International Conferance on Public Health Inn

WELCOME The National Institute of Health Sciences of Sri Lanka extends a very warm welcome to all distinguished invitees, speakers, researchers, health professionals and other participants to the International Conference on Public Health Innovations (ICPHI), 2013.

Since the inception of the first health unit in Kalutara, Sri Lanka in 1926, public health has tremendously improved over the years. While the achievements are immense, some of the public health problems are still remaining, while new challenges are immerging due to changes of the life styles, demography, urbanization and industrialization. In the same track, regional countries too, face almost the same profile of challenges.

The emerging public health issues need to be addressed with innovative approaches. Meanwhile, some of the innovative projects in public health, best practices and field research are confined to the place of invention and not shared with the communities of interest. ICPHI will fulfill this need and bring the policy makers, stake holders, academics, inventors, different categories public health staff, health staff from clinical disciplines, other professionals who work closely with public health sector such as Engineers, Communication Specialists, officers from Non-governmental organizations etc. and professionals interested in public health together. We feel ICPHI becomes unique among other such conferences in this respect.

ICPHI is the first ever conference in Sri Lanka organized by a World Health Organization Collaborating Center. We are proud that it may be the first ever conference in Sri Lanka which promotes healthy living through workshops on total wellbeing. We are also proud to state that ICPHI has not accepted sponsorships from parties who deal with products considered injurious to peoples' health. During the conference you will witness the presentations of high quality research papers, community interventions and best practices on key health issues related to diverse disciplines of public health. These papers have been reviewed and chosen by an expert panel of eminent public health scholars through an anonymous review process. Moreover, we sincerely hope that you will also appreciate the scenic beauty and the peaceful surroundings of National Institute of Health Sciences and Kalutara through this visit to our conference. We have also tried to touch upon your lives by promoting a blend of healthy refreshments during the conference.

Again with great pleasure we welcome you to the International Conference on Public Health Innovations 2013 at National Institute of Health Sciences.

Organizing Committee International Conference on Public Health Innovations

CONTENTS GENERAL INFORMATION

03-04

PROGRAMME AT A GLANCE

05-07

NIHS SITE MAP AND PROGRAMME VENUES MESSAGES

08 09-15

KEYNOTE ADDRESS

16

PRE-CONGRESS WORKSHOPS

17

PLENARY SESSIONS AND SYMPOSIA

18

DETAIL PROGRAMME OF ORAL FREE PAPER SESSIONS

32

ABSTRACTS OF ORAL FREE PAPER PRESENTATIONS

39

DETAIL PROGRAMME OF POSTER PRESENTATIONS

72

ABSTRACTS OF POSTER PRESENTATIONS

77

ORGANISING COMMITTEE

108

ABSTRACTS REVIEW TEAM

109

NIHS STAFF PHOTOGRAPH

110

ICPHI INAUGURATION CEREMONY

111

ACKNOWLEDGMENTS

112

GENERAL INFORMATION

General Information nd

ICPHI2013 -Venue National Institute of Health Sciences, Sri Lanka is the

Key note speech:Date: 2 May 2013 Time: 5:30 - 6:15 pm Venue: Auditorium - NIHS Plenary sessions Session 1: rd Date: 3 May 2013 Time: 10:30 am - 12:00 pm Venue: Auditorium – NIHS Session 2: th Date: 4 May 2013 Time: 10:30 am - 12:15 pm Venue: Auditorium – NIHS

venue of ICPHI2013. Different events and sessions will be held in this 18 acre eco-friendly beautifully landscaped premises.

Registration Onsite registration and issuing of identification badges nd and the conference bag will start on Thursday, 02 of May 2013 from 8:00 am at the front reception area of the main administrative building.

Free paper sessions (Oral): There will be 21 free paper sessions. Please refer the section on free paper sessions

ICPHI2013 -program Please refer to the ICPHI2013 program on pages 5 to 7.

in the Conference Programme to identify the date, time and venue to identify the specific free paper. There will

Pre congress workshops There will be two parallel pre-congress workshops on

be 3 or 4 parallel free paper sessions. Free paper sessions will be held in following timeintervals. Please refer the abstract number and session title to identify

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2 of May 2013 from 9.00am to 1.00pm.

Pre-congress workshops are on:

the time and location of the presentation.

Date: 2nd of May

1. Towards Total Wellbeing: Workshop addresses the total well-being concepts with practical texture.

Free paper session 1 -3: 2.00 pm to 3.00 pm Free paper session 4-6: 3.30 pm to 4.30 pm Date: 3rd of May

2. Introduction to Research Methodology: The workshop will outline basic steps in research

Free paper session 7 - 9: 9.00 am to 10.00 am Free paper session 10 - 13: 3.45 pm to 4.45 pm

methodology.

Attendance to the pre-congress workshops is free of charge for the participants registered for the conference. Refreshments during the workshop are provided (lunchwill not be provided). You may order your lunch from the NIHS cafeteria.

th

Date: 4 of May Free paper session 14 -17: 9.00 am to 10.00 am Free paper session 18 - 21: 12.15 pm to 1.15 pm Free paper sessions (poster): There will be two poster

Social Functions Cultural show nd Date: 2 May 2013 Time: 7:00 - 8:00 pm Venue: Auditorium - NIHS Welcomereception and dinner nd Date: 2 May 2013 Time: 8:00 – 9:30 pm Venue: Pool side cafeteria– NIHS

viewing areas. Please refer to “NIHS site map and conference venues” on page 9 for exact locations of the poster areas. Please refer the abstract number to identify the location of the poster.

Symposia: Conference will have8 symposia which will deliver important public health issues, innovative approaches and latest knowledge in difference aspects of public health.

Symposia will be held at following time slots and there will be 4 parallel symposia in each time slot.

Scientific Sessions Please refer to“Who will speak in ICPHI2013”atwww.icphi2013.info for more information about speakers of the conference.

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Date: 3rd May 2013 Time: 1:00 - 2:00 pm and 2.15 – 3.15 pm Venue: Auditorium, Seminar room 1, 2, and 3

Accommodation for participants Accommodation for international participants will be offered at Tangerine Beach Hotel, Panorama Beach Hotel and Garden Beach Hotel at a concessionary rate.

Participants are expected to contact hotels directly.

Safe Exercise Program Master trainers of NIHS will conduct a safe exercise rd th program on 3 and 4 of May morning from 7.30 am to 8.00 am at the NIHS playground. Exercise program will

Booking of hotels is a responsibility of participants and Conference Organizing Committee will not take any responsibility relevant to reservations, pricings and payment.

include the warm-up exercises, jogging and stretching exercises. Registered participants can join the exercise

NIHS Hostels NIHS hostels are with limited facilities and offer only to local participants on request. As there are limited number of rooms, participants are encouraged to apply early. Please note that the booking will be done on first registered first served basis. Hostel fee should be paid by the participants.

program on their choice.

Internet access Wi-Fi facilities are available at seminar rooms. User name and passwordwill be provided free. A limited number of computer terminals will be available at seminar room 2.

Accommodation for accompanying drivers Participants requesting the accommodation may request the accommodation for drivers as well. Drivers will be provided the accommodation in a separate venue. Please contact the Registration Desk for more information. They should pay the hostel fee.

Refreshments and meals for registered participants nd

rd

th

Dinner on the 2 of May, lunch on the 3 and 4 of May will be served free of charge for all registered participants at the NIHS cafeteria. Only the registered participants will be served at the NIHS cafeteria. Tokens will be given at the time of registration and should be

Transportation NIHS will arrange transport from designated hotel to the conference venue at 8.30 am on 2nd to 4thof May and from the conference venue to hotels at 10.00 pm nd rd th on 2 of May, 5.00 pm on 3 of May and 2.45 pm on 4 of May. Participants who need transport should report to the Registration Desk for us to arrange the transport facilities. There will be a designated officer at the Registration Desk to assist the participants.

produced to obtain lunch and refreshments.

Refreshments on the 2nd, 3rd and 4th of May will be served free of charge for all registered participants at nd

the poster viewing areas. Lunch on the 2 of May, breakfast on any of the conference days and dinner on the 3rd and 4th of May will not be provided by the conference organizing committee. You may order these

Certificate of Participation A Certificate of Participation will be available for the registered participants upon the request at the Registration Desk.

meals from the NIHS cafeteria.

Refreshments and meals for accompanying drivers Refreshments and meals for accompanying drivers will be served on 2nd of May from 6.00 pm to 7.00 pm and 8.00 pm to 9.30 pm respectively at a separate venue.

Drivers will not be served with any other refreshments or meals.

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Message from the Honorable Minister of Health, Sri Lanka Hon. Maithripala Sirisena I am glad to see that National Institute of Health Sciences has rapidly progressed in to a centre of excellence in training. As the only national training centre under the Ministry of Health, NIHS has fulfilled its mandate to the fullest satisfaction of the trainees and the Ministry of Health.

After becoming a WHO collaborating centre, the scope of the training has further widened to receive the international participants for various training programs and this is a commendable achievement. I see this international event as a step forward to achieve the “Maninda Chinthana Idiri Dekma� where it is clearly spelt out that Sri Lanka will be developed into a knowledge hub in Asia.

Ministry of Health is always encouraging constant improvements of its vastly diverse institutional network. I am proud to see that as the premier public health training institution, NIHS has undertaken the task of improving the training especially in the public health sector. This conference, I presume is a culmination of such improvements.

I wish the Director and the staff at NIHS all success in their future endeavors and sincerely hope that this international conference will pave the way for further dissemination of productive work done by the NIHS and the public health sector in Sri Lanka.

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Message from the Honorable Deputy Minister of Health, Sri Lanka Hon. Lalith Dissanayake I am delighted to send this message on the occasion of NIHS hosting an international conference. I believe that the theme chosen is very appropriate as Sri Lanka is now facing a double burden of disease, both communicable and noncommunicable.

This is an era where we are experiencing more and more non communicable diseases and our public health sector should be prepared to face this challenge.

Therefore the Ministry of Health has taken various measures to strengthen knowledge and skills of health professionals. In this context, this event is a great opportunity for the health professionals to share the latest public health knowledge and practices for the betterment of the community at large.

National Institute of Health Sciences was started as the first public health unit in Sri Lanka in 1926 and we have witnessed its impressive growth both quantitatively and qualitatively in the recent past. This has helped the capacity building of our public health staff which has contributed to improve the quality of their service. I am happy to see that NIHS has stepped in to international public health arena for the benefit of the country and its people.

I hope that under the present leadership the NIHS will further spread its wings internationally to share our public health experience with the rest of the world.

I wish all success for this international conference.

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Message from the Secretary Health, Ministry of Health, Sri Lanka Dr. Nihal Jayathilaka I am pleased to send this message to the National Institute of Health Sciences on the occasion of hosting an International Conference on Public Health.

Sri Lanka is now experiencing a demographic and epidemiological transition.

Therefore it is important that we think of appropriate strategies to face the new health challenges ahead of us resulting from these gradual transitions. We have to empower our health staff to face these challenges successfully. This is where the NIHS is required to play a key role in identifying these challenges and improving the capacity of the health staff. I am glad to understand that the NIHS has taken up this task seriously and as a major obligation. This is evident from its recent collaboration with the WHO to design new training programmes to empower health staff.

This conference has created an opportunity to share the latest knowledge and innovations with the rest of the world. Good practices and innovations emerging out of this conference will be useful for decision makers in the health sector to make improvements in their respective fields.

I wish this conference and its deliberations all success.

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Message from the Director General of Health Services Department of Health Services, Ministry of Health, Sri Lanka Dr. P. G. Mahipala National Institute of Health Sciences is the premier public health training institution in Sri Lanka under the department of health services. From the inception in 1926 this institution was in the forefront of the development of the public health staff in Sri Lanka. Today it has further enhanced this mandate as a Collaborating Centre of the World Health Organization.

I am glad to see that NIHS has organized its first major activity under the WHO Collaboration Centre in a grand level with the participation of international organizations. I hope this conference will help the public health sector in our country to have a novel experience of sharing innovative projects with other sectors and countries. We in Sri Lanka have the best public health indicators in the region. Department of health is always supporting the public health staff to maintain this status and further improve on it.

This conference is an important event in this regard to explore the opportunities to further strengthen our public health system. This is very important at this time as we are facing the challenge of controlling non communicable diseases. This forum will give an opportunity for strengthening of our public health staff by empowering them with latest knowledge. The outcome of this event should be not only to disseminate novel knowledge but impart this knowledge to the community to gain results.

I hope this conference will come out with valuable scientific evidence for the department of health to act on further strengthening of our public health system.

I wish NIHS and this conference all the success.

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Message from the Deputy Director General (Education, Training & Research) Department of Health Services, Ministry of Health, Sri Lanka Dr. Sunil De Alwis

Making Sri Lanka the knowledge hub in Asia is one of the key goals of the present Government. To achieve this task in the health sector, NIHS has an important role nationally and internationally in disseminating the vast knowledge and sharing our experiences with other countries. We have been successful in obtaining the WHO collaborating status for NIHS in 2012 and this international conference is one of the obligations in the programme. There will be several other important public health events in the near future to augment the image of the NIHS. This conference is designed to expose the innovative projects of local and foreign health professionals. There will be several sessions by eminent speakers from right round the globe with highest pinnacles of academic excellence as well as by world renowned authorities in many health territories.

It is undoubted that ICPHI 2013 will be a heart-warming experience for all of us in the health sector as this is the first of the series of international conferences to be held after I took the reins as the Deputy Director General (ET&R). I am truly blessed to have NIHS under my guidance with many competent health professionals dedicated to the art and science of training in Sri Lankan health sector.

I am thankful to all stakeholders who contributed in various ways to make ICPHI 2013 a real success.

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Message from the WHO Country Representative Dr. Firdosi Rustom Mehta It gives me great pleasure in sending this message to the International Conference on Public Health Innovations organized by the National Institute of Health Sciences and the Ministry of Health Sri Lanka.

I was delighted to see the impressive growth of NIHS in the recent past culminating it being designated as a WHO collaborating centre. This has opened up immense opportunities for NIHS to grow further.

One would understand that, in the end, innovation is all about human beings. New ideas and methods must empower people, whether as patients taking charge of their own health or the health of loved ones, or as public health workers seeking to save lives across populations, or as policy-makers weighing evidence to make enlightened decisions.

We need to look for innovative ways to face the emerging public health challenges effectively. Home grown solutions are the best and the most effective. So I sincerely hope this conference will be an insight to the public health community in finding the solutions.

I congratulate NIHS on this international event and wish all success for the conference.

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Message from the Director, National Institute of Health Sciences Department of Health Services, Ministry of Health, Sri Lanka Dr. Lakshman Gamlath

I am delighted to see that the NIHS has stepped on to the international health arena. We are now performing our training activities with international collaboration and lots of well reputed professionals and institutions all over the world are linked with us today to share their knowledge and skills.

Being the first ever WHO collaborating centre under the Ministry of Health - Sri Lanka, we are proud to host the International Conference on Public Health Innovation at NIHS. This is the first major activity under the newly established WHO collaboration centre at NIHS. We have organized this event in such a way to facilitate any public health inventor to come and present their scientific papers in this conference. Therefore you have the opportunity to listen not only to public health professionals in the Department of Health but also to professionals from other disciplines as well.

This is the first ever conference in Sri Lanka that gives an opportunity for all interested parties in Public Health, irrespective of their basic disciplines to present their scientific findings. Thus the profile of Sri Lankan gathering includes presenters from Medical Doctors, other primary health care staff such as public health inspectors, Public Health Midwives, Paramedical staff such as Medical Laboratory Technicians, Pharmacists and even engineers and officers working in non- governmental organizations.

This event will be a great opportunity for Sri Lankan health professionals to share their knowledge and experience both locally and internationally.

I sincerely thank the Ministry of health, Department of Health Services, DDG (ET&R) and National Health Development Fund for all the support and guidance given to us to make this event a success. I am also thankful to the Deputy Director (Training), Deputy Director (Field services), conference secretary Dr. Sumal Nandasena and all other officials at NIHS who worked tirelessly for the last few months to make this event a success.

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KEYNOTE ADDRESS Public Health Challenges in South Asia nd

2 May 2013, 5.30 pm to 6.15 pm at NIHS Auditorium South Asia, a region of strategic importance, faces public health challenges on a demographic and geographic scale unmatched in the world. India, Pakistan, Bangladesh, Nepal, Sri Lanka and Maldives are home to nearly one-fifth of the world's population. Of note, is that South Asia is also home to two-thirds of the world's population living on less than one dollar/day. Consistent with other countries in the region, South Asia is experiencing a rapid economic growth with concurrent improvements in health and consequent decline in mortality rates. However, inequalities in health conditions exist across and within countries. As with other developing countries, South Asia faces four central challenges to health which are at a much greater magnitude due to its enormous population and limited resources:(1) transition from primary communicable disease burden, toan increasing burden of non-communicable diseases such as cardiovascular diseases, cancer and psychiatric disorders, and additionally, injuries from road traffic accidents; (2) Human immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS) epidemic in low-income populations; (3) preparedness for emerging new diseases such as avian influenza; and (4) persistence of preventable deaths from malaria, tuberculosis, diarrhea, and pneumonia, with malnutritionas the common underlying condition. Improving the outcomes of these challenges depends not only on economic investments but also on the circumstances within each country such as government implementation of policies and processes, and the infrastructure to provide services. There is no single strategy that will work for all countries; and thus, context-specific strategies and responses are essential. Experiences of Sri Lanka, and Kerala state in India among many others, conclusively show that dramatic improvements in health can occur without high or rapidly growing incomes. Investments in evidence-based research in epidemiology and health systems, newer fields such as epigenetics and early origins of disease and the incorporation of economics are needed to improve the efficiency of available clinical and public health interventions and to inform new interventions. Evidencebased knowledge should be the basis of allocation of limited resources to derive the maximum benefit from each dollar spent on health. Although there is no optimal formula for health spending, a major portion should be allocated for primary (avoid development of a disease) and secondary (halt or slow the progress of a disease) prevention of disease. A holistic and cost-effective approach to establish goals and priorities tailored for each country is needed to achieve the ultimate goal of reducing morbidity and mortality for all segments of the population. Finally, there must be a political will to ensure that quality is a top priority on the health care agenda.

Prof. Nalini Sathiakumar MBBS, MD, MSPH, DrPH

Professor in Epidemiology Department of Epidemiology School of Public Health University of Alabama at Birmingham USA

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PRE-CONGRESS WORKSHOPS 2nd May 2013, 9.00 am to 1.00 pm There will be two parallel pre-congress workshops.

Pre-Congress Workshop I –'Towards Total Wellbeing” Venue: Seminar Room 1 Do you want to look better, feel better and perform better?

If you are genuinely in need of making a positive difference to your own wellbeing we are geared to offer the pathway to you.

This total wellbeing workshop is designed to offer a holistic approach to wellness – introducing simple but evidence based effective techniques that would motivate you to achieve your physical, mental , social and emotional wellbeing- virtually covering all wellbeing aspects .

During this special workshop, participants will get hands on experience in modern physical training and ancient meditation techniques. The subtopics include simple mental training techniques and meditation techniques such as imagery techniques, activity meditation, diaphragmatic breathing, and Chakra meditation. Furthermore, workshop will introduce the NIHS safe physical exercise program as well as fitness concepts. Experienced panel of master trainers in mental training and physical fitness will conduct the workshop.

We look forward to bring life time experience to you where you can discover a range of natural ways to total wellbeing at the hand of experts.

Workshop convenor: Dr. Ruchith Priyananda, MBBS, PG Certificate (Medical Education), Personal Training Specialist (Canada), Head, Department of Educational Science, National Institute of Health Sciences.

Pre-Congress Workshop II–Introduction to Research Methodology Venue: Seminar Room 2 The famous inventor and chemist Hudson Maxim said “All progress is born of inquiry. Doubt is often better than overconfidence, for it leads to inquiry, and inquiry leads to invention” implying the importance of research.

Research is an art of searching pertinent information on a specific topic. It is a systemic and scientific effort to gain new knowledge in a particular area. The systematic procedure adopted to solve the research problem is called research methodology. There are various steps that are generally adopted by a researcher in studying a research problem.

During this special workshop participants will learn the scientific way of conducting a research. Workshop will be conducted by a panel of experienced research methodologists. The workshop will outline basic steps in research methodology and link up the participants with the experts to design research studies when they are back to their respective stations. Participants will be awarded CPD certificates.

Workshop convenor: Dr.Murali Vallipuranathan,MBBS, PGD (Population Studies), MSc, MD (Community Medicine), Consultant Community Physician, Management, Development and Planning Unit, Ministry of Health.Visiting lecturer, University of Colombo; PhD Scholar, King's College, London.

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PLENARY SESSIONS AND SYMPOSIA Plenary Session 1 rd

3 May 2013, 10.30 am to 12.00 pm at NIHS Auditorium Burden and Prevention of Non-Communicable Diseases Co - Chairs: Dr. Palitha Mahipala, Director General of Health Services, Department of Health Services, Ministry of Health, Sri Lanka Professor Rohini de Alwis Senevirathne, Head of the Department, Department of Community Medicine, University of Colombo, Sri Lanka Speakers: Dr. Graham Roberts, Deputy Director, Human Resources for Health Knowledge Hub, School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Australia.

Dr. Thalatha Liyanage, Director, Non Communicable Disease Unit, Ministry of Health, Sri Lanka Dr. Susie Perera, President, College of Community Physicians of Sri Lanka and Director, Policy Analysis, Ministry of Health, Sri Lanka The plenary session will begin with an overview on the STEPS reports for pacific states by Dr. Graham Roberts.

Globally, Non Communicable Diseases (NCDs i.e.cardiovascular diseases, diabetes, cancers and chronic respiratory diseases) are the leading causes of mortality, accounting for 63% of 57 million deaths in 2008; 80% occurring in low and middle income countries. The epidemics of NCDs in the Pacific are now reaching alarming proportions; with increasing treatment costs are having the potential to deplete small islands state health budgets. Leading risk factors for NCD are tobacco use, alcohol consumption, low fruit and vegetable consumption, lack of physical activity, raised BMI, raised blood pressure, raised fasting blood sugar and raised blood cholesterol. The STEPS Reports for 13 Pacific Island states are presented to characterise the NCD epidemics in the Pacific region, the prevalence of behavioural and biometric risk factors and the prevalence of hypertension, raised fasting blood sugar and raised cholesterol. Recent development of the STEPS framework includes the estimation of a 10 year risk of a fatal or non-fatal cardiovascular event, although yet to be adjusted for high Pacific rates of obesity, among the highest in the world.

Dr. Thalatha Liyanage in her presentation will be elaborating the NCD burden in Sri Lanka. The country's transition from a low income country to a middle income country has changed traditional agricultural to industrial base life style. Life expectancy of citizens is over of 71 years, and is in the advanced stages of a demographic transition. NCDs are more common with aging and likely to increase more in the future years since proportion of people 60 years and older is likely to more than double by 2040, to just above 24 percent of the total. NCDs, are the leading cause of mortality, morbidity and disability in the country. During the past halfcentury the proportion of deaths due to circulatory disease (such as heart disease and stroke) has increased from 3 percent to 24 percent, while that due to infectious diseases has decreased from 42 percent to 20 percent.

Mortality rates from NCDs were currently 20–50 percent higher in Sri Lanka than in developed countries. The disparities were most substantial for cardiovascular diseases and asthma. In Sri Lanka two-thirds of all deaths in the country is attributed to NCDs. Out of all deaths, 29.6 percent were attributed to CVDs, 9.4 percent to cancers, 8.5 percent to respiratory diseases and 3.9 percent to diabetes. Incidence of hospitalization increased by 36 percent, 40 percent and 29 percent due to diabetes mellitus, hypertensive disease and ischemic heart disease respectively, in 2010 as compared to 2005.

The government of Sri Lanka acknowledges that the prevention and control of chronic NCDs is a priority issue in the national health agenda and priority been given in the National Health Master Plan 2007-2016. Ministry of Health has formulated the National Policy for Prevention and Control of Chronic Non-communicable Diseases in 2010. It addresses prevention of shared modifiable risk factors through community based health promotion programme and island wide screening programme at healthy life style centers, providing acute and integrated 18

long-term care for people with NCDs (secondary and tertiary prevention) in order to maximize their quality of life.

Commitments and guiding principles for way forward in prevention and control of NCDs in Ministry of Health Sri Lanka, are addressing risk factors through multi-stakeholder partnership, health system strengthening, providing essential medicines and technology and monitoring and evaluation leading to accountability.

Lastly Dr. Susie Perera will be presenting about the “Healthfest” launched as an entry point to social marketing in adopting healthier lifestyles since changes in lifestyle are major contributing factors to non communicable diseases among fast ageing population of Sri Lanka. “Healthfest” was an event planned as a day for advocacy, awareness and activities, creating a platform for all age groups to experience healthier lifestyle options. The event created opportunity for different supply agencies (food, beverages, etc) to promote and sell healthier options.

“Healthfest” was aimed at launching a social marketing strategy to empower people and organizations to adopt healthy life style through achieving eight health targets throughout life. A process of multi-sectoral engagement was adopted to create the platform for “Healthfest” through College of Community physicians of Sri Lanka.

Initial advocacy was done through presentations highlighting the present situation and the importance of partner organizations supporting the event. The agencies advocated included; cooperate sector, government sector (health, agriculture, education, armed forces, local government), Colombo Municipal Council, youth groups, preschools, NGOs, leading catering and beverage companies. Eight health targets were identified to overcome the contribution of modifiable risk factors for non communicable diseases by a panel of experts by consensus based on scientific evidence. These eight targets were branded as the "Super Eight- a simple way to a better life" with a specific logo as a means for socially marketing empowerment. The President of Sri Lanka was invited to launch Super Eight at “Healthfest” giving a national importance to the targets. Media campaign was planned before and after the event for several weeks with leading newspapers and electronic media giving prominence to the event and health targets.

The Ministry of Health has accepted super eight as a social marketing strategy that can be used in the 'settings approach in health promotion'. The National Nutrition Secretariat, the highest coordinating body for nutrition too has incorporated Super Eight as one of its strategies. The armed forces have adopted the strategy among their cadres. Leading schools have indicated interest. Tools that have been developed in creating advocacy and awareness have been used repeatedly with an increasing demand. More requests are being made by organizations to know about Super Eight. A chain reaction has set in which needs continuous promulgation.

The “Healthfest” created a useful platform for the initiation of the social marketing strategy to empower people of all ages and organizations on eight health targets. Creating supply side interventions as useful healthier options in lifestyle change will take time. Continuous social marketing of Super Eight is needed to create a healthy demand that is profitable for supply organizations. The 'Super Eight' is a useful social marketing concept for a settings approach in health promotion and further supply side changes need to be advocated to facilitate population wide change. This also highlights the role that can be played by an independent non partisan professional body in health promotion in Sri Lanka.

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Plenary Session 2 th

4 May 2013, 10.30 am to 12.15 pm at NIHS Auditorium Innovative approaches to improve mortality statistics Co- Chairs: Dr. Palitha Abeykoon, Former Director, Health Systems and Human Resources Development, SEARO, WHO and Consultant, Ministry of Health, Sri Lanka Dr. Lene Mikkelsen, Independent Consultant, Australia Speakers: Prof. Ian Riley, Professor of Emeritus, University of Queensland, Australia Dr. Rasika Rampatige, Health Information Systems Knowledge Hub, University of Queensland, Australia Mr. Dilip Hensman, National Professional Officer, Health Information Systems WHO Country Office for Sri Lanka Dr. Abusayeed Haniffa, Health Information Officer, Ministry of Health, Sri Lanka Understanding mortality rates and causes of death (COD) has been fundamental to public health practice since the 19th century. Its usefulness involves the description and explanation of levels, trends and differentials in mortality, tracking changes in the burden of disease, setting priorities for interventions, monitoring the effects of public health programs, and the allocation and distribution of resources within the health sector. Mortality data are fundamental to the measurement of burden of disease.

Ideally, national mortality statistics would be based on the registration of all deaths in a country with each death being supported by a medical certificate showing the cause of death. Unfortunately, the quality of such data is not always as good as it should be, even in a country such as Sri Lanka with a long history of civil registration. A common response to deficiencies in civil registration is to rely more heavily for COD data on the analysis of deaths in hospital. Yet doubts remain about the quality of death certification in hospitals not only in terms of recording diagnoses but also of causes of death being wrongly entered into certificates and of subsequent faults in their coding. Also, hospital COD data are not necessarily representative of population mortality because of selective attendance to hospitals based on factors such as distance, education, wealth, age and the effects on behaviour of different diseases. One response to deficiencies in hospital data has been to collect information about population deaths from verbal autopsies, based on family recollection of terminal illness, which have now achieved high levels of accuracy. The symposium will begin with an overview of the field and of recent advances in the measurement of mortality. It will be followed by presentations on an automated tool for the assessment of the quality of mortality data, on new levels of precision using computer-based methods for the analysis of verbal autopsy COD data, and on a computer-based approach to the coding of mortality data.

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Symposium 1 rd

3 May 2013, 1.00pm to 2.00 pm at NIHS Auditorium Improving Adolescent Health in Sri Lanka Co-Chairs: Dr. R. Siyambalagoda, Deputy Director General (Public Health Services - II), Ministry of Health, Sri Lanka Dr. Prakin Suchaxaya, WHO,SEARO Regional Advisor, Nursing and Midwifery Speakers: Dr. Manjula Nishanthi Danansuriya, Consultant Community Physician, Adolescent Health, Family Health Bureau, Ministry of Health, Sri Lanka Dr. Shiromalee Renuka Ferdinandez, Medical Officer, Maternal and Child Health, National Institute of Health Sciences, Kalutara, Sri Lanka Dr. Priyani Devika Karunaratne, Medical Officer of Health, Ingiriya, Sri Lanka Dr. Nethanjalie Mapitigama, Consultant Community Physician, Women's Health and Gender, Family Health Bureau, Ministry of Health, Sri Lanka There are 3.8 million adolescents in Sri Lanka accounting for 19% of population. Of them 70% attend to school.

Adolescence is a time of transition, exploration, and experimentation. Associated risk behaviors not only influence morbidity and mortality of the adolescents, but also have long-lasting impact in determining future adult lifestyle.

It is crucial to consider young people as assets to work with to improve Maternal and Child health indicators further and to achieve Millennium Developmental Goals. The needs of adolescents are often being ignored by the society including service providers.

The Adolescent Health Strategic plan (2013-2017) has been formulated to provide strategic directions addressing emerging issues and challenges pertaining to health of the adolescents to provide better services for adolescents.

The School and Adolescent Health Unit of the Family Health Bureau, acts as the focal point for the National School and Adolescent Health (SAH) Program and works in collaboration with the Ministry of Education and is responsible for planning, monitoring and evaluation and also build capacity of service providers on adolescent health.

The SAH program includes School Medical Inspection, weekly iron folate supplementation, oral health services, health education and Health Promoting School Program. Teacher counseling services are offered to schools with more than 400 students.

The Directorate of Youth, Elderly Disabled and Displaced in the Ministry of Health engages in providing care for young persons through a network of Youth Friendly Health Centers located in selected hospitals.

Pilot project has been carried out in Kurunegala District on establishing Adolescent friendly health services at field level. The health workers were trained on Adolescent health and life skill. The health staff mainly focused on outreach activities focusing schools, vocational training institutes and youth corps as a mean of building relationship and advertising the services available. SRH education, nutritional screening, counseling services, life skill education and carrier guidance services have been offered.

Peer group approach has been adopted in some areas with a group of motivated adolescents to create a bridge between adolescents in need and the health services and to facilitate referrals. Providing adolescent services via Maternal and Child Health clinics has been attempted in some MOH areas. Screening for health problems, micronutrient supplementation, contraceptive services and information services has been offered for adolescents.

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A new package focusing the newly married couples including young persons is being implemented in several districts to improve knowledge and attitudes on pre-conception health, to detect and manage the health problems of the couple before they attain parenthood and also to provide pre- conception care services including family planning.

The symposium will begin with a presentation on the improvement of health of adolescents in Sri Lanka. Then two field experiences of sharing best practices in delivering adolescent friendly health services in Sri Lanka will be highlighted. It will be followed by a presentation on improving adolescent health through pre- conception care.

Symposium 2 rd

3 May 2013, 1.00 pm to 2.00 pm at Seminar Room 1 Improving Civil Registration & Vital Statistics Co-chairs: Dr. Anoma Jayathilaka, National Professional Officer-MPS, WHO - Sri Lanka Prof. Ian Riley, Professor of Emeritus, University of Queensland, Australia Speakers: Dr. Lene Mikkelsen, Independent Consultant, Australia Dr. Saman Gamage, Department of Management, National Institute of Health Sciences, Kalutara, Sri Lanka “Too many people, especially the poor, are never counted; they are born, and live and die uncounted and ignored”. Since this was written in the Lancet’s “Who Counts?” series in 2007, which lamented the poor state of civil registration and vital statistics (CRVS) in many countries, much has fortunately changed. Dr. Mikkelsen’s presentation gives an overview of what have been the drivers of the now global movement for improving CRVS, in which many Asian countries have been at the forefront. The demand for assistance in this area has not gone unnoticed by donors and technical partners and has resulted in funding for initiatives such as the Health Metrics Network (HMN) and the Health Information Systems Knowledge Hub (HISHub) in Australia.

Dr. Mikkelsen, who first worked for HMN and now works for HISHub, has been closely aligned with the tools and knowledge products which have come out of these two initiatives. Just after its creation in 2008, HISHub together with WHO, HMN and other partners began to develop a series of tools that countries can apply to help them improve the functioning of their CRVS systems. At that time it was becoming increasingly clear that without better vital statistics it would be very difficult for countries to monitor whether they were achieving the Millennium Development Goals. The need for a set of standards-based tools, which could be applied in any country with minimum adaptation, was clear and has guided much of HISHub’s research effort.

The presentation will describe the basic framework for CRVS which is common to all the tools, the purpose of each tool, and what results can be expected from their application. The symposium will also be an opportunity to inform about the training and technical assistance work that HISHub has carried out in Asia and the Pacific, and the key lessons learnt which might be of benefit to CRVS development strategies in the region.

Completeness is a measure of the extent to which the births and deaths that occur in a country in a given year are registered by the CRVS. Dr. Saman Gamage in his first presentation will describe how he used the capture – recapture approach to assess the completeness of birth and death registration in Maldives.

The few studies that have been carried out in Sri Lanka to assess the quality of death certification have revealed a considerable percentage of misclassifications of causes of death as well as a high proportion of deaths attributed to ill defined causes. Doctors across the world, as in Sri Lanka, do not generally have adequate opportunities for training on cause of death certification.

Dr. Saman Gamage in his second presentation will introduce an educational package to be used in Sri Lanka to improve the quality of cause of death certification by Doctors.

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Symposium 3 rd

3 May 2013, 1.00 pm to 2.00 pm at Seminar Room 2 Application of Research into Practice in Cancer Control in Sri Lanka Co- chairs: Dr. Sunil De Alwis, Deputy Director General (Education, Training and Research), Ministry of Health, Sri Lanka Dr. Sarath Samarage, National Consultant, World Health Organization, Sri Lanka Speakers: Dr. Hemantha Amarasinghe, Consultant in Community Dentistry, National Cancer Control Programme, Sri Lanka Dr.P.V.S.C. Vithana, Consultant Community Physician, National Cancer Control Programme, Sri Lanka Dr.Eshani Fernando, Deputy Director and Consultant in Community Dentistry, National Cancer Control Programme, Sri Lanka Dr.Suraj Perera, Consultant Community Physician, National Cancer Control Programme, Sri Lanka The first presentation is on a new intervention launched for early detection of oral cancer which is the commonest malignancy among males in Sri Lanka and the sixth most common cancer among females. Screening for oral cancer has been carried out at various levels and in different settings, ranging from whole communities, targeted to high-risk groups and opportunistically in clinical environments. Considering the main obstacles to effective oral cancer screening over the intervening three decades, National Cancer Control Programme has developed a Risk Factor Model (RFM) to identify the high risk groups. This RFM and its criteria were utilized through a social marketing campaign and through primary health care structure to invite high risk people for screening.

The second presentation is on enhancing early detection of breast cancer which is the commonest neoplasm in Sri Lanka. Early detection and timely management was proven to be important. Clinical breast examination coverage is still very low: 2.2% among 35-60 year women in 2007. Further, lack of guidelines and health education materials, insufficient training for public health staff and inadequate monitoring and supervision were found to be barriers for provision of quality services on breast cancer early detection. National cancer control programme considering above evidence-based findings has implemented several island-wide interventions in the process of strengthening breast cancer early detection services.

It will be followed by a socio economic study on breast & oral cancer, which are the most common cancers among females and males . This study was conducted with the objective of finding out the socioeconomic impact of the disease on patients' seeking treatment at the National Cancer Institute (NCI), Maharagama. The educational level and the level of family income were found to be higher in breast cancer patients compared to oral cancer patients. Request for support for financial and social difficulties and advice regarding treatment and side effects of treatment were named by 60% as expected some aspects of community level services. Counseling services at community level for psychological problems and transport services to attend the hospital clinic were the other expected services by nearly 50% of the sample.

Last presentation is on caring cancer patients in the community. Cancer patients are offered active treatment with curative or palliative intent at cancer treatment units. After the active treatment, cancer patients go back to the community. Therefore, needs of people living with cancer have to be addressed at the community level.

Existing services available at the community were reviewed and the importance of cancer support network to facilitate cancer patients' needs and to improve their life condition was identified. Further, palliative care needs have to be addressed in the community for those who have received treatment with palliative intent. Experience of commencing hospice based and home based palliative care is available in Sri Lanka and needs to be further strengthened.

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Symposium 4 rd

3 May 2013, 1.00 pm to 2.00 pm at Seminar Room 3 Health System Improvement through Good Governance Co- chairs: Dr. Graham Roberts, Deputy Director, Human Resources for Health Knowledge Hub, School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Australia Dr. S. Dalpatadu, Former Deputy Director General, Ministry of Health Speakers: Dr. Lakshman Gamlath, Director, National Institute of Health Sciences, Ministry of Health Surgeon Rear Admiral Nicholas E.L.W. Jayasekera, Director General Health Services, Sri Lanka Navy Dr. Suranga Dolamulla, Regional Director of Health Services, Hambantota Improvement of quality of services in most government departments was a priority in Sri Lanka with the dawn of the new millennium. The session will begin with a presentation on Innovative approach to improve the quality of health care delivery by Dr. Gamlath. Department of Health services also took a special interest in improving the quality of health care delivery. Although there is widespread interest in the health sector to improve quality of care there was little technical guidance until 2010 when the series of guidelines were developed and published.

Those “National Guidelines for Improvement of Quality and Safety of Health Care Institutions” were a baseline for quality improvement in health care facilities.

Although there were quality concepts like Japanese 5S, practical difficulties were encountered in implementing these concepts in our institutions. Therefore this novel concept was developed and implemented in General Hospital Kegalle in 2010. It was so successful that within one year Kegalle hospital won the gold award for quality and safety as the best hospital in its category.

The core concept was based on Pareto Law or 80-20 theory which states that, for many events, roughly 80% of the effects come from 20% of the causes. Most important areas in health care delivery in hospitals were identified and grouped in to 10 different committees. Each committee did a situation analysis in its area and identified key areas of concern and then developed a plan of action to address the issues. Action plan was reviewed every month and at the end of one year, 93% of the activities had been completed successfully, another 4% partially and 3% could not be achieved.

This shows that this approach is highly effective in improving the quality of service delivery in government health institutions and could be applied in other institutions as well.

Then there will be presentation on medical leadership by Dr. Nicholas E.L.W Jayasekera. Leadership could be defined as “a process whereby an individual influences a group of individuals to achieve a common goal”.

Medical Leadership is issuing the technical knowledge in medicine leading a health care organization towards its common goal.

For almost 140 years since the creation of the first medical administrative post, management skills have not been prominent in either the curricula or the appraisal systems of courses for medical undergraduate and post graduate students. During this period most doctors ended up in administrative positions as they became senior without any formal management training.

Today we have 1067 state and 125 private sector health care institutions, and our services are experiencing a gap in quality and productivity in the backdrop of increasing demand, costs and competition. Despite these developments only about 20% of the state sector health care institutions are manned by medical leaders who have had a formal training in Medical Administration. However, a key question discussed in many circles is whether we are producing the desired type of leaders for optimum performance at all levels in health care. When considering the multitude of issues related to both patients as well as providers, the answer is that there is much room for improvement.

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What we need is a paradigm shift from developing knowledge and skills to developing attitudes. To do this we need to change the way we think, feel and behave towards others developing positive attitudes through social learning. Hence, permit me to make two broad proposals.

The first and long term proposal is to place attitude and leadership development high on the agenda of all school, undergraduate and post graduate curricula. As a majority of these skills are learnt, all of us here have a social responsibility to lead by example so that our juniors may learn. In this regard let me quote Albert Einstein who said “Setting an example is not the main means of influencing another, it is the only means”.

As a prescription for developing attitude let me quote two publications. The first is “Working with Emotional Intelligence” by Danel Goleman who defines Emotional Intelligence (EI) as “capacity for understanding our own feelings and those of others, to motivate ourselves and manage emotions in ourselves and in our relationships”. In developing EI we need to understand self by self-awareness, self-regulation and motivation and we need to understand others by empathy and build relationships. The other publication which is linked to the relationship dimension of the first, is “The Speed of Trust” by Steven Covey who argues that trust by increasing speed and reducing cost is an essential ingredient for building relationships and effective leadership.

The second and short term proposal, until we achieve the above in the long term, is to recruit for attitudes and train for skills. Traditionally our recruitment and advancement criteria have been based on knowledge and skills.

We need to move away from this mindset, and give adequate weight to positive attitudes, particularly at recruitment. I am aware that identifying an individual's attitudes is no easy task, but it must and can be done.

Dr. Suranga Dolamulla will speak on 'Rural Health System Strengthening through Governance'. Governance in health is increasingly regarded as a silent theme on the development agenda. Increased interest in governance has been driven by the need for greater accountability arising from both increased funding and a growing demand to demonstrate results.

Health care facilities globally are unequally distributed across sectors with less priority given to the rural sector and attracting health care resources and diversified funding to such areas and retaining continuous development becomes a challenge. Since the underlying factors are complex, the health sector may not address this challenge in an effective manner without health care governance.

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Symposium 5 rd

3 May 2013, 2.15 pm to 3.15 pm at NIHS Auditorium Researching on Adolescents And Beyond Co-Chairs: Dr. R. Siyambalagoda, Deputy Director General (Public Health Services- II), Ministry of Health, Sri Lanka Dr. Prakin Suchaxaya, WHO, SEARO Regional Advisor, Nursing and Midwifery Speakers: Dr. Neelamani S. Rajapaksa-Hewageegana, Consultant Medical Administrator and Director, Health Education Bureau, Sri Lanka Dr. Kapila Sooriyaarachchi, Communication Specialist, Health Education Bureau, Sri Lanka Dr. Uthpala Amarasinghe, Head, Life Skills Development and Health Media Unit, Health Education Bureau, Sri Lanka The session begins with a presentation on the difficulties encountered in a research on adolescent health and the innovative approaches utilized to achieve data gathering. The dearth of research conducted in Sri Lanka and the limited relevance of those that have been conducted elsewhere to the Sri Lankan context was known. There was a clear need to address this gap in knowledge, by generating empirical data on the complexities of adolescent pregnancy in Sri Lanka. However, the degree of resistance that encountered and the potential consequences which were there not only on the study itself, but on study participants and the health care staff working in this area will be elaborated.

The research titled “Exploration of Adolescent Sexuality and Pregnancy in Sri Lanka - A Quantitative Approach� had three components. Component on pregnant adolescents (Sample size 450, interviewer administered questionnaire), their partners (Sample size 150 interviewer administered questionnaire) and school adolescents (Sample size 2020, Self-administered questionnaire). The inclusion of questions related to reproductive health was considered inappropriate for the school adolescents by the Ministry of Education. The pregnant adolescent data collection from over 18 has been achieved without any difficulty; collecting data from under 18 pregnancies was a challenge. How tightening was the regulations around eligibility for marriage and how the law enforcement officers started to focus attention on the midwives who provide antenatal care to underage girls will be elaborated. When the data collectors attempted to recruit partners of pregnant adolescents to the study, many of them were very reluctant to participate because they were fearful of potential legal ramifications of providing detailed information about themselves. Innovative steps were taken and the data were successfully gathered amidst hardships.

Next speaker will address creative communication approaches for adolescents. Most of the adolescents are familiar in using modern communication technologies. For the same reason they are more vulnerable to get exposed or appealed into unhealthy or harmful motivations. Use of creative communication approaches for empowerment of youth has a supplementary effect on behavior changing programmes. Strategies used were development of different communication materials creatively which can be used in interpersonal, group and mass media communications such as tele films, video clips, dramas, advertisements, visualized songs etc. Also the use of community music therapy to restore, protect and nurture our social values and nourish humanity among adolescents by introducing music in a way that will relieve emotional burdens, facilitate expression of feelings will be discussed.

Lastly a flexible and novel ways of touching the behaviours of youth will be presented named "Let Me Become One of You". A teacher, parent, adolescent and a journalist will be joining the session with their views and activities. Nowadays, various ways of entertaining and changing behaviours of the youth are practiced all over the world. To communicate with young people, interactive and sharing methods are recommended. This session presents some methods used to interact and build the life skills of youth. It demonstrates the ten life skills and the life skills promotional approaches in health education targeting common challenges faced by the youth of Sri Lanka. Life skill development is a team effort and this session will be an eye opener for parents, peer leaders and teachers for implementing youth friendly programs.

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Symposium 6 rd

3 May 2013, 2.15 pm to 3.15 pm at Seminar Room 1 Innovative Health Projects Co-chairs: Dr. Joe Fernando, Former Secretary of Health, Ministry of Health, Sri Lanka Dr. Sudhansh Malhotra, Regional Adviser (Primary and Community Health Care) WHO –SEARO 1. National Healthy Schoolbag Campaign of Sri Lanka Speaker: Dr. Kapila Jayaratne, Consultant Community Physician, Maternal and surveillance Unit, Family Health Bureau, Ministry of Health, Sri Lanka

Child Morbidity and Mortality

One of the crucial parameters of the environment is the ergonomics which plays an important role in influencing the health of school children. To optimize the compatibility between user population and operating environment, an ergonomic perspective is essential. School constitutes an important environment for the child where 'productivity' in terms of attainment of expected educational levels is of prime importance to the child, the family and the country as a whole.

A school-based cross-sectional study was conducted to describe carriage of school material and to determine their relationship to musculoskeletal pain and selected physical attributes of school children. A sample of 1607 school children of Grade 6, 7 and 8 were selected from 55 schools using stratified multi-stage cluster sampling method.

The study revealed the need for major improvements in several ergonomic parameters related to schoolbag and behavior. Mean weight of a schoolbag was 3.72 Kg (11.04% of body weight). A heavy bag (>10% of body weight) was carried by 57.9%. Text books (36.7%), other books (30.4%) and non-book items (17.7%) accounted for the total weight. Most (96.9%) students always carried their school bag by themselves.

Although 79.6% used a healthy model (backpack), >80% were not ergonomically designed. Evaluation of backpacks revealed presence of movable straps (99.4%), padded shoulder straps (91.6%) and 10.4% compartmentalized. A waist-belt was present in 29.5% backpacks and usage only 30.5%.Both shoulder carriage of backpacks 97.1% and only 2.9% carried the backpack in other styles.

Children reported musculoskeletal pain at anytime (72%) and recurrent pain (35.9%). Perceived discomfort having to carry school material was 72%. Both shoulder carriage (OR=0.06) and use of waist-belt (OR = 0.57) lowered risk of recurrent pain. Children perceived severe general tiredness and reported discomfort linked with the carriage of schoolbag.

Research findings were translated into action based on: strategies for bag-weight reduction, introduction of a model healthy bag and “bag behaviour change”. Advocacy of policy makers of both health and education sectors carried out. Text books were split in to several volumes. The size of the exercise books was limited to 80 pages. A healthy schoolbag was modeled and introduced at national level. Standards on schoolbags were developed by Sri Lanka Standards Institute. Bag manufacturers were registered and made aware on “healthy bag”. Children, parents and teachers were made knowledgeable through mass media, leaflets and at exhibitions on healthy bag and bag behaviour. Nearly four million school children will be the beneficiaries of this project.

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2. “Jevithayata Nava Eliyak� (Light for Life): Interventions for Sri Lankan prison inmates to prevent HIV/AIDS Speaker: Dr. Janaki Vidanapathirana, Consultant Community Physician, National STD/AIDS Control Programme, Ministry of Health, SriLanka Sri Lanka is a low prevalent country for HIV/AIDS. High risk target interventions are aimed to maintain a low prevalence in Sri Lanka. Prisoners are one of the high risk groups for targeted interventions due to the high prevalence of unprotected homosexual activities in the prisons.

In 2010, Quantitative and qualitative surveys were carried out in island wide prisons to find out the current knowledge on HIV and current sexual behaviors among prison inmates. Global fund for HIV prevention activities in island wide prisons, included advocacy, skill building of welfare officers and medical staff on sexual health promotion. Trained welfare officers trained the prison inmates as peer leaders. Prison inmates trained as peer leaders have carried out both formal and informal sessions with inmates using different communication materials. Inmate peer leaders have taken the leadership in the prisons to prevent HIV/AIDS. Setting up of STI clinics in the prison hospital and awareness amongst inmates were done time to time. Special two days life skill training was given to young offenders and juvenile prisoners. Prison inmates were volunteered for HIV testing after peer leader discussions. HIV testing was carried out through mobile clinics as a preventive option. Problem solving workshops were carried out for both trained officers and peer leaders.

External evaluation in qualitative method and problem solving workshops revealed that peer leader interactive behavior change communication package is effective in HIV/AIDS prevention among prison inmates. Peer leader training and peer leader activities should be done continuously as prison inmates and remand prisoners are a group of highly mobile population.

3. National Intensive Care Surveillance: An innovative public health intervention for the Developing World in critical care medicine Speaker: Dr. A. Pubudu de Silva, National Intensive Care Surveillance, Ministry of Health, Sri Lanka Critical care provision is expensive but important. The competition for ICU beds in the developing world is fierce.

Whilst the global burden of critical illness is growing, the research into the critically unwell in resource poor settings is minimal.

There are several critical care registries in the Western world while similar systems in the developing world are rare. In Sri Lanka though there are around 100 critical care units in the Island, there was no such registry or an emergency bed availability system.

The primary objective of this program is to develop a national critical care registry and a critical care bed availability system. Other objectives are promoting local audit of critical care through the provision of comparative data, improving the quality of audit and research in critical care, promoting the use of evidence in critical care practice, planning and policy making, contributing to training and education in critical care, collaborating with similar overseas registries and building capacity in critical care research.

The National Intensive Care Surveillance was set up by the Ministry of Health, Sri Lanka in collaboration with the Mahidol Oxford Research Unit (MORU) and NICE (National Intensive Care Evaluation) of the Academic Medical Centre, University of Amsterdam in 2012. The College of Anesthetists of Sri Lanka, The College of Physicians and the Faculty of Medicine, University of Colombo and Information Communication Technology Agency (ICTA) are the main partners.

Each ICU in the NICS system was provided with a computer, a landline telephone and internet access. Software to capture a defined critical care minimum dataset, bed availability and staffing information was piloted and developed in collaboration with NICE. The medical staff is trained to enter this information, at predetermined intervals.The data is transmitted to a central office on a daily basis where it can be assessed for completeness, 28

and in due course, for accuracy by trained data validators. Data accuracy will be assessed using horizontal and vertical validation methods. Any missing or unclear data is queried from the ICU concerned and necessary amendments made. The system has linked 58 ICUs with a critical care bed availability system where a caller can be directed to the closest available ICU bed and summary data to feedback to the ICUs. The first feedback reports are being sent to the respective ICUs. Reports on the completeness or otherwise of the data submitted and some indicators regarding the accuracy of data are now available. Our experience shows that it is possible to establish a high quality critical care clinical registry in the developing world with an inherent data validation system, using basic technology and existing clinical staff in the ICU, leading to feedback reports to act as quality assurance. A bed availability system is an immediate end product. The registry can act as a tool to raise and answer clinical and research questions and to stimulate projects using the network as a base. Critical care training programmes using the network links for Medical staff can also be arranged.

Symposium 7 rd

3 May 2013, 2.15 pm to 3.15 pm at Seminar Room 2 Environmental Health and Climate Change Co chairs: Prof. Rohinie de Alwis Seneviratne, Senior Professor and Head, Department of Community Medicine, Faculty of Medicine, University of Colombo Dr. Sarath Amunugama, Deputy Director General (Public Health Services -I), Ministry of Health, Sri Lanka Speakers: Mr. Myles F. Elledge, Senior Director, RTI International, North Carolina, USA Prof. Rohinie de Alwis Seneviratne, Senior Professor and Head, Department of Community Medicine, Faculty of Medicine, University of Colombo Dr. Inoka Suraweera, Consultant Community Physician, Directorate of Environmental and Occupational Health, Ministry of Health Every year, an estimated 6.6 million deaths in Asia are attributable to various modifiable environmental health risks, accounting for one quarter of all deaths in the region. People living in South East Asia are faced with environmental challenges such as air and water pollution, improper solid and hazardous waste management practices, environmental emergencies, and exposure to toxic chemicals and hazardous substances. Some environmental health issues are trans-boundary and require concerted policies and approaches by countries to address them. Developing countries in South East Asia, has not paid enough attention to environmental health issues despite the magnitude of environmental health problems. The first speaker will address the environmental challenges in South Asia.

The next speaker will discuss the climatic factors and dengue fever in selected settings in Sri Lanka. It is the belief of climate scientists that the climate change is the result of emission of greenhouse gases from burning of fossil fuel and resultant global warming. The weather variability experienced in many parts of the world is also considered to be an outcome of global warming. The change in climate and in ecological systems enhances the geographical range, breeding sites, reproductive and biting rates and activities of vectors of disease. The occurrence of mosquito-borne diseases, including malaria, dengue, and viral encephalitic diseases are identified to be sensitive to effects of climate. In addition urbanization, population expansion and movement and the increasing population density along with human behaviour changes have resulted both in the formation of vector breeding sites and contributing to a higher risk of exposure of people to the vectors. Increasing trends in minimum and maximum temperature, rates of temperature rise, an increase in the number of warm days and nights and of the number of consecutive dry days and a decrease in the number of wet days have been reported by the Meteorology Department of Sri Lanka for the past 40 years than for the entire century of 1900-2000. The average rainfall analysis for the whole country shows that there is a slight decrease in annual total rainfall in Sri Lanka but the variability is higher during the 1961-1990 than 1931-1960, the two averaging thirty year periods.

The more important feature of the change identified in the report is the gradually enhancing variability of 29

rainfalls, as the higher variability of rainfall affects all climate sensitive activities and events adversely. A retrospective study done using routinely collected data on dengue fever, leptospirosis and dysentery and climatic data in five different settings in Sri Lanka. The presentation briefly highlights issues related to climate factors and dengue fever in these settings. It is also hoped that it will provide an insight to the relationship between the climate changes and the selected infectious diseases. The findings could also help in informing the prevention and control of the disease.

With the dawn of peace, Sri Lanka is aiming for rapid economic development. The development should be sustainable and should encompass nurturing the environment, enhancing economic growth and social equity to reduce poverty, promoting the health and well-being of people and encouraging partnerships and cooperation among various stakeholders and across countries in the region. Without environmental and health protection, development is undermined. On the other hand a healthy workforce is vital for sustainable social and economic development in any country in the world and Sri Lanka is no exception. Therefore, the need for a healthy workforce for Sri Lanka is warranted than any other times before. However, in the process of development, environmental and occupational health issues are anticipated warranting special attention. Considering the importance of these issues, the last speaker will discuss emerging environmental and occupational health issues in Sri Lanka.

Symposium 8 rd

3 May 2013, 2.15 pm to 3.15 pm at Seminar Room 3 “NCD Policy and Care Delivery Models�: Pilot Studies to National Programme

Co –Chairs: Dr. Manuj C. Weerasinghe, Consultant Community Physician & Senior Lecturer,Department of Community Medicine, Faculty of Medicine, University of Colombo, Sri Lanka Professor Vijay Jayasena, Professor of Food Science & Technology, School of Public Health, Faculty of Health Sciences, Curtin University Speakers: Professor Chandrika Wijeyaratne, Professor in Reproductive Medicine, Faculty of Medicine, University of Colombo, Chairperson,Nirogi Lanka Project Dr. Thalatha Liyanage, Director, Non Communicable Disease Unit, Ministry of Health Dr. Susie Perera, President,College of Community Physicians of Sri Lanka and Director, Policy Analysis and Development, Ministry of Health, Sri Lanka Dr. J.C.M. Tennakoon, Regional Director of Health Services, Badulla Non Communicable disease is emerging as a major threat to public health in Sri Lanka. Morbidity and mortality statistics of last decade points to alarming increase in many NCDs, mainly diabetes, hypertension and other metabolic syndrome related diseases. Apart from that morbidity and mortality related to cancer are also rising.

Sri Lanka being a fast aging country in the Asian region, chronic disease will be ever increasing. Changing economic environment, increase consumerism and sedentary lifestyle predisposes majority of the population to risk levels for NCDs. Within this atmosphere awareness on NCD as a public health emergency has increased among the health and allied professionals. Hence, many initiatives were proposed and implemented to combat the NCD epidemic.

Majority of those initiatives were started as pilot projects under the auspicious of Ministry of Health and multi lateral donors. However, there has been little discussion on how these models could be incorporated into the national programme. Such an opportunity would be extremely valuable to initiate a productive discussion to scale up activities at national level. Further, it provides an excellent opportunity to learn from each initiative to develop a common model to the country. With this objective in mind, a structured symposium in the form of a policy dialogue is organized at the International Conference on Public Health Innovations where main stakeholders for NCD would participate.

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The symposium starts with brief presentations on specific questions directed to each initiative. The questions are formulated to elicit how individual initiatives could be incorporated at national level. A presentation will provide a brief introduction to the initiative followed by lessons learnt supported by evidence. It will end with suggestions for changes needed in the current health system to incorporate the successful elements of each initiative at national level. The presentation will be on WHO/PEN in Uva province, “Nirogi Lanka� project, pilot project on NCD care in primary care setting and the current national programme on NCD. Presentations will be followed by a moderated discussion. Presence of decision makers from the Ministry of Health, Ministry of Finance and the public health practitioners for the discussion will be crucial to take this dialogue forward.

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FREE PAPER SESSIONS DETAIL PROGRAMME OP- 06 Contamination status of well water with special emphasis on some physico-chemical and microbiological parameters in selected five GN divisions in Maharagama

FREE PAPER SESSION 1 THEME: REPRODUCTIVE HEALTH 2nd May 2013 2:00 pm - 3:00 pm Venue: Seminar Room 1

Ganegoda, G. S. S., Manage, M. M., Pathirage, S. OP-07 Waste water filtering system: Innovative system to discharge the residential waste water safely

Chairpersons Dr. Nalika Gunawardena, Senior Lecturer in Community Medicine, Faculty of Medicine, University of Colombo

Sujeewa, J.

Dr. Sudhansh Malhotra, Regional Advisor (Primary and Community Health Care), World Health Organization, Regional Office for South-East Asia

OP-08 Eco-friendly cup Mudalige, M.P., Jayasuriya, M.

OP-01 The acceptability and the side effects of Jadelle速 Subdermal Implants among clinic attendees to the Family Planning Association of Sri Lanka

FREE PAPER SESSION 3 THEME: FOOD, NUTRITION AND HEALTH

Pathiratne, P.A.S.R., Tissera, S., Jayatilleke, A.C., Wimalarathne, M., Guruge, P.

2nd May 2013 2:00 pm - 3:00 pm Venue: Seminar Room 3

OP-02 Effectiveness of community based health educational intervention in reducing unmet need for family planning among women in reproductive age in Kalutara District

Chairpersons Prof. Machiko Higuchi, Professor, International Health and Nursing, National College of Nursing, Japan

Malwenna, I., Jayewardene, P.L., Balasuriya, A.

Dr. Thushara Ranasinghe, National Professional Officer, WHO Country Office, Sri Lanka

OP-03 Introduction of an educational material to improve knowledge and practices on selected factors among antenatal mothers in PHNS area Aluthgama

OP-09 Dairy products spoilage Gunasekara, S.P. Pathirage, M.V.S.C., Delpachitra, C.D., Paranagama, D.H.D., Kumarasinghe, K.W.M.L., Gunasekara,

Kusumalatha, P.D., Perera E.B., Ramyakanthi, P.L.M., Ratnasiri, D., Prasani N.M.N., Dayawathi, M.G., Mustapha, B.

U.K.D.H.M. OP-10 Public Health Issues Associated with Chicken Supply Chain

OP-04 Effect of Body Mass Index on outcome of pregnancy in women delivering singleton babies in MOH Area Thihagoda, Matara.

Coorey, R., Abu khalil, F., Bertolatti, D., Dhaliwal, S.,Jayasena, V.

Yaddehige, I. S., Sunethra , K.A. OP-11 Quality of dispensing folic acid supplements to pregnant mothers at government antenatal clinics of Kegalle Medical Officer of Health area

FREE PAPER SESSION 2 THEME: ENVIRONMENTAL HEALTH 2nd May 2013 2:00 pm - 3:00 pm Venue: Seminar Room 2

Wickramasinghe, A., Senarath, U. OP-12 Development of innovative healthy foods to address some of the current major public health issues

Chairpersons Dr.Hemantha Herath, Deputy Director, Directorate of Environmental and Occupational Health, Ministry of Health, Sri Lanka.

Jayasena, V., Syed M. Nasar-Abbas, Coorey, R., Dhaliwal, S

Mr. Myles F. Elledge, Senior Director for Global Development & Strategy Research Triangle Institute (RTI), USA OP-05 Environment noise levels in the city of Colombo Nagodawithana, N. S., Pathmeswaran, A., Pannila, A.S., Gurusinghe, R., Kalansuriya, C., Sathiakumar, N., Wickremasinghe, A.R.

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OP-18 Health system contribution in promoting leadership amongst Public Health Midwifes of Southern Province in Sri Lanka

FREE PAPER SESSION 4 THEME: ADVANCES IN DIAGNOSIS AND MANAGEMENT OF PUBLIC HEALTH PROBLEMS

Dolamulla, S.S., Samarage,S.M., Wickramasinghe, P.K., Edirimanna,H. 2nd May 2013 3:30 pm - 4:30 pm

OP-19 Training needs assessment on supervision among Public Health Nursing Sisters referring "Triple A" concept in Kalutara Regional Director of Health Services

Venue: Seminar Room 1 Chairpersons Dr. Sarath Samarage, National Consultant,World Health Organization, Sri Lanka

Ratnayake, U. I., Hettiarachchi, R., Gunasekara, P.L., Perera, S.Y.C. OP-20 National Institute of Health Sciences Safe Exercise Programme

Dr. Ranil Coorey, Senior Lecturer, School of Public Health, Faculty of Health Sciences, Curtin University

Priyananda, R.

OP-13 Impact of the Visual Stethoscope: Point of Care Sonography in Emergency and Critical Care

FREE PAPER SESSION 6 THEME: PUBLIC HEALTH, ADVOCACY AND COMMUNICATION

Munasinghe, M.A.A.K., Abeywickrama, A., Jayasekera, K., Samarakoon, M.A.S.C., Vidanapathirana, T.

2nd May 2013 3:30 pm - 4:40 pm Venue: Seminar Room 3

OP-14 Augmentative and alternative communication learning platform and therapeutic device

Chairpersons Dr.Neelamani Sandhaya Rajapaksa-Hewageegana, Consultant Medical Administrator, Director, Health Education Bureau, Sri Lanka.

Inas, J.M. Senarathna, R.M.T.S., Dissanayaka, A.P., Gnanathilaka, K.G.S.S.

Dr. S.D. de Silva, Former Director, National Institute of Health Sciences, Sri Lanka.

OP-15 Estimated Glomerular Filtration Rate calculated using IDMStraceable MDRD equation may predict the duration of diabetes in Sri Lankan Type 2 diabetic patients Wijayatunga, N.N., Perera, P.P.R.P., Peiris, H., Wanigasuriya, K.

OP-21 "Super Eight" a social marketing strategy to promote healthier lifestyles

OP-16 Developing a reliable method for measuring the parameters of orthotic and prosthetic gait in a less resourced setting.

Perera, H.S.R., Ranasinghe, A.T., Ranaweera, K.D.N.P., Fernando, S., Abeysekara, P., Wickramasingh, S., Amarasena, P., Dissanayaka, D. M. N.

Munasinghe, C.

OP-22 An Adverting Strategy to prevent Non Communicable Diseases through behavioral changes

FREE PAPER SESSION 5 THEME: HEALTH MANPOWER DEVELOPMENT

Wimalaratna, P.L., Wijewardhana, B.V.N., Poruthota, P.C.

2nd May 2013 3:30 pm - 4:30 pm Venue: Seminar Room 2

OP-23 A Study on impact of communication methods in cases of sexual assaults in Sri Lanka

Chairpersons Dr. Graham Roberts, Deputy Director, Human Resources for Health Knowledge Hub School of Public Health and Community Medicine, UNSW, Australia.

Vadysinghe, A.N., Senasinghe, D.P.P., Attygalle, U. Ilangarathna Banda,Y.M.G., AmeenIzzath, M.H.M. OP-24 “DAKSHINA JEEWANI�: an innovative approach for health education in Southern Province

Dr. U.K.D. Piyaseeli, Former Director, National Institute of Health Sciences, Sri Lanka.

Chandrasiri , P.A.A., Welarathna, A.U., Edirimanne, H., Godakandage,

OP-17 Development of competencies of Public Health Inspectors in Nothern and Eastern Provinces in Sri Lanka in order to improve their public health practices

S.S.P., Samaraweera A.

De Silva, P.S.C.K., Kaggoda Arachchi, S.M., Karunarathna, D.D.N., Mangala, I.G.

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OP-31 Provision of Mental Health Services through Community Partnership

FREE PAPER SESSION 7 THEME: COMMUNICABLE DISEASES

Wijewickrama, B. A. O., Fernando, N .F.J., Hettige, N., Samanthi, W. L. D.G., Rajapakshe, N., Kumarappeli, V., Priyadarshani, R.

3rd May 2013 9:00 am - 10:00 am Venue: Seminar Room 1

OP-32 Can music improve the disease status of stable angina? A randomized controlled trial

Chairpersons Dr. Paba Palihawadana, Chief Epidemiologist, Epidemiology Unit Prof. Ian Riley, Professor Emeritus, University of Queensland, Australia

Siritunga, S., Wijewardena, K., Ekanayaka, R., Mudunkotuwa, P.

OP-25 Prevention and control of dengue epidemics through application of evidence based dengue alerts and vector control interventions

FREE PAPER SESSION 9 THEME: SCHOOL AND ADOLESCENT HEALTH 3rd May 2013 9:00 am - 10:00 am Venue: Seminar Room 3

Kusumawathie,P.H.D., Jayakody, G., Samarasinghe, K .A. S. OP-26 Community acceptance and compliance for Long-Lasting Insecticidal Nets (PermaNet®) in rural villages during malaria elimination in Kurunegala District in Sri Lanka

Chairpersons Dr.Neelamani Sandhaya Rajapaksa-Hewageegana, Consultant Medical Administrator, Director – Health Education Bureau

Bandara, M.R.S.S., De Alwis, A.K.S.B., Deniyage, S.L.

Dr.Prakin Suchaxaya, Regional Advisor - Nursing and Midwifery, WHO Regional Office for South-East Asia

OP-27 Mathematical modeling and Dengue: An analysis of incidence of dengue in urban Colombo using wavelet approach

OP-33 Psychosocial environment of schools in relation to peer violence among schooling adolescents in Gampaha District

Wickrmaarachchi,W.P.T.M., Perera,S.S.N., Jayasinghe,S., Karunanayake, P. Kariyawasam, P.

Wijeratne, M.P., Seneviratne, R. de A., Gunawardena, N.

OP-28 Sputum positive tuberculosis among convicted prisoners in Sri Lankan prisons: prevalence and contributory factors

OP-34 Emotional and behavioral problems of school going adolescents aged 13-15 years in MOH Area Maha-Oya: prevalence, correlates and association with school performance

De Alwis, A.K.S.B., Samaraweera, S.D., Pallewatte, N.C., Ambagahage, T.M.

Jayawickrama, W.I.U., Senaratna, C. FREE PAPER SESSION 8 THEME: MENTAL HEALTH

OP-35 Simple interventions based on community empowerment to promote mental wellbeing among school children

3rd May 2013 9:00 am - 10:00 am Venue: Seminar Room 2

Liyanage, C. P. G., Anuradha, K. W. D. A., Rathnayake, U.I., Gunasinghe, A. D., Kumari, K. A. D. L.

Chairpersons Dr. Lakshmi Somathunga (Deputy Director General – Medical Services I)

OP-36 Mapping and size estimation of especially vulnerable youth in the Western Province, Sri Lanka

Dr. Lakmini Magodarathne, Head, Department of Public Health, National Institute of Health Sciences

Vidanapathirana, J., Karavita, A.

OP-29 Jeewanodaya community based rehabilitation center for mentally ill patients Fernando, W.D.Y., Anuradha, K.W.D.A. , Wickramasingha, L., Thalagala, Y.D., Abeywickrama, G.S., Kumara, P.G.H., Aluthge, P.C. OP-30 A qualitative study on improvement of mental health among a group of adults who took up vipassana meditation as part of lifestyle Gunathunga, P. M.W., Gunathunga, C.K.

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OP-43 Preventive dental clinic solutions to tackle early childhood dental caries

FREE PAPER SESSION 10 THEME: NON COMMUNICABLE DISEASES

Perera, I.R., Wickramaratne, P.W.N, Liyanage, N.L.P.,

3rd May 2013 3:45pm - 4:45 pm Venue: Auditorium

Karunachandra, K.N.N ., Bollagala, A.D., Kottahachchi, M.J., Wimalasena, B.A.S.S.

Chairpersons Dr. Lakshman Gamlath, Director, National Institute of Health Sciences, Sri Lanka

OP-44 Screening for HIV in the dental clinic

Dr. H.R.U. Indrasiri, Former Deputy Director General (ET & R), Department of Health Services, Ministry of Health, Sri Lanka

Perera, A. M. I. R., Johnson, N. W., Buddhakorala, K., Ariyarathne, M., Lalloo, R. Whitty, J., Amarasinghe, H., Rizwan, A.

OP-37 Cardiovascular disease risk score prediction models for women and its applicability to Asians

FREE PAPER SESSION 12 THEME: CHILD HEALTH 3rd May 2013 3:45pm - 4:45 pm Venue: Seminar Room 2

Goh, L.G.H., Dhaliwal, S.S., Lee, A.H., Della, P.R., Bertolatti, D., Coorey, R., Jayasena V., Binns, C.W. OP-38 Incidence and Risk Factors for Falls among the Elderly in the district of Colombo

Chairpersons Dr.Deepthi Perera, Director, Family Health Bureau, Ministry of Health, Sri Lanka.

Ranaweera, A.D., Fonseka, P., Siribaddana, S.H., Pattiya Arachchi , A. Dr.Anoma Jayathilaka, National Professional Officer, World Health Organization, Sri Lanka.

OP-39 Quality of life and its associated factors among patients with Chronic Kidney Disease attending the Provincial General Hospital Badulla

OP-45 The impact of exclusive breastfeeding on growth, respiratory tract infections and diarrhea during infancy: A retrospectiveprospective cohort study

Jayasinghe, J.A.D.A.E., Arambepola, C.

Chandraratne, S.H., Agampodi, S. B., Samita, S., Dharmaratne, S. S., Fernando, S.

OP-40 Coping strategies and treatment-seeking behaviour of patients with non-communicable diseases in four MOH areas of Sri Lanka

OP-46 Reducing of low birth weight of new borns in PHM area, Rathmalgahaela

Higuchi, M., Liyanage, C.

Herath, G.P.K., Jayasundara, S.J.B., Nandani , D.A.T.

FREE PAPER SESSION 11 THEME: ORAL HEALTH

OP-47 The development and validation of an instrument to assess caregiver burden in cerebral palsy: Caregiver Difficulties Scale

3rd May 2013 3:45pm - 4:45 pm Venue: Seminar Room 1

Wijesinghe, C.J., Hewage, C.G., Fonseka, P. Chairpersons Dr. Jayasundara Bandara, Deputy Director General of health services-Dental Services, Department of Health Service, Sri Lanka.

OP-48 Prevalence of Parental Disciplinary Practices in a Rural Community of Anuradhapura District

Dr. Ruwan Ferdinando, Deputy Director (Training), National Institute of Health Sciences, Sri Lanka

Siriwardhana J. D. D., Weerasinghe M. C.

OP-41 An innovative approach to utilization of risk factor model as an early detection tool for oral cancer in NIHS Field Practice Area

FREE PAPER SESSION 13 THEME: HEALTH PROMOTION / EMPOWERMENT

Sajeewa Lakmini, M.G., Amarasinghe, H.

3rd May 2013 3:45pm - 4:45 pm Venue: Seminar Room 3

OP-42 Prevention of early childhood caries

Chairpersons Dr. Sunil de Alwis, Deputy Director General (ET & R), Department of Health Services, Ministry of Health, Sri Lanka

Fernando, E.I., Seneviratna, H., Bandara, J., Perera ,D.

Dr. Sudhansh Malhotra, Regional Adviser (Primary and Community Health Care), World Health Organization, Regional Office for SouthEast Asia

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FREE PAPER SESSION 15 THEME: COMMUNITY NUTRITION

OP-49 A health promotion intervention on selected healthy behaviours in preschool settings in Colombo District

4th May 2013 9:00am - 10:00am Venue: Seminar Room 1

Perera, K.A.K.D., Kanthi, R.D.F.C., Hettiarachchi, R.M., Ranasinghe, N., Wijayalath, P.

Chairpersons Professor Vijay Jayasena, Professor of Food Science & Technology, School of Public Health, Faculty of Health Sciences, Curtin University, Australia.

OP-50 Healthier generation through health promotion school settings Ratnayake, U.I., Sunil Shantha, S.K., Bandara T., Jayakodi, N.P., Wijewardhana, J.C. I .K.

Dr. Sriyani Ranasinghe, Deputy Director (Field Services), National Institute of Health Sciences, Sri Lanka.

OP-51 A health promotion intervention to reduce domestic violence in a rural community in the Anuradhapura district, Sri Lanka Reyal, H. P., Guruge, G.D.N., Fernando, W. M. S.

OP-57 Nutritional status and complementary feeding practices of children aged 6 to 23 months in Medical Officer of Health area, Kaduwela

OP-52 Happy villages through health promotion

Abhayagunaratne, T.R., Batawala, C.P., Gunasekara, C., Ekanayake, M.M.C., De Silva, A. OP-58 Validation of the Sinhala version of the Dutch Eating Behaviour Questionnaire

Rajapaksa-Hewageegana, N.S., Munaweera ,B..

Dissanayaka,D.M.N., Dharmagunawardena, D.

Illangasekera, Y.A., Kumarasiri, P.V.R., Dalton, C.F., Fernando, D.J. FREE PAPER SESSION 14 THEME: HEALTH INFORMATION MANAGEMENT

OP-59 Complimentary feeding programme in Hambantota District

4th May 2013 9:00am – 10:00am Venue: Auditorium

Rajapaksha , S.

Chairpersons

OP-60 An innovative project that links child nutrition status by supporting growth monitoring

Dr. S.R.U. Wimalarathne, Director, Information- Ministry of Health, Sri

Peiris, D.R., Miralan,V., Sutharsan V., Logithrajah P.

Lanka Dr. Lene Mikkelsen , Independent Consultant, Australia

FREE PAPER SESSION 16 THEME: PUBLIC HEALTH ISSUES IN CURATIVE SETTINGS

OP-53 Improving ICD Mortality Coding Practices Gamage, U.S.H.

4th May 2013 9:00am - 10:00am Venue: Seminar Room 2

OP-54 Comparison of electronic and paper based Indoor Morbidity Mortality Reporting Systems

Chairpersons Dr. Stanly de Silva, Former Deputy Director General (ET & R), Department of Health Services, Ministry of Health, Sri Lanka

Kariyawasam, N., Wickramasinghe, S.C., Dayaratne, M.K.D.R.B., Sylva, K.K.P.

Dr. Manuj C. Weerasinghe, Senior Lecturer -Department of Community Medicine, Faculty of Medicine, University of Colombo, Sri Lanka

OP-55 Development and validation an instrument (Physician Documentation Quality assessment Instrument) to assess the quality of documentation in medical records

OP-61 Diagnosis of dengue: a diagnostic accuracy study in colombo, Sri Lanka Mahipala, J. R. G., Weerakoon, W. A. B., Mendis ,S. A., Amarasinghe, A., Weeraman ,J., Palihawadana, P., Wider-Smith, A., Gubler, D., Tissera,H.

Wijesekera, N.M., Gunawardena, N. S. OP-56 A client friendly and physician accepted Personal Health Record System relevant to Sri Lanka

OP-62 A Survey of survivors of Attempted Suicide admitted to Ampara General Hospital Jayasinghe, P.K.C.J.I., Gunasekara, K.V.N.N.

Wijesooriya, D.D.S.

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OP-63 Four health promoting hospitals in Gampaha and Matara Districts: a pilot study

OP-69 Adhering and ignoring policy directions: the case of medicines purchasing in Sri Lanka

Fernando S., Kanthi, R.D.F.C.

Weerasinghe, M.C.

OP-64 Addressing Violence against Women at health care provision

OP-70 Tobacco regulations of Sri Lanka and Australia: lessons to be learnt from the Australian regulations

Samarakoon, M.A.S.C.

De Silva, S.H.P., Gamage, A.U., Barraclough, S. FREE PAPER SESSION 17 THEME: RECENT DEVELOPMENTS IN PUBLIC HEALTH

OP-71 Expanded Programme of Dog Vaccination and Human Rabies Control Programme in Galle District

4th May 2013 9:00am - 10:00am Venue: Seminar Room 3

Singarachchi, V.

Chairpersons Dr. Ananda Gunasekera, (Deputy Director General – Medical Services 2) Department of Health Services, Ministry of Health, Sri Lanka

OP-72 Sustainable waste management programme in Balangoda Urban Council

Dr. Ranil Coorey, School of Public Health, Faculty of Health Sciences, Curtin University

Prematilaka, N. FREE PAPER SESSION 19 PUBLIC HEALTH: PAST, PRESENT AND FUTURE

OP-65 A retrospective analysis of epidemiology and clinical patterns of Cutaneous Leishmaniasis in Anuradhapura District

4th May 2013 12:15pm - 01:15pm Venue: Seminar Room 1

Weerakoon, K.M.H.S., Munasingha, A.V., Palitha Bandara, W.M. OP-66 Research Innovations to increase understanding of Indoor Air Pollution in Sri Lanka

Chairpersons Dr. Wimal Jayantha, Deputy Director General (Planning), Department of Health Serives, Ministry of Health, Sri Lanka

Elledge, M.F., Chartier, R., Bronstein, K., Phillips, M. J., Amarasekara, R.M., Nandasena, S., Vanessa,T, Paul, M, Charles, R., Kibri,E., Jonathan, T.

Dr. Palitha Abeykoon, Former, Director Health Systems and Human Resources Development, WHO South East Asia Region Office and Consultant, Ministry of Health

OP-67 Subjective Well-Being and perceived parenting styles among late adolescents in Gampaha Educational Zone

OP-73 Disease Trends in Government Hospitals in Sri Lanka 1975-2009 Murali, V.

Jayawardena, K.A.R.N., Senaratna C. OP-68 Pilot Project of Utilizing an Electronic Disease Registry System for Recording & Reporting in Respiratory Clinics of Sri Lanka

OP-74 A comparison of the efficacy of micro cellular foot wear and the normal foot wear for prevention of foot ulcers in Leprosy

Rodrigo, S.S., Samaraweera, D. S. D., Fernando, E. A. C.,

Aluthge, I. N.

Wijerathne, P. G., Hewapathirana, R.

OP-75 An Intervention for Personal Hygiene related to Influenza among School Children in Kalutara District

FREE PAPER SESSION 18

Gunarathna, N K C., Sivayogan, S., Balasuriya, A., Wijayasiri, W A.

THEME: POLICY AND PRACTICE OF PUBLIC HEALTH

OP-76 Digitizing routine immunization information system for requirements of tomorrow

4th May 2013 12:15pm - 01:15pm Venue: Auditorium

Palihawadana, P., Peiris, T.S.R., Edirisuriya, C. S., Kariyawasam, M.P., Liyanage, L.B.B., Wijesinghe, T.S.

Chairpersons Dr. Thushara Ranasinghe, National Professional Officer, WHO Country Office – Sri Lanka Mr. Myles F. Elledge, Senior Director for Global Development & Strategy Research Triangle Institute (RTI), USA

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FREE PAPER SESSION 20

OP-83 Designing an in-service training course on skills development pertaining to court procedure for Public Health Inspectors

CULTURE, PEOPLE AND HEALTH 4th May 2013 12:15pm - 01:15pm Venue: Seminar Room 2

Wickramasinghe, N.T. OP-84 The reproductive health knowledge among the school teachers and their attitudes to provision of such information through schools In Zonal Education Division Udugama in Galle District

Chairpersons Prof. Machiko Higuchi, Professor, International Health and Nursing, National College of Nursing, Japan

Amarasinghe, P.V.N.P., Weerasinghe, M.C.

Dr. Rasanjalee Hettiarachchi, Acting Director, Directorate of Mental Health, Ministry of Health OP-77 A review on preserving health through Ayurveda Panchakarma Ediriweera, E.R.H.S.S. OP-78 Community partcipation in health promotion in Maldives Asma, I.S., Hajar, S.A. B., Harish, A.W. OP-79 Contraceptive usage in relation to birth spacing practices in Kalpitiya MOH Area Ghouse, A. OP-80 Kola Kenda (Herbal Gruel) plays an important role in promoting health Ediriweera, E.R.H.S.S., Maragalawaththa, M.G.S.K., S.S., Chandimarathna, P.B. FREE PAPER SESSION 21 WORK AND PUBLIC HEALTH 4th May 2013 12:15pm - 01:15pm Venue: Seminar Room 3 Chairpersons Dr. Amal Harsha de Silva, Provincial Director of Health Services, Western Province Dr. K.C.S. Dalpatadu, Former Director, National Institute of Health Sciences OP-81 Occupational Hazards in the work environment in small scale industries in Gampaha District Suraweera, S.A.I.K., Wijesinghe, M.S. D., Senanayake, S.J., Herath, H. D. B., Ananda Jayalal, T.B. OP-82 Prevalence of Neck Pain and its association with computer ergonomics among visual display unit users in banks of Horana Urban Council Area De Silva, N.C.L., Senarath U.

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FREE PAPER ABSTRACTS FREE PAPER SESSION 1 THEME: REPRODUCTIVE HEALTH OP-01 THE ACCEPTABILITY AND THE SIDE EFFECTS OF JADELLE速 SUBDERMAL IMPLANTS AMONG CLINIC ATTENDEES TO THE FAMILY PLANNING ASSOCIATION OF SRI LANKA

Background Unmet need for family planning describes the discrepancy between fertility preferences and the contraceptive behaviors among sexually active couples in the reproductive age.

Pathiratne, P.A.S.R., Tissera, S., Jayatilleke, A.C., Wimalarathne, M., Guruge, P. The Family Planning Association of Sri Lanka asankap33@yahoo.com.au

Aims To determine effectiveness of health educational intervention in reducing unmet need for modern methods of family planning among 15 - 49 year old married women in Kalutara District

Background Reproductive health hazards of unwanted pregnancies and unsafe abortions have been reduced with the use of modern contraception.

Jadelle速 Subdermal Implant is a newly introduced contraceptive method. Research done on Jadelle速 is few and far between.

Methods A community based intervention study was conducted among two randomly selected Medical Officer of Health (MOH) areas: MOH Horana being the intervention area (IA) and MOH Matugama being the control area (CA). Study samples consisted of all Public Health Midwives (PHMs) of intervention (34) and Control (43) areas and 264 target group women with unmet need for modern methods from each study area, selected by cluster sampling technique. Following baseline assessments, health education intervention was applied on target women through trained PHMs in IA. After 6 months, effectiveness was assessed in relation to change in knowledge, attitudes and reduction of unmet need for modern methods.

Aims To describe the characteristics of acceptors and the side effects of Jadelle速 Subdermal Implants among the clinic attendees of the Family Planning Association of Sri Lanka Methods Case files of the acceptors of Subdermal Implants between 25.08.2009 and 30.04.2012 at the Family Planning association of Sri Lanka were retrieved for analysis. We included the case files that belonged to acceptors between 18- 45 years. They have been followed up at one month and thereafter at yearly intervals till discontinuation. Descriptive statistics were analyzed using SPSS version 16 statistical software.

Results Increased mean knowledge scores in IA following intervention was statistically significant compared to increase in CA, both in PHMs (IA: p<0.001and CA: p=0.10) and in target women (IA: p<0.001and CA: p=0.06). Increased mean attitude scores in IA following intervention was statistically significant compared to the change in CA, both in PHMs (IA: p<0.001and CA: p=0.09) and in target women (IA: p<0.001 and CA: p=0.06). At the end of six months, the reduction of unmet need for modern methods was 68.7% in IA and was 21% in CA; the difference being statistically significant (p<0.001).

Results Of all Subdermal Implants acceptors (n= 289), 39.1% were between 3140 years, 33.6% were between 21-30 years and 17.3% were above 40 years on acceptance. Many (37%) were not using a contraceptive method at the time of accepting Subdermal Implants, while 22.1% changed from DMPA, 11.1% from OCP, 11.8% from condoms, 5.2% from IUD and 12.8% re-inserted the implant. Of all Subdermal Implants users, 42.2% had two children, 31.1% had one child and 19.4% had more than three children. The reason for Subdermal Implants insertion was family limitation for 50.2%, spacing for 35.3%, and to delay the first pregnancy for 14.5%. Most (78.2%) did not report any side effect for Subdermal Implants while 9% reported irregular vaginal bleeding and 12.5% reported symptoms such as head ache, acne and breast pain.

Only 0.3% reported a weight gain. There were no accidental pregnancies during this study period. Only 0.9% had discontinued using Subdermal Implants for reasons such as menstrual complaints, headache, nausea etc.

Conclusions Intervention conducted through PHMs revealed a significant impact on changing the contraceptive behavior reducing unmet need for modern methods.

OP-03 INTRODUCTION OF AN EDUCATIONAL MATERIAL TO IMPROVE KNOWLEDGE AND PRACTICES ON SELECTED FACTORS AMONG ANTENATAL MOTHERS IN PHNS AREA ALUTHGAMA Kusumalatha, P.D., Perera, E.B., Ramyakanthi, P.L.M., Ratnasiri, D., Prasani, N.M.N., Dayawathi, M.G., Mustapha, B. National Institute of Health Sciences, Kalutara kusum63@gmail.com

Conclusions Subdermal Implants appears to be a good contraceptive method which is well tolerated by women in the reproductive age. It has less menstrual complaints and a low discontinuation rate.

Background Aluthgama Public Health Nursing Sister (PHNS) area belongs to Medical Officer of Health (MOH) area Beruwala. Even though health education sessions were conducted at clinics and during home visits, there is widespread lack of knowledge and poor practices on early child hood care and development, importance of regular clinic visits, risk factors of pregnancy and post partum exercises.

OP-02 E F F E C T I V E N E S S O F C O M M U N I T Y B A S E D H E A LT H EDUCATIONAL INTERVENTION IN REDUCING UNMET NEED FOR FAMILY PLANNING AMONG WOMEN IN REPRODUCTIVE AGE IN KALUTARA DISTRICT

Objectives To improve the knowledge and practices on selected factors among ante natal mothers in PHNS area Aluthgama

Malwenna,I1, Jayewardene, P.L.2, Balasuriya, A.3 1 Provincial Director of Health Services Office, Sabaragamuwa, 2 University of Kelaniya, 3 Sir John Kothalawala Defence University indrani.malwenna@gmail.com

Methods After analyzing the prevailing situation, health team of Aluthgama PHNS area decided to design a file cover with important health messages for pregnant mothers as a document holder. File covers were developed in

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an attractive and user friendly way giving special emphasis to the family concept. Selection of messages to be included into the cover was done by a group of public health staff at divisional and district level including consultants. A well wisher from Kaluwamodara area provided financial support for printing. All the ante natal mothers were given this file cover following a brief introduction by the Public Health Midwife when registering them.

Aims Identify the association between BMI and obstetric and perinatal outcomes in women delivering singleton babies using data available at the MOH Office.

Methods This retrospective study was on women delivering singleton babies in MOH area Thihagoda, Matara, Sri Lanka in 2011. Prevalence of underweight, over weight and association of BMI with maternal age, parity, mode of delivery and birth weight were assessed using the data from B format of H509.

Results Five thousand file covers were printed and distributed free of charge to newly registered mothers. During supervisions it was revealed that their knowledge and practices related to the messages given in the file cover have been improved. It was revealed that their family members were also aware about the health messages. This educational material has been appreciated by the mothers, public health staff and hospital staff.

Results Among 374 singleton mothers 100 (26.7%) were underweight and 21 (5.6 %) were overweight. Eight among 19 teenage mothers (42.1%), 12 among 57 elderly mothers (21.1%) and eighty of mothers of 20-35 age groups (26.9%) were underweight. Prevalence of overweight was 5.2% (1/19), 7.0% (4/57), 5.36% (16/298) respectively among teenage mothers, elderly mothers and mothers of 20-35 age group. Fifty one of nulliparous mothers were underweight (32.5%). The prevalence of low birth weight among underweight mothers, overweight mothers and mothers with normal BMI were 12%, 4.76% and 11.8% respectively.

These were statistically not significant (p>0.05, df=2). The rate of cesarean section among underweight mothers, overweight mothers and mothers with normal BMI were 17%, 42.85% and 34.78% respectively.

There is a significantly low LSCS rate among low BMI mothers When compared to the mothers with normal BMI and overweight mothers (P=0.002, df=2).

Conclusion This innovative educational material could be considered as an effective method of communicating with people. Public health staff could be motivated to develop innovative health educational tools.

OP-04 BODY MASS INDEX AND OUTCOME OF PREGNANCY IN WOMEN DELIVERING SINGLETON BABIES IN MOH AREA THIHAGODA, MATARA Yaddehige, I. S., Sunethra, K.A. MOH Office, Thihagoda iranga1@yahoo.com

Conclusions Prevalence of underweight is more among teenage and nulliparous mothers. Low Body Mass Index is not necessarily leading to low birth weight. LSCS rate was low among mothers with low BMI.

Background Pre pregnancy Body Mass Index (BMI) is a key factor determining the outcome of the pregnancy. This study examines the prevalence and the effect of BMI on pregnancy outcomes in women delivering singleton babies in Area of Medical officer of Health, Thihagoda, Matara using routinely collected data in the Public Health Information System.

FREE PAPER SESSION 2 THEME: ENVIRONMENTAL HEALTH Results LAeq (8hrs) within selected locations in Colombo City ranged from 76.6dB (at Bank of Ceylon Roundabout, Colombo 12) to 84.0dB (at Lipton's Roundabout, Colombo 07), well above the maximum permissible noise levels (63dB) for municipal council area. All recorded LAeq values were more than 80dBs in Colombo 5, 9, 10, 13 and 14.

Median LAeq value for whole selected locations in Colombo City area was 81.0dB. Median LAeq value for peak traffic hours was 81.1dB and for off-peak traffic hours was 80.4dB. Median values for L10, L50 and L90 were 83.1dB, 76.6dB and 71.9dB respectively.

OP-05 ENVIRONMENT NOISE LEVELS IN THE CITY OF COLOMBO Nagodawithana, N.S., Pathmeswaran, A., Pannila, A.S., Gurusinghe, R., Kalansuriya, C., Sathiakumar, N., Wickremasinghe, A.R. Ministry of Health nnagodawithana@yahoo.com Background Noise is a physical pollutant and produces number of health effects.

Noise levels in most of the cities are higher than the levels recommended by environmental regulatory authorities of relevant countries.

Conclusions Environmental noise levels in selected locations in Colombo city are well above (13.3dB to 21.0dB) the levels recommended in the National Environmental (Noise Pollution) Act of Sri Lanka.

Aims Purpose of this study was to determine the level of environmental noise at identified locations in the City of Colombo.

OP- 06 CONTAMINATION STATUS OF WELL WATER WITH SPECIAL EMPHASIS ON SOME PHYSICO-CHEMICAL AND MICROBIOLOGICAL PARAMETERS IN SELECTED FIVE GN DIVISIONS IN MAHARAGAMA.

Methods Colombo Municipal Council Area was divided into 15 divisions. Sixty places with high traffic density, four from each of the 15 divisions were purposively selected. At each selected site equivalent continuous sound pressure level (LAeq) was measured for six hours during day time (three hours each from peak and non-peak traffic hours) using a Class-I Sound Level Meter on week days. LAeq for eight hours (LAeq[8hrs]) was calculated and taken as average noise level of that place. L10, L50, and L90 measurements were also taken.

Ganegoda, G.S.S., Manage, M.M.P., Pathirage, S. Department of Zoology, Faculty of Applied Sciences, University of Sri Jayewardenapura, Medical Research Institute, Sri Lanka pathmalalmanage@yahoo.com

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Background The quality of drinking water is a powerful environmental determinant of health. In Sri Lanka, information regarding contamination of well water is limited. The study area contained a major solid waste dumping site.

Past research has found contamination of well water in the study area in terms of coliforms, heavy metals and other chemical parameters.

However, no information is available about the identification of pathogenic microorganisms in well water in the study area.

instrument, which consisted of 10 feet long 1 inch diameter pipe system laid 14 inches deep in the ground. Four inches above the pipe line was filled with metal stones of 1- 0.75 inch. System was installed at the office of the PHI as a demonstration unit and the community was educated using it. Survey was conducted among the residence who has installed the system.

Results Sixty one households in the Gamagoda PHI area installed the system

by February 28th of 2013. Public complaints on waste water discharge without a proper mechanism were also addressed. All households which have implemented the system were satisfied about the functionality of the system. Council of the Dodangoda Pradesiya Saba has recommended the system and approved the financial support to further publicize the system in the Pradesiya Saba area.

Aims To assess the water quality in five selected Grama Niladari (GN) divisions in terms of microbiological and some physicochemical parameters with reference to Sri Lankan Standards (SLS) for drinking water quality Methods All the wells in the selected Grama Niladari divisions were sampled monthly from January 2012 to October 2012. Water samples were collected into sterilized glass bottles using standard methods both for microbial and physicochemical tests. Microbiological and physicochemical parameters were measured using the standard methods and Principal Component Analysis (PCA) was carried out to evaluate the relative water quality among GN divisions. Identification of pathogenic microorganisms in well water was conducted in collaboration with Medical Research Institute, Sri Lanka. In addition a questionnaire survey was carried out among residents in the area.

Conclusions The simple innovative waste water discharge system has accepted by the community and is an efficient way of discharging the waste water with minimum disturbance to the environment.

OP-08 ECO-FRIENDLY CUP Mudalige, M.P., Jayasuriya, M. Medical Officer of Health Office, Mathugama, . Rubber Technology and Development Department, Ratmalana. mohmatugama@yahoo.com

Results Results showed that both total and fecal coliform counts ranged between 0 to >1100 counts per 100ml and almost all tested wells were significantly contaminated with total and fecal coliforms, sometimes exceeding 1100/100ml. Salmonella spp., Shigella spp. or Campylobacter spp. were not detected in any samples. The total nitrate concentration was significantly high (p<0.001) exceeding more than 60mg/l in Wattegedra GN division. Mean ranges of physicochemical parameters were as follows: nitrate (0.64-77.31mg/l), pH (4.11-7.14), conductivity (114-70000µScm-1), Biological Oxygen Demand (BOD) (0.03-19.40mg/l), phosphate (0.07-2.68mg/l) and Chemical Oxygen demand (COD) (0.14-64.13mg/l). According to PCA, Wattegedara GN division contained the highest polluted wells. According to the survey there were concerns by the people of the area about the contamination status of water.

Background Dengue is an emerging threat to the health services and the economy of Sri Lanka over the past few years. Water collection in used containers such as yogurt cups, plastic bottles become main breeding sites for dengue mosquitoes. A large number of containers are released to the environment on a daily basis.

Aims To invent an economically favorable, environmentally friendly container Methods The container was developed with “paper pulp” materials. The “paper pulp” material was lined with a water proof layer made of food grade rubber. Water proof layer is broken at the time of opening the container, thus “paper pulp” material is exposed to the environment leading to the bio degradation. An easy method was developed to puncture the base of the container at the time of discarding. Furthermore, the structure of the base of the container was modified to turn up side down spontaneously, if the container is not punctured at the time of discharge to the ground on rare occasions.

Conclusions Total coliform, fecal coliform, nitrate, phosphate, COD, BOD and conductivity values exceeded the drinking water standards. However, there were no pathogenic bacteria detected in well water samples collected during the study.

OP-07 WASTE WATER FILTERING SYSTEM: INNOVATIVE SYSTEM TO DISCHARGE THE RESIDENTIAL WASTE WATER SAFELY

Results The product obtained the patent from the National Intellectual Property Office of Sri Lanka. The developed container is used in commercial products of several establishments in Sri Lanka. Due to the cost effectiveness, it was popular among those establishments and was found to have minimum water collection. Container could be used to store different consumer products such as yogurt, milk, carbonated beverages and ice cream. The container could be commercially produced at the same price as plastic containers available in the market.

Sujeewa, J. National Institute of Health Sciences, Kalutara.

Background A preliminary survey conducted in Gamagoda Public Health Inspector (PHI) area shows that the waste water is not properly discharged in 90% of the households. Simple innovative methods can be used to discharge the waste water safely.

Conclusions Structurally modified container made of bio-degradable materials was a successful innovation that will help prevent water collection after use.

The container could be commercialized with the other containers available in the market.

Aims To develop a novel technology with simple instrumentation to filter the waste water discharged from households of Gamagoda PHI area Methods Low cost PVC pipes of different sizes were used. A gully was developed from the PVC pipes. A mechanism was developed to separate the sludge from the liquid component of the waste water. The liquid component of the waste was directed to second component of the

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FREE PAPER SESSION 3 THEME: FOOD, NUTRITION AND HEALTH OP-09 DAIRY PRODUCTS SPOILAGE

Lanka's national development plans call for the increase in the agricultural and food productivities, including the doubling of the poultry products by 2015. At present there are approximately 13.6 million chickens nationwide with over 75,000 families directly or indirectly engaged in industry.

Gunasekara, S.P., Pathirage, M.V.S.C., Delpachitra, C.D., Paranagama, D.H.D., Kumarasinghe, K.W.M.L., Gunasekara, U.K.D.H.M. National Institute of Health Sciences, Kalutara. samanmalee12@yahoo.com

Aims The aim of the study was to evaluate the changes to the microbial load in chicken from processing to retail from different processing plants.

Background Micro organisms can render our food unfit for consumption. Milk is an excellent culture medium for microorganisms, being high in moisture, having a neutral pH and being rich in microbial food. There is no information available on the forms of spoilage that occur with milk and milk products.

Methods Chicken samples from two processing facilities that were located in two different climatic areas but employed similar slaughtering and processing conditions were studied. Samples were withdrawn after slaughter and de-feathering, before and after the chlorine bath process.

Samples from retail were drawn from supermarkets within the area of the processing plants in Western Australia for analysis. Samples from retail were full carcasses and some chicken parts.

Aims To determine the level of microbiological contamination of milk and milk products received at the Food Microbiology Laboratory at National Institute of Health Sciences, Kalutara

Results The mean aerobic microbial counts from the two plants were 5.24 log10 cfu/cm2 and 8.00 log10 cfu/cm2 before the chlorination. The aerobic microbial levels in the carcass after chlorination and packaging were similar for both plants. Retail whole chicken samples obtained from the supermarkets were significantly different for total aerobic counts 4.65 log10 cfu/cm2 and 13.39 log10cfu/cm2 respectively. The microbial counts at retail for chicken wings from the two plants were 9.78 log10 cfu/cm2 and 12.68 log10cfu/cm2 and for thighs from the two plants were 10.57 log10cfu/cm2 and 14.40 log10cfu/cm2 respectively, which were significantly different. The aerobic microbial counts for chicken parts were higher compared to whole carcasses from the respective production facilities.

Methods A retrospective study was done on all the milk and milk products received to the Food Microbiology Laboratory at National Institute of Health Sciences, Kalutara within the period of 1st January to 31st December 2012. Samples were obtained by the Public Health Inspectors of the districts of Kalutara, Galle, Matara and Hambantota. The samples have been obtained on the following instances: when a new product was introduced to the market; when there was suspicion about the quality of the product; when there were complaints made by the customers; randomly as part of the routine surveillance. Food samples were processed for testing and reported according to standards approved by the Sri Lanka Standards Institute (SLSI).

Conclusions Even though the manufacturing processes and microbial load after chlorination were similar in both plants, at retail the microbial load in carcasses and chicken parts from the two plants were different. The difference could be due to post processing handling at manufacture or retail highlighting the need for controlling post processing handling to improve public health.

Results Total number of dairy samples processed during the study period was 152 and 47.3% (72/152) of dairy samples were unsatisfactory as the tested parameters were not within the specified bacteriological limits.

Fifty one percent of samples were satisfactory and 1.7 % of them were acceptable. Sixty eight of total diary samples were yoghurts and 58 % (40/68) of them were unsatisfactory. Majority (37/40) of the yoghurt samples were contaminated with yeast and moulds.

OP-11 QUALITY OF DISPENSING FOLIC ACID SUPPLEMENTS TO PREGNANT MOTHERS AT GOVERNMENT ANTENATAL CLINICS OF KEGALLE MEDICAL OFFICER OF HEALTH AREA

Conclusions Approximately half of the milk and milk products received at the Food Microbiology Laboratory at National Institute of Health Sciences was in unsatisfactory condition. This highlights the need for strengthening routine surveillance of dairy products.

Wickramasinghe, A., Senarath, U. MOH Office, Matara, Medical Faculty, University of Colombo aravinda2000al@gmail.com

OP-10 CHANGES TO THE MICROBIAL LOAD ASSOCIATED WITH CHICKEN SUPPLY CHAIN

Background Folic acid supplementation programme to pregnant mothers is implemented through Public Health Midwives (PHMM) in Sri Lanka, to prevent neural tube defects of foetus and anaemia among pregnant mothers. Folic acid tablets are distributed to pregnant mothers free of charge at the government field antenatal clinics.

Coorey,R., Abu Khalil, F., Bertolatti, D., Dhaliwal, S.,Jayasena, V. School of Public Health and Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia r.coorey@curtin.edu.au

Aims To describe the quality of dispensing folic acid tablets at field antenatal clinics to pregnant mothers

Background Chicken meat is the most preferred and consumed meat all over the world due to its low price compare to other meat sources such as beef and pork. Despite the increase in food prices, chicken meat prices are still comparatively lower than other meats. The chicken meat production has significantly increased and the trend is expected to continue with more focus on quality. In Australia the production per capita was 6 kg in 1965, which had increased to 36 kg by 2008. In Sri Lanka 2012 per capita consumption of chicken meat was 6.5 kg, up from 4.6 kg in 2010. Sri

Methods A descriptive cross-sectional study was carried out in Kegalle Medical Officer of Health (MOH) area in 2011. All the twelve field antenatal clinics of Kegalle MOH were included in the study. Randomly selected two clinic sessions were directly observed for dispensing practice of folic acid, using Lot Quality Assurance Sampling technique. Observational

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check list was the study instrument. Equal or less than 50% of “good practices” was considered as “Highest Risk” and equal or more than 80% of “good practices” was considered as “Lowest Risk”. A Decision Rule of 24:8 was applied considering a Provider risk of 3.6% and Consumer risk of 7.6% where the lowest total classification error (0.112) would occur. Equal or more than 8 defective observations in the entire MOH area was considered as the decision rule to decide whether the sample was “substandard”. If the defective observations were less than 8, it was “accepted” as good for the entire MOH area.

Background Obesity, diabetes, cardiovascular disease and related health problems are some of the current major health challenges in the world. Obesity has reached epidemic proportions with over 1 billion overweight people.

Lack of physical activity and consumption of unhealthy foods (low in dietary fibre and protein, high in oil and starch, etc.) play a key role in the current health problems. Consumption of junk food is increasing at an alarming rate. Development of healthy alternatives to junk foods could be an effective solution.

A grain legume known as lupin has a unique nutritional profile. Lupin flour is high in protein (40%) and dietary fibre (30%) and contains less than 2% starch. Lupin is also a good source of a range of minerals and bio-active compounds. Independent studies have shown that the consumption of lupin enriched foods lower blood cholesterol and glucose levels, provide protection against cancer and reduce the risk of obesity and diabetes.

Results General cleanliness and tidiness of the dispensing counter was “acceptable” where Defective Observations (DO) were 7. Both the quality (expiry date, dryness of the tablets and the discolourness of tablets if any) (DO=1) and storage (DO=0) of folic acid were “acceptable”. All the components in providing knowledge on folic acid were “substandard” where DO of introducing the tablet by name =18, DO of educating the usefulness =24, DO of instructing the dose to be taken =20 and DO of instructions on storage =17. Inquire about the compliance (DO=20) and wrapping folic acid tablets at the counter (DO=23) were also “substandard”.

Aims To develop low cost novel healthy foods high in protein and dietary fibre contents and rich in minerals including iron, zinc and calcium and bioactive compounds to address some of the major health issues

Conclusions Though the cleanliness, tidiness, quality and storage of folic acid tablets in the clinics were satisfactory, aspects such as providing knowledge on folic acid, inquiring about compliance and wrapping the tablets need to be improved.

Methods A range of novel foods were developed by incorporating lupin flour at 10 – 70% level. Nutritional profiles and consumer acceptability were determined by the standard methods.

OP-12 DEVELOPMENT OF INNOVATIVE HEALTHY FOODS TO ADDRESS SOME OF THE CURRENT MAJOR PUBLIC HEALTH ISSUES

Results Developed novel lupin chips had consumer acceptance similar to commercial potato chips, however, contained 5 times more protein, 10 times more dietary fibre and 50% less fat. Consuming 100g of lupin chips, provide 40% of the recommended daily intake of dietary fibre.

Pasta and noodles prepared with 20% lupin flour had 50% more protein and 150% more dietary fibre than the traditional products.

Jayasena, V., Nasar-Abbas S. M., Coorey, R., Coorey, S.D. School of Public Health, Curtin Health Innovation Research Institute, Curtin University, Perth, Australia. v.jayasena@curtin.edu.au

Conclusions Low cost novel foods can be used to address obesity, diabetes and CVDs as well as hunger and malnutrition.

FREE PAPER SESSION 4 THEME: ADVANCES IN DIAGNOSIS AND MANAGEMENT OF PUBLIC HEALTH PROBLEMS Aims The purpose of this study is to evaluate the impact of point of care sonography in managing emergency and critically ill patients in the Emergency and Trauma Care Centre, Karapitiya which is the largest of such facility.

OP-13 THE VISUAL STETHOSCOPE IN THE 21ST CENTURY: POINT OF CARE SONOGRAPHY IN EMERGENCY AND CRITICAL CARE Munasinghe, M.A.A.K. 1, Abeywickrama, A.1, Jayasekera, K.1, Samarakoon, M.A.S.C.2, Vidanapathirana, T. 2 1

Methods A qualitative study was conducted at Emergency and Trauma Care Centre at Teaching Hospital Karapitiya and District General Hospital Matara which included focus group discussions involving three Resident Physicians and 20 Grade Medical Officers. The key areas discussed were: usefulness in diagnosis; management issues; limitations; perceptions on cost-effectiveness and outcome following this new practice. The interview was recorded and analysis was done according to these key themes.

Emergency & Trauma Care Centre, Teaching Hospital, Karapitiya, 2

District General Hospital, Matara drakmunasinghe@gmail.com Background Management of critically ill patients requires imaging techniques which are essential for optimizing diagnostic and therapeutic procedures.

Recently, the point of care sonography including lung ultra sound has become an attractive new tool for assessing critically ill patients. Point of care sonography which is essentially a bed side tool helps in not only arriving at an early accurate diagnosis but also in monitoring the efficacy of the treatment. Apart from these advantages, absence of radiation, reproducibility, cost effectiveness and short learning curve are additional benefits for a critically ill patient. Although a large numbers of studies are conducted to assess the validity and advantages of sonography in other parts of the world, there are no studies available in Sri Lanka on point of care sonography.

Results All participants agreed about the utmost value of this novel approach, especially about the addition of lung ultra sound sonography. It was emphasized that this tool which is so useful should have been introduced much earlier, especially in the light of many reviews on the value of it. Twenty percent of users expressed the concern regarding the following limitations such as lack of experience on the part of the operator, patient related factors such as anxiety towards sonography. All agreed that point of care sonography has revolutionized the diagnosis and the management of critically ill patients without subjecting them to

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harmful and sometimes invasive techniques such as x-ray, diagnostic peritoneal lavage, CT scan. Most of them were of the view that point of care sonography is one of the life saving investigations in an unstable patient who cannot be transported for other facilities or who cannot be positioned for chest x-ray, CT and other invasive procedures such as CVP, which is often the case in emergency or critically ill patient. Many believed the total cost for investigating a critically ill patient could be brought down with the introduction of point of care sonography. Most believe that this technique could easily be trained to Medical Officers to obtain valid and reliable results.

OP-15 ESTIMATED GLOMERULAR FILTRATION RATE CALCULATED USING IDMS-TRACEABLE MDRD EQUATION MAY PREDICT THE DURATION OF DIABETES IN SRI LANKAN TYPE 2 DIABETIC PATIENTS Wijayatunga, N.N, Perera, P.P.R.P., Peiris, H., Wanigasuriya, K. Department of Biochemistry, Faculty of Medical Sciences, University of Sri Jayawardanapura nadeejawi@yahoo.com

Conclusions Point of care sonography is an extremely useful and a cost effective technique provided it is performed by properly trained personnel in an appropriate setting.

Background Duration of type 2 diabetes (T2D) is associated with renal impairment. estimated Glomerular Filtration Rate (eGFR) calculated using standardized serum creatinine (SC) measured by an Isotope Dilution Mass Spectrometry (IDMS) traceable method is the recommended method of assessing renal function.

Aims To assess the association between duration of T2D with eGFR calculated using IDMS-traceable Modification of Diet in Renal Disease (MDRD) study equation.

OP-14 AUGMENTATIVE AND ALTERNATIVE COMMUNICATION LEARNING PLATFORM AND THERAPEUTIC DEVICE Inas, J.M., Senarathna, R.M.T.S., Dissanayaka, A.P., Gnanathilaka, K.G.S.S., Nanayakkara, N.D. University of Moratuwa inasjenab@gmail.com

Methods Fifty seven patients (41 females and 16 males) diagnosed with type 2 diabetes for more than 6 months and with a past eGFR value of less than 60 ml/min/1.732m² were recruited from the Diabetic Clinic of Colombo South Teaching Hospital. SC was measured using Biolabo Creatinine Kinetic method traceable to IDMS on Kone 20XT auto analyzer. eGFR was calculated using the IDMS-traceable MDRD Study equation.

Background Augmentative and Alternative Communication (AAC) is a widely used tool for alternative communication in overcoming speech disability faced by those who are suffering with speech restricting illnesses such as Autism, Celebral Palsy, partial stroke etc. There are no successful platforms in Sri Lanka to bridge the need of alternative speech in terms of new technology based devices which function in Sinhala/Tamil languages. This platform and the device enable those who are suffering with permanent speech disability to learn and use artificial speech for their day to day communication needs.

Results Subjects had a mean age of 53.82 years (SD=4.98). Mean duration of diabetes was 10.1 years (SD= 7.1; range 6 months to 35 years). Mean eGFR calculated using MDRD equation was 67.52 ml/min/1.732m² (SD= 15.95). Eighteen (32.1%) subjects had eGFR less than 60ml/min/1.73m² while 38 (67.9%) subjects had eGFR more than 60 ml/min/1.732m There was a significant (p<0.05) positive correlation (r=0.3) between SC traceable to IDMS and duration of diabetes whereas a significant (p<0.05) negative correlation (r= -0.38) was found between duration and eGFR . However there was no significant correlation between duration of diabetes and SC values from clinic records (p>0.05) and for eGFR values calculated using clinic SC (p>0.05).

Aims To derive a wide scope of speech content to cover a considerable range of basic speech needs and create an AAC learning platform and a device to conduct AAC based therapy with Sinhala /Tamil bilingual capabilities based on research on globally used AAC devices / technologies Methods and Results The learning platform provides a multistage development capability where the users can generate speech in the early stages based on touching image icons representing basic speech needs. Upon certain level of development they can move into combining icons into creating more meaningful speech which is the next level. Then users move into combining words to generate speech through an interactive interface and finally they are able to create unlimited artificial speech using an interface where they can type text which will be converted into speech.

The device used for this purpose is a touch surface computer customized for above functions. We have successfully created an Augmentative and Alternative Communication learning platform and a therapeutic device which can convert text to speech enabling unlimited speech generation in Sinhala language and a basic icon based speech generation for basic speech needs in Tamil language. These platforms enable stage wise development which is mapped to the age and level understanding of the user.

Conclusions A significant correlation was observed between duration and eGFR calculated with IDMS-traceable standardized SC values in Sri Lankan T2D patients. Use of analytical methods which are not traceable to IDMS for SC measurements could be the reason for not observing a significant correlation between duration with eGFR values from clinic data.

OP-16 DEVELOPING A RELIABLE METHOD FOR MEASURING THE PARAMETERS OF ORTHOTIC AND PROSTHETIC GAIT IN A LESS RESOURCED SETTING. Munasinghe, C. Sri Lankan School Of Prosthetics and Orthotics chathurange.munasinghe@apos-asia.org Background In Sri Lanka there are no gait laboratory facilities to measure the parameters of gait in a scientific way. A system of measuring gait parameters reliably and effectively is an essential component in analyzing the results of orthotic and prosthetic interventions.

Conclusions All above features combined in one platform and device provides the best solution for AAC learning and therapy in the Sri Lankan context.

Aims To investigate an alternative method of gait analysis using materials suited to a less resourced environment Methods A standardized method of videoing gait, and measuring parameters

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from the footage was developed and trailed on 12 patients.

Conclusions It is possible to measure key gait parameters using basic equipment suited to a less resourced setting. Quantifying the reliability of this method in comparison to gait laboratory techniques and to standard observational gait analysis requires further research.

Results The standardized method allowed us to take comparable measurements of key gait parameters in the sagittal and coronal planes.

This allowed a more accurate analysis of the effectiveness of orthotic or prosthetic intervention on gait.

FREE PAPER SESSION 5 THEME: HEALTH MANPOWER DEVELOPMENT OP-17 DEVELOPMENT OF COMPETENCIES OF PUBLIC HEALTH INSPECTORS IN NORTHERN AND EASTERN PROVINCES OF SRI LANKA IN ORDER TO IMPROVE THEIR PUBLIC HEALTH PRACTICE

Conclusions Regular in-service training programmes for PHII is a need. A two-week programme could incorporate many practical learning experiences and this could be the minimum for a group who have had no in-service training for a long period.

De Silva, P.S.C.K., Kaggoda Arachchi, S.M., Karunarathna, D.D.N., Mangala, I.G. School of Public Health Inspectors, NIHS, Kalutara saliyabalapitiya@gmail.com

OP-18 HEALTH SYSTEM CONTRIBUTION IN PROMOTING LEADERSHIP AMONGST PUBLIC HEALTH MIDWIFES OF SOUTHERN PROVINCE IN SRI LANKA

Background During the conflict situation that existed in the Northern and Eastern provinces of Sri Lanka, the normalcy of all services delivered by both the state and private sectors was disturbed where health services were no exception. In the aforesaid provinces, most of the PHII were working with very few opportunities to update their knowledge and professional skills. Moreover, there is no standard professional development pathway laid out to develop the PHII in facing the current public health challenges.

Dolamulla, S.S., Samarage, S.M., Wickramasinghe,P. K., Edirimanna, H. Regional Director of Health Services Office, Hambantota surangadolamulla@yahoo.com Background Strengthening leadership and management is an essential component to scaling health services to reach the development goals while health care leadership at community level is important in enhancement of preventive health sector.

Aims To develop and conduct an effective in-service training programme for PHII in the Northern and Eastern Provinces of Sri Lanka

Objectives The main aim of this study was to identify the organizational support needed for leadership development amongst the Public Health Midwifes (PHMM) in the Hambantota District to develop a leadership programme for PHMs.

Methods Need assessment was conducted by the key staff from the National Institute of Health Sciences (NIHS) visiting the Regional Health Training Centres in the Northern and Eastern provinces. Self administered questionnaire was used to get information from PHII and focus group discussions were conducted with supervising officers to assess the gaps of knowledge and skills that required urgent updating to enhance their competency. Key informant interviews were held with the Tutors in Public Health, higher officials in health administration and community leaders with a view to identifying the prevailing situation. Having understood the dimensions of the situation and urgency for remedial action, discussions were held at the NIHS regarding the measures to be taken to uplift their capacity and working environments.

Methods The design was explorative and the data was collected through 7 focus groups involving 7 doctors, 7 public health nurses and 42 PHMM randomly selected from diverse localities in the Hambantota District of the Southern Province during the second quarter of 2012.

Results Nine major themes which underline health system (HS) contributions were identified. Strong leadership at every level was imaged as the main factor. The second finding was shared goals, objectives and participatory planning in public health activities. Appreciation, valuing and promoting of PHM's performance by the HS was identified as the next important factor. 'An incentive payment for the extra work may enhance motivation and leadership among the midwives' was also noted. The next key theme was the value of training and sharing experience on motivation and management strategies in development of leadership among the PHMM. Empowerment of work force on decision making was also acknowledged as an important element.

Respondents established the positive contribution from all levels of the HS such as national, provincial and institutional level along with constructive work relationships with other employees.

Results From the information gathered it was understood that the following key areas need to be strengthened: Provision of Safe Food; Promoting Environmental Health and Enforcing Public Health Legislation. A two week programme was planned and undertaken using different types of teaching methods giving more emphasis on practical training. Practical training included site visits to places where public health programs are effectively implemented in the country such as the Sustainable Urban Solid Waste Management Project at Balangoda Urban Council; taking part in a moot court where simulated court proceedings are undertaken; food raids during the nights with the assistance of the field PHII; firsthand experience on taking samples on food and water for chemical and microbiological analysis; field visits to food production sites etc.

Tamil translations and handouts were provided during the training period as necessary. The training programme was evaluated by the trainees as a very good and a needy one. They pointed out that there should be a regular in-service training programme for the PHII especially those from Northern and Eastern provinces.

Conclusions This study highlighted that leadership, participatory planning, appreciation, flexibility, human resource development and empowerment as the main HS contributions which already exist in the system to a certain extent in a non formal manner. These need to be properly structured and addressed.

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OP-19 TRAINING NEEDS ASSESSMENT ON SUPERVISION AMONG PUBLIC HEALTH NURSING SISTERS REFERRING "TRIPLE A" CONCEPT IN KALUTARA REGIONAL DIRECTOR OF HEALTH SERVICES

OP-20 NATIONAL INSTITUTE OF HEALTH SCIENCES SAFE EXERCISE PROGRAMME Priyananda, R. National Institute of Health Sciences, Kalutara. ruchithpriyananda@yahoo.com

Ratnayake, U. I. , Hettiarachchi, R., Gunasekara, P.L., Perera, S.Y.C. Regional Director of Health Services Office, Kalutara isaacuster@gmail.com

Back ground Physical exercise is one of the most important aspects of prevention and control of non communicable diseases, a major health challenge in Sri Lanka. Regular exercises contribute immensely in achieving physical wellbeing. Unavailability of a complete scientific exercise program with qualified Exercise Trainers is a major setback confronted today.

Background The desk review on Public Health Nursing Sister (PHNS) supervision reports has shown that only 30% of PHNSS have submitted the proper supervision reports in the year 2011. The average number of supervisions carried out by them per month was lower than the expected standard and the quality of those supervision reports were not up to the standard level. Based on these findings we identified that PHNSS working in the RDHS area Kalutara are not having adequate knowledge, skills and most importantly attitudes to supervise the existing Family Health Programme and performances of PHMM.

Aims This paper discusses the Safe Exercise Programme developed at National Institute of Health Sciences, Kalutara with a view to highlighting its development and how it addressed the issue of training of master trainers who are capable of training the developed programme to others.

Aims To assess training needs on supervision among PHNSS according to a conceptual model on supervision based on “Triple A” concept

Methodology This programme was developed at NIHS according to the principles of Exercise Science such as fitness components and FITT formula, which stands for Frequency, Intensity, Time and Type. Frequently used exercises in Sri Lanka were kinesiologically analyzed and safe and effective exercises were only chosen. Exercises of this program involve all the major joints and major muscles of the body. Stretching exercises were also included to improve the flexibility. Strengthening exercises using dumbbells were also included in order to improve muscular strength and muscular endurance. Slow running / fast walking were included to improve aerobic fitness. In the curriculum of the Tutor Training, 'Health Promoter' was included as a learning outcome and trainees were given the responsibility of improving their own physical wellbeing during the training programme.

Methods A descriptive cross-sectional study was conducted from 25.09.2012 to 25.01.2013. All the PHNS (n=20), PHM (n=297) and MOH (n=22) working under RDHS Kalutara was included into this survey.

Knowledge on supervision among PHNS was assessed under the components of “Triple A” process and attitudes towards supervision of PHNSS and PHMM were assessed with a Likert scale. Checklist was used to assess the supervisory skills of PHNS. Data analysis was carried out by using SPSS. Ethical clearance was obtained from the ethical review committee of Medical Research Institute, Colombo.

Results Only 20% of PHNSS have good knowledge on supervision. Majority (73%) of PHNSS are of the opinion that lack of evaluation by superior officers may negatively effect on their supervision. Although 50% of PHNSS have skills on supervision, 70% do not know how to prepare an action plan. Half of the PHMM do not have an idea on how supervision improves their work.

Results This program was introduced to Public Health Tutor Training Group (n=32) in 2012 and they have in turn introduced this to trainees of Public Health Midwife Training Centres throughout Sri Lanka. Tutor Training Group (32) of the training schools of the Ministry of Health, Sri Lanka is also practicing this program currently at the NIHS. All trainees are actively taking part in the Safe Exercise Programme. They will introduce this program to their respective schools and training centres (Physiotherapy School, Colombo; Regional Training Center, Jaffna etc.) in future.

Conclusions PHNSS need more in-service training on supervision. “Triple A process” is a concept which could be used as the basis in evaluating supervision at individual and at group level.

Conclusions Showing the benefits of physical exercises may help getting adults motivated to incorporate exercises in to their daily routine. Introducing 'health promoter' as a learning outcome may help in addressing the issue of lack of master trainers in this respect to some degree.

FREE PAPER SESSION 6 THEME: PUBLIC HEALTH, ADVOCACY AND COMMUNICATION Background Sri Lanka is currently challenged with high burden of Non Communicable Diseases (NCDs). As the burden is greater than what can be attributed to an ageing population and with early onset of hypertension, diabetes, ischaemic heart diseases and stroke, life style changes are increasingly being incriminated. The spectrum of diseases have common and confounding effects in modifiable risk factors such as unhealthy diet, smoking and physical inactivity. There is inconsistency in the understanding of lifestyle factors both amongst the health care workers and the public and a specific message that can easily be remembered was required. A multi sector, multi agency effort using a

OP-21 "SUPER EIGHT" A SOCIAL MARKETING STRATEGY TO PROMOTE HEALTHIER LIFESTYLES Perera, H.S.R., Ranasinghe, A.T., Ranaweera, K.D.N.P., Fernando, S., Abeysekara, P., Wickramasinghe, S., Amarasena, P., Pandipperuma, M. Ministry of Health, Sri Lanka susiepds@gmail.com

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consistent message is expected to create a shift both in demand and supplies for healthier lifestyle change.

audience. In-depth interviews were conducted with professionals from the NCD Unit of the Health Ministry and the National Diabetes Centre.

Three foreign case studies were analyzed in depth with comparison to three minor local case studies on social marketing. It was proven that many developed countries use innovative methods of advertising communication to solve similar situations.

Aims The aim of this paper is to describe how the approach of 'Super Eight ' was launched in Sri Lanka Methods and Results The College of Community Physicians identified the eight health targets based on scientific evidence and the lifestyle associated changes that are most needed for Sri Lanka. The targets were identified by a logo, with a theme message in the three commonly used languages in Sri Lanka. The regional (district) health authority of Ampara was advocated to adopt Super Eight. The Community health staff of one divisional secretariat area was made aware. They identified target groups that needed to be intervened. Awareness tools, power point presentations, posters were shared to be used in subsequent awareness sessions. A group of local dancing teachers and students were trained on Zumba dancing. Awareness sessions were arranged to coincide with a Mega National event 'Deyata Kirula' that attracted large numbers to Ampara District. This event too adopted the 'Super Eight concept through the National Nutrition Secretariat which placed its importance at the highest level. Several advocacy programs were conducted during the one week event to make other local governmental sectors, private sector (banking sector) and youth on institutionalizing Super eight. The local health authority extended the 'Super Eight concept to other divisional secretariat areas in the Ampara District conducting a training of trainers to the health teams. 'Super Eight tools were distributed to these teams.

The local health authorities were empowered to adopt Super Eight strategy in institutions of their choice. Since the adoption they are now requesting for further technical guidance in creating different healthier options in the food catering industry.

Results Among the study sample only 32.5% were aware on the primary and primordial preventive measures. The in-depth interviews conducted with professionals from the NCD Unit and the National Diabetes Centre revealed that their traditional methods of communication had less impact on the issue. From the qualitative studies it was revealed that prevention can be done through four lifestyle changes namely consuming a healthy diet, regular physical activities, quitting smoke and alcohol consumption and living in a stress free life. These call for a behavioral change in a person's life. It is evident that these lifestyle changes require a perception change, which will lead to an attitude change in the respective target audience and the change in the attitudes has to be transformed into a behavioral change over a certain period of time with the proposing communications solution.

Conclusions NCD prevention can be addressed with an innovative advertising strategy to create widespread awareness in building an emotional arousal in the target audience which will initiate a behavioral change.

There is possibility of bringing up innovative methods to reach the targeted audience that will captivate their interests, effects and moods in the Sri Lankan context.

OP-23 A STUDY ON IMPACT OF COMMUNICATION METHODS IN CASES OF SEXUAL ASSAULTS IN SRI LANKA

Conclusions From the preliminary observations it seems the methods and tools to adopt 'Super Eight are appropriate. This may become an approach to social marketing of health targets.

Vadysinghe, A.N., Senasinghe, D.P.P., Attygalle,U.,Ilangarathna Banda,Y.M.G., AmeenIzzath, M.H.M. Faculty of Medicine, University of Peradeniya, General HospitalsNawalapitiya, Rathnapura & Chilaw senasinghe@yahoo.com

OP-22 A N A D V E R T I S I N G S T R AT E G Y T O P R E V E N T N O N COMMUNICABLE DISEASES THROUGH BEHAVIORAL CHANGE

Background The sexual assaults are a serious public health problem with hazardous socioeconomic and health related consequences. Studies which have been performed internationally have shown that young individuals from poor socioeconomic and low educational status are at highest risk. It had been observed that the mobile phone related communication methods are utilized more frequently to commit the offence. Though the authors had experienced a similar trend in Sri Lanka, only few studies were available in literature.

Wimalaratna, P.L., Wijewardhana, B.V.N., Poruthota, P.C. University of Moratuwa lakruwani@gmail.com Background Non Communicable Diseases (NCDs) are a common social issue nowadays. NCDs are caused due to unhealthy behavioral patterns of people and they cause hazardous impacts, socially and economically that can be rather prevented than cured. Primordial and primary prevention are the cost effective interventions than the secondary and tertiary prevention. The government has taken many measures to minimize and prevent these diseases. Innovative methods of advertising can be vital in communicating the message to the expected audience that will create more impact.

Aims The objectives of the study are to determine the socio-demographic factors and modes of communication used between the assailants and the victims in cases of sexual assault.

Methods This study was conducted on the sexually assaulted individuals who were brought to the hospitals in Central, Sabaragamuwa and North Western provinces for medico-legal examination during the period of December 2011 and June 2012. Data was collected using a questionnaire by specialists and trainees in Forensic Medicine, maintaining the professional standards. Data was analyzed using Microsoft Excel software.

Aims To explore the characteristics of the most vulnerable group for diseases, to find the best communicative methods to convey the idea across and to identify appropriate ways of using advertising for prevention of diseases and possibility of bringing up innovative methods to reach the target audience Methods This paper is based on a research on social advertising methods. It identifies the importance of a strategic approach in using advertising to find a communication solution to such social problem. A descriptive study was conducted on a sample of 100 suburban living and urban working middle class office workers between 25-40 years as target

Results Among 62 sexually assaulted victims, 96% were females. Eighty one percent of them were less than 18 years of age and among them, 43% were in 12-16 years age group. Seventy two percent of the victims were from low socioeconomic group. In almost all cases, the victim knew the

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assailant. Verbal communication was the commonest method of communication (43%) in which 88% have directly spoken with assailant, followed by mobile phone and verbal (22%) and mobile phone only (16%). However, the mobile phone usage could be seen in 47% of cases. 36% of the victims used mobile phones owned by parents. 93% of the phones used had prepaid connections and most of the time the payments had been settled by the accused (38%). Verbal communication (70%) was identified in single episode of sexual assault while communication with mobile phone was commonly seen in 63% of repeated assaults.

conventional methods are used, an innovative approaches are warranted.

Aims To improve knowledge and attitudes of school children on important health issues in the view of promoting the wellbeing of community Methods Under the patronage of Ministry of Health, Southern Province, Provincial Director of Health Office organized a school quiz program called “Dakshina Jeewani”. It consisted of 3 rounds and conducted under 3 age categories. All students from grade 6 to grade 13 in southern province were requested to participate. The first round consisted of a MCQ paper with 40 questions. Top 3 from each category in each school were qualified for the 2nd round which was again a MCQ paper. For the final round top 3 from each category from all 3 districts were selected. It was an oral quiz which was telecasted in National Rupavahini. Questions were based on many areas giving more priority to important themes like non communicable diseases, communicable diseases, nutrition and reproductive health. Some questions were focused on developing healthy attitudes.

Conclusions In our study, most of the victims were young, school going females belonging to the low socioeconomic group. Verbal communication was the commonest method used especially in single episode of sexual assaults but mobile phone mediated communication was observed in repeated sexual assaults. It appears that the unhindered access to mobile phones by the young individuals and technological advancements in the mobile telephony had facilitated the commission of sexual offences.

OP-24 “DAKSHINA JEEWANI”: AN INNOVATIVE APPROACH FOR HEALTH EDUCATION IN SOUTHERN PROVINCE Chandrasiri , P.A.A. Welarathna, A.U., Edirimanne, H., Godakandage, S.S.P., Samaraweera, A., Kahawevithana, H. Provincial Director of Health Science Office, Southern Province amilachan@yahoo.com

Results The program let health and education sectors to work closely. Intersectoral collaboration was a key factor for the success and also expects to make a lasting impact on school health program. Total participation for the first round was 294,000 students. They were motivated to explore knowledge and it was shown a great enthusiasm. After the 1st round all schools were advised to arrange special sessions to discuss answers and it provided an opportunity to discuss about those topics in depth.

Background Students are a potent vehicle to spread health messages across society. Changing behavior of younger generation towards a healthy life style is a good investment for future as well. Though various

Conclusions A health quiz appears to be a satisfactory way for health education among school students which can be implemented in other provinces as well.

FREE PAPER SESSION 7 THEME: COMMUNICABLE DISEASES Methods Data on the annual incidence of suspected and serologically positive DF/DHF in the Kandy District and in whole Sri Lanka from 2001 – 2012 were collected from the Office of the Regional Director of Health Services (RDHS) in Kandy and the Epidemiology Unit in the Ministry of Health in Colombo, respectively. The data were analysed to identify the district and country DF/DHF trends over the years and to determine the percentage contribution of the Kandy District data to the total incidence of DF/DHF in the country. Entomological surveillance and evidence based vector control interventions, supported by dengue alerts, were strengthened in 2009. Pre and post intervention disease trends and percentage contribution of dengue incidence in the Kandy District to the total DF/DHF incidence in the country were compared.

OP-25 PREVENTION AND CONTROL OF DENGUE EPIDEMICS THROUGH APPLICATION OF EVIDENCE BASED DENGUE ALERTS AND VECTOR CONTROL INTERVENTIONS Kusumawathie, P.H.D., Jayakody, K.W.G. G., Samarasinghe, K .A. S., Jayasooriya, G.A.J.S.K. Regional Office, Anti Malaria Campaign, Kandy and Office of the Provincial Director of Health Services, Central Province kusum_amc57@yahoo.com Background Dengue fever (DF) and dengue haemorrhagic fever (DHF) is an arboviral disease complex transmitted by Aedes aegypti and Aedes albopictus. Ae. aegypti is the major and epidemic causing vector of dengue while Ae. albopictus less frequently cause epidemics. Since 2000, Sri Lanka showed an increasing trend of DF/DHF with epidemics at 2-3 year intervals, making the disease a major public health concern at present. In the absence of a specific treatment or a vaccine for DF/DHF, vector control is the mainstay of disease prevention and control. Implementation of appropriate vector control interventions heavily depends on the entomological information.

Results From 2001 to 2009, Sri Lanka experienced dengue epidemics at 2-3 year intervals, with a severe epidemic in 2009 (34,896 cases). The number of DF/DHF cases were not considerably declined after 2009, instead, there was an increase of the number of cases in 2012 (44,456 cases). Although the Kandy District followed the country DF/DHF trend till 2009, the district showed 59.9, 60.1 and 38.8% percent reductions of DF/DHF incidence in the years 2010, 2011 and 2012 respectively. From 2001 – 2009, Kandy District contributed 5.2- 25.9% (mean 11.8% + 6.2) to the total DF/DHF in the island. After intervention (2010 to 2012) the district contributed 4.8 - 5.7% (mean 5.4 + 0.52) to the total DF/DHF incidence in the island. In the post intervention period, of the 23 Medical Officers of Health (MOH) areas in the Kandy District, 21 areas prevented / controlled dengue epidemics. Of the remaining 2 MOH areas, one was caused by Ae. albopictus, thus this outbreak occurred unprecedented while the other occurred due to lack of coordination among the relevant sectors.

Aims To assess the feasibility of prevention and control of dengue epidemics through application of entomological evidence based vector control interventions supported by dengue alerts

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Conclusions Strengthening entomological surveillance facilitates application of evidence based vector control interventions supported by dengue alerts, thus, preventing / controlling dengue epidemics successfully.

Failures in dengue alerts and application of appropriate vector control interventions may result in DF/DHF epidemics in vulnerable areas.

Background Dengue is a major public health problem mainly in tropical and sub tropical regions around the world. The epidemiology and the transmission of dengue is complex and climatic fluctuations, social and demographic factors heavily influence its incidence. As a result of the disease, there is considerable morbidity, mortality and costs to the health system.

OP-26 COMMUNITY ACCEPTANCE AND COMPLIANCE FOR LONGLASTING INSECTICIDAL NETS (PERMANET®) IN RURAL VILLAGES DURING MALARIA ELIMINATION IN KURUNEGALA DISTRICT IN SRI LANKA

Aims To examine the applicability and the adaptability of wavelet theory on the dengue incidents in Colombo Municipal Council area and explore it as a tool for an early warning system for larger dengue outbreaks Methods We retrospectively analyzed data on the reported dengue cases for DF and DHF in Colombo Municipal Council (CMC) area from year 2006 to 2011. Wavelet analysis was performed for each fifteen zones in urban Colombo to explore the periodicity in the dengue incidence time series.

We used the Morlet wavelet power spectrum for the analysis and all analyses were performed using MATLAB package. The continuous time-frequency representation of a signal offers very good time and frequency localization being compared to the Fourier Transformation.

Bandara, M.R.S.S., De Alwis, A.K.S.B., Deniyage, S., Amarasinghe, P.G. Regional Office, Anti-Malaria Campaign, Kurunegala mrssbandara@yahoo.com Background One of the major components of the Malaria Elimination Strategy in Sri Lanka (SL) is coverage of malaria risk population with long-lasting insecticidal nets (LLINs). The success of this strategy is mainly dependent on LLINs acceptability and compliance. There has been unresolved debate among policy makers and implementers on LLIN acceptance and compliance by the local community in Sri Lanka.

Results Generally, the wavelet power spectra show periodicity for each zone in CMC area. The analysis shows predominant semiannual (6 months) cycles of dengue outbreaks in zones 1, 2, 7, 9, 10, 13 and 14 and they are statistically significant at 5% significant level. But there can be seen a significant quarterly (4 months) cycle in zone 7 in years 2009 and 2010.

The pattern of dengue outbreaks in zone 1 and 2 is quite similar between years 2009 and 2010.

Aims To investigate the level of acceptance and compliance of LLINs by the local community in Kurunegala District in order to improve the method of implementation and for further monitoring and evaluation.

Methods The surveys were carried out in randomly selected LLIN-used localities in five MOH areas in Kurunegala District in 2008. Each household received one LLIN (PermaNet® 2.0) treated with 0.55g/sqm deltamethrin. An interviewer-directed questionnaire was used to study community acceptance and compliance of net-users from informal interviews. LLIN acceptance and compliance were evaluated through surveys at three defined time points, three months, one year and two years after distribution.

Conclusions Wavelet spectrum is a powerful tool for analyzing noisy dengue data series where basic time series models are not informative. We have used only the reported dengue cases (DF and DHF) for this analysis. It would be useful to apply wavelet coherency and phase difference to examine the statistical relationships between dengue cases and other external factors such as climate, social factors and demography.

OP-28 SPUTUM POSITIVE TUBERCULOSIS AMONG CONVICTED PRISONERS IN SRI LANKAN PRISONS: PREVALENCE AND CONTRIBUTORY FACTORS

Results The acceptability of LLIN after short-term and long-term use was not significantly different over time of use (p<0.005). Majority of people preferred conical shape nets. Willingness to use LLINs was very high among non-users (96.7%) and the most acceptable reason for the use was “receiving a pleasant night's sleep” (64%) with LLINs. “LLINs did not prevent mosquito bites” was significantly less acceptable (10%) than “preventing mosquito bites” (49%). LLIN compliance was significantly higher (p<0.05) in females than males. More than 69% users were 'group-sleepers' under LLINs. Highest LLIN compliance (91%) was observed among teenagers followed by infants (86%), adult elders (78%).

De Alwis, A.K.S.B., Samaraweera, S.D., Pallewatte, N.C., Ambagahage,T.M. National Programme for Tuberculosis Control and Chest Diseases ccpnptccd@hotmail.com Background Tuberculosis is considered as one of the major public health problems in Sri Lanka. Socially deprived populations such as prisoners are at higher risk of TB. The unfavourable conditions in prisons such as poor living conditions will contribute to the spread of disease.

Conclusions The LLIN is an acceptable intervention and sustenance of the use with close monitoring of usage is needed to achieve the coverage in malaria elimination.

Aims To determine the prevalence and disease pattern of sputum smear positive TB and its contributory factors among convicted prisoners

OP-27 MATHEMATICAL MODELING AND DENGUE: AN ANALYSIS OF INCIDENCE OF DENGUE IN URBAN COLOMBO USING WAVELET APPROACH

Methods A descriptive cross-sectional study was carried out among convicted prisoners in all prisons in Sri Lanka. Information on socio-demographic factors, life style factors, living conditions, past & present medical conditions, contact history were collected using an interviewer administered questionnaire. Symptom checklist was used to identify TB suspects. All TB suspects were subjected to sputum microscopy for Acid Fast Bacilli in 3 sputum samples collected in 3 consecutive mornings, sputum culture and drug sensitivity test.

Wickrmaarachchi, W.P.T.M., Perera, S.S.N., Jayasinghe, S., Karunanayake, P., Kariyawasam, P. Department of Public Health, Colombo Municipal Council wptharindu86uoc@gmail.com

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Results A total of 5510 prisoners were included in the study. Prevalence of sputum smear positive TB among study population is 1688 per 100,000 population (N=93). Significant associations were found between smear positive TB and level of education below 5th grade (p= 0.028) inadequate space in the house previously lived (p=0.0049),dirty/untidy previously lived house (P=0.0172), poor lighting in the house previously lived (0.0003), > 5 times of previous imprisonment (0.0001), > 10 inmates (p=0.0003), <1 hour stay in outside(p=0.0219), BMI<18 (p=0.0000), perception of poor nourishment (P=0.0409), perception of poor health status (p=0.0001) and previous contact with TB patients (p<0.0000).

Conclusions Prevalence of TB in prison is exorbitantly high when compared with the prevalence among general population. Attention should be given to inmates with low BMI, poor health status, contacts of TB patients, frequent admissions to prisons in order to identify TB patients in prisons and their living conditions needs to be improved.

FREE PAPER SESSION 8 THEME: MENTAL HEALTH OP-29 'JEEWANODAYA' COMMUNITY BASED REHABILITATION CENTER FOR MENTALLY ILL PATIENTS

OP-30 A QUALITATIVE STUDY ON IMPROVEMENT OF MENTAL HEALTH AMONG A GROUP OF ADULTS WHO TOOK UP VIPASSANA MEDITATION AS PART OF LIFESTYLE

Fernando, W.D.Y, Anuradha, K.W.D.A, Wickramasingha, L., Thalagala, Y.D, Abeywickrama, G.S., Kumara, P.G.H., Aluthge, P.C. MOH Office, Madurawala kwdanu@yahoo.com

Gunathunga,. M.W., Gunathunga, C.K. Faculty of Medicine, University of Colombo wasantg@hotmail.com Background Mental stress is a risk factor for a variety of non-communicable diseases and an antecedent for unfavorable behaviors among â&#x20AC;&#x153;normalâ&#x20AC;? people.

This is compounded by modern living and the need to play multiple roles in the society. This situation demands urgent new methods to help people to reduce mental stress and live a healthier life. Vipassana Meditation (VM) is known to improve mental health among ascetics with a stabilizing effect on mind. Present study was designed to test VM as a tool for improvement of mental health among lay people.

Background Rehabilitation of mentally ill patients involves making them independent in their daily activities, improving their life skills and giving a vocational training which are less focused and should be done by a multidisciplinary team.

Aims Rehabilitation of mentally ill patients to make them independent in daily activities, developing life skills and vocational training

Aims To describe the improvement of selected aspects of mental health and the sustainability of improvements among a small group of long term regular lay vipassana meditators.

Methods and Results This project was undertaken as collaboration between MOH Office Madurawala, AGA office, Madurawala & Mental Health Unit, Base Hospital Horana. Capital funds to establish the centre were provided by the Area MP. It commenced in January 2011 with 10 mentally ill patients free of positive symptoms at Ampitigala Temple. Daily activities are undertaken according to a schedule. These include: religious observances; cleaning the temple; exercises; indoor and outdoor games; agricultural work etc. Some activities are conducted once in 2 weeks: a program by the field staff of Divisional Secretariat, occupational therapist of the GH Kalutara, a health talk by one of the field health staff.

Once a month programmes include special programmes by a guest resource person such as musical, sports, vocational training such as making candles, mats, compost, envelops etc. Special activities are carried out also on special days of the year such as New Year festival / Wesak (Flower 'Dansala', Sil programe) etc. The resource persons for these programmes include public sector officers, field staff of the MOH office, AGA Office, MH unit-Horana and community leaders. RDHS has provided physical resources. Private Sector has provided raw materials for the production of economically important goods. Community participation and support has been established. The communities have provided tea and lunch and sometimes they celebrate birthdays and special days of the village with the inmates. Several groups have been rehabilitated by now. The initial observations of the programme shows that the inmates are very satisfied with the services offered to them. This community based rehabilitation center will be stationed at a permanent building at the MOH Office Madurawala with RDHS office funds in the future.

Methods A qualitative study design with participatory observation was used. A group of six practitioners, three females and three males, from Colombo and Gampaha districts were included. They practiced meditation approximately two hours every day for the past five years or more. A two year period ending in December 2012 was taken for analysis. Method of data collection was participatory observation in meditation and weekly group discussions. Analysis was on-going using Grounded Theory.

Observations and discussions were designed to develop and test eight constructs.

Results Out of the eight constructs achievement of stability against emotional challenges was confirmed by all in the group. Reduction of conflicts in social and family life, reduction of stress levels, compelling desires and internal noise were also confirmed by all. Pain and reaction to pain were reported to be reduced. There was evidence that personality of the individuals did not change.

Conclusions VM had a favourable and sustainable effect on selected aspects of mental health. VM can be recommended to promote sustainable mental health among those who can take up meditation as part of lifestyle.

Conclusions Community mental health rehabilitation is feasible in Sri Lankan setting, however, strong inter sectoral links need to be established for its maintenance.

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OP-31 Provision of Mental Health Services through Community Partnership

OP-32 Can music improve the disease status of stable angina? A randomized controlled trial

Wijewickrama, B. A. O., Fernando, N .F.J., Hettige, N., Samanthi, W. L. D.G., Rajapakshe, N., Kumarappeli, V., Priyadarshani, R. National Institute of Mental Health, Angoda arosha24@gmail.com

Siritunga,S., Wijewardena, K., Ekanayaka, R., Mudunkotuwa, P. National Institute of Health Sciences, Kalutara sssiritunga@yahoo.com Background The aim of management of angina is to stop or minimize symptoms and to improve quality of life and long-term morbidity and mortality. Other than medical and surgical management for angina, alternative therapies such as relaxing music have also been identified. However, research done to recognize the actual clinical effect of music was sparse.

Background The World Health Organization signaled the urgent need for provision of community mental health services at its Global Forum for Community Mental Health. The present project was planned to utilize the already available state services to provide better mental health services through community partnership.

Aims To determine the effect of music on selected aspects of clinical profile in chronic stable angina patients aged 45 to 65 years

Aims To minimize treatment gap in provision of mental health care services and deinstitutionalization of the mentally ill patients

Methods This single blind randomized clinical trial was conducted for one month.

While the intervention group (n = 30) listened to a music based on Indian classical system at home twice a day complementary to their regular treatment, control group (n= 30) was only on their usual treatment. The clinical profile (severity of symptoms and state of ischaemia) of both groups was assessed before and after the intervention through Canadian Classification of Angina Guidelines, their treatment details and exercise ECG results.

Methods Project was carried out in the catchment area for admissions for Unit 06 of National Institute of Mental Health (NIMH), Angoda from the Colombo District. A community mental Health team was established under the Consultant Psychiatrist consisting of Medical Officer-Mental Health (MOMH), Community Psychiatric Nurse (CPN), Psychiatric Social Worker (PSW) and Occupational Therapist. The community was involved in planning, implementation, monitoring and evaluation of the programme. Community meetings were held in selected areas.

Community volunteers were recruited and a training done. The volunteers went into the community and started active case detection.

Upon new case detection the team consisting of above, visited to evaluate and plan treatment. The multitude of satellite clinics established are used to provide treatment and where necessary Depot injections were provided monthly at home. All patients were reviewed periodically by the MOOMH. CPNN and PSWW ensured tracking of all follow up patients with the aid of the volunteers. Volunteers themselves assembled periodically for feedback and appreciation.

Results While significant improvement in the symptoms (p<0.05 - p<0.01), in the treatment of chest pain (p<0.01) and in the state of ischaemia [increase in mean exercise duration by 123 seconds (p<0.01), the stage at which the test was terminated (p<0.01), Maximum MET level achieved by 2.1 (p<0.01), the time until 1 mm ST depression by 127.3 seconds (p<0.01) and the time until maximum ST segment depression by 85.9 seconds (p<0.01) and significant reduction in mean maximal ST segment depression by 0.55 mm (p<0.01)] were observed in the study group. The reduction in the mean heart rate was not significant. However, no significant improvement was observed in the control group.

Results Feedback from the community and clients indicate satisfaction. Clients are functional in the community while on treatment and unnecessary admissions have been prevented. Community volunteers are bringing in new clients to NIMH and other clinics for treatment.

Conclusions Systematic, regular listening to the music based on Indian classical system significantly improved the severity of the disease of stable angina. Hence music has a potential benefit for use as complementary to treatment in reducing morbidity.

Conclusions Community partnership in provision of mental health care serves to reduce the treatment gap.

FREE PAPER SESSION 9 THEME: SCHOOL AND ADOLESCENT HEALTH Methods A descriptive cross-sectional study was conducted in 28 schools in four educational zones in Gampha District to assess the psycho-social and physical environment of schools. Assessment was using a tool developed based on the Psycho-Social Environment (PSE) profile of World Health Organization. Principal Investigator collected data through observation, from records and by interviewing teachers and principals.

OP-33 PSYCHO-SOCIAL ENVIRONMENT OF SCHOOLS IN RELATION TO PEER VIOLENCE AMONG SCHOOLING ADOLESCENTS IN GAMPAHA DISTRICT Wijeratne, M. P.1, Seneviratne R. de. A.2, Gunawardena, N.2 1

Ministry of Health, Sri Lanka, 2Faculty of Medicine, University of

Colombo monika.wijeratne@gmail.com

Results Of the 28 schools 9 (32.1%) had a code of conduct or school policy regarding students' behaviour related to involvement in violence and 2 had updated it in the last 5 years. Only 2 (7.1%) schools had trained staff members to mediate violence among students. Only six (21.4%) schools had a policy discouraging physical punishments by teachers and four (14.3%) were keeping records of violent incidents. Ten (35.7%) schools involved parents in formulating policies regarding student behaviour. In eighteen (64.3%) schools, primary care health staff was involved in functioning of school health club. Four (14.3%) had

Background Creating an environment favourable for emotional and social well-being is an important responsibility of a school.

Aims To assess the physical and psychosocial environment of the schools for features that promotes and prevents interpersonal violence among 1315 year old schooling adolescents

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displayed posters promoting non-violent behaviour and twelve (42.9%) schools had one or more places which may facilitate violence.

Background Students are exposed to various stresses. Studies have shown that the school environment is the best place to promote mental wellbeing and life skills.

Conclusions Schools had paid minimal attention for prevention of violence in schools through modifying the physical and psychosocial environment in schools.

Aims To introduce an intervention package to improve life skills and reduce stress among school children

OP-34 EMOTIONAL AND BEHAVIORAL PROBLEMS OF SCHOOL GOING ADOLESCENTS AGED 13-15 YEARS IN MOH AREA MAHA-OYA: PREVALENCE, CORRELATES AND ASSOCIATION WITH SCHOOL PERFORMANCE

Methods This project was started in Yatiyana Kanishta Vidyalawa in Agalawatte Medical Officer of Health area in October 2012. School children (n = 317) of age 5 - 16 years were selected for the project. The study was facilitated by the principal and teachers. Each student was encouraged to maintain a book to draw their mood of the day at school on a daily basis. Teachers and the students were asked to assess the predominant mood of the class at the end of the day with an attention to students with sad moods. Twenty five volunteered grandparents from Yatiyana area were invited to the school. Fifteen students were allocated to a grandparent to have interactions with children in different modes (stories, viridu etc.). A song with a sensible meaning was played at the start of school once a week and the meaning was displayed on notice board. One student was to comment on the song at the weekly assembly.

Jayawickrama, W.I.U., Senaratna, C. Ministry of Health, Sri Lanka. dr.iresha@yahoo.com Background The mental health problems in children and adolescents have become a major public health challenge universally.

Aims The present study was conducted to describe the prevalence and correlates of emotional and behavioural problems and its association with school performance of school going adolescents aged 13-15 years in Maha-Oya MOH area.

Results Analysis of mood records for a period of two weeks at the start of the project showed a good mood level (happy faces) of 54% among all students. This increased to 72% after 3 months. School attendance increased from 77% to 89% during these 3 months with all students having an attendance of more than 80%. An improved interaction among teachers and students were noticed. Grandparents appreciated the interaction they had with children and they felt they are being valued more by the students after the interaction. The programme is taken over by the school and its sustainability has been established.

Methods A descriptive cross sectional study was carried out with a sample size of 539. The selection of the sample was done using cluster sampling technique. The study instruments consisted of validated Sinhala version of Strengths and Difficulties Questionnaire (SDQ) for the assessment of the emotional and behavioural problems, a self administered questionnaire for the associated factors and a data extraction sheet to collect the students' second term test marks in grade 8, 9 and 10.

Conclusions The present intervention highlights the feasibility of undertaking simple interventions to improve the mental health of school children.

Results The prevalence of emotional and behavioural problems was 15.9%. The factors which were significantly associated with the emotional and behavioural problems were: the age (p<0.01), parent's education (p><0.05), family members quarrel at home (P<0.01), unnecessary scolding at the adolescents (P<0.001)), parental support for academic activities (p<0.01) and extracurricular activities (p<0.05), attending tuition classes or not (p<0.05), being scolded for poor school performance (p<0.001), financial difficulties in purchasing academic needs (P<0.01) and loss of a family member due to armed conflict (p<0.001). The means of the average marks of students were 33.4, 34.6, and 33.1, respectively, for grade 8, grade 9, and grade 10. The average marks of those with emotional and behavioural problems were significant less than that of students with normal mental health (p<0.01).

Further, the z scores of students were also significantly associated with some individual symptom-scales of SDQ, namely, emotional problems (p<0.001), conduct problems (p<0.01), peer problems (p<0.01) and prosocial behaviours (p<0.05).

OP-36 Mapping and size estimation of especially vulnerable youth in the Western Province, Sri Lanka Vidanapathirana, J., Karavita, A. National STD/AIDS Control Programme, Colombo. kavigaya@yahoo.com Background All youth in Sri Lanka are not at risk for HIV/AIDS. However, certain socio-economic and behavior factors are present among youth which make them vulnerable. There are subsets of especially vulnerable youth (EVY) and most-at-risk youth who need to be identified for targeted interventions. Identification of types of subsets and size are essential for interventions.

Aims To identify the subsets of EVY and estimate the size according to the geographical area in the Western Province

Conclusions Emotional and behavioural problems of school going adolescents have a high prevalence.

Methods Groups of EVY in the western province were identified using participatory approach with broad based consultation of various stakeholders in the public, private and civil society organizations including youth organizations. Geographic mapping and size estimation was done using the participatory method in group consensus with the key partners. Previous studies, ad hoc surveys, programmatic data from the various organizations including census and statistic data and experience of the participants were used. Series of mapping workshops conducted to finalize the locations and size of the population groups identified as EVY. This was done interactively within each group of

OP-35 S I M P L E I N T E RV E N T I O N S B A S E D O N C O M M U N I T Y EMPOWERMENT TO PROMOTE MENTAL WELLBEING AMONG SCHOOL CHILDREN Liyanage, C. P. G., Anuradha, K. W. D. A., Rathnayake, U.I., Gunasinghe, A. D., Kumari, K. A. D. L. Medical Officer of Health Office, Agalawaththa prasadgliyanage@gmail.com

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experts assigned to each study zone. Locations were marked as a point layer manually on Topographic maps. Each point was assigned a definite number relevant to the size.

scrutinized carefully in a systematic way to read the locations and the number of the population group marked by group ID. Different point layers for each identified EVY was created on digital topographic maps.

Results Ten number groups of EVY were identified with total of 47,285 in the Western Province. Final results were generated by using the topographic maps of the Western Province. These maps were then

Conclusions Ten groups of EVY were identified according to the size and geographical areas. These data will be using future HIV prevention interventions with different approaches.

FREE PAPER SESSION 10 THEME: NON COMMUNICABLE DISEASES OP-37 CARDIOVASCULAR DISEASE RISK SCORE PREDICTION MODELS FOR WOMEN AND ITS APPLICABILITY TO ASIANS

OP-38 INCIDENCE AND RISK FACTORS FOR FALLS AMONG THE ELDERLY IN THE DISTRICT OF COLOMBO

Goh, L.G.H1., Dhaliwal, S.S.1, Lee, A. H.1, Della, P.R.2, Bertolatti, D.1, Coorey, R.1, Jayasena V.1, Binns, C.W.1 1 School of Public Health, 2School of Nursing and Midwifery, Curtin Health Innovation Research Institute, Curtin University, Australia S.Dhaliwal@curtin.edu.au

Ranaweera, A.D., Fonseka, P., Siribaddana, S.H., Pattiya Arachchi, A. Environmental Health Institute, Singapore dranaweera90@gmail.com Background The proportion of elderly population in Sri Lanka is growing. Falls are an important cause of morbidity and mortality among the elderly.

Approximately 28-35% of people aged 65 and over fall each year. There is inadequate emphasis on prevention of falls.

Background Cardio Vascular Diseases (CVD) is the leading cause of mortality globally with 17 million deaths in 2008. Women account for more CVD deaths than men. Risk score models enable the quantification of CVD mortality risk by factoring in multiple variables and, infrequently, their interactions. This is a cost-effective approach enabling “most at risk” individuals to be identified and targeted for preventive treatment.

Current CVD models include most of the conventional risk factors, such as age, sex, lipids, systolic blood pressure, smoking status, family history and left ventricular hypertrophy. Although the association between these variables and CVD risk is generally consistent across populations, there is growing evidence for developing ethnic-specific risk prediction models as the prevalence of CVD risk factors and CVD rates differ.

Aims To assess the incidence and risk factors of falls among the elderly population in Colombo District Methods The study was carried out during the months of August 2010 –March 2011. Incidence of falls was assessed by a community based descriptive study with prospective follow up. At baseline, 1200 elderly aged 65 years or more, from 40 Grama Niladhari divisions in Colombo District was enrolled by multi stage cluster sampling method based on probability.

They were followed up for four months. Risk factors for falls were assessed by a nested case control study. Elderly who had falls during the follow up period was considered as cases (n=151) while two controls per a case were selected from others. Data was collected using interviewer administered questionnaires and few clinical tests by pre-intern medical officers. Data was analyzed using Statistical Package for Social Studies.

Aims This study compares the performance of Framingham, SCORE and general CVD risk score models in predicting the 10-year CHD and CVD mortality risk in Australian women.

Results The incidence rate of falls was 492 per 1000 person years (95% CI= 448536). Incidence rates of falls in females and males were 515 (95% CI=469-561) and 462 (95% CI= 420-504) per 1000 person years, respectively. Risk factors for falls identified in the multivariate analysis included falls in the previous year (OR= 4.67), high disability level (OR=2.04) and high house risk level (OR=1.68).

Methods Using the National Heart Foundation Risk Factor Prevalence Study, we determined 10-year CHD and CVD mortality risk of a representative population-based sample of 4,487 Australian females aged 20-69 years with no previous history of CVD and diabetes. Ethnicity was determined using country of birth. These models were assessed against two criteria: discrimination and calibration. Sensitivity, specificity and positive and negative-predictive values were also examined.

Conclusions The high incidence of falls reported in this study and identification of preventable risk factors, indicate the necessity and feasibility of prevention of falls among elderly.

Results These models were primarily developed and validated in Caucasian women and did not consider ethnicity as a risk variable. Therefore, they often overestimated CHD and CVD risk and had limited applicability in Asian women.

OP-39 QUALITY OF LIFE AND ITS ASSOCIATED FACTORS AMONG PATIENTS WITH CHRONIC KIDNEY DISEASE ATTENDING THE PROVINCIAL GENERAL HOSPITAL BADULLA

Conclusions It is important to incorporate ethnicity in CVD assessment. Further research using multi-ethnic cohorts are needed to examine the applicability of these models in Asian women. It is also crucial to select the most appropriate anthropometric measurement in assessing adiposity in women of different ethnic background for inclusion into these models.

Jayasinghe, J.A.D.A.E.1, Arambepola, C.2 MOH office, Gangawata Korale, Kandy, 2Medical Faculty, Colombo 1

achilajayasinghe@yahoo.com

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Background Chronic Kidney Disease (CKD) is an emerging major public health problem of Sri Lanka. It is associated with multiple disabling symptoms, co-morbidities, complications, multiple drug treatment regimens and intrusive treatments (dialysis) that invariably affect Quality of Life (QOL) among CKD patients.

OP-40 COPING STRATEGIES AND TREATMENT-SEEKING BEHAVIOUR OF PATIENTS WITH NON-COMMUNICABLE DISEASES IN FOUR MOH AREAS OF SRI LANKA Higuchi, M., Liyanage, C. National College of Nursing, Japan, National Centre for Global Health and Medicine hondai2003jp@yahoo.co.jp

Aims To describe the QOL and its associated socio demographic, economic and disease related factors among clinic attendees of PGH Badulla.

Background Non-communicable disease (NCD) can be identified as a rapidly growing health problem worldwide with more than 36 million deaths due to NCD reported yearly. Sri Lanka is one of many developing countries faced with a great challenge in addressing issues related to NCD. However, only a few studies have attempted to explore the coping strategies and treatment-seeking behaviour of people with NCD.

Methods A descriptive cross-sectional study done, consecutively recruiting confirmed clinic patients to obtain a sample of 405. An interviewer administered questionnaire was used and the QOL was assessed by the SF 36 in relation to its eight dimensions and two summary measures.

The 't' test was applied.

Results The majority were males (66.4%), married (88.4%), Sinhalese (75.6%) and Buddhists (74.8%). The mean age was 59.1 years (SD = 11.67). The majority were paddy farmers (38.6%), educated up to Grade 5 or below (31%) and earning less than Rs. 10000 monthly (80.5%). The average duration of CKD was 2.2 years (SD = 1.87). Hypertension was the commonest (55.3%) risk factor and 36% were currently suffering from >3 symptoms. QOL was lower in domains of role limitations due to Physical problem and Emotional problem, and General Health, while Higher in Social Function. Older age, being unmarried, being aware of chronicity and poor compliance were associated with poor QOL in mental functioning. Older age, being on dialysis, on blood transfusion, presence of > 3 symptoms and having more than 2 years of CKD were associated with poor physical QOL. Unemployment, lower level of education, lower income, distance to clinic > 10 km, no regular clinic visits and needing >2 days hospital admission monthly were significantly associated with poor QOL in both physical and mental aspects.

Aims This study aimed to explore the behavioural patterns and coping strategies of NCD patients in a Sri Lankan community.

Methods Both qualitative and quantitative methods, such as a semi-structured questionnaire and in-depth interviews, were used to collect data.

Results A total of 138 NCD patients in four Medical Officer of Health (MOH) areas in Colombo and Gampaha districts were included in this study. Diabetic mellitus (DM) was the leading health problem among the study population. The majority of patients received a diagnosis of NCD after suffering from multiple symptoms for a long period of time. The treatment-seeking behaviour of patients is rather complicated and most undergo multiple therapies they consider to be complementary, rather than alternative. The social network of patients and their families plays a crucial role in not only making decisions about treatment options but also in developing certain misconceptions regarding the prevalence and prevention of illnesses.

Conclusions QOL was relatively lower in some aspects of physical and mental functioning among clinic patients with CKD. Factors associated with QOL of them were related to older age, unmarried status, their lower socio-economic status and some aspects of high disease burden and poor service utilization. It is recommended that patient perception views especially of these vulnerable groups should be incorporated in the long term management of CKD.

Conclusions This study highlights the importance of community-based NCD programmes, which should be designed in collaboration with all stakeholders in the community including indigenous, religious, and ritual healers. People are not aware of the need of receiving assessment from medical practitioners until their problems worsen. Their belief system and principles in everyday life need to be evaluated by using a narrative study approach that can be flexibly adapted to the local culture.

FREE PAPER SESSION 11 THEME: ORAL HEALTH criteria has been developed based on the cut off value.

OP-41 AN INNOVATIVE APPROACH TO UTILIZATION OF RISK FACTOR MODEL AS AN EARLY DETECTION TOOL FOR ORAL CANCER IN NIHS FIELD PRACTICE AREA

Aims To utilize the RFM strategy as an early detection tool for screening oral cancer and to assess its applicability in conducting health education sessions

Lakmini, M.G S., Amarasinghe, H. National Institute of Health Sciences, Kalutara and National Cancer Control Programme sajeewalakmini14@yahoo.com

Methods All the Dental Surgeons in the area were given a one day refresher training programme on early detection of oral cancer by the National Cancer Control Programme. Oral cancer and Oral Potentially Malignant Disorders (OPMD) surveillance system was introduced from July 2012.

Interactive out reached sessions were conducted to the Gramasewa officers, Samurdhi Officers, Agriculture Officers, Three wheeler drivers, Health staff, and Divisional Secretariats office staff to introduce the high risk criteria for early detection of oral cancer. Power point presentation, video clips, posters, and leaflets were used as teaching learning materials. Training programmes were conducted for the various categories to send the messages to the high risk individuals to attend Dental clinic for screening.

Background Oral cancer is a huge burden for Sri Lanka. For a better outcome, early detection of oral cancer is very important. Due to lack of man power, screening of total target population is very difficult. As a possible solution to this problem, National Cancer Control Programme has developed a Risk Factor Model (RFM). RFM is based on age, socioeconomic status of the individuals and habits such as betel-quid chewing, alcohol drinking, and tobacco smoking. Each variable were given a score based on odds ratio obtained in an epidemiological research study. A risk score of 12 has been taken as the cutoff value for screening and high risk

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Background Early Childhood Caries (ECC) is a global public health problem predominantly affecting disadvantaged children. If unattended this infectious disease could hamper quality of life of children and their parents to a greater extent. National Oral Health Survey 2002/2003 reveals that there was 65% of dental caries among 5-year-olds.

However, there are well-proven, innovative strategies to tackle ECC. The Community Dental Unit of Dental Institute, Colombo conducts a preventive dental clinic on a daily basis for high- risk children aimed at developing sustainable, best- practice models for preventing and controlling ECC.

Results Sixteen sessions were held from September to December 2012. The number of people seeking advice and treatment for the pre-cancerous lesions were increased dramatically following the outreach interactive sessions and clinic sessions. Clinic attendances were increase by 80 %.

The general perceptions of staff and the community with regard to the relevance and quality of these activities and services are very satisfactory.

Conclusions RFM strategy could be utilized very effectively through interactive out- reach sessions and health education sessions in the Dental Clinic.

Aims To describe the burden of dental caries among high risk children attending the Preventive Dental Clinic and to assess the preventive dental clinic solutions to reduce the burden ECC.

OP-42 PREVENTION OF EARLY CHILDHOOD CARIES Fernando, E.I., Seneviratna, H., Bandara, J., Perera ,D National Cancer Control Programme , Ministry of Health eshani.anoja@hotmail.com

Methods All High Risk preschool children in the Colombo Municipal council (CMC) region, who attended the Community Dental Unit from 1st of January to 31st December, 2012 were considered as the study sample.

Data were extracted from routine record forms and analysed using SPSS-16 version.

Background In Sri Lanka, dental caries remain a major public health problem among children. Sixty six percent of 5-year old children suffer from dental caries with an average of 3 decayed teeth. Dental caries is an infectious and transmissible disease. Streptococcus mutans (MS) is the main bacteria responsible for development of dental caries. Children are born without these bacteria and they can acquire the bacteria through contact, typically from the mother within first 2-3 years in life. The risk of transmission of the bacteria to baby is increasing with high maternal salivary levels of MS and frequent innoculation.

Results A total of 2221 children, 326 (14.7%) from pre-school screening programmes and 1895 (85.3%) from OPD have attended the Unit. The OPD referred had a significantly higher mean decayed teeth 7.4 (Âą3.26) than pre-school referred children 6.1 (Âą 3.51). The total number of visits made by them during the given period was 5614 visits (first and follow up visits). The total number of Behavioural Change Communication Sessions conducted for them was 3000. These included dietary counseling and oral hygiene improvement sessions. A total number of 2903 fluoride varnish applications and 2304 Glass Lonomer Cement restorations were performed. The majority (78.4%) of carious teeth was treated by simple fillings and 3.9% children with pulp exposed teeth were referred to pulp therapy at Restorative Unit B.

Aims To decrease early childhood caries by reducing the risk of transmission of caries causing bacteria to the newborn and to educate eligible couples and pregnant mothers about preventing dental caries in young children.

Methods Provision of oral health was incorporated into the existing MCH programme namely to both eligible couple education programme and to ante natal care. Role of different categories of PHC staff and the hospital dental surgeons were identified. Oral health education sessions were organized to address the importance of good oral health for both mother and child In the booking visit. Pregnant mothers were referred to a hospital dental surgeon and government dental surgeons allocated a specific time period every week for providing appropriate and adequate care to the referred and treatment was recorded in the Pregnancy Record. The role of RDS and MOMCH was to monitor and evaluate the programme in their respective districts by consolidating the records sent by the MOOH and dental surgeons.

Conclusions Simple Preventive dental clinic solutions are available to tackle the high burden of ECC among high risk children and these could be recommended for use in other settings as well. However, the effectiveness should be further assessed by outcome indicators such as caries increment at baseline and after follow-up periods.

OP-44 SCREENING FOR HIV IN THE DENTAL CLINIC Perera, A. M. I. R., Johnson, N. W., Buddhakorala, K., Ariyarathne, M., Lalloo, R. Whitty, J., Amarasinghe, H., Rizwan, A. School of Dentistry and Oral Health Griffth Health Institute, Grifith University, Queensland, Australia r.perera@griffith.edu.au

Results No baseline data is available on providing oral healthcare to pregnant mothers. Island wide data is not available yet. In a study done in Dehiwela MOH area, 28% had utilized oral health services.

Background Over three decades in to the epidemic, HIV/AIDS remains a global health debacle with no cure in sight: prevention is thus the main focus of combat, where early case detection is crucial. The traditional high risk groups for screening, men who have sex with men and female sex workers is now expanded, e.g. to women at antenatal clinics; patients presenting to health institutions for any reason; school children; tracing partners and house to house screening.

Conclusions Further research is needed to assess whether the programme has achieved the objectives.

OP-43 PREVENTIVE DENTAL CLINIC SOLUTIONS TO TACKLE EARLY CHILDHOOD DENTAL CARIES

Aims To ascertain importance of assessing oral lesions in HIV case detection for Sri Lanka

Perera, I.R., Wickramaratne, P.W.N, Liyanage, N.L.P., Karunachandra, K.N.N., Bollagala, A.D., Kottahachchi, M.J., Wimalasena, B.A.S.S., Bandara, M D., Hewawitharana, H.I.C.S., Rajapakshe, P.G.K.S. Community Dental Unit and Restorative Consultant Unit B, Dental Institute, Colombo

Methods One hundred and fifty seven known HIV cases presenting for treatment at Antiretroviral Treatment Clinic Colombo were selected, consent obtained, interviewed and a clinical examination conducted by a dentist.

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The nature and prevalence of oral soft tissue lesions were compared with available national figures.

14% and 0.5% ; angular cheilitis 13% and 0.7%; ulceration 3% and 0.9% ; and leukoplakia 0.6% and 1.57%. Linear Gingival Erythema 13% and geographic tongue 3% were only seen among HIV patients, while Lichen Planus 0.25% was seen only among the comparison group.

Results The demographics in the sample were as follows: males 91 (58%), females 66 (42%); average age 41.7 years; ever married 80%; currently employed 78%; educated up to grade 6, 84%. On average the sample was 5 years post diagnosis, 77% were on anti-retroviral treatment (ART) with an average treatment duration of 3.5 years. The pattern of lesions among the HIV and comparison group (national figures) was: Prevalence of any lesion 41.4 and 3.9%; oral candidiasis

Conclusions Oral soft tissue lesions are common among HIV patients, some of which are known to be characteristic of immunosupression. Therefore, presence and pattern of oral lesions holds potential for HIV case detection in the dental clinics in Sri Lanka.

FREE PAPER SESSION 12 THEME: CHILD HEALTH OP-45 THE IMPACT OF EXCLUSIVE BREASTFEEDING ON GROWTH, RESPIRATORY TRACT INFECTIONS AND DIARRHEA DURING INFANCY: A RETROSPECTIVE- PROSPECTIVE COHORT STUDY

OP-46 REDUCING OF LOW BIRTH WEIGHT OF NEWBORNS IN PHM AREA, RATHMALGAHAELA: AN INNOVATIVE INTERVENTION BY A PHM

Chandraratne, S.H., Agampodi, S. B, Samita, S., Dharmaratne, S. S, Fernando, S. Base Hospital, Mutur and MOH Office, Naula ch.shashik@gmail.com

Herath, G.P.K., Jayasundara, S.J.B., Nandani , D.A.T. MOH Office, Dambulla shantha.rmpg@gmail.com Background Birth weight of a new born is an important determinant in one's health after birth. Low birth weight can lead to poor cognitive development and chronic disease in later life. According to RHMIS 513 and 524 reports, percentage of low birth weight in Rathmalgahaela Public Health Midwives (PHM) area at the end of 2nd quarter 2011 was reported as 15.1% and it was 11.6% for the year 2010. A survey conducted in the PHM area revealed that happiness of mother and satisfying five senses of baby during pregnancy was unsatisfactory.

Background Breast feeding is embedded in Sri Lankan culture while six month of Exclusive Breast Feeding (EBF) was recommended in Sri Lanka from 2005 onwards. Information regarding EBF knowledge, attitudes and practices is still low.

Aims The present study was designed to determine the impact of EBF on selected health factors (growth, diarrheal attacks, upper (URTI) and lower (LRTI) respiratory tract infections) during infancy in Naula Medical Officer of Health area.

Aims To design and implement a project to reduce low birth weight in PHM area, Rathmalgahaela by improving happiness of mother and satisfying five senses of baby during pregnancy period.

Methods We carried out a retrospective- prospective cohort study. Study population includes all infants born during the period of February 2008 to April 2008 and residing in Naula Medical Officer of Health area, in Matale District. For the Study sample, infants born during the above time period and registered in birth and immunization registers were selected.

Cluster sampling technique was used and a total of 114 infant mother pairs were selected for the study. Kaplan-Meir survival analysis, weibull model and linear logistic models were used to analyze data.

Methods Activities to be undertaken were determined from the information gathered from following methods: analysis of answers given to questionnaire on happiness and satisfying of five senses of the baby by 10 pregnant mothers; panel discussions conducted with 6 health officers. All newly registered pregnant mothers (70) in last two quarter of the year 2011 participated in the project. The health education sessions on knowledge and practices on happiness and satisfying of five senses of the baby were conducted at the ante natal clinic. All participants and her family members were guided by PHM during her home visits. The programme was evaluated by analyzing the birth weight of newborns and the observations made by PHM.

Results EBF rates in MOH area Naula at four month and six month were 57.8% and 50.8% respectively. Maternal age (p=0.0010) and ethnicity (p<.0001) were the determinants of EBF. Teenage mothers and Muslim mothers showed early cessation of EBF compared to other categories.

There was no significant association between growth and diarrheal attacks with EBF in this study sample. However formula feeding (p=0.0017) and mother being occupied (p<.0001), showed increased risk of diarrheal attacks. When the mother is aged between 20 and 35 years, EBF for less than four months showed significant association with URTI ( p=0.0374). When the child was looked after by a person other than the mother and when EBF duration was less than four months significant association with URTI was noticed (p<.0001).

Results Analysis of birth weight of newborns belongs to this cohort of mothers reported only 4.2% low birth weight rate in the year 2012. It is noted that all the members gave their fullest support to the pregnant mother to engage in suggested activities.

Conclusion The convincing results obtained from this project showed improvement of happiness and satisfying of senses of the foetus may be an effective strategy to reduce low birth weight.

Conclusions Identification of locally prevalent incorrect feeding behaviors and programs targeting to improve EBF practice for six months will help to improve infant health status.

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OP-48 PREVALENCE OF PARENTAL DISCIPLINARY PRACTICES IN A RURAL COMMUNITY OF ANURADHAPURA DISTRICT

OP-47 THE DEVELOPMENT AND VALIDATION OF AN INSTRUMENT TO ASSESS CAREGIVER BURDEN IN CEREBRAL PALSY: CAREGIVER DIFFICULTIES SCALE Wijesinghe, C.J., Hewage, C.G., Fonseka, P. Faculty of Medicine, University of Ruhuna cjw@med.ruh.ac.lk

Siriwardhana, J. D. D., Weerasinghe, M. C. Faculty of Health Care Sciences, Easten University and Faculty of Medicine, University of Colombo, Sri Lanka deepani_siriwardhana@yahoo.com

Background Caregivers of children with disabilities frequently experience distress due to burden of caregiving. Assessment of caregiver burden is essential for designing caregiver support interventions, to prevent them from becoming second-order patients and enhance the quality of care provided to the care recipient.

Background Disciplining is viewed as behaviour alteration without inflicting pain to maintain norms and authority. Punishment differs from disciplining as it is a behavioral alteration with psychological or physical pain which harms the child's dignity. Disciplinary acts can be categorized into non violent, physical assaults and acts of psychological aggression.

Aims To develop a valid and reliable instrument to assess caregiver burden experienced by caregivers of children with cerebral palsy (CP)

Aims To determine the prevalence of parental disciplinary practices Methods This study was carried out in two rural villages of Anuradhapura District.

The study sample consisted of 114 children between 11-16 years, 69 females and 45 males. Parent Child Conflict Tactic Scale (CTSPC), a validated self administered instrument to Sri Lankan context was used.

CTSPC elicits the occurrence of a particular disciplinary strategy in a scale from never occurred to more than 20 times in the referent period.

Past month was the considered as the referent period. The scale use prevalence as the measure. In calculating the prevalence 'never occurred' and 'occurred earlier but not in this month' response categories were excluded. Responses given to all other categories were counted as single encounters.

Methods A self-administered, multi-dimensional instrument, Caregiver Difficulties Scale (CDS) was developed using a combined qualitativequantitative approach. Items for the preliminary draft were selected from existing caregiver assessment instruments through consensus of experts or derived from key informant interviews with caregivers and service providers of children with CP. Standard item reduction techniques based on responses of 50 caregivers were used to develop the 25 item final draft of CDS. Multidimensionality of CDS was established by exploratory factor analysis, using responses of 125 caregivers. Construct validity of CDS was confirmed by demonstrating appropriate correlations between CDS score and two constructs: “Caregiver quality of life” and “Severity of disease in the care recipient”, in a sample of 90 caregivers. Internal consistency and reliability of CDS were assessed using Cronbach's alpha and test-retest reliability.

Results Of the physical assaults, prevalence of 'slapping on the hand' was 47.4% and 'squeezing ear' was 45.6%. The prevalence of 'spanking', 'hitting some part of the body beside the bottom', 'hitting head with knuckle' and 'hit on the bottom with hard object' were 43.9%, 43% 40.4% and 37.7% respectively. Prevalence of being 'beaten repeatedly' and being 'shaken' was 34.2% and 26.3%. Out of psychological disciplinary acts prevalence of 'threatening to spank', 'shouting', 'compare with another child', 'threatening to send away from the house', 'calling dumb/lazy' and 'blaming with filthy word' were 72.8%, 71.1%, 45.6%, 22.8% and 16.7% respectively. Prevalence of using different non violent disciplinary acts, ranged from 71.9% to 41.2%.

Results We developed a new instrument with four subscales measuring caregiver's concerns for child, impact on self, support for caregiving and social & economic strain. Face validity, content validity and consensual validity of CDS was established through the process of item generation.

Caregiver quality of life and severity of disease in the care recipient demonstrated significant moderate to good correlations (r = 0.3) with the scores of CDS, confirming construct validity. Both internal consistency and reliability of CDS were found to be satisfactory.

Conclusions Besides use of non violent methods to discipline children, use of violent methods is also common in this community.

Conclusions A multidimensional scale was developed to assess caregiver burden in CP, which demonstrated good psychometric properties during the preliminary appraisal of validity and reliability.

FREE PAPER SESSION 13 THEME: HEALTH PROMOTION / EMPOWERMENT Colombo District

OP-49 A HEALTH PROMOTION INTERVENTION ON SELECTED HEALTHY BEHAVIOURS IN PRE-SCHOOL SETTINGS IN COLOMBO DISTRICT

Methods A quasi-experimental study (pre-post design) was conducted to develop, implement and assess the health promotion intervention. Convenient sampling technique was adopted and the intervention was carried out in selected 20 pre-schools by trained school dental therapists. Phase I consisted of developing a validated intervention package with selected healthy behaviours and a pre-tested observational check list for pre post assessment of the intervention. The intervention package included five major criteria namely: good sanitary conditions, healthy dietary pattern, physical activities, development of health education materials by preschool community and active community participation. Phase II was the pre intervention assessment of pre-schools using observation check list by trained investigators. Phase III was implementation of the intervention by school dental therapists Phase IV included post intervention assessment of preschools using observation check list by

Perera, K.A.K.D.1, Kanthi , R.D.F.C.1, Hettiarachchi ,R.M.1, Ranasinghe ,N.1, Wijayalath, P.2 1 Health Education Bureau, 2 Base Hospital, Panadura kdilum@yahoo.com Background Adopting behaviors in the entire life will depend on the behaviours learnt during the early years of life.

Aims To develop, implement and evaluate a health promotion intervention to promote selected healthy behaviours among children in pre-schools in

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trained investigators after six months of the implementation.

OP-51 A HEALTH PROMOTION INTERVENTION TO REDUCE DOMESTIC VIOLENCE IN A RURAL COMMUNITY IN THE ANURADHAPURA DISTRICT, SRI LANKA

Results Under good sanitary conditions, hand washing practice; correct toilet practices; disposal of garbage in a hygienic way was observed in all preschools and it was 100% after the intervention comparing with 50%, 40% and 45% respectively before the intervention. All pre-schools have started tooth brushing though none of them practiced it before the intervention. Safe play area is available in 75% of pre-schools compared to 20% earlier. All pre-schools have adapted healthy diet, displayed health education materials developed on their own and have obtained active community participation after the intervention.

Reyal, H. P., Guruge, G.D.N., Fernando, W. M. S. Rajarata University of Sri Lanka parween11@yahoo.com Background Domestic violence (DV) is a form of interpersonal violence which occurs at home in between family members and it is the most common form of violence against women. At some point in life 10% to 69% of women around the world have being physically assaulted while 34.4% women in Sri Lanka have being abused. Due to the serious consequences and high prevalence of DV, this study focused on a health promotion (HP) approach to reduce DV through generating a community based process via empowering people to address selected determinants of DV.

Conclusions The health promotion intervention carried out in pre-schools in Colombo District has proven to be effective and could be recommended for other settings too.

OP-50 HEALTHIER GENERATION THROUGH HEALTH PROMOTION SCHOOL SETTINGS

Aims To reduce DV through developing a HP process in a rural community

Ratnayake, U.I., Shantha, S.K. S., Bandara, T., Jayakodi, N.P., Wijewardhana, J.C.I.K. Regional Director of Health Services Office, Kalutara isaacuster@gmail.com

Methods This community based intervention study was conducted through assigning two villages as 'intervention' and 'control' within the Anuradhapura district. The study population of both villages was approximately similar to each other according to their socioeconomic characteristics. An existing group of the 'intervention' village was selected to deliver the intervention to the village. An intervention module was used chronologically to broaden the understanding of family wellbeing and DV, while supporting them to recognize the determinant factors of DV. It explored the factors which most affect, and modified factors which can be changed with a mechanism of involving the community. Pre and post data were collected from the both villages using self administered and interviewer administered questionnaires.

Data were analyzed using the Minitab 15 software.

Background Hadigalla Kanishta Vidyalaya is situated in the MOH area Badurelliya.

Students attending it are from a background of economically and socially deprived families. Stealing, use of abusing words, fighting, unhygienic conditions of living, lack of discipline and manners were some of the common features among students. Lack of parents' guidance and poor participation in school development activities were observed. De-motivated teachers and high turnover caused staff shortage.

Aims By introducing health promotion concept to develop the school, the village and the students to become disciplined, decent and committed

Results The study showed significant changes in the 'intervention' area in addressing DV compared to the 'control' area. The ability to identify determinant factors of DV significantly increased in the intervention area with a 0.001 P value (P<0.05) compared to the control area. The overall analysis of the questionnaires showed significant improvement in addressing DV in the 'intervention' area (P<0.001) compared to the 'control' area (P=0.679).

Methods Principal, teachers and the health staff as a team did the situation analysis and comprehensively performed the problem analysis using problem tree method. They identified underlying causes and developed five main strategies to address these: (1) to strengthen the community participation discussions held with parents, students, formal and non formal leaders. School development committee established. (2) Supportive environment in the school was created by establishing a sound teacher-student friendly atmosphere. Implemented 5S concept in the school. Creative innovations of students ware utilized to modify the environment. (3) Spiritual and life skills programmes carried out to enhance the personal skills of children. Peer leaders trained and under the guidance of the principal ownership of the school development handed over to students. (4) Reoriented educational and social welfare services by means of conducting interactive educational programmes, encouraged extracurricular activities and special emphasis was given to agriculture based projects. Introduced very innovative student centered banking system to buy and sell frequently required school items. (5) Introduced healthy canteen, polythene free, mosquito free, hand washing policies etc.

Conclusions This study provides the evidence that a community based HP approach is effective in confronting DV, where it caters on the general population and empowers them to generate a process in recognizing determinants of DV and addressing them.

OP-52 HAPPY VILLAGES THROUGH HEALTH PROMOTION: EVIDENCE BASED REDUCTION OF MALNOURISHMENT Rajapaksa-Hewageegana, N.S., Munaweera, B., Dissanayaka, D.M.N., Dharmagunawardena, P.V.D.S. Health Education Bureau and Regional Director of Health Services Office, Uva drneelamani@yahoo.com

Results Within a period of three years students' behavior changed remarkably.

All the problems identified at the inception of the project have decreased in frequency and severity.. Image of the school was improved following the project. Teachers stooped requesting transfers.

Background “Health Promoting Villages” or “Saukya Prawardhana Gammana” (today named as “Happy villages”) was introduced to the Uva Province in 2007.

Enabling the communities by upgrading the living standards of 20 households through safe housing environment initiated in each Public Health Midwife area as the stepping stone. It initially included 5 strategies which ensured: Safe Kitchen, Safe Water Source, Safe Sanitation, Composting and Home Gardening. Later it expanded to include Early Childhood Care and Development (ECCD) and Non

Conclusions Health staff could contribute to overall development of settings using the health promotion approach.

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nutrition was 0% and 4.8% respectively. These percentages were lower than the national (Moderate – 22.0%, Severe – 4.0%), Badulla District (Moderate – 32.8%, Severe – 7.0%) and Moneragala District (Moderate – 22.6%, Severe – 7.8%) percentages. A positive trend was observed in the Moneragala MOH area, where the percentage of normal weight children has been increased from 0% to 22.8%, while percentage of severe under nutrition has been decreased from 27.5% to 5.1% between 2009 and 2011. All Mothers were of the impression that their children having more weight gain following this health promotion program and they perceived their children achieving the milestones more rapidly compared with other children.

Communicable Disease (NCD) prevention strategies.

Aims To evaluate the contribution of “Health Promoting Villages – Happy Villages” concept in the reduction of childhood malnutrition and improvement of ECCD in selected Medical Officer of Health (MOH) areas in the Uva Province.

Methods Informal interviews were conducted in Gavarawela (Ella MOH), Gangasirigama (Mahiyanganaya MOH) and Handapanagla (Wellawaya MOH) and secondary data collection from Child Health Development Record was done in Gangasirigama, Handapanagala and Moneragala MOH areas.

Conclusions The improvements of the nutritional status in the selected MOH areas may have been influenced by the introduction of the “Health Promoting Villages” programme to the Uva Province. Health promotion strategies may be utilized for the improvement of nutritional status in the community.

Results Moderate under nutrition was 11.1% and 14.29% (2012) in two villages (Gangasirigama and Handapanagla) respectively. Severe under

FREE PAPER SESSION 14 THEME: HEALTH INFORMATION MANAGEMENT OP-53 IMPROVING ICD MORTALITY CODING PRACTICES

Undertaking mortality coding centrally, allows consistent application of common standards and procedures.

Gamage, U.S.H. National Institute of Health Sciences, Kalutara samanhattotuwa@yahoo.com

Conclusions Above strategies ensure high quality mortality coding through consistent application of coding rules, enabling better understanding of cause of death structure of countries, regions and populations.

Background Mortality coding includes the correct assignment of ICD codes for the conditions reported on the death certificate and the selection of Underlying Cause of Death (UCD). For public health the correct identification of UCD is important to manage resources and plan out public health programs for the prevention of major causes of death.

Mortality coding is a specialized task that requires thorough training and skill development. Many coders are trained on the job but a formal training based on a standard curriculum is important. However resources and coder training opportunities are not uniformly distributed across countries.

OP-54 COMPARISON OF ELECTRONIC AND PAPER BASED INDOOR MORBIDITY MORTALITY REPORTING SYSTEMS Kariyawasam, N., Wickramasinghe, S.C , Dayaratne, M.K.D.R.B., Sylva, K.K.P. Ministry of Health scwickrama@sltnet.lk Background In Sri Lanka, discharge data is presently collected using paper based Indoor Morbidity and Mortality Record (PBIMMR). This process is identified as time consuming, non-comprehensive, error prone and incomplete. To overcome these problems associated with paper based system, an Electronic Indoor Morbidity Mortality Report (eIMMR) was developed. New system was piloted in 7 hospitals in Sri Lanka for more than a year.

Aims In this article we looked in to the strategies and solutions for the common problems encountered with mortality coding which are reported in past literature.

Methods A comprehensive literature review of existing databases was performed.

Aims To evaluate PBIMMR and eIMMRin areas of accuracy, customer satisfaction, timeliness and implementation cost.

Results Suggested strategies to improve coding practices included the following: Increasing training opportunities for the coders; Standardizing mortality coder training programs and certification of trainers and coders; Introducing mortality coding tools; Conducting regular coding quality assessments; and Centralizing mortality coding.

World Health Organization - Family of International Classifications (WHO - FIC) collaborating centres worldwide provide training opportunities for countries. WHO has developed an electronic ICD training tool designed for self learning. The US National Centre for Health Statistics (NCHS) training portal also contains web-based training. WHO - FIC has a program for standardization of coder training programs and certification of coders and trainers. Using computerized or paper-based mortality coding tools enables coders to better understand causal relationships and ensures consistent application of the ICD selection and modification rules. The most commonly used tool is the decision tables contained within the US NCHS Medical Mortality Data System. Work of coders should be systematically evaluated on a regular basis. A sample of coded certificates could be re-coded by expert coders and the level of agreement could be assessed.

Methods The accuracy of PBIMMR and eIMMR was studied in Base Hospitals Horana and Panadura. The former was using the PBIMMR while the latter was using the eIMMR for one year. A randomly selected sample of 470 Bead Head Tickets (BHT) from each hospital was studied and data collected using a check list. Focus group discussions (FGD) with Medical Records Officers (MRO) who implemented eIMMR was conducted to determine the customer satisfaction. Initial implementation cost of eIMMR and PBIMMR for one year was calculated.

Results The eIMMR found to be significantly accurate in entering of ICD codes (SND =13.33, P<0.001), Age(SND 6.74, P = 0.009), Sex (SND 9.57, P = 0.002) and correct quarter (SND = 10.12, P = 0.001) compared to the PBIMMR. FGD revealed that eIMMR was more user friendly than the PBIMMR in due to ease of procedure, non-complicated data entry, automatic report generation and validation and it is possible to produce

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Results “Availability” was operationalized as whether a particular selected entry is present or absent while “legibility” was operationalized as whether the entry could be read without any difficulty by another person. “Adequacy” means a particular entry is written abiding to the rules governing MR documentation while “accountability” means that the identity of the documenter is available. Assessment of all aspects was considered for some entries while for others only some aspects were considered.

more timely reports with eIMMR. Further, MRO and Hospital Administrators requested for more analytical features included in the eIMMR at hospital level. eIMMR have a significant initial capital cost of Rs 76 Million for complete island wide implementation to 614 hospitals, but the recurrent cost of the two systems was almost identical with Rupees 10 Million per year in PBIMMR and 14 Million per year in eIMMR. Conclusions It is recommended to use eIMMR to improve the accuracy and timeliness of the IMMR returns. Further, more data analysis features should be included to the system. It is also recommended to explore possibilities of using the eIMMR as a platform to introduce other surveillance systems such as NCD surveillance, cancer surveillance and accident surveillance with resources allocated to eIMMR with no additional costs.

Conclusions PDQI was developed as a valid tool to assess quality of documentation in MR. OP-56 A CLIENT FRIENDLY AND PHYSICIAN ACCEPTED PERSONAL HEALTH RECORD SYSTEM RELEVANT TO SRI LANKA

OP-55 DEVELOPMENT AND VALIDATION OF AN INSTRUMENT (PHYSICIAN DOCUMENTATION QUALITY ASSESSMENT INSTRUMENT) TO ASSESS THE QUALITY OF DOCUMENTATION IN MEDICAL RECORDS

Wijesooriya, D.D.S. National Institute of Health Sciences, Kalutara deepal.wijesooriya@gmail.com Background It is common knowledge that patients and clinicians experience problems due to lack of transfer of clear information during their encounters. Much of the information may have to be repeated during these sessions and this can raise questions on the accuracy of data transferred between the two groups. This problem may affect the health care institution and decision makers too. A Personal Health Record (PHR) System will be helpful to solve most of the problems arising in handling of data and information between patients, clinicians and health institutions.

Wijesekera, N.M., Gunawardena, N. S. National Institute of Health Sciences Kalutara and Medical Faculty, University of Colombo nmwijesekera@yahoo.com Background Medical Record (MR) or the Bed Head Ticket is the most important document maintained for hospital in-ward patients. Though there are many instruments that have been developed to assess quality of MR documentation in specific clinical situations, none have been designed to assess the quality of documentation of all important sections of the MR. The quality of statistics generated through MR would be dependent on the quality of documentation. Therefore, developing and validating an instrument to assess the quality of documentation of the MR is important.

Aims To develop an internet based PHR with mobile interface which is compatible with client, doctor, and institutional needs and requirements of Sri Lanka.

Methods Action research methodology was used to collect user requirements from stockholders. This was organized by Focus Group Discussions from each stakeholder separately in first cycle. Each Focus Group consists of ten to twelve participants, a modulator and an assistant. The results of each Focus Group was analyzed to refine needs and wants of participants and compared with the information gathered from literature review. This analysis was further fine-tuned with additional information with semi-structured (phone call interview or direct) interview with Focus Group participants.

Aims To develop and validate an instrument (Physician Documentation Quality assessment Instrument - PDQI) to assess the quality of documentation in MR Methods The PDQI was developed to assess “availability”, “legibility”, “adequacy” and “accountability” of selected entries of the MR. Operationalization of these aspects of quality for MR documentation was the first step in developing the PDQI. Selection of the entries to be included was decided based on review of literature and with the assistance from the experts in Health Information Management (HIM).

Of a selected list of important entries in a MR, the most suitable entries for assessment of availability, legibility, adequacy and accountability were selected by the experts in the field of health information. Criteria to assess these aspects and a weighted scoring system to decide on the level of overall quality and quality of each aspect was also developed by the expert group, using the Delphi technique. It was developed as a checklist. Reliability is assessed by test- retest method.

Results Above findings were used to develop requirement analysis report which is used to develop prototype interfaces of clients, physicians and institutions. Prototype is used to collect user satisfaction survey data.

According to the survey findings of second cycle, there are 77.85% who would like to use this product and 100% would like to recommend it to others.

Conclusions There is a potential for PHR in Sri Lanka. This is a challenge at initial stage due to this being a new concept. Awareness of PHR and attitude of the community are major factors to be addressed.

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FREE PAPER SESSION 15 THEME: COMMUNITY NUTRITION (10 questions), emotional eating (13 questions) and external eating (10 questions).

OP-57 NUTRITIONAL STATUS AND COMPLEMENTARY FEEDING PRACTICES OF CHILDREN AGED 6 TO 23 MONTHS IN MEDICAL OFFICER OF HEALTH AREA, KADUWELA

Aims To translate the DEBQ to the Sinhalese language to produce a locally relevant, culturally adopted tool for the assessment of eating behaviors in Sri Lankan adults.

Abhayagunaratne, T.R.1, Batawala, C.P.1, Gunasekara, C.1, Ekanayake, M.M.C.1, De Silva, A.2 1 Regional Director of Health Service's Office, Colombo 2Faculty of Medicine University of Colombo batawala75@gmail.com

Methods A back translation method was used after having obtained written permission from the original author. The translations were done by two professional, independent, bilingual translators. The back translation was compared with the original version and modified according recommendations of the original author. The final version was administered to 35 randomly selected adult subjects from the community. Factoral validity was assessed by principal component analysis and internal consistency was measured by calculating Cronbach's alpha values for each item and subscale.

Background Infant and young child feeding practices directly affect the nutritional status of children under two years of age and ultimately, impact child survival. Improving infant and young child feeding practices in children 0–23 months of age is therefore critical to enhanced nutrition, health and development of children.

Aims To assess the nutritional status and complementary feeding practices of children aged 6 to 23 months in Medical Officer of Health area, Kaduwela.

Results Principal component analysis revealed 2 factors which accounted for 49% of the variance whilst the component plot indicated 3 clusters of variables which closely matched the dimensions of the original questionnaire. Cronbach's alpha values for emotional eating, restrained eating and external eating were 0.857, 0.871 and 0.652 respectively.

Exclusion of item no.21 from the external eating subscale increased the alpha value to 0.778. Exclusion of Item no. 3 from the emotional eating subscale and item no. 14 from the restrained eating subscale increased the reliability values to 0.884 and 0.891 respectively. These items were examined closely and retained.

Methods A community based descriptive cross sectional study was carried out using anthropometric measurements to estimate nutritional status and an interviewer administered questionnaire based on “Indicators for assessing infant and young child feeding practices” by WHO (2008).

Out of total 294 children selected from the MOH area Kaduwela, the numbers selected from each PHM area was determined according to probability proportionate size of the population of children aged 6 to 23 months. Using the updated Birth and Immunization Registers as the sampling frame, the required number of children from each PHM area was selected employing simple random sampling method.

Conclusions The Sinhalese version of the DEBQ is a valid tool in assessing eating behaviors in Sinhala literate Sri Lankan adults. Characterization of individuals to the type of overeating will enable more targeted interventions in the treatment of obesity and eating disorders. It would also be a valuable tool usable on research into the physiological and molecular genetic factors influencing feeding behavior.

Results The present study found that the prevalence of exclusive breast feeding for six months was 71.8%. Prevalence of stunting, wasting and underweight in children aged 6-23 months were 15.6%, 13.9% and 17.3% respectively.The study also revealed continued breastfeeding at 2 years was 66.15%, introduction of complementary foods was 100%, minimum dietary diversity was 92.85%, minimum meal frequency for breast-fed children was 85.26% and minimum meal frequency for non breast-fed children was 77.14%, in MOH area, Kaduwela. The study also showed a statistically significant association in stunting and wasting with low birth weight and also with dietary diversity less than four food groups at p< 0.05 level.

OP-59 COMPLIMENTARY FEEDING PROGRAMME IN HAMBANTOTA DISTRICT Rajapaksha , S. Regional Director of Health Services Office, Hambantota sriyanthir@yahoo.com Background The nutritional status of infants and under 5 year children in Hambantota District showed a marked decline after the 6 months of age. According to the analysis of H 509, 15.2% of infants, 32% of children between 1-2 years and 28% of children in 2-5 years were underweight in the year 2007.

Conclusions These findings reveal that nutritional problems are still prevalent in the study population.

OP-58 VALIDATION OF THE SINHALESE VERSION OF THE DUTCH EATING BEHAVIOUR QUESTIONNAIRE

Aims To design and implement a programme to improve complimentary feeding practices of mothers / caregivers with infants aged 5 months in Hambantota District.

Illangasekera, Y.A., Kumarasiri, P.V.R., Dalton, C.F., Fernando, D.J.S. Faculty of Medicine, University of Peradeniya yasi04@gmail.com

Methods The programme was planned and designed to raise awareness and skills of mothers and other care givers in correct Infant and Young Child Feeding (IYCF) practices. All the field health staff was trained on IYCF with the FHB training guidelines. A booklet and information, education and communication materials including 10 key messages on complementary feeding were developed. Programme guidelines and programme calendar were also developed to ensure uniformity of the

Background Eating behavior is an important contributory factor in the development of obesity and various eating disorders. The Dutch Eating Behavior Questionnaire (DEBQ) is a valid psychometric tool in the assessment eating behaviors with excellent factorial validity and good reliability. It is a self-report questionnaire consisting of 33 questions and a 5 point Likert scale covering 3 subscales of eating behavior: restrained eating

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programme implementation. The programme was started in the year 2008 at community level. One day workshops on correct complementary feeding practices were conducted in every other month by the Public Health Midwives with the help of community members for all the mothers and care givers who are having 5 months completed babies in Hambantota District according to predetermined calendar.

These programmes were closely monitored by supervisory staff at district and primary health care level and evaluated by using national indicators for nutritional status of under five children.

simply means “different in a positive way from what is 'normal'.” In communities where many children are malnourished, children who live in the same conditions with limited resources but are well nourished are considered to be “positively deviant (PD)” from the normal. “Hearth” refers to the place within a house where the family gathers and food is cooked and served. PD/Hearth leads the community to discover the practices and knowledge these “positively deviant families” use to keep their children well-nourished and healthy.

Aims The aims of INA include: Quick rehabilitation, Enable families to sustain the rehabilitation, Prevent future malnutrition in the community, Integrate food security, Livelihoods and/or other key underlying contextual causes of malnutrition to sustainably prevent malnutrition.

Results Workshops were conducted in 77 centers from the year 2008. According to FHB feedback reports on analysis of 509 data infant underweight was 15% in 2007 and 4.7% in 2012 (more than 50% reduction), 1-2y underweight was 33% in 2007 and14.5% in 2012 (More than 50% reduction). According to Nutrition Month data from FHB 2-5Y underweight was 47.4% in 2009 and 17.6% in 2012 (more than 50% reduction).

Methods This is having beneficiary selection criteria and various execution steps implementing partnering with the local health. It assesses and identifies the families with undernourished children and discovers good practices and behaviors of certain individuals which enable them to prevent malnutrition than their neighbors through an inquiry. Then spread those good practices and behaviors among mothers with malnourished children in the same community by gathering them in a common suitable place through 12 days of nutrition rehabilitation and education sessions, and support new learning or practices through regular follow-ups by volunteers. It uses local resources and wisdom to promote the feeding, caring, hygienic and health seeking practices through cost effective, culturally acceptable and sustainable complementary interventions.

Complementary interventions are: BCC on maternal and child health & nutrition, infant and young child feeding, growth monitoring and promotion and ensuring access to health services. Identified families will be linked to the complimentary sectors than health as agriculture, food security, water, sanitation and hygiene, ECCD, economic and livelihood projects.

Conclusions The community based complimentary feeding practices programme was very effective in improving nutritional status of under five children and it can be recommended for the other districts of the country.

OP-60 AN INNOVATIVE PROJECT THAT LINKS CHILD NUTRITION STATUS BY SUPPORTING GROWTH MONITORING Peiris, D.R., Miralan,V., Sutharsan V., Logithrajah P. World Vision Lanka dilka_peiris@wvi.org Background From birth to five years of age children are in a stage of rapid growth and development. Those who are malnourished during this stage will not develop to their full potential. Integrated Nutrition Action (INA) is a comprehensive contextualized, community based approach adopted by Positive Deviance Hearth approach (PD/Hearth) to address malnutrition. PD/Hearth is an internationally proven community-based model to rehabilitate malnourished children in their own home. It targets malnourished children 6–59 months.“Positive deviance” is a term that

Results This approach has been implemented in World Vision working areas and shown a contribution in following ways: Improved nutritional status of children, Improved knowledge and practices, Improved self esteem of women, Solidarity, Community participation and ownership

FREE PAPER SESSION 16 THEME: PUBLIC HEALTH ISSUES IN CURATIVE SETTINGS Methods Laboratory tests including NS-1 antigen, IgM ELISA and RT-PCR were performed in patients who presented with fever of <7 days between March and October 2012 in selected sentinel sites in the Colombo district.

OP-61 DIAGNOSIS OF DENGUE: A DIAGNOSTIC ACCURACY STUDY IN COLOMBO, SRI LANKA Mahipala, J. R. G.1, Weerakoon, W. A. B.1, Mendis ,S. A.1, Amarasinghe, A.1, Weeraman ,J.1, Palihawadana P.1, Wider-Smith, A.2, Gubler, D.2, Tissera,H.1 1 Epidemiology Unit, Ministry of Health, Sri Lanka, 2University of Heideberg, Duke National University of Singapore dr_korelege@yahoo.co.uk

Results From a total of 1180 clinically suspected cases (679 Inward patients and 501 Outdoor patients), 649 (55%) were positive for dengue by any one or more of the laboratory tests. Among the laboratory tested dengue patients 487 (41.27%) were IgM positive, 391(33.14%) were NS-1 antigen positive and 234 (19.83%) were PCR positive. Majority, 207 (31.89%) of dengue positive patients were between 6 – 15 years of age and 337 (51.9%) were males. Among inward patients 526 (77.47%) became positive by one of the tests while for outpatients it was 123 (24.55%). This difference was statistically significant (p <0.001).

Background Dengue is a major public health problem in Sri Lanka. Majority of patients with dengue are managed on the clinical diagnosis. Laboratory confirmation is available for a limited proportion of patients. A correlation between the clinical and laboratory diagnosis is important in the management of Dengue illness.

Conclusions Overall, this study shows that the clinician's decision on diagnosis of dengue correlates well with the laboratory diagnostics particularly in inward setting. In outpatient setting, performance of clinical diagnosis alone may not be adequate and therefore continuous clinical follow-up and further laboratory testing is desired.

Aims To compare the clinical diagnosis of dengue with laboratory diagnostic results

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OP-62 A SURVEY OF SURVIVORS OF ATTEMPTED SUICIDE ADMITTED TO AMPARA GENERAL HOSPITAL Jayasinghe, P.K.C.J.I., Gunasekara, K.V.N.N. General Hospital, Ampara ghampara@gmail.com

promotion concept and a 5 day training programmes was conducted on initiation, maintaining, monitoring and evaluation of health promotion activities at four hospitals. A representation from all categories of staff was included into these training programmes. Central level evaluation was done by the researchers, every three months, for a period up to one year.

Background Suicide is the 10th leading cause of death in young people between the ages of 15-24 and the 4th leading cause of death in Sri Lanka. WHO statistics indicate that Sri Lanka had the second highest female suicide rate in the world and total Sri Lanka suicide rate is 44.6/1000 which holds the 4th rank in the world according to WHO.

Results It was found that a variety of health promotion activities have been initiated at the respective hospitals. One hospital has been able to implement most of the activities recommended by the WHO. Active health education unit and its staff was the best resource team to coordinate all the hospital health promotion activities. Motivated hospital administrators gave maximum support to establish health promoting hospitals.

Aims To ascertain the background of survivors of attempted suicide in Ampara District and to identify the factors that contribute to this act.

Conclusion Sustainability of the health promotion activities mainly depend on the motivation of the administrators and other staff members.

Method A self administered questionnaire was used for data collection. A total of 50 patients who were admitted to the medical wards in Ampara General Hospital from 21.04.2012 to 21.07.2012 were included into the study.

OP-64 ADDRESSING VIOLENCE AGAINST WOMEN AT HEALTH CARE PROVISION Samarakoon, M.A.S.C. General Hospital, Matara samiddhisamarakoon@yahoo.com

Results There was a significant female predominance (72.7%) , while 41.8% were teenagers (11-19yrs) and 38.18% were young adults (20-29) and there were 14.5% school children among them. Majority of the survirors had an education up to the secondary level only (43.6%). Most of the survirors were unemployed (63.63%). Ten percent were house wives.

In a great majority (89.0%), it was the first attempt of attempting suicide.

The most frequently used method was ingestion of poison (98.18%).

Agriculture poisoning's were 29.0% and overdose of medicines was 48.48%. There was ingestion of poisonous plants and seeds among 48.48%. Most (74.54%) have found these poisons from their home or their garden. Most people have attempted suicide due to family disputes (63.63%), while 18.18% attempted suicide due to relationship difficulties. Most of them (85.4%) had not discussed their problem with anybody prior to attempted suicide. Majority (63.63%) has called for help following the attempted suicide and 34.5% were willing to get mental health assistance for their problems.

Background Gender base violence (GBV) is well recognized as human rights violation and a public health problem with legal, social, cultural, economic and psychological dimensions. A multi sectoral response is required to offer comprehensive support to women who suffer violence.

In particular, health sector has a greater opportunity to aid survivors of violence, may be, than the other sectors. In an attempt to institutionalize the treatment of GBV into the state sector health care, a service point was established in 2007 at District General Hospital, Matara, Sri Lanka.

Methods This paper reports the findings of a study carried out in the service point for GBV established at District General Hospital, Matara. The aim of the study was to investigate the profile of victims of GBV and the type of medical care received from the service point. Service point is situated at the OPD and relevant patients were referred from hospital (OPD and wards) as well as from the field (MOH, field Midwife, Police). All clients who attend the service point in 2011 were included in the study and interviewer administered questionnaire was completed by the trainees.

The respondents were assured of confidentially.

Conclusions Attempted suicide was common among teenagers and young adults.

Ingestion of agrochemicals was common due to easy availability of such products in the house. Family disputes were the commonest reason for attempted suicide.

OP-63 FOUR HEALTH PROMOTING HOSPITALS IN GAMPAHA AND MATARA DISTRICTS: A PILOT STUDY

Results There were 222 in the sample. In majority of the cases were females (82%). Among the affected female only 11% were employed and majority 90% of them were with educational level of GCE (O/L). Married and unmarried clients were almost equally affected. Of the type of violence that took place, emotional violence (76%) was the highest among attendees followed by sexual (10%), physical (20%) and economical (4%) violence. Clients attended this service point received medical care 40%, surgical care (20%) and 8% were referred for psychiatric care. Only 4.5% needed the legal support. Majority of the cases perpetrator was the husband (61%). Alcohol intoxication was a supportive cause for the violence but 69% violence had occurred irrespective of alcohol intoxication.

Fernando S., Kanthi, R.D.F.C. Health Education Bureau surani_f@yahoo.com Background WHO has identified health promotion strategy as a practical and effective way of improving hospital settings.

Aims The purpose of the pilot study was to convert two identified hospitals in each district as health promotion hospitals.

Conclusions Gender based violence occurs in all social classes irrespective of level of education or civil status. Affected women suffer both emotional and physical symptoms. Nobody (0%) knew about the legal implication following GBV. Majority (>50%) need social (economic) support other than medical, counseling and legal support. The state sector health service should play an important role in island-wide for capacity building to expand the service provision for GBV victims and to create awareness among community on the importance of this issue.

Methods After a literature review, researchers visited five hospitals in Sri Lanka to observe the ongoing health promotion activities. A series of consultative meetings were held with the experts in health promotion and some identified hospital administrators, who were very supportive and who are already involved in health promotion activities. Practical and feasible health promotion activities were identified. All provincial and regional health authorities were advocated regarding hospital health

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FREE PAPER SESSION 17 THEME: RECENT DEVELOPMENTS IN PUBLIC HEALTH

OP-65 A RETROSPECTIVE ANALYSIS OF EPIDEMIOLOGY AND CLINICAL PAT T E R N S O F C U TA N E O U S L E I S H M A N I A S I S I N ANURADHAPURA DISTRICT

Aims To quantify exposure from cook stoves in 50 households through an innovative and comparative field study in a village near Kandy during May - August 2012.

Weerakoon, K.M.H.S.,Munasingha, A.V., Bandara, W.M. P. Regional Directors of Health service's Office, Anuradhapura. hema_weerakoon@yahoo.com

Methods We measured personal IAP exposure levels from particulate matter and carbon monoxide in kitchens using either a traditional or Anagi stove, with and without chimneys. The cooking women wore small, state-of-theart personal exposure monitors (MicroPEM®) that are proven to produce reliable and robust data. Personal and indoor exposure data were captured every 10 seconds over 48 hours. Few studies have gathered such detailed information over such a long time frame. Kitchen characteristics and cooking habits were documented via observation and surveys.

Background Cutaneous leishmaniasis (CL) is and emerging health problem in Anuradhapura district and it is increasingly being recognized as an endemic area for CL in Sri Lanka. CL has variable presentations due to diversity of the organism and Immune status of the patients.

Methods All reported cases of CL to the Dermatology clinic Teaching Hospital Anuradhapura for the period of 5 years (2007 July - 2012 July) were analysed retrospectively. Data included the number of patients per year, age distribution, sex distribution, occupation, site of the disease involvement, duration of lesion before treatment, and residence according to the areas under Medical Officers of Health. (MOH)

Results We identified the most hazardous exposure scenario - traditional cook stoves without chimneys, resulting in personal PM exposure levels averaging 201 µg/m3 and peaking at 6,000 µg/m3, far exceeding the WHO Guideline of 25 µg/m3 24-hour mean. On average, the Anagi stove was shown to reduce both indoor and personal exposure by 36%. A chimney reduced exposure by 60 to 70%.

Results The study sample was 1919. The incidence was 29.71 per 100,000 populations per year. Majority of cases were from Padaviya (32.9%), Thalawa (14 .73%) Nuwaragampalatha East (13.68%) and Nuwaragampalatha Central (12.1%) MOHs. The affected main age group was 20 to30 years and male: female ratio was 3: 1. The exposed areas were mostly affected with the predominant site being upper limb (44.45%). The majority (44.7%) presented with erythematous papule, nodule or plaque. Main occupations affected were farmers (15.1%). and armed forces personal (43, 25%).Apart from those children (15%) also affected. The majority of patients presented with in 3to6 months of duration whilst earliest being ½ month.

Conclusions Indoor air pollution exposure levels are very high in the study location.

The anagi stove reduces personal and indoor exposure by ~25% over traditional stove when no chimney was present. The study finds only modest difference between traditional and Anagi stove when chimney is present. Public health education on the effects of IAP, using the Anagi, and designing improved ventilation structures are important priorities reduce personal exposure.

OP-67 SUBJECTIVE WELL-BEING AND PERCEIVED PARENTING STYLES AMONG LATE ADOLESCENTS IN GAMPAHA EDUCATIONAL ZONE

Conclusions Most patients presented with asymtomatic erythematous nodule or papule in exposed parts of the body with behaviour and occupational activities related to scrub jungles. Control measure should be implemented to prevent CL becoming a major health problem.

Jayawardena, K.A.R.N., Senaratna B.C.V. Ministry of Health. nadeeka429@gmail.com Background The mental health problems among adolescents have shown a rapid incline during the recent past which warrants promoting mental wellbeing. Among various methods of evaluating mental health, Subjective Well-Being has been considered a valuable measure which captures the positive aspect in the mental health continuum. Subjective Well-Being is considered to be influenced by parenting styles and the effect on parenting style on Subjective Well-Being in collectivistic culture is not adequately studied.

OP-66 RESEARCH INNOVATIONS TO INCREASE UNDERSTANDING OF INDOOR AIR POLLUTION IN SRI LANKA Elledge, M.F.1, Chartier, R.1, Bronstein, K.1, Phillips, M. J.1, Amarasekara, R.M.3, Nandasena, S.2, Thornburg V.1, Paul Mosquin1, Rodes C.1, Everett K.1, Thornburg J.1 1

RTI International, NC, USA, 2Ministry of Health, Sri Lanka, 3IDEA, Sri Lanka melledge@rti.org

Aims This study was conducted among school going late-adolescents studying in Gampaha Educational Zone to describe the association between Subjective Well-Being among adolescents and the perceived parenting styles of their parents.

Background Approximately four million people die prematurely from indoor air pollution (IAP) as a result of long-term exposure to the burning of biomass fuel for cooking. 78% of Sri Lankan households use woody biomass fuels for cooking. Biomass cooking occurs on traditional 3 stone fires or on “improved” cook stoves such as the Anagi in either poorly ventilated or unventilated (i.e., without chimneys) kitchen environments. Women, and often children and the elderly, are exposed to the highest health risks.

Methods A cross-sectional study design was employed in the present study, to describe the association between Subjective Well-Being among adolescents and personal, parental and family factors and especially the perceived parenting styles of the parents uniquely and in combination.

Multi stage stratified random cluster sampling method was applied to select 729 participants from the school going late-adolescents in the selected Educational Zone. An anonymous self-administered questionnaire was used for data collection, which included (1) components regarding personal, family and parental factors, (2) parental

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Sri Lanka is having a moderate burden of Tuberculosis (TB) while the burden of other respiratory diseases is rising. We have a strong TB and chest diseases control program, but there are areas we have to further strengthen. Recording & reporting (R & R) of respiratory diseases in outpatient settings is unsatisfactory. This has badly effected patient management, administration and surveillance. According to recommendation of WHO, electronic R & R is a timely need. National Program for TB Control & Chest Diseases (NPTCCD) is proposing a practically useful and sustainable electronic R & R system for chest clinics. This will facilitate management of patient wise information in clinics and it captures aggregated data useful in program management.

Considering introduction of a sustainable and affordable solution for Sri Lanka DHIS2 - a WHO recommended flexible, free & open source software (FOSS) after customized will be used. There is in country and foreign technical support in order use this system in our setup. Prior to implementation as it is important to proceed with a pilot, it will be tested in two selected clinics. Initially infrastructure and capacity development in these centres will be carried out. Final expected outcome after several initial steps is a total transfer of paper based R & R into an on & offline web based electronic system. End of 4 months of piloting the outcome will be evaluated. Evaluation will be conducted to assess the improvement in patient clinic, satisfaction of clinic staff and enhancement of program management. In future, with lessons learned this will be further expanded into other chest clinics island wide. This eHealth innovation seems to be a sustainable solution since with the time this may attract both care providers and receivers as it is interactive, informative, interesting and time saving while uplifting patient care.

Moreover, Ministry of Health has incorporated this project into strategic plan of upcoming 'Health Information System Modernization of National Health Development Plan'. Furthermore, same framework can used for R & R in clinics related to other chronic diseases as well.

authority questionnaire and (3) a component on Subjective Well-Being, which was assessed using Multidimensional Students' Life Satisfaction Scale, Global Life Satisfaction Scale and the Affect Balance Scale.

Results When the predictor variables of the Subjective Well-Being were modeled with logistic regression analysis, only the combination of the parenting styles showed a significant association which contributed to 40% of the variation of the Subjective Well-Being. Personal, family or parental factors did not show any association with the Subjective WellBeing. Highest mean score for Subjective Well-Being was reported among the students who perceived both their parents as authoritative.

However, only three combinations of parenting styles showed significant decline in the Subjective Well-Being compared to this best style.

Conclusions Combinations of both parents being authoritarian and father being permissive while the mother being either authoritative or authoritarian were identified as having poor Subjective Well-Being among lateadolescents. The relationship between the normal Subjective WellBeing and the authoritative parenting style as suggested by this study can be utilised to develop tailor-made programs to address mental health ill-being among adolescents. Parents should be made aware of the complementary nature of the parenting styles of the parents and the specific interventions targeting negative combinations could be incorporated to the existing school health programme.

OP-68 PILOT PROJECT OF UTILIZING AN ELECTRONIC DISEASE REGISTRY SYSTEM FOR RECORDING & REPORTING IN RESPIRATORY CLINICS OF SRI LANKA Rodrigo, E.S.S.1, Samaraweera, D. S. D.1, Fernando, E. A. C.2, Wijerathne, P. G.4, Hewapathirana, R.3, Wimalarathna, S.R.U.2 1 National Programme Tuberculosis Control and Chest Diseases, 2 Ministry of Health, Sri Lanka, 3University of Oslo, Norway, 4University of Kelaniya semuthurodrigo@gmail.com

FREE PAPER SESSION 18 THEME: POLICY AND PRACTICE OF PUBLIC HEALTH Results Policy initiatives for purchasing of medicines for state usage dated to late 1950s with preparation of medicines list for state hospitals. BibileWickramasinghe report that established procurement of medicines through state agency using international tender in bulk quantities in 1971 streamlined the policy directions. Use of generic name and selecting essential drugs became the core principles. The success of this policy direction was hailed in non-aligned summit in 1976. It helped to maintain a healthy balance of payment situation in the country for an extended period. Political change and opening up of economy in 1977 effectively reduced the applicability of this procedure. The vigor of strict inventory control faded creating shortages. Although the policy directions in 1992 and 2005 emphasized the importance, they were not executed appropriately. The ability of state to control the medicines market is gradually losing its grip.

OP-69 ADHERING AND IGNORING POLICY DIRECTIONS: THE CASE OF MEDICINES PURCHASING IN SRI LANKA Weerasinghe, M.C. Faculty of Medicine, University of Colombo manujchri@gmail.com Background Unavailability of many essential drugs and regular out of stock situations in state run health facilities in Sri Lanka has become a major concern.

Malfunctioning of medicine purchasing in state sector is seen as the main contributor.

Aims To analyze existing policy directions for purchasing of medicines for state sector.

Conclusions Despite the availability of clear policy directions and evidence for their successful applicability, those are not pursued in procurement of medicinal drugs for state use in Sri Lanka at present which results in shortages and increase out-of-pocket costs for medicines.

Methods Policy documents and evidence for last five decades related to medicines policies in Sri Lanka was identified and compiled. A chronology of documents was prepared and an analysis was conducted. A literature search was also done to assess the sociopolitical environment in relation to development of policy guidance.

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OP-70 TOBACCO REGULATIONS OF SRI LANKA AND AUSTRALIA: LESSONS TO BE LEARNT FROM THE AUSTRALIAN REGULATIONS

significant increase since 2006. The reported dog vaccination coverage was around 20% over the years in Galle District and the main reason behind this was lack of trained vaccinators. Therefore, this project was designed to increase the vaccination coverage of the dogs and control of human rabies in Galle District.

De Silva, S.H.P., Gamage, A.U., Ramachandra, R.B.B.S., Barraclough, S. School of Public Health and Human Biosciences, La Trobe University, Australia, Nutrition Division, Ministry of Health, National Institute of Health Sciences, Kalutara padmaldes@gmail.com

Aims To assess the effectiveness of Expanded Programme of Dog Vaccination and Human Rabies Control Programme in Galle District conducted since November 2008 under the World Bank Fund.

Methodology The programme was commenced on November 2008. The new vaccinators were selected and employed on contract basis and trained for six weeks at Public Health Veterinary Services in Colombo. The Dog vaccination card which included the health education messages and dog registration register were designed. A vaccinator was assigned to a Medical Officer of Health (MOH) area and given the responsibility of registration of dogs and vaccination and maintaining relevant records.

Coordination and monitoring of programme was done by distinct level health staff and primary health care staff. Effectiveness of programme was assessed by using indicators related to reported number of human rabies cases, vaccination coverage and utilization of Anti Rabies Vaccine (ARV) and Anti Rabies Serum (ARS).

Background The significance of packaging in tobacco product brand identity and consumer appeal and the concern of tobacco corporations with refreshing and using packaging for marketing purposes is established.

It is maintained that in Sri Lanka, and in other countries, packaging regulation represents a symbolic and substantive compromise between the freedom to market tobacco and efforts to curtail its promotion.

Aims Compare and perform a gap analysis of the current and proposed regulations on tobacco control in Sri Lanka, with a view of demonstrating the feasibility of translating the current Australian regulations with minimal effort.

Results Dog vaccination coverage was improved from 20% in 2008 to 60% 65% since 2009 up to now and zero deaths were reported in the 2012.

Percentage of patient started in post exposure therapy showed remarkable decline in hospitals where the programme was conducted.

The expenditure for post exposure therapy reduced from 5.8 million in 2008 to 1.8 million in 2010.

Methods The regulations on tobacco products in Sri Lanka: tobacco products labelling and packaging regulations No.1 of 2012, was reviewed using the WHO evaluation framework, with the current regulation of Australia: tobacco plain packaging act of 2011, with a view of identifying the gaps in present packaging regulations in Sri Lanka and future trends and directions.

Conclusions High vaccination coverage has reduced the incidence of human rabies.

The burden of post exposure therapy has been remarkably reduced due to the high vaccination coverage. The effectiveness of the programme showed high vaccination coverage (60-79%) which can be attained through comprehensive strategies of well designed vaccination programmes with health educational activities and community participation.

Results With the latest regulations Sri Lanka had endorsed graphical / pictorial health warnings to appear and cover a total 80% of the cover. The Australian regulations had gone beyond the Sri Lankan regulations as to stipulate the warning to be placed in the top of the principal display area of the package, banning descriptors depicting flavours, displaying quantitative information on emission yields, display of the expiry dates of cigarette packaging, display of a mandatory quit line and plain packaging which prohibited the use of logos, colours, brand images or promotional information on packaging other than brand names and product names displayed in a standard colour and a font style.

OP-72 SUSTAINABLE WASTE MANAGEMENT PROGRAMME IN BALANGODA URBAN COUNCIL

Conclusions Although many gaps observed in the previous regulations have been covered in the new regulation, opportunities for improvement still exist in tobacco packaging regulations. The example set by the Australian government in legislating for plain packaging of tobacco products presents an opportunity for other nation to take the next logical step in regulation, thereby both symbolically and substantially intensifying control policies.

Prematilaka, M.A.N. Urban Council, Balangoda nimalprematilaka@yahoo.com Background Poor Solid Waste Management is recognized as a public health problem in Sri Lanka. Issues related to the waste disposal had emerged as a social problem in the 1990's due to the rapid growth of city's population.

Balangoda urban council (UC) area also faced the problem of waste disposal.

OP-71 EXPANDED PROGRAMME OF DOG VACCINATION AND HUMAN RABIES CONTROL PROGRAMME IN GALLE DISTRICT

Aims To design and implement a waste management programme in Balangoda urban council

Singarachchi W. Office of Medical Officer of Health, Municipal Council, Galle mohgalle@yahoo.com

Methods Compost plant was constructed according to the own low tech method (Open Window System) which was designed with the help of information gathered from internet sources, international seminars and local engineers. A key factor for the successful operation of the compost plant is source separation and this was ensured with a mass education campaign. Expenditure required for the maintenance of compost plant was obtained by selling compost fertilizer. The UC introduced a tax system for the main generators of waste, which covers shops in town like restaurants, tea boutiques, markets, etc. The training center on

Background Human rabies is a consistent public health problem in Sri Lanka. Even though there had been a Rabies control programme in place it has not been successful enough to achieve the expected control. According to the statistics of Public Health Veterinary Services / National Rabies Control Programme, a significant number of Human Rabies deaths have been reported from Sri Lanka. Galle district was identified as a major contributor for those deaths from year 2000 to 2010 with a

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waste management was started.

Conclusions Well panned waste management programme is the effective solution for problem of waste disposal and it also generate good income to the UC.

Results Approximately seventeen metric tons of degradable waste was recycled per day and thirty metric tons of compost fertilizer was produced per month. Adequate orders were received for compost fertilizer and have earned approximately 2,000,000 rupees per year since 2009. A quality certificate was awarded for this waste management programme by the Sri Lankan government.

FREE PAPER SESSION 19 PUBLIC HEALTH: PAST, PRESENT AND FUTURE OP-74 A COMPARISON OF THE EFFICACY OF MICRO CELLULAR FOOT WEAR AND THE NORMAL FOOT WEAR FOR PREVENTION OF FOOT ULCERS IN LEPROSY

OP-73 DISEASE TRENDS IN GOVERNMENT HOSPITALS IN SRI LANKA 1975-2009 Murali, V. Ministry of Health, Sri Lanka vallipuranathan.murali@gmail.com

Aluthge, I. N. School of Physiotherapy, Colombo. irangaaluth@gmail.com

Background Epidemiological transition is a global phenomenon influenced by changing demography, medical technology, nutrition, life styles and other social determinants of health. Analyzing the trends of diseases help the health planners to predict the future trends and propose appropriate preventive measures.

Background Leprosy is a communicable disease caused by bacteria and affects the skin and nerves and progresses slowly with an average incubation period of three years. If detected early and treated, Leprosy will not lead to disabilities. Patients with insensitive hands or feet injure themselves without noticing it. These wounds can get infected and overtime, lead to irreversible deformities. It is a major problem among chronic leprosy patients in Sri Lanka. The Central Leprosy Clinic of Sri Lanka provides them Micro Cellular (MCR) Foot wear free of charge and conducts ulcer care programs. This MCR foot wears are very soft rubber made and having supple straps and evenly distributes the pressure over the foot.

But some Leprosy patients do not like to wear these MCR foot wears due to various reasons.

Aims To describe the trend of admission rates, death rates and case fatality rates of selected disease categories n Government Hospitals between 1975 and 2009 Methods Secondary data was obtained from Medical Statistics Unit. For selected diseases categories according to the International Classification of Diseases (ICD 10), trends in the rates of cases and deaths admitted to government hospitals between 1975 and 2009 were analyzed. Case fatality rates (CFR) were computed and trends were analyzed.

Admission rates and death rates were calculated respectively using the total number of admissions and deaths reported at government hospitals on a particular year and dividing them by the total Sri Lankan population of the same year.

Aims The main aim of the study was to compare the efficacy of MCR foot wear and the normal foot wears in Leprosy patients in Central Leprosy Clinic, National Hospital of Sri Lanka Colombo.

Methods Thirty nine Leprosy patients of Central Leprosy Clinic from January to December 2012, suffering from bilateral foot anesthesia were provided MCR foot wear in every three months duration for prevention of foot ulcers. The first group (n=20) has used the provided MCR Foot wears all the time during their activities. But the second group (n=19) has not used the MCR foot wear during their activities but they have used normal foot wears. The effects of MCR foot wear after 12 to 24 weeks was observed and recorded. After the qualitative discussion with the patients the reasons were identified for not wearing the MCR footwear.

Results Communicable diseases: Cases ofIntestinal Infectious Diseases (IID), Tuberculosis, Viral Hepatitis, Malaria andHelminthiasis have shown a decreasing trend. Anaemias and Nutritional Deficiencies are also in a decreasing trend. However, non-communicable diseases (NCD): Diabetes Mellitus (DM), Hypertensive Disease (HTD), Ischeamic Heart Diseases (IHD), Asthma (BA) and Diseases of Liver (DOL) showed an increasing trend. CFR showed an increasing trend in BA and DOL. All other diseases showed a decreased trend in CFR. In 1975 the leading cause for admissions was IID and it was replaced by Asthma in 2009. In 1975 leading cause for mortality was IID and it was replaced by IHD in 2009.

Results In the follow-up after 24 weeks usage of the MCR foot wears, 2 out of 20 (10%) patients in the MCR foot wear group had developed foot ulcers at the heel of the foot and 12 out of 19 (63%) patients in the non MCR foot wear group and ulcer was at the heels and the forefoot also. The reasons for not wearing MCR foot wears were the stigma and non availability of attractive designs them to wear.

Conclusions Sri Lanka followed the global trend in decrease in the communicable diseases while increase in non-communicable diseases. Despite the increasing trend in the NCD, CFR in most diseases showed a decrease mainly due to improvement in medical technology and management options. Increasing trend in CFR of BA and DOL need to be investigated and appropriate measures to be taken to prevent this increasing trend.

At the same time health promotion activities need to be advocated to prevent the increasing trend of NCD's. Control and preventive measures of Communicable Diseases need to be sustained to maintain the current decreasing trend.

Conclusions MCR foot wear used percentage was 51% and the results indicate that MCR foot wear are more effective than normal foot wears and prevent the foot ulcers in leprosy patients. Furthermore can recommend to make MCR foot wears in several attractive designs motivate patients to wear them and there should be an active mechanism to reduce the stigma towards the disease.

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OP-75 AN INTERVENTION FOR PERSONAL HYGIENE RELATED TO INFLUENZA AMONG SCHOOL CHILDREN IN KALUTARA DISTRICT

OP-76 DIGITIZING ROUTINE IMMUNIZATION INFORMATION SYSTEM FOR REQUIREMENTS OF TOMORROW

Gunarathna, N.K.C., Sivayogan, S., Balasuriya, A., Wijayasiri, W.A. National Institute of Health Sciences, Kalutara, Faculty of Medical Sciences, University of Sri Jayawardanapura, Sir John Kothalawala Defence University, Sri Lanka chintha.gunarathna@gmail.com

Palihawadana, P., Peiris, T.S.R., Edirisuriya, C. S., Kariyawasam, M.P., Liyanage, L.B.B., Wijesinghe, T.S. Epidemiology Unit, Ministry of Health, Sri Lanka chathura.cse@gmail.com Background Sri Lanka has one of the strongest immunization programmes in the world, evolved since 1886. Present immunization programme is supported by a manual management information system (MIS). This MIS only covers the government and affiliated private sector institutions, involved in vaccination. Registration of a new born child is a mandatory act for functioning of the current MIS but it is increasingly becoming difficult. Current trends in communicable diseases throughout the world force one to have an immunization certificate in many social activities.

Current manual system will not help in this process due to the present arrangements. With this background, in consistence with eGovernment and eHealth policies, the Epidemiology Unit of the Ministry of Health has initiated a project to create a web based National Immunization Registry to overcome the present obstacles.

Background Influenza is a highly contagious disease caused by influenza virus that affects the respiratory tract. The influenza virus has great potential to undergo mutation or re-assortment leading to the emergence of new strains causing seasonal epidemic or more destructive influenza pandemics. Vaccination is the main preventive method adopted for influenza. Non-pharmaceutical measures, especially, hand washing has equal place in the prevention of influenza.

Aims To assess the effectiveness of a Behaviour Change Communication package in improving the personal hygiene related to influenza diseases among Grade 8 and 9 school children.

Methods The BCC package was developed with the participation of School Health Club members and primary health care staff in the intervention area. It consisted of an education session, distribution of communication materials, monitoring personal hygiene, supplying soap, memorization of messages using different communication methods and problem solving sessions. A quasi experimental community trial was conducted to assess the effectiveness.

Aims This paper intends to illustrate the background and how Web Based Immunization Information System (WEBIIS) is lauched in Sri Lanka.

Methods and Results The WEBIIS is designed to achieve the following objectives: To create a National Immunization Registry (NIR); To provide prompt access to immunization history of an individual without geographic barriers; To make available data and information to managers of the immunization programme. Requirement gathering for an immunization MIS was done with the involvement of stakeholders of all layers of the National Immunization Programme. This requirement gathering was managed and assessed by a professional software developer. Based on the requirements gathered, a blueprint of the new electronic MIS was created and agreed upon by the software developer and the Epidemiology Unit. The new system was built on this foundation. At present the WEBIIS is live on the web. This will facilitate achievement of the first and second objectives. In the first step of piloting, a group of 58 personnel comprising of MOOH, PHNS and PHMM were trained. Eight net-book computers with internet connection have been employed for data gathering purposes. A target of 10,000 birth registrations in 60 days was set. At the end of 60 days, 6623 (66.23%) records were entered.

Mean number of days worked by a PHM was 10 days. Mean number of records entered by a PHM per day was 20. Mean number of PHMM worked per day was 5. The most critical problem identified was the poor computer literacy among the senior PHM staff.

Results Pre and post tests were conducted among 1463 school children from intervention (n=734) and control areas (n=729). The mean knowledge score obtained for different aspects of influenza diseases, cough etiquettes and hand washing significantly increased by 25% to 30% after the intervention, whereas no significant improvement was reported by behaviours during illness which had a mean score of 87% during the preintervention stage. The overall attitude score shifted towards the positive direction with more than 10 point improvement. Both self reported hand washing practice and observed hand washing technique showed significant improvement.

Conclusions The implementation of a BCC package to improve personal hygiene through SHC was effective in improving the knowledge, attitude and practices on personal hygiene related to influenza diseases and the knowledge on influenza disease.

Conclusions Web based management information system will be a viable option to overcome the present day practical issues faced by the current manual immunization MIS.

FREE PAPER SESSION 20 CULTURE, PEOPLE AND HEALTH enhance the public awareness in preserving health through Panchakarma. Data was gathered from authentic books. According to Ayurveda, normalcy of Dosha (humors), Dhatu (basic tissues), Mala (waste products or toxic excretable metabolites) and Agni (metabolic activity) is termed as Swasthya (health). Ayurveda describes that three Doshas; Vata, Pitta, Kapha govern the body. Improper diet, lifestyle habits and drugs may cause vitiation of Doshas. Vitiated Doshas and Mala can get accumulated in Srotas (physiological channels), cause blockages and may leads to diseases. Vitiated Doshas can be normalized through Shodhana and Shamshamana Karmas (evacuation and palliative therapies). Five types of Shodhana Karma, also known as Panchakarma, namely, Vamana (emesis), Virechana (purgation), Vasti

OP-77 A REVIEW ON PRESERVING HEALTH THROUGH AYURVEDA PANCHAKARMA Ediriweera, E.R.H.S.S. Institute of Indigenous Medicine, University of Colombo ayurvedadocsujatha@yahoo.com Health is a state of complete physical, mental, and social well-being and not merely absence of disease or infirmity. Term Ayurveda indicates Science of Life. Aim of Ayurveda is to maintain healthy mind in a healthy body and to prevent and cure diseases. The Aims of this study is to

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(medicated enema), Nasya (Errhine therapy) and Raktamokshana (Blood-letting therapy) are prescribed for elimination of vitiated Doshas and detoxification of the body, resulting in preservation of health. Prior performing Panchakarma, Purva Karma; Snehana (Oleation) and Swedana (Fomentation), is carried out to enhance the mobility of Doshas. Snehana loosens adhesive vitiated Doshas and toxic metabolites. Swedana helps liquefaction of accumulated vitiated Doshas, facilitating their mobility and elimination. In Swedana, endogenous toxins are eliminated with sweat. In Vamana, drugs are administered orally and vitiated Kapha Dosha is expelled through Urdhavabhaga (oral route). In Nasya, drugs are administered nasally and vitiated Kapha Dosha accumulated in Urdhava Pradesha (area above clavicle/ the head region) are expelled through the naso-oral route. In Virechana, drugs are administered orally causing evacuation of vitiated Pitta Dosha through Adhobhaga (anal passage). In Vasti, drugs are administered through rectum, urethra and vagina and vitiated Vata Dosha are expelled through the same routes. In Raktamokshana eliminates vitiated Pitta Dosha with blood. Excretion of accumulated Dosha and toxic metabolites using Panchakarma therapy makes normalization of Dosha, Dhatu, Mala and Agni; thereby preventing diseases and preserving health.

which was significant (P = 0.005). A similar analysis was carried out to determine whether there is an association between operational factors and implementation process at chi-square value 8.722 which was significant 0.10 (P = 0.068). Moreover with community factor at chisquare value 12.34 which was significant at 0.05 level (P = 0.015). The analysis of participant factor and implementation process was not significant. The overall study result of benefit sharing found that more than one-half of the respondents (62.7%) moderately participate in benefit sharing, 20.6% were not involved at all and 16.7% participated always in benefit sharing. The overall composite mean score was 11.6 which were lower between the lowest possible score of 4 and the highest possible score of 20. The overall study result of evaluations found that more than half of the respondents (54.0%) moderately participate in program evaluations, 23.8% were not involved at all and 22.2% participated always in evaluation process. The overall composite mean score was 13.5 which were lower between the lowest possible score of 5 and the highest possible score of 25.The analysis of chi-square to find association between evaluation and structural factors was significant at 0.01 (P =0.014) chi-square value of 12.45. It can be concluded that there is a significant association between structural factor and evaluation process in communities. However there is no significant association between operational factors, community factors and participant factors.

OP-78 COMMUNITY PARTCIPATION IN HEALTH PROMOTION IN MALDIVES

Conclusions This study revealed factors which are associated with community participation at different levels of the programmes.

Asma, I.S., Hajar, S.A B., Harish, A W. Department of Social Administration and Justice, The University Malaya asma_ibrahim@health.gov.mv

OP-79 CONTRACEPTIVE USAGE IN RELATION TO BIRTH SPACING PRACTICES IN KALPITIYA MOH AREA

Background Community participation was said to be important because the origins of disease lie outside the health sector. Health promotion is a high priority agenda in Maldives' government policies. The concepts of people participation in health development have been practicing long back in Maldives.

Ghouse, A. Family Health Bureau docazharghouse@yahoo.com Background Being a multi ethnic and multi cultural region, Kalipitiya MOH area has faced many issues providing family planning services.

Aims To assess Maldives' community participation in health promotion programs

Aims This study was aimed at exploring the deviations in contraceptive usage with its relation to birth spacing practices and socio-economic determinants.

Methods A cross-sectional survey was conducted at 3 selected atolls in total 1,074 participants. Multi-stage cluster sampling techniques were used to select the respondents for this study. The total geographical area was divided into 7 provinces and 3 provinces from Upper North, North Central and Upper South were taken for this study. The survey adopted a self-report technique.

Methods Community based cross sectional descriptive study was carried out among all pregnant women under care in the Kalpitiya MOH area during the study period. The sample size was 423 at 94% response rate. Data was collected through an interviewer administered questionnaire and analyzed with 95% confidence interval using SPSS.

Results A total of 1,074 respondents were administered the questionnaire. The response rate of the survey was 86% (n=923). The large majority of the volunteers in this study were female, better educated and reported average incomes. The vast majority of subjects were women (72.8%) were involved in projects or developmental activities and 27.2% were men. Finding from overall scores in community participation in decisionmaking reveals that 56% had occasionally participated in decision making and 23.4% had always participated and 20.6 percent had never participated in any decision making process respectively. Overall participation in decision making was relatively low. The overall mean score was only 26.6 which were moderately lower between the lowest possible score of 9 and the highest possible score of 45. The overall study result, the level of implementation found that more than one-half of the respondents (57.9%) moderately participate in program implementation, 21% were not involved at all and 20% participated always in implementation process. The overall composite mean score was 28.6 which were lower between the lowest possible score of 10 and the highest possible score of 50. The chi-square analysis was carried out to determine whether any association between factors and types of community participation. The association between structural factors and implementation process, data reveals chi-square value of 15.00

Results The study population is relatively young (more than two thirds under 30 years) and a predominantly Muslim (>50%) with better education level (approximately 90% above secondary level). Household Crowding Index (HCI) was 2.32 persons per room in a house. Age at marriage was 21.36 yrs and significantly associated with the ethnicity and husband's occupation. Eighty percent were married before 24 years of age and approximately 30% before completing 18 years. Average number of pregnancies for a woman was 2.36 and parity had a significant (p<0.05) association with age and education level of the woman and her husband as well as with HCI. Contraceptive usage after the last pregnancy showed a â&#x20AC;&#x153;non-userâ&#x20AC;? rate of 47% and DMPA 37% which are much higher than the expected norms. The trend in using DMPA decreases and non user rates increases with each parity level. Two third wished for another pregnancy which was mostly (36.2%) after 3 years. The most preferred FP method before the next pregnancy was DMPA (43.2%) and Pills/Implants by 25% while 15% planned not to use any method.

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Kiri Kenda (Milk gruel). Kola Kenda is usually taken by many Sri Lankans prior to breakfast day to day life. The lists of the plants used to prepare Kola Kenda were gathered from traditional medical books and patients attending Chamal Rajapaksha Ayurvedic Research Hospital, Hambantota, Sri Lanka. According to the present study, fourty five plants are used to prepare different types of Kola Kenda is prepared by adding juices freshly extracted from various leaves and coconut milk, to well boiled red rice gruel. Kola Kenda is highly nutritious food which contains macronutrients and micronutrients It is also an easily digestible food preparation. Furthermore, different varieties of Kola Kenda have different medicinal properties and can be consumed on a day-to-day basis. Some pacifies vitiated Vata, Pitta or Kapha Dosha. Some have the properties of relieving anorexia, constipation, gastritis, malabsorption, hyperlipidaemea, diabetes mellitus, haemorrhoids, hepatitis, burning sensation of body, micturition, renal calculi, cough, bronchial asthma, phlegm , dermatitis, sub fertility, hypertension, oedema, insomnia and worm infestation. Some herbal gruel have anti inflammatory, anti oxidant, diuretics, anti pyretic, anti rabies, antidote for snakes bite poisoning and anti-toxic effects. Some herbal gruel enhance fracture healing, reduce bruises, beneficial for lactating mothers as these help to increase milk production. They also act as blood purifiers. Kola Kenda prepared with some plants act as aphrodisiacs. Some of them are beneficial for improving vision. Some strengthen the memory power and improve intellectual function. It is concluded that Kola Kenda (Herbal gruel) is a traditional Sri Lankan preparation with high nutritional and medicinal values.

Conclusions Results have revealed that the female population is much better educated than had expected from a rural area. Health sector approaches and efforts to educate them on reproductive health matters should be handled taking religious and cultural factors into consideration. Knowledge and awareness on contraceptive methods need to be improved among the target population and among the males who may influence their womenfolk regarding contraceptive decision making.

OP-80 KOLA KENDA (HERBAL GRUEL) PLAYS AN IMPORTANT ROLE IN PROMOTING HEALTH Ediriweera, E.R.H.S.S., Maragalawaththa, M.G.S.K., S.S., Chandimarathna, P.B. Chamal Rajapaksha Ayurvedic Research Hospital , Hambanthota drmgsk@gmail.com Cultures differ from country to country. Sri Lanka too has a unique culture with a long history and also a distinct food culture. Our ancestors' meals were mainly based on rice. Yet, they also possessed a wide knowledge on different methods of food processing, preparation and natural preservations. One of these preparations is Kenda (gruel). It is a traditional rice- gruel dish which could be prepared in three different ways. That is, Lunu Kenda (Salt gruel), Kola Kenda (Herbal gruel ) and

FREE PAPER SESSION 21 WORK AND PUBLIC HEALTH available in 62.7 % (n=64) of industries. Injuries were treated mostly (69.6%, n=71) by the nearest general practitioner or the private hospital.

OP-81 OCCUPATIONAL HAZARDS IN THE WORK ENVIRONMENT IN SMALL SCALE INDUSTRIES IN GAMPAHA DISTRICT.

Conclusions The working environment of small scale industries in Gampaha District was found to be unhealthy. Urgent attention should be given to address this situation and plan simple interventions to protect the health of small scale industry workers.

Suraweera, S.A.I.K., Wijesinghe, M.S. D., Senanayake, S.J., Herath, H. D. B., Jayalal, T.B. A. Ministry of Health, Sri Lanka sjsenanayake@yahoo.com

OP-82 PREVALENCE OF NECK PAIN AND ITS ASSOCIATION WITH COMPUTER ERGONOMICS AMONG VISUAL DISPLAY UNIT USERS IN BANKS OF HORANA URBAN COUNCIL AREA

Background Small scale industries play an important role in the economy of Sri Lanka. A majority of these work places are inbuilt with occupational hazards exposing the workers to hazardous working conditions.

Identification of these hazards is of paramount importance in improving the working environment in small scale industries.

De Silva, N.C.L., Senarath U. Faculty of Medicine, University of Colombo chaidslv@gmail.com

Aims To identify occupational hazards in the working environment of some selected categories of small scale industries in a district of Sri Lanka.

Background Neck pain is one of the common conditions among visual display unit users. According to the literature, poor ergonomic practice is a major predisposing factor for this problem. But only limited studies have been done to investigate the current situation in Sri Lanka in this regard.

Methods A descriptive cross-sectional study was carried out among four categories of small scale industries namely food and beverages, apparel, non metallic mineral and fabricated metal products in Gampaha District. A sample of 102 industries was randomly selected using probability proportionate to size of industries according to Census of Industry 2003/2004. Interviewer administered pre-tested checklist was used as the study instrument.

Aims To describe the prevalence of neck pain and its association with computer ergonomics and socio-demographic factors among visual display unit (VDU) users in Banks of Horana Urban Council area.

Methods A cross sectional descriptive study was done among 100 visual display unit users in selected five banks in Horana Urban Council area. Neck pain was evaluated by using a self administered questionnaire and practices of ergonomics was checked by using a interviewer administered checklist. Chi square test was used to find out the relationships.

Results Safety signs were not displayed in 78.4% (n=80) of the industries while machines were properly guarded only in 25 (24.5%) of the industries.

The working environment was found to be accident prone in 38.2% (n=39) of the industries. Lighting was adequate in 93(91.2%) and noise was found to be excessive in 35 (34.3%) industries. A functioning safety committee was available in 5 (4.9%) industries while workers trained in occupational safety and first aid, were present only in 18.6% (n=19) and 23.5% (n=24) of the industries respectively. Accidents were recorded in 16 (15.7%) industries. A separate meal room and a changing room were

70

Results Response rate was 96%. Mean age of the sample was 38.1 years.

Female distribution was higher than the male. Mean working hours per day was 8.30 and mean working experience was 14.8 years.

Prevalence of neck pain among VDU users was 38.5%. The mean mark obtained for ergonomic checklist was 12.9 (SD=2.20) out of 20. Working hours with the computer per day (p=0.015) and poor ergonomic practice (p = 0.012) had a significant association with neck pain. Lack of ergonomics of keyboard (p=0.01), computer table (p=0.03) and incorrect postures (p=0.006) were significantly associated with neck pain. Of the 5 Ergonomic sections, lack of ergonomics of chair (p=0.67) and monitor was (p=0.21) not significantly associated with neck pain.

OP-84 THE REPRODUCTIVE HEALTH KNOWLEDGE AMONG THE SCHOOL TEACHERS AND THEIR ATTITUDES TO PROVISION OF SUCH INFORMATION THROUGH SCHOOLS IN ZONAL EDUCATION DIVISION UDUGAMA IN GALLE DISTRICT Amarasinghe, P.V.N.P., Weerasinghe, M.C. National Institute of Health Sciences, Kalutara, Faculty of Medicine, University of Colombo prabathav@yahoo.com Background There is an increasing tendency of Reproductive Health (RH) problems in rapidly changing rural areas and schools have a major role for rectifying this through the dissemination of RH knowledge.

Conclusions VDU users in the banks had a high prevalence of neck pain. Ergonomic practices contribute to this.

Aims To assess the knowledge of selected aspects of RH and their attitudes on providing such information through schools among school teachers in a rural zonal education division

OP-83 DESIGNING AN IN-SERVICE TRAINING COURSE ON SKILLS DEVELOPMENT PERTAINING TO COURT PROCEDURE FOR PUBLIC HEALTH INSPECTORS

Methods A quantitative study in cross sectional descriptive design was conducted among 500 teachers selected from cluster sampling in zonal educational division Udugama, Galle District. A Self administered questionnaire was used to collect the data.

Wickramasinghe, N.T. Regional Health Training Centre, Kadugannawa wicks76@yahoo.com Background Public health legislation (PHL) performs a vital role in protection and promotion of public health. Public Health Inspector (PHI) is the responsible for implementing PHL at grass root level in the Department of Health in Sri Lanka. Their basic training addresses a significant quantity on public health legislation. However, the theory and practical sessions on procedural law including court procedure in the curriculum are not adequate to make the student capable of facing new challenges.

Results The results of the study indicate that Most of the teachers are from the 05year service category (45.6%) as well as having an experience of 0-5 year of RH teaching (32.5%). A large proportion of them (92.7%) are not having training in RH teaching. Majority (61.5%) are teaching arts. The overall knowledge of the RH is fair (81.9%) for a large number of them.

Knowledge of the most of the subcomponents was also fair. But knowledge of sexuality (98.7%) and contraception was poor (34.8%) for most of them. The overall attitudes of providing RH information through schools were positive (78.5%). The main sources of RH information to them were electronic media (60.6%), television (29.7%) and radio (14.2%) was the most preferred media. It was found that although sex of the respondents has no association with the total knowledge on RH, there is an association with the total attitude on RH. This difference is statistically significant (p=0.02, df=1).In the same way, there is an association between the total knowledge and attitude. This difference is also statistically significant (p=0.00, df=1).

Aims This paper describes the designing and implementation of a new inservice training which had the objective to developing skills of PHII regarding court procedure to ensure proper implementation of public health legislation Methods and Results After undertaking a training need assessment among the PHII the objectives and content areas were identified with the help of educational science and public health experts. The objectives included the following: Describe the nature of law and the judicial system in Sri Lanka; Formulate plaint forms, charge sheets, affidavits and the other court documents; Describe the steps in enforcement of law and different methods of prosecution; Recognize the principles of criminal law and criminal procedure; Explain the different aspects of law of evidence; Becomes familiarized with the court procedure; Follow the food sampling procedure correctly. The contents included Nature of Law, Judicial System in Sri Lanka, Formulation of Plaint Forms & Charge Sheets, Enforcement of Law & Prosecution, Principles of Criminal Law & Criminal Procedure, Building up Cases for Trial, Food Sampling Procedure, Court Procedure, Preparation for Trial Cases, Law of Evidence, Leading Witnesses, Preparation for Trial Cases, Magistrate's View about PHI as Law Enforcing Officer, Motions, Submissions & Appeals and Moot Court. Nineteen programmes have been conducted in the following Provinces up to now: Central Southern, North Western and North Central. The evaluations among the trainees showed that this training has been very effective in improving their competencies.

Conclusions A fair general knowledge and positive attitudes regarding RH as well as a poor knowledge regarding contraception and sexuality with negative attitudes towards both components were revealed by this study. RH should be an integral part of training among school teachers.

Conclusions It is recommended to conduct this course for the all existing PHII in Sri Lanka and to include this module for their basic training.

71

POSTER PRESENTATIONS Detailed Programme PP-11

PP-01 Knowledge, attitudes and practices of Water, Sanitation and Hygiene

Knowledge, attitudes and practices among nurses of Lady Ridgeway

(WASH) among school children in Kiran MOH area

hospital regarding mercury containing medical devices

Wickrematilake, M.S.K, Arnold, S.M., Pethiyagoda, K, Faizal, A.M,

Senanayake, S.J., Gunawardena, N.S.

Suraweera, S.M.J.P PP-12 PP-02

Epidemiological profile of Varicella: situation in Sri Lanka

Interpersonal violence among 13-15 year old schooling adolescents in

Munasingha, H., Malavige, N., Amarasinghe, A.

Gampaha District PP-13

Wijeratne, M. P., Seneviratne, R. de. A., Gunawardena, N.

Behavioural management strategies and oral health- related behaviors of preschool children receiving preventive dental care

PP-03 Weight reduction of post partum mothers through increased level of

Karunachandra, K.N.N., Bollagala, A.D., Perera, I.R., Liyanage, N.L.P.,

physical activities in a rural setting

Kottahachchi, M.J., Wimalasens, B.A.S.S., Bandara, M.D.,

Kumari, P.D. D.

Wickramarachchi, M.V.

PP-04

PP-14

Knowledge, treatment compliance and prevalence of known risk factors

Urinary tract infection and asymptomatic bacteriuria in pregnant women:

among patients attending Glaucoma clinics at Eye hospital Colombo

Causative organisms and Antimicrobial sensitivity pattern Muhunthan, K., Guruparan, K., Lakshy, G., Ratnasamy, V., Rasalingam,

Piyasena, D.A.K.N., Fonseka, P., Fonseka, I.

P. PP-05 Study of Cu2+ Ion Tolerance Activity of Unknown Bacterial (P) Strain

PP-15

Isolated from Textile Dyeing Effluent

Study of dermatitis associated with Cutaneous leishmaniasis in

Pushpamalie, E.K. P., Wijayarathne, C. D., Wijesundara, W.S.S.

Anuradhapura Weerakoon, K.M.H.S., Herath, P., Bandara, W.M. P.

PP-06 PP-16

A review on the availability of services for the limb disabled in Sri Lanka Weerasinghe, I.E., Fonseka, P., Dharmaratne, S.D., Jayathilaka,

Effectiveness of neutral wrist splinting for conservative management of

J.A.M.S.

Carpal Tunnel Syndrome Dematagoda, D.K.V., Ramachandra, R.B.B.S.

PP-07 PP-17

Responsiveness in the Medical Wards of the General Hospital Matara

Parents' knowledge on fever and its association with selected factors in

Ranasinghe, J. P., Samarage, S.M.

children treated as dengue fever Mahesh, P.K.B., Arnold, S.M.

PP-08 Coping strategies for stress adopted by female student nurses in the Nursing Training School Galle

PP-18

Ellawela, Y. G., Fonseka, P.

Knowledge and self reported practices regarding infection control

PP-09

General Hospital Kalutara and their correlates

Biomass fuel use pattern and acute respiratory infections in children in

Poruthota, P.C., Goonewardena, C.S.E., Wijayasiri ,W.A.A.

methods among selected â&#x20AC;&#x153;Minor Health Care Workersâ&#x20AC;? in District

Sri Lanka: An analysis of Demographic and Health Survey Data Kaththiriarachchi, L., Nandasena, Y.N.S.

PP-19

PP-10

visited base hospital Udugama after an exposure during the year 2011

Physician uptake of new medicines: A prescription audit from Sri Lanka

and 2012

Weerasinghe, M. C.

Karunarathna, S.M.P.

Assessment of anti rabies post exposure therapy given to the clients who

72

PP-20

PP-30

Knowledge attitudes and practices regarding human rabies and factors

Changing perceptions on safe and unsafe, sexual practices among

associated with knowledge among grade ten students in the Nugegoda

three-wheeler drivers in selected three-wheeler parks in Anuradhapura

Education Division

town area in Sri Lanka through a Health Promotion approach

Jayawardene, D.M.S., Gunawardena, N.S.

Pallewaththa, P. W. P. W. K., Fernando, W.M.S., Duminda, G.G.N.

PP-21

PP-31

Secondary Data Analysis for Assessing Overweight, Obesity and

household survey to identify persons with leprosy in Tambapanni

Hypertension among a group of selected Employees in Kandy District,

area in Puttalam District, Sri Lanka

Sri Lanka

Dabrera, T.M.E., Sumanaweera, R.A., Kasthuriaratchi, N.D.,

Senevirathne, E.M.C.P., Thennakoon, T.M.S.N., Katulanda, P.

Ratnayake, R.M.S.K., Ranjith, K.H.A.P.

PP-22

PP-32

Occupational hazards in the ceramic industry in the district of Colombo

Positive health through Ayurveda Dietetics

Perera, P.K.D.C., Arnold, S.M.

Ranasinghe, R.L.D.S., Ediriweera, E.R.H.S.S.

PP-23

PP-33

Dental caries

among pregnant mothers: a cross sectional study on

Validation of Sinhala Version of Arthritis Impact Measurement Scale 2-

disease burden among antenatal mothers in Divulapitiya MOH area

Short Form (AIMS2-SF) for Quality of Life Assessment of Rheumatoid

Karunachandra K.N.N., Herath, L., Perera, I.R.

Arthritis Patients Basnayake, A.C.M., Pathmeshwaran, A., Panangala, H.B.A.G.L.,

PP-24

Munidasa, D., Karunapema, R. P.P

Pre-hospital care received by injured children less than five years admitted to Lady Ridgeway Hospital

PP-34

Gunawardhana, Y.A.G.K., Goonewardena, C.S.E., Wijayasiri, W.A.A.

The occupational factors associated with burnout subtypes among police officers in the Kandy police division

PP-25

Wickramasinghe, W.A.N.D., Wijesinghe, P.R.

Desired characteristic for psychometric instruments by the elderly population in Sri Lanka

PP-35

de Silva, S.H.P., de Silva, A.P., Ramachandra, R.B.B.S., de Silva, A.,

Factors associated with initiation of breastfeeding at hospital discharge:

Rajapaksa, L.C.

late preterm compared to term infant and mother pairs Pathiratne P.A.S.R.

PP-26 Health promotion strategies for developing life skills to fight against

PP-36

HIV/AIDS among school children

A community based health promotion intervention to reduce family

Vidanapathirana, J., Nanayakkara, S., Samaraweera, G.

acceptance of gender roles in Medawachchiya MOH Area in Sri Lanka Herath, H.M.T.P., Duminda, G.G.N., Fernando, W.M.S.

PP-27 An outreach program to improve well women clinic coverage: a success

PP-37

story from Medical Officer of Health area, Imaduwa

A community based health promotion intervention in changing the image

Chandrasiri, P.A.A., Mahindasiri, K.V.P., Nandani, W.D.

of alcohol among students in a government school in north western province

PP-28

Jayarathna, J.E.M.S.S., Fernando, W.M.S., Duminda, G.G.N.

Physical activity, quality of diet and psychosocial stress among postpartum mothers in Biyagama and Kelaniya Medical Officer of Health

PP-38

areas

Knowledge, attitudes and practices on Food hygiene in school canteens

Perera, M.G.S.N.S., Abeysena, C.

in Colombo Municipal Area Subaskaran, S., Balasuriya, A.

PP-29 Effectiveness of health promotion approach in improving weight under

PP-39

five year old children in Kunchikulama village of Mihintale MOH area

Impact of introducing IYCF practices at the completion of 5 months to

Bhagya, B.L.G.U., Jayathilaka, I., Lakmali, T.M.I., Punchihewa, C.M.,

prevent infant malnutrition

Shivakumar, Y., Kumarathunga, H., Guruge, D., Fernando, M.

Wijethunga, T.S., Attygalle, D., Senevirathne, A., Jayakody, H.

73

PP-40

PP-49

Computerized data monitoring and evaluation system to improve

Dengue prevention: An innovative programme to build a sustainable

nutritional surveillance

model behavior among preschoolers

Wijethunga, T.S., Senevirathne, K., Senevirathne ., Jayakody, H.

Kossinna,T.K.M.S., Jayantha, G.P., Jayasekara, G.S., Jayasinghe, J.M.D.C., Jayasinghe, J.A.P.M., Jayasinghe, S.A., Jayasiri, W.A.M.P.,

PP-41

Jayasooriya, E.W.S.N., Jayasundara, P.K.H.E., Jayathilaka, K.I.C.,

Attitudes of public health midwives (PHMM) in Colombo district on infant

Jayathunga, J.M.H.K., Karunajeewa, A.M.A.A.N., Karunarathna,R.A.J.,

and young child feeding (IYCF)

Karunarathna, H.G.K., Karunaratne, H.D.L.S., Karunasiri, R.P.W.P.,

Nanayakkkara, I.O.K.K., Godakandage, S.S.P.

Karunathilaka, H.M.W., Kaushalya, N.K.Y., KodikaraArachchi, D.N., Kodikara, T.D., Kodikara, S.P., Ranasinghe, P.D.

PP-42 Early and rapid detection of dengue and chikungunya viruses in fever

PP-50 A tiered, integrated approach to identifying potential risk factors associated with chronic kidney disease of unknown etiology (CKDu) in sri lanka Redmon, J.H., Womack, D.S., Beaulieu, S. M., Levine, K.E., Elledge, M.F.

patients by reverse transcription polymerase chain reaction (RT-PCR) during the recent epidemics 2008-2009 in Sri Lanka Kuruppuarachchi, K.G.R., Perera, M.G.A.N., Gunasena, S., Ramesh, R. PP-43 Preschool teachers as agents of oral health promotion

PP-51

Fernand,o S., Kanthi, R.D.F.C.

A Review on Ayurvedic 'Dina Charya' for Long and Healthy Life Journey Kalawana, O.T.M.R.K.S.B., Ediriweera, E.R.H.S.S.

PP-44 The incidence and risk factors of Low Birth Weight among 1535 live births

PP-52

in MOH area Kiriella

Exploration of adolescent sexuality in a district in Sri Lanka

Kalubowila, K.C.

Rajapaksa-Hewageegana, N.S., Samarage, S., Wickramasingha, R.

PP-45

PP-53

Evaluation of a health promotion approach in improving the physical

Protecting national health through Rasayana and Vajikarana Chikithsa

wellbeing among women in a village in Anuraghapura district in Sri Lanka

(Rejuvenation and Aphrodisiac therapy)

Athapaththu, A.M.C.S.R.K., Fernando, C.J., Croos, C.S., Herath,

Ediriweera, E.R.H.S.S.

H.M.T.P., Liyanage, N.K., Pallewaththa, P.W.P.W.K., Duminda, G.G.N. PP-54 PP-46

Probiotic bacterial counts in curd product produced in Sri Lanka

Oral health care for Child Development Centers and Elderly Homes in

Athiththan, L.V., Jayaratne, S.D., Peiris, H.

NIHS Field Practice Area PP-55

De Alwis, W. M. M. S.

Non communicable diseases and risk factor screening programme in PP-47

workplaces , Galle MC Area

Characteristics and outcomes of tuberculosis patients who fail to smear

Ubeysekara, N.H.

convert at 2 months in Sri Lanka Jayakody, G.W.K., De Alwis, S., Samaraweera, S., Pallewatta, N.,

PP-56

Ramachandran, A., Jayakody, J. K. M. N., Hewagama, A., Thomas, G. S.

Mosquito larvae trap

S.

Basnayake, S.

PP-48

PP-57

Identification of Specific Foods Causing Hypersensitivity among School

Assay of urine protein and awareness of laboratory tests associated with

Children in Colombo District- A Pilot study

diabetes in a selected population in Gangodawilla area in Colombo

Wimalasiri, Y.S.G., Ratnayake, R.M.U., Karunaratne, T.D.N.,

District â&#x20AC;&#x201C; A preliminary study

Ranaweera, K.K.D.S.

Shifana, A.A.F., Raziya, M.S., Athiththan, L.V.

74

PP-68

PP-58 Knowledge on sexually transmitted infections and mother to child

Mammographic diagnosis in symptomatic breast diseases in women

transmission among public health midwives and student public health

referred to the mammography unit, National Hospital Sri Lanka

midwives attached to the National Institute of Health Sciences, Kalutara

Bandara, L.M.H., Bandara, H.M.S.T., Attanayake, S., Gunathunga, M.W.

Kaluarachchi, D.V.V., Ranasinghe, R.D.S., Kulathilake, K.A.D.T., De Alwis, W.M.M.S., De Silva, A.S.U.

PP-69

PP-59

preventing transmission of gastro intestinal and upper respiratory tract

Application of Finger loop splints for patients with ulnar claw hand in

infections

Leprosy, Sri Lanka

Rathnayake, B.M.C., Jayawardena, J.A.C.K.

Awareness and knowledge of rural women about “Hand Hygiene” in

Aluthge, I. N. PP-70 PP-60

Knowledge and practices regarding health-care waste management

Association of blood pressure and microalbuminuria in a group of Sri

among undergraduate nursing students in selected universities of Sri

Lankan type 2 diabetes patients- A Preliminary study

Lanka

Wijayatunga, N.N., Perera, P.P.R.P., Wanigasuriya, K., Peiris,H.

Madurangi, E.D.G., Meegoda, K.D.L.

PP-61

PP-71

Knowledge and practice of safety precautions among a population of

The effects of long-term Metformin treatment on neuro-cognitive

rubber factory workers in Kegalle District

parameters

Amunupura, K.N., Hettiaratchi, U.P.K.

Bandara, L.M.H., Dissanayake, D.W.N., Atapattu, P.M., Senevirathne, P.L.D.R., Upekshani, A.V.N.N.

PP-62 Validation of a selected section of the Nordic questionnaire to use as a

PP-72

tool to identify Musculo-Skeletal Disorders in Sri Lankan nurses

To study characteristics in community pharmacy within the Kalutara MOH division in relation to current drug regulation of Sri Lanka

Munidasa, K.G.P.K., Pethiyagoda, K., Samarasinghe, K.

Nidangada, H.A.D.W. PP-63 Identification of patients with diabetes mellitus and assessment of

PP-73

glycaemic control in a single surgical unit at National Hospital of Sri

Assessing the awareness of diabetic complications and some correlates

Lanka-A preliminary study

of diabetes in a selected population in the Gangodawilla area in colombo

Athiththan, P., Bandara, A., Mahendrarajah, K.

district – a Pilot Study Raziya, M.S., Shifana, A.A.F., Athiththan, L.V.

PP-64 PP-74

Contraceptive Prevalence and Unmet Need for Family Planning among ever married reproductive aged women in Kalutara district, Sri Lanka

The effects of treatment parameters on statin-induced peripheral

Malwenna, L.I., Jayawardana, P.L., Balasuriya, A.

neuropathy

PP-65

S.S., Atapattu. P.M.

Bandara, H.M.S.T., Manchanayake, M.A.N., Tissera, H.C., Batagoda.

Development of Outcome based curriculum for the Tutor Training

PP-75

Diploma Program

Prevalence and correlates of school readiness among children at school

Priyananda, R.

entry in Regional Director of Health Services (RDHS) Division Ampara Talagala, S.

PP-66 Practice and accessibility to Emergency Contraceptive among the post-

PP-76

natal mothers in rural Sri Lanka

The factors for incompletion of the treatment of Tuberculosis patients in

Dolamulla, S.S., Rajapaksha, S., Wickramasinghe, P.K.

Kurunegala District Balasooriya, B.M.S.P.G

PP-67 The study on pharmacovigilance to monitor safety of anti-tuberculosis

PP-77

medicines in Sri Lanka

Electric controlled mercury sphygmomanometer

Seneviratne, K.N.G., Samaraweera, S., Ambagahage, T.M.,

Marshal, P.

Fernandopulle, R., Pallewatta, N.C., De Alwis, A.K.S.B.

75

PP-78 A survey to assess the level of awareness regarding thalassemia in antenatal mothers Jayasinghe, P.K.C.L., Gunasekara, K.V.N.N. PP-79 Maternal child health management information system Manoj, M.S. PP-80 Attitudes of medical student's for occupational safety and health De Silva, P.V. PP-81 Fathers' participation in infant feeding: associated factors and Mothers' satisfaction in MOH area Kalutara Godakanda, I.P. PP-82 Common oral diseases: knowledge and practices among Public Health Midwives in Puttalam District Fernando, S., Kanthi, R.D.F.C. PP-83 Healthy Village Initiative: Innovative approach to address diverse health issues in a community Sujeewa, J. PP-84 Critical evaluation of the medical laboratory technology curriculum Ketipearachchi S., Shafeek, N.M., Lakmali K.A.I. PP-85 Defining depression for Sri Lanka Ferdinando, R.

76

POSTER ABSTRACTS Methods A descriptive cross sectional study was carried out among a sample of 1770 adolescents, recruited using multi-stage cluster sampling.

Violence was measured using a self-report inventory of 39 physical and relational violent activities.

PP-01 KNOWLEDGE, ATTITUDES AND PRACTICES OF WATER, SANITATION AND HYGIENE (WASH) AMONG SCHOOL CHILDREN IN KIRAN MOH AREA Wickrematilake, M.S.K., Arnold, S.M., Pethiyagoda, K., Faizal, A.M., Suraweera, S.M.J.P. Faculty of Medicine, University of Peradeniya, Infectious Disease Hospital, Angoda wickrematilakesepali@yahoo.com

Results Response rate for the study was 96%. The prevalence of being an overall victim for any violent activity at least once within preceding six month was 85.1% (95% CI= 83.4-86.8%). This was significantly higher (p<0.001) than the prevalence of being an overall perpetrator (66.5%, 95% CI=64.3-68.7%). Prevalence of being a victim of physical violence (77.6 %, 95% CI=75.6-79.6%) was significantly higher (p<0.001) than being a perpetrator of physical violence 60.4%, (95% CI=58.1-62.7%).

With regard to relational violence, prevalence of being a victim was 70.4 % (95% CI=68.2-72.6%) and this prevalence was significantly higher (p<0.001) than of being a perpetrator of relational violence (50.9%, 48.553.3%). In an approach to examine adolescent's participatory roles for violence, they were categorized as pure perpetrator, pure victim, and mixed perpetrator-victim and uninvolved. The mixed perpetrator-victim was found to be the commonest participatory role in both physical and relational violence. Participatory roles for physical violence revealed that 57.6% (95% CI=55.3-59.9) to be mixed perpetrator-victims and for relational violence, 47.8% (95% CI=45.4-50.2%) adolescents were mixed perpetrator-victims.

Background One of the targets of the Millennium Development Goals is to halve the proportion of people without sustainable access to safe drinking water and sanitation by 2015. UNICEF highlighted 1,299 out of 9,662 schools did not have functional sanitation facilities. Due to the civil war situation the WASH facilities in the North and East were under developed and it is important that water and sanitation given high priority.

Aims To assess the knowledge, attitudes and practices on water sanitation and hygiene of the school children in MOH area Kiran Methods A descriptive cross sectional study was carried out in the Kiran MOH area in Batticaloa District. A total of 153 students in year 7 and 8 participated in the study. Pre-tested self administered questionnaire and an observational checklist were used as study instruments.

Conclusions Study revealed that involvement of adolescents in violence is through victimization, perpetration or both. The prevalence of being victims and perpetrators for both physical and relational violence was high among schooling adolescents indicating the need of urgent interventions.

Results Majority of students were knowledgeable that boiling water kills germs and water storage containers needs both cleaning and covering (97.4%, n=149), and hand washing with soap removes germs (73.9%, n=113).

However, knowledge was not satisfactory in areas of water contamination by open defecation (22.9%, n=35), spread of infections through uncleaned nails (26.1%, n=40) and use of toilets as a measure of preventing diarrhoea (13.1%, n=20). Mean attitude score on water and sanitation was only 56.08 out of 100. Seventy two percent (n=110) cleaned their teeth using toothbrush and toothpaste. Thirty nine percent (n=59) indicated they go to a nearby shrub for defecation. In the schools only 54.1% had access to a clean toilet and 51% to a safe drinking water source.

PP-03 WEIGHT REDUCTION OF POST PARTUM MOTHERS THROUGH INCREASED LEVEL OF PHYSICAL ACTIVITIES IN A RURAL SETTING Kumari, P.D.D. Rajawaththa PHM Area, National Institute of Health Sciences, Kalutara Background Rajawaththa is a Public Health Midwife area situated in the MOH area of Kalutara. It has a population of 5259. The PHM area is divided in to 3 parts namely Rajawaththa I, II and Pulertan with geographical boundaries. The area midwife observed many post partum mothers in her area are overweight and do not lose weight, that is gained during pregnancy.

Conclusions The knowledge and attitudes in certain important areas of sanitations were not satisfactory. Schools lacked adequate water and sanitary facilities. The communities including schools should be provided with adequate water and sanitary facilities which would improve WASH practices of school children.

Aims To motivate post partum mothers maintain the normal body mass index (BMI) and to reduce the percentage of overweight post partum mothers by 50% within a period of one year

PP-02 INTERPERSONAL VIOLENCE AMONG 13-15 YEAR OLD SCHOOLING ADOLESCENTS IN GAMAPAHA DISTRICT

Methods During the child immunization clinics PHM proposed to post partum mothers to have some programme to improve physical activities. Some mothers in her area agreed with her and they got together at her office and discussed. Finally most mothers agreed to have a team of â&#x20AC;&#x153;elleâ&#x20AC;?.

Three elle teams from the different parts of her area were established. All of them including the area PHM gathered in Rajawatta play ground in the area and played for about two hours every day until dusk. Weight and height of the participants were recorded initially. Weight and 24 hour dietary records were taken every 3 months. Dietary advices to correct wrong practices were done at the same time.

Wijeratne, M. P., Seneviratne, R. de. A., Gunawardena, N. Ministry of Health, Sri Lanka and Faculty of Medicine, Colombo monika.wijeratne@gmail.com Background Violence among schooling adolescents has been identified as a global phenomenon which demonstrates a considerable cultural diversity.

Prevalence of peer violence has not been studied in detail in Sri Lanka.

Aims The Aims of this research was to determine prevalence of peer violence among 13-15 year olds in Gampaha District schools.

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PP-05 STUDY OF CU2+ ION TOLERANCE ACTIVITY OF UNKNOWN BACTERIAL (P) STRAIN ISOLATED FROM TEXTILE DYEING EFFLUENT

Results There were 50 post partum mothers participated in the “elle” team and 10 were with low BMI, 12 with normal BMI and 28 were with high BMI. “Elle” practice was started at the beginning of year 2011 and there was an “elle” tournament on 2011.12.08. Two teams participated at the tournament from the Rajawatta PHM area won the 1st and 2nd places respectively. Out of 28 high BMI mothers, 24 mothers moved into normal BMI group by 2012 while none of low and normal BMI mothers moved to high BMI group.

Pushpamalie, E.K. P., Wijayarathne, C. D., Wijesundara, W.S.S. National Blood Centre, Colombo ekpp80@gmail.com Background Heavy metal pollution is a global problem affecting living organisms. It generates health problems in human such as carcinoma, neurological problems, cardio vascular and respiratory disorders, liver diseases and problems in immune system. It is important to remove the heavy metals such as copper, arsenic, and zinc from contaminated water bodies reducing health risk. Heavy metal bioremediation using metal tolerant mechanisms of bacteria grows in heavy metal contaminated environments is a promising solution. Heavy metal tolerance activity of bacteria is important in bioremediation applications.

Conclusions PHM can motivate their client towards healthy practices practice through innovative approaches apart from health education. She should have a very good relationship with the population to have the support for these extra-ordinary activities.

PP-04 KNOWLEDGE, TREATMENT COMPLIANCE AND PREVALENCE OF KNOWN RISK FACTORS AMONG PATIENTS ATTENDING GLAUCOMA CLINICS AT EYE HOSPITAL COLOMBO

Aims Evaluate the effectiveness of heavy metal bioremediation of P strain by measuring its Maximum Cu2+ Tolerable Concentration and efficiency of Cu2+ reduction in the medium.

Piyasena, D.A.K.N., Fonseka, P., Fonseka, I. STD & AIDS Control Program, National Eye Hospital, Sri Lanka kapilapiyasena@yahoo.com

Methods LB medium with 1ppm, 2ppm, 3ppm, 4ppm, 5ppm, 6ppm, 7ppm and 8ppm Cu2+ ions were inoculated with P strain. Measurement of optical density at 600nm and colony forming units (CFU) counts using spread plate were taken to obtain the growth curve and maximum Cu2+ ions tolerable concentration of P strain. Measurement of atomic absorption spectroscopy at 324.8nm were measured in day1, day2, day3, day6, day8 intervals to observe the effectiveness of bacterial strain in Cu2+ ions reduction of the medium.

Background Glaucoma is the second leading cause of preventable blindness in the world. Blindness caused by glaucoma is irreversible. Therefore early detection and regular follow up of these patients is essential to prevent permanent disability.

Aims To describe the socio demographic characteristics, assess the knowledge on glaucoma, treatment compliance and proportion with known risk factors among patients attending glaucoma clinics at Eye Hospital, Colombo with a view identifying existing knowledge and recommendation to improve compliance

Results Bacterial growth was completely inhibited at 7ppm Cu2+ ion concentration. Slight growth was seen in 6ppm copper concentration.

When Cu2+ ions concentration get increased from 0 ppm to 7 ppm, CFU counts of 72h broth cultures have been decreased resulting complete growth inhibition of bacteria from 352 CFU to 0 CFU. Atomic absorption spectrophotometry results have shown average 17.8% copper reduction in 24h time, 43.3% in 48h and 58.8% in 72h.

Methods A descriptive cross sectional study was carried out at glaucoma clinics in Eye hospital Colombo during the period August to November 2008.

Diagnosed glaucoma patients attending glaucoma clinics were selected for the study. An interviewer administered pre-tested questionnaire and a data extraction form were used for data collection.

Conclusions Maximum copper tolerable concentration of P strain is 6ppm and it shows applicable Cu2+ ion bioremediation activity in Cu2+ ion contaminated water bodies.

Results Among the 431 glaucoma patients a majority were females 57.5% (n=248). Male female ratio was 1:1.4. All patients were on ocular medication while 16.4% (n=71) were on both oral & topical medications.

Thirty eight point eight percent (n=167) named the disease as glaucoma while 45.5% (n=196) referred to eye pressure. Knowledge on the name of disease was significantly higher in those less than 60 years compared to equal or more than 60 years ( p=0.04). Among patients 15.3% (n=66) had knowledge on currently used medication. The overall knowledge on glaucoma among patients attending Eye Hospital Colombo was not satisfactory. Among glaucoma patients 74.5% (n=321) were in a view that blindness caused by glaucoma is irreversible. Compliance of glaucoma patients on their medication was good in 65.1% (n=280) and poor in 15.7% (n=68). Compliance to treatment was significantly higher (p=0.000) in those less than 60 years compared to more than 60 years; and monthly income > Rs. 10,000 (p=0.001). Presence of diabetes & hypertension was 23.2 % & 16% respectively.

PP-06 A REVIEW ON THE AVAILABILITY OF SERVICES FOR THE LIMB DISABLED IN SRI LANKA Weerasinghe, I.E., Fonseka, P., Dharmaratne, S.D., Jayathilaka, J.A.M.S. 1Ministry of Health, Sri Lanka, 2Faculty of medicine, University of Sri Jayawardanapura & Peradeniya eranganie@yahoo.com Background Physically disabled benefit enormously by rehabilitation through health care services. However, disability related health care services are scarce worldwide. Unfortunately, awareness of the available services, resources and benefits of rehabilitation among people is also poor.

Conclusions The overall knowledge on glaucoma and its medication was not satisfactory.

Aims This study aims at reviewing the services available for the limb disabled in Sri Lanka.

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highest is the confidentiality (141.2=70.58%), followed by dignity (137.7=68.83%), communication (128.7=64.35%), prompt attention (128.6=64.33%), social support (127.6=63.77%), basic amenities (103.2=51.65%), choice of care provider (79.2=39.61%) and autonomy (75.2=37.61%).

Methods Medline and Google data bases were searched for published articles from 1980 to 2011 using the key words; limb disability, health services, social service department services, non-governmental organization services, Sri Lanka. Further, services for the limb disabled were reviewed using documents available in governmental and nongovernmental organizations and institutes of Sri Lanka. The service providers, officials and specialists in the field of disability including Health and Social Services Department of Sri Lanka were interviewed.

Conclusions By addressing the eight domains of responsiveness and also improving the physical and human resources a successful behavioral and organizational development can be achieved in public sector health institutions in Sri Lanka.

Results In Sri Lanka, the government sector provides services for the limb disabled through the Ministry of Health and the Department of Social Services. Under the Ministry of Health, all Teaching, General and Base hospitals supply services for the limb disabled. Trained family health workers provide services through early referrals and assisting in rehabilitation services. Social Services Department provides varied facilities for the limb disabled including provision of monetary allowances and loan schemes, assistance for self-employment, medical assistance and vocational training services. Social-service officers in the Department of Social Services provide services to the limb disabled in the community by engaging in community based rehabilitation services. A few non-governmental services operate for the limb disabled in Sri Lanka namely the Jaipur Foot Project of the Friend-In-Need Society and Sarvodaya. They mainly supply mobility assistance providing artificial limbs.

PP-08 COPING STRATEGIES FOR STRESS ADOPTED BY FEMALE STUDENT NURSES IN THE NURSING TRAINING SCHOOL, GALLE Ellawela, Y. G., Fonseka, P. Ministry of Health, Sri Lanka yamuna.ellawala@gmail.com Background Student nurses during their training face various stressful situations.

There is a whole variety of simple, healthy ways of coping with stress.

Awareness of coping strategies that are used by the nursing students is important to improve their mental wellbeing as future nurses.

Aims To describe selected coping strategies practiced by female student nurses in the Nursing Training School (NTS) Galle

Conclusions Varied types of services for the limb disabled are available in Sri Lanka.

Effective flow of information is crucial for the improvement of awareness of these services among the limb disabled as well as the public.

Methods A descriptive cross-sectional study was carried out among all 525, 2nd and 3rd year female student nurses in the NTS Galle in 2009. A Selfadministered questionnaire gathered information on coping strategies for stress. The responders had to indicate the frequency of practicing each coping method, which were analyzed according to problemfocused, harmless, harmful and cognitive emotion-focused strategies.

PP-07 RESPONSIVENESS IN THE MEDICAL WARDS OF THE GENERAL HOSPITAL MATARA Ranasinghe, J. P., Samarage, S.M. Base Hospital, Kamburupitiya, Sri Lanka jayangaranasinghe@yahoo.com

Results The majority of student nurses (62.2%) were in the 22-24 year age group. More than 40% of student nurses seldom practiced each problem-focused coping strategy. Majority of the female student nurses were frequently practicing the comfort in religion or spiritual beliefs (52.6%, n=270) followed by listening to music (36.5%, n=187) and by getting emotional support from friends/colleagues (34.7%, n=178).

Approximately 67% (n=342) of them were never trying to reduce stress by physical exercise. Among female student nurses 12.7% (n=65) were frequently practicing the methods of keeping the feeling to self and nearly 17% of them (n=86) were practicing the reappraisal of the situation to make it less stressful. Majority of nursing students never practiced the harmful stress coping strategies.

Background World Health Organization described 3 intrinsic goals to measure the performance of health systems in the World Health Report of 2000.

They are Health, Fair financing, and Responsiveness. Responsiveness is the non-health expectations of population which has eight domains.

Aims To assess the level of responsiveness in the Medical Wards of the General Hospital Matara Methods Descriptive cross-sectional study was conducted in the Medical Wards with a total sample of 422 patients and 23 key staff members. An interviewer administered questionnaire, a checklist and guidelines were used.

Conclusions There is an overall decrease of adaptation to healthy ways of coping.

Unavailability of proper counseling service was indirectly represented by relatively less proportion of female student nurses who tried to get advice from others. Stress management workshops should be organized periodically to improve the coping abilities of student nurses in parallel to the awareness programmes about effective coping strategies.

Results The calculated overall Responsiveness Rate ranges from 33-165 and average was 116.85 (SD=16.872). For OPD treatment majority (55.7%) go for the private sector due to better care and shorter distance, while 40.5% preferred government sector mainly due to better facilities and to low cost. For in-ward treatment majority (72.3%) go for the public sector mainly due to better facilities and care. When describing level of responsiveness in relation to the socio-demographic characteristics there were significant difference across the age (p=00), gender (p=00), education level (p=00). There is no significant difference observed with distance (p=0.01), monthly income level (p=0.416). Measuring the Total Responsiveness Score (TRS) for each domain of responsiveness, the

PP-09 BIOMASS FUEL USE PATTERN AND ACUTE RESPIRATORY INFECTIONS IN CHILDREN IN SRI LANKA: AN ANALYSIS OF DEMOGRAPHIC AND HEALTH SURVEY DATA Kaththiriarachchi, L1., Nandasena, Y.N.S.2 Ministry of Health, Sri Lanka, 2National Institute of Health Sciences, Kalutara lasakamd@ymail.com 1

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Background Indoor air pollution is a growing public health concern due to its well documented ill effects. Biomass cooking fuel is the main source of indoor air pollution in the majority of households in the developing world.

selecting essential drugs became the core principles. The success of this policy direction was hailed in non-aligned summit in 1976. It helped to maintain a healthy balance of payment situation in the country for an extended period. Political change and opening up of economy in 1977 effectively reduced the applicability of this procedure. The vigor of strict inventory control faded creating shortages. Although the policy directions in 1992 and 2005 emphasized the importance, they were not executed appropriately. The ability of state to control the medicines market is gradually losing its grip.

Aims To determine the trends of biomass fuel use pattern and its association with acute respiratory infections (ARI) in Sri Lanka Methods The type of cooking fuel used in households and other relevant data were extracted from the Demographic Health Surveys (DHS) of 2000 and 2007. The DHS was based on a representative sample (multi-stage stratified probability sample) of the whole country except the provinces afflicted by civil unrest. The results are based on a sample of 8,169 households in 2000 and 19,862 households in 2007. The data sets were re-analyzed to address the Aims.

Conclusions Despite the availability of clear policy directions and evidence for their successful applicability, those are not pursued in procurement of medicinal drugs for state use in Sri Lanka at present which results in shortages and increase out-of-pocket costs for medicines.

PP-11 KNOWLEDGE, ATTITUDES AND PRACTICES AMONG NURSES OF LADY RIDGEWAY HOSPITAL REGARDING MERCURY CONTAINING MEDICAL DEVICES

Results Wood was the principal type of cooking fuel used in 78.3% and 78.5% of households in years 2000 and 2007, respectively. In 2007, 96.3% of estate sector households used wood as compared to 84.2% in the rural and 34.6% in the urban sector. Similar trends were seen in year 2000 as well. Higher the educational level of the respondents, lower the proportion of biomass and kerosene use in both surveys (Chi square for trend: p<0.001). In 2007, children residing in households using biomass or kerosene as the principal cooking fuel were 1.53 times (CI 95% 1.082.22) more likely to have an episode of ARI in 2 weeks preceding the survey as compared children residing in households using gas or electricity as the principal cooking fuel.

Senanayake, S. J., Gunawardena, N. S. Post Graduate Institute of Medicine, Sri Lanka sjsenanayake@yahoo.com Background Mercury is a highly toxic heavy metal. Mercury is used in many medical devices in the healthcare sector. Nurses are one of the most vulnerable occupational groups for mercury exposure.

Conclusions The shift from biomass to cleaner fuels in Sri Lanka is negligible from 2000 to 2007. The incidence of acute respiratory infections was significantly higher among children residing in households that use biomass fuel or kerosene as compared to children residing in houses using gas or electricity as the principal cooking fuel.

Aims The aims of this study were to describe knowledge, attitudes and practices among nurses of Lady Ridgeway hospital (LRH) regarding mercury containing medical devices.

Methods This was a descriptive cross sectional study. A self administered questionnaire assessed knowledge, attitudes and practices on mercury containing medical devices of nurses (n=538) working in any ward or unit in LRH, at the time of the study.

PP-10 PHYSICIAN UPTAKE OF NEW MEDICINES: A PRESCRIPTION AUDIT FROM SRI LANKA

Results All nurses were females and a majority (67.8%) was in the age group 24â&#x20AC;&#x201C;34 years. A majority (91.5%) knew that gloves should be worn before cleaning a spillage. Of the 347 who used mercury thermometers, 33.9% had seen more than 10 thermometer breakages in their units during the 3 months period prior to the study. Among those who used mercury sphygmomanometers (n=405), 20.0% had seen mercury sphygmomanometer breakages in their units. A total of 271(57.4%) had either cleaned a mercury spillage or had supervised a mercury spillage being cleaned. A total of 112(41.3%) had incorrectly collected mercury and glass pieces together and of them, 67.0% had incorrectly disposed them to the sharps bin. A majority (94.1%) had favorable attitudes towards issues related to mercury use in health sector. Of the population 80.7% disagreed to the statement that 'spending money on mercury free alternatives is a waste'.

Weerasinghe, M. C. Medical Faculty, University of Colombo manujchri@gmail.com Background Unavailability of many essential drugs and regular out of stock situations in state run health facilities in Sri Lanka has become a major concern.

Malfunctioning of medicine purchasing in state sector is seen as the main contributor.

Aims To analyze existing policy directions for purchasing of medicines for state sector Methods Policy documents and evidence for last five decades related to medicines policies in Sri Lanka was identified and compiled. A chronology of documents was prepared and an analysis was conducted. A literature search was also done to assess the sociopolitical environment in relation to development of policy guidance.

Conclusions Large amount of mercury is being released in to the environment by the LRH. The study participants lacked knowledge regarding mercury used in the health sector but the overall attitudes were mostly favourable. Gaps in practices on managing a mercury spillage were evident.

Results Policy initiatives for purchasing of medicines for state usage dated to late 1950s with preparation of medicines list for state hospitals. BibileWickramasinghe report that established procurement of medicines through state agency using international tender in bulk quantities in 1971 streamlined the policy directions. Use of generic name and

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correct oral health practices.

PP-12 EPIDEMIOLOGICAL PROFILE OF VARICELLA: SITUATION IN SRI LANKA

Aims To describe behavior management strategies employed to gain cooperation and to educate preschool children on oral health promotion

Munasingha, H., Malavige, N., Amarasinghe, A. Epidemiology Unit, Ministry of Health, Sri Lanka munasinghahathshya@gmail.com

Methods Sample consisted of 267 preschool children of the Colombo Municipal Council- Division 1 region who visited the Preventive Dental Clinic, Community Dental Unit, Dental Institute, Colombo from 1st of January to 30th September 2012. Data were extracted from routine clinic records.

First visit cooperativeness was assessed by child's compliance with fluoride gel application. Mother/Father/Primary care giver was educated for effective brushing and dietary modifications needed based on existing practice assessed by the amount and frequency of consuming cariogenic food items (containing fermentable carbohydrates) by dietary recall. A tooth brush was given to each child as a reward to gain their cooperation. Assertiveness and modeling were practiced among some children. On the second visit, compliance with dietary counseling assessed by daily consumptions of biscuits, toffees and chocolates and level of cooperation were assessed. Data were analyzed using SPSS package.

Background Chickenpox (Varicella) is a notifiable disease in Sri Lanka since year 2005. Though it is a mild disease in children, it can cause complications in adults, pregnant women, neonates and immune compromised patients. The epidemiology unit was reported an average of 6,427 cases per year in 2008-2012. The average number of deaths was 12 per year. The available data suggest an increase of reported cases of Chickenpox in the country.

Aims To review the situation of Varicella in Sri Lanka Methods Literature survey which are currently available and published, through pubmed, Google Scholar, Medline, Epid Unit web site, Epidemiological Bulletins and Weekly Epidemiological Returns.

Results The mean number of decayed teeth for the sample was 6.1 Âą 3.5. The Majority 155 (58%) of the children was uncooperative at the first visit.

Tooth brushing of 71% (n=190) of the children was assisted by an adult, also 81% (n=218) brushed twice daily. On average, they consumed 3.4 biscuits with a range of 0-16 (one biscuit 5-10g), 1 chocolate (15-20 g) and 1.5 toffees per day. Seventy one percent of the previously uncooperative children became corporative to treatments on the second visit. Moreover, 55% of children responded satisfactorily by reducing the consumption of cariogenic food items complying with dietary counseling provided to parents/primary care givers.

Results In a study, a total of 331 individuals (36%) out of 913 subjects were seropositive for VZV: forty eight percent of seropositivity were among urban population and 27.9% in rural. It was found that 56.2% (131) of females of childbearing age were not immune to VZV. The seroprevalence rates were higher in females 54% than males 45.1%.

Secondary bacterial infection (62.1%), Pneumonia (9.1%), neurological complications (3.4%) and Carditis (1.01%) were the complications identified. IMMR statistics revealed 1749 admissions with Chickenpox, out of which 15 were fatal 2005. Adults were more likely to develop severe complications during primary VZV infection. This increased clinical disease severity with advancing age is positively correlated with peripheral blood viral load during the disease and reduced viral specific T cells responses. Forty two percent from total 451 University Students reported history of Chickenpox. Median reported age of acquiring the disease was 14 years. Half of the student population (222/436) 50.9%, (95% CI 46.2 - 55.6) was susceptible to VZV infection. Incidence density of VZV infection was 65.1 per 1,000 person years. Three hundred and seventy seven working days were lost by 43 students out of the 172 susceptible.

Conclusions This approach finds some evidence for the feasibility of educating preschool children, adopting behavioural management strategies with a resultant change in their oral health behavior.

PP-14 URINARY TRACT INFECTION AND ASYMPTOMATIC BACTERIURIA IN PREGNANT WOMEN: CAUSATIVE ORGANISMS AND ANTIMICROBIAL SENSITIVITY PATTERN

Conclusions Though Varicella is a mild disease it can cause a significant economic and social impact to the community.

Muhunthan, K., Guruparan, K., Lakshy, G., Ratnasamy, V., Rasalingam, P. Faculty of Medicine, University of Jaffna lakshys@gmail.com

PP-13 BEHAVIOURAL MANAGEMENT STRATEGIES AND ORAL HEALTH RELATED BEHAVIORS OF PRESCHOOL CHILDREN RECEIVING PREVENTIVE DENTAL CARE

Background Urinary tract infection during pregnancy has been proven to be associated with significant maternal and peri-natal complications. To prevent this detrimental outcome, urinary tract infection has to be treated with most sensitive antimicrobial therapy. That needs the identity of the organism and the sensitivity pattern in the community concerned to various antimicrobial agents. While the usual practice at the antenatal clinic was to screen ante-natal women with urine full report and treat with empirical antimicrobial therapy, usually either cephalexin or amoxicillin due to their safety profile.

Karunachandra, K.N.N., Bollagala, A.D., Perera, I.R., Liyanage, N.L.P., Kottahachchi, M.J., Wimalasena, B.A.S.S., Bandara, M.D., Wickramarachchi, M.V. Dental Institute, Colombo, Sri Lanka nkarunachandra@gmail.com

Aims To find out the prevalence of urinary tract infection, both symptomatic and asymptomatic among pregnant women, identify the common causative organisms and the antibiotic sensitivity pattern

Background Dental Caries especially early childhood caries is a major childhood public health problem in many parts of the world including Sri Lanka.

Underlying causes are often multi-factorial including dietary pattern, brushing practices, factors related to oral cavity as well as wider sociocultural determinants. Provision of safe and effective dental care for children often requires modifying their behavior for oral health promotion. As small children become anxious and fearful on visiting hospitals and on receiving treatment it is a challenge to educate them on

Methods A descriptive cross sectional study was carried out in a group of 196 pregnant women presenting to antenatal clinic at teaching hospital Jaffna, Sri Lanka, from April to June 2012. Sample of urine was collected

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PP-16 EFFECTIVENESS OF NEUTRAL WRIST SPLINTING FOR CONSERVATIVE MANAGEMENT OF CARPAL TUNNEL SYNDROME

and analysed by direct microscopy and culturing on CLED (Cystine lactose electrolyte deficient) media. Antibiotic sensitivity test pattern was done on positive cultures.

Results The prevalence of urinary tract infection was found to be 12% with asymptomatic bacteriuria in 5% of the women attended the antenatal clinic. Coliforms were identified in 87% of the positive cultures.

Antimicrobial sensitivity test showed sensitive to Nitrofurontoin in 95.7%, Cefuroxime in 91.3%, Coamoxiclav in 78% and Nalidixic Acid in 65% of the study population. While Amoxicillin and Cephalexin showed resistance in 56.5% and 83% of the women respectively. .

Conclusions From these finding it can be recommended to screen all the pregnant women attending antenatal clinic teaching hospital Jaffna for urinary tract infection as it has been found to be cost effective if the prevalence rate is >2% and also recommend to derive the antimicrobial therapy based on sensitivity pattern than empirically for successful treatment.

Dematagoda, D.K.V1., Ramachandra, R.B.B.S2.

National Hospital Sri Lanka, 2National Institute of Health Sciences, Kalutara samantharamachandra19@gmail.com 1

Background Carpal Tunnel Syndrome (CTS) is defined as symptoms manifested when the median nerve is compressed at the wrist as it travel through the carpal tunnel. Decompression of the nerve at the carpus is considered to be the gold standard treatment. However, many patients in Sri Lanka suffer from this condition due to long surgical lists. Neutral wrist splint is a conservative management option for mild to moderate CTS with low health cost.

Aims To describe the effectiveness of neutral wrist-splinting for diagnosed patients with Carpal Tunnel Syndrome

PP-15 STUDY OF DERMATITIS ASSOCIATED WITH CUTANEOUS LEISHMANIASIS IN ANURADHAPURA

Methods A descriptive cross sectional study was conducted among all patients with mild to moderate CTS who have registered at department of Occupational Therapy, National Hospital Sri Lanka in years 2011 January – 2012 December. BUSTON Protocol on assessing history of discomfort; Hydraulic Dynamo Meter to measure the power grip; Mechanical Pinch Gauge to measure Pincer grip; and Lowenstein Monofilament Hand Test to examine the sensation were performed on patients before and after treatment. Data were analyzed with paired “t” test to assess the pre and post values. Ethical approval for the study was obtained from the Ethics Review Committee, National Hospital Sri Lanka.

Weerakoon, K.M.H.S., Herath,. P., Bandara, W.M. P. Regional Director of Health Service's Office, Anuradhapura rdhsdpmu@gmail.com Backgroud Cutaneous leishmaniasis (CL) is an emerging health problem in Anuradhapura district and it is increasingly being recognized as an endemic area for CL in Sri Lanka. CL has variable presentations due to diversity of the organism and Immune status of the patients.

Aims The present study aims at: analyzing epidemiology and clinical presentation of CL patients.

Results There were 71 patients and majority of them were females (90%) in 4060 year age group. Only 59 patients attended for the post assessment.

Improvement in all assessment areas of BUSTON protocol including severity of pain at night, sleep disturbance due to pain, pain during day time, duration of a single pain episode in day time, difficulty of holding small objects were highly significant with the p value of <0.005. Both Power Grip and Pincer Grip reported significant improvements (p <0.005) after wearing neutral wrist splint at night for 6-8 weeks.

Methods All reported cases of CL to the Dermatology Clinic Teaching Hospital Anuradhapura for the period of 5 years (2007 July - 2012 July) were analysed retrospectively. Data included the number of patients per year, age distribution, sex distribution, occupation, site of the disease involvement, duration of lesion before treatment, and residence according to the areas under Medical Officers of Health (MOH).

Results The study sample was 1919. The incidence was 29.71 per 100,000 populations per year. Majority of cases were from Padaviya (32.9%), Thalawa (14.73%) Nuwaragampalatha East (13.68%) and Nuwaragampalatha Central (12.1%) MOH areas. The affected main age group was 20 to30 years and male: female ratio was 3:1. The exposed areas were mostly affected with the predominant site being upper limb (44.45%). The majority (44.7%) presented with erythematous papule, nodule or plaque. Main occupations affected were farmers (15.1%). and armed forces personal (43, 25%). Apart from those children (15%) also affected. The majority of patients presented with in 3 to 6 months of duration whilst earliest being ½ month.

Conclusions Neutral wrist splint is a successful conservative method of treatment for mild to moderate CTS with no disturbance to day to day activities.

PP-17 PARENTS' KNOWLEDGE ON FEVER AND ITS ASSOCIATION WITH SELECTED FACTORS IN CHILDREN TREATED AS DENGUE FEVER Mahesh, P.K.B., Arnold, S.M. Ministry of Health, Sri Lanka buddhikamahesh@ymail.com

Conclusions Most patients presented with asymtomatic erythematous nodule or papule in exposed parts of the body with behaviour and occupational activities related to scrub jungles. Control measures should be implemented to prevent CL becoming a major health problem.

Background Presence of four dengue subtypes and favorable breeding conditions has made dengue a major public health problem in Sri Lanka. The Island is one of the four South East Asian countries in which dengue is a leading cause of hospitalization and death in children. Early detection of fever and timely interventions reduce the morbidity and mortality of dengue.

Parents play the major role in fever detection and treatment seeking behaviour.

Aims To evaluate the knowledge on fever and its association with selected

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adequate knowledge on infection control. Knowledge of MHCWs on infection control was significantly associated with their age (P=0.04), employment category (P=0.001), duration of employment (P=0.046), training experience with related to infection control (P=0.006), type of training on infection control (P=0.001), training on selected areas of infection control such as hand washing (P=0.009), handling patients with communicable diseases (P=0.000) and instrument cleaning (P=0.015).

Majority (71%; n=429) of “MHCW”s had poor practices. Practices were significantly associated with age (P=0.040), civil status (P=0.001), educational status (P=0.043), employment category (P=0.04), training experience in relation to infection control (P=0.001), training on selected areas of infection control such as hand washing (P=0.001), handling patients with communicable diseases (P=0.011), handling waste (P=0.001). Although they had a good knowledge on infection control it was not significantly associated with the self reported practices.

factors and response to fever, in parents of children treated as dengue fever Methods A descriptive cross sectional study was carried out at the Lady Ridgeway Hospital for Children. Systematic sampling was done with a sample size of 425. Knowledge of parents was assessed using an interviewer administered questionnaire. Associations between knowledge and selected factors and response to fever were evaluated.

Results In 50.4% (n=213) of the respondents, the knowledge score was below 50%. Knowledge had a positive correlation with respondent's age (rs=0.027), spouse's age (rs=0.008) and income of the family (rs=0.276).

The association with income was statistically significant (p<0.001).

Significant association with knowledge was seen with parent's education level (p<0.001), and having a thermometer at home (p<0.001). Knowledge on fever significantly influenced the response to fever such as usage of a thermometer (p<0.001) and administering the correct paracetomol dose (p=0.01).

Conclusions Many gaps were identified with regard to knowledge and self reported practices in District General Hospital Kalutara on infection control among MHCWs. Regular in-service programmes are needed to improve the knowledge and good practices in relation to infection control.

Conclusions Parents' knowledge on fever was not satisfactory. Parents' knowledge on fever was influenced by age, education level and income.

PP-19 ASSESSMENT OF ANTI-RABIES POST EXPOSURE THERAPY GIVEN TO THE CLIENTS WHO VISITED BASE HOSPITAL UDUGAMA AFTER AN EXPOSURE DURING THE YEAR 2011 AND 2012

PP-18 KNOWLEDGE AND SELF REPORTED PRACTICES REGARDING INFECTION CONTROL METHODS AMONG SELECTED “MINOR HEALTH CARE WORKERS” IN DISTRICT GENERAL HOSPITAL KALUTARA AND THEIR CORRELATES

Karunarathna, S.M.P. Base Hospital, Udugama samadaramadhu@gmail.com

Poruthota, P.C., Goonewardena, C.S.E., Wijayasiri, W.A.A. National Institute of Health Sciences, Kalutara charithaporuthota@gmail.com

Background In Sri Lanka there are 50 to 60 deaths occurring due to rabies yearly. The main reasons for deaths in Sri Lanka are not getting post exposure treatments. If treated properly immediately after infected animal bite it is 100% preventable and post exposure vaccine and serum are freely available at government hospitals. There was a death of a 64 year male at Udugama MOH area in 2010 due to incomplete anti-rabies post exposure therapy.

Background Basic infection control measures in any healthcare setup can reduce the rates of health care-associated infections.

Aims To study the knowledge and self reported practices regarding infection control methods among selected “Minor Health Care Workers” (MHCW)s in District General Hospital Kalutara and their correlates

Aims To assess completeness of the anti-rabies post exposure therapy among clients who visited BH Udugama after an exposure

Methods A hospital based descriptive cross sectional study was carried out in relation to infection control. Knowledge and self reported practices of the MHCWs (n=429) were studied using an interviewer administered questionnaire. The term MHCWs referred to categories of attendants and ”Saukya Karya Sahayaka”s attached to the hospital. The level of knowledge related to infection control of the study participants were examined through 13 questions. Questions were organized under seven components as hand hygiene, diseases spread with related to poor infection control procedures, procedures causing HCAIs to the patients, procedures following accidental needle prick injuries, environmental cleaning and sharp disposal. For the propose of description the practices were divided into five categories as practices in relation to hand hygiene, practices related to handling of used linen, practices related to handling of sharps, practices related to wearing personal protective equipments (PPE), practices related to cleaning of instruments.

Methods We analyzed the available records of post exposure therapy given to clients who visited Base Hospital Udugama after an exposure during the year 2011 and 2012 Results Only 561 clients out of 951 (59%) completed the anti-rabies post exposure therapy (D7 or more). Eighty eight clients (9%) received only the first dose (D0) of ARV. One hundred and fifty nine (17%) received only two doses (D0, D3) .Available records of 143 clients (15%) cannot be comment on .

Conclusions There is a high proportion of incompleteness with regard to anti rabies post exposure therapy.

PP-20 KNOWLEDGE ATTITUDES AND PRACTICES REGARDING HUMAN RABIES AND FCTORS ASSOCIATED WITH KNOWLEDGE AMONG GRADE TEN STUDENTS IN THE NUGEGODA EDUCATION DIVISION

Results Majority of the MHCWs (n=258; 60.1 %) were females and 56.7% (n=243) had more than 10 years of working experience. Seventy four point six percent (n=320) of the MHCWs had participated at least one training on infection control during their service experience. Only 4.4% (n=19) MHCWs had experienced accidental exposure to sharps within last six months duration. Majority of MHCWs (n=384; 89.5%) had

Jayawardene, D.M.S., Gunawardena N. S. Faculty of Medicine, University of Colombo marysudharshani@ymail.com

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were used to define overweight and obesity. Statistical analysis was performed using SPSS 16 version.

Background Human rabies has proved to be a public health problem in Sri Lanka. A lack of knowledge, incorrect practices and unfavourable attitudes regarding preventive measures, have been attributed as the main cause of this dilemma.

Results Among them 307 adults were in the age group 25 - 55 years. One hundred and twenty eight were males and the mean (SD) age was 40 - 42 years (+/-10 years). Nearly 40% of employees were obese, 18% were overweight, 31% were with normal body weight, and 10% were underweight. Thirty four percent were hypertensive. Mean (SD) values of BMI, waist circumference (WC), systolic BP, diastolic BP, and RBS were 24.03 kgm-2(+4.29), 81.7 cm (+/-11.88), 128 Hgmm (+/-19.00), 82 Hgmm (+/-13.00) and 118.96 mg/dl (+/-50.24) respectively. There were statistically significant correlations of anthropometric measurements [(BMI; r=0.301, P=0.0001), (WC; r=0.476,p=0.0001), BP (SBP; r=0.367, p=0.0001), (DBP; r=0.198, p=0.001)] and random blood glucose (r=0.232, p=0.001) with their age.

Aims To describe the knowledge, attitudes and practices regarding human rabies and the factors associated with knowledge, among grade ten students in the Nugegoda education division Methods A descriptive cross-sectional study design with multi-stage cluster sampling using probability proportionate to the size of the grade 10 student population was used. A pre-tested, structured, self-administered questionnaire was used to collect data from grade ten students studying in state Type 1AB and Type 1C schools.

Conclusions More than half of the middle aged employees participated in the screening program were having risk of being overweight and obese and hypertensive in this selected group.

Results The majority of students (68.2%) were found to have a poor knowledge regarding rabies. A majority of the dogs (74.9%) had been vaccinated at some point or the other. A majority of students (65.9%) who had experienced dog bites had washed the wound well with soap and running water. In the assessment of attitudes most of the students (78.2%) agreed that the public should have a responsible attitude towards their dogs in-order to control rabies among the dog population.

Having a parent who had completed the G.C.E O/L examination or studied further, attending Type 1 AB schools or schools with a school health club, not fondling stray dogs and cats, vaccinating pet dogs and not having experienced harm by an animal during the past year was found to be significantly associated with a good level of knowledge among the study units.

PP-22 OCCUPATIONAL HAZARDS IN THE CERAMIC INDUSTRY IN THE DISTRICT OF COLOMBO Perera, P.K.D.C., Arnold, S.M. Faculty of Medical Sciences, University of Sri Jayawardanapura dinushacp@yahoo.com Background Ceramic industry has been identified as a hazardous industry by the nature of the industry itself. A multitude of physical, chemical, ergonomic, biological and psychological hazards are seen in the ceramic industry.

Conclusions A majority of students had poor knowledge regarding rabies, although most had correct practices pertaining to the prevention of rabies and favourable attitudes. The study identified factors that could be modified through interventions to improve knowledge on rabies among these students.

Aims To assess selected occupational hazards in the ceramic industry in the district of Colombo Methods A descriptive cross sectional study was conducted in all medium and large scale ceramic factories (n=5) in the Colombo District which consisted a workforce of 1200. Hazards were identified and direct measurements were done in the manufacturing sections of the factories.

Sound level, heat level and light level were measured using standard equipment and classified according to international standards for each category of hazard. Space and ventilation were assessed according to the recommendations of the â&#x20AC;&#x153;Factories Ordinance No 45 of 1942â&#x20AC;? of Sri Lanka. Hazards such as chemicals, dust, machinery safety, vibration, and ergonomics were assessed subjectively using an observational checklist. Dust, improper storage of raw materials and finished products, unguarded transmitters of machines and dangerous parts of the machines were observed in all factories.

PP-21 SECONDARY DATA ANALYSIS FOR ASSESSING OVERWEIGHT, OBESITY AND HYPERTENSION AMONG A GROUP OF SELECTED EMPLOYEES IN KANDY DISTRICT, SRI LANKA Senevirathne, E.M.C.P., Thennakoon, T.M.S.N., Katulanda, P. Diabetes Research Unit, Faculty of Medicine, University of Colombo cpchamil@yahoo.com Background The health of the working population is determined by a number of factors including several modifiable risk factors at the working environment. These can lead to obesity and the risk of noncommunicable diseases such as cancers, diabetes, cardio vascular diseases. Working conditions such as stressful working environment, work load, inadequate leisure time, inadequate physical activities leading to sedentary life and unhealthy dietary patterns are considered as the modifiable risk factors.

Results Space as well as ventilation in all the ceramic factories was identified as adequate. Chemical and ergonomic hazards were present in each factory. Light levels of different sections varied in a range of 45 - 713 lux and inadequate light levels was an identified hazard in all factories. Heat was a common hazard in all the ceramic factories ranging from 801060F. Excessive noise was present in certain sections of each factory and ranged from 79- 87 db which was marginally higher than the recommended level.

Aims To assess of prevalence of obesity, hypertension and diabetes among employees participated in a health promotion and screening program in Kandy District

Conclusions A majority of the selected hazards were present in all the ceramic factories.

Methods The secondary data was collected from a health promotion and screening program conducted for 360 employees of teachers, bus drivers, conductors and office workers in district of Kandy. Height, weight, waist circumference, blood pressure and random blood glucose were the measurements at the screening program. Asian BMI cutoffs

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Results Majority of care givers were unemployed mothers, belonging to 30-39 years age group. Only 15.7% of the care givers had first aid training. A first aid box with basic equipments was available at home of 56.8% injured children. The majority (59.3%) of children was transported within the golden hour and used three wheelers (57%). Although the majority (87.5%) of care givers had access to communication methods, only 21.5% knew the emergency telephone number. The majority (60.5%) of care givers had good knowledge on first aid. Care giver's education level of above or equal to O/L and having first aid training were significantly associated with good knowledge on first aid (p<0.05). Having first aid training of the care giver was significantly associated with the correct practice for bleeding wound, contusion and fractures (p<0.05).

Availability of first aid box with basic equipments and use of suitable vehicle to transport the child were significantly associated with care giver education level >O/L and child belonging to upper social class (p<0.05).

PP-23 DENTAL CARIES AMONG PREGNANT MOTHERS: A CROSS SECTIONAL STUDY ON DISEASE BURDEN AMONG ANTENATAL MOTHERS IN DIVULAPITIYA MOH AREA Karunachandra, K.N.N.1, Herath, L.2, Perera, I.R.1 Community Dental Unit, Dental Institute, Colombo, 2Department of Community Dentistry, Faculty of Dental Sciences, University of Peradeniyankarunachandra@gmail.com 1

Background Oral health is considered as an important aspect of general health. It is evident from the literature that pregnancy could have an impact on oral health as well as oral health status could affect pregnancy related conditions. Dental caries is one of the most common dental diseases worldwide and this fact is also true for Sri Lanka. There is a well organized maternal and child health program in Sri Lanka and oral health care has recently been incorporated into that.

Conclusions There is high proportion of pre hospital care givers who lack knowledge on first aid.

Aims This study aims to identify dental caries disease burden in of antenatal women relation to socio-demographic characteristics in a selected MOH area

PP-25 DESIRED CHARACTERISTICS FOR PSYCHOMETRIC INSTRUMENTS BY THE ELDERLY POPULATION IN SRI LANKA

Methods A descriptive cross sectional study was conducted in the Divulapitiya MOH area from a sample of 459 pregnant women in their second trimester. The data were collected by means of an oral examination according to WHO basic methods and a pre-tested interviewer administered questionnaire to gather socio-demographic data.

De Silva, S.H.P., de Silva, A.P., Ramachandra, R.B.B.S., de Silva, A., Rajapaksa, L.C. University of La-Trobe, Australia padmaldes@gmail.com Background Sri Lanka has one of the fastest aging populations in the world with 2.5 million (12.2%) in 2011, which is expected to increase up to 6.1 million (28.8%) by 2051. Many studies are binge conducted and more research in to this age group is anticipated in the future. Perceptions of the elderly population on the nature of the instrument and scales of measurement preferred by them in measuring psychometric properties have not been documented for the Sri Lankan population.

Results Dental caries prevalence of the sample was 92%. Mean DMFT was 5.4 (SD= 3.0). Prevalence of decayed teeth was 75% and the mean number of active caries was 2.2 (SD=2.3). Prevalence missing and filled teeth were 40% and 64% respectively. Mean and SD of missing and filled teeth were 1.2 (SD= 2.0) and 2.0 (SD= 1.9) respectively. DMFT value was significantly associated with age, education level and income level.

Seventy five percent of the sample needed some kind of treatment for dental caries.

Aims The aims of this study was to identify the most desired characteristics for a survey tool / instrument to measure psychometric variables from the young elderly population in Sri Lanka.

Conclusions Findings of this study reveals high dental caries burden among antenatal women.

Methods Focused group discussions (FGD) were conducted with 35 participants comprising of four groups: “well” elderly group, “un-well” elderly group, “care provider group” and “health professional group”, were conducted as a component of a larger study to determine client preferences.

Different administrative modalities, different types of question formats, different scales of measurement such as: nominal, ordinal, interval, visual analogue scales, those having stylized presentation of human faces depicting emotions (smiles), as well as different recall periods were discussed to identify preferred characteristics such as mode of administration, length of the questionnaire, preferred recall period, language and wording, the response scale for the instrument. The discussions were conducted by the principle investigator using preestablished methods.

PP-24 PRE-HOSPITAL CARE RECEIVED BY INJURED CHILDREN LESS THAN FIVE YEARS ADMITTED TO LADY RIDGEWAY HOSPITAL Gunawardhana, Y.A.G.K., Goonewardena, C.S.E., Wijayasiri, W.A.A. Ministry of Health, Sri Lanka gayanikau@gmail.com Background Childhood injuries are a growing problem all over the world. Pre-hospital care plays a major role in preventing death and disabilities due to injuries.

Aims To describe the pre-hospital care received by injured children less than five years admitted to the Lady Ridgeway Hospital and associated factors for injuries

Results Thirty five participants took part in these FGDs. The groups agreed that questionnaires were the preferred tool for data collection and the two elderly groups had preferred questionnaires without mental activates.

Interviewer- administered tools were preferred to self-administered tools due to problems of vision and problems of reading written language and common consensus was that the tool should be simple, preferably in the mother language and should not take more than 30 minutes. A five point ordinal scale with worded explanations was preferred over Visual Analogue Scales, 1 – 5 interval scales, 1 – 10 interval scales, smiles (faces depicting emotions) and colour spectrum scales and the preferred recall period was two weeks.

Methods A hospital based descriptive cross sectional study was carried out at the Lady Ridgeway Hospital accident ward. A sample of 400 pairs consisting of a pre-hospital care giver and child were recruited using the consecutive sampling method. A pre-tested, interviewer administered questionnaire was used to collect the data.

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services for non-communicable diseases including pap smear services too. National program had set up a target to reach 80% coverage of women in the target group. But in many parts of the country public health services are struggling to achieve that target. An innovative approach is warranted to reach working women.

Conclusions Different characteristics used in research instruments have different level of preference among the elderly population. Using elderly population preferred characteristic in elderly population research instruments will facilitate greater compliance and accuracy.

Aims To improve the utilization of WWC by women at 35 years to achieve the target coverage by conducting outreach programs in Medical officer of health (MOH) area, Imaduwa, Galle District

PP-26 HEALTH PROMOTION STRATEGIES FOR DEVELOPING LIFE SKILLS TO FIGHT AGAINST HIV/AIDS AMONG SCHOOL CHILDREN

Methods Six work places were identified and an action plan was prepared during monthly conference of MOH. As the first step factory management was advocated regarding the benefits of the program to the work place. Then MOH staff visited each factory and addressed the female workers on importance of undergoing WWC screening. Target women were short listed with the support of management and dates were fixed. Outreach clinics were conducted for each work place with the contribution of MOH staff. A remarkable enthusiasm was showed by factory management and an overwhelming participation was received. Many factories requested to conduct similar programmes.

Vidanapathirana, J., Nanayakkara, S., Samaraweera, G. STI/AIDS Control Programme, Colombo kavigaya@yahoo.com Background Sri Lankan schools setup makes every effort to improve well-being of school children. One aims is to develop life skills to promote sexual wellbeing. Advocacy, skill building of education officer and school teachers were carried out using health promotion strategies with participatory approach. Health promoting schools were established and concept were introduced to achieve in which the school community for developing life skills.

Results During the year 2012, 6 programs were conducted successfully. 87 women at 35 years of age from Imaduwa MOH area attended those programs and WWC coverage had increased from 34.6% to 68.3% within the year (with 222 women who were screened in clinics). It was a statistically significant increase (p < 0.05).

Aims To assess the usefulness of Health promotion strategies for developing life skills to fight against HIV/AIDS among school children Methods Audit and check list methods were used to assess the application of some health promotion strategies. Altogether 20 pre and post focus group discussions (FGDs) were conducted, with school teachers before and after establishing the health promoting schools to assess the knowledge on HIV/AIDS. Content analysis was used. A quantitative post intervention survey was carried out to assess knowledge and attitudes among school children using a scientific sampling technique in three consecutive years.

Conclusions Outreach programs targeting working women will help improving the coverage of WWCs hence achieving the target level.

PP-28 PHYSICAL ACTIVITY, QUALITY OF DIET AND PSYCHOSOCIAL STRESS AMONG POSTPARTUM MOTHERS IN BIYAGAMA AND KELANIYA MEDICAL OFFICER OF HEALTH AREAS

Results Audit and check list methods revealed that more than 80% of schools were implemented health promotion strategies in related to HIV/AIDS prevention by adopting various strategies including the relevant policies.

FGDs revealed that the majority of teachers had poor knowledge on transmission and prevention of HIV/AIDS and post intervention FGDs revealed that majority had improved the knowledge up to satisfactory level on transmission and prevention. Quantitative survey among school children showed more than 80% of school children ranked the knowledge on transmission, prevention and misconception of HIV/AIDS during year 2009 and 90% and 86% in year 2010 and 2012 respectively.

Perera, M.G.S.N.S., Abeysena, C. Ministry of Health, Sri Lanka, University of Kelaniya perera.subha@yahoo.com Background Behaviors like physical activity, diet and psychosocial stress in postpartum mothers places a woman at risk of developing over weight and obesity in later life.

Aims To describe the physical activity, quality of diet and psychosocial stress among mothers at six months post-partum, who attended child welfare clinics in Biyagama and Kelaniya Medical Officer of Health areas.

Conclusions Skill based education via school teachers is a successful Methods to improve knowledge and attitude among school children on HIV prevention. Health promotion strategies were useful for developing life skills to fight against HIV/AIDS among school children.

Methods This was a clinic based descriptive cross sectional study, conducted from August to October in 2012 among 387 consecutive attendees.

International Physical Activity Questionnaire (IPAQ) was used to measure physical activity, while quality of diet was measured with food frequency questionnaire. General Health Questionnaire (GHQ 12) was used to measure psychological distress. Presence of psychological distress was indicated by >2 score. Results were expressed as median, interquartile range (IQR), percentages, and 95% confidence intervals (CI).

PP-27 AN OUTREACH PROGRAM TO IMPROVE WELL WOMEN CLINIC COVERAGE: A SUCCESS STORY FROM MEDICAL OFFICER OF HEALTH AREA, IMADUWA Chandrasiri , P.A.A., Mahindasiri, K.V.P., Nandani, W.D. Medical Officer of Health Office, Imaduwa amilachan@yahoo.com

Results Median total physical activity was 1,087 (IQR 240 - 1836) MET (Metabolic Equivalents of Task) minutes per week. Physical activity level was Low in 38.8% (95% CI 34 - 44%) of mothers. Quality of diet was poor in 92.5% (95% CI 89.7 -95.3 %) of mothers while excess consumption of

Background Well women clinics (WWC) provide an important opportunity for women at and above 35 years of age to improve their health. It offers screening

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vegetable was 48.6%(n= 169), fruits 33.9% ( n= 125), milk 72% (n= 254), egg 56.7% ( n= 102), whole grain 47.7%(n=89), pulse 16.8% (n= 31), red meat 37.7% (n= 139), commercially baked food 41.1% ( n= 151), deep fried foods 19.4% (n= 72) and sweets 1.6% (n= 6). Fifty nine point three percent (N= 213) consumed > 1 Snack/day. GHQ score >2 was observed in 17.8 % (95% CI 8.8 - 26.8 %).

PP-30 CHANGING PERCEPTIONS ON SAFE AND UNSAFE, SEXUAL PRACTICES AMONG THREE-WHEELER DRIVERS IN SELECTED THREE-WHEELER PARKS IN ANURADHAPURA TOWN AREA IN SRI LANKA THROUGH A HEALTH PROMOTION APPROACH Pallewaththa, P. W. P. W. K., Fernando, W.M.S., Duminda, G.G.N. Faculty of Medicine, University of Rajarata vpvijihp@gmail.com

Conclusions Physical activity level was low in 38.8%. A majority of mothers had a poor quality diet, consumed milk in excess and consumed one or more than Snack/day. Psychological distress was observed in 17.8% of mothers.

Background In the world, the highest prevalence of 48 million of Sexually Transmitted Infections (STI) has been reported from the region of South and South East Asia. In Sri Lanka, annually estimated STI cases exceed 60,000 and three-wheeler drivers are identified as an inter-mediate risk group.

Also, the number of reported STI cases is significantly higher in Anuradhapura District, compared to the rest of the country. Therefore, this study focuses on a Health Promotion approach to address perceptions on sexual practices.

PP-29 EFFECTIVENESS OF HEALTH PROMOTION APPROACH IN IMPROVING WEIGHT GAIN UNDER FIVE YEAR OLD CHILDREN IN KUNCHIKULAMA VILLAGE OF MIHINTALE MOH AREA Bhagya, B.L.G.U., Jayathilaka, I., Lakmali, T.M.I., Punchihewa, C.M., Shivakumar, Y., Kumarathunga, H., Guruge, D., Fernando, M. Faculty of Medicine, University of Rajarata upuli.bhagya@yahoo.com

Aims Aims was to change perceptions on safe and unsafe, sexual practices among three-wheeler drivers in Anuradhapura town.

Background Nutrition and stimulation given to a child through the five sensory organs place a key role in their psycho-social and physical development. The crucial period of psycho-social and growth and development is below the age of five years. Caregivers' enthusiasm towards the facilitating stimulations and nutrition influence the development of the child. Health promotion means implementing actions that positively impact on the health of communities and populations generally. Community health promotion is a comprehensive, systematic, coordinated approach affecting a long-term health behavior change by influencing the community norms through education and community organization.

Based on that approach the present intervention program was launched for improving physical status and the psycho-social status of children via improving caregivers' enthusiasm towards giving stimulations and nutrition while addressing obstacles.

Methods Quasi-experimental design was used for the study. Intervention group (N=50) and control group (N=44) were recruited from selected settings in Anuradapura and Polonnaruwa towns, respectively under the means of similar socio-economic background. According to the logical framework at the beginning, experimental group was facilitated to create action groups, and ownership was consigned to them. They were facilitated to generate the need for improving individual and family wellbeing and later on sexual well-being. They were strengthened to identify and analyze perceptions on safe and unsafe sexual practices as a determinant factor of sexual well-being. Mechanisms were created to address the perceptions and to measure the change of perceptions. It was consisted of participatory discussions, facilitated with innovative tools. Resultantly, active members were enabled to intervene and measure the changes of perceptions of other members. Data were analyzed using Willcoxon and Mann-Whitney U tests.

Aims Improve weight gain of under five year old children in Kunchikulama village within 6 months from the health promotion approach

Results Thirteen perceptions out of selected seventeen perceptions have been changed significantly in the intervention group and eight perceptions on safe and unsafe sexual practices have been changed significantly in the intervention group, compared to the control group (p<0.05).

Methods The intervention was carried out during a period of six months in Kunchikulama village for selected 12 caregivers of children less than five years. Selected caregivers were categorized by child's age.Mothers' club were established by their own consent in the village.

They were aware of the theoretical relationships among stimulations, brain development and growth. The interventions was carried out using set of tools, and as monitoring tools a book to write five senses feedings and a book to write foods given to child and as intervention tool by making baby rooms. Implementation of these interventions met with few obstacles.In addressing obstacles ” five senses feeding book” was replaced with a “brain development charts”, “nutrition feeding book” was replaced with a “food chart” and “baby room” was replaced with a “baby umbrella”.

Conclusion Health Promotion interventions to change perceptions related to safe and unsafe sexual practices among this particular community are effective.

PP-31 HOUSEHOLD SURVEY TO IDENTIFY PERSONS WITH LEPROSY IN TAMBAPANNI AREA IN PUTTALAM DISTRICT, SRI LANKA Dabrera, T.M.E., Sumanaweera, R.A., Kasthuriaratchi, N.D., Ratnayake, R.M.S.K., Ranjith, K.H.A.P. Regional Director of Health Services, Puttlam thushanidabrera@yahoo.com

Results According to the results after six months, 83% of children showed improvement in their growth in the sample. There are 12 baby rooms, five baby umbrellas and one nutrition feeding book, three food charts were created in the village. .

Conclusions The provision of stimulation and nutrition through health promotion approach, interventions implemented with caregivers was effective to improve the weight gain of children under 5 years in Kunchikulama.

Background Hansen's disease (Leprosy) is a chronic debilitating disease. Inspection of routinely generated reports of notification system indicated increase number of new leprosy cases reported from Medical Officer of Health areas of Puttlam. The high incidence of cases could be localized to the Thambapanni area; a location with internally displaced personnel (IDP).

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physical strength, clarity of complexion and perception of sense organs.

It is concluded that consumption of food as recommended in Ayurveda can prevent diseases and promote longevity.

Aims To identify new cases of leprosy, contacts and to provide appropriate management to identified patients in Thambapanni area Methods A household survey was conducted in 166 households in the Thambapanni area by a designated team. The team comprised of one pre-intern medical officer, a Public Health Inspector, a Public Health Midwife and two female volunteers from the community. Intervieweradministered questionnaire and a clinical examination sheet were used for data collection. Full skin examination was done for detection of leprosy lesions. Patients with confirmed diagnosis were issued the first pack of MDT and referred to the Dermatology clinic at Puttlam Hospital for follow up. Others in whom the diagnosis could not be confirmed too were referred to the Dermatology clinic.

PP-33 VALIDATION OF SINHALA VERSION OF ARTHRITIS IMPACT MEASUREMENT SCALE 2-SHORT FORM (AIMS2-SF) FOR QUALITY OF LIFE ASSESSMENT OF RHEUMATOID ARTHRITIS PATIENTS Basnayake, A.C.M., Pathmeshwaran, A., Panangala, H.B.A.G.L., Munidasa, D., Karunapema, R. P.P Ministry of Health, Sri Lanka and University of Kelaniya anomamb@gmail.com Background Being a chronic progressive disabling disease, rheumatoid arthritis has a great impact on patients' Health Related Quality of Life (HRQL). The availability of a validated disease specific tool to assess the HRQL will be of benefit for clinical practice and research. Therefore, we have translated and validated Sinhala version of the AIMS2-SF.

Results Full skin examination was done in 939 people and 53 (7.5%) had leprosy. There were15 children below 15 years of age. The majority of the patients were females. However 165 people who were expected to be residents were not available for examination at the field survey (majority of them were males).Out of the patients detected, only one patient had a grade 2 disability. Only one case of Multi Bacillary Leprosy was found. At least one leprosy patient was detected in 20% of the households while 5% of the households had more than one patient. One adult and a child were reported to be affected in 3.6% of the households.

Aims To determine the reliability and validity of the Sinhala version of AIMS2SF for assessment of quality of life among Sri Lankan rheumatoid arthritis (RA) patients

Conclusions Leprosy which is a low infectious disease could reach “epidemic” proportions in vulnerable populations.

Methods One hundred and forty six rheumatoid arthritis patients seeking care at clinics in a specialized hospital were recruited to the study. Cultural and linguistic adaptation was done and the validity of translation was checked using forward – backward translation Methods, with review by expert panel and pretesting among 20 RA patients. Randomly selected 31 RA patients who re-visited the clinic within 10-14 days were assessed by re-administering the questionnaire for test –retest reliability.

PP-32 POSITIVE HEALTH THROUGH AYURVEDA DIETETICS Ranasinghe, R.L.D.S., Ediriweera, E.R.H.S.S. Institute of Indigenous Medicine, Kaduwela rlsandu@gmail.com

Results Mean age of the study sample was 53 years and 94.5% of it was females.

All 26 Items correlated more strongly with its own domain than with the other domains and the correlations were statistically significant (p < 0.05). Internal consistency assessment was good in all domains with Chronbach's alpha over 0.7 except for symptom domain (Chronbach's alpha of 0.62). Moderate to high correlations (r = 0.44 to 0.82) were found between relevant domains of AIMS2-SF and the SF-36 except for social interaction domain (r = 0.264). Pearson 'r' correlation coefficients of repeat scores in all domains exceeded 0.8 showing excellent test retest reliability.

According to Ayurveda, healthy life is primarily dependent on three fundamental activities called “Thrayah Upasthambha”namely Ahara (BalancedDiet), Nidra (Sound sleep) and Brahmacharya (Balanced sexual life). Ahara (Food) is a major contributing factor in it. Food is the most important source of energy which enables the human body to perform the biological functions. In discipline and carelessness of the modern day dietary regimen motivated us to focus this subject. This work is an effort towards creating awareness on importance of food in maintaining health. In Ayurveda it is mentioned that food sustains the living beings and all living beings in the universe require food. Food is divided into several categories according to their Rasa (Taste), Udbhava sthana (Sources), Varga sangraha (Types of food), Guru laghu bheda (Digestibility) and Prayoga vidhi (way of consuming). Further, Ayurveda describes “Ashta Ahara vidhi visheshayatana”• (Eight factors in the dietary regimen) which provides specific guidelines for deciding an ideal diet. They are Prakriti (Natural qualities), Karana (Preparation), Samyoga (Combination), Rashi (Quantum), Desha (Place of origin), Kala (Time of procurement and eating), Upayoga (Procedure of use) and Upayokta (Consumer). According to Ayurveda, a well balanced diet should consist of food which contains all of the six Rasas (Shad-rasa).

For proper maintenance of positive health one should consume proper quantity of food. This quantity depends upon Guru laghu bheda, Agni (Digestive capacity), Prakrit (Constitution), Desha (Environmental conditions), Deha Bala (Strength) and Vayah (Age) of the consumer.

Another excellent concept in Ayurveda is “Viruddha Ahara”• (Incompatible food combinations) which may act as toxins upon the body. Some oils and spices are mentioned in Ayurveda as “Ahara Yogi”• (Food additives) which make all the food items delicious as well as nutritious. Food gives Varna (complexion), Prasada (Clarity), Sausvarya (Good voice), Ayu (Longevity), Prathibha (Geniuses), Sukha (Happiness), Thusti (Satisfaction), Pushti (Nourishment), Bala (Strength) and Medha (Intellect). Proper diet promotes mental as well as

Conclusions Sinhala version of AIMS2-SF has reasonably good convergent and discriminant validity, internal consistency, and excellent test-retest reliability. It can be used to evaluate the quality of life in rheumatoid arthritis patients and to apply in future outcome studies.

PP-34 THE OCCUPATIONAL FACTORS ASSOCIATED WITH BURNOUT SUBTYPES AMONG POLICE OFFICERS IN THE KANDY POLICE DIVISION Wickramasinghe, W.A.N.D., Wijesinghe, P.R. Faculty of Medicine, University of Rajarata nuwick74@yahoo.com Background Burnout has been extensively explored among a wide range of occupations across the globe. Even though policing has been identified as an essential human service profession involving very high levels of occupational stress and burnout, no studies have been conducted to identify burnout subtypes among police officers globally.

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perception that breast feeding is sufficient for initial months (61.90%).

Majority of the term mothers had fed within 1 hour of delivery (73.4%) and most common reason for not feeding within 30 minutes was fatigability (69.7%) followed by separation of the baby (17.5%). Minority of the late preterm mothers had fed within 1 hour of delivery (43.9%) and most common reason for not feeding within 30 minutes was separation of the baby (76.1%) followed by health professionals advice not to breastfeed due to medical reasons of the baby (13.9%). Late preterm infants were less likely to be discharged exclusively breastfeeding from hospital (13.4%) compared to term infants (6.7%).

Aims To determine the occupational factors associated with burnout subtypes among police officers in the Kandy Police Division Methods A cross sectional study was conducted among 495 randomly selected police officers in the Kandy Police Division. A self administered questionnaire including â&#x20AC;&#x153;Burnout Clinical Sub-type Questionnaireâ&#x20AC;? was used to assess the burnout sub-types. The degree of association between variables was assessed using adjusted odds ratio obtained from multivariate logistic regression models.

Conclusion A late preterm birth is predictive of breastfeeding failure with late preterm infants at greater risk of not initiating breastfeeding and/or exclusively breastfeeding at hospital discharge, compared with those infants born at term.

Results The response rate was 100%.The mean age of the sample was 41.1years (SD=9.3years). Among the police officers, 17.6% (n=87) were gazetted officers. Gazetted police officers were predisposed (Adjusted Odds Ratio {AOR}=1.8; 95% CI = 1.1-3.0; p= 0.02) to frenetic subtype as opposed to non-gazetted officers while, those working in ASP Kandy I district were less likely (AOR=0.6; 95% CI = 0.4-1.0; p=0.03) to have frenetic subtype than those in other police districts. Service experience of less than 20 years was found to be a significant factor predisposing for under challenged subtype (AOR = 1.8; 95% CI = 1.1-2.9; p=0.02).

Satisfactory infrastructure facilities (AOR = 0.4; 95% CI = 0.2-0.6; p<0.001) and overall job satisfaction (AOR = 0.4; 95% CI = 0.2-0.8; p=0.01) emerged as statistically significant negative associations with under challenged subtype. Perceived satisfaction on staff adequacy (AOR = 0.5; 95% CI = 0.3-0.9; p=0.03), more frequent superior guidance (AOR = 0.5; 95% CI = 0.3-0.9; p=0.01) and satisfactory support from higher rank officers (AOR = 0.3; 95% CI=0.2-0.6; p=0.001) revealed significant negative associations with worn-out subtype.

PP-36 A COMMUNITY BASED HEALTH PROMOTION INTERVENTION TO REDUCE FAMILY ACCEPTANCE OF GENDER ROLES IN MEDAWACHCHIYA MOH AREA IN SRI LANKA Herath, H.M.T.P., Duminda, G.G.N., Fernando, W.M.S. Faculty of Medicine, University of Rajarata herathhmtp@gmail.com BackgroundJustifications for violence frequently evolve from gender norms. Family and relationships are one of the key determinants of gender based violence. Therefore family acceptance on gender roles on this regard is important. The Health promotion approach used in this study works through concrete and effective community actions.

Conclusions Different occupational factors emerged as significant predictors for different burnout subtypes. Owing to the modifiable nature of many of them, it is recommended to design a package of interventions to prevent burnout subtypes among police officers.

Aims to assess the effectiveness of health promotion approach in changing the acceptance of gender roles among families in a rural community.

PP-35 FACTORS ASSOCIATED WITH INITIATION OF BREASTFEEDING AT HOSPITAL DISCHARGE: LATE PRETERM COMPARED TO TERM INFANT AND MOTHER PAIRS

Methods A quasi experimental study was conducted. Two communities with similar socio demographic backgrounds were selected with appropriate distance to overcome cross contamination. The intervention and control group consisted of 40 and 32 families who participated at the selected village weighing center respectively. Both groups were selected by using simple random sampling method. Intervention was delivered to the families through the women groups created at the weighing center.

Women groups were empowered targeting their skills to address the consequences of gender norms and determinants of continuation of gender norms among families. Interactive discussions and role plays were conducted with the women groups focusing on 6 selected gender norms by using concepts of gender based violence, family happiness and child well being. Pre and post data were collected using interviewer administered questionnaires in both groups. A random number for each family was generated to collect the data. Data was analyzed using SPSS 20 statistical package.

Pathiratne P.A.S.R. Family Planning Association, Sri Lanka asankap33@yahoo.com.au Background Early initiation of breastfeeding (within the first hour) provides benefits for infant and mother. Despite its benefits, many women delay initiation of breastfeeding. Only 39 percent of newborns in developing countries are put to the breast within one hour of birth.

Aims To investigate and examine the factors associated with initiation of breastfeeding of, late preterm (340/7-366/7weeks) compared to Term (370/7-396/7week) mother and baby pairs.

Results Family acceptance on 5 out of 6 gender norms was significantly reduced in the intervention group with a P value < 0.05 by comparing post evaluation results in the intervention group with the post evaluation results in the control group according to the Mann Whitney U test.

Methods A cross sectional study was carried out between 1 October 2012 and 30 January 2013. A total of 53 women with Late preterm infants and 109 women with term infants were compared in relation to initiation of breast feeding in two primary care hospitals in Colombo, Sri Lanka. They were randomly selected and interviewed using a pretested semi structured questionnaire.

Conclusion Health promotion intervention that consisted of a community level active groups who were strengthened to address gender norms are effective in changing the gender norms.

Results The mean age of the mothers who delivered at the hospital was 27years.Majority were Buddhists (68.0%) and had received secondary education (53.6%) and were house wives (48.5%). Majority (81.2%) were with an income of less than 20000LKR. Primi parous mothers accounted for 71.4% of cases. Majority of the mothers had the

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Methods It is a descriptive cross sectional study. The study comprised of two components. In component one the level of food hygiene was assessed.

For the first component 123 school canteens were studied using an observational check list. In component two the knowledge, attitudes and practices of food handlers were assessed using interviewer administered questionnaire and by direct observation.

PP-37 A COMMUNITY BASED HEALTH PROMOTION INTERVENTION IN CHANGING THE IMAGE OF ALCOHOL AMONG STUDENTS IN A GOVERNMENT SCHOOL IN NORTH WESTERN PROVINCE Jayarathna, J.E.M.S.S., Fernando, W.M.S., Duminda, G.G.N. Plan Sri Lanka ssjayarathna@gmail.com

Results The study of first component demonstrated that the level of food hygiene was satisfactory in 41.1 % of canteens in government schools and 83.3% in semi government and private schools. The environmental sanitation was satisfactory in 12.6% of canteens in government schools and 91.7% in semi government and private schools. Only 69.1% of canteens had water supply. In the second component the study demonstrated that almost half (55.8%) of the food handlers only had good knowledge regarding food hygiene and food borne diseases. The knowledge of food borne was rather inadequate. Only 23.1% of food handlers knew about school canteen policy. Almost all the food handlers had favourable attitudes towards food hygiene, personal hygiene and selling a safe food. But one-fifth of food handlers had unfavourable attitudes towards leaning about food hygiene. The practices were poor among 63.3% of food handlers. Only 32.7% have been educated on food safety. Large majority of food handlers were serving food bare handedly. Only 8%of food handlers used to wash hands with detergents before handling the food.

Background The attractive image given to alcohol is a key attraction which drives adolescents to experiment alcohol consumption in their early ages. Most of the adolescents in Sri Lanka initiate their alcohol experience at 16-20 ages. Hence, school is the most important setting to conduct interventions to delay the age of initial alcohol consumption. Health promotion is a proven approach which enabling people to increase control over the determinants of their health.

Aims The Aims of this study was to assess the effects of a Health promotion intervention in changing the attractive image on alcohol among students.

Method An interventional study was conducted in two government schools in 2 different educational divisions in Anuradhapura & Polonnaruwa districts.

The region of these intervention and control groups and the groups itself were comparable in their socio demographic characteristics. Simple random sampling was used to select the schools. The intervention and control group consisted with 35 and 32 students in grade 11 classes respectively. The intervention was conducted focusing on developing skills of the students to challenge 10 selected norms which contribute to the attractive image on alcohol. A pre-tested interviewer administered questionnaire and a focus group discussion were used for the data collection in both groups. Data were analyzed by using SPSS 16 statistical software.

Conclusions Either knowledge or practices were significantly associated with age, sex, educational level or experience the work. All the canteens were supervised by both PHII and school administrations. The frequency of supervisions by PHII is not adequate. No canteens had H- 800 forms.

The food handlers have to be registered, educated and certificated.

PP-39 IMPACT OF INTRODUCING IYCF PRACTICES AT THE COMPLETION OF 5 MONTHS TO PREVENT INFANT MALNUTRITION

Results Acceptance on 6 out of 10 norms effecting on students image towards alcohol were significantly changed in the intervention group (p< 0.05). It was shown by the qualitative analysis of this study that students in the intervention group had begun informal activities to challenge norms on attractive image within their school.

Wijethunga, T.S., Attygalle, D., Senevirathne, A., Jayakody, H. Medical Officer of Health Office, Kothmale gayathri_hj@yahoo.com Introduction Prevention of malnutrition in infancy is a prime public health necessity.

Infant and Young Child Feeding guideline was introduced to Sri Lanka in 2007 and field public health staff uses it to educate mothers. Despite the fact of widespread use, there is high prevalence of under nutrition in this age group. With the inspiration we got from the model practiced at Hambanthota District, a targeted, practically approached and participatory based health education programme which utilizes IYCF guideline was developed and currently being practiced in Kothmale and Nawathispane MOH areas in Nuwaraeliya District.

Conclusions Health Promotion intervention that consists of challenging norms of attractive image on alcohol is effective in reducing the attractive image of alcohol among students in grade 11 in schools.

PP-38 KNOWLEDGE, ATTITUDES AND PRACTICES ON FOOD HYGIENE IN SCHOOL CANTEENS IN COLOMBO MUNICIPAL AREA Subaskaran S., Balasuriya A. Family Health Bureau saseelasubash@yahoo.com

Aims To reduce infant under-nutrition by introducing IYCF practice guidelines to mothers of 5 months old infants

Background The term â&#x20AC;&#x153;food hygieneâ&#x20AC;? has been defined as all conditions and measures that are necessary during production, processing, storage, distribution and preparation of food to ensure that it is safe, sound and wholesome and fit for human consumption.

Methods Target population for the intervention was mothers of five months old infants. The programmes were conducted monthly at 16 centres in both languages in both MOH areas. Health education programme was prepared and PHMM were trained on conducting the programme in a standardized manner. A written set of guidelines on presentation, food demonstrations and role play were given. Close supervision was maintained. The time frame concerned for evaluation is from March 2012 to December 2012. The programme was evaluated for participation and the impact. Latter was conducted by following up of 350 infants for 6 months and comparing the weight at the age of 1 year, among participated and non participated groups.

Aims Study was carried out to describe the level of food hygiene and the knowledge, attitudes and practices of food handlers in school canteens in Colombo Municipal Council area.

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Results With the analysis of exposure data for the programme there is a significant difference of infant underweight during the post programme follow up period. Infant underweight reduction according to Management Information System data was 3% from January to November 2012. A total of 350 infants were followed up for 6 months. Of them 16% of growth faltering was detected among non participants (CI 95%, p= 2.89) with opposed to 6% among participants.

Background Proper feeding during infancy and young childhood is crucial for growth and development of children. It is recommended that infants be exclusively breastfed for the first six months and thereafter to receive proper complementary foods in addition until two years or beyond. At grassroot level the PHM is responsible for strengthening proper IYCF. Research findings are scarce on attitudes of PHMM in Sri Lanka on IYCF counseling.

Conclusions With the convincing results, the community enthusiasm on participation has improved. The evaluation process is continued up to 18 months of follow up.

Aim To explore the attitudes of PHMM in Colombo District on IYCF Methods A cross sectional study was done with 348 PHMM in Colombo District .A self-administered questionnaire with 10 attitudinal questions with a likert scale ranging from “strongly disagree” to “strongly agree”• was used to collect data. The questions explored the attitudes in relation to various aspects of IYCF.

PP-40 Computerized data monitoring and evaluation system to improve nutritional surveillance Wijethunga, T.S., Senevirathne, K., Senevirathne, A., Jayakody, H. Regional Director of Health Services' Office, Nuwara Elliya thilinawijetunga@yahoo.com

Results More than 80% of PHMM had unfavorable attitudes for formula feeding in relation to maternal satisfaction and convenience. More than 90% believed that there is a necessity to improve current complimentary feeding practices. Only 18.6% agreed and 75.6% were neutral on whether complimentary feeding can be improved by proper counseling.

Only 15.2% and 58% were in favor of feasibility of dietary counseling at weighing-posts and at home-visits. Only 20.7% perceived that in-service training is essential for IYCF.

Background Nutritional deficiencies are prevalent in Nuwaraeliya District and various nutrition programmes are underway to rectify it. Due to inefficient monitoring, the objectives of those programmes are hardly achieved.

Currently established paper based monitoring systems have the following limitations: less focus on outcome indicators, minimum attention is paid to an individual, minor changes in weight gain are not appreciated and nutritional interventions on individual children are not discussed. To address above, a color coded and computer based surveillance system is adopted and currently in use with the multisectoral nutrition programme with the support of UNICEF.

Conclusions Majority of PHMM had favorable attitudes on the importance of proper IYCF. Most were neutral on the role of counseling in improving complimentary feeding and believed that there is lack of time for it.

Around one fifth identified the necessity of getting updates on IYCF. PHMM training programs should inculcate favorable attitudes on dietary counseling and getting the knowledge updated. PHMM duty lists must be re-evaluated as they may give less priority to IYCF counseling.

Aims To introduce a simple but comprehensive surveillance system to monitor and evaluate nutritional programmes Methods A Nutrition book was introduced to PHMM into which they include all their target population of the programme with basic information. There is a color coded system introduced to mark the weight gain. Basic information on family status, nutritional interventions and other sector interventions are recorded in the row of the each child. This book was updated monthly and sent to the MOH. At the MOH, all these information is entered into specially designed software. At the MOH, data is easily summarized PHM area wise and the progress is discussed. Also each child's progression can be individually assessed and discussed. With the multi sectoral nutrition programme this data is also being shared with other sectors to review the divisional level progress.

PP-42 EARLY AND RAPID DETECTION OF DENGUE AND CHIKUNGUNYA VIRUSES IN FEVER PATIENTS BY REVERSE TRANSCRIPTION POLYMERASE CHAIN REACTION (RT-PCR) DURING THE RECENT EPIDEMICS 2008-2009 IN SRI LANKA Kuruppuarachchi, K.G.R., Perera, M.G.A.N., Gunasena, S., Ramesh, R. Medical Research Institute, Sri Lanka kgrkuruppuarachchi@gmail.com Background Dengue and Chikungunya are the most common vector born viral diseases of humans. According to the WHO, 37667 chikungunya cases were reported from Sri Lanka during 2001-2007. Sri Lanka has been affected by dengue for over two decades now and dengue epidemics are becoming more regular with the number of cases rising with each epidemic. Since complications of Dengue can be potentially fatal, differential diagnosis of these two infections is essential for clinical management, prevention & control. RT-PCR has provided most adaptable method, which offers rapid, highly sensitive, specific and low cost to confirm the diagnosis of dengue and chikungunya as etiological agents.

Results Currently this nutritional surveillance system is practiced at 11 MOOH in Nuwaraeliya to monitor and evaluate multisectoral nutrition programme.

The outcome indicators are routinely discussed at monthly conferences in the MOH. Conclusions Although there are few limitations in the system, this surveillance system is a useful tool to evaluate progress of nutrition programmes.

Aims To find the causative viral agent/agents responsible for the epidemic 2008/2009

PP-41 ATTITUDES OF PUBLIC HEALTH MIDWIVES (PHMM) IN COLOMBO DISTRICT ON INFANT AND YOUNG CHILD FEEDING (IYCF)

Methods Sample collection Department of Virology, Medical Research Institute (MRI), Colombo, received peripheral venous blood samples from suspected patients for diagnosis of dengue and chikungunya during the outbreak period. Samples were sent from clinics, military camps and

Nanayakkkara, I.O.K.K., Godakandage, S.S.P. Ministry of Health, Sri Lanka drkumudu@yahoo.com

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Conclusions Oral Health promotion is a broader perspective, where health and nonhealth categories can be involved to promote oral health of children oral health of preschool children can be promoted with the concept of Oral Health Promotion.

hospitals in different parts of the island. Samples collected within 1 -4 days of fever, sent to the department of molecular biology, MRI for molecular diagnosis of dengue and chikungunya were included in this study. Viral RNA extraction and RT-PCR Sera were separated from blood samples and viral RNA was extracted from serum using silica. RTPCR was done according to the Methods of Hasebe et.al with modifications.

PP-44 THE INCIDENCE AND RISK FACTORS OF LOW BIRTH WEIGHT AMONG 1535 LIVE BIRTHS IN MOH AREA KIRIELLA

Results Total of 30 and 47 samples were RT-PCR tested for chikungunya virus and dengue virus respectively and 3 samples were tested for both viruses. Out of which, 21 tested positive for chikungunya virus and 12 tested positive for dengue virus where as none tested positive for both viruses.

Kalubowila K.C. Medical Officer of Health Office, Kiriella kckalubowila@yahoo.com

Conclusions Based on our laboratory findings Epidemiology unit of the Ministry of Health, Sri Lanka concluded that the epidemic of chikungunya is spreading over the areas Embilipitiya, Monaragala, Polonnaruwa and Kalmunai. On the basis of the above conclusion, Health officials recommended to initiate special safety measures to prevent an epidemic of chikungunya in the Embilipitiya area of Ratnapura District.

Background Low Birth Weight (LBW) contributes to a high morbidity and mortality.

Research on LBW is few and far between.

Aims To identify the incidence of LBW among 1535 live births in Kiriella MOH area during 01.01.2008 to 31.12.2012 and to identify its risk factors

PP-43 PRESCHOOL TEACHERS AS AGENTS OF ORAL HEALTH PROMOTION

Methods Study design was an analytical cross sectional study and the study group was infants who birth weight was below 2500 grams weighed during 24 hours after birth. Normal birth weight (NBW) infants in equal numbers during same period were selected randomly as the control group. Pregnant mothers who were more than 12 weeks of period of gestation at booking visits and who left the area before childbirth were excluded.

Fernando, S.1, Kanthi, R.D.F.C.2 Griffith University, Australia, 2Health Education Bureau, Sri Lanka surani.fernando@griffith.edu.au 1

Background Health promotion includes changing human behavior through a series of activities. Involving traditionally considered 'non-health' staff becomes vital in achieving the health promotion goals.

Results Incidence of LBW was 20.5%. Among them 28% were preterm and 0.38% were preterm in NBW group. The rate of multiple gestations was 6.3% in LBW and 0.15% in NBW. Excluding multiple gestations there were 311 infants in NBW and 295 in LBW. The age distribution of pregnant mothers of LBW was 15.25% and 9% in NBW in less than 20 years of age. In between 20 to 35 years 77.2% was LBW and 82% was NBW. Greater than 35 years 7.4% was LBW and 9% NBW. Fifty percent of LBW and 30% of NBW babies were delivered by low BMI mothers. In LBW 35% were delivered by LSCS and in NBW 10% it was.

Objectives To improve the oral health knowledge and practices of preschool teachers and to promote preschool environment to an oral health friendly setting by improving practices of preschool teachers and to improve oral health friendly practices among preschool children Methods Preschools and teachers were selected based on recruiting all available sampling method. All preschools registered under the Sri Lankan government in Colombo District were considered eligible for the study and a total of 52 preschools from intervention and Control areas were studied. Total number of preschool teachers from the two Medical Officer of Health (MOH) areas was 72. Preschool teachers in the IG were educated on common oral health problems among preschool children, direct and indirect causes, preventive strategies and available oral health care services including treatment availability. They were trained on how to identify dental caries of preschool children and were introduced to the concept of oral health promotion and on how to create an oral health friendly environment. The training workshops for the preschool teachers were conducted based on a tailor made manual. No intervention was done for the CG. Pre and Post Intervention assessment was done using a questionnaire for preschool teachers and a checklist for the observation of preschool environment.

Conclusions The incidence of LBW is high in Kiriella MOH area in the study sample.

Preterm, LSCS and multiple gestations are common risk factors. Low BMI and teenage age group are other important risk factors.

PP-45 EVALUATION OF A HEALTH PROMOTION APPROACH IN IMPROVING THE PHYSICAL WELLBEING AMONG WOMEN IN A VILLAGE IN ANURADHAPURA DISTRICT IN SRI LANKA Liyanage, N.K., Fernando, C.J., Croo,s C.S., Athapaththu, A.M.C.S.R.K., Herath, H.M.T.P., Pallewaththa, P.W.P.W.K., Fernando, M., Duminda, G.G.N. Faculty of Medicine, University of Rajarata nilukshi1985@gmail.com

Results After 6 months, the mean oral health knowledge score of the IG was 69 (SD, 11.31) and 62 (SD, 11.6) in the CG. Mean score for oral health related practices were 35 (SD, 6.34) in IG and 32 (SD, 6.6) in CG. At preschool setting, variables; oral health friendly preschool environment, availability of brushing facilities and availability of Information Education and Communication materials related to oral health were significantly different between the two groups after 6 months.

Introduction Health promotion is the process of enabling people to increase control over their health and its determinants, and thereby improve their health (WHO 2005). These studies have concluded that the physical wellbeing is highly affected to individual overall health. Body mass index (BMI) is a simple physical health parameter which can be used to measure the physical wellbeing of individuals.

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Aims This study aimed to assess the effectiveness of Health Promotion approach in improving the physical wellbeing among women.

Results A total of 1400 children were examined through June 2012 â&#x20AC;&#x201C; February 2013 period and 80% was diagnosed with dental caries and gum diseases. Out of the 53 elders examined, three cases were diagnosed with suspicious precancerous lesions.

Methods A pretest- posttest quasi experimental study was conducted in Ashokapura village in Mihintale Medical Officer of Health area in Anuradhapura district. Study population was women who are in the reproductive age in this village. All the 78 women who were included in to the eligible criteria were recruited as the study sample. Community level active group (N=15) who could work themselves for their community physical wellbeing was strengthened as the intervention for a period of one and a half year. Intervention and activities included interactive discussions and training sessions with the support of innovative tools and materials. Those interventions and activities were planned, implemented, monitored and evaluated by the active group members of the community. A selected anthropometric measurement (BMI) and interviewer administered questionnaire were used as the quantitative assessments. The SPSS 20 statistical package was used to analyze the data.

Conclusions Out of the results of this project, the diagnosed cases are being treated and referred for specialized attention. This pilot project supports the initiative of drawing more attention to children and elders who have neglected their oral hygiene.

PP-47 CHARACTERISTICS AND OUTCOMES OF TUBERCULOSIS PATIENTS WHO FAIL TO SMEAR CONVERT AT 2 MONTHS IN SRI LANKA Jayakody, G.W.K., De Alwis, S., Samaraweera, S., Pallewatta, N., Ramachandran, A., Jayakody, J. K. M. N., Hewagama, A., Thomas, G. S. S. National Programme for Tuberculosis Control and Chest Diseases, Sri Lanka

Results According to the analysis of the questionnaire, knowledge on nutritional diet and BMI among women have been significantly improved comparatively, with a mean value of 61.54 in the pre-test and 38.72 in the post-testFollowing the intervention the number of overweight women had decreased significantly with a 25.99 mean value in the post-test compared with a 26.38 mean value in the pre-test. When concerning number of underweight women it has been reduced significantly with a 17.38 mean value in the post-test compared with a 16.99 mean value in the pre-test.

mo1nptccdsrilanka@gmail.com Background Routine records revealed a declining in sputum smear conversion rates at 2 months from 81% in 2007 to 75% in 2010. This finding is of concern and warranted further investigation.

Aims To determine the proportion of sputum smear-positive pulmonary TB cases who failed to smear convert at 2 months, to assess their management and to see whether baseline characteristics and final treatment outcomes were different from smear converted patients

Conclusions With the changes shown in the process a Health Promotional intervention targeting strengthening community actions can be used effectively to improve the physical wellbeing among women.

Methods Five districts were randomly selected. Data were collected from patient records, DOT cards and District TB registers using a structured proforma. Variables included: baseline characteristics, treatment characteristics, doses missed during the initial phase, sputum results at 2 months, the management of those still smear-positive at 2 months including results of culture and DST, and final treatment outcomes Data were analysed using Epi-Data.

PP-46 ORAL HEALTH CARE FOR CHILD DEVELOPMENT CENTERS AND ELDERLY HOMES IN NIHS FIELD PRACTICE AREA De Alwis, W. M. M. S. National Institute of Health Sciences, Kalutara manel266@hotmail.com

Results Of 925 smear positive patients registered, 840 submitted sputum at 2 months, and 137 (16%) were smear-positive. Heavy bacterial load (3+ in smear) at baseline (p<0.0001) and missing doses of anti-TB drugs during initial phase (p=0.0443) were significantly associated with failure of smear conversion at 2 moths. Sex, age, ethnicity, lung cavitation and place of DOT provision has no significant association with smear conversion. Only 46 (34%) out of smear conversion failures had submitted sputum for culture and drug sensitivity suggesting poor adherence to management guidelines. Initial phase of treatment was extended for one month among 120 (88%) and 23% (n=30) remained smear-positive at 3-months. However, there was no significant difference in the treatment success rate (p=0.4037) between sputum converted at 2-months (94%) and 3-months (92%).

Background Children living in Child Development Centers (CDC) or as commonly called, orphanages and elder citizens in elderly homes (EH) are the most common culprits of neglected and poorly attended oral health care. Most CDCs in Sri Lanka are run under minimum budgets and they rarely receive attention of a dental surgeon unlike other children. Ignorance of oral health and malnutrition cause most of the children to have dental caries and gum diseases. Elders who are sheltered by EHs are in a similar situation. Due to a lack of proper geriatric dental care in Sri Lanka, malnutrition, common medications, infections, cancers due to betel chewing, tobacco and alcohol cause elderly people to suffer from many dental problems.

Aims There is no regular program to give coverage for these two less privileged groups within the present health services setup. The aims of the project were to study and improve the status of the oral health of children in CDCs and elders in EHs.

Conclusions Sixteen percent of smear positive PTB patients failed to convert, but treatment success rates were similar regardless of smear conversion at 2 or 3 months. This may have implications on management guidelines.

Method As a starting point a total of 10 EHs and 13 CDCs in Kalutara and Beruwala MOH areas were included into this project. Five dental surgeons were involved in visiting an EH and a CDC according to a schedule with a mobile dental unit. A brief health education, oral health screening, service provision, referral and follow up were given.

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PP-48 I D E N T I F I C AT I O N O F S P E C I F I C F O O D S C A U S I N G HYPERSENSITIVITY AMONG SCHOOL CHILDREN IN COLOMBO DISTRICT- A PILOT STUDY

Background Dengue is an ongoing epidemic in Sri Lanka. Public health interventions are needed to inculcate exemplary behavior in younger generations to eliminate mosquito breeding sites.

Wimalasiri, Y.S.G., Ratnayake, R.M.U., Karunaratne, T.D.N., Ranaweera, K.K.D.S. Faculty of Medicine, University of Rajarata

Aims We aimed at designing and conducting a preschool programme to develop sustainable model behavior among preschoolers for the prevention of dengue.

udayar5017@yahoo.com

Methods The programme was designed using focus group discussions with a group of medical students, in depth interviews with experts in community medicine, preschool teachers and public health midwives. Preliminary program was conducted at a preschool in medical officer of health area, Kolonnawa. Components of programme were: to pre inform and gather parents for the pre-school programme, introduce concepts of dengue, mosquito bites, breeding sites and its elimination via child-friendly discussion, allow children to draw what they learnt, appreciate them with applause, praise and rewards, circle time activity of forming a train to go to the garden to find hidden mosquito breeding sites and actively learn to eliminate them, discussion on dengue prevention with parents, attach a leaflet on dengue prevention and check lists in the parent-teacher communication book to reinforce the message given to parents, empowering the teacher to maintain a progress chart and reward “stars” monthly for children who observe their houses and eliminate dengue breeding sites regularly to ensure sustainability. The teacher was provided with an attractive chart and stickers of stars.

Background Food sensitization is a public health problem among children and adolescents known to negatively affect their growth and development both in physical and psychological levels. In most cases rather than prevention a proper cure of the disease is not recognized in allopathic medicine system. Patients with related complications such as rashes, urticaria, eczema, boils, gastritis and other allergic conditions are discouraged eating the food items termed as 'Ushna Kema' according to the 'Shiita and 'Ushna' concept in Ayurveda.

Aims Broad Aims of the project is to identify specific foods causing food sensitization among Sri Lankans to support in finding new herbal formulas or optimizing persisting Ayurvedic remedies to cure specific food sensitized individuals through a systematic study. This pilot study was conducted to identify different foods causing hypersensitivity in school children in Colombo District, Sri Lanka as a prerequisite for designing the clinical study.

Results We were able to assess the reception of the message promptly via the art competition and the circle time activity and found that the impact was remarkable. Enthusiastic participation of children, teachers and parents was encouraging.

Methods Descriptive cross sectional study - school children aged between 6 to 19 years from three sub-urban schools in Maharagama Educational Division, Colombo District from July to December 2012. Study tool - Preplanned self administered semi structured questionnaire. Statistical data analysis was performed by using statistical package SPSS 15.

Conclusions This preschool program can be introduced to all preschools in Sri Lanka as a public health intervention to inculcate sustainable Dengue preventive behavior in the next generation and to utilize preschooler as change agents of families

Results Five hundred school children were recruited for the study and 497 had responded. From the respondents 143(28.6%) had declared “yes” for overall hypersensitivity. From hypersensitivity declared individuals, 96 (19.2%) respondents had food specific hypersensitivity. Studied food categories and obtained hypersensitive percentages; Fruits (59; 41.26%), Fish and sea foods (54; 37.76%), Vegetables (40; 27.97%), Meat & eggs (29; 20.28%), Milk (8; 5.6%), Spices (2; 1.4 %) and “Other food” category (31; 21.68 %). Pineapple (49; 34.26%), Rambutan (28; 19.58%), tomato (25; 17.48%), bread fruit (14; 9.79 %), prawns (27; 18.88%), cuttle fish (25; 17.48%), tuna (26; 18.18%) and canned fish (18; 12.58%) were found to be predominantly hypersensitive to the study population.

PP-50 A TIERED, INTEGRATED APPROACH TO IDENTIFYING POTENTIAL RISK FACTORS ASSOCIATED WITH CHRONIC KIDNEY DISEASE OF UNKNOWN ETIOLOGY (CKDu) IN SRI LANKA Redmon, J.H., Womack, D.S., Beaulieu, S. M., Levine, K.E., Elledge, M.F. RTI International, Research Triangle Park, NC, USA dsw@rti.org

Conclusions The study has revealed that pineapple, Rambutan, tomato, bread fruit, prawns, cuttle fish, tuna and canned fish as the most hypersensitive foods among the school children. Therefore the clinical study will be designed using these food items as source antigens to evaluate the efficacy of Ayurvedic formulas suitable to the local population.

Background As Sri Lanka transitions to a middle income country, the disease pattern is shifting toward non-communicable diseases (NCDs), such as diabetes and associated chronic kidney disease (CKD). Since the 1990s, the emergence of an apparently new form of CKD of unknown etiology (CKDu) has exacerbated the issue. Although many risk factors associated with the onset of diabetes are known, there is insufficient evidence to reasonably pinpoint the potential cause (s) of CKDu. Studies conducted to-date attempt to associate CKDu with agrochemicals, lowquality cookware, Ayurvedic medicines, recreational substances, and other environmental or lifestyle factors. However, the complexity and multifaceted nature of the emerging health crisis requires an interdisciplinary approach to achieve tangible, lasting improvement in health outcomes.

PP-49 DENGUE PREVENTION: AN INNOVATIVE PROGRAMME TO BUILD A SUSTAINABLE MODEL BEHAVIOR AMONG PRESCHOOLERS Kossinna,T.K.M.S., Jayantha, G.P., Jayasekara, G.S., Jayasinghe, J.M.D.C., Jayasinghe, J.A.P.M., Jayasinghe, S.A., Jayasiri, W.A.M.P., Jayasooriya, E.W.S.N., Jayasundara, P.K.H.E., Jayathilaka, K.I.C., Jayathunga, J.M.H.K., Karunajeewa, A.M.A.A.N., Karunarathna,R.A.J., Karunarathna, H.G.K., Karunaratne, H.D.L.S., Karunasiri, R.P.W.P., Karunathilaka, H.M.W., Kaushalya, N.K.Y., KodikaraArachchi, D.N., Kodikara, T.D., Kodikara, S.P., Ranasinghe, P.D. Faculty of Medicine, University of Colombo priyangaran@yahoo.com

Aims and Methods Using our expertise in laboratory analytics, science-based risk assessment and decision support, RTI aimed to develop a tiered, integrated approach to 1) identify potential CKDu risk factors and

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linkages to diabetic nephropathy, and 2) recommend effective risk mitigation strategies.

Methods: RTI proposes four phases to address this public health issue.

1) Data review, conceptual model development, and data gap identification, 2) Supplementary data collection and analysis and conceptual model refinement, 3) Analysis planning, risk modeling, statistical analyses, and risk characterization, and 4) Risk mitigation evaluation. Integrating the findings from each phase will allow RTI to leverage current data, optimize additional supplementary data analyses, and maximizes resources.

PP-52 EXPLORATION OF ADOLESCENT SEXUALITY IN A DISTRICT IN SRI LANKA Rajapaksa-Hewageegana, N.S., Samarage, S., Wickramasingha, R. Health Education Bureau, Colombo drneelamani@yahoo.com Background Considerable academic and professional interest and debate has been created in recent years around adolescent sexual and reproductive health issues. With increasing sexual activity reported at younger ages leading to teenage pregnancies, adolescent suicides and other societal issues, it is important to explore the contributory factors in addressing these problems.

Expected Results In April 2012, RTI secured internal funds to begin evaluating NCDs using our innovative approach. The following activities are expected to occur in 2012: a data-gathering trip, initial laboratory analyses, data prioritization, international collaboration, and a discussion of preliminary findings.

Aims Purpose of the study was to understand the context and patterns of adolescent sexual behaviour in a district in Sri Lanka.

Conclusions RTI's proposed approach provides a transparent, integrated way to assist decision makers in identifying potential risk factors associated with CKDu and subsequently develop efficient risk mitigation techniques cost-effectively within a reasonable timeframe.

Methods A cross sectional descriptive study was conducted. A sample 2020 school adolescents (1499 girls and 521 boys) were randomly selected from five educational zones in the Badulla district. A self administered questionnaire was used for data collection.

PP-51 A REVIEW ON AYURVEDIC 'DINA CHARYA' FOR LONG AND HEALTHY LIFE JOURNEY

Results Three hundred and eighty six (19%) adolescence stated that they are currently having a relationship. Thirty eight (3%) boys and 17 (1 %) girls revealed that they have experienced a sexual relationship. The difference was statistically significant. Thirty (6%) males and five (0.3 %) females have accepted that they have had an intimate sexual relationship. There is a statistically significant difference between the two genders. Seventeen (3%) males and 3 (0.2%) females said they had an intimate sexual relationship with their consent. This difference between males and females are statistically significant. The sexually active adolescents who had intimate relationships with their consent have used contraceptives. School going boys had higher odds of being sexually active when they reported their mother was abroad compared to the boys whose mothers were in Sri Lanka. Nine percent of sexually active girls and 1% of non- sexually active girls' fathers were abroad.

Differences above were statistically significant in the bivariate analysis.

The difference between the sexually active and sexually inactive adolescents in relation to the family environment, parent relationships, the education and aspirations of the adolescents too were explored.

Sexually active adolescents had siblings who had children, more than the sexually inactive adolescents. This difference was statistically significant.Only 80% of sexually active adolescents perceived that their home environment was peaceful, 91% of sexually inactive adolescents perceived that their home environment was peaceful. This is a statistically significant difference.Thirty per cent of sexually active adolescents perceived their economic status was poor compared to 16% of sexually inactive adolescents. The difference was statistically significant. Sexually active adolescents have smoked and have used intoxicating substances significantly more than the sexually inactive adolescents.About 31% of sexually active adolescents did not discuss sexual issues with anybody as compared to only 22% of sexually inactive adolescents. Both sexually active and sexually inactive adolescents preferred to get solutions to sexuality issues from health personnel.

Kalawana, O.T.M.R.K.S.B., Ediriweera, E.R.H.S.S. Institute of Indigenous Medicine, University of Colombo dr.senanikalawana@gmail.com The word “Ayurveda” means “Science of Living”. Aims of Ayurveda are, “SwastaSamrakshana” (protecting health) and “Athura Prashamana” (treating ailments). Ayurveda has described a ritual as “Din Charya” to follow for obtaining mental and physical health. This attempt is to make awareness on importance of the “Din Charya” and to persuade public to follow them. Data was collected from authentic books. ”˜Dina Charya” means daily routine to be followed from awakening to sleep and it has been described in Ayurveda as follows. Waking up early morning, Defecation and Urination, Teeth and tongue cleaning, Betel chewing, Gargling, Collyrium, Snuffing, Medicated smoking, Oiling and Massaging the head, ears, body and foot, Exercising, Bathing, Clean clothing, Consuming food, Following Sadvritta (Moral and spiritual conduct), Attending profession, Using fragrance, garlands, ornaments and gems, Cleaning feet and excretory orifices, Shaving, Hair dressing, Wearing footwear, Using umbrella and stick, Resting and Sleeping.

Waking up in early morning makes mind peaceful and fresh. Defecation and Urination prevents abdominal discomfort. Teeth and tongue cleaning, betel chewing and gargling helps to maintain a good oral hygiene, remove halitosis and improve taste sensation. Bathing, Cleaning feet and excretory orifices, Shaving, Hair dressing, clean clothing remove dirt, reduce fatigue and provide healthiness and pleasure. Collyrium removes dirt, enhances vision and luster, resists to heat, wind, dryness and prevent eye disorders. Snuffing and medicated smoking prevents diseases in nose, mouth and throat. Oiling, massaging and exercising strengthen the body, removes excessive fat and endogenous toxins, and enhances flexibility. Consuming balanced diet leads to healthy life. Wearing garlands and gems promotes beauty, wealth, longevity, and act as an aphrodisiac. Wearing footwear prevents injuries and beneficial for eye-sight and tactile sense organ. Using umbrella and stick protects the entire body and complexion from the bad effects of the sun rays and avoid slippery. Sadvritta bestow physical and mental satisfaction. Profession is to earn money for livelihood. Rest and Sleep gives sufficient relaxation to body and mind. Hence, it can be concluded that Ayurvedic way of living should be followed as possible in order to attain the biggest wealth in the world, healthiness.

Conclusions Siblings with children, mother father being away and an unhappy home environment were suggestive of children becoming sexually active in adolescence. The younger adolescents in the study group who are physically developed enough to conceive, is often not adequately developed to cope with the mental stresses of child bearing as well as have a knowledge gap. They need much assistance with psychosocial counseling and support. This is a special need and the health sector should develop adequate personnel capable of offering such assistance

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PP-53 PROTECTING NATIONAL HEALTH THROUGH RASAYANA AND VAJIKARANA CHIKITHSA (REJUVENATION AND APHRODISIAC THERAPY)

C-sum of all colonies on all the plates counted, n1-number of colonies in the first dilution plate n2-number of colonies in second dilution plate and d-dilution from which the first count was obtained.

Ediriweera, E.R.H.S. Institute of Indigenous Medicine, University of Colombo ayurvedadocsujatha@yahoo.com

Results Mean APC count on day 0, day 7 and expiry day was 17 x 109, 26 x 108 and 63 x 107 respectively. The count decreased with time. This may be due to production of lactic acid (pH decreased from 4.6 to 3.8) or due to improper storage.

"Health is Wealth". Rasayana (Rejuvenation therapy) promote longevity by retarding ageing process and preventing diseases. Ayurveda describes different classifications of Rasayana. According to the methods of prescribing, Rasayana is of two types namely; Kutipravesika (Indoor treatment, meaning taking treatment while staying in a special room), and Vatatapika (Outdoor treatment, meaning taking treatment while being in a normal environment, attending day to day duties). As per scope of use, Rasayana is of two types. That is, NaimittikaRasayana which promotes vitality in specific diseases and Kamya Rasayana which promotes health. Kamya Rasayana is of three types; namely; Pranakamya (Promoter of vitality and longevity of life), Medhakamya (Promoter of intelligence) and Srikamya (Promoter of complexion).

Further Ayurveda describes three types of Rasayana. They are; Ajasrika Rasayana (rejuvenation through food), Aushadha Rasayana (rejuvenation through drugs) andAchara Rasayana (rejuvenation through behavior and controlling mental urges such as anger, jealousy so on). Droni praveshika is an another special type of Rasyana procedure described in Ayurveda. A person may attain longevity, freedom from diseases, excellence of complexion and voice, enhanced memory power and intellect and preservation of youth, through rejuvenation therapy. Vajikarana (Aphrodisiac therapy) deals with the promotion of sexual health, healthy progeny, treatment of male sexual disorders (erectile dysfunction, premature ejaculation) and infertility.

Vajikarana therapy improves the nourishment and function of the reproductive organs and vitalizes tissues of reproductive organs, increasing semen count and strengthening their motility and making sperms more viable for conception. Vajikarana helps to increase fertility of both sexes, thereby leading to the propagation of healthy future generations. Authentic texts state that Vajikarana makes a man capable of sexual intercourse with women with vigor of stallion and for a long duration. Rasayana (Rejuvenation therapy) and Vajikarana (Aphrodisiac therapy) play an important role in promoting and protecting the health of the human race.

Conclusions This study suggests that this commercially produced curd have the optimum number of bacterial colony but decreased at the time of expiry.

However colony counts are not displayed on the retail outlets of any curd products in Sri Lanka.

PP-55 NON COMMUNICABLE DISEASES AND RISK FACTOR SCREENING PROGRAMME IN WORK PLACES, GALLE MUNICIPAL COUNCIL AREA Ubeysekara, N.H. Regional Director of Health Services' Office, Galle nishaniubaysekara@yahoo.com Background Screening is a main strategy of Non Communicable Disease (NCD) prevention programme. Screening helps to diagnose the NCDs and risk factors early and helps to prevent premature deaths and complications due to NCDs. Knowledge of the disease burden among people is essential to plan best possible preventive programmes with limited resources. Pilot screening programmes were planned for the working population specially office workers who spend more sedentary life styles and with poor health seeking behaviors because of lack of time and interest .Galle MC Area was selected to initiate the programme as majority of workplaces are situated in Galle MC Area. These activities are conducted as district level activities of the National NCD control programme.

Aims To identify the NCD burden among selected working groups and to diagnose the common NCDs and their risk factors early in selected work places and direct them for proper interventions and treatment

PP-54 PROBIOTIC BACTERIAL COUNTS IN CURD PRODUCT PRODUCED IN SRI LANKA

Methods Ten government offices were selected to conduct the screening and all workplaces had over 100 workers. All workers over 35 years and who were not diagnosed as having diabetes and hypertension earlier were screened. BMI, fasting capillary glucose and BP assessment were done by the trained health staff. All the eligible workers were issued Personnel Health Recorda and they were categorized in to 3 groups after the results of the screening tests using multiple risk factor approach. High risk participants were referred to the specialist clinics in hospitals.

Athiththan, L.V., Jayaratne, S.D., Peiris, H. Faculty of medical Sciences, University of Sri Jayawardanapura lohinia@gmail.com Background Milk cannot be tolerated by large amount of adults in Asia. Fermented milk products provide nutrients for lactose intolerant individuals stabilizing the gut mucosal barrier. In order to obtain these beneficial effects, the bacterial count should be present at a higher number at least 106 cfu/mL or 106 bacteria/g (Lactic Acid bacteria) at the time of consumption and should be consumed regularly.

Results The number of workers in all 10 work places was 1585 and 1432 (91%) were screened .Out of 1432, 911 (64%) were female and 521 (36%) were males. Out of screened workers 415 (29%) had BMI over 25 and 601 (42%) had BMI over 23. Over weight percentage was high in females (30%) than in Males (26%). Fasting blood glucose is over 110mg/dl in 243 (17%) of participants and FBG was over 126 mg/dl in 186 (13%) of participants. Blood pressure was 120/80 mmHg or less in 745 (52%) of participants and more than 120/80 mmHg in 687 (48%) of participants and more than 140/90 mmHg in 301 (21%) of participants.

Only 587 (41%) were categorized as normal and only given health education. Risk participants were 845(59%) in number and 152 (18 %) out of them were categorized as high risk and referred to the specialist care at hospitals.

Aims This study was carried out to find out the bacterial colony counts on a randomly selected Sri Lankan commercially available curd brand on production day and at the time of expiry.

Methods Twelve samples in duplicates of six different batches were obtained.

From 10-7, 10-8 and 10-9 diluted curd 1 mL was pipetted into the Petri dish containing 20 mL milk agar and incubated at 44 C. Aerobic plate count (APC) was calculated at 24Âą2h. Colony count within 25â&#x20AC;&#x201C;250 was considered for calculation. The colony count was calculated using N= C/[(1 x n1) + 0.1 x n2)] x (d). N is the number of colonies per mL product,

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Conclusions Commonest risk factor among the workers is overweight and the commonest NCD detected was high blood pressure. Prevalence of diabetes among workers is also high. They are very important target group for the NCD preventive activities as more than half (59%) of the workers have risk of developing NCDs.

Methods Urine samples from 116 diabetic and 100 non-diabetic patients who visited the Family Practice Centre at University of Sri Jayewardenepura during July 2012 to October 2012 were tested using Strip test, Sulphosalicylic acid test (SAT) and Heat precipitation test (HPT). The sensitivity and specificity of these tests were assessed against the strip test which was considered as the gold standard. An interviewer administered questionnaire was also used. Chi-squared test was used to determine the statistical significance of variables.

PP-56 MOSQUITO LARVAE TRAP

Results Out of 116 diabetic subjects 13 had microalbuminuria by strip test, 11 by SAT, 6 by HPT. Sensitivity and Specificity of SAT was 76.92%, 99% and HPT was 46.15%, 100% respectively. One patient was positive for SAT but negative for strip test indicating other causes of proteinuria other than albumin. None of the non-diabetic patients was positive for these tests. But only 8.8% knew about HbA1C and only 5.1 % had knowledge about Oral Glucose Tolerance Test.

Basnayake, S. MOH Office, Mawathagama sisirabasnayaka@gmail.com Background Dengue is one of the emerging diseases in South East Asia including Sri Lanka. Among the dengue control methods more priority is given to reduce the mosquito breeding places. However, elimination of all the breeding places is impracticable. The mosquito can adapt to the existing environmental conditions. As a result, they could identify new breeding places. It is time to pay more attention on larvae control methods as well as reducing the breeding places.

Conclusions As strip test is only sensitive for albuminuria, SAT can be used with strip test in order to detect proteinuria other than albuminuria. SAT is a cost effective method than strip test. Majority was unaware of other investigations except the commonly done FBS test; indicating the knowledge regarding other better laboratory assays should be updated.

Aims To design an instrument (larvae trap) to reduce mosquito density

PP-58 KNOWLEDGE ON SEXUALLY TRANSMITTED INFECTIONS AND MOTHER TO CHILD TRANSMISSION AMONG PUBLIC HEALTH MIDWIVES AND STUDENT PUBLIC HEALTH MIDWIVES ATTACHED TO THE NATIONAL INSTITUTE OF HEALTH SCIENCES, KALUTARA

Methods Literature survey was done to study the breeding behavior of mosquitoes. Small scale experiments were also conducted to study the mosquito breeding behavior by the investigator. Currently practicing larvae control methods were studied and their strengths and weakness were identified. By using these information and observations, a new instrument was designed to trap mosquito larvae. It prevents the development of larvae to adult mosquito by this method. Effectiveness of the developed instrument was carried out by distributing five larvae traps per house (n=20) in a village and they were kept in appropriate places.

Larvae trap was developed with degradable plastic and at a cost of 150 rupees per larvae trap. It did not need frequent attention by users.

Kaluarachchi, D.V.V1., Ranasinghe, R.D.S2., Kulathilake, K.A.D.T3., De Alwis4, W.M.M.S., De Silva, A.S.U5.

1 Post Graduate Institute of Medicine, 2 4 National Institute of Health Sciences, Ministry of Health , 3Emergency Treatment Unit, DGH Nawalapitiya, 5 Access Engineering PLC vkaluarachchi@yahoo.com

Results It was observed that mosquito density in the area was markedly reduced three months after implementation of larvae trap. This product has been selected for a patent.

Background The Public Health Midwife (PHM) is the key primary care knowledge provider to mothers and their families on Sexually Transmitted Infections.

Conclusions Developed larvae trap was effective in controlling mosquito density.

Scientific well planned pilot project need to be conducted to evaluate the effectiveness.

Aims To assess the knowledge on STI and Mother to Child Transmission (MTCT) of STI among the Public Health Midwives (PHMM) and the student PHMM attached to the National Institute of Health Sciences (NIHS)

PP-57 ASSAY OF URINE PROTEIN AND AWARENESS OF LABORATORY TESTS ASSOCIATED WITH DIABETES IN A SELECTED POPULATION IN GANGODAWILLA AREA IN COLOMBO DISTRICT – A PRELIMINARY STUDY

Methods A descriptive cross sectional study was carried out among 68 PHMM and 74 PHM students. Data was collected using a pre tested self administered questionnaire. The data were analyzed using the SPSS v 16.00. The Mann-Whitney U Testwas used to assess the significance.

Shifana, A.A.F., Raziya, M.S., Athiththan, L.V. University of Sri Jayawardanapura

Results Almost all the PHMM (98.5%) and PHM students (100%) could identify syphilis and gonorrhea as STI but less than 20% of both the groups could identify Non Gonococcal Urethritis as a STI. Majority of PHMM and students could not identify “working away from home” (100%, 83.8% respectively) as a risk factor of STI. Majority of both groups (more than 50%) did not identify 'Abstinence' as a preventive measure of STI. PHMM were having better significantly higher knowledge on this aspect (p = 0.002). A significant difference was found between PHMM and PHM students (p = 0.005) regarding the knowledge on consequences of untreated or partially treated STI and >60% of both the groups expressed an average knowledge on this aspect. Nearly 50% of both PHMM and PHM students were unaware of the availability of Anti

Background Diabetes mellitus could be controlled to avoid development of further common complications such as diabetic nephropathy and heart diseases.

Aims To compare different assay techniques available for urine protein analysis, to explore the cost effectiveness of these tests for proteinuria assessment and to assess the awareness of laboratory tests for diabetes among diabetic and non-diabetic people.

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Retroviral Therapy for HIV/AIDS (p = 0.487) and post exposure prophylaxis for health care workers (p = 0.029) in Sri Lanka. A significant difference was found between the PHMM and PHM students on the knowledge on STI that can be transmitted from Mother to Child (p = 0.001). On the aspects of 'identification of a disease as STI' (p = 0.01), 'importance of partner tracing' (p = 0.002) and 'causes of death in AIDS patients' (p = 0.004) PHM students expressed more awareness.

Methods Fifty one type 2 diabetes patients with a past estimated Glomerular Filtration Rate (eGFR) value of less than 60 ml/min/1.732m2 and 33 apparently healthy volunteers as controls were recruited from Colombo South Teaching Hospital. Urine samples were analyzed for creatinine using Biolabo Creatinine Kinetic Methods and for albumin using Konelab Albumin MST kit (immune turbidimetric method) on Kone 20XT auto analyzer. ACR was calculated as a ratio of albumin: creatinine(mg/g).

Results Based on ACR, the diabetics were categorized as microalbuminuric (ACR 30-300mg/g) and normoalbuminuric(ACR<30mg/g). There was no significant difference between the mean ages of the normo and microalbuminuric diabetics and the controls. Out of the diabetic patients 19 had microalbuminuria with a mean ACR of 104.78 mg/g (SD=68.71) and 32 patients had normoalbuminuria with a mean ACR of 10.14 (SD= 9.12) while the control group had a mean ACR 7.26mg/g(5.92). There was a significant (p<0.05) positive correlation (r=0.6) between ACR and SBP as well as a significant (p<0.05) correlation (r= 0.51) between DBP and ACR in the diabetics with microalbuminuria. There was no significant correlation between the blood pressure and ACR in diabetics with normoalbuminuria as well as in the control group.

Conclusions There are some important deficiencies of essential knowledge among PHMM and the student PHMM with regard to STI. PP-59 APPLICATION OF FINGER LOOP SPLINTS FOR PATIENTS WITH ULNAR CLAW HAND IN LEPROSY, SRI LANKA Aluthge, I. N. School of Physiotherapy, Colombo irangaaluth@gmail.com Background Leprosy is a communicable disease caused by bacteria. It mainly affects the skin and nerves and progresses slowly with an average incubation period of three years. If neglected leprosy will lead to disabilities in hand, foot and face. Ulnar claw hand is one of the major hand deformities in leprosy. It is caused by affected ulnar nerve and resultant paralysis of intrinsic muscles. Finger loop splints are used to correct the ulnar claw hand with the other physiotherapeutic measures. Finger loop splint contains finger loops with rubber bands and a wrist belt and place the hand in Intrinsic- plus hand position. With this patient is able to do the exercises to the hand muscles without moving to intrinsic minus position.

Conclusions A significant correlation was observed between ACR with systolic and diastolic blood pressure in a group of Sri Lankan type 2 diabetic patients with microalbuminuria. However a significant correlation was not observed between ACR and blood pressure in the normoalbuminuric diabetics as well as in the controls.

PP-61 KNOWLEDGE AND PRACTICE OF SAFETY PRECAUTIONS AMONG A POPULATION OF RUBBER FACTORY WORKERS IN KEGALLE DISTRICT

Aims To explore the usefulness of this application among patients with ulnar claw hand

Amunupura, K.N., Hettiaratchi, U.P.K. University of Sri Jayawardanapura kumari31@yahoo.com

Methods All the leprosy patients who were having mobile ulnar claw hand have been provided this finger loop splints at central leprosy clinic, National Hospital of Sri Lanka from 1991. There were 58 patients in the sample.

They were advised to wear this and to do the exercise three times per day repeating100 times at each time. After one year patients were examined and the improvements recorded. Twenty seven patients had good improvements nearly correcting the deformity and 6 got ulcers in the finger webs and others did not show any change.

Background Rubber sector has relatively difficult working conditions and hazardous work environments that give rise to many occupational accidents and illnesses.

Aims To assess the knowledge and practice of safety precautions among a population of rubber factory workers in Kegalle district

Conclusions A preliminary observation seems to suggest an improvement of half of the patients however the reasons for non-improvement of others needs to be investigated.

Methods This descriptive cross sectional study was conducted among a randomly selected sample of 105 factory workers (Males -35; females -70) from 07 factories in kegalle district. Observational check list and interviewer administered questionnaires were used for data collection. Data were analyzed using SPSS version 16. Ethical approval was obtained from Ethical review committee, Faculty of Medical Sciences, University of Sri Jayewardenepura.

PP-60 ASSOCIATION OF BLOOD PRESSURE AND MICROALBUMINURIA IN A GROUP OF SRI LANKAN TYPE 2 DIABETES PATIENTS- A PRELIMINARY STUDY

Results Sixty three percent of the study population had either secondary or tertiary level education. Over 90% recognized the usage of gloves and boots during work as a safety measure. However, <17% were aware of ear-guards as a safety measure. Participants were aware of asthma, hypertensive reactions as medical conditions associated with the work (>60%) if proper safety precautions are not used. However, < 3% identified cancer as a risk associated with the work environment. About 80% of the sample were aware of the injuries that can happen at work place except for the injuries associated with inhalation of chemicals/ fumes (<32%) and ingestion of chemicals (<18%). 86% of males and 79% females did not use safety precautions. The usage of gloves, boots and overalls during work among males and females were <40%. When questioned about the reasons for not using safety precautions, 65%

Wijayatunga, N.N., Peiris,H., Perera, P.R.P., Wanigasuriya, K., Faculty of Medical Sciences, University of Sri Jayawardanapura nadeejawi@yahoo.com Background Microalbuminuria is defined as urinary Albumin : Creatinine Ratio (ACR) of 30 to 300 mg/g in a spot urine sample .

Aims The aims of our study was to assess association between systolic blood pressure (SBP) and diastolic blood pressure (DBP) with ACR in microalbuminuric and normoalbuminuric type 2 diabetic patients.

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responded that it is due to the uncomfortable feelings and <40% mentioned that it is due to lack of resources.

Background Early diagnosis and control is essential in the management of diabetes to prevent complications.

Conclusions The knowledge and practices of safety precautions among a population of rubber factory workers were not satisfactory in this study group.

Aims To identify patient with diabetes and to assess their glycaemic control on admission for surgery

PP-62 VALIDATION OF A SELECTED SECTION OF THE NORDIC QUESTIONNAIRE TO USE AS A TOOL TO IDENTIFY MUSCULOSKELETAL DISORDERS IN SRI LANKAN NURSES

Methods Fasting blood sugar and glycated haemoglobin were measured in patients who were admitted to a single surgical unit at National Hospital of Sri Lanka during January 2010 to April 2011. The duration of diabetes, age, fasting blood sugar and glycated haemoglobin were recorded. The diabetic patients were identified from fasting blood sugar and glycated haemoglobin.

Munidasa, K.G.P.K., Pethiyagoda, K., Samarasinghe, K. The Open University of Sri Lanka priyangamunidasa@yahoo.com

Results Among the admitted patients 531 (307 females and 224 males) were identified as having diabetes mellitus and more than 90 % were admitted on casualty basis. Among the diabetic patients 26.75% were unaware that they have diabetes mellitus. In the female who were below 40 years 50% were unaware that they have diabetes. This may be due to negligence and social factors. Mean fasting blood sugar was 155.1 mg/dL (female 171.5 and males 138.5 mg/dL) and glycated haemoglobin was 8.82 % (females 8.4 and males 9.2%) indicating a very poor glycaemic control.

Background A cross sectional observational descriptive study was designed to find the work related factors influencing the occurrence of musculoskeletal disorders (MSDs) in 369 nurses in the central province. Reports in the literature have identified a need for standardized and reliable measurements to analyze musculoskeletal symptoms. The Nordic General Questionnaire is a standardized instrument used to identify and analyze musculoskeletal symptoms in occupational health context. A selected section of the Nordic questionnaire which was translated into Sinhala and Tamil was used in this study. As translation can decrease the validity of questions, testing the validity in a small sample of nurses was thought to be essential.

Conclusions High percentage (above 25%) was unaware that they have diabetes mellitus; this suggests that screening for diabetes has to be improved in various ways and means. High fasting blood sugar and very high glycated haemoglobin indicates that patients must be educated on controlling diabetes which could lead to a poor wound healing after surgery.

Aims To test the validity and reliability of the translated form of the selected section of the Nordic questionnaire Methods Twenty four nurses who already had MSDs were selected by convenient sampling and were given the translated version of the selected part of Nordic questionnaire. Study period was from December 2012 to January 2013 in the central province of Sri Lanka. The study sample consisted of female hospital nurses from three categories of hospitals such as Teaching hospitals, Base Hospitals and District hospitals. The scores were correlated with the actual diagnosis score. Further, the same questionnaire was given to this sample of nurses under similar conditions a week later and the diagnosis and the scores were compared.

PP-64 CONTRACEPTIVE PREVALENCE AND UNMET NEED FOR FAMILY PLANNING AMONG EVER MARRIED REPRODUCTIVE AGED WOMEN IN KALUTARA DISTRICT, SRI LANKA Malwenna, L.I., Jayawardana, P.L., Balasuriya, A. Provincial Director of Health Services' Office, Sabaragamuwa indrani.malwenna@gmail.com Background Correct use of modern contraceptives remains the most effective methods of avoiding unplanned pregnancies and their consequences.

Results The twenty four nurses had consultant's diagnostic notes, which were given scores according to diagnosis. Pearsons correlation between the Nordic questionnaire scores and diagnosis scores was found to be 0.867 (P<0.001). The correlation between the re-test scores was found to be 0.810, (P<0.001).

Aims To determine the contraceptive prevalence and unmet need for family planning among ever married women in 15 - 49 years age group in Kalutara District, Sri Lanka

Conclusions The translated version of the selected part of the Nordic questionnaire can be considered as a valid and reliable tool to measure MSDs in Sri Lankan nurses and can be considered for use in further MSD studies.

Methods Community based descriptive cross sectional study was conducted to assess contraceptive prevalence and its sub categories and unmet need for family planning among 1200 ever married females in 15-49 years age group in Kalutara district, selected by cluster sampling technique. Data was collected from 60 clusters, using Interviewer Administered Questionnaire by Public Health Nursing Sisters in all Medical Officer of Health areas of the district. Each prevalence was expressed as a percentage with its 95% confidence intervals.

PP-63 IDENTIFICATION AND ASSESSMENT OF GLYCAEMIC CONTROL OF PATIENTS WITH DIABETES MELLITUS IN A SINGLE SURGICAL UNIT AT NATIONAL HOSPITAL OF SRI LANKA - A PRELIMINARY STUDY

Results The overall contraceptive prevalence for the study group was 69.4% (95% CI: 66.1-72.7) with a prevalence of 60.5% (95% CI: 51.9-69.1) for modern methods of contraceptives and 8.9% (95% CI: 3.3-14.5) for natural and traditional methods. Prevalence of unmet need for any Methods of family planning was 9.4 % (95% CI: 7.7-11.1) [n=105] while that of for spacing was 1.5 % (95% CI: 0.79-2.2) [n=17] and for limiting

Athiththan, P., Bandara, A., Mahendrarajah, K. National Hospital Sri Lanka pathiththan@yahoo.com

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was 7.9% (95% CI: 6.3-9.5) [n=88]. Unmet need for modern methods of family planning was 18.7% (95% CI=16.1 - 20.6) [n=205]. The community prevalence of correct use of modern family planning methods was 51.3%.

Aims To assess practice and accessibility to EC amongst the post-natal mothers in rural areas to develop a programme to enhance the health care services on EC.

Conclusions Although contraceptive prevalence is high in the district, existence of high prevalence of unmet need for limiting coupled with incorrect use of modern methods indicates the need of identifying characteristics of women with high risk of unplanned pregnancies.

Methods Pretested, anonymous and self-administered questionnaire which included basic demographic data, contraceptive practice, knowledge and practice on EC, accessibility was administered during March, 2012 amongst the post-natal mothers who attended child immunization clinic in rural areas of Hambantota District of Sri Lanka, Significance is measured with Pearson's chi-square test and p>0.05 taken as significant.

PP-65 DEVELOPMENT OF OUTCOME BASED CURRICULUM FOR THE TUTOR TRAINING DIPLOMA PROGRAM

Results Valid responses received from 156 (94%) from 166 respondents.

Average age was 27.2 (Âą4.1) years. Majority of mothers had an average education level with a single child and not on current contraceptive practice but nearly 68% had EC at least once in the past. Most of them (61.5%, n=96) had average knowledge about EC but the practice was not rational. A majority had easy accessibility for medical advice (73.7%, n=115) regarding EC but not willing to take it (58.9%, n=92). Only 6% of participant had EC at home, nearly 22% (n=34) of mothers did not know that EC is available with field health care works. Most of them needed more than 2 days take EC from community health workers and GP, and less than one day from a local pharmacy.

Priyananda, R. National Institute of Health Sciences, Kalutara ruchithpriyananda@yahoo.com Back ground Evaluation of the curriculum of Tutor Training Program at National Institute of Health Sciences (NIHS) revealed this program was more teacher centered, apprenticeship based (level 1) and midway between information gathering / problem based and discipline based / integrated (level 3). In order to improve the program outcome based curriculum with portfolio based evaluation suggested. This was the first time that outcome based curriculum with portfolio based evaluation was adopted in the training history of NIHS.

Conclusions Even thought post natal mothers had good knowledge on EC, the practice is inappropriate. However, EC could be accessed at a reasonable time period but accessibility through field health care workers needs to be improved.

Aims This paper discusses the curriculum of the newly developed Tutor Training Diploma Program and benefits and challenges faced.

Methods The curriculum development took place at National Institute of Health Sciences, Kalutara during the academic year 2011-2012. Previous curriculum was evaluated using Harden's SPICES model. Need assessment was carried out using documentary analysis, both trainer and trainee interviews and continuous observations and expert interviews.

PP-67 THE STUDY ON PHARMACOVIGILANCE TO MONITOR SAFETY OF ANTI-TUBERCULOSIS MEDICINES IN SRI LANKA Seneviratne, K.N.G.1, Samaraweera, S.1, Ambagahage, T.M.1, Fernandopulle, R.2, Pallewatta, N.C.1, De Alwis, A.K.S.B.3 1 National Programme for Tuberculosis Control and Chest Diseases, 2 Faculty of Medicine, Kotalawala Defense University, 3Education Training and Research Unit, Ministry of Health departmentdoctor@gmail.com

Results Ten exit outcomes were identified for this program: lecturer, practical trainer, facilitator, role model, manager, communicator, curriculum developer, assessor, resource material developer and researcher.

Portfolio evaluation was identified as the main assessment method.

Background Tuberculosis control in Sri Lanka moved in to new dimensions with implementation of DOTS strategy and fixed dose combination drugs.

Case detection rate too has improved, relieving the disease burden significantly. Yet it is noted since recently, there is an increased death rate with a prolonged sputum conversion rate. The contribution of the adverse reactions of anti-tuberculosis drugs towards this phenomenon still remains obscure.

Conclusions Outcome based curriculum with portfolio based assessment has resulted in the active learning and deep learning. At present, a group of trainees are following this newly designed program and they show great interest towards their studies and they are steadily achieving exit outcomes. It is timely now to develop outcome based curricula for other training programs of the NIHS and those of the health sector in order to gain higher achievements.

Aims To detect the incidence of adverse reactions of anti-tuberculosis drugs, determine the safety of them in co-morbid situations, identify factors affecting treatment adherence, and establish a sustainable pharmacovigilance system for anti-tuberculosis drugs, with the knowledge accumulated.

PP-66 PRACTICE AND ACCESSIBILITY TO EMERGENCY CONTRACEPTIVE AMONG THE POST-NATAL MOTHERS IN RURAL SRI LANKA

Methods A cohort study for active detection and reporting of adverse reactions of anti-tuberculosis drugs will be conducted in selected districts, throughout a calendar year. An interviewer administered questionnaire with a symptom check list will be used. Other important information on the patients will be gathered using a separate format, at the commencement of treatment. Adverse reaction outcomes will be closely monitored by the relevant chest clinics in collaboration with DOTS providers.

Dolamulla, S.S., Rajapaksha, S., Wickramasinghe, P.K. Regional Director of Health Services' Office, Hambanthota surangadolamulla@yahoo.com Background Emergency Contraceptives [EC}can prevent an estimated 75 % of pregnancies when taken within five days after unprotected sex. Since timing is essential for effective use of EC, it is critical that women are able to access this medication without delay.

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Usage of the Results The knowledge generated on data analysis will be disseminated to relevant focal points for safety actions. The questionnaires used for the study will become reporting formats of adverse reactions,with necessary modifications. A sustainable pharmacovigilance system will be established with Medical Technology and Supplies Office, Ministry of Health as the focal point for monitoring the safety of anti-tuberculosis drugs.

PP-69 AWARENESS AND KNOWLEDGE OF RURAL WOMEN ABOUT “HAND HYGIENE” IN PREVENTING TRANSMISSION OF GASTRO INTESTINAL AND UPPER RESPIRATORY TRACT INFECTIONS Rathnayake, B.M.C., Jayawardena, J.A.C.K. University of Peradeniya chameesh@gmail.com Background Gastro Intestinal Infections (GII ) and Upper Respiratory Tract Infections (URTI) have become some leading causes for morbidity and mortality globally and locally. These infections are contacted by contaminated foods or respiratory secretions, in which hands come into direct contact with them most frequently. Therefore, preventive methods of GII and URTI hand hygiene (HH) are highly recommended by scientists.

Though HH is an easily practicable health behavior in home setting, public unawareness and poor motivation can lead to spread of virulent micro-organisms.

PP-68 MAMMOGRAPHIC DIAGNOSIS IN SYMPTOMATIC BREAST DISEASES IN WOMEN REFERRED TO THE MAMMOGRAPHY UNIT, NATIONAL HOSPITAL SRI LANKA Bandara, L.M.H., Bandara, H.M.S.T., Attanayake, S., Gunathunga, M.W. Faculty of Medicine, University of Colombo 1harshanabandara@gmail.com Background Breast cancer is the commonest malignancy of women and the commonest cause for cancer related deaths in Sri Lanka.

Mammography is a noninvasive technique is for screening of breast cancer and in triple assessment of breast complaints in women above the age of 35 year. In this study mammographic results were described according to the Breast Imaging Reporting and Data System (BIRADS).

Aims This study was aimed to assess the knowledge of rural women about transmission of GII and URTI and the importance of HH in preventing them.

Methods A self administered questionnaire was distributed among 110 women in Delpitiya Grama Niladhari division in Kandy district who were selected through stratified sampling method. The questionnaire included questions that were designed to assess the knowledge on (i) health consequences of poor hand hygiene (ii) routes of infection transmission and (iii)concern of HH in domestic activities. Knowledge was assessed giving scores for correct answers.

Aims To assess the pattern of presenting complaints ,mammographic diagnosis in symptomatic breast disease and awareness regarding disease and available screening methods.

Methods Study carried out in a sample of 110 women referred to the mammography unit, National Hospital, Sri Lanka. An interviewer administered questionnaire was used and analyzed with SPSS version 17.0.

Results The respondent rate was 92%. Majority (86%) had educated up to grade 11. It was found that 84% and 86% of women scored more than 50% for the questions which assessed the (i) knowledge on health consequences of poor HH and (ii) routes of infection transmission respectively. Regarding the importance of HH in transmission of GII, majority (68%) identified more than 50% of correct responses. However, nearly 41% only selected correct responses for the questions which assessed the knowledge on the importance of HH in prevention of URTI. For the statement “Can respiratory tract infections be prevented through hand hygiene?” only 32% stated “yes”. Many (71%) responded that they did not care about the duration spent for hand washing at one washing.

Regarding the use of soap, majority (69%) responded that they use soap for every hand washing while 17% indicated that they use soap only after defecation.

Results Forty one (31%) had malignant potential (BIRADS > 4). Commonest presenting complaint was breast lump which was 70(63.6%) and 31 (45%) participants with breast lump had malignant potential. All cases with skin changes and 43.75% of cases with nipple discharge were associated with malignant potential. Among the study population 59 (53.3%) complaints were found incidentally, 45(40.9%) consulted general practitioner as first contact care and 58 (52.7%) referred by the consultant surgeons. Although there was an average awareness of Well Women Clinic (WWC) (n=66, 60%), he number of attendance is low (n=13, 11.81%). Practicing of self-breast examination also registers a low number, 27 (24.54%).

Conclusions Although the majority of women have a reasonable level of knowledge on health consequence of poor hand hygiene and mode of transmission specially related to GII, knowledge gaps were identified with regard to the importance of hand hygiene in prevention of URTI. Therefore, it is recommendable, that an effective and precise health education program series designed for this population is needed to improve their poor knowledge to a better status.

Conclusions Less common symptoms such as skin changes had more malignant potential. Majority of breast lumps are incidental findings presented mostly to the general practitioners and Out Door Patient Department and referred to mammography mostly by consultant surgeons. In symptomatic breast diseases proper clinical evaluation is utmost importance to minimize the unnecessary mammography and to avoid under recognition of malignant lesions. Awareness about the well women clinic and attendance to well women clinic should be encouraged.

PP-70 KNOWLEDGE AND PRACTICES REGARDING HEALTH-CARE WASTE MANAGEMENT AMONG UNDERGRADUATE NURSING STUDENTS IN SELECTED UNIVERSITIES OF SRI LANKA Madurangi, E.D.G., Meegoda, K.D.L. University of Sri Jayawardanapura gayanimadurangi@gmail.com Background Health care facilities generate and release large amounts of waste

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state examination (MMSE:<21 indicative of poor cognitive functions) were also administered. HbA1c levels were measured. Data were analyzed using SPSSv20.0.

materials which contain many pathogens and potentially toxic materials that can cause serious harm to staff members, patients, the general public and environment. Inadequate knowledge of potential hazards of medical waste and improper handling practices in the hospital can cause serious health problems as a result of inadvertent exposure to many potentially infectious materials .The occupational risk faced by these students and the potential exposure of others to these materials is serious concern, given their limited experience and proficiency in handling and disposal of health-care waste.

Results Mean age of the sample (n=31, males=25; females=6) was 62.71±7.70 (mean ± SD) years. The mean durations of diabetes and Metformin use were 11.42±7.29 and 9.48±6.66 years respectively. The mean Metformin daily dose was 1403.23±676.01 mg. Only 2 (6.5%) were vegetarians. All were symptomatic and mean m-DNS was 2.94±0.99.

Twenty nine (93.6%) scored more than 3 in m-DNE score. The daily dose of Metformin demonstrated a correlation with the m-DNS score (r=0.355, p =0.05). The mean MMSE score was 27.19±3.16. The daily dose or duration of Metformin treatment had no effect on the MMSE score. HbA1c was below 6.5% in 21(67.7%) and mean was 6.28±1.62%.

Aims To determine knowledge and practices regarding health-care waste management among undergraduate nursing students in selected universities of Sri Lanka and to make appropriate recommendations to strengthen their training.

Methods This was a descriptive cross- sectional study among 152 undergraduate nursing students in university of Sri Jayewardenepura and Ruhuna. A validated self-administered questionnaire was used for data collection and data analysis was done in the SPSS 16.0 version using the Chi square test.

Conclusions Metformin daily dose had a positive association with the symptom score.

Symptom scoring could be used as an indicator of Metformin related peripheral neuropathy. Patients on Metformin with high m-DNS would require the assessment of B12 levels, a correctable form of neuropathy associated with long-term Metformin use. Long-term use of Metformin had no significant effect on the cognitive functions assessed via MMSE.

Results Of the 152 students almost 58% were from University of Ruhuna and 42% were from University of Sri Jayewardenepura. Among them 80.3% were female and 19.7% were male. There was no significant association between sex and knowledge level (p>0.05). More than 75% female students and almost 67% male students had been average awareness.

Among fourth year students 57.4% had been average practice and 24.1% students had been good practice. More than 7% students always recap needles before discard 46% were sometimes recapped and others never recap needles before discard. 43.7% students'level of knowledge on waste management had been high and their practice was good.

PP-72 CHARACTERISTICS IN COMMUNITY PHARMACY IN THE KALUTARA MOH DIVISION IN RELATION TO CURRENT DRUG REGULATIONS OF SRI LANKA Nidangada, H.A.D.W. National Institute of Health Sciences, Kalutara wnidang@yahoo.com A community pharmacy is a community-based pharmacy which is responsible for appropriate procurement, storage, dispensing, consultation and documentation of medicines. Therefore, the community pharmacists should have a proper knowledge on Good Pharmacy Practice (GPP) and current drug regulations in Sri Lanka and skills to deliver this professional service.

Conclusions The data reveals that average level of Knowledge and practices regarding health-care waste management among most students, poor level of knowledge among few students. Based on the findings, it is very important to further improve nursing students' knowledge and practices to prevent and minimize contamination with health-care waste.

Aims To describe the characteristics of community pharmacy in the MOH area Kalutara in relation to current drug regulation of Sri Lanka in the 1st quarter of year 2009

PP-71 THE EFFECTS OF LONG-TERM METFORMIN TREATMENT ON NEURO-COGNITIVE PARAMETERS

Methods This descriptive cross sectional study was carried out in MOH area Kalutara. All the pharmacies (23) in the MOH area were selected for the study. Community pharmacists' knowledge was assessed by a self administered questionnaire and an observation checklist was used to collect data regarding setting of the pharmacy. Client pharmacist interaction was assessed by interviewing two random clients who were in the pharmacy at time of data collection.

Bandara, L.M.H., Dissanayake, D.W.N., Atapattu, P.M., Senevirathne, P.L.D.R., Upekshani, A.V.N.N. Faculty of Medicine, University of Colombo 1harshanabandara@gmail.com Background Metformin is widely used in patients with type 2 diabetes mellitus and is associated with vitamin B12 deficiency. Long-term treatment with Metformin may lead to neuropathy or exacerbate the existing peripheral neuropathy.

Results Analysis of data revealed that approximately 70% of pharmacists scored 40 percent or less for knowledge on GPP and current drug regulations in Sri Lanka. When consider the setting of pharmacy, the mean score obtained was 13.8% and it was highly unsatisfactory. However, 70% of clients are satisfied with the services delivered from pharmacy.

Aims To assess the correlation between treatment parameters and clinical neuro-cognitive parameters in patients who are on long-term Metformin

Conclusion Even though client pharmacist's interaction was satisfactory, the level of knowledge of pharmacists and setting of pharmacy was at an unsatisfactory level.

Method The study sample consisted of 31 patients having diabetic neuropathy symptoms who are on Metformin treatment for >2 years and attending the medical clinics of National Hospital, Sri Lanka. An interviewer administered questionnaire was administered. Modified diabetic neuropathy symptom (m-DNS> 1 indicative of Neuropathy) and examination (m-DNE:>3 indicative of neuropathy) scores, mini mental

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Method The study sample consisted of 30 patients who are on atorvastatin for more than 2 years and attending the medical clinics, National Hospital, Sri Lanka. An interviewer-administered questionnaire, and a modified neuropathy symptom (mNS>1 indicative of neuropathy) and examination (mNE>3indicative of neuropathy) scoring were used ascertain data. Total serum cholesterol (TC) and Low Density Lipoprotein (LDL) levels were measured. Data were analyzed by SPSS version 17.

PP-73 ASSESSING THE AWARENESS OF DIABETIC COMPLICATIONS AND SOME CORRELATES OF DIABETES IN A SELECTED POPULATION IN THE GANGODAWILLA AREA IN COLOMBO DISTRICT – A PILOT STUDY Raziya, M.S., Shifana, A.A.F., Athiththan, L.V. University of Sri Jayawardanapura razee89@yahoo.com

Results The Study population (n=30; males=13; females=17) had a mean age of 60.8±8.4 years (mean±2SD). Mean statin dose is 14±4.98mg and mean duration of both diagnosis and treatment of hypercholesterolemia with statin was 5.07±2.65 years. Ten (33.3%) had scored >1 in mNS and six (n=6;20%) had scored >3 in mNE. No relationship was observed with age and the mNS and mNE. There were significant correlations between disease/treatment duration and mNS (r= -0.495,p=0.005), mNE(r= 0.362,p=0.049). There were no correlations between drug dose with the mNS and mNE. No relationship was identified between TC (mean TC=159.1±31.5) and LDL (mean LDL=89.9±28.3) with mNS and mNE.

Background Diabetes Mellitus is a non-communicable disease which is increasing in the Sri Lankan population. It is associated with a number of complications Data on awareness and associated factors are important to plan the public health programmes.

Aims To assess the awareness of diabetic complications and some correlates of diabetes mellitus Methods An interviewer administered questionnaire was administered to 216 people (116 diabetic patients and 100 non-diabetic patients) who visited the Family Practice Centre at University of Sri Jayewardenepura during July 2012 to October 2012. Data were analyzed using SPSS 16.0 software. Chi-squared test and Fisher's exact test were used to determine the statistical significance for assessing the correlates of diabetes.

Conclusions The clinical parameters of neuropathy in the study group were not associated with dose of statin or the biochemical indicators of hypercholesterolemia. Duration of disease/treatment has improved the clinical parameters. Since the prevalence of clinical indicators exceeds the global prevalence rate, it is necessary to further investigate the underlying cause.

Results Out of the study sample 86.2 % diabetic patients and 65.0 % control were aware of diabetic nephropathy. Regarding other complications 85.3% of diabetics and 65.0% of non-diabetics were aware about retinopathy, while 85.3% of diabetics and 60.0% of non-diabetics were aware about foot ulcers. According to the results, diabetics were aware on diabetic complications more than the control subjects (nondiabetics). Hypertension (45%), hypercholesterolemia (86.2%), alcohol usage (11.2%), old age (51-65 years, 54.31%) and betel chewing (8.6%) were significantly (p<0.05) associated with diabetes. Sex, lack of exercise and family history of diabetes did not have any significant association.

PP-75 PREVALENCE AND CORRELATES OF SCHOOL READINESS AMONG CHILDREN AT SCHOOL ENTRY IN REGIONAL DIRECTOR OF HEALTH SERVICES (RDHS) DIVISION AMPARA Talagala, S. Regional Director of Health Services, Ampara talagalasenaka@yahoo.com Background School readiness is the stage of human development that enables a child to engage in, and benefit from primary learning experiences.

Conclusions Above 75% of the study sample were aware about the major diabetic complications such as nephropathy, retinopathy and foot ulcers.

Hypertension, hypercholesterolaemia, alcohol usage, old age and betel chewing were some correlates of diabetes mellitus

Aims This study was aimed at defining school readiness, development and validation an instrument to assess the prevalence of school readiness, assessing the prevalence using the instrument in a sample of children at school entry and determining the correlates of school readiness.

PP-74 THE EFFECTS OF TREATMENT PARAMETERS ON STATININDUCED PERIPHERAL NEUROPATHY

Methods The school readiness instrument was validated by content analysis and criterion validity. It was found to be a valid instrument to assess school readiness of children at school entry. Altogether five domains of school readiness were assessed, i.e. fine motor development, language development, pre-mathematical skills, memory and gross motor development in the study group.

Bandara, H.M.S.T., DissanayakaD.W.N., Atapattu, P.M., Manchanayake, M.A.N., Tissera, H.C., Batagoda, S.S. Faculty of Medicine, University of Colombo sajithbandara77@gmail.com

Results The prevalence of school readiness was assessed in a sample of 707 children aged between 59-71 months residing in the RDHS Division Ampara. The prevalence of fine motor, memory and language development was more than 90% for all children. The gross motor development and mathematical skills both were comparatively low in prevalence. Overall, 52.3% of students were found to be ready for school in all five domains. The duration of preschool education for 9 months or more, exclusive breast feeding for 4 months, educational expectations of the mother and the birth weight had statistically significant associations with the school readiness (p < 0.05). The type of family, age of the mother at the delivery of child, educational level of mother and educational level of father were not statistically associated (p> 0.05) with the school

Background Atorvastatin is increasingly being used in primary prevention of cardiovascular diseases as a first line drug in Sri Lanka. Development of peripheral neuropathy is an adverse effect, which is reversible if statins are stopped early. Global prevalence rate of statin-induced peripheral neuropathy is about 10%.

Aims To describe the prevalence of statin-induced peripheral neuropathy and to assess the association between drug dose and duration of treatment with clinical and biochemical parameters of neuropathy

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Aims To invent a new technique for electrification of the inflation cuff of the mercury sphygmomanometer

readiness. In the logistic regression analysis, preschool education for 9 months or more (OR=1.45) and exclusive breast feeding for 4 months (OR=1.96) were detected as protective factors for schools readiness.

The p values were 0.014 and 0.033 respectively.

Methods At first, 12V DC micro compressor was selected as an inflator to inflate the cuff. The motor of the micro compressor was controlled by a computer mouse, which functions as a control unit of the sphygmomanometer. The power supply to the meter was controlled by on/off switch on the left side of the mouse. The right and the left click switches of the mouse controlled the 3 relays and, relays would control the micro compressor and the solenoid valve for releasing the cuff. Since the mouse is considered as a compact and a familiar device for everyone's use, this use of this sphygmomanometer too becomes easy.

High pressure sensor was used in the unit to cut off the maximum pressures. Two LEDs were fixed on the front panel to indicate the operations. USB port and a cuff connector were connected on the front panel. AC mains could be used with AC to 12V DC power supply to the unit.

Conclusions The validated study instrument could be used as a screening instrument in the community, especially for vulnerable groups for early identification of children with learning difficulties. The educational authorities could take necessary measures to streamline the preschool education in a view of improving the educational opportunities of children. The health authorities should concentrate more on strengthening the breast feeding programme in the country.

PP-76 TO DETERMINE REASONS FOR INTERRUPTION OF MULTI DRUG TREATMENT AMONG TUBERCULOSIS PATIENTS AT CHEST CLINIC, KURUNEGALA

Results By applying this new technology, time wastage could be minimized by right clicking of the mouse to inflate the cuff and the left clicking of the mouse to release the cuff. The product obtained the patent from the National Intellectual Property Office of Sri Lanka. The product has been appreciated by the Biomedical Engineering Services of the Ministry of Health of Sri Lanka.

Balasooriya, B.M.S.P.G Provincial Health Training Centre, Kurunegala sagarabalasuuriya@gmail.com Background Tuberculosis (TB) is a bacterial infection. For the prevention of TB, it is essential that recognized TB patients get cured. However, 26% of patients interrupted their treatment in Kurunegala District in 2007. This poses threats to the TB control measures in Kurunegala District.

Conclusions An intervention of electrically control mercury sphygmomanometer through a computer mouse was a good technique to improve the efficacy of that meter and to reduce the time wastage.

Aims To identify possible reasons for the treatment interruptions of TB patients

PP-78 A SURVEY TO ASSESS THE LEVEL OF AWARENESS REGARDING THALASSEMIA IN ANTENATAL MOTHERS

Methods Data was collected from the sputum positive TB patients, who did not continue the treatment but registered at Kurunegala Chest Clinic in 2007. Interviewer admitted questionnaire was used to collect data from these patients. Descriptive statistics were calculated.

Jayasinghe, P.K.C.L., Gunasekara, K.V.N.N. GH Ampara ghampara@gmail.com

Results Main reasons for the treatment interruptions were poor economy (53%), lack of knowledge on consequences of treatment interruption (44%), less support of family members on treatment (44%). Some other reported reasons were lack of proper advice, disliking of drugs, side effects of drugs, disliking of DOTs method.

Introduction Thalassemia is the most common genetic disease in Sri Lanka. If not treated it could result in early childhood death. On average, a child with thalassemiais is born in every 4 days. But it is a preventable disease.

Conclusions According to the study poor economy, lack of knowledge on consequences of treatment interruption and less support of family members has influenced on treatment interruption.

Aims To establish and uplift ongoing preventive programmes for thalassemia in Ampara District and to help national programe on Thalassemia prevention in total elimination of the disease from Sri Lanka in 8 years.

PP-77 ELECTRIC CONTROLLED MERCURY SPHYGMOMANOMETER

Methods A pre-tested self administered questionnaire was given to the antenatal mothers who were registered in antenatal clinic (n = 393), General Hospital Ampara from 21.04.2012 to 21.07.2012.

Marshal, P. DH Kilinochchi marshal.prasad@gmail.com

Results There were 2.7% consanguineous marriages. Majority of antenatal mothers stated thalassemia is an inherited blood disorder (59%), 4.07% said it was a contagious disease, 5.08% think it was a viral disease, 2.54% patents said thalassemia is a cancer, 20.8% of mothers did not know about thalassemia. Almost all the mothers have not undergone thalassemia screening test before or after their previous pregnancies.

Thirty percent of mothers were not aware about the test and 40.7% did not know where the test is available. Mothers who were willing to do the test in the future were 21%. Financial reasons were an issue in 4.07%of mothers for not performing test.

Background Several types of sphygmomanometers are available in the medical field.

Among them, the mercury sphygmomanometer is considered as the most accurate. Most problems related to this type of sphygmomanometer occur in the inflation bulb, such as air leak in the inflation bulb and leaks or blocks in the control & non return valve.

Manual use of the sphygmomanometer may worsen these problems.

Inflation of the cuff manually may lead to time wastage.

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Conclusions Fifty nine percent of people knew thalassemia is an inherited blood disorder. Almost all the mothers have not undergone thalassemia test.

faculty, university of Ruhuna. The principal investigator distributed the survey forms just after the completion of OSH lecture series and collected after about 15 minutes.

PP-79 MATERNAL CHILD HEALTH MANAGEMENT INFORMATION SYSTEM

Results Out of the 130 students in the batch, 118 were participated in the survey.

Overall interest of medical students towards OSH was low with a mean of 2.8+ SD=1.1 on a scale 1=very low to 6=very high. About 55% of students rate OSH as less relevant to medical students. However, 63.6% of students rate their knowledge as high in OSH after the lecture series.

Becoming an occupational health physician was identified as an option only by 3 (2.5%) students. However, majority (60.1%) of students identified the importance of diagnosing a disease as an occupational disease. About 89% of students identify the need of reporting occupational diseases by all the physicians.

Manoj, M.S. Department of Informatics, University of Oslo, Norway subodha.manoj@gmail.com Introduction Sri Lanka is having good Maternal and Child Health statistics reflecting the efficiency and the efficacy of its Maternal and Child Health Care program. In the current Maternal and Child Health Program, data is collected from the field level and disseminated in paper-based forms.

The Existing Maternal and Child Health Management Information system is having some limitations regarding quality of data, gaps in timeliness, poor monitoring of data and feedback. An important component of any Health program is its Information Management System.

Conclusions Overall interest of medical students towards OSH was low and therefore it is necessary to popularize this among medical students to cater the country's future need.

PP-81 FATHERS' PARTICIPATION IN INFANT FEEDING: ASSOCIATED FACTORS AND MOTHERS' SATISFACTION, IN MOH AREA KALUTARA

Aims To customize District Health Information Software package to manage the information flow of a selected area of the maternal and child health program

Godakanda, I.P. Family Health Bureau, Colombo indu_kgp@yahoo.com

Methods A software system was developed by customizing District Health Information Software package. District Health Information Software is designed to manage aggregated Health Information and it is a component Health Information Management tool kit recommended by the World Health Organization. This Software is further customized to meet the demands of the Sri Lankan Maternal and Child Health program.

Background First year of life represents the most crucial period of the life. Malnutrition during this period is responsible for more than half of the deaths that occur in childhood globally. As care givers, mainly the mother and the father are responsible for timely, safe and adequate feeding practices during infant feeding. Fathers' involvement and participation in infant feeding is low in most of the families due to various reasons though the father can play an important role in this regard.

Results Customized software could be efficiently utilized in the maternal and child health information systems, and integrated to national health information systems, which eliminates fragmentation.

Aims To determine the level of fathers' participation in infant feeding by selected socio-cultural and demographic factors and the mother's satisfaction regarding husband's participation.

Conclusions Vendor neutral open source software provides the resources to develop most of the Health Information Management systems. By following open standards; quality, productivity, cost management and data safety can be improved.

Methods Descriptive cross sectional study was done among 421 families having children between six to twelve months age in Kalutara Medical Officer of Health area. Fathers' participation was assessed by questioning the mothers using an interviewer administered questionnaire. Study units were selected by simple random sampling and the sampling frame prepared from the Birth and immunization registers of every PHMM areas.

PP-80 ATTITUDES OF MEDICAL STUDENT'S FOR OCCUPATIONAL SAFETY AND HEALTH De Silva, P.V. Medical Faculty, University of Ruhuna pvdesilva@med.ruh.ac.lk

Results Fathers' help to the mother reported as “poor” during breast feeding as 10.6% and buying complementary foods, as 15.4%. It showed poor level during maintaining baby's personal hygiene as 21.1% and in maintaining of baby's growth monitoring as 21.6%. Fathers' participation regarding food preparation, feeding and storage as 26.1%, in keeping good personal hygiene of the baby 21.1% and in growth monitoring of the infant 21.6% showed “poor” level. Non Sinhalese fathers showed “poor” participation in breastfeeding (20.3%), buying complementary foods (31.5%, p<0.05), food preparation, feeding and storage of baby's foods (48.2%, p<0.000), baby's personal hygiene (48.1%, p<0.000) and baby's growth monitoring as (51.7%, p<0.000). Lower educational level fathers showed “poor” participation in breastfeeding (15.5%, p<0.000), buying complementary foods (24.8%, p<0.000), baby's food preparation, feeding and storage (37.2%, p<0.000), maintaining baby's hygiene (31.6%, p<0.000), and baby's growth monitoring (32.9%,p<0.000).

Mothers' satisfaction regarding husbands' participation in breastfeeding and buying complementary foods for was in 90.0% level. About 72% of mothers were not satisfied in feeding the baby, baby's food preparation

Background Occupational health is an important part of community medicine under graduate medical curriculum in Sri Lanka. However, occupational safety and health (OSH) is a neglected area in Sri Lanka. There is a need of trained physicians in OSH with the rapid industrialization of the country.

However, getting medical students interested for OSH is challenging due to various reasons.

Aim To assess the attitudes of medical students on OSH in the Medical Faculty, University of Ruhuna Methods A cross sectional survey was performed using a self-administered questionnaire among one batch of 4th year medical students of medical

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and storage.

PP-83 HEALTHY VILLAGE INITIATIVE: INNOVATIVE APPROACH TO ADDRESS DIVERSE HEALTH ISSUES IN A COMMUNITY

Conclusions Low level of fathers' participation in infant feeding may be due to fathers less knowledge and priority to those activities. It can be due to health workers are mainly targeting mothers only to educate their infant's feeding.

Sujeewa, J. National Institute of Health Sciences, Kalutara.

Background Health issues in communities are complex and inter-related. Thus the integrated activities are needed to address all aspects of the health issues.

PP-82 COMMON ORAL DISEASES: KNOWLEDGE AND PRACTICES AMONG PUBLIC HEALTH MIDWIVES IN PUTTALAM DISTRICT

Aims Implement an integrated package of healthy initiatives to address array of health issues with communities

Fernando, S., Kanthi, R.D.F.C. Health Education Bureau, Colombo kanthi.rdfc@gmail.com

Methods Gayan Upendra Mawatha community was identifies as a model community to develop. A baseline survey was conducted to identify the health issues in the selected community. Following the analysis of baseline survey, an array of activities was implemented to address the identified health issues in this community. Some of the interventions included separation of waste based on the type and use the degradable materials to produce compost; implementation of innovative waste water management system; screening and health promotion pertaining to non-communicable diseases; promotion of mental health by regular discussions; introduction of proper hand washing techniques etc.

Multidisciplinary human resources in the Medical Officer of Health Office were utilized for interventions.

Background It is debatable whether oral health care has adequately been integrated into the mainstream preventive health services.

Aims To assess the level of oral health knowledge and level of oral health care practices of Public Health Midwives (PHMM) in Puttalam District, in relation to selected socio demographic, socio-economic and known contributory factors Methods The study design was a descriptive cross-sectional survey. The survey was carried out in the months of August and September in 2006. Study population was the total number of PHMM, employed in Puttalam District. Out of 156 PHMM employed, 139 participated in the study. Oral health care practices of PHMM were further evaluated by interviewing a sample of 225 mothers under the care of PHMM, representing all 09 Medical Officer of Health (MOH) areas in Puttalam District. A selfadministered questionnaire was used to collect data from PHMM. All PHMM employed in Puttalam District during the study period were considered as eligible to participate in the study. A non-probability convenient sampling methods was used to select the sample of mothers, as the investigator was pressed for time and resource.

Results The selected community consists of 31 families, 88 adults and 29 children less than 18 years of age. About 80% of households didn't have a proper waste water management system at the baseline. This was improved to 29 households in two months period since the baseline survey. None of the people smoke in community in the follow-up survey which was 6 in the baseline survey. Only 13% (n = 3) of households produce compost from the households waste and all households produce the compost at the two months of follow-up. About 15% and 7% of adult population reported to have diabetes and hypertension in the screening. Follow-up survey indicated that the health behaviors and health related structural changes have considerably improved.

Results Participation of the PHMM was 89%. PHMM in Puttalam District were Sinhala (except for only one Tami participant). The majority belonged to the age group of 30-40 years. Most of the PHMM were married and had children. Location of residence was closed by to the place of work, of the majority of the PHMM. They were fairly well educated, but lacked motivation. In service trainings the PHMM have received were mostly related to maternal and general, infant and child and available oral health knowledge of PHMM in Puttalam District was poor. For all the components of oral health knowledge tested (general, maternal, infant/child and available services), the obtained marks were below 50%. Significant associations were observed between the level of education (P= 0.047), duration of service (P=0.037) and, oral health knowledge related to infants and children. Association between the exposure to in-service training on oral health knowledge was significantly poor among the PHMM who have received oral health inservice training (P=0.042). Level of oral health care practices increased significantly with the age (P=0.034) and parity (P=0.057) of the PHMM. Level of education had a significantly “inverse” association with the level of oral health care practices (p=0.050), as mean practice score was lower among the PHMM who were educated up to General Certificate in Education (Advanced Level) (G.C.E. A/L) than the PHMM who had General certificate in education (Ordinary Level) (D.C.E. O/L) qualification.

Conclusions Integrated activities with multi-sector collaboration assist to achieve the concept of “healthy village”.

PP-84 CRITICAL EVALUATION OF THE MEDICAL LABORATORY TECHNOLOGY CURRICULUM Ketipearachchi S., Shafeek, N.M., Lakmali K.A.I. Regional Training Center Galle, School of Medical Laboratory, Teaching Hospital, Peradeniya siripala.katipe445@gmail.com Background SPICES model introduced by Ronald M. Harden consists with six continuums, considered as an innovative approach in medical education. It has been used by many experts to develop tools for curricular evaluation. Medical laboratory technology (MLT) education taught at schools of MLT, with the curriculum developed by experts in the field, was last revised in 1998 and remains unchanged for a period of 15 years.

Conclusions The level of oral health knowledge and level of oral health care practices of Public Health Midwives (PHMM) in Puttalam District are unsatisfactory.

Aims To evaluate the Present MLT curriculum taught at school of MLT.

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Methods A group of trainees in the Tutor Training Diploma and one educational science expert participated in the evaluation. A Course Evaluation Tool Based on SPICES Model developed by Changiz et.al. was used for the assessment. The MLT curriculum was compared and evaluated using the tool and placed between conventional and SPICES model with respect to each continuum.

stigmatizing agreed terminology to communicate the concept of depression between psychiatrists and patients. However, there are local lay terms and concepts, which may signify depression such as 'Peretha Doshaya'. In the FGDs participants agreed depression was more akin to 'Epaweema' and 'Kalakireema' rather than 'Duka' which is a very common everyday experience ('people commit suicide not because they have 'Duka' but when they have 'Epaweema').

Results The place of MLT curriculum, from Conventional Teaching Learning Method to SPICES model will be as follows: Teacher Centred / Student Centred (2); Information Gathering / Problem Based (2); Disciplinary Based / Integrated (3); Hospital Based / Community Based (2); Standard Programs / Electiveness (1); Systematic / Apprenticeship (1).

Conclusions The concept of depression is existent in Sri Lanka; however, the instruments need to be made following a rigorous validation which is inclusive of a cultural adaptation, since there are cultural specificities of this concept as expressed by the psychiatrists.

Conclusions MLT Curriculum stands more at Conventional Teaching Learning methods end and steps should be taken to make it more towards SPICES model continuums.

PP-85 DEFINING DEPRESSION FOR SRI LANKA Ferdinando, R. National Institute of Health Sciences, Kalutara ruwanferdinando@gmail.com Background Whether the concept of depression, which has been defined in the West, is present in Sri Lankan society, as it appears the West, is a debatable question. Cultural modification of depressive disorder is an important topic of ongoing research. Culture is a set of guidelines (both explicit and implicit) that individuals inherit as members of a particular society, and which tells them how to view the world, how to experience it emotionally, and how to behave in it in relation to other people, to natural and supernatural environment.

Aims To define the concept of depression to Sri Lanka as a preliminary step in a study of validating two depression measuring instruments developed in the West and assessing depression in a Sri Lankan context Methods The concept of depression was investigated for cultural adaptability in 3 settings: (1) The conceptualization of depression among depressed patients at the Psychiatric Clinic General Hospital, Kalutara was studied using an interview based on the Short Explanatory Model Interview (SEMI); (2) A self-administered postal questionnaire was mailed to all practicing psychiatrists in Sri Lanka which contained information regarding 'cultural specificity' of depression in Sri Lanka, the terms the psychiatrists use to communicate the diagnosis of depression to lay people, the appropriateness and validity of measuring depression according to the Western standards (ICD-10 and DSM-IV) etc.; (3) A focus group discussion was held with the objective of identifying the 'idioms of distress' the lay people use to express the experience of depressed mood and to find out the appropriate terms to be included in the instrument being translated. Even though these people are not depressed now, it is most likely that they know about these experiences from their past experiences or from others' experiences.

Results The concept of ICD-10 depressed mood is existent in the Sri Lankan community as expressed by psychiatrists. However, there are cultural presentations in Sri Lanka which may be poorly detected by the instruments based on ICD-10 criteria alone according to the some psychiatrists. The conceptualization of depression among the depressed patients as revealed by SEMI is not based on Western concept of depression. Depressed people and the general public don't have knowledge about and they do not use the presently accepted technical terms of 'Western' depression. There is no appropriate non-

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ORGANIZING COMMITTEE ORGANIZING COMMITTEE MEMBERS

Co- Chairs Dr. Sunil de Alwis, Deputy Director General (Education, Training and Research), Ministry of Health Dr. Lakshman Gamlath, Director, National Institute of Health Sciences

Dr. Malika Karunarathna Dr. Nandalal Wijesekera Dr. W.M.P.A. Fernando Dr. Samantha Ramachandra Dr. Anoma Mannadi Dr. Kamanie Wijesekera Dr. Chandima Abeysinghe Dr. Ruchith Priyananda Dr. T.Y. Kulatunga Dr. Gayani Wickramasekara Dr. Zayana Cader Dr. U.P. Paranamana Dr. Chithrani Lenadora Dr. Chaminda Senevirathne Dr. Charitha Poruthota Dr. P. Fernando Dr. T. Karunarathne Dr. Matanga Gunawardhana Dr. M. G. Sajeewa Lakmini Dr. Chatura Delpachitra Dr. Thushara Edirisinghe Dr. Fouzi Sherrif Dr. Anusha Vidyaratna Dr. Thamali Karunaratna Dr. Pradeep Fernando Dr. Prasangika Weerasooriya Dr. Chinthaka Sanjeewa Mr. Premachandra Mr. R.M.D. Danapala Mr. Sarath Kaludewa Mr. Nimal Karunarathne Mr. Lasitha Mendis Mr. R.J. Sinhabahu Mr. Y.R.K. De. Silva Mrs. Hema Lalani De Silva Mrs. J.A.T .Jayakody Mrs. M.R. C. De Silva Mrs. R.L.S. Rajapaksha Ms. P.D. Kusumalatha Mrs. Chandra Geekiyanage Mrs. Menaka Ukwatta Mrs. Nilmini Kumari Mrs. R.S.L. Rajapaksha Mrs. B.M.N.K. BalasuriyaMenike Mrs. Srimathi Samarasinghe Mrs. Anusha Jeevani Hewage Ms. A.M.K. Hemalatha Mrs. K.A.S. Perera Mrs. N.Parameshwaree

Secretary Dr. Sumal Nandasena Abstracts Review Process, Selection, Conference Book Preparation Focal Point Dr. Ruwan Ferdinando Symposia Focal Point Dr. Lakmini Magodaratna Registration Focal Point Dr. Saman Gamage Oral Presentations Focal Point Dr. Samitha Sirithunga Poster Presentations Focal Point Dr. Lakshman Walpola Meals and Refreshments Focal Point Dr. Yoga Senarathne Publicity and Accommodations Focal Point Dr. Shiromalee Ferdinandez Inaugural Session Focal Point Dr. Sriyani Ranasinghe Pre-Congress Workshops and Field Tours Focal Point Dr. Chintha Gunarathna Fund Raising Focal Point Dr. Nishan Jayamuni Ground Planning Focal Point Dr. Rajitha Suwaris Website and Information Technology Focal Point Dr. Deepal Wirasooriya 108

THE ABSTRACT REVIEW TEAM Professor Marilys Guillemin Professor Martha McIntyre Professor Amna Rehana Siddiqui Professor Nalini Sathiakumar Professor Arun Kumar Professor Masood Kadir Professor Ramachandra Kamath Professor Rohini Seneviratne Professor M. Wasantha Gunathunga Dr. Champika Wicramasinghe Dr. Renuka Jayatissa Dr. Janaki Vidanapathirana Dr. Nalika Gunawardena Dr. Sriyakanthi Beneragama Dr. Sampatha Goonawardena Dr. Santhushya Fernando Dr. S.M. Arnold Dr. M.C. Weerasinghe Dr. Rasanjalee Hettiarachchi Dr. Sanjeewa Godakandage Dr. Kapila Jayaratne Dr. Vindya Kumarapeli Dr. Shamini Prathapan Dr. Manjula Danansuriya Dr. Dhammica Rowel Dr. Inoka Surweera

ICPHI INAUGURATION CEREMONY nd

2 MAY 2013 AT THE AUDITORIUM OF NIHS KALUTARA

AGENDA 5.00 p.m.

Lighting of the oil lamp

5.05 p.m.

NIHS School Song – NTS Students, NIHS and NIHS Staff

5.10 p.m.

Welcome speech by Dr. Lakshman Gamlath, Director NIHS

5.15 p.m.

Speech by Dr. Firdosi R. Mehta, The WHO Country Representative, Sri Lanka

5.20 p.m.

Speech by Dr. Nihal Jayathilake, The Secretary of Health

5.25 p.m.

Speech by Honorable Maithripala Sirisena, The Minister of Heath

5.30 p.m.

Key Note Address “Public health challenges in South Asia”

By Prof. Nalini Sathiakumar, University of Alabama at Birminham, USA Citation - Dr. Sumal Nandasena, Consultant Community Physician, Head , Department of Research, WHO CC NIHS, Kalutara

6.10

p.m.

Vote of Thanks by Dr. Ruwan Ferdinando, Deputy Director (Training), NIHS

6.15

p.m.

High Tea at “Poster Presentation & Refreshments Venues”

7.00

p.m.

Cultural Show at Auditorium

8.00

p.m.

Reception at Cafeteria

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Acknowledgements w Hon. Maithripala Sirisena – Minister of Health w Hon. Lalith Dissanayake – Deputy Minister of Health w Dr. Y. D. Nihal Jayathilaka – Secretary, Ministry of Health w Dr. P. G. Mahipala – Director General of Health Services w Dr. Sunil De Alwis – Deputy Director General Education Training & Research w Dr. F. R. Metha and staff of WHO Country Office of Sri Lanka w Professional staff of the WHO - SEARO Office w Prof. Nalini Sathiakumar – Keynote Speaker, University of Alabama, USA w Mr. S.A. Dharmawardhana – Accountant, National Health Development Fund w All resource personnel of free paper sessions w All chairpersons and members of symposia w All chairpersons and panel members of free paper sessions w All those who implemented and submitted their innovative work w External experts who reviewed the abstracts w All staff of NIHS w All Sponsors of the conference The Organizing Committee wishes to express its sincere thanks to all those who have contributed in numerous ways in making this event a success and inadvertently whose names might have got omitted from this list. Our apologies if there are any such omissions.

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