Risk factors for 'small for gestational age babies'.

OBJECTIVE: To identify the risk factors for small for gestational age (SGA) babies. METHODS: The present study was a nested case control study which was carried out by two Medical Officers of Health areas (The field level administrative unit responsible for provision of preventive and promotive health services) in Colombo district. SGA babies were identified using 'weight for gestational age' curves developed for Sri Lankan babies. Newborns of 1,200 pregnant women, who were identified within the first 8 wk of amenorrhea and who delivered in selected hospitals were included in the study. Sample size was calculated as n=167 cases and 4 n=668 controls, with four controls for each case. A case was defined as a newborn whose birth weight was less than the 10th percentile of the weight for gestational age, the control being a newborn whose birth weight was between the 10th and the 90th percentile of the weight for gestational age. RESULTS: Multivariate analysis identified 7 significant risk factors as, number of live born children=0, inadequate weight gain during pregnancy according to initial BMI, maximum and minimum physical work, mother's pre-pregnant weight less than 38 kg, high level of stress at second trimester, presence of pregnancy induced hypertension (PIH) and inadequate support from husband. CONCLUSION: The risk factors indicate the directions for planning intervention programs.

Ergonomics related to seating arrangements in the classroom: worst in South East Asia? The situation in Sri Lankan school children.

Sri Lanka is a resource-poor country in the South-East Asian region with good health indices. Ergonomics of children in educational environments is still novel in the region. An exploration into such issues and dissemination of the scientific evidence will stimulate policy makers in both education and health sector. An important ergonomic issue of the classroom is the seating arrangement. Essential aspects of seating include location of the chair and desk in relation to the blackboard and features of the chair and desk. Musculoskeletal pain is considered to be the most important negative effect due to mismatched ergonomics. A school-based descriptive cross sectional study was carried out in a district of Sri Lanka to ascertain the distribution of selected ergonomic factors related to seating arrangements in the classroom of school-going early adolescents and to assess their relationship to musculoskeletal pain. A sample of 1607 school children of Grade 6,7 and 8 were selected using stratified multi-stage cluster sampling method. There were 52.1% (N=838) females and 47.9% (N=769) males. Many ergonomic aspects related to classroom seating arrangements are not conducive for children. Children were seated with a mean distance of 398.04 cm (SD=132.09) to the blackboard. Nearly 23% of children had to turn more than 45~degrees to see the blackboard. A prevalence of > 80% mismatch was found between body dimensions of children and measurements of furniture. Musculoskeletal pain may have resulted from efforts to maintain stability while seated in incompatible furniture. Nearly 36% children complained of recurrent musculoskeletal pain. Musculoskeletal pain may have resulted from efforts to maintain stability while seated in incompatible furniture. Mismatched seat depth - buttock-popliteal length posed 1.59 times risk recurrent musculoskeletal pain. Despite, children perceived a good chair comfort. Use of backrest lowered the risk of recurrent pain. Results shows that programme planners can utilize such evidence to provide simple ergonomic solutions at national and school level.

Iodine nutrition status among schoolchildren after salt iodisation.

UNLABELLED: Earlier studies done in Sri Lanka have indicated the importance of iodine deficiency as a public health problem. The universal salt iodisation programme has been implemented since 1995. The goals of salt iodisation are reduction of the goitre rate to <5% in school-aged children, to maintain the median urinary iodine level in the population between 100-200 microg/L and >90% of households using iodised salt. OBJECTIVE: To estimate the goitre prevalence, the urinary iodine level, and measure the household iodised salt consumption pattern by Province. METHOD: A school-based study of 6574 randomly selected children in the age group 8-10 years, from 263 schools was assessed for goitre by palpation. The concentration of urinary iodine levels was measured in 2630 of these children. Estimation of iodine in the 6181 samples of salt used in households of the schoolchildren was also assessed by test kits. RESULTS: The prevalence of goitre in the Provinces varied from 16.3% to 26.2%. The median urinary iodine levels were above the cut-off point of 100 microg/L in all Provinces except in Uva. The highest median urinary iodine level was reported in North Central Province (231.3 microg/L). Overall, 35.4% of the children had urine iodine levels in the 'ideal' range (100-199.9 microg/L); 30.6% with lower values (<100 microg/L) indicated iodine deficiency and 16.3% with higher values (< 300 microg/L) indicated excessive iodine intake. Only 49.5% of households had used adequately iodised salt. CONCLUSIONS: This study showed that iodine deficiency still exists in Uva Province, and that more than adequate iodine levels were found in the North Central Province. The level of permitted salt iodine at household level needs to be revised.

Assessment of community maternal care performance of public health midwives of a province in Sri Lanka: a multi-method approach.

The maternal care performance of public health midwives' (PHM) was reviewed using 4 methods in a province of Sri Lanka. The objectives of this descriptive study were to provide a comprehensive assessment of their work and to determine the use of a multi-method system to assess their performance in terms of self- assessed competency, knowledge, attitudes and performance of domiciliary and field clinic services. There were 301 (87.2%) PHMs with good or moderate level of knowledge in antenatal care with only 165 (47.8%) and 238 (69.8%) in natal and postnatal care, respectively. Total knowledge decreased with increasing age and duration of service. Self-assessed competencies were high but not positively correlated with actual knowledge. Attitudes were found to indicate dissatisfaction with the job and a preference of clinic services at the expense domiciliary care. The results indicated that continuing education and enhancement of career prospects were necessary. The methods used in this study could be adopted with appropriate modification for evaluation of personnel in similar settings.

Exclusive breastfeeding among women on the plantations in Sri Lanka.

A cross-sectional questionnaire survey, using the current status method for the assessment of breastfeeding, was conducted among women working in the plantations in Sri Lanka. The exclusive breastfeeding rate was 32.4 per cent. The mothers' return to work and the feeling of having insufficient milk were significantly and negatively associated with exclusive breastfeeding. Women will sometimes start with powdered milk several weeks before going back to work, suggesting that work itself is not the only reason for introducing powdered milk. Although the health authorities have endorsed the concept of exclusive breastfeeding, further health education is needed for the full acceptance of exclusive breastfeeding in the population.

Childhood poisoning in Sri Lanka.

Poisoning in children is a common accident and poison information services should be aware of the toxic agents responsible for poisoning in the community. A retrospective hospital based study was performed, before the establishment of the National Poisons Information Centre in Sri Lanka. There were 4,556 admissions of poisoning to the selected hospitals in the Western Province in 1986 and of this, 540 (11.4%) were below 15 years. Males accounted for 66%. Kerosene oil was responsible for 47% of the poisoning cases in less than 5 years age group, while kerosene oil, pesticides and plants/mushrooms were the commonest toxic agents in the 5 to 14 years age group. The case fatality rate was 3.2%.

Risk factors of acute lower respiratory tract infections in children under five years of age.

This study attempted to identify the determinants of acute lower respiratory-tract infections (ALRI) among children under five years of age, by comparing hundred children hospitalized with ALRI with a control group. Data on socio-demographic, biological and environmental characteristics were collected by interviewing mothers and anthropometric measurements were carried out to assess the nutritional status of the children. Risk of disease in the presence of each exposure was calculated in the univariate analysis and the best explanatory variables among them were identified in the multivariate analysis. The following variables were found to increase the risk of ALRI: (1) history of wheezing, (2) low birth weight, (3) passive smoking, (4) male sex, (5) delivery by cesarean section (6) sharing of sleeping space, (7) not being exclusively breast fed upto the completion of four months, (8) stunting, (9) having pets. The findings highlight some simple strategies which would help in prevention of ALRI.

Influence of work on pregnancy outcome.

OBJECTIVES: To study the effect of working in health services on complications of pregnancy, preterm deliveries and low birthweight (LBW). METHODS: These indices were studied in 130 pregnancies that occurred within the preceding 5 years in 100 nursing officers (NOs) and 126 pregnancies in 100 clerical workers (CWs). Risk was assessed by calculating odds ratios. Confounding and interaction effects were studied by stratification. RESULTS: Socio-economic background and antenatal care utilization in the two groups were similar. Occurrence of LBW was not significantly different (OR = 1.04; 0.57 < OR < 1.89; P = 0.89) although complications of pregnancy (OR = 2.18; 1.09 < OR < 4.38; P = 0.017) and preterm deliveries (OR = 5.64; 1.15 < OR < 37.73; P = 0.013) were higher in NOs. Further analysis showed that employment in health services has a positive effect in prevention of LBW among NOs in the presence of other risk factors. CONCLUSIONS: Working in the health services had a negative effect on some of the indices while benefits of such employment had a positive effect on birth-weight.

Self-evaluation of skills as a method of assessing learning needs for continuing education.

Identification of self-perceived learner needs is important in continuing education programmes for health professionals. This paper describes the use of a self-evaluation skill inventory as a method of determining priorities for continuing education of a category of middle-level health professionals.

Acute poisoning: a major health concern in Sri Lanka.

The importance of acute poisoning as a cause of morbidity and mortality in many developing countries has been highlighted in recent times. This study discusses the utilization of routinely collected data from hospitals for background information required in planning and implementing preventive programs. The high prevalence of poisoning and its distribution countrywide were highlighted by the routinely collected data, while the retrospective study of hospital admissions identified the wide range of toxic agents and age and sex differentials in the pattern of poisoning. Even though the overall case fatality rate was 7.6%, there was wide variation among the different toxic agents.

Poisoning with plants and mushrooms in Sri Lanka: a retrospective hospital based study.

A retrospective hospital-based study in Sri Lanka showed that out of 4556 cases of poisoning, 2.5% were caused by plants and mushrooms. Gloriosa superba (44%), and Ricinus communis (24%) were the commonest plants responsible for poisoning; 39% of the victims were less than 15 y old. Gastric lavage and iv fluids were the most common therapeutic measures used. There were 8 deaths, all due to G superba. There is a need for public education to prevent poisoning, which is a major health concern.

Observer evaluation as a tool for field level evaluation of performance.

A field-level assessment of the job performance of a category of health professionals was carried out using the technique of non-participant observation of client-health worker interactions. Presenting the data so obtained in the form of a 'performance profile' enabled identification of areas in which this category of health workers showed a lower level of performance, indicating areas where alterations in basic and in-service training programmes are required.

Integrating occupational health services with primary health care.

In most developing countries, the occupational health services designed according to a Western model fail to reach millions of people working in small industries and agricultural settings. This article describes a WHO-assisted project in Sri Lanka to integrate occupational health with the existing primary health care services.