Loa loa in a Sri Lankan expatriate from Nigeria

A worm was extracted from the subconjunctival space of the left eye in a 14-year old Sri Lankan girl, who returned to Sri Lanka in 1983 after spending six years in Nigeria. It was identified as a male Loa loa. A history of evanescent (Calabar) swellings was obtained. She also had significant eosinophilia. Microfilariae were not detected in the blood. This is the first case of Loa loa infection reported from Sri Lanka.     

Paroxysmal kinesigenic dyskinesia

Paroxysmal kinesigenic dyskinesia (PKD) is a rare disorder characterised by brief and frequent attacks of abnormal involuntary movements induced by sudden movement. This disorder has not been reported previously in Sri Lanka. We studied six patients with respect to clinical presentation, aetiology, family history and response to treatment, and describe the Sri Lankan patterns of this illness. All the patients were males and the age at onset was from 11 to 22 years. The involuntary movements in all were dystonic and affected one or both sides, involving the face in the majority. All had difficulty in speaking during the attacks. One patient had an occasional attack during exercise. In all, the illness was sporadic, none had a family history of a similar illness and in none was it due to a secondary cause. The attacks usually lasted 10-60 seconds, and occurred up to 20 times a day. All patients responded well to anticonvulsants. PKD in Sri Lanka has a pattern similar to that described worldwide.     

Sri Lankan health care provision and medical education: a discussion

My elective was spent at a teaching hospital in Galle, in Sri Lanka. My time was spent shadowing final year students in the specialties of general medicine and paediatrics. This period provided me with much food for thought in comparing and contrasting the health service in Sri Lanka with that of the UK and also considering the differences in the style of medical education. In addition, during my stay, I was able to gain some appreciation of the political and organisational problems faced by a country in the midst of a civil war.In this report, I have attempted to integrate an account of my observations with a discussion of the thoughts and emotions that I experienced while working in a developing country. Studying in Sri Lanka facilitated my appreciation of facets of British health care and medical education that I had not previously considered. However, fewer resources do not necessarily mean poorer patient care: could Britain have something to learn from the Sri Lankan Health Service?     

Knowledge, behaviour and attitudes on induced abortion and family planning among Sri Lankan women seeking termination of pregnancy

INTRODUCTION: In Sri Lanka over 500 induced abortions are done daily in spite of restrictive legislation. Experiences in other countries show that liberal laws alone have not solved the issues of induced abortions which may harm a woman's physical and mental health. OBJECTIVE: To determine the socio-demographic features of women seeking termination of pregnancy, and their knowledge, attitude and behaviour with respect to induced abortion and family planning. METHODS: A prospective study on a randomly selected group of 210 women attending a clinic in Colombo requesting termination of pregnancy. A pre-tested interviewer-administered questionnaire was used for data collection. RESULTS: Over 80% of women seeking abortion were between 20 and 40 years of age. All religions were represented. 13% were single and 10% wanted to postpone a pregnancy. 38.6% had three or more children. In 90% the period of gestation was less than 10 weeks. Presence of a young child was the commonest reason for termination, followed by poverty. Only 0.9% were due to incest and foetal abnormality. 96% were not aware of adverse effects of abortion. 91% thought that induced abortion was immoral and 94% did not know that it was illegal. 29% had previous terminations and post-abortion contraception counselling was poor. Although 78% were knowledgeable on at least one method of contraception, only 16.3% were using it regularly. DISCUSSION: A majority used induced abortion as a family planning method. Improving accessibility and the quality of family planning services is of paramount importance. Every encounter of a woman with a health care worker should be an opportunity for counselling.     

Zimbabwe: a family planning profile

This brief article focuses on the history of family planning in Zimbabwe, available services, community-based distribution, contraceptive use, and program problems. Family planning services were first available in Zimbabwe in 1953. The Rhodesian Family Planning Association (RFPA) was established formally in 1965. RFPA distributed contraceptives in 1966 and trained for the first time "field educators" in 1967. The first community-based distributors were trained in 1972. The Ministry of Health integrated the RFPA into its department in 1981. In 1985, the family planning association became a parastatal and was renamed the Zimbabwe National Family Planning Council (ZNFPC). Services today are provided through 37 family planning clinics. The distribution of contraceptives includes IUDs, condoms, pills, and injectables. Harare and Bulawayo centers receive referrals and perform tubal ligation, vasectomy, and infertility counseling. 700 community-based distributors (CBDs) received a 6-week training course in order to educate about oral contraceptives, encourage their use, and screen clients for high blood pressure and side effects for oral contraceptives. CBDs use bicycles to make home visits and also have access to motorcycles. Each CBD averages 135 clients/month. Most visits are revisits. CBDs provided 25.3% of family planning in 1988. Local clinics provided 19.1% of family planning. Ministry of Health facilities provided 14.8% of services. ZNFPC clinics provided 13.7% of services. Private doctors or pharmacies provided 2.3% of services. 38% of women currently in a union used family planning in 1984, and 43% used it in 1988. 36% in 1988 used modern methods. The pill was the most common method, followed by withdrawal. Logistics of supplies and equipment remain problematic.     

Validity and reliability of Tamil version of Strengths and Difficulties Questionnaire self-report

BACKGROUND: Child and adolescent mental health services are scarce in Sri Lanka. Moreover there are no validated instruments to measure the mental health problems of Tamil speaking adolescents in Sri Lanka. Hence, strengths and difficulties questionnaire (SDQ) self-report was translated into Tamil and validated in the District of Jaffna, Sri Lanka. SDQ self-report was translated from English to Tamil using standard translation and back translation method. The Tamil version of the SDQ self-report was validated against a gold standard (ie. diagnosis made by a consultant psychiatrist). Both clinic and community samples were included in the validation study. Thirty-five adolescents (11-16 years) attending a psychiatric clinic and 91 adolescents from the community were included. The consultant psychiatrist made the diagnosis independent of the SDQ responses. Receiver operating characteristics (ROC) curve was used to measure the validity of SDQ. Reliability was measured using internal consistency. RESULTS: The ROC curve indicated high validity for the identification of adolescents with mental health problems: area under the curve 0.87 (95% - CI = 0.79-0.93). International cut-off point of 15 gave a sensitivity of 69.4% and specificity of 92.2%. Cronbach's alpha values (0.67-0.78) were good in all subscales and total difficulties scale. CONCLUSION: The SDQ self-report Tamil version can be used effectively for screening of adolescents to identify mental health problems as well as for research purposes.     

农村地区妇女孕产期保健干预效果评价

目的　评价人员技术培训对农村地区妇女妇幼保健服务的改善效果。方法　利用准人群试验设计方法 ,从 32个项目县中选择 6个县作为干预组。选择人口和经济状况与项目县类似 ,且未实施“生殖健康 /计划生育”项目的 6个县作为对照组。采用结构式问卷共访谈 3岁以下儿童的母亲 348名 ,干预组和对照组各为 1 85名和 1 6 3名。调查内容为孕产期保健的产前检查和产后访视的情况。干预措施 :统一对乡、村两级妇幼卫生人员进行 3轮为期两周理论培训 ,并安排一个月的临床进修。结果　在产前检查方面 ,干预组调查对象的平均产前检查次数高于对照组 ,分别为 6 .6 4和 5 .6 4 (P<0 .0 5 ) ;干预组平均产前检查项目数高于对照组 ,分别为 6 .71和 5 .6 7(P<0 .0 5 ) ;干预组中医生告知孕期注意事项的比例高于对照组 (P<0 .0 5 )。在 8项孕期不良症状和体征中 ,干预组调查对象平均知道 3.4 3项 ,对照组 2 .0 9项 ,两组间差异有统计学意义 (P<0 .0 5 )。在产后访视方面 ,干预组平均产后访视次数为 3.1 0次 ,对照组为 2 .5 4次 ,两组间差异有统计学意义 (P<0 .0 5 )。调查对象在接受产后访视时 ,医生仅询问了情况 ,而未做检查 ,对照组 (1 9.0 % )高于干预组 (6 .0 % )。干预组被告知避孕方法比例 (94 % )高于对照组 (78.5     

Prevalence of Chlamydia trachomatis and genital mycoplasmas in asymptomatic women.

To establish the prevalence of Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum in women attending a family planning and a prenatal clinic in Halifax, cervical swabs were obtained at the time of the first visit from 491 women who had no symptoms of genital infection. Among the women attending the family planning clinic M. hominis occurred in combination with C. trachomatis more frequently than expected (p less than 0.05). It occurred in the absence of U. urealyticum in only a few cases (13% of the occurrences in the family planning clinic and 6% of those in the prenatal clinic). C. trachomatis was significantly more prevalent in women under 25 years of age (p less than 0.04). However, mycoplasmas were as prevalent in women over 30 years as in those under 30. There were no significant differences in the infection rates of the organisms by trimester among pregnant women. More research is necessary for a proper understanding of the role of M. hominis and U. urealyticum in genitourinary infections and pregnancy outcomes.     

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.     

Gender differences in undergraduate medical examination results in Sri Lanka

OBJECTIVE: To identify possible gender related differences in performance at undergraduate medical examinations in Sri Lanka. STUDY DESIGN AND METHODS: Results of examinations conducted by the faculty of medicine, University of Kelaniya in 1997 and 1998, and data published by the University Grants Commission (UGC) on final examinations conducted by 4 other Sri Lankan medical faculties (in the Universities of Colombo, Peradeniya, Ruhuna and Jaffna) in 1996 and 1997, were analysed for sex related differences. RESULTS: The proportion of women in each batch of students who sat for 8 examinations conducted at the faculty of medicine, University of Kelaniya in 1997 and 1998, ranged from 40.7 to 48.4% (average 44.3%). Among students sitting for the final MBBS examinations in other medical faculties in 1996 and 1997, the proportion of women ranged from 37.3% in Peradeniya to 53.7% in Jaffna. The proportions of women who obtained "classes" were higher than that of men in 12/15 examinations, with statistically significant differences in four. Higher proportions of men were referred or failed in all 8 examinations analysed; the differences were statistically significant in two. CONCLUSIONS: Women appear to do marginally better than men in undergraduate medical examinations in Sri Lanka.     

Theophylline blood levels in Sri Lankan asthmatics: comparison of two methods of assay

OBJECTIVES: To assay theophylline blood levels in a sample of Sri Lankan chronic asthmatics taking oral theophylline, and to evaluate a simple and cost effective ultraviolet spectrophotometric assay for theophylline levels in blood. SETTING: Chronic asthmatics taking oral theophylline attending medical clinics at the National Hospital of Sri Lanka (NHSL) were recruited for the study. Blood samples were collected from recruited patients on their subsequent clinic visit. DESIGN AND METHODS: A cross-sectional study of theophylline blood levels. Blood samples were assayed for trough theophylline levels using two methods: an automated homogeneous enzyme immunoassay (EMIT), and a low cost ultraviolet spectrophotometric method. RESULTS: Only 2 patients of the 24 had theophylline blood levels in the accepted therapeutic range (10 to 20 micrograms/ml) (3.4); 19 patients had levels under 5 micrograms/ml. A correlation coefficient of 0.99 was obtained in the statistical comparison of the two methods, indicating that the spectrophotometric method has similar accuracy as the reference EMIT assay. CONCLUSIONS: The results signal a need for monitoring of theophylline in asthmatics when accepted clinical indications are present. The ultraviolet spectrophotometric method is ideal to initiate therapeutic drug monitoring (TDM) in the country because of its low cost (about Rs. 55 per assay), requiring only a UV recording spectrophotometer.     

Growth hormone deficiency in Sri Lanka: a preliminary study

Growth hormone deficiency is a recognised cause of severe short stature. A community of 16,001 Sri Lankan children aged between 5 and 6 years was screened for short stature using a simple growth chart, and a sample of 172 identified as short was investigated for the aetiology. Growth hormone deficiency was confirmed in 12 out of the 172 children using the insulin-induced hypoglycaemia test. Another group of 27 out of the 172 children who could potentially benefit from growth hormone therapy were identified using an exercise screening test. Growth hormone deficiency has not been previously documented in Sri Lanka.     

Integrated family planning services: a Nigerian experience

An integrated health and family planning program, operated by the University of Ife Teaching Hospital, was assessed to determine the impact of the integrated approach on family planning service utilization among the predominantly Yoruba residents of the city. In Nigeria, family planning services are generally delivered in clinics which have little or no connection with medical facilities, and service utilization is low. In 1979 the hospital decided to include family planning as part of the routine medical services provided at its 8 clinics located within a 25 kilometer radius of the hospital. Staff members at the clinics were trained in family planning. Trained female fieldworkers conducted motivational activities to encourage the women in the community to use the family planning services of the clinic. The program provided women with an opportunity to obtain contraceptives in a familiar setting and as part of their routine medical care. Neither parental nor spousal consent was required. Yoruba men tend to oppose family planning. Data for the study was obtained from the records of the program's 1495 new acceptors served by the program during its first 2 years of operation. 50.6% of the acceptors were 25-34 years of age, and another 31.7% were between 35-44 years of age. Very few teenagers utilized the services. 96% of the wome were married and they had an average of 4.4 living children. 56% were Catholic, 25% were Protestant, and 16% were Muslim. 37% were illiterate, and another 42.5% could barely read or write. Most were wives of government workers or service men. 88% had never used a modern contraceptive, and 94.5% were not using a method at the time of their first clinic visit. 68.4% of the acceptors were referred to the clinic by the fieldworkers or other health personnel. Only 11.2% sought the services on their own. 85% of the acceptors choose oral contraceptives (OCs), 13% had IUDs inserted, 0.3% were sterilized, and the remaining 2% chose other methods. The low sterilization rate probably reflected the fact that spousal consent was required for sterilization. Side effects reported by the OC users included asthma (9.6%), headaches (5.2%), phlebitis (3.5%), jaundice (1.7%), chest pain (1.5%), depression (1.5%), scanty menses (0.8%), and high blood pressure (0.4%). Among IUD users, 10.8% had intermenstrual bleeding, 18.4% reported pelvic pain, and another 6.8% reported a variety of other problems. 42.1% of the acceptors wanted no more children, and the remainder wanted to avoid the hardships associated with traditional methods of spacing. Correlation analysis revealed that the total number of living children was negatively related to maternal education and that women with sons wanted significantly fewer additional children than women with fewer or no sons. 51% of the acceptors were continuing contraceptive use at the time of the study. The study confirmed the feasibility of an integrated approach. The findings should be of use to government officials who want to improve service utilization in the national family planning program.     

Colposcopy in a family planning clinic: a future model?

The first year's experience of a satellite colposcopy clinic in the Glasgow Family Planning Centre was analysed. Establishment of the clinic was supervised by an experienced member of the colposcopy team at the department of gynaecology, Western Infirmary, Glasgow, who trained one of the family planning centre's staff. Close links were thus maintained with the hospital clinic to which patients were referred for treatment. The policy at the new colposcopy clinic was to study prospectively all women in the hospital catchment area whose cervical smears were reported as abnormal. In 58 of 162 such patients there was at least moderate dyskaryosis and the cytologist's recommendation had been referral for colposcopy. In 104 cases the changes were either atypia alone or mild dyskaryosis and a repeat smear was recommended within three to 12 months; 18 of these patients had grade II or III cervical intraepithelial neoplasia on biopsy, and relying on repeat smears would have resulted in an 11.7% false negative rate. If an atypical cytological picture is to be an indication for colposcopy clinics attached to family planning centres may have an important role, given satisfactory training and close links with central specialist colposcopy clinics.     

上海县妇女保健服务

上海县妇女保健服务在1981～1990年间,依靠三级保健网络对妇女进行了以孕产期为中心的系统保健,即在早孕建卡、定期产前检查、住院分娩、科学接生和产后访视等方面做到系列服务,重视高危孕产妇的管理和推行孕期家庭自我监护。每3～5年还为已婚育龄妇女进行一次妇女病普查普治。1988年开始实行的婚前健康检查制度和开展的婚育疾病指导,促使妇幼保健工作朝优生优育方向发展。     

Anti-tuberculosis drug inducd hepatitis - a Sri Lankan experience

OBJECTIVE: To assess the incidence of anti-tuberculosis (TB) drug induced hepatitis (AIH) in Sri Lankan patients, determine risk factors of AIH, and to address management options in AIH. DESIGN: A prospective study. SETTING: Chest Hospital, Welisara, Sri Lanka, from April 2001 to April 2002. PATIENTS: Seven hundred and eighty three patients with a confirmed diagnosis of TB and resident in the Colombo and Gampaha districts who presented to Chest Hospital, Welisara, Sri Lanka. METHODS: WHO recommended treatment was commenced in all cases. AIH was diagnosed when patients complained of decreased appetite with nausea or vomiting and elevated serum bilirubin (SB; >1.1 mg/dL) or elevated serum alanine transferase (ALT; > 3 times upper limit of normal). RESULTS: Of 783 enrolled patients, 74 (9.5%) developed AIH, the majority (58%) developing AIH within the first 2 weeks of the intensive phase of treatment. AIH was more common among patients over 60 years (p = 0.018), who developed pulmonary TB (p = 0.028), and in patients weighing 33-55 kg (p = 0.004). Age, weight and rifampicin overdosage were significant predictors of AIH. Of the 74 AIH patients, standard treatment was restarted in 60, treatment modified in six, two defaulted and six died. CONCLUSIONS: The incidence of AIH in Sri Lanka is 9.5% in treated patients. AIH was associated with age, low body weight and rifampicin overdosage.     

刍议在基层计划生育服务机构开展生殖道感染防治的意义

随着我国的计划生育工作发生战略性的转变,国家人口计生委组织实施的包括生殖道感染（RTI）干预工程在内的＂三大工程＂在全国计划生育服务机构逐步推开。基层计划生育技术服务工作也有了新的内容,特别是包括RTI防治工作面临新的、巨大的机遇。经过多年各级政府的努力,基层计划生育服务网络逐步健全,技术人员、技术设备逐步配齐,开展生殖道感染防治的条件成熟。     

An overview of the socio-cultural and psychiatric aspects of women's reproductive health in West Africa

The challenges associated with women reproductive health in West African sub region have over the years become a source of concern to relevant world bodies such as WHO, UNFPA, World Bank etc. Some of these challenges include Infertility, Family Planning and Female Genital Mutilation (FGM). However, of greater concern is the scourge of Sexually Transmitted Diseases (STDs) most especially HIV/ AIDS and the unacceptably high maternal mortality in the sub region where Nigeria alone accounts for the highest percentage (10%) of the global 60,000 maternal deaths annually. Significant psychiatric complications such as anxiety and depression are associated with menstruation and menopause. However, the postpartum period is the most vulnerable with significant proportion of women developing such psychopathologies as Puerperal (maternity) blues, Postpartum Depression (PPD) and Acute Organic Brain Syndrome. Sociocultural factors, the dearth of psychiatrists in West Africa coupled with the poor or non-recognition of the psychiatric complications by the obstetric staff have not allowed enough clinical attention to be paid to these problems. It is thus advocated that improvement in the maternal and child health care component of the primary health care (PHC) services will go a long way to attenuate the psychiatric complications associated with childbirth.     

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.