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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 The impact of COVID-19 on health care accessibility and financial risk protection in Sri Lanka(Sri Lanka Medical Association, 2023) Nandasena, S.; Gamage, A.U.; Periyasamy, N.; Rismy, M.; Balachandran, K.; Kasturiratne, A.INTRODUCTION: The COVID-19 pandemic negatively impacted the global economy, disrupted essential health services, and distorted social determinants of health, reducing healthcare accessibility and increasing financial risk. AIM: we aimed to assess the impact of COVID-19 on healthcare accessibility and financial risk protection in Sri Lanka. METHODOLOGY: We conducted a cross-sectional study on a representative sample (multi-stage sampling process) of 3151 households in 105 clusters representing all the districts of Sri Lanka. The data collection was conducted using an interviewer-administered questionnaire in early November 2021. This was important to classify three periods of interest, namely: (1) the pre-lockdown period (2) the nationwide lockdown period, and (3) the new normal period. (After Oct 1 to early November 2021). RESULTS: Among 11,463 household occupants, 12.6% reported having chronic diseases, with 76.5% diagnosed prior to six months. The majority had heart disease, high blood pressure, or diabetes. Of them, 53.7% have been followed up during the lockdown, increasing to 80.8% in the new normal period. Provincial variations in expenses were observed, with the highest food expenses in the Western Province. Catastrophic health expenditures affected 9.5% and 3.4% of households at 10% and 25%, respectively. CONCLUSIONS: A considerable proportion of those having heart disease, high blood pressure, high blood sugar or diabetes mellitus were not followed up in the lockdown period and the first month of the new normal period. Antenatal care and family planning were the least affected. Participants had incurred high out-of-pocket expenditures for healthcare during the entire period.Item Evidence-based and epidemiological interpretation of the diagnosis of SARS-COV-2(College of Community Physicians of Sri Lanka, 2021) Abeysena, C.; Gamage, A.U.Introduction: Diagnostic tests are never perfect, leading to inaccurate decisions by healthcare workers. Study aimed to compile the evidence and facilitate the epidemiological interpretation of testing available for the COVID-19. Methods: Published systematic reviews, especially Cochrane reviews and evidence summaries were used. Positive-predictive-values (PPV), negative-predictive-values (NPV), and its 95% confidence intervals (CI) were calculated following application to a hypothetical cohort of 1000 patients, the reported sensitivities and specificities and assumed pre-test probability levels. Results: At a low pre-test probability level, PPV is 63.6%(95%CI: 37.8%-83.5%) when assumed 72%sensitivity of the antigen test among symptomatic patients and 60.0% 95%CI: 33.3%-81.8%) when assumed 58% sensitivity of the antigen test among asymptomatic patients. If the sensitivity is low, PPV will become a low value. PPV is high with a higher pre-test probability level; however, the NPV is 78%(95%CI: 75.5%-80.4%) among symptomatic and 70.3%(95%CI: 68%-72.4%) among asymptomatic patients. PPV is 44.4% (95%CI: 28.6%-61.5% at a low pre-test probability level) when assumed 80% sensitivity for the RT-PCR test. Further, assuming that the sensitivity of 95%, PPV is 47.4% (95%CI: 32%-63%). At a higher pre-test probability level, the NPV is 83.2% (95%CI: 80.6%-85.5%) when assumed 80% sensitivity. Further, the sensitivity of the RT-PCR is 95%, NPV is 95.2%(95%CI: 93.1% to 96.7%). Conclusions: With a low pre-test probability, positive results should be interpreted cautiously and need a second specimen tested for confirmation for both Ag and PCR testing. With higher pre-test probability, the confidence in negative COVID-19 test results is low. Therefore, a combination of symptoms, signs, laboratory investigations can be used with antigen and RT-PCR tests, for diagnosis of COVID-19.