Evaluation of flood preparedness in government healthcare facilities in Eastern Province, Sri Lanka.

BACKGROUND: Sri Lanka is vulnerable to floods and other hydro-meteorological disasters. Climate change is projected to increase the intensity of these events. OBJECTIVE: This study aimed to assess the flood preparedness in healthcare facilities in Eastern Province. DESIGN: This was a cross-sectional, descriptive, mixed methods study conducted in Trincomalee District. Surveys were conducted in 31 government healthcare facilities, using a pre-tested, structured questionnaire covering the last 5 years. Seven in-depth interviews were conducted with randomly selected Medical Officers in Charge or their equivalent, and 3 interviews were conducted with Medical Offices of Health. RESULTS: Two general hospitals, 3 base hospitals, 11 divisional hospitals, and 15 primary care units were included. Six respondents (19.4%) reported flooding in their facility, and 19 (61.3%) reported flooding in their catchment area. For the health workforce, 77.4% of respondents reported not enough staff to perform normal service delivery during disasters, and 25.5% reported staff absenteeism due to flooding. Several respondents expressed a desire for more disaster-specific and general clinical training opportunities for themselves and their staff. Most respondents (80.7%) reported no delays in supply procurement during weather emergencies, but 61.3% reported insufficient supplies to maintain normal service delivery during disasters. Four facilities (12.9%) had disaster preparedness plans, and 4 (12.9%) had any staff trained on disaster preparedness or management within the last year. One quarter (25.8%) of respondents had received any written guidance on disaster preparedness from the regional, provincial, or national level in the last year. CONCLUSIONS: While there is a strong health system operating in Sri Lanka, improvements are needed in localized and appropriate disaster-related training, resources for continuing clinical education, and investments in workforce to strengthen flood and other disaster resilience within the government healthcare system in the study district.

Knowledge of diabetes among type 2 diabetes patients attending a primary health care clinic in Sri Lanka.

Patients' knowledge about their illness is considered important in controlling diabetes and preventing complications. A descriptive, cross-sectional study was conducted among patients attending the diabetes clinic of a primary care level hospital in Moratuwa, Sri Lanka. During a 1-month period in 2009 all consenting patients diagnosed with type 2 diabetes who had been attending the clinic for more than 3 months were included in the study. Using an interviewer administered, structured questionnaire 150 patients (135 females, 15 males) answered 25 questions about diabetes knowledge (scored x4 to give score range 0-100). A majority of patients (70.0%) had a good score (> 65) on the knowledge test but critical gaps in knowledge were revealed, especially regarding knowledge about symptoms of poor control and importance of regular follow-up. Although patients with longer duration of diabetes had higher mean knowledge scores, they also had higher fasting blood glucose levels. Education programmes are needed to address critical gaps in patients' knowledge.

Knowledge of diabetes among type 2 diabetes patients attending a primary health care clinic in Sri Lanka

Patients' knowledge about their illness is considered important in controlling diabetes and preventing complications. A descriptive, cross-sectional study was conducted among patients attending the diabetes clinic of a primary care level hospital in Moratuwa, Sri Lanka. During a 1-month period in 2009 all consenting patients diagnosed with type 2 diabetes who had been attending the clinic for more than 3 months were included in the study. Using an interviewer administered, structured questionnaire 150 patients [135 females, 15 males] answered 25 questions about diabetes knowledge [scored 4 to give score range 0-100]. A majority of patients [70.0%] had a good score [> 65] on the knowledge test but critical gaps in knowledge were revealed, especially regarding knowledge about symptoms of poor control and importance of regular follow-up. Although patients with longer duration of diabetes had higher mean knowledge scores, they also had higher fasting blood glucose levels. Education programmes are needed to address critical gaps in patients' knowledge

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.