Prevalence of hepatitis B and hepatitis C infections and their relationship to injectable drug use in a cohort of Sri Lankan prison inmates.

INTRODUCTION: Prisoners are considered to be at high risk for Hepatitis B (HBV) and Hepatitis C (HCV) virus infections. This is attributed to intravenous drug use and high-risk sexual behaviour. There are no published studies on HBV and HCV among prison inmates or injecting drug users in Sri Lanka. OBJECTIVES: To determine prevalence of HBV and HCV infections, and their relationship to injectable drug use among Sri Lankan prisoners. METHODS: We investigated 393 (median age 42 years (range 16 to 93); 82% males) randomly selected inmates of Mahara and Welikada prisons. RESULTS: Though 167 (42.5%) admitted drug abuse, only 17 (4.3%) had ever used intravenous drugs. Twelve (70.6%) of them reported sharing needles. One inmate was positive for HBsAg but was negative for HBV-DNA. Twenty seven (6.9%) were positive for anti-HCV antibodies, of whom only 2 (0.5%) were positive for HCV-RNA. None of the injecting drug users were positive for HBV-DNA or HCV-RNA. CONCLUSIONS: The prevalence of HBV and HCV infections as well as injecting drug use was very low among this cohort of Sri Lankan prison inmates.

Substance use disorders among mentally ill patients in a General Hospital in Sri Lanka: prevalence and correlates.

OBJECTIVES: To determine the prevalence, and demographic and clinical correlates of substance use disorders among the mentally ill. DESIGN AND SETTING: Cross sectional analytical study. Data were collected from consecutive patients treated at a Tertiary care Psychiatry Unit, Western Province, Sri Lanka using an interview schedule administered by a senior registrar in psychiatry. MEASUREMENTS: Diagnosis was based on ICD 10 criteria and the Clinician Rating Scale: Alcohol Use Scale (AUS) and the Drug Use Scale (DUS). The data were analysed using SPSS and WinPepi software programmes, utilising the chi squared, t test and median test. RESULTS: Among a sample of 325 patients, 66% were male; 33% were diagnosed with depressive disorder, 30% with schizophrenia, 23% with bipolar affective disorder and 13% with other disorders. Prevalence of comorbid substance use disorders was 43% (95% CI 38 - 49%). Alcohol was the commonest type of substance used. Those who had a comorbid substance use diagnosis were more likely to be male, have a lower educational level, be unemployed and have a poorer level of social support. They were also found to have poorer treatment adherence, increased number of hospital admissions and an increased association with episodes of violence. CONCLUSION: A significant proportion of patients were found to have a comorbid substance use diagnosis and associated complications. These findings have important implications for service provision for mentally ill patients with a comorbid substance use disorder.

Use of herbal medications among out-patients in a psychiatry clinic in Sri Lanka.

The use of complementary and alternative medicine is increasing among psychiatric populations. Herbal medications are a form of alternative and complementary medicine whose use has increased over the last decade. Two studies done among Western out-patient groups have reported rates of use of herbal medicine at 15% ('current use'; Matthews et al, 2003) and 24% (Knaudt et al, 1999).

Attitudes toward prenatal diagnosis and termination of pregnancy for genetic disorders among healthcare workers in a selected setting in Sri Lanka.

OBJECTIVES: Assess attitudes toward prenatal diagnosis (PND) and termination of pregnancy (TOP) for Down syndrome (DS), hemophilia, lethal autosomal recessive disorder (LRD) and a hypothetical late-onset neurodegenerative disorder (NDD) among healthcare workers in one Sri Lankan district. METHODS: Self-administered questionnaire (tested for content validity) completed by medical (n = 218) and nursing (n = 368) students, nurses (n = 178) and doctors (n = 127). RESULTS: Acceptability of PND was 94%, 91%, 86% and 71% respectively for LRD, DS, hemophilia and NDD. Favorable attitudes toward TOP for DS (84%), and LRD (82%) were higher compared with hemophilia (65%) and NDD (53%). There was willingness to consider TOP for self/spouse for DS (79%), LRD (78%), hemophilia (60%) and NDD (54%). The proportions willing to participate in a pregnancy termination (DS 54%, LRD 51%, hemophilia 38%, NDD 38%) were lower. Religious affiliation influenced attitudes regarding TOP with Christians being more opposed than Buddhists. CONCLUSIONS: There is acceptance of and willingness to participate in TOP for fetal anomalies among Sri Lankan healthcare workers. These findings have relevance for developing prenatal diagnostic services in Sri Lanka. Religious affiliation among Asian doctors, nurses (and patients) in developed countries is likely to determine permissiveness toward PND and TOP.