Some sociological aspects of cutaneous leishmaniasis in patients attending a tertiary referral centre in Colombo, Sri Lanka.

Over 1800 clinically suspected cases of cutaneous leishmaniasis have been referred to the Department of Parasitology, Faculty of Medicine, Colombo, Sri Lanka for investigation since 2001. This study analyses some sociological aspects of 120 patients with laboratory confirmed cutaneous leishmaniasis. This information is important to design and implement control programmes. The disease was predominant among males. In females lesions occurred mainly on the face, while in men they were seen mainly on the limbs. Immediate medical advice was sought by 13% of the population; the others sought treatment when the skin lesion grew or failed to heal. Females delayed seeking treatment as they probably misinterpreted the lesion as a pimple. Only 39% were referred to a Consultant Dermatologist by a medical officer during the first visit. The mean duration of time from the detection of the lesion to referral was approximately eight months. Psychologically, the presence of the lesion affected less than 20% of individuals. Costs related to treatment were relatively low in Sri Lanka. Late presentation and diagnostic delay was related to lack of awareness. Educational programmes should be carried out, aimed both at health care workers and the community to ensure early diagnosis and treatment for cutaneous leishmaniasis.

Sleeping arrangements under long-lasting impregnated mosquito nets: differences during low and high malaria transmission seasons.

Sleeping arrangements under long-lasting impregnated nets (LLIN) were recorded in 2467 households during the low malaria transmission season (May-June 2007) and the same families were followed up during the high malaria transmission season (December 2007-January 2008) in two malaria-endemic areas of Sri Lanka. Approximately 800 households each from the three main ethnic groups were studied. The number of families lost to follow-up was 68. A significant increase was seen in the proportion of households using LLINs the previous night during the high transmission season (96%) compared with the low transmission season (90%) (P< or =0.001 for all three ethnic groups). When sleeping arrangements of the entire population were considered, priority to sleep under the LLIN was given to children under 5 years during both seasons. The percentage of children under five who slept under a LLIN increased from 75% during the low transmission season to 90% during the high transmission season. Utilisation of LLINs by pregnant women was low; only approximately 45% of pregnant women reported sleeping under a LLIN during both seasons. The study suggests the possible need for re-focusing of health education messages regarding the importance of LLIN use among pregnant women.

Development of a screening instrument to detect physical abuse and its use in a cohort of pregnant women in Sri Lanka.

The objective of this study was to develop and validate a screening instrument (Abuse Assessment Questionnaire) to estimate the prevalence of physical abuse in a cohort of pregnant women in a district of Sri Lanka. The samples of 1200 pregnant women were identified by using a cluster sampling technique. Public health midwives (primary healthcare workers) were selected as interviewers and the antenatal clinic was identified as the setting to identify physical abuse. The reliability and validity (sensitivity 85.7%; specificity 89.7%) of the screening instrument proved to be high. The prevalence of physical abuse in categories 'ever-abuse', 'current abuse' and 'current pregnancy'were 18.3%, 10.6% and 4.7% respectively. In addition, 'current sexual abuse' was reported by 2.7% of women. The prevalence rates indicate that the physical abuse of women is a significant public health problem. The Abuse Assessment Questionnaire, administered by public health midwives, proved valuable in detecting physical abuse in pregnant women. If this instrument is used universally to screen Lankan women for physical abuse in antenatal clinics, it has good potential for early detection and intervention.

Safe motherhood in Sri Lanka: a 100-year march.

The present safe motherhood status in Sri Lanka has been achieved by a series of activities for health and social development during the past century. While ancient and traditional religious, as well as cultural concepts provided a sound foundation, it was the policies that focused on human development that resulted in reducing the maternal mortality rate to 2.4 per 10000 live births, and the infant mortality rate to 16.5 per (1000) live births. Maternal and Child Health (MCH) services were initially closely linked to improvements in the healthcare infrastructure and social development, while family planning introduced in 1953 enhanced its progress further. With MCH integrated into reproductive health, the march towards a safer motherhood in Sri Lanka will require the implementation of new policies and strategies.

Risk factors of acute lower respiratory tract infections in children under five years of age.

This study attempted to identify the determinants of acute lower respiratory-tract infections (ALRI) among children under five years of age, by comparing hundred children hospitalized with ALRI with a control group. Data on socio-demographic, biological and environmental characteristics were collected by interviewing mothers and anthropometric measurements were carried out to assess the nutritional status of the children. Risk of disease in the presence of each exposure was calculated in the univariate analysis and the best explanatory variables among them were identified in the multivariate analysis. The following variables were found to increase the risk of ALRI: (1) history of wheezing, (2) low birth weight, (3) passive smoking, (4) male sex, (5) delivery by cesarean section (6) sharing of sleeping space, (7) not being exclusively breast fed upto the completion of four months, (8) stunting, (9) having pets. The findings highlight some simple strategies which would help in prevention of ALRI.

Incidence of induced abortion determined by the randomised response technique.

OBJECTIVE: To estimate the incidence of induced abortion using the randomised response technique, and to compare the results with estimates obtained by direct questioning. DESIGN: Cross-sectional study. SETTING: Medical Officer of Health area, Homagama. SUBJECTS: Married women in the reproductive age group. RESULTS: The annual incidence of induced abortion for the three year period 1988 to 1990 was 15.7 per 1000 married women of the reproductive age group as estimated by the randomised response technique. Direct questioning led to 30.5% under-reporting of induced abortion. The application of the method failed only in 8.1% of the population studied. CONCLUSIONS: The randomised response technique is a feasible method to use in our population and provides the best estimates of induced abortion.

PIP: The objective was to estimate the incidence of induced abortion using the randomized response technique, and to compare the results with estimates obtained by direct questioning in a cross-sectional study. The Medical Officer of Health area of Homagama, Sri Lanka, was chosen for study. The sample consisted of all married women of reproductive age (MWRA) living in every other house within the study area. In the first stage, a total of 16,770 of the MWRA group were interviewed by surveying a population of 109,901 about their abortion experiences during the 3 calendar years preceding the survey, 1988-1990. 909 women reported at least 1 abortion during this period. From among those not reporting an abortion, a control was chosen for each case, matched for year of birth and year of marriage. Thus 1818 women were chosen for the second stage of study, which was performed 3 months later. Of these, 836 cases and 802 controls (1638 MWRA) were interviewed (a 90% response rate). During the second stage of the study, a detailed pregnancy history was obtained, and subsequently the RRT was applied to this population. For induced abortions the crude abortion rate for 1990 was 1.8/1000 population, while the general abortion rate was 11.9/1000 MWRA. The abortion ratio was 11.7/100 live births and 9.6/100 pregnancies. The age specific abortion rates were highest in the 15-19 age group and lowest in women aged 40 or over. Of the 16,770 MWRA interviewed in the first stage, 548 admitted to an induced abortion in the period 1988-1990 when questioned directly during the second stage, giving an average induced abortion rate of 10.89/1000 MWRA. Of the 1638 MWRA who were interviewed in the second stage of the study, the RRT technique could be applied only to 1504 (91.8%). The estimated average induced abortion rate for 1988-1990 was 15.68/1000 MWRA/year. Direct questioning led to a 30.5% rate of underreporting of induced abortion.