Medicine

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Challenges faced in establishing a pediatric liver transplant program in a lower‐middle‐income country with free healthcare service
(Wiley, 2024) Fernando, M.; Tillakaratne, S.; Gunetilleke, B.; Liyanage, C.; Appuhamy, C.; Weerasuriya, A.; Uragoda, B.; Welikala, N.; Ranaweera, L.; Ganewatte, E.; Dissanayake, J.; Mudalige, A.; Siriwardana, R.
ABSTRACT: BACKGROUND: Liver transplant is the cure for children with liver failure. Sri Lanka is a lower-middle-income country with a predominant free, state health system. Pediatric liver transplant program in Sri Lanka is still in the budding state where the initial experience of the program is yet to be documented. METHODS: A retrospective review was performed including the clinical characteristics of all pediatric liver transplant recipients of Colombo North Centre for Liver Diseases since the inception of the program from June 2020 to May 2023. RESULTS: There were 14 PLT performed in 3 years. The median recipient age and weight were 8 years (6 months–15 years) and 23.3 kg (6.4–49.2), respectively. The majority were boys (64%). All were from low-income backgrounds. Indications for LT were acute liver failure (5/14), decompensated chronic liver disease (5/14), and acute on chronic liver failure (4/14). Underlying liver diseases were Wilson disease (6/14), autoimmune liver disease (3/14), biliary atresia (2/14) and progressive familial intrahepatic cholestasis type 3 (1/14), and unknown etiology (2/14). The majority were living donor liver transplants (86%). Of the living donors, 42% (5/12) were Buddhist priests. There were three immediate deaths and two late deaths. The 3-month survival was 78%, and overall survival was 64%. Living donor transplants carried a higher success rate (92%) compared to diseased donor transplants (0%; 2/2). CONCLUSIONS: Initial experience of pediatric liver transplant program of Sri Lanka is promising despite being established in a free healthcare system amidst the crisis circumstances.
Screen addiction among children and adolescents and the self-efficacy of mothers in screen use management during the COVID-19 lockdown in Sri Lanka
(Sri Lanka College of Psychiatrists, 2023) Baminiwatta, A.; Nanayakkara, T.D.; Fernando, A.; Wijethunga, S.
BACKGROUND: The prevalence of problematic screen use (PSU) or “screen addiction” among children and adolescents may have escalated during the COVID-19 pandemic. The self-efficacy of the mothers in managing screen use in their children may play an important preventive role in children developing PSU. AIMS: This study aimed to assess PSU among children aged 4-18 years during the lockdown period imposed during the COVID-19 pandemic and to explore the association between PSU and self-efficacy of mothers in managing screen use. METHODS: An online survey was conducted using social media groups among mothers of children aged 4-18 years. The PSU in their children was measured using the Problematic Media Use Measure (PMUM), and maternal self-efficacy in managing screen use was assessed using the Parental Screen Use Management Scale (PSUMS). The two questionnaires were translated and validated into Sinhala prior to this study. RESULTS: A total of 320 mothers responded to the survey. Based on the PMUM cut-off score, 25.3% of the children were found to have PSU. PSU was inversely correlated with maternal self-efficacy in managing screen use (r=-0.63, p<0.001). All three subscales of the PSUMS; reactive management (r=-0.56, p<0.001), proactive management (r=-52, p<0.001), and monitoring (r =-45, p<0.001), were significantly correlated with PSU. Younger age at screen use onset showed a marginal correlation (rho=-0.11, p=0.05) with PSU. The child’s age, gender and the educational level of the mother were not associated with PSU. CONCLUSION: Maternal self-efficacy in managing screen use among children was associated with lower PSU in children.
Use of electronic devices and screen time of pre-school children in Homagama Medical Officer of Health area
(Sri Lanka Medical Association, 2021) Rathnasiri, G.B.A.M.; Rathnayaka, H.; Yasara ,N.; Mettananda ,S.
Introduction and objectives Electronic device use and screen time are increasing health problems in children. Here, we aim to describe the use of electronic devices and screen time in preschool children in the Homagama Medical Officer of Health area. Methods A cross-sectional study was conducted in the Homagama Medical Officer of Health area from January to March 2020 before the COVID-19 travel restrictions. All children aged between 3-5 years attending ten randomly selected pre-schools were recruited into the study. Data were collected using a parent-administered questionnaire and analysed using logistic regression in SPSS. Ethical approval was obtained from Sri Lanka College of Paediatricians. Results A total of 320 children (Male-48.1%; mean age-50.1±6.9 months) were recruited. Electronic devices were used by 95.6% of children. The use of different devices were; television-86.8%, smartphone- 62.9%, laptop- 15.9%, tablet- 8.2% and desktop-5.6%. Of these children, 20.9% used devices for more than 2 hours, and 18.7% commenced using devices before one year. Higher education level of father was independently associated with use of smartphones [OR-3.3(1.8-6.3); p<0.001] and laptops [OR-6.6(1.7-25.3); p<0.01] and screen time >2 hours [OR-3.1(1.3-7.2); p<0.01]. Male sex [OR-1.7(1.02- 2.8); p<0.05] and being the only child [OR-2.1(1.2-3.6); p<0.01] was associated with use of smartphones whereas maternal employment was associated with use of laptops [OR-2.2(1.07-4.5); p<0.05]. Conclusion Electronic devices were used by over 95% of preschoolers, and over one-fifth used them for more than the recommended upper limit of 2 hours. Higher paternal education, maternal employment and being the only child were significantly associated with electronic device use.

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