Delay in diagnosis to treatment and impact on survival of gastric adenocarcinoma in a low income setting without screening facility.

The treatment modality of gastric adenocarcinoma (GCA) depends on the stage of the disease at the clinical presentation. Long delays are probably an unfavorable factor for the patient's prognosis. A prospective longitudinal, study involving 145 consecutive GCA was conducted at the National Hospital of Sri Lanka (NHSL). The overall delay (in weeks) was recorded for each patient and divided into four periods-patient, endoscopy, pathology and treatment. The median and Interquartile Range (IQR) duration of delays were calculated and differences were explored with chi square test and Mann Whitney U test Survival analysis was done with Kaplan Meier technique and Cox regression. The median duration of delays for patient, endoscopy, histology reporting delay, other histology delay (specimen transfer delay and report receipt delay) and treatment were 18 (IQR 14-27), 2 (IQR 2-3), 3 (IQR 2-3), 2 (IQR 1-2) and 6 (IQR 4-8) weeks respectively. Delayed patient presentation to hospital was associated with significant adverse median survival 16 (IQR 11.5-22.5) weeks versus 20 (IQR 16-27.5) weeks, p = 0.004. Delay in initiating treatment was associated with significantly lower median survival 04 (IQR 4-6) weeks versus 06 (IQR 4-8) weeks, p = 0.003. Over 60% of both proximal and distal GCA presented at an advanced radiological stage (stage III/IV). The Kaplan Meier analysis showed that the higher hazard function was associated with a higher tumour stage and undergoing chemotherapy. Age of the patient and the treatment modality were significant predictors of the survival. Patient delay and delay in initiation of definitive treatment are the most important factors that adversely affect the outcomes of GCA. Public health interventions aiming to shorten the patient delay time with proper referral for specialist care would play an important role. Also, it is important to minimize these preventable delays and there should be time limits in producing the histopathology report and to establish online portals of hospital and laboratory information systems for easy access of histology reports in future.

Betel chewing among bus drivers in Jaffna district

Objective: To assess the prevalence, pattern and sociocultural factors associated with betel chewing among bus drivers in Jaffna district. Methodology: Cross-sectional study was conducted among 423 registered drivers using an interviewer administered questionnaire from March to April 2014. Results: All were males. Mean age of the respondents was 41.42 years (SD= ±10.3; range 20-65). The overall prevalence of betel chewing was 70.4%. Of the total 9.4% had chewed betel in the past. Of the current users 61% had chewed betel for more than 5 years. Betel was chewed daily by 89.2%. (of them 60.8% used ≤3 times). Almost all current chewers used areca nut. Fifty five percent of the drivers said they used betel to improve concentration while driving. Seventy five percent of those who used betel in the past said that staining of teeth was the reason for stopping the habit. Private bus drivers were more likely to chew betel while driving than SLTB drivers (p=0.002). Conclusion: The prevalence of betel chewing among bus drivers in Jaffna District was high. Majority had chewed betel for more than five years. Areca nut was a main ingredient of betel quid.

Prevalence of antenatal risk conditions among women in an underserved district of Northern Sri Lanka.

OBJECTIVE: To assess the prevalence of risk conditions among antenatal women in the Vavuniya District. DESIGN AND SETTING: A cross-sectional study was conducted among 392 pregnant women who had completed 36 weeks of gestation and were admitted or referred to two leading hospitals in the district. MEASUREMENTS: Women were interviewed consecutively using a questionnaire, and their antenatal details were extracted from records by trained investigators. Data on socio-demographics, antenatal care utilisation, risk condition in present and past pregnancies, and preexisting illnesses were obtained. RESULTS: Prevalence of an antenatal risk condition was 52.0%. The common risk conditions included teenage (9.7%) or elderly mother (14.3%), anaemia (8.2%) and abnormal BMI (8.2%). The common risk conditions due to past pregnancy were: history of abortion (19.3%), past caesarean delivery (8.0%), and stillbirth/neonatal death (4.8%). Less than half of the 'at risk' mothers were educated regarding the risk condition (47.5%) or referred to (48.5%) by the primary care providers. The majority was advised to deliver at a facility with emergency obstetric care. CONCLUSIONS: One in every two pregnancies in the Vavuniya District had an antenatal risk condition and services should be organised to meet this need.