A comparison of transmissibility of SARS-CoV-2 variants of concern.

BACKGROUND: The World Health Organization (WHO) has currently detected five Variants of Concern of SARS-CoV-2 having the WHO labels of 'Alpha', 'Beta', 'Gamma', 'Delta' and 'Omicron'. We aimed to assess and compare the transmissibility of the five VOCs in terms of basic reproduction number, time-varying reproduction number and growth rate. METHODS: Publicly available data on the number of analyzed sequences over two-week windows for each country were extracted from covariants.org and GISAID initiative database. The ten countries which reported the highest number of analyzed sequences for each of the five variants were included in the final dataset and was analyzed using R language. The epidemic curves for each variant were estimated utilizing the two-weekly discretized incidence data using local regression (LOESS) models. The basic reproduction number was estimated with the exponential growth rate method. The time-varying reproduction number was calculated for the estimated epidemic curves by the ratio of the number of new infections generated at time step t to the total infectiousness of infected individuals at time t, using the EpiEstim package. RESULTS: The highest R0 for the variants Alpha (1.22), Beta (1.19), Gamma (1.21), Delta (1.38) and Omicron (1.90) were reported from Japan, Belgium, the United States, France and South Africa, respectively. Nine out of ten epidemic curves with the highest estimated growth rates and reproduction numbers were due to the Omicron variant indicating the highest transmissibility. CONCLUSIONS: The transmissibility was highest in the Omicron variant followed by Delta, Alpha, Gamma and Beta respectively.

Mothers' ability to determine and measure paracetamol doses for children-a contrived observational study.

Caregivers are primarily responsible for the administration of Over The Counter (OTC) medications in children. This study examines the mothers' ability to determine and measure paracetamol doses for children aged between 1 and 5 years. A contrived observational study was conducted for mothers of preschool aged children at two Public Health Midwifery (PHM) areas in Southern province, Sri Lanka. Stratified random sampling was used. Only 26.9% (n = 95, 95% CI = 22.5%-31.7%) of the 353 participants correctly determined and measured the doses of paracetamol. Errors were frequently made in both determining and measuring dose together (n = 113, 32.0%, 95% CI = 27.3%-37.1%), determining only (n = 94, 26.6%, 95% CI = 22.2%-31.5%) and measurement only (n = 51, 14.4%, 95% CI = 11.1%-18.5%). Dose determined errors were not significantly associated with maternal education, number of children in the family, total monthly income and age of the index child. Similarly measuring errors were not significantly associated with mothers' education, income of the family and number of children in the family. However, there was a weak positive correlation between measuring errors and age of the index child. The study suggests that mothers made errors when determining doses and measuring doses of paracetamol. Results emphasize importance of clear, concise guardian information leaflet and healthcare professionals' guidance to minimize dosing errors of child medication.

Source code and secondary data of the stochastic process based COVID-19 simulation model.

The novel coronavirus disease (COVID-19) culminated in a pandemic with many countries affected in varying stages. We aimed to develop a simulation environment for COVID-19 spread, taking environmental and social factors into account. This program consists of three main components; a stochastic process-based model for simulating epidemics, a basic reproduction number estimation unit and a graphics generator. The model can take a variety of environmental factors as input and simulate expected behaviours of the infection spread, enabling policymakers and the scientific community to test the effects of different mitigation strategies in a sandbox.

A stochastic process based modular tool-box for simulating COVID-19 infection spread.

Background: The novel coronavirus disease (COVID-19) culminated in a pandemic with many countries affected in varying stages. We aimed to develop a simulation environment for COVID-19 spread, taking environmental and social factors into account. Methods: The program was written in R language. A stochastic point process simulation model for simulating epidemics, a maximum-likelihood estimation model, an exponential growth rate model for calculating the basic reproduction number (R0), and functions for generating graphical representations of the simulations were utilized.Geographical area definition, population size, the number of initial infected individuals, period of simulation, parameters accounting for the radius of spread like masks usage, mobility level, intrinsic viral virulence, average infectious period, fraction of population vaccinated, time of vaccination, the efficacy of the vaccine, presence or absence of quarantine centers, time of establishment of quarantine centers, the efficacy of case detection and average time to quarantine from the detection of the infection were considered. Results: When the defined parameters were input, the model performed successfully producing the epidemic curve, R0 and an animation of infection spread. It was found that when parameters of known epidemics such as COVID-19 in California, Texas and, Florida were input, the epidemic curve generated was comparable to the epidemic curve in reality. Conclusion: This model can be utilized by many countries to visualize the effects of various mitigation strategies applied in their stage of disease and for policy makers to make informed decisions. It is applicable to many infectious diseases and hence can be used for research and educational purposes.

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

BACKGROUND: Malnutrition in older persons is a public health concern. This study aimed to estimate the prevalence of malnutrition and its associated factors among community-dwelling older persons in Sri Lanka. METHODS: A cross-sectional study was conducted in the Kandy district, Sri Lanka. The nutritional status of older persons was assessed using the Mini Nutritional Assessment -Short Form (MNA-SF). A standardised questionnaire was used to record factors associated with malnutrition: demographic characteristics, financial characteristics, food and appetite, lifestyle, psychological characteristics, physical characteristics, disease and care, oral health, and social factors. Complex sample multinomial logistic regression analysis was performed. RESULTS: Among the 999 participants included in the study, 748 (69.3%) were females and 251 (25.1%) were males. The mean age was 70.80 years (95% CI: 70.13, 71.47). The prevalence of malnutrition, risk of malnutrition and well-nutrition was 12.5%, 52.4% and 35.1% respectively. In the multivariate model, hypertension (adjusted OR = 1.71; 95% CI: 1.02, 2.89), alcohol consumption (aOR = 4.06; 95% CI: 1.17, 14.07), and increased age (aOR = 1.06; 95% CI: 1.01, 1.11) were positively associated with malnutrition. An increased number of people living with the older person (aOR: 0.91; 95% CI: 0.85, 0.97) was a protective factor among those at risk for malnutrition. CONCLUSION: Both the prevalence of malnutrition and risk of malnutrition were commonly observed among community-dwelling older persons in Sri Lanka. The associated factors identified in this study might help public health professionals to implement necessary interventions that improve the nutritional status of this population.

Association between intestinal helminth infections and mid-upper-arm circumference among children in Sri Lanka: A cross-sectional study.

Intestinal helminth infections constitute a major health problem in low socio-economic communities worldwide. A cross-sectional study was conducted in children aged between 12 and 60 months. A structured questionnaire was used to collect socio-demographic data and stool samples were subjected to direct smear, stained with Lugol's iodine, and formaldehyde-ether concentration techniques to determine the prevalence of intestinal helminth infections. The circumference of each child's left mid upper arm (MUAC) was measured using standard procedures. Two hundred and six children with a mean MUAC of 14.7 cm (SD ± 1.1) were assessed from September to December 2014. The prevalence of acute energy undernutrition was 6.3% (13/206). All of them had moderate acute undernutrition and no cases of severe acute undernutrition. Paternal occupation was significantly associated with MUAC. Intestinal helminth infections were detected in 12.6% of children. Four species of parasites were identified; Ascaris lumbricoides (9.7%) followed by Enterobius vermicularis (1.5%), Trichuris trichiura (1.0%) and hookworms (1.0%). Uninfected children aged between 1 and 2 years showed significantly higher MUAC than infected children. No statistically significant association was detected between the severity of intestinal helminth infections and MUAC. Although intestinal helminth infections are a major public health problem in this community, they are not related to MUAC. Future research, providing more insight into the nutritional impact of intestinal helminth infections, is required to determine the association between parasitic infections and physical growth in this community.

Engaging a rural community in identifying determinants of low birth weight and deciding on measures to improve low birth weight: an experience from a Sri Lankan study.

BACKGROUND: Involving communities in identifying and addressing determinants of their own health is effective in addressing complex problems, such as low birth weight (LBW). LBW is an important public health problem which has not improved significantly in Sri Lanka in the last 10 years. This study reports the ability of lay persons to identify and address determinants of LBW. METHODS: A health promotion intervention was conducted among 403 mothers registering at 26 antenatal clinics in the district of Anuradhapura, in Sri Lanka. The components of a health promotion process-initiation, maintenance and continual monitoring, and re-direction towards greater effectiveness-were explained to the mothers. Inputs were initially provided through different methods to enable mothers' groups to identify determinants of LBW and to decide actions to address those identified determinants. The overall study was carried out over a period of 1 year, of which the intervention phase took around 7 months. The mothers in the clinic group were encouraged to continue an ongoing process in smaller "neighborhood action committees" (NACs)-of which there were 71. The findings are based on field notes maintained during the process, analyzed using thematic analysis. RESULTS: Each group of mothers identified at least eight determinants of LBW at the first attempt (without first author's guidance), four of which corresponded with those already mentioned in published studies. Up to five other determinants were agreed, after facilitation by the first author, at the second attempt. Of the total, 10 determinants of LBW were finally prioritized. Twenty actions to address the 10 selected prioritized determinants were agreed through a collective consensus development process. CONCLUSIONS: Lay communities successfully identified determinants of LBW and household level actions to address these, with relatively simple guidance, when stimulated to initiate the relevant process. This capacity should be nurtured and better used in interventions to improve LBW.

Working conditions of bus drivers in the private sector and bus crashes in Kandy district, Sri Lanka: a case-control study.

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

Public road transport crashes in a low income country.

OBJECTIVE: To assess the safety of government versus non-government public road transportation. DESIGN: Descriptive study. SETTING: Kandy Municipality Area, Sri Lanka. SUBJECTS: All road traffic crashes reported to the Kandy Police from 1 October 1998 to 30 September 1999. MAIN OUTCOME: Involvement in a road traffic crash reported to the Kandy Police in which a government bus, private bus, or a three-wheeler was involved. RESULTS: During the study period, 132 government buses, 243 private buses, and 115 three wheelers were involved in 437 police reported road crashes. Of these crashes, eight (1.8%) were fatal and 132 (30.2%) were crashes resulting in injury requiring hospitalization. The majority of road crashes involved vehicle-vehicle interaction (63.4%) and vehicle-pedestrian interaction (17.8%), while the remainder consisted of vehicle-passenger and vehicle-road structure crashes. The research highlights an increased risk associated with travel on privately owned buses (RR = 2.0, 95% CI 1.6 to 2.5) and three wheelers (RR = 2.2, 95% CI 1.7 to 2.8) compared to travel on government buses. The disparity in crash rates between government and privately owned transportation modes can be explained, in part, by fewer safety requirements being imposed on the deregulated public transportation system. CONCLUSIONS: Recommendations are made in order to address the differential in crash rates between public and private vehicle ownership used for public transportation in Sri Lanka.