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All over the world, sustainability has been given immense attention, thus novel state-of-the-art materials and building systems are emerging as alternatives. With those different alternatives, comparison and the selection of a better-performing material or a building system using diverse perspectives becomes important. Literature shows its complexity in adopting social and cultural dimensions in decision-making that adversely impacted on most desirable material selections in tropical underdeveloped countries as well as indigenous communities. This study proposed an eco-design-based material selection approach that considers the individual and holistic perspective of diverse eco-design indicators such as economic, ecological, social, and cultural. Several sub-themes are identified under each theme and are verified through expert surveys. The identified sub-themes are verified and compared Pairwise through expert surveys and using the Analytical Hierarchy Process leads to proposing weights for each theme and sub-theme and developing an eco-design-based material selection framework. Accordingly, saving energy (10.7%), reducing the overexploitation of natural resources (9.1%), reducing energy emissions (7.9%), and reducing construction (7.3%), as well as operational cost (7.6%), are the parameters that create a greater impact on the selection of sustainable material with the aid of eco-design. Overall, the ecological theme creates the highest impact of around 46% and the cultural theme contributes to a lower percentage of around 5% while the economic and social themes impact considerably 30% and 19% respectively. Furthermore, the developed framework is tested in a case study by comparing an emerging walling material, Cement Stabilized Earth Blocks with conventional materials such as Burnt Clay Bricks and Cement Sand Blocks. Technique for Order Preference by Similarities to Ideal Solution was carried out to compare and rank the respective walling materials under different scenarios. Accordingly, Cement Stabilized Earth Blocks is concluded to be the best alternative when analyzed in the eco-design concept. The proposed framework could be highly beneficial for industry practitioners in tropical underdeveloped countries and indigenous communities in choosing community-preferred, affordable, and environmentally-friendly construction materials.

BackgroundObesity and diabetes are known risk factors for severe dengue. Therefore, we sought to investigate the association of obesity with increased risk of hospitalization, as there is limited information.Methods and findingsChildren aged 10 to 18 years (n = 4782), were recruited from 9 districts in Sri Lanka using a stratified multi-stage cluster sampling method. Details of previous admissions to hospital due to dengue and anthropometric measurements were recorded and seropositivity rates for dengue were assessed. The body mass index (BMI) centile in children aged 10 to 18, was derived by plotting the values on the WHO BMI-for-age growth charts, to acquire the percentile ranking.ResultsAlthough the dengue seropositivity rates were similar in children of the different BMI centiles, 12/66 (18.2%) seropositive children with a BMI centile >97th, had been hospitalized for dengue, compared to 103/1086 (9.48%) of children with a BMI centile of 97th (OR 2.33, 95% CI, 1.47 to 3.67, p = 0.0003) was significantly associated with hospitalization when compared to children in other BMI categories.ConclusionsObesity appears to be associated with an increased risk of hospitalization in dengue, which should be further investigated in longitudinal prospective studies. With the increase in obesity in many countries, it would be important to create awareness regarding obesity and risk of severe disease and hospitalization in dengue.

Introduction : Patient satisfaction is considered to be a vital component in the evaluation of the quality of care.Objectives: To describe the maternal satisfaction on care received by the neonates and mothers during their stay in the secondary and tertiary care hospitals in a district of Sri Lanka.Methods: This was a descriptive study conducted among 235 postpartum mothers of neonates who were treated for sepsis in the neonatal intensive care units. An interviewer-administered questionnaire was used to assess maternal satisfaction regarding the care received by the mothers (20 items) and neonates (20 items). The mothers were also requested to make suggestions for improvement. The questionnaire was administered on the day of discharge from the hospital. Overall satisfaction scores for maternal care and neonatal care were calculated separately and was considered satisfactory if it was more than 75% of the total score.Results: The overall mean satisfaction score for maternal care was 84.2 (range 49-100) and for neonatal care, it was 94.0 (range 52-98). Majority of the mothers were satisfied with the maternal care (n=208; 88.5%) and neonatal care (n=220; 93.6%). The majority were satisfied regarding the breastfeeding counselling (n=224; 93.3%), information on the treatment their neonates received (n=227; 94.6%) and investigations of the neonates (n=196; 81.7%). A higher percentage also recommended the obstetric unit to others as a favourable place (n=224; 93.3%) and preferred to return to the same unit for neonatal care for any future episode of illness (n=227; 94.6%).Conclusions: The overall maternal satisfaction regarding the neonatal and maternity care was high. There was a gap between the needs and provision of healthcare.

Introduction: Adherence to infection control practices are crucial for neonatal care. Objectives: To describe the adherence to clean birth and postnatal care practices by healthcare workers in selected procedures in major hospitals in a district of Sri Lanka Methods: This was a qualitative observational study. The study sample comprised healthcare workers (doctors, nurses and midwives) attached to the labour room (LR), postnatal ward (PNW), neonatal intensive care unit (NICU) and operating theatre (OT). A total of 70 healthcare workers from the LR, 90 from the PNW, 50 from the NICU and 60 from the OT were assessed in relation to each procedure they carried out. Four checklists were used to record the observations on infection control standards. The performance of each healthcare worker for each specific procedure was observed only once. Results: Hand washing practices among the healthcare workers in LR, NICU, PNW and OT varied, with better practices seen in NICU and PNW. Recapping of the needles was done by 18.6%, 18.0% and 31.2% in LR, NICU and PNW, respectively. Disposal of sharps to the bin was done by almost all healthcare workers in the LR, NICU and PNW, respectively. All the healthcare workers used 70% alcohol to disinfect the skin, of whom the majority used povidone iodine when drawing blood samples for blood culture in the NICU. Changing or washing gloves before cutting the umbilical cord was observed in the majority of healthcare workers in LR and the minority in OT. Conclusions: Adherence to infection control standards by healthcare workers in observed procedures was not up to the standard.

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

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Abstract Background Further research gaps exist in relation to the promotion of breastfeeding. Robust scientific evidence obtained by a meta-analysis would provide objectively summarized data while enabling the assessment of consistency of findings. This review includes the first documented meta-analysis done on the effectiveness of targeting fathers for promoting breastfeeding (BF). Assessments have been done for a primary outcome and for six more secondary outcomes. Methods PubMed, EMBASE, Google Scholar, CENTRAL databases and unpublished researches were searched. Selections of randomized-controlled trials and quasi-experimental studies were done in three rounds. Heterogeneity and potential publication bias were assessed. Eight studies were included in meta-analysis and others in narrative synthesis of the outcomes. Pooling was done with the Mental- Haenszel method using risk ratio (RR). Summary-of-Findings table was composed by Review-Manager (version 5.3) and GRADEproGDT applications. Subsequent sensitivity analysis was done. Results Selected eight interventional studies included 1852 families. Exclusive BF at six months was significantly higher (RR = 2.04, CI = 1.58–2.65) in the intervention groups. The RR at 4 months was 1.52 (CI = 1.14 to 2.03). Risk of full-formula-feeding (RR = 0.69, CI = 0.52–0.93) and the occurrence of lactation-related problems were lower in the intervention groups (RR = 0.24, CI = 0.10–0.57). More likelihood of rendering support in BF-related issues was seen in intervention groups (RR = 1.43, CI = 1.22–1.68). Increase of maternal knowledge and favorable attitudes on BF were higher in the intervention groups (P ≤; 0.001). The quality of evidence according to GRADE was “low” (for one outcome), “moderate” (for four outcomes), and “high” (for two outcomes). Conclusions Targeting fathers in promotion of BF has provided favorable results for all seven outcomes with satisfactory quality of evidence. This review was registered in the PROSPERO-registry (ID: 2017-CRD42017076163) prior to its commencement.