Health-care system and nursing in Sri Lanka: An ethnography study

This article stems from a larger ethnographic study that primarily explored nurses' cancer pain management in Sri Lanka. The findings presented in this article report on two aspects revealed in that study: the Sri Lankan health-care system and nursing. The findings indicate that the Sri Lankan health-care system is under considerable strain. Poor hospital management allows doctors to admit too many patients, resulting in chaotic and overcrowded work environments with unsustainable resources. This then impacts on the role of the nurse. This study highlights the adverse conditions under which nurses in Sri Lanka try to administer care, within a powerless and unchanging professional situation. Although this study extends the level of understanding of the situation for nurses in a government hospital, it also offers directions for policy-makers and international nursing organizations to improve nursing education and governance in Sri Lanka.     

A cohort study of graphite workers in Sri Lanka

A cohort of workers from a graphite mine in Sri Lanka was studiedin 1987, 1990 and 1993. Radiographic lesions were found in 8.5%,8.9% and 4.1% of the workers in these respective rounds. Whenworkers with radiographic lesions were clinically examined,a total of 18 cases of graphite pneumoconiosis and seven casesof active pulmonary tuberculosis were detected in the threerounds. The prevalence of both these diseases showed a declinein 1993 when compared to 1987. This favourable situation wasprobably the result of dust control measures introduced in themine after 1972. Five workers developed graphite pneumoconiosisin the course of the study. They had worked in the mine forart average of 22.6 years. The right lung appeared to be morevulnerable than the left.     

Paediatric prescribing in out-patient care

Summary Few drug utilization studies have been focused on children in developing countries, where they constitute a large part of the total population. The present study describes prescribing in 5 outpatient departments (15 practitioners) in an area of Sri Lanka over a period of seven months. It includes a random sample of 2484 paediatric consultations.On average, 2.7 drugs were prescribed per patient. With a few exceptions generic prescribing of oral drugs prevailed, and only 1% of the children were given injections. In all, 107 different products were used. Antipyretics, antihistamines, antibiotics and sulphonamides were the most commonly used classes of drugs, being prescribed for 40–50% of the children.Penicillin V represented 43% of the total antibiotic prescribing. Only 1.2% of the children and 0.5% of the infants were given tetracycline. Paracetamol was the preferred antipyretic drug in infants. The use of injectables and tetracycline in children has been reported to be common in other developing countries.The practitioners in Sri Lanka showed a more rational prescribing pattern with the exception of the frequent use of antihistamines, cough medicine and an antiflatulent. The need to develop a paediatric drug policy is discussed.     

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.     

Incidence and pattern of dry eye after cataract surgery

Purpose

The objectives of the study were to identify the incidence and pattern of dry eye after phacoemulsification and manual small incision cataract surgeries.

Follow-up study of blindness attributed to cataract in Karnataka State,India

AIM. Presentation of the results of rapid assessments of bilateral cataract blindness in persons 50 years of age and older in 19 districts of Karnataka State, India. MATERIALS. A total of 21,950 persons 50 years of age and older in 19 out of 20 districts were examined. In each district, 15 clusters were randomly selected and in each cluster the visual acuity and lens status were assessed in 90 persons 50 years of age and older. METHODS. Systematic Random Cluster Sampling was used. Assuming a prevalence of at least 4.3% and a design effect of 1.5, the survey was designed to give an estimated prevalence with a sampling error of 20% or less at 80% confidence. Visual acuity was measured with a tumbling E chart at 6 meters distance with available correction. Lens status was assessed by distant direct ophthalmoscopy with undilated pupil under semi-dark conditions. RESULTS. The average age and sex adjusted prevalence of cataract blindness was 4.93%, with a variation of 1.58% to 7.24% in different districts. The prevalence in females was higher than in males. Cataract Surgical Coverage, an indicator for coverage and service utilization, varied from 42% to 68% in different districts. On average, males had a higher coverage than females. Of all aphakic eyes in the sample, 26.4% could not see 6/60. Barriers to cataract surgery are linked to service providers. CONCLUSIONS. Rapid assessments for cataract blindness in persons aged 50 years and older can be conducted at district level in India with existing resources and at affordable costs. The results suggest an increase in cataract blindness since the previous survey of 1986. The long-term visual outcome needs improvement. Change in barriers to cataract surgery requires a shift in health education strategy and messages. The large variation in prevalence justifies district-level surveys.     

Knowledge, attitudes, and practices survey of rabies in a community in Sri Lanka

Objectives The primary objective of this study was to determine the level of knowledge, attitudes and practices (KAP) of rabies management and control of a sample population. The secondary objective was to compare the KAP with respect to rabies management and control between urban and rural areas and between pet and non-pet owners. Methods This cross-sectional study was carried out by conducting face-to-face interviews using structured questionnaires among 1570 respondents from selected households in the Kandy District, Sri Landa. Results Approximately 58% of the sample population was pet owners. Among all the respondents, there was a high level of awareness (90%) that dogs are the most common rabies reservoir, that the disease is fatal (79%), and that rabies can be prevented by vaccination (88%). Most of the subjects (96%) would seek treatment from a doctor or a hospital after being bitten by a dog. Although 76% of the respondents said that their pet dogs were vaccinated, only one-half were able to present a vaccination certificate upon request. The subjects from the urban areas would submit the head of an animal for rabies evaluation (69%) compared with those from the rural areas (57%). Pet owners (93%) are more aware that dog rabies vaccines are available from authorized offices than non-pet owners (87%). Conclusions The level of awareness of rabies and the level of receptiveness to rabies control measures are high. There is a difference in the attitudes and pet care practices relevant to rabies control between urban and rural areas. Pet owners tend to be more cooperative to rabies control activities. The attitudes and practices of the respondents may reflect the inaccessibility of facilities and the lack of services that would enable community participation in rabies control.