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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 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 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-14