Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Content analysis of policy documents related to non-communicable diseases prevention and control in Sri Lanka: a developing country in the South-East Asia(F1000 Research, 2024) Talagala, I.; Abeysena, C.; Wickremasinghe, R.BACKGROUND: Health policies form the foundation for provisioning best level care and are important for all stakeholders including patients and healthcare providers. Health policy analysis and evaluation allows policy makers to improve an existing policy, terminate a non-effective policy and to successfully implement future policies. The objective was to assess the coherence between the two local policy documents on NCD prevention and control in Sri Lanka, the national NCD policy (NCD policy) and the multisectoral action plan (MSAP), and to assess the consistency of MSAP with the global action plan for NCDs. METHODS: The content analysis of the NCD policy and MSAP of Sri Lanka was conducted based on the modified criteria developed to the ‘Analysis of determinants of policy impact’ model, by two reviewers independently. Coherence between MSAP and the global NCD action plan were also assessed by two reviewers independently. Consensus for discrepancy was achieved through discussion. RESULTS: Accessibility was the strongest criteria for the NCD policy, while, resources and obligations were the weakest. Goals and monitoring and evaluation criteria were the strongest in the MSAP. Requirement for improvement were identified in policy background, goals, monitoring and evaluation, and public opportunities for the NCD policy. Accessibility, policy background, resources, public opportunities and obligations require further improvement in the MSAP. The MSAP is well coherent with the global road map for NCD prevention and control. CONCLUSION: Policy documents related to NCD prevention and control in Sri Lanka are coherent with the global action plan, while, there are areas within the local policy documents that need to be improved to enhance the coherence between the local documents. Lessons learnt by this activity need to be utilized by Sri Lanka and other countries to improve the uniformity between the NCD policy documents within the country as well as internationally.Item Healthy lifestyle profile scale for elderly: A novel tool to assess healthy lifestyle among young elderly live in South Asian settings(Medknow Publications, 2024) Jayasinghe, V.; Ferdinando, R.; Abeysena, C.BACKGROUND: Many lifestyle modification interventions have been introduced for young elderly population (aged from 60 to 74 years) in Sri Lanka to improve their health and well being. However, little is known about the outcome of those interventions as there is no valid tool available to measure the level of a healthy lifestyle. This study was conducted to develop and validate a new tool to assess the level of healthy lifestyle among young elderly in Sri Lanka. MATERIALS AND METHODS: An operationalized definition of the healthy lifestyle was formulated. Items for the tool were identified following a literature review, key informant interviews, and focus group discussions. The content validity of the tool was ensured by the panel of experts. Both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to explore factor structure and construct validity, respectively. The internal consistency, test–retest, and interobserver reliabilities of the tool were also assessed. RESULTS: Sixty two items were identified initially, and they were reduced to 31 based on experts’ opinion. Out of those, 28 items were loaded into 8 factors during the EFA. The results of the CFA showed a satisfactory model fit. Internal consistency (Cronbach’s alpha >0.7), test–retest, and interobserver reliabilities (Interclass correlation coefficients >0.7) were also found to be satisfactory. CONCLUSIONS: The tool was named the Healthy Lifestyle Profile Scale for Elderly (HLPSE). The HLPSE is a valid and reliable tool to assess the level of healthy lifestyle among Sri Lankan young elderly.Item Development of a complex intervention package for dengue prevention(Ministry of Health, Sri Lanka, 2022) Rajapaksha, R.M.N.U.; Abeysena, C.; Balasuriya, A.; PannilaHetti, N.; Alagiyawanna, A.; Manilgama, S.INTRODUCTION: Complex interventions are widely used in public health practices with noteworthy health impacts. Communication for Behavioural Impact (COMBI) plan is an effective method directed at enacting behaviour change to benefit health and social development which encourage precise behavioural outcomes and is effective in planning a behavioural change for dengue control. The aim of this study was to develop an intervention package to change the behaviour to prevent dengue in one of the highest dengue-endemic areas of Sri Lanka. METHODS: The development of the intervention package was formulated according to the two phases, the ‘Theoretical phase’ and ‘Modelling phase’ of the framework for ‘Developing and Evaluating Complex Interventions’. World Health Organization’s 10 key steps in planning COMBI strategies were followed in order to develop the present intervention package. A situational market analysis was conducted in the highest dengue-endemic area in Kurunegala district to identify the Specific Behavioural Objectives (SBOO) for the COMBI plan. The development of the COMBI plan was conducted using the mixed methodological approach including quantitative and qualitative designs. RESULTS: The overall goal of the COMBI plan was to decrease the morbidity and mortality due to dengue illness by improving the dengue prevention behaviours among householders. The SBOO for the plan were to improve the proper waste management practices according to the ‘3R concept’ (Reduce, Reuse and Re-cycling) and to improve the dengue prevention practices by 30 minutes of weekly cleaning. The strategies of intervention package were to conduct a community empowerment program to improve household waste management and weekly practices on dengue prevention by conducting administrative mobilization and public relationship, public advocacy, community mobilization, personal selling, advertising, and point of service promotion during follow-up. CONCLUSION: Developing a COMBI plan for an area after the identification of SBOO would be feasible to implement in order to empower the community to prevent dengue and improve community health services.Item Development and assessment of psychometric properties of model medication adherence (MMA) questionnaire to measure adherence to oral medication among patients with type 2 diabetes mellitus(College of Community Physicians of Sri Lanka, 2023) Perera, S.; Abeysena, C.INTRODUCTION: Medication adherence among patients with type 2 diabetes (DM) is assessed in everyday clinical practice. OBJECTIVES: To develop a questionnaire to measure adherence to oral medication among patients with DM and to assess its psychometric properties METHODS: The “Model Medication Adherence (MMA)” questionnaire was developed using the evidence from literature review and interviews with key stakeholders and patients. Answers were set on a five-point Likert scale that scored from 1 to 5, with 15-73 as the possible range of the total score. MMA was drafted in English and translated to Sinhala language by forward- backward translation. A descriptive cross-sectional study was carried out among adult patients with type 2 DM who attended clinics in Gampaha District General Hospital (DGH). A sample of 150 patients was recruited consecutively. The construct validity of MMA was assessed by Exploratory Factor Analysis (EFA) through Principal Component Analysis (PCA) with Varimax rotation RESULTS: EFA yielded four factors; sick role behaviour, autonomy, forgetfulness, and barriers that explained 64.36% of the variance of the total score of MMA. Internal consistency was acceptable (Cronbach’s alpha 0.73). The testretest reliability coefficient was 0.85 (p=0.01). Acceptability of the MMA was established by non-response items (none) and the time taken to complete (20 minutes). CONCLUSIONS & RECOMMENDATIONS: MMA is a simple valid questionnaire that adds a novel concept to the adherence literature; sick role and autonomy. It has a good factor structure with established construct validity and is recommended to be used in the clinical setting.Item Health seeking behaviours, dengue prevention behaviours and community capacity for sustainable dengue prevention in a highly dengue endemic area, Sri Lanka(BioMed Central, 2023) Rajapaksha, R.M.N.U.; Abeysena, C.; Balasuriya, A.INTRODUCTION: Dengue has become a major health problem in globally as well as locally. The delay in health-seeking is significantly associated with complications leading to severe dengue and active engagement of communities needs to minimize the delays in management to control epidemics. The aim of the study was to evaluate the relationship between sociodemographic characteristics and householders' Health-Seeking Behaviours (HSB), Dengue-Prevention Behaviours (DPB), and Community Capacities (CC) for sustained dengue prevention in Sri Lanka, a country with a high dengue endemicity. METHODS: A cross-sectional analytical study was carried out in a district with the highest dengue endemicity from January to April 2019. Of the householders, 532 were chosen randomly. A pre-tested, validated, and interviewer-administered questionnaire was used to assess HSB and DPB. The HSB was assessed using three aspects, initial response for fever management, the duration of blood testing and initial response if suspected dengue. The DPB assessment was evaluated using 'waste, outdoor water container, indoor water container, roof gutter and water storage management'. 'Dengue Community Capacity Assessment Tool', with 14 key items was used to assess the level of community capacity for dengue prevention. Out of the total, ≥ 50% was considered as an "adequate" HSB, DPB and CC. Multiple logistic regression was performed to control confounding effects. The results were expressed as adjusted Odds-Ratios (aOR) and 95% Confidence Intervals (CI). RESULTS: The response rate was 93.2% (n = 496). Among them, 44.6% (n = 221) had adequate overall HSB, and 19.2% (n = 95) had adequate DPB. Householders who have ≤ 4 family members are 1.74 times (aOR = 1.74; 95% CI: 1.17 - 2.61) more likely to have adequate HSB and 1.85 times (aOR = 1.85; 95% CI: 1.11 - 3.09) more likely to have adequate DPB. The age group of 46 to 70 years' individuals (aOR = 1.74; 95% CI:1.12 - 2.92), and who engaged in employment (aOR = 1.68; 95% CI: 1.05 - 2.67) were more likely to have adequate DPB than the group of 18 to 45 years and the non-employed individuals respectively. Of them, 24.6% (n = 122) perceived that they have adequate CC. The householders who have per-capita income < USD 50 are 1.95 times (aOR = 1.95; 95%CI:1.11 - 3.40) more likely to have adequate CC. CONCLUSION: The HSB, DPB and CC need to be improved to change the behaviour for sustainable dengue prevention and community capacity-building programmes need to be conducted in the Kurunegala district, Sri Lanka.Item Success and challenges of health systems resilience-enhancing strategies for managing Public Health Emergencies of International Concerns (PHEIC): A systematic review protocol(BMJ Publishing Group Ltd, 2022) Rajapaksha, R.M.N.U.; Khatri, R.B.; Abeysena, C.; Wijesinghe, M.S.D.; Endalamaw, A.; Thomas, T.K.; Perera, N.; Rambukwella, R.; de Silva, G.; Fernando, M.; Alemu, Y.A.Introduction: Health systems resilience is the ability to prepare, manage and learn from a sudden and unpredictable extreme change that impacts health systems. Health systems globally have recently been affected by a number of catastrophic events, including natural disasters and infectious disease epidemics. Understanding health systems resilience has never been more essential until emerging global pandemics. Therefore, the application of resilience-enhancing strategies needs to be assessed to identify the management gaps and give valuable recommendations from the lessons learnt from the global pandemic. Methods: The systematic review will be reported using the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA-P) protocols guideline. Reporting data on World Health Organization (WHO) health system building blocks and systematic searches on resilience enhancing strategies for the management of Public Health Emergencies of International Concerns (PHEIC) after the establishment of International Health Regulations (IHR) in 2007 will be included. The search will be conducted in PubMed, Scopus, Web of Science and Google Scholar ETHICS AND DISSEMINATION: Ethics approval and safety considerations are not applicable. Pre-print of the protocol is available online, and the screening of the articles will be done using Rayyan software in a transparent manner. The findings will be presented at conferences and the final review's findings will be published in a peer-reviewed international journal and will be disseminated to global communities for the application of successful management strategies for the management of future pandemics.Item Prevalence of being 'At Risk' of endometrial carcinoma among postmenopausal women in Sri Lanka(College of Community Physicians of Sri Lanka, 2021) Jayawickrama, W.I.U.; Abeysena, C.INTRODUCTION: Identifying women who are at risk of developing endometrial carcinoma helps to personalize the management strategies by increasing the survival of high-risk women. OBJECTIVES: To estimate the 'at risk' prevalence and prevalence of selected risk factors for endometrial carcinoma among postmenopausal women in the district of Colombo METHODS: A community-based descriptive cross-sectional study was conducted among 1168 postmenopausal women selected using multistage cluster sampling technique. Women who are 'at risk' for developing endometrial carcinoma was decided based on a cut-off value developed for the set of predictors related to the risk of developing endometrial carcinoma among postmenopausal women. RESULTS: The prevalence of at risk of endometrial carcinoma was 19.2% (95% CI=17.0-21.6). The prevalence of selected risk factors: physical inactivity 86.2% (95% CI=84.1-88.1), hypertension 37.8% (95% CI=35.1-40.7), diabetes mellitus 39.9% (95% CI=37.1-42.8), early menarche 12.1% (95% CI=10.3-14.1), late menopause 5.7% (95% CI=4.5-7.2), never conceived 7.8% (95% CI=6.3-9.5), generalized obesity 48% (95% CI=45.1-50.9), central obesity 58.6% (95% CI=55.8-61.5), and inadequate servings of vegetables and fruits 69.4% (95% CI=66.8-72.0). CONCLUSIONS & RECOMMENDATIONS: The identification of 'at risk' women who need to be investigated or followed up closely for endometrial carcinoma and the observed high prevalence of selected modifiable risk factors among postmenopausal women warrant population level interventions to curb unhealthy lifestyle practices and advocate relevant stakeholders for prompt action since childhood as a primary prevention measure. KEYWORDS: Endometrial carcinoma, Women at risk, Increased risk, Risk factor prevalenceItem Knowledge and attitudes on sexually transmitted infections and HIV among undergraduates in the state universities(Universitas Ahmad Dahlan - Faculty of Publich Health, 2020) Perera, U.A.P.; Abeysena, C.ABSTRACT: This study aimed to describe knowledge and attitudes on sexually transmitted infections (STI) and HIV among undergraduates in state universities of Western province, Sri Lanka. A descriptive cross-sectional study was conducted among second and third year undergraduates in 2014. The stratified cluster sampling method was applied to select 1575 undergraduates. A pre-tested self-administered questionnaire was administered to assess knowledge and attitudes on STI and HIV. The associations of knowledge and attitude categories with selected variables were assessed. Most (42.3%, n=667) of the undergraduates belonged to poor knowledge category, 41% (n=646) satisfactory knowledge on STI. Only 16.6% (n=262) had good overall knowledge on STI. Undergraduates who had studied in bioscience stream (36.7%, n=91) were better knowledge than others (12.6%, n=171) (p<0.001). A majority (62.6%, n=976) of undergraduates had overall good knowledge on HIV, 27.7%, (n=432) satisfactory knowledge and 9.7% (n=151) had poor knowledge. Males who had studied in bioscience stream and those who had studied at non-mixed schools were better knowledge on HIV than the counterparts. A majority (56.5%, n=883) of undergraduates had undesirable attitudes and 43.5% (n=681) had desirable attitudes towards HIV. Males (45.9%, n=294) had more desirable attitudes than females (42%, n=386) (p>0.05). Knowledge on STI was low and HIV was higher. About half of the undergraduates had desirable attitudes towards HIV.Item Mental health status among females aged 15 to 45 years in Medical Officer of Health area, Kayts(College of the Community Physicians of Sri Lanka, 2007) Thatparan, R.; Abeysena, C.OBJECTIVE: To describe mental health status among females aged 15-45 years in Medical officer of Health area, Kayts. METHODOLOGY: This was a descriptive cross-sectional study carried out in Kayts MOH Division during the period between October and November 2006. The study population consisted of 365 females of age 15- 45 years. Data collection was made using the GHQ-30 and a self-administered questionnaire, which included socioeconomic data and exposure to adverse effects of war and social support received. Data analysis was done by applying chi-square test and multiple logistic regression. RESULTS: Of 365, 278 females had a GHQ-30 >5 giving a prevalence of poor mental health status of 76.4%. of them 27(7.7%) experienced loss of a limb, 126(35.9%) complained loss of assets such as jewelry or furniture, 17(4.8%) experienced disappearance of family members or relatives, 94(26.8%) had partially and 84(23.9%) fully damaged houses. There were statistically significant association between poor mental health status and single marital status (OR:2.2; 95% Cl:1.3-3.7; P=0.005), experience of displacement (OR:2.4; 95 % Cl: 1.1-5.2; P=0.03) and receiving of any form of assistances (OR:0.3; 95% Cl: 0.2-0.6; P=O.OO1). There were no statistically significant associations between poor mental health status and age, religion, educational level, employment, income, experience of injury, loss of a family member and property or having partially or fully damaged houses. After controlling for confounding effect by applying multiple logistic regression statistically significant associations were observed between poor mental health status and experience of displacement (OR:3.4; 95% Cl: 1.4-8.2; P=0.006) and receiving any form of assistance (OR:0.3; 95% Cl: 0.1-0.5; P=O.OOO). There was no statistically significant association between poor mental health status and single marital status (OR: 1.7; 95% Cl: 0.9-3.0; P=O.08). CONCLUSION: Prevalence of poor mental health status was very high in the area. It was associated with experience of displacement and receiving assistance.Item Presenting symptoms/conditions and selected aspects of health care quality at the Outpatient Department (OPD) of the Wickramarachchi Ayurvedic Hospital, yakkala(College of the Community Physicians of Sri Lanka, 2007) Wanigasekara, C.; Weerasinghe, P.; Weerasinghe, A.; Weerasooriya, S.; Wellagiriya, S.; Wickramarathne, S.; Wijerathne, B.; Abeysena, C.OBJECTIVE: To describe the presenting symptoms/conditions and selected aspects of health care quality of the Outpatient Department (OPD) of the Wickramarachchi Ayurvedic Hospital. METHODOLOGY: A descriptive cross sectional study was conducted on patients seeking treatment from the CPD oi the Wickramarachchi Ayurvedic Hospital. Yakkala between February to April 2007. A pre-tested interviewer administered questionnaire was used to gather information from 250 patients. RESULTS: Fever, cold and respiratory symptoms (44.2%; n=46), musculoskeletal complaints (28.8%; n=30) and dermatological conditions (14.4%; n=15) were the commonest presentations among persons up to 40 years old. Musculoskeletal complaints (26.8%; n=38). lever, cold and respiratory symptoms (24.6%; n=35) diabetes and hypertension (20.4%; n=29) and eye problems (9.8%; n=14) were the commonest presentations among persons above 40 years. Out of 250 patients, 56(22.4%) had visited the Ayurvedic Hospital as the first preference for the current illness and the balance 194(77.6%) patients had taken treatment from other health care institutions. The majority (86%: =168) sought ayurvedic medicine after taking western medicine. The most common reason for giving up previous treatment methods was treatment failure (69%; n=135). The distance between home and the hospital was <10 km for 52.4%(n=137) patients and >20 km for 11.6%(n=54) patients. Median total expenditure for one visit to the Ayurvedic hospital was Rs.200 (Range Rs. 00500 to 3000.00) and 57.6%(n=144) had spent Rs.100-500 for one visit. Median waiting time for consultation was 90 minutes (Range 5 — 300min). Consultation time was <5 minutes in 52%(n=131) and >10minutes in 24%(n=60) of patients. Two hundred and seven (83%) patients were satisfied with treatment given and 224 (69.6%) on facilities provided by the Ayurvedic hospital. Statistically significant associations were observed between high satisfaction and low educational level (p<0.001) and previous treatment failure from other systems (p<0.001). CONCLUSION: Patients seek ayurvedic treatment for various symptoms/diseases irrespective of their severity. patient's age and the distance to the hospital. The commonest reason for seeking ayurveda treatment was treatment failure at other methods. A majority were satisfied with the treatment provided and facilities available.