Direct Microscopy of Stool Samples for Determining the Prevalence of Soil-Transmitted Helminthic Infections among Primary School Children in Kaduwela MOH Area of Sri Lanka following Floods in 2016.

A descriptive cross-sectional school based study was carried out to investigate the prevalence of soil-transmitted intestinal helminths and the associated factors among school children in Kaduwela Medical Officer of Health (MOH) area in the Colombo district, which was affected by floods in 2016. The study was conducted in 9 selected schools in Kaduwela MOH area from September 2016 to March 2017. Permission was obtained from the relevant authorities. Grade 1 students were enrolled in the study after obtaining informed written consent from their parents/guardian. Interviewer based questionnaire was administered to gather demographic data and other relevant information. Stool samples were collected and examined by direct wet saline smear. Study population comprised 53.4% male students. None of stool samples were positive for soil-transmitted helminths but 17.4% of students complained of nocturnal itching and parents of 23% of them had seen worms passing out from their children's anus at night. Fourteen stool samples were found to be positive for cyst of Entamoeba coli. Majority of parents (69%) stated that their children always wash their hands with soap and water before meals, whereas 26% stated that their children practice this sometimes. Majority of students (88%) washed their hands after going to the toilet. Almost all students (86%) used water sealed toilets and very few used pit latrines (14%). In this study, 67% of students had received anti-helminthic drugs after the floods. These findings suggest that zero prevalence of helminthic infections could be due to anti-helminthic prophylaxis and good health practices. Further studies should be done in this area with a large sample size to investigate the true prevalence of helminthic infections. Students and parents should be educated on Enterobius vermicularis infection. The source of water supply should be tested for fecal contamination.

Physical disability and psychosocial impact due to chronic filarial lymphoedema in Sri Lanka.

BACKGROUND: Information on the physical and psychosocial disability of lymphatic filariasis in Sri Lanka is scarce. Therefore this study was carried out to describe the physical disability and psychosocial impact associated with chronic lymphoedema in patients attending filariasis clinics in the Colombo district, Sri Lanka. METHODS: Four hundred and thirteen patients with lymphoedema of limbs attending filariasis clinics in Werahera and Dehiwala in the Colombo district were enrolled in the study after obtaining informed written consent. Data were collected using a pre-tested, interviewer-administered questionnaire and analyzed using SPSS. RESULTS: Majority (95%) of patients had lower limbs affected and there was a significant association with difficulty in walking (p = 0.023). The swollen limb affected the work of 87 (52%) of employed patients and 26 persons reported loss of job. Approximately 25% and 6% reported having problems interacting with the community and family, respectively and 8.7% felt that they were rejected by society. The swollen limb was perceived as a major problem by 36.8% of patients. Of the married persons, 5.7% and 6.2% reported sexual and marital problems respectively, due to their swollen limb/s. Of those who had marital problems, 77.3% reported sexual problems as well (p < 0.001). CONCLUSION: Lymphoedema significantly affects physical, psychological and social functioning in affected individuals. Morbidity control, in addition to control of physical disability, should target the psychosocial consequences.

Treatment-seeking behavior and treatment practices of lymphatic filariasis patients with lymphoedema in the Colombo district, Sri Lanka.

This cross-sectional, descriptive study describes the treatment-seeking behavior of 413 lymphoedema patients attending 2 filariasis clinics in the Colombo district, Sri Lanka. A pretested, interviewer-administered questionnaire obtained information regarding sources and types of treatment taken, time taken for diagnosis, and details regarding diethylcarbamazine citrate (DEC) treatment. There was a mean delay of 2.37 years (SD 1.37) in diagnosing filariasis after the first appearance of limb swelling. General practitioners were the most frequent first-contact health care providers and the most visited source overall, followed by government hospitals and Ayurvedic practitioners. Approximately 95% of patients were on DEC treatment ranging from 10 days to 43 years (mean 2.5 years SD +/- 1.1). Sixty-one percent of patients reported always having taken the recommended DEC course. Nonsteroidal anti-inflammatory drugs, diuretics, and antibiotics were liberally prescribed. Approximately 97% had sought treatment from a medical practitioner for an acute adenolymphangitis attack. Despite the area being endemic for filariasis, there was a delay in treatment and inappropriate use of DEC in patients with chronic filarial lymphoedema.