Postgraduate Institute of Medicine: Colombo University

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Project report on child mental health problems.
(Post Graduate Institute of Medicine, Colombo: PGIM., 1996) Gunaratne, EMP
A field project report on the health education programmes for the prevention of mental health problem among children under 12 years of age whose mothers are employed abroad on the area of Rajawella
Health care needs of prisoners in Sri Lanka
(Post Graduate Institute of Medicine, Colombo: PGIM., 1999) TISSERA, WAA
Objective of this survey was to determins the health care needs of prisoners and to assess the facilities available to them an perceived by the prisoners. It is recomended that their should be a close link between the ministry of health and the department of and prisons and also to restucture the porison to deliver primitive pereative curative and rehalibilitative health care to prisoners
Traditional Treatment methods used by psychiatric patients seeking treatment from The University Psychiatric Unit, National Hospital Sri Lanka.
(Post Graduate Institute of Medicine, Colombo: PGIM., 2011-02-07) Karandawala,I
The subject of this study (N=405) were patients who sought psychiatric treatment at the Department of psychological medicine at the National Hospital of Sri Lanka over a period of 3 months.Traditional practitioners are consulted at some stage by many pshchiatric patients.Consulation of a traditional practitioner was significantly higher in among patients with low income and those with a psychtic disoder.There was no significant different in the age,sex,marital status,occupation and education levelbetween those who consulted and those who hadn't consulted a traditional practitioner.There was no significantdifference between the propotions of patients who delayed more than 6 months to seek psychiatric treatment in the group that sought traditional treatment initially and those who did not use it at any instance.
Indications for and Outcome of total abdominal Hysterectomy for benign disease.
(Post Graduate Institute of Medicine, Colombo: PGIM., 2005) BUDDHINATHA, KKJ
The principal indications were bleeding, pain or both giving the commonest diagnosis of dysfunctional uterine bleeding (53.4). Symptoms were severe enough to have a considerable impact on lifestyle. Otherwise, the women were in good health. During the first ten post-operative days, the women experienced a reduction in their ability to perform activities of daily living. Urinary (15.5) and wound (8.7) infections were the commenest complications. By three months, the principal symptoms had resolved for 97 of the women while there was significant improvement in urinary function, psychological health, activities of daily living, lifestyle activities and sexual enjoyment. Despite this, these changes did not meet the pre-operative expectations of some women. Most women reported substantial benefits from hysterectomy. However, women should be counselled about early, transient adverse effects. These findings can be served as a benchmark for a multicentre study.
A Study to evaluate the hospital dental services with reference to several alternative parameters
(Post Graduate Institute of Medicine, Colombo: PGIM ., 1997) WIMALARATNE, SRU
A research project was undertaken to evaluate the efficiency and productivity of the hospital dental services as well as the perception of patients and dentists regarding various aspects of the service. This project was conducted in two stages. Stage I wa a hospital based study conducted in the Kurunegala district and comprised of a work sampling study, survey of records and a cross sectional survey of random sample of 1305 patients attending hospital dental clinics in the district. State II of the project was a national mail survey of hospital dentists aimed at assessing their perceptions of the quality of the hospital dental services. I Stage I, the work sampling study revealed that on an average working day, hospital dentists spent only 40 percent of their time for clinical activities. They remained idle in their clinics for 15 percent of the time. While they were not available in the clinic for 45 percent of the time. The overall efficiency of the hospital dental service was estimated to be 40 percent. The survey of records disclosed that the predominant dental treatment provided in hospital clinics was extraction of teeth. The mean number of extractions per day per dentist was 14.04, while the mean number of scalings was 0.44 and the mean number of permanen fillings placed was 0.71. Only about 50 percent of the patients were aware of the working hours in hospital clinics. Preventive instructions were received by less than 40 percent of the sample. Over 75 percent of the patients spent over 60 minutes as waiting time in the clinics. Over 70 percent of the patients reported that the dentists spent less than 5 minutes in treating them. 80-90 percent of the patients were satisfied with the extractions r fillings carried out in the hospital clinics. The major reason given by those who were dissatisfied, was pain incurred by the treatment. In Stage II of the study, 61 percent of the dentists responded to the questionnaire. Their responses indicated that many dentists had an unfavourable opinion regarding the quality and quantity of equipment. instruments and consumables in the clinics. Infrastructural facilities were also not as good as expected by many dentists. Many dentists were also unhappy about other aspects of hospital infrastructure including water supply, toilet facilities and availability of space. A majority of dentists felt that the supply and maintenance of equipment was unsatisfactory. The supervision of hospital dental clinics too was considered unsatisfactory by 25 percent of the dentists. This study was the first definitive evaluation of the hospital dental services in Sri Lanka, which have been in existence for over 60 years. It has provided an objective profile of the hospital dental services from several perspectives, revealing several prominent shortcomings in the service. It is likely that the results of this investigation will of considerable value to health planners and administrators in the task of improving and further developing the existing services.
Infant feeding practices of mothers in urban slums and shanties of the Colombo municipality
(Post Graduate Institute of Medicine, Colombo: PGIM ., 1995) GOONEWARDENA, CSE
The objective of this study was to determine the knowledge, attitudes and practices of infant feeding among the urban slums and shanties of the Colombo Municipality. It also focused on the exclusive breast feeding practices of the aforesaid area. The study group comprised of 652 mothers with infants of 0 to 9 months of age was selected using a multistage sampling technique. Majority of mothers were housewives. The percentage of mothers exclusively bteast feeding was 95.06 percent at completion of one month. Gradually the percentage declined to 59 percent by the end of the completion of four months. Overall prevalence of breast feeding as at time of interview was 94.63 percent. There was a marked decline after 5 months of age. All mothers had trained assistance at delivery. 50 percent had initiated breast feeding within 1 hour of delivery. Income level of the family had a significant association with exclusive breast feeding whilst formal education and the age of the mother had no significant association with exclusive breast feeding. The education level of mother, nationality, parity and the presence of a grandmother/mother-in-law had no significant association to the overall knowledge of the mother on breast feeding/complementary feeding. The presence of a grandmother however had a significant association with breast feeding practice. The place of delivery had a highly significant association with initiation of breast feeding. Initiation was started very early in the municipal maternity homes in comparison to government and private hospitals. 30 percent of the mothers had introduced cunjee by the end of the fourth month, and 29.38 percent had introduced fruit juice by the end of the fourth month. This practice is incorrect . 50 percent of the mothers with babies under 5 months who had started on complementary food stated that they were adviced to do so by the midwife and/or clinic.
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.
Socioeconomic and Behavioural risk factors of home accidents in a rural area of Sri Lanka
(Post Graduate Institute of Medicine, Colombo: PGIM., 1992) KUMARASIRI, PVR
This study was under taken as there are no properly conducted community based study on home accidents in Sri Lanka. This study was conducted in three parts, a descriptive one, a prospective one and a case control one. The descriptive study covering a cluster sample of 4450 rural individuals from the Kegalle districts, revealed a prevalence of 8.2 percent for nome accidents. The rate was slightly higher for males than females. It was higher among the under 05 age group, tended to decline with increasing age up to 60 years. The prevalence was slightly higher among the over 60 age group. 23 percent of the home accidents reported during the study period did not result in injury. 64 percent resulted in mild injuries, 13.1 percent resulted in moderate injuries and only one accident led to serious injury. The common accidents among the less educated people were falls on the same level. Falls from height, cuts and objects fallen on the body, while these among more educated people were cut injuries and struck in between objects. More than 80 percent of all nome accident events took place in between 6.00 am and 4.00pm, nearly half of them were occurring between 9.00 am and 10,00am and 2.00pm and 4.00pm. the prospective study conducted on a random sample of 586, 01 to 14 years children, showed that the incidence of home accidents was 827.6 for 1000 children over a period of three months. Girls had more accidentsthan boys and the smaller children had more accidents than older. the socio economic and demographic factors identified by the study as ris factors were age, sex, birth order, number of under 15's living at home, age of the mother, educational level of the mother, monthly percapita income of the family, household lighting, sopcial class and the condition of the house. the case control study was undertaken on 105 pairs of 05 to 10 year old children for the purpose of relating the behaviour to the risj of home accidents. The results revealed that the children with behavioural problems had a 3.9 times higher risk of home accidents than those with normal behaviour.
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.
Prevalence, incidence and correlates of postpartum depression in the Puttalam District.
(Post Graduate Institute of Medicine, Colombo: PGIM., 2004) Rowel, DDS
The EPDS was considered a reliable and valid instrument to determine postpartum depression and the cut off scores were identified as 9/10 for antenatal and postnatal mothers. Prevalance and incidence of postpartum depression was 32.1 and 23.9 respectively. The correlates for prevalence were unplanned pregnancy, conflicts with husband, physical abuse during pregnancy, use of harsh words by the husband, death of a friend, normal vaginal delivery and low birth weight, illness and poor night sleeping pattern of the baby. The correlates for incidence were death of a friend, arguments with family members, normal vaginal delivery, condition of the baby, prematurity and illness of the baby. The use of the EPDS is recommended for field use by the public health staff. Mental health services to be made available and accessible. Family and pregnancy planning to be strengthened. To carryout awareness programs for health staff and the community on postpartum depression. To emphasize on life skills and personality development among the adolescent. Marriage counseling to be made avaliable to address issues of abuse and family conflicts. To strengthen the extended family system in order to support the mother in the care of the baby.
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.
Spontaneous Miscarriage and Subsequent Pregnancy Outcome.
(Post Graduate Institute of Medicine, Colombo: PGIM., 2005) Mohamed, Siraj SH
A cohort study with external controls was carried out among mothers presented to the De Soysa Hospital for Women. Study cohort consisted of 204 mothers presented in second pregnancy whose first pregnancy ended up as spontaneous first trimested miscarriage(P2 CO) age matched control cohort consisted of 204 mothors wo presented in second pregnancy with previous normal vaginal delivery (P2CO).These mothors were followed up throughout pregnancy and found no statistically significant difference ;in age, eethniity, monthly inocme and the levelof education itween the study cohort and control cohor.. There were statistically significant incresaed incidence of second trimester bleeding, Pregnancy induced hypertension,m complaints of reduced fetal movements, Babies of birth weight less than 2.5Kg and Neonatal Unit Admissions in mothers who had previous first trimester miscarriage than mothers who had normal vaginal delivery.(p\<0.05)
The Understandings of concept and attitudes on school-based health promotion among teachers coordinating school health clubs in Colombo DPDHS area.
(Post Graduate Institute of Medicine, Colombo: PGIM., 2003) Elvitigala, DJ
The majority of coordinating teacher possess more favorable attitudes on school-based health promotion. The coordinating teachers with more favorable attitudes were having well functioning school health clubs. However, the relationship between favorability of attitudes and understandings on concept of school-based health promotion was not described. The perceived obstacles to develop school health programme among coordinating teachers were assessed in areas of resources, planning process. According to coordinating teachers perception most important obstacles to develop school health programme were inadequate allocation of time. lack of parent participation and community involvement for school health and unavailability of proper monitoring and evaluation system to school health programme.
A Study of knowledge attitudes and practices on the use of oral rehydration salt in the management of diarrhoea among mothers and health care providers in a defined area in Sri Lanka.
(Post Graduate Institute of Medicine, Colombo: PGIM., 1990) EESWARAARACHCHIGE, P
It was found that there was widespread awareness of ORS among the mothers in this area. The educational level of the mother was significantly associated with her knowledge regarding ORS. There was no significant cultural barrier to the acceptance of oral rehydration solution. The public health midwife emerged as the chief informant on ORS to most mothers. Partial or total suspension of solid foods during diarrhoea was a common practice adopted by 67 per cent of mothers and 66 per cent health care providers. The educational level of the mother was associated with proper feeding practices during diarrhoea. Awareness, that malnutrition could be a serious consequence of diarrhoea was lacking among 72 per cent of the health care providers. ORS was used in the management of diarrhoea by almost all health care providers although there were different opinions about the procedures followed in it's use in the treatment of dehydration.
Rotavirus infection in Sri Lanka: Epidemiology, Clinical Presentation, Immuno response and diagnosis
(Post Graduate Institute of Medicine, Colombo: PGIM ., 1988) MENDIS, LN
Studies on rotavirus infection in Sri Lanka, including epidemiological, clinical, and immunological aspects are reported, as well as a comparison of Dakopatts ELISA and WHO ELISA for rotavirus detection. The investigations included a hospital based study of ome years duration, on acute diarrhoea in children; a two year prospective study on rotavirus infection in the first two years of life; studies pm mepmates amd om adits. ELOSA was used to detect rotavirus in stools, and rotavirus specific IgG and IgA in serum, breast milk and faeces. Single radial immunoddiffusion was used to quantitate tital igA in faeces. Electrophoresis of rotavirus RNA was performed in polyacrylamide gel using the Laemmli buffer system and a silver stain. Viruses were serotyped at the WHO Reference Laboratory in Birmingham. Rotavirus infection was prevalent throughout the year. 2 per cent of adults were infected at any one time. Children below two years experienced 0.9 episodes of rotavirus infection per child per year. 75 per cent of such infections were asymptomatic. They caused 5 per cent of diarrhoeal episodes in the first 2 years, and 20-30 per cent of episodes requiring hospitalisation. The 4 month -2year age group was the commonest requiring hispitalisation. The commonest presenting symptoms were watery diarrhoea, vomiting, and fever. Some episodes of blood stained diarrhoea appeared to result from double infections involving rotavirus. Such double infections were associated with protracted diarrhoea too. Case fatality associated with rotavirus diarrhoea was low. Prevalence studies of S-patternand L-pattern electropherotypes taken together with serotyping results indicated that, hers immunity to serotype 2 rotavirus lasted at least 3 years, and that there was no cross protection between serotype 2 and serotype 4. Although nearly 100 per cent babies received high titres of rotavirus specific placental and breast milk antibody, there was no evidence to show that they protected against rotavirus infection. A primary reponse to rotavirus infection (serum and intestinal) was observed in 75 per cent of cases and lasted approximately 5 months. Secondary and tertiary infection increased the numberof reponders to 100 per cent and significantly enhanced serum but not intestinal antibody. The duration of the secondary response was similar to that of the primary response.
A Comparison of post partum sequelae between mothers undergoing vaginal delivery and caesarian section.
(Post Graduate Institute of Medicine, Colombo: PGIM., 2003) Fernando, MMP
This study was planned with the objectives of describing postpartum health prpblems during the puerperium and to compare thes promlems between those undergoing vaginal delivery and caesarian section.this study that all mothers especially those who undergo vaginal delivery,should be assessed at least once following delivery for idintification and appropriate management of sequalae,which may need medical intervention.
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 on the outcome of a distance education programme on knowledge, attitudes and performances of public health midwives in post partum care of the mother and in care of the newborn
(Post Graduate Institute of Medicine, Colombo: PGIM ., 1997) FERNANDO, TEI
The objective of the study was to plan, develop, implement and to assess the outcome of a Distance Education programme for a group of identified Public Health Midwives (PHMM) in post partum care of the mother and on 'care of the newborn' in the field using an experimental study design. The study was carried out on Public Health Midwives working in the Divisional Director of Health Services (DDHS) areas of Kalutara and Galle Districts of Sri Lanka. The study population consisted of 519 Public Health Midwives attached to DDHS areas of the two districts who fulfilled the eligibility critera specified before the study. Randomisation of PHMM into study and control groups were achieved by randomization of DDHS areas. The baseline of knowledge, attitues and performances of the PHMM of study and control groups on study topics, were assessed before the intervention. A Multiple Choice Questions (MCQ) and a Short Answer Question (SAQ) paper were used to assess the knowledge. Attitudes were assessed by using a questionnaire. In assessment of performance of the PHMM a non participatory observation of a sub sample of PHMM using a check list was used. The basic socio-demographic and service information of the two groups were collected by a self administered questionnaire. Distance Education programme was implemented among PHMM of the DDHS areas randomized into the study group. This consisted of self learning modules on 'post partum care of the mother' and 'care of the newborn' in the field and three tutorials were distributed monthly while the control group were not exposed to the DE programme. the post intervention assessment was carried out using the same instruments and the same procedure used for the pre intervention assessment. It was conducted six weeks after the completion of the Distance Education programme. The results showed that the total knowledge scores of the study group has increased at a level which is satistically significant from 44.9+_7.3 to 62.0+_10.1 at the post intervention assessment (p\<0.001) in comparison to the control group which has improved from 44.9=_7.7 to 46.6+_11.0 during the same period (p\>0.05). However, the attitude scores of the study and control groups have only shown a slight improvement from 64.6+_20.8 to 66.7+_18.2 and 68.1+_19.2 to 71.3+_16.4 respectively. The difference of the attitude scores of the two groups obtained at the pre and post intervention assessments were not statistically significant (p\>0.05). The performance score of the two groups showed that the performance of PHMM of the study group has improved only in certain areas where as the pre intervention assessment scores were lower. This was not seen in the control group. The Distance Education approach was effective in improving the knowledge of the PHMM. Although it was not foound to be successful in improviving attitudes, it was effective in improving the performance of PHMMin selected areas. Planning, development and implementation of a Distance Education programme is feasible specially in the context of the availability of personnel and organizational structure of Divisional Directors of Health Services areas.
A Study of the performance of school dental therapists in Kurunegala health region
(Post Graduate Institute of Medicine, Colombo: PGIM ., 1992) WIMALARATHNE, SRU
This study was carried out in order to evaluate the performace of school dental therapists in the Kurunegala health region. Apart from that the study helped to identify, some problem and constarints faced by them and their attitude towards the service. One aspect of the study performance of scnool dental therapists was assessed in relation to time utilization for productive clinical activities. By analyzing the records, it was found that the school dental therapists in the health region had not fulfilled their time targets as expected by the ministry of health. Secondly, the other part of the study seemed to effect the performance of school dental therapists. The changes of oral health of the target population were studied and it revealed the improvement of therir oral health status substantially. Thirdly, according to the study, it was revealed that most of the school dental therapists in the health region were not satisfied with their present occupation owing to the rasons attributed to their career prospects. Some major problems and constraints faced by them at base school clinics and out reach clinic were identified.
A Community based study on suicidal behaviours from suicidal ideations to compited suicide in Ratnapura District
(Post Graduate Institute of Medicine, Colombo: PGIM., 2003) Samaraweera, DSD
Psychological autopsy method was used to investigate potential risk factors and the cicumstances that led to completed acts of suicide.From this information,a psychological tretment package was developed based on cognitive behaviour therapy (CBT)linking the community-based to tretment development research.The knowledge on the risk factors significantly associated with suicide prevention programmes.Suicide prevention should be commuinty based as most of these people do not visit a health care provider.Adequate tretment of psychiatric patients and improved detection and tretment of commen mental disoders in the general population are essential for suicide prevention .Researchers extending this study further inthe community can give more insight into the issue .

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