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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Development of a complex intervention package for dengue prevention(Ministry of Health, Sri Lanka, 2022) Rajapaksha, R.M.N.U.; Abeysena, C.; Balasuriya, A.; PannilaHetti, N.; Alagiyawanna, A.; Manilgama, S.INTRODUCTION: Complex interventions are widely used in public health practices with noteworthy health impacts. Communication for Behavioural Impact (COMBI) plan is an effective method directed at enacting behaviour change to benefit health and social development which encourage precise behavioural outcomes and is effective in planning a behavioural change for dengue control. The aim of this study was to develop an intervention package to change the behaviour to prevent dengue in one of the highest dengue-endemic areas of Sri Lanka. METHODS: The development of the intervention package was formulated according to the two phases, the ‘Theoretical phase’ and ‘Modelling phase’ of the framework for ‘Developing and Evaluating Complex Interventions’. World Health Organization’s 10 key steps in planning COMBI strategies were followed in order to develop the present intervention package. A situational market analysis was conducted in the highest dengue-endemic area in Kurunegala district to identify the Specific Behavioural Objectives (SBOO) for the COMBI plan. The development of the COMBI plan was conducted using the mixed methodological approach including quantitative and qualitative designs. RESULTS: The overall goal of the COMBI plan was to decrease the morbidity and mortality due to dengue illness by improving the dengue prevention behaviours among householders. The SBOO for the plan were to improve the proper waste management practices according to the ‘3R concept’ (Reduce, Reuse and Re-cycling) and to improve the dengue prevention practices by 30 minutes of weekly cleaning. The strategies of intervention package were to conduct a community empowerment program to improve household waste management and weekly practices on dengue prevention by conducting administrative mobilization and public relationship, public advocacy, community mobilization, personal selling, advertising, and point of service promotion during follow-up. CONCLUSION: Developing a COMBI plan for an area after the identification of SBOO would be feasible to implement in order to empower the community to prevent dengue and improve community health services.Item Cross-cultural adaptation and validation of the Sinhala version of the hospital anxiety and depression scale (HADS) for patients diagnosed with ischemic heart disease (IHD) in Sri Lanka(College of Community Physicians of Sri Lanka, 2023) Gamage, C.K.W.; de Zoysa, P.; Balasuriya, A.; Fernando, N.; Jayamanne, D.INTRODUCTION: The Hospital Anxiety and Depression Scale (HADS) is a frequently used instrument to measure depression and anxiety symptoms among patients diagnosed with ischaemic heart disease (IHD). However, a Sinhala version of HADS for Sri Lankan IHD patients has not been validated in Sri Lanka. OBJECTIVES: To translate, cross-culturally adapt and validate the HADS in a Sinhala-speaking Sri Lankan population with IHD METHODS: The Sinhala translation of HADS was conducted in four phases: forward translation, backward translation, patient testing and proofreading with the Mapi Research Trust guidelines. Content and consensual validation of the translated scale was conducted with the Delphi method, and the ratings were evaluated for consensus. The validated scale was administered to a sample selected using systematic sampling of 140 IHD patients attending medical clinics at a base hospital in Sri Lanka. Factor structure was verified with Confirmatory Factor Analysis (CFA) and reliability with internal consistency by Cronbach's alpha. RESULTS: The HADS Sinhala version showed good content and consensual validity. CFA proved that the uncorrelated two-factor structure was compatible with the original instrument (x2=156.98; df=76; p<0.001). The Confirmatory Fit Index (CFI) was 0.89, and the Root Mean Square Error of Approximation (RMSEA) was 0.09. The reliability analysis indicated Cronbach's alpha for depression and anxiety as 0.86 and 0.83, respectively. CONCLUSIONS & RECOMMENDATIONS: The cross-culturally adapted HADS Sinhala version shows similar psychometric properties as the original instrument and can be used in future studies with confidence.Item Health seeking behaviours, dengue prevention behaviours and community capacity for sustainable dengue prevention in a highly dengue endemic area, Sri Lanka(BioMed Central, 2023) Rajapaksha, R.M.N.U.; Abeysena, C.; Balasuriya, A.INTRODUCTION: Dengue has become a major health problem in globally as well as locally. The delay in health-seeking is significantly associated with complications leading to severe dengue and active engagement of communities needs to minimize the delays in management to control epidemics. The aim of the study was to evaluate the relationship between sociodemographic characteristics and householders' Health-Seeking Behaviours (HSB), Dengue-Prevention Behaviours (DPB), and Community Capacities (CC) for sustained dengue prevention in Sri Lanka, a country with a high dengue endemicity. METHODS: A cross-sectional analytical study was carried out in a district with the highest dengue endemicity from January to April 2019. Of the householders, 532 were chosen randomly. A pre-tested, validated, and interviewer-administered questionnaire was used to assess HSB and DPB. The HSB was assessed using three aspects, initial response for fever management, the duration of blood testing and initial response if suspected dengue. The DPB assessment was evaluated using 'waste, outdoor water container, indoor water container, roof gutter and water storage management'. 'Dengue Community Capacity Assessment Tool', with 14 key items was used to assess the level of community capacity for dengue prevention. Out of the total, ≥ 50% was considered as an "adequate" HSB, DPB and CC. Multiple logistic regression was performed to control confounding effects. The results were expressed as adjusted Odds-Ratios (aOR) and 95% Confidence Intervals (CI). RESULTS: The response rate was 93.2% (n = 496). Among them, 44.6% (n = 221) had adequate overall HSB, and 19.2% (n = 95) had adequate DPB. Householders who have ≤ 4 family members are 1.74 times (aOR = 1.74; 95% CI: 1.17 - 2.61) more likely to have adequate HSB and 1.85 times (aOR = 1.85; 95% CI: 1.11 - 3.09) more likely to have adequate DPB. The age group of 46 to 70 years' individuals (aOR = 1.74; 95% CI:1.12 - 2.92), and who engaged in employment (aOR = 1.68; 95% CI: 1.05 - 2.67) were more likely to have adequate DPB than the group of 18 to 45 years and the non-employed individuals respectively. Of them, 24.6% (n = 122) perceived that they have adequate CC. The householders who have per-capita income < USD 50 are 1.95 times (aOR = 1.95; 95%CI:1.11 - 3.40) more likely to have adequate CC. CONCLUSION: The HSB, DPB and CC need to be improved to change the behaviour for sustainable dengue prevention and community capacity-building programmes need to be conducted in the Kurunegala district, Sri Lanka.Item Cross-cultural adaptation of the type D personality scale for use with patients diagnosed with Ischemic heart disease in Sri Lanka(The Sri Lanka Medical Association, 2021) Walpita Gamage, C.K.; de Zoysa, P.; Balasuriya, A.; Fernando, N.; Jayamanne, B.D.W.INTRODUCTION: Ischemic Heart Disease (IHD), a major cardiovascular disease globally, has become the primary cause of death in Sri Lanka. Negative affectivity (NA) and social inhibition (SI) are two personality traits which increase the risk of IHD. The Type D Scale (DS-14) evaluates a person’s general level of distress on NA and SI. However, DS-14 has not been translated and validated into Sinhala in Sri Lanka. OBJECTIVES: The study aimed to cross-culturally adapt and validate the DS-14 for use with Sinhala speaking patients diagnosed with IHD. METHODS: Translation, back translation and pre-test were conducted before a two-rounds of a Delphi process which assessed content and consensual validity of the instrument. The validated questionnaires were administered to 140 patients diagnosed with IHD at a Base Hospital. Factor structure was confirmed through Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) and reliability, by internal consistency with Cronbach’s alpha. RESULTS: The questionnaire was administered among 140 participants (85 females), aged 18-60 years. The DS-14 Sinhala version showed good content and consensual validity. Factor analysis proved two factors compatible with the original instrument, which explained the variance of 62.9%. CFA confirmed the two-factor model. The reliability analysis indicated Cronbach’s alpha for NA and SI as 0.93 and 0.88, respectively. CONCLUSION: The cross-culturally adapted DS-14 Sinhala version indicated the same psychometric properties as the original instrument, in the local context with IHD patients. It can be confidently applied in the investigation of Type D personality in IHD prevention and treatment, as well as in research. KEYWORDS: Ischemic Heart Disease, Type D Personality, DS-14Item Post war psychological morbidity among internally displaced, married females in Northern Sri Lanka(OMICS International, 2016) Attidiya, D.S.R.; Wickremasinghe, A.R.; Balasuriya, A.; Ediriweera, E.P.D.S.; Manuelpillai, S.; Williams, S.BACGROUND: A three-decade long conflict between the government military and Tamil rebels in Sri Lanka ended in 2009 with the defeat of the rebels. The civilians were the most affected in the war with reports of scant respect for human rights on both sides of the warring factions. OBJECTIVE: To conduct a cross-sectional study to assess the prevalence of psychiatric morbidity among married females in two villages in Northern Sri Lanka that was affected significantly in the last phase of the war. METHOD: All married females in two resettled villages in the Mannar District were interviewed by trained data collectors using the translated K-10 and PSSR-17 questionnaires to estimate the prevalence of post-traumatic stress disorder (PTSD) and depressive disorder. All families in these villages were from internally displaced camps where they had been living for more than a year after having been displaced from their homes and having experienced direct war trauma for weeks. Data was collected from 135 married females between March to May 2011 with ethical approval for the study. RESULTS: Criteria for diagnosis of severe PTSD were met in 57% of all participants and all participants had at least mild symptoms of PTSD. The screening tool for depression showed 63% to have significant depressive symptoms. Both depressive and severe PTSD features were present in 24%. Nearly 73% of participants were having either depression or severe PTSD. CONCLUSION: Psychiatric morbidity was high in the post-conflict period, in a highly vulnerable population of married females.