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Adolescent sexual practices and contraceptive usage
(Faculty of Medicine, University of Kelaniya & Plan International, 2008) Herath, H.M.R.P.; Dissanayake, D.M.A.B.; Hilmi, M.A.M.; Pathmeswaran, A.; Wijesinghe, P.S.
INTRODUCTION: Adolescence is a critical period of development, as adoption of unhealthy risk behaviours such as unprotected sex, smoking and drug abuse, avoiding contraceptive methods will lead to long standing health and socioeconomic consequences. Therefore information is needed about the sexual practices and contraceptive usage of adolescents and young adults to develop interventions in the community. This study was undertaken to describe and compare the sexual practices, knowledge and usage of contraceptives by adolescents and young adults in selected urban and rural settings.METHOD: This cross sectional descriptive study was conducted among young adults aged less than 21 years at the time of interview in three settings in both rural and urban areas. The study subjects were students from universities, technical colleges and garment factory workers representing both rural and urban areas. The data was collected using a pretested self administered questionnaire during June 2007 to August 2007. Information collected included marital status, gender and the level of education, first sexual relationship (age, partner, contraception used), current contraceptive practices and knowledge about contraceptive methods. The data was analysed using SPSS 10.1 statistical package. Informed consent was obtained from all participants. RESULTS : There were a total of 1258 subjects who had returned the completed questionnaires. Out of them there were 290 garment factory employees, 480 technical college students, and 488 university students. The percentage of females was 58.9%. The mean ages of the males and the females of the total population were 20.75(50 1.13) years and 20.55(SD 1.63) and it was similar in the three settings. The level of education was highest among the undergraduates lowest among garment factory workers. Out of the population 303 (24.1%) were sexually active. It was significantly higher among males {33.5%0 than females (17.0%). Both among male and females this trend was significantly more common among garment factory workers. Sexual activity of the unmarried and the premarital sexual practices of married subjects are shown in the table. 6. 17% of females and 33.5% of males were sexually active before marriage. 90% male garment factory workers were sexually active. In contrast the proportion
Characteristics of menarche in adolescent girls in Sri Lanka
(Faculty of Medicine, University of Kelaniya & Plan International, 2008) Salgado, L.S.S.; Abeysuriya, V.; Wickremasinghe, A.R.
INTRODUCTION: Menarche is an important biological milestone in girls. The age at attainment of menarche is important for implementing programmes to improve the life skills of girls. OBJECTIVE: To describe the characteristics of menarche, the factors influencing the onset of menarche and to describe the knowledge, beliefs and practices during menarche of adolescent girls in Sri Lanka. Methods: This cross sectional study was conducted among girls 10-16 years of age in four schools situated in the Ragama Medical Officer of Health (MOH) area. Six hundred and sixty two girls were randomly selected and data were collected using a pre-tested, self-administered questionnaire. RESULTS: The median age of our sample was 13 years (range 10-16 years); the mean and median ages of attaining menarche were 12,53 and 11,48 years respectively. The mean BMI of girls who had attained menarche was 17.6 (SEM 0.22) Kg/m2 and those who did not was 16.92 (SEM 0.32) Kg/m2. 47% of the girls had a menstrual cycle length of e" 29 days, 23.4% had irregular cycles and 59% reported that the duration of bleeding was 3-5 days. First borns reported a IcJwer mean age at menarche (12.34 years) than the later borns (12.6 years) (p=0.02). Girls from single child families, who were from higher social categories (Categories 1 & 2) and whose parents were educated beyond 0/L attained menarche earlier. 40.8% stated that menstrual blood is not dirty, 70% admitted that there was no prohibition of having cold or sour foods. The majority of the students had adequate knowledge regarding physical changes during menarche. Girls experienced negative emotions during menstruation. CONCLUSION: The median age of attaining menarche is 11.48 years. Girls experienced negative emotions during menstruation.
A Collection of research papers on adolescent sexual and reproductive Health
(Faculty of Medicine, University of Kelaniya & Plan International, 2008) Wickremasinghe, A.R.; Pathmeswaran, A.
A comparative descriptive study on adolescents presented to Ragama and Anuradhapura Teaching Hospitals for medico-legal examination with a history of 'sexual activity'
(Faculty of Medicine, University of Kelaniya & Plan International, 2008) Edirisinghe, P.A.S.; Perera, W.N.S.; Paranithran, P.; Perera, B.P.P.; Samarasekera, A.; Waidarathna, M.D.; Jayasena, A.S.
INTRODUCTION: Adolescents engaged in sexual activity are brought for medico-legal examination as they are minors. Though some have consented for sexual activity, it is not legally acceptable. The perpetrators include boyfriends, relatives, known persons and strangers. The 'boyfriend' group is unique as the consent is not obtained by illegal means. OBJECTIVE: To find out potential predisposing factors that contribute to 'consensual' or 'non consensual' sexual activity of adolescents and to find out how 'consensual' and 'non consensual' sexual activity affects sexual health of adolescents. METHODS: A retrospective descriptive study was done using records maintained at the offices of the Judicial Medical Officers of Ragarna and Anuradhapura. The data was analyzed using SPSS statistical package. RESULTS: 202 and 154 victims examined between 2000 to 2006 at Ragama and Anuradhapura were analyzed. Male to female ratio was 1:10 in Ragama and 1:24 in Anuradhapura. The most vulnerable age group for sexual activity was 14-15 years. The majority of cases were from the low socio-economic strata. Vaginal intercourse was the most preferred sexual activity; the likelihood of an adolescent from Anuradhapura to have penetrative sex was 2.47 times more as compared to an adolescent from Ragama. Boyfriend was the assailant in 39% and 37% of cases in Ragama and Anuradhapura respectively. 63 % of victims from Ragama had eloped as compared to 19% from Anuradhapura. In both groups, nearly half of the cases had a relationship less than 6 months. An adolescent having sexual activity with a relative was 2.31 (95% CI 1.36-3.93) times greater in Anuradhapura as compared to Ragama. There were 18 and 16 pregnancies in Ragama and in Anuradapura, respectivly. 61 cases from Ragama had psychological symptoms and signs after the incident. CONCLUSIONS: Adolescents are more susceptible to engage in sexual acts around 14 years. Consented sexual activity with a boy friend resulting in legal action is a significant social problem. The high incidence of sexual activity with relatives and known persons indicate the vulnerability of adolescents to engage in sexual activity in their own environments.
Do newspapers fulfil the demand for adolescent reproductive health?
(Faculty of Medicine, University of Kelaniya & Plan International, 2008) Kumarendran, B.; Nandasena, Y.L.S.; Abeysena, C.
OBJECTIVE: To describe the expectations of adolescent school children, perceptions of editorial staff and coverage of topics of articles published by selected Sinhala newspapers regarding reproductive health. METHOD: Data were extracted from three national and three tabloid newspapers published during the period May to October 2007. Thematic analysis was done to analyse in-depth interviews of eleven editorial staff. One hundred and thirty four 17-18 year old school children were sampled using stratified (based on stream, sex and urban/rural) purposive sampling from the Gampaha district. Content analysis of 14 Focus Group Discussions (FGD) was done. RESULTS: Ninety two and 58 articles on reproductive health were published in national and tabloid papers respectively during the study period. Pregnancy related issues were the commonest topic addressed followed by reproductive system, commercial sex and sexually transmitted infections (STIs). Most of the published articles included photographs. The majority was written with the guidance of professionally qualified doctors. Although journalists knew the spectrum of reproductive health issues, they were more prone to write on STIs and less on homosexuality, virginity and family planning. The opportunities given for selecting a topic by the press authorities were not satisfactory. Adolescent girls were interested to read about puberty, menstruation, contraception, commercial sex, virginity and STIs and boys were interested to read about homosexuality, heterosexuality, masturbation, STIs, contraception and abortion. Most of the students claimed that they were not provided with adequate RH related knowledge by the newspapers. The way of presenting the articles was not, satisfactory. Most of the adolescents preferred information in simple language (than scientific jargon) in question and answer form without seductive photographs. CONCLUSIONS: Reproductive health coverage by newspapers are not satisfactory. Publishing articles to fulfil the expectations of adolescents would make newspapers a successful mode of RH education.
Epidemiological and pathophysiological aspects of abdominal pain predominant functional gastrointestinal disorders in children and adolescents: a Sri Lankan perspective
(Author Publication, 2015) Devanarayana, N.M.
SUMMARY Abdominal pain is the second common painful health problem in children, only second to headache. Abdominal pain can be acute or recurrent in origin. Chronic abdominal pain is a misnomer since episodes of abdominal pain in children are distinct and separated by periods of well being. Numerous organic disorders lead to recurrent abdominal pain (RAP). However, in Sri Lanka, and also in developed countries, common causes for RAP are functional gastrointestinal disorders (FGIDs) such as irritable bowel syndrome (IBS), functional abdominal pain (FAP), functional dyspepsia (FD), and constipation. John Apley, the British pediatrician is the first person to study abdominal pain among children. He gave the initial definition for RAP. Apley’s criteria has been used frequently to diagnose non-organic RAP in children until Rome criteria for abdominal pain predominant functional gastrointestinal disorders (AP-FGIDs) are released. Main AP-FGIDs recognized by Rome III definition are IBS, FD, abdominal migraine (AM) and FAP. Childhood FGIDs are a worldwide health problem. With growing population trends and increasing predisposing factors such as psychological stress and obesity, it can be predictable that the incidence of FGIDs will increase further and become a significant healthcare problem. Although FGIDs are not life threatening, research shows that children suffering from FGIDs tend to have a lower quality of life than their healthy peers and frequently miss school. In addition many FGIDs such as constipation and IBS has high healthcare expenditure and are becoming a major challenge on already overstretched healthcare budgets. Chapter 1 of this thesis introduces these key aspects of FGIDs in children including definitions, global epidemiology and burden of the disease. Chapter 2 of this thesis gives a detailed account on possible underlying pathophysiological mechanisms for AP-FGIDs and available treatment modalities. In the currently accepted biopsychosocial model, the interplay of genetic, physiological, psychological and immunological factors are considered to give rise to FGIDs in children. The prevailing viewpoint is that the pathogenesis of func¬tional pain syndromes involves the inter-relationship between changes in visceral sensation, so-called visceral hyperalgesia or hypersensitivity, and altered gastrointestinal motility. Potential targets for pharmacological and nonpharma¬cological therapy are arising from this model. To date, high-quality efficacy studies of treatment in pediatric AP FGIDs are scarce. Available evidence indicates benefi¬cial effects of hypnotherapy and combined behavior therapy. Evidence for diets low in fermentable oligosaccharides, disaccharides, monosaccharaides and polyols (FODMAP) and probiotics is promising, as well as for drug treatment such as peppermint oil, cyprohep¬tadine or famotidine, but well-designed trials with long-term follow-up are needed to confirm these preliminary results. Chapter 3 describes the prevalence and risk factors for development of AP-FGIDs in Sri Lanka. AP-FGIDs are seen in 12.5% of Sri Lankan children ages 10 to 16 years. IBS is the most common AP-FGID diagnosed, followed by FAP and FD. AP-FGIDs are significantly higher in girls compared with boys. There is a negative correlation between the age and prevalence of AP-FGIDs, with highest prevalence observed in children aged 10 years. Intestinal-related symptoms and extraintestinal symptoms are more frequent in affected children, compared with controls. Exposure to home- and school-related stressful life events are significantly associated with AP-FGIDs. The distribution of IBS subtypes in 10-16 year olds, their symptom characteristics, and bowel habits are described in details in chapter 4 of this thesis. Constipation predominant IBS (IBS-C), diarrhea predominant IBS (IBS-D) and mixed IBS (IBS-M) have almost equal distribution while untyped IBS (IBS-U) has a relatively lower prevalence. IBS is more frequent in girls than in boys. Several intestinal-related and extraintestinal symptoms are significantly associated with all four subtypes of IBS, indicating higher occurrence of somatization among affected children. Asia is the home for over 50% of the world’s childhood population. In addition, most of Asian countries are going through a rapid change in socio-economic status and their cultural foundations are constantly being challenged by globalization. In that light, we believed that studying epidemiological patterns of IBS in Asian children in a systematic way will provide a greater perspective for understanding the burden of IBS, its epidemiological distribution, and patterns of subtypes in this continent. Chapter 5 is a systematic review and meta-analysis which has demonstrated that a sizeable population of young Asians have IBS. The prevalence of IBS varies widely depending on the country, diagnostic criteria, and age of the participants. It is more common among girls compared to boys. There is a significant difference in the prevalence of sub-types in different studies. This systematic review concluded that further studies using pediatric criteria for IBS are needed to understand the true prevalence, especially in other parts of the Asia with large populations. It is believed that exposure to abuse as a child may subsequently result in abdominal pain. However, only a handful of studies have evaluated the impact of abuse on AP-FGIDs in children and none in teenagers. Results of a study conducted to assess this association between exposure to child abuse and AP-FGIDs in teenagers is presented as Chapter 6. The prevalence of AP-FGIDs is significantly higher in teenagers who have been exposed to physical, sexual, and emotional abuse. In addition, scores obtained for severity of bowel symptoms were significantly higher in teenagers with AP-FGIDs exposed to abuse than those not exposed to such events. Chapter 7 describes the health related quality of life (HRQoL) and healthcare consultation in Sri Lankan teenagers aged 13 to 18 years with AP-FGIDs. Children with AP-FGIDs have significantly lower HRQoL scores for physical, emotional, social and school functioning. Approximately 28% of affected children have sought medical advice for their symptoms during previous 3 months. The main symptoms associated with healthcare consultation were abdominal bloating and vomiting. The HRQoL was an important determinant of healthcare consultation, more than the severity of individual symptoms. Chapter 8, chapter 9, chapter 10 and chapter 11, using a simple, safe and non-invasive ultrasound method, we have shown a significant delay in gastric emptying and impairment in antral motility in children who fulfil Rome III criteria for all 4 main types of AP-FGIDs, namely FAP, IBS, FD and AM. Furthermore, there is a significant negative relationship between delayed gastric emptying and severity of symptoms in children with FAP, FD and AM. Furthermore, children with IBS who were exposed to recent stressful life events had a significantly lower gastric emptying rate compared to those not exposed to such events, suggesting the possibility of altered brain-gut interactions. In this light, our findings suggest that delayed gastric emptying and impaired antral motility play a role in the pathogenesis of AP-FGIDs. CONCLUSIONS This thesis clearly shows that AP-FGIDs are common among Sri Lankan children, especially those exposed to psychological factors such as school and home related stressful events and abuse. The commonest AP-FGID type is IBS of which IBS-D, IBS-C and IBS-M have almost equal prevalence. Affected children have a poor HRQoL in physical, emotional, social and school functioning domains. Only approximately a quarter of children with this troublesome symptom have received healthcare. Affected children have significant abnormalities in their gastric motility functions, and in some, the abnormal motility correlates with the severity of symptoms.
An exploratory qualitative study on marriage and pregnancy of adolescent females in the Hikkaduwa Medical Officer of Health (MOH) area
(Faculty of Medicine, University of Kelaniya & Plan International, 2008) Kasturiratne, K.T.A.A.
INTRODUCTION: Marriage in adolescence before 18 years is prohibited in Sri Lanka. However, marriages of adolescent females are not rare in some areas in Sri Lanka. OBJECTIVE: To describe the factors associated with marriage of and pregnancy among adolescent females (14-17 years) in a village in the Hikkaduwa Medical Officer of Health (MOH) area. METHODS: This exploratory qualitative study was conducted in Angankanda in the Kalupe PHM division in the Hikkaduwa MOH area in November 2007. Data were collected through focus group discussions and key informant interviews and analysed using qualitative content analysis. RESULTS: Fourteen females who had been married during adolescence (14-17 years) and five key informants participated in the study. Marriages of adolescent females have taken place following emotional relationships. Married adolescents have a low level of education and reduced awareness about health issues. Death or separation of a parent, poverty and lack of security within the family unit are important predisposing factors to adolescent marriages. Elopement is common following which parents or relatives from both parties collaborate to register the marriage to avoid litigation on the male partner. Most male partners are above 18 years of age at the time of the marriage. The age of the adolescent provided at registration of the marriage was false. Public health field staff of the area were aware of the problem and have taken preliminary steps to focus on this group. The services provided by the Public Health Midwife for married females are sought and acknowledged but not strictly adhered to, due to negative pressures or lack of motivation from the family. Delaying of the first pregnancy is not a common practice. Exposure to other modes providing awareness on health issues is limited. CONCLUSION: Despite legislature, marriages of adolescent females are a common occurrence in this community. Targetted interventions to prevent these marriages and to upgrade the overall health of adolescent females are necessary in areas where this problem is prevalent.
Sri Lankan parents' attitudes towards adolescent reproductive and sexual health education needs: A qualitative study
(Faculty of Medicine, University of Kelaniya & Plan International, 2008) Godamunne, P.K.S.
INTRODUCTION: Adolescents have unique reproductive health needs when compared to adults, and the behaviours adopted in adolescence have serious implications for their later well being. Serious gaps have been found in providing sexual and reproductive health information to adolescents in Sri Lanka. OBJECTIVE: To explore the attitudes of Sri Lankan parents' towards adolescent reproductive and sexual health education, to identify current parental practices of imparting reproductive and sexual health information to their children and to identify perceived barriers parents face in discussing sexual and reproductive health issues with their children. METHODS: A qualitative study conducted using focus groups discussions in Kurunegala, Kandy, Gampaha and Colombo districts among 71 parents having an adolescent child. RESULTS: All'parents said that it was essential to provide reproductive and sexual health education to adolescents, mainly to deter them from engaging in any precocious sexual activity and to protect children from various threats posed by society, such as sexually transmitted diseases and child sexual abuse. Generally most parents were reluctant to directly discuss reproductive and sexual health issues with their children due to cultural taboos and resultant feelings of shyness and embarrassment. However, mothers, to some extent, discussed reproductive and sexual health matters with their children, often with their daughters and sometimes even with sons. However, some parents expressed lack of knowledge to do so. Parents also indirectly educated their children on sexual and reproductive health topics by providing them with books to read. Many parents considered school and teachers to be the best source of reproductive and sexual health information for their children. Doctors too were considered by parents to be a reliable source of reproductive and sexual health information. CONCLUSION: Parents considered adolescent reproductive and sexual health education as essential to protect and deter children from engaging in any precocious sexual activity. However, most parents were reluctant to openly discuss reproductive and sexual health topics with their children. In general, parents preferred outside sources, people other than themselves, such as teachers and doctors to provide their children with reproductive and sexual health information.
A study on adolescent sexual & violent behaviour, drugs & alcohol abuse and its relationship to the past experiences
(Faculty of Medicine, University of Kelaniya & Plan International, 2008) Mettananda, D.S.G.; de Silva, D.G.H.; Jayasinghe, Y.C.; Waduge, T.R.W.; Pathmeswaran, A.; Abeysinghe, A.P.S.D.
A study on the incidence and the outcome of teenage pregnancies and the associated socio-economic factors: an interim analysis
(Faculty of Medicine, University of Kelaniya & Plan International, 2008) Palihawadana, T.S.; Motha, M.B.C.; Fernando, W.S.; Wijesinghe, P.S.
INTRODUCTION: Teenage pregnancy is known to be associated with adverse pregnancy outcomes for both the mother and her offspring. Knowledge on the socio-economic conditions associated with teenage pregnancy and the short term and intermediate outcomes would provide information useful in prevention and management of teenage pregnancy. OBJECTIVE: To describe the prevalence of teenage pregnancy in a low risk population and two identified high risk populations and to identify the associated socio-economic characteristics as well as to assess the incidence of short term and intermediate adverse outcomes in the mother and the offspring. METHODS: The study will be conducted in three phase. The prevalence of teenage pregnancy and associated socio-economic factors would be assessed at three study settings of Ragama, Nuwara Eliya and Puttalam. Second phase would be at Ragama and the pregnancy outcome of the teenage mothers would be compared against a parity matched sample of controls while in phase three a community based follow up study would be done in teenage mothers who delivered at Ragama Hospital two years ago to assess the intermediate outcome of mothers and their offspring. Here we report the results of the Ragama component of Phase I and a part of the data accumulated for Phase II. RESULTS: Review of records of 5249 deliveries yielded a teenage pregnancy rate of 4.74% (n=249). Results pertaining to 25 subjects and 50 parity matched controls in phase I and 102 subjects with 179 controls are described here. The distribution according to religion and ethnicity was not different between the subjects and the controls. The occupations and marital status as well as alcohol consumption of fathers did not demonstrate a difference between the teenage mothers and the controls. Five percent of subjects were not married while all were married in the control group (p<0.05). There was a significant difference in the educational level between subjects and controls (p<0.001); education beyond Ordinary level was 14% in subjects as compared to 33% among