Medicine
Permanent URI for this communityhttp://repository.kln.ac.lk/handle/123456789/12
This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
Browse
39 results
Search Results
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 Community driven tobacco surveillance system: Engaging communities to monitor tobacco industry using a mobile app(EUEP European Publishing, 2021) Perera, C.N.S; Perera, K.M.N.; Wijesuriya, H.; Kandeepan, S.; Periyannan, D.; Lakmal, P.A.C.S.; Fernando, A.B.I.; Rajasuriya, M.INTRODUCTION: Centre for Combating Tobacco (CCT) is the tobacco observatory in Sri Lanka established under the FCTC Article 5.3. CCT has experimented several resource-efficient methods in low-resource settings. Sri Lanka, a developing lower-middle income country, reports user rates closer to 100% for smart mobile device and social media. OBJECTIVES: To effectively engage the public in monitoring tobacco industry interference and activities (TIIA) METHODS: “Tobacco Unmasked HotSpots” (TU-HotSpots) mobile app, was developed and launched in two stages. The preliminary launch (May 2018) was to pilot the app for feasibility and acceptability. A community network to monitor TIIA, Community-Driven Tobacco Surveillance System (CDTSS) using an upgraded app (based on the pilot project findings) was launched in March 2019. Freely downloadable from any mobile app store, TU-HotSpots enables registered users to report TIIA under three categories: “Report a HotSpot” (geographical location of TIIA (Articles 5.3, 6, 12, 13, 15, 16), “Interference through Media” (Article 13) and “Tobacco Industry contacted me” (Article 5.3). Data is fed to the TU-HotSpots Map, a website with an interactive map and a dashboard of interactive graphs and charts after reviewing and approval by the CCT team. RESULTS: Two evaluations done to explore the feasibility and acceptability revealed that 91.4% (n=54) agreed this app would be useful in tobacco control and 82.8% (n=48) stated that it would be accepted by the public. Inadequate technological knowledge and interrupted online connection were the perceived challenges for implementation. Active promotion using organized trainings among youth and field officers were the main suggestions for improvement. As at October 2019, 289 registrants reported 786 incidents; with 315 approved “Report a HotSpot” and 383 approved “Interference through Media” reports. “Tobacco Industry contacted me” category only had a one reporting. CONCLUSION(S):A mobile app coupled with an actively established community network is an effective tool to engage the public in monitoring TIIA.Item Tobacco industry targeting political giants in Sri Lanka: Presidential candidates 2019(EUEP European Publishing, 2021) Kandeepan, S.; Perera, C.; Wijesuriya, H.; Dias, I.S.; Periyannan, D.; Perera, K.M.N.; Rajasuriya, M.INTRODUCTION: The presidential election to elect the 7th Executive President of Sri Lanka was held on November 2019. Ceylon Tobacco Company (CTC), a subsidiary of British American Tobacco (BAT), holds the monopoly of manufacturing and selling cigarettes in Sri Lanka, which has a comprehensive ban on tobacco advertisement, promotion and sponsorship under the National Authority on Tobacco and Alcohol (NATA) Act. OBJECTIVES: To explore tobacco industry (TI) engagements of the 2019 presidential election candidates. METHODS: Investigative research techniques were used. Key informant interviews, news reports, online content, industry reports and community-level documentary evidence were used. A deductive data analysis approach was used based on the themes ‘type of engagement’, ‘TI investment’ and ‘potential impact’. RESULTS: All three top ranked candidates depicted a positive result. Two had a history of direct engagement with the CTC and the other declared support for beedi industry during the election campaign. The engagements of the candidate who was a former Defence Secretary included accepting sponsorships to construct police stations and Army welfare shops. Police are one of the authorized officers of the NATA Act and Sri Lanka Army distributed tax free cigarettes for its soldiers until recent past. The candidate who was a former Agriculture Minister accepted CTC sponsorships for renovation of water reservoirs. CTC cultivates almost all tobacco they need for manufacturing cigarettes and is accused of exploiting the Sri Lankan farmers during the process. One candidate was the guest of honour of the opening ceremony of a pilgrim’s rest in a Buddhist shrine constructed with CTC sponsorship (around 70% of Sri Lankans are Buddhists). All TI engagements of these leading politicians received positive media coverage. CONCLUSION(S): TI engaging main political figures in Sri Lanka has potential to cause serious policy implications, thus, highlights the need for a national policy for implementation of the FCTC Article 5.3.Item Tobacco industry interference against the single stick cigarette sales ban(EUEP European Publishing, 2021) Kandeepan, S.; Perera, K.M.N.; Wijesuriya, H.; Perera, C.S.; Rajasuriya, M.INTRODUCTION: Sri Lanka implemented 80% Pictorial Health Warnings and is planning to implement standardised packaging. However, a considerable proportion of smokers buy cigarettes in the loose form. Sale of cigarettes as single sticks promotes smoking among minors, beginners and poor due to high affordability and accessibility. In September 2018, Health Minister proposed to ban sale of single sticks as recommended by the Framework Convention on Tobacco Control. The proposal failed to gain Cabinet approval preventing its implementation. OBJECTIVES: This study aimed to explore the tobacco industry’s tactics in sabotaging the proposed ban on single stick sale of cigarettes in Sri Lanka. METHODS: Investigative research techniques were used. Content analysis was carried out on identified web posts and documents to determine the tobacco industry’s strategic involvement, their front groups and arguments used. RESULTS: First argument, the ban would reduce government tax revenue due to reduction of cigarette sales, was made by three parties: cigarette industry, media and Minister of Finance (MoF). The strongest advocate against the ban was the Tobacco Retailer’s Association (TRA), backed by the Ceylon Tobacco Company (CTC). TRA’s argued that retail business would be impacted, again because of reduced sales. TRA directly advocated MoF via a meeting. Third argument, used by the MoF was that the ban would increase beedi use. The cabinet rejected the ban as MoF and three other ministers opposed. CONCLUSION(S): CTC successfully interfered in the ban on single sticks cigarette sale through the TRA, media and the MoF, arguing that resulting reduced cigarette sales would generate a negative impact.Item Advocating university undergraduate students on implementing FCTC Article 5.3(EUEP European Publishing, 2021) Kandeepan, S.; Perera, K.M.N.; Wijesuriya, H.; Perera, C.S.; Rajasuriya, M.INTRODUCTION: Tobacco industry uses aggressive strategies to use to make people want to buy their products, especially youths. Therefore It is needed to enhance the knowledge about industry tactics among the youngsters. OBJECTIVES: Establishment of network with university undergraduates to combat tobacco industry interferences in public health in Sri Lanka. METHODS: Centre for Combating Tobacco (CCT) organized a series of advocacy sessions on Tobacco Industry Impact on Public Health and Framework Convention on Tobacco Control (FCTC) Article 5.3 targeting the university undergraduates in Sri Lanka. The first session was held on June 23rd, 2019. It was organized by a group of undergraduates currently working as volunteers with CCT to empower their peers in state university science stream faculties of the Western Province. In this session Industry’s impact on substance use and public health and direct and indirect promotion strategies, Tobacco industry interference in Sri Lanka, FCTC Article 5.3 and current activities by CCT to monitor tobacco industry interference on public health and implementation of FCTC Article 5.3 in Sri Lanka were discussed. Networking and establishment of action committees to support CCT activities with university undergraduate students were discussed. Results Opportunities for best practice strategies for tobacco interference control were identified. Policy adherence and enforcement was improved to raising the awareness with students. CONCLUSION(S): A majority of students supported the advocacy programme. A Network with university students was formed to combat the tobacco industry interference.