Reconstitution of oral antibiotic suspensions for paediatric use in households: a cross-sectional study among caregivers of 3-5-year-old children from a selected district, Sri Lanka.

INTRODUCTION: Reconstitution of oral pediatric antibiotic suspension by primary caregivers plays an essential role in determining the overall health outcome of the child. Incorrect reconstitution techniques could lead to underdosing, overdosing, or introduction of infection. Underdosing could lead to non-resolving infection and antimicrobial resistance. OBJECTIVES: To assess the practice and associated factors on reconstitution of oral pediatric antibiotic suspensions (OPAS) among primary caregivers of 3-5-year-old children in a selected district in Sri Lanka. METHODS: A cross-sectional study was carried out among 835 primary caregivers selected using two-stage cluster sampling at field clinics to assess practices for the reconstitution of OPAS. A live demonstration of the reconstitution of the OPAS was assessed by a checklist. Associated factors with caregiver practices on reconstitution were assessed using Chi-square with the statistical significance level set at 0.05. RESULTS: A total of 820 respondents were recruited and completed the study (response rate = 98.2%). Overall, 56.0% displayed good performance in the demonstration of reconstitution of oral pediatric antibiotic suspension. Poorest performances were observed in shaking the bottle to loosen the powder (Correct: 53.7%), topping up the bottle with water up to the marked line (Correct: 58.0%), and filling the water below the marked line in the bottle (Correct: 59.0%). Caregivers in urban areas compared to rural and estate regions (45.6% vs. 22.7% and 26.5% respectively) and caregivers aged 35 years or above compared to less than 35 years age group (31.5% vs. 22.5%) performed the reconstitution of OPAS poorly. Parental factors, namely age, gender, level of education, and geographical region (urban/rural/estate) were significantly associated with the performance in reconstituting the oral paediatric antibiotic suspension (p = 0.002, p < 0.001, p < 0.001, and p < 0.001 respectively). Factors related to the child, specifically whether they attend preschool and whether they have an older sibling, were found to have a significant association with the correct execution of the reconstitution of OPAS (p = 0.017, and p = 0.030 respectively). CONCLUSIONS AND RECOMMENDATIONS: A significant number of primary caregivers displayed poor practice in key steps during the reconstitution of OPAS, which could have a negative impact on the health of the child. Targeted place-based behavioural change health programs with the use of infographic leaflets/ posters may correct the practices of caregivers.

Development and validation of the Quality of Work Life Scale for elderly workers.

BACKGROUND: With the rapid rise in the elderly population and their labour force participation, quality of work life (QoWL) of elderly workers becomes an important concept. A valid instrument to measure elderly workers QoWL is a prerequisite to further in this direction. OBJECTIVE: To develop and validate the Quality of Work Life Scale-Elderly (QoWLS-E) for elderly workers 60 years and above in Sri Lanka. METHODS: The development and validation of 35 items in QoWLS-E was carried out in two stages. Using a literature search and expert opinion, the items were developed in English language and later translated to Sinhala language. The initial scale consisted of 38 items and a principle component analysis (PCA) was conducted among 275 elderly workers in selected administrative divisions of Colombo district. Then a confirmatory factor analysis (CFA) was conducted among a separate group of 250 elderly workers to confirm the factor structure of the developed scale. RESULTS: PCA identified 9 principle components accounting for a variance of 71%, which was later confirmed in the CFA (RMSEA-0.07, SRMR-1.0, NNFI-0.87, GFI-0.82, CFI-0.96). The final QoWLS-E with a structure of 9 domains namely; physical health, psychological, welfare facility, safety, job content, co-worker, supervisor, flexibility and autonomy having 35 items correlated satisfactorily with Cronbach's alpha of 0.77 and test - retest reliability of 0.82. CONCLUSION: QoWLS-E is conceptually and culturally appropriate to assess Quality of Work Life Scale in elderly. It could be a useful tool to describe and monitor improvement of QOWL in elderly.

Improving uptake of non-communicable disease screening in Sri Lanka: eliciting people's preferences using a discrete choice experiment.

A national programme to universally screen the population between 35 and 65 years for non-communicable diseases was established at 'Healthy Lifestyle Centres (HLCs)' in 2011 in Sri Lanka. Despite several efforts by policymakers, the uptake of screening remained <10% of the target population and with disparities in uptake across districts and among men and women. Considering service beneficiaries as a vital stakeholder, a discrete choice experiment was carried out to estimate people's preference for a non-communicable disease screening service delivery model in rural, urban and estate sectors in a district in Sri Lanka. The choice design and the general survey questionnaire was developed through focus group discussions, literature reviews and stakeholder consultations. Data were collected by stratified random sampling, with 187 participants from the urban sector, 253 from the rural sector and 152 from the estate/plantation sector. People's preference was assessed as utility estimates derived using multinomial logistic regression. Reliability was assessed within test among all study participants and with test-retest among 40 participants showed 80% precision. Urban and rural sectors gave the highest priority to workplace screening over screening at HLCs. The estates attributed the highest priority for cost-free screening. If cost-free screening is offered with having to spend 1-2 hours at the most preferred opening times for each sector with warm and friendly staff, the uptake of screening can predicted to be increased by 65, 29 and 21 times in urban, rural and estate sectors, respectively, relative to having to attend HLCs from 8 a.m. to 4 p.m., spending >2 hours and Rs. 1000 with unfriendly staff. Thus, people's preferences on service delivery aspects seemed to have differed from government priorities. Preferences when ill and apparently healthy differed, as they preferred to spend less time and money when healthy than when ill.

Health in rural Sri Lanka: A cross-sectional survey of three rural districts

Introduction: Sri Lanka has a predominantly rural population. However, there is a dearth of research on health and socioeconomic issues in this group. Objective: To describe basic socioeconomic characteristics and health profile in a rural population. Methods: A descriptive cross-sectional household survey was conducted in 1950 households in three rural districts, selected by a three-stage stratified cluster sampling method. Results: The population pyramid showed an ageing population (dependency ratio of 50%). Only 39% had completed GCE (ordinary level). Unemployment rates were high (25% males, 76% females). Agriculture and related work were main occupations. Most lacked amenities (e.g. 61% households lacked a refrigerator) and practiced inappropriate methods of waste disposal (e.g. open burning by 72%). Household illnesses were frequent: episodes of acute illness within two weeks, injuries within past year and chronic illness were reported from 35.9%, 14.9% and 48.3% households. The prevalence of chronic diseases in adults >20 years were high: diabetes 13.5%, hypertension 16.7% and overweight/obesity 28.2%. Of the males, 22.1% smoked and 12.3% took alcohol. Almost 25% adults chewed betel. Reports of snake bite, dog bites and suicide/attempted suicide were seen in 15.5%, 9.7% and 3.0% households respectively. Conclusions: This study shows a unique clustering of health-related problems in rural Sri Lanka. This was characterized by demographic transition, burden from snake bites, chronic diseases and acute illnesses. There were resource limitations and low levels of education. Cohort studies and comparisons with urban areas will enable further elucidation of determinants of health and other issues in rural Sri Lanka.

Prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries: a systematic review and meta-analysis.

OBJECTIVE: To systematically review the research conducted on prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries (LMICs) and to estimate the pooled prevalence of frailty and prefrailty in community-dwelling older adults in LMICs. DESIGN: Systematic review and meta-analysis. PROSPERO registration number is CRD42016036083. DATA SOURCES: MEDLINE, EMBASE, AMED, Web of Science, CINAHL and WHO Global Health Library were searched from their inception to 12 September 2017. SETTING: Low-income and middle-income countries. PARTICIPANTS: Community-dwelling older adults aged ≥60 years. RESULTS: We screened 7057 citations and 56 studies were included. Forty-seven and 42 studies were included in the frailty and prefrailty meta-analysis, respectively. The majority of studies were from upper middle-income countries. One study was available from low-income countries. The prevalence of frailty varied from 3.9% (China) to 51.4% (Cuba) and prevalence of prefrailty ranged from 13.4% (Tanzania) to 71.6% (Brazil). The pooled prevalence of frailty was 17.4% (95% CI 14.4% to 20.7%, I2=99.2%) and prefrailty was 49.3% (95% CI 46.4% to 52.2%, I2=97.5%). The wide variation in prevalence rates across studies was largely explained by differences in frailty assessment method and the geographic region. These findings are for the studies with a minimum recruitment age 60, 65 and 70 years. CONCLUSION: The prevalence of frailty and prefrailty appears higher in community-dwelling older adults in upper middle-income countries compared with high-income countries, which has important implications for healthcare planning. There is limited evidence on frailty prevalence in lower middle-income and low-income countries. PROSPERO REGISTRATION NUMBER: CRD42016036083.

Risk factors of peripheral arterial disease: a case control study in Sri Lanka.

BACKGROUND: Peripheral artery disease (PAD) is an important global health problem and contributes to notable proportion of morbidity and mortality. This particular manifestation of systemic atherosclerosis is largely under diagnosed and undertreated. For sustainable preventive strategies in a country, it is mandatory to identify country-specific risk factors. We intended to assess the risk factors of PAD among adults aged 40-74 years. METHODS: This case control study was conducted in 2012-2013 in Sri Lanka. Seventy-nine cases and 158 controls in the age group of 40-74 years were selected for the study in order to have case to control ratio 1:2. The criterion for selecting cases and control was based on Ankle brachial pressure index (ABPI). Cases were selected from those who had ABPI 0.85 or less (ABPI ≤0.85) in either lower limb. Controls were selected from those ABPI score between 1.18 and 1.28 in both lower limbs. Only newly identified individuals with PAD were selected as cases. Controls were selected from the same geographical location and within the 5 year age group as cases. RESULTS: The history of diabetes mellitus more than 10 years (OR 5.8, 95% CI 2.2-14.2), history of dyslipidemia for more than 10 years (OR 4.9, 95% CI 2.1-16.2), history of hypertension for more than 10 years (OR 3.8, 95% CI 1.8-12.7) and smoking (OR 2.9, 95% CI 1.2-6.9), elevated HsCRP (OR 3.7, 95% CI 1.2-12.0) and hyperhomocysteinemia (OR 3.0, 95% CI 1.1-8.1) were revealed as country specific significant risk factor of PAD. CONCLUSIONS: Diabetes mellitus, hypertension, dyslipidemia, smoking as well as elevated homocysteine and HsCRP found as risk factors of PAD. Longer the duration or higher level exposure to these risk factors has increased the risk of PAD. These findings emphasis the need for routine screening of PAD among patients with the identified risk factors.

Gaps in awareness of peripheral arterial disease in Sri Lanka: a cross sectional study.

BACKGROUND: Peripheral arterial disease (PAD) is an emerging problem in Sri Lanka, particularly with the ageing population. A considerable number of patients are detected at a late stage with severe limb ischemia or chronic non-healing leg ulceration. Public awareness about PAD is important in developing preventive strategies. METHODS: A cross sectional study was conducted to assess awareness of PAD among adults aged 40-74 years in a district in Sri Lanka. In total, 2912 adults were selected for the study using a multistage probability proportionate to size sampling technique. Data were collected by an interviewer-administered questionnaire. Participants who were aware of PAD were asked about common risk factors, possible consequences of untreated PAD, and sources of information. Multivariate logistic regression analysis was used to assess the independent predictors of PAD awareness. RESULTS: We found that 4.1 % of participants were aware of PAD (95 % confidence interval: 3.4-4.8), which was significantly lower than awareness of other cardiovascular diseases such as cerebrovascular accidents (67.3 %) and myocardial infarction (57.6 %) (p < 0.001). Being male, an urban resident, and having a higher level of education were independent predictors of high PAD awareness. CONCLUSIONS: Our findings suggest that a comprehensive PAD awareness program that covers risk factors, consequences, and preventative strategies is needed to enhance public awareness of PAD.

ABPI against Colour Duplex Scan: A Screening Tool for Detection of Peripheral Arterial Disease in Low Resource Setting Approach to Validation.

Background. In Sri Lanka the ABPI has not been used as a screening tool to detect peripheral arterial disease (PAD) in epidemiological studies. This study was conducted to determine the best cutoff value of ABPI to detect PAD in Sri Lankan population. Methods. The ABPI measured by arterial Doppler to detect PAD was validated against colour duplex scan as the criterion using 165 individuals referred to vascular laboratory, National Hospital Sri Lanka. In all selected individuals ABPI was measured and lower limb colour duplex scan was performed. Narrowing of luminal diameter of lower limb arteries 50% or more was considered as haemodynamically significant and having PAD. The discriminative performance of the ABPI was assessed using Receiver Operator Characteristic (ROC) curve and calculating the area under the curve (AUC). The sensitivity and specificity of different threshold levels of ABPI and the best cutoff value of ABPI to detect PAD were determined. Results. ABPI 0.89 was determined as the best cutoff value to identify individuals with PAD. At this level of ABPI high sensitivity (87%), specificity (99.1%), positive predictive value (98.9%), and negative predictive value (88.4%) were observed. Conclusion. ABPI ≤ 0.89 could be used as the best cut off value to detect PAD.

A cross-sectional study on peripheral arterial disease in a district of Sri Lanka: prevalence and associated factors.

BACKGROUND: Peripheral arterial disease (PAD), a slowly progressive atherosclerotic disease affecting vital organs of the body, is increasingly recognized as a health burden worldwide. Epidemiological information on peripheral arterial disease is scarce in Sri Lanka. The present study intended to estimate the prevalence and associated factors of PAD among adults aged 40-74 years in Gampaha district, Sri Lanka. METHODS: A cross-sectional study was carried out to estimate the prevalence of PAD among adults aged 40-74 years in four randomly selected divisional secretariat areas in Gampaha district in 2012-2013. The sample size of 2912 adults was obtained from 104 clusters using multistage probability proportionate to size sampling. The number of individuals to be included in the 5-year age groups between 40 and 74 years was determined based on the population proportion of the respective age groups in the district. Cluster size was 28, and equal numbers of males and females were selected for each age group per cluster. PAD was defined as having an ankle-brachial pressure index ≤ 0.89. RESULTS: The age-and sex-standardized prevalence of PAD, adjusted for the sensitivity of the ankle-brachial pressure index was 3.6% (95% CI 2.9-4.3%), and no significant difference was found between males (3.7%) and females (3.6%) (p = 0.08). Eighty-eight individuals were newly identified as having PAD, and a significant trend of prevalence with increasing age was observed (p < 0.001). Histories of diabetes mellitus, hypertension, dyslipidemia, coronary artery disease, cerebrovascular accident, smoking, and erectile dysfunction among males were significantly associated with PAD (p < 0.001). Only one third of those with PAD experienced claudication symptoms. CONCLUSIONS: PAD was found to be a hidden disease in the Gampaha district population. Although there is minimal attention on PAD at present, the disease is likely to become a problematic public health concern in Sri Lanka, particularly with its aging population. Primary prevention measures to modify risk factors of PAD, including screening activities for early identification, should be a priority.

Paradox in treatment seeking: an experience from rural Sri Lanka.

Sri Lanka has had a pluralist health care system for centuries, in which Western biomedicine coexists with the Ayurveda system. However, recent studies suggest a declining trend in the use of the Ayurveda system. This study provides insights into the reasons for the low utilization of the Ayurveda system at present. The study findings reveal that low utilization of the Ayurveda system can be attributed to several factors, including the quick effect of Western medicines, the perception of being accustomed to Western medicines, a lack of competent Ayurveda practitioners, the high cost and low quality of Ayurveda medicines, and the rapidly changing lifestyles of villagers. However, for certain conditions such as fractures, snakebite, and paralysis, the majority of the Sri Lankan population still uses Ayurveda treatment. In conclusion, we suggest that health authorities should take into account these changes for future health planning in Sri Lanka.