Postgraduate Institute of Medicine: Colombo University

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Acute diarrhoeal disorders among pre-school children in the estate population of two selected estates in Hunnasgiriya in the Kandy District
(Post Graduate Institute of Medicine, Colombo: PGIM., 2001) AMARASEKERA, MTJ
The objective was to find the prevalence of acute diarrhoeal disorders among children aged 2-5 years in the estate population and to study the knowledge and practices of mothers regarding acute diarrhoeal disorders and to describe some socio-economic factors of these families. There was a significant difference in knowledge regarding " Jeewani" between literate and illiterate mothers and also between mothers with formal and mothers with no formal education. There was a significant difference in practices in dealing with acute diarrhoeal disorders between literate and illiterate mothers at P= 0.05 level. Majority of mothers restricted food during diarrhoeal episodes. Inability to generalise the results of this study to the overall estate population of Sri Lanka is a limitation of this study.
Acute lymphoblastic leukaemia in Sri Lankan children: a 10 year experience at National Cancer Institute, Sri Lanka
(Post Graduate Institute of Medicine, Colombo: PGIM ., 1995) SIRIWARDENA, PAV
This retrospective study was carried out in 66 children ranging from 1 Â« years to 12 Â« years who were referred to Cancer Institute, Maharagama, Sri Lanka after being diagnosed as having Acute Lymphoblastic Leukaemia. The study was undertaken to evaluate patient characteristics, (Age and sex distribution) long term sequelae of CNS prophylaxis (growth retardation) and the treatment outcome in these 66 paediatric patients who were treated and followed up at Cancer Institute, Maharagama, Sri Lanka during the period between 1st May 1982 and 27th September 1993. Two of them expired within this 11 year period of follow up of CNS leukaemia. The majority of children belonged to 3 to 6 year age group with 64 percent of cases. The treatment given had been the standard treatment for Acute lymphoblastic leukaemia during the period concerned.
The Aetiology of low birth weight in a plantation population in Nuwara Eliya, Sri Lanka
(Post Graduate Institute of Medicine, Colombo: PGIM ., 1989) PERERA, RS
The objective of this study was to identify the aetiological factors of low birth weight in this context.For this study an up-country plantation population in Nuwara Eliya was selected.Following measures have been recommended to reduce the low birth weight incidence on up-country plantations:- Maternity leave in the two weeks penultimate to delivery should be ensured.Maternal weight gain should be monitored at ante-natal clinics to ensure a weight gain of 300g,per week or more," At risk" care should be given to mothers with a past history of low birth weight and low maternal height.Mothers in parity 1 or with an age of below 20 years or between 30-34 years should also receive special care,Spacing of births to 24 months or above should be achieved with family planning and breast feeding,Health education should be given to mothers to commence ante-natal care early in the pregnancy,preferably before 20 weeks of gestation,Regular ante-natal clinic visits should be promoted and,Better literacy should achieved through education.
Anal incontinence following child birth.
(Post Graduate Institute of Medicine, Colombo: PGIM., 2004) ABEYSUNDERA, SS
There were a statistical significance of incontonence symptoms with instrumental deliveries when compared with normal vaginal deliveries at six weeks, four (15) in the instrumental delivery group (p = 0.034). General perception of health was also unsatisfactory and statistically significant in this group, five women (19) (p= 0.012). Birth weights of more than 3.5 kg was found to have significant association with unsatisfactory perception of health at six months, nine women (9) (p = 0.0003). There was also significant association between incontinence symptoms and this group, seven women (8) (p = 0.017). Caesarean section done in labor was found to have significant unsatisfactory general health compared to caesarean section not done in labor at six weeks. Women who were in labour for more than 8 hours showed a significant association with unsatisfactory general health at six week. There were no statistical significance found with unsatisfactory general perception of health or incontinence symptoms when compared to forceps and vacuum delivery, episiotomy suturing by medical officers and medical students, with 1st and 2nd degree perineal injuries, position of vertex at delivery. The proportion of anal incontinence in the present study is relatively smaller than reported in other countries. A much larger community based study should be undertaken to evaluate this problem and identify preventive measures.
An Analysis of patient care cost for selected preventable diseases in intensive care unit at Lady Ridgeway Hospital in 1992
(Post Graduate Institute of Medicine, Colombo: PGIM ., 1994) JAYATISSA, KLR
A retrospective study was performed to calculate the cost of intensive therapy of the patients with preventable conditions, admitted to LRH, ICU in 1992, on an individual basis. The study revealed that the Ministry of Health has achieved a certain level of success in controlling the preventable diseases. Intensive care utilization for this categories was only 23 percent as compared to 77 percent for non preventable diseases. Per patient day cost at the ICU was Rs.3,306.00. Which is almost ten times greater than that for general ward treatment at LRH. The cost was studied in terms of the ficed (equipment, building) 12 percent, semi ficed (staff emoluments and administration) 31 percent and variable (treatment) costs 57 percent. Emoluments of staff was 30 percent of the total cost. The mortality rate for patients with preventable diseases had remained at a high level (60 percent). 70 percent of the preventable conditions were due to birth asphyxia and complications of LBW. These two conditions produce high incidence of admissions under one month (97 percent out of all neonates). The money spent on treatment of birth asphyxia and LBW at LRH ICU would be sufficient to provide 175 ambu bags and 85,000 hand mucus extractors to reach an island wide coverage. Control programmes specific for these two problems with wide coverage is a need of the day. Among the nin preventable diseases, there were patients with long standing public health problems such as complications of worm infestation (0.7 percent), gastroenteritis (4.1 percent), malaria (0.7 percent), neonatal tetanus (1.4 percent), tetanus (1.4 percent),Tuberculosis (1.4 percent) and typhoid (0.7 percent). There were also patients appearing with newly highlighted public health problems such as dengue haemorragic fever (2.1 percent) and encephalitis (7.5 percent) which could be a major public health problems in the future. 8.9 percent of patients presented as poisoning which is easily preventable. 55 percent of the total ICU cost for preventable diseases has consumed by non survivors as compared to the cost consumed by survivors. This highlights well known important concept of prevention is better than cure. There is a growing demand for intensive care by the health professionals and other pressure groups, this may not be a right investment considering the loss of opportunity of primary and secondary care for large numbers due to lack of resources. While accepting the fact, that intensive care are integral part of tertiary care these should not be established at the expense of basic primary care.
An Analysis of utilisation, quality and costs of maternal and child health clinic services
(Post Graduate Institute of Medicine, Colombo: PGIM ., 1997) JAYATISSA, KLR
In Sri Lanka, maternal and child health (MCH) services are provided through a wide netwoek of clinics at hospital and field level. A descriptive study was carried out to determine the pattern of utilisation, unit costes and the quality of services provided through the different types of clinics in a Divisional Director of Health Services (DDHS) area. Several approaches were used to obtain the relevant data. they included: a community survey, clinic observations, interviews with consumers, revies of clinic records and a time and motion study. The findings of the community survey indicated a high of utilisation of state sector clinics approximately 95 percent. Comparison of the relevant characteristics of mothers who were regular users and non users of the clinic services indicated that the higher the socioeconomic caterory, the lower the extent of use, for both antenatal and child welfare services. The educated mothers had a tendency to attend the clinics to obtain immunisation services but not for the growth monitoring and promotional services. Use of child welfare services was positively influenced by the clinics being in the close proximity, while distance was not an influencing factor in the utilisation of antenatal services. No significant factors were shown to influence the use of family planning clinics, probably due to the selective nature of the family planning users identified for this study. The lowest unit cost for antenatal care (Rs. 159) was shown in clinics where all 3 services were provide. The unit cost for the child care was least in clinics where they provide only child welfare services i.e. Rs.55. To provide the family planning injection the combined clinics cost the least (Rs67). the influence of the pattern of utilisation of clinics, on the unit cost was clearly indicated in this analysis. there were no differences in the qualityof care between different types of clinics, when data from clinic observations, examination of records and interviews with recipients of the services were studied. However, several areas where improvements could be made were identified, many of them could be achieved with minimum costs with improved managerial efforts (e.g. improving supervision, implementing a client flow system in the clinics). Such interventions could have a psoitive influence on the quality of care and on costs. This study also identified that useful information can be obtained on quality of wervices by developing simple tools (e.g. check-list) and using them for periodic review. In order to gain improvements in the health status of mothers and young children, it is necessary to improve the quality of services. The additional resources needed for such improvements are minimum. Inter relationships between utilisation, cost of services and quality has to be considered for relevant changes.
An Analytical study of notifiable diseases in Sri Lanka at Lady Ridgeway Hospital for children during the period January - June 1989
(Post Graduate Institute of Medicine, Colombo: PGIM ., 2011-02-07) SENANAYAKE, GS
Under reporting is a world wide problem in prevention of communicable diseases. Developed countries have done several studies to identify the _ backs in their notification systems but in this country very few studies have been done in this field. Poor attitudes of doctors is the major set back for notification. Poor knowledge also plays an important role . This situation cannot be improved by enforcing the law alone but the mutual understanding between the curative health officer and preventive health officer.An attempt was made to evaluate the efficiency of the present notification system and it was found that only 38 percent of cases had been reported by the Lady Ridgeway hospital and of that only 12 percent had been investigated by the Public Health Inspectors in the Colombo district. This notification rate is similar to the rates of developed countries prior to introducing their new methods. Developed countries have used modern and expensive methods such as the toll-free telephone reporting system, the sentinel reporting system, the use of paid physicians and special public health personnel to canvass physicians etc. Developing countries cannot afford such expensive methods. Therefore these countries have to look for less expensive but more effective methods to improve their notification systems.
Assessment of client satisfaction on antenatal care services offered from the Castle Street Hospital for Women(C.S.H.W.)
(Post Graduate Institute of Medicine, Colombo: PGIM., 2002) Weragoda, WAJL
Objectives of the study were to determine the socio-economic and demography factors influencing the level of client satisfaction,to assess the client satisfaction on antenatal care service in the ward,in relation to interaction with the ward staff,services and facilities available in antenatal wards and toi assess the overall level of client satisfaction on antenatal care service deliverd in wards at the Castle Street Hospital for Women.Satisfaction regarding explantion on cleint's condition and result of investigations provided by ward staff was reported to be low.In general client satisfaction demonstrated in the study was at a hihg level.However,the communication between the client and the ward staff was observed to be low.this needs to be addressed by the hospital administrators.
Assessment of Growth Monitoring and activities Related to the Growth Promotion of Children aged one to three years in Colombo Municipal Council Area.
(Post Graduate Institute of Medicine, Colombo: PGIM., 2002) Wijayathilaka, HVBS
The main objective is to determine factors influencing growth monitoring.to assess growth promotional activities and the skills of mothers in interpriting growth curves in CHDR and also to determine the service factors for growth monitoring provided by the CMC.The study revealed 99 person of the children possessed CHDR.85 person of the childrenof the study area attend to CWC in the CMC.Knowledge of mother on Frequancy of weighting,has significantly improved the weighting of the children.Dropouts have significantly reduced when the birth space from the immediate younger sibling is less than one year.Fathers lacking school education have significant adverse effect on the weghting of the children.The type of clinic atrtending has not shown effect on the frequancy of weighting.
Assessment of Microbiological investigations and role of C - reactive protein in early Diagnosis of neonatal septicaemia
(Post Graduate Institute of Medicine, Colombo: PGIM., 2000) Weerakoon, W
The objectives of this study were the assessment of microbiology investigations and role of C-reactive protein levels in early dignosis and follow up of neonatal speticaemia.109 newborn babies admitted to the neonatal intensive care units of general hospital, Kandy over a three months period with suspected septicaemia were prospectively studies.Out of 109 babies who were screened,39 babies were confirmed septic,28 were non septic and 42 babies were categorized into an indeterminate group.Clinical features such as poor cry and activity,poor feeding and jaundice were found to be unreliable predictors of septicaemia.This study highlights the significance of C-reactive protein levels in 1 or day 2 in early detection of neonatal septicaemia,before sterile fluid cultures confirm and specify the aetiological diagnosis with antibiotic sensitivity results.The usefulness of CRP levels in following up septic babies needs to be assessed with further studies.
Assessment of quality of care provided at antenatal feild clinics in the Gampaha district.
(Post Graduate Institute of Medicine, Colombo: PGIM., 2003) Pinidiyapathirage, MJ
A large presentage of pregnent females did not receive information on some routine procedures carried out at antenatal clinics such as blood pressure monitoring (68.7) weight gain in pregnency (50.2).) and on the vaccine given or its side effects (55.3) therefore it is recommended that health personal be more awere of the right of woman to have access to information and to participate in decicions affecting their health.Antenatal record keeping was cinsiderd satisfactory.It is recommended that supervision of clinics and maintanence of proper supervision notes should be strengthened in order to overcome trivial problems and improve the quality of services renderd at field antenatal clinics.
An Assessment of quality of care provided by the Government family Planning clinic and field services in the DPDHS Area Colombo.
(Post Graduate Institute of Medicine, Colombo: ., 2004) Gunawardena, UD
Study recommends infrastructure improvement in family planning clinics, regular in-service training of the service providers on family planning and counselling and steps to improve domiciliary follow-up care. Divisional and district administration should pay attention to maintain adequate cleanliness in the clinics, make sure all the necessary instruments for IUD insertion are available in the clincs, regularly update the knowledge of the service providers; especially the PHMM and introduce quality oriented supervision. To improve FP counseling it is importnant to train the service providers on counseling, identifying a place with privacy for this purpose in the clibic, and recorganize poly/combine clinics so as to give more time and opportunity for the service providers to counsel the clients. Study also recommends development of IEC materials, screening checklists, and must know information to PHMM and make these available at field level. Routine evaluation of the quality of the FP services by the divisional and district managers using quality indicators, and incorporation of few quality indicators to the routine information system will be useful in monitoring the quality of the service regularly. Obtaining the views of the clients, service providers and the service managers are also important to improve the quality of the FP service delivery.
An Assessment of reproductive health education in Sri Lankan Schools.
(Post Graduate Institute of Medicine, Colombo: PGIM., 2003) SENARATNA, BCV
The study revealed that teachers percived their knowledge to be inadequate.Their sources of RH information were limited.Their teaching skills were percived to be inadequate partly due to the low knowledge in some RH contents areas,but more due to inadequate skills training they had received and persisting cultural variables.Unfavorable opinions in some teachers regarding RHEP,from the science subject curriculam were found to be adversely affecting current RHEP.In order to improve current RHEP,it is recommended that:RH as applied to school curriculam be cl;early defined widening and deepening contents;all curriculam developers be aware of past experiences of the RHEP and factors affecting attitudes and behavior of the adolescents;role of other organizations be considerd in RHEP;teachers' skills and knowledge be improved;both teachers' and students access to RH contents;and distribution of RH contents under different subjects be done in a complementing manner,or, alternatively,be taught under a single subject.
Assessment of selected aspects of quality of patient care at cardiology clinic General Hospital Kandy in year 2003
(Post Graduate Institute of Medicine, Colombo: PGIM., 2003) Perera, MDL
The objectives of this study were to assess selected aspects of quality of patient care.This study was carried out in cardiology clinic general hospital kandy design was a descriptive cross sectional study.Knowledge of patients regarding coronary heart disease.its complications and risk factors were poor .Health information gained from the nurces on risk factors for heart.disease was very poor.Health education activities were not observed during the entire study period. infrustructure facilities were satisfactory exept for the waiting area at the dispensery.Thre is much scope for the improment of quality of care for pationts with CHD at the cardiology clinic general hospital Kandy.
Assessment of some components of quality of patient care in general medical wards in the National hospital of Sri Lanka
(Post Graduate Institute of Medicine, Colombo: PGIM ., 1998) GUNATUNGA, CK
A descriptive study to assess some components of quality of patient care was carried out over a period of three months in general medical wards of NHSL. Patients who were diagnosed as having Bronchial Asthma, Diabetes Mellitus and Ischaemic heart disease were interviewed on discharge using a pre tested questionnaire. Two check lists were used to assess the completeness of the Bed Head Ticket and the Diagnosis card. Information provided to the patients at the time of discharge with regard to precautions at home, need of follow up visits, proper use of medicine and other related issues were found to be inadequate. Several omissions such as time of clerking and informations on family history and past drug history were noted in the BHTs. In small proportion of diagnosis cards serious omissions were seen. Majority of patients had a favourable opinion regarding the staff and other facilities available in the wards. Patients' knowledge on their disease was found to be unsatisfactory. It was recommended to provide in service training ro staff and to increase supervision to improve the quality of services related to recording of information on BHTs and diagnosis cards and devote more time to educate patients.
An Assessment of the role of dengue IgM-ELISA test in assisting in the diagnosis of clinically suspected cases of dengue haemorrhagic fever
(Post Graduate Institute of Medicine, Colombo: PGIM., 1994) BANDARANAYAKA, V
The study group consisted of a total of 273 samples from clinically suspected DHF patients whose samples were sent to the MRI between March and September 1995.Out of these,244 were acute samples and 29 were convalescent samples.These were grouped into the following.Group 1-consisted of 29 paired sera clinically suspected of having DHF who had a four fold rise in the HI antibody titre,where there were 5 primary dengue infections and 24 secondary dengue infections.The acute samples were collected between 1-8 days of onset of illness and the convalescent samples were collected between 12-20 days of onset of illness.Group 2- consisted of 111 single sera with a HI titre of \>= 1:2560 collected between 2-8 days of onset of illness.Group 3- consisted of 64 single serum samples with a HI titre of \>1:20 and \<1:1280 with the collection of blood samples between 2-9 days of onset of illness.Group 4- consisted of 40 single sera with a HI titre of \<1:20 and samples were collected between 1-9 days of the onset of the disease.No laboratory based study has been carried out using both HI and IgM MAC-ELISA tests in sri lanka.The serum samples were tested for both HI and IgM antibody.A commercially available IgM MAC-ELISA test kit (PanBio,Australia) was used.The appearance of IgM was seen in all 4 groups at a higher precentage in the 5-8 day than the 0-4 day of the onset of illness ie.the figures for group 1,2,3 and 4,on the 0-4th day of illness respectively were 25 per cent,17 per cent,18.2 per cent,and 12.5 per cent.On the 5-8th day of the illness it was 81.8 per cent,85.7 per cent,73.8 per cent and 20.8 per cent.This shows a similar respones as with other studies done in puerto rico and brazil.Further studies should be done to see the persistence of IgM in the sri lankan population.
Assessment of the role of the public health midwife in the delivery of primary health care
(Post Graduate Institute of Medicine, Colombo: PGIM ., 1991) DE SILVA, DS
This study was done to assess the role of the public health midwife in the delivery of primary health care. The study was carried out in RDHS division, Galle in 1988. 40 public health midwives were frandomly selected and questionnaire 1 and 2 were ad,omostered to them. Questionnaire 1 was designed to collect the basic data of the public health midwife and her needs and requirements as the provider. Questionnaire 2 had variables to assess the qualify and quantity of her work performace. Required records and returns were collected from the selected public health midwives. 800 eligible families were selected randomly from the study areas. Questionnaire 3 was adjministered to them. This consisted of variables to assess acceptance of the PHMM by the mothers and particulars of home visit of the Public Health midwife. the work performance of the study sample was assessed and the relationship of the work performance to demographic, socio economic, service experience and service facilities of the Public Health Midwife was analyzed. 92.5 per cent of the public health midwives lived in the working aarea. Home visiting of 45 pe cent public health midwives were statisfactory, but due to the wide variation of the size of the population, but due to the wide variation of the size of the population, number of visits per household was poor in 40 per cent of the public health midwife areas (an average of less than 3 visits per year). 60 per cent of the Public Health Midwives did an average of 2-3 antenatal field visits per mother.77.5 per cent of Public Health Midwives did 2 or less post partum visits per mother. 32.5per cent of the Public Health Midwife areas had more than 100 per cent registration of eligible families. Average number of home deliveries attended by the Public Health Midwife in the study area was 3 per year. 32.5 per cent of the Public Health Midwives had not attended a single home delivery during the year and 12.5 per cent of them had an average of 19 home deliveries for the year 1988. 65 per cent of the public health midwife areas had no untrained deliveries. The immunization coverage of children and pregnant mothers were very good in the study area. 92.5 per cent of the public health midwife areas had an average birth weight of 2.5 kg. or more. The performance of ante natal examination and immunization was good. The public health midwives scored very poorlyfor the examination of preschool child. The age of the public health midwife had no significant effect on her work performance. Performance of examination of pregnant mothers by married Public Health midwives were significantly better than the unmarried public midwives were significantly better than the unmarried public health midwives. The number of ante natal visits were significantly high in public health midwife with many children in her family. The public health midwife classified in the social class 4\&5 score significantly higher in the performance of immunization and talquist's test. Educational level of the public health midwife had no significant association to work performance. The service experience or the service period in the present station of the ppublic health midwife did not demonstrate any significant difference in work performance except, the number of untrained deliveries and the average birth weight in the area. The areas with senior public health midwives had significantly high number of untrained deliveries. there was positive correlation between the untrained deliveries and number of home deliveries (r= 0.9). The average birth weight was low in the areas where the public health midwives with less seniority. The work performance of public health midwives with and without bicycles were not significantly different. The population and the extent of the public health midwife area showed no significant association to work performance except, a negative correlation was found between the population and number of home visits per household. The average number of supervisions by the supervising public health midwife and public health nurse was 5 and 3 (respectively) per public health midwife per year. The number of supervisions by the medical officers were very poor. Considering the civil disturbances prevailed in the country during the study period and the limited facilities the performance of the public health midwife was stisfactory. Provision of achievable targets, organized supervision, manageable population and incentive for field work may improve the performance thus enabling the country to reach the goal of health for all by the year 2000.
Attempted Suicides Antecedents \& Consequences
(Post Graduate Institute of Medicine, Colombo: PGIM., 2000) Thalagala, NI
Based on the data obtained from different components of the study, it was possible to develop a " model" identifying relationship between precipitating factors,predisposing factors and depressive illness which enabled identification of strategies for intervention.Based on the observations of the study following recommendations could be made. Empowering individuals \& families to cope with situations where a suicidal act might occur, taking actions to control depressive illness, improving patient management skills and facilities at local and specialist hospitals, and establishing a program for the follow up of persons who attempt suicides after returning to community from hospital.
The Attitudes primary health care of second year and final year students, following the Assist. Medical Practitioner Course,at the National Institute of Health Sciences, Kalutara during the year 1987.
(Post Graduate Institute of Medicine, Colombo: PGIM., 1988) Kumarasiri, PVR
This study was undertaken to assess the attitudes,of second and final year students,following the assistant medical practitioner course at the national institute of health sciences,kalutara,towards primary health care,during the year 1987.Finding of this study showed that the attitudes to primary health care of the AMP students was not in favour of primary health care.This may be related to low priority being given in medical curriculum to prevention of diseases anf the promotion of health,and the neglect of some non medical sciences that may be considered the basic of community medicine such as sociology and anthropology.
Awareness of dental treatment modalities of patients attending for dental treatment
(Post Graduate Institute of Medicine, Colombo: PGIM ., 1991) RAVINDRAN, K
This study investigated the level of awareness of dental treatment modalities available to treat dental caries, gingivitis, periodontitis, orthodontic problems and oral cancer. A total of 309 patients attending one government dental clinic and two private dental clinicts were omterviewed during the study. Highly significant differences in awareness of dental treatment modalities existed among patients attending the three dental clinics and also among patients with different levels of education and income. But there was no significant difference in awareness of dental treatment modalities between males and females. Apart from tertiary education group and high income group, others had relatively low awareness of treatment modalities. No schooling group, primary education group and low income group had very low awareness of treatment midalities for all five diseases considered in this study. Generally patients are more aware of treatment modaities for dental caries than of treatment modalities for otner four diseases considered in this study.

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