Dehydration and malaria augment the risk of developing chronic kidney disease in Sri Lanka.

Chronic kidney disease (CKD) of unknown etiology (CKDu) is a serious health issue in Sri Lanka. One-to-one age and sex-matched two sample comparative study was carried out in the Medawachchiya divisional secretariat area of the North Central Province (NCP) of Sri Lanka, by randomly selecting 100 CKDu patients and 100 age and sex-matched subjects from non-CKDu affected families from the same area. An interviewer-administered questionnaire was used for the collection of data pertaining to occupation, medical history and lifestyle. Data were analyzed using a conditional linear logistic model. Working for >6 h in the field per day, exposure to sun, drinking water only from well, consumption of <3 L of water per day, and having a history of malaria were found to be having significant (P < 0.05) likelihood toward the development of CKDu. Treatment of water prior to consumption had a significant protective effect against CKDu. Dehydration, history of malaria and drinking untreated well water from are likely contribute to the development of CKD of unknown etiology among the inhabitants of NCP, Sri Lanka.

Factor structure and normative data of the Sinhalese version of self reported Strength and Difficulties Questionnaire (SDQ) for adolescents.

OBJECTIVES: To describe the normative data, factor structure and the internal consistency of the Sinhalese, self reported version of SDQ for adolescents. METHODS: The present study was carried out in eight provinces in Sri Lanka. A sample of school going adolescents aged 12-16 years were selected from Sinhalese medium schools using a multi stage cluster sampling technique with probability proportionate to size. The component structure of the SDQ was examined using principal component analysis. Normative banding and the cut off values were determined, based on the distribution of raw data in this non-clinical sample. RESULTS: The study sample consisted of 535 (45.3%) boys and 645 (54.5%) girls. Mean total difficulty score for girls (10.66±5.440) was significantly (p=0.014) higher than that for boys (9.93±4.671). Mean scores for emotional (2.97±2.009), conduct (2.11±1.755) and peer (2.24±1.760) subscales were also significantly higher among girls than that of boys (2.7±1.915, 1.78±1.406 and 2.04±1.383 respectively). In the factor analysis, only factor that was loaded with all five items in the original subscale was "emotional" and the loading values were more than .445 for all five items. None of the other extracted factors contained more than 3 items from one subscale. Internal consistency (Cronbach's alpha) for total difficulties was satisfactory in the total sample as well as in boys and girls separately (>.71). However, in all five subscales, Chrobach's alpha was less than six, showing a low homogeneity. CONCLUSIONS: Factor structure and internal consistency of the current Sinhalese version of the self reported SDQ is not satisfactory. Revalidation of this version of SDQ is recommended to capture the intended objectives of the SDQ.

Effect of different milling methods on glycaemic response of foods made with finger millet (Eucenea coracana) flour.

OBJECTIVES: Compare glycaemic response of foods prepared with finger millet flour, using traditional stone grinding and industrial milling. DESIGN: Crossover study. PARTICIPANTS: Healthy volunteers (n=11) consisting of five males and six females), aged between 20 and 30 years, with a body mass index of 18.5-23.5 Kgm-2. MAIN OUTCOME MEASURES: Blood glucose concentration was measured at fasting and 30, 45, 60, 90, 120 minutes after ingestion of roti and pittu made with stone ground or industrially milled finger millet flour, containing 50 g of available carbohydrates. Glycaemic Index (GI) values were expressed as the average value of the 11 subjects. RESULTS: Significant differences (p<0.05) in GI between similar food types made of flour milled using different methods were observed. GI for roti made of stone ground flour was 44±5 and that of roti made of industrially milled flour was 59±7. Pittu made of stone ground flour had a GI of 67±5 and GI of pittu made of industrially milled flour was 79±5. Microscopic analysis of flour samples and a sieving process using different sieve sizes showed larger particle size distribution in stone ground flour compared to industrially milled flour. CONCLUSIONS: Larger particle sizes in the stone ground flour compared with industrially milled flour was established as the only factor affecting the difference in GI of same type of food prepared with flour milled using different methods. There were no significant differences (p>0.05) in proximate compositions of the different foods or raw flours. Foods prepared with finger millet (kurakkan) flour with a larger particle size distribution resulted in a lower glycaemic response.

The association of iron status with educational performance and intelligence among adolescents.

INTRODUCTION: The aim was to identify the association of iron status with educational performance and intelligence of adolescents. METHOD: This was a cross sectional comparative study among adolescents aged 13-15 years. Each iron deficient student was matched with an iron sufficient student from the same school, class and sex. Iron status was based on haemoglobin and serum ferritin levels. The marks for mathematics, science, Sinhala language and social science were considered to assess educational performance. Intelligence was measured by Raven's Standard progressive matrices. All the possible confounders and effect modifiers were considered. Home visits to a sub-sample checked the quality of data. RESULTS: The final analysis included 188 students (94 matched pairs). Neither educational performance nor intelligence showed significant associations with the iron status. The severity of the iron deficiency did not relate to these cognitive variables either. Twenty-three and 8 co-variables showed statistically significant associations with educational performance and intelligence respectively. Following a multiple regression analysis intelligence, the enthusiasm of the student towards learning, occupational ambition, household possession, problems at home and private tuition for mathematics were key factors predicting educational performance. Stunting and educational level of the mother were important factors influencing intelligence. CONCLUSION: Iron status does not play a major role in educational performance and intelligence of school going adolescents. Several factors affect educational performance and intelligence. This study highlights the difficulty in extrapolating the findings of similar studies to different ecological settings.

Health and social status of an elderly urban population in Sri Lanka.

Although Sri Lanka has generally a young demographic profile, with decreasing overall mortality and birth rates, its population is aging gradually and will continue to do so in the future. In order to have an idea of the needs of the elderly a survey was conducted in a sample of randomly selected Sinhalese elders living in an urban community. Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) assessments were done. Ten percent of the respondents had at least one ADL impairment. Another ten percent had only IADL impairment. The commonest ADL to be affected were bathing and feeding. Children and the family provide all care for the impaired elderly. The family support system should be encouraged and assisted to prevent the necessity for more formal and expensive institutional care. A large proportion of the elderly were handicapped with defects in vision and hearing and the absence of teeth. Correction of these defects would improve both quality of life of these subjects and reduce their risk of accidents.

Prevalence of diabetes mellitus and impaired glucose tolerance in a rural Sri Lankan community.

The prevalence of diabetes mellitus and impaired glucose tolerance (IGT) in a rural Sri Lankan community adopting the World Health Organization (WHO) criteria were 2.5% and 8% respectively. The low socioeconomic status, adequate physical exercise and the low prevalence of obesity appear to have not only contributed to the low prevalence of diabetes but also has prevented progression from IGT to overt diabetes.

Health aspects of an urban elderly population.

The health status of an urban elderly Sinhala population ordinarily resident in their homes was investigated by interview and physical examination. Just over one fifth of the subjects had been hospitalised at least once for an episode of illness during the previous 12 months. 47.7% of the subjects complained of impaired vision, and 12.8% had cataract; 45.0% had less than the minimum number of teeth required for proper mastication; 24.8% of the subjects had impaired hearing. Medical histories showed that 10.1% of the subjects suffered from haemorrhoids; 2.0% were hemiplegic. A random single blood pressure recording showed 34.2% of the subjects to have a diastolic blood pressure of 95 mm Hg or more. 9.4% of the subjects had glucosuria. With the high morbidity seen among this elderly population a case is made for the establishment of geriatric clinics in government hospitals, and that care of the elderly be included in the Primary Health Care programme of Sri Lanka.