Annual Research Symposium (ARS)
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Item Prevalence and determinants of Low Back Pain (LBP) among nurses in different health care units in four hospitals in Colombo, Sri Lanka(University of Kelaniya, 2013) Warnakulasuriya, S.S.P.; Peiris-John, R.; Sivayogan, S.; Sathiakumar, N.; Coggan, D.; Wickremasinghe, A.R.Introduction: Hospitals are complex systems that rely on nursing care in diverse care settings where many nursing job tasks are physically and psychologically demanding. In healthcare, the highest prevalence of Low Back Pain (LBP) is reported among nurses. There is little information regarding its prevalence and the determinants. Objectives: To determine the prevalence of LBP among nurses in diverse care settings in hospitals and its association with work-related psychosocial and ergonomic risk factors. Method: This analytical cross sectional study comprised 862 female nurses sampled from two teaching hospitals and two base hospitals in the Colombo district. Information on regular physical activity and work-related ergonomic and psychosocial stress factors were collected using a pre-tested self administered questionnaire. Descriptive statistics used to determine the prevalence and associations of risk factors with pain symptoms were assessed by logistic regression analysis adjusting for age, and summarised by odds ratios (ORs) with associated 95% confidence intervals (CIs). Results: The response rate was 70% (n=602). The overall prevalence of LBP among nurses during the past 12 months was 38% (n=229), in nurses in teaching hospitals being 40% and in nurses in base hospitals being 31%. Among the patient care units/wards, nurses in ICU had the highest prevalence of LBP (35%); the lowest prevalence was among nurses in pediatric wards (4.4%). Factors significantly associated with LBP were BMI> 25 (overweight) (OR 1.85; 95% CI 1.20-2.84), working in the ICU (OR 1.55; 95% CI 1.06-2.25), time pressure to complete tasks (OR 1.55; 95% CI 1.10-2.19), perception of poor general health (OR 1.95; 95% CI 1.12-3.38), and history of an accident (OR 1.80; 95% CI 1.17-2.78). Conclusions: Personal, work-related ergonomic and psychosocial factors were significantly associated with LBP among nurses. These need to be taken into consideration when planning strategies to reduce LBP among nurses.Item Species succession of malaria vector mosquitoes and physicochemical factors affecting their abundance in rice ecosystems in Trincomalee, Sri Lanka(University of Kelaniya, 2013) Gunathilaka, P.A.D.H.N.; Ranathunge, R.M.T.B.; Fernando, M.A.S.T.; Hapugoda, M.D.; Wijeyerathne, P.; Wickremasinghe, A.R.; Abeyewickreme, W.Background: Mosquito-borne diseases are a major public health threat in Asia. The present investigation was carried out to study the ecology of vector mosquitoes in Sri Lanka, in order to explore effective mosquito control strategies in rice ecosystems from the ecological point of view. Method: As part of investigations on potential linkages between irrigation and malaria transmission, all surface water bodies in and around 20 selected villages along an irrigation distributary in the District of Trincomalee, Sri Lanka, were surveyed for anopheline mosquito larvae (Diptera: Culicidae) from January 2012 - June 2013. Breeding sites were characterized according to exposure to sunlight, substratum, and presence of vegetation, fauna, inorganic matter and physical water condition (clear/turbid). Dissolved Oxygen (DO), conductivity, salinity, pH, temperature, Total Dissolved Solids (TDS) and turbidity were recorded. Results: A total of 3914 Anopheles larvae of twelve morphological types were collected from 685 breeding habitats. Anopheles peditaeniatus (n= 1041), was the most abundant, followed by An. subpictus (n= 893), An. nigerrimus (n= 808), An. barbirostris (n= 581), An. pallidus (n= 184), An. annularis (n=124), An. jamesii (n= 80), An. varuna (n= 76), An. vagus (n= 56), An. barbumbrosus (n= 48). An. culicifacies (n= 22) and An. aconitus (n= 1). The four most abundant species were significantly associated with waterlogged paddy fields. Anopheles culicifacies was noted only from irrigational canals with vegetation. Conductivity, salinity, and TDS were positively correlated with larval densities of An. peditaeniatus (Pearson correlations= 0.04, 0.17, 0.33: P= 0.94, 0.77, 0.58), An. subpictus (Pearson correlations= 0.6, 0.68, 0.56: P= 0.19, 0.20, 0.31), and An. vagus (Pearson correlations= 0.6, 0.42, 0.17: P= 0.28, 0.47, 0.77). However all physicochemical variables were negatively correlated with An. culicifacies densities. Conclusion: Major malaria vector of An. culicifacies complex occurred at relatively low densities, mainly in irrigated and waterlogged fields. These findings support understanding of mosquito ecology and will support future mosquito control strategies in rice ecosystems in Sri Lanka.Item Resting behavior of malaria vectors in Mannar District of Sri Lanka with reference to zooprophylaxis(University of Kelaniya, 2013) Gunathilaka, P.A.D.H.N.; Fernando, M.A.S.T.; Hapugoda, M.D.; Wijeyerathne, P.; Wickremasinghe, A.R.; Abeyewickreme, W.Background: The most important factors for effective zooprophylaxis in reducing malaria transmission are the presence of predominate populations of a strongly zoophilic mosquitoes and domestic animals for their blood-meal. Methods: Resting behavior of anopheline mosquitoes was evaluated using indoor and outdoor mosquito collection techniques. Mosquitoes were captured using 389 outdoor cattle-baited traps and indoor hand catches in 5672 houses at 12 possible malaria sensitive areas situated 12 km apart; Pesali, Keeri, Erukkallampeddi, Moor, Vankalai, Narawallikulam, Vanchiyankulam, Arvanum, Arrippu, Kokkupadayan, Koolankulam and Pandaraveilli for 12 months (June 2012 to June 2013) on a weekly basis. These areas had mostly homogenous characteristics in vegetations and house type. All collected mosquitoes were identified using standard taxonomic keys. A hypothesis test was conducted to determine whether there is a difference between indoor and outdoor collections. Results: A total of 3986 anopheline mosquitoes were collected from both indoor (n= 3122) and outdoor (n= 864) collection techniques. Anopheles subpictus was found to account for over 97.5% (n= 3887) of Anopheles species collected in the study areas. Other species were; 1.4% An. peditaeniatus (n= 57), 0.6% An. varuna (n= 22), 0.3% An. pallidus (n= 10), 0.2% An. nigerrimus (n= 7), 0.05% An. tessellatus (n= 2), and 0.03% An. aconitus (n= 1). Only 3 species namely, An. subpictus (n= 485), An. tessellatus (n= 2) and An. aconitus (n= 1) were recorded from indoor hand catches. In experimental cattle-baited hut trials, An. subpictus (n= 3026) was found to have the highest exophilic tendency (96.9%) compared to other anophelines encountered. The hypothesis test suggests that there was a significant difference of An. subpictus attracted to cattle-baited traps and human dwellings (P = 0.008). Although the main vector An. culicifacies was absent, the presence of the secondary vector An. subpictus was observed in high numbers in the District. Conclusion: Exophilic and zoophilic tendencies of An. subpictus are conducive for zooprophylaxis. The study further indicates that zooprophylaxis may be a potential strategy for malaria control. It is recommended that in areas with a predominant An. subpictus population, cattle could be kept close to human dwellings to maximize the effects of zooprophylaxis.Item Breeding of Anopheles culicifacies in different waterbodies in the district of Trincomalee(University of Kelaniya, 2012) Gunathilaka, P.A.D.H.N.; Fernando, M.A.S.T.; Hapugoda, M.D.; Wijeyerathne, P.; Wickremasinghe, A.R.; Abeyewickreme, W.Introduction: Anopheles culicifacies (Diptera: Culicidae), the major vector of malaria in Sri Lanka is known to breed in clean and clear water. This study was focused to understand the larval habitats of the major malaria vector with the eco system changes in the Trincomalee district of the Eastern Province. Method: Potential larval habitats for Anopheles mosquitoes were surveyed on a monthly basis for 17 months (January 2011 –June 2012) in 4 different selected sampling sites (Murthankulam, Kommnaimottai, Paranamadawachchiya and Kokmotawewa). Collected larvae were identified using standard taxonomic keys. The species Distribution (C) and Density (D) were calculated. Results: A total of 2996 larval specimens representing 13 Anopheles species were reported from 16 different breeding habitats namely, waste water (n= 635), built well (n= 1229), earth well (n=149), agricultural well (n=9), rain water collection (n=89), animal hoof print (n=17), burrow pit (n=256), rock pool (n=10), canal (n=15), irrigation canal (n=27), lake margin (n=27), tank margin (n=448), pond margin (n=15), marshy land (n=13), paddy field (n=15) and slow moving water (n=42). An. culicifacies was observed as the most predominant species throughout the survey. According to Density criterion, An. culicifacies (44.0%), An. subpictus (19.2%), An. barbirostris (13.2%), An. peditaeniatus (10.28%) and An. nigerrimus (8.7%) were within the dominant class; (D > 5%). Two species (An. vagus, An. pallidus) were in the subdominant class (1< D <5%). Only An. annularis, An. varuna, An. barbumbrosus, An. pseudojamesi, An. jamesii and An. tessellatus were the satellite species (D < 1%). An. nigerrimus, An. subpictus and An. peditaeniatus can be regarded as constant according to distribution (C= 80.1-100%). Only An. vagus was the most frequently reported (C= 60.1 – 80%) species. All other Anopheles including An. culicifacies were observed as infrequent species (C= 20.1 – 40%) and no species was identified as sporadic appearance (C= 0 – 20%). Most productive breeding site for An. culicifacies were drains covered with waste water (Density= 81.57%) in remote areas. Interpretation & conclusion: These results indicate that An. culicifacies has adapted to breed in a wide range of water bodies including waste water collections although they are considered to breed in clean and clear water. The survival of the major vector mosquito in widespread water bodies could be responsible for the increase in the incidence of malaria in the future.Item Susceptibility of malaria vectors to insecticides in Ampara, Batticaloa, Trincomalee & Mannar districts of Sri Lanka(University of Kelaniya, 2012) Gunathilaka, P.A.D.H.N.; Fernando, M.A.S.T.; Hapugoda, M.D.; Wijeyerathne, P.; Wickremasinghe, A.R.; Abeyewickreme, W.Background: The current status of insecticide resistance was studied for potential malaria vectors in four districts namely Ampara, Batticaloa, Mannar and Trincomalee of Sri Lanka. Methods: Insecticide-susceptibility tests were carried out using WHO standard kits against various chemical compounds at ambient room temperature of 27+1oC and relative humidity of 75-80% for adult and larvae separately. A total of 3629 adult female Anopheles mosquitoes belong to nine species (An. subpictus, An. vagus, An. nigerrimus, An. peditaeniatus, An. pallidus, An. annularis, An. jamesii, An. pseudojamesi and An. barbirostris) were exposed to cyfluthrin- 0.15%, etofenofrox- 0.5%, bendiocarb- 0.01%, malathion – 5%, deltamethrin – 0.05%, permethrin – 0.75%, λ- cyhalothrin– 0.05%, fenitrothion – 1.0% and propoxur – 0.1%. A total of 610 larvae belong to five Anopheles species (An. subpictus, An. vagus, An. barbirostris and An. peditaeniatus) were exposed to 0.0025, 0.005, 0.125 and 0.625 mg/l of viz. temephos (Abate). Results: All of the mosquito larvae or adult species used for the study were susceptible for selected insecticides (Mortality 98-100%). Adult Anopheles species showed a possibility of developing resistance to some chemicals (Mortality 97- 80%): An. nigerrimus (lambdacyhalothrin and permethrin), An. peditaeniatus (malathion, deltamethrin and cyfluthrin) An. subpictus (deltamethrin, permethrin, propoxur, cyfluthrin, and etofenprox), An. vagus (deltamethrin, permethrin and etofenprox) and An. pallidus (deltamethrin). Anopheles larvae of An. subpictus, An. barbirostris and An. peditaeniatus showed the potential of developing resistance (Mortality 97-80%). Interpretation & conclusion: As a result of resettlements and expanding commercial agriculture there can be a potentiality of developing insecticide resistance in mosquito individuals. Therefore, proper use of chemicals as pesticides should be adopted in these areas.Item Blood-feeding patterns of Anopheles mosquitoes in malaria-endemic areas of Sri Lanka(University of Kelaniya, 2012) Gunathilaka, P.A.D.H.N.; Fernando, M.A.S.T.; Hapugoda, M.D.; Wijeyerathne, P.; Wickremasinghe, A.R.; Abeyewickreme, W.Background: Studies on host preference patterns in blood-feeding of anopheline mosquitoes are crucial for incriminating them as malaria vectors. However, little information is available on the host preferences of Anopheles mosquitoes in Sri Lanka. Therefore, the objective of the present study was to determine the hematophagic tendency of the anophelines. Methods: Adult Anopheles mosquitoes were collected using Cattle Baited Trap Collection (CBTC), Cattle Baited Net Collection (CBNC), Window Trap Collection (WTC), and Hand Collection (HC) from selected sentinel sites in Mannnar (3) and Trincomalee (5) Districts during June 2011- June 2012. Each blood fed mosquito was processed in to 9 cm whatman filter papers within 24 hours after blood meal has taken. DNA was extracted using the dried blood meal protocol of the QIAmp DNA mini kit. A multiplexed, Real Time Polymerase Reaction (RT- PCR) assay targeting 8 animals was developed for two panels (Panel 1: Bovine, cat, pig, monkey: Panel 2: Human, rat, dog, chicken) to identify the host meal of Anopheles. Human Blood Index (HBI), Forage Ratio (FR) and Host Feeding Index (HFI) were calculated. Results: A total of 216 field caught freshly engorged females mosquitoes belonging to 12 Anopheles species was analyzed. The host preference of anophelines observed in this study was bovine (86.17%), human (1.84%), cat (0.46%) and pig (0.46%). Only 6.91 % was positive for both human and bovine. In addition 5.0 % of the total samples tested were unknown. The overall HBI and HFI in the present study were low indicating the humans were not the preferred host for the tested anopheline species. Nevertheless, a small proportion engorged An. aconitus (0.37), An. culicifacies (0.27), An. barbirostris (0.2), An. annularis (0.125) and An. subpictus (0.12), An. peditaeniatus (0.08), An. pseudojamesi (0.04) and An. barbumbrosus (0.04) contained human blood, The FRs for human were <1.0 for most of the anophelines, except An. aconitus (1.04). Conclusion: The presence of human blood, in mosquito species indicates the possibility of them transmitting malaria. Hence, further studies on vector competence are needed to determine the role of each of the above anopheline species currently as efficient vectors of malaria.Item Morphological differences among Anopheles subpictus sibling species B breeding in waste water habitats in Mannar District, Sri Lanka(University of Kelaniya, 2011) Gunathilaka, P.A.D.H.N.; Fernando, M.A.S.T.; Premasiri, D.S.; Hapugoda, M.D.; Wijeyerathne, P.; Wickremasinghe, A.R.; Abeyewickreme, W.Anopheles culicifacies and An. subpictus are considered as the principal and subsidiary vector for malaria in Sri Lanka respectively. An. subpictus sibling species B has been specifically implicated in transmitting malaria in the coastal areas in the west coast of Sri Lanka. The main objective of this study was to identify morphological similarities and differences of An. subpictus B, breeding in waste water habitats in Mannar District. Waste water breeding habitats in three sampling sites having a radius of 20 km in Mannar District were studied for one year (June 2010 to July 2011). These sampling sites were Mannar town, Vankalai and Silawathura. Anopheles larvae and water samples were collected from each breeding site. Larvae were reared until the adults emerged and identified to the species level by taxonomic keys. Densities of Anopheles larvae were calculated. Adult An. subpictus were prepared for egg laying. Sibling status was basically determined based on the number of ridges in the floats of egg with reference to the available keys. Further, other morphological characters were also examined. Water samples were checked for fourteen abiotic variables (pH, dissolved oxygen, conductivity, hardness, free Ammonia, total dissolved solids, colour, odour, suspended solids, alkalinity, conductivity, chloride, total iron and salinity). Breeding of Anopheles species in waste water habitats was observed only in Silawathura and Vankalai sampling sites. A considerable number of Anopheles larvae were collected (n=1197): An. subpictus (96.6%), An. nigerrimus (2.25%), An. barbirostris (0.67%) and An. pallidus (0.5%). According to standards available for surface waters, qualities of water in selected habitats were in the ranges of third class quality. Egg character based on similarities in number of ridges in the egg, all An. subpictus belong to sibling species B. Although they belong to the same sibling species, they showed some morphological differences in their proboscis and palps. Some mosquitoes showed stunted lebellum in the proboscis and their palps had extended more than the length of proboscis (n= 632). Other members had extended lebellum in their proboscis compared to the length of pals (n=357). With ecological changes mosquito sibling species may shift their breeding habitats in order to reduce competition and to attain a wide dissemination in the environment. It is difficult to determine sibling species status using morphological characters. The existing morphological variations and their use for identifying closely related anopheline mosquitoes, especially when they exist as species complexes, are imprecise and need to be replaced with DNA sequence-based techniques.Item The Role of a Cardiac Rehabilitation Programme on Risk Modification in Patients with Established Coronary Heart Disease(University of Kelaniya, 2007) Pinidiyapathirage, M.J.; Wickremasinghe, A.R.; Mendis, S.Objective: To evaluate the effectiveness of a cardiac rehabilitation programme (CRP) on risk modification behaviour of patients following a major cardiac event. Methods: A quasi-experimental pre-test post-test design was used to evaluate the CRP. The study was conducted at the National Hospital of Sri Lanka (NHSL) from July 2005 to August 2006. Patients admitted with a myocardial infraction (MI) to the Institute of Cardiology of the NHSL and all patients who underwent a coronary artery by-pass graft (CABG) surgery or a Percutaneous Transluminal Coronary Angioplasty (PTCA) during the study period were invited to participate in the CRP. Control group consisted of patients admitted with a MI to all medical wards at the. NHSL. An intervieweradministered questionnaire with a food frequency questionnaire and a physical activity questionnaire was used to collect data. Weight, height, and waist and hip circumferences were measured adhering to standard protocols and using standardized instruments. Biochemical analysis of blood at follow up was done at the laboratory of the Nawaloka Group of Hospitals and the National Diabetes Centre. Results: 91% of those who participated in the CRP (n=167) and 75% of the control group (n=168) were followed up at six months following the major cardiac event. There were significant changes in the risk profiles at six months in both groups when each group was taken separately. However, the absolute changes were seen only with regard to serum LDL cholesterol level (difference in improvement in the two groups=9.7%, p=0.015), quality of diet (difference in improvement in the two groups=19.3%, p<0.001), physical activity levels (difference in improvement in the two groups =22.2%, p<0.001) and smoking status (difference in improvement in the two'groups=16%, pItem Development and validation of a tool to assess neuro-developmental outcome of 5-9 year old children in Sri Lanka(2009) Abeysuriya, V.; Wickremasinghe, A.R.; Perera, K.P.J.; Kasturiratne, A.; Poddalgoda, I.Objective: To determine the validity and reliability of a tool which has been developed based on Griffiths Mental Development scale (GMDS) to assess the neuro-developmental outcome of 5-9 year old children in Sri Lanka. Design: Descriptive cross sectional study Setting: Randomly selected five primary schools of the Medical Officer of Health (MOH) area in Ragama, Pediatrics Out patient clinic at Colombo North Teaching Hospital in Ragama and the Department of Pediatrics at the Faculty of Medicine, University of Kelaniya. Method: The study population consisted of two groups. Group A had 60 children. This sample consisted of 20 children who have been clinically diagnosed as having poor neuro-development and 40 children with normal neuro development. They were assessed using the developed neurodevelopment assessment tool at Colombo North Teaching Hospital, Ragama to determine the cutoff value for poor and normal neuro- developmental outcome. The ROC curve analysis was used to determine the statistical significant of the cutoff GQ value which identify the poor and normal neuro developmental outcome of children by the tool. Group B had 100 primary school children (n=100) who were selected from Ragama MOH area. It consisted of 50 children with the high educational performance and 50 with the poor performance based on teacher’s assessment based on student performance reports. The group B has been used to re-asses the validity of the developed tool with the identified cut off GQ value. History of birth and development, family history, teachers’ records, school performance, clinical examination and aptitude test were used to determine neuro-developmental outcome of children by the pediatrician. Result: A cut-off value of GQ 100 (P<0.05) was identified to differentiate children with poor and normal neuro-developmental outcome (sensitivity 100% and specificity 100%). Reliability of identified cutoff value was tested by administrating the tool to the selected primary school children. Out of 50 poor educational performance children who were identified by the teachers’ only 36 were below GQ 100. There were 31 children who were clinically diagnosed as having poor neruo-development by the pediatrician and all of them had GQ of below 100 (Sensitivity 100%). Conclusion: The developed neuro-developmental outcome assessment tool is a valid and reliable instrument to screen neuro developmental outcome of Sri Lankan children aged between 5-9 years.Item The prevalence of micronuclei in lymphocytes among persons resident in the vicinity of a heavy mineral sand processing factory in Pulmoddai, Sri Lanka.(Book of Abstracts, Annual Research Symposium 2017, 2014) Warnakulasuriya, T.; Williams, S.; Wickremasinghe, A.R.Lanka Mineral Sands (LMS) factory in Pulmoddai produces thorium which emits alpha radiation on decay. Micronuclei (MN) are formed in peripheral blood lymphocytes as a result of exposure to ionizing radiation. MN are used as a marker of biological dosimetry.