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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Chemoprophylaxis for malaria: A costly approach to prevent re-establishment of malaria in Sri Lanka(Sri Lanka Medical Association, 2021) Muzrif, M.M.; Mendis, K.N.; Weerasekera, C.J.; Karunaratna, S.; Wickremasinghe, R.; Ranaweera, K.D.N.P.; Fernando, S.D.Introduction and Objectives As a measure to prevent the re-establishment of malaria in the country, the Anti Malaria Campaign (AMC) provides antimalarial chemoprophylactic medicines for up to six months free-of-charge to anyone travelling to malaria endemic countries. The objective of this study was to identify the trends of chemoprophylaxis prescription by the AMC and the costs involved. Methods Data were extracted from the national malaria database regarding the number of travellers issued with antimalarial chemoprophylactic medicines during the years 2017-2019. The amount spent for purchase of antimalarial chemoprophylactic medicines was determined. Results Over the three year period the overall number of individuals issued with antimalarial chemoprophylaxis increased (1714 in 2017, 2600 in 2018 and 3053 in 2019). The number of travellers obtaining chemoprophylaxis for malaria when travelling to African countries reduced, while the number travelling to India increased. The cost incurred to the Government of Sri Lanka to purchase mefloquine and doxycycline for prophylaxis was USD 45,755, while the cost to purchase CQ over the three year period for prophylaxis alone was USD 310,714. The total cost incurred to purchase the prophylactic antimalarials have also increased significantly over the three year period, the cost being eleven times higher in 2019 than in 2017. Conclusion Chemoprophylaxis against malaria remains an important strategy to sustain the malaria elimination status in Sri Lanka, and the cost of this intervention is considerable and increasing over time. The local production of anti malarials might be warranted if it will reduce the cost of chemoprophylaxis.Item Clinicopathological Profile of Cutaneous Leishmaniasis in Army Personnel in the Kilinochchi and Mulllativu Districts of Sri Lanka(Sri Lanka Medical Association, 2020) Wijesinghe, H.D.; Gunathilaka, N.; Semege, S.; Pathirana, K.P.N.; Manamperi, N.; de Silva, M.V.C.; Fernando, S.D.INTRODUCTION AND OBJECTIVES: Leishmaniasis is caused by an intra cellular protozoan of the genus Leishmania. The clinicopathological profile of cutaneous leishmaniasis (CL) varies according to the species. Leishmania donovani is the causative organism for leishmaniasis in Sri Lanka. This study describes the clinicopathological features of cutaneous leishmaniasis among army personnel serving in two Northern districts of the country. METHODS: In this collaborative cross-sectional study, the histopathology of fifty cases of CL confirmed by at least two methods (slit skin smear, lesion aspirate, tissue impression and histology) were reviewed. The parasitic load was assessed semi-quantitatively. The histological features were correlated with the clinical presentation and organism load. RESULTS: The majority (89.8%; n=44) presented with a single lesion mostly located in the upper limb (69.4%, n=34). The lesion types included papule (34.7%, n=17), nodule (32.7%, n=16) and ulcer (30.6%, n=15). Evolution time of lesions averaged 31.55 weeks. Epidermal changes were observed in 49 and included hyperkeratosis (90.0%; n=45), acanthosis (44.0%; n=22), atrophy (34.0%; n=17) and interface change (66%; n=33). Dermal changes were seen in all cases and characterized by a lymphohistioplasmacytic inflammatory infiltrate of variable intensity with ill-formed granuloma in 19 cases (38%) and well-formed epithelioid granulomas in 22 cases (44%). Focal necrosis was present in 20 % (n=10). Leishmania amastigote forms were observed in 88% (n=44). Transepidermal elimination (P=0.025), granuloma (P=0.027) formation and type of lesion (P=0.034) were significantly associated with organism load with granuloma formation being associated with reduction in organism load. CONCLUSION: Histopathological changes were characterised by a diffuse lymphohistioplasmacytic infiltrate, ill-defined granuloma or well-formed granuloma. Well-formed granulomata were associated with a reduction in organism load.Item Importance of active case detection in a malaria elimination programme(The Bulletin of the Sri Lanka College of Microbiologists, 2014) Wickremasinghe, R.; Fernando, S.D.; Thiliekaratne, J.; Wijeyaratne, P.M.; Wickremasinghe, A.R.INTRODUCTION AND OBJECTIVES: Malaria surveillance methods routinely used in Sri Lanka are passive and active case detection (PCD, ACD) and activated passive case detection (APCD). Active case detection is carried out by mobile malaria clinics. Tropical and Environmental Diseases and Health Associates (TEDHA) an implementation partner of the Anti Malaria Campaign (AMC) carries out APCD and ACD in four districts in Sri Lanka namely Trincomalee, Batticaloa, Ampara and Mannar, complementing the parasitological surveillance activities carried out by the AMC. DESIGN, SETTING AND METHODS: The ACD programme of TEDHA involves screening of populations irrespective of the presence of fever or any other signs or symptoms of malaria to detect infections and residual parasite carriers. TEDHA screens a) high risk populations using ACD through mobile malaria clinics including armed forces personnel and b) pregnant females who visit antenatal clinics for asymptomatic malaria infections during their first trimester. Populations are selected in consultation with the Regional Malaria Officer of the AMC thus avoiding any overlap with the population screened by the government. RESULTS: TEDHA screened 387.309 individuals between January 2010 and December 2012, for malaria by ACD including high risk groups and pregnant women and diagnosed eight malaria positive cases (7 Ptasmodium vivax infections and one mixed infection with P. vivax and Plasmodium falciparum}. All these cases were from the Mannar district amongst resettled populations and army personnel. During this period 125 cases were detected in the Mannar district by the Anti Malaria Campaign by passive case detection. No cases of malaria were detected by ACD by the AMC. CONCLUSIONS: The progress made by Sri Lanka in the malaria elimination drive is largely due to increased surveillance and judicious use of control methods. The country now needs to focus on enhanced surveillance to be malaria free and to prevent re-introduction of malaria into the country. As highlighted here, ACD played a major role in interrupting malaria transmission in the country. ACKNOWLEDGEMENTS: Financial assistance by the Global Fund (Grant, No. PR2 SRL809G11-M) is gratefully acknowledged. The authors would like to acknowledge the support given by the staff of TED HA.Item Impact of mass chemotherapy filariasis control programme on soil-transmitted helminth infections in Ragama(Sri Lanka Medical Association, 2003) de Silva, N.R.; Pathmeswaran, A.; Fernando, S.D.; Weerasinghe, C.R.; Selvaratnam, R.R.; Padmasiri, E.A.OBJECTIVE: To assess the impact of using albendazole in the'national Mass Drug Administration (MDA) programme for filariasis control, on soil-transmitted helminth (STH) infections'in Ragama. METHODS: The prevalence and intensity of STH infections was assessed before and after introduction of albendazole into the MDA programme in the Ragama MOH area, which has endemic transmission of both lymphatic filariasis and STH. Children attending Year 3 classes in 6 schools (selected in a random stratified manner) were examined during a baseline survey in March-May 2002. The follow-up survey (Sept-Oct) covered Year 4 children in the same schools after the MDA programme in July. All stool samples were examined on the day of collection using the modified Kato-Katz technique. RESULTS: The cumulative prevalence of STH infection was very low in both surveys: 4.5% (12/265) at baseline, and 2.0% (5/252) at follow-up. Trichuriasis was. the commonest infection (4.1% and 1.6%), followed by ascariasis (0.8% and 0.4%). The species prevalence rates, cumulative prevalence, and mean egg counts all declined from baseline to follow-up, but the differences were not statistically significant. The majority of children (85%) examined in the follow-up survey said they had taken both diethylcarbamazine citrate and albendazole during the MDA programme. CONCLUSIONS: Although it is possible that inclusion of albendazole in the MDA programme had an impact on STH infections, it is unlikely that any resultant decline in prevalence will have a significant impact on the health of schoolchildren in the Ragama MOH area since prevalence rates are now very low.Item Importance of active case detection in a malaria elimination programme(BioMed Central, 2014) Wickremasinghe, R.; Fernando, S.D.; Thillekaratne, J.; Wijeyaratne, P.M.; Wickremasinghe, A.R.Introduction of human immunization reduced Japanese Encephalitis (JE) cases dramatically in Sri Lanka. However, the increased reporting ofadverse events following immunization (AEFI) affected vaccine acceptance by the community. Against this background, we describe the incidence of overall AEFI and incidence and profile of AEFI, thought to be causally related to the mouse-brain derived JE vaccine. A follow-up of 9798 vaccine recipients was performed for a period of two weeks post-vaccination. Parents self-recorded observed signs and symptoms. The self-records were collected by trained supervisors. All monitored children who manifested symptom/s were investigated in details by medical officers experienced in AEFI investigations within two weeks after ending the follow-up period. Using the results of the investigation, the causality assessment was performed. The estimated cumulative incidence rate of overall AEFI was 8.6 children per 100 immunizations. The same for observed AEFI consistent with causal association to the inactivated JE vaccine was 4.3 children (95% CI-3.9-4.7%) per 100 immunizations. The most frequent AEFI was fever (81%). The frequency of high fever (>102 °F) was 26%. Other major AEFI were body ache (22%) vomiting (21%), urticaria (19%), pruritus (5%), and headache (5%). Though 83% of children with AEFI thought to be causally related to the vaccine sought medical care, only 6.6% required hospitalizations. The incidence rate of AEFI in the cohort event monitoring was several-fold higher than that reported through the national AEFI surveillance system. The incidence rate of allergic manifestations among Sri-Lankan children approached what was reported for non-endemic settings and was higher than in other JE endemic populations elsewhere. Contrary to the belief of medical practitioners and the general public, incidence of seizures was low and vaccine related other neurological manifestations were absent.Item The social and economic burden of malaria in Sri Lanka(2005) Wickremasinghe, A.R.; Wickremasinghe, R.; Fernando, S.D.; Galappaththi, G.; Mahawithanage, S.T.C.Item Impact of childhood malaria in Sri Lanka(2005) Fernando, S.D.; Wickremasinghe, R.; Wickremasinghe, A.R.; Mahawithanage, S.T.C.Item A cost analysis of the use of the rapid, whole-blood, immunochromatographic P.f/P.v assay for the diagnosis of Plasmodium vivax malaria in a rural area of Sri Lanka(Academic Press, 2004) Fernando, S.D.; Karunaweera, N.D.; Fernando, W.P.; Attanayake, N.; Wickremasinghe, A.R.Between May 2001 and March 2002, a prospective study was conducted in a malaria-endemic area of Sri Lanka, to determine the cost implications of using the immunochromatographic P.f/P.v test to detect Plasmodium vivax infection. All consecutive subjects aged >5 years who presented with a history of fever were recruited. Each was checked for P. vivax infection by the standard microscopical examination of bloodsmears and by theimmunochromatographic test (ICT). The costs of diagnosis using each method and the sensitivity, specificity and predictive values of the ICT (with blood smear examination used as the 'gold standard') were estimated, the costs/case detected being simulated for different slide positivity 'rates' and ICT sensitivities. In the detection of P. vivax, the ICT had a sensitivity of 70% and a specificity of 99%. The costs of the ICT per subject investigated and per case detected were, respectively, approximately 14 and 20 times more than those of bloodsmear examination. The costs of the ICT per case detected would fall as the sensitivity of the test increased. The ICT gave relatively few false-positive results. The current, relatively high cost of the ICT is the most important barrier to its routine operational use in the diagnosis of malaria. The test is already useful, however, in specific situationsItem The impact of repeated malaria attacks on the school performance of children(American Society of Tropical Medicine and Hygiene, 2003) Fernando, S.D.; Gunawardena, D.M.; Bandara, M.R.; de Silva, D.; Carter, R.; Mendis, K.N.; Wickremasinghe, A.R.The impact of repeated malarial infections on the school performance of children was investigated in 571 school children 6-14 years of age in a malaria-endemic area in southern Sri Lanka where both Plasmodium falciparum and P. vivax infections are prevalent. Malaria infections confirmed by microscopy were monitored over a six-year period. School performance was assessed by two specially designed, school grade-specific, test papers for Sinhala language and mathematics. The scores for Sinhala language and mathematics for each school term test for the year 1997 were obtained. Malarial infections were a major predictor of children's performance in language and mathematics after controlling for parent's education, monthly family income, and house type. The education of the father predicted language scores but not mathematics scores. A child who experienced more than five attacks of malaria scored approximately 15 percent less than a child who experienced less than three attacks of malaria. The data suggest that repeated attacks of malaria have an adverse impact on the school performance of children.Item Impact of mass chemotherapy for the control of filariasis on geohelminth infections in Sri Lanka(Academic Press, 2003) de Silva, N.R.; Pathmeswaran, A.; Fernando, S.D.; Weerasinghe, C.R.; Selvaratnam, R.R.; Padmasiri, E.A.; Montresor, A.No Abstract Available