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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 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 Stakeholders' perspectives on the provision of vocational training for youth with disabilities in Sri Lanka: protocol for a mixed-methods study(BMJ Publishing Group Ltd, 2022) Colonne, U.T.; Dharmarathna, I.; Siriwardhana, D.D.; Handy, T.; Gamage, M.H.; Athawuda, N.; Sumanasena, S.P.Introduction: The quality and the range of vocational training (VT) courses offered to youth with disabilities (YwD) in low-middle-income countries are underexplored. This protocol describes a study designed to gather perceptions of a range of stakeholders related to the quality and relevance of VT programmes conducted by the Department of Social Services in Sri Lanka. The purpose of this study is to communicate with authorities the ways in which they can improve their services by paying close attention to the needs and recommendations of all stakeholders. Methods and analysis: A parallel mixed-methods study will be conducted at eight vocational training institutes (VTIs). A survey will be conducted with five participant groups; YwD presently enrolled in VTIs (n=358) and their caregivers (n=358), YwD who completed the VT (n=45) and their caregivers (n=45) and educators at VTIs (n=47). The qualitative component includes semi-structured interviews and focus group discussions. The three groups of participants include: educators, caregivers of potential YwD for future VT (6-10 per group) and key informants from state, corporate and non-governmental sectors (a total of 20). Quantitative and qualitative data will be analysed using descriptive and inferential statistics and cross-thematic analysis, respectively. Ethics and dissemination: This study received ethical clearance from the Ethics Review Committee, Faculty of Medicine, University of Kelaniya (Ref. No: P/15/02/2021). All data collection processes will abide by health and safety measures required by the national government. Written informed consent will be obtained from all participants. Results from this research will be disseminated, to local stakeholders and participants, via local and international conferences and publications in peer-reviewed journals.Item Parental and professional perceptions of informed consent and participation in a time-critical neonatal trial: a mixed-methods study in India, Sri Lanka and Bangladesh(BMJ Publishing Group Ltd, 2021) Pant, S.; Elias, M.A.; Woolfall, K.; Morales, M.M.; Lincy, B.; Jahan, I.; Sumanasena, S.P.; Ramji, S.; Shankaran, S.; Thayyil, S.; HELIX Trial Consortium Investigators.INTRODUCTION: Time-critical neonatal trials in low-and-middle-income countries (LMICs) raise several ethical issues. Using a qualitative-dominant mixed-methods design, we explored informed consent process in Hypothermia for encephalopathy in low and middle-income countries (HELIX) trial conducted in India, Sri Lanka and Bangladesh. METHODS: Term infants with neonatal encephalopathy, aged less than 6 hours, were randomly allocated to cooling therapy or usual care, following informed parental consent. The consenting process was audio-video (A-V) recorded in all cases. We analysed A-V records of the consent process using a 5-point Likert scale on three parameters-empathy, information and autonomy. In addition, we used exploratory observation method to capture relevant aspects of consent process and discussions between parents and professionals. Finally, we conducted in-depth interviews with a subgroup of 20 parents and 15 healthcare professionals. A thematic analysis was performed on the observations of A-V records and on the interview transcripts. RESULTS: A total of 294 A-V records of the HELIX trial were analysed. Median (IQR) score for empathy, information and autonomy was 5 (0), 5 (1) and 5 (1), respectively. However, thematic analysis suggested that the consenting was a ceremonial process; and parental decision to participate was based on unreserved trust in the treating doctors, therapeutic misconception and access to an expensive treatment free of cost. Most parents did not understand the concept of a clinical trial nor the nature of the intervention. Professionals showed a strong bias towards cooling therapy and reported time constraints and explaining to multiple family members as key challenges. CONCLUSION: Despite rigorous research governance and consent process, parental decisions were heavily influenced by situational incapacity and a trust in doctors to make the right decision on their behalf. Further research is required to identify culturally and context-appropriate strategies for informed trial participation. KEYWORDS: child health; clinical trial; public health; qualitative study; randomised control trial.Item Neurocognitive skills in children with congenital hypothyroidism attending the endocrine clinic of the Professorial Unit of the Lady Ridgeway Hospital for Children, Colombo.(Sri Lanka College of Paediatricians, 2017) Sumanasena, S.P.; Gunawardena, N.; Dissanayake, B.; Dilanka, S.; de Silva, S.This is the correspondence to the article appeared in Sri Lanka Journal of Child Health. 2016; 45 (2):95-102. by same authors,Item Neurocognitive skills in children with congenital hypothyroidism attending the endocrine clinic of the Professorial Unit of the Lady Ridgeway Hospital for Children, Colombo(Sri Lanka College of Paediatricians, 2016) Sumanasena, S.P.; Gunawardena, N.; Dissanayake, B.; Dilanka, S.; de Silva, S.BACKGROUND: Early thyroxine replacement prevents intellectual impairment due to congenital hypothyroidism (CHT). There is minimal evidence on neurodevelopmental outcome of children commenced on thyroxine during early infancy from countries not screening for CHT. OBJECTIVE: To assess the neurocognitive skills of children with CHT of age group 6-10 years, attending the endocrine clinic of the Professorial Paediatric Unit, LRH compared to age matched controls and to assess the influence of age at diagnosis, initial thyroid stimulating hormone (TSH) levels, thyroxine commencement dose and number of clinic visits in the first year on neurocognitive skills. METHOD: A retrospective study was carried out from 1st January 2010 to 1stJanuary 2011 on children with CHT of age group 6-10 years, followed up in the endocrine clinic of the Professorial Paediatric Unit, LRH. Age matched healthy children aged 6-10 years were selected from similar socioeconomic backgrounds to compare the neurocognitive attainments. Neurocognitive skills were assessed using an age appropriate battery of instruments. Children older than 10 years were excluded as the assessment tools were designed only for the age range 6-10 years. Children with other co-morbidities adversely affecting their neurocognitive development were also excluded. RESULTS: Twenty three children with CHT of age group 6-10 years were followed up in the endocrine clinic of the Professorial Paediatric Unit, LRH during the study period and 2 were excluded. Forty two age matched controls of age group 6-10 years also participated in the study. The mean age of the children was 2.42±2.59 years. The mean TSH levels at diagnosis was 43.17± 34.25mU/L. Starting dose of thyroxine in the majority was less than 10µg/kg/day. Children with CHT performed less than their peers in all age ranges and in all areas of skills. Statistically significant differences were documented in the total performance percentiles at ages of 8 (p=0.0001) and 9 years (p=0.0002). Similarly, they performed less in literacy at 8 (p=0.015) and 9 years (p=0.004), verbal performance at 8 years (p= 0.0002) and numeracy in 9 years (p=0.035). There was no significant correlation between the neurocognitive scores and age at diagnosis, initial TSH levels, thyroxine commencement dose or the number of clinic visits in the first year. CONCLUSIONS: Children with CHT of age group 6-10 years, attending the endocrine clinic of the Professorial Paediatric Unit, LRH had significantly reduced neurocognitive skills compared to age matched controls. There was no significant correlation between the neurocognitive scores and age at diagnosis, initial TSH levels, thyroxine commencement dose or number of clinic visits in the first year.Item Protocol for the Sri Lankan Cerebral Palsy Register pilot study(BMJ Publishing Group Ltd., 2020) Heiyanthuduwage, T.M.; Sumanasena, S.P.; Kitnasamy, G.; Sheedy, H. S.; Khandaker, G.; Fernando, R.; Wijesekara, S.; Jagoda, J.; Ratnayake, P.; Wanigasinghe, J.; Mclntyre, S.; Goldsmith, S.; Waight, E.; Badawi, N.; Muhit, M.; Muttiah, N.INTRODUCTION: Cerebral palsy (CP) describes a heterogeneous group of motor disorders resulting from disturbance in the developing brain. CP occurs in approximately 2.1 per 1000 live births in high-income countries, but in low- and middle-income countries (LMICs) the prevalence and severity of CP may be greater and aetiological risk factors different. In Sri Lanka, a LMIC, there have been no epidemiological studies of CP to date. Systematically collected data are required to identify opportunities for primary and secondary prevention, to plan and establish services to support children and adults with CP and their families and to act as a sampling frame for new research. Here we describe a pilot study protocol for a CP register in Sri Lanka. METHODS AND ANALYSIS: The aim of this study is to establish a CP register in Sri Lanka. We will use different surveillance methodologies in two provinces of Sri Lanka: hospital and community surveillance in the Western Province and community surveillance in the Eastern Province. A common record form will collect demographic, clinical and service data for children with CP <18 years living in these two provinces. Data will be transferred to a secure online data repository and used to describe the epidemiology of CP in these regions. We will describe the strengths and challenges of the surveillance mechanisms and estimate the resources required for ongoing hospital and community based surveillance in the Western and Eastern provinces and to include additional provinces across the country. ETHICS AND DISSEMINATION: This study has ethical clearance from The University of Kelaniya, National Health Research Council, the Institutional Ethics Review Committee of the Lady Ridgeway Hospital, Colombo South Teaching Hospital and the Director of the North Colombo Teaching Hospital. Results from this research will be disseminated through local and international conferences and through publications in peer-reviewed journals. KEYWORDS: developmental neurology & neurodisability; perinatology; public health; rehabilitation medicine.Item Beyond survival: 5-year neurodevelopmental follow-up of a cohort of preterm infants in Colombo, Sri Lanka(Maney Publishing, 2018) Sumanasena, S.P.; Vipulaguna, D.V.; Mendis, M.M.; Gunawardena, N.S.BACKGROUND: There is a lack of information on long-term neurodevelopmental outcome in preterm neonates in low- and middle-income countries. OBJECTIVES: To describe the developmental attainments of preterm neonates followed up for 5 years and to identify the risk factors for impairment. METHOD: A prospective descriptive cohort study was undertaken in neonates of 34 weeks gestation born within a period of 12 months at a single tertiary maternity and neonatal unit in Colombo, Sri Lanka. Infants were assessed for neurodevelopment using the Bayley Infant and Toddler III® Assessments at 6, 12 and 24 months of corrected age and school readiness assessment at 5 years. RESULTS: Fifty-one infants were assessed at least once, 45 were assessed at 2 years and 39 had a final assessment at 5 years. Neurodevelopmental attainment deteriorated significantly in the cognitive and motor composite scores from 6 to 24 months (p < 0.05). By 5 years the number of children with delay in cognitive, language and motor domains had reduced significantly from 24 months (p < 0.05) but the cognitive skills remained most affected (10/39). At 5 years, 13 of 39 children had a confirmed diagnosis of a neurodevelopmental disorder: eight had attention deficit hyperactivity disorder, three autism spectrum disorder, one cerebral palsy and one visual impairment. Surfactant administration and retinopathy of prematurity were the most significant risks for delayed development at 5 years (p < 0.05). CONCLUSION: Deterioration of cognitive and motor composite scores over the first 24 months highlights the need for regular surveillance of premature infants. There was a discrepancy between the diagnosis of neurodevelopmental delay at 24 months and at 5 years. But the notable impact on school readiness skills requires public health initiatives to cater for the needs of these children.Item The perspectives of a selected group of families and teachers from Sri Lanka on high- technology augmentative and alternative communication devices(Faculty of Medicine, University of Kelaniya, 2014) Weerasinghe, Y.; Sumanasena, S.P.Weerasinghe, Y. and Sumanasena, S.P., 2014. The perspectives of a selected group of families and teachers from Sri Lanka on high- technology augmentative and alternative communication devices. In: Voice for All – Speech and Language Therapy, Audiology and Disability Conference Book of Abstracts, Department of Disability Studies, Faculty of Medicine, University of Kelaniya, p. 24.Item Excluded in inclusive schools: experiences of children with disabilities, their families and teachers in Sri Lanka(VU e-Publishing, Netherlands, 2013) Abeywickrama, S.P.; Jayasinghe, I.K.; Sumanasena, S.P.Purpose: This study examined the experiences of children with disabilities, their parents and teachers at the special education units in 3 public schools, located in the Kandy district of Sri Lanka. Method: The participants were 20 children with disabilities, 18 parents and 8 teachers. In order to examine the influence of physical, social and psychological environments on children’s participation in learning, this qualitative study employed participatory tools, in-depth interviews, focus group discussions and non-participatory observations. The data were manually coded using thematic analysis. Results: Five themes emerged: attitudes, values and beliefs; support and relationships; devices and technology; natural and built environment; and services systems and policies. Factors facilitating or hindering learning were identified within each theme. Parents and teachers tend to focus on the children’s impairments and academic achievements. However, extracurricular activities and supportive relationships were found to promote student participation. Conclusions: Overall, the current practices in Sri Lankan education for children with disabilities did not meet the global recommendations. There is a need to design culturally compatible inclusive education models and to achieve a paradigm shift within all communities towards inclusion