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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 The ParaSightT-F dipstick test as a routine diagnostic tool for malaria in Sri Lanka(Oxford University Press, 1997) Kodisinghe, H.M.; Perera, K.L.R.L.; Premawansa, S.; Naotunne, T. de S.; Wickremasinghe, A.R.; Mendis, K.N.Blood from 1053 persons who presented for treatment at outpatient clinics of government health institutions in Sri Lanka, and 250 who took part in a blood survey for malaria, was examined by thick blood film microscopy under routine field conditions, and by the ParaSight-F dipstick method. All the samples were also examined microscopically under laboratory conditions when 4 times the number of microscope fields were examined. Compared with this reference standard, the sensitivity and specificity of the ParaSight-F test were 90.2% and 99.1%, and those of microscopy in the field were 92.4% and 98.4% respectively, there being no statistically significant difference between the 2 methods. The ParaSight-F test reading correlated significantly and positively with the intensity of clinical disease of patients but not with their peripheral parasitaemia, indicating that it may be a more accurate measure of the true parasite load than microscopy, which detects only parasites which are in the peripheral blood and not those which are sequestered in deep organs. The ParaSight-F test, however, failed to detect Plasmodium falciparum infections with only gametocytes in the blood (19.6% of the infected blood samples in this study). The time taken for a patient to revert to negativity by the ParaSight-F test was also significantly longer, up to 14 d. This would make the test unsuitable for checking the response to antimalarial treatment within 14 d. In an endemic area it would therefore fail to detect drug resistant populations of parasites.Item Optimizing the malaria data recording system through a study of case detection and treatment in Sri Lanka(Blackwell Scientific Publications, 1997) Abeysekera, T.; Wickremasinghe, A.R.; Gunawardena, D.M.; Mendis, K.N.The potential of using malaria incidence data routinely collected from endemic regions for disease control and research has increased with the availability of advanced computer-based technologies, but will depend on the quality of the data itself. We report here an investigation into the relevance of malaria statistics provided by the routine data collection system in Moneragala, a rural malaria-endemic region in Sri Lanka. All patients (n = 321) treated for malaria in 2 clusters of health care centres (HCCs) of both the private and the public sector in the administrative regions of Moneragala and Buttala Divisional Secretariat (D.S.). Divisions were studied in December 1995/ January 1996. The catchment area of these HCCs included a population resident in 53 Grama Niladhari (GN) areas, the smallest administrative units of the country. Almost equal numbers of malaria patients were detected and treated at Government and private health care institutions, and in 70 percent of them treatment was based on a diagnosis confirmed by microscopy. The routine data recording system, however, included only statistics from the Government sector, and only of patients whose diagnosis was microscopically confirmed. In compiling data, the origin of a case of malaria is attributed to the D.S. Division in which the institution (at which the patient was treated) was located, rather than the area in which the patient was resident, which was inaccurate because 90 percent of malaria patients sought health care at institutions located closest to their residence, thus crossing administrative boundaries. It also led to a loss of resolution of spatial data because patients' addresses recorded at the Government HCCs to the village-level are replaced in the statistics by the D.S. Division, which is a coarse spatial unit. Modifications to the system for malaria case recording needed to correct these anomalies are defined here. If implemented, these could result in major improvements to the quality of data, a valuable resource for the future of malaria control. The paper reiterates the call for the use of a standard spatial unit within a country to facilitate exchange of data among health and other sectors for the control of tropical diseases.