Medicine

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A Cost-of-illness analysis of β-Thalassaemia major in children in Sri Lanka - experience from a tertiary level teaching hospital.
(BioMed Central., 2020) Reed-Embleton, H.; Arambepola, S.; Dixon, S.; Maldonado, B. N.; Premawardhena, A.; Arambepola, M.; Khan, J. A. M.; Allen, S.
BACKGROUND: Sri Lanka has a high prevalence of β-thalassaemia major. Clinical management is complex and long-term and includes regular blood transfusion and iron chelation therapy. The economic burden of β-thalassaemia for the Sri Lankan healthcare system and households is currently unknown. METHODS: A prevalence-based, cost-of-illness study was conducted on the Thalassaemia Unit, Department of Paediatrics, Kandy Teaching Hospital, Sri Lanka. Data were collected from clinical records, consultations with the head of the blood bank and a consultant paediatrician directly involved with the care of patients, alongside structured interviews with families to gather data on the personal costs incurred such as those for travel. RESULTS: Thirty-four children aged 2-17 years with transfusion dependent thalassaemia major and their parent/guardian were included in the study. The total average cost per patient year to the hospital was $US 2601 of which $US 2092 were direct costs and $US 509 were overhead costs. Mean household expenditure was $US 206 per year with food and transport per transfusion ($US 7.57 and $US 4.26 respectively) being the highest cost items. Nine (26.5%) families experienced catastrophic levels of healthcare expenditure (> 10% of income) in the care of their affected child. The poorest households were the most likely to experience such levels of expenditure. CONCLUSIONS: β-thalassaemia major poses a significant economic burden on health services and the families of affected children in Sri Lanka. Greater support is needed for the high proportion of families that suffer catastrophic out-of-pocket costs. KEYWORDS: Children; Cost-of-illness; Sri Lanka; Thalassaemia.
A study of psychological impact on women undergoing miscarriage at a Sri Lankan hospital setting
(Sri Lanka College of Obstetricians and Gynaecologists, 2015) Wijesooriya, L.R.A.; Palihawadana, T.S.; Rajapaksha, R.N.G.
INTRODUCTION: Miscarriage is common and affect one third of women some time during their lifetime. Its management has seen many advances in recent times including introduction of less interventional methods, thus seldom cause serious complications. However, the psychological morbidity associated with miscarriage is often overlooked and data on the subject among Sri Lankan population is scarce. This study was aimed at describing the presence of psychological morbidity among women after a miscarriage and to determine the factors associated with development of such morbidity in a local population. METHOD: A cohort study was carried out at a gynaecology unit of the North Colombo Teaching Hospital, Ragama, between August 2011 and April 2012. The exposed group included 198 consecutive consenting women who had an early pregnancy loss and were compared with 179 parity and gestation matched controls. Two validated psychological assessment tools, the General Health Questionnaire 30 (GHQ30) and the Edinburgh postnatal depression questionnaire (EPDS) were administered at the initial visit and 6-8 week later in both groups. The threshold levels of 6 and 9 were used for GHQ30 and EPDS scales, respectively. RESULTS: At the initial assessment, the psychological morbidity of screen positives by the GHQ30 was 42.4% and 11.7% (OR5.54, 95%CI 3.25-9.46) in the exposure and controls groups, respectively. With the EPDS it was 23.7% and 10.1% (OR2.78, 95%CI 1.55-5.0). At the 6-8 week follow up the GHQ30 screen positive rate among exposure and control groups were 25.4% vs. 9.9% (OR 3.0, 95%CI 1.64-5.48), while with the EDPS, it was 24.8% vs. 10.5% (OR 2.81, 95%CI 1.55-5.09). The factors associated with screen positive psychological morbidity among subjects of the exposure group were common to both scales. At the initial visit they included age>30 years, having had secondary or more education, a history of infertility preceding the miscarriage, a history of previous miscarriage, nulliparity and a gestation >12 weeks. The same factors, with the exception of education level, were associated with screen positive psychological morbidity with both scales at 12 weeks too. DISCUSSION: This study shows the psychological morbidity following miscarriage can be as high as 40% in the initial stage while it can persist in around a quarter of patients even after 6-8 weeks. Recognitions and providing effective treatment including psychological support should be an integral part of management of miscarriage. Risk factors associated with psychological morbidity have been identified and these should be used to identify women who are at a higher risk of developing such abnormalities in order to provide effective screening and offer treatment
Discrepancy between patients food ordered and received at a teaching hospital
(Sri Lanka Medical Association, 1996) de Silva, D.G.H.; Liyanage, U.; de Silva, H.
No Abstract Available
Viral hepatitis complicating pregnancy--a five year hospital based retrospective study
(Sri Lanka Medical Association, 1993) de Silva, H.J.; Jayawardena, J.; Pethiyagoda, A.U.; Pethiyagoda, C.J.B.; Sirisena, J.L.
Limited data are available on viral hepatitis (VH) complicating pregnancy from Sri Lanka. We retrospectively studied all pregnant and non-pregnant women of child bearing age, who were admitted with VH to the Teaching Hospital Peradeniya between January 1987 and December 1991. During this period, there were 187 cases of icteric VH among non-pregnant women of child bearing age, but only 10 cases among pregnant women (hospital incidence of 0.35 cases of VH per 1000 pregnancy related admissions). Two of the 10 (case fatality 20%) pregnant women died of causes related to VH compared with only 3 of the 187 (1.6%) non-pregnant women (p < 0.001), giving a relative risk of death due to VH in pregnant women of 12.5 (95% confidence limits 1.8-85.6). The perinatal case fatality rate due to VH was 20%. VH complicating pregnancy does not appear to be a common cause of hospital admission, but pregnancy makes death due to VH more likely. VH complicating pregnancy also results in a high perinatal mortality

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