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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Double burden of maternal and child malnutrition and socioeconomic status in urban Sri Lanka(Public Library of Science, 2019) Shinsugi, C.; Gunasekara, D.; Gunawardena, N.K.; Subasinghe, W.; Miyoshi, M.; Kaneko, S.; Takimoto, H.Child malnutrition and maternal obesity are serious public health issues in Sri Lanka. This study explores the associations between socioeconomic status and the double burden of malnutrition among school-aged children and within their household. A total of 543 primary school children aged 5-10 years (204 boys and 339 girls) in Gampaha District, Sri Lanka, were included in the analysis. The nutritional statuses of thinness, normal, overweight, and obesity for children and mothers were defined according to WHO growth references and body mass index. Maternal education, household equivalent income, and maternal employment were used as socioeconomic status indicators. The proportion of child thinness and overweight was 19.3% and 13.4%, respectively, and that of maternal overweight (body mass index ≥ 25 kg/m2) was 36.5%. A positive correlation was found between maternal body mass index and the child's body mass index for age z-score in older boys and younger girls. A multivariate stepwise logistic regression analysis showed that lower education of mothers posed a higher association with child thinness (adjusted odds ratio = 2.33, 95% confidence interval: 1.08-5.00). Mothers with overweight and obesity were less likely to have a child with thinness (adjusted odds ratio = 0.30, 95% confidence interval: 0.16-0.58). Maternal employment status and household equivalent income were not significantly, but marginally, associated with child overweight and obesity. Socioeconomic inequality combined with maternal nutritional status affected child malnutrition. These findings suggest that the underlying circumstances within households should be considered to improve child malnutrition. Erratum in: PLoS One. 2020;15(3):e0230785.Item The epidemiology of irritable bowel syndrome among children and adolescents in Asia: a systematic review(Belgian Society of Paediatric Gastroenterology, Hepatology and Nutrition (BeSPGHAN),, 2013) Rajindrajith, S.; Gunawardena, N.K.; Abeygunasekara, C.; Devanarayana, N.M.Aims: Irritable bowel syndrome (IBS) is characterized by chronic abdominal pain and changing bowel habits including frequency and consistency. The aim of this study was to systematically review published literature on prevalence, risk factors and comorbid factors of IBS among children living in Asia. METHOD: A computer assisted search of PUB MED, CINHAL, and Index Medicus for South East Asia was carried out. Study selection criteria were; 1) Asian population based samples of children/adolescents; 2) Clear diagnostic criteria for IBS (Rome I, II or III); 3) Full manuscripts published in English. Selected articles were reviewed in depth; data were extracted and presented in descriptive form. RESULTS: Thirteen cross sectional studies which reported prevalence of IBS were included in the final analysis. Preva¬lence of IBS among Asian children and adolescents ranges from 2.8% to 25.7%. Nine studies have shown a higher prevalence of IBS in girls compared to boys. Studies from China have indicated untyped IBS as the commonest IBS subtype, while studies from Sri Lanka have shown approximately even distribution of all four subtypes. Clearly identi¬fied predisposing factors to develop IBS in Asian children included psychological stress, anxiety, depression, consump¬tion of alcohol and fatty food, smoking, and exposure to gastrointestinal infections. Comorbid factors of IBS reported among Asian children included an array of somatic symptoms, fatigue and psychological problems such as depression. CONCLUSIONS: According to published data, IBS is a significant problem among Asian children and adolescents. Female gender, exposure to stress, certain food habits, life styles and gastrointestinal infections predispose children to develop IBS in Asia.Item The Effect of intestinal nematode infections on atopic diseases in children(Allergy and Immunology Society of Sri Lanka, 2009) Amarasekera, N.D.D.M.; Gunawardena, N.K.; de Silva, N.R.; Douglas, J.; O'Hehir, R.; Weerasinghe, A.BACKGROUND : The effect of helminth infections on atopic diseases and allergic sensitization is controversial. Little is known about the effect of infection on atopic diseases in children living in areas where both intestinal nematodes and Toxocara infections are prevalent. OBJECTIVE : To examine the association between atopic diseases and helminth infection among children exposed to both intestinal nematodes and Toxocara. METHODS: Children attending grade 5 (age group 9-11 years) in 17 schools in the Western Province of Sri Lanka were recruited. The association of atopic diseases (asthma, rhinitis, eczema) with active intestinal nematode infections (excreting eggs in faeces) and with exposure to Toxocara (specific IgG antibodies in serum) was investigated. A child was deemed sensitized if positive for at least one of the allergens tested (Dermatophagoides pteronyssinus, Blomia tropicalis, cockroach, cat epithelium, grass pollen), based on specific IgE levels in serum. RESULTS: A total of 640 children participated in the study; serum analysis was done in 203. Active intestinal nematode infection appeared to reduce the risk of atopic diseases (OR 0.47, P=0.016) whereas Toxocara exposure did not (OR 0.85 P=0.602). When specific IgE levels against Blomia tropicalis, the most common allergen in the study group (67.5%), were expressed as percentages of the total IgE levels for each child, infected children had significantly lower levels compared to uninfected children (P=0.001). CONCLUSIONS : Intestinal nematode infections seem to protect against atopic diseases in children in Sri Lanka. Polyclonal IgE synthesis may be involved in this protection.Item Allergic sensitization in children(The Sri Lanka College of Paediatricians, 2008) Amarasekera, N.D.D.M.; Gunawardena, N.K.; de Silva, N.R.; Weerasinghe, A.BACKGROUND :Allergic sensitization is considered a significant risk factor for the development of atopic diseases. Appropriate allergen avoidance measures can be taken only when the pattern of sensitization to allergens in a particular population is known. No data is available regarding allergic sensitization among Sri Lankan children. OBJECTIVE: To identify the common allergens causing sensitization in a selected group of schoolchildren. DESIGN, SETTING AND METHOD: A cross-sectional study was carried out in 640 children in grade 5 (age group 9-11 years), from 17 schools in the Western Province. Data regarding atopic diseases was collected using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Specific IgE was estimated by ImmunoCAP method for five common aeroallergens (the dust mites Dermatophagoides pteronyssinus and Blomia tropicalis, cockroach, cat epithelium and dander, grass pollen) in a sub-sample of 203. RESULTS: Aeroallergen sensitivity was detected in 163 (80.3%) children. No significant difference for sensitization between boys and girls was noted (P= 0.549). The pattern of allergens in the two groups was similar. Mite allergen sensitivity was the most prevalent (B. tropicalis 84.0%, D. pteronyssinus 69.9%), followed by cockroach (67.5%), cat dander (46.0%) and grass pollen (35.6%). Twenty seven (13.3%) children were sensitized to all allergens tested; 28 (13.8%) children were sensitized to only one allergen; and 68.7% were sensitized to both B. tropicalis and D. pteronyssinus. Children with rhinitis or eczema (but not those with asthma) were significantly more likely to show sensitization to cat dander than asymptomatic controls (P=0.02 and P=0.002 respectively), but not to other allergens. The likelihood of being sensitized to one allergen was well correlated with sensitization to other allergens as evident by the significant correlation coefficients. CONCLUSION: Mites and cockroaches were the most common aeroallergens causing sensitization among schoolchildren in the Western Province.Item Prevalence of enterobiasis among primary school children in Ragama, Sri Lanka(Sri Lanka Medical Association, 2013) Gunawardena, N.K.; Chandrasena, T.G.A.N.; de Silva, N.R.OBJECTIVES: To determine the prevalence of enterobiasis among school children in Ragama Medical Officer of Health (MOH) region and the association between clinical features, potential risk factors and infection status. DESIGN: Cross sectional study. SETTING: School based. Participants 260 school children aged 5-7 years, attending five state schools in the Ragama MOH region. MAIN OUTCOME MEASURES: Prevalence of Enterobius vermicularis infection as diagnosed using adhesive cellophane tapes on the perianal skin on 2 consecutive days. RESULTS: The overall prevalence of enterobiasis was 38%. The risk factors significant on a univariate analysis were male gender, maternal under-education, non-permanency of paternal employment, more household members, more siblings in a family, more persons sleeping with an index child and lack of recent deworming. On a multivariate model more household members, more children in a household, more persons sleeping with the index child, non-permanency of paternal employment and lack of recent deworming were significantly associated with infection. None of the clinical manifestations evaluated (peri-anal itching, insomnia, abdominal pain, and enuresis) showed a significant association with enterobiasis. CONCLUSIONS: Enterobiasis is highly prevalent among primary school children in Ragama.