Family Health Bureau

Colombo, Sri Lanka

Family Health Bureau

Colombo, Sri Lanka

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Lumbiganon P.,Khon Kaen University | Laopaiboon M.,Khon Kaen University | Gulmezoglu A.M.,The World Bank | Souza J.P.,The World Bank | And 19 more authors.
The Lancet | Year: 2010

Background: There has been concern about rising rates of caesarean section worldwide. This Article reports the third phase of the WHO global survey, which aimed to estimate the rate of different methods of delivery and to examine the relation between method of delivery and maternal and perinatal outcomes in selected facilities in Africa and Latin America in 2004-05, and in Asia in 2007-08. Methods: Nine countries participated in the Asia global survey: Cambodia, China, India, Japan, Nepal, Philippines, Sri Lanka, Thailand, and Vietnam. In each country, the capital city and two other regions or provinces were randomly selected. We studied all women admitted for delivery during 3 months in institutions with 6000 or fewer expected deliveries per year and during 2 months in those with more than 6000 deliveries. We gathered data for institutions to obtain a detailed description of the health facility and its resources for obstetric care. We obtained data from women's medical records to summarise obstetric and perinatal events. Findings: We obtained data for 109 101 of 112 152 deliveries reported in 122 recruited facilities (97% coverage), and analysed 107 950 deliveries. The overall rate of caesarean section was 27·3% (n=29 428) and of operative vaginal delivery was 3·2% (n=3465). Risk of maternal mortality and morbidity index (at least one of: maternal mortality, admission to intensive care unit [ICU], blood transfusion, hysterectomy, or internal iliac artery ligation) was increased for operative vaginal delivery (adjusted odds ratio 2·1, 95% CI 1·7-2·6) and all types of caesarean section (antepartum without indication 2·7, 1·4-5·5; antepartum with indication 10·6, 9·3-12·0; intrapartum without indication 14·2, 9·8-20·7; intrapartum with indication 14·5, 13·2-16·0). For breech presentation, caesarean section, either antepartum (0·2, 0·1-0·3) or intrapartum (0·3, 0·2-0·4), was associated with improved perinatal outcomes, but also with increased risk of stay in neonatal ICU (2·0, 1·1-3·6; and 2·1, 1·2-3·7, respectively). Interpretation: To improve maternal and perinatal outcomes, caesarean section should be done only when there is a medical indication. Funding: US Agency for International Development (USAID); UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, Switzerland; Ministry of Health, Labour and Welfare of Japan; Ministry of Public Health, China; and Indian Council of Medical Research. © 2010 Elsevier Ltd. All rights reserved.


Vithana P.V.S.C.,National Cancer Control Programme | Hemachandra N.N.,Family Health Bureau | Ariyaratne Y.,National Cancer Institute | Jayawardana P.L.,University of Kelaniya
Asian Pacific Journal of Cancer Prevention | Year: 2013

Background: Breast cancer is the most common cancer diagnosed among women in Sri Lanka. Early detection can lead to reduction in morbidity and mortality. The objective here was to identify perceptions of public health midwives (PHMs) on the importance of early detection of breast cancer and deficiencies of and suggestions on improving existing breast cancer early detection services provided through Well Woman Clinics. Materials and Methods: A qualitative study using four focus group discussions (FGDs) were conducted among 38 PHMs in the Gampaha district in Sri Lanka and the meetings were audio-recorded, transcribed and analyzed using constant comparison and identifying themes and categories. Results: All the PHMs had a firm realization on the need of breast cancer early detection. The four FGDs among PHMs revealed non-availability of guidelines, inadequacy of training, lack of skills and material to provide health education, inability to provide privacy during clinical examination, shortage of stationery, lack of community awareness and motivation. The suggestions for the improvements of the programme identified in FGDs were capacity building of PHMs, making availability of guidelines, rescheduling clinics, improving the supervision, strengthening the monitoring, improving coordination between clinical and preventive sectors, and improving community awareness. Conclusions: Results of the FGDs can provide useful information on components to be improved in breast cancer early detection services. Study recommendations were training programmes at basic and post basic levels on a regular basis and supervision for the sustainance of the breast cancer early detection program.


Senarath U.,University of Colombo | Siriwardena I.,Information and Communication Technology Agency | Jayawickrama H.,Family Health Bureau | Fernando D.N.,University of Colombo | Dibley M.J.,University of Sydney
Maternal and Child Nutrition | Year: 2012

Identification of factors that predict a woman's infant feeding choice is important for breastfeeding promotion programmes. We analysed a subsample of children under 2 years of age from the most recent Sri Lanka Demographic and Health Survey (SLDHS) to assess breastfeeding practices and factors associated with suboptimal practices. SLDHS 2006-2007 used a stratified two-stage cluster sample of ever-married women aged 15-49 years. Breastfeeding indicators were estimated for the last-born children (n=2735). Selected indicators were examined against independent variables through cross-tabulations and multivariate analyses. Of the sample, 83.3% initiated breastfeeding within 1h of birth. Continuation rates declined from 92.6% in first year to 83.5% in second year. Exclusive breastfeeding (EBF) rate under 6 months of age was 75.8%, with median duration being 4.8 months. Delayed initiation of breastfeeding was associated with low birthweight [odds ratio (OR)=2.24] and caesarean delivery (OR=3.30), but less likely among female infants (OR=0.75), mothers from 'estate' sector (OR=0.61) or richer wealth quintile (OR=0.60). Non-EBF was associated with children from urban areas (OR=1.72) and estate sector (OR=4.48) and absence of post-natal visits by a public health midwife (OR=1.89). A child was at risk for not currently breastfeeding if born in a private hospital (OR=3.73), delivered by caesarean section (OR=1.46) or lived in urban areas (OR=2.80) or estate sector (OR=3.23). Those living in estates (OR=11.4) and not receiving post-natal home visits (OR=2.62) were more likely to discontinue breastfeeding by 1 year. Breastfeeding indicators in Sri Lanka were higher compared with many countries and determined by socio-economic and health care system factors. © 2011 Blackwell Publishing Ltd.


Ruwanpathirana T.,Family Health Bureau
Indian Journal of Pediatrics | Year: 2014

Objective: To identify the risk factors for small for gestational age (SGA) babies.Methods: The present study was a nested case control study which was carried out by two Medical Officers of Health areas (The field level administrative unit responsible for provision of preventive and promotive health services) in Colombo district. SGA babies were identified using ‘weight for gestational age’ curves developed for Sri Lankan babies. Newborns of 1,200 pregnant women, who were identified within the first 8 wk of amenorrhea and who delivered in selected hospitals were included in the study. Sample size was calculated as n = 167 cases and 4 n = 668 controls, with four controls for each case. A case was defined as a newborn whose birth weight was less than the 10th percentile of the weight for gestational age, the control being a newborn whose birth weight was between the 10th and the 90th percentile of the weight for gestational age.Results: Multivariate analysis identified 7 significant risk factors as, number of live born children = 0, inadequate weight gain during pregnancy according to initial BMI, maximum and minimum physical work, mother’s pre-pregnant weight less than 38 kg, high level of stress at second trimester, presence of pregnancy induced hypertension (PIH) and inadequate support from husband.Conclusion: The risk factors indicate the directions for planning intervention programs. © 2014, Dr. K C Chaudhuri Foundation.


PubMed | University of Technology, Sydney, Latin American Center for Perinatology, GLIDE Technical Cooperation and Research, Social Protection and Health Division and 20 more.
Type: Journal Article | Journal: BJOG : an international journal of obstetrics and gynaecology | Year: 2016

To generate a global reference for caesarean section (CS) rates at health facilities.Cross-sectional study.Health facilities from 43 countries.Thirty eight thousand three hundred and twenty-four women giving birth from 22 countries for model building and 10,045,875 women giving birth from 43 countries for model testing.We hypothesised that mathematical models could determine the relationship between clinical-obstetric characteristics and CS. These models generated probabilities of CS that could be compared with the observed CS rates. We devised a three-step approach to generate the global benchmark of CS rates at health facilities: creation of a multi-country reference population, building mathematical models, and testing these models.Area under the ROC curves, diagnostic odds ratio, expected CS rate, observed CS rate.According to the different versions of the model, areas under the ROC curves suggested a good discriminatory capacity of C-Model, with summary estimates ranging from 0.832 to 0.844. The C-Model was able to generate expected CS rates adjusted for the case-mix of the obstetric population. We have also prepared an e-calculator to facilitate use of C-Model (www.who.int/reproductivehealth/publications/maternal_perinatal_health/c-model/en/).This article describes the development of a global reference for CS rates. Based on maternal characteristics, this tool was able to generate an individualised expected CS rate for health facilities or groups of health facilities. With C-Model, obstetric teams, health system managers, health facilities, health insurance companies, and governments can produce a customised reference CS rate for assessing use (and overuse) of CS.The C-Model provides a customized benchmark for caesarean section rates in health facilities and systems.


PubMed | World Health Organization, University of Tsukuba, National Health Research Institute, Family Health Bureau and 3 more.
Type: Journal Article | Journal: PloS one | Year: 2016

To investigate optimal timing of elective repeat caesarean section among low-risk pregnant women with prior caesarean section in a multicountry sample from largely low- and middle-income countries.Secondary analysis of a cross-sectional study.Twenty-nine countries from the World Health Organization Multicountry Survey on Maternal and Newborn Health.29,647 women with prior caesarean section and no pregnancy complications in their current pregnancy who delivered a term singleton (live birth and stillbirth) at gestational age 37-41 weeks by pre-labour caesarean section, intra-partum caesarean section, or vaginal birth following spontaneous onset of labour.We compared the rate of short-term adverse maternal and newborn outcomes following pre-labour caesarean section at a given gestational age, to those following ongoing pregnancies beyond that gestational age.Severe maternal outcomes, neonatal morbidity, and intra-hospital early neonatal mortality.Odds of neonatal morbidity and intra-hospital early neonatal mortality were 0.48 (95% confidence interval [CI] 0.39-0.60) and 0.31 (95% CI 0.16-0.58) times lower for ongoing pregnancies compared to pre-labour caesarean section at 37 weeks. We did not find any significant change in the risk of severe maternal outcomes between pre-labour caesarean section at a given gestational age and ongoing pregnancies beyond that gestational age.Elective repeat caesarean section at 37 weeks had higher risk of neonatal morbidity and mortality compared to ongoing pregnancy, however risks at later gestational ages did not differ between groups.


Siriwardana H.V.Y.D.,University of Colombo | Thalagala N.,Family Health Bureau | Karunaweera N.D.,University of Colombo
Annals of Tropical Medicine and Parasitology | Year: 2010

Sri Lanka is the newest reported focus of human leishmaniasis within the Indian subcontinent. Over the last 8 years, more than 2000 cases of cutaneous leishmaniasis (CL), apparently caused by Leishmania donovani (a species usually associated with the visceral form of the disease), have been passively identified in the country. The clinical profiles of 401 suspected cases of CL in Sri Lanka were recently explored and some of the cases' immunological responses were investigated, in antibody-detection assays based on the rk39 antigen. These studies were followed by cross-sectional surveys, involving active case detection, in three areas of Sri Lanka, two of them known to be at relatively high risk for CL, with the aims of estimating the local prevalences of the disease and identifying the main risk factors for its acquisition. This appears to be the first detailed report on the prevalence, risk factors and human serological response associated with human leishmaniasis in Sri Lanka. Although the data collected indicated that the transmission of the parasite causing CL was mostly outdoor (and possibly zoonotic) in the north of the country, most of the transmission in the south seemed to be peridomestic. The CL was found to affect a wide age range, in both male and female subjects. Curiously, the 24 cases of CL that were investigated in the rk39 assays gave negative results whereas the single cases of mucosal or visceral leishmaniasis that were studied were found positive for antibodies reacting with the rk39 antigen. More programmes of active case detection need to be launched across Sri Lanka before the true national burden posed by human leishmaniasis can be accurately evaluated. General awareness of leishmaniasis needs to be raised. Hopefully, continued research and disease monitoring will allow the effective control of leishmaniasis in Sri Lanka. © 2010 W. S. Maney & Son Ltd.


Senarath U.,University of Colombo | Godakandage S.S.P.,Family Health Bureau | Jayawickrama H.,Family Health Bureau | Siriwardena I.,Information and Communication Technology Agency | Dibley M.J.,University of Sydney
Maternal and Child Nutrition | Year: 2012

Inappropriate complementary feeding increases risk of undernutrition, illness and mortality in infants and children. This paper aimed to determine the factors associated with inappropriate complementary feeding practices in Sri Lanka. The Sri Lanka Demographic and Health Survey 2006-2007 used a stratified two-stage cluster sample of ever-married women 15-49 years, and included details about foods given to children aged 6-23 months during the last 24 h. The new World Health Organization indicators for infant and young child feeding (IYCF) - (introduction of solid/semi-solid or soft foods; minimum dietary diversity; minimum meal frequency; and minimum acceptable diet) were calculated for 2106 children aged 6-23 months. These indicators were examined against explanatory variables with multivariate analyses to identify factors associated with inappropriate practices. Eighty-four per cent of infants aged 6-8 months were introduced to complementary food. The proportion of infants aged 6-8 months who consumed eggs (7.5%), fruits and vegetables other than those rich in vitamin A (29.6%) and flesh foods (35.2%) was low. Of children aged 6-23 months, minimum dietary diversity was 71%, minimum meal frequency 88% and minimum acceptable diet 68%. Children who lived in tea estate sector had a lower dietary diversity and minimum acceptable diet than children in urban and rural areas. Other determinants of not receiving a diverse or acceptable diet were lower maternal education, shorter maternal height, lower wealth index, lack of postnatal visits, unsatisfactory exposure to media and acute respiratory infections. In conclusion, complementary feeding indicators were adequate except in the 6-11 months age group. Subgroups with inappropriate feeding practices should be the focus of IYCF promotion programs. © 2011 Blackwell Publishing Ltd.


Gartland D.,Murdoch Childrens Research Institute | Lansakara N.,Family Health Bureau | Flood M.,La Trobe University | Brown S.J.,Murdoch Childrens Research Institute
American Journal of Obstetrics and Gynecology | Year: 2012

Objective: We sought to assess congruity between data abstracted from medical records with answers to self-administered questionnaires. Study Design: This was a multicenter prospective nulliparous pregnancy cohort. Results: A total of 1507 women enrolled. Analyses were reported for 1296 with medical record data and 3-month postpartum follow-up. There was near-perfect agreement (κ <0.80) between maternal report and abstracted data for reproductive history, induction/augmentation method, epidural/spinal analgesia, method of birth, perineal repair, infant birthweight, and gestation. Agreement was poor to moderate for maternal position in second stage and duration of pushing. Conclusion: Maternal report of pregnancy, labor, and birth factors was very reliable and considered more accurate in relation to maternal position in labor and birth, smoking, prior terminations, and miscarriages. Use of routine birthing outcome summaries may introduce measurement error as hospitals differ in their definitions and reporting practices. Using primary data sources (eg, partograms) with clearly defined prespecified criteria will provide the most accurate obstetric exposure and outcome data. © 2012 Mosby, Inc. All rights reserved.


PubMed | University of Colombo and Family Health Bureau
Type: | Journal: Journal of clinical laboratory analysis | Year: 2016

The complete blood count (CBC) is a frequently performed laboratory test today. This study evaluated the effects of temperature and sample storage time on parameters of CBC which could produce misleading results of clinical significance.In a cross-sectional study, CBC was checked in 102 randomly selected healthy individuals and baseline measurements were analyzed using the Sysmex XS 500i fully automated hematology analyzer. CBC was done on samples up to 48 hr of storage at temperatures of 4 2C, 23 2C, and 31 2C. Values were checked at time intervals of 6, 24, and 48 hr.Among CBC parameters, white blood cell, red blood cell, hemoglobin, mean cell hemoglobin (MCH), neutrophils and lymphocytes were stable at all three temperatures up to 48 hr. Monocytes, eosinophils, MCH concentration, hematocrit (Htc), and red cell distribution width-coefficient of variation showed statistically significant changes at 23 2C and 31 2C. A significant decline in platelet count (PLT) and increment in mean platelet volume and basophil count were seen at all study temperatures up to 48 hr.This study shows that most parameters of the CBC are unaffected with the studied storage temperature up to 48 hr except for the PLT which should be performed within 6 hr of the post-collection time. To avoid changes in a few parameters such as Htc, it is best to store the sample at 4 2C if any delay is anticipated.

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