North Central Province Research Articles

Changing epidemiologic patterns of deliberate self poisoning in a rural district of Sri Lanka

BackgroundAcute poisoning is a major public health issue in many parts of the world. The epidemiology and the mortality rate is higher in low and middle income countries, including Sri Lanka. The aim of this study was to provide details about the epidemiology of acute poisoning in a rural Sri Lankan district and to identify the changing patterns and epidemiology of poisoning.MethodsA prospective study was conducted from September 2008 to January 2010 in all hospitals with inpatient facilities in Anuradhapura district of North Central Province of Sri Lanka. Acute poisoning data was extracted from patient charts. Selected data were compared to the data collected from a 2005 study in 28 hospitals.ResultsThere were 3813 poisoned patients admitted to the hospitals in the Anuradhapura district over 17 months. The annual population incidence was 447 poisoning cases per 100,000 population. The total number of male and female patients was approximately similar, but the age distribution differed by gender. There was a very high incidence of poisoning in females aged 15–19, with an estimated cumulative incidence of 6% over these five years. Although, pesticides are still the most common type of poison, medicinal drug poisonings are now 21% of the total and have increased 1.6 fold since 2005.ConclusionsAcute poisoning remains a major public health problem in rural Sri Lanka and pesticide poisoning remains the most important poison. However, cases of medicinal drug poisoning have recently dramatically increased. Youth in these rural communities remain very vulnerable to acute poisoning and the problem is so common that school-based primary prevention programs may be worthwhile.Lalith Senarathna, Shaluka F Jayamanna, Patrick J Kelly, Nick A Buckley,michael J Dibley, Andrew H Dawson. These authors contributed equally to this work.

Moderating Influences on the Strategy Making and Firm Performance Relationship: A Study of Small and Medium Entreprises

Over the years, SMEs have gained wide reorganization as a major source of employment, income generation, poverty alleviation and regional development in Sri Lanka. Strategy making in business firms has also been identified as a vital process of coping with rapid changes and stiff competition in the today’s business environment. This study aims to examine the nature of strategy making and its relationship with firm performance, and moderating influences on the underline relationship of small and medium enterprises. A sample of 150 small and medium enterprises pertaining to six manufacturing sectors in North Central Province in Sri Lanka provided the data for an empirical test of these issues. Data, collected through the standard questionnaire from owner managers of the selected firms, were analyzed using the descriptive statistical techniques as well as the inferential statistical techniques of correlation, hierarchical regression, ANOVA and chi-square test. The analysis was conducted using SPSS 16 version. The study found that significant and positive influence of strategy making on the firm performance. Results of hierarchical regression show that the relationship between strategy making and performance is moderated by the internal factors such as owner’s experience and education level and as well as the external environment conditions. The findings further indicate that the firms whose managers promote strategy making maintain better performance levels than those who do not. Accordingly, strategic making is identified as a mechanism to overcome constraints imposed by limited resources in small firms to take advantage of new opportunities arising from challenging environmental conditions.

Contextualising the Tabbova-Maradanmaduva ‘Culture’: Excavations at Nikawewa, Tirappane District, Anuradhapura District, Sri Lanka

Terracotta figurines and artefacts discovered throughout Sri Lanka, especially in the North Central Province, have been traditionally assigned to the Tabbova-Maradanmaduva culture. Not a single stratigraphic excavation has been conducted at any site where a terracotta assemblage has been recovered, leading to a variety of divergent opinions as to the date of such artefacts. In addition, the corpus is often presumed to represent ‘folk art’ spontaneously created by individuals or local communities to suit and satisfy immediate ritual, economic, and social concerns. Recent fieldwork conducted as part of the Anuradhapura (Sri Lanka) Project: The Hinterland (Phase II) has addressed the uncertainty surrounding the Tabbova-Maradanmaduva culture. Not only has excavation at the site of Nikawewa (D339) provided the first absolute scientific date for such an assemblage, but data collected from the project's sample universe suggests that the terracotta corpus exhibits a high degree of uniformity and that these assemblages may represent a formalised ritual structure parallel to that provided by Buddhist monasteries.

Chronic kidney disease of unknown aetiology in the North Central Province of Sri Lanka: trying to unravel the mystery

Chronic kidney disease of unknown aetiology in the North Central Province of Sri Lanka: trying to unravel the mystery

Uncertain etiologies of proteinuric-chronic kidney disease in rural Sri Lanka

The global prevalence of chronic kidney disease (CKD) of uncertain etiology may be underreported. Community-level epidemiological studies are few due to the lack of national registries and poor focus on the reporting of non-communicable diseases. Here we describe the prevalence of proteinuric-CKD and disease characteristics of three rural populations in the North Central, Central, and Southern Provinces of Sri Lanka. Patients were selected using the random cluster sampling method and those older than 19 years of age were screened for persistent dipstick proteinuria. The prevalence of proteinuric-CKD in the Medawachchiya region (North Central) was 130 of 2600 patients, 68 of 709 patients in the Yatinuwara region (Central), and 66 of 2844 patients in the Hambantota region (Southern). The mean ages of these patients with CKD ranged from 44 to 52 years. Diabetes and long-standing hypertension were the main risk factors of CKD in the Yatinuwara and Hambantota regions. Age, exceeding 60 years, and farming were strongly associated with proteinuric-CKD in the Medawachchiya region; however, major risk factors were uncertain in 87% of these patients. Of these patients, 26 underwent renal biopsy; histology indicated tubulointerstitial disease. Thus, proteinuric-CKD of uncertain etiology is prevalent in the North Central Province of Sri Lanka. In contrast, known risk factors were associated with CKD in the Central and Southern Provinces.

A community-based cluster randomised trial of safe storage to reduce pesticide self-poisoning in rural Sri Lanka: study protocol

BackgroundThe WHO recognises pesticide poisoning to be the single most important means of suicide globally. Pesticide self-poisoning is a major public health and clinical problem in rural Asia, where it has led to case fatality ratios 20-30 times higher than self-poisoning in the developed world. One approach to reducing access to pesticides is for households to store pesticides in lockable "safe-storage" containers. However, before this approach can be promoted, evidence is required on its effectiveness and safety.Methods/DesignA community-based cluster randomised controlled trial has been set up in 44,000 households in the North Central Province, Sri Lanka. A census is being performed, collecting baseline demographic data, socio-economic status, pesticide usage, self-harm and alcohol. Participating villages are then randomised and eligible households in the intervention arm given a lockable safe storage container for agrochemicals.The primary outcome will be incidence of pesticide self-poisoning over three years amongst individuals aged 14 years and over. 217,944 person years of follow-up are required in each arm to detect a 33% reduction in pesticide self-poisoning with 80% power at the 5% significance level. Secondary outcomes will include the incidence of all pesticide poisoning and total self-harm.DiscussionThis paper describes a large effectiveness study of a community intervention to reduce the burden of intentional poisoning in rural Sri Lanka. The study builds on a strong partnership between provincial health services, local and international researchers, and local communities. We discuss issues in relation to randomisation and contamination, engaging control villages, the intervention, and strategies to improve adherence.Trial RegistritationThe trial is registered on ClinicalTrials.gov ref: NCT1146496 (http://clinicaltrialsfeeds.org/clinical-trials/show/NCT01146496).

Comparative enumeration for dominant species in selected natural forests, North Central Province, Sri Lanka to be used in assessment of Carbon sequestration

With the increasing attention placed on climate change as the prime environmental hazard, more and more attention is on the forest ecosystems as sinks of carbon dioxide. At the International Convention on Climate Change in 1992 and subsequently the Kytoto Protocol Clean Development Mechanisms were introduced and one of its clauses was the trading of carbon between developing and developed countries. Despite the recognized potential of forests as an important sink to sequester carbon, accurate estimates of the carbon sequestration potential of different ecosystems or their component species are lacking especially in Sri Lanka. Out of the natural forests, the work done in this area on the dry zone forests is minimal.Monteith (1972 & 1977) showed that the rate of biomass production is directly proportional to the amount of radiation intercepted by the foliage canopy. The above relationship can be given as: W = e RI , Where, W is the amount of total biomass (above and belowground biomass) produced and RI is the amount of radiation intercepted by canopy. The proportionality constant, e is termed as Radiation Use Efficiency (RUE). In order to find the carbon sequestration of particular ecosystem it is imperative to find the radiation use efficiency of dominant species which is being taken as the Important Value Index. This study reports the findings of the comparative assessment of 3 forest ecosystems ie Padawiya Proposed Reserve, Weddakanda Proposed Reserve (PR) and Nagalakanda Proposed Reserve (PR) which are located in DL 1 a, DL 1 b and DL 1 c agro-ecological regions respectively for their dominant species. Padewiya PR lay on almost flat land and others are on isolated mountains. Elevation levels distributed between 55m to 210m from Mean Sea Level (MSL). Circular shape sample plots were located representing whole area and low, mid and high elevations.No of species and no of families were resulted as Padawiya PR 30, 17, Weddakanda PR 37, 18 and Nagalakanda PR 40, 25 respectively. Stem density (for all species) of Padawiya, Weddakanda PR, and Nagalakanda PR were recorded as 526, 1800 and 2038 stems ha-1. Basal area of the selected forest (for all species) was 35.0, 45.2 and 51.8 m2ha-1 respectivly. Relative density, relative basal area and relative frequency were calculated for each species. According to Important Value Index (IVI) dominant species are ranked as higher values are most dominant. Most dominant five species for Padawiya PR are Drypetes sepiaria, Syzygiyum cordifolium, Terminalia arjuna, Diospyros ovalifolia, and Wrightia angustifolia. Most dominant five species for Weddakanda PR are Drypetes sepiaria, Diospyros ebenum, Croton officinalis, Diospyros ovalifolia and Pterospermum suberifolium. As well as Mallotus walkerae, Drypetes sepiaria, Ficus tinctoria, Pterospermum suberifolium, and Glycosmis angustifolia are the most dominant species for Nagalakanda PR.

Performance Evaluation of Four Wheel Tractor Driven High Capacity Combined Paddy Thresher

Lower performances of traditional threshing methods, labour shortage, reduced turn-around time and use of high yielding varieties have inevitably forced farmers to shift into mechanical grain threshing. Recently introduced four-wheel tractor driven high capacity combined paddy thresher gained popularity among Sri Lankan farmers. However, this thresher has not been properly evaluated. This study evaluated the field performances and economics of this thresher and monitored the emission of chaff and dust to compare the commercial makes, grain types and operational conditions. This study was carried out in the North Central Province of Sri Lanka, during the Maha season of 2008/2009. Air monitoring on inhaled air was done by filtration technique, using special masks and surrounding environment by gravity techniques, using Polyurethane foam. As per the RNAM test code procedures, three commercial makes of high capacity combined paddy threshers were evaluated under different operational conditions for long and short grain paddy varieties with two replicates. The combined paddy threshers showed 1.8% damaged grain, 0.2% blown grains, 1.6% grain losses, 96.7% threshing recovery, 98.8% threshing efficiency, 90.7% cleaning efficiency, 1178 kg/h corrected output capacity and Rs. 2744 actual cost of threshing per metric ton of output at 14% moisture content. Though this thresher is suited for Sri Lankan conditions, it is associated with considerable amount of chaff and dust content such as; 2.04 mg/cm²/h in inhaled air and 35.59 mg/cm²/h in surrounding environment. The performance, economics and chaff and dust emission vary with make of the machine, grain type and operational conditions. Grain moisture is the most dominantly affected factor for the thresher performance. <strong>Keywords: </strong>Chaff; dust; paddy; threshing DOI: http://dx.doi.org/10.4038/tar.v22i3.3700 <em>Tropical Agricultural Research </em>22(3) (2011) 273-281<em> </em>

Tubulointerstitial damage as the major pathological lesion in endemic chronic kidney disease among farmers in North Central Province of Sri Lanka

Chronic kidney disease of uncertain etiology (CKDu) in North Central Province of Sri Lanka has become a key public health concern in the agricultural sector due to the dramatic rise in its prevalence and mortality among young farmers. Although cadmium has been suspected as a causative pathogen, there have been controversies. To date, the pathological characteristics of the disease have not been reported. Histopathological observations of 64 renal biopsies obtained at Anuradhapura General Hospital from October 2008 to July 2009 were scored according to Banff 97 Working Classification of Renal Allograft pathology. The correlations between the histological observations and clinical parameters were statistically analyzed. Interstitial fibrosis and tubular atrophy with or without nonspecific interstitial mononuclear cell infiltration was the dominant histopathological observation. Glomerular sclerosis, glomerular collapse, and features of vascular pathology such as fibrous intimal thickening and arteriolar hyalinosis were also common. Although hypertension was identified as one of the common clinical features among the cases, it did not influence the histopathological lesions in all the cases. This study concludes that tubulointerstitial damage is the major pathological lesion in CKDu. Exposure(s) to an environmental pathogen(s) should be systematically investigated to elucidate such tubulointerstitial damage in CKDu.

Risk factors associated with disease progression and mortality in chronic kidney disease of uncertain etiology: a cohort study in Medawachchiya, Sri Lanka

The alarming rise in the prevalence of chronic kidney disease of uncertain etiology (CKDu) among the low socioeconomic farming community in the North Central Province of Sri Lanka has been recognized as an emerging public health issue in the country. This study sought to determine the possible factors associated with the progression and mortality of CKDu. The study utilized a single-center cohort registered in 2003 and followed up until 2009 in a regional clinic in the endemic region, and used a Cox proportional hazards model. We repeatedly found an association between disease progression and hypertension. Men were at higher risk of CKDu than women. A significant proportion of the patients in this cohort were underweight, which emphasized the need for future studies on the nutritional status of these patients. Compared with findings in western countries and other regions of Asia, we identified hypertension as a major risk factor for progression of CKDu in this cohort.

Delayed Psychological Morbidity Associated with Snakebite Envenoming

IntroductionThe psychological impact of snakebite on its victims, especially possible late effects, has not been systematically studied.ObjectivesTo assess delayed somatic symptoms, depressive disorder, post-traumatic stress disorder (PTSD), and impairment in functioning, among snakebite victims.MethodsThe study had qualitative and quantitative arms. In the quantitative arm, 88 persons who had systemic envenoming following snakebite from the North Central Province of Sri Lanka were randomly identified from an established research database and interviewed 12 to 48 months (mean 30) after the incident. Persons with no history of snakebite, matched for age, sex, geograpical location and occupation, acted as controls. A modified version of the Beck Depression Inventory, Post-Traumatic Stress Symptom Scale, Hopkins Somatic Symptoms Checklist, Sheehan Disability Inventory and a structured questionnaire were administered. In the qualitative arm, focus group discussions among snakebite victims explored common somatic symptoms attributed to envenoming.ResultsPrevious snakebite victims (cases) had more symptoms than controls as measured by the modified Beck Depression Scale (mean 19.1 Vs 14.4; p<0.001) and Hopkins Symptoms Checklist (38.9 vs. 28.2; p<0.001). 48 (54%) cases met criteria for depressive disorder compared to 13 (15%) controls. 19 (21.6%) cases also met criteria for PTSD. 24 (27%) claimed that the snakebite caused a negative change in their employment; nine (10.2%) had stopped working and 15 (17%) claimed residual physical disability. The themes identified in the qualitative arm included blindness, tooth decay, body aches, headaches, tiredness and weakness.ConclusionsSnakebite causes significant ongoing psychological morbidity, a complication not previously documented. The economic and social impacts of this problem need further investigation.

Chronic kidney disease of unknown aetiology in Sri Lanka: is cadmium a likely cause?

BackgroundThe rising prevalence of chronic kidney disease (CKD) and subsequent end stage renal failure necessitating renal replacement therapy has profound consequences for affected individuals and health care resources. This community based study was conducted to identify potential predictors of microalbuminuria in a randomly selected sample of adults from the North Central Province (NCP) of Sri Lanka, where the burden of CKD is pronounced and the underlying cause still unknown.MethodsExposures to possible risk factors were determined in randomly recruited subjects (425 females and 461 males) from selected areas of the NCP of Sri Lanka using an interviewer administered questionnaire. Sulphosalicylic acid and the Light Dependent Resister microalbumin gel filtration method was used for initial screening for microalbuminuria and reconfirmed by the Micral strip test.ResultsMicroalbumnuria was detected in 6.1% of the females and 8.5% of the males. Smoking (p < 0.001), alcohol use (p = 0.003), hypertension (p < 0.001), diabetes (p < 0.001), urinary tract infection (UTI) (p = 0.034) and consumption of water from wells in the fields (p = 0.025) were associated with microalbuminuria. In the binary logistic regression analysis, hypertension, diabetes mellitus, UTI, drinking well water in the fields, smoking and pesticide spraying were found to be significant predictors of microalbuminuria.ConclusionsHypertension, diabetes mellitus, UTI, and smoking are known risk factors for microalbuminuria. The association between microalbuminuria and consumption of well water suggests an environmental aetiology to CKD in NCP. The causative agent is yet to be identified. Investigations for cadmium as a potential causative agent needs to be initiated.

Evidence of tubular damage in the very early stage of chronic kidney disease of uncertain etiology in the North Central Province of Sri Lanka: a cross-sectional study

In the North Central Province of Sri Lanka, chronic kidney disease of uncertain etiology (CKDue) has increased markedly over the past 15-20years. From around 4,700 patients who were followed up, 106 affected patients who visited two local clinics in the endemic area for CKDue on August 10, 2009 and 10 pedigrees of 10 of these cases with familial clustering of CKDue participated in this study. Urine samples, collected from affected patients (n=106), unaffected relative controls (n=81), and Japanese controls (n=50), were analyzed for two tubular markers: α1-microglobulin and N-acetyl-β-D: -glucosaminidase. Urine samples from patients with CKDue stages 1-4 (n=101) and all the samples from unaffected relatives and Japanese controls were analyzed for urinary cadmium concentration. Urinary excretion of α1-microglobulin was elevated even in the earliest stage of CKDue compared with its levels in unaffected relative controls. Urinary excretion of N-acetyl-β-D: -glucosaminidase was elevated only in stage 5. In contrast, urinary cadmium excretion was similar in CKDue patients and in the unaffected relative controls, and levels in both these groups were significantly lower than the level in the Japanese controls. All levels were below the threshold level for renal toxicity, indicating the absence of any evidence of cadmium toxicity. The present study indicates that renal tubular damage occurs in the very early stage of CKDue and demonstrates the existence of familial clustering, suggesting that CKDue is likely to be the outcome of exposure to an unknown nephrotoxin in susceptible subjects in the endemic region.

Mycotoxin Detection in Urine Samples from Patients with Chronic Kidney Disease of Uncertain Etiology in Sri Lanka

This was a screening study that aimed to determine the presence of nephrotoxic mycotoxins in urine samples from patients with chronic kidney disease of uncertain etiology in the North Central Province of Sri Lanka. The percentage detection of aflatoxins, ochratoxins and fumonisins in 31 patients were 61.29%, 93.5% and 19.4%, respectively. Geometric means of urinary aflatoxins and ochratoxins were 30.93 creatinine and 34.62 ng/g creatinine in chronic kidney disease of uncertain etiology stage 1-2 patients and 84.12 ng/g creatinine and 63.52 ng/g creatinine in unaffected relatives of patients. In chronic kidney disease of uncertain etiology stage 3-5 patients, geometric means of urinary aflatoxins and ochratoxins were 10.40 and 17.08 ng/g creatinine, respectively. Non-affected relatives of patients (n = 6) had comparable levels of these mycotoxins, but healthy Japanese individuals (n = 4) had lower levels than in Sri Lanka. The higher detection rate of urinary ochratoxins in Sri Lankans indicates that exposure is common in the region.

Entrepreneurs’ Traits and Firm Performance - A Study of Rural Entrepreneurs in North Central Province in Sri Lanka

Over the years, much research has been devoted to answering the question what factors explain small firm performance and growth. Entrepreneurs’ traits and firm performance have been developed in numerous research works. This study aims to investigate the attributes of entrepreneurs and their role on firm performance. The Sample of 175 manufacturing small and medium enterprises in North Central Province in Sri Lanka provided the data for the study and found that the entrepreneurs have moderate high level of internal locus of control, need for achievement and risk taking propensity. The result of ANOVA indicated that the attributes identified are varied on the gender, education level and business experiences of the entrepreneurs. Further, significant positive relationships were found between internal locus of control, need for achievement and firms performance. Surprisingly, no significant correlation was found between RTP and firms performance. Limitations and suggestions also are made for future research into this topic.

Pollution of River Mahaweli and farmlands under irrigation by cadmium from agricultural inputs leading to a chronic renal failure epidemic among farmers in NCP, Sri Lanka

Chronic renal failure (CRF) associated with elevated dietary cadmium (Cd) among farming communities in the irrigated agricultural area under the River Mahaweli diversion scheme has reached a significantly higher level of 9,000 patients. Cadmium, derived from contaminated phosphate fertilizer, in irrigation water finds its way into reservoirs, and finally to food, causing chronic renal failure among consumers. Water samples of River Mahaweli and its tributaries in the upper catchment were analyzed to assess the total cadmium contamination of river water and the possible source of cadmium. Except a single tributary (Ulapane Stream, 3.9μgCd/l), all other tested tributaries carried more than 5μgCd/l, the maximum concentration level accepted to be safe in drinking water. Seven medium-sized streams carrying surface runoff from tea estates had 5.1-10μgCd/l. Twenty larger tributaries (Oya), where the catchment is under vegetable and home garden cultivation, carried 10.1-15μgCd/l. Nine other major tributaries had extremely high levels of Cd, reaching 20μgCd/l. Using geographic information system (GIS), the area in the catchment of each tributary was studied. The specific cropping system in each watershed was determined. The total cadmium loading from each crop area was estimated using the rates and types of phosphate fertilizer used by the respective farmers and the amount of cadmium contained in each type of fertilizer used. Eppawala rock phosphate (ERP), which is mostly used in tea estates, caused least pollution. The amount of cadmium in tributaries had a significant positive correlation with the cadmium loading of the cropping system. Dimbula Tea Estate Stream had the lowest Cd loading (495.9g/ha/year), compared with vegetable-growing areas in Uma Oya catchment with 50,852.5gCd/ha/year. Kendall's τ rank correlation value of total Cd loading from the catchment by phosphate fertilizer used in all crops in the catchment to the Cd content in the tributaries was +0.48. This indicated a major contribution by the cropping system in the upper catchment area of River Mahaweli to the eventual Cd pollution of river water. Low soil pH (4.5-5.2), higher organic matter content (2-3%), and 18-20cmol/kg cation exchange capacity (CEC) in upcountry soil have a cumulative effect in the easy release of Cd from soil with the heavy surface runoff in the upcountry wet zone. In view of the existing water conveyance system from upcountry to reservoirs in North Central Province (NCP) through diversion of River Mahaweli, in addition to their own nonpoint pollution by triple superphosphate fertilizer (TSP), this demands a change in overall upper catchment management to minimize Cd pollution through agriculture inputs to prevent CRF due to elevated dietary cadmium among NCP farmers.

Remediation of cadmium contaminated irrigation and drinking water: A large scale approach

Cadmium is one of the most troublesome toxic heavy metals. It accumulates in the water reservoirs and agricultural soil as a result of intensive use of Cd contaminated phosphate fertilizers, e.g. in agriculture in the North Central Province (NCP) of Sri Lanka. The hyper-accumulator Thlaspi caerulescens, accumulates up to 1000 ppm Cd in shoots without exhibiting toxicity symptoms. The storage rhizomes of year old Nelumbo nucifera (lotus) natural vegetation in water reservoirs in NCP accumulated 253 ± 12 mg Cd/kg. Seedlings of lotus grown in 5% Hoagland's solution at 0.75, 1.0 and 1.25 ppm cadmium sulphate showed a significant increase in Cd removal of 0.0334–0.121 ppm/week. However the removal rate of Cd from water failed to increase any further at higher concentrations of Cd in water. The slow growth rate and low rate of phytoextraction demands a more effective but an affordable method of remediation in order to combat the prevailing elevated cadmium levels in NCP that causes chronic renal failure (CRF). We have developed a large scale filtering device using rice husk. We have achieved successful results in sequestering Cd using raw rice husk as well as amorphous silica derived from rice husk.

Prevalence of hypertension, diabetes and obesity: baseline findings of a population based survey in four provinces in Sri Lanka

To determine the prevalence of selected cardiovascular risk factors in adult Sri Lankan population in four provinces. Cross-sectional, based on a stratified cluster sampling method. Four provinces, namely the Western, North Central, Southern and Uva. Six thousand and forty seven participants (2692 men) between the age of 30 and 65 years were surveyed. Risk factors measured included height, weight, waist and hip circumference. Waist to hip ratio and body mass index were calculated, and overweight (23 kg/m2) and obesity (> or = 25 kg/m2) determined. Hypertension (systolic blood pressure > or = 140 mmHg or diastolic blood pressure > or = 90 mmHg or use of anti-hypertensive medications), and diabetes mellitus (fasting serum plasma glucose level > or = 7 mmol/L or use of anti-diabetic medications) and impaired fasting glycaemia (> or = 6.1 to < 7 mmol/L) were also determined. The prevalence of hypertension as defined was 18.8% (CI 14.5-23.1) for men and 19.3% (CI 12.2-26.4) for women. The prevalence of diabetes was 14.2% (CI 11.9-16.5) for men and 13.5% (CI 6.9-20.1) for women while impaired fasting glycaemia was 14.2% for men and 14.1% for women. The mean body mass index was 21.5 kg/m2 (SD = 3.7) in men. It was lower than that in women, 23.3 kg/m2 (SD = 4.5). The prevalence of obesity was 20.3% in men and 36.5 % in women. Regional differences were seen in the mean fasting blood glucose and prevalence of diabetes, and mean BMI and prevalence of obesity were highest in Western province. Mean blood pressure and prevalence of hypertension were highest in the Uva Province. Southern Province had the lowest prevalence of hypertension and diabetes, and North Central Province had lowest anthropometric measures of obesity. The prevalence of the selected cardiovascular risk factors is common in the adult Sri Lankan population surveyed. Regional differences exist in the prevalence of these risk factors. The prevalence of high level of risk factors requires urgent public health action.

Analysis of Factors Influencing the Performance of Small and Medium Enterprises in North Central Province in Sri Lanka

Small and Medium Enterprises (SMEs) play very significant role in the economies of both developed and developing countries, representing well over 90 percent of all manufacturing enterprises in the world. Over the years, SMEs have gained wide recognition as a major source of employment, income generation, poverty alleviation and regional development in Sri Lanka. While little empirical research has addressed the small firm performance, even few studies have concentrated in rural areas; this study aims to examine the factors influencing the performance of SMEs in North Central Province (NCP) in Sri Lanka. The study directs to SMEs owner Managers to examine their character traits, strategic capabilities and external environment influences and effect of them towards the firm performance.

Iodine nutrition status among schoolchildren after salt iodisation

Earlier studies done in Sri Lanka have indicated the importance of iodine deficiency as a public health problem. The universal salt iodisation programme has been implemented since 1995. The goals of salt iodisation are reduction of the goitre rate to <5% in school-aged children, to maintain the median urinary iodine level in the population between 100-200 microg/L and >90% of households using iodised salt. To estimate the goitre prevalence, the urinary iodine level, and measure the household iodised salt consumption pattern by Province. A school-based study of 6574 randomly selected children in the age group 8-10 years, from 263 schools was assessed for goitre by palpation. The concentration of urinary iodine levels was measured in 2630 of these children. Estimation of iodine in the 6181 samples of salt used in households of the schoolchildren was also assessed by test kits. The prevalence of goitre in the Provinces varied from 16.3% to 26.2%. The median urinary iodine levels were above the cut-off point of 100 microg/L in all Provinces except in Uva. The highest median urinary iodine level was reported in North Central Province (231.3 microg/L). Overall, 35.4% of the children had urine iodine levels in the 'ideal' range (100-199.9 microg/L); 30.6% with lower values (<100 microg/L) indicated iodine deficiency and 16.3% with higher values (< 300 microg/L) indicated excessive iodine intake. Only 49.5% of households had used adequately iodised salt. This study showed that iodine deficiency still exists in Uva Province, and that more than adequate iodine levels were found in the North Central Province. The level of permitted salt iodine at household level needs to be revised.