oral presentations - journal of the college of community

6 Journal of the College of Community Physicians of Sri Lanka

JCCPSL 2018, 24 (3) Special Edition Open Access

ORAL Presentations

Session A: Behaviour and Health Promotion

Chairpersons:Dr Paba PalihawadanaProf. Rajitha Wickramasinghe

OP A.1Prevalence of sugar-sweetened beverageconsumption among Grade 10 school childrenin Panadura Educational Division, Sri Lanka

Esha Mahindadasa1*, Padmal De Silva2

1MOH Office, Panadura, Sri Lanka; 2World HealthOrganization, Country Office for Sri Lanka*Correspondence: [email protected]

Background: Increase in the prevalence of over-weight/obesity globally during the past few decadeshas resulted in serious complications in adult life suchas premature illnesses and deaths. Non-communi-cable diseases play a major role in this regard. Therising prevalence of overweight/obesity is linked toexcess energy intake and reduced physical activityamong children and adolescents. The consumption ofsugar-sweetened beverages is associated with obesity,dental caries, diabetes and heart disease accordingto most of the studies done in Western countries.

Objective: To determine the prevalence of sugar-sweetened beverage consumption among Grade 10school children in Panadura Educational Division

Methods: A cross-sectional study was done.Multistage stratified cluster sampling was used, inwhich the primary sampling unit was a classroom.Cluster size was 30. Students with chronic diseaseswere excluded. A self-administered questionnairewas used as the study instrument. Data collectionwas done by trained data collectors. Descriptivestatistical analysis was used in presenting the findings.

Results: The sample consisted of 600 Grade 10students. There were 319 (53.2%) female students.Majority were Sinhalese (85.5%) and Buddhists

(82.3%). Almost half (n=298) of the students andmore than three quarter (82.7%) were buyingbeverages from the school canteen and outside schoolrespectively. A total of 550 (92%) students wereusually getting pocket money. Carbonated/soft drinkswere the favourite beverage among 212 (35.5%)students. However, only seven (1.2%) studentsconsumed carbonated soft drinks daily. Sweetenedmilk products were consumed daily by 16% (n=96)while tea, coffee and milk tea with added sugar wasconsumed by 75% (n=448). The percentage ofstudents who consumed any type of sugar-sweetenedbeverage was 80% (n=478).

Conclusions & Recommendations: The studyshowed a high prevalence (n=478, 80%) of dailyconsumption of sugar-sweetened beverages. Dailyconsumption of soft drinks (n=7, 1.2%) were lessthan sweetened milk product (n=96, 16%) con-sumption. Findings of this study emphasized theimportance of extending the colour coding andtaxation to sweetened milk and milk products.

Key words: sugar-sweetened beverages, con-sumption

OP A.2Health seeking behaviour and comparison ofattitudes and practices towards dogs betweenadult dog-bite victims and non-victimsattending the District General HospitalNuwara Eliya, Sri Lanka

Achala Galliyadda1, Manuj C Weerasinghe2*

1Postgraduate Institute of Medicine, Universityof Colombo; 2Department of Community Medicine,University of Colombo*Correspondence: [email protected]

DOI: http://doi.org/10.4038/jccpsl.v24i3.8175

mailto:[email protected]


https://creativecommons.org/licenses/by/4.0/

7Journal of the College of Community Physicians of Sri Lanka


Background: Dog bites among adults continue tobe a public health problem in Sri Lanka despitemultiple preventive strategies.

Objective: To describe the health seeking behaviouramong adult dog-bite victims and compare theirattitudes and practices with a comparable groupattending the District General Hospital Nuwara Eliya

Methods: A cross-sectional study design wasemployed. Dog bite victims were selected frompreliminary care unit of the District General HospitalNuwara Eliya (n=275) through consecutive sampling.An age and sex matched comparable group (n=275)was selected from the outpatient department. A pre-tested interviewer-administered questionnaire wasused to collect data. Differences in attitudes andpractices towards dogs were compared between thetwo groups using Chi-squared test at 5% significancelevel.

Results: Majority of the victims (n=254, 92.4%)have received first aid within 30 minutes and 95% ofthem have received the correct first aid. Majority(n=171, 62.2%) have decided to seek medical careby themselves. The majority of dog bite victims(50.5%) and the comparable group (55.3%) hadpositive attitudes towards dogs (p=0.27). Althoughthe majority of both victims (72%) and the comparablegroup (52.4%) had ever owned dogs, the differencebetween proportions was significant (p<0.001).Almost half of the victims (50.5%) and comparablegroup (56.2%) have not taken measures to protectothers from their dogs (p=0.22). The majority ofvictims (85.1%) and the comparable group (81.1%)had non-disturbing practices towards adult dogs(p=0.21).

Conclusions & Recommendations: Majority hadcorrect practices on first aid following dog bites andsought medical care without a delay. There were nosignificant differences in attitudes or practicestowards dogs between the two groups. Responsibledog ownership should be strengthened to prevent dogbites.

Key words: dog bites, health seeking, attitudesand practices towards dogs

OP A.3Awareness & utilization of the child healthdevelopment record as a tool for childcareinformation by caregivers of children aged 12months to 2 years in Battaramulla MedicalOfficer of Health area, Sri Lanka

Loshan Moonasinghe1, Samanthi Nupehewa2*

1Family Health Bureau, Ministry of Health, SriLanka; 2Postgraduate Institute of Medicine,University of Colombo*Correspondence: [email protected]

Background: The child health development record(CHDR) is a useful tool in child health programmes.Assessing the overall awareness and utilization ofCHDR by the caregivers is paramount in improvingthe child health programme.

Objective: To describe the awareness and utilizationof CHDR as a tool for child care by caregivers ofchildren between 12 months and 2 years of age inBattaramulla Medical Officer of Health (MOH) area

Methods: A community-based cross-sectional studywas conducted among 403 care givers fromBattaramulla MOH area. The sample was selectedby systematic sampling using the birth andimmunization register. A pre-tested interviewer-administered questionnaire was administered by theprincipal investigator. Percentages and mean valueswere used to describe variables. Associations weretested using Chi-squared test (p<0.05).

Results: The response rate was 100%. Mother wasthe main caregiver (n=337, 83.6%). Majority of thecaregivers (n=384, 95.3%) had good awareness onnew born, child care, growth and development while66.3% (n=267) were aware on measurementsrecorded in the CHDR. About 81.1% (n=327) ofcaregivers used the CHDR as an information sourcefor complementary feeding, growth and development.The Chi-squared test revealed significant associationsbetween age of the caregiver and obtaining infor-mation on complementary feeding (=7.69; df=1;p=0.01). Statistically significant associations werefound between caregivers’ level of education andawareness on reading the yellow pages (=29.61;df=1; p<0.001).




Conclusions & Recommendations: Most of thecaregivers had good awareness on the informationin CHDR and they utilized the CHDR as aninformation source for childcare. Public healthmidwife should pay more attention when deliveringinformation regarding the CHDR to caregivers whoare more than 40 years of age and having a lowlevel of education.

Key words: child health development record,caregiver, complementary feeding, growth

OP A.4Knowledge, practices and associated factorsof public health midwives on implementingpreconception care package in the district ofColombo, Sri Lanka

Nilmini Hemachandra1, Wathsala Abeysinghe2*

1World Health Organization, Country Office forSri Lanka; 2Postgraduate Institute of Medicine,University of Colombo*Correspondence: [email protected]

Background: Preconception care is of paramountimportance in reducing maternal and child morbidityand mortality. A new ‘package of interventions forpreconception’ has been introduced in 2012 to bedelivered through the existing public health system.

Objective: To assess the knowledge and practicesof public health midwives (PHM) and to determinethe factors associated with knowledge on imple-menting preconception care package in the districtof Colombo

Methods: A descriptive cross-sectional study wascarried out using a pre-tested self-administeredquestionnaire among all PHMs in Colombo District(N=366). A checklist was used in four randomlyselected medical officer of health (MOH) areas toassess the practices. Data were described usingmean values and frequency. Chi-squared test wasused for associations (p<0.05).

Results: Response rate was 97.3% (n=366). Theoverall knowledge of PHMs on the preconceptioncare package was high (mean total mark of 89.7(SD=9.1); median of 92 (IQR 88-96)). However,

knowledge on some specific components wassignificantly low. Knowledge levels were significantlyhigher among PHMs aged less than 50 years(p=0.01), PHMs with 10 years of service ex-perience as a field PHM (p=0.01), PHMs who werespending 1 hour to come to work (p=0.04) andPHMs who were married (p=0.04). Majority of thePHMs (n=349, 95.4%) were conducting precon-ception care clinics. However, 292 (79.8%) con-ducted health education sessions. Only 3 (5.8%)PHMs had evaluated the screening tool. Nutritionalassessment was done in all clinics (100%). However,laboratory investigations were not done at any of theclinics neither couples were given the informationbooklet.

Conclusions & Recommendations: Althoughoverall knowledge was high, knowledge on someaspects was not adequate. Most of the practiceswere poor and not in par with their high knowledgelevel. No uniformity was observed in the practicesand procedures carried out indicating lack of properguidance and deficiencies in training. Therefore, it isrecommended to have a national guideline regularizedby a circular on preconception package and conductrefresher training on its implementation.

Key words: preconception care, public healthmidwife

OP A.5Road safety related knowledge, attitudes andpractices among Grade 12 students of schoolsin Piliyandala Educational Zone, Sri Lanka

Rangika Fernando1*, Mahendra Arnold2

1Postgraduate Institute of Medicine, Universityof Colombo; 2Regional Directorate of HealthServices, Colombo District, Sri Lanka*Correspondence: [email protected]

Background: In Sri Lanka, seven road trafficfatalities occur every day, of which 10% are relatedto children.

Objective: To assess the road safety related know-ledge, attitudes and practices among Grade 12students attending government schools in PiliyandalaEducational Zone





Methods: A descriptive cross-sectional study wasconducted among 511 students, selected using multi-stage cluster sampling. Simple random sampling wasused to select 30 students from each cluster. Datawere collected using a self-administered ques-tionnaire. Cut off mark for the knowledge score(which comprised knowledge on common road signs;safety for pedestrians, bus users, bicycle and motor-cycle users, vehicle drivers/passengers and threewheeler users) was decided prior to analysis of thedata. Responses to individual questions were analysedusing frequency tables.

Results: Knowledge on road signs and basic roadsafety was satisfactory, although only 300 (58.7%)knew it was illegal to travel on the footboard of abus; and only 251 (49.1%) knew that it was man-datory by law to report all accidents to the nearestpolice station. Only 206 (40.3%) students thoughtthat it was dangerous to cross the road while using amobile phone, while a similar proportion admitted to

talking on mobile phone while crossing the street and19.6% (n=100) using headphones while walking onthe road. Notably, 128 (25.1%) students had drivena car, a three wheeler or a motorcycle without avalid driving license, and nine (1.7%) had driven amotorised vehicle after consuming alcohol. Majority(n=451, 88.3%) thought children should be taught howto use the road safely with the help of practicaldemonstrations.

Conclusions & Recommendations: Basic know-ledge on road safety was satisfactory, but attitudesand practices regarding the use of mobile phonesand headphones, and driving without a valid drivinglicense were poor. This should be addressed whenplanning future road safety programmes as well asin the school curriculum.

Key words: road traffic crashes, road trafficinjuries, road safety, child injury prevention, roadsafety education



OP B.1Burnout and its correlates among correctionaland rehabilitation officers working in SriLankan Prisons

1National STD/AIDS Control Programme,Ministry of Health, Sri Lanka*Correspondence: [email protected]

Background: Burnout of Sri Lankan prison officershas not been assessed previously. As a group ofemployees who undergo stress at regular intervalsduring their work, they are highly susceptible toburnout, and various factors can affect this situation.

Objective: To assess burnout and its personal andwork-related correlates among the correctional andrehabilitation officers working in Sri Lankan prisons

Methods: A descriptive cross-sectional study wascarried out in 2017 among 1803 correctional andrehabilitation officers working in 32 prison institutionsin Sri Lanka, selected through multistage samplingmethods including random sampling and probability-proportionate-to the sample size. The self-adminis-tered, translated and validated Maslach BurnoutInventory-Human Services Survey (MBI-HSS) anda questionnaire on correlates were used as the studyinstruments to assess the prevalence and correlates.Chi-squared test was used (p<0.05) to identify thesignificant correlates in the bivariate analysis, follo-wed by the use of logistic regression in the multi-variate analysis of the significant variables identifiedthrough bivariate analysis.

Results: The ‘true’ prevalence of burnout and itsthree dimensions, which indicate the proportion ofparticipants actually suffering from burnout or aparticular dimension was calculated using the numberof test positives identified through the use of cut-off

values, the sensitivity values and the positive predic-tive values. Thus, the true prevalence of burnout was31.1% (95% CI=22.1, 40.1%), while the trueprevalence for emotional exhaustion, depersona-lization and diminished personal accomplishmentwere 28.6% (95% CI=19.7, 37.5%), 26.9% (95%CI=18.2, 35.6%) and 37.8% (95% CI=28.3, 47.3%),respectively.

Feeling overburdened by housework (odds ratio(OR)=3.9; 95% CI=1.6, 9.3) and family-work conflict(OR=1.8; 95% CI=1.1, 2.9) were associated with ahigher risk for burnout. Being married or livingtogether was protective for burnout (OR=0.3; 95%CI=0.2, 0.5). Working in closed prisons (OR=5.4;95% CI=1.3, 21.7), remand prisons (OR=4.9; 95%CI=1.2, 19.3) and work camps (OR=6.7; 95%CI=1.6, 28.4) was associated with more burnoutcompared to working in open prison camps, drugrehabilitation centres, correctional centres for youthfuloffenders and lock-ups. Perceived difficulty in shiftwork (OR=2.4; 95% CI=1.4, 4.0) and taking leave(OR=2.8; 95% CI=1.5, 5.4), poor welfare facilities(OR=3.8; 95% CI=1.6, 8.7), work overload (OR=2.1;95% CI=1.1, 3.7), role ambiguity (OR=1.6; 95%CI=1.1, 2.3), poor relationship with colleagues(OR=10.6; 95% CI=1.1, 103.3) and families ofinmates (OR=4.7; 95% CI=1.4, 16.0), perceived poorrespect from inmates (OR=1.9; 95% CI=1.2, 3.0),job dissatisfaction (OR=14.3; 95% CI=4.4, 46.8), poorwork environment (OR=1.04; 95% CI=1.01, 1.08)and faking emotions with colleagues (OR=1.09; 95%CI=1.02, 1.17) were associated with higher risk ofburnout, whereas regulating emotions with superiorswas protective of burnout (OR=0.9; 95% CI=0.84,0.94). Work experience was not significantlyassociated with burnout (p>0.05).

Conclusions & Recommendations: Burnout is asignificant issue affecting the prison officers in SriLanka. It is recommended to include stress manage-ment to their basic and in-service curricula in thefuture.

Session B: Environmental and Occupational Health

Chairpersons:Prof. Rohini de A SeneviratneDr. Lakshman Gamlath

Nimali Wijegoonewardene1*,Janaki Vidanapathirana1




Key words: burnout, prison, correctional officers,rehabilitation officers, Sri Lanka

OP B.2Musculoskeletal symptoms and related healthseeking behaviour among health activityassistants in operating theatres of teachinghospitals in the district of Colombo, Sri Lanka

Shermi Jayasumana1*, Dulani Samaranayake2

1Education, Training & Research Unit, Ministryof Health, Sri Lanka; 2Department of CommunityMedicine, University of Colombo*Correspondence: [email protected]

Background: Musculoskeletal disorders (MSDs)are gaining importance worldwide, causing highmorbidity, disability and poor quality of life. In SriLanka, most of the manual tasks in health caredelivery are done by health activity assistants(HAAs). Therefore, it is important to focus on muscu-loskeletal symptoms (MSSs), factors associated andhealth seeking behaviour of HAAs.

Objective: To determine the prevalence and factorsassociated with MSSs, and health seeking behaviouramong HAAs attached to operating theatres

Methods: A workplace-based cross-sectional studywas conducted among 378 HAAs attached tooperating theatres of teaching hospitals in ColomboDistrict, selected by simple random sampling. MSSswere assessed using Cornell MusculoskeletalDiscomfort Questionnaire. Prevalence of MSSs wascalculated for the preceding three months and oneweek. Associations were analysed using odds ratio(OR) and Chi-squared test at 5% significance level.

Results: The prevalence of MSSs at least in oneanatomical region during the preceding three monthsand work week was 59.7% (n=226; 95% CI=54.8,64.6) and 53% (n=131; 95% CI=47.9, 58.0),respectively. Transferring 15 patients or more a day(p<0.0001), pushing and/or pulling 15 trolleys or morea day with patients (p=0.002), cleaning surgicalinstruments for one or more hours per day (p=0.004),excessive work load (p<0.0001), fast pace of work(p<0.0001) and too many different tasks (p<0.0001)were significantly associated with developing MSSsduring preceding three months. Over 60% of theHAAs with MSSs had sought health care. Others

who did not seek health care believed that medicationwould not resolve their symptoms.

Conclusions & Recommendations: Prevalenceof MSSs among HAAs was high. Health seekingbehaviour was satisfactory, but deficiencies inunderstanding the illness were observed.

Key words: musculoskeletal symptoms, prevalence,factors associated, health seeking behaviour,health activity assistants

OP B.3High resolution spatial analysis of groundwaterfluoride levels and population at risk for dentalcaries and dental fluorosis in Sri Lanka

Nirosha Ranasinghe1*, Estie Kruger2, MarcTennant2

1National Institute of Health Sciences, Kalutara,Sri Lanka, 2International Research Collaborative –Oral Health and Equity, School of HumanSciences, University of Western Australia*Correspondence: [email protected]

Background: Fluoride intake has both beneficial anddetrimental effects to human health. The fluoridecontamination in groundwater has potential risks ofdental fluorosis. However, it provides natural pro-tection against dental caries if the fluoride concen-tration lies within the recommended values formaximum caries protection.

Objective: To investigate the distribution of ground-water fluoride levels in natural ground water sourcesin Sri Lanka in relation to its population distributionand to determine the population at risk for dentalcaries or dental fluorosis

Methods: The study used the most upgraded spatialdistribution map of groundwater fluoride levels inSri Lanka (based on the raw data collected byChandrajith R. et al originally and donated to thisstudy). It was overlaid with Sri Lankan populationdata (2012) obtained from the Census using QGIS2.14.1.

Results: Results indicate that 12% (0.53 million) ofthe children aged less than 12 years lived in high





fluoride zones (>1 mg/L), and were at risk for dentalfluorosis, while 81.4% (3.57 million) of those wholived in low fluoride zones (<0.5 mg/L) might be athigher risk for childhood dental decay. Overall, 82.4%(16.1 million) of the country’s total population livedin low fluoride zones (<0.5 mg/L) and 11.2% (2.2million) in high fluoride areas.

Conclusions & Recommendations: The highresolution spatial approach provides a useful decisionsupport tool to develop a population health strategyof safe fluoride use, based on predicted health risksin communities. A national consensus on fluoride useis needed in Sri Lanka to prevent dental caries andminimize dental fluorosis, as well as other adversehealth problems associated with excessive fluorideexposure in the population.

Key words: groundwater, dental fluorosis, dentalcaries

OP B.4Respiratory symptoms, lung functions andassociated factors among quartz processingworkers in Matale District, Sri Lanka

Vishaka Gunaratne1*, Inoka Suraweera2

1Postgraduate Institute of Medicine, Universityof Colombo; 2Directorate of Environmental andOccupational Health, Ministry of Health, SriLanka*Correspondence: [email protected]

Background: Occupational exposure to silica dustis known to cause silicosis, airway diseases and lungcancer. Hence, quartz processing industry isconsidered a high-risk occupation for silica-inducedlung diseases.

Objective: To assess the prevalence of selectedrespiratory symptoms, lung functions and to determineits associated factors among quartz processingworkers in Matale District

Methods: A cross-sectional study was conductedamong all workers engaged in quartz industry in the

district of Matale. A total of 379 fulfilled the eligibilitycriteria and were included in the study. Informationon socio-demographic, occupational, behaviouralcharacteristics and personal protective equipmentusage of the workers were assessed through a pre-tested interviewer-administered questionnaire.Spirometry was conducted to assess lung functions.Associations were assessed using Chi-squared testand significance of associations was identified. Theconfidence interval was assessed at 95%.

Results: The response rate was 98% (n=373).There were 52% (n=194) workers who had at leastone respiratory symptom within the past three months.There were 19.3% (n=72) workers with abnormalforced vital capacity (FVC) and 18.8% (n=70)workers with abnormal forced expiratory volumeduring first second (FEV1). The peak expiratory flowrate (PEFR) was abnormal in 72.9% (n=272). Outof all workers, 276 (74%) were directly exposed toquartz dust. Among them, around 58.6% (n=162) ofthe workers were using at least a face mask aspersonal protective equipment. Having at least onerespiratory symptom within the past three monthsshowed a statistically significant association with sex(p=0.002), age (p=0.04), average monthly income(p=0.026), highest educational qualification (p=0.01),smoking during anytime of the life (p<0.001) andusage of at least the facemask (p=0.04). AbnormalFVC showed statistically significant associations withsex (p<0.001), age (p=0.04), work duration (p<0.001)and job category (p=0.02). Abnormal FEV1 showedstatistically significant associations with sex (p<0.001)and age (p=0.005).

Conclusions & Recommendations: Majority ofthe quartz processing workers in Matale District hadat least one respiratory symptom. Nearly one fifthwas having restrictive type respiratory impairmentwhile nearly 70% (n=272) had an obstructive type.Strengthening of the regulations related to workerwell-being, occupational disease surveillance andprovision of occupational health services to workersin quartz processing industries is recommended.

Key words: quartz industry, respiratory symptoms,personal protective equipment, FVC, FEV1, PEFR




OP B.5Causes and types of injuries in patientspresenting with occupational injuries to theAccident Service Unit of Colombo SouthTeaching Hospital, Sri Lanka

Dilukshi Wickramasinghe1*, Mahendra Arnold2

1MOH Office, Maharagama, Sri Lanka; 2RegionalDirectorate of Health Services, Colombo District,Sri Lanka*Correspondence: [email protected]

Background: Globally, occupational injuries cause2.3 million deaths per year and it is estimated thatover 313 million non-fatal occupational injuries occurannually. Though a similar picture can be expectedin Sri Lanka as well, the true magnitude on typesand causes of work-related injuries is not revealeddue to underreporting.

Objective: To describe the types and causes ofoccupational injuries in patients admitted withoccupational injuries to the Accident Service Unit ofthe Colombo South Teaching Hospital

Methods: A descriptive cross-sectional study wasconducted among 221 patients with occupationalinjuries attending the Accident Service Unit of theColombo South Teaching Hospital. Convenientconsecutive sampling technique was applied. A pre-

tested interviewer-administered questionnaire wasused as the study instrument, and two medicalofficers administered the questionnaire.

Results: The response rate was 100% (n=221). Cutby sharp objects was the most common cause ofinjury (n=72, 32.6%) followed by being struck by anobject (n=58, 26.2%), falls (n=32, 14.5%) and slips(n=8, 3.6%). Only a minor proportion had injuriesdue to exposure to electricity (n=7, 3.2%), acids andcorrosives (n=3, 1.4%) and burns (n=1, 0.5%). Ofthe type of injuries, lacerations constituted a majorityproportion (n=91, 41.2%) followed by fractures/dislocations (n=47, 21.3%), superficial injuries/abrasions (n=38, 16.3%) and crush injuries (n=22,9.4%). Only one patient (0.5%) presented with spinalinjury following an occupational accident.

Conclusions & Recommendations: The studyrevealed that there was a wide range of injuries andcauses. Accurate data is important to plan and imple-ment preventive programmes. Since there is noorganised mechanism to capture data on occupationalinjuries at present, it is recommended that the existinginjury surveillance system of the Ministry of Healthinclude data on occupational injuries which wouldgreatly overcome the issue of under-reporting ofoccupational injuries.

Key words: occupational injuries, occupationalaccidents, cut injuries, lacerations




OP C.1Suitability of verbal autopsy to improve thequality of mortality statistics for communitydeaths in Sri Lanka

Vindya Kumarapeli1*, Rajitha Jayasuriya1, LeneMikkelsen1

1Global Burden of Disease Group, University ofMelbourne*Correspondence:[email protected]

Background: Sri Lanka has a well-established deathregistration system; the completeness of it is closeto 100%. Of the 130,000 annual deaths, nearly 50%takes place ‘out-of-hospital’ and the cause of deathfor these is declared by non-medical persons(Coroner, Grama Niladhari officer), reducing thereliability of data to determine health priorities andpreventive strategies.

Objective: To test the suitability of SmartVA toassign a reliable cause for community deaths in SriLanka

Methods: ‘SmartVA’ uses a validated automatedquestionnaire and computer algorithms to diagnosethe cause of death. The cause of death is establishedbased on a structured interview conducted with thefamily on signs, symptoms and events prior to death.SmartVA questionnaire was translated into Sinhalaand Tamil languages. A cross-sectional study wasconducted to pilot test SmartVA in seven medicalofficer of health (MOH) areas, representing threedistricts (Colombo, Kurunegala and Jaffna) while 146public health midwives (PHMs) were trained asinterviewers and 12 medical officers of health(MOHs) as supervisors. Data collection was carriedout through the existing PHM domiciliary care modeland 286 VA were conducted from January-March2017 on all ‘out-of-hospital’ deaths. Data entered onandroid tablets were analysed using the ‘Tariff’

method (computer algorithms) to assign a probablecause of death for 55 main diseases.

Results: Comparison of results with the GlobalBurden of Disease estimates for Sri Lanka showedsimilar distributions among the leading causes ofdeath (stroke, cancer, ischaemic heart disease,chronic respiratory diseases and diabetes). Comparedto Registrar General’s data for all ‘out-of-hospital’deaths, there was a significant improvement in theproportion of causes of death for utility for policy.Consequently, it was decided to expand the pilot tomore MOH areas for final evaluation based on alarger number of VAs.

Conclusions & Recommendations: Applicationof SmartVA has shown the ability to significantlyimprove the quality of cause of death informationfor ‘out-of-hospital’ deaths. Until all deaths aremedically certified in Sri Lanka, SmartVA can beused to obtain a valid cause of death for deaths thatare not medically certified.

Key words: verbal autopsy, SmartVA, communitydeaths, cause of death

OP C.2Knowledge, practices and the factorsassociated with Mother Baby FriendlyInitiative among postpartum mothers atColombo South Teaching Hospital, Sri Lanka

Vihanga Maddumahewa1*, Dhammica Rowel2

1MOH Office, Pitakotte, Sri Lanka; 2FamilyHealth Bureau, Ministry of Health, Sri Lanka*Correspondence: [email protected]

Background: In 2014, International Federation ofGynecology and Obstetrics launched guidingprinciples for mother baby friendly birthing facility.These are evidence based, simple, cost effective

Session C: Health Systems

Chairpersons:Dr Lakshmi SomathungaDr Nihal Abeysinghe





measures that could navigate the world towardsanticipated low maternal and neonatal morbidity andmortality rates. Such agenda warrants correctknowledge and practices of the service recipients.

Objective: To describe knowledge, practices andthe factors associated with Mother Baby FriendlyInitiative among postpartum mothers at ColomboSouth Teaching Hospital

Methods: A cross-sectional descriptive study wasconducted among 384 immediate postpartum mothersat Colombo South Teaching Hospital using non-probability sampling method and an interviewer-administered questionnaire. Percentages and meanvalues were used to describe variables whileassociations were tested using Chi-squared test.

Results: The mean age was 27.9 (SD=5.57) yearsand 66.6% (n=256) was educated up to GCEOrdinary Level. Knowledge on ability to have a lightdiet in first stage of labour was 8.2 % (n=32) while itwas 4.9% (n=19) for having a companion duringlabour, 93% (n=357) for timing of initiation breast-feeding, 76% (n=292) on how to identify hunger cuesand 72.2% (n=279) for exclusive breastfeeding. Only2.3% (n=8) had correct knowledge on the need fordiscouraging artificial teats on a breastfeedingbaby. As for the practices, 56.5% (n=217) was ableto correctly perform positioning and 55.5% (n=213)on attachment of baby, but only 12.2% (n=47) wasconfident on cup feeding practice. Educational levelshowed a significant association with knowledge onbreastfeeding initiation (p=0.04), identifying hungercues (p=0.01), correct positioning of baby (p=0.04)and cup feeding practice (p=0.01).

Conclusions & Recommendations: The need forfurther knowledge improvement was identified. Moreevaluations, awareness creating and training appearto be appropriate.

Key words: mother baby friendly initiative,postpartum mothers

OP C.3An intervention to improve the quality of causeof death certification in Sri Lanka by introducingWHO recommended format of the medicalcertificate of cause of death

USH Gamage1*, AR Wikremasinghe2, WSandiligama3, A Senevirathna3, LM Mikkelsen4

1National Institute of Health Sciences, Kalutara,Sri Lanka; 2Department of Public Health,University of Kelaniya; 3Registrar General’sDepartment, Sri Lanka; 4Global Burden ofDisease Unit, University of Melbourne*Correspondence: [email protected]

Background: Previous studies in Sri Lanka suggestpoor cause of death certification by medical officers.The poor quality was partly attributed to the non-useof a medical certificate of cause of death, as recom-mended by the World Health Organization (WHO).

Objective: To evaluate the impact of introducingthe WHO recommended format of a medicalcertificate to improve the quality of cause of deathcertification by medical officers

Methods: A hospital-based interventional study wasconducted. At baseline, a proportionate sample(n=1585 from each district) of death declarationforms (Old B33) was randomly selected, and thecorresponding medical records were retrieved fromselected hospitals of Colombo and Galle districts. Anew WHO format compatible death declaration formand an information booklet were introduced inColombo district hospitals; Galle district hospitalswere selected as controls. Post-interventionassessments were done at 12 and 18 weeks. Causeof death was validated with the data obtained fromcorresponding medical records by trained studyphysicians.

Results: At baseline, 4.5% and 4.9% of deathdeclaration forms were of ‘good’ quality in Colomboand Galle districts, respectively. ‘Use of abbreviations’was 54.3% in Colombo compared to 57% in Galle;‘legibility’ was 54% in Colombo compared to 51.4%in Galle. The overall sensitivity of the vital registrationsystem for leading causes of death was 0.43 and 0.4in Colombo and Galle districts, respectively. ‘Good’quality cause of death certificates in Colombo districtsignificantly increased to 57.2% and 64%, at the twopost-intervention assessments, respectively (p<0.001)in contrast to no such change in Galle district. Theoverall sensitivity and positive predictive values




increased significantly at the post-interventionassessments in the Colombo district but not in theGalle district.

Conclusions & Recommendations: The inter-vention significantly improved the cause of deathcertification in the intervention group. It isrecommended that the new death declaration form(New B33) be introduced in Sri Lanka.

Key words: quality of certification of cause ofdeath, accuracy of cause of death

OP C.4Internet usage patterns, its health impacts andfactors associated among internet users aged18-60 years in Sri Lanka

Sinha De Silva1*, Lalani De Silva2, GeethaniGunasekara3, Jayalath Gunathilaka3, PradeepJayashantha4, Dulani Samaranayake1

1Department of Community Medicine, Universityof Colombo; 2Department of Pathology, Universityof Sri Jayewardenepura; 3MOH Office, Mahara-gama, Sri Lanka; 4Base Hospital, Avissawella, SriLanka*Correspondence: [email protected]

Background: Internet is becoming an integral partof today’s lives. New health problems related tointernet behaviour are rising.

Objective: To describe the epidemiology of internetbehaviour, its health impacts and factors associatedamong internet users in Sri Lanka

Methods: A web-based cross-sectional study wasconducted among 323 adults aged 18-60 years withat least one valid e-account, using respondent-drivensampling technique. Data were collected throughweb-based self-administered questionnaire includingthe Internet Addiction (IA) Test. The analysis wasconducted using descriptive statistics and Chi-squared test.

Results: Response rate was 70.6% (n=323). Meanage of the participants was 33.5 (SD=8.24) yearswith 54.5% (n=176) being males. Approximately 94%

(n=287) used internet for official work with a meanduration of 2.41 (SD=2.35) hours per day for com-munication (n=259, 84.9%), searching literature(n=129, 42.2%), marketing (n=60, 19.6%) anddeveloping software (n=36, 11.8%). All used internetfor non-official work for a mean duration of 2.74(SD=1.96) hours per day for communication (n=318,98.5%), networking (n=270, 83.6%), gossip (n=165,51.1%) and gaming (n=98, 30.3%). Out of allrespondents, 94.4% (n=305) used Facebook; 76.6%(n=241) WhatsApp; 76.8% (n=248) Viber; and57.3% (n=185) Skype. About 86% (n=278) usedsmart phones; 67.2% (n=217) laptops; 49.8%(n=161) desktops; and 41.2% (n=133) PC tablets toaccess internet for leisure time activities. Frequentbackache (n=57, 17.6%) and neck pain (n=70, 21.7%)were common physical complaints. IA score (out of100) ranged from 0-91 (Mean=47.35, SD=25.8).Mild, moderate and severe internet addiction wereseen in 27.6% (n=89), 22.9% (n=74), and 18.3%(n=59), respectively. Internet addiction wassignificantly associated with age (p<0.001), maritalstatus (p=0.02), level of education (p=0.003) andemployment status (p=0.005).

Conclusions & Recommendations: Internetaddiction is affecting a remarkable proportion ofinternet users. Age, marital status, education andemployment status could be considered as vulnerablefactors for internet addiction. Musculoskeletalcomplaints are the commonest physical problem.Tailor-made interventions need to be done targetingvulnerable groups to reduce internet addiction whileawareness needs to be carried out about correctpostures when devices are used to access theinternet.

Key words: internet, usage patterns, addiction

OP C.5Epilepsy profile adherence to medication andknowledge of caregivers of children attendingthe epilepsy clinic at the Lady RidgewayHospital for Children, Sri Lanka

Nayani Dharmakeerthi1*, Mahendra Arnold2,Anuruddha Padeniya3

1National STD/AIDS Control Programme, Ministryof Health, Sri Lanka; 2Regional Directorate of




Health Services, Colombo District, Sri Lanka;3Lady Ridgeway Hospital for Children, Colombo,Sri Lanka*Correspondence:[email protected]

Background: Approximately 50 million peoplecurrently live with epilepsy worldwide. Childhoodepilepsy is reported to affect 6-10 per 1000 childrenin developing countries. Promotion of medicationadherence is important particularly in a disease likeepilepsy which needs long term medication.

Objective: To describe the epilepsy profile, adhe-rence to medication and knowledge of caregivers inchildren attending the epilepsy clinic at the LadyRidgeway Hospital for Children

Methods: A descriptive cross sectional study wasconducted among 349 children with epilepsy attendingthe epilepsy clinics at the Lady Ridgeway Hospitalfor Children. Systematic sampling method wasapplied. A pre-tested interviewer-administered ques-tionnaire was used to collect data. A medical officeradministered the questionnaire.

Results: The response rate was 98.6%. The com-

monest type of epilepsy was generalized epilepsy(30.8%, n=106). Epilepsy syndromes were diagnosedin 24.7% (n=85) of children and 14.8% (n=51) hadfocal epilepsy. In 24.1% (n=83) the type of epilepsywas not clear. Of the children 52.3% (n=180) wereon mono therapy while 47.7% (n=164) were on morethan one drug. Good adherence to antiepilepticmedication, which is a score of 6 or more out of 8 inMorisky Medication Adherence Scale, was seen in83.7% (n=288). It was revealed that 84.6% (n=252)of the children who did not miss clinic visits had goodadherence. Of the main caregivers 82.6% (n=284)had above average knowledge with a score of 50 ormore on emergency management at home in an eventof an acute seizure.

Conclusions & Recommendations: The studyrevealed that there was a high level of adherence tomedication, regular clinic visits and good level ofknowledge among caregivers. It is important tosustain these factors by regular assessment ofadherence to anti-epileptic medication and updatingcare givers’ knowledge on the disease to improvethe overall care in children with epilepsy.

Key words: epilepsy profile, epilepsy control,care givers, children, epilepsy clinic




OP D.1Level of emotional intelligence and itsassociation with perceived stress and copingstrategies among primary grade schoolteachers in Homagama Educational Zone, SriLanka

Aruni Hathamuna1*, Inoka Suraweera2

1Directorate of Mental Health, Ministry of Health,Sri Lanka; 2Directorate of Environmental andOccupational Health, Ministry of Health, SriLanka*Correspondence: [email protected]

Background: Emotional intelligence (EI) amongteachers has been found to be an important area ineducational reforms globally. However, studies onemotional intelligence in this study group are scarcein Sri Lanka.

Objective: To determine the level of emotionalintelligence and its association with perceived stressand coping strategies among primary grade schoolteachers in Homagama Educational Zone

Methods: A descriptive cross-sectional study wascarried out from August 2017 to November 2017among primary grade school teachers with6 monthsexperience in teaching in Homagama EducationalZone, using a self-administered, pre-tested andvalidated questionnaire consisting of ‘Schutte SelfReport Emotional Intelligence Test’, 10 item‘Perceived Stress Scale’ and ‘Brief Cope’. Level ofemotional intelligence was described using percen-tages and mean values. Associations were assessedusing Chi-squared test and p value less than 0.05was considered as significant.

Results: Response rate was 95.8% (n=549). Amongthem, 72.1% (n=396) showed a normal level of EIand 14.2% (n=228) a high level. Of the participants,13.7% (n=75) had low EI. The majority (n=453,82.5%) had low perceived stress (0-20). Results

showed statistically significant associations betweenEI with perceived stress (p<0.05), problem focusedcoping strategies (p<0.001) and emotional focusedcoping strategies (p<0.05) among them. Pearsoncorrelation coefficient showed significant andnegative correlation between EI and perceived stress(r=-0.27; p<0.01). Both emotional focused coping andproblem focused coping strategies were significantlyand positively correlated with EI (r=0.21; p<0.01 andr=0.27; p<0.05), respectively.

Conclusions & Recommendations: Majority ofthe primary grade teachers were found to be havinghigh or normal level of EI. A significant negativeassociation was seen between EI and perceivedstress. Significant positive associations were seenbetween EI with emotional focused and problemfocused coping. Training programmes for teachersto further develop EI are recommended.

Key words: primary grade teachers, emotionalintelligence, perceived stress, coping

OP D.2Perception on knowledge and beliefs relatedto the management of depression amongengineering undergraduates of the Universityof Peradeniya, Sri Lanka

Anuruddhika Rathnayake1*, ParakramaEkanayake2, Chiranthika Vithana3

1Directorate of Mental Health, Ministry of Health,Sri Lanka; 2Department of Electrical and ElectronicEngineering, University of Peradeniya; 3FamilyHealth Bureau, Ministry of Health, Sri Lanka*Correspondence:[email protected]

Background: Depression, the most common mentalhealth problem accounts for second highest globalburden of disease due to the high rate of suicidalattempts, reduced productivity of the workforce and

Session D: Mental Health

Chairpersons:Dr Chithramali de SilvaProf. Wasantha Gunathunga





other socio-economic problems. The knowledge andbeliefs on management of depression lead to timelyutilization of available treatment facilities.

Objective: To assess the perception on knowledgeand beliefs related to the management of depressionamong engineering undergraduates at the Universityof Peradeniya and associated factors

Methods: A descriptive cross-sectional study wasconducted at the Faculty of Engineering, Universityof Peradeniya in 2016 among 1631 undergraduatesusing a self-administered vignette-based question-naire consisting of their knowledge and beliefs onthe management of depression and associatedfactors. Percentage scores for knowledge and beliefswere presented with median and inter quartile range(IQR). Associated factors were assessed using oddratio (OR) and 95% confidence interval (CI), and pvalue. Data were analyzed using univariate analysis.

Results: The median percentage score for know-ledge and beliefs on the management of depressionwere 20.6 (IQR=17.6-36.8) and 22.1 (IQR=17.6-38.2). Significantly higher knowledge was seen amongfemales than males (OR=1.56; 95% CI=1.2, 2.0),Sinhalese than non-Sinhalese (OR=2.53; 95% CI=1.6,4.0) and Buddhists than non-Buddhists (OR=2.43;95% CI=1.53, 3.85). Significantly better beliefs wereseen among Sinhalese than non-Sinhalese (OR=2.82;95% CI=1.76, 4.49) and Buddhists than non-Buddhists (OR=2.67; 95% CI=1.67, 4.27).

Conclusions & Recommendations: Study showsthe inadequacy of mental health literacy on themanagement of depression among engineeringundergraduates. Study recommends implementationof interventions to increase mental health literacyamong this group at institutional level taking asso-ciated factors into account.

Key words: depression, management, knowledge,beliefs

OP D.3Prevalence of factors associated with psy-choactive substance use and practices amonglate adolescents schooling in WattalaEducational Division, Sri Lanka

Ranamayurie de Alwis1*, Manoj Fernando2,Sugandika Perera3

1Colombo North Teaching Hospital, Ragama, SriLanka; 2Department of Health Promotion,University of Rajarata; 3World Health Organization,Country Office for Sri Lanka*Correspondence: [email protected]

Background: Substance abuse is a devastatingproblem in Sri Lanka. Adolescence is the criticaltransition period where risk taking behaviour is a keycharacteristic.

Objective: To describe the prevalence of selectedfactors known to be associated with psychoactivesubstance use and practices among late adolescentsschooling in Wattala Educational Division of thedistrict of Gampaha

Methods: A cross-sectional study was conductedamong 15-19 year old 600 adolescents selected from24 schools of Wattala Educational Division withprobability-proportionate-to the size, using multi-stagestratified random cluster sampling. A structured, pre-tested, self-administered questionnaire was used toassess the prevalence and pattern of ever usingalcohol, smoking, smokeless tobacco, heroin andmarijuana; and factors within the family context,environmental factors and knowledge on health effectof using psychoactive substances. Chi-squared testwas used to evaluate the strength of associationbetween ever use of psychoactive substance andselected factors at 5% significance level.

Results: A total of 152 (25%) adolescents had usedsome form of substance at least once in life time.Prevalence of ever use of alcohol, smoking, smokelesstobacco and illicit drugs was 17.7%, 8.3%, 3.2% and3.2%. Age (2=15.9; df=1), ethnicity (2=11.8; df=4),enjoying in schooling (2=10.4; df=2), engage inextracurricular activities (2=12.8; df=2), presenceof peer influence (2=120.6; df=2) and psychoactivesubstance use by a family member (2=25.4; df=2)showed significant associations with the ever use ofpsychoactive substances (p<0.05). In contrast, livingwith a single parent, parents’ level of education andemployment status, perception on relationship withfamily members and knowledge on health effects ofsubstance abuse did not show significant associationswith ever use of psychoactive substances (p>0.05).




Conclusions & Recommendations: Many environ-mental factors and factors within family context havesignificantly influenced the substance use amongadolescents. A prospective cohort study with an in-depth assessment of the factors associated with suchuse should be conducted, in view of improving theeffectiveness of risk focused prevention programs.

Key words: adolescents, substance abuse,psychoactive substances, associated factors forsubstance abuse

OP D.4Utilization of information sources ondepression by patients followed-up at thegeneral psychiatric clinics of National Insti-tute of Mental Health, Sri Lanka

Kusal Weerasinghe1*, Monika Wijeratne2

1Management, Development & Planning Unit,Ministry of Health, Sri Lanka; 2ProvincialDirectorate of Health Services, Western Province,Sri Lanka*Correspondence: [email protected]

Background: Depression is a widely prevalent,highly disabling mental illness. Being well-informedon the disorder has been shown to reduce the rate ofrelapses and diminish the severity of symptomsamong patients with depression.

Objective: To describe the utilization of healthinformation sources on depression among patientsfollowed-up for depression at general psychiatricclinics of the National Institute of Mental Health(NIMH)

Methods: A cross-sectional study was conductedamong 385 patients with depression followed up atgeneral psychiatric clinics of the NIMH. All theeligible patients who attended the clinic duringthe period of data collection were recruited. Aninterviewer- administered questionnaire was used tocollect data.

Results: Among the respondents, 97.9% (n=377)claimed that they almost always use the treating

clinician as the source of information while only 4.4%(n=17) claimed to be using internet to seekinformation on depression. While 99.2% (n=382)were extremely confident in seeking informationfrom the treating clinician only one among the 385patients was extremely confident in using internetfor the purpose. Only 29.6% (n=113) of the patientshad ever come across any form of reading materialon depression and 52.3% (n=90) of them admittedof hardly being confident in seeking informationthrough printed sources. Although only 7.5% (n=29)of them had ever been at a health education session,96.5% (n=17) of others said the knowledge impartedat the session was useful while 86.2% (n=25)perceived it to be an extremely credible source.

Conclusions & Recommendations: Clinicianswere the most widely utilised source of information.Internet and printed material are seldom used andthe majority of patients who had ever used them lackconfidence in their ability to do so. Past experienceof patients and the confidence placed on it makehealth education sessions an effective tool in educatingpatients at the clinic.

Key words: depression, information seeking,health information

OP D.5Prevalence & associated factors of depressionamong Army personnel in Security ForcesHeadquarters area, Jaffna District, Sri Lanka

Darshitha Jothipala1*, Saveen Semage2, RoshanMonaragala2, Aindralal Balasuriya3

1Department of Health Services, Sri Lanka Army;2Directorate of Preventive Medicine & MentalHealth Services, Sri Lanka Army; 3Departmentof Community Medicine, General Sir JohnKotelawala Defence University*Correspondence: [email protected]

Background: Depression is one of commonestmental disorders, a major contributor to the globaldisease burden. Military environment is morevulnerable for depression.





Objective: To describe the prevalence andassociated factors of depression among armypersonnel in Security Forces Headquarters (SFHQ),Jaffna

Methods: A cross-sectional descriptive study wasconducted in a sample of 986 military personnel ofSFHQ, Jaffna. A self-administered questionnaireincluding depression scale and alcohol risk assessingscale were used. Chi-squared test was used to assesssignificance.

Results: Mean age of the participants was 30.7years (SD=6.47). Majority (72%) had not passedGCE Ordinary Level. The married proportion was68.2% (n=640). Monthly salary of 82% (n=779) liedbetween Rs. 30,000-50,000. 48.1% (n=451) hadservice period of 6-10 years. Further, 54.8% (n=513)had engaged in battle and 18% of them (n=90) gotbattle injuries. Current Smoker percentage was 40%(n=375) while 4.6% (n=45) were high risk alcoholconsumers. Prevalence of probable major depressionwas 9.7% (95% CI=7.84, 11.56). Unsatisfied marriedlife (p<0.05) and bank saving status (p<0.001) were

the significantly associated family and socio-demographic-economic related factors. Total serviceperiod, leave frequency, combat exposure period,feeling fear of death at battle and been injured atbattle (p<0.05) showed significant associations withdepression. However, the exposure to battle, age atfirst exposure and absenteeism were not significant.Psycho-social factors including childhood abuse,family history of psychiatric illness (p<0.05), hazar-dous behaviour of smoking and alcohol misuse(p<0.001), and all work life balance related factors(p<0.001) were significantly associated withdepression.

Conclusions & Recommendations: There is ahigh prevalence of probable major depressive disorderamong army personnel in Security Forces Head-quarters in Jaffna. It would adversely influence onthe achievement of organizational goals of Sri LankaArmy. Utilizing the findings for designing futuremental health programmes is recommended.

Key words: depression, prevalence, militarypersonnel, Sri Lanka Army



OP E.1The burden of chronic kidney disease ofuncertain aetiology in Anuradhapura District,Sri Lanka

Thilanga Ruwanpathirana1*, Sameera Sena-nayake1, Samitha Ginige1, Deepa Gamage1,Jagath Amarasekara1, Chamley Premajayantha1,Buddi Lokuketagoda2, Pubudu Chulasiri2,Nalika Gunawardana3, Sarath Amunugama4,Paba Palihawadana1

1Epidemiology Unit, Ministry of Health, SriLanka; 2CKDu Unit, Ministry of Health, SriLanka; 3World Health Organization, CountryOffice for Sri Lanka; 4Ministry of Health, SriLanka*Correspondence: [email protected]

Background: Chronic kidney disease of unknownaetiology (CKDu) is known as a problem among paddyfarmers of the North Central Province. Ministry ofHealth published a three-tiered epidemiological casedefinition in 2016 as suspected, probable and con-firmed CKDu. Suspected CKDu provides a uniformmethod to estimate the burden in epidemiologicalstudies and is defined as the presence of essentialcriteria of eGFR<60mL/min AND/OR albuminuria>=30mg/g. Among those satisfying the essentialcriteria, those with urine protein:creatinine ratio>2g/g creatinine OR urine albumin:creatinine ratio>0.3g/g creatinine; hypertensive on more than 2 drugs ORuntreated blood pressure>160/100mmHg; history ofdiabetes OR being on treatment OR capillary randomplasma glucose>200mg/dL were excluded.

Objective: To assess the prevalence of ‘suspectedCKDu’ in Anuradhapura District

Methods: A cross-sectional study in five GramaNiladhari (GN) areas of Anuradhapura District

included adults over 18 years of age resident duringthe past six months other than being pregnant and ontreatment for cancer. The study was based on thepublished standardized international protocolDEGREE. A sample of 1000 per area was requiredto estimate the prevalence with 2.5% precision.Recruiting the study units was through a householdsurvey while laboratory testing was in ‘clinics’organized in the locality. Medical history was throughan interviewer-administered questionnaire. Labo-ratory testing was done at Anuradhapura TeachingHospital.

Results: Response rate was 88.7% (n=4803).Among them, 68.2% (n=3274) were females and46.3% (n=2225) were 31-50 years of age. In thesample, 85.7% (n=1310) of males were full time/part time farmers. The prevalence of ‘suspectedCKDu’ was 10.7% (n=442) (95% CI=9.8, 11.7) witha marked male preponderance (n=229, 17.5%) versusfemales (n=213, 6%).

Conclusions & Recommendations: Prevalenceof ‘Suspected CKDu’ is a considerable public healthproblem. Periodic estimation using the same casedefinition and protocol is recommended to observethe trends.

Key words: chronic kidney disease of uncertainaetiology, creatinine, hypertension, DEGREEprotocol

OP E.2Factors associated with drug compliance amongcoronary heart disease patients attending theoutpatient cardiology clinic, National Hospitalof Sri Lanka

Kumudumali de Silva1*, Samitha Siritunga2,Sumedha Udumalagala3

Session E: Non Communicable Diseases

Chairpersons:Dr Nalika GunawardenaDr Sudath Samaraweera




1Postgraduate Institute of Medicine, Universityof Colombo; 2Non-Communicable Disease Unit,Ministry of Health, Sri Lanka; 3National Hospitalof Sri Lanka, Colombo, Sri Lanka*Correspondence: [email protected]

Background: Recent data show a rapid rise inchronic non-communicable diseases (NCDs) in SriLanka. Coronary heart diseases (CHDs) are respon-sible for a major proportion of chronic NCDs. Drugcompliance among CHD patients has become animportant issue in the current field of medicine. Sincepoor drug compliance is associated with increasedmorbidity, mortality and economic cost, identificationof drug compliance and factors related to drugcompliance is a timely need.

Objective: To describe the factors associated withdrug compliance among CHD patients attending theNational Hospital of Sri Lanka

Methods: A descriptive cross-sectional study wasconducted among CHD patients attending theoutpatient cardiology clinic of National Hospital ofSri Lanka during 2017. The calculated sample sizewas 403. Study participants were selected by syste-matic random sampling. An interviewer-administeredquestionnaire was used. Drug compliance wasmeasured by adapting MMAS-8 questionnaire.Associations of drug compliance with patient related,disease and treatment related, and healthcare systemrelated factors were identified by applying Chi-squared test. Significance level was tested at 0.05.

Results: Response rate was 97.5% (n=393). Amongthem, 43.0% (n=168) had good compliance while 57%(n=222) had poor compliance to their drug treatment.Patient related factors such as age, sex, marital status,ethnicity, educational level, current employment statusand monthly income were not significantly associatedwith drug compliance (p>.05). Disease related factorssignificantly associated with poor drug compliancewere, longer duration of the disease from diagnosis(p<0.001) and the presence of severe disease symp-toms (p=0.01). Of the treatment related factors,individuals with higher number of drug types per day(p=0.03), higher daily dosing frequency (p=0.03),frequent change of drugs (p=0.04) and drug sideeffects (p=0.01) were more likely to have poor drugcompliance. Healthcare system related factorssignificantly associated with poor drug compliance

were, lesser time spent by doctor to see the patient(p=0.03), not providing explanations about thetreatment and compliance (p=0.02), longer time takento complete the clinic visit (p=0.04) and higher costper clinic visit (p=0.01).

Conclusions & Recommendations: The drugcompliance was found to be low among CHDpatients. Poor compliance was associated withseveral disease, treatment and healthcare systemrelated factors. Developing multidisciplinaryintervention programs to address the factorsidentified is necessary to improve compliance.

Key words: coronary heart disease, drugcompliance, factors associated, MMAS-8

OP E.3Physical activity and functional status in kneeosteoarthritis patients attending clinics at theNational Hospital Sri Lanka

Nuwanthika Kadugala Arachchi1*, ShreenikaWeliange2

1Department of Allied Health Sciences, Universityof Colombo; 2Department of Community Medicine,University of Colombo*Correspondence: [email protected]

Background: Knee osteoarthritis is one of theleading causes for knee pain and functional limitationsin elderly people, which in turn affects the quality oflife. Functional limitations result in weakening of themuscles and loss of flexibility in the joints.

Objective: To assess the avoidance of physicalactivity and functional status of knee osteoarthritispatients

Methods: A descriptive cross-sectional study wascarried out among 120 knee osteoarthritis patients60 years or below attending the National HospitalSri Lanka using systematic consecutive sampling.Knee pain, functional status and avoidance ofphysical activity were assessed using the visualanalogue scale, knee injury and osteoarthritis outcomescore, and pain coping inventory. Pearson correlationwas done to analyse the relationship between thelevel of avoidance of activity and functional status.





Results: Majority were females with bilateral kneeosteoarthritis. Majority (n=117, 97.5%) were inmoderate to severe pain categories. Resting was themostly used coping style to avoid physical activities.The passive coping style which includes resting wasused than the active coping style to avoid physical acti-vities. There were significant negative moderate tohigh correlations between functional status QOL com-ponent with avoidance factors (p<0.01). Functionalstatus sports component showed significant negativemoderate correlations avoidance factors (p<0.01).

Conclusions & Recommendations: Most of thepatients suffered from knee pain with majorityadopting passive coping style. Avoidance of physicalactivity subscales (distraction, resting, decreasingdemands and worrying) showed significantrelationships with QOL and sports. It is recommendedthat to identify each patient’s coping style of pain toimprove functionality. Further studies can be recom-mended with more qualitative studies on non-pharmacological methods of pain relief whichosteoarthritis patients have successful experiencesfrom their application.

Key words: avoidance of physical activity,functional status, knee pain

OP E.4Prevalence and associated psychosocialfactors of depression among postpartummothers in Kolonnawa Medical Officer ofHealth area, Colombo, Sri Lanka

Shermi Jayasumana1*, Kasun Wasala2

1Education, Training & Research Unit, Ministryof Health, Sri Lanka; 2Postgraduate Institute ofMedicine, University of Colombo*Correspondence: [email protected]

Background: Postpartum depression (PPD) is gain-ing importance as a public health concern globally.The prevalence of PPD in Sri Lanka ranges from27.1% to 32.1%. Depression can occur in postpartummothers irrespective of their psychosocial status.Therefore, active screening is necessary during thepostpartum period. By finding out the associatedfactors of PPD, quality of care for postpartummothers can be improved.

Objective: To determine the prevalence ofdepression among postpartum mothers in the MOHarea, Kolonnawa, Sri Lanka and to describe thepsychosocial factors associated with it

Methods: A clinic-based cross-sectional study wasconducted among all mothers in 4-8 weeks ofpostpartum period attending the child welfare clinicsat Kolonnawa MOH area during the first quarter of2017 (N=341). A self-administered questionnaireincluding Edinburgh Post-Partum Depression Scale(EPDS) was used for data collection. A cut-off valueof 9 was used for the EPDS. Prevalence of PPDwas calculated. Associations were analysed usingodds ratio (OR) and Chi-squared test with p value at5% significance level.

Results: Median EPDS score among post-partummothers was 4(IQR=2-8). Prevalence of PPD in thisstudy sample was 15.24% (n=52). Thought of self-harming (item number 10 of EPDS) was reportedby 21 postpartum mothers (6.15%). None of thepsychosocial factors were significantly associatedwith PPD or thought of self-harming in this studysample.

Conclusions & Recommendations: Prevalenceof PPD in Kolonnawa MOH area was relatively high,which is compatible with the available literature onSri Lankan studies. Depression can occur in post-partum mothers irrespective of their psychosocialstatus. Therefore, active screening is necessaryduring postpartum period.

Key words: postpartum depression, prevalence,associated factors

OP E.5Development and validation of a quality of lifetool for stroke survivors in Sri Lanka: Post-Stroke Quality of Life Index

PKB Mahesh1*, MW Gunathunga2, SarojJayasinghe3, SM Arnold1, SN Liyanage4, IAOVIllangakoon5

1Regional Directorate of Health Services,Colombo District, Sri Lanka; 2Department ofCommunity Medicine, University of Colombo;




3Department of Clinical Medicine, University ofColombo; 4Postgraduate Institute of Medicine,University of Colombo; 5Colombo North TeachingHospital, Sri Lanka*Correspondence: [email protected]

Background: Burden of stroke is rising due to thedemographic and epidemiological transitions in SriLanka. Assessment of the success of stroke manage-ment requires tools to assess the quality of life ofstroke survivors. Most of the currently used QOLtools are developed in high income countries and maynot reflect domains relevant to poorer countries.

Objective: To develop and validate a new QOL toolfor stroke survivors in Sri Lanka

Methods: The Consensus-based Standards for theselection of health Measurement Instruments(COSMIN) checklist was referred. A conceptualframework was prepared. Item generation was donereviewing the existing QOL tools, inputs from expertsand from stroke victims. Non-statistical item reductionwas done for the 36 generated items with Delphitechnique. Retained 21 items were included in thedraft tool. A cross-sectional study was done with 180stroke survivors. Exploratory factor analysis wasdone and factors identified were subjected to varimax

rotation. Further, construct validity was tested withsix a-priori hypotheses using already validatedtools (SF-36, EQ-5D-3L) and a formed construct.Reliability was assessed with internal consistency.

Results: Four factors identified with principalcomponent analysis explained 72.02% of the totalvariance. All 21 items loaded with a level >0.4. Thedeveloped tool was named as Post-stroke QOL Index(PQOLI). Four domains were named as “physicaland social function”, “environment”, “financial-independence” and “pain and emotional-wellbeing”.Four domain scores of PQOLI correlated as expectedwith the SF-36, EQ-5D Index and EQ-5D-VASscores. Higher domain scores were obtained forambulatory group than the hospitalized group. Higherscores for financial independence domain wereobtained for the group without financial instability.Five a-priori hypotheses were completely proven tobe true. Cronbach-alpha level ranged from 0.91 to0.68 for the four domains.

Conclusions & Recommendations: PQOLI is avalid and reliable QOL tool for measuring the QOLof stroke survivors.

Key words: stroke, quality of life, quality of lifetool, Sri Lanka




OP F.1Proportion of unplanned pregnancies, theirassociated factors and health outcomes ofwomen delivering at Colombo North TeachingHospital, Ragama, Sri Lanka

Jayani Ranatunga1*, Kapila Jayaratne2

1Postgraduate Institute of Medicine, Universityof Colombo; 2Family Health Bureau, Ministry ofHealth, Sri Lanka*Correspondence: [email protected]

Background: Unplanned pregnancy is a significantpublic health issue in the developing world and itsburden is reflected in women opting for pregnancyterminations despite the presence of well-establishedfamily planning services. Quality data on unplannedpregnancies are needed to address issues in the SriLankan context.

Objective: To describe the proportion of unplannedpregnancies, their associated factors and healthoutcomes of women delivering at Colombo NorthTeaching Hospital, Ragama (CNTH)

Methods: A cross-sectional study was carried outamong 494 pregnant women selected by non-probability consecutive sampling who were awaitingdelivery at CNTH. A pre-tested interviewer-adminis-tered questionnaire was used to collect data onantenatal women. Intention of the pregnancy wasmeasured using a self-administered culturally adaptedSinhalese translation of six item London Measure ofUnplanned pregnancy (LMUP).

Results: Response rate was 97.8% and mean ageof conception was 28.5 year. Study reported 17.2%unplanned pregnancies, 12.7% ambivalent and 70.1%planned pregnancies. Majority (n=141, 95.2%) ofwomen with unplanned pregnancy were married;43.9% (n=65) married at their teens,; and 18.2%(n=27) were teenage mothers.

Associated factor profile of women with unplannedpregnancies include; not married women (OR=17.13;95% CI=2.09, 140.5), educated up to passing of GCEOrdinary Level by women (OR=2.33; 95% CI=1.56,3.47) and spouse (OR=3.33; 95% CI=2.14, 5.17) andmonthly household income below Rs.40,000(OR=1.82; 95% CI=1.23, 2.68), women who hadinitiated sex before 20 years of age (OR=2.74; 95%CI=1.81, 4.13), being a teenager (OR=4.06; 95%CI=2.16, 7.65), multi parity (p=0.01) and inadequateknowledge on emergency contraceptives (OR=1.52;95% CI=1.03, 2.24). Less planned pregnancies werealso significantly associated with anemia, low moodfor last two weeks, having a partner with problematicalcohol consumption, presence of gender-basedviolence, poor relationship with partner and family.Inadequate pre-pregnancy preparation and antenatalcare were associated with unplanned pregnancy. Nodifference was found in neonatal outcomes.

Conclusions & Recommendations: A sizeableproportion of pregnancies were unplanned. Teenagepregnancies, non-marital relationships and inadequateknowledge on emergency contraceptives, maternalanaemia, low mood and gender-based violence weremodifiable associated factors that could be preventedby evidence-based locally applicable approaches.

Key words: unplanned pregnancy, maternal andnewborn health outcomes

OP F.2Comparative study on unmet need of familyplanning and associated factors amongpostpartum mothers aged 20-35 years andover 35 years attending the child welfareclinics in Colombo Municipal Council area, SriLanka

Thanuja Wickramatunga1*, Sampatha Goone-wardena2

Session F: Maternal and Child Health

Chairpersons:Dr. Anuradhini KasturitatneDr N Mapitigama




1Postgraduate Institute of Medicine, Universityof Colombo; 2Department of CommunityMedicine, University of Sri Jayewardenepura*Correspondence: [email protected]

Background: Unmet need of family planninghighlights the gap between women’s reproductivegoals and their contraceptive behaviour. This leadsto unwanted outcomes, which in turn negativelyaffects the health and wellbeing of woman and thewhole family.

Objective: To compare the unmet need of familyplanning and associated factors among postpartummothers aged 20-35 years and over 35 yearsattending child welfare clinics in Colombo MunicipalCouncil (CMC) area

Methods: A comparative cross-sectional study wascarried out among 212 postpartum mothers agedmore than 35 years and 212 postpartum mothersbetween 20-35 years having a child less than sevenmonths attending the child welfare clinics in CMCarea. Older mothers were recruited using non-probability consecutive sampling method andmultistage systematic sampling for younger mothers.An interviewer-administered questionnaire was usedfor data collection. Chi-squared test was done forassociations and p<0.05 was considered as thestatistical significant level.

Results: The proportion of unmet need of familyplanning was 30.2% (n=64) in more than 35 yearage group while it was 31.1% (n=66) in the 20-35group. Not having sex (p=0.02) and health concerns(p=0.04) were the statistically significant reasons forunmet need among two groups. A higher proportionof mothers in the over 35 age group had goodknowledge than their counterpart, yet this differencewas not statistically significant (p=0.39). More than35 year old mothers who were less educated(p=0.02), being a nuclear family (p=0.01), had nofamily support (p=0.04) and with more children(p=0.001) were not using any family planning methodcompared to the 20-35 age group and this differenceamong the two groups was statistically significant.

Conclusions & Recommendations: Proportion ofunmet need of family planning is high among bothstudy groups. Family planning programmes shouldbe streamlined to address the high unmet need of

family planning, and health education programmesshould be targeted for a behavioural change amongcouples.

Key words: unmet need, family planning,postpartum mothers

OP F.3Validity and reliability of a new multi-dimensional instrument to assess maternalperceptions of the quality of immediatepostnatal care services in Sri Lanka

Sashimali Wickramasinghe1*, Wasantha Guna-thunga1, Nilmini Hemachandra2

1Department of Community Medicine, Universityof Colombo; 2World Health Organization, CountryOffice for Sri Lanka*Correspondence: [email protected]

Background: Immediate postnatal period or the first24 hours after delivery is a period where high qualityservices are required to prevent adverse healthoutcomes for mother and baby. Mothers’ perceptionof the care received during this period is consideredan important attribute in assessment and improve-ment of quality of care provided by the hospitals.However, this should be assessed using a valid andreliable instrument to guarantee the validity of thedata.

Objective: To determine the validity and reliabilityof a newly developed instrument to measure maternalperceptions of quality of routine care provided in theimmediate postnatal period following a normal vaginaldelivery, by the state sector specialized care healthinstitutions in Sri Lanka

Methods: Multiple qualitative methods were usedto generate culturally suitable items for theinstrument. The developed instrument was validatedusing an exploratory factor analysis. Data werecollected among 200 mothers who had undergonenormal vaginal delivery in Colombo North TeachingHospital and were in the immediate postnatal period.Consecutive sampling technique was used to recruiteligible mothers until the required sample size was





achieved. Reliability was estimated by measuringinternal consistency and test retest method.

Results: The qualitative methods were able togenerate an item pool of 28 items. Following factoranalysis, the instrument consisted of 23 items. Threemain domains identified were: Interpersonal care,Technical care and Information, and Ward facilitiesand Cleanliness. The three-factor model identifiedwas able to explain 58.9% of the total variance ofthe scale. Cronbach’s alpha value for the total scalewas 0.94. The spearman’s rank correlation coefficientvalue for the test retest reliability was 0.94.

Conclusions & Recommendations: The newlydeveloped 23-item instrument demonstratedsatisfactory level of validity and reliability. Applicationof this instrument will provide heath mangers withvaluable information which can be utilized to improvethe quality of routine care in the immediate postnatalperiod.

Key words: client-perceived quality, instrumentdevelopment, exploratory factor analysis, validation,postnatal care quality

OP F.4Service-related factors associated withantenatal screening for gestational diabetesmellitus among mothers delivering atsecondary care hospitals in Matara District,Sri Lanka

GJ Chandana1*, CJ Wijesinghe2

1Provincial Directorate of Health Services,Southern Province, Sri Lanka; 2Department ofCommunity Medicine, University of Ruhuna*Correspondence: [email protected]

Background: Gestational diabetes mellitus (GDM)defined as ‘any degree of glucose intolerance withonset or first recognition during pregnancy’, accountsfor certain adverse maternal and perinatal outcomes.Early detection and prompt glycaemic control canminimize such outcomes, thus universal screening forGDM is recommended. It has been incorporated to

the maternal care programme since 2014 and carriedout twice during the antenatal period at field antenatalclinics.

Objective: To assess the service-related factorsassociated with effective implementation of antenatalGDM screening programme among mothers inMatara District

Methods: In a cross-sectional study, 423 postpartummothers delivered at three secondary care hospitalsin Matara District were recruited using a pro-portionate sampling technique. Data on access toantenatal GDM screening services and screeningprocess were collected using an interviewer-adminis-tered questionnaire. Data on the availability ofscreening facilities were collected using a data recordsheet. Chi-squared test and Fisher’s exact test wereused to test the associations between variables.

Results: Response rate was 92.3% (n=420).Distance to the nearest laboratory with blood sugartesting was within 30-minute reach for 91.7%(n=385). Area public health midwife was not availableduring the time of first and second GDM screeningfor 5.5% (n=23) and 13.2% (n=55) of the participants,respectively. Availability of logistics to performscreening test were 22.7% (n=85) and 11.5% (n=43).Coverage of first and second screening was foundto be 91.4% (n=384) and 94.5% (n=393) whiletimeliness was 72.4% (n=278) and 59.5% (n=234),respectively. Proper documentation was done in76.8% (n=295) and 65.4% (n=265); and 47.7%(n=21) and 21.2% (n=7) reported appropriatereferral, respectively after first and second screening.Screening coverage was negatively associated witha longer distance to nearest laboratory (p=0.002) andtimeliness with non-availability of logistics (p=0.002)in second screening, but not in first screening.

Conclusions & Recommendations: Despitehigher coverage, GDM screening programme needsimprovement in timeliness, proper documentationand appropriate referral. Availability of logistics atMOH level will improve the performance of GDMscreening and hence the maternal care package.

Key words: GDM screening, service relatedfactors, antenatal mothers




OP F.5Preference and associated factors for thecaesarean section as a mode of deliveryamong primi-pregnant mothers attendingselected antenatal clinics of BandaragamaMedical Officer of Health in Sri Lanka

Subhashini Suwandaarachchi1*, ShaminiPrathapan2

1Postgraduate Institute of Medicine, Universityof Colombo; 2Department of Community Medicine,University of Sri Jayewardenepura*Correspondence: [email protected]

Background: Increasing caesarean section (CS)rate is observed in the world, which has a significantnegative impact on the health of pregnant mother,family and the economy of country.

Objective: To describe the preference, and asso-ciated factors for the caesarean section as a modeof delivery among primi pregnant mothers attendingantenatal clinics of the medical officer of health(MOH) area of Bandaragama

Methods: This study was a descriptive cross-sectional study among 238 primi pregnant motherswho were in their second and third trimester andwho would undergo planned caesarean section (those

with severe heart diseases, pelvic deformities, HIVand multiple pregnancies) attending antenatal clinicsin Bandaragama MOH area. They were selectedby systematic random sampling method. A pre-testedinterviewer-administrated questionnaire was used.Associated factors of preferred mode of deliverywere determined using Chi-squared test. Significancelevel was set at 5%.

Results: Response rate was 90% (n=217). Pre-valence of preferred mode of delivery for caesareansection was 12% (n=26). Factors significantlyassociated with caesarean section were high maternalage (p<0.05), being Sinhalese (p<0.05), private jobsector (p<0.05) and monthly income more thanRs. 40,000 (p<0.05). There was no significantassociation of preferred mode of delivery with periodof gestation, having planned pregnancy, body massindex and channelling an obstetrician in the privatesector (p>0.05).

Conclusions & Recommendations: As thepreferred mode of delivery, caesarean section issignificantly associated with high maternal age, beinga Sinhalese, private job sector and monthly incomemore than Rs. 40,000. Health education interventionsare recommended to educate pregnant mothers inreducing the caesarean section rate in Sri Lanka.

Key words: pregnant mothers, caesarean section,preferred mode of delivery




OP G.1A strategy to train doctors in medicalcertification of cause of death in selected largehospitals in Sri Lanka

USH Gamage1*, LC Somathunga2, LMMikkelsen3, R Wadugedara4

1National Institute of Health Sciences, Kalutara,Sri Lanka; 2Ministry of Health, Sri Lanka; 3GlobalBurden of Disease Unit, University of Melbourne;4Postgraduate Institute of Medicine, Universityof Colombo*Correspondence: [email protected]

Background: Poor quality of cause of medicalcertification of cause of death (MCCOD) by medicalofficers has been identified as a key public healthissue globally. Previous studies in Sri Lanka andinformation released by the Registrar General’sDepartment suggests poor MCCOD by medicalofficers.

Objective: To pilot a strategy and training approachto improve the quality of MCCOD in selected largehospitals in Sri Lanka

Methods: Twenty-five hospitals in Sri Lanka wereselected based on being large hospitals, where aconsiderable proportion of deaths are taking place.A baseline of the quality of certification practiceswas done on a sample of death declarations usingthe University of Melbourne’s (UoM) death certifica-tion assessment tool. After six months of in-hospitaltraining, another sample of death declarations willbe drawn to assess progress in each hospital. Theintervention package introduced by the Bloombergdata for health initiative of the UoM included two-day training workshops for five doctors from eachhospital on correct MCCOD. The material providedfor in-hospital training includes handbook, assessment

tool, training prospectus, power point presentations,etc.

Results: Master trainers (n=125) from 25 largehospitals were trained. A two-hour training packagecomprising general and specific certification guidelinesand case scenario discussions were developed forthe hospital roll-out by master trainers. A Google groupwas formed to communicate with all the trainers.Master trainers were added to the UoM MCCODmaster trainers’ Facebook forum for posting trainingnews and sharing experience with internationaltrainers. Some hospitals set up MCCOD call centresto answer queries from doctors. A number ofhospitals have completed training all the doctors. Inthe pre-assessment, only 2.17% of the deathdeclarations were without errors. The commonesterror was missing time intervals. Incorrect sequence,reporting multiple causes in a line, and ill-definedUCOD were among the other errors.

Conclusions & Recommendations: The pre-intervention results show that the certificationpractices are poor in the 25 hospitals. In the pilot,this seems to be a feasible approach to train them.Post-intervention results will demonstrate howeffective the strategy and training are in improvingthe cause of death certification practices in theselected hospitals.

Key words: quality of medical certification, causeof death

OP G.2Service quality for patients with mentalillnesses at the National Hospital Sri Lanka

Priyasha Wijenayake1*, Vindya Kumarapeli2

1Postgraduate Institute of Medicine, Universityof Colombo; 2Education, Training & ResearchUnit, Ministry of Health, Sri Lanka*Correspondence: [email protected]

Session G: Patient Care Quality

Chairpersons:Dr. Manuj C WeerasingheDr S Sridharan





Background: In Sri Lanka, mental health has beengiven a low priority, despite one out of ten in popu-lation suffering from a mental illness. Most patientsare treated and followed up at psychiatric clinics atgovernment hospitals.

Objective: To assess perception and expectationsof clinic attendees on quality of services, factorsaffecting quality and opinion of the consultantpsychiatrists at psychiatric clinics of the NationalHospital of Sri Lanka (NHSL)

Methods: A descriptive cross-sectional study wascarried out at psychiatric clinics of NHSL, among292 clinic attendees in remission, followed-up at theclinics for 1year, and decided by treating team ascapable of giving information and consent. Partici-pants were recruited through systematic samplingmethod. Perception and expectations on five qualitydimensions of SERVQUAL model (tangibles,reliability, responsiveness, assurance, empathy) wereassessed using pre-tested, interviewer-administeredquestionnaire with 30 items on a five-point Likertscale. In-depth interviews were conducted amongconsultant psychiatrists (n=5). Associations weretested through Chi-squared test. Thematic framework approach was used for analysis of qualitativedata.

Results: Response rate was 93% (n=274). Majoritywere aged 45-54 years (n=61, 22.4%), males (n=161,59.2%), married (n=145, 53.3%), Sinhala (n=179,65.8%), passed GCE Ordinary Level (n=72, 26.5%),currently unemployed (n=186, 68.3%) and ontreatment for 2-5 years (n=117, 43.5%). Tangibilityscored highest (mean=1.48; SD=0.001), assurancescored least (mean=1.11; SD=0.001) for expec-tations. Responsiveness scored highest (mean=2.98;SD=0.164) and tangibility scored least (mean=2.14;SD=0.001) for perceptions. Overall perception(mean=2.55; SD=0.66) regarding the quality ofservice was higher than expectations (mean=1.22;SD=1.36). Perception of tangibility was associatedwith level of education (p=0.004), ethnicity (p=0.01)and empathy with unemployment (p=0.03). In-depthinterviews revealed the need for privacy and confi-dentiality at clinics, avoiding stigma during communi-cation by the staff.

Conclusions & Recommendations: Servicequality for patients with mental illness at NHSL was

found to be better than their expectations. In-servicetraining of the staff, creating a culture where patientsare treated with respect and dignity is recommended.

Key words: service quality, psychiatric patients,clinics, perceptions and expectations

OP G.3Evaluation of the effect of pre-operative over-fasting on post-operative vomiting in childrenundergoing bone marrow aspiration at atertiary care setting in Sri Lanka

Vidura Jayasinghe1*, PK Buddhika Mahesh2,SN Liyanage1

1Postgraduate Institute of Medicine, Universityof Colombo; 2Regional Directorate of HealthServices, Colombo District, Sri Lanka*Correspondence: [email protected]

Background: Fasting prior to induction of anaes-thesia is the main requirement to prevent aspiration.Keeping children fasting is a major challenge in manyinstances. Not adhering to proper standard fastingguidelines and subsequent over-fasting are knownto cause many complications including post-operativevomiting.

Objective: To determine the association betweenpre-operative, over-fasting and post-operativevomiting among children undergoing general anaes-thesia in Sri Lanka

Methods: A prospective cohort study was con-ducted in children undergoing bone marrow aspirationunder general anaesthesia. The exposure status wasdetermined by the duration of fasting time of the child.Children kept fasting for three or more hours fromlast clear fluid intake constituted the exposed group,while children fasting for less than 3 hours constitutedthe non-exposed group. The calculated sample sizewas 202 participants in each group. Both groups werefollowed-up till six hours following induction ofanaesthesia. The outcome of interest was develop-ment of post-operative vomiting during the follow-up period.

Results: The mean (SD) duration time of fasting ofthe exposed and non-exposed groups were 7.2 (2.4)




and 2.2 (0.3) hours, respectively. Thirty two (15.8%)children in the exposed group and 17 (8.4%) childrenin the non-exposed group developed post-operativevomiting. The relative risk of developing post-operative vomiting among over-fasting children was1.9 (95% CI=1.1, 3.3) while adjusting for age, it was2.1 (95% CI=1.1, 4.0). Significantly more caregiverswere clear about the fasting advice in the non-exposed group than in the exposed group (p<0.001).

Conclusions & Recommendations: Over-fastingis a significant risk factor to develop post-operativevomiting in paediatric anaesthetic practice. Needfulmeasures need to be taken to minimize over-fasting.

Key words: fasting, vomiting, paediatric,caregiver, general anaesthesia

OP G.4Validation and application of a verbal autopsytool in Sri Lanka: basic steps of a crescendoto improve the quality of cause of death data

Rajitha L Jayasuriya1*, Samath D Dharmaratne2

1Ministry of Health, Colombo; 2Department ofCommunity Medicine, University of Peradeniya*Correspondence: [email protected]

Background: Sri Lanka’s poor quality of cause ofdeath (COD) data is due to two main reasons; first,all deaths that occur outside of hospital settings arenot certified by doctors but by non-medically trainedstaff (coroners and registrars of births and deaths),and over half of all deaths in Sri Lanka occur outsidehospitals; second, CODs are not accurately recordedfor some deaths certified in health facilities by doctors.Verbal autopsy (VA) is a tool used to ascertain validCODs where medical certification of COD is notpossible.

Objective: To assess the effectiveness of verbalautopsy in improving the quality of cause of deathdata of adults and adolescents

Methods: The study consisted of two parts;validation study (a) and an implementation study (b).a) International Standard Verbal Autopsy Ques-tionnaire designed by the World Health Organization

was translated into Sinhala language, pre-tested andvalidated (judgmental and criterion validity). Todetermine the criterion validity, a study was conductedin Kandy Teaching Hospital using in-hospital deathsin the year 2010 (n=316). b) A descriptive cross-sectional study was done retrospectively to redistri-bute unusable CODs in Gangawatakoralaya regis-tration division, Kandy. A medical record assistantcoded deaths in the division from 1 January to 30June 2010. The causes coded as signs symptoms orill-defined conditions (432 deaths) were selected toadminister VA questionnaire to re-distribute theCODs.

Results: Sensitivity for ischemic heart disease,intentional self-harm and transport accidentsexceeded 90% while chronic lower respiratory tractdiseases and pneumonia were 77.5% and 74.7%,respectively. Positive predictive values of the abovecategories were over 75%. In the implementationstudy, verbal autopsy was done to 405 deaths, and55.8% (n=226) CODs were redistributed to usableCODs.

Conclusions & Recommendations: Verbalautopsy can be used in Sri Lanka to redistributeunusable CODs into valid CODs.

Key words: verbal autopsy, cause of death

OP G.5School dental service in Sri Lanka: geo-spatialanalysis of access to oral healthcare

Nirosha Ranasinghe1*, Estie Kruger2, MarcTennant2

1National Institute of Health Sciences, Kalutara,Sri Lanka, 2International Research Collaborative– Oral Health and Equity, School of HumanSciences, University of Western Australia*Correspondence: [email protected]

Background: The school dental service has longbeen recognised as a cost-effective approach for theprovision of oral healthcare for school children. Itcontributes to the reduction of social inequalities inoral health among children.





Objective: To investigate the distribution of schooldental clinics manned by school dental therapists inSri Lanka in relation to the distribution of childpopulation and socio-economic status

Methods: School dental clinics were mapped usinggeographic information system (GIS) software andoverlayed with population data of 3-13 year oldchildren, including poverty status.

Results: Overall, there was an uneven geographicdistribution of the total 422 school dental clinics andthe attached 374 school dental therapists. Sri Lankanchildren have restricted access to school dental carein a few poverty-stricken districts in the Northern,Eastern, North Central and Uva Provinces. Overall,61% were within 5km of dental care, and the

accessibility was remarkably high in the Western andCentral regions. When the geographic distribution ofchildren by poverty status was analysed, it was foundthat in Sri Lanka only 53% of the most sociallydisadvantaged children lived within 5km from a schooldental clinic, compared to 75% of the least dis-advantaged.

Conclusions & Recommendations: A coordinatednational school dental service strategy is needed inresponse to identified areas of poor or inadequateaccessibility to dental services for large parts of thechild population, especially those from low socio-economic backgrounds.

Key words: school dental service, school dentaltherapist, Sri Lanka, spatial distribution



OP H.1Perceived self-efficacy in managing chronicdiseases among elders attending medicalclinics at Mulleriyawa Base Hospital, SriLanka

Niludi Ranwanee1*, Supun Wijesingha1

1Anti Leprosy Campaign, Ministry of Health, SriLanka*Correspondence: [email protected]

Background: Self-efficacy is posited as funda-mental to achieve behaviour change of individuals.Study aims to fill the present gaps in self-managementof chronic diseases.

Objective: To assess the perceived self-efficacyand associated factors in managing chronic diseasesamong elders in a clinic setting

Methods: An institution-based descriptive cross-sectional study was conducted. By systematicsampling, 461 eligible patients diagnosed with fivechronic diseases were interviewed using pre-tested,validated Chronic Disease Self-efficacy Ques-tionnaire. Self-efficacy was calculated by averagingthe mean scores of 10 efficacy domains and cate-gorized as good, satisfactory and poor levels.

Results: Response rate was 92% (n=424). Meanage was 69.5 years, while 75.7% (n=321) consistedof females, 95% (n=402) were educated and 70.6%(n=298) were living with children. 46.3% (n=193)were economically dependent on children. Meanperceived self-efficacy was 3.64 (SD=0.54) withgood (n=128, 31.4%), satisfactory (n=141, 34.6%)and poor (n=138, 33.9%) self-efficacy levels. Riskfactor control domain (diet, exercises and substance)had the lowest mean efficacy (2.195). Age category(p=0.004), education (p=0.007), income levels(p=0.015), impaired vision (p=0.002), impairedmobility (p=0.017), multiple co-morbidities (p=0.02),

blood pressure (p=0.04) and total blood cholesterolcontrol (p=0.04) had statistically significantassociations with self-efficacy levels but not the bloodsugar control (p=0.64) and recent hospitalizations forchronic illness (p=0.2). Those of 60-69 years weremainly (n=84, 38.7%) in good efficacy level.Percentages of good self-efficacy increased withimproved education. 52.1% (n=25) of good self-efficacy was seen in higher income group. A higherproportion of poor self-efficacy was found amongelders with disabilities. Multiple co-morbiditiesshowed a decrease in good self-efficacy with thenumber of co-existing diseases.

Conclusions & Recommendations: Perceivedself-efficacy levels were significantly associated withsocio-demographic factors, disability status andmultiple co-morbidities, which are important factorsto address self-management of chronic diseases.Improvement of self-efficacy may have a beneficialeffect on blood pressure control, total cholesterol andrisk factor management. Further cohort studies areneeded to assess the temporality of perceived self-efficacy and its determinants.

Key words: self-efficacy, chronic diseases,elderly

OP H.2Level of stress and selected socio-demogra-phic factors among grandparents upbringing ofgrandchildren aged six months to five years inHomagama Medical Officer of Health area,Colombo, Sri Lanka

Rishmi Hewawasam1*, Sampatha Goonewardena2

1Non-Communicable Disease Unit, Ministry ofHealth, Sri Lanka; 2Department of CommunityMedicine, University of Sri Jayewardenepura*Correspondence: [email protected]

Session H: Health among Vulnerable Populations

Chairpersons:Dr Aindralal BalasuriyaDr Janaki Vidanapathirana





Background: The traditional role of enjoying thegrandparenthood without many responsibilities hasbeen changed. The growing trend of grandparentsas primary caregivers is seen throughout the world.In the recent past, the role of grandparents haschanged to fulltime caregivers because of the failureof their parents to meet the parenting responsibilities.

Objectives: To assess the level of stress andselected socio-demographic factors among grand-parents caring upbringing of grandchildren inHomagama Medical Officer of Health (MOH) areain Colombo District

Methods: A community-based cross-sectional studywas conducted among 510 grandparents upbringingtheir grandchildren aged six months to five years inHomagama MOH area. An interviewer-adminis-tered questionnaire, Parental Stress Scale and Ten-item Perceived Stress Scale were used to assessthe overall stress among the grandparents. P valueless than 0.05 was considered as the statisticalsignificant level.

Results: Majority (n=383, 76%) were grand-mothers. The mean age of grandparents was 62.6years (SD=6.55). Nearly two thirds (>65%) ofgrandparents lived in their own place. Approximately51% (n=256) of grandparents reported as having achronic disease and were on regular clinic followup. Mean parental score was 34.9 (SD=8.27) andperceived stress level was 20.2 (SD=7.0). Being agrandfather, having a chronic disease, higher incomelevel, advancing age of the grandchild, higher theduration of upbringing and presence of a housemaidwere significantly associated with parental stress ingrandparents (p<0.05). However, educational leveland their occupational status were not significantlyassociated with the parental stress level (p>0.05).

Conclusions & Recommendations: Grandparentswho look after their grandchildren should be givenmore free time to enjoy their hobbies, to meet theirfriends and to engage in religious activities whichwould improve their quality of life.

Key words: grand parenting, grandchildren,caring practices, stress level

OP H.3Assessment of HIV related stigma amongpeople living with HIV in Sri Lanka

Janaki Vidanapathirana1, Buddhika Senanayake1,Nimali Wijegoonewardene1*, Mekala Fernando1,Nirosha Disanayake1

1National STD/ AIDS Control Programme,Ministry of Health, Sri Lanka*Correspondence: [email protected]

Background: People living with HIV face stigmaduring their lives which can affect them adversely inmany ways, as well as have adverse outcomes onthe community with regard to the transmission ofHIV infection. Stigma can undermine the HIVprevention efforts and practice of safe behaviours.

Objective: To assess the stigma associated withHIV among people living with HIV in Sri Lanka

Methods: A descriptive cross-sectional study wascarried out in 2017 among 150 people living with HIVin Sri Lanka selected through purposive sampling,which is the common method of sampling in similarstudies. The judgmentally validated Stigma Index wasadministered as an interviewer-administeredquestionnaire by four data collectors who were livingwith HIV themselves. It included personal infor-mation, experience of stigma and discrimination fromothers, access to work, health and education services,internal stigma, among other details, and was pre-tested prior to administration. Descriptive data wereanalysed as frequencies and proportions.

Results: The study population consisted of 54%(n=81) of males and the age varied from 15 to 70years. Of them, 68% (n=102) were living with HIVfor five or more years. Fourteen Participants (9.3%)have not declared their HIV status to their spouse orpartner. HIV positive people have found it easier toshare their status with other people living with HIV.Verbal abuse, harassment or threat due to HIV statuswas experienced by 10% (n=15). Four percent (n=6)suffered physical abuse, harassment or threat directlyrelated to their HIV status. Only 6% (n=9) of thestudy population indicated that the loss of a job oranother source of income was due to their HIVstatus. Regarding internal stigma, self-blame (46.7%)




and shame (42.7%) were the most prevalent feelings,followed by guilt (31.3%), low self-esteem (n=38,25.3%) and suicidal thoughts (20%).

Conclusions & Recommendations: Stigmaamong people living with HIV still prevails in thecommunity, where many are not willing to share theirstatus due to fear of stigma. Awareness on HIV andattitudinal change can improve the situation.Psychological services should be strengthened toovercome internal stigma.

Key words: stigma, people living with HIV, SriLanka

OP H.4Water, sanitation and hygiene promotionamong adolescents: knowledge, attitudes andpractices

HND Zoysa1*, Ayesha Lokubalasooriya2

1National Institute of Health Sciences, Kalutara,Sri Lanka, 2Family Health Bureau, Ministry ofHealth, Sri Lanka*Correspondence: [email protected]

Background: Communicable diseases, mainlyrespiratory and intestinal infections, cause suffering,lifelong disability or untimely death of millionspredominantly in developing regions of the world.Knowledge, attitudes and hygienic practices amongyoung school children in Sri Lanka are poorly under-stood though it is critical for prevention and sustainablecontrol of communicable diseases.

Objective: To describe the knowledge, attitudes andpractices on hygiene among Grade 7 school children

Methods: A cross-sectional descriptive study wasconducted among students of Grade 7 in 12 out of36 schools in Kalutara Medical Officer of Healtharea. Data were gathered under three main sections:personal hygiene, knowledge, attitudes and practices.Two checklists and a self-administered questionnairewere used.

Results: The response rate was 92.6% (n=574).Females had better practices of cleaning with soapand water after defecation, drinking boiled water and

washing hands after playing. Males had better bathingpractices and higher knowledge on personal hygiene.Students with satisfactory knowledge on personalhygiene practised cleaning with soap and water afterdefecation. Conversely, they used boiled water fordrinking less than the ones with unsatisfactory know-ledge. Students with mothers having an educationbeyond GCE Ordinary Level had better bathingpractices, better practices of brushing teeth, washingclothes, drinking boiled water and hand washing afterplaying. Students with fathers having an educationbeyond GCE Ordinary Level drank boiled water andpractised washing hands after using toilet more, butwashed hands less frequently after playing.

Conclusions & Recommendations: Majority ofstudents were aware of personal hygiene andpractised it routinely. Most of the students had positiveattitudes towards key aspects of personal hygiene.There is an alarming disparity between awarenesson hygiene and its implementation especially ondrinking boiled water. Mothers’ level of educationhas a prominent influence on children's hygiene,whereas fathers play a less significant role.

Key words: water and sanitation, adolescents,communicable diseases, school health

OP H.5Pattern of screen time and association ofcaregiver practices with screen time among3-5 year pre-school children in the MedicalOfficer of Health area of Kegalle, Sri Lanka

Anoma Marasinghe1*, Sriyani Ranasinghe2

1Postgraduate Institute of Medicine, Universityof Colombo; 2Health Promotion Bureau, Ministryof Health, Sri Lanka*Correspondence: [email protected]

Background: ‘Screen time’ is the time spent withany screen including television, computer screens andsmartphones. Caregivers play an important role indeciding screen time of pre-schoolers.

Objective: To assess the pattern of screen timeamong 3-5 year old pre-school children and itsassociation with caregiver practices in KegalleMedical Officer of Health area





Methods: A community-based cross-sectional studywas conducted among 510 caregivers, selected bytwo-stage cluster sampling. A pre-tested interviewer-administered questionnaire was used for datacollection. Associations were assessed using Chi-squared test. Associations were considered assignificant when the p value is less than 0.05.

Results: The response rate was 91.3% (n=466).Television (96.1%) was the most popular screenmedia device. The average television viewing timewas 67.6 minute/day (SD=56.1). The prevalence ofscreen time of any duration was 85.5%. High screentime (>60min/day) and normal screen time (60min/day) was 32% (95% CI=27.9, 36.3) and 52.7% (95%CI=48.3, 57.4), respectively. The majority (n=280,70.8%) used screen devices during 4-6 pm. Themajority (n=229, 59.3%) watched cartoon mostly. Asmall proportion (n=33, 8.3%) used devices in the

bedroom. The caregiver practices of enforcing ruleson the duration (p=0.003), on time (p=0.02) and ondays of the week (p=0.005) of screen viewing, andon the type of program (p=0.04) were significantlyassociated with high screen time. Rewarding goodbehaviour (OR=7.04; 95% CI=4.39, 11.29) and co-viewing (OR=1.54; 95% CI=1.01, 2.34) weresignificantly associated with high screen time.

Conclusion & Recommendations: Prevalence ofscreen media use is high among pre-schoolers.Several caregiver practices were associated withhigh screen time. Awareness programs need to beconducted for caregivers. Further research isnecessary to identify prevention and interventionstrategies.

Key words: screen time, pre-school children,caregiver practices

oral presentations - journal of the college of community

Documents