Search

Background Resistant hypertension is defined as an uncontrolled blood pressure despite treatment at best-tolerated doses with at least three antihypertensive agents including a diuretic. It is an emerging public health problem. At present clinical trial data on management of resistant hypertension is limited. Management is largely based on observational studies and expert opinions. Propranolol is a nonselective beta blocker. Several studies have confirmed that propranolol has a significant hypotensive action, both when used alone and as an adjuvant therapy. At present there are no prospective, randomized, clinical studies evaluating the effectiveness of propranolol in patients with resistant hypertension. Therefore, we have designed a prospective randomized trial to evaluate the safety and efficacy of propranolol in patients with resistant hypertension. Methods/design The study will be conducted as a randomized, double-blind, placebo-controlled clinical trial for a period of 3 months. The study has been approved by the Ethics Review Committee of the Faculty of Medicine, University of Colombo. A total of 200 adults with resistant hypertension will be recruited for the study. They will be randomly assigned to the test and placebo groups on a 1:1 ratio. The test group will receive propranolol 40 mg three times a day and the control group will receive an identical placebo capsule. The study drugs will be double blinded to both investigators and subjects. The visits and the evaluations will be done as follows: screening (visit 0), 1 month (visit 1), 2 months (visit 2) and 3 months (visit 3). The primary outcomes of the study is to find a statistically significant difference between the fall in mean systolic and mean diastolic blood pressure measured by ABPM (ambulatory blood pressure monitoring) from baseline between the two groups. Data will be analyzed using SPSS v16. Discussion To our knowledge this is one of the first randomized controlled trials evaluating the effects of propranolol in resistant hypertension. This study will provide the necessary groundwork for future large-scale, multicentered clinical trials. The result, positive or negative, should provide a step change in the evidence guiding current and future policies regarding treatment of resistant hypertension. Trial registration Sri Lanka Clinical Trials Registry, identifier: SLCTR/2016/002. Registered on 27 January 2016; Study protocol version 2.1. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1863-1) contains supplementary material, which is available to authorized users.

Background Emotional intelligence (EI) has been linked with academic and professional success. Such data are scarce in Sri Lanka. This study was conducted to describe the pattern of EI, to determine its predictors and to determine the effect of EI on academic performance at the final MBBS examination, in medical undergraduates of a Sri Lankan university. Methods This is a cross-sectional study in a selected university, involving those who did final MBBS examination in 2016. Consecutive sampling was done. EI was assessed with self-administered Genos Emotional Intelligence Full Version (7 domains; 70 questions equally weighted; total score 350). Socio-demographic data were obtained using a self-administered questionnaire. Academic performance was assessed with final MBBS results in the first attempt. Results Of 148 eligible students 130 responded (response rate-88%); 61.5% were females; mean age was 26.3 ± 1 years. Mean total EI score was 241.5 (females-245.5, males-235.1; p = 0.045).Among different domains, mean score was highest for Emotional Self-Awareness (36.8/50) and lowest for Emotional Expression (32.6/50). Multiple linear regression analysis indicated that having good family support (p = 0.002), socializing well in university (p = 0.024) and being satisfied with facilities available for learning (p = 0.002), were independent predictors of EI. At the final MBBS examination 51.6% obtained classes, 31.5% passed the examination without classes and 16.9% got repeated. Females had better academic performance than males (p = 0.009). Mean EI of second-class upper division, second-class lower division, pass and repeat groups were 249.4, 246.6, 240.2 and 226.9, respectively (with one-way ANOVA p = 0.015). After adjusting for gender, ordinal regression analysis indicated that, total EI score was an independent predictor of final MBBS results [β-0.018 (95% CI 0.005-0.031); p = 0.006]. Conclusions In the study population, both EI and academic performance were higher among females. Independent of gender, academic performance was better in those who were more emotionally intelligent. Several psychosocial factors were found to be independent predictors of EI. These results suggest that emotional skills development might enhance academic performance of medical undergraduates in Sri Lanka. Further research is needed in this under-explored area. Electronic supplementary material The online version of this article (10.1186/s12909-017-1018-9) contains supplementary material, which is available to authorized users.

Top 10 actors for each measure of IYCF network centrality in Sri Lanka. (DOCX 14 kb)

Level of influence of the actors with the highest level of influence. (DOCX 22 kb)

Socio-demographic factors and academic performance at final MBBS examination (nâ =â 130). This table shows the association between socio-demographic factors and examination results at the final MBBS examination. (DOCX 17Â kb)

Introduction Disc herniation is a complex spinal disorder associated with disability and high healthcare cost. Lumbar disc herniation is strongly associated with disc degeneration. Candidate genes of the aggrecan metabolic pathway may associate with the severity of lumbar disc herniation. Objectives This study evaluated the association of single nucleotide variants (SNVs) of the candidate genes of the aggrecan metabolic pathway with the severity of lumbar disc herniation in patients with chronic mechanical low back pain. In addition, we assessed the in-silico functional analysis of the significant SNVs and association of their haplotypes with the severity of lumbar disc herniation. Methods A descriptive cross sectional study was carried out on 106 patients. Severity of disc herniation and disc degeneration were assessed on T2-weighted mid sagittal lumbar MRI scan. Sixty two exonic SNVs of ten candidate genes of aggrecan metabolic pathway (ACAN, IL1A, IL1B, IL6, MMP3, ADAMTS4, ADAMTS5, TIMP1, TIMP2 and TIMP3) were genotyped on a Sequenom MassARRAY iPLEX platform. Multivariable linear regression analysis was carried out using PLINK 1.9 software adjusting for age, gender, body mass index and severity of disc degeneration. Four online bioinformatics tools (Provean, SIFT, PolyPhen and Mutation Taster) were used for in-silico functional analysis. Results Mean age was 52.42 ± 9.42 years and 69.8% were females. The mean severity of disc herniation was 2.81 ± 1.98. The rs2272023, rs35430524, rs2882676, rs2351491, rs938609, rs3825994, rs1042630, rs698621 and rs3817428 variants and their haplotypes of ACAN were associated with the severity of lumbar disc herniation. However, only the rs35430524, rs938609 and rs3817428 variants of ACAN were detected as pathogenic by in-silico functional analysis. Conclusions SNVs of ACAN and their haplotypes are associated with the severity of lumbar disc herniation. Functional genetic studies are necessary to identify the role of these significant SNVs in the pathogenesis of disc herniation.

Level of support of the actors. (DOCX 13 kb)

Introduction Sri Lanka has a predominantly rural population. However, there is a dearth of research on health and socioeconomic issues in this group. Objective To describe basic socioeconomic characteristics and health profile in a rural population. Methods A descriptive cross-sectional household survey was conducted in 1950 households in three rural districts, selected by a three-stage stratified cluster sampling method. Results The population pyramid showed an ageing population (dependency ratio of 50%). Only 39% had completed GCE (ordinary level). Unemployment rates were high (25% males, 76% females). Agriculture and related work were main occupations. Most lacked amenities (e.g. 61% households lacked a refrigerator) and practiced inappropriate methods of waste disposal (e.g. open burning by 72%). Household illnesses were frequent: episodes of acute illness within two weeks, injuries within past year and chronic illness were reported from 35.9%, 14.9% and 48.3% households. The prevalence of chronic diseases in adults > 20 years were high: diabetes 13.5%, hypertension 16.7% and overweight/obesity 28.2%. Of the males, 22.1% smoked and 12.3% took alcohol. Almost 25% adults chewed betel. Reports of snake bite, dog bites and suicide/attempted suicide were seen in 15.5%, 9.7% and 3.0% households respectively. Conclusions This study shows a unique clustering of health-related problems in rural Sri Lanka. This was characterized by demographic transition, burden from snake bites, chronic diseases and acute illnesses. There were resource limitations and low levels of education. Cohort studies and comparisons with urban areas will enable further elucidation of determinants of health and other issues in rural Sri Lanka.

Brucellosis is a systemic zoonotic bacterial infection. We studied the seroprevalence and risk factors for human Brucella infection in 1,294 healthy people from 4 provinces: Central, North-Western, North-Central and Western Provinces. Farmers in contact with farm-animals, veterinary staff, abattoir workers, and non-contact urban-dwellers were tested against B. abortus and B. melitensis antigens by SAT. Seroprevalence was 8.4% of the study population. Farm-animal owners and working full-time with livestock have a significantly higher risk of acquiring Brucella infection. Enhanced laboratory support and surveillance is necessary to control brucellosis in Sri Lanka. This is the first report on human Brucella infection.

PurposeThis paper aims to assess patient satisfaction with nursing care and related hospital services, and association between satisfaction and patient characteristics at the National Hospital of Sri Lanka (NHSL).Design/methodology/approachA systematically selected sample of 380 patients warded for three to 90 days in general surgical/medical units was interviewed on discharge. Data were collected using a satisfaction instrument previously developed and validated for the same setting, that contained 36 items under five sub‐scales. Multiple logistic regression analyses were used to identify factors associated with satisfaction in each sub‐scale.FindingsThe paper finds that the majority of respondents were males (61 percent), aged 35‐64 years (70 percent), educated to GCE (O/L) and above (61 percent), and previously hospitalized (66 percent). The proportion satisfied with “interpersonal care” was 81.8 percent, “efficiency and competency”, 89.7 percent, “comfort and environment”, 59.2 percent, “cleanliness and sanitation”, 48.7 percent, and “personalized and general information”, 37.4 percent. Males reported higher satisfaction (OR varied from 2.29‐2.87, p < 0.001) than females. Patients with GCE (A/L) were less satisfied with “comfort and environment” (OR=0.45, p < 0.05) and “cleanliness and sanitation” (OR=0.45, p < 0.05) compared with those educated below grade 5. Satisfaction with “comfort and environment” was lower among patients from medical (OR=0.51, p < 0.01) rather than from surgical units.Practical implicationsQuality can be improved by assuring comfort, cleanliness, sanitary facilities in wards, and provision of general and personalized instructions. Nursing staff should understand patient characteristics and their expectations when providing care.Originality/valueThis is the first study that described patient satisfaction with nursing care and related supportive services using a validated instrument at the NHSL. The study highlighted aspects of dissatisfaction and recognized patient characteristics that predict satisfaction.

Sri Lanka, a non-industrialized country with limited resources, has been able to achieve a maternal mortality ratio that is markedly lower than the ratios of similar countries. Many factors have contributed to Sri Lanka's success story. A political commitment to the cause and implementation of clear policies through well-structured and organized community-based and institutional healthcare services--expanded to cover the whole country and provided free of charge--have been the foundation of maternal and child health (MCH) services in the country. The healthcare programs have been well accepted and utilized by the people as the literacy rate is more than 90% for both men and women. Public health midwives form the backbone of MCH services and provide frontline reproductive health care. More than 98% of deliveries occur in hospitals and are attended by midwives. Furthermore, 85% of women in Sri Lanka deliver in facilities served by specialist obstetricians/gynecologists. The Sri Lanka College of Obstetricians and Gynecologists plays a leading role by assisting the Family Health Bureau in making policies and guidelines, training staff, and acting as team leaders for maternity care services. This was evident after the tsunami in December 2004. National maternal mortality reviews, monitoring and evaluation of MCH activities, and relatively high contraceptive prevalence rates have also contributed to the success in Sri Lanka, which could serve as a model for other countries.

South Asian region has the highest global burden of child undernutrition, with almost 41% of children stunted, 16% wasted and 33% underweight. Improved feeding of children less than 2 years of age is particularly important because they experience rapid growth and development, and are vulnerable to illnesses such as acute respiratory infections and diarrhoeal diseases. The present supplement aimed to describe complementary feeding practices in five South Asian countries - Bangladesh, India, Nepal, Pakistan and Sri Lanka - using the new and updated global complementary feeding indicators and to identify determinants of inappropriate complementary feeding practices. The South Asia Infant Feeding Research Network held a series of workshops to study and discuss the operational guidelines for the new complementary feeding indicators in consultation with regional and international experts. The latest Demographic and Health Surveys for Bangladesh, Nepal, Pakistan and Sri Lanka, and the National Family Health Survey of India were used as data sources. Four key indicators were calculated: introduction of solid, semisolid or soft foods in 6-8 months aged, minimum dietary diversity, minimum meal frequency and minimum acceptable diet in 6-23-month-aged children. Univariate and multivariate logistic regression analyses were performed to identify determinants of poor complementary feeding practices. The papers in this supplement present results of these analyses for each individual country and a comparison between countries. The results have important implications for policies, programmes and research on infant and young child feeding in the region, especially for targeting groups at high risk for suboptimal practices.

Inappropriate complementary feeding increases risk of undernutrition, illness and mortality in infants and children. This paper aimed to determine the factors associated with inappropriate complementary feeding practices in Sri Lanka. The Sri Lanka Demographic and Health Survey 2006-2007 used a stratified two-stage cluster sample of ever-married women 15-49 years, and included details about foods given to children aged 6-23 months during the last 24 h. The new World Health Organization indicators for infant and young child feeding (IYCF) - (introduction of solid/semi-solid or soft foods; minimum dietary diversity; minimum meal frequency; and minimum acceptable diet) were calculated for 2106 children aged 6-23 months. These indicators were examined against explanatory variables with multivariate analyses to identify factors associated with inappropriate practices. Eighty-four per cent of infants aged 6-8 months were introduced to complementary food. The proportion of infants aged 6-8 months who consumed eggs (7.5%), fruits and vegetables other than those rich in vitamin A (29.6%) and flesh foods (35.2%) was low. Of children aged 6-23 months, minimum dietary diversity was 71%, minimum meal frequency 88% and minimum acceptable diet 68%. Children who lived in tea estate sector had a lower dietary diversity and minimum acceptable diet than children in urban and rural areas. Other determinants of not receiving a diverse or acceptable diet were lower maternal education, shorter maternal height, lower wealth index, lack of postnatal visits, unsatisfactory exposure to media and acute respiratory infections. In conclusion, complementary feeding indicators were adequate except in the 6-11 months age group. Subgroups with inappropriate feeding practices should be the focus of IYCF promotion programs.

Inappropriate complementary feeding increases the risk of undernutrition, illness and mortality in infants and children. This study uses a subsample of 1428 children of 6-23 months from Nepal Demographic and Health Survey (NDHS), 2006. The 2006 NDHS was a multistage cluster sample survey. The complementary feeding indicators were estimated according to the 2008 World Health Organization recommendations. The rate of introduction of solid, semi-solid or soft foods to infants aged 6-8 months was 70%. Minimum meal frequency and minimum dietary diversity rates were 82% and 34%, respectively, and minimum acceptable diet for breastfed infants was 32%. Multivariate analysis indicated that working mothers and mothers with primary or no education were significantly less likely to give complementary foods, to meet dietary diversity, minimum meal frequency and minimum acceptable diet. Children living in poor households were significantly less likely to meet minimum dietary diversity and minimum acceptable diet. Mothers who had adequate exposure to media, i.e. who watch television and who listen to radio almost every day, were significantly more likely to meet minimum dietary diversity and meal frequency. Infants aged 6-11 months were significantly less likely to meet minimum acceptable diet [adjusted odds ratio (OR)=3.13, confidence interval (CI)=2.16-4.53] and to meet minimum meal frequency (adjusted OR=4.46, CI=2.67-7.46). In conclusion, complementary feeding rates in Nepal are inadequate except for minimum meal frequency. Planning and promotion activities to improve appropriate complementary feeding practices should focus on illiterate mothers, those living in poor households, and those not exposed to media.

Improving infant and young child feeding practices will help South Asian countries achieve the Millennium Development Goal of reducing child mortality. This paper aims to compare key indicators of complementary feeding and their determinants in children aged 6-23 months across five South Asian countries - Bangladesh, India, Nepal, Pakistan and Sri Lanka. The latest Demographic and Health Survey and National Family Health Survey India data were used. The analyses were confined to last-born children aged 6-23 months - 1728 in Bangladesh, 15,028 in India, 1428 in Nepal, 2106 in Sri Lanka and 443 infants aged 6-8 months in Pakistan. Introduction of solid, semi-solid or soft foods, minimum dietary diversity, minimum meal frequency and minimum acceptable diet, and their significant determinants were compared across the countries. Minimum dietary diversity among children aged 6-23 months ranged from 15% in India to 71% in Sri Lanka, with Nepal (34%) and Bangladesh (42%) in between. Minimum acceptable diet among breastfed children was 9% in India, 32% in Nepal, 40% in Bangladesh and 68% in Sri Lanka. The most consistent determinants of inappropriate complementary feeding practices across all countries were the lack of maternal education and lower household wealth. Limited exposure to media, inadequate antenatal care and lack of post-natal contacts by health workers were among predictors of inappropriate feeding. Overall, complementary feeding practices among children aged 6-23 months need improvement in all South Asian countries. More intensive interventions are necessary targeting the groups with sup-optimal practices, while programmes that cover entire populations are being continued.

Inappropriate timing of introducing complementary food deprives the infant of optimum nutrition, leading to undernutrition, and increased mortality and morbidity. The aim of this analysis was to identify determinants of inappropriate timing of introduction of solid, semi-solid and soft foods in Pakistan. Data on 941 infants 3.00 to 8.99 months were obtained from the Pakistan Demographic and Health Survey 2006-2007. The prevalence of introduction of foods among infants aged 3.00-5.99 months and 6.00-8.99 months was examined against a set of individual, household and community level variables using univariate analysis. Adjusted odds ratio (AOR) for early introduction in age 3.00-5.99 months and non-introduction in 6.00-8.99 months of age were calculated using backward stepwise logistic regression models. The prevalence of early introduction of complementary foods among 3.00- to 5.99-month-old and timely introduction among 6.00- to 8.99-month-old infants were 10.6% and 39.2%, respectively. Multivariate analyses revealed that mothers who had four or more antenatal clinic visits (AOR=2.68) and who lived in the provinces of Sindh (AOR=2.89) and Baluchistan (AOR=6.75) were more likely to introduce complementary foods early. Mothers from middle-level households (AOR=7.82), poorer households (AOR=4.84) and poorest households (AOR=5.72) were significantly more likely to delay introduction of complementary foods. In conclusion more than half (60.8%) of Pakistani infants do not receive complementary foods at recommended time. Public health interventions to improve the timing of introduction of complementary food are needed at national level with special focus on high risk groups.

The South Asia Infant Feeding Research Network (SAIFRN) was established in 2007 to foster and coordinate a research partnership among South Asian and international research groups interested in infant and young child feeding. SAIFRN has brought together a mix of researchers and program managers from Bangladesh, India, Nepal, Pakistan, and Sri Lanka together with international partners from Australia. As the first activity, SAIFRN conducted a series of analyses using Demographic and Health Surveys of Bangladesh, Nepal, and Sri Lanka and the National Family Health Survey of India. The results highlight that most indicators of infant and young child feeding in these four countries have not reached the targeted levels. The rates vary considerably by country, and the factors associated with poor feeding practices were not always consistent across countries. Driven by the ultimate goal of improved child survival in the region, SAIFRN wishes to expand its partnerships with governmental and nongovernmental organizations that share common interests both within and outside the South Asia region. In the future, SAIFRN hopes to provide more opportunities to researchers in the region to improve their skills by participating in capacity-building programs in collaboration with international partner institutions, and looks forward to liaising with potential donors to support such activities.

Background Poor feeding practices in early childhood contribute to the burden of childhood malnutrition and morbidity. Objective To estimate the key indicators of breastfeeding and complementary feeding and the determinants of selected feeding practices in Sri Lanka. Methods The sample consisted of 1,127 children aged 0 to 23 months from the Sri Lanka Demographic and Health Survey 2000. The key infant feeding indicators were estimated and selected indicators were examined against a set of individual-, household-, and community-level variables using univariate and multivariate analyses. Results Breastfeeding was initiated within the first hour after birth in 56.3% of infants, 99.7% had ever been breastfed, 85.0% were currently being breastfed, and 27.2% were being bottle-fed. Of infants under 6 months of age, 60.6% were fully breastfed, and of those aged 6 to 9 months, 93.4% received complementary foods. The likelihood of not initiating breastfeeding within the first hour after birth was higher for mothers who underwent cesarean delivery (OR = 3.23) and those who were not visited by a Public Health Midwife at home during pregnancy (OR = 1.81). The rate of full breastfeeding was significantly lower among mothers who did not receive postnatal home visits by a Public Health Midwife. Bottle-feeding rates were higher among infants whose mothers had ever been employed (OR = 1.86), lived in a metropolitan area (OR = 3.99), or lived in the South-Central Hill country (OR = 3.11) and were lower among infants of mothers with secondary education (OR = 0.27). Infants from the urban (OR = 8.06) and tea estate (OR = 12.63) sectors were less likely to receive timely complementary feeding than rural infants. Conclusions Antenatal and postnatal contacts with Public Health Midwives were associated with improved breastfeeding practices. Breastfeeding promotion strategies should specifically focus on the estate and urban or metropolitan communities.

Background In India, poor feeding practices in early childhood contribute to the burden of malnutrition and infant and child mortality. Objective To estimate infant and young child feeding indicators and determinants of selected feeding practices in India. Methods The sample consisted of 20,108 children aged 0 to 23 months from the National Family Health Survey India 2005–06. Selected indicators were examined against a set of variables using univariate and multivariate analyses. Results Only 23.5% of mothers initiated breastfeeding within the first hour after birth, 99.2% had ever breastfed their infant, 89.8% were currently breastfeeding, and 14.8% were currently bottle-feeding. Among infants under 6 months of age, 46.4% were exclusively breastfed, and 56.7% of those aged 6 to 9 months received complementary foods. The risk factors for not exclusively breastfeeding were higher household wealth index quintiles (OR for richest = 2.03), delivery in a health facility (OR = 1.35), and living in the Northern region. Higher numbers of antenatal care visits were associated with increased rates of exclusive breastfeeding (OR for ≥ 7 antenatal visits = 0.58). The rates of timely initiation of breastfeeding were higher among women who were better educated (OR for secondary education or above = 0.79), were working (OR = 0.79), made more antenatal clinic visits (OR for ≥ 7 antenatal visits = 0.48), and were exposed to the radio (OR = 0.76). The rates were lower in women who were delivered by cesarean section (OR = 2.52). The risk factors for bottle-feeding included cesarean delivery (OR = 1.44), higher household wealth index quintiles (OR = 3.06), working by the mother (OR=1.29), higher maternal education level (OR=1.32), urban residence (OR=1.46), and absence of postnatal examination (OR=1.24). The rates of timely complementary feeding were higher for mothers who had more antenatal visits (OR=0.57), and for those who watched television (OR=0.75). Conclusions Revitalization of the Baby Friendly Hospital Initiative in health facilities is recommended. Targeted interventions may be necessary to improve infant feeding practices in mothers who reside in urban areas, are more educated, and are from wealthier households.

Background and Objectives Health related quality of life of children encompasses the clinical status and the perception of health. The aim of the study was to adapt and validate TAPQOL health related quality of life instrument for children in the age group of 3 to 4 years in Sri Lanka. Methods English TAPQOL was adapted to Sinhala language using modified Delphi technique. A community based cross-sectional descriptive study was conducted among 492 children in the age range of 3 to 4 years in Colombo district. Multistage cluster sampling method was used to select children. Mothers of children were interviewed using a structured questionnaire which included the adapted tool. Factor extraction, reliability and discriminant validity were tested in the analysis. Results Response rate was 94.9% (n=467). In the factor extraction, 44 items were extracted and arranged to 12 subscales. Subscales represented different dimensions of health. All subscales had less than 2% of missing values indicating high acceptability. Cronbach’s alpha was more than 0.7 in eleven subscales. High correlations were observed for test-retest reliability for responses 2 weeks apart. The instrument showed satisfactory discriminant validity with preterm born children obtaining low scores in eleven subscales compared to term born group. Conclusions and recommendations TAPQOL questionnaire could be used in the community setting for preschool aged children to assess health related quality of life.

This study aimed to examine individual-, household-, and community-level characteristics associated with nonexclusive breastfeeding (non-EBF) in infants younger than 6 months of age using Demographic and Health Surveys data collected between 2002 and 2005 in East and Southeast Asia. Multilevel logistic regression was used to estimate the odds ratios for factors associated with non-EBF. Exclusive breastfeeding rates in infants younger than 6 months were as follows: Vietnam, 15.5%; Timor-Leste, 30.7%; the Philippines, 33.7%; Indonesia, 38.9%; and Cambodia, 60.1%. The significant individual factors associated with non-EBF included first-born infants, working mothers, and higher maternal age. Communities with a higher proportion of wealthier households in Indonesia, trained delivery assistance in the Philippines, and poor maternal education in Vietnam and Cambodia were at greater risk for non-EBF. All countries need effort to improve EBF, specifically targeting working mothers, less educated women, rich households, and first-time mothers. Health institutions and care providers should be appropriately guided to support EBF. J Hum Lact. 26(3):248-257.

Objectives: To assess utilization of antenatal care (ANC) and its determinants in a conflict-affected area in Northern Sri Lanka. Design and Sample: A cross-sectional study was conducted among pregnant mothers who had completed 36 weeks of gestation, and were admitted or referred to 2 leading hospitals in Vavuniya district. Measures: Data were collected from 392 mothers using an interviewer-administered questionnaire. Results: 55% of the respondents reported that their families were affected directly by conflict. Approximately 68% of mothers were registered by public health midwife (PHM) for ANC; 31.4% were registered before 12 weeks of gestation; 38.5% were visited at home by PHM; 37.8% had the first clinic visit before 12 weeks; and 90.1% made at least 4 clinic visits. The average number of antenatal visits to specialist clinics (5.34, 95%CI: 5.03–5.65) was significantly higher than field clinics (2.97, 95%CI: 2.69–3.25). On average, a pregnant woman was seen by PHM at home 1.47 times. ANC utilization was significantly poor in women whose families were affected by conflict, living in active conflict areas and urban regions, had a lower education level, and were not involved in decision making on ANC. Conclusion: Provision of field antenatal clinics, early entry to ANC, and domiciliary care by PHM need improvement.

This article aims to discuss women's autonomy in decision making on health care, and its determinants in 3 South Asian countries, using nationally representative surveys. Women's participation either alone or jointly in household decisions on their own health care was considered as an indicator of women's autonomy in decision making. The results revealed that decisions of women's health care were made without their participation in the majority of Nepal (72.7%) and approximately half of Bangladesh (54.3%) and Indian (48.5%) households. In Sri Lanka, decision making for contraceptive use was a collective responsibility in the majority (79.7%). Women's participation in decision making significantly increased with age, education, and number of children. Women who were employed and earned cash had a stronger say in household decision making than women who did not work or worked not for cash. Rural and poor women were less likely to be involved in decision making than urban or rich women.

Objective To evaluate the effectiveness of a training program for care providers in improving practice of essential newborn care in obstetric units. Design Before‐and‐after study with an intervention and a control group. Setting Five hospitals in the Puttalam district in Sri Lanka. Participants Eight hundred and ninety‐two mother‐newborn pairs (446 before and 446 three months after). Intervention A 4‐day training program on essential newborn care for doctors, nurses, and midwives of the obstetric units in two hospitals. Main outcome measures By direct observation, practices of essential newborn care at delivery in the labor room on a subsample. By interviewing mothers, immediate skin‐to‐skin contact and early initiation of breastfeeding. From health records, “undesirable health events” of the newborns. Results Practices of cleanliness, thermal protection, and neonatal assessment improved significantly in the intervention group. The intervention was effective in improving skin‐to‐skin contact by 1.5 times and early initiation of breastfeeding by 3.4 times. Undesirable health events declined from 32 to 21 per 223 newborns in the intervention group and from 20 to 17 per 223 newborns in the control group. Conclusion A comprehensive 4‐day training program can be followed by a significant improvement in essential newborn care practices in obstetric units. JOGNN , 36, 531‐541; 2007. DOI: 10.1111/J.1552‐6909.2007.00183.x

ObjectivesTo develop a composite index to describe the overall breast-feeding performance of infants Design, setting and subjectsThe 2003 Demographic and Health Survey was a multi-stage cluster sample survey of 4320 households in Timor-Leste which covered 573 infants aged ResultsExclusive breast-feeding rate was 29.9%. The BPI (mean 4.4, standard deviation 1.77) was categorised as low, average and high according to tertiles. Multivariate analysis indicated that infants from the richest households were 1.70 (95% confidence interval (CI) 1.04–2.77) times more likely to have ‘low BPI’ than the poorest. Maternal BMI − 2was predictive of poor breast-feeding (odds ratio = 1.79; 95% CI 1.27–2.52). In the ‘low’ BPI group, the incidence of diarrhoea (13.4%) and acute respiratory infections (20.7%) during the previous two weeks was significantly higher than in ‘average’ (4.3 and 9.3%) and ‘high’ BPI groups (4.6 and 5.5%).ConclusionsCreating a composite index to assess the overall breast-feeding performance among infants

Cutaneous leishmaniasis (CL) was first detected in Sri Lanka in 1992.Local disease is caused by a genetically different variant of Leishmania donovani. Early case detection and management is the mainstay of L. donovani control. High degree of clinical suspicion is critical but a clinical diagnostic tool is not available for leishmaniasis. Current study described, for the first time, a two-staged clinical algorhythm that facilitates screening of CL in Sri Lanka by primary health care worker in stage 1 and management by medical professional in stage 2.Selected clinical markers of 400 patients suspected of CL were analysed retrospectively with laboratory confirmation of leishmaniasis. Ten clinical markers predicted CL with a over 90% accuracy. Subsets of markers showed high levels of sensitivities (60–97.2%) and/or significant association with positive laboratory results as compared to negative lesions [typical onset (acne-form, painless non-itchy), (P = 0.026), size up to 2 cm (P = 0.046), well-defined edges (P = 0.002), regular edges (P = 0.018), rounded shape (P = 0.030), and lesions at 5–8 months (P = 0.052)]. Five of them (typical onset, number up to 2, small size, rounded edges, and rounded shape) also had > 70% sensitivity levels as compared to laboratory findings. Typical onset had the highest sensitivity of 97% and a PPV of 72%. Lesions at 5–8 months duration having defined edges (P = 0.013, specificity 89.7%, PPV 83.1) or having regular edges (P = 0.006, specificity 86.2%, PPV 82.4%) were also predictive of CL. Most of early laboratory-confirmed ( 67%, PPV > 70%) and had defined edges (sensitivity of 52–71%, specificity 46.7–68.8%), (PPV 75.1–86%). Four clinical markers served as good diagnostic markers in both early ( ≤ 4) and late (>12 months) lesions, viz. typical onset (91.3–98.4%), presence of ≤ 2 lesions (sensitivity 82.6–94.7%), size ≤ 2 cm (66.9–73.7%), and regular edges (68.6–76.3%). Reliability of clinical markers generally declined in chronic lesions. However, small lesions of over 12 months were highly indicative of CL (sensitivity of 66%, specificity 66.7%). None of the single/combination markers, however, were 100% sensitive or specific, highlighting the undeniable usefulness of laboratory confirmation, in diagnosis. Decision-making algorithm used 10 basic clinical features for screening and seven specific clinical markers for clinical handling and referral for investigations.

To describe breastfeeding practices and to assess the sociodemographic factors associated with selected breastfeeding indicators. The 2003 Demographic and Health Survey was a multi-stage cluster sample survey of 4320 households from four different geographic areas in Timor-Leste. A total of 2162 children aged 0–23 months. A high proportion (97.6%) of infants had been ever breastfed, but only 46.1% had initiated breastfeeding within the first hour of birth. Seventy-eight percent of children

s of the Twenty-First Annual Academic Sessions, College of Comunity Physicians of Sri Lanka, 1-3 September 2016 Contains: List of oral presentations List of poster presentations Abstracts of oral presentations Abstracts of poster presentations Acknowledgements

The study was conducted with the aim of assessing the effects of paraplegia caused by spinal cord injuries on the quality of life of patients and their family economy.A descriptive cross-sectional study.The study was carried out in Accident Service, Orthopedic and Neurosurgery Units of the National Hospital of Sri Lanka and the Spinal Injury Unit of Rehabilitation Hospital Ragama.One hundred traumatic paraplegic patients were included as the study sample. Modified Ferrans and Powers quality of life index: spinal cord injury version was used to measure the quality of life. Pre- and post-family economic data were collected using an interviewer-administered questionnaire.Quality of Life was calculated under four major components. Paraplegics' family component (mean=3.50) and social, economic aspects (mean=3.24) are considerably good when compared with health and functioning (mean=2.83) and psychological (mean=2.78) components. Also the study revealed that expenditures are significantly high (P=0.001) and income is significantly less (P=0.001) after injury than before.Quality of life is relatively good on family and social aspects, whereas the physical and psychological aspects are somewhat poor. Regarding family economy, expenses are significantly high and earnings are significantly less after the injury. Contribution to the income from self-employment shows the most significant decline. Findings suggest that the family economy of such patients should be supported.

Introduction Information on triple-negative (TNBC) and basal-like (BLBC) breast carcinoma (BCa) is limited in South-Asia. We aimed to determine the prevalence and clinicopathological characteristics of TNBC and BLBC and shortterm survival of TNBC among a cohort of BCa patients. Methodology Clinicopathological characteristics and short term survival of 211 women with BCa treated at the National Hospital of Sri Lanka from 2012-2014 were analyzed, excluding postneoadjuvant chemotherapy cases. Immunohistochemistry for hormonal and HER2 receptors and basal markers (CK5/6, CK14, EGFR, 34βE12) were performed on TNBCs. Data was analyzed using chi-squared test, logistic and Cox-regression. Results Forty-five (21.33%) were TNBC (95%, CI=15.8%-26.86%), correlating with younger age (p=0.03), premenopausal state (p=0.047), negative lymph nodes (p=0.016), lower stage (p=0.011), higher Nottingham grade (p Discussion TNBC prevalence was comparable to studies from the Indian-subcontinent, however, higher than in the West. Clinicopathological characteristics were similar. Lack of association with adverse short-term survival was possibly due to exclusion of postchemotherapy cases. Conclusion Triple negative breast carcinoma prevalence was 21.33%. Younger age, premenopausal status, low TNM stage, high tumour grade, necrosis, pushing margins, lymphoid infiltrate at tumour margin, absent DCIS and absent/mild central desmoplasia were predictive of triple negative breast carcinoma. Moderate/extensive necrosis in a tumour with this morphology was predictive of basal like breast carcinoma. Triple negative breast carcinoma was not predictive of adverse short-term survival.

Introduction Despite having a national cervical cancer(CC) screening programme, CC is still the second leading cancer among Sri Lankan females. The aim of this study was to assess knowledge and attitudes of the cytology test for CC screening in a rural population. Methodology HETC Rural Health Project, Faculty of Medicine, Colombo used a 2-stage stratified cluster sample of 1950 households from 13 divisional secretariats in Ampara, Monaragala, Hambanthota and Kalmunai to interview married females aged 35-65 years using an interviewer administered questionnaire. Results Total of 1499 females were interviewed. The mean age at marriage was 22 years. There were 1053(70%) housewives and 278(18%) were involved in agriculture, forestry or fishery industries. Of those who disclosed ethnicity (n=1397), 1115(80%), 191(14%) and 89(6%) were Sinhalese, Muslims and Tamils respectively. Of those who disclosed education level (n=1484), 1337(90%) had not passed ordinary level. Questions related to knowledge and attitudes of the cytology test were answered by 1233 participants. The awareness of the test in the age categories 35-40 years (n=311) and 41-45years (n=215) were 249 (80%) and 160(74%) respectively; the awareness decreased with the advancing age. Of 1233 participants 888(72%) have not done the test as, 448(50%) thought it was unnecessary as they did not have an illness, 306(34%) were unaware of the facility, 69(8%) were afraid of the procedure and 69(8%) had “practical difficulties”. Cultural/ religious reasons, attitudes of parents and healthcare workers were reasons in less than 2.5%. These proportions remained more or less the same for all education levels, ethnic groups and occupation. Conclusion The majority of the participants were aware of the screening test. However, negative attitudes resulted in failure to undergo cervical cancer screening test in a significant proportion, which can be corrected by a simple intervention like distributing a leaflet.

Background Economic contribution by internal migrant workers, in particular the workers in Export Processing Zones (EPZ) in Sri Lanka, is well recognized, yet the social and health consequences are unknown. Objective To systematically review the health issues affecting female internal migrant workers in EPZ in Sri Lanka Methods A literature review was conducted through electronic databases and hand searches of grey literature. Studies eligible for inclusion were those reported health or social issues among females employed in an industry within EPZ from 1978 to 2012. Studies were selected using a defined checklist for their methodological quality and in relation to measurement of health status. Results Of the 550 studies identified, eight publications were included for the review. The respondents were relatively young and educated females, and the large majority have migrated predominantly from rural areas to work in garment factories located in urban centers. These studies described health issues related to nutrition, reproductive health, mental health, musculo-skeletal disorders and gender issues. The review identified high prevalence of nutritional deficiencies such as underweight and anaemia; risky sexual behavior; and psychological disorders among female factory workers. Migrant workers had higher prevalence of anaemia and psychological depression than their nonmigrant counterparts. As a positive effect, women experienced empowerment through gaining income and new knowledge. Conclusions Female migrant workers generally tend to exhibit some disadvantage due to health risks, and are more likely to be subject to ill-health than non-migrants. More rigorous research is needed to determine true health impacts within this population.

Inappropriate complementary feeding increases risk of undernutrition, illness and mortality in infants and children. This paper aimed to determine the factors associated with inappropriate complementary feeding practices in Sri Lanka. The Sri Lanka Demographic and Health Survey 2006–2007 used a stratified two‐stage cluster sample of ever‐married women 15–49 years, and included details about foods given to children aged 6–23 months during the last 24 h. The new World Health Organization indicators for infant and young child feeding (IYCF) – (introduction of solid/semi‐solid or soft foods; minimum dietary diversity; minimum meal frequency; and minimum acceptable diet) were calculated for 2106 children aged 6–23 months. These indicators were examined against explanatory variables with multivariate analyses to identify factors associated with inappropriate practices. Eighty‐four per cent of infants aged 6–8 months were introduced to complementary food. The proportion of infants aged 6–8 months who consumed eggs (7.5%), fruits and vegetables other than those rich in vitamin A (29.6%) and flesh foods (35.2%) was low. Of children aged 6–23 months, minimum dietary diversity was 71%, minimum meal frequency 88% and minimum acceptable diet 68%. Children who lived in tea estate sector had a lower dietary diversity and minimum acceptable diet than children in urban and rural areas. Other determinants of not receiving a diverse or acceptable diet were lower maternal education, shorter maternal height, lower wealth index, lack of postnatal visits, unsatisfactory exposure to media and acute respiratory infections. In conclusion, complementary feeding indicators were adequate except in the 6–11 months age group. Subgroups with inappropriate feeding practices should be the focus of IYCF promotion programs.

Background Information on infant and young child feeding is widely available in Demographic and Health Surveys and National Family Health Surveys for countries in South Asia; however, infant and young child feeding indicators from these surveys have not been compared between countries in the region. Objective To compare the key indicators of breastfeeding and complementary feeding and their determinants in children under 24 months of age between four South Asian countries. Methods We selected data sets from the Bangladesh Demographic and Health Survey 2004, the India National Family Health Survey (NFHS-03) 2005–06, the Nepal Demographic and Health Survey 2006, and the Sri Lanka 2000 Demographic and Health Survey. Infant feeding indicators were estimated according to the key World Health Organization indicators. Results Exclusive breastfeeding rates were 42.5% in Bangladesh, 46.4% in India, and 53.1% in Nepal. The rate of full breastfeeding ranged between 60.6% and 73.9%. There were no factors consistently associated with the rate of no exclusive breastfeeding across countries. Utilization of health services (more antenatal clinic visits) was associated with higher rates of exclusive breastfeeding in India but lower rates in Nepal. Delivery at a health facility was a negative determinant of exclusive breastfeeding in India. Postnatal contacts by Public Health Midwives were a positive factor in Sri Lanka. A considerable proportion of infants under 6 months of age had been given plain water, juices, or other nonmilk liquids. The rate of timely first suckling ranged from 23.5% in India to 56.3% in Sri Lanka. Delivery by cesarean section was found to be a consistent negative factor that delayed initiation of breastfeeding. Nepal reported the lowest bottle-feeding rate of 3.5%. Socioeconomically privileged mothers were found to have higher bottle-feeding rates in most countries. Conclusions Infant and young child feeding practices in the South Asia region have not reached the expected levels that are required to achieve a substantial reduction in child mortality. The countries with lower rates of exclusive breastfeeding have a great potential to improve the rates by preventing infants from receiving water and water-based or other nonmilk liquids during the first 6 months of life.

Background In Bangladesh, poor infant and young child feeding practices are contributing to the burden of infectious diseases and malnutrition. Objective To estimate the determinants of selected feeding practices and key indicators of breastfeeding and complementary feeding in Bangladesh. Methods The sample included 2,482 children aged 0 to 23 months from the Bangladesh Demographic and Health Survey of 2004. The World Health Organization (WHO)-recommended infant and young child feeding indicators were estimated, and selected feeding indicators were examined against a set of individual-, household-, and community-level variables using univariate and multivariate analyses. Results Only 27.5% of mothers initiated breastfeeding within the first hour after birth, 99.9% had ever breastfed their infants, 97.3% were currently breastfeeding, and 22.4% were currently bottle-feeding. Among infants under 6 months of age, 42.5% were exclusively breastfed, and among those aged 6 to 9 months, 62.3% received complementary foods in addition to breastmilk. Among the risk factors for an infant not being exclusively breastfed were higher socioeconomic status, higher maternal education, and living in the Dhaka region. Higher birth order and female sex were associated with increased rates of exclusive breastfeeding of infants under 6 months of age. The risk factors for bottle-feeding were similar and included having a partner with a higher educational level (OR = 2.17), older maternal age (OR for age ≥ 35 years = 2.32), and being in the upper wealth quintiles (OR for the richest = 3.43). Urban mothers were at higher risk for not initiating breastfeeding within the first hour after birth (OR = 1.61). Those who made three to six visits to the antenatal clinic were at lower risk for not initiating breastfeeding within the first hour (OR = 0.61). The rate of initiating breastfeeding within the first hour was higher in mothers from richer households (OR = 0.37). Conclusions Most breastfeeding indicators in Bangladesh were below acceptable levels. Breastfeeding promotion programs in Bangladesh need nationwide application because of the low rates of appropriate infant feeding indicators, but they should also target women who have the main risk factors, i.e., working mothers living in urban areas (particularly in Dhaka).

Background Childhood undernutrition and mortality are high in Nepal, and therefore interventions on infant and young child feeding practices deserve high priority. Objective To estimate infant and young child feeding indicators and the determinants of selected feeding practices. Methods The sample consisted of 1,906 children aged 0 to 23 months from the Demographic and Health Survey 2006. Selected indicators were examined against a set of variables using univariate and multivariate analyses. Results Breastfeeding was initiated within the first hour after birth in 35.4% of children, 99.5% were ever breastfed, 98.1% were currently breastfed, and 3.5% were bottle-fed. The rate of exclusive breastfeeding among infants under 6 months of age was 53.1%, and the rate of timely complementary feeding among those 6 to 9 months of age was 74.7%. Mothers who made antenatal clinic visits were at a higher risk for no exclusive breastfeeding than those who made no visits. Mothers who lived in the mountains were more likely to initiate breastfeeding within 1 hour after birth and to introduce complementary feeding at 6 to 9 months of age, but less likely to exclusively breastfeed. Cesarean deliveries were associated with delay in timely initiation of breastfeeding. Higher rates of complementary feeding at 6 to 9 months were also associated with mothers with better education and those above 35 years of age. Risk factors for bottle-feeding included living in urban areas and births attended by trained health personnel. Conclusions Most breastfeeding indicators in Nepal are below the expected levels to achieve a substantial reduction in child mortality. Breastfeeding promotion strategies should specifically target mothers who have more contact with the health care delivery system, while programs targeting the entire community should be continued.

ObjectiveTo compare infant and young child feeding practices in children aged 0–23 months across nine East and Southeast Asian countries.DesignSecondary analyses of cross-sectional data from available Demographic and Health Surveys (DHS; Indonesia, Philippines, Timor-Leste, Cambodia and Vietnam), Multiple Indicator Country Surveys (Lao People's Democratic Republic (Lao PDR) and Myanmar) and national nutrition surveys (Democratic People’s Republic of Korea (DPR Korea) and Mongolia) conducted between 2000 and 2005.SettingSeven countries from Southeast Asia and two from East Asia.SubjectsChildren aged 0–23 months with samples ranging from 826 to 5610 for DHS, and from 477 to 5860 for non-DHS data.ResultsMore than 93 % of infants were ever breast-fed, and over 75 % were currently breast-fed except in the Philippines. Timely initiation of breast-feeding varied from 32 % in Indonesia to 46 % in Timor-Leste. Exclusive breast-feeding (EBF) rate in infants under 6 months of age ranged from 11 % in Myanmar to 60 % in Cambodia. EBF rates were also low in Vietnam (15·5 %) and Lao PDR (23 %), and varied between 30 % and 40 % in Indonesia, Philippines and Timor-Leste. The proportion of infants under 6 months of age who were given breast milk with non-milk liquids was high except in Indonesia and Timor-Leste. Bottle-feeding rates were lower in DPR Korea (3 %), Lao PDR (6 %) and Myanmar (6 %) and higher in the Philippines (49 %) and Mongolia (31 %). Timely complementary-feeding rate varied widely across countries (6–99 %).ConclusionsAll the countries studied should make greater efforts to improve timely initiation of breast-feeding and EBF for 6 months. Measures should be taken to reduce high bottle-feeding rate in the Philippines, Mongolia, Indonesia and Vietnam, and improve complementary-feeding rate in Lao PDR, Myanmar, DPR Korea and Philippines.

To assess utilization of antenatal care (ANC) and its determinants in a conflict-affected area in Northern Sri Lanka.A cross-sectional study was conducted among pregnant mothers who had completed 36 weeks of gestation, and were admitted or referred to 2 leading hospitals in Vavuniya district.Data were collected from 392 mothers using an interviewer-administered questionnaire.55% of the respondents reported that their families were affected directly by conflict. Approximately 68% of mothers were registered by public health midwife (PHM) for ANC; 31.4% were registered before 12 weeks of gestation; 38.5% were visited at home by PHM; 37.8% had the first clinic visit before 12 weeks; and 90.1% made at least 4 clinic visits. The average number of antenatal visits to specialist clinics (5.34, 95%CI: 5.03-5.65) was significantly higher than field clinics (2.97, 95%CI: 2.69-3.25). On average, a pregnant woman was seen by PHM at home 1.47 times. ANC utilization was significantly poor in women whose families were affected by conflict, living in active conflict areas and urban regions, had a lower education level, and were not involved in decision making on ANC.Provision of field antenatal clinics, early entry to ANC, and domiciliary care by PHM need improvement.

Goal: To assess the association between duration of breastfeeding and the risk of breast cancer in Sri Lankan women. Methods: We conducted a case–control study in women aged 30–64 years in selected health care facilities in the Western province. A total of 100 recent cases of breast cancer (histologically confirmed) and 203 controls (age and parity matched) were included. Detailed information regarding breastfeeding, menstruation, reproductive factors, passive smoking and other confounders was collected using a structured questionnaire. Adjusted odds ratios and 95% confidence intervals were calculated using multiple logistic regressions. Principle results: Multivariate analysis found that those women who breastfed for 24 months during lifetime had significantly lower risk of breast cancer than those who breastfed for less than 24 months (OR = 0.40; 95%CI = 0.22, 0.73). Compared to 0–11 months of lifetime breastfeeding, there was a 66.3% reduction in breast cancer risk in women who breastfed for 12–23 months, 87.4% reduction in 24–35 months and 94% reduction in 36–47 months categories. The mean duration of breastfeeding per child for 12 months was also associated with reduced risk of breast cancer (OR = 0.52; 95%CI = 0.28, 0.94). The significant factors associated with increased risk of breast cancer were: post-menopausal women (OR = 1.74; 95%CI = 1.01, 3.01); having an abortion in the past (OR = 3.42; 95%CI = 1.75, 6.66) and exposure to passive smoking (OR = 2.96, 95%CI = 1.53, 5.75). Major conclusions: Prolonged breastfeeding significantly reduces the risk of breast cancer and this protective effect was supported by a dose–response relationship. Risk due to passive smoking should be emphasized in anti-smoking programmes.

The aim of the present study was to evaluate the effect of an essential newborn care (ENC) training programme for maternity ward staff in improving newborn care practices after hospital discharge. A before-and-after study was conducted in the community involving mothers who had given birth in two hospitals in the Puttalam district in Sri Lanka. The intervention was a 4-day training programme and primarily aimed at increasing knowledge and skills of ENC among health care providers in the maternity units of these hospitals. Before the intervention, 144 mother-newborn pairs were followed-up and interviewed at their households within 28-35 days of delivery. Three months after the intervention, 150 mother-newborn pairs were interviewed at home. Results revealed that there was a significant improvement in umbilical cord care practices at home following the intervention. Application of 'surgical spirit' on umbilical cord has declined from 71.5% in the pre-intervention to 45.3% in the post-intervention samples (p < 0.001). Pre-intervention breastfeeding rates were high, and there wasn't any further improvement in the post-intervention. There was a 35% reduction in the proportion of newborns who developed any undesirable health events at home (p < 0.05). Findings suggest that the implementation of a comprehensive 4-day training programme of ENC for maternity ward health professionals can be followed by a significant improvement in mothers' practices on care of umbilical cord and clinical outcomes of newborns.

The aim of this study was to assess mothers' knowledge on newborn care as well as factors associated with poor knowledge. A cross-sectional study sampled 446 mother-newborn pairs from five hospitals in the Puttalam district of Sri Lanka by stratified random sampling. Maternal knowledge on newborn care was assessed using a questionnaire with 50 statements via exit interview. A knowledge score was created by allocating 1 point for each correct response, which was dichotomised as 'satisfactory' or 'poor' by the median score. Only 21.7% correctly answered that 'surgical spirit' (70% isopropyl alcohol) should not be applied on the umbilical stump. More than 90% of mothers knew about breastfeeding on demand, the advantages of colostrum and the duration of exclusive breastfeeding. Except for a few conditions, mothers demonstrated a satisfactory knowledge in recognising danger signs of the newborn. According to multivariate analysis, primiparae (odds ratio (OR)=2.31; 95% CI 1.53-3.50), unemployed women (OR=3.31; 95% CI 1.89-5.80) and those with delayed antenatal booking visits (OR=2.02; 95% CI 1.26-2.23) were more likely to have poor knowledge. In conclusion, mothers had a satisfactory level of knowledge about breastfeeding and recognition of danger signs, but knowledge about care of the umbilical cord was poor. Maternal education programmes should place more emphasis on first-time mothers, unemployed women and those with delayed booking visits.

DOI: http://dx.doi.org/10.4038/jccpsl.v18i1.6077 Journal of the College of Community Physicians of Sri Lanka Vol.18(1) June 2013 19-29

Introduction Teenage pregnancies with their negative obstetric and foetal outcomes are a maternal and child health concern of the country. Objectives To study the prevalence, trends and district differentials in teenage pregnancies in Sri Lanka Methods Three main sources of available national level data were used in this study. They were : vital event registration data from the Registrar General's (RG) Department, data collected routinely by the Family Health Bureau (FHB), Ministry of Health through the Reproductive Health Information Management System (RHMIS) and data from the Demographic and Health Survey (DHS) 2006/07. Other than utilizing reported information of all three sources, primary data of DHS 2006/07 was accessed with permission and further analysis were performed. Results Routinely available data from the Registrar General's (RG) Department are based on the registrations of live births throughout the island, hence could be considered as a proxy for information on pregnancies. A consistent declining trend in pregnancies among women less than 19 years of age was observed from the year 2000 (8.1%) to 2006 (5.4%). Marked inter district variations were noted. The highest percentage of teenage pregnancy was among the Sri Lankan Tamils. The rural sector showed the highest percentages while the estate sector showed the lowest. High percentage of illegitimate births in the estate sector was noteworthy. Data from the routine RHMIS of the Family Health Bureau also showed a declining trend of teenage pregnant females registered by Public Health Midwives as a percentage of all registered pregnant mothers, during the period 2007 (7.7%) to 2010 (6.5%). The marked inter district variation was observed with the variations consistent to what was observed in the RG's data. Further analysis of DHS data showed that the percentage of teenage pregnancies among ever married women aged between 15 – 49 years to be 6.3% (95% CI 5.4-7.2). Teenage pregnancy rates declined significantly with increasing levels of education (p Conclusions and recommendations Analysis of national level information related to teenage pregnancies from three different sources of available data showed that there is a declining trend in the prevalence of teenage pregnancies. All three sources identified that there is a marked inter-district variation in the teenage pregnancy rates and the districts identified to have high rates of teenage pregnancy by the three different sources were mostly consistent. This indicates the need for district specific interventions. Journal of the College of Community Physicians of Sri Lanka Volume 16, No. 02, December 2011 21-30 DOI: http://dx.doi.org/10.4038/jccpsl.v16i2.4577

Objectives : To evaluate the efficacy and safety of balloon pulmonary valvuloplasty (BPV) in children. Design, setting and method: This is a retrospective review of 101 consecutive patients with pulmonary stenosis who underwent BPV at the Lady Ridgeway Hospital for Children over a period of 42 months. Four patients were excluded as they had complex cardiac problems. Data was obtained from Excel based cardiac catheterization reports in the Department of Paediatric Cardiology. Reduction of pressure gradient across pulmonary valve to less than 25 mmHg was defined as a successful procedure. Results: Ninety seven BPVs were performed in 94 patients. The mean age, bodyweight and height were 19 months, 9.5 kg and 80 cm respectively. Sex distribution was equal. The mean of the balloon to pulmonary annular ratio was 108% (range 50-150%). After the BPV, mean peak to peak pressure gradient across the pulmonary valve dropped from 70±29 mmHg to 24.7±16.8 mmHg. Overall success rate was 55.7%. Mortality was 3.1%. Major complications were haemopericardium (4.1%), bradycardia (2%) endocardial damage (1%) and pulmonary oedema (1%). The correlation between pulmonary annulus on echocardiography and angiography was significant (p Sri Lanka Journal of Child Health , 2011; 40 : 13-15 (Key words: balloon pulmonary valvuloplasty; BPV; pulmonary stenosis; children) doi: 10.4038/sljch.v39i4.2862