical feasibility of the screening test were assessed. Data entry was done by using the statistical package IBM SPSS version 20. RESULTS: Overall response rate was 91.1% (n = 836). Clients' perception was highly positive for HPV/DNA screening test procedure (99.9%, n = 821) and 99.6% (n = 819) of clients had mentioned that the HPV/DNA screening test is worthwhile to be incorporated into the National Cervical Cancer Screening program. The prevalence of HPV was 6.2% (95%CI: 6.18-6.22%). The coverage of the HPV/DNA screening was 89.5%(n = 822). Invalid results reported were 0.12% (n = 1). The percentage of HPV/DNA test positive women who underwent pap test within 3 months of the initial screening was 100% (n = 51), while the percentage of women who attempted to get a colposcopy within the 1 month of referral was 86.7% (n = 13). CONCLUSIONS: HPV/DNA test implementation as a primary cervical cancer screening method is feasible among the 35- year age cohort of ever- married women in Kalutara district. It is necessary to further attempt alternative methods of cobas 4800 HPV/DNA test, which would be much suitable for resource-limited settings. KEYWORDS: Cervical cancer; Feasibility; HPV/DNA test; Implementation; Screening.

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