Conflict in Sri Lanka. Sri Lanka's health service is a casualty of 20 years of war.
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The family and demographic change in Sri Lanka.
Sri Lanka has almost completed the demographic transition with low mortality rates and fertility rates approaching replacement levels. Sri Lanka shares these characteristics with the South Indian states of Kerala and Tamil Nadu in contrast to elsewhere in South Asia where mortality and especially fertility rates remain much higher. A key part of the explanation for these differences lies in the nature of the family. The Sri Lankan family is essentially the conjugal unit of husband, wife and dependent children whereas in northern South Asia agnatic relations between son and parents are central to family structure. Related to this family system the position of women in Sri Lankan society was relatively high in South Asian terms. Consequently women had a strong say in health and fertility behaviour. When required, for example, mothers take the initiative in seeking health care for themselves and their children. Importantly family structure has facilitated female education which is associated with both mortality and fertility decline. There are few concerns that the values imparted by secular education are contrary to the values of the family or to women's roles within it. The egalitarian family structure has also contributed to fertility decline by raising the costs of children and reducing the long-run benefits to be gained from them. Sri Lanka is particularly distinctive in the contribution of changes in female age at marriage to its fertility decline, marriage age having risen six years this century. This change has been accompanied in recent times by a shift from family-arranged to self-selected (love) marriage. The explanation lies in changes in the socio-economic system which have reduced the centrality of the family in wider social and economic relations, and placed a greater premium on an individual's own abilities and attributes.
Birth Rate↗
A study of the investigation of death (coroner system) in Sri Lanka.
Sri Lanka (Ceylon) inherited the 'coroner system' of investigating death in the early nineteenth century. Unlike in England and Wales, the coroner system in Sri Lanka did not change much in the last century. This study, the first of its kind, was performed for a period of three months in 1995 to analyse the causes and circumstances of deaths reported for inquest, and the number of autopsies performed. Of the 868 cases reported to the Inquirer, the circumstances were not determined in 94 cases at the initial inquest proceedings. Of the other 774 cases, 454 (58.7%) were natural deaths. Autopsies were performed on 44.5% of natural deaths, 58.2% of accidental deaths, 96% of road traffic accidents, 44.9% of suicides and 81.6% of homicides. Coronary heart disease was the leading cause of natural death (33.9%). Head injuries were responsible for 31.8% of accidental deaths while burns accounted for 24.5% of accidental deaths and 46.3% of suicides. There were 38 cases (4.9%) of homicide of which autopsies were performed in 31. There is an urgent need to reform the century-old laws relating to inquest procedures in the country.
Autopsy↗
Suicides and pesticides in Sri Lanka.
Sri Lanka has one of the highest rates of suicide in the world (29 per 100,000 population in 1980). Suicides are especially frequent among young adults, both male and female. Compared to the US, the suicide rate for males ages 15 to 24 years in Sri Lanka is nearly four times greater; the female rate nearly 13 times greater. The most common mode of suicide is ingestion of liquid pesticides.
Adolescent↗
Healthcare rationing: a guide to policy directions in Sri Lanka.
Sri Lanka's tax-financed public health system has played a significant role in achieving high levels of health status for its people. The 21st century brings new challenges in terms of rapidly aging population and increasing prevalence of NCDs. These challenges are expected to place a heavier burden on the government health financing and provision. However, the government expenditure as a proportion of GDP has declined to 1.1-1.2%, the lowest level, since the country's independence in 1948. Available funding is channeled out of the preventive services and primary healthcare to the complex hospitals, contributed by inadequacy of prioritization in resource allocation. Already, there are evidences of high level of under-funding and implicit rationing with higher impacts on the rural poor and the estate poor. Analysis of the government subsidization of healthcare shows shifting of benefits to the urban better-off from the poor. In light of the findings, the paper focuses attention on policy directions the government health sector in Sri Lanka should follow.
Health Care Rationing↗
The drug abuse problem in Sri Lanka.
Sri Lanka's experience in dealing with drugs of abuse and with the drug abuse problem is unique in many ways. From the sixteenth century until the middle of the twentieth century, the colonial powers regulated the use of opium as a revenue earning measure. Since independence was achieved in 1948, various measures have been taken to scale down the abuse of opium, cannabis and certain pyschotropic substances, but not all these efforts have been successful. In the wake of ethnic problems, there has been an increase in the involvement of Sri Lankan nationals in smuggling drugs across national frontiers. The absence of a comprehensive national policy on drug abuse has been a major constraint on law enforcement and the development of interventions for education, treatment, rehabilitation and crop substitution. Sri Lanka is fortunate to have a rich tradition of networks of non-governmental organizations and religious institutions, and these can be mobilized to discourage the use of intoxicating drugs and alcohol.
Drug and Narcotic Control↗
Preventive dentistry--a priority in Sri Lanka.
Sri Lanka, being a developing country, cannot resort to high technology and sophisticated dentistry to achieve coverage for its whole population. The most cost effective means of controlling and preventing oral diseases has to be used and the primary health care approach with its basic philosophy of self-reliance and community participation will contribute substantially to the improvement of oral health of Sri Lankans. This paper outlines the decisions made in relation to preventive dentistry and the epidemiological data on which the goals were based.
Adult↗
Community-based rice ecosystem management for suppressing vector anophelines in Sri Lanka.
Sri Lanka is one of the Asian countries most affected by mosquito-borne diseases, especially malaria. This 18-month study assessed the effectiveness of a new community-based ecosystem management programme to control mosquito vectors in the country's rice ecosystem. Farmers in a malaria-prone village were educated and motivated to engage in source reduction as well as measures to restore and maximise rice ecosystem functions. Over the course of the programme, the impact of farmers' ecosystem management on local mosquito ecology was also examined. Although little impact was detected on Culex and Aedes densities, adult Anopheles density was significantly suppressed in the southwest monsoon season. Rice farmers who manage their ecosystems can reduce the burden of Anopheles mosquitoes, interrupt malaria transmission and prevent the destruction of ecosystems.
Adolescent↗
Sri Lanka: sterilization bonus announced in Sri Lanka; new CBD experiments in Sri Lanka; orchids and family planning.
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Asia↗
Protective measure use and symptoms among agropesticide applicators in Sri Lanka.
Sri Lankan farmers use large amounts of pesticides to control the pests affecting their vegetable crops. Improper use of pesticides by farmers has resulted in poisoning of occupational origin. This paper examines the use of protective measures by pesticide applicators and its relationship to their illness symptoms. The data were collected by interviewing a stratified random sample of 150 farmers from predominantly vegetable growing areas of the Matale district during 1990/91 using structured questionnaires. These data were supplemented with secondary data and observation of all stages of pesticide application. Scales were constructed to measure the domains of material style of life, awareness and use of protective measures, and illness symptoms experienced by pesticide applicators. It was found that most of the farmers were aware of the protective measures to be used when applying pesticides. There was, however, no significant positive relationship between awareness and use of protective measures. The main reason for not using protective measures was discomfort. The most common symptoms reported by pesticide applicators were faintish feeling, headache and dizziness. A significant negative relationship was observed between use of protective measures and symptoms exhibited within four hours of application. It is recommended that protective materials adapted to the climate and socio-economic conditions of farmers be developed, and that farmers be encouraged to use these protective materials through appropriate educational efforts and incentives.
Adult↗
Anopheles culicifacies Y-chromosome dimorphism indicates sibling species (B and E) with different malaria vector potential in Sri Lanka.
In Sri Lanka, malaria is transmitted mainly by Anopheles culicifacies Giles sensu lato (Diptera: Culicidae). In India, this nominal taxon comprises sibling species A, B, C, D and E, distinguished by their chromosome morphology. Species B (identified by polytene chromosome sequence Xab, 2g1 + h1) is not such an efficient vector of malaria as other members of the An. culicifacies complex in India. All specimens of An. culicifacies s.l. examined from Sri Lanka possess Xab, 2g1 + h1 polytenes, previously interpreted as species B, despite their important vector status. Recently, species E was described from Rameshwaram Island (Tamil Nadu, India) between Sri Lanka and the Indian mainland, where both species B and E are sympatric. Species B and E share polytene sequence Xab, 2g1 + h1 but differ by the mitotic Y-chromosome being acrocentric in species B, submetacentric in species E, the latter implicated as vector of vivax malaria. From May 1999 to January 2000, we surveyed Y-chromosomes of male progeny from An. culicifacies Xab, 2g1 + h1 females collected from cattle bait in diverse malarious districts of Sri Lanka: Badulla, Monaragala, Puttalam and Trincomalee. Karyotypes of readable quality were obtained from 42/83 families examined, with overall proportions 24% acrocentric and 76% submetacentric Y-chromosome carriers, both types being sympatric in at least 3/4 localities sampled. By analogy with the situation on Rameshwaram Island, we interpret these observations to demonstrate widespread presence of two members of the An. culicifacies complex in Sri Lanka, their karyotypes being compatible with species B and E, the latter predominant and having greater vector potential.
Animals↗
Ethnic differences in contraceptive use in Sri Lanka.
In Sri Lanka in 1975, the majority Sinhalese had a much higher use of contraception than either the Sri Lanka Tamils or the Moors. This study uses a national sample of women of childbearing age gathered by the Sri Lanka World Fertility Survey in 1975 to assess four possible reasons for differential contraceptive use: (1) differences in socioeconomic position; (2) cultural differences; (3) minority status; and (4) differential access to family planning services. The first three explanations focus on differences in the demand for contraception while the fourth explanation focuses on differences in the availability of contraceptives. The socioeconomic, cultural, and minority status hypotheses fail to explain the higher contraceptive use among the Sinhalese. The evidence is consistent with the idea that ethnic differences in contraceptive use were largely caused by differential access to family planning services.
Adult↗
The current state of leprosy control activities in Sri Lanka.
In Sri Lanka the overall prevalence of leprosy was 0.14 per 1000 population and the incidence 0.07 per 1000 population at the end of 1987. Although the endemicity is low in the island, disease transmission has not yet been achieved as the annual detection of new cases and the child rate has been gradually rising. The major activities of the leprosy control programme are case-finding, treatment and defaulter retrieval, health education, rehabilitation and training. The field programme is implemented through 15 specially trained paramedical workers. In addition there are 5 medical officers attached to the Anti-leprosy Campaign. The Director of the Anti-leprosy Campaign is in overall charge of the National Leprosy Programme and is also project manager for the Sri Lanka Emmaus Leprosy Control Project.
Female↗
Osteoporosis in Sri Lanka.
In Sri Lanka the median age, which was 25 in year 1991, is expected to rise to 45 by the year 2041 and half of the population will be over 45 years and vulnerable to osteoporosis. We describe 2 large epidemiological studies done in Sri Lanka. The first one, Galle Prospective Osteoporosis Survey, in its initial phase recruited 350 women randomly from the current voters registers. 42.4% of women in the entire sample and 61.5% in women over 50 years were found to have osteoporosis. The second study was to assess the prevalence of stiffness index with heel ultrasound and calcium intake in a suburban population close to Colombo. We randomised 1250 from electoral register numbers and 986 people consented to participate. Stiffness index start decreasing after the age of 50, which is the average age of age of menopause. In men stiffness decreases after age of 70.
Adult↗
Behavioral convergence and institutional separation: an analysis of plural medicine in Sri Lanka.
In Sri Lanka, as in India, two formally structured systems of medical service exist side-by-side. While Western-style biomedicine is believed to be useful, Ayurvedic medicine is also well established and commonly used. Underlying one explanation for the existence of plural medical systems is the idea that traditional and Western systems of medicine provide unique treatments for distinct problems, and patients having certain characteristics select them accordingly. A brief review of several studies in Sri Lanka suggest, however, that Western and Ayurvedic physicians practice medicine in similar ways, are selected for treatment of very similar symptoms, and from the patient's point of view are often indistinguishable from each other. A second structural explanation rests on the fact that, as institutions, Western and Ayurvedic medicine have effectively divided up territory and jobs to the satisfaction of each; this division allows for upward mobility, through medicine, for young people from different segments of society. Thus these medical systems persist, not because each provides something unique for patients, but because they provide access to status and power for the physicians themselves.
Delivery of Health Care↗
Occurrence of aflatoxins in parboiled rice in Sri Lanka.
In Sri Lanka, rice is the main staple which is mostly processed into parboiled rice. The levels of aflatoxin B1 (AFB1) and aflatoxin G1 (AFG1) in parboiled and raw milled rice collected from major rice producing areas and rice consuming townships were estimated. In almost all the samples of parboiled rice examined, the AFB1 and AFG1 contents were significantly higher than in raw milled rice. The highest AFB1 content was 185 micrograms/kg and AFG1 content 963 micrograms/kg. These samples were collected from a major rice producing/milling district where the mean relative humidity is 78% and mean annual temperature 27 degrees C which is the highest amongst the rice growing areas in Sri Lanka. Raw rice was either free of aflatoxins or when toxins were detected, they occurred in less than 10% of the samples. The frequency of occurrence of surface fungal flora (Aspergillus/Penicillium) and aflatoxin content in market samples was closely related. Brownish or greenish moldly rice samples with fermented odour contained over 1000 micrograms/kg of AFB1.
Aflatoxin B1↗
Health care systems in transition III. Sri Lanka, Part I. An overview of Sri Lanka's health care system.
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Delivery of Health Care↗
Thalassaemia in Sri Lanka: implications for the future health burden of Asian populations. Sri Lanka Thalassaemia Study Group.
BACKGROUND: Thalassaemias pose an increasing problem for the Indian subcontinent and many Asian countries. We analysed the different types of thalassaemia in the Sri Lankan population, surveyed gene frequencies in schoolchildren, and estimated the burden of disease and requirements for its control. METHODS: We analysed blood samples from patients attending clinics in nine hospitals and defined the different types of beta thalassaemia by high-performance liquid chromatography (HPLC) and DNA analysis. The range of mutations was obtained by analysis of beta-globin genes. Capillary blood was obtained from schoolchildren from different parts of the island and analysed by HPLC to provide an approximate assessment of the carrier frequency of beta thalassaemia and haemoglobin E (HbE). To estimate the frequency of alpha thalassaemia the alpha-globin genotypes were also analysed when it was possible. FINDINGS: Blood samples were obtained from 703 patients with beta thalassaemia and from 1600 schoolchildren. The thalassaemia mutations were unevenly spread. Although 23 different beta-thalassaemia mutations were found, three accounted for the thalassaemia phenotype in about 70% of the patients, most whom are homozygotes or compound heterozygotes for IVS1-5 (G-->C) or IVS1-1 (G-->A). The third common mutation, codon 26 (G-->A), which produces HbE, interacts with one or other of these mutations to produce HbE/beta thalassaemia; this comprises 13.0-30.9% of cases in the main centres. Samples from 472 patients were analysed to determine the alpha-globin genotype. Overall, 15.5% patients were carriers for deletion forms of alpha+ thalassaemia. Average gene frequencies showed that there will be more than 2000 patients requiring treatment at any one time, in the future, of whom those with HbE/beta thalassaemia will account for about 40%. INTERPRETATION: In Sri Lanka, interactions of the two common beta-thalassaemia alleles will nearly always result in a transfusion-dependent disorder. However, about 40% of patients will have HbE/beta thalassaemia, which has a variable course. The management of these disorders could require about 5% of the total health budget. We need to learn more about the natural history and appropriate management of HbE/beta thalassaemia if resources are to be used effectively.
Adult↗