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.     

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.     

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.     

Health and social status of an elderly urban population in Sri Lanka

Although Sri Lanka has generally a young demographic profile, with decreasing overall mortality and birth rates, its population is aging gradually and will continue to do so in the future. In order to have an idea of the needs of the elderly a survey was conducted in a sample of randomly selected Sinhalese elders living in an urban community. Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) assessments were done. Ten percent of the respondents had at least one ADL impairment. Another ten percent had only IADL impairment. The commonest ADL to be affected were bathing and feeding. Children and the family provide all care for the impaired elderly. The family support system should be encouraged and assisted to prevent the necessity for more formal and expensive institutional care. A large proportion of the elderly were handicapped with defects in vision and hearing and the absence of teeth. Correction of these defects would improve both quality of life of these subjects and reduce their risk of accidents.     

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.     

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.     

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.     

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     

Leishmania donovani and cutaneous leishmaniasis, Sri Lanka

To investigate the relationship of cutaneous leishmaniasis isolates from Sri Lanka to known species, we performed DNA sequencing and microsatellite analyses. We identified Leishmania donovani as the agent of Sri Lanka cutaneous leishmaniasis and showed that these parasites are closely related to those causing visceral leishmaniasis in the Indian subcontinent.     

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.     

Increasing Medicaid clients' access to care. Church, state, and private providers collaborate

Medicaid clients often have difficulty obtaining a physician referral and thus seek treatment for nonemergent conditions in hospital emergency rooms. A committee with representatives from Alexian Brothers Health System, Inc., Elk Grove Village, IL, and Catholic Charities of the Archdiocese of Chicago, Rolling Meadows, IL, has collaborated with six other organizations to put an end to this misuse of the healthcare system in Chicago's northwest suburbs. Catholic Charities Physician Referral Service came about as the result of research conducted by the committee which indicated that persons on public aid have limited resources available to secure primary healthcare. The committee also reviewed a United Way needs assessment and a survey of healthcare professionals and community leaders which substantiated that the community needed a referral service. In the past, Medicaid clients often had to make numerous futile telephone calls to locate physicians who would accept them. Through this service, however, Medicaid clients simply call Catholic Charities Physician Referral Service (which has information on participating physicians' specialty, location, and hospital affiliations) and then call the physician to whom they are referred. When physicians join the referral service, they specify the number of Medicaid patients they are willing to treat during the year. Catholic Charities will help the participating physicians secure payment from the Illinois Department of Public Aid for the health services they have provided.     

Ayurveda, malaria and the indigenous herbal tradition in Sri Lanka

Using key informants and available records, the way in which inhabitants of purana villages in Nuwarakalaviya, Sri Lanka coped with malaria during the pre-DDT era is examined. This study found that the Nuwarakalaviya peasants responded to endemic malaria through a localized herbal tradition, which was to some extent independent of the scholarly ayurveda system common to the whole of South Asia. The relevant herbal tradition, consisting of a combination of antiparasite and antivector strategies using locally available natural resources, represented an effective adaptation to the local ecosystem.