Public Health Midwives Research Articles

Development and validation of the Japanese version of EPDS-P for indirect screening of paternal perinatal depression based on maternal reporting: Protocol for a prospective longitudinal observational study.

The main purpose of this study is to develop an indirect screening system for paternal perinatal depression based on the female partner's assessment in the Japanese population. The Japanese version of the Edinburgh Postnatal Depression Scale-Partner (EPDS-P) will be used as the indirect screening tool, and its accuracy will be studied in this longitudinal prospective observational study. Public health nurses and midwives at the participating community health center are currently inviting couples to participate, and are distributing self-rating scales to the participants. The primary evaluation scales being used in this study are the Japanese versions of the Center for Epidemiologic Studies Depression Scale (CES-D) and the Japanese version of the EPDS-P which evaluates paternal perinatal depression by women. We will evaluate EPDS-P performance against CES-D, including accuracy, sensitivity, specificity, and correlations. Perinatal depression is a mental illness that occurs between pregnancy and postpartum within the 12months, and it is known to increase the risk of adversely impacting on child development. Men may also experience a psychosocial crisis during their partners' perinatal period. Although it was recently reported that the EPDS-P can indirectly detect paternal perinatal depression, there is, as yet, insufficient evidence of this because the previous studies had relatively small sample sizes and were limited to cross-sectional studies in the postpartum period. The development of a screening system for paternal perinatal depression using the EPDS-P will lead to increased awareness of the disease and provide an opportunity to establish a family-based support system in Japan.

An assessment of the effectiveness of supervision in preventive healthcare institutions under the purview of the Regional Directorate of Health Services, Kalutara

Background: Supervision is an essential element in primary healthcare. It is not only the number that matters but the quality and effectiveness of supervision as well. Ineffective supervision is a cause of poor performance that can lead to sub-optimal health outcomes.Objective: To assess the effectiveness of supervision in preventive healthcare institutions under the administrative purview of the Regional Directorate of Health Services (RDHS), Kalutara.Method: A descriptive cross-sectional study was designed and carried out in all preventive sector healthcare institutions under the administrative purview of the RDHS, Kalutara. The entire population of the supervisors (Regional Director and Deputy Regional Director of Health Services, Consultant Community Physician, Medical Officer-Maternal & Child Health, Regional Epidemiologist, District Dental Surgeon, Supervisory Public Health Nursing Officers, Supervisory Public Health Inspector, Medical Officers of Health, Additional Medical Officers of Health, Supervisory Public Health Inspectors, Public Health Nursing Sisters, and Supervisory Public Health Midwives) and supervisees (Public Health Inspectors and School Dental Therapists) in the RDHS division except the Public Health Midwives (PHMs) was included in the study as their actual numbers are low. The selection of PHMs, the major category of supervisees, was subjected to random sampling. Self-administered questionnaires, focus group discussions, and observatory visits were used to collect the data. Data were analyzed both quantitatively and qualitatively. The effectiveness of supervision was assessed utilizing Manchester Clinical Supervision Scale (MCSS-26). Knowledge, attitudes, and practices of supervisors were assessed through a self-administered questionnaire and to some extent through observations.Results: The overall response rate was 67.8%. The knowledge related to supportive supervision among the supervisors was moderate. The level of knowledge was not significantly different among the different categories of supervisors. The level of attitudes towards supervision was also moderate. However, it was significantly different among the supervisory categories. As per the scale devised through the questionnaire, the supervisory practice was moderate as well, but it was not significantly different among the different categories of supervisors. The mean score of MCSS-26 was 65.67 indicating that overall supervision was ineffective by its threshold limit of 73. Apart from the administrative function of supervision, the supportive and educational functions were largely ineffective.Conclusion and recommendations: The effectiveness of supervision was suboptimal in preventive care health institutions of the RDHS division Kalutara. Appropriate measures that focused on enhancing supportive and educational functions of supervision are therefore required to improve the effectiveness of supervision among different categories of supervisors in the division. Designing and implementing more focused training and development activities to improve knowledge, attitude, and practices in supportive supervision; facilitating, encouraging, and empowering the supervisors to implement their post-supervisory recommendations; and utilizing the MCSS-26 as a tool of measuring supervisory effectiveness for the purpose of monitoring and evaluating the supervisory activities, are therefore recommended to improve the effectiveness of supervision in the division.

Cervical cancer screening coverage and the availability of healthcare resources for public health midwives in the Jaffna district

Effective cervical cancer screening requires high rates of service coverage. Very little is known about the determinants of cervical cancer screening coverage in Sri Lanka. This study aims to describe the association between the availability of resources for public health midwives (PHM), sociodemographic and work-related factors, and cervical cancer screening coverage in the Jaffna district in northern Sri Lanka. A descriptive cross-sectional study was carried out among field PHMs working in Jaffna District in 2019. Data were collected with a pre-tested, self-administered questionnaire at the monthly Medical Officer of Health conferences. Data were analysed with SPSS (v21). Frequencies, percentages and the Chi Squared test were used in the analysis. The critical level was set at 0.05. A total of 131 (of 144) field PHMs working in Jaffna district participated in the study (response rate 91%). Over half (n=67, 51%) had >10 years’ work experience, 44% (n=58) covered an additional PHM area and 48% (n=63) reported having received training in organising cervical cancer screening. In the sample, 49% (n=64) of PHMs reported having all essential facilities for cervical cancer screening and 48 (75%) achieved ≥50% coverage. Although 11 PHMs (8%) achieved 100% coverage, less than half the sample (n=54, 41%) achieved the Ministry of Health target of ≥70% coverage. Achieving 50% coverage was significantly associated with the availability of all essential facilities (p=0.01) and work experience (p=0.03), but not with having received training in organising cervical cancer screening (p=0.73). None of the selected sociodemographic and work-related factors were associated with having achieved the target of ≥ 70% coverage. Public health facilities and human resources are essential for improving cervical cancer screening coverage in Jaffna and elsewhere in Sri Lanka.

More than health care

The Norwegian community health centres are one of the main providers of maternal and child health care services. They are often the primary, as well as a regular point of contact, for women during pregnancy and after childbirth. As such, they are a place where encounters between primary health care providers like public health nurses, midwives and immigrant women, are frequent. Midwives and public health nurses play an important role as state employees in the distribution of universal health provisions at the local level. This is especially important in meeting the diverse needs of service users in a universal health care system. This study investigates the implications of cultural diversity for health care practice in a universal system. It employs a qualitative approach, using data from nine semi-structured interviews with midwives and public health nurses across three Norwegian municipalities. It analyses their experiences in working with immigrant women during pregnancy, and after childbirth, through thematic analysis. The findings illustrate the practitioners’ different approaches to meeting with culturally diverse patients, the challenges they face in their work, and how they overcome them. The discussions address the practice of cross-cultural health care in the absence of national guidelines or formal training using street-level bureaucracy as an analytical concept. This article contributes to knowledge on the practice of cross-cultural health care at Norwegian community health centres in the absence of a culturally cognizant health policy. On a broader scale, this study illustrates the implications of diversity for policy and practice in a universal welfare state.

Knowledge, attitudes and practices of public health midwives on adolescent and youth friendly health services and their role in Gampaha District, Sri Lanka

Official publication of the College of Community Physicians of Sri Lanka and was established in 1995. Full text articles available.Journal of the College of Community Physicians of Sri Lanka (JCCPSL) has been recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations. The journal is indexed in DOAJ.Manuscripts are only accepted online through the portal of the JCCPSL https://jccpsl.sljol.info/ . The prospective authors must read carefully the section on Author Guidelines and prepare their manuscript accordingly. To submit a manuscript or to check the status of a submission the authors must first be registered in the JCCPSL Editorial Management System using an existing or newly created username and password. Next, choose the ‘Start Submission’ link and follow the five-step article submission process which is a simple and self-guided process.

Healthy lifestyle behaviors among field public health workers in a selected district of Sri Lanka

Background: Healthy lifestyle behaviors: diet, physical activity and non-consumption of tobacco and alcohol of health workers are important as they engage in educating the community and people follow them as role models. Objective of this study was to describe the healthy lifestyle practices among field public health workers in one of the districts in Sri Lanka. Methods: Descriptive cross-sectional study was carried out in the Galle district. 303 Public Health Midwives (PHMs) were taken to the sample and Lifestyle practices were assessed using a pre-tested self-administered questionnaire. Results: Overweight and obesity prevalence were 24% and 3.7% respectively. None of them used tobacco or alcohol. Regular balance diet consumption was 57%. 18.2% have consumed 2 or >2 servings of fruit per day. The majority (49.2%) consumed vegetables 3 times per day and 21.8% consumed four or >4 servings per day. 43.6% consumed Sugar and sugar containing food daily. Only 12.2% preferred low-salt food. 21.8% of PHMs consumed oily foods few times a day. The majority (56.8%) of PHMs have engaged in recommended moderate physical activity but only 6.9% engaged in vigorous physical activity. The mean duration of walking time was 463 minutes per week. Conclusions and recommendations: Most lifestyle practices (Dietary and physical activity) are not very healthy among PHMs except for their alcohol and smoking behaviors. Public health workers should be motivated to spend healthy lifestyles by increasing awareness and incorporating healthy lifestyle promotion programs into their routine field work.

Help-seeking intention for depression and suicidal ideation during pregnancy and postpartum in rural Sri Lanka, a cross-sectional study.

Suicides are a leading cause of maternal deaths. Depression, the commonest mental illness during pregnancy, amidst its numerous morbidities, can precipitate suicides. So, early detection and treatment of maternal depression and suicidal thoughts are important for reducing maternal morbidity and mortality. Pregnant women's help-seeking patterns play a crucial role in this. Limited availability and accessibility of potential sources, poor knowledge, and perceptions of the condition and the help-seeking process itself ,would act as barriers for help-seeking, especially in resource-constrained settings. This study explores the help-seeking intention, preferred sources, and factors influencing help-seeking for depression and suicidal thoughts among pregnant women in rural Sri Lanka. A cross-sectional study was conducted among pregnant women attending antenatal clinics in Anuradhapura, Sri Lanka. A multistage cluster sampling technique with probability proportionate to size was used. A self-completed, vignette-based questionnaire was developed, validated and pretested for the study. The vignette described the experience of a postpartum mother with symptoms of peripartum depression without suicidal ideation (part A) and the same mother developing suicidal ideation (part B). Out of 624 participants, 202 (33.8%, 95%CI 30.0-37.7%) and 206 (36.7%, 95%CI 32.7-40.8%) reported they would seek help soon if they experienced symptoms of depression and suicidal ideations, respectively, while 181 (30.3%, 95%CI 26.6-34.1%) and 161 (28.6%, 95%CI 24.9-32.6%) said they would so if symptoms or suicidal thoughts did not resolve with time. Women were most likely to seek help from their husbands for symptoms of depression (n=445, 72.6%) and for suicidal thoughts (n=406, 71.1%). A public health midwife (n=346, 57.9%) was preferred over other formal or semiformal sources. If they were to seek help, 467 (49.2%) would contact a doctor or midwife specifically. The majority did not perceive that the described emotions could be symptoms of an illness (n=300, 50.1%) or that having suicidal ideation can be a threat to the life of the affected person (n=308, 52.1%) or that there was a probability for them to develop a mental illness during a current pregnancy (n=379, 65%). The majority perceived that positive responses were likely to be received, and negative responses were less likely to be received, if they were to seek help from their husband, another family member and midwife. Using a vignette approach allowed an exploration of how the 'at risk population' would construct meaning to symptoms of depression and suicidal ideation during pregnancy and the postpartum period, and what their actions would likely be if they were in a similar situation. It was observed that symptoms of depression and suicidal thoughts were regarded as normal by the pregnant women in this rural community, and they also perceived a low threat of getting a similar condition. This is a crucial point to intervene at for improving help-seeking. Informal and semiformal sources of help preferred by these women, especially husbands and public health midwives, should be empowered to respond effectively and facilitate further help-seeking from mental health professionals.

Pilot Study of Evaluating Attitudes toward Childhood Immunization among Healthcare Workers in Japan.

Providing appropriate immunization information during the perinatal period is important for improving immunization rates among infants and children; however, the distribution of immunization information by healthcare workers (HCWs) is not standardized in Japan. We investigated HCWs’ attitudes toward childhood immunization and factors related to vaccine hesitancy. We conducted a cross-sectional descriptive survey of HCWs involved in childhood immunization in Niigata City, Japan, from November 2017 to January 2018. We assessed contextual, individual and group, and vaccine/vaccination-specific influences. Of 290 HCWs, 139 (47.9%) returned completed questionnaires. Most HCWs (87/139, 64.9%) reported providing immunization information verbally to parents; 51/87 (58.6%) spent fewer than five minutes doing so. Pediatricians provided vaccines based on the parents’ best interest, whereas public health nurses and midwives emphasized government policy. Nurses had greater hesitancy related to personal perceptions and social/peer factors than pediatricians (p < 0.001). Nurses were significantly more likely than pediatricians to suggest that children receive more shots than necessary (p < 0.01). Nurses tended to have more negative attitudes toward vaccination and little awareness of immunization promotion compared to pediatricians. Thus, all HCWs involved in childhood immunization should receive sufficient information to provide timely and appropriate immunization to infants and children.

Does Being Diagnosed As Anemic in Early Pregnancy Have an Impact on the Household Expenditure for Food? Evidence From a Maternal Cohort in Rural Sri Lanka

ObjectivesAnemia, commonly attributed to nutritional issues, affects more than one third of pregnancies worldwide. Early screening for anemia in pregnancy aims to provide appropriate treatment, including lifestyle modifications, to prevent the morbidity and mortality of the condition on both mother and the baby. We investigated the impact of the “diagnosis of anemia” in early pregnancy on household food expenditure in rural Sri Lanka.MethodsAll first-trimester pregnant women registered at the public health midwives in Anuradhapura district, Sri Lanka, during the third quarter of 2019 were invited to participate in a pregnancy Cohort. Hemoglobin level was assessed at the baseline. Self-administrated questionnaires were used to collect data on the household economic status, household food expenditure, and pregnancy-related food expenditure during the first (T1), second (T2), and third (T3) trimesters. Descriptive statistics and Mann-Whitney U tests were used for data analysis.ResultsThe mean (SD) age of participants (n = 1573) was 28.3 (5.6) years and 21.2% (n = 295) were employed. Mild (Hb < 100g/l) and moderate anemia (Hb < 110g/l) were observed in 11.1% (n = 161) and 3.5% (n = 51), in T1 respectively. Monthly household income (median [IQR]) = USD 226.8 [170.09–328.84]) was not significantly different in women with and without anemia (U = 92,365.00, p = 0.85). The median (IQR) household food expenditure was USD 56.70 (39.69–85.04) in both T1 and T2, and the pregnancy-related food expenditure in T2 and T3 were USD 11.34 (5.67–17.01) and USD 8.50 (5.24–11.34), respectively. There was no statistically significant difference in the household food expenditure during T1 (p = 0.85) and T2 (p = 0.98), and the pregnancy-related food expenditure in T2 (p = 0.09) and T3 (p = 0.62) between anemic and non-anemic women. The percentage of household food expenditure spent as pregnancy-related food expenditure in T2 (p = 0.65) and T3 (p = 0.25) were also not significantly different between anemic and non-anemic women.ConclusionsHousehold and pregnancy-related food expenditure were not significantly different in women diagnosed with anemia in early pregnancy. Possible explanations for this observation, including effectiveness of nutritional education given to anemic pregnant women, need to be explored further.Funding SourcesAHEAD Operation, Ministry of Higher Education, Sri Lanka.

Understanding the Multi-Level Factors Influencing Maternal Diets in Sri Lanka

ObjectivesTo understand the multi-level factors influencing maternal diet in Sri Lanka. MethodsStudy design. This ethnographic sub-study was conducted using an iterative four-phase, mixed methods formative research design. Data collection methods and sampling. To understand the multi-level factors influencing maternal diets across the rural, urban and estate sectors of Sri Lanka, community members from each sector were purposefully sampled. Pregnant women (n = 21), community leaders (n = 10) and influencers (n = 37) were interviewed using a semi-structured interview guide. Data analysis. Data were analyzed using Dedoose software and the socio-ecological model to conceptualize influencing factors of maternal diets across sectors. ResultsIn Sri Lanka, a variety of multi-level factors reportedly influence maternal diets. At the community level, high food availability and inter-household food sharing facilitate diverse maternal diets while traditional food rules (e.g., 20 prescriptions and 21 proscriptions) may negatively influence them. Strong social protection and antenatal care programs provided by the Sri Lankan government promote improved nutrition, but food baskets provided as part of social assistance are not always utilized by beneficiaries as intended. At the interpersonal level, pregnant women receive health and nutrition information from many social influencers such as Public Health Midwives, female elders, and husbands, among others. At the individual level, differential nutrition knowledge, food preferences, risk perception, competing demands, and food access influence maternal diet synergistically. ConclusionsUpstream factors (e.g., culturally bound food taboos) seem to be more important drivers of maternal diets than individual-level knowledge and personal food preferences addressing multi-level determinants of maternal diets in concert may positively impact population-level maternal nutrition in Sri Lanka. Funding SourcesUNICEF Sri Lanka.

Public Health Midwives’ Perceptions, Challenges and Attitudes Towards Health Education on Vulvovaginal Discharge

Background and Objective: Public Health Midwife (PHM) is the grass root level health care provider in the Sri Lankan health care system. This study was carried out to assess perceptions, challenges and attitudes of PHMs’ in educating women on vulvovaginal discharge (VVD) and their current health education activities on hygienic practices and behaviour changes among females aged 18 to 49 years. Methods: This cross-sectional study was conducted among all volunteering PHMs who work in the Colombo district, Sri Lanka. A self-developed, content validated, pre-tested, self-administered questionnaire was used to collect data. Descriptive statistics were used to analyse data using SPSS software version 21. Results: A total of 308 PHMs participated and the mean age of the participants was 40 years (SD = 10). Thirty-six percent of the participants had work experience of more than 11 years. Majority of PHMs have performed health education activities during home visits (72.7%) and at clinics (66.2%). Most (97%) agreed that educating females on VVD is one of their primary responsibilities. Majority (70.7%) disagreed that “for most patients, health education does little to promote health-seeking behaviour” indicating positive attitudes towards health education. Nearly 17% of the participants rated their competency in providing health education on VVD as poor. Lack of available time (84.7%), teaching aids (75%) and women’s anxiety and shyness in asking questions or revealing health problems in the community (73.4%) were the major challenges faced during their health education on gynaecological health conditions. Conclusions: The majority of the PHMs had positive attitudes towards health education on VVD. It is recommended that learning opportunities should be created in the form of training programmes. This will help in updating knowledge, skills and attitudes to meet the growing demand for quality health education and referral activities at the community level.

Sri Lankan Public Health Midwives’ Knowledge on Maternal Mental Health Disorders

Emotional support and services provided by Public Health Midwives (PHMs) play a crucial role in identification and management of maternal mental health disorders as they are the first line contact in maternal and child-care and the focal field health members in caring for the antepartum and postpartum mothers. Aim of this study was to describe the Sri Lankan PHMs’ knowledge on maternal mental health disorders. Cross-sectional descriptive study was conducted using probability proportionate sampling, covering PHMs of all districts in Sri Lanka. Total of 434 PHMs were recruited with 99.1% response rate. A content-validated pre-tested questionnaire was administered. Univariate and multivariate analysis was used to assess the knowledge of each component with selected study variables. Respondents’ mean age was 40.6 years. Out of the 430 PHMs, 36% of them were unaware, that symptoms of Depression and anxiety could be commonly seen during antenatal and postpartum period. It was found that only 21.8% of the respondents knew the average number of maternal deaths due to suicides in Sri Lanka. Forty seven percentage of the respondents did not know, that providing understanding, empathy and support was the most appropriate step in managing mothers with Postpartum Blues. This study findings highlight major deficiencies in basic knowledge of PHMs in identifying and initial management of common maternal mental health disorders. Therefore, focus on continuous professional development of PHMs should be prioritized.

Cervical Cancer: The outcomes of liquid-based cytology vs conventional cytology among HPV/DNA screening test positives of ever married 35 and 45 years old women in Kalutara district and unit cost estimation of colposcopy and biopsy

Background: One major drawback of the present National Cervical Cancer Screening programme is, the suboptimal sensitivity (53%) of the pap smear to detect Cervical Intraepithelial Neoplasia (CIN). HPV/DNA test is highly sensitive (92.9%) for CIN II viral load and the feasibility of HPV/DNA screening with conventional cytology for screen positive follow-up was successfully attempted. The sensitivity of Liquid Based Cytology (LBC) to detect CIN II+ is 79.1%. Objective: To describe the results of LBC vs conventional cytology among HPV/DNA screen positives of 35 and 45 year old ever-married women in MOH areas of Kalutara district. Methods: There are 15 Medical Officer of Health areas in Kalutara district and the Public Health Midwife area (n=413) is taken as a cluster. Three clusters were randomly selected in each MOH area (n=45) by the lot method. Eligible family registers were the sampling frame. Nine subjects in the 35 and 45 age cohort each from all 45 clusters were selected by consecutive sampling technique. The total number of 393 and 390 subjects from 35 and 45 age cohorts were subjected to cervical specimen collection at community Well Woman Clinics (WWC) after applying exclusion criteria at field and clinic setting. HPV/DNA screen positives were subjected to both LBC and pap smear. HPV/DNA screen positive with either conventional cytology or LBC≥ Atypical Squamous Cells of Undetermined Significance (ASCUS) were referred for colposcopy. The incremental cost of the pap smear was calculated. The Scenario-Building technique was used to calculate the per- procedure cost of colposcopy and biopsy. Results: The response rate of 35 and 45 age cohorts women was 97.5% and 96.5% respectively. The number of 25 (6.36%) among 35 and 18 (4.61%) among 45-year- old women were positive for HPV/DNA test. The number of 7 (1.78 %) among 35 year and 5 (1.28%) among 45 year old women had ≥ASCUS in conventional cytology, while the number of 10 (2.54%) among 35 years and 8 (2.05%) among 45 years old women had ≥ASCUS in LBC. Prevalence of CIN by colposcopy among 35 years and 45 years women for LBC vs conventional cytology were 1.53%, 1.28% and 1.53%, 1.03% respectively and there was no significant difference. No invalid results were reported for LBC and the treatment adherence for colposcopy was 86.7%. The incremental cost of pap smear was Rs. 626.18, while the per-procedure cost of colposcopy and biopsy was Rs.1528.15 and Rs.681.16. Conclusions and recommendations: To improve the quality and coverage of the programme HPV/DNA PCR test as a primary cervical cancer screening method with LBC for only screen positive follow-up can be recommended.

Antenatal depression in Sri Lanka: a qualitative study of public health midwives\u2019 views and practices

BackgroundAlmost all pregnant people in Sri Lanka receive antenatal care by public health midwives. While there is strong infrastructure in Sri Lanka for postpartum mental health care, the current practices within antenatal mental health care have not been externally evaluated. The purpose of this study is to investigate the current clinical guidelines and experiences of how public health midwives diagnose and treat antenatal depression.MethodsWe conducted in-depth interviews with 12 public health midwives from four antenatal clinics in the Bope Poddala division in Galle, Sri Lanka and reviewed and extracted information on antenatal depression from clinical guidelines. Data was collected in Sinhala and translated into English. We used applied thematic analysis and worked closely with our local team to ensure data trustworthiness.ResultsMidwives (n = 12) reported varying degrees of knowledge on antenatal depression and did not have standardized diagnosis patterns. However, they were very consistent in their clinical practices, following guidelines for referral and follow-up of case management, building strong rapport. In their practice, midwives continue to face challenges of lack of human resources and high stigma around mental illness. They suggested that that care could be improved with use of a standardized diagnostic tool, and easier access to specialist care. We found the clinical guideline on the diagnosis and treatment of antenatal depression is lacking key details on symptoms for appropriate diagnosis, but it clearly guides on how to navigate treatment.ConclusionsPublic health midwives are following the clinical guideline to refer pregnant women who need intervention for antenatal depression and follow-up for case management. However, there is a need for more specific and context-relevant guidelines, especially for diagnosis of antenatal depression. Formative research is needed to explore intervention strategies to improve antenatal depression management in Sri Lanka.

Parental entries on hearing in Child Health and Development record: How reliable in early detection of paediatric hearing loss?

Aim: To assess the effectiveness of parental entries regarding functional hearing in the Child Health and Development Record(CHDR), in patients with severe to profound hearing loss, and detection of the hearing issues by the public health midwife(PHM). Material and Method: A descriptive cross sectional study was carried out among parents/caregivers of children with severe to profound hearing loss who underwent cochlear implantation before the age of 5 years from 01.01.2017 to 31.12. 2018 at Lady Ridgeway hospital for children, Sri Lanka. An interviewer administered questionnaire was used based on the hearing assessment in CHDR. Results: The age of the mother at the birth of the index child spans from 17years to 50 years. Majority( 64.1% ) had another child older to the index child. The majority were diagnosed between 18-24 months. The age of cochlear implantation spans from 9 months upto 5 years. Average waiting period was 2 years. The correct entries were observed as follows: 20.8% at birth, 22.7% at 1 month and 22.6% at 4 months, 7 months, 9 months and 12 months respectively. Among those who have not marked or marked incorrectly, 45.9% stated that they couldn't recognise the hearing impairment and 23.4% stated they were reluctant to accept it. Only 4% of these children were referred for further assessment by the PHM. Conclusion: Parental and the PHM’s assessment of a child’s hearing is not a reliable indicator to detect early sensorineural deafness.

Cervical smear screening in a tertiary care gynaecological clinic in Sri Lanka: A survey from a middle income country

Introduction: Awareness and knowledge about cervical smear are lacking among the women in the developing world. The aim of the study was to study the awareness and knowledge regarding cervical smear screening among a cohort of Sri Lankan women. Methods: A cross-sectional study was conducted at a gynaecology clinic in a tertiary care hospital, Sri Lanka from January to August 2018. A consecutively recruited clinic attendees who attended the clinic for the first-time; aged over 35 years were interviewed using a previously piloted questionnaire. Outcome measures were socio-demographic and clinical characteristics, knowledge about cervical smear screening and uptake of Pap smear testing. Results: Among the 165 women interviewed, 146 (88.5%) had heard about cervical carcinoma. Median (IQR) age was 46.0 (39.0-54.0) years. Only 75.2% had heard about cervical screening. Knowledge about cervical smear screening was low and 60% of women were not worried about themselves getting cervical carcinoma. Awareness about cervical smear screening was 58.8% and only 78/165 (47.3%) had ever undergone screening. Fear of vaginal examination and lack of awareness was noted in 6.7% and 29.7% of them respectively. Public health midwives were the commonest source of information to them regarding cervical smear. Conclusion: Awareness and knowledge regarding cervical carcinoma is poor in the study sample.

Perception of public health midwives on adolescent and youth friendly health service: Sri Lankan experience

Official publication of the College of Community Physicians of Sri Lanka and was established in 1995. Full text articles available.Journal of the College of Community Physicians of Sri Lanka (JCCPSL) has been recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations. The journal is indexed in DOAJ.Manuscripts are only accepted online through the portal of the JCCPSL https://jccpsl.sljol.info/ . The prospective authors must read carefully the section on Author Guidelines and prepare their manuscript accordingly. To submit a manuscript or to check the status of a submission the authors must first be registered in the JCCPSL Editorial Management System using an existing or newly created username and password. Next, choose the ‘Start Submission’ link and follow the five-step article submission process which is a simple and self-guided process.

Predictors and occurrence of antenatal depressive symptoms in Galle, Sri Lanka: a mixed-methods cross-sectional study

BackgroundThere is a high prevalence of antenatal depression in low-or-middle-income countries, but information about risk factors in these settings is still lacking. The purpose of this study is to measure the prevalence of and explore risk factors associated with antenatal depressive symptoms in Galle, Sri Lanka.MethodsThis study used a mixed-method approach. The quantitative portion included 505 pregnant women from Galle, Sri Lanka, with health record data, responses to psychometric questionnaires (MSPSS and PRAQ-R2), and antenatal depression screening (EPDS). The qualitative portion included interviews with public health midwives about their experiences and routine clinical practices with women with antenatal depressive symptoms.ResultsPrevalence of antenatal depressive symptoms was 7.5%, highest in women over the age of 30 (13.0%, OR = 3.88, 95%CI = 1.71 – 9.97), with diabetes (21.9%, OR = 3.99, 95%CI = 1.50 – 9.56), or pre-eclampsia in a previous pregnancy (19.4%, OR = 3.32, 95%CI = 1.17 – 8.21). Lower prevalence was observed in the primiparous (3.3%, OR = 0.29, 95%CI = 0.12 – 0.64) employed outside the home (3.6%, OR = 0.33, 95%CI = 0.13 – 0.72), or upper-middle class (2.3%, OR = 0.17, 95%CI = 0.04 – 0.56). Anxiety levels were elevated in depressed women (OR = 1.13, 95%CI = 1.07 – 1.20), while perceived social support was lower (OR = 0.91, 95%CI = 0.89 – 0.93). After multivariable adjustment, only parity (OR = 0.20, 95%CI 0.05 – 0.74) and social support from a “special person” (OR = 0.94, 95%CI = 0.77 – 0.95) remained significantly associated with depressive symptoms. Qualitative findings also identified antenatal health problems and poor social support as risk factors for depressive symptoms. They also identified different contributing factors to poor mental health based on ethnicity, higher stress levels among women working outside the home, and misinformation about health conditions as a cause of poor mental health.ConclusionsPrevalence of antenatal depressive symptoms in Galle is lower than the recorded prevalence in other regions of Sri Lanka. Risk factors for antenatal depressive symptoms were identified on biological, psychological, and social axes. These variables should be considered when developing future guidelines for mental health and obstetric treatment in this context.

Exercise based in-service training to primary healthcare staff for physical activity promotion among the public in Sri Lanka

Introduction: Although Sri Lanka has a well-established preventive and curative healthcare system, physical inactivity, which is one of the four main risk factors for development of NCDs is prevalent among one third the adult population. Implementation of in-service trainings in relation to reduction of physical inactivity and sedentary behavior has not been carried out in a uniform manner in Sri Lanka. Aim: To describe the design, implementation, monitoring and evaluation of a novel exercise based in-service training strategy for primary care health staff on promotion of physical activity among the public. Methods: The existing mechanism for promotion of physical activity among the public by the primary care staff was reviewed and challenges and limitations were identified. A series of consultative meetings were conducted with the participation of all stakeholders to develop a Training of Trainers (TOT) manual on physical activity guidelines for the public. In order to overcome the deficiencies identified a novel strategy was developed for the implementation of in-service trainings on the developed TOT manual at the Healthy Lifestyle Centers. A post training evaluation was conducted among the trainees three months after the training. Results: Out of the trainees, 138 (76.6%) responded to the post training follow up evaluation. Mean age of participants was 40.09 years (SD =7.18). Majority of the respondents were females (N=101, 73.2%). There were, 44 (31.8%) Medical officers, 45 (32.6%) Nursing Officers, 20 (14.5%) Public Health Nursing Officers, 11 (7.9%) Public Health Midwives, 2 (1.4%) Public Health Inspectors and 16 (11.5%) other staff members among the participants. The median satisfaction score was 7.9 out of 10. There was a significant improvement in competency following the training (X 2 =44.6, Df=1, P<0.05). Conclusions and Recommendations: The novel strategy is effective and was received with enthusiasm by the target audience. Possibility of implementing similar strategies for risk reduction of other modifiable NCD risk factors must be explored.

Breast Feeding in Pandemic Situation. How Does Sri Lanka Face the Challenge?

ObjectivesSri Lanka has been awarded the first-ever ‘Green’ breastfeeding (BF) nation status by the World Breastfeeding Trends Initiative (WBTi) in January 2020 (1) with the support of public health system. But, deviating attention of health services towards emergency pandemic situation has resulted in strained health systems and interruptions in humanitarian response leading to eroding access to essential and often life-saving nutrition services. Therefore, optimal breast feeding practices are at risk due to infected mothers’ isolation practices, exhausted public health system and misbeliefs among the community (2). This finds out how Sri Lanka plans to maintain high standards of breast feeding in pandemic situation.MethodsWe searched for the publications on breast feeding, Sri Lanka in pandemic situation from January 2020 to date.ResultsAs a low and middle income country with an unbeatable public health system, Sri Lanka has already issued an interim guideline for public health staff in continuation maternal and child care services (3). It ensures domiciliary visits by public health midwives (PHMs), although the clinic based teaching sessions on breast feeding have been cancelled. Community awareness has been created that no evidence of transmission of SARS COV-2 via breast milk is available and how the benefits of breast feeding outweigh the risk of infection (4). It is recommended that breast feeding shouldn't be interrupted at all and hand hygienic practices before touching the baby are ideal. Infected mothers can wear a protective mask and rooming in, and kangaroo mother care should be practiced. Sri Lanka already had guidelines on ensuring adequate and appropriate infant feeding guidelines in emergency situations (5).ConclusionsDespite the challenges faced by community and public health staff, Sri Lanka make efforts to maintain the achieved breast feeding standards. Further studies are needed to assess the impact of the pandemic on breast feeding practices in near future.Funding SourcesNone