In this cross-sectional descriptive study conducted in the Ratnapura district, Sri Lanka, we assessed the affordability of oral pediatric anti-infective medicines (OPAIMs). Using a modified WHO/HAI medicinal price methodology, we examined the availability, median price ratios (MPRs), mean percentage difference, and affordability of the standard treatment of the originator brand (OB) and lowest-priced generic (LPG) OPAIMs in 30 private and 2 state-owned pharmacies. The study revealed disparities in availability, with only 50% of private pharmacies offering all 11 medicinal drugs in their generic form. The MPRs of OPAIMs for OB and LPG varied, with three drugs exceeding the financially acceptable MPR of 2 (albendazole, amoxicillin, and erythromycin). The standard treatment with LPGs costs between 0.17 and 0.85 and between 0.06 and 0.28 days’ wages for the lowest daily salary of the private sector and unskilled public employees, respectively. We identified erythromycin and albendazole as having less than 50% availability in their generic form in private pharmacies. To address these findings, we recommend frequent pricing revisions based on exchange rates and associated costs, coupled with the establishment of a transparent scientific criterion to subsidize essential medicines deemed “unaffordable.” Failure to implement such measures amidst economic crises may adversely impact financial access to essential medications.

The objective ofthis paper is to investigate the impact ofthe COVID-19 pandemic and subsequent economic recession on the three demographic components, namely mortality, fertility and migration in Sri Lanka and possible implications. A secondary data analysis of mortality, fertility, migration, and marriage data from the Registrar General's Department of Sri Lanka and the Ministry of Health was conducted. Although excess mortality (COVID-19 deaths) in 2022 was substantially lower, it was elevated in 2021. In comparison to non-COVID-19 years, the number of deaths has increased substantially during the post-COVID-19 era - 146 thousand deaths in 2019 increased to 194 thousand in 2023 (30.1%). This marked increase could be attributed to the economic recession and related serious constraints faced by the health system in Sri Lanka. Further, a marked decrease in marriages (14.2%) was observed in 2020 due to COVID-19 which recovered to pre-COVID-19 level in 2021. However, instead of experiencing the "baby- boom" phenomenon (as observed in some previous pandemics) in the aftermath of the COVID-19 pandemic, the observed data for Sri Lanka indicates a significant downward trend in fertility. Unexpectedly, 319 thousand births were reported in 2019 in Sri Lanka dropping to 257 thousand by 2023, which is a decline of over 62 thousand births (19%). This situation is further complicated by the highest reported outbound migration ever reported in Sri Lanka in 2022, displaying a 250% year-toyear increase. The changes in these demographic components would impact the macroeconomics and the future size of the Sri Lankan population.

Abstract Introduction Reconstitution of oral pediatric antibiotic suspension by primary caregivers plays an essential role in determining the overall health outcome of the child. Incorrect reconstitution techniques could lead to underdosing, overdosing, or introduction of infection. Underdosing could lead to non-resolving infection and antimicrobial resistance. Objectives To assess the practice and associated factors on reconstitution of oral pediatric antibiotic suspensions (OPAS) among primary caregivers of 3–5-year-old children in a selected district in Sri Lanka. Methods A cross-sectional study was carried out among 835 primary caregivers selected using two-stage cluster sampling at field clinics to assess practices for the reconstitution of OPAS. A live demonstration of the reconstitution of the OPAS was assessed by a checklist. Associated factors with caregiver practices on reconstitution were assessed using Chi-square with the statistical significance level set at 0.05. Results A total of 820 respondents were recruited and completed the study (response rate = 98.2%). Overall, 56.0% displayed good performance in the demonstration of reconstitution of oral pediatric antibiotic suspension. Poorest performances were observed in shaking the bottle to loosen the powder (Correct: 53.7%), topping up the bottle with water up to the marked line (Correct: 58.0%), and filling the water below the marked line in the bottle (Correct: 59.0%). Caregivers in urban areas compared to rural and estate regions (45.6% vs. 22.7% and 26.5% respectively) and caregivers aged 35 years or above compared to less than 35 years age group (31.5% vs. 22.5%) performed the reconstitution of OPAS poorly. Parental factors, namely age, gender, level of education, and geographical region (urban/rural/estate) were significantly associated with the performance in reconstituting the oral paediatric antibiotic suspension (p = 0.002, p < 0.001, p < 0.001, and p < 0.001 respectively). Factors related to the child, specifically whether they attend preschool and whether they have an older sibling, were found to have a significant association with the correct execution of the reconstitution of OPAS (p = 0.017, and p = 0.030 respectively). Conclusions and recommendations A significant number of primary caregivers displayed poor practice in key steps during the reconstitution of OPAS, which could have a negative impact on the health of the child. Targeted place-based behavioural change health programs with the use of infographic leaflets/ posters may correct the practices of caregivers.

Introduction: Sexual and reproductive health (SRH) education is crucial to prevent unwanted pregnancies and sexually transmitted infections (STIs) among young people. However, in Sri Lanka, little is known about the level of access to SRH education and knowledge among unmarried youth. This study aimed to assess perceptions of SRH education at school and the level of knowledge on selected aspects of SRH among unmarried youth aged 15–24 years in Sri Lanka. Methods: A cross-sectional study was conducted among 1057 unmarried male and female youth aged 15–24 years in three selected districts of Sri Lanka. A semi-structured, self-administered questionnaire was operationalized after receiving informed consent. Twelve focus group discussions were also conducted with the youth. Results: A sizable proportion of youth demonstrated low access to SRH education and a low level of knowledge on pregnancy, contraception, and STIs. Although it is limited, respondents felt that the SRH education received in school is useful for their life. Friends and the Internet were identified as the primary sources of information among boys, whereas the mother was the primary source for the majority of girls. Boys demonstrated better SRH knowledge compared to girls for most of the aspects. SRH knowledge was increased among both boys and girls significantly with maturity. Conclusion: Results conclude that there is a significant knowledge gap on SRH among unmarried youth. Introduction of age-specific and gender-sensitive SRH education is important to address the current gap in SRH knowledge.

The Sri Lankan law only permits induced or iatrogenic abortion to save the life of the mother. Despite the restricted law, law enforcement mechanisms, and reported high national contraceptive prevalence rate, a significant proportion of pregnant women terminate their pregnancy outside the law. Despite the existence of restrictions and inertia, numerous stakeholders concerned about women’s health have made several attempts to liberalize the abortion law in Sri Lanka. Although several amendments were proposed to rationalize the abortion law in Sri Lanka, nothing has been successful – we are back to square one. Expansion of legal exceptions for induced abortions and improved safe abortion with the revolutionized medical abortion (MA) were observed in numerous countries globally during the past decade. On the other hand, some countries with broadly liberal laws, including the United States, have added restrictions. How these global changes have affected countries like Sri Lanka is worth studying. This article assesses the response of the Sri Lankan government and the society towards those global changes in terms of the policies and practices on induced abortion. Authors argue that the paradigm shift in abortion practices in Sri Lanka, driven by the emerging occurrence of medical abortion, has highlighted the disparity between the existing legal status and the aspirations of most Sri Lankans. Given the widespread support for legalizing abortion in cases of rape, incest, and fetal abnormalities, it is imperative the government seriously consider legal amendments.

ABSTRACTObjectivesThis study aims to describe the population level data on neonatal and maternal outcomes of COVID-19 positive pregnant women of Sri Lanka by secondary analysis using National COVID-19 Positive Pregnant Women Surveillance.DesignSecondary analysis of surveillance data from the National COVID-19 positive pregnant women surveillance, Sri Lanka. Data of all pregnant women whose maternal and neonatal outcomes were reported in National Surveillance from 1st March 2020 to 31st October 2021 were included in the study. Associated factors for maternal and neonatal outcomes, namely POA at delivery, mode of delivery, birthweight, immediate place of newborn care, congenital abnormalities, and condition of neonate at completion of one month were calculated using univariate and multivariate Odds ratios.ResultsMaternal COVID-19 infection reported preterm birth rate of 11.9%, LSCS rate of 54.5%, low birthweight rate16.5% and 8.3% of the newborns requiring intensive care. Neonatal mortality rate was 9 per 1000 live births. Pre-pregnancy overweight and obesity increased the risk of preterm delivery compared to pregnant women with normal BMI by 46.7% (AOR=1.467, CI=1.111-1.938, P=0.007). In contrast, the risk of preterm delivery reduced by 82.4% (AOR=0.176, CI=0.097-0.317, p<0.001) and presence of any type of congenital abnormalities in newborns by 72.4% among the COVID-19 positive women who required only inward treatment in comparison to women with severe COVID-19 infection requiring intensive care (AOR=0.276, CI=0.112-0.683, p=0.005).ConclusionIncreased severity of maternal COVID-19 infection and pre-pregnancy overweight/ obesity were associated with many adverse pregnancy and neonatal outcomes. Therefore, close observation and aggressive management of COVID-19 among the pregnant women should be considered to reduce the risk of progressing to severe illness.

Emotional support and services provided by Public Health Midwives (PHMs) play a crucial role in identification and management of maternal mental health disorders as they are the first line contact in maternal and child-care and the focal field health members in caring for the antepartum and postpartum mothers. Aim of this study was to describe the Sri Lankan PHMs’ knowledge on maternal mental health disorders. Cross-sectional descriptive study was conducted using probability proportionate sampling, covering PHMs of all districts in Sri Lanka. Total of 434 PHMs were recruited with 99.1% response rate. A content-validated pre-tested questionnaire was administered. Univariate and multivariate analysis was used to assess the knowledge of each component with selected study variables. Respondents’ mean age was 40.6 years. Out of the 430 PHMs, 36% of them were unaware, that symptoms of Depression and anxiety could be commonly seen during antenatal and postpartum period. It was found that only 21.8% of the respondents knew the average number of maternal deaths due to suicides in Sri Lanka. Forty seven percentage of the respondents did not know, that providing understanding, empathy and support was the most appropriate step in managing mothers with Postpartum Blues. This study findings highlight major deficiencies in basic knowledge of PHMs in identifying and initial management of common maternal mental health disorders. Therefore, focus on continuous professional development of PHMs should be prioritized.

Aims: Adolescents and youth belong to high-risk groups for sexual and reproductive issues. The aim of this investigation is to critically evaluate whether the sexual and productive health issues are addressed in adolescent and youth policies and strategies in Sri Lanka. Study Design: Two distinct methods were used. Desk review to assess the coverage of sexual and reproductive health (SRH) issues addressed in adolescent and youth policies and strategies in Sri Lanka was followed by 3 focus group discussions (FGDs) with youths and 8 key informant interviews (KII) on SRH policy issues related to sexual and reproductive health of youth. Place and Duration of Study: Both methods were conducted between June 2021 to December 2021. Youth were selected from District of Colombo for FGDs. KIIs were conducted with youth SRH experts in government, private, universities and non-governmental organizations. Methodology: Triangulation of data from FGDs, KIIs and desk review was conducted. Thematic content and narrative methods were used for analysis of data. Results: Adequacy of SRH coverage, issues and challenges was summarized using key six domains of SRH as mentioned by World Health Organization, namely overall focus on SRH, comprehensive SRH education, contraception counselling & provision, safe abortion care, sexually transmitted infections (STIs) and HIV prevention care, and violence against women and girls- prevention, support and care. All key stakeholders in education and health sector unanimously agreed that comprehensive sexual education should be implemented in the country. However, there is general disagreement on the grade (or age) of inclusion of contraception of CSE; Level of skills and competencies of the teachers assigned to teach SRH and; Learning aids for students on SRH. The only policy/ strategic plan which covers the SRH aspects of youth adequately was the National Strategic Plan- Adolescent and Youth Health (2018-2025) by the Family Health Bureau. Similarly, lack of priority for SRH aspects of youth was evident in youth policies and strategic plans formulated by non-health governmental organizations. Conclusion: Overall findings highlight the non-priority for SRH aspects in youth policies and strategic plans in Sri Lanka. Coordinated effort of all key stakeholders is needed to improve the SRH representation in youth policies and strategies in Sri Lanka.

Telehealth is the delivery of health-related services and information using electronic information and communication technologies. Telehealth enables the health service providers to connect with a remote patient to provide care, advice, reminders, education, intervention, monitoring and facilitates remote admissions. Due to COVID-19 related travel restrictions, disruptions in access to healthcare were observed in Sri Lanka. Therefore, a telehealth solution to connect patients where specialist medical doctors were inaccessible or unavailable, was planned and implemented in the North Central province of Sri Lanka in 2020. The objective of this case study is to describe the experience during the planning and implementation of the telehealth intervention. Issues faced during planning and implementation were securing adequate funds, limited knowledge of information technology among the health staff, the reluctance of patients to explain and show the signs through video consultation, and difficulties faced during the allocation of responsibility at each step of the telehealth services and provision of network facilities to peripheral hospitals. These issues were overcome by creating awareness among the key stakeholders on telehealth and its advantages, addressing concerns of the patients and conducting awareness campaigns on telehealth, streamlining the maintenance of equipment and most importantly, addressing concerns of the administrators, including health officials, and obtaining their consensus for the implementation of telehealth services. If these key issues can be forecasted and addressed timely, telehealth services could be successfully implemented in a resource-limited country like Sri Lanka.

Aims: Main objective of this study was to describe the diagnosis, treatment, outcomes, and associated factors of presumed ocular tuberculosis patients attending Central Chest Clinic, Colombo. Study Design, Place and Duration: A cross sectional descriptive study was conducted among all ocular tuberculosis patients referred to Central Chest Clinic, Colombo for treatment from 1st of January 2016 to 31st June 2018. Methodology: Pretested content validated secondary data extraction form was used. Socio-demographic and work-related characteristics were analysed using frequency distributions. Association between socio-demographic characteristics and factors associated with diagnosis, treatment and outcomes were analysed using Fisher-extract test. Results: Among study respondents, 52.6% showed abnormal ESR finding (>20mm), 17.8% displayed Chest X-ray abnormalities and 89.5% reported positive Tuberculin skin test (>14mm in diameter). Uveitis was the most common diagnosis (87.9%). Among Uveitis patients, 36.5% presented with posterior uveitis. Out of all ocular TB patients who have completed the treatment, 77.6% reported improvement of vision following the anti-TB treatment regimen. Duration of the treatment with anti-TB drugs was similar across all types of ocular diseases among Ocular TB patients (p=0.590). Conclusions: Large number of patients received treatment for 6 months with majority reported as improved vision on completion of treatment. Further prospective studies using primary data need to be conducted to have greater insight of the ocular tuberculosis in Sri Lanka.

The aim of the study is to assess objectively patterns of romantic relationships and dating among the youth in Sri Lanka. Using a structured, pre-tested, self-administered questionnaire, a field survey was conducted in a sample of 1,100 unmarried 15-24-year old youth in Puttalam, Nuwara Eliya, and Hambantota districts in the latter part of 2019, selected from various vocational and training centres, tuition classes, and NGOs. Of the 1,100 persons contacted, 1,057 completed the questionnaire. In the sample, 89% admitted having had one or more romantic relationships. Some 19% and 10% of males and females respectively reported having three or more such relationships. The proportion of males and females who had been romantically engaged at the time of the survey was 83% and 86% respectively. The continuation of romantic relationships was higher among females compared to their male counterparts with around 62% of the females continuing their present relationships for more than 2 years as compared romantic relationships at the time of the survey, went out with on young people, so parents, educational authorities, and objective reality.

Aims: Limited information is available on private sector contribution for maternal care in Sri Lanka. The main objective of this assessment is to describe the maternal and newborn characteristics of deliveries in private sector in Colombo District, Sri Lanka. Secondly, the assessment of the factors associated with key newborn care practices using the National Maternal and Newborn Health Management Information System of Private Health Institutions (NMNMIS-PHI)-Phase 1 was conducted. Study design: Secondary descriptive analysis was performed using data reported in the NMNMIS-PHI-Phase 1, Sri Lanka. Place and Duration of Study: All deliveries in private health institutions in Colombo District which were reported in the NMNMIS-PHI-Phase 1 was included in the study. The time period was from 1st January 2021 to 31st December 2021. Methodology: Maternal, delivery and newborn characteristics of national vs. private sector in Colombo District were compared using Z test. Associated factors for key newborn care practices was calculated using univariate and multivariate Odds ratios. Results: Incidence of Gestational DM was higher among pregnant women delivered at private sector, Colombo compared to national rate (17.9% vs. 7.1%, p<0.001). Further, the reported caesarean section rate in private sector was close to twofold that of the national rate (76.5% vs. 41.9%, p<0.001). Stillbirth rate of private sector in Colombo was comparatively low than the national rate (0.2% vs. 0.7%). Similarly, reduced number of low-birth-weight newborns was reported in private sector in comparison to national figure (12.4% vs. 13.9%). Significantly more newborns of primi-pregnant women received skin-to-skin contact (SSC) immediately after birth compared to newborns of multi-parous women (AOR=0.814, CI=0.735-0.900, p<0.001). Conclusion: Maternal and neonatal characteristics of pregnant women delivered in private sector in Colombo was significantly different from the national profile of pregnant women. Promotion of immediate SSC and reduction in unnecessary caesarean sections should be considered in private sector deliveries in Sri Lanka to further enhance the positive maternal and newborn outcomes.

Background Youth are at high risk for casual and unprotected sexual activities even before marriage. The objective of the study is to describe the sexual behavior, and contraceptive use among unmarried youth of Sri Lanka and to assess the factors associated with sexual behaviour. Methods An observational descriptive cross-sectional study was conducted in three selected districts in Sri Lanka from 1st March 2019 to 31st January 2020 among 1057 never-married youth using a self-administered questionnaire. Both stratified cluster sampling and snowball sampling were used to select the eligible never-married youth. Factors associated with sexual intercourse were assessed using logistic regression. Results Compared to boys (26%), more girls (35%) were engaged in unprotected sexual intercourse. Among sexually active unmarried youth aged less than 20 years, 10% had sexual intercourse with an unknown person. Unmarried Tamil and estate sector youth displayed significantly lower chances of sexual intercourse compared to Sinhala and urban counterparts (OR = 0.390, CI = 0.213-0.715, p = 0.002 and OR = 0.807, CI = 0.709-0.978, p = 0.020 respectively). Youth in the rural (69.5%) and urban sectors (87.3%) tend to use contraceptives during intercourse compared to the youth in the Estate sector (51.1%). Conclusions A significant portion of youth are exposed to sexual risk behavior including unprotected sexual intercourse even before marriage which can contribute to many social and health consequences. Focus interventions are needed to address the issue.

Some of us, coping with severe dengue (SD) on a daily basis, have questions concerning the report, “Dengue Management in Triage using Ultrasound in children from Cambodia: a prospective cohort study.”1Gleeson T Pagnarith Y Habsreng E et al.Dengue management in triage using ultrasound in children from Cambodia: a prospective cohort study.Lancet Reg Health Western Pac. 2022; 19100371PubMed Google Scholar During 2018–19, at the Siem Reap hospital out-patient department, the authors identified 252 children with acute dengue who were given thoracic and abdominal ultrasound examinations by trained sonographers. Ultrasound results were withheld from physicians who subsequently admitted 37 and discharged 215 patients. Of children initially admitted to hospital, (62.2%) had ultrasound abnormalities compared with 2.0% (42 of 215) in children sent home. During the next 7 days, 42 discharged patients revisited the clinic or were admitted to hospital with dengue. On initial visit, 12 of 42 (30%) had a thickened gallbladder wall (> 3.0 mm) compared with 17% (30/173) of those with no revisit (P < 0.01). The authors concluded that point-of-care ultrasound findings, particularly gallbladder wall thickening, in children with early dengue can help predict disease progression in ambulatory patients. Do they?Ultrasound is in long use searching for evidence of dengue vascular leakage. However, a recent review of 12 studies found only one provided a well-balanced accuracy of ultrasound detection of SD.2Low GK Looi SY Yong MH Sharma D. Predictive and diagnostic test accuracy of ultrasonography in differentiating severe dengue from nonsevere dengue.J Vector Borne Dis. 2018; 55: 79-88Crossref PubMed Scopus (5) Google Scholar,3Setiawan MW Samsi TK Wulur H Sugianto D Pool TN. Dengue haemorrhagic fever: ultrasound as an aid to predict the severity of the disease.Pediatr Radiol. 1998; 28: 1-4Crossref PubMed Scopus (65) Google Scholar The positive predictive value of ultrasound detection of SD corresponded to that of WHO 2009 warning signs with a <25% predictive value. Also, SD is notoriously affected by epidemiological variables. A review of 177 dengue studies observed that positive findings were usually obtained on hospitalized patients with an already established clinical diagnosis.4Dewan N Zuluaga D Osorio L Krienke ME Bakker C Kirsch J. Ultrasound in dengue: a scoping review.Am J Trop Med Hyg. 2021; 104: 826-835PubMed Google Scholar They noted the clinically relevant pathology in dengue is not pulmonary edema but vascular permeability detected as serous effusions, gall bladder wall thickening and/or a thin rim of pericystic fluid. Ultrasound could have early prognostic value in dengue. But, its utility is challenged by limited data describing how findings have influenced management decisions. Less than one-third of published studies described patient outcomes. Studies also failed to characterize ultrasound as an independent predictor of morbidity or mortality. No standard protocol for ultrasound examination of dengue cases has been proposed. In our practice in Sri Lanka an ultrasound examination of pleural and peritoneal spaces is routine in haemodynamically unstable patients with positive dengue NS1 and those with falling platelet counts or with counts below 100 × 109/liter. An international effort is needed to determine the usefulness of ultrasound in different settings by evaluating standardized ultrasound examinations in the context of the patient's pathophysiological status. Some of us, coping with severe dengue (SD) on a daily basis, have questions concerning the report, “Dengue Management in Triage using Ultrasound in children from Cambodia: a prospective cohort study.”1Gleeson T Pagnarith Y Habsreng E et al.Dengue management in triage using ultrasound in children from Cambodia: a prospective cohort study.Lancet Reg Health Western Pac. 2022; 19100371PubMed Google Scholar During 2018–19, at the Siem Reap hospital out-patient department, the authors identified 252 children with acute dengue who were given thoracic and abdominal ultrasound examinations by trained sonographers. Ultrasound results were withheld from physicians who subsequently admitted 37 and discharged 215 patients. Of children initially admitted to hospital, (62.2%) had ultrasound abnormalities compared with 2.0% (42 of 215) in children sent home. During the next 7 days, 42 discharged patients revisited the clinic or were admitted to hospital with dengue. On initial visit, 12 of 42 (30%) had a thickened gallbladder wall (> 3.0 mm) compared with 17% (30/173) of those with no revisit (P < 0.01). The authors concluded that point-of-care ultrasound findings, particularly gallbladder wall thickening, in children with early dengue can help predict disease progression in ambulatory patients. Do they? Ultrasound is in long use searching for evidence of dengue vascular leakage. However, a recent review of 12 studies found only one provided a well-balanced accuracy of ultrasound detection of SD.2Low GK Looi SY Yong MH Sharma D. Predictive and diagnostic test accuracy of ultrasonography in differentiating severe dengue from nonsevere dengue.J Vector Borne Dis. 2018; 55: 79-88Crossref PubMed Scopus (5) Google Scholar,3Setiawan MW Samsi TK Wulur H Sugianto D Pool TN. Dengue haemorrhagic fever: ultrasound as an aid to predict the severity of the disease.Pediatr Radiol. 1998; 28: 1-4Crossref PubMed Scopus (65) Google Scholar The positive predictive value of ultrasound detection of SD corresponded to that of WHO 2009 warning signs with a <25% predictive value. Also, SD is notoriously affected by epidemiological variables. A review of 177 dengue studies observed that positive findings were usually obtained on hospitalized patients with an already established clinical diagnosis.4Dewan N Zuluaga D Osorio L Krienke ME Bakker C Kirsch J. Ultrasound in dengue: a scoping review.Am J Trop Med Hyg. 2021; 104: 826-835PubMed Google Scholar They noted the clinically relevant pathology in dengue is not pulmonary edema but vascular permeability detected as serous effusions, gall bladder wall thickening and/or a thin rim of pericystic fluid. Ultrasound could have early prognostic value in dengue. But, its utility is challenged by limited data describing how findings have influenced management decisions. Less than one-third of published studies described patient outcomes. Studies also failed to characterize ultrasound as an independent predictor of morbidity or mortality. No standard protocol for ultrasound examination of dengue cases has been proposed. In our practice in Sri Lanka an ultrasound examination of pleural and peritoneal spaces is routine in haemodynamically unstable patients with positive dengue NS1 and those with falling platelet counts or with counts below 100 × 109/liter. An international effort is needed to determine the usefulness of ultrasound in different settings by evaluating standardized ultrasound examinations in the context of the patient's pathophysiological status. All authors disclose no financial and personal relationships with other people or organizations that could inappropriately influence their work. Dengue Management in Triage using Ultrasound in children from Cambodia: a prospective cohort studyPoint-of-care ultrasound findings, particularly gallbladder wall thickening, in suspected early dengue can help predict disease progression in ambulatory patients. Ultrasound has potential to help guide management of suspected dengue patients and resource management during periods of dengue outbreak. Full-Text PDF Open Access

Initiation and continuation of healthy relationships among youth critical for the long-term wellbeing of the youth. Present socio-cultural environment presents numerous pitfalls which inhibit such relationships. Aim of this qualitative investigation was to describe the current status, trends and patterns of love affairs, dating and sexual behaviour among unmarried youth in Sri Lanka. Case studies, key informant interviews and focus group discussions were selected as methods of data collection. Thematic analysis was used. Four themes were generated, namely initiation of love affairs; dating and sexual behaviour, preferences, pattern and places; phycological, physical and sexual issues and violence related to love affairs and dating behaviour; assistance and advice on issues, problems in love affairs, dating and sexual behaviour. One of the key issues identified was lack of reliable person to seek advice for issues related to love affairs, dating and sexual behaviour among youth. Unmarried youth should be desensitized of the norms that inhibit the communication of love affairs, dating, sexuality and reproduction. Furthermore, a mechanism to identify high risk youth groups: those who have multiple love affairs, youth with inadequate knowledge of STIs, youth with casual sex, victims of sexual harassment need be designed and implemented

Introduction: The global first national level social marketing programme (SMP) implemented by a non­governmental organization was started in Sri Lanka on 1973 by The Family Planning Association of Sri Lanka. After four decades, this operation has grown to be the market leader of contraceptives, distributing over 15 products through 4867 pharmacies island wide. In 2020, despite the COVID-19 pandemic and other related challenges, it generated 367 442 couple years of protection (CYP). Objectives: To assess the impact and contribution of SMP to the National Family Planning Programme (NFPP) during the past two decades with a special focus on the effect of the COVID-19 pandemic in 2020. Methods: The product-wise annual sales figures of the SMP during past two decades (2001-2020) were analyzed using Marries Stop International Impact2 Calculation Tool (MSI-Impact2) to estimate the impact and contribution to the NFPP. The programme data published in the Annual Report of the Family Health Bureau was used to compare and triangulate the results obtained from MSI-Impact2. Results: Contribution of the SMP to the national modem contraceptive prevalence rate (mCPR) during the past two decades is 10-1 7%. The SMP averts over 40 000 unsafe abortions, 15 maternal deaths and 60 child deaths annually. Although the national level impact of COVID-19 on contraceptive SM is negligible, a significant shift in the contraceptive purchasing pattern was observed in 2020. Conclusions & Recommendations: SM of contraceptives has contributed to improving women's health significantly in Sri Lanka. In the absence ofSMP, the country mCPR would have been reduced by 10-17%.

Public Health Inspectors (PHIs) are key field health workers in Sri Lanka who are responsible for many preventive health functions in the community Job satisfaction is one of the crucial factors which motivate field health care workers such as PHIs The objective of this study is to examine the job satisfaction and its associated factors, and the problems and challenges faced by PHIs in the Sabaragamuwa Province while performing their duties This descriptive cross sectional study was conducted in all 29 Medical Officer of Health (MOH) areas of the Sabaragamuwa Province Study unit was a PHI working in the Sabaragamuwa Province at the time of the study All 128 PHIs fulfilled eligibility criteria, consented and were recruited Validated self-administered questionnaire assessing socio-demographic and work characteristics, job satisfaction based on Herzberg's Two Factor Theory, factors influencing job satisfaction, and a diary for self-reporting of time utilisation were used for data collection Out of the 128 PHIs recruited, 119 completed the questionnaire Among intrinsic factors, responsibility showed highest level of satisfaction (n=100, 84%) and among extrinsic factors, it was interpersonal relationship (n=108, 90 8%) Highest percentage of dissatisfaction among intrinsic factors was shown for advancement (n=88, 73 9%) and among extrinsic factors, it was for income and payment (n=74, 62 2%) More PHIs were dissatisfied when their area population increased (p=0 04) PHIs who spent more time in the field were less satisfied compared to officers who spent less time in the field (p<0 01) Majority of the PHIs were not satisfied with their salary and allowances, system of promotion and training and thus, attention is needed on these areas to improve the job satisfaction of PHIs

The Sri Lanka Journal of Bio-Medical Informatics (SLJBMI) is the official journal publication of the Health Informatics Society of Sri Lanka. It is the only academic publication in Sri Lanka which focuses on the emerging field of health informatics. SLJBMI was launched in 2010 as an open access and peer reviewed e-journal. It was temporarily paused publishing since June 2015 and relaunched in 2019 with an improved reader friendly format .The mission of SLJBMI is to publish high-quality original research and other relevant publications that would contribute to the promotion of digital health and health informatics. It aspires to be the most prominent publishing spotlight related to health informatics in the region and to be the gathering platform of the renowned experts and enthusiasts worldwide.