Spatial distribution of COVID-19 patients in Sri Lanka.

BACKGROUND: A new type of viral pneumonia, which has been named Coronavirus disease (COVID-19) began in Wuhan, China in late 2019 and has spread across the world since then. It has claimed more than 370 million confirmed cases and over 5.6 million deaths have been reported globally by the end of January 2022. This study aimed to analyze the trends, highly-nuanced patterns, and related key results relative to COVID-19 epidemiology in Sri Lanka. METHODS: Data on COVID-19 from March 2020 to January 2022 were obtained from published databases maintained by the Epidemiology Unit of the Ministry of Health in Sri Lanka and information regarding populations in administrative districts was obtained from the Department of Census and Statistics, Sri Lanka. Descriptive spatiotemporal analysis and autocorrelations were analyzed using SPSS statistical software. RESULTS: In Sri Lanka, the first case of COVID-19 was a Chinese national and the first local case was identified in the second week of March. As of 31st of January 2022, a total of 610,103 COVID-19 cases had been recorded in the country, and 15,420 patients had died. At the beginning, the disease was mainly concentrated in the Western province and with time, it spread to other provinces. However, very low numbers of patients were identified in the North, Eastern, North Central, and Uva provinces until April 2021. The peak of COVID-19 occurred in August and September 2021 in all provinces in Sri Lanka. Then a decreasing trend of COVID-19 cases showed after September 2021. CONCLUSIONS: COVID-19 is an emerging public health problem in Western and Southern Sri Lanka where the population density is high. A decreasing trend of COVID-19 cases showed in all provinces after September 2021. Public awareness programs for the prevention and control of the disease in endemic regions are essential to reduce the incidence of this infection.

Evaluation of learning environment among Nursing undergraduates in state universities, Sri Lanka.

BACKGROUND: The learning environment is a vital part of the undergraduate curriculum which enable to delivery of quality education in the stipulated time. Therefore, this study aimed to evaluate the learning environment among BSc. Nursing undergraduates in Sri Lankan state universities. METHODS: A descriptive cross-sectional study was conducted among 161 final year BSc. Nursing undergraduates in six state universities. Socio-demographic characteristics were collected using a self-administered questionnaire. The Dundee Ready Educational Environment Measure (DREEM) questionnaire was used to evaluate the learning environment in Perception of learning (SPL), Perceptions of teaching (SPT), Academic self-perceptions (SASP), Perceptions of the atmosphere (SPA), and Social self-perceptions (SSP). Based on the SPL, SPT, SASP, SPA, and SSP domains, the overall score of learning environment was ranged from 0 to 200 and then the overall score was classified into four categories such as poor (0-50), many problems (51-100), more positive than negative (101-150) and excellent (151-200). One-way Analysis of Variance (ANOVA) and t-test were used to determine the difference in the subscales and the overall scale. RESULTS: The mean age of the students was 24.9 ± 0.9 years. The overall score of the learning environment was 127.1 ± 14.3. Student's Perception of learning showed the highest mean score of 31.1 ± 3.9 while the social self-perception showed the lowest score (mean 16.4 ± 3.1). A significant group effect was observed in SPL and SPT subdomains among state universities while no significant group effect was observed in other subdomains. Furthermore, participating in extracurricular activities, travelling time to the faculty, and gender were observed as associated factors for the learning environment among BSc. Nursing undergraduates in state universities. CONCLUSIONS: Although the overall learning environment of BSc. Nursing undergraduates in state universities in Sri Lanka was within more positive than negative category, none of the university reaches to the excellent category. Therefore, each university should have improved their subdomains of learning environment to reach excellent category through addressing the gaps of curricular and extracurricular activities in the future.

Maternal coping strategies in response to child's oncological diseases in Sri Lanka.

Introduction: Parents with cancer children face multiple and unexpected difficulties and apply coping strategies to minimize stressful conditions. The objective of this study was to assess maternal coping strategies in response to their children with cancer in Sri Lanka.Material and methods: A cross-sectional study was conducted among 200 mothers having children with cancers. Coping Health Inventory for Parents instrument was used to collect information about coping strategies.Results: More than 75% children were diagnosed as cancer more than 6 months before when starting this study. Maintaining family integration, cooperation, optimistic definition of the situation was the most helpful coping strategy while seeking medical helps through communication with parents and consultation with medical staff was the least helpful coping strategy among mothers. Gender of the child and current condition of the disease were significantly associated with social support and medical support. Type of disease was significantly associated with family support and the number of other children per mother was significantly associated with social support.Conclusions: Relaxation and counseling programs to modify less desirable coping strategies are emphasized for mothers who were with cancer children. More researches need to identify coping strategies and its impact on psychological and physical adjustment as well.

Assessment of intralesional cytokine profile of cutaneous leishmaniasis caused by Leishmania donovani in Sri Lanka.

BACKGROUND: Cytokines play a vital role in the host immune response to infection by initiating the healing process and/or accelerating the progression of the disease in cutaneous leishmaniasis (CL). Very little evidence is available on cytokine profiles and their regulatory function in CL patients in Sri Lanka. The aim of this study was to determine the cytokine expression pattern of IFN-γ, IL-4, IL-11 and IL-12p40 in CL patients and in healthy volunteers. Patients with suspected CL lesions attending to the Dermatology Clinic at the Anuradhapura Teaching Hospital were included in the study. Reverse transcription real time polymerase chain reaction (real-time RT-PCR) was performed to determine the relative expression level of target cytokines. Expression levels were quantified by 2- ∆∆CT equation. RESULTS: The expression of cytokines IFN-γ, IL-4, IL-11 and IL-12p40 were significantly higher in CL patients compared to healthy volunteers (p <  0.05). There was a significant association between the expression of IFN-γ and the duration of the lesion (p = 0.021). Wet CL lesions showed significantly higher expression of IL-4, IL-11 and IL-12p40 (p = 0.039, 0.018 and 0.021 respectively) compared to dry lesions. Papulo-nodular lesions showed significantly high expression of IFN-γ (p = 0.023). However, cytokine expression was not significantly associated with the number, size and the locations of lesions. CONCLUSIONS: The expression levels of all cytokines tested in the present study were significantly (p <  0.05) high in CL patients. Th1 response (IFN-γ and IL-12p40) had higher expression levels compared to Th2 (IL-4) and IL-11 in CL patients.

Socioeconomic factors associated with tobacco smoking among adult males in Sri Lanka.

BACKGROUND: Tobacco smoking is considered as a major public health issue worldwide. Reduction of tobacco usage has been one of the main government policies in Sri Lanka and the price of cigarettes has been raised several times in the last few years. The purpose of this study was to evaluate the socioeconomic factors associated with tobacco smoking among adult males in Sri Lanka. METHODS: A study was conducted in Gampaha district in Sri Lanka recruiting 365 tobacco smoking people and their spouses. Data regarding tobacco smoking were obtained using an interviewer administrated questionnaire. RESULTS: Frequency of tobacco smoking was negatively associated with the improvement of educational levels. Employment, monthly income, influence of friends, smoking frequency before price increment, weekly expenditure for smoking, low educational level and the age of first smoking exposure was significantly associated with tobacco smoking among smokers. According to the spouses, smoking frequency before price increment, weekly expenditure of the husbands of smoking and influence of friends, number on smoking friends, spouse's employment and husband's monthly income were factors associated with tobacco smoking of their husbands. In addition, smoking at home, at work places and at friend's houses was significant with the frequency of daily smoking. CONCLUSIONS: Increasing the price of tobacco products has no significant impact on smoking behaviors in Sri Lanka. The need for essential strategies to educate and motivate the smokers to stop smoking is required. Primary care health workers might play a major role in motivating smokers to quit smoking.

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

BACKGROUND: Ascaris lumbricoides infections are one of the commonnest intestinal nematode infections in the world, with a profound negative effect on nutritional status among underprivileged populations. In Sri Lanka, Ascaris infections and low nutritional status still persist in the plantation sector. However, research regarding the association between Ascaris infections and nutritional status is scarce. The main purpose of this study was to determine the association between Ascaris infections and physical growth among children in a plantation sector in Sri Lanka. METHODS: A cross sectional study was conducted among 489 children aged between 1 and 12 years ina plantation sector, Sri Lanka, from January to April 2013. Anthropometric measurements were collected to assess height-for-age (HAZ), weight-for-age (WAZ) and weight-for-height (WHZ) to determine stunting, underweight and wasting respectively. Data on socio-demographic and antihelminthic treatment were ascertained using an interviewer administrated structured questionnaire. Stool samples were subjected to wet mount preparation followed byformaldehyde-ether sedimentation technique to diagnose Ascaris infection and a Kato Katz technique was performed to determine the eggs intensity. AnthroPlus, EpiInfo and SPSS software was used to analyze data. RESULTS: Of the study sample, 38.4% showed Ascaris lumbricoides infections. Light intensity infections (51%) were common in the infected children, followed by moderate (30%) and heavy (19%) infections. Prevalence of Ascaris infections was significantly associated with de-worming more than six months prior to the study. Prevalence of undernutrition among children was 61.7%. Forty-five per cent were underweight, while 24.1% and 21.5% of children were stunted and wasted respectively. However, no significant association was found between Ascaris infections status and undernutrition. Meanwhile, heavy intensity infections were associated with decreased values of WHZ (p = 0.020). CONCLUSIONS: Ascaris infections and undernutrition are still highly prevalent and a major public health problem in the plantation sector in Sri Lanka. Health and nutrition intervention programs should be implemented to increase the nutritional status of children.

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

BACKGROUND: Child malnutrition is a major public health concern worldwide, leading to higher morbidity and mortality. It is mostly preventable through public health and economic development. The aim of the present study was to determine socio-economic factors associated with nutritional status among children in plantation communities, Sri Lanka. METHODS: A cross-sectional study was performed among preschool and school going children in three rural communities of Sri Lanka from January to August 2014. Demographic and household characteristics were documented and anthropometric measurements were collected to calculate weight-for-age (WAZ), height-for-age (HAZ) and BMI-for-age (BAZ). Anthroplus, epiinfo and SPSS versions were used for the analysis of data. RESULTS: A total of 547 children (aged 1-15 years, mean 7.0 ± 3.6 years, 53% female) participated in the study. 35.6%, 26.9% and 32.9% of children were underweight, stunting and wasting respectively. Undernutrition was more common in primary school children. Maternal employment, high number of siblings, high birth orders and female children were significantly associated with undernutrition among preschool children. Living in small houses, large number of family members, low monthly income and maternal employment were significantly associated with undernutrition among school children. CONCLUSIONS: Child undernutrition is a major public health concern in the plantation sector, Sri Lanka. Health education programs among the study population could be effective for solving the problem.

Clinico-Epidemiological Patterns of Cutaneous Leishmaniasis Patients Attending the Anuradhapura Teaching Hospital, Sri Lanka.

Cutaneous leishmaniasis (CL) caused by Leishmania donovani is an endemic vector-borne disease in Sri Lanka. Over 2,500 cases have been reported since 2000 and the number of CL cases has dramatically increased annually. Total 57 clinically suspected CL patients attending the dermatology clinic in Anuradhapura Teaching Hospital were recruited from January to June 2015. Slit skin smears and skin biopsies were taken from each of the subjects. Clinical and epidemiological data were obtained using interviewer administered questionnaire. Forty-three (75.4%) patients among 57 were confirmed positive for L. donovani. The majority of infected patients was males (P=0.005), and the most affected age group was 21-40 years. Soldiers in security forces, farmers, and housewives were identified as high risk groups. The presence of scrub jungles around the residence or places of occupation (P=0.003), the presence of sandflies (P=0.021), and working outsides more than 6 hr per day (P=0.001) were significantly associated with CL. The number of lesions ranged from 1-3, and the majority (76%) of the patients had a single lesion. Upper and lower extremities were the prominent places of lesions, while the wet type of lesions were more prevalent in females (P=0.022). A nodular-ulcerative type lesion was common in both sexes. The presence of sandflies, scrub jungles, and outdoor activities contributed to spread of Leishmania parasites in an endemic pattern. Implementation of vector control programs together with health education with regard to transmission and prevention of CL are necessary to control the spread of this infection.

FACTORS ASSOCIATED WITH THE PREVALENCE OF ASCARIS LUMBRICOIDES INFECTION AMONG PRESCHOOL CHILDREN IN A PLANTATION COMMUNITY, KANDY DISTRICT, SRI LANKA.

Plantation living conditions in Sri Lanka are often poor. Ascaris lumbricoides infections are common among those living in plantations. We conducted a cross sectional study of children aged 1 - 6 years living on a plantation to determine the prevalence of ascariasis and factors associated with it in order to educate on prevention and to implement treatment programs. A total of 258 preschool children selected using a simple random sampling was included in the study conducted during January - April, 2013. Data regarding socio-demographic and hygienic habits were collected from heads of households via an interviewer administered structured questionnaire. Wet mount preparation, formaldehyde-ether sedimentation and Kato-Katz techniques were used to evaluate stool samples for Ascaris eggs. The overall prevalence of Ascaris infection among study subjects was 37.8%. On multivariate logistic regression analysis, factors significantly associated with Ascaris infections were: living in attached houses (p=0.035), shared toilet facilities (p=0.001), de-worming period more than three months (p<0.001), maternal education level (p<0.001) and living in the "Top" government administrative division (p=0.028) in the study area. Poor sanitation facilities and poor health education were important factors associated with Ascaris infections. A health education program promoting improved sanitary facilities and good hygiene is needed to reduce the prevalence of Ascaris infection in the study population.

Canine intestinal parasitic infections and soil contamination by Toxocara spp. in selected areas of Sri Lanka.

INTRODUCTION: Contaminated environment with canine parasitic eggs is the main source for toxocariasis and other geohelminth infections of humans. This study aimed to determine the prevalence and associated risk factors for intestinal parasitic infections in dogs and the degree of soil contamination with Toxocara eggs in Kandy and Gampaha districts in Sri Lanka. METHODS: A total of 188 fecal samples from both stray and domestic owned dogs from Gampaha district and Kandy district were collected. In addition, soil samples were collected from home gardens and public places. Hypochlorite recovery technique and zinc sulfate floatation method were used to concentrate eggs in soil samples. RESULTS: The prevalence of intestinal parasitic infections of domestic and stray dogs in Gampaha district was 38.2% and 42.9%, respectively, while in Kandy district, it was 41.1% and 50%, respectively. Hookworms were the most common parasitic infection among domestic dogs (18.5%), while Toxocara spp. were the most common among stray dogs (17.2%). Intestinal parasitic infections were significantly more prevalent among female dogs than males. Age, deworming, immunization, immunization time, and living in rural areas were not significantly associated with intestinal parasitic infections in domestic dogs. A total of 4% and 4.5% soil samples were contaminated with Toxocara spp. eggs in Gampaha and Kandy districts, respectively. CONCLUSIONS: The higher prevalence of intestinal parasitic infections in dogs could be a major public health issue. Implementations of programs to improve the awareness of parasitic infections among pet owners and control strategies need to decrease the risk of infections to both animal and human health.

In vitro anti-inflammatory activity of Ficus racemosa L. bark using albumin denaturation method.

INTRODUCTION: In Ayurveda, many natural plant compounds are used to inhibit inflammatory pathways for centuries with less side effects. Different parts of Ficus racemosa L. (Udumber) plant are used in Ayurveda for many diseases. However, few studies have been conducted to evaluate pharmacological activities of F. racemosa. OBJECTIVE: The objective of the study was to in vitro analyze anti-inflammatory property of F. racemosa bark using albumin denaturation activity. METHODOLOGY: F. racemosa bark extraction was performed using cold water and hot water. The concentration gradient of extracts was prepared using egg albumin and phosphate-buffered saline. The extract was incubated in a water bath at 37°C for 15 min and was heated at 70°C for 5 min. One nonsteroidal anti-inflammatory drug and one steroid were used as reference drugs. The percentage inhibition of protein denaturation was calculated. RESULTS: The inhibition rate of egg albumin denaturation for water extraction increased gradually with concentration. Significantly higher inhibition was showed in hot water extracts than cold water extracts at the concentration of 0.01 µg/ml and 0.1 µg/ml. In addition, the inhibition rate of water extraction was significantly higher than the reference drugs (P < 0.05). CONCLUSION: Anti-inflammatory activity increases with the concentration of F. racemosa bark. Furthermore, the action of this plant is significantly higher than the reference drugs.

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

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