Browsing by Author "Sathiakumar, N."

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Air pollution and health in Sri Lanka: a review of epidemiologic studies
(BioMed Central, 2010) Nandasena, Y.L.S.; Wickremasinghe, A.R.; Sathiakumar, N.
BACKGROUND: Air pollution is increasingly documented as a threat to public health in most developing countries. Evaluation of current air quality levels, regulatory standards and scientific literature on outdoor and indoor air pollution, and health effects are important to identify the burden, develop and implement interventions and to fill knowledge gaps in Sri Lanka.METHODS: PUBMED and Medline databases, local journals and conference proceedings were searched for epidemiologic studies pertaining to air pollution and health effects in Sri Lanka. All the studies pertaining to air pollution and health effects were considered. RESULTS: Sixteen studies investigated the association between exposure to ambient or indoor air pollution (IAP) and various health outcomes ranging from respiratory symptoms, low birth weight and lung cancers. Of the sixteen, three used a case control design. Half of the studies collected exposure data only through questionnaires. There were positive associations between air pollution and adverse health effects in all studies. Methodological limitations in most of the studies resulted in poor quantification of risk estimates. CONCLUSION: A limited number of epidemiological studies in Sri Lanka have investigated the health effects of air pollution. Based on findings of studies and reported air quality levels, air pollution may be considered a neglected public health problem in Sri Lanka.
Air pollution and public health in developing countries: Is Sri Lanka different?
(College of Community Physicians of Sri Lanka, 2012) Nandasena, S.; Wickremasinghe, A.R.; Sathiakumar, N.
Indoor and outdoor air pollution is a major public health challenge in developing countries and much concern has been raised among policy makers, public health experts, clinicians, and the general public in recent years. A spectrum of health outcomes has been shown to be associated with exposure to air pollution in epidemiological studies and by laboratory investigations. It is estimated that indoor air pollution resulting from exposure to solid fuel accounts for over 1.5 million premature deaths and 38.5 million Disability-Adjusted Life Years. Globally, it is estimated that outdoor air pollution accounts for over 800,000 premature deaths and 6.4 million years of life lost; of these numbers, 65% is from Asia alone. There is emerging evidence that the actual burden is much larger than the estimated values. The World Health Organization has estimated the number of deaths attributable to indoor air pollution and outdoor air pollution in Sri Lanka to be 4200 and 1000 deaths, respectively. Although country information is limited, a few epidemiological studies gives us the opportunity to understand and compare the Sri Lankan situation vis a vis other countries. This includes the 16 epidemiological studies identified by a scientific review in 2010 and several other published studies and preliminary data from ongoing studies.
Biomass fuel use for cooking in Sri Lanka: analysis of data from national demographic health surveys
(Wiley-Blackwell, 2012) Nandasena, S.; Wickremasinghe, A.R.; Sathiakumar, N.
BACKGROUND: Biomass cooking fuel is the main source of indoor air pollution in the majority of households in the developing world. Sri Lanka is an island of about 20 million population with urban, rural, and estate population of 14.6%, 80.0%, and 5.4%, respectively. This study describes biomass fuel use for cooking in Sri Lanka. METHODS: We analyzed data from two national Demographic Health Surveys (2000 and 2007) to identify the use and determinants of cooking fuels in Sri Lankan households. The results are based on a sample of 8,169 households in 2000 and 19,862 households in 2007. RESULTS: Wood was the principal cooking fuel used in 78.3% and 78.5% of households in 2000 and 2007, respectively. In 2007, 96.3% of estate sector households used firewood as compared to 84.2% in the rural and 34.6% in the urban sectors. Similar trends were noted in 2000 as well. CONCLUSIONS: The shift from firewood to cleaner fuels in Sri Lanka is negligible from 2000 to 2007. Improving the quality of life of the population does not necessarily predict a shift towards the use of cleaner cooking fuels in Sri Lanka.
Building global partnerships through shared curricula for an MPH programme in India and Sri Lanka.
(Informa Healthcare, 2019) Sathiakumar, N.; Tipre, M.; Wickremasinghe, R.; Bhat, V.; Kadir, M. M.; Coggon, D.; Pathemeswaran, A.; Kamath, R.; Arunkumar, G.; Fatmi, Z.; Smith, T. L.; Pattanshetty, S. M.; Delzell, E.
OBJECTIVE:To design and implement a locally relevant competency- based MPH programme. METHODS:The demand for trained public health professionals in South Asia is enormous and growing, which created a unique opportunity for a Fogarty International Center-funded University of Alabama at Birmingham-South Asia [Aga Khan University, Pakistan; Manipal Academy of Higher Education, India; and University of Kelaniya, Sri Lanka] international research training in environmental and occupational health (ITREOH) programme. In 2009, a Master of Public Health (MPH) degree programme was designed using a combination of competencies developed by the Association of School of Public Health, the World Health Organization and the Centers for Disease Control and Prevention. RESULTS: A competency- based curriculum was developed with two specialty tracks in applied epidemiology and environmental and occupational health, emphasising applied practice and research. CONCLUSIONS: This is the most comprehensive skill-based MPH programme in the region, which positions each institution as a regional leader in public health training. The success of the programme has been amply demonstrated by placements of graduated MPH students in leadership roles in public, private and academic sectors within their countries.
Cadmium a metalloestrogen: are we convinced?
(Wiley, 2012) Silva, N.; Peiris-John, R.; Wickremasinghe, R.; Senanayake, H.; Sathiakumar, N.
Metalloestrogens are inorganic metal ions that bind to and activate oestrogen receptors. They are implicated in the aetiology of oestrogen-dependent diseases such as cancers of the breast and endometrium as well as endometriosis. Cadmium is one of the most studied metalloestrogens. In this review, scientific evidence for the oestrogenic effects of cadmium is critically evaluated to determine if there is sufficient evidence to support cadmium as an aetiological factor of oestrogen-dependent disease in humans. Results of the review indicated that, although the in vitro and in vivo evidence of the oestrogenic properties of cadmium was persuasive, evidence from population-based human studies remains conflicting. Considerable knowledge gaps exist on the potential oestrogenic effect of cadmium in humans. Research that focuses on bridging these knowledge gaps would be useful in preventing and managing oestrogen-dependent disease in humans
Capacity building in environmental and occupational health in Sri Lanka
(Wiley-Blackwell, 2013) Wickremasinghe, A.R.; Peiris-John, R.; Nandasena, S.; Delzell, E.; Tipre, M.; Sathiakumar, N.
BACKGROUND: Although environmental and occupational health (EOH) research and services in Sri Lanka have a long history, policies related to EOH are outdated. METHODS: We review the International Training and Research in Environmental and Occupational Health (ITREOH) program in Sri Lanka that commenced in 2006 as a collaboration between the University of Alabama at Birmingham and the Faculty of Medicine of the University of Kelaniya, Sri Lanka. RESULTS: The program has trained over 20 scientists in conducting EOH research. New pioneering research in EOH was initiated. The program was instrumental in furthering the training and research in EOH by initiating a MPH degree program, the first in the country .CONCLUSIONS: The program has established North-South, South-South and in-country collaborations between institutions and scientists, increasing the visibility of EOH in the future.
Classification of neck/shoulder pain in epidemiological research: a comparison of personal and occupational characteristics, disability and prognosis among 12,195 workers from 18 countries
(Elsevier-North-Holland, 2016) Sarquis, L.M.; Coggon, D.; Ntani, G.; Walker-Bone, K.; Palmer, K.T.; Felli, V.E.; Harari, R.; Barrero, L.H.; Felknor, S.A.; Gimeno, D.; Cattrell, A.; Vargas-Prada, S.; Bonzini, M,; Solidaki, E.; Merisalu, E.; Habib, R.R.; Sadeghian, F.; Kadir, M.M.; Warnakulasuriya, S.S.; Matsudaira, K.; Nyantumbu, B.; Sim, M.R.; Harcombe, H.; Cox, K.; Marziale, M.H.; Harari, F.; Freire, R.; Harari, N.; Monroy, M.V.; Quintana, L.A.; Rojas, M.; Harris, E.C.; Serra, C.; Martinez, J.M.; Delclos, G.; Benavides, F.G.; Carugno, M.; Ferrario, M.M.; Pesatori, A.C.; Chatzi, L.; Bitsios, P.; Kogevinas, M.; Oha, K.; Tiina; Freimann; Sadeghian, A.; Peiris-John, R.J.; Sathiakumar, N.; Wickremasinghe, A.R.; Yoshimura, N.; Kelsall, H.L.; Hoe, V.C.; Urquhart, D.M.; Derrett, S.; McBride, D.; Herbison, P.; Gray, A.; Salazar Vega, E.J.
To inform case-definition for neck/shoulder pain in epidemiological research, we compared levels of disability, patterns of association and prognosis for pain that was limited to the neck or shoulders (LNSP) and more generalised musculoskeletal pain that involved the neck or shoulder(s) (GPNS). Baseline data on musculoskeletal pain, disability and potential correlates were collected by questionnaire from 12,195 workers in 47 occupational groups (mostly office workers, nurses, and manual workers) in 18 countries (response rate = 70%). Continuing pain after a mean interval of 14 months was ascertained through a follow-up questionnaire in 9,150 workers from 45 occupational groups. Associations with personal and occupational factors were assessed by Poisson regression and summarised by prevalence rate ratios (PRRs). The one-month prevalence of GPNS at baseline was much greater than that of LNSP (35.1% vs. 5.6%), and it tended to be more troublesome and disabling. Unlike LNSP, the prevalence of GPNS increased with age. Moreover, it showed significantly stronger associations with somatising tendency (PRR 1.6 vs. 1.3) and poor mental health (PRR 1.3 vs. 1.1); greater variation between the occupational groups studied (prevalence ranging from 0% to 67.6%) that correlated poorly with the variation in LNSP; and was more persistent at follow-up (72.1% vs. 61.7%). Our findings highlight important epidemiological distinctions between sub-categories of neck/shoulder pain. In future epidemiological research that bases case definitions on symptoms, it would be useful to distinguish pain which is localised to the neck or shoulder from more generalised pain that happens to involve the neck/shoulder region.
Comparison of performance of Sri Lankan and US children on cognitive and motor scales of the Bayley scales of infant development
(Biomed Central, 2014) Godamunne, P.; Liyanage, C.; Wimaladharmasooriya, N.; Pathmeswaran, A.; Wickremasinghe, A.R.; Patterson, C.; Sathiakumar, N.
BACKGROUND: There is no validated scale to assess neurodevelopment of infants and children in Sri Lanka. The Bayley III scales have used widely globally but it has not been validated for Sri Lankan children. We administered the Cognitive and Motor Scales of the Bayley III to 150 full-term children aged 6, 12 and 24 months from the Gampaha District of Sri Lanka. We compared the performance of Sri Lankan children 6, 12 and 24 months of age on the cognitive and motor scales of the Bayley III with that of US children. RESULTS: Compared to the US norms, at 12 months, Sri Lankan children had significantly higher cognitive scores and lower gross motor scores, and at 24 months significantly lower cognitive scores. The test had a high test-retest reliability among Sri Lankan children. CONCLUSIONS: There were small differences in the cognitive and motors scores between Sri Lankan and US children. It is feasible to use Bayley III scales to assess neurodevelopment of Sri Lankan children. However, we recommend that the tool be validated using a larger representative sample of all population groups.
The CUPID (Cultural and Psychosocial Influences on Disability) study: methods of data collection and characteristics of study sample
(Public Library of Science, 2012) Coggon, D.; Ntani, G.; Palmer, K.T.; Felli, V.E.; Harari, R.; Barrero, L.H.; Felknor, S.A.; Gimeno, D.; Cattrell, A.; Serra, C.; Bonzini, M.; Solidaki, E.; Merisalu, E.; Habib, R.R.; Sadeghian, F.; Kadir, M.; Warnakulasuriya, S.S.; Matsudaira, K.; Nyantumbu, B.; Sim, M.R.; Harcombe, H.; Cox, K.; Marziale, M.H.; Sarquis, L.M.; Harari, F.; Freire, R.; Harari, N.; Monroy, M.V.; Quintana, L.A.; Rojas, M.; Salazar Vega, E.J.; Harris, E.C.; Vargas-Prada, S.; Martinez, J.M.; Delclos, G.; Benavides, F.G.; Carugno, M.; Ferrario, M.M.; Pesatori, A.C.; Chatzi, L.; Bitsios, P.; Kogevinas, M.; Oha, K.; Sirk, T.; Sadeghian, A.; Peiris-John, R.J.; Sathiakumar, N.; Wickremasinghe, A.R.; Yoshimura, N.; Kielkowski, D.; Kelsall, H.L.; Hoe, V.C.; Urquhart, D.M.; Derrett, S.; McBride, D.; Gray, A.
BACKGROUND: The CUPID (Cultural and Psychosocial Influences on Disability) study was established to explore the hypothesis that common musculoskeletal disorders (MSDs) and associated disability are importantly influenced by culturally determined health beliefs and expectations. This paper describes the methods of data collection and various characteristics of the study sample. METHODS/PRINCIPAL FINDINGS: A standardised questionnaire covering musculoskeletal symptoms, disability and potential risk factors, was used to collect information from 47 samples of nurses, office workers, and other (mostly manual) workers in 18 countries from six continents. In addition, local investigators provided data on economic aspects of employment for each occupational group. Participation exceeded 80% in 33 of the 47 occupational groups, and after pre-specified exclusions, analysis was based on 12,426 subjects (92 to 1018 per occupational group). As expected, there was high usage of computer keyboards by office workers, while nurses had the highest prevalence of heavy manual lifting in all but one country. There was substantial heterogeneity between occupational groups in economic and psychosocial aspects of work; three- to five-fold variation in awareness of someone outside work with musculoskeletal pain; and more than ten-fold variation in the prevalence of adverse health beliefs about back and arm pain, and in awareness of terms such as "repetitive strain injury" (RSI). CONCLUSIONS/SIGNIFICANCE: The large differences in psychosocial risk factors (including knowledge and beliefs about MSDs) between occupational groups should allow the study hypothesis to be addressed effectively.
Descriptive Epidemiology of Somatising Tendency: Findings from the CUPID Study
(Public Library of Science, 2016) Vargas-Prada, S.; Coggon, D.; Ntani, G.; Walker-Bone, K.; Palmer, K.T.; Felli, V.E.; Harari, R.; Barrero, L.H.; Felknor, S.A.; Gimeno, D.; Cattrell, A.; Bonzini, M.; Solidaki, E.; Merisalu, E.; Habib, R.R.; Sadeghian, F.; Kadir, M.M.; Warnakulasuriya, S.S.; Matsudaira, K.; Nyantumbu, B.; Sim, M.R.; Harcombe, H.; Cox, K.; Sarquis, L.M.; Marziale, M.H.; Harari, F.; Freire, R.; Harari, N.; Monroy, M.V.; Quintana, L.A.; Rojas, M.; Harris, E.C.; Serra, C.; Martinez, J.M.; Delclos, G.; Benavides, F.G.; Carugno, M.; Ferrario, M.M.; Pesatori, A.C.; Chatzi, L.; Bitsios, P.; Kogevinas, M.; Oha, K.; Freimann, T.; Sadeghian, A.; Peiris-John, R.J.; Sathiakumar, N.; Wickremasinghe, A.R.; Yoshimura, N.; Kelsall, H.L.; Hoe, V.C.; Urquhart, D.M.; Derrett, S.; McBride, D.; Herbison, P.; Gray, A.; Vega, E.J.
Somatising tendency, defined as a predisposition to worry about common somatic symptoms, is importantly associated with various aspects of health and health-related behaviour, including musculoskeletal pain and associated disability. To explore its epidemiological characteristics, and how it can be specified most efficiently, we analysed data from an international longitudinal study. A baseline questionnaire, which included questions from the Brief Symptom Inventory about seven common symptoms, was completed by 12,072 participants aged 20-59 from 46 occupational groups in 18 countries (response rate 70%). The seven symptoms were all mutually associated (odds ratios for pairwise associations 3.4 to 9.3), and each contributed to a measure of somatising tendency that exhibited an exposure-response relationship both with multi-site pain (prevalence rate ratios up to six), and also with sickness absence for non-musculoskeletal reasons. In most participants, the level of somatising tendency was little changed when reassessed after a mean interval of 14 months (75% having a change of 0 or 1 in their symptom count), although the specific symptoms reported at follow-up often differed from those at baseline. Somatising tendency was more common in women than men, especially at older ages, and varied markedly across the 46 occupational groups studied, with higher rates in South and Central America. It was weakly associated with smoking, but not with level of education. Our study supports the use of questions from the Brief Symptom Inventory as a method for measuring somatising tendency, and suggests that in adults of working age, it is a fairly stable trait.
Disabling musculoskeletal pain in working populations: is it the job, the person, or the culture?
(Elsevier/North-Holland., 2013) Coggon, D.; Ntani, G.; Palmer, K.T.; Felli, V.E.; Harari, R.; Barrero, L.H.; Felknor, S.A.; Gimeno, D.; Cattrell, A.; Serra, C.; Bonzini, M.; Solidaki, E.; Merisalu, E.; Habib, R.R.; Sadeghian, F.; Masood Kadir, M.; Warnakulasuriya, S.S.; Matsudaira, K.; Nyantumbu, B.; Sim, M.R.; Harcombe, H.; Cox, K.; Marziale, M.H.; Sarquis, L.M.; Harari, F.; Freire, R.; Harari, N.; Monroy, M.V.; Quintana, L.A.; Rojas, M.; Salazar; Vega, E.J.; Harris, E.C.; Vargas-Prada, S.; Martinez, J.M.; Delclos, G.; Benavides, F.G.; Carugno, M.; Ferrario, M.M.; Pesatori, A.C.; Chatzi, L.; Bitsios, P.; Kogevinas, M.; Oha, K.; Sirk, T.; Sadeghian, A.; Peiris-John, R.J.; Sathiakumar, N.; Wickremasinghe, A.R.; Yoshimura, N.; Kelsall, H.L.; Hoe, V.C.; Urquhart, D.M.; Derrett, S.; McBride, D.; Herbison, P.; Gray, A.
To compare the prevalence of disabling low back pain (DLBP) and disabling wrist/hand pain (DWHP) among groups of workers carrying out similar physical activities in different cultural environments, and to explore explanations for observed differences, we conducted a cross-sectional survey in 18 countries. Standardised questionnaires were used to ascertain pain that interfered with everyday activities and exposure to possible risk factors in 12,426 participants from 47 occupational groups (mostly nurses and office workers). Associations with risk factors were assessed by Poisson regression. The 1-month prevalence of DLBP in nurses varied from 9.6% to 42.6%, and that of DWHP in office workers from 2.2% to 31.6%. Rates of disabling pain at the 2 anatomical sites covaried (r = 0.76), but DLBP tended to be relatively more common in nurses and DWHP in office workers. Established risk factors such as occupational physical activities, psychosocial aspects of work, and tendency to somatise were confirmed, and associations were found also with adverse health beliefs and group awareness of people outside work with musculoskeletal pain. However, after allowance for these risk factors, an up-to 8-fold difference in prevalence remained. Systems of compensation for work-related illness and financial support for health-related incapacity for work appeared to have little influence on the occurrence of symptoms. Our findings indicate large international variation in the prevalence of disabling forearm and back pain among occupational groups carrying out similar tasks, which is only partially explained by the personal and socioeconomic risk factors that were analysed. Copyright © 2013 International Association for the Study of Pain. All rights reserved.
Effect of household air pollution due to solid fuel combustion on childhood respiratory diseases in a semi urban population in Sri Lanka.
(BioMed Central, 2019) Ranathunga, N.; Perera, P.; Nandasena, S.; Sathiakumar, N.; Kasturiratne, A.; Wickremasinghe, R.
BACKGROUND:Household air pollution from combustion of solid fuels for cooking and space heating is one of the most important risk factors of the global burden of disease. This study was aimed to determine the association between household air pollution due to combustion of biomass fuel in Sri Lankan households and self-reported respiratory symptoms in children under 5 years. METHODS: A prospective study was conducted in the Ragama Medical Officer of Health area in Sri Lanka. Children under 5 years were followed up for 12 months. Data on respiratory symptoms were extracted from a symptom diary. Socioeconomic data and the main fuel type used for cooking were recorded. Air quality measurements were taken during the preparation of the lunch meal over a 2-h period in a subsample of households. RESULTS: Two hundred and sixty two children were followed up. The incidence of infection induced asthma (RR = 1.77, 95%CI;1.098-2.949) was significantly higher among children resident in households using biomass fuel and kerosene (considered as the high exposure group) as compared to children resident in households using Liquefied Petroleum Gas (LPG) or electricity for cooking (considered as the low exposure group), after adjusting for confounders. Maternal education was significantly associated with the incidence of infection induced asthma after controlling for other factors including exposure status. The incidence of asthma among male children was significantly higher than in female children (RR = 1.17; 95% CI 1.01-1.37). Having an industry causing air pollution near the home and cooking inside the living area were significant risk factors of rhinitis (RR = 1.39 and 2.67, respectively) while spending less time on cooking was a protective factor (RR = 0.81). Houses which used biomass fuel had significantly higher concentrations of carbon monoxide (CO) (mean 2.77 ppm vs 1.44 ppm) and particulate matter2.5 (PM2.5) (mean 1.09 mg/m3 vs 0.30 mg/m3) as compared to houses using LPG or electricity for cooking. CONCLUSION: The CO and PM2.5 concentrations were significantly higher in households using biomass fuel for cooking. There was a 1.6 times higher risk of infection induced asthma (IIA) among children of the high exposure group as compared to children of the low exposure group, after controlling for other factors. Maternal education was significantly associated with the incidence of IIA after controlling for exposure status and other variables.
Effect of indoor air pollution due to solid fuel combustion on childhood respiratory diseases
(Sri Lanka Medical Association, 2014) Ranathunga, R.A.N.; Perera, K.P.J.; Nandasena, Y.L.S.; Kasturiratne, A.; Sathiakumar, N.; Wickremasinghe, A.R.
Introduction and objectives: To determine the association between indoor air pollution and respiratory symptoms in children under 5 years of age. Methods: A prospective study was conducted over a 22 month period in the Ragarna MOH area. All children under 5 years in the selected households were followed up for 12 months and data on respiratory symptoms were extracted from a symptom diary. Sodoeconomic data of the households and main fuel type used for cooking was recorded. Air quality measurements were made in a sub sample of househords. Results: 262 children were followed up. The incidence of lower respiratory tract infections (RR-1.513, 95% C.t= 1.071-2.158) and infection induced asthma (RR-1.758, 95% C.l= 1.159-2.718) were significantly higher among in children resident in households using biomass fuel compared to children resident in households using LPG and electricity. The incidence of asthma attacks, rhinitis exacerbations and rhino conjunctivitis exacerbations were not associated with exposure to indoor air pollution. Houses which used biomass fuel had significantly higher concentrations of CO (3.27 vs. 1.49) and PM2.5 (1.14 vs. 0.31} compared to houses using LPG and electricity for cooking but CO2 concentration was not higher. Conclusions: CO and PM2.5 concentrations are significantly higher in households which use biomass fuel for cooking. There is a 1.5 times higher risk of lower respiratory tract infections and 1.8 times higher risk of infection induced asthma among children resident in households using biomass fuel for cooking compared to children in households using LPG or electricity.
Effects of indoor air pollution due to solid fuel combustion on physical growth of children under 5 in Sri Lanka: A descriptive cross sectional study
(Public Library of Science, 2021) Ranathunga, N.; Perera, P.; Nandasena, S.; Sathiakumar, N.; Kasturiratne, A.; Wickremasinghe, A.R.
ABSTRACT: Solid fuel combustion is an important risk factor of morbidity. This study was conducted to determine the effect of indoor air pollution (IAP) due to solid fuel combustion on physical growth in 262 Sri Lankan children under five. Exposure was defined by the type of fuel used for cooking. Pollutant levels were measured in a subsample of households. "High" exposure group (households using biomass fuel/kerosene oil for cooking) comprised 60% of the study population; the prevalence of wasting was 19.7% and underweight was 20.4% in the entire population where 68% were from the high exposure group. Children from the "high" exposure group had significantly lower mean z-scores for weight-for-height (p = 0.047), height-for-age (p = 0.004) and weight-for-age (p = 0.001) as compared to the "low" exposure group (children of households using liquefied petroleum gas and/or electricity) after adjusting for confounders. Z-scores of weight-for-age, height-for-age and weight-for-height were negatively correlated with CO (p = 0.001, 0.018, 0.020, respectively) and PM2.5 concentrations (p<0.001,p = 0.024 p = 0.008, respectively). IAP due to combustion of biomass fuel leads to poor physical growth.
Effects of indoor air pollution on the development of children under five years of age in Sri Lanka
(MDPI, 2022) Ranathunga, N.; Perera, P.; Nandasena, S.; Sathiakumar, N.; Kasturiratne, A.; Wickremasinghe, R.
Air pollution is a multifaceted environmental toxin affecting the Central Nervous System (CNS) through diverse pathways. The CNS of young children is particularly susceptible to the detrimental effects of toxins, as brain development continues postnatally with the formation of interneuronal connections, glial cell proliferation and myelination of axons. Indoor air pollution (IAP) from solid fuel combustion is more harmful than outdoor air pollution. Numerous air pollutants hazardous to health are released during the burning of unprocessed biomass. The primary source of fuel in Sri Lanka for cooking is biomass, mainly wood. In this study, we evaluated the influence of IAP resulting from biomass combustion on the neurodevelopment of children. In a cohort of children under five years living in a semi-urban area of Sri Lanka, neurodevelopment was assessed using Denver II developmental screening test. Air quality levels were measured (Carbon Monoxide (CO) and Particulate Matter 2.5 (PM2.5)) in a subsample. There were significantly high levels of CO and PM2.5 in the ambient air of households using biomass as the primary fuel for cooking. Children living in these households had a significantly higher number of children with ‘suspect’ developmental assessment scores in the language, social behavior and play and gross motor development domains.
Environmental noise levels in the city of Colombo, Sri Lanka
(Sri Lanka Medical Association, 2013) Nagodawithana, N.S.; Pannila, A.S.; Gurusinghe, R.D.; Kalansuriya, C.; Sathiakumar, N.; Wickremasinghe, A.R.; Pathmeswaran, A.
INTRODUCTION AND OBJECTIVES: Noise is a physical pollutant, which causes adverse health effects. Noise levels in most cities are higher than that recommended by environmental regulatory authorities of the relevant countries. Objective of this study was to determine the level of environmental noise at identified locations in the city of Colombo. METHODS: Colombo Municipal Council area is divided into 15 divisions. Sixty places with high traffic density, four from each of the 15 divisions, were purposively selected. At each selected site, equivalent continuous sound pressure level (LAeq) was measured for six hours during day time (three hours each from peak and non-peak traffic hours) using a Class-I Sound Level Meter on week days. LAeq for eight hours (LAeq [8hrs]) was calculated and taken as the average noise level of that place. L10, L50, and L90 measurements were also taken. RESULTS: LAeq (8hrs) within the Colombo city ranged from 76.6dB (at BOC roundabout, Colombo 12) to 84.0dB (at Lipton’s roundabout, Colombo 07), well above the maximum permissible noise level (63dB) for municipal council areas. All recorded LAeq values were more than 80dBs in Colombo 5, 9, 10, 13 and 14. Median LAeq value for the entire city was 81.0dB. Median LAeq value for peak traffic hours was 81.1dB and for off-peak traffic hours 80.4dB. Median values for L10, L50 and L90 for the city were 83.1dB, 76.6dB and 71.9dB respectively. CONCLUSIONS: Environmental noise levels in Colombo city are well above (13.3dB to 21.0dB) the levels recommended in the National Environmental (Noise pollution) Act of Sri Lanka.
Environmental pollution by traffic noise in the city of Colombo, Sri Lanka
(IOS Press, 2016) Nagodawithana, N.S.; Pathmeswaran, A.; Pannila, A.S.; Wickremasinghe, A.R.; Sathiakumar, N.
Traffic noise levels in most cities of the world are higher than the recommended levels. Exposure to high levels of noise may cause adverse health effects such as ischemic heart diseases and noise induced hearing loss. We conducted a cross-sectional study to determine road traffic noise levels at 60 selected locations in the city of Colombo, Sri Lanka. On randomly selected days we measured equivalent continuous sound pressure level (LAeq) for six hours during the day. From these measurements LAeq for eight hours were calculated and used as the average noise level of a particular location. LAeq (8 hrs) within Colombo ranged 76.6 to 84.0 dB; well above the Sri Lankan recommendation of 63.0 dB (an increase of 13.3 to 21.0 dB), and the WHO recommendation of 55.0 dB (an increase of 21.6 to 29.0 dB). These levels translate into increase of sound pressure level by 21.4 to 794.3 times above the recommendations on the logarithmic scale of dB. Thirty-eight of 60 locations recorded levels more than 80.0 dB. Road traffic noise levels in Colombo were well above the recommended levels. Though the increase in measured decibels might not appear to be too high, in reality this translates into an increase manifold times in the sound pressure level that reaches the ear
Epidemiological differences between localized and nonlocalized low back pain
(Lippincott Williams & Wilkins, 2017) Coggon, D.; Ntani, G.; Walker-Bone, K.; Palmer, K.T.; Felli, V.E.; Harari, R.; Barrero, L.H.; Felknor, S.A.; Gimeno, D.; Cattrell, A.; Vargas-Prada, S.; Bonzini, M.; Solidaki, E.; Merisalu, E.; Habib, R.R.; Sadeghian, F.; Kadir, M.M.; Warnakulasuriya, S.S.; Matsudaira, K.; Nyantumbu, B.; Sim, M.R.; Harcombe, H.; Cox, K.; Sarquis, L.M.; Marziale, M.H.; Harari, F.; Freire, R.; Harari, N.; Monroy, M.V.; Quintana, L.A.; Rojas, M.; Harris, E.C.; Serra, C.; Martinez, J.M.; Delclos, G.; Benavides, F.G.; Carugno, M.; Ferrario, M.M.; Pesatori, A.C.; Chatzi, L.; Bitsios, P.; Kogevinas, M.; Oha, K.; Freimann, T.; Sadeghian, A.; Peiris-John, R.J.; Sathiakumar, N.; Wickremasinghe, A.R.; Yoshimura, N.; Kelsall, H.L.; Hoe, V.C.; Urquhart, D.M.; Derrett, S.; McBride, D.; Herbison, P.; Gray, A.; Vega, E.J.
STUDY DESIGN: Cross-sectional survey with longitudinal follow-up OBJECTIVES.: To test the hypothesis that pain which is localised to the low back differs epidemiologically from that which occurs simultaneously or close in time to pain at other anatomical sites SUMMARY OF BACKGROUND DATA.: Low back pain (LBP) often occurs in combination with other regional pain, with which it shares similar psychological and psychosocial risk factors. However, few previous epidemiological studies of LBP have distinguished pain that is confined to the low back from that which occurs as part of a wider distribution of pain. METHODS: We analysed data from CUPID, a cohort study that used baseline and follow-up questionnaires to collect information about musculoskeletal pain, associated disability and potential risk factors, in 47 occupational groups (office workers, nurses and others) from 18 countries. RESULTS: Among 12,197 subjects at baseline, 609 (4.9%) reported localised LBP in the past month, and 3,820 (31.3%) non-localised LBP. Non-localised LBP was more frequently associated with sciatica in the past month (48.1% vs. 30.0% of cases), occurred on more days in the past month and past year, was more often disabling for everyday activities (64.1% vs. 47.3% of cases), and had more frequently led to medical consultation and sickness absence from work. It was also more often persistent when participants were followed up after a mean of 14 months (65.6% vs. 54.1% of cases). In adjusted Poisson regression analyses, non-localised LBP was differentially associated with risk factors, particularly female sex, older age and somatising tendency. There were also marked differences in the relative prevalence of localised and non-localised LBP by occupational group. CONCLUSIONS: Future epidemiological studies should distinguish where possible between pain that is limited to the low back and LBP which occurs in association with pain at other anatomical locations.
Fine particle air pollution due to secondhand smoke in selected public places in Colombo
(College of Community Physicians of Sri Lanka, 2009) Nandasena, Y.L.S.; Wickremasinghe, A.R.; Lee, K.; Sathiakumar, N.
INTRODUCTION: Globally, about five million deaths per year are attributed to tobacco smoke. Secondhand smoke accounts for a substantial proportion of these deaths. Most countries including Sri Lanka have legislation banning smoking in indoor workplaces and public places. Certain public places such as entertainment venues continue to permit smoking. Particulate matter (PM2.5) is a widely accepted indicator to evaluate secondhand smoke levels. OBJECTIVE: To determine PM2.5 concentrations in selected public places (defined as a space which can be visited without permission) in Colombo, Sri Lanka. METHODS: Using convenient sampling technique, we measured PM2.5 concentration levels in four types of public places (restaurants: n=6; bars: n=6; cafes: n=4; pubs and entertainment venues: n=4) during January to March, 2009. A particulate matter monitor (Model AM510 - SIDEPAK Personal Aerosol Monitor) was used to measure indoor air quality for 40 minutes and the immediate outdoors for 10 minutes before and after the indoor measurement. RESULTS: The mean indoor PM2.5 concentration was 124.9 ug/m3 (SD± 81.0) [range 33 ug/m3 - 299 ug/m3; median, 97.0 ug/m3]. The mean outdoor PM2.5 concentration was 39.7 ug/m3 (±14.3) [range 18 ug/m - 83 ug/m3; median, 37.5 ug/m3]. Indoor to outdoor (I/O) PM2.5 ratio ranged from 1.1 to 14.9. The highest PM2.s concentration was recorded in a bar and the highest I/O ratio in an entertainment venue. Smoking density (number of burning cigarettes divided by volume of the public place) was not correlated with average indoor PM2.5 concentration (Pearson correlation = 0.36, p=0.12) or with I/O PM2.5 ratio (Pearson correlation = 0.07, p=0.76). The reported values are equal or above, compared to such venues in other countries. CONCLUSION: The authorities should take steps in enforcing the smoking ban in public places. Areas where smoking is permitted, proper ventilation should be ensured.
Fine particle air quality levels of Sri Lankan households and associated respiratory conditions: preliminary findings of an ongoing longitudinal study
(Lippincott Williams & Wilkins, 2011) Nandasena, S.; Wickremasinghe, A.R.; Sathiakumar, N.
BACKGROUND/AIMS: Data on fine particle (PM2.5) air pollutant levels in Sir Lankan households are scarce. A high proportion of households are known to use unclean fuels for cooking, without proper ventilation. The aim of the study was to determine the respiratory health status of children and PM2.5 levels in a sample of home environments (indoors and outdoors). METHODS: A total of 612 children (aged 7–10 years) were selected from 2 study settings (setting 1, n = 408; setting 2, n = 204) for a prospective study. Study “setting 1” was selected from a high outdoor air-polluted area of the Colombo Municipal Council, and “setting 2” from a low-polluted area. The study commenced in March 2009. Measurements were made in the main living room using UCB particle monitors for 24 hours with minute logging. The outdoor 24-hour PM2.5 levels were measured using gravimetric air samplers in 3 selected outdoor locations in each setting at monthly intervals. RESULTS: On the basis of the 124 household measurements, the median PM2.5levels in households of settings 1 and 2 were 66.6 μg/m3 (mean = 104.0, range = 25.5–644.8) and 50.0 μg/m3 (mean = 142.0, range = 5.9–749.5), respectively. The highest PM2.5 concentrations were reported from houses using wood as cooking fuel (mean = 145.2, median = 66.8, range = 5.9–749.5 μg/m3). The prevalences of wheezing during the past 12 months (at least one episode during the last 12 months) were 20.8% (n = 85) and 10.8% (n = 22) (odds ratio = 2.2, confidence interval = 1.3–3.6) in setting 1 and 2, respectively. The prevalences of children ever having asthma were 18.9% (n = 77) and 12.7% (n = 26) in settings 1 and 2, respectively. CONCLUSION: Most of the households had PM2.5 levels exceeding the upper limit recommended by the World Health Organization. Children living in setting 1 had a higher risk of experiencing respiratory ill health than children living in setting 2. © 2011 Lippincott Williams & Wilkins, Inc.