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Objectives To describe the rehabilitation services available for communication disorders in Sri Lanka and to estimate the adequacy of the services in provinces and districts of the country.Setting The study considered government and private institutions, which provide rehabilitation services for communication disorders in Sri Lanka.Participants Institutions providing services of speech–language pathologists, audiologists and audiology technicians in Sri Lanka.Primary and secondary outcome measures We investigated the number of government hospitals and private institutions, which provide speech–language pathology and audiology services in Sri Lanka as the primary outcome measure. A number of speech–language pathologists, audiologists and audiology technicians working in the institutions were obtained from records and institution-based inquiries to identify the adequacy of the services in the country as the secondary outcome measure.Results Of the 647 government hospitals that provide free healthcare services in the country, 45 and 33 hospitals had speech and language therapy and audiology units, respectively. Government hospitals do not have audiologists but only have audiology technicians. The number of speech and language therapists and audiology technicians in the government sector per 100 000 population in the country was 0.44 and 0.18, respectively. There were wide variations in specialist to population ratio between districts. 77 private centres provide speech therapy services in 15 out of the 25 districts; 36 private centres provide audiological evaluations in 9 districts.Conclusions The number of specialist speech and language therapists and audiologists is not sufficient to provide adequate rehabilitation services for communications disorder for the Sri Lankan population. Not recruiting audiologists to the government sector affects the management of hearing impairment in the affected.

Introduction Time-critical neonatal trials in low-and-middle-income countries (LMICs) raise several ethical issues. Using a qualitative-dominant mixed-methods design, we explored informed consent process in Hypothermia for encephalopathy in low and middle-income countries (HELIX) trial conducted in India, Sri Lanka and Bangladesh.Methods Term infants with neonatal encephalopathy, aged less than 6 hours, were randomly allocated to cooling therapy or usual care, following informed parental consent. The consenting process was audio-video (A-V) recorded in all cases. We analysed A-V records of the consent process using a 5-point Likert scale on three parameters—empathy, information and autonomy. In addition, we used exploratory observation method to capture relevant aspects of consent process and discussions between parents and professionals. Finally, we conducted in-depth interviews with a subgroup of 20 parents and 15 healthcare professionals. A thematic analysis was performed on the observations of A-V records and on the interview transcripts.Results A total of 294 A-V records of the HELIX trial were analysed. Median (IQR) score for empathy, information and autonomy was 5 (0), 5 (1) and 5 (1), respectively. However, thematic analysis suggested that the consenting was a ceremonial process; and parental decision to participate was based on unreserved trust in the treating doctors, therapeutic misconception and access to an expensive treatment free of cost. Most parents did not understand the concept of a clinical trial nor the nature of the intervention. Professionals showed a strong bias towards cooling therapy and reported time constraints and explaining to multiple family members as key challenges.Conclusion Despite rigorous research governance and consent process, parental decisions were heavily influenced by situational incapacity and a trust in doctors to make the right decision on their behalf. Further research is required to identify culturally and context-appropriate strategies for informed trial participation.

Caregivers are increasingly recognised as significant in providing naturalistic interventions for children with autism spectrum disorder in high-income countries and low- and middle-income countries including Sri Lanka. It is imperative to assess the impact of programmes targeting desired parenting skills within cultural boundaries. A preliminary study evaluated the effectiveness of a play-based parent coaching programme by assessing caregiver interaction skills. A mixed-method approach included a prospective pre-post interventional study. A caregiver skills assessment checklist was designed by adapting a freely available tool to assess caregiver-child interactions following a 3-h parent coaching programme. Pre-/post-training 10-min video recordings were obtained for each child-caregiver dyad 2 weeks apart. Thirty mothers (25-55 years) participated. Mean scores improved significantly in all caregivers (p < 0.005) for special emotional (8.80-22.83), cognitive (4.63-14.13) and language (5.53-12.97) domains. Higher education level and older age of caregivers positively associated with the skill acquisition. Qualitative data revealed caregiver satisfaction of detailed workshops. Promising short-term outcomes demonstrated the potential role of parents as partners in autism spectrum disorder management in low- and middle-income countries. Longer-term outcomes on larger groups of children and caregivers need exploration.