Prevalence of hypertension, diabetes and obesity: baseline findings of a population based survey in four provinces in Sri Lanka.

OBJECTIVE: To determine the prevalence of selected cardiovascular risk factors in adult Sri Lankan population in four provinces. DESIGN: Cross-sectional, based on a stratified cluster sampling method. SETTINGS: Four provinces, namely the Western, North Central, Southern and Uva. PATIENTS: Six thousand and forty seven participants (2692 men) between the age of 30 and 65 years were surveyed. MEASUREMENTS: Risk factors measured included height, weight, waist and hip circumference. Waist to hip ratio and body mass index were calculated, and overweight (23 kg/m2) and obesity (> or = 25 kg/m2) determined. Hypertension (systolic blood pressure > or = 140 mmHg or diastolic blood pressure > or = 90 mmHg or use of anti-hypertensive medications), and diabetes mellitus (fasting serum plasma glucose level > or = 7 mmol/L or use of anti-diabetic medications) and impaired fasting glycaemia (> or = 6.1 to < 7 mmol/L) were also determined. RESULTS: The prevalence of hypertension as defined was 18.8% (CI 14.5-23.1) for men and 19.3% (CI 12.2-26.4) for women. The prevalence of diabetes was 14.2% (CI 11.9-16.5) for men and 13.5% (CI 6.9-20.1) for women while impaired fasting glycaemia was 14.2% for men and 14.1% for women. The mean body mass index was 21.5 kg/m2 (SD = 3.7) in men. It was lower than that in women, 23.3 kg/m2 (SD = 4.5). The prevalence of obesity was 20.3% in men and 36.5 % in women. Regional differences were seen in the mean fasting blood glucose and prevalence of diabetes, and mean BMI and prevalence of obesity were highest in Western province. Mean blood pressure and prevalence of hypertension were highest in the Uva Province. Southern Province had the lowest prevalence of hypertension and diabetes, and North Central Province had lowest anthropometric measures of obesity. CONCLUSIONS: The prevalence of the selected cardiovascular risk factors is common in the adult Sri Lankan population surveyed. Regional differences exist in the prevalence of these risk factors. The prevalence of high level of risk factors requires urgent public health action.

An attempt to measure burden of disease using disability adjusted life years for Sri Lanka.

INTRODUCTION: Disability adjusted life years (DALY) is a measure of burden of disease (BOD) that assesses the years of healthy life lost due to disease or illness. OBJECTIVE: The main objective of the study was to develop a draft measure of the BOD in Sri Lanka, using DALY. METHODS: Computation was done for 100 disease categories identified to reflect the disease pattern in Sri Lanka. Factors that were considered for the calculation of DALY were incidence, degree of disability, duration of the illness and age of onset. RESULTS: Injuries, ischaemic heart disease, asthma, disease of the pulmonary circulation and burns contribute to 55% of BOD in Sri Lanka. CONCLUSION: The highest burden was due to non-communicable diseases, as their duration and degree of disability are high. Diseases such as malaria, which are short term illnesses with low disability, although affecting large numbers, did not give a high value for DALY.

Dietary cravings and aversions during pregnancy.

Although nausea and vomiting in early pregnancy has been studied in detail, there is little information available regarding dietary aversions and some cravings during pregnancy. To study the prevalence and factors associated with dietary aversions and cravings during pregnancy, a survey was carried out on 1000 randomly selected pregnant women attending antenatal clinics in a district in southern Sri Lanka. In this group 473 (47.3%) had pregnancy cravings for wide variety of foods: sour food 65%, unripe fruits 40%, meat and fish 47%, ripe fruits 30%, food from alms giving 26% and jam and bread fruit 22%. Ninety nine per cent of those who had pregnancy cravings had made special attempt to obtain the food of their choice and all of them had their cravings satisfied by eating the food of their choice. Pregnancy cravings was significantly higher in women who married after a love affair's than in those who had on 'arranged' marriage (p < 0.05), in women who were superstitious (believed in devil dancing and gods) than in those who were not (p < 0.05), and in women with a family income of less than Rs. 2,500 than in those with an income of more than Rs. 2,500 (p < 0.05).

Neonatal and post-neonatal mortality in the Galle district.

OBJECTIVE: To determine some factors associated with infant mortality. DESIGN: Descriptive study. SETTING: Galle district in Sri Lanka. SUBJECTS: 350 infant deaths of singleton births. MEASUREMENTS: Association between variables. RESULTS: Neonatal:post-neonatal death ratio was 3.2:1, and 62.3% (218) were early neonatal deaths. First day deaths comprised 28.6% (100); 67.8% (237) died at the Teaching Hospital. A high incidence (65.7%) of low birthweight (LBW) was noted. Mean birthweights of neonates and post-neonates were 1925 +/- 729 and 2520 +/- 620 gram respectively, and the difference between means was statistically significant (p < 0.001). LBW and related disorders were the major cause of death in 44% (154) of the total sample, and in 55.8% (149) of neonates. Infections were the commonest cause (55.8%) of death in post-neonates. Pediatric clinical assessment to differentiate small-for-dates (SFD) was not recorded in 90.3%. Statistically significant associations were found between the period of death (neonatal and post-neonatal) and the following variables: period of gestation (p < 0.001); birthweight (p < 0.001) and cause of death (p < 0.001). CONCLUSIONS: There was a high incidence of neonatal deaths and a high proportion of early neonatal deaths. About one-third of deaths occurred on the first day of life. Incidence of LBW was high. The major cause of death was LBW and related disorders in the total sample and in neonates. Assessment of SFD was not carried out in the vast majority of infants.

Risk factors contributing to acute diarrhoeal disease in children below five years.

Data regarding factors contributing to acute diarrhoea in children under five years in urban populations in Sri Lanka is meagre. Studies of diarrhoeal disease have been limited mainly to descriptive epidemiological investigations. A case control study on 200 families in the Galle Municipality was undertaken to identify some of the social, behavioural and environmental factors contributing to childhood diarrhoea. Twelve variables were studied by logistic regression, and the following variables were identified as conferring a significant risk of causing diarrhoeal disease in children below five years in an urban setting in Sri Lanka; (1) unavailability of pipe-borne water in the house (2) lack of water-seal latrine in the household (3) low level of mother's education and her lack of awareness regarding infectious nature and mode of spread of diarrhoea (4) not disposing of children's faeces in a latrine (5) improper disposal of garbage.