Effect of repeated mass chemotherapy for filariasis control on soil-transmitted helminth infections in Sri Lanka

BACKGROUND: In July 2006 Sri Lanka completed 5 rounds of annual mass drug administration (MDA) with diethylcarbamazine citrate (DEC) and albendazole as part of its national programme for elimination of lymphatic filariasis (LF). Albendazole is highly effective against soil-transmitted helminths (STH). This study was carried out to assess the effect of repeated annual MDA on STH infections in the Western Province of Sri Lanka, an area co-endemic for LF and STH. METHODS: Faecal samples were obtained (during August-September 2006), from grade 5 students in 17 schools in the Western Province that were included in a national survey of schoolchildren's health in 2003, and examined using the modified Kato-Katz technique. The prevalence and intensity of roundworm, whipworm and hookworm infections in 2003 and 2006 were compared. RRESULTS:Faecal samples from 255 children were examined in 2003; 448 were examined in 2006. Roundworm prevalence was marginally lower in 2006 (4.0%) than in 2003 (4.7%), as was hookworm (0.2% vs 0.4%), whereas whipworm prevalence was higher (13.8% vs 9.4%). These differences as well as that between the geometric mean egg counts were not statistically significant. Compliance with MDA in 2006, as reported by the schoolchildren examined, was only 59%. CCONCLUSIONS:Four annual rounds of MDA with DEC and albendazole had virtually no effect on STH infections in the study area.     

PCR detection and typing of human papilloma virus DNA in squamous carcinoma of the cervix in a cohort of Sri Lankan women

OBJECTIVE: To determine the prevalence of human papilloma virus (HPV) types 16 and 18 in squamous carcinomas of the cervix in Sri Lanka. DESIGN: Case control study. SETTING: One gynaecological unit at the Cancer Institute, Maharagama, Sri Lanka. PATIENTS: 15 patients with squamous carcinoma of the cervix, and 15 age matched controls with histologically normal cervices. MEASUREMENTS: DNA was extracted from paraffin embedded cervical biopsies. Polymerase chain reaction was performed on extracted DNA employing primers specific for HPV types 16 and 18. RESULTS: HPV 16 DNA was detected in 11 out of 15 cervical cancer biopsies (73.3%), in comparison with 3 out of 15 normal controls (20%). HPV 18 was detected in 3 out of 15 cervical cancer biopsies, but not in a single control biopsy. CONCLUSION: Despite the limited number of cases in this cohort, this study supports the strong association between HPV 16 and squamous cancer of the cervix.     

Prevalence of dental fluorosis in four selected schools from different areas in Sri Lanka

The prevalence of dental fluorosis in four selected schools from different areas in Sri Lanka was investigated by dental examination of 377 school children aged 14 years. In the endemic zone the prevalence of dental fluorosis was 51 to 78% while in a non-endemic area it was 5.4%. There were no significant sex differences in the prevalence of fluorosis. Attention is drawn to the need for using non-fluoridated tooth-paste in areas where dental fluorosis is common. The problem could be further aggravated in the future by the use of water from tube wells in these areas which are known to contain higher concentrations of fluoride than those from shallow wells.     

Audit of stroke care at the Institute of Neurology,National Hospital of Sri Lanka, 1994-1997

OBJECTIVE: To audit the process of stroke care. DESIGN: Retrospective case record evaluation using an audit package designed by the Royal College of Physicians of London. SETTING: Institute of Neurology, National Hospital of Sri Lanka, Colombo. PATIENTS: 263 patients with stroke admitted over a period of 3 years. MEASUREMENTS: Documentation of 60 audit items related to 13 aspects of stroke care. RESULTS: The process of care was considered 'very good' for only 11 (18.3%), and 'good' for only 9 (15%) of the audit items. Care was 'average' for 5 (8.3%), 'poor' for 9 (15%) and 'very poor' for 26 (43.3%) of the items. CONCLUSIONS: Stroke care was suboptimal in many aspects. Care related to rehabilitation oriented neurological assessments, initiation of secondary preventive measures, rehabilitation planning and discharge planning were especially deficient. Competing interests: none declared. Some of the data reported in this paper have been presented at the Annual Scientific Sessions of the Sri Lanka Medical Association, 1998.     

An observational study of staghorn calculi in south Sri Lanka

OBJECTIVES: To ascertain patient characteristics, management strategies and outcome of patients with staghorn calculi in southern Sri Lanka. METHODS: All patients with staghorn calculi seen at the urology unit in a teaching hospital during a period of eighteen months were included in this prospective study. Data in relation to patient demography, investigations, treatment and postoperative complications were collected. RESULTS: There were 60 patients with a mean age of 54 years. Eight (13%) of them were female. Urine pH was less than 7.0 in 52 (87%) patients. Urine culture was positive for bacteria in four (7%) patients. 58 patients underwent open surgery, and two patients were managed non-operatively. Seven (12%) patients developed postoperative complications. CONCLUSIONS: Staghorn calculi elsewhere are usually commoner in females and associated with alkaline urine. But in our study there was a clear male preponderance (M:F = 6.5:1), and urine pH was alkaline in 8 (13%) patients only. Hence the aetiological factors for staghorn calculi in Sri Lanka appear to be different. Although open surgical procedures which form the mainstay of treatment of staghom calculi in Sri Lanka can be performed safely and effectively, there is a necessity to provide minimal access surgical facilities.     

The nutritional status of Tanzanian children: A cross-sectional anthropometric community survey report

Anthropomorphic measurements have been found to be most useful in the assessment of nutritional and health status. Scattered cross-sectional community anthropomorphic measurements of rural preschool children from 8 regions of Tanzania were carried out in 1976 and 1977. This report involves 4766 preschool children and 341 school children who had their anthropomorphic measurements analyzed. The results showed that 2.4% of the preschool children had severe Protein Energy Malnutrition (PEM), whereas 42.6% suffered from mild to severe PEM. There were more underweight children among preschool girls than among the boys in all age groups, except in those aged 0-6 months. School girls, however, had fewer underweight children among them than school boys. This is a finding not reported in 4 other studies in Tanzania involving some 2000 preschool children, in the past. There is a cumulative stunting becoming maximum at the 18-30 month age group. The mean average "stunting" prevalence was 46.5% while the mean average "wasting" prevalence was 8.3%. There is a need to find out the reason why PEM prevalence among preschool children has not changed since about 15 years ago, while it is common knowledge that primary health care facilities have doubled or even quadrupled in quantity during the same period. It is rather expedient to find out if there is preferential treatment of preschool boys by parents.     

Nutritional status of schoolchildren in an urban area of Sri Lanka

BACKGROUND: As in many other Asian countries, Sri Lanka is in the phase of a rapid demographic, nutritional and epidemiological transition. As a result dietary habits and lifestyle are changing. These have led to new health problems in the region. Childhood overweight and obesity are examples of such problems. OBJECTIVE: To provide information on the nutritional status of 8-12 years old schoolchildren in an urban area of Sri Lanka. SUBJECTS AND METHODS: Seven schools situated in the city of Colombo were randomly selected. They showed a fair representation of children of all social levels. Fifty students from each grade (years 4, 5, 6, 7) of each school were randomly selected. Their height was measured using a stadiometer to the closest 0.1cm and weight measured using an electronic weighing scale (Seca, France) to the closest 100 g. Calibration was checked with a standard weight at each 25 measurements. Information regarding behaviour, feeding practices and socioeconomic factors were obtained by a questionnaire filled by the parent or the guardian. To define obesity and overweight, sex and age specific body mass index (BMI) criteria recommended by the International Obesity Task Force (IOTF) were used. The age and sex specific BMI 5th percentile from revised NCHS (2000) growth charts were used to define thinness. Weight and height Z score of less than -2 from the median of height for age and weight for age derived using the ANTHRO software (CDC, USA) were used to define stunting and underweight respectively. Data were analysed using Epilnfo 2000 (CDC, USA) computer package. RESULTS: Anthropometric data of 1 224 children (48% boys), and feeding practices and behaviour pattern data of 1 102 children (44% boys) were analysed. Obesity prevalence among boys (4.3%) was higher than in girls (3.1%). The prevalence of thinness was 24.7% in boys and 23.1% in girls. 5.1% of boys and 5.2% of girls were stunted. 7.0% of boys and 6.8% of girls were underweight. 66% of obese children and 43.5% of overweight children belonged to high-income category (monthly family income more than Rs. 20,000). Apart from family income, behaviour patterns did not significantly influence the nutritional status. CONCLUSIONS: Although the data are not representative of the entire country, nutritional transition is evident in the city of Colombo. Obesity and overweight in older children are some emerging nutritional problems that may be the consequence of emerging patterns of the lifestyle and diet in response to social and cultural changes.     

An audit of state sector intensive care services in Sri Lanka

OBJECTIVE: To survey the facilities, functioning characteristics, bed strength, manpower, operational practices and the distribution of the Intensive Care Units (ICU) of Government Hospitals in Sri Lanka. DESIGN: A cross-sectional observational study. METHOD: Interview of the sister or the nurse in charge of each unit by telephone using a structured questionnaire. SETTING: Department of Anaesthesiology, Faculty of Medicine, University of Peradeniya. STUDY POPULATION: All intensive care units of the government hospitals in Sri Lanka. MEASUREMENTS: Bed strength, facilities, functioning characteristics, manpower and equipment. RESULTS: Fifty two intensive care units were identified in the island. Two units could not be contacted over the telephone and one refused to participate. Of the 49 ICUs studied 28 (57.1%) were located in teaching hospitals, six (12.2%) in provincial hospitals, 13 (26.5%) in base hospitals and two (4.1%) in special hospitals. Twenty five (51%) of the 49 ICUs were multidisciplinary, three (6.1%) general medical, four (8.2%) general surgical and the remainder were of medical, surgical and paediatric subspecialities. The minimum acceptable standard of a ventilator: bed ratio of 1:1 was seen in 28 (57%) and a nurse : bed ratio of 1:1 was seen in 37 (75.5%) ICUs. A 24-hour resident medical officer was available in 46 (93.9%) of the 49 ICUs. ICUs are mostly located in larger cities. The lowest ICU coverage (one ICU for about 1.2 million people) was seen in the Uva Province. CONCLUSIONS: ICUs in Sri Lanka are mainly located in teaching hospitals. The standards and management strategies vary widely.     

Impaired glucose tolerance and diabetes mellitus in a suburban Sri Lankan community.

The prevalence of impaired glucose tolerance and diabetes mellitus was studied in a suburban Sri Lankan community using 1985 WHO criteria. Oral 75 g glucose tolerance tests were performed on 633 subjects aged 30-64 years. The age-standardized prevalence rates for diabetes mellitus were 5.02 (95% CI 3.59-6.43) and impaired glucose tolerance 5.27 (95% CI 3.74-6.78). A total of 21% of diabetic patients were not known to have diabetes and were diagnosed for the first time during the survey. Obesity was more common (P < 0.05) in diabetic patients (21%) when compared to non-diabetic subjects (10.5%). Diabetes mellitus is a common health problem in Sri Lanka, and there is a need for developing national policies for its prevention and control.     

Stroke subtypes in Sri Lanka--a hospital based study

AIM: Data on stroke subtypes in Sri Lanka are limited, mainly due to the unavailability of brain imaging facilities in most government hospitals. In two leading private hospitals in Colombo, a high proportion of stroke patients have computerised tomography (CT) scanning. Hence we studied stroke patients admitted to these two hospitals to determine the stroke subtypes. METHODS: A prospective study of 103 consecutive first ever stroke patients who were under the care of the first author during the period 15 May 1995 to 30 August 1996 were studied. Diagnosis of stroke was made according to the WHO definition, and transient ischaemic attacks (TIA) were not included. The pathological subtype was confirmed by CT scan in 99 patients. RESULTS: The age of the patients ranged from 37 to 94 years (mean 64.5). 87 patients were over the age of 50 years. The proportion of pathological subtypes confirmed by CT scanning was cerebral infarction (CI) 74.7%, intracerebral haemorrhage (ICH) 19.1% and subarachnoid haemorrhage (SAH) 62.2%. Of the infarcts 31 (42%) were cortical, 30 (41%) lacunar, 12 (16%) cerebellar and brainstem, and 1 (1.3%) was a border zone infarct. CONCLUSION: Direct comparisons with stroke subtypes seen in other countries are not valid due to differences in methodology. In developed countries in the West cerebral infarcts account for about 80% of all first ever strokes and of these 13 to 21% are lacunar strokes. Countries in the East (e.g. Japan and Hong Kong) have reported a higher proportion of haemorrhages (27% of first ever strokes in Hong Kong). In Sri Lanka the proportion of stroke subtypes seem to be intermediate between these countries in the West and East. Lacunar strokes are commoner in Sri Lanka than in other countries.     

遵义地区1岁以下农村留守儿童蛋白质-能量营养不良状况调查及影响因素分析

背景　蛋白质-能量营养不仅在认知发育,还在神经系统、生长发育、心血管系统等方面发挥重要作用,并且蛋白质-能量营养对0~1岁儿童体格、智力发育的影响可能是长期的、不可恢复的。因此,研究分析儿童蛋白质-能量营养不良（PEM）的状况及相关影响因素,对预防留守儿童的PEM及相关疾病具有重要意义。但是,遵义市农村留守儿童（≤1岁）的具体蛋白质-能量营养状况与健康问题还没有详细的资料。目的　分析遵义地区1岁以下农村留守儿童PEM状况及相关影响因素。方法　2017年8月-2019年9月采用分层随机抽样法选取遵义地区1岁以下农村留守儿童进行PEM筛查,采用问卷调查的方法收集儿童性别、月龄、看护人文化程度、吸收情况、饮食结构、父母平均身高、家庭人均年收入等情况,并测量儿童身高、体质量,采用多因素Logistic回归分析探讨1岁以下农村留守儿童PEM的影响因素。结果　共发放问卷700份,回收有效问卷650份,问卷有效回收率为92.9%。650例遵义地区1岁以下农村留守儿童PEM患病率为32.5%（211/650）。不同月龄、看护人文化程度、吸收情况、饮食结构、父母平均身高、家庭人均年收入的遵义地区1岁以下农村留守儿童PEM患病率比较,差异均有统计学意义（P<0.05）。多因素Logistic回归分析结果显示,月龄〔OR=9.562,95%CI（4.737,19.299）〕、看护人文化程度〔OR=0.482,95%CI（0.330,0.704）〕、吸收情况〔OR=2.508,95%CI（1.678,3.747）〕、饮食结构〔OR=0.298,95%CI（0.196,0.453）〕、父母平均身高〔OR=0.317,95%CI（0.208,0.481）〕、家庭人均年收入〔OR=0.367,95%CI（0.240,0.561）〕是PEM的影响因素（P<0.05）。结论　遵义地区1岁以下农村留守儿童PEM患病率较高,月龄、看护人文化程度、吸收情况、饮食结构、父母平均身高、家庭人均年收入是遵义地区1岁以下农村留守儿童PEM的影响因素。     

The prevalence of macrovascular disease and lipid abnormalities amongst diabetic patients in Sri Lanka.

The prevalence of macrovascular disease and hyperlipidaemia was examined in 500 patients with non-insulin-dependent diabetes mellitus attending a diabetic clinic in a Sri Lankan teaching hospital and 250 controls matched for age and gender. Macrovascular disease was assessed using a modified World Health Organisation questionnaire and modified Minnesota coding of electrocardiogram recordings. Twenty-one per cent of diabetic patients and 14.3% of controls had hypercholesterolaemia (P < 0.05). Macrovascular disease was present in 13.4% of diabetic patients and 8.2% of controls. Significant differences were seen in the prevalence of hypertension (15.6% vs 4.8%, P < 0.05), obesity (16.2% vs 9.7%, P < 0.05), peripheral vascular disease (5.6% vs 2%, P < 0.05) and electrocardiographic abnormalities (12% vs 6%, P < 0.05) in diabetic patients when compared to controls. Hyperlipidaemia and macrovascular disease is common in non-insulin-dependent diabetic patients in Sri Lanka and accounts for significant morbidity.     

Adaptation and validation of the parent-child conflict tactics scale for use in Sri Lanka

OBJECTIVE: The purpose of the study was to validate the Parent-Child Conflict Tactics Scale (CTSPC) in Sri Lanka, for use with 12-year old children. DESIGN: A Delphi Process determined the consensual and content validity of the CTSPC. Test-retest reliability and internal consistency were determined by a large and a small group administration. SETTING: Professionals from the social and behavioural sciences were the judges in the Delphi Process. Conveniently located schools in the Gampaha District were chosen for determining the test-retest reliability and internal consistency. MEASUREMENTS: This included original CTSPC and its Sinhala translation, a structured interview schedule and a focus group guide. RESULTS: The Sinhala version of the CTSPC showed adequate consensual and content validity. Its test-retest reliability and internal consistency were satisfactory. The instrument is best administered in small rather than in large groups of children. CONCLUSION: The Sinhala version of the CTSPC is appropriate to be used with 12-year old Sinhala speaking schoolchildren in Sri Lanka.     

The diabetes epidemic in Sri Lanka - a growing problem

Diabetes mellitus, which was once considered a disease of the developed world, has become a worldwide pandemic, with two thirds of the global diabetic population living in the developing countries. Local studies show a definite upward trend in the prevalence of diabetes mellitus. The earliest available study on a rural community in 1990 reported a prevalence of 2.5%. The largest-ever study on the diabetes prevalence in Sri Lanka was published in 2005. It showed a prevalence of 14.2% among males and 13.5% among females. The World Health Organisation and the International Diabetic Federation estimates and forecasts are much lower than the available local prevalence rates, and what may be predicted from the prevalence rates in South India. Further research is necessary to investigate the exact underlying mechanisms for the South Asian epidemic. Wider preventive programmes need to be urgently implemented to stem the tide.     

The isolation of Burkholderia cepacia in a hospital setting in Sri Lanka

INTRODUCTION: Burkholderia cepacia is widely prevalent in nature. The natural habitat of this organism is soil, water and vegetation, but the hospital environment remains the main source of infection. It causes a wide variety of infections in hospitalised patients. Since there are no reports of its prevalence in Sri Lanka, a data retrieval and analysis was undertaken to determine its incidence among patients at Sri Jayawardenepura General Hospital (SJGH). OBJECTIVE: To determine the prevalence, morphological characteristics, biochemical profile and antibiotic susceptibility pattern of B cepacia in a Sri Lankan tertiary care hospital. METHODS: Relevant clinical data were retrieved from all isolates of B cepacia from SJGH for 12 months from October 1996. Standard procedures were used to isolate the organism from clinical specimens. API 20E was employed for biochemical identification. Antibiotic susceptibility tests was carried out using the modified Kirby Bauer method. RESULTS: B cepacia was isolated from 17 patients. 16 of them were hospitalised and were from the medical, surgical, and intensive care units. All were in a compromised state of health. The organism was isolated from a variety of specimens which included swabs of surgical wounds, chronic ulcers, sputum, bronchial lavage, endotracheal aspirate, urine, peritoneal fluid and blood. Blood agar, MacConkey agar and cystine lactose electrolyte deficient medium supported the growth of all strains. They were motile Gram negative rods. All strains were oxidase positive. Strains gave variable results with other biochemical tests. Antibiograms too were variable. All strains were sensitive to ceftazidime, and the majority of the strains were sensitive to the other third generation cephalosporines. All strains were resistant to four or more antimicrobial agents included in the study. Of the 17 patients from whom B cepacia was isolated, only 9 seem to have had actual infection; others were probably instances of colonisation or contamination. CONCLUSIONS: The present report confirms the prevalence and importance of B cepacia as a hospital pathogen in Sri Lanka. Hospital laboratories should be equipped to isolate, identify and perform antibiotic sensitivity test on these strains. Antibiotic susceptibility testing is necessary as the patterns seem to differ among strains. The multiple drug resistant nature of the organism warrants strict infection control measures to prevent spread in a hospital setting.     

Evaluation of a rapid whole blood immunochromatographic assay for the diagnosis of Plasmodium falciparum and Plasmodium vivax malaria

OBJECTIVE: Microscopic examination of blood smears is the 'gold standard' for malaria diagnosis, but is labour intensive and requires skilled operators. Plasmodium vivax malaria accounts for up to 70% of infections in Sri Lanka. The objective of this study was to determine the effectiveness of an immunochromatographic test which can detect both the species of Plasmodium, P. vivax and P. falciparum, present in Sri Lanka. DESIGN: Prospective study from May 2001 to March 2002. SETTING AND METHODS: All persons above 5 years of age who presented to the Malaria Research Station, Kataragama or the Anti-malaria Clinic, Kurunegala, with a history of fever were recruited to the study. Thick and thin blood smears were examined for malarial parasites. The rapid diagnostic test (RDT), ICT Malaria P.f/P.v (AMRAD ICT, Australia) was performed simultaneously by an independent investigator. The severity of clinical disease of all patients was evaluated. RESULTS: The study sample comprised 328 individuals of whom 126 (38%) were infected, 102 with P. vivax (31.1%) and 24 with P. falciparum (7.3%). The RDT was found to be highly sensitive (100%) and specific (100%) for the diagnosis of P. falciparum when compared with field microscopy. The sensitivity for the diagnosis of P. vivax malaria was only 70%. When P. vivax parasitaemia was greater than 5000 parasites/microL the RDT was 96.2% sensitive. A significant association was noted between the band intensity on the dipstick and both peripheral blood parasitaemia (p < 0.001) and clinical severity of disease with P. vivax (p = 0.011). CONCLUSIONS: The ICT Malaria P.f/P.v test can be used in Sri Lanka in the absence of microscopists.