Browsing by Author "Fernando, S.D."

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Association of depression, anxiety and stress among outpatients with rheumatoid arthritis at a tertiary care hospital in Sri Lanka; a cross-sectional study
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2021) Wijewantha, K.S.L.; Wijewardena, D.L.T.M.; Wijethunga, W.T.N.K.; de Silva, N.L.; Fernando, S.D.
Introduction: Depression, anxiety and stress and their associated factors, in patients with rheumatoid arthritis, vary across regions. Sri Lankan studies assessing the prevalence and associations of these factors are lacking. Objectives: To describe the prevalence and factors associated with depression, anxiety and stress among patients with Rheumatoid arthritis at specialised Rheumatology clinics of the National Hospital Sri Lanka. Methods: A cross-sectional study was carried out at three rheumatology clinics at the National Hospital of Sri Lanka. Sociodemographic and clinical data including the Clinical Disease Activity Index (CDAI) was recorded using an interviewer-administered questionnaire. The validated Depression, Anxiety, Stress Scale-21 was used. Analysis was done using descriptive analysis and chi-square. Results: The prevalence of depression, anxiety and stress in the study cohort (n= 118) was 50.93%, 57.41% and 47.17% respectively. Majority of the patients were in the moderate (39%) and high disease activity groups (36%). Increased prevalence of all three was observed with reduced functional status. Depression was observed among those > 60 years (p=0.035) and with CDAI >22.1 (p=0.004). Anxiety was observed with increased CDAI >22.1 (p=0.023). Stress was associated with unemployment (p=0.009) and morning stiffness > 60 minutes (p=0.001). Diabetes (p=0.016), ischemic heart disease (p= 0.042) and dyslipidaemia (p=0.005) were adversely associated with depression. Anxiety was associated with dyslipidaemia (p=0.005). Conclusions: Prevalence of depression, anxiety and stress is high and interferes with the quality of life and disease prognosis. Disease activity, functional deterioration as well as the presence of co-morbidities are associated with these mental health issues.
Characterization of a Dengue Positive Population in Colombo Municipal Council (CMC) Medical Officer of Health (MOH), Colombo
(Faculty of Graduate Studies, University of Kelaniya, Sri Lanka, 2016) Lakmal, M.G.K.; Udayanga, N.W.B.A.L.; Gunathilaka, P.A.D.H.N.; Fernando, S.D.; Karunathilaka, K.; Abeyewickreme, W.
Dengue that has caused 29,777 suspected infections in 2015 has emerged the most challenging health issue faced in Sri Lanka. Approximately 51% of dengue infections are reported from the Western Province. The susceptibility of a population to dengue is influenced by a combination of socio-economic, environmental and epidemiological factors. The current study was conducted to characterize a population of dengue patients residing in a high dengue risk area in terms of their socio-economic appearance. An interviewer administrated questionnaire was used to collect information on the socio-economic aspects of a group of 140 randomly selected dengue positive patients residing in Colombo Municipal Council (CMC) Medical Officer of Health (MOH) area. Out of 140, a majority (63.6%, n=89) were females, while the age groups of 31-40 and 21-30 years were recognized as the most susceptible age groups for dengue. High proportion of the patients (79.3%, n=111) were having an educational level below secondary school (O/L) with a total family income below 20,000 LKR (80.7%, n=113). All the homesteads were smaller (<5 perch) in size, with small roads for access (77.1%, n=108) and/or a footpath (22.9%, n=32) as the access route. Majority of the households (69.3%, n=97) were temporary with moderate conditions (51.4%, n=72), that were mainly utilized for both residential and commercial purposes (63.5%, n=89) at once. In a majority of households’ solid waste was disposed within 7 days (62.1%) via the Municipal Council or by keeping near the main roads (37.9%). Source separation of waste, home gardening and composting by the study population was minimal (n=137, 97.9%). Pipe water remained as the only water source while approximately 27.9% (n=39) households were lacking sanitary facilities. Use of mosquito coils and bed-nets were the most preferred mosquito biting prevention methods. Low educational level, income, poor living conditions and limitations in solid waste disposal methods were recognized as potential risk factors for high infection rates of dengue in this population. Special focus should be given to these key areas by the relevant vector controlling authorities in order to facilitate controlling of dengue outbreaks within the CMC area.
Chemoprophylaxis for malaria: A costly approach to prevent re-establishment of malaria in Sri Lanka
(Sri Lanka Medical Association, 2021) Muzrif, M.M.; Mendis, K.N.; Weerasekera, C.J.; Karunaratna, S.; Wickremasinghe, R.; Ranaweera, K.D.N.P.; Fernando, S.D.
Introduction and Objectives As a measure to prevent the re-establishment of malaria in the country, the Anti Malaria Campaign (AMC) provides antimalarial chemoprophylactic medicines for up to six months free-of-charge to anyone travelling to malaria endemic countries. The objective of this study was to identify the trends of chemoprophylaxis prescription by the AMC and the costs involved. Methods Data were extracted from the national malaria database regarding the number of travellers issued with antimalarial chemoprophylactic medicines during the years 2017-2019. The amount spent for purchase of antimalarial chemoprophylactic medicines was determined. Results Over the three year period the overall number of individuals issued with antimalarial chemoprophylaxis increased (1714 in 2017, 2600 in 2018 and 3053 in 2019). The number of travellers obtaining chemoprophylaxis for malaria when travelling to African countries reduced, while the number travelling to India increased. The cost incurred to the Government of Sri Lanka to purchase mefloquine and doxycycline for prophylaxis was USD 45,755, while the cost to purchase CQ over the three year period for prophylaxis alone was USD 310,714. The total cost incurred to purchase the prophylactic antimalarials have also increased significantly over the three year period, the cost being eleven times higher in 2019 than in 2017. Conclusion Chemoprophylaxis against malaria remains an important strategy to sustain the malaria elimination status in Sri Lanka, and the cost of this intervention is considerable and increasing over time. The local production of anti malarials might be warranted if it will reduce the cost of chemoprophylaxis.
Climate change and malaria
(United Nations Publications, 2010) Wickremasinghe, R.; Wickremasinghe, A.R.; Fernando, S.D.
The Clinical and epidemiological features of childhood malaria in a moderately endemic area of Sri Lanka
(SEAMEO Regional Tropical Medicine and Public Health Project, 2002) Fernando, S.D.; Wickremasinghe, A.R.
This study describes some clinical and epidemiological features of childhood malaria in a moderately endemic area of southern Sri Lanka. Six hundred and sixty-two children, who experienced 1,138 attacks of malaria, and 172 children, who experienced 202 attacks of acute non-malarial fever, were followed over a period of two years. Of the 1,138 malaria infections followed, 776 were due to P. vivax, 359 were due to P. falciparum, and 3 were mixed infections. The majority of children presented within the first three days of the onset of symptoms. Headache (96%), feeling cold (81%) and arthralgia (77%) were the commonest presenting symptoms. Two hundred and sixty-four children experienced more than one attack of malaria. The clinical and epidemiological features of childhood malaria that have important implications for the planning and targeting of preventive measures are discussed.
Clinicopathological Profile of Cutaneous Leishmaniasis in Army Personnel in the Kilinochchi and Mulllativu Districts of Sri Lanka
(Sri Lanka Medical Association, 2020) Wijesinghe, H.D.; Gunathilaka, N.; Semege, S.; Pathirana, K.P.N.; Manamperi, N.; de Silva, M.V.C.; Fernando, S.D.
INTRODUCTION AND OBJECTIVES: Leishmaniasis is caused by an intra cellular protozoan of the genus Leishmania. The clinicopathological profile of cutaneous leishmaniasis (CL) varies according to the species. Leishmania donovani is the causative organism for leishmaniasis in Sri Lanka. This study describes the clinicopathological features of cutaneous leishmaniasis among army personnel serving in two Northern districts of the country. METHODS: In this collaborative cross-sectional study, the histopathology of fifty cases of CL confirmed by at least two methods (slit skin smear, lesion aspirate, tissue impression and histology) were reviewed. The parasitic load was assessed semi-quantitatively. The histological features were correlated with the clinical presentation and organism load. RESULTS: The majority (89.8%; n=44) presented with a single lesion mostly located in the upper limb (69.4%, n=34). The lesion types included papule (34.7%, n=17), nodule (32.7%, n=16) and ulcer (30.6%, n=15). Evolution time of lesions averaged 31.55 weeks. Epidermal changes were observed in 49 and included hyperkeratosis (90.0%; n=45), acanthosis (44.0%; n=22), atrophy (34.0%; n=17) and interface change (66%; n=33). Dermal changes were seen in all cases and characterized by a lymphohistioplasmacytic inflammatory infiltrate of variable intensity with ill-formed granuloma in 19 cases (38%) and well-formed epithelioid granulomas in 22 cases (44%). Focal necrosis was present in 20 % (n=10). Leishmania amastigote forms were observed in 88% (n=44). Transepidermal elimination (P=0.025), granuloma (P=0.027) formation and type of lesion (P=0.034) were significantly associated with organism load with granuloma formation being associated with reduction in organism load. CONCLUSION: Histopathological changes were characterised by a diffuse lymphohistioplasmacytic infiltrate, ill-defined granuloma or well-formed granuloma. Well-formed granulomata were associated with a reduction in organism load.
Contribution of the private sector healthcare service providers to malaria diagnosis in a prevention of re-introduction setting
(BioMed Central, 2016) Fernando, S.D.; Dharmawardena, P.; Epasinghe, G.; Senanayake, N.; Rodrigo, C.; Premaratna, R.; Wickremasinghe, R.
BACKGROUND: Sri Lanka is currently in the prevention of re-introduction phase of malaria. The engagement of the private sector health care institutions in malaria surveillance is important. The purpose of the study was to determine the number of diagnostic tests carried out, the number of positive cases identified and the referral system for diagnosis in the private sector and to estimate the costs involved. METHODS: This prospective study of private sector laboratories within the Colombo District of Sri Lanka was carried out over a 6-month period in 2015. The management of registered private sector laboratories was contacted individually and the purpose of the study was explained. A reporting format was developed and introduced for monthly reporting. RESULTS: Forty-one laboratories were eligible to be included in the study and 28 participated by reporting data on a monthly basis. Excluding blood bank samples and routine testing for foreign employment, malaria diagnostic tests were carried out on 973 individuals during the 6-month period and nine malaria cases were identified. In 2015, a total of 36 malaria cases were reported from Sri Lanka. Of these, 24 (67 %) were diagnosed in the Colombo District and 50 % of them were diagnosed in private hospitals. CONCLUSIONS: An equal number of cases were diagnosed from the private sector and government sector in the Colombo District in 2015. The private sector being a major contributor in the detection of imported malaria cases in the country should be actively engaged in the national malaria surveillance system.
Core Banking Systems and Business Intelligence for Effective Strategic Decision Making
(Faculty of Commerce and Management Studies, University of Kelaniya, 2015) Fernando, S.D.
Considering about the nature of existing core banking systems the fundamental attribute is it can be identify as a transaction processing system. It means that the system is processing day-to-day banking business transactions and stored historical information. Core banking systems are playing vital role in any fully automated bank as an information system hub. But the basic question is raised when focus to the information requirement for strategic decision making process. Are core banking systems providing required information to make effective strategic decisions? Can core banking systems fulfilling the task as an alternative for the business intelligence system? When focus to the identified problems with core banking systems it can be separated in to two categories such as system operational issues and strategic decision making difficulties due to using core banking historical system information. System integration issues due to different database platforms, data processing issues due to using different front end applications, data mining and quarry limitation can be identified as System Operational Issues and above two questions can be review under the strategy issue. Review of literature and case study approach has been applied as a methodology with qualitative analysis. Conclusions and recommendations are based on the analysis.
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
Employee Personal Financial Literacy as Strategic Human Resource Management Initiative: With Special Reference to ABC Bank PLC
(Faculty of Commerce and Management Studies, University of Kelaniya, Sri Lanka, 2016) Fernando, S.D.
The innovation of mechanics has opened the door to industrial revolution in the 18th century. Labor factor has become a most essential part of the conventional process as a result of new trading system as well as the mass production. With the above environmental changes many new academic disciplines came to the scenario including the personnel management. From the beginning to the modern day practices the rational objective of HRM is to increase the labor productivity with the minimum cost. However, through the evolution of HRM today employees are enjoying high level of work life conditions. Today some schools are talking about employee welfare oriented HRM initiatives. This paper contributes to the development of employee welfare oriented HRM imitative through reviewing the concept of employee’s personal financial literacy. The basic assumption behind the concept of employee financial literacy would be the employees are depending on the total financial reward which is provided by the employer and the basic argument would be that the employer should have a policy to empower their employees’ personal financial literacy as a strategic HR initiative. Reviewing literature was the primary method of concept development. The primary objective of this paper is to review the employee’s personal financial literacy oriented SHRM policy in ABC bank plc. Full time bank employees are considered as a population of the study and simple random sampling technique used to collect primary data. Both qualitative and quantitative techniques are applied to obtain the results. The study is very much significant to HR professionals as well as business policy makers.
First report of V1016G and S989P knockdown resistant (kdr) mutations in pyrethroid-resistant Sri Lankan Aedes aegypti mosquitoes
(BioMed Central, 2018) Fernando, S.D.; Hapugoda, M.; Perera, R.; Saavedra-Rodriguez, K.; Black WC 4th; de Silva, N.K.; ; ;
BACKGROUND: Dengue is a serious arboviral disease in Sri Lanka with a large number of dengue fever (DF) cases every year. Control of the primary vector Aedes aegypti depends upon larval habitat source reduction and insecticide application. However, increases in the number of reported cases suggest the inefficiency of current control strategies and the possibility of resistance to currently used insecticides. Early detection of mutations in the voltage-gated sodium channel (vgsc) gene that confer knockdown resistance (kdr) to pyrethroid insecticides is important in resistance management in vector populations. RESULTS: Resistance to pyrethroid insecticides was detected in the three populations studied. Polymerase chain reaction was used to detect the presence of two kdr mutations F1534C and V1016G. During this process a S989P mutation was also detected in pyrethroid-resistant Ae. aegypti populations. These mutations were found to be widespread and frequent in the collections studied. CONCLUSIONS: To our knowledge, this study reveals for the first time the presence of V1016G and S989P mutant alleles in the vgsc of Sri Lankan Ae. aegypti populations. The spread of the mutant alleles throughout the country poses a threat of increased resistance to pyrethroids. Long-term insecticide applications and indiscriminate use of pyrethroids has led to the evolution of resistance. More strategic and diverse strategies, including novel insecticides with new modes of action and community participation, should be engaged for Ae. aegypti control.
Geo-helminth infections in a rural area of Sri Lanka
(SEAMEO Regional Tropical Medicine and Public Health Project, 2001) Fernando, S.D.; Goonethilleke, H.; Weerasena, K.H.; Kuruppuarachchi, N.D.; Tilakaratne, D.; de Silva, D.; Wickremasinghe, A.R.
School children carry the heaviest burden of morbidity due to intestinal helminth infection. The objective of this investigation was to study geo-helminth infections in 349 school children aged 6 to 13 years living in a rural area of Sri Lanka. Stool samples were examined by direct saline smear in an initial survey to determine the prevalence of intestinal parasitic infections and thereafter the children were followed up over a two year period with cross sectional surveys of stool samples being carried out at yearly intervals. Following collection of a stool sample, all the subjects were treated with mebendazole 500 mg as a single dose. Weights and heights were measured using standardized procedures. 2 ml of venous blood were collected from each subject under aseptic conditions to determine hematological indices. The prevalence of geo-helminth infections was low, and the prevalence declined during the two-year period from 5.4 percent in 1997 to 2.2 percent in 1998 and 2.0 percent in 1999 following yearly mass anti-helminth treatment. The incidence density was 0.021 cases per child year. The reduction in the prevalence from the baseline to the second survey is probably due to the reduction of the reservoir of infection among children as a result of mass treatment at baseline. The prevalence of infection during the second and third surveys were almost the same probably due to infections originating from other segments of the untreated population.
The Health and nutritional status of school children in two rural communities in Sri Lanka
(Blackwell Scientific Publications, 2000) Fernando, S.D.; Paranavitane, S.R.; Rajakaruna, J.; Weerasinghe, S.; Silva, D.; Wickremasinghe, A.R.
There is growing evidence of considerable burden of morbidity and mortality due to infectious diseases and undernutrition in school children. This study describes the nutritional status and parasitic infections of school children in two areas of rural Sri Lanka. All children in four primary schools in the Moneragala district of Sri Lanka were included in the study. The height and weight of children were measured and anthropometric indices calculated. Stool and blood samples were examined for evidence of intestinal helminthiasis, malaria and anaemia. A greater proportion of boys than girls were underweight, wasted and stunted. Over 80 percent of the children were anaemic but did not apparently have iron deficiency anaemia according to their blood picture. The prevalence of parasitic infections such as hookworm and Plasmodium spp that may contribute to anaemia was low.
Impact of childhood malaria in Sri Lanka
(2005) Fernando, S.D.; Wickremasinghe, R.; Wickremasinghe, A.R.; Mahawithanage, S.T.C.
Impact of mass chemotherapy filariasis control programme on soil-transmitted helminth infections in Ragama
(Sri Lanka Medical Association, 2003) de Silva, N.R.; Pathmeswaran, A.; Fernando, S.D.; Weerasinghe, C.R.; Selvaratnam, R.R.; Padmasiri, E.A.
OBJECTIVE: To assess the impact of using albendazole in the'national Mass Drug Administration (MDA) programme for filariasis control, on soil-transmitted helminth (STH) infections'in Ragama. METHODS: The prevalence and intensity of STH infections was assessed before and after introduction of albendazole into the MDA programme in the Ragama MOH area, which has endemic transmission of both lymphatic filariasis and STH. Children attending Year 3 classes in 6 schools (selected in a random stratified manner) were examined during a baseline survey in March-May 2002. The follow-up survey (Sept-Oct) covered Year 4 children in the same schools after the MDA programme in July. All stool samples were examined on the day of collection using the modified Kato-Katz technique. RESULTS: The cumulative prevalence of STH infection was very low in both surveys: 4.5% (12/265) at baseline, and 2.0% (5/252) at follow-up. Trichuriasis was. the commonest infection (4.1% and 1.6%), followed by ascariasis (0.8% and 0.4%). The species prevalence rates, cumulative prevalence, and mean egg counts all declined from baseline to follow-up, but the differences were not statistically significant. The majority of children (85%) examined in the follow-up survey said they had taken both diethylcarbamazine citrate and albendazole during the MDA programme. CONCLUSIONS: Although it is possible that inclusion of albendazole in the MDA programme had an impact on STH infections, it is unlikely that any resultant decline in prevalence will have a significant impact on the health of schoolchildren in the Ragama MOH area since prevalence rates are now very low.
Impact of mass chemotherapy for the control of filariasis on geohelminth infections in Sri Lanka
(Academic Press, 2003) de Silva, N.R.; Pathmeswaran, A.; Fernando, S.D.; Weerasinghe, C.R.; Selvaratnam, R.R.; Padmasiri, E.A.; Montresor, A.
No Abstract Available
The impact of repeated malaria attacks on the school performance of children
(American Society of Tropical Medicine and Hygiene, 2003) Fernando, S.D.; Gunawardena, D.M.; Bandara, M.R.; de Silva, D.; Carter, R.; Mendis, K.N.; Wickremasinghe, A.R.
The impact of repeated malarial infections on the school performance of children was investigated in 571 school children 6-14 years of age in a malaria-endemic area in southern Sri Lanka where both Plasmodium falciparum and P. vivax infections are prevalent. Malaria infections confirmed by microscopy were monitored over a six-year period. School performance was assessed by two specially designed, school grade-specific, test papers for Sinhala language and mathematics. The scores for Sinhala language and mathematics for each school term test for the year 1997 were obtained. Malarial infections were a major predictor of children's performance in language and mathematics after controlling for parent's education, monthly family income, and house type. The education of the father predicted language scores but not mathematics scores. A child who experienced more than five attacks of malaria scored approximately 15 percent less than a child who experienced less than three attacks of malaria. The data suggest that repeated attacks of malaria have an adverse impact on the school performance of children.
Importance of active case detection in a malaria elimination programme
(The Bulletin of the Sri Lanka College of Microbiologists, 2014) Wickremasinghe, R.; Fernando, S.D.; Thiliekaratne, J.; Wijeyaratne, P.M.; Wickremasinghe, A.R.
INTRODUCTION AND OBJECTIVES: Malaria surveillance methods routinely used in Sri Lanka are passive and active case detection (PCD, ACD) and activated passive case detection (APCD). Active case detection is carried out by mobile malaria clinics. Tropical and Environmental Diseases and Health Associates (TEDHA) an implementation partner of the Anti Malaria Campaign (AMC) carries out APCD and ACD in four districts in Sri Lanka namely Trincomalee, Batticaloa, Ampara and Mannar, complementing the parasitological surveillance activities carried out by the AMC. DESIGN, SETTING AND METHODS: The ACD programme of TEDHA involves screening of populations irrespective of the presence of fever or any other signs or symptoms of malaria to detect infections and residual parasite carriers. TEDHA screens a) high risk populations using ACD through mobile malaria clinics including armed forces personnel and b) pregnant females who visit antenatal clinics for asymptomatic malaria infections during their first trimester. Populations are selected in consultation with the Regional Malaria Officer of the AMC thus avoiding any overlap with the population screened by the government. RESULTS: TEDHA screened 387.309 individuals between January 2010 and December 2012, for malaria by ACD including high risk groups and pregnant women and diagnosed eight malaria positive cases (7 Ptasmodium vivax infections and one mixed infection with P. vivax and Plasmodium falciparum}. All these cases were from the Mannar district amongst resettled populations and army personnel. During this period 125 cases were detected in the Mannar district by the Anti Malaria Campaign by passive case detection. No cases of malaria were detected by ACD by the AMC. CONCLUSIONS: The progress made by Sri Lanka in the malaria elimination drive is largely due to increased surveillance and judicious use of control methods. The country now needs to focus on enhanced surveillance to be malaria free and to prevent re-introduction of malaria into the country. As highlighted here, ACD played a major role in interrupting malaria transmission in the country. ACKNOWLEDGEMENTS: Financial assistance by the Global Fund (Grant, No. PR2 SRL809G11-M) is gratefully acknowledged. The authors would like to acknowledge the support given by the staff of TED HA.
Importance of active case detection in a malaria elimination programme
(BioMed Central, 2014) Wickremasinghe, R.; Fernando, S.D.; Thillekaratne, J.; Wijeyaratne, P.M.; Wickremasinghe, A.R.
Introduction of human immunization reduced Japanese Encephalitis (JE) cases dramatically in Sri Lanka. However, the increased reporting ofadverse events following immunization (AEFI) affected vaccine acceptance by the community. Against this background, we describe the incidence of overall AEFI and incidence and profile of AEFI, thought to be causally related to the mouse-brain derived JE vaccine. A follow-up of 9798 vaccine recipients was performed for a period of two weeks post-vaccination. Parents self-recorded observed signs and symptoms. The self-records were collected by trained supervisors. All monitored children who manifested symptom/s were investigated in details by medical officers experienced in AEFI investigations within two weeks after ending the follow-up period. Using the results of the investigation, the causality assessment was performed. The estimated cumulative incidence rate of overall AEFI was 8.6 children per 100 immunizations. The same for observed AEFI consistent with causal association to the inactivated JE vaccine was 4.3 children (95% CI-3.9-4.7%) per 100 immunizations. The most frequent AEFI was fever (81%). The frequency of high fever (>102 °F) was 26%. Other major AEFI were body ache (22%) vomiting (21%), urticaria (19%), pruritus (5%), and headache (5%). Though 83% of children with AEFI thought to be causally related to the vaccine sought medical care, only 6.6% required hospitalizations. The incidence rate of AEFI in the cohort event monitoring was several-fold higher than that reported through the national AEFI surveillance system. The incidence rate of allergic manifestations among Sri-Lankan children approached what was reported for non-endemic settings and was higher than in other JE endemic populations elsewhere. Contrary to the belief of medical practitioners and the general public, incidence of seizures was low and vaccine related other neurological manifestations were absent.
The need for preventive and curative services for malaria when the military is deployed in endemic overseas territories: a case study and lessons learned
(BioMed Central, 2017) Fernando, S.D.; Booso, R.; Dharmawardena, P.; Harintheran, A.; Raviraj, K.; Rodrigo., C.; Danansuriya, M.; Wickremasinghe, A.R.
BACKGROUND: Sri Lanka has been free from indigenous malaria since November 2012 and received the WHO certificate for malaria-free status in September 2016. Due to increased global travel, imported malaria cases continue to be reported in the country. Military personnel returning home from international peace-keeping missions in malaria endemic countries represent a key risk group in terms of imported malaria. The present study intended to characterize the potential causes of a malaria outbreak among the Sri Lankan security forces personnel deployed in the Central African Republic (CAR). METHODS: Data were collected from a cross-sectional survey distributed among Sri Lankan Air Force personnel who had returned from United Nations peace-keeping missions in the CAR region. A pre-tested questionnaire was used for the data collection, and focus group discussions were also conducted. RESULTS: One hundred twenty male Air Force personnel were interviewed (out of a group of 122 officers and airmen). All participants were deployed in the CAR for 14 months and were aware of the existence of chemoprophylaxis against malaria. The majority of the subjects (92.5%, 111/120) also knew that prophylaxis should be started prior to departure. However, the regular use of chemoprophylaxis was reported by only 61.7% (74/120) of the sample. Overall, 30.8% of the participants (37/120) had 44 symptomatic episodes of malaria during deployment, and one person succumbed to severe malaria. All cases were associated with noncompliance with chemoprophylaxis. CONCLUSION: Better coordination with overseas healthcare services and the establishment of directly observed chemoprophylaxis may help to avoid similar outbreaks in the future.