Community factors affecting long-lasting impregnated mosquito net use for malaria control in Sri Lanka

The Anti Malaria Campaign distributed approximately 300,000 long-lasting impregnated nets (LLINs) to malaria-endemic areas in Sri Lanka during the years 2005 to 2007. We conducted a community-based cross-sectional survey among 2467 households distributed among the three major ethnic groups of Sri Lanka to study the perceptions and practices with regard to the use of LLINs in order to improve their use. In a majority of households the number of LLINs available was not sufficient for the number of people, although there was a small percentage of households that had excess nets. The information and advice given at the time of distribution regarding use of the nets differed amongst the three groups and was not consistent. Dissemination of this knowledge within the family was not observed. A relationship between knowledge regarding LLINs and reported practices on washing and drying of LLINs was found. It was noted that net shape may influence net use, with cone shaped nets being more popular. Efforts to increase knowledge on LLINs using behaviour change communication techniques would have more effectively contributed to achieve planned outcomes. Proper use of LLINs will undoubtedly contribute to further reduction of malaria in Sri Lanka.     

Entomological aspects of filariasis control in Sri Lanka

Historical events and suitable environmental conditions in the southwestern coastal areas of Sri Lanka have led to the establishment of a zone of endemic filariasis caused by Wuchereria bancrofti and transmitted by Culex pipiens fatigans. The previous Brugia malayi foci, scattered over widely dispersed areas of the island, were apparently completely eliminated as a result of control of the Mansonia vectors by the destruction of the larval host plants in their swamp habitats. Control measures by the Anti-Filariasis Campaign against W. bancrofti and C. p. fatigans have greatly reduced the human infection rates in the endemic coastal belt and have kept the rate in the dense population to less than 1% over the last several years. This paper assesses the entomological aspects of the control programme during the years 1970-72.     

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.     

A village treatment center for malaria: community response in Sri Lanka

Early diagnosis and treatment of malaria cases is one of the basic elements of the current global malaria control strategy. In order to provide this service to people in rural areas there is a need for new cost-effective approaches. To ensure that such new approaches are acceptable to the target communities, it is important to know the rationale for people's malaria treatment-seeking behavior. The present study provides insights into the reasons for people's preferences for different types of healthcare facilities and describes variation of these preferences within a rural community in Sri Lanka. The study reports on the experiences with the establishment of a village health facility and its effect on the treatment-seeking behavior of the population. After the introduction of the village treatment center it quickly took over the role of main provider for diagnosis and treatment of malaria from the government facilities. The treatment center did not improve the response time in seeking treatment for young children, but the delay for adults was reduced by 1-2 days. Mothers with small children often preferred the government facilities since they wanted a more qualified opinion than available from the locally recruited staff of the village treatment center. The treatment center significantly reduced the stress and discomfort experienced by the elderly and handicapped segment of the community. The study indicated that the effective catchment area of a village treatment center will be influenced by the degree of initial support from key individuals in the communities, the selection procedure and training of assistants, and the history of the relationships between different villages to be served by the center. The government health services and communities across the dry zone of Sri Lanka could benefit substantially from the establishment of more village treatment centers. To ensure the long-term sustainability of these type of facilities it is necessary to assess the feasibility of charging a user fee and establishing multi-purpose clinics. Government policies and administrative procedures will need to be adjusted to make the successful operation of village treatment centers possible.     

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.     

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.     

Congenital malaria due to Plasmodium vivax: a case report from Sri Lanka

A case of Plasmodium vivax malaria in an eight-week-old infant in Colombo is documented, with epidemiological and circumstantial evidence which strongly supports a transplacental route of infection. The malarial antibody levels detected by the indirect fluorescent antibody technique in both mother and child are discussed in terms of the present epidemiological pattern of malaria in the country. We also comment on the species incidence of congenital malaria, this case being the first caused by P. vivax in Sri Lanka, despite this species being more prevalent than P. falciparum which has been reported in six previous cases of congenital malaria in Sri Lanka.     

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.     

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     

Socioeconomic and demographic effects of malaria eradication: a comparison of Sri Lanka and Sardinia

The relationship between disease control, population growth and economic development is examined through a comparison of changes subsequent to malaria eradication campaigns in Sri Lanka and Sardinia. Both islands were similar in terms of malaria morbidity and mortality rates as well as a history of massive malaria eradication campaigns using DDT immediately after the Second World War. The critical comparative distinction is that Sardinia had a much lower population density than Sri Lanka. In both cases, the anticipated effects of malaria control were increased agriculture production in endemic zones coupled with a relief of population pressure in non-malaria areas. This has not happened. Patterns of demographic change, marked by sharp declines in general mortality and accelerated population rates, are similar in both cases. Malaria control has resulted in economic development in neither case, however, and this is explained using ecological and political-economic analyses.     

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.