Medical Officer Of Health Area Research Articles

Duration of exclusive breastfeeding; validity of retrospective assessment at nine months of age

BackgroundIn cross sectional, case control and retrospective cohort studies, duration of Exclusive Breastfeeding (EBF) usually depends on maternal recall. Retrospective data are often subjected to recall bias and could lead to a potential for exposure misclassification. The purpose of the present paper is to assess the validity of maternal recall of EBF duration during infancy, after cessation of EBF and to evaluate the two methods to collect retrospective data on EBF.MethodsA cohort study was carried out in Naula Medical Officer of Health (MOH) area. Study cohort included all infants born during the months of February to April 2008 and currently residing in Naula MOH area. Baseline data collection was carried out using the pregnancy record, the child health development record and by using an interviewer administered structured questionnaire. Data extraction from the pregnancy record and the child health development record were carried out by public health midwives. The interviewer administered structured questionnaire was administered by the MOH during the follow-up visits. Duration of EBF was assessed in three ways; based on prospective data since birth: Retrospective data based on an event calendar: and the Mother reported EBF duration.ResultsA total of 114 mother-infant pairs were recruited and followed up. Proportion of infants receiving EBF up to the completion of the sixth month by the three methods were; data since birth (actual EBF rate) - 23.9%; mother reported data - 77.7% and event calendar method - 41.3%. Median duration of EBF reported in the three methods was 5, 6, and 5 respectively. A statistically significant difference was observed in these differences from Kaplan-Meire Survival analysis (Log rank test - Chi square-63.4, p < 0.001). Validity of retrospective methods was analysed using data since birth as the gold standard. Sensitivity of both methods to detect exclusively breastfed babies were 100.0%. Specificity of mother recall data was 26.2% (95%CI-17.9, 36.8%) compared to 75.0% (95% CI-64.5, 83.2%) in the event calendar method.ConclusionsRetrospective evaluation methods systematically overestimate the duration of EBF. Maternal recall data provide highly unspecific data whereas use of an event calendar provided more valid data. Reporting of data accrual methods in breastfeeding studies will allow the readers to interpret findings accurately and the use of event calendars rather than direct questioning as a valid method of determining EBF is recommended.

P2-130 Epidemiology of hypertension in an urban Sri Lankan population

IntroductionHypertension is a common risk factor for cardiovascular disease. In Sri Lanka, despite the existence of a universal free health system, services are not available for routine screening of hypertension...

SP1-88 Mortality in an urban cohort in Ragama, Sri Lanka

IntroductionThe leading causes of mortality in Sri Lanka are due to chronic diseases. We describe the mortality patterns in a 35–64-year-old urban cohort resident in Ragama, Sri Lanka and followed...

Reducing the delay in eligible couple registration through networking with marriage registrars

Introduction: The newly married couples are rarely encountered by the Medical Officer of Health (MOH) and there is a de-lay in registering them in the Eligible Couple Register (ECR). A new service model was developed with marriage registrars for newly married. Objective: To describe the delay in eligible couple registration before and after networking with marriage registrars (MR) and to describe the detected pre-pregnancy risk factors through this newly implemented model. Methods: A network was established with the MR to receive information of newly married in the Arachchikattuwa MOH area. Delay in eligible couple registration before and after the implementation of the new model was assessed using data from 06 January 2004 to 12 January 2006. Results: The mean delay in eligible couples registration before and after intervention were 518.9 days and 46.5 days respectively (p=0.001). Registered in the ECR on the same day or after pregnancy registration before and after intervention were 133 (71.1%) and 16 (50%) respectively (p The MOH had seen 52 newly married couples during the study period. The number of teenage pregnancies was 14 (26.9%). There were 17 (32.7%) females with a BMI, Conclusion: Linking up with marriage registrars reduces the delay in eligible couple registration significantly. Through provision of services by MOH to newly married couples selected pre-pregnancy risk factors can be identified and addressed. It also provides an opportunity for provision of pre-pregnancy care. Key Words Newly married; pre-pregnancy risk factors; new service model; marriage registrars DOI: 10.4038/jccpsl.v13i2.2966 Journal of the College of Community Physicians of Sri Lanka Vol.13(2) 2008 29-33

The Nutritional Status of Grade Eleven Students in the Medical Officer of Health Area Kalutara

Objectives: To describe the nutritional status of grade eleven school children in the Medical Officer of Health (MOH) area Kalutara. Methodology: A descriptive cross-sectional study was carried out among grade eleven school children in Type 1AB and Type 1C state schools in the MOH area Kalutara. Eighteen classes from a total of 14 schools were studied. Cluster sampling technique, probability proportionate to size was used to select the sample. The heights and weights were measured, and the Body Mass Index (BMI) was calculated for each child. The age and sex specific BMI charts developed by the National Centre for Health Statistics 2000 were used as standards. A structured, pre-tested self-administered questionnaire was used to collect the socio-demographic characteristics. Results : The prevalence of thinness ( Conclusions: Under-nutrition is a problem among grade eleven school children in the MOH area Kalutara. Almost 7% of them were at risk of overweight. Key Words: Nutritional Status; School Children DOI: 10.4038/jccpsl.v13i2.2967 Journal of the College of Community Physicians of Sri Lanka Vol.13(2) 2008 34-38

Evaluation of Cervical Screening Coverage in Kalutara District

Objective: To determine the cervical screening coverage of women 40-60 years in Kalutara District since the inception of the programme in 1996. Methodology: Cervical screening which is conducted in Well Woman Clinics (WWC), involves both visual inspection of the cervix and Pap smear testing. A descriptive cross sectional survey was conducted to assess the cervical screening coverage achieved since the inception of the programme and to assess the quality of services. The area investigated was the Kalutara district and individual MOH (Medical Officer of Health) areas within it. Data of screened females between 33 to 63 years were obtained from the records maintained in the WWClinics Results The results were expressed as a percentage of the total 40-60 females in the District and individual MOH areas. The cervical screening coverage in Kalutara District was 2.2% since the inception of the programme. Although the cover-age was low, a rising trend of cervical screening from 1996 was observed particularly after the year 1998. Only three MOH areas out of 7 conducted more than 4 WWClinics per month, which is the recommendation of Ministry of Health. Seventy four percent (1135) of total screenings (1535) were performed in those three clinics. Only one MOH area conducted an out-reach clinic. Five MOH areas conducted the clinics in combination with Maternal and Child Health/Family Planning (MCH/FP) clinics, while the other two MOH areas conducted separate WWClinics. The highest cumulative coverage was observed in Bulathsinhala MOH area (9.3%) where there were more than 4 WWclinics per month and clinics were conducted separately. Conclusion The low cervical screening coverage of 2.2% over a 5 year period in Kalutara District resembled the cervical screen-ing coverage pattern in other developing countries. Cervical screening coverage could be increased by increasing fre-quency and number of clinics especially in the periphery and conducting WWClinics separately without combining with MCH/FP Clinics. Key words: Cervical screening; Well Woman Clinics; evaluation; coverage DOI: 10.4038/jccpsl.v14i1.2946 Journal of the College of Community Physicians of Sri Lanka Vol.14(1) 2009 33-38

Feeding practices among children attending child welfare clinics in Ragama MOH area: a descriptive cross-sectional study

BackgroundFeeding during early childhood is important for normal physical and mental growth as well as for health in later life. Currently, Sri Lanka has adopted the WHO recommendation of exclusive breastfeeding for six months, followed by addition of complementary feeds thereafter, with continuation of breastfeeding up to or beyond two years. This study was conducted to evaluate the current feeding practices among Sri Lankan children during early childhood.MethodsThis study was a descriptive cross-sectional study conducted in the Ragama Medical Officer of Health (MOH) area. It was conducted between 10 August 2010 and 30 October 2010. Children between the ages of 24 and 60 months, attending child welfare clinics, were included in the study on consecutive basis. An interviewer-administered questionnaire was used to collect data regarding sociodemographic characteristics and feeding practices.ResultsThere were 208 boys and 202 girls in the study population. Of them, 255 (62.2%) were exclusively breastfed up to 6 months. Younger children had a statistically significant, higher rate of exclusive breastfeeding compared to older children. Three hundred and fifty one (85.6%) children had received infant formula, and it was started before the age of 6 months in 61 children, and in 212 before one year. Sugar was added to infant formula in 330 (80.4%) children, and out of them 144 had sugar added within first year of life. Complementary foods were started before 4 months in 29 (7%) children. Of the 410 children, 294 (71.7%) were breastfed beyond 2 years and 41.6% of them were breastfed at regular intervals throughout the day. Three hundred and thirty eight (82.6%) children were receiving overnight feeding of either breast milk or infant formula even after 2 years.ConclusionsThough a high rate of exclusive breastfeeding was observed in this study population, there are many other issues related to feeding during the early years of life that need immediate intervention. Too early introduction of complementary food, using infant formula without an indication, adding sugar to infant formula, too frequent breastfeeding and overnight feeding of older children are among them.

Maternal haemoglobin level at booking visit and its effect on adverse pregnancy outcome

To determine the effect of maternal haemoglobin levels at booking visit on pregnancy outcome. A prospective study was carried out at two Medical Officer of Health areas in a district in Sri Lanka, including 817 pregnant mothers who were followed up until delivery. Maternal haemoglobin level was measured according to specified standard protocols. The reliability and the accuracy of haemoglobin measurements were assessed and were found to be satisfactory. Pregnancy outcome was defined in terms of miscarriage, maternal morbidities, preterm birth (PTB), low birth weight (LBW) and small for gestational age (SGA) infants. Potential confounding factors for each pregnancy outcome were also assessed. Multiple logistic regression was applied and the results were expressed as odds ratios (OR) and 95% confidence intervals (95% CI). The prevalence of anaemia (Hb < 11 g/dL) was 7.1% (95% CI 5.4-8.9%). Anaemia during pregnancy was not significantly associated with any of the pregnancy outcomes studied. Reference range for haemoglobin measurements among mothers with normal pregnancy outcome was 10.4-13.9 g/dL. Haemoglobin level of >13.9 g/dL had a significant adverse association with maternal morbidities (OR 3.0; 95% CI 1.03-8.90) and LBW (OR 3.95; 95% CI 1.30-12.0) compared with the reference range. Although anaemia during pregnancy was not adversely associated with any of the pregnancy outcomes, Hb level of >13.9 g/dL was adversely associated with maternal morbidities and LBW.

Breastfeeding practices in a public health field practice area in Sri Lanka: a survival analysis

BackgroundExclusive breastfeeding up to the completion of the sixth month of age is the national infant feeding recommendation for Sri Lanka. The objective of the present study was to collect data on exclusive breastfeeding up to six months and to describe the association between exclusive breastfeeding and selected socio-demographic factors.MethodsA clinic based cross-sectional study was conducted in the Medical Officer of Health area, Beruwala, Sri Lanka in June 2006. Mothers with infants aged 4 to 12 months, attending the 19 child welfare clinics in the area were included in the study. Infants with specific feeding problems (cleft lip and palate and primary lactose intolerance) were excluded. Cluster sampling technique was used and consecutive infants fulfilling the inclusion criteria were enrolled. A total of 219 mothers participated in the study. The statistical tests used were survival analysis (Kaplan-Meier survival curves and Cox proportional Hazard model).ResultsAll 219 mothers had initiated breastfeeding. The median duration of exclusive breastfeeding was four months (95% CI 3.75, 4.25). The rates of exclusive breastfeeding at 4 and 6 months were 61.6% (135/219) and 15.5% (24/155) respectively. Bivariate analysis showed that the Muslim ethnicity (p = 0.004), lower levels of parental education (p < 0.001) and being an unemployed mother (p = 0.021) were important associations of early cessation of exclusive breastfeeding. At the time of the study, 62% (135/219) of infants were receiving feeds via a bottle and 23% (51/219) were receiving infant formula. Muslim ethnicity was significantly associated with bottle and formula feeding (p < 0.001). Bottle feeding was also significantly higher among mothers with a low level of education and among employed mothers.ConclusionThe rate of breastfeeding initiation and exclusive breastfeeding up to the fourth month is very high in Medical Officer of Health area, Beruwala, Sri Lanka. However exclusive breastfeeding up to six months is still low and the prevalence of inappropriate feeding practices is high.