Browsing by Author "Punchihewa, P.M.G."

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Analysis of nutritional status and factors associated with undernutrition in children aged 6-59 months in a rural area of Sri Lanka
(Sri Lanka Medical Association, 2017) Samarasekera, G.S.; Punchihewa, P.M.G.; Mettananda, S.
INTRODUCTION & OBJECTIVES: This study aims to describe the prevalence and factors associated with undernutrition among children aged 6-59 months in a selected rural area of Sri Lanka. METHODS: A community-based cross-sectional analytical study was conducted among randomly selected children aged 6-59 months attending well baby clinics in Dehiattakandiya Medical Officer of Health area from November2016 to January2017. Data were collected using an intervieweradministered questionnaire and weight and height were measured using calibrated equipment. Ethical clearance was obtained from the ethical committee of the Sri Lanka College of Paediatricians. Data were analyzed using logistic regression by IBM SPSS statistics 22. RESULTS: A total of 464 children were recruited; mean age was 29.3(SD±14.6) months; 53% were females. Prevalence of stunting, being underweight and wasting were 36.4%, 42.9% and 19.0% respectively. Following independently associated factors were identified: for stunting – low birth weight [OR=1.94 (95% CI 1.44-2.61), p=0.025], prolonged breast feeding beyond 2 years [OR=1.89 (95% CI 1.43-2.50), p=0.022], lower maternal educational level [OR=2.24 (95% CI 1.78-2.81), p<0.001] and paternal smoking [OR=2.30 (95% CI 1.81-2.94), p=0.001]; for being underweight – birth order>2 [OR=1.80 (95% CI 1.37-2.38), p=0.032], low birth weight [OR=2.22 (95% CI 1.64-3.00), p=0.008], prolonged breast feeding beyond 2 years [OR=1.80 (95% CI 1.36-2.38), p=0.036], lower maternal educational level [OR=2.60 (95% CI 2.06-3.27), p<0.001] and paternal smoking [OR=2.58 (95% CI 2.04-3.27), p<0.001] and alcohol use [OR=1.89 (95% CI 1.47-2.44), p=0.011]; For wasting – male sex [OR=2.11 (95% CI 1.62-2.74), p=0.005], low birth weight [OR=2.52 (95% CI 1.85-3.44), p=0.003] and paternal smoking [OR=1.85 (95% CI 1.38-2.48), p=0.35]. CONCLUSION: Low birth weight, prolonged breast feeding, lower maternal educational level and paternal smoking were significantly associated with stunting and being underweight whereas male sex, low birth weight and paternal smoking were associated with wasting in children aged 6-59 months.
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.
Role of dipsticks in diagnosis of urinary tract infection in children: is it accurate enough
(Sri Lanka College of Paediatricians, 2015) Fernando, C.M.P.; Galappaththi, A.G.A.R.; Punchihewa, P.M.G.; Karunaratne, G.K.D.; Warnakulasuriya, D.T.D.
BACKGROUND:Urinary tract infection (UTI) is a common problem in childhood. Urine culture is the Gold standard for diagnosis. Dipstick tests for leucocyte esterase reaction (LE) and nitrites (N) are bedside tests useful in the diagnosis of UTI. Accuracy of above tests have been extensively investigated in other countries. No published data is available from Sri Lankan children up to date.OBJECTIVES:To study the diagnostic accuracy of dipstick tests in diagnosis of UTI in Sri Lankan children.DESIGN, SETTING AND METHOD:Descriptive, cross sectional study was conducted in a medical ward at Lady Ridgeway Hospital for Children. 300 children less than 12 years, clinically suspected of UTI were recruited. Dipstick tests (LE and N) and urine culture were performed.RESULTS:Of the 300 children, 118 (39.3%) had positive cultures (pure growth of bacteria >105 cfu/ml), 16 (54%) had negative cultures and 20 (6.7%) had mixed growth. Cultures with mixed growths were excluded and remaining 280 were analyzed. Mean age of the participants was 49 months (SD 41.3), 148 (53%) being males.Accuracy of dipsticks tests (LE and N) in detecting UTI was as follows. LE and N in combination had a sensitivity of 97.5%, specificity of 77.2%, positive predictive value (PPV) of 75.6% and negative predictive value (NPV) of 97.6%. LE alone showed a sensitivity of 96.6% specificity of 77.7%, PPV of 76% and NPV of 96.9%. Corresponding values for N alone were 78.8%, of 97.5%, 95.8% and 86.3% respectively.CONCLUSIONS:Leucocyte esterase reaction and nitrite test in combination showed promising results to detect UTI in children. LE was more sensitive and N was more specific.