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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Effects of indoor air pollution on the development of children under five years of age in Sri Lanka(MDPI, 2022) Ranathunga, N.; Perera, P.; Nandasena, S.; Sathiakumar, N.; Kasturiratne, A.; Wickremasinghe, R.Air pollution is a multifaceted environmental toxin affecting the Central Nervous System (CNS) through diverse pathways. The CNS of young children is particularly susceptible to the detrimental effects of toxins, as brain development continues postnatally with the formation of interneuronal connections, glial cell proliferation and myelination of axons. Indoor air pollution (IAP) from solid fuel combustion is more harmful than outdoor air pollution. Numerous air pollutants hazardous to health are released during the burning of unprocessed biomass. The primary source of fuel in Sri Lanka for cooking is biomass, mainly wood. In this study, we evaluated the influence of IAP resulting from biomass combustion on the neurodevelopment of children. In a cohort of children under five years living in a semi-urban area of Sri Lanka, neurodevelopment was assessed using Denver II developmental screening test. Air quality levels were measured (Carbon Monoxide (CO) and Particulate Matter 2.5 (PM2.5)) in a subsample. There were significantly high levels of CO and PM2.5 in the ambient air of households using biomass as the primary fuel for cooking. Children living in these households had a significantly higher number of children with ‘suspect’ developmental assessment scores in the language, social behavior and play and gross motor development domains.Item Effects of indoor air pollution due to solid fuel combustion on physical growth of children under 5 in Sri Lanka: A descriptive cross sectional study(Public Library of Science, 2021) Ranathunga, N.; Perera, P.; Nandasena, S.; Sathiakumar, N.; Kasturiratne, A.; Wickremasinghe, A.R.ABSTRACT: Solid fuel combustion is an important risk factor of morbidity. This study was conducted to determine the effect of indoor air pollution (IAP) due to solid fuel combustion on physical growth in 262 Sri Lankan children under five. Exposure was defined by the type of fuel used for cooking. Pollutant levels were measured in a subsample of households. "High" exposure group (households using biomass fuel/kerosene oil for cooking) comprised 60% of the study population; the prevalence of wasting was 19.7% and underweight was 20.4% in the entire population where 68% were from the high exposure group. Children from the "high" exposure group had significantly lower mean z-scores for weight-for-height (p = 0.047), height-for-age (p = 0.004) and weight-for-age (p = 0.001) as compared to the "low" exposure group (children of households using liquefied petroleum gas and/or electricity) after adjusting for confounders. Z-scores of weight-for-age, height-for-age and weight-for-height were negatively correlated with CO (p = 0.001, 0.018, 0.020, respectively) and PM2.5 concentrations (p<0.001,p = 0.024 p = 0.008, respectively). IAP due to combustion of biomass fuel leads to poor physical growth.Item Effect of household air pollution due to solid fuel combustion on childhood respiratory diseases in a semi urban population in Sri Lanka.(BioMed Central, 2019) Ranathunga, N.; Perera, P.; Nandasena, S.; Sathiakumar, N.; Kasturiratne, A.; Wickremasinghe, R.BACKGROUND:Household air pollution from combustion of solid fuels for cooking and space heating is one of the most important risk factors of the global burden of disease. This study was aimed to determine the association between household air pollution due to combustion of biomass fuel in Sri Lankan households and self-reported respiratory symptoms in children under 5 years. METHODS: A prospective study was conducted in the Ragama Medical Officer of Health area in Sri Lanka. Children under 5 years were followed up for 12 months. Data on respiratory symptoms were extracted from a symptom diary. Socioeconomic data and the main fuel type used for cooking were recorded. Air quality measurements were taken during the preparation of the lunch meal over a 2-h period in a subsample of households. RESULTS: Two hundred and sixty two children were followed up. The incidence of infection induced asthma (RR = 1.77, 95%CI;1.098-2.949) was significantly higher among children resident in households using biomass fuel and kerosene (considered as the high exposure group) as compared to children resident in households using Liquefied Petroleum Gas (LPG) or electricity for cooking (considered as the low exposure group), after adjusting for confounders. Maternal education was significantly associated with the incidence of infection induced asthma after controlling for other factors including exposure status. The incidence of asthma among male children was significantly higher than in female children (RR = 1.17; 95% CI 1.01-1.37). Having an industry causing air pollution near the home and cooking inside the living area were significant risk factors of rhinitis (RR = 1.39 and 2.67, respectively) while spending less time on cooking was a protective factor (RR = 0.81). Houses which used biomass fuel had significantly higher concentrations of carbon monoxide (CO) (mean 2.77 ppm vs 1.44 ppm) and particulate matter2.5 (PM2.5) (mean 1.09 mg/m3 vs 0.30 mg/m3) as compared to houses using LPG or electricity for cooking. CONCLUSION: The CO and PM2.5 concentrations were significantly higher in households using biomass fuel for cooking. There was a 1.6 times higher risk of infection induced asthma (IIA) among children of the high exposure group as compared to children of the low exposure group, after controlling for other factors. Maternal education was significantly associated with the incidence of IIA after controlling for exposure status and other variables.Item Building global partnerships through shared curricula for an MPH programme in India and Sri Lanka.(Informa Healthcare, 2019) Sathiakumar, N.; Tipre, M.; Wickremasinghe, R.; Bhat, V.; Kadir, M. M.; Coggon, D.; Pathemeswaran, A.; Kamath, R.; Arunkumar, G.; Fatmi, Z.; Smith, T. L.; Pattanshetty, S. M.; Delzell, E.OBJECTIVE:To design and implement a locally relevant competency- based MPH programme. METHODS:The demand for trained public health professionals in South Asia is enormous and growing, which created a unique opportunity for a Fogarty International Center-funded University of Alabama at Birmingham-South Asia [Aga Khan University, Pakistan; Manipal Academy of Higher Education, India; and University of Kelaniya, Sri Lanka] international research training in environmental and occupational health (ITREOH) programme. In 2009, a Master of Public Health (MPH) degree programme was designed using a combination of competencies developed by the Association of School of Public Health, the World Health Organization and the Centers for Disease Control and Prevention. RESULTS: A competency- based curriculum was developed with two specialty tracks in applied epidemiology and environmental and occupational health, emphasising applied practice and research. CONCLUSIONS: This is the most comprehensive skill-based MPH programme in the region, which positions each institution as a regional leader in public health training. The success of the programme has been amply demonstrated by placements of graduated MPH students in leadership roles in public, private and academic sectors within their countries.Item Epidemiological differences between localized and nonlocalized low back pain(Lippincott Williams & Wilkins, 2017) Coggon, D.; Ntani, G.; Walker-Bone, K.; Palmer, K.T.; Felli, V.E.; Harari, R.; Barrero, L.H.; Felknor, S.A.; Gimeno, D.; Cattrell, A.; Vargas-Prada, S.; Bonzini, M.; Solidaki, E.; Merisalu, E.; Habib, R.R.; Sadeghian, F.; Kadir, M.M.; Warnakulasuriya, S.S.; Matsudaira, K.; Nyantumbu, B.; Sim, M.R.; Harcombe, H.; Cox, K.; Sarquis, L.M.; Marziale, M.H.; Harari, F.; Freire, R.; Harari, N.; Monroy, M.V.; Quintana, L.A.; Rojas, M.; Harris, E.C.; Serra, C.; Martinez, J.M.; Delclos, G.; Benavides, F.G.; Carugno, M.; Ferrario, M.M.; Pesatori, A.C.; Chatzi, L.; Bitsios, P.; Kogevinas, M.; Oha, K.; Freimann, T.; Sadeghian, A.; Peiris-John, R.J.; Sathiakumar, N.; Wickremasinghe, A.R.; Yoshimura, N.; Kelsall, H.L.; Hoe, V.C.; Urquhart, D.M.; Derrett, S.; McBride, D.; Herbison, P.; Gray, A.; Vega, E.J.STUDY DESIGN: Cross-sectional survey with longitudinal follow-up OBJECTIVES.: To test the hypothesis that pain which is localised to the low back differs epidemiologically from that which occurs simultaneously or close in time to pain at other anatomical sites SUMMARY OF BACKGROUND DATA.: Low back pain (LBP) often occurs in combination with other regional pain, with which it shares similar psychological and psychosocial risk factors. However, few previous epidemiological studies of LBP have distinguished pain that is confined to the low back from that which occurs as part of a wider distribution of pain. METHODS: We analysed data from CUPID, a cohort study that used baseline and follow-up questionnaires to collect information about musculoskeletal pain, associated disability and potential risk factors, in 47 occupational groups (office workers, nurses and others) from 18 countries. RESULTS: Among 12,197 subjects at baseline, 609 (4.9%) reported localised LBP in the past month, and 3,820 (31.3%) non-localised LBP. Non-localised LBP was more frequently associated with sciatica in the past month (48.1% vs. 30.0% of cases), occurred on more days in the past month and past year, was more often disabling for everyday activities (64.1% vs. 47.3% of cases), and had more frequently led to medical consultation and sickness absence from work. It was also more often persistent when participants were followed up after a mean of 14 months (65.6% vs. 54.1% of cases). In adjusted Poisson regression analyses, non-localised LBP was differentially associated with risk factors, particularly female sex, older age and somatising tendency. There were also marked differences in the relative prevalence of localised and non-localised LBP by occupational group. CONCLUSIONS: Future epidemiological studies should distinguish where possible between pain that is limited to the low back and LBP which occurs in association with pain at other anatomical locations.Item Quest to identify geochemical risk factors associated with chronic kidney disease of unknown etiology (CKDu) in an endemic region of Sri Lanka-a multimedia laboratory analysis of biological, food, and environmental samples(Springer, 2016) Levine, K.E.; Redmon, J.H.; Elledge, M.F.; Wanigasuriya, K.P.; Smith, K.; Munoz, B.; Waduge, V.A.; Periris-John, R.J.; Sathiakumar, N.; Harrington, J.M.; Womack, D.S.; Wickremasinghe, R.The emergence of a new form of chronic kidney disease of unknown etiology (CKDu) in Sri Lanka's North Central Province (NCP) has become a catastrophic health crisis. CKDu is characterized as slowly progressing, irreversible, and asymptomatic until late stages and, importantly, not attributed to diabetes, hypertension, or other known risk factors. It is postulated that the etiology of CKDu is multifactorial, involving genetic predisposition, nutritional and dehydration status, exposure to one or more environmental nephrotoxins, and lifestyle factors. The objective of this limited geochemical laboratory analysis was to determine the concentration of a suite of heavy metals and trace element nutrients in biological samples (human whole blood and hair) and environmental samples (drinking water, rice, soil, and freshwater fish) collected from two towns within the endemic NCP region in 2012 and 2013. This broad panel, metallomics/mineralomics approach was used to shed light on potential geochemical risk factors associated with CKDu. Based on prior literature documentation of potential nephrotoxins that may play a role in the genesis and progression of CKDu, heavy metals and fluoride were selected for analysis. The geochemical concentrations in biological and environmental media areas were quantified. Basic statistical measurements were subsequently used to compare media against applicable benchmark values, such as US soil screening levels. Cadmium, lead, and mercury were detected at concentrations exceeding US reference values in many of the biological samples, suggesting that study participants are subjected to chronic, low-level exposure to these elements. Within the limited number of environmental media samples, arsenic was determined to exceed initial risk screening and background concentration values in soil, while data collected from drinking water samples reflected the unique hydrogeochemistry of the region, including the prevalence of hard or very hard water, and fluoride, iron, manganese, sodium, and lead exceeding applicable drinking water standards in some instances. Current literature suggests that the etiology of CKDu is likely multifactorial, with no single biological or hydrogeochemical parameter directly related to disease genesis and progression. This preliminary screening identified that specific constituents may be present above levels of concern, but does not compare results against specific kidney toxicity values or cumulative risk related to a multifactorial disease process. The data collected from this limited investigation are intended to be used in the subsequent study design of a comprehensive and multifactorial etiological study of CKDu risk factors that includes sample collection, individual surveys, and laboratory analyses to more fully evaluate the potential environmental, behavioral, genetic, and lifestyle risk factors associated with CKDu.Item Descriptive Epidemiology of Somatising Tendency: Findings from the CUPID Study(Public Library of Science, 2016) Vargas-Prada, S.; Coggon, D.; Ntani, G.; Walker-Bone, K.; Palmer, K.T.; Felli, V.E.; Harari, R.; Barrero, L.H.; Felknor, S.A.; Gimeno, D.; Cattrell, A.; Bonzini, M.; Solidaki, E.; Merisalu, E.; Habib, R.R.; Sadeghian, F.; Kadir, M.M.; Warnakulasuriya, S.S.; Matsudaira, K.; Nyantumbu, B.; Sim, M.R.; Harcombe, H.; Cox, K.; Sarquis, L.M.; Marziale, M.H.; Harari, F.; Freire, R.; Harari, N.; Monroy, M.V.; Quintana, L.A.; Rojas, M.; Harris, E.C.; Serra, C.; Martinez, J.M.; Delclos, G.; Benavides, F.G.; Carugno, M.; Ferrario, M.M.; Pesatori, A.C.; Chatzi, L.; Bitsios, P.; Kogevinas, M.; Oha, K.; Freimann, T.; Sadeghian, A.; Peiris-John, R.J.; Sathiakumar, N.; Wickremasinghe, A.R.; Yoshimura, N.; Kelsall, H.L.; Hoe, V.C.; Urquhart, D.M.; Derrett, S.; McBride, D.; Herbison, P.; Gray, A.; Vega, E.J.Somatising tendency, defined as a predisposition to worry about common somatic symptoms, is importantly associated with various aspects of health and health-related behaviour, including musculoskeletal pain and associated disability. To explore its epidemiological characteristics, and how it can be specified most efficiently, we analysed data from an international longitudinal study. A baseline questionnaire, which included questions from the Brief Symptom Inventory about seven common symptoms, was completed by 12,072 participants aged 20-59 from 46 occupational groups in 18 countries (response rate 70%). The seven symptoms were all mutually associated (odds ratios for pairwise associations 3.4 to 9.3), and each contributed to a measure of somatising tendency that exhibited an exposure-response relationship both with multi-site pain (prevalence rate ratios up to six), and also with sickness absence for non-musculoskeletal reasons. In most participants, the level of somatising tendency was little changed when reassessed after a mean interval of 14 months (75% having a change of 0 or 1 in their symptom count), although the specific symptoms reported at follow-up often differed from those at baseline. Somatising tendency was more common in women than men, especially at older ages, and varied markedly across the 46 occupational groups studied, with higher rates in South and Central America. It was weakly associated with smoking, but not with level of education. Our study supports the use of questions from the Brief Symptom Inventory as a method for measuring somatising tendency, and suggests that in adults of working age, it is a fairly stable trait.Item Household air pollution research and policy: a worked example(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Sathiakumar, N.OBJECTIVES: 1) To describe the importance of scientific evidence in policy development in the area of household air pollution 2) To present a framework on designing evidence based interventions and policy on exposure reduction related to household air pollution The future of policy development in the area of household air pollution (HAP) depends on credible scientific data that documents the health risks associated with HAP. In most instances, it is necessary to base decisions on the evidence generated elsewhere and to make inferences about the extent to which this evidence is generalizable to another location or country. The ways in which elements of the structural, physical, social and/or cultural environmental factors can influence HAP and how these factors may influence the effectiveness of interventions to reduce HAP exposure are discussed. A framework to be used by public health professionals who are designing, executing, reporting and synthesizing research on HAP, designing and implementing interventions for HAP exposure reduction or formulating policy is suggested.Item Socio-demographic characteristics and principal cooking fuel type in Sri Lanka: comparison of data from two Demographic and Health Surveys(College of Community Physicians of Sri Lanka, 2009) Nandasena, Y.L.S.; Wickremasinghe, A.R.; Sathiakumar, N.INTRODUCTION: Indoor air pollution is a growing public health concern due to its well documented ill effects. Biomass- cooking fuel is the main source of indoor air pollution in the majority of households in the developing world. OBJECTIVES: To determine the trends of cooking fuel pattern and associated factors in Sri Lanka. METHODS: Determinants and the use of cooking fuel in households in Sri Lanka were abstracted from data collected by the Demographic Health Surveys (DHS) of 2000 and 2007. The DHS was based on a representative sample (multi-stage stratified probability sample) of the whole country except the provinces afflicted by the war. The results are based on a sample of 8,169 households in 2000 and 19,862 households in 2007. RESULTS: Firewood was the principal type of cooking fuel in 78.3%(n=6397) and 78.5%(n=15592) of households in years 2000 and 2007, respectively. In 2007, 96.3%(n=897) of estate sector households used firewood as compared to 84.2%(n=13850) in the rural and 34.6%(n=859) in the urban sector. Similar trends were seen in year 2000 as well. Electricity was the main source of lighting in 68%(n=5571) of households in year 2000 and the corresponding figure for year 2007,was 80%(n=15890). In year 2000, 25.9%(n=1442) of the houses having electricity used clean fuel (electricity/ LP gas) for cooking and the rest relied on biomass or kerosene. The higher the educational level of the respondent, the more likely the household will use a clean fuel (Chi square for trend: p<0.001). CONCLUSION: 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 Fine particle air pollution due to secondhand smoke in selected public places in Colombo(College of Community Physicians of Sri Lanka, 2009) Nandasena, Y.L.S.; Wickremasinghe, A.R.; Lee, K.; Sathiakumar, N.INTRODUCTION: Globally, about five million deaths per year are attributed to tobacco smoke. Secondhand smoke accounts for a substantial proportion of these deaths. Most countries including Sri Lanka have legislation banning smoking in indoor workplaces and public places. Certain public places such as entertainment venues continue to permit smoking. Particulate matter (PM2.5) is a widely accepted indicator to evaluate secondhand smoke levels. OBJECTIVE: To determine PM2.5 concentrations in selected public places (defined as a space which can be visited without permission) in Colombo, Sri Lanka. METHODS: Using convenient sampling technique, we measured PM2.5 concentration levels in four types of public places (restaurants: n=6; bars: n=6; cafes: n=4; pubs and entertainment venues: n=4) during January to March, 2009. A particulate matter monitor (Model AM510 - SIDEPAK Personal Aerosol Monitor) was used to measure indoor air quality for 40 minutes and the immediate outdoors for 10 minutes before and after the indoor measurement. RESULTS: The mean indoor PM2.5 concentration was 124.9 ug/m3 (SD± 81.0) [range 33 ug/m3 - 299 ug/m3; median, 97.0 ug/m3]. The mean outdoor PM2.5 concentration was 39.7 ug/m3 (±14.3) [range 18 ug/m - 83 ug/m3; median, 37.5 ug/m3]. Indoor to outdoor (I/O) PM2.5 ratio ranged from 1.1 to 14.9. The highest PM2.s concentration was recorded in a bar and the highest I/O ratio in an entertainment venue. Smoking density (number of burning cigarettes divided by volume of the public place) was not correlated with average indoor PM2.5 concentration (Pearson correlation = 0.36, p=0.12) or with I/O PM2.5 ratio (Pearson correlation = 0.07, p=0.76). The reported values are equal or above, compared to such venues in other countries. CONCLUSION: The authorities should take steps in enforcing the smoking ban in public places. Areas where smoking is permitted, proper ventilation should be ensured.