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Browsing by Author "Weerasinghe, M."

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    An analysis of the Effectiveness of English Medium Instruction at the University of Kelaniya
    (University of Kelaniya, 2008) Weerasinghe, M.
    Over the past decade, many Sri Lankan universities have shifted to offering English as a medium of instruction in their degree courses. Furthermore, several sub sections of these universities have made the English stream compulsory for all students. This paper will analyse how students have been affected by these shifts in policy, and whether these changes are helping advance the goals that were outlined when implementing them. Research has shown that in many developing countries, a strong correlation exists between external funding and English language policy changes (Brock-utne, 2002), and that many of these shifts are often fueled by external pressure (Phillipson, 2001) and are made without a satisfactory understanding of the mechanics of language acquisition. This paper will examine the circumstances surrounding policy changes in the departments being studied, and compare the goals of these initiatives with the results they actually deliver. Specifically, this paper will focus on the new English language policies of the Faculty of Commerce and Management of the University of Kelaniya, and attempt to analyse how effective they have been in helping undergraduates switch over to the English medium. In order to do so, this project will use both qualitative and quantitative research, including questionnaires, interviews with members of faculty and an analysis of student grades.
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    Community-based cluster randomised trial of safe storage to reduce pesticide self-poisoning in rural Sri Lanka: study protocol
    (BioMed Central, 2011) Pearson, M.; Konradsen, F.; Gunnell, D.; Dawson, A.H.; Pieris, R.; Weerasinghe, M.; Knipe, D.W.; Jayamanne, S.; Metcalfe, C.; Hawton, K.; Wickremasinghe, A.R.; Atapattu, W.; Bandara, P.; de Silva, D.; Ranasinghe, A.; Mohamed, F.; Buckley, N.A.; Gawarammana, I.; Eddleston, M.A.
    BACKGROUND: The WHO recognises pesticide poisoning to be the single most important means of suicide globally. Pesticide self-poisoning is a major public health and clinical problem in rural Asia, where it has led to case fatality ratios 20-30 times higher than self-poisoning in the developed world. One approach to reducing access to pesticides is for households to store pesticides in lockable "safe-storage" containers. However, before this approach can be promoted, evidence is required on its effectiveness and safety. METHODS/DESIGN: A community-based cluster randomised controlled trial has been set up in 44,000 households in the North Central Province, Sri Lanka. A census is being performed, collecting baseline demographic data, socio-economic status, pesticide usage, self-harm and alcohol. Participating villages are then randomised and eligible households in the intervention arm given a lockable safe storage container for agrochemicals. The primary outcome will be incidence of pesticide self-poisoning over three years amongst individuals aged 14 years and over. 217,944 person years of follow-up are required in each arm to detect a 33% reduction in pesticide self-poisoning with 80% power at the 5% significance level. Secondary outcomes will include the incidence of all pesticide poisoning and total self-harm. DISCUSSION: This paper describes a large effectiveness study of a community intervention to reduce the burden of intentional poisoning in rural Sri Lanka. The study builds on a strong partnership between provincial health services, local and international researchers, and local communities. We discuss issues in relation to randomisation and contamination, engaging control villages, the intervention, and strategies to improve adherence.
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    Consumer knowledge and demand for antibiotics in Gampaha District
    (Sri Lanka Medical Association, 2005) Premaratna, R.; Weerasinghe, M.; Vipulanayake, T.; Mettananda, K.C.D.; Balasooriya, H.; de Silva, H.J.
    INTRODUCTION: Misuse of antibiotics in clinical practice is common. Patients' demand has been identified as a cause for wide use of antibiotics. Demand for antibiotics is affected by consumers' knowledge, attitudes, and medical practice. METHODS: Patients and their relatives attending out patient clinics in Colombo North Teaching Hospital and two private consultation clinics in the Gampaha District were interviewed using a pre¬tested questionnaire to study their knowledge of antibiotics and behavior during a febrile illness. RESULTS: Total population 763 [(487 females); Mean age 37.6 (SD; 15.9)]. Proper awareness of antibiotics was observed in 51/763(6.6%); with an increasing trend with level of education (LOE). More than 90% would accept any treatment prescribed by the doctor while antibiotics were expected by 64/763(8.3%) with no difference to LOE. During a febrile illness 563 (73.8%) visited a general practitioner within the first 2 days. Only 2 (0.3 %) claimed to have self-medicated with antibiotics. 376/487 (76%) females and 180/276 (65%) males expected some treatment without investigations. 67/487 (16%) of females and 34/276 (12%) males claimed they would have changed the doctor if there was no improvement in the first instance. Only 122/763 (16%) were aware of the cause for the most recent febrile illness they had suffered. CONCLUSIONS: In our population, knowledge of antibiotics, self medication and demand for antibiotics is lower than in European populations. Most of the patients are ready to accept any treatment prescribed and antibiotics were expected only by a minority. Therefore, patient behavior may not play a major role in the misuse of antibiotics.
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    Differences in the characteristics of people who purchase pesticides from shops for self-harm versus those who use pesticides available in the domestic environment in Sri Lanka
    (Blackwell Publishing, 2023) Weerasinghe, M.; Jobe, L.; Konradsen, F.; Eddleston, M.; Pearson, M.; Jayamanne, S.; Hawton, K.; Gunnell, D.; Agampodi, S.
    OBJECTIVE: Data from South Asia indicate that for 15%-20% of suicide attempts, pesticides are purchased from shops; otherwise, pesticides are obtained from an individual's house or nearby environment. We aimed to investigate the difference between individuals who directly purchase pesticides from shops for suicide attempts and suicide deaths versus those related to accessing the pesticides from an individual's house or nearby environment. METHODS: We conducted two comparative studies in rural Sri Lanka: (1) non-fatal shop cases (n = 50) were survivors of self-poisoning with pesticides who ingested the pesticides after purchasing them from a shop; non-fatal domestic cases (n = 192) were survivors who accessed pesticides from their house or nearby environment. (2) fatal shop cases (n = 50) were individuals who died after ingesting pesticides they purchased for the act; fatal domestic cases (n = 102) were patients who died after ingesting pesticides they accessed at house or nearby environment. Logistic regression analysis was used to assess the characteristics which distinguished between the shop and domestic cases. RESULTS: Data indicate that 20.7% and 32.9% of individuals who used pesticides for suicide attempts and suicide deaths had purchased them from shops, respectively. Being a non-farmer was the main distinguishing characteristic of shop cases: adjusted odds ratios (AOR) 8.9, 95% confidence intervals (CI) 3.2-24.4 for non-fatal shop cases, and AOR 4.0, 95% CI 1.5-10.6 for fatal shop cases. Non-fatal shop cases also had higher suicide intent (AOR 3.0, CI 1.0-8.9), and ingesting an insecticide (AOR 4.8, CI 1.8-1.0-8.9) than non-fatal domestic cases. CONCLUSION: A high suicide intent of individuals who purchase pesticides for the event explains the high proportion of such fatal cases. Such high suicide intent makes the prevention implications difficult to spell out for those individuals who purchase pesticides for self-poisoning. However, our findings are valuable for clinicians to assess pesticide poisoning cases in hospitals.
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    The digital commons: a gift culture
    (University of Kelaniya, 2008) Weerasinghe, M.
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    Disciplining the children: mothers' perceptions from a rural Sri Lankan community
    (iMed Publishing, 2015) Siriwardhana, D.; Weerasinghe, M.
    BACKGROUND: Disciplining is a major component of parenting. Studying the perception on disciplining children provides information to reduce harmful practices in communities. The aim of this study was to develop an instrument and assess maternal perception towards the physical and psychological disciplinary practices in a rural community of Sri Lanka. METHODS AND MATERIAL: Vignettes based interviewer administered questionnaire incorporating a visual analog scale was developed to capture the perceptions. Sixty seven mothers of children aged 11-16 years participated. Mothers were asked to categorize the vignettes into three groups and to rate the perception on three domains; severity, approval and harm. Mean scores and standard deviation was calculated for each disciplinary act. Then weighted mean scores were calculated for total physical and psychological disciplinary acts in three domains. Pearson correlation co efficient was calculated and significance of the correlation was tested between the perception of severity and approval, perception of severity and harm, perception of harm and approval for each of the disciplinary acts. RESULTS: The mean scores for perception of severity for eight individual physical disciplinary acts varied from 4.57 to 7.93 and for harm from 3.24 to 7.72. For perception of approval it varied from 2.91 to 7.34. The mean scores for perception on severity of psychological disciplinary acts varied from 4.29 to 7.52 and for harm from 4.43 to 7.39. For approval of the act it was from 3.06 to 5.43. Negative correlation was observed for the perception of approval with perception of severity and harm. Positive correlation was seen between the perception of severity and harm. CONCLUSION: The study demonstrates that mothers in this community favour physical disciplinary practices compared to the psychological disciplinary practices. Even though the perceived culpability of the child is low in the psychological disciplinary acts they perceive those acts as comparatively severe, harmful and less approved. © Copyright iMedPub
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    Effectiveness of household lockable pesticide storage to reduce pesticide self-poisoning in rural Asia: a community-based, cluster-randomised controlled trial
    (London : J. Onwhyn, 2017) Pearson, M.; Metcalfe, C.; Jayamanne, S.; Gunnell, D.; Weerasinghe, M.; Pieris, R.; Priyadarshana, C.; Knipe, D.W.; Hawton, K.; Dawson, A.H.; Bandara, P.; de Silva, D.; Gawarammana, I.; Eddleston, M.; Konradsen, F.
    BACKGROUND: Agricultural pesticide self-poisoning is a major public health problem in rural Asia. The use of safer household pesticidestorage has been promoted to prevent deaths, but there is no evidence of effectiveness. We aimed to test the effectiveness of lockablehousehold containers for prevention of pesticide self-poisoning. METHODS: We did a community-based, cluster-randomised controlled trial in a rural area of North Central Province, Sri Lanka. Clusters of households were randomly assigned (1:1), with a sequence computer-generated by a minimisation process, to intervention or usual practice (control) groups. Intervention households that had farmed or had used or stored pesticide in the preceding agricultural season were given a lockable storage container. Further promotion of use of the containers was restricted to community posters and 6-monthly reminders during routine community meetings. The primary outcome was incidence of pesticide self-poisoning in people aged 14 years or older during 3 years of follow-up. Identification of outcome events was done by staff who were unaware of group allocation. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT1146496. FINDINGS: Between Dec 31, 2010, and Feb 2, 2013, we randomly assigned 90 rural villages to the intervention group and 90 to the control group. 27 091 households (114 168 individuals) in the intervention group and 26 291 households (109 693 individuals) in the control group consented to participate. 20 457 household pesticide storage containers were distributed. In individuals aged 14 years or older, 611 cases of pesticide self-poisoning had occurred by 3 years in the intervention group compared with 641 cases in the control group; incidence of pesticide self-poisoning did not differ between groups (293·3 per 100 000 person-years of follow-up in the intervention group vs 318·0 per 100 000 in the control group; rate ratio [RR] 0·93, 95% CI 0·80-1·08; p=0·33). We found no evidence of switching from pesticide self-poisoning to other forms of self-harm, with no significant difference in the number of fatal (82 in the intervention group vs 67 in the control group; RR 1·22, 0·88-1·68]) or non-fatal (1135 vs 1153; RR 0·97, 0·86-1·08) self-harm events involving all methods. INTERPRETATION: We found no evidence that means reduction through improved household pesticide storage reduces pesticide self-poisoning. Other approaches, particularly removal of highly hazardous pesticides from agricultural practice, are likely to be more effective for suicide prevention in rural Asia. FUNDING: Wellcome Trust, with additional support from the American Foundation for Suicide Prevention, Lister Institute of Preventive Medicine, Chief Scientist Office of Scotland, University of Copenhagen, and NHMRC Australia.
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    Emerging pesticides responsible for suicide in rural Sri Lanka following the 2008-2014 pesticide bans.
    (BioMed Central, 2020) Weerasinghe, M.; Pearson, M.; Konradsen, F.; Agampodi, S.; Sumith, J. A.; Jayamanne, S.; Senanayake, S. M. H. M. K.; Rajapaksha, S.; Eddleston, M.
    BACKGROUND: Sri Lanka has reduced its overall suicide rate by 70% over the last two decades through means restriction, through a series of government regulations and bans removing highly hazardous pesticides from agriculture. We aimed to identify the key pesticide(s) now responsible for suicides in rural Sri Lanka to provide data for further pesticide regulation. METHODS: We performed a secondary analysis of data collected prospectively during a cluster randomized controlled trial in the Anuradhapura district of Sri Lanka from 2011 to 16. The identity of pesticides responsible for suicides were sought from medical or judicial medical notes, coroners' records, and the person's family. Trend analysis was done using a regression analysis with curve estimation to identify relative importance of key pesticides. RESULTS: We identified 337 suicidal deaths. Among them, the majority 193 (57.3%) were due to ingestion of pesticides while 82 (24.3%) were due to hanging. A specific pesticide was identified in 105 (54.4%) of the pesticide suicides. Ingestion of carbosulfan or profenofos was responsible for 59 (56.2%) of the suicides with a known pesticide and 17.5% of all suicides. The increasing trend of suicides due to carbosulfan and profenofos over time was statistically significant (R square 0.846, F 16.541, p 0.027). CONCLUSIONS: Ingestion of pesticides remains the most important means of suicides in rural Sri Lanka. The pesticides that were once responsible for most pesticide suicides have now been replaced by carbosulfan and profenofos. Their regulation and replacement in agriculture with less hazardous pesticides will further reduce the incidence of both pesticide and overall suicides in rural Sri Lanka. KEYWORDS: Pesticide; Pesticide regulation; Self-poisoning; Sri Lanka; Suicide.
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    Estimating the government health-care costs of treating pesticide poisoned and pesticide self-poisoned patients in Sri Lanka.
    (PA : Taylor & Francis, Philadelphia, 2019) Ahrensberg, H.; Madsen, L.B.; Pearson, M.; Weerasinghe, M.; Eddleston, M.; Jayamanne, S.; Hansen, K.S.; Ariyarathna, V.; Rajapaksha, S.; Konradsen, F.
    BACKGROUND: Pesticide self-poisoning as a method of suicide is a major global health problem. OBJECTIVES: To estimate the cost and per patient cost of treating pesticide self-poisoning at different hospital levels in a Sri Lankan district, and to examine the distribution of cost components. Another objective was to investigate changes in total cost of treatment of pesticide poisoning for all causes at different administrative levels in Sri Lanka in 2005 and 2015.METHODS: The economic framework was a costing analysis, adopting a government perspective. Cost data were collected prospectively over a 4-month period in 2016 for patients admitted for pesticide self-poisoning to six hospitals in the Anuradhapura District. Assumption-based scenario analyses were run to determine changes in total pesticide poisoning treatment costs. RESULTS: We included 67 self-poisoned patients in the study. The total cost of treatment was US$ 5,714 at an average treatment cost of US$ 85.3 (9.7-286.6) per patient (across all hospital levels). Hospital costs constituted 67% of the total cost for treating self-poisoning cases and patient-specific costs accounted for 29%. Direct cost of patient hospital transfer constituted the smallest share of costs (4%) but accounted for almost half of the total costs at primary level. The estimated total cost of treating all causes of pesticide poisoning in Sri Lanka was US$ 2.5 million or 0.19% of the total government health expenditure (GHE) in 2015. CONCLUSION: Our findings indicate that the average per patient cost of pesticide self-poisoning treatment has increased while the total cost of pesticide poisoning treatment as a percentage of the total GHE in Sri Lanka has declined over the past decade. A continuous focus on banning the most hazardous pesticides available would likely further drive down the cost of pesticide self-poisoning and pesticide poisoning to the government.
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    Factors associated with purchasing pesticide from shops for intentional self-poisoning in Sri Lanka
    (Blackwell Publishing Ltd, 2020) Weerasinghe, M.; Konradsen, F.; Eddleston, M.; Pearson, M.; Jayamanne, S.; Knipe, D.; Hawton, K.; Gunnell, D.; Agampodi, S.
    ABSTRACT: Objective: In South Asia, up to one in five individuals who ingest pesticides for self-poisoning and survive purchased them from a shop immediately prior to the event. Thus far, no research has taken place to determine whether interventions implemented through the pesticide sellers might be acceptable or effective, despite the hundreds of thousands of such risk purchases each year. We aimed to investigate factors associated with purchasing pesticides for self-poisoning in Sri Lanka. METHODS: We used a case–control study. Cases (n = 50) were individuals who ingested pesticides after purchasing them for the act, and controls (n = 200) were customers who bought pesticides but did not use them for self-harm. Logistic regression analysis was used to assess socio-demographic and purchase-specific risk factors. RESULTS: Alcohol intoxication (adjusted odds ratios [AOR] 36.5, 95% confidence intervals [CI] 1.7–783.4) and being a non-farmer AOR 13.3, 95% CI 1.8–99.6 were the main distinguishing factors when purchasing pesticides for self-poisoning. The positive predictive values were 93.3% (95% CI 68.0–99.8%) and 88.2% (95% CI 72.5–96.7%), respectively. One and/or other of these factors characterised 72.0% of cases but only 2.5% controls. CONCLUSION: While results need to be interpreted cautiously, sales restrictions to prevent alcohol-intoxicated persons and non-farmers purchasing pesticides for self-poisoning may be effective. © 2020 John Wiley & Sons Ltd AUTHOR KEYWORDS: pesticide shops; pesticides; self-poisoning; Sri Lanka; suicide. INDEX KEYWORDS: pesticide, environmental factor; pesticide; poisoning; regression analysis; risk factor, adult; alcohol consumption; alcohol intoxication; Article; automutilation; case control study; controlled study; female; human; major clinical study; male; predictive value; purchasing; self poisoning; sex difference; social status; Sri Lanka, Sri Lanka
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    Gatekeeper training for vendors to reduce pesticide self-poisoning in rural South Asia: a study protocol for a stepped-wedge cluster randomised controlled trial
    (BMJ Publishing Group Ltd, 2022) Weerasinghe, M.; Pearson, M.; Turner, N.; Metcalfe, C.; Gunnell, D.J.; Agampodi, S.; Hawton, K.; Agampodi, T.; Miller, M.; Jayamanne, S.; Parker, S.; Sumith, J.A.; Karunarathne, A.; Dissanayaka, K.; Rajapaksha, S.; Rodrigo, D.; Abeysinghe, D.; Piyasena, C.; Kanapathy, R.; Thedchanamoorthy, S.; Madsen, L.B.; Konradsen, F.; Eddleston, M.
    Introduction: Pesticide self-poisoning kills an estimated 110 000-168 000 people worldwide annually. Data from South Asia indicate that in 15%-20% of attempted suicides and 30%-50% of completed suicides involving pesticides these are purchased shortly beforehand for this purpose. Individuals who are intoxicated with alcohol and/or non-farmers represent 72% of such customers. We have developed a 'gatekeeper' training programme for vendors to enable them to identify individuals at high risk of self-poisoning (gatekeeper function) and prevent such individuals from accessing pesticides (means restriction). The primary aim of the study is to evaluate the effectiveness of the gatekeeper intervention in preventing pesticide self-poisoning in Sri Lanka. Other aims are to identify method substitution and to assess the cost and cost-effectiveness of the intervention. Methods and analysis: A stepped-wedge cluster randomised trial of a gatekeeper intervention is being conducted in rural Sri Lanka with a population of approximately 2.7 million. The gatekeeper intervention is being introduced into 70 administrative divisions in random order at each of 30 steps over a 40-month period. The primary outcome is the number of pesticide self-poisoning cases identified from surveillance of hospitals and police stations. Secondary outcomes include: number of self-poisoning cases using pesticides purchased within the previous 24 hours, total number of all forms of self-harm and suicides. Intervention effectiveness will be estimated by comparing outcome measures between the pretraining and post-training periods across the divisions in the study area. The original study protocol has been adapted as necessary in light of the impact of the COVID-19. Ethics and dissemination: The Ethical Review Committee of the Faculty of Medicine and Allied Sciences, Rajarata University, Sri Lanka (ERC/2018/30), and the ACCORD Medical Research Ethics Committee, Edinburgh University (18-HV-053) approved the study. Results will be disseminated in scientific peer-reviewed journals.
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    Genetic sequencing of the 56-kDa surface protein antigen gene of Orientia tsutsugamushi causing contemporary human scrub typhus at two sites in Sri Lanka
    (Sri Lanka Medical Association, 2014) Premaratna, R.; Blanton, L.; Samaraweera, D.N.; de Silva, G.N.N.; Kumara, T.A.D.N.; Liyanarachchi, M.S.; Weerasinghe, M.; Gunasekara, C.; Chandrasena, T.G.A.N.; Walker, D.; de Silva, H.J.
    INTRODUCTION AND OBJECTIVES: Genetic and antigenic characterisation of Orientia tsutsugamushi (OT) causing human disease in OT-endemic regions of Sri Lanka is not known. METHODS: Eschar biopsies (in age> 18 years} and buffy coat samples {in age<18 years) collected from patients with OT confirmed by IFA were further studied at the Rickettsia! Diseases Research Laboratory, Texas, USA by real time PCR (Orientia 47 kD} and nested PCR (Orientia 56 kD) amplification. DNA sequences were obtained for 56 kD gene amplicons and phylogenetic comparisons were analysed using currently available data in GenBank [Neucleotide substitution per 100 residues, 1000 Bootstrap Trials]. RESULTS: Twenty eschar biopsies (Balapitiya:19, Ragama:1} and eight buffy coat samples (Balapitiya:6, Ragama:2} examined by real time PCR revealed Orientiaamplicons in 16 samples. DNAsequences were obtained for the 56 kD gene amplicons in 12 eschars and 4 buffy coat samples. The genotypes of the Balapitiya samples revealed that, 7 exhibiting close homology with JP1 [distantly related to UT177 Thai (Karp related}], two had close homology with JGv and JG AF [distantly related to Kawasaki M63383], one had close homology with Gilliam strain, and five had close homology with Kato strain. The Ragama strain was closely related to Kuroki-Boryong L04956. CONCLUSIONS: We observed all three main OT genotypes in Sri Lanka, and the majority fell into Thai Karp related clade. These results demonstrate antigenic diversity of OT in the studied areas of Sri Lanka.
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    Potential interventions for preventing pesticide self-poisoning by restricting access through vendors in Sri Lanka
    (Hogrefe Publishing, 2018) Weerasinghe, M.; Konradsen, F.; Eddleston, M.; Pearson, M.; Jayamanne, S.; Gunnell, D.; Hawton, K.; Agampodi, S.
    BACKGROUND: In South Asia, up to one in five individuals who use pesticides for self-harm purchase them immediately prior to the event. AIMS: From reviewing the literature we proposed four interventions: (a) farmer identification cards (ID); (b) prescriptions; (c) cooling-off periods; and (d) training pesticide vendors. We aimed to identify the most promising intervention. Method: The study was conducted in Sri Lanka. We mapped stakeholders' interest and power in relation to each intervention, and followed this by a ranking exercise. Seven focus group discussions (FGDs) were conducted to assess facilitators and barriers to implementation. RESULTS:Vendor training was the most supported intervention, being ranked first by the stakeholders. The participants in the FGDs strongly supported training of vendors as it was seen to be easy to implement and was considered more convenient. Farmer IDs, prescriptions, and cooling-off periods were thought to have more barriers than facilitators and they were strongly opposed by end users (farmers and vendors), who would potentially block their implementation. LIMITATIONS: Cost considerations for implementing the proposed intervention were not considered. CONCLUSION: Training vendors might be the most appropriate intervention to restrict sales of pesticides to people at risk of suicidal behavior. This requires field testing
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    Reappraisal of symptoms and signs of uncomplicated β thalassemia trait
    (Sri Lanka Medical Association, 2005) Premawardhena, A.; Malewana, T.; Weerasinghe, M.; Arambepola, M.
    INTRODUCTION: Although considered a mild disorder, J3 thalassemia trait has been reportedly associated with symptoms of anaemia, while in other series hepatosplenomegaly has been reported as associated with this diagnosis. No controlled study has examined the symptoms and signs of individuals with {5 thalassemia trait and compared these with age- and sex-matched normal individuals. Materials and METHODS: We administered a questionnaire to 397 parents of children with J3 thalassemia major attending the National Thalassemia Centre in Kurunagala, Sri Lanka, and to 87 normal volunteers. All individuals underwent physical examination by the same investigator, as well as testing by automated cell counter, and HPLC. RESULTS: The mean age of the parents (33 years) and controls (29.5 years) was not significantly different. In parents with thalassemia trait, 20% of males and 42% of females complained of reduced exercise tolerance compared to 12.5% of males and 38% of females in the controls. The questionnaire revealed that 41% of parents, and 36% of controls, complained of recurrent headache; 18% of parents, and 15% of controls, complained of lethargy. Mean quality-of-life score, recorded formally by a linear analog scale, from 0 to 10 was 7.1 in parents and 7.2 in controls. CONCLUSIONS: These findings suggest that, by contrast to many reports in the older literature, in uncomplicated p thalassemia trait there appears to be no symptoms or signs greater than those observed in a normal control population.
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    Risk factors associated with purchasing pesticide from shops for self-poisoning: a protocol for a population-based case-control study
    (British Medical Association, 2015) Weerasinghe, M.; Konradsen, F.; Eddleston, M.; Pearson, M.; Gunnell, D.; Hawton, K.; Jayamanne, S.; Pabasara, C.; Jayathilaka, T.; Dissanayaka, K; Rajapaksha, S.; Thilakarathna, P.; Agampodi, S.
    INTRODUCTION: Pesticide self-poisoning is one of the most frequently used methods of suicide worldwide, killing over 300,000 people annually. Around 15-20% of pesticide self-poisonings occur soon after the person has bought the pesticide from a shop. We aim to determine the characteristics of individuals who purchase pesticides directly from shops and how they differ from individuals who access pesticides from other sources such as home, home garden or farmland. This information will help inform possible vendor/shop-based intervention strategies aimed at reducing access to pesticides used for self-harm. METHODS AND ANALYSIS: This study will investigate risk factors associated with purchasing pesticides for acts of self-poisoning from pesticide shops, including cases identified over a 9-month period using a population-based case-control group approach. Four interviewer-administered data collection tools will be used for this study: a semistructured questionnaire, Beck Suicidal Intent Scale (SIS), Clinical Interview Schedule-Sinhalese version (CIS-Sn) and Alcohol Use Disorders Identification Test (AUDIT). Each case (expected n=33) will be compared with two groups of individuals: (1) those who have self-poisoned using pesticides from the home, home garden or farmland and (2) those who bought pesticides from the same shops as the above cases, but not did not self-poison. Logistic regression models will be used to identify risk factors of purchasing pesticides for self-poisoning from shops. ETHICS AND DISSEMINATION: The study has received ethical approval from the Ethical Review Committee of the Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka. A sensitive data collection technique will be used and ethical issues will be considered throughout the study. Results will be disseminated in scientific peer-reviewed articles. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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    Risk factors for deliberate self-harm in young people in rural Sri Lanka: a prospective cohort study of 22,000 individuals
    (Sri Lanka Medical Association, 2021) Fernando, K.; Jayamanna, S.; Weerasinghe, M.; Priyadarshana, C.; Ratnayake, R.; Pearson, M.; Gunnell, D.; Dawson, A.; Hawton, K.; Konradsen, F.; Eddleston, M.; Metcalfe, C.; Knipe, D.
    Background: Over 90% of youth suicide deaths occur in low- and middle-income countries. Despite this relatively little is known about risk factors in this context. Aims: Investigate risk factors for deliberate self-harm (non-fatal) in young people in rural Sri Lanka. Methods: A prospective cohort study of 22,401 individuals aged 12-18 years with complete data on sex, student status, household asset score, household access to pesticides and household problematic alcohol use. Deliberate self-harm was measured prospectively by reviewing hospital records. Poisson regression estimated incidence rate ratios (IRRs) for the association of risk factors with deliberate self-harm. Results: Females were at higher risk of deliberate self-harm compared to males (IRR 2.05; 95%CI 1.75 – 2.40). Lower asset scores (low compared to high: IRR 1.46, 95%CI 1.12 - 2.00) and having left education (IRR 1.61 95%CI 1.31 – 1.98) were associated with higher risks of deliberate self-harm, with evidence that the effect of not being in school was more pronounced in males (IRR 1.94; 95%CI 1.40 – 2.70) than females. There was no evidence of an association between household pesticide access and deliberate self-harm risk, but problematic household alcohol use was associated with increased risk (IRR 1.23; 95%CI 1.04 – 1.45), with evidence that this was more pronounced in females than males (IRR for females 1.42; 95%CI 1.17 – 1.72). There was no evidence of deliberate self-harm risk being higher at times of school exam stress. Conclusion: Indicators of lower socioeconomic status, not being in school, and problematic alcohol use in households, were associated with increased deliberate self-harm risk in young people.
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    The Role of private pesticide vendors in preventing access to pesticides for self-poisoning in rural Sri Lanka
    (London : BMJ Pub. Group, 2014) Weerasinghe, M.; Pearson, M.; Peiris, R.; Dawson, A.H.; Eddleston, M.; Jayamanne, S.; Agampodi, S.; Konradsen, F.
    In 15% to 20% of self-poisoning cases, the pesticides used are purchased from shops just prior to ingestion. We explored how pesticide vendorsinteracted with customers at risk of self-poisoning to identify interventions to prevent such poisonings. Two strategies were specifically discussed: selling pesticides only to farmers bearing identity cards or customers bearing pesticide 'prescriptions'. Vendors reported refusing to sell pesticides to people thought to be at risk of self-poisoning, but acknowledged the difficulty of distinguishing them from legitimate customers; vendors also stated they did want to help to improve identification of such customers. The community did not blame vendors when pesticides used for self-poison were purchased from their shops. Vendors have already taken steps to restrict access, including selling low toxic products, counselling and asking customer to return the next day. However, there was little support for the proposed interventions of 'identity cards' and 'prescriptions'. Novel public health approaches are required to complement this approach.
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    Should colloid boluses be prioritized over crystalloid boluses for the management of dengue shock syndrome in the presence of ascites and pleural effusions?
    (BioMed Central, 2011) Premaratna, R.; Liyanaarachchi, E.; Weerasinghe, M.; de Silva, H.J.
    BACKGROUND: Although the WHO guideline for the management of dengue fever considers the presence of ascites or pleural effusions in the diagnosis of DSS, it does not emphasize the importance of their presence when selecting fluids for resuscitation. CASE PRESENTATION: We highlight three patients with DSS who received boluses of crystalloids on priority basis as recommended by WHO guidelines during resuscitation. All three patients had varying degrees of third space fluid loss (ascites and pleural effusions) at the time of development of DSS. Ascites and pleural effusions were detected in all 3 patients at the time of shock irrespective of whether iv fluids were given or not. All three patients had documented liver involvement at the time of shock evidenced by elevation of AST (4800 iu/L, 5000 iu/L and 1960 iu/L). One patient who had profound shock died 6 hours after admission with evidence of acute pulmonary oedema in the convalescence phase. All of them needed CPAP ventilator support and potent diuretics. CONCLUSIONS: We therefore feel that resuscitation of patients with DSS who already have third space fluid accumulation with crystalloid boluses on priority basis may contribute to recovery phase pulmonary oedema.
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    Socioeconomic position and suicidal behaviour in rural Sri Lanka: a prospective cohort study of 168,000+ people.
    (Springer International, 2019) Knipe, D. W.; Gunnell, D.; Pieris, R.; Priyadarshana, C.; Weerasinghe, M.; Pearson, M.; Jayamanne, S.; Hawton, K.; Konradsen, F.; Eddleston, M.; Metcalfe, C.
    PURPOSE:Lower socioeconomic position (SEP) is associated with an increased risk of suicidal behaviour in high income countries, but this association is not established in low- and middle-income countries (LMIC). METHODS: We investigated the association of SEP with suicidal behaviour in a prospective cohort study of 168,771 Sri Lankans followed up for episodes of attempted suicide and suicide. SEP data were collected at baseline at the household and individual level at the start of the follow-up period. We used multilevel Poisson regression models to investigate the association of SEP at community, household and individual levels with attempted suicide/suicide. RESULTS: Lower levels of asset ownership [IRR (95% CI) suicide 1.74 (0.92, 3.28); attempted suicide 1.67 (1.40, 2.00)] and education [suicide 3.16 (1.06, 9.45); attempted suicide 2.51 (1.70, 3.72)] were associated with an increased risk of suicidal behaviour. The association of these measures of SEP and attempted suicide was stronger in men than women. Individuals living in deprived areas [1.42 (1.16, 1.73)] and in households with a young female head of household [1.41 (1.04, 1.93)] or a temporary foreign migrant [1.47 (1.28, 1.68)] had an elevated risk of attempted suicide. Farmers and daily wage labourers had nearly a doubling in risk of attempted suicide compared to other occupations. CONCLUSIONS: Improved employment opportunities, welfare and mental health support services, as well as problem-solving skills development, may help support individuals with poorer education, farmers, daily wage labourers, individuals in young female-headed households and temporary foreign migrant households.
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    Symptoms and signs of β thalassaemia trait: results of the first comparative study
    (Sri Lanka Medical Association, 2007) Premawardhena, A.P.; Weerasinghe, M.; Kottachchi, D.; Arambepola, M.; Katugaha, N.; Samarakoon, S.; Otivieri, N.F.; Weatherall, D.J.
    OBJECTIVE: Thalassaemia trait is considered a mild and asymptomatic condition. However patients with this disease may be symptomatic. Should these be attributed to the disease? Does pre-knowledge about the diagnosis affect patients' symptoms? Previous studies were affected by the lack of a control arm. This is the first controlled study which compares symptoms of (3 thalassaemia trait with matched controls and also looks at how prior knowledge of the disease affects symptoms. DESIGN, SETTING AND METHODS: We administered a questionnaire to 146 individuals who knew that they had thalasseamia trait (Group 1} and to 248 "normal" volunteers who did not know their "thalassaemic status". Eleven symptoms were assessed. All individuals were examined by the same investigator and had a full blood count from an automated analyzer and a thalassaemia screening with High Performance Liquid Chromatography (HPLC- Bio Rad). RESULTS: The FBC and HPLC data showed that of the 248 "normal" controls , 63 had p thalassaemia trait (Group 2), and a further 96 had MCV< 80 and MCH <27 without thalassaemia (Group 3), presumably due to iron deficiency. 89 had normal red cell indices and normal HPLC (Group 4). Comparison of the four groups showed that "anaemic symptoms" like headache, exercise intolerance and lethargy occurred in significantly higher numbers in Groups 1 and 2 compared to Group 4. Comparison of Group 1 and Group 3 did not show any significant difference suggesting a similar mechanism for symptoms. Group 2 did not differ significantly from Group 1 in anyway. CONCLUSIONS: The p thalasseamia trait can be a symptomatic disorder and the symptoms arc those of anaemia. Symptoms are not affected or caused by being aware of the diagnosis.
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