Ethnic differences in contraceptive use in Sri Lanka

In Sri Lanka in 1975, the majority Sinhalese had a much higher use of contraception than either the Sri Lanka Tamils or the Moors. This study uses a national sample of women of childbearing age gathered by the Sri Lanka World Fertility Survey in 1975 to assess four possible reasons for differential contraceptive use: (1) differences in socioeconomic position; (2) cultural differences; (3) minority status; and (4) differential access to family planning services. The first three explanations focus on differences in the demand for contraception while the fourth explanation focuses on differences in the availability of contraceptives. The socioeconomic, cultural, and minority status hypotheses fail to explain the higher contraceptive use among the Sinhalese. The evidence is consistent with the idea that ethnic differences in contraceptive use were largely caused by differential access to family planning services.     

Endemic goitre in Sri Lanka

This survey examined 59,158 children from 87 schools in 17 out of 24 districts in Sri Lanka for goitre. The overall prevalence rate was 18.8%: 23.2% for girls and 14.0% for boys. Prevalence in districts varied from 30.2% in Kalutara to 6.5% in Matale. It was higher in rural than urban areas, and in inland than coastal areas. The sex ratio of prevalence rates was directly related and the ratio of palpable to visible goitre was inversely related to the severity of the endemic. It is suggested that for a rapid epidemiological assessment when the latter ratio is less than four, it is indicative of endemicity for public health purposes and calls for intervention. The iodination of salt is both practical and feasible in Sri Lanka.     

Vitamin A status of children in Sri Lanka.

A representative country-wide rural nutrition status survey determined the extent and distribution of vitamin A deficiency in Sri Lanka in children 6 through 71 months of age. Trained paramedical personnel recorded the presence or absence of selected ophthalmological signs and symptoms associated with vitamin A deficiency in 13,450 children. The results of the country-wide clinical survey indicate that a vitamin A deficiency problem of public health importance may exist in two of 15 health areas. Serum vitamin A levels were determined on 346 survey children from two of 15 health areas and compared with clinical findings for these areas. The lowest mean serum vitamin A, 26.3 microgram/100 ml, occurred in children with clinical eye findings. A high prevalence of clinical eye findings, 34%, and the low mean serum vitamin A value, 28.2 microgram/100 ml, were found in the group of chronically undernourished children--children who are less than 90% of their expected height for age. The survey results enabled planned redirection of the distribution of vitamin A capsules to preschool children in Sri Lanka to areas shown to have the highest prevalences of ophthalmological signs and symptoms and/or the highest prevalence of chronic undernutrition.     

A cohort study of graphite workers in Sri Lanka

A cohort of workers from a graphite mine in Sri Lanka was studiedin 1987, 1990 and 1993. Radiographic lesions were found in 8.5%,8.9% and 4.1% of the workers in these respective rounds. Whenworkers with radiographic lesions were clinically examined,a total of 18 cases of graphite pneumoconiosis and seven casesof active pulmonary tuberculosis were detected in the threerounds. The prevalence of both these diseases showed a declinein 1993 when compared to 1987. This favourable situation wasprobably the result of dust control measures introduced in themine after 1972. Five workers developed graphite pneumoconiosisin the course of the study. They had worked in the mine forart average of 22.6 years. The right lung appeared to be morevulnerable than the left.     

Cutaneous leishmaniasis in southern Sri Lanka

Cutaneous leishmaniasis is an established disease in Sri Lanka. The majority of cases have been reported from the North-Central Province, with the southern parts of the country considered less affected. However, during 2004, when the services of a dermatologist were available, a considerable number of patients were referred from the Southern Province, which formed the basis for this study. The clinical pattern, detailed geographical distribution within the Southern Province and periodicity of the cases were studied over a period of 12 months. Of the 113 patients diagnosed, the highest number was within the 10-19 years age group. Most patients were from densely populated rural areas around Matara, a large town within this province. There was a notable increase in the number of cases presenting during February-March and August-September, which are periods following monsoonal rains. Exposed areas of the skin were commonly affected, with the majority of patients having single lesions. Females and males were equally affected. This is in contrast to our previous findings in the North-Central Province where the majority of patients were male soldiers with multiple lesions.     

A bedside test for methemoglobinemia,Sri Lanka

ProblemPropanil is an aniline herbicide that is widely used for rice cultivation, but is also used for self-poisoning. Toxicity from propanil is largely due to methemoglobinemia. In resource-poor settings, the capacity to determine methemoglobin concentration is insufficient and prevents effective case management, which results in increased deaths from propanil poisoning.ApproachBlood with a methemoglobin concentration greater than 15% of total haemoglobin levels appears brownish in colour. We introduced a colour reference chart that can be used to semiquantitatively determine methemoglobinemia. Each ward in three rural hospitals received a chart. Ward staff, medical officers and trainee doctors were given a presentation describing the test method and how it should be used with the relevant national treatment guidelines.

Local setting

In three rural hospitals in Sri Lanka, 401 patients were admitted with a diagnosis of propanil poisoning before the introduction of this test (2003–2007) and 262 patients after it was introduced (2008–2014), 46 of 663 patients died.

Relevant changes

The chart can be freely produced with any good-quality colour printer. In three rural hospitals, deaths from propanil poisoning fell from 10% of those admitted with this diagnosis in 2003–2007 (38/401) to 3% (8/262) in 2008–2014 and the use of methylene blue increased from 10% (13/136) to 55% (59/107) over this period.

Lessons learnt

This simple bedside test was associated with increased use of the first line treatment for propanil poisoning and improved survival. In 2011, the test was included in the national guidelines for the management of propanil poisoning.     

Wheat Miller's Asthma in Sri Lanka

Occupational asthma in wheat millers is well documented butit has not previously been reported from a non-wheatgrowingcountry. Sixteen wheat millers with disabling asthma from SriLanka where they handled imported and therefore old wheat werestudied. They developed asthma after working for an averageof 5.2 years in the industry. Eleven of them were followed upafter retirement: 9 had complete remissions while the other2 had partial remissions at the time of examination which wereat 1 and 1 months respectively after retirement. In one workerthe remission was immediate, while the others took up to 3 months.The time taken for the remission to occur appears to dependon the intensity of asthma during weekends rather than its severityduring working days. Length of service, duration of asthma andsmoking did not influence these remissions. Accepted        1 November 1981 Dr C. G. Uragoda, Central Chest Clinic, 385 Dean Road, Colombo 10, Sri Lanka     

Country watch: Sri Lanka

Though reporting on HIV/AIDS is supposed to be confidential, the social and cultural contexts in Sri Lanka are such that this type of information spreads very rapidly within the community. Reports of transgressions involving the medical staff illustrate how difficult it is to guarantee confidentiality in reporting HIV/AIDS in the country. As a consequence, individuals who can afford to travel prefer to be tested abroad to avoid stigmatization, and blood donors sometimes provide false information to avoid being identified. In view of such, the Community Front for the Prevention of AIDS (CFPA) decided to take action to guarantee strict confidentiality in reporting HIV in the country. The goal of CFPA was to protect human rights of people living with HIV and AIDS and their families and to facilitate voluntary counseling and testing. The analysis of existing legislation that might have impact on HIV/AIDS, conducted by CFPA, resulted to the formulation of legislation and policy recommendations to the Ministries of Health and Justice, confirming the principles of protecting public health and respect for human rights. Moreover, it raised the awareness of medical officers and lawyers on legal ethics and HIV/AIDS.     

Cutaneous leishmaniasis, Sri Lanka

Cutaneous leishmaniasis (CL) is an emerging disease in Sri Lanka. Of 116 patients with clinical symptoms suggestive of CL, 86 were confirmed positive for Leishmania donovani. Most patients had single dry lesions, usually on the face. Patients were from 5 of the 7 agroclimatic zones in Sri Lanka.     

Pattern of poisoning in rural Sri Lanka

An epidemiology study of poisoning was done in a geographically defined area in rural Sri Lanka, a developing agricultural country. The incidence of poisoning was 75 per 100,000 population and the death rate was very high (22 per 100,000 population). Both were highest in the age group 15-34 and there were significant ethnic differences in the incidence of poisoning. Agrochemicals were responsible for 59% of all poisonings. Paraquat was the commonest poisoning agent with a high fatality rate of 68%. Use of highly toxic agents may have resulted in deaths where there was no intention to commit suicide. Strict legislation regarding the sale, distribution and storage of agrochemicals could result in the reduction of mortality and perhaps the incidence of poisoning, in developing agricultural countries.     

Teaching of medical ethics in Sri Lanka

Medical ethics as taught by members of the Department of Forensic Medicine in three of five medical colleges in Sri Lanka is a 'rule ethic' ('normative ethic') based on 'traditional' or 'classical' ethics. Instruction includes the teaching of moral principles, illustrated with examples. Also included are aspects concerning the functions of the Sri Lanka Medical Council. The topic is evaluated in the essay, multiple choice question and oral components of the third MBBS (Part II) examination (end of fourth year). As presently taught the syllabus is thoroughly inadequate for dealing with modern (medical) ethical issues. The shortcomings and limitations in the present programme are pointed out and requisite improvements suggested. A case is made for an eclectic view of ethics, in which a 'situation ethic' would play a part. Finally, the training of a highly moral responsible medical professional is emphasized.     

Survey of pesticide poisoning in Sri Lanka

This study included a sample survey of the clinical records of patients admitted to the different hospitals in Sri Lanka, and showed that approximately 13 000 patients are admitted to hospital annually for pesticide poisoning and that each year 1000 of them die. Suicidal attempts account for 73% of the total, and occupational and accidental poisoning accounts for 24.9%. It is recommended that urgent action be taken to minimize the extent of the problem.     

Suicides and pesticides in Sri Lanka.

Sri Lanka has one of the highest rates of suicide in the world (29 per 100,000 population in 1980). Suicides are especially frequent among young adults, both male and female. Compared to the US, the suicide rate for males ages 15 to 24 years in Sri Lanka is nearly four times greater; the female rate nearly 13 times greater. The most common mode of suicide is ingestion of liquid pesticides.     

Rabies in Sri Lanka: splendid isolation

Rabies virus exists in dogs on Sri Lanka as a single, minimally divergent lineage only distantly related to other rabies virus lineages in Asia. Stable, geographically isolated virus populations are susceptible to local extinction. A fully implemented rabies-control campaign could make Sri Lanka the first Asian country in >30 years to become free of rabies virus.     

Corynebacterium haemolyticum infections in Sri Lanka.

Corynebacterium haemolyticum infections are described for the first time in Sri Lanka. In a period of 2 years from 1978-80 C. haemolyticum was isolated from the pharynx of 9 patients wih tonsillitis and from local septic lesions in 7 other patients. Association with other pathogens was common. No patients had a rash. The properties of the isolates are described.