Browsing by Author "Hewage, S.A."

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    Barriers for cataract treatment among elderly in Sri Lanka
    (Hindawi Publication Corporation, 2019) Nishad, N.; Hewage, S.A.; Arulmoly, K.; Amaratunge, M.S.; de Silva, J.; Kasturiratne, K.T.A.A.; Abeysundara, P.K.; Wickremasinghe, A.R.
    Cataract is still the leading cause of blindness. Many government institutes and voluntary organizations in Sri Lanka are providing free treatment services to patients with cataract. Still people are not patronizing the available free services; thus they have to live with impaired vision or blindness. This paper describes the barriers for cataract treatment among the population over 60 years of age. Out of 470 elders, 379 were found to have some kind of cataract. This study demonstrated lack of awareness and knowledge, socioeconomic factors, and misconceptions as the main barriers for cataract treatment which has led to a lower cataract surgery rate irrespective of the high cataract prevalence reported. Findings of this study highlight the importance of cataract as a common health problem in elderly and need for removal of the barriers for its treatment which should be given due prominence in the formulation of public health policy in Sri Lanka at the earliest.
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    Does routine episiotomy for vaginal births prevent major degree perineal tears? Summary of the evidence and its application to Sri Lanka
    (Postgraduate Institute of Medicine, University of Colombo, 2018) Hewage, S.A.; Abeysena, C.; Ziard, H.; Rishard, M.
    An updated Cochrane Review concluded that in addition to increasing the risk of major perineal/vaginal trauma by 30%, routine episiotomy does not play a role in lowering the risk of many other outcomes including blood loss at delivery, perineal pain, delivering a non-asphyxiated baby or urinary incontinence at six months compared to selective episiotomy.This review evaluated 12 randomized controlled trials carried out on 6177 women from Europe, North America, South America, South Asia and South-East Asia.Following critical evaluation of the systematic reviews conducted so far in this field along with local evidence and the aptness of this evidence to local setting, we strongly recommend changing the current practice of routine episiotomy to selective episiotomy in vaginal delivery, in accordance with the National Guidelines of Sri Lanka.
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    Prediction of colorectal cancer risk among adults in a lower middle-income country
    (AME Publishing Company, 2019) Samarakoon, Y.M.; Gunawardena, N.S.; Pathirana, A.; Perera, M.N.; Hewage, S.A.
    BACKGROUND: Globally, colorectal cancer (CRC) is ranked as the third most common cancer in men and the second in women. Use of a simple, validated risk prediction tool will offer a low-cost mechanism to identify the high-risk individuals for CRC. This will increase efficient use of limited resources and early identification of patients. The aim of our study was to develop and validate a risk prediction model for developing CRC for Sri Lankan adults. METHODS: The risk predictors were based on the risk factors identified through a logistic regression model along with expert opinion. A case control design utilizing 65 CRC new cases and 65 hospital controls aged 30 years or more was used to assess the criterion validity and reliability of the model. The information was obtained using an interviewer administered questionnaire based on the risk prediction model. RESULTS: The developed model consisted of eight predictors with an area under the curve (AUC) of 0.849 (95% CI: 0.8 to 0.9, P<0.001). It has a sensitivity of 76.9%, specificity of 83.1%, positive predictive value (PPV) of 82.0%, negative predictive value (NPV) of 79.3%. Positive and negative likelihood ratios are 4.6 and 0.3. Test re-test reliability revealed a Kappa coefficient of 0.88. CONCLUSIONS: The model developed to predict the risk of CRC among adults aged 30 years and above was proven to be valid and reliable and it is an effective tool to be used as the first step to identify the high-risk population who should be referred for colonoscopy examination. © Journal of Gastrointestinal Oncology. All rights reserved.