Effectiveness of an educational intervention to promote psychosocial well-being of school-going adolescents in Sri Lanka.

BACKGROUND: One-fifth of the Sri Lankan population consists of adolescents, with 71% of them schooling. An extreme need exists in the country for the introduction of evidence-based interventions for the psychosocial well-being of adolescents. The present study assessed the effectiveness of an educational intervention to promote the psychosocial well-being of school-going adolescents in grade nine in Western Province, Sri Lanka. MATERIALS AND METHODS: A quasi-experimental study was conducted among grade nine students in Western Province in 2019. Panadura Medical Officer of Health (MOH) area was selected as the interventional area (IA), and Kelaniya MOH area was identified as the control area (CA). Teachers at schools in the IA received training on psychosocial health promotion of adolescents. They delivered the activity-based educational intervention package to the grade nine students as 20-min classroom sessions for three months. Pre- and post-intervention assessments of attitudes and practices related to the psychosocial well-being of adolescents were conducted using an interviewer-administered questionnaire. Categorical data were compared using Chi-Square or Fisher's exact test. Mann-Whitney U test was applied to determine the difference between the medians of the pre-and post-intervention scores on attitude and practices for psychosocial well-being. RESULTS: A total of 1040 grade nine students were enrolled. There was a statistically significant increase in median score on attitudes [81.8 (IQR:75.5-85.5) to 82.3(IQR:78.6-87.2] and practices [81.7(IQR: 76.1-85.7) to 83.1(IQR: 79.1-86.9)] in the IA while there was no significant difference in the CA. The proportion of bullied adolescents in the past 30 days reduced significantly from 14.8% (n = 38) to 7.9% (n = 20) in IA(p = .03), whereas there was a slight reduction from 17.1% (n = 44) to 11.3% (n = 26) in CA (p = .17). CONCLUSIONS: The present psychosocial intervention is effective in improving the psychosocial well-being of school adolescents, though long-term effectiveness was not assessed. It is recommended to utilise study findings in deciding to introduce the present intervention to basic and in-service teacher training packages and school curricula with necessary modifications.

Knowledge, attitudes and self-perceived competencies on palliative care among medical officers at National Cancer Institute, Sri Lanka.

Introduction: Though palliative care is an essential component in the continuum of cancer care, it is still at an evolving phase in Sri Lanka. Objective: To identify knowledge, attitude, self-perceived competencies in practicing palliative care and factors associated among medical officers in National Cancer Institute, Sri Lanka. Methods: A descriptive cross sectional study was conducted among doctors in National Cancer Institute in 2020/21 using self-administered questionnaire to assess knowledge, attitudes and self-perceived competencies on palliative care. Doctors worked less than 3 months and directly not involved in patient care were excluded. Scoring systems were used to assess knowledge, attitudes and self-perceived competencies. A descriptive analysis of data was done using SPSS 21 using median scores, frequencies and chi- square test. Ethical clearance was taken from the Ethical Review Committee, Faculty of Medicine, University of Colombo. Results: Out of 120 doctors included in the study, 83 (69.3%) were females and 37 (30.7%) were males. Majority 101(84.2%) were Sinhalese. Sixty (60%) were 31-40 years. Eleven (9.2%) had training in service. Five (4.2%) had a percentage score for knowledge ≤50 while 57 (47.5%) had > 75. Only 3 (2.5%) had a percentage score for attitudes of 51-75 while 116 (96.7%) had > 75. For competency level 57 (47.5%) had percentage score ≤50 while 23 (19.2%) had > 75. Ethnicity, age, work experience, receiving undergraduate training were not significantly associated with knowledge, attitudes and practices (p > .05). Conclusion: Though level of knowledge and attitudes were high, self -perceived competencies were low which highlights the need of training in palliative care. Eg: undergraduate curricular and in-service.

Trends in Sri Lankan cause-specific adult mortality 1950-2006.

BACKGROUND: Although all-cause mortality in Sri Lanka decreased significantly from 1950 to 1970, subsequent declines have been more modest with divergent trends by age and sex. This study investigates these trends through cause of death analysis for 1950-2006 in adults aged 15-64 years. METHODS: Deaths were obtained from the World Health Organisation (WHO) mortality database for 1950 to 2003, and the Department of Census and Statistics Sri Lanka for 1992-95 and 2004-06 where WHO data was unavailable. Adult deaths were categorised by age (15-34 and 35-64 years) and sex into: infectious diseases; external-causes; circulatory diseases; cancers; digestive diseases; respiratory diseases; pregnancy-related; ill-defined; and other-causes. Cause-specific mortality rates were directly age-standardised to the 2001 Sri Lankan Census population. RESULTS: Mortality declined in females aged 15-34 years by 85% over 1950-2006, predominantly due to sharp declines in infectious disease and pregnancy-related mortality over 1950-70. Among males aged 15-34 years the mortality decline was less at 47%, due to a rise in external-cause mortality during 1970-2000. In females aged 35-64 years mortality declined by 67% over 1950-2006, predominantly due to a sharp decline in infectious disease, ill-defined and other cause mortality over 1950-70. Among males aged 35-64 years, decline in mortality is evident to 1960 (19%) from decline in infectious disease mortality, followed by increased mortality from circulatory diseases and external cause mortality, despite continued decline in infectious disease mortality. All-cause mortality in males 35-64 years has stagnated since 1970, with fluctuating increases. Circulatory diseases were the leading cause of death among adults 35-64 years in 2002-06, with the male rate almost three times higher than females. CONCLUSIONS: Significant disparities are demonstrated in Sri Lankan cause-specific adult mortality by sex and age group for 1950-2006. Female mortality progressively declined while male mortality demonstrated periods of increase and stagnation. Among males aged 15-34 years this coincides with periods of civil conflict over 1970-2000. Among males aged 35-64 years the increased mortality from non-communicable disease and external causes are the main reasons for stagnation in all-cause mortality since the 1970's.