Direct and indirect costs for hospitalized patients with dengue in Southern Sri Lanka.

BACKGROUND: The Southern Province of Sri Lanka is endemic with dengue, with frequent outbreaks and occurrence of severe disease. However, the economic burden of dengue is poorly quantified. Therefore, we conducted a cost analysis to assess the direct and indirect costs associated with hospitalized patients with dengue to households and to the public healthcare system. METHODS: From June 2017-December 2018, we prospectively enrolled children and adults with acute dengue hospitalized at the largest, public tertiary-care (1800 bed) hospital in the Southern Province, Sri Lanka. We administered a structured questionnaire to obtain information regarding direct costs spent by households on medical visits, medications, laboratory testing, and travel for seeking care for the illness. Indirect costs lost by households were estimated by identifying the days of work lost by patients and caregivers and school days lost by children. Direct hospital costs were estimated using gross costing approach and adjusted by multiplying by annual inflation rates in Sri Lankan rupees and converted to US dollars. RESULTS: A total of 1064 patients with laboratory-confirmed dengue were enrolled. The mean age (SD) was 35.9 years (15.6) with male predominance (66.2%). The mean durations of hospitalization for adults and paediatric patients were 3.86 (SD = 1.51) and 4 (SD = 1.32) days, respectively. The per-capita direct cost borne by the healthcare system was 233.76 USD, and was approximately 14 times greater than the per-capita direct cost borne by households (16.29 USD, SD = 14.02). The per-capita average number of loss of working days was 21.51 (SD = 41.71), with mean per-capita loss of income due to loss of work being 303.99 USD (SD = 569.77), accounting for over 70% of average monthly income. On average, 10.88 days (SD = 10.97) of school days were missed due to the dengue episode. School misses were expected to reduce future annual income of affected children by 0.44%. CONCLUSIONS: Dengue requiring hospitalization had a substantial economic burden on the public healthcare system in Sri Lanka and the affected households. These findings emphasize the importance of strengthening dengue control activities and improved use of hospital-based resources for care to reduce the economic impact of dengue in Sri Lanka.

Candidaemia: Risk factors and validity of tools to predict risk of Candidaemia in Intensive care unit patients in Teaching Hospital Karapitiya

Introduction: The ability to predict candidaemia gives a significant advantage to the clinician by enabling pre-emptive treatment to reduce mortality. Objectives: To identify the prevalence, risk factors, and to validate candida colonization index (CI), candida score (CS) to reliably predict the development of candidaemia in the identified study sample. Methods: Cross sectional analytical study of consecutive admissions fulfilling inclusion criteria to intensive care units (ICUs) of Teaching Hospital Karapitiya from 1st December 2015 to 30th March 2016. Candida colonization of non-blood body sites was measured by culture on admission and repeated every 3rd day until discharge from ICU, death or development of candidaemia. CI, corrected CI (CCI), and CS were calculated for the study patients. Results: Candida colonization was found in 100 (65.7%) patients out of 152 patients screened. The presence of sepsis, gastro-intestinal infection or surgery, central venous line colonization, higher density of rectal, oral and urine colonization was significantly different among the infected and non-infected groups. Change of species of colonizing candida was also a significant new risk factor found in the study. All the indices and scores had excellent sensitivity and negative predictive values. However none of the scores had good specificity except for CCI, which was 94%. Conclusions: A combination of CI, CCI and CS formulated for the study sample could reliably predict candidaemia.

Proportion of lower limb fungal foot infections in patients with type 2 diabetes at a tertiary care hospital in Sri Lanka.

BACKGROUND: Superficial fungal foot infection (SFFI) in diabetic patients increases the risk of developing diabetic foot syndrome. Sixteen percent of urban population is suffering from diabetes in Sri Lanka. As the diabetes patients are more prone to get fungal foot infections, early intervention is advisable owing to the progressive nature of the infection. There is no data on the prevalence of SFFIs in diabetic patients in Sri Lanka. OBJECTIVE: To determine the etiological agents causing SFFI in patients with type 2 diabetes. MATERIALS AND METHODS: Three hundred eighty five diabetic patients were included. Nail clippings and swabs were collected from the infected sites using the standard protocol. Laboratory identification was done and pathogens were identified to the species level by morpho physiological methods. RESULTS: Clinically 295 patients showed SFFI, of which 255 (86%) were mycologically confirmed for infection. Out of 236 direct microscopy (KOH) positives, 227 (96%) were culture positive. Two hundred and fifty one patients (98%) with SFFI had diabetes for more than 10 years. Of the patients with SFFIs 92% had >100 mg/dl FBS and 81% had >140 mg/dl PPBS levels and 80% had both elevated FBS and PPBS. Non-dermatophyte fungal species were the commonest pathogens followed by yeast and dermatophytes. CONCLUSION: Aspergillus niger was the commonest pathogen followed by Candida albicans. SFFIs were seen significantly with the increasing age, gender, duration of diabetes and with less controlled glycaemic level.