Samath D. Dharmaratne

Under reporting of road traffic injuries in the district of Kandy, Sri Lanka

Objectives To conduct a community survey to estimate the degree to which road traffic injuries (RTIs) are under reported and to compare the characteristics of RTI reported to the police to those not reported. Design A cross-sectional population-based study. Setting Kandy district, Sri Lanka. Participants RTIs and deaths during the preceding 12u2005months were identified through a community-based cross-sectional survey with a sample size of 3080 households. A stratified multistage cluster sampling with population proportion to size was used. ‘Events reported’ to the police were cross checked against events in the police records of the given or adjacent police stations, and either were ‘Events found’ or ‘Not found’. ‘Under reported’ included those ‘Not reported’ and those reported but ‘Not found’ in the police dataset. Results Information about 11u2005724 persons were obtained from 3080 households, identifying 149 persons who suffered an RTI. Of these, 57% were ‘Events reported’, and of these 43.6% (n=65) were ‘Events found’ in police records (95% CI, 36.0 to 51.6). There were 42 events ‘Not reported’ to police while an additional 7 were ‘Not found’ in the police records of the given police station. Although they were claimed to have been reported to the police, 33% (95% CI 25.8 to 40.7) were ‘Under reported’. There were significant differences in age (p=0.02), family income (p<0.001), road user type (p=0.001), injury severity (p<0.001) and injury category (p=0.01) between ‘Events found’ in the police records and ‘Under reported’ events. Conclusions In the Kandy district, 33% of RTIs were ‘under reported’. These findings could be used as evidence for policy planning to prevent RTIs, and highlights the need for a nation-wide community-based survey to determine the true rates of RTI for a better understanding of the reasons for under reporting.

Nutritional status and correlated socio-economic factors among preschool and school children in plantation communities, Sri Lanka

BackgroundChild malnutrition is a major public health concern worldwide, leading to higher morbidity and mortality. It is mostly preventable through public health and economic development. The aim of the present study was to determine socio-economic factors associated with nutritional status among children in plantation communities, Sri Lanka.MethodsA cross-sectional study was performed among preschool and school going children in three rural communities of Sri Lanka from January to August 2014. Demographic and household characteristics were documented and anthropometric measurements were collected to calculate weight-for-age (WAZ), height-for-age (HAZ) and BMI-for-age (BAZ). Anthroplus, epiinfo and SPSS versions were used for the analysis of data.ResultsA total of 547 children (aged 1–15xa0years, mean 7.0xa0±xa03.6xa0years, 53% female) participated in the study. 35.6%, 26.9% and 32.9% of children were underweight, stunting and wasting respectively. Undernutrition was more common in primary school children. Maternal employment, high number of siblings, high birth orders and female children were significantly associated with undernutrition among preschool children. Living in small houses, large number of family members, low monthly income and maternal employment were significantly associated with undernutrition among school children.ConclusionsChild undernutrition is a major public health concern in the plantation sector, Sri Lanka. Health education programs among the study population could be effective for solving the problem.

Risky Driving Behaviours of Three-Wheeler Drivers and Three-Wheeler Crashes 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.

Factors associated with RTCs among for-hire three-wheeler drivers 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 12u2005months (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.

Leishmaniasis in Sri Lanka: Spatial distribution and seasonal variations from 2009 to 2016

BackgroundLeishmaniasis is listed as one of the eight neglected tropical diseases by the World Health Organization and the number of cases in endemic areas has seen a sharp rise in the past decade. More alarmingly, reports have shown that leishmaniasis is spreading to non-endemic areas of the world due to co-infection with HIV. In Sri Lanka, leishmaniasis is considered asxa0a notifiable disease from 2008 and has seen a rising trend of incidence since then. This is the first study describing the burden, seasonal variation and spatial distribution of leishmaniasis in Sri Lanka since the disease has been included as a notifiable disease.MethodsData on health statistics from 2009 to 2016xa0were obtained from published databases maintained by the Epidemiology Unit of the Ministry of Health in Sri Lanka. Climatic data for Sri Lanka were obtained from the Department of Meteorology and the populations in administrative districts were obtained from the Department of Census and Statistics, Sri Lanka. Descriptive spatiotemporal analysis, correlation between leishmaniasis incidence and climatic variables were analyzed using SPSS statistical software.ResultsThe total number of people reported with leishmaniasis during the study period was 8487. Cutaneous leishmaniasis is the prominent form in Sri Lanka while few visceral and muco-cutaneous cases were reported. Although leishmaniasis patients were identified from all 25 districts in the island, almost 90% of the total caseload was reported from Anuradhapura, Hambantota, Polonnaruwa, Kurunegala and Matara districts. The highest number of patients was reported from the Anuradhapura district and the highest incidence per 100,000 persons was reported from the Hambantota district. The disease has a seasonal trend, a peak of leishmaniasis occur in July to September in the north-central region and in October to December in the southern region. Maximum temperature, humidity and wind speed are significantly associated climatic variables with leishmaniasis in endemic regions.ConclusionsLeishmaniasis is an emerging public health problem in north-central and southern Sri Lanka. Public awareness programs for the prevention and control of the disease in endemic regions are essential to reduce the incidence of leishmaniasis.

Prevalence and intensity of Ascaris lumbricoides infections in relation to undernutrition among children in a tea plantation community, Sri Lanka: a cross-sectional study

BackgroundAscaris lumbricoides infections are one of the commonnest intestinal nematode infections in the world, with a profound negative effect on nutritional status among underprivileged populations. In Sri Lanka, Ascaris infections and low nutritional status still persist in the plantation sector. However, research regarding thexa0association between Ascaris infections and nutritional status is scarce. The main purpose of this study was to determine the association between Ascaris infections and physical growth among children in a plantation sector in Sri Lanka.MethodsA cross sectional study was conducted among 489 children aged between 1 and 12xa0years ina plantation sector, Sri Lanka, from January to April 2013. Anthropometric measurements were collected to assess height-for-age (HAZ), weight-for-age (WAZ) and weight-for-height (WHZ) to determine stunting, underweight and wasting respectively. Data on socio-demographic and antihelminthic treatment were ascertained using an interviewer administrated structured questionnaire. Stool samples were subjected to wet mount preparation followed byformaldehyde-ether sedimentation technique to diagnose Ascaris infection and a Kato Katz technique was performed to determine the eggs intensity. AnthroPlus, EpiInfo and SPSS software was used to analyze data.ResultsOf the study sample, 38.4% showed Ascaris lumbricoides infections. Light intensity infections (51%) were common in the infected children, followed by moderate (30%) and heavy (19%) infections. Prevalence of Ascaris infections was significantly associated with de-worming more than six months prior to the study. Prevalence of undernutrition among children was 61.7%. Forty-five per cent were underweight, while 24.1% and 21.5% of children were stunted and wasted respectively. However, no significant association was found between Ascaris infections status and undernutrition. Meanwhile, heavy intensity infections were associated with decreased values of WHZ (pu2009=u20090.020).ConclusionsAscaris infections and undernutrition are still highly prevalent and a major public health problem in the plantation sector in Sri Lanka. Health and nutrition intervention programs should be implemented to increase the nutritional status of children.

Prevalence of malnutrition and associated factors among community-dwelling older persons in Sri Lanka: a cross-sectional study

BackgroundMalnutrition in older persons is a public health concern. This study aimed to estimate the prevalence of malnutrition and its associated factors among community-dwelling older persons in Sri Lanka.MethodsA cross-sectional study was conducted in the Kandy district, Sri Lanka. The nutritional status of older persons was assessed using the Mini Nutritional Assessment –Short Form (MNAxadSF). A standardised questionnaire was used to record factors associated with malnutrition: demographic characteristics, financial characteristics, food and appetite, lifestyle, psychological characteristics, physical characteristics, disease and care, oral health, and social factors. Complex sample multinomial logistic regression analysis was performed.ResultsAmong the 999 participants included in the study, 748 (69.3%) were females and 251 (25.1%) were males. The mean age was 70.80xa0years (95% CI: 70.13, 71.47). The prevalence of malnutrition, risk of malnutrition and well-nutrition was 12.5%, 52.4% and 35.1% respectively. In the multivariate model, hypertension (adjusted ORu2009=u20091.71; 95% CI: 1.02, 2.89), alcohol consumption (aORu2009=u20094.06; 95% CI: 1.17, 14.07), and increased age (aORu2009=u20091.06; 95% CI: 1.01, 1.11) were positively associated with malnutrition. An increased number of people living with the older person (aOR: 0.91; 95% CI: 0.85, 0.97) was a protective factor among those at risk for malnutrition.ConclusionBoth the prevalence of malnutrition and risk of malnutrition were commonly observed among community-dwelling older persons in Sri Lanka. The associated factors identified in this study might help public health professionals to implement necessary interventions that improve the nutritional status of this population.

Handgrip Strength and Its Associated Factors among Community-dwelling Elderly in Sri Lanka: A Cross-sectional Study

PURPOSEnLow muscle strength is central to geriatric physical disabilities and mortality. The purpose of the present study was to examine handgrip strength (HGS) and its associated factors among community-dwelling older people in Sri Lanka.nnnMETHODSnA cross-sectional study was conducted in the Kandy district using multistage sampling. A total of 999 older people were recruited, with a female preponderance. Data were collected using interviewer-administered questionnaires on demographic characteristics, depression, and physical activity. Anthropometric measurements including weight, height, mid-upper arm circumference, calf circumference, and HGS were recorded. Complex sample general linear model was used to examine the association between HGS and its associated factors.nnnRESULTSnThe mean highest HGS of the study group was 12.56xa0kg (95% confidence interval: 11.94-13.19). Male older people had a higher HGS (17.02, 95% confidence interval: 15.55-18.49xa0kg) than females (10.59, 95% confidence interval: 10.12-11.06xa0kg). For both men and women, older age was associated with lower HGS, while mid-upper arm circumference was associated with better HGS. Diabetes mellitus, vegetarian diet, and alcohol consumption were associated with HGS for women only.nnnCONCLUSIONnMen had a higher HGS compared with women. Age, mid-upper arm circumference, diabetes mellitus, vegetarian diet, and alcohol consumption were factors associated with HGS among community-dwelling older people in Kandy district, Sri Lanka. HGS can be used as a feasible strategy to improve health status of older people by community health nurses.

Disastrous but preventable: Road traffic accidents

A major cause of death and disability is road traffic injuries, with an increasing number of incidences in low and middle income countries (Khatib, Gaidhane, Quazi, & Khatib, 2015). The World Health Assembly is the decision-making body of the World Health Organization (WHO) and provides a roadmap for strategic interventions. This meeting is attended by delegates from all WHO member states and focuses on a specific health agenda. Last month, the 69th World Health Assembly approved several new resolutions including one focusing on decreasing the burden of road traffic deaths and injuries. Road traffic accidents kill more than 1.2 million people annually and injure up to 50 million (WHO, 2016). The resolution calls for policies and plans to decrease this burden which most commonly impacts vulnerable people on the roads. Member states are asked to look at innovative transportation strategies particularly in urban areas. Road traffic injuries are largely preventable and should be the focus of population health strategies. Although men are more likely to be involved in traffic accidents, women and children are also susceptible. If correctly installed and used, child restraints reduce deaths among infants by approximately 70% and deaths among small children by between 54% and 80% (WHO, 2016). At the International Council on Women’s Health Issues meeting in Baltimore in 2016, we will discuss the importance of gender based framework to decrease road traffic accidents.