The state of primary health care in south Asia.

The south Asian region (SAR) is home to 1·74 billion people, corresponding to 22% of the global population. The region faces several challenges pertaining to changing epidemiology, rapid urbanisation, and social and economic concerns, which affect health outcomes. Primary health care (PHC) is a cost-effective strategy to respond to these challenges through integrated service delivery, multi-sectoral action, and empowered communities.

Improving urban health through primary health care in south Asia.

South Asia is rapidly urbanising. The strains of rapid urbanisation have profound implications for the health and equity of urban populations. This Series paper examines primary health care (PHC) in south Asian cities.

Assessing the WHO-UNICEF primary health-care measurement framework; Bangladesh, India, Nepal, Pakistan and Sri Lanka.

Objective: To assess the availability of information on indicators of the World Health Organization and United Nations Children's Fund primary health-care measurement framework in Bangladesh, India, Nepal, Pakistan and Sri Lanka and to outline the opportunities for and challenges to using the framework in these countries.

Methods: We reviewed global and national data repositories for quantitative indicators of the framework and conducted a desk review of country documents for qualitative indicators in February-April 2023. We assessed data sources and cross-sectional survey tools to suggest possible sources of information on framework indicators that were not currently reported in the countries.

Prevalence of pretreatment drug resistance in persons initiating and reinitiating antiretroviral therapy in Sri Lanka: results from a national representative survey.

Background: We conducted a nationwide cross-sectional study to estimate pretreatment drug resistance (PDR) prevalence in adults initiating ART in Sri Lanka following the WHO's recommendations.

Methods: HIV drug resistance was determined on dried blood spots (DBSs) using population-based sequencing of the protease and reverse transcriptase genes and interpretation was based on Stanford HIVdb v9.0.

HIV-1 pol gene diversity and molecular dating of subtype C from Sri Lanka.

Background: The first case of HIV infection in Sri Lanka was reported in 1987 and at the end of 2018 there were 3500 people living with HIV. There have been commendable efforts made towards the detection, treatment, and prevention of HIV in the country. Even though the genetic diversity of HIV has been shown to affect the parameters ranging from detection to vaccine development, there is no data available with respect to the molecular epidemiology of HIV-1 in Sri Lanka.

Inequalities in the prevalence of diabetes mellitus and its risk factors in Sri Lanka: a lower middle income country.

Background: Explorations into quantifying the inequalities for diabetes mellitus (DM) and its risk factors are scarce in low and lower middle income countries (LICs/LMICs). The aims of this study were to assess the inequalities of DM and its risk factors in a suburban district of Sri Lanka.

Methods: A sample of 1300 participants, (aged 35-64 years) randomly selected using a stratified multi-stage cluster sampling method, were studied employing a cross sectional descriptive design.

Risk of unsafe abortion associated with long-term contraception behaviour: a case control study from Sri Lanka.

Background: When faced with an unintended pregnancy, some women choose to undergo an unsafe abortion, while others do not. This choice may depend on long-term contraception that shapes the fertility goals of women, along with many other risk factors. We assessed the risk for unsafe abortion associated with contraceptive practices based on women's long-term behaviour, and its likely modification by the use of different types of contraceptives among women in Sri Lanka.

Relationship of family formation characteristics with unsafe abortion: is it confounded by women's socio-economic status? - A case-control study from Sri Lanka.

Background: Literature shows that choice for unsafe abortion is often driven by poverty. However, factors related to the family formation behaviour of women are also implied as determinants of this decision. This study assessed which family formation characteristics of women are associated with the risk of unsafe abortion, without being confounded by their low socio-economic status among Sri Lankan women admitted to hospital following post-abortion complications.

Development and Validation of a Measure of Quality of Life for the Young Elderly in Sri Lanka.

Sri Lanka has one of the fastest aging populations in the world. Measurement of quality of life (QoL) in the elderly needs instruments developed that encompass the sociocultural settings. An instrument was developed to measure QoL in the young elderly in Sri Lanka (QLI-YES), using accepted methods to generate and reduce items.

Genetic, familial and environmental correlates of asthma among early adolescents in Sri Lanka: a case control study.

Background: Despite advances in management, the mortality and morbidity due to asthma are increasing globally. Identification of specific correlates in the local context is useful in disease management. The objective of this study was to estimate the prevalence and to describe selected correlates of asthma among12-14 year old school children in a district in Sri Lanka.

Decision making on unsafe abortions in Sri Lanka: a case-control study.

Background: Following an unintended pregnancy, not every woman would invariably choose to undergo an unsafe abortion. It suggests that in the decision making process, women face both 'push' factors that favour abortion and 'pull' factors that work against it. This study assessed the circumstances that surrounded a woman's decision to undergo an unsafe abortion, compared to a decision to continue, when faced with an unintended pregnancy in Sri Lanka.

Usual hospital care versus post-abortion care for women with unsafe abortion: a case control study from Sri Lanka.

Background: Good quality post-abortion-care (PAC) is essential to prevent death and long-term complications following unsafe abortion, especially in countries with restrictive abortion laws. We assessed the PAC given to women following an unsafe abortion, compared to the routine hospital care following spontaneous abortion or unintended pregnancy carried to term in Sri Lanka.

Methods: A case-control study was conducted in Sri Lanka among 171 cases following unsafe abortion, 638 controls following spontaneous abortion (SA-controls) and 600 women following delivery of an unintended pregnancy (TUP-controls) admitted to same hospitals during the same period.

Psychometric properties of the Sinhala version of the PedsQL™ 4.0 Generic Core Scales in early adolescents in Sri Lanka.

Background: The concept Health related Quality of life (HRQOL) is increasingly recognized as an important health outcome measure in clinical and research fields. The present study attempted to evaluate the psychometric properties of the Sinhala version of the Pediatric Quality of Life Inventory™ 4.0 (PedsQL™ 4.

Some sociological aspects of cutaneous leishmaniasis in patients attending a tertiary referral centre in Colombo, Sri Lanka.

Over 1800 clinically suspected cases of cutaneous leishmaniasis have been referred to the Department of Parasitology, Faculty of Medicine, Colombo, Sri Lanka for investigation since 2001. This study analyses some sociological aspects of 120 patients with laboratory confirmed cutaneous leishmaniasis. This information is important to design and implement control programmes.

Absence of asymptomatic malaria infections in previously high endemic areas of Sri Lanka.

As the goal of malaria elimination from Sri Lanka is currently being pursued, this study was planned to determine the prevalence of asymptomatic malaria infections. Five health areas in Trincomalee and Kurunegala districts that reported high prevalence in the recent past were purposively selected. The smallest administrative units (GN divisions) having high malaria risk within each area were identified.

A "usual occurrence:" stress incontinence among reproductive aged women in Sri Lanka.

Stress urinary incontinence (SUI) is a common condition among women of all ages, often with devastating consequences, such as depression, anxiety and reduced quality of life. Researchers have largely focused on its prevalence and clinical management, particularly in highly industrialized country settings. In this article, drawing on epidemiological, clinical and qualitative research undertaken in Sri Lanka, we discuss how stress incontinence affects women's lives and how they personally manage the problem.

Health-related quality-of-life in patients with head-and-neck cancer in Sri Lanka: psychometric properties of the 'Sinhala' version of the EORTC QLQ-H&N35.

Objective: To translate and validate the 'Sinhala' language version of the European Organization for Research and Treatment of Cancer head-and-neck cancer-specific health-related quality-of-life questionnaire module, the QLQ-H&N35, for use in Sri Lanka.

Methods: Psychometric testing assessed the hypothesized scale structure, scale reliability, construct validity and acceptability of the translated version of the QLQ-H&N35 in a consecutive series of 196 newly diagnosed head-and-neck cancer patients, recruited from tertiary-care oncology treatment centres in Sri Lanka.

Results: Compliance was high (97.

Sleeping arrangements under long-lasting impregnated mosquito nets: differences during low and high malaria transmission seasons.

Sleeping arrangements under long-lasting impregnated nets (LLIN) were recorded in 2467 households during the low malaria transmission season (May-June 2007) and the same families were followed up during the high malaria transmission season (December 2007-January 2008) in two malaria-endemic areas of Sri Lanka. Approximately 800 households each from the three main ethnic groups were studied. The number of families lost to follow-up was 68.

Measuring breast cancer-specific health-related quality of life in South Asia: psychometric properties of the Sinhala version of the EORTC QLQ-BR23.

Objective: To evaluate the psychometric properties of the Sinhala version of the breast cancer-specific health-related quality of life (HRQL) module of the European Organization for Research and Treatment of Cancer (QLQ-BR23).

Methods: Psychometric testing assessed the hypothesized scale structure, internal consistency, construct validity and acceptability of the Sinhala version of the QLQ-BR23 in a consecutive series of 356 newly diagnosed breast cancer patients recruited from tertiary care oncology treatment centres in Sri Lanka.

Results: Compliance and self-completion rates were high (98% and 88%, respectively), and missing data low (0.

Quality of life in cancer patients in South Asia: psychometric properties of the Sinhala version of the EORTC QLQ-C30 in cancer patients with heterogeneous diagnoses.

Background: The European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30) was evaluated for its psychometric properties in a sample of cancer patients from the culturally distinct South Asian subcontinent, which accounts for a significant proportion of the global cancer burden.

Methods: Psychometric testing assessed the hypothesised scale structure, internal consistency, content and construct validity, and acceptability of the Sinhala version of the QLQ-C30 independently in two heterogeneous groups of cancer patients at pretreatment (N = 489) and during treatment (N = 343).

Results: Qualitative feedback from an expert panel assessing content validity recommended measuring family support during illness as an additional, culturally-relevant dimension of health-related quality of life (HRQL).

Psychometric evaluation of the European Organization for Research and Treatment of Cancer in-patient satisfaction with care questionnaire ('Sinhala' version) for use in a South-Asian setting.

Background: Patients' satisfaction with cancer care has not been studied in detail in the South-Asian region in spite of rising cancer incidence.

Objective: To validate the 'Sinhala' translation of the European Organization for Research and Treatment of Cancer (EORTC) in-patient satisfaction with care questionnaire (IN-PATSAT32) in Sri Lanka.

Method: We administered the translated version of the IN-PATSAT32 on 343 newly diagnosed adult in-patients with cancers of head and neck, breast, oesophagus, cervix uteri and lung, recruited from seven tertiary care oncology treatment centres in the District of Colombo.

The EORTC QLQ-CX24 cervical cancer-specific quality of life questionnaire: psychometric properties in a South Asian sample of cervical cancer patients.

Objective: The cervical cancer-specific Quality of Life module of the European Organization for Research and Treatment of Cancer, EORTC QLQ-CX24, was recently validated in an international field study that did not include cervical cancer patients from South Asia. The aim of our study was to assess the psychometric properties of the instrument in a sample of cervical cancer patients from Sri Lanka to assess its suitability for use in the South Asian region.

Methods: One hundred and twelve newly diagnosed patients with cervical cancer completed the translated version of the QLQ-CX24 in a cross-sectional validation study.

Development of a screening instrument to detect physical abuse and its use in a cohort of pregnant women in Sri Lanka.

The objective of this study was to develop and validate a screening instrument (Abuse Assessment Questionnaire) to estimate the prevalence of physical abuse in a cohort of pregnant women in a district of Sri Lanka. The samples of 1200 pregnant women were identified by using a cluster sampling technique. Public health midwives (primary healthcare workers) were selected as interviewers and the antenatal clinic was identified as the setting to identify physical abuse.