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The COVID-19 pandemic poses an ongoing risk to health workers globally. This is particularly true in low- and middle-income countries (LMICs) where resource constraints, ongoing waves of infection, and limited access to vaccines disproportionately burden health systems. Thus, infection prevention and control (IPC) training for COVID-19 remains an important tool to safeguard health workers. We report on the implementation of evidence-based and role-specific COVID-19 IPC training for health workers in a hospital and public health field setting in Sri Lanka.We describe the development of training materials, which were contextualized to local needs and targeted to different staffing categories including support staff. We describe development of role- and context-specific IPC guidelines and accompanying training materials and videos during the first year of the COVID-19 pandemic. We describe in-person training activities and an overview of session leadership and participation.Key to program implementation was the role of champions in facilitating the training, as well as delivery of training sessions featuring multi-media videos and role play to enhance the training experience. A total of 296 health workers participated in the training program sessions. Of these, 198 were hospital staff and 98 were from the public health workforce. Of the 296 health workers who participated in a training session, 277 completed a pre-test questionnaire and 256 completed post-test questionnaires. A significant increase in knowledge score was observed among all categories of staff who participated in training;however, support staff had the lowest pre-test knowledge on IPC practices at 71%, which improved to only 77% after the formal class.Implementing an IPC training program during a complex health emergency is a challenging, yet necessary task. Leveraging champions, offering training through multiple modalities including the use of videos and role play, as well as inclusion of all staff categories, is crucial to making training accessible.

Several COVID-19 vaccines have received emergency approval. Here we assess the immunogenicity of a single dose of the AZD1222 vaccine, at one month, in a cohort of health care workers (HCWs) (629 naïve and 26 previously infected). 93.4% of naïve HCWs seroconverted, irrespective of age and gender. Haemagglutination test for antibodies to the receptor binding domain (RBD), surrogate neutralization assay (sVNT) and ex vivo IFNγ ELISpot assays were carried out in a sub-cohort. ACE2 blocking antibodies (measured by sVNT) were detected in 67/69 (97.1%) of naïve HCWs. Antibody levels to the RBD of the wild-type virus were higher than to RBD of B.1.1.7, and titres to B.1.351 were very low. Ex vivo T cell responses were observed in 30.8% to 61.7% in naïve HCWs. Previously infected HCWs, developed significantly higher (p, Here the authors show in a large cohort of healthcare workers that one dose of the AZD1222 vaccine seroconverts 92.9% of vaccinees, irrespective of age and gender, and results in high antibody titers to wild-type SARS-CoV-2 but only low titers to the B.1.351 variant.

In response to an outbreak of coronavirus disease 2019 (COVID-19) within a cluster of Navy personnel in Sri Lanka commencing from 22nd April 2020, an aggressive outbreak management program was launched by the Epidemiology Unit of the Ministry of Health. To predict the possible number of cases within the susceptible population under four social distancing scenarios, the COVID-19 Hospital Impact Model for Epidemics (CHIME) was used. With increasing social distancing, the epidemiological curve flattened, and its peak shifted to the right. The observed or actually reported number of cases was above the projected number of cases at the onset; however, subsequently, it fell below all predicted trends. Predictive modelling is a useful tool for the control of outbreaks such as COVID-19 in a closed community.

Over the last few decades, there have been very few low- or middle-income countries in the world that have simultaneously achieved strong health outcomes, good financial protection by low cost and Sri Lanka stands tall amongst them. Moreover, the Sri Lankan health system was well in line with achieving the Sustainable Development Goals prior to the COVID-19 pandemic. At a time of combating the COVID-19 crisis on many fronts, the country often witnessed a concerted effort from the health sector to maintain its current achievements while improving the quality of the existing health services. The launching of the Sri Lanka Journal of Health Research is one such endeavor.

BackgroundIn order to determine the immunogenicity of a single dose of the AZD1222/Covishield vaccine in a real-world situation, we assessed the immunogenicity, in a large cohort of health care workers in Sri Lanka.MethodsSARS-CoV-2 antibodies was carried out in 607 naïve and 26 previously infected health care workers (HCWs) 28 to 32 days following a single dose of the vaccine. Haemagglutination test (HAT) for antibodies to the receptor binding domain (RBD) of the wild type virus, B.1.1.7, B.1.351 and the surrogate neutralization assay (sVNT) was carried out in 69 naïve and 26 previously infected individuals. Spike protein (pools S1 and S2) specific T cell responses were measured by ex vivo ELISpot IFNγ assays in 76 individuals.Results92.9% of previously naive HCWs seroconverted to a single dose of the vaccine, irrespective of age and gender; and ACE2 blocking antibodies were detected in 67/69 (97.1%) previously naïve vaccine recipients. Although high levels of antibodies were found to the RBD of the wild type virus, the titres for B.1.1.7 and B.1.351 were lower in previously naïve HCWs. Ex vivo T cell responses were observed to S1 in 63.9% HCWs and S2 in 31.9%. The ACE2 blocking titres measured by the sVNT significantly increased (pDiscussiona single dose of the AZD1222/Covishield vaccine was shown to be highly immunogenic in previously naïve individuals inducing antibody levels greater than following natural infection. In infected individuals, a single dose induced very high levels of ACE2 blocking antibodies and antibodies to RBDs of SARS-CoV-2 variants of concern.FundingWe are grateful to the World Health Organization, UK Medical Research Council and the Foreign and Commonwealth Office.

Introduction: Infectious diseases such as coronavirus disease 2019 (COVID-19) can spread dangerously fast in semi-confined places. Nevertheless, it has been found that rapid public health interventions such as isolation and quarantine could successfully curtail such outbreaks. An outbreak of COVID-19 was reported within a cluster of Navy personnel in the Western Province of Sri Lanka commencing from 22nd April 2020. An epidemiological investigation followed by aggressive public health measures were implemented by the Epidemiology Unit of the Ministry of Health with the support of the Sri Lanka Navy in response to the above outbreak. The objective of this research was to predict possible number of cases within the susceptible population in Sri Lanka Navy, to be used primarily for operational planning purpose by the Ministry of Health in control of outbreak in Sri Lanka.Methods: COVID-19 Hospital Impact Model for Epidemics (CHIME) developed by Predictive Health Care Team at Penn Medicine, which was a Susceptibility, Infected and Removed (SIR) model was used. The model was run on 20.05.2020 for a susceptible population of 10400, with number of hospitalized patients on the day of running the model being 357, first case hospitalized on 22.04.2020 and social distancing being implemented on 26.04.2020. Social distancing scenarios of 0, 25, 50 and 74% were run with 10 days of infectious period and 30 days of projection period.Results: With increasing social distancing measures, the peak number of infected persons decreased, as well as the duration of the curve extended. The number of infected cases from the first case ranged from 49th day to 54th day under social distancing scenarios from 0% to 74%. The doubling time increased from 3.1 days to 4.1 days from no social distancing to application of 74% social distancing, with corresponding decrease of Ro from 3.54 to 2.83. Expected daily growth rate of COVID-19 cases has decreased from 25.38 % to 18.53% under aforementioned increasing social distancing scenarios. The observed or actually experienced number of cases were well above the projected number of cases up to 07.05.2020, however, since this date the reported number of cases were lower than the projected number of cases from the model under four social distancing scenarios considered. Similar pattern was noted for the observed or actually experienced number of cases until the 20.05.2020, however, since then it was continuing at a very low intensity until the end of the modelling period. The number of COVID-19 cases prevented as per the model ranged from 2.3 – 21.1 %, compared to the base line prediction of no social distancing. However, based on the observed number of cases and the baseline model with no social distancing, 90.3% reduction was observed by the time of the model application date.Conclusion: The research demonstrated the practical use of a prediction model made readily available through an online open source platform for the operational aspects of controlling a COVID-19 or similar communicable disease outbreaks in a closed community such as armed forces. While comprehensive epidemiological surveillance, contact tracing, case isolation and case management should be the cornerstone of outbreak management, predictive modelling could supplement above efforts.

Background – With the onset of COVID-19 pandemic, the government of Sri Lanka took proactive measures to prevent a community outbreak in the country. This paper describes the measures taken by the government in the initial stages to contain the virus, along with the epidemiological characteristics of the first 200 laboratory confirmed COVID-19 patients.Methods – Telephone interviews were conducted for first 200 consecutive patients diagnosed with COVID-19, after obtaining informed verbal consent. Descriptive data are presented as binary variables and in frequency distribution tables.Results- From the diagnosis of the first patient, 76 days elapsed for the first 200 patients to be diagnosed. Majority were males in the 40-49 age group. There were three foreign nationals, while others were Sri Lankans. Among the Sri Lankans, 81 (41.1%) had an overseas travel history. Following implementation of the cohort quarantine concept, 47% of the overseas returnees were reported from quarantine centres. Over two-thirds of the patients presented with symptoms (n=137, 68.5%) and the most common symptoms were fever, cough and sore throat. The case fatality rate for the sample was 3.5%. out of the 200 patients, 103 (51.5%) were primary patients, while 92 (46%) were secondary patients. The source of exposure could not be determined for five patients. Conclusions – Due to measures instigated by the government, such as cohort quarantining, extensive contact tracing and testing of close contacts, Sri Lanka was able to prevent a wide spread community outbreak of COVID-19.

Introduction: A descriptive cross sectional study was carried out in 5 randomly selected districts i.e Gampaha, Kandy, Badulla, Nuwara Eliya and Ratnapura during the period of March to September 2014. The general objective of the study was to describe the trend of TB among young population over past 6 years in Sri Lanka and to determine contributory factors associated with TB among young population.Methodology: The study was carried out in two stages. The first stage was analysis of the trend of TB over the 6 year period of 2008-2014. The analysis of the trend was carried out using the existing secondary data at the Medical Records Division of the National Programme for Tuberculosis Control and Chest Diseases (NPTCCD). Trend was analyzed for new cases of TB patients of 15--34 years of age and separately for 15-24 and 25-34 age groups and for each type of new TB cases. The second stage was a descriptive cross sectional study which was carried out to determine the associated factors. All the patients (new/ retreatment)in age group of 15-34 years and registered at the selected district chest clinics with confi rmed TB were selected as the study subjects. Operational Definitions were used to identify confi rmed TB cases ie, Sputum smear positive TB, smear negative pulmonary TB and Extra pulmonary TB. The data were collected using a pre tested interviewer administered questionnaire by the District Tuberculosis Control Officers attached to the relevant District Chest Clinics.Result: The main findings of the study were, The two peaks of TB incidence were observed in the trend across age groups and first one was in the age group of 25-34 years second peak in the age group of 45-54.Overall trend of TB in the country is more towards the older age groups (over 45 years), but shift to younger age groups were observed in 15 out of 16 districts in the country. A total of 223 patients were included in the descriptive study. The highest proportion (34%) of study population was from the district of Gampaha while least proportion (10%) of it was from Nuwara Eliya. Nearly 53% of the study population was above 25 years of age with the sex ratio of 1:1. A majority (68%) of the study population was Sinhalese while nearly 70% of the study population has passed the O/L, A/L, Diploma or a degree. About one third of the study population was unemployed. Nearly half (50.4%) of the study population was having monthly income of about Rs. 20,000.00 or above. 31% of the study population were current or past alcohol consumers and 29% were smokers and 7% of the study population were current or past cannabis consumers. Majority (77%) of the study population were under-nourished while 14% of them were less than 15 kg/m2. Nearly three fourth (72%) of the study population have been diagnosed by a consultant. Statistically signifi cant associations were found between the age category and more than 3 family members (χ2=5.063, df=1, p

IntroductionThe COVID-19 pandemic has required the rapid development of comprehensive guidelines to direct health service organisation and delivery. However, most guidelines are based on resources found in high-income settings, with fewer examples that can be implemented in resource-constrained settings. This study describes the process of adapting and developing role-specific guidelines for comprehensive COVID-19 infection prevention and control in low-income and middle-income countries (LMICs).MethodsWe used a collaborative autoethnographic approach to explore the process of developing COVID-19 guidelines. In this approach, multiple researchers contributed their reflections, conducted joint analysis through dialogue, reflection and with consideration of experiential knowledge and multidisciplinary perspectives to identify and synthesise enablers, challenges and key lessons learnt.ResultsWe describe the guideline development process in the Philippines and the adaptation process in Sri Lanka. We offer key enablers identified through this work, including flexible leadership that aimed to empower the team to bring their expertise to the process; shared responsibility through equitable ownership; an interdisciplinary team; and collaboration with local experts. We then elaborate on challenges including interpreting other guidelines to the country context; tensions between the ideal compared with the feasible and user-friendly; adapting and updating with evolving information; and coping with pandemic-related challenges. Based on key lessons learnt, we synthesise a novel set of principles for developing guidelines during a public health emergency. The SPRINT principles are grounded in situational awareness, prioritisation and balance, which are responsive to change, created by an interdisciplinary team navigating shared responsibility and transparency.ConclusionsGuideline development during a pandemic requires a robust and time sensitive paradigm. We summarise the learning in the ‘SPRINT principles’ for adapting guidelines in an epidemic context in LMICs. We emphasise that these principles must be grounded in a collaborative or codesign process and add value to existing national responses.

Cancer surveillance is a process of systematic, continuous collection, storage, analysis, interpretation and dissemination of epidemiological information on cancer cases occurring in a particular geographic area. The process of cancer surveillance is also called 'cancer registration'. A system to conduct cancer registration is called 'cancer registry'. The purpose of the project is to implement cancer registry informatics to enhance electronic cancer registry reporting activities that take advantage of emerging health information technology. The expected function of the application is to strengthen the cancer registry data accuracy, completeness, and timeliness. The goals to be achieved are: determine the incidence of cancers with respect to geographic, demographic characteristics; monitor trends and patterns of cancer incidences over time; identify high-risk populations; provide data for epidemiological studies and prioritize health resource allocations.

Contents of the survey tool. (DOCX 14Â kb)

Level of social status by effects to the lifestyle of the study population (n =â 266). (DOCX 18 kb)

A Study on Social status and associated factors of tuberculosis patients attending to Central Chest Clinic Colombo and the influence of the disease on their life style. (DOCX 288Â kb)

Level of social status correlated with demographic, disease-specific and risk factor related characteristics of the study population (nâ =â 425). (DOCX 18Â kb)

Limited attention has been made by countries of ‘new immigration’ to define an immigration medical examination requirement of inbound migrant flows. Importation of TB through inbound migration routes have been a largely neglected strategy in TB control in Sri Lanka despite increasing migrant flows from endemic regions. We contend that establishing a health assessment for those long stay resident visa applicants to Sri Lanka may be useful in mitigating the spread of TB. However the approach should harness a ‘rights based’ approach to health assessment, and also be linked to the national health system. In this way the assessment becomes a vital mechanism for global public health good rather than be perceived as a tool for discrimination or immigration control. Migrants need to be included in national and global TB control strategies, especially since mobility is a key feature of the post-2015 Millennium Development Goals agenda.DOI: http://dx.doi.org/10.4038/sljid.v4i2.6719 Sri Lankan Journal of Infectious Diseases 2014; Vol.4(2):67-76

NOTE: The initials of the first author of this paper were changed from 'KI' to 'K' on 30th August 2013.We present a case of an international labour migrant worker from India who acquired multiple-drug resistant tuberculosis (MDR-TB) as a result of poor treatment compliance throughout his work and travel history. The travel to Sri Lanka was made under the resident visa scheme. Currently there are no mandatory health assessment requirements for inbound migrants such as resident visa holders to Sri Lanka. The diagnosis of MDR-TB was made at a district level chest clinic and the National Tuberculosis Program (NTP). This is the first documented case of MDR-TB in a foreign born migrant worker in Sri Lanka. The volume of resident visa applicants and foreign migrant workers to Sri Lanka from high TB burden countries has increased dramatically over the past five years. We examine the rationale and public health impact for undertaking a health assessment of the growing numbers inbound migrant workers to Sri Lanka from high TB burden countries.DOI: http://dx.doi.org/10.4038/sljid.v3i2.5286 Sri Lankan Journal of Infectious Diseases 2013; Vol.3(2):31-36

Introduction: Sri Lanka had achieved a significant improvement in the tuberculosis control including a reduction of the default rate since introduction of the DOTS strategy to the National TB control Programme in 1997. Patients’ adherence to anti TB treatment may be measured using either process oriented or outcome oriented definitions. Default rate is an outcome oriented definition that may be used as an indicator of poor patient adherence to anti TB treatment. One of the main obstacles in achieving the best tuberculosis (TB) control is that patients do not complete full course of anti TB treatment. A prospective cohort study was carried out with the objective to identify patient characteristics that associate with defaulting anti tuberculosis treatment. Methodology: This was a prospective cohort study of new smear positive pulmonary tuberculosis patients registered for treatment between 1.6.2008 and 31.8.2008 in seven districts in Sri Lanka. Data on the patient characteristics and the plan of management were collected at the beginning of the treatment using a pre tested structured questionnaire. During the follow up and at the end of the treatment, results of sputum microscopy and the treatment outcome were recorded. The patients who interrupted treatment for 2 months or more (defaulters) during the course of treatment were again investigated in the field. In the statistical analysis, patient characteristics of the defaulters were compared with the characteristics of patients who were cured. Results: There were 22 defaulters giving a default rate of 4.59%. Being a male, poor educational background, having a casual job, regular smoking, and regular alcohol use were significantly associated with defaulting treatment (p < 0.05). Sinhalese had lower default rate than other ethnic groups. At the field investigation, 43% of the defaulters were found not living in the addresses given to the treatment providers. Field investigators have further reported that financial reasons, substance abuse, feeling well, and lack of family support also as causes of defaulting treatment. Conclusion: Identification of risk factors by careful patient interview, early home visit, and monitoring of patient behaviour early in the course of treatment will help to predict whether adherence is likely to be a problem. So that, the treatment provider will be able to arrange a flexible and patient centered approach to ensure maximum adherence. SAARC Journal of Tuberculosis, Lung Diseases & HIV/AIDS; 2012; IX(2) 19-25 DOI: http://dx.doi.org/10.3126/saarctb.v9i2.7974

Five districts in Sri Lanka.To determine: 1) the proportion of sputum smear-positive pulmonary tuberculosis (PTB) cases who failed to smear convert at 2 months, 2) their management, and 3) whether baseline characteristics and final treatment outcomes were different from those who did smear convert.Cross-sectional retrospective review of medical files, tuberculosis (TB) registers and TB treatment records of new smear-positive PTB patients registered from January to December 2010.Of 925 patients, 840 were available to submit sputum at 2 months, of whom 137 (16%) were smear-positive. Baseline sputum smears showing 3+ acid-fast bacilli and missing doses of anti-tuberculosis drugs during the initial phase of treatment were significantly associated with being smear-positive at 2 months. Management was poor: of 137 patients, 46 (34%) submitted sputum for culture and drug susceptibility testing and Mycobacterium tuberculosis was cultured in six cases; 120 (88%) received a 1-month extension of the initial phase, and of the 30 patients still smear-positive at 3 months there were no culture results available. Final treatment outcomes were similar, regardless of smear conversion at 2 or 3 months.Certain characteristics were risk factors for failure to smear convert at 2 months. However, treatment outcomes for all patients were good. These findings have implications for the modification of national programme recommendations.Cinq districts du Sri Lanka.Déterminer : 1) la proportion de cas de tuberculose (TB) pulmonaire à frottis des crachats positifs dont les frottis n’ont pas été négativés à 2 mois, 2) leur prise en charge, et 3) dans quelle mesure les caractéristiques initiales et les résultats finaux du traitement sont différents de ceux dont les frottis ont été négativés.Revue rétrospective transversale des dossiers médicaux, des registres de TB et des rapports de traitement des patients atteints d’une nouvelle TB pulmonaire à frottis positif enregistrés entre janvier et décembre 2010.Sur les 925 patients, 840 ont pu fournir des crachats à 2 mois, parmi lesquels le frottis a été positif chez 137 (16%). Sont en association significative avec une positivité des frottis à 2 mois le degré de positivité 3+ des crachats initiaux pour les bacilles acido-résistants et le fait de n’avoir pas pris toutes les doses de médicament anti-tuberculose au cours de la phase initiale du traitement. La prise en charge a été médiocre : sur les 137 patients, 46 (34%) ont fourni des expectorations pour la culture et la détermination de la sensibilité aux médicaments ; on a cultivéCertaines caractéristiques constituent des facteurs de risque d’échec de la négativation des frottis à 2 mois. Toutefois, les résultats du traitement sont bons pour l’ensemble des patients. Ces observations ont des implications pour la modification des recommandations des programmes nationaux.Cinco distritos en Sri Lanka.1) Definir la proporción de casos de tuberculosis (TB) pulmonar con baciloscopia positiva que no convierten el esputo a los 2 meses de tratamiento; 2) describir su tratamiento; y 3) analizar si las características iniciales y los desenlaces terapéuticos son diferentes en los pacientes que sí convierten el esputo.Fue este un estudio transversal retrospectivo con análisis de los expedientes médicos, los registros de TB y los registros de tratamiento de los casos nuevos de TB pulmonar con baciloscopia positiva notificados entre enero y diciembre del 2010.De los 925 casos analizados, 840 pacientes aportaron una muestra de esputo a los 2 meses y 137 (16%) obtuvieron una baciloscopia positiva al segundo mes. Las baciloscopias de esputo 3+ y los casos que habían fallado a la administración de dosis de medicamentos anti-tuberculosos durante la fase inicial del tratamiento se asociaron de manera significativa con la persistencia de la baciloscopia positiva al segundo mes. El tratamiento fue deficiente en 137 casos y 46 de los pacientes con baciloscopia positiva persistente (34%) aportaron una muestra de esputo para cultivo y pruebas de sensibilidad; en 6 de estas muestras se cultivóAlgunas características de los pacientes representaron factores de riesgo de persistencia de la baciloscopia positiva del esputo al segundo mes de tratamiento. Sin embargo, los desenlaces terapéuticos de todos los pacientes fueron favorables. Estos resultados pueden inducir modificaciones en las recomendaciones del programa nacional.

Given the well-known linkage between diabetes mellitus (DM) and tuberculosis (TB), the World Health Organization recommends bidirectional screening. Here we report the first screening effort of its kind from a chest clinic in the Ampara district of Sri Lanka. Of 112 TB patients registered between January 2013 and October 2014, eight had pre-existing DM. Of those remaining, 83 (80%) underwent fasting plasma glucose testing, of whom two (2%) and 17 (20%) were found to have diabetes and impaired fasting glucose, respectively. All of these were enrolled in care. Screening TB patients for DM was found to be feasible at the district level. Further studies at the provincial/country level are required before making any decision to scale up bidirectional screening.Etant donné le lien bien connu entre diabète (DM) et tuberculose (TB), l'Organisation Mondiale de la Santé recommande un dépistage bidirectionnel. Nous rapportons ici le premier effort de dépistage de ce type au Sri Lanka dans un centre de maladies respiratoires du district d'Ampara. Sur 112 patients TB enregistrés entre janvier 2013 et octobre 2014, huit avaient un DM préexistant. Parmi les autres, 83 (80%) ont eu une glycémie à jeun et parmi eux, respectivement deux (2%) et 17 (20%) ont eu un diabète et une glycémie à jeun trop élevée; tous ont été enrôlés dans un programme de soins. Le dépistage du DM chez des patients TB s'est avéré faisable au niveau du district. D'autres études au niveau provincial/national sont nécessaires avant de décider l'extension de la stratégie.Dado el vínculo reconocido entre la diabetes (DM) y la tuberculosis (TB), la Organización Mundial de la Salud recomienda la detección sistemática bidireccional. En el presente estudio se comunica la primera campaña de detección de este tipo emprendida en Sri Lanka, en un consultorio de neumología del distrito de Ampara. De los 112 pacientes notificados al registro de TB de enero del 2013 a octubre del 2014, en ocho prexistía el diagnóstico de DM. De los casos restantes (80%), en 83 se practicó la glucemia plasmática en ayunas y se puso en evidencia el diagnóstico de DM en dos de ellos (2%) y 17 pacientes presentaron una glucemia basal alterada (20%); todos los pacientes ingresaron a un programa de atención. Se confirmó que es factible practicar la detección sistemática de la DM en los pacientes con diagnóstico de TB a escala distrital. Será necesario realizar estudios a escala de la provincia y del país antes de adoptar decisiones de ampliación de escala de la medida.

Summary: Objectives: Sri Lanka has a high suicide rate. The importance of suicidal ideations and their relationship to the common mental disorders (CMD) have not been adequately explored. This study examined whether patients harboring suicidal thoughts or life weariness would volunteer them. It also examined the relationship between life weariness, suicidal ideations, and the probability of underlying CMD. Method: A case control study was nested within a cross-sectional survey of attendees to the outpatients department in a general hospital. The index group consisted of patients presenting with multiple complaints and repeated visits, the control group was 100 patients randomly selected from a total of 5,767 between 16 and 65 years of age, not fulfilling criteria for the index group. Presence of underlying CMD was assessed by the General Health Questionnaire 30 (GHQ-30). The two groups were compared for symptoms volunteered, response to questions from GHQ-30 on suicidal ideations, and hopelessness. Results: Somatic symptoms were the most common in both groups. Eighty-one patients (81%) in the index group and 34 patients (34%) in the control group had probable CMD. No patient in either group volunteered suicidal ideation as a symptom. However, 59% of index patients and 26% of controls admitted life weariness, and 51/59 index patients and 15/26 controls who had life weariness also had underlying CMD as defined by GHQ scores. Conclusion: Patients who have suicidal thoughts do not volunteer them unless directly asked. There is a strong relationship between suicidal ideation and the probability of underlying CMD.

Background Tuberculosis (TB) is an infectious air borne disease and it is a major public health problem. The disease is more commonly seen in under developed countries. Association of TB with stigmatization and its impact on lifestyle of the patient is an important aspect that worth exploring. Objective To describe the influence of the disease on their lifestyle among tuberculosis patients attending the Central Chest Clinic Colombo Methods This was a descriptive cross sectional study. The study population consisted of all diagnosed tuberculosis patients, who were above the age of 15 attending to Central Chest Clinic Colombo. The total sample size comprised of 266 Tuberculosis patients, who have completed the first two months of treatment course to assess the impact of the disease on their lifestyle. Systematic sampling was conducted by considering the total number of clinic attendees and the duration of data collection. An interviewer administered questionnaire was used to collect data. Results Tuberculosis is associated with the lower socio economic status and linked with poverty. It is common in people with lower level of education and unemployment. More negative lifestyle changes were commonly seen in the socially disadvantaged group of patients which could further worsen their social status. More lifestyle changes had significant associations with male sex, low education level, employment, low income level, retreatment and infective patients, residing within the CMC area and substance abuse (alcohol, smoking, narcotic drug use). The stigma associated with the disease had a major impact on patients’ lifestyles as it has influenced to the family interactions, marital status and social interactions. Conclusion Tuberculosis is associated with poverty, low socio economic status; they change their lifestyle more negatively making them more vulnerable to social disadvantages. Not only the medical treatment, but also the lifestyle aspects of the TB patients need to be considered in patient management.

There is an enormous inequity in global health as well as research. Less than 10% of research funds are spent on the diseases that account for 90% of the global disease burden. This case study of north-south, south-south collaborations in Sri Lanka is a classic example of the issues faced by mental health researchers in low and middle income countries (LMICs). In this paper, work carried out by the Institute of Psychiatry (IoP), King's College London and the Institute for Research and Development (IRD) partnership since 1997 in Sri Lanka is presented to show an example of a successful private research institution based in a LMIC as a product of south-south and north-south collaboration in mental health research. The evidence of scarcity of mental health research and resources is overwhelmingly abundant in the context of Sri Lanka. IRD-IoP partnership showcases a successful north-south partnership with equality and efficiency. It has moved beyond start-up phase and has become a sustainable initiative in terms of funding, collaboration, research output and policy impact. International funding agencies, academics, and other bodies need to address sustaining such initiatives as priorities in reducing scarcity and inequity in mental health research in developing countries.

Background: Suicidal ideation can often lead to suicide attempts and completed suicide. Studies have shown that Sri Lanka has one of the highest rates of suicide in the world but so far no studies have looked at prevalence of suicidal ideation in a general population in Sri Lanka. Aims: We wanted to determine the prevalence of suicidal ideation by randomly selecting six Divisional Secretariats (Dss) out of 17 in one district. This district is known to have higher than national average rates of suicide. Methods: 808 participants were interviewed using Sinhala versions of GHQ-30 and Beck’s Scale for Suicidal Ideation. Of these, 387 (48%) were males, and 421 (52%) were female. Results: On Beck’s Scale for Suicidal Ideation, 29 individuals (4%) had active suicidal ideation and 23 (3%) had passive suicidal ideation. The active suicidal ideators were young, physically ill and had higher levels of helplessness and hopelessness. Conclusions: The prevalence of suicidal ideation in Sri Lanka is lower than reported from the West and yet suicide rates are higher. Further work must explore cultural and religious factors.

Sri Lanka has the one of highest rates of suicide. Important factors associated with suicide were determined via the psychological autopsy approach (which had not been carried out previously in Sri Lanka). Over a 3-month period, in a catchment area, 31 suicides among Sinhalese were identified and 27 were investigated. Males were more likely to commit suicide and alcohol abuse and domestic violence were reported as contributory factors. We found it possible to use psychological autopsy methods to obtain information which can inform planned prevention measures.

–Background and Objectives:With one of the highest rates of suicide in theworld and high rates of suicidal ideation in the population, we set out to pilot a study toascertain whether it is possible to conduct a randomised controlled trial. Secondly weaimed to study whether Cognitive Behavioural Therapy (CBT) for suicidal ideation is bet-ter than treatment as usual (TAU).Method: Those with suicidal ideation (identified by a population survey using GHQ-30and Beck’s suicidal ideation scale) were randomly allocated to 3-6 sessions of structured Cog-nitive Behavioural Therapy. The CBT was provided using a manual in primary care settings. Results: Of the two groups (CBT = 5, TAU = 4) the group which had received CBTshowed a greater reduction in Beck’s Suicidal Intent Score (from mean 11.2 to 0.2) and inGHQ-30 (from 22.0 to 10.8) in three months. Conclusions: The pilot study indicates that it is possible to conduct CBT and RCT indeveloping countries. The implications of this are discussed.Received 1 November 2005Revised 21 March 2007 Accepted 8 May 2007

Introduction: Despite its simplicity, efficiency and reliability, Sri Lanka has not used the Annual Risk of Tuberculosis Infection (ARTI) to assess the prevalence and efficiency of tuberculosis (TB) control. Hence, a national tuberculin survey was conducted to estimate the ARTI. Materials and Methods: A school-based, cross-sectional tuberculin survey of 4352 children aged 10 years irrespective of their BCG vaccination or scar status was conducted. The sample was selected from urban, rural and estate strata using two-stage cluster sampling technique. In the first stage, sectors representing three strata were selected and, in the second stage, participants were selected from 120 clusters. Using the mode of the tuberculin reaction sizes (15 mm) and the mirror-image technique, the prevalence and the ARTI were estimated. Results: The prevalence of TB estimated for urban, rural and estate sectors were 13.9%, 2.2% and 2.3%, respectively. The national estimate of the prevalence of TB was 4.2% (95% CI = 1.7-7.2%). ARTI for the urban, rural and estate sectors were 1.4%, 0.2% and 0.2%, respectively, and the national estimate was 0.4% (95% CI = 0.2-0.7%). The estimated annual burden of newly infected or re-infected TB cases with the potential of developing into the active disease (400/100 000 population) was nearly 10-fold higher than the national new case detection rate (48/100 000 population). Conclusion: The national estimate of ARTI was lower than the estimates for many developing countries. The high-estimated risk for the urban sector reflected the need for intensified, sector-specific focus on TB control activities. This underscores the need to strengthen case detection. Repeat surveys are essential to determine the annual decline rate of infection.

Sri Lanka is an island situated close to the southern tip of the Indian subcontinent with a land area of about 65 000 km2. The population in 2001 was 18.5 million. It has an interesting genetic diversity, its five main populations revealing both European and Asian origins. Although Sri Lanka is a developing country, it has strengths that other developing countries do not have, mainly in health and education. However, Sri Lanka lacks a research culture and has inadequacies in its research capabilities; hence, capacity building is essential. Based on our research findings, we plan to achieve this by working with professionals, statutory services, policy-makers and the public. Our model is international collaboration based on our own research agenda. Such partnerships can produce high-quality research, with greater influence on national policy and practice (Costello & Zumla, 2000).

In Sri Lanka, leptospirosis is a notifiable disease. In addition to having a routine disease reporting system, Sri Lanka has implemented a hospital-based sentinel surveillance system since 2004. This report discusses the findings of a descriptive analysis of the sentinel surveillance data collected from 2005 to 2008. Of the 4,000 suspected leptospirosis cases, 46.9% and 26.8% were recorded from the Western and Sabaragamuwa provinces, respectively. Most of the individuals were male (83.5%), and approximately 45.6% were aged 30-49 years. Farmers accounted for 16.5%, and laborers for 16.1%; however, the occupation of nearly half (44.8%) of the study population was unknown. More than half (53.9%) of the individuals worked in paddy fields. Almost all had acute fever (98.8%), myalgia (92.9%), and headache (92.7%), but fewer had other related symptoms. Out of the 4,000 individuals, 2,496 (62.4%) underwent a laboratory test; however, the laboratory test results of only 1,445 (57.9%) and the microscopic agglutination results of 41 (2.8%) were available at the sentinel sites. Less than 2% of the reported individuals underwent prophylactic treatment. These findings will help enhance the ongoing efforts for controlling and preventing leptospirosis in Sri Lanka. Sentinel surveillance is a useful tool, but the data quality needs to be improved by supplementing the findings with adequate laboratory diagnosis data.