Browsing by Author "de Silva, N.R."

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Accessing a Moodle based Learning Management System and Exam Performance by Medical Students: A Retrospective Analysis.
(Faculty of Computing and Technology, University of Kelaniya, Sri Lanka., 2017) Hettiarachchi, W.G.; Hettige, S.; Ediriweera, E.P.D.S.; Chandrathilake, M.N.; de Silva, N.R.
Considering the high computer literacy of students and the need for being students centred, the MBBS programme of University of Kelaniya introduced a Moodle-based learning management system (LMS) as a supplementary component to its blended delivery approach of the curriculum. Accordingly, LMS is a parallel component to the curriculum delivered face-to-face. Each module of learning in the curriculum is represented in the LMS by giving lecture notes, PowerPoint presentations, web links and assignments. The broad aim of this study is to determine the relationship between the extent of interactively of learners with LMS and their exam performance. First-year medical students (172 from 2016 intake and 166 from 2017 intake) at University of Kelaniya were considered for the analysis. Student’s access to LMS during the first two modules of the MBBS curriculum and the results of the first continuous assessment were compared. Total LMS access for each student during the two modules were calculated by counting the number of views in the course log. The particular course logs of LMS were downloaded and filtered out the details pertaining to students in the above two modules in both batches. Total access during the two modules were calculated for individual student and used for the analysis. Continuous assessment results ranged from grades A to F and we assigned sequential numerical marks in the descending order from 6 to 1 to denote grade A to F. Total LMS access with respect to assessment grades were visualized using boxplots and median with interquartile ranges were calculated. Association between LMS access and assessment grades were investigated. Statistical analysis was done in R. Median (interquartile range) of LMS access of the students were 43.0 (12.25 – 72.0) times. The number of results grades for the students as follows; A – 3, B – 41, C – 117, D – 122, E – 51 and F – 4 and the respective number of median (interquartile range) access to LMS for the above grades were 110.0 (102.0 – 113.0), 51.0 (21.0 – 76.0), 49.0 (16.0 – 76.0), 39.0 (11.0 – 64.75), 29.0 (6.0 – 59.5) and 6.5 (3.0 – 16.0). There was significant correlation between LMS access and results grades (rho = 0.2, P < 0.01). Students with grade A showed significantly higher LMS access compared to the rest of groups. There was no difference in LMS access between students with grades B and C, C and D, D and E, D and F or E and F. However, grade B showed significantly higher LMS access compared to grades D, E and F; and grade C showed significantly higher LMS access compared to grades E and F. The findings demonstrate that students’ interaction with LMS were significantly associated with the performance in the examination. The learning management system has a positive impact on student performance.
Admission to medical schools in Sri Lanka: predictive validity of selection criteria
(Sri Lanka Medical Association, 2006) de Silva, N.R.; Pathmeswaran, A.; de Silva, N.; Edirisinghe, J.S.; Kumarasiri, P.V.R.; Parameswaran, S.V.; Seneviratne, R.; Warnasuriya, N.; de Silva, H.J.
OBJECTIVE: To assess the extent to which current selection criteria predict success in Sri Lanka's medical schools. METHODS: The study sample consisted of all students selected to all six medical schools in two consecutive entry cohorts. The aggregate marks of these students at the General Certificate of Education (GCE) Advanced Level examination, the district of entry, admission category, candidate type (school/private) and gender, were identified as entry point variables. Success in medical school was measured in four ways: the ability to pass the first summative examination and the final examination at the first attempt, and obtaining honours in either examination. Multivariate analysis using logistic regression was used to assess the extent to which these entry point factors predict variability in outcome measures.RESULTS: Aggregate scores among the 1740 students in the study sample ranged from 212 to 356, with a median of 285. The male:female ratio was 1.4:1. Private candidates (taking the examination for the third time) accounted for 22% of students. Being a school candidate, female and having a higher aggregate score, were the only independent predictors of success for all four outcome measures. The aggregate score alone accounted for only 1-7% of the variation in performance in medical school. CONCLUSIONS: Marks obtained at the A Level examination (the only academic criterion currently used for selection of medical students in SriLanka) is a poor predictor of success in medical school.
Allergic sensitization in children
(The Sri Lanka College of Paediatricians, 2008) Amarasekera, N.D.D.M.; Gunawardena, N.K.; de Silva, N.R.; Weerasinghe, A.
BACKGROUND :Allergic sensitization is considered a significant risk factor for the development of atopic diseases. Appropriate allergen avoidance measures can be taken only when the pattern of sensitization to allergens in a particular population is known. No data is available regarding allergic sensitization among Sri Lankan children. OBJECTIVE: To identify the common allergens causing sensitization in a selected group of schoolchildren. DESIGN, SETTING AND METHOD: A cross-sectional study was carried out in 640 children in grade 5 (age group 9-11 years), from 17 schools in the Western Province. Data regarding atopic diseases was collected using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Specific IgE was estimated by ImmunoCAP method for five common aeroallergens (the dust mites Dermatophagoides pteronyssinus and Blomia tropicalis, cockroach, cat epithelium and dander, grass pollen) in a sub-sample of 203. RESULTS: Aeroallergen sensitivity was detected in 163 (80.3%) children. No significant difference for sensitization between boys and girls was noted (P= 0.549). The pattern of allergens in the two groups was similar. Mite allergen sensitivity was the most prevalent (B. tropicalis 84.0%, D. pteronyssinus 69.9%), followed by cockroach (67.5%), cat dander (46.0%) and grass pollen (35.6%). Twenty seven (13.3%) children were sensitized to all allergens tested; 28 (13.8%) children were sensitized to only one allergen; and 68.7% were sensitized to both B. tropicalis and D. pteronyssinus. Children with rhinitis or eczema (but not those with asthma) were significantly more likely to show sensitization to cat dander than asymptomatic controls (P=0.02 and P=0.002 respectively), but not to other allergens. The likelihood of being sensitized to one allergen was well correlated with sensitization to other allergens as evident by the significant correlation coefficients. CONCLUSION: Mites and cockroaches were the most common aeroallergens causing sensitization among schoolchildren in the Western Province.
Amoebic liver abscess in northern Sri Lanka: first report of immunological and molecular confirmation of aetiology
(Biomed Central, 2017) Kannathasan, S.; Murugananthan, A.; Kumanan, T.; Iddawala, D.; de Silva, N.R.; Rajeshkannan, N.; Haque, R.
BACKGROUND: Since 1985, amoebic liver abscess (ALA) has been a public health problem in northern Sri Lanka. Clinicians arrive at a diagnosis based on clinical and ultrasonographic findings, which cannot differentiate pyogenic liver abscess (PLA) from ALA. As the treatment and outcome of the ALA and PLA differs, determining the etiological agent is crucial. METHODS: All clinically diagnosed ALA patients admitted to the Teaching Hospital (TH) in Jaffna during the study period were included and the clinical features, haematological parameters, and ultrasound scanning findings were obtained. Aspirated pus, blood, and faecal samples from patients were also collected. Pus and faeces were examined microscopically for amoebae. Pus was cultured in Robinson's medium for amoebae, and MacConkey and blood agar for bacterial growth. ELISA kits were used for immunodiagnosis of Entamoeba histolytica infection. DNA was extracted from selected pus samples and amplified using nested PCR and the purified product was sequenced. RESULTS: From July 2012 to July 2015, 346 of 367 clinically diagnosed ALA patients admitted to Jaffna Teaching Hospital were enrolled in this study. Almost all patients (98.6%) were males with a history of heavy alcohol consumption (100%). The main clinical features were fever (100%), right hypochodric pain (100%), tender hepatomegaly (90%) and intercostal tenderness (60%). Most patients had leukocytosis (86.7%), elevated ESR (85.8%) and elevated alkaline phosphatase (72.3%). Most of the abscesses were in the right lobe (85.3%) and solitary (76.3%) in nature. Among the 221 (63.87%) drained abscesses, 93.2% were chocolate brown in colour with the mean volume of 41.22 ± 1.16 ml. Only four pus samples (2%) were positive for amoeba by culture and the rest of the pus and faecal samples were negative microscopically and by culture. Furthermore, all pus samples were negative for bacterial growth. Antibody against E. histolytica (99.7%) and the E. histolytica antigen were detected in the pus samples (100%). Moreover, PCR and sequencing confirmed these results. CONCLUSION: To our knowledge, this is the first report from Sri Lanka that provides immunological and molecular confirmation that Entamoeba histolytica is a common cause of liver abscesses in the region.
Association between asthma and rhinitis
(Sri Lanka Medical Association, 2010) Amarasekera, N.D.D.M.; Gunawardena, N.K.; de Silva, N.R.; Weerasinghe, G.A.K.
INTRODUCTION AND OBJECTIVES: It has been suggested that'both asthma and allergic rhinitis are manifestations of a single disease and they are related epidemiologically and pathophysiologically. The objective was to assess the relationship between asthma and allergic rhinitis in terms of serum total IgE (tlgE) and allergic sensiti-satipn in children. METHODS: Children attending grade 5 in 17 schools in the Western Province of Sri Lanka were recruited to the study. Data were collected using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Their serum total IgE (tlgE) and allergen-specific IgE (slgE) for five common aeroallergens (Dermatophagoides pteronyssinusr Blomia tropicalis, cockroach, cat epithelium and dander, grass pollen) were measured by ImmunoCAP method. RESULTS: A total of 640 schoolchildren were recruited. Their mean age was 10 years (SD ± 0.5) Prevalence (95% CI) of asthma and rhinitis was 17% (13.7-20.3) and 21.4% (17.8-25.1) respectively. Male preponderance was seen for both diseases, but was significant only for rhinitis. Among children with asthma, 44.4% had rhinitis. The geometric mean tlgE level was higher in children with asthma (804.6 kU/L) than with rhinitis (708.9 kU/L), but the difference was not statistically significant. Univariate analysis showed that sensitization to allergens from cat epithelium and dander was strongly associated with rhinitis (OR 2.104, 95% CI 1.1.16 - 3.969, P = 0.022) but not with asthma. CONCLUSION: Asthma and rhinitis appear to be different in our study population with respect to sensitising allergens and gender. The risk factors and development of these two diseases may vary in different populations.
Association between serum total IgE, allergic diseases and geohelminth infections in Sri Lankan children
(BioMed Central, 2007) Amarasekera, N.D.D.M.; Gunawardena, N.K.; de Silva, N.R.; Douglass, J.; O’Hehir, R.E.; Weerasinghe, A.
BACKGROUND: Elevated levels of total IgE (tIgE) in serum are characteristic of allergic diseases. Levels of tIgE are influenced by genetic predisposition, age, sex and helminth infections. However, the association between tIgE and allergic diseases in children living in areas endemic for helminth infections is not clear. The aim of our study was to assess the relationship between tIgE, allergic diseases and geohelminth infections in children. METHODS: A total of 640 schoolchildren 9Y11 years of age was selected by stratified random sampling. Data regarding allergic diseases (asthma, rhinitis and eczema) were collected by a standard questionnaire given to the parent or guardian. Screening for helminth infections was done by examining their fresh stool samples by modified Kato-Katz technique. Serum tIgE was measured by Fluoroenzymeimmunoassay in 67 geohelminth-positive subjects and in a comparable group of geohelminth-negative subjects. RESULTS: The mean age in the study population was 10 years (SDT0.3). The prevalence of geohelminth infection was 15.5%. Trichuris trichiura (14.3%) was the most common followed by Ascaris lumbricoides (4.2%) and hookworm (0.2%). Mixed infection was detected in 20.3% of infected children. Infection intensity was light in 68.9% of infected children while 28.4% and 2.7% showed moderate and heavy infection respectively. The cumulative prevalence of allergic diseases was 33.7%. Prevalence of asthma, rhinitis and eczema was 17%, 21.4% and 5% respectively. Serum tIgE concentrations showed a positively skewed distribution. Geometric mean (GM) for tIgE for the geohelminth infected group (1039.9kU/L) was significantly higher than that of the non-infected group (575.4kU/L) (p = 0.004). It was also higher in the allergic group (933.3kU/L) than in the non-allergic group (639.7kU/L) but the difference was not statistically significant (p = 0.068). The GM for tIgE for non-allergic children in the study population was much higher than that seen in non-allergic children in developed countries. CONCLUSION: Serum tIgE concentration was strongly associated with the presence of geohelminth infections in children. Serum tIgE may not be a useful marker for allergic diseases in children living in areas endemic for geohelminth infections. © 2007 World Allergy Organization
Attributes of professionalism expected of a medical doctor in Sri Lanka
(Sri Lanka Medical Association, 2016) Ellawala, A.T.; Chandratilake, M.N.; de Silva, N.R.
INTRODUCTION: Professionalism is an essential competency for a doctor. OBJECTIVES: To identify the attributes of professionalism expected of a doctor in the Sri Lankan setting. METHOD: A two-round Delphi study was conducted online with the participation of 158 representatives of various stakeholders in healthcare. In the first round, participants outlined attributes of professionalism expected of a doctor in the local context. Through conventional content analysis, a list of attributes was compiled. These were rated by participants in round II. The most important attributes were identified by calculating the Content Validity Index (CVI) of responses. Kappa value was calculated to determine the adequacy of inter-rater agreement. RESULTS: In round I, 56 attributes of professionalism were identified. These items were compiled into a questionnaire with four distractors (i.e. misperceptions of professionalism) to minimize indiscriminate rating of items. In round II, 46 items received a CVI >0.78 (cutoff value to determine essential items). ‘Possessing adequate knowledge and skills’ received the highest CVI (0.99), followed by ‘displaying a sense of responsibility’ (0.98) and ‘being compassionate and caring’ (0.97). ‘Altruism’ and ‘socio-cultural sensitivity’ were not rated as important. Interestingly, one of the 4 distractors (‘stands for professional autonomy’) also received a CVI>0.78. The K-value was 0.77, indicating adequate inter-rater agreement. CONCLUSIONS: This study enabled the development of a prioritized list of professionalism related attributes expected of a doctor in Sri Lanka. The conceptualization of professionalism in the local healthcare context appears to have both commonalities and disparities with the rest of the world.
Biochemical and histopathological changes in Wistar Rats after consumption of boiled and un-boiled water from high and low disease prevalent areas for Chronic Kidney Disease of Unknown Etiology (CKDu) in North Central Province (NCP) and Its comparison with Low disease prevalent Colombo, Sri Lanka
(BioMed Central,, 2020) Thammitiyagodage, M.G.; de Silva, N.R.; Rathnayake, C.; Karunakaran, R.; Wgss, K.; Gunatillka, M.M.; Ekanayaka, N.; Galhena, B.P.; Thabrew, M.I.
BACKGROUND: Chronic Kidney Disease of unknown etiology (CKDu) is prevalent in North Central Province (NCP) of Sri Lanka. Consumption of un-boiled dug well water has been identified as one of the causative factors. This in-vivo study was performed to investigate some of the suspected factors associated with the pathogenesis of CKDu mediated via ground water. METHOD: Rats were given water, collected from high and low disease prevalent areas from the NCP of Sri Lanka and the results compared with those obtained from previously identified low disease prevalent area; Colombo. Blood Urea Nitrogen, creatinine, urinary microalbumin:creatinine ratio together with ALT and AST levels were analyzed and results were compared using one-way ANOVA and paired t-Test. Histopathology was analyzed using non-parametric method. RESULTS: Rats that ingested water from New Town Medirigiriya (NTM) from high disease prevalent NCP reported significantly elevated microalbumin:creatinine ratios compared to other water sources after 8 months, whilst boiled water from NTM had been able to significantly reduce it. Histopathological findings after the 14 months experimental period revealed significantly high tubular lesion index in rats that ingested water from NCP compared to Colombo. Rats that ingested water from high disease prevalent Divuldamana (DD) from NCP showed the highest kidney lesion index though the fluoride content was relatively low in this area compared to other water sources from high disease prevalent NCP. Rats that ingested boiled and un-boiled water from NTM also developed severe lesions whilst the group from Colombo reported the lowest. Low disease prevalent area from NCP, Huruluwewa (HW) also reported elevated liver enzymes and altered renal histopathology. Association of Na+:Ca2+ ratio in the disease progression was not reflected by the current study. Compared to Colombo, high fluoride, calcium and sodium contents were observed in water from high disease prevalent areas. All the water samples were negative for heavy metals. CONCLUSIONS: Though Fluoride is a known kidney toxic agent it cannot be the sole reason for CKDu in NCP, Sri Lanka. Various toxic elements present in NCP water may contribute to different grade of kidney and liver lesions in Wistar rats. KEYWORDS: BUN; CKDu; Microalbumin:creatinine; NCP.
Breeding of aedes Aegypti and Aedes albopictus in some dengue endemic areas.
(Sri Lanka College of Microbiologists, 2000) Hapugoda, G.P.G.M.D.; de Silva, N.R.; Abeyewickreme, W.
Dengue fever (DF)/Dengue haemorrnagic fever (DHF) is now- the most important and rapidly spreading vector borne disease in the world. Since 1956, over 350 000 patients have been hospitalized and nearly 12 000 deaths have been reported. In Sri Lanka the incidence of DF/DHF has increased cyclically since the first outbreak in Sri Lanka during which 26 deaths were reported. Aedes aegypti is classified as the predominant vector of dengue in Sri Lanka. Ae, albopictus is considered as an important vector in the absence of Ae. aegypti. In this study, larval surveillance was carried out in fixed monitoring stations / hot-spots and random monitoring stations. Fixed monitoring stations were selected based on high incidence of DF/DHF recorded since 1996 in Kurunegala district. Ten premises within one fixed monitoring station were checked for mosquito breeding weekly using ovitraps and the average monthly ovitrap index (%) was calculated. During outbreaks larval surveillance was conducted in fifteen random monitoring stations including 66 houses which were selected based on serologically confirmed DPI DHF cases in and around Kurunegala and Ragama. Observations on average monthly ovitrap index (%) in the fixed monitoring stations showed that the highest ovitrap index was in Kurunegala town area, Ovitrap index of Ae. albopictus was higher than of Ae. aegypti all localities in and around Kurunegala throughout the study period. Data obtained from random monitoring-stations in and around Kurunegala and Ragama revealed that only Ae. albopictus larvae were present in seven stations. There were no stations in which only Ae.aegypti larvae were present. House index of Ae. albopictus was 28% whereas it was 10.6% for both species in random monitoring stations. Results suggest that Ae.albopictus may play a major role in transmitting dengue in some localities in Sri Lanka. This investigation received financial support from University of Kelaniya (Research Grant no-97/1-23) and from the IAEA (Technical Corporation Grant no-SRL/06/024).
Burden of mental illness and the need for better undergraduate education in psychiatry
(Sri Lanka Medical Association, 2014) Kuruppuarachchi, K.A.L.A.; de Silva, N.R.
No Abstract Available
Can we deworm this wormy world?
(Oxford University Press, 1998) Bundy, D.A.P.; de Silva, N.R.
While programmes such as the Rockefeller campaign were specifically targeted at a particular parasite species, the current trend is towards the simultaneous control of all the major geohelminth species. New, broad-spectrum, low-cost anthelmintics and new understanding of epidemiology have led to more cost-effective and sustainable strategies. The WHO, UNICEF and the World Bank all now support global and regional efforts to achieve control of morbidity from intestinal worms. In this paper, we aim to show what's new in clinical helminthology and what has brought about the great improvement in the success of the new approaches to control.
Can we eliminate soil-transmitted helminth infections in Sri Lanka?
(Sri Lanka Medical Association, 2012) de Silva, N.R.; Jayawickrama, H.
No Abstract Available
Can we improve the criteria for selection of medical students in Sri Lanka?
(Sri Lanka Medical Association, 2010) de Silva, N.R.; Salgado, L.S.S.; Fernando, G.M.O.; Liyanage, P.L.C.K.; Hewage, S.N.; Pathmeswaran, A.
OBJECTIVE: To examine the validity of selected entry level characteristics in relation to the GCE Advanced Levei (AL) examination as predictors of performance of medical students. METHODS: Data on two consecutive batches of students at the Medical Faculty, Kelaniya University, were analysed. These included students' sex. AL attempt, AL z-score, English placement test marks on registration at the faculty, and aggregate marks at summadve examinations held in the 2nd (Phase I), 3rd and 4l (Phase II) years. The effect of predictor variables on medical school marks was assessed by multivariate analysis with causal path diagrams. RESULTS: The sample consisted of 294 students; 58.8% were females. Most had entered after the 2nd attempt (32% from 1s1, 48.3% from 2nd, 19.7% from 3rd attempt). The mean z-score was 2.017 (SD0.142). Mean English placement test mark was 59.1 (SD14.2). Mean marks in Phase I and II examinations were 54.3 (SD7.3) and 56.5 .(SD7.6) respectively. Significantly more males had entered after the 3rd attempt than females (27.2% of males, vs 14.5% of females, Pearson x2=0.027). Females did significantly better in English and in Phase I and II examinations. Path analysis showed that z-score, attempt and English placement test marks were all significant predictors of outcome at the First Examination. There was high correlation between performance at First and Second Examinations. CONCLUSION: Requiring prospective medical students to pass General English and restricting the number of attempts at the AL to two instead of three, will result in selection of medical students that perform better.
A Case of imported malaria: the first report of Plasmodium malariae infection in Sri Lanka after 37 years
(Sri Lanka Medical Association, 2008) Hapuarachchi, H.A.C.; Gunawardena, N.K.; Senevirathne, M.P.; Abeyewickreme, W.; de Silva, N.R.
We report a case of Plasmodium falciparum and P. malariae mixed infection in a patient who had been living in Malawi. This is the first case of P. malariae reported in Sri Lanka in 4 decades. The presence of both parasites was confirmed by microscopy and polymerase chain reaction (PCR). The history strongly indicated that the infection had been acquired from Malawi. The patient had liver dysfunction and a transient glomerulonephritis, both of which subsided with antimalarial treatment.
The Changing face of malaria in Sri Lanka: implications for diagnosis and treatment
(Sri Lanka College of Microbiologists, 2010) de Silva, N.R.
Chloroquine resistant falciparum malaria among security forces personnel in the Northern Province of Sri Lanka
(Sri Lanka Medical Association, 2004) Hapuarachchi, H.A.C.; Dayanath, M.Y.D.; Abeysundara, S.; Bandara, K.B.A.T.; Abeyewickreme, W.; de Silva, N.R.
OBJECTIVE: To determine the occurrence and species distribution of malaria and the extent of chloroquine resistance among security forcespersonnel in a selected region of the Northern Province of Sri Lanka. DESIGN: A descriptive study. SETTING: Mannar District in the Northern Province. METHODS: Nine hundred and seventy five security personnel were screened for malaria by microscopy. Those who were positive were treated withchloroquine and were subjected to 28 day in vivo assay to determine chloroquine resistance. In vitro microtest assay was performed to determine the response of Plasmodium falciparum isolates to chloroquine in vitro. RESULTS: Of the 975 personnel screened, 181 (18.6%) were positive for malaria. P. falciparum was the predominant species (n = 125; 69.1%). The rest were due to P. vivax (n = 42; 23.2%) and mixed infections (n = 14; 7.7%). This was an inversion of the usual species distribution pattern in the country. In vivo assay revealed 38 (53.5%) P. falciparum infections as chloroquine resistant. Fifteen of 23 (65.2%) P. falciparum isolates showed evidence of resistance in vitro. None of the P. vivax infections showed evidence of chloroquine resistance. There was no significant difference in the severity of clinical disease between chloroquine resistant and sensitive infections at first presentation. Recrudescent P. falciparum infections had significantly lower mean parasite densities as well as lower clinical scores at recrudescence than at first presentation. CONCLUSION: Results demonstrate the high prevalence of malaria and chloroquine resistance in the study area and explains several contributory factors for this. There is an urgent need to review antimalarial drug policies in Sri Lanka
Clearance of microfilaraemia and red blood cell glutathione peroxidase(GPX) levels in asymptomatic microfilaraemics after single dose and 14 days’ treatment with diethyl carbamazine citrate(DEC)
(Wiley, 2001) Premaratna, R.; Chandrasena, T.G.A.N.; Abeyewickreme, W.; de Silva, N.R.; Chandrasena, L.G.; de Silva, H.J.
Abstract Available
Clearance of microfilaraemia and red blood cell glutathione peroxidase(GPX) levels in asymptomatic microfilaraemics after single dose and 14 days’ treatment with diethyl carbamazine citrate(DEC)
(Sri Lanka Medical Association, 2001) Premaratna, R.; Chandrasena, T.G.A.N.; Abeyewickreme, W.; de Silva, N.R.; Chandrasena, L.G.; de Silva, H.J.
Abstract Available
Cluster randomized trial of the impact of school based deworming and weekly iron supplementation on haemoglobin level of plantation primary school children
(College of the Community Physicians of Sri Lanka, 2013) Ebenezer, R.; Gunawardena, N.K.; Kumarendran, B.; Pathmeswaran, A.; de Silva, N.R.
BACKGROUND: School-based deworming and iron supplementation are being promoted as effective interventions to deal with the high prevalence of anaemia among school children. OBJECTIVE: The objective of this study was to determine the effectiveness of school based deworming and weekly iron supplementation on increasing the haemoglobin level of primary school children in the plantation sector in Sri Lanka. METHODS: A placebo-controlled cluster randomized trial was conducted in which the treatment group received a single dose of 500 mg mebendazole and 6-months of weekly iron supplementation (200 mg ferrous sulphate) while the control group received placebo for both anthelmintic and iron. The tablets were administered by the class teacher. Children attending grade 4 in schools in the plantation sector were recruited. The treatment arm was allocated with 813 children attending 49 schools and the placebo arm with 808 children attending 49 schools. Height, weight and haemoglobin were measured at baseline and after 6-months. A regression model adjusting for the cluster design was used to assess the effectiveness of the intervention on the haemoglobin level. In order to increase the precision of the estimates, various background variables were controlled for in regression models. RESULTS: Complete data were available for 633 children in the treatment group and 613 children in the control group. The mean age was 9 years and 6 months and 52% of them were males. In the treatment arm 98% had received mebendazole and over 80% had received 16 doses of iron. A reduction in the prevalence of soil-transmitted helminth (STH) infection (from 25.1% to 16.4%) was found in the treatment group, with significant differences between treatment and control groups in the levels of Ascaris and Trichuris. There was a small non-significant reduction in the mean haemoglobin level (at baseline 12.6g/dl, sd - 1.2) of both groups. No impact of treatment was found on haemoglobin levels. CONCLUSIONS: Though the intervention was effective in reducing the prevalence of STH infection there was no evidence of effectiveness in increasing haemoglobin levels.
Cluster-randomised trial of the impact of school-based deworming and iron supplementation on the cognitive abilities of schoolchildren in Sri Lanka's plantation sector
(Wiley-Blackwell, 2013) Ebenezer, R.; Gunawardena, K.; Kumarendran, B.; Pathmeswaran, A.; Jukes, M.C.; Drake, L.J.; de Silva, N.R.
OBJECTIVE: To assess the impact of deworming and iron supplementation on the cognitive abilities and educational achievement of school-age children in Sri Lanka. METHODS: Prospective, placebo-controlled randomised study. The treatment group received deworming and weekly iron supplementationfor 6 months; the control group received placebo for both the anthelmintic and iron. A mixed effects regression model was used to answer the main research question. To increase the precision of this study's estimates, various background variables were controlled for that were not related to treatment but could have some impact on the outcome. RESULTS: The prevalence of soil-transmitted helminth (STH) infection was reduced in the treatment group (n = 615), with significant differences between treatment and control groups (n = 575) in the levels of Ascaris and Trichuris. No impact was found on haemoglobin (Hb) levels, nor any significant impact on concentration levels or on educational test scores. CONCLUSION: Decline in STH prevalence alone, in the absence of improved Hb status, produced no evidence of impact on concentration levels or educational test scores. © 2013 John Wiley & Sons Ltd.