Capacity-building of the allied health workforce to prevent and control diabetes: lessons learnt from the National Initiative to Reinforce and Organize General Diabetes Care in Sri Lanka (NIROGI Lanka) project

In 2008, to tackle the exponential rise in the clinical burden of diabetes that waschallenging the health systems in Sri Lanka, a shift in focus towards patientcentred care linked with community health promotion was initiated by the NationalInitiative to Reinforce and Organize General Diabetes Care in Sri Lanka (NIROGILanka) project of the Sri Lanka Medical Association. Specific training of “diabeteseducator nursing officers” (DENOs), field staff in maternal and child health, footweartechnicians, and health promoters from the community, was instituted to improveknowledge, skills and attitudes in the area of control and prevention of diabetes.This article highlights some of the activities carried out to date with the allied healthworkforce and volunteer community. Specifically, it describes experiences withthe DENO programme: the educational and administrative processes adopted,challenges faced and lessons learnt. It also highlights an approach to preventionand management of complications of chronic diabetic foot through training acohort of prosthetics and orthotics technicians, in the absence of podiatrists, andan initiative to provide low-cost protective footwear. Harnessing the enthusiasmof volunteers – adults and schoolchildren – to address behavioural risk factorsin a culturally appropriate fashion has also been a key part of the NIROGI Lankastrategy.

Annual risk of tuberculosis infection in Sri Lanka: a low prevalent country with a high BCG vaccination coverage in the South-East Asia Region

Introduction: Despite its simplicity, efficiency and reliability, Sri Lanka has notused the Annual Risk of Tuberculosis Infection (ARTI) to assess the prevalenceand efficiency of tuberculosis (TB) control. Hence, a national tuberculin surveywas conducted to estimate the ARTI.Materials and Methods: A school‑based, cross‑sectional tuberculin survey of4352 children aged 10 years irrespective of their BCG vaccination or scar statuswas conducted. The sample was selected from urban, rural and estate strata usingtwo‑stage cluster sampling technique. In the first stage, sectors representing threestrata were selected and, in the second stage, participants were selected from120 clusters. Using the mode of the tuberculin reaction sizes (15 mm) and themirror‑image technique, the prevalence and the ARTI were estimated.Results: The prevalence of TB estimated for urban, rural and estate sectors were13.9%, 2.2% and 2.3%, respectively. The national estimate of the prevalenceof TB was 4.2% (95% CI = 1.7-7.2%). ARTI for the urban, rural and estatesectors were 1.4%, 0.2% and 0.2%, respectively, and the national estimate was0.4% (95% CI = 0.2-0.7%). The estimated annual burden of newly infected orre‑infected TB cases with the potential of developing into the active disease(400/100 000 population) was nearly 10‑fold higher than the national new casedetection rate (48/100 000 population).Conclusion: The national estimate of ARTI was lower than the estimates for manydeveloping countries. The high‑estimated risk for the urban sector reflected theneed for intensified, sector‑specific focus on TB control activities. This underscoresthe need to strengthen case detection. Repeat surveys are essential to determinethe annual decline rate of infection.