Prevalence and risk factors for postpartum depression in Sri Lanka: A population-based study.

BACKGROUND: Previous studies in Sri Lanka have shown a high prevalence of postpartum depression (PPD). Postpartum depression screening using the Edinburgh Postnatal Depression Scale (EPDS) has been validated and included in routine postnatal care in 2012. OBJECTIVES: This study aimed to estimate the prevalence of PPD at 10 days and 4 weeks postpartum in 2017 in two medical officer of health (MOH) areas in Sri Lanka, and to assess the association between risk factors and postpartum depression. METHODS: An EPDS total score higher than 9 was used to estimate the prevalence of postpartum depression. PPD outcomes were assessed by mothers' responses to the EPDS. Potential risk factors were extracted from routine paper-based medical records. The associations were examined using simple and multivariable linear regression and multivariate logistic regression models. RESULTS: A total of 1349 mothers in the two areas, 523 from Dankotuwa and 826 from Bope Poddala, were included. The prevalence of PPD was 15.5% and 7.8% among mothers assessed 10 days postpartum (in Dankotuwa) and 4 weeks postpartum (in Bope Poddala), respectively. EPDS total scores were positively related to delivery age of mothers. Presence of postpartum depression was significantly associated with delivery age over 35, having more than 4 living children and mothers' diseases. Mothers who attended prenatal sessions and whose partners were employed were less likely to report postpartum depression. CONCLUSION: The prevalence of PPD in Sri Lanka was 15.5% at 10 days and 7.8% at 4 weeks postpartum. Future studies on the effect of time since delivery on postpartum depression screening outcomes are warranted.

Point-prevalence study of antimicrobial use in public hospitals in southern Sri Lanka identifies opportunities for improving prescribing practices.

A point-prevalence study of antimicrobial use among inpatients at 5 public hospitals in Sri Lanka revealed that 54.6% were receiving antimicrobials: 43.1% in medical wards, 68.0% in surgical wards, and 97.6% in intensive care wards. Amoxicillin-clavulanate was most commonly used for major indications. Among patients receiving antimicrobials, 31.0% received potentially inappropriate therapy.

Barriers to Engagement in a Workplace Weight Management Program: A Qualitative Study.

PURPOSE: To investigate (1) why some participants in a workplace weight management program were more engaged in the program, (2) specific barriers and facilitators for engagement and weight loss, and (3) suggest how workplaces may better engage employees in these programs to improve their effectiveness. DESIGN: Qualitative study (8 focus groups). SETTING: A large academic university and medical system. PARTICIPANTS: Twenty-six (5%) of the 550 employees who participated in a weight management program as part of the Steps to Health study. MEASURES: A trained moderator guided the audio-recorded focus groups. ANALYSIS: Transcripts were analyzed using the directed content analysis approach. RESULTS: Participants faced numerous barriers to engagement in workplace weight management programs, both within and outside the workplace. Participants viewed the coaches positively and reported that the coaches had a strong influence on their engagement in the program. Participants suggested increased frequency and variety of contact by coaches, on-site group exercise classes, and tailored educational materials. CONCLUSION: Workplace weight management programs may be improved by being more flexible around participants' schedules and changing needs, by increasing access to affordable, convenient exercise facilities, and by implementing institutional changes that encourage healthy eating and physical activity during the workday. Employers should measure program engagement and solicit participant feedback to ensure that the programs are appropriate and delivered in an optimal manner.

Antibiotic overuse for acute respiratory tract infections in Sri Lanka: a qualitative study of outpatients and their physicians.

BACKGROUND: Acute respiratory tract infections (ARTIs) are a common reason for antibiotic overuse worldwide. We previously showed that over 80% of outpatients presenting to a tertiary care hospital in Sri Lanka with influenza-like illness received antibiotic prescriptions, although almost half were later confirmed to have influenza. The purpose of this qualitative study was to assess Sri Lankan patients' and physicians' attitudes towards ARTI diagnosis and treatment. METHODS: Semi-structured interviews were conducted with 50 outpatients with ARTIs and five physicians in the Outpatient Department (OPD) at a large, public tertiary care hospital in southern Sri Lanka. Interviews were audio-recorded, transcribed, and analyzed for themes related to ARTI diagnosis and treatment. RESULTS: Patients frequently sought ARTI care in the public sector due to the receipt of free care and the perception that government hospitals carried a sense of responsibility for patients' health. Patients reported multiple medical visits for their illnesses of short duration and many indicated that they were seeking care in the OPD while at the hospital for another reason. While patients generally expected to receive medication prescriptions at their visit, most patients were not specifically seeking an antibiotic prescription. However, more than 70% of patients received antibiotic prescriptions at their OPD visit. Physicians incorrectly perceived that patients desired antibiotics or "capsules," a common formulation of antibiotics dispensed in this outpatient setting, and cited patient demand as an important cause of antibiotic overuse. Physicians also indicated that high patient volume and fear of bacterial superinfection drove antibiotic overuse. CONCLUSIONS: Patients in this study were seeking medication prescriptions for their ARTIs, but physicians incorrectly perceived that antibiotic prescriptions were desired. High patient volume and fear of bacterial superinfection were also important factors in antibiotic overuse. Training of physicians regarding guideline-concordant management and dealing with diagnostic uncertainty, education of patients regarding ARTI etiology and management, and systematic changes in the public outpatient care structure may help decrease unnecessary antibiotic prescriptions for ARTIs in this setting.

Prevalence and Correlates of Leprosy in a High-Risk Community Setting in Sri Lanka.

Leprosy is caused by the Mycobacterium leprae bacillus. Pockets of high endemicity remain in a number of countries including Sri Lanka, in spite of the fact that elimination has been achieved at the national level. In 2012, in a village in the Puttlam district, dermatologists reported an increase in individuals with leprosy. This village had been established in the 1990s for people displaced from Northern Sri Lanka during a civil war. A comprehensive household survey was conducted by district health officials from June to July 2012, and all household members present during the survey period were examined for leprosy lesions. Patients with suspected leprosy were referred to a dermatology clinic for clinical or pathological confirmation. The prevalence of leprosy was high (511 per 10 000 population). Household contact with another patient with leprosy increased the risk of leprosy (odds ratio = 6.69; P < .001). Continued vigilance is needed to keep leprosy at bay in high-risk communities.