Achala Upendra Jayatilleke

Working Conditions of Bus Drivers in the Private Sector and Bus Crashes in Kandy District, Sri Lanka: A Case–Control Study

Objective: To explore the effects of working conditions of private-bus drivers on bus crashes in Kandy district, Sri Lanka. Methods: A case–control study was carried out from August to September 2006. All private-bus drivers registered in Kandy district and involved in crashes reported to the police between November 2005 and April 2006 (n = 63) were selected as cases. Two control groups were included: private-bus drivers working on the same routes as the case drivers (n = 90) and private-bus drivers selected randomly from other routes of the district (n = 111). Data were collected using an anonymous self-administered questionnaire. Associations between working conditions and crashes were analysed using logistic regression. Results: A strong association was observed between drivers’ disagreements about working hours and bus crashes (matched controls, adjusted odds ratio (AOR) 5.98, 95% CI 1.02 to 34.90; unmatched controls, AOR 18.74, 95% CI 2.00 to 175.84). A significant association was also observed between low salaries (<US

Feasibility of standardized injury surveillance and reporting: a comparison of data from four Asian nations

100) and private-bus crashes (matched controls, AOR 1.01, 95% CI 0.40 to 2.54; unmatched controls, AOR 3.09, 95% CI 1.26 to 7.57). Conclusions: Drivers’ disagreements about working hours and low salaries were significant risk factors for private-bus crashes in Kandy district, Sri Lanka. Therefore, new legislation for private-bus owners on the working hours and salaries of their drivers to prevent private-bus crashes is recommended.

Training Sri Lankan public health midwives on intimate partner violence: a pre- and post-intervention study

Background: To address the increasing number of injuries in developing countries, the World Health Organization (WHO) encourages the establishment of hospital-based surveillance systems and systematic data collection. Although a computerized system is preferable in terms of efficiency, many developing countries have difficulty accessing the appropriate resources. Objectives: To assess the possibility of comparing and sharing data among countries, and then to discuss the possibility of establishing an international data management system through the internet. Methods: A point-by-point comparison of data directories from injury surveillance systems in Thailand, Cambodia, Sri Lanka, and Japan was conducted using guidelines published by WHO as the standard. Results: Thailand, Cambodia, and Sri Lanka used data items that are comparable to each other and to WHO guidelines, with few, readily amenable, differences. The Japanese system used quite different data items. Conclusions: Data comparability suggests the feasibility of a global data management system that can store data from various countries. Such a system, if made accessible over the internet, would benefit resource-constrained countries by providing them with a ready-made framework to implement a surveillance system at low cost.

Wives’ Attitudes Toward Gender Roles and Their Experience of Intimate Partner Violence by Husbands in Central Province, Sri Lanka

BackgroundIn many developing countries, intimate partner violence (IPV) training is not available for health providers. As a pioneer among developing countries, in 2009, the Sri Lankan Ministry of Health trained a group of community health providers known as public health midwives (PHMs) on IPV. We evaluated that training program’s efficacy in improving PHMs’ identification and management of IPV sufferers in Kandy, Sri Lanka.MethodsWe conducted this study from August 2009 to September 2010. We used a self-administered structured questionnaire to examine the following variables among 408 PHMs: self-reported IPV practices, IPV knowledge, perceived barriers, perceived responsibility, and self-confidence in identifying and assisting IPV sufferers. We used McNemar’s test to compare PHMs’ pre- and post-intervention IPV practices. Using the Wilcoxon signed-rank test, we compared PHMs’ pre-and post-intervention IPV knowledge, as well as their perceived barriers, responsibility, and self-confidence scores.ResultsThe IPV training program improved PHMs’ IPV practices significantly. Six months after the intervention, 98.5% (n = 402) of the 408 PHMs identified at least one IPV sufferer in the previous three months, compared to 73.3% (n = 299) in the pre-intervention (p < 0.001). At post-intervention, 96.5% (n = 387) of the PHMs discussed IPV with identified sufferers and suggested solutions; only 67.3% (n = 201) did so at the pre-intervention (p < 0.001). In addition, after the intervention, there were significant increases (p < 0.001) in the median total scores of PHMs’ IPV knowledge (0.62 vs. 0.88), perceived responsibility (3.20 vs. 4.60), and self-confidence (1.81 vs. 2.75). PHMs’ perceived barriers decreased from 2.43 to 1.14 (p < 0.001).ConclusionsAn IPV training program for PHMs improved identification and assistance of IPV sufferers in Kandy, Sri Lanka. This training program has the potential to improve PHMs’ skills in preventing IPV and supporting sufferers in other regions of Sri Lanka. Other developing countries might learn lessons from Sri Lanka’s IPV training.

Road traffic crashes, injury and fatality trends in Sri Lanka: 1938-2013

The authors conducted a community based, cross-sectional study to describe the prevalence of intimate partner violence (IPV) by husbands and the association between wives’ attitudes toward gender roles and their experience of IPV in Central Province, Sri Lanka. This article included a representative sample of 624 wives between 15 and 49 years of age and examined the prevalence of physical, psychological, and sexual abuse. Then, using multivariate logistic regression analysis, the authors examined the association between wives’ attitudes toward gender roles and IPV. Of the 624 wives, 36% had experienced at least one episode of physical, psychological, or sexual abuse by their husbands during their life time (ever abuse), and 19% had experienced such abuse during the past 12 months (current abuse). The wives were less likely to experience current abuse by husbands if they believed that “outsiders should not intervene to protect abused wives.” They were more likely to experience ever and current isolated psychological abuse by husbands if they did not believe that “a good wife always obeys her husband.” This study suggests that the prevalence of IPV is high in Sri Lanka. Although several published studies on IPV suggest that traditional gender role attitudes tend to increase women’s vulnerability to IPV, this study suggests that in Sri Lanka, the wives who respect cultural norms tend to experience less IPV by husbands.

Risky Driving Behaviours of Three-Wheeler Drivers and Three-Wheeler Crashes in Sri Lanka: A Case–Control Study

Abstract Objective To analyse trends in road traffic crashes, injuries and fatalities over 75 years in Sri Lanka. Methods Data on road traffic crashes, injuries and fatalities between 1938 and 2013 were obtained from the Police Statistics Unit. Rates per 100 000 population were calculated and trends were analysed using joinpoint regression analysis. Findings Road traffic crashes and injuries rose substantially between 1938 and 2013: annual crashes increased from 61.2 to 183.6 per 100 000 people; injuries, from 35.1 to 98.6 per 100 000; and fatalities, from 3.0 to 10.8 per 100 000 people per year. Joinpoint analysis showed large fluctuations in crashes and injuries over time but the fatalities rose almost continuously. These fluctuations paralleled the country’s political and economic development. In some years, better traffic law enforcement and improved public transportation may have been associated with reduced crashes and injuries, whereas rapid growth in vehicle numbers, especially two- and three-wheeled vehicles, may have contributed to increased crashes and injuries. In addition, insurance policies that did not require a police report to claim may have led to underreporting of crashes and allowed drivers to avoid prosecution. Conclusion Fluctuations over time in road traffic crashes and injuries in Sri Lanka are associated with changes in political, economic and traffic policy. There is potential for reducing road traffic crashes and injuries through better traffic law enforcement, restrictions on the importation of two- and three-wheeled vehicles and policies to improve road safety and prevent underreporting of crashes.

Factors associated with RTCs among for-hire three-wheeler drivers in Sri Lanka: a case-control study

Objectives In this study, we examined the association between risky driving behaviours of three-wheeler drivers and three-wheeler crashes in Sri Lanka. Methods We conducted a case–control study in Kandy, Sri Lanka between August 2008 and March 2009. Cases were all the three-wheeler drivers involved in crashes in Kandy between 1 January and 31 December 2007 (n=95). We included two control groups: a control group matched to the age of the cases (n=88), and a control group matched to the sites of the crashes (n=82). We used the Manchester Driver Behavior Questionnaire (DBQ) to examine the risky driving behaviours of the drivers. Using the multivariate logistic regression analysis we examined the association between risky driving behaviours and three-wheeler crashes. Results The DBQ revealed three types of risky behaviours of three-wheeler drivers: intentional violations, dangerous errors and violations due to drivers hurry. The violations were associated with three-wheeler crashes: intentional violations (control-1 adjusted OR (AOR)=2.18, 95% CI=1.30 to 3.64, control-2 AOR=2.38, 95% CI=1.32 to 42.61), violations due to drivers hurry (control-1 AOR=1.84, 95% CI=1.11 to 3.05, control-2 AOR=2.20, 95% CI=1.29 to 3.73). Driving errors, however, did not show an association with three wheeler crashes (control-1 AOR=0.62, 95% CI=0.34 to 1.11, control-2 AOR=0.86, 95% CI=0.55 to 1.33). Following variables also showed significant associations with three-wheeler crashes: obtaining driving license through private driving schools, carrying more than three passengers in the rear seat, daily mileage above 80 km and driving experience of less than 6 years. Conclusion Road rule violations by three-wheeler drivers were associated with three-wheeler crashes in Sri Lanka.

Traffic Rule Violations of Private Bus Drivers and Bus Crashes in Sri Lanka: A Case-Control Study

Objective For-hire three-wheeler crashes are a growing burden in Sri Lanka. We conducted this study to examine the factors associated with road traffic crashes (RTCs) among for-hire three-wheeler drivers in Sri Lanka. Methods We conducted a case–control study in Kandy, Sri Lanka between August 2008 and March 2009. Cases were all the for-hire three-wheeler drivers involved in crashes in Kandy between 1 January and 31 December 2007 (n=88). Controls were non-crash-involved for-hire three-wheeler drivers in Kandy, matched to the ages of the cases (n=88). We examined participants’ sociodemographic characteristics, job characteristics, driving behaviours and the characteristics of their three wheelers. We used conditional logistic regression analysis to examine the factors associated with for-hire three-wheeler crashes. Results Three factors were positively associated with for-hire three-wheeler crashes. They were as follows: taking more than three passengers in the passenger seat (adjusted OR (AOR)=8.03, 95% CI 1.16 to 55.71), higher age of the three wheelers (AOR=1.38, 95% CI 1.04 to 1.84), and being convicted by police for traffic law violations during the past 12 months (AOR=1.74, 95% CI 1.16 to 2.58). Conclusions We identified three factors that might lead to for-hire three-wheeler crashes in Sri Lanka. They were as follows: carrying excessive passengers, higher three-wheeler age and drivers’ traffic law violations. To prevent three-wheeler crashes, laws should prevent three wheelers carrying more than three passengers. Yearly examinations should be mandated to ensure proper driving conditions of for-hire three wheelers. Police should enforce traffic laws to prevent traffic law violations by three-wheeler drivers.

Web Based Injury Surveillance System (WBISS) for Road Traffic Injuries

Objective: To explore the association between self-reported traffic rule violations of private sector bus drivers and bus crashes in the Kandy district, Sri Lanka. Methods: We carried out a case-control study from August to September 2006. Cases were all the private bus drivers registered in the Kandy district and involved in crashes reported to the police between November 2005 and April 2006 (n = 63). We included two control groups: the private bus drivers working on the same routes of the cases (n = 90; matched controls) and the drivers selected randomly from the other routes of the district (n = 111; unmatched controls). We used a self-administered questionnaire to collect data on the self-reported traffic rule violations and analyzed the association between the self-reported traffic rule violations and crashes using logistic regression. Results: The following variables showed significant associations with private bus crashes: illegal overtaking (matched controls, adjusted odds ratio [AOR] = 14.78, unmatched controls, AOR = 1.04), taking passengers outside the bus bays (matched controls, AOR = 3.96, unmatched controls, AOR = 2.29), and overloading (matched controls, AOR = 10.26, unmatched controls, AOR = 1.93). However, we did not observe an association between high-speed driving and bus crashes matched controls, AOR = 1.22, unmatched controls, AOR = 0.81. Conclusions: Traffic rule violations, such as illegal overtaking, overloading, and taking passengers outside the bus bays, are significant risk factors for private bus crashes in Sri Lanka.

70-year trends of road traffic crashes, injuries, and fatalities in Sri Lanka: a systematic analysis

Road traffic injuries are a major, but neglected public health problem in Sri Lanka. As their economic costs are high and emergency trauma care is lacking in the country, the prevention of the road traffic injuries is extremely important. To prevent road traffic injuries, accurate information are mandatory on modes, patterns and trends of crashes and injuries. However, existing surveillance systems in Sri Lanka carry enormous deficiencies in receiving, recording and disseminating information of road traffic crashes and injuries. Hence, we designed a Web based injury surveillance system (WBISS) to overcome these deficiencies and to improve the inter-sector coordination for road traffic injury prevention in Sri Lanka. We adopted to WHO injury surveillance guidelines and used standard injury scales in designing this system. The system utilizes available resources without causing extra burden to government of Sri Lanka. This WBISS collects data on road traffic injuries from hospitals and relevant police stations. Data will be entered online to a Web based data base. WBISS will provide accurate, complete, timely data on patterns and determinants of road traffic injuries and will help to implement timely interventions. This system will also aid the frequent updating of the knowledge on road traffic injuries in the country. WBISS can be used worldwide. Other developing countries can also share the same system.