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

A malaria death due to an imported Plasmodium falciparum infection in Sri Lanka during the prevention of re-establishment phase of malaria

Abstract Background Sri Lanka has maintained a rigorous programme to prevent the re-establishment of malaria ever since the disease was eliminated in October 2012. It includes efforts to sustain case surveillance to ensure early diagnosis and management of malaria. Yet, in April of 2023 the death occurred of an individual with imported malaria. Case presentation The deceased was a 37-year-old Sri Lankan male who returned to Sri Lanka on the 10th of April after a business trip to several countries including Tanzania. He was febrile on arrival and consulted three Allopathic Medical Practitioners in succession in his home town in the Western Province of Sri Lanka, over a period of 5 days starting from the very day that he arrived in the country. Malaria was not tested for at any of these consultations and his clinical condition deteriorated. On the evening of 14th of April he was admitted to the medical intensive care unit of a major private hospital in the capital city of Colombo with multiple organ failure. There, on a request by the treating physician blood was tested for malaria and reported early the next morning as Plasmodium falciparum malaria with a high parasitaemia (> 10%). The patient died shortly after on the 15th of April before any anti-malarial medication was administered. The deceased had been a frequent business traveller to Africa, but with no past history of malaria. He had not taken chemoprophylaxis for malaria on this or previous travels to Africa. Discussion The patient’s P. falciparum infection progressed rapidly over 5 days of arriving in Sri Lanka leading to severe malaria without being diagnosed, despite him seeking healthcare from three different Medical Practitioners. Finally, a diagnosis of malaria was made on admission to an intensive care unit; the patient died before anti-malarial medicines were administered. Conclusions This first death due to severe P. falciparum malaria reported in Sri Lanka after elimination of the disease was due to the delay in diagnosing malaria