[Type the document title]

Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from –

Non Communicable Disease Unit, Ministry of Health

Dr. Anura Jaysasinghe MD, MSc, MBBS

υ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Acknowledgement

I should thanks for all stakeholders who contributed to accomplish this task. Especially, I wish to express our deep sense of gratitude to the Japan International Cooperation Agency, Sri Lanka for their invaluable support in providing us with necessary human resource to complete this project.

It‘s my pleasure to thanks staff of Postgraduate Institute of Medicine library, Alcohol and Drug Information Centre, Sri Lanka Medical Association Library, National Science Foundation, World Health Organization library , University of Colombo and Ministry of Health Library, who gave fullest support to carry out this task.

I would also take this opportunity to thank all the authors who made available their publications to meet the requirement of this project. I would also like to express my gratitude towards the colleagues of Ministry of Health Sri Lanka for their fullest support and encouragement in completion of this important project.

Lastly on behalf of the NCD unit, my special thanks goes to the research assistant Sayuri Nakandala, for her effort in making this project a success.

Dr. Anura Jayasinghe. MD, MSc, MBBS Principal Investigator Non Communicable Disease Unit Ministry of Health Sri Lanka.

φ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Contents

Acknowledgement ......................................................................................................................... 1

1. Introduction ........................................................................................................................... 3

2. Objective ............................................................................................................................... 3

3. Methodology ......................................................................................................................... 4

Key words*: ............................................................................................................................... 6

4. Results ................................................................................................................................... 7

5. Discussion .............................................................................................................................. 8

6. Limitations ............................................................................................................................. 9

7. Conclusion ............................................................................................................................. 9

References .................................................................................................................................... 9

Group A Publications (Studies which showed the prevalence of NCD’s and their risk factors in the general population) ..................................................................................................................... 10

Group B Publications (Studies which found under the key words and carried out among specific population) ................................................................................................................................ 101

Group C Publications (Studies found under the key words, but unable to meet the criteria for Group A and B) .......................................................................................................................... 158

χ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

1. Introduction

Sri Lanka faces escalating health care costs with rising rates of Non – Communicable Diseases (NCD’s) such as Cardiovascular Diseases, Cancers, Chronic Respiratory Diseases, and Diabetes as well as their risk factors such as Obesity, physical inactivity, smoking, High sugar and salt intake, etc.

Due to rising levels of urbanization: sedentary lifestyles, unhealthy diet, excessive use of alcohol and cigarettes, people are increasingly exposed to the risk factors of NCD’s and as a result, create new burden for the health care system to cater for their health needs. The effect of reducing risk factors such as cigarette use, alcohol consumption, promoting an active lifestyle and eating balanced diets, will go a long way in reducing the prevalence of NCD’s in Sri Lanka (1).

The Ministry of Health has introduced “The National Policy and Strategic Framework for Prevention and Control of Chronic Non- Communicable Diseases” with the aim of reducing the burden due to chronic NCD’s by promoting healthy lifestyles, reducing the prevalence of common risk factors, and providing integrated evidence-based treatment options for diagnosed NCD patients. The Ministry of Health has given priority to certain strategic areas in the effort to achieve the goals such as to implement a cost-effective NCD screening program at community level (2).

The aim of this project was to uncover the prevalence of NCD and their risk factors in Sri Lanka, and to assess the socioeconomic burden they impart on the population. Findings of studies conducted by other organizations regarding NCD’s would helpful to check the reliability of routine survey of the Ministry. These valuable information will eventually be used to plan and monitor prevention programme, which conduct by the Ministry of Health.

2. Objective

To compile studies and reports on prevalence of Non Communicable Diseases and their risk factors in Sri Lanka published from 1990 – 2012.

ψ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

3. Methodology In order to achieve the objective of this project, there was a need to find the all physical and electronic data published on the topic of NCD’s. However, there was no specific study compiled for this purpose, and so a search was carried out to find the definite locations of the publications on different directories such as “The Profile Partner in Health”, published by WHO Sri Lanka.

Initially, the details of different organizations were obtained, which have libraries containing the relevant publications on NCD, from several directories. Many online databases were also looked into for studies carried out in Sri Lanka with regard to NCD’s. After preparing a list of organizations, libraries, research institutions and websites which contained potential data for this purpose, the relevant personnel in charge of the respective institutions were contacted, either by visiting them personally or over the phone, and gained permission to use their facilities. According to a schedule, they were visited during the August to November 2012. A list of keywords was determined based on the risk factors and prevalence of NCD’s. Permission was vested by the Ministry of Health to visit the particular institutions.

The first institution visited was the Post Graduate Institute of Medicine (PGIM) Library. The PGIM is an institute attached to the University of Colombo, which is responsible for the specialist training of medical officers. It is recognized internationally for its training programmes, and works in close collaboration with the Ministry of Higher Education, Ministry of Health, Faculties of Medicine and Professional Colleges. It is situated in Norris Canal Road, Colombo 07. With help of the Senior Librarian, a list of references was found using the keywords in their database. The publications identified were mainly theses and dissertations compiled by the postgraduate trainees in Medicine to fulfill the requirement for the Doctor of Medicine and Master of Science degrees in different fields (3). All of the relevant publications were studied and the essential information was extracted and noted down on a Microsoft Word document. The Word document was copied on to the software program EndNote. Certain authors were contacted to obtain clarification on areas of the publication and to gain further information.

Then, information collected from Alcohol and Drug Information Centre (ADIC). ADIC is a well-recognized National Resource Centre, which works to reduce drug demand. It provides a voluntary and charity service for the public by collecting and disseminating information, conducting seminars, training, and workshops on the effects of substance abuse and mobilizes communities through effective strategies. The institution also works in association with many international networks such as the Global Alcohol Policy Alliance, etc.(4). The ADIC conducts a variety of surveys designed to determine the trends of alcohol and tobacco consumption on selected districts in order to support other programmes of ADIC and the information needs of the country. The institution annually evaluates the activities of selected programmes and donor funded projects in order to determine the impact and effectiveness of the activities carried out.The ADIC library compiles data from spot surveys into reports. These surveys along with research evaluations were extracted to the program EndNote and scrutinized.

The Sri Lanka Medical Association (SLMA) was visited subsequently. The SLMA is the national medical professional association in Sri Lanka, which brings together medical

ω Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

practitioners of all grades and all branches of medicine. It is in fact the oldest professional medical association in Asia and Australasia, with a proud history dating from 1887 (5). Many published journals such as Ceylon Medical Journal, Journal of Medical Sciences, British Medical Journal and several other local and international journals were examined for relevant publications. The online databases available at the SLMA library were also utilized to find data relating to NCD’s and their risk factors.

The National Science Foundation (NSF) was visited next. The NSF is a state funded organization under the Ministry of Technology and Research(6). It promotes research, development and innovation to create knowledge based economy by building public-private, institution-industry partnerships. National Science Library & Resource Centre (NSLRC) of the National Science Foundation is the National Focal Point for the dissemination of Science & Technology (S&T) Information in the country. The efficiency of the information service is enhanced through a network (Sri Lanka Science & Technology Information Network) operated among S&T libraries in the country. The NSLRC web site functions as a central hub which links other S & T related information sources in the country for efficient exchange of information among the scientific counterparts. NSLRC services extend to the reach & accessibility of resources within & outside the country(7). Electronic online databases were available within the NSF premises, some of which had limited access to the outside. NCD relevant studies were also found in the studies done under the category of Anthropology and Sociology. Eventually, all relevant publications were extracted and later placed onto the software program EndNote.

The World Health Organization (WHO) was visited thereafter. The WHO is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends(8). The publications and the online databases were utilized to obtain the necessary data to accumulate the studies onto the software program EndNote.

The Ministry of Health Library was also visited. Almost all available publications were in the physical format, most of which had been previously encountered in prior institutions. Previous publications were also verified as to the validity of the content of the publications, in addition to gathering new data on publications.

Research groups of several universities were also contacted, such as University of Colombo, University of Peradeniya, University of Sri Jayawardenapura, and a number of their publications were included into this project.

The publications contained within each library were studied along with the key words*, and the essential data were documented directly onto the software program EndNote.

ϊ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Key words*:

Cardio vascular diseases Stroke Cerebrovascular diseases Diabetes Mellitus Peripheral vascular diseases Cancer Hyperglycemia Hypertension Myocardial Infarction Heart failure Smoking Alcohol Physical Inactivity/ activity Hypercholesterolemia Overweight Obesity Wasting Asthma Chronic non communicable diseases

The availability of publications on electronic databases was very helpful in recognizing potential publications, but many of them were password restricted, so separate visits were necessary to uncover these restricted electronic databases from their respective institutions.

EndNote is a software program which searches, organizes, and sharing researches and bibliographies. Being an online search tool, it provides a simple way to search online bibliographic databases and retrieve the references directly into EndNote. This software has the capability to make bibliographies and manuscripts; it can format citations, figures, and tables in Microsoft® Word with the Cite While You Write™ feature.

The reliability of individual publications was checked twice a week during the study period and changes were made. After creating a library database on the EndNote software program, which included all the probable publications relating to NCD’s, a grading system was implemented on these publications in the order of their relevance to the risk factors and prevalence of NCD’s, whether they were carried out as a community based study, etc. The publications were placed into one of three categories “A”, “B”, or “C”, based on the following features.

Publications were graded “A”, if they contained data involving mentioned NCD risk factors and prevalence rates, and if they were based on a general population.

Publications were graded “B”, if they contained data involving mentioned risk factors

and prevalence rates, but they were from specific group or population which made it difficult to infer the status of the general population.

Publications were graded “C”, if they contained information matching the keywords,

but were unable to meet the criteria for Group A and B.

ϋ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Some publications, despite matching the keywords, were excluded as they failed to address the issue of NCD or any other component relevant to this project.

4. Results

During the period of four months, seven libraries/institutions were visited (PGIM Library, ADIC, SLMA Library, NSF Library, WHO Library, University of Colombo and Ministry of Health Library). Publications regarding NCD’s and published from January 1st 1990 - November 30th 2012, referred from these libraries were found mainly in Journals of Medicine and in dissertations and theses of Postgraduate trainees in preparation for their Doctor of Medicine and Master of Science degrees.

The Journals referred were:

Ceylon Medical Journal Journal of the Ceylon College of Physicians Journal of the College of the Community Physicians of Sri Lanka British Medical Journal Sri Lanka Journal of Population Studies International Journal of Public Health Galle Medical Journal Kandy Medical Journal Anuradhapura Medical Journal Sri Lanka Journal of Diabetes, Endocrinology and Metabolism

The electronic databases from which data were gathered included:

Sri Lanka Journals Online - http://www.sljol.info/ Hinari - www.who.int/hinari/ Scopus - www.scopus.com/scopus/home.url EBSCO - www.ebsco.com/ SLSTINET - www.cmb.ac.lk/academic/Science/science-library/networks/slstinet PubMed - www.ncbi.nlm.nih.gov/pubmed Sciencedirect - www.sciencedirect.com/

From these data sources, after a period of 4 months, a total of 356 publications relating to the topic of NCD’s were gathered. After analyzing and verifying their content, 241 publications were deemed to be appropriate for the need of this project.The publications were categorized into Groups:

A (75 studies);Studies which showed the prevalence of NCD’s and their risk factors in the general population,

ό Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

B (74 studies); Studies which found under the key words and carried out among specific population (e.g. hospital based or disease specific population) and

C (92 studies); Studies found under the key words, but unable to meet the criteria for Group A and B.

Group A was further analyzed to identify the study method, study population, and the prevalence of NCD related risk factors. There were 75 studies in group A, out of which 57.6% examined only a single risk factor relating to NCD’s and 42.4% studied multiple risk factors. Table 1 shows the number of studies carried out to determine the prevalence of each of NCD risk factors in the general population.

Table 1. Number of studies carried out to determine the prevalence of each of NCD risk factors in the general population, published from January 1st 1990 - November 30th 2012.

NCD related risk factor Number of studies found Smoking 25 Alcohol 14 Physical Inactivity/ activity 13 Hyperglycemia 19 Hypertension 17 Hypercholesterolemia 4 Overweight, Obesity, wasting 20 Asthma 4

The individual studies of Group A (studies which contain data involving risk factors and prevalence rates, and which were based on the general population: published from January 1st 1990 –November 30th 2012) can be found Annexure 1.

Group B (studies which were based on a specific group or population which made it difficult to infer the status of the general population) can be found in Annexure II and Group C (studies which contain information matching the keywords, but were unable to meet the criteria for Group A and B) can be found in Annexure III.

5. Discussion

Regarding the type of population studied in group A, most of smoking and alcohol related studies have been carried out among the adolescent. Other NCD risk factors such as hyperglycemia, hypertension and hypercholesterolemia were carried out among the adult population.

A few studies were carried out among certain group of population such as estate community, urban or rural population, school children and elderly population.

ύ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

It was noticed that a large number of these studies targeted the adolescents and middle age group ranging up to about 64 years, and relatively few were aimed at the elderly. Several studies had not mentioned the age of study population, and most of them were abstracts publication.

Among the 75 studies, it was observed that the majority were conducted within the Colombo district, and other studies around other urban areas in Sri Lanka, while only a very few studies were conducted in the rural areas. Among our study search, hardly any published studies on prevalence of Type I DM were found.

6. Limitations A number of studies which were gathered had only the abstract, which limited the

amount of information extracted from those publications.

In some instances, entering of key words by authors has not exactly reflected the

content of publication, so they are unable to find by using of our key words searching,

and a number of publications may have been missed out.

Several authors had published pieces of same study in different journals. So one

study may be appeared in different publications.

7. Conclusion

This project was done in order to fill a large gap existing in the field of NCD’s. With the minor limitation, this document is presented most of local studies (242) on NCD risk factors. While taking possible effort to disseminate this document among needy people, it is suggested to continue mapping up NCD researches/publication further more.

References

(1)http://www.worldbank.org/en/news/2012/05/16/non-communicable-diseases-sri-lanka (2)http://203.94.76.60/NCD/temp/NCD%20Policy%20English.pdf (3) http://www.cmb.ac.lk/pgim/ (4) http://www.adicsrilanka.org/Page_About%20Us.html (5) http://www.slmaonline.info/ (6) http://www.nsf.ac.lk/index.php/the-nsf-/about-us (7) http://www.nsf.ac.lk/index.php/resources-and-publications/library-and-information-

centre (8) http://www.who.int/about/en/

υτ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Group A Publications (Studies which showed the prevalence of NCD’s and their risk factors in the general population) Alcohol and Drug Information Centre, (1995). Community Survey on substance on substance abuse 1992/93 preliminary results of a research study carried out in 7 districts in Sri Lanka, 1995Colombo, Alcohol and Drug Information Centre (ADIC), Objective: To determine the prevalence and the socio-economic differentials of the use of tobacco, alcohol and the other drugs (such as heroine) Study method: An interviewed administered questionnaire was used to obtain the data use to tobacco/alcohol and other drugs types and quantity used, age of initiation and environment in which substances were consumed. Study Area: The study was carried out in seven districts of Colombo, Gampaha, Kurunegala, Polonnaruwa, Hambantota, Monaragala, and Nuwara-Eliya. Study population: Selected samples of both sexes, irrespective of their age from the seven districts Study Instrument: Interviewed administered questionnaires Study type: A cross sectional study Sample size: 8257 Sampling method: A multistage sampling technique Risk Factors Investigated: Alcohol Tobacco Drugs such as heroine Results: Prevalence rates (shown on table 1,2) Ever use (substance was consumed at least once in their lifetime) rates for the three substances varied from •26% in Kurunegala to 34.8% in Moneragala for tobacco •25.1% in Kurunagela to 33.8% in Gampaha for alcohol •0.7% in Nuwara Eliya to 5.7% in Moneragala for other drugs Thus it was seen that percentage of adults (including women) who had smoked, were slightly higher than the corresponding rates for alcohol. In contrast, percentage of respondents who had tried an illicit drug was very low, less than 4% in 5 of the 7 districts. Current prevalence rates for the three substances varied from •22.6% in Kurunegala to 31.8% in Moneragala for tobacco •19.8% in Kurunegala to 31.4% in Gampaha for alcohol •0.2% in Nuwara Eliya to 3.1% in Moneragala for other drugs Male prevalence rate, both ever and current was higher than in women in all seven districts.

υυ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Types of substances used •Cigarettes were main types of tobacco smoked by males in all districts with over 70% of the respondents in all 6 districts (except Nuwara Eliya), with beedi used (30%) to a lesser degree. •Arrack was the most frequently mentioned type of alcohol used by the respondents (over 70% in all districts).0n the other hand, 20% of the study population had used Kassipu, which includes 23.3% Monaragala, 20.3% Kurunegala and 21.5% Polonnaruwa. •Over 50% of the users of illicit drugs stated that they had used Ganja in 4 districts (Hambantota, Monaragala, Polonnaruwa, and Kurunegala), with heroine being mentioned by 50% of the users only in the Gampaha. Age of Initiation Age of initiation by 60%of smokers was 15 to 24 years with 35% being between 15 to 19 years (except Colombo and Nuwara Eliya) Over 50% of ever users (except in Nuwara Eliya) had initially taken alcohol between the ages of 15 to 24 years, with over 30% stating they started using between 20 to 24 years. Of those who had used illicit drugs, over 30% in five districts had not mentioned the age of first use. However in Polonnaruwa and Hambantota, of those who responded, 30% were between 20 to 24 years. Enviroment in which substances were consumed - Smoking occured mostly at home ( over 50%) of the respodents in all districts and either alone ( >70%) or with friends (45-70%) - Alcohol was mostly consumed at functions (over 60% of users in 6 districts)and with friends (over 70% in most districts). In all the districts among 20-35% had consumed at home. - Place of use of illicit drugs varied among the respondents as well as within the districts. At home and while at travelling werethe places and instances mentioned by few of then drug users commonly. Alcohol and Drug Information Centre, A. (1995). Substance use among school children in 6 distiricts of Sri Lanka. Colombo, Alcohol and Drug Information Centre (ADIC) Objective: To assess the prevalence of smoking, alcohol and the use of other drugs ( such as heroine among the the students Study area: Colombo, Hambantota , Badulla, Kandy , Anuradhapura and Puttalam Study population: School students of 33 different schools in year 7 and above with an age range between 12 to 20 years. Type of study: A cross sectional study Study instrument: Self administered questionnaire Sampling method: A multi stage cluster sampling Sample size: 4843 males 3215 females total 8058 Risk Factors investigated: Alcohol

υφ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

tobacco Illicit drugs Results: The number of student subjects in each district is given below- Colombo, 2116 Kandy 834 Badulla 1332 Hambantota 1486 Anuradhapura 944 Puttalam 1344 According to the study, the substance use of the population was divided into ever users and current users. Ever users are the students who had used alcohol , tobacco or other illicit drug at least once in their life time and current users are the students who at present using one of the three substances. The prevalence of the study population of both sexes is shown under table 1. It showed that among the ever users highest percentage of alcohol and tobacco user were from Puttlam (38.6% and 19.3% respectively.) and the highest other drug users were from Hambantota (4.6%). Among the current users, highest tobacco users were from Colombo 6.0% and the highest alcohol and drug users were from Hambantota, 8.0% and 2.8% respectively. The study also revealed that the number of females who were currently using these three substances were less than 10 for tobacco and other drugs and less than 20 for alcohol. Therefore further detail analysis of the female population on the use of these three substances was not taken. Regarding the type and the quantity of the substance currently used, it was observed that cigarettes were the main type of tobacco smoked (over 85%) by the students in all districts. Moreover except Hambantota, over 50% of the students smoked only 1 to 5 tobacco unit (refers to any unit of smoking such as cigarette, beedi, cigar etc.) per month. While a regular smoker (a student who smoked one unit a day or 30 units or more a month) ranged from 5% in Puttlam to 14% in Hambantota. Regarding the alcohol use among the study population it showed that, out of different types of alcohol consumed, Beer was the most common alcohol drunk (35%) by the students in all six districts, while arrack was drunk by 30% and kassipu by 10%. Data of different types of drugs used was not mentioned and the study revealed that the drug used was less than 12 % in eac district. The details of the type of alcohol used was not mentioned. Alcohol and Drug Information Centre, A., Kandy Drug Prevention Project (Life), (1995). Survey of substance use among a selected sample of households in an estate community Colombo, Alcohol and Drug Information Centre (ADIC). Objective: To determine the knowledge, attitude and use of substances by workers on this estate, before the interventions were carried out Study method: A small sample of the 60 estate workers in the four divisions of the estate was interviewed regarding alcohol and tobacco use. Of the respondents 80% were males. Since the number of female respondents were only 12 , the detailed analysis were confined to males. Study Area: In the 4 divisions of St. Claires Estate, Thalawakele, Nuwara Eliya District

υχ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Study population: Selected estate workers from the estate from various ages Study Instrument: Interviewer administered questionnaires Study type: A cross sectional study Sample size: 48 males 12 females Total 60 Sampling method: Random sampling method Risk Factors Investigated: Alcohol Tobacco Results: The respondents of this survey were mainly males (80%), Tamil (92%), 95% married and 81.7% estate workers. Furthermore, the majority of the sample had not studied beyond grade 5 (73.4%). Prevalence rate for tobacco and alcohol Prevalence rate for tobacco was 56.7%. Consumption was comparatively higher among males. It was revealed that 64.4% (31) males had and 33.3% (3) of the females have smoked Cigarettes (32.3%) and beedi ( 29%) were the type of tobacco used by the estate workers . Majority stated they smoked as a habit.(74.2%). Prevalence rate for alcohol was 60%. Male prevalence rate was higher (65%) when compared to the female rate (41.7%). Reasons given for consuming alcohol were “ gives enjoyment” (54.8%), and “relieves tiredness” (25.8%). The frequency of the alcohol and tobacco use among the estate workers during 1995 is given under table 1 and 2. Attitudes regarding alcohol and tobacco 78% stated that use of alcohol and tobacco leads to relieving tiredness and 71% stated that it leads to increased happiness. Majority agreed with the statement that people are unware of their behavior when they are under the influence of alcohol.(50%) Impact of substance use 25% of the families who use substances had spent 20% of their total expenditure on alcohol and tobacco. Alcohol and Drug Information Centre, A. (2009). Trends in Alcohol use , spot survey. Colombo, Alcohol and Drug Information Centre. General objectives: 1.To find the prevailing alcohol trends in Sri Lanka 2.To compare the alcohol trends with the previous year

υψ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Specific Objectives: •To find the prevailing alcohol trends in the sampling districts •To find the prevailing alcohol trends according to age groups •To find the prevailing attitudes and reasons for alcohol use •To find the age and initiation of alcohol use •To find the trends in the alcohol brands according to age groups Study Area: The study was conducted in the following districts; Colombo, Gampaha, Galle, Kegalle, Anuradhapura and Nuwara Eliya Study population: Male of age fifteen and above Study Instrument: Interviewer administered questionnaire Study type: A cross sectional study Sample size: 1414 Sampling method: Random sampling method Risk Factors Investigated: Alcohol Results: The age distribution of the study sample population shows that 41.1% of the sample population comprised of the age rand 15-24 years, 35.9% of the study sample population comprised of the age range 25-39 years and 23.1% in the age range of 40 years and above. The mean age of the sample population was 31 years. The minimum age was 15 years and maximum age was 85 years. When considering the employment status, highest percentage of the study population consisted of vendors (21.3%). The current users (respondents who used alcohol within the previous month) of alcohol among the study population was 46% in July 2009. The highest percentage of alcohol intake from the study area was in the district of Colombo (49.6%) and the lowest percentage was on the district of Kegalle (44.0%). The study also revealed that most (54.5%) of the alcohol users were belonging to the age group 25-39 years. Most (48%) of the users were occasional users and highest percentage of respondents who were occasional users were in the age range 15-24 (52.5%) and this was mostly observed in the district of Kegalle (58.1%). Arrack (63.6%) was the most common type of alcohol used ( as shown below) among the study subjects and it was more prominent among the subject s who belong the age group >/=40 years (77.9%). The highest response on the use of arrack was from the district of Galle (70.6%). The survey showed that the most of the subjects common reason for the use for consuming alcohol was for ‘fun/enjoyment and to be happy’ (33%). Regarding the age of initiation of alcohol use, most (55.6%) of the study population started using alcohol at the age range 16-20 years of age. The initiation of alcohol was mostly at a ‘function’ (52.4%), and the commonest type of alcohol used was beer (51.7%). In the comparison with the results of July 2009 spot survey and the July spot survey, the alcohol use has decreased in comparison to the previous year (2008 July -48.6% to 46% in July 2009)

υω Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Alcohol and Drug Information Centre, A. (2009). Trends in Tobacco use. Colombo, Alcohol and Drug Information centre: 32. General objective: 1.To find the prevailing tobacco trends in Sri Lanka 2.To compare the tobacco trends with the previous year Specific Objective: •To find the prevailing tobacco trends in the sampling districts •To find the prevailing tobacco trends according to age groups •To find the prevailing attitudes and reasons for tobacco use •To find the age and initiation of tobacco use •To find the trends in the tobacco brands according to age groups Study Area: The study was conducted in the following districts; Colombo, Gampaha, Galle, Kegalle, Anuradhapura and Nuwara Eliya Study population: Male of age fifteen and above Study Instrument: Interviewer administered questionnaire Study type: A cross sectional study Sample size: 1414 Sampling method: Random sampling method Risk Factors Investigated: Tobacco Results: The age distribution of the study sample population shows that 41.1% of the sample population comprised of the age rand 15-24 years, 35.9% of the study sample population comprised of the age range 25-39 years and 23.1% in the age range of 40 years and above. The mean age of the sample population was 31 years. The minimum age was 15 years and maximum age was 85 years. When considering the employment status, highest percentage of the study population consisted of vendors (21.3%). 37% of the sample population used tobacco. The highest percentage was recorded from the district of Nuwara Eliya (44.6%) and lowest from the district of Kegalle (31.7%). The highest percentage of tobacco users were found to be among those belonging to the age group of 25-39 years (42%) as shown in table 1. 72% of the tobacco users of the study sample were daily users (used of tobacco at least one stick per day). The highest percentage of daily users was from the district of Colombo (78%). The daily use was mainly seen in the age group of 40 and above (90.1%) and the lowest in the age group 15-24. The main reason for using tobacco in the study population was regarded as ‘Habit’ of using by 25.8% of the study subject as give in the chart below. The age of initiation of tobacco as told by the subjects was the age of 16-20 years 57.9%of the study population. The highest percentage on the occasion of initiation of tobacco use was with the friends (56.6%).

υϊ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Alcohol and Drug Information Centre, R. a. I. p. (2008 ). Spot Survey 2008 December - Alcohol. Colombo, Alcohol and drug Information centre General objective: To find the prevailing alcohol trends in Sri Lanka Specific Objective: •To find the prevailing alcohol trends in the sampling districts •To find the prevailing alcohol trends according to age groups •To find the prevailing attitudes and reasons for alcohol use •To find the age and initiation of alcohol use •To find the trends in the alcohol types according to age groups •To find the t types of alcohol use according to the age groups Study method: Questionnaires Study Area: The study was conducted in the following districts; Colombo, Gampaha, Galle, Kegalle, Anuradhapura and Monaragala Study population: Males of age fifteen and above Study Instrument: Interviewer administered Questionnaires Study type: A cross sectional study Sample size: 1179 Sampling method: Random sampling method Risk Factors Investigated: Alcohol Results: The population distribution of the study sample among the districts studies is as follows: Colombo 216 Gampaha 195 Galle 177 Kegalle 207 Anuradhapura 213 Monaragala 171 The age distribution of the study sample – 15-24 - 410 24-40 - 499 >40- 270 The alcohol use was based on the respondents alcohol used in the previous week of the study. The study revealed that 48% of the overall study population was consuming alcohol as at December 2008. The results were further categorized in obtaining the alcohol use among the study population- •Alcohol use – age basis 15-24 – 44.9% 24-40 - 50.8% >40- 48.6% The highest percentage of alcohol users were among the age group 25-40 (50%)

υϋ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

•Alcohol use – district basis Colombo 51.9% Kegalle 50.5% Anuradhapura 49.8% Gampaha 48.1% Galle 47.9% Monaragala 39.5% The highest alcohol consumption was recorded was in Colombo 51.9% and the lowest from Monaragala 39.5% •Alcohol use (Ever used- whether they have ever used alcohol even once, in their life until now). From analyzing the ever use of alcohol from the study population, it revealed that 29% of the study subjects used alcohol at least once in their lifetime while 71 % did not. The ever used population was further analyzed according to their district as follows- Colombo 41% Kegalle 21.8% Anuradhapura 34.3% Gampaha 27.7% Galle 14.7% Monaragala 29.7% •Frequency of alcohol use The frequency of the alcohol use was further analyzed according to daily use (at least a glass of alcohol), monthly use and occasional basis- The frequency of alcohol use among the overall study population was as follows- Daily basis 11.5% Few times per month 45.5% On special occasion 42.9% With regarding to the age group, highest percentage of daily users of alcohol was found among > 40 years (20.5%). •Types of alcohol use Arrack 68.2% Beer 51.9% Kassippu 11.1% Other (whisky, Brandy, wine) 10% With considering the age of the study population and the type of alcohol used 15-24 ,24-40 and >40, Arrack was the most common type of alcohol used among all three age groups , 60%, 71.5% and 73.6% respectively. •Reasons of using alcohol “For partying, fun and feel happy” was the commonest reason to consume alcohol, given by the study population 37.3% •Age of initiation of alcohol Among the alcohol users, 78% have initiated in consuming alcohol at the ages of 21-25 years. <15 years – 2% 16-20 years- 11% 21-25 years- 78% 26-40 years -8% The most common type of alcohol used at the time of initiation was Arrack (46.1%)

υό Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Arrack 46.1% Beer 45% Kassippu 3.7% Other (whisky, Brandy, wine) 5.2% Alcohol and Drug Intervention Centre, R. a. E. D. (1990 ). Research Project – Mirissankotuwa. Colombo, Alcohol and Drug Intervention Centre Objective: 1.To identify the present socio-economic level of the village 2.To evaluate the extent to which the inhabitants are involved in the production of illicit liquor 3.To recognize the attitudes , concepts and knowledge within the community regarding substance abuse 4.To identify the present level of Alcohol and Drug consumption, and make an assessment of the magnitude and characteristics of the drug problem in the community Study method: This survey was designed to investigate a population of special interest to those engaged in the prevention of substance abuse. Two methods of data collection were employed in this survey – 1.By direct observation to elicit information pertaining to the illegal production of liquor in this village. 2.A community survey using a interviewer administered questionnaire to find out the number of people using alcohol and tobacco in Mirissankotuwa Study Area: North and South Mirissankotuwa Study population: A selected sample of both males and females, irrespective their age from both North and South Mirissankotuwa Study Instrument: Interviewer administered questionnaire Study type: A cross sectional study Sample size: Males 262 Female 250 Total 512 Sampling method: Random sampling Risk Factors Investigated: Alcohol Tobacco Results: A total of 512 people from this area were interviewed. The percentage of males in this population is slightly higher than the percentage of females (51% are males). 67% of the population over 15 years was married. 58% of the sample was below 30 years of age. Only 4% of the sample was above age 60. Only 23% of the population over the 16 years had studied beyond GCE (O/level). 6 people out of the 396 had studied beyond GCE (A/Level). When classifying according to the ethnicity, majority (98%) of them were Sinhalese and the rest were Tamils. 96% of the sample was Roman Catholic. There were very few Buddhists (1%) and Hindus (0.5%) in this village. Prevalence of Tobacco

υύ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Of the 512 interviewed, 375 were above age 17. Among the 197 males of this group, 88 were current smokers. 3 of the 178 females who came under the above stated category were current smokers. Thus the prevalence of smoking for males over 17 years of age is 44.7% and the corresponding figure for females is 1.7%. Table 1 and 2 shows the age specific prevalence of smoking and the choice of tobacco products among smokers. There is no correlation between the incidence smoking and the level of education. When considering the population over the age of 16 years, 24% of those studied up to GCE o/Level used tobacco. The corresponding figure for those who had studied beyond GCE O/Level was 19%. The study showed no significant relation P<0.05 between the use of tobacco and the level of income in which the minimum income per month was Rs.200 and the maximum income of the study population was Rs.59000 per month. The degree of cigarette consumption was divides as light smoker (average of 1 cigarette per day), moderate smokers (average of 5 cigarettes per day) and heavy smokers (average of 10 cigarettes per day). Among the 91 smokers, twenty (22%) were light smokers, twenty nine (31%) were moderate smokers and forty two (46%) were heavy smokers. Prevalence of Alcohol Of the 375 (all over 17 years of age) interviewed, 197 were males and 178 females. The users of alcohol were defined as those who were occasional or habitual drinkers. The prevalence of alcohol for males over 17 years of age was 61.4% (121) and the corresponding figure for females was 3.4% . The age specific prevalence of Alcohol and the type of Alcoholic Beverages used are giving under the table 3 and 4 respectively. There is no significant relation between the use of alcohol and the level of education. Among those who were above 16 years who studied less than GCE O/Level, 33% used alcohol and for those who studied beyond GCE O/Level this figure was 29%. Among those who use alcohol 69% belong to families which earn an income of less than Rs.2000/- . Sixteen percent of them can be categorized as middle class (i.e. generating an income Rs.2000-Rs.3000/-) while the rest (15%) had an income had an income greater than Rs.3000/-. Arambepola C. Allender S. Ekanayake R. Fernando D (2008). "Urban living and obesity: is it independent of its population and lifestyle characteristics?" Tropical Medicine and International Health 13(4): pp 448–45. Objective: Living in an urban area influences obesity. However, little is known about whether this relationship is truly independent of, or merely mediated through, the demographic, socio-economic and lifestyle characteristics of urban populations. The objective of this study was to identify and quantify the magnitude of this relationship in a Sri Lankan population. Study method: Cross-sectional study of adults aged 20–64 years representing the urban (n = 770) and rural (n = 630) populations, in the district of Colombo in 2004. Obesity was measured as a continuous variable using body mass index (BMI). Demographic, socio-economic and lifestyle factors were assessed. Gender-specific multivariable regression models were developed to quantify the independent effect of urban ⁄ rural living and other variables on increased BMI

φτ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Study Area: Colombo district Study population: Adults aged 20–64 years. Participants were those currently residing in urban or rural sectors in the district of Colombo (estate sector was excluded as it represented only 0.3% of the total population of Colombo) at least for a continued period of 1 year to ensure a stable lifestyle related to their residence in the area. Those with pathological or iatrogenic obesity (e.g. hypothyroidism, Cushing syndrome), ascites or pregnancy up to a postpartum period of 3 months were excluded by perusing diagnosis cards and medical records of participants. Study Instrument: Pre-tested questionnaires Height and weight measurements Study type: A community-based cross-sectional study Sampling method: Multi-stage, stratified, probability sampling method Risk Factors Investigated: Body mass index, Obesity Results: The BMI (mean; 95% confidence interval) differed significantly between urban (men: 23.3; 22.8–23.8; women: 24.2; 23.7–24.7) and rural (men: 22.3; 21.9–22.7; women: 23.2; 22.7–23.7) sectors (P < 0.01). The observed association remained stable independently of all other variables in the regression models among both men (coefficient = 0.64) and women (coefficient = 0.95). These coefficients equated to 2.2 kg weight for the average man and 1.7 kg for the average woman. Other independent associations of BMI were with income (coefficient = 1.74), marital status (1.48), meal size (1.53) and religion (1.20) among men, and with age (0.87), marital status (2.25) and physical activity (0.96) among women. Conclusions Urban living is associated with obesity independently of most other demographic, socioeconomic and lifestyle characteristics of the population. Targeting urban populations may be useful for consideration when developing strategies to reduce the prevalence of obesity. Arambepola C. Ekanayake R. Fernando D (2007). "Gender differentials of abdominal obesity among the adults in the district of Colombo, Sri Lanka." Preventive Medicine 44(2): 129-134. Objective: To assess the gender-specific prevalence and determinants of abdominal obesity (AO) within the population and lifestyle diversity of an urban district in Sri Lanka. Study Method: Prevalence of AO (defined by waist circumference) was estimated in a cross-sectional study of 1400 adults aged 20-64, residing in the district of Colombo in 2004. Demographic, socio-economic and lifestyle factors were assessed in gender-specific logistic regression models to identify determinants of AO. Study area: Colombo district Study population: Adults aged 20-64 Type of study: Cross-sectional study Sample size: 1400

φυ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Factors investigated: Age, insufficient level of physical activity, frequent large meals, household income, increased alcohol, moderately urban sector Results: Prevalence of AO was 44.7% (95% confidence interval (CI): 41.0, 48.5) in females and 25.7% (95% CI: 22.6, 29.0) in males. Significant determinants of AO were age 35-49 (adjusted odds ratio: 1.7; 95% CI: 1.2, 2.5), moderately urban sector (1.9; 1.3, 2.9) and insufficient level of physical activity (1.7; 1.1, 2.4) among females in contrast to household income > Rupees 10,000 (6.1; 2.7, 13.5), increased alcohol (medium: 1.9; 1.2, 2.9; high: 2.1; 1.2, 3.5), low-fiber diet (1.6; 1.1, 2.4) and frequent large meals (1.7; 1.0, 2.8) among males. Determinants common to males (M) and females (F) were age ≥ 50 years (M: 2.5; 1.5, 4.2 and F: 2.9; 1.9, 4.4), most urban sector (M: 2.0; 1.3, 3.1 and F: 1.8; 1.2, 2.7) and married status (M: 2.2; 1.3, 3.6 and F: 2.4; 1.6, 3.6). Conclusion: A distinct gender differential was observed in the prevalence and determinants of AO. It appears vital that preventive strategies of AO be developed to be more 'gender-sensitive' in urban districts. Arambepola C. Fernando D. Ekanayake R (2008). "A simple valid tool for measuring obesity-related-CHD risk in Sri Lankan adults." Prevention and Control 3(1): 11-19. Objective: To compare waist circumference (WC) and body mass index (BMI) in identifying the "obesity-related-CHD risk" among Sri Lankan adults. Study Method: A population-based cross-sectional study of 515 adults aged 20-64 years, residing in the district of Colombo in 2004 was selected by a multi-stage, stratified, probability sampling method. WC, height and weight were measured. Demographic, socio-economic and lifestyle characteristics, smoking and obesity-related-CHD risk factors (hypertension, dyslipidaemia, diabetes) were assessed by questionnaires, physical measurements and biochemical assessments. "Obesity-related CHD risk" was defined by the presence of ≥1 obesity-related-CHD risk factors. Study area: Colombo Study population: Adults aged 20-64 years Type of study: Population-based cross-sectional study Study instrument: Questionnaires, physical measurements and biochemical assessments Sampling method: Multi-stage, stratified, probability sampling method Sample size: 515 Factors investigated: Waist Circumference (WC), height, weight, demographic, socio-economic and lifestyle characteristics, smoking and obesity-related-CHD risk factors (hypertension, dyslipidaemia, diabetes) Results: Compared to BMI, WC was a stronger correlate of systolic and diastolic blood pressure, triglycerides among both sexes and of plasma glucose among males. It was also an independent predictor of obesity-related-CHD risk in both males (beta co-efficient = 0.046; standard error = 0.013) and females (0.024; 0.012) in contrast to BMI, which was significant only among males (0.138; 0.037) in the logistic regression models adjusted for confounders. At the same level of obesity-related-CHD risk corresponding with BMI of 25 kg/m2 (OR = 1.7) and 30 kg/m2 (OR = 3.5), the corresponding WC

φφ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

values were 90.5 cm and 105.5 cm for males and 100 cm and 129 cm for females. The derived optimal risk thresholds of WC for identifying obesity-related-CHD risk was 88.5 cm for males and 82 cm for females. Conclusion: WC with its sex-specific cutoff values can serve as a better screening tool than BMI in identifying individuals at risk of obesity-related CHD in low-resource settings. Athukorala LK. Kumarendran B. Kasturiratne A. Wickremasinghe AR (2012). "Negative health effects of coconut - Are they real at the population level?" The Ceylon Medical Journal 57(Supplement 1): Page 19. Objective: The aim is to evaluate the impact of consumption of coconut products on CVD – Cardiovascular death rates. Study method: Data from 1961 to 2006 were abstracted from different sources, coconut consumption from FAO database, CVD death rates from reports of the Department of Census and Statistics , Population data from the UN databases and per capita GDP from the World Bank database Correlation and Regression analysis were carried out. Results: From 1961 to 2006, the average consumption of coconut including copra was 66.19 kg/ capita per year, the average consumption of energy was 271.47 kcal/ capita/ day, the average fat supply was 24.46 g/ capita/ day. There was no increase in the per capita consumption of coconut production from 1961 – 2006 in Sri Lanka (range 54.1 – 76.2 kg/ capita/ year) The CVD death rates and the proportion mortality rate due to CVD have increased from 1961 -2006. Consumption of coconut products was correlated with CVD death rates but no lags were seen. CVD death rates were significantly associated with per capita GDP and percentage of urban population but not consumption of coconut products after adjusting for the other variables (R2 = 0.865). Athuraliya NTC. Abeysekera TDJ. Amerasinghe PH. Kumarasiri R. Bandara P. Karunaratne U. Milton AH. Jones AL (2011). "Uncertain etiologies of proteinuric-chronic kidney disease in rural Sri Lanka." Kidney International 80(11): 1212-1221. Objective: To describe the prevalence of proteinuric-CKD and disease characteristics of three rural populations in the North Central, Central, and Southern Provinces of Sri Lanka. Study Method: Patients were selected using the random cluster sampling method and those older than 19 years of age were screened for persistent dipstick proteinuria. Study area: North Central, Central, and Southern Provinces of Sri Lanka Study population: Adults older than 19 years of age Study instrument: Dipstick for proteinuria Sampling method: Random cluster sampling Sample size: 6153 Factors investigated: Diabetes, long-standing hypertension, age, farming

φχ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Results: The prevalence of proteinuric-CKD in the Medawachchiya region (North Central) was 130 of 2600 patients, 68 of 709 patients in the Yatinuwara region (Central), and 66 of 2844 patients in the Hambantota region (Southern). The mean ages of these patients with CKD ranged from 44 to 52 years. Diabetes and long-standing hypertension were the main risk factors of CKD in the Yatinuwara and Hambantota regions. Age, exceeding 60 years, and farming were strongly associated with proteinuric-CKD in the Medawachchiya region; however, major risk factors were uncertain in 87% of these patients. Of these patients, 26 underwent renal biopsy; histology indicated tubulointerstitial disease. Conclusion: Proteinuric-CKD of uncertain etiology is prevalent in the North Central Province of Sri Lanka. In contrast, known risk factors were associated with CKD in the Central and Southern Provinces. Atukorala TM. Jayawardene MI (1991). "Lipid patterns and dietary habits of healthy subjects living in urban, suburban and rural areas." Ceylon Med J 36(1): 9-16. Lipid patterns were determined in 167 healthy subjects in the age group 28 to 50 years living in an urban area, a suburban area and two rural areas to determine a possible relationship between their serum lipid patterns and food habits. Total cholesterol, high density lipoprotein (HDL)-cholesterol, and triglyceride concentrations were determined in the sera of fasting subjects, and low density lipoprotein (LDL)-cholesterol concentration was calculated. Risk of coronary heart disease as assessed by the body mass index, ratios of total cholesterol to HDL-cholesterol, and LDL-cholesterol to HDL-cholesterol, was significantly lower in subjects in rural area 2, who were agricultural workers with a high degree of physical activity, subsisting on a diet consisting mainly of plant food, despite a higher consumption of coconut, a saturated fat. It is possible that the hypercholesterolaemic effect of saturated fats was mitigated by the high fibre content of their diets. Bandara KMGK (2008). Prevalence of Coronary Heart Disease risk factors among adolescents of Kandy Municipal Council area and evaluation of effect of an intervention to reduce sedentary lifestyle. Postgraduate Institute of Medicine. Colombo, University of Colombo. Doctor of Medicine in Community Medicine: Main objective: To determine the prevalence of Coronary Heart Disease risk behaviors and biological risk factors among adolescents of public schools in the Kandy Municipal Council area and to find out the effects of an intervention program in reducing sedentary lifestyle among adolescents. Specific objective: 1.To determine the prevalence of the following Coronary Heart Disease risk behaviors and biological risk factors among adolescents:

Unhealthy dietary habits Physical inactivity Smoking Psychological stress Overweight High blood pressure.

2.To assess the knowledge and attitudes towards the Coronary Heart Disease risk factors among adolescent. 3.To determine the association between socioeconomic status and the prevalence of Coronary Heart Disease risk behaviors and biological risk factors among the adolescents 4.To describe the plasma lipid profile and the plasma sugar levels in a subsample of adolescents

φψ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

5.To plan , implement and evaluate as intervention program to reduce sedentary lifestyle among adolescents Study method: The study consisted of two phases Phase 1- Component 1: A school based cross sectional study among adolescents in public schools of Kandy Municipal Council area. This component was planned to achieve the first three specific objectives of the study Component 2: A cross sectional study in a subsample of the study population included in component 1. The fourth specific objective of the study was achieved at the end of the component 2 Phase 2- A school based health promotion intervention trial and its evaluation among a subsample of the study population in component 1 of phase 1.Phase 2 was planned to achieve the fifth specific objective of the study. Study area: Public schools of Kandy Municipal Council area. Study population: Adolescents between 14 to 15 old, studying in Sinhala medium public schools of the Kandy Municipal Council area All adolescent with a diagnosis of any chronic illness, physical abnormality or mentally subnormal or who were acutely ill at the time of the survey were excluded from the sample. Type of study: A school based cross sectional study school based intervention trial Study instrument: Self administered questionnaires Anthropometric measurements Blood pressure measurements Sampling method: A stratified cluster sampling method Sample size: 3718 Risk Factors investigated: Smoking Alcohol Unhealthy dietary habits Physical inactivity Psychological stress Overweight High blood pressure Results: Smoking and Alcohol As smoking and alcohol have been known risk factors for coronary heart disease, study revealed that the overall ever smoking ( at least one puff during the lifetime) prevalence was 1.8% (95% CI: 1.4-2.2) among the adolescents with a prevalence of 3.7% (95% CI:2.9-4.7) among males and 0.2% (95% CI: 0.0-0.5) among the females while the overall prevalence of ever alcohol consumption (at least one drink during their life time) was 3%(95% CI:2.5-3.6) among adolescents with a prevalence of 5.2%(95% CI: 4.2-6.3) among males and 1.3%(95% CI: 0.9-1.9) among females. High blood pressure Regarding elevated blood pressure hypertension was defined as an average Systolic Blood Pressure (SBP) and / or Diastolic Blood Pressure (DBP) that is > 95th percentile for gender, age and height on >3 occasions for this study..

φω Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Pre hypertension in children was defined as average SBP or DBP levels that are >90th percentile but <95th percentile. Adolescents with BP levels greater than or equal to 120/80mmgh were considered as pre-hypertensive (National Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents 2004). The overall prevalence of prehypertension was 5.5 %( 95% CI: 4.8-6.3) and elevated blood pressure was 0.1% in this study. High blood pressure and overweight (Adults are defined as overweight if their BMI exceeds 25kg/m2) was significantly associated p=0.001 in the study. Physical inactivity The prevalence of insufficient physical activity was 33.6% (95% CI: 32.1-35.2) and it was higher among the females 35.4% than the male 31.5% students. BMI levels and physically activities did not show a relationship but hypertension was lower among the male and female students who were physically active (p=0.042 and p=0.395 respectively). Psychological stress Psychological distress is another risk factor for coronary heart disease and it was significantly higher among the male adolescents 12.5 %( 95% CI: 11.0-14.2) than female adolescents 7.1% ((95% CI: 6.1-8.3). The study also revealed that stress was lower among the physically active adolescents that those who are inactive. Unhealthy dietary habits The consumption of fruits was low among both males (44.9%) and females (42.1%) students. when considering energy dense foods such as milk, diary products , eggs, commercially baked foods and deep fried items etc, the consumption of deep fried foods (p=0.808) were higher among both the sexes (>55%). Consumption of commercially baked foods were was also higher among the males (33.8%) than females (25.9%) students with p<0.001. the consumption of sugar sweetened beverages was also high among the both the sexes (males 31.2% and females 28% p=0.049) In the present study, fasting blood sugar (FBS) was taken as high it exceeded more than 105mg/dL and the lipid levels, total cholesterol >200 mg/dL , LDL (Low density lipoproteins) >130 mg/dL and triglyceride levels >150 mg/dL were taken as High respectively. The mean FBS was significantly higher (p<0.001) among the male students as shown in the table below. The mean triglyceride, total cholesterol and LDL were higher among the female students. The difference of the mean total triglycerides and cholesterol was significant (p=0.002) and the difference was not statistically significant for triglyceride and LDL. The mean FBS, total cholesterol and triglyceride and LDL was higher among the overweight students than normal (BMI 18.5 - 25kg/m2) and underweight (<18.5kg/m2) students for both the sexes. The study also revealed that the mean values of FBS and LDL were higher among the students with pre hypertension and increased blood pressures than students with normal blood pressures for both the sexes. The knowledge on most coronary heart disease risk factors was satisfied among the adolescents. The intervention programme was successful and it had an effect in decreasing physically inactivity and further improvement of knowledge and attitudes toward coronary heart disease risk factors among adolescents. But the sustainability of improve knowledge and attitudes and physical activity decreased with time.

φϊ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Beneragama APS (2002). An epidemiological study of type II diabetes mellitus in Kalutara district in Sri Lanka. Postgraduate Institute of Medicine Colombo, University of Colombo. Doctor of Medicine in Community Medicine: General objective: To determine the extent of the problem of type II diabetes mellitus among 30-64 year old population in the Kalutara District of Sri Lanka and to develop and validate a screening tool that can be used by PHC workers in identifying type II diabetes mellitus. Specific Objective: 1.To estimate the prevalence rates of type II diabetes mellitus and IFG according to the new WHO/ADA criteria. 2.To study the socio-demographic characteristics of the people with type II diabetes mellitus in the sample. 3.To develop a simple screening tool which can be used by the PHC workers in the detection of type II diabetes mellitus in the field setting. 4.To validate the screening tool with a reference test, Fasting Plasma Glucose (FPG) measurement using Receiver Operating Characteristic (ROC) analysis. Study method: Fasting plasma glucose levels were measured after a minimum of10 hours of overnight fasting. Structured pre coded questionnaire was used to collect information on socio-demographic variables, symptoms and risk factors of type II DM. Anthropometric measurements height, weight and waist circumference were measured using standard protocols. A screening tool was developed following the standard procedure in developing of a new instrument. Study Area: Kalutara District in Sri Lanka Study population: All individuals aged 30-64 years who were in the voter’s list in the Kalutara District. Study Instrument: Interviewer administered questionnaire Electronic weighing scale A microtoise 04116 steel tape for height measurement Study type: Community base cross sectional descriptive study for the prevalence study Screening tool development Screening tool validation. Sample size: 3000 Sampling method: A stratified cluster sampling method Results: There were 3000 selected study subjects out which 2865 participated in the study. There were 1391 males and 1474 female subjects in the study population. Mean age of the sample was 45.3 years (S.D 9.76). Age standardized prevalence rate NIDDM for both sexes were 10.3 %( 95% C.I 6.92-13.07). For females crude prevalence rate was 10.2% and for males it was 9.3%. Prevalence of Impaired Fasting Glucose was 4.4% for males and 3.5% for Females. Prevalence rate for Total Glucose Tolerance was (age adjusted) 14.02% indicating that Type II DM is highly prevalent in this district. Age was significantly associated with Type II DM status with a maximum prevalence in the age group of 50-54 years. Prevalence rate among the females was a little higher than the males. Urban people had significantly higher crude prevalence rate of 14.7% than their rural counterparts. For each three known people with diabetes there were two persons with undiagnosed diabetes.

φϋ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

BMI levels correlated with NIDDM in both sexes. Non occupational physical activity level was significantly (p<0.001) associated with NIDDM. Obesity was more prevalent among Type II DM people. In the screening tool, important risk factors found (p<0.05) were age more than 40 years, dryness of the mouth, constipation, presence of family history of diabetes and nocturia. Screening tool was validated with the FPG value and the ROC analysis showed that the screening tool carries 53.3% sensitivity, 60.8 % specificity and positive predictive values of 6 %. It is concluded that a questionnaire based on symptoms and risk factors is not suitable to screen for diabetes in the field setting. Chang T. Gajasinghe S. Arambepola C (2012). "Epidemiology of stroke in the district of Colombo,Sri Lanka: a community -based study." The Ceylon Medical Journal 57(Supplement 1): Objective: To study the prevalence of stroke and its risk factors in an urban population Study method: The study was conducted among 2313 adults currently living in the district of Colombo. A multi stage probability-proportionate-to-size cluster sampling technique was used to collect all eligible persons in 46 administrative divisions. Data were collected using a questionnaire. ‘Ever diagnosis’ of stroke confirmed by Pre-intern Medical Officers using a check list and documental evidence Study Area: Colombo District Study Instrument: An interviewer administered questionnaire Study type: A cross sectional study Sample size: 2313 Sampling method: A multi stage probability-proportionate-to-size cluster sampling Disease Investigated: Stroke Results: Of the total population (52% females; mean age 44.2 years, SD =16.6), the prevalence of stroke was 1.0% (95% CI: O.006, 0.014) with a 2:1 male to female ratio. The prevalence increased 6-fold amongst males and two fold amongst females over the age of 65 years. There were none (92%) developed hemi-paresis, 58.3% dysphasia, and 16.7% loss of balance. 58% sought Western medical treatment, 4.2% indigenous medical treatment , and 37.5% both. Only 58.3% had CT brain scans, of which 85.7% had ischemic strokes. Hypertension was the commonest risk factor (62.5%) followed by smoking (50%), excess alcohol( 45.8%), diabetes (33%), transient ischemic attack ( 29.2%) and had a family history (20.8%). 79.2%, mostly males , had two or more risk factors. Conclusion: The prevalence of stroke in urban Sri Lanka lies between high-income and low- and middle- income countries. Increasing age remains the most important risk factor.

φό Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Danansuriya MN (2009). Prevalence and correlates of asthma among 12-14 year old school children in a district and their quality of life. Postgraduate Institute of Medicine. Colombo, University of Colombo. Doctor of Medicine in Community Medicine: Main objective: To determine the prevalence and correlates of asthma among 12-14 year old school children in a selected district and to determine their general and asthma specific quality of life. Specific objective: 1. To determine the prevalence and describe the correlates of asthma among 12-14 year old school children. 2. To describe the sensitization pattern to common indoor allergens in a sub sample of asthmatc students with with current asthma compared to their healthy siblings. 3.To describe the general quality of life among 12-14 years old school children and compare the general quality of life (Qol) among student with asthma identified, with an age matched healthy control group using the vallidated generic QOL questionnaire. 4. To describe the disease specific quality of life in the children with asthma using the vallidated asthma specific QOL questionnaire. Study area: Gampaha District. Study population: For the translaton and vallidation of the study instruments- a healthy group of children selected from randomly selected two schools age 12 to 14 years in the Ragama MOH area and a group of asthmatic students from asthma amd medical clinics from LRH,North Colombo Teaching Hospital,National Hospital and chest hospital Welisara of ages between 11years and 12 months to 14 years and 12 months. Type of study: For the prevalence study -A descriptive cross sectional study To examine the correlates of asthma - A case control study Study instrument: For the prevalence study 1. A student questionnaire on respiratory diseases. 2. Teacher Information form To examine the correlates of asthma-an interviewer administered questionnaire. Sampling method: The multi staged stratified cluster sampling method Sample size: For the prevalence study 1483 To examine the correlates of asthma - 158 Risk Factors investigated: Results: The reported prevalence rates for current wheezing (having wheezing or whistling sound in the chest during the last 12 months), ever wheezing (having wheezing or whistling sound in the chest at any time in the past.), current asthma and physician diagnosed asthma were 16.7%, 19.4%,10.7% and 14.5% respectively as shown in the table given below. One hundred and fifty eight students were identified as having current asthma (defined as those with physician diagnosed asthma and having symptoms (wheezing) during the previous 12 months )were enrolled for the case control study with two healthy controls- healthy students (as defined below) per case from the same class. The study revealed that the following were predictors of current asthma in the case control study- §Being the only child (OR=4.2, 95% CI:1.7-9.9) §Being the first born (OR=2.6, 95% CI:1.3-5.2)

φύ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

§Presence of allergic rhinitis (OR=2.7, 95% CI:1.6-4.6) §Family history of asthma (OR=1.8, 95% CI:1.1-3.2) §Family history of allergic rhinitis (OR=1.9, 95% CI:1.1-3.2) §Family history of eczema (OR=1.8, 95% CI:1.0-3.2) §Exposure in-utero to tobacco smoke (OR=2.0, 95% CI:1.06-3.7) §Skin prick testing, was done with 61 current asthma cases- healthy sibling pairs from which it revealed that adolescents with asthma show 9,3 times risk of atopy and have a significant atopy towards cockroaches (OR=5.3, 95% CI:-2.2-12.6), house dust mite (OR=13.0, 95% CI:3.08-54.7) and blomia (OR=11.5, 95% CI:2.71-48.7) The assessment of general quality of life among the school children was assessed using the validated Pediatric Quality of Life InventoryTM (PedsQLTM ) Generic core scale. Based on the cut off value of one standard deviation below the population mean (-1SD) , the study sample was stratified into groups of “Poor QOL” ( total score less than 71.0) and “ better QOL” ( total score equal or more than 71.0) based on QOL scores. There were 1236 (83.3%) with good QOL and 246 (16.6%) were classified as having poor QOL. Following factors were found to predictors of poor general QOL after accounting for cofounding – §Living with person other than parents (OR=2.8, 95% CI:1.5-5.3) §Studying in a low category school (OR=1.9, 95% CI:1.2-3.0) §Presence of allergic rhinitis (OR=1.8, 95% CI:1.3-2.5) §Presence of other allergies (OR=1.7, 95% CI:1.2-2.5) §Presence of current asthma (OR=1.7, 95% CI:1.1-2.7) §Poor academic performance (OR=0.98, 95% CI:0.97-0.99) §Poor school attendance (OR=0.99, 95% CI:0.98-0.99) and §Increasing BMI (OR=1.06, 95% CI:1.02-1.1) The students with current asthma were found to have significantly lower general health related quality of life compared to their healthy colleagues. The presence of allergic rhinitis was significantly associated with poor asthma quality of life. The students who perceived that their asthma was under control and those who were on regular treatment had better asthma specific quality of life. There were significant correlations between the academic performance, school absenteeism due to illness and general QOL with asthma specific QOL scores. Dassanayake AS. Kasturiratne A. Niriella MA. Kalubovila U. Rajindrajith S. De Silva AP. Kato N. Wickremasinghe AR. De Silva HJ (2011). "Prevalence of Acanthosis Nigricans in an urban population in Sri Lanka and its utility to detect metabolic syndrome." BioMed Central Research Notes 4. Objective: To investigate the prevalence of AN among adults in an urban Sri Lankan community and describe its utility to detect metabolic syndrome. Study Method: This study was part of a community based investigation - the Ragama Health Study (RHS), conducted in the Ragama Medical Officer of Health area. This area has characteristics typical of an urban community in Sri Lanka. Participants were a representative sample of 35-64 year old adults selected by stratified random sampling from electoral lists. Ethical approval for the study was obtained from the Ethics Review Committee of the Faculty of Medicine University of Kelaniya. The purpose of the study, the procedures to be carried out with potential hazards and benefits were explained to the individuals prior to obtaining informed written consent. Consenting adults were screened by a structured interview, clinical examination, liver ultrasound (8 MHz probe, Toshiba ultrasound

χτ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

diagnostic systems SSA-51 OA, Toshiba Medical Systems Corporation, Otawara-city, Tochigi-prefecture, Japan) and collection of 10 ml venous blood for biochemical tests. Metabolic syndrome was diagnosed on revised ATP III criteria for Asian populations. AN was identified by the presence of dark, thick, velvety, pigmented skin in the neck. Statistical analysis Data were entered in Epi Info 2000 (Centres for Disease Control and Prevention, Atlanta. GA) and logical and random checks were done. Statistical analysis was done using SPSS version 16.0 (SPSS Inc., Chicago, IL). Continuous and categorical data were described using mean and standard deviations. Significance testing was done using the Student T test, Chi squared test and multiple logistic regression. p < 0.05 was considered as significant. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of AN to detect metabolic syndrome were calculated. Study area: Ragama Medical Officer of Health area Study population: 35-64 year old adults Type of study: Community based investigation Study instrument: structured interview, clinical examination, liver ultrasound, biochemical tests Sampling method: Stratified random sampling Sample size: 2957 Factors investigated: Metabolic syndrome, Acanthosis Nigricans, type 2 diabetes mellitus Results: 2957 subjects were included in this analysis. The prevalence of AN, metabolic syndrome and type 2 diabetes mellitus were 17.4%, 34.8% and 19.6%, respectively. There was a strong association between AN and metabolic syndrome. The sensitivity, specificity, positive predictive value and negative predictive value of AN to detect metabolic syndrome were 28.2%, 89.0%, 45.9% and 79.0% for males, and 29.2%, 88.4%, 65.6% and 62.3% for females, respectively. Conclusion: AN was common in our study population, and although it did not have a high enough sensitivity to be utilized as a screening test for metabolic syndrome, the presence of AN strongly predicts metabolic syndrome. De Lanerolle-Dias M. De Silva A. Lanerolle P. Arambepola C. Atukorala S (2011). "Body fat assessment in Sri Lankan adolescent girls; development of a simple field tool." Annals of Human Biology 38(3): 330–336. Objective: To determine percentage fat mass (%FM) of Sri Lankan adolescent girls using Fourier Transform Infrared spectrometry (FTIR) as a reference method and develop a SFT-prediction equation to estimate %FM. Study Method: Weight, height and SFT were measured and %FM determined by FTIR in 131 adolescent, post-menarcheal girls (15–19 years). SFT-measurements were applied to available body composition equations for validation in the population. A new equation for %FM was derived and validated.

χυ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Study area: Western Province of Sri Lanka Study population: Out-of-school adolescent girls aged 15–19 years Study instrument: Calibrated electronic scale, Stadiometer, Harpenden Caliper, Sampling method: Convenience sampling method Sample size: 650 Factors investigated: Weight, height, Biceps, triceps, sub-scapular and supra-iliac SFT, percentage fat mass Results: Mean %FM (FTIR) was 19.13 ^ 8.2.Selected body composition prediction equations over-estimated %FM. The multiple regression procedure yielded a final equation consisting of two anthropometric and one demographic variable, %FM = 9.701 -(0.460) x age + (0.640) x TricepsSFT + (0.583) x Supra-iliacSFT. Conclusion: Existing SFT prediction-equations are unsuitable for predicting %FM in this population. The new equation utilizing one peripheral and one truncal skin-fold, is appropriate for prediction of %FM in this population and may be applicable to other South Asian/Asian-Indian adolescents following validation. De Silva AP. Liyanage IK. De Silva STGR. Somatunga L. Bandara J. Sooriyarachchi U. Sooriyarachchi K (2012). "National survey on tobacco use among 13 to 15 years school children in Sri Lanka." The Ceylon Medical Journal 57(Supplement 1): Objective: To describe the prevalence and correlates of smoking among 13 to 15 years old school children in Sri Lanka Study method: This study was done using a multi stage cluster sampling method to randomly selected thirty schools from each of the school categories of 1AB, 1C and II. From each school a number of classes were randomly selected using probability proportionate to size model. All students in selected classes were enrolled. From 5891 students, 4963 (84.2%) participated. the final sample was weighted and data was collected on their tobacco use. Study Area: Randomly selected thirty schools from each of the school categories of 1AB, 1C and II Study population: 13 to 15 year old school children Study Instrument: A pre-tested self administered questionnaire Study type: A cross sectional study Sample size: 4,963 Sampling method: A multi- stage cluster Sampling Method Risk Factors Investigated: Tobacco use

χφ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Results: The prevalence of all time smoking was 6.5% (95% CI: 4.9-8.6) (Male: 11.9%, Females: 1.6%). Prevalence of smoking during the past 30 days was 1.5% (95% CI: 1.0-2.5) and 42.5% (95% CI: 39.8-45.1) was exposed to passive smoking. There were 3.4% (95% CI: 2.6-4.4) never smokers who were considering to start smoking. Majority (88.9%, 95% CI: 86.8-90.6) believe that smoking should be banned from public places .Among the current smokers 49.3 %( 95% CI: 20.4-78.7) were not refused to sell cigarettes from the stores because of their age. Intention to quit smoking were observed among 80.6% ((95% CI: 55.9-93.2) of current smokers and 79.4 %( 95% CI: 58.0-91.5) have tried to quit during the past year. Conclusion: The prevalence of smoking was low. However the exposure to passive smoking in public was high. Students who smoked have access to cigarettes from public shops in spite of being under age. Intention to quit smoking is also high. De Silva KSH. Wickramasinghe VP. Gooneratne INA (2006). "Metabolic consequences of childhood obesity—a preliminary report." The Ceylon Medical Journal 51(3): 105-109. Objective: To document the presence of metabolic syndrome (MetS) and non-alcoholic steatohepatitis (NASH) in obese Sri Lankan children, to correlate the fat mass (FM) with the waist circumference (WC) and the body mass index (BMI), and to compare the association of the WC( waist circumference), BMI ( body mass index) and the WHR (waist-hip ratio) with the metabolic derangements Study method: Children attending the Obesity Clinic at Lady Ridgeway Hospital, Colombo, from November 2004 to September 2005 were studied. The relevant sociodemographic data, anthropometric measurements and examination findings were documented. After a 12-hour overnight fast, blood was taken for estimation of lipid profile, serum insulin, liver enzymes and blood glucose. The oral glucose tolerance test (OGTT) was done in children over 5 years of age. Fatty infiltration of the liver was assessed by identifying specific features on ultrasonography and the degree of infiltration was given a score. The International Diabetes Federation (IDF) 2004 guidelines was modified to define MetS. NASH was defined as fatty infiltration of the liver associated with a raised serum ALT. Study Area: Obesity Clinic at Lady Ridgeway Hospital, Colombo Study population: Children attending the Obesity Clinic at Lady Ridgeway Hospital, Colombo Study Instrument: Sample size: 70 Sampling method: Convenient sampling method Risk Factors Investigated: Metabolic syndrome, non-alcoholic steatohepatitis, obese Sri Lankan children, waist circumference Results: Of the 92 children seen in the clinic during the study period, 70 (76%) consented to participate in the study. The demographic features of the study population are given in Table 1. The age of the patients ranged from 25 to 177 months. The %FM (SD) of 47.5 (5.7) in boys and 48.6 (10.9) in girls was far in excess of the values associated with adverse health outcomes (> 25% in boys and > 32% in girls [15]) The mean (SD) age was 9.7 (2.5) and 9.3 (3.0) years for boys and girls respectively. Mean BMI was 25.9 in both groups. All patients had a WC>98th percentile. MetS was found in 13 of the 63 (21%)

χχ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

children on whom all criteria were assessed. Sixty children had ultrasonography and NASH was seen in 11 (18%). The correlation of the percentage FM ( fat mass) was greater with the BMI (r=0.80; p< 0.001) than with the WC (r=0.56; p< 0.001), but the WC was more significantly associated with the metabolic derangements than either BMI or WHR. Demographic features of the study population Boys mean (SD) Girls mean (SD) Number 40 30 Age (years) 9.7 (2.5) 9.3 (3.0) BMI (kg/m2) 25.9 (3.6) 25.9 (4.4) WC 84.2(11.4) 84.0 (12.0) HC 85.7(10.9) 90.1 (12.2) WHR 0.98 (0.05) 0.93 (0.05) FM(kg) 24.2(10.1) 26.7 (10.9) %FM 47.5 (5.7) 48.6(10.9) Components of the metabolic syndrome in the study population Boys Girls Percentage (%) WC (>98l h percentile) 40 30 100 TG n=70 (> 95t h percentile) 18 9 39 HDL n=70 (< 5t h percentile) 1 1 3 HBPn=70 (^95'" percentile) SBP 5 3 11 DBP 0 3 4 Abnormal glucose homeostasis n=63 9 8 27 Metabolic syndrome n=63 5 8 21 Conclusions: Serious metabolic abnormalities are found in obese Sri Lankan children and the WC is a reliable indicator of these derangements. De Silva S (2008). "The Nutritional Status of Grade Eleven Students in the Medical Officer of Health Area Kalutara." Journal of the College of Community Physicians of Sri Lanka 13(2). objective: To describe the nutritional status of grade eleven school children in the Medical Officer of Health (MOH) area Kalutara.

χψ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Study Method A descriptive cross-sectional study was carried out among grade eleven school children in Type 1AB and Type 1C state schools in the MOH area Kalutara. Eighteen classes from a total of 14 schools were studied. Cluster sampling technique, probability proportionate to size was used to select the sample. The heights and weights were measured, and the Body Mass Index (BMI) was calculated for each child. The age and sex specific BMI charts developed by the National Centre for Health Statistics 2000 were used as standards. A structured, pre-tested self-administered questionnaire was used to collect the socio-demographic characteristics. Study area: Type 1AB and Type 1C state schools in the MOH area Kalutara Study population: Grade eleven school children Type of study: A descriptive cross-sectional study Study instrument: A structured, pre-tested self-administered questionnaire Height and Weight Measurements Sampling method: Cluster sampling method Sample size: 639 Female 356 55.7 % Male 283 44.3 % Risk Factors investigated: Nutritional Status Results: The study included 639 school children where the great majority were Sinhalese (99.5%, n= 636), Buddhists (95%, n=607). There were no Tamils or Hindus. Females accounted for 55.7% (n=356) of the sample. Most (84.8%, n=542) of the students were residing in rural areas. The mean age of the study sample was 16.1(SD±0.4) years. The age range was 15.5 to 18.5 years. Seventy nine percent (n=502) of the children were able to record their monthly family income and 265 families had a monthly income of less than 10,000 rupees. Ninety eight percent [n=627] of the students were residing in there own homes where as 12 (1.9%) were residing outside home. The prevalence of thinness(<5th percentile) was 35.4% (n=226) and prevalence of being at risk of overweight (≥85th percentile)was 6.7% (n=43). Out of the males 43.8% (n=124) were in the thinness category compared to the girls (28.7%, n=102). Among those at risk of overweight, fe-males (8.7%, n=31) had a higher prevalence than the males (4.3%, n=12). This finding was statisti-cally significant (p=0.0001). More of the rural children were in the thinness cate-gory (36.3%, n=197) and more urban students were at risk of overweight (10.3%, n=10), yet not statisti-cally significant. Although there was no statistically significant difference between the nutritional status and parental factors, a higher proportion of thinness was observed when the mothers did not reside with the children and where mothers‘ education was less than G.C.E. O/L Conclusions: Under-nutrition is a problem among grade eleven school children in the MOH area Kalutara. Almost 7% of them were at risk of overweight

χω Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

De Silva V. Samarasinghe D. Gunawardena N (2009). "Alcohol and tobacco use among males in two districts in Sri Lanka." The Ceylon Medical Journal 54 (4). Objective: To investigate the prevalence and consumption of tobacco and alcohol among males in the Colombo and Polonnaruwa districts Study method: A multistage cluster sampling was carried out in 4 Medical Officer of Health (MOH) areas in the Colombo (urban) and Polonnaruwa (rural) districts to assess the prevalence of alcohol and tobacco use in males over 18 years of age. Nugegoda and Moratuwa MOH areas located in the district of Colombo are densely populated, suburban areas. Thamankaduwa and Elahara located in the district of Polonnaruwa are rural agricultural areas in the north central part of Sri Lanka. Each MOH area has a population of 80,000-90,000 and is divided into Public Health Midwife (PHM) areas for delivery of community based healthcare services. Sixty five PHM areas were considered as primary clusters. Roads within the primary clusters were considered as secondary clusters. All male occupants over 18 years of age in randomly selected houses were included in the study. The data collection was carried out as part of a pre-intervention assessment in a programme to reduce alcohol and tobacco use in selected MOH areas. The sample size was calculated to detect a 20% reduction in use. The study was conducted during May to August 2007. Information was obtained using an interviewer administered questionnaire. Alcohol consumption was quantified for each person using quantity-frequency estimation. Consumption was recorded for the past 30 days through self report. The type of beverage consumed, the average number of days per week alcohol was consumed and the average consumption on each occasion was recorded for different beverage types. The reported consumption was converted to units using average ethanol content of the different beverages. For cigarettes, the brand and average consumption per day were recorded. Study Area: The study was conducted in 4 Medical Officer of Health (MOH) areas in the Colombo (urban) and Polonnaruwa (rural) districts. Study population: All male occupants over 18 years of age in randomly selected houses were included in the study. Study Instrument: Interviewer administered questionnaire. Study type: A cross-sectional study Sample size: 2684 Sampling method: A multistage cluster sampling method Risk Factors Investigated: Alcohol Results: Study population The study population consisted of 2684 males over 18 years. There were 1318 from the urban areas and 1366 from the rural areas. There was no significant difference in mean age between urban and rural males (p=0.41). Urban males had a significantly higher income (p<0.001). The ethnic distribution (percentages) was Sinhalese 92.1, Tamils 2.7, Moor 4.5 and others 0.6. The percentage distribution of the sample by religion was Buddhists 82.5, Christian 11.2, Muslim 4.5 and Hindu 1.8. Distribution according to religion was significantly different between urban and rural groups (p<0.001), but racial distribution was not (p=0.133).

χϊ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Alcohol and tobacco use Current drinkers were defined as those consuming one or more drinks during the past 30 days and current smokers as those smoking one or more cigarettes during the past 30 days. Those who did not consume alcohol during the past 12 months were classified as abstainers. There were significantly more abstainers in the rural areas (75.2%) than in urban areas (56.5%) (p<0.001). Odds of current drinking was lowest among the Moor ethnic group (OR 0.40) and the Muslim religious group (OR 0.43). The 45-54 year age group had the highest odds of being current drinkers (OR 7.11) or current smokers (OR 4.84). Overall, prevalence of current drinking was 27.8% and current smoking 27.6%. The prevalence of current drinking in urban areas (32.9%) was significantly higher than in rural areas (20.8%) (p<0.001). The prevalence of current smoking in urban areas (29.9%) was also higher than in rural areas (24.4%) (p=0.052). In both urban and rural areas the prevalence of alcohol use and smoking increased with age, reaching a maximum in the 45-54 year category, and decreasing thereafter. In urban areas, the prevalence of drinking and smoking were highest among the lowest income category (<Rs. 5000). The mean consumption of alcohol in urban areas (33.1 units/week) was significantly higher than in rural areas (20.9 units/week) (p=0.004). Mean number of cigarettes smoked in urban areas (49.2/week) was higher than in rural areas (43.2/week) (p=0.21). From the age of 25 years tobacco consumption increased with age and decreased after 65 years of age. There was no clear age related pattern for amounts of alcohol consumed. The mean alcohol consumption in urban areas was highest among the Rs. 8000-14999 income category and in rural areas was highest among the Rs. 15000-24999 income category. Type of beverage used When indicating the types of beverages used some men reported more than one type. The total study population in the urban areas 16.9% drank beer, 26% drank arrack and 3.4% drank ‘kasippu’. Of the rural population 5.1% drank beer, 16.1% drank arrack and 5.1% drank ‘kasippu’. The consumption of imported beverages such as whisky, brandy, rum and gin was 3.3% in urban and 1.2% in rural areas. High risk drinking The rate of daily drinking of arrack or ‘kasippu’ was 51.6/1000 in urban and 14.6/1000 in rural areas. 14.8% (CI 12.5-17.3) of all urban males and 5.8% (CI 4.4-7.5) of all rural males consumed >14 units of alcohol per week. Amongst alcohol users 27.7% of rural users (CI 22.0-34.3) and 44.9% of urban users (CI 38.3-51.7) consumed >14units/week. Dhanapala S (1994). Prevalence,Selected risk factors and Perception of hypertension in rural community in the District of Matale. Postgraduate Institute of Medicine. Colombo, University of Colombo. Master of Science in Community Medicine. Main objective: To study the prevalence, screening, knowledge, attitudes and practices and selected risk factors of hypertension in an adult population of Matale District. Specific objective: 1.To find out the extent of prevalence of hypertension in the adult Sinhala rural population in the Divisional Secretary area of Matale. 2.To determine the extent to which the hypertensive persons were aware of their condition, were under treatment and were controlling their blood pressures.

χϋ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

3.To assess the knowledge, attitudes and beliefs on hypertension. 4.To assess the prevalence and determine the association between some of the known risk factors of hypertension Study area: Matale District Study population: All the Sinhalese population of ages 35 years or more from selected 5 Grama niladhari areas in the Divisional Secretary area of Matale with all the pregnant mothers at the time were excluded Type of study: Descriptive cross sectional study Study instrument: -Structured questionnaires -To measure the blood pressures –mercury blood pressure apparatuses -Anthropometric data collection using the weight (bathroom weighing scales) and height(Stably steel tapes) Sampling method: A multistage random sampling Sample size: Sample of 510 Sinhalese persons were selected out of which 97% participated Males 193 Females 304 Total sample of 497 Risk Factors investigated: Elevated Blood pressure Results: The study population was categorized into normotensive, borderline hypertensive and hypertensive persons according to their blood pressures. Normal adult blood pressure is arbitrarily defined as systolic blood pressures (SBP) equal to or below 140 mmHg (18.7 kPa), together with a diastolic blood pressure (DBP)(fifth Korotkoff phase ) equal to or below 90 mmHg (12.0 kPa). Hypertension in adults is arbitrarily defined as systolic blood pressures (SBP) equal to or greater than 160 mmHg (21.3 kPa), together with a diastolic blood pressure (DBP) (fifth Korotkoff phase) equal to or greater than 95 mmHg (12.7 kPa). The term “borderline hypertension “ is used to denote the blood pressure values between the normal and hypertensive ranges described above. Distribution of Sample population by level of blood pressure is given below Category Number Percentage Definite hypertensive 86 17.3 Borderline hypertensive 94 18.9 Normotensive 317 63.8 Total 497 100.0 From the study population, based on sex, hypertension was higher among the male population (19.7%) of persons aged >35 years compared to females (15.8%), out of which 23.8% were equal or more than 50 years of age and 7.2% were between 35 to 49 years of age.

χό Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Nearly 83.3% of the population had been screened previously for hypertension and it had been significantly higher among the females (92.4%) compared to males (68.9%) with z=6.85 Out of the 86 hypertensive’s only 29.1% (Z=0.13) were aware that they had hypertension. 88.0% of the known hypertensives were on treatment for hypertension while only 28.0% had their blood pressures controlled at the time of the survey. Overall 76.3% of the sample population had as adequate knowledge on hypertension especially among the 35-49 year old age group0(84.5%, Z=3.47),the educated group (educated up to or more than O/Levels) (88.0%, Z= 4.33) and the population with high income of more than Rs.2500 per month (93.6%, Z= 2.26) Fernando DJS. Siribaddana S. De Silva D (1994). "Impaired glucose tolerance and diabetes mellitus in a suburban Sri Lankan community." Postgraduate Medical Journal 70: 347-349. Objective: To assess the prevalence of diabetes mellitus in a suburban population in Sri Lanka. Study Method: The target population comprised adults in the defined electoral area (area 8 Maharagama, a suburb of Colombo) aged 30-64 years. Of the 4,334 persons in the register, 2,974 were within the target population. A simple random sample was obtained from the electoral list by using a table of random numbers. A total of 700 individuals (337 men) were selected to participate in this survey: 633 (312 men) agreed to participate, 65 of whom were Tamil, 12 Muslim and the rest Sinhala (88% Sinhala, 10.3% Tamil). The relative proportions for the different ethnic groups were similar to those at national level. The participants attended a hospital clinic located within 3 miles of their homes. They were instructed to come in the morning after a 12 hour overnight fast, after at least 3 days of unrestricted diet (carbohydrate intake >150 g), usual levels of physical activity and abstaining from smoking. The height without shoes was recorded in cm and the weight without shoes was recorded in kg. The body mass index was calculated according to the formula BMI = weight (kg)/height2 (m) (kg/M2). Obesity was defined as a body mass index >25 in women and >27 in men in a study on prevalence of diabetes in South India. We used the same criteria. A 75 g 2-hour glucose tolerance test was performed. Glucose was measured in venous whole blood using the glucose oxidase method and a Cobas Mira photoanalyser in the hospital laboratory. Random samples of blood for glucose estimations were measured in duplicate. The correlation coefficient for duplicate readings was 0.992 and coefficient of variation was 1.7%. Diabetes mellitus and impaired glucose tolerance were defined according to the WHO criteria. Patients currently on oral anti-diabetic agents or insulin therapy were classified as diabetic if initial criteria for diagnosis were stated in hospital discharge letters. If no data were available, oral hypoglycaemics were withdrawn and patients retested after 3 days. Patients treated with insulin were labelled as diabetic and were not subjected to glucose tolerance tests. The prevalence of diabetes may vary with the age structure of a sample. In order to ensure comparability between different studies it is helpful to express prevalence as an age-standardized rate for a standard population. This would then represent the prevalence that would be observed in a reference population. A hypothetical standard population age structure is used in many multinational comparative studies. The 5-year age specific rates for the sample were calculated and standardization performed by the direct method against the standard world population of Segi. Results were expressed as age-standardized rates with 95% confidence intervals. Comparison of crude prevalences of obesity in diabetic and nondiabetic groups was by chi-squared analysis.

χύ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Study area: Maharagama, a suburb of Colombo Study population: Adults aged 30-64 years Study instrument: Glucose oxidase method and a Cobas Mira photoanalyser Sampling method: Random sampling Sample size: 633 (312 men) Factors investigated: Diabetes, IGT, Oral hypoglycaemic agents use, Insulin treatment, Obesity, Diabetic complications, Height, Weight Results: The crude prevalence of diabetes in the population studied was 5.2 and the age-adjusted prevalence 5.02 (95% CI 3.59-6.43). The age-adjusted prevalence rate for impaired glucose tolerance (IGT) was 5.27 (95% CI 3.74-6.78). The prevalence of diabetes and IGT increased with age (Table I). Eighteen of the 33 diabetic patients and 20 of the 34 subjects with IGT were women. However, the sample studied is too small to comment on gender-specific prevalence rates or prevalence rates for different ethnic/racial groups. Twenty-six patients had previously diagnosed diabetes. Two were treated with insulin. Six patients in whom criteria for diagnosis were not documented were retested with glucose tolerance tests 3 days after withdrawal of oral hypoglycaemic agents. All had glucose tolerance test results in the diabetic range. Seven (21 %) diabetic patients were not previously known to have diabetes. Two of the patients diagnosed as having diabetes for the first time had clinical evidence of retinopathy at the time of diagnosis. One had neuropathic foot ulcers. A strong relationship existed between diabetes mellitus and excess body weight. The prevalence of obesity in diabetic patients (21%) was higher (P<0.05) than in non-diabetic individuals (10.5%). Conclusion: We conclude that diabetes mellitus is a common health problem in Sri Lanka and that health planners and policy makers should follow the WHO guidelines to develop national policies for the prevention and control of diabetes. Hanwella R. De Silva VA. Jayasekera NELW "Alcohol use in a military population deployed in combat areas: a cross sectional study." PubMed. Objective: To describe alcohol consumption patterns among military personnel in Sri Lanka Study Method: A cross sectional study was carried out among representative samples of Sri Lanka Navy (SLN) Special Forces and regular forces deployed in combat areas to assess their mental health status. Data collection commenced three months after combat operations ended. Only personnel who had served continuously in combat areas during the one year period prior to end of combat operations were included in the study. Both Special Forces and regular forces were selected using simple random sampling. The sample of SLN Special Forces was selected from the Special Boat Squadron which is the only Special Forces unit in the SLN. Since there are no females in the Special Forces, females were excluded from the regular forces group. The SLN central data base was used to identify all personnel who had served in combat areas continuously for at least one year. Participants were selected from this population using computer generated random numbers.

ψτ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

The participants thus identified were contacted at their workplace. They were briefed regarding the nature and objectives of the study by personnel from the medical corps. The briefings were carried out in small groups at the place of deployment to improve response rates, aid clarification and facilitate provision of support for those with mental health problems. Participation was voluntary. The response rate was 93.8 %. The rate of missing values for individual items in the survey was about 10 %. The sample size was calculated to detect an odds ratio of 2.0 for disorders with an estimated prevalence of 15 %, a power of 90 % and confidence of 95 % (two tailed). The required sample size was 240 in each group. The sample size was increased by 15 % to adjust for nonresponse. The comparison group (regular forces) was oversampled to include more combat troops. A total of 259 Special Forces and 412 regular navy personnel were recruited into the study. Study area: Sri Lanka Study population: Sri Lanka Navy (SLN) Special Forces and regular forces Type of study: Cross sectional study Study instrument: Alcohol Use Disorder Identification Test (AUDIT), General Health Questionnaire 12 (GHQ-12) Sampling method: Simple random sampling Sample size: 671 Factors investigated: Drinking, Results: Sample consisted of 259 Special Forces and 412 regular navy personnel. The median AUDIT score was 2.0 (interquartile range 6.0). Prevalence of current drinking was 71.2 %. Of the current users 54.81 % were infrequent users (frequency ≤ once a month) while 37.87 % of users consumed 2–4 times a month. Prevalence of hazardous drinking (AUDIT ≥ 8) was 16.69 % and binge drinking 14.01 %. Five (0.75 %) had AUDIT total ≥20. There was no significant difference between Special Forces and regular forces in hazardous drinking or binge drinking. Total AUDIT score ≥16 were associated with difficulty performing work. Conclusion: High rates of hazardous drinking and binge drinking described among military personnel in US and UK were not seen among SLN personnel deployed in combat areas. This finding contrasts with previously reported association between combat exposure and hazardous alcohol use among military personnel. Alcohol use among military personnel may be significantly influenced by alcohol consumption patterns among the general population, access to alcohol and attitudes about alcohol use. Similar to findings from other countries, heavy alcohol use was associated with poorer psychological health and functional impairment. Hettige S (2005). A Study of Obesity and related Cardiovascular Risk factors in an urban area in Sri Lanka. Postgraduate Institute of Medicine. Colombo, University of Colombo. Doctor of Medicine in Family Medicine Main objective: To study the relationship of body mass index and waist to hip circumference ratio to selected physical and biochemical parameters

ψυ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Specific objective: To determine- 1.The proportion of overweight in an apparently healthy population. 2.The relationship of Body Mass Index and waist to hip circumference ratio to blood pressure. 3.The relationship of Body Mass Index and waist to hip circumference ratio to plasma glucose. 4.The relationship of Body Mass Index and waist to hip circumference ratio to serum lipids. 5.The influence of physical activity on the Body Mass Index and the waist to hip circumference ratio. 6.The influence of familial predisposition on Body Mass Index. Study area: Author’s Family practice which is situated in Gramaseva Division of Wattegedara. Study population: All persons of ages between 20-70 years in Wattegedara Type of study: A cross sectional study Study instrument: 1.For body weight measurement – a beam balance with movable weights, graduated in kilograms and grams 2.For standing height measurement, a vertical pillar to which a metric rule (cm) has been fixed and also with an attached horizontal headboard that can be moved up of down to touch the head. 3.For waist circumference and hip circumference measurement, a narrow (0.75cm wide), flexible non stretch fiberglass tape graduated in centimeters and subdivided in millimeters. 4.For blood pressure measurement a mercury sphygmomanometer. 5.For familial predisposition, color photographs of the whole body of people clad in their usual clothing’s were used. 6.For plasma glucose concentration determination a Diagnostic Kit – GOD-PAP was used. 7.For the determination of serum cholesterol concentration a Diagnostic Kit – Cholesterol Enzymatic Endpoint Method. 8.For serum triglyceride levels – Diagnostic Kit GPO-PAP was used. Sampling method: Random Sampling Sample size: 414 Results: The total study sample consisted of 414 persons, out of which there were 177 (42.8%) males and 237 (57.2%) female subjects. The mean age of the subjects was 39.66 years (+/- 11.02 years). Nearly 89% of the subjects have had education beyond Grade VIII. Monthly incomes in rupees <Rs 5000,>Rs 5000 to Rs 10000,>Rs 10000 to Rs 20000, >Rs 20000 were drawn by 81(20%), 154(37%), 100 (24%), 50 (12%) respectively. The general obesity of the population was determined with body mass index (weight in kilograms and [height in meters]2) and the truncal or abdominal obesity with the waist to hip circumference ratio [both in centimeters]. The values obtained for the BMI of the study subjects were interpreted cut-off values recommended by the WHO and applicable globally. This was done in order to compare the findings of this study with the findings of global studies

ψφ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

BMI category BMI or BMI Range (kg.m2) Underweight <18.50 Desirable 18.50-24.99 Overweight: >25 Preobese 25.00-29.99 Obese >30 The waist to hip circumference ratio (WHR) cut off values used in this study: >1.0 for men and >0.85 for women recommended by the WHO for global populations was used as cut –off values for undesirable abdominal fat accumulation. Also the WHR data obtained in this study were interpreted using the cut – off values, >0.88 for men and > 0.85 for women, recommended for Asian populations. The BMI, mean + SD, of the overall study population was 25.21 + 4.67kg m-2 , with range, minimum to maximum 1.41 – 42.4 kgm-2. The BMI values of the study subjects were analysed according to the criteria laid down by the WHO and the number of subjects belonging the four BMI subgroups are presented graphically in Figure 1. The overall BMI distribution of the study population showed a shift towards being overweight. The range of WHR remained between a minimum of 0.48 and a maximum of 1.13. The WHR for the study group (n= 414) was 0.91 + 0.08, with median of 0.92 and in which the males and the female having 0.95 + 0.07 and 0.88 + 0.09, respectively. The findings are presented in the table 1. The number and percentage of subjects in comparison of distribution of body mass index and WHR categories< 0.79, 0.8-0.89, 0.9-0.99 and > 1.0 were determined as shown in table 2. WHR, an indicator of abdominal fat accumulation, clearly identified 39 subjects (9.4%) with a WHR < 0.79 as shown in table 1. These individuals, disregarding the gender, were likely to carry minimal comorbidities associated with abdominal fatness. At the other end of the WHR spectrum 73 subjects (17.6%) had a WHR > 1.0. These individuals, regardless of the gender, would embrace cormormidities owing to undesirable abdominal fat accumulation or truncal obesity. The results also revealed that waist to hip circumference ratio correlated significantly with the BMI (p=0.01). For analyzing the relationship of BMI and WHR on Blood pressure values, following cut- off values were used. The values of blood pressure, in the sitting position, were interpreted as by World Health Organization criteria. Systolic blood pressure >140mmhg and or diastolic blood pressure > 90 mmhg were taken off as cut off values for hypertension. The distribution of systolic and diastolic blood pressures of the overall study subjects are given in table 3. Influence of BMI on Blood pressure on the subjects is given in table 3.1. There was a statistically significant association (p=0.01) between both the systolic and diastolic blood pressures with the BMI. The systolic and diastolic blood pressure were cross tabulated against the broad BMI categories <25 and >25 kgm-2 .The results of the analysis showed that in the overweight subjects (>25 kgm-2), systolic and the diastolic hypertension was in 15.1% and 25.0% respectively. Among those who were <25kgm-2 systolic and the diastolic hypertension was in 4% and 5.9% respectively. The odds ratio , 4.3 for systolic blood pressure and 5..3 for diastolic blood pressure implied that overweight subjects

ψχ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

were 4 times more likely to develop systolic hypertension and 5 times more likely to get diastolic hypertension. The influence on the waist to hip ratio on blood pressure is given under Table 3.2. The results revealed that females were more vulnerable to abdominal obesity related hypertension than the males and diastolic hypertension exceeded systolic hypertension. The glycaemic status of the study population were by done by analyzing their fasting and 2 hour post –glucose –load plasma glucose concentration. Plasma glucose cut-off values are given below, in which their fasting plasma glucose (FPG) concentration values were taken by taking their venous plasma (mmol-1) obtained after 12 hours of fasting and the 2 hour post parandial glucose (PPG) after 2 hours after 75g oral glucose load. The cut off values were used in the study as interpreted by the WHO FPG (mmol-1) Glycaemic status <6.1 Normoglycaemia 6.1-6.9 Impaired fasting glycaemia >7.0 diabetes PPG (mmol-1) Glycaemic status <7.8 Normoglycaemia 7.8-11.0 Impaired glucose tolerance >11.1 diabetes To determine the glycaemic status of the subjects only 157(37.9%) both males and females, out of the 414 study sample participated and out of the 157 subjects 128(81.5%) participated to determine the postprandial plasma glucose levels. The glycaemic status of the study population is given under Table 4.1 and 4.2. The results revealed that in comparison with fasting plasma glucose, plasma glucose concentration at 2 hours following 75g oral glucose detected more marginal glucose intolerant and diabetic individuals. When studying the influence of the subjects BMI on hyperglyaecemia, the FPG and PPG increased with increasing BMI. Correlation was significant p=0.05 (FPG) and p=0.01(PPG), respectively. Overweight (BMI >25kg.m-2) were more likely to have to have an elevated plasma glucose concentrations, fasting and post glucose load, than those with a desirable BMI (odds ratios FPG=2.4 and PPG=1.7). Regarding WHR and hyperglyaecemia, the study revealed that all male and female subjects with a WHR<0.88 and <0.85 were normoglycaemic. At a WHR > 0.88 and > 0.85, impaired glycaemia (FPG,>6.1) was found in 17.4 % of male and 7.3% female subjects. With WHR, FPG and PPG had a positive correlation (p>0.01) in the males. The odds ratio 3.0, implied that the risk or elevation of plasma glucose concentration in the subjects with a higher WHR was 3 times that in subjects with a desirable WHR (<0.88 and <0.85). According to table 6 the study has revealed that the increase of total serum cholesterol levels with BMI increase was not significant. Studying the relationship between WHR and the serum total cholesterol levels of the subjects revealed that hypercholesterolemia (> 4.4 mmol/L) was found in 90% of the males with a WHR of >

ψψ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

0.88 and 50% with a WHR of < 0.88. While from the females 92% with a desirable WHR (< 0.85) and 88% of the females with an undesirable WHR (> 0.85) showed hypercholesterolemia. In males undesirable WHR was associated with hypercholesterolemia (OR=8.8, p=0.01) while the in the females the serum total cholesterol had no relationship with WHR. BMI and the Serum triacylglycerol levels showed no significant relationship but WHR, of both males and females showed a significant relationship with the Serum triacylglycerol level (p=0.05 and p=0.01 respectively). Illangasekera U. Nugegoda DB. Perera LS (1993). "Prevalence of diabetes mellitus and impaired glucose tolerance in a rural Sri Lankan community." Ceylon Med J 38(3): 123-6. Objective: To determine the prevalence of diabetes mellitus and impaired glucose intolerance (IGT) in a rural Sri Lankan community. Study method: The survey was done in a Sinhala population over the age of 18 years living in the Hindagala community Health Project Area. The total Sinhala population in the selected villages according to the 1990 electoral register was 7140 from which a random sample if 200 subjects were selected. The demographic and socioeconomic data included age sex, level of education, occupation and family income. The subjects were requested to report to a centre after a 12 hour over night fast . A sample of urine and 2 ml venous blood were collected from each subject. 75g of glucose in 200ml of water was then given orally and a second sample of urine and blood were collected after 2 hours. The sample of urine was immediately tested for glucose with ‘Glukotest’ dipsticks. Blood glucose levels , height , weight and blood pressure of the subjects were recorded using standard methods. The Body Mass Index of each subject was calculated from their weight and height measurements Study Area: Hindagala community Health Project Area Study population: Sinhala population over the age of 18 years living in the Hindagala community Health Project Area Study Instrument: Blood and urine glucose measurements Weight and height measurements Blood pressure recordings Study type: A cross sectional study Sample size: 199 Sampling method: Random sampling method Results: 199 subjects (79 males ), with age range of 18 to 90 years, completed the study. The study revealed that mild obesity was present in six subjects (3.01%) and eight (4.0%) had hypertension. Five subjects (3 females) of whom were previously diagnosed to have diabetes were identified. The prevalence rate of diabetes for each sex was 2.5% and the crude prevalence rate for the whole population was 2.5%. Sixteen subjects (14 females were found to have impaired glucose intolerance accounting for a prevalence rate of 8%. Only data relating to the females were used for statistically analysis as they were formed majority of subjects with IGT. There was no significant difference between the mean BMI of those with IGT and those without The prevalence of diabetes mellitus and impaired glucose tolerance (IGT) in a rural Sri Lankan community adopting the World Health

ψω Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Organization (WHO) criteria were 2.5% and 8% respectively. The low socioeconomic status, adequate physical exercise and the low prevalence of obesity appear to have not only contributed to the low prevalence of diabetes but also has prevented progression from IGT to overt diabetes. Illangasekera U. Rambodagalla S. Tennakoon S (2004). "Temporal trends in the prevalence of diabetes mellitus in a rural community in Sri Lanka." Journal of The Royal Society for the Promotion of Health 124(2): 92-94. Objective: To objectively assess whether the prevalence of diabetes has increased in a named rural community in Sri Lanka during a period of ten years and whether there has been a change in the socio-economic status of the community during this period. Study Method: The study was conducted on a sample of 220 subjects randomly selected from an adult population of 25,605 residents in a rural area in central Sri Lanka. Each of these subjects had the fasting blood sugar estimated and the height, weight, resting blood pressure and socio-economic parameters, such as the level of education, occupation and monthly income, recorded. These data were compared with those of a similar study conducted by the main author in the same community ten years ago. Study area: Rural area in central Sri Lanka Study population: Adult population Sampling method: Random sampling Sample size: 220 Factors investigated: Fasting blood sugar estimated and the height, weight, resting blood pressure and socio-economic parameters, such as the level of education, occupation and monthly income Results: The results revealed that the age-standardised prevalence of diabetes had increased from 2.5% in 1990 to 8.5% in 2000 (p=0.008) and that this was accompanied by an increase in the monthly income, level of education and body mass indices. Conclusion: Since nearly 70% of all Sri Lankans live in villages, continuation of the present trend would result in a dramatic increase in the number of patients with diabetes in the future. Suitable strategies should be implemented to arrest this trend and manage a large number of patients with diabetes in the future. Ismail AC. Senevirathne R. De A (2008). "Prevalence and pattern of substance use among secondary school students in the Colombo District." Journal of College of Community Physicians of Sri Lanka 13(2): 17. Objective: To determine the prevalence and pattern of lifetime and current substance use among 13 - 18 year old adolescents attending schools in the Colombo District. Study Method: Cross sectional survey was conducted among 3454, 13 – 18 year old adolescents from 29 schools selected proportionate to size using multi- stage cluster sampling. Validated Sinhala Adolescent

ψϊ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Substance Use Questionnaire (ASUSQ) assessed: cigarettes, alcohol, marijuana, other drug use; age at first use; substance, source and place of first use; consequences and reasons for use and non-use. A standardised procedure was used to collect data. Analytical strategies eliminated returned questionnaires of questionable validity. Study area: 29 schools in Colombo District Study population: 13 – 18 year old adolescents Type of study: Cross sectional survey Study instrument: Validated Sinhala Adolescent Substance Use Questionnaire (ASUSQ) Sampling method: Multi- stage cluster sampling Sample size: 3196 Factors investigated: Prevalence, cigarette, alcohol, marijuana, adolescents Results: The final sample size was 3196 (1550 boys) with a mean age of 15.4 years (SD + 1.69). Sixteen percent (n = 512) of adolescents reported having used at least one of the substances at least once in their lifetime. A majority of substance users reported alcohol (n = 325, 63.5%) as the substance of first use, followed by cigarette (n = 158, 30.9%), other drug(s) (n = 19, 3.7%), and marijuana (n = 8, 1.9%). A majority reported source and place of substance of first time use as friends (n = 209, 55.4%), and at a wedding celebration (n = 114, 30.1%), respectively. Reasons most frequently agreed upon for use of any substances were curiosity (n = 140, 29.5%), and friends use (n = 67, 14.1%). Consequences of substance use included feeling sick (n = 53, 21.7%), trouble concentrating on the task at hand (n = 51, 20.9%), and criticized by an adult (n = 36, 14.8%). Reasons for non-use of any substances were just did not want to use (n = 1459, 127.8%), would not be able to live up to one’s expectations (n = 985, 18.8%), family disapproval (n = 896, 17.1%) and religious reasons (n = 685, 3.1%). Reasons least frequently agreed upon for non-use of any substance were fear of addiction (n = 118, 2.2%), fear of psychological effects (n = 110, 2.1%), illegality (n = 54, 1.0%), and cost of use (n = 19, 0.4%). Conclusion: Lifetime and current prevalence, and frequency of substance use indicated that a majority of users were experimenters. Use of a validated instrument and standardised procedure improved accuracy of prevalence estimates in this study. Jayakody KWG. Nugegoda DB. Kumarasiri PVR (2007). "Nutritional status of the elderly in the Matale district." The Twelfth Annual Academic Session of the College of Community Physicans of Sri Lanka September 2007 Objective: To determine the nutritional status of the elderly by sector in the district of Matale Study method: A community based descriptive comparison study was carried out to assess the nutritional status among the elderly age >60 years in the district of Matale using a stratified multistage cluster sampling method. A sample of 3194 subjects was selected (urban- 1200; rural-1163, and estate 831). Of the selected sample 95.2% participated in the study. Information was obtained by using and interviewer administered structure questionnaire conducted by Public Health Midwives.

ψϋ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Anthropometric measurements weight, height, arm span and mid upper arm circumference (MUAC was measured by the principle investigator according to the standard protocols.) Study Area: Matale district Study population: Elderly population of age >60 years Study Instrument: Interviewer administered structure questionnaire Anthropometric measurements weight, height, arm span and mid upper arm circumference Study type: A community based descriptive comparison study Sample size: 3194 Sampling method: Stratified multistage cluster sampling method Risk Factors Investigated: Nutrition Results: Prevalence if undernutrition according to the BMI (Body Mass Index) in the estate, rural and urban sectors 58.3% (n=468), 40.1% (n=448) and 22.3% (n=250) respectively with an over-all prevalence of 38.4% (n=1166). In all three sectors females (14.3% n=261) had a higher prevalence of obesity than males (7.3%, n=88). Prevalence of under nutrition among the elderly in the 3 sectors increased with advanced age. Prevalence of overweight was significant higher (p<0.001) among the elderly in the urban sector (20.5%, n=246) in comparison to rural (7.1%, n=82) and estate sectors (2.5%, n=21) combined together. Recommendation: More emphasis should be made a population based programmes using IEC (?) to prevent elders from becoming undernourished. Awareness on prevention, promotion, and intervention programmes the health care professional as well as general population needs to be addressed. According to this study majority of estate elders were undernourished, hence special attention should be paid to the estate elders. Special attention should be paid to overcome the problem of overweight among the urban elders. Jayatissa R (2012). "Cardiovascular risk profile of working population in Colombo District." The Ceylon Medical Journal 57(Supplement 1): Page 79. Objective: To estimate the total cardiovascular risk of working population who have not yet developed clinical manifestations of cardiovascular disease for primary prevention. Study method: All the workers in 23 public institutions were screened by the Department of Health, Western Province in November 2010 to September 2011. Weigh, Height Fasting blood sugar, fasting lipid levels were estimated. WHO/ISH risk predication chart was applied to identify the 10 year risk of fatal or non fatal cardiovascular events in this population. WHO defined cut off levels were taken to categorize the Body mass index and the blood levels Study Area: Colombo District Study population: Workers between the ages of 18-79 in 23 public institutions

ψό Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Sample size: 5218 Risk Factors Investigated: Weight, Height Fasting blood sugar, fasting lipid levels Results: From the total sample size, 64.9% were males. Among them, 8.3%, 57.0% and 30.1% and 4.6% were underweight, normal, overweight and obese respectively. High systolic (>140) and diastolic (>90) was found with 6.3% and 5.4% of them respectively. Prevalence of diabetics was 22.8% and 1.7% were smokers. 10-year risk of cardiovascular event in this population is shown as 30% was 97.2%, 2.1%, 0.5% and 0.2% respectively. Conclusions Majority of the working population are at a low risk of developing CVDs. Only 3% of the working population need follow up. Urgent measures to be adopted on lifestyle interventions in the working population to prevent CHD risk. Jayatissa R. Bekele A (2006). Nutritional Surveillance in tsunami affected areas. The Eleventh Annual Academic Session of the College of Community Physicans of Sri Lanka October 2006: Page 17. Objective: To compare the nutritional status of under 5 year old children affected and not affected by tsunami over a period of six months in the districts struck by tsunami. Study Method: A follow up survey was conducted in 30 clusters selected form 12 tsunami affected districts. Three groups of under 5 year olds were identified, namely, those affected by the tsunami and 1) living in camps and 2) living in own homes and 3) those not affected. They were assessed initially in May 2005 and six months later. Interviewer administered questionnaire was used to collect data on relevant information from the mothers/ immediate care takers of the child. Anthropometric measurements included height/length and weight. Study population: Under 5 year old children Type of study: Retrospective study Study instrument: Interviewer administered questionnaire Sampling method: Cluster sampling Sample size: 1,127 Risk Factors investigated: Nutritional status, Wasting Results: A total of 1,127 children of tsunami affected families living in camps (n = 314) and living in their houses (n = 397) and non-affected families (n = 416) were assessed. There was a significant reduction (p < 0.005) in the prevalence of wasting from 16.8% to 10.8% among children living in camps. The reduction of wasting among children living at home (15.7% - 14.1%) and not displaced (13.9% - 11.8%) were not marked. The proportion of children aged > 6 months receiving Triposha in the camps increased from 25.4% to 33.1%. The proportion of families living in camps taking loans increased from 12% to 21.3%.

ψύ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Fever/ cough increased from 43.2% to 69.1%. Affected children living in houses, fever/ cough increased from 4.9% to 58.9% and non-affected children from 38.3% to 56%. Conclusion: This study showed that targeted interventions can make a drastic difference in the nutritional status of children less than five years of age. It is equally important to reinvigorate the control of respiratory infections. Jayatissa R. Ranbanda RM (2006). "Prevalence of challenging nutritional problems among adolescents in Sri Lanka." Food Nutr Bull 27(2): 153-60. BACKGROUND: Although 21% of the population of Sri Lanka consists of adolescents, studies of nutritional status among this group are limited. OBJECTIVE: To assess nutritional problems and dietary and activity patterns among adolescents in Sri Lanka. METHODS: A nationally representative cross-sectional study was conducted on 6,264 adolescents 10 to 15 years of age. All subjects were clinically examined for Bitot's spots, and their weights and heights were measured. The subjects were interviewed during regular class time. Hemoglobin concentration and dietary and activity patterns were assessed among a subsample (n = 787) of 1,521 adolescents. The World Health Organization age- and sex-specific references for body-mass index and height-for-age were used to estimate the prevalence of underweight and stunting, respectively. The International Obesity Task Force age- and sex-specific reference for body-mass index was used to estimate the prevalence of overweight. Age-specific WHO-defined cut off points were used to estimate the prevalence of anemia. RESULTS: The prevalence rates of underweight, stunting, and overweight were 47.2%, 28.5%, and 2.2%, respectively. The prevalence rates of anemia and vitamin A deficiency were 11.1% and 0.4%, respectively. During the previous 6 months, 10.4% of the subjects had usually not eaten breakfast before going to school. During the week before the interview, 24.4% of the children had not consumed green leafy vegetables, 26.6% had not consumed fruit, 19.0% had not participated in physical activities, and 27.5% had watched television for more than 2 hours per day. CONCLUSIONS: The nutritional problems of adolescents aged 10 to 15 years should be addressed through the schools. Specific policies should be developed in collaboration with the Ministry of Health and Education to control nutritional problems among adolescents. Jayawardena R. Byrne NM. Soares MJ. Katulanda P. Hills AP "Food consumption of Sri Lankan adults: an appraisal of serving characteristics." Public Health Nutr: 1-6. OBJECTIVE: The main aim of the present study was to identify food consumption in Sri Lankan adults based on serving characteristics. DESIGN: Cross-sectional study. Fruits, vegetables, starch, meat, pulses, dairy products and added sugars in the diet were assessed with portion sizes estimated using standard methods. SETTING: Twelve randomly selected clusters from the Sri Lanka Diabetes and Cardiovascular Study. SUBJECTS: Six hundred non-institutionalized adults. RESULTS: The daily intake of fruit (0.43), vegetable (1.73) and dairy (0.39) portions were well below national recommendations. Only 3.5 % of adults consumed the recommended 5 portions of fruits and vegetables/d; over a third of the population

ωτ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

consumed no dairy products and fewer than 1 % of adults consumed 2 portions/d. In contrast, Sri Lankan adults consumed over 14 portions of starch and 3.5 portions of added sugars daily. Almost 70 % of those studied exceeded the upper limit of the recommendations for starch intake. The total daily number of meat and pulse portions was 2.78. CONCLUSIONS: Dietary guidelines emphasize the importance of a balanced and varied diet; however, a substantial proportion of the Sri Lankan population studied failed to achieve such a recommendation. Nutrition-related diseases in the country may be closely correlated with unhealthy eating habits. Jayawardena R. Ranasinghe P. Byrne NM. Soares MJ. Katulanda P. Hills AP (2012). "Prevalence and trends of the diabetes epidemic in South Asia: a systematic review and meta-analysis." BMC Public Health 12: 380. Objective: To discuss the prevalence of pre-diabetes and diabetes in South Asia and explore the differential risk factors reported Study Method: The study was conducted in adherence to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and the PRISMA checklist is provided as a Supplementary file. Diabetes prevalence data among South Asian adults in regional countries were obtained by a three-stage process. In the first stage a search of the online Medline® database (Medical Literature Analysis and Retrieval System) was performed with a combination of MeSH® (Medical Subject Headings) terms; ‘prediabetes’ and ‘diabetes mellitus’ were the MeSH major topic and Epidemiology/EP was the MeSH subheading. The search limits were; language (‘English’), dates (between ‘1st January 1980’ and ‘31st December 2011’), Species (‘Humans’) and age (‘all adults: 19+ years’). The conjunction of the above results were narrowed down by adding the name of each regional country (India, Pakistan, Bangladesh, Sri Lanka, Nepal, Bhutan and Maldives), South Asian and Indian Asians as key words. In the second stage the total hits obtained from searching Medline® using the above search criteria were screened by reading the ‘title’ and ‘abstract’. Studies not satisfying the inclusion criteria were excluded at this stage. The studies selected for inclusion in stage two were further screened for suitability during stage three by reading the selected manuscripts. At this stage studies were excluded based on the following exclusion criteria: being confined to only a specific age group, being hospital/clinic-based, studies reporting the results of larger studies as duplications and studies conducted among South Asians residing elsewhere. To obtain additional data a manual search was performed using the reference lists of selected articles. This process was conducted by two independent reviewers (RJ and PR) and the final group of articles to be included in the review was determined after an iterative consensus process among the reviewers. For the purpose of describing prevalence data for the individual countries, the studies that were most recent, nationally representative or with the largest sample size were included. For meaningful comparisons of prevalence data among the countries, age-standardized data are presented here, unless otherwise stated. Additional data not available in the published manuscript such as gender and area-specific prevalence were obtained from corresponding authors or calculated using the available raw data. Area of residence and social status are key factors determining the prevalence of diabetes; therefore, when exploring the secular trend in diabetes prevalence it is meaningless to plot the prevalence data from studies based on different populations even in a single country. Hence, when evaluating the secular trends in prevalence of diabetes and pre-diabetes in a country we only considered studies that evaluated the temporal change in prevalence between similar populations or prospective studies based on the same population. Presence of ‘diabetes mellitus’ in the individual studies were defined according to the World Health Organization (WHO) or American Diabetes Association (ADA) criteria adopted at the time of the respective studies. ‘Prediabetes’ was defined as the presence of Impaired Fasting Glucose (IFG) or

ωυ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Impaired Glucose Tolerance (IGT) according to the above criteria. The diabetes epidemicity index (a prognostic index of the diabetes epidemic in a population) was defined as the ratio between the prevalence of IGT/IFG (pre-diabetes) and Total Glucose Intolerance (TGI) (diabetes and pre-diabetes) i.e. the ‘diabetes epidemicity index’ is the percentage of the TGI made up by IGT/IFG. A meta-analysis of studies examining the risk factors associated with diabetes mellitus in South Asian populations was conducted for parameters that were defined identically across studies. Hence the meta-analysis was performed on the following clinical and biochemical parameters; family history of diabetes, age, male gender, Body Mass Index (BMI), Waist-Hip Ratio (WHR), Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP). A fixed effect analysis was initially conducted for all comparisons. Heterogeneity was assessed using the χ2 test on Cochrane’s Q statistic and by calculating I2. If significant heterogeneity was present (p < 0.05 from χ2 test) a random effects meta-analysis was carried out. Data were analysed using RevMan version 5.1.2 (Review Manager, Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011) statistical software package. In all analyses a p-value < 0.05 was considered statistically significant. Factors investigated: Family history of diabetes, age, male gender, Body Mass Index (BMI), Waist-Hip Ratio (WHR), Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) Results: The most recent reported prevalence of pre-diabetes:diabetes in regional countries were; Bangladesh– 4.7%:8.5% (2004–2005;Rural), India–4.6%:12.5% (2007;Rural); Maldives–3.0%:3.7% (2004;National), Nepal–19.5%:9.5% (2007;Urban), Pakistan–3.0%:7.2% (2002;Rural), Sri Lanka–11.5%:10.3% (2005–2006;National). Urban populations demonstrated a higher prevalence of diabetes. An increasing trend in prevalence of diabetes was observed in urban/rural India and rural Sri Lanka. The diabetes epidemicity index decreased with the increasing prevalence of diabetes in respective countries. A high epidemicity index was seen in Sri Lanka (2005/2006–52.8%), while for other countries, the epidemicity index was comparatively low (rural India 2007–26.9%; urban India 2002/2005–31.3%, and urban Bangladesh–33.1%). Family history, urban residency, age, higher BMI, sedentary lifestyle, hypertension and waist-hip ratio were associated with increased risks of diabetes. Conclusion: A significant epidemic of diabetes is present in the South Asian region with a rapid increase in prevalence over the last two decades. Hence there is a need for urgent preventive and curative strategies. Jayawardena R. Ranasinghe P. Katulanda P. Sheriff R. Matthews DR (2012). " Pattern and Correlates of Physical Activity among Sri Lankan adults." The Ceylon Medical Journal 57(Supplement 1). Objective To evaluate the pattern of physical activity and its relationships with socio-demographic, clinical and biochemical parameters in Sri Lankans Study Method: Data on Physical Activity (PA) were obtained by a cross-sectional survey on 5000 Sri Lankan adults. PA was assessed using a short version of IPAQ. A binary logistic analysis was performed using the dichotomous variable“Health Embracing PA (O = Active; 1 = Inactive)”. Results: Sample size was 4,485 with 39% males. Mean age was 46.1 ± 15.1 years. Mean weekly MET minutes in all adults was 4703 ± 4369. Males (5464 ± 5452) had significantly higher total MET minutes than females (4205 ± 3394) (p < 0.01).

ωφ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Rural adult (5175 ± 4583) were significantly more PA than urban adults (2956 ± 2847) (p < 0.001). Tamils had the highest mean weekly total MET minutes than other ethnicities. Those with tertiary education had the lowest mean weekly total MET minutes. In all adults 60.0% were in the highly active category. From the “highly active” adults, 85.8% were residing in rural areas, while only 14.2% were form urban areas (p < 0.001). Female gender (OR 2:11), Age > 70 (OR 3:8), Urban living (OR 2:5), Muslim ethnicity (OR 2:7), Tertiary education (OR 3:6), Obesity (1:8), Central Obesity (OR 1:5), Presence of Diabetes (OR 1:6), Hypertension (OR 1:2), Metabolic Syndrome (OR 1:3) had significantly increased odds of being physical inactivity. Kasturiratne A. Medagoda K. Kurukulasuriya SAF. Wickremasinghe AR (2012). "Incidence of hypertension in an urban population - can we modify the risk?" The Ceylon Medical Journal 57(Supplement 1): Page 43. Objective: To determine the incidence and risk factors of incident hypertension in an urban population in Sri Lanka Study method: This study was conducted in Ragama Health Study Cohort which consisted of 2986 individuals living in the Ragama Medical Health Officer area in the district of Gampaha. The Participants were selected from the electoral lists in 2007 and investigated using clinical, biochemical, and anthropometric examinations and liver ultrasound for assessment of fatty liver. A complete follow up assessment of the cohort was conducted in 2010. Baseline age-adjusted prevalence and three year incidence of hypertension was estimated. Independent predictors of incident hypertension were identified using Cox’s Proportional Hazards modeling. Study Area: Ragama Health Study Cohort Study population: Individuals between 35-64 years of age living the Ragama Medical Health Officer area in the district of Gampaha Study Instrument: Clinical, biochemical, and anthropometric examinations and liver ultrasound Study type: Cohort study Sample size: 2986 Sampling method: Age –stratified random sampling method Disease Investigated: Hypertension Results: Baseline age-adjusted prevalence of hypertension was 33% in males and 37% in females. Out of 1644 normotensive subjects at baseline, 407(24.8%) developed hypertension by 2010. Incidence was 80.2 per 1000 person- years of follow up. Overall incidence was higher in females. Highest incidence (111 per 1000 person- years of follow up) was seen in males in the oldest age group (55-64 years). Independent predictors of incident hypertension were low level of physical activity, presence of diabetes mellitus, a BMI over 25 kg/m2, presence of nonalcoholic fatty liver disease and older age group.

ωχ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Conclusion: Risk of incident hypertension is largely modifiable as evident from the findings from this population of high incidence of hypertension highlighting the need for lifestyle modifications targeting physical activity and diet in both population and individual level for prevention of hypertension. Katulanda P. Constantine GR. Mahesh JG. Sheriff R. Seneviratne RDA. Wijeratne S. Wijesuriya M. McCarthy MI. Adler AI. Matthews DR (2008). "Prevalence and projections of diabetes and pre-diabetes in adults in Sri Lanka - Sri Lanka Diabetes, Cardiovascular Study (SLDCS)." Diabetic Medicine 25(9): 1062-1069. Objective: To determine the prevalence of diabetes mellitus and pre-diabetes (impaired fasting glucose and impaired glucose tolerance) in adults in Sri Lanka. Study Method: This cross-sectional study was conducted between 2005 and 2006. A nationally representative sample of 5000 adults aged ≥ 18 years was selected by a multi-stage random cluster sampling technique. Fasting plasma glucose was tested in all participants and a 75-g oral glucose tolerance test was performed in non-diabetic subjects. Prevalence was estimated for those > 20 years of age. Study area: Sri Lanka Study population: Adults aged ≥ 18 years Type of study: Cross-sectional study Sampling method: Multi-stage random cluster sampling technique Sample size: 5000 Factors investigated: Body mass index, waist circumference, waist-hip ratio, systolic/diastolic blood pressure, low-density lipoprotein cholesterol and triglycerides Results: Response rate was 91% (n = 4532), males 40%, age 46.1 ± 15.1 years (mean ± standard deviation). The age-sex standardized prevalence (95% confidence interval) of diabetes for Sri Lankans aged ≥ 20 years was 10.3% (9.4-11.2%) [males 9.8% (8.4-11.2%), females 10.9% (9.7-12.1%), P = 0.129). Thirty-six per cent (31.9-40.1%) of all diabetic subjects were previously undiagnosed. Diabetes prevalence was higher in the urban population compared with rural [16.4% (13.8-19.0%) vs. 8.7% (7.8-9.6%); P < 0.001]. The prevalence of overall, urban and rural pre-diabetes was 11.5% (10.5-12.5%), 13.6% (11.2-16.0%) and 11.0% (10.0-12.0%), respectively. Overall, 21.8% (20.5-23.1%) had some form of dysglycaemia. The projected diabetes prevalence for the year 2030 is 13.9%. Those with diabetes and pre-diabetes compared with normal glucose tolerance were older, physically inactive, frequently lived in urban areas and had a family history of diabetes. They had higher body mass index, waist circumference, waist-hip ratio, systolic/diastolic blood pressure, low-density lipoprotein cholesterol and triglycerides. Insulin was prescribed to 4.4% (2.7-6.1%) of all diabetic subjects. Conclusion: One in five adults in Sri Lanka has either diabetes or pre-diabetes and one-third of those with diabetes are undiagnosed.

ωψ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Katulanda P. Constantine. Godwin R. Sheriff R. McCarthy. Mark I. Seneviratne RD. Matthews DR (2007). "Prevalence of Diabetes, Impaired Fasting Glucose (IFG) and Impaired Glucose Tolerance (IGT) in Sri Lanka--Sri Lanka Diabetes and Cardiovascular Study." Diabetes 56, (Supplement 1): pA249-A249. Objective: IFG and IGT increase the risk of diabetes and are termed pre-diabetes. The objective was to determine the prevalence of these conditions among different socio-demographic groups in Sri Lanka Study method: In this nationally representative prevalence survey, 5000 subjects above 18years of age were selected by a multi stage random cluster sampling technique. A structured questionnaire was used to record detailed interview data and physical examination findings. Fasting and post-glucose load plasma glucose was estimated. New cases of diabetes, IGT and IFG were diagnosed according to the ADA criteria. Standardisation was performed using UN population estimates 2004. Sampling method: Random sampling method Results: Altogether 4464 subjects participated (response 89%); males 40%; mean age 46years (SD 15). The crude prevalence of diabetes was 11.5% and 40% of these were newly diagnosed. The overall age and sex standardised prevalence of diabetes was 10%; Male 9.2% and Female 10% (p not significant). The prevalence in the urban, rural and plantation sectors were 17.3%, 10.6% and 3.8% respectively (p<0.0001). The difference in the diabetes prevalence between ethnic groups did not persist when corrected for the area of residence and physical activity. The overall prevalence of pre-diabetes by sector was 13.9% (urban), 12.3% (rural) and 5.1% (plantations). The prevalence of individual components of pre-diabetes: IFG, IGT and both IFG and IGT were 4.3%, 6% and 2% respectively. Means of age in years (54.7 SD12.5 vs 44.7 SD 15), BMI (23.8kg/m³ SD4 vs 21.5 kg/m³ SD4.2), waist circumference (84.7cm SD 10.8 vs 76.3cm SD11.5), systolic blood pressure (138mmHg SD 24 vs 127mmHg SD20) were significantly higher (p<0.0001) among diabetic subjects compared to others. The prevalence was significantly higher among those with positive family history (21.5% vs 8.2%; p<0.0001) and who had undertaken overseas stay >6 months (19% vs 10.7% p<0.0001). In conclusion there was a high prevalence of diabetes and pre-diabetes in urban, rural and plantation sectors and all ethnic groups in Sri Lanka. High prevalence of diabetes and the findings on risk factors indicate the need for primary preventive strategies involving adoption of healthy lifestyles in order to counteract the effects of urbanisation Katulanda P. Jayawardana R. Ranasinghe P. Rezvi Sheriff. Matthews DR "Physical activity patterns and correlates among adults from a developing country: the Sri Lanka Diabetes and Cardiovascular Study." Public Health Nutr: 1-9. OBJECTIVE: To evaluate patterns of physical activity (PA), the prevalence of physical inactivity and the relationships between PA and sociodemographic, clinical and biochemical parameters among Sri Lankan adults. DESIGN: Descriptive cross-sectional study. SETTING: Nationally representative population-based survey conducted in Sri Lanka. SUBJECTS: Data on PA and associated details were obtained from 5000 adults. PA was assessed using the International Physical Activity Questionnaire (short-form). A binary logistic regression analysis was performed using the dichotomous variable 'health-enhancing PA' (0 = 'active', 1 = 'inactive').

ωω Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

RESULTS: Sample size was 4485. Mean age was 46.1 (sd 15.1) years, 39.5 % were males. The mean weekly total MET (metabolic equivalents of task) minutes of PA among the study population was 4703 (sd 4369). Males (5464 (sd 5452)) had a significantly higher weekly total MET minutes than females (4205 (sd 3394); P < 0.001). Rural adults (5175 (sd 4583)) were significantly more active than urban adults (2956 (sd 2847); P < 0.001). Tamils had the highest mean weekly total MET minutes among ethnicities. Those with tertiary education had lowest mean weekly total MET minutes. In all adults 60.0 % were in the 'highly active' category, while only 11.0 % were 'inactive' (males 14.6 %, females 8.7 %; P < 0.001). Of the 'highly active' adults, 85.8 % were residing in rural areas. Results of the binary logistic regression analysis indicated that female gender (OR = 2.1), age >70 years (OR = 3.8), urban living (OR = 2.5), Muslim ethnicity (OR = 2.7), tertiary education (OR = 3.6), obesity (OR = 1.8), diabetes (OR = 1.6), hypertension (OR = 1.2) and metabolic syndrome (OR = 1.3) were all associated with significantly increased odds of being physically 'inactive'. CONCLUSIONS: The majority of Sri Lankan adults were 'highly active' physically. Female gender, older age, urban living, Muslim ethnicity and tertiary education were all significant predictors of physical inactivity. Physical inactivity was associated with obesity, diabetes, hypertension and metabolic syndrome. Katulanda P. Jayawardena MAR. Sheriff MHR. Constantine GR. Matthews DR (2010). "Prevalence of overweight and obesity in Sri Lankan adults." Obesity Reviews 11(11): 751-756. Objective: To determine the prevalence of overweight, obesity and abdominal obesity, and the underlying socio-demographic correlates among Sri Lankan adults. Study Method: Data were from 4532 adults aged ≥18-years randomly selected for a national level study on diabetes and cardiovascular disease. Weight, height and waist circumference (WC) were measured and body mass index (BMI) calculated. The mean (95% confidence interval) BMI and WC were 21.1 kg m -2 (20.9-21.3), 22.3 kg m -2 (22.1-22.4) and 78.0 cm (77.5-78.6) and 77.5 cm (77.0-78.0) for males and females, respectively. Study area: Sri Lanka Study population: Adults aged ≥ 18-years Type of study: National level study Sampling method: Random sampling Sample size: 4532 Factors investigated: Weight, height and waist circumference (WC) were measured and body mass index (BMI) calculated Results: Characteristics of the study variables are summarized in Table 1. below. Mean age (standard deviation) of males was 46.3 years (15.8) and that of females was 46.0 years (14.6).

ωϊ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Table 1. Baseline characteristics of the sample Characteristic Male Female P value Age (years) + SD 46.3 (15.8) 46.0 (14.6) 0.510 Urban (%) 17.4 17.7 0.821 BMI (kg m–2) + SD 21.1 (3.7) 22.8 (4.5) <0.001 WC (cm) + SD 78.1 (11.0) 76.7 (12.1) <0.001 WHR+ SD 0.89 (0.07) 0.85 (0.08) <0.001 BMI, body mass index; SD, standard deviation; WC, waist circumference; WHR, waist-hip-ratio. Males had significantly higher WC, waist-hip-ratio but lower BMI, compared with females. Out of 5000 invited subjects, 4532 participated in the study (response rate was 91%). The prevalence of obesity is presented both for generalized obesity based on BMI and central obesity based on WC (Table 2). According to the proposed WHO cut-off values for Asians , the percentage of Sri Lankan adults in the OW, obese and centrally obese categories were 25.2%, 9.2% and 26.2%, respectively. Based on the cut-offs for Caucasians these were, respectively, 16.8%, 3.7% and 10.8%. The prevalence of obesity was higher in women comapared with men irrespective of the cut-off used (Table 2) Table 2 Prevalence (95% CI) of overweight and obesity by gender according to cut-offs for Asians and Caucasians Overweight (%) Obese (%) Centrally obese (%) Men* 22.6 (21.6–25.5) 7.2 (6.6–7.8) 16.5 (15.6–17.3) Women* 28.0 (26.9–28.1) 11.3 (10.5–12.0) 36.3 (35.1–37.4) Overall* 25.2 (24.5–26.0) 9.2 (8.7–9.7) 26.2 (25.5–26.9) Men† 14.3 (13.5–15.1) 2.6 (2.2–2.9) 3.1 (2.7–3.5) Women† 19.4 (18.5–20.4) 4.8 (4.3–5.3) 18.9 (17.9–19.8) Overall† 16.8 (16.2–17.4) 3.7 (3.4–4.0) 10.8 (10.3–11.3) *According to the existing cut-offs for Asians. †According to the exis ng cut-offs for Caucasians.). According to the area of residence the prevalence of OW, obesity and central obesity were higher (32.7 (CI:30.9–34.7) 18.5 (CI:17.1–19.9) 40.8 (CI:39.0–42.6) respectively ) in urban population compared with rural population both in men and women. In particular, over half (53.2 %(CI:50.6–55.7))of urban women were centrally obese. The youngest age groups years for males had the lowest levels of OW, obesity and central obesity both in males and females. The middle age groups had the highest levels of OWand obesity and the prevalence became lower in older age groups. Compared with generalized obesity, central obesity remained disproportionately high in the older age groups The underlying factors for being OW or obese (BMI 23 kg m-2 – according to the cut-off proposed for Asians) among Sri Lankan adults were examined using binary logistic regression analysis . Accordingly, female sex(p<0.001), physical inactivity (p=0.007), higher income (p<0.001), higher education (p<0.001) , urban living (p<0.001) and being middle aged (p<0.001) were significantly associated with OW or obesity

ωϋ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Conclusion: In conclusion, we have documented a relatively high prevalence of overweight and obesity, particularly, abdominal obesity among adults in Sri Lanka which is a middle-income country. Urgent public health interventions are needed to control the problem at an early stage. Katulanda P. Liyanage IK. Wickramasinghe K. Piyadigama I. Karunathilake IM. Palmer PH. Mathews DR (2012). "Tobacco Smoking Among School Children in Colombo District, Sri Lanka." Asia Pac J Public Health. Tobacco smoking is an important problem among schoolchildren. The authors studied the patterns of tobacco smoking among schoolchildren in Colombo, Sri Lanka, using a self-administered questionnaire. Multistaged stratified random sampling was used to select 6000 students. Response rate was 90.7% (5446), out of which 53.4% were males. Prevalence rates for males and females, respectively, were as follows: having smoked at least 1 complete cigarette: 27.0% and 13.3%, smoked more than 100 cigarettes: 2.3% and 0.3%, daily smoking: 1.8% and 0.2%. Mean age of starting to smoke was 14.16 years. The tobacco products most used were cigarettes (91.5%) and bidis (3.8%). In univariate analysis, male gender, parental smoking, studying non-science subjects, peer smoking, and participating in sports were significantly associated with smoking of at least 1 complete cigarette (P < .05). In multivariate analysis, the most significant correlates were having close friends (odds ratio = 3.29, confidence interval = 2.47-4.37) or parents who smoked (odds ratio = 1.86, confidence interval = 1.28-2.71). Female smoking has increased from previously reported values. These high-risk groups can be targets for preventive programs. Katulanda P. Ranasinghe P. Jayawardana R. Sheriff R. Matthews DR (2012). "Metabolic syndrome among Sri Lankan adults: Prevalence, patterns and correlates." 4(1). Objective: To evaluate the prevalence of MS among Sri Lankan adults and investigates its relationships with socio-demographic, clinical and biochemical parameters Study Method: Data on MS and its associated details were obtained from a population-based cross-sectional study conducted between years 2005 - 2006. MS was defined according to the International Diabetes Federation criteria. A binary logistic regression analysis was performed using the dichotomous variable MS (0 = absent, 1 = present). The independent co-variants were: gender, age category, area of residence, ethnicity, level of education, income and physical activity. Study area: Sri Lanka Study population: Sri Lankan non institutionalized adults over 18 years Type of study: Population-based cross-sectional study Sample size: 4,485 Factors investigated: Gender, age category, area of residence, ethnicity, level of education, income and physical activity Results: Sample size was 4,485 (Response rate 89.7%), 39.5% were males and mean age was 46.1 ± 15.1 years. The crude prevalence of MS was 27.1% (95% CI: 25.828.5), and age-adjusted prevalence was 24.3% (95% CI: 23.025.6). Prevalence in males and females were 18.4% (95% CI: 16.520.3) and 28.3% (95% CI: 26.630.0) respectively (p<0.001). Urban adults (34.8% [95% CI: 31.837.9]) had a significantly higher prevalence than rural adults (21.6% [95% CI: 20.223.0]). Among ethnic groups, the highest

ωό Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

prevalence of MS was observed in Sri Lankan Moors (43.0% [95% CI: 37.248.9]). In all adults, MS was observed in those with the highest level of education and monthly household income. Prevalence of MS in the different physical activity categories of the IPAQ were; inactive 38.8% (95% CI 34.5-43.2), moderately active 33.5% (95% CI 30.9-36.1) and active 21.1% (95% CI 19.6-22.7). The results of the binary logistic regression analysis indicates that female gender (OR:1.7), increasing age, urban living (OR:1.7), Moor ethnicity (OR:2.6), secondary (OR:1.5) and tertiary levels of education (OR:2.3), monthly household income LKR 7,00024,999 (OR:1.5) and >50,000 (OR:2.1), and physical inactivity (OR:1.6), all significantly increased risk of developing MS. Conclusion: MS is common among Sri Lankan adults affecting nearly one-fourth of the population. Female gender, increasing age, urban living, higher socio-economical status and physical inactivity were important associated factors. Katulanda P. Wickramasinghe K. Mahesh JG. Rathnapala A. Constantine GR. Sheriff R. Matthews DR. Fernando SS (2012). "Prevalence and correlates of tobacco smoking in Sri Lanka." Asia Pac J Public Health 23(6): 861-9. OBJECTIVES: This study aimed to determine the prevalence and underlying sociodemographic correlates of smoking among Sri Lankans. METHODS: A cross-sectional sample (N = 5000, age >18 years) was selected using a multistage random cluster sampling. Data were collected using an interviewer-administered questionnaire. RESULTS: Response rate was 91% (n = 4532); males 40%; mean age 46.1 years (+/-15.1). Overall, urban and rural prevalence of current smoking (smoking) was 18.3%, 17.2%, and 18.5%, respectively (P = non significant, urban vs rural). Smoking was much higher in males than in females (38.0% vs 0.1%, P < .0001). Ex-smokers comprised 10.0% (males 20.7%, females 0.1%, P < .0001). Among the smokers 87.0% smoked <10 cigarettes per day. The male age groups < 20 and 20 to 29 years had the lowest (15.6%) and the highest (44.6%) prevalence of smoking, respectively. In males, smoking was highest in the least educated (odds ratio = 1.96, P = .001). CONCLUSIONS: Smoking is common among Sri Lankan males and is associated with lower education, income, and middle age. Lekamwasam S. Wijayaratne LS. Rodrigo M. Hewage U (2007). "Physical activity and bone mineral density." The Ceylon Medical Journal 52(1). Objective: To determine the relationship between physical activity and bone mineral density of a large community survey in 7 provinces in Sri Lanka, involving 3422 community dwelling men and women. Study method: 1486 men and 1936 women who participated in the Community Osteoporosis Survey done from October 2004 to October 2005 in 7 provinces, except the North and East, were included in the analysis. At least one urban and one rural area were selected from the each province. The classification of urban and rural areas used by the Department of Census and Statistics during the last census was used in selecting these areas. Men and women aged 20 years or more were invited to undergo the measurement of phalangeal bone mineral density (PBMD) in the non-dominant hand, using AccuDXA scanner (Schick Technologists Inc, USA) and asked to fill a brief health related questionnaire.

ωύ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Participants were asked to describe their general physical activity, past and current, to the best of their knowledge, into one of the three categories: very active (152 women and 280 men), moderately active (1581 women and 1104 men) or less active (203 women and 102 men). Mean PBMDs in the 3 categories of physical activity were compared using ANOVA, unadjusted and then adjusted for age, weight, and milk consumption. Data of men and women were analysed separately and are given as mean (SD). The level of statistical significance was set at P (two tailed) below 0.05. Study Area: 7 PROVINCES OF Sri Lanka Study population: Community dwelling men and women aged 20 years or more Study Instrument: Measurement of phalangeal bone mineral density (PBMD) A self administered questionnaire Sample size: 3422 Sampling method: Random sampling method Risk Factors Investigated: Physical activity and bone mineral density Results: Mean age and weight of women were 41.1 (13.3) years and 54.7 (10.8) kg and the corresponding values of men were 39.1 (12.8) years and 62.3 (11.1) kg respectively. Most active men and women had the highest PBMD and the less active men and women had the lowest PBMD values. Further, there was a continuous trend in PBMD across the three categories. When adjusted for age, weight and milk consumption, these values did not change materially and the differences between categories persisted (table). Table- Phalangeal BMD of three categories of physical activity in men and women Most active Moderately active Less active p value Women Unadjusted 0.508 (0.073) 0.489(0.067) 0.440(0.086) <0.001 Adjusted* 0.500(0.073) 0.493 (0.068) 0.463 (0.085) 0.004 Men Unadjusted 0.607(0.067) 0.599(0.066) 0.557(0.074) <0.00l Adjusted* 0.610(0.068) 0.599(0.066) 0.560(0.073) <0.001 * adjusted for age, weight, milk consumption The results also showed the positive effect of physical activity on BMD in both men and women in the study group. Most physically active men had 8.9% higher PBMD when compared with less active men. Similarly most physically active women had 15% higher PBMD when compared with less active women. Further, there was a gradient across the three categories to indicate a dose effect relationship. These differences were independent of age, body weight and milk consumption and were seen in both sexes.

ϊτ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Liyanage IK. De Silva O. Piyadigama I. Pathirana ACA. Wickramasinghe AKK. WithanageTDP. Katulanda P (2012). "Perceived stress,tobacco smoking, use of alcohol and illicit substances among school children in the district of Colombo." The Ceylon Medical Journal 57(Supplement 1): Page 84. Objective: To study the relationship between perceived stress and substance use behaviours among school children Study method: A sample of 6000 students from grades 10 and 12 was selected from Colombo district using random sampling method. Perceived stress (PS) was assessed using Sheldon Cohen’s self administered “Global Measure of Perceived Stress Scale”. A higher Perceived Stress Score (PSS) indicates a higher degree and longer duration of self perceived stress. Students with one or more missing value for the scale were excluded from the analysis Study Area: Colombo district Study population: School Students from grades 10 and 12 Study Instrument: Questionnaires Sample size: 5040 Sampling method: A multi staged stratified random sampling technique Risk Factors Investigated: Stress, smoking, alcohol use, illicit drug use Results: Perceived Stress Scores (PSS) of 5040 students (84.0%) were calculated (47.9%males, mean age 15.74% years). Mean PSS was 15.3 (SD =5.3) (maximum 40). Prevalence of substance use was; lifetime smoking: 19.5% smoke >100 cigarettes -1.5%, life-time alcohol use -28.3%, cannabis use -2.14%. Mean PSS was significantly higher among the students who smoked tobacco (16.3 against 15.1 p<0.001), smoked>100 cigarettes (17.9 against 15.3 p<0.001), used alcohol (16.4 against 14.1 p<0.001) and used cannabis (17.9 against 15.2 p<0.001). These associations remained significant in multivariate analysis when academic performance, parental factors, socioeconomic status, ethnicity, gender and age were controlled (p<0.001). Conclusions Higher levels of perceived stress were associated with substance use behaviors among school children in Colombo District. Helping Students to refrain from these behaviors may alleviate their level of perceived stress and other related adversities. Mendis S (1990). "Tobacco use in a cohort of children in Sri Lanka." British Joumal of Addiction 85: 397-398. Objective: To examine the smoking behaviour and attitude of children Study Method: Ten secondary schools in the Central Province of Sri Lanka were randomly selected to provide five from an urban setting and five from a rural setting. Under the supervision of trained health assistants, 3447, 11-18 year old children completed self administered confidential, questionnaires (WHO/SMO/83.4/NO4), during school time. The survey was conducted in 1986/1987. The participation rate was 85%.

ϊυ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Study area: Ten secondary schools in the Central Province of Sri Lanka Study population: 11-18 year old children Study instrument: Self administered confidential, questionnaires (WHO/SMO/83.4/NO4) Sample size: 3447 Factors investigated: Smoking prevalence, knowledge of the effects of smoking, effect of parent and sibling smoking behaviour and attitude Results: The prevalence of current smoking in relation to age is shown in Table 1. Smoking prevalence is positively associated with age; the prevalence steadily increasing during adolescence (Table 1). There are higher proportions of smokers ('smokers' here and elsewhere refer to current smokers; last three categories in Table 2) in schools in urban areas. In keeping with the social and cultural norms, smoking in female children is very uncommon (Table 2). Tobacco snuff is used by 0.5% of children and 0.5% of children chew tobacco with betel. Ten items in the questionnaire measured children's knowledge of the effects of smoking on health. Less than 50% of smokers as well as nonsmokers gave correct responses to the following statements; (a) Nicotine from smoking contracts the blood vessels, (b) There are some cigarettes which are not dangerous, (c) Smoking is bad for you only if you smoke for many years, (d) Smoking decreases heart rate. More non-smokers than smokers (p < 0.001), provided correct responses to four of the ten items that tested knowledge of health hazards of smoking. (These items were; (a) Smoking is only bad for you if you smoke a lot every day, (b) Smokers usually die younger than non-smokers, (c) Just about everyone who gets lung cancer has been a regular smoker, (d) If you smoke you are more likely to cough. There was no significant difference in the response of smokers and nonsmokers to the remaining two items; these being (a) Breathing air harms babies and young children, (b) A women who is going to have a baby would harm the baby if she smokes. Smokers therefore had less knowledge of the harmful effects of smoking on health. Rejection of short-term health hazards emerged as an important risk factor influencing smoking behaviour (X2=24.8, d.f. = 1, p < 0.001). Children who smoked intended to continue smoking while non-smokers, did not intend to smoke in the future X2 =111.3, d.f.= 1,p < 0.001). The most important reason given for smoking is the need to smoke in the company of friends. Childrens smoking behaviour is strongly associated with their friends smoking behaviour (X2= 105.3, d.f= l, p <0.001) and approval of smoking (X2=59, d.f. = l, p <0.001). The effect of parent and sibling smoking behaviour and attitude did not assume importance. Banning teachers from smoking in schools, smoking in public places and advertising are supported by 77%, 28% and 44% of children respectively. Surprisingly, there is no significant difference in these attitudes in smokers and non-smokers. Conclusion: Overall the findings of this study suggest that school and social environment may be more important than home background in determining smoking behaviour. Friends smoking behaviour and attitude to smoking, appears to be the best predictor of smoking in children. This influence comprising friends in school may be easier to penetrate if children rather than adults are used as health educators in anti-smoking programmes aimed at children in Sri Lanka. Furthermore since available resources for antismoking programmes are limited these should be aimed at high risk groups; i.e. adolescent male school children in urban areas.

ϊφ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Mendis S. Abegunde D. Yusuf S. Ebrahim S. Shaper G. Ghannem H. Shengelia B (2005). "WHO study on Prevention of REcurrences of Myocardial Infarction and StrokE (WHO-PREMISE)." Bulletin of the World Health Organization 83(11). Objective: To determine the extent of secondary prevention of coronary heart disease (CHD) and cerebrovascular disease (CVD) in low- and middle-income countries Study method: A descriptive cross-sectional survey of a sample of 10 000 CHD (85.2%) and CVD (14.8%) patients (6252 men; 3748 women) was conducted over 6 months in geographically defined areas. The mean age was 59.2 years (standard deviation (SD),10.8). Consecutive patients were recruited from a stratified random sample of primary, secondary and tertiary care facilities in defined areas in 10 countries (Brazil, Egypt, India, Indonesia, Islamic Republic of Iran, Pakistan, Russian Federation, Sri Lanka, Tunisia and Turkey). The main outcome measures were levels of lifestyle and physiological risk factors, and the use of drugs for secondary prevention of CHD and CVD. Study Area: Primary, secondary and tertiary care facilities in defined areas in 10 countries (Brazil, Egypt, India, Indonesia, Islamic Republic of Iran, Pakistan, Russian Federation, Sri Lanka, Tunisia and Turkey) Study population: Coronary heart disease (CHD) and cerebrovascular disease patients Study type: A descriptive cross-sectional survey Sample size: 9957 (993 Sri Lankans) Sampling method: A stratified Random sampling method Results: The mean age of patients in the study was 59.2 years (standard deviation (SD), 10.8). About 45.6% of patients were aged more than 60 years, and 22.5% less than 50 years. These younger patients made up more than 30% of the study population in three of the 10 countries. Table 1 shows the age distribution of patients by country. The majority were men (62.1%). Although women comprised 37.9% of the study sample there was a wide variation between countries in the percentage of women recruited (14.5%–54.5%). The extent to which these data reflect differences in disease prevalence and/or barriers to access to heath care is not clear. Approximately 82%, 89% and 77% of patients were aware of the cardiovascular benefits of quitting smoking, a hearthealthy diet and regular physical activity, respectively. About half (52.5%) engaged in less than 30 minutes of physical activity per day, 35% did not follow a heart-healthy diet and 12.5 % were current tobacco users. Blood pressure had been measured in 93.8% (range 71–100%), blood cholesterol in 85.5% (range 29–97%) and blood sugar in 75.5% (range 65–99%) in the preceding 12 months.On average, 67.7% of patients reported high blood pressure and 40.3% high levels of blood cholesterol. About one-third (31.5%) of patients reported that they had diabetes. Analysis of the extent of exposure to risk factors, found that an average of only 16.2% of patients had no major coronary risk factors. About 46.6% of patients were exposed to at least two risk factors, and 16.4% at least three. The proportions who had received medications among CHD and CVD patients were: aspirin, 81.2%, 70.6%; beta-blockers, 48.1%, 22.8%; angiotensin-converting enzyme inhibitor, 39.8%, 37.8%; statins, 29.8%, 14.1%, respectively. About one-fifth of patients with CHD had undergone revascularization. Conclusion A significant proportion of patients did not receive appropriate medications. About 47% of patients had at least two or more modifiable risk factors (smoking, physical inactivity, hypertension, diabetes or hypercholesterolaemia). There are considerable missed opportunities for prevention of recurrences in those with established CVD in low- and middle-income countries.

ϊχ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Mendis S. Bulugahapitiya DUS. Ranarunge PK (1998). "Physical activity in a cohort of Sri Lankan adults." Sri Lanka Journal of Medicine 7(1): 22-25. Objective: To determine the self reported levels of intensity and duration of PA in adults (20-70 years) in a defined population Study Method: The study was conducted in the Yatinuwara Divisional Secretariat Division (DSD). The Yatinuwara DSD has 95 gramasevaka divisions. Four rural and 2 suburban gramasevaka divisionswere selected randomly from them. Using electoral lists 300 adults (125 males), 150 rural adults and 150 suburban adults were randomly selected for the study. 101 males mean age 44.2(SD 14.2) and 174 females, mean age 42.9 (SD 13.9) participated. The occupational and educational characteristics of the cohort are shown in table 1. Physical activity was assessed for the preceding week retrospectively by personal interview of subjects utilizing a structured questionnaire. Subjects were also asked to estimate the intensity with which they engaged in occupational, household and leisure time physical activities by rating their usual participation on a scale of 0-3 (0 = no breathlessness, no sweating, 1 = breathlessness, no sweating, 1.5 = breathlessness and slight sweating, 2=breathlessness and moderate sweating, 3 = breathlessness and a lot of sweating). During analysis each physical activity was assigned a multiple of resting metabolic rate (MET score), according to the reported intensity levels (No breathlessness and no sweating=3 METS, breathlessness and no sweating = 5 METS, moderately intense physical activity causing breathlessness and slight sweating = 5.5 METS, vigorous physical activity causing breathlessness and moderate sweating=6 METS and very vigorous physical activity causing breathlessness and lot of sweating = 7.5 METS). Study area: Four rural and 2 suburban gramasevaka divisions of the Yatinuwara Divisional Secretariat Division Study population: Suburban adults Type of study: Cohort Study Study instrument: Structured questionnaire Sampling method: Random sampling Sample size: 274 Factors investigated: Intensity of Physical Activity Results: About one third (30%) of males and 3% of females were engaged in an occupation that was involved with moderately intense physical activity (more than 5.5 METS). A substantial proportion of females (44%) and 27% of males carried out various household chores (chopping fire wood, pounding, grinding and carrying water), involving moderately intense physical activity (more than 5.5 METS). Gardening was the commonest leisure time physical activity. Only 5% of men were engaged in other leisure time physical activities such as sports elle, cricket, jogging, volley-ball, foot-ball, rugger and swimming. All of them were below 30 years of age. Among females 40% did gardening and this was the only leisure time physical activity that women were involved in. Overall 39% men and 47% females were involved in moderately intense physical activity (more than 5.5 METS), at work, at home or during leisure time. The mean duration of physical activity (>3 METS) involved with household chores, leisure time activity and walking in males and females is shown in table 2.

ϊψ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Proportion of males and females devoting more than 30 minutes a day to different physical activities are shown in table 3. Conclusion: Routine activities such as walking, household chores and manual occupations were important sources of physical exercise. Mendis S. Ekanayake EM (1994). "Prevalence of coronary heart disease and cardiovascular risk factors in middle aged males in a defined population in central Sri Lanka." Int J Cardiol 46(2): 135-42. In a cross-sectional survey, we estimated the prevalence of coronary heart disease in a sample of 975 middle-aged males (35-59 years), from a defined population in the Central province of Sri Lanka using the London School of Hygiene cardiovascular questionnaire and a 12-lead electrocardiogram. The estimated prevalence rates were: (a) Definitive evidence of ischemic heart disease (positive symptoms and ECG changes of ischemia), 16/1000 (95% C.L., 9-27). (b) Evidence of coronary heart disease based on history alone 54/1000 (95% C.L., 40-71). (c) Estimate based on ECG changes of ischemia without symptoms 32/1000 (95% C.L., 21-46). Median values for major risk factors were: systolic blood pressure 120 mmHg, diastolic blood pressure 88 mmHg, serum cholesterol 4.99 mmol/l, high density lipoproteins 0.99 mmol/l and body-mass index 20.4 kg/m2. About half (57.9%) the subjects were current smokers, 17% had actual hypertension (systolic blood pressure > 159 mmHg and/or diastolic blood pressure > 94 mmHg and/or been treated for hypertension), 12.6% had hypercholesterolemia (serum cholesterol levels > 6.5 mmol/l), 18.4% had a body-mass index > 24 kg/m2 and 5.8% were diabetic. Hypercholesterolemia (> 6.5 mmol/l), a higher body-mass index (> 24 kg/m2) and diabetes were more prevalent among subjects living in an urban rather than a rural environment. Mendis S. Ekanayake EMTKB (1993). "Non-insulin dependent diabetes mellitus: prevalence and predisposing factors in Sri Lankans." Journal of the Ceylon College of Physicians 26: 32-35. Objective: To investigate the prevalence of non-insulin dependent diabetes in a middle aged male population and to find the risk factors for non-insulin dependent diabetes. Study Method: Between January 1990 and December 1991, 975 males aged 35-59 years were randomly selected from the electoral lists of 12 Gramasevakas divisions in Kandy and Matale districts. Eight hundred and fifty two men responded comprising 108 subjects from Wattarantanne,103 subjects from Bowala, 97 subjects from Deekirimada wela, 97 subjects from Welata, 87 subjects from Godagandeniya, 83 subjects from Yatiwawala, 70 subjects from Gatambe, 54 subjects from Ambilmegama, 48 subjects from Talgahagoda, 47 subjects from Dodanwela, 37 subjects from Daulagala and 21 subjects from Deiyannewela. The overall response rate was 87.4%. A questionnaire was administered and each participant was personally interviewed. Questions were asked concerning family history of diabetes mellitus, physical activity at work and during leisure time, smoking and regular medication. All measurements were made by a team of two medical officers and two field Assistants. Resting, sitting blood pressure was recorded twice with an aneroid sphygmomanometer. Height was measured without shoes and the weight measured in casual clothes. Body mass index was calculated as weight in (kg) divided by height (m) squared. Serum was separated from venous blood drawn from subjects after an overnight fast. Total cholesterol and high density lipoprotein cholesterol were estimated by enzymatic methods using reagent tests obtained from Boehringer Manheim, Germany (Cat no 816302). A quality control serum sample was analyzed with every batch of estimations and the coefficient of variation was less than 2.7%. A single sample of urine was tested for glycosuria using test strips (medi test glucose). The detection is based on the

ϊω Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

glucoseoxidase — peroxidase — chromogen reaction. Apart from glucose no other compound in urine is known to give a positive reaction. Those who had glycosuria were later confirmed as having diabetes mellitus by blood glucose assay. Statistical analyses was done using the Systat program package. Statistical significance was assessed using the student's t-test and the chi square test. Study area: 12 Gramasevakas divisions in Kandy and Matale districts Study population: Males aged 35-59 years Study instrument: Interviewer administered questionnaire Sampling method: Random sampling Sample size: 852 Factors investigated: Family history of diabetes mellitus, physical activity at work and during leisure time, smoking and regular medication, Resting, sitting blood pressure, Height, Weight, Total cholesterol, high density lipoprotein, glycosuria. Results: Forty nine subjects had glycosuria and later were confirmed as having non insulin dependent diabetes mellitus. Thirty of them (61%) were aware they were diabetics. There was a prevalence of diabetes mellitus with age but statistically this was not significant (p > 0.05,Table 1). The results also shows that the prevalence of diabetes mellitus increased from 4.9% (35 out of 706 subjects), in men who had no history of diabetes mellitus in a parent, to 10.6% (11 out of 104) in those with a history of diabetes mellitus in a parent. This difference was statistically significant (p > 0.05). Blood pressure of diabetic subjects is compared with non-diabetics in Table 2. Diastolic and mean blood pressure [SBP+2X DBP)/3] was significantly high in diabetic subjects. Among hypertensives (DBP > 90mmHg) the prevalence of diabetes mellitus was 6.3%. Among normotensives the prevalence of diabetes mellitus was 5.6%. This difference was statistically not significant. The mean body mass index of diabetics was significantly higher (22.25) than in non diabetics (20.69, 0.05 > p > 0.02). Comparison of serum cholesterol, serum high density lipoproteins (HDL) and cholesterol/HDC ratio in diabetics and non-diabetics did not show any significant difference (Table 3). Conclusion: The only environmental influences on insulin resistance are dietary energy intake and physical activity12. Non insulin dependent diabetes mellitus and other disturbances associated with insulin resistance such as hypertension may be a consequence of low physical activity and high energy intake in populations adapted to survive under conditions of unreliable food supply and physically demanding work. If the insulin resistance hypothesis is correct, correction of obesity and greater physical activity are likely to be the most effective means of preventing diabetes and other disorders like hypertension and coronary heart disease associated with insulin resistance in our population. Mendis S. Naser MACKA. Perera KRH (1997). "A study on rheumatic heart disease and rheumatic fever in a defined population in Sri Lanka." The Ceylon Journal of Medical Science 40(2): 31-36. Objective: To investigate the epidemiology of rheumatic heart disease (RHD) and rheumatic fever (RF) in children in a defined population Study method: The study was conducted in 1995/1996 in two stages, comprising an initial screening clinical interview and examination of the total study sample (n=1848), followed by echocardiography of children with cardiac murmurs (n=280). The sample consisted of all children 5 to 18 years of age in

ϊϊ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

16 villages in the Hanguranketha Divisional secretariat area in the Nuwara Eliya District. The participation rate was 90.7% in the first stage of the study and 89% in the second stage of the study. Rheumatic fever polyarthritis was diagnosed retrospectively in those who gave a history of fleeting polyarthritis of large joints and the diagnosis of definite rheumatic heart disease was done using the following criteria: •Unequivocal mitral stenosis •Unequivocal aortic regurgitation Significant mitral regurgitation (grade 3 systolic murmur with cardiac enlargement on chest radiography or echocardiography and /or unequivocal of rheumatic fever) •Aortic systolic murmur with a palpable systolic thrill ( and history of RF) •Any combination of the above. Study Area: The study was conducted in sixteen villages belonging to Hanguranketha Divisional secretariat area in the Nuwara Eliya District. Study population: All children 5 to 18 years of age in the 16 villages Study Instrument: Clinical interview (using structured questionnaires) and examinations Echocardiography Sample size: 1848 Sampling method: Random sampling method Disease Investigated: Rheumatic Heart Disease Results: The study revealed that nine hundred fourteen of the study sample was males and 934 females. There were 1836 Sinhalese and 12 Tamil children. The age and sex (Table) distribution of the study sample revealed that majority (41%, 758) of the study population were between the ages of 5 to 9 years. In this sample of children, 22.7 per 1000 (95% CL 16.6-30.8) gave a past history of polyarthritis compatible with rheumatic fever arthritis. The prevalence of RHD was seen in 12 children out of the total sample that is 6.5 per 1000 (95% CL 3.5-11.0) and the maximum prevalence was in the 15-18 age group (11.2 per 1000, 95% CL 3.9-26.8). More female than males were affected by both RHD and rheumatic polyarthritis (3:1 and 1.6:1) Mitral regurgitation was the commonest lesion seen in the children affected with rheumatic heart disease and was seen in 11 children (92%). Four of the affected children (33%) had mitral regurgitation only and 7 children (58%) had mixed valve lesions. Mitral stenosis was detected in 67% of the affected children but pure mitral stenosis was present only in one child. Aortic regurgitation was seen in one affected child as a mixed lesion. The mean number of siblings in families of children with a past history of rheumatic arthritis or RHD was significantly higher (4.2 SD 1.88, 4.8SD 1.8 respectively) compared to those who had no history of rheumatic arthritis or RHD (3.7 SD 1.5, 3.7SD 1.5 respectively, p<0.05). Of the children with RHD, 75% were undiagnosed. Only 25% of the RHD patients and 12 % of children with past history of rheumatic arthritis were receiving RF prophylaxis. Conclusion: The prevalence of RHD in this population is high and is comparable to this reported in countries. The majority of those suffering from RHD in the community are undiagnosed. Only fraction of those suffering from RHD and RF are receiving secondary prophylaxis.

ϊϋ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Munasinghe NM (2009). Prevalence of tobacco,alcohol and hard drugs use and the asscoiated factors among 15 to 19 years school going children in the Kandy Municipal Council area. Postgraduate Institute of Medicine. Colombo, University of Colombo. Master of Science in Community Medicine: Main objective: To determine the prevalence the use of tobacco, alcohol and hard drugs and the associated factors among the school going children of 15 to 19 years of age in Kandy Municipal Council (KMC) area. Specific objective: 1.To determine the prevalence of tobacco alcohol and hard drugs and the associated factors among the school going children of 15 to 19 years. 2.To describe the socioeconomic and demographic factors which may affect the use of tobacco, alcohol and hard drugs. 3.To determine the association of the use tobacco, alcohol and hard drugs on their academic work and extracurricular activities. 4.To describe the attitudes towards the use of tobacco, alcohol and hard drugs. Study area: Sinhala medium classes of type 1AB and 1C government schools of Kandy Municipal Council. (Type 1AB schools are the schools having grades from grade 1 to 13 including all four Advanced level subject streams namely Arts, Commerce, Mathematical sciences and Bio-sciences. Type 1C are the schools having grades from 1 to 13 including two of the Advanced level subjects namely Arts and Commerce. Study population: All school going children of 15 to 19 years age studying in Sinhala medium classes of type 1AB and 1C government schools of Kandy Municipal Council, except students who were on long term medication e.g. epilepsy and in classes with less than 20 children. Type of study: A cross-sectional study Study instrument: A Structured self administered questionnaire Sampling method: A probability proportionate multistage cluster sampling method. Sample size: 1276 Risk Factors investigated: Tobacco Hard drugs use Alcohol Results: The total number studied was 1276, out which there were 525 boys and 751 girls. The mean age of the study sample was 16.68 years (SD + 1.17). Majority, 97.8% comprised of Sinhalese students with 96.8% Buddhists. The use of tobacco in these students were obtained in terms of ever smokers ( meaning those who have even tested one puff of tobacco during their lifetime.) and current smokers ( meaning they are using tobacco ,even a puff currently.) by asking their frequency as once in a life time , occasionally, once a month, once a week or once a day.

ϊό Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

The use of alcohol in these students were obtained in terms ever drinkers meaning they ever took at least one drink during their lifetime and current drinkers by asking the frequency of alcohol intake as once in a life time , occasionally, once a month, once a week or once a day. The use of hard drugs in these students were obtained and categorized according to ever hard drug users meaning if ever tested hard drugs during lifetime and current hard drug users by asking the frequency of use of hard drugs as once in a life time , occasionally, once a month, once a week or once a day. The study revealed that the prevalence of ever and current use of tobacco was 11.3%, alcohol17.3% and use of hard drugs was 2.1% among the study population. There were no female students found as hard drug users. The mean ages of tobacco, alcohol and use of hard drugs were 14.41 (SD+ 2.97), 14.89 (SD+ 2.33), and 15.94 (SD+ 2.97) respectively. The prevalence of initiation of tobacco smoking before the age of 10 years was 18.6%. The commonest places of substance use were stated at parties for tobacco 24.7% and alcohol 53.2%. Meanwhile for hard drug s the commonest place (36.4%) was friend’s place where a 43.5% peer influence was observed. The use of alcohol was statistically significant p<0.001 among the A/L students who doing Commerce subjects (34%). Almost 38% of male students used tobacco smoke among tobacco smoking fathers compared to 18% used in non smoking father ( Chi- 22.08 ,df=1,p<0.001). The study also showed that there was a statistically significant association seen in fathers alcohol use and student use with a p<0.001.Almost 27.5% of both males and females students consumed alcohol when the father is also an alcohol user whom compared to 10% in non alcohol using father. Nearly one third (34%, p<0.05) of males and 7.4% (p<0.001) females have smoked tobacco when they had a tobacco smoking family member.The study also showed that 37% of the male students and 11.5% of the females used tobacco among tobacco using friends. Nearly 40% of the female students consumed hard drugs when there was hard drug using family member in the family. Almost half (50%) of the students (both males and females) consumed alcohol among alcohol consuming friends compared to 4.8% in nonalcohol using friends.There were 18.8% of the male smokers among the students who engaged in sport activities, which was statistically significant. (Chi-18.427, DF= 2, p<0.001) 64 (5.4%) of the students thought they look smart when they smoke. Murali V (2005). The Burden of Adult Asthma in Vavuniya District. Postgraduate Institute of Medicine. Colombo, University of Colombo. Doctor of Medicine in Community Medicine: Main Objective: To measure the physical, psychological and the economic burden of adult asthma in Vavuniya District. Specific object: 1.To validate the quality of life questionnaire. 2.To determine the period prevalence of adult asthma in Vavuniya District. 3.To measure the quality of life in adult asthma. 4.To measure the psychological burden caused by adult asthma. 5.To measure the economic burden caused by adult asthma.

ϊύ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Study method The study consisted of 3 phases; •Phase1- the quality of life questionnaire was validated by using peak expiratory flow rate measurements. Quality of life questionnaire used a questionnaire scale based on 4 domains- Activity limitation, symptoms, emotional function, and exposure to emotional stimuli. •Phase 2- a community based cross sectional survey was conducted with interviewer administered questionnaire on 1008 participants to measure the period prevalence of asthma and quality of life and psychological burden of adult asthma. •Phase 3 – a prospective study was conducted to measure the economic burden consisting of the asthmatic diagnosed by the screening test and another subsample of patients admitted to Vavuniya General Hospital with asthma. They were followed up from January 2005 till end of March 2005 in order to measure the economic burden. Study Instruments: 1.Questionnaires The questionnaires used in the study consisted of 4 sections- I.The screening component to screen asthmatic patients and to exclude other diseases. II.To measure the disabilities in asthma. III.Asthma bother profile to measure the psychological distress in asthma patients. IV.Another questionnaire was prepared to measure the economic burden of asthma All four sections were pretested in phase 1 of the study 2.Patients Bed head tickets Sampling method: Stratified sampling and cluster sampling Study population: Adults between 20-44 years of age who resided in Vavuniya District permanently were the target population. Age limit was fixed between these ages to exclude childhood asthma of younger population and chronic obstructive airway disease of elderly. Persons who were seriously ill or disable due to diseases or conditions other than asthma were excluded. Sample size: 1008 adults Disease investigated: Asthma Results: Out of the total study population there 607 females and 410 males. The total population mean age = 30.8+ 72. Females mean age was 30.6+ 7.3 and male mean age 31.2+ 6.9. There was no significant age difference between males and females p>0.05. The prevalence of asthma in the community survey was 75/1008 (7.4%). And out of 75 asthmatics 12 were excluded as they were diagnosed with other diseases as well. 30 males and 45 females were found to have asthma by the screening questionnaire and the difference in the proportion of asthma among males and females is not significant (d=0.04, p>0.01). The study also showed that 51 (88%) of the bronchial asthma patients also had fever symptoms. After exclusion of 12 participants with other diseases those who were diagnosed of asthma alone were administered with an internationally validated instrument to measure the quality of life and psychological burden with asthma. They were also followed up by another subsample of indoor asthma patients at Vavuniya General Hospital to measure the economic burden. By using quality of life questionnaire based on the 4 domains , it was seen that among the asthmatic patients ,professionals such as teachers etc had a better quality of life score compared to

ϋτ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

unemployed and housewives (p<0.05). No significant differences were observed between different age groups or sex with respect to quality of life scores or psychological distress scores (p>0.05). Economic burden measurements showed that out of the 63 persons found with asthma in the community, 34 were treated for asthma for asthma in the previous week prior to the study. They have spent average of Rs.212 out of their pockets and average of Rs 93.82 for transport. Cost incurred to government for these patients were on average Rs 25.66. Indirect costs due to absence from work was on average of Rs.56.37. In the hospital 49 patients were admitted with asthma during phase 3 of the study. The have spent on average of Rs.189.25 for medications and average of Rs.110.67 for transport out of their pocket. Costs incurred to the government for these patients were average of Rs. 712.83. Indirect cost due to the absence from work was on average of Rs 42.85 Economic burden of these patients differ according to the severity and presentation of asthma. Nugegoda DB. Illangasekera U (1991). "Prevalence of some risk factors of Atherosclerosis in a rural community." The Ceylon Journal of Medical Science 34(2): 57-61. Objective: To identify the prevalence of some community accepted risk factors of Ischemic Heart Disease and cerebrovascular disease such as cigarette smoking, hypertension, diabetes mellitus, diet and obesity. Study method: The study was conducted in September 1990 in the 13 rural Grama Niladhari divisions in the Hindagala Community Health Project area situated near the University of Peradeniya. According to the 1988 electoral register the Sinhalese adult population of these 13 divisions was 7140. A random sample of 200 individuals was selected from this population, as listed in the electoral register, no attempt being made to differentiate between the genders. The subjects were requested to assemble at a central location at 8.00am after an overnight fast, no food, drinking water being taken after 10.00pm the previous evening. An oral glucose tolerance test (OGTT) was performed on all subjects using a method recommended by the World Health Organization. Subjects were questioned regarding their diet and smoking habits. Height and weight of all subjects were measured and Quetelet’s body mass index (BMI) was calculated (BMI> 25 was considered to be obese). After a minimum of 15 minutes resting period, a sing recording of blood pressure was taken on each subject in the seated position. (The subjects with a systolic blood pressure of 160mmHg and diastolic pressure of 95 mmHg were classified as having Hypertension). Study Area: The study was conducted in 13 rural Grama Niladhari divisions in the Hindagala Community Health Project area situated near the University of Peradeniya. Study population: A random sample of 200 adults selected from the 1988 electoral register and no attempt being made to differentiate between the genders. Study Instrument: Interviewer administered questionnaires Height and Weight measurements OGTT results Blood pressure measurements using sphygmomanometers Sample size: 198 Sampling method: Random sampling method

ϋυ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Risk Factors Investigated: Cigarette smoking, hypertension, diabetes mellitus, diet and obesity Results: The study population consisted of 79 (39.9%)males and 119 (60.1%) females. Majority, both males and females were between the age of 30-49 years (17.7, 28.3). Table 1 presents the age/gender distribution of subjects while table 2 presents the blood pressure recordings. Table 3. shows the prevalence of risk factors by gender. Pathmeswaran A (1997). The Pattern and Problems of Alcohol use in Gampaha District. Postgraduate Institute of Medicine. Colombo, University of Colombo. Doctor of Medicine Community Medicine: Main objective: 1.To describe alcohol consumption and peoples attitude towards alcohol and to detemine the extent of some health and socioeconomic problems related to alcohol consumption in Gampaha District. 2. To assess the burden of problems related to alcohol consumption at goverment hospitals and police department in Gampaha District Specific objective: 1.To describe alcohol consumption pattern in relating to age,sex,social class,level of education,occupation,family size and availability 2.To assess the type of alcohol consumed and the amount of alcohol consumed based on quantity and frequency. 3.To assess peoples attitude and beliefs regarding alcohol consumption. 4.To relate marital discord,child and spouse abuse,child neglect,unemployement and absenteeism among workers to alcohol consumption pattern 5.To determine alcohol related medical problems such as gastritis,pancreatits,and liver diseases, admitted to hospitals in the district over a period of 3 months. Study area: Gampaha District Study population: All permenant residants living in Gampaha ,age over 18 years , both males and females Type of study: A cross sectional study in which data was collected in two stages- Stage 1-A population survey on using alcohol by an interviewer administered questionnaire Stage 2-Data regarding identified alcohol related problems was collected from selected hospitals and police stations in the area over a period of 3 months. Study instrument: Questionnaire Sampling method: Simple random sampling Sample size: 554 males,551 females Interviewed =1105 Final sample size - 1091 Risk Factors investigated: Alcohol consumption Results:

The study population was catagorized according to the following definitions; 1.Regular Drinker - consumed alcohol during the fortnight preceding the interveiw( regular heavy drinker and Regular light drinker).

ϋφ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

2.Regular heavy drinker (Heavy drinker)- consumed alcohol on more than six days during the fortnight preceding the interview. 3.Regular light drinker - consumed alcohol on six days or less during the fortnight preceding the interview. 4.Never drinker /Abstainer - Never consumed alcohol 5.Ex-drinker - consumed alcohol in the past but not during the year preceding the interview 6.Occasional drinker - consumed alcohol during the past year but not during the fortnight preceding the interview. 7.Current drinker - consumed alcohol during the year preceding the interview (Occasional drinker, Regular light drinker, Regular heavy drinker) 8.Ever drinker - consumed alcohol during their lifetime.

The quantity of alcohol consumed by the regular drinkers was assessed based on the information provided regarding consumption during the two week period preceding the interview. For each of the types alcoholic drinks consumed the quantity consumed on each occasion was obtained. Quantity was measured in bottles for all drinks except wine which was measured in glasses (1 glass = 100ml). The bottle was used as the unit of measurement because this was the measure the drinkers were most familiar with and it’s the measure in which most transactions took place. Out of the 1105 study population, eight males and six females were excluded from further analysis on frequency of alcohol consumption as they had given inconsistent answers regarding their alcohol consumption which resulted in546 males and 545 females respondents. . So out of the 1091 respondents 543 or 49.8% had never consumed alcohol and 83 (7.6%) were drinking daily or almost every day. 70% of males (388 out 546) and 8% (44 out of 545) females had consumed alcohol as current drinkers. The standard error of percentages was calculated taking into consideration that the sample was selected using a cluster sampling technique. The design effect was 1.113 for the males sample and 1.678 for the female sample.The study also showed that 37.7% of Males and 1.6% Females consumed alcohol during the fortnight preceding the interview and were classified as Regular drinkers and Percentage of men drinking more than 21 units per week =13.2%, percentage of women drinking more than 14 units per week were none. Consumption of alcohol by men at any time during their lifetime was associated with being a Catholic (OR=2.35), being married (OR=1.79) and low (education up to year 10 or less) education level (OR=1.75). It was not associated with the family size, age, area of residence (whether urban or rural), social class, or house hold income. 50% of men aged 18 to 29 years had started drinking alcohol by the time they were 20years old. Heavy Drinking (drinking every other day or more frequently) by male Current drinkers was associated with having 3 or more children (OR=2.32), age over 39 years (OR=3.06) and being in a social class 5 (OR=6.82). It was not associated with religion, marital status, area of residence (whether urban or rural), education level, or house hold income. Consumption of alcohol by women at any time during their lifetime was associated with being a Catholic (OR=6.93), being in a Social class of 1-4 (OR=2.46), having a monthly income over Rs.2500/- (OR=2.01) and of married, having less than 3 children (OR=2.46). It was not associated with the family size, age, area of residence (whether urban or rural), social class, or house hold income. 65% of women preferred to drink beer; wine was preferred by 18.6% and arrack by 11.6%.

ϋχ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Among the men, 53% of current drinkers preferred to drink Arrack, the illicit brew Kasippu was preferred by 30.5% and beer by 12.8%, but the preferred drink by 75.9% of heavy drinkers was Kasippu. Commonly stated reasons for drinking by the respondents were: 1. To celebrate 60% of men ( men N= 388) and 51% of women (N=42) 2. To keep company with friends 42% of men ( men N= 388) and 18% of women (N=42) 3. To relieve body aches after work 40% of men ( men N= 388) and 03% of women (N=42) Among women the most commonly stated reason for not drinking or limiting drinking was because it was against their religion/culture. (61.7%). Among men the most commonly stated reason for not drinking or limiting drinking was because it could adversely affect their health. (60.2%). The study also revealed that among the study population there was almost total disproval of 1. Drinking by a man spending time with his children 2. During working hours 3. Just before driving 4. Drinking by teenage boys Domestic violence were more common among male drinkers than female drinkers and Heavy drinkers than the light drinkers. 35% of the cases reported to the minor offences branch of the police department were associated with alcohol consumption. There were 76.8% of the family disputes reported were associated with alcohol consumption. Proportion of admissions to hospital with illness due to alcohol consumption - 6% in the male wards 0.6% in the female wards Out of which two-thirds were diagnosed with cirrhosis or chronic liver disease Recommendations: The finding of the present studies show that if state interventions aimed at reducing alcohol consumption are to effective existing laws should be enforced more effectively to reduce the availability of Kasippu. Educational programmes should be implementedto educate the drinkers about sensible/'safe' drinking.Special programmes should be targeted at young males from lower social classes . Counselling services should be made available at or near Police stations to deal with marital problems reported to the Police and to help the problems related to alcohol consumption. Perera B. Fonseka P. Ekanayake R. Lelwala E (2005). "Smoking in adults in Sri Lanka: prevalence and attitudes." Asia Pac J Public Health 17(1): 40-5. A questionnaire was administered to 1565 adults to identify the prevalence of smoking and to assess respondents' attitudes toward smoking. Of men 41% were yearly smokers, 27.8% were monthly smokers and 21% were daily smokers. The corresponding figures for women were 3.4%, 2% and 0.6% respectively. Higher prevalence rates were observed among less educated, middle-aged men who were from underprivileged families. About 23% of men and 0.9% of women were monthly alcohol users. Alcohol use seems to be positively associated with smoking. A considerable portion of both smokers and non-smokers expressed a favorable attitude towards smoking habits of adult males (40.1% of smokers and 12.8% of non-smokers) and towards the tobacco industry (25.1% of smokers and 13.1 of non-smokers). Since the majority of people in Sri Lanka are non-smokers,

ϋψ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

attitudinal support given by them in promoting smoking in the society needs to be addressed effectively in smoking control interventions. Perera PCS (2009). Physical activity and its associated factors among adults in the divisional secratariat division of Gampaha. Postgraduate Institute of Medicine Colombo, University of Colombo. Masters of Science in Community Medicine Main objective: To describe the level of physical activity and associated factors of adults aged 18-44 years living in the Divisional Secretariat (DS) division of Gampaha. Specific objective: 1. To assess the level of physical activity (PA) of adults aged 18-44 years living in the DS division of Gampaha. 2. To identify the association of level of physical activity of the adults with their demographic and socioeconomic characteristics,area of residence (urban/rural) and dietary practices. Study area: Gampaha Divisional Secretariat division Study population: Adults both males and females aged 18-44 years and residing in the DS division of Gampaha for a minimum period of 1 year duration. Housewives formed the largest group in the study population Type of study: A descriptive cross sectional study Study instrument: Three interviewer administered questionnaire, which comprised of Questionnaire 1 - Socio demographic characteristics Questionnaire 2 - Level of physical activity Questionnaire 3 - Dietary practices Sampling method: A three stage sampling technique using cluster sampling Sample size: Males 155 females 185 Total =340 Risk Factors investigated: Physical activity Results: Physical activity is defined as the bodily movement produced by the contraction of skeletal muscles that increases energy expenditure above the basal (resting) level (TRB 2005). The level of physical activity was assessed by the International physical activity Questionnaire long form (IPAQ-L) as an interviewer administered questionnaire. It was assessed mainly in four main domains of human activity: domestic, transportation , work place, and leisure time. In each domain specific types of activities were assessed in terms of walking, moderate-intensity activities and vigorous intensity activities carried out for at least 10 minutes during the previous week. And the energy requirement of each type of physical activity was calculated in MET-minutes. A MET-minute was computed by multiplying the MET score of an activity by the minutes (IPAQ core group 2005). The calculated MET values were categorized into Low, Moderate and High as given below, according to the guidelines given by the committee of IPAQ

ϋω Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

1.Low •No activity reported OR •Some activity reported but not enough to meet Moderate or High categories 2.Moderate Any of the following three criteria’s: •3 or more days of vigorous activity of at least 20 minutes per day OR •5 or more days of moderate intensity activity and /or walking of at least 30 minutes per day OR •5 or more days of any combination of walking, moderate-intensity or vigorous intensity activities achieving a minimum of at least 600 MET –minutes /week. 3.High Any of the following 2 criteria: •Vigorous – intensity activity on at least 3 days and accumulating at least 1500 MET-minutes /week OR •7 or more days any combination of walking, moderate-intensity or vigorous intensity activities achieving a minimum of at least 3000 MET –minutes /week. Below show the distribution of the level of Physical activity among the study population Physical activity categories Number % Low 88 25.9 Moderate 138 40.6 High 114 33.5 Total 340 100.0 The study also revealed that the following factors had a significant association with low level of physical activity 1.Living in an urban residence (x^2 = 6.85; p<0.05) 2.Female sex (x^2 = 5.5; p<0.01) 3.Income over Rs.40,000 (x^2 = 6.5; p<0.05) 4.Unemployment status (x^2 = 56.7; p<0.001) 5.Upper and middle level skilled occupations (as defined below) (x^2 = 7.7; p<0.05) 6.Unhealthy consumption of commercially baked foods (x^2 = 8.56; p<0.05) Prevalence of physical inactivity was 25.9%. Several factors related to demographic-,socioeconomic, residence, and diet were significantly associated with it. Recommendation: It is recommended that interventions be made at community level such as a national level surveying system for physical activity status targeting the vulnerable groups such as house wives, workers in sedentary occupations and residents of urban areas. Perera T. Wijesuriya RE. Suraweera PHR. Wijewardene K. Kumarage SK. Ariyaratne MHJ. Deen KI (2008). "The prevalence of colorectal cancer and survival in patients from the Gampaha District, North Colombo region." Ceylon Medical Journal 53(1). Objective: To determine the pattern of colorectal cancer in the Gampaha District of North Colombo, Sri Lanka, and to evaluate survival after surgery for colorectal cancer in a cohort of patients.

ϋϊ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Study Method: Between 1992 and 1997, the medical records of all patients with histology proven colorectal cancer presenting to 4 regional hospitals and a regional teaching centre were reviewed in phase I of this study. The following demographic data obtained were entered into a database; age at presentation, gender, site of index cancer, the presence of synchronous polyps or cancer, stage of cancer (Duke's and TNM [1]). Because data on survival in this group of patients in retrospective review was not complete, a prospective study of all patients with colorectal cancer presenting only to the University Surgical Unit was commenced in January 1996 and data analysed in April 2004. This constituted phase II of the study. All patients were followed up in the clinic at 3-month intervals for the first 2 years and at 6- month intervals up to 5 years. Thereafter follow up was annually up to 10 years after surgery. Survival was assessed by Kaplan Meier life-table analysis using SPSS v.10.0 for Windows. Approval for this study was granted by the Ethics Committee of the University of Kelaniya. Study area: Gampaha District of North Colombo Study population: Patients with colorectal cancer Type of study: Prospective study Sample size: 395 Factors investigated: Demographics, tumour stage and survival Results: Colorectal cancer incidence The crude incidence of colorectal cancer in the Gampaha District, North Colombo was calculated from phase I of the study. A total of 175 cases were reported in this district between 1992 and 1997 giving a crude annual incidence of 1.9 per 100 000 population. 220 new cases of colorectal cancer were treated at the North Colombo Teaching Hospital and provided data for phase II which aimed to assess 5 year survival. The number of new cases recorded annually had increased over the periods under review in both groups of patients (table 1). Demography In the retrospective review (phase I) the median age (range) at presentation was 60 (9-87) years, and presentation in the prospective series (phase II) was also 60 years (15-88). The age specific cancer prevalence in both series is depicted in table 2. 28% of cancers were in patients less than 50 years in both subsets (49/175 phase I cohort and 60/220 phase II cohort). Colorectal cancer occurred in similar numbers of men and women; phase I study male:female = 94 (54%):81 (46%): phase II male:female = 109 (49.5%):111 (50.5%). The majority of cancers were found either in the rectum or rectosigmoid junction in both cohorts; phase I 111/175 (64%); phase II 176/220 (80%). Tumour stage Complete tumour staging (Duke's and TNM [1]) was available for 126 patients in phase I and 201 patients in phase II. Combined evaluation of 327 patients revealed Duke's A and B lesions in 175 (53.5%) patients. Tumour stage is shown in tables 3 and 4. Treatment Of 220 patients analysed prospectively 6 patients were managed without operation either due to advanced disease or high surgical risk. 214 patients had surgery (table 5). Perioperative mortality was 5% (11 of 220) and was due to myocardial infarction (5), anastomotic leakage and multi-organ failure (3) and bronchopneumonia (3).

ϋϋ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Survival Survival analysis was possible only in phase II of the study. Eighty of 220 patients (36%) analysed prospectively had died during follow up (median 24 months: range 1-94 months). The majority of deaths occurred during the first 24 months. Survival at 2 years and at 5 years was 69% and 52% (figure 1). Cancer in patients <50 years 60 patients (27.3%; 30 male: 30 female) in the prospective series were under the age of 50 years. The median age (range) at the time of diagnosis was 42 years (16-49). The majority (69%) presented with rectal bleeding, and the remainder presented with abdominal pain (36%), anaemia or unexplained loss of weight. Only one patient presented with large bowel obstruction. Altogether, 12 (20%) patients had a family history of cancer of which 4 (6.7%) were site specific, and the rest were extra-colonic. In 48 (80%) young patients, cancer was found in the left colon compared with 12 (20%) who had right-sided cancer. Two patients with rectal cancers had familial adenomatous polyposis. Complete tumour staging was available in 55 patients (table 4). Duke’s staging revealed that 7 (11.6%) were Duke’s A, 22 (36.6%) Duke’s B, and 26 (43%) Duke’s C or D. Survival in young patients in the first 2 years was 73% versus 66% in older patients and appeared to plateau between 2 and 5 years, whereas in older patients, survival continued to decline annually up to 5 years after operation (figure 2). Conclusion: The burden of colorectal cancer in Sri Lanka is on the rise. Up to a third of cancers occur in those under 50 years, and the majority of cancers are in the rectum or recto sigmoid region. Flexible sigmoidoscopy offers a useful screening tool. Perera. Torabi B. Mohammad R (2004). "Preliminary study of smoking and alcoholuse among students in southern Sri Lanka." Psychological Reports 94 (3): p856-858. Objective: To identify the prevalence of tobacco and alcohol use and to assess student attitudes toward the alcohol and tobacco industries Study method: 455 students, ages 15-19 years and living in a southern district of Sri Lanka, were self-administered a questionnaire to identify the prevalence of tobacco and alcohol use and to assess student attitudes toward the alcohol and tobacco industries. Study Area: A southern district of Sri Lanka Study population: School students of age between 15-19 years Study Instrument: Self-administered questionnaire Study type: A cross sectional study Sample size: 455 Risk Factors Investigated: Tobacco use Alcohol use Results: The current prevalence of smoking was 10.6% among men and 0.0% among women. The current prevalence of alcohol use was 21.2% among men and 3.3% among women. A significantly higher proportion of men than women expressed favorable attitudes toward the alcohol industry (27% versus 7%) and the tobacco industry (13% versus 5%). Given that aggressive marketing strategies are used by these industries to promote their products among young people, epidemiological studies of

ϋό Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

the substances using scientifically sound methods to formulate effective prevention strategies are essential. Ranasingha KNP. Weeraekara MM (2012). "Prevalence of prediabetes among health care workers in Provincial General Hospital, Badulla." The Ceylon Medical Journal 57(Supplement 1). Objective: To assess the prevalence of pre-diabetes in health care workers (HCW) in Provincial General Hospital, Badulla and identify high risk pre-diabetics. Study method: Three hundred and twenty one HCW’s were included in this study with written consent. Blood pressure, Body Mass Index (BMI), and Oral Glucose Tolerance Test results were recorded. Other risk factors were also assessed. Study Area: Provincial General Hospital, Badulla Study population: Health care workers (HCW) in Provincial General Hospital, Badulla Sample size: 321 Sampling method: Random sampling method Risk Factors Investigated: Blood pressure, Body Mass Index (BMI), Blood glucose levels Results: Pre- diabetes (Fasting Blood Sugar (FBS) of 100 – 125 mg/dl or Impaired Fasting Glucose (IFG) and/or Impaired Glucose Tolerance (IGT) level of 140 – 199 mg/dl after glucose tolerance test (GTT), is a condition where blood glucose level is higher than normal but not sufficiently high to be categorized as Diabetes Mellitus. Persons who develop Type II Diabetes tend to go through a pre-diabetic stage. Dietary modification and medication prevent or postpone diabetes mellitus. Those with both IFG and IGT and one additional risk factor are considered as high risk pre-diabetes. Of the 321 HCW’s, 39 (12.6%) were identified as pre-diabetics. Prevalence of high risk pre-diabetics was 3% and there were 9%, 2%, 15%, 21% pre-diabetics in the age groups 20-29, 30-39, 40-49, and 50-60 years respectively. Prevalence of IFG was 11.6% and IGT 4%. Four percent had both IFG and IGT. Incidence of Diabetes and Hypertension was seen in 3.5% and 6% respectively. Conclusions: The pre diabetics rate in this study is higher than in comparable studies. IFG is a sensitive test to detect pre diabetic state. Majority would need dietary modifications and behavior therapy and a few drug treatment. Ranasinghe P. Jayawardena R. Wijesundara WRUAS. Wijetunga WMUA. Tilakaratne TAD. Subasinghe S. Katulanda P (2012). "Waist-to-height ratio has the best anthropoemetric association with cardio-metabolic disease among Sri Lankan adults." The Ceylon Medical Journal 57(Supplement 1): Objective: To investigate the association of waist-to-height ratio (WtHR) and cardio-metabolic disease among Sri Lankan adults and to compare with conventional anthropometric indices (Body Mass Index [BMI], waist circumference [WC], and waist-to-hip ratio [WHR])

ϋύ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Study method: Five thousand adults were recruited from a nationally-representative community based sample using multi stage random sampling method. Weight, height, WC and hip circumference were measured using standard techniques. Receiver operating characteristics (ROC curves were performed and area under the curve (AUC) was calculated for each anthropometric indices Sample size: 4,485 Sampling method: Multi stage random sampling method Risk Factors Investigated: Weight, height, WC and hip circumference Results: The population consisted of 39.5% males and mean age was 46+15.1 years. The mean WtHR in all adults was 0.496+0.077. Males (0.477+0.065) had significantly lower WHtR than the females (0.508+0.081) (P<0.001). A significantly higher WHtR was observed among the diabetes (0.547+0.068) than those without (0.489+0.075). The mean WHtR in those with and without hypertension was 0.483+0.073 and 0.529+0.076 respectively (p<0.001). Those with the metabolic syndrome (MS) in which the crude adjusted prevalence was 27.1% had a significantly higher WHtR than those without (p<0.001). WHtR had the highest correlation with the blood pressure, total cholesterol, and LDL-cholesterol in comparison to classical anthropometric indices. The AUC of WHtR has significantly higher than that of BMI, WC and WHR in the prediction of diabetes, prediabetes, hypertension, MS, and hypercholesterolemia. Conclusion: Among Sri Lankan adults WHtR had a greater association with diabetes, prediabetes, hypertension, MS, and hypercholesterolemia than traditional anthropometric indices. Ranasinghe RDS (2009). Physical Activity and selected correlates among adolescent school children aged 13 and 14 years in the Rathnapura District. Postgraduate Institute of Medicine. Colombo, University of Colombo, Doctor of Medicine in Community Medicine: 148 pages. Main objective: To assess physical activity pattern and selected correlates among adolescent school children aged 13 -14 years in the Rathnapura District. Specific objective: 1.To select, modify, translate and validate a physical activity questionnaire to assess physical activity pattern of adolescent school children aged 13-14 years. 2.To assess physical activity pattern among adolescent school children aged 13 -14 years using the validated questionnaire. 3.To identify selected environmental, soci-demograohic and psychosocial correlates of physical activity pattern of adolescent school children. 4.To describe the sedentary activities of adolescent school children aged 13-14 years. Study method: The study included two phases. Phase 1- Two study instruments were selected , modified and translated to assess the physical activity ,pattern, sedentary behavior and physical activity correlates of the mentioned school children (PAQ-S and PACE+PSM-S). A questionnaire to collect socio demographic date of the adolescents (PQPA-S) was also developed during this phase. The outcome measure of physical activity assessment questions was participation in moderate (walking briskly, recreational swimming, tennis, bicycling 5 to 9mph-level terrain or with few hills), to vigorous physical activity (Race walking, jogging or running, swimming laps, bicycling more than 10

ότ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

mph or on steep uphill terrain, moving r pushing furniture) for at least 60 minutes per day for 5 days or more per week. Based on this cut off value adolescents were categorized as sufficiently active or insufficiently active. Phase 2- during this phase the study comprised of assessing the physical activity pattern, sedentary activities and to identify selected environmental, socio-demographic and psychosocial correlates of physical activity pattern of the children. Perceived correlates based on research findings were assessed using the PACE+PSM-S. Study area: Schools of the Rathnapura District, in the Sabaragamuwa province. Study population: Adolescent school children aged 13-14 years of Grade 9 attending Sinhala medium government schools of the Rathnapura district. Type of study: A cross sectional school based survey Study instrument: Three study instruments were used: 1.Physical activity questionnaire-Sinhala (PAQ-S) 2.Patient centered Assessment and Counseling for Exercise (PACE) Adolescent psychosocial measure related to physical activity behavior –Sinhala (PACE-PSM-Sinhala) 3.Parental questionnaire on Physical activity (PQPA-Sinhala) Sampling method: A two stage stratified cluster sampling method Sample size: 1041 Risk Factors investigated: Physical activity Results: Physical activity has been defined as any bodily movement produced by skeletal muscles those results in energy expenditure (Casperson et al. 1985). A total 0f 1041 grade 9 students of Sinhala medium schools on the Rathnapura district participated for the cross sectional study and mean age of the sample was 13.8+ 0.39 years. Forty nine percent of the sample was boys. Participation in moderate to vigoruous physical activity (as defined below) for at least 60 minutes per day for 5 or more days per week was taken as the cut off for categorizing adolescents as sufficiently active or insufficiently active.Approximately 38% of adolescent school children were sufficiently active . 40% of the boys and 36.4% girls were sufficiently physically active. A significant difference in the level of physical activity was not observed between boys and girls (p>0.05). In the bivariate analysis, physical activity level showed a significant association with the following correlates: Ø Functional classification of schools (as defined below) – in which both sexes of type 1AB schools were sufficiently active compared to other type of schools. (x2 =15.45,p<0.001) Ø Income of the family of >Rs.5000 per month (x2=5.08,p<0.05) Ø Sector by place of residence Urban residences compared to rural residences (x2 =15.45,p<0.05) Ø Location of school – Urban schools compared to rural schools (x2=5.15) Ø Physical activity level of parents – with parents who are involved in some physical activity everyday (x2 =7.59,p<0.05) Ø Participation in sport teams (x2 for trend =14.55,p<0.0001) Ø Physical activity change strategy (r=0.19,p<0.01) Ø Physical activity pros (r=0.08,p<0.01)

όυ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Ø Self efficacy (r =0.13,p<0.01) Ø Friend support (r=0.16,p<0.01) Ø Family support ( r=0.08, p<0.01) Ø Environmental factors (r=0.12,p<0.01) Ø Physical activity recreational choices (x2 =16.21,p<0.01) Multivariate regression model controlling for confounders showed statistically significant associations with: O Sufficient physical activity with type 1AB schools (OR 1.73,95% CI-1.20-2.49) O Parents being physically active for 6-7 days per week (OR 1.59,95% CI-1.15-2.22) O Thoughts, activities and feelings of adolescents to make a positive behavioral change ( physical activity change strategy) (OR 1.38,95% CI-1.07-1.78) O Availability of active physical activity choices to make when a recreational choices had to be made (OR 1.56,95% CI-1.05-2.33) The findings suggest that physical activity level of the adolescents need to be promoted. Therefore , physical activity intervention studies considering the possible factors that can affect the participation of physical activity of adolescents such as physical activity level of the parents, thoughts, activities and feelings of adolescents to make a positive behavioral change and etc, should be conducted to address this problem. Ranaweera HDHJ (2008). Outcome of pregnancy in women with an increased body mass index. Postgraduate Institute of Medicine. Colombo, Unversity of Colombo. Doctor of Medicine in Obstetrics and Gynaecology: Main objective: To describe the association of antenatal booking visit maternal Body Mass Index-BMI (in first and early second trimester) on maternal and fetal outcomes. Specific objective: To compare the association of booking visit maternal BMI in normal and high BMI categories on:

Past dates Induction of Labour Fetal distress Presence of meconium stained liquor Mode of delivery Birth weight Presence of congenital abnormalities Early neonatal complications (admission to special baby care unit)

Study method: The data was collected by the eligible mothers by interviewing and by measuring relevant variables such as their height .weight, their blood pressures , postprandial blood sugars and as well their babies once born. The study also included in observing the outcomes. All the data were collected to a preformed data collection sheet. Study area: Professorial, obstetric and gynaecology unit of the Teaching Hospital Peradeniya. Study population: Primigravid mothers between 18-35 years of age with a singleton uncomplicated pregnancies , who attended the antenatal clinic and received inward care of Professorial obstetric and gynecology unit of the Teaching Hospital Peradeniya. Mother who had past history of subfertility or were treated for subfertility or other preexisting medical problems, or bony deformities or developed gestational diabetes mellitus or preeclampsia or pregnancy induced hypertension were excluded from the study.

όφ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Type of study: Hospital based prospective cohort study. Study instrument: A health scale ZT 120 to measure the weight and the height of the mothers Sphygmomanometers for there blood pressures CTG machines Data collection sheets Antenatal books. Sampling method: Convenient sampling Sample size: 226 Risk Factors investigated: High body mass index on pregnancy Results: The Body Mass Index (BMI) is an anthropometric measurement that correlates with the body weight. It is calculated by dividing the body weight in kilograms by height in square meters. Weight changes can also occur as a result of both acute and chronic factors such as food and nutrition, illnesses, energy intake, and output of the individual. BMI has been categorized according to World Health Organization (WHO) classification as follow: BMI (kg/m2) <18.5 Underweight 18.5-24.9 Normal weight 25-29.9 Overweight >30 Obese From clinical, etiological and prognostic point of view, three broad BMI categories could be also made. Low BMI group <18.5 Normal BMI group 18.5-24.9 High BMI group >25 Out of the 226 study subjects, 72.6% of the mothers were in normal BMI category and 27.8% were in high BMI category as shown below: BMI category Number Percentage Normal 164 72 overweight 46 20.4 Obese 16 7.1 Total 226 100.0 The study also revealed that there was a significant difference between high BMI categories and Normal BMI categories in the following outcomes- •Past dates ( birth after 40 weeks of gestation) - p=0.012 •Induction of labour – p=0.001 •Fetal distress – p=0.009 •Instrumental delivery – p=0.047 •Caesarian section – p=0.001

όχ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

•Emergency caesarian sections – p=0.025 •Admission to special care baby unit – p=0.001 •Mean birth weight – p=0.001 There was no significant difference in the appearance of meconium stained liquor (p=0.519) and the prevalence of congenital abnormalities between the two groups. In conclusion high maternal BMI appears to be associated with an increased risk of adverse pregnancy outcomes maybe starting from increased induction of labour. They should be considered as high risk and be counselled accordingly. Research and Evaluation Programme - Alcohol and Drug Information Centre (2003). Study on Prenatal Drug Use. Colombo, Alcohol and Drug Intervention Centre Objective: 1. To determine the prevalence of smoking , alcohol and other drug use among the parents of school students. 2. To identify urban/rural differentials in tobacco/alcohol use 3. To determine the attitudes and beliefs related to alcohol/tobacco use among student Study Method: By administering a questionnaire on school going children who were in Grades 6 to 13. Study Area: Schools in 20 different districts of Sri Lanka, which were stratified into 5 different strata based on Zones used in the Consumer Finance and Socioeconomic Surveys conducted by the Central Bank of Sri Lanka Strata 1 Schools in Colombo Municipal Council area Strata 2 Schools in the district of Colombo ( excluding Colombo Municipal Council area),Gampaha , Kalutara, Galle and Matara Strata 3 Schools in the Districts of Hambantota, Ampara , Puttlam, Anuradhpura, Pollonaruwa and Moneragala Strata 4 Schools in the Districts of Kandy, Matale, Nuwara Eliya , Kurunegala,Badulla, Ratnapura and Kegalle Strata 5 Schools in the District of Batticoloa, Trincomalee Study population: School going children who were in Grades 6 to 13. Study Instrument: Questionnaire Study type: A cross sectional survey Sample size: A total number of 9195 school students were selected for the suvery Sampling method: A systemic simple random sampling method Risk Factors Investigated: tobacco alcohol Results: The study revealed that 50.4% of the respodents were females while 49.6% were males and 14.1 % resided in an urban sector ad the majority ( 85.9%) lived in the rural area as shown in table 1. When regarding the father's occupation , 21.8%of the fathers were farmers, 20.8% were self-employed and 19.9% were laborers. When considering the rural sector, the highest percentage of the fathers were

όψ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

employed as Farmers (24.7%), where as in the urban sector 29.0% of the fathers were self-employed. Out of the total sample 48.2% of the students stated that their fathers’ smoke. This percentage was higher in the rural areas 49.9% as opposed to the urban areas (38.3%) as given in table 2.Regarding the frequency of their fathers’ smoking pattern 47.6% classified their father as a daily smoker ( at least one smoke per day), while 52.4% mentioned that their father was occasional smoker. When zones is considered , it seen that parents of the students living in the Colombo Municipal area smoked less (23%) where as a high prevalence was seen by the parents living in dry zone district (56%). Parents living in Batticaloa and Trincomalee (34.7%) also smoke comparatively less than those living in the other zones (except Colombo Municipal area). When considering the mothers of these school children, only a 0.4% of all respondents showed positive response saying their mothers smoke from both the urban and rural areas. Further analysis on smoking patterns of the mother was not carried out in the survey as the sample of smoking among the mothers was small. Regarding the parental use of Alcohol, 49.7% of the students had reported that their fathers’ used alcohol. The percentage of fathers drinking was higher in the rural sector (50.2%) as opposed to the urban sector (46.6%) as shown under table 3. The frequency of alcohol use was also considered , in which the study showed 15.1% were daily users (at least one glass) and 84.9% were occasional users , with daily users being more frequent in rural areas (15.5% , and in urban areas 12.5%) The study also revealed that the fathers who lived in Batticaloa and Trincomalee drink least (37.3%) while the fathers’ of students living in the Districts of Kandy, Matale, Nuwara Eliya , Kurunegala, Badulla, Ratnapura and Kegalle drank the most (53.2%) compared to all the other districts. Mother’s pattern of drinking was only 0.6% among the student’s mothers living in both the urban and rural areas. The prevalence was more (1.5%) in the urban areas when compared to the prevalence in the rural areas which was (0.5%). Since the percentage for mothers smoking is comparatively low, no further analysis was carried out. Examination of student’s attitude reveals that the majority of students do not believe that tobacco / alcohol use leads to enjoyment, aggressive behavior and relief from tiredness. ‘Influences of friends’ (over 65% of the study population) was seen as the main influence that lead people to smoke and drink. Samarage SM (1996). Some epidemiological aspects of non-insulin dependent diabetes mellitus in a defined population in the Kalutara District of Sri Lanka. Postgraduate Institute of Medicine. Colombo, University of Colombo. Doctor of Medicine in Community Medicine General objective: To study the prevalence and risk factors for non insulin dependent diabetes mellitus in a defined population in the Kalutara District of Sri Lanka Specific Objective: 1.To estimate the prevalence of non insulin dependent diabetes mellitus in the field practice area of the National Institute of Health Sciences, Kalutara 2.To estimate the prevalence of impaired glucose tolerance.

όω Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

3.To assess the relationship [between selected socio demographic, metabolic, lifestyle and other risk factors for non-insulin dependent diabetes mellitus. 4.To determine the sensitivity and specificity of the screening test for diabetes mellitus Study method: The study population was selected using stratified cluster sampling method , and data on required to comply with the objectives were obtained using questionnaires and other study instruments (as below ) and oral 75g 2 hour glucose tolerance test was performed on the study subjects. Glucose was measured in capillary whole blood using a reflectance photometer Data collection was carried out between October 1993 and January 1994, with two survey teams working concurrently at different survey sites .Strict standardization of the methodology was sought through pre training and in-survey checks. Age standardized prevalence and associated 95% confidence intervals were calculated by the direct method. Relative risk estimates for risk factors were determined and multiple regression analysis was used in attempts to elaborate important independent risk factors Study Area: The study was conducted in the Field Practice Area of the National Institute of Health Sciences (NIHS) situated in the Administrative District of Kalutara in the Western Province of Sri Lanka Study population: All the individuals age 25-74 years who are ‘registered voters’ in the Field Practice Area of the NIHS Kalutara Study Instrument: Interviewer administered questionnaires Height using a height measurement board Weight – electronic digital weighing scale Waist and hip circumferences using a standard measuring tape Blood pressure using standard sphygmomanometers A Boehringer Refloflux II glucose meter to measure the blood glucose levels Study type: A Cross sectional prevalence study Sample size: 1480 Sampling method: Stratified cluster sampling method Risk Factors Investigated: Socio demographic factor –age, race, sex, residence (urban or rural), occupation, educational level, Family income Glucose concentration Obesity Blood pressure Physical activity Smoking, alcohol Family History Results: There were 1054 females and 426 males; the mean age of the sample was 44.7 (SD=12.7) years with the age range of 25 -74 years. Base on the 75g oral glucose tolerance test and world health organization criteria, the age standardized prevalence rate for NIDDM was 8.1 % (95% Confidence Interval (CI) 6.6-9.6) and impaired glucose tolerance 12.9% (95% CI:11.2-14.6).The age standardized prevalence of NIDDM was significantly higher in men 9.4% (95% CI: 6.6-12.2) than women 7.2% (95% CI: 5.7-8.7). By contrast the prevalence of Impaired glucose tolerance was significantly higher in women 14.5% (95% CI: 12.4-16.7) than men 8.5% (95% CI: 5.9-11.0)

όϊ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

The results also revealed that subjects residing in the urban sector carried an increased risk for NIDDM in relation to the rural sector (Odds ratio=1.65, CI=1.44-2.39, p<0.05). Moors were at an increased risk of NIDDM compared to Sinhalese (OR: 1.74 CI: 1.10-2.70, p=0.03). There is considerable reservoir of undetected NIDDM subjects in the study population – 50% of the total cases. In the multivariate analysis for women, glucose levels were related to age, family, history of diabetes and systolic blood pressure, and for men only age, systolic blood pressure and waist-hip ratio were significantly related to glucose levels. Samaranayake SWW (2006). Study of the Risk Factors and Trigger Factors of Childhood Asthma and the Economic Implications of Asthma Management in a Family Practice. Postgraduate Institute of Medicine. Colombo, University of Colombo. Doctor of Medicine in Family Medicine. Main objective: Study of the Risk Factors and Trigger Factors of Childhood Asthma and the Economic Implications of Asthma Management in a Family Practice. Specific objective: 1.To identify the risk/trigger factors which could cause an increase in prevalence of childhood wheezing. 2. To describe the socio demographic characteristics of children presenting with wheezing in family practice. 3. To determine the economic implications of appropriate long term management of childhood wheezing. 4. To evaluate the cost effectiveness of inhaled corticosteroids(ICS). 5. To describe the patient/parent satisfaction of the management of childhood asthma with inhaled corticosteroid therapy. Study area: The Katukurunda Nursing Home and Clinic in Kalutara. Study population: Children up to fourteen years of age attending the practice during a period of three years (July 2001-July 2004). Type of study: A semi prospective observational study. Study instrument: An ashtma diary and questionnaires Sampling method: Convenient sampling Sample size: Study group 1089 (children under 14 years of age who presented with asthma) Control group 239 (children with the same age group who presented for other illnesses and had no history of asthma) Risk Factors investigated: Certain food items such as chilled drinks, red fish, red meat diary products such as cheese ,curd and yoghurt King coconut water,sour plantains Family history of asthma or eczema Smoking Household pets Cooking oil

όϋ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Disease investigated : Asthma Results: There were 1328 patients recruited into the study and 1089 (82%) were asthmatic children below 14 years of age and 239 (18%) were controls. Controls were children of below 14 years of age who presented to the clinic with problems other than respiratory diseases. They had no history of childhood asthma. Findings revealed that family history of Allergic rhinitis (OR=1.45,p<0.05) eczema(OR=2.41,p<0.0001) and asthma(OR=2.78,p<0.001) are significantly associated with childhood wheezing according to the study.However , after logistic regression analysis studies it was shown that childhood wheezing is 2.362 times more likely in children with a family history of asthma and 1.854 times more likely in children with a family history of eczema. Other factors which were significantly associated with childhood asthma shown by the study include: •Past history of occurrence of rashes (Chi square = 6.37 OR= 1.94, P value < 0.05, 95% CI- 1.12-3.42. •Past history of sneezing and / or cold ( Chi square = 193.75 OR= 7.28, P value < 0.001, 95% CI- 5.31-10.03.) A child with past history of frequent attacks of sneezing and / or cold is 5.7 times more likely to be asthmatic as compared to a child not having those symptoms according to regression analysis studies. •Use of kerosene oil as cooking fuel ( Chi square = 0.91 OR= 3.21, P value < 0.01, 95% CI- 1.22-9.22). It was shown by regression analysis that the incidence of wheezing in children is likely to increase by 2.904 times when kerosene oil is used as a fuel for cooking.) •Smoking in the presence of the child ( Chi square = 9.73 OR= 1.95, P value < 0.01, 95% CI- 1.25-3.08). Children whose fathers smoked in their presence were 1.7 times more likely to be asthmatic than children who were not exposed to tobacco smoke. Following are the significant trigger factors of childhood wheezing according to the guardian/parent perception: •Consumption of red fish (Chi square = 7.33 OR= 3.31, P value < 0.01, 95% CI- 1.25-9.5). •Consumption of red meat (Chi square = 7.12 OR= 3.26, P value < 0.01, 95% CI- 1.24-9.36). •Consumption of diary products such as cheese, curd and yoghurt (Chi square = 10.48 OR= 1.9, P value < 0.01, 95% CI- 1.26-2.88). •Consumption of king coconut water (Chi square = 23.91 OR= 2.32, P value < 0.001, 95% CI- 1.62-3.34). •Consumption of sour plantains (Chi square = 19.53 OR= 2.03, P value < 0.001, 95% CI- 1.45-2.83). •Consumption of chilled drinks (Chi square = 50.61 OR= 5.2, P value < 0.001, 95% CI- 3.08-8.89). Regarding Inhaled corticosteriod therapy (ICS) the study was done under a protocol criteria regarding the number of patients who are qualified to be initiated on ICS therapy. Out of the 1089 study sample , 60 patients were qualified to be initiated on ICS therapy.Thus , in this series 5.5% of the total asthmatics needed steroid inhalers. Age distribution of the patients who needed ICS therapy is given in the table below. The findings also revealed that direct and indirect expenses gradually reduced when the ICS therapy was used over a period of time and there is a decline in total expenses in managing childhood

όό Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

asthma because the episodes of asthma reduced from 7 attacks to 1 attack per month when inhaled steroids were used for three months. Samarasinghe AIP (2007). Prevalence of Childhood Asthma among 5-11 years old children in an urban setting and its impact on the Child and the Family. Postgraduate Institute of Medicine Colombo University of Colombo. Doctor of Medicine in Community Medicine: 131. Main objective: To study the prevalence of Childhood Asthma among 5-11 years old children residing in the Colombo Municipal Council area and to assess the impact of the disease on their physical health , emotional health and day to day activities and the emotional health and day to day activities of their mothers or the caregivers. Specific objective: 1. To determine the prevalence of asthma in 5-11 year old children. 2. To describe some selected factors associated with childhood asthma. 3. To modify and validate the Children's Health Survey for Asthma (CHSA) Questionnaire as an instrument to assess the impact of asthma in Sri Lanka, in children aged between 5-11 years 4. Using the validated CHSA questionnaire to assess the impact of asthma on the physical health , emotional health and day to day activities among the 5-11 years old children and their mothers or the caregivers. The study was done in four phases Phase 1- Translation and validation of modified Children's Health Survey for Asthma (CHSA) Questionnaire Phase 2- Measurement of the prevalence of asthma among children aged 5-11 years and some socio demographic and enviromental factors associated with asthma. Phase 3- Assessment of the impact of the disease on the emotional functions and day to day activities of the ashtmatic children and the caregivers Phase 4-Comparison of dust levels of the living enviroments between a sub sample of asthmatic and non-asthmatic children. Study area: Asthma Emergency Unit at OPD/LRH Colombo Municipal Council Study population: Phase 1- Children aged 5-11 years diagnosed by a paediatrician as having asthma or wheezing.Th respondents were the mothers or the principal caregivers of the above children. Phase 2- Children aged 5-11 years residing tn the CMC area for a minimum period of six months at the time of the data collection. Phase 3- Children aged 5-11 years identified as having asthma during Phase 2 of the study and their mothers and / or caregivers. Type of study: Phase 1- A hospital base cross sectional study Phase 2- A community based descriptive cross sectional study Phase 3- A community based descriptive cross sectional study Phase 4-A community based descriptive cross sectional study Study instrument: Phase 1- CHSA questionnaire Phase 2-Interviewer administered questionnaire Phase 3- S-CHSA questionnaire Phase 4-GILAIR-3 Portable Dust sampler

όύ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Sampling method: Phase 1- Convenient sampling Phase 2-Cluster sampling Phase 3- same as Phase 2 Phase 4-Random sampling Sample size: Phase 1- 100 Phase 2- 1380 Phase 4-80 houses Risk Factors investigated: eczema breast feeding birth weight family history of asthma smoking Frozen foods cold weather Disease investigated: Asthma Results: In the present study Asthma prevalence was measured by “Ever Wheezing” (meaning there was a lifetime prevalence of asthma as diagnosed by a physician), “Wheezing during the past twelve months” and “Child ever had asthma”(was the child ever diagnosed to have asthma in the past but now it has resolved) in addition to exercise induced asthma and Night cough without infection. The prevalence was 22.4% (95% CI 20.2- 24.7) in ever wheezing category while the prevalence of wheezing during the past 12 months prior to the data collection was 12.8 %( 95% CI 11.1-14.7). Prevalence of exercise induced childhood asthma was 7% (95% CI 6.8-7.3) as shown in the table give below. Approximately 12.8% of children had wheezing for a period of 12 months. The prevalence was highest in the age groups 7-8 years (13.5%, n= 412) and 11-12 years (13.5%, n= 274). Lowest prevalence of 11.8% was in the age group 9 to 10 years. 80% of the asthmatic children were diagnosed as having asthma before they are 4 years. 80% of them were diagnosed as having asthma before the age of 4 years. No association was found between prevalence of asthma between the girls and boys(p>0.05).The study also revealed that there was a significant association (p<0.001) was found between prevalence of childhood asthma and ethnicity, in which the prevalence of asthma was higher among the sinhalese children (17.6%) compared to other ethnic groups(p<0.05). The following factors below showed statistically significantly association with Childhood asthma in the study population:

Child's history of eczema (p<0.05) exclusive breast feeding beyond six months (p<0.05) location of the house near a dusty enviroment (p<0.001), main source of fuel as firewood (p<0.001) place of sleep (p<0.05) the type of mattress cover (p<0.001), burning of mosquito coils (p<0.05) birth weight less than 2.5 kg (p<0.001), family history of asthma (p<0.001), smoking habits of the father when at home (p<0.001)

ύτ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

The commonest triggering factors of childhood -Frozen foods (68.4%) -cold weather (46.3%) -artificial food (43.3%) -changing weather (32.2%) The other factors which were looked into were the age of starting of complimentary feeding (p>0.05), age of starting of formula feeding (p>0.05) and a family history of allergy and these were not significant. During phase 3 of the study, assessment of impact of childhood asthma on the child and the family were done using the CHSA questionnaire. It was found that symptom activity was significantly associated with four or five domains: -Physical health of the child (p<0.001). -Emotional health of the child (p<0.001) -Emotional health of the family (p<0.001) -Day to day activities of the child (p<0.001) During phase 4 of the study, respirable dust levels of 40 asthmatic children and 40 non asthmatic children were compared. There was no significant association between the respirable dust levels in the houses of the asthmatic children and non-asthmatic children. (p>0.005), Samarawickrema IVM (2005). A study on prevalence and factors influencing smoking among teenagers in the district of colombo and a health promotion intervention for the parents to promote non smoking behaviour among teenagers. Postgraduate Institute of Medicine. Colombo, University of Colombo. Doctor of Medicine in Community Medicine: Main objective: To assess the prevalence of smoking among teenagers in the community. To describe factors influencing smoking among teenagers and to develop a health promotion intervention. To promote non smoking behaviour among teenagers Specific objective: 1.To determine prevalence and current patterns of smoking among teenagers and to assess their knowledge and attitudes towards smoking. 2.To identify the factors influencing smoking among teenagers. 3.To recognize patterns of smoking and the knowledge and attitudes towards smoking among parents. 4.To assess the awareness of tobacco advertising among teenagers and their parents. 5.To develop a health promotion intervention to improve knowledge among parents about practices adopted by tobacco companies to promote smoking . 6.To carry out a health promotion intervention and to evaluate its effect on improvement of knowledge. Study method - The study included a.A Two focus group discussions with young current smokers and ex smokers b.A cross sectional study among the teenagers and their parents in the district of Colombo to determine the prevalence of smoking and knowledge and attitudes towards smoking c.A development of a health promotion intervention for the parents to improve knowledge among parents about the practices adopted to promote smoking by tobacco smokings and to promote non smoking behavior among their children.

ύυ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

d.Implementation and evaluation of the impact of the intervention. Study area: For Focus Group Discussions(FGD) -random 8 Grama sevaka Niladari areas were chosen and these included MOH area such as Kolonnawa,Colombo CMC,Piliyandala,Kaduwela,Homagama,Dehiwala,and Morutuwa. For the Cross sectional study- District of Colombo For the health promotion intervention and evaluation of its effect -MOH areas of Morutuwa and Dehiwala Study population: Two FGDs 1.Current smokers age between 18-22 years and smoked daily for 1 year 2. Ex-smoker who has quit smoking for past one year,age below 40years,stopped smoking due to an illness For the cross sectional study - teenagers between age of 13-18years and their parents For implementation and evaluation of the health promotion intervention - Parents or guardians of children between 10-15 years of age. Type of study: Cross sectional studies and comparitive inteventional study Study instrument: Set of guidelines with questions for the FGDs Self administered questionnaires Book and Flash cards for health promotion intervention Sampling method: Simple random sampling for FGDs Cluster sampling for cross sectional study and for the implementation of health promotion intervention Sample size: For the cross sectional study 900 The total number of family units with the child aged 10 -15 years for health promotion intervention 225 Risk Factors investigated: Smoking Results: Non responsive rate for cross sectional survey was 7.2% The following results for the survey were given according to - A smoker is someone who, at the time of the survey , smokes any tobacco product either daily or occasionally (World Health Organization 1998). Smokers are divided into two catagories (World Health Organization 1998). Daily smoker - Occasional smoker - A non smoker - is someone who at the time of survey , does not smoke at all (World Health Organization 1998) A non smoker can be divided into three catagories Ex smoker - Never smoker - Ex occasional smokers Ever smokers are defined as those who have ever smoked at least 100 cigarettes (or the equivalent amount of tobacco) in their lifetime. This study showed;

ύφ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

a. ever smoking prevalence of 9.9% (+/- 2.1)(Ever smokers are defined as those who have ever smoked at least 100 cigarettes (or the equivalent amount of tobacco) in their lifetime.) , b.never smoking prevalence of 90.1% (+/- 2.0)(Never smoker - are those who either have never smoked at all of have never been daily smokers and have if at all smoked less than 100 cigarettes (or the equivalent amount of tobacco) in their lifetime) c. experimental smokers( Experimenters - people who have smoked less than100 cigarettes (or the equivalent amount of tobacco) and now smoke occasionally.)4.5% in the district of Colombo.

Prevalence of ever smoking among the males was 17.6 %( +/- 3.6), and females was 1.7% (+/- 1.3), where majority of them were current smokers 68.3% and 45% were experimenters. Mean age of ever smoking is 13.4 years (SD +/- 2.4).Ever smoking is significantly higher among the teenagers who do not attend school (p<0.05) and among those who are employed (p<0.05) compared to the school going teenagers.

Prevalence of current smoking among teenagers is 6.8 %( +/- 1.7) with 12% for males and 1.2% for females. Current smoking prevalence is the highest among the 17 year old teenagers (14.3%). The risk of current smoking was higher among the rural teenagers (9%) than the urban teenagers (5%) (p<0.05). The majority of the current smokers were experimenters (66%) followed by daily smokers (25%). None of the females were daily smokers. These currently smoking teenagers smoke as their friends smoked and 18% smoked as they like the thrill of smoking.

The majority of teenagers have their first smoke with their friend (58%) and on the roadside (40%).The study also showed that first tobacco smoking product given by a friend was 59%.

96% of the currently smoking teenagers smoke cigarrettes and out of which 59% of the teenage smokers only smokes if they get their cigarettes for free. Although 29% of teenage current smokers intend to quit smoking, 61% of the current smoking teenagers have not been informed about health effects of smoking , which shows that the percentage who intended to quit would have been much higher if these teenagers currently smoking had a better overview about the health effects of smoking. The intervention was found to be successful in changing knowledge, attitudes of children as well as parents . Their awareness of insidious advertisements improved significantly. Current smoking of the children in the intervention group decreased with an increase in reducers (from none to 2.5%) and those quitting smoking from 0.5 -1.5%. Currently smoking fathers in the intervention group decreased significantly from 43.9% to 36.9%. Awareness of low cost cigarettes, tobacco logos attached to the children's bags and clothes, and tobacco smoking scenes associated with happy events significantly increased in the intervention group. Conclusion: Being a male (OR:13.0,CI:5.8-29.1,p<0.05 )for ever smoking and(OR:12.8,CI:4.9-33.4,p<0.05 ) for current smoking and increasing age for every increasing year during the age of 13-19years (OR:1.2,CI:1.1-1.4,p<0.05 ) for the ever smokers carried a higher odds about smoking . Protective factors against smoking are - being at school(OR:0.301,CI:0.152-0.596,p<0.05 )for ever smoking and(OR:0.128,CI:0.062-0.267,p<0.05 ) for current smoking , -living in urban areas (OR:0.550,CI:0.323-0.936,p<0.05 )for ever smoking and(OR:0.322,CI:0.164-0.633,p<0.05 ) for current smoking , -positive attitudes against smoking(OR:0.935,CI:0.897-0.975,p<0.05 )for ever smoking and(OR:0.921,CI:0.874-0.970,p<0.05 ) for current smoking - not noticing tobacco advertisements protects against current smoking(OR:0.210,CI:0.061-0.725,p<0.05 ).

ύχ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Siyambalagoda RRMLR. Perera PAJ. Wickremasinghe AR. Sumanaweera NP (2003). "A comparison of nutritional status of primary school children in two settlements in the Polonnaruwa District." The Ceylon Journal of Medical Science 46(1): 21-23. Objective: To assess and compare the nutritional status of primary school children of new ( Maheweli system B) and an old settlement (Parakrama Samudraya) area in the Polonnaruwa district. A total of 941 and 7 Study method: This cross sectional study was carried was carried out from January to August 1993. A total of 941 and 719 primary school children from the new and old settlements respectively were taken for the study. Heights and weights of these children were measured using standard techniques. Finger prick blood samples were obtained to measure hemoglobin concentrations using “Erma AE-11-N” photoelectric colorimeter. Weight for height, height for age , weight for age Z-scores were calculated using EPIINFO.A Z- scores of -2 SD was used as the cut off value to define a state of undernutrition. Weight for height for males was calculated only if they were less than 145 cm in height and, for females only if they were 120 months and 135 cm in height. Height for age and weight for age were calculated for all children less than 18 years of age. Study Area: Polonnaruwa district Study population: Primary school children of new ( Maheweli system B) and an old settlement (Parakrama Samudraya) area in the Polonnaruwa district. Study Instrument: Heights and weights of these children were measured using standard techniques. Finger prick blood samples were obtained to measure hemoglobin concentrations using “Erma AE-11-N” photoelectric colorimeter. Weight for height, height for age, weight for age Z-scores were calculated using EPIINFO Study type: Cross sectional study Sample size: 1660 Sampling method: Random sampling method Risk Factors Investigated: Nutrition Results: The nutritional status of the primary school children of the new settlement was poorer than those in the old settlement in all three anthropometric indicators, namely stunting, wasting and underweight. The prevalence of stunting among children from the new settlement (36.2% and 31.2% in males and females respectively) was significantly higher than those of children in the old settlement (29.0% and 28.6% in males and females respectively). The prevalence of wasting among children from the new settlement (51.8% and 41.2% in males and females respectively) were significantly higher than that of children in the old settlement (27.3% and 23.2% in males and females respectively). The prevalence of underweight was 65.4% and 62.4% in the new settlement and 47.2% and 38.3% in the old settlement, in the male and female children, respectively. More than 85% of children were anemic with the prevalence being significantly higher among children from the new settlement (91.5%), as compared to those from the old settlement (72.3%).

ύψ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Sudasinghe SPBH (2006). Prevalence and some associated factors of overweight in year eight students of girl’s only schools in the Gampaha Municipal Council in 2005.Postgraduate Institute of Medicine. Colombo, University of Colombo Main objective: To determine the prevalence and some associated factors of overweight in year eight students of girls only schools in the Gampaha Municipal Council in 2005 Specific objective: 1.To determine the prevalence of overweight in year 8 students of girls only schools in the Gampaha Municipal Council 2.To describe the socio-demographic and economic factors of the study population 3.To determine some associated factors of overweight in the above group Study area: Girls only schools in the Gampaha Municipal Council, which included Rathnawali Balika Vidyalaya, Yasodara Devi Balika and Holycross Vidyalaya Study population: Year 8 students of girl only schools in the Gampaha Municipal Council Type of study: A cross sectional descriptive study Study instrument: Two self-administered questionnaires An electronic solar power weighing scales for weight measurement A microtoise tape for height measurement Sampling method: Convenient sampling method Sample size: 657 Risk Factors investigated: Overweight Obesity Results: Socio-demographic and economic factors were assessed in 657 students. 23 students suffered from long term illnesses and they were excluded in the analysis of associated factors of overweight. The prevalence of overweight ( which is classified as above 23.0-27.5kg/m2) was 7.73% and of obesity ,( which is classified as above 27.5kg/m2 relatively for the Asian population according to the World Health Organisation (WHO) c was 2.05%. The study also revealed that sitting > 8 hours (p=0.04), parental body size (p<0.001) showed a statistical significant association with overweight. Consumption of cheese, butter, and margarine (p=0.04), milk and other dairy products (p=0.04) and fruits (p=0.03) showed a statistical significant negative association with overweight. Other variables did not show any statistical significant association with overweight. The study showed that overweight and obesity are becoming increasingly common in our adolescent school girl with economic and nutritional transition. Tennakoon SUB. Kumar BN. Nugegoda DB. Meyer HE (2010). "Comparison of cardiovascular risk factors between Sri Lankans living in Kandy and Oslo." BMC Public Health Objective: To compare selected cardiovascular risk factors between migrant Sri Lankans living in Oslo, Norway and Urban dwellers from Kandy, Sri Lanka.

ύω Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Study Method: Data on non fasting serum lipids, blood pressure, anthropometrics and socio demographics of Sri Lankan Tamils from two almost similar population based cross sectional studies in Oslo, Norway between 2000 and 2002 (1145 participants) and Kandy, Sri Lanka in 2005 (233 participants) were compared. Combined data were analyzed using linear regression analyses. Study area: Oslo, Norway and Kandy, Sri Lanka Study population: Sri Lankan Tamils Type of study: Population based cross sectional study Sample size: 1145 and 233 Factors investigated: HDL levels, Mean waist circumference, Height, Weight, Smoking, Systolic and diastolic blood pressure Results: Men and women in Oslo had higher HDL cholesterol. Men and women from Kandy had higher Total/HDL cholesterol ratios. Mean waist circumference and body mass index was higher in Oslo. Smoking among men was low (19.2% Oslo, 13.1% Kandy, P = 0.16). None of the women smoked. Mean systolic and diastolic blood pressure was significantly higher in Kandy than in Oslo. Conclusion: Our comparison showed unexpected differences in risk factors between Sri Lankan migrants living in Oslo and those living in Kandy Sri Lanka. Sri Lankans in Oslo had favorable lipid profiles and blood pressure levels despite being more obese. VP Wickramasinghe. Lamabadusuriya SP. Atapattu N. Sathyadas G. Kuruparananthan S. Karunaratne (2005). "Dietary and physical activity patterns of school children in an urban area of Sri Lanka." Sri Lanka Journal of Child Health 34(2): 44-9 Objective: To provide information on nutritional status and dietary and physical activity pattern of 8-12 year old school children in an urban area of Sri Lanka. Study method: Seven schools in Colombo were randomly selected. These schools showed a fair representation of children of all social levels. Students of years 4, 5, 6 and 7 were included. 50 students from each grade of each school were randomly selected and recruited into study. The purpose of study was explained to the students and any withdrawals allowed. Medical officers performed the anthropometric measurements. Height was measured using a stadiometer and weight using an electronic weighing scale. Medical assessment was done in all children who participated in study. To define obesity and overweight, sex and age specific body mass index (BMI) cutoffs recommended by International Obesity Task Force were used. Age and sex specific BMI 5th percentile from revised NCHS (2000) growth charts were used to define thinness. Information regarding physical activity, behaviour, feeding practices and socioeconomic factors were obtained using a pretested questionnaire filled by parent/guardian. Data was analyzed using Epi Info 2000 (CDC, USA) software. Study Area: Seven Schools from the Colombo district Study population: Students of years 4, 5, 6 and 7 Study Instrument: Height was measured using a stadiometer

ύϊ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

weight using an electronic weighing scale. pretested questionnaire filled by parent/guardian Sample size: 1260 Sampling method: Random sampling method Risk Factors Investigated: Dietary and physical activity patterns Results: One thousand two hundred and sixty six children were recruited to the study. Data of 1224 subjects were used in the anthropometric analysis, while 1102 data sets were used in analysis of dietary and physical activity. Of the latter group 44% were boys. The children belonged to 3 types of schools based on type of administration. About 12% each were from ages 8 and 12; the rest were almost equally distributed among the other age categories. More than 80% of mothers had a level of education above GCE (O/L). 60.8% watched television for 1-2 hours each day during weekdays and 39.5% watched television for 3-4 hours during weekends. More than 50% engaged in daily physical activity for more than one hour during weekdays as well as weekends. 80.1% attended tuition classes. A similar distribution was seen in all age groups. Although consumption of vegetables was high, fruit consumption was not satisfactory. Majority had eggs or fish as their main source of protein. Prevalence of obesity and overweight increased with increase in family income and thinness was high among low socio-economic groups. Dental caries was the commonest health problem. Highest prevalence was among children from public non-national schools (48.7%), whilst public national and private schools had a prevalence of 10.5% and 11.8% respectively. Of the skin lesions commonest was scabies. Conclusion The main factor that influenced the nutritional status and related behaviour was the socioeconomic standard. Health programmes should be designed targeting these groups. Waidyatilaka PHIU. De Silva A. Lanerolle P. Wickramasinghe R. Somasundaram N. Athukorala S (2012). "Contribution of physical activity and sedentary behavior to glycemic status in urban women." The Ceylon Medical Journal 57(Supplement 1) Objective: To assess the percentage of body fat mass (FM%), Waist Circumference (WC), Physical Activity (PA) and Sedentary behaviour (Sitting Time) in relation to glycemic status in urban women. Study Method: Newly diagnosed Diabetic and Non-Diabetic urban women (30 – 45 years) were recruited in a community based cross-sectional study following a screening using Fasting Blood Sugar (FBS) (n = 425). HbA1c was used to categorize women as normoglycemic (n = 182) or dysglycemic (n=243). Physical activity and sitting time were assessed by the International Physical Activity Questionnaire (IPAQ). WC was measured and FM% was determined by the Bio-impedance analysis. Means were used to describe variables and Spearman correlation coefficients and multiple linear regression analysis were used to test for associations. Study population: Newly diagnosed Diabetic and Non-Diabetic urban women (30 – 45 years) Type of study: A community based cross-sectional study Study instrument: International Physical Activity Questionnaire HbA1c,body fat mass (FM%), Waist Circumference (WC) and Fasting blood sugar measurements

ύϋ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Sample size: 425 Results: Mean age of women was 37 ± 4.0 years. Compared to normoglycemic, dysglycemic had significantly higher WC (70 ± 7.1cm versus 80.7 ± 7.5cm), FM% (32.0 ± 5.6% versus 37.0 ± 4.7%) and Sitting Time (144 ± 66 minutes per day versus 311 ± 120 minutes per day) (p < 0.001 for each variable). PA (7252 ± 2935 versus 2769 ± 1762 MET minute/ week) was significantly lower (p < 0.001) in dysglycemic people. WC (rs = 80.575, p < 0.001) Sitting time (rs = 0.712, p < 0.001) was negatively correlated with HbA1c. WC and Sitting Time were significantly associated with glycemic status (F = 69.3, p < 0.001) after adjusting for PA.WC, Sitting Time and PA are significantly associated with glycemic status. Independent of PA, WC, and Sedentary behaviour are associated with dysglycemia. Wijesuriya M. Gulliford M. Charlton J. Vasantharaja L. Viberti G. Gnudi L. Karalliedde J (2012). "High prevalence of cardio-metabolic risk factors in a young urban Sri-Lankan population." PLoS ONE 7(2): Article number 31309. Objective: To determine by questionnaire and anthropometry the prevalence of first degree family history (FH) of T2DM, physical inactivity, raised waist circumference (WC) and raised body mass index (BMI) in a representative healthy urban population Study Method: To determine by questionnaire and anthropometry the prevalence of first degree family history (FH) of T2DM, physical inactivity, raised waist circumference (WC) and raised body mass index (BMI) in a representative healthy urban population selected by cluster sampling. Those with ≥2 risk-factors were evaluated for metabolic syndrome (MS) and recruited for an intervention trial. Of 23,296 participants screened, 22,507 (53% Female) were eligible [8,497 aged 10-14 yrs, 4,763 aged 15-19 yrs and 9,247 aged 20-40 yrs]. Study area: Urban population of Sri Lanka Study population: Young urban Sri-Lankan population (10 - 40 years) Study instrument: Questionnaire Sampling method: Cluster sampling Sample size: 22,507 Factors investigated: Physical activity, waist circumference (WC) and body mass index (BMI) Results: 51% had none of the 4 risk-factors, 26% 1 risk-factor and 23% (5,163) ≥2 risk-factors of whom 4,532 were assessed for MS. Raised BMI was noted in 19.7% aged 10-14 yrs, 15.3% between 15-19 yrs, and between 20-40 yrs, 27.4% of males vs. 21.8% of females p<0.001. Prevalence of raised WC was greater in females for each age group: 42.7% vs. 32.1%; 28.1% vs. 16.1%; 34.5% vs. 25.7% (p<0.05 for all) as was physical inactivity: 39.9% vs. 14.5%; 51.7% vs. 20.0%; 62.7% vs. 41.3% which rose in both sexes with age (p<0.05 for all). FH of T2DM was present in 26.2%. In 4532 (50%<16 yrs) with ≥2 risk-factors, impaired fasting glycaemia/impaired glucose tolerance (pre-diabetes) prevalence was 16%. MS was more prevalent in males [10-16 yrs (13.0% vs. 8.8%), 16-40 yrs (29.5% vs. 20.0%) p<0.001 for both].

ύό Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Conclusion: There is a high prevalence of modifiable cardio-metabolic risk-factors in young urban Sri-Lankans with significant gender differences. A primary prevention intervention trial is ongoing in this cohort. Wijewardene K. Mohideen MR. Mendis S. Fernando DS. Kulathilaka T. Weerasekara D. Uluwitta P (2005). "Prevalence of hypertension, diabetes and obesity: Baseline findings of a population based survey in four provinces in Sri Lanka." The Ceylon Medical Journal 50(2): 62-70. Objective: To determine the prevalence of selected cardiovascular risk factors in adult Sri Lankan population in four provinces. Study Method: Cross-sectional, based on a stratified cluster sampling method. Settings: Four provinces, namely the Western, North Central, Southern and Uva. Patients: Six thousand and forty seven participants (2692 men) between the age of 30 and 65 years were surveyed. Measurements: Risk factors measured included height, weight, waist and hip circumference. Waist to hip ratio and body mass index were calculated, and overweight (23 kg/m 2) and obesity (≥25 kg/m 2) determined. Hypertension (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg or use of anti-hypertensive medications), and diabetes mellitus (fasting serum plasma glucose level ≥ 7 mmol/L or use of antidiabetic medications) and impaired fasting glycaemia (≥ 6.1 to < 7 mmol/L) were also determined. Study area: Four provinces, namely the Western, North Central, Southern and Uva Study population: All adults between the age 30 and 65 years were taken into the study. Pregnant women and those who were physically disabled were excluded. Type of study: Cross-sectional study Study instrument: Syphgmomanometer, questionnaires, height and weight measurements, fasting glucose measurements Sampling method: Stratified cluster sampling Sample size: 6047 Factors investigated: Height, weight, waist and hip circumference, Blood pressure, serum glucose level Results: The prevalence of hypertension as defined was 18.8% (CI 14.5-23.1) for men and 19.3% (CI 12.2-26.4) for women. The prevalence of diabetes was 14.2% (CI 11.9-16.5) for men and 13.5% (CI 6.9-20.1) for women while impaired fasting glycaemia was 14.2% for men and 14.1% for women. The mean body mass index was 21.5 kg/m 2 (SD = 3.7) in men. It was lower than that in women, 23.3 kg/m 2 (SD = 4.5). The prevalence of obesity was 20.3% in men and 36.5% in women. Regional differences were seen in the mean fasting blood glucose and prevalence of diabetes, and mean BMI and prevalence of obesity were highest in Western province. Mean blood pressure and prevalence of hypertension were highest in the Uva Province. Southern Province had the lowest prevalence of hypertension and diabetes, and North Central Province had lowest anthropometric measures of obesity.

ύύ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Conclusion: The prevalence of the selected cardiovascular risk factors is common in the adult Sri Lankan population surveyed. Regional differences exist in the prevalence of these risk factors. The prevalence of high level of risk factors requires urgent public health action.

υττ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

υτυ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Group B Publications (Studies which found under the key words and carried out among specific population) Alagiyawanna AMALR. Wickramaratne PAJN. Samarasekera DD. (2005). "Smoking, addiction and promotion - an inquiry into perceptions of a group of adolescents in the Kandy Education Zone." The Ceylon Journal of Medical Science 48(1): 25-31. Objective: To describe the attitudes regarding smoking among the students, their awareness regarding promotional strategies of tobacco companies and to identify the methods of acquiring knowledge regarding these strategies among Grade 12 students in the Kandy Educational Zone. Study method: A descriptive cross sectional study was carried out among students in Grade 12 in the Kandy Educational Zone. A multi stage cluster sampling method was adopted to select the study sample of 204. All the students who were present on the day of the study and who were willing to participate were included in the study. A pre-tested, self-administered questionnaire was used as the study instrument. Most of the questions were close ended for the convenience of the respondents. Study Area: Kandy Educational Zone Study population: Grade 12 student, irrespective of their age Study Instrument: Self-administered questionnaires Study type: A descriptive cross sectional study Sample size: 204 Sampling method: A multi stage cluster sampling method Risk Factors Investigated: Attitudes of smoking Results: The study sample included 134 male students (66%) and 70 female students (34%). Part 1 . Attitudes o f the students regarding smoking On analysis of the attitudes on smoking, more than 8 0% of both sexes (88% of girls and 9 1% of boys) perceived smoking as a negative social characteristic. The difference between sexes is not statistically significant! However, when analyzing the distribution of the responses given by the students on different aspects of smoking, 96.3% of boys and 67% of the girls said that it is a silly thing . This difference is statistically significant. Twenty six percent of the girls said that smoking is an method to stand out in a crowd while only 11.2% of boys said so and this difference is statistically significant (P<0.05). On analysis of the students attitudes regarding why people get addicted to smoking, majority (91.6%) said that it is due to lack of proper understanding. Only 27% said that it is the effect of seeing tobacco use in films. Part 2 . Assessment of the knowledge of students regarding promotional strategies of tobacco companies Knowledge was assessed using 20 questions and these were categorized into 3 parts, (A, B & C) according to the responses. When the final analysis was done, it was found that 49% of boys

υτφ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

and 43% of girls knowledge is in the satisfactory category. However, 37% of boys and 49% of girls knowledge is in the poor/very poor category. The knowledge regarding indirect promotional strategies of the tobacco companies among girls and boys did not show a statistically significant difference. Part 3. Ways of acquiring knowledge, which helped in answering the questionnaire. Most of the students (80%) acquired the knowledge regarding indirect promotional strategies of the tobacco companies by the mass media. Nearly 38% acquired this by participating in seminars/ workshops conducted by anti-narcotic organizations .The difference between the knowledge of those who have participated in seminars / workshops conducted by anti-narcotic organizations and those who have not is statistically significant. Amarasena. Najith Ekanayaka. Asoka N Herath. Lilani Miyazaki. Hideo. (2003). "Association between smoking, betel chewing and gingival bleeding in rural Sri Lanka. ." Journal of Clinical Periodontology 30(5): p403-408. Objective: To ascertain the association between tobacco use and gingival bleeding in a rural community in Sri Lanka Study method: A cross-sectional field-based study was carried out in 2178 rural males aged 20–60 years, employing a multistage cluster sampling technique. The levels of plaque and gingivitis were recorded on four sites of all teeth present excluding third molars, using the plaque index (PLI) and gingival index (GI). Information pertaining to sociodemographic variables, oral hygiene practices and tobacco consumption habits was obtained from all subjects. Study population: Males aged 20–60 years Study Instrument: Oral examination Interviewer administered questionnaire Study type: A cross-sectional field-based study Sample size: 2178 Sampling method: A multistage cluster sampling method Risk Factors Investigated: Tobacco use and gingival bleeding Results: One-way anova combined with the Bonferroni test disclosed that betel chewers had a significantly higher mean number of sites with gingival bleeding (22.6±21.8) than smokers (10.8±11.2) and nontobacco users (8.7±6.8) (p <0.0001). A higher proportion of betel chewers (55.1%) showed ≥12 bleeding sites compared to smokers (27.6%). Logistic regression analysis revealed that the association between betel chewing and gingival bleeding was positive (OR=2.41; p <0.0001) whereas that of smoking and gingival bleeding was negative (OR=0.75; p <0.05). Oral hygiene had the strongest relationship with gingival bleeding (OR=18.11). Conclusion: While confirming the masking effect of smoking on gingival bleeding, these findings indicate that betel chewing might significantly enhance gingival bleeding in the population studied.

υτχ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Amarasinghe Hemantha K. Usgodaarachchi. Udaya S. Johnson. Newell W. Lalloo. Ratilal. Warnakulasuriya. Saman (2010). "Public awareness of oral cancer, of oral potentially malignant disorders and of their risk factors in some rural populations in Sri Lanka. ." Community Dentistry & Oral Epidemiology 38 (6): 540-548. Objective: To investigate the level of public awareness of oral cancer, of oral potentially malignant disorders (OPMD) and of risk factors for developing these diseases in a province of Sri Lanka Study method: A cross-sectional community-based survey was carried out in Sabaragamuwa province by interviewing 1029 subjects above 30 years of age, over a 1-year period from November 2006. Study Area: Sabaragamuwa province Study population: All subjects above 30 years of age Study Instrument: Interview administered questionnaires Study type: A cross-sectional study Sample size: 1029 Risk Factors Investigated: Tobacco smoking Alcohol Chewing betel quid Results: The level of public awareness of oral cancer was 84%, but only 23% for OPMD. Awareness was especially poor in low socioeconomic groups. The majority of subjects were not aware of the symptoms of oral cancer and of OPMD. Thirty-two precent were unaware that chewing betel quid was a risk factor for these diseases, as were 65% for tobacco smoking and 81% for heavy consumption of alcohol. Overall, 76% were not aware of any of the dangers inherent in the frequent use of areca nut. The majority of smokers, betel quid chewers and alcohol consumers were not aware that their lifestyles were placing their long-term health at serious risk. Knowledge of oral cancer, OPMD and their associated risk factors was poor among this population, indicating an urgent need to implement public health education and promotion strategies. Aravindan K. (2010). "Study of non communicable disease pattern in Mannar District of Sri Lanka." The Jaffna Medical Journal 26(1): Page 48. Objective: To find out the important non communicable disease patterns to plan future epidemiological research in Mannar. Study method: The study was carried out at the district general hospital Mannar medical clinic. All patients who attended the medical clinics over a period of one month were included in the study. Relevant information and consultant physician made diagnosis were obtained from the patient’s medical records. Disease pattern was analyzed by simple descriptive statistical method. Study Area: District general hospital Mannar medical clinic.

υτψ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Study population: All patients who attended the medical clinics over a period of one month Study Instrument: Patient’s medical records Study type: Descriptive statistical study Sample size: 1640 Sampling method: Convenient sampling method Results: A total of 1640 patients were studied.494 males and 1146 females with non-communicable disease were giving a male to female ratio 1.2 :3.2 Most patients were in the 51-60 age group (33%); followed by the 61-70 years (24.6%); 41-50 years (19.4%); 71-80 years (9.9%) and 31-40 years (7.8%) years age groups. Hypertension and Diabetes were most commonly seen accounting for 957(58.35%) and 539 (32.86%). Frequencies of other diseases were Hypothyroidism 149(9.0%); Ischemic Heart Disease 142(8.65%); Bronchial Asthma 116(7.0%), Hypercholesterolemia 103(6.3%), Valvular Heart Diseases 42(2.56%), Neurological diseases 40(2.43%); Arthritis 21 (1.28%); while the renal diseases accounted for 11(0.67%). Ariyawardana A. Sitheeque MAM. Ranasinghe AW. Perera I. Tilakaratne WM. Amaratunga EAPD. Yi-Hsin Yang. Warnakulasuriya S. (2007). "Prevalence of oral cancer and pre-cancer and associated risk factors among tea estate workers in the central Sri Lanka." Journal of Oral Pathology & Medicine; 36 (10): 581-587. Objective: To find the prevalence of oral cancer and pre-cancer and associated risk factors among tea estate workers in the central Sri Lanka Study method: The study comprised of oral mucosal examinations of labourers employed in tea estate plantations in Sri Lanka. In a two-stage screening procedure, first by estate medical officers and then by visiting specialists, 12 716 persons were examined at their workplaces achieving a coverage of one-sixth of the total workforce. Study population: Labourers employed in tea estate plantations in Sri Lanka. Results: Fourteen oral cancers and 848 subjects with oral pre-cancer (6.7%) were detected giving population prevalence of 46.1 per 1000 for leukoplakia and 16.4 per 1000 for oral submucous fibrosis. Among subjects with any oral mucosal disorder (n = 1159) proportions of current users of betel quid, smokers and alcohol use was recorded at 92%, 31% and 61% respectively. The synergistic effect of these three risk habits on the development of oral leukoplakia was evident in mixed habit groups. Conclusions: The prevalence of oral pre-cancer in tea estate labourers was higher than estimates reported in previous studies. In the absence of state-sponsored preventive activities, it is necessary to improve the capacity of individual health practitioners and small medical centres to participate in oral health promotion and oral cancer/pre-cancer screening.

υτω Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Ariyawardana A. Vithanaarachchi N. (2005). "Awareness of oral cancer and precancer among patients attending a hospital in Sri Lanka." Asian Pac J Cancer Prev 6(1): 58-61. OBJECTIVE: To assess awareness about oral cancer and precancer among patients attending for dental treatment at a University Dental hospital. METHODS AND MATERIALS: A self-administered questionnaire was used to collect information from 410 randomly selected outpatients attended the Dental Hospital (teaching), Faculty of Dental Sciences, University of Peradeniya, Sri Lanka. The questionnaire included questions to ascertain information on socio-demographic parameters, awareness of oral cancer and precancer, habits of betel chewing, smoking and alcohol consumption. RESULTS: Ninety five percent of the respondents were aware of the possibility of occurrence of cancer in the mouth while only 44.9% (n=184) were aware about precancer. Of the 390 individuals who were aware of the existence of oral cancer, 80.7% were knowledgeable about the causal relationship between betel chewing habit and oral cancer. Forty-seven and 17 percent were aware of links with tobacco smoking and alcohol consumption, respectively. However, out of those who had knowledge of oral cancer, 18 % (n=69) were not knowledgeable about associations with habits. CONCLUSIONS: This survey revealed that the patients attending the hospital were well informed about oral cancer. However, awareness about precancer was relatively low. Knowledge about the causal relationships with tobacco smoking and use of alcohol was low compared to that for betel chewing. Bastimpillai S. Samarasinghe HHR. (1992). "Acute Coronary Care in a General Hospital." Journal of the Ceylon College of Physicians 25: 56-61. Objective: To analyse the mortality of patients admitted to a Coronary Care Unit in a General Hospital, to assess the incidence of myocardial infarction in all patients admitted with chest pain, and to evaluate the usefulness of a Coronary Care Unit. Study Method: The study population consisted of all patients admitted to the Coronary Care Unit at Sri Jayawardenapura General Hospital with confirmed or suspected myocardial infarction. Patients were included in the myocardial infarction study if they satisfied at least two out of three diagnostic criteria. These criteria consisted of a history of prolonged chest pain unrelieved by rest or nitrates; elevation of serum levels of creatine kinase or its isoenzyme subtraction, or of aspartate aminotransferase or lactic dehydrogenase; and serial electrocardiographic tracings showing S-T segment changes or Q waves (or both) typical of acute myocardial infarction. The complications of myocardial infarction were assessed on the basis of information available from the clinical charts. Cardiogenic shock was indicated by a systolic blood pressure level below 80 mm Hg in the absence of hypovolaemia, and associated with cyanosis, cold extremeties, changes in mental status, persistent oliguria, or chronic heart failure.Ventricular fibrillation (VF) was classified as either primary or secondary based on whether the VF occurred without (primary VF) or with heart failure or cardiogenic shock (secondary VF). Of the 536 patients admitted to the Coronary Care Unit, an analysis of patients who were subsequently found not to have an infarction was also done. Study area: Coronary Care Unit at Sri Jayawardenapura General Hospital Study population: Patients with confirmed or suspected myocardial infarction.

υτϊ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Sample size: 536 Results: During the five year period of study (January 1986 to December 1990), 343 patients with confirmed myocardial infarction (Ml) were admitted to the Coronary Care Unit (CCU). 321 (93.6%) were first infarctions and 22 (6.4%) were recurrent infarctions. Sex: Of the 343 patients, 265 (77.3%) were males and 78 (22.7%) were females. Age: The age group varied from 22 years to 74 years. The largest group of 106 patients were in the 51 - 60 age groups. The second largest group of 90 patients were in the 61 - 70 age group. Four patients were below 30 years of age. Risk Factors 75 (21.9%) of the patients had a history of hypertension; 74 (21.6%) had diabetes mellitus; 68 (19.2%) gave a history of smoking cigarettes; 35 (10.2%) had a previous history of ischaemic heart disease (IHD); and 18 were obese (5.2%). 124 (36.2%) patients had hyperlipidaemia. Of these, 102 had elevated total serum cholesterol, 12 patients had elevated low-density lipoprotein fraction only, and 10 patients had hypertriglyceridaemia. (Table 1) Duration of Stay Average duration of stay in the CCU was 3.90 days. Average duration of stay in the medical ward was 6.2 days. Type of Infarct 175 (51%) patients had anterior Q-wave infarction; 51 (41.9%) had anterior non-Q wave infarct; 92 (26.8%) had inferior Q-wave infarction; 19 (5.5%) had inferior non-Q wave infarction; 5 (1.5%) had right ventricular infarction and 1 (0.3%) had both anterior and inferior infarction. Complications Of the 343 patients, 196 (57.1 %) developed complications. These were heart failure cardiogenic shock, tachyarrhythmias, bradyarrhythmias and embolism. 1 patient with heart failure developed a pulmonary infarction. Of the 196 patients, 129(65.8%) patients had left ventricular failure. 95 had an anterior infarct, 33 an inferior infarct and 1 had a right ventricular infarct. 39 (19.9%) patients had cardiogenic shock. 24 patients had an anterior infarct, 12 an inferior infarct, 2 a right ventricular infarct, and 1 patient had both anterior and inferior infarction. 12 (61%) patients had bradyarrhythmias. 7 patients had sinus bradycardia, 1 patient had sick — sinus syndrome, 1 patient had first degree heart block, 2 had second degree heart block and 1 had complete heart block. 10 patients had inferior infarcts; 2 had anterior infarcts. 43 patients (22.4%) had tachyarrhythmias. Of these, 36 were ventricular tachycardias. 13 patients had ventricular extrasystoles, 3 had ventricular tachycardias corrected by DC conversion, 7 had primary ventricular fibrillation and 13 had ventricular fibrillation secondary to heart failure or shock. Of these, 36 patients, 25 had an anterior infarct and 11 had an inferior infarct. 7 patients had supraventricular tachycardias. 5 patients had sinus tachycardia and 2 patients had atrial fibrillation. 5 patients had an anterior infarct and 2 patients an inferior infarct. 12 patients had intraventricular conduction blocks. 6 had right bundle branch block,(RBBB) 4 had left bundle branch block, (LBBB) and 2 had left anterior hemiblock with right bundle branch block. 4 patients had cerebral embolism following admission to the CCU; 1 patient had pulmonary embolism. Deaths 66 (19.2%) of the 343 patients died. 46 (69.7%) were male patients and 20 (20.3%) were female. The largest number of deaths were in the 61 - 70 age group,(Table 5). 46 patients had anterior infarcts; 18 patients had inferior infarct; 1 patient had both anterior and inferior infarcts and 1 patient had right ventricular infarction. 31 patients had heart failure, 22 patients had cardiogenic shock. Of the 66 patients, 15 had terminal ventricular fibrillation and 51 had ventricular asystole. Of the 196 patients who had complications of myocardial infarctions, 55 (28%) died. Of the 147 patients with uncomplicated myocardial infarction, 11 (7.5%) died.

υτϋ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Analysis of Non-lnfarct Patients admitted to CCU Of the total of 536 patients admitted to the CCU with suspected or confirmed myocardial infarction, 193 were subsequently found to have no infarction. Of these, 143 patients (74.1 %) had electrocardiographic evidence of IHD. A further 11 patients had ECG evidence of cardiovascular disease in whom an etiology of IHD could not be conclusively made. A total of 154 patients (79.8%) therefore had evidence of cardiovascular disease. 8 patients had costochondritis; 11 patients had evidence of peptic ulcer, later confirmed by endoscopy; I patient had hypereosinophilic syndrome and 1 patient had chronic obstructive airways disease. 18 patients (9.3%) had no clinical abnormality. Chang T. Ibrahim S. Arambepola C. Ranasinghe HM. Mihirini AHTM. Weerasinghe D. Vithanage TDP. Maithripala C (2012). "Public awareness of stroke, its warning symptoms,risk factors and treatment in Sri Lanka." The Ceylon Medical Journal 57(Supplement 1): Page 43. Objective: To evaluate the knowledge on stroke, its warning symptoms and risk factors among the general public. Study method: Relatives of non-stroke patients admitted to medical wards of the National Hospital of Sri Lanka who did not have a personal or first degree family history of stroke/TIA were selected and were interviewed by pre-intern doctors using questionnaires regarding their knowledge on stroke. Study population: Relatives of non-stroke patients admitted to medical wards of the National Hospital of Sri Lanka Study Instrument: Pre-tested questionnaires. Study type: A cross sectional study. Sample size: 840 Sampling method: Random systematic sampling. Disease Investigated: Stroke Results: 840 individuals (51.7% males; mean age 40.7 years ; SD=12.8) from 21 to 25 districts were interviewed; 52.2% were educated up to ordinary levels, 62.7% were employed; and 60.6% earned more than Rs 10,000 per month. 48.3% had at least 1 type of vascular risk factors. 53.2% did no that the brain was affected in stroke. Only about a third knew that a stroke could be caused by an occlusion or rupture of a brain blood vessel. In the logistic regression analysis, age <40 years, lower income, lower education was associated with lower knowledge. Over 90% of the respondents correctly indentified what stroke 3 stroke warning symptoms and 3 stroke risk factors. Although 84.6% would seek immediate western medical treatment following a stroke warning symptom, 52.9% believed that indigenous medicine was the best treatment for stroke. 44.2% were not sure whether stroke was preventable whilst 80.1% did know that aspirin could prevent stroke. 56.7% learnt about stroke from friends /relatives and 45.3% from television, but only 7.8% had received information from medical staff. Conclusion: Public awareness of stroke warning symptoms and risk factors was adequate but knowledge on stroke mechanisms, treatment and prevention was lacking.

υτό Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

De Silva DJDP. Alwis LLDN. Abeyratne GG. Molligoda US. Nanayakkara RS (2012). "Ischaemic heart disease and dietary habits." The Ceylon Medical Journal 57(Supplement 1): Page 121. Objective: To describe the association of Ischemic Heart Disease with Sri Lankan food types and frequencies of their consumption. Study method: A case control study was conducted in Colombo South Teaching Hospital and Sri Jayewardenepura General Hospital. Cases (n=147) were inward patients who have had an episode of stable angina (SA) or acute coronary syndrome (ACS) for the first time during the last six months. Controls (n=147) were inward patients who never had SA or ACS. Risk factor assessment (including dietary factors) was conducted using an interviewer administered questionnaire. Anthropometric measurements were recorded using the standard methods. Chi-square test was used to compare two groups and odds ratio was used to check magnitude of IHD risks of dietary components. Study Area: Colombo South Teaching Hospital and Sri Jayewardenepura General Hospital Study population: Inward patients from the study area. Study Instrument: Interviewer administered questionnaire. Study type: Case-control study. Sample size: 194 Risk Factors Investigated: Diet. Ischemic Heart disease. Results: Compared to control, the cases consumed , in significantly higher frequency , fried food (OR:2.1,p=0.001), fast food (OR:1.9,p<0.05), and coconut oil (OR:1.8,p<0.05). Controls frequency of consumption was significantly higher for pulses (OR: 2.3, p<0.05), green leaves (OR: 1.4, p<0.05), and plain milk (OR: 2.2, p<0.05) compared to cases. Proportion of patients with body mass index >25 and females with waist to hip ratio>0.85 was significantly higher among the cases than the controls (OR: 2.2, p<0.01 and OR: 4.8, p<0.001 respectively). De Silva EJMP. Jayawardena PL. Padmeshwaran A (2011). "Risk factors for hazardous drinking and alcohol use disorders among married men in Wattala." The Eleventh Annual Academic Session of the College of Community Physicans of Sri Lanka October 2011. Objective: To determine risk factors for hazardous drinking (HZD) and alcohol use disorders (AUD) among married men in Wattala. Study Method: A case control study was conducted. The sample consisted of 670 married men in the Wattala selected using cluster sampling technique. The validated Alcohol Use Disorders Identification Test was used to identify cases and controls among current drinkers (n = 513). An interviewer administered questionnaire was used to obtain information on relevant factors. The control group for HZD (n = 201), was low risk drinking (LRD) (n = 155) and for AUD (n = 157), hazardous drinking (HZD). Risk factors were determined by performing multivariate logistic regression and the results are expressed as adjusted odds ratios and the 95% confidence intervals.

υτύ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Study area: Wattala Study population: Married Men Type of study: Case control study Study instrument: Cluster sampling technique Sampling method: Interviewer administered questionnaire Sample size: 670 Risk Factors investigated: The accessibility to liquor centres and bars, pro – drinking attitudes and lower standard of living index, drinking on the way home, symptoms of anxiety and depression and visits to illicit liquor centres. Results: The strongest risk factor for HZD was the visits to illicit liquor centers (OR = 7.4, 95% CI = 2.4 – 23.1), followed by visits to bars (OR = 4.2, 95% CI = 1.6 – 10.9), pro- drinking attitudes (OR = 2.9, 95% CI = 1.5 – 5.6), and a lower standard of living index (OR = 2.1, 95% CI = 1.1 – 3.8). The strongest factor for AUD was having a drink on the way home (OR = 5.4, 95% CI = 2.2 – 13.4), followed by presence of symptoms of anxiety or depression (OR = 4.0, 95% CI = 1.9 – 8.7), and visits to illicit liquor centers (OR = 3.8, 95% CI = 1.7 – 8.1). Conclusion: The accessibility to liquor centres and bars, pro – drinking attitudes and lower standard of living index were risk factors for hazardous drinking and drinking on the way home, symptoms of anxiety and depression and visits to illicit liquor centres were risk factors for alcohol use disorders among married men in Wattala. De Silva GLS. Senevirathne R. De A. (1997). "Patterns and trends of childhood malignancy in Sri Lanka." Journal of College of Community Physicians of Sri Lanka 2: 22-30. Objective: To determine the patterns and trends in morbidity and mortality from childhood malignancy in Sri Lanka. Study Method: Data on morbidity from 3633 malignancies in children 0 – 15 years of age for the period 1982 – 1994 were collected from three cancer hospitals in Sri Lanka. The death register maintained at the Office of Registrar General was utilized to obtain information on deaths from malignancies in the same age group from 1980 – 1990. Age standardization of rates was achieved by using the mid-year population of children in the age group for the year 1988. Study area: Three cancer hospitals in Sri Lanka. Study population: Children 0 – 15 years Type of study: Factors investigated: Morbidity, mortality, childhood malignancy, Sri Lanka Results: An increase in the incidence of childhood malignancy from 2.6 in 1982 to 6.2 in 1994 from all causes was observed. Leukemia (42%) was the commonest malignancy of which 82.7% of cases were acute

υυτ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

lymphoblastic leukemia, followed by lymphomas (12.6%) and malignant tumors of CNS (9.7%). The highest rate of increase was observed for CNS malignancies. Of 40.4% solid tumors, 27.2% were localized to the site at diagnosis while 42.7% had spread by direct extension and 10% to distant sites. 4.2% of all deaths during the study period were from childhood malignancies and of these, 52% were of lymphatic and hemopoietic origin. Leukemias accounted for 82% of deaths. De Silva HJ. Peiris MUPK. Samarasinghe DS. Ellawala S. (1992). "A two-year follow-up study of alcohol dependent men rehabilitated at a special unit in a developing country." British Journal of Addiction 87: 1409-1414. Objective: To assess the outcome of alcohol dependent persons who entered a rehabilitation programme in Sri Lanka at 2 years post treatment and to relate continued abstinence or relapse to certain socio-demographic factors during a longer period of follow-up. Study Method: The 'Sumithrayo' Alcohol Rehabilitation Unit in Colombo, Sri Lanka, which is a non-governmental organization, has had rehabilitation facilities for alcohol dependent persons since 1984. The present programme schedule which was started in January 1986 was evolved from experimental programmes conducted in 1984 and 1985. It consists of 6-week residential period following detoxification at a psychiatric unit. On completion of the residential module, the clients are offered follow-up appointments. Only persons defined as alcohol dependent and referred by a consultant psychiatrist, and who have failed interventions in the past are admitted to the programme. The small staff consists of salaried full-time and volunteer part-time workers, and includes a programme manager (psychiatric male nurse), social workers, counsellors (two-thirds of whom are ex-clients of the programme), and a consultant psychiatrist and a physician who assist on an honorary basis. There are usually 10 to 15 clients at any given time, and the staff to residents ratio is about 1:3. The stated goals of the programme are total abstinence from alcohol and an improved quality of life. Controlled drinking is not considered a successful treatment outcome. Dependent persons and methods All 234 alcohol dependent persons consecutively admitted to the residential rehabilitation programme between January 1986 and December 1988 were included in this study. They were all males, and were referred to our unit by consultant psychiatrists from two hospitals after detoxification. At intake to the programme, socio-demographic data relating to age, marital status, family support, education level, income and employment, and data regarding duration of dependence and number of interventions, were obtained on the results of a closed questionnaire and an interview of the dependent person and a family member (usually the wife) by a social worker. Information obtained about duration of dependence and previous hospital-based interventions were verified by the clients' past medical records. The 6-week residential period included individual counselling and group therapy aimed at modifying attitudes and behaviour, family counselling, self-awareness excercises, development of decision-making and coping skills, job counselling and participation in recreational activities. Sedative hypnotics, tranquilizers and other psychoactive drugs were avoided. After-care support was offered to all chents who completed the residential programme and included bi-weekly group meetings. They were encouraged to attend these meetings or maintain contact with the programme once a week. If there was no contact or ex-clients failed to attend meetings for more than 2 weeks a social worker visited them at home. In addition to this, a more formal interview was conducted every 3 months, and data with regard to alcohol consumption and socio-demographic factors were recorded in prepared questionnaires for each individual. Self-reports of abstinence were always confirmed by interview of family members. By these methods the programme maintained (and still continues to maintain) up-to-date records of compliant ex-clients. Outcome was assessed for each

υυυ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

individual 2 years after intervention. Follow-up was then extended to a mean 39.2 months (range 24 to 60 months), and the treatment outcome at the end of this period was correlated to several sociodemographic variables which were re-assessed for each individual in December 1990. Study area: 'Sumithrayo' Alcohol Rehabilitation Unit in Colombo, Sri Lanka Study population: Subjects who are alcohol dependent and who have failed interventions in the past Type of study: Prospective study Study instrument: Closed ended questionnaire and an interview Sample size: 234 Factors investigated: socio-demographic data relating to age, marital status, family support, education level, income and employment, and data regarding duration of dependence and number of interventions, Results: Characteristics of the dependent persons on admission. The majority (74.4%) of the dependent persons were between 30 and 49 years of age. All of them had failed previous hospital-based interventions for their alcoholism and had resumed heavy drinking. Of the 166 who had regular employment, 4 (2.4%) were professionals, 67 (40.4%) were semi-professionals, 57 (34.3%) were self-employed (mainly small businesses), 28 (16.9%) were skilled and 10 (6%) were unskilled labourers. The majority (148 (63.2%)) had an education to the General Certificate of Education Ordinary level (GCE 0-level). Forty-five (19.2%) were below this level, 27 (11.7%) had an education to the GCE Advanced level, while only 14 (5.9%) were graduates or had a technical qualification (Table 1). Drop-outs Of the 234 dependent persons admitted, 29 (12.4%) dropped out before completion of the residential programme. For the analysis, it was assumed that these individuals had relapsed. A two-year followup was achieved in 185 (83.3%), with 10 more dropping out and 10 deaths (all 20 had relapsed at last contact) during this period. The extended follow-up (mean 39.2 months (range 24 to 60 months)), ending in December 1990, was achieved in 175 (74.8%) dependent persons. At the end of this follow-up period a total of 13 (5.5%) had died, and contact was lost with 17 (7.3%) clients. All 30 of them had relapsed at the last contact. Outcome Eighty-five (36.3%) of the 234 dependent persons initially admitted to the rehabilitation programme remained totally abstinent at 2 years post-treatment. The remaining 149, of whom only 100 completed follow-up, were considered to have relapsed. Of these 149,16 were considered to be unstable in their drinking habits, with either binges interspersed with long periods of abstinence (« = 13) or drinking in a 'controlled' manner (« = 3). The rest had resumed heavy alcohol consumption. When outcome was assessed at the end of the extended follow-up period in December 1990, the number of totally abstinent individuals had fallen to 76 (32.5%). The majority of those who relapsed did so within 6 months of starting the programme (Table 2). Relationship between outcome and socio-demographic variables Of the 175 persons who were foUowed-up till December 1990, 76 were totally abstinent and 99 were considered to have relapsed. Abstinence was significantly associated with marriage or cohabitation [x2 = 13.7 (1 df), p <0.001, chi-square test],stable family support [x2 = 62 (1 Ai),p < 0.001], a higher monthly income [x2 = 34.4 (2 df), p < 0.001], and regular employment [x2 = 26.6 (2 df),p < 0.001] (Table 3). In our patients, there was no significant association between abstinence and

υυφ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

either age [x2 = 0.6 (2 df), p > 0.5], duration of alcohol dependence [x2 = 0.1 (2 df), p > 0.5], the level of education [x2 = 5.7 (3 df), 0.5 > p > 0.1] or type of employment [x2 = 1.9 (4 df), p > 0.5] (Table 4). De Silva KSH. Wickramasinghe VP. Gooneratne INA. (2006). "Metabolic consequences of childhood obesity—a preliminary report." The Ceylon Medical Journal 51(3): 105-109. Objectives: To document the presence of metabolic syndrome (MetS) and non-alcoholic steatohepatitis (NASH) in obese Sri Lankan children, to correlate the fat mass (FM) with the waist circumference (WC) and the body mass index (BMI), and to compare the association of the WC( waist circumference), BMI ( body mass index) and the WHR (waist-hip ratio) with the metabolic derangements Study method: Children attending the Obesity Clinic at Lady Ridgeway Hospital, Colombo, from November 2004 to September 2005 were studied. The relevant sociodemographic data, anthropometric measurements and examination findings were documented. After a 12-hour overnight fast, blood was taken for estimation of lipid profile, serum insulin, liver enzymes and blood glucose. The oral glucose tolerance test (OGTT) was done in children over 5 years of age. Fatty infiltration of the liver was assessed by identifying specific features on ultrasonography and the degree of infiltration was given a score. The International Diabetes Federation (IDF) 2004 guidelines was modified to define MetS. NASH was defined as fatty infiltration of the liver associated with a raised serum ALT. Study Area: Obesity Clinic at Lady Ridgeway Hospital, Colombo. Study population: Children attending the Obesity Clinic at Lady Ridgeway Hospital, Colombo Sample size: 70 Sampling method: Convenient sampling method Risk Factors Investigated: Metabolic syndrome, non-alcoholic steatohepatitis, obese Sri Lankan children, waist circumference Results: Of the 92 children seen in the clinic during the study period, 70 (76%) consented to participate in the study. The demographic features of the study population are given in Table 1. The age of the patients ranged from 25 to 177 months. The %FM (SD) of 47.5 (5.7) in boys and 48.6 (10.9) in girls was far in excess of the values associated with adverse health outcomes (> 25% in boys and > 32% in girls [15]) The mean (SD) age was 9.7 (2.5) and 9.3 (3.0) years for boys and girls respectively. Mean BMI was 25.9 in both groups. All patients had a WC>98th percentile. MetS was found in 13 of the 63 (21%) children on whom all criteria were assessed. Sixty children had ultrasonography and NASH was seen in 11 (18%). The correlation of the percentage FM ( fat mass) was greater with the BMI (r=0.80; p< 0.001) than with the WC (r=0.56; p< 0.001), but the WC was more significantly associated with the metabolic derangements than either BMI or WHR. Demographic features of the study population Boys mean (SD) Girls mean (SD) Number 40 30 Age (years) 9.7 (2.5) 9.3 (3.0) BMI (kg/m2) 25.9 (3.6) 25.9 (4.4) WC 84.2(11.4) 84.0 (12.0) HC 85.7(10.9) 90.1 (12.2)

υυχ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

WHR 0.98 (0.05) 0.93 (0.05) FM(kg) 24.2(10.1) 26.7 (10.9) %FM 47.5 (5.7) 48.6(10.9) Components of the metabolic syndrome in the study population Boys Girls Percentage (%) WC (>98l h percentile) 40 30 100 TG n=70 (> 95t h percentile) 18 9 39 HDL n=70 (< 5t h percentile) 1 1 3 HBP n=70 (^95'" percentile) SBP 5 3 11 DBP 0 3 4 Abnormal glucose Homeostasis n=63 9 8 27 Metabolic syndrome n=63 5 8 21 Conclusions: Serious metabolic abnormalities are found in obese Sri Lankan children and the WC is a reliable indicator of these derangements. De Silva NT. (2006). "Periodontitis: A complication of type 2 diabetes in Sri Lankans." Diabetes Research and Clinical Practice 74: 209–210. Objective: The aim of this study was to ascertain the periodontal health of Sri Lankans with type 2 diabetes mellitus. Study method: 277 Sri Lankans with type 2 diabetes randomly selected from a clinical database underwent a full oral examination to characterize their periodontal status. All were residents of Colombo, Sri Lanka. Probing depths, attachment levels and bleeding on probing were measured at six sites per tooth by periodontists experienced in clinical periodontal examination. A diagnosis of chronic periodontitis was reached based on the extent (number of periodontal sites affected) and severity (degree of attachment loss) in the patients examined, using established diagnostic criteria Study population: Patients with type 2 diabetes mellitus. Study Instrument: Periodontal examinations Sample size: 277 Sampling method: Random sampling method

υυψ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Risk Factors Investigated: Periodontal disease and type 2 diabetes mellitus Results: Of the 277 patients recruited, 142 (51.3%) were female and 135 (48.7%) were male. The mean (S.D.) age was 46.4 (12.6) years. Ninety-four (34%) of the individuals examined were diagnosed with moderate/severe chronic periodontitis, representing a very large proportion of patients with periodontal disease in this population with diabetes. De Silva SNT. Weerasuriya N. De Alwis NMW. De Silva MWA. Fernando DJS. (2002). "Excess maternal transmission and familial aggregation of Type 2 diabetes in Sri Lanka." Diabetes Research and Clinical Practice 58: 173-177. Objective: To observe whether familial aggregation of Type 2 diabetes is prominent in Sri Lanka and to determine whether there is an excess maternal or paternal influence for the transmission of the disease in this population Study method: Primary-care practitioners in defined suburbs in the greater Colombo area of Sri Jayawardenepura, Maharagama, Dehiwela, Mount Lavinia, Rathmalana, Moratuwa, Nugegoda, Pannipitiya and Piliyandala were invited to participate in the study by referring all newly-diagnosed people with diabetes to a specialist diabetes clinic. From a total of 20 general practitioners, 17 agreed to participate and a total of 6000 patients were referred to the clinic, of which 3200 were newly diagnosed. All the patients who attended the clinic had clinical data recorded on standardized forms and stored in a computerized clinical database. These data included demographic information and clinical data on glycaemic control and complications. Diabetes and type of diabetes were determined according to WHO criteria [10]. Blood glucose was measured using the glucose oxidase method. Patients who had been treated with oral glucose lowering agents for over 2 years with no history of ketoacidosis were considered to have Type 2 diabetes [11]. One thousand of the 3200 newly diagnosed people with Type 2 diabetes were selected from the database using a table of random numbers and were given a questionnaire to complete. Details of family history of diabetes mellitus were recorded for five generations, together with total number of relatives from grandparents to grandchildren of probands . Study population: Patients with type 2 diabetes mellitus Study Instrument: Self-administered questionnaires Blood glucose measurements Study type: A clinic based cross sectional study Sample size: 1000 Sampling method: Convenient sampling method Results: Complete data sets on family history were obtained for all 1000 index cases, 502 of whom male. Mean age of onset of the diabetes was 47+/-12 years and mean duration of diabetes was 9.2+/-/7 years. Of the 1000 probands, 370 (37%) (187 male) reported that at least one parent had diabetes, 469 (46.9%) reported no parents with diabetes, while 161 (16.1%) were not aware of the diabetes status of at least one parent. The probands were classified as maternal (diabetes in the mother

υυω Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

only), paternal (diabetes in the father only), both, none or unknown . Among the 370 probands with a parental history of diabetes and where both parents’ diabetes status was known and only one was affected, diabetes was more common among mothers (n=156) than fathers (n=/125, P</ 0.001). Both parents had diabetes in 54% but 35% were unaware whether or not the second parent had diabetes. The diabetes status of either the mother or father was unknown in 19.6% (196) probands. Among those who were not aware of the mother’s diabetes status (145), the mother was not alive in 83.3%, was living in 9.7%, while in 6.9%, it could not be determined if the mother was alive or not, owing either to illegible records or this column not being filled in. In probands who did not know whether their fathers had diabetes (151), the father was dead in 90.1%, living in 3.3% and dead/living status was unclear in 6.6%. History of diabetes in maternal grandparents was more frequent in probands with maternal than paternal diabetes (P<0.0001) . In the maternal diabetes group, 36 out of 156 (23%) grandmothers and 31 out of 156 (20%) grandfathers had diabetes. In the paternal diabetes group, 11 out of 125 (9%) grandmothers and 37 out of 125 (30%) grandfathers had diabetes. However, the diabetes status of maternal grandparents was unknown in 56.7% of all probands and the diabetes status of paternal grandparents was not clear in 53.0%. Among probands in the both-parents diabetic group, the frequency of affected siblings was higher than in other groups (61.1%). The frequency of diabetes among the siblings and children was higher in the maternal group (53.8%, 4.5%) than in the paternal group (42.4%, PB/0.001, 1.6%, PB/0.01). Among probands who had siblings with Type 2 diabetes, 87.9% of those siblings were living. Among those who had children with Type 2 diabetes, 95.6% of those children were living .Of the 1000 probands, 330 (33%) had one affected sibling, 159 (15.9%) had two affected siblings, 73 (7.3%) had three affected siblings and 31 (3.1%) had four affected siblings. Among the probands with a maternal history of diabetes, both parents were living in 17.9% (28), mothers alone were alive in 26.3% (41) and fathers alone were living in 7.1% (11). In probands with a paternal history of diabetes, both parents were alive in 18.4% (23), mothers alone were alive in 36.8% (46) and fathers alone in 3% (5). Overall, there were 145 probands with both parents alive (trios). Mean age of onset of diabetes appeared to be earlier in the both parents diabetic group (41.2+/-10.7 year) and mean duration of the condition (11.33+/-/6.3 year) was longer than in the other groups (P</0.05). Conclusion: Familial aggregation and excess maternal transmission were observed in people with Type 2 diabetes in Sri Lanka. De Silva V. Samarasinghe D. Gunawardena N (2009). "Alcohol and tobacco use among males in two districts in Sri Lanka." Ceylon Med J 54(4): 119-24. OBJECTIVES: To investigate the prevalence and consumption of tobacco and alcohol among males in the Colombo and Polonnaruwa districts. DESIGN: A cross-sectional study based on multistage cluster sampling was carried out in four Medical Officer of Health (MOH) areas in the Colombo (urban) and Polonnaruwa (rural) districts to assess the prevalence of tobacco and alcohol use. The Public Health Midwife areas were considered as primary clusters. The sample consisted of males over 18 years. There were 1318 from the Colombo District and 1366 from the Polonnaruwa District. The quantity frequency method was used to assess consumption. RESULTS: Abstinence was significantly higher in the rural areas (75.2%) compared to urban areas (56.6%) (p < 0.001). Prevalence of current drinking in the urban areas (32.9%) was significantly higher than in

υυϊ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

rural areas (20.8%) (p < 0.001). Alcohol consumption in the urban areas (33.1 units/week) was significantly higher than in rural areas (20.9) (p < 0.004). 51.6/1000 males in the urban areas and 14.6/1000 males in rural areas consumed daily. The prevalence of current smoking was also higher in the urban areas (29.9%) than (p = 0.052) in rural areas (24.4%). CONCLUSION: High-risk alcohol consumption was prevalent especially in urban areas as indicated by the mean alcohol consumption and number who consumed spirits daily. The prevalence of smoking is much lower than in many Asian countries but similar to western Europe. De Silva V. Samarasinghe D. Hanwella R. "Association between concurrent alcohol and tobacco use and poverty." Drug Alcohol Rev 30(1): 69-73. INTRODUCTION AND AIMS: The harm from alcohol and tobacco use in low- and middle-income countries includes substantial economic cost to the individual. Our aim was to describe the expenditure on concurrent alcohol and tobacco use in relation to family income in two districts in Sri Lanka. DESIGN AND METHODS: A community-based cross-sectional study was carried out in two districts in Sri Lanka. We sampled 2684 men over 18 years of age using multistage cluster sampling. Cost of alcohol and cigarettes was calculated using the retail price for each brand and multiplying by the amount consumed. RESULTS: Among current alcohol users 63.1% were also smokers. Among current smokers 61.9% were also using alcohol. Prevalence of concurrent alcohol and tobacco use in urban areas was 20.1% and in rural areas 14%. The two lowest income categories (<$US76 per month) spent more than 40% of their income on concurrent use while the next category ($US76-143 per month) spent 34.8% of their income on concurrent use. DISCUSSION AND CONCLUSIONS: The poor spent less than those with higher income on alcohol and tobacco, but the expenditure constituted a much larger slice of their income thus compromising their ability to meet basic needs. In low-income countries, damaging economic consequences start at lower levels of alcohol and tobacco consumption and affect a significant proportion of the population. Defining risk levels and guidelines on safe limits based purely on individual health harm has, at best, little meaning in such settings. De Silva VA. Hanwella DR. Gunawardena N. (2009). "Prevalence of Betel Chewing Among Males in Colombo and Polonnaruwa Districts." Journal of the College of Community Physicians of Sri Lanka 14(1): 20-23. Objective: To assess the prevalence of betel chewing among adult males in a rural and urban district in Sri Lanka and describe the demographic characteristics of betel chewers. Study Method: Betel use among 2684 males aged >18 years resident in a rural (Polonnaruwa) and urban (Colombo) district in Sri Lanka was assessed using multistage cluster sampling. Data on quantity and frequency of use was obtained using an interviewer administered questionnaire. Study area: Four Medical Officer of Health (MOH) areas in the Colombo and Polonnaruwa districts. The MOH areas surveyed were Nugegoda, Moratuwa, Thamankaduwa and Elahara Study population: Males over 18 years of age.

υυϋ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Type of study: A descriptive cross sectional study Study instrument: Data was collected using an interviewer administered questionnaire which recorded self reports of quantity and frequency of alcohol, tobacco and betel use during the last 30 days prior to the study Sampling method: A multistage cluster sampling method Sample size: 2684 Risk Factors investigated: Betel chewing tobacco and alcohol use Results: The study population consisted of 2684 males over 18 years. There were 1318 in the urban and 1366 in the rural groups. There was no significant difference in mean age between urban (40.9 years) and rural males (40.3 years) (t= 1.03, p=0.41). The urban males had a significantly higher income (p<0.001). In the rural sample 36.5% earned <Rs. 5000, and in the urban sample 9.8% earned <Rs. 5000. The percentage distribution by ethnic group was Sinhalese 92.1, Tamils 2.7, Moor 4.5 and others 0.6. The percentage distribution of the sample by religion was Buddhists 82.5, Christian 11.2, Muslim 4.5 and Hindu 1.8. Betel chewing Prevalence in the rural area (17.6 %) was significantly higher than in the urban areas (1.6%) ( χ2=195.3, df=1, p<0.001). In rural areas prevalence of betel chewing was 18.2% among Sinhalese and 6.6% among Moors. In the rural areas prevalence of betel chewing was significantly associated with age (χ2= 28.9, df=6, p<0.001). Prevalence was lowest among males between 18-24 years of age (2.7%) and highest among over 65 years (36%). This increase in the prevalence with age was seen in the urban area too though the prevalence in all age categories was lower than in rural areas. In both rural and urban areas prevalence was significantly associated with income (p<0.05). In both study areas prevalence was highest among those with a monthly income < Rs.5000. In rural areas 23.8% of those with a monthly income <Rs. 5000 chewed betel while only 4.7% of those earning >Rs. 25000 a month chewed betel. The odds of being a betel chewer increased with age, with the odds for those aged > 65 years being 19.85 compared to the reference group18-24 years. Among income categories odds were highest for those with monthly income of <Rs. 5000. Of the betel chewers 93.8% used it daily while only 5% used it less than 10 days a month. The mean number of betel quid used per day was 5.9 (SD 4.06). Association with tobacco and alcohol use Alcohol consumption was more prevalent among betel users (32.4%) as compared to those who do not use betel (26.3%) (OR 1.35). Odds ratio of a smoker being a betel user was 0.71. Conclusions There was a significant difference in prevalence of betel chewing between rural and urban areas. Betel chewing now remains mainly a habit of the elderly in rural areas. De Silva. Senarath M. Upul. Gunatilake. Mangala. Lokuhetty. Dilani (2010). "Prolonged breastfeeding reduces risk of breast cancer in Sri Lankan women: A case–control study." Cancer Epidemiology 34p267-273(3): p267-273. Objective: To assess the association between duration of breastfeeding and the risk of breast cancer in Sri Lankan women

υυό Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Study method: A case–control study was conducted in women aged 30–64 years in selected health care facilities in the Western province. A total of 100 recent cases of breast cancer (histologically confirmed) and 203 controls (age and parity matched) were included. Detailed information regarding breastfeeding, menstruation, reproductive factors, passive smoking and other confounders was collected using a structured questionnaire. Adjusted odds ratios and 95% confidence intervals were calculated using multiple logistic regressions. Study Area: Health care facilities in the Western province of Sri Lanka Study population: Women aged 30–64 years Study Instrument: Interviewer administered questionnaire Study type: Case control study Sample size: 303 Sampling method: Convenient sampling method Risk Factors Investigated: Prolong breastfeeding Results: Multivariate analysis found that those women who breastfed for ≥24 months during lifetime had significantly lower risk of breast cancer than those who breastfed for less than 24 months (OR=0.40; 95%CI=0.22, 0.73). Compared to 0–11 months of lifetime breastfeeding, there was a 66.3% reduction in breast cancer risk in women who breastfed for 12–23 months, 87.4% reduction in 24–35 months and 94% reduction in 36–47 months categories. The mean duration of breastfeeding per child for ≥12 months was also associated with reduced risk of breast cancer (OR=0.52; 95%CI=0.28, 0.94). The significant factors associated with increased risk of breast cancer were: post-menopausal women (OR=1.74; 95%CI=1.01, 3.01); having an abortion in the past (OR=3.42; 95%CI=1.75, 6.66) and exposure to passive smoking (OR=2.96, 95%CI=1.53, 5.75). Major conclusions: Prolonged breastfeeding significantly reduces the risk of breast cancer and this protective effect was supported by a dose–response relationship. Risk due to passive smoking should be emphasized in anti-smoking programmes. Ekanayake JPU. (2004). Analysis of Carcinoma of Oesophagus patients admitted to the General Hospital Anuradhapura. Postgraduate Institute of Medicine. Colombo, University of Colombo. Doctor of Medicine in Clinical Oncology. Main objective: To analyse the data available at the cancer unit Anuradhapura in relation to patient and tumour characteristics and review the clinical experience of the disease with factors such as its risk factors to improve quality of life and survival. Specific objective: 1.Present the data available at Cancer unit- G.H Anuradhapurapa in relation to the patient characteristics,probable risk factors, histology , grade and the staging investigations done. 2.Study the treatment modalities used and its outcome comparing them with international results. 3.Record the early and late morbidity of the treatments. Study area: Cancer unit General Hospital Anuradhapura.

υυύ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Study population: All known patients with primary tumour of the oesophagus and histologically proven oesophageal cancer diagnosed and treated at the cancer unit General Hospital Anuradhapura. Type of study: A retrospective cohort study Study instrument: Bed head tickets Sampling method: Convenient sampling Sample size: 91 Risk Factors investigated: Betel chewing, tobacco, alcohol Disease investigated Carcinoma of the oesophagus. Results: At the time analysis the median follow up period was 34 months with a range of 18 to 65 months. THe mean age of the patients was 61years with a range of 35 to 96 years. 34 patients were males and 57 were females.The male to female ratio was 1:1.6. 97.8% patients had squamous cell carcinoma,and mid thoracic region was involved in majority of the patients. At the time of presentation ,majority of thepatients were in poor health condition due to patients and tumour related factors( 76% of patients had moderate to severe dysphagia, 63% of the patients had significant weight loss). The treatment intent was palliation in 69% of patients and radiotherapy with or without chemotherapy was the main modality used in palliatively treated group. Surgery with or without post-operative radiotherapy and radical radiation were the treatment modalities used in patients who were treated with curative intent. 70 patients (76.9%) had a habit(current/ex) of chewing betel,26 patients( 28.5% ) were tobacco smokers (current/ex) and 24 patients (26.3%) were current/ex drinkers (alcohol). 25 patients (27%) had one of the combinations of known risk factors and 12 patients (13%) did not have any of the above risk factors. The optimum management of oesophageal cancer requires allocating the best treatment modality available after considering characteristics related to patients and their tumor. Further attention is required in several areas of supportive care including treatment related morbidity , nutrtional and psychological support to get the best outcome and to minimize the rates of treatment defaults and lost to follow up. Fernando DJ. Perera SD. (1994). "The work of a diabetes clinic: an audit." The Ceylon Medical Journal 39(3): 138-139. Objective: To audit outcome and process of care at the diabetic and medical clinics. Study Method: Prospective interventional study with each patient acting as a retrospective control. SETTING: The Sri Jayawardenepura General Hospital (SJGH) diabetic clinic.

υφτ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

PATIENTS: 250 consecutive patients with NIDDM transferred to the diabetic clinic from the general medical clinic. INTERVENTION: Participation in a structured scheme of health care delivery which included patient education, dietary advice and screening for complications. MEASUREMENTS: Fasting blood glucose, patients' knowledge score, patient satisfaction, frequency of screening. Study area: Sri Jayawardenepura General Hospital (SJGH) diabetic clinic Study population: 250 consecutive patients with NIDDM patients transferred to the diabetic clinic from the general medical clinic Type of study: Prospective interventional study Study instrument: Fasting blood glucose, patient’s knowledge score, frequency of screening, validated questionnaires Sample size: 250 Factors investigated: Fasting blood glucose, patients' knowledge score, patient satisfaction, frequency of screening Results: A Significant improvement was seen after attendance at the diabetic clinic in fasting blood glucose (8.7 SD 1.3 vs 12.5 SD 3.2 mmol/l, p < 0.05), body mass index (26.8 SD 0.6 vs 27.4 SD 0.4 kg/m2, p < 0.05), admission rates (10% vs 21%, p < 0.05), patients knowledge score (76 SD 12 vs 42 SD 16%, p < 0.05) rates of screening for retinopathy (88% vs 6%, p < 0.05) and patient satisfaction in clinical care (87% vs 13%, p < 0.05). There was no significant improvement in cholesterol levels (5.7 SD 0.1 vs 5.8 SD 0.9 mmol/l). Conclusion: The diabetes clinic is a more efficient system and a more appropriate setting to care for patients with NIDDM. Fernando DJS. Siribaddana S. De Silva D. (1994). "Impaired glucose tolerance and diabetes mellitus in a suburban Sri Lankan community." Postgraduate Medical Journal 70(823): 347-349. Objective: To identify the prevalence of impaired glucose tolerance and diabetes mellitus in a suburban Sri Lankan community Study Method: The prevalence of impaired glucose tolerance and diabetes mellitus was studied in a suburban Sri Lankan community using 1985 WHO criteria. Oral 75 g glucose tolerance tests were performed on 633 subjects aged 30-64 years. Study area: Suburban Sri Lankan community Study population: Adults aged 30-64 years Study instrument: Oral 75 g glucose tolerance test Sampling method: Convenient Sampling method

υφυ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Sample size: 633 Disease investigated: Impaired glucose tolerance, Diabetes Mellitus Results: The age-standardized prevalence rates for diabetes mellitus were 5.02 (95% CI 3.59-6.43) and impaired glucose tolerance 5.27 (95% CI 3.74-6.78). A total of 21% of diabetic patients were not known to have diabetes and were diagnosed for the first time during the survey. Obesity was more common (P < 0.05) in diabetic patients (21%) when compared to non-diabetic subjects (10.5%). Conclusion: Diabetes mellitus is a common health problem in Sri Lanka, and there is a need for developing national policies for its prevention and control. Fernando DJS. Siribaddana S. Perera N. Perera S. De Silva D. (1993). "The prevalence of macrovascular disease and lipid abnormalities amongst diabetic patients in Sri Lanka." Postgraduate Medical Journal 69(813): 557-561. Objective: To identify the prevalence of macrovascular disease and hyperlipidaemia in non-insulin-dependent diabetes mellitus patients attending a diabetic clinic in a Sri Lankan teaching hospital Study Method: The prevalence of macrovascular disease and hyperlipidaemia was examined in 500 patients with non-insulin-dependent diabetes mellitus attending a diabetic clinic in a Sri Lankan teaching hospital and 250 controls matched for age and gender. Macrovascular disease was assessed using a modified World Health Organisation questionnaire and modified Minnesota coding of electrocardiogram recordings. Study area: Diabetic clinic in a Sri Lankan teaching hospital Study population: Non-insulin-dependent diabetes mellitus patients Study instrument: Modified World Health Organisation questionnaire and modified Minnesota coding of electrocardiogram recordings Sample size: 750 Factors investigated: Hypercholesterolemia, Macrovascular disease, hypertension, obesity, peripheral vascular disease, electrocardiographic abnormalities Results: Twenty-one per cent of diabetic patients and 14.3% of controls had hypercholesterolemia (P < 0.05). Macrovascular disease was present in 13.4% of diabetic patients and 8.2% of controls. Significant differences were seen in the prevalence of hypertension (15.6% vs 4.8%, P<0.05), obesity (16.2% vs 9.7%, P<0.05), peripheral vascular disease (5.6% vs 2%, P<0.05) and electrocardiographic abnormalities (12% vs 6%, P<0.05) in diabetic patients when compared to controls. Conclusion: Hyperlipidaemia and macrovascular disease is common in non-insulin-dependent diabetic patients in Sri Lanka and accounts for significant morbidity.

υφφ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Ginige S. Wijewardhena K. Wijeyaratne CN. (2004). "Prevalence of Gestational Diabetes Mellitus in Homagama Divisional Director of Health Service area." Journal of the College of Community Physicians of Sri Lanka . Objective: To determine the prevalence of gestational diabetes mellitus (GDM) in the Homagama Divisional Director of Health Service (DDHS) area. Study method: The selected pregnant women were subjected to a two hour 75g Oral Glucose Tolerance Test (OGTT) at period of amenorrhea (POA) of 24- 28 weeks. Study Area: In the field practice area of the Homagama Divisional Director of Health Services (DDHS), situated in the administrative district of Colombo. Study population: All pregnant women who were registered by Public Health midwives (PHMs) in the Homagama DDHS area for antenatal care before 12 weeks of POA during the study period. Women who were known diabetes or on diabetogenic drugs were excluded from the study Study Instrument: An interview administered questionnaire OGTT tests Sample size: 853 Sampling method: A multistage cluster sampling method Risk Factors Investigated: Gestational diabetes mellitus Results: The prevalence of GDM was 8.4%, the age standard GDM prevalence was 10.3% [95% CI 7.3-13.4]. The prevalence of diabetes first detected during pregnancy was 1.2% and that of an impaired glucose tolerance (IGT) was 7.2%. Conclusion Prevalence of GDM has increased among rural Sri Lankan pregnant women during the recent past. The majority (86%) of pregnant women with GDM belonged to the asymptomatic IGT category. This suggests the need for screening all pregnant women for GDM with a valid screening test during pregnancy instead of testing urine for reducing substances. Gunawardena DUR. (1991). "Risk Factors for Stroke in Sri Lankans." Journal of the Ceylon College of Physicians 24: 40-41. Objective: To analyse the association of known risk factors for stroke in Sri Lankan patients Study method: 119 stroke patients, 86 men and 33 women, admitted to Base Hospital, Panadura from 1 July 1989 to 30 June 1990 were studied. Data on previous stroke, previous transient ischemic attacks (TIA), previous coronary artery disease (CAD) and valvular heart disease, smoking habits, alcohol use of the contraceptive pill were recorded. Blood pressure was recorded regularly during the hospital stay. On clinical assessment, the extent of the stroke was noted as reversible ischemic neurological deficit, stroke with minimum residue or completed stroke and the site as in the carotid or vertebrobasilar distribution.

υφχ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Investigations; ESR, haemoglobin and packed cell volume (PCV), fasting and postprandial blood sugars, blood urea and serum electrolytes, total cholesterol and ECG were done on all patients. Selected cases had echocardiography Study Area: Base Hospital, Panadura Study population: Stroke patients admitted to Base Hospital, Panadura from 1 July 1989 to 30 June 1990 Study Instrument: Clinical interviews and examinations Investigations; ESR, haemoglobin and packed cell volume (PCV), fasting and postprandial blood sugars, blood urea and serum electrolytes, total cholesterol and ECG. Sample size: 119 Sampling method: Convenient sampling method Risk Factors Investigated: Smoking, diabetes, hypertension, ischemic heart disease, use of oral contraceptive pills Results: Strokes accounted for 1.2 per cent of all admissions to the medical unit during this period and 8.3 per cent of all deaths. Eighty seven patients (73%) were 60 years or older with a peak incidence at 60 years for men and 70 years for women. There were 25 deaths (21%) with 13 per cent mortality in strokes in the carotid distribution and 61 percent mortality in strokes in the vertebrobasilar distribution. One patient with a subarachnoid haemorrhage also died. 71 patients had a completed stroke, 33 had a stroke with minimum residue and 15 had a reversible ischemic neurological deficit. Twenty one per cent had previous stroke, 11 per cent had previous CAD 1.7 per cent had valvular heart disease and 2.5 per cent had a previous TIA. Fourteen (11.8%) used alcohol in excess and 44 (37%) smoked more than 5 cigarettes per day. Smoking as a sole risk factor was seen in 3 patients. Six patients (5%) had diabetes. Hypertension was found in 85 patients (714%), 59 males and 26 females. Eighty one per cent with hypertension were under 70 years of age while 59 percent were over 70 years. Only 14 percent took regular treatment, 30 percent took intermittent treatment, 21 per cent had stopped treatment, while 35.5 per cent were not aware of their hypertension. Inability to attend the hospital clinic or purchase drugs and taking treatment only when "ill" (Headaches, giddiness, heaviness of the body) were the reasons given for taking intermittent treatment while approximately equal numbers of patients stopped treatment on the advice of a qualified Western medical practitioner, or an unqualified Western practitioner or an Ayurvedic practitioner. Two patients had mitral valve disease with thrombi in the left atrium. ESR and PCV were normal in all patients. Total cholesterol was elevated (over 240 mg) in 8, all women over 60 years of age. None of the women had used the contraceptive pill. Herath HMM. Palangasinghe DR. Prasad JD. Ruchiranga SKL. Singhapura SDAL. (2010). "Prevelence of conventional cardio vascular risk factors in patients with acute coronary syndrome. An observational study." Galle Medical Journal 15(1). Introduction Acute coronary syndrome (ACS) is one of the leading causes of morbidity and mortality in Sri Lanka. A study was conducted to determine the presence of Conventional cardiac risk factors (CCRF) such

υφψ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

as diabetes mellitus (DM), hypertension (HT), dyslipidaemia, and cigarette smoking in patients with ACS in Galle. Methods Patients withACS admitted to the professorial medical unit, Teaching Hospital Karapitiya from October 2009 to June 2010 were recruited. Data on CCRF were recorded and investigation results were obtained from hospital records. Results There were 142 patients with 83 (59.0%) males and 58 (41.0%) females with mean age of 61.0 years. Of them 14 . (10.0%) were diagnosed as ST elevated myocardial infarction, and 45 (31.0%) and 82 (58.0%) patients had non ST elevated myocardial infarction and unstable angina respectively. The most prevalent CCRF was, HT which was seen among 79 (56.0%) patients, followed by dyslipidemia (54.0%), DM (26.0%), family history of premature CAD (24.0%), smoking (13.0%) and renal diseases (5.0%). Twenty six patients (18.0%) had 3 or more CCRF forACS. However, 18 (13.0%) patient had no CCRF and 51(36.0%) patients had only one CCRF for ACS. Conclusions More than 87.0%ACS events can be explained with the presence of conventional risk factors. Hypertension and dyslipidaemia are the leading risk factors. Hettihewa LM. Gunasekera SW. Jayasinghe SS. Palangasinghe S. Weerarathna TP. Imendra Kotapola (2007). "Lipid abnormalities in type 2 diabetes mellitus patients in Sri Lanka." Galle Medical Journal 12(1): 1 to 4. Background & Objective: Previous studies suggest that the prevalence of dyslipidaemia in type 2 diabetes is high with respect to the general population. But data related to the prevalence of dyslipidaemia in diabetic population is limited in Sri Lanka. This study was planned to identify the prevalence of abnormalities in lipid profile among type 2 diabetic population. Methods: All subjects were studied for their quantitative lipid abnormalities after an overnight fast. Their anthropometric indices were measured and fasting blood sample was collected for glucose and lipids determinations. Results: Mean value of BMI was 23.67 ± 0.58 kg/m2 and FBS was 179.3 ± 9.98 mg/dL. There were 67% patients with high TC levels and 44% of patients with high triglyceride levels. Increased LDL levels were found in 51% of patients and 19% of patients had lower HDL levels both in males & females. We found that 65% of patients had more than one risk factor in lipid profiles. Further, 74% of patients had combination of significantly high TC and low HDLlevels. Interpretation & Conclusion: Contrary to the previous research findings, total cholesterol is the most common lipid abnormality in type 2 diabetics. Considering our different prevalence rates of dyslipidaemia among diabetic patients, we strongly suggest to promote investigations related to the effects of abnormalities of total cholesterol on the development of insulin resistance, the major causative factor for type 2 diabetes.

υφω Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Hewavisenthi SJ DS. Dassanayaka AS. De Silva HJ. (2005). "Clinical, biochemical and histological characteristics of a Sri Lankan population of non-alcoholic steatohepatitis (NASH) patients." The Ceylon Medical Journal, 50(3). Objective: To describe the clinical, biochemical, and histological characteristics of a cohort of NASH patients in Sri Lanka, and to determine their short term outcome following modifications of lifestyle Study method: During a 4-year period from May 1999 to may 2003, liver biopsies were performed on 296 patients who had elevated serum transaminase levels for more than 6 months. Hundreds of them were diagnosed as having NASH. Patients who had an alcohol intake of over 40 g/week were excluded. Detailed clinical and biochemical data of patients with histologically confirmed NASH were compiled. Histological grading and staging was done using the Brunt system. Clinical and biochemical details were recorded at the first visit. The clinical details included a history of diabetes, hyperlipidaemia, drug treatment, anassessment of alcohol and dietary fat intake, and exercise. A family history of co-morbid factors associated with NASHwas also assessed. The height and weight were recorded and body mass index calculated. In addition to liver transaminases, the following investigations were performed: lipid profile, a fasting and post-prandial blood glucose (venous), serum insulin, hepatitis viral serology,alpha 1 antitrypsin, caeruloplasmin level, anti-nuclear antibody, anti-smooth muscle antibody, serum iron and total iron binding capacity, and ESR. The patients were advised on lifestyle modifications and the control of diseases known to be associated with NASH. They were followed up at 3 -monthly intervals Study population: Population of non-alcoholic steatohepatitis (NASH) patients Sample size: 100 Sampling method: Convenient sampling method Risk Factors Investigated: Diabetes Obesity Hyperlipidaemia Family History Atherosclerosis , Liver disease Hyperlipidaemia , Diabetes mellitus High fat intake Results: During the study period liver biopsies were performed on 296 patients and 100 ( 35.1%) were diagnosed as having NASH. (Men = 79, Mean age 37.2 years, SD 10.6). Risk factors for NASH included diabetes mellitus (55%), obesity (52%), hyperiipidaemia (54%), a family history of risk factors (66%)-(Atherosclerosis 40%,Liver disease 14% Hyperlipidaemia 13%, Diabetes mellitus 55 %)and a high dietary fat intake (66%). However, 44.3% of men and 33.3% of women were not overweight. The histological grading and staging of 80 biopsies showed Grade 1 in 31 (38.8%), Grade 2 in 29 (36.3%), Grade 3 in 20 (25%), Stage 1 in 57 (71.3%) Stage 2 in 13 (16.3%), Stage 3 in 2 (2.5%) and Stage 4 in 8 (10%). In 55/91 (60.4%) patients who were followed up for a median of 2.5 years (range 1-4 years) the serum transaminases returned to normal in a median of 7 months (range 3-14 months). Conclusion The clinical, biochemical and histological features of NASH patients in our series are similar to that reported in western countries. However "lean males" accounted for a significant proportion. In the short term a majority of patients showed improvement in serum transaminases with lifestyle modification

υφϊ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Ilayperuma I. Nanayakkara BG. Palahepitiya KN (2011). "Sexual Differences in the Diameter of Coronary Arteries in an Adult Sri Lankan Population." International Journal of Morphology 29(4): 1444-1448. Objective: To investigate the sexual differences in the diameter of coronary arteries in a group of adult Sri Lankan population Study Method: This study was carded out on one hundred and two apparently healthy human hearts obtained from cadavers (68 male and 34 female) during routine gross anatomy dissections in the Department of Anatomy, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka. The cadavers were preserved in formalin for a variable pedod of time (3 months - 1 year). Tbe age group of the cadavers varied between 48-67 years. Hearts weighing more than 370 g in males and 280 g in females were excluded from the study to avoid the possibility of hypertensive cases. The height and the weight of the cadavers as well as the weights of the hearts were recorded. The chambers of the hearts were open and blood clots were removed before recording the weights of the heeirts. Body surface areas were calculated using them method descdbed by Dubois & Dubois in 1916 (DuBois & DuBois, 1989). The external diameters of the coronary artedes were measured at the following predetermined sites: (i) Right coronary artery at its odgin (ii) Right coronary artery 2.5 cm away from the origin (iii) Left coronary artery at its odgin (iv) Anterior interventdcular artery 5 mm away from its origin (v) Circumflex artery 5 mm away from its origin The diameters were recorded using a digital sliding caliper (Mitutoyo, Japan) capable of measuring to the nearest 0.01 mm. All the measurements were repeated thrice by the same person and the mean was taken for further analysis. Results were expressed as mean ± SD. Statistical analysis was performed using the t test. P value < 0.05 was considered statistically significant. To determine whether sex differences in coronary artery diameters are manifestations of differences in body size and heart weigbt, each measurement was divided by body surface area (BSA) and heart weight respectively and t test was repeated for the corrected values. Study area: Department of Anatomy, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka Study population: Cadavers between 48-67 years old Study instrument: Digital sliding calliper Sample size: 102 Factors investigated: Mean coronary arterial diameter, Sex, body surface area, heart weight, height, weight Results: Demographic characteristics of the male and female study group are presented in Table I. The mean age, body weight and heart weights were not significantly different between the sexes. The mean height and body surface area were significantly smaller in females than in males. There was a definite trend in coronary artery diameters. Females showed a significantly smaller arterial diameters in both right and left coronary arteries compared to that of the males (P<0.05). Female coronary arterial diameters of the anterior interventricular and circumflex artedes were also smaller than that of the males although the differences were not statistically significant between the sexes (P>0.05). Females demonstrated smaller coronary arterial diameters than males even after normalization for body surface area and heart weight.

υφϋ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Conclusion: Precise knowledge of the expected normal coronary arterial diameter at a given anatomic location is the first step towards developing a quantitative estimate of the severity of the coronary artery disease. This study provides a reference data set for adult Sri Lankans against which to compare the diameters of coronary arteries in various pathological conditions. Illangasekera U. Rambodagalla S. Tennakoon S. (2004). "Temporal trends in the prevalence of diabetes mellitus in a rural community in Sri Lanka." Journal of The Royal Society for the Promotion of Health 124(2): 92-94. Objective: To objectively assess whether the prevalence of diabetes has increased in a named rural community in Sri Lanka during a period of ten years and whether there has been a change in the socio-economic status of the community during this period. Study Method: The study was conducted on a sample of 220 subjects randomly selected from an adult population of 25,605 residents in a rural area in central Sri Lanka. Each of these subjects had the fasting blood sugar estimated and the height, weight, resting blood pressure and socio-economic parameters, such as the level of education, occupation and monthly income, recorded. These data were compared with those of a similar study conducted by the main author in the same community ten years ago. Study area: Rural area in central Sri Lanka Study population: Adult population Sampling method: Random sampling Sample size: 220 Factors investigated: Fasting blood sugar estimated and the height, weight, resting blood pressure and socio-economic parameters, such as the level of education, occupation and monthly income Results: The results revealed that the age-standardised prevalence of diabetes had increased from 2.5% in 1990 to 8.5% in 2000 (p=0.008) and that this was accompanied by an increase in the monthly income, level of education and body mass indices. Conclusion: Since nearly 70% of all Sri Lankans live in villages, continuation of the present trend would result in a dramatic increase in the number of patients with diabetes in the future. Suitable strategies should be implemented to arrest this trend and manage a large number of patients with diabetes in the future. Jayasinghe SJ. (2005). Glucose Challenge Test as a Screening for Gestational Diabetes Mellitus and the Influence of some of the Associated Risk Factors. Postgraduate Institute of Medicine. Colombo, University of Colombo. Doctor of Medicine in Obstetrics and Gynaecology: 21. Main objective: To study the sensitivity and the predictive values of GCT as screening test for GDM and the influence of certain factors on the predictive value for GDM.

υφό Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Specific objective: 1.To study the sensitivity and the predictive values of GCT as screening test for GDM 2.To study the influence of a)Age b)Parity c) History of DM in the first degree relatives on the predictive value for GDM. Study method: 517 pregnant women who attended the Antenatal clinic at Sri Jayewardenepura General Hospital for their booking visits were selected for the study. Each first 10 mothers who attended the clinic were selected for the GCT and 50g of glucose was give orally and a venous blood was taken after one hour. Blood glucose levels of or over 140mg dl were considered positive and they were subjected to a definitive 100g OGTT. They were required to fast overnight and the test was done the following morning with a fasting blood sugar level. Diagnosis of GDM was made if there were two or more of the values were above normal. (Normal 105mg/dl or 5.8 mmol /l fasting blood sugar level after 100g glucose) Study area: Antenatal clinic at Sri Jayawardenapura General Hospital Study population: Pregnant women who attended the Antenatal clinic at Sri Jayawardenapura General Hospital for their booking visits. Known diabetic and women with other pregnancy related illnesses like pregnancy induced hypertension and also women with multiple pregnancies were excluded from the Type of study: A hospital based prospective cohort study Study instrument: Patient's bed head tickets The register maintained at the antenatal clinic. Blood sugar level was assessed using Enzmatic colorimetric test. Sampling method: Convenient sampling Sample size: 517 Risk Factors investigated: Age Parity History of DM in the first degree relatives Disease investigated: Gestational Diabetes Mellitus Results: A total number of 517 pregnant women were screened antenatal with 50g GCT and 22 patients were excluded from the study due to discontinuation of the antenatal follow up or due to incomplete data. Out of 494, 168 women were found to have blood sugar values equal or exceeding the threshold value of 140mg (7.8mmol/l). Thus the prevalence of GCT positive women in the index population was 34%. All of them were subjected to 100g OGTT and 42 of the index population had gestational diabetes giving a sensitivity of 75% and positive predictive value of 25%. In the index population the prevalence of GDM was 11.3%. Hence two thirds of the GCT positives were false positives. Out of the 326 who was GCT negative 14 had positive OGTT results. The figures are given in the contingency Table 1 below.

υφύ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

The incidences of gestational glucose intolerance in subgroups with three different risk factors are shown in table 2 given below. It shows that the incidence of GDM is high in all three groups of women with risk factors age, parity and family history of diabetes. The study also revealed that in the group having a family history of diabetes the figures of the sensitivity and the predictive values were 81% and 33% respectively and among the women older than 30 years the figures were 82% and 30%. In the group having both risk factors the sensitivity and the positive predictive values were 92% and 42% respectively. Thus the sensitivity and positive predictive values of the glucose challenge test are significantly increased in the presence of known risk factors of gestational diabetic mellitus. Jayathilaka KGH. Dahanayake S. Abewardhana R. Ranaweera AKP. Rishard MRM. Wijeyaratne CN (2012). "Diabetes in pregnancy among Sri Lankan women: gestational or pre-gestational?" Sri Lanka Journal of Diabetes Endocrinology and Metabolism 1(1): 8-13. Introduction: There is an exponential rise in the occurrence of diabetes during pregnancy in South Asia. However data is sparse on the actual pre-gestational diabetes mellitus (PGDM) versus gestational diabetes mellitus (GDM) case-mix. The applicability of the WHO gold standard diagnostic tool – 75g oral glucose tolerance test (OGTT) – and its optimal timing between 24-28 weeks gestation in South Asians is unknown. Objective: To assess optimal timing for diagnosis, determine the case-mix of PGDM and GDM and their specific risk profiles, insulin needs and pregnancy outcomes among Sri Lankans. Method: Prospective data was collected from consecutive women diagnosed with diabetes in pregnancy, at the Professorial Unit, De Soysa Hospital, Colombo from 1st January 2010, - 28th Feb 2011. All were screened by an initial 2 hour post prandial (PPBS) at antenatal booking and risk stratified to determine the optimal timing of OGTT. Results: (Total n=140) GDM and PGDM occurred in 82% and 18% of patients respectively. GDM (n=115) Mean age 32.16±5.26; booking POA 13.7±5.8weeks; booking BMI 26±4.9kg/m2. Risk factor profile – 1(33%); 2(29.3%); ³3 (29%); 64% were detected before 24 weeks. Those >30 years were 67% among early diagnosis versus. 36% among those diagnosed between 24-28 weeks (p=0.02). Previous miscarriages were 36% among early diagnosed versus. 18% among those diagnosed late (p=0.145). Pregnancy induced hypertension occurred in 7.8% with similar occurrence in both subgroups. Pregnancy outcome was similar in the two subgroups (100% live births, mean birth weight 3.127±0.50kg, macrosomia 21%; LSCS 43%, pre-term 6.9%; neonatal hypoglycaemia and jaundice 11%; congenital malformation=1(0.9%). Pre-GDM (n=25) Mean age 32.92±5.9 (2/3 >30 years); booking POA 12.7±6.1weeks; booking BMI 23.49±3.52kg/m2, significantly less than GDM group (p=0.03). Risk factor profile – 1(28%); 2(28%); ³3 (32%). Previous miscarriage had occurred in 24% with more still births than in GDM group (p=0.002). Previous GDM was significantly more (p=0.03). Pregnancy induced hypertension occurred in 8%. Pregnancy outcome: 100% live births. Mean birth weight 3.014±0.56kg; macrosomia 20%; LSCS 44%; pre-term 16%; neonatal jaundice and hypoglycaemia 20% (significantly more than GDM group, p=0.02); congenital malformation =1(4%). Conclusion: Unequivocal PGDM occurs among 18% of pregnant diabetics, among older multiparous women with previous GDM and still births. GDM was diagnosed before the internationally recommended 24

υχτ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

weeks in 64%, although their insulin requirement was significantly less than those diagnosed after 24 weeks. Recommendations: 1) The current timing in pregnancy for screening by OGTT in Sri Lanka requires review. 2) A comprehensive pre-conception screening programme, particularly for older women with previous GDM and/or previous pregnancy loss, is required. Jayatissa R. Bekele A (2011). Nutritional Surveillance in tsunami affected areas. The Eleventh Annual Academic Session of the College of Community Physicans of Sri Lanka October 2011 Objective: To compare the nutritional status of under 5 year old children affected and not affected by tsunami over a period of six months in the districts struck by tsunami. Study Method: A follow up survey was conducted in 30 clusters selected form 12 tsunami affected districts. Three groups of under 5 year olds were identified, namely, those affected by the tsunami and 1) living in camps and 2) living in own homes and 3) those not affected. They were assessed initially in May 2005 and six months later. Interviewer administered questionnaire was used to collect data on relevant information from the mothers/ immediate care takers of the child. Anthropometric measurements included height/length and weight. Study population: Under 5 year old children Type of study: Retrospective study Study instrument: Interviewer administered questionnaire Sampling method: Cluster sampling Sample size: 1,127 Risk Factors investigated: Nutritional status, Wasting Results: A total of 1,127 children of tsunami affected families living in camps (n = 314) and living in their houses (n = 397) and non-affected families (n = 416) were assessed. There was a significant reduction (p < 0.005) in the prevalence of wasting from 16.8% to 10.8% among children living in camps. The reduction of wasting among children living at home (15.7% - 14.1%) and not displaced (13.9% - 11.8%) were not marked. The proportion of children aged > 6 months receiving Triposha in the camps increased from 25.4% to 33.1%. The proportion of families living in camps taking loans increased from 12% to 21.3%. Fever/ cough increased from 43.2% to 69.1%. Affected children living in houses, fever/ cough increased from 4.9% to 58.9% and non-affected children from 38.3% to 56%. Conclusion: This study showed that targeted interventions can make a drastic difference in the nutritional status of children less than five years of age. It is equally important to reinvigorate the control of respiratory infections.

υχυ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Jayawardena JBJM. De Silva PV. Karunanayake A. Weerasuriya MA (2010). "The prevalence of coronary artery disease in Bope-Poddala : A semi-urban population in Southern Sri Lanka. .Galle Medical Journal 15(1). Introduction The incidence of coronary artery disease (CAD) in Sri Lanka has risen sharply over the past 20 years as reflected in the hospital admissions and is the commonest cause of death. Comparable published data on the prevalence of CAD in Sri Lanka are sparse. This study was undertaken to determine the prevalence of CAD in a semi urban community and describe the related risk factors. Methods The study sample consisted of 930 adults aged >30 years in Bope-Poddala in Southern Sri Lanka, made of 31 clusters of 30 adults, each selected using the probability proportion to size. A detailed history was obtained, and clinical examination, body mass index (BMI) determination and electrocardiographs (ECG) were carried out on all subjects. The diagnosis of IHD was based on history of myocardial infarction, angina pectoris and ECG abnormalities according to criteria used by Epstein. Results The prevalence of CAD was 6.9% with a mean BMI of 22.56 kg/m2 and silent CAD occurring at 40%. There was no significant gender difference. There appears to be no association between daily physical exercise and CAD. Identified risk factors were diabetes and hypertension. Conclusions The prevalence rate of CAD is low with a lesser occurrence of silent CAD in the study population Jayawardena R. Katulanda P. Byrne N. Soares M. Hills A. (2012). "Energy and nutrient intake - findings from a Sri Lankan adult nutrition survey." The Ceylon Medical Journal 57(Supplement 1): Page 18. Objective: To identify the major nutrient intake and food consumption patterns among Sri Lankan adults. Study method: A nationally representative sample of adults was selected using a multi – stage random cluster technique. An interviewer administered a 24 hour dietary recall was used to obtain nutritional intake of the population – Nutri Survey® software was used to analyze the nutrition consumption of meals. Sample size: 468 Sampling method: A multi – stage random cluster technique. Risk Factors Investigated: Nutrition Results: Data from 468 participants (166 males, 297 females) were analyzed. Total energy was significantly higher in males (1913 ± 567 kcal/ day) than females (1514 ± 458 kcal/ day), however, there was no significant gender difference in the percentage of energy from carbohydrate (male – 72.8 ± 6.4%, female – 73.9 ± 6.7%), fat (male – 19.9 ± 6.1%, female 18.5 ± 5.7%) and proteins (male 10.6 ± 2.1%, female 10.9 ± 5.6%). The average intake of dietary fibre was 21.3 g/day and 16.3 g/day for males and females respectively. There is a significant difference in nutritional intake among ethnicities, areas of residence, education levels, BMI categories.

υχφ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Conclusion: The present study provides the first national estimates of energy and nutrient intake of the Sri Lankan adult population. Regular nutrition surveys are needed at the national level to obtain valuable information on diet and associated diseases. Karunasekera KAW. Perera KPJ. Perera MTPR. Abeynarayana J. (2005). "Genetic and environmental risk for asthma in children aged 5-11 years." Sri Lanka Journal of Child Health 34: 79-83. Objective: To assess genetic and environmental risk factors of asthma among children aged 5-11 years. Study Method: Data were collected from children aged 5-11 years in 3 schools in Gampaha District. 441 children with asthma and 1510 without asthma were evaluated for following risk factors viz. family history of atopy, gender, duration of breast feeding, commencement of formula in infancy, dusty home environment, passive indoor cigarette smoking, presence of firewood smoke in bedroom when cooking, burning of mosquito coil and incense stick/powder and presence of pets at home. Data were analyzed using Epi info version 6 and SPSS package. Chi Squared test was used in bivariate analysis and forward logistic regression was used to adjust confounding factors. Study area: 3 schools in Gampaha District Study population: Children aged 5-11 years Type of study: A cross sectional analytical study Study instrument: Self - administered questionnaires Sample size: 1951 Disease investigated: Childhood Asthma Results: Risk of asthma in child (on bivariate analysis) was increased when father has a history of asthma (odds ratio (OR) 6.4 (95% confidence interval (CI) 3.2 -13.2), mother has a history of asthma (OR 4.4, CI 2.6 -7.5), sibling has asthma (OR 4.3, CI 2.0 -9.7), father has a history of allergic rhinitis (OR 2.0, CI 1.5-2.8), mother has a history of allergic rhinitis (OR 2.5, CI 1.9-3.4)and sibling has allergic rhinitis (OR 3.4, CI 2.1-5.4). Asthma risk was significantly increased with following environmental factors: non continuation of breast feeding beyond first 6 months in infancy (OR 1.5, CI 1.2-1.9), presence of firewood smoke in bedroom when cooking (OR 1.4, CI 1.1-1.9), use of mosquito coil (OR 1.5, CI 1.2 -1.9) and dusty home environment (OR 1.8, CI 1.4-2.3). After adjusting for confounding factors, paternal history of asthma, maternal history of asthma, allergic rhinitis in mother and sibling, non continuation of breastfeeding beyond first 6 months of life and dusty environment remained significant with increased risk of asthma (p<0.01). Conclusion: This study reinforces that asthma has a multifactorial aetiology. Childhood asthma is influenced by paternal asthma more than maternal asthma. Significant modifiable environmental factors in this study were duration of breastfeeding in infancy and dusty home environment.

υχχ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Katulanda P. Groves CJ. Barrett A. Sheriff R. Matthews DR. McCarthy MI. Gloyn AL. (2008). "Prevalence and clinical characteristics of maternally inherited diabetes and deafness caused by the mt3243A > G mutation in young adult diabetic subjects in Sri Lanka." Diabetic Medicine 25(3): 370-374. Objective: To determine the prevalence and clinical characteristics of MIDD in a large South Asian cohort of young adult-onset diabetic patients from Sri Lanka Study Method: DNA was available from 994 subjects (age of diagnosis 16-40 years, age at recruitment ≤ 45 years). Mutation screening was performed using a QRT-PCR method on an ABI 7900HT system using sequence-specific probes. Samples with heteroplasmy ≥ 5.0% were considered positive. Study area: Sri Lanka Study population: Adults ≤ 45 years Study instrument: ABI 7900HT system using sequence-specific probes Sample size: 994 Factors investigated: Age, Height, Weight Results: Nine (four males) mutation-positive subjects were identified (prevalence 0.9%). They were diagnosed at a younger age (25.9 ± 4.8 years vs. 31.9 ± 5.6 years, P = 0.002) and were lean (body mass index [BMI] 18.7 ± 2.7 kg/m 2 vs. 24.7 ± 4.0 kg/m2, P < 0.001) compared to NMCs. One mutation-positive subject (11.1%) had metabolic syndrome, compared to 633 (64.3%) of NMCs. Insulin therapy within 6 months of diagnosis was used in four (44.0%) carriers compared to 6.9% of NMCs (P = 0.002). Combined screening criteria of any two of maternal history of diabetes, personal history of hearing impairment and family history of hearing impairment only identified five (55%) of the carriers, with a positive predictive value of 7.4%. Conclusion: The prevalence of mt3243A > G mutation among young adult-onset diabetic subjects from Sri Lanka was 0.9%. Our study demonstrates that a maternal family history of diabetes and either a personal and/or family history of deafness only distinguish half of patients with MIDD from Sri Lankan subjects with young-onset diabetes. Katulanda P. Jayawardena MAR. Sheriff MHR. Matthews DR (2011). "Derivation of anthropometric cut-off levels to define CVD risk in Sri Lankan adults." British Journal of Nutrition 105(7): 1084-1090. Objective: To derive population-specific anthropometric cut-off values to define high CVD risk for Sri Lankan adults. Study Method: A nationally representative sample of 4474 non-institutionalised adults aged ≥18 years was analysed. Cut-off values to provide optimum sensitivity and specificity were derived using receiver-operating characteristic curve analysis. BMI, waist circumference (WC), waist-to-hip ratio (WHR), blood pressure and overnight fasting venous blood samples were collected to measure glucose, HDL-cholesterol and TAG. An oral glucose tolerance test was also performed.

υχψ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Study area: Sri Lanka Study population: Non-institutionalised adults aged ≥18 years Study instrument: Oral glucose tolerance test Sample size: 4474 Factors investigated: Height, Weight, waist circumference (WC), waist-to-hip ratio (WHR), blood pressure and overnight fasting venous blood levels. Results: The age-adjusted BMI, WC and WHR were significantly associated with all cardiovascular risk factors (P,<•001). Cut-off values for BMI, WC and WHR for males were 20•7 kg/m 2, 76•5 cm and 0•89, respectively. The respective values for females were 22•0 kg/m2, 76•3 cm and 0•85. The common cut-off value for BMI for males and females was 21•5 kg/m 2. Similarly, WC and WHR cut-off values for both males and females were 76•3 cm and 0•87, respectively. The Asian and Caucasian anthropometric cut-off levels showed lower sensitivity and higher false negative percentage compared with newly derived cut-off levels. Conclusion: BMI, WC and WHR were all associated with increased CVD risk. We propose the following anthropometric cut-off points to determine high CVD risk level for Sri Lankan adults: BMI ≥ 21•5 kg/m 2, WC ≥ 76 cm and WHR ≥ 0•85 (women) and 0•90 (men). Katulanda P. Katulanda Gaya W. Shine Brian. Matthews David R. (2007). "Cigarette Smoking Is Associated with Dyslipidaemia Among Young Adults with Diabetes. ." Diabetes 56(Supplement 1) Objective: To identify the prevalence and patterns of dyslipidaemias among subjects with young adult diabetes in Sri Lanka Study method: Data from 1007 consecutive subjects (age of onset 16-40 years) attending government and private clinics in Sri Lanka were recruited. Blood for glucose, total cholesterol (TC), high density lipoprotein cholesterol (HDLC), triglycerides (TG), HBA [sub 1] C was obtained after a 12-14 hour fast. Low density lipoprotein cholesterol (LDLC) was calculated using Friedewald equation. Non-high density lipoprotein (nun-HDLC) was calculated by subtracting HDLC from TC. The cut offs for diabetes dyslipidaemias were based on ADA guidelines. Study population: Subjects with young adult diabetes with age of onset 16-40 years attending government and private clinics in Sri Lanka Study type: A cross sectional study Sample size: 1007 Results: Mean age of the population was 36.6 years (SD 5.8) and mean diabetes duration was 4.8 years (SD 4.1). Mean HBA [sub 1] C was 8%. High LDLC (>2.6mmol/l), high TG (>1.7mmol) and low HDLC (M<I.03/F<1.29mmol) were seen among 74.8% (M 75.5% vs F 74.2%; p=0.35), 36.7% (M 42.6% vs F 32.5%; p=0.001) and 66.9% (M 49.4% vs F 79.7%; p<0.001) respectively. Combined high TG and low HDLC was seen among 26.0% (M 24% vs F 28%; p= 0.09). Any form of dyslipidaemia was seen among 94.2% (M 91.8% vs F 96%; p=0.003). HDLC showed a negative correlation (r=-0.162; p=0.01) and TG a

υχω Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

positive correlation (r=0.144; p=0.01) with BMI. The mean LDLC among the 208 (20.5%) subjects on statins were lower than others; 127.8 (SD 36.8) vs. 144.4 (SD 37.6); p=0.001. Mean HDLC and TG were highest in the most physically active group (p=ns) and least physically active groups (p=0.04) respectively. In the multiple logistic regression model Low HDLC and high TG were independently associated with waist circumference (p<0.001) compared to BMI. Subjects with poor glycaemic control (HBA [sub 1] C>7%) had high TC (p<0.001) and high LDLC (p=0.004). There was no significant association of high HBA [sub 1]C with HDLC and TG. Higher TC (p<0.001), non HDLC (p=0.001), TG (p=0.008) and LDLC (p=0.04) was seen among smokers compared to those who did not smoke. In conclusion there was a high prevalence of diabetes dyslipidaemia among this cohort of young adult diabetic subjects. It needs further investigation to determine whether cigarette smoking is a marker of poor lifestyle choices or whether there are underlying pathophysiological mechanisms. Katulanda P. Rathnapala DAV. Sheriff R. Matthews DR (2011). "Province and ethnic specific prevalence of diabetes among Sri Lankan adults." Sri Lanka Journal of Diabetes Endocrinology and Metabolism 1(1): 2-7. Objective: To determine the province and ethnic specific prevalence and correlates of diabetes mellitus among Sri Lankan adults. Method: A nationally representative sample of 5000 adults aged ³18 years was selected by a multistage random cluster sampling technique in this cross-sectional study conducted between 2005 and 2006. Results: Response rate was 91% (n=4532), males were 40%, age 46.1±15.1 years (mean ±SD). The age-sex standardized prevalence (95% CI) of diabetes for Sri Lankans aged ³ 20 years has been previously published as 10.3% (9.4-11.2%) [males 9.8% (8.4-11.2%), females 10.9% (9.7-12.1%), P=0.129). There was a marked variation in the province specific prevalence of diabetes with the highest (18.6%) in the Western and the lowest (6.8%) in the Uva provinces. The monthly income, BMI, waist circumference and per capita monthly expenditure were highest in the Western and lowest in the Uva. In contrast, the mean physical activity level was lowest in the Western province and highest in the Uva. However, the per capita daily energy consumption was lowest in the Western and highest in the Uva provinces. The Sri Lankan Tamil ethnicity has the highest (22.1%) diabetes prevalence followed by the Sri Lankan Moor (21.4%). The Indian Tamil ethnic group living in the plantation sector had the lowest prevalence. Conclusions: The provincial and ethnic distribution of diabetes closely resembled that of obesity (waist circumference more than the BMI) and the income level in the respective provinces and ethnic groups. The physical activity level had an inverse relationship. High level of physical activity had a protective effect from diabetes even when the energy consumption is high. Lekamwasam S. Weerarathna T. Rodrigo M. Arachchi W.K. Munidasa D (2009). "Osteoporosis and Cardiovascular Risk Among Premenopausal Women in Sri Lanka." Journal of Clinical Densitometry 12(2): 245-250. Objective: To examine the association between bone mineral density (BMD) and cardiovascular risk in a group of premenopausal women selected from the Southern province of Sri Lanka. Study Method: One hundred six previously healthy premenopausal volunteers (aged 30-54 yr) were recruited by open invitations. Subjects with previous history of diabetes, hypertension, epilepsy, chronic renal or

υχϊ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

liver disease, hyperlipidemia, ischemic heart disease, endocrine diseases, or prolonged inflammatory conditions were excluded. Subjects who were taking medications that can affect bone density, blood sugar, serum lipids, or blood pressure (BP) were also excluded. Women with the history of previous fractures were not excluded. BMDs in the spine, hip, and total body (TB) were measured using a Hologic Discovery scanner (Hologic Inc, Bedford, MA). BP, fasting glucose, and fasting lipids were also measured. Study area: Southern province of Sri Lanka Study population: Premenopausal women aged 30-54 years Study instrument: Hologic Discovery scanner, Sample size: 106 Factors investigated: BMD, BMC, BP, fasting glucose, and fasting lipids Results: Independent of body mass index (BMI) and age, TB bone mineral content (BMC) and spine BMD showed inverse and significant correlations with total cholesterol (TC), low density cholesterol, and the ratio between TC and high density lipoprotein cholesterol (r ranged from -0.24 to -0.27, p < 0.05 for all). The highest mean lipid levels were seen among the women in the lowest third of spine BMD, whereas women in the upper third of spine BMD had the lowest lipid levels. The number of women with metabolic syndrome in the 3 tirtiles of spine BMD was not significantly different. Fasting glucose or BP had no association with either BMD or BMC Conclusion: Our data demonstrates an association, independent of age and BMI, between BMD and BMC or lipid levels among previously healthy, premenopausal women. This may explain the high cardiovascular risk seen in women with osteoporosis in old age. Mendis S. Ranatunga P. Jayatilake M. Wanninayake S. Wickremasinghe R. (2002). "Hyperhomocysteinaemia in Sri Lankan patients with coronary artery disease." 47(3): 89-92. Objective To determine the association between hyperhomocysteinaemia and coronary artery disease (CAD) in a sample of Sri Lankans. Design A case control study. Setting Asiri Hospital, Kirula Road, Colombo 5, Sri Lanka. Subjects 105 patients with coronary artery disease and 112 controls. Method Fasting serum homocysteine levels were measured in 105 patients diagnosed as having CAD and in 112 unmatched controls. All patients admitted with clinical, electrocardiographical, biochemical or echocardiographical evidence of CAD were included in the study. Controls were selected from subjects admitted for health screening. Results 105 patients with CAD and 112 controls (unmatched for age and sex) were studied. A serum homocysteine level in excess of 18.2 μmol/l was considered high. Confounding effects of other conventional risk factors for CAD were controlled using multivariate logical regression analysis.

υχϋ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Conclusion Hyperhomocysteinaemia is significantly associated with CAD. Multivariate logistic regression analysis indicated that the association between hyperhomocysteinaemia and CAD was confounded by other risk factors. However, statistical analysis revealed a significant independent association between hyperhomocysteinaemia and CAD (adjusted odds ratio = 2.881). Mendis S. Athauda SBP. Naser M. Takahashi K. (1999). "Association between hyperhomocysteinaemia and hypertension in Sri Lankans." Journal of International Medical Research 27(1): 38-44. Objective: To examine the relationship between homocysteine and its metabolites, and hypertension in a cohort of Sri Lankan patients with essential hypertension. Study Method: This study examined the relationship between homocysteine and its metabolites, and hypertension in a cohort of Sri Lankan patients with essential hypertension. Serum homocysteine, cysteine, cysteinylglycine and glutathione were measured in 86 patients with a diagnosis of essential hypertension and compared with those of an age- and sex-matched control group. Study area: Sri Lanka Study population: Patients with essential hypertension Type of study: Cohort Study Sample size: 86 Factors investigated: Serum homocysteine, cysteine, cysteinylglycine and glutathione Results: Patients with hypertension had significantly higher mean serum concentrations of homocysteine, cysteine and cysteinylglycine. The odds ratio for hypertension for those with a mean serum homocysteine concentration above 18 μmol/l was 2.8. Conclusion: Hyperhomocysteinaemia is a risk factor for hypertension in Sri Lankans and can lead to a threefold increase in risk. Muzrif MMM. Kumarapeli V (2012). "Under-nutirition, feeding practices and asscoiated factors among pre-school children attending child welfare clinic in Passara MOH area." The Ceylon Medical Journal 57(Suppement 1): Page 40. Objective: Assess the proportion with under-nutrition, feeding practices, and factors associated with under-nutrition among children age 3-5 years Study method: A clinic based study was carried out among 422 children recruited using systematic sampling. Response rate was 98.13%. Data was collected using the study instruments regarding the socio-demographic-economic characteristics, long and short term feeding practices by 24 hour dietary recall and associated factors, Individual Dietary Diversity Score (IDDS) was calculated under 8 food groups. Study Area: A child welfare clinic at Passara Medical Officer of Health Area

υχό Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Study population: Children of age between 3 to 5 years Study Instrument: Interviewer administered questionnaires Child Health Development Record Health and Weight was measured using standard methods Study type: A clinic based cross sectional study Sample size: 414 Sampling method: A systematic Sampling Method Risk Factors Investigated: Diet Nutrition Results: Stunting, underweight and wasting was found among 45.5%, 41.0%, and 14.5% respectively. Rice was the main meal among 99.1%, Rotti and bread being 82.2% and 51.2% respectively. Snacks were: biscuits (95.0%), fruits (56.9%), yoghurt (45%), and buns (42.2%). Drinks were: Milk –tea (84.6%), plain –tea (72%), milk (64.2%), Bottled drinks (25.8%); homemade fruit drinks (15.4%). Main meal frequency was 3.08(SD 0.63), 16.6 % recommended 4 meals per day. Mean IDDS was 4.66 (SD 1.36); 23.2% were below recommended level of 4. Low IDDS was significantly associated with underweight, stunting, and wasting (p<0.05). Average monthly income, presence of >3 children in the family and index child’s birth order being >2 were significantly associated with underweight (p<0.05). Conclusions: Food availability in the estate sector should be increased to achieve dietary diversity among children. Special prevention programmes are needed targeting most vulnerable groups with continuous monitoring. Padumadasa S. Goonewardene M. (2003). "Knowledge and awareness about gynaecological cancer." Sri Lanka Journal of Obstetrics and Gynaecology 25: 30-33. Objective: To assess the knowledge and awareness about gynaecological cancer. Study Method: A total of 516 consecutive women who attended the University Gynaecology Clinic at Teaching Hospital, Mahamodera, Galle during August and September 2002 were administered a pretested structured questionnaire. Study area: University Gynaecology Clinic at Teaching Hospital, Mahamodera, Galle Study population: Women Study instrument: Pretested structured questionnaire Sample size: 516 Factors investigated: Knowledge in the following areas; risk factors, symptoms, methods of early detection and prevention of cancers of theuterine body, cervix and ovaries.

υχύ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Results: The knowledge about gynaecological cancer presenting as abnormal vaginal bleeding was poor. Two-hundred and thirty six (45.8%) women thought that as one approaches menopause, irregular vaginal bleeding was normal. Only 185 (35.8%) women knew that post-menopausal bleeding was abnormal. Only 163 (31.5%) women knew that post-coital bleeding might be a symptom of cancer. Two hundred and forty one (46.7%) women had heard about the cervix. Only 89 (17.3%) knew that early marriage was a risk factor for cervical cancer while only 143 (27.7%) knew that multiple sexual partners was a risk factor for cervical cancer. Only 27 (5.2%) were aware of the cervical smear. Although 363 (70.3%) had heard about Hormone Replacement Therapy (HRT), only 38 (7.4%) knew that there was an association with the occurrence of breast cancer and only 63 (12.2%) knew that there was a high risk of endometrial cancer if used inappropriately. Only 134 (26.0%) women had heard about ovarian cancer. Conclusion: The knowledge about gynaecological cancer in women attending the University Gynaecology Clinic was poor. Educational programmes in schools and community intervention programmes should be considered to increase the awareness about gynaecological cancer. Perera BJC. (1990). "Underdiagnosis of Childhood Asthma." Ceylon Journal of Child Health 19(1): 45-47. Objective: To determine the degree to which childhood asthma is underdiagnosed in a suburban population in this island. Study Method: The study was carried out on all consecutive children admitted to the paediatric unit of the Colombo South General Hospital, Kalubowila, Sri Lanka from 30th July 1990 to 30th August 1990. Each patient was assessed as to the presence of a respiratory disorder and if positive, the mother was interviewed in detail on a specific questionnaire. Definitive information was sought on the onset and progress of the present illness, significant past history if any and treatment given to the child prior to admission to hospital. Specific information was obtained on what details of the illness were given to the parents by doctors before admission. Whenever available, general practitioner referral notes, outpatient treatment notes and admission notes made by the outpatient doctor who saw the child immediately prior to admission, were carefully scrutinised. The in-patient diagnosis of asthma was made on the history of the present illness, past history of wheezing of at least two episodes during the previous six months, history of atopy, family history of asthma and the typical clinical presentation. Study area: Paediatric unit of the Colombo South General Hospital, Kalubowila Study population: Children under 12 years Study instrument: Interviewer administered questionnaire Sample size: 118 Disease investigated: Childhood Asthma Results: The total number of children under 12 years admitted was 430 out of which 118(27%) had respiratory problems. Out of these 118 patients, 58 were diagnosed as asthmatics on the criteria given above. Of the 58 children with asthma, 52 (90%) were seen by either hospital outpatient doctors, general practitioners in the area or both. The correct diagnosis was made in only 23 (44%)

υψτ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

of these prior to admission. 21 out of the 58 patients had acute severe asthma and this had been detected in only 13 prior to admission. Life threatening severe asthma was present in 8 and the proper diagnosis was made in only 4 before admission. The information given to mothers was assessed by a verbal recall method and out of the 52 asthmatics seen by hospital and private doctors, only 21 were told that their child had asthma. Conclusion: It is imperative that active efforts are made to improve the situation of underdiagnosis of childhood asthma in this country. Improvements in the patient and parent education coupled with continuing medical education seems to be the only rational way towards better diagnosis. Early detection would invariably mean useful and appropriate treatment so that the quality of life could be improved a great deal for these unfortunate children. Perera R. Ekanayake L (2012). "Distribution and correlates of Body Mass Index in the elderly residents of the Colombo District." Journal of the College of Community Physicians of Sri Lanka Vol 17(1): 9-14. Objective: To determine the distribution and correlates of body mass index in the elderly residents of the Colombo District. Study Method: The data for the present paper was obtained from a broader study that was carried out to assess tooth loss and its effects on the well-being of an adult population aged 20 years and above residing in the Colombo district. Those living in business premises, prisons, hostels and religious institutions as well as those who were physically and mentally challenged were excluded. Also written informed consent was obtained from all participants. The formula for estimating a population proportion with absolute precision was used to calculate the sample size. For the purpose of calculating the sample size, the prevalence of underweight in 55-65 year olds in the Western Province (20%) reported in a previous study was considered ( Wijewardene K, Mohideen MR, Mendis S, Fernnando DS, Kulathilaka T, Weerasekara D.et al. Prevalence of hypertension, diabetes and obesity: baseline findings of a population based survey in four provinces in Sri Lanka).Accordingly, the minimum sample size required for the present study using a prevalence estimate of 20% at a 95% confidence level and accepting a sample error of 5% was 246. Since it was decided to use the cluster sampling method to select the sample, it was necessary to make allowance for the design effect which was considered as 1.5. After making adjustments for the design effect and non-responses (10%), the sample size required was 406. However 452, ≥ 60 year old subjects were included in the main study which exceeded the minimum sample size (406) required for this part of the study. Therefore that sample of 452 was adopted for the present study as well. Cluster sampling technique- a method of probability sampling was used to select the sample and when this technique is used it is necessary to include at least 30 clusters to obtain valid data (Kirkwood, B.R. and Sterne, JAC. Essential Medical Statistics. 2nd ed. London). As the study population is large and distributed over a wide geographical area, it was decided to select the subjects from 60 clusters to ensure validity and also the same number of subjects from each cluster. Administration of health services in the Colombo district is carried out by the Ministry of Health and the Colombo Municipal Council (CMC). The regions under the purview of these two authorities are further divided into Public Health Inspector areas (PHI). Based on the population proportions of the two regions, it was decided to select 17 of the 60 clusters from the CMC area and 43 from the rest of the district. A PHI area was considered as a cluster.

υψυ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

The probability proportionate to size technique (PPS) was used to identify the required number of clusters from each of the two regions and 7 subjects per age group (452/60) were selected from each identified cluster. By using the PPS technique and selecting the equal number of subjects per cluster, each individual in the population would have the same probability of being selected to the sample . The households from a selected cluster were identified by the method recommended by the World Health Organization for cluster surveys . The individuals who satisfied the inclusion criteria were chosen by visiting the selected households in each cluster. Data were collected by means of a pre-tested interviewer administered questionnaire and a physical examination The BMI was classified based on the proposed World Health Organization cut-off values for Asians; normal (18.5-22.99 kg/m2 ), under weight (<18.5 kg/m 2), over weight (≥23-24.99 kg/m2 ), obese (≥ 25 kg/m2 ) . Chi square test was used to determine the associations between categorical variables. Study area: Colombo District. Study population: Subjects aged 60 years and above residing in the Colombo district of Sri Lanka ,and those living in business premises, prisons, hostels and religious institutions as well as those who were physically and mentally challenged were excluded Type of study: A cross-sectional study Study instrument: A physical examination (height and weight measurements) and an interviewer administered questionnaire. Sampling method: Cluster sampling technique Sample size: 452 Risk Factors investigated: BMI, the elderly, obesity, overweight, under weight Results: Of the 452 subjects, height and weightmeasurements were obtained only from 437 subjects giving a response rate was 97%. The mean age of the sample was 67.6 ± 6.4 years and there was a preponderance of females (52%). The mean BMI of the sample was 21.75 ± 3.88 kg/m2. Table 1 shows the BMI according to age and sex. The mean BMI of males and females were 21.07 ± 3.55 kg/m and 22.38 ± 4.06 kg/m respectively. The BMI was significantly higher in females compared to males and in the 60-70 year old group than in the >70 year old group. Also in males, the 60-70 year old group had a significantly higher BMI than the >70 year old group. According to the BMI cut-offs used in this study, 46% of the sample was normal weight while 20, 16 and 18% were under weight, over weight and obese respectively. Age, sex, ethnicity and the level of education were significantly associated with the BMI in the bivariate analysis (Table 2). The results also revealed that With a unit increase in age, the odds of being overweight and obese relative to being normal weight decreased by 6% and 5% respectively (0.94-1.00=-0.06; 0.95-1.00=-0.05). The odds of being obese relative to being normal weight was 58% (0.42-1.00=0.58) lower in males compared to women. Also the odds of being obese relative to being normal weight was lower in the Sinhalese (OR=0.14; 95% CI= 0.03-0.79) and the Tamils (OR=0.14; 95% CI= 0.02-0.84) compared to the Moors.

υψφ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Table 1: BMI according to age group and sex Age group (years) BMI Mean SD 60-70 (143) 21.75 3.53 >70 ( 66) 19.59 3.16 Total male (209) 21.07 3.55 60-70 (155) 22.70 4.00 >70 ( 73) 21.70 4.15 Total female (228) 22.38 4.06 Table 2: Associations between some variables and nutritional status as assessed by the BMI Variable Underweight N=87 Normal N=203 OverweightN=69 ObeseN=78 N % N % N % N % Sex Male (209) 46 22.0 109 52.2 28 13.4 26 12.4 Female(228) 41 18.0 94 41.2 41 18.0 52 22.8 Agegroup(years) ≥60-70 (298) 46 15.4 13 45.3 55 18.5 62 20.8 >70 (139) 41 29.5 68 48.9 14 10.1 16 11.5 Ethnicity Sinhala (352) 75 21.3 164 46.6 54 15.3 59 16.8 Tamil (73) 9 12.3 37 50.7 13 17.8 14 19.2 Moor (12) 3 25.0 2 16.7 2 16.7 5 41.7 Marital status Married (284) 59 20.8 128 45.1 49 17.3 48 16.9 Single/divorced/ Widowed (153) 28 18.3 75 49.0 20 13.1 30 19.6 Education (years) ≤ 5 (130) 35 26.9 59 45.4 13 10.0 23 17.7 >5 (307) 52 0.9 144 46.9 56 18.2 55 17.9 Smoking status Current (40) 7 17.5 27 67.5 3 7.5 3 7 .5 Ever (93) 23 24.7 Never (304) 57 18.8 132 43.4 54 17.8 61 20.1 Diabetes Yes (128) 26 20.3 55 43.0 23 18.0 24 18.7 No (309) 61 19.7 148 47.9 46 14.9 54 17.5 Hypertension Yes (150) 31 20.6 70 46.7 22 14.7 27 18.0 No (287) 56 19.5 133 46.3 47 16.4 51 17.8 Total (437) 87 19.9 203 46.5 69 15.8 78 17.8 Conclusion: The results indicate that the prevalence of under nutrition and overweight/ obesity was high in this sample of the elderly.

υψχ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Perera WLSP. Fernando HTEI. Tissera PAD. "Knowledge of prevention of chronic complications of Diabetes Mellitus among diabetic patients attending clinics in the Provincial General Hospital, Ratnapura." Objective: To describe the knowledge on prevalence of chronic complications of diabetes mellitus among diabetic patients attending clinics in Provincial General Hospital, Ratnapura. Study Method: A descriptive cross-sectional study was conducted, using a pre tested interviewer administered questionnaire, in the medical clinics of Provincial General Hospital, Ratnapura. Systematic sampling was used to select 385 respondents over 15 clinic sessions. Study area: Provincial General Hospital, Ratnapura Study population: Diabetic patients who attended diabetic clinics Type of study: Cross sectional Study Study instrument: Pre tested interviewer administered questionnaire Sampling method: Systematic sampling Sample size: 385 Disease investigated: Diabetes Mellitus Results: All 385 selected participated in the study. With regard to control of Diabetes Mellitus, 89.6% (n = 345) knew the importance of regular blood sugar monitoring and 96.9% (n = 373) knew lifelong medication was necessary. Knowledge on chronic complications varied greatly as 98% (n = 377) knew the risk of foot ulceration when only 58% (n = 223) had heard of Cerebro-Vascular Accidents. Uncontrolled blood sugar levels were correctly identified by 98.7% (n = 379) as a risk factor for the development of chronic complications but only 19.3% (n = 72) correctly mentioned smoking as a risk factor. Conclusion: Even though the importance of blood sugar control was understood by the patients, their knowledge on the range of chronic complications and the risk factors for the development of chronic complications was not satisfactory. Simple and effective health education methods are recommended to improve the knowledge. Premaratne R. Amarasinghe A. Wickremasinghe AR (2005). "Hospitalisation trends due to selected non-communicable diseases in Sri Lanka, 2005–2010." The Ceylon Medical Journal 50(2). Objective: To project hospitalization trends due to selected noncommunicalble diseases (NCD) from 2005 to 2010. Study method: Morbidity data , maintained at the Medical Statistics Unit of the Ministry of Health , from 1981 to 200 , were used to model trends of hospitalization due to diabetes mellitus , hypertensive diseases and ischemic heart diseaseds. Linear and quadratic trends were used to model morbidity trends.

υψψ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Results: The results of the models used for disease projections are given in table 1. For all three diseases considered, the quadratic trend is positive and significant, indicating that the increase in the incidence of hospitalization is exponential. Table 2. gives the projected incidence of hospitalization and the 95% confidence intervals of the projections. Based on these projections, it predicted that by the year 2010 there will be an increase, as compared to the projections for the year 2005, in the incidence of hospitalization by 36%, 40%, and 29% due to diabetes mellitus, hypertensive diseases, and ischemic heart disease diseases respectively. The greatest burden and the largest increase in the rate of hospitalization will be due to hypertensive diseases. Rajapakse PS. Nagarathne M. Chandrasekra KB. Dasanayake AP (2005). "Periodontal disease and prematurity among non-smoking Sri Lankan women." J Dent Res 84(3): 274-7. The hypothesis that periodontal disease is associated with pre-term low birth weight was tested in a prospective follow-up study of rural prima-gravida women (N = 227) who were free of tobacco, alcohol, and drug use. Women with 3rd trimester mean probing pocket depths, plaque, and bleeding scores that were greater than the median value in the cohort were defined as "exposed". There were 17 (7.5%) preterm low birth weight singleton deliveries in the cohort (among "exposed" = 12%; among "unexposed" = 5.6%; Odds Ratio = 2.3; 95% CI = 0.9-6.3). After adjustment for the independent variables, the OR for preterm low birth weight in relation to "exposure" was 1.9 (95% CI = 0.7-5.4). Our results are only suggestive of an association between periodontal disease and preterm low birthweight, perhaps indicating that previously reported associations may have been subjected to residual confounding due to tobacco, alcohol, and drug use. Ranawaka PRD. Abayasuriya KC. Mettananda DSG. De Abrew K. Wijesuriya M (2010). "Clinical profile of type 2 diabetes mellitus in relation to the body mass index." The Ceylon Journal of Medical Science 53(1 and 2): 23-35. Objective: To evaluate the body mass index of patients with type 2 diabetes and to compare the glycaemic control, prevalence of complications and co-morbidities and treatment of those with a BMI of <23 kg/m2 (low and normal body weight patients) those with a BMI of >23kg/m2 (overweight and obese patients). Study method: The study was conducted at the National Diabetes Centre of Sri Lanka (NDC), to evaluate the clinical associations of patients with type 2 diabetes in different categories of Body Mass Index (BMI). Data was obtained by perusal of records of people with type 2 diabetes who attended the screening programme for complications at the NDC. Records of the patients screened in the year 2003 were perused in alphabetical order. All patients who were on a diet therapy alone or oral hypoglyceamic drugs for a minimum of a period of 3 months following diagnosis irrespective of the age at diagnosis were considered as having type 2 diabetes. Patients were usually referred to the NDC by General Practitioners and specialists for screening for complications. Self referral was also possible. Data on age, gender, height waist circumference, duration of diabetes, and family history of diabetes, presence of complications and co- morbidities and current treatment of each patient was obtained using the data records of the patients. Further the BMI, glycemic control and the presence or absence of peripheral neuropathy, retinopathy, maculopathy, cataract, nephropathy, ischemic heart disease and foot problems were also assessed in these patients. BMI and glycemic controls were measured using the relevant standard techniques, while the complications were directly obtained from the records which were based on medical officer’s clinical judgment at the time of screening.

υψω Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Study Area: National Diabetes Centre of Sri Lanka (NDC) Study population: All patients who were on a diet therapy alone or oral hypoglyceamic drugs for a minimum of a period of 3 months following diagnosis irrespective of the age at diagnosis were considered as having type 2 diabetes. Study Instrument: Medical records of the patients Measurement of glycemic control by fasting blood glucose, HbA1c% and the presence glucose in the early morning sample of urine using glucose strips. Study type: Retrospective analytical study Sample size: 1022 Sampling method: Convenient sampling method Risk Factors Investigated: Body Mass Index and type 2 Diabetes Mellitus Results: The results revealed that there were 631 (61.7%) males and 391(38.3%) females. Majority, 62.6% were between 41-60 years of age. Mean BMI was below 23 kg/m2 in 392 (38.3%) patients and above 23 kg/m2 in 630 (61.7%) patients. Of the patients who had BMI below 23 kg/m2 32 (8.2%) had their waist circumference at a high risk level. In the group with BMI> 23 kg/m2, 191 (30.2%) had their waist circumference at a high level (above 102 cm in males and above 88cm in females). Majority of those who had waist circumference at high risk level were females (86.1%). Blood glucose control of those with BMI below 23 kg/m2 was significantly poor when compared to those with the BMI above 23 kg/m2 (p<0.05). Subjects were screened for complications by trained medical staff using set criteria for each complication. Those with a BMI below 23 kg/m2 had a significantly higher association with peripheral neuropathy,retinopathy,maculopathy and cataract irrespective to the duration of diabetes. A sulphonylurea drug was not used by majority in this group. Subjects with type 2 Diabetes mellitus having a BMI below 23 kg/m2 were at a significantly higher risk of having peripheral neuropathy (OR=1.45, CI 1.04-2.02), Retinopathy (OR=1.64, CI 1.22-2.21), maculopathy (OR=2.76, CI1.54-4.96 ), and cataract (OR=1.65, CI 1.13-2.42). Although general recommendation is to use metformin in overweight patients it was used as many as 34.7% patients with a BMI of below 23 kg/m2 and only 46.2% with a BMI above 23 kg/m2 . Sulfonylureas were used by 158(40.3%) patients with a BMI of below 23 kg/m2 and 238 (37.7%) patients with a BMI above 23 kg/m2 although they were known to cause weight gain. Insulin was used by a minority of patients: 37(9.4%) patients with a BMI of below 23 kg/m2 and 29 (4.6%) patients with a BMI above 23 kg/m2 . Rikki Mistry . Nandanee Wickramasingha. Simon Ogston. Meenu Singh. Vasantha Devasiri. Somnath Mukhopadhyay. (2004). "Wheeze and urban variation in South Asia." European Journal of Paediatrics. Objective: Typically, urban South Asia is characterised by narrow streets, heavy traffic, visible haze, unplanned city architecture and the use of kerosene or wood-burningstoves at home. However, some urban areas in South Asia are clean and modern, with concrete housing, vehicle emission regulations and use of smoke-freehousehold fuel. The purpose of this study was to compare wheeze prevalence in 13–14-year-olds between two South Asian cities (Galle, Chandigarh), representing each of the above two archetypes.

υψϊ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Study method: The validated one-page International Study on Asthma and Allergies in Childhood (ISAAC) questionnaire for 13–14-year-olds was used for the study. Crude prevalence rates, and prevalence odds ratios (with 95% two sided confidence intervals (CI)) for comparison of prevalence rates were calculated (SPSS; 11.50). A further sub-group analysis was performed to calculate prevalence rates specific for gender. Study Area: Galle (population 100,000), a busy urban seaport, has printing presses, mills, limestone works and grinding industries. Industrial and domestic pollutants visibly peak at commuting hours. Houses are tile-or asbestos-roofed and have concrete floors. Kerosene and firewood are the predominant domestic fuels; the use of gas as a domestic fuel is an exception. Broadly, the population is vegetarian (curries and rice based staples). Chandigarh (population 750,000) is a clean, modern city with no factories. Houses are made of concrete. The city was designed and constructed around 1950 by the Swiss-born architect Le Corbusier. ‘‘Smokeless’’ liquid petroleum gas is used almost universally as a cooking and heating fuel. Since 2000, the local government has maintained a drive to cut vehicle emissions . The majority of the population is vegetarian (staples: wheat and rice). Study population: 13–14-year-olds young adolescents Study Instrument: The validated one-page ISAAC questionnaire Sample size: 1737 Sampling method: Random sampling method Results: Of 1814 distributed questionnaires, 1737 (95.8%) were completed correctly (Galle: n =1162; Chandigarh: n =575). A total of 77 questionnaires were rejected (47 incorrectly completed; 30 incomplete). A random Sample was re-checked to establish accuracy of data entry. The high prevalence rate for wheezing in Galle (28.7%) led to higher odds ratios (P <0.05) for lifetime wheezing, wheezing in the previous year, exercise-related wheeze and physician-diagnosed wheeze, than Chandigarh (12.5%).The numbers of 13–14-year-olds experiencing mild to moderate wheeze (<12 wheezing episodes/year) or moderate sleep disturbance due to wheeze (<1 night per week) were significantly higher (P <0.05) for Galle than Chandigarh. For frequent wheezers (12 or more episodes per year), the odds ratios between Galle and Chandigarh did not achieve significance OR:2.2 ( C.I 0.5–10.3). The differences were also not significant for sleep disturbance due to wheeze of one or more nights per week, or for speech disturbance due to wheeze. There was more self-reported night cough without cold or chest infection in the previous 12 months in Chandigarh than in Galle (19.2% versus 27.5%, prevalence odds ratio 0.7; CI 0.6–0.8, P <0.05). Prevalence odds ratios for self-reported wheeze symptoms were significantly higher for males (M) than females (F) in Chandigarh (M (n =313) : F (n =262); wheezing ever 2.2; CI 1.3–3.6; wheeze in the previous 12 months 1.9; CI 1.1–3.3) but not for Galle (M (n =559) : F (n =603); wheezing ever 1.1; CI 0.9 -1.3; wheeze in the previous 12 months 1.1; CI 0.9–1.4).

υψϋ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Conclusion: Of 1814 distributed questionnaires, 1737 (95.8%) were completed correctly and returned (Galle: n =1162; Chandigarh: n =575). Crude prevalence rates, and prevalence odds ratios (with 95% two-sided confidence intervals (CI) for comparison of prevalence rates), were calculated. The prevalence rate for wheezing in Galle (28.7%) was higher than in Chandigarh (12.5%). The prevalence odds ratios (Galle versus Chandigarh) for lifetime wheezing (2.3; 1.8–2.9), wheezing in the previous year (2.1; 1.6–2.7), exercise-related wheeze (4.8; 3.5–6.7) and physician-diagnosed wheeze (1.7; 1.2–2.3) demonstrated significant differences in wheeze prevalence between the two cities (P<0.05). The numbers of 13–14-year-olds experiencing less than 12 wheezing episodes per year or sleep disturbance due to wheeze of less than 1 night per week were also significantly higher for Galle than Chandigarh. There is a higher prevalence of wheeze in 13–14-year-old children living in an old-fashioned, congested city than in a clean and modern city in South Asia. Samarasinghe D. (1992). "Reducing tobacco use in Sri Lanka." Ceylon Med J 37(3): 68-71. Tobacco use is steadily declining in wealthy countries, whereas it is increasing in poor countries. Approaches found successful in wealthy countries should be applied vigorously in Sri Lanka too. This requires sustained and active lobbying, especially by doctors. Some promising strategies are already being used in Sri Lanka which indicate that countries such as ours could develop appropriate local approaches in addition to those found useful in rich countries. These have evolved with little active support from the medical profession. If doctors actively complement these efforts, Sri Lanka could provide a model in successful smoking control for poor nations. Sarath M. Samarage (1992). A study on the utilization of patient care services of a general hospital by diabetics. Postgraduate Institute of Medicine. Colombo, University of Colombo. Master Degree in Community Medicine Main objective: To study the utilization of patient care services of the General Hospital Kalutara by diabetics Specific objective: 1.To study the socio-economic characteristics of the diabetic patients utilizing the services of the General Hospital Kalutara. 2.To describe the pattern of utilization of patient care services. 3.To determine the adequacy of patient care services provided. 4.To recommend measures to improve the patient care services available to the diabetics. Study area: General Hospital Kalutara Study population: Diabetic patients utilizing the patient care services of the General Hospital Kalutara, and their service providers. Type of study: Descriptive cross sectional study Study instrument: A pre tested structured questionnaire A structured observation schedule for the observation of selected patient care services . Sampling method: All the diabetic patients registered at the medical clinics held in the hospital were selected as the study sample. Usually the patients attended the clinic once in two weeks. All the diabetic patients attending the clinic during a two week period were included for this study.

υψό Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Sample size: 228 Diabetic patients Disease investigated: Diabetic mellitus Results: 13.9% of the patients attending the medical clinic were diabetics.Only 45% of the diabetics were from Kalutara A.G.A Division ,where the hospital is situated. The services are utilized predominantly by lower socio-economic groups. Majority (55%) of the respondents travel over 5 miles to attend the clinic.46% had bypassed at least one goverment health care facility. A diabetic spends at least Rs.13 to Rs. 67 for a clinic visit.They spend 1 to 6 hours (mean 2.2 hours) in the hospital to attend the medical clinic. The waiting time ranged from 41 minuthes to 1 hour and 51 minutes (mean 1 hour and 29 minutes). The consultation time ranged from 30 seconds to 4.5 minutes ( mean 2.2 minutes). Consequently the clinic care provided to the diabetic patients are inadequate. Conclusion Very little patient education takes place at the clinic, although adequate opportunities are available. This was further confirmed by the poor level of knowledge about diabetes among the diabetic patients. Audio visual material which enrich the patient education on diabetes, too are lacking. Siritunga TLJC. (2006). Effect of outdoor air pollution on respiratory health of children in an urban and a rural area in the district of Kandy. Postgraduate Institute of Medicine. Colombo, University of Colombo. Doctor of Medicine in Community Medicine General objective: To determine the occurrence of selected respiratory symptoms among children and to describe the association of outdoor air pollution with respiratory health of children, in an urban and a rural area in the district of Kandy Specific Objective: 1.To compare the levels of selected outdoor air pollutants in an urban and a rural area in Kandy district 2.To compare the occurrence of selected respiratory symptoms among children in an urban and a rural area in Kandy district 3.To estimate the ventillatory functions of the two groups of children 4.To determine the risk of selected outdoor air pollutants and other selected factors on occurrence of respiratory symptoms and ventilator functions of children in an urban area and a rural area in Kandy District Study method: The study was carried out in two phases – - Phase 1. – One year community based prospective cohort study to estimate and compare the occurrence of selected respiratory symptoms ( cough , nasal discharge, phlegm production, shortness of breath, throat irritation and wheezing) to identify the risk factors for the occurrence of those symptoms by using a questionnaire and a monthly filled diary - Phase 2- 1. A community based cross sectional study to estimate outdoor air pollutant level in monthly intervals in two areas for a period of one year. 2. A community based cross sectional study to estimate the ventilatory functions of a sub sample of the two groups of children Study Area: Kandy Municipal Council area as the urban area and the Yatinuwara divisional secretariat area as the rural area and 32 grama niladhari (GN) divisions (sixteen from each area) were selected for the study.

υψύ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Study population: Children aged 7-12 years, who have been living in the respective study area for at least 5 years by September 1st 2004 and also attending school of the selected area. Children who were diagnosed with congenital deformities such as congenital heart disease, lung diseases etc, those who were diagnosed by a physician with Chronic respiratory diseases, those with a history of injury or surgical intervention affecting the thorax and those who lived in a domestic environment with high exposure risk to occupational air pollutants were excluded from the study. Study Instrument: Interviewer administered questionnaire A monthly filled one page diary A passive gas sampling technique to monitor air pollution A spirometer and a peak flow meter to estimate the lung functions Study type: A prospective cohort study for phase 1 A community based cross sectional study for Phase 2. Sample size: 1033 children Sampling method: Random Sampling technique Risk Factors Investigated: Air pollution Results: The study populations included 518 subjects from the urban area and 515 from the rural area. The results show the average of episodes of four respiratory symptoms – cough, nasal discharge, phlegm production and throat irritation were higher in the KMC area compared to Yatinuwara area and the differences were statistically significant as follow- Symptom Urban area Rural area significance Cough 3.99 2.23 P<0.001 Throat irritation 1.52 0.86 P<0.001 Nasal discharge 4.39 3.13 P<0.001 Phlegm production 2.21 1.29 P=0.003 However, there was no difference of the other two symptoms studied (shortness of breath and wheezing) in both areas Symptom Urban area Rural area significance Shortness of breath 0.49 0.44 P=0.6 Wheezing 0.47 0.48 P=0.92 The monthly concentrations of the three pollutants studied and the results revealed that they were significantly higher in the urban (KMC) area compared to the rural (Yatinuwara) area as shown below- Concentration of the pollutants Urban area Rural area significance NO2 0.061 0.0158 P<0.001 SO2 0.0693 0.0149 P<0.001 O3 0.0607 0.0206 P<0.001 The monthly levels of NO2 and so2 in the KMC area exceeded the recommended air quality standards for Sri Lanka, as for monthly O3 levels they were below the recommended air quality

υωτ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

standards for Sri Lanka, and it was not considered as a risk factor and was not taken for further analysis. The average duration in days of an episode of each symptom suffered per child was not significantly different between the two areas Symptom Urban area Rural area significance Cough 3.73 3.64 P=0.44 Throat irritation 3.08 3.14 P=0.62 Nasal discharge 3.72 3.91 P=0.1 Phlegm production 3.56 3.57 P=0.97 Shortness breath 3.35 3.46 P=0.54 Wheezing 3.18 3.12 P=0.78 Significant positive correlations were seen between NO2 levels and episodes of cough (p=0.013) and nasal discharge (p=0.034), however, the other four symptoms did not show a significant correlation with NO2. SO2 levels also did not show a significant correlation with any of the symptoms studied- -Cough P=0.146 -Throat irritation P=0.438 -Nasal discharge P=0.448 -Phlegm production P=0.229 -Shortness breath P=0.106 -wheezing P=0.929 The protective factors identified for respiratory symptoms adjusted for co founders were for cough; increasing age (OR=0.862, 95% CI=0.770-00.964), for nasal discharge; increasing age (OR=0.860, 95% CI=0.751-0.983): for shortness of breath; being a male (OR=0.611, 95% CI=0.455-0.820): for wheezing, being a male (OR=0.7, 95% CI=0.521-0.940). the risk factors identified for respiratory symptoms adjusted for cofounders were: for cough; NO2 > 0.05 ppm (OR=2.621, 95% CI=1.825-3.764): for nasal discharge; use of mosquito coils inside thee house (OR=1.822,95% CI = 1.113 – 2.981): for phlegm production; SO2≥ 0.05 ppm (OR = 1.509, 95% CI = 1.022 – 2.229), NO2≥ 0.05 ppm (OR = 4.709, 95% CI = 3.078 – 7.205): for throat irritation; NO2 ≥ 0.05 ppm (OR = 2.730, 95% CI = 2.099 – 3.552): for shortness of breath; NO2 ≥ 0.05 ppm (OR =3.588, 95% CI = 1.971 – 6.531): for wheezing; NO2 ≥ 0.05 ppm (OR = 1.430, 95% CI = 1.062 – 1.925) Two measurements of ventilatory functions, mean FEV1 and FVC were higher in KMC area compared to Yatinuwara and the difference was statistically significant (FVC : Urban = 1.55 l, Rural = 1.42 l, p = 0.002, FEV1 : Urban = 1.52 l, Rural = 1.4 l, p = 0.01). However, the means of the other two measurements FEF25-75%and PEFR were not different in the two areas (FEF25-75% : Urban = 1.35 l, Rural = 1.27 l, p = 0.017, PEFR: Urban = 300.12 l/min, Rural = 298.13 l/min, p = 0.78). Multiple linear regression analysis identified the predictors for ventilator functions as sex, height, weight and exposure to biomass combustion (FVC: height; p = 0.002, weight; p = 0.005, sex; p < 0.001, exposure to smoke due to biomass combustion; p = 0.018. FEV1: height; p = 0.019, weight; p = 0.001, sex; p < 0.001, exposure to smoke due to biomass combustion; p = 0.035. FEF25-75%: height; p = <0.001. PEFR: height; p < 0.001, age; p = 0.024, sex; p < 0.001).

υωυ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

The air pollution was more evident in the urban areas and the most episodes of respiratory symptoms also occurred in urban areas. High concentrations of these pollutants in the air predict the occurrence of respiratory symptoms. Programmes to promote respiratory health should aim at reducing levels of air pollutants. However, the other co- pollutants such as particulate matter, carbon monoxide and other co-factors such as allergy also play a role in prediction of respiratory symptoms and ventilator functions and further research is needed to identify the associations of those factors with respiratory health. Surenthirakumaran R. Pathmeswaran A. Jeyakumaran N. Sivaraja N (2010). "The contribution of known cancer risk factors to the burden of cancer in Jaffna, Sri Lanka." The Jaffna Medical Journal 26(1): Page 58. Objective: To estimate the contribution of selected known cancer risk factors to the burden of cancer in Jaffna Study method: The study subjects were cancer cases seen at the regional cancer unit at Teaching Hospital Jaffna from 1st of January 2006 to 31st of December 2008 and a random sample of residents in Jaffna District selected using stratified cluster sampling. Data was collected by trained interviewers using an interviewer administered pre-tested questionnaires. Prevalence of known cancer risk factors among patients and residents, odd ratios, adjusted odd ratios using logistic regression and population attributable risk fraction percentage (PAF%) were calculated. The study had 80% power at 5% significance to detect the factors that had 10% prevalence in the population and doubled the risk of cancer. Variables such as age category sex, tobacco usage, alcohol usage, inadequate consumption of whole grain products and foods rich in beta carotene, and excess consumption of processed commercial foods, red and processed meat and food containing preservatives were included in the logistic regression model and adjusted odds ratio and PAF% were calculated. Study Area: Regional cancer unit at Teaching Hospital Jaffna and selected sample of residents in Jaffna District Study population: The study subjects were cancer cases seen at the regional cancer unit at Teaching Hospital Jaffna and a random sample of residents in Jaffna District Study Instrument: An interviewer administered pre-tested questionnaires Study type: A cross sectional study Sample size: 365 cancer patients 800 community controls Total =1165 Sampling method: Stratified cluster sampling method Results: Data was obtained from a total study sample of 1156 subjects. The five most common known risk factors for all types of cancers in Jaffna, based on PAF%, were tobacco usage (42.2%), inadequate consumption of beta carotene containing foods (42.0%), inadequate consumption of whole grain products(17.0%), excessive consumption of preserved food (26.5%) and alcohol usage (14.8%). Conclusion Majority of cancer cases can be attributed to modifiable risk factors such as tobacco usage, inadequate consumption of beta carotene containing foods and alcohol usage.

υωφ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Weerarathna TP. Herath HMM. Liyanage. Ariyaratne PGCL (2012). "Variations in the modifiable cardiovascular risk factors in different phenotypes of type 2 diabetes " The Ceylon Medical Journal 57(Suplplement 1): Page 22. Objective: To study the prevalence and pattern of modifiable cardiovascular risk factors according to the gender and age at onset of type 2 Diabetes Mellitus . Study method: Data on gender , age at onset , body mass index (BMI),waist circumference (WC), fasting lipid profile, albuminuria were obtained from a data base of 2082 T2 DM patients who underwent single visit screening . Proportion of subjects with global ( BMI>23kg/m2) and central obesity (WC>90 cm in males and >80 cm in females), dyslipidemia (LDL>100mg/dL, TG>150mg/dL, HDL <40 mg/dL in males and <50mg/dL in females ) , hypertension ( SBP>130 mmHg, DBP >85mmHg or both ) and albuminuria ( urine albumin excretion >300mg/dL) according to gender ,age at onset of T2DM (<30 and >30 yrs) were analyzed. Study population: Patients who were diagnosed to have type 2 diabetes mellitus. Sample size: 2082 Risk Factors Investigated: Age at onset Body mass index (BMI), Waist circumference (WC), Blood pressure, Albuminuria Fasting lipid profile Results: Mean age and duration of T2DM were 43.3 and 5.9 years. Prevalence of any type of dyslipidemia, albuminuria, global obesity, central obesity and hypertension were 82.9%, 69.4%, 63.2 %, 60.3% and 28.5% respectively. Females had a higher significant prevalence of hypertension and central obesity. Younger patients with T2DM had significantly high prevalence of dyslipidaemia. Conclusions Significant variations exist in the prevalence of cardiovascular risk profile in different subjects with T2DM.Management protocols for individual patients with T2DM to reduce cardiovascular morbidity should give priority to these factors to achieve desirable clinical outcomes. WeerarathnaTP. Herath HMM. Liyanage PGCL. Ariyarathne MHB (2012). "Prevalence and prediction of high density lipoprotein (HDL) levels among individuals with Type 2 Diabetes Mellitus." The Ceylon Medical Journal 57(Supplement 1): Page 20 Objective: To describe the prevalence and predictors of low HDL levels among Type 2 DM subjects. Study method: From the electronic database, 2083 subjects who underwent screening data on gender, age at onset of DM, Waist circumference (WC), Body Mass Index (BMI), Glycosylated Hemoglobin (HbA1c) and Fasting Lipid Profile were obtained. Prevalence of low HDL (<40mg/dl in males and <50mg/dl in females) in different categories was estimated and regression analysis was done to study the influence of each variable on HDL level. Sample size: 2083 Sampling method:

υωχ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Random sampling method Results: The sample contained 1348 males and 735 females with a mean age of 49 years. Proportion of females with low HDL levels was significantly higher than males (65.6% versus 34.4%).From those with global obesity, central obesity and suboptimal glucose control, a higher proportion had low HDL levels (66.75% versus 33.3%, 76% versus 24% and 59.7% versus 40.3%). When HbA1c, Central Obesity, Global obesity, duration of disease, gender and age at diagnosis, were included in the binary logistic regression model, female gender, age at diagnosis, duration of disease were found to be significant determinants of low HDL levels. Conclusion: Females with Type 2 DM and those with both forms of obesity and suboptimal glycemic control are at a higher risk of having a lower level of HDL. Special attention to raise the HDL levels should be given to these categories of individuals with Type 2 DM to reduce their cardiovascular risk. Weerasinghe IE. Gunawardhane CSE. Jayatilake JAMS. (2007). "Participation in extracurricular activities and factors associated among grade ten students in Sinhala medium schools of Matale Municipality Area." The Twelfth Annual Academic Session of the College of Community Physicans of Sri Lanka September 2007: Page 17. Objective: To determine the extent and factors associated with participation in ECA by grade ten students in the Matale Municipality Area. Study Method: A descriptive cross-sectional study was carried out in all Sinhala medium Government schools, having grade ten classes in MMA from July to November 2006. A total of 620 students were selected by cluster sampling form nine schools. Study instruments included a self-administered questionnaire, data extraction sheet and a focus group discussion (FGD) guide. Study area: Matale Municipality Area Study population: Grade ten students Type of study: Descriptive cross-sectional study Study instrument: Self-administered questionnaire, data extraction sheet and focus group discussion (FGD) guide Sampling method: Cluster sampling Sample size: 620 Factors investigated: Academic performance, sports, aesthetics, clubs and associations, leadership activities Results: Availability and type of ECA in schools differed with school type, Type 1A schools had the highest variety (n = 60) whereas type 2 schools had the lowest (n = 13). Total number who participated in ECA was 405 (65.3%). Out of them 287 (46.3%) were engaged in sports, 69 (11.1%) in aesthetics, 115 (18.5%) in clubs and associations and 185 (29.8%) in leadership activities. Boys (n = 253, 62.5%) demonstrated a higher participation in ECA than girls (n = 152, 37.5%) (p = 0.007) and students whose siblings were involved in exercise had a higher participation in ECA ( n = 176, 71.8%), than whose siblings did not (n = 229, 61.9%) (p = 0.007). Students in Boys’ schools had a higher participation in sports (n = 92, 62.6%), than Girls’ (n = 40, 35.4%) and Mixed (n = 155, 43.1%) schools (p < 0.001). Similarly, Boys’ schools had a higher participation in aesthetics (n = 27, 18.4%) than Girls’

υωψ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

(n = 12, 10.6%) and Mixed (n = 30, 8.3%) schools (p < 0.025). However, Mixed schools had a higher participation in clubs and associations (n = 76, 21.1%) than Boys’ (n = 17, 11.6%) and Girls’ (n = 22, 19.5%) schools (p = 0.04). Among students who participated in ECA, boys had a higher academic performance (mean score = 52.5) than girls (mean score = 43.1) (p = 0.029). FDG revealed that although a majority was willing to participate in ECA, it was limited by academic workload, lack of facilities in schools and individual financial constraints. Conclusion: Engagement in ECA had not affected academic performance among boys. Recommend improvement of school facilities to enhance participation in ECA by schools adolescents. Wickramasinghe VP. Lamabadusuriya SP. Cleghorn GJ. Davies PSW (2009). "Validity of currently used cutoff values of body mass index as a measure of obesity in Sri Lankan children." The Ceylon Medical Journal 54(4): 114-119. Objective: To study was to determine the reliability of body mass index based (BMI) cutoff values in diagnosing obesity among Sri Lankan children. Study Method: Five to 15-year old healthy Sri Lankan children were recruited from schools in Colombo which had a fair representation of all socio-economic groups. Stratified random sampling based on age and gender was used to recruit subjects. A class from each grade from each school was randomly selected and students were invited to participate and they were given an appointment to come to the clinical laboratory of the University Paediatric Unit of the Lady Ridgeway Hospital for Children, Colombo for the examination. The study was carried out from September 2004 to April 2005 in which body composition of Sri Lankan children were assessed and some of the results had been published previously [Wickramasinghe VP, Lamabadusuriya SP, Cleghorn GJ, Davies PSW. Assessment of body composition in Sri Lankan children: validation of a skin fold thickness equation]. Both parents and children were informed about the procedure. Informed written consent from parents and assent from children were obtained. The height and weight were measured using standard protocols . BMI was calculated by weight/height (kgm-2 ). Waist circumference (WC) was measured in the horizontal plane at the level of mid-point between lower costal margin and upper margin of iliac crest in the mid axillary line [15]. Hip circumference (HC) was measured while the subject stood erect with arms at the sides of the body and feet together at the level of maximum extension of the buttocks that can be seen. Waist-hip ratio (WHR) was calculated by WC/HC. The total body water (TBW) was measured by isotope dilution method using deuterium in the form of water (D2O). The absolute fat mass (FM) was calculated subtracting FFM from weight based on two-compartment body composition model. Percentage FM is when FM was expressed as a fraction of body weight. Percentage FM associated with morbidity was considered to be 25% for boys and 30% for girls and was considered as criterion diagnosis of obesity. Apart from this, obesity was diagnosed based on BMI cut-offs described by IOTF, CDC/ NCHS and British Growth Standards BMI-Z scores. BMI changes with growth from infancy through childhood to adolescents. Therefore BMI-Z score is considered as a better tool for follow up [16]. A BMI above 95th centile for age and gender on CDC/NCHS BMI centile or a BMI-Z above +2 in British Standards was considered to be obese. Obesity was also diagnosed based on percentage FM centile charts (% FM >98th centile) [and WC centilecharts (WC >98th centile). Validity and accuracy of BMI indicators in the diagnosis of obesity were evaluated by calculating sensitivity, specificity, positive predictive value and efficiency, relative to true obesity diagnosed by

υωω Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

absolute %FM (using D2 O), using a 2´2 table and method . Pearson product moment correlation was calculated between anthropometric measures and FM %. Study area: Colombo District Study population: Five to 15-year old healthy Sri Lankan children from schools in Colombo Type of study: Cross sectional study Sampling method: Stratified random sampling Sample size: 282 Risk Factors investigated: fat mass, BMI Results: Two hundred and eighty two children (M/F: 158/124) were studied and 99 (80%) girls and 72 (45.5%) boys were obese based on % body fat. Eight (6.4%) girls and nine (5.7%) boys were obese based on International Obesity Task Force (IOTF) cutoff values. Percentage FM and WC centile charts were able to diagnose a significant proportion of children as true obese children. The FM and BMI were closely associated in both girls (r=0.82, p < 0.001) and boys (r=0.87, p < 0.001). Percentage FM and BMI had a very low but significant association; girls (r=0.32, p < 0.001) and boys (r=0.68, p < 0.001). FM had a significant association with WC and HC. BMI based cutoff values had a specificity of 100% but a very low sensitivity, varying between 8% and 23.6%. Conclusions BMI is a poor indicator of the percentage fat and the commonly used cut-off values were not sensitive to detect cases of childhood obesity in Sri Lankan children. Wickramasooriya T. Tikiribandara H. Thissera N. Udayanga S. Udugoda P. Wanigsekara R. Abeysena C (2012). "Risk factors for Childhood Asthma." The Twelfth Annual Academic Session of the College of Community Physicans of Sri Lanka September 2012: Page 41. Objective: To determine the risk factors for childhood asthma Study Method: A hospital based case control study was done on children between 1-5 years, who were brought to the Pediatric clinics at Colombo North Teaching Hospital. Cases (n = 100) included children those who were diagnosed as asthmatics by a physician. Controls (n = 100) included children not diagnosed of having asthma or recurrent wheezing or any other respiratory tract infections. Children who were having congenital abnormalities were excluded from both cases and controls. Data were collected using a self- administered questionnaire distributed among mothers who visited the clinics with children, to gather information regarding nutritional, environmental, and other relevant factors related to childhood asthma. Multiple logistic regression was applied and the results were expressed as Odds Ratios and the 95% confidence intervals. Study area: Colombo North Teaching Hospital Study population: Children between 1-5 years Type of study: Hospital based case control study Study instrument: Self- administered questionnaire

υωϊ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Sample size: 200 Risk Factors investigated: Cigarette smoking at home, exposure to kitchen smoke during cooking, family history of having asthma, wheezing or atopy, presence of child during cleaning of the house and having an atopic condition in the child. Results: There were statistically significant associations between childhood asthma and breast feeding of <10 months (OR = 4.8, 95% CI = 1.02 – 23.0). Introduction of formula feeds before 1 year of age ( OR = 1.9, 95% CI = 1.1 – 3.2), cigarette smoking at home ( OR = 4.9, 95% CI = 1.1 – 3.3), cleaning house in the presence of child ( OR = 2.9, 95% CI = 1.6 – 5.2), kitchen smoke ( OR = 2.7, 95% CI = 1.4 – 5.2), family history of having asthma, wheezing or atopy ( OR = 2.1, 95% CI = 1.2 – 3.7), and having an atopic condition in the child (OR = 40.4, 95% CI = 5.2 – 303.8) in the univaraite analysis. Multiple logistic regression revealed that cigarette smoking at home (OR = 4.4, 95% CI = 2.2 – 8.8), kitchen smoke ( OR = 2.2, 95% CI = 1.02 – 4.6), cleaning house in the presence of child ( OR = 2.2, 95% CI = 1.1 – 4.4), and having an atopic condition in the child (OR = 38.3, 95% CI = 4.9 – 299.4). Conclusion: Cigarette smoking at home, exposure to kitchen smoke during cooking, presence of child during cleaning of the house and having an atopic condition in the child were the risk factors for the development of childhood asthma. Wijesundara WRUAS. Weeratunga LL. Wijetunga WMUA.Tilakaratne TAD. Subasinghe S. Katulanda P (2012). Risk factors and prevalence of non-fatal stroke Sri Lanka - a community based study. Annual Research Symposium 2012 Objective: To determine the prevalence and risk factors of non-fatal strokes or transient ischemic attacks in the Sri Lankan population Study method: A random sample of 4485 non institutionalized adults 18 years and over was selected and their anthropometric details and its correlations were collected as a part of the Sri Lankan Diabetic and Cardiovascular study (SLDCS), which was a national level community based study on diabetics and cardiovascular diseases. Diagnosis of stroke was made according to the World Health Organization (WHO) definition. Patients who had suffered a non-fatal stroke were identified using an interviewer administered questionnaire, using a defined diagnostic criterion. Results were analyzed using independent T-test and correlation Study population: A random sample of non-institutionalized adults 18 years and over Study Instrument: An interviewer administered questionnaire Sample size: 4473 Sampling method: Random sampling method Disease Investigated: Stroke Results: Out of 4473 participants, 72 had suffered a non-fatal stroke/transient ischemic attack (TIA) giving a prevalence of 1.609% in the community. Occurrence of non-fatal stroke/TIA showed a statistical significant p<0.05 relationship with the male sex, alcohol consumption, low physical activity, waist

υωϋ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

hip ratio, low HDL cholesterol level, raised blood sugars (fasting blood sugars, Postprandial sugars) and left ventricular hypertrophy. Presences of co-morbidities such as Diabetic mellitus, Hypertension, Ischemic Heart Disease, Peripheral vascular disease, pancreatic disease also proved to have a significant association with the occurrence of stroke/TIA. There was no statistical significant relationship with regarding to the presence of family history of hypertension, ischemic heart disease and stroke in siblings, parents or grandparents. Wijetunga WMUA. Tilakaratne TAD. Subasinghe S. Katulanda P (2012). Comparison of skin fold thickness, waist circumference, waist hip ratio, and Body mass index in predicting body fat percentage. Annual Research Symposium 2012 Objective: To compare the skin fold thickness (SFT), waist circumference (WC), waist hip ratio (WHR) and BMI in predicting the body fat percentage (BFP) in adults. Study method: A sample of 1007 adult diabetic patients (age 20-45 years) were randomly selected and their anthropometric measurements were obtained. BFP was measured using a single frequency Bio-impedance analysis (which provides an accurate way of measuring BFP). The association between the anthropometric measurements and BFP was determined using the Pearson test and linear regression analysis. Study population: Adult diabetic patients between the ages 20-45 years Sample size: 1007 Sampling method: Random sampling method Risk Factors Investigated: Skin fold thickness, waist circumference, waist hip ratio and BMI Results: Out of the 1007 patients 42.3% were males. Mean age was 36.6 (+11.17) years. The majority of the study sample (68.3%) was moderately physically active. The mean body fat percentage (BFP) was 28.6% (males 21.3% and females 33.8%, p<0.001). the mean skin fold thickness (triceps), waist circumference, waist hip ratio(WHR) and BMI of males and females were 10.5mm,88.2cm,0.92 and 24.2kgm 2 for males and for the females 19.3mm,86.6cm,0.9, and 24.9kgm-2. All skin fold thickness measurements (p<0.001) and other anthropometric measurements (p<0.01) except waist hip ratio, showed a significance difference between males and females. Body fat percentage showed significant correlation with the body mass index (r=0.4, p<0.01) and skin fold thickness (r=0.67, p<0.01) but not with waist circumference (r=0.226) and waist hip ratio (r=0.121). Skin fold thickness in triceps (r=0.67, p<0.01) and biceps (r=0.61, p<0.01) regions showed the strongest correlation followed by skin fold thickness in the suprailiac (r=0.42, p<0.01) and sub scapular (r=0.4, p<0.01) regions.

υωό Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Group C Publications (Studies found under the key words, but unable to meet the criteria for Group A and B) Abeysena C. Jayawardana P. (2011 ). "Body mass index and gestational weight gain in two selected Medical Officer of Health areas in the Gampaha District." Journal of the College of Community Physicians of Sri Lanka 16(1). Objective: To describe gestational weight gain pattern according to the body mass index (BMI) categories. Study Method This is a descriptive component of a cohort study which was carried out in two Medical Officer of Health (MOH) areas namely Ja-ela and Ragama in the Gampaha District which cover both urban and rural areas. Both these MOH areas conduct 36 antenatal clinics per month. The study was conducted between May 2001 to April 2002. All pregnant mothers eligible to participate in the study were recruited from the antenatal clinics on or before 16 weeks of gestation and followed up until delivery. Exclusion criteria were age <15 years, pre-existing diabetes mellitus and hypertension and multiple pregnancies. Maternal weight was measured at the booking visit, during the second trimester and at delivery. Inadequate and excessive weight gain were defined as weight gain below and above the Institute of Medicine (IOM) 2009 recommendations for the BMI categories as well as Ministry of Health (MoH) recommendations. Study area: Two Medical Officer of Health areas of the Gampaha District Study population: Pregnant women who were on or before 16 weeks of gestation Type of study: A descriptive cohort study Study instrument: Clinic records Height and weight measurements Sample size: 829 Results: The total number recruited to the study was 885. Fifty six mothers were excluded from the analysis due to multiple pregnancies (10) and fetal deaths (46). Of the remaining 829 mothers, 247 (30%) had a BMI of <18.5 kg/m2, 432 (52%) between 18.5–24.9 kg/m2, 114 (14%) between 25.0 – 29.9 kg/m2 and 17 (2%) ≥30 kg/m2. For 19 (2.3%), the BMI values were missing. The corresponding values according to Asian BMI categories were 247 (30%) for <18.5 kg/m2, 338 (41%) between 18.5–22.9 kg/m2, 179 (21.6%) between 23.0 – 27.4 kg/ m2 and 46 (5.5%) ≥27.5 kg/m2. Two hundred and forty seven (30%) of the women were underweight, 432(52%) were normal weight and 131(18%) overweight and obese. According to the Asian BMI classification, 338(41 %) were normal weight and 225(29%) were overweight and obese. Total mean weight gain for the sample was 10.6(SD 3.3) kg and mean rate of gestational weight gain was 0.27(SD 0.08) kg/week. Mean weight gain during second trimester was 6.7(SD 2.7) kg and during third trimester 3.9(SD 2.2) kg. Mean gestational weight gain and rate of weight gain per week was higher among underweight women. Of the 710, 404(57%) women gained less and 62(8.7%) more weight, than recommended by the IOM, whereas 108(15%) gained more weight by MoH standards.

υωύ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Conclusions: One third of the women were underweight and mean gestational weight gain and rate of weight gain per week were higher amongst them. More than half of the women gained less weight than recommended. Allender Steven. Wickramasinghe Kremlin. Goldacre Michael. Matthews David. Katulanda Prasad. (2011). Quantifying Urbanization as a Risk Factor for Noncommunicable Disease. . Journal of Urban Health;. 88: p 906-918. Objective: To investigate the poorly understood relationship between the process of urbanization and non-communicable diseases (NCDs) in Sri Lanka using a multicomponent, quantitative measure of urban city. Study method: NCD prevalence data were taken from the Sri Lankan Diabetes and Cardiovascular Study, comprising a representative sample of people from seven of the nine provinces in Sri Lanka ( n = 4,485/5,000; response rate = 89.7%). They constructed a measure of the urban environment for seven areas using a 7-item scale based on data from study clusters to develop an 'urban city' scale. The items were population size, population density, and access to markets, transportation, communications/media, economic factors, environment/sanitation, health, education, and housing quality. Linear and logistic regression models were constructed to examine the relationship between urban city and chronic disease risk factors Sampling method: Random sampling method Results: Among men, urbanicity was positively associated with physical inactivity (odds ratio [OR] = 3.22; 2.27-4.57), high body mass index (OR = 2.45; 95% CI, 1.88-3.20) and diabetes mellitus (OR = 2.44; 95% CI, 1.66-3.57). Among women, too, urbanicity was positively associated with physical inactivity (OR = 2.29; 95% CI, 1.64-3.21), high body mass index (OR = 2.92; 95% CI, 2.41-3.55), and diabetes mellitus (OR = 2.10; 95% CI, 1.58 - 2.80). There is a clear relationship between urban city and common modifiable risk factors for chronic disease in a representative sample of Sri Lankan adults. Amarasena N. Ekanayaka AN. Herath L. Miyazaki H. (2002). "Tobacco use and oral hygiene as risk indicators for periodontitis." Community Dent Oral Epidemiology 30(2): 115-23. OBJECTIVE: To detect the periodontal status of male smokers and betel chewers in a rural community in Sri Lanka and compare it with that of male non-tobacco users of the same community. METHODS: A cross-sectional community based study was carried out in a sample of 2277 rural adult males aged 20-60 years, adopting multistage cluster sampling technique. The present analysis was confined to 2178 subjects who were mutually exclusive smokers, betel chewers or non-tobacco users. The periodontal status was assessed by clinical measurement of levels of bacterial plaque (PLI), gingival inflammation (GI) and loss of epithelial attachment (LA). All measurements were carried out on four sites of all teeth present except third molars and the mean values for periodontal parameters were calculated. RESULTS: Bivariate analysis revealed that the overall periodontitis levels were significantly higher in betel chewers and smokers than in non-tobacco users. Multiple linear regression analysis showed that

υϊτ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

there were no significant effects of smoking and betel chewing per se on LA, independent of age, socioeconomic status (SES) and whether or not controlled for PLI. The effect of the quantified tobacco use on LA was statistically significant regardless of age, PLI or SES. However, the effect of the quantified tobacco use was considered limited when compared to that of oral hygiene. CONCLUSIONS: The findings highlighted the importance of oral hygiene in the aetiology of periodontitis while confirming the statistical significance of the quantified tobacco use on LA. Oral hygiene and the quantified tobacco use may be considered as risk indicators for periodontitis. Amarasinghe DACL. (1999). A clinical based case-control study on risk factors in developing long term complications in patients with Type 2 Diabetes Mellitus in the Western Province, Sri Lanka. Postgraduate Institute of Medicine. Colombo, University of Colombo. Doctor of Medicine in Community Medicine. Main objective: To study some selected long term complications amongst patients with type 2 diabetes mellitus attending selected clinics at different level of medical institutions in the Western Province of Sri Lanka ,with particular emphasis on some risk factors for such complications and to compare direct opthalmoscopy and retinal photography in the detection of diabetic retinopathy. Specific objective: 1.To determine the frequency distribution of the following selected long term complications amongst selected patients with type 2 diabetes mellitus attending clinics at different level of medical institutions. ; a)diabetic retinopathy b)peripheral sensory neuropathy c)micro albuminuria d)coronary heart diseases 2.To identify some patients characteristics (e.g.; socio-demographic,self care,etc.) for long term complications in patients with type 2 DM. 3.To study the association between selected clinical variables, namely: duration, glycemic control, hypertension, Body Mass Index (BMI), serum cholesterol levels and the long term complications of type 2 DM. 4.To study the association between selected health care provision variables and the long term complications in patients with type 2 DM. 5.To compare the two screening methods, i.e direct ophthalmoscopy and retinal photography, in the detection of diabetic retinopathy. Study area: Western Province of Sri Lanka Study population: Primary, secondary and tertiary level government institutions in the Western Province, with clinic facilities available for diabetic patients were selected, and all diabetics attending the medical or diabetic clinics of the medical institutions were identified and who fulfilled eligible criteria were included as a study population. Type of study: Unmatched case - control study Study instrument: 1.Interviewer administered questionnaire to the patients 2.Clinic records 3.Check list 4.Clinical examinations 5.Laboratory investigations

υϊυ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

6.Self-administered questionnaire to the Medical Officers Sampling method: Selection of the clinic centres was done using a simple random sampling technique Cases and controls were selected using consecutive method of sampling technique. Sample size: 700 diabetics enrolled for the study 80% participated from which 252 were cases and 288 controls Total sample size:540 Risk Factors and Diseases investigated: Duration of diabetes mellitus, glycaemic control, Diet, age, level of education and income, effects of smoking on DM, association between alcohol consumption and long term complications of DM, hypertension, Body Mass Index (BMI), serum cholesterol levels and the long term complications of type 2 DM. Results: Out of the 700 diabetics enrolled for the study ,only 80% participated in the study;252 cases and 288 controls. The study revealed that the frequency distribution of the selected long term complications amongst the selected patients with type 2 diabetes mellitus attending clinics at different level of medical institutions that Diabetic neuropathy (25.2%) was the commonest complication among the study population as shown under Image-Table 1. The socio-demographic factors which were found to be significantly associated with long term complications include: - age between 40-60 years (OR-3.49,P<0.01) - lower level of education (below grade 5)(OR-1.00,P<0.001) - low monthly income less than Rs.2500(OR-1.00,P=0.01) . - males(OR-1.33,P=0.19) , - divorced persons(OR-2,59,P=0.21), - Among ethnicity, the Muslims (OR-1.98,P=0.09), - people living in the urban areas(OR-1.04,P=0.49), - from the occupations,thelabourers(OR-2.80,P=0.29) had a higher risk of complications. The other signifiant person related characteristics that lead to long term complications were lack of knowledge on diabetic complications(OR-1.52,P=0.03),patients' dissatisfation towards health care given at the clinic(OR-1.00,P=0.01), poor clinic attendence ,needs of another person’s help to attend the clinc(P=0.01) and smoking.Out of these , smoking was highly significant(P<0.001) When studying the association between selected clinical variables such as durationnof DM, glycemic control, hypertension etc, it revealed that duration (11-20 years) of DM (OR-1.63,P=0.11) itself had a twofold increased risk of developing complications. Lack of glycaemic control was also an essentially important risk factor for long term complications with random blood sugar levels of 200-300mg/dl and over 300mg/dl had nearly four and three fold increased risks respectively. It showed that increased risk (OR-2.4) of complications was observed when RBS was between 201-300mg/dl and the risk was low (OR=1.86) among diabetics with higher RBS level of more than 300mg/dl. Both these OR values were statistically significant and the association between different levels of RBS and long term complications was statistically significant (P<0.001) Among the diabetic patients raised diastolic blood pressure of 90mmHg or above (OR-1.45,P=0.03) had a statistically significant (P<0.05 ) increased risk of risk of long term complications compared to

υϊφ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

raised systolic blood pressures of 160 and above (OR-1.26,P=0.38). However the results showed that the serum cholesterol levels above or below 240mg/dl was statistically not significantly (P<0.05 ) associated with complications of DM. BMI>25 (OR-2.16,P<0.01) aslo had a two fold increase risk of complications than BMI<25(OR-1.00,P=0.01) and it is identified as a significant risk factor in the final logistic regression model (P<0.05) . The results of the randomly selected 176 diabetic patients who were screened by the two methods (direct ophthalmoscopy and retinal photography for diabetic retinopathy) are shown below under Table 2. The overall provision of health care at diabetic clinic was inadequate.This was significant at primary level medical institutions as basic clinical examinations and laboratory investigations such as measuring blood pressure, testing for urine sugar were not carried out in certain clinics. The findings suggest that long term complications in type 2 diabetes are important health problems among patients attending state sector clinics in the Western Province of Sri Lanka. Amarasinghe Hemantha K. Usgodaarachchi Udaya S. Johnson Newell W. Lalloo Ratilal. Warnakulasuriya Saman. (2010). "Betel-quid chewing with or without tobacco is a major risk factor for oral potentially malignant disorders in Sri Lanka: A case-control study." Oral Oncology; 46 (4): p297-301. Objective: To investigate the prevalence of, and risk factors for, oral potentially malignant disorders (OPMDs) in rural Sri Lanka Study method: A cross-sectional community-based study was conducted by interview and oral examination of 1029 subjects aged over 30years. A community-based nested case-control study then took those with OPMDs as ‘cases’, “controls” being those with no oral abnormalities at time of initial screening. Study Area: Sabaragamuwa province Study population: The study population included all subjects aged over 30years Study Instrument: Interviewer administered questionnaires Oral examinations Study type: A community based cross sectional and case control study Sample size: 1029 Results: The prevalence of OPMD was 11.3% (95% CI: 9.4–13.2), after weighting for place of residence and gender. Risk factors were betel-quid (BQ) chewing daily [OR=10.6 (95% CI: 3.6–31.0)] and alcohol drinking daily or weekly [OR=3.55 (1.6–8.0)]. A significant dose–response relationship existed for BQ chewing. Smoking did not emerge when adjusted for covariates. A synergistic effect of chewing and alcohol consumption existed. The attributable risk (AR) of daily BQ chewing was 90.6%, the population AR 84%. This study demonstrates high prevalence of OPMD, betel-quid chewing with or without tobacco being the major risk factor.

υϊχ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Amaratunga MS. De Silva T. Wasthuhewaarachchi IM. Uyangoda SH. Mallawaarachchi MAJI. Premarathna R. Nishad AAN. (2012). "Prevalence of Diabetes Mellitus and Hypertension among 3 populations with Cataract in Vavuniya and Gampaha districts in the post-conflict era." The Ceylon Medical Journal 57(Supplement 1): Objective: To compare the prevalence of diabetes mellitus (DM) and Hypertension (HT) among three groups of cataract patients. Study method: Prevalence of Diabetes Mellitus(DM) and hypertension( HT) was compared in groups of patients with cataracts during the second quarter of 2011. Group A: A rural population in Vavuniya, Group B: Semi-urban low socioeconomic group and Group C: Semi-urban higher socioeconomic group in Gampaha. Standard criteria used to detect DM and HT. Study Area: A rural area in in Vavuniya, and a urban area in Gampaha Study population: Group A: A rural population in Vavuniya, Group B: Semi-urban low socioeconomic group and Group C: Semi-urban higher socioeconomic group in Gampaha Sample size: 781 Sampling method: Convenient sampling method Risk Factors Investigated: Diabetes Mellitus, Hypertension, Cataract Results: Population A – 167 (36% males), B – 207 (62% males) and C – 407 (40% males). Mean (SD) age was 65 (10) years. Male diabetes prevalence (95% CI) were A – 20% (9.3 – 28), B – 30% (22.6 – 38.4), C – 37.9% (30.8 – 45.6) (p = 0.009). Prevalence (95% CI) of DM in females were A – 17.8% (11.7 – 26), B – 19% (11.9 – 29) and C – 33.7% (28.1 – 39.9) (p = 0.002) Hypertension Prevalence in males (95% CI) were A – 23.3% (15 – 35.4), B – 35.4% (27.6 – 44) and C – 36.6% (29.6 – 44.3) (p = 0.16) and in females A – 26.2% (18.8 – 35.2), B – 15.2% (9 – 24.7) and C – 45.1% (39 – 51.4) (p = 0.001). Prevalence of either DM or HT among males were A – 31.7% (21 – 44), B – 54.3% (45.7 – 62.7) and C-56% (48.2 – 63.3) (p = 0.001) and among females A – 34.6% (26 – 44), B – 26.6% (18 – 37.2) and C – 57.8% (51.5 – 63.7) (p = 0.001). Overall prevalence of HT and DM were higher than for general population in Sri Lanka. Ann Kristin Hjelle. Yasmin H. Neggers TW. Wikramanayake and Bindon R. (1994). "Dietary intake and the prevalence of goitre among pregnant women on the Southwestern coast of Sri Lanka." The Ceylon Journal of Medical Science 37: 31-38. Objective: 1. To ascertain whether the intake of dietary goitrogens among pregnant women is linked to the prevalence of goitre in this population. 2. To evaluate the frequency of seafood consumption, and iodine content of drinking water of pregnant women with goitre (cases) and without goitre (controls).

υϊψ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Study method: Fifty-nine cases and 31 controls, recruited from antenatal clinics and from the field, participated in the study. A single 24 hour dietary recall for each subject was analyzed for intake of energy. A food frequency questionnaire was used to measure usual intakes of seafood and goitrogen containing foods. The relationship between goitre status and high (> 1 serving/d) versus low (< 1 serving/d) consumption frequencies of goitrogen containing foods and seafood was assessed by logistic regression. Study Area: Prenatal clinics at the Mahamodera Hospital, Galle Study population: Subjects came from coastal towns and villages stretching as far as 28 km north and 16 km south, of the city of Galle. Subjects were recruited at prenatal clinics at the Mahamodera Hospital and from coastal villages. Pregnant, Sinhalese women, living in close proximity to the ocean, no further than 2 km inland, were invited to participate. Study Instrument: A single 24 hour dietary recall A food frequency questionnaire Sampling method: Random sampling method Results: General characteristics of the subjects are summarized in Table 1. The mean age of the sample was 26 + 5.25 y (mean+ SD). The controls were significantly older than cases (P = 0.02). The mean gestational age was 29+5.35 wk for cases and 25 + 6.62 wk for controls (P = 0.01). Approximately 43% of the sample was primigravida, and the mean parity was 1 +1.21. The per capita income differed greatly between participants but not significantly between cases and controls (Table 1). Thirty-nine percent of cases and approximately 35% of controls received food stamps; whereas, less than 7% of cases and controls received Janasaviya assistance. There was no significant difference between the groups in number of participants who received food stamps and Janasaviya assistance. The mean energy intake for cases and controls were approximately 1554 kcal and 1559 kcal, respectively (P = 0.97). Almost the entire sample used uniodized granulated salt. No one used iodized salt although a few subjects reported having used it previously, taking it more as a course of medication and stopping when the packet emptied. Ninety-seven percent of cases and 84% of controls stated that they always rinsed the salt before using it; whereas, only one case and two controls stated that they never rinsed the salt. Thus, no significant difference existed between cases and controls in rinsing of salt (P = 0.10). Goitre status and consumption of goitrogen containing foods and seafood. The average monthly frequency of consumption of cassava, cruciferous vegetables, yams, and seafood are presented in Table 2. Goitrogen and seafood intake frequencies varied greatly, both in cases and controls. The frequency of consumption of total goitrogens was significantly higher in controls than in cases (P = 0.02). However, there was no significant difference between cases and controls in the mean frequency of consumption of each individual goitrogen containing food or seafood. Cassava was eaten on an average of three times per month (range 0-16 times per month) by cases and five times per month (range 0-20) by controls. On average, cases consumed cruciferous vegetables eight times per month (range 0-40) and controls 11 times per month (range 1-32). The mean consumption frequency of yams was 5 times per month (range 0-20) for cases and 7 times per month (range 1-28) for controls. The mean frequency of seafood consumption, (39 and 42 times per month, respectively), was not significantly different between cases and controls. Goitrogen containing foods were also evaluated as categorical variables. After adjusting for maternal and gestational age, energy intake, and frequency of seafood intake, there was no significant difference in risk of goiter development between subjects with high and low frequency of goitrogen intake (B = -1.11, P =0.08,

υϊω Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

O.R. = 0.33, C.J. = 0.09 - 1.17) (Table 3). Similarly, no significant relationship was found between goitre status and high and low frequency of intake of seafood or any of the individual goitrogen containing foods after adjusting for the above-mentioned covariates. Iodide concentrations in drinking water Table 1 shows that the I" content of the water differed greatly between the various sites of collection, ranging from as low as 3.2 Ug/L to a high of 101.6 Ug/L. The mean I" concentrations of the drinking water of cases and controls were not significantly different with respective mean values of 12.9 ug/L and 13.1 ug/L. Ariyawardana A. Athukorala ADS. Arulanandam A. (2006). "Effect of betel chewing, tobacco smoking and alcohol consumption on oral submucous fibrosis: a case–control study in Sri Lanka." Journal of Oral Pathology & Medicine Apr2006, Vol. 35 Issue 4, p197-201, 5p, 6 Charts(4): p197-201. Study method: A total of 74 patients with OSMF and 74 controls who consecutively attended the Oral Medicine clinic at the Dental Hospital (Teaching) Faculty of Dental Sciences, University of Peradeniya, Sri Lanka were included in the study. Binary logistic regression analyses were performed to model the influence of betel chewing, smoking and alcohol use and to determine the effects of different combinations of chewing habits on OSMF. Study Area: Oral Medicine clinic at the Dental Hospital (Teaching) Faculty of Dental Sciences, University of Peradeniya. Study population: 74 patients with OSMF and 74 controls who consecutively attended the Oral Medicine clinic at the Dental Hospital. Results: Betel chewing was the only significantly associated factor in the aetiology of OSMF (OR = 171.83, 95% CI: 36.35–812.25). There were no interaction effects of chewing, smoking and alcohol consumption in the causation of OSMF. Conclusion: The present study has shown a strong association of betel quid chewing (including tobacco as an ingredient) with the causation of OSMF. Athuraliya Nimmi TC. Abeysekera Tilak D. Amerasinghe Priyanie. Kumarasiri Ranjit. Bandara Palitha. Karunaratne Upul. Milton Abul H. Jones Alison L. (2011). Uncertain etiologies of proteinuric-chronic kidney disease in rural Sri Lanka. Kidney International. 80 p1212-1221. Objective: To describe the prevalence of proteinuric-CKD and disease characteristics of three rural populations in the North Central, Central, and Southern Provinces of Sri Lanka. Study method: Patients were selected using the random cluster sampling method and those older than 19 years of age were screened for persistent dipstick proteinuria. Study Area: Medawachchiya region (North Central), Yatinuwara region (Central) and Hambantota region (Southern). Sample size: Medawachchiya region (North Central) 2600 patients, Yatinuwara region (Central) 709 patients, Hambantota region (Southern Province) 2844 Total sample size 6153 Sampling method: Random cluster sampling method

υϊϊ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Disease Investigated: Chronic Kidney disease Results: The prevalence of proteinuric-CKD in the Medawachchiya region (North Central) was 130 of 2600 patients, 68 of 709 patients in the Yatinuwara region (Central), and 66 of 2844 patients in the Hambantota region (Southern). The mean ages of these patients with CKD ranged from 44 to 52 years. Diabetes and long-standing hypertension were the main risk factors of CKD in the Yatinuwara and Hambantota regions. Age, exceeding 60 years, and farming were strongly associated with proteinuric-CKD in the Medawachchiya region; however, major risk factors were uncertain in 87% of these patients. Of these patients, 26 underwent renal biopsy; histology indicated tubulointerstitial disease. Thus, proteinuric-CKD of uncertain etiology is prevalent in the North Central Province of Sri Lanka. In contrast, known risk factors were associated with CKD in the Central and Southern Provinces. Athuraliya TNC. Abeysekera DTDJ. Amerasinghe PH. Kumarasiri PVR. Dissanayake V. (2009). "Prevalence of chronic kidney disease in two tertiary care hospitals: high proportion of cases with uncertain aetiology." Ceylon Medical Journal 54(1): .23-25. Objective: To document some features of chronic kidney disease (CKD) and describe cases with an uncertain aetiology observed at two teaching hospitals in Kandy and Anuradhapura between 2000 and 2002 Study Method: A retrospective, descriptive study of CKD patients (n=492), using information collected from clinic records (Nephrology Unit, Kandy, NUK =146, RenalClinic, Anuradhapura, RCA = 246). When further information was required, verbal consent was obtained by the research officer who administered the questionnaire. The diagnosis of CKD was based on KDQOI of National Kidney Foundation of USA criteria . The study commenced at NUK and was then extended to RCA, since a high number of CKD patients from the North Central Province (NCP) was noted . Study area: Nephrology Unit, Kandy and RenalClinic, Anuradhapura, Study population: CKD patients Type of study: A retrospective, descriptive cohort study Study instrument: Clinic records Interviewer administered questionnaire Sample size: 492 Results: The cohort was observed to be in different stages of CKD varying from mild, moderate, severe to end-stage . The majority (61%) of patients at NUK were in late stages (severe and end-stage) of the disease whilst most (79%) at RCA were in early stages. A fair number of patients from RCA (9%) were from Medawachchiya. The key finding in this study was that the cause of CKD was not identifiable in the majority of patients in both clinics (NUK = 54%, RCA 82%). These patients were categorized into a separate group as “uncertain aetiology” (UA). In contrast, the world literature shows that the prevalence of UA among CKD patients less than 65 years old varies from 6.2-14.7%. CKD of UA in this study appeared to affect young males, from low socio-economic, paddy farming communities (NUK =90%, RCA = 94.5%). Patients with mild to moderate stages of the disease were typically without uraemia and had only vague symptoms of backache and dysuria. Mild proteinuria

υϊϋ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

(<1 gram/24 hours) and bilateral echogenic small kidneys were typical findings, and the mean bipolar length of the kidneys was 8.3 cm ± 1.4 (n = 122). The urine full report did not show an active deposit and hypertension was not a common feature. Those who were in late stages of CKD and were hypertensive (NUK = 40% and RCA = 14%) did not have ECG evidence of left ventricular hypertrophy, indicating that raised blood pressure was probably due tothe disease, rather than being the cause of CKD. Balasuriya BMAC. Sumanatilleke MR. Jayasekera TI. Wijesuriya MA. Somasundaram NP. (2012). "Prevalence of micro and macrovascular complications of diabetes detected at single visit screening." Sri Lanka Journal of Diabetes, Endocrinology and Metabolism 2(1): 17-20. Objective: To describe the prevalence of complications of diabetes and to study the relationship between the prevalence of complications and the duration of diabetes in a subset of Sri Lankan population Study method: The study was a cross sectional study on a sample population of both type 1 and 2 diabetic patients who had at least two screening visits to the National Diabetic Centre Rajagiriya. Electronic medical records of patient data were analyzed and results were categorized into major micro and macrovascular complications of diabetes. Screening of diabetic retinopathy was carried out by dilated fundoscopy and a retinal camera, Study Area: National Diabetic Centre Rajagiriya Study population: Type 1 and 2 diabetic patients Study type: Cross sectional case analysis Sample size: 6765 Sampling method: Random sampling method Results: The study sample consisted of 6765 patients (4121 males and 2629 females) .the mean age of the study group was 51.63 years range. There were 95.5% patients with type 2 diabetes and 4.5% with type 1 diabetes. Study sample represented 14.1% rural and 85.7% urban dwellers. Employment categorization break down showed that 46.5% were employed (12.9% professionals and 33.6% non professionals), 9.5% retired and 43.1% unemployed people in the study sample. The mean duration of diabetes in the study population was 7.9 years (SD=6.7). The results showed that the prevalence of micro vascular complications increased with increasing duration of diabetes. In patients with diabetes mellitus for less than 1 year, retinopathy prevalence was 6.8% and in those with 16-20 years diabetes duration it rose to 52.6%. Neuropathy prevalence e at diagnosis was 11% and at 16-20 years diabetes duration it rose to 54.3%. Nephropathy prevalence at diagnosis and at 16-20 years was 18.8% and 23.8% respectively. Conclusions The study has demonstrated high prevalence of complications at the initial diagnosis. Hence, early screening techniques would be beneficial in order to prevent and retard the progression of the disease and to reduce the associated morbidity and mortality.

υϊό Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Bandara GMTR. Fonseka VNRM. Danansuriya DST. Harshanie RLP. Thirumavalavan K. Premawansa G. Samarakoon SMSB. De Silva AP. De Silva ST. Ranawaka UK. (2012). "Recurrent vs. first presentation with acute coronary syndrome in a tertiary care hospital." The Ceylon Medical Journal 57(Supplement 1). Objective: To describe the characteristics of patients with recurrent acute coronary syndrome (ACS) admitted to a tertiary care hospital. Study method: Data was prospectively collected form all patients admitted with ACS to the Colombo North Teaching Hospital over 18 months. Differences in demographic data, presentation, risk factors, management and early outcome between those with first and recurrent ACS were analyzed. Study Area: Colombo North Teaching Hospital, Sri Lanka Study population: All patients admitted with ACS to the Colombo North Teaching Hospital over 18 months Sample size: 765 Disease Investigated: Acute coronary syndrome Results: Out of the total population with ACS, 501 (65.5%) presented with the first episode, while 264 (34.5%) presented with the second or subsequent episode. Those with recurrent ACS were more likely to present with unstable angina (61.4% vs. 39.5%, p<0.001), present directly to hospital instead of primary care provider (84.1% vs. 71.3%, p<0.001), have hypertension (74.1% vs. 50.1%, p<0.001) and hyperlipidemia (51.5% vs. 34.3%, p<0.001), and be ex smokers (28% vs. 19.3%, p<0.001). Those with the first episode were more likely to be current smokers (23.8% vs. 11%, p<0.001). No differences were noted between the two groups in:- age and sex distribution , presenting symptoms, presence of diabetes, family history of coronary heart disease, alcohol use, in-hospital management, duration of hospital stay, and early outcome. Conclusions: Patients with recurrent ACS were more likely to have unstable angina than myocardial infarction. They were more likely to present directly to the hospital, and to have stopped smoking. Hypertension and Hyperlipidemia were commoner among them, highlighting the need for better secondary preventive measures. Bandara JMRS. Senevirathna DMAN. Dasanayake DMRSB. Herath V. Bandara JMRP. Abeysekara T. Rajapaksha KH. (2008). "Chronic renal failure among farm families in cascade irrigation systems in Sri Lanka associated with elevated dietary cadmium levels in rice and freshwater fish (Tilapia)." Environmental Geochemistry and Health 30(5): 465-478. Objective: To establish the etiology of the CRF Study Method: Concentrations of nine heavy metals were determined in sediments, soils of reservoir peripheries, water and Nelumbo nucifera (lotus) grown in five major reservoirs that supply irrigation water. Study area: Agricultural region of Sri Lanka Study population: Five major reservoirs that supply irrigation water

υϊύ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Factors investigated: levels of dissolved cadmium (Cd), iron (Fe), lead (Pb), Results: All five reservoirs carried higher levels of dissolved cadmium (Cd), iron (Fe) and lead (Pb). Dissolved Cd in reservoir water ranged from 0.03 to 0.06 mg/l. Sediment Cd concentration was 1.78 - 2.45 mg/kg. No arsenic (As) was detected. Cd content in lotus rhizomes was 253.82 mg/kg. The Provisional Tolerable Weekly Intake (PTWI) of Cd based on extreme exposure of rice is 8.702 - 15.927 μmg/kg body weight (BW) for different age groups, 5 - 50 years. The PTWI of Cd due to extreme exposure of fish is 6.773 - 12.469 μg/kg BW. The PTWI on a rice staple with fish is 15.475 - 28.396 μg/kg BW. The mean urinary cadmium (UCd) concentration in CRF patients of age group 40 - 60 years was 7.58 μg Cd/g creatinine and in asymptomatic persons UCd was 11.62 μg Cd/g creatinine, indicating a chronic exposure to Cd. The possible source of Cd in reservoir sediments and water is Cd-contaminated agrochemicals. Conclusion: The CRF prevalent in north central Sri Lanka is a result of chronic dietary intake of Cd, supported by high natural levels of fluoride in drinking water, coupled with neglecting of routine de-silting of reservoirs for the past 20 years. Chuang LM. Tsai ST. Huang BY. Tai TY. (2002). "The status of diabetes control in Asia—a cross-sectional survey of 24 317 patients with diabetes mellitus in 1998." Diabetic Medicine 19: 978–985. Objective: To establish the status of diabetes control in Asia, the Diabcare-Asia 1998 study collected data from 230 diabetes centres in Bangladesh, People's Republic of China, India, Indonesia, Malaysia, Philippines, Singapore, South Korea, Sri Lanka, Taiwan, Thailand and Vietnam from March to December 1998. Study Method: Data were obtained either by patient interview during the enrolment visit or by reviewing medical records for the most recent laboratory assessment and clinical examinations. Blood samples were also collected during patients visits for central assessments of HbA1c (normal range 4.7 - 6.4%). Study area: Bangladesh, People's Republic of China, India, Indonesia, Malaysia, Philippines, Singapore, South Korea, Sri Lanka, Taiwan, Thailand and Vietnam. Study population: Diabetic patients Type of study: Cross-sectional survey Study instrument: Interview, Sample size: 24 317 Factors investigated: Date of birth, sex, time since the patient visited the centre for diabetes management, onset of diabetes, type of diabetes, weight, height and blood pressure, fasting blood glucose (FBG), glycated haemoglobin, serum creatinine, urinary albumin, proteinuria, fasting plasma levels of total cholesterol, HDL-cholesterol and triglyceride, existence of diabetes complication (retinopathy, neuropathy, albuminuria, cerebral stroke, myocardial infarction, angioplasty and end-stage renal failure).

υϋτ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Results: The mean of centrally measured HbA1c as 8.6 ± 2.0% for 18 211 patients (82% of the analysis population). Of the patients with central HbA1c measurements, the majority (55%) had values exceeding 8%, indicative of poor glycaemic control. The prevalence of retinopathy, micro albuminuria and neuropathy was also higher in the group of patients with higher HbA1c. Based on the findings from central HbA1c measurements and reported local HbA1c assessments, it also appears that more patients with poor glycaemic control did not have access to glycated haemoglobin measurements. Mean HbA1c of the diabetic populations in Bangladesh, Indonesia, Korea, Malaysia and Taiwan were significantly lower (all P = 0.0001, except P = 0.0007 for Malaysia), while that of China, India, Philippines and Vietnam was significantly higher (all P = 0.0001) than the grand mean. Conclusion: In our study population of the Asian diabetes patients treated at diabetes centres, more than half were not well controlled. The prevalence of diabetic microvascular complications was higher in the group of patients with higher HbA1c. Further therapeutic actions to improve glycaemic control are required to prevent chronic diabetic complications. Dahanayaka NJ. Agampodi SB. Ranasinghe ORJC. Jayaweera PMED. Wickramasinghe WAND. Adhikari ANCWB. Chathurani HKJU. Dissanayaka UT. (2012). "Inadequacy of the risk factor based approach to detect gestational diabetes mellitus." The Ceylon Medical Journal 57(1). Objective: To evaluate the present risk factor based approach in diagnosis of gestational diabetes mellitus (GDM) in Sri Lanka in comparison with new guidelines proposed by the International Association of Diabetes and Pregnancy Study Groups (IADPSG). Study Method: A community based cross sectional descriptive study was conducted among pregnant women with gestational age of 24-28 weeks and residing in Anuradhapura district. All eligible pregnant women from selected Medical Officers of Health areas were invited to participate. The 75 g oral glucose tolerance test was carried out among all participants. During the antenatal clinics and home visits , venous blood samples were obtained for fasting and at 1 hr and 2 hr post glucose load sugar levels and investigators collecteddata during the 2 hours of waiting period using an interviewer administered questionnaire from the study population. Study area: The study was conducted in three Medical Officer of Health areas (MOH) in Anuradhapura district: Nuwaragampalatha East, Nuwaragampalatha Central and Kekirawa. Study population: All pregnant mothers residing in the selected MOH areas and receiving services through public health midwives (PHMs). All pregnant mothers completing 24 weeks and not more than 28 weeks of gestation were invited to participate in the study. Type of study: A community based cross sectional descriptive study. Study instrument: An interviewer administered questionnaire Plasma glucose measurements Sampling method: Convenient method Sample size: 405

υϋυ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Results: A total of 405 pregnant women from 61 PHM areas participated in the study. Mean age of the pregnant women was 27.3 years (SD 5.4 years). Primiparous women accounted for 42.2% (n=171) of the study sample . Period of amenorrhoea at registration was less than 12 weeks among 90.3% (n=366) of the pregnant women. 81.5% (n=330) of participants were between 24 to 28 weeks of gestation. There were 74 (18.5%) pregnant mothers who were invited at 28 weeks, but visited the sample collection centres few weeks later. The results showed, according to IADPSG criteria, 36 (8.9%) of pregnant women had GDM, compared to 29 (7.2%) according to WHO criteria. Prevalence of GDM in the study population (positive by one or both methods) was 10.6% (n=43) (95% CI 7.9-13.9%). Of these 43 women, 22 (51.1%) had positive results by both methods. Seven (16.3%) and 14 (32.6%) mothers were positive only according to WHO and IADPSG criteria respectively. Out of 29 mothers who fulfilled WHO criteria, only one had an abnormal fasting plasma glucose, but 28 had abnormal 2 hour values. A total of 170 (42.0%) participants had at least one risk factor or early indicator of GDM. A risk based approach would have detected only 22 GDM patients according to IADPSG criteria, missing 14 cases (38.9%),who did not have any of the risk factors for GDM. Conclusions: The risk factor based approach misses more than one third of GDM cases. Urgent revision of current GDM screening guidelines is recommended. Dassanayake AS. Kasturiratne A. Rajindrajith S. Kalubowila U. Chakrawarthi S. De Silva AP. Makaya M. Mizoue T. Kato N. Wickremasinghe AR. De Silva HJ. (2009). "Prevalence and risk factors for non-alcoholic fatty liver disease among adults in an urban Sri Lankan population." J Gastroenterol Hepatol 24(7): 1284-8. BACKGROUND AND AIMS: Non-alcoholic fatty liver disease (NAFLD) is an emerging problem in the Asia-Pacific region. However, its prevalence and risk factors in Asian (especially South Asian) communities is poorly studied. In this study, the aim was to determine the community prevalence and risk factors for NAFLD among adults in an urban Sri Lankan population. METHODS: The study population consisted of 35-64-year-old adults, selected by stratified random sampling. NAFLD was diagnosed on established ultrasound criteria for fatty liver, safe alcohol consumption (< 14 units/week for men, < 7 units/week for females) and absence of hepatitis B and C markers. Blood pressure (BP) and anthropometric measurements were made, and fasting glucose, glycosylated hemoglobin, serum lipids, fasting serum insulin and serum alanine aminotransferase (ALT) were determined. RESULTS: Of the 2985 study participants, 974 (32.6%) had NAFLD (605 [62.1%] women, mean age 52.8 years [standard deviation, 7.3]). On multivariate analysis, obesity, acanthosis nigricans, insulin resistance, elevated diastolic BP, fasting plasma glucose, plasma triglycerides, and ALT twice the upper limit of the reference range or more were independently associated with NAFLD. CONCLUSION: The prevalence of NAFLD among adults in this urban Sri Lankan community is high and is strongly associated with constituent features of the metabolic syndrome.

υϋφ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Dassanayake AS. Kasturiratne A. Rajindrajith S. Kalubowila U. Chakrawarthi S. De Silva AP. Makaya M. Mizoue T. Kato N. Wickremasinghe AR. De Silva HJ. (2009). "Prevalence and risk factors for non-alcoholic fatty liver disease among adults in an urban Sri Lankan population." Journal of Gastroenterology and Hepatology 24(7): 1284-1288. Objective: To determine the community prevalence and risk factors for NAFLD among adults in an urban Sri Lankan population. Study Method: The study population consisted of 35-64-year-old adults, selected by stratified random sampling. NAFLD was diagnosed on established ultrasound criteria for fatty liver, safe alcohol consumption (< 14 units/week for men, < 7 units/week for females) and absence of hepatitis B and C markers. Blood pressure (BP) and anthropometric measurements were made, and fasting glucose, glycosylated hemoglobin, serum lipids, fasting serum insulin and serum alanine aminotransferase (ALT) were determined. Study area: Urban Sri Lankan population Study population: 35-64-year-old adults Sampling method: Stratified random sampling Sample size: 2985 Factors investigated: Obesity, acanthosis nigricans, insulin resistance, elevated diastolic BP, fasting plasma glucose, plasma triglycerides, and ALT Results: Of the 2985 study participants, 974 (32.6%) had NAFLD (605 [62.1%] women, mean age 52.8 years [standard deviation, 7.3]). On multivariate analysis, obesity, acanthosis nigricans, insulin resistance, elevated diastolic BP, fasting plasma glucose, plasma triglycerides, and ALT twice the upper limit of the reference range or more were independently associated with NAFLD. Conclusion: The prevalence of NAFLD among adults in this urban Sri Lankan community is high and is strongly associated with constituent features of the metabolic syndrome. Dassanayake S. Kalyani N. (2012). "Effect of stroke on an individual’s functional status, quality of life and economic status." The Ceylon Medical Journal 57(Supplement 1). Objectives: To assess the effects of stroke on an individual’s functional status, quality of life and family economy. Study Methods: This descriptive study was carried out in the Institute of Neurology, National Hospital of Sri Lanka with 70 stroke patients. Study Area: Institute of Neurology, National Hospital of Sri Lanka Study population: Stroke patients admitted in the hospital Study Instrument: Questionnaires Bed head tickets

υϋχ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Study type: Descriptive cross sectional study Sample size: 70 Sampling method: Convenient sampling method Risk Factors Investigated: Stroke Results: Sample consisted of 57.14% males. Majority (61.42%) was aged 41 to 60 years, 78.57% were married, 38.57% were employed and 21.42% were retired. Hemorrhagic stroke was reported in 50%. 52.42% were able to feed themselves, 34.28% were highly dependent on toileting. Bladder and bowel management needed assistance in 57.14% and 51.42% respectively. Most individuals needed total to maximum assistance for transferring and locomotion. Indicators of quality of life showed better scores on the Social and Economic Subscale (mean = 3.59) compared to Health and Functioning Subscale (mean = 2.97) and Psychological/ Spiritual Subscale (mean = 2.75). Family expenditure had significantly increased and high (p = 0.001) and income is significantly decreased less (p = 0.0001) after the stroke. Conclusions: The study found that most stroke patients were aged over 40 and Hemorrhagic stroke is the commonest. Assistance was needed for functions such as bathing, locomotion. Stroke had a negative impact on physical health and level of functioning and economic status. De Lanerolle-Dias M. De Silva A. Lanerolle P. Arambepola C. Atukorala S. (2012). "Micronutrient status of female adolescent school dropouts." Ceylon Medical Journal 57(2): 74-78. Objective: No data exists for nutritional status of female adolescent school dropouts despite one in seven adolescent girls in Sri Lanka being an early school leaver. The aim of this study was to assess the nutritional status of working and non-working female adolescent school dropouts. Study Method: A cross-sectional design was used to recruit 613 female adolescent school dropouts, aged 15-19 years, in two districts of the Western Province of Sri Lanka. BMI was calculated by assessment of weight and height. Haemoglobin, serum ferritin, serum folic acid, vitamin B12, and serum zinc were measured. Weight was measured to the nearest 0.1 kg with acalibrated electronic scale (Seca 813). Height wasdetermined to the nearest 0.1 cm using a stadiometer (Seca225, telescopic height measurement) according to standardprotocol. In order to avoid variability in results, all heightand weight data were measured by one researcher using the same equipment and participants were attired in light indoor clothing. Body mass index (BMI) was calculatedas weight (kg) / height(m2), and categorised into underweight, normal weight and overweight on the basis of agespecific World Health Organisation classification of BMIfor adolescent girls . Non-fasting venous blood samples (10 ml) were obtained from all participants under standardised conditions. Haemoglobin concentration was measured bythe cyanmethaemoglobin method using reagent kits provided by Randox, UK. Serum ferritin was assessed by an immunoradiometric assay using the Ferritin IRMA Coata-Count test kit (DPC Inc USA) and measured using a Gamma Counter (Perkin Elmer, 1470). Serum folic acid/ vitamin B12 concentration was measured by radioisotopic assay (SimulTRAC-SNBMP Biomedicals Diagnostic Division, USA). Serum zinc concentrations were measured using a flame atomic absorption spectrometer (GBC, 932 plus). Inflammatory status was

υϋψ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

assessed using C-reactive protein by latex agglutination (Humantex CRP complete test kit, Germany). Quality control was ensured by using control sera and an analytical variation <5% for all assays. Participants completed an interviewer administered questionnaire containing information on domains of occupation, education and schooling. Nutrition knowledge was assessed by a pre-tested self-administered questionnaire with true/false type responses. The Statistical Package for the Social Sciences for Windows (v. 15.0, SPSS Inc., Chicago, IL, USA) was used in the data analysis. The level of significance was set at p<0.05. As serum ferritin and zinc data did not show a normal distribution the data were normalised by log transformation prior to analysis. For assessment of nutrition knowledge, a composite score was calculated and expressed as a Percentage. Differences between non-working and working girls were assessed using the χ2 test for categorical variablesand analysis of variance (ANOVA) for continuous variables. Anaemia was defined as haemoglobin <120 g/L, low serum ferritin as ferritin <20 μg/L, low serum folic acid as folic acid <3 μg/L low serum vitamin B12 as vitamin B12 <150 pg/ml and zinc deficiency as serum zinc <66μg/dl [13-17]. Three separate binary logistic regression models were developed for the three dependent variables; low serum ferritin, low serum folic acid and zinc deficiency to examine the effects of different parameters (being employed, dropping out of school early (<14 years), low income, low serum ferritin, low serum folic acid, zinc deficiency). Odds ratios and their 95% CI were calculated. Study area: Colombo representing as an urban district and Kalutara representing as a rural district Study population: Female adolescentschool dropouts (15-19 years) were recruited.All participants were free of overt disease. Exclusion criteria were pregnancy, lactation or having a child below the age of 6 months Type of study: A cross-sectional study design Study instrument: Weight and height measurements Haemoglobin, serum ferritin, serum folic acid, vitamin B12, and serum zinc measurements An interviewer administered questionnaire containing information on domains of occupation, education and schooling Sample size: 603 Results: Mean age of adolescent girls was 17.5 ± 1.2 years (15-19 years). Fifty eight percent of girls claimed that they dropped out of school between the ages of 14-16 years. Reasons for dropping out included financial/personal problems (47%), cultural issues (22.2%), to follow a vocational course or for employment (12.4%) and failure at school examinations (18.4%). Thirteen percent of study participants were married. All girls were from low income families (mean family income Rs. 13,666/ month). Approximately one third (32.5%) were employed while others were not. The majority of employed girls (86.7%) were unskilled workers mostly in factories, 7.1% wereskilled workers and 6.1% were self-employed. The mean total family income/month was significantly (p=0.022) higher among working girls (Rs. 15,518) than non-working girls (Rs. 12,908). Monthly income of the girls ranged from Rs. 200 - 13,000. Non-working girls showed a trend (p=0.06) towards a higher mean knowledge score on nutrition than working girls (working girls: 49.7%, SD=19.6% vs non-working girls:53%, SD=20.1%). When girls were grouped into age specific BMI categories, 32.8% of girls were underweight, while 6.1% were overweight. Prevalence of anaemia (haemoglobin <120 g/l) in the study population was 17 %. Low iron status (serum ferritin <20 μg/l) was noted in 29.4 % of girls, low serum folate in 28% (folic acid <3 μg/l) and zinc deficiency in 28.8% (zinc <66 μg/dl). Regression modeling indicated that dropping out of school early (at <14 years of age) was a significant risk factor for low serum ferritin (p=0.001, odds ratio=2.1). Working adolescents were at

υϋω Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

greater risk of low micronutrient status: low serum ferritin (p=0.009; odds ratio=1.8) serum folic acid (p=0.006; odds ratio=1.9) and zinc deficiency (p=0.001; odds ratio=2.1) than non-working adolescents. Conclusions Dropping out of school early and being employed increases the risk of micronutrient deficiencies. De Lanerolle-Dias M. De Silva A. Lanerolle P. Arambepola C. Atukorala S. (2011). "Body fat assessment in Sri Lankan adolescent girls; development of a simple field tool." Annals of Human Biology 38(3): 330–336. Objective: To determine percentage fat mass (%FM) of Sri Lankan adolescent girls using Fourier Transform Infrared spectrometry (FTIR) as a reference method and develop a SFT-prediction equation to estimate %FM. Study Method: Weight, height and SFT were measured and %FM determined by FTIR in 131 adolescent, post-menarcheal girls (15–19 years). SFT-measurements were applied to available body composition equations for validation in the population. A new equation for %FM was derived and validated. Study area: Western Province of Sri Lanka Study population: Out-of-school adolescent girls aged 15–19 years Study instrument: Calibrated electronic scale, Stadiometer, Harpenden Caliper, Sampling method: Convenience sampling method Sample size: 650 Factors investigated: Weight, height, Biceps, triceps, sub-scapular and supra-iliac SFT, percentage fat mass Results: Mean %FM (FTIR) was 19.13 ̂8.2.Selected body composition prediction equations over-estimated %FM. The multiple regression procedure yielded a final equation consisting of two anthropometric and one demographic variable, %FM = 9.701 -(0.460) x age + (0.640) x TricepsSFT + (0.583) x Supra-iliacSFT. Conclusion: Existing SFT prediction-equations are unsuitable for predicting %FM in this population. The new equation utilizing one peripheral and one truncal skin-fold, is appropriate for prediction of %FM in this population and may be applicable to other South Asian/Asian-Indian adolescents following validation. De Silva HJ. Ellawala NS. (1994). "Influence of temperance on short-term mortality among alcohol-dependent men in Sri Lanka." Alcohol Alcohol 29(2): 199-201. The influence of temperance on short-term mortality was assessed in a group of alcohol-dependent men admitted to a rehabilitation unit in Sri Lanka. Of the 234 men initially admitted to the programme, 188 were followed up for at least 3 years (mean +/- SD 49.5 +/- 12.6 months) or until death. All 188 were totally abstinent from alcohol on leaving the 6 week residential module of the programme. During follow-up, 115 relapsed to continued heavy drinking, whereas 73 remained either totally abstinent or drank infrequently. There were no significant differences in the age, duration of dependence, number of previous interventions, duration of follow-up or smoking habits between the two groups of patients. The overall mortality for the whole sample population was

υϋϊ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

9.6%. The mortality among those who relapsed to heavy drinking (13.9%) was more than five times that of those who were abstinent or drank infrequently (2.7%) (P < 0.04). Fifteen of the 16 deaths (93.8%) among those who relapsed to heavy drinking were alcohol-related, and included five suicides and accidents whilst under the influence of alcohol. Temperance significantly reduces short-term mortality in alcohol-dependent men when compared to those who relapse to continue heavy drinking. This difference was primarily due to reduction in the risk of alcohol-related deaths. De Silva R. Gamage R. Wewelwala C. Gunarathna D. Kittner S. Sirisena D. Weerasinghe A. Amarasinghe P. (2009). "Young strokes in Sri Lanka: An unsolved problem." Journal of Stroke and Cerebrovascular Diseases 18(4): 304-308. Objective: To elucidate the risk factors and radiologic features in young people (age < 45 years) with ischemic stroke. Study Method: Sociodemographic data, stroke risk factor information, and laboratory investigations were recorded in 41 cases with first-ever ischemic stroke. Study population: Young people (age < 45 years) Sample size: 41 Factors investigated: Hypertension, diabetes, transient ischemic attack, hyperlipidemia, family history of stroke Results: Most common risk factors for stroke in the 15- to 45-year-old age group were: hypertension, 8 (21%); family history of stroke, 7 (18%); transient ischemic attack, 6 (16%); hyperlipidemia, 3 (8.0%); and diabetes, two (5%). Age group younger than 15 years included 3 girls and one had a mass attached to the posterior mitral valve leaflet. Stroke in the young adults (15 to 45 years) accounted for 10% in 1974 and 33.6% in 1989 of strokes in the General Hospital, Colombo, 19 – 32% in India as compared to 3-5% in the West, the average age of patients in the developing countries with stroke is 15 years younger than in developed countries. The reasons for these differences are not well-understood. We attempted to elucidate risk factors of stroke in less than 45 years of age with first-ever ischemic stroke. Socio-demographic data, stroke risk factor information, clinico-investigative proÞ le were recorded in 41[21 male and 20 female (3 patients below the age of 15 yrs)] in unit one of the Neurological Institute of the National Hospital of Sri Lanka. The most common risk factors for stroke in the 15-45 age group were hypertension (HT) 8 (21 %), family history of stroke 7 (18%), transient ischemic attack (TIA) 6 (16%), hyperlipidemia (HL) 3 (8.0 %), diabetes (DM) 2 (5%), eclampsia 2 (5%), 5 (13%) had valvular heart diseases. In the less than 15 age group, one had mass attached to the posterior mitral valve leaflet. Conclusion: Our observations underscore the importance of the presence of hypertension, family history of stroke, and transient ischemic attack in young adults and thus to adopt preventative strategies. Further multicentre studies are needed to ascertain the interplay between genetic and environmental factors in the Region.

υϋϋ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

De Silva S. (2008). "The Nutritional Status of Grade Eleven Students in the Medical Officer of Health Area Kalutara." Journal of the College of Community Physicians of Sri Lanka 13(2). Objective: To describe the nutritional status of grade eleven school children in the Medical Officer of Health (MOH) area Kalutara. Study Method A descriptive cross-sectional study was carried out among grade eleven school children in Type 1AB and Type 1C state schools in the MOH area Kalutara. Eighteen classes from a total of 14 schools were studied. Cluster sampling technique, probability proportionate to size was used to select the sample. The heights and weights were measured, and the Body Mass Index (BMI) was calculated for each child. The age and sex specific BMI charts developed by the National Centre for Health Statistics 2000 were used as standards. A structured, pre-tested self-administered questionnaire was used to collect the socio-demographic characteristics. Study area: Type 1AB and Type 1C state schools in the MOH area Kalutara Study population: Grade eleven school children Type of study: A descriptive cross-sectional study Study instrument: A structured, pre-tested self-administered questionnaire Height and Weight Measurements Sampling method: Cluster sampling method Sample size: 639 Female 356 55.7 % Male 283 44.3 % Risk Factors investigated: Nutritional Status Results: The study included 639 school children where the great majority were Sinhalese (99.5%, n= 636), Buddhists (95%, n=607). There were no Tamils or Hindus. Females accounted for 55.7% (n=356) of the sample. Most (84.8%, n=542) of the students were residing in rural areas. The mean age of the study sample was 16.1(SD±0.4) years. The age range was 15.5 to 18.5 years. Seventy nine percent (n=502) of the children were able to record their monthly family income and 265 families had a monthly income of less than 10,000 rupees. Ninety eight percent [n=627] of the students were residing in there own homes where as 12 (1.9%) were residing outside home. The prevalence of thinness(<5th percentile) was 35.4% (n=226) and prevalence of being at risk of overweight (≥85th percentile)was 6.7% (n=43). Out of the males 43.8% (n=124) were in the thinness category compared to the girls (28.7%, n=102). Among those at risk of overweight, fe-males (8.7%, n=31) had a higher prevalence than the males (4.3%, n=12). This finding was statisti-cally significant (p=0.0001). More of the rural children were in the thinness cate-gory (36.3%, n=197) and more urban students were at risk of overweight (10.3%, n=10), yet not statisti-cally significant. Although there was no statistically significant difference between the nutritional status and parental factors, a higher proportion of thinness was observed when the mothers did not reside with the children and where mothers‘ education was less than G.C.E. O/L. Conclusions:

υϋό Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Under-nutrition is a problem among grade eleven school children in the MOH area Kalutara. Almost 7% of them were at risk of overweight. Dheerasinghe DSAF. (2009). Quality of life in Clinic Attendees of the Diabetic Clinic National Hospital of Sri Lanka. Postgraduate Institute of Medicine. Colombo, University of Colombo. Master of Science in Community Medicine. Main objective: To describe the quality of life among clinic attendees of the diabetic clinic at the National Hospital, Sri Lanka. Specific objective: 1.To describe the sociodemographic characteristics of the clinic attendees of the diabetic clinic; 2.To describe the physical health aspects of quality of life among the study population ; 3.To describe the psychological aspects of quality of life among the study population; 4.To describe the quality of life in respect to social relationships and enviroment among the study population, 5.To describe the selected factors associated with the quality of life and diabetes mellitus. Study area: Diabetic clinic of National Hospital of Sri Lanka (NHSL) Study population: All clinic attendees who were 40-60 years of age and diagnosed to have diabetes mellitus, irrespective of the duration of diabetes mellitus but who had other chronic illnesses were excluded from the group as it may also affect the quality of life. Type of study: A hospital based cross sectional study Study instrument: Two interviewer administered questionnaires Sampling method: Systematic sampling Sample size: 422 clinic attendees Calculated sample size 384 Risk Factors and diseases investigated: Diet, physical activity, Diabetes mellitus Results and conclusions: The study revealed that people with DM have significant poor Quality of Life(QoL) compared to healthy individuals. Out of the 422 participants , 79.4% were females and 66.1% were in the age group of 50-60 years. Approximately 85.5% of the study population was Sinhalese and 91.1% had primary education. Approximately 79% of the study population was married . Unemployed rate was higher among the females The study population of less educated (grade 5 or less ) or not attended to school, or with less income (less than Rs 10000) and the patients with complications had poor QoL in all the four aspects of the selected sociodemographic factors (i.e physical health, psychological health, and social and environmental relationships). Currently unmarried populaiton had poor QoL than the married population in both psychological health, and social relationship aspect of QoL. Male has a significant had poor QoL in enviromental relationship of QoL than Females. The patients who are on insulin had a significant poor QoL in physical health, psychological health, and social aspects than those who were on oral Hypoglycemics.

υϋύ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Recommendation: The prevention of complication is one of the most important issues regarding the Health aspects as it is strongly associated with QoL of diabetes patients.Thus a multidisciplinary approach is needed for the management of such patients. It is necessary to educate all the clinic attendees regarding the importance of good drug compliance, healthy dietary habits, adequate physical activities to minimize the introduction of insulin which may in turn improve the QoLof these patients.. Since educational aspects were also significantly associated with QoL , it is recommended to include information on DM and its consequences abd the importance of prevention of disease in the school curriculum. Fernando DJ. (1993). "Knowledge about diabetes and metabolic control in diabetic patients." Ceylon Med J 38(1): 18-21. It is widely accepted that patient education is an essential adjunct to the care of diabetic patients. A randomised controlled clinical trial in patient education was conducted at a diabetic and general medical clinic in Sri Jayawardenepura General Hospital. Two groups of diabetic patients matched for age, gender and duration of diabetes were allocated randomly to conventional care at general medical clinics or to a diabetes clinic where specific educational objectives were defined and patients trained to achieve these objectives. The doctors treating these patients were not 'blinded' to treatment groups. Diabetes knowledge was assessed using a diabetes knowledge scale and metabolic control assessed by mean fasting blood glucose. The patients attending the diabetic clinic showed significant improvement in both knowledge scores (67% vs 34%, p < 0.01) and mean fasting blood glucose 6.38 +/- 0.85 mmol/l vs 9.7 +/- 1.7 mmol/l, p < 0.01) at 6 months. We conclude that diabetes education improves patient knowledge and diabetes control. Fernando DJ. (1996). "The prevalence of neuropathic foot ulceration in Sri Lankan diabetic patients." The Ceylon Medical Journal 41(3): 96-98. Objective: To determine the prevalence of diabetic neuropathy and neuropathic ulceration among patients with non-insulin dependent diabetes (NIDDM) attending a Sri Lankan diabetic clinic. Study Method: Five hundred randomly selected diabetic patients (mean age 47.4 SD 17.59 years, 275 were males, mean duration of diabetes 5.29, SD 6.44 years) were screened for diabetic neuropathy using a neuropathy symptom score (NSS) neurological disability score (NDS) and pressure perception threshold using Semmes Weinstein monofilaments. Study area: The diabetic clinic of the General Hospital Colombo (Sri Lanka National Hospital). Study population: Non-insulin dependent diabetes patients. Type of study: Neuropathy Symptom Score (NSS), Neurological Disability Score (NDS) and Pressure preception threshold using Semmes Weinstein monofilaments. Sampling method: Random sampling Sample size: 500 Factors investigated: Age, diabetes for a longer period, foot ulcer, lower extremity amputation due to neuropathic ulceration.

υότ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Results: Patients with neuropathy were older (mean 55.69 years SD 14.16) than those who did not (mean 47.1 years, SD 15.05 p = 0.001) and had diabetes for a longer period (mean 7.5, SD 8 years vs 4.8 SD 5.66, p = 0.002). 123 (30.6%, 95% CI 28-32%) patients had neuropathy according to the criteria used. 51(10.2%, 95% CI 8.2-12.2%) had a foot ulcer, a history of foot ulceration or a lower extremity amputation due to neuropathic ulceration. 26(5.1%, 95% CI 3.2-7%) patients had neuropathic foot ulcers at presentation and a further 14 (2.8%, 95% CI 1.4-4.2%) had developed an ulcer within one year of diagnosis of diabetes. 24 (4.8%, 95% CI 3-6.8%) had a history of lower extremity amputation. Conclusion: Neuropathic ulceration is a significant cause of morbidity in patients with NIDDM. One third of all NIDDM patients attending the clinic had a risk of foot ulceration. Preventive foot care programmes should be implemented at all diabetic clinics in Sri Lanka. Fernando DJ. Siribaddana S. De Silva Subasinge Z. (1993). "Prevalence of retinopathy in a Sri Lankan diabetes clinic." The Ceylon Medical Journal 38(3): 120-123. Objective: To determine the prevalence of diabetic retinopathy among patients with non-insulin dependent diabetes (NIDDM) attending a Sri Lankan diabetes clinic and assess the skills of non-ophthalmologist in screening for retinal disease. Study Method: One thousand and three consecutive diabetic patients were screened for diabetic eye disease using a standardised technique based on the WHO Multinational Study. Study area: Sri Lanka Study population: Non-insulin dependent diabetes . Type of study: Sample size: 1003 Factors investigated: Retinopathy, cataract, refraction errors, blind due to advanced retinal disease, blind as a result of cataract Results: 31.3% (95% confidence intervals 28.0% to 31.6%) had retinopathy, 23% (95% confidence intervals 21% to 25%) had cataract and 20% (95% confidence intervals 17% to 23%) had previously undetected refraction errors. 4.1% (95% confidence intervals 2.1% to 6.0%) of patients were blind due to advanced retinal disease while 6.2% (95% confidence intervals 5.0% to 7.2%) were blind as a result of cataract. General physicians had a 90.6% sensitivity and 100% specificity in screening for retinal disease. Conclusion: Retinopathy accounts for significant visual handicap. Untreated cataract is more commonly associated with blindness. Undiagnosed errors of refraction account for significant visual handicap in Sri Lankan diabetic patients. Physicians trained in techniques of retinal screening can correctly assess diabetic retinal changes in a high proportion of patients.

υόυ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Fernando DJS. (1994). "Symptomatic hypoglycaemia in elderly diabetic patients." The Ceylon Medical Journal 39(2): 110-111. Objective: To study the incidence of symptomatic hypoglycemia mainly including sulphonylurea induced hypoglycemia (SIH) in elderly diabetic patients Study Method: Consecutive patients of aged over 61 years attending an outpatient diabetic clinic in a teaching hospital was studied over a four week period. All patients (and accompanying persons if any) were asked whether the patient had experienced any key symptoms if hypoglycemia within the previous 3 months, and if so, whether symptoms were severe enough to require assistance of another person or seek treatment from a doctor. Symptoms were attributed to hypoglycemia if they respond to oral or intravenous glucose therapy alone. Patients were also asked whether they had received any advice on identification, prevention or treatment of “low blood sugar”. All patients were asked what they would do if they suspected that they had low blood sugar. Study area: Outpatient diabetic clinic of General Hospital Colombo. Study population: Consecutive diabetic patients of aged over 61 years attending an outpatient diabetic clinic in a teaching hospital Study instrument: Interviewer administered questionnaire Sampling method: Convenient sampling method Sample size: 144 Results: The study included 144 consecutive patients ( 61 men , mean age 67.1,SD 7.7 years, mean duration of diabetes 9.1, SD 7.5 years) aged over 61 attending the relevant outpatient diabetic clinic . At least one episode of symptoms suggestive of SIH requiring assistance of another person was experience by 82 patients within the previous 3 months. Of these 22 sought medical advice and 7 required hospital admissions. 44 (53.6%) of the patients experiencing SIH were being treated with chlorpropamide, 26 (18%) with glibenclamide and 12 (8.3%) with tolbutamide. Eight patients receiving glibenclamide who experienced SIH were prescribed a dose of 10mg bd, which is in excess of the maximum daily dose of 15mg. The prevalence of SIH among those taking different sulphonylurea was chlorpropamide 68.7%, glibenclamide 72.2% and tolbutamide 27%. 49 (34.2%) patients were aware of the need to take food or sugar if they suspected low blood sugar. 32 (22.2%) patients had been given advice regarding recognition, treatment and prevention of hypoglycemic attacks. Only 8 patients had received this advice from the doctor who prescribed the medication. Fernando GNN. De Silva KHPUD. (2010). "Adherence to the National Guidelines on the management of bronchial asthma: a cross-sectional study in Medical Clinics in Teaching Hospital, Karapitiya." Galle Medical Journal 15(1): 8-13. Introduction: In persistent asthma, the regular use of inhaled corticosteroids (ICS) on daily basis is the mainstay of therapy. As little is known about the use of ICS in the local set up, this study was planned to identify how the ICS are used, compliance of patients and factors that limit the correct use of ICS.

υόφ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Objectives: To describe the adherence to the guidelines; in prescribing and dose titration and to assess the correct technique of using inhaler device. Also to describe patient factors that limit adherence to guidelines. Methods: This is a descriptive cross-sectional study involving 106 Physician-diagnosed bronchial asthmatics attending medical clinics in Teaching Hospital, Karapitiya. Results: Patients were between the age of 12-93 years. 67% were between 41-70 years. 67.9% patients were prescribed appropriate optimal treatment according to the guidelines. 67% of patients showed a good compliance to the prescribed medications. The commonest reasons for poor compliance were unaffordability of drugs (56.75%) and improvement of symptoms as felt by the patients (18.9%). Compliance declined with the duration of follow up. 64.2% were following the correct inhaler technique. The most critical step in the inhaler technique was the 'breath holding for 10 seconds' (only 41.3% adhered to this). Males were significantly (chi-square test; =0.01) better in practicing the proper inhaler technique as compared to females. Conclusions: Majority of patients need ICS as the primary treatment with some requiring long acting bronchodilators. Programs to improve the knowledge of doctors would be beneficial to improve the adherence to the guidelines. Supplying ICS free of charge by the hospital, at least in the initial years, and continuous health education would improve the compliance to ICS. The inhaler technique should be checked at least in non-responders. When checking the inhaler technique special attention should be paid to the ability of holding breath after inhalation and females are the most vulnerable group. Changing over to metered dose inhaler with a spacer device should not be delayed in repeated failures of dry powder inhalers. Fernando MAM. Senathilake PHRS. Perera BJC. (2004). "Body mass index, allergic rhinitis and asthma in children." Sri Lanka Journal of Child Health 33(4): 102-105. Objective: To assess the possible relationship of bodyweight and body mass index (BMI) to childhood asthma and allergic rhinitis. Study method: Children aged 13-14 years in 20 out of 22 schools were assessed from April to June 2003 using the internationally validated ISAAC questionnaire on asthma and allergies. The children and parents filled the questionnaire. Height and weight of children were measured using a standardized procedure. Reference ranges for the normal BMI data were obtained from reference growth charts of Ministry of Health. Data was analysed using Epi info version 6.0. Study Area: Chilaw divisional secretariat area Study population: Children, aged 13-14 years [grade 8], in 20 out of 22 schools in Chilaw divisional secretariat region, were assessed. Study Instrument: Self-administered questionnaires Height and weight measurements Study type: Prospective observational study. Sample size: 866

υόχ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Sampling method: Risk Factors Investigated: BMI, Wheezing, allergic rhinitis Results: Total number of children recruited was 866.of whom 448 (51.8%) were males and 417(48.2%) were females. 185 (21%) gave a positive response to ever having had wheezing. Allergic rhinitis was found in 233 [27%]. Only 97 [11%] had both asthma and allergic rhinitis. The BMI was <5th centile in 407 (47%), 5th-85th centile in 418 (48.3%) and >85th centile in 41 (4.7%). It was observed that more boys were underweight while more girls were overweight. P<0.001 Conclusion In Chilaw divisional secretariat region 47% of 13- 14 year age group children were found to be underweight for their age. 61% of them were boys. Only 4.7% were above 85th percentile for age and 68% of them were girls. It was a significant (P<0.001)finding that more boys had wheezing than girls in the sample. There was no difference in sexes among the children with allergic rhinitis. No significant association (P>0.05) was found between BMI and asthma/allergic rhinitis in 13-14 year old school children in the Chilaw area. Fernando SD. Paranavitane SR. Rajakaruna J. Weerasinghe S. De Silva D. Wickremasinghe AR. (2000). "The health and nutritional status of school children in two rural communities in Sri Lanka." Tropical Medicine and International Health 5 (6): pp 450–452. Objective: To describe the nutritional status and parasitic infections of school children in two areas of rural Sri Lanka. Study method: Informed written consent was obtained from the parent or guardian of each child who was present on the day of the survey. The study was conducted in September 1997. A brief questionnaire was administered to the parent or guardian which recorded monthly reported household income and parents’ educational level. The age of each subject was recorded from the birth certificate held by the school. The height of each child was measured to a precision of 0.1 cm using a stadiometer and the weight was measured to a precision of 0.1 kg using a spring scale. The scale was checked with a 20-kg weight after every tenth measurement and 10% of measurements were rechecked. A fresh stool specimen was collected from each child and was examined using the Kato–Katz method. Every child was given a single dose of 500 mg mebendazole. A sample of 2 ml venous blood was drawn from each child and transported at 4 8C to a laboratory in Colombo, where haemoglobin concentration and packed cell volume were measured and the mean corpuscular volume (MCV) as well as mean corpuscular haemoglobin (MCH) calculated. A child with a haemoglobin concentration , 12 mg/dl was classified as anaemic. A thin blood film was stained with Giemsa and examined for human Plasmodium spp. Any child found to be infected with Plasmodium spp. was given chloroquine phosphate (25 mg/kg) and primaquine (1.25 mg/kg) for 5 days. Children infected with P. falciparum were followed-up after 14 days with a blood film examination and treated with sulphadoxine/pyrimethamine, if patent parasitaemia existed. Anthropometric indices were calculated using EpiInfo software (Centres for Disease Control and Prevention, Atlanta, GA, USA) and children were classified as moderately stunted, underweight or wasted if their z-score of height for age, weight for age or weight for height was < - 2 standard deviations below the NCHS median, and severely stunted, underweight or wasted if their z-score was <- 3 standard deviations below the NCHS median. Z-scores of weight for height were not calculated for girls . 10.0 years and boys. 11.5 years.

υόψ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Study Area: Four primary schools in the Moneragala district Study population: All children in grades 1–5 in four primary schools in the Moneragala district in the dry zone of Sri Lanka. Study Instrument: Questionnaires Height and weight measurements Stool and blood samples Sampling method: Convenient sampling method Risk Factors Investigated: Nutrition level Results: A greater proportion of boys than girls were underweight ,(p<0.001), wasted ,(p<0.001), and stunted. There was no association between age and the degree of stunting. Only weight for age was associated with the education of parents: mothers who had been educated above grade 6 were less likely to have underweight children (62% vs. 72%, p 5 0.007). Eighty-five per cent of parents reported a household income of , 2000 Sri Lankan rupees per month Over 80% of the children were anaemic but did not apparently have iron deficiency anaemia according to their blood picture. The prevalence of parasitic infections such as hookworm and Plasmodium spp that may contribute to anaemia was low. Fernando TRN. Jayaratna BGS. Lankeshwara E K. (2012). "Screening for gestational diabetes in the Anuradhapura district." Sri Lanka Journal of Diabetes Endocrinology and Metabolism 2(1): 11-16. Introduction: Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy. GDM is associated with 2-4 times increase in perinatal complications. Asian women are at higher risk of GDM compared to white Caucasians. Only few studies have been done to understand GDM among rural Sri Lankan women. Objectives: To determine if risk assessment for GDM is conducted at the field antenatal booking and to determine the types of screening methods for GDM applied in the Anuradhapura district (AD). Method: Cross sectional retrospective analysis of a hospital based sample of pregnant women attending for their delivery. Study population: Pregnant mothers with period of amenorrhoea (POA) >28 weeks, in the AD. Results: N = 422. Six out of seven risk factors mentioned in the antenatal record (ANR) were well documented, in >90%. Eight risk factors, not mentioned in the ANR were poorly documented (<22%). Random urine sugar testing was done in 93%, while blood sugar tests were done in <41%. Conclusion: Screening for GDM in the primary health care of Anuradhapura district is grossly inadequate.

υόω Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Fernando WHKN. Wijesinghe DGNG. (2010). "Assessment of Nutritional Status and Disease Prevalence among Elderly Population in Elderly Homes in Kandy." Tropical Agricultural Research 21(3). Objective: To assess the nutritional status and the prevalence of non-communicable diseases among elderly people in elderly homes in Kandy. Study Method: A population of 105 elderly people (>65 years), representing 7 elderly homes in Kandy was examined using the Mini Nutritional Assessment (MNA) tool and an additional questionnaire. Skinfold thickness was measured using the Harpenden calliper and body fat was measured using a digital Fat Analyzer Study area: 7 elderly homes in the Kandy district, Study population: 105 adults (68 females and 37 males) aged over 65 years, from 7 elderly homes in the Kandy district, Study instrument: Questionnaires Measurement of weight and height Measurement of mid upper-arm, calf-, waist- and hip circumferences Measurement of skinfold thickness Measurement of fat percentage Measurement of dietary intake and energy requirement Sample size: 105 Results: According to the MNA tool 59.1% were at risk of being malnourished, 3.8% weres malnourished and 37.1% were normal. Based on BMI classification, 16.2% was under-weight, 55.2% was normal and 28.6% was over-weight. According to waist-to-hip ratio, 51.4% had a lower risk, 32.4% a moderate risk and 16.2% a higher risk for health problems while 41.9% of the population had hypertension, 13.3% had diabetes and 19.0% had airway obstructive disorders. Furthermore, 31.4% of the population was less active and 67.6% was moderately active. The daily mean energy intake (1945.6 kcal) of subjects was higher than the calculated energy requirement (1490.1 kcal). Among the variables studied BMI had a strong positive correlation with body fat mass (r=0.901, p<0.0001) and skin fold thickness (biceps r=0.594, p=0.000; triceps r=0.538, p<0.0001). Waist circumference also had a positive correlation with skinfold thickness (biceps, r=0.521, p<0.0001; triceps, r=0.337, p<0.01) and fat mass(r=0.645, p<0.0001). Waist-to-hip ratio showed a positive correlation (r=0.322, p <0.05) with biceps skinfold thickness. With waist-to- hip ratio >0.95, the prevalence of non-communicable diseases was clearly high. Further studies are needed using data from other regions in the country to verify the above findings. Gobishangar S. Jayanthan N. Raviraj S. (2010). "Demographic analysis of thyroid malignancies in a single surgical unit, Teaching Hospital Jaffna." The Jaffna Medical Journal 26(1): Page 43. Objective: To identify the pattern of thyroid malignancy, distribution among males and females and compare with national and international data Study method:

υόϊ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

A retrospective study was conducted in patients who underwent treatment for thyroid malignancy at a single surgical unit; Teaching Hospital Jaffna over 8 year period from 2003 till 2010 May. Study Area: In a single surgical unit; Teaching Hospital Jaffna Study population: Patients who underwent treatment for thyroid malignancy Study Instrument: Bed Head Tickets, clinic records, theatre records, histopathological reports, and unit computer database records. Study type: Retrospective cohort study Sample size: 52 Disease Investigated: Thyroid Malignancy Results: Results revealed that there were at least 5 to 8 patients annually, with a higher incidence in females diagnosed with thyroid carcinoma have been reported to the hospital. Male to female ratio was 1:4.2. International studies shows male to female ratio was 1:3. In this study 52% have papillary, 38% have follicular, 8% have Medullary and 2 % have anaplastic carcinoma. International data showed papillary 80%, follicular 5-10%, medullary 5-10%and1- 2 % anaplastic carcinoma. The study also revealed that the peak age groups were 20-29 years and 50-59 years (37.8%), while the international data showed than the peak incidence of thyroid carcinoma was between the 5th and the 8th decade. Gooneratne IK. Ranaweera AKP. Liyanarachchi NP. Gunawardane N. Lanerolle RD. (2008). "Epidemiology of chronic kidney disease in a Sri Lankan population." International Journal of Diabetes in Developing Countries 28(2). Objective: To describe demographic patterns and identify common causes of CKD in patients admitted to ward 41 and 48B, National Hospital of Sri Lanka. Study method: A hospital based descriptive 3-month study was conducted at ward41 and 48B, National Hospital of Sri Lanka. A case record form was used to record sociodemographic variables, stage of renal disease, and etiology of patients in established chronic renal failure. Sources of data included patient interviews, diagnosis cards and case records, ultrasound scan reports, and biopsy findings Study Area: Ward 41 and 48B, National Hospital of Sri Lanka Study population: Patients with chronic renal failure Study Instrument: Clinical interviews, diagnosis cards and case records Study type: A hospital based descriptive study Sample size: 121 Sampling method: Convenient sampling method

υόϋ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Results: One hundred and twenty-one patients were recruited with male to female ratio being 2.5:1 (86:35). Mean age of the population was 47.8 years (SD ± 13.7). Common causes of CKD identified in these patients included diabetic nephropathy (37, 30.6%), hypertension (16,13.2%), glomerulonephritis (12, 9.9%), and obstructive uropathy (10, 8.3%). The cause was unknown in 25.6% of patients with chronic renal disease. Fifty percent of patients were from the Western Province. The leading cause of CKD in patients from the Western Province was diabetic nephropathy (26, 37.7%). The etiology of CKD was unknown in majority of the patients (14, 27.4%) from other provinces. The difference in incidence of diabetic nephropathy in the Western Province as to other provinces was not statistically significant (P >0.05). CONCLUSION: Diabetes is a major contributor to CKD reflecting changing disease epidemiology in Sri Lanka. Gurugama NP. Seneviratne SL. Peiris DTS. De Silva HJ. (2003). "Detection and management of alcohol misuse by general practitioners." Ceylon Medical Journal 48(4): 122-124. Introduction Alcohol misuse and related problems are common in Sri Lanka. The appropriateness of the primary care setting in dealing with alcohol misuse is well recognised, and general practitioners (GPs) constitute an important first contact setting. Methods One hundred and fifty randomly selected GPs practising in the Colombo and Gampaha districts were given a questionnaire to assess how they detect and manage alcohol misuse, and their attitudes towards persons who misuse alcohol. Results Seventy per cent of GPs responded [74 male; mean age 42 years (SD 6.7)]. Our results suggest that although a majority (81%) of GPs were frequently confronted with problems related to alcohol misuse, their efforts to detect the problem and knowledge regarding risk limits of alcohol consumption were poor. Only 25.7% had even heard of CAGE and MAST questionnaires. The majority of GPs felt inadequately trained to deal with alcohol misuse, but only a few made any self-directed efforts to improve their knowledge and skills regarding its management or referred their patients for specialised care. Participation in preventive programmes was minimal, and many GPs expressed negative attitudes towards persons misusing alcohol. Conclusions The ability of general practitioners to detect and alcohol misuse appears to be inadequate. Hasheni BV , S. K. (2012). "Quality of life after acute coronary syndrome; a comparative study." Galle Medical Journal 17(2): 12-18. Introduction: Quality of life (QOL) is a measure based on patients' perspective. Measurement of QOLis useful in the evaluation of cardiac diseases. Methods: QOL scores of patient with the diagnosis of acute coronary syndrome were assessed using WHOQOL-100 questionnaire one month and three months after being discharged from hospital. QOL scores of patients were compared with that of the controls and scores of one month after discharge with that of three months after discharge. Results: 56 and 30 patients out of 111 responded for the assessment at one month and three months after the discharge respectively. There were 45 in the control group. QOL scores for physical capacity

υόό Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

(PC), psychological aspects (PSY) and level of independence (LOI) were significantly lower in patients than the controls at one month after discharge. The scores of one month after discharge with the scores of three months after discharge showed significant differences in PC and LOI. Conclusions: The QOL scores of PC, PSY and LOI domains are lower in patients who had acute coronary syndrome than in controls. There is improvement in PC and LOI scores with time from one month to three months after getting discharged from the hospital. Herath HMM. Palangasinghe DR. Prasad JD. Ruchiranga SKL. Singhapura SDAL. (2010). "Prognostic value of thrombolysis in myocardial infarction (TIMI) score in predicting the morbidity and mortality following acute coronary syndrome- an observational study." Galle Medical Journal 15(1). Introduction Thrombolysis in myocardial infarction (TIMI) score has good predictive accuracy for morbidity and mortality following acute coronary syndrome (ACS) in some patients. However the prognostic accuracy of TIMI score among Sri Lankan withACS has not been studied. This study was undertaken with the objective of assessing the value of TIMI scores in predicting the morbidity and mortality in patients withACS in Galle. Methods Patients who were admitted to the university medical unit of Teaching Hospital Karapitiya (n=142) with ACS from October 2009 to June 2010 were analyzed. Data on baseline characteristics were obtained with a predesigned questionnaire and patients were followed up for a month. The primary endpoint was death and the secondary end points were heart failure (HF), recurrent angina (RA), and arrhythmias. Results There were 83 (59.0%) males and 58 (41%) females with mean (SD) age of 61.0 () years. 14 (10%) patients were diagnosed as having ST-elevation myocardial infarction (STEMI) and 45 (31%) and 83 patients (58%) had nonST elevation myocardial infarction (NSTEMI) and unstable angina respectively. Fourteen patients (10.0%) suffered from HF, 25 (18.0%) had RA and 8 (2.0%) died due to ACS. Ninety four (67.0%) patients had TIMI scores of 0-3 and 24 (25%) of them met either primary or secondary end points. TIMI scores of 4-7 were observed in 48 (34.0%) patients and 48.0% had complications of ACS (p=0.03). Higher TIMI was associated with high mortality rate (TIMI <4.0, rate was 3.1% and TIMI 4, rate was 10.4%). Conclusions TIMI has a good prognostic value with higher TIMI being associated with higher morbidity and mortality at one month after ACS events. Hettiarachchi M. Liyanage C. (2010 ). "Dietary macro- and micro-nutrient intake among a cohort of pre-school children from southern Sri Lanka." The Ceylon Medical Journal 55.(5): 47-52. Objective: To establish a database on dietary intake among children aged 3-5 years in southern Sri Lanka. Study Method: A retrospective, quantitative method (24-hour dietary recall on 3 consecutive days) in combination with a food composition database was used to assess the nutrient intake among 248 children in Galle. Anthropometry measurements were done to assess their nutritional status. Two well baby-clinics that were conducted by 8 public health midwives (PHM) were purposively selected out of 4 clinics in this division. Two PHM areas from each of the 2 clinics were selected by simple random sampling. Parents of randomly selected children aged 3-5 years in these PHM areas (n=267) were invited to a meeting at which the purpose of the study (procedure involved in obtaining dietary

υόύ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

intake data) were explained in detail. They were demonstrated how to measure the portion size using household measuring units. They were given an opportunity to ask questions regarding the study. Informed written consent was obtained from parents of each study participant. Children who had a history of medical conditions lasting more than one month (n=7) and consumed medications, including vitamin or mineral preparations for more than one month (n=12), were not included in the study. Height, weight and medical history were obtained, and a brief physical examination was conducted. Height and weight were measured using a portable stadiometer and a beam balance respectively. Dietary intake was assessed by the 24-hour recall method on 3 consecutive days from the mother (in some children the father participated, however same individual was present on all 3 days). Intake of all foods, drinks and snacks during the previous day were recorded. Data collectors were trained to record the food intake on a standard format. Special attention was given to estimation of portion sizes using household measuring units. After completion, the food quantities were converted to nutrient intake by each participant using food composition tables and this was further compared with recommended dietary allowances (RDA) established by the Ministry of Health to assess the adequacy of their diet The NutStat programme of the Epi-info version 3.4.1 (2008) for Windows was used to generate Z-scores of weight-for-age (WAZ), height-for-age (HAZ) and weightfor-age (WHZ). A Z-score <-2.0 from the reference median was used to detect wasting, stunting and thinness respectively. The average energy and nutrient intake have been presented as a mean of the 3-day intake. Data were analysed using SPSS version 10.0 (Chicago, USA). Student t-test was used to compare males and females. P values less than 0.05 were considered to be significant Study area: The study was conducted in year 2007 in the University of Ruhuna, Galle, field training area (Bope-Poddala health division) Study population: Children aged 3-5 years Type of study: A retrospective, quantitative method Study instrument: Interviewer administered questinnaire Height and weight measurements Sampling method: Simple random sampling Sample size: 248 Risk Factors investigated: Diet Results: A total of 248 children (122 males and 126 females) participated. There was no difference in the age distribution (p=0.17) by sex. Mean age of males was 51.0 (SD, 7.2) months and 48.7 (7.5) months in females. Male children had mean weight of 14.0 (2.2) kg and a mean height of 100.7 (5.9) cm. In female children those were 13.3 (2.0) kg and 99.2 (5.9) cm respectively . The body mass index also showed a significant difference (p=0.03); mean levels of 13.7 (1.1) kg/m2in males and 13.5 (0.9) kg/m2 in females. None of the children below 3 years of age was stunted (HAZ <-2.0) . Overall stunting was 3% (3 each from males and females) with underweight (WAZ <-2.0) in 25% (n=25) of males and 26% (n=27) of females. The prevalence of thinness as an indicator of malnourishment (WHZ <-2.0) was seen among 23% (n=23) of males and 16% (n=17) of females. The survey data sheets that lacked information on any of the 3 days were excluded (n=28). Further, incomplete recall or unrealistic data, that could not be corrected reliably, were also rejected (n=14).

υύτ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Hence, data have been reported on 206 participants. Overall mean dietary intake of energy among males (6.23 (1.3) MJ/day) was significantly higher (p=0.05) than females (5.75 (1.3) MJ/day). The contribution from dietary fat towards the daily energy requirement was 16% among males and 15% among females respectively. Although, there were statistically significant differences in mean daily intake of some of the nutrients between males and females by age groups it was not evident in the total sample. The percentage of participants with energy intake below RDA were 44% among males and 55% among females. None of the 3-year old females met the daily energy requirement. There was no significant correlation between the nutrient intake and anthropometric parameters. The total dietary energy intake was significantly correlated with intakes of protein (r=0.60, p<0.001), fat (r=0.69, p<0.001), calcium (r=0.40, p<0.001), phosphate (r=0.48, p<0.001),folate (0.48, p<0.001), β-carotene (r=0.37, p<0.001) and vitamin D (r=0.22, p<0.05). The dietary fat intake was significantly correlated with dietary intakes of β-carotene (r=0.50, p<0.001), vitamin D (0.54, p<0.001), protein (r=0.20, p=0.04), calcium (r=0.32, p=0.001) and phosphate (r=0.24, p=0.01). Dietary intake of vitamin D was positively correlated with calcium intake (r=0.37, p<0.001). Conclusions There were no significant correlations between the constituents of the diet with the anthropometric parameters. The overall mean (SD) energy intake of male children 6.23 (1.3) MJ/day was significantly higher (p=0.05) than female counterparts [5.75 (1.3) MJ/day]. 44.0% (n=45) of males and 55.0% (n=57) of females had an energy intake below the recommended level. None of the females of 3 years of age met the daily energy requirement. The intake of energy, protein, calcium, â-carotene, vitamin D and iron was satisfactory in preschool children. Consumption of nutrients except iron and energy was better in males than in females. The dietary macro- and micro- nutrient intake by both sexes exponentially increased with age. Illangasekera U, D. N. S. B. (2012). "Relative importance of the metabolic syndrome as a cardiovascular risk factor in Sri Lankans." Sri Lanka Journal of Diabetes Endocrinology and Metabolism 2(1). Objective To determine the prevalence of the MS in those with and without CVD and to evaluate the strength of the relationship between individual cardiovascular risk factors in those with CVD. Methodology The study was cross sectional in design and was carried out in Teaching Hospitals of Kandy and Peradeniya. All patients over the age of 30 years attending the Cardiology Clinic at Teaching Hospital, Kandy (n=164) and the Diabetic Clinic (n=667) at Teaching Hospital, Peradeniya over a period of one month were selected. One hundred and eighty subjects with no evidence of CVD too were selected from hospital visitors and bystanders. Informed consent was obtained from all patients and subjects. The International Diabetes Federation (IDF) definition was used to diagnose the MS . Cardiovascular disease was diagnosed on clinical features such as the presence of symptoms and signs of ischaemic heart disease, being treated for such disease and investigations such as ECG, echocardiography, exercise ECG and coronary angiography. The proportion of patients with MS among those with and without CVD was determined. The relationship between individual cardiovascular risk factors and CVD was carried out by assessing partial correlation for each risk factor while controlling for others. The waist circumference which is considered to be a surrogate marker of the MS too was assessed as a cardiovascular risk factor. Study area: Teaching Hospitals of Kandy and Peradeniya.

υύυ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Study population: All patients over the age of 30 years attending the Cardiology Clinic at Teaching Hospital, Kandy (n=164) and the Diabetic Clinic (n=667) at Teaching Hospital, Peradeniya over a period of one month were selected. Type of study: A cross sectional study Sample size: 831 Results: The total number of patients enrolled for the study was 831 consisting of 164 (110 males, 54 females) from the Cardiology Clinic, Teaching Hospital, Kandy, and 667 (437 males and 230 females) from the Diabetic Clinic at Teaching Hospital, Peradeniya. One hundred and eighty seven (98 males, 89 females) matched for age were selected as those without CVD from hospital visitors and bystanders. The association between the MS and the CVD is shown in Table 1. As the results indicate there was no statistically significant relationship between the MS and CVD. When the strength of the relationship between individual risk factors and CVD was assessed it was found that while diabetes was negatively correlated the least correlation was for the waist circumference compared with other cardiovascular risk factors (Table 2). Table 1. Relationship between the metabolic syndrome and cardiovascular disease CVD present CVD absent Total MS present 157 (59) 432 (57) 582 (57) MS absent 109 (41) 320 (43) 429 (43) Total 266 (100) 752 (100) 1011 (100) Significance: p 0.655 (t-test) MS: metabolic syndrome, CVD: cardiovascular disease Percentages in parentheses Table 2. Correlation between individual risk factors and cardiovascular disease Risk factor Correlation coefficient Significance Diabetes - 0.24 p < 0.001 Smoking 0.28 p < 0.001 Hypertension 0.18 p < 0.001 Dyslipidaemia 0.29 p < 0.001 Family history 0.77 p < 0.05 W.C. Male 0.10 p < 0.05 W.C. Female 0.04 N.S W.C. – waist circumference, N.S. – not significant Jayasekera CR. (2006). "Nutritional status of children under five in three State foster care institutions in Sri Lanka." Ceylon Medical Journal 51(2): 63-65. Objective: To determine the Nutritional status of children under five in three State foster care institutions in Sri Lanka

υύφ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Study Method: Prajapathi Children’s Home in Panadura, Tikiri Sevana Children’s Home in Peradeniya, and Ruhunu Children’s Home in Galle were randomly selected from among eight State Receiving Homes. Informed consent for the study was obtained in writing from the Commissioner of the Department of Probation and Child Care Services, respective Provincial Commissioners of the Department, and from matrons of each institution before evaluating children. The combined occupancy of the three institutions was 103 children of all ages (n=21, 36, 46, respectively). Children were recruited if they possessed a government issued birth certificate or Child Health and Development Record (CHDR), and were between 3 and 60 months of age, and not physically disabled. Of the 103 children, 77 were under five, of whom 52 (n=12, 13, 27, respectively)satisfied the other selection criteria and were recruited. Recruited children were weighed on a UNICEF electronic scale with 100 g accuracy. Recumbent length for those <24 months, and height for those >25 months was measured for each child by two individuals using a standard technique, with a UNICEF height board with 0.1 cm accuracy [3]. Besides anthropometric data, age, and sex, data on date of admission, and birth weight from the CHDR if available, were collected. The duration of parental care and breastfeeding could not be recorded due to unreliable family histories. Anthropometric analyses, viz., length- or height-forage, weight-for-age, and weight-for-height Z-scores were performed with EpiInfo v.3.2.2, based on the 1978 NCHS/WHO growth reference [4]. Determining the degree of stunting, underweight and wasting followed the WHO classification, where ≤2 to −3 Z-scores was considered moderate, and ≤3 Z-scores was considered severe for each indicator. Stratified analysis was performed to determine prevalence by age group, sex, birthweight (low or appropriate birthweight), and duration of institutionalisation. Additionally, matrons were administered a questionnaire to determine the number of care givers, nutrition provided to infants under two years, health care and nutritional monitoring, access to formal education, and frequency of inspection visits from the Department of Probation and Child Care Services. Study area: Prajapathi Children’s Home in Panadura, Tikiri Sevana Children’s Home in Peradeniya, and Ruhunu Children’s Home in Galle. Study population: Children under five Sample size: 52 Results: Recruited children ranged from 3.9 to 57.3 months of age (median = 18, mean = 23.6, SD = 17.3). Period of institutionalisation ranged from 0.1 to 56.1 months (mean=14.6, SD=13.8). Of the recruited children, 44.2% (23) were female. . The results showed that , the children institutionalised for over 12 months were worse off (stunted=66.7%, underweight= 85.7%, wasted=28.6%) than those institutionalised for 12 months or less (stunted=41.9%, underweight=48.4%, wasted=22.6%). Birth weight information was available for 78.8% (n=41) of children, of whom 21 had low birth weight (LBW) (<2500g) and 20 had appropriate birth weight. Gestational age, including incidence of preterm birth, could not be determined reliably. The children:care giver ratio of the institutions was 5:1 on average (3.5:1 at Prajapathi, 5:1 at Tikiri Sevana,6.5:1 at Ruhunu), based on information reported by matrons. At all three institutions, matrons reported the on-demand provision of Nestlé Lactogen 1 formula for infants under 6 months and Nestlé Lactogen 2 formula for those 6–24 months. Pre-school facilities were not provided at Prajapathi, though both Tikiri Sevana and Ruhunu did have such facilities. Only children at Tikiri Sevana had regular health and nutritional monitoring, performed by an a physician. At Prajapathi and Ruhunu, contact with health care providers was limited to when children presented with symptoms warranting a clinic visit. Frequency of inspections by the Department of Probation and Child Care Services was reported as being weekly at Ruhuna, monthly at Tikiri Sevana, and biannual at Prajapathi.

υύχ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Jayatissa R , M. H. S., Gunawardana S, Ranbanda JM , Gunathilaka M, De Silva PC (2012). "Prevalence and associations of overweight among adult women in Sri Lanka: a national survey." Sri Lanka Journal of Diabetes Endocrinology and Metabolism 2(2): 61-68. Objective: (i) To estimate the prevalence and distribution of overweight and obesity, in adult females and (ii) To analyze its possible causes. Study Method: Multi-stage cluster sampling method was used to select a representative sample at national level. A cross sectional household survey was carried out in nine districts of Sri Lanka, one district randomly selected from each province. Each district constituted one study area, except the Colombo district which had two study areas: the Colombo Municipal Council area (Colombo MC) and the Colombo Regional Director of Health Services (RDHS) area. The selected study areas were Jaffna, Trincomalee, Colombo MC, Colombo RD, Kurunegala, Anuradhapura, Nuwara Eliya, Badulla, Ratnapura and Hambantota districts. The probability proportional to size sampling technique was used to identify the clusters which are defined at the Grama Niladhari (GN) division level. The first cluster was identified randomly, followed by identification of a total of 30 clusters per district, using the sampling interval. A systematic random sampling technique was used within each cluster to identify 21 households. Each GN area was divided into several blocks, including 100 households per block. One block was randomly selected to collect the samples. A household was defined as persons routinely sharing food from the same cooking pot and living in the same compound or physical location. The first household was selected randomly and after that every third household was visited. The estimated sample size per district was 617 households totaling to 6170 households in the 10 study areas. Non pregnant and non lactating women between 15-49 years living in the selected households were included. A pregnant woman was defined as any reported pregnancy by the women and a lactating woman was defined as woman with a live birth within the previous 6 months. The household survey included the administration of a pre-tested questionnaire, assessment of the nutritional status of women using anthropometric indicators which was done using standardized procedures for measuring the height and weight (6). Height was recorded to the nearest 0·1 cm, using UNICEF stadiometers. Body weight was measured to the nearest 0·1 kg using a SECA digital UNICEF weighing scales. Data analysis was conducted in SPSS software packages. Body mass index (BMI) was calculated using weight and height. Four categories of women were identified based on BMI – thin (<18.5), normal (18.5-24.9), overweight (≥25.0-29.9) and obese (≥30.0) (7). Asian cutoff was also applied to assess the BMI categories as follows; BMI – thin (<18.5), normal (18.5-23.0), overweight (23.01-27.5) and obese (≥27.5) (7). For detail analysis international BMI cutoff values were used for comparative purposes. Multiple logistic regression analysis was used to determine the factors associated with overweight or obesity in women of 15-49 years of age. The magnitude of association was expressed as adjusted Odds Ratio (OR) and 95 percent confidence interval (95%CI) with the p value <0.05 for statistical significance. Study area: Jaffna, Trincomalee, Colombo MC, Colombo RD, Kurunegala, Anuradhapura, Nuwara Eliya, Badulla, Ratnapura and Hambantota districts Study population: Non pregnant and non lactating women aged 15 to 49 years in Sri Lanka Type of study: A descriptive cross sectional study

υύψ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Study instrument: Interviewer administered questionnaire. Weight and height measurement Sampling method: Multi-stage cluster sampling method Sample size: 6071 Results: A total of 6071 households were included in the survey. Out of the total, 69.4 % of the households were in the rural sector, 25.0 % in the urban sector and 5.6 % in the estate sector. Of the total 27,862 individuals who were usually resident in the selected households, 7604 (27.3 %) were women aged between 15.0 and 49.9 years. Thirty nine percent of the households had a monthly income less than Rs.9000 and 8.5% had Rs.≥32,000. Percentage of households classified as belonging to the lowest wealth quintile varied from 4.6 percent in the Colombo district to 40 percent in Jaffna district. Conversely, households belonging to the highest wealth quintile ranged from 5.1 percent in Jaffna to 46.6 percent in Colombo district . A total of 2146 non-pregnant and non lactating women aged between 15 to 49 years were included in the assessment of body mass index. The results also showed that of the total sample, 18.2 percent had BMI less than 18.5 (thin), 52.6 percent had BMI between 18.5 and 24.9 (normal), 22.5 percent with values between 25 and 29 (overweight) and 6.7 percent, with BMI values 30 or above (obese). When the Asian cutoff was applied 18.2 percent had BMI less than 18.5 (thin), 37.8 percent had BMI between 18.5 and 23.0 (normal), 28.7 percent with values between 23.01 and 27.5 (overweight) and 15.2 percent, with BMI values above 27.5 above (obese). The prevalence of underweight (BMI less than 18.5) was high in the 15-19 age group (40.5 percent) with a substantial decline in the age groups 20-29 years (22.5 percent) and 30-39 years (12.9 percent). Of all non-pregnantand non lactating women studied, 29.2 percent were either overweight or obese. This percentage increased with increasing age, most marked after 30 years of age.Marked inter-sectoral differences were seen, with the estate sector showing the highest percentage (42.6 percent) of women with BMI less than 18.5, compared to 11.3 percent in the urban sector. Conversely, in the urban sector, there was a high percentage of women who were overweight (28.3%) and obese (15.0%). Comparison between districts show that the percentage with low BMI ranged from 12.1 percent in Colombo RD to 25.3 percent in Ratnapura. Conversely, overweight ranged from 11.8 percent in NuwaraEliya district and 32.3 percent in Colombo MC. Obesity varied from 0.8 percent in Ratnapura district to 19.7 percent in Colombo MC. There was a declining pattern in the prevalence of underweight with increasing income levels and wealth quintiles. The prevalence of overweight and obesity showed an increase with higher income levels and wealth quintiles. Overweight and/or obesity in women were significantly higher after 30 years of age, in the urban sector, Colombo MC and Colombo RD, highest income and wealth quintiles. Women in the estate sector had lower (OR=0.21) risk of being overweight/obese compared to urban sector. Compared to the Colombo MC, risk of overweight/obesity was low in certain districts: Ratnapura (OR=0.46), Jafffna (OR=0.50), Colombo RD (OR=0.53), Hambantota OR=0.57), and Badulla (OR=0.56). Increasing level of husband's education and wealth quintiles were strong correlates for the risk of having overweight/obesity in women. Jayatissa R. Ranbanda RM. (2006). "Prevalence of challenging nutritional problems among adolescents in Sri Lanka." Food Nutr Bull 27(2): 153-60. BACKGROUND: Although 21% of the population of Sri Lanka consists of adolescents, studies of nutritional status among this group are limited.

υύω Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

OBJECTIVE: To assess nutritional problems and dietary and activity patterns among adolescents in Sri Lanka. METHODS: A nationally representative cross-sectional study was conducted on 6,264 adolescents 10 to 15 years of age. All subjects were clinically examined for Bitot's spots, and their weights and heights were measured. The subjects were interviewed during regular class time. Hemoglobin concentration and dietary and activity patterns were assessed among a subsample (n = 787) of 1,521 adolescents. The World Health Organization age- and sex-specific references for body-mass index and height-for-age were used to estimate the prevalence of underweight and stunting, respectively. The International Obesity Task Force age- and sex-specific reference for body-mass index was used to estimate the prevalence of overweight. Age-specific WHO-defined cut off points were used to estimate the prevalence of anaemia. RESULTS: The prevalence rates of underweight, stunting, and overweight were 47.2%, 28.5%, and 2.2%, respectively. The prevalence rates of anemia and vitamin A deficiency were 11.1% and 0.4%, respectively. During the previous 6 months, 10.4% of the subjects had usually not eaten breakfast before going to school. During the week before the interview, 24.4% of the children had not consumed green leafy vegetables, 26.6% had not consumed fruit, 19.0% had not participated in physical activities, and 27.5% had watched television for more than 2 hours per day. CONCLUSIONS: The nutritional problems of adolescents aged 10 to 15 years should be addressed through the schools. Specific policies should be developed in collaboration with the Ministry of Health and Education to control nutritional problems among adolescents. Jayawardena R. Ranasinghe P. Byrne NM. Soares MJ. Katulanda P. Hills AP. "Prevalence and trends of the diabetes epidemic in South Asia: a systematic review and meta-analysis." BMC Public Health 12: 380. BACKGROUND: Diabetes mellitus has reached epidemic proportions worldwide. South Asians are known to have an increased predisposition for diabetes which has become an important health concern in the region. We discuss the prevalence of pre-diabetes and diabetes in South Asia and explore the differential risk factors reported. METHODS: Prevalence data were obtained by searching the Medline(R) database with; 'prediabetes' and 'diabetes mellitus' (MeSH major topic) and 'Epidemology/EP' (MeSH subheading). Search limits were articles in English, between 01/01/1980-31/12/2011, on human adults (>/=19 years). The conjunction of the above results was narrowed down with country names. RESULTS: The most recent reported prevalence of pre-diabetes:diabetes in regional countries were; Bangladesh-4.7%:8.5% (2004-2005;Rural), India-4.6%:12.5% (2007;Rural); Maldives-3.0%:3.7% (2004;National), Nepal-19.5%:9.5% (2007;Urban), Pakistan-3.0%:7.2% (2002;Rural), Sri Lanka-11.5%:10.3% (2005-2006;National). Urban populations demonstrated a higher prevalence of diabetes. An increasing trend in prevalence of diabetes was observed in urban/rural India and rural Sri Lanka. The diabetes epidemicity index decreased with the increasing prevalence of diabetes in respective countries. A high epidemicity index was seen in Sri Lanka (2005/2006-52.8%), while for other countries, the epidemicity index was comparatively low (rural India 2007-26.9%; urban India 2002/2005-31.3%, and urban Bangladesh-33.1%). Family history, urban residency, age, higher BMI, sedentary lifestyle, hypertension and waist-hip ratio were associated with increased risks of diabetes.

υύϊ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

CONCLUSION: A significant epidemic of diabetes is present in the South Asian region with a rapid increase in prevalence over the last two decades. Hence there is a need for urgent preventive and curative strategies. Kasturiratne A. Wickremasinghe AR. De Silva A. (2005). "Morbidity pattern and household cost of hospitalisation for non-communicable diseases (NCDs): a cross-sectional study at tertiary care level." Ceylon Medical Journal 50(3): 109-113. Objective To determine the pattern of morbidity and the demographic and socioeconomic characteristics of patients seeking in-patient services for noncommunicable diseases (NCDs) in medical units of a tertiary care hospital, and to estimate the economic burden imposed by these admissions on the households. Methods A descriptive cross-sectional study was conducted in medical units of the Colombo North Teaching Hospital, Ragama. Data were collected using a pre-tested interviewer-administered questionnaire. Morbidity patterns and demographic and socio-economic characteristics of patients with NCDs were determined. Direct and indirect components of the household cost of hospital stay were estimated. Results Fifty five per cent of the patients men male and the largest age group (11%) was 50-54 years. Seventy per cent were above 40 years of age, and 63% represented social classes 4 and 5. Diseases of the circulatory system were the commonest (31%). Median household cost of the total hospital stay was Rs. 852.00 (inter-quartile range Rs. 351.00-1885.00) of which 70% were direct costs. Median daily cost was Rs. 340.00 (interquartile range Rs.165.00-666.00). Only 44% of patients incurred an indirect cost. Cost of travelling was the main contributor (36%) to the household cost. Laboratory investigations contributed 16%. Conclusions Most patients seeking in-patient services were from a poor socioeconomic background. The economic burden imposed by the admission to the household was mainly due to direct costs incurred for travelling and investigations. Katulanda P., R. P., Jayawardena R., Constantine G.R., Sheriff M.H.R., Matthews D.R. (2012). "The prevalence, patterns and predictors of diabetic peripheral neuropathy in a developing country." Diabetology and Metabolic Syndrome 4(1): Article number 21. Objective: To describe prevalence, patterns and predictors of DPN in patients with DM in Sri Lanka. Study Method: Data were collected as part of a national study on DM. In new cases DPN was assessed using the Diabetic-Neuropathy-Symptom (DNS) score, while in those with established diabetes both DNS and Toronto-Clinical-Scoring-System (TCSS) were used. A binary logistic-regression analysis was performed with presence of DPN as the dichomatous dependent variable and other independent co-variants. The study included 528 diabetic patients (191-new cases), with a mean age of 55.0 ± 12.4 years and 37.3% were males, while 18% were from urban areas. Study area: Sri Lanka

υύϋ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Study population: Diabetic patients Study instrument: Diabetic-Neuropathy-Symptom (DNS) score, Toronto-Clinical-Scoring-System (TCSS) Sample size: 528 Factors investigated: Presence of foot ulcers, female gender, insulin treatment, treatment with sulphonylureas, diabetic retinopathy, increasing height, rural residence, higher levels of triglycerides, longer duration of DM, smoking Results: Prevalence of DPN according to DNS score among all patients, patients with already established diabetes and newly diagnosed patients were 48.1%, 59.1% and 28.8% respectively. Prevalence of DPN in those with established DM as assessed by TCSS was 24% and the majority had mild DPN (16.6%). The remainder of the abstract is based on subjects with established DM. The prevalence of DPN in males and female was 20.0% and 26.4% respectively. The mean age of those with and without DPN was 62.1 ± 10.8 and 55.1 ± 10.8 years respectively (p<0.001). The majority of those with DPN were from rural-areas (75.3%) and earned a monthly income<Sri Lankan Rupees 12,000 (87.6%). In the binary logistic-regression presence of foot ulcers (OR:10.4; 95%CI 1.816.7), female gender (OR:6.7; 95%CI 2.09.8) and smoking (OR:5.9; 95%CI 1.49.7) were the strongest predictors followed by insulin treatment (OR:4.3; 95%CI 1.36.9), diabetic retinopathy (OR:2.7; 95%CI 1.3 5.4), treatment with sulphonylureas (OR:1.8; 95%CI 1.13.2), increasing height (OR:1.8; 95%CI 1.22.4), rural residence (OR:1.8; 95%CI 1.12.5), higher levels of triglycerides (OR:1.6; 95%CI 1.22.0) and longer duration of DM (OR:1.2; 95% CI 1.11.3). Conclusion: There is a high prevalence of DPN among Sri Lankan adults with diabetes. The study defines the impact of previously known risk factors for development of DPN and identifies several new potential risk factors in an ethnically different large subpopulation with DM. Kumari PBVR. Goonewardena CSE. (2011). "Delay among women reporting symptoms of Breast cancer." Journal of the College of Community Physicians of Sri Lanka 16(1): 17-22. Objective: To describe factors related to timing of first contact with an allopathic medical practitioner, among patients with symptoms of breast cancer attending breast clinic at Cancer Institute, Maharagama. Study Method: A descriptive cross sectional study was conducted among a total of 335 consecutive women who attended the clinic for the first time, during the period of survey. All the patients registered at the breast clinic for the first time were recruited. A pre-tested, interviewer administered questionnaire was used. Study area: Breast clinic at Cancer Institute, Maharagama Study population: All the women presenting with a symptom of breast cancer to the Breast clinic for the first time. If the patients were referred from Well Women clinics after incidental finding of the symptom (patient has not detected the symptom by herself) and patients who came for screening of breasts without any symptoms were excluded from the study. Type of study: A hospital based descriptive cross sectional study Study instrument: An interviewer administered, validated, pre tested questionnaire was used

υύό Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Sampling method: Convenient Sampling method Sample size: 335 Factors investigated: Breast cancer Results: The participants represented 12 Districts, but most were from Colombo, which consisted of 46.6 % (n=156) of the study sample. Mean age of the study sample was 45.42 years (SD 14.189). The minimum and maximum ages were 20 years and 78 years. Sinhalese represented the majority (95.2%, n=319) and most of the women were married (69 %, n=231). The results revealed Thirty eight percent (n=127) of patients had a delay in presentation which was defined as greater than 12 weeks. The mean time duration between experiencing a symptom and in seeking medical care was 11.5 weeks (SD=1.41). Factors significantly related to delayed presentation were age (elderly) [p<0.001], marital status (unmarried, divorced or widowed) [p=0.037], fertility status (women with no children) [p=0.011], ethnicity (Tamils and Muslims) [p= 0.002], an income of less than Rs. 10,000 (p= 0.002), low social class (p<0.001), first symptom not being a lump (p<0.001), a distance of > 5 km from home to medical facility (p=0.003), not attending a well woman clinic (p=0.002), assuming the condition to be a benign one (p<0.001), having undergone any kind of surgery under general anaesthesia (p =0.038) and poor knowledge on breast cancer (p<0.001). Conclusion Delay in seeking treatment for suspected breast cancer is a problem in Sri Lanka. Women may benefit from greater awareness of the benefits of early detection and expansion of diagnostic and treatment facilities for breast cancer. Lekamwasam S. Wijayaratne L. Rodrigo M. Hewage U. (2009). "Prevalence and determinants of osteoporosis among men aged 50 years or more in Sri Lanka: a community-based cross-sectional study." Arch Osteoporos 4(1-2): 79-84. SUMMARY: This study, based on phalangeal bone mineral density (BMD) of 1,174 community dwelling male volunteers aged 50 years or more from seven provinces in Sri Lanka, shows 5.8% prevalence of osteoporosis among them. Advancing age, less physical activity, and low body weight were associated with low BMD. Men with larger families were more likely to have a lower bone mineral density. PURPOSE: The prevalence of osteoporosis among Sri Lankans is not well-known. We wished to estimate the prevalence and determinants of osteoporosis among older men in Sri Lanka. METHODS: One thousand one hundred seventy-four healthy, community dwelling male volunteers, aged 50 years or more from seven out of nine provinces in Sri Lanka underwent phalangeal bone mineral density estimation using an AccuDXA(R) scanner. We calculated T scores using the local reference data, and subjects with T score equal or less than -2.5 was considered to have osteoporosis. RESULTS: Sixty-six men (5.8%) were detected to have osteoporosis. In contrast to men in the highest tertile of bone mineral density, men in the lowest tertile were older (60.0 versus 55.8 years, p < 0.001), lighter (56.3 versus 65.6 kg, p < 0.001), less physically active (16.1% versus 5.5%, p < 0.001) and had larger families consisting of four or more children (36% versus 20.9%, p < 0.001). Smoking, alcohol, or milk consumption showed no association with bone mineral density. CONCLUSIONS: We report 5.8%

υύύ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

prevalence of osteoporosis among men older than 50 years in Sri Lanka, and advancing age, less physical activity, and low body weight were associated with low bone mineral density. Men with larger families were more likely to have a lower bone mineral density. Lukshmy M Hettihewa. Lalith P Dharmasira. Chamil D Ariyaratne. Sudheera S Jayasinghe. Thilak P Weerarathna. Imendra G Kotapola. (2007). "Correlation between BMI and insulin resistance in type 2 diabetes mellitus patients on pioglitazone treatment." Galle Medical Journal 12(1): 18-24. Objectives To determine the effect of PIO therapy on kinetic changes of IR and obesity in adult type 2 diabetic population and correlation of IR with obesity hence BMI or BWor TGs. Materials and method: 24 patients with type 2 diabetes were randomly selected using fasting blood glucose (FBS) > 7 mmol/L (126 mg/dL) in one occasion if the patient is symptomatic, or in ,two occasions if the patient is asymptomatic. ,Patients were treated with 15 mg of pioglitazone (PIO) daily and investigated for BW, BMI, FBS, fasting insulin (FI) & triglycerides (TG). IR was calculated by McAuley (McA), HOMA & QUICKI indices at baseline and repeated after 3 months. Results: Mean age was 45.83 1.82 years. There was no significant difference of BMI (23.95 0.82 kg/m2 to 24.08 0.85 kg/m 2), BW (58.78 2.00 kg to 59.08 2.00 kg) and TG (1.82 0.08 mmol/L to 1.7 0.05 mmol/L) after 3 months (mean SE, p>0.05). There was a significant reduction in FI (37.58 6.09 to 15.37 3.28 mU/L) and IR by McA (4.68 0.25 to 6.18 0.31) with PIO treatment (p<0.001). Reduction of IR by HOMA and QUICKI indices were also significant (17.51 3.36 to 5.41 1.57 and 0.27 0.0 to 0.34 0.01, p>0.001 respectively) after therapy. There was a reduction of TG levels in our participants but it is not statistically significant. No significant correlation was observed between BMI or BW with any of the IR indices before the therapy but significant correlation developed later between BMI with FI (r = 0.4, p>0.05) and McA(r = 0.48, p = 0. 02) after 3 months. The reduction of hepatic insulin sensitivity index (hepatic ISI) was significant and found a substantial positive association between hepatic ISI with BMI after the PIO therapy. Correlation between hepatic ISI with HOMA, QUICKI and McA also significant but no significant correlation was detected between TG, HOMA or QUICKI with BMI or BW before or after therapy in our study cohort. Conclusions: There was an improvement of both hepatic and peripheral insulin sensitivity with three months of PIO. In addition,significant correlations between BMI vs. McAand FI but not with HOMA or QUICKI can be related to inclusion of TG in McA's equation but not in other indices. Reduction of both hepatic and peripheral IR suggests effects of PIO on fat clearance from liver. Therefore we propose that reduction of IR is related to the TG metabolic pathway possibly by clearance of VLDL-TGs and activation of lipoprotein lipase in plasma by PIO. Matthias AT. Ekanayake R. (2012). "Precipitant profile for acute heart failure: experience of tertiary level cardiac centre in Sri Lanka." The Ceylon Medical Journal 57(Supplement 1 ) Objective: To describe the precipitants and clinical outcome of acute heart failure (AHF). Study method: A prospective study on sequential admissions with AHF to the institute of cardiology, National Hospital Sri Lanka. Study Area: Institute of cardiology, National Hospital Sri Lanka.

φττ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Study population: Both males and females with a mean age of 60.66 years admitted to the cardiology unit were included in the study. Study type: A prospective cohort study Sample size: 58 males 42 females Total 100 Sampling method: Convenient sampling Disease Investigated: Acute Heart Failure Results: The study revealed that the mean hospital stay was 5.5 (SD=4.6) days. Sixty had de novo heart failure and forty had pre-existing heart failure. The most common identifiable precipitant s were acute ischemia 37 (37%), anemia 41 (41%), respiratory tract infection 10 (10%), arrhythmia 11 (11%), worsening renal function 11 (11%), and alcohol 5(5%). Non adherence to medication 4(4.6%), smoking 3 (3.9%), exposure to environmental stress 3 (3.4%), uncontrolled hypertension 1 (1%) were also observed as precipitants. Commonest arrhythmia was atrial fibrillation. The mortality rate was 8%. Those with ischemia had a higher mortality rate compared to those who did not p=0.023. Out of the 34 patients in whom angiotensin –converting enzyme inhibitors and angiotensin –converting enzyme receptor blockers were indicated, 11% were not on the drug. Among 29 patients in whom spironolactone was indicated, seven patients were not on the drug. Conclusions: Most precipitating factors of AHF are preventable. Early identification and prevention of anemia, preventing RTI by influenza vaccination, aggressive revascularization for patients with ischemia, monitoring renal functions and patient education of alcohol smoking and diet compliance would reduce the number of admissions. Mendis S. Sbp A. Kenji T. (1997). "Association between hyperhomocysteinemia and ischemic heart disease in Sri Lankans." International Journal of Cardiology 62(3): 221-225. Objective: The objective of this study was to examine the relation between hyperhomocysteinaemia and ischemic heart disease in a cohort of Sri Lankan patients with ischemic heart disease. Study Method: Serum homocysteine, cysteine and cysteinylglyceine were measured in 54 patients with a definite diagnosis of ischemic heart disease and compared with those of an age and sex matched control group. Study area: Sri Lanka Study population: Ischemic heart disease patients. Type of study: Cohort Study Sample size: 54 Factors investigated: Serum homocysteine, cysteine and cysteinylglyceine

φτυ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Results: Patients with coronary ischaemia had significantly higher mean concentrations of homocysteine and its metabolite cysteine (P<0.01). Of the 54 patients with ischemic heart disease 14 (35%) had fasting homocysteine concentrations above the 90th percentile of the controls (odds ratio 3.2, 95% CL 1.0-11.3). Conclusion: Hyperhomocysteinaemia is associated with a threefold increase in coronary risk. Mendis S. Wickramasinghe R. (1996). "Mortality from hypertensive and cerebrovascular disease in Sri Lankans, 1974-1986." KandyMedJ 5((1)): 16-19. Objective: To collate National mortality data in the Sri Lankan population for hypertension and cerebrovascular disease for the period 1974-1986. Study Method: The information on numbers of deaths was obtained from the Registrar General's Department. Population data are available as a result of censuses carried out in 1971 and 1981. In the intervening years estimates of the population were calculated by the Department of Census and Statistics by sex and five year age groups based on the preceding and following censuses with allowance for both deaths and migration. Annual age-specific death rates were computed for 1974,1977,1980,1983 and 1986. For the denominator the estimated mid year population of each year was used. The period under review encompasses two revisions of the International Classification of Diseases (ICD): 1969-1978, ICD 8th revision, 'hypertensive disease" (rubrics 400-404), 'cerebrovascular disease' (rubrics 430-438) and 'chronic rheumatic heart disease' (rubrics 393-398); 1979 & 1983 ICD 9th revision, 'hypertensive disease' (rubrics 401- 405) and 'cerebrovascular disease' (rubrics 430- 438). Results: Mortality from circulatory disease During the years 1974, 1977, 1980, 1983 and 1986 circulatory disease accounted for 13%, 14%, 18%, 15% and 19 respectively of all deaths among males. In females, the corresponding figures were 7%, 10%, 12%, 11% and 14%. During this period cerebrovascular disease seems to have been responsible for 12-14% of male deaths and 14-19% of female deaths due to .circulatory disease. Hypertensive disease was responsible for a further 8-10% of male deaths and 11-14% of female deaths. This means-thatrcerebrovascular disease was responsible for 1.6- 2.7 % of all male deaths and 1.4-2.6% of all female deaths, while hypertensive disease accounted for a further 1.3 - 1.8 % of all male deaths and 0.9 - 1.8 % of all female deaths during this period. Mortality from cerebrovascular and hypertensive disease Table 1 shows mortality rates from all causes, CVD and hypertensive disease. Table 2 shows age standardised annual death rates for hypertensive disease and CVD by sex, for ages 25 years and over, for 1974, 1977, 1980, 1983 and 1986. During this period, mortality rates from hypertensive disease and CVD declined from 1977 to 1980 and then gradually increased from 1980 to 1986. The increase has been more in males than in females, and as a result the male/female mortality ratio has increased from 1.4 to 1.6 for CVD. The age specific annual death rates by year for CVD and hypertension are shown in Table 3. In all age groups mortality rates are consistently higher in males than in females. All age groups in both sexes show a rise in mortality from 1983 to 1986. Relative risk of death from cerebrovasculardisease and hypertension in relation to age. As shown in Table 4, the risk of dying, from CVD and hypertension increased appreciably in both males and females when an individual moved from age group 25-44 years to age group 45-64 years. There was no statistically significant difference between the risk of death from CVD and hypertension for the

φτφ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

different years. There was also no difference in the risk ratios between males and females for the years considered. The increase in risk of death due to CVD and hypertension when an individual moved from age group 45-64 years to 65- 74 years was much less than above, but statistically significant, In general, females had a higher risk when compared to males, and the difference was significant in relation to hypertensive deaths for 1977, 1983 and 1986. The increase in risk of death due to CVD and hypertensive disease was much less when individuals moved from age group 64-75 years to 75 years and over, when compared with the increases seen in the other two age groups, for both males and females. Conclusion: Except for ages 75 years and above there has been a slight decline in mortality from cerebrovascular disease from 1974 to 1980. The decline has been greater in females than in males. However, in all age groups there has been an increase in mortality from cerebrovascular disease from 1983 to 1986. Mortality rates for hypertensive disease also show a similar trend, but is less marked than for cerebrovascular disease. Mendis Shanthi. Lindholm Lars H. Anderson Simon G. Alwan Ala. Koju Rajendra., O. B. J. K. A. M. A. N. D. A. T. S. F. W. (2011). "Total cardiovascular risk approach to improve efficiency of cardiovascular prevention in resource constrain settings." Journal of Clinical Epidemiology 64(12): p1451-1462. Objective: To determine the population distribution of cardiovascular risk in eight low- and middle-income countries and compare the cost of drug treatment based on cardiovascular risk (cardiovascular risk thresholds ≥30%/≥40%) with single risk factor cut-off levels. Study method: Using World Health Organization (WHO) and the International Society of Hypertension risk prediction charts, cardiovascular risk was categorized in a cross-sectional study of 8,625 randomly selected people aged 40–80 years (mean age, 54.6 years) from defined geographic regions of Nigeria, Iran, China, Pakistan, Georgia, Nepal, Cuba, and Sri Lanka. Cost estimates for drug therapy were calculated for three countries. Study Area: Nigeria, Iran, China, Pakistan, Georgia, Nepal, Cuba, and Sri Lanka Study population: Randomly selected people aged 40–80 years (mean age, 54.6 years Study type: A cross sectional study Sample size: 8,625 Sampling method: Random sampling method Results: A large fraction (90.0–98.9%) of the study population has a 10-year cardiovascular risk <20%. Only 0.2–4.8% are in the high-risk categories (≥30%). Adopting a total risk approach and WHO guidelines recommendations would restrict unnecessary drug treatment and reduce the drug costs significantly. Conclusion: Adopting a total cardiovascular risk approach instead of a single risk factor approach reduces health care expenditure by reducing drug costs. Therefore, limited resources can be more efficiently used to target high-risk people who will benefit the most. This strategy needs to be complemented with population-wide measures to shift the cardiovascular risk distribution of the whole population.

φτχ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Menikgoda Shyamali C. (1992). A study of some risk factors of acute lower respiratory tract infections in children under five years of age. Postgraduate Institute of Medicine. Colombo, University of Colombo. Master of Science in Community Medicine: 109. General objective: To study some risk factors of Acute Lower Respiratory Tract Infections (ALRI) requiring hospitalization, among children under 5 years of age compared with similar criteria in a control group matched for age. Specific Objective: To compare the following characteristics of children with Acute Lower Respiratory Tract Infections under five years with the control group a)Socio-demographic characteristics b)Environmental risk factors c)Some biological risk factors Study method: 100 children with ALRI admitted to the Lady Ridgeway hospital were compared with an age matched control group of 100 children admitted to the surgical unit of the same hospital. Data were collected on certain characteristics by interviewing the mothers and by carrying out certain anthropometric measurements. The odds of diseases associated with a given exposure was determined applying Mc Nemar’s test to the matched pairs. Study Area: Medical and surgical units of Lady Ridgeway Hospital Study population: All patients under five years of age 5 admitted to one medical ward of the LRH and who had been diagnosed as having ALRI (lobar pneumonia, Broncho pneumonia, or Bronchiolitis) by a Consultant Pediatrician. Study Instrument: Interviewer administered questionnaires Bed Head Tickets of the patients Anthropometric measurements (Height of < 2years by a pedometer and > 2 years by using a microtoy, and the weight by a weighing scale.) Study type: A case control study Sample size: 100 cases 100 controls Results: The mean age of the cases and the controls were 14.60 and 14.87 respectively. 73% of the cases were males in comparison to the controls where on 54 % were males. This difference observed was statistically significant (p=0.005). The ethnic distribution of the cases and controls, almost two fold increase of Tamils ( 16% cases and 9% were controls) and Muslims( 15% cases and % were controls) are observed among cases as compared with the controls but with the Sinhalese this was not the case , where 68% were cases and 82% were controls. It was also observed that more cases had been delivered through elective (5%) and emergency caesarian section (11%) compared to the controls. (p=0.02) Three socio-economic factors that is, male, sex, urban residence p<0.001 and belonging to an ethnic group other than Sinhala were shown to be important. Delivery by Caesarian section and a birth weight below 2.5kg 55% cases and 24.5% controls p=0.004were found have an increase risk of the ALRI. Infant feeding practices have shown

φτψ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

to have an important influence on infection; in that the absence of exclusive breast feeding at least until the completion of four months of age p<0.001 , the early introduction of both formula feeds p=0.003 and complimentary foods p<0.01 seemed to increase such risks. The study revealed that a history of wheezing to be a predictor of ALRI and the predilection of the stunted to infection was confirmed. Overcrowding in home p<0.001, sharing of sleeping space with two or more persons, air pollution associated with the lack of a separate kitchen=0.01 and a chimney p=0.04, the presence of a smoker among the members of the extended family and having more than one pet in the home all were seen to increase risk of infection. Monaragala RMM. (2008). Prevalence of Depression in Recent Myocardial Infarction. Postgraduate Institute of Medicine. Colombo, University of Colombo. Board Certification in Psychiatry: 111. Main objective: To determine the prevalence of depressive disorder in patients who were recently diagnosed as having myocardial infarction Specific objective: 1.To assess the prevalence of depressive disorder in patients who were recently diagnosed as having myocardial infarction within the period of one to three months . 2.To determine the association between socio-demographic factors and depressive disorder following myocardial infarction. 3.Vallidating the Zung Self Rating Depression Scale (SDS) by comparing it with the structured clinical interview using the Diagnostic Criteria for Research 10th revision (DCR-10) which is the gold standard 4.Validating the Beck Depression Inventory (BDI) for the patient population with myocardial infarction by comparing it with the structured clinical interview using the DCR-10 criteria which is the gold standard. Study area: Cardiology outpatient department of the Teaching Hospital Kandy. Study population: Patients who have been diagnosed as having MI for a period of 1 to 3 months, attending the review clinic at the Cardiology unit of the Teaching Hospital Kandy during the period of July 2007 to January 2008. Type of study: A cross sectional hospital based study. Study instrument and method: 1.A questionnaire to collect information about socio-demographic characteristics. 2.A self administered instrument to assess depressive disorder,by a validated Sinhala version of Beck Depression Inventory scale. 3. A questionnaire of Zung Self Rating Depression Scale (SDS) to diagnose depressive disorder in patients who were recently diagnosed as having myocardial infarction. 4.A clinical assessment of the patients to diagnose depressive disorder using the Diagnostic Criteria for Research 10th revision (DCR-10) Sampling method: Every consecutive patient diagnosed of myocardial infarction reviewed at the out patient facility eligible for the study, were selected for the sample until the required number for the study was completed. Convenient sampling Sample size: Required sample size 200 Participated sample size 211

φτω Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Diseases investigated: Myocardial Infarction Depressive disorders Results: Hundred and sixty nine men and forty two women participated in the study. The mean age of the participants was 58.3 years. The prevalence of depressive disorder following MI according to the DCR-10,BDI and SDS are given in the tables under image 1,2 and 3 respectively. The ratio of post MI depression between men and women was 1 to 1.5. Patients at or above 61 years were marginally over represented in post MI depressed group than those less than 61 years. Compared to the married ,depression was clinically more common among the unmarried ,divorced or widowed group. The rate of post MI depression reduced with the rising monthly income although depression was more common in the patients with lowest level of education. Conclusion: The prevalence of depressive disorder following a recent MI is 38.4%.Female sex,lack of social support, poor socio-economic state and lowest level of education are vulnerable factors for clinical presentation for depression post MI. The socio-economic state is a strong predictor of post MI depression. BDI and SDS are acceptable as efficient and useful diagnostic instruments to screen depression in patients with recent MI. Mudduwa L. Punchihewa G. (2011). "Psychological impact of breast cancer; a study done in a Sri Lankan setting." Galle Medical Journal 16(1): 16-21. Introduction: Breast cancer is the commonest cancer in Sri Lanka. Our aim was to assess the magnitude of the psychological morbidity of breast cancer in our setting. Methods: A self administered questionnaire and the 12 question General Health Questionnaire were used to collect data from a cohort of breast cancer patients. Out of 183 patients, 75 returned the duly filled questionnaire. Results: The age range of the study sample was 24 to 83 years (mean 53.2). Psychological distress was experienced by 30.66% during the two year period following the diagnosis of breast cancer. Thirty four (48.6%) participants claimed that they have experienced psychological distress sometime during the period following diagnosis up to the time of data collection. Only one had moderate depression. Most of them feared of future recurrences and concerned of inadequacy of information given by the healthcare team regarding the illness. Most of the patients adopted both positive and negative styles of coping. Nearly all (95.8%) were satisfied with the family support. Conclusions: The present study reveals that a significant proportion of patients had distress related to breast cancer at the time of filling the questionnaire. A significantly high proportion of patients receive satisfactory family support to cope with the illness. Most of them have developed mixed positive and negative coping styles towards the illness. In a significant proportion of patients' distress was related to uncertainty about the future recurrences.

φτϊ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Muhammad R Haniffa. (2002). The effect of posture on musculoskeletal disorders among automated sewing machines operators and on productivity among female garment factory workers. Postgraduate Insititute of Medicine. Colombo, University of Colombo. Master of Science 73. Main objective: To determine the prevalence of musculoskeletal disorders among female machine operators working in the seated and standing positions and assess the impact on productivity in the two positions. Specific objective: 1.To determine the prevalence of musculoskeletal disorders among workers in the seated and standing positions. 2.To assess the productivity in the seated and standing positions. 3.To determine the impact of age prevalence of musculoskeletal disorders in the seated and standing positions 4.To determine the impact of duration of employment on the prevalence of musculoskeletal disorders 5.To recommend appropriate work posture Study method A descriptive cross sectional study was conducted in the garment factory during the months of June, July, and August 2002. A sample of female factory workers was selected and data was collected to by using the study instruments given below. Study area: A garment factory in the Gampaha District Study population: Female factory workers, where two variables were taken which included those who worked in the seated position as one set of variable for the study and those who worked in the standing position as another set of variable. Type of study: A descriptive cross sectional study Study instrument: 1.A self administered questionnaire 2.A clinical examination 3.A rapid ergonomic assessment by using a pre prepared checklist devised by Work Safe Australia 4.An assessment of productivity by calculation the number of items produced by individual/ group of workers for a specified period. Sampling method: Random sampling Sample size: Seated position 96 Standing position 163 259 Risk factors investigated: Prolong Sitting Prolong Standing position Disease investigated: Musculoskeletal disorders Results: Musculoskeletal disorders (MSD) are a group of problems affecting the muscles , tendons, ligaments, joints as well as the nerve that regulate muscular movements , caused by accumulation if small often

φτϋ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

unnoticed trauma occurring over a period of time.( these includes carpel tunnel syndrome, tennis elbow, humoral tendinitis, cervical syndrome back pain etc). This dissertation is confined to assess the prevalence of musculoskeletal disorders in workers in relation to posture, specifically in seated and standing postures. The age range of these female garment factory workers were 17 to 39 years and the mean age was 22.84 years with a standard deviation of 4.5years. Out of these women, 71.04% of the workers were never married. To find out the prevalence of musculoskeletal disorders in these workers the results were obtained in a subjective and in an objective manner. The study showed that the total number of workers that were complaining of musculoskeletal disorders were 81 worker out of the total of 259 , therefore the prevalence of subjective musculoskeletal disorders were 31.27%. The total number of workers who were clinically found to have musculoskeletal disorders was 37 out of the total 259, therefore the prevalence of objective MSD 14.28%. The study also showed that the commonest overall subjective MSD was back pain (30.9%) and the commonest objective MSD was also back pain (59.45%) as shown on table 3 and 4. Regarding the postures, only 20 out of the total 96 seated workers were complaining of MSD, which shows that the subjective prevalence of MSD in the seated posture is 20.38% and 61 out 163 working in the standing posture complained of MSD so their subjective prevalence was 32.42%. This difference between the two groups were statistically significant (p<0.05). The objective prevalence of MSD in the seated position was 9.38% (9 out of 96) and in the standing posture was 17.18%. This difference between the two groups were also found to be statistically different (p<0.05). The comparative frequency distribution of subjective and objective MSD among the two groups are given below in the tables 1 and 2. The study recommended the conduct of a health program based on the principal of the Ottawa Charter for Management and Workers, the use of heel rest for standing workers and seated posture for garment manufacturers rather than standing posture. Finally to device an index to assess the productivity taking in to account the health component of factory workers was also recommended. Nagodavithana KC. (2008). Knowledge, attitude and practices of doctors at the National Hospital of Sri Lanka on screening and management of alcohol misuse among patients. Postgraduate Institute of Medicine. Colombo, University of Colombo. Master of Science in Community Medicine Main objective: To describe knowledge,attitude and practices of doctors at NHSL on screening and management of alcohol misuse among patients. Specific objective: 1.To assess the knowledge of doctors at NHSL towards screening and management of alcohol misuse among patients. 2.To describe the attitudes of doctors at NHSL towards screening and management of alcohol misuse among patients. 3.To describe the association of selected factors and the attitude and practices of doctors at NHSL on screening and management of alcohol misuse among patients. Study area: National Hospital of Sri Lanka, Colombo

φτό Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Study population: All the doctors ( Consultant,senior registrar,registrar,medical officers,and house officers) who are directly involved in the management of patients and has the opportunity to communicate with patients who are admitted to wards with problems related to alcohol. Type of study: Descriptive cross sectional study Study instrument: A pretested self-administered questionnaire Sampling method: The numbers of eligible doctors in the ward/unit to which they were attached to and their designation was obtained from the updated data base of administration unit of NHSL. Each of these wards/units was visited and eligible doctors of all designations were invited to participate in this study. Sample size: 385 Risk Factors investigated: Alcohol Results: Response rate was 94%. 63.6% of the study population were male doctors and in the age group 25-34 (48%) while a majority were in the catagory of medical officers'(39.4%) attached to medicine and surgery units (49,7%) with work experience of less than 10 years (68.2%). A weighted score was developed for overall knowledge on screening and management and the proportion of doctors with 'good' level of overall knowledge was high (75.9%) The proportion of doctors with awareness on the accepted methods to reduce alcohol misuse in the ward setup was high (>80%). The overall attitude of doctors towards screening and managing alcohol misuse was favourable(91.5%). Majority (96%)felt there will be some benefit to the patient while about two thirds (69.9%) the outcome to be rewarding. However ,many had the opinion that inquiring into consumption routines and recognising alcohol misuse was time consuming 77%. The majority (93.5%) of the study population were making inquiries in to alcohol habits of mainly on male patients during their routine practice. However only half (49.1%) practiced that always. Among those who inquire into alcohol habits, the proportion of the study participants utilizing standard screening questionnaires to determine alcohol misuse was low 22.8% Though the proportion of doctors who took steps to reduce misuse was high, the steps that would achieve sustainable reduction were taken by only 45.9% and approximately three fourths do arrange further follow up. Limitations: 1.NHSL is a teaching hospital,where there are many oppotunities for the doctors to be exposed to means of acquiring new knowledge compared to doctors attached to an institution of a different catagory.Therefore ,results of the Study may not not be generalized to other institutions. 2.Some of the completed questionairres were collected within three days from distribution as the survey was conducted during working hours and it was essential to ensure that the routine work of the hosiptal was not interrupted.Therefore the likelihood of contamination of responses within the three days cannot be excluded. 3.Practices of screening and management of of alcohol misuse were assessd by self report method using the self administered questionairres,though the doctors were thought to have no specific reason to over report or under report these practices ,some over reporting cannot be excluded. Conclusion and recommendation: Overall knowledge was found to be 'Good' and overall attitudes were mostly favourable. Gaps in practice of screening and management were evident while most do not use screening tools when assessing patients.Educational activites were recommended for specific areas that needed

φτύ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

strengthening, The study also recommended the group of doctors for whom these educational activities should be targeted to. Nagodavithana KC. Gunawardena N. (2010 ). "Knowledge and practices of doctors at the National Hospital of Sri Lanka on screening and management of alcohol misuse among patients." Journal of the College of Community Physicians of Sri Lanka 15(1): 24-32. Objective: To assess the knowledge and practices of doctors at the National Hospital of Sri Lanka on screening and management of alcohol misuse among patients. Study Method: This was a hospital based descriptive cross-sectional study. Doctors (n=385) of all designations attached to wards where patients with alcohol related problems are admitted, were assessed using a self-administered questionnaire. A weighted score was developed for the assessment of the overall knowledge on detection and management of alcohol misuse, of which 0-60 was taken as „poor‟ and 61-100 as „good‟ Factors associated with practices were assessed using cross tabulations and χ2 statistic. Study area: National Hospital of Sri Lanka (NHSL) Study population: All the doctors (Consultants, senior registrars, registrars, medical officers, and house officers) who are directly involved in the management of patients and have the opportunity to communicate with patients who are admitted to wards with problems related to alcohol misuse. All the doctors attached to the wards of general medicine, general surgery, accident service, orthopaedic, cardiology, cardiothoracic surgery, psychiatry, neurology, gastroenterology and burns unit were considered as eligible to be included in the study. Type of study: A hospital based descriptive cross-sectional study. Study instrument: A pre tested, self administered questionnaire . Sampling method: Convenient Sampling method. Sample size: 352 Results: Study included 352 doctors with a response rate of 91.4% (352/385). Respondents were mainly males (63.6%; n=224) in the age group of 25-34 years (48.0%; n=169). A majority were in the category of “medical officers” (39.4%; n=139) attached to general medicine or surgery units (49.7%; n=175) with work experience of <10 years (68.2%; n=240). A weighted score was developed for overall knowledge on screening and management. The proportion of doctors with “Good” overall knowledge was high (75.9%; n=267). However, only 53.4% (n=188) were aware of available standard screening tools. The majority (93.5%; n=329) of doctors were inquiring into alcohol habits of male patients during their routine practice. However, those utilizing standard screening tools to determine alcohol misuse was low (22.8%; n=75). Though the proportion of doctors who took steps to reduce misuse was high (80.3%; n=283), the steps that would achieve sustainable reduction were taken by only 45.9 %( n=130). “Good” overall knowledge (p<0.001), working in a medical unit (p<0.001), work experience <10 years (p<0.001), were associated with “always inquiring” into alcohol habits in routine practice while “Good” overall knowledge (p<0.001), being a house officer (p<0.001) and work experience <10 years (p<0.001) were associated with taking steps to reduce misuse.

φυτ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Conclusion and Recommendations Overall knowledge was found to be “Good”. Gaps in practice of screening and management were evident, which need to be corrected. Nandasena YLS. (2010). Respiratory health effects of exposure to indoor and outdoor air population among children (age 7 – 10 years) in selected settings in the Western Province of Sri Lanka. Postgraduate Institute of Medicine. Colombo, University of Colombo: 178 pages. Main objective: To determine the association between air pollutants in home environment and respiratory health among children aged 7 to 10 years in selected settings in the Western Province of Sri Lanka Specific objective: 1.To measure selected air pollutants in the home environment of children aged 7-10 years in selected localities 2.To compare the level of air pollutants in different types of dwellings in different settings. 3.To determine the incidence of respiratory symptoms among children aged 7-10 years in these localities 4.To determine the lung functions of children aged 7-10 years in the selected localities 5.To determine the association between respiratory health of children and air pollutants in the home environment 6.To identify the factors associated with respiratory health of children living in different home environments. Study Method 3 panels of children from 2 settings were followed up over a period of one year. The study settings were located in the Colombo Municipal Council area (setting 1) and Panadura Medical Officer of Health area (setting 2) Two panels of children were selected in Setting 1 based on the type of housing unit (panel 1 –children living in semi permanent or improvised houses and panel 2- children living in flats and permanent single houses). The third panel was selected from children living in the Panadura Medical Officer of Health area. Study area: Colombo Municipal Council area (setting 1) and Panadura Medical Officer of Health area (setting 2) Study population: Children of 7 to 10 years of age living in the selected study settings Type of study: A Longitudinal Study Study instrument: -Baseline questionnaire -Respiratory symptom diary -Follow up questionnaires -A portable electronic spirometer (Spiroanalyzer SF 95) to assess the lung functions -Gent air sampler, UCB monitor, NO2 passive sampler, SO2 passive sampler and Liquid bubblers to measure the levels of air pollutants Sampling method: Cluster sampling method Sample size: 612 Risk Factors investigated: outdoor and indoor air pollutants

φυυ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Results: Six hundred twelve 7-10 years children (204 children from each panel) were recruited from the two settings. Three air pollutants (PM2.5 – particulate matter of 2.5 microns in diameter, SO2, and NO2) were measured both indoors and outdoors in the two settings. Questionnaires were handed out to these children to obtain data in Socioeconomic status and each child had to maintain a diary to monitor respiratory symptoms daily. Lung function was assessed as the beginning and at the end of the follow up. The mean age of the children at recruitment was 8.39 (SD=0.89) years in Panel 1, 8.49 (SD=0.89) years in Panel 2 and 8.49 (SD=0.90) years of the children in Panel 3. The total number of children comprised of 323 males and 289 females. 568 children remained in the study at the end of 1 year. Majority of the children were from families with income of Srilankan Rs 10,000 to 20,000 (46%, 45% and 51%) in panels 1, 2 and 3 respectively. The results showed that the prevalence of wheezing (wheezy/whistling sounds coming from the chest while breathing – at least one episode per day) within the last 12 months was significantly (p=0.02) higher among the children within setting 1 (20.8%) as compared to children of Setting 2 (10.8%). Persistent cough ( at least a single cough for more than 6 times a day)was reported by 10% of the children in Setting 1 and 3.4% from Setting 2 (p=0.004). There was no difference in the proportion of children having asthma between the two settings (p=0.06) By measuring the annual outdoor air pollutants in setting 1, it showed there is an average NO2 concentration of 41.7 µg /m3, 24 hour average SO2 concentration of 35.7 µg /m3 , 24 hour average PM2.5 concentration of 39.1µg/m3. These results suggested that air pollution in setting 1 was exceeding the WHO recommended threshold values for air pollution. But this was not seen when measuring the outdoor air pollution of setting 2(average NO2 concentration of 8.5 µg /m3,24 hour average SO2 concentration of 8.4 µg /m3 ,24 hour average PM2.5 concentration of 16.6µg/m3) The indoor SO2, NO2 and the PM2.5 concentrations were significantly higher in households of setting 1 compared to household of setting 2 as shown under table 1. There were no association between the indoor SO2, NO2 concentration and the type of principal cooking fuel used in households of setting 1. Household using biomass in setting 1 had significantly higher PM2.5 concentration (243.2µg /m3) as compared to household using kerosene or clean fuels such as electricity as their principal cooking fuel. The incidence rates of days of symptoms and episodes of symptoms were, in general, significantly higher in children of setting 1 as compared to those of setting 2. There were difference in the incidence rates of days of wheezing (RR=1.104, 95% CI: 0.915-1.170) and throat irritation (RR=1.142, 95% CI: 1.082-1.206) between children of panels 1 and 2; children of panel 3 had significantly lower risk of all symptoms as compared to children of panel 1(RR=1.597, 95% CI: 1.506-1.694) and 2(RR=1.398, 95% CI: 1.316-1.485). The average daily growth related increases of FVC and FEV1 of children were not significantly different between the two settings after adjusting for age, sex, height, weight and ethnicity. Peiris JB. (1993). "Strokes — A Sri Lankan perspective." Journal of the Ceylon College of Physicians 26: 42-44. Study Method: This paper presents briefly important information regarding strokes in Sri Lanka derived from 4 studies.

φυφ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

1. A study of admissions to the General Hospital, Colombo over a 12 month period from 1st June 1974 with a 12 month follow up. 2. An ongoing clinical study of strokes in the young. 3. An autopsy study of strokes in the young. 4. An autopsy study of 'sudden deaths' due to non traumatic intracranial causes. Study area: Colombo Disease investigated: Stroke Results: Incidence According to the WHO stroke registry program covering 17 centres in 12 countries over a period of 3 years which included Colombo, the incidence was 1 to 5 per 1000 population. In Sri Lanka, the age adjusted incidence rate per 1000 population is 1.89, with a male: female ratio of 1.4:1, not much different from the Western scene. The age adjusted incidence rate was 2.19 per 1000 for the male and 1.56 per 1000 for the female. Risk at different ages The incidence of strokes increases markedly with increasing age. From a very low figure of 0.03 per 1000 population for the under 45 year age group, the incidence rises sharply to 3.29 for the 65-74 year group and 4.07 per 1000 in the over 75 year age group. Stroke is not a major problem in the under 40 year age group in the west, while in the developing countries it may account for as much as 10 — 20%. In Sri Lanka it accounts for 10.4% of all strokes. Male-female differences In most developed countries, males have a greater chance of developing strokes than females until the age of 65 years, when the ratio reverses. In the study of strokes in the city of Colombo, M:F ratio under the age of 65 years was 1.3:1, but the greater incidence of strokes in the male continued to an even greater extent in the over 65s. In the 65-74 year age group the M:F ratio was 3.86 to 2.68 per 1000 (1.4:1) and in the over 75 age group 5.79 to 2.68 per 1000 (2.15:1). In other words it means that an over 75 year male in the city of Colombo has a 1 in 200 chance of developing a stroke in any given year. Premorbid Bio Data -Hypertension Like in the developed countries, in Sri Lanka, hypertension is the most important predisposing cause, about 40% of patients having a high blood pressure at the time of first, admission. Only the young female suffering from a stroke had a low incidence of hypertension. Blood pressure was much higher in the comatose patient than in those who were alert. The most important revelation was the fact that less than half the patients with hypertension were receiving antihypertensive medication at the time of the stroke — the greatest defaulter was the over 65 year female, perhaps living up to the phrase of the 'stubborn old female'. The mean blood pressure for the male irrespective of age was around 170/100 while the females had a mean systolic of 170 while the diastolic was 95.5 in the under 65 and 92.2 in the over 65 year group. -Diabetes There was a history of diabetes in 15.2% over the age of 65 in both sexes. Diabetes was commonest among the young female, being 23.3% as compared with the male 7.4%. Worldwide, there is a slightly higher incidence of diabetes among women stroke patients.

φυχ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

-Previous stroke Among the under 65 males, 24.1% had suffered a previous stroke but only 6.5% in the over 65 year male. This may be due to the poorer survival of the over 65 year male stroke patient. Among the female, this age ratio was reversed. Perhaps this may be due to the better survival of the older female who are also known to tolerate hypertension better than other categories. Previous myocardial infarction (Ml) . In the under 65s, irrespective of sex, 10% or more had suffered a previous Ml. Surprisingly only 2.2% over the age of 65 gave a history of previous Ml. This is also probably due to the poorer survival of the older patient with a Ml. -Heart disease other than myocardial infarction Heart disease other than Ml was low or conspicuously absent in the males and older female, but one fifth of the younger female had evidence of a previous rheumatic valvular disease. -Negative medical history Over 50% of the over 65 year male stroke patients did not give a past history of HT, DM or previous Ml — not a reassuring revelation for the healthy old male of the species. Thus in many old people, a stroke was indeed a 'bolt from the blues'. Even in the under 65s, there were no 'predisposing factors' in as many as one third. -The hospitalized stroke patient It is the more seriously ill stroke patient who seeks admission to hospital. It was thus not surprising that in the GHC based study more than half the patients did not leave the hospital alive (87 of 163 patients in one year = 57.5%). Of these 68% died in the first week and of them 2/3 in the first 3 days. Of those who survived, more than half stayed for longer than 30 days for management of complications and rehabilitation. Only about 15% of the survivors left hospital in the first fortnight. -Mortality Figures When we compare the mortality figures of the hospitalized patient with the all island mortality figures it is seen that only a third of those who suffer strokes, die in hospitals. While only 1 /3 of those who die, die in hospitals 2/3 of those who are bom are bom in hospital. Obviously the hospital is a better place to start life than end it!. Certainly an intensive care unit with tubes and cannulae surrounded by machines and masked men and women is not a good point of departure after a meaningful life). -Factors governing survival Factors governing survival included age, conscious level on admission, blood pressure and history of previous stroke. -Age In the first few days after the stroke, under 65 year strokes appear to do worse than the over 65s. Thereafter, survival rates were less favorable for the older patient, perhaps due to other complications. -Conscious level There was a direct relationship with the lowest level of consciousness during the first 24 hours. Survival decreased markedly with conscious level, and this occurredalmost exclusively in the first week.

φυψ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

-Systolic blood pressure (SBP) SBP over 200 mm on admission were related to poor survival. Systolic BP of less than 160 mm shortly after the stroke had a poorer survival than when the SBP was between 160-180—the significance being almost exclusively in the first few days after the onset. High BP at onset while reflecting pre-existing poorly controlled HT may also indicate severity of the cerebral lesion causing stroke. In both instances poorer survival was likely. -Recovery of function The extent of physical and mental recovery is of utmost importance to those who survive a stroke. Would they be able to lead an independent life and return to normal work and their previous life style or would they be a burden to the family and society. It is often possible to give a reliable answer on clinical grounds alone. An unfavorable prognosis is associated with age over 70 years, severe motor deficit, impairment of consciousness and impairment of mental function. Perera BJC. (2005). "Successful withdrawal of inhaled corticosteroids in childhood asthma." Respirology 10: 385–388. Objective: Although inhaled corticosteroids are useful and effective in the prophylaxis of childhood asthma, there is a dearth of information regarding the duration of treatment. The present study was undertaken to assess the possibility of successful withdrawal of inhaled corticosteroids in childhood asthma following good control of the disease. Study method: The study was carried out at the Asiri Hospital, Colombo, Sri Lanka and was a prospective observational clinical study. The participants were consecutive children with documented moderately severe and severe asthma seen over a period of 4 years from January 1990 and followed up to December 2003. Patients were allocated randomly to receive either beclomethasone dipropionate or budesonide. Initial dose of the selected drug was 300, 400 or 600mg/ day, depending on the child’s age. After a period of stabilization, the dose was reduced from the starting dose to a maintenance level of 200, 300 or 400mg/day, respectively. Once sustained control had been maintained for a period ranging from 9 to 18 months, gradual withdrawal was attempted. The dosage was reduced by 50–100 mg each time, at intervals of 3 months. Long-term follow up was maintained following withdrawal of inhaled corticosteroids. Breakthrough wheezing, acute severe attacks, hospitalization for wheezing and absence from school were used to assess the response. Study Area: Asiri Hospital, Colombo, Sri Lanka Study population: Eighty-six consecutive children seen at Asiri Hospital, Colombo, Sri Lanka, with recurrent or persistent wheezing that disrupted their lives, were entered into the study over a period of 4 years from January 1990. None had previously been given inhaled corticosteroids. They were selected on one or more of the following criteria documented during the previous 12 months: (i) perennial asthma with wheezing everyday; (ii) frequent episodic attacks of wheezing more often than once in 3 weeks; (iii) repeated hospital admissions for wheezing more often than once in 3 months; and (iv) absence from school of more than 2 days per month due to acute wheezing. Study type: A prospective observational clinical study Sample size: 86 Sampling method: Convenient sampling method

φυω Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Results: Of the 86 patients, 52 were male (M : F= 1.5 : 1). The mean age at onset of asthma was 3.4 years (range 1–9 years) and mean age at enrolment was 7.4 years (range 2–12 years) Eighty children responded well. The initial period on a high dose of corticosteroid was 8.4 months (range 4–12 months) and the average period of maintenance dosing was 11.7 months (range 9–18 months). The average time taken for withdrawal was 12.6 months (range 9–18 months). Successful withdrawal was achieved in 73 children. In this group, the mean total duration of treatment was 27.4 months (range 20–44 months). Up to December 2003, the subjects had been observed for an average period of 97.1 months (range 86– 121 months) following withdrawal of inhaled corticosteroids. Of the 73 children in whom corticosteroids were withdrawn, 57 (78%) have remained well without any episodes of wheezing, and 14 (19%) have had mild episodes of wheezing that were easily controlled by bronchodilators. No patient needed hospitalization, long-term treatment or systemic corticosteroids. In two (3%) patients, it was necessary to restart inhaled corticosteroids because of troublesome recurrences. Conclusion: It is possible to gradually withdraw inhaled corticosteroids in a significant proportion of asthmatic children once good control has been sustained on a maintenance dose for a considerable. Perera PPR. Wickremasinghe AR. Indrakumar J. Peiris H. (2010). "Hyperhomocysteinaemia and ischemic heart disease in Sri Lanka: more a problem in the young than the elderly?" The Ceylon Journal of Medical Science 53(1 and 2): 15-21. Objective: To determine the association between hyperhomocysteinaemia and ischemic heart disease (IHD) in young (equal to or less than 50 years of age) IHD patients compared to elderly (more than 50 years of age) IHD patients in a sample of Sri Lankans Study method: Plasma homocysteine levels after a 14-hour fast was measured in 221 patients diagnosed with IHD and in 221 age and sex matched controls. Patients admitted with evidence of IHD according to the World Health Organization criteria were included in the study (diagnosis of acute coronary syndrome was based on the presence of two out of the three criteria given below- •Clinical: Highly suggestive symptoms-substernal chest pain on exertion or at rest •Biochemical: elevation of cardiac enzymes cardiac troponin I/T or creatinine phosphokinase , and CPK-MB fraction elevation to suggestive range •ECG changes- Characteristic features of cardiac ischemia on an ECG taken at rest/during treadmill exercise (showing T inversions/ ST depressions of > 2mm/ ST elevation of >or equal to 1mm). Controls were selected from subjects presenting for routine visits. Study Area: Colombo South Teaching Hospital, Kalubowila Sri Lanka Study population: Patients with ischemic heart disease and controls matched for age and sex Study Instrument: Plasma homocysteine level measurements Study type: Case-control study Sample size: 442 Results: Homocysteine concentrations of the 221 subjects with IHD ranged from 3.42-27.61umol/L with a mean of 13.95umol/L. In the 221 controls, plasma homocysteine concentration ranged from 2.21- 32.84 umol/L. there was a significant association (p=0.002) between hyperhomocysteinaemia and

φυϊ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

IHD in the entire sample. There was a significant association (p=0.02) between hyperhomocysteinaemia and young IHD patients compared to these subjects over 50 years of age. Hyperhomocysteinaemia was found to be a significant predictor of IHD, after controlling for hypertension and hypercholesterolemia. (OR: 2.411) Perera WLS P. (2006). Knowledge and practices on prevention of complications of diabetes, among diabetic patients at a provincial general hospital and the facilities available Postgraduate Institute of Medicine. University of Colombo. Master of Science in Community Medicine. Main objective: To describe the knowledge and practices in relation to prevention of complications of diabetes, among diabetic patients attending medical clinics at the Provincial General Hospital, Rathnapura and to assess the facilities available Specific objective: 1.To assess the knowledge of diabetes on prevention of complications in relation to selected socio-demographic factors. 2.To describe the association of reported practices on prevention of complications of diabetes by selected socio-demographic 3.To determine the facilities available at the clinics with respect to the guidelines given by Ministry of Health. 4.To identify reasons leading to shortcomings in practices which prevent optimum disease management by the patients Study method: The study was conducted at the provincial General Hospital of Rathnapura. A total of 385 diagnosed diabetic patients were interviewed using pretested questionnaire. In addition a check list was utilized to collect information on the facilities available in the hospital Study area: Provincial General Hospital, Rathnapura Study population: All men and women irrespective of their age, presented seeking care for diabetes at any of the six medical clinics conducted by the two medical units of the hospital. Type of study: Cross sectional descriptive study Study instrument: An interviewer administered questionnaire A checklist Sampling method: Systematic sampling technique Sample size: 385 Results: The study revealed 52.2 %( 201) were females and 47.8% (184) were males and in which 41% were at the ages of 51-60 years. 85.8% of the study population was Sinhalese. The respondent’s knowledge on basic facts regarding blood sugar control showed mixed result. 338 (87.8%) of the respondents were aware that they had to check their blood pressures monthly, while 31 (8.1%) were of view that quarterly measures were adequate. 373(96.9%) responded saying that life long medication is indeed necessary while 4 responded not so, and out of the sample , only one third that is 34% were aware of the fact that regular physical exercise helps to control blood sugar levels, when 31.7% disagreed. Most of the socio-demographic factors showed a statistically significant association with almost all areas questioned on various aspects of blood sugar control as shown on Table 1.

φυϋ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

The knowledge on the increase of risks for foot ulcerations and amputations was almost universal but the knowledge on other chronic complications such as diabetic nephropathy, diabetic retinopathy, ischemic heart disease and cerebrovascular disease were unsatisfactory as seen on table 2. The knowledge on the occurrence of chronic complications was seen to be statistically significant (p=0.025) with many socio demographic factors such as females, ethnicity, higher education (> o/Level) etc. The respondents’ awareness of the risk factors for the development of complications were far from satisfactory. As shown on table 3, other than for uncontrolled blood sugars, disease duration, the patients didn’t understand adequately the risk posed by the other factors. There was statistically significant association (p<0.05) seen with socio-demographic factors varying with the knowledge on different risk factors. Other than for monthly clinic follow up, and daily use of medications, the patients were not adherent to some of the practices (such as ophthalmological check-ups) that were pivotal in prevention of chronic complications. Perera WLSP. Fernando HTEI. Tissera PAD. (2007). "Knowledge of prevention of chronic complications of Diabetes Mellitus among diabetic patients attending clinics in the Provincial General Hospital, Ratnapura." The Twelfth Annual Academic Session of the College of Community Physicans of Sri Lanka September 2007: 18. Objective: To describe the knowledge on prevalence of chronic complications of diabetes mellitus among diabetic patients attending clinics in Provincial General Hospital, Ratnapura. Study Method: A descriptive cross-sectional study was conducted, using a pre tested interviewer administered questionnaire, in the medical clinics of Provincial General Hospital, Ratnapura. Systematic sampling was used to select 385 respondents over 15 clinic sessions. Study area: Provincial General Hospital, Ratnapura Study population: Diabetic patients who attended diabetic clinics Type of study: Cross sectional Study Study instrument Pre tested interviewer administered questionnaire Sampling method: Systematic sampling Sample size: 385 Disease investigated: Diabetes Mellitus Results: All 385 selected participated in the study. With regard to control of Diabetes Mellitus, 89.6% (n = 345) knew the importance of regular blood sugar monitoring and 96.9% (n = 373) knew lifelong medication was necessary. Knowledge on chronic complications varied greatly as 98% (n = 377) knew the risk of foot ulceration when only 58% (n = 223) had heard of Cerebro-Vascular Accidents. Uncontrolled blood sugar levels were correctly identified by 98.7% (n = 379) as a risk factor for the development of chronic complications but only 19.3% (n = 72) correctly mentioned smoking as a risk factor.

φυό Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Conclusion: Even though the importance of blood sugar control was understood by the patients, their knowledge on the range of chronic complications and the risk factors for the development of chronic complications was not satisfactory. Simple and effective health education methods are recommended to improve the knowledge. Punchihewa PMG. Vithanage Sukumar S.S. (2010). "Deficiencies associated with the use of inhaler devices for asthma." Sri Lanka Journal of Child Health, 2010; 39: 133-136 39(4): 133-136. Objective: To study the deficiencies associated with the use of inhaler devices among children with asthma. Design: Observational descriptive study Method: Study population comprised consecutive children seen at all medical clinics of Lady Ridgeway Hospital using inhaler devices for asthma. Study was carried out from February 2008 until 150 patients were enrolled. Data was collected using an interviewer administered questionnaire. Technique of using inhaler was checked. Knowledge about maintenance of the device was assessed. Results: Of the 150 patients 63% were in the 5-13 year age group. Fifty six percent were using the inhaler for 1-4 years. Seventy one percent in the below 2 year age group used the Holding chamber (Babyhaler). Forty percent in the 2-4 year age group used a volume spacer and a face mask. Eighty four percent in the 5-13 year age group used a dry powder inhaler or volume spacer without the face mask. Steroids alone were used by 84% of children while 16% used combination drugs. Compliance was good in 85%. Technique was satisfactory in 67% cases. Conclusion: There are major deficiencies in the usage of inhaler devices among patients with asthma. Rajakumaraswamy N. , R. I. H., Fernando D. J. S. (2008). "The frequency of cognitive dysfunction in elderly Sri Lankans with type 2 diabetes mellitus." INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY 23: 1205–1206. Objective: To study the frequency of cognitive dysfunction among elderly Sri Lankans with type 2 diabetes Study Method: We studied the frequency of cognitive dysfunction among elderly Sri Lankans with type 2 diabetes by recruiting a random sample of 204 persons from a specialist diabetic clinic database. Their demographic, health and diabetes- related data were obtained from medical records on clinical database software (Electronic Medical Record, Endocrine & Metabolic Disease Trust and SS Technologies, Sri Lanka). The data not available on the database were obtained at screening during a study visit. The development of the database received ethical review committee approval for a larger study of diabetes complications and the dementia screening component of this study was the student elective project of the first author. All participants were screened using a Sri Lankan version of Mini Mental State Examination (de Silva and Gunatilake, 2002). Those with a MMSE score of 25 or less and were examined by a psychiatrist using the CAMDEX (Cambridge examination for mental disorders of the elderly) diagnostic interview (Roth et al., 1986) and a CAMCOG score (Cambridge Cognitive Score) calculated. Previous studies have validated the CAMDEX cross- culturally in Sri Lanka (de Silva et al., 2003). A CAMCOG score of 80 of a maximum of 107 was used as the cut-off to suggest cognitive impairment, as in previous studies (Roth et al., 1986; De Silva et al., 2003).

φυύ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Diagnoses of psychiatric disorders were excluded after evaluation by a psychiatrist blind to cognitive assessment scores. Study area: Sri Lanka Study population: Elderly Sri Lankans Study instrument: Mini Mental State Examination, CAMDEX (Cambridge examination for mental disorders of the elderly) diagnostic interview, CAMCOG score (Cambridge Cognitive Score) Sampling method: Random sampling Sample size: 204 Factors investigated: Duration of diabetes, hypertension, dyslipidaemia, neuropathy, retinopathy, nephropathy, peripheral vascular disease, dementia, Results: The sample consisted of 85 men and 119 women, mean age of 63.6 (SD 8.3) years and a mean duration of diabetes of 12.2 SD 7.8 years. The prevalence of diabetic complications amongst our study participants were: hypertension- 78.4%; dyslipidaemia 75.7%; neuropathy 45.6%; retinopathy 19.1%; nephropathy 78.5%; peripheral vascular disease 18.5%. Sixty-seven out of 204 patients (32.8%) had a MMSE score of 25 or less. There was no significant gender related difference of MMSE scores within the age groups. Fifty-seven attended the CAMDEX interview. Of those who attended the interview, 21 participants (10.3% of the original sample) scored less than 80. There were no statistically differences between patients with CAMCOG<80 and those with CAMCOG>80, with regard to age, 70.2 SD 9.9 vs 65.5 SD 8.5 years, duration of diabetes, 13.5 SD 8.9 vs 13 SD 8.9 years, and BMI, 22.9 SD 6.3 vs 23.7 SD 3.7 Kg/m2. Statistically significant differences were observed with HBA1c (7.2 SD 1.3 vs 7.5 SD 2.3%, p = 0.034), micro albumin (113.2 SD 70 vs 39.7 SD 56 g/l, p = 0.035), systolic blood pressure (125.6 SD 45.8 vs 133.3 SD 12.7, p = .22), diastolic blood pressure (72.2 SD 24.7 vs 79 SD 7mm Hg, p = 0.1). We found no association between performance on the CAMCOG test and age, education level or gender. An increased risk of developing both Alzheimer’s dementia (AD) and vascular dementia in type 2 people with diabetes is acknowledged (Allen et al., 2004). In a community based prevalence study in Sri Lanka, 10% had cognitive impairment (De Silva et al., 2003). In our younger cohort of people with diabetes the frequency was 33%. The prevalence of dementia in Sri Lankan population with a mean age of 70 years was 4% (De Silva et al., 2003). Our younger study population had dementia in 11.8%, suggesting that dementia is three times as common in a diabetic population. Conclusion: The high rate of cognitive impairment and dementia found in our patients implies that correlation between type 2 diabetes and dementia, previously reported in the Europid populations also exists in South Asia. Rajanayagam S. Pirinthini M. Jeyalakshmy S. (2010). "A study of stroke patients presented to Teaching Hospital Jaffna." The Jaffna Medical Journal 26(1): Page 45. Objective: To study the demographic and clinical data of stroke patients presenting to Jaffna teaching Hospital, to identify high risk categories where primary prevention can be improved , to plan acute stroke management and to determine the outcome of stroke patients.

φφτ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Study method: Study was conducted in all stroke patients presenting to medical units in the Jaffna Teaching Hospital between the periods of 1st October 2009 till 31st March 2010. Diagnosis of stroke was made on clinical grounds (as defined as the onset of rapidly developing clinical signs of focal and global disturbances in the cerebral function). Study Area: Medical units of Jaffna Teaching Hospital Study population: All diagnosed stroke patients presenting to medical units in the Jaffna Teaching Hospital Study Instrument: Bed Head tickets and all other clinical record Sample size: 165 Disease Investigated: Stroke Results: 165 patients presented over a period of six months. Majority of the patients (84.2%) were between the ages of 46 to 80 years, and 4.24 % of the patients were below 45 years of age. More than half of the patients were males (52.12%). Only 25.45% of the patients presented to the hospital within 3 hours of onset of the stroke symptoms. 72.72% had ischemic stroke, 32.12 % of the patients had no previously detected co morbidities. 43.63% had diagnosed hypertension, 25.45% had diabetes, 24.84% had a history smoking and 3.04% had atrial fibrillation.9.69% of patients died in-ward, of the rest 19.39% were bed bound, and 48.48% were dependent for their activities of daily living at the time of discharge. Ranasinghe P. Jayawardena R. Constantine GR. Sheriff R. Katulanda P. (2012). "The prevalence, patterns, and correlations of Diabetic Peripheral Neuropathy (DPN) in Sri Lanka." The Ceylon Medical Journal 57(Supplement 1) Objective: To describe the prevalence, patterns and correlates of DPN in patients with Diabetes Mellitus (DM) in Sri Lanka. Method: Data was collected as part of a national study on DM. In new cases, DPN was assessed using the Diabetic Neuropathy Score (DNS). While in established DM patients, both DNS and Toronto Clinical Scoring System (TCSS) were used. A binary logistic regression analysis was performed with “presence of DPN” as the Dichotomous dependent variable and other independent co-variants. Study population: Diabetic patients Sample size: 528 Sampling method: Convenient sampling method Results: Sample size was 528. Mean age was 55.0 ± 12.4 years, 37.3% were males. Prevalence of DPN, according to DNS, in all established and newly diagnosed DM patients was 48.1% (n = 254), with 59.1% (n = 199) and 28.8% (n = 55) respectively. Prevalence of DPN in those with established DM (TCSS) was 24.6%. The majority had mild DPN (n = 56, 16.6%). In males and females, the prevalence of DPN was 20.0% (n = 25/125) and 26.4% (n = 56/212) respectively. Mean age of those with and without DPN were 62.1 ± 10.8 years and 55.1 ± 10.8 years respectively (p < 0.001). The majority of

φφυ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

those with DPN were from rural areas (75.3%) and earned a monthly income of < LKR 12,000 (87.6%). In the binary logistic regression analysis, the presence of foot ulcers, female gender, and smoking were the strongest predictors followed by insulin treatment and Diabetic Retinopathy and Sulphonylureas treatment, increased height, rural residence, high triglyceride levels, lower monthly income, longer duration of DM. Conclusion: The study defines the impact of previously known risk factors for the development of DPN while identifying several new potential risk factors in this ethnically different subpopulation of DM. Ratnatunga PCA. Amarasinghe SC. Ratnatunga NVI. (2003). "Changing patterns of thyroid cancer in Sri Lanka. Has the iodination programme helped?" Ceylon Medical Journal 48(4): 125-128. Objectives To ascertain if there has been a change in the pattern of thyroid cancer in Sri Lanka. If so, whether there is a correlation to the implementation of the programme of iodination. Design Retrospective (1974–1986) and prospective (1987–2001) Setting Kandy Hospital (1974–1982), Peradeniya Hospital (1982–2001) and private hospitals in Kandy (1979–2001). Method Three hundred consecutive patients with cancer of the thyroid seen over 28 years (1974–2001) period were reviewed for demography, histopathology and extent of spread at presentation. Seventy one patients of this group had a pre-existing goitre of greater than 10 years’ duration and were similarly reviewed. Results A highly significant reduction of anaplastic thyroid cancer and a highly significant reduction in the extent of extra-thyroidal spread at presentation of differentiated thyroid cancer were observed after 1995. In malignancy supervening on pre-existing goitre, a significant reduction in anaplastic carcinoma and a highly significant increase in papillary carcinoma were noted in the post-1996 period. A significant reduction of extra-thyroidal spread was also observed. Conclusion A trend towards more differentiated thyroid cancer with lesser degree of spread was observed in recent years. The iodination programme implemented in 1995 is likely to be responsible for this change. Ratnatunga PCA. Sivakanesan R. (1994). "Lipid patterns in patients with chronic occlusive arterial disease affecting lower limbs." Ceylon Medical Journal 39(4): 169-172. Objective: To correlate the clinical patterns of pressentation with the incidence of lipid disorders and to identify possible high risk sub groups. Study Method: Two groups comprising 114 patients (mean age in years: 49.4 SD 22.9; males 112) with chronic occlusive arterial disease of lower limbs (COADL) and another of 62 patients (mean age in years: 46.3 SD 10.8; males 62) admitted for minor surgery (ie herniae, hydroceles, varicose veins etc.) were prospectively studied with their consent and their lipid patterns estimated. Patients with a recent history of myocardial infarction, major surgery, serious intercurrent illnes (especially of an endocrine, renal or biliary nature) and all those on diuretics, beta receptor blockers and steroids

φφφ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

were excluded. None of the patients, other than the diabetics, practiced any form of dietetic restriction. Nor were they on lipid reducing drugs. The diagnosis of COADL was based on clinical features, ankle pressure indices and when possible angiography. The patients were consecutive, and admitted to the Vascular unit of the General Hospital, Peradeniya during the 21 month period(October 1989 to June 1992). Clinical data were recorded on a protocol. 41 of these patients (36%) underwent angiography. Lipid patterns were obtained on all patients and controls on 14 hour fasting serum samples. The cholesterol in the high density lipoprotein fraction, serum triglycerol and low density lipo protein cholesterol were obtained by standard techniques. The Body Mass Index (BMI) was calculated by dividing the weight in kilograms by the height in metres. For purposes of analysis the patients were grouped into aortoiliac disease (AID), femoropopliteal disease (FPD) and tibial disease (TD) based on the most proximal level of occlusion or stenosis, which in turn was based on clinical pulse examination. The clinical findings in the 114 patients were reinforced by angiographic data in 41. Study area: Vascular unit of the General Hospital, Peradeniya Study population: Patients with chronic occlusive arterial disease of lower limbs Study instrument: Angiogram Sample size: 114 Factors investigated: Weight, height, high density lipoprotein, serum triglycerol and low density lipoprotein Results: The patterns of serum lipids among persons in the control group are given below (Table 1).Comparing the serum lipid pattern of all COADL patients using cut-off points for normal/abnormal obtained from control patient data given above, 53 of the 114 (46.5%) of those with COADL had one or more lipid disorders. Reviewing data from all subgroups, the commonest type of lipid disorder was an abnormal serum total cholesterol to HDL cholesterol (TC/HDL/- C) ratio greater than 5.5 in 39 of 114 (34%) patients. Serum LDL cholesterol (LDL-C) was elevated > 160 mg/dl in 22 of the 114 (19.3%) and a serum total cholesterol (TC) of > 240 mg/dl was seen in 21 of 114 (18.4%) patients. Serum triglycerides (TG) level of > 180 mg/dl and serum HDL cholesterol (HDL-C) of < 25 mg/dl was found in 21/114 and 13/114 patients respectively. Multiple lipid abnormalities were found in 36 of 53 patients with such abnormalities. Table 2 shows the distribution of lipid disorders according to age group and shows the relatively high incidence in the young age groups. Only two diabetics and two hypertensives were found among the 54 patients with COADL under 50 years of age. 91 of 114 patients had a BMI of < 21.25. Table 4 shows the patterns of lipid disorders in different subgroups. 17 of 35 patients under 40 years of age (AO) had lipid abnormalities. Analysis of the figures showed 11 of 14, five of 14 and one of six in the subgroups AID, FPD and TD respectively, were so affected. 50 patients had one (n=25) or both (n=25) femoral pulses weak or absent. 25 of these patients underwent transfemoral or translumbar aortography and in consequence the exact location of the stenosis or occlusion was delineated. 14 of 16 patients with aortic occlusive disease (both high and low) had lipid abnormalities. Seven of them were under 45 years of age and though all had multiple lipid abnormalities, a consistent abnormality was not found. TC/HDL-C of > 5.5 in nine, a TG of > 2.1 mmol/1 in nine and a TC of > 6.2 mmol/1 in six patients were the dominant abnormalities. Nine patients with bilateral femoral pulse loss did not have angiography. Seven of them had lipid abnormalities. The number of patients per lipid abnormality were TC two; HDL-C two TC/ HDLC five TG 1 andLDL-C two. In the group with unilateral iliac occlusive disease, of the eight patients under 45 years, five had lipid abnormalities, being multiple (ie > 1) in four, while in the 17 patients over 45 years of age only three patients had a lipid abnormality (p=0.0388). Two had multiple lipid

φφχ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

abnormalities in the latter group. Femoropopliteal occlusive disease (n = 50). The femoropopliteal group consisted of 22 patients (mean age 45.2 years) with bilateral occlusive disease and 28 (mean age 56.2 years) with unilateral occlusive disease. 10 of 22 (45%) with bilateral disease and 11 of 28 (39%) with unilateral disease had a lipid abnormality. 13 patients in this group were 35 years and less. Five of them had features of thromboangiitis obliterans (upper limb ischaemia (three), thrombophlebitis (two), angiographic appearance (five) and histology (one). None of the five had a lipid disorder. Five of the eight (63%) remaining patients had a lipid abnormality and three of whom had bilateral femoropopliteal occlusion, and two also had ischaemic heart disease on presentation. 31 patients were over 44 years (AO). The mean age of those with an lipid abnormality (n=15) was 56.6 years and contrasted with those without a lipid abnormality (n=16) 64.3 years (p=0.0671). It is interesting to note that those with a lipid abnormality, though younger, had three with ischaemia of the heart and two with cerebrovascular accidents. Those without a lipid abnormality had six patients with ischaemic heart disease and one had a history of a cerebrovascular accident. Tibial occlusive disease (n=14) Six of the 14 patients with tibial or more distal occlusions had lipid abnormalities, five of them being over 44 years of age. Conclusion: We conclude that lipid studies on those with aortoiliac and femoropopliteal occlusive disease will yield useful data to improve the quality of care offered to these high risk patients. Samarage SM. Senevirathne WKVS. Comparative Community Based Study of the Rural and Urban Poor, Economic burden of Alcohol Related Illness to the health system and household. Objective: To determine the admission pattern of patients with alcohol related illness at General Hospital Ratnapura and their economic burden to the health system and the household. Specific Objective: 1)To determine the admission pattern of patients with Alcoholic related illness at General Hospital Ratnapura. 2)To describe selected demographic and socioeconomic characteristics of the study population. 3)To estimate the cost of providing patient care services to inward patients with alcohol related illness. 4)To estimate the cost of medical care of selected alcohol related illnesses. 5)To estimate the household cost during hospitalization of patients with alcohol related illnesses. Study Type: Hospital Based Descriptive Cross Sectional Study Study Area: General Hospital Ratnapura Study Population: All male patients with alcohol related illnesses admitted to medical and psychiatry wards at General Hospital Ratnapura. Excluded population: 1)Patients admitted for other diseases, but have an underlying contributory factor related to alcohol were not included in the study. 2)Injuries related to alcohol e.g. victims of RTA 3)Patients admitted with an alcohol related illness to the ICU. Sample Size: 392 Study Instruments: Interviewer administered pre-coded questionnaire, Bed head Tickets

φφψ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Factors investigated: Age, Alcohol related Illness, Area of Residence, Ethnicity, Religion Results: Age distribution of patients with alcohol related illnesses – from 12 to > 70 years. The higher percentage of admissions was observed in the age group 41 – 50 years (29.58%), and in the age group 31 – 40 years (28.39%), 13 patients (3.27%) between the age group 12 – 20 years. The study finds that the largest proportion of patients with alcohol related illness (29.85%) was admitted from Ratnapura Divisional Secretariat area. The second largest proportion (11.22%) was from Alapatha Divisional Secretariat area. From the Pelmadulla and Kuruwita areas, the proportion of patients admitted was 10.46% and 10.20% respectively. The lowest percentage (0.76%) was from Kolonne Divisional Secretariat area. The majority of study sample was Sinhalese (82.14%). The next largest ethnic group was Tamils (16.58%). Buddhists were the majority (82.14%) and there were no Catholics. Majority of the patients (64.03%) were unskilled workers. There were no patients involved in administrative or management work. There were 19.54% of patients who had not been employed. Santharaj WS. Athukorala DP. Ekanayake RAI. Senaratne N. (1992). "Complete Heart Block after Acute Myocardial Infarction." Journal of the Ceylon College of Physicians 24: 37-38. Objective: To discuss the presentation, symptomatology and the management of patients who developed complete heart block following acute mycoardlal infarction and treated at the Institute of Cardiology. Study Method: Twenty eight patients who developed complete heart block following acute myocardial infarction were studied prospectively during a period of six months. During their stay in the coronary care unit their rhythm and haemodynamic status were continuously monitored. Study area: Institute of Cardiology Study population: Patients who developed complete heart block following acute myocardial infarction Type of study: Prospective Study Sample size: 28 Factors investigated: Systolic blood pressure, Results: There were 27 males and one female, their age ranging from 34 to 66 yrs.. The time interval between the onset of chest pain and admission to C.C.U. varied between 4 hrs and 72 hours. Seven patients were admitted within 4 hrs of onset of chest pain. The systolic blood pressure (B.P.) was less than 90mmhg in twelve patients. Eight patients has systolic B.P. between 90 and 100 mmhg. Others had a systolic BP More than 100 mmhg. The following complications of acute myocardial infarction were noted in addition to complete heart block in these patients. Management Twenty three patients were managed by insertion of a temporary pacemaker. Five patients were managed conservatively for the following reasons. One patient had a transient CHB, 03 patients were haemodynamically stable with heart rate more than 50 b/minute and one had a streptokinase infusion. Duration of temporary pacing varied between 1 hr and 192 hrs. Except five patients who had cardiogenic shock, others showed a definite improvement in their haemodynamic status, level of consciousness and L.V.F., after pacing. 03 patients had non-sustained ventricular tachycardia during pacing and one had infection of the cutdown site. 02 patients with acute inferior Q wave

φφω Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

myocardial infarction with evidence of right ventricular infarction were given streptokinase infusion. One of these patients was paced because of a very slow heart rate. He did not have any haemorrhage. Site of Infarction and out come Seven patients (25%) died in this group. Five patients had cardiogenic shock and two had cardiac arrest in asystole.Except one patient others were in sinus rhythm when they were discharged from the hospital. One patient who had a anterior Ml had persistant CHB and warranted a permanent pacemaker insertion. Conclusion: Complete heart block with cardiogenic shock carries a grave prognosis carrying almost 100% mortality. Complete heart block is a common complication of inferior myocardial infarction than anterior myocardial infarction. CHB with anterior myocardial infarction carries a bad prognosis. Persistant complete heart block can occur after an anterior myocardial infarction. These patients need permanent pacemaker insertion. Senaratna B C V , W. B. V. N. (2012). "Risk behaviour of street children in Colombo." Ceylon Medical Journal 2012; 57: 106-111 57: (3): 106-111. Objective: To describe risk behaviour and determinants of such risk behaviour among street children in Colombo city. Study Method: This is a qualitative, cross-sectional study (in three phases) done in Colombo Fort, Pettah, Slave Island and Maradana areas of Colombo City. For purposes of this research, street children were defined as children living on street most of time regardless of whether they still maintained some contact with their families or not. In Phase I, we conducted twenty semi-structured interviews (SSIs) with key informants (KIs – including parents/guardians of street children, street vendors/ persons working in boutiques in areas frequented by street children, and social workers/researchers who have working experience regarding street children). They were identified through prior knowledge. In Phase II, we recruited street children for research using referral sampling. Focus group discussions (FGDs) were conducted with recruited children until no new information was forthcoming (ten FGDs, each with 8-10 children, aged 8-<18 years). We also conducted SSIs with 25 children, selected to represent their variability in age, sex, ethnic group and religious group. In Phase III, we profiled all recruited children using variables generated through SSIs and FGDs. Two pre-piloted, interviewer-administered, semi-structured questionnaires were used to conduct SSIs with KIs and street children. A pre-piloted, moderator's question guide was used to moderate FGDs. An interviewer administered questionnaire was used for profiling. All interviewers had prior experience in studies/programmes involving street children, and therefore had a good rapport with participants. SSIs and FGDs were tape recorded with consent of participants whenever possible, and notes were taken down. Tapes were transcribed and notes expanded immediately after each SSI and FGD. Data were analysed using qualitative content analysis. Children’s behavior were observed using a pre-piloted behaviour checklist and these data were used to validate information that emerged from SSIs and FGDs. Informed consent was obtained from all participants, including children. In addition, informed consent of parents/guardians was also obtained for participation of their children. Study area: Colombo Fort, Pettah, Slave Island and Maradana areas of Colombo City Study population: Street children aged 8-<18 years

φφϊ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Type of study: Cross-sectional study Study instrument: Interviewer-administered, semi-structured questionnaires Sample size: 283 Results: KIs included 6 parents/guardians, 6 street vendors, 5 persons working in boutiques, and 3 social workers/ researchers. Our sample included 283 children (of-street n=102; 36% and on-street n=181; 64%) representing all major ethnic and religious groups. Nearly 62% were aged 14 years or less. Majority were boys. Around 40% lived either with one or both parents, but nearly 18% lived alone. Two thirds had never enrolled in a school. Despite diversity of social, demographic, cultural and economic strata these children represent, they shared common socio-economic disadvantages, and valued delinquent behaviour over traditional social norms and values. Social prestige is usually bestowed upon a street child based on a set of mostly anti-social behavior demonstrated by that child. On the other hand, their lifestyle, and at times their very survival, is closely tied to such risk behaviour which are means of their sustenance. However, they also use some risk behaviour as recreations. Recreational risk behaviour There is a gender difference in recreational risk behaviour (Table ). Abuse of alcohol and narcotic substances is widespread among boys but less among girls. Smoking cigarettes and cannabis, which are equally prevalent, is a practice exclusively of boys with rare exceptions. Sexual promiscuity is common among both male and female adolescents and includes male homosexual behaviours. Boys patronise CSWs at times. Usage of pornography is commoner among boys. “Nobody cares whom they (children) have sex with... I have slept with sixteen already” - FGD 4. “We get free drugs and free sex. It is good life” - FGD 8. Other risk behaviour These children, especially boys, often encounter violence. As a rule, most boys live in 'gang's which are tightly knit and function based on their own rules and norms. Entry into gangs is difficult, and membership is guarded. These gangs facilitate peddling of illicit alcohol and narcotic substances. In order to protect such financial interests of gang membership the gangs display territorial behaviour, which at times leads to violent encounters with other gangs. “how could they operate in our area? ... One day, we ambushed them and cut (them) with razor knives” - FGD 9. Correlates of risk behaviour Extreme poverty, socio-cultural and peer pressures, and low educational achievements are considered as important factors promoting risk behaviour. Lack of families/guardians and inadequate family support and attachment to alternative value systems in their culture are also considered as risk factors. Most children consider risk behaviour as their recreational activities. Lack of acceptable recreations for these children promotes such behaviour as recreations. Table . Risk behaviour adopted by street children as means of frequent recreation Risk behaviour Female Male Total (n=73*) (n=210*) (n=283*) Abuse of alcohol 10 (13.7%) 169 (80.5%) 179 (63.2) Abuse of narcotic substances (including cannabis 4 (5.5%) 153 (72.9%) 157 (55.5%) Smoking 2 (2.7%) 178 (84.8%) 180 (63.6%) Use of pornography 6 (8.2%) 163 (77.6%) 173 (82.4%) Promiscuous sexual activities 25 (34.2%) 78 (37.1%) 103 (36.4%)

φφϋ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Patronising CSWs 74 (35.2%) 74 (26.2%) * Many children engage in multiple risk behaviours as recreations. Senevirathna L. Abeysekera T. Nanayakkara S. Chandrajith R. Ratnatunga N. Harada KH. Hitomi T. Komiya T. Muso E. Koizumi A. "Risk factors associated with disease progression and mortality in chronic kidney disease of uncertain etiology: a cohort study in Medawachchiya, Sri Lanka." Environ Health Prev Med 17(3): 191-8. BACKGROUND: The alarming rise in the prevalence of chronic kidney disease of uncertain etiology (CKDu) among the low socioeconomic farming community in the North Central Province of Sri Lanka has been recognized as an emerging public health issue in the country. METHODS: This study sought to determine the possible factors associated with the progression and mortality of CKDu. The study utilized a single-center cohort registered in 2003 and followed up until 2009 in a regional clinic in the endemic region, and used a Cox proportional hazards model. RESULTS: We repeatedly found an association between disease progression and hypertension. Men were at higher risk of CKDu than women. A significant proportion of the patients in this cohort were underweight, which emphasized the need for future studies on the nutritional status of these patients. CONCLUSIONS: Compared with findings in western countries and other regions of Asia, we identified hypertension as a major risk factor for progression of CKDu in this cohort. Seneviratne NHG. Weerarathna TP. (2010). "AUDIT ON DRUG COMPLIANCE AND ITS IMPACT ON HOSPITAL ADMISSIONS WITH ACUTE COMPLICATIONS AMONG PATIENTS WITH MAJOR NON-COMMUNICABLE DISEASES." Galle Medical Journal 15(1): 59. Introduction Good drug compliance is vital in preventing complications of common non-communicable diseases (NCDs) such as hypertension, ischemic heart disease and diabetes mellitus. The assessment of drug compliance and its associated factors has not been studied in a local setting. This study was done with the objective of evaluating drug compliance among patients admitted with acute complications of NCDs and studying associated factors. Methods Data were collected from 174 patients admitted to University Medical Unit, Teaching Hospital Karapitiya with, stroke, acute myocardial infarction (AMI), heart failure (HF), diabetic ketoacidosis (DKA) and non-ketotic hyperosmolar coma (HONK). Demographic data, drug compliance [i.e., poor (missing 5 or more), average (< 5) and good (none) doses of medications respectively a week preceding the admission] and associated factors were studied in these 174 patients. Results Poor, average and good drug compliances were observed in 27.6%, 36.8% and 35.6% of these patients (chisquare 14.9; p< 0.05). Poor drug compliance was observed in 30 (34.5%) patients with strokes and the relevant figures for AMI, HF, DKA and HONK were 23%, 18%, 33% and 26% respectively Among the reasons for poor compliance were ignorance and financial reasons in 41% and 8% respectively. Forty percent of patients had more than one reason for poor compliance

φφό Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Conclusions A significant proportion of patients admitted with complications of common NCDs reported poor drug compliance. Among the reasons found, ignorance was the single most common cause. Patients with NCD should be properly advised on the need for long term drug therapy. Siribaddana S. Perera N. Perera S. Fernando D. Weerasuriya N. (1994). "Prevalence of lipid abnormalities in Sri Lankan patients with non-insulin dependent diabetes mellitus." The Ceylon Medical Journal 39(1): 22-25. Objective: To determine the prevalence of hyperlipidaemia in Sri Lankan patients with non-insulin dependent diabetes mellitus (NIDDM) and a normal control population. Study Method: A cross-sectional study. Patients with NIDDM randomly selected from a diabetic clinic register and non-diabetic controls randomly selected from an electoral register. 498 patients with NIDDM (197 females mean age 53.5, SD 6.2 years) and 253 non-diabetic controls (101 females, mean age 53, SD 5.5 years matched for age and sex. Diabetes and impaired glucose tolerance (IGT) were excluded in the control group by a 75g oral glucose tolerance test. Total cholesterol, high density cholesterol and triglycerides were determined in fasting blood samples. Study area: Sri Lanka Study population: Patients with NIDDM Type of study: Cross-sectional study Study instrument: 75g oral glucose tolerance test, fasting blood samples Sampling method: Random sampling Sample size: 498 Factors investigated: Total cholesterol, high density cholesterol and triglycerides, Diabetes and impaired glucose tolerance (IGT) Results: The prevalence of lipid abnormalities was significantly higher in diabetic patients than in controls. The prevalence of hypercholesterolaemia was 21% vs 14% and that of hypertriglyceridaemia 16% vs 8.3%. Mean fasting blood glucose was higher (9.7 + 2.7) in hyperlipidaemic patients than in normolipidaemic diabetic patients (7.5 + 2.1). Conclusion: Hyperlipidaemias are common in Sri Lankan patients with NIDDM and screening for them should be an essential component of management of patients with diabetes mellitus.

φφύ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Siriwardena BSMS. Tilakaratne A. Amaratunga EAPD. Tilakaratne WM. (2006). "Demographic, aetiological and survival differences of oral squamous cell carcinoma in the young and the old in Sri Lanka." Oral Oncology 42(8): p831-836. Oral squamous cell carcinoma (OSCC) is a major oncological problem in many regions of the world where tobacco habits are practiced in the form of chewing and/or smoking with or without alcohol intake. It accounts for 16.5% of all cancers in Sri Lankan patients with a male: female ratio of 4:1. In Sri Lanka nearly 5% of OSCC are diagnosed in young patients. This comparative study describes, demographic, aetiological and survival data from young and old patients with OSCC (n =56). Both younger and older groups showed a marked male predilection (male: female ratio was 4:1 and 3.7:1 in younger and older groups respectively). Tongue was the commonest site for younger group (41%, P <0.01) whilst buccal mucosa (37.5%, P <0.05) and alveolar mucosa (25%, P <0.01) were for older group. 39% of cancers in younger group were not associated with any identifiable risk factor (P <0.01) and 70% of SCC of the tongue has no associated habits (P <0.01). SCC of the tongue in the younger group shows poor prognosis than the older patients. Three-year survival rate for the total number showed no significant difference in two age groups. Survival appeared to be better in patients without associated habits in the older group. Sivakanesan R. Padmini Suraweera SMJ. (2007). "Frequency of microalbuminuria and the associated risk factors for microalbuminuria among newly diagnosed type II diabetes mellitus patients." Objective: To determine the frequency of microalbuminuria and some associated risk factors for microalbuminuria among newly diagnosed Sri Lankan type II diabetes mellitus patients attending diabetic clinics of three major hospitals in Kandy District. Study Method: A hospital based cross sectional, descriptive and analytical study was carried out in 3 major hospitals in the district of Kandy. The sample studied (n=268) represented newly diagnosed type 2 diabetic patients between 20 and 70 years of age from all 3 hospitals. Patients with conditions that affect determination of microalbumin were excluded, in order to minimize the number of false positives. An interviewer administered questionnaire was used to collect information on factors associated with microalbuminuria and probable confounders affecting albuminuric status. Anthropometric measurements were recorded. Blood pressure was measured and the subjects were screened for diabetic retinopathy. Morning spot urine specimens collected from the subjects who refrained from strenuous physical activity or smoking were screened for macroalbuminuria, haematuria and ketonuria before determination of microalbumin. Lipid profile and fasting plasma glucose were measured on fasting blood samples. Study area: Teaching Hospital Peradeniya, General Hospital, Kandy and Base Hospital, Gampola Study population: Newly diagnosed type 2 diabetic patients between 20 and 70 years of age Type of study: Hospital based cross sectional, descriptive and analytical study Study instrument: Interviewer administered questionnaire, sphygmomanometer, standard weighing balance, height measuring device (stadiometer), standard non-stretchable measuring tapes, ‘Multistix’ urine strips, ‘Randox’ assay kit, Sample size: 278

φχτ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Factors investigated: Age, sex, ethnicity, socio-economic status, marital status, family history of hypertension, presence of hypertension, mean arterial pressure, smoking, alcohol status, body mass index, waist circumference, waist/hip ratio, retinopathy, total cholesterol, HDL cholesterol, total cholesterol/HDL cholesterol ratio, LDL cholesterol, triglycerides, and fasting plasma glucose Results: The overall occurrence of microalbuminuria in type 2 diabetic patients at the time of diagnosis was 25% with no significant sex difference. The significantly associated factors for microalbuminuria in the sample were marital status (p = 0.013), hypertension (p = 0.000), mean arterial pressure (p =0.000), smoking (p = 0.012) and retinopathy (p = 0.000). With a borderline significance, advancing age (p = 0.074), and fasting plasma glucose (p = 0.067) were associated with microalbuminuria in the sample. The significantly associated factors for microalbuminuria in males were advancing age (p = 0.047), hypertension (p = 0.001), smoking (p = 0.014) and retinopathy (p = 0.000). With a borderline significance, mean arterial pressure (p = 0.069) was associated with microalbuminuria in males. The significantly associated factors for microalbuminuria in females were marital status (p = 0.002), hypertension (p = 0.000), mean arterial pressure (p = 0.001), retinopathy (p = 0.000) and fasting plasma glucose (p = 0.047). With a borderline significance, advancing age (p = 0.085) was associated with microalbuminuria in females. The independent risk factors for microalbuminuria in sample were hypertension (p = 0.000), retinopathy (p = 0.000) and marital status (p = 0.012). The independent risk factor for microalbuminuria in males was retinopathy only (p = 0.004). The independent risk factors for microalbuminuria in females were hypertension (p = 0.006), retinopathy (p = 0.004) and marital status (p = 0.005). Conclusion: 1. The overall occurrence of microalbuminuria in type 2 diabetes mellitus patients at the time of diagnosis is 25%. 2. The significantly associated factors for microalbuminuria in the population include marital status, hypertension, mean arterial pressure, smoking and retinopathy. The associated factors with a borderline significance include advancing age and FPG. 3. The significantly associated factors for microalbuminuria in males include advancing age, hypertension, mean arterial pressure, smoking and retinopathy. 4. The significantly associated factors for microalbuminuria in females include advancing age, marital status, hypertension, mean arterial pressure, retinopathy and FPG. 5. The independent risk factors for microalbuminuria in the population include retinopathy, hypertension and marital status. The most significant factor was retinopathy. 6. The independent risk factors for microalbuminuria in females include retinopathy, hypertension and marital status. 7. Retinopathy was the only independent risk factor for microalbuminuria in males. 8. Abnormal lipid levels were not risk factors for microalbuminuria at the time of diagnosis. Surenthirakumaran R. Pathmeswaran A. Jeyakumaran N. Sivaraja N. (2010). "Cancer incidence and pattern of cancer disease in Jaffna District." The Jaffna Medical Journal 26(1): Page 51. Objective: To estimate the incidence of cancer and identify the common types of cancers in Jaffna district Study method: Cancer disease diagnostic details in the records at cancer unit Jaffna from 1st of January 2006 to 31st of December 2008 were used. Coding of cases was based on the modified ICD10 classification used by Medical statistics unit of Ministry of Health.

φχυ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Study Area: Cancer unit Jaffna Study population: Cancer patients residing in Jaffna Study Instrument: Medical records Sample size: 768 Sampling method: Convenient sampling method Disease Investigated: Cancer Results: During the three year period 768 cases (374 males were registered at the cancer unit Jaffna. The estimated annual incidence of cancer was 47 per 100 000 population among both males and females. The five most common cancers, which contributed 65% of all cancers, in males were lip, oral cavity and pharynx (31%); esophagus (13%), trachea, bronchus and lung (8%); larynx (7%) and prostate (6%). The five most common cancers , which contributed 71% of all cancers, in females were breast (30%); lip, oral cavity and pharynx (13%); esophagus (10%); female genital organs (10%); uterine cervix (8%). Conclusion The estimated incidence is probably an underestimate as with any incidence rate calculated based on hospital based data. The common types if cancer in Jaffna District is similar to the national pattern. The fact that limited types of cancers account for over two thirds of all cancers should be made use of in planning curative and preventive services. Wanigasuriya KP. Peiris-John RJ. Wickremasinghe R. (2011). "Chronic kidney disease of unknown aetiology in Sri Lanka: Is cadmium a likely cause?" BMC Nephrology 12(1): Article number 32. Objective: To identify potential predictors of microalbuminuria in a randomly selected sample of adults from the North Central Province (NCP) of Sri Lanka Study Method: Exposures to possible risk factors were determined in randomly recruited subjects (425 females and 461 males) from selected areas of the NCP of Sri Lanka using an interviewer administered questionnaire. Sulphosalicylic acid and the Light Dependent Resister microalbumin gel filtration method was used for initial screening for microalbuminuria and reconfirmed by the Micral strip test. Study area: North Central Province (NCP) of Sri Lanka Study population: Adults Type of study: Community based study Study instrument: Interviewer administered questionnaire, Micral strip test, Sulphosalicylic acid, Light Dependent Resister microalbumin gel filtration method Sampling method: Random sampling Sample size: 886

φχφ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Factors investigated: Microalbumnuria, Smoking, alcohol use, hypertension, diabetes, urinary tract infection (UTI), consumption of water from wells in the fields, pesticide spraying Results: Microalbumnuria was detected in 6.1% of the females and 8.5% of the males. Smoking (p < 0.001), alcohol use (p = 0.003), hypertension (p < 0.001), diabetes (p < 0.001), urinary tract infection (UTI) (p = 0.034) and consumption of water from wells in the fields (p = 0.025) were associated with microalbuminuria. In the binary logistic regression analysis, hypertension, diabetes mellitus, UTI, drinking well water in the fields, smoking and pesticide spraying were found to be significant predictors of microalbuminuria. Conclusion: Hypertension, diabetes mellitus, UTI, and smoking are known risk factors for microalbuminuria. The association between microalbuminuria and consumption of well water suggests an environmental aetiology to CKD in NCP. The causative agent is yet to be identified. Investigations for cadmium as a potential causative agent needs to be initiated. Wanigasuriya KP. Peiris-John RJ. Wickremasinghe R. Hittarage A. (2007). "Chronic renal failure in North Central Province of Sri Lanka: an environmentally induced disease." Transactions of the Royal Society of Tropical Medicine and Hygiene 101(10): 1013-1017. Objective: To determine the aetiology of chronic renal failure (CRF) in the North Central Province of Sri Lanka. Study Method: Patients (n = 183) with CRF of unknown aetiology were compared with controls (n = 200) who had no evidence of chronic renal dysfunction. Exposure to possible risk factors was determined by an interviewer-administered questionnaire. Study area: North Central Province of Sri Lanka Study population: Patients CRF of unknown aetiology Study instrument: Interviewer-administered questionnaire Sample size: 383 Factors investigated: Results: Being a farmer (P < 0.001), using pesticides (P < 0.001), drinking well water (P < 0.001), a family history of renal dysfunction (P = 0.001), use of ayurvedic treatment (P < 0.001) and a history of snake bite (P < 0.001) were risk factors for CRF of unknown aetiology. Using logistic regression analysis, a family history of chronic renal disease, taking ayurvedic treatment and history of snake bite were found to be significant predictors for CRF of unknown aetiology. Conclusion: There is evidence to support an environmental aetiology to CRF in Sri Lanka.

φχχ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Weerarathna TP. Lekamwasam S. Rodrigo M. (2008). "Prediction of total and visceral fat contents using anthropometric measures of adiposity in women." Ceylon Medical Journal 53(4): 128-132. Background Although techniques such as dual energy xray absorptiometry (DXA) and quantitative CT are available to estimate global and regional adiposity, anthropometric measurements are often used to detect adiposity in clinical practice. Objectives To assess the association between the anthropometric measurements of obesity with total and regional fat mass determined by DXA. Method 106 healthy women volunteers, aged between 30 and 54 years were studied. Anthropometric measurements including body mass index (BMI), waist circumference (WC), hip circumference (HC), height adjusted WC (WC/HT), waist-hip ratio (WHR), and skin-fold thickness (SFT) over triceps, infrascapular, and iliac regions were made. All women underwent assessment of total fat mass (TFM) and visceral fat mass (VFM) using a Hologic DXA scan. Study type: A cross-sectional, descriptive study. Study Sample: 106 Results TFM and VFM showed positive correlations with all the anthropometric measurements examined, the strongest correlation was with BMI (r= 0.89 and 0.77 for TFM and VFM respectively, p < 0.001). Correlations of TFM with WC, HC, and WC/HT were 0.72, 0.87, and 0.65, (p < 0001 for all) respectively. Corresponding figures for VFM were 0.73, 0.74, and 0.68, (p < 0001 for all). WHR showed a poor correlation with TFM (r=18, p=0.09) and VFM (r=0.33, p=0.002). SFTs measured at three sites showed less strong correlations with TFM and VFM (r = 0.48 to 0.69, p < 0.001). Conclusions BMI has the strongest association with total and visceral fat mass among these women. Waist and hip circumferences showed high correlations with total and visceral fat mass, but adjusting waist circumference for height did not improve the correlation. Weerasuriya N. Siribaddana S. Dissanayake A. Subasinghe Z. Wariyapola D. Fernando DJS. (1998). "Long-term complications in newly diagnosed Sri Lankan patients with type 2 diabetes mellitus." QJM - Monthly Journal of the Association of Physicians 91(6): 439-443. Objective: To identify long-term complications in newly diagnosed Sri Lankan patients with type 2 diabetes mellitus Study Method: We screened 597 newly-diagnosed diabetic patients (201 women) mean ± SD age 42.3 ± 6.2 years to determine the prevalence of diabetic complications; 22% presented because of symptoms of diabetes, 27% were diagnosed when hyperglycaemia was discovered at a health screening, and 36% were diagnosed while being treated for intercurrent illness. Study area: Sri Lanka Study population: Newly-diagnosed diabetic patients Sample size: 597

φχψ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Factors investigated: Neuropathy, nephropathy, retinopathy, coronary vascular disease, stroke, peripheral vascular disease, hypertension, obesity, central obesity, hypercholesterolaemia, hypertriglyceridaemia, low high-density lipoprotein cholesterol Results: Neuropathy was present in 25.1%, nephropathy in 29%, retinopathy in 15%, coronary vascular disease in 21%, stroke in 5.6%, peripheral vascular disease in 4.8%, hypertension in 23%, obesity in 16%, central obesity in 21.3%, hypercholesterolaemia in 11%, hypertriglyceridaemia in 14%, and low high-density lipoprotein cholesterol in 12%. Conclusion: The prevalence of coronary vascular disease, hypertension, stroke, neuropathy and retinopathy at the time of diagnosis were higher in our patients than in Caucasian and Indo-Asian patients in the UK. Both a genetic predisposition to develop complications, and exposure to a longer duration of asymptomatic hyperglycaemia due to poor access to adequate health care, may contribute to the high frequency of complications at diagnosis. Since complications are already present at diagnosis, there is a case for implementing primary prevention programmes combined with screening for diabetes in high-risk groups. Welikumbura RMPR. (2005). Study on Patient's Knowledge,Attitudes and practices about Diabetes and its control. Postgraduate Institute of Medicine. Colombo, University of Colombo. Doctor of Medicine in Family Medicine Main objective: To assess the knowledge, attitudes and practices of patients with diabetes and their association with glycemic control in patients with diabetes attending the researcher's Family clinic and patients with diabetes attending the diabetic clinic of the Colombo South Teaching Hospital. Specific objective: 1. To assess - the knowledge required to control diabetes - the attitudes towards the illness - the practices in regard to diabetes control 2. To assess the glycemic control. 3.To determine whether there is an association between the knowledge, attitudes and practices and glycemic control. Study area: Diabetes clinic of Colombo South Teaching Hospital Researcher's Family practice in Kotte Study population: Patients with diabetes attending the researcher's Family practice in Kotte and diabetes clinic of Colombo South Teaching Hospital Type of study: A cross-sectional comparative study Study instrument: Interviewer-administered,pre tested questionnaires Medical records containing the recent two fasting blood sugars Fasting blood sugar tests Sampling method: Random sampling and convenient sampling Sample size: 177

φχω Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Risk Factors investigated: Diet, exercise, glycaemic control Disease investigated: Diabetes mellitus Results: Mean duration of the study population was 6.98+/-5.85 years whilst the mean age of the patients was 57.99+/-10.5 years. More than 90% fell into the age group 40-80 years and the male to female ratio was 1:1.8. 70% of the patients were living with their spouse and 98.8% were living in their own accommadation. There were more singhalese and Buddhists in the study sample than in the general population(91%and 87% respectively),Knowledge regarding diabetes was average or good in all patients (above 50% ). 55.4% of patients could identify symptoms of hypoglycaemia. There was statistically significant association between the knowledge about hypoglycaemic symptoms and the fasting blood sugar.(Chi square test p=0.05) Nearly 95.5% of patients thought that it is important to control diabetes and that the patient's commitment is necessary. They also thought that the diet and exercise are as important as medicine to control the disease . The results shown below in figure 1 shows that more than half of the study population never took sugar and one third never took sweets ,however 40.7% never took adequate exercises (figure 2 ). In this study, the mean fasting blood sugar was 129+/- 36.4 mg/dl -33.3% fasting blood sugar less than 110 mg/dl(which should be the goal) -30.5% fasting blood sugar between 110-130 mg/dl(which is satisfactory) -36.2% fasting blood sugar above 130 mg/dl(which was poor) Conclusion Knowledge required to control diabetes was adequate in all patients but there was room for improvement. There was statistically significant association between the knowledge about hypoglycemic symptoms and the fasting blood sugar in this study, Most of the patients had correct attitudes towards the illness, but one third of them felt that diabetes curtail activities and that diabetes can be cured. The glycaemic control and monitoring could have been better. There was association of knowledge with attitudes and practices but not with glycaemic control. Wijesinghe MSD. (2007). Selected aspects of quality of care recieved by Diabetic Mellitus patients attending diabetic and medical clinics at National Hospital Sri Lanka. Postgraduate Institute of Medicine. Colombo, University of Colombo. Master of Science in Community Medicine: 75. Main objective: To assess the quality of care recieved by the diabetes mellitus patients attending medical and diabetic clinics at National Hospital Sri Lanka (NHSL) Specific objective: 1.To assess the knowledge of the diabetic patients in relation to diabetes and its complications. 2. To assess the therapeutic and patient care procedures adopted in the management of diabetic patients in terms of HbA1c level assessment, FBS,and PPBS assessment and lipid levels,follow up clinics visits, compliance to drug treament etc. 3. To determine the compliance of the diabetic patients to drug treatment.

φχϊ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Study area: Medical and diabetic clinics of the National Hospital Sri Lanka (NHSL) Study population: All diabetic patients who are attending diabetic clinic and diabetic patients who attending medial clinic sessions in Room 26 and 27 at the NHSL. Type of study: Hospital based descriptive cross sectional study Study instrument: Interviewer adminstered questionnaire Sampling method: Systematic sampling method Sample size: 512 Risk Factors and disease investigated: Diet, Exercise,Drug compliance Diabetes mellitus Results: There is no statistically significant difference found in the composite knowledge score about the disease and complications in-between the clinics. HbA1c were ever done only in 3.7% of the subjects.Out of the sample 43.4% had a fasting blood sugar value less than 110mg/dl. During the last year.42.3% lipid profiles were done in the medical clinic while 22.3% lipid profiles were done in the diabetic clinic. Out of all the lipid profiles done in the last year,88.5%(n=69)in the diabetic clinic and 76.8%(n=53) in the medical clinic were found to be abnormal. In follow up clinic visits weighing was only done in 52.1%in the diabetic clinic and only 1.2% in the medical clinics. Foot examination was done in 22.1%9(n=77) of the subjects in the diabetic clinic compared to 3.7% (n=6 ) in the medical clinics. All the annual screening indices such as BMI, Fundoscopy, presence of proteinuria and Serum creatinine had been done in a higher proportions in the diabetic clinic than in the medical clinic. The current study found, 41.8% (n=146) in the diabetic clinic and 48.5% (n=79) in the medical clinic ha discontinued any of the diabetic drugs without medical advise prescribed to them in their last clinic visit. Conclusions: Patient knowledge about about diabetes was poor on aspects such as curability of the disease, importance of diet and exercise and symptoms of hypoglycemia and hyperglycemia. HbA1c level , FBS, PPBS and lipid profiles and blood pressure values did not meet the giudeline recommendations irrespective of the clinic. Patient compliance was not satisfactory in both clinics.

φχϋ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

Wijesinghe UAD. Medagama A. Dissanayake NSB. (2012). "Diagnosis of Metabolic Syndrome in Type 2 Diabetic patients: comparison of Modified NCEPATP III and International Diabetes Federation (IDF) Criteria." The Ceylon Medical Journal 57(Supplement 1). Objective: To compare the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) and International Diabetes Federation (IDF) Criteria in determining the prevalence of Metabolic Syndrome (MS) in a subset of the Sri Lankan patients with newly diagnosed Type 2 Diabetes Mellitus (T2DM). Study method: 552 consecutive newly diagnosed patients with T2DM over the age of 18 years who were referred to the Diabetic Clinic at Teaching Hospital, Peradeniya from 1 January 2012 to 30 September 2011 were enrolled. MS was determined according to the modified NCEP ATP III and IDF criteria. Cohen’s kappa was used to measure agreement between these two criteria. Receiver operating characteristics. Curves of serum triglycerides, HDL, waist circumference, systolic blood pressure and diastolic blood pressure were created for the prediction of MS and area under the corresponding curves (AUC) were used to evaluate the predictive efficiency of each MS parameter. Study Area: Diabetic Clinic at Teaching Hospital, Peradeniya Study population: Newly diagnosed patients with T2DM over the age of 18 years Sample size 552 Sampling method: Convenient sampling method Risk Factors Investigated: Serum triglycerides, HDL, waist circumference, systolic blood pressure and diastolic blood pressure Results: The prevalence of MS was 66.3% with the modified NCEP ATP III and 62.9% with IDF criteria (p = 0.23). The agreement between these two criteria was excellent (kappa = 0.92). With both criteria females were more affected than males. Serum triglycerides had the highest predictive value with both modified NCEP ATP III (AUC’s: overall – 0.754, female – 0.801, males – 0.758) and IDF (AUC’s: overall – 0.823, females – 0.880, males – 0.821) criteria. Conclusions: The agreement between modified NCEP ATP III and IDF criteria for diagnosis of MS in diabetic patients is excellent. Both criteria showed high prevalence of Metabolic Syndrome in patients with newly diagnosed T2DM. Elevated serum triglyceride was the strongest single predictor of MS. Wijesooriya R. Widyaratne T. Wijesinghe R. Wijeweera G. (1998). "Knowledge of carcinoma of the cervix among women aged 20-50 living in the city of Colombo." Sri Lanka Journal of Obstetrics and Gynaecology 20: 21-24. Objective: To assess the knowledge of cervical carcinoma among females aged 20-50 years, living in the city of Colombo Study Method: A descriptive cross sectional study was conducted in the city of Colombo during December 1995. The study population consisted of 200 females between 20-50 years of age, who were assessed using an interviewer-administered questionnaire. Cluster sampling technique was used to select the sample as a sampling frame was not available. 50 women were selected from each of the 4 clusters selected randomly, from the 47 municipal wards in Colombo. Population range per cluster was between

φχό Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

10101-17209. Data was analyzed manually and basic statistical procedures applied where appropriate. Study area: Colombo Study population: Females between 20-50 years of age Type of study: Descriptive cross sectional study Study instrument: Interviewer-administered questionnaire Sampling method: Cluster sampling technique Sample size: 200 Factors investigated: Knowledge of the existence of the disease, the risk factors, it's preventability, and awareness regarding the cervical smear test. Results: Sociodemographic characteristics The mean age of the sample was 33.23 years and 40% of them were in the 20-29 years age group. 68% of the sample were married. 97% of them had undergone schooling, and 82% had an educational level of year 9 and above (Table 1). Housewives or unemployed women accounted for 49.5% of the sample while 14% were professionals. Knowledge on cervical carcinoma Of the total sample, 62.5% were aware of the existence of carcinoma of the cervix, compared to 91.5% who were aware of carcinoma of the breast. Out of those who were aware of carcinoma of the cervix 93.6% had learned of it through mass media, while only 19.2% heard it through the health services. Awareness of risk factors for cervical carcinoma Nearly 50% of them were aware of multiple sexual partners, smoking and sexually transmitted diseases as possible risk factors for carcinoma of the cervix. Only 31.2% identified early commencement of sexual intercourse as a risk factor, 37.6% thought that contraceptive methods can cause carcinoma of the cervix. Knowledge on cervical carcinoma Only 30% of the total sample knew carcinoma of the cervix is preventable. Knowledge on pap smear Only 66 (33%) out of the women of the total sample were aware about the pap smear (Table 6). Out of these 66 women, 31.8% (10.5% of the study group) knew that a smear was taken from the cervix, and 83.3% (27.4% of the study group) were aware of it as a diagnostic test. Factors affecting knowledge regarding existence of carcinoma of the cervix There is a statistically significant difference between the age groups 20-29 and 40-50 in the knowledge regarding carcinoma of the cervix (p < 0.001). Between each age group, there is a statistically significant difference regarding the existence of the cervical smear test (p < 0.05). There was a statistically significant difference in the knowledge on carcinoma of the cervix, according to educational level. Women who were educated to less than year 9, compared to those who were more educated showed a statistically significant difference in their knowledge regarding carcinoma of the cervix (p < 0.001) and regarding the cervical smear test (p < 0.05). Conclusion: Our study suggests that awareness regarding carcinoma of the cervix is low. Secondly, exploiting the potential of the mass media as an educational tool can increase acceptance of the cervical smear

φχύ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

test. The health educational system has been wanting. The overall awareness regarding the disease and its prevention by screening is poor. These can be overcome by specially designed programmes, which are directed particularly to less well educated, and young women. As in any screening programme, the success of the proposed national cervical smear test campaign will depend on raising awareness. Wijetunga WMUA. Wickramasinghe DSA. Wijesundara WRUAS. Wijelaskhman PUN. Atapattu P. (2012). Mental status of hypertensive patients attending medical clinic in the National Hospital of Sri Lanka. Annual Research Symposium 2012. Objective: To describe the mental status of hypertensive patients who attended the medical clinics of National Hospital of Sri Lanka (NHSL) and practices they adopt to improve it Study method: The study was conducted in the medical clinics of NHSL. One hundred and thirty two patients with hypertension between the ages of 40 to 60 years were randomly selected. Socio-demographic data of the patients were collected using an interviewer administered questionnaire. The Mental Health Score (MHS) was calculated using a validated data questionnaire which contained eleven questions about the patient’s current mental status. The patients were asked to describe various aspects of their mental status on a scale of 0-10 and the MHS was calculated out of the total score of 110. The data was analyzed to describe the above variables in relation to the MHS using SND and Chi square test. Study Area: Medical clinics at the National Hospital Sri Lanka Study population: Patients with hypertension between the ages of 40 to 60 years Study Instrument: An interviewer administered questionnaires Sample size: 132 Sampling method: Random sampling method Disease Investigated: Hypertension and mental status Results: The mean age of the population was 50.2 years and 54.5% were females. The mean MHS in the sample population was 62.79 (SD=16.04). Age ,level of education, alcohol and smoking had a significant association (p<0.05) with the MHS, while gender, marital status, religion, monthly family income, BMI , family history ,duration and the age of onset of hypertension and total number and the type of medication taken did not. Wikramanayake ER. Wikramanayake TW and Chandrasekera MS. (1994). "Body Mass Index of the Kandeganvila Veddas." The Ceylon Journal of Medical Science 37(1): 13-16. Objective: To study the BMI of the veddas before and after their change of habitat. Study method: The heights and weights of the Veddas at Kandeganvila measured in 1973/74 (12) have been used in calculating their BMI. The relocated Veddas (total population 750) live in 132 households in Hennanigala South. They have been measured during 14 field visits between October 1993 and March 1994, approximately 10 households being studied at each visit. The ages were those recorded at interview. The ages of the children were obtained from their mothers. In both the1971/73 and

φψτ Abstracts of Non Communicable Diseases and prevalence of risk factors in Sri Lanka, published from 1990 – 2012

1993/94 studies a Harpenden anthropometer and a standard weighing scale were used. In each study the measurements were taken by one observer throughout. Study Area: Hennanigala South Study population: The relocated Veddas in Hennanigala South. Sample size: 247 Sampling method: Random sampling method Risk Factors Investigated: Body mass index Results: The sample size in 1971/73 study totaled 37, with 18 males and 19 females. The sample size in the 1993/94 study totalled 247, with 109 males and 138 females. Table 1 gives the results of the adult Veddas separately for the males and females in the two studies, as percentages of the population with BMI values < 15, between 15.0 and 18.4 and >/=18.5. Table 2 gives the BMI of the pre-adolescents (ages 1-9.9 years) and adolescents (ages 10-18.9 years) separately for males and females, in the two studies, as percentages of population with BMI values < 13.5, between 13.5-14.9 and > 15.0. In the adults none of the males or females had BMI values less than 15 in 1971/73 whereas 6% of the males and 12% of the females are below this value in 1993/94. Only 46% of the males had BMI values less than 18.5 in 1971/73 whereas 71% are below this value in 1993/94. Among females, only 38% had BMI values less than 18.5 in 1971/73 whereas 59% has less than this value in 1993/94. Although these figures consistently point towards a greater degree of undernutrition in the adults in 1993/94, the differences between the two studies are not statistically significant. The percentage of male pre-adolescents with BMI values less than 13.5 is 20% in 1971/73 which is significantly lower (p < 0.05) than the 63% in 1993/94. Further the percentage of male pre-adolescents with BMI values between 13.5and 14.9 is 60% in 1971/73, which is significantly higher (p < 0.05) than the 27% within this range of BMI in 1993/94. The percentage of female pre-adolescents with BMI < 13.5 is 50% in 1971/73 which is not significantly lower than the 69% in 1993/94. However the percentage of female preadolescents in the BMI range 13.5-14.9 is 50% in 1971/73, which is significantly higher (p < 0.05) than the value of 20% in 1993/94. There are no male adolescents in the 1971/73 study for comparison. The percentage of female adolescents with a BMI values less than 15 is 40% in 1971/73 which is not significantly higher than the 32% in 1993/94. Thus, when the BMI is used as a criterion of dietary energy adequacy, the Veddas appear to have been better nourished at Kandeganvila than in their new habitat at Hennanigala.