Nutrition Division

Objectives: Earlier treatment of publicly funded patients may achieve health gains that justify the additional costs of reducing waiting times. This study reports on the cost-effectiveness of implementing a private contracting model to meet alternative maximum waiting time targets for publicly funded patients undergoing total knee replacement surgery in Australia.Methods: A linked decision tree and cohort Markov model was developed and populated and validated using secondary data sources to represent the pathways, costs, and quality adjusted life-years (QALYs) gained of non-urgent patients with alternative waiting times for total knee replacement surgery to a maximum age of 100 years.Results: Assuming public waiting times are reduced through the purchase of private services, additional QALYs are gained at an incremental cost of less than $40,000. Value could be increased if lower private prices could be negotiated. Results are also sensitive to the rate of deterioration in function ...

Climate change (CC) is the most significant global environmental challenge the human race has faced. It is defined as a long-term shift in weather conditions identified by changes in temperature, precipitation, winds, and other indicators. 1 Factors that cause CC can be categorized as those related to natural processes and others related to human activity. 2,3 The dominant causative factors due to human endeavour are the emission of greenhouse gasses (GHGs) from the combustion of fossil fuels and deforestation of natural rain forests. The primary product of fossil fuel combustion is carbon dioxide (CO 2), one of the harmful GHGs. 2,3 Irrespective of the place of origin of the GHGs, they are absorbed into the atmospheric GHGs stock and subsequently spread around the globe. Since the world's Industrialized Revolution, the GHGs stock has continued to rise, and breakdown, which is contingent of the type of gas, may take from few decades to thousands of years. 2 Thus, the GHGs absorb energy, slowing and preventing the loss of heat to space, making the earth warmer than it would otherwise be. This process is commonly known as the 'greenhouse effect' and has an enormous impact on global CC. 4 Figure 1 shows the increase in GHG concentrations in the air over the last 2,000 years. Since the industrialized revolution, the levels of these gasses have risen markedly. Figure 2 from global carbon project, 6 depicts observed and future scenarios of global emissions for the period 1980 to 2100. If 'business as usual' means an ongoing and unchanged state of affairs with limited mitigation,  CC would create new poverty traps and exacerbate hunger, disease, and social disruption and the long run growth and development of these countries will be affected.  The countries in SEAR should rethink their growth strategies to maximize future growth prospects and reduce their contribution to global warming through appropriate investment in adaptation and mitigation strategies.  The health impacts can be controlled through adopting proactive measures such as public health preparedness.

Background: Physical inactivity is a leading cause of morbidity and mortality and is a major public health problem. Insufficient activity is responsible for a large proportion of non-communicable diseases such as hypertensionObjectives: The purpose of this study was to assess socio-economic variations in physical activity and to measure the association between physical-inactivity and hypertension among government officials in Sri Lanka.Methods: A cross-sectional study was carried out among 275 senior-officers(SOs) and 760 managerial-assistants(MAs) aged 30-60 years and attached to Public Administration institutions in Colombo District in Sri Lanka. Physical-activity(PA) was gathered using the International Physical Activity Questionnaire(IPAQ) adopted and validated to the Sri Lankan context. Blood pressure(measured and classified using JNC-7 guidelines), and anthropometric indices were recorded. Energy utilization of all vigorous and moderated PA and walking was expressed as metabol...

A cross-sectional survey was carried out among 275 and 760 randomly selected senior officers (SOs) and managerial assistants (MAs) aged between 30 and 60 years. Sum of scores of efforts, rewards, and overcommitment and effort-reward ratio assessed job stress. Blood pressure was measured and classified using JNC-7 guidelines. The response rates of SOs and MAs were 98.9% and 97.2%, respectively. The prevalence of job stress based on high effort-rewards imbalance among SOs and MAs was 74.6% and 80.5%, respectively. The prevalence of overcommitment among SOs and MAs was 35.3% and 29%, respectively. Statistically significant differences (P = .05) were observed between the prevalence of effort-reward imbalance and overcommitment among SOs and MAs. Multivariate analysis indicated effort-reward imbalance (odds ratio [OR] = 2.8; 95% confidence interval [CI] = 1.1-7.4), high efforts (OR = 2.5; 95% CI = 1.2-5.3), and overcommitment (OR = 2.5; 95% CI = 1.1-5.6) were significantly associated wit...

Background: Behaviors established during the adolescence have life-long consequences to the onset of noncommunicable diseases (NCDs) in later life. Therefore, it is essential to understand adolescents' knowledge and practices with the intention of developing preventive programs focusing on this age group. The objective of the study was to assess knowledge about selected NCDs, and lifestyle choices among school students aged 17-19 years in state schools of the Maharagama Educational Division, Sri Lanka. Methods: A descriptive, cross-sectional study was conducted among students aged 17-19 years attending state schools in Maharagama Education Division. A total of 634 students were selected from 9 schools conducting Advance Level classes. Stratified sampling was done based on stream of study and the number needed from each stratum was decided according to probability proportionate to size which was followed by cluster sampling within the strata to select the classes included. Data were collected using a self-administered-questionnaire on socio-demographic characteristics and economic status; lifestyle-related practices; knowledge on Non-Communicable -Diseases. Logistic regression was used to assess the associations. Results: Proportion students with good overall knowledge was 43%(n = 272). Forty-three percent (n = 275) consumed a healthy diet, and 20%(n = 129) engaged in adequate physical activity 3%(n = 18) of students were current smokers and 12%(n = 73) current alcohol users 12%(n = 73). Overall "good" knowledge about NCDs was associated with being a science stream student(OR = 3.3; 95%CI:2.1-5.2). Healthy diet was associated with female sex (OR = 2.1; 95%CI: 1.5-3.0), and adequate physical activity with male sex (OR = 2.1; 95% CI:1.4-3.2), non-science-stream (OR = 2.1; 95%CI:1.2-3.7) and upper socio economic status (OR = 2.0; 95%CI:1.3-3.0). Non-smoking was associated with overall good knowledge (OR = 4.1; 95%CI:1.2-13.7) and female sex (OR = 0;95%CI:1.5-infinity). Abstinence from alcohol was associated with being a female (OR = 6.9; 95%CI:3.4-13.9), and with mother and fathers' education level of > General-Certificate of Examinations Ordinary Level (GCE O/L) (OR = 2.9; 95%CI:1.1-8.4 and OR = 3.5; 95%CI:1.1-11.2 respectively). Conclusion: Knowledge about NCDs and healthy lifestyle-practices were poor among school students aged 17-19 years. Lack of knowledge about healthy and unhealthy behaviors highlights the importance of carrying out regular surveillance for NCD risk factors, and initiating programs for the prevention of NCDs amongst adolescents.

Objective: To compare predeparture tuberculosis (TB) screening policies, including screening criteria and screening tests, and visa requirements for prospective migrants to high-income countries that have low to intermediate TB incidence and high immigration. Study design: Systematic review of policy documents. Methods: We systematically identified high-income, high net-migration countries with an estimated TB incidence of <30 per 100,000. After initial selection, this yielded 15 countries which potentially had TB screening policies. We performed a systematic search of governmental and official visa services' websites for these countries to identify visa information and policy documents for prospective migrants. Results were summarized, tabulated, and compared. Results: Programs to screen for active TB were identified in all 15 countries, but screening criteria and screening tests varied substantially between countries. Prospective migrants' country of origin represented an initial assessment criterion which generally focused on elevated TB incidence based on World Health Organization data but also focused on the countries of origin that sent the most migrants, and this varied between destination countries. Specific categories of migrants represented a second assessment criterion that focused on duration of stay and reasons for migration; the focus of which showed variation between the destination countries. Specific screening tests including medical examination and chest X-rays were used as the final stage of assessment, and there were differences between which tests were used between the destination countries. Conclusions: Current approaches to migrant TB screening are inconsistent in their approach and implementation. While this variation might reflect adaptation to local public health situations, it could also indicate uncertainty concerning optimal strategies. Comparative research studies are needed to define the most effective and efficient methods for TB screening of migrants.

This study translated and validated the Effort-Rewards Imbalance Questionnaire among Sri Lankan government administrators. A standard translation procedure was followed in translating the Effort-Rewards Imbalance Questionnaire to Sinhala language. Modified Delphi process determined judgmental validity. A descriptive cross-sectional survey was conducted to assess the construct validity of the translated Effort-Rewards Imbalance Questionnaire. Judgmental validity was achieved. Satisfactory test-retest reliability and internal consistency were obtained. The three subscales namely efforts, rewards and over-commitment had Cronbach's alpha coefficients of 0.80, 0.84 and 0.60, respectively. Four competitive models were explored. The theoretically postulated factor structure obtained the best fit according to Chi-square values and goodness-of-fit indices. The Sinhala version 22-item Effort-Rewards Imbalance Questionnaire is an acceptable, reliable and valid self-report measure in assessing occupational stress among administrators in Sri Lanka.

Introduction: Facing a pandemic is quite challenging for resource-poor healthcare settings. As the COVID-19 pandemic unfolded, healthcare workers (HCWs) had to work with insufficient skills, knowledge and experience regarding the novel coronavirus, which increased their risk of infection. Methods: This study aimed to determine the personal protective equipment (PPE) usage, exposure characteristics, clinical outcomes and seroprevalence of SARS-CoV-2 antibodies among a group of quarantined HCWs in seven hospitals in the Western province of Sri Lanka, during the first wave of the pandemic. Data were collected using an intervieweradministered questionnaire and a serum sample was collected at six weeks of exposure to detect SARSCoV- 2 specific IgG antibodies. Both descriptive statistics and chi square test were performed to identify distribution patterns and associations. Results: Of 167 quarantined HCWs, 89(53.3%) had high-risk exposures, while 78 (46.4%) reported lowrisk exposures. Eig...

Introduction This study's objective was to produce robust, comparable estimates of the prevalence of diabetes and prediabetes in the Sri Lankan adult population, where previous studies suggest the highest prevalence in South Asia. Research design and methods We used data on 6661 adults from the nationally representative 2018/2019 first wave of the Sri Lanka Health and Ageing Study (SLHAS). We classified glycemic status based on previous diabetes diagnosis, and either fasting plasma glucose (FPG), or FPG and 2-hour plasma glucose (2-h PG). We estimated crude and age-standardized prevalence of pre-diabetes and diabetes and by major individual characteristics weighting the data to account for study design and subject participation. Results Crude prevalence of diabetes in adults was 23.0% (95% CI 21.2% to 24.7%) using both 2-h PG and FPG, and age-standardized prevalence was 21.8% (95% CI 20.1% to 23.5%). Using only FPG, prevalence was 18.5% (95% CI 7.1% to 19.8%). Previously diagnosed prevalence was 14.3% (95% CI 13.1% to 15.5%) of all adults. The prevalence of pre-diabetes was 30.5% (95% CI 28.2% to 32.7%). Diabetes prevalence increased with age until ages ≥70 years and was more prevalent in female, urban, more affluent, and Muslim adults. Diabetes and pre-diabetes prevalence increased with body mass index (BMI) but was as high as 21% and 29%, respectively, in those of normal weight. Conclusions Study limitations included using only a single visit to assess diabetes, relying on self-reported fasting times, and unavailability of glycated hemoglobin for most participants. Our results indicate that Sri Lanka has a very high diabetes prevalence, significantly higher than previous estimates of 8%-15% and higher than current global estimates for any other Asian country. Our results have implications for other populations of South Asian origin, and the high prevalence of diabetes and dysglycemia at normal body weight indicates the need for further research to understand the underlying drivers.

Introduction: The COVID-19 pandemic negatively impacted the global economy, disrupted essential health services, and distorted social determinants of health, reducing healthcare accessibility and increasing financial risk.Aim: We aimed to assess the impact of COVID-19 on healthcare accessibility and financial risk protection in Sri Lanka.Methodology: We conducted a cross-sectional study on a representative sample (multi-stage sampling process) of 3151 households in 105 clusters representing all the districts of Sri Lanka. The data collection was conducted using an interviewer-administered questionnaire in early November 2021. This was important to classify three periods of interest, namely: (1) the pre-lockdown period (2) the nationwide lockdown period, and (3) the new normal period. (After Oct 1 to early November 2021).Results: Among 11,463 household occupants, 12.6% reported having chronic diseases, with 76.5% diagnosed prior to six months. The majority had heart disease, high blo...

Introduction: Facing a pandemic is quite challenging for resource-poor healthcare settings. As the COVID-19 pandemic unfolded, healthcare workers (HCWs) had to work with insufficient skills, knowledge and experience regarding the novel coronavirus, which increased their risk of infection. Methods: This study aimed to determine the personal protective equipment (PPE) usage, exposure characteristics, clinical outcomes and seroprevalence of SARS-CoV-2 antibodies among a group of quarantined HCWs in seven hospitals in the Western province of Sri Lanka, during the first wave of the pandemic. Data were collected using an intervieweradministered questionnaire and a serum sample was collected at six weeks of exposure to detect SARS-CoV-2 specific IgG antibodies. Both descriptive statistics and chi square test were performed to identify distribution patterns and associations. Results: Of 167 quarantined HCWs, 89(53.3%) had high-risk exposures, while 78 (46.4%) reported lowrisk exposures. Eighty-four HCWs have been exposed when interacting with the patient's environment and 90.5% of them were not using recommended PPE. None of the HCWs wore N95 or higher respirators when performing aerosolgenerating procedures. SARS-COV-2 RT-PCR assay was performed only on 117 (70.1%) HCWs, with 49.6% of them being subjected to the test after

Objectives More than 80% of cardiovascular diseases (CVD) and diabetes mellitus (DM) burden now lies in low and middle-income countries. Hence, there is an urgent need to identify and implement the most cost-effective interventions, particularly in the resource-constraint South Asian settings. Thus, we aimed to systematically review the cost-effectiveness of individual-level, group-level and population-level interventions to control CVD and DM in South Asia. Methods We searched 14 electronic databases up to August 2016. The search strategy consisted of terms related to 'economic evaluation', 'CVD', 'DM' and 'South Asia'. Per protocol two reviewers assessed the eligibility and methodological quality of studies using standard checklists, and extracted incremental cost-effectiveness ratios of interventions. results Of the 2949 identified studies, 42 met full inclusion criteria. Critical appraisal of studies revealed 15 excellent, 18 good and 9 poor quality studies. Most studies were from India (n=37), followed by Bangladesh (n=3), Pakistan (n=2) and Bhutan (n=1). The economic evaluations were based on observational studies (n=9), randomised trials (n=12) and decision models (n=21). Together, these studies evaluated 301 policy or clinical interventions or combination of both. We found a large number of interventions were cost-effective aimed at primordial prevention (tobacco taxation, salt reduction legislation, food labelling and food advertising regulation), and primary and secondary prevention (multidrug therapy for CVD in high-risk group, lifestyle modification and metformin treatment for diabetes prevention, and screening for diabetes complications every 2-5 years). Significant heterogeneity in analytical framework and outcome measures used in these studies restricted metaanalysis and direct ranking of the interventions by their degree of cost-effectiveness. Conclusions The cost-effectiveness evidence for CVD and DM interventions in South Asia is growing, but most evidence is from India and limited to decision modelled outcomes. There is an urgent need for formal health technology assessment and policy evaluations in South Asia using local research data. PrOsPErO registration number CRD42013006479. ► This is the first systematic review to synthesise cost-effectiveness evidence on all types of interventions (policy, clinical or behavioural) to control cardiovascular diseases and diabetes mellitus in South Asia. ► This review used a rigorous and broad search strategy including a wide range of sources to ensure all published studies are included for review. ► This review used explicitly stated methods (protocol paper published) and standard checklists to assess methodological quality of studies. ► The search was confined to English language publications performed as of August 2016, and this review excluded unpublished and 'grey' literature domain as we wanted to include studies that have undergone peer review process. ► Significant heterogeneity in analytical framework and outcome measures used in these studies restricted meta-analysis and direct ranking of the interventions by their degree of cost-effectiveness.

This study translated and validated the Effort-Rewards Imbalance Questionnaire among Sri Lankan government administrators. A standard translation procedure was followed in translating the Effort-Rewards Imbalance Questionnaire to Sinhala language. Modified Delphi process determined judgmental validity. A descriptive cross-sectional survey was conducted to assess the construct validity of the translated Effort-Rewards Imbalance Questionnaire. Judgmental validity was achieved. Satisfactory test-retest reliability and internal consistency were obtained. The three subscales namely efforts, rewards and over-commitment had Cronbach's alpha coefficients of 0.80, 0.84 and 0.60, respectively. Four competitive models were explored. The theoretically postulated factor structure obtained the best fit according to Chi-square values and goodness-of-fit indices. The Sinhala version 22-item Effort-Rewards Imbalance Questionnaire is an acceptable, reliable and valid self-report measure in assessing occupational stress among administrators in Sri Lanka.