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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Evaluating the efectiveness of a community based health promotion intervention on knowledge improvement regarding low birth weight and its determinants among antenatal couples in Sri Lanka(Springer Nature, 2024) Guruge, G.N.D.; Young, S.M.; Perera, K.M.N.; Dharmaratne, S.D.; Gunathunga, M.W.BACKGROUND Improvement of the knowledge of pregnant mothers and their partners related to low birth weight (LBW) is a vital factor in preventing LBW and reducing its prevalence. OBJECTIVES Implement and evaluate the effectiveness of a community based health promotion intervention on preg nant mothers and their partners to increase knowledge on birth weight and its determinants. The second objective is to determine the difference of the birth weight after implementing the intervention. METHODS A quasi experimental study design was used, and the setting was 806 pregnant mothers, 403 each in two dis tricts. In 26 ANCs, twenty six initial training sessions were conducted as a group, with an average of three hours for each session. Three follow up sessions were conducted in each ANC over 04 months (in total 104 sessions). All sessions were conducted in groups of 10 to 20 antenatal couples. The pregnant mothers and their partners completed interviewer administered questionnaires. Pre and post data were analysed based on four major knowledge categories using statistical methods. The McNemar’s Chi Square test; Chi Square test, Fisher’s Exact test, Paired t test, Student’s independent sample t test, Wilcoxon Signed Ranks test and Mann Whitney U test methods were applied as appropriate. RESULTS Both mothers and their partners in the intervention group (IG) reached significantly higher gains in knowledge than in the comparison group (CG). The participants who got the lowest scores for knowledge, at the pre assessment, in IG, also improved more than the CG {mothers (p = 0.002) and partners (p = 0.007)}. The mean birth weight shows that the IG has significantly improved for both mothers (p < 0.001) and partners (p = 0.013) with low knowledge scores (< 50% of total). CONCLUSIONS Knowledge about birth weight and its determinants among pregnant mothers and their partners improved significantly.Item Reported tobacco industry interference during COVID-19 pandemic in South Asia(Sri Lanka Medical Association, 2023) Perera, N.C.S.; Horadagoda, N.; DineshKumar, P.; Perera, K.M.N.; Rajasuriya, M.INTRODUCTION: Articles 13 and 5.3 of the Framework Convention on Tobacco Control (FCTC) recommend banning sponsorships and restricting Corporate Social Responsibility (CSR) activities of the tobacco industry (TI). It is known that TI uses catastrophic situations to promote its image through CSR activities. OBJECTIVES: This study aimed to explore TI activities during the COVID-19 pandemic in South Asia from March 2020 to February 2022. METHODS: A mixed methods design was used. Investigative research techniques were used to gather data. Media reports, websites, industry reports and social media posts during the pandemic were analysed using content analysis methods. RESULTS: A total of 132 incidents were identified and 122 directly involved 10 tobacco companies. The highest were reported in India (80), Bangladesh (27) and Sri Lanka (18). The majority of incidents (73) were related to ITC Limited India. Influencing media (41), promotion (31), CSR activities (donating money/medical equipment/food/ hygiene goods) (15), and partnering with governments (15) were the commonest incidents. Lobbying governments and officials, increasing accessibility to products, receiving awards, directors/ executive officers featuring in conferences, and sponsorships were other themes identified. These received wide positive media coverage. Media highlighted the drop in revenue and later recovery of sales. Online cigarette sales and home delivery services were initiated in Sri Lanka and Bangladesh. In Bhutan, the trade ban was lifted, and cigarettes were added to the essential goods list and sold in “state-owned duty-free” sales outlets. CONCLUSION: TI used the pandemic to promote its image via CSR activities, sponsorships and partnering with governments violating FCTC and national laws.Item Maternal satisfaction and knowledge of early childhood development (ECD) related public health services(Sri Lanka Medical Association, 2023) Gunathilake, A.M.C.M.; Perera, K.M.N.INTRODUCTION: A good start in life gives rise to better outcomes as adults, hence the provision of quality health care helps children to reach maximum development potential. OBJECTIVES: To determine the level of satisfaction and knowledge on ECD-related public health services, screening, and psychosocial stimulation among mothers in the Medical Officer of Health area Damana. METHODS: Mothers of children attending polyclinics in the Damana MOH area were recruited through a consecutive sampling method to conduct a descriptive cross-sectional study. A structured and pre-tested interviewer-administered questionnaire was used. RESULTS: Satisfaction with ECD services was reported by 98.4% (95%CI[96.0-99.0]; n=306) mothers. A good level of knowledge was reported by the majority (78.5%; 95%CI[74.0-83.0]; n=244) of mothers on child development milestones. Only 56.3% (95%CI[51.0-62.0]; n=175) mothers had a good knowledge level on psychosocial stimulations (CI=0.51-0.62). However, a poor level of knowledge on child developmental screening was noted among 87.1% (95%CI[83.0-90.0]; n=271) mothers. In addition, 58.8% (95%CI[53.0-64.0]; n=183) of mothers reported a poor knowledge level of available child developmental services in the area. A good level of knowledge in psychosocial stimulation has shown a significant association with mothers being educated beyond O/L (X2(1, N=311) =5.69,p =0.017). Working mothers had a significant association with a good level of knowledge on psychosocial stimulation (χ2(1,N=311)=4.62,p=0.03). CONCLUSION: Lack of maternal knowledge in available ECD services needed to be addressed to enhance the quality of care at the field level.Item Knowledge, attitudes and practices in managing violence among G.C.E. advanced level students in Gampaha educational zone(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2023) Soysa, E.M.N.; Suraweera, S.A.S.S.; Thewage, A.P.; Thudugala, M.T.K.L.; Anjula, S.A.P.D.; Perera, K.M.N.INTRODUCTION: Increased exposure to violence of various types can be observed during the adolescent period. Therefore managing violence among adolescents is important. This study describes knowledge, attitudes and practices in managing violence among G.C.E advanced level students in Gampaha education zone. METHOD: A descriptive cross-sectional study was conducted among 420 Grade 13 students of Type 1AB schools in Gampaha educational zone selected using a multistage cluster sampling method. An online self-administered questionnaire, which included mixed-type questions and four case-scenarios for the four violence types, assessed knowledge, attitudes and practices in managing physical, mental, social and sexual violence. Responses were categorized as positive or negative based on prevention or positive management of violent acts. RESULTS: Case scenario assessing sexual violence reported the highest positive responses in all aspects (practices -91.79%, knowledge -97.54%) except for the attitudes (2.92%). Physical violence reported highest positive responses for attitudes (5.13%).Scenario on physical violence reported the lowest positive responses on knowledge (83.62%) whereas lowest positive responses for attitudes and practices were reported for mental violence (attitudes= 2.43%, practices= 66.41%). The majority (>75%) correctly identified violent actions mentioned in the questionnaire as violent. Males reported more experiences related to violence than females and also predominated in negative attitudes and practices regarding managing violence. CONCLUSION: Knowledge on violence and its management was good among the majority of study participants. The minority who does not have even a minimal knowledge regarding managing violence is a concern. Attitudes and practices were more towards encouraging prevention of violent acts and was associated with gender.Item Availability of rehabilitation services for communication disorders in Sri Lanka: a cross-sectional survey(BMJ Publishing Group Ltd, 2023) Caldera, A.V.; Wickremasinghe, R.; Munasinghe, T.U.; Perera, K.M.N.; Muttiah, N.; Tilakarathne, D.; Peiris, M.K.R.R.; Thamilchelvan, E.; Sooriyaarachchi, C.; Nasma, M.N.; Manamperige, R.M.; Ariyasena, A.D.K.; Sumanasena, S.P.OBJECTIVES: To describe the rehabilitation services available for communication disorders in Sri Lanka and to estimate the adequacy of the services in provinces and districts of the country. SETTING: The study considered government and private institutions, which provide rehabilitation services for communication disorders in Sri Lanka. PARTICIPANTS: Institutions providing services of speech-language pathologists, audiologists and audiology technicians in Sri Lanka. PRIMARY AND SECONDARY OUTCOME MEASURES: We investigated the number of government hospitals and private institutions, which provide speech-language pathology and audiology services in Sri Lanka as the primary outcome measure. A number of speech-language pathologists, audiologists and audiology technicians working in the institutions were obtained from records and institution-based inquiries to identify the adequacy of the services in the country as the secondary outcome measure. RESULTS: Of the 647 government hospitals that provide free healthcare services in the country, 45 and 33 hospitals had speech and language therapy and audiology units, respectively. Government hospitals do not have audiologists but only have audiology technicians. The number of speech and language therapists and audiology technicians in the government sector per 100 000 population in the country was 0.44 and 0.18, respectively. There were wide variations in specialist to population ratio between districts. 77 private centres provide speech therapy services in 15 out of the 25 districts; 36 private centres provide audiological evaluations in 9 districts. CONCLUSIONS: The number of specialist speech and language therapists and audiologists is not sufficient to provide adequate rehabilitation services for communications disorder for the Sri Lankan population. Not recruiting audiologists to the government sector affects the management of hearing impairment in the affected.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 Accessibility challenges for the disabled community accessing public health care services and disability care institutions in Ragama Medical Officer of Health area(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2021) Pathirage, C.K.; Padmasiri, U.G.M.; Nuvvarapakshage, N.S.R.P.; Panditharatne, W.D.; Hewawardhane, S.N.; Phuntsho, T.; Perera, K.M.N.Introduction: Ragama Medical Officer of Health (MOH) area is a developing center for the disabled with the National Rehabilitation Hospital and the specialized disability care institution targeting children. It also hosts the main teaching hospital in the district and a school for disabled children. Visual, walking and audibility impairments account for the highest number of disabled individuals in the country. Ragama MOH area is a developing hub for all these communities. Objectives: The objective of this study is to describe access-related challenges for the disabled community accessing public health care services and disability care institutions in Ragama MOH area. Methods: This is the qualitative study component of a larger study which also quantitatively assessed the compliance of the settings using an observational checklist. This component focused on the qualitative evaluation of accessibility-related challenges. Independent research team members interviewed 15 service providers, disabled and community stakeholders sampled purposively using semi-structured questionnaires. Data was analysed using thematic analysis method. Results: Financial constraints were identified as the main constraint for development of accessibility. “Dependence”, “gaps in awareness” and “negative attitudes” in order of perceived importance, revealed to hinder empowerment of the disabled on demanding for better access. Prioritisation of one disability was identified as a significant determinant for reduced access for individuals with multiple disabilities. Service providers were perceived to have the greatest power to address the challenges in their respective settings. Conclusions: Empowering clients to demand for improvement of accessibility and engaging primary service providers in development processes will lead to improvement of the existent challenges.Item Accessibility to disability-care institutions and public health services in Ragama Medical Officer of Health Area(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2021) Pathirage, C.K.; Padmasiri, U.G.M.; Nuwarapakshage, N.S.R.P.; Panditharatne, W.D.; Hewawardhane, S.N.; Phuntsho, T.; Perera, K.M.N.Introduction: Ragama Medical Officer of Health (MOH) area is a developing centre for the disabled with the National Rehabilitation Hospital and the specialized disability care institution targeting children. It also hosts the main teaching hospital in the district and a school for disabled children. Objectives: The objective was to describe compliance of identified settings related to disability health services in the Ragama MOH Area with current accessibility regulations. Methods: This is the quantitative component of a larger study which explored accessibility challenges and perceptions of service providers and the clients as well. This component assessed identified 16 settings including all disability care institutions, public health care services and selected access-points in Ragama MOH area using an observational checklist based on ‘disabled persons’ accessibility regulations act no. 1, 2006’. Photographic documentation of accessibility was performed. Data analysis utilized descriptive statistics based on a score of 1 for complete compliance and 0 for non-compliance. Results: Accessibility for visually impaired and signage for the disabled reported the lowest compliance with a score of 0% across all assessed settings. Highest compliance was observed related to pathways and corridors which scored 93.3%. Specific shortcomings and strongholds of accessibility in each institution were identified. Only one institution specializing in children with disabilities displayed a total compliance of 61.11%. The road network accessing the institutions portrayed less than 5% compliance with the recommended standards. Conclusions: Failure to meet accessibility regulations as expected in a developing hub such as Ragama MOH area emphasizes the need for greater attention to disabled accessibility in the country.Item A Six-step process to reduce bullying in schools; The content of a health promotion intervention to reduce bullying among early adolescents in a rural school in Sri Lanka(2021) Jayasinghe, V.P.K.K; Guruge, G.N.D.; Perera, K.M.N.ABSTRACT: Bullying is a form of aggression which has negative impacts on health. Bullying acts are reported to be common among early adolescents in rural schools in Sri Lanka. It is timely to design and implement interventions aiming to reduce bullying in schools in Sri Lanka. In this article, we aim to describe the process and the content of a health promotion intervention carried out aiming to reduce bullying among early adolescents in a rural school in Sri Lanka. The intervention is comprised of a six-step process. A logical framework developed based on Samarasinghe et al (2011) was used to guide the intervention. The content of the intervention was designed following health promotion principles. Health promotion aims for empowering people-to take collective community actions aiming to achieve desired health outcomes. The intervention for bullying was designed aiming for empowering early adolescents -to generate collective actions to reduce bullying in their school. In the intervention, adolescents not merely participated but also engaged and involved in modifying the planned intervention. Different activities, brainstorming sessions, facilitated discussions, role plays, etc. were carried out in the process. In this intervention, the health promotion approach we employed enabled engagement and involvement of adolescents beyond mere participation in the intervention. KEYWORDS: adolescents, bullying, health promotion, schoolItem Validity and clinical utility of a Sinhalese version of the abnormal involuntary movement scale (AIMS)(Sri Lanka College of Psychiatrists, 2021) Baminiwatta, A.K.A.B.; Gunesekara, T.; Kuruppuarachchi, K.A.L.A.; Hapangama, A.; Harshini, M.L.; Bandara, T.R.; Perera, K.M.N.INTRODUCTION: Tardive dyskinesia (TD) is a movement disorder caused by long-term treatment with dopamine antagonists such as antipsychotics. As there is no medication universally effective for TD, prevention is important. We propose that non-medical clinicians working in psychiatry can also be trained and involved in a screening programme for TD. To facilitate such a programme, validation of a standard tool translated to Sinhala is a need. AIMS: To translate and validate the Abnormal Involuntary Movement Scale (AIMS) into Sinhala. METHODS: Translation and pilot testing followed standard guidelines. The translated version was administered by five raters (two registrars in psychiatry, a medical officer, a community psychiatry nurse (CPN) and a psychiatric social worker) amongst patients treated with antipsychotic medication for a minimum of one year. The goldstandard diagnosis was the Diagnostic and Statistical Manual (DSM)-5 criteria, applied by a psychiatrist. RESULTS: Of the 137 patients screened (53.3% male; mean age = 49 years), the percentage of patients diagnosed with TD using AIMS and DSM-5 were 33% and 34%, respectively. The sensitivity and specificity of AIMS in detection of TD were 67% and 83.4% respectively. The degree of agreement between the AIMS and DSM- 5 indicated moderate criterion validity (Cohen's kappa= 0.5). For different raters, the agreement with the psychiatrist's diagnosis (kappa) ranged from 0.41 (CPN) to 0.63 (registrar), indicating modest reliability between raters. CONCLUSIONS: Our findings provide preliminary evidence for the validity of AIMS in detecting TD among Sinhalaspeaking patients, when administered by a range of mental health professionals. KEYWORDS: Tardive dyskinesia, Abnormal involuntary movement scale