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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Incidence management system of the healthcare institutions for disaster management in Sri Lanka(BioMed Central, 2023) Rajapaksha, N.U.; Abeysena, C.; Balasuriya, A.; Wijesinghe, M.S.D.; Manilgama, S.; Alemu, Y.A.BACKGROUND: Incident management systems and disaster planning processes facilitate maximal use of available resources. Evaluation of the Incident Command System (ICS) is one of the top five key areas of research priority in the field of surge. The study was aimed at assessing the disaster preparedness and ICS of the public healthcare institutions for the disaster management in a disaster-prone district of Sri Lanka. METHODS: A descriptive cross-sectional study was conducted among all public sector healthcare institutions (n = 74), including curative-healthcare institutions (n = 46) which have inward-care facilities for patient care and preventive healthcare institutions (n = 28) in Kurunegala district, Sri Lanka from May-September 2019 using a validated interviewer administered questionnaire which was based on 'CO-S-TR Model' for ICS assessment including 'Clear need for increased capacity (≤25%), Basic level (26 - 50%), Moderate level (51 - 75%) and High level (>75%)'.RESULTS: Focal points for disaster management were nominated by the majority of the curative sector (n = 33; 76.7%) and preventive sector (n = 19; 73.1%) healthcare institutions. A written disaster preparedness and response plans were available in 72% (n= 31) curative sector and 76% (n= 19) preventive sector institutions. The higher proportion of the curative sector institutions had moderate level capacity in the area of providing treatment, and basic level capacities were in the areas of 'staff mobilization, coordination of activities, supplying of special needs, triage of cases and transportation'. There is a clear need for improvement in the areas of communication commanding, management of controlling the incidence and tracking of the cases in the curative sector. The majority of the preventive sector institutions had moderate level capacity in commanding, control, coordination and tracking of cases. The basic level capacity in the areas of staff mobilization, stuff management and triage of cases. There is a clear need for improvement in the areas of communication in preventive sector. Of the public sector healthcare institutions, the higher proportion of the preventive sector (n = 20; 76.9%) and curative sector (n = 29; 67.4%) had basic level overall surge capacity of ICS for disaster management. CONCLUSION: Coordination, communication, commanding, management of controlling the incidence and tracking of cases following outbreaks need to be improved and capacity development programmes could implement to develop the preparedness for future disasters.Item 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.Item 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.Item 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.Item 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.Item 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.Item Effectiveness of a community based health educational intervention in reducing unmet need for modern methods of family planning among ever married reproductive age women in the Kalutara district, Sri Lanka(Insight Medical Publishing, 2012) Malwenna, L.I.; Jayawardana, P.L.; Balasuriya, A.INTRODUCTION: Unmet need is defined as the percentage of all fecund women who are married or living in union and thus presumed to be sexually active but are not using any method of contraception, either do not want to have any more children or want to postpone their next birth at least for two more years or do not know when or if they want another child 1. Unmet Need for Modern Methods includes all in the unmet need group and those who are using natural and traditional methods at the time of survey (The Westoff Model) 2. It describes the discrepancy between sexual and contraceptive behaviors and stated fertility preferences of women in the reproductive age. OBJECTIVE: This study was designed to evaluate the effectiveness of a health educational intervention in improving the knowledge and attitudes on family planning (FP) among Public Health Midwives (PHMM) who function as community health workers and acceptance of modern FP methods planning which eventually reduce the Unmet Need (UMN) and thereby reducing the risk of unintended pregnancy among 15 - 49 year old married women in in the Kalutara district. METHOD: Initially the perceptions on unmet need in community service providers was assessed by three Focus Group Discussions conducted among Medical Officers of Health, Public Health Nursing Sisters and PHMM. It was followed by assessment of the baseline knowledge and attitudes on FP and UMN among all the PHMM and a group of married women in reproductive age (15-49) with unmet need for modern methods selected from cluster sampling of PHM areas in the district using PPS technique, allocating 22 clusters of 12 women in each Intervention (IA) and Control Area (CA).The developed health education intervention was applied on PHMM followed by the selected group of women with unmet need for modern methods only to the IA. The effectiveness was assessed in terms of the change in knowledge and attitudes of PHMM after 2 months of intervention, of target group of women after 6 months of intervention and the reduction of unmet need for modern methods in the IA compared to CA. RESULT: In PHMM, overall percentage mean knowledge score in IA at pre and post intervention were 29.9% and 65.7% respectively with a statistically significant difference (p<0.001) but with no such difference (p=0.10) in CA between pre (20%) and post (30%) scores. Median attitude scores were 37.5% and 86% in IA at pre and post intervention with a statistically significant difference (p<0.001). For CA respective figures were (40%) and (41%) with no significant difference (p=0.09) Regarding the target group, in IA had pre (37.6%) and post (70.6%) mean knowledge scores with a statistically significant difference (p<0.001); but with no significant difference (p=0.06) in CA between pre (39.0%) and post (40.2%) scores. Similarly, between groups comparison shows statistically significant difference (p<0.001) between IA and CA in post intervention, the scores being 70.6% and 40.2% respectively. CONCLUSION: The training conducted on PHMM revealed a significant impact on knowledge and attitudes in both service providers and clients leading to change in the FP practice and reduction in unmet need for modern methods of FP. AUTHOR KEYWORDS: Family planning; Health education intervention; Married women; Reproductive age; Unmet need