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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 REACh for the preschoolers; a developmental assessment tool for 2-5 year old children in Sri Lanka(BioMed Central, 2023) Caldera, A.V.; Wickremasinghe, A.R.; Muttiah, N.; Godamunne, P.K.S.; Jayasena, B.N.; Chathurika, L.K.E.; Perera, K.M.N.; Mendis, M.; Tilakarathne, D.; Peiris, M.K.R.R.; Wijesinghe, T.; Senarathna, N.E.; Saubhagya, W.D.L.; Chandraratne, M.; Sumanasena, S.P.BACKGROUND: Preschool children in low resource settings are at higher risk of missing developmental potential due to the lack of standardized and validated methods for the timely detection of children with developmental delays or neurodevelopmental disorders. The preschool teacher is a non-specialist resourceful link within the community to detect and offer interventions early. This paper discusses the preliminary iteration of designing and testing the psychometric properties of a developmental assessment for children aged 24 to 60 months in Sri Lanka. This assessment is designed to be conducted by preschool teachers in their preschool setting. METHODS: Three processes followed: 1. Designing and development of the Ragama Early Assessment for Children (REACh) complete preschool developmental assessment and a tool kit 2. Testing and training teachers on conducting the REACh assessment 3. Preliminary assessment of the psychometric properties including content validity, internal consistency, interrater reliability and concurrent validity. RESULTS: A literature search identified 11 assessments and 542 items representing cognitive, social-emotional and adaptive, language and motor domains. Content validity was assessed to select and adapt items. A complete assessment tool was designed to be administered in four settings within the preschool. This was further improved during pre and pilot testing and teacher training. Cronbach's alpha measuring internal consistency was > 0.70 for cognitive, language, social-emotional and adaptive domains across all three age groups in 1809 children. Interrater reliability was > 65% for age groups 36-47 and 47- 60 months. Concurrent validity using a clinical gold standard demonstrated sensitivity of more than 0.75 for all age groups with variable specificities (24-35 months: 0.71, 36- 47 months: 0.43 and 48-60 months: 0.67) assessed in 75 children. CONCLUSIONS: This culturally and linguistically adapted tool was tested nationally in Sri Lanka. The inte-rrater reliability between teachers and research assistants was higher than 65% for all domains in children more than 36 months. The preliminary iteration confirms it as an acceptable screening assessment for all age groups but with significantly lower specificity in the 36-47 month age group. Further improvement in certain domains together with intense teacher training is likely to enhance the validity and reliability of the assessment.Item Designing a tool to monitor development of 2-5 year old children by preschool teachers in Sri Lanka: A preliminary report(Sri Lanka Medical Association, 2018) Caldera, A.; Mendis, M.; Muttiah, N.; Wijesinghe, T.M.; Godamunne, P.K.S.; Chathurika, L.K.E.; Jayasena, B.N.; Wickremasinghe, A.R.; Perera, K.M.N.; Tilakarathne, N.; Peiris, M.K.R.R.; Sumanasena, S.P.INTRODUCTION AND OBJECTIVES: Identifying neurodevelopmental impairments and providing early intervention positively impacts later academic and functional outcomes of children. Globally available child development screening tools are not readily accessible or validated for Sri Lanka. As a large proportion of Sri Lankan children aged 2-5 years attend preschools, teachers can complement developmental monitoring. The aim of this study was to design a tool to monitor the development of 2-5 year old children by preschool teachers. METHODS: Twelve local and global tools including the tool developed by Plan International and the Child Health Development Record (CHOR) were reviewed. All tools were mapped according to the domains and subdomains in the National Early Childhood Developmental Standards for Sri Lankan Children. A Delphi process was carried out by a panel of experts to include culture specific activities that assess all domains and subdomains across age groups. RESULTS: The existing tool developed by Plan International lacked indicators for health, daily living and social and emotional development. The CHOR was deficient in cognitive, receptive language, social and emotional indices. Several activities in some instruments were common to more than one age group. The domains incorporated into the proposed tool included motor, cognitive, language, social and emotional and self- help skills. Approximately 50 items per each age group were included in this tool CONCLUSION: A preliminary play-based tool for monitoring development of children 2-5 years of age across five main domains in natural settings for preschool children was developed. A pilot study is required to assess the validity of the tool.Item Sri Lankan parents' attitudes towards adolescent reproductive and sexual health education needs: A qualitative study(Faculty of Medicine, University of Kelaniya & Plan International, 2008) Godamunne, P.K.S.INTRODUCTION: Adolescents have unique reproductive health needs when compared to adults, and the behaviours adopted in adolescence have serious implications for their later well being. Serious gaps have been found in providing sexual and reproductive health information to adolescents in Sri Lanka. OBJECTIVE: To explore the attitudes of Sri Lankan parents' towards adolescent reproductive and sexual health education, to identify current parental practices of imparting reproductive and sexual health information to their children and to identify perceived barriers parents face in discussing sexual and reproductive health issues with their children. METHODS: A qualitative study conducted using focus groups discussions in Kurunegala, Kandy, Gampaha and Colombo districts among 71 parents having an adolescent child. RESULTS: All'parents said that it was essential to provide reproductive and sexual health education to adolescents, mainly to deter them from engaging in any precocious sexual activity and to protect children from various threats posed by society, such as sexually transmitted diseases and child sexual abuse. Generally most parents were reluctant to directly discuss reproductive and sexual health issues with their children due to cultural taboos and resultant feelings of shyness and embarrassment. However, mothers, to some extent, discussed reproductive and sexual health matters with their children, often with their daughters and sometimes even with sons. However, some parents expressed lack of knowledge to do so. Parents also indirectly educated their children on sexual and reproductive health topics by providing them with books to read. Many parents considered school and teachers to be the best source of reproductive and sexual health information for their children. Doctors too were considered by parents to be a reliable source of reproductive and sexual health information. CONCLUSION: Parents considered adolescent reproductive and sexual health education as essential to protect and deter children from engaging in any precocious sexual activity. However, most parents were reluctant to openly discuss reproductive and sexual health topics with their children. In general, parents preferred outside sources, people other than themselves, such as teachers and doctors to provide their children with reproductive and sexual health information.