Disability-adjusted life years due to leptospirosis in Monaragala District of Sri Lanka.

Leptospirosis is a zoonotic infection with significant morbidity and mortality. As an occupational disease, it has become a global concern due to its disease burden in endemic countries and rural areas. The aim of this study was to assess disease burden in terms of Disability-adjusted life years (DALYs) of leptospirosis.A hospital-based descriptive cross-sectional study was conducted using 450 clinically diagnosed leptospirosis patients admitted to base and above hospitals in Monaragala District, Sri Lanka, using a pre-tested interviewer-administered questionnaire. The patients were followed up until normal day-to-day life after discharge. Estimation of DALYs was done using laboratory-confirmed leptospirosis patients. Leptospirosis disease burden in Monaragala District was 44.9 DALYs per 100,000 population, which includes 33.18 Years of life losts and 10.9 YLDs. The incidence of leptospirosis in Monaragala District during the study period was 59.8 per 100,000 population, and the case fatality rate (CFR) was 1.5% and 75% of deaths were among males.The disease burden of leptospirosis in Monaragala District was significantly high and urgent efforts to control and prevent leptospirosis should be a priority.

Mass media interventions for promoting HIV testing.

BACKGROUND: Use of the mass media is one of the important strategies in communicating behavioral change in relation to HIV/AIDS prevention. Mass media are used to promote voluntary HIV counseling and testing and to sustain test-seeking behavior. OBJECTIVES: To assess the effect of mass media interventions and the most effective form of mass media intervention at a general population level or in specific target populations, in relation to changes in HIV testing, compared with a control group or with pre-intervention levels. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2004), MEDLINE (1966 to April 2004), EMBASE (1980 to April 2004), NLM Gateway, CINAHL (1982 to April 2004), AIDSearch (1980 to April 2004), and PsycINFO (1974 to April 2004), Sociological abstracts (1982 to April 2004), and Communication studies (1982 to April 2003). The reference lists of related reviews were searched and experts in the field were contacted to identify ongoing research. Relevant web sites of international agencies (UNAIDS, WHO, UNFPA, World Bank, and Centers for Disease Control and Prevention) were also searched. All these searches were done without language restriction. All databases were searched up to April 2004. SELECTION CRITERIA: Randomized controlled trials, including cluster-randomized trials and controlled clinical trials, that compared either multimedia interventions or one type of media strategy with a control in relation to promotion of HIV testing were included. Interrupted time series analyses that assessed the effect of mass media against no media or an alternative intervention to promote HIV testing were also included. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information. Types of mass media interventions, participants, and outcomes were extracted in every possible instance. MAIN RESULTS: Of the 35 references that were identified, two randomized controlled trials, three non-randomized controlled studies, and nine interrupted time series were included in the final analysis. All individual studies concluded that mass media were effective, and this was confirmed by reanalysis of the interrupted time series studies which all had initial impact. Mass media interventions for promotion of HIV testing showed significant immediate (Random effect: Estimated mean = 5.487, 95%CI = 2.370 to 8.605) and overall (Random effect: Estimated mean = 6.095, 95%CI = 1.812 to 10.378) effect. No long-term effects were seen on mass media interventions for promotion of HIV testing (Random effect: Estimated mean = 4.447, 95%CI = -0.188 to 9.082). AUTHORS' CONCLUSIONS: Mass media interventions have immediate and overall effects in promotion of HIV testing. No long-term effects were seen. There was no significant impact of detecting seropositive status after mass media intervention for promoting HIV testing, and this finding was limited to a small number of studies. Further research is required to identify possible effects on seropositivity status after mass media intervention for promotion of HIV testing among high-risk groups in epidemic countries. Additional research is needed to identify the effectiveness of different types of mass media interventions, the cost effectiveness of the interventions, and characteristics of messages.