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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Larval indices of vector mosquitoes as predictors of dengue epidemics: An approach to manage dengue outbreaks based on entomological parameters in the districts of Colombo and Kandy, Sri Lanka(Hindawi Pub. Co., 2020) Udayanga, L.; Aryaprema, S.; Gunathilaka, N.; Iqbal, M. C. M.; Fernando, T.; Abeyewickreme, W.BACKGROUND: Early detection of dengue epidemics is a vital aspect in control programmes. Predictions based on larval indices of disease vectors are widely used in dengue control, with defined threshold values. However, there is no set threshold in Sri Lanka at the national or regional levels for Aedes larval indices. Therefore, the current study aimed at developing threshold values for vector indices in two dengue high-risk districts in Sri Lanka. METHODS: Monthly vector indices (House Index [HI], Container Index [CI], Breteau Index for Aedes aegypti [BIagp], and Ae. albopictus [BIalb]), of ten selected dengue high-risk Medical Officer of Health (MOH) areas located in Colombo and Kandy districts, were collected from January 2010 to June 2019, along with monthly reported dengue cases. Receiver Operating Characteristic (ROC) curve analysis in SPSS (version 23) was used to assess the discriminative power of the larval indices in identifying dengue epidemics and to develop thresholds for the dengue epidemic management. RESULTS: Only HI and BIagp denoted significant associations with dengue epidemics at lag periods of one and two months. Based on Ae. aegypti, average threshold values were defined for Colombo as Low Risk (2.4 ≤ BIagp < 3.8), Moderate Risk (3.8 ≤ BIagp < 5), High Risk (BIagp ≥ 5), along with BIagp 2.9 ≤ BIagp < 4.2 (Low Risk), 4.2 ≤ BIagp < 5.3 (Moderate Risk), and BIagp ≥ 5.3 (High Risk) for Kandy. Further, 5.5 ≤ HI < 8.9, 8.9 ≤ HI < 11.9, and HI ≥ 11.9 were defined as Low Risk, Moderate Risk, and High Risk average thresholds for HI in Colombo, while 6.9 ≤ HI < 9.1 (Low Risk), 8.9 ≥ HI < 11.8 (Moderate Risk), and HI ≥ 11.8 (High Risk) were defined for Kandy. CONCLUSIONS: The defined threshold values for Ae. aegypti and HI could be recommended as indicators for early detection of dengue epidemics and to drive vector management activities, with the objective of managing dengue epidemics with optimal usage of financial, technical, and human resources in Sri Lanka.Item Climate change induced vulnerability and adaption for dengue incidence in Colombo and Kandy districts: the detailed investigation in Sri Lanka(BioMed Central., 2020) Udayanga, L.; Gunathilaka, N.; Iqbal, M. C. M.; Abeyewickreme, W.BACKGROUND: Assessing the vulnerability of an infectious disease such as dengue among endemic population is an important requirement to design proactive programmes in order to improve resilience capacity of vulnerable communities. The current study aimed to evaluate the climate change induced socio-economic vulnerability of local communities to dengue in Colombo and Kandy districts of Sri Lanka. METHODS: A total of 42 variables (entomological, epidemiological, meteorological parameters, land-use practices and socio-demographic data) of all the 38 Medical Officer of Health (MOH) areas in the districts of Colombo and Kandy were considered as candidate variables for a composite index based vulnerability assessment. The Principal Component Analysis (PCA) was used in selecting and setting the weight for each indicator. Exposure, Sensitivity, Adaptive Capacity and Vulnerability of all MOH areas for dengue were calculated using the composite index approach recommended by the Intergovernmental Panel on Climate Change. RESULTS: Out of 42 candidate variables, only 23 parameters (Exposure Index: six variables; Sensitivity Index: 11 variables; Adaptive Capacity Index: six variables) were selected as indicators to assess climate change vulnerability to dengue. Colombo Municipal Council (CMC) MOH area denoted the highest values for exposure (0.89: exceptionally high exposure), sensitivity (0.86: exceptionally high sensitivity) in Colombo, while Kandy Municipal Council (KMC) area reported the highest exposure (0.79: high exposure) and sensitivity (0.77: high sensitivity) in Kandy. Piliyandala MOH area denoted the highest level of adaptive capacity (0.66) in Colombo followed by Menikhinna (0.68) in Kandy. The highest vulnerability (0.45: moderate vulnerability) to dengue was indicated from CMC and the lowest indicated from Galaha MOH (0.15; very low vulnerability) in Kandy. Interestingly the KMC MOH area had a notable vulnerability of 0.41 (moderate vulnerability), which was the highest within Kandy. CONCLUSIONS: In general, vulnerability for dengue was relatively higher within the MOH areas of Colombo, than in Kandy, suggesting a higher degree of potential susceptibility to dengue within and among local communities of Colombo. Vector Controlling Entities are recommended to consider the spatial variations in vulnerability of local communities to dengue for decision making, especially in allocation of limited financial, human and mechanical resources for dengue epidemic management. KEYWORDS: Climate change; Dengue; Sri Lanka; Vulnerability.Item Field-based evaluation of Novaluron EC10 insect growth regulator, a chitin synthesis inhibitor against Dengue vector breeding in leaf axils of pineapple plantations in Gampaha district, Sri Lanka(BioMed Central, 2020) Gunathilaka, N.; Ranathunga, T.; Hettiarachchi, D.; Udayanga, L.; Abeyewickreme, W.BACKGROUND: Insect growth regulators (IGRs) are considered a novel group of insecticides to control mosquitoes. Novaluron is an IGR with benzoylphenyl urea insecticide, which inhibits chitin synthesis in insects and can reduce insect population density; it is also known to have a high margin of safety for mammals. METHODS: The effective minimum concentration of novaluron formulation EC10 was tested. Six pineapple plantations [control (n = 3) and test (n = 3)] were selected from Meerigama Medical Officer of Health area in Gampaha District, Sri Lanka. Fifteen plots (10 × 10 m) were demarcated in each site with a 200 m distance apart. Leaf axils of 450 pineapple plants (30 plants × 15 plots) were screened for immature stages of Aedes mosquitoes weekly for 12 weeks. The required concentration (20 ppm) of novaluron was sprayed onto the selected pineapple plants (n = 1350) individually in 3 selected test sites for 5-10 s. The reduction in the vector population was interpreted as the percentage of reduction in immature stages of Aedes mosquitoes. RESULTS: The 100% mortality of the Ae. aegypti larvae within 24 h was observed at 20 ppm (0.05 ml of novaluron 100 g/l in 250 ml of water) as the minimum dose. Variation in the number of Aedes larvae present in the control and intervention sites was found to be significantly different throughout the entire observational period (χ2 = 128.29, df = 11, P < 0.001). The total elimination of Aedes larvae continued for up to 2 weeks and a 50% reduction was observed until the 8th week. CONCLUSIONS: The present study emphasizes that novaluron (10% EC) can be used as an effective larvicide at the treatment dose of 20 ppm. The residual effect of the IGR lasted for 12 weeks with a functional efficacy of 8 weeks. The 100% reduction of larval breeding was observed up to the 2nd week after application and the percentage reduction of immature stages remained > 50% until the 8th week. The lowest reduction (34.2%) was observed at 12 weeks after the initial treatment. Therefore, re-treatment may be recommended based on the reduction in the efficacy of the IGR. Keywords: Aedes; Field efficacy; Insect growth regulator; Novaluron; Pineapple plantation.Item Effect of larval nutritional regimes on morphometry and vectorial capacity of Aedes aegypti for Dengue transmission(BioMed Research International, 2019) Gunathilaka, N.; Upulika, H.; Udayanga, L.; Amarasinghe, D.BACKGROUND: Nutritional level in larval diet of mosquito vectors influence on life history traits and vectorial capacity (VC). Therefore, the present study was carried out to assess the effect of larval diet concentration on vector bionomic and VC of Aedes aegypti in Sri Lanka. Method. Three batches of 400 Ae. aegypti larvae (first instar) were reared under different concentrations of larval diet (6%, 8%, and 10%; Volume/Volume), which was prepared by mixing 12.5 g of tuna meal, 9.0 g of bovine liver powder, and 3.5 g of Brewer’s yeast, in 100 ml of distilled water. The effect of larval diet concentration on different morphometric and functional parameters of larvae (length and width of head, abdomen, survival rate, and pupation success), pupae (length and width of cephalothorax, survival rate, and adult emersion), adult (length and width of thorax, abdomen, survival rate, longevity, biting frequency and fecundity of adults) were examined. In addition, VC of Ae. aegypti was evaluated. The General Linear Model (GLM) was used for the statistical analysis. Results. Larval head length, head width, thoracic width, abdominal length, abdominal width, total length, and survival rate significantly increased with higher doses of larval diet (P<0.05). In case of pupae, length, and width of cephalothorax, survival rate and adult emergence rate denoted an increasing trend with the elevated larval diets. However, the variations of survival rate and adult emergence rate were statistically significant (P<0.05). In adults, all morphometric parameters (thoracic length, abdominal length, abdominal width, and wing length) significantly increased with elevating larval diets levels (except for thoracic width) along with the biting frequency, fecundity, and survival rate (P<0.05) of adult females. The VC also denoted significant variations (F4,14 = 24.048; ) with the larval diet concentration, whereby the highest VC of 196.37 was observed at 10% treatment. Conclusion. Larval food availability has a significant influence on the adult fitness and thus may affect the incidence of dengue due to variations in the VC of Ae. aegypti. Hence, this investigation highlights the requirement in accounting the environmental variation at the larval stages in order to understand transmission dynamics and control of dengue in Sri Lanka.Item Level of Awareness of Dengue Disease among School Children in Gampaha District, Sri Lanka, and Effect of School-Based Health Education Programmes on Improving Knowledge and Practices.(Hindawi Pub. Co., 2019) Radhika, N. M. L.; Gunathilaka, N.; Udayanga, L.; Kasturiratne, A.; Abeyewickreme, W.INTRODUCTION:Limited awareness and nonsystematized health education programmes have contributed adversely to the increase in dengue incidence at schools due to limited attention which has positively contributed to the increase in vector receptivity. The current study was conducted to evaluate the existing level of awareness of dengue infection among a selected group of school children and to assess the effectiveness of dengue awareness programmes to improve the existing knowledge and preventive practices on dengue.METHODS:A cohort of 2,194 students (13-15 years old) from 10 schools at Kelaniya educational zone, Gampaha District, Western Province of Sri Lanka, was enrolled for the current study, which was conducted during 2015-2016. A self-administered questionnaire, comprising 20 questions, was used to evaluate the present knowledge of the students on various aspects of dengue. A structured awareness programme (2 hours) was conducted for students, followed by a reassessment. General Linear Model (GLM) and chi-square test of independence were used to investigate the variations in knowledge levels.RESULTS:The majority of students were characterized by "Good" (46.31%, n= 1016) and "Moderate" (42.62%, n= 935) awareness, while only 2.92% (n= 64) of students fell into the "Excellent" (>80%) category prior to the awareness programme. Even though, existing knowledge of students about dengue ranged between "Moderate" and "Good" categories, awareness of "symptoms & patient care" and "control & prevention practices" were limited. After the programme, the awareness level reached the "Excellent" (41.84%, n=918) level indicating a significant increase by 38.92%, according to the chi-square test (p<0.05 at 95% level of confidence).CONCLUSION:We recommend implementing school-based educational programmes in order to raise the awareness and to translate knowledge into sound practice to control dengue disease epidemics in these areas.Item Predatory efficacy of five locally available copepods on Aedes larvae under laboratory settings: An approach towards bio-control of dengue in Sri Lanka.(San Francisco, CA : Public Library of Science, 2019) Udayanga, L.; Ranathunge, T.; Iqbal, M. C. M.; Abeyewickreme, W.; Hapugoda, M.Many countries are in search of more effective and sustainable methods for controlling dengue vectors, due to undeniable inefficiencies in chemical and mechanical vector control methods. Bio-control of vectors by copepods is an ideal method of using interactions in the natural ecosystem for vector management, with minimum consequences on the environment. Current study determined the predatory efficacy of five locally abundant copepod species on, Aedes larvae under laboratory conditions. Copepods were collected from the pre-identified locations within the districts of Gampaha and Kandy, and identified morphologically. Individual species of copepods were maintained as separate colonies with Paramecium culture and wheat grain as supplementary food. Five adult copepods of each species was introduced into separate containers with 200 larvae (1st instar) of Aedes aegypti. Number of larvae survived in containers were enumerated at 3 hour intervals within a duration of 24 hours. Each experiment was repeated five times. The same procedure was followed for Ae. albopictus. Significance in the variations among predation rates was evaluated with General Linear Modelling (GLM) followed by Tukey's pair-wise comparison in SPSS (version 23). Significant variations in predation rates of studied copepod species were reported (p<0.05), whereby M. leuckarti indicated the highest followed by M. scrassus, while C. languides indicated the lowest predatory efficacy. The effect of different Aedes larval species on the predation rates of copepods remained significant (p<0.05), even though the effect on predatory efficiency was not significant. Based on the findings, both M. leuckarti and M. scrassus, with the highest predatory efficiencies, could be recommended as potential candidates for biological controlling of Aedes vectors in Sri Lanka.Item Comprehensive evaluation of demographic, socio-economic and other associated risk factors affecting the occurrence of dengue incidence among Colombo and Kandy Districts of Sri Lanka: a cross-sectional study(BioMed Central, 2018) Udayanga, L.; Gunathilaka, N.; Iqbal, M.C.M.; Lakmal, K.; Amarasinghe, U.S.; Abeyewickreme, W.BACKGROUND: Comprehensive understanding of risk factors related to socio-economic and demographic status and knowledge, attitudes and practices (KAP) of local communities play a key role in the design and implementation of community-based vector management programmes, along with the identification of gaps in existing control activities. METHODS: A total of 10 Medical Officers of Health (MOH) areas recording high dengue incidence over the last five years were selected from Colombo (n = 5) and Kandy (n = 5) Districts, Sri Lanka. From each MOH area, 200 houses reporting past dengue incidence were selected randomly as test group (n = 1000 for each district) based on the dengue case records available at relevant MOH offices. Information on socio-economic and demographic status and knowledge, attitudes and practices were gathered using an interviewer administered questionnaire. The control group contained 200 households from each MOH area that had not reported any dengue case and the same questionnaire was used for the assessment (n = 1000 for each district). Statistical comparisons between the test and control groups were carried out using the Chi-square test of independence, cluster analysis, analysis of similarities (ANOSIM) and multi-dimensional scaling (MDS) analysis. RESULTS: Significant differences among the test and control groups in terms of basic demographic and socio-economic factors, living standards, knowledge, attitude and practices, were recognized (P < 0.05 at 95% level of confidence). The test group indicated similar risk factors, while the control group also shared more or less similar characteristics as depicted by the findings of cluster analysis and ANOSIM. Findings of the present study highlight the importance of further improvement in community education, motivation and communication gaps, proper coordination and integration of control programmes with relevant entities. Key infrastructural risk factors such as urbanization and waste collection, should be further improved, while vector controlling entities should focus more on the actual conditions represented by the public on knowledge, attitudes and personal protective practices. CONCLUSIONS: The design of flexible and community friendly intervention programmes to ensure the efficacy and sustainability of controlling dengue vectors through community based integrated vector management strategies, is recommended.Item Empirical optimization of risk thresholds for dengue: an approach towards entomological management of Aedes mosquitoes based on larval indices in the Kandy District of Sri Lanka(BioMed Central, 2018) Udayanga, L.; Gunathilaka, N.; Iqbal, M.C.M.; Najim, M.M.M.; Pahalagedara, K.; Abeyewickreme, W.BACKGROUND: Larval indices such as Premise Index (PI), Breteau Index (BI) and Container Index (CI) are widely used to interpret the density of dengue vectors in surveillance programmes. These indices may be useful for forecasting disease outbreaks in an area. However, use of the values of these indices as alarm signals is rarely considered in control programmes. Therefore, the current study aims to propose threshold values for vector indices based on an empirical modeling approach for the Kandy District of Sri Lanka. METHODS: Monthly vector indices, viz PI, BI and CI, for Aedes aegypti and Aedes albopictus, of four selected dengue high risk Medical Officer of Health (MOH) areas in the Kandy District from January 2010 to August 2017, were used in the study. Gumbel frequency analysis was used to calculate the exceedance probability of quantitative values for each individual larval index within the relevant MOH area, individually and to set up the threshold values for the entomological management of dengue vectors. RESULTS: Among the study MOH areas, Akurana indicated a relatively high density of both Ae. aegypti and Ae. albopictus, while Gangawata Korale MOH area had the lowest. Based on Ae. aegypti, threshold values were defined for Kandy as low risk (BIagp > 1.77), risk (BIagp > 3.23), moderate risk (BIagp > 4.47) and high risk (BIagp > 6.23). In addition, PI > 6.75 was defined as low risk, while PI > 9.43 and PI>12.82 were defined as moderate and high risk, respectively as an average. CONCLUSIONS: Threshold values recommended for Ae. aegypti (primary vector for dengue) along with cut-off values for PI (for Ae. aegypti and Ae. albopictus), could be suggested as indicators for decision making in vector control efforts. This may also facilitate the rational use of financial allocations, technical and human resources for vector control approaches in Sri Lanka in a fruitful manner.Item Socio-economic, Knowledge Attitude Practices (KAP), household related and demographic based appearance of non-dengue infected individuals in high dengue risk areas of Kandy District, Sri Lanka(BioMed Central, 2018) Udayanga, L.; Gunathilaka, N.; Iqubal, M.C.M.; Pahalagedara, K.; Amarasinghe, U.S.; Abeyewickreme, W.BACKGROUND: Socio-economic, demographic factors and Knowledge Attitude Practices (KAPs) have been recognized as critical factors that influence the incidence and transmission of dengue epidemics. However, studies that characterize above features of a risk free or low risk population are rare. Therefore, the present study was conducted to characterize the household related, demographic, socio-economic factors and KAPs status of five selected dengue free communities. METHOD: An analytical cross-sectional survey was conducted on selected demographic, socio-economic, household related and KAPs in five selected dengue free communities living in dengue risk areas within Kandy District, Central Province, Sri Lanka. Household heads of 1000 randomly selected houses were interviewed in this study. Chi-square test for independence, cluster analysis and Principal Coordinates (PCO) analysis were used for data analysis. RESULTS: Knowledge and awareness regarding dengue, (prevention of the vector breeding, bites of mosquitoes, disease symptoms and waste management) and attitudes of the community (towards home gardening, composting, waste management and maintenance of a clean and dengue free environment) are associated with the dengue free status of the study populations. CONCLUSIONS: The vector controlling authorities should focus on socio-economic, demographic and KAPs in stimulating the community to cooperate in the integrated vector management strategies to improve vector control and reduce transmission of dengue within Kandy District.Item Oviposition preferences of dengue vectors; Aedes aegypti and Aedes albopictus in Sri Lanka under laboratory settings.(CABI Publishing, 2018) Gunathilaka, N.; Ranathunge, T.; Udayanga, L.; Wijegunawardana, A.; Abeyewickreme, W.Investigations on oviposition behaviour of dengue vectors are critical for effective controlling of vector breeding. Therefore, the aim of the present study was to determine the oviposition behaviour of dengue vectors, Aedes aegypti and Aedes albopictus in Sri Lanka. Batches of 1000 adult mosquitoes (1 : 1, male: female ratio) housed in rearing cages were used for each experimental setup from Ae. aegypti and Ae. albopictus. Oviposition responses with respect to the size of the ovitrap, colours of the ovitrap, water source, sodium chloride (NaCl) concentration and presence/absence of larvae were evaluated by enumerating the number of eggs laid in the ovitraps. The analysis of variance and cluster analysis were used to investigate the significance in the variations among oviposition. The number of eggs laid by both species were improved with the increasing size of ovitraps. Ae. albopictus indicated the highest mean number of eggs in 0.2% of NaCl than in the ovitraps filled with distilled water. However, the egg laying preference was reduced with increasing salinity in both species. Drain water with low dissolved oxygen (DO) level (0.43 ± 0.12 mg l-1) was the preferred water source for both species, while a significantly high oviposition rate was observed in ovitraps with larvae. Black colour ovitraps attracted the majority of gravid females, while white was least preferred. There were no significant variations among oviposition behaviours of Ae. albopictus and Ae. aegypti. The ability of these vectors to breed in waste water with low DO levels may lead them to attain wide dissemination in the natural environment, enhancing their potential threat to human life.