Prevalence of occupational injury and its contributing factors among rubber tappers in Galle,Sri Lanka

Background: Rubber tapping involves carrying heavy loads, navigating rough terrain, and using sharp tools. However, little is known about occupational injury among this vulnerable working population.

Objective: To assesses the prevalence, severity, and contributing factors associated with occupational injury among Sri Lankan rubber tappers and to identify possible interventions to improve occupational safety.

Methods: A questionnaire was administered to 300 Sri Lankan rubber tappers. The associations between tapper characteristics and injury within the last year were examined using log-binomial regression models. Short response answers were analyzed using qualitative content analysis.

Results: 300 tappers reported 594 injuries in the previous 12 months, and missed 1,080 days of work. The prevalence of one or more injuries was 49%. Factors associated with injury were being female, working an additional job, tapping with a two-handed approach, and depressive symptomology. Qualitative findings suggest three interventions to address injuries: (1) landscaping, (2) personal protective equipment, and (3) provision of eyeglasses.

Conclusions: Work-related injuries are common among Sri Lankan rubber tappers. These results highlight the importance of working with and including informal workers in the creation of Sri Lankan occupational health and safety regulations. We believe that the three interventions identified by respondents could help to reduce the risk of occupational injury among rubber tappers.     

General preferences for involvement in treatment decision making among European women with urinary incontinence

Current health care policies advocate patient participation in treatment decision making. Little evidence on possible differences between European women's preferences for involvement in this process exists. In this study we explore preferences for involvement in treatment decision making in 15 European countries in a sample of 9434 women seeking treatment for urinary incontinence in an outpatient setting. Their generally preferred role in treatment decisions was assessed using the Control Preferences Scale. Results show variations within and between countries in preferences for involvement in treatment decision making. The 'collaborative role' was the most preferred role in Austria, Belgium, Denmark, France, Germany, Ireland, Sweden, Switzerland, the Netherlands and the UK. In Greece, Portugal and Spain the 'passive role' was most preferred. Over a third of women in Denmark, Finland and Norway preferred an 'active role'. Multinominal regression analyses found that, after adjusting for case mix and factors previously associated with role preferences, country membership was strongly associated with role preferences, with women living in Southern European countries preferring a more passive role. Such clear differences are of interest in the current health care environment where active patient participation is being encouraged. Greater efforts need to be made to establish whether patient preferences are genuine or merely a learned response influenced by cultural attitudes and traditions so that a balance can be struck between assisting women to play a more active role in the treatment decision-making process without disregarding some women's genuine preferences to play a more passive role.     

Exposure to polychlorinated biphenyls (PCBs) among welders in Sri Lanka

Abstract

Polychlorinated biphenyls (PCBs) are a group of persistent organic pollutants with the ability to cause adverse impacts on human health and the environment. This study describes the indiscriminate use of PCB-contaminated transformer oil as a coolant in informal welding shops in Kalutara, Sri Lanka. Sixty-three welders, one each from a convenience sample of 63 welding workshops participated in the study. We administered a questionnaire and observed work practices. Sixty-two (98%) workplaces used transformer oil as the coolant in the welding equipment, 60 (95%) claiming that it was the only one available. Sixty-two (98%) did not use any protective measures when refilling coolant oil, while none of them safely disposed of the empty coolant oil containers. Only four (6%) were aware of the possible health effects of PCB-contaminated coolant oil. Health and safety measures in the work places studied were very poor. Coolant oil samples from a sub-sample of 30 welding workshops were tested for PCBs; 19 (63%) were positive. PCB-contaminated coolant oil is widely used by the welders in Kalutara without adequate precautions or safety measures.     

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.     

Incidence of Physical Injuries in a Rural Community in Sri Lanka: Results of the First Community Survey in Sri Lanka

Background:

Injuries account for approximately 11% of all hospital admissions in Sri Lanka. However, no published data are available with regard to the community incidence of injuries in Sri Lanka.

Objectives:

To determine the community incidence of major intentional and unintentional physical injuries in a rural community in Sri Lanka.

Materials and Methods:

A rural community consisting of 225 families with 1029 inhabitants was studied. Data on major injuries for a period of one year were collected retrospectively.

Results:

There were 85 major injuries in the community during the year of study. This gives a major injury incidence of 82.6 per 1000 person years. This is three times the incidence based on hospital-derived data. Animal bites being the most common cause of injury was noted in 2.3% of the population followed by falls in 1.6%, contact with objects in 1.5%, cut injuries in 1% and road trauma in 1%.

Conclusions:

This study shows a higher incidence of major physical injuries (both intentional and unintentional) in the community than figures derived from hospital data. The prevention of injuries in a community such as the one studied here should be aimed at animal bites, falls, contacts with objects, cut injuries and road trauma.     

Religious leaders as potential advocates for HIV/AIDS prevention among the general population in Sri Lanka

Abstract

Religious leaders in Sri Lanka may have a high potential of contributing to HIV/AIDS prevention among the general public because of their social status. In order to assess their current HIV/AIDS-related knowledge and attitude and the possibility of becoming community advocates of HIV/AIDS prevention, we conducted a questionnaire survey among Buddhist, Hindu, Muslim and Christian leaders in Sri Lanka in 2009. There were limited correct responses about HIV/AIDS-related knowledge and attitudes toward people living with HIV/AIDS (PLHIV), and information regarding condoms, HIV testing and counselling were poorly understood. Although a condom was less acceptable as a part of HIV/AIDS prevention, they were willing to learn more about HIV/AIDS and expressed support for both PLHIV and HIV prevention activities. Their experiences, preparedness and willingness of HIV prevention activities were associated with age, knowledge and/or religious background. In conclusion, intensive and systematic learning opportunities should be provided to equip the religious leaders with overall HIV/AIDS knowledge to become key players for HIV/AIDS prevention in their communities.     

A study of tuberculosis, malnutrition and gender in Sri Lanka

This study assesses the nutritional status of tuberculosis (TB) patients in Sri Lanka and differences in the nutritional presentation between males and females. In May-June 2002, cases from Colombo hospitals and controls from both the Sri Lankan Air Force Base and audience members at a 'better health' presentation in Colombo were assessed for nutritional status using a modified Standard Global Assessment. Fifty cases and 49 controls were recruited. Nutritional examinations revealed the cases to have significantly lower nutritional values than the controls (body mass index 16.2 vs. 24.0 kg/m(2); arm circumference 20.7 vs. 28.4 cm; muscle wasting [temple 56% vs. 0%; shoulder 46% vs. 0%]). The nutritional history revealed the cases to have higher levels of anorexia, vomiting, nausea and diarrhoea within the preceding fortnight. Differences between the genders were minimal other than an increase of 23 and 19% in the frequency of female cases having suffered with vomiting and nausea respectively. Consequently, both male and female TB patients in Sri Lanka are significantly malnourished. It is recommended that patients receive nutritional support during their treatment, with studies of the exact nutritional deficiencies at the micronutrient level and their effect on the immune system being required.     

Occupational risk factors for low back pain among drivers of three-wheelers in Sri Lanka

Background:

Approximately 5% of all households in Sri Lanka operate a three-wheeler as their primary source of income. However, very little is known about the occupational health risks associated with driving these vehicles.

Objectives:

The aim of this study was to assess occupational risk factors, including the number of hours worked associated with the 4-week prevalence of low back pain (LBP) among drivers of three-wheelers.

Methods:

Questionnaires were administered to 200 full-time drivers of three-wheelers from the Galle District in Sri Lanka. Occupational, psychological, socio-demographic, lifestyle, and anthropometric variables were collected. Univariate and multivariate analysis were used to investigate the correlation between occupational risk factors of the prevalence of LBP.

Results:

15.5% of respondents reported experiencing LBP in the previous 4 months. Univariate analysis revealed that the number of hours worked per week, feeling pressure to compete with other drivers, and perceived stress scale scores were significantly associated with the 4-week prevalence of LBP. Multivariate analysis found that the number of hours worked per week and engine type were significantly associated with LBP.

Conclusions:

LBP is common among drivers of three-wheelers in Sri Lanka. Long work hours and two-stroke engines were significantly associated with LBP. Results from this study point towards a role for educational, behavioral health, and policy interventions to help prevent and reduce LBP among these drivers.     

Factors associated with maternal knowledge of newborn care among hospital-delivered mothers in Sri Lanka

The aim of this study was to assess mothers' knowledge on newborn care as well as factors associated with poor knowledge. A cross-sectional study sampled 446 mother-newborn pairs from five hospitals in the Puttalam district of Sri Lanka by stratified random sampling. Maternal knowledge on newborn care was assessed using a questionnaire with 50 statements via exit interview. A knowledge score was created by allocating 1 point for each correct response, which was dichotomised as 'satisfactory' or 'poor' by the median score. Only 21.7% correctly answered that 'surgical spirit' (70% isopropyl alcohol) should not be applied on the umbilical stump. More than 90% of mothers knew about breastfeeding on demand, the advantages of colostrum and the duration of exclusive breastfeeding. Except for a few conditions, mothers demonstrated a satisfactory knowledge in recognising danger signs of the newborn. According to multivariate analysis, primiparae (odds ratio (OR)=2.31; 95% CI 1.53-3.50), unemployed women (OR=3.31; 95% CI 1.89-5.80) and those with delayed antenatal booking visits (OR=2.02; 95% CI 1.26-2.23) were more likely to have poor knowledge. In conclusion, mothers had a satisfactory level of knowledge about breastfeeding and recognition of danger signs, but knowledge about care of the umbilical cord was poor. Maternal education programmes should place more emphasis on first-time mothers, unemployed women and those with delayed booking visits.     

Occupational risk factors for low back pain among drivers of three-wheelers in Sri Lanka

Abstract

Background:

Approximately 5% of all households in Sri Lanka operate a three-wheeler as their primary source of income. However, very little is known about the occupational health risks associated with driving these vehicles.

Objectives:

The aim of this study was to assess occupational risk factors, including the number of hours worked associated with the 4-week prevalence of low back pain (LBP) among drivers of three-wheelers.

Methods:

Questionnaires were administered to 200 full-time drivers of three-wheelers from the Galle District in Sri Lanka. Occupational, psychological, socio-demographic, lifestyle, and anthropometric variables were collected. Univariate and multivariate analysis were used to investigate the correlation between occupational risk factors of the prevalence of LBP.

Results:

15·5% of respondents reported experiencing LBP in the previous 4 months. Univariate analysis revealed that the number of hours worked per week, feeling pressure to compete with other drivers, and perceived stress scale scores were significantly associated with the 4-week prevalence of LBP. Multivariate analysis found that the number of hours worked per week and engine type were significantly associated with LBP.

Conclusions:

LBP is common among drivers of three-wheelers in Sri Lanka. Long work hours and two-stroke engines were significantly associated with LBP. Results from this study point towards a role for educational, behavioral health, and policy interventions to help prevent and reduce LBP among these drivers.     

Maternal Compliance to Recommended Iron and Folic Acid Supplementation in Pregnancy,Sri Lanka: A Hospital-Based Cross-Sectional Study

Iron deficiency anaemia during pregnancy is a common public health problem that negatively affects maternal and newborn health. This study aims to identify the rate of maternal compliance with the recommended iron and folic acid (IFA) supplementation during pregnancy and to identify factors associated with maternal compliance and non-compliance. A hospital-based cross-sectional study was conducted among 703 women at 0–4 days postpartum. The prevalence of anaemia at the initial antenatal clinic (ANC) visit and at the third trimester were 20.8% and 44.9%, respectively. The rate of IFA supplementation compliance during pregnancy was 80.1%. Forgetfulness (66.9%) was the major reason for non-compliance, followed by side effects (15.7%). Maternal employment [OR (95%CI): 1.7 (1.00–2.89)], history of a low birth weight infant [OR (95%CI): 0.4 (0.19–0.9)] and history of anaemia [OR (95%CI): 0.4 (0.12–0.98] were significantly associated with maternal compliance with IFA supplementation. Only 26.6% of the participants adhered to dietary recommendations during the period when IFA supplements were provided. The rate of maternal compliance with IFA supplementation was high. However, the prevalence of maternal anaemia during pregnancy was also high, which was presumably due to poor dietary compliance despite high IFA supplementation compliance.     

Tubulointerstitial damage as the major pathological lesion in endemic chronic kidney disease among farmers in North Central Province of Sri Lanka

Chronic kidney disease of uncertain etiology (CKDu) in North Central Province of Sri Lanka has become a key public health concern in the agricultural sector due to the dramatic rise in its prevalence and mortality among young farmers. Although cadmium has been suspected as a causative pathogen, there have been controversies. To date, the pathological characteristics of the disease have not been reported. Histopathological observations of 64 renal biopsies obtained at Anuradhapura General Hospital from October 2008 to July 2009 were scored according to Banff 97 Working Classification of Renal Allograft pathology. The correlations between the histological observations and clinical parameters were statistically analyzed. Interstitial fibrosis and tubular atrophy with or without nonspecific interstitial mononuclear cell infiltration was the dominant histopathological observation. Glomerular sclerosis, glomerular collapse, and features of vascular pathology such as fibrous intimal thickening and arteriolar hyalinosis were also common. Although hypertension was identified as one of the common clinical features among the cases, it did not influence the histopathological lesions in all the cases. This study concludes that tubulointerstitial damage is the major pathological lesion in CKDu. Exposure(s) to an environmental pathogen(s) should be systematically investigated to elucidate such tubulointerstitial damage in CKDu.     

Chronic renal failure in North Central Province of Sri Lanka: an environmentally induced disease

This study was conducted to determine the aetiology of chronic renal failure (CRF) in the North Central Province of Sri Lanka. Patients (n=183) with CRF of unknown aetiology were compared with controls (n=200) who had no evidence of chronic renal dysfunction. Exposure to possible risk factors were determined by an interviewer-administered questionnaire. Being a farmer (P<0.001), using pesticides (P<0.001), drinking well water (P<0.001), a family history of renal dysfunction (P=0.001), use of ayurvedic treatment (P<0.001) and a history of snake bite (P<0.001) were risk factors for CRF of unknown aetiology. Using logistic regression analysis, a family history of chronic renal disease, taking ayurvedic treatment and history of snake bite were found to be significant predictors for CRF of unknown aetiology. There is evidence to support an environmental aetiology to CRF in Sri Lanka.     

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.     

Case reports: intra-aural tick infestations in humans in Sri Lanka

Intra-aural tick infestation was detected in 29 patients presenting with acute ear pain in the central province of Sri Lanka during June 1999 to January 2002. The ages ranged from 9 months to 67 years. All showed oedematous aural canals and enlarged adjacent lymph nodes. Of 30 ticks removed, 29 were nymphs of Dermacentor auratus and 1 and male Hyalomma marginatum isaaci.     

A cohort event monitoring to determine the adverse events following administration of mouse brain derived,inactivated Japanese Encephalitis vaccine in an endemic district in Sri Lanka

Introduction of human immunization reduced Japanese Encephalitis (JE) cases dramatically in Sri Lanka. However, the increased reporting of adverse events following immunization (AEFI) affected vaccine acceptance by the community. Against this background, we describe the incidence of overall AEFI and incidence and profile of AEFI, thought to be causally related to the mouse-brain derived JE vaccine.     

Gender bias in health research: implications for women's health in Kerala (India) and Sri Lanka

Indian state of Kerala, and Sri Lanka have a special place in global health discourses, although there has been a relatively little systematic analysis of women's health in these societies. Moreover, there are a number of dimensions of women's health that have been underappreciated by public health researchers and development experts due to systematic gender biases in health research. This article seeks to provide a more complete picture of women's health in Kerala and Sri Lanka by explicitly addressing three key gender biases: inattention to health issues that particularly affect women, incomplete approaches to understanding the health of women and insufficient attention paid to the interactions between gender and other social stratification, such as class, ethnicity or caste.     

Risk factors associated with disease progression and mortality in chronic kidney disease of uncertain etiology: a cohort study in Medawachchiya, Sri Lanka

Background

The alarming rise in the prevalence of chronic kidney disease of uncertain etiology (CKDu) among the low socioeconomic farming community in the North Central Province of Sri Lanka has been recognized as an emerging public health issue in the country.

Methods

This study sought to determine the possible factors associated with the progression and mortality of CKDu. The study utilized a single-center cohort registered in 2003 and followed up until 2009 in a regional clinic in the endemic region, and used a Cox proportional hazards model.

Results

We repeatedly found an association between disease progression and hypertension. Men were at higher risk of CKDu than women. A significant proportion of the patients in this cohort were underweight, which emphasized the need for future studies on the nutritional status of these patients.

Conclusions

Compared with findings in western countries and other regions of Asia, we identified hypertension as a major risk factor for progression of CKDu in this cohort.