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Over the years, the Internet and information technology have become a crucial part of the day-to-day activities of modern human lives. Meanwhile, there is a rising concern regarding those who are excessively using technology which can lead to Internet addiction. This may eventually result in marked distress and functional impairments of the general life of youth such as academic performance, social interaction, future occupational interest, and behavioral problems. Nonetheless, the condition is widespread and problematic, limited scientific evidence is available on the diagnosis of Internet Addiction Disorder globally as well as locally. The objective of this study was to adapt, translate and validate an instrument (Internet Addiction Test) to assess Internet addiction disorder to the Tamil Language among 15-19-year-old adolescents in Colombo district. Internet Addiction Test (IAT) developed by Young (1998) was adapted, translated, and validated into Tamil language resulting IAT-Tamil version by conducting a descriptive cross-sectional validation study. The developed tool was intended to assess Internet addiction disorder among 15-19-year-old adolescents in Colombo district. Statistical analysis was carried out to test the construct validity with a sample of 225 and a sample of 240 for the Confirmatory Factor Analysis. The statistical analysis was carried out by using SPSS-21 (Principal Component Analysis) and LISREL 8.8 (Confirmatory Factor Analysis). The reliability was assessed by internal consistency and test-retest reliability methods. The IAT-Tamil version demonstrated a three-factor model with 20 items and the model indices were RMSEA=0.07, CFI=0.91, NNFI=0.87, and SRMR=0.066. It also demonstrated excellent levels of reliability with a Cronbach alpha value of 0.948. The IAT-Tamil version was a valid and reliable tool to assess Internet addiction disorder among 15-19-year-old school-going adolescents in Sri Lanka. The validated IAT-Tamil version is recommended to use in future local studies and to aid the policymakers and the administrators in the prevention, diagnosis, and management of Internet addiction disorder among this age group.

Background: One fifth of Sri Lankan population consists of adolescents with 71% of them are school going. Extreme need exists in the country for introducing of evidence-based intervention for psychosocial wellbeing of adolescents. Present study assessed the effectiveness of an educational intervention to promote psychosocial wellbeing of school-going adolescents in grade nine in Western Province, Sri Lanka Materials and methods: A quasi-experimental study was conducted among grade nine students in Western Province in 2019. Panadura Medical Officer of Health (MOH) area was selected as the interventional area (IA) and Kelaniya MOH area was identified as the control area (CA). Teachers at schools in the IA received training on psychosocial health promotion of adolescents and they delivered the activity-based, educational intervention package to the grade nine students as 20-minute sessions in the classrooms during a 3-month period. Pre- and post-intervention assessments of attitudes and practices related to psychosocial wellbeing of adolescents were conducted using an interviewer-administered questionnaire. Categorical data were compared using Chi-Square or Fisher’s Exact test. Mann-Whitney U test was applied to determine the difference between medians of the pre- and post-intervention scores on attitude and practices on psychosocial wellbeing. Results: A total of 1040 grade nine students were enrolled. There was a statistically significant increase in median score on attitudes [81.8 (IQR:75.5-85.5) to 82.3(IQR:78.6-87.2] and practices [81.7(IQR: 76.1-85.7) to 83.1(IQR: 79.1-86.9)] in the IA while there was no significant difference in the CA. The proportion of bullied adolescents in past 30 days reduced significantly from 14.8% (n=38) to 7.9% (n=20) in IA(p=.03) whereas there was a slight reduction from 17.1% (n=44) to 11.3% (n=26) in CA (p=.17). Conclusions: Present psycho-social intervention is effective in improving the psychosocial wellbeing of school adolescents though long-term effectiveness was not assessed.

Background: Sexual and reproductive health is a major concern among adolescents and youth in Sri Lanka. The study was carried out to assess the knowledge, and practices of the youth trainees attached to youth training institutes in Sri Lanka. Methodology: A descriptive, cross-sectional study was carried out among randomly selected 425 youth trainees attached to youth training centers in Sri Lanka using a pre-tested self-administered questionnaire. Statistical analysis was conducted using SPSS-21. Categorical variables were presented as numbers and percentages. Comparison of categorical variables was conducted using Chi-Square test and Fisher’s exact test as applicable. Results: Study group consisted of 51.8% (n=220) males and 48.2% (n=205) females with mean age of 18.6 years (SD= 1.8). Only 49% (n=211) knew that nocturnal emission is normal in young men, while 8% (n=34) thought that nocturnal emission would weaken their body. Only 47.5% (n=202) had ever heard of condoms, and 13.2% (n=56) knew about the emergency contraceptive pill. While 23.3% (n=98) identified abortion could cause maternal death, 53.9% (n=227) knew that teenage pregnancy lead to complications in both mother and baby. A majority, 75.5% (n=318) expressed that HIV/AIDS can be transmitted via unprotected sexual intercourse. Only 114 (26.8%) correctly identified abstinence and limiting to one faithful sexual partner as successful ways to prevent sexually transmitted infections (STI). Nearly 8% (n=33) said that they engaged in sexual intercourse at least once in their lifetime. Of them, nearly 75% (n=23) had their first sexual contact at the age of 14-18 years and only 58% (n=19) had used condoms. Male gender (pConclusions and recommendations: Knowledge and practices on sexual and reproductive health among youth trainees were sub-standard. Study recommends strengthening sexual and reproductive health education at youth training centers.

ObjectivesThis study aims to describe the population level data on neonatal and maternal outcomes of COVID-19 positive pregnant women of Sri Lanka by secondary analysis using National COVID-19 Positive Pregnant Women Surveillance.DesignSecondary analysis of surveillance data from the National COVID-19 positive pregnant women surveillance, Sri Lanka. Data of all pregnant women whose maternal and neonatal outcomes were reported in National Surveillance from 1st March 2020 to 31st October 2021 were included in the study. Associated factors for maternal and neonatal outcomes, namely POA at delivery, mode of delivery, birthweight, immediate place of newborn care, congenital abnormalities, and condition of neonate at completion of one month were calculated using univariate and multivariate Odds ratios.ResultsMaternal COVID-19 infection reported preterm birth rate of 11.9%, LSCS rate of 54.5%, low birthweight rate16.5% and 8.3% of the newborns requiring intensive care. Neonatal mortality rate was 9 per 1000 live births. Pre-pregnancy overweight and obesity increased the risk of preterm delivery compared to pregnant women with normal BMI by 46.7% (AOR=1.467, CI=1.111-1.938, P=0.007). In contrast, the risk of preterm delivery reduced by 82.4% (AOR=0.176, CI=0.097-0.317, pConclusionIncreased severity of maternal COVID-19 infection and pre-pregnancy overweight/ obesity were associated with many adverse pregnancy and neonatal outcomes. Therefore, close observation and aggressive management of COVID-19 among the pregnant women should be considered to reduce the risk of progressing to severe illness.

Nepal and Sri Lanka ministries of health shared best practices and learnings, in a South-South learning exchange (SSLE) to improve access to quality and rights-based family planning services. The SSLE between the two countries followed a five-step methodology designed by the WHO, under the Family Planning Accelerator project. SSLE between the two countries started in January 2020 and is still continuing. Both countries started implementation of the learnings (step 4) at the time of preparing this manuscript (December 2021). An independent consultant from Sri Lanka carried out an evaluation, to inform future SSLEs. The evaluation included a desk review on SSLE and family planning in both countries and key informant interviews with Sri Lanka Ministries Health, WHO CO, external partners. A final evaluation of the outcomes/impact is planned in December 2022. The SSLE resulted in a systematic cross-country transfer of knowledge and implementation of the learnings. Sri Lanka implemented a web-based system for logistics management of family planning commodities and Nepal commenced implementing integrated family planning services in a decentralised environment using a lifecycle approach to improve postpartum family planning uptake. The success of this SSLE is attributed to the rigorous methodology, country-led designing of the learning agenda and process, extensive communication amongst the teams, a focus on outcomes, commitment and leadership by ministries of health in both countries. Learning and technical assistance needs of countries can be met by SSLE if national contexts, availability of resources are considered.

OBJECTIVES: To understand how community perspectives toward young child nutritional illness compare to biomedical perspectives in Sri Lanka. METHODS: This ethnographic sub-study was embedded in a multi-phase, mixed methods formative research design to understand infant and young child feeding practices in urban, rural, and estate sectors of Sri Lanka. Data were collected among caregivers of young children to understand nutritional illness using free lists (n = 150), pile sorts (n = 84), semi-structured interviews with caregivers (n = 21) and community leaders (n = 24). Data were collected in Sinhalese and Tamil languages and translated into English for analysis. Free list and pile sort data were analyzed using cultural domain analysis with Anthropac. Textual data were analyzed thematically using Dedoose. Data sets were combined for methodological triangulation. RESULTS: During interviews, caregivers described a combination of biomedical and traditional medicine approaches for treating common childhood illness, a reflection of the continued importance of traditional medical belief systems. Beliefs grounded in Ayurvedic medicine remain important drivers of health and nutrition-seeking behaviors. Consumption of ‘cold’ foods was frequently cited as an important cause of child illness. Some caregivers did explain that promoted foods such as eggs, leafy green vegetables, fruits, and green grams are appropriate dietary choices for good child health and nutrition. Cultural domain analysis revealed nutrition-related illnesses were less salient than other common young child illnesses such as fever, common cold, and cough. Low weight was the only nutritional illness that appeared in the top 15 most salient illnesses among participants. Despite a 17% average child stunting prevalence across all sectors of Sri Lanka, chronic malnutrition and stunting were not mentioned by nearly all participants, suggesting that a local understanding of this condition may not align with the biomedical importance placed on it by health professionals. Overweight/obesity did not appear to be a concern despite a growing national prevalence. CONCLUSIONS: Policies and programs aimed at improving infant and young child feeding practices in Sri Lanka may benefit from understanding and incorporating community perspectives toward nutrition-related illnesses. FUNDING SOURCES: UNICEF

OBJECTIVES: 1) To understand how Sri Lankan caregivers conceptualize young child foods; 2) To explore local food classification systems; 3) To explain why some foods are culturally prescribed (remedies) or proscribed (taboos) for young children METHODS: Design: This ethnographic sub-study was conducted within a four-phase, mixed methods formative research design across rural, estate, and urban sectors of Sri Lanka. Data collection methods and sampling. Data were collected between Oct. 2020 – Feb. 2021 using free lists, pile sorts, and semi-structured interviews in urban (Batticaloa and Colombo), rural (Kilinochchi, Ratnapura, and Matara), and estate (Nuwara Eliya) sectors of Sri Lanka. Free lists (n = 150) and pile sorts (n = 84) were conducted among caregivers of young children. Both community leaders (n = 24) and caregivers (n = 21) were purposively sampled for interviews. Data analysis. Cultural domain analysis was conducted using Anthropac. Textual analysis of interview data followed an inductive approach whereby themes were identified, coded, and extracted for interpretation using Dedoose. Findings across methods were triangulated to enhance credibility. RESULTS: 1. Among all sectors of Sri Lanka, caregivers identified rice as the most important food for young children diets, highlighting the importance of this staple regardless of sector or ethnicity. Only 2 animal source foods (eggs and fish) were included within the top 15 most salient foods. 2. Local food classification systems highlight a ‘hot’ and ‘cold’ paradigm, reflecting the underlying Ayurvedic medical belief system, influencing dietary choices. 3. Overall, 48 food proscriptions were identified, including ‘egg’ and ‘fish, specifically during child illness. Some locally-available fruits and vegetables were also proscribed, depending on their ‘cold’ nature, level of digestibility, and relation to illness causation. Prescribed foods (n = 47) were also found, most of which were herbal remedies (22 food or spice mixtures) to address child illness. CONCLUSIONS: Understanding local food definitions, food classification systems, and food rules may aid in shaping policies aiming to include culturally-appropriate strategies to improve feeding practices in Sri Lanka. FUNDING SOURCES: UNICEF.

In the past, mental health services in Sri Lanka were limited to tertiary-care institutions, resulting in a large treatment gap. Starting in 2000, significant efforts have been made to reconfigure service provision and to integrate mental health services with primary health care. This approach was supported by significant political commitment to establishing island-wide decentralized mental health care in the wake of the 2004 tsunami. Various initiatives were consolidated in The mental health policy of Sri Lanka 2005-2015, which called for implementation of a comprehensive community-based, decentralized service structure. The main objectives of the policy were to provide mental health services of good quality at primary, secondary and tertiary levels; to ensure the active involvement of communities, families and service users; to make mental health services culturally appropriate and evidence based; and to protect the human rights and dignity of all people with mental health disorders. Significant improvements have been made and new cadres of mental health workers have been introduced. Trained medical officers (mental health) now provide outpatient care, domiciliary care, mental health promotion in schools, and community mental health education. Community psychiatric nurses have also been trained and deployed to supervise treatment adherence in the home and provide mental health education to patients, their family members and the wider community. A total of 4367 mental health volunteers are supporting care and raising mental health literacy in the community. Despite these important achievements, more improvements are needed to provide more timely intervention, combat myths and stigma, and further decentralize care provision. These, and other challenges, will be targeted in the new mental health policy for 2017-2026.