Browsing by Author "Rajapaksha, R.M.N.U."

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A complex-intervention to change dengue prevention behaviours of the householders in the Kurunegala District
(Sri Lanka Medical Association, 2021) Rajapaksha, R.M.N.U.; Abeysena, H.T.C.S.; Balasuriya, A.
INTRODUCTION AND OBJECTIVES: Dengue is a leading public health problem in Sri Lanka. Evaluation of community-based intervention on behavioural change is identified as the key functional areas to prevent future outbreaks. The study was aimed to assess the complex intervention package on changing the behaviour of the householders to prevent dengue in Kurunegala district. METHODS: A community-based parallel group cluster randomized trial was conducted to assess the effectiveness of the COMBI based behavioural change intervention (n=167) versus routine standards of dengue control activities (n=166) among the householders in highly dengue endemic area in Kurunegala district from May to September 2019. A pre-tested, validated, interviewer-administered tool was used to collect data. Intention to treat analysis was applied using Logistic Regression with Generalized Estimating Equations. RESULTS: There were significant improvements of the overall dengue prevention behaviour (27.4%, 95% CI: 17.1% - 37.7%), knowledge (12.3%; 95% CI: 1.7% - 22.9%), attitude (7.3%; 95% CI: - 1.77% - 16.4%), practices (29.2%; 95% CI: 18.9% - 39.5%), health seeking behaviour (14.7%; 95% CI: 4.12% - 25.3%), and reduction of Pupal-Index (49.3%; 95% CI: 39.7% - 58.9%), House- Index (30.8%; 95% CI: 28.3 - 47.1%), Container-Index (17.7%; 95% CI: 8.8% - 26.6%) and Breteau-Index (52.2%; 95% CI: 43.5% - 60.9%) in the intervention group in comparison with the control group after three-months of the intervention. CONCLUSION: A COMBI planning process based interventional approach to change the behaviour for sustainable dengue control is effective. Importantly, it contributed to a significant reduction in the density of dengue vectors (Pupal Index and HI, CI, BI) and a number of potentials.
Development of a communication for behaviour impact plan on dengue prevention in the Kurunegala District
(Sri Lanka Medical Association, 2021) Rajapaksha, R.M.N.U.; Abeysena, H.T.C.S.; Balasuriya, A.; Alagiyawanna, M.A.A.P.; Pannilahetti, N.
INTRODUCTION AND OBJECTIVES: Communication for Behaviour Impact (COMBI) is a methodological process that blends strategically a variety of communication interventions intended to engage individuals and families in adopting healthy behaviours and maintaining those behaviours. The objective was to develop a COMBI plan to change the behaviour to prevent dengue in Kurunegala district, Sri Lanka. METHOD: The plan was developed according to World Health Organization’s COMBI planning 10 steps with the scientific evidence and expert opinion. The situation analysis was conducted using mixed-methodology from January to March 2019 among the adults in the highly dengue-endemic area in Kurunegala District. RESULTS: The overall goal of the plan was to contribute to the reduction in morbidity and mortality from dengue disease in the Kurunegala district by improving the dengue prevention behaviours by three months in 2019. After finalizing Specific Behaviour Objectives (SBOs) by conducting Situational Market Analysis for Communication Keys, the plan was developed. The SBOs for the plan were to improve the proper waste management practices according to ‘Three R concept’ (Reduce, Reuse and Recycling) and to improve the dengue prevention practices 30 minutes weekly cleaning. The strategies were to conduct a community empowerment program to improve household waste management and weekly practices on dengue prevention by conducting the administrative mobilization and public relationship, public advocacy, community mobilization, personal selling, advertising, point of service promotion during follow up. Conclusion: Developing a COMBI plan for an area after identification of specific behavioral objectives would be feasible to implement in order to empower the community to prevent dengue in the area.
Development of a complex intervention package for dengue prevention
(Ministry of Health, Sri Lanka, 2022) Rajapaksha, R.M.N.U.; Abeysena, C.; Balasuriya, A.; PannilaHetti, N.; Alagiyawanna, A.; Manilgama, S.
INTRODUCTION: Complex interventions are widely used in public health practices with noteworthy health impacts. Communication for Behavioural Impact (COMBI) plan is an effective method directed at enacting behaviour change to benefit health and social development which encourage precise behavioural outcomes and is effective in planning a behavioural change for dengue control. The aim of this study was to develop an intervention package to change the behaviour to prevent dengue in one of the highest dengue-endemic areas of Sri Lanka. METHODS: The development of the intervention package was formulated according to the two phases, the ‘Theoretical phase’ and ‘Modelling phase’ of the framework for ‘Developing and Evaluating Complex Interventions’. World Health Organization’s 10 key steps in planning COMBI strategies were followed in order to develop the present intervention package. A situational market analysis was conducted in the highest dengue-endemic area in Kurunegala district to identify the Specific Behavioural Objectives (SBOO) for the COMBI plan. The development of the COMBI plan was conducted using the mixed methodological approach including quantitative and qualitative designs. RESULTS: The overall goal of the COMBI plan was to decrease the morbidity and mortality due to dengue illness by improving the dengue prevention behaviours among householders. The SBOO for the plan were to improve the proper waste management practices according to the ‘3R concept’ (Reduce, Reuse and Re-cycling) and to improve the dengue prevention practices by 30 minutes of weekly cleaning. The strategies of intervention package were to conduct a community empowerment program to improve household waste management and weekly practices on dengue prevention by conducting administrative mobilization and public relationship, public advocacy, community mobilization, personal selling, advertising, and point of service promotion during follow-up. CONCLUSION: Developing a COMBI plan for an area after the identification of SBOO would be feasible to implement in order to empower the community to prevent dengue and improve community health services.
Health seeking behaviours, dengue prevention behaviours and community capacity for sustainable dengue prevention in a highly dengue endemic area, Sri Lanka
(BioMed Central, 2023) Rajapaksha, R.M.N.U.; Abeysena, C.; Balasuriya, A.
INTRODUCTION: Dengue has become a major health problem in globally as well as locally. The delay in health-seeking is significantly associated with complications leading to severe dengue and active engagement of communities needs to minimize the delays in management to control epidemics. The aim of the study was to evaluate the relationship between sociodemographic characteristics and householders' Health-Seeking Behaviours (HSB), Dengue-Prevention Behaviours (DPB), and Community Capacities (CC) for sustained dengue prevention in Sri Lanka, a country with a high dengue endemicity. METHODS: A cross-sectional analytical study was carried out in a district with the highest dengue endemicity from January to April 2019. Of the householders, 532 were chosen randomly. A pre-tested, validated, and interviewer-administered questionnaire was used to assess HSB and DPB. The HSB was assessed using three aspects, initial response for fever management, the duration of blood testing and initial response if suspected dengue. The DPB assessment was evaluated using 'waste, outdoor water container, indoor water container, roof gutter and water storage management'. 'Dengue Community Capacity Assessment Tool', with 14 key items was used to assess the level of community capacity for dengue prevention. Out of the total, ≥ 50% was considered as an "adequate" HSB, DPB and CC. Multiple logistic regression was performed to control confounding effects. The results were expressed as adjusted Odds-Ratios (aOR) and 95% Confidence Intervals (CI). RESULTS: The response rate was 93.2% (n = 496). Among them, 44.6% (n = 221) had adequate overall HSB, and 19.2% (n = 95) had adequate DPB. Householders who have ≤ 4 family members are 1.74 times (aOR = 1.74; 95% CI: 1.17 - 2.61) more likely to have adequate HSB and 1.85 times (aOR = 1.85; 95% CI: 1.11 - 3.09) more likely to have adequate DPB. The age group of 46 to 70 years' individuals (aOR = 1.74; 95% CI:1.12 - 2.92), and who engaged in employment (aOR = 1.68; 95% CI: 1.05 - 2.67) were more likely to have adequate DPB than the group of 18 to 45 years and the non-employed individuals respectively. Of them, 24.6% (n = 122) perceived that they have adequate CC. The householders who have per-capita income < USD 50 are 1.95 times (aOR = 1.95; 95%CI:1.11 - 3.40) more likely to have adequate CC. CONCLUSION: The HSB, DPB and CC need to be improved to change the behaviour for sustainable dengue prevention and community capacity-building programmes need to be conducted in the Kurunegala district, Sri Lanka.
Pilot intervention to assess the efficacy of a complex-intervention package to prevent dengue in Kurunegala district, Sri Lanka
(College of Community Physicians of Sri Lanka, 2021) Rajapaksha, R.M.N.U.; Abeysena, H.T.C.S.; Balasuriya, A.
Background: Dengue is a leading public health problem in Sri Lanka. Development and evaluation of community-based intervention on behavioural changes are identified as key functional areas to prevent dengue outbreaks. The research study aimed to assess the complex-intervention package on changing household behaviour to prevent dengue. Method: A community based pre-post pilot-intervention was conducted to assess the efficiency of a COMBI-based complex-intervention among 121 adults, aged between 18 to 70 years in households in highly-endemic area in the Kurunegala district. Improvement of proper waste management practices according to the 3R concept (Reduce, Reuse and Re-cycling) was the finalized specific behavioural objectives of the COMBI plan. The outcomes were compared with paired t-test and McNemar test. Results: The response-rate of the pilot-study was 97.5% (n=118). The result revealed that the adequate post interventional knowledge on dengue prevention of the intervention group, positive atitude towards dengue prevention, adequate health-seeking behaviour and the overall community capacity was significantly improved by 37.3%, 39.9%, 31.3% and 16.3% in the post-interventional assessment than the pre-intervention assessment respectively. Notably, adequate dengue prevention behaviours were improved by 51.7% in the post-intervention assessment than the preintervention assessment. Conclusion: A COMBI planning process based interventional approach to change the behaviour for sustainable dengue control is feasible, implementable and efficient. it was able to achieve the significant improvement of the desired outcome of interest including knowledge, atitudes, practices, health seeking behaviours, community capacity and dengue prevention behavior following the pilot intervention.
Psychological stress and associated factors among adults in the quarantine families following COVID-19 in Kurunegala district, Sri Lanka
(College of Community Physicians of Sri Lanka, 2021) Rajapaksha, R.M.N.U.; Abeysena, H.T.C.S.; Jayasooriya, S.P; Pushpalal, G.C; Dissasnayake, M.; Wijesingha, S.; Athukorala, P.; de Mel, N.
Background: Psychosocial-stress for a newly-emerged contagious-disease of the COVID-19 needs to be evaluated. The aim of the study was to assess the prevalence of psychosocial-stress and associated predictors in the home-quarantine families following the COVID-19 outbreak. Method: A descriptive cross-sectional study was conducted among randomly selected 403 Quarantined adults in Kurunegala district from May to July 2020 during the first wave of the COVID-19 outbreak. The suspected index-cases and known patients with mental-health abnormalities were excluded. The GHQ-30, a validated screening tool, was used to assess psycho-social status. The scores were given as 0-0-1-1 for each item in GHQ30, out of which a score of ≥6 was considered as adults under psychosocial-stress. The binary Probit model and multivariate-regression model were used to assess the associated factors.Results: The response rate was 96.5% (n=389). The prevalence of psychological stress was 37%(n=144; 95% CI = 32.6 – 42.4). The probit model shows the likelihood of influence of the factors affecting the prevalence, and the Odds-Ratio was examined. The multivariate-regression model was 2 significant at F (12, 309) = 3.86, R = 12.95 (n=322). The results of the best fitting regression model th depicted that the associated determinants including arrived in Sri Lanka after 10 of March 2020, within 5 days of exposure to a COVID-19 patient, stayed at a quarantined-centre and male-gender were statistically significant (p<0.05) factors of predicting the psychosocial stress. Conclusion: The prevalence of psychosocial stress among the home-quarantined adults following COVID-19 are significantly high and the factors that determine the stress are likely to occur in the significant predictors.
Success and challenges of health systems resilience-enhancing strategies for managing Public Health Emergencies of International Concerns (PHEIC): A systematic review protocol
(BMJ Publishing Group Ltd, 2022) Rajapaksha, R.M.N.U.; Khatri, R.B.; Abeysena, C.; Wijesinghe, M.S.D.; Endalamaw, A.; Thomas, T.K.; Perera, N.; Rambukwella, R.; de Silva, G.; Fernando, M.; Alemu, Y.A.
Introduction: Health systems resilience is the ability to prepare, manage and learn from a sudden and unpredictable extreme change that impacts health systems. Health systems globally have recently been affected by a number of catastrophic events, including natural disasters and infectious disease epidemics. Understanding health systems resilience has never been more essential until emerging global pandemics. Therefore, the application of resilience-enhancing strategies needs to be assessed to identify the management gaps and give valuable recommendations from the lessons learnt from the global pandemic. Methods: The systematic review will be reported using the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA-P) protocols guideline. Reporting data on World Health Organization (WHO) health system building blocks and systematic searches on resilience enhancing strategies for the management of Public Health Emergencies of International Concerns (PHEIC) after the establishment of International Health Regulations (IHR) in 2007 will be included. The search will be conducted in PubMed, Scopus, Web of Science and Google Scholar ETHICS AND DISSEMINATION: Ethics approval and safety considerations are not applicable. Pre-print of the protocol is available online, and the screening of the articles will be done using Rayyan software in a transparent manner. The findings will be presented at conferences and the final review's findings will be published in a peer-reviewed international journal and will be disseminated to global communities for the application of successful management strategies for the management of future pandemics.
Surge capacity of the curative sector healthcare institutions for the management of Dengue in Kurunegala district, Sri Lanka
(College of Community Physicians of Sri Lanka, 2021) Rajapaksha, R.M.N.U.; Abeysena, H.T.C.S.; Balasuriya, A.
Background: Surge capacity is defined as the ability to obtain adequate staff, supplies, structures and systems to provide sufficient care to meet immediate needs of an influx of patients. The aim of the study was to describe surge-capacity of the curative-healthcare institutions for the management of dengue in Kurunegala district. Methods: A descriptive cross-sectional study was conducted among all curative-healthcare institutions with inward-care (n=46), May-September 2019. The data was taken from the medical administrator or designated person using an interview administered tool, which was formulated using 'Science of Surge Theory' and 'CO-S-TR Model'. Results: Response-rate was 93.5% (n=43). The higher proportion had inadequate staff capacity (55.8%; n=24), adjustable beds (69.8%; n=30), infusion-pumps (72.1%; n=31), monitors (51.2%; n=22), oxygen (100%; n=43) and 27.9% (n=12) had Pack-Cell-Volume (PCV) monitors. Of the equipped institutions, 13.3% (n=4), 38.7% (n=12), 40.9% (n=9), 30.2% (n=13) and 66.7% (n=8) had adequate number of adjustable beds, infusion-pumps, monitors, oxygen and PCV-monitors respectively. The majority had designated emergency units (90.7%; n=39) and 11.6% (n=5) X-ray, 9.3% (n=4) USS and 9.3% (n=4) blood bank. The majority had focal-points (76.7%; n=33), written disaster plans (72.1%; n=31) and 34.9% (n=15) had teams with adequate risk-communication capabilities. The higher proportion (69.8%; n=30) had inadequate overall surge capacity. The Provincial General Hospitals and 75% (n=3) of the Base-hospitals had moderate-level and 76.3% (n=29) of the District-Hospitals had basic-level overall surge capacity for dengue outbreak management. Conclusion: There is a need for improvement of surge capacity of the curative-healthcare institutions and capacity development programmes need to be initiated.
Surge-capacity of the preventive healthcare institutions for the management of dengue in the Kurunegala District
(Sri Lanka Medical Association, 2021) Rajapaksha, R.M.N.U.; Abeysena, H.T.C.S.; Balasuriya, A.
INTRODUCTION AND OBJECTIVES: The surge-capacity is defined as the ability to obtain adequate ‘Staff, Supplies, Structures and Systems’ to provide sufficient care to meet the immediate needs of an influx of patients following a large-scale incident or outbreak. The aim of the study was to describe the surge- capacity of the preventive healthcare institutions for the management of dengue in Kurunegala district. METHODS: A descriptive cross-sectional study was conducted among all institutions (n=28) in 2019. An interviewer-administered tool was formulated according to the ‘Science of Surge Theory’ and ‘CO-S-TR Model’. There was basic-level (26 to 50%), moderate-level (51 to 75%) and high- level (>75%) surge-capacities for 10 broad areas of the assessment. RESULTS: The majority of the institutions (69.2%; n=18) had inadequate staff-capacity. Three-fourth (76.0%; n=19) did not have a written plan for preparedness. The higher proportion (n=19; 73.1%) had focal points, Personal Protective Equipment (AE) (65.4%; n=17), chemical for mosquito control (92.3%; n=24), and fogging-instrument (88.5%, n=23). The basic-level capacity existed in the areas of staff mobilization (53.8%; n=14), management of staff (76.9%; n=20), triage of cases (76.9%; n=20), and transportation (46.2%; n=12). The moderate-level capacity was existed in the areas of commanding (42.3%; n=11), controlling (38.5%; n=10), coordinating (61.5%; n=16), supplying of special needs (50.0%; n=13) and tracking of the cases (76.9%; n=20). The higher proportion (84.6%; n=22) had inadequate overall-surge capacity for the management of dengue. CONCLUSION: There is a need for improvement of surge capacity of the preventive healthcare institutions and capacity development programmes need to be initiated.