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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 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 Identifying the biting species in snakebite by clinical features: an epidemiological tool for community surveys(Oxford University Press, 2006) Pathmeswaran, A.; Kasturiratne, A.; Fonseka, M.; Nandasena, S.; Lalloo, D.G.; de Silva, H.J.The outcome of snakebite is related to the biting species but it is often difficult to identify the biting snake, particularly in community settings. We have developed a clinical scoring system suitable for use in epidemiological surveys, with the main aim of identifying the presumed biting species in those with systemic envenoming who require treatment. The score took into account ten features relating to bites of the five medically important snakes in Sri Lanka, and an algorithm was developed applying different weightings for each feature for different species. A systematically developed artificial data set was used to fine tune the score and to develop criteria for definitive identification. The score was prospectively validated using 134 species-confirmed snakebites. It correctly differentiated the bites caused by the three snakes that commonly cause major clinical problems (Russell's viper (RV), kraits and cobra) from other snakes (hump-nosed viper (HNV) and saw-scaled viper (SSV)) with 80% sensitivity and 100% specificity. For individual species, sensitivity and specificity were, respectively: cobra 76%, 99%; kraits 85%, 99%; and RV 70%, 99%. As anticipated, the score was insensitive in the identification of bites due to HNV and SSV