Prevalence and determinants of self-reported ocular morbidity and utilization of eye services in Sri Lanka: results from a national population-based survey

Introduction Data on ocular morbidity is essential for planning primary and referral eye care services. Objectives Determine the prevalence and causes of self-reported ocular morbidity and eye care service utilization in Sri Lanka among adults ≥ 40 years of age. Methods Multistage, stratified, cluster random sampling was used to select a nationally representative sample aged ≥40 years. All participants were administered a questionnaire to assess ocular morbidity they had experienced in the previous month and the pattern of service utilization for reported eye problems. The interviews were conducted by a team of trained investigators at the clinical examination site before they underwent an eye examination. Results 5779 of those presenting for a clinical examination were interviewed among 6713 enumerated (86.1%). The prevalence of self-reported ocular morbidity was 89.9% [95% Confidence Interval (CI): 89.0–90.6%]. Near vision impairment was the commonest problem reported (72.1%; 95% CI: 70.8–73.3%) followed by distance vision impairment (36.2%; 95% CI: 34.9-37.5%). Among those reporting an eye problem, 31.4% sought treatment. 49.4% of those seeking care utilized private facilities. Financial constraints, perceptions that the condition was not serious or had insufficient impact on day-to-day tasks were the most important reasons for not accessing care. Conclusions Ocular morbidities are common in the Sri Lanka population; however utilization of services is relatively low, particularly for asymptomatic illnesses. It is important that the service planners take into account geographical and social inequalities and focus the services on underserviced areas and disadvantaged social groups

Prevalence and visual outcomes of cataract surgery and cataract surgical coverage in Sri Lanka: findings from the National Blindness and Visual Impairment Survey

Introduction Cataract surgical coverage and visual acuity outcomes are important population level indicators for monitoring access to and the quality of cataract surgery, allowing subgroups with poorer access to be identified. Data on these indicators are not available for Sri Lanka at national level. Objectives Determine cataract surgical coverage and the outcomes of cataract surgery in a nationally representative sample of adults aged ≥40 years. Methods Cluster random sampling with proportionate to size procedures was used. All participants were interviewed to obtain data on education level, movable assets, and the year and place of cataract surgery, if applicable. Presenting and best corrected visual acuities were measured. All participants underwent slit lamp examination, including a dilated examination of the fundus. Cataract surgical coverage was calculated at the person level vision of <3/30, <6/60 and <6/18. Outcomes of cataract surgery were categorized as good (6/18 or better), borderline (<6/18-6/60) or poor (<6/60). Results A total of 345 persons among the 5,779 participants who were examined had undergone cataract surgery in one or both eyes (486 eyes). Cataract surgical coverage, which was high overall 85.4% for vision <3/60; 79.1% for vision <6/60), was significantly higher in younger age groups (Odds Ratio [OR] 5.65, 95% confidence interval [CI] 1.42-22.52), those in urban areas (OR 2.8, 95% CI 1.01-7.74) those with higher socio-economic status (OR 6.0; 95% CI 1.96-18.4). Coverage ranged from 60% in Uva Province to 100% in Southern Province. 59.7% of eyes had good outcomes at presentation increasing to 75.1% with correction. Conclusions Cataract surgery indicators for Sri Lanka are good, being better than most other Asian countries. Services should target those living in underserved Provinces

Prevalence, causes, magnitude and risk factors of visual impairment and blindness in Sri Lanka

Introduction There is paucity of data on the epidemiology of visual impairment in Sri Lanka. Objectives Estimate the prevalence and determine causes and risk factors of visual impairment among adults aged ≥40 years in Sri Lanka. Methods Multistage, stratified, cluster random sampling was used to select a nationally representative sample aged ≥40 years. All participants underwent vision testing, autorefraction and a basic eye examination. Participants with a presenting acuity of <6/12 in either eye underwent detailed eye examination, assessment of best-corrected acuity if required, and a cause of visual loss assigned. Results 5,779 of those enumerated (6,713) were examined (response rate 86.1%). The prevalence of blindness was 1.7% (95% confidence interval [CI]: 1.3-1.99%) and low vision was 17% (95% CI: 16.0-18.0%). Cataract (66.7%) and uncorrected refractive errors (12.5%) were the commonest causes of blindness. Uncorrected refractive errors (62.4%) and cataract (24.2%) were the commonest causes of low vision. Blindness was significantly higher in older age groups (OR 132.4: 95% Cl 11.7-149.3), those residing in the North Central (OR-12.5), North (OR-12.0), North West (OR-7.3), Eastern (OR-6.7), Western (OR-5.3) and Uva provinces (OR-5.3) compared to the Southern, and in those educated up to and including secondary school (OR 2.3: 95% CI 1.5- 3.17). Gender and socio-economic status were not significant after adjusting. Conclusions The prevalence of blindness in Sri Lanka is lower than in other South Asian countries and most causes are avoidable. Access to eye care needs to improve amongst the aged, those less educated and those in provinces with higher blindness risk

Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action

Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or “golden rules,” for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice

Colombo South Teaching Hospital, Kalubowila. Corresponding author:

A fourteen year old girl presented to us with persistent left hypochondrial and left loin pain for several months, associated with loss of weight and dyspeptic symptoms. Physical examination did no

Ten golden rules for optimal antibiotic use in hospital settings : the WARNING call to action

Abstract: Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or "golden rules," for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice