Browsing by Author "Attanayake, N."

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A cost analysis of the use of the rapid, whole-blood, immunochromatographic P.f/P.v assay for the diagnosis of Plasmodium vivax malaria in a rural area of Sri Lanka
(Academic Press, 2004) Fernando, S.D.; Karunaweera, N.D.; Fernando, W.P.; Attanayake, N.; Wickremasinghe, A.R.
Between May 2001 and March 2002, a prospective study was conducted in a malaria-endemic area of Sri Lanka, to determine the cost implications of using the immunochromatographic P.f/P.v test to detect Plasmodium vivax infection. All consecutive subjects aged >5 years who presented with a history of fever were recruited. Each was checked for P. vivax infection by the standard microscopical examination of bloodsmears and by theimmunochromatographic test (ICT). The costs of diagnosis using each method and the sensitivity, specificity and predictive values of the ICT (with blood smear examination used as the 'gold standard') were estimated, the costs/case detected being simulated for different slide positivity 'rates' and ICT sensitivities. In the detection of P. vivax, the ICT had a sensitivity of 70% and a specificity of 99%. The costs of the ICT per subject investigated and per case detected were, respectively, approximately 14 and 20 times more than those of bloodsmear examination. The costs of the ICT per case detected would fall as the sensitivity of the test increased. The ICT gave relatively few false-positive results. The current, relatively high cost of the ICT is the most important barrier to its routine operational use in the diagnosis of malaria. The test is already useful, however, in specific situations
Malaria risk factors in an endemic region of Sri Lanka, and the impact and cost implications of risk factor-based interventions
(American Society of Tropical Medicine and Hygiene, 1998) Gunawardena, D.M.; Wickremasinghe, A.R.; Muthuwatta, L.; Weerasingha, S.; Rajakaruna, J.; Senanayaka, T.; Kotta, P.K.; Attanayake, N.; Carter, R.; Mendis, K.N.
In an 18-month study of malaria in a population of 1,875 residents in 423 houses in an endemic area in southern Sri Lanka, the risk of malaria was found to be 2.5-fold higher in residents of poorly constructed houses than in those living in houses of good construction type. In residents of poorly constructed houses but not in others, the risk was even greater when the house was located near a source of water that could act as a potential breeding place for malaria vector mosquitoes (P = 0.0001). Based on previous findings that confirmed that house construction type was itself a risk determinant, and not merely a marker of other behavioral factors, we have estimated the potential impact of two feasible interventions to reduce the risk of malaria: 1) the imposition of a buffer zone of 200 meters around bodies of water from which houses of poor construction were excluded, which was estimated to lead to a 21 percent reduction of the malaria incidence in the overall population and a 43 percent reduction in the relocated community; and 2) the conversion of houses of poor construction type located in the buffer zone to those of a good construction type, which was estimated to lead to a 36 percent reduction in the incidence rates in the whole population and a 76 percent reduction in the residents of houses whose construction type was improved. Taking into consideration the cost to the Government of malaria prevention, we estimated the worth of a Government's investment in improving house construction type. The investment in housing was estimated to be offset in 7.2 years by savings to the Government on malaria costs alone, and beyond this period, to bring a return on the Government's investment by way of savings to the malaria control program.
Predicted cost benifits of establishment of Ricckettsial didease diagnostics in Sri Lanka
(American Society of Rickettsiology, 2008) Premaratna, R.; Dissanayake, I.; Chandrasena, T.G.A.N.; Attanayake, N.; de Silva, H.J.
Abstract Available
A Study on cost of caring for patients with dengue fever at Professorial Medical Unit, Colombo North Teaching Hospital
(Sri Lanka Association for the Advancement of Science, 2008) Hapangama, H.A.D.C.; Attanayake, N.; Premaratna, R.; Abeyewickreme, W.
Dengue fever (DF) and Dengue Hemorrhagic Fever (DHF) may constitute a substantial economic burden on both the healthcare system and individual households in Sri Lanka. The objective of this study was to determine cost of caring for patients with DF and to determine the economic impact of DF on households and healthcare institution. The direct economic impact of the healthcare system and on the households of 31 laboratory confirmed dengue patients who were managed in the professorial medical wards of the North Colombo Teaching Hospital, Ragama was assessed during October, 2006 to March, 2007. The institutional cost was calculated using data obtained from relevant departments of the hospital. The cost for the households of each patient was calculated using an interviewer administrated questionnaire. Of the 31 patients enrolled all had DF and none developed DHF. The median and mode for hospital admission of study sample was third day of fever (range 1-7). The mean Direct Household Cost (DHC) for a single day in hospital of a dengue patient was Rs 820.06. Over 90% of DHC consisted of cost for transportation (33.22%), food (30.44%) and for services obtained from outside hospital sources (30.14%). The mean basic institutional cost for a patient-day in a medical ward of the hospital (excluding the cost for specific management of an illness) was Rs.961.81. Total institutional cost of caring dengue patient per day was Rs. 1142.57 which comprised of cost for basic inpatient care (84.2%) and specific management of dengue fever (15.82%). Further, total cost of hospitalization due to dengue for the study sample comprised of 6.5% for drugs, 17% for investigations and 76.5% for accommodation, staff, transportation, food and other expenses. The study shows a considerable economic burden for both hospital and households due to hospitalization with dengue fever. Although this study focused on some aspects of curative care, primary prevention should be regarded as the basis for minimizing the economic and social burden. The rising demand for the laboratory investigations needs to be addressed by the public sector in a more systematic manner. The substantial burden on the household can be reduced by integration of the private sector in to the system in a rational manner and ensuring a pricing policy. "All medical and nursing staff of the Medical Wards of the North Colombo Teaching Hospital and staff of the Molecular Medicine Unit are gratefully acknowledged."