Browsing by Author "Pinidiyapathirage, M.J."

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Alcohol consumption and tobacco smoking in an urban adult Sri Lankan population
(Sri Lanka Medical Association, 2008) Kasturiratne, A.; Pinidiyapathirage, M.J.; Perera, H.K.K.; Fernando, E.D.P.S.; Ranasinha, C.D.; Edirisinghe, P.A.S.; Makaya, M.; Kato, N.
BACKGROUND: Data on the prevalence and patterns of alcohol consumption and smoking in the general population in Sri Lanka are scarce. Objective: To describe patterns of alcohol use and smoking in an urban adult population in Sri Lanka. DESIGN, SETTING AND METHODS: A random sample of the general population aged between 35-65 years, resident in the Ragama Medical Officer of Health area was interviewed to obtain drinking and smoking habits. RESULTS: Among 2985 subjects [males 45.5%; mean age 52.7 years (SD7.8)], 1156(39.7%) reported ever use of alcohol, and 892(29.7%) reported current use. 58.8% of males and 5.7% of females were current drinkers. 190(14%) males and 12(0.7%) females consumed alcohol above the weekly safe limit (>14 units for males, >7 units for females). The median duration of alcohol use among ever users was 18 years (interquartile range 10-25), and current users was 20 years (interquartile range 1,0-25). The commonest type of alcohol consumed was arrack (n=492), followed by beer (n=217). 60.2% of males and 2.1% of females reported ever smoking, 483(16.2%) were current smokers. 35.1% of males and 0.5% of females were current smokers. The median duration of smoking was 20 years among both ever smokers (interquartile range 10-27.3), and current smokers (interquartile range 15-30). Most (55.3%) smoked cigarettes, only 36(4.2%) smoked beedi. The median pack years of current smokers was 4,5 (interquartile range 2-10). CONCLUSION: Lifetime and current use of alcohol and smoking are high among males. Focused interventions are required to reduce current rates among males and to maintain low rates reported by females.
Antenatal care provided and its quality in field clinics in Gampaha district, Sri Lanka
(SAGE Publishing, 2007) Pinidiyapathirage, M.J.; Wickremasinghe, A.R.
A descriptive cross-sectional study was carried out in the Gampaha District in Sri Lanka to assess the quality of care provided at antenatal field clinics. Checklists were used to assess the structure and process attributes of quality. An interviewer administered questionnaire assessed the quality of information provided to the clients and client satisfaction. The findings indicated that several resource components need upgrading in the district. The majority of clinics did not have adequate seating arrangements, lacked a footstool, a height measuring instrument and Vitamin C. Less than 50% of the staff were present at 8.00 a.m. in eight clinics. Health education material was substandard in nine clinics. No supervisory notes were made during the preceding year in fourteen clinics. Testing urine for sugar and albumin was substandard in 11 and eight clinics, respectively. Physical examination of pregnant females was substandard in all 20 clinics. No information was provided on some routine procedures carried out at the clinic such as blood pressure monitoring, weight gain and vaccines given. Client satisfaction exceeded 95% in all aspects except building and infrastructure and time spent at the clinic.
Anti-tuberculosis drug inducd hepatitis:a Sri Lankan experience
(Sri Lanka Medical Association, 2006) Senaratne, W.V.; Pinidiyapathirage, M.J.; Perera, G.A.M.H.E.; Wickremasinghe, A.R.
OBJECTIVE: To assess the incidence of anti-tuberculosis (TB) drug induced hepatitis (AIH) in Sri Lankan patients, determine risk factors of AIH, and to address management options in AIH. DESIGN: A prospective study. SETTING: Chest Hospital, Welisara, Sri Lanka, from April 2001 to April 2002. PATIENTS: Seven hundred and eighty three patients with a confirmed diagnosis of TB and resident in the Colombo and Gampaha districts who presented to Chest Hospital, Welisara, Sri Lanka. METHODS: WHO recommended treatment was commenced in all cases. AIH was diagnosed when patients complained of decreased appetite with nausea or vomiting and elevated serum bilirubin (SB; >1.1 mg/dL) or elevated serum alanine transferase (ALT; > 3 times upper limit of normal).RESULTS: Of 783 enrolled patients, 74 (9.5%) developed AIH, the majority (58%) developing AIH within the first 2 weeks of the intensive phase of treatment. AIH was more common among patients over 60 years (p = 0.018), who developed pulmonary TB (p = 0.028), and in patients weighing 33-55 kg (p = 0.004). Age, weight and rifampicin overdosage were significant predictors of AIH. Of the 74 AIH patients, standard treatment was restarted in 60, treatment modified in six, two defaulted and six died. CONCLUSIONS: The incidence of AIH in Sri Lanka is 9.5% in treated patients. AIH was associated with age, low body weight and rifampicin over dosage.
Anti-tuberculous drug induced hepatitis in Sri Lankan patients
(Sri Lanka Medical Association, 2007) Senaratne, W.V.; Pinidiyapathirage, M.J.; Perera, G.A.M.H.E.; Wickremasinghe, A.R.
OBJECTIVE: To determine the incidence and risk factors of anti-TB drug induced hepatitis (AIH) in Sri Lankan patients and to address management options. DESIGN, SETTING AND METHODS: 783 patients with a confirmed diagnosis of TB who presented to a unit at Chest Hospital, Welisara from April 2001 to April 2002 were recruited for a follow up study. WHO category 1 for new and category 2 for re-treatment cases was commenced using single drug formulations. Doses were based on three weight bands. AIH was diagnosed when patients complained of decreased appetite, nausea/vomiting and elevated serum biliru&n (SB) l.lmg/dl or elevated serum alanine transferase (ALT) 3 times upper limit of normal (ULN). Results: 74 patients (9.5%) out of 783 enrolled patients developed AIH; the majority (58%) developing AIH within the first two weeks of the intensive phase of treatment. AIH was commoner among patients over 60 years (p=0.018), with pulmonary TB (p=0.028) and weighing 33-35 kg (p=0.004). Using regression analysis, age, weight and rifampicin overdosage were significant predictors of AIH. Of the 74 AIH patients, standard treatment was restarted in 60 and treatment was modified in six; two defaulted and six died. Conclusions: Incidence of AIH among Sri Lankan patients is 9.5%. They develop symptoms of hepatitis when ALT levels rise to three times the ULN lowering the threshold for diagnosis of AIH. Old age, 33-55 kg weight band and rifampicin over dosage are risk factors for AIH. Majority (81%) of AIH patients could be restarted on standard treatment.
Availability of drugs for the treatment of non-communicable diseases in the government health care institutions in Sri Lanka
(Sri Lanka Medical Association, 2006) Pinidiyapathirage, M.J.; Chandratilake, M.N.; Kasturiratne, A.; Jayaratna, G.S.; Jayasekera, D.P.A.R.N.; Subhasini, K.A.P.; Mahawithanage, S.T.; Wickremasinghe, A.R.
OBJECTIVE: To assess the availability of commonly used drugs in the treatment of non-communicable diseases in government health care institutions. METHODS: Forty four government health care institutions, representing the 3 levels of health care institutions (level 1 - CD & MH, level 2 - PU, DH, RH, level 3 - BH, GH, PH, TH) were randomly selected from the districts of Colombo, Anuradhapura, Moneragala and Matara. Each of the selected institutions was visited and the availability of a selected list of drugs was ascertained on the day of the visit. Availability was considered satisfactory if the drug was available in at least 75% of institutions of a particular level. RESULTS: Of the drugs that should be available at each level the following results were obtained: Level I -Availability of thiazides, beta-blockers, aspirin and nitrates were satisfactory. Availability of benzathine benzylpenicillin, glibenclamide andprednisolone were unsatisfactory. LevelII- Furosemide, thiazides, nitrates, glibenclamide, metformin andprednisolone were available in all and the availability of methyldopa, nifedipine, beta-blockers and aspirin was satisfactory. Availability of benzathine benzylpenicillin, insulin (isophane/so ruble) and spironolactone were unsatisfactory. Level III - Furosemide, thiazides, metformin, aspirin, beta-blockers, nitrates, nifedipine and prednisolone were available in all while the availability of benzathine benzylpenicillin, captopril, spironolactone, methyldopa, glibenclamide, insulin (isophane/soluble) and timolol eye-drops were satisfactory. Availability of steptokinase, inhalation steroids and salbutamol, ipratropium bromide, losartan, and tamoxifen were unsatisfactory. CONCLUSIONS: Availability of some essential drugs for non-communicable diseases was unsatisfactory at all 3 levels of health care institutions. This may be a reason for patients bypassing smaller institutions and the back referral system not functioning properly in the country. Inadequacy of national stocks cannot by itself explain the non-availability of these drugs as the survey was carried out in July/August.
The Burden of diabetes mellitus and impaired fasting glucose in an urban population of Sri Lanka
(Wiley-Blackwell, 2013) Pinidiyapathirage, M.J.; Kasturiratne, A.; Ranawaka, U.K.; Gunasekara, D.; Wijekoon, N.; Medagoda, K.; Perera, S.; Takeuchi, F.; Kato, N.; Warnakulasuriya, T.; Wickremasinghe, A.R.
AIMS: To describe the burden of diabetes mellitus and impaired fasting glucose in middle-aged residents (35-64 years) in an urban area of Sri Lanka. METHODS: A cross-sectional survey was conducted in the Ragama Medical Officer of Health area, from which 2986 participants (1349 men and 1637 women) were randomly selected from the electoral registry between January and December 2007. The participants underwent a physical examination and had their height, weight, waist and hip circumferences and blood pressure measured by trained personnel. Fasting blood samples were taken for measurement of glucose, HbA(1c) and lipids. The prevalence of diabetes (fasting plasma glucose > 7 mmol/l) and impaired fasting glycaemia (fasting plasma glucose 5.6-6.9 mmol/l) and major predictors of diabetes in Sri Lanka were estimated from the population-based data. RESULTS: Age-adjusted prevalence of diabetes mellitus in this urban population was 20.3% in men and 19.8% in women. Through the present screening, 263 patients with diabetes and 1262 with impaired fasting glucose levels were identified. The prevalence of newly detected diabetes was 35.7% of all patients with diabetes. Among patients with diabetes, only 23.8% were optimally controlled. In the regression models, high BMI, high waist circumference, high blood pressure and hypercholesterolaemia increased the fasting plasma glucose concentration, independent of age, sex and a family history of diabetes. CONCLUSIONS: Our data demonstrate the heavy burden of diabetes in this urban population. Short- and long-term control strategies are required, not only for optimal therapy among those affected, but also for nationwide primary prevention of diabetes
The burden of diabetes mellitus in an urban population of Sri Lanka
(Sri Lanka Medical Association, 2011) Pinidiyapathirage, M.J.; Kasturiratne, A.; Williams, S.; Wijekoon, N.; Pathmeswaran, A.; Ranawaka, U.K.; Warnakulasuriya, T.; Takeuchi, F.; Kato, N.; Wickremasinghe, A.R.
INTRODUCTION AND OBJECTIVES: To describe the burden of diabetes in middle and old aged residents (35-64 years) in an urban area of Sri Lanka. METHODS: A cross-sectional survey was conducted in the Ragama Medical Officer of Health area, in which 2986 participants (1349 men and 1637 women) were randomly selected from the electoral registry between January and December 2007. The participants underwent a physical examination and had their height, weight, waist and hip circumferences and 51ood pressure measured by trained personnel. Blood samples were taken after a 14 hour fast for measurement of glucose, HbAlc and lipids. The prevalence of diabetes (fasting plasma glucose [FPG] >7mmol/L) and impaired fasting glycaemia [IFG] (FPG=5.6-6.9mmol/L) and major predictors of diabetes in Sri Lanka were estimated from the population based data. RESULTS: In the whole sample two thirds of the participants were diagnosed as either people with diabetes (20%) or IFG (45%). Among the diabetics only 23.8% were optimally controlled. Through the present screening, 235 diabetics (7.9%) and 1257 (42.1%) participants with impaired fasting glucose levels were newly identified. Old age (OR=5.1, 55-64 years vs. 35-44 years), male sex (OR=3.1), family history (OR- 2.7), central obesity (OR-1.8), and reduced physical activity (OR=1.3) were significantly associated with increased risk of diabetes. CONCLUSIONS: Our data demonstrate the heavy burden of diabetes in the general population. Short and long term control strategies are required not only for optimal-therapy among those affected but also for nationwide primary prevention of pre-diabetes.
Cardiovascular risk profile of the estate population of Sri Lanka
(Sri Lanka Medical Association, 2010) Pinidiyapathirage, M.J.; Chackrewarthy, S.; Perera, P.S.; Wijayasinghe, Y.S.; Williams, S.; Williams, S.S.; Kato, N.; Wickremasinghe, A.R.
OBJECTIVES: To estimate the prevalence of biochemical and anthropometric risk markers of cardiovascular diseases in the estate population of Sri Lanka. METHODS: Using a cross sectional design, consenting adults aged 35-64 years resident in 3 selected estates in the Nuwara-Eliya District were recruited with the support of estate medical assistants and welfare officers. AH participants were subjected to an interview, blood pressure and anthropometric measurements and collection of fasting blood samples. RESULTS: Of the 401 participants recruited, 53% were females and 99% were cither Indian or Sri Lankan Tamils. The mean age of the participants was 50.3 years (SD 8.5). 47 (12%) participants had a BMI >25, 8 (2%) a BMI >30. 29 males (15%) and 29 females (14%) had a waist circumference [WC] >90cm and >80 cm, respectively. 151 (38%) participants had systolic blood pressure (SBP) > 140mmHg , 127 (32%) had diastolic blood pressure (DBF) > 90mmHg and 170 (42%) had either SBF > 140 or DBF > 90. 41(10%) participants had fasting blood glucose (FBG) >126mg/dL. In 197 (49%) participants, some form of dyslipidaemia was present. Males had a significantly higher mean BMI, FBG and triglyceride (TG) level and a significantly lower high density lipoprotein (HDL) level as compared to females. CONCLUSIONS: Obesity, as defined by BMI or WC, was low in this population as compared to other reported studies from different population groups in the country. But prevalence of hypertension and dyslipidaemia (especially high TG and low HDL levels in males) was high.
Defaulter rate and predictors of defaulting of patients on anti-tuberculosis treatment
(Sri Lanka Medical Association, 2006) Pinidiyapathirage, M.J.; Senaratne, W.V.; Perera, G.A.M.H.E.; Wickremasinghe, A.R.
OBJECTIVE: To determine the defaulter rate and risk factors of defaulting of patients on anti- tuberculosis treatment. METHODS: All consenting patients with a confirmed diagnosis of tuberculosis admitted to a unit at Chest Hospital, Welisara were recruited from April 2001 to April 2002 for follow up. Personal and follow up data were recorded in a pre-tested questionnaire and data sheet respectively. A defaulter was defined as a patient who interrupted treatment for more than two consecutive months before the end of the course of treatment. RESULTS: Of the 892 patients recruited, 770 were new cases and 122 were relapses. Defaulter rate was 10.3%(95%CI:8.3%-12.6%) and 30.3% (95% CI:22.7%-38.1%) among new cases and re-treatment cases respectively in the intensive phase of treatment and 10.9 % (95% CI:8.7%-13.3%) and 16.5% (95% CI: 9.7- 25.5) respectively in the continuation phase. 90% of new cases and 94% of re-treatment cases were sputum positive at diagnosis. Altogether 205 (22.9%) defaulted treatment (95% CI: 20.3%-25.8%). Age, sex, occupational status, family income, regular alcohol consumption, current smoking and substance abuse were independently significantly associated (p<0.05) with defaulting. Defaulters were significantly different (p<0.05) from compliers with regard to the site of the lesion, being in new or re-treatment category (type), acid-fast bacilli in sputum and extent of lung involvement. Using logistic regression analysis, a regular smoker (OR=1.9), a smear positive defaulter (OR=2.4) and a patient having involvement of more than 3 zones of the lung on chest x-ray examination (OR=0.5) was more likely to default as compared to a patient who did not smoke regularly, a smear positive patient who had relapsed after taking the full course of treatment and a patient with less lung involvement, respectively. Of the occupational categories, skilled and unskilled labourers were most likely to default (OR=2.03) followed by sales personnel (OR=2.00) as compared to those unemployed or home-bound. Conclusions: A high defaulter rate of 23% was observed among the study participants. Smoking status, occupation, type of patient, and extent of lung involvement are predictors of defaulting.
Epidemiology of hypertension in an urban population of Sri Lanka
(Sri Lanka Medical Association, 2011) Kasturiratne, A.; Pinidiyapathirage, M.J.; Pathmeswaran, A.; Kato, N.; Wickremasinghe, A.R.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: To describe the epidemiology of hypertension in 35-64 year old adults resident in Ragama Medical Officer of Health area in the Gampaha district, Sri Lanka. Methods: The Ragama Health Study is conducted in the Ragama MOH area of the Gampaha district. An age- stratified random sample of 2986 adults between 35-64 years of age, were screened for cardiovascular risk factors. Socio-demographic and risk factor related data were obtained by structured interview. Anthropometric and blood pressure measurements were obtained and relevant biochemical investigations were conducted. RESULTS: The prevalence of hypertension (systolic > 139 mm Hg and/or diastolic > 89 mm Hg) in 2986 participants (males 45%), was 30.4% (27.8% in males; 32.5% in females). 31.8% (n=288) were previously undetected. Of the known hypertensives, 19.5% were not on anti-hypertensive medication and only 32.1% were controlled (defined by systolic <140 mm Hg and diastolic <90 mm Hg). Factors associated with hypertension in both males and females were body mass index, waist circumference, fasting blood glucose and serum triglycerides. CONCLUSIONS: The prevalence observed is comparable to the prevalence of developed countries with relatively older populations. A considerable proportion of known hypertensives are not on treatment and the observed poor control indicates problems in drug compliance. Interventions targeting lifestyle modification and drug compliance are essential to control adverse outcomes of hypertension.
Exposure characteristics of patients presenting to an anti-rabies treatment unit
(Sri Lanka College of Microbiologists, 2006) Pinidiyapathirage, M.J.; Wimalarathne, O.; Gunasekara, W.P.A.D.
OBJECTIVE: With increased availability, accessibility and safety of rabies post exposure treatment (PET), costs borne by the Government in the purchase of anti-rabies vaccines have increased dramatically. This study was conducted to identify exposure characteristics of patients presenting to an anti-rabies treatment unit (ARU) and to propose measures that could minimise PET use. METHOD: A hospital based descriptive study was carried out in the ARU of the National Hospital of Sri Lanka (NHSL), An interviewer administered questionnaire assessed socio-demographic characteristics and the nature of exposure of patients. Treatment received was obtained from patient records. RESULTS: All consenting, first visit patients (n-266) presented during a period of one week to the ARU with an exposure history to a suspected rabid animal were studied. Mean age of those exposed was 36.6 years (SD 16.6). Exposure to dogs (208, 78.2%) was the commonest followed by exposure to cats (33, 12.4%). Majority were exposed to domesticated animals (172, 64.7%) which were unvaccinated or did not have reliable proof of vaccination (167, 62.8%). Of the 266, 13 (4.9%) did not need PET, 51 (19.2%) needed both anti-rabies inactivated tissue culture vaccine (ARV) and anti rabies serum and202(75.9%) needed ARV only. CONCLUSION: Majority of the exposures that needed PET was to domesticated dogs which were unvaccinated or had no reliable proof of vaccination. Importance of regular vaccination of pets and safe-keeping of animal vaccination records should be stressed to the general public and awareness of responsible pet ownership should be raised among the public.
Genome-wide association study in individuals of South Asian ancestry identifies six new type-2 diabetes susceptibility loci
(Nature Publishing Company, 2011) Kooner, J.S.; Saleheen, D.; Sim, X.; Sehmi, J.; Zhang, W.; Frossard, P.; Been, L.F.; Chia, K.S.; Dimas, A.S.; Hassanali, N.; Jafar, T.; Jowett, J.B.; Li, X.; Radha, V.; Rees, S.D.; Takeuchi, F.; Young, R.; Aung, T.; Basit, A.; Chidambaram, M.; Das, D.; Grundberg, E.; Hedman, A.K.; Hydrie, Z.I.; Islam, M.; Khor, C.C.; Kowlessur, S.; Kristensen, M.M.; Liju, S.; Lim, W.Y.; Matthews, D.R.; Liu, J.; Morris, A.P.; Nica, A.C.; Pinidiyapathirage, M.J.; Prokopenko, I.; Rasheed, A.; Samuel, M.; Shah, N.; Shera, A.S.; Small, K.S.; Suo, C.; Wickremasinghe, A.R.; Wong, T.Y.; Yang, M.; Zhang, F.
We carried out a genome-wide association study of type-2 diabetes (T2D) in individuals of South Asian ancestry. Our discovery set included 5,561 individuals with T2D (cases) and 14,458 controls drawn from studies in London, Pakistan and Singapore. We identified 20 independent SNPs associated with T2D at P < 10(-4) for testing in a replication sample of 13,170 cases and 25,398 controls, also all of South Asian ancestry. In the combined analysis, we identified common genetic variants at six loci (GRB14, ST6GAL1, VPS26A, HMG20A, AP3S2 and HNF4A) newly associated with T2D (P = 4.1 × 10(-8) to P = 1.9 × 10(-11)). SNPs at GRB14 were also associated with insulin sensitivity (P = 5.0 × 10(-4)), and SNPs at ST6GAL1 and HNF4A were also associated with pancreatic beta-cell function (P = 0.02 and P = 0.001, respectively). Our findings provide additional insight into mechanisms underlying T2D and show the potential for new discovery from genetic association studies in South Asians, a population with increased susceptibility to T2D.
Geohelminthic infection in an estate child population in Sri Lanka: association with hygienic practices and eosinophil counts
(Sri Lanka College of Microbiologists, 2006) Banneheke, B.M.H.A.; Gunawardane, D.M.D.E.A.; Pinidiyapathirage, M.J.; Ekanayake, S.; Withana, R.J.; Tilakaratne, W.D.T.
OBJECTIVES: To describe hygienic practices, prevalence of geohelminthic infections and its association with eosinophil counts among children. Methods: A descriptive cross sectional study was conducted in a tea plantation in Ratnapura District involving 316 school children. An interviewer-administered questionnaire was used to collect data from the child or parent. Stool and blood samples were obtained from all the consenting children. Stool examinations were conducted using saline smear, agar-plate culture technique, and Kato-Katz quantitative technique. Eosinophil count was obtained using blood smears. RESULTS: Mean age of the children (n=317) in the sample was 8.5 years (SD 1.7). Of the selected sample 219(85%) had access to pipe borne water, 228(72%) washed hands before meals, 164(52%) did not use a toilet, 180(57%) had a domesticated dog or a cat and 168(53%) used antihelminthic drugs regularly. A history of asthma, wheezing/allergies was reported by 101(32%) subjects. Of the 317 stool samples examined, Ascaris infection was prevalent in 60(19%), hookworm infection in 25(8%) (15 of them had>4000 eggs per gram - severe infection), Trichuris infection in 7(2.2%) and Strongyloides infection in 3(0.9 %) children. Of the 298 blood samples examined 12 (4%) had an eosinophil count of > 16 %( severe eosinophilia). A statistically significant association was observed with hookworm infection and increased eosinophil counts (p=0.006). CONCLUSION: Prevalence of geohelminthic infections was low among this population, Ascaris showing the highest prevalence (n~60, 19%). An association between the presence of helminthic infection and an increased eosinophil count was observed only with hookworm infection in which (n= 15)60% reported a severe degree of infection.
Introduction of a Safe Water System (SWS) In a tsunami attuned community In Hikkaduwa, Sri Lanka
(College of the Community Physicians of Sri Lanka, 2007) Pinidiyapathirage, M.J.; Wijeyaratnez, P.; Wickremasinghe, A.R.; Kalluri, P.
INTRODUCTION: The SWS is an intervention that employs simple, robust, and inexpensive technologies to make drinking water safe at the point oi use through disinfection and safe storage. OBJECTIVE: To introduce a sale water system using household chlorination and washing of hands with soap in the community. METHODS: A commercially prepared solution of 0.9% sodium hypochlorite ('Chlovathura') in 130ml plastic bottles and a 20-liter plastic container with a narrow mouth and a lid was provided tree 01 charge. Trained community assistants distributed and promoted the use of the SWS using interpersonal communication methods. Hand washing using soap was promoted simultaneously. Surveys were conducted at baseline (n=452). six months (n=100) and 18 months (n=200) post- intervention to assess use. RESULTS: All were aware of the product ’Chlovathura' by six months of its introduction. 0t those who were aware oi the product, 49% (n=98) correctly described how it should be used at baseline and this percentage improved to 75% (n=149) post-intervention. When stored water at household level was tested for chlorine, it was present in the specified concentration in 6% 01:26), 27% (n=27) and 34% (n=67) at baseline, six months and 18 months respectively. The incidence of a diarrhoeal episode within the past two weeks among children under 5 years in the sample reduced to 4.8% (n=4) at 18 months from 5.4% (n=8) at baseline (p>0.05). CONCLUSION: The SWS was accepted and correctly practiced by more than one third of the target population. The SWS can be promoted in other areas with remote access to safe drinking water and may be a solution to reduce the morbidity due to diarrhoeal diseases in the country.
Knowledge and practices of dengue control and their effect on breeding sites and vector populations
(Sri Lanka Medical Association, 2010) Pinidiyapathirage, M.J.; Gunethilake, M.A.G.N.; Wijegunawardana, N.D.A.D.
OBJECTIVE: To describe the association between knowledge and practices of dengue control with the observed dengue breeding sites and vector populations in a community. METHODS: A cross-sectional survey was conducted among households in Negombo area in July 2009 during the height of the dengue epidemic in the country. Knowledge and practices in this community were measured using two methodologies. The first was a questionnaire, to be answered by the household respondent; the second, a mosquito larval survey, to identify potential and actual mosquito breeding sites in the corresponding household. The use of the two instruments allowed comparison of respondent knowledge and reported practice with the actual condition of the compound. RESULTS: All respondents (n=120) have heard of dengue, 89% knew at least one symptom of dengue and 93% knew that a mosquito was responsible for transmission. 60% correctly stated the preferred biting times of the vector and 80% knew that discarded tyres, bottles and plastic containers with water collections were the potential vector breeding sites. On inspection, 104 (87%) households had at least one potential breeding source. However, Aedes aegypti/albopictus larvae/pupae were observed only in water samples collected from 3 (2.5%) households. Knowledge about dengue symptoms, methods of prevention or level of education had no association with the potential breeding sites found. Low income was significantly associated with having at least one potential breeding source in the household. CONCLUSION: Although the level of knowledge about dengue was high in this community, we found only httle evidence that this knowledge was put into practice.
Lifestyle correlates of cardiovascular risk factors in a Sri Lankan population
(Sri Lanka Medical Association, 2008) Pinidiyapathirage, M.J.; Kasturiratne, A.; de Silva, B.A.; Perera, D.M.; Ramanayake, R.P.J.C.; Sumathipala, W.L.A.H.; Mizoue, T.; Makaya, M.
OBJECTIVES: To determine the association between selected lifestyle risk behaviours (physical activity-PA, smoking and fruit, vegetable and alcohol consumption) and cardiovascular risk factors in an urban Sri Lankan population. DESIGN, SETTING AND METHODS: A random sample of 3650 individuals between 35-64 years resident in the Ragama MOH area were selected from the electoral list. A validated, interviewer-administered, food frequency questionnaire and a physical activity questionnaire were used to collect data. Blood samples were analysed for serum lipid and fasting blood glucose (FBG) concentrations. RESULTS: Of the 2602 participants (males:46%), 47% reported low physical activity (PA), 51% sub-optimal fruit consumption, 13% sub-optimal vegetable consumption, 6% excess alcohol consumption and 16% were current smokers. A significantly higher percentage of males reported moderate to high physical activity, had a lower BMI, consumed more alcohol, smoked currently and consumed less fruits. Vegetable consumption was similar between sexes. In females, risk behaviours were not associated with serum lipid and FBG concentrations. Among males, those reporting a low PA had a significantly higher percentage with serum triglyceride concentrations >150mg/dl and FBG >110mg/dl. A significantly higher percentage of male smokers had a serum total cholesterol concentration >200mg/dl and serum LDL concentration >100mg/dl. Excessive alcohol consumption in males was associated with high triglyceride concentrations (>150mg/dl). Serum lipid and FBG levels were similar among those with different fruit and vegetable consumption patterns, CONCLUSION: Low physical activity, smoking and excessive alcohol consumption were associated with serum lipid and FBG concentrations in males. Fruit and vegetable consumption was not correlated with risk factors.
Mortality in an urban cohort in Ragama, Sri Lanka
(BMJ Publishing Group, 2011) Vithanage, P.V.T.S.; Panapitiya, P.A.S.; Padmakumara, N.; Hemantha, S.; Kasturiratne, K.T.A.A.; Wickremasinghe, A.R.; Pathmeswaran, A.; Pinidiyapathirage, M.J.
INTRODUCTION: The leading causes of mortality in Sri Lanka are due to chronic diseases. We describe the mortality patterns in a 35–64-year-old urban cohort resident in Ragama, Sri Lanka and followed over 3 years. METHODS: A follow-up study was conducted among 2986 35–64 year olds randomly selected from the Ragama Medical Officer of Health area, Sri Lanka. A baseline survey was conducted from January to September 2007 and a follow-up survey was conducted from March to November 2010. Mortality data were obtained from next of kin and cause of death was verified from death certificates. RESULTS: There were 49 deaths during 9186.46 person years of observations. Of the 49 deaths, 11 were due to myocardial infarctions, 5 were due to strokes, 5 were due to other ischaemic heart disease and the rest included 6 due to cancer and 2 due to train accidents. The increase in mortality in men occurs after 45 years and in females it is observed later on. Mortality among men was more than twice as much as females (RR 7.96 vs 3.17 per 1000 person years). All cause mortality was significantly higher in diabetics. Mortality was not associated with hypertension, dyslipidaemia, smoking, central obesity, obesity or physical activity. Conclusions Diabetes Mellitus was significantly associated with all cause mortality. Other associations may have not been significant due to the small number of deaths.
Non-alcoholic fatty liver disease in a rural, physically active, low income population in Sri Lanka
(Biomed Central, 2011) Pinidiyapathirage, M.J.; Dassanayake, A.S.; Rajindrajith, S.; Kalubowila, U.; Kato, N.; Wickremasinghe, A.R.; de Silva, H.J.
BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is recognized as a metabolic disorder largely seen in urbanized populations. The purpose of this study was to assess prevalence and risk factors for NAFLD in a rural, physically active, economically deprived population in Sri Lanka. METHODS: By visiting individual households in the community, 35-64 year old adults resident in two selected estates in the Nuwara Eliya District of Sri Lanka, were invited to participate in the study. Blood pressure and anthropometric measurements were made on all participants. Blood samples were obtained for the assay of fasting glucose, serum lipids, serum insulin and alanine aminotransferase. NAFLD was diagnosed on established ultrasound criteria for fatty liver in the absence of hepatitis B and C markers and high alcohol consumption. RESULTS: Of those invited, 403 (65%) participated in the study. Almost all participants were either Indian or Sri Lankan Tamils and 53% were females. Prevalence of NAFLD was 18% in this population. Twice as many males were diagnosed as having NAFLD compared to females. Male sex, high BMI, high waist circumference, high diastolic blood pressure and high plasma glucose levels were significant predictors of NAFLD. CONCLUSION: Nearly one in five people in this predominantly Indian Tamil, rural, physically active, economically deprived population had NAFLD. The condition was associated with constituent features of the metabolic syndrome. These results support studies reporting ethnic variations in disease susceptibility and suggest that genetic factors may also play a role in determining disease risk
Prevalence and predictors of osteoporosis in an urban Sri Lankan population
(Wiley-Blackwell, 2010) Karunanayake, A.L.; Pinidiyapathirage, M.J.; Wickremasinghe, A.R.
AIM: To determine the prevalence of osteoporosis in both women and men and to determine the association between osteoporosis and selected risk factors among a sample of urban Sri Lankan adults. METHODS: The population aged 35-64 years residing in 22 Grama Niladhari divisions, the smallest administrative units in the country, of the Medical Officer of Health area Ragama, Sri Lanka, was identified using the electoral list and stratified into three age groups (n = 3012). A random sample was obtained from each stratum and selected individuals were invited to participate in the study (n = 1100). A structured, interviewer-administered questionnaire was used to collect information on demographic data and details of risk factors. Bone mineral density (BMD) was measured using a peripheral dual-energy X-ray absorptiometry (DEXA) scan in 700 subjects (64%). A BMD < -2.5 was considered as osteoporosis. Although peripheral DEXA is less sensitive and specific compared to central DEXA it was used in this study as it is less costly and easily transportable. RESULTS: Of the 700 subjects who consented to participate in the study, 60% (n = 421) were females. In subjects < 50 years, 9% of women and 3% of men had osteoporosis. In subjects ≥ 50 years, 27% of women and 7% of men had osteoporosis. Female sex (odds ratio [OR] 12.0), smoking (OR 5.5), age > 50 years (OR 3.1), low BMI (OR 3.1) and low level of education (OR 1.7) were positively associated with osteoporosis. CONCLUSIONS: Female sex, age, BMI, smoking and level of education were significant predictors of osteoporosis. The prevalence of osteoporosis increased in both women and men after 50 years.
Prevalence of psychological morbidity in an urban population: Is it related to modifiable physical risk factors?
(Sri Lanka Medical Association, 2013) Williams, S.S.; Pinidiyapathirage, M.J.; Wijeratne, L.T.; Kasturiratne, A.; Peris, M.U.P.K.; Williams, H.S.A.; Wickremasinghe, A.R.
INTRODUCTION AND OBJECTIVES: To determine the prevalence of psychological morbidity and its relationship to diabetes mellitus, hypertension and alcohol use in an urban population in Sri Lanka. METHODS: This study was conducted in the Ragama Health Study cohort that consists of 2986 individuals, between 35-64 years of age, living in the Ragama Medical Officer of Health area in the district of Gampaha. Subjects were selected using age-stratified random sampling, from the electoral lists in 2007, and investigated using clinical, bio¬chemical and anthropometric examinations. Psychological morbidity was estimated using a pre-validated K10 questionnaire which has high sensitivity and specificity for non psychotic psychiatric disorders and a self administered GHQ 30 questionnaire. Baseline age-adjusted prevalence and three year incidence of hypertension and diabetes were estimated. Odds ratios for independent risk factors were calculated. RESULTS: The prevalence of psychological morbidity identified using the K10 questionnaire ranged from 18- 26% in a total population of 2919. Females had a higher prevalence of psychologrcal morbidity than males (28.6% vs 22.4%; p<0.001). Diabetic or hypertensive status and alcohol use did not predict psychological morbidity. A self report of overall low health status was predictive of psychological morbidity OR1.925 (95% CI 1.62 - 2.28). DISCUSSION: High prevalence of psychological morbidity was identified in this community study. Females are more at risk. In the initial analysis, psychological status was not associated with diabetes mellitus, hypertension or alcohol use.