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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Quality of care in the management of asthmatic children with regard to compliance with the guidelines in in-ward setting in a district of Sri Lanka: a descriptive study(College of Community Physicians of Sri Lanka, 2020) Abeysena, C.; Perera, N.INTRODUCTION: The quality of paediatric asthma management in the in-ward settings has not been assessed in Sri Lanka. OBJECTIVES: To describe the quality of care in the management of asthmatic children with regard to compliance with the guidelines. METHODS: A descriptive cross-sectional study was carried out in state hospitals with paediatric units in a district of Sri Lanka. A sample of 577 children diagnosed by a consultant paediatrician was selected. Eleven indicators were chosen by modified Delphi technique. Data collection instruments were an interviewer-administered questionnaire and a record sheet. Compliance with guidelines according to 11 indicators was expressed in percentages. RESULTS: The assessment of acute severity was 100%. The use of systemic corticosteroid at first prescription was 88.9% (n=513), whereas it was 69% (n=398) with oral steroid therapy and 54.5% (n=315) with long-term use of steroid inhaler. Assessment of chronic asthma severity was 31.2% (n=180). Caregivers who had received health education on triggering factors of asthma, on what to do during an asthma attack, and how to use the inhaler were 62.0% (n=358), 37.1% (214) and 68.8% (n=217), respectively. All patients have been issued a diagnosis card on discharge and among them, 74.4% (n=429)received a complete discharge summary and 90.6% (n=523) were scheduled for follow up appointments. CONCLUSIONS: Assessment of acute severity of asthma and the provision of diagnosis card on discharge were exceptional. Assessment of the severity of chronic asthma and providing health education for caregivers should be improved. Prescribing long term use of a steroid inhaler is to be revised. KEYWORDS: Children, Clinical, Indicators, Medication, PerformanceItem Knowledge on primary and secondary prevention of asthma among caregivers of asthmatic children admitted to paediatric wards in Gampaha District.(College of Community Physicians of Sri Lanka., 2019) Perera, N.; Abeysena, C.INTRODUCTION: Asthma is considered to be one of the major public health problems. The accurate knowledge of caregiver on asthma is important for the management. OBJECTIVES: To describe the knowledge on primary and secondary prevention of asthma among caregivers of asthmatic children admitted to the paediatric wards in the district of Gampaha. METHODS: A descriptive cross-sectional study was carried out among 577 caregivers of inward asthmatic children. Pre-tested interviewer- and self-administered questionnaires were used to assess the knowledge on asthma. The grand score of knowledge on asthma was calculated out of 34. The 75th percentile value was considered to differentiate ‘good’ knowledge from ‘poor’ knowledge. Multiple logistic regression was applied to determine the factors associated with poor knowledge on asthma. Results were expressed in adjusted odds ratio (aOR) and 95% confidence interval (CI). RESULTS: The mean score for knowledge on asthma was 20.6 (SD=4.42) ranging from 7 to 30. Among the caregivers, 369 (64%) had poor knowledge on asthma. Low educational level of the caregiver (aOR=2.48; 95% CI=1.59, 3.86) and being under prophylaxis treatment for less than one year (aOR=2.49; 95% CI=1.50, 4.13) were the determinants of poor knowledge on asthma. CONCLUSIONS: Majority of the caregivers’ knowledge on asthma was poor. The caregivers’ low educational level and shorter duration of prophylaxis treatment for the children were associated with poor knowledge on asthma.Item Effectiveness of providing health education to caregivers of hospitalized children with asthma for the prevention of recurrent attacks: a quasi-randomized trial(Informa Healthcare, 2020) Perera, N.; Abeysena, C.OBJECTIVE: To determine the effectiveness of health education intervention for caregivers of children with asthma, focused on preventing recurrent attacks and improving knowledge. METHODS: A quasi-randomized trial of 177 caregivers of asthmatic children was conducted in government hospitals in a district of Sri Lanka. At the time of discharge from the hospital, a health education booklet was prepared and given to the caregivers in the intervention group, along with individual explanation and discussion. The caregivers' knowledge of asthma and preventive practices was assessed. The primary outcome was the proportion of children with recurrent attacks of asthma who needed doctor visits during the three month post discharge period. The intention-to-treat principle was applied for data analysis.RESULTS: In comparison to the control group, the intervention group had a 76% significant reduction in visits to the doctor for recurrent attacks (95% CI:45%-90%) and a 75% significant reduction in hospital admissions required for asthmatic children (95% CI:16%-93%) at the end of three months of intervention. The mean score of knowledge of asthma in the intervention group was 1.73 units higher at three months (p < 0.01) and 1.47 units higher at six months (p < 0.01) than the control group. The mean score of preventive practices for asthma in the intervention group was 1.25 units higher at three months (p = 0.02) and 1.15 units higher at six months (p < 0.01) versus the control group.CONCLUSION: Health education intervention significantly decreased doctor and hospital visits at three months. In addition, caregiver knowledge of asthma and preventive practices also improved. TRIAL REGISTRATION NUMBER: SLCTR/2010/007.Item Prevalence and correlates of asthma among selected garment factory workers at the Free Trade Zone, Ekala(College of Community Physicians of Sri Lanka, 2015) Jayawardana, P.; Abeysena, C.Objective To determine prevalence of bronchial asthma (BA) and its correlates and respiratory functions among selected garment factory workers (GFW) at the Free Trade Zone, Ekala. Methods This consisted of a cross sectional descriptive and an analytical study. It was conducted at three selected garment factories and a clinic setting in Ekala. Study group for first component included 674 GFW who have worked for 1 or more years at the current garment factories. Control group for second component included 100 participants who have never worked in garment factories. Study instruments consisted of an interviewer administered questionnaire and spirometry. Bivariate analysis was followed by multiple logistic regressions. Results were expressed as odds ratios (OR) and 95% Confidence intervals (CI). Results Overall prevalence of BA among GFW was 32.3% (95% CI:28.8-36.0%). Prevalence of “probable occupational asthma” among asthmatic GFW was 49.5% (95% CI:42.7-56.4%). Being a GFW (OR=3.5, 95% CI:1.9-7.2) and age >30 years (OR=1.5; 95% CI:1.1-2.1) were significantly associated with prevalence of BA. Among GFW, FEV1.0 and PEFR were significantly lower among asthmatics compared to non asthmatics, and FVC, FEV1.0, and PEFR among those exposed to dust for >3 years compared to ≤3 years. Conclusions Prevalence of bronchial asthma was higher among Garment Factory Workers. However, respiratory functions were lower only among those who were asthmatics.Item Prevalence of asthma and comparison of ventilator capacity of asthmatics (when free of asthma) and non asthmatics among workers in selected garment factories(College of the Community Physicians of Sri Lanka, 2009) Abeysena, C.; Jayawardana, P.; Wickramasinha, W.P.K.; Dassanayake, I.S.INTRODUCTION: Asthma has been reported to be common among garment factory workers. Objective: To determine the prevalence of asthma and to compare the lung functions among asthmatics and non asthmatics among garment factory workers. METHODS: A descriptive comparison study was conducted among 774 workers of selected garment factories in the Ekala Industiral Area, Ja ela. All workers who have served for a minimum period of one year in the factory were included in the study. An interviewer administered questionnaire was used to assess personal details and presence of wheezing, dysponoea and cough and other relevant data. All those with wheezing and those with presence of both cough and dyspnoea in the absence of wheezing during the past one year were considered as asthmatics. Spirometry was performed using an electronic spirometer. Forced Vital Capacity (FVC), Forced Expiratory Volume in first second of FVC (FEV) and Peak Expiratory Flow Rate (PEFR) were assessed. The ventilatory capacity was compared among asthmatics and non asthmatics using Student T test, Mann Whitney U test or chi-squired test. Results: The prevalence of asthma was 30% (95%CI: 26.7%, 33%). The mean ventilator capacity of asthmatics and non asthmatics respectively were as follows FVC: 2.24 L versus 2.39 L (p<0.05), FEV-i.o: 2.17 L versus 2.37 L (p<0.001), PEFR {geometric mean): 5.87 L/sec versus 7.17 L/sec (p<0.001). The mean difference between the predicted normal values and observed values among asthmatics and non asthmatics were as follows: FVC: 0.53 L versus 0.58 L (p>0.05), FEVro: 0.30 L versus 0.25 L (p>0.05), PEFR (median): 1.21 L/sec versus 0.45 L/sec (p<0.001). Ninety three (40.3%) of asthmatics and 149 (27.5%) non-asthmatics had PEFR <80% of the predicted which was statistically significant (p<0.001). CONCLUSION: Prevalence of asthma was high among garment factory workers. Ventilatory capacity and predicted normal values of asthmatics when free of asthma were affected in comparison to non asthmatics.