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Whiddena C.E.,University of Oxford | Premaratneb R.G.,Anti Malaria Campaign | Jayanettic S.R.,Office of the Regional Director of Health Services | Fernandod S.D.,University of Sfax
Transactions of the Royal Society of Tropical Medicine and Hygiene | Year: 2015

Background: Long-lasting insecticidal nets (LLINs) have been widely distributed in Sri Lanka for malaria control. Their effectiveness depends on proper utilisation and maintenance at the household level. Methods: A cross-sectional study was performed to examine the patterns and predictive factors of LLIN maintenance and use in Anuradhapura district. Data was collected and analysed from 530 LLIN-owning households, selected by a multi-stage cluster sampling technique. Multivariable logistic regression identified factors associated with proper maintenance at the household level. Hierarchical linear modelling identified factors associated with LLIN use the previous night. Results: Almost 75% (377/504) of households had used all their LLINs the previous night, while 82.9% (418/504) had used at least one. Only 3.2% (15/474)were maintaining the LLIN in such away as to maximise its insecticidal efficacy. Six variables were significantly associated (p,0.05) with use the previous night: more residents, fewer plain nets, reporting practical benefits of LLINs, conical shape, newer nets and lack of side effects. Two variables were significantly associated with proper maintenance: increasing level of education and taking safety precautions while washing. Conclusions: Results suggest LLIN practices could improve in settings of low malaria transmission if distribution programmes took into account recipient preferences, promoted LLIN use over plain nets, and emphasised the techniques and significance of proper net maintenance. © The Author 2015.


Fernando S.D.,University of Colombo | Fernando S.D.,PVT Ltd TEDHA | Ihalamulla R.L.,PVT Ltd TEDHA | Wickremasinghe R.,PVT Ltd TEDHA | And 5 more authors.
Malaria Journal | Year: 2014

Background: Individuals with fever are screened for malaria in specially-established malaria diagnostic laboratories set up in rural hospitals in the Northern and Eastern Provinces of Sri Lanka. Large numbers of blood smears negative for malaria parasites are being screened daily. Good quality smears are essential to maintain a high diagnostic competency among the technical staff. The modifications made to the World Health Organization (WHO) standard operating procedures to improve the quality of smears have been studied. Methods. A blinded, controlled, interventional study was conducted in 22 intervention and 21 control malaria diagnostic laboratories. Changes were made to the WHO standard operating procedure protocols to prepare, stain and examine blood smears for malaria parasite detection which were implemented in intervention laboratories. These included wipe-cleaning slides, preparing both thick and thin smears on the same slide, reversing the order of collecting blood for thick and thin smears, dry fixing thick smear for 20-25 minutes under table lamp, polishing the edge of spreader slide with sand paper and fixing the thin smear with methanol if not stained within four hours. Parameters with respect to quality of the smear as per WHO criteria were studied using randomly selected slides, and time taken for the report to be issued was recorded in both groups before and after the intervention. Results: There were no significant differences observed in the parameters studied at baseline between the two groups or pre and post intervention in the control group. In the intervention group streak formation in thin smears was reduced from 29.4% to 5.0%. The average fixing time of thick smears was reduced from 2.4 hours to 20 minutes. Inappropriate thickness of thick smears reduced from 18.3% to 1.5%. Overall quality of thick smears and thin smears increased from 76.1% to 98.0% and 81.7% to 87.0%, respectively. The quality of slides bearing both thick and thin smears increased from 60.0% to 87.0%. Conclusions: New protocols with amendments to the WHO standard technical procedures ensure that good quality blood smears are prepared rapidly to diagnose malaria and the time required to issue the reports was reduced. © 2014 Fernando et al.; licensee BioMed Central Ltd.


Moonen B.,Clinton Health Access Initiative | Moonen B.,University of California at San Francisco | Cohen J.M.,Clinton Health Access Initiative | Snow R.W.,Kenya Medical Research Institute | And 10 more authors.
The Lancet | Year: 2010

Present elimination strategies are based on recommendations derived during the Global Malaria Eradication Program of the 1960s. However, many countries considering elimination nowadays have high intrinsic transmission potential and, without the support of a regional campaign, have to deal with the constant threat of imported cases of the disease, emphasising the need to revisit the strategies on which contemporary elimination programmes are based. To eliminate malaria, programmes need to concentrate on identification and elimination of foci of infections through both passive and active methods of case detection. This approach needs appropriate treatment of both clinical cases and asymptomatic infections, combined with targeted vector control. Draining of infectious pools entirely will not be sufficient since they could be replenished by imported malaria. Elimination will thus additionally need identification and treatment of incoming infections before they lead to transmission, or, more realistically, embarking on regional initiatives to dry up importation at its source. © 2010 Elsevier Ltd.


Fernando S.D.,University of Colombo | Ainan S.,University of Oxford | Premaratne R.G.,Anti Malaria Campaign | Rodrigo C.,University of Colombo | And 2 more authors.
International Health | Year: 2015

Introduction: Sri Lanka has eliminated local transmission of malaria. Assessing physician preparedness for early case detection is important, in order to prevent re-establishment of local transmission. Methods: Adherence to malaria screening practices in patients admitted with fever to 12 hospitals in a previously malaria endemic district was evaluated using a cross sectional survey. In addition, knowledge and attitudes among doctors on current malaria surveillance practices and treatment recommendations was assessed. Results: Of 403 fever patients, 150 warranted screening for malaria under the criteria defined by the Anti Malaria Campaign (AMC), with 93 of them having fever for over 7 days. Of these eligible patients, 12.6% (19/150) were investigated by doctors (including 3 persons with fever over 7 days), 14.6% (22/150) by laboratory staffand 72.6% (109/150) by the research team. The majority of doctors were not familiar with the treatment guidelines for malaria (76.5%, 75/98). Conclusions: Mandatory continuous medical education programmes need to continue to ensure that malaria remains on the differential diagnosis of a fever patient, especially in patients with fever over 7 days. It is essential to publicize the availability of free-of-charge malaria diagnostic facilities, and to ensure that proper notification procedures are followed when a malaria patient is diagnosed. © The Author 2015. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved.


Kirkbya K.,University of Oxford | Galappaththy G.N.L.,Anti Malaria Campaign | Kurinczuk J.J.,University of Oxford | Rajapakse S.,University of Colombo | Deepika Fernando S.,University of Colombo
Transactions of the Royal Society of Tropical Medicine and Hygiene | Year: 2013

Malaria-related knowledge, preventative methods and treatment-seeking behaviours were investigated in a post-conflict district of Sri Lanka in order to guide the development of components of malaria interventions and to support future programme evaluation A structured questionnaire was used to collect data from a random sample of 300 households in four Divisional Secretariat Divisions (DSD) of the district where internally displaced populations were being resettled after a 30-year civil war. Results: The surveyed community had a good overall level of knowledge of malaria. There was high bednet ownership (94.0%), although only 48.0% of households in the study had long-lasting insecticide-treated nets (LLIN). Most respondents reported rapid treatment-seeking behaviour (71.0%) and easy access to malaria diagnostic facilities (67.0%). The Tamil population living in Manthai West and Madhu DSDs who were displaced to refugee camps had better malaria-related knowledge and practices, probably due to the malaria control activities focused on these camps by the government. Conclusions: Although knowledge and practices regarding malaria amongst resettled populations in Mannar District were high, continued malaria surveillance, case management, vector control including distribution of LLINs, education and information campaigns are important not only amongst the communities affected by the conflict but the entire district. © Royal Society of Tropical Medicine and Hygiene 2012. All rights reserved.

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