A Comprehensive Assessment of Lymphatic Filariasis in Sri Lanka Six Years after Cessation of Mass Drug Administration

BackgroundThe Sri Lankan Anti-Filariasis Campaign conducted 5 rounds of mass drug administration (MDA) with diethycarbamazine plus albendazole between 2002 and 2006. We now report results of a comprehensive surveillance program that assessed the lymphatic filariasis (LF) situation in Sri Lanka 6 years after cessation of MDA.ConclusionsComprehensive surveillance is feasible for some national filariasis elimination programs. Low-level persistence of LF was present in all study sites; several sites failed to meet provisional endpoint criteria for LF elimination, and follow-up testing will be needed in these areas. TAS was not sensitive for detecting low-level persistence of filariasis in Sri Lanka. We recommend use of antibody and MX testing as tools to complement TAS for post-MDA surveillance.     

Detection of Oral Human Papillomavirus in HIV-Positive Men Who Have Sex with Men 3 Years after Baseline: A Follow Up Cross-Sectional Study

Background

Human papillomavirus (HPV) is a causative agent in oropharyngeal squamous cell carcinoma. The natural history of oral HPV in HIV-positive men who have sex with men (MSM) is unclear.

Methods

Detection of oral human papillomavirus in 173 HIV-positive MSM using oral rinse samples 3 years apart was investigated. HPV DNA was detected by polymerase chain reaction, and genotyped by Roche Linear Array.

Results

Of 173 men tested in 2010, 30 had at least one HPV genotype (17%, 95% CI: 12–23), 15 at least one hr-HPV (9%, 95% CI: 5–14) and 8 had HPV 16 (5%, 95% CI: 2–9) detected. In 2013, 33 had at least one HPV genotype (19%, 95% CI: 14–26), 20 had at least one hr-HPV (12%, 95% CI: 7–17) and 7 had HPV 16 (4%, 95% CI: 2–8) detected. Of 30 men at baseline (2010) with any HPV detected, 14 (47%, 95% CI: 28–66) had at least one persistent genotype. Of the 15 men in 2010 with high risk (hr-) HPV, 6 men (40%, 95% CI: 16–68) had at least one persistent hr-HPV genotype. The incidence rate of detection of at least one new HPV genotype was 4.8 per 100 person years (95% CI: 3.1–7.0), of at least one hr-HPV genotype was 3.2 per 100 person years (95% CI: 1.8–5.1) and of HPV 16 was 0.8 per 100 person years (95% CI: 0.2–2.0). The clearance rate was 14.9 per 100 person years (95% CI: 8.2–24.2) for any HPV, 18.2 per 100 person years (95% CI: 8.2–32.7) for hr-HPV and 17.4 per 100 person years (95% CI: 5.0–38.8) for HPV-16. Persistent HPV detection was associated with duration of HIV (OR 1.13 (per additional year), 95% CI: 1.00–1.26) and tonsillectomy (OR 8.17, 95% CI: 1.30–51.40).

Conclusion

The same oral HPV genotype was detected again after 3 years in nearly half of HIV-positive men who have sex with men.     

A One Health Framework for the Evaluation of Rabies Control Programmes: A Case Study from Colombo City,Sri Lanka

Background

One Health addresses complex challenges to promote the health of all species and the environment by integrating relevant sciences at systems level. Its application to zoonotic diseases is recommended, but few coherent frameworks exist that combine approaches from multiple disciplines. Rabies requires an interdisciplinary approach for effective and efficient management.

Methodology/Principal Findings

A framework is proposed to assess the value of rabies interventions holistically. The economic assessment compares additional monetary and non-monetary costs and benefits of an intervention taking into account epidemiological, animal welfare, societal impact and cost data. It is complemented by an ethical assessment. The framework is applied to Colombo City, Sri Lanka, where modified dog rabies intervention measures were implemented in 2007. The two options included for analysis were the control measures in place until 2006 (“baseline scenario”) and the new comprehensive intervention measures (“intervention”) for a four-year duration. Differences in control cost; monetary human health costs after exposure; Disability-Adjusted Life Years (DALYs) lost due to human rabies deaths and the psychological burden following a bite; negative impact on animal welfare; epidemiological indicators; social acceptance of dogs; and ethical considerations were estimated using a mixed method approach including primary and secondary data. Over the four years analysed, the intervention cost US $1.03 million more than the baseline scenario in 2011 prices (adjusted for inflation) and caused a reduction in dog rabies cases; 738 DALYs averted; an increase in acceptability among non-dog owners; a perception of positive changes in society including a decrease in the number of roaming dogs; and a net reduction in the impact on animal welfare from intermediate-high to low-intermediate.

Conclusions

The findings illustrate the multiple outcomes relevant to stakeholders and allow greater understanding of the value of the implemented rabies control measures, thereby providing a solid foundation for informed decision-making and sustainable control.     

Puerperal morbidity: A neglected area of maternal health in Sri Lanka

Abstract

Data on women with at least two children are used to examine how the breastfeeding experience with the first child affects whether subsequent children are breastfed. Our results indicate that women most often repeat with later children the feeding decision they made with their first child. That is, those who breastfed their first child are very likely to breastfeed a later child and those who did not breastfeed their firstborn are unlikely to breastfeed a later‐bom. Among those who did not breastfeed their first child, education beyond high school increases the likelihood that they will switch to breastfeeding with a later‐born. Those who breastfed their first child are less likely to breastfeed a later‐born if the first breastfeeding experience was of short duration or was perceived to be unsuccessful or unsatisfactory or if the woman had not gone beyond high school or received anesthesia at the later birth. Hence, educational differences are greater at higher parities than at first parity.     

Releasing Rain Forest Succession: A Case Study in the Dicranopteris linearis Fernlands of Sri Lanka

Throughout tropical moist climates, Dicranopteris linearis fernlands can develop as a result of rain forest clearance followed by frequent burning. In Sri Lanka, D. linearis fern-lands are capable of suppressing the regeneration of rain forest. Field experiments were conducted at Sinharaja Man and Biosphere Reserve, a rain forest where fernlands occupy substantial areas of the reserve boundary. The experiment's objective was to identify methods for initiating forest regeneration in fernlands dominated by D. linearis Three disturbance treatments were used to initiate seedling regeneration: clean weed, root removal, and till. We hypothesized that increasing the severity of the soil disturbance would establish vegetation with higher species richness and diversity, greater above-ground dry biomass, and higher percentage cover and seedling density. Results indicate only partial support for this hypothesis. Dry biomass was greatest in till treatments, the most severe soil disturbance. By comparison, species richness and diversity, seedling density, and percentage cover were greatest in root-removal treatments, though in many instances the differences were not significant. The study clearly demonstrated that any kind of soil disturbance can facilitate the establishment of herbs, shrubs, and trees in a fernland dominated by D. linearis. Results showed that herbs, sedges, grasses, and pioneer shrubs represented greater proportions of seedling recruits than did pioneer trees. Seedlings of primary-forest tree species were nearly nonexistent. In general, results showed that soil disturbance can play an important role in site preparation for the purpose of initiating non-fern vegetation in fernlands dominated by D. linearis.     

Psychedelics and Mental Health: A Population Study

Background

The classical serotonergic psychedelics LSD, psilocybin, mescaline are not known to cause brain damage and are regarded as non-addictive. Clinical studies do not suggest that psychedelics cause long-term mental health problems. Psychedelics have been used in the Americas for thousands of years. Over 30 million people currently living in the US have used LSD, psilocybin, or mescaline.

Objective

To evaluate the association between the lifetime use of psychedelics and current mental health in the adult population.

Method

Data drawn from years 2001 to 2004 of the National Survey on Drug Use and Health consisted of 130,152 respondents, randomly selected to be representative of the adult population in the United States. Standardized screening measures for past year mental health included serious psychological distress (K6 scale), mental health treatment (inpatient, outpatient, medication, needed but did not receive), symptoms of eight psychiatric disorders (panic disorder, major depressive episode, mania, social phobia, general anxiety disorder, agoraphobia, posttraumatic stress disorder, and non-affective psychosis), and seven specific symptoms of non-affective psychosis. We calculated weighted odds ratios by multivariate logistic regression controlling for a range of sociodemographic variables, use of illicit drugs, risk taking behavior, and exposure to traumatic events.

Results

21,967 respondents (13.4% weighted) reported lifetime psychedelic use. There were no significant associations between lifetime use of any psychedelics, lifetime use of specific psychedelics (LSD, psilocybin, mescaline, peyote), or past year use of LSD and increased rate of any of the mental health outcomes. Rather, in several cases psychedelic use was associated with lower rate of mental health problems.

Conclusion

We did not find use of psychedelics to be an independent risk factor for mental health problems.     

Trauma and Poor Mental Health in Relation to Economic Status: The Case of Cambodia 35 Years Later

Background

Cambodia is one of the poorest countries in south-east Asia and is still emerging from the events of the Khmer Rouge reign. It has been suggested that the atrocities experienced by the Cambodian population can explain why Cambodia continues to lag behind its neighbours in economic outcomes. The purpose of this study is to investigate whether there is an association between exposure to past trauma and/or current poor mental health and current economic status in Cambodia.

Method

A newly conducted survey performed in two regions (north-west and south-east Cambodia) collected information on trauma exposure, psychiatric symptoms, self-rated health outcomes and socio-economic information for 3200 persons aged 18–60. Economic outcomes were measured as household debt and poverty status and whether the respondent was economically inactive. All models were analysed using logistic regression.

Results

No association was found between high exposure to conflict-related or civilian trauma and any economic outcomes save for a negative association between civilian trauma and poverty in the south-east. Current post-traumatic stress was related solely to poverty status. All other measures of current mental health status, however, were found to be strongly negatively associated with all measures of economic status. Thus, mental health interventions could potentially be utilised in poverty reduction strategies, but greater efficacy is likely to be achieved by targeting current mental health status rather than previous trauma exposure.     

Cutaneous Manifestations of Spotted Fever Rickettsial Infections in the Central Province of Sri Lanka: A Descriptive Study

Background

Characteristic skin lesions play a key role in clinical diagnosis of spotted fever group rickettsioses and this study describes these cutaneous manifestations along with basic histological features.

Methods and Findings

Study was conducted at Medical Unit, Teaching Hospital, Peradeniya, from November 2009 to October 2011, where a prospective data base of all rickettsial infections is maintained. Confirmation of diagnosis was made when IgM and IgG immunofluorescent antibody titre of 1/32 and >1/256 respectively. Of the 210 clinical cases, 134 had cutoff antibody titers for Rickettsia conorii antigen for confirmation. All these 134 patients had fever and skin rash, and of them 132(98%) had discrete maculopapular rash while eight (6%) had fern leaf type skin necrosis. Eight patients (6%) had healed tick bite marks. Average size of a skin lesion was 5 mm and rash involved 52% of body surface, distributed mainly in limbs and back of the chest. Generally the facial and leg skin was slightly oedematous particularly in old aged patients. Sixteen patients (12%) had pain and swelling of ankle joints where swelling extended to feet and leg. Biopsies from skin rash of six patients showed evidence of cutaneous vasculitis and of them, 247 bp region of the 17-kDa spotted fever group specific protein antigen was amplified using PCR.

Conclusions

A discrete maculopapular rash and occasional variations such as fern leaf shape necrosis and arthritis are found in spotted fever group. Histology found vasculitis as the pathology of these lesions.     

Movement among healers in Sri Lanka: A case study of a sinhalese patient

Sinhalese patients in Sri Lanka have a variety of practitioners to choose from in seeking treatment for illness. These include: Ayurvedic physicians, Western physicians, and ritual practitioners. This paper traces the movement of a single patient seeking treatment for pissu (madness) from a number of healers. It is suggested that this movement of the patient among a variety of treatment systems allows a fluidity of diagnosis which prevents any one explanatory system from dominating her perception of her illness. It is also argued that treatments are linked by an underlying continuity of process, in which the personal antecedents of the illness are reinterpreted in terms of public representations of affliction and in which all treatments phrase illness most basically in terms of excess and imbalance.This paper was originally represented to an Anthropology Department colloquium at the University of Massachusetts, Boston, in the fall of 1977. I would like to thank the following people for reading and commenting on an earlier version of the paper: H. L. Seneviratne, Brenda Beck, David Landy, Nancy Waxler, Arthur Kleinman, Charles Ducey, Daniel Brown, John McCreery, and Allan Meyers.     

A new genus and species of Urodidae (Lepidoptera: Urodoidea) from Sri Lanka

A new genus of Urodidae, Geoesthia gen. nov., is described with the type species, Geoesthia ceylonica sp. nov. from Sri Lanka. This is the second urodid genus from the Oriental Region. The new species is the only urodid recorded from Sri Lanka. The new genus is distinguished from all the known genera within Urodidae by a combination of four characteristics: the lack of scale tufts on the labial palpi; the absence of raised scales of two subbasal spots on the forewings; the presence of M-stem on the hindwings; and the female corpus bursae bearing five signa. Key to the genera and species of Urodidae from the Oriental Region is provided.     

Soil-transmitted helminth infections among plantation sector schoolchildren in Sri Lanka: prevalence after ten years of preventive chemotherapy

Background

The plantation sector in Sri Lanka lags behind the rest of the country in terms of living conditions and health. In 1992, a sector-wide survey of children aged 3–12 years and women of reproductive age showed >90% prevalence of soil-transmitted helminth infections. Biannual mass de-worming targeting children aged 3–18 years started in 1994 and was continued until 2005. The present study was carried out to assess the status of infection four years after cessation of mass de-worming.

Methods/Findings

A school-based cross-sectional survey was carried out. Faecal samples from approximately 20 children from each of 114 schools in five districts were examined using the modified Kato-Katz technique. Data regarding the school, the child''s family and household sanitation were recorded after inspection of schools and households. Multivariate analysis was carried out using logistic regression, to identify risk factors for infection. Faecal samples were obtained from 1890 children. In 4/5 districts, >20% were infected with one or more helminth species. Overall combined prevalence was 29.0%; 11.6% had infections of moderate-heavy intensity. The commonest infection was Ascaris lumbricoides, present in all five districts, as was Trichuris trichiura. Hookworm was not detected in two districts. Multivariate analysis identified low altitude and maternal under-education as risk factors for all three infections. Poor household sanitation was identified as a risk factor for A. lumbricoides and hookworm, but not T. trichiura infections.

Conclusions/Significance

The results indicate that regular mass de-worming of plantation sector children should be resumed along with more emphasis on better sanitation and health education. They show that even after 10 years of mass chemotherapy, prevalence can bounce back after cessation of preventive chemotherapy, if the initial force of transmission is strong and other long-term control measures are not concomitantly implemented.     

A Study of Changes Occurring in Plasmodium lophurae after Three Years of Continuous Existence in Mice

SUMMARY. The characteristics of Plasmodium lophurae infections in mice have been studied for a period of 3 years. The average height of parasitemias increased steadily for several months then leveled off with but minor changes for the remainder of the time. Gametocytes were found during the ninth month after the passages were begun. Comparison of the strain after 3 years in mice with the same species of parasite maintained constantly in chick embryos indicated that the sojourn in the mouse had temporarily disturbed the mean numbers of merozoites produced.     

某部入伍新兵心理卫生服务状况及需求调查

目的：调查入伍新兵心理卫生服务状况及对心理卫生服务的需求。方法：采用质性研究和量性研究相结合的方法,对42名入伍新兵作半结构性访谈,编制《部队心理卫生服务状况和需求》调查表,采用调查表对1609名新兵进行调查。结果：9．4％的新兵心理健康知识比较了解;接近半数新兵（43．5％）对心理健康知识很感兴趣;新兵获取心理知识的途径依次为网络、心理知识讲座、报刊杂志、广播电视、面对面咨询;新兵最期望获得的心理知识依次为如何调节自己的情绪、如何建立良好的人际关系、如何塑造自己的个性和常见的心理障碍表现;新兵认为最有帮助的心理服务形式依次为一对一心理咨询、心理知识讲座、心理测验和团体心理活动;只有7．7％的新兵接受过心理卫生服务。结论：新兵对心理健康知识感兴趣,但认知度和利用度均较低,应通过网络、心理知识讲座等方式普及新兵需要的心理健康知识。     

Determinants and Causes of Neonatal Mortality in Jimma Zone,Southwest Ethiopia: A Multilevel Analysis of Prospective Follow Up Study

Background

Ethiopia is among the countries with the highest neonatal mortality with the rate of 37 deaths per 1000 live births. In spite of many efforts by the government and other partners, non-significant decline has been achieved in the last 15 years. Thus, identifying the determinants and causes are very crucial for policy and program improvement. However, studies are scarce in the country in general and in Jimma zone in particular.

Objective

To identify the determinants and causes of neonatal mortality in Jimma Zone, Southwest Ethiopia.

Methods

A prospective follow-up study was conducted among 3463 neonates from September 2012 to December 2013. The data were collected by interviewer-administered structured questionnaire and analyzed by SPSS V.20.0 and STATA 13. Verbal autopsies were conducted to identify causes of neonatal death. Mixed-effects multilevel logistic regression model was used to identify determinants of neonatal mortality.

Results

The status of neonatal mortality rate was 35.5 (95%CI: 28.3, 42.6) per 1000 live births. Though significant variation existed between clusters in relation to neonatal mortality, cluster-level variables were found to have non-significant effect on neonatal mortality. Individual-level variables such as birth order, frequency of antenatal care use, delivery place, gestation age at birth, premature rupture of membrane, complication during labor, twin births, size of neonate at birth and neonatal care practice were identified as determinants of neonatal mortality. Birth asphyxia (47.5%), neonatal infections (34.3%) and prematurity (11.1%) were the three leading causes of neonatal mortality accounting for 93%.

Conclusions

This study revealed high status of neonatal mortality in the study area. Higher-level variables had less importance in determining neonatal mortality. Individual level variables related to care during pregnancy, intra-partum complications and care, neonatal conditions and the immediate neonatal care practices were identified as determinant factors. Improving antenatal care, intra-partum care and immediate neonatal care are recommended.     

Symbolic Heat: Gender, Health and Worship among the Tamils of South India and Sri Lanka.; Relocated Lives: Displacement and Resettlement in the Mahaweli Project, Sri Lanka.; Amiable Incoherence: Manipulating Histories and Modernities in a Batticaloa Hindu Temple.

Healing Dramas and Clinical Plots: The Narrative Structure of Experience. Cheryl Mattingly. New York: Cambridge University Press, 1998. 192 pp.