Journal/Magazine Articles
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This collection contains original research articles, review articles and case reports published in local and international peer reviewed journals by the staff members of the Faculty of Medicine
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Item The need for preventive and curative services for malaria when the military is deployed in endemic overseas territories: a case study and lessons learned(BioMed Central, 2017) Fernando, S.D.; Booso, R.; Dharmawardena, P.; Harintheran, A.; Raviraj, K.; Rodrigo., C.; Danansuriya, M.; Wickremasinghe, A.R.BACKGROUND: Sri Lanka has been free from indigenous malaria since November 2012 and received the WHO certificate for malaria-free status in September 2016. Due to increased global travel, imported malaria cases continue to be reported in the country. Military personnel returning home from international peace-keeping missions in malaria endemic countries represent a key risk group in terms of imported malaria. The present study intended to characterize the potential causes of a malaria outbreak among the Sri Lankan security forces personnel deployed in the Central African Republic (CAR). METHODS: Data were collected from a cross-sectional survey distributed among Sri Lankan Air Force personnel who had returned from United Nations peace-keeping missions in the CAR region. A pre-tested questionnaire was used for the data collection, and focus group discussions were also conducted. RESULTS: One hundred twenty male Air Force personnel were interviewed (out of a group of 122 officers and airmen). All participants were deployed in the CAR for 14 months and were aware of the existence of chemoprophylaxis against malaria. The majority of the subjects (92.5%, 111/120) also knew that prophylaxis should be started prior to departure. However, the regular use of chemoprophylaxis was reported by only 61.7% (74/120) of the sample. Overall, 30.8% of the participants (37/120) had 44 symptomatic episodes of malaria during deployment, and one person succumbed to severe malaria. All cases were associated with noncompliance with chemoprophylaxis. CONCLUSION: Better coordination with overseas healthcare services and the establishment of directly observed chemoprophylaxis may help to avoid similar outbreaks in the future.Item Post war psychological morbidity among internally displaced, married females in Northern Sri Lanka(OMICS International, 2016) Attidiya, D.S.R.; Wickremasinghe, A.R.; Balasuriya, A.; Ediriweera, E.P.D.S.; Manuelpillai, S.; Williams, S.BACGROUND: A three-decade long conflict between the government military and Tamil rebels in Sri Lanka ended in 2009 with the defeat of the rebels. The civilians were the most affected in the war with reports of scant respect for human rights on both sides of the warring factions. OBJECTIVE: To conduct a cross-sectional study to assess the prevalence of psychiatric morbidity among married females in two villages in Northern Sri Lanka that was affected significantly in the last phase of the war. METHOD: All married females in two resettled villages in the Mannar District were interviewed by trained data collectors using the translated K-10 and PSSR-17 questionnaires to estimate the prevalence of post-traumatic stress disorder (PTSD) and depressive disorder. All families in these villages were from internally displaced camps where they had been living for more than a year after having been displaced from their homes and having experienced direct war trauma for weeks. Data was collected from 135 married females between March to May 2011 with ethical approval for the study. RESULTS: Criteria for diagnosis of severe PTSD were met in 57% of all participants and all participants had at least mild symptoms of PTSD. The screening tool for depression showed 63% to have significant depressive symptoms. Both depressive and severe PTSD features were present in 24%. Nearly 73% of participants were having either depression or severe PTSD. CONCLUSION: Psychiatric morbidity was high in the post-conflict period, in a highly vulnerable population of married females.Item Knowledge of basic epidemiological and statistical concepts among doctors in selected Sri Lankan hospitals(College of Community Physicians of Sri Lanka, 2010) Abeysena, H.T.C.S.; Jayawardana, P.L.; Wickremasinghe, A.R.; Wickramasinghe, U.INTRODUCTION: This study was conducted to describe the ability to comprehend basic epidemiologic and statistical concepts among doctors in selected hospitals in the Western Province. METHODOLOGY: A cross-sectional descriptive study was conducted during January to February, 2008. The study population consisted of 315 doctors - 43 (13.7%) specialists, 50 (16%) postgraduate trainees (PG) and 222 (70.3%) grade medical officers. A self administered questionnaire was used to assess perceived knowledge on selected epidemiologic and statistical concepts/parameters and two problem based questions which tested the ability to apply knowledge were used. Data were analyzed calculating the proportion who perceived to have good knowledge regarding each concept. Logistic regression was applied to test for differences in good knowledge between different groups of subjects. RESULTS: More than 75% of the respondents claimed to have good knowledge on prevalence, sensitivity, specificity and case control studies. Less than 50% of them had good knowledge on risk difference, number needed to treat, systematic reviews, meta-analysis, p-value and 95% confidence intervals. Male doctors had a significantly higher good knowledge than female doctors (p<0.001), and those who read medical journals regularly than those who did not (p<0.05). Specialists and PG trainees had a significantly higher good knowledge (p<0.001) than grade medical officers. Correct answers of the respondents to the two problem based questions were 25% (n=79) and 15.8% (n=50), respectively. CONCLUSION : Even though some doctors claimed to have a good knowledge with regard to selected epidemiologic and statistical concepts, their ability to apply their knowledge was poor.Item Evaluation of the effectiveness of the national vitamin A supplementation programme among school children in Sri Lanka(Cambridge University Press, 2007) Madatuwa, T.M.; Mahawithanage, S.T.C.; Chandrika, U.G.; Jansz, E.R.; Wickremasinghe, A.R.The Ministry of Health in Sri Lanka commenced a vitamin A supplementation programme of school children with a megadose of 105 micromol (100,000 IU) vitamin A in school years 1, 4 and 7 (approximately 5-, 9- and 12-year-olds, respectively) in 2001. We evaluated the vitamin A supplementation programme of school children in a rural area of Sri Lanka. A cross-sectional study was conducted among children supplemented with an oral megadose of vitamin A (105 micromol; n 452) and children not supplemented (controls; n 294) in Grades 1-5. Children were clinically examined and a sample of blood was taken for serum vitamin A concentration estimation by HPLC. Socio-demographic information was obtained from children or mothers. Supplemented children had a higher proportion of males and stunted children, were younger and lived under poorer conditions as compared to controls. There was no difference in the prevalences of eye signs and symptoms of vitamin A deficiency in the two groups. Supplemented children had higher serum vitamin A concentrations than controls (1.4 (SD 0.49) micromol/l v. 1.2 (SD 0.52) micromol/l). The serum vitamin A concentrations were 1.6 (SD 0.45), 1.4 (SD 0.50), 1.3 (SD 0.44) and 1.1 (SD 0.43) micromol/l in children supplemented within 1, 1-6, 7-12 and 13-18 months of supplementation, respectively. Vitamin A concentrations were significantly greater than controls if supplementation was carried out within 6 months after adjustment. The oral megadose of 105 micromol vitamin A maintained serum vitamin A concentrations for 6 months in school children.Item Seroprevalence of rubella antibodies among pregnant females in Sri Lanka(SEAMEO Regional Tropical Medicine and Public Health Project, 2003) Palihawadana, P.; Wickremasinghe, A.R.; Perera, J.The purpose of this study was to determine the seroprevalence of rubella antibodies among pregnant females in the Kalutara District of Sri Lanka, and to identify factors associated with susceptibility to rubella infection among pregnant females. A cross-sectional clinic-based study was conducted among 620 pregnant women attending antenatal clinics and residing in the district for more than one month. Data on the pregnant females and the socio-economic characteristics of the families were obtained using an interviewer-administered structured questionnaire. Three milliliters of blood was obtained to measure rubella-specific IgG antibody levels by ELISA (enzyme linked immunosorbent assay) tests. Overall, 76 percent of pregnant females were seropositive for rubella antibodies. Seropositivity in pregnant females increased with age. Susceptibility to rubella was significantly associated with rubella immunization status. Given the high susceptibility rate to rubella infection among pregnant females, it is imperative that any vaccination strategy in the short-term should focus on reducing the number of susceptible women of child-bearing age.Item Cognitive performance at school entry of children living in malaria-endemic areas of Sri Lanka(Oxford University Press, 2003) Fernando, D.; Wickremasinghe, R.; Mendis, K.N.; Wickremasinghe, A.R.In a cross-sectional study, carried out in January 1997 at the beginning of the school year, the impact of repeated attacks of malarial infection on the cognitive performance of children at school entry in moderate malaria-endemic areas of Sri Lanka was investigated. The cognitive performance of 325 schoolchildren in grade 1 (mostly aged 5-6 years) in 2 districts of Sri Lanka which are endemic for malaria (Anuradhapura and Moneragala) was assessed by an entry performance test developed by the National Institute of Education, Sri Lanka. The indices assessed included writing, language and mathematical skills. There was no difference in any of the cognitive performance indices between children from Anuradhapura and Moneragala districts. The scores of most of the indices decreased as the number of malaria infections experienced by a child increased and the ability to identify letters was significantly impaired by the number of malaria infections a child had experienced after controlling for socio-economic and nutritional status. These findings suggest that repeated attacks of malaria in children can have an adverse impact on their development.Item Geo-helminth infections in a rural area of Sri Lanka(SEAMEO Regional Tropical Medicine and Public Health Project, 2001) Fernando, S.D.; Goonethilleke, H.; Weerasena, K.H.; Kuruppuarachchi, N.D.; Tilakaratne, D.; de Silva, D.; Wickremasinghe, A.R.School children carry the heaviest burden of morbidity due to intestinal helminth infection. The objective of this investigation was to study geo-helminth infections in 349 school children aged 6 to 13 years living in a rural area of Sri Lanka. Stool samples were examined by direct saline smear in an initial survey to determine the prevalence of intestinal parasitic infections and thereafter the children were followed up over a two year period with cross sectional surveys of stool samples being carried out at yearly intervals. Following collection of a stool sample, all the subjects were treated with mebendazole 500 mg as a single dose. Weights and heights were measured using standardized procedures. 2 ml of venous blood were collected from each subject under aseptic conditions to determine hematological indices. The prevalence of geo-helminth infections was low, and the prevalence declined during the two-year period from 5.4 percent in 1997 to 2.2 percent in 1998 and 2.0 percent in 1999 following yearly mass anti-helminth treatment. The incidence density was 0.021 cases per child year. The reduction in the prevalence from the baseline to the second survey is probably due to the reduction of the reservoir of infection among children as a result of mass treatment at baseline. The prevalence of infection during the second and third surveys were almost the same probably due to infections originating from other segments of the untreated population.