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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Factor structure of medical students’ attitudes towards psychiatry: findings from a nationally representative sample from Sri Lanka(Cambridge University Press, 2021) Baminiwatta, A.; Chandradasa, M.; Ediriweera, D.; Dias, S.AIMS : The aim of this study was to examine the factor structure of attitudes towards psychiatry among medical students by using the ‘Attitude towards psychiatry-30’ (ATP-30) scale, which is one of the most widely used psychometric tools in assessing medical students’ attitudes regarding psychiatry. We also aimed to explore the possible existence of meaningful subscales in the ATP-30 scale. METHOD: Secondary data from a survey of 743 final-year medical students from nine medical schools in Sri Lanka were subjected to factor analysis. Models based on empirical evidence were tested with Confirmatory Factor Analysis (CFA) for model fit using Comparative Fit Index (CFI), Tucker Lewis Index (TLI), root mean square error of approximation (RMSEA) and Chi square. To explore the underlying latent structure of the scale, Exploratory Factor Analysis (EFA) with oblique (i.e. Promax) rotation was employed. Horn's parallel analysis and goodness-of-fit statistics for a series of EFA models tested with different numbers of factors were used in determining the number of factors to retain. Items conceptually external to the emerging factors or with factor loadings less than 0.4 were discarded. Gender invariance of the final model was tested by configural, metric and scalar invariance. Internal consistency of subscales was assessed using McDonald's omega (ω). RESULT: Three models based on literature (one-, five-, and eight- factor) were disproved by CFA. EFA revealed a six-factor solution, encompassing 18 out of the 30 items, to be the most theoretically meaningful factor structure. This six-factor model was affirmed by a CFA (CFI = 0.94, TLI = 0.92, RMSEA = 0.036). These factors were, namely, ‘the image of psychiatrists’, ‘psychiatric patients and mental illness’, ‘efficacy of treatment’, ‘psychiatric teaching’, ‘career choice’, and ‘psychiatry as an evidence-based discipline’. This six-factor solution was invariant across gender. ‘The image of psychiatrists’ appeared to be the most salient factor, and formed the most consistent subscale (ω = 0.71). The internal consistencies of the other subscales were modest (ω = 0.55–0.67). The overall 18-item scale showed good internal consistency (ω = 0.78). CONCLUSION: Our findings provide evidence of a multi-dimensional structure in medical students’ attitudes towards psychiatry, endorsing six meaningful subscales of the ATP-30. Future researchers and educators can utilize these subscales in identifying specific attitudinal domains which are more closely associated with students’ future choice of a career in psychiatry, and also in identifying specific areas where attitudes are more stigmatized, so that appropriate interventions can be incorporated into the undergraduate psychiatric curriculum.Item Knowledge and attitudes on unsafe abortions among the state university undergraduates in Western Province(College of Community Physicians of Sri Lanka, 2018) Perera, U.; Abeysena, C.ABSTRACT OBJECTIVE: To describe the knowledge and attitudes on unsafe abortions among undergraduates in the state universities of the Western Province. METHODS: A descriptive cross sectional study was conducted among 1575 second and third year undergraduates using stratified cluster sampling of the selected universities. Pre-tested self-administered questionnaire was administered to assess socio-demographic factors, knowledge and attitudes on unsafe abortions. The responses to the knowledge and attitude questions were scored and graded. Percentage of knowledge categories and attitudes were calculated. The associations of knowledge categories with selected variables were assessed. RESULTS: A majority (53.3 %, n=839) of respondents had good knowledge on unsafe abortions while 30.5% (n=480) had satisfactory knowledge and minority (16.3%) had poor knowledge. Females (55%, n=509) had more good knowledge than males (51%, n=329, P>0.05). Those who studied in Bio-Science stream (70.2%, n=174, P<0.001) and who had their secondary education at mixed schools (54.4%, n=351, P>0.05) had more good knowledge than the others (P<0.001). The majority (68.5%, n=1074) agreed that the legal restrictions would drive people to unsafe abortions and making abortion services through the government health facilities could increase the inappropriate sexual behaviors (63.7%,n=998). Only a very few (7.1%, n=111) of undergraduates agreed that abortion was a convenient form of contraceptive and 47.7% (n=747) agreed to be restricted to save mother’s life. A majority (53.2%, n=833) agreed that it should be a right of a pregnant woman to decide whether she wants an abortion or not. CONCLUSION: A majority of undergraduates had good knowledge on unsafe abortions. Most of the undergraduates wanted not to fully liberalize abortion policies due to inappropriate usage and merely it is a right of a pregnant mother.Item Comprehensive evaluation of demographic, socio-economic and other associated risk factors affecting the occurrence of dengue incidence among Colombo and Kandy Districts of Sri Lanka: a cross-sectional study(BioMed Central, 2018) Udayanga, L.; Gunathilaka, N.; Iqbal, M.C.M.; Lakmal, K.; Amarasinghe, U.S.; Abeyewickreme, W.BACKGROUND: Comprehensive understanding of risk factors related to socio-economic and demographic status and knowledge, attitudes and practices (KAP) of local communities play a key role in the design and implementation of community-based vector management programmes, along with the identification of gaps in existing control activities. METHODS: A total of 10 Medical Officers of Health (MOH) areas recording high dengue incidence over the last five years were selected from Colombo (n = 5) and Kandy (n = 5) Districts, Sri Lanka. From each MOH area, 200 houses reporting past dengue incidence were selected randomly as test group (n = 1000 for each district) based on the dengue case records available at relevant MOH offices. Information on socio-economic and demographic status and knowledge, attitudes and practices were gathered using an interviewer administered questionnaire. The control group contained 200 households from each MOH area that had not reported any dengue case and the same questionnaire was used for the assessment (n = 1000 for each district). Statistical comparisons between the test and control groups were carried out using the Chi-square test of independence, cluster analysis, analysis of similarities (ANOSIM) and multi-dimensional scaling (MDS) analysis. RESULTS: Significant differences among the test and control groups in terms of basic demographic and socio-economic factors, living standards, knowledge, attitude and practices, were recognized (P < 0.05 at 95% level of confidence). The test group indicated similar risk factors, while the control group also shared more or less similar characteristics as depicted by the findings of cluster analysis and ANOSIM. Findings of the present study highlight the importance of further improvement in community education, motivation and communication gaps, proper coordination and integration of control programmes with relevant entities. Key infrastructural risk factors such as urbanization and waste collection, should be further improved, while vector controlling entities should focus more on the actual conditions represented by the public on knowledge, attitudes and personal protective practices. CONCLUSIONS: The design of flexible and community friendly intervention programmes to ensure the efficacy and sustainability of controlling dengue vectors through community based integrated vector management strategies, is recommended.Item Socio-economic, Knowledge Attitude Practices (KAP), household related and demographic based appearance of non-dengue infected individuals in high dengue risk areas of Kandy District, Sri Lanka(BioMed Central, 2018) Udayanga, L.; Gunathilaka, N.; Iqubal, M.C.M.; Pahalagedara, K.; Amarasinghe, U.S.; Abeyewickreme, W.BACKGROUND: Socio-economic, demographic factors and Knowledge Attitude Practices (KAPs) have been recognized as critical factors that influence the incidence and transmission of dengue epidemics. However, studies that characterize above features of a risk free or low risk population are rare. Therefore, the present study was conducted to characterize the household related, demographic, socio-economic factors and KAPs status of five selected dengue free communities. METHOD: An analytical cross-sectional survey was conducted on selected demographic, socio-economic, household related and KAPs in five selected dengue free communities living in dengue risk areas within Kandy District, Central Province, Sri Lanka. Household heads of 1000 randomly selected houses were interviewed in this study. Chi-square test for independence, cluster analysis and Principal Coordinates (PCO) analysis were used for data analysis. RESULTS: Knowledge and awareness regarding dengue, (prevention of the vector breeding, bites of mosquitoes, disease symptoms and waste management) and attitudes of the community (towards home gardening, composting, waste management and maintenance of a clean and dengue free environment) are associated with the dengue free status of the study populations. CONCLUSIONS: The vector controlling authorities should focus on socio-economic, demographic and KAPs in stimulating the community to cooperate in the integrated vector management strategies to improve vector control and reduce transmission of dengue within Kandy District.Item Multicomponent intervention versus usual care for management of hypertension in rural Bangladesh, Pakistan and Sri Lanka: study protocol for a cluster randomized controlled trial(BioMed Central, 2017) Jafar, T.H.; Jehan, I.; de Silva, H.A.; Naheed, A.; Gandhi, M.; Assam, P.; Finkelstein, E.A.; Quigley, H.L.; Bilger, M.; Khan, A.H.; Clemens, J.D.; Ebrahim, S.; Turner, E.L.; Kasturiratne, A.; for COBRA-BPS Study GroupBACKGROUND: High blood pressure (BP) is the leading attributable risk for cardiovascular disease (CVD). In rural South Asia, hypertension continues to be a significant public health issue with sub-optimal BP control rates. The goal of the trial is to compare a multicomponent intervention (MCI) to usual care to evaluate the effectiveness and cost-effectiveness of the MCI for lowering BP among adults with hypertension in rural communities in Bangladesh, Pakistan and Sri Lanka. METHODS/DESIGN: This study is a stratified, cluster randomized controlled trial with a qualitative component for evaluation of processes and stakeholder feedback. The MCI has five components: (1) home health education by government community health workers (CHWs), (2) BP monitoring and stepped-up referral to a trained general practitioner using a checklist, (3) training public and private providers in management of hypertension and using a checklist, (4) designating hypertension triage counter and hypertension care coordinators in government clinics and (5) a financing model to compensate for additional health services and provide subsidies to low income individuals with poorly controlled hypertension. Usual care will comprise existing services in the community without any additional training. The trial will be conducted on 2550 individuals aged ≥40 years with hypertension (with systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, based on the mean of the last two of three measurements from two separate days, or on antihypertensive therapy) in 30 rural communities in Bangladesh, Pakistan and Sri Lanka. The primary outcome is change in systolic BP from baseline to follow-up at 24 months post-randomization. The incremental cost of MCI per CVD disability-adjusted life years averted will be computed. Stakeholders including policy makers, provincial- and district-level coordinators of relevant programmes, physicians, CHWs, key community leaders, hypertensive individuals and family members in the identified clusters will be interviewed. DISCUSSION: The study will provide evidence of the effectiveness and cost-effectiveness of MCI strategies for BP control compared to usual care in the rural public health infrastructure in South Asian countries. If shown to be successful, MCI may be a long-term sustainable strategy for tackling the rising rates of CVD in low resourced countries.Item Knowledge and practices regarding selected aspects of sexual abuse among mothers of adolescent children in the Medical Officer of Health area, Udubaddawa(College of Community Physicians of Sri Lanka, 2009) Makawita, M.U.M.; Jayawardana, P.INTRODUCTION: Emergence of child sexual abuse of adolescents is one of the major issues encountered globally. Inadequacy of preventive measures undertaken by mothers as a result of poor knowledge would make their children vulnerable to this horrendous experience which may have disastrous consequences on their physical, psychological and social well being. OBJECTIVE: To determine the knowledge and practices related to selected aspects of sexual abuse among mothers of adolescent children in the Medical Officer of Health (MOH) area, Udubaddawa. METHODS: A descriptive cross sectional study was conducted in all 13 Public Health Midwife areas in the MOH area, Udubaddawa. Seven hundred and fifteen mothers, 55 from each PHM area, having an adolescent child/children were selected through cluster sampling. Knowledge and practices were assessed using a self administered questionnaire. A score of ^50% was selected to define "good" knowledge and practices. Chi squared test was applied to determine factors associated with "good" knowledge and practices. RESULTS: The proportions of mothers with good overall knowledge and practices were 52.3% (n=374) and 39.2% (n=280) respectively. The variables that were significantly associated with good over all knowledge were educational level of >GCE O/L (60%; n=206) in comparison to Rs. 15,000 (63%; n=64) in comparison toItem Knowledge and practices on selected non communicable diseases among GCE Advanced Level students in state schools, Maharagama(College of Community Physicians of Sri Lanka, 2009) Gamage, A.U.; Jayawardana, P.OBJECTIVE: To assess the knowledge on selected non communicable diseases (NCDs) and practices related to prevention of selected NCDs among GCE Advanced Level (A/L) students attending government schools in the Maharagama education division. METHODS: A descriptive cross sectional study was conducted among year 13 students (A/L) attending state schools in Maharagama education division. A total of 634 students were selected from 9 schools which had at least one class in a given stream. Stratified sampling was done according to stream of study and the number needed from each stratum was decided according to probability proportionate to size. Cluster sampling was conducted when the number of classes in each stream was more than one. A self administered questionnaire was used to gather information on socio demographic data, practices, knowledge on NCDs and sources of information. Height and weight measurements were recorded. Each practice was analysed separately, either based on the indulgence or on a cut off score. A composite score of >60% was considered as good overall knowledge. RESULTS: Of the 634 respondents 45.3% (n=287) were males. The mean age was 18.4(SD±0.38) years. Knowledge: The proportion with good overall knowledge was 43% (95%CI: 39%-46.9%) [n=272]. Good overall knowledge was significantly higher among non Sinhalese (88%; n=5) and science stream students (65%; n=85) (p< 0.001). Practices: Proportion of students who had a healthy diet was 43% (n=275) and adequate physical activity was 20% (n=129). Three percent (n=18) were current smokers, all of whom were males and 10% (n=61) of males and 2% (n=12) of females were current users of alcohol. Proportion of females was significantly higher in relation to healthy dietary habits (52.2%; n=181 versus 32.8%; n=94 ), non smoking (100%; n=347 versus 93.7%; n=269) and non alcohol consumption (96.5%; n=335 versus 78.7%; n=226) and males in relation to adequate physical activity (27.5%; n=79 versus 14.4%; n=50). Schools (41%; n=233) were the major source of information on NCDs and preferred sources were healthcare workers (34%; n=201) and schools (32%; n=192). CONCLUSION: Proportion of year 13 A/L students with good knowledge and practices was low and recommend awareness raising programs.Item Knowledge, attitudes and practices (KAP) on dengue control in Gampaha district.(Sri Lanka Association for the Advancement of Science, 2008) Abeyewickreme, W.; Hapangama, H.A.D.C.; Gunawardene, Y.I.N.S.; Hapugoda, M.D.; Gunawardena, N.K.; Wickremasinghe, A.R.Dengue/Dengue Hemorrhagic Fever (DHF) has become a major public health problem in many parts of the tropics. In Sri Lanka, it is endemic in some parts of the country with outbreaks of dengue/ DHF. The present study was done to assess 1) knowledge regarding dengue among the general population in the district of Gampaha, 2) whether simple preventive measures are being practiced in the community. A cross-sectional survey was conducted in selected 2000 households in the Gampaha District from June - August, 2007 using a pre-tested structured questionnaire to assess the level of knowledge, attitudes and practices regarding dengue. The majority of the respondents interviewed were females (65.2%). More than 90% have had secondary education (90.2%). The main source of water supply were pipe borne (43.4%) and well water (40.6%). 64.3% households stored water for washing, drinking and cleaning purposes. More than 95% of the respondents had heard about dengue fever and its transmission. 91.3% cited that their main source of information on dengue was from television/radio. 34.3% had either received advice or participated in a training programme on dengue prevention and 7.8% had received support materials. The main preventive measure used to reduce the mosquito nuisance was personal protection with repellents (73.6%). Most of the respondents (56.8%) felt that no action was taken by the government to control mosquitoes. When respondents views were taken, the suggestions made by them to improve dengue control included, fogging (31.8%), educating people (30.5%), treating water (24.3%) and cleaning the environment (19.5%). When questions were directed at possible methods for community participation for dengue control, the majority were in favour of removing solid waste (84.15%), eliminating stagnant water collections (40.7%), removing larvae (8.75%) and covering all the water containers using lids (8.1%). The community had good understanding on dengue and the main source of information was from the electronic media. However it was found that good knowledge itself does not necessarily lead to good practices. The respondents' attitudes were found to be good and most of them were supportive of control measures. Mass media is an important means of conveying health messages to the public, thus research and development of educational strategies designed to improve behaviour and practices of effective control measures through mass media among the community are recommended. Financial support by World Health Organization TDR/WHO Multi Country Study on "Eco-Bio-Social Research on Dengue in Asia" is acknowledged.Item Knowledge and perceptions of lymphedema in patients attending filariasis clinics in the Colombo district(Sri Lanka Association for the Advancement of Science, 2005) Wijesinghe, R.; Ekanayake, S.; Wickremasinghe, A.R.Item Knowledge, attitude and practice of the community on dengue infection in Gampaha district of Sri Lanka(University of Kelaniya, 2008) Karunathilake, K.; Abeyewickreme, W.; Wickremasinghe, R.