Interventions for increasing chlamydia screening in primary care: a review

<p>Abstract</p> <p>Background</p> <p>Despite guidelines recommending opportunistic chlamydia screening of younger women, screening rates in some countries remain low. Our aim was to review the evidence for specific interventions aimed at increasing chlamydia screening rates in primary care.</p> <p>Methods</p> <p>A Medline search was conducted for controlled trials that assessed the effectiveness of interventions aimed at improving chlamydia screening rates in primary health care settings. The Medline search was done for studies in English published prior to December 2005 using the following key words: chlamydia, screening, intervention, primary care and GPs. In addition, the references cited in the articles were reviewed. Studies in English published prior to December 2005 were reviewed.</p> <p>Results</p> <p>Four controlled studies met the inclusion criteria – 3 were randomized studies and one was not. Strategies to increase screening rates included the use of educational packages targeting primary care physicians and the correction of barriers to screening within clinic systems. In 3 studies, the intervention was associated with an increase in screening rates of between 100% and 276% (p < 0.04). In the fourth study, the intervention was associated with a significant attenuation in declining screening rates over time (4% versus 34% decline, p = 0.04).</p> <p>Conclusion</p> <p>There are only a limited number of randomized or controlled studies that demonstrate improved chlamydia screening of younger women in primary care.</p

Prevalence and risk factors for impaired kidney function in the district of Anuradhapura, Sri Lanka: a cross-sectional population-representative survey in those at risk of chronic kidney disease of unknown aetiology.

BACKGROUND: Over the last 20 years there have been reports of a form of chronic kidney disease of unknown cause (CKDu) affecting rural communities in the North Central Province of Sri Lanka. Valid prevalence estimates, using a standardised methodology, are needed to assess the burden of disease, assess secular trends, and perform international comparisons. METHODS: We conducted a cross-sectional representative population survey in five study areas with different expected prevalences of CKDu. We used a proxy definition of CKDu involving a single measure of impaired kidney function (eGFR< 60 mL/min/1.7m2, using the CKD-Epi formula) in the absence of hypertension, diabetes or heavy proteinuria. RESULTS: A total of 4803 participants (88.7%) took part in the study and 202 (6.0%; 95% CI 5.2-6.8) had a low eGFR in the absence of hypertension, diabetes and heavy proteinuria and hence met the criteria for proxy CKDu. The proportion of males (11.2%; 95% CI 9.2-13.1) were triple than the females (3.7%; 95% CI 2.9-4.5). Advancing age and history of CKD among parents or siblings were risk factors for low GFR among both males and females while smoking was found to be a risk factor among males. CONCLUSIONS: These data, collected using a standardised methodology demonstrate a high prevalence of impaired kidney function, not due to known causes of kidney disease, in the selected study areas of the Anuradhapura district of Sri Lanka. The aetiology of CKDu in Sri Lanka remains unclear and there is a need for longitudinal studies to describe the natural history and to better characterise risk factors for the decline in kidney function

Health situation and challenges in Sri Lanka

Sri Lanka, an island in the Indian Ocean, is 65 610km2 with a population of 21 million (population density 315/km2). It is a low-middle income country with GDP per capita of USD 4 310. However, due to policies of free education and health, it is ranked 73 (among 188 nations) in the human development index. Sri Lankans have a life expectancy of 76 years and literacy of 92%. Infant mortality is 7.45 deaths/ 1 000 live births and maternal mortality is 30 deaths/100 000 live births, with all deliveries taking place in hospitals. Sri Lanka faces major health challenges in a rapidly ageing population and increasing burden of non-communicable diseases. Cardiovascular disease is the leading cause of death followed by cancer. A third of males smoke and abuse alcohol. Substance abuse is increasing. Snake bite still causes morbidity and mortality. Road accidents have become an important cause of premature deaths. Sri Lanka is at risk for tropical infections which it has been battling in public health campaigns. Some of these have been very successful, with leprosy eliminated as a public health problem in the 1990’s and malaria and lymphatic filariasis in 2016. Rabies will be eliminated as a public health problem in 2020. Tuberculosis remains a challenge with 9 000 new cases annually. However, MDRTB is uncommon. Immunisation coverage is 100% and maternal/neonatal tetanus was eliminated in 2015. Measles, rubella and congenital rubella syndrome are due for elimination in 2020. Sri Lanka has an extremely low prevalence of HIV (<0.1%) and Hepatitis B and C (<2%). Sanitation coverage is 92% and access to safe drinking water 94%. Hepatitis A and enteric fever rates are low. Cholera was last reported in 2003. However, unplanned urbanization has fueled a dengue epidemic. Leptospirosis is increasing in the rice farming areas. Melioidosis has recently been established as endemic in Sri Lanka. Other emerging infections include amoebic liver disease in the North and rickettsial disease and cutaneous leishmaniasis in rural areas. Sri Lanka faces a grave threat in the emergence of antimicrobial resistance. Urgent measures are needed to foster antibiotic stewardship as well as prevent and control infectious diseases

Cultural Adaptation, Translation and Validation of Tuberculosis Specific Health Related Quality of Life Measuring Functional Assessment of Chronic Illness Therapy Tuberculosis (FACIT-TB) Scale in Sri Lanka

The aim of the present study was to culturally adapt, translate and validate the functional assessment of chronic illness therapy tuberculosis (FACIT-TB) scale with a view to assess health related quality of life among pulmonary tuberculosis patients in Sri Lanka. The cultural adaptation was performed by Delphi method. The translation into Sinhala (the local Sri Lankan dialect) was carried out through forward–backward translation method by five translators. A multidisciplinary team of experts assessed the Sinhala FACIT-TB scale for its content validity. The construct validity, the reliability and the acceptability of the scale were determined by conducting a validation study among 225 pulmonary tuberculosis patients. The confirmatory factor analysis technique was used to assess the construct validity. The reliability was assessed through internal consistency by Cronbach’s alpha and test re- test reliability by intraclass correlation coefficient after one week of assessment. The FACIT-TB showed adequate content validity. The confirmatory factor analysis yielded high fit indices with the original five factor model of FACIT-TB: Root Mean Square Error of Approximation (RMSEA) =0.05, Standardized Root Mean Square Residual (SRMSR) =0.07, Comparative Fit Index (CFI) =0.94 and Non –Normal Fit Index (NNFI) =0.94. Reliability showed high internal consistency with Cronbach’s alpha values exceeding the Nunnally’s criteria of 0.7 and all factors of the scale showed high test-retest reliability with intra-class correlation coefficient exceeding 0.7. Overall the FACIT-TB Sinhala version showed adequate validity to assess health related quality of life among pulmonary tuberculosis patients in Sri Lanka.</p

EQ-5D-3L-Derived Health-Related Quality of Life Among Tuberculosis Patients in Sri Lanka

Tuberculosis is a public health problem globally and as well in Sri Lanka. By calling for the health-related quality of life assessments, attention is focused on the problems experienced by the patients. The objective of this study was to assess how tuberculosis patients have reported health-related quality of life in Sri Lanka. This cross-sectional study enrolled 552 new pulmonary tuberculosis patients. Each participant completed the EQ-5D-3L in a face-to-face interview at the initiation, at the end of 2 months and at 6 months of medication completion. Data derived from EQ-5D-3L reported problems at three levels in each dimension and the EQ-Visual Analogue Scale (EQ-VAS) described the quality of life as a single index score. Utility values were calculated using the Sri Lankan EQ-5D-3L value set and quality-adjusted life years (QALYs) were calculated by multiplying the medication period with the utility value difference between the initiation of medication and the medication completion at 6 months. Problems related to all dimensions of health-related quality of life were decreased during the medication. The mean EQ-VAS score at initiation was 59.64 (SD = 21.6) and increased up to 78.0 (SD = 16.1) and 83.4 (SD = 16.5) at end of 2 months and at end of 6 months, respectively, which was significant at each phase of medication (Wilks’ Lambda = 0.55, F = 187.33, P < 0.001). The mean QALYs gained during the medication was 0.05 (SD = 0.07). Health-related quality of life improved significantly among tuberculosis patients with medication

Spatiotemporal distribution of cutaneous leishmaniasis in Sri Lanka and future case burden estimates

BackgroundLeishmaniasis is a neglected tropical vector-borne disease, which is on the rise in Sri Lanka. Spatiotemporal and risk factor analyses are useful for understanding transmission dynamics, spatial clustering and predicting future disease distribution and trends to facilitate effective infection control.MethodsThe nationwide clinically confirmed cutaneous leishmaniasis and climatic data were collected from 2001 to 2019. Hierarchical clustering and spatiotemporal cross-correlation analysis were used to measure the region-wide and local (between neighboring districts) synchrony of transmission. A mixed spatiotemporal regression-autoregression model was built to study the effects of climatic, neighboring-district dispersal, and infection carryover variables on leishmaniasis dynamics and spatial distribution. Same model without climatic variables was used to predict the future distribution and trends of leishmaniasis cases in Sri Lanka.ResultsA total of 19,361 clinically confirmed leishmaniasis cases have been reported in Sri Lanka from 2001-2019. There were three phases identified: low-transmission phase (2001-2010), parasite population buildup phase (2011-2017), and outbreak phase (2018-2019). Spatially, the districts were divided into three groups based on similarity in temporal dynamics. The global mean correlation among district incidence dynamics was 0.30 (95% CI 0.25-0.35), and the localized mean correlation between neighboring districts was 0.58 (95% CI 0.42-0.73). Risk analysis for the seven districts with the highest incidence rates indicated that precipitation, neighboring-district effect, and infection carryover effect exhibited significant correlation with district-level incidence dynamics. Model-predicted incidence dynamics and case distribution matched well with observed results, except for the outbreak in 2018. The model-predicted 2020 case number is about 5,400 cases, with intensified transmission and expansion of high-transmission area. The predicted case number will be 9115 in 2022 and 19212 in 2025.ConclusionsThe drastic upsurge in leishmaniasis cases in Sri Lanka in the last few year was unprecedented and it was strongly linked to precipitation, high burden of localized infections and inter-district dispersal. Targeted interventions are urgently needed to arrest an uncontrollable disease spread

Spatiotemporal distribution of cutaneous leishmaniasis in Sri Lanka and future case burden estimates.

BackgroundLeishmaniasis is a neglected tropical vector-borne disease, which is on the rise in Sri Lanka. Spatiotemporal and risk factor analyses are useful for understanding transmission dynamics, spatial clustering and predicting future disease distribution and trends to facilitate effective infection control.MethodsThe nationwide clinically confirmed cutaneous leishmaniasis and climatic data were collected from 2001 to 2019. Hierarchical clustering and spatiotemporal cross-correlation analysis were used to measure the region-wide and local (between neighboring districts) synchrony of transmission. A mixed spatiotemporal regression-autoregression model was built to study the effects of climatic, neighboring-district dispersal, and infection carryover variables on leishmaniasis dynamics and spatial distribution. Same model without climatic variables was used to predict the future distribution and trends of leishmaniasis cases in Sri Lanka.ResultsA total of 19,361 clinically confirmed leishmaniasis cases have been reported in Sri Lanka from 2001-2019. There were three phases identified: low-transmission phase (2001-2010), parasite population buildup phase (2011-2017), and outbreak phase (2018-2019). Spatially, the districts were divided into three groups based on similarity in temporal dynamics. The global mean correlation among district incidence dynamics was 0.30 (95% CI 0.25-0.35), and the localized mean correlation between neighboring districts was 0.58 (95% CI 0.42-0.73). Risk analysis for the seven districts with the highest incidence rates indicated that precipitation, neighboring-district effect, and infection carryover effect exhibited significant correlation with district-level incidence dynamics. Model-predicted incidence dynamics and case distribution matched well with observed results, except for the outbreak in 2018. The model-predicted 2020 case number is about 5,400 cases, with intensified transmission and expansion of high-transmission area. The predicted case number will be 9115 in 2022 and 19212 in 2025.ConclusionsThe drastic upsurge in leishmaniasis cases in Sri Lanka in the last few year was unprecedented and it was strongly linked to precipitation, high burden of localized infections and inter-district dispersal. Targeted interventions are urgently needed to arrest an uncontrollable disease spread