Dulitha N. Fernando

Factors determining client satisfaction with hospital-based perinatal care in Sri Lanka.

Objectives  To describe mothers’ satisfaction with perinatal care received during hospitalization for delivery, and to identify sociodemographic and health‐care‐related factors associated with satisfaction.

Childhood poisoning in Sri Lanka

Poisoning in children is a common accident and poison information services should be aware of the toxic agents responsible for poisoning in the community. A retrospective hospital based study was performed, before-the establishment of the National Poisons Information Centre in Sri Lanka. There were 4,556 admissions of poisoning to the selected hospitals in the Western Province in 1986 and of this, 540 (11.4%) were below 15 years. Males accounted for 66%. Kerosene oil was responsible for 47% of the poisoning cases in less than 5 years age group, while kerosene oil, pesticides and plants/mushrooms were the commonest toxic agents in the 5 to 14 years age group. The case fatality rate was 3.2%.

Urban living and obesity: is it independent of its population and lifestyle characteristics?

Objectives  Living in an urban area influences obesity. However, little is known about whether this relationship is truly independent of, or merely mediated through, the demographic, socio‐economic and lifestyle characteristics of urban populations. We aimed to identify and quantify the magnitude of this relationship in a Sri Lankan population.

Paradox in Treatment Seeking: An Experience From Rural Sri Lanka

Sri Lanka has had a pluralist health care system for centuries, in which Western biomedicine coexists with the Ayurveda system. However, recent studies suggest a declining trend in the use of the Ayurveda system. This study provides insights into the reasons for the low utilization of the Ayurveda system at present. The study findings reveal that low utilization of the Ayurveda system can be attributed to several factors, including the quick effect of Western medicines, the perception of being accustomed to Western medicines, a lack of competent Ayurveda practitioners, the high cost and low quality of Ayurveda medicines, and the rapidly changing lifestyles of villagers. However, for certain conditions such as fractures, snakebite, and paralysis, the majority of the Sri Lankan population still uses Ayurveda treatment. In conclusion, we suggest that health authorities should take into account these changes for future health planning in Sri Lanka.

The Child Behaviour Assessment Instrument: development and validation of a measure to screen for externalising child behavioural problems in community setting

BackgroundIn Sri Lanka, behavioural problems have grown to epidemic proportions accounting second highest category of mental health problems among children. Early identification of behavioural problems in children is an important pre-requisite of the implementation of interventions to prevent long term psychiatric outcomes. The objectives of the study were to develop and validate a screening instrument for use in the community setting to identify behavioural problems in children aged 4-6 years.MethodsAn initial 54 item questionnaire was developed following an extensive review of the literature. A three round Delphi process involving a panel of experts from six relevant fields was then undertaken to refine the nature and number of items and created the 15 item community screening instrument, Child Behaviour Assessment Instrument (CBAI). Validation study was conducted in the Medical Officer of Health area Kaduwela, Sri Lanka and a community sample of 332 children aged 4-6 years were recruited by two stage randomization process. The behaviour status of the participants was assessed by an interviewer using the CBAI and a clinical psychologist following clinical assessment concurrently. Criterion validity was appraised by assessing the sensitivity, specificity and predictive values at the optimum screen cut off value. Construct validity of the instrument was quantified by testing whether the data of validation study fits to a hypothetical model. Face and content validity of the CBAI were qualitatively assessed by a panel of experts. The reliability of the instrument was assessed by internal consistency analysis and test-retest methods in a 15% subset of the community sample.ResultsUsing the Receiver Operating Characteristic analysis the CBAI score of >16 was identified as the cut off point that optimally differentiated children having behavioural problems, with a sensitivity of 0.88 (95% CI = 0.80-0.96) and specificity of 0.81 (95% CI = 0.75-0.87). The Cronbachs alpha exceeded Nunnalys criterion of 0.7 for items related to inattention, aggression and impaired social interaction.ConclusionsPreliminary data obtained from the study indicate that the Child Behaviour Assessment Instrument is a valid and reliable screening instrument for early identification of young children at risk of behavioural problems in the community setting.

Self-evaluation of skills as a method of assessing learning needs for continuing education

Identification of self-perceived learner needs is important in continuing education programmes for health professionals. This paper describes the use of a self-evaluation skill inventory as a method of determining priorities for continuing education of a category of middle-level health professionals.

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

BackgroundEnvironmental 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.MethodsThe 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 Cronbachs alpha respectively.ResultsThirty 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.ConclusionsThe PASES is a valid and reliable tool which could be used to assess the physical and social environment associated with PA in Sri Lanka.

Acute Poisoning: A Major Health Concern in Sri Lanka

The importance of acute poisoning as a cause of morbidity and mortality in many developing countries has been highlighted in recent times. This study discusses the utilization of routinely collected data from hospitals for background information required in planning and implemeting preventive programs. The high prevalence of poisoning and its distribution countrywide were highlighted by the routinely collected data, while the retrospective study of hospital admissions identified the wide range of toxic agents and age and sex differentials in the pattern of poisoning. Even though the overall case fatality rate was 7.6 %, there was wide variation among the different toxic agents.

Influence of Long-Term Malnutrition on Educational Performance

A random sample of 60 Grade I school children, who were chronically malnourished, were studied along with an age-sex matched control group of nutritionally “normal” children from the same class, information on environmental factors were obtained from the parents and a behavioural assessment was done by the teacher. Two sets of tests in language and arithmetic were used to measure educational performance. In addition, a development quotient was obtained for each child. The majority of the stunted children were from an economically deprived background and were likely to show a deviant behavioural pattern. They also had a lower level of educational performance. This study indicates that inter-relationships between socio-economic factors, stunting, deviant behaviour and development quotient influence educational performance, even though the relative contributions made by each of these factors vary.