Demographic, medical, and financial statistics from the Jaffna Jaipur Centre for Disability Rehabilitation (JJCDR) database, 1987-2018: a prosthetics, orthotics, and mobility clinic in northern Sri Lanka

# Background When dealing in global health, it is crucial to have a comprehensive understanding of community demographics and needs. From 1983-2009, a 26-year ethnic civil conflict devastated Sri Lanka, disproportionately affecting people living in the north and creating a large amputee population. Here, we use routinely collected prosthetic and orthotic data to investigate the composition of the amputee community in northern Sri Lanka. # Methods The Jaffna Jaipur Centre for Disability Rehabilitation (JJCDR) was established in 1987 and has been the only centre consistently providing prosthetic, orthotic, and non-orthopaedic services in northern Sri Lanka spanning during and after the civil war. In 2004, with the help of the charity Motivation, they established an electronic patient database, which records and maintains information on the JJCDR’s patients. An anonymized copy of the JJCDR database was obtained in November 2018. Summative statistics and temporal trends in patient data were investigated. # Results 3,665 unique patients registered with the JJCDR from 1986-2018 (2,605 male, 1,060 female). Individuals ranged from 0-90 years old, with a mean/median age of 34.76/32 years old. Key findings include: (i) 93.0% patients with amputation site recorded were lower limb amputees, with 74.3% being transtibial amputees; (ii) The majority of patients with cause of amputation recorded had war-related amputations (61.2%); (iii) diabetes was the highest cause for non-war-related amputations (18.3%); (iv) war-related amputations have ceased, while diabetic amputations are on the rise; and (v) peak recorded financial costs due to prosthetic and orthotic (P&O) creation/maintenance occurred in 2013, 4 years after the war ended. # Conclusions These analyses provide crucial insight into the P&O population in northern Sri Lanka, including distribution and frequency for causes/sites of amputations, temporal patterns in causes of amputations, and costs to a P&O centre due to device creation and maintenance. This database and analysis provide invaluable insight into the P&O cohort in northern Sri Lanka, and a unique insight into the P&O needs of a post-conflict LMIC from the perspective of a P&O centre

The Long-Term Consequences of Early Life Exposure to Tsunami and Conflict on Adolescents in Sri Lanka

The consequences for adolescent health due to early life exposure to natural disasters combined with war are not known. We collected data from adolescents aged 12-13 years in Sri Lanka whose mothers were pregnant during the Indian Ocean tsunami in 2004 in a tsunami-affected region (n = 22), conflict-affected region (n = 35), conflict-plus-tsunami-affected region (n = 29), or controls in areas unaffected by either (n = 24). Adjusted BMI-for-age z-scores were 1.3 (95% confidence interval [CI] 0.4, 2.2), 1.0 (95% CI 0.2, 1.9), and 2.0 (95% CI 1.1, 2.9) for conflict, tsunami, and conflict-plus-tsunami, respectively, compared with the control group. Greater skinfold thickness and higher diastolic blood pressure were found in adolescents born in the conflict zone but no differences were found in height, head circumference, and waist circumference, or blood results, with the exception of serum insulin. Being born after a natural disaster or during conflict was associated with increased adolescent BMI and body fat, which are associated with longer-term risk of noncommunicable disease

Characteristics of the initial dengue outbreaks in a region without dengue prior to mid-2009 in a dengue-endemic country

Introduction: The present study evaluated the characteristics of the initial dengue outbreaks in the Jaffna peninsula, a region without dengue prior to mid-2009 in dengue-endemic Sri Lanka, a tropical island nation. Methodology: This is a cross-sectional study conducted using a total of 765 dengue patients’ clinical data and samples collected from the Teaching Hospital, Jaffna during the initial dengue outbreaks. Clinical, non-specific, and specific virological laboratory characteristics including the platelet count, NS1 antigen, and anti-DENV IgM/IgG were evaluated as correlates of dengue virus (DENV) infection in the two initial outbreaks of 2009/2010 and 2011/2012 in Northern Sri Lanka. Results: Firstly, affected age and clinical characteristics were significantly different between the outbreaks (p p Conclusions: Clinical and non-specific laboratory characteristics and the infecting DENV serotypes between the two initial outbreaks in Northern Sri Lanka were significantly different. NS1 antigen, anti-DENV IgM/IgG, and platelet counts were identified 90% of the dengue patients. Hepatomegaly and platelet count o

Administration of oral dosage forms of medicines to children in a resource limited setting.

BackgroundThere are many paediatric specific challenges such as lack of age-appropriate dosage forms, inability of young children to swallow tablets and capsules and poor acceptability, during administration of oral dosage forms of medications to children. Parents adopt various methods which they consider best to circumvent this problem. The objective of this study was to describe the administration practice by parents when giving oral dosage forms of medications to children.MethodsA descriptive cross-sectional study was conducted to assess the administration practice of 1800 oral dosage forms of medications administered to children under the age of 12 years using validated indicators. A pre-tested interviewer-administered questionnaire given to parents or caregivers was used to collect the necessary data. The data were analysed using descriptive statistics.ResultsData from 1800 oral dosage forms was obtained from 663 children. Of the 1287 solid dosage forms, almost one-third were manipulated by parents at the time of giving the medications to children. They were crushed and dissolved in water given to children. In about 17% of instances safety of water was questionable. In 92% of instances, measuring device was found to be inappropriate.ConclusionAdministration of oral dosage forms of medications to children is far from ideal and hinders successful use of medications in children

The long-term consequences of early life exposure to tsunami and conflict on adolescents in Sri Lanka

The consequences for adolescent health due to early life exposure to natural disasters combined with war are not known. We collected data from adolescents aged 12-13 years in Sri Lanka whose mothers were pregnant during the Indian Ocean tsunami in 2004 in a tsunami-affected region (n = 22), conflict-affected region (n = 35), conflict-plus-tsunami-affected region (n = 29), or controls in areas unaffected by either (n = 24). Adjusted BMI-for-age z-scores were 1.3 (95% confidence interval [CI] 0.4, 2.2), 1.0 (95% CI 0.2, 1.9), and 2.0 (95% CI 1.1, 2.9) for conflict, tsunami, and conflict-plus-tsunami, respectively, compared with the control group. Greater skinfold thickness and higher diastolic blood pressure were found in adolescents born in the conflict zone but no differences were found in height, head circumference, and waist circumference, or blood results, with the exception of serum insulin. Being born after a natural disaster or during conflict was associated with increased adolescent BMI and body fat, which are associated with longer-term risk of noncommunicable disease