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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Ecology of healthcare: Symptom prevalence and health care seeking behaviour in Gampaha District, Sri Lanka(Sri Lanka Medical Association., 2019) Withana, S. S.; Mendis, K.; Nandasena, S.; Wickremasinghe, A.R.INTRODUCTION & OBJECTIVES: In 20 J 5, the Ministry of Health reported that 55 million outpatient visits were made to government OPDs and estimates 100 million visits by 2027. We studied the community symptom prevalence, associated factors and the trends in healthcare seeking behaviour in the Gampaha district. METHODS: A community-based prospective study, using a participant held symptom diary and interviews was conducted from May to June 20 J 8 in three Public Health Midwife areas each from Raga ma (urban) and Mirigama (rural) MOH areas. RESULTS: We invited 2330 individuals from 557 households and 2046 participated. Majority were: females. (n=l 127, 55.1%). Highest recruitment was from Mirigama area (n=1207, 59%). Of the study population 1919 (93.8%) reported at least one symptom. Phlegm (n=4871, 7.2%) had the highest frequency, musculoskeletal symptoms were the highest (26.8%) as a group. Females had a higher symptom prevalence (p = 0.001). Employment, income, having a chronic disease and distance to healthcare institution were significantly (p < 0.05) associated with both symptom prevalence and healthcare seeking behaviour. How the symptoms were managed: Ignored symptoms (n=l53, 8%), Self-care (n=560, 29.2%) and Seeking healthcare (n=924, 48.1%). Majority (n=763,82.6%) sought allopathic treatment, of whom 515 (55.7%) chose private sector ambulatory care. Of the 43 (2.2%) hospital admissions, 28 (65%) were to government hospitals. CONCLUSION: People in Gampaha District have a high symptom prevalence (93.8%) and healthcare seeking behaviour (48.1%) compared to USA which was (80%) and (32.7%) respectively. Gender did not influence the healthcare seeking behaviour. Majority (55%) preferred private allopathic ambulatory care.Item Health and social impact of indoor air pollution(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Nandasena, S.Indoor air pollution from combustion of solid fuel used for cooking and heating is one of the 10 leading contributors to the global burden of disease. Three billion of the world’s population and up to 90% of rural households in developing countries and 78% of Sri Lankan households still rely on solid fuel for cooking. Out of the households that use solid fuel for cooking, about 65% cook inside the main households. Only 72% of such households have a chimney. Reported air quality levels in the majority of Sri Lankan households are several fold higher than the WHO guideline values. Infiltration of air pollutants from outdoors is a key source of indoor air pollution in urban settings especially if the households are close to industries and major roads. The evidence for indoor air pollution and acute respiratory infections in children and chronic obstructive pulmonary disease or chronic bronchitis in women is compelling, while effects on adverse pregnancy outcomes, low birth weight and infant neurodevelopment is growing.Item Beliefs and knowledge regarding snakebite in rural Sri Lanka: a qualitative survey(Sri Lanka Medical Association, 2003) Makita, L.S.; Nandasena, S.; Costa, M.R.A.; Kasturiratne, A.; Pathmeswaran, A.; Lalloo, D.G.; de Silva, H.J.OBJECTIVES: To identify common beliefs and assess knowledge regarding snakebite in rural Sri Lanka, and their influence on health-seeking behaviour. METHODS: Qualitative methods (focus group discussions and key informant interviews) were used to obtain data in five rural locations in wet, intermediate and dry zones. Data was subjected to "framework analysis" involving familiarisation, identification of thematic frame, indexing and coding, charting, mapping, and interpretation. RESULTS: People are aware of risk-behaviour associated with snakebite, and have reasonable knowledge regarding venomous and non-venomous snakes. However, differences in nomenclature sometimes lead to confusion in identifying species. Beliefs and legends, which are linked to religion, have lead people to respect the cobra. Traditional healers claim they can determine the snake species, clinical manifestations that may occur, and prognosis, based on phenomena, such as, day of the week and phase of the moon when the bite took place. They still employ treatment methods, such as wound incision with broken glass and scalp incision for applying potions. Although there is respect for traditional healing, there is acceptance of the efficacy of western medicine. Beliefs, such as, anti-venom though effective is toxic, long-term effects of snake venom can be completely neutralised only by traditional medicine, and producing the dead snake is essential for treatment in hospitals, lead people to seek treatment by traditional healers rather than in hospitals. CONCLUSIONS: Beliefs and misconceptions influence health-seeking behaviour following snakebite. There seems to be a growing acceptance of western medicine. However, traditional healing methods are still popular, but include harmful^rjractices. This information could form a basis for. educational intervention.Item Geographical variations of goitre prevalence in Sri Lanka: visualisation with geographic information systems(Sri Lanka Medical Association, 2012) Fernando, R.; Pathmeswaran, A.; Nandasena, S.INTRODUCTION: Widely held beliefs about the geographical distribution of goiter prevalence in Sri Lanka are not based on reliable data. Geographic Information Systems provide an excellent means to visualize and present epidemiological data. AIMS: To map and explore the geographical variation of goiter prevalence in Sri Lanka METHODS: An island-wide representative sample of residents (n=5200) from 95 Gramasewa Niladhari (GN) divisions in 87 Divisional Secretariats (DS) were screened for goiter. A subsample was investigated for thyroiditis. Digital maps were developed to visualize the goiter and thyroiditis prevalence across the country. Maps were developed for the GN and DS level representations. Based on the data from 95 GN divisions, goiter prevalence was estimated for the un-sampled areas of the country using the interpolation techniques. ArcGIS 10.0 software was used for analysis. RESULTS: A total of 426 goiters and 177 thyroiditis cases were identified. The male and female goiter prevalence showed similar patterns of geographical variation. The DS_.divisions with goiter prevalence more than 15% were seen distributed across the country without any discernible pattern. Distribution of thyroiditis exhibited a similar pattern. There was some evidence of clustering together of areas/ GN divisions with a similar prevalence of goiter but it was not possible to demarcate large contiguous areas ('zones'] with a similar prevalence of goiter. CONCLUSIONS: Geographical distribution of goiter prevalence did not show any large regional or zonal variations. Areas of high and low prevalence were distributed randomly across the country.Item Identifying the offending species in snakebite: a clinical score for use in community based epidemiological surveys(Sri Lanka Medical Association, 2004) Pathmeswaran, A.; Fonseka, M.M.D.; Kasturiratne, A.; Nandasena, S.; Gnanatilaka, G.K.; Gunaratne, L.; de Silva, A.P.; Lalloo, D.C.; de Silva, H.J.INTRODUCTION: Hospital data on snakebite fails to account for victims who do not reach hospital or who seek alternative treatment. In community surveys, identification of biting species is very difficult because the offending snake may sometimes not even be seen, is infrequently captured or killed, and antigen detection cannot be used in this setting. OBJECTIVE: To develop and validate a clinical score to identify biting species. METHODS: We identified 10 features relating to bites of the 6 venomous snakes in Sri Lanka (3 relating to circumstances of a bite and 7 clinical features of envenoming). Based on these, we developed a score applying different weightings to individual features depending on the species of snake. We then constructed 60 artificiaLdata sets containing different clinical scenarios, typical and atypical, for bites of a particular species. They were used to make adjustments to the score and determine cut-off values for identification (total ≥60/100 + difference of ≥5/100 from second highest score). The score was prospectively validated on 134 cases of snakebite with definite species identification, six months after the incident. RESULTS: Data were available from 25 cobra bites, 32 hump-nosed viper bites, 27 krait bites, 30 Russel's viper bites and 20 saw-scaled viper bites. Sensitivity/specificity of the score were: cobra 76/99, kraits 85/99, RV 70/99, HNV 97/83, SSV 100/83. 114 (85%) cases were correctly identified. 17 (12.7%) were misidentified, and 3 (2.3%) could not be identified. Conclusions: This score identifies the offending snake species with reasonable accuracy, and may be suitable for use in epidemiologicai surveys.Item Fine particle air quality levels of Sri Lankan households and associated respiratory conditions: preliminary findings of an ongoing longitudinal study(Lippincott Williams & Wilkins, 2011) Nandasena, S.; Wickremasinghe, A.R.; Sathiakumar, N.BACKGROUND/AIMS: Data on fine particle (PM2.5) air pollutant levels in Sir Lankan households are scarce. A high proportion of households are known to use unclean fuels for cooking, without proper ventilation. The aim of the study was to determine the respiratory health status of children and PM2.5 levels in a sample of home environments (indoors and outdoors). METHODS: A total of 612 children (aged 7–10 years) were selected from 2 study settings (setting 1, n = 408; setting 2, n = 204) for a prospective study. Study “setting 1” was selected from a high outdoor air-polluted area of the Colombo Municipal Council, and “setting 2” from a low-polluted area. The study commenced in March 2009. Measurements were made in the main living room using UCB particle monitors for 24 hours with minute logging. The outdoor 24-hour PM2.5 levels were measured using gravimetric air samplers in 3 selected outdoor locations in each setting at monthly intervals. RESULTS: On the basis of the 124 household measurements, the median PM2.5levels in households of settings 1 and 2 were 66.6 μg/m3 (mean = 104.0, range = 25.5–644.8) and 50.0 μg/m3 (mean = 142.0, range = 5.9–749.5), respectively. The highest PM2.5 concentrations were reported from houses using wood as cooking fuel (mean = 145.2, median = 66.8, range = 5.9–749.5 μg/m3). The prevalences of wheezing during the past 12 months (at least one episode during the last 12 months) were 20.8% (n = 85) and 10.8% (n = 22) (odds ratio = 2.2, confidence interval = 1.3–3.6) in setting 1 and 2, respectively. The prevalences of children ever having asthma were 18.9% (n = 77) and 12.7% (n = 26) in settings 1 and 2, respectively. CONCLUSION: Most of the households had PM2.5 levels exceeding the upper limit recommended by the World Health Organization. Children living in setting 1 had a higher risk of experiencing respiratory ill health than children living in setting 2. © 2011 Lippincott Williams & Wilkins, Inc.Item Capacity building in environmental and occupational health in Sri Lanka(Wiley-Blackwell, 2013) Wickremasinghe, A.R.; Peiris-John, R.; Nandasena, S.; Delzell, E.; Tipre, M.; Sathiakumar, N.BACKGROUND: Although environmental and occupational health (EOH) research and services in Sri Lanka have a long history, policies related to EOH are outdated. METHODS: We review the International Training and Research in Environmental and Occupational Health (ITREOH) program in Sri Lanka that commenced in 2006 as a collaboration between the University of Alabama at Birmingham and the Faculty of Medicine of the University of Kelaniya, Sri Lanka. RESULTS: The program has trained over 20 scientists in conducting EOH research. New pioneering research in EOH was initiated. The program was instrumental in furthering the training and research in EOH by initiating a MPH degree program, the first in the country .CONCLUSIONS: The program has established North-South, South-South and in-country collaborations between institutions and scientists, increasing the visibility of EOH in the future.Item Biomass fuel use for cooking in Sri Lanka: analysis of data from national demographic health surveys(Wiley-Blackwell, 2012) Nandasena, S.; Wickremasinghe, A.R.; Sathiakumar, N.BACKGROUND: Biomass cooking fuel is the main source of indoor air pollution in the majority of households in the developing world. Sri Lanka is an island of about 20 million population with urban, rural, and estate population of 14.6%, 80.0%, and 5.4%, respectively. This study describes biomass fuel use for cooking in Sri Lanka. METHODS: We analyzed data from two national Demographic Health Surveys (2000 and 2007) to identify the use and determinants of cooking fuels in Sri Lankan households. The results are based on a sample of 8,169 households in 2000 and 19,862 households in 2007. RESULTS: Wood was the principal cooking fuel used in 78.3% and 78.5% of households in 2000 and 2007, respectively. In 2007, 96.3% of estate sector households used firewood as compared to 84.2% in the rural and 34.6% in the urban sectors. Similar trends were noted in 2000 as well. CONCLUSIONS: The shift from firewood to cleaner fuels in Sri Lanka is negligible from 2000 to 2007. Improving the quality of life of the population does not necessarily predict a shift towards the use of cleaner cooking fuels in Sri Lanka.Item Air pollution and public health in developing countries: Is Sri Lanka different?(College of Community Physicians of Sri Lanka, 2012) Nandasena, S.; Wickremasinghe, A.R.; Sathiakumar, N.Indoor and outdoor air pollution is a major public health challenge in developing countries and much concern has been raised among policy makers, public health experts, clinicians, and the general public in recent years. A spectrum of health outcomes has been shown to be associated with exposure to air pollution in epidemiological studies and by laboratory investigations. It is estimated that indoor air pollution resulting from exposure to solid fuel accounts for over 1.5 million premature deaths and 38.5 million Disability-Adjusted Life Years. Globally, it is estimated that outdoor air pollution accounts for over 800,000 premature deaths and 6.4 million years of life lost; of these numbers, 65% is from Asia alone. There is emerging evidence that the actual burden is much larger than the estimated values. The World Health Organization has estimated the number of deaths attributable to indoor air pollution and outdoor air pollution in Sri Lanka to be 4200 and 1000 deaths, respectively. Although country information is limited, a few epidemiological studies gives us the opportunity to understand and compare the Sri Lankan situation vis a vis other countries. This includes the 16 epidemiological studies identified by a scientific review in 2010 and several other published studies and preliminary data from ongoing studies.