Iodine nutrition status among schoolchildren after salt iodisation.

Earlier studies done in Sri Lanka have indicated the importance of iodine deficiency as a public health problem. The universal salt iodisation programme has been implemented since 1995.The goals of salt iodisation are reduction of the goitre rate to <5% in school-aged children, to maintain the median urinary iodine level in the population between 100-200 microg/L and >90% of households using iodised salt. OBJECTIVE: To estimate the goitre prevalence, the urinary iodine level, and measure the household iodised salt consumption pattern by Province. METHOD: A school-based study of 6574 randomly selected children in the age group 8-10 years, from 263 schools was assessed for goitre by palpation. The concentration of urinary iodine levels was measured in 2630 of these children. Estimation of iodine in the 6181 samples of salt used in households of the schoolchildren was also assessed by test kits. RESULTS: The prevalence of goitre in the Provinces varied from 16.3% to 26.2%. The median urinary iodine levels were above the cut-off point of 100 microg/L in all Provinces except in Uva. The highest median urinary iodine level was reported in North Central Province (231.3 microg/L). Overall, 35.4% of the children had urine iodine levels in the 'ideal' range (100-199.9 microg/L); 30.6% with lower values (<100 microg/L) indicated iodine deficiency and 16.3% with higher values (< 300 microg/L) indicated excessive iodine intake. Only 49.5% of households had used adequately iodised salt. CONCLUSIONS: This study showed that iodine deficiency still exists in Uva Province, and that more than adequate iodine levels were found in the North Central Province. The level of permitted salt iodine at household level needs to be revised.

Assessment of community maternal care performance of public health midwives of a province in Sri Lanka: a multi-method approach.

The maternal care performance of public health midwives' (PHM) was reviewed using 4 methods in a province of Sri Lanka. The objectives of this descriptive study were to provide a comprehensive assessment of their work and to determine the use of a multi-method system to assess their performance in terms of self- assessed competency, knowledge, attitudes and performance of domiciliary and field clinic services. There were 301 (87.2%) PHMs with good or moderate level of knowledge in antenatal care with only 165 (47.8%) and 238 (69.8%) in natal and postnatal care, respectively. Total knowledge decreased with increasing age and duration of service. Self-assessed competencies were high but not positively correlated with actual knowledge. Attitudes were found to indicate dissatisfaction with the job and a preference of clinic services at the expense domiciliary care. The results indicated that continuing education and enhancement of career prospects were necessary. The methods used in this study could be adopted with appropriate modification for evaluation of personnel in similar settings.

Childhood poisoning in Sri Lanka.

Poisoning in children is a common accident and poison information services should be aware of the toxic agents responsible for poisoning in the community. A retrospective hospital based study was performed, before the establishment of the National Poisons Information Centre in Sri Lanka. There were 4,556 admissions of poisoning to the selected hospitals in the Western Province in 1986 and of this, 540 (11.4%) were below 15 years. Males accounted for 66%. Kerosene oil was responsible for 47% of the poisoning cases in less than 5 years age group, while kerosene oil, pesticides and plants/mushrooms were the commonest toxic agents in the 5 to 14 years age group. The case fatality rate was 3.2%.

Risk factors of acute lower respiratory tract infections in children under five years of age.

This study attempted to identify the determinants of acute lower respiratory-tract infections (ALRI) among children under five years of age, by comparing hundred children hospitalized with ALRI with a control group. Data on socio-demographic, biological and environmental characteristics were collected by interviewing mothers and anthropometric measurements were carried out to assess the nutritional status of the children. Risk of disease in the presence of each exposure was calculated in the univariate analysis and the best explanatory variables among them were identified in the multivariate analysis. The following variables were found to increase the risk of ALRI: (1) history of wheezing, (2) low birth weight, (3) passive smoking, (4) male sex, (5) delivery by cesarean section (6) sharing of sleeping space, (7) not being exclusively breast fed upto the completion of four months, (8) stunting, (9) having pets. The findings highlight some simple strategies which would help in prevention of ALRI.