Browsing by Author "Pieris, R."

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Community-based cluster randomised trial of safe storage to reduce pesticide self-poisoning in rural Sri Lanka: study protocol
(BioMed Central, 2011) Pearson, M.; Konradsen, F.; Gunnell, D.; Dawson, A.H.; Pieris, R.; Weerasinghe, M.; Knipe, D.W.; Jayamanne, S.; Metcalfe, C.; Hawton, K.; Wickremasinghe, A.R.; Atapattu, W.; Bandara, P.; de Silva, D.; Ranasinghe, A.; Mohamed, F.; Buckley, N.A.; Gawarammana, I.; Eddleston, M.A.
BACKGROUND: The WHO recognises pesticide poisoning to be the single most important means of suicide globally. Pesticide self-poisoning is a major public health and clinical problem in rural Asia, where it has led to case fatality ratios 20-30 times higher than self-poisoning in the developed world. One approach to reducing access to pesticides is for households to store pesticides in lockable "safe-storage" containers. However, before this approach can be promoted, evidence is required on its effectiveness and safety. METHODS/DESIGN: A community-based cluster randomised controlled trial has been set up in 44,000 households in the North Central Province, Sri Lanka. A census is being performed, collecting baseline demographic data, socio-economic status, pesticide usage, self-harm and alcohol. Participating villages are then randomised and eligible households in the intervention arm given a lockable safe storage container for agrochemicals. The primary outcome will be incidence of pesticide self-poisoning over three years amongst individuals aged 14 years and over. 217,944 person years of follow-up are required in each arm to detect a 33% reduction in pesticide self-poisoning with 80% power at the 5% significance level. Secondary outcomes will include the incidence of all pesticide poisoning and total self-harm. DISCUSSION: This paper describes a large effectiveness study of a community intervention to reduce the burden of intentional poisoning in rural Sri Lanka. The study builds on a strong partnership between provincial health services, local and international researchers, and local communities. We discuss issues in relation to randomisation and contamination, engaging control villages, the intervention, and strategies to improve adherence.
Cost-effectiveness of TLH versus NDVH versus TAH: a multi-centre randomized controlled trial.
(Sri Lanka College of Obstetricians & Gynaecologists, 2018) Ekanayake, C.D.; Pathmeswaran, A.; Pieris, R.; Wijesinghe, P.S.
OBJECTIVE: Hysterectomy is the commonest major gynaecological surgical procedure. There are many approaches in performing a hysterectomy which depend on clinical criteria. However certain patients are suitable to be operated through any approach. The objective of this study was to provide evidence on the optimal approach in terms of cost-effectiveness between non-descent vaginal hysterectomy (NDVH), total laparoscopic hysterectomy (TLH) and total abdominal hysterectomy (TAH). METHODS: A multi-centre three arm randomized controlled trial is being conducted at the professorial gynaecology unit, North Colombo Teaching Hospital, Ragama and gynaecology unit, District General Hospital, Mannar. Results of the Mannar arm are presented. Study population were women needing hysterectomy for non-malignant uterine causes. Exclusion criteria were uterus 14 weeks, previous pelvic surgery, those requiring incontinence/pelvic floor surgery, co-morbidities which precludes laparoscopic surgery and women who are illiterate. Primary outcome was time taken to resume all activities done prior to surgery. A micro-costing approach was adopted to calculate utilization of hospital resources from the time of presentation to the gynaecology clinic up to six months after surgery. The treatment groups were compared using a one-way analysis of variance (ANOVA) followed by Tukey's HSD for post hoc comparisons of the mean values. Incremental cost-effectiveness ratios (ICER) were obtained by calculating the incremental costs divided by the incremental effects (time to recover) for the intervention groups (NDVH and TLH) over the standard care (TAH) group. RESULTS: There was a significant difference in time to recover in TLH [28.9 days (26.2-31.2), p<0.02] and NDVH [29.8 days (26.8-32.9), p<0.05] versus TAH [35.5 days (32.0-39.0)]. There was no significant difference between TAH and NDVH [p=0.90].The direct cost of a TLH [Rs. 45371 (43770-46972)] was significantly more than TAH [Rs. 34060 (32521-35599), p<0.001] or NDVH [Rs. 33038 (29720-36356), p<0.001]. There was no significant difference between TAH and NDVH (p=0.81). The incremental costs of a TLH was significantly more than TAH [Rs.11311 (9710 to 12912), p<0.001]. The incremental cost of a NDVH was [Rs. 1022(-4340 to 2296), p=0.81) less than TAH. ICER-TLH was Rs.1714/day. As both the cost as well as the time to recover was more favourable than TAH, ICER-NDVH was not calculated. CONCLUSION: This interim analysis shows that TLH and NDVH have a faster recovery compared to TAH. However, the incremental costs for a TLH were considerably higher. The optimum approach to hysterectomy appears to be NDVH in terms of cost-effectiveness
Cost-Effectiveness of Three Approaches to Hysterectomy: A Randomized Controlled Trial.
(In: Proceedings of the International Postgraduate Research Conference 2017 (IPRC – 2017), Faculty of Graduate Studies, University of Kelaniya, Sri Lanka., 2017) Ekanayake, C.D.; Pathmeswaran, A.; Pieris, R.; Wijesinghe, P.S.
Hysterectomy is the commonest major gynaecological surgical procedure. There are many approaches in performing a hysterectomy which depend on clinical criteria. However certain patients are suitable to be operated through any approach. The aim of this study was to provide evidence on the optimal approach in terms of cost-effectiveness between non-descent vaginal hysterectomy (NDVH), total laparoscopic hysterectomy (TLH) and total abdominal hysterectomy (TAH).
Effectiveness of household lockable pesticide storage to reduce pesticide self-poisoning in rural Asia: a community-based, cluster-randomised controlled trial
(London : J. Onwhyn, 2017) Pearson, M.; Metcalfe, C.; Jayamanne, S.; Gunnell, D.; Weerasinghe, M.; Pieris, R.; Priyadarshana, C.; Knipe, D.W.; Hawton, K.; Dawson, A.H.; Bandara, P.; de Silva, D.; Gawarammana, I.; Eddleston, M.; Konradsen, F.
BACKGROUND: Agricultural pesticide self-poisoning is a major public health problem in rural Asia. The use of safer household pesticidestorage has been promoted to prevent deaths, but there is no evidence of effectiveness. We aimed to test the effectiveness of lockablehousehold containers for prevention of pesticide self-poisoning. METHODS: We did a community-based, cluster-randomised controlled trial in a rural area of North Central Province, Sri Lanka. Clusters of households were randomly assigned (1:1), with a sequence computer-generated by a minimisation process, to intervention or usual practice (control) groups. Intervention households that had farmed or had used or stored pesticide in the preceding agricultural season were given a lockable storage container. Further promotion of use of the containers was restricted to community posters and 6-monthly reminders during routine community meetings. The primary outcome was incidence of pesticide self-poisoning in people aged 14 years or older during 3 years of follow-up. Identification of outcome events was done by staff who were unaware of group allocation. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT1146496. FINDINGS: Between Dec 31, 2010, and Feb 2, 2013, we randomly assigned 90 rural villages to the intervention group and 90 to the control group. 27 091 households (114 168 individuals) in the intervention group and 26 291 households (109 693 individuals) in the control group consented to participate. 20 457 household pesticide storage containers were distributed. In individuals aged 14 years or older, 611 cases of pesticide self-poisoning had occurred by 3 years in the intervention group compared with 641 cases in the control group; incidence of pesticide self-poisoning did not differ between groups (293·3 per 100 000 person-years of follow-up in the intervention group vs 318·0 per 100 000 in the control group; rate ratio [RR] 0·93, 95% CI 0·80-1·08; p=0·33). We found no evidence of switching from pesticide self-poisoning to other forms of self-harm, with no significant difference in the number of fatal (82 in the intervention group vs 67 in the control group; RR 1·22, 0·88-1·68]) or non-fatal (1135 vs 1153; RR 0·97, 0·86-1·08) self-harm events involving all methods. INTERPRETATION: We found no evidence that means reduction through improved household pesticide storage reduces pesticide self-poisoning. Other approaches, particularly removal of highly hazardous pesticides from agricultural practice, are likely to be more effective for suicide prevention in rural Asia. FUNDING: Wellcome Trust, with additional support from the American Foundation for Suicide Prevention, Lister Institute of Preventive Medicine, Chief Scientist Office of Scotland, University of Copenhagen, and NHMRC Australia.
Socioeconomic position and suicidal behaviour in rural Sri Lanka: a prospective cohort study of 168,000+ people.
(Springer International, 2019) Knipe, D. W.; Gunnell, D.; Pieris, R.; Priyadarshana, C.; Weerasinghe, M.; Pearson, M.; Jayamanne, S.; Hawton, K.; Konradsen, F.; Eddleston, M.; Metcalfe, C.
PURPOSE:Lower socioeconomic position (SEP) is associated with an increased risk of suicidal behaviour in high income countries, but this association is not established in low- and middle-income countries (LMIC). METHODS: We investigated the association of SEP with suicidal behaviour in a prospective cohort study of 168,771 Sri Lankans followed up for episodes of attempted suicide and suicide. SEP data were collected at baseline at the household and individual level at the start of the follow-up period. We used multilevel Poisson regression models to investigate the association of SEP at community, household and individual levels with attempted suicide/suicide. RESULTS: Lower levels of asset ownership [IRR (95% CI) suicide 1.74 (0.92, 3.28); attempted suicide 1.67 (1.40, 2.00)] and education [suicide 3.16 (1.06, 9.45); attempted suicide 2.51 (1.70, 3.72)] were associated with an increased risk of suicidal behaviour. The association of these measures of SEP and attempted suicide was stronger in men than women. Individuals living in deprived areas [1.42 (1.16, 1.73)] and in households with a young female head of household [1.41 (1.04, 1.93)] or a temporary foreign migrant [1.47 (1.28, 1.68)] had an elevated risk of attempted suicide. Farmers and daily wage labourers had nearly a doubling in risk of attempted suicide compared to other occupations. CONCLUSIONS: Improved employment opportunities, welfare and mental health support services, as well as problem-solving skills development, may help support individuals with poorer education, farmers, daily wage labourers, individuals in young female-headed households and temporary foreign migrant households.