Mothers' ability to determine and measure paracetamol doses for children-a contrived observational study.

Caregivers are primarily responsible for the administration of Over The Counter (OTC) medications in children. This study examines the mothers' ability to determine and measure paracetamol doses for children aged between 1 and 5 years. A contrived observational study was conducted for mothers of preschool aged children at two Public Health Midwifery (PHM) areas in Southern province, Sri Lanka. Stratified random sampling was used. Only 26.9% (n = 95, 95% CI = 22.5%-31.7%) of the 353 participants correctly determined and measured the doses of paracetamol. Errors were frequently made in both determining and measuring dose together (n = 113, 32.0%, 95% CI = 27.3%-37.1%), determining only (n = 94, 26.6%, 95% CI = 22.2%-31.5%) and measurement only (n = 51, 14.4%, 95% CI = 11.1%-18.5%). Dose determined errors were not significantly associated with maternal education, number of children in the family, total monthly income and age of the index child. Similarly measuring errors were not significantly associated with mothers' education, income of the family and number of children in the family. However, there was a weak positive correlation between measuring errors and age of the index child. The study suggests that mothers made errors when determining doses and measuring doses of paracetamol. Results emphasize importance of clear, concise guardian information leaflet and healthcare professionals' guidance to minimize dosing errors of child medication.

The effect of a community based health promotion intervention to change gender norms among women in a rural community in Sri Lanka.

BACKGROUND: Gender norms practiced by respective societies increase the risk of violence by men against women. To date, there is a dearth of research evidence on changing gender norms through health promotion approaches around the globe, including in Sri Lanka. This study provides an evaluation of effectiveness of a health promotion intervention in changing the acceptance of gender norms among women. METHODS: A quasi-experimental study was conducted in two rural villages in Anuradhapura district in Sri Lanka including women who have a child under five years of age. One village was allocated to receive an intervention developed based on a health promotion approach and the other village was a control. A community based mechanism to question selected gender norms among women was developed as the intervention. The pre- and post-intervention assessments of the level of acceptance of gender norms were done using an interviewer administered questionnaire and by using focus group discussions. RESULTS: Following the intervention, acceptances of prominent gender norms were changed significantly among the women receiving the intervention method. The control group showed no changes towards the acceptance of gender norms during this period. Women in the intervention group had higher levels of self-reported positive behavior changes and greater understanding of gender concepts compared to the control group. CONCLUSION: The acceptance of gender norms among women in rural villages in Sri Lanka can be changed by a community based intervention targeting gender norms.

Validity of referral hospitals for the toxicovigilance of acute poisoning in Sri Lanka.

OBJECTIVE: To identify the hospital admission data set that best captures the incidence of acute poisoning in rural Sri Lanka. METHODS: Data were collected on all acute poisoning cases admitted to 34 primary and 1 referral hospital in Anuradhapura district from September 2008 to January 2010. Three admission data sets were compared with the "true" incidence of acute poisoning to determine the systematic bias inherent to each data set. "True" incidence was calculated by adding all direct admissions (not transfers) to primary hospitals and to the referral hospital. The three data sets were: (i) all admissions to primary hospitals only; (ii) all admissions to the referral hospital only (direct and referrals), and (iii) all admissions to both primary hospitals and the referral hospital ("all admissions"). The third is the government's routine statistical method but counts transfers twice, so for the study transferred patients were counted only once through data linkage. FINDINGS: Of 3813 patients admitted for poisoning, 3111 first presented to a primary hospital and 2287 (73.5%) were later transferred to the referral hospital, where most deaths (161/177) occurred. All data sets were representative demographically and in poisoning type, but referral hospital data yielded a more accurate case-fatality rate than primary hospital data or "all admissions" data. Admissions to primary hospitals only or to the referral hospital only underestimated the incidence of acute poisoning by about 20%, and data on "all admissions" overestimated it by 60%. CONCLUSION: Admission data from referral hospitals are easily obtainable and accurately reflect the true poisoning incidence.

Prediction of outcome after paraquat poisoning by measurement of the plasma paraquat concentration.

BACKGROUND: Paraquat is a herbicide with a good occupational safety record, but a high mortality after intentional ingestion that has proved refractory to treatment. For nearly three decades paraquat concentration-time data have been used to predict the outcome following ingestion. However, none of the published methods has been independently or prospectively validated. We aimed to use prospectively collected data to test the published predictive methods and to determine if any is superior. METHODS: Plasma paraquat concentrations were measured on admission for 451 patients in 10 hospitals in Sri Lanka as part of large prospective cohort study. All deaths in hospital were recorded; patients surviving to hospital discharge were followed up after 3 months to detect delayed deaths. Five prediction methods that are based on paraquat concentration-time data were then evaluated in all eligible patients. RESULTS: All methods showed comparable performance within their range of application. For example, between 4- and 24-h prediction of prognosis was most variable between Sawada and Proudfoot methods but these differences were relatively small [specificity 0.96 (95% CI: 0.90-0.99) vs. 0.89 (0.82-0.95); sensitivity 0.57 vs. 0.79, positive and negative likelihood ratios 14.8 vs. 7.40 and 0.44 vs. 0.23 and positive predictive values 0.96 vs. 0.92, respectively]. CONCLUSION: All five published methods were better at predicting death than survival. These predictions may also serve as tools to identify patients who need treatment and for some assessment to be made of new treatments that are trialled without a control group.