Paradox in treatment seeking: an experience from rural Sri Lanka

Sri Lanka has had a pluralist health care system for centuries, in which Western biomedicine coexists with the Ayurveda system. However, recent studies suggest a declining trend in the use of the Ayurveda system. This study provides insights into the reasons for the low utilization of the Ayurveda system at present. The study findings reveal that low utilization of the Ayurveda system can be attributed to several factors, including the quick effect of Western medicines, the perception of being accustomed to Western medicines, a lack of competent Ayurveda practitioners, the high cost and low quality of Ayurveda medicines, and the rapidly changing lifestyles of villagers. However, for certain conditions such as fractures, snakebite, and paralysis, the majority of the Sri Lankan population still uses Ayurveda treatment. In conclusion, we suggest that health authorities should take into account these changes for future health planning in Sri Lanka.     

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.     

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.     

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.     

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.     

Cost of malaria control in Sri Lanka.

The study provides estimates of the cost of various malaria control measures in an area of North-Central Province of Sri Lanka where the disease is endemic. We assumed that each measure was equally effective. In these terms, impregnating privately purchased bednets with insecticide was estimated to cost Rs 48 (US(40.87) per individual protected per year, less than half the cost of spraying houses with residual insecticides. Larviciding of vector breeding sites and especially the elimination of breeding habitats by flushing streams through seasonal release of water from upstream reservoirs was estimated to be cheaper than other preventive measures (Rs 27 (US$ 0.49) and Rs 13 (US$ 0.24) per individual protected, respectively). Inclusion of both operational and capital costs of treatment indicates that the most cost-effective intervention for the government was a centrally located hospital with a relatively large catchment area (Rs 71 (US$ 1.29) per malaria case treated). Mobile clinics (Rs 153 (US$ 2.78) per malaria case treated) and a village treatment centre (Rs 112 (US$ 2.04)) per malaria case treated) were more expensive options for the government, but were considerably cheaper for households than the traditional hospital facilities. This information can guide health planners and government decision-makers in choosing the most appropriate combination of curative and preventive measures to control malaria. However, the option that is cheapest for the government may not be so for the householders, and further studies are needed to estimate the effectiveness of the various preventive measures.     

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.     

Acute poisoning: a major health concern in Sri Lanka.

The importance of acute poisoning as a cause of morbidity and mortality in many developing countries has been highlighted in recent times. This study discusses the utilization of routinely collected data from hospitals for background information required in planning and implementing preventive programs. The high prevalence of poisoning and its distribution countrywide were highlighted by the routinely collected data, while the retrospective study of hospital admissions identified the wide range of toxic agents and age and sex differentials in the pattern of poisoning. Even though the overall case fatality rate was 7.6%, there was wide variation among the different toxic agents.     

Abortion in Sri Lanka: The Double Standard

In Sri Lanka, women do not have access to legal abortion except under life-saving circumstances. Clandestine abortion services are, however, available and quite accessible.Although safe specialist services are available to women who can afford them, others access services under unsafe and exploitative conditions. At the time of this writing, a draft bill that will legalize abortion in instances of rape, incest, and fetal abnormalities awaits approval, amid opposition.In this article, I explore the current push for legal reform as a solution to unsafe abortion. Although a welcome effort, this amendment alone will be insufficient to address the public health consequences of unsafe abortion in Sri Lanka because most women seek abortions for other reasons. Much broader legal and policy reform will be required.IN DECEMBER 2011, THE abortion debate in Sri Lanka took off once again when the Minister of Child Development and Women’s Affairs, Tissa Karaliyadda, raised the need for abortion law reform in parliament.1 The existing law, a legacy of colonial rule, permits abortion only to save a woman’s life. 2 This archaic piece of legislation has not been revised since 1883.3 The proposed amendment will make abortion legal in instances of rape, incest, and fetal abnormalities.1,4 A draft bill, prepared by the Law Commission in consultation with the Ministry of Child Development and Women’s Affairs and the Ministries of Health and Justice, awaits approval at this writing.4,5 This bill, if passed in parliament, will permit abortion under those circumstances if recommended by a panel of medical experts based at a government hospital (Anonymous, e-mail communication, August 28, 2012). Although the proposed amendment will make abortion law less restrictive and provide some leeway to women in Sri Lanka, much broader legal and policy changes will be required to address unsafe abortion.     

Effects of the health service and environmental factors on infant mortality: the case of Sri Lanka.

One of the findings of this study is that regional variations in the infant mortality rates of Sri Lanka are large, ranging from 26 per 1000 live births in Jaffna to 91 per 1000 in Nuwara Eliya, a tea estate district. These differences are more strongly associated with regional variations in environmental determinants of mortality than with regional variations in public health expenditure. The most significant environmental factor associated with interregional infant mortality rates was to be the nature of the water supply (r = -0.82, significant at the 99% level). Regional government expenditure on health had only a weak association with infant mortality rates (r = 0.08).     

Care seeking behaviour for childhood illness- a questionnaire survey in western Nepal

Background  

The World Health Organization estimates that seeking prompt and appropriate care could reduce child deaths due to acute respiratory infections by 20%. The purpose of our study was to assess care seeking behaviour of the mothers during childhood illness and to determine the predictors of mother's care seeking behaviour.     

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.     

Underestimation of snakebite mortality by hospital statistics in the Monaragala District of Sri Lanka

Estimates of snakebite mortality are mostly based on hospital data, although these may considerably underestimate the problem. In order to determine the accuracy of hospital-based statistics, data on snakebite mortality in all hospitals in the Monaragala District of Sri Lanka were compared to data on snakebite as the certified cause of death for the district, for the 5-year period between 1999 and 2003. Data were cross-checked in a sample of hospitals and divisional secretariats within the district. Hospital statistics did not report 45 (62.5%) of the true number of snakebite deaths in the Monaragala District. Twenty-six (36.1%) of the victims either did not seek, or had no access to, a hospital. Another 19 (26.4%) had arrived at hospital, but had done so too late to receive treatment. Our study confirms the limitations of official hospital-based mortality data on snakebite.     

Excreta disposal behaviour and latrine ownership in relation to the risk of childhood diarrhoea in Sri Lanka.

A case-control study of environmental and behavioural risk factors for childhood diarrhoea was conducted in Kurunegala district, Sri Lanka. From five hospitals, 2458 children aged less than 5 years and suffering from diarrhoea were recruited as clinic cases, and a further 4140 reporting with complaints other than diarrhoea were recruited as clinic controls. Community-based cross-sectional surveys were also conducted in three of the five areas served by these hospitals, and from these a further 1659 children were recruited as community controls. Children from households where excreta were reported to be disposed of in a latrine were less likely to have diarrhoea than children whose families improperly disposed of excreta. The results obtained from comparisons of cases with clinic controls (adjusted odds ratio [OR] 1.42, 95% confidence interval [CI] : 1.01-1.98), and of cases with community controls (OR 1.35, 95% CI : 0.85-2.13) were in agreement, suggesting that no important selection bias operated on this association. If the observed proportion (91%) of improper excreta disposal among the population could be reduced to 50%, 12% of childhood diarrhoea episodes would be prevented. Although latrine ownership may be a necessary condition for safe excreta disposal behaviour, diarrhoeal morbidity may only be reduced in Sri Lanka if behavioural changes take place concomitant with the construction of sanitation facilities.     

Assessing potential demand for Norplant implants in Sri Lanka

This study assesses potential demand for Norplant^R implants using data from a population-based survey conducted in rural Sri Lanka. Overall, 35% of currently married non-sterilized women of childbearing age expressed interest in using the implants, 52% did not want to use the method, and 13% were unsure about using it. The demand was substantially higher (44% vs 28%) among younger age groups (<30 years) than among older age groups (30–44). The results showed that life-cycle variables (age, parity and marital duration) and fertility preference variables (desire for another child and desired birth-interval) were generally more important than socioeconomic variables in determining variations in potential demand for Norplant in Sri Lanka. Desired birth spacing was found to be a powerful indicator of the potential demand. The majority (85%) of respondents interested in using Norplant were also willing to absorb at least some of the cost of the implants. Among older age groups, those who were using modern temporary methods of contraception either exclusively or in combination with traditional methods had a higher demand for Norplant than non-users or exclusive users of traditional methods. For the younger women, however, potential demand did not vary significantly according to whether they were currently using a method or the type of method used.

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Resumen En este estudio se evalúa la demanda potencial de implantes Norplant según datos recopilados de una encuesta demográfica del área rural de Sri Lanka. En general, el 35% de las mujeres casadas no esterilizadas y en edad de procrear manifestaron interés en utilizar implantes, el 52% no deseaba utilizar este método y el 13% sentía dudas respecto de su utilización. La demanda era considerablemente mayor (44% en comparación con 28%) entre las más jóvenes (<30 años) que en el grupo de mujeres de más edad (30 a 44 años). Los resultados indicaron que las variables de condiciones de vida (edad, número de hijos y duración del matrimonio) y las variables de preferencias en materia de fecundidad (deseo de tener otro hijo y deseo de un intervalo determinado entre nacimientos) eran por lo general más importantes que las variables socioeconómicas en la determinación de las variaciones relativas a la demanda potencial de Norplant en Sri Lanka. Se observó que el deseo de espaciar los nacimientos era un fuerte indicador de la demanda potencial. La mayoría de las mujeres (85%) interesadas en utilizar implantes Norplant también estaban dispuestas a absorber al menos una parte de los costos. En el grupo de mujeres de más edad, la demanda era más alta entre las que utilizaban temporalmente métodos anticonceptivos modernos, ya fuera exclusivamente o en combinación con otros métodos clásicos, que entre las que no practicaban la anticoncepción o bien recurrían a métodos tradicionales. Sin embargo, entre las más jóvenes, la demanda potencial no variaba significativamente según si utilizaban en ese momento algún método o el tipo de método utilizado.

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Resumé L'étude présentée cherche à déterminer la demande potentielle pour les implants Norplant d'après les données recueillies lors d'une enquête auprès de la population rurale au Sri Lanka. Dans l'ensemble, 35% des femmes mariées non privées de leur possibilité de procréer ont exprimé de l'intérêt en faveur de l'utilisation des implants, 52% ne voulaient pas appliquer cette méthode et 13% hésitaient à l'employer. La demande était considérablement plus élevée (44% contre 28%) chez les plus jeunes (<30 ans) que dans le groupe de femmes plus âgées (30 à 44 ans). Les résultats ont montré que la demande potentielle pour les Norplant au Sri Lanka dépendait en général plus de variables relatives aux conditions de via (âge, nombre e'enfants et durée de mariage) et de variables dans les préférences en matière de fécondité (désir d'avoir un autre enfant et désir de prévoir un intervalle entre les naissances) que des variables socio-économiques. On a constaté que le désir d'espacer les naissances était un indicateur puissant de la demande potentielle. La majorité des femmes (85%) ayant répondu que l'utilisation des Norplant les intéressait étaient également disposée à en absorber au moins une partie des coûts. Dans le groupe des femmes plus âgées, la demande était plus élevée chez celles qui utilisaient temporairement des méthodes de contraception modernes, soit exclusivement soit en combinaison avec d'autres méthodes classiques, que chez celles qui ne pratiquaient pas de contraception ou faisaient appel à des méthodes traditionnelles. Chez les plus jeunes, par contre, la demande ne variait pas de façon significative selon qu'elles utilisaient à l'époque une méthode quelconque, ni selon le type de méthode employé,

     

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.     

Utilization of Boxes for Pesticide Storage in Sri Lanka

Pesticide self-poisoning is now considered one of the two most common methods of suicide worldwide. Encouraging safe storage of pesticides is one particular approach aimed at reducing pesticide self-poisoning. CropLife Sri Lanka (the local association of pesticide manufacturers), with the aid of the Department of Agriculture, distributed lockable in-house pesticide storage boxes free of charge to a farming community in a rural district of Sri Lanka. Padlocks were not provided with the boxes. These storage boxes were distributed to the farmers without prior education. The authors carried out a cross-sectional follow-up survey to assess the usage of boxes at 7 months after distribution. In an inspection of a sample of 239 box recipients’ households, 142 households stored pesticides in the provided box at the time of survey. Among them, only 42 (42/142, 29.65%) households had locked the box; the remaining households (100/142, 70.4%) had not locked the box. A simple hand over of in-house pesticide storage boxes without awareness/education results in poor use of boxes. Additionally, providing in-house storage boxes may encourage farmers to store pesticides in and around houses and, if they are not locked, may lead to unplanned adverse effects.