Browsing by Author "Gamage, A.U."

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Evidence-based and epidemiological interpretation of the diagnosis of SARS-COV-2
(College of Community Physicians of Sri Lanka, 2021) Abeysena, C.; Gamage, A.U.
Introduction: Diagnostic tests are never perfect, leading to inaccurate decisions by healthcare workers. Study aimed to compile the evidence and facilitate the epidemiological interpretation of testing available for the COVID-19. Methods: Published systematic reviews, especially Cochrane reviews and evidence summaries were used. Positive-predictive-values (PPV), negative-predictive-values (NPV), and its 95% confidence intervals (CI) were calculated following application to a hypothetical cohort of 1000 patients, the reported sensitivities and specificities and assumed pre-test probability levels. Results: At a low pre-test probability level, PPV is 63.6%(95%CI: 37.8%-83.5%) when assumed 72%sensitivity of the antigen test among symptomatic patients and 60.0% 95%CI: 33.3%-81.8%) when assumed 58% sensitivity of the antigen test among asymptomatic patients. If the sensitivity is low, PPV will become a low value. PPV is high with a higher pre-test probability level; however, the NPV is 78%(95%CI: 75.5%-80.4%) among symptomatic and 70.3%(95%CI: 68%-72.4%) among asymptomatic patients. PPV is 44.4% (95%CI: 28.6%-61.5% at a low pre-test probability level) when assumed 80% sensitivity for the RT-PCR test. Further, assuming that the sensitivity of 95%, PPV is 47.4% (95%CI: 32%-63%). At a higher pre-test probability level, the NPV is 83.2% (95%CI: 80.6%-85.5%) when assumed 80% sensitivity. Further, the sensitivity of the RT-PCR is 95%, NPV is 95.2%(95%CI: 93.1% to 96.7%). Conclusions: With a low pre-test probability, positive results should be interpreted cautiously and need a second specimen tested for confirmation for both Ag and PCR testing. With higher pre-test probability, the confidence in negative COVID-19 test results is low. Therefore, a combination of symptoms, signs, laboratory investigations can be used with antigen and RT-PCR tests, for diagnosis of COVID-19.
Health Technology Assessment (HTA) and health policy making: a narrative review
(College of Community Physicians of Sri Lanka., 2020) Gamage, A.U.; Abeysena, C.
INTRODUCTION: Health Technology Assessment (HTA) is a policy tool for informed decision making that supports the entry and use of health-technologies. Three main forces have driven the development of HTA; rising healthcare demands and expectations, scarcity of resources, and increasing entry of new technologies to the healthcare market. With a commitment to Universal Health Coverage (UHC), decisions on allocations considering cost-effectiveness is crucial. OBJECTIVES: To evaluate the global evidence on the process, outcome and importance of HTA and evidence-based decision making in health policymaking and the potential way forward in Sri Lanka. METHODS: A narrative review on HTA and policy making was undertaken using the databases Medline, Embase, Biomedcentral, Science Direct, Web of Science. Useful websites, reports were looked up. The search was conducted during July- December 2019. The search strategy for scientific literature consisted of free text and MeSH terms related to keywords, namely, HTA, evidence-informed decision making, HTA-report and health policy. For the SWOT analysis and the way forward, literature review and expert opinion were obtained. RESULTS: HTA studies the medical, social, ethical, and economic implications of development and use of health-technology and guides the healthcare system in evidence-based decision making that is patient-centred and achieves the highest value for money. Once the topic nomination and prioritization of health-technology is done, it undergoes assessment, appraisal and decision making. Most countries have a process of collecting and analysing information about health technologies mainly for planning and budgeting purposes and most reports mainly on safety and clinical effectiveness, followed by economic and budgetary considerations. The findings generated through the HTA-process were used mainly to inform decision makers in most countries. Implementation of HTA needs the following; 1. A competent health information technology infrastructure, 2. Establish a core HTA team and building national capacity 3. Transparency of HTA agency and process and legislations 4. Extensive networks 5. Linking HTA to decision making the process. CONCLUSIONS: HTA is an essential tool for evidence-based decision making and allocating health budgets towards achieving UHC. HTA systematically evaluates the effectiveness, costs, and health impact, of a health-technology while considering ethical and equity issues. Institutionalizing HTA needs a conducive environment and commitment. KEYWORDS: HTA, Evidence-informed decision making, Health policy, Institutionalizing HTA
The impact of COVID-19 on health care accessibility and financial risk protection in Sri Lanka
(Sri Lanka Medical Association, 2023) Nandasena, S.; Gamage, A.U.; Periyasamy, N.; Rismy, M.; Balachandran, K.; Kasturiratne, A.
INTRODUCTION: The COVID-19 pandemic negatively impacted the global economy, disrupted essential health services, and distorted social determinants of health, reducing healthcare accessibility and increasing financial risk. AIM: we aimed to assess the impact of COVID-19 on healthcare accessibility and financial risk protection in Sri Lanka. METHODOLOGY: We conducted a cross-sectional study on a representative sample (multi-stage sampling process) of 3151 households in 105 clusters representing all the districts of Sri Lanka. The data collection was conducted using an interviewer-administered questionnaire in early November 2021. This was important to classify three periods of interest, namely: (1) the pre-lockdown period (2) the nationwide lockdown period, and (3) the new normal period. (After Oct 1 to early November 2021). RESULTS: Among 11,463 household occupants, 12.6% reported having chronic diseases, with 76.5% diagnosed prior to six months. The majority had heart disease, high blood pressure, or diabetes. Of them, 53.7% have been followed up during the lockdown, increasing to 80.8% in the new normal period. Provincial variations in expenses were observed, with the highest food expenses in the Western Province. Catastrophic health expenditures affected 9.5% and 3.4% of households at 10% and 25%, respectively. CONCLUSIONS: A considerable proportion of those having heart disease, high blood pressure, high blood sugar or diabetes mellitus were not followed up in the lockdown period and the first month of the new normal period. Antenatal care and family planning were the least affected. Participants had incurred high out-of-pocket expenditures for healthcare during the entire period.
Knowledge and practices on selected non communicable diseases among GCE Advanced Level students in state schools, Maharagama
(College of Community Physicians of Sri Lanka, 2009) Gamage, A.U.; Jayawardana, P.
OBJECTIVE: To assess the knowledge on selected non communicable diseases (NCDs) and practices related to prevention of selected NCDs among GCE Advanced Level (A/L) students attending government schools in the Maharagama education division. METHODS: A descriptive cross sectional study was conducted among year 13 students (A/L) attending state schools in Maharagama education division. A total of 634 students were selected from 9 schools which had at least one class in a given stream. Stratified sampling was done according to stream of study and the number needed from each stratum was decided according to probability proportionate to size. Cluster sampling was conducted when the number of classes in each stream was more than one. A self administered questionnaire was used to gather information on socio demographic data, practices, knowledge on NCDs and sources of information. Height and weight measurements were recorded. Each practice was analysed separately, either based on the indulgence or on a cut off score. A composite score of >60% was considered as good overall knowledge. RESULTS: Of the 634 respondents 45.3% (n=287) were males. The mean age was 18.4(SD±0.38) years. Knowledge: The proportion with good overall knowledge was 43% (95%CI: 39%-46.9%) [n=272]. Good overall knowledge was significantly higher among non Sinhalese (88%; n=5) and science stream students (65%; n=85) (p< 0.001). Practices: Proportion of students who had a healthy diet was 43% (n=275) and adequate physical activity was 20% (n=129). Three percent (n=18) were current smokers, all of whom were males and 10% (n=61) of males and 2% (n=12) of females were current users of alcohol. Proportion of females was significantly higher in relation to healthy dietary habits (52.2%; n=181 versus 32.8%; n=94 ), non smoking (100%; n=347 versus 93.7%; n=269) and non alcohol consumption (96.5%; n=335 versus 78.7%; n=226) and males in relation to adequate physical activity (27.5%; n=79 versus 14.4%; n=50). Schools (41%; n=233) were the major source of information on NCDs and preferred sources were healthcare workers (34%; n=201) and schools (32%; n=192). CONCLUSION: Proportion of year 13 A/L students with good knowledge and practices was low and recommend awareness raising programs.
Knowledge of non-communicable diseases and practices related to healthy lifestyles among adolescents, in state schools of a selected educational division in Sri Lanka
(BioMed Central, 2017) Gamage, A.U.; Jayawardana, P.L.
BACKGROUND: Behaviors established during the adolescence have life-long consequences to the onset of non-communicable diseases (NCDs) in later life. Therefore, it is essential to understand adolescents' knowledge and practices with the intention of developing preventive programs focusing on this age group. The objective of the study was to assess knowledge about selected NCDs, and lifestyle choices among school students aged 17-19 years in state schools of the Maharagama Educational Division, Sri Lanka. METHODS: A descriptive, cross-sectional study was conducted among students aged 17-19 years attending state schools in Maharagama Education Division. A total of 634 students were selected from 9 schools conducting Advance Level classes. Stratified sampling was done based on stream of study and the number needed from each stratum was decided according to probability proportionate to size which was followed by cluster sampling within the strata to select the classes included. Data were collected using a self-administered-questionnaire on socio-demographic characteristics and economic status; lifestyle-related practices; knowledge on Non-Communicable -Diseases. Logistic regression was used to assess the associations. RESULTS: Proportion students with good overall knowledge was 43%(n = 272). Forty-three percent (n = 275) consumed a healthy diet, and 20%(n = 129) engaged in adequate physical activity 3%(n = 18) of students were current smokers and 12%(n = 73) current alcohol users 12%(n = 73). Overall "good" knowledge about NCDs was associated with being a science stream student(OR = 3.3; 95%CI:2.1-5.2). Healthy diet was associated with female sex (OR = 2.1; 95%CI: 1.5-3.0), and adequate physical activity with male sex (OR = 2.1; 95% CI:1.4-3.2), non-science-stream (OR = 2.1; 95%CI:1.2-3.7) and upper socio economic status (OR = 2.0; 95%CI:1.3-3.0). Non-smoking was associated with overall good knowledge (OR = 4.1; 95%CI:1.2-13.7) and female sex (OR = 0;95%CI:1.5-infinity). Abstinence from alcohol was associated with being a female (OR = 6.9; 95%CI:3.4-13.9), and with mother and fathers' education level of > General-Certificate of Examinations Ordinary Level (GCE O/L) (OR = 2.9; 95%CI:1.1-8.4 and OR = 3.5; 95%CI:1.1-11.2 respectively). CONCLUSION: Knowledge about NCDs and healthy lifestyle-practices were poor among school students aged 17-19 years. Lack of knowledge about healthy and unhealthy behaviors highlights the importance of carrying out regular surveillance for NCD risk factors, and initiating programs for the prevention of NCDs amongst adolescents.