Ethnolinguistic concordance and the receipt of postpartum IUD counseling services in Sri Lanka.

CONTEXT: Ethnic and linguistic concordance are important dimensions of the patient-physician relationship, and are linked to health care disparities. However, evidence on the associations between health behavior and outcomes and patient-provider concordance is limited, especially in low- and middle-income settings. METHODS: To examine how concordance between women and their primary health midwife is associated with women's receipt of postpartum IUD counseling, observational data from a cluster-randomized trial assessing an intervention to increase postpartum IUD counseling were used. Data on 4,497 women who delivered at six hospitals in Sri Lanka between September 2015 and March 2017 were merged with data on 245 primary health midwives, and indicators of linguistic concordance, ethnic concordance and their interaction were generated. Multivariate logistic regression analyses were used to assess the associations between concordance and women's receipt of counseling. RESULTS: Women from non-Sinhalese groups in Sri Lanka face disparities in the receipt of postpartum IUD counseling. Compared with the ethnolinguistic majority (Sinhalese women who speak only Sinhala), non-Sinhalese women have lower odds of having received postpartum IUD counseling, whether they speak both Sinhala and Tamil (odds ratio, 0.6) or only Tamil (0.5). Ethnic discordance- rather than linguistic discordance-is the primary driver of this disparity. CONCLUSIONS: The findings highlight the need for interventions that aim to bridge the sociocultural gaps between providers and patients. Matching women and their providers on ethnolinguistic background may help to reduce disparities in care.Accepted manuscrip

The effect of a postpartum IUD intervention on counseling and choice: Evidence from a cluster-randomized stepped-wedge trial in Sri Lanka

BACKGROUND: The International Federation of Gynaecology and Obstetrics (FIGO), in collaboration with the Sri Lankan College of Obstetrics and Gynaecologists (SLCOG), launched an initiative in 2014 to institutionalize immediate postpartum IUD (PPIUD) services as a routine part of antenatal counseling and delivery room services in Sri Lanka. In this study, we evaluate the effect of the FIGO-SLCOG PPIUD intervention in six hospitals by means of a cluster-randomized stepped-wedge trial. METHODS/DESIGN: Six hospitals were randomized into two groups of three using matched pairs. Following a 3-month baseline period, the intervention was administered to the first group, while the second group received the intervention after 9 months of baseline data collection. We collected data from 39,084 women who delivered in these hospitals between September 2015 and January 2017. We conduct an intent-to-treat (ITT) analysis to determine the impact of the intervention on PPIUD counseling and choice of PPIUD, as measured by consent to receive a PPIUD, as well as PPIUD uptake (insertion following delivery). We also investigate how factors related to counseling, such as counseling timing and quality, are linked to choice of PPIUD. RESULTS: We find that the intervention increased rates of counseling, from an average counseling rate of 12% in all hospitals prior to the intervention to an average rate of 51% in all hospitals after the rollout of the intervention (0.307; 95% CI 0.148-0.465). In contrast, we find the impact of the intervention on choice of PPIUD to be less robust and mixed, with 4.1% of women choosing PPIUD prior to the intervention compared to 9.8% of women choosing PPIUD after the rollout of the intervention (0.027; 95% CI 0.000-0.054). CONCLUSIONS: This study demonstrates that incorporating PPIUD services into postpartum care is feasible and potentially effective. Taking the evidence on both counseling and choice of PPIUD together, we find that the intervention had a generally positive impact on receipt of PPIUD counseling and, to a lesser degree, on choice of the PPIUD. Nevertheless, it is clear that the intervention's effectiveness can be improved to be able to meet the demand for postpartum family planning of women. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02718222 . Registered on 11 March 2016 (retrospectively registered).Published version and Accepted manuscript versions

A study of long-term complications associated with enteral ostomy and their contributory factors

BACKGROUND: Complications of ostomy significantly affect the quality of life of ostomates. There is little evidence on the rate of long-term complications in ostomates, especially from the developing countries which include Sri Lanka. This study was aimed to describe the long-term complications of enteral ostomies and their contributory factors. METHODS: A retrospective analysis was carried out on 192 patients who underwent ostomy creation over a period of 5 years. Data on type of complications, age, sex, type of ostomy, type of surgery and perioperative care by enteric stoma therapist were gathered. Associations were established using Chi square test and multiple logistic regression. RESULTS: Out of 192 patients, only 146 patients presented regularly for follow up. The mean follow up duration was 28 months (range: 3–183). Around 34.2% developed surgical long-term complications related to the ostomy. Common complications were prolapse (n = 24, 16.4%), skin excoriation (n = 22, 15.1%) and parastomal hernia (n = 14, 9.6%). Overall complication rate was significantly less in loop ostomies (p < 0.05) and defunctioning ostomies (p < 0.05). Skin excoriation was significantly high in males (p < 0.05) and in ileostomies (p < 0.001). Parastomal hernia was commoner in end ostomies (p < 0.05). Perioperative care by enteric stoma therapist reduced the overall and specific complications (p < 0.001). CONCLUSION: The overall complication rate in our cohort of patients was 34.2%. The perioperative care of a stoma therapist may be very effective in preventing complications particularly in a setting with limited resources. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13104-016-2304-z) contains supplementary material, which is available to authorized users

Management and birth outcomes of pregnant women with Chiari malformations : a 14 years retrospective case series

Objective The management of Chiari malformations in pregnancy is challenging due to the perceived risk of adverse maternal neurological outcomes and raising intracranial pressure during labour. Our aim was to evaluate the management and health outcomes of pregnant women cared for at a regional referral center and highlight elements of best practice. Study Design A retrospective case series of all pregnant women diagnosed with Chiari malformation over fourteen years (January 2004- June 2018) at the Birmingham Women’s Hospital – UK. Results Twenty-one women (23 pregnancies) with Chiari malformation were included, four had syringomyelia (4/21,19%) and six had previously undergone craniovertebral decompression (6/21, 29%). The median age was 34-years (range 20-41), the median gravidity was two (range 1-8), the median parity was one (range 0-6), and the median extent of tonsillar herniation was 11 mm (range 9-18). The majority of women received their preferred mode of delivery (15 normal vaginal deliveries (15/23, 65.2%) and 6 elective Caesarean sections (6/23, 26.1%)) with two pregnancies ending with an emergency caesarean section for obstetric complications (2/23, 8.7%). Five Caesarean section were performed under general anaesthetic, two under spinal (2/23, 8.7%) and one under epidural anaesthesia (1/23, 4.3%) with no neurological sequelae. There were no adverse neurological outcomes at discharge postnatally. Conclusions Offering normal vaginal delivery with effective analgesia, for women with Chiari malformation, appears to be safe. Pregnancy care should be provided by a multi-disciplinary team with experience in managing Chiari malformation

A comprehensive assessment of lymphatic filariasis in Sri Lanka six years after cessation of mass drug administration

The Sri Lankan Anti-Filariasis Campaign conducted 5 rounds of mass drug administration (MDA) with diethycarbamazine plus albendazole between 2002 and 2006. We now report results of a comprehensive surveillance program that assessed the lymphatic filariasis (LF) situation in Sri Lanka 6 years after cessation of MDA.Transmission assessment surveys (TAS) were performed per WHO guidelines in primary school children in 11 evaluation units (EUs) in all 8 formerly endemic districts. All EUs easily satisfied WHO criteria for stopping MDA. Comprehensive surveillance was performed in 19 Public Health Inspector (PHI) areas (subdistrict health administrative units). The surveillance package included cross-sectional community surveys for microfilaremia (Mf) and circulating filarial antigenemia (CFA), school surveys for CFA and anti-filarial antibodies, and collection of Culex mosquitoes with gravid traps for detection of filarial DNA (molecular xenomonitoring, MX). Provisional target rates for interruption of LF transmission were community CFA <2%, antibody in school children <2%, and filarial DNA in mosquitoes <0.25%. Community Mf and CFA prevalence rates ranged from 0-0.9% and 0-3.4%, respectively. Infection rates were significantly higher in males and lower in people who denied prior treatment. Antibody rates in school children exceeded 2% in 10 study sites; the area that had the highest community and school CFA rates also had the highest school antibody rate (6.9%). Filarial DNA rates in mosquitoes exceeded 0.25% in 10 PHI areas.Comprehensive surveillance is feasible for some national filariasis elimination programs. Low-level persistence of LF was present in all study sites; several sites failed to meet provisional endpoint criteria for LF elimination, and follow-up testing will be needed in these areas. TAS was not sensitive for detecting low-level persistence of filariasis in Sri Lanka. We recommend use of antibody and MX testing as tools to complement TAS for post-MDA surveillance

Acute care Nurses' competence on pain Management of adult Burn patients : A Descriptive Literature Review

It is estimated that major burns remain a major global health problem with millions of affected individuals and high mortality, morbidity and disability particularly in the developing world. Consequently, it is with such injuries that their after-effects present continuous difficulties for the healthcare teams. Nurses have a vital responsibility in the management of burn patients primarily in terms of the severe pain that is often encountered in burns. Effective pain management is crucial to enhance a patient's well-being, however, there are evident shades in that regard at present. Nurses require essential knowledge and competencies regarding pain management to ensure the best care to patients. However, standards for competency of the burn care nurses have not been developed. In this qualitative study, the aim is to produce new knowledge that can be utilized in addressing acute care nurses’ challenges regarding pain management of adult burn patients. In this research study, the researcher wants to generate knowledge that can enhance the level of competence of acute care nurses in managing pain for adult burn patients. A qualitative descriptive literature review was executed following the PICo framework to find applicable articles. The inclusion criteria focused on the qualitative and quantitative peer reviewed research articles released from the period of 2018 to 2024, which resulted in the final sample of 10 articles and through inductive content analysis method, the articles were analysed as follows. Both CINAHL and PUBMED data bases as well as a manual search were used to retrieve data. This study examines the challenges in acute burn pain management, focusing on nursing workload, patient care, communication, and pain assessment. Increased nurse responsibilities, non-standardized patient communication, and inconsistent use of pain management tools contribute to stress and emotional strain among nurses. Frequent, painful procedures like dressing changes heighten patient anxiety, adding to nurses' emotional burden. Key strategies identified include implementing structured protocols, such as the Pathways to Pain Management (PPM), which standardize care and enhance patient engagement. Non pharmacological interventions like virtual reality, music therapy, and guided imagery reduce pain and anxiety. Enhanced practitioner competence and sensitive communication, using objective language and closed questions, support effective pain management. Together, these approaches create a more supportive environment, benefiting both patients and nurses in burn care. In conclusion, effective burn pain management requires a multifaceted approach, combining structured protocols, empathetic communication, and complementary pain relief methods. Implementing standardized practices like the PPM protocol and non-pharmacological tools can alleviate nurse stress, enhance patient comfort, and improve care outcomes, ultimately fostering a supportive and responsive burn care environment

Programmatic use of molecular xenomonitoring at the level of evaluation units to assess persistence of lymphatic filariasis in Sri Lanka

BACKGROUND:Sri Lanka's Anti Filariasis Campaign distributed 5 rounds of mass drug administration (MDA with DEC plus albendazole) to all endemic regions in the country from 2002-2006. Post-MDA surveillance results have generally been encouraging. However, recent studies have documented low level persistence of Wuchereria bancrofti in Galle district based on comprehensive surveys that include molecular xenomonitoring (MX, detection of filarial DNA in mosquitoes) results. The purposes of this study were to demonstrate the use of MX in large evaluation units (EUs) and to field test different mosquito sampling schemes. METHODOLOGY/PRINCIPAL FINDINGS:Galle district (population 1.1 million) was divided into two EUs. These included a coastal EU with known persistent LF and an inland EU with little persistent LF. Mosquitoes were systematically sampled from ~300 trap locations in 30 randomly selected clusters (health administrative units) per EU. Approximately 28,000 Culex quinquefasciatus were collected with gravid traps and tested for filarial DNA by qPCR. 92/625 pools (14.7%) from the coastal EU and 8/583 pools (1.4%) from the inland EU were positive for filarial DNA. Maximum likelihood estimates (MLE) for filarial DNA rates were essentially the same when the same number of mosquito pools were collected and tested from 75, 150, or 300 trap sites (range 0.61-0.78% for the coastal EU and 0.04-0.07% for the inland EU). The ability to use a smaller number of trap sites reduces the cost and time required for mosquito sampling. CONCLUSIONS/SIGNIFICANCE:These results suggest there is widespread persistence of W. bancrofti infection in the coastal Galle EU 8 years after the last round of MDA in 2006, and this is consistent with other data from the district. This study has shown that MX can be used by national programs to assess and map the persistence of W. bancrofti at the level of large EUs in areas with Culex transmission

Insecticidal Natural Products From Sri Lankan Plants

This thesis describes investigations of the insecticidal compounds of three Sri Lankan plants, Pleurostylia opposita (Wall) Alston (Celastraceae), Aegle marmelos Correa (Rutaceae) and Excoecaria agallocha Linn. (Euphorbiaceae). After establishing the insecticidal activity of the extracts of three plants, separation of compounds was achieved by bio-assay directed chromatography, and the compounds were characterised by NMR especially 2D experiments, mass, UV and IR spectroscopy. Three new macrocyclic sesquiterpene polyol ester alkaloids 1, 2 and 3 containing a novel 6,7 ring skeleton have been identified from the petroleum ether-ethyl acetate extract of the stem bark of Pleurstylia opposita. They are homologues of known macrocyclic sesquiterpene alkaloids which contains a 6,6 ring system based on the ß-dihydroagarofuran core. The extra methylene has been shown by NMR to be in the 8 position of the 6,7 ring. Observation of insecticidal activity in the Pleurostylia genus is novel. The previously reported 20-hydroxylupane-3- one has also been identified from the active extract and shown to be noninsecticidal. Two new insecticidal compounds 6 and 7 have been identified from the petroleum ether-ethyl acetate extract of the stem bark of Aegle marmelos. They are shown to be protolimonoids, and are senecioate ester analogues of the known isovalerate esters of C-21-ß and C-21-α glabretal which were also isolated. Compounds 8 and 9 were also found to be insecticidal against mustard beetles and houseflies. Separation and characterisation of epimeric mixtures were first achieved for the di p-nitrobenzoate derivative. Previously recorded epoxyaurapten, marmesin, marmin and lupeol have been isolated from the active extract of Aegle marmelos and shown to be noninsecticidal. Five compounds 24-28 have been isolated from the ethyl acetate extract of the stem bark of Excoecaria agallocha. They all have the previously reported daphnane diterpenoid orthoester skeleton, and differ only in the orthoester alkyl side chain. Two of them 24 and 27 are novel. Insecticidal activity has not been recorded previously for extracts of Excoecaria species, nor for the daphnane orthoesters