Factors influencing the maternal choice of packaged snacks for 6-10 years old children: A cross-sectional study from Sri Lanka.

Childhood overweight and obesity due to unhealthy diet result in several adverse effects. Mothers play a major role in selecting snacks for younger children. This study assessed the factors associated with the choice of packaged food/beverage snacks among mothers of 6- to 10-year-old children in the Medical Officer of Health area Balangoda. A community-based descriptive cross-sectional study with an analytical component was conducted in 2022 among 450 mothers with 6- to 10-year-old children through two-stage, stratified (year of birth considered as a stratum), simple random sampling technique in ten randomly selected Public Health Midwife areas in the medical officer of health area Balangoda. An interviewer-administered questionnaire was used to assess participants' sociodemographic, usual practices, attitudes, and knowledge toward packaged snacks. Factors associated with maternal practices related to packaged snack selection were assessed through the chi-square test at the p<0.05 significance level. The response rate was 99.3% (N = 447). Children were commonly provided with biscuits (94.4%) and flavoured milk (44.7%) daily (66.4%) at home (93.5%). The majority of mothers reported poor practices in selecting packaged snacks (88.8%), but good knowledge (62.9%) and favorable attitudes (93.5%) toward packaged snacks. The majority (75.5%) were aware that snacks are important for overcoming the hunger gap among children. Childs' preference (77.6%) was the leading influencing factor while, the nutritional value of the packaged snacks minimally influenced the maternal (2.7%) choice. Only 49.9% mothers knew that packaged fruits could be consumed as snacks. Maternal Sinhalese ethnicity (p<0.001), secondary or higher education (p<0.001), having one child (p = 0.003), residing in a rural or urban area (p = 0.011) and having favourable attitudes (p = 0.002) were significantly associated with poor maternal practices in packaged snack selection. Although mothers' knowledge toward packaged snacks were good, their practices in selecting packaged snacks were poor. Maternal ethnicity, educational level, number of children, area of residence and attitudes were significantly associated with mothers' selection of packaged snacks. The results of the study highlighted the need to plan, develop and implement focused health promotion programmes to empower mothers to select healthier packaged snack options for their 6- to 10-year-old children.

Content analysis of policy documents related to non-communicable diseases prevention and control in Sri Lanka: a developing country in the South-East Asia.

Background: Health policies form the foundation for provisioning best level care and are important for all stakeholders including patients and healthcare providers. Health policy analysis and evaluation allows policy makers to improve an existing policy, terminate a non-effective policy and to successfully implement future policies.The objective was to assess the coherence between the two local policy documents on NCD prevention and control in Sri Lanka, the national NCD policy (NCD policy) and the multisectoral action plan (MSAP), and to assess the consistency of MSAP with the global action plan for NCDs. Methods: The content analysis of the NCD policy and MSAP of Sri Lanka was conducted based on the modified criteria developed to the 'Analysis of determinants of policy impact' model, by two reviewers independently. Coherence between MSAP and the global NCD action plan were also assessed by two reviewers independently. Consensus for discrepancy was achieved through discussion. Results: Accessibility was the strongest criteria for the NCD policy, while, resources and obligations were the weakest. Goals and monitoring and evaluation criteria were the strongest in the MSAP. Requirement for improvement were identified in policy background, goals, monitoring and evaluation, and public opportunities for the NCD policy. Accessibility, policy background, resources, public opportunities and obligations require further improvement in the MSAP. The MSAP is well coherent with the global road map for NCD prevention and control. Conclusion: Policy documents related to NCD prevention and control in Sri Lanka are coherent with the global action plan, while, there are areas within the local policy documents that need to be improved to enhance the coherence between the local documents. Lessons learnt by this activity need to be utilized by Sri Lanka and other countries to improve the uniformity between the NCD policy documents within the country as well as internationally.

Sri Lankan clinical practice guidelines: A methodological quality assessment utilizing the AGREE II instrument.

RATIONALE, AIMS, AND OBJECTIVES: Clinical practice guidelines (CPG) play a major role in patient care in Sri Lanka. This study evaluates the methodological quality of the Sri Lankan CPGs developed in 2007. METHODS: A total of 94 CPGs developed by several professional colleges in Sri Lanka in the year 2007 were evaluated by 2 independent reviewers using AGREE II instrument for their methodological quality. Item score being ≤3 points was defined as "poor quality". Each domain score was calculated according to AGREE II. A guideline was labelled as "strongly recommended" if 4 or more domains scored above 60%, "recommended for use with certain modification" if only 3 domain scores were above 60% or if 4 or more domain scores were between 30% and 60%, and "not recommended" if 4 or more domains scored less than 30%. RESULTS: Most (22.3%) guidelines were developed by the College of Pathologists. Most of the guidelines (>55%) poorly reported on all the items, except for items 1, 2, and 22 of AGREE II. Median domain scores [range] and the proportion of the guidelines with domain score of <30% were as follows: domain on scope and purpose (33.3% [2.8%-83.3%]; 42.6%), stakeholder involvement (14.9% [0.0%-61.1%]; 81.9%), rigour of development (6.1% [0.0%-49%]; 98.9%), clarity and presentation (30.5% [8.3%-61.1%]; 46.8%), and applicability (8.3% [4.2%-14.6%]; 100%). All CPGs scored 50% for "editorial independence". Reviewers reported the overall quality was poor in 86 (91.5%). Based on the definitions used in the study, of 94 CPGs, 8 (8.5%) could be recommended to be used with modifications, while 86 (91.5%) could not be recommended for clinical practice. CONCLUSIONS: The methodological quality of the CPGs was poor irrespective of the source of development. Major efforts are essential to update the CPGs according to the principles of evidence based medicine.

Changes in quality of life following initial treatment of oesophageal carcinoma: a cohort study from Sri Lanka.

BACKGROUND: Oesophageal carcinoma is one of the leading cancers in Sri Lanka. Recent advances in treatment modalities have drastically improved the survival of these patients. However, the quality of life (QoL) among the survivors needs to be reviewed in order to recognise the need for advocating more focussed rehabilitation for oesophageal carcinoma in Sri Lanka. METHODS: A prospective cohort study was conducted among 51 incident cases of oesophageal carcinoma recruited consecutively from the National Cancer Institute, Maharagama. Data were collected on their QoL using EORTC QLQ-C30 and EORTC-OES18 questionnaires validated for Sri Lankan oesophageal carcinoma patients, before and one month after the completion of initial treatment. Scoring was based on the EORTC manual. Comparison of baseline and follow-up scores was done using paired t test at significance level of 0.05. RESULTS: Response rate was 80%. The majority consisted of squamous cell carcinoma of stage IV. On a scale of 0-100, the overall QoL (mean score = 49.8; SD = 22); and role (42.2; SD = 34), physical (53.1; SD = 29), emotional (53.4; SD = 26) and social (57.2; SD = 23) functioning were relatively low at diagnosis. The scores of functioning scales further deteriorated (difference > 5 points) following the initial treatment (p < 0.05). Dysphagia (mean = 54; SD = 27) was the main symptom at diagnosis, which improved significantly (p < 0.05) in contrast to dry mouth (mean = 39.2; SD = 34) that worsened (p < 0.05) following initial treatment. Family support and financial difficulties were adversely affected (p < 0.05) during the initial treatment. CONCLUSIONS: The deterioration of several dimensions of QoL of oesophageal carcinoma patients following the initial treatment highlights the need for more targeted tertiary preventive strategies that address the issues identified.

Novel risk factors for primary prevention of oesophageal carcinoma: a case-control study from Sri Lanka.

BACKGROUND: Oesophageal carcinoma (OC) is one of the leading cancers in Sri Lanka. Its increasing incidence despite the implementation of various preventive activities addressing the conventional risk factors indicates the possibility of the existence of novel, country-specific risk factors. Thus, the identification of novel risk factors of OC specific to Sri Lanka is crucial for implementation of primary prevention activities. METHODS: A case-control study was conducted among 49 incident cases of OC recruited from the National Cancer Institute, Maharagama using a non-probability sampling method, and unmatched hospital controls (n = 196) excluded of having OC recruited from the endoscopy unit of the National Hospital of Sri Lanka. Data were collected using an interviewer administered questionnaire. Risk factors for OC were assessed by odds ratio (OR) with 95% confidence interval (CI). The risk factors were adjusted for possible confounding by logistic regression analysis. RESULTS: Of the study population, OC was common among males (69%) and the majority presented with squamous cell carcinoma (65%) at late stages (Stage IV: 45%; Stage III: 37%). Following adjusting for confounders, the risk factor profile for OC included; age > 65 years (OR = 4.0; 95% CI: 1.2-14.2); family history of cancer (OR = 5.04; 95% CI: 1.3-19.0); sub-optimal consumption of dietary fibre (OR = 3.58; 95% CI: 1.1-12.3); sub-optimal consumption of anti-oxidants (OR = 7.0; 95% CI: 2.2-22.5); over-consumption of deep fried food (OR = 6.68; 95% CI:2.0-22.6); 'high risk' alcohol drinking (OR = 11.7; 95% CI: 2.8-49.4); betel quid chewing (OR = 6.1; 95% CI: 2.0, 20.0); 'low' lifetime total sports and exercise activities (MET hours/week/year) (OR = 5.83; 95% CI: 1.5-23.0); agrochemicals exposure (OR = 6.57; 95% CI: 1.4-30.3); pipe-borne drinking water (OR = 5.62; 95% CI:1.7-18.9) and radiation exposure (OR = 4.64; 95% CI: 1.4-15.5). Significant effect modifications were seen between betel quid chewing and male sex (p = 0.01) and between ever exposure to radiation and age over 65 years (p = 0.04). CONCLUSIONS: Risk profile for OC includes novel yet modifiable risk factors in relation to diet, occupation, environment and health. Primary prevention should target these to combat OC in Sri Lanka.

Use of food labels by adolescents to make healthier choices on snacks: a cross-sectional study from Sri Lanka.

BACKGROUND: Unhealthy snacking is commonly seen among adolescents. Therefore, use of food labels is promoted for making healthier choices on packaged snacks. This study was conducted to assess the use of food labels in making choices on packaged snack and its associated factors among adolescents. METHODS: A cross-sectional study was conducted in 2012 among 542 Grade 12 students in Sri Lanka. Eight classes were selected as 'clusters' for the study (two classes each from two schools that were selected randomly from each list of 'Girls only' and 'Boys only' schools in Colombo district). A self-administered questionnaire assessed their socio-demography, snacking behaviour, attitudes and nutrition knowledge related to food labels. Adolescents' use of labels was assessed by three practices (label reading frequency, attention paid to label contents and correct interpretation of six hypothetical labels of snacks). Based on total scores obtained for the three practices, 'satisfactory' (score ≥75(th) percentile mark) and 'unsatisfactory' (score <75(th) percentile mark) label users were identified. Using SPSS, associations were assessed at 0.05 significance level using Chi-square-test. RESULTS: Of the participants, 51 % were males; 61 % spent their pocket money at least once/week on packaged snacks; predominantly on biscuits (85 %) and cola-drinks (77 %) and 88 % selected snacks on their own. The majority (74.5 %) was frequent ('always' or 'most often') label readers with female predominance (p < 0.05). Over 74 % paid attention frequently to the brand name (75 %), price (85 %) and nutrition panel (81 %). Over 64 % were able to select the better food label when given a choice between two snacks, although some did it for reasons such as attractive label (63 %). The majority (84 %) had good knowledge (obtaining more than the 75(th) percentile mark) on interpreting labels. Although not statistically significant, 'unsatisfactory' label use was higher among males (73 %), purchasing power (70.4 %) and unhealthy snacking behaviour (73 %). In contrast, among the marketing strategies, identifying known brands (73.2 %) and imported products (75.8 %) as 'good' products were significantly associated with 'unsatisfactory' label use (p < 0.05). CONCLUSIONS: Despite having good knowledge and positive attitudes, food label use is unsatisfactory among adolescents. Skills in reading labels should be addressed in the 'School canteen policy' in Sri Lanka.