District Of Gampaha Research Articles

Awareness of the General Public within the District of Gampaha, Regarding the Biomedical Waste Disposed by Clinical Laboratories and its Consequences

The Waste management is a primary concern in a clinical laboratory for overall laboratory safety as biomedical wastes generated in medical laboratories are hazardous for humans and the environment. This study aimed to assess the awareness regarding biomedical waste and its consequences among the public in the Gampaha district and to observe the correlation between the level of education with this extent. 150 people between the ages of 18 and 55 years were considered for inclusion criteria, while current, retired, and minor healthcare workers were excluded. The convenience sampling method was used when selecting the target population, and data was collected through online surveys (google forms) with close-ended questionnaires. The age groups have been divided into four major categories: (18-25), (25-35), (35-45) and (45-55). SPSS software was used to analyze and evaluate the results. The results showed that people aged 18-25 years and 45-55 years have a low awareness of biomedical waste and its consequences, whereas people aged 25-35 years have good awareness. Individuals between the ages of 35 and 45 had the highest level of awareness. The responses obtained revealed that the highest level of awareness regarding the biomedical wastes disposed of by clinical laboratories and its consequences was given by 90% of the 35-45 age group, 60% of the 25-35 age group, 58% of the 45-55 age group, and 52% of the 18- 25 age group. Except for a few exceptions, many participants in the 35-45 age groups were educated as most of them had completed their studies at least up to advanced level. Having a doctorate was the highest education level observed in the sample. According to the findings, the analyzed P value was 0.026, with a correlation coefficient of 0.6631 indicating that the results are statistically significant. Therefore, it can be concluded that there is a clear correlation between the levels of education and age regarding the awareness of biomedical waste. Therefore, strengthening the waste management systems and educating the public regarding biomedical waste would be recommended.
 Keywords: Biomedical wastes, Awareness, Level of Education, General Public, Gampaha District

Magnitude of resilience among Grade 10 Adolescents of State Schools in the District of Gampaha, Sri Lanka

Resilience is the process of adapting well in the face of adversity. Objective was to determine magnitude of resilience among Grade 10 Sinhala conversant adolescents in state schools of Gampaha district. A descriptive cross sectional study was conducted. Computed final sample size was 1380. All three stages of cluster sampling were conducted applying probability sampling techniques to obtain the final sample. Study instrument comprised 14-Item Resilience Scale-Sinhala version. Magnitude of resilience was described as proportions and expressed as percentages and 95% confidence intervals (CI). Overall resilience score ranged from 15 to 98. The median was 79.00 (IQR: 70.00-86.00). Levels of magnitude were: High 11.6% (n=159; 95%CI=9.9–13.3), Moderately high 29.3% (n=405; 95%CI=27.0-31.8), Moderate 25.5% (n=352; 95%CI=23.2-27.9), Lower end 20.2% (n=279; 95%CI=18.2–22.5), Low 7.8% (n=108; 95%CI=6.4–9.3) and Very low 5.6% (n=77; 95%CI=4.4-6.9). Latter three low levels together comprised one third of the adolescents. Recommend a psycho-behavioral intervention to enhance resilience.

Prevalence of Coronary Heart Disease (CHD) and Selected Risk Factors of CHD, Among People Aged 30-64 Years in the District of Gampaha, Sri Lanka

Background- Coronary heart disease (CHD) is the leading cause of hospital deaths in Sri Lanka. The underlying risk factors include; tobacco smoking, unhealthy diet, harmful alcohol use, physical inactivity, and medical conditions; hypertension, diabetes mellitus, obesity, dyslipidaemia. Objective of this study was to determine prevalence of CHD and risk factors among people aged 30-64 in Gampaha District, Sri Lanka. Methods- A community based cross-sectional study was conducted among 1192 people aged 30-64 years in district of Gampaha, recruited by probability proportionate to the population size, cluster sampling. Data were collected using a pre-tested interviewer-administered questionnaire on prevalence of CHD, hypertension, diabetes mellitus, dyslipidaemia, obesity, harmful alcohol use, unhealthy diet, physical inactivity and tobacco smoking and anthropometric measurements by trained data collectors. Twelve-lead ECG, blood pressure, fasting plasma glucose and lipid levels were done for previously undiagnosed. Data were analyzed using SPSS-21. Results- The estimated prevalence of CHD based on already diagnosed cases and Rose positive angina 6.9% (95% CI 5.4% – 8.4%), CHD based on already diagnosed cases and ECG 6.4 (95% CI 4.9% – 7.8%), hypertension 37.5% (95% CI 34.7% to 40.3%), diabetes mellitus 17.4% (95% CI 15.2% to 19.6%), dyslipidaemia 66.5% (95% CI 63.8% – 69.2%). The estimated prevalence of other modifiable risk factors of generalized obesity (BMI≥25.0) (44.0%, 95%CI41.1-46.9), sub-optimal quality diet (71.9%, 95%CI 69.3-74.5), low level of physical activity (21.7%, 95%CI 19.3-24.1), heavy or high-risk drinking 11.4% (95%CI 9.56-13.2), smoking 14.2% (95%CI 12.2-16.2). Conclusions- Estimated prevalence of CHD and selected risk factors were high in Gampaha District with a large proportion of previously undiagnosed disease. Immediate public health action is needed including training programs for healthcare workers on detection of risk factors and awareness among the public for screening for risk factors.

Prenatal oral health: geo-spatial analysis of access to care

Introduction: Prenatal oral care is important for both the oral and general health of the woman and the offspring and it should be maintained throughout the life course. Objectives: To determine the distribution of both hospital and community dental care facilities for the provision of oral healthcare to antenatal mothers referred to the maternal and child health (MCH) clinics, in the district of Gampaha, Sri Lanka Methods: All the MCH clinics and all available public dental care facilities were mapped using Geographic Information System (GIS) software, and the minimum referral distance was measured from each MCH clinic to the nearest public dental clinic using the distance-based GIS tools. Results: The referral distance reported from an MCH clinic to a public dental clinic varied between 0- 8.5 km. About 22% (n=37) of the MCH clinics had an in-house or proximate dental facility not more than 1 km away. About 41% (n=69) of MCH clinics had a public dental clinic within a 2.5 km distance, and it increased up to 81% (n=136) when the referral distance expanded up to 5km. The average referral distance for pregnancy oral healthcare in the entire district was 3 km. Conclusions: The study identified service disparities in pregnancy oral healthcare in the district using geo-spatial techniques. It could contribute to future planning of hospital and community based dental clinic locations for antenatal mothers, emphasising the importance of referral distance in improving the dental attendance among pregnant women.

Entomological surveillance with viral tracking demonstrates a migrated viral strain caused dengue epidemic in July, 2017 in Sri Lanka.

Dengue is the most important mosquito-borne viral infection disease in Sri Lanka triggering extensive economic and social burden in the country. Even after numerous source reduction programmes, more than 30,000 incidences are reporting in the country every year. The last and greatest dengue epidemic in the country was reported in July, 2017 with more than 300 dengue related deaths and the highest number of dengue incidences were reported from the District of Gampaha. There is no Dengue Virus (DENV) detection system in field specimens in the district yet and therefore the aim of the study is development of entomological surveillance approach through vector survey programmes together with molecular and phylogenetic methods to identify detection of DENV serotypes circulation in order to minimize adverse effects of imminent dengue outbreaks. Entomological surveys were conducted in five study areas in the district for 36 months and altogether, 10,616 potential breeding places were investigated and 423 were positive for immature stages of dengue vector mosquitoes. During adult collections, 2,718 dengue vector mosquitoes were collected and 4.6% (n = 124) were Aedes aegypti. While entomological indices demonstrate various correlations with meteorological variables and reported dengue incidences, the mosquito pools collected during the epidemic in 2017 were positive for DENV. The results of the phylogenetic analysis illustrated that Envelope (E) gene sequences derived from the isolated DENV belongs to the Clade Ib of Cosmopolitan genotype of the DENV serotype 2 which has been the dominant stain in South-East Asian evidencing that a recent migration of DENV strain to Sri Lanka.

Early phase child and adolescent psychiatry response after mass trauma: Lessons learned from the Easter Sunday attack in Sri Lanka.

Sri Lanka is a South-Asian nation with a multi-ethnic population. A 26-year-old armed conflict ended in 2009 and the relative stability over the last decade was unexpectedly disrupted by the Easter Sunday Bombings of Catholic Churches and luxury hotels in 2019. More than 250 were killed and most of the deaths were reported from the St. Sebastian's Church in Negombo in the District of Gampaha. This article describes how mental health services of the District of Gampaha, with a population of 2.3 million and only one child and adolescent psychiatrist responded to the psychological trauma in children. The child and adolescent psychiatry response to the mass trauma was a collaboration between health, educational and voluntary organisations. The psychological support was provided at affected villages, schools and hospital settings. Medical and non-medical personnel were able to refer affected children directly to the child and adolescent psychiatrist. Children who had developed psychological consequences of trauma were provided with evidence-based psychotherapies and psychopharmacology where necessary. In addition, health staff members and teachers were trained to provide psychological support and a booklet was prepared in the local language based on trauma-focused cognitive behaviour therapy. Psychoeducation about the psychological response to trauma was provided through electronic, printed and social media. The limited number of trained psychotherapists and experts in child mental health were a major barrier to implement effective management strategies. Due to the severe shortage of child mental health experts, practical low-cost methodologies were employed to provide an early response to trauma. Traditional ways of mental health service provision were modified to be implemented via non-experts.

Use of Novaluron-Based Autocidal Gravid Ovitraps to Control Aedes Dengue Vector Mosquitoes in the District of Gampaha, Sri Lanka.

Dengue is the most important mosquito-borne viral infection in Sri Lanka causing an enormous social and economic burden in the country. In the absence of therapeutic drugs and the developed vaccines are under investigation, vector control is the best strategy to reduce the disease transmission. Therefore, the development of novel tools to control dengue vector mosquitoes has become the need of the hour. Novaluron is a recently developed Insect Growth Regulator (IGR) which inhibits chitin synthesis in immature stages of insects. The aim of the study was to identify the efficacy of a simple and cost-effective Autocidal Gravid Ovitrap (AGO) developed using Novaluron to control dengue outbreaks in the District of Gampaha, Sri Lanka. Laboratory and semifield experiments were performed to identify the activity range, optimum field dosage, and residual effects of Novaluron following the World Health Organization guidelines, and field experiments were performed in the Ragama Medical Officer of Health (MOH) area. Two study areas 800 m apart were selected and assigned as treated and control areas randomly. In each study area, 30 households were selected randomly. Each household was given two ovitraps, one placed indoors and the other placed outdoors. Mortality and survival counts were recorded separately for one-year time period and data were analyzed using a two-way repeated measures analysis of variance model. During the laboratory experiments, the adult emerging inhibition was 100% in all tested concentrations. The optimum field dosage was 2 ppm and the residual effect was 28 days. In the field experiments, significantly higher mortality counts were recorded in treated areas both indoor- and outdoor-placed AGOs. Two-factor repeated measures ANOVA followed by Tukey's test confirmed that the mean mortality count is high for the developed AGOs both indoor and outdoor settings. The developed AGO can be deployed to control both indoor and outdoor dengue vector mosquito populations, and in dengue-risk areas, the ovitrap will be supportive to local health authorities to enhance the efficiency of future vector control programs.

Neonatal sepsis for postpartum depression

Introduction: The postpartum period is generally a time of happiness and bonding between mother and the newborn, but complicated pregnancies can alter this. Postpartum depression (PPD) is a common complication of childbirth. Objectives: To determine the effect of neonatal sepsis on PPD of mothers Methods: This was a descriptive study conducted in secondary and tertiary care hospitals in the district of Gampaha. The study population comprised postpartum mothers of neonates who were diagnosed with sepsis (n=236) and those who were not (n=240). Neonatal sepsis was defined by the presence of one of the clinical signs according to the IMCI strategy or culture positive blood or cerebrospinal fluid. The validated Edinburgh Postpartum Depression Scale and an interviewer-administrated questionnaire were used. Multiple logistic regression was applied and adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated. Results: The study revealed that among the mothers of sepsis neonates, 185 (78.4%) were depressed. There were 51 (21.2%) mothers also depressed among the mother of non-sepsis babies. The association between PPD and neonatal sepsis was statistically significant (aOR=13.44; 95% CI=8.68, 20.83). The socio-demographic factors, obstetric and neonatal factors were not independently associated with PPD. Conclusions: Postpartum depression among mothers of sepic neonates was higher than in mothers of apparently healthy neonates. It is essential to arrange a screening programme and counselling sessions while in the hospital for all the mothers.

Sero-prevalence of viral hepatitis A in a district of Sri Lanka: a community based cross-sectional study

BackgroundHepatitis A Virus (HAV) is one of the most common food and water borne infectious disease prevailing globally. The objective of the study was to determine sero-prevalence of HAV infection in a district of Sri Lanka.MethodsThis was a descriptive cross sectional study conducted on 1403 participants aged 1 year and above selected by multistage stratified (for age group and area of residence) cluster sampling from September 2015 to December, 2016. An interviewer-administered questionnaire was used to collect data and Anti-IgG testing was done to determine sero-positivity. The overall, the age and sex specific sero-prevalence of HAV were calculated with 95% confidence intervals (CI).ResultsOf the 1403 participants 1132 were anti HAV IgG positive. Therefore the overall sero-prevalence of HAV infection was 80.7% (95%CI: 78.64–82.76). There were 283 (20.2%) individuals below the age group of 14 years and below and out of them, 204 had anti HAV IgG, therefore sero-prevalence was 72.1% for that age group. The age group 15 years and aboe comprised of 1120 (79.8%) participants and of them 928 had anti HAV IgG, making sero-prevalence 82.9%. The lowest sero-prevalence (66.9%, n = 232) was observed in the age group of 11–20 years followed by 21–30 age group. From age 31 years onwards, the sero-prevalence exceeded 90%, reaching 100% after 71 years. The urban population showed a sero-prevalence of 83% (n = 195) and 80.2% (n = 937) for the rural sector while females had a sero-prevalence of 82.2% (n = 766) and it was 77.7% (n = 366) for males. Thirty-four (3.0%) participants who had sero-positive results (n = 1132) claimed that they have had HAV in the past.ConclusionsOverall, four fifth of the population was immune to HAV infection in the district of Gampaha.

Prevalence of Ectoparasitic Infections and Other Dermatological Infections and Their Associated Factors among School Children in Gampaha District, Sri Lanka.

Skin disorders are one of the commonest conditions among school children in developing countries. There are only a few published studies available from Sri Lanka on the prevalence of skin disorders. A community-based cross-sectional study was carried out among five government-run schools randomly selected from the district of Gampaha, Sri Lanka, during 2016-2017. A total of 41 students between 5 and 16 years of age were randomly selected from each school. Sociodemographic profile and hygienic behaviors of selected students were assessed using a pretested interviewer-administered questionnaire. Students were examined by a medical officer for the presence of different skin disorders. The chi-squared test of association and binary logistic regression were used for the identification of the significance of socioeconomic factors and hygienic practices among the study participants. A total of 205 school children participated in the study. The commonest skin disorder was pediculosis (42.0%; n=86), followed by dandruff (8.3%; n=17), fungal infections (6.8%; n=14), and scabies (1.5%; n=3). Almost one-fourth of the study participants (22.9%; n=30/131) had more than one disorder, majored by Pediculus captis infestation with dandruff. Over one-third (36.1%; n=74) were free of any skin disorders. The prevalence of skin disorders was significantly high among females (87.3%; n=110), compared to males (26.6%; n=21). Presence of long hair, higher family size, and limited number of rooms in the house were risk factors associated with the prevalence of skin disorders. The commonest skin disorder was pediculosis, while scabies and fungal infections were scarce among school children in the district of Gampaha, Sri Lanka. Implementation of health education and monitoring programs at the school level for maintaining the dermal health status of school children is recommended.

The effectiveness of teaching science subjects through English medium: A narrative analysis of teacher experiences and perceptions in Sri Lankan secondary schools

This article analyses four narratives told by four teachers teaching science subjects in four different public secondary schools in the district of Gampaha in Sri Lanka. Gampaha is the second most populous district in Sri Lanka, and is known for excellent results in General Certificate of Education (Advanced Level) exams which school leavers sit at the end of the secondary school cycle. The teachers’ narratives focus on the policy and practice of teaching science subjects through English at secondary level, which was reintroduced in a small number of selected government schools in Sri Lanka in 2002. After using the two local languages, Sinhala and Tamil, for nearly half a century, the Sri Lankan education authorities decided to bring back the English medium to the teaching of science subjects at secondary level as a third language option. One of the policymakers’ reasons was an apparent decline in the English-language fluency of students at this level. To implement the new policy, science teachers (who had themselves been taught in Sinhala or Tamil) were asked to teach in English. More than a decade into the English-medium option, the author interviewed four of them. Their testimonies about their experiences in teaching science subjects offer valuable insights into the difficulties experienced by both teachers and students when teaching and learning in a foreign language such as English. The author’s analysis of his respondents’ statements reveals hidden realities which challenge the benefits of reintroducing English as a medium of instruction (MOI) for science subjects. Thus, the lived experiences of the teachers may help to inform language policy in education in Sri Lanka, and perhaps also in other countries.

A forecasting model for dengue incidence in the District of Gampaha, Sri Lanka

BackgroundDengue is one of the major health problems in Sri Lanka causing an enormous social and economic burden to the country. An accurate early warning system can enhance the efficiency of preventive measures. The aim of the study was to develop and validate a simple accurate forecasting model for the District of Gampaha, Sri Lanka. Three time-series regression models were developed using monthly rainfall, rainy days, temperature, humidity, wind speed and retrospective dengue incidences over the period January 2012 to November 2015 for the District of Gampaha, Sri Lanka. Various lag times were analyzed to identify optimum forecasting periods including interactions of multiple lags. The models were validated using epidemiological data from December 2015 to November 2017. Prepared models were compared based on Akaike’s information criterion, Bayesian information criterion and residual analysis.ResultsThe selected model forecasted correctly with mean absolute errors of 0.07 and 0.22, and root mean squared errors of 0.09 and 0.28, for training and validation periods, respectively. There were no dengue epidemics observed in the district during the training period and nine outbreaks occurred during the forecasting period. The proposed model captured five outbreaks and correctly rejected 14 within the testing period of 24 months. The Pierce skill score of the model was 0.49, with a receiver operating characteristic of 86% and 92% sensitivity.ConclusionsThe developed weather based forecasting model allows warnings of impending dengue outbreaks and epidemics in advance of one month with high accuracy. Depending upon climatic factors, the previous month’s dengue cases had a significant effect on the dengue incidences of the current month. The simple, precise and understandable forecasting model developed could be used to manage limited public health resources effectively for patient management, vector surveillance and intervention programmes in the district.

Tuberculosis Among Young People on Rise in Sri-Lanka (An Analysis of Trend and Associated Factors)

Introduction: A descriptive cross sectional study was carried out in 5 randomly selected districts i.e Gampaha, Kandy, Badulla, Nuwara Eliya and Ratnapura during the period of March to September 2014. The general objective of the study was to describe the trend of TB among young population over past 6 years in Sri Lanka and to determine contributory factors associated with TB among young population.Methodology: The study was carried out in two stages. The first stage was analysis of the trend of TB over the 6 year period of 2008-2014. The analysis of the trend was carried out using the existing secondary data at the Medical Records Division of the National Programme for Tuberculosis Control and Chest Diseases (NPTCCD). Trend was analyzed for new cases of TB patients of 15--34 years of age and separately for 15-24 and 25-34 age groups and for each type of new TB cases. The second stage was a descriptive cross sectional study which was carried out to determine the associated factors. All the patients (new/ retreatment)in age group of 15-34 years and registered at the selected district chest clinics with confi rmed TB were selected as the study subjects. Operational Definitions were used to identify confi rmed TB cases ie, Sputum smear positive TB, smear negative pulmonary TB and Extra pulmonary TB. The data were collected using a pre tested interviewer administered questionnaire by the District Tuberculosis Control Officers attached to the relevant District Chest Clinics.Result: The main findings of the study were, The two peaks of TB incidence were observed in the trend across age groups and first one was in the age group of 25-34 years second peak in the age group of 45-54.Overall trend of TB in the country is more towards the older age groups (over 45 years), but shift to younger age groups were observed in 15 out of 16 districts in the country. A total of 223 patients were included in the descriptive study. The highest proportion (34%) of study population was from the district of Gampaha while least proportion (10%) of it was from Nuwara Eliya. Nearly 53% of the study population was above 25 years of age with the sex ratio of 1:1. A majority (68%) of the study population was Sinhalese while nearly 70% of the study population has passed the O/L, A/L, Diploma or a degree. About one third of the study population was unemployed. Nearly half (50.4%) of the study population was having monthly income of about Rs. 20,000.00 or above. 31% of the study population were current or past alcohol consumers and 29% were smokers and 7% of the study population were current or past cannabis consumers. Majority (77%) of the study population were under-nourished while 14% of them were less than 15 kg/m2. Nearly three fourth (72%) of the study population have been diagnosed by a consultant. Statistically signifi cant associations were found between the age category and more than 3 family members (χ2=5.063, df=1, p<0.017), ethnicity (χ2=4.229, df=1, p<0.04), employment category (χ2=13.859, df=3, p<0.003). Statistically significant associations were not found between the age category and residing district (χ2=5.962, df=4, p<0.202) and type of house (χ2=1.875, df=1, p<0.110),Conclusion: The study recommends more detailed assessment regarding the dietary habits of the patients, Emphasis on community awareness regarding nutritional aspects. Improving the nutritional status among adolescents and young adults. Modification of risky life style factors, Improvement of socio economic status through enhancement of financial stability, minimizing overcrowding and improvement of housing conditions and involving of non NTP health care providers and health professionals for TB diagnosis and management through capacity building and awareness. SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS, Vol. 14, No. 2, 2017, Page: 18-30

Coverage of the Oral Healthcare services providing for Antenatal mothers in the district of Gampaha, in Sri Lanka

Coverage of the Oral Healthcare services providing for Antenatal mothers in the district of Gampaha, in Sri Lanka

Identification of cattle, buffaloes and rodents as reservoir animals of Leptospira in the District of Gampaha, Sri Lanka

BackgroundLeptospirosis is an important emerging infectious disease in Sri Lanka. Rats are the most important reservoir of Leptospira but domestic and wild mammals may also act as important maintenance or accidental hosts. In Sri Lanka, knowledge of reservoir animals of leptospires is poor. The objective of this study was to identify potential reservoir animals of Leptospira in the District of Gampaha, Sri Lanka.FindingsBlood and kidney samples were collected from 38 rodents and mid-stream urine samples were randomly collected from 45 cattle and five buffaloes in the District of Gampaha. Kidney and urine samples were tested by real-time polymerase chain reaction (PCR) and serum samples were tested by the microscopic agglutination test (MAT). Of the 38 rodent kidney samples, 11% (4/38) were positive by real-time PCR. The prevalence of leptospiral carriage was 11% (3/26) and 8% (1/12) in female and male rodents, respectively. Three rodent serum samples were positive by MAT. Of the 50 cattle/buffalo urine samples tested, 10% (5/50) were positive by real-time PCR. The prevalence of leptospiral carriage was 9% (4/45) and 20% (1/5) in cattle and buffaloes, respectively.ConclusionResults of PCR and MAT showed that Leptospira were present in a significant proportion of the rodents and farm animals tested in this study and suggest that these (semi-) domestic animals form an infection reservoir for Leptospira. Therefore, there is a potential zoonotic risk to public health, most notably to farmers in this area.

Management of patients with sexually transmitted infections by general practitioners in the district of Gampaha

Introduction: In Sri Lanka, care for sexually transmitted infections (STIs) is given by both public and private sectors. Though there is an organized system for provision of care in government STD clinics, system available for the same purpose in private sector has not been studied. Objective: To describe the knowledge and practices related to the management of patients presenting with symptoms and signs of sexually transmitted infections (STD Syndromes) among general practitioners in the District of Gampaha. Method: A descriptive cross sectional study was carried out among 200 general practitioners. Data were collected by using a self-administered structured questionnaire in English language and analyzed using SPSS 16. Results: Majority of the study population were male (76%) with MBBS qualifications (97%) and involved in part time general practice (92.5%). Significant number (21% ) of GPs have not heard the term syndromic management of STDs. Almost three quarter (74%) of GPs did not use any guideline for the management for STIs. Only a minority of GPs has prescribed the recommended antibiotic combination for patients presenting with urethral discharge (10%), vaginal discharge (16%), non vesicular genital ulcers (3.5%) and vesicular genital ulcers (35%). Majority (55.5%) of GPs have done condom promotion. Counselling on STI prevention was done only by about half (48%) of the GPs. Conclusions: Most GPs were not aware of the syndromic management of STDs. Diagnostic tests that have been carried out were not appropriate to the symptoms and recommended treatment was not prescribed for most of the syndromes. They were unfamiliar with the STI management guidelines.

Evaluation of the Oral Healthcare Programme during Pregnancy in reducing Dental Caries in young children in the district of Gampaha, in Sri Lanka

Evaluation of the Oral Healthcare Programme during Pregnancy in reducing Dental Caries in young children in the district of Gampaha, in Sri Lanka

Spatial and seasonal analysis of human leptospirosis in the District of Gampaha, Sri Lanka

Leptospirosis is a zoonostic infectious disease, caused by a pathogenic species of the Genus Leptospira. In recent years, a markedly increased number of leptospirosis cases have been reported in the District of Gampaha, in the Western Province of Sri Lanka. Typically, the risk of the disease in the district is seasonal with a small spike occurs in March to May and a large spike occurs during October to December. Objectives of this study were to analyze spatial and seasonal patterns of human leptospirosis and to predict the leptospirosis epidemic trend in the District of Gampaha, Sri Lanka. All Divisional Secretariats (DS) of the district of Gampaha were selected for the study. Epidemiological data were obtained from the Regional Epidemiological Unit, Gampaha. The leptospirosis cases were georeferenced according to DS in where these cases were reported. The cumulative incidence and the fatality were calculated for each DS. Of the georeferenced data, highest mean (±S.E.) of number of leptospirosis cases (72.60 ±15.54) were observed from DS of Mirigama. The highest mean cumulative incidence (4.97±1.10) and case fatality rate (3.88±2.42) were observed from DS of Divulapitiya and Katana respectively. According to past 10 years data on leptospirosis, highest mean numbers of leptospirosis cases were reported in March (51.00±12.99) and November (56.80±8.27). A predictive model for clinically confirmed human leptospirosis was designed for the district by using TSA package of the statistical software R. This study provides an evidence base for reducing disease burden by improving the understanding of the dynamic patterns of the disease in the District of Gampaha, Sri Lanka.

Effectiveness of an educational intervention among public health midwives on breast cancer early detection in the district of Gampaha, Sri Lanka.

Breast cancer is the commonest cancer among Sri Lankan females, accounting for 26% of the cancer incidence in women. Early detection of breast cancer is conducted by public health midwives (PHMs) in the Well Woman Clinics. The aim of the present study was to determine the effectiveness of an educational intervention on improving knowledge, attitudes and practices (KAP) on breast cancer screening among PHMs in the district of Gampaha. Two Medical Officer of Health (MOH) areas in Gampaha district were selected using random sampling as intervention (IG) and control (CG) groups. All the PHMs in the two MOH areas participated in the study, with totals of 38 in IG and 47 in CG. They were exposed to an educational intervention with the objective of using them to subsequently conduct the same among 35-59 year women in the community. Following the intervention, post-intervention assessments were conducted at one month and six months to assess the effectiveness of the intervention. The overall median scores for KAP among PHMs respectively were as follows. Pre-intervention: IG:58%(IQR: 53- 69%), 90%(IQR: 70-100%) and 62%(IQR: 57-70%). CG: 64%(IQR: 56-69%), 90%(IQR: 70-90%) and 62%( IQR: 50-77%). Post-intervention: one month, IG:96%(IQR: 93-96%), 100%(IQR: 100-100%), and 85%(IQR: 81-89%). CG:67%(IQR: 60- 73%), 90%(IQR: 80-100%) and 65%(IQR: 50-73%). Post-intervention: six months, IG: 93% (IQR: 91-93%), 100%(IQR: 90- 100%), and 81%(IQR: 77-89%). CG: 67%(IQR: 58- 71%), 90%(IQR: 90-100%), and 62%( IQR: 58-73%). All the above post-intervention scores of PHMs in the IG were significantly higher in comparison to CG (p<0.001). This planned educational intervention had a significant impact on improving KAP of PHMs for early detection of breast cancer in the Gampaha district.

Qualitative Assessment of Breast Cancer Early Detection Services Provided through Well Woman Clinics in the District of Gampaha in Sri Lanka

Breast cancer is the most common cancer diagnosed among women in Sri Lanka. Early detection can lead to reduction in morbidity and mortality. The objective here was to identify perceptions of public health midwives (PHMs) on the importance of early detection of breast cancer and deficiencies of and suggestions on improving existing breast cancer early detection services provided through Well Woman Clinics. A qualitative study using four focus group discussions (FGDs) were conducted among 38 PHMs in the Gampaha district in Sri Lanka and the meetings were audio-recorded, transcribed and analyzed using constant comparison and identifying themes and categories. All the PHMs had a firm realization on the need of breast cancer early detection. The four FGDs among PHMs revealed non-availability of guidelines, inadequacy of training, lack of skills and material to provide health education, inability to provide privacy during clinical examination, shortage of stationery, lack of community awareness and motivation. The suggestions for the improvements of the programme identified in FGDs were capacity building of PHMs, making availability of guidelines, rescheduling clinics, improving the supervision, strengthening the monitoring, improving coordination between clinical and preventive sectors, and improving community awareness. Results of the FGDs can provide useful information on components to be improved in breast cancer early detection services. Study recommendations were training programmes at basic and post basic levels on a regular basis and supervision for the sustainance of the breast cancer early detection program.