Postgraduate Institute of Medicine: Colombo University

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A Study of the physical characteristics and nutritional status of new entrants to the University of Colombo
(Post Graduate Institute of Medicine, Colombo: PGIM ., 1982) PEIRIS, RGX
Epidemiology of congenital malformations in Sri Lanka
(Post Graduate Institute of Medicine, Colombo: PGIM ., 1982) COREA, SMX
The study which was intended to the exploratory in nature provides base-line data for the indidence of various types of malformation and their possible association with aetiological influences like race, region, consangunity etc. The findings gave support to many views based on previous evidence while they are not compatible with some others e.g. the highest rate of anencephalus in the wet zone area (Zone 3) with better socio economic conditions was contrary to the findings of Fredrick (1970) who found the incidence was highest in the lowest socio-economic groups - In the case of male: female ratio for central nervous system malformations there was a marked difference between the results of the WHO study (Stevenson etal 1966) - where the male: female ratio was 1:3 and in the present study where the ratio was 2:1. It is accepted that in studies of this nature no definite conclusion can be drawn but nevertheless possible association of probable aetiological agents can be detected which would need further detailed investigation-one such area of study would be the difference in the hardness and PH of water in the dry zone and wet zone areas. Finally, it is hoped that this study would be the first in a series on many more studies of this nature which would provide valuable information on congenital malformation.
Studies in the relationship of Health status to socio economic factors \& Health resources in Sri Lanka.
(Post Graduate Institute of Medicine, Colombo: PGIM., 1983) Jayasuriya, AR
This study attempts to find relationships between health status and socio-economic factors that influence health levels.Another objective was to assess the relative importance of socio -economic factors and health resources on health status.Variables mesuring the socio-economic factors and health resources available were identified.Their relationships to health status indicators were studied using the areas of superintendent of health services (Health districts) as the unit of analysis.These areas were chosen as they conform to the drainage areas for health care and overcomes to some extent the error of deaths being registered by place of death and not the place of residence.The findings of the study show that in general the health status indicators have a closer relationship to socio-economic indicators than health resource indicators.It was identified that 'micro' level studies to untangle some of the inter relationsips between health status and its determinants are to be measured.
A Comprehensive study on immunization in a rural, Urban and Estate area in Sri Lanka
(Post Graduate Institute of Medicine, Colombo: PGIM., 1983) SENEVIRATNE, GDT
The Pattern of dermatological disorders seen in skin biopsy material from the central province, Sri Lanka, with special reference to histopathology
(Post Graduate Institute of Medicine, Colombo: PGIM ., 1983) BABAPULLE, M
The pattern of dermatological disorders as seen in 110 skin biopsies of patients from the Central Province, Sri Lanka in a one year period (1982/1983) was studied with reference to incidence, age, sex race and clinical and histopathological features. The commonest disorders observed in biopsies were lichen amyloidosus, skin tumours, leprosy and collagen diseases. Viral and fungal diseases were only very rarely seen. Skin disorders in general were commoner in females, and rare in the very old and very young. Facilities required for proper and completed laboratory investigations of dermatological cases are suggested.
A Genetic study of the Veddas of Sri Lanka
(Post Graduate Institute of Medicine, Colombo: PGIM ., 1985) ELLEPOLA, SB
The study of primitive tribes like the Veddas has an urgency for the following reason. They have lived under conditions which approximate closely to the greater part of man's existence, but today they face a threat of extinction as a community owing to the rapid absorption of the culture of the Sinhalese which will be more accentuated as they begin living together with the Sinhalese in the new settlements of the Mahaweli.The anthropoiemetric studies of earlier workers indicate that the present day Vedda has a mixed ancestry of Sinhalese Australoid, Negroid stock together with features which belonged to the Prehistoric man of Sri Lanka, who was referred toa as Homo sapiens balangodensis. (Balangoda man) The recent development in the detection of single gene multi allele systems by starch gel electrophoresis has made it possible to study many new genetic markers like serum proteins and red cell enzymes. In the present study a total of twenty six alleles both multi and single allele systems were studied. A comparison of the allele systems of the Veddas and Sinhalese show a genetic identity between them of 0.9905 with a genetic distance of 0.0095 and a phylogenetic time of 47,500 years. Therefore there is a possibility that the Veddas may have a link with the Homosapients Balangodensis ("Balangoda Man") and his ancestors who belonged to the Paleolitic and Mesolithic periods of Sri Lanka in addition to the link with the Sinhalese. A comparison of the allele frequencies of the Vedda with the primitive tribes of Asia and Oceania demonstrate that they are closely related to the primitive tribes of Malaysia or the Negrito of the Philippine Islands. All these tribes however appears to be of Asiatic origin. One of the interesting features seen in the Veddas when compared with Sinhalese was the higher frequency of Haemoglobin E and of Glucose six phosphate dehydrogenase deficiency in them. This may be due to natural selection which may have afforded them protection against malaria. There is a also a higher incidence of Hepatitis B antigen and antibodies in the Veddas when compared with the Sinhalese which may also be due to genetic factors. The other diseases like yaws and asthma found in the Vedda is due to local conditions and the life style of the Vedda.
A Study of some factors influencing the high defaulter rate among leprosy patients in the Western Province of Sri Lanka
(Post Graduate Institute of Medicine, Colombo: PGIM ., 1985) ABEYAGUNAWARDENE, LND
Although non compliance with recommended treatment regimens is a problem that often crops up in the case of most chronic illnesses, it is particularly so in the case of chronic diseases sucha s leprosy which require long periods of uninterrupted treatment. Failure on the part of patients to attend clinics regularly, which are conducted specifically for the purpose of medical examination of patients and distribution of prescribed drugs, makes case holding one of the major problems in the leprosy control programme. In this study, an attempt has been made to find out the reasons for non-acceptance of treatment services and to ascertain what factors affect the decision making process of the patients. Although this complex problem warrants a full scale investigation to cover a complete spectrum of psycho-socio-cultural factors, medical factors and service factors, the contrasting nature of each group of factors, calls for the use of a different research methodology to cover each group. The present study is confined to the medical factors and some of the demographic factors which can conveniently be covered through a quantitative analysis of patients' clinic records. Due to certain operational constraints, the study area is restricted to the Western Province of Sri Lanka which has the highest prevalenvce of the disease and where more than 50 of all known cases are concentrated. A literature search revealed that a study of this nature had never been undertaken in Sri Lanka before, although a few studies on the problem of case holding in leprosy have been reported from elsewhere. This study includes a review of all available literature, not only on the subject of case holding in leprosy, but non-compliance with treatment regimens in general. 5681 files of all patients registered in 21 clinics in the Western Province were scrutinised. Of these, 4286 patients who remained on the register during the entire 2 year period from 1st January 1980 to 31st December 1981, were considered as eligible for the study. Data relating to the factors being studied (age, sex, marital status, place of residence, type of leprosy, degree of deformity etc.) were obtained from patients' clinic records and recorded using a suitable format. The clinic attendance history of each patient during the 2 year period was also recorded so that the degree to which each patient defaulted (kept away from clinics) could be expressed in quantitative terms. The data collected was processed and analysed by computer. The maim was to establish any significant association between each of the independent variables such as age, sex, marital status, type of leprosy, degree of deformity etc., and the degree or intensity of default, which was the dependent variable. Multiple regression analysis using the forward selection procedure was used as the statistical technique in carrying out the analysis. Of a total of 16 factors considered in this study, a significant association was established between 10 of them and the intensity or degree of default. They were: 1)Reactions 2)Place of residence 3)Duration of treatment 4)Degree of deformity 5)Activity 6)Family history 7)Duration of disease 8)Age 9)Marital status and 10)Efficiency of treatmet. Other factors namely: 1)Religion 2)Visibility of lesions 3)Type of leprosy 4)Race 5)Number of lesions and 6)Sex, did not have any significant association with the degree of default. The more significant finding however, was the fact that the above factors taken togenter accounred for only 17.22 of variance, implying that there are more important factors responsible for the high degree of default of patients. This finding indicates that the socio-cultural and service factors not covered in the present study may holf the key in explaining the balance 83.78 of variance. The significant association between some of the independent variables and the degree of default can be explained by the application of the Health Belief Model, which is an accepted theory in behavioural sciences. For instance, patients with severe deformities were found to attend clinic more regularly tha those who were not deformed. It is postulated that the patient gauges the severity of this illness by the degree of deformity, which prompts him to attend clinic regularly. On the other hand, the type of leprosy was not found to be an associated factor. rhis sounds logical because, the patient being a laymen, will not be able to differentiate between the different types of leprosy. The need for further research to examine the role of socio-cultural factors and service factors as contributory causes for the high rate of default, is clearly established. The need to focus attention on the providers of services and the service organisation, and not merely the community, in carrying out research of thid type, is particularly stressed. Suitable research methodologies to study these aspects are suggested.
Study of the health and socio-economic conditions of the elderly
(Post Graduate Institute of Medicine, Colombo: PGIM ., 1985) SIVARAJAH, N
This study was undertaken to obtain demographic and socioeconomic data and particulars relating to morbidity, personal care capacity, utilization of health services, habits, recreation and attitudes of old people. Old age is hard to define, since aging is a process, which starts from birth. In this study personable age of 55 years was taken as the dividing line between middle age and old age, and those who were 55 years and above were included in the study. The study area had a population of 28086, with 11.8 percent, being 55 years and above. The study was carried out in two phases. In phase I, general data was, collected from 3344 persons 55 years and above, living in the area. In phase II a 2 percent sample of the elders interviewed were medically examined. The coverage in phase I was almost 100 percent and in phase II it was 87.8 percent. During phase 1,69.6 percent of the 3344 elders were personally interviewed, and in the case of 19 percent of the elders the questionnaire was answered by the spouse or child living with the elder. Unlike in the more developed countries where two thirds of the elderly population are females, in this study, there were an almost equal number of males and females except in the 55-59 years old age group where females constituted 58.2 percent. Only 7.7 percent of the elders were living alone. Most of the elders were living with their spouses, and when the partner is no longer living, they lived with their children - preferably the female children. Out of the 3344 elders, 24.4 percent were employed; two thirds of them were in the 55-64 years old age group. The percentage of elders who have had no schooling was 13.3 percent compared to 34.2 percent for Sri Lanka. Arterial hypertension was found in 11.7 percent, heart disease in 5.5 percent, diabetes mellitus in 7.8 percent and bronchial asthma in 8.2 percent of the elders. Residual paralysis of one or more limbs or face was seen in 2.2 percent. Only 9.9 percent of the elders had obtained impatient medical care at least once during the previous one-year. This figure is comparatively low when compared to developed countries. The medical examination conducted during phase II of the study indicated that 39.7 percent of the 58 elders examined had a diastolic blood pressure of 90-99 mm of mercury and 6.9 percent had a diastolic blood pressure over 110 mm of mercury. Diabetes (17.2 percent) and arthritis (10.3 percent) were other common diseases. Only 27.6 percent of the elders were using glasses. Out of those who were not wearing glasses 66.6 perce were unable to read the newspaper. Distant vision too was impaired. One elder was completely blind and 33.3 percent were able to identify hand movements only. Ten percent of the elders had a haemoglobin less than 10 g per 100 ml. A majority (80 percent) of them were females. Oral hygiene among the elders was very poor. Paradontal disease was found in 82.8 percent of the elders. Carious and loose teeth were found in 32 percent of the elders but, none of them had gone to a dentist for dental care. It is suggested that: a. a) Geriatric health care be incorporated into Primary Care (PHC) system. The PHC workers should carry out, education, screening and referrals, monitoring of chronically ill patients, training of patients or relations to carry out simple tests like testing urine for sugar in diabetes, administration of insulin, supervision of drug administration etc. b. Geriatric clinics be established at secondary and tertiary levels of the primary health care structure. c. Geriatric wards should be established at tertiary level. d. Long term care services be established involving, screening rehabilitation, assisting the elders to cope with impairments and permanent residental or out patient services as well as assistance in their homes. e. The criterion for retirement should not only be the age. Part time emloyement should be provided to those who are capable of working.
The Social dynamics of voluntary health workers in primary health care
(Post Graduate Institute of Medicine, Colombo: PGIM ., 1985) PERERA, MALR
A study was undertaken to: Identify predominant characteristics and activities of a group of voluntary health workers to Study the impact of activities of a primary health care development project.The following recommendations flow out of the experience gained from the study: Induced,indirect community participation in primary health care is feasible. A village health development committee and a nerwork of voluntary health workers is a suitable organization for the above purpose.The committee is to consist of village leaders.The leaders will nominate voluntary health workers.This model can be adopted on a national basis.Training of new voluntary health wokers should be an on-going activity of a primary health care development programme.The activity is designed to cater to drop- outs of vountary health workers.Such training programmes need to be arranged once in about six months.New voluntary health workers of a number of public health midwife areas could be trained together,at a central location.ON the job-training of voluntary health workers needs strengthening.Evaluation of primary health care programmes should be built into such programmes.The evaluation should focus on expected changes in health practices.It is desirable for each health unit to train an evaluation team.The middle level supervisors are suitable for the purpose.Surveys of random samples of households should generate data for evaluations of primary health care programmes.The ideal characteristics of voluntary health workers.The exact contribution of voluntary health workers to any changes in the health situation in an area has to be determined.The cost benefit of the voluntary health worker programme can be thus determined.
A Study of morbidity patterns and utilization of outpatients services in a defined area of Kalutara District
(Post Graduate Institute of Medicine, Colombo: PGIM ., 1985) DALPATADU, KCS
Hospital out patients and community studies of morbidity patterns and utilization patterns will provied locally the nature and extent of health problems as well as uses of Government health facilities. This is useful to plan for provision of health seervices considering the needs of the community. It will also provide although limited, certain indications of trends of morbidity and utilization of out-patients services during the present period, as compared to Health Manpower Development study of 1975. In addition specific data generated will be useful to design future research studies in narrow fields of interests. With this inview the research study was undertaken. The general objective being to study morbidity patterns and utilization of out-patients services in selected Government hospitals and from the community in a defined area in a district of Sri Lanka. The study was limited to a period of one mont and confined to the field practice area of the National Institute of Helath Sciences, Kalutara due to the limitation of resources. The study also attempts to identify the factors associated with by-passing phenomenon which has been a growing (or even increasing) problem in the out-patients departments of larger Govenment heaalth institutions in Sri Lanka. Two studies, a community survey and a hospital survey of out patients services in selected hospitals in the study area were undertaken simultaneously to obtain specific data. Thousand households were randomly selected for the community study. The survey was carried out by trained public health midwives in their owh areas. Illnesses recorded were, where the patient has taken rededial treatment within two weeks prior to the day of survey, for the illness. The hospita survey was carried out over a period of one month. A systematic random sample of one in five out patients were selected to be included in the sample. The results of the community survey indicates the sampling methodology used in the study as well as the use of trained Public Health Midwives of their own area, contributed to a hundred percent response rate. Further, there was very high degree of reliability in the morbidity classification made by the Public Health Midwives when modified morbidity classification list adapted from the basic tabulation list of the international Classification of Diseases (Ninth Revision) was used. This was another advantage of using Public Health Midwives for these surveys. Findings of the study shows that the leading causes of morbidity of the community area diseases of rrespiratory system, Infectious and Parasitic Diseases and Injuries and Poisoning. This is similar to the morbidity patterns observed in the hospital survey which shows that the community morbidity patterns are reflected at the out patients department of Government health institutions. Hence tje study of the out patients department morbidity patterns providde a measure of health needs of the community. It is noteworthy that these are diseases which could be prevented and therefore indicate priority areas for intervention. It is significant to note that injuries and poisoning ranked third in the disease conditions which may have been due to the urban nature of the study ares. Nevertheless it is seen to be a major concern even in the national context. It was....seen that the most vulnerable groups for illnesses were the infants and preschool children. The study of utilization of out patients services indicate that the demand for private western medical practitioners seems to be increasing where as the demand for Government western health secter is decreasing. Despite easy accessibility to and availability of free health services in the area, the decline in utilization of government health sector needs further indepth studies. It was shown a fair percentage of people were relying on self medication as the first line of treatment rather than seeking treatment from Ayurvedic Practitiones which shown to be very low compared to other sectors. the community study showed that the infants were mainly cared by the Western Private Practitioners(85.2 per cent of those whof fell ill) which may have been due to priority given by parents where-by they seek prompt treatment at any time of the day. This was supported by the hospital study where the percentage of infants seeking treatment was low. Further, findings show that people with higher educational and higher level of income utilize the westerna private practitioners more, where as it was mainly those of lower socio economic class who patronized the government out patients departments. The findings of the survey show that the problems of by-passing is significant and in general hospital Kalutara 44.6per cent of the patients had by-passed smaller institutions. The commonest institution by passed was the central dispensary. Of the variables studied only degree of illness and the distance from the institution by passes to the institution attended were significant at 5 per cent significant level. But factors like age, educational level.......status which were though to influence by passing was found to be not significant. The main reasons given for by-passing were availablitiy of specialised investigations, availability of specialised staff and availability of drugs. these institutional factors of the institution attended and institution by passed were identified to be the other significant contributiory factors which need further research to study this phenomenon in depth.
The Medico-Legal Science:different aspects, different places
(Post Graduate Institute of Medicine, Colombo: PGIM., 1986) BEN'IMRAN, FA
This represents some aspects of medico legal experience of the author during the past five years.The subject of the medico-legal autopsy has been discussed in the first chapter,which included also a discussion of procedures and different techniques.Cases of homicides,suicides and accidents,natural causes were also discussed,sudden infant death syndrome,ischaemic heart disease.In every chapter a case history has been given followed by detailed autopsy report (in the last case a clinical examination report) including the results of any applicable laboratory investigation or highly specialized techniques.The topic appropriate to the presented case was then discussed in an elaborate manner with a review of the literature dealing with that topic.
The Medico-Legal Science:different aspects, different places
(Post Graduate Institute of Medicine, Colombo: PGIM ., 1986) IMRAN, FAB
This thesis represents some aaspects of medicolegal experience of the author during the past five years. It is intresting to say that the first three years were spent in the department of Forensic Medicine \& Science at the University of Glasgow in Scotland. It is worth mentioning that this was the very department which was chaired at some stage by the late professor Glaister, famous for the Ruchston case. The last two years were spent in the Medicolegal section of the Ministery of Justiciary in Benghazi, Libya, where the author had the task of establishing and organizing a reputable medico-legal practice. In the introductory part of this thesis simple statistics have been included. Points of intrest have been mentioned and highlighted. Relevant data, collected over the stated period of work, were presented in table form to give an idea about the incidence and pattern of different causes of death investigated by the author whether in Glasgow or Benghazi. In Benghazi, particularly, a considerable amount of clinical work had been carried out and duly presented. the subject of the medico-legal autopsy has been discussed in the first chapter, which included also a discussion of procedures and different techniques. Many aspects of Forensic Medicine have been discussed in the following chapters through presenting different cases of medico-legal importance. These included cases of homicides, suicides and accidents. Two cases where death was due to natural causes were also discussed including the sudden infant death syndrome and ischaemic heart disease. The last chapter was devoted to an intresting problem of disputed paternity which was investigated in Benghazi, An unusual mythical belief which complicated the issue have been presented. In every chapter a case history has been given followed by detailed autopsy report (in the last case a clinical examination report) including the rresults of any applicable laboratory investigation or highly specialized techniques. The topic appropriate to the presented case was then discussed in an elaborate mannerwith a review of the literature dealing with that topic. Certain conclusions were drawn at the end of each chapter. Illustrative photographs were included wherever appropriate. In many chapters, up-to-date figures obtined from punlished national statistics have been included and occasionally compared with our own figures. Particularly in the chapter dealing with ischaemic heart disease, statistical information were given in the form of curves as well as tables.
A Study to ascertain the extent of preparation and utilization of visual aids for health education by public health inspectors and public health midwives functioning in a defined training area and in non-training health unit in Kalutara District
(Post Graduate Institute of Medicine, Colombo: PGIM ., 1987) SOMARATNE, HM
Over the years, the emphasis on health education for the netterment of health status of the country has gathered momntum to meet new challenges requiring health educational inputs. Hence, for health education to be a sucess, initiative of the health workers is a pre-requisite. It has been the practice to advise the production of low-cost visual aids at local level which will address very specific health problems. Considering the portability, easy reviewing, ability to control picture detail and non-involvement of hardware in using, graphic media have been accepted as suitable for field settings. Mass produced visual aids re mor appropriate for use in dealing with general issues. Production techniques and presentation methods are part of the curricula in basic courses and many continuing education programmes. Attempts in follow-up and evaluation of post-training status of production and utilization of visual aids by health workers are rarely undertaken. Present study discloses that attention to pretesting and reviewing has been poor. Supervising officers can be of help to overcome any weaknesses detected and encourage teamwork to share health workers' talents. There is no difference in production and utilization of visual aids between the officers of the training area andnon-training area selected for the study. the inadequacy of both production and utilization of visual aids was reflective in the findings.
Infant mortality on Sri Lankan plantations from 1887 to 1985
(Post Graduate Institute of Medicine, Colombo: PGIM ., 1987) PERERA, RS
The infant mortality rate is used as a sensitive indicator of the health of the resident plantaion population. The general characteristics of plantations are describe by Laing as follows (Laing 1986): "Plantations developed as a particular form of colonial agriculture. Despite independence coming to many countries, plantations persist, and with them their particular health problems. Plantations depend on imported labour or their descendents working and living within the plantations, and all aspects of life are controlled by the plantation manager. Frequently incomes have been low, housing, water and sanitation inadequate and living conditions difficult; and all these have been reflected in the poor health status of residents on estates". This description faithfully reflects the situation in Sri Lanka prior to 1974. This dissertation attemps to de4scribe the pre-1974 period as well as the rapid improvement thereafter. In the early days of plantations estate worker-houseing was constructed as rows of single rooms, known as single barrack 'lines' or as double rows of rooms reffered to as back-toback or double barrack 'lines'. A family of five or evenmore lived, cooked and slept in this single room. Since the 1940s cottage-type housing has been constructed and the line-type of housing is not constructed any more. Medical facilities are provided on estates mostly through a dispensary. Some estates have a maternity home and a few have a hospital which consists of a maternity ward, a male and a female ward. A few registered medical practitioners and Assistant Medical Practitioners work on estates. But most estates employ an Estate Medical Assistant, a pharmacist or even an apprentice who is medically imqialified. the Estate Medical Assistant qualifies after an examination held by the Ceylon Medical College Council. He has no formal medical training. Fifty percent of those in service are unqualified. Most midwives are Government-trained and registered but some estates still employ unqualified midwives. A new cadre of plantation Family Welfare Supervisors perform liasion activities between the medical staff and the workers. Other functions include maintenance of environmental sanitation, motivation for family planning and health education.
Screening for cervical cancer using exfoliative cervical cytology at a sexually transmitted diseases clinic in Colombo
(Post Graduate Institute of Medicine, Colombo: PGIM ., 1987) ABEYEWICKREME, I
Squamous cell neoplasia (including cancer precursors) of the uterine cervix is the second most prevalent neoplasm affecting women, after breast cancer in the world as a whole. It is estimated that approximately half a million new cases occur each year (Parkin etal, 1984). It is also the most common cancer in women in developing countries. Since these countries currently contain some three quarters of the global population, the size of the cancer problem, and the investment, needed for its control are likely to increase considerably in the future. Carcinoma of the cervix is one of the best studied human neoplasms. Even though it's epidemiology and natural history are well understood, and there are effective forms of treatment available, the morbidity and mortality continue to increase, especially in those under 35 years (Draper and Cook, 1983) Carcinoma of the cervix is now being considered a sexually transmitted disease (S.T.D.) because, the oncogenic agent, or agents, appear to be sexually transmissible. These agents are thought to act on the cervox during periods of metaplasia (Coppleson and Reid, 1968). such periods are most active at puberty, early pregnancy, and during oral contraceptive use. All the factors of increased risk for this neoplasm are related to coitus, and cervical carcinoma has been shown to be extremely uncommon in virgins and nuns (Rotkin, 1973, Gagnon, 1950). women attending S.T.D. clinics are most vulnerable to developing cervical cancer because, they commonly share two major risk factors: early onset of coitus and multiple sex partners (Rotkin, 1973). therefore it is necessary that these women be screened for cervical cancer in order to control further increases in morbidity and mortality. Exfoliative cervical cytology which forms the basis for such a screening programme, is routinely carried out on female patients attending S.T.D. clinics in the western countries. this facility is available to a greater or lesser extemt in other Asian countries as well. However, cervical cytology screening is not carried out in S.T.D. clinics in Sri Lanka. A literature search also revealed that no previous research has been done on this subject in this country. Taking these factors into consideration, a preliminary study of cervical cytology screening of patients attending a S.T.D. clinic was designed. Objective of the study: General objective to assess the usefulness of screening for cervical pre-cancer and cancer in women attending S.T.D. clinics in Sri Lanka. Specific objectives: (1)To determine the proportion of cervical smears showing abnormal cytology, in women attending the central veneral diseases clinic in Colombo. (2)To describe the different types of abnormalities that are to be found in the abnormal smears. (3)To describe findings in age, sexual history, contraceptive practices, number of pregnancies and S.T.D. diagnossed in the women screened, and to compare this data between those with normal smears and abnormal smear.
A Study of the control of urban filariasis by the case detection method through Night Blood Filming and treatment programme
(Post Graduate Institute of Medicine, Colombo: PGIM ., 1987) RATNAPRIYA, WMS
A study was conducted on one aspect of the filariasis control programme of the AFC. This study was the case detection programme of the Campaign by the NBF technique and the treatment of infected individuals. It was carried out at the Dehiwela-Mt. Lavinia unit of the AFC. Administration reports of the D/AFC for a period of ten years were studied to assess the emphasis placed on case detection and treatment programme of the AFC. It is clear that the main strategy of control of filariasis is the case detection programme. This is the first time that a study on this aspect of the programme has been done in Sri Lanka. The officers responsible for this programme in the AFC are F.AA who work under the PHI. They are directly under the supervision of the MOH of that unit, who in turn is responsible to the D/AFC. Each F.A. is alloted an area with a population of 10,000 to 15,000. He has to familiarise himself with the area and the population under his purview, bring to their notice the problems associated with the disease, blood film this community, treat the infected individuals and follow them up with a view to interrupt further transmission of the disease. The performance of F.AA was studied in depth. The public were interviewed to obtain their response to the work carried out by F.AA in connection with the detection of the disease. In addition the quality of the F.AA themselves were studied. It could be concluded from this study that the F.AA by and large carry out the programme effectively.
Study of perinatal deaths and infant mortality in the area of the Jaffna Municipal Council.
(Post Graduate Institute of Medicine, Colombo: PGIM., 1987) PONNAMPALAM, G
This is retrospective case-control study of III perinatal deaths and a descriptive analysis of 52 infant after the early neonatal period,done in the area of the jaffna municiple council from 1.7.85 to 30.6.86. The perinatal death rate of 43.3/1000 total births, still birth rate of 23.8/1000 total births,and infant mortality rate of 40.8/1000 live births are high when compared with the corresponding sri lanaka figures.Complications during pregnancy especially breech,toxaemia and haemorrhage and the history of having taken unspecified drugs during pregnancy increased the rate of perinatal mortality.Babies with low birth weight and those who were born preterm were at more risk of dying during the perinatal period.Deaths of infants after the early neonatal period esopecially during the post neonatal period were due to gastroenteritis and respiratory infection.Environmental fatoes were found to influence these adversely.As an epidemiological study for the improvement of health services of the jaffna municipality,recommendations have been made.Some of these observations and recommendations may be applicable for comparable situations.This study identifies areas for future health service research
A Study of educational achievement, behaviour and socio-economic characteristics associated with chronic undernutrition among grade I students
(Post Graduate Institute of Medicine, Colombo: PGIM ., 1987) RAJAPAKSA, LC
The objectives of this study were to describe the nutritional status of the children in grade I of the schools of the University Community Health Project Area and to compare the behavior, educational achievement and intelligence in group of children identified as having chronic malnutrition with a normal group matched for sex, age and class. In the first stage of the study, some anthropometric measurements were carried out and they were analyzed using the three indices of weight for age, height for age and weight for height. The prevalence of protein energy malnutrition (PEM) was found to be 11.7 percent - acute, 10.8 percent -chronic and 2 percent - concurrent acute and chronic malnutrition. The data were analyzed utilizing the commonly used classifications. The relationship between these different methods were studied with special emphasis on the relevance of the extensively used indicator of weight for age. Comparison of basic socio-economic data between different categories of malnutrition were made. It was found that stunting was commoner among female children and was associated with a low occupational category of the father, low educational level of the mother and was commoner when the birth order was three and above. The data was disaggregated to study the association between these factors and sex. Comparison of behavior problems between the normal and stunted children showed a higher prevalence among the stunted. Similar differences were found in educational achievement and in their performance in the test of "intellegence". This study also shows that the development quotient rind behavior had the highest influence on the variability observed in the educational performance and these effects were independent of the influence of the socio-economic factors. These results have important national implications since a large proportions of children at school entry are stunted.
A Study of night calls in a family practice in Sri Lanka
(Post Graduate Institute of Medicine, Colombo: PGIM ., 1987) JAYAWARDENE, LD
The continuity of medical care is the quintessence of General Practice or Family Medicine. A family physiciand's responsibility to his patients extends beyond the confines of his surgery and the limits of his surgery hours. A few decades ago, a physician did not really have any leisure time to call his own, fot he was on a round-the-clock service to his community. Appointment systems hardly existed and there was no strict adherence to 'office hours'. However, the delivery of this service has undergone considerable changes since then.. At present, most family physicians have developed carefully structured services which permit their patients to walk-in to the surgery during office-hours, sometimes on an appointment basis. However, extension of such a service after-hours presents significant organisational difficulties to a family physician. While the subject of 'night calls' has dealt with from various angles in the developed countries, there has been no study of the subject for Sri Lanka. the practice of Family Medicine in Sri Lanka is basically different from that in developed countries, and there are inherent difficulties in transpolating these foreign findings to the local scene. This makes a study done in this country very important.
Some epidemiological aspects of the outbreak of Japanese Encephalitis in Anuradhapura district, Sri Lanka 1985-86
(Post Graduate Institute of Medicine, Colombo: PGIM ., 1987) ABEYSINGHE, MRN
Epidemiological findings of the first major outbreak of Japanese encephalitis which occurred between November, 1985, and February, 1986, in Anuradhapura and the surrounding districts, Sri lanka are herewith presented. Out of the 326 cases admitted during the period of 20th November, 1985 to 20th February, 1986 120 cases were serologically confirmed. there were 65 deaths. The case fatality rate was 19.9. the Anuradhapura District had 288 cases, and out of that, 105 were serologically confirmed. the incidence rate was 45.6 per 100,000 population and the mortality rate was 7.9 per 100.000 population. The highest age specific incidence rate (71.9 per 100.000 population) and the highest age specific mortality rate (57.5 per 100,000 population) were seen in the age group of 65-69. the case fatality rate was high (100) in the 55-59 and 60-64 age groups. the above-15 years age group incidence was higher than the below-15 years age group. The difference was statistically significant (p\<.05). the sex specific incidence rate was higher (54.2 per 100,000 population) in males. the difference was statistically significant (p\<.01). the inter-relationship between the patients and their occupations, period of stay in the district and animal rearing habits too, have been discussed. Compairing the epidemiological findings of the countries in the South-East Asian region, the probable factors which led to the occurrence of the outbreak, are enumerated.

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