Introduction: Hospitalizations due to exacerbated asthma remai ns high in Sri Lanka leaving a huge burden on the healthcare system. Identification of the burden of ‘high risk asthma patients’ for hospitalization due to exacerbation is a cost-effective strategy for prioritizing management options. Objectives: To estimate the prevalence of ‘high-risk asthma patients ’ and selected risk predictors for hospitalization due to exacerbation among asthma patients aged ≥20 years in the district of Gampaha, Sri Lanka Methods: A community-based descriptive cross-sectional study was conducted among 1200 asthma patients aged ≥20 years, selected using a multistage sampling technique. The risk for hospi talization was assessed using a newly developed and validated risk prediction model. High-risk asthma patients were defi ned according to the cut-off value of the summary risk score of the model. Results: The prevalence of ‘high-risk asthma patients’ for hospitali zation due to exacerbation was 16.4% (95% CI: 14.2, 18.6). The prevalence of selected risk predictors: age ≥ 60 years 24.2% (95% CI: 21.9, 26.7), poor educational attainment 67.3% (95% CI: 64.5, 70.0), having diabetes mellitus 18.8% (95% CI: 16.5, 21.0), family history of asthma 41.3% (95% CI: 38.5, 44.2), ever smoked 12.2% (95% CI: 10.2, 14.1), ever int ubated or given intensive care 2.8% (95% CI: 1.8, 3.7), previous hospitalizations due to exacerbations 6.6% (95% CI: 5.1, 8.0) , having uncontrolled asthma 63.6% (95% CI: 60.8, 66.7), having symptomatic GORD 18% (95% CI: 15.7, 20.2) and ha ving body mass index (BMI) ≥ 25 kg/m2 36.3% (95% CI: 33.5, 39.0). Conclusions & Recommendations: A significant proportion of asthm a patients being at risk of hospitalization indicates the need to adopt cost-effective asthma management strategies to ac hieve better control of the disease. Prompt primary healthcare interventions are required to address modifiable risk predi ctors among asthma patients.

Abstract Background Exacerbations of asthma are a leading contributor to hospitalisations. Information on risk factors for hospitalisations due to exacerbated asthma will help to identify high-risk asthma patients for specialised care. We aimed to identify the risk factors for ‘hospitalisations due to exacerbations’ among adult asthma patients in a district of Sri Lanka. Methods A hospital-based, case-control study was carried out among asthma patients aged ≥ 20 years. Sample of 466 asthma patients (116 cases, 350 controls) recruited from all tertiary care hospitals in the district. Data were collected by pre-intern Medical Officers via pre-tested interviewer administered questionnaire on asthma control, asthma co-morbidities, risk behaviors, physiological and sociodemographic factors. Risk factors were evaluated using bivariate and multivariate logistic regression. Data were analyzed using SPSS version 20. Results Risk factors were; age ≥ 60 years (OR 2.1; 95% CI 1.2–3.7), educated G.C.E. O/Level or less (OR 2.2; 95% CI 1.1–4.4), having diabetes mellitus (OR 2.0; 95% CI 1.1–3.7), having symptomatic Gastroesophageal Reflux Disease (GORD) (OR 3.4; 95% CI 1.8–6.4), exposure to vehicular traffic (OR 3.2; 95%CI 1.8–5.7), exposure to secondhand tobacco smoke (OR 2.1; 95% CI 1.2–3.5), having ever smoked (OR 2.4; 95% CI 1.2–4.6), ever intubated/given ICU care (OR 3.5; 95% CI 1.5-8.0), previous hospitalizations due to exacerbations (OR 5.5; 95% CI 2.6–11.4), having uncontrolled asthma (OR 3.4; 95% CI 1.6–7.1) and BMI ≥ 25kg/m2 (OR 2.3; 95% CI 1.4-4.0). Conclusions Preventive strategies need to address the modifiable risk factors: smoking, and obesity and manage comorbid conditions: diabetes and symptomatic GORD appropriately in asthma patients.

Background Asthma patients experience higher rates of hospitalizations due to exacerbations leaving a considerable clinical and economic burden on the healthcare system. The use of a simple, risk prediction tool offers a low-cost mechanism to identify these high-risk asthma patients for specialized care. The study aimed to develop and validate a risk prediction model to identify high-risk asthma patients for hospitalization due to exacerbations. Methods Hospital-based, case-control study was carried out among 466 asthma patients aged ≥ 20 years recruited from four tertiary care hospitals in a district of Sri Lanka to identify risk factors for asthma-related hospitalizations. Patients ( n = 116) hospitalized due to an exacerbation with respiratory rate > 30/min, pulse rate > 120 bpm, O2 saturation (on air) < 90% on admission, selected consecutively from medical wards; controls ( n = 350;1:3 ratio) randomly selected from asthma/medical clinics. Data was collected via a pre-tested Interviewer-Administered Questionnaire (IAQ). Logistic Regression (LR) analyses were performed to develop the model with consensus from an expert panel. A second case-control study was carried out to assess the criterion validity of the new model recruiting 158 cases and 101 controls from the same hospitals. Data was collected using an IAQ based on the newly developed risk prediction model. Results The developed model consisted of ten predictors with an Area Under the Curve (AUC) of 0.83 (95% CI: 0.78 to 0.88, P < 0.001), sensitivity 69.0%, specificity 86.1%, positive predictive value (PPV) 88.6%, negative predictive value (NPV) 63.9%. Positive and negative likelihood ratios were 4.9 and 0.3, respectively. Conclusions The newly developed model was proven valid to identify adult asthma patients who are at risk of hospitalization due to exacerbations. It is recommended as a simple, low-cost tool for identifying and prioritizing high-risk asthma patients for specialized care.

According to a study of blindness and visual impairment in Sri Lanka that examined a nationally representative sample of 5,779 people aged ≥ 40 years, the prevalence of blindness in the country is 1.7% and that of low vision is 17%. Cataract (66.7%) and uncorrected refractive errors (12.5%) are the most common causes of blindness.1 Blindness is significantly higher in those aged ≥ 70 years, as compared to those aged 40 to 49 years.1 The data are helpful for assessing and planning for the eye care needs of the population. The focus on improving service delivery at the primary eye care level is an important step in identifying the needs early.

Background: In Sri Lanka, consumption of foods high in salt is high. Efforts are underway to tackle this issue, including the reformulation of fast foods to contain less salt. To succeed, understanding the practices in using salt among restaurant owners, cooks, and chefs are important. The objective of this study was to explore the challenges that may prevent the reformulation of foods to contain less salt in selected food premises in Sri Lanka.Methods: In a qualitative study design using semi-structured interviews and focus groups as data gathering tools, food premises from ten districts in Sri Lanka were selected; while owners of food premises, chefs and cooks were the study population.Results: The study recognised several key themes related to the study objective including awareness and practices on salt use, ‘eating outside’ behaviour, dominance of experience when using salt, commercial vs. domestic use of salt and catering to the demand. Findings included both supportive and resistive perceptions and attitudes.Conclusion: Fears of competition and consumer demands may prevent restaurant owners, chefs and cooks from taking decisive steps towards lowering salt use. Training them on ways of lowering salt, while maintaining the appeal for foods and building trust on equitable implementation of salt lowering policies may win industry support. However, such efforts must parallel approaches to changing consumer behavior towards salt containing foods.

Background Sri Lankan citizens consume almost double the recommended daily amount of salt. Objective of this study was to assess the knowledge, attitudes and practices related to health effects of dietary salt among adults and adolescents in Sri Lanka to inform a national behavior change communication campaign. Methods We conducted a descriptive household survey among adults (n=1016) and adolescents (n=505) in 10 districts. An, interviewer administered questionnaire was used for data collection. The approximate amount of dietary salt intake of the individuals was estimated based on household purchases. Findings The recommended salt limit was identified by 40% of the population. Majority, adults (90.8%) and adolescents (86.1%) knew the adverse health effects of high salt intake. Although household monthly purchase of salt indicated consumption is much higher than recommended, 48.3% of adults and 45.9% of adolescents believed that they consume ‘just the right’ amount. Discretionary salt added to home cooking was a major contributor to intake, with approximately half (50%) adding salt when cooking rice, the staple. For health-related information most preferred (adults - 72%, adolescents – 69%) media is television. Interpretation The study identified gaps as well strengths in knowledge, attitudes and practices of Sri Lankans related to salt and health and recommends that the communication campaign include specific messaging to address gaps and leveraging on strengths. The survey identified adult females to be a key target group for the campaign and television is recommended as the mode of delivery.

Introduction: Rabies is a zoonotic disease that is endemic in Sri Lanka and the main vector of human rabies is the dog. The county invests a huge portion of its annual health budget to prevent this deadly disease. The treatment following dog bite has an important place in the prevention of human rabies, which consists of the provision of first aid and Post Exposure Therapy (PET). The objective of the study was to describe knowledge on human rabies and treatment following dog bites (TFDB) and their associated factors among persons aged 20-59 years in a semiurban Medical Officer of Health area in Sri Lanka Method- A community-based cross-sectional study was carried out among a random sample of 340 participants, aged 20-59 years in a semi-urban Medical Officer of Health area, Sri Lanka by using probability proportionate to the population size cluster sampling technique. Data were collected by using a pre-tested interviewer-administered questionnaire by two trained pre intern doctors and analyzed using SPSS 22 software. Results- Response rate was 94.7% (322/340). The mean age was 38.1 years (SD=11.2 years).Of the participants, 94% were Sinhalese (n=303): 87% Buddhists (n=280); 74.2% married (n=239); 64.6% employed (n=208); 82% lived in own house (n=264) with a median income of Rs. 38,000.00 (IQR=Rs. 38,000/=). Only 11.5% (n=37) were dog owners. Overall knowledge on rabies was good in 64.9%, (n=209): 70.8% (n=228) knew the route of entry of virus but < 45% knew cat & bat are also reservoirs. The factors associated with good knowledge on rabies were Sinhala (OR=3.4, 95% CI- 1.3 -8.9,p=0.01); having higher level of education (OR=18.7, 95% CI- 9.7 -35.8 ,p<0.001), being employed (OR=2.3, 95% CI- 1.4 -3.6 p<0.001), having a higher income level (OR=4.8, 95% CI- 2.9 -7.9, p<0.001);owning dog (OR=2.7, 95% CI- 1.6 -4.4, p<0.001). Overall knowledge on treatment following dog bite was good in 61.2 %,(n=197):89.6%,(n=288) on first aid but < 30% knew the importance of noticing offending dog’s health, observability, and what to do if a dog is suspected to have rabies. The factors associated with knowledge on the treatment following dog bite were: ever-married(OR=1.7, 95% CI- 1.1 -3.2, p=0.02); having a higher level of education (OR=13.3, 95% CI- 7.5-23.5, p<0.001); having a higher level of monthly income (OR=3.0, 95% CI-1.9 -4.8, p<0.001); being employed (OR=2.2, 95% CI- 1.4 -3.5, p<0.001); owning a dog (OR=27.7, 95% CI-3.7 -205.0, p<0.001). Conclusions and Recommendations: The majority of the study participants had good overall knowledge of rabies and treatment following a dog bite. In general, knowledge on non-canine reservoirs of rabies and treatment following dog bites on specific events were deficient. There is a need to give holistic knowledge with regard to rabies as well as treatment following a dog bite to the general public. Keywords—rabies, treatment following dog bites, knowledge, Sri Lanka

Introduction: Although Sri Lanka has a well-established preventive and curative healthcare system, physical inactivity, which is one of the four main risk factors for development of NCDs is prevalent among one third the adult population. Implementation of in-service trainings in relation to reduction of physical inactivity and sedentary behavior has not been carried out in a uniform manner in Sri Lanka. Aim: To describe the design, implementation, monitoring and evaluation of a novel exercise based in-service training strategy for primary care health staff on promotion of physical activity among the public. Methods: The existing mechanism for promotion of physical activity among the public by the primary care staff was reviewed and challenges and limitations were identified. A series of consultative meetings were conducted with the participation of all stakeholders to develop a Training of Trainers (TOT) manual on physical activity guidelines for the public. In order to overcome the deficiencies identified a novel strategy was developed for the implementation of in-service trainings on the developed TOT manual at the Healthy Lifestyle Centers. A post training evaluation was conducted among the trainees three months after the training. Results: Out of the trainees, 138 (76.6%) responded to the post training follow up evaluation. Mean age of participants was 40.09 years (SD =7.18). Majority of the respondents were females (N=101, 73.2%). There were, 44 (31.8%) Medical officers, 45 (32.6%) Nursing Officers, 20 (14.5%) Public Health Nursing Officers, 11 (7.9%) Public Health Midwives, 2 (1.4%) Public Health Inspectors and 16 (11.5%) other staff members among the participants. The median satisfaction score was 7.9 out of 10. There was a significant improvement in competency following the training (X 2 =44.6, Df=1, P<0.05). Conclusions and Recommendations: The novel strategy is effective and was received with enthusiasm by the target audience. Possibility of implementing similar strategies for risk reduction of other modifiable NCD risk factors must be explored.

INTRODUCTION: NCD screening and lifestyle modification counselling services are delivered through the network of healthy lifestyle centers (HLC) situated across Sri Lanka. Medical Officers (MO), Public Health Nursing Officers (PHNO), Nursing Officers (NO), and other categories provide their services at HLCs. The aim of this study was to identify the training needs of these healthcare workers (HCW). METHOD: 125 HLCs were selected using purposive sampling in a manner to represent all the districts of the country and 132 HCW of MO, NO, PHNO and other major staff categories employed were recruited using simple random sampling. Data was collected by using a self-administered questionnaire containing modified Hennessy-Hicks Training Needs questionnaire. Data were analyzed by using descriptive statistics. The magnitude of the training need was recognized by calculating the average difference between the importance score and performance score for each training area. The training needs were prioritized for each staff category based on the magnitude of differences in the score. RESULTS: The response rate for the study was 91% (n=120). The study participants consisted of 76 (63.3%) MO, 21(17.5%) NO, 19(15.8%) PHNO, and 4 (3.4%) and the ‘other’ category. When the first five prioritized training areas were considered, conducting special programs to clients on a healthy diet, physical activity, and conducting oral examination were common among MOs, NOs, and PHNOs. Both MOs and PHNOs identified conducting brief interventions for tobacco cessation as a priority training need. Furthermore, PHNOs and NOs shared the priority training need of logistics management. MOs and NOs had unique priority training needs of conducting health education sessions and conducting breast examination respectively. Training need of conducting health education session among MO was statically significant p<0.001 compared with other staff categories. CONCLUSION AND RECOMMENDATIONS: There are training needs at different intensities among healthcare workers. Preparation of training programs/ interventions tailormade to address these priorities health needs will serve the purpose.

Official publication of the College of Community Physicians of Sri Lanka and was established in 1995. Full text articles available.Journal of the College of Community Physicians of Sri Lanka (JCCPSL) has been recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations. The journal is indexed in DOAJ.Manuscripts are only accepted online through the portal of the JCCPSL https://jccpsl.sljol.info/ . The prospective authors must read carefully the section on Author Guidelines and prepare their manuscript accordingly. To submit a manuscript or to check the status of a submission the authors must first be registered in the JCCPSL Editorial Management System using an existing or newly created username and password. Next, choose the 'Start Submission' link and follow the five-step article submission process which is a simple and self-guided process.

NCDs were estimated to account for 83% of the total deaths in Sri Lanka in the year 2016. Continuing regular health services for patients with NCDs, amidst the COVID-19 pandemic, is a challenge. Ministry of Health has taken steps to provide guidance and training to continue services of medical clinics in government Healthcare institutions (HI). The aim of the study was to determine the Covid-19 preparedness of medical clinics in government sector HI to provide NCD services. A descriptive crosssectional study was carried out involving 682 HI from all health districts of Sri Lanka, recruited by purposive sampling technique. A pretested self-administered questionnaire was administered to the heads of the institution (HOI) as a google form. The response rate was 97.4%. Out of the respondents, 41.2 %, 49.9%, and 9.1% were primary, secondary, and tertiary HI respectively. More than 60% of the HI had updated patient databases, nearly 70% had appointment systems to minimize overcrowding of patients, patient waiting areas with adequate distancing and ventilation, and drug dispensing mechanisms for a longer duration. Out of HIs 56.2% had triage of patients on Covid19 symptoms before entering the medical clinic. Less than 20% of HIs had telemedicine facilities and 33.1% has digital blood pressure apparatus. Medical clinics of HIs in Sri Lanka have satisfactory preparedness with regard to the prevention of Covid-19.

Background: Rapid rise in non-communicable diseases (NCD) has become a major public health challenge in Sri Lanka. Healthy lifestyle centers (HLCs) were established in 2011 for screening of NCDs and risk factors with majority of them functioning at primary care institutions. A web based HIMS-HLC module was developed to gather screening data from HLCs. Objective of the study was to assess the post-training status of the Healthcare workers (HCW) conducting HLCs trained on HLC-HIMS module in Sri Lanka. Materials and Methods: A descriptive cross-sectional study was carried out in June 2021 among 119 HCW attached to the HLC trained on HLC-HIMS module selected using simple random sampling. The questionnaire was formulated based on Kirkpatrick model covering four domains i.e., reaction, learning, behaviour and result. Data were collected by using a pre-tested self-administered questionnaire by the means of a google form shared via online platforms; e mail and WhatsApp and Viber after obtaining informed written consent. Data were analyzed by using descriptive statistics and associations were determined by using chi square test. Results: The response rate was 87.3% (n=104). Mean age 40.4 years (SD = 8.0 years) with majority in 36-50 years group (52.9%, n=55), Of participants, females 73.1% (n=76), nursing officers 70.2% (n=73) good computer literacy 61.5% (n=64). Only one third had overall good knowledge (37.5%, n=39) regarding the HIMS-HLC module. However, 74.0% (n=77) had favourable reactions, 78.8% (n=82) had favourable behaviour and 83.7% (n=87) had favourable results following HIMS training. Younger age and good computer literacy were significantly (P<0.05) associated with favourable reactions, behaviour and results. Conclusion: HIMS training has given favourable outcomes in majority of the participants especially in reaction, behavior and results following training. The concept of e-training can be adopted for the in-service training of HCW including those working at PHC level to combat the difficulties in conducting physical trainings during a pandemic. A special emphasis should be added for participant’s age and computer literacy when such trainings are designed. Key Word: NCD; HIMS; Healthy Lifestyle Centres; post-training evaluation. --------------------------------------------------------------------------------------------------------------------------------------Date of Submission: 05-06-2021 Date of Acceptance: 18-06-2021 --------------------------------------------------------------------------------------------------------------------------------------

Background: Setting public health policies and effectively monitoring the impact of health interventions requires accurate, timely and complete cause of death (CoD) data for populations. In Sri Lanka, almost half of all deaths occur outside hospitals, with questionable diagnostic accuracy, thus limiting their information content for policy. Objectives: To ascertain whether SmartVA is applicable in improving the specificity of cause of death data for out-of-hospital deaths in Sri Lanka, and hence enhance the value of these routinely collected data for informing public policy debates. Methods: SmartVA was applied to 2610 VAs collected between January 2017 and March 2019 in 22 health-unit-areas clustered in six districts. Around 350 community-health-workers and 50 supervisory-staffs were trained. The resulting distribution of Cause-Specific-Mortality-Fractions (CSMFs) was compared to data from the Registrar-General's-Department (RGD) for out-of-hospital deaths for the same areas, and to the Global-Burden-of-Disease (GBD) estimates for Sri Lanka. Results: Using SmartVA, for only 15% of deaths could a specific-cause not be assigned, compared with around 40% of out-of-hospital deaths currently assigned garbage codes with “very high” or “high” severity. Stroke (M: 31.6%, F: 35.4%), Ischaemic Heart Disease (M: 13.5%, F: 13.0%) and Chronic Respiratory Diseases (M: 15.4%, F: 10.8%) were identified as the three leading causes of home deaths, consistent with the ranking of GBD-Study for Sri Lanka for all deaths, but with a notably higher CSMF for stroke. Conclusions: SmartVA showed greater diagnostic specificity, applicability, acceptability in the Sri Lankan context. Policy formulation in Sri Lanka would benefit substantially with national-wide implementation of VAs.

Introduction- Rabies is a 100% vaccine-preventable and 100% fatal zoonotic, viral illness. Dogs are the source of nearly all the deaths from rabies in Sri Lanka. Annually nearly 20-30 persons die due to human rabies and the health system provides post-exposure prophylaxis for 300,000 individuals in the country. One of the main strategies in the prevention of rabies in the country is the promotion of responsible dog ownership (RDO). This study was done with the aim of describing the knowledge, attitude, and practice on Responsible Dog Ownership and their associated factors among persons aged 20-59 years in a semi-urban Medical Officer of Health (MOH) area in Sri Lanka Method- A community-based cross-sectional study was carried out among a random sample of 340 participants, aged 20-59 years in the MOH area Maharagama, Sri Lanka by using probability proportionate to the population size cluster sampling technique. Data were collected by using a pre-tested interviewer-administered questionnaire by two trained pre intern doctors and analyzed using SPSS software. Results- Response rate was 94.7% (322/340). The mean age was 38.1 years (SD=11.2 years).Of the participants, 94% were Sinhalese (n=303): 87% Buddhists (n=280); 74.2% married (n=239); 64.6% employed (n=208); 82% lived in own house (n=264) with a median income of Rs. 38,000.00 (IQR=Rs. 38,000/=). Only 11.5% (n=37) were dog owners. Overall knowledge on Responsible Dog Ownership (RDO) was good among 69.3% (n=223) with: > 50% knew about rabies vaccine and breeding control but 95% on dog vaccination against rabies but 60% had practiced: immunization; de worming but < 40% had practiced breeding control. The factors associated with good knowledge on RDO: age 20-39 years (OR=1.7, 95% CI- 1.1 -2.8 ,p=0.01); being Sinhalese (OR=2.7, 95% CI- 1.01 -6.8, p=0.03); being Buddhists (OR=2.1, 95% CI- 1.01 -4.0, p=0.03), having higher education (OR=21.4, 95% CI- 10.2 -44.9, p<0.0001); having higher income (OR=3.5, 95% CI- 2.1 -5.8, p<0.001), being employed (OR=2.7, 95% CI- 1.6 -4.4, p<0.001) and owning dog (OR=18.9, 95% CI- 2.5 -139.7, p<0.001) .The factors associated with favorable attitudes on RDO: age 20-39 years (OR=2.6, 95% CI- 1.6 -4.3, p<0.001); being Sinhalese (OR=2.6, 95% CI- 1.03 -6.7, p=0.04);being Buddhists (OR=2.3, 95% CI- 1.2 -4.6, p=0.01); being unmarried (OR=2.5, 95% CI- 1.2 -5.2, p=0.01); having higher education (OR=1.7, 95% CI- 1.1 -2.9,p=0.02). Practices on RDO among dog owners: having a higher level of education was associated with hygienic disposal of dung (OR=12.8, 95% CI 2.1 -78.6, p<0.01) and expression of ownership (OR=8.1, 95%CI-1.7-38.6,p=0.01). Being employed was associated with measures taken to prevent pet dog becoming a public nuisance (OR=6.6, 95% CI 1.3-32.5, p=0.04). Conclusions and Recommendations: The majority of study participants had good knowledge, attitudes, and practices with regard to the prevention of Rabies. However, their knowledge, attitudes, and practices on other elements of RDO are not as good. Responsible Dog Ownership should be introduced as a regulation for the general public by the Ministry of Health in order to further reduce deaths due to Rabies in Sri Lanka . Keywords—Responsible Dog Ownership, Rabies, Sri Lanka

Effective and rapid decision making during a pandemic requires data not only about infections, but also about human behavior. Mobile phone surveys (MPS) offer the opportunity to collect real-time data on behavior, exposure, knowledge, and perception, as well as care and treatment to inform decision making. The surveys aimed to collect coronavirus disease 2019 (COVID-19) related information in Ecuador and Sri Lanka using mobile phones. In Ecuador, a Knowledge, Attitudes and Practices (KAP) survey was conducted. In Sri Lanka, an evaluation of a novel medicine delivery system was conducted. Using the established mobile network operator channels and technical assistance provided through The Bloomberg Philanthropies Data for Health Initiative (D4H), Ministries of Health fielded a population-based COVID-19-specific MPS using Surveda, the open source data collection tool developed as part of the initiative. A total of 1,185 adults in Ecuador completed the MPS in 14 days. A total of 5,001 adults over the age of 35 in Sri Lanka completed the MPS in 44 days. Both samples were adjusted to the 2019 United Nations Population Estimates to produce population-based estimates by age and sex. The Ecuador COVID-19 MPS found that there was compliance with the mitigation strategies implemented in that country. Overall, 96.5% of Ecuadorians reported wearing a face mask or face covering when leaving home. Overall, 3.8% of Sri Lankans used the service to receive medicines from a government clinic. Among those who used the medicine delivery service in Sri Lanka, 95.8% of those who used a private pharmacy received their medications within one week, and 69.9% of those using a government clinic reported the same. These studies demonstrate that MPS can be conducted quickly and gather essential data. MPS can help monitor the impact of interventions and programs, and rapidly identify what works in mitigating the impact of COVID-19.

Introduction:Documented literature includes mixed interpretations of the impact of paternal alcoholism on psycho-behavioral well-being in children. A systematic review and a meta-analysis would facilitate the accurate establishment of this association.Aim:To evaluate the effects of paternal alcoholism on the psycho-behavioral well-being of children by a systematic review with a meta-analysis and a narrative review componentMethods: This PROPERO registered review (CRD42018114754) was conducted by reviewing searching literature in MEDLINE, EMBASE and PsycINFO databases. Twenty nine articles out of 16398 were selected for data extraction after three selection rounds. Thirteen were included in the meta-analyses for four numerical outcomes and two categorical outcomes. Meta-analysis outcomes included; internalizing behavior, externalizing behavior, depression and anxiety. Heterogeneity, risk of biases and the quality of evidence were assessed. Sensitivity analysis was done by re-analyzing with random-model assumption following the fixed model assumption. Furthermore re-analysis with standardized mean difference was done following the analysis with mean difference. Rev Man (version 5.3) software and “GRADEproGDT” online applications were used. Summary of Findings Tables were prepared. A narrative review was done with studies and sub-groups not included in the meta-analysis, under five identified themes: depression and mood disorders; self-perceived mental health problems and personality; aggression; ADHD and other problems.Results: With meta-analysis, all four numerical outcomes for demonstrated significant mean differences (MD) with higher values in the group with paternal alcoholism. “Low” level was assigned as the GRADE certainty. For the anxiety when it is regarded as a categorical outcome, the resulting relative effect was significant (OR=2.18, 95% CI= 2.03 to 2.33) with “Moderate” certainty. In sensitivity analysis, associations of similar directions were observed. Narrative review reflected other negative psycho-behavioral consequences of children associated with paternal alcoholism, falling under the five identified themes.Conclusions:Robust findings were observed for the positive associations of paternal alcoholism with the selected psycho-behavioral pathologies of children in the meta-analysis. The narrative review further demonstrated negative implications of paternal alcoholism on five identified thematic areas.

Official publication of the College of Community Physicians of Sri Lanka and was established in 1995. Full text articles available.Journal of the College of Community Physicians of Sri Lanka (JCCPSL) has been recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations. The journal is indexed in DOAJ.Manuscripts are only accepted online through the portal of the JCCPSL https://jccpsl.sljol.info/ . The prospective authors must read carefully the section on Author Guidelines and prepare their manuscript accordingly. To submit a manuscript or to check the status of a submission the authors must first be registered in the JCCPSL Editorial Management System using an existing or newly created username and password. Next, choose the 'Start Submission' link and follow the five-step article submission process which is a simple and self-guided process.

Official publication of the College of Community Physicians of Sri Lanka and was established in 1995. Full text articles available.Journal of the College of Community Physicians of Sri Lanka (JCCPSL) has been recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations. The journal is indexed in DOAJ.Manuscripts are only accepted online through the portal of the JCCPSL https://jccpsl.sljol.info/ . The prospective authors must read carefully the section on Author Guidelines and prepare their manuscript accordingly. To submit a manuscript or to check the status of a submission the authors must first be registered in the JCCPSL Editorial Management System using an existing or newly created username and password. Next, choose the 'Start Submission' link and follow the five-step article submission process which is a simple and self-guided process.