Prevalence and predictors of self-medication in a selected urban and rural district of Sri Lanka.

BACKGROUND: Self-medication is widely practised in many developing countries. The determinants of self-medication need to be understood to design adequate medicine information policies and patient-dispenser education strategies. Hence, the prevalence of medicine use and predictors of self-medication were determined in Sri Lanka. METHODS: In a community-based cross- sectional study, data were collected from 1800 adults selected from Gampaha and Polonnaruwa districts respectively. Study participants were sampled using a multistage cluster sampling technique. Trained public health midwives administered the questionnaire. Two Likert scales provided information on access to medical care and satisfaction with available pharmacy services. About 95% of the sampled population participated in the study. RESULTS: Overall, prevalence of medication use (allopathic, traditional, home remedies) in urban and rural population was 33.9% and 35.3%, respectively. Self-medication prevalence of allopathic drugs in the urban sector (12.2%) was significantly higher than in the rural (7.9%) sector(p<0.05). In the urban sector, small household size and preference to have medicines from outside the pharmacies predisposed to self-medication. The higher acceptability of medical services and regularity of medical care decreased the likelihood of self-medication. In the rural sector, lower satisfaction about the healthcare providers' concern for clients, lower satisfaction about affordability of medical care and higher satisfaction with technical competence of the pharmacy staff increased the likelihood of self-medication. In both urban and rural sectors, when symptom count increased, tendency to self-medicate decreased. CONCLUSIONS: Self-medication prevalence was higher in urban compared to rural areas in Sri Lanka. Some aspects of access to medical care, satisfaction with pharmacy services and perceived severity of the disease were found to be important determinants of self-medication.

Health systems responsiveness and its correlates: evidence from family planning service provision in Sri Lanka.

BACKGROUND: The World Health Organization has described health systems responsiveness (HSR) as a multi-domain concept encompassing eight non-medical expectations of health-care service seekers. HSR is a valuable measure of health systems performance, providing policy-makers and service providers much information to improve services. This paper presents findings of a cross-sectional survey conducted to assess HSR and its correlates through family planning (FP) services in Colombo district, Sri Lanka. METHODS: A Health Systems Responsiveness Assessment Questionnaire, developed and validated in Sri Lanka, was used. Trained interviewers administered the questionnaire in 38 FP clinics randomly selected to sample 1520 clients. RESULTS: The rating of responsiveness as 'good' for six domains ranged from 88% (n=1338) to 72% (n=1094). The overall HSR was rated to be 'good' by 83.4% (1268). Ethnicity being majority Sinhalese, persons who were currently employed and those using oral contraceptive pills (OCP) or condoms were negatively associated with rating of HSR. Positive associations with the HSR assessment were a family income of less than Rs 40 000 (US$ 303) per month, satisfaction with current FP method, use of only one method within the past year, use of only one FP clinic within the past year, health service provider being a medical officer, intention to use the FP clinic services in future, and satisfaction with overall services of the clinic. CONCLUSIONS: Though overall HSR was rated by the majority as 'good', some aspects need more attention in delivering FP services.

Maternal haemoglobin level at booking visit and its effect on adverse pregnancy outcome.

AIMS: To determine the effect of maternal haemoglobin levels at booking visit on pregnancy outcome. METHODS: A prospective study was carried out at two Medical Officer of Health areas in a district in Sri Lanka, including 817 pregnant mothers who were followed up until delivery. Maternal haemoglobin level was measured according to specified standard protocols. The reliability and the accuracy of haemoglobin measurements were assessed and were found to be satisfactory. Pregnancy outcome was defined in terms of miscarriage, maternal morbidities, preterm birth (PTB), low birth weight (LBW) and small for gestational age (SGA) infants. Potential confounding factors for each pregnancy outcome were also assessed. Multiple logistic regression was applied and the results were expressed as odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS: The prevalence of anaemia (Hb < 11 g/dL) was 7.1% (95% CI 5.4-8.9%). Anaemia during pregnancy was not significantly associated with any of the pregnancy outcomes studied. Reference range for haemoglobin measurements among mothers with normal pregnancy outcome was 10.4-13.9 g/dL. Haemoglobin level of >13.9 g/dL had a significant adverse association with maternal morbidities (OR 3.0; 95% CI 1.03-8.90) and LBW (OR 3.95; 95% CI 1.30-12.0) compared with the reference range. CONCLUSIONS: Although anaemia during pregnancy was not adversely associated with any of the pregnancy outcomes, Hb level of >13.9 g/dL was adversely associated with maternal morbidities and LBW.

'Hawks' and 'doves': effect of feedback on grades awarded by supervisors of student selected components.

BACKGROUND: Supervisors of some student selected components (SSCs) may appear to give higher grades than others. It is not known if feedback can influence the behaviour of supervisors in the grades they award. We have introduced feedback letters in our institution. AIMS: (1) To assess the feasibility of objectively identifying SSCs where grades awarded are consistently higher or lower than the average; (2) To assess the effect of feedback on the grades awarded by supervisors of SSCs. METHODS: The breakdown of SSC grades was examined over four consecutive years, before and after feedback letters were introduced in 2005. The grades awarded globally, and in five individual SSCs, were compared using the chi(2) goodness-of-fit test. RESULTS: (1) Individual SSCs were identified which awarded grades that were consistently different from the average. (2) Overall grades awarded in 2003/04 and 2004/05 (before feedback) were similar (chi2=0.37, df=2, p=0.83). Likewise, overall grades awarded in 2005/06 and 2006/07 (after feedback) were similar (chi2=1.72, df=2, p=0.42). Comparison of 2003/04 with 2005/06 (chi2=16.0, df=2, p<0.001), and 2006/07 (chi2=26.6, df=2, p<0.001), and of 2004/05 with 2005/06 (chi2=13.5, df=2, p=0.001), and 2006/07 (chi2=23.7, df=2, p<0.001), revealed highly significant differences. The grades awarded after feedback were higher than the grades awarded before feedback. CONCLUSIONS: The chi2 goodness-of-fit test may be used to identify individual SSCs where the grades awarded are different from the average, although the interpretation of the results thus obtained is fraught with difficulty. Our data also suggest that it is possible to influence assessors in the grades they award.

Student selected components: student-designed modules are associated with closer alignment of planned and learnt outcomes.

BACKGROUND: Student selected components (SSCs) are staff-designed modules selected by students from a menu of options provided separately from the 'core' curriculum. Students completing these do not always learn what teachers think they teach. Some medical schools also allow students to design their own modules. It is not known whether greater student input into planning of modules is associated with closer alignment of planned and learnt outcomes. AIMS: To compare student perception of learning outcomes addressed by student-designed ('self-proposed') SSCs, before and after completion, using the 'Dundee learning outcomes' template that we apply to all components of the undergraduate curriculum. METHODS: Students were required at the time of self-proposal, and subsequently as part of feedback on completed modules, to indicate which of twelve learning outcomes they felt were addressed by their self-proposed SSC. The chi2 test was used to compare student perceptions of learning outcomes before and after completion. RESULTS: More students thought that learning outcome 10 (appropriate decision making skills, clinical reasoning and judgement) was addressed after completion than before (96.3% versus 90.0%, chi2 4.99, p=0.02); for all other learning outcomes global perceptions were not significantly different after completion. Individual changes in perception ranged from 2.1% for outcome 12 (aptitude for personal development) to 19.6% for outcome 2 (competent to perform practical procedures). CONCLUSION: Greater student input into planning of modules is associated with closer alignment of planned and learnt outcomes. Our findings provide further evidence for the benefit of student-directed learning.

Maternal sleep deprivation is a risk factor for small for gestational age: a cohort study.

AIMS: To determine trimester-specific risk factors for small-for-gestational-age (SGA) infants. METHODS: A population-based prospective cohort study was conducted in Sri Lanka from May 2001 to April 2002. Pregnant women were recruited on or before 16 weeks of gestation and followed up until delivery. The sample size was 690. Trimester-specific exposure status and potential confounding factors were gathered on average at 12th, 28th and 36th weeks of gestation. SGA was assessed using customised birth centile charts. Multiple logistic regression was applied, and the results were expressed as odds ratios (OR) and 95% confidence intervals (95%CI). RESULTS: The risk factors for SGA less than 5th centile were shift work and exposure to physical and chemical hazards during 2nd and 3rd trimesters (OR 4.20, 95%CI 1.10-16.0), sleeping for less than or equal to 8 h during 2nd or 3rd or both trimesters (OR 2.23, 95%CI 1.08-4.59), walking for less than or equal to 2.5 h per day (OR 2.66, 95%CI 1.12-6.31) and alcohol consumption during the 3rd trimester (OR 14.5, 95%CI 2.23-94.7). Poor weekly gestational weight gain was significantly associated with both SGA < 10th and < 5th centiles. None of the other factors became significant for SGA < 10th centile. CONCLUSIONS: Risk factors for SGA less than 5th centile were sleep deprivation and shift work and exposure to physical and chemical hazards during 2nd and 3rd trimesters, less walking hours and alcohol consumption during 3rd trimester. Poor weekly gestational weight gain may be considered as a predictor of delivering an SGA infant.