Browsing by Author "Kumarendran, B."

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Admission patterns and completeness of documentation of clinical features of head injuries in Accident and Emergency Unit of a Sri Lankan hospital for children
(College of Community Physicians of Sri Lanka, 2009) Kumarendran, B.; Kumanan, T.
INTRODUCTION: Accident and Emergency unit (AEU) of Lady Ridgeway Hospital for Children (LRH) provides outpatient care (OPD) and in-patient care (admissions). OBJECTIVE: To describe the pattern of admissions and completeness of documentation of clinical features of head injury cases admitted to AEU of LRH. METHODS: This was a clinical audit. Data on daily attendance at OPD and admissions from January 2003 - April 2009 were collected using bed head tickets, admission registers and monthly epidemiological reports at LRH. Pattern of admissions from 2003 to 2008 were described on a monthly and those from January to April 2009 on a daily basis. Completeness of documentation of clinical features of head injury was assessed using a check list developed for the purpose for 243 head injury cases admitted during March 2009. RESULTS: During 2003 to 2008, monthly attendance to OPD showed an increasing trend, while a reducing trend was observed in monthly admissions. During January to April 2009, median OPD attendance in morning (8am-2pm), evening (2pm-8 pm) and night (8pm-8am) shifts were 53(IQR:45,59), 35(IQR:32,40) and 15(IQR:12,17) respectively. Median admissions during these shifts was 9(IQR:7,11), 8(IQR:7,10) and 4(IQR:3,6) respectively. Number of medical officers listed for these shifts was 9, 7 and 2 respectively. Most admissions were for males (63.5%; n=445) and commonest age group was 2 to 3 years (26.2%, n=184). Proportion of head injury admissions for March 2009 was 34.7% (243/701). Date, time and signature were documented by, medical officers only in 30.9% (n =75), 10.3% (n=25) and11.1% (n=27) of BHTs. Documentation of presence/absence of selected symptoms on head injury included, nausea or vomiting (80.2%; n=195), unconsciousness (76.1%; n=185), headache (49.4%; n=120), fits (24.7%, n=60) and drowsiness (14.4%, n=35). Documentation of presence/absence of selected signs included site and side of injury in 41.6% (n = 101), diagram on site of injury in 8.6% (n=21), Glasgow Coma Scale (GCS) in 53.1% (n=123), clinical evidence of fracture in 63.8% (n=155) and ENT bleeding in 69.2% (n=178). CONCLUSION: Trend shows a rise in OPD attendance with a decline in IPC admissions. Documentation of clinical features of head injuries needs improvement.
Analysis of effects of meteorological factors on dengue incidence in Sri Lanka using time series data
(Public Library of Science, 2013) Goto, K.; Kumarendran, B.; Mettananda, S.; Gunasekara, D.; Fujii, Y.; Kaneko, S.
In tropical and subtropical regions of eastern and South-eastern Asia, dengue fever (DF) and dengue hemorrhagic fever (DHF) outbreaks occur frequently. Previous studies indicate an association between meteorological variables and dengue incidence using time series analyses. The impacts of meteorological changes can affect dengue outbreak. However, difficulties in collecting detailed time series data in developing countries have led to common use of monthly data in most previous studies. In addition, time series analyses are often limited to one area because of the difficulty in collecting meteorological and dengue incidence data in multiple areas. To gain better understanding, we examined the effects of meteorological factors on dengue incidence in three geographically distinct areas (Ratnapura, Colombo, and Anuradhapura) of Sri Lanka by time series analysis of weekly data. The weekly average maximum temperature and total rainfall and the total number of dengue cases from 2005 to 2011 (7 years) were used as time series data in this study. Subsequently, time series analyses were performed on the basis of ordinary least squares regression analysis followed by the vector autoregressive model (VAR). In conclusion, weekly average maximum temperatures and the weekly total rainfall did not significantly affect dengue incidence in three geographically different areas of Sri Lanka. However, the weekly total rainfall slightly influenced dengue incidence in the cities of Colombo and Anuradhapura. Copyright: 2013 Goto et al.
Association of smoking with some aspects of pulmonary tuberculosis in Central Chest Clinic, Colombo
(Sri Lanka Medical Association, 2011) Kajarajan, R.; Kumarendran, B.; Fernando, A.
INTRODUCTION AND OBJECTIVES; to study the association of smoking with some aspects of sputum positive pulmonary tuberculosis (SP-PTB) in Central chest clinic, Colombo (CCC). Methods: This descriptive cross-sectional study recruited 99 consecutive SP-PTB patients (both new and re treatment) registered in CCC and produced treatment outcome as cured, treatment completion or treatment failures. Data were collected by the principal investigator using a questionnaire and data extraction sheet. Smoking status was categorised into ever smoked and never smoked. Pre-treatment sputum status was categorised as <1+ (scanty/ 1+) and >2+ (2+/S+). Chi-square test was used as significance test. RESULTS: Of the 29 female participants, only one had ever smoked in life. Hence, only males were included in the subsequent analysis. Among males, 56 (80.0%) answered as ever smoked and 21 (30.0%) were current smokers. Median age was 50 years (IQR: 45 to 60) among those ever smoked and 46 years (IQR: 21 to 51) among those never smoked. Smoking status was not associated with sputum status of first smear (p=0.53). Smoking status was significantly associated with sputum status of second smear (p=0.02), third smear (p=0.001) and pretreatment smear p=0.04). Association was not significant with smoking status and category of treatment (p=0.4), delay in sputum conversion (p=0.43), chest X-ray findings such as upper lobe infiltration (p=0.62), cavitation (p=0.1) and multiple lobe involvement (p=0.2). CONCLUSIONS: Prevalence of smoking was higher in patient with sputum positive pulmonary tuberculosis. Second and third sample showed significant positivity in smokers than non smokers.
Bypassing primary healthcare facilities among admissions to medical wards, Teaching Hospital, Kandy
(Sri Lanka Medical Association, 2018) Jeyasuthan, M.; Kumarendran, B.
INTRODUCTION AND OBJECTIVES: Bypassing of health institutions is a major concern in healthcare. This study aimed to estimate the proportion and to determine the factors associated with bypassing primary health care facilities among admissions to medical wards, Teaching Hospital, Kandy (THK). METHODS: This descriptive cross sectional study was carried out during March & April 2015 among 380 patients selected using systematic sampling from medical wards, THK. Patients transferred from other hospitals were excluded data was collected using an interviewer administered questionnaire and analysed using SPSS. 'By-passer” is defined as a person admitted to medical ward, THK without seeking treatment from a state facility closest to home.RESULTS: Of the 596 patients accessed, 216 patients transferred from other hospitals were excluded. Of 380 non• transferred patients, 162 patients were by-passers (42.6%, 95% CI: 37.7 to 47.6%). Mean age of the respondents was 57.72 years. Majority of the respondents (78.4%, n=l27) were married and 51.2% (n=83) did not have job,46.9% (n=76) of them had primary education. By-passing was associated with age group (p=0.03), educational level (P=0.02), category of employment (p=0.002) and monthly income (p<0.001). Availability of facilities for diagnosis and treatment, adequacy of medical supplies, competent health staff, severity of the illness, patient friendly approach of staff, use of latest technologies and self-satisfaction due to unknown reasons were cited as reasons for by-passing.CONCLUSION: By-passing was around 2 in 5 admissions in medical wards of THK and was associated with age, education, employment and monthly income. Participants indicated their reasons for by-passing.
Characteristics of tuberculous lymphadenitis
(Sri Lanka Medical Association, 2010) Jawahir, A.G.M.; Kumarendran, B.; Fernando, A.
OBJECTIVE: To describe the characteristics of tuberculous lymphadenitis (TBL) cases in Central Chest Clinic, Colombo. METHOD: This descriptive cross-sectional study was conducted in Central Chest Clinic, Colombo (CCC) using a structured format, from 49 consecutive TBL cases registered at CCC during November 2008 - January 2009. Data was analysed using SPSS soft-ware. TBL was diagnosed based on caseating granuloma in histology, TBL culture for AFB or FNA direct smear for acid fast bacilli and supported by Mantoux test and erythrocyte sedimentation rate (ESR). RESULTS: Majority were aged 21 - 40 years (n=29, 59.2%) and 51 % (n^ 25J were males. Four cases (8.2%) had past TBL. Of the tests, histology showed the highest sensitivity (85.7%), followed by Mantoux test (81.6%), smear (45.8%) and culture (13.3%). Although, smear or culture was not positive among seven TBL cases with non-caseating granuloma (14.3%), diagnosis of TBL was made based on higher mantoux tests ranging from 15 to 50 mm. One case had both TBL and PTB. ATT was continued for more than the standard period in 11 cases (22.4%) with surgical interventions (n=7), persistent lymph node (n=3) and drug induced hepatitis (n=l). Oral prednisolone was given to ten cases for persistent lymph node (n=7) or cutaneous reaction (n-1). All the cases (n=10) who received antibiotics had a surgical intervention. Cut-offs for ESR and Mantoux determined by ROC curves. CONCLUSION: At the Chest Clinic, Colombo the diagnosis of TBL is made commonly by histology and Mantoux test rather than a positive culture.
Cluster randomized trial of the impact of school based deworming and weekly iron supplementation on haemoglobin level of plantation primary school children
(College of the Community Physicians of Sri Lanka, 2013) Ebenezer, R.; Gunawardena, N.K.; Kumarendran, B.; Pathmeswaran, A.; de Silva, N.R.
BACKGROUND: School-based deworming and iron supplementation are being promoted as effective interventions to deal with the high prevalence of anaemia among school children. OBJECTIVE: The objective of this study was to determine the effectiveness of school based deworming and weekly iron supplementation on increasing the haemoglobin level of primary school children in the plantation sector in Sri Lanka. METHODS: A placebo-controlled cluster randomized trial was conducted in which the treatment group received a single dose of 500 mg mebendazole and 6-months of weekly iron supplementation (200 mg ferrous sulphate) while the control group received placebo for both anthelmintic and iron. The tablets were administered by the class teacher. Children attending grade 4 in schools in the plantation sector were recruited. The treatment arm was allocated with 813 children attending 49 schools and the placebo arm with 808 children attending 49 schools. Height, weight and haemoglobin were measured at baseline and after 6-months. A regression model adjusting for the cluster design was used to assess the effectiveness of the intervention on the haemoglobin level. In order to increase the precision of the estimates, various background variables were controlled for in regression models. RESULTS: Complete data were available for 633 children in the treatment group and 613 children in the control group. The mean age was 9 years and 6 months and 52% of them were males. In the treatment arm 98% had received mebendazole and over 80% had received 16 doses of iron. A reduction in the prevalence of soil-transmitted helminth (STH) infection (from 25.1% to 16.4%) was found in the treatment group, with significant differences between treatment and control groups in the levels of Ascaris and Trichuris. There was a small non-significant reduction in the mean haemoglobin level (at baseline 12.6g/dl, sd - 1.2) of both groups. No impact of treatment was found on haemoglobin levels. CONCLUSIONS: Though the intervention was effective in reducing the prevalence of STH infection there was no evidence of effectiveness in increasing haemoglobin levels.
Cluster-randomised trial of the impact of school-based deworming and iron supplementation on the cognitive abilities of schoolchildren in Sri Lanka's plantation sector
(Wiley-Blackwell, 2013) Ebenezer, R.; Gunawardena, K.; Kumarendran, B.; Pathmeswaran, A.; Jukes, M.C.; Drake, L.J.; de Silva, N.R.
OBJECTIVE: To assess the impact of deworming and iron supplementation on the cognitive abilities and educational achievement of school-age children in Sri Lanka. METHODS: Prospective, placebo-controlled randomised study. The treatment group received deworming and weekly iron supplementationfor 6 months; the control group received placebo for both the anthelmintic and iron. A mixed effects regression model was used to answer the main research question. To increase the precision of this study's estimates, various background variables were controlled for that were not related to treatment but could have some impact on the outcome. RESULTS: The prevalence of soil-transmitted helminth (STH) infection was reduced in the treatment group (n = 615), with significant differences between treatment and control groups (n = 575) in the levels of Ascaris and Trichuris. No impact was found on haemoglobin (Hb) levels, nor any significant impact on concentration levels or on educational test scores. CONCLUSION: Decline in STH prevalence alone, in the absence of improved Hb status, produced no evidence of impact on concentration levels or educational test scores. © 2013 John Wiley & Sons Ltd.
Do newspapers fulfil the demand for adolescent reproductive health?
(Faculty of Medicine, University of Kelaniya & Plan International, 2008) Kumarendran, B.; Nandasena, Y.L.S.; Abeysena, C.
OBJECTIVE: To describe the expectations of adolescent school children, perceptions of editorial staff and coverage of topics of articles published by selected Sinhala newspapers regarding reproductive health. METHOD: Data were extracted from three national and three tabloid newspapers published during the period May to October 2007. Thematic analysis was done to analyse in-depth interviews of eleven editorial staff. One hundred and thirty four 17-18 year old school children were sampled using stratified (based on stream, sex and urban/rural) purposive sampling from the Gampaha district. Content analysis of 14 Focus Group Discussions (FGD) was done. RESULTS: Ninety two and 58 articles on reproductive health were published in national and tabloid papers respectively during the study period. Pregnancy related issues were the commonest topic addressed followed by reproductive system, commercial sex and sexually transmitted infections (STIs). Most of the published articles included photographs. The majority was written with the guidance of professionally qualified doctors. Although journalists knew the spectrum of reproductive health issues, they were more prone to write on STIs and less on homosexuality, virginity and family planning. The opportunities given for selecting a topic by the press authorities were not satisfactory. Adolescent girls were interested to read about puberty, menstruation, contraception, commercial sex, virginity and STIs and boys were interested to read about homosexuality, heterosexuality, masturbation, STIs, contraception and abortion. Most of the students claimed that they were not provided with adequate RH related knowledge by the newspapers. The way of presenting the articles was not, satisfactory. Most of the adolescents preferred information in simple language (than scientific jargon) in question and answer form without seductive photographs. CONCLUSIONS: Reproductive health coverage by newspapers are not satisfactory. Publishing articles to fulfil the expectations of adolescents would make newspapers a successful mode of RH education.
An ecological study for Sri Lanka about health effects of coconut
(Sri Lanka Medical Association, 2015) Athauda, L.K.; Wickremasinghe, A.R.; Kumarendran, B.; Kasturiratne, A.
An ecological correlation study was conducted to determine the association between consumption of coconut products and cardiovascular disease (CVD) deaths in Sri Lanka. Data on coconutconsumption patterns from 1961 to 2006 were abstracted from the FAO database, and mortality data from reports of the Department of Census and Statistics, and UN databases. Correlational and regression analyses were carried out. There was no increase in the per capita consumption ofcoconut products from 1961 to 2006 (range 54.1-76.2kg/ capita/year). The CVD death rates and the proportionate mortality rate due to CVD increased from 1961 to 2006. CVD death rates were significantly associated with per capita GDP, percentage of urban population, and elderly dependency ratio but not consumption of coconut products after adjusting for the other variables (R2=0.94). The results do not provide evidence at the population level that consumption of coconutproducts increases mortality due to cardiovascular diseases.
Effectiveness of mebendazole and health education in control of pinworm infection among children living in low income settlements
(Sri Lanka Medical Association, 2017) Kumarendran, B.; Pathmeswaran, A.; de Silva, N.R.
INTRODUCTION & OBJECTIVES: We aimed to evaluate the effectiveness of mebendazole (MBZ) mass treatment and health education in reducing reinfection with pinworm among children living in low income settlements (LIS). METHODS: A factorial cluster-randomized, controlled trial was conducted during January to May 2014, to compare the effectiveness of MBZ 100mg for positive cases versus mass treatment, and routine versus special health education. 1257 children aged 3-7 years, from 48 clusters of LIS in the Colombo Municipal Council area, were selected using cluster sampling. Perianal cellophane adhesive swabs (CAS) were examined for pinworm eggs. About 2-3 weeks after collection of the first sample (CAS1), depending on the intervention arm, eligible participants were given MBZ. Second sample (CAS2) was collected a week after administration of the first dose (MBZ1). Second dose (MBZ2) was given two weeks after MBZ1. Third sample (CAS3) was collected a week after MBZ2, and a fourth sample (CAS4) was collected 12 weeks after MBZ2. RESULTS: Sample collection rate was 94%, 80%, 75% and 73%, for CAS1, CAS2, CAS3 and CAS4 respectively. Overall egg positivity reduced from 42.5% to 10% following MBZ1, and to 6.8% following MBZ2, but increased to 29.3% at 12 weeks following MBZ2. In logistic regression, reinfection rate at 12 weeks after MBZ2 (i.e. those who were CAS3 negative but CAS4 positive) was associated with baseline pinworm egg positivity (OR=1.2) and BMI for age Z score (OR=0.96), but not with intervention arm. CONCLUSION: MBZ is effective in reducing pinworm egg positivity, but re-infection is common.
Epidemiology and treatment of patients with tuberculosis in Mannar District
(Sri Lanka Medical Association, 2010) Pachek, S.J.R.; Kumarendran, B.
OBJECTIVES: To describe the characteristics of patients with tuberculosis in the Mannar district. Method: This was a cross sectional study. We visited almost all the houses of patients (143 out of 145) who were registered during January 2005 to December 2008 HI the District tuberculosis register maintained at the District chest clinic, Mannar. Data were collected using a pre-designed interviewer administered questionnaire and analysed using SPSS software. RESULTS: The yearly registrations of patients with tuberculosis (TB) from 2005 to 2008 were 52, 27, 42 and 24 respectively. These 145 cases included 113 middle aged (77.9 %), 23 elders (15.9%), seven adolescents and two children. Majority of cases were men (n= 90, 62.1 %) and married (n= 116, 80%). Treatment type included 137 new cases, six relapses and two defaulters. Cure rate was 91.5%. Treatment completed constituted 31.7% of cases (n=46) while five were dead and one defaulted treatment. Fifty five cases (37.9%) were living in welfare facilities for displaced (WFD). 93.1 % of cases (n=135) had ever been to India as a refugee. Cases in WFD had a higher risk of having undiagnosed death of a family member (OR = 6.4, 95% CI, 1.3 - 32.1), under-ventilated houses (OR -20, 95% CI, 8.4 - 47.4), and overcrowding of the living place (OR = 5.6, 95% CI, 2.7 - 11.4). CONCLUSION: Treatment outcome of TB cases was satisfactory in Mannar District. The TB cases living in WFD had increased risk factors for TB.
Food environment and diabetes mellitus in South Asia: A geospatial analysis of health outcome data
(Public Library of Science,San Francisco, 2022) Kusuma, D.; Atanasova, P.; Pineda, E.; Anjana, R.M.; de Silva, L.; Hanif, A.A.; Hasan, M.; Hossain, M.M.; Indrawansa, S.; Jayamanne, D.; Jha, S.; Kasturiratne, A.; Katulanda, P.; Khawaja, K.I.; Kumarendran, B.; Mridha, M.K.; Rajakaruna, V.; Chambers, J.C.; Frost, G.; Sassi, F.; Miraldo, M.
Background: The global epidemic of type 2 diabetes mellitus (T2DM) renders its prevention a major public health priority. A key risk factor of diabetes is obesity and poor diets. Food environments have been found to influence people's diets and obesity, positing they may play a role in the prevalence of diabetes. Yet, there is scant evidence on the role they may play in the context of low- and middle-income countries (LMICs). We examined the associations of food environments on T2DM among adults and its heterogeneity by income and sex. Methods and findings: We linked individual health outcome data of 12,167 individuals from a network of health surveillance sites (the South Asia Biobank) to the density and proximity of food outlets geolocated around their homes from environment mapping survey data collected between 2018 and 2020 in Bangladesh and Sri Lanka. Density was defined as share of food outlets within 300 m from study participant's home, and proximity was defined as having at least 1 outlet within 100 m from home. The outcome variables include fasting blood glucose level, high blood glucose, and self-reported diagnosed diabetes. Control variables included demographics, socioeconomic status (SES), health status, healthcare utilization, and physical activities. Data were analyzed in ArcMap 10.3 and STATA 15.1. A higher share of fast-food restaurants (FFR) was associated with a 9.21 mg/dl blood glucose increase (95% CI: 0.17, 18.24; p < 0.05). Having at least 1 FFR in the proximity was associated with 2.14 mg/dl blood glucose increase (CI: 0.55, 3.72; p < 0.01). A 1% increase in the share of FFR near an individual's home was associated with 8% increase in the probability of being clinically diagnosed as a diabetic (average marginal effects (AMEs): 0.08; CI: 0.02, 0.14; p < 0.05). Having at least 1 FFR near home was associated with 16% (odds ratio [OR]: 1.16; CI: 1.01, 1.33; p < 0.05) and 19% (OR: 1.19; CI: 1.03, 1.38; p < 0.05) increases in the odds of higher blood glucose levels and diagnosed diabetes, respectively. The positive association between FFR density and blood glucose level was stronger among women than men, but the association between FFR proximity and blood glucose level was stronger among men as well as among those with higher incomes. One of the study's key limitations is that we measured exposure to food environments around residency geolocation; however, participants may source their meals elsewhere. Conclusions: Our results suggest that the exposure to fast-food outlets may have a detrimental impact on the risk of T2DM, especially among females and higher-income earners. Policies should target changes in the food environments to promote better diets and prevent T2DM.
Food environments and obesity: A geospatial analysis of the South Asia Biobank, income and sex inequalities
(Elsevier Ltd, 2022) Atanasova, P.; Kusuma, D.; Pineda, E.; Anjana, R.M.; de Silva, L.; Hanif, A.A.M.; Hasan, M.; Hossain, M.M.; Indrawansa, S.; Jayamanne, D.; Jha, S.; Kasturiratne, A.; Katulanda, P.; Khawaja, K.I.; Kumarendran, B.; Mrida, M.K.; Rajakaruna, V.; Chambers, J.C.; Frost, G.; Sassi, F.; Miraldo, M.
Introduction: In low-middle income countries (LMICs) the role of food environments on obesity has been understudied. We address this gap by 1) examining the effect of food environments on adults' body size (BMI, waist circumference) and obesity; 2) measuring the heterogeneity of such effects by income and sex.Methods: This cross-sectional study analysed South Asia Biobank surveillance and environment mapping data for 12,167 adults collected between 2018 and 2020 from 33 surveillance sites in Bangladesh and Sri Lanka. Individual-level data (demographic, socio-economic, and health characteristics) were combined with exposure to healthy and unhealthy food environments measured with geolocations of food outlets (obtained through ground-truth surveys) within 300 m buffer zones around participants' homes. Multivariate regression models were used to assess association of exposure to healthy and unhealthy food environments on waist circumference, BMI, and probability of obesity for the total sample and stratified by sex and income.Findings: The presence of a higher share of supermarkets in the neighbourhood was associated with a reduction in body size (BMI, β = - 3∙23; p < 0∙0001, and waist circumference, β = -5∙99; p = 0∙0212) and obesity (Average Marginal Effect (AME): -0∙18; p = 0∙0009). High share of fast-food restaurants in the neighbourhood was not significantly associated with body size, but it significantly increased the probability of obesity measured by BMI (AME: 0∙09; p = 0∙0234) and waist circumference (AME: 0∙21; p = 0∙0021). These effects were stronger among females and low-income individuals.Interpretation: The results suggest the availability of fast-food outlets influences obesity, especially among female and lower-income groups. The availability of supermarkets is associated with reduced body size and obesity, but their effects do not outweigh the role of fast-food outlets. Policies should target food environments to promote better diets and reduce obesity.
Formative research to design an implementation strategy for a postpartum hemorrhage initial response treatment bundle (E-MOTIVE): study protocol
(BioMed Central, 2021) Bohren, M.A.; Lorencatto, F.; Coomarasamy, A.; Althabe, F.; Devall, A.J.; Evans, C.; Oladapo, O.T.; Lissauer, D.; Akter, S.; Forbes, G.; Thomas, E.; Galadanci, H.; Qureshi, Z.; Fawcus, S.; Hofmeyr, G.J.; Al-Beity, F.A.; Kasturiratne, A.; Kumarendran, B.; Mammoliti, K.M.; Vogel, J.P.; Gallos, I.; Miller, S.
BACKGROUND: Postpartum hemorrhage (PPH) is the leading cause of maternal death worldwide. When PPH occurs, early identification of bleeding and prompt management using evidence-based guidelines, can avert most PPH-related severe morbidities and deaths. However, adherence to the World Health Organization recommended practices remains a critical challenge. A potential solution to inefficient and inconsistent implementation of evidence-based practices is the application of a 'clinical care bundle' for PPH management. A clinical care bundle is a set of discrete, evidence-based interventions, administered concurrently, or in rapid succession, to every eligible person, along with teamwork, communication, and cooperation. Once triggered, all bundle components must be delivered. The E-MOTIVE project aims to improve the detection and first response management of PPH through the implementation of the "E-MOTIVE" bundle, which consists of (1) Early PPH detection using a calibrated drape, (2) uterine Massage, (3) Oxytocic drugs, (4) Tranexamic acid, (5) Intra Venous fluids, and (6) genital tract Examination and escalation when necessary. The objective of this paper is to describe the protocol for the formative phase of the E-MOTIVE project, which aims to design an implementation strategy to support the uptake of this bundle into practice. METHODS: We will use behavior change and implementation science frameworks [e.g. capability, opportunity, motivation and behavior (COM-B) and theoretical domains framework (TDF)] to guide data collection and analysis, in Kenya, Nigeria, South Africa, Sri Lanka, and Tanzania. There are four methodological components: qualitative interviews; surveys; systematic reviews; and design workshops. We will triangulate findings across data sources, participant groups, and countries to explore factors influencing current PPH detection and management, and potentially influencing E-MOTIVE bundle implementation. We will use these findings to develop potential strategies to improve implementation, which will be discussed and agreed with key stakeholders from each country in intervention design workshops. DISCUSSION: This formative protocol outlines our strategy for the systematic development of the E-MOTIVE implementation strategy. This focus on implementation considers what it would take to support roll-out and implementation of the E-MOTIVE bundle. Our approach therefore aims to maximize internal validity in the trial alongside future scalability, and implementation of the E-MOTIVE bundle in routine practice, if proven to be effective. KEYWORDS: Behavior change; Care bundle; Formative research; Implementation; Intervention development; Maternal health; Maternal mortality; Obstetric hemorrhage; Postpartum hemorrhage.
Low uptake of COVID-19 prevention behaviours and high socioeconomic impact of lockdown measures in South Asia: Evidence from a large-scale multi-country surveillance programme
(Elsevier Science, 2021) Kusuma, D.; Pradeepa, R.; Khawaja, K.I.; Hasan, M.; Siddiqui, S.; Mahmood, S.; Ali Shah, S.M.; de Silva, C.K.; de Silva, L.; Gamage, M.; Loomba, M.; Rajakaruna, V.P.; Hanif, A.A.; Kamalesh, R.B.; Kumarendran, B.; Loh, M.; Misra, A.; Tassawar, A.; Tyagi, A.; Waghdhare, S.; Burney, S.; Ahmad, S.; Mohan, V.; Sarker, M.; Goon, I.Y.; Kasturiratne, A.; Kooner, J.S.; Katulanda, P.; Jha, S.; Anjana, R.M.; Mridha, M.K.; Sassi, F.; Chambers, J.C.; NIHR Global Health Research Unit for diabetes and cardiovascular disease in South Asia.
BACKGROUND: South Asia has become a major epicentre of the COVID-19 pandemic. Understanding South Asians' awareness, attitudes and experiences of early measures for the prevention of COVID-19 is key to improving the effectiveness and mitigating the social and economic impacts of pandemic responses at a critical time for the Region. METHODS: We assessed the knowledge, behaviours, health and socio-economic circumstances of 29,809 adult men and women, at 93 locations across four South Asian countries. Data were collected during the national lockdowns implemented from March to July 2020, and compared with data collected prior to the pandemic as part of an ongoing prospective surveillance initiative. RESULTS: Participants were 61% female, mean age 45.1 years. Almost half had one or more chronic disease, including diabetes (16%), hypertension (23%) or obesity (16%). Knowledge of the primary COVID-19 symptoms and transmission routes was high, but access to hygiene and personal protection resources was low (running water 63%, hand sanitisers 53%, paper tissues 48%). Key preventive measures were not widely adopted. Knowledge, access to, and uptake of COVID-19 prevention measures were low amongst people from disadvantaged socio-economic groups. Fifteen percent of people receiving treatment for chronic diseases reported loss of access to long-term medications; 40% reported symptoms suggestive of anxiety or depression. The prevalence of unemployment rose from 9.3% to 39.4% (P < 0.001), and household income fell by 52% (P < 0.001) during the lockdown. Younger people and those from less affluent socio-economic groups were most severely impacted. Sedentary time increased by 32% and inadequate fruit and vegetable intake increased by 10% (P < 0.001 for both), while tobacco and alcohol consumption dropped by 41% and 80%, respectively (P < 0.001), during the lockdown. CONCLUSIONS: Our results identified important knowledge, access and uptake barriers to the prevention of COVID-19 in South Asia, and demonstrated major adverse impacts of the pandemic on chronic disease treatment, mental health, health-related behaviours, employment and household finances. We found important sociodemographic differences for impact, suggesting a widening of existing inequalities. Our findings underscore the need for immediate large-scale action to close gaps in knowledge and access to essential resources for prevention, along with measures to safeguard economic production and mitigate socio-economic impacts on the young and the poor. KEYWORDS: COVID-19; Preventative measures; Socioeconomic impact; South Asia; Surveillance system.
Measles infection in lady Ridgeway hospital in 2013: a case control study
(Sri Lanka College of Paediatricians, 2015) Navageevan, N.; Punchihewa, P.M.G.; Kumarendran, B.; Hathagoda, K.L.W.; Galappaththi, A.G.A.R.; Jayathilaka, A.
BACKGROUND:A measles outbreak was reported in 2013 in the Lady Ridgeway Hospital for Children (LRH).OBJECTIVES:To describe the epidemiology of measles among paediatric patients admitted to LRH. DESIGN, SETTING AND METHOD:This case control study, conducted among patients admitted to LRH, recruited 167 clinical cases and 693 controls of six to 24 months age. All the clinically positive cases admitted to any of the six paediatric medical units during January to June 2013 and four patients admitted following each case were included. Data was gathered from the bed head tickets using data extraction sheet and by telephone interview. Significance was assessed at 5% level.RESULTS:Of the 140 clinical cases with available reports, 126 (90%) were positive for measles lgM (confirmed cases - CC). The CC included 75 (60%) males, 48 (38%) aged up to 9 months and 50 (40%) aged 10 to 12 months. Clinical features among the CC include high fever (100%), rash (100%), cough (94%), coryza (83%), conjunctivitis (63%), Koplik spots (14%), post measles staining (31%), diarrhoea (48%) and vomiting (31%). Complications among the CC included at least one complication (68%), pneumonia (65%) and 2 cases of death. Of the 47 CC with positive contact history, 41 had contacts in the hospital. Of the 28 cases aged above 12 months, 23 did not receive measles vaccine.Measles status was associated with measles vaccination status among children above 12 months of age (P<0.001), contact history (P<0.001), ethnicity (P<0.001) and mother's education (P<0.01). There was no evidence for an association of measles infection status with sex (p=0.9), income (p=0.3) and weight for age (p=0.2). CONCLUSIONS: • Around 78% cases were below 12 month old. • Majority of cases above 12 month of age did not receive measles vaccine. • Majority of cases had contact history in the hospital.
Negative health effects of coconut-are they real at the population level?
(Sri Lanka Medical Assosiation, 2012) Athauda, L.K.; Kumarendran, B.; Kasturiratne, A.; Wickremasinghe, A.R.
INTRODUCTION: An ecological correlation study was carried out to assess the validity of incriminations on the effects of consumption of coconut products on deaths due to cardiovascular diseases (CVD) Aims: The aim was to evaluate the impact of consumption of coconut products on CVD death rates. Methods: Data from 1961 to 2006 were abstracted from different sources; coconut consumption from the FAO database, CVD deaths from reports of the Department of Census and Statistics, population data from the UN databases and per capita GDP from the World Bank database. Correlational and Regression analyses were carried out. RESULTS: From 1961 to 2006, the average consumption of coconut including copra was 66.19 kg/capita/year, the average consumption of energy was 271.47 kcal/ capita/ day and the average fat supply was 24.46 g/capita/ day. There was no increase in the per capita consumption of coconut products from 1961 to 2006 in Sri Lanka (range 54.1-76.2 kg/capita/year]. The CVD death rates and the proportionate mortality rate due to CVD have increased from 1961 to 2006. Consumption of coconut products was correlated with CVD death rates but no lags seen. CVD death rates were significantly associated with per capita GDP and percentage of urban population but not consumption of coconut products after adjusting for the other variables (R2=0.865J. CONCLUSIONS: Mortality due to cardiovascular diseases was significantly correlated with per capita GDP and percentage of urban population after controlling for other variables. The results do not provide any evidence that consumption of coconut products increases mortality due to cardiovascular diseases at the population level.
Neonatal hypothermia and associated factors in a special care baby unit
(Sri Lanka Medical Association, 2012) Krishnapradeep, S.; Kumarendran, B.; Bandara, S.
INTRODUCTION: Neonatal hypothermia is known to result in many adverse consequences. Aims: To estimate the incidence and associated factors of neonatal hypothermia METHODS: This cohort study followed up 125 neonates consecutively admitted to Special Care Baby Unit of Teaching Hospital, Peradeniya from November 2011 to January 2012. A paediatric registrar interviewed parents using a structured-questionnaire and direct observation using a check list. On admission, axillary body temperature was measured and graded using WHO classification. Results: Of the 125 neonates, 96 were admitted within first day of birth (78.6%) and 72 had low birth weight (57.6%). Neonates were admitted from operation theater (58, 46.4%), postnatal ward (34, 27.2%) and labour room (23, 18.4%). Median temperature on admission was 36.2 °C with 38.4% having moderate hypothermia (n=48), 19.2% cold-stress (n=24) and none with severe hypothermia. Risk of hypothermia was increased by prematurity (OR = 9.9, 95% CI: 4.2 - 23), low birth weight (OR= 6.8, 3.1 -15.1), being delivered by caesa-pean section (OR=4, 1.8 - 9.1), admission from operation theatre or labour room (OR =9.1, 3.9 - 21.4) and cold delivery room ( p < 0.001). Caesarean rate was higher among neonates admitted to PBU than all the children delivered (OR = 3.35, 2.2 - 5.1). Hypothermia increases risk of poor activity (OR =1.8, 1.4 - 2.4), poor feeding (OR= 7.2, 1.5 - 34.9), poor cry (OR = 1.9, 1.5 - 2.4), respiratory distress (OR= 1.5, 1.1 - 2.0) and hypoglycemia (OR = 1.6, 1.2 - 2.0).
Perceptions of editorial staff and coverage of reproductive health related newspaper articles and adolescents3 expectations
(Sri Lanka Medical Association, 2009) Kumarendran, B.; Nandasena, Y.L.S.; Abeysena, H.T.C.S.
OBJECTIVE: 1. To describe coverage of selected Sinhalese newspaper articles on reproductive health (RH) and to explore the attitudes of editorial staff related to RH publications. 2. To explore the mpressions and expectations of adolescent school children about reproductive health (RH) information published in Sinhalese newspapers METHODS: Most popular three national and three tabloid newspapers were identified through focus group discussions with adolescent school children in the Gampaha district. The newspapers published during the preceding six months (May to October 2007) to the survey were selected and data extraction was done by two medical officers. In-depth interviews were conducted with ditorial staff (n=ll) of the selected newspapers to explore their attitudes regarding the RH related publications and their constraints. Focus group discussions (FGD) were conducted among advanced level students (n=134) in five schools in the Gampaha district selected by stratified purposive sampling based on subject stream, sex and location (urban/rural). RESULTS: 268 articles were published on RH in national and tabloid papers during the reference period. Pregnancy related issues (n= 67, 25%) were the most commonly discussed topic in both types of newspapers. Other articles were mainly on sexually transmitted diseases (n=38, 14.2%), commercial sex (n=35, 13.1%), and abortion (n= 26, 9.7%). Most of the published articles included photographs. Half (n= 138) of the articles were written with the guidance of qualified medical doctors. Although the spectrum of RH issues was known, the journalists tend to write on topics such as sexually transmitted diseases but not on homosexuality, virginity and family planning. This narrow coverage was due to limited space, cultural restrictions in the selection of topics and inadequate guidance from medical personnel. The majority of the students were not satisfied about the adequacy of various aspects covered and presentation of RH related information by newspapers. CONCLUSION: RH related newspaper information was limited to selected topics. Although journalists knew the spectrum of RH related topics, publications were limited to selected topics. The topics covered on RH by newspapers were not presented in an adolescent friendly manner and were not on areas that they have a quest for.
Policy implementation and recommended actions to create healthy food environments using the healthy food environment policy index (Food-EPI): a comparative analysis in South Asia
(Elsevier Ltd, 2024) Pineda, E.; Atanasova, P.; Wellappuli, N.T.; Kusuma, D.; Herath, H.; Segal, A.B.; Vandevijvere, S.; Anjana, R.M.; Shamim, A.A.; Afzal, S.; Akter, F.; Aziz, F.; Gupta, A.; Hanif, A.A.; Hasan, M.; Jayatissa, R.; Jha, S.; Jha, V.; Katulanda, P.; Khawaja, K.I.; Kumarendran, B.; Loomba, M.; Mahmood, S.; Mridha, M.K.; Pradeepa, R.; Aarthi, G.R.; Tyagi, A.; Kasturiratne, A.; Sassi, F.; Miraldo, M.
BACKGROUND The increasing prevalence of diet-related non-communicable diseases (NCDs) in South Asia is concerning, with type 2 diabetes projected to rise to 68%, compared to the global increase of 44%. Encouraging healthy diets requires stronger policies for healthier food environments.METHODS This study reviewed and assessed food environment policies in Bangladesh, India, Pakistan, and Sri Lanka from 2020 to 2022 using the Healthy Food Environment Policy Index (Food-EPI) and compared them with global best practices. Seven policy domains and six infrastructure support domains were considered, employing 47 good practice indicators to prevent NCDs. Stakeholders from government and non-governmental sectors in South Asia (n = 148) were invited to assess policy and infrastructure support implementation using the Delphi method.FINDINGS Implementation of food environment policies and infrastructure support in these countries was predominantly weak. Labelling, monitoring, and leadership policies received a moderate rating, with a focus on food safety, hygiene, and quality rather than obesity prevention. Key policy gaps prioritized for attention included front-of-pack labelling, healthy food subsidies, unhealthy food taxation, restrictions on unhealthy food promotion, and improvements in school nutrition standards to combat NCDs.INTERPRETATION Urgent action is required to expand food policies beyond hygiene and food security measures. Comprehensive strategies targeting NCD prevention are crucial to combat the escalating burden of NCDs in the region.