Quality of life and its associated factors among home-dwelling older people residing in the District of Colombo, Sri Lanka: a community-based cross-sectional study.

INTRODUCTION: This community-based cross-sectional study explored the factors affecting overall and domain-specific (physical health, psychological health, social relationships and environmental) quality of life (QOL) of home-dwelling older residents of the District of Colombo, Sri Lanka. METHODS: A representative sample (n=723) of older adults aged >65 years was obtained by the multistage cluster sampling technique. QOL was assessed using the validated Sinhala version of WHOQOL BREF Questionnaire. Data analysis was done using SPSS V.20. RESULTS: The mean±SD age was 72.23±6.3 years with the overall QOL score being (mean±SD) 56.73±12.57/100. The mean±SD QOL score of physical health, psychological health, social relationships and environmental domains were 55.81±15.80, 59.25±14.68, 46.36±20.08 and 64.61±11.96, respectively. The overall QOL in the adjusted model showed a significant positive association with the educational status, living conditions (with spouse, with spouse and children), participation in religious activities, being visited by friends or relatives and financial independence. The overall QOL was negatively associated with limitations in activities of daily living and instrumental activities of daily living, chronic arthritis and heart disease in the adjusted model. Living with the spouse was positively associated with the psychological domain of QOL. Osteoporosis and chronic arthritis affected the physical health domain, while cancer and disabling stroke affected the psychological domain of QOL negatively. All statistical significances were considered at p<0.05. CONCLUSION: The overall QOL of home-dwelling elders of the Colombo District is moderate, with the lowest score being in social relationships and the highest in the environmental domain. Educational status, engaging in religious activities and financial independence are key factors associated with a better QOL. Limitations in physical activity and chronic diseases are associated with a reduced QOL. Living with the spouse is a key factor associated with the psychological health domain.

Efficacy and safety of Sri Lankan traditional medicine regimen for knee osteoarthritis: study protocol for an open-label, active comparator, randomized controlled trial.

BACKGROUND: Knee osteoarthritis (KOA) is the most common form of arthritis, causing disability and impaired quality of life especially in the elderly. Sri Lankan traditional medicine (STM) is widely used to treat OA, but no clinical trial evaluated on STM regimens for KOA to discuss their safety and efficacy in the treatment. The aim of this study is to compare the efficacy and safety of STM regimen for KOA in comparison to recommended conventional pain management therapy over a period of 8 weeks on relieving the condition. STUDY DESIGN: This is a clinical trial following a protocol-driven open-labeled randomized controlled study enrolling patients with KOA that will be conducted as a single-center trial in the National Ayurveda Teaching Hospital, Sri Lanka. Rasnadvigunabhagasaya herbal decoction (RDBD) and an herbal pill Yoaraja Guggulu were selected as the rescue medication for treating joint disorders. The two Ayurvedic dosage forms will be tested against the non-steroidal anti-inflammatory drugs tab paracetamol and tab ibuprofen as the rescue medication for their safety and efficacy. As test products for external application, oil with an herbal fomentation-Kumburuetaperumkayam Pottani (KAP)-and paste-Sandivadam Lepaya (SVL)-were selected. External applications will be tested against the diclofenac sodium gel and hot water fomentation. KOA patients will be allocated randomly into two arms, and the medications will be given orally for 60 days and externally for 30 days. The primary endpoint is the change in the score on the WOMAC after 08 weeks. WOMAC and KOOS will be recorded and compared between the two arms prior to visiting 1, at the end of 15 days and end of 30 days, and end of the 45 days and end of the second month and 3 months of follow-up. KOOS and WOMAC subscales, a pain disability index, a visual analog scale for pain and sleep quality, and a quality-of-life index are used as secondary outcome measurements. DISCUSSION: This clinical trial will be able to provide evidence-based scientific data on Sri Lankan traditional medicine regimens in the management of KOA. This trial is expected to develop capacity to scientifically evaluate various STM that are claimed to have efficacy in treatment of various disease conditions. TRIAL REGISTRATION: ISRCTN58050062 .

Characterization of Recalcitrant Dermatophytosis in a Multicenter Study in Sri Lanka.

A changing clinical scenario of dermatophytosis has been observed in Sri Lanka during the past few years. In keeping with the trend described in India, an increase in the number of chronic, relapsing, and recalcitrant infections has been noted. The objective of our study was to assess the therapeutic response of dermatophytosis to standard antifungal treatment in Sri Lanka and to identify possible contributory factors in cases showing inadequate therapeutic response. A descriptive, observational, cross-sectional study was carried out in nine hospitals, representing each province. Over 6 months, patients with dermatophytosis on glabrous skin were included. All subjects underwent skin scrapings for mycological studies and were treated with a standard course of antifungals for a specific period. In those patients who achieved complete clearance, recurrences were noted. The study included 796 patients, of whom 191 (24%) had symptoms for more than 3 months at presentation. A total of 519 patients (65.2%) had multiple-site involvement, and 503 (63.2%) had evidence of prior use of topical steroids. Skin scrapings were positive for fungal elements in the direct smears of 659 patients (82.8%), and the predominant dermatophyte isolated was Trichophyton mentagrophytes (65.6%). Partial responders after 10 weeks of treatment and recurrences after complete clearance were significantly greater in the group that used topical steroids before presentation (P < 0.001). This study highlights the magnitude of the threat of an inadequate therapeutic response in dermatophytosis in Sri Lanka, and identifies steroid misuse, and the shift of the predominant fungal species to T. mentagrophytes as possible causative factors.

Effectiveness of a health promotion intervention to address determinants of child neglect in a disadvantaged community in Sri Lanka.

BACKGROUND: Child neglect is a form of child maltreatment and it is a neglected area of research. As similar to other forms of maltreatment, neglect also results in negative health outcomes for children. Child neglect is concentrated in disadvantaged communities. The community-centered health promotion approach empowers communities to identify and address determinants of perceived health issues. This study aimed to implement a health promotion intervention to enable a disadvantaged community to address determinants of child neglect and evaluate the effectiveness of the intervention. METHODS: A quasi-experimental study design was used. Two disadvantaged communities in Anuradhapura District, Sri Lanka with similar socio-demographic characteristics were purposively selected as the experimental and control study settings. The mothers who have at least one child in the age range 5-18 years were included in the sample. The sample included 42 mothers from the experimental group and 44 mothers from the control group. The elder children of mothers in the experimental group were selected to be the agents of change. A health promotion intervention was implemented only with the experimental setting. The steps of the intervention included; (1) identifying prevention of child neglect as a goal, (2) understanding the determinants, (3) analyzing determinants and identifying actions and (4) implementing and modifying the actions. The total study duration was 1 year, with the intervention taking an average of 6 months. Data were collected at both pre and post-intervention phases from mothers and children through interviewer-administered questionnaires. RESULTS: Mothers of the experimental group improved their knowledge on child neglect significantly in comparison to the control group (p < 0.05). In the post-intervention phase, there were significant differences in attitudes related to child neglect between experimental and control groups (p < 0.05). Following the health promotion intervention, mothers of the experimental group had significantly improved their practices related to the safety, education, nutrition of children, relationships with the child and social support for child caring (p < 0.05) when compared with the control group. CONCLUSIONS: The health promotion intervention was effective in addressing the selected determinants of child neglect in a disadvantaged community. Children could act as active agents of change to deliver the interventions to their mothers (perpetrators).

Perceived social and built environment associations of leisure-time physical activity among adults in Sri Lanka.

OBJECTIVE: Although perceived neighbourhood environment is considered a predictor of leisure-time physical activity (LTPA), evidence for this is limited in South Asia. Thus, the aim was to determine the association between neighbourhood social and built environment features in carrying out LTPA among adults in Colombo District, Sri Lanka. A cross-sectional study among 1320 adults was carried out using validated questionnaires for physical activity (PA) and built environment data collection. Multiple logistic regression analysis was conducted to assess the associations between environment characteristics and LTPA after adjusting for gender, age, employment status, income level and sector of residence. RESULTS: A total of 21.7% of adults participated in some LTPA. The commonest type of LTPA was walking; carried out by 14.5%. Moderate and vigorous activity at leisure was carried out by 10.3% and 3.9% respectively. Perceived social acceptance for PA was positively associated with LTPA. Out of the built environment characteristics perceived infrastructure for walking, and recreational facilities for PA were negatively associated with LTPA. Self-efficacy emerged as an important positive correlate of LTPA. The participants were positively influenced by the self-efficacy and perceived social environment which should be addressed when promoting LTPA.

Evaluation of the Good Start Program: a healthy eating and physical activity intervention for Maori and Pacific Islander children living in Queensland, Australia.

BACKGROUND: Reducing the prevalence of obesity and chronic disease are important priorities. Maori and Pacific Islander communities living in Australia have higher rates of obesity and chronic disease than the wider Australian population. This study aims to assess the effectiveness of the Good Start program, which aims to improve knowledge, attitudes and practices related to healthy eating and physical activity amongst Maori and Pacific Islander communities living in Queensland. METHODS: The intervention was delivered to children aged 6-19 years (N = 375) in schools by multicultural health workers. Class activities focused on one message each term related to healthy eating and physical activity using methods such as cooking sessions and cultural dance. The evaluation approach was a quantitative uncontrolled pre-post design. Data were collected each term pre- and post-intervention using a short questionnaire. RESULTS: There were significant increases in knowledge of correct servings of fruit and vegetables, knowledge of sugar and caffeine content of common sugar-sweetened drinks, recognition of the consequences of marketing and upsizing, and the importance of controlling portion size (all P < 0.05). There was also increases in knowledge of physical activity recommendations (P < 0.001), as well as the importance of physical activity for preventing heart disease (P < 0.001) and improving self-esteem (P < 0.001). In terms of attitudes, there were significant improvements in some attitudes to vegetables (P = 0.02), and sugar-sweetened drinks (P < 0.05). In terms of practices and behaviours, although the reported intake of vegetables increased significantly (P < 0.001), the proportion of children eating discretionary foods regularly did not change significantly, suggesting that modifying the program with an increased emphasis on reducing intake of junk food may be beneficial. CONCLUSION: The study has shown that the Good Start Program was effective in engaging children from Maori and Pacific Island backgrounds and in improving knowledge, and some attitudes and practices, related to healthy eating and physical activity. The evaluation contributes valuable information about components and impacts of this type of intervention, and considerations relevant to this population in order to successfully change behaviours and reduce the burden of chronic disease.

Pattern of Physical Activity Among Sri Lankan Adults in the District of Colombo: A Cross-sectional Study.

Physical inactivity is a modifiable risk factor of many non-communicable diseases. The aim of this study was to assess the pattern of physical activity among Sri Lankan adults in the district of Colombo, Sri Lanka. The study was carried out among a sample of 1320 adults aged 20 to 59 years, selected using stratified, cluster sampling method. Physical activity was assessed using the long form of the International Physical Activity Questionnaire validated for Sri Lanka. The prevalence of sufficient physical activity was 82.0% (CI = 78.5-85.0) for males and 79.7% (CI = 76.5-82.6) for females. The odds of having sufficient activity were lower with increase in the level of urbanisation. Activity was achieved mainly through domestic and transport related activity. Only 21.7% carried out at least some activity for leisure. As Sri Lanka continues to urbanize, it is important to find strategies to increase the level of activity especially at leisure.

Development and validation of a tool to assess the physical and social environment associated with physical activity among adults in Sri Lanka.

BACKGROUND: Environmental characteristics are known to be associated with patterns of physical activity (PA). Although several validated tools exist, to measure the environment characteristics, these instruments are not necessarily suitable for application in all settings especially in a developing country. This study was carried out to develop and validate an instrument named the "Physical And Social Environment Scale--PASES" to assess the physical and social environmental factors associated with PA. This will enable identification of various physical and social environmental factors affecting PA in Sri Lanka, which will help in the development of more tailored intervention strategies for promoting higher PA levels in Sri Lanka. METHODS: The PASES was developed using a scientific approach of defining the construct, item generation, analysis of content of items and item reduction. Both qualitative and quantitative methods of key informant interviews, in-depth interviews and rating of the items generated by experts were conducted. A cross sectional survey among 180 adults was carried out to assess the factor structure through principal component analysis. Another cross sectional survey among a different group of 180 adults was carried out to assess the construct validity through confirmatory factor analysis. Reliability was assessed with test re-test reliability and internal consistency using Spearman r and Cronbach's alpha respectively. RESULTS: Thirty six items were selected after the expert ratings and were developed into interviewer administered questions. Exploration of factor structure of the 34 items which were factorable through principal component analysis with Quartimax rotation extracted 8 factors. The 34 item instrument was assessed for construct validity with confirmatory factor analysis which confirmed an 8 factor model (x2 = 339.9, GFI = 0.90). The identified factors were infrastructure for walking, aesthetics and facilities for cycling, vehicular traffic safety, access and connectivity, recreational facilities for PA, safety, social cohesion and social acceptance of PA with the two non-factorable factors, residential density and land use mix. The PASES also showed good test re-test reliability and a moderate level of internal consistency. CONCLUSIONS: The PASES is a valid and reliable tool which could be used to assess the physical and social environment associated with PA in Sri Lanka.