Prevalence of goiter in a rural community in Sri Lanka.

The prevalence of goiter in a rural community was determined in a defined geographical area, namely, the Hindagala Community Health Project (HCHP). In this area which is divided into six Public Health Midwife (PHM) areas, the mean altitude varies from 450 to 775 meters. The house-to-house goiter survey conducted by the trained field health staff covered 70% of the population. The total goiter prevalence was 7% while the prevalence of visible goiter was 2.8%. The goiter prevalence was higher in the females than in the males at all age groups. Among males, the prevalence was highest in the school-going age group 6-18 years, while among females the highest prevalence was in the early childbearing period of 19-34 years. Further, an increasing trend in the prevalence was observed with increase in mean altitude of the PHM area. Correlation between community prevalence and age-sex specific prevalence gave the best relationship with the 6-18 year age group and a regression equation to predict the community prevalence from the prevalence in the school-going age group is presented.     

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.     

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.     

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     

Prevalence and severity of micronutrient deficiency: a cross-sectional study among adolescents in Sri Lanka

In order to determine the prevalence of micronutrient deficiencies (iron, zinc and folate) in Sri Lankan adolescent school children and the extent to which multiple micronutrient deficiencies exist in this population, a cross-sectional survey (2003) in the Galle district of the micronutrient and anthropometric status of 945 school children of ages 12-16 years was performed. The prevalence of anemia (Hb < 120.0 g/L) was 49.5% in males and 58.1% in females (overall 54.8%, gender difference, P = 0.004). In anemic children 30.2% of males and 47.8% of females were iron deficient (serum ferritin < 30.0 microg/L). Folate deficiency (<6.80 nmol/L) was found in 54.6% and 52.5% of boys and girls respectively whereas zinc deficiency (<9.95 micromol/L) occurred in 51.5% and 58.3%. Anemic boys had a 1.5 (95% confidence interval (CI) 0.9-2.6) and 1.6-fold (CI; 1.1-2.6) greater risk of being stunted and underweight, whereas the risk among anemic girls was 1.7 (CI; 1.1-2.7) and 1.0 (CI; 0.7-1.5) for being stunted and underweight. The relative risks of having at least two deficiencies in iron, zinc and folate among anemic children were 1.6 (CI; 0.6-4.2) among boys and 0.8 (CI; 0.5-1.5) among girls. Iron deficient subjects had a significantly increased risk of 1.8 (CI, 1.1-3.0) of being deficient in folate and 1.7 (CI, 1.2-2.6) of being deficient in zinc. Zinc deficient subjects had a risk of 1.3 (CI, 1.0-1.8) being iron deficient and 1.2 (CI, 0.9-1.7) of being folate deficient. Multiple micronutrient deficiencies are prevalent in Sri Lankan adolescents.     

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.     

Prevalence of antibodies to arboviruses in various animals in Israel

A serological survey of the prevalence of arbovirus antibodies in various mammals and birds was made in Israel during the years 1959-60, employing the haemagglutination-inhibition technique and using group-A and group-B antigens. High proportions of the animals of several species were found to be positive to group-B arboviruses. Most of these animals showed higher titres against the West Nile virus than against that of turkey meningoencephalitis, but in some cases there were higher titres against the latter virus. Group-A positive sera were also encountered, but in a smaller proportion of the tested animals. Most of the group-A positive sera were also group-B positive, and very few were group-A positive only.     

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.     

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.