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Biomedical subjects

D Perera

Publications and source records attributed to D Perera.

10 recordsLinked to original sources
PubMed2000

A village treatment center for malaria: community response in Sri Lanka.

Early diagnosis and treatment of malaria cases is one of the basic elements of the current global malaria control strategy. In order to provide this service to people in rural areas there is a need for new cost-effective approaches. To ensure that such new approaches are acceptable to the target communities, it is important to know the rationale for people's malaria treatment-seeking behavior. The present study provides insights into the reasons for people's preferences for different types of healthcare facilities and describes variation of these preferences within a rural community in Sri Lanka. The study reports on the experiences with the establishment of a village health facility and its effect on the treatment-seeking behavior of the population. After the introduction of the village treatment center it quickly took over the role of main provider for diagnosis and treatment of malaria from the government facilities. The treatment center did not improve the response time in seeking treatment for young children, but the delay for adults was reduced by 1-2 days. Mothers with small children often preferred the government facilities since they wanted a more qualified opinion than available from the locally recruited staff of the village treatment center. The treatment center significantly reduced the stress and discomfort experienced by the elderly and handicapped segment of the community. The study indicated that the effective catchment area of a village treatment center will be influenced by the degree of initial support from key individuals in the communities, the selection procedure and training of assistants, and the history of the relationships between different villages to be served by the center. The government health services and communities across the dry zone of Sri Lanka could benefit substantially from the establishment of more village treatment centers. To ensure the long-term sustainability of these type of facilities it is necessary to assess the feasibility of charging a user fee and establishing multi-purpose clinics. Government policies and administrative procedures will need to be adjusted to make the successful operation of village treatment centers possible.

Adult↗
PubMed1999

Isolation of subgenus B adenovirus during a fatal outbreak of enterovirus 71-associated hand, foot, and mouth disease in Sibu, Sarawak.

BACKGROUND: In mid-1997, several children died in Sarawak, Malaysia, during an epidemic of enterovirus-71 (EV71) hand, foot, and mouth disease. The children who died had a febrile illness that rapidly progressed to cardiopulmonary failure and the cause was not satisfactorily resolved. We describe the isolation and identification of a subgenus B adenovirus from the children who died. METHODS: We studied two groups of children presenting to Sibu Hospital from April 14 to Sept 30, 1997. For children who died, the inclusion criterion was death after febrile illness, and for those who did not die it was acute flaccid paralysis (AFP). Serum and cerebrospinal fluid samples were tested for IgM antibodies to Japanese encephalitis and dengue viruses. Viruses isolated were identified by immunofluorescence, reverse-transcriptase PCR, or PCR and DNA sequencing. FINDINGS: Enterovirus was isolated in three (19%) of 16 children who died and in none of the eight surviving children with AFP. However, an agent that was initially difficult to identify was found in ten (63%) children who died and five (63%) surviving children who had AFP. The agents isolated from ten (66.7%) of these 15 children were eventually identified as adenoviruses and were isolated mainly from clinically important sterile sites or tissues. All the enterovirus-positive children who died had this second agent. INTERPRETATION: Our data raises doubts that EV71 was the only aetiological agent in these deaths.

Adenoviridae↗
PubMed1999

Cost of malaria control in Sri Lanka.

The study provides estimates of the cost of various malaria control measures in an area of North-Central Province of Sri Lanka where the disease is endemic. We assumed that each measure was equally effective. In these terms, impregnating privately purchased bednets with insecticide was estimated to cost Rs 48 (US(40.87) per individual protected per year, less than half the cost of spraying houses with residual insecticides. Larviciding of vector breeding sites and especially the elimination of breeding habitats by flushing streams through seasonal release of water from upstream reservoirs was estimated to be cheaper than other preventive measures (Rs 27 (US$ 0.49) and Rs 13 (US$ 0.24) per individual protected, respectively). Inclusion of both operational and capital costs of treatment indicates that the most cost-effective intervention for the government was a centrally located hospital with a relatively large catchment area (Rs 71 (US$ 1.29) per malaria case treated). Mobile clinics (Rs 153 (US$ 2.78) per malaria case treated) and a village treatment centre (Rs 112 (US$ 2.04)) per malaria case treated) were more expensive options for the government, but were considerably cheaper for households than the traditional hospital facilities. This information can guide health planners and government decision-makers in choosing the most appropriate combination of curative and preventive measures to control malaria. However, the option that is cheapest for the government may not be so for the householders, and further studies are needed to estimate the effectiveness of the various preventive measures.

Capital Expenditures↗
PubMed1997

Outcome for patients with abdominal aortic aneurysms that are treated non-surgically.

BACKGROUND: There are few reports in the literature describing the outcome for patients with abdominal aortic aneurysm who are not treated by surgical repair. This is in spite of the fact that this group of patients often defines the success of surgical treatment. The purpose of this report is to review those patients from St George Hospital Kogarah who have been rejected for surgical therapy and to examine the long-term outcome and mode of demise of these patients. METHODS: At the end of December 1992 we completed a computerized list of all patients seen at St George Hospital Kogarah with abdominal aortic aneurysm. Since that time we have continued to accrue patients to this list and obtain follow-ups prospectively. End points examined in this study were aortic aneurysm transverse diameter, sex, age, intercurrent illnesses, reasons for not undertaking surgical treatment, length of survival and cause of death. RESULTS: The mean age of patients in this series was 77 +/- 8.29 years (SD). Survival at yearly intervals for 5 years in our 101 patients were 69, 55, 44, 35 and 33%, respectively. For patients with an abdominal aortic aneurysm of < or = 5 cm, the 5-year survival rate was 42% while for patients with an abdominal aortic aneurysm of > 5 cm, the 5-year survival rate was 25%. There were 66 deaths in this series; 40% were due to cardiopulmonary events and 30% were due to ruptured abdominal aortic aneurysm. The median time between presentation and death was 12 months. CONCLUSION: The patients from this report were significantly older than those reported from previous series. We believe that it will become increasingly important to develop methods of selection of patients for current and newer modalities of treatment for abdominal aortic aneurysm. It will be increasingly important for groups offering these treatments to be able to explain to patients what their prognosis is likely to be should they not be selected for those treatments.

Aged↗
PubMed1993

[Vacation].

Explore the source record for details and available documents.

Humans↗
PubMedDate not supplied

Bartonellosis in Zamora Chinchipe province in Ecuador.

Human bartonellosis was investigated in the Ecuadorian province of Zamora Chinchipe; 17 cases were identified retrospectively from hospital records over the period 1984-1995, mostly from 6 communities in the provincial district of Zumba. A questionnaire concerning risk factors for disease transmission was administered in these 6 communities. Blood samples were taken from individuals with current febrile illnesses or skin lesions suggestive of bartonellosis. Samples for detection of Bartonella bacilliformis were also taken from all school-age children in communities where historical cases had been identified by questionnaire. No bacteriologically positive case was identified and no evidence of asymptomatic infection was detected. Risk factors for disease transmission, identified by the questionnaire, included the presence of sick or dying chickens and guinea-pigs. It was suggested that bartonellosis is a zoonosis with wild animals, probably rodents, as the reservoir. The widespread use of residual insecticides and the easy availability of antibiotics is likely to have modified the epidemiology of this disease over the last decade.

Adolescent↗