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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 The impact of the National Programme to Eliminate Lymphatic Filariasis on filariasis morbidity in Sri Lanka: Comparison of current status with retrospective data following the elimination of lymphatic filariasis as a public health problem(Public Library of Science, 2024) Gunaratna, I.E.; Chandrasena, T.G.A.N.; Vallipuranathan, M.; Premaratna, R.; Ediriweera, D.; De Silva, N.R.INTRODUCTION Sri Lanka implemented the National Programme for Elimination of Lymphatic Filariasis (NPELF) in its endemic regions in 2002. Five annual rounds of mass drug administration using the two-drug combination diethylcarbamazine (DEC) and albendazole led to sustained reductions in infection rates below threshold levels. In 2016, WHO validated that Sri Lanka eliminated lymphatic filariasis as a public health problem.OBJECTIVE To explore the impact of the NPELF on lymphatic filariasis morbidity in Sri Lanka.METHODS Passive Case Detection (PCD) data maintained in filaria clinic registries from 2006-2022 for lymphoedema and hospital admission data for managing hydroceles/spermatoceles from 2007-2022 were analyzed. The morbidity status in 2022 and trends in overall and district-wise PCD rates were assessed. Poisson log-linear models were used to assess the trends in PCD for endemic regions, including district-wise trends and hospital admissions for the management of hydroceles/spermatoceles.RESULTS In 2022, there were 566 new lymphoedema case visits. The mean (SD) age was 53.9 (16.0) years. The staging was done for 94% of cases, of which 79% were in the early stages (57.3% and 21.4% in stages two and one, respectively). Western Province had the highest caseload (52%), followed by the Southern (32%) and Northwestern (16%) Provinces, respectively. The reported lymphoedema PCD rate in 2022 was 0.61 per 10,000 endemic population. The overall PCD rate showed a decline of 7.6% (95%CI: 4.9% - 10.3%) per year (P < 0.0001) from 2007 to 2022. A steady decline was observed in Colombo, Gampaha and Kurunegala districts, while Kalutara remained static and other districts showed a decline in recent years. Further, admissions for inpatient management of hydroceles/spermatoceles showed a declining trend after 2015.CONCLUSIONS The PCD rates of lymphoedema and hydroceles/spermatoceles showed a declining trend in Sri Lanka after the implementation of the NPELF.Item Initial response to SARS-CoV-2 (COVID-19) outbreak in Sri Lanka; views of public health specialists through an International Health Regulations lens(Public Library of Science, 2023) Caldera, A.; Wickremasinghe, R.; Newby, G.; Perera, R.; Mendis, K.; Fernando, D.The COVID-19 pandemic affected Sri Lanka despite having developed an International Health Regulations (IHR) steering committee in 2016 and a national action plan for health security following the Joint External Evaluation in 2018. Many steps were taken to improve the disaster management skills of healthcare workers even before the COVID-19 outbreak. We interviewed seven public health specialists to obtain their views on the country's response to the pandemic. A thematic analysis was conducted, leading to the emergence of three major themes and seven subthemes. The major themes included health security preparedness; COVID-19 management; and effects of COVID-19. The subthemes were; preparedness prior to pandemic and gaps in the preparedness (under health security preparedness); dual burden for the curative sector, strategies to reduce transmission and barriers to managing COVID-19 (under COVID-19 management) and negative and positive effects of COVID-19 (under effects of COVID-19). When COVID-19 reached Sri Lanka, healthcare workers, border control authorities and those involved with infectious disease control were overwhelmed by the magnitude of the pandemic. Healthcare workers' hesitation to work amidst the pandemic due to fear of infection and possible transmission of infection to their families was a major issue; the demand for personal protective equipment by health workers when stocks were low was also a contributory factor. Lockdowns with curfew and quarantine at government regulated centers were implemented as necessary. Perceptions of the public including permitting healthcare workers to perform field public health services, logistical barriers and lack of human resources were a few of the barriers that were expressed. Some persons did not declare their symptoms, fearing that they would have to be quarantined. The pandemic severely affected the economy and Sri Lanka relied on donations and loans to overcome the situation. Pandemic also brought about innovative methods to maintain and upgrade health service provision. Individuals with non-communicable diseases received their regular medications through the post which reduced their risk of being infected by visiting hospitals. Improvement of laboratory services and quarantine services, a reduction of acute respiratory infections and diarrhoeal diseases, improved intersectoral coordination and public philanthropic response were other positive effects.Item Health-related quality of life of parents of children with feeding disorders in a tertiary care clinical setting in Western province, Sri Lanka.(University of Kelaniya, Sri Lanka, 2023) Nirmani, N.; Dharmarathne, N.I.;BACKGROUND: Parents of children with Feeding Disorders (CFD) have to be much stronger in their lives by keeping good Health-Related Quality of Life (HRQoL), as they are primary caregivers of children. It is extremely beneficial for clinicians and researchers to explore the HRQoL of parents of CFD to continue optimal care for children in Sri Lanka. OBJECTIVE/S: The aim of the study was to examine the impact of children’s Feeding Disorders (FD) on their parents’ health-related quality of life (HRQOL) in Sri Lanka. METHODS: Demographic, economic, and feeding history were obtained from 246 parents of CFD, aged between 6 months and 7 years, who receive feeding therapy at a community multidisciplinary care center. Participants completed standard adapted assessments on identifying the severity of feeding disorders (Pedi-EAT) and its impact on their HRQoL (FS-IS). Statistical analysis was performed on data using the Statistical Package for the Social Sciences (SPSS) version 26.0. RESULTS: The results indicated that caring for CFD issues negatively affected the caregivers’ health-related quality of life (HRQoL). Independent sample t-test revealed that mothers of CFD have significantly lower HRQoL compared to fathers (t (245) = .947, p=.001). HRQoL of parents has not significant different when the severity of feeding disorders of their children was higher. But socio-demographic factors directly affect HRQoL. Similarly, long-term FD in children showed significantly higher worry among parents and restrictions to their daily activities, reducing their HRQoL. CONCLUSION/S: In conclusion, this is the first study of this nature conducted in Sri Lanka to investigate parents’ HRQoL of CFD. The findings of the study expand our understanding of the impact of pediatric feeding disorders on the parents and families, which is a critical element in determining the effectiveness of healthcare intervention for CFD and their prognosis. Clinicians need to pay attention to factors that could improve the HRQoL of parents of CFD, in order to offer more effective care.Item Intestinal and Ectoparasites of Human Health Importance among Stray Dogs in Galle District, Sri Lanka.(19th Conference on Postgraduate Research, International Postgraduate Research Conference 2018, Faculty of Graduate Studies,University of Kelaniya, Sri Lanka, 2018) Rathnayake, S.P.; Sudusinghe, H.P.; Nilaweera, T.H.W.T.; Marasinghe, M.A.P.; Sriyalatha, W.A.; Gunathilaka, P.A.D.H.N.Human-animal bond is a reciprocally favorable dynamic relationship which is beneficial to the health and well-being of both. Dogs have close contact with humans and play a pivotal role as definitive hosts or reservoirs for different zoonotic parasites, especially in developing countries. There are only few studies have focused on the zoonotic potential of animals in Sri Lanka. Therefore, the objective of the present study was the determine the intestinal and ectoparasites among dog population that may be important for human health. A total of 40 stray dogs captured for an animal welfare clinic conducted in Galle District of Sri Lanka was recruited for the study. Faecal samples were collected per rectal in to separate vials containing 10% formaldehyde. Ectoparasites of selected dogs were collected using a lose comb and stored in alcohol solution. The stool samples were processed by Kato-Katz techniques and intestinal parasitic stages were morphologically identified. For quantitative analysis, the modified McMaster technique was used to estimate eggs per gram of feces. The ectoparasites were characterized referring to morphological features. The results revealed eight intestinal parasites namely; Ancylostomacaninum (Prevalence: 66.75%; Eggs per gram: 362.82), Toxocaracanis (13.51%; 73.41), Enterobiusvermicularis (9.1%; 49.41), Trichurisvulpis (7.0%; 38.12), Physalopterarara (1.56%; 8.47), Paragonimuskellicotti (1.0% 5.65), Uncineriastenocephala (0.78%; 4.24) and Eucoleusaerophilus (0.26%; 1.41). The high prevalence rates of T. canis may cause visceral and ocular larva migrans to humans, which lead to blindness and A. caninum associated with hookworm related cutaneous larva migrans. Humans can be infected with T. vulpis when they accidentally ingest embryonated eggs, through contamination of infected soil, food or fomites even though it has been recorded as a rare infection. P. rara infection can be caused to humans by the accidental ingestion of arthropod hosts such as German cockroaches. In addition, the P. kellicotti, U. stenocephala, E. aerophilus and E. vermicularis may cause some health issues to humans. Even though present study did not indicate the presence of Echinococcusgranulosus which resides in the small bowel of dogs and other canids may lead to cause echinococcosis in humans. Argaspersicus (Prevalence; 34.18%) was the predominant among ectoparasites followed by Ctenocephalidescanis (32.91%) and Ixodesscapularis (32.91%). A. persicus can cause serious allergies on humans. The bites of I. scapularis may lead to cause human babesiosis (Babesiamicroti), human granulocytic ehrlichiosis (HGE); and tick-borne encephalitis (TBE). The presence of C. canis may indicate the transmission potential of Dipylidiumcaninum to humans as an occasional host. Overall, the investigation indicated that stay dogs in Galle District contain a multitude of ectoand endoparasites, thus posing a risk for the human population.