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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Ovi-trap based surveillance for Aedes in dengue endemic Gampaha District, Sri Lanka during rainy season(Faculty of Tropical Medicine, Mahidol University, 2008) Hapangama, H.A.D.C.; Wijegunawardana, N.D.A.D.; Gunawardene, Y.I.N.S.; Benjamin, S.; Abeyewickreme, W.Dengue is endemic in Gampaha District, Sri Lanka. Aedes aegypti and Aedes albopictus have been incriminated as vectors in urban and suburban environments. An ovitrap-based weekly surveillance was carried out to determine the distribution and abundance of Dengue vectors, in six dengue endemic areas; Galudupita, Gongitota, Wanawasala, Kerangapokuna, Mabole and Welikadamulla in the Gampaha District during May and June 2008 in both indoors and outdoors. Galudupita and Gongitota gave the highest ovitrap indices, both indoors and outdoors as 97% and 73% respectively. Of the total positive ovitraps(1320), positivity for Ae. albopictus, Ae. aegypti and both were 63.5%, 32.9% and 3.6% respectively. Highest mean number of Ae. aegypti and Ae. albopictus larvae per ovitrap in both indoor and outdoor ovitraps were observed Galudupita and Gongitota respectively. However, statistical analysis showed that ovitrap index of Ae. aegypti in six study was not significantly different from each other (P > 0.05). Outdoor mean number of Ae. aegypti larvae per ovitrap in Galudupita, was significantly higher than other sites (F=3.587, P=0.012). Indoor Ae. albopictus ovitrap index of Gongitota was significantly higher than of Welikadamula (F=2.59, P=0.046) while outdoor Ae. albopictus ovitrap index of Gongitota and Wanawasala was significantly higher than of Welikadamula F=3.19 P=.0.02). Results irnplicate that Ae. albopictus prefers more vegetation as observed in Gongitota and Wanawasala. In highly populated and urbanized Galudupita, area with less vegetation, Ae. albopictus population was less than Ae. aegypti even outdoors. Study implicates that Ae. albopictus is the predominant indoor and outdoor breeder during rainy season.Item Silent transmission of the dengue fever in Gampaha District, Sri Lanka(Malaysian Society of Parasitology and Tropical Medicine, 2007) Hapangama, H.A.D.C.; Gunawardene, Y.I.N.S.; Gunasena, S.; Hapugoda, M.D.; Premaratna, R.; Wellawaththage, L.C.; Abeyewickreme, W.Dengue fever is a major infectious disease in Sri Lanka. Silent transmission of dengue virus has been suggested as a possible risk factor for the increasing incidence of dengue. The present study was carried out in the District of Gampaha using cluster investigation method. A cluster consisted of a minimum of 20 volunteers (family members and immediate neighbours) of a hospitalized serologically/molecular biologically confirmed dengue patient. Serum samples were collected from 148 volunteers in 7 clusters. Samples were tested for anti-dengue antibodies using Dengue Duo IgM and IgG Rapid Strip Test. Of these, positives were further tested for anti-dengue IgG antibody by Haemagglutination Inhibition (HAI) assay, the gold standard test for serological diagnosis of virus infection. Of the 148, 41 had evidence of exposure to dengue virus by Dengue Duo IgM and IgG Rapid Strip Test [positive for IgM: 28(68.4%), IgM & IgG: 7(17%) and IgG: 6(14.6%)]. Of that 41, paired sera were collected from 36 volunteers and tested by HAI assay which confirmed dengue virus infection in 4(11.1%) [confirmed secondary-4(100%)]. Additional 32(88.9%) were diagnosed as recent dengue infections [probable secondary-17(53.1%), probable dengue- 15(46.9%)]. Out of 36 volunteers, 12(33.3%) were symptomatic [confirmed secondary-1(8.3%), probable secondary-10(83.4%), probable dengue-1(8.3%)] and 24(66.7%) were asymptomatic [confirmed secondary-3(12.5%), probable secondary-7(29.2%), probable dengue-14(58.3%)]. Presence of dengue vectors, Aedes aegypti and/or Aedes albopictus were detected around all 7 clusters. The present study serologically confirms the persistence of silent transmission of dengue virus with a trend towards clustering around cases. Presence of vector species in the area further supports this phenomenon.Item Effect of silent transmission and clustering of cases on transmission of dengue in Gampaha district(Sri Lanka Association for the Advancement of Science, 2007) Hapangama, H.A.D.C.; Gunawardene, Y.I.N.S.; Hapugoda, M.D.; Premaratna, R.; Dayanath, M.Y.D.; Abeyewickreme, W.Silent transmission of dengue virus and clustering of cases have been suggested as possible factors for the increasing incidence of dengue fever. Objective of this study was to determine the presence of silent transmission and clustering of cases of dengue fever in the Gampaha District. Study was carried out using cluster investigation method. A cluster consists of family members and immediate neighbours (minimum of 20) of a dengue index-case. Serum samples from volunteers were tested for anti-dengue antibodies using Dengue-Duo-IgM/IgG Rapid Cassette (Panbio diagnostics, Australia). Using 7 index cases, 148 volunteers (68 Males); mean age: 35.9 years were enrolled. Of the 148, 41 had evidence of exposure to dengue virus [positive for IgM: 68.4% (28/41), IgM & IgG: 17% (7/41) and IgG: 14.6% (6/41)]. Out of 28 primary infections, 71.4% (20/28) were asymptomatic. Of the 7 secondary infections, 14.28% (1/7) was asymptomatic. Of the 6 previous exposures to dengue, 4 (66.67%) were asymptomatic. There was no significant association between sex and exposure to infection [31% (21/68) males vs 25% (20/80) females, p>0.05] or between sex and occurrence of symptoms among exposed individuals [71% (15/21) males vs 50% (10/20) females, p>0.05]. Older individuals aged over 40 years, were most likely to be asymptomatic than younger persons (94% (14/15 exposed) vs 50% (13/26 exposed), P<0.01). Out of 7 clusters investigated, 1 had >50%, 4 had >25% and 2 had <25% clustering effects. A high proportion of asymptomatic infections were observed among adults over 40 years without gender difference. Study suggests persistence of silent transmission of dengue virus with a trend towards clustering around cases. Acknowledgement: World Health Organization (WHO/SEARO SN1144) and technical co-operation by International Atomic Energy Agency (TC/SRL 06/28)Item Knowledge, attitudes and practices (KAP) on dengue control in Gampaha district.(Sri Lanka Association for the Advancement of Science, 2008) Abeyewickreme, W.; Hapangama, H.A.D.C.; Gunawardene, Y.I.N.S.; Hapugoda, M.D.; Gunawardena, N.K.; Wickremasinghe, A.R.Dengue/Dengue Hemorrhagic Fever (DHF) has become a major public health problem in many parts of the tropics. In Sri Lanka, it is endemic in some parts of the country with outbreaks of dengue/ DHF. The present study was done to assess 1) knowledge regarding dengue among the general population in the district of Gampaha, 2) whether simple preventive measures are being practiced in the community. A cross-sectional survey was conducted in selected 2000 households in the Gampaha District from June - August, 2007 using a pre-tested structured questionnaire to assess the level of knowledge, attitudes and practices regarding dengue. The majority of the respondents interviewed were females (65.2%). More than 90% have had secondary education (90.2%). The main source of water supply were pipe borne (43.4%) and well water (40.6%). 64.3% households stored water for washing, drinking and cleaning purposes. More than 95% of the respondents had heard about dengue fever and its transmission. 91.3% cited that their main source of information on dengue was from television/radio. 34.3% had either received advice or participated in a training programme on dengue prevention and 7.8% had received support materials. The main preventive measure used to reduce the mosquito nuisance was personal protection with repellents (73.6%). Most of the respondents (56.8%) felt that no action was taken by the government to control mosquitoes. When respondents views were taken, the suggestions made by them to improve dengue control included, fogging (31.8%), educating people (30.5%), treating water (24.3%) and cleaning the environment (19.5%). When questions were directed at possible methods for community participation for dengue control, the majority were in favour of removing solid waste (84.15%), eliminating stagnant water collections (40.7%), removing larvae (8.75%) and covering all the water containers using lids (8.1%). The community had good understanding on dengue and the main source of information was from the electronic media. However it was found that good knowledge itself does not necessarily lead to good practices. The respondents' attitudes were found to be good and most of them were supportive of control measures. Mass media is an important means of conveying health messages to the public, thus research and development of educational strategies designed to improve behaviour and practices of effective control measures through mass media among the community are recommended. Financial support by World Health Organization TDR/WHO Multi Country Study on "Eco-Bio-Social Research on Dengue in Asia" is acknowledged.