Ceylon Medical Journal最新文献

{"title":"The impact of COVID-19 on health care accessibility and financial risk protection in Sri Lanka.","authors":"Sumal Nandasena,&nbsp;A U Gamage,&nbsp;Nithershini Periyasamy,&nbsp;Mohammad Rismy,&nbsp;Kumarendran Balachandran,&nbsp;Kasturiratne Anuradhani","doi":"10.4038/cmj.v68iSI1.9729","DOIUrl":"https://doi.org/10.4038/cmj.v68iSI1.9729","url":null,"abstract":"<p><strong>Introduction: </strong>The COVID-19 pandemic negatively impacted the global economy, disrupted essential health services, and distorted social determinants of health, reducing healthcare accessibility and increasing financial risk.</p><p><strong>Aim: </strong>we aimed to assess the impact of COVID-19 on healthcare accessibility and financial risk protection in Sri Lanka.</p><p><strong>Methodology: </strong>We conducted a cross-sectional study on a representative sample (multi-stage sampling process) of 3151 households in 105 clusters representing all the districts of Sri Lanka. The data collection was conducted using an interviewer-administered questionnaire in early November 2021. This was important to classify three periods of interest, namely: (1) the pre-lockdown period (2) the nationwide lockdown period, and (3) the new normal period. (After Oct 1 to early November 2021).</p><p><strong>Results: </strong>Among 11,463 household occupants, 12.6% reported having chronic diseases, with 76.5% diagnosed prior to six months. The majority had heart disease, high blood pressure, or diabetes. Of them, 53.7% have been followed up during the lockdown, increasing to 80.8% in the new normal period. Provincial variations in expenses were observed, with the highest food expenses in the Western Province. Catastrophic health expenditures affected 9.5% and 3.4% of households at 10% and 25%, respectively.</p><p><strong>Conclusions: </strong>A considerable proportion of those having heart disease, high blood pressure, high blood sugar or diabetes mellitus were not followed up in the lockdown period and the first month of the new normal period. Antenatal care and family planning were the least affected. Participants had incurred high out-of-pocket expenditures for healthcare during the entire period.</p>","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10049192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutritional status and dietary intake of the population aged 1-60 years during the COVID-19 Pandemic in Sri Lanka.","authors":"Renuka Jayatissa,&nbsp;Ranbanda Jayawardana,&nbsp;Amila Perera,&nbsp;Nawamali De Alwis,&nbsp;Devisri Abeysingha,&nbsp;K H De Silva,&nbsp;Wasana Marasinghe","doi":"10.4038/cmj.v68iSI1.9749","DOIUrl":"10.4038/cmj.v68iSI1.9749","url":null,"abstract":"<p><strong>Background: </strong>There is a co-existence of different forms of malnutrition leading to a Triple Burden of Malnutrition (TBM) in Sri Lanka. Accessing basic needs and services was a challenge during COVID-19 pandemic, which led to issues in food security with an effect on nutrition status of the population.</p><p><strong>Objectives: </strong>To estimate the prevalence of malnutrition and dietary intakes of the population aged 1 to 60 years. Methods: This study was conducted in 2021. A multistage cluster sample was drawn to represent households at national level using 75 clusters, and 24-hour dietary recalls were compared with estimated average requirements of different age groups. Height and weight of all selected participants were measured.</p><p><strong>Results: </strong>A total of 1776 households and 2991 individuals were studied. The prevalence of wasting, stunting and overweight of children aged 1-4 years (n=486) was 14%, 16.3% and 0.8% respectively. Thinness, stunting, overweight and obesity of children aged 5-9 years (n=388) was 21.4%, 8.5%, 5.2%, 5.1%; children aged 10-17 years (n=355) was 21.1%, 14.1%,11%, 8.2%; and adults aged 18-60 years (n=1762) was 9.9%, 5.4%, 32.6% and 11.5% respectively. Dietary intake gaps were minimal with energy and protein while it was wider with majority of vitamins, iron and calcium. Stunting of children aged 1-4 years was significantly associated with the low calcium and iron intakes.</p><p><strong>Conclusions: </strong>The presence of TBM amongst children and adults were observed with a dietary gap of essential micronutrients. This study highlights the need to re-orient the nutritional interventions to control TBM at population level.</p>","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10433920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perinatal mental health in Sri Lanka, current status, programmes, gaps, and recommendations.","authors":"Thilini Agampodi,&nbsp;Suneth Agampodi","doi":"10.4038/cmj.v68iSI 1.9792","DOIUrl":"https://doi.org/10.4038/cmj.v68iSI 1.9792","url":null,"abstract":"No abstract available","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10080042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal health in Sri Lanka: 75 years of national commitment towards excellence","authors":"Lakshmen Senanayake, Ananda Ranathunga, Athula Kaluarachchi","doi":"10.4038/cmj.v68isi1.9767","DOIUrl":"https://doi.org/10.4038/cmj.v68isi1.9767","url":null,"abstract":"Sri Lanka has a legacy of religious and cultural practices promoting health, and its rulers have been responsive to health needs of the populace. The healthcare milieu that prevailed in the pre-colonial and colonial periods favorably influenced the evolution of maternal health in the last 75 years. Since independence, maternal health in the country improved in many dimensions and directions, in the backdrop of multiple sociodemographic changes and geopolitical fluxes, while far-reaching advances in the medico-technological and communication fields were taking place at global level.By 1948, maternal health services were extensive with maternity hospitals, midwifery training school and functional health units in place. The establishment of a cadre of government-trained midwives instead of training traditional birth attendants (TBAs) was a key policy decision that brought long-term dividends. The WHO supported training primary health care workers even before opening their country office in 1952. In the early days, obstetricians relied mostly on their skills to conduct dexterous maneuvers with the generous use of rotational forceps rather than resorting to abdominal deliveries.The Family Planning Association was founded in 1953, which introduced family planning services to the country till the government took over the subject in 1958. A rigorous campaign (punchi pawla raththaran), promoting sterilization was conducted for population control in 1974, which resulted in the total fertility rate coming down significantly.Maternal Death Surveillance and Response system (MDSR) was established in 1981 which has been recognized globally as a success and is being upscaled to a confidential Inquiry status. Commitment and untiring efforts of the Ministry of Health: Family Health Bureau, professional organizations, development partners including the WHO, have contributed for the achievements in the area of women’s health.","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135464682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survey on the psychosocial impact of COVID-19 on the Sri Lankan mental healthcare system and the needs of frontline healthcare workers in the post-covid era.","authors":"Chamara Wijesinghe,&nbsp;Miyuru Chandradasa,&nbsp;Piyumi Ranwella,&nbsp;Achini Samaranayake,&nbsp;Prabath Wickrama,&nbsp;Nilanga Gamage,&nbsp;Gayani Siriwardane,&nbsp;Narmada Goonathilake,&nbsp;Sayuri Perera,&nbsp;Dulangi Dahanayake,&nbsp;Jayan Mendis,&nbsp;Ranasinghe Kapila","doi":"10.4038/cmj.v68iSI1.9727","DOIUrl":"https://doi.org/10.4038/cmj.v68iSI1.9727","url":null,"abstract":"<p><strong>Introduction: </strong>The COVID-19 pandemic severely strained the health care in Sri Lanka. The subsequent economic crisis compounded this issue. Priority was given to treating those afflicted with COVID-19 and preventing its spread, and healthcare staff faced immense difficulties dealing with the situation. The psychosocial impact of COVID on health care staff has not been properly assessed or addressed.</p><p><strong>Objectives: </strong>A study was conducted to identify the psychosocial impact of COVID-19 among four different categories of health care workers, and perform a needs assessment among these groups.</p><p><strong>Methods: </strong>A convenient sample of frontline health workers, mental health teams, 1926 mental health helpline workers and 1990 Suwa Sariya emergency ambulance service staff were assessed via a self-administered questionnaire for mental health impact, work capacities and needs.</p><p><strong>Results: </strong>Among frontline workers (n=188), 42.5% experienced anxiety symptoms, 12.8% depressive symptoms and 4.1% suicidal thoughts. Most (58.9%) lacked a psychological support system at the workplace. Only 20% have accessed specific programs or services at their workplace to obtain support for mental health issues, and all have benefitted from them. All categories of health workers lacked training and resources.</p><p><strong>Conclusion: </strong>The findings demonstrate that a significant amount of health care workers undergo psychological problems in the course of their work especially in the aftermath of the COVID-19 pandemic. The analysis reveals that Sri Lanka lacks structured psychological support systems for health workers and needs more resources and training. Psychological support for health workers through strengthening resources and training should be prioritised when planning service development.</p>","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10433915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health financing options for Sri Lanka","authors":"Sundararajan S. Gopalan","doi":"10.4038/cmj.v68isi1.9737","DOIUrl":"https://doi.org/10.4038/cmj.v68isi1.9737","url":null,"abstract":"The purpose of this paper is to renew and stimulate the national discourse on how to further Sri Lanka’s aspirational goal of achieving Universal Health Coverage(UHC [1]) in line with the global sustainable development goals (SDG) to which Sri Lanka is a signatory. After a brief status update about UHC in Sri Lanka, the paper focuses on the financing function, justified on the basis of its central role in addressing the problems confronting the health system, in terms of its inherent inefficiencies as well as the specific context of the economic crisis which the country is currently facing. The paper argues for a well-managed prepaid, pooled health financing mechanism (such as the current tax-based system or social health insurance schemes), incorporating strategic purchasing approaches, leveraging the private sector (both for-profit and non-profit), in order to increase efficiency, equity and accountability by separating the financing and purchasing functions from service delivery.","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135464679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health in Sri Lanka: building on a success story","authors":"Michael Marmot","doi":"10.4038/cmj.v68isi1.9787","DOIUrl":"https://doi.org/10.4038/cmj.v68isi1.9787","url":null,"abstract":"No abstract available","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135465976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perinatal mental health in Sri Lanka, current status, programmes, gaps, and recommendations","authors":"Thilini Agampodi, Suneth Agampodi","doi":"10.4038/cmj.v68isi1.9792","DOIUrl":"https://doi.org/10.4038/cmj.v68isi1.9792","url":null,"abstract":"No abstract available","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135465988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a Risk Prediction Model for endometrial carcinoma among postmenopausal women in the Western province of Sri Lanka.","authors":"Iresha Udayanagani Jayawickrama, Chrishantha Abeysena","doi":"10.4038/cmj.v67i4.9746","DOIUrl":"10.4038/cmj.v67i4.9746","url":null,"abstract":"<p><strong>Introduction: </strong>Globally, endometrial carcinoma is the most common reproductive tract cancer among women. Risk prediction model is a simple, low-cost tool to identify women with increased risk of developing endometrial carcinoma. Objectives: The aim of the study was to develop a model to predict the risk of endometrial carcinoma among postmenopausal women in Sri Lanka.</p><p><strong>Methods: </strong>A case control study was conducted. The cases and the controls were defined as postmenopausal women who had and had not been diagnosed as endometrial carcinoma based on histological confirmation respectively. Variable selection was done considering the objectivity and feasibility of the measurements in addition to the statistical criteria. A scoring system [0-9] was designed based on weighted score of each risk predictor. Predictive validity of the model was tested by calibration and discrimination. Receiver Operator Characteristic (ROC) curve was used to determine the cut-off value.</p><p><strong>Results: </strong>The developed model consisted of six predictors; Age >55 years, never conceived, age at menarche ≤11 years, ever experienced postmenopausal bleeding, having family history of any type of cancer among first degree relative, generalized obesity. Discrimination of the model was measured by the area under the ROC curve (0.92, 95% Confidence Interval: 0.88-0.95). Calibration with goodness of fit by Hosmer and Lemeshow test (p=0.72) was satisfactory. The tool demonstrated a good predictive ability with sensitivity of 79.5% (CI: 68.9%-87.3%) and specificity of 90.7% (CI: 86.8%-93.5%) at the cut-off point of 4.5.</p><p><strong>Conclusions: </strong>Model demonstrated good discrimination and well calibration. It can be used in screening of high-risk women for developing endometrial carcinoma.</p>","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47382165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severity of SARS-CoV-2 infection among vaccinated individuals: A hospital-based study.","authors":"Dumitha Govindapala, Priyamali Jayasekara, Rajmohan Rajramanan, Nipun de Silva","doi":"10.4038/cmj.v67i4.9742","DOIUrl":"10.4038/cmj.v67i4.9742","url":null,"abstract":"<p><strong>Introduction: </strong>Post-vaccination infections impart the need for real-world data on protection conferred by the vaccines against SARS-CoV-2. We aimed to evaluate the severity of post-vaccination COVID-19 and the predictors of severe disease.</p><p><strong>Methods: </strong>This cross-sectional study analysed data from 307 patients admitted to the University Hospital KDU with confirmed COVID- 19 from March 1st to November 1st, 2021, after receiving at least a single dose of a vaccine against SARS-CoV-2. Vaccination status and the disease severity were classified using standard definitions. A binary logistic regression model was fitted to investigate severe/critical disease predictors.</p><p><strong>Results: </strong>Of the surveyed patients, 122(39.7%) were fully vaccinated, 127(41.4%) were partially vaccinated and 58 (18.9%) had developed the disease within 14 days of the first vaccine dose. Most were Sinopharm vaccine recipients (52.4 %). Non- severe disease was observed among 249(81.1%) patients and 47(15.3%) had severe disease, while 11(3.6%) needed ICU care (critical illness). Severe/critical disease was reported among 32(25.2%) partially vaccinated and 13(22.4%) patients who developed the disease within 14 days of the first vaccine dose. Of the patients deemed to have vaccine breakthrough infections (122 fully vaccinated patients), 13(10.6%) suffered severe/critical disease. Patients with comorbidity experienced more severe/critical illness (adjusted odds ratio [AOR]= 3.684, P=0.003) than those without pre-existing medical conditions. Disease progression to severe or critical illness was significantly higher among Sinopharm recipients than Covisheild recipients (AOR:2.064, P=0.048).</p><p><strong>Conclusions: </strong>Comorbidity was the most important predictor of severe COVID-19 irrespective of the vaccination status. Observed higher incidence of severe disease among Sinopharm recipients warrants more extensive population studies.</p>","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70108399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}