Browsing by Author "Dawson, A."

Now showing 1 - 20 of 25

Acute human self-poisoning with bispyribac-containing herbicide Nominee: a prospective observational study
(Informa Healthcare, 2010) Gawarammana, I.B.; Roberts, D.M.; Mohamed, F.; Roberts, M.S.; Medley, G.; Jayamanne, S.; Dawson, A.
INTRODUCTION: Self-poisoning with herbicides is an important reason for hospital admission and death in Asia. Although some herbicides have a well-described toxicity profile in humans, many of the newer compounds rely on extrapolation from animal results as no published literature on clinical outcomes of human self-poisoning has been described. One example of these compounds is bispyribac, a selective herbicide used in rice and wheat cultivation that is marketed in two containers, one containing bispyribac 400 g/L with a solvent and the other the surfactant, polyethylene glycol. We present the first case series of acute human self-poisoning with an herbicide product containing bispyribac. METHODS: Clinical data for all patients who presented with acute poisoning from a bispyribac-containing herbicide (Nominee) to two general hospitals in Sri Lanka from June 2002 to January 2009 were collected prospectively. Admission and serial blood samples were collected from consenting patients to confirm exposure and to study the toxicokinetics of bispyribac, respectively. RESULTS: One hundred ten patients with a history of bispyribac ingestion presented after a median time of 4 h post-ingestion. There were three deaths at 15, 6, and 5 h post-ingestion because of asystolic cardiac arrest. All three patients had reduced Glasgow Coma Score (GCS) (3, 12, and 13, respectively) of whom the former two had co-ingested ethanol and developed tonic-clonic seizures. Admission blood sample was obtained from the former two of these patients but bispyribac was detected in only one of these patients. The other patient presented 2.5 h post-ingestion with a GCS of 12 but bispyribac was not detected. Excluding the patient with undetectable bispyribac, a conservative estimate of the case fatality ratio at 1.81% (95% confidence interval 0.32-5.8) can be made. The majority of the remaining patients had self-limiting upper gastrointestinal symptoms and eight patients had an abnormal GCS on presentation to hospital. The overall median hospital stay was 3 days. Bispyribac was not detectable on admission in 21 patients; in the remaining patients, the median plasma concentration was 50.55 microg/mL (interquartile range 1.28-116.5; n=32). The peak concentration was noted around 3 h post-ingestion and plasma bispyribac concentration did not predict the severity of poisoning. CONCLUSION: The majority of patients developed self-resolving symptoms and were successfully managed in rural general hospitals without transfer to larger tertiary hospitals. Patients who died developed significant poisoning within 6 h and plasma bispyribac concentrations did not appear to predict mortality. The lack of correlation between bispyribac outcomes and the available plasma concentrations may be because of exposure to nonbispyribac components or other undefined factors. Clinical outcomes from acute self-poisoning with bispyribac-containing herbicides appear to be relatively more favorable than other commonly used herbicides.
Adverse drug reactions in a cohort of Sri Lankan patients with non-communicable chronic diseases
(Elsevier, 2017) Wijekoon, C.N.; Shanika, L.G.T.; Jayamanne, S.; Coombes, J.; Dawson, A.
BACKGROUND: Adverse drug reactions (ADRs) pose a major problem in medication use. This study was done to describe incidence, nature and associated factors of ADRs in a cohort of Sri Lankan patients with non-communicable chronic diseases (NCCDs). METHODS: The prospective observational data presented here are obtained as a part of a large study conducted in a tertiary-care hospital in Sri Lanka. In-ward patients with NCCDs were recruited systematically using the admission register in the ward as the sampling frame. All ADRs occurred during the index hospital admission and 6-month post-discharge period were detected by active surveillance. RESULTS: 715 patients were studied (females – 50.3%; mean age – 58.3±15.4years). 35.4% were aged ≥65years. Mean number of drugs prescribed per patient was 6.11±2.97. Most prevalent NCCDs were hypertension (48.4%), diabetes (45.3%) and ischemic heart disease (29.4%). 154 ADRs [33 (21.4%) during index hospital admission; 121 (78.6%) during 6-month post-discharge period) were detected involving 112 (15.7%) patients. 51.9%(80/154) of them were potentially avoidable. 47% (73/154) of ADRs were serious adverse events (SAEs); 13 were life threatening, 46 caused hospitalization and 14 caused disability. The most common causes for re-hospitalization due to ADRs were hypoglycemia due to anti-diabetic drugs (17/46), bleeding due to warfarin (6/46) and hypotension due to anti-hypertensives (6/46). ADRs were more common in elderly (34% vs 14.7%, p<0.001), in those who were on ≥5 drugs (25.9% vs 12.7%, p<0.001) and among those with diabetes (28.5% vs 15.6%, p<0.001). CONCLUSIONS : Incidence of ADRs was high in the study population. A large proportion of them were SAEs. The majority of ADRs that required re-hospitalization were caused by widely used drugs and were potentially avoidable. Factors associated with a higher incidence of ADRs were age ≥65years, ≥5drugs in the prescription and presence of diabetes. The healthcare system in the study setting needs improvement in order to minimize ADRs.
Adverse drug reactions in a cohort of Sri Lankan patients with non-communicable chronic diseases
(Sri Lanka Medical Association, 2016) Shanika, L.G.T.; Wijekoon, C.N.; Jayamanne, S.; Coombes, J.; de Silva, H.A.; Dawson, A.
INTRODUCTION AND OBJECTIVES: Adverse drug reactions (ADRs) are a major problem in drug utilization. The study aimed to describe the incidence and nature of ADRs in a cohort of Sri Lankan patients with non-communicable chronic diseases (NCCDs). METHOD: This prospective observational study conducted in a tertiary-care hospital recruited in-ward patients with NCCDs. All ADRs that occurred during the index hospital admission and in the 6-month period following discharge were detected by active surveillance. Details were recorded using the ADR reporting form, developed based on the publication of the Clinical Center, Pharmacy Department, National Institutes of Health. RESULTS: 715 patients were studied (females-50.3%, mean age–57.6 years). The mean number of medicines given per patient was 6.11±2.97. The most prevalent NCCDs were hypertension (48.4%; 346/715), diabetes (45.3%; 324/715) and ischemic heart disease (29.4%; 210/715). 112 patients (15.7%) experienced at least one ADR. In the 112 patients, 154 ADRs (33 during index hospital admission; 121 during 6-month period following discharge) were detected. 51.9% (80/154) of them were potentially avoidable. 47% (73/154) of ADR swere Serious Adverse Events (SAEs); 13 were life threatening, 46 caused hospitalization and 14 caused disability. The most common causes for re-hospitalization due to ADRs were hypoglycemia due to anti-diabetic drugs (17/46), bleeding due to warfarin (14/46) and hypotension due to anti-hypertensives (6/46). CONCLUSIONS: Incidence of ADRs was high in the study population. A large proportion of them were SAEs. The majority of ADRs that required re-hospitalization were caused by widely used medicines and were potentially avoidable.
Community incidence of snakebite and envenoming in Sri Lanka; results of a national survey
(Sri Lanka Medical Association, 2014) Pathmeswaran, A.; Kasturiratne, A.; Gunawardena, N.K.; Wijayawickrama, B.A.; Jayamanne, S.F.; Ediriweera, D.S.; Isbister, G.; Dawson, A.; Lalloo, D.G.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: We undertook the first ever country-wide community-based survey to determine the incidence of snakebite in Sri Lanka. METHODS: Data were collected through household interviews by trained data collectors.125 clusters were allocated to each of the 9 provinces of the country. Within each province the clusters were divided among the districts in proportion to their population. A Grama Niladhari (GN) division was defined as a cluster for data collection. The clusters were selected using simple random sampling, and in each cluster 40 households were sampled consecutively from a random starting point. RESULTS: Data relating to 165,665 individuals (0.8% of the population of Sri Lanka) living in 44,136 households in 1,118 clusters was collected from June 2012 to May 2013. 695 (males 418) snakebites and 323 (males!93) significant envenomings (local tissue necrosis or systemic envenoming) were reported during the 12 months preceding the interview. The overall community incidence of snakebites and significant envenoming were 398 and 151 per 100,000 population, respectively. 446 (64.2%) bites and 208 (64.4%) envenomings were in people aged 30 to 59 years. There was wide variation between districts, the worst affected being Mullaitivu, Anuradhapura, Batticaloa, and Poionnaruwa, ali in the dry zone, mainly agricultural areas of the country. CONCLUSIONS: Sri Lanka has a high community incidence of snakebite and envenoming with a marked geographical variation.This variation underlines both the inaccuracy of extrapolating data of localised surveys to national or regional levels and the need to prioritise distribution of resources for treatment of snakebite even in small countries.
Community incidence of snakebite in the Amiradhapura district
(Sri Lanka Medical Association, 2013) Kasturiratne, A.; Gunawardena, N.K.; Wijayawickrama, B.A.; Jayamanne, S.F.; Pathmeswaran, A.; Isbister, G.; Dawson, A.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: The community incidence of snakebite in Sri Lanka is unknown. To investigate incidence of snakebite, we undertook a community study in the Anuradhapura district as part of an ongoing countrywide survey on snakebite. METHODS: The survey was designed to sample at least 1% of the population in each district Within the district, a Grama Niladhari (GN) division, was defined as a cluster for data collection. The number of clusters required to sample at least 1 % of the population was first determined, and clusters were then selected using simple random sampling. In each selected cluster 40 households were sampled consecutively from a random starting point. Population estimates of snakebite were constructed for the district. RESULTS: The Anuradhapura district has a total of 694 GN divisions, and 84 were surveyed. This included 3357 households and a population of 13,428 (1.6% of the district's population). Eightysix snakebites were reported within the last 12 months. Extrapolating this to the district (mid-year population=855,373), the estimated snakebites in Anuradhapura district was 5478. The crude community incidence of snakebite in the Anuradhapura district was 640.5 per 100, 000 population. CONCLUSIONS: The incidence of snakebite in the community is high in the Anuradhapura district, with one in 156 persons bitten annually.
Delayed psychological morbidity in victims of snakebite envenoming
(Sri Lanka Medical Association, 2010) Williams, S.S.; Wijesinghe, C.A.; Jayamanne, S.F.; Buckley, N.; Dawson, A.; Lalloo, D.G.; de Silva, H.J.
OBJECTIVES: We assessed delayed somatic symptoms, depressive disorder, post-traumatic stress disorder (PTSD) and impairment in functioning among snakebite victims. The psychological impact of snakebite on its victims has not been systematically studied. METHODS: The study had qualitative and quantitative arms. In the quantitative arm, 88 persons who had systemic envenoming following snakebite from the Polonnaruwa District were randomly identified from an established research database and interviewed 12 to 48 months (mean 30) after the incident. 88 persons with no history of snakebite, matched for age, sex, geograpical location and occupation acted as controls. A modified version of the Beck Depression Inventory, Post-Traumatic Stress Symptom Scale, Hopkins Somatic Symptoms Checklist and Sheehan Disability Inventory, together with a structured questionnaire were administered. In the qualitative arm, focus group discussions among snakebite victims explored common somatic symptoms attributed to envenoming. Results: Snakebite victims had more symptoms as measured by the modified Beck Depression Scale (mean 19.1 vs 14.4) and Hopkins Symptoms Checklist (38.9 vs. 28.2) compared to controls (p<0.001). 48(54%) victims met criteria for depressive disorder compared to 13(15%) controls. 11(12.5%) victims also met criteria for PTSD. 24(27%) claimed that the snakebite caused a negative change in their employment; 9(10.2%) had stopped working. 15(17%) victims claimed residual physical disability, and themes identified in the qualitative arm included blindness, tooth decay, body aches, tiredness and weakness. CONCLUSIONS: Snakebite causes delayed psychological morbidity, a complication not previously documented.
Development and assessment of a psychological intervention for snakebite victims
(Sri Lanka Medical Association, 2014) Wiiesinahe, C.A.; Williams, S.S.; Dolawatta, N.; Wimalaratne, A.K.G.P.; Kasturiratne, A.; Wijewickrema, B.; Jayamanne, S.F.; Lalloo, D.G.; Isbister, G.K.; Dawson, A.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: There is significant delayed psychological morbidity and negative psycho-social impact following snakebite. However, no psychological support is provided to victims. We aimed to develop and assess the effectiveness of a brief intervention which can be provided by non-specialist medical officers aimed at reducing psychological morbidity. METHODS: In a single blind clinical trial at Polonnaruwa Hospital, 187 snakebite victims were randomised into three arms. One arm received no psychological intervention (Group A; n=59; control). Group B (n=60) received psychoeducation at discharge from hospital. Group C (n=68) received psychoeducation and a.second intervention one month later based on cognitive behavioural principles. All patients were assessed six months after discharge from hospital using standardised tools for presence of psychological symptoms and level of functioning. RESULTS: Compared with Group A, there was a significant reduction in anxiety symptoms measured by the Hopkins Psychiatric Symptom check list (16.9% vs. 5.9%, p=0.047, Chi-Squared test) and a non-significant trend towards improvement in the level of functioning measured by the Sheehan Disability inventory (6.47 vs. 4.69) in Group C, but not in Group B. There was no difference in rates of depression and post-traumatic stress disorder (PTSD) between the three groups. CONCLUSIONS: Our preliminary findings suggest that brief psychological interventions which include psychoeducation plus cognitive behavioural therapy given by non-specialist doctors, but not psychoeducation alone seem to reduce anxiety and facilitate a trend towards improved function in snakebite victims. However, these interventions had no effect on depression or PTSD.
Development of a Snakebite risk map for Sri Lanka
(Sri Lanka Medical Association, 2016) Ediriweera, D.S.; Kasturiratne, A.; Pathmeswaran, A.; Gunawardena, N.K.; Wijayawickrama, B.A.; Jayamanne, S.F.; Isbister, G.K.; Dawson, A.; Giorgi, E.; Diggle, P.J.; Lalloo, D.G.; de Silva, H.J.
INTRODUCTION: Snakebite is a public health problem in Sri Lanka and about 37,000 patients are treated in government hospitals annually. At present, health care resources which are required to manage snakebite are distributed based on the administrative boundaries, rather than based on scientific risk assessment. OBJECTIVES: The aim of the study is to develop a snakebite risk map for Sri Lanka. METHOD: Epidemiological data was obtained from a community-based island-wide survey. The sample was distributed equally among the nine provinces. 165,665 participants (0.8%of the country’s population) living in 1118 Grama Niladhari divisions were surveyed. Generalized linear and generalized additive models were used for exploratory data analysis. Model-based geostatistics was used to determine the geographical distribution of snakebites. Monte Carlo maximum likelihood method was used to obtain parameter estimates and plug-in spatial predictions were obtained. Probability contour maps (PCM) were developed to demonstrate the spatial variation in the probability that local incidence does or does not exceed national snakebite incidence. RESULTS: Individual point estimate snakebite incidence map and PCM were developed to demonstrate the national incidence of snakebite in Sri Lanka. Snakebite hotspots and cold spots were identified in relation to the national snakebite incidence rate. Risk maps showed a within-country spatial variation in snakebites. CONCLUSIONS: The developed risk maps provide useful information for healthcare decision makers to allocate resources to manage snakebite in Sri Lanka.
Duplication errors due to brand name confusion; It is not always the name-Short case series
(John Wiley & Sons, 2023) Mamunuwa, N.; Jayamanne, S.; Wijekoon, N.; Coombes, J.; Perera, D.; Shanika, T.; Mohamed, F.; Lynch, C.; de Silva, A.; Dawson, A.
Confusion of drug names has been identified as a leading cause of medication errors and potential iatrogenic harm. Most of these errors occur because of look-alike or sound-alike drugs. This case series gives examples of duplication errors due to brand confusion, where there are no similarities in the names.
Evaluating spatiotemporal dynamics of snakebite in Sri Lanka: Monthly incidence mapping from a national representative survey sample
(Public Library of Science, 2021) Ediriweera, D.S.; Kasturiratne, A.; Pathmeswaran, A.; Gunawardena, N.K.; Jayamanne, S.F.; Murray, K.; Iwamura, T.; Isbister, G.; Dawson, A.; Lalloo, D.G.; de Silva, H.J.; Diggle, P.J.
BACKGROUND: Snakebite incidence shows both spatial and temporal variation. However, no study has evaluated spatiotemporal patterns of snakebites across a country or region in detail. We used a nationally representative population sample to evaluate spatiotemporal patterns of snakebite in Sri Lanka. METHODOLOGY: We conducted a community-based cross-sectional survey representing all nine provinces of Sri Lanka. We interviewed 165 665 people (0.8% of the national population), and snakebite events reported by the respondents were recorded. Sri Lanka is an agricultural country; its central, southern and western parts receive rain mainly from Southwest monsoon (May to September) and northern and eastern parts receive rain mainly from Northeast monsoon (November to February). We developed spatiotemporal models using multivariate Poisson process modelling to explain monthly snakebite and envenoming incidences in the country. These models were developed at the provincial level to explain local spatiotemporal patterns. PRINCIPAL FINDINGS: Snakebites and envenomings showed clear spatiotemporal patterns. Snakebite hotspots were found in North-Central, North-West, South-West and Eastern Sri Lanka. They exhibited biannual seasonal patterns except in South-Western inlands, which showed triannual seasonality. Envenoming hotspots were confined to North-Central, East and South-West parts of the country. Hotspots in North-Central regions showed triannual seasonal patterns and South-West regions had annual patterns. Hotspots remained persistent throughout the year in Eastern regions. The overall monthly snakebite and envenoming incidences in Sri Lanka were 39 (95%CI: 38-40) and 19 (95%CI: 13-30) per 100 000, respectively, translating into 110 000 (95%CI: 107 500-112 500) snakebites and 45 000 (95%CI: 32 000-73 000) envenomings in a calendar year. CONCLUSIONS/SIGNIFICANCE: This study provides information on community-based monthly incidence of snakebites and envenomings over the whole country. Thus, it provides useful insights into healthcare decision-making, such as, prioritizing locations to establish specialized centres for snakebite management and allocating resources based on risk assessments which take into account both location and season.
Evaluating temporal patterns of snakebite in Sri Lanka: The potential for higher snakebite burdens with climate change
(Sri Lanka Medical Association, 2018) Ediriweera, D.S.; Diggle, P.J.; Kasturiratne, A.; Pathmeswaran, A.; Gunawardena, N.K.; Jayamanne, S.F.; Isbister, J.K.; Dawson, A.; Lalloo, D.G.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: Snakebite is a neglected tropical disease that has been overlooked by healthcare decision makers in many countries. Previous studies have reported seasonal variation in hospital admission rates due to snakebites in endemic countries including Sri Lanka, but seasonal patterns have not been investigated in detail. METHODS: A national community-based survey was conducted during the period of August 2012 to June 2013. The survey used a multistage cluster design, sampled 165,665 individuals living in 44,136 households and recorded all recalled snakebite events that had occurred during the preceding year Log-linear models were fitted to describe the expected number of snakebites occurring in each month taking into account seasonal trends and weather conditions, and addressing the effects of variation in survey effort during the study and due to recall bias amongst survey respondents RESULTS: Snakebite events showed a clear seasonal variation. Typically, snakebite incidence was highest during November to December followed by March to May and August, but this varied between years due to variations in relative humidity, which is also a risk-factor. Low relative humidity levels was associated with high snakebite incidence. If current climate change projections are correct, this could lead to an increase in the annual snakebite of burden of 35,086 (95% CI: 4 202 a€" 69,232) during the next 25 to 50 years. CONCLUSION: Snakebite in Sri Lanka shows seasonal variation Additionally, more snakebites can be expected during periods of lower than expected humidity. Global climate change is likely to increase the incidence of snakebite in Sri Lanka.
Evaluating temporal patterns of snakebite in Sri Lanka: the potential for higher snakebite burdens with climate change
(Oxford University Press, 2018) Ediriweera, D.S.; Diggle, P.J.; Kasturiratne, A.; Pathmeswaran, A.; Gunawardena, N.K.; Jayamanne, S.K.; Isbister, G.K.; Dawson, A.; Lalloo, D.G.; de Silva, H.J.
BACKGROUND: Snakebite is a neglected tropical disease that has been overlooked by healthcare decision makers in many countries. Previous studies have reported seasonal variation in hospital admission rates due to snakebites in endemic countries including Sri Lanka, but seasonal patterns have not been investigated in detail. METHODS: A national community-based survey was conducted during the period of August 2012 to June 2013. The survey used a multistage cluster design, sampled 165 665 individuals living in 44 136 households and recorded all recalled snakebite events that had occurred during the preceding year. Log-linear models were fitted to describe the expected number of snakebites occurring in each month, taking into account seasonal trends and weather conditions, and addressing the effects of variation in survey effort during the study and of recall bias amongst survey respondents. ResulTS: Snakebite events showed a clear seasonal variation. Typically, snakebite incidence is highest during November–December followed by March–May and August, but this can vary between years due to variations in relative humidity, which is also a risk factor. Low relative-humidity levels are associated with high snakebite incidence. If current climate-change projections are correct, this could lead to an increase in the annual snakebite burden of 31.3% (95% confidence interval: 10.7–55.7) during the next 25–50 years. CONCLUSIONS: Snakebite in Sri Lanka shows seasonal variation. Additionally, more snakebites can be expected during periods of lower-than-expected humidity. Global climate change is likely to increase the incidence of snakebite in Sri Lanka.
Fetal effects of environmental exposure of pregnant women to organophosphorus compounds in a rural farming community in Sri Lanka
(Informa Healthcare, 2008) Samarawickrema, N.; Pathmeswaran, A.; Wickremasinghe, R.; Peiris-John, R.; Karunaratna, M.; Buckley, N.A.; Dawson, A.; de Silva, J.
BACKGROUND: The possible deleterious effects of low-grade, chronic environmental and occupational exposure to organophosphorus compounds (OPCs) are not well documented. OBJECTIVE: To investigate the possible effects of low-level, chronic exposure of pregnant mothers to OPCs on the fetus by measuring OPC levels, and using markers of OPC exposure, oxidative stress and oxidative tissue damage. METHODS: Toxicity was assessed by measuring (i) OPC levels in breast milk and plasma from maternal and cord blood using gas chromatography, (ii) maternal and fetal butyrylcholinesterase (BChE) activity using inhibition assays, (iii) antioxidant status of the fetus using superoxide dismutase activity assays, (iv) oxidative stress in the fetus by determining malondialdehyde (MDA) concentrations, and (v) examining for fetal DNA fragmentation using electrophoresis. Samples were obtained from consenting mothers living in a farming community in southern Sri Lanka at the end of the pesticide spray season (study group) and just before the commencement of the spray season (in-between spray season; control group). RESULTS: Organophosphate residues were detected in only two subjects (chlorpyrifos in maternal and cord blood of one during the spray season and dimethoate in breast milk of another during the in between spray season), but the test employed was capable of only detecting concentrations above 0.05 mg/l. However, cord blood obtained during the spray season showed significant inhibition of BChE activity, increased oxidative stress and more DNA fragmentation when compared with cord blood obtained during the in-between spray season. CONCLUSIONS: Inhibition of cord blood BChE activity indicates fetal exposure to organophosphorus compounds during times when there is a high probability of environmental drift. This provides a plausible explanation for the increased oxidative stress and high DNA fragmentation in the fetus. Long-term outcomes of such exposures are unknown.
Formulation changes and time trends in outcome following paraquat ingestion in Sri Lanka
(Informa Healthcare, 2011) Wilks, M.F.; Tomenson, J.A.; Fernando, R.; Ariyananda, P.L.; Berry, D.J.; Buckley, N.A.; Gawarammana, I.B.; Jayamanne, S.; Gunnell, D.; Dawson, A.
INTRODUCTION: Deliberate self-harm with pesticides is a significant public health problem in rural Asia. We have previously shown an improved survival of patients with paraquat self-poisoning following the introduction of a new formulation with an increased emetic concentration, an alginate and a purgative in Sri Lanka. Further, formulation changes were introduced in October 2006; this study was designed to assess the impact of these changes on 6-week mortality following paraquat ingestion. METHODS: Prospective, cohort study of patients admitted with paraquat poisoning to 10 hospitals across Sri Lanka between September 2006 and September 2008. RESULTS: Overall, there was a significant (p < 0.001) increase in survival in the 533 patients included in this study compared to previous data (44.5 vs. 35.2% before September 2006 and 27.1% before October 2004). Patients ingesting the new INTEON formulation had a higher survival rate than those ingesting standard formulation (40.2 vs. 31.0%), but this effect was not statistically significant in Cox's proportional hazards model (hazard ratio 0.81, 95% CI 0.61?1.08 (unadjusted) and 1.17, 95% CI 0.82?1.68 (fully adjusted), respectively). CONCLUSIONS: This study has confirmed a continued improvement in survival of patients following self-harm with paraquat in Sri Lanka in recent years; however, in contrast to previous investigations, a beneficial effect associated with the INTEON formulation could not be substantiated. This may be partly due to the large number of patients in whom paraquat concentrations were too low for analytical confirmation of the formulation (n = 105) and who had a very high survival rate (86.7%).
Health seeking behavior of snakebite victims in Sri Lanka: findings from an island-wide community-based study
(Sri Lanka Medical Association, 2014) Kasturiratne, A.; Pathmeswaran, A.; Gunawardena, N.K.; Ediriweera, E.P.D.S.; Wijayawickrama, B.A.; Jayamanne, S.F.; Isbister, G.; Dawson, A.; Lalloo, D.G.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: Health seeking behaviour of snakebite victims in the community has rarely been described and we investigated this as part of a community-based island-wide study on snakebite in Sri Lanka. METHODS: The national snakebite study was conducted in a!! 25 districts, in SriJ_anka in 2012/2013. 44,136 households were sampled in randomly selected clusters. In these households, any member reported to have experienced a snake bite within the preceding 12 months was considered a case. Data related to the health seeking behavior of snakebite were obtained using an interviewer-administered questionnaire. RESULTS: Among 165,665 individuals surveyed, 695 (60% males; median age 43 years) snakebite victims were identified. 323 (46.5%) had evidence of envenoming. 682 (98.2%) had sought health services after the bite. 381 (54.8%) sought allopathic medicine and 99.7% of them obtained this service from the state health sector, while 43.3% sought alternative medicine. The lowest rates of seeking allopathic medicine were seen in the Kalutara (8.7%) and Kegalie (10.7%) districts while highest rates were seen in the districts Mannar, Mullativu and Kilinochchi (100%). Puttalam (92.9%), Vavuniya (92.3%},) Ampara (89.5%), Jaffna (88.9%) and Anuradhapura (86.0%) also had high rates. 70.1% of the victims with envenoming sought allopathic medicine. Victims who had envenoming were significantly more likely to seek allopathic medicine (OR=3.35; 95% confidence interval 2.44-4.59) than those without envenoming. CONCLUSIONS: A considerable proportion of snake bite victims still seek alternative medicines in Sri Lanka.'A wide variation of practices exists across the country. Victims with envenoming are more likely to seek allopathic medicine.
Impact of a ward based clinical pharmacist intervention on improving the quality use of medicines in patients with chronic non communicable diseases in a tertiary hospital
(Sri Lanka Medical Association, 2014) Shanika, L.G.T.; Jayamanne, S.; Wijekoon, N.; Coombes, J.; Coombes, I.; Perera, D.; Dawson, A.; de Silva, H.A.
INTRODUCTION AND OBJECTIVES: To investigate the impact of a ward based clinical pharmacy service (CPS) on appropriate prescribing of discharge medications. METHODS: This is a non-randomised controlled trial conducted to assess CPS in a medical unit. Eligible patients admitted with non-communicable chronic diseases were considered. The female and the maie wards were the control and intervention during initial phase. Groups were swapped between two wards during next phase. The control patients received usual management. Intervention received CPS in addition to the existing management. Both clinical and demographic data were collected until discharge. Appropriateness of prescribing was assessed at discharge with the Medication Appropriateness Index (MAI). RESULTS: 354 (2140 medications) and 359 (2232 medications) patients' data were evaluated respectively in, control and intervention. Medications received per patient in both groups were similar. Appropriateness of discharged medications in intervention' group was significantly higher compared to control, 66% (235/359) and 34% (120/354) respectively (p< 0.0001). Furthermore, the mean MAI score per patient was significantly lower in intervention compared to th.e control (0.99 vs. 4.1, p< 0.001). Proportion of appropriate prescriptions in relation to all MAI criteria was significantly lower in intervention group compared to the control, all (p< 0.01). Among the drugs prescribed in the intervention [5% (112/2232)] and control groups, [20% (420/2140)] respectively had at least one inappropriate MAI criterion (p< 0.0001). CONCLUSIONS: This study demonstrates that a ward based CPS can reduce inappropriate prescribing of medications at discharge providing an opportunity to improve quality use of medicine.
Impact of a ward-based clinical pharmacist on improving medication knowledge and adherence in patients with chronic non-communicable diseases
(Sri lanka Medical Association, 2015) Shanika, L.G.T.; Wijekoon, N.; Jayamanne, S.; Coombes, J.; Coombes, I.; Perera, D.; Pathiraja, V.; Dawson, A.; de Silva, H.A.
INTRODUCTION AND OBJECTIVES: This is the first study done in Sri Lanka to evaluate the benefit of a ward-based pharmacist on improving medication knowledge and adherence in patients with chronic non-communicable diseases. METHOD: This is a part of a controlled trial conducted in a tertiary care hospital to evaluate ward-based clinical pharmacy service. Intervention group (IG) received a ward-based pharmacist's service during hospitalization to optimize the patients' drug therapy. At discharge the pharmacist counseled patients regarding all aspects (name, indication, dose, frequency, side effects, and actions for side effects, timing, monitoring and storage) of long term medications and written instructions were also provided. Control group (CG) received usual care without a ward-based pharmacist. The knowledge and adherence were assessed over the phone on the 6th day after discharge by a different pharmacist. Previously validated knowledge and adherence questionnaires were used. RESULTS: There were 334 and 311 patients in the IG and CG, respectively, The IG had a significantly higher average medication knowledge compared to the CG {IG-75.81+19.14 vs. CG-40.84+19.20; P < 0.001). Proportion of drugs with correct answers, to all 9 dimensions tested, was greater in the IG compared to the CG (P < 0.001). IG had a significantly higher medication adherence score compared to the CG (IG-92.97±15.04 vs. CG-80.42±28,29; P <0.001). A significantly large number of individuals in the IG had high adherence score on Morisky adherence scale compared to the CG (P < 0.001). CONCLUSION: Discharge counseling by a ward-based pharmacist improves medication knowledge and adherence of patients on long term medications.
Impact of a ward-based clinical pharmacy service in reducing drug-related hospital re-admissions in patients with chronic non-communicable diseases; evidence from a controlled trial in Sri Lanka
(Sri lanka Medical Association, 2015) Shanika, L.G.T.; Wijekoon, N.; Jayamanne, S.; Coombes, J.; Mamunuwa, N.; Dawson, A.; de Silva, H.A.
INTRODUCTION AND OBJECTIVES: Literature showed that pharmacists' interventions helped to reduce drug related hospital re-admissions. The objective of this study was to determine the impact of a ward-based clinical pharmacy service on drug related hospital re-admissions in Sri Lanka. METHOD: This was a part of a controlled trial conducted in a tertiary care hospital in Sri Lanka to evaluate the clinical pharmacy service. The intervention group (IG) received a clinical pharmacist's service in addition to the standard care provided to control group (CG). The pharmacist performed a prospective medications review of patients with chronic non-communicable diseases during hospital stay and made recommendations to the health care team when appropriate. At discharge reconciliation of discharge prescription was done. Patients were educated about discharge medicines to improve knowledge and compliance. Both groups were followed up monthly for six months to identify drug-related hospital re-admissions. RESULTS: Of 137 drug-related re-admissions, 93 (involving 87/356 patients) were from the CG, and 44 (involving 42/361 patients) were from the IG {P < 0.001). Non-compliance was the main reason for re-admissions in the CG. Significantly higher incidence of non-compliance per patient were recorded in CG (CG vs. IG: 13.8% vs. 4.2%; P < 0.001). There was a significantly higher percentage of re-admissions per patient in the CG due to unintentional omission of drugs on discharge prescription (CG vs. IG: 4.5% vs. 0.3%; P < 0.001). The percentage of re-admissions per patient due to adverse drug reactions was similar in the two groups. CONCLUSION: The ward-based clinical pharmacy service is useful in reducing drug related hospital re-admissions in patients with chronic non-communicable diseases. clinical pharmacist's service in addition to the standard care provided to control group (CG). The pharmacist performed a prospective medications review of patients with chronic non-communicable diseases during hospital stay and made recommendations to the health care team when appropriate. At discharge reconciliation of discharge prescription was done. Patients were educated about discharge medicines to improve knowledge and compliance. Both groups were followed up monthly for six months to identify drug-related hospital re-admissions. RESULTS: Of 137 drug-related re-admissions, 93 (involving 87/356 patients) were from the CG, and 44 (involving 42/361 patients) were from the IG {P < 0.001). Non-compliance was the main reason for re-admissions in the CG. Significantly higher incidence of non-compliance per patient were recorded in CG (CG vs. IG: 13.8% vs. 4.2%; P < 0.001). There was a significantly higher percentage of re-admissions per patient in the CG due to unintentional omission of drugs on discharge prescription (CG vs. IG: 4.5% vs. 0.3%; P < 0.001). The percentage of re-admissions per patient due to adverse drug reactions was similar in the two groups. CONCLUSION: The ward-based clinical pharmacy service is useful in reducing drug related hospital re-admissions in patients with chronic non-communicable diseases.
Improvement in survival after paraquat ingestion following introduction of a new formulation in Sri Lanka
(Public Library of Science, 2008) Wilks, M.F.; Fernando, R.; Ariyananda, P.L.; Eddleston, M.; Berry, D.J.; Tomenson, J.A.; Buckley, N.A.; Jayamanne, S.; Gunnell, D.; Dawson, A.
BACKGROUND: Pesticide ingestion is a common method of self-harm in the rural developing world. In an attempt to reduce the high case fatality seen with the herbicide paraquat, a novel formulation (INTEON) has been developed containing an increased emetic concentration, a purgative, and an alginate that forms a gel under the acid conditions of the stomach, potentially slowing the absorption of paraquat and giving the emetic more time to be effective. We compared the outcome of paraquat self-poisoning with the standard formulation against the new INTEON formulation following itsintroduction into Sri Lanka. METHODS AND FINDINGS: Clinical data were prospectively collected on 586 patients with paraquat ingestion presenting to nine large hospitals across Sri Lanka with survival to 3 mo as the primary outcome. The identity of the formulation ingested after October 2004 was confirmed by assay of blood or urine samples for a marker compound present in INTEON. The proportion of known survivors increased from 76/297 with the standardformulation to 103/289 with INTEON ingestion, and estimated 3-mo survival improved from 27.1% to 36.7% (difference 9.5%; 95% confidence interval [CI] 2.0%-17.1%; p = 0.002, log rank test). Cox proportional hazards regression analyses showed an approximately 2-fold reduction in toxicity for INTEON compared to standard formulation. A higher proportion of patients ingesting INTEON vomited within 15 min (38% with the originalformulation to 55% with INTEON, p < 0.001). Median survival time increased from 2.3 d (95% CI 1.2-3.4 d) with the standard formulation to 6.9 d (95% CI 3.3-10.7 d) with INTEON ingestion (p = 0.002, log rank test); however, in patients who did not survive there was a comparatively smaller increase in median time to death from 0.9 d (interquartile range [IQR] 0.5-3.4) to 1.5 d (IQR 0.5-5.5); p = 0.02. CONCLUSIONS: The survey has shown that INTEON technology significantly reduces the mortality of patients following paraquat ingestion and increases survival time, most likely by reducing absorption. Comment in : New formulation of paraquat: a step forward but in the wrong direction. [PLoS Med. 2008]
Mapping the risk of snakebite in Sri Lanka - A national survey with geospatial analysis
(Public Library of Science, 2016) Ediriweera, E.P.D.S.; Kasturiratne, A.; Pathmeswaran, A.; Gunawardena, N.K.; Wijayawickrama, B.A.; Jayamanne, S.F.; Isbister, G.K.; Dawson, A.; Giorgi, E.; Diggle, P.J.; Lalloo, D.G.; de Silva, H.J.
BACKGROUND: There is a paucity of robust epidemiological data on snakebite, and data available from hospitals and localized or time-limited surveys have major limitations. No study has investigated the incidence of snakebite across a whole country. We undertook a community-based national survey and model based geostatistics to determine incidence, envenoming, mortality and geographical pattern of snakebite in Sri Lanka. METHODOLOGY/PRINCIPAL FINDINGS: The survey was designed to sample a population distributed equally among the nine provinces of the country. The number of data collection clusters was divided among districts in proportion to their population. Within districts clusters were randomly selected. Population based incidence of snakebite and significant envenoming were estimated. Model-based geostatistics was used to develop snakebite risk maps for Sri Lanka. 1118 of the total of 14022 GN divisions with a population of 165665 (0.8%of the country’s population) were surveyed. The crude overall community incidence of snakebite, envenoming and mortality were 398 (95% CI: 356–441), 151 (130–173) and 2.3 (0.2–4.4) per 100000 population, respectively. Risk maps showed wide variation in incidence within the country, and snakebite hotspots and cold spots were determined by considering the probability of exceeding the national incidence. CONCLUSIONS/SIGNIFICANCE: This study provides community based incidence rates of snakebite and envenoming for Sri Lanka. The within-country spatial variation of bites can inform healthcare decision making and highlights the limitations associated with estimates of incidence from hospital data or localized surveys. Our methods are replicable, and these models can be adapted to other geographic regions after re-estimating spatial covariance parameters for the particular region.