Is Leishmaniasis adequately notified in Sri Lanka? A survey among doctors from an endemic district, Sri Lanka.

Abstract Background: Leishmaniasis is a notifiable disease in Sri Lanka since 2008. Previous studies show a gap in the notification of leishmaniasis. Purpose of the present study was to determine the Knowledge, attitudes and practice of medical officers regarding leishmaniasis.Methods: A cross-sectional study was conducted in the Anuradhapura district which reported the highest case load of leishmaniasis. Medical officers from public and private health care institutes in the area filled a self-administered questionnaire in the presence of the investigators.Results: One hundred and eighty-eight (188) medical officers completed the questionnaire. Of them, 95.7% were aware of leishmaniasis as a parasitic infection and 84.7% correctly identified Leishmania donovani as the causative organism in Sri Lanka. From the respondents, 181 (96.8%) knew that the vector of leishmaniasis is sand fly. Cutaneous leishmaniasis was reported as the most prevalent form of leishmaniasis in the country by 176 (94.1%). Nearly half of the respondents (98, 54.1%) were aware of the fact that the Anuradhapura district has the highest disease burden. Many of them had the idea that leishmaniasis is an emerging disease (155, 84.3%,) and early diagnosis is important in controlling the disease (163, 89.1%). Although about three fourth (123, 73.7 %,) of the participants mentioned that leishmaniasis should be notified at first clinical suspicion, only 74 (42.5%) were aware that it is a legal requirement. Some medical officers (39, 22%) believed that the current notification system in the country is not effective. Unavailability of notification forms (60, 36.8%) heavy workload (85, 50.3%) and inadequate supportive staff (55, 35.1%) were reported as barriers for timely notification. Even though 105 (58.0%) of medical officers had suspected leishmaniasis during last eight years period only 35 (19.4%) had notified.Conclusions: Even though more than 90% of the participants had good theoretical knowledge about leishmaniasis; notification of leishmaniasis is considerably inadequate. This study emphasizes the need for greater efforts to improve the notification of leishmaniasis in Sri Lanka.

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Is Leishmaniasis adequately notified in Sri Lanka? A survey among doctors from an endemic district, Sri Lanka.

10.21203/rs.2.19233/v4 ◽

2020 ◽

Author(s):

Chandana Hewawasam ◽

Hema S Weerakoon ◽

Vyshnavi Thilakan ◽

Tishni Lelwala ◽

Kalana Prasanka ◽

...

Keyword(s):

Sri Lanka ◽

Leishmania Donovani ◽

Parasitic Infection ◽

Cross Sectional Study ◽

Sand Fly ◽

Causative Organism ◽

Cross Sectional ◽

Public And Private ◽

Notification System ◽

Endemic District

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Is Leishmaniasis adequately notified in Sri Lanka? A survey among doctors from high endemic district of Sri Lanka.

10.21203/rs.2.19233/v2 ◽

2020 ◽

Author(s):

Chandana Hewawasam ◽

Hema S Weerakoon ◽

Vyshnavi Thilakan ◽

Tishni Lelwala ◽

Kalana Prasanka ◽

...

Keyword(s):

Sri Lanka ◽

Leishmania Donovani ◽

Parasitic Infection ◽

Cross Sectional Study ◽

Causative Organism ◽

Cross Sectional ◽

Public And Private ◽

Notification System ◽

Endemic District ◽

Self Administered Questionnaire

Abstract Background: Leishmaniasis is a notifiable disease in Sri Lanka since 2008. Previous studies show a gap in the notification of leishmaniasis. Purpose of the present study was to determine the Knowledge, attitudes and practice of medical officers regarding leishmaniasis. Methods: A cross-sectional study was conducted in the Anuradhapura district which reported the highest prevalence of leishmaniasis. Medical officers from public and private health care institutes in the area filled a self-administered questionnaire in the presence of the investigators. Results: One hundred and eighty-eight (188) medical officers completed the questionnaire. Of them, 95.7% were aware of leishmaniasis as a parasitic infection and 84.7% correctly identified Leishmania donovani as the causative organism in Sri Lanka. From the respondents, 181 (96.8%) knew that the vector of leishmaniasis is sandfly. Cutaneous leishmaniasis was reported as the most prevalent form of leishmaniasis in the country by 176 (94.1%). Nearly half of the respondents (98, 54.1%) was aware of the fact that the Anuradhapura district has the highest prevalence of the disease. Many of them had the idea that leishmaniasis is an emerging disease (155, 84.3%,) and early diagnosis is important in controlling the disease (163, 89.1%). Although about three fourth (123, 73.7 %,) of the participants mentioned that leishmaniasis should be notified at first clinical suspicion, only 74 (42.5%) were aware that it is a legal requirement. Some medical officers (39, 22%) believed that the current notification system in the country is not effective. Unavailability of notification forms (60, 36.8%) heavy workload (85, 50.3%) and inadequate supportive staff (55, 35.1%) were reported as barriers for timely notification. Even though 105 (58.0%) of medical officers had suspected leishmaniasis during last eight years period only 35 (19.4%) had notified. Conclusions: Even though more than 90% of the participants had good theoretical knowledge about leishmaniasis; notification of leishmaniasis is considerably inadequate. This study emphasizes the need for greater efforts to improve the notification of leishmaniasis in Sri Lanka.

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Is Leishmaniasis adequately notified in Sri Lanka? A survey among doctors from high endemic district of Sri Lanka.

10.21203/rs.2.19233/v1 ◽

2019 ◽

Author(s):

Chandana Hewawasam ◽

Hema S Weerakoon ◽

Vyshnavi Thilakan ◽

Tishni Lelwala ◽

Kalana Prasanka ◽

...

Keyword(s):

Sri Lanka ◽

Leishmania Donovani ◽

Parasitic Infection ◽

Cross Sectional Study ◽

Causative Organism ◽

Cross Sectional ◽

Public And Private ◽

Notification System ◽

Endemic District ◽

Self Administered Questionnaire

Abstract Background : Leishmaniasis is a notifiable disease in Sri Lanka since 2008. Previous studies show a gap in the notification. Purpose of the present study was to determine the Knowledge, attitudes and practice of medical officers regarding leishmaniasis. Methods : A cross-sectional study was conducted in Anuradhapura district which reported the highest prevalence of leishmaniasis. Participants from public and private health care institutes in the area filled a self-administered questionnaire in the presence of the investigators. Results : One hundred and eighty-eight (188) medical officers (involved in treating 75,326 population) completed the questionnaire. Of them, 95.7% (n=177) were aware of leishmaniasis as a parasitic infection and 84.7% (n=155) correctly identified Leishmania donovani as the causative organism in Sri Lanka. From the respondents, 96.8% (n=181) knew that the vector of leishmaniasis is sandfly. Cutaneous leishmaniasis was reported as the most prevalent form of leishmaniasis in the country by 94.1% (n=176). Nearly half of the population (54.1%, n=98) was aware of the fact that Anuradhapura district has the highest prevalence of the disease. Many of them had the idea that leishmaniasis is an emerging disease (84.3%, n=155) and early diagnosis is important in controlling the disease (89.1%, n=163). Although about three fourth (73.7 %, n=123) of the population mentioned that leishmaniasis should be notified at first clinical suspicion, only 42.5% (n=74) were aware that it is a legal requirement. Some medical officers (22%, n=39) believed the current notification system in the country is not effective. Unavailability of notification forms (36.8%, n=60), heavy workload (50.3%, n=85) and inadequate supportive staff (35.1%, n=55) were reported as barriers for timely notification. Even though 58.0% (n=105) of medical officers had suspected leishmaniasis during last eight years period only 19.4% (n=35) had notified. Conclusions : Even though more than 90% of the participants had good theoretical knowledge about leishmaniasis; notification of leishmaniasis is considerably inadequate. This study emphasizes the need for greater efforts to improve the notification of leishmaniasis in Sri Lanka. Keywords : Leishmaniasis, Notification, Physicians, Knowledge, attitude, practice, Sri Lanka

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Histopathology of Cutaneous Leishmaniasis Caused by Leishmania donovani in Sri Lanka

BioMed Research International ◽

10.1155/2020/4926819 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Harshima Wijesinghe ◽

Nayana Gunathilaka ◽

Saveen Semege ◽

Nishantha Pathirana ◽

Nuwani Manamperi ◽

...

Keyword(s):

Sri Lanka ◽

Cutaneous Leishmaniasis ◽

Leishmania Donovani ◽

Clinical Presentation ◽

Cross Sectional Study ◽

Causative Organism ◽

Variable Intensity ◽

Cross Sectional ◽

The North ◽

Parasitic Load

Cutaneous leishmaniasis (CL) is a neglected tropical disease that is gaining importance in Sri Lanka and internationally. The clinical presentation, pathology, and method of parasite elimination in CL vary according to the species. Leishmania donovani is the causative organism for leishmaniasis in Sri Lanka. This collaborative cross-sectional study describes the clinicopathological features of cutaneous leishmaniasis among personnel of the tri-forces serving in the North and East of the country. The histology of fifty cases of CL confirmed by at least two methods (slit skin smear, lesion aspirate, tissue impression, and histology) was reviewed. The parasitic load was assessed semiquantitatively. The histological features were correlated with the clinical presentation and organism load. The majority (89.8%; n=44) presented with a single lesion mostly located in the upper limb (69.4%). The lesion types included papule (34.7%), nodule (32.7%), and an ulcer (30.6%). The evolution time of lesions averaged 31.55 weeks. Epidermal changes were observed in 49 of the biopsies and included hyperkeratosis (90.0%; n=45), acanthosis (44.0%; n=22), atrophy (34.0%; n=17), and interface change (66%; n=33). Dermal changes were seen in all cases and were characterized by a lymphohistioplasmacytic inflammatory infiltrate of variable intensity with ill-formed granuloma in 19 cases (38%) and well-formed epithelioid granulomas in 22 cases (44%). Focal necrosis was present in 20% (n=10). Leishmania amastigote forms were observed in 88% (n=44). Transepidermal elimination (P=0.025), granuloma (P=0.027) formation, and type of lesion (P=0.034) were significantly associated with the organism load. Granuloma formation was associated with a reduction in organism load, indicating that the macrophage activation played an important role in the control of the organism.

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Genetic diversity of Leishmania donovani that causes cutaneous leishmaniasis in Sri Lanka: a cross sectional study with regional comparisons

BMC Infectious Diseases ◽

10.1186/s12879-017-2883-x ◽

2017 ◽

Vol 17 (1) ◽

Cited By ~ 10

Author(s):

Udeshika Lakmini Kariyawasam ◽

Angamuthu Selvapandiyan ◽

Keshav Rai ◽

Tasaduq Hussain Wani ◽

Kavita Ahuja ◽

...

Keyword(s):

Genetic Diversity ◽

Sri Lanka ◽

Cutaneous Leishmaniasis ◽

Leishmania Donovani ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Regional Comparisons

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Improving the leptospirosis disease burden assessment by including ambulatory patients from outpatient departments: a cross-sectional study

F1000Research ◽

10.12688/f1000research.26202.2 ◽

2021 ◽

Vol 9 ◽

pp. 1129

Author(s):

Janith Warnasekara ◽

Parami Aberathna ◽

Geetha Nanayakkara ◽

Joseph Vinetz ◽

Suneth Agampodi

Keyword(s):

Sri Lanka ◽

Disease Burden ◽

Quantitative Polymerase Chain Reaction ◽

Care Center ◽

Cross Sectional Study ◽

Primary Care Center ◽

Cross Sectional ◽

Notification System ◽

Ambulatory Patients ◽

Outpatient Departments

Background: In Sri Lanka, the disease burden of leptospirosis is estimated based on a routine notification system, which is predominated by patients ill enough to be hospitalized. The notification system does not function well with ambulatory patients in outpatient departments (OPDs). The objective of this study was to determine the proportion of leptospirosis in an OPD setting in a regional public hospital in Sri Lanka to provide further estimation of disease burden. Methods: This study was conducted in the OPD of the Rathnapura Provincial General Hospital from August to September 2017. Suspected leptospirosis patients were recruited based on standardized criteria and tested using the microscopic agglutination test and quantitative polymerase chain reaction. The number of OPD patients was compared with the reported patient numbers with leptospirosis from the hospital during the same period as the denominator, and the 95% confidence interval was calculated for the proportions using Poisson distribution. Results: During the study period, of 2,960 fever patients presenting to the OPD, 33 (1.1%) were suspected to have leptospirosis; 8/33 suspected (22.3%) cases were confirmed as being due to leptospirosis. There were 82 notifications of leptospirosis cases from hospital inpatients during the same period, none from the OPD. The total missing proportion from the surveillance system was 28.6% (95% CI, 19.4-40.4%). Among OPD patients, 12 (36.4%) had been given antibiotics from a primary care center prior to the OPD visit. No OPD patient was admitted to the hospital for inward care. Conclusions: More than 25% of cases of leptospirosis were not identified because they were not sick enough to be admitted nor subjected to routine leptospirosis diagnostic testing.These data have public health implications if the sources of leptospirosis transmission are to be controlled.

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CONSUMO DE ALIMENTOS PROCESSADOS E ULTRAPROCESSADOS POR ESCOLARES DE ARROIO DO TIGRE, RS

Revista Interdisciplinar de Estudos em Saúde ◽

10.33362/ries.v7i1.1300 ◽

2018 ◽

Vol 7 (1) ◽

pp. 157-164

Author(s):

Rubiane Inara Wagner ◽

Patrícia Molz ◽

Camila Schreiner Pereira

Keyword(s):

Public School ◽

Nutritional Status ◽

Private School ◽

Food Habits ◽

Cross Sectional Study ◽

School Students ◽

Cross Sectional ◽

Public And Private ◽

The Public ◽

Cereal Bars

O objetivo deste estudo foi comparar a frequência do consumo de alimentos processados e ultraprocessados e verificar a associação entre estado nutricional por adolescentes do ensino público e privado do município de Arroio do Tigre, RS. Trata-se de um estudo transversal realizado com adolescentes, com idade entre 10 e 15 anos, de uma escola pública e uma privada de Arroio do Tigre, RS. O estado nutricional foi avaliado pelo índice de massa corporal. Aplicou-se um questionário de frequência alimentar contendo alimentos processados e ultraprocessados. A amostra foi composta por 64 adolescentes com idade média de 12,03±1,15 anos, sendo 53,1% da escola pública. A maioria dos adolescentes encontravam-se eutróficos (p=0,343), e quando comparado com o consumo de alimentos processados e ultraprocessados, a maioria dos escolares eutróficos relataram maior frequência no consumo de balas e chicletes (50,0%) e barra de cereais (51,0%), de 1 a 3 vezes por semana (p=0,004; p=0,029, respectivamente). Houve também uma maior frequência de consumo de alimentos processados e ultraprocessados como pizza (73,5%; p0,001), refrigerante (58,8%; p=0,036) e biscoito recheado (58,8%; p=0,008) entre 1 a 3 vezes por semana na escola pública em comparação a escola privada. O consumo de suco de pacote (p=0,013) foi relatado não ser consumido pela maioria dos alunos da escola particular em comparação a escola pública. Os dados encontrados evidenciam um consumo expressivo de alimentos processados e ultraprocessados pelos adolescentes de ambas as escolas, destacando alimentos com alto teor de açúcar e sódio.Palavras-chave: Hábitos alimentares. Adolescentes. Alimentos industrializados. ABSTRACT: The objective of this study was to compare the frequency of consumption of processed and ultraprocessed foods and to verify the association between nutritional status by adolescents from public and private schools in the municipality of Arroio do Tigre, RS. This was a cross-sectional study conducted with adolescents, aged 10 to 15 years, from a public school and a private school in Arroio do Tigre, RS. Nutritional status was assessed by body mass index. A food frequency questionnaire containing processed and ultraprocessed foods was applied. The sample consisted of 64 adolescents with a mean age of 12.03±1.15 years, 53.1% of the public school. Most of the adolescents were eutrophic (p=0.343), and when compared to the consumption of processed and ultraprocessed foods, most eutrophic schoolchildren reported a higher frequency of bullets and chewing gum (50.0%) and cereal bars (51.0%), 1 to 3 times per week (p=0.004, p=0.029, respectively). There was also a higher frequency of consumption of processed and ultraprocessed foods such as pizza (73.5%, p0.001), refrigerant (58.8%, p=0.036) and stuffed biscuit (58.8%, p=0.008) between 1 to 3 times a week in public school compared to private school. Consumption of packet juice (p=0.013) was reported not to be consumed by the majority of private school students compared to public school. Conclusion: The data found evidenced an expressive consumption of processed and ultraprocessed foods by the adolescents of both schools, highlighting foods with high sugar and sodium content.Keywords: Food Habits. Adolescents. Industrialized Foods.

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SERVICE QUALITY OF PUBLIC AND PRIVATE PHYSIOTHERAPY INSTITUTES: A COMPARATIVE STUDY IN LAHORE

Pakistan Journal of Medicine and Dentistry ◽

10.36283/pjmd8-4/019 ◽

2019 ◽

Author(s):

Roohi Abbas

Keyword(s):

Physical Therapy ◽

Service Quality ◽

Cross Sectional Study ◽

Quality Of Services ◽

Sectional Study ◽

Cross Sectional ◽

Public And Private ◽

Quality Dimensions ◽

Service Quality Dimensions

Background: Ever since quality of services is gaining importance in every industry as it is the indicator of consumer/customer satisfaction, it is of utmost importance to measure service quality of educational institutes to determine the satisfaction of students. Thus, the study aimed to determine the important factors in service quality dimensions which contribute to the satisfaction of students. Methods: This was a Comparative Cross Sectional study in which final year department of physical therapy (DPT) students were included from three private and three public physiotherapy institutes. Results: The largest mean Positive Gap scores for Public Physiotherapy Institutes was 0.18 for accessibility and affordability 0.18. The largest negative mean gap score for Private Physiotherapy domain was “Accessibility and Affordability” found to be -1.96. Conclusion: Students were satisfied with service quality of private institutes in all domains except for the “Accessibility and Affordability” whereas, in Public Institutes largest negative quality gaps were found in “Empathy” and “Assurance”.

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Preparedness of pre-intern medical graduates of three universities in Sri Lanka to diagnose and manage anaphylaxis

BMC Medical Education ◽

10.1186/s12909-021-02588-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chandrani Nirmala Wijekoon ◽

Indika Wettasinghe ◽

Dinithi Fernando ◽

Arosha Sampath Dissanayake ◽

Malinda Gunawardana ◽

...

Keyword(s):

Sri Lanka ◽

Early Recognition ◽

Correct Diagnosis ◽

Cross Sectional Study ◽

Intravenous Route ◽

Cross Sectional ◽

Diagnosis And Management ◽

Medical Graduates ◽

Self Confidence ◽

Case Diagnosis

Abstract Background Early recognition and the optimal management of anaphylaxis saves lives but studies from different countries have demonstrated gaps in knowledge and practices between healthcare workers. There is a paucity of such data from Sri Lanka. We assessed knowledge, perception and self-confidence in the diagnosis and management of anaphylaxis amongst pre-intern medical graduates who would soon become first-contact doctors attending emergencies. Methods This cross-sectional study included pre-interns who graduated with Bachelor of Medicine, Bachelor of Surgery (MBBS) degrees in 2019 from three Sri Lankan universities with differing undergraduate curricula. Using consecutive sampling data were collected within four months of the final-MBBS examinations with a self-administered questionnaire and the answers on case diagnosis and management were used as the basis of outcome scores. Results 385 participants responded (response rate: 91.5%). 16.4% correctly identified all anaphylaxis triggers. Only 7.3% correctly diagnosed all ten case scenarios and 34.5% all seven cases of anaphylaxis. 98.2 and 97.9% correctly identified 1:1000 adrenaline as the first-line treatment and the intramuscular route. 9.9% would preferentially but incorrectly use the intravenous route if access was available. Only 79.2 and 55.6% knew the correct adult and paediatric doses of adrenaline and 50% agreed that follow-up care was needed. The mean scores for case diagnosis and management of anaphylaxis were 7.7/10 ± 1.4 and 16.9/20 ± 1.9, respectively. Multiple linear regression indicated that the final MBBS results classification (class of degree or no class indicated) was a positive predictor of case diagnosis score [class vs no class: B = 0.662 (95% CI 0.347–0.978), p < 0.001] and being a graduate of University 2 [B = 1.568 (95% CI 1.182–1.953), p < 0.001] and passing with a class at final MBBS [B = 0.716 (95% CI 0.319–1.113), p < 0.001] were positive predictors of management score. Self confidence in diagnosing and managing anaphylaxis were rated as 79.7 and 62.1% and there was a positive correlation between knowledge and perception scores and self-confidence (case-diagnosis: rpb = 0.111, p = 0.03; management: rpb = 0.164, p = 0.001). Conclusions Knowledge, perception and self confidence in the diagnosis and management of anaphylaxis was sub optimal amongst pre-interns and we identified areas that need improvement. A higher MBBS qualification classification was a predictor for correct diagnosis and management and confidence in diagnosis and management positively correlated with knowledge and perception scores. Further and enhanced educational and training strategies are needed for this life threatening emergency condition.

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