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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Silent transmission as a risk factor affecting transmission of dengue fever.(Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, 2007) Hapangama, H.A.D.C.; Hapugoda, M.D.; Gunawardene, Y.I.N.S.; Premaratna, R.; Dayanath, M.Y.D.; Abeyewickreme, W.The global incidence of dengue fever has increased by more than four-folds over the last 30 years, making it the most threatening mosquito-borne viral disease at present. Objective of this study is to determine the role of silent transmission •on' incidence of dengue. A total of 40 households, living within a 300 m radius of seven selected ‘confirmed dengue cases at different dengue high risk localities in Gampaha District were recruited for this study. A minimum of three inhabitants were tested for anti-dengue antibodies using a commercial kit to determine the prevalence of silent transmission on dengue infection in each households. Entomological surveillance was carried out in all seven localities. Out of 40 households, 26 (65%) houses were positive for dengue viral infection. Total of 148 inhabitants (68 Males); mean age; 35.9 years were enrolled. Of the 148, 41 (27.7%) had evidence of exposure to dengue virus [positive for IgM: 28/41(68.4%), IgM'& IgG: 7/41(17%) and IgG: 6/41(14.6%)]. Out of 28 primary infections, 20(71.4%) were asymptomatic. Of the 7 secondary infections, 1(14.28%) was asymptomatic. Of the 6 previous exposures to dengue 4(66.67%) were asymptomatic. Of the 7 localities investigated, 1 had >50%, 4 had >25% and 2 had <25% clustering of cases. Ae. albopictus found in all seven localities and Ae. aegypti found only in two localities. This study suggests presence of silent transmission of dengue virus with a trend towards clustering around cases and also this shows that the presence of vectors increases the incidence of dengue.Item A Study on cost of caring for patients with dengue fever at Professorial Medical Unit, Colombo North Teaching Hospital(Sri Lanka Association for the Advancement of Science, 2008) Hapangama, H.A.D.C.; Attanayake, N.; Premaratna, R.; Abeyewickreme, W.Dengue fever (DF) and Dengue Hemorrhagic Fever (DHF) may constitute a substantial economic burden on both the healthcare system and individual households in Sri Lanka. The objective of this study was to determine cost of caring for patients with DF and to determine the economic impact of DF on households and healthcare institution. The direct economic impact of the healthcare system and on the households of 31 laboratory confirmed dengue patients who were managed in the professorial medical wards of the North Colombo Teaching Hospital, Ragama was assessed during October, 2006 to March, 2007. The institutional cost was calculated using data obtained from relevant departments of the hospital. The cost for the households of each patient was calculated using an interviewer administrated questionnaire. Of the 31 patients enrolled all had DF and none developed DHF. The median and mode for hospital admission of study sample was third day of fever (range 1-7). The mean Direct Household Cost (DHC) for a single day in hospital of a dengue patient was Rs 820.06. Over 90% of DHC consisted of cost for transportation (33.22%), food (30.44%) and for services obtained from outside hospital sources (30.14%). The mean basic institutional cost for a patient-day in a medical ward of the hospital (excluding the cost for specific management of an illness) was Rs.961.81. Total institutional cost of caring dengue patient per day was Rs. 1142.57 which comprised of cost for basic inpatient care (84.2%) and specific management of dengue fever (15.82%). Further, total cost of hospitalization due to dengue for the study sample comprised of 6.5% for drugs, 17% for investigations and 76.5% for accommodation, staff, transportation, food and other expenses. The study shows a considerable economic burden for both hospital and households due to hospitalization with dengue fever. Although this study focused on some aspects of curative care, primary prevention should be regarded as the basis for minimizing the economic and social burden. The rising demand for the laboratory investigations needs to be addressed by the public sector in a more systematic manner. The substantial burden on the household can be reduced by integration of the private sector in to the system in a rational manner and ensuring a pricing policy. "All medical and nursing staff of the Medical Wards of the North Colombo Teaching Hospital and staff of the Molecular Medicine Unit are gratefully acknowledged."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.Item Efficacy and potential use of VectoBac WGr for the control of Culex quinquifaciatus mosquitoes in three different localities of Gampaha district, Sri Lanka(Sri Lanka Association for the Advancement of Science, 2009) Wijegunawardana, N.D.A.D.; Hapangama, H.A.D.C.; Gunawardene, Y.I.N.S.; Manamperi, A.; Abeyewickreme, W.Some methods of mosquito population control, especially the application of pesticides for adult mosquitoes, can have an impact on the environment and individuals with a heightened sensitivity to pesticides. Of the available control tools, biological controls are considered to be generally host-specific and environmental friendly. Although biological controls are not feasible on a large scale, they are often very effective in localized areas. Therefore, efficacy and potential use of water dispersible granular (WDG) formulations of bacterial larvicide, Vectobac- WGr (Bacillus thuringiensis israelensis [Bti]) (Valent BioSciences Cooperation in USA) was tested against Culex quinquefasciatus in three selected localities in the district of Gampaha. Pre-treatment, treatment and post-treatment adult C. quinquefasciatus mosquito densities were recorded for 20 consecutive days within the study period between May to December 2008. The study period covered both rainy and dry seasons. The larvicide was applied to three selected treatment sites and three control sites with a backpack sprayer to test the efficacy of Bti treatment. The six Pre-treatment surveillances in the three treatment and three control sites were done once a week in the first month and once in two weeks for the second month. Adult mosquitoes collected were identified in the laboratory to the species level and the numbers were recorded. For each site, 30 households were selected, with a total of 180 households. During the first month, treatment and surveillance cycles were carried out at weekly intervals, and once in two weeks during the next two months. Six posttreatment surveillances were carried out in the same way as the pre-treatment surveillances. According to the results obtained in this study, out of three treatment sites, two sites were shown to have Culex mosquito density reduction of 19% and 4%, while an increase in mosquito density was observed in the third site. Further, the three control sites, showed an average of 17% mosquito density reduction even without the application of Vectobac-WGr treatment. These results suggest that the product Vectobac-WGr is not effective on Culex quinquefasciatus as a larvicide to control filariasis in Sri Lanka.Item Towards an innovative approach to control dengue: Bio-Social study in Gampaha District, Sri Lanka(University of Kelaniya, 2008) Abeyewickreme, W.; Wickremasinghe, R.; Karunathilake, K.; Hapangama, H.A.D.C.