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Senavirathna I, Jayasundara D, Warnasekara J, Matthias MA, Vinetz JM, Agampodi S. Whole genome sequencing data of Leptospira weilii and Leptospira kirschneri isolated from human subjects of Sri Lanka. Data Brief 2024; 52:109840. [PMID: 38059003 PMCID: PMC10696454 DOI: 10.1016/j.dib.2023.109840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/02/2023] [Accepted: 11/16/2023] [Indexed: 12/08/2023] Open
Abstract
Leptospirosis is a re-emerging zoonotic disease. This article reports the complete genome sequences of three novel strains of Genus Leptospira: two from the species Leptospira weilii (FMAS_RT1, FMAS_PD2) and one from Leptospira kirschneri (FMAS_PN5). These isolates were recovered from the blood samples of acute febrile patients in different geographical and climatic zones of Sri Lanka. High-quality genomic DNA was extracted from the three isolates in mid-log phase cultures. Whole genome sequencing was conducted using the PacBio Single Molecule Real-Time (SMRT) platform to identify the species, genome features, and novelty of the strains. The annotation was conducted using RAST (Rapid Annotation Using Subsystem Technology version 2.0) and the NCBI Prokaryotic Genome Annotation Pipeline. The genome sequences of three isolates have been deposited in the Mendeley data repository and the National Center for Biotechnology Information (NCBI) repository. This data will be useful for future researchers when conducting comparative genomic analysis, revealing the exact mechanism of pathogenesis of leptospirosis and developing molecular diagnostic tools for early detection.
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Affiliation(s)
- Indika Senavirathna
- Leptospirosis Research Laboratory, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka
- Department of Biochemistry, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka
| | - Dinesha Jayasundara
- Leptospirosis Research Laboratory, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka
- Department of Microbiology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka
| | - Janith Warnasekara
- Leptospirosis Research Laboratory, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka
| | - Michael A. Matthias
- Section of Infectious Disease, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Joseph M. Vinetz
- Section of Infectious Disease, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Suneth Agampodi
- Section of Infectious Disease, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
- International Vaccine Institute, Seoul, Republic of Korea
- Center for Public Health, Anuradhapura, Sri Lanka
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Senavirathna I, Jayasundara D, Warnasekara J, Kappagoda C, Agampodi S. Levels of Cytokines in Leptospirosis Patients with Different Serovars and rfb Locus. J Interferon Cytokine Res 2024; 44:80-93. [PMID: 38377491 PMCID: PMC10880283 DOI: 10.1089/jir.2023.0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 11/21/2023] [Indexed: 02/22/2024] Open
Abstract
Leptospirosis has a wide spectrum of clinical manifestations ranging from mild to severe disease. The cytokine response is considered one of the key drivers for this varying manifestation. The different cytokine response observed in patients with leptospirosis could be due to the variation of infecting serovars. Since the rfb locus codes for the lipopolysaccharide synthesis of the bacterial cell wall, which also determines the serovar, this locus may play a role in driving a specific cytokine response in the host. We investigated 12 commonly used cytokine profiles in serum samples of culture, microscopic agglutination test (MAT), or polymerase chain reaction (PCR)-positive patients with leptospirosis. The sequences of the rfb locus in culture-positive samples were generated from whole genome sequencing and serovar status was drawn from original data published. Isolated cultures were subjected to whole genome sequencing using the PacBio RS II system, and the resulting data were used to determine the species. The recovered genomic data were annotated with the Rapid Annotation using Subsystem Technology (RAST) subsystem, and the rfb locus was extracted. The cytokine analysis was carried out using the Qiagen human ELISA kit. Eighteen samples were found to be positive by culture, while the other 7 samples were positive by PCR or MAT. Infections from Leptospira interrogans serovar Autumnalis (5), Pyrogens (3), Icterohaemorrhagiae (1) Leptospira borgpetersenii (all 7 samples clustered in same clonal group with serovar status not determined), Leptospira weilii (1 with serovar status not determined), and Leptospira kirschneri serovar Grippotyphosa (1) were included in the analysis. Three patients [infected with Leptospira interrogansserovar Autumnalis (2) and Pyrogens (1)] and 2 MAT-positive patients (highest titer against serovar Bratislava of L.interrognas) were reported to have severe clinical manifestations, while the rest had mild to moderate symptoms. Although the serum cytokine concentration of patients with severe clinical manifestation was comparatively higher, a statistically significant difference was observed only for interleukin (IL)-1β (P < 0.05). IL-10/tumor necrosis factor-alpha (TNF-α) ratio was high in patients with severe complications. In general, patients infected with L. interrogans showed higher concentration of cytokines compared to L. borgpetersenii.
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Affiliation(s)
- Indika Senavirathna
- Leptospirosis Research Laboratory, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
- Department of Biochemistry, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Dinesha Jayasundara
- Leptospirosis Research Laboratory, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
- Department of Microbiology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Janith Warnasekara
- Leptospirosis Research Laboratory, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Chamila Kappagoda
- Leptospirosis Research Laboratory, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Suneth Agampodi
- International Vaccine Institute, Seoul, Republic of Korea
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, California, USA
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Wijerathna N, Wijerathne C, Wijeratne H, Wijesiri C, Wijerathna R, Wijerathna W, Warnasekara J, Agampodi T, Rajapakse S. Knowledge and attitudes on attention deficit hyperactivity disorder (ADHD) among school teachers in Anuradhapura district, Sri Lanka: a descriptive cross-sectional study. BMJ Open 2023; 13:e080039. [PMID: 38035746 PMCID: PMC10689374 DOI: 10.1136/bmjopen-2023-080039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/23/2023] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVE This study aimed to assess the knowledge and attitude of school teachers from a rural district in a developing country towards children with attention deficit hyperactivity disorder (ADHD). DESIGN A population-based descriptive cross-sectional study was conducted using probability proportionate to size cluster sampling. SETTING This study was conducted in 21 government schools in Anuradhapura district, Sri Lanka. PARTICIPANTS The study sample consisted of 458 teachers with a mean age of 41 completed years ranging from 24 to 59 years. MAIN OUTCOME MEASUREMENTS We assessed knowledge, attitudes and sources of information on ADHD using the self-administered, validated Knowledge of Attention Deficit Disorder Scale (KADD), Teacher Attitudes Towards Inclusion Scale (TAIS) and the Perceived and Actual Sources of Information questionnaires. RESULTS The median KADD score was 11 (IQR 8-14) and 45.5% (n=208) of participants lacked sufficient knowledge. Percentages of the correct answers, misconceptions and 'don't know' responses were 28.2%, 24.5% and 45.5%, respectively. The majority of teachers believed that the children with ADHD generally experience more problems in novel situations than in familiar situations (63.5%), a diagnosis of ADHD by itself makes a child eligible for placement in special education (61.1%), and children with ADHD do not often have difficulties organising tasks and activities (61.1%). Some participants (12%) stated that punishment would improve the outcome of the children with ADHD. The attitudes were positive with TAIS 1 and 2 median scores of 46 (IQR 36-58) and 49 (IQR 40-59). The majority of participants relied on informal knowledge gained through their personal experience in the classroom on ADHD (n=337, 76%). The majority of teachers (n=300, 67.7%) preferred to be educated through seminars. CONCLUSIONS School teachers possess a positive attitude. However, they have poor knowledge and significant misconceptions regarding ADHD which may affect the identification and management.
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Affiliation(s)
- Navoda Wijerathna
- Rajarata University of Sri Lanka Faculty of Medicine and Allied Sciences, Saliyapura, Sri Lanka
| | - Charith Wijerathne
- Rajarata University of Sri Lanka Faculty of Medicine and Allied Sciences, Saliyapura, Sri Lanka
| | - Himeshika Wijeratne
- Rajarata University of Sri Lanka Faculty of Medicine and Allied Sciences, Saliyapura, Sri Lanka
| | - Chathuri Wijesiri
- Rajarata University of Sri Lanka Faculty of Medicine and Allied Sciences, Saliyapura, Sri Lanka
| | - Randika Wijerathna
- Rajarata University of Sri Lanka Faculty of Medicine and Allied Sciences, Saliyapura, Sri Lanka
| | - Windhya Wijerathna
- Rajarata University of Sri Lanka Faculty of Medicine and Allied Sciences, Saliyapura, Sri Lanka
| | - Janith Warnasekara
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Thilini Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Shashanka Rajapakse
- Department of Physiology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
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Senavirathna I, Jayasundara D, Warnasekara J, Matthias MA, Vinetz JM, Agampodi S. Complete genome sequences of twelve strains of Leptospira interrogans isolated from humans in Sri Lanka. Infect Genet Evol 2023; 113:105462. [PMID: 37301334 DOI: 10.1016/j.meegid.2023.105462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/31/2023] [Accepted: 06/04/2023] [Indexed: 06/12/2023]
Abstract
Leptospirosis, a major zoonotic disease caused by pathogenic Leptospira spp. is recognized globally as an emerging zoonotic disease. Whole-genome sequencing reveals hidden messages about Leptospira's pathogenesis. We used Single Molecule Real-Time (SMRT) sequencing to obtain complete genome sequences of twelve L. interrogans isolates from febrile patients from Sri Lanka for a comparative whole genome sequencing study. The sequence data generated 12 genomes with a coverage greater than X600 with sizes ranging from 4.62 Mb to 5.16 Mb, and a G + C content ranging from 35.00% to 35.42%. The total number of coding sequences predicted by the NCBI (National Center for Biotechnology Information) genome assembly platform ranged from 3845 to 4621 for the twelve strains. Leptospira serogroup with similar-sized LPS biosynthetic loci that belonged to the same clade had a close relationship in the phylogenetic analysis. Nonetheless, variations in the genes encoding sugar biosynthesis were found in the serovar determinant region (rfb locus). Type I and Type III CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats) systems were found in all of the strains. Genome BLAST Distance Phylogeny of these sequences allowed for detailed genomic strain typing. These findings may help us better understand the pathogenesis, develop a tools for early diagnosis, comparative genomic analysis and evolution of Leptospira.
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Affiliation(s)
- Indika Senavirathna
- Leptospirosis Research Laboratory, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka; Department of Biochemistry, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka.
| | - Dinesha Jayasundara
- Leptospirosis Research Laboratory, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka; Department of Microbiology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka
| | - Janith Warnasekara
- Leptospirosis Research Laboratory, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka; Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka
| | - Michael A Matthias
- Section of Infectious Disease, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Joseph M Vinetz
- Section of Infectious Disease, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Suneth Agampodi
- Section of Infectious Disease, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA; International Vaccine Institute, Seoul, Republic of Korea
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Agampodi T, Amarasinghe G, Wickramasinghe A, Wickramasinghe N, Warnasekara J, Jayasinghe I, Hettiarachchi A, Nimesha D, Dilshani T, Senadheera S, Agampodi S. Incorporating early pregnancy mental health screening and management into routine maternal care: experience from the Rajarata Pregnancy Cohort (RaPCo), Sri Lanka. BMJ Glob Health 2023; 8:e012852. [PMID: 37748792 PMCID: PMC10533714 DOI: 10.1136/bmjgh-2023-012852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/30/2023] [Indexed: 09/27/2023] Open
Abstract
Early identification of mental health problems in pregnancy in low-income and middle-income countries is scarcely reported. We present the experience of a programme assimilating screening and management of antenatal anxiety and depression in conjunction with the Rajarata Pregnancy Cohort, in Sri Lanka. We adopted a two-stage screening approach to identify the symptoms and the reasons for anxiety and depression. Pregnant women (n=3074), less than 13 weeks of period of gestation underwent screening with the Edinburgh Postnatal Depression Scale (EPDS). Scores were positive among 23% and 14% of women in the first and second trimesters, respectively. Clinical (telephone) interviews (n=78, response 56.9%) were held for women having high EPDS scores to screen for clinical depression using the 'mental health GAP' tool. Targeted interventions including counselling, financial and social support and health education were employed. The procedure was repeated in the second trimester with in-person clinical interviews and inquiry into intentional self-harm. Our findings indicated that (1) the majority of mental health problems in early pregnancy were anxiety related to early pregnancy-associated conditions manageable at the primary healthcare level, (2) coupling mental health screening using psychometric tools with clinical interviews facilitates targeted patient-centred care, (3) the majority of intentional self-harm during pregnancy is not in the routine health surveillance system and (4) promoting women to attend the psychiatry clinic in tertiary care hospital has been difficult. Following the experience, we propose a model for mental health service provision in routine pregnancy care programme starting from early pregnancy.
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Affiliation(s)
- Thilini Agampodi
- Center for Public Health, Anuradhapura, Sri Lanka
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Gayani Amarasinghe
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | | | - Nuwan Wickramasinghe
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Janith Warnasekara
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Imasha Jayasinghe
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Ayesh Hettiarachchi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Dilshi Nimesha
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Thivanka Dilshani
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Subhashinie Senadheera
- Department of Biochemistry, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
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Agyei DD, Sangare M, Anyiam FE, Machingura PI, Warnasekara J, Heller RF. Open access publication of public health research in African journals. Insights the UKSG journal 2023. [DOI: 10.1629/uksg.605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
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Warnasekara J, Agampodi S, NR A. SARIMA and ARDL models for predicting leptospirosis in Anuradhapura district Sri Lanka. PLoS One 2022; 17:e0275447. [PMID: 36227833 PMCID: PMC9562162 DOI: 10.1371/journal.pone.0275447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 09/16/2022] [Indexed: 11/07/2022] Open
Abstract
Leptospirosis is considered a neglected tropical disease despite its considerable mortality and morbidity. Lack of prediction remains a major reason for underestimating the disease. Although many models have been developed, most of them focused on the districts situated in the wet zone due to higher case numbers in that region. However, leptospirosis remains a major disease even in the dry zone of Sri Lanka. The objective of this study is to develop a time series model to predict leptospirosis in the Anuradhapura district situated in the dry zone of Sri Lanka. Time series data on monthly leptospirosis incidences from January 2008 to December 2018 and monthly rainfall, rainy days, temperature, and relative humidity were considered in model fitting. The first 72 months (55%) were used to fit the model, and the subsequent 60 months(45%) were used to validate the model. The log-transformed dependent variable was employed for fitting the Univariate seasonal ARIMA model. Based on the stationarity of the mean of the five variables, the ARDL model was selected as the multivariate time series technique. Residuals analysis was performed on normality, heteroskedasticity, and serial correlation to validate the model. The lowest AIC and MAPE were used to select the best model. Univariate models could not be fitted without adjusting the outliers. Adjusting seasonal outliers yielded better results than the models without adjustments. Best fitted Univariate model was ARIMA(1,0,0)(0,1,1)12,(AIC-1.08, MAPE-19.8). Best fitted ARDL model was ARDL(1, 3, 2, 1, 0),(AIC-2.04,MAPE-30.4). The number of patients reported in the previous month, rainfall, rainy days, and temperature showed a positive association, while relative humidity was negatively associated with leptospirosis. Multivariate models fitted better than univariate models for the original data. Best-fitted models indicate the necessity of including other explanatory variables such as patient, host, and epidemiological factors to yield better results.
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Affiliation(s)
- Janith Warnasekara
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
- Postgraduate Institute of Agriculture, University of Peradeniya, Peradeniya, Sri Lanka
- * E-mail:
| | - Suneth Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
| | - Abeynayake NR
- Postgraduate Institute of Agriculture, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Agribusiness Management, Faculty of Agriculture and Plantation Management, Wayamba University of Sri Lanka, Kuliyapitiya, Sri Lanka
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Agampodi S, Warnasekara J, Siribaddana S, Kularatna SAM, Gamage C, Jayasundara D, Senevirathna I, Srimantha S, Kappagoda C, Weerawansa P, Pilapitiya S, Lokunarangoda N, Sarathchandra C, Senanayake H, Matthias M, Vinetz J. Demographic, exposure, clinical, biochemical and diagnostic data of febrile patients recruited for the largest field study on leptospirosis in Sri Lanka. Data Brief 2022; 43:108378. [PMID: 35770027 PMCID: PMC9234077 DOI: 10.1016/j.dib.2022.108378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/31/2022] [Accepted: 06/07/2022] [Indexed: 11/23/2022] Open
Abstract
This dataset includes data from febrile patients recruited for a large hospital-based study in Sri Lanka from 2016 to 2019. The variables include primary socio-demographic data, exposure data, clinical data, biochemical and investigation data. Some of these data are available as serial data from admission to discharge daily. Microscopic agglutination test, quantitative PCR of whole blood, urine and serum and culture isolation was performed to diagnose the patients with leptospirosis.
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Affiliation(s)
- Suneth Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka
- Corresponding author. @sunethagampodi
| | - Janith Warnasekara
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka
| | - Sisira Siribaddana
- Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka
| | - SAM Kularatna
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka
| | - Chandika Gamage
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Sri Lanka
| | - Dinesha Jayasundara
- Department of Microbiology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka
| | - Indika Senevirathna
- Department of Biochemistry, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka
| | - Shalka Srimantha
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka
| | - Chamila Kappagoda
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka
| | - Prasanna Weerawansa
- Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka
| | - Senaka Pilapitiya
- Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka
| | - Niroshan Lokunarangoda
- Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka
| | - Chamara Sarathchandra
- Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka
| | - Hemal Senanayake
- Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka
| | - Michael Matthias
- Section of Infectious Diseases, Department of Internal Medicine, School of Medicine, Yale University, United States
| | - Joseph Vinetz
- Section of Infectious Diseases, Department of Internal Medicine, School of Medicine, Yale University, United States
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Koralegedara IS, Warnasekara J, Jayasinghe I, Agampodi T, Agampodi S, Dayaratne KG. Non-Alcoholic Fatty Liver Disease Among Pregnant Women With Metabolic Syndrome: Should Nutritional Intervention Be a Priority? A Cross Sectional Study in Rural Sri Lanka. Curr Dev Nutr 2022. [PMCID: PMC9194234 DOI: 10.1093/cdn/nzac061.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objectives Although non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome (MetS), the prevalence data of NAFLD in MetS are scarce in literature, especially in south Asian populations. Knowledge regarding NAFLD in Mets is important as both conditions can be controlled using Nutritional interventions. This study aims to compare the proportions of NAFLD among first trimester pregnant mothers with MetS and without MetS in Anuradhapura District, Sri Lanka. Methods A community based cross-sectional comparative study was conducted among randomly selected first trimester pregnant mothers (less than 12 weeks of gestational age), in Anuradhapura district, Sri Lanka. Detailed clinical examination, biochemical investigations, and ultrasound scan(USS) to diagnose fatty liver were performed at the time of recruitment. MetS was defined according to the criteria by International Diabetes Federation, American Heart Association, and World Health Organization. NAFLD was categorized as fatty liver grades (FLG) 0, I, II and III by ultrasound criteria. Results Of the 634 mothers recruited, 30 (4.7%) were categorized as metabolic syndrome. The proportion of NAFLD among MetS group was 80% (n = 24/30) while it was 49.8% (n = 300/604) in none- MetS group. (Chi-sq = 10.4, p = 0.001). The proportion of FLG 0, FLG I, FLG II among MetS participants were 6(20%), 8(26.7%), 16(53.3%) respectively while they were 302(50.2%), 226(37.5%), 74(12.5%) respectively in non -MetS participants. (Chi-sq = 40, P < 0.000) None of the mothers were categorized as FLG III. The mean Gamma glutamyl transferase level and the Alanine aminotransferase levels were significantly higher (P < 0.025) in the MetS group, while no significant difference was observed in the Aspartate aminotransferase level. The mean dome to pole length of the liver among the MetS group was significantly higher (13.9 vs. 13.0 cm) in the MetS group. (t = 3.8, p = 0.001). Conclusions The proportion of NAFLD in pregnant mothers with MetS was significantly higher. Therefore, promising nutritional interventions are recommended to control the disease and minimize adverse pregnancy outcomes. Funding Sources Accelerating Higher Education Expansion and Development (AHEAD) grant (Grant number: DOR STEM HEMS [6026-LK/8743-LK]), a World Bank-funded project through the University grant commission, Sri Lanka.
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Rajapakse Mudiyanselage SIR, Amarasiri L, Yasaratne D, Warnasekara J, Agampodi S. Allergic risk factors for severe asthma among preschool children: a descriptive-analytical study from rural Sri Lanka. Epidemiology 2022. [DOI: 10.1183/23120541.lsc-2022.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Warnasekara J, Srimantha S, Kappagoda C, Jayasundara D, Senevirathna I, Matthias M, Agampodi S, Vinetz JM. Diagnostic method-based underestimation of leptospirosis in clinical and research settings; an experience from a large prospective study in a high endemic setting. PLoS Negl Trop Dis 2022; 16:e0010331. [PMID: 35377883 PMCID: PMC9009773 DOI: 10.1371/journal.pntd.0010331] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 04/14/2022] [Accepted: 03/15/2022] [Indexed: 11/18/2022] Open
Abstract
Background Leptospirosis has globally significant human mortality and morbidity, yet estimating the clinical and public health burden of leptospirosis is challenging because timely diagnosis remains limited. The goal of the present study was to evaluate leptospirosis undercounting by current standard methods in both clinical and epidemiological study settings. Methodology/Principal findings A prospective hospital-based study was conducted in multiple hospitals in Sri Lanka from 2016 to 2019. Culture, whole blood, and urine samples were collected from clinically suspected leptospirosis cases and patients with undifferentiated fever. Analysis of biological samples from 1,734 subjects confirmed 591 (34.1%) cases as leptospirosis and 297 (17.1%) were classified as “probable” leptospirosis cases. Whole blood quantitative PCR (qPCR) did identify the most cases (322/540(60%)) but missed 40%. Cases missed by each method include; urine qPCR, 70% (153/220); acute sample microscopic agglutination test (MAT), 80% (409/510); paired serum sample MAT, 58% (98/170); and surveillance clinical case definition, 53% (265/496). qPCR of negative culture samples after six months of observation was of diagnostic value retrospectively with but missed 58% of positives (109/353). Conclusion Leptospirosis disease burden estimates should consider the limitations of standard diagnostic tests. qPCR of multiple sample types should be used as a leading standard test for diagnosing acute leptospirosis. Diagnostics of leptospirosis have not been optimised yet and is considered as a significant limiting factor for estimating the disease burden. This prospective hospital-based study, including 1734 clinically suspected leptospirosis cases and undifferentiated febrile patients, revealed that a minimum of 40% of cases would be missed by using any of the following tests individually. (Whole blood qPCR, single or paired-sample MAT, Urine qPCR, culture, culture qPCR, surveillance case definition). Therefore, we conclude that whole blood qPCR should be the standard test for diagnosing leptospirosis for clinical purposes until day 10 of the reported disease. MAT should be limited to places where the serological diagnosis has an epidemiological interest. qPCR testing of microscopically-negative cultures should be done before discarding to increase the yield in research settings.
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Affiliation(s)
- Janith Warnasekara
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Shalka Srimantha
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Chamila Kappagoda
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Dinesha Jayasundara
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
- Department of Microbiology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Indika Senevirathna
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
- Department of Biochemistry, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Michael Matthias
- Section of Infectious Diseases, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut, United States of America
| | - Suneth Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
- Section of Infectious Diseases, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut, United States of America
- * E-mail: ,
| | - Joseph M. Vinetz
- Section of Infectious Diseases, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut, United States of America
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Warnasekara J, Srimantha S, Senavirathna I, Kappagoda C, Farika N, Nawinna A, Agampodi S. The variable presence of Leptospira in the environment; an epidemiological explanation based on serial analysis of water samples. PLoS One 2022; 17:e0263719. [PMID: 35167605 PMCID: PMC8846531 DOI: 10.1371/journal.pone.0263719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/25/2022] [Indexed: 11/19/2022] Open
Abstract
Human leptospirosis involves the classic epidemiological triad (agent, host and environment); hence the investigations should include the knowledge on Leptospira within the animals and the environment. The objectives of this study are to explore the abundance of Leptospira in different climate zones of Sri Lanka and to describe the presence of Leptospira in the same water source at serial time points. First, water and soil samples were collected from different parts of Sri Lanka (Component-1); second, water sampling continued only in the dry zone (Component-2). Finally, serial water sampling from ten open wells was performed at five different time points (Component-3). Quantitative PCR of water and metagenomic sequencing of soil were performed to detect Leptospira. Three replicates for each sample were used for PCR testing, and positive result of two or more replicates was defined as 'strongly positive,' and one positive replicate was defined as positive. In the water and soil sample analysis in the whole country (Component-1), two out of 12 water sites were positive, and both were situated in the wet zone. Very small quantities of the genus Leptospira were detected by 16 amplicon analysis of soil in all 11 sites. In the dry zone water sample analysis (Component-2), only samples from 6 out of 26 sites were positive, of which one site was strongly positive. In the serial sample analysis (Component-3), Six, five, four, five, and six wells were positive in serial measurements. All wells were positive for at least one time point, while only one well was positive for all five time points. Proximity to the tank and greater distances from the main road were associated with strong positive results for Leptospira (P<0.05). The presence of Leptospira was not consistent, indicating the variable abundance of Leptospira in the natural environment. This intermittent nature of positivity could be explained by the repetitive contamination by animal urine.
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Affiliation(s)
- Janith Warnasekara
- Faculty of Medicine and Allied Sciences, Department of Community Medicine, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Shalka Srimantha
- Faculty of Medicine and Allied Sciences, Department of Community Medicine, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Indika Senavirathna
- Faculty of Medicine and Allied Sciences, Department of Community Medicine, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
- Faculty of Medicine and Allied Sciences, Department of Biochemistry, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Chamila Kappagoda
- Faculty of Medicine and Allied Sciences, Department of Community Medicine, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Nirmani Farika
- Faculty of Medicine and Allied Sciences, Department of Community Medicine, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Achala Nawinna
- Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Suneth Agampodi
- Faculty of Medicine and Allied Sciences, Department of Community Medicine, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
- Department of Internal Medicine, Section of Infectious Diseases, School of Medicine, Yale University, New Haven, Connecticut, United States of America
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Rajapakse S, Amarasiri L, Yasaratne D, Warnasekara J, Agampodi S. Temporal Variation and Factors Associated with Allergic Rhinitis in a Cohort of Rural Preschool Children from Sri Lanka. J Trop Pediatr 2022; 68:6533388. [PMID: 35188209 DOI: 10.1093/tropej/fmac017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Allergic rhinitis is a common chronic childhood disease with a low diagnosis rate, causing poor quality of life, absenteeism, decreased school performance and significant healthcare cost. However, data on the prevalence of allergic rhinitis is sparse in preschoolers of rural geography, especially in developing countries. AIM To describe the epidemiology of allergic rhinitis in preschoolers from a rural geography of a developing country. METHODS A population-based cross-sectional study was conducted in Anuradhapura district, Sri Lanka using the WHO-30 cluster methodology with probability proportionate to size sampling. The International Study of Asthma and Allergy in Childhood questionnaire was used to assess symptomatology. RESULTS The response rate was 91.8%, with 548 (51.7%) male and 512 (48.3%) female participants. The mean age was 4.4 (± 0.7) years. Allergic rhinitis was reported in 123 (11.6%; 95% CI 9.7-13.5), and eye symptoms were reported in 41 (3.9%; 95% CI 2.8-5.2) children. Activities of daily living were disturbed due to nasal symptoms in 113 (10.7%; 95% CI 8.8-12.5). Allergic rhinitis was independently associated with severe asthma (OR 6.26; 95% CI 3.54-11.06), sleeping on the floor (OR 4.79; 95% CI 1.33-17.25) and having cats in the households (OR 1.86; 95% CI 1.18-2.91). Nasal symptoms were more common in January and August to October months. The standardized local highest monthly temperature, lowest monthly temperature, highest monthly humidity and dew point strongly predicted allergic rhinitis symptom exacerbation (F=4.8, p=0.036, adjusted R square=57.8%, VIF≤2.259, DW=2.1). CONCLUSIONS Allergic rhinitis affects 1 in 10 preschool children of rural Sri Lanka. The factors associated and environmental factor model developed to predict symptom exacerbation could be used to prevent allergic rhinitis exacerbations.
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Affiliation(s)
- Shashanka Rajapakse
- Department of Physiology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka
| | - Lakmali Amarasiri
- Department of Physiology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Duminda Yasaratne
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Janith Warnasekara
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka
| | - Suneth Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka
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Warnasekara J, Agampodi S. Neglecting the neglected during the COVID-19 pandemic: the case of leptospirosis in Sri Lanka. Epidemiol Health 2022; 44:e2022015. [PMID: 35038829 PMCID: PMC9117097 DOI: 10.4178/epih.e2022015] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/10/2022] [Indexed: 11/09/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has disrupted global health systems and affected the transmission dynamics as well as the surveillance of other infectious diseases. This study described the probable effect of the COVID-19 pandemic on the surveillance and control of leptospirosis in Sri Lanka. With 8,579 reported cases and more than 800 estimated deaths, the Sri Lankan public health surveillance system documented the largest outbreak of leptospirosis in Sri Lankan history in 2020. This was the worst infectious disease outbreak Sri Lanka experienced in 2020, but it was neglected, primarily due to the COVID-19 pandemic.
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Affiliation(s)
- Janith Warnasekara
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Suneth Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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Dahanayaka NJ, Agampodi SB, Seneviratna I, Warnasekara J, Rajapakse R, Ranathunga K, Matthias M, Vinetz JM. Clinical spectrum of endemic leptospirosis in relation to cytokine response. PLoS One 2021; 16:e0261025. [PMID: 34879100 PMCID: PMC8654203 DOI: 10.1371/journal.pone.0261025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/22/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To describe the clinical spectrum and the cytokine response of leptospirosis patients in an endemic setting of Sri Lanka. METHODS Patients presenting to the university teaching hospital, Anuradhapura, Sri Lanka with a leptospirosis-compatible illness were recruited over a period of 12 months starting from June 2012. Daily clinical and biochemical parameters of the patients were prospectively assessed with a follow-up of 14 days after discharge. A magnetic bead-based multiplex cytokine kit was used to detect 17 cytokines. RESULTS Of the 142 clinically suspected leptospirosis patients recruited, 47 were confirmed and, 29 cases were labeled as "probable." Thrombocytopenia and leukocytosis were observed at least once during the hospital stay among 76(54%) and 39(28%) patients, respectively. Acute kidney injury was observed in 31 patients (22%) and it was significantly higher among confirmed and probable cases. Hu TNF-α and IL-1β were detected only in patients without complications. Hu MIP-1b levels were significantly higher among patients with complications. During the convalescence period, all tested serum cytokine levels were lower compared to the acute sample, except for IL-8. The cytokine response during the acute phase clustered in four different groups. High serum creatinine was associated GM-CSF, high IL-5 and IL-6 level were correlates with lung involvement and saturation drop. The patients with high billirubin (direct)>7 mmol/l had high IL-13 levels. CONCLUSIONS Results of this study confirms that the knowledge on cytokine response in leptospirosis could be more complex than other similar tropical disease, and biosignatures that provide diagnostic and prognostic information for human leptospirosis remain to be discovered.
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Affiliation(s)
- Niroshana J. Dahanayaka
- Faculty of Medicine and Allied Sciences, Department of Medicine, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
- Faculty of Medicine, Department of Medicine, University of Ruhuna, Matara, Sri Lanka
| | - Suneth B. Agampodi
- Department of Internal Medicine, Section of Infectious Diseases, School of Medicine, Yale University, New Haven, Connecticut, United States of America
- Faculty of Medicine and Allied Sciences, Department of Community Medicine, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
- * E-mail: ,
| | - Indika Seneviratna
- Faculty of Medicine and Allied Sciences, Department of Biochemistry, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Janith Warnasekara
- Faculty of Medicine and Allied Sciences, Department of Community Medicine, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Rukman Rajapakse
- Faculty of Medicine and Allied Sciences, Department of Medicine, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Kosala Ranathunga
- Faculty of Medicine and Allied Sciences, Department of Medicine, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Michael Matthias
- Department of Internal Medicine, Section of Infectious Diseases, School of Medicine, Yale University, New Haven, Connecticut, United States of America
| | - Joseph M. Vinetz
- Department of Internal Medicine, Section of Infectious Diseases, School of Medicine, Yale University, New Haven, Connecticut, United States of America
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Warnasekara J, Srimantha SM, Agampodi SB. Estimating the burden of leptospirosis: global lessons from Sri Lanka. BMJ Glob Health 2021; 6:bmjgh-2021-006946. [PMID: 34706880 PMCID: PMC8552134 DOI: 10.1136/bmjgh-2021-006946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/08/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Janith Warnasekara
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Shalka Madushan Srimantha
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Suneth Buddhika Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
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Rajapakse Mudiyanselage SIR, Wickramasinghe ND, Agampodi TC, Amarasinghe G, Hettiarachchi A, Jayasinghe IU, Koralegedara I, Warnasekara J, Agampodi SB. Effect of pregnancy on asthma control: a cohort study in rural Sri Lanka. Epidemiology 2021. [DOI: 10.1183/13993003.congress-2021.oa4216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Rajapakse Mudiyanselage SIR, Amarasiri WADL, Yasaratne BMGD, Warnasekara J, Agampodi S. Epidemiology of wheeze among preschool children: a population-based cross-sectional study from rural Sri Lanka. BMJ Open 2021; 11:e046688. [PMID: 34233982 PMCID: PMC8264903 DOI: 10.1136/bmjopen-2020-046688] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To assess the prevalence of wheeze and factors associated with its severity among 3-6 years old children. METHODOLOGY DESIGN: A population-based, cross-sectional study using the WHO 30 cluster methodology with probability proportionate to size sampling. SETTING 36 preschools registered at the divisional secretariat offices of Anuradhapura district, Sri Lanka. PARTICIPANTS We recruited 1060 preschool children from 36 preschools aged 3-6 years. MAIN OUTCOME MEASUREMENTS We used the International Study of Asthma and Allergy in Childhood questionnaire to assess the prevalence, symptomatology and associated factors of wheeze. RESULTS The study sample consisted of 548 (51.70%) male and 512 (48.30%) female children with a mean age of 4.41 (±0.66) years. At least one wheezing episode ever was reported in 323 (30.47%; 95% CI 27.71% to 33.34%) children and 247 (23.30%; 95% CI 20.79% to 25.97%) children had a wheezing attack in the preceding year. Severe episodes of wheezing were reported in 76 (7.17%; 95% CI 5.69% to 8.89%) participants. However, only 27 (35.53%; 95% CI 24.88% to 47.34%) children with severe wheezing had been diagnosed as asthmatics by a clinician. The identified independent risk factors for severe wheeze were allergic rhinitis (OR 6.90; 95% CI 3.84 to 12.40), domestic dog(s) (OR 2.34; 95% CI 1.01 to 5.40), frequent consumption of skipjack tuna (OR 1.94; 95% CI 1.11 to 3.39) and passive smoking (OR 1.70; 95% CI 0.93 to 3.11) while living in a house with a cement floor is a protective factor (OR 0.41; 95% CI 0.21 to 0.80). CONCLUSION Wheezing commonly affects one-fourth of preschool children in rural Sri Lanka. Severe wheezing is often not diagnosed as asthma despite frequent symptoms, probably due to hesitancy in labelling preschool children as asthmatics. Allergic rhinitis, domestic dogs, frequent consumption of Skipjack tuna fish and exposure to passive smoking were independent risk factors for severe wheeze.
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Affiliation(s)
| | | | | | - Janith Warnasekara
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Suneth Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
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Jayasundara D, Gamage C, Senavirathna I, Warnasekara J, Matthias MA, Vinetz JM, Agampodi S. Optimizing the microscopic agglutination test (MAT) panel for the diagnosis of Leptospirosis in a low resource, hyper-endemic setting with varied microgeographic variation in reactivity. PLoS Negl Trop Dis 2021; 15:e0009565. [PMID: 34197457 PMCID: PMC8279374 DOI: 10.1371/journal.pntd.0009565] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/14/2021] [Accepted: 06/15/2021] [Indexed: 11/19/2022] Open
Abstract
The microscopic agglutination test (MAT) is the standard serological reference test for the diagnosis of leptospirosis, despite being a technically demanding and laborious procedure. The use of a locally optimised MAT panel is considered essential for proper performance and interpretation of results. This paper describes the procedure of selecting such an optimised panel for Sri Lanka, a country hyper-endemic for leptospirosis. MAT was performed using 24 strains on 1132 serum samples collected from patients presenting with acute undifferentiated fever. Of 24 strains, 15 were selected as the optimised panel, while only 11% of serum samples showed positivity. A geographical variation in predominantly reactive serovars was observed, whereas reactivity was low with the saprophytic strain Patoc. Testing with paired sera yielded a higher sensitivity but provided only a retrospective diagnosis. Serological tests based on ELISA with complementary molecular diagnosis using PCR are a feasible and robust alternative approach to diagnose leptospirosis in countries having a higher burden of the disease.
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Affiliation(s)
- Dinesha Jayasundara
- Leptospirosis Research Laboratory, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
- Department of Microbiology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Chandika Gamage
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Indika Senavirathna
- Leptospirosis Research Laboratory, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
- Department of Biochemistry, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Janith Warnasekara
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Michael A. Matthias
- School of Medicine, Yale University, New Haven, Connecticut, United States of America
| | - Joseph M. Vinetz
- School of Medicine, Yale University, New Haven, Connecticut, United States of America
| | - Suneth Agampodi
- Leptospirosis Research Laboratory, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
- School of Medicine, Yale University, New Haven, Connecticut, United States of America
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Jayasundara D, Senavirathna I, Warnasekara J, Gamage C, Siribaddana S, Kularatne SAM, Matthias M, Mariet JF, Picardeau M, Agampodi S, Vinetz JM. Correction: 12 Novel clonal groups of Leptospira infecting humans in multiple contrasting epidemiological contexts in Sri Lanka. PLoS Negl Trop Dis 2021; 15:e0009471. [PMID: 34038414 PMCID: PMC8153494 DOI: 10.1371/journal.pntd.0009471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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21
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Agampodi TC, Dharmasoma NK, Koralagedara IS, Dissanayaka T, Warnasekara J, Agampodi SB, Perez-Escamilla R. Barriers for early initiation and exclusive breastfeeding up to six months in predominantly rural Sri Lanka: a need to strengthen policy implementation. Int Breastfeed J 2021; 16:32. [PMID: 33832496 PMCID: PMC8034146 DOI: 10.1186/s13006-021-00378-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 03/17/2021] [Indexed: 11/10/2022] Open
Abstract
Background Sri Lanka was named as the first-ever ‘Green’ breastfeeding nation status by the World Breastfeeding Trends Initiative (WBTi) in January 2020. However, improvements are still needed. This study aims to identify barriers and facilitators for early initiation of breastfeeding and exclusive breastfeeding for 6 months in rural Sri Lanka. Methods We conducted in-depth interviews with 16 mothers with infants, who had been unable to practice early initiation of breastfeeding and/or exclusive breastfeeding (EBF), in six child-welfare clinics in Anuradhapura, Sri Lanka. Three focus group discussions were held with public health midwives (PHMs). Initial thematic analysis that built upon force field and social learning theories was performed. Results Main barriers for EBF were clustered at three time periods; during the first 2–3 days, 2–3 weeks, and 4–5 months postpartum. Early barriers included cesarean section pain, poor breast latch, maternal exhaustion, suboptimal maternity ward environment, and lack of support for breastfeeding. Around 2–3 weeks postpartum mothers introduced water or infant formula due to social norms and poor support. On-demand feeding was misunderstood. Around 4 and 5 months postpartum, EBF ended due to return to work. PHMs reported a heavy workload limiting their time to support breastfeeding. Conclusion EBF interruption was due to diverse individual- and environnmental- level barriers that varied across the first 6 months. To improve EBF, Sri Lanka should focus on strengthening policies for reducing the excessive rates of cesarean section, improving support in maternity ward facilities, fostering on-demand breastfeeding, enhancing support for working mothers and reducing the work load of PHMs. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-021-00378-0.
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Affiliation(s)
- Thilini Chanchala Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka.
| | - Neerodha Kithmini Dharmasoma
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Iresha Sandamali Koralagedara
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Thushari Dissanayaka
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Janith Warnasekara
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Suneth Buddhika Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Rafael Perez-Escamilla
- Department of Social and Behavioral Science, Yale School of Public Health, New Haven, USA
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22
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Jayasundara D, Senavirathna I, Warnasekara J, Gamage C, Siribaddana S, Kularatne SAM, Matthias M, Mariet JF, Picardeau M, Agampodi S, M. Vinetz J. 12 Novel clonal groups of Leptospira infecting humans in multiple contrasting epidemiological contexts in Sri Lanka. PLoS Negl Trop Dis 2021; 15:e0009272. [PMID: 33735202 PMCID: PMC8009393 DOI: 10.1371/journal.pntd.0009272] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 03/30/2021] [Accepted: 02/25/2021] [Indexed: 12/13/2022] Open
Abstract
Leptospirosis is a ubiquitous zoonotic disease and a major clinical challenge owing to the multitude of clinical presentations and manifestations that are possibly attributable to the diversity of Leptospira, the understanding of which is key to study the epidemiology of this emerging global disease threat. Sri Lanka is a hotspot for leptospirosis with high levels of endemicity as well as annual epidemics. We carried out a prospective study of Leptospira diversity in Sri Lanka, covering the full range of climatic zones, geography, and clinical severity. Samples were collected for leptospiral culture from 1,192 patients from 15 of 25 districts in Sri Lanka over two and half years. Twenty-five isolates belonging to four pathogenic Leptospira species were identified: L. interrogans, L. borgpetersenii, L. weilii, and L. kirschneri. At least six serogroups were identified among the isolates: Autumnalis (6), Pyrogenes (4), Icterohaemorrhagiae (2), Celledoni (1), Grippotyphosa (2) and Bataviae (1). Seven isolates did not agglutinate using available antisera panels, suggesting new serogroups. Isolates were sequenced using an Illumina platform. These data add 25 new core genome sequence types and were clustered in 15 clonal groups, including 12 new clonal groups. L. borgpetersenii was found only in the dry zone and L. weilii only in the wet zone. Acute kidney injury and cardiovascular involvement were seen only with L. interrogans infections. Thrombocytopenia and liver impairment were seen in both L. interrogans and L. borgpetersenii infections. The inadequate sensitivity of culture isolation to identify infecting Leptospira species underscores the need for culture-independent typing methods for Leptospira. There is a huge diversity in pathogenic Leptospira species worldwide, and our knowledge of the currently circulating species is deficient owing to limited isolation and identification of Leptospira species from endemic countries. This prospective study reveals the wide pathogen diversity that causes human leptospirosis in Sri Lanka, representing four species, more than six serogroups, and fifteen clonal groups. Further, the different geographic and climatic zone distributions and clinical manifestations observed underscores the need for prospective studies to expand the molecular epidemiological approaches to combat leptospirosis.
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Affiliation(s)
- Dinesha Jayasundara
- Leptospirosis Research Laboratory, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
- Department of Microbiology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Indika Senavirathna
- Leptospirosis Research Laboratory, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
- Department of Biochemistry, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Janith Warnasekara
- Leptospirosis Research Laboratory, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Chandika Gamage
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Sisira Siribaddana
- Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | | | - Michael Matthias
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | | | | | - Suneth Agampodi
- Leptospirosis Research Laboratory, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
- * E-mail:
| | - Joseph M. Vinetz
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
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Warnasekara J, Aberathna P, Nanayakkara G, Vinetz J, Agampodi S. Improving the leptospirosis disease burden assessment by including ambulatory patients from outpatient departments: a cross-sectional study. F1000Res 2020; 9:1129. [PMID: 34123371 PMCID: PMC8145224 DOI: 10.12688/f1000research.26202.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 11/20/2022] Open
Abstract
Background: In Sri Lanka, the disease burden of leptospirosis is estimated based on a routine notification system, which is predominated by patients ill enough to be hospitalized. The notification system does not function well with ambulatory patients in outpatient departments (OPDs). The objective of this study was to determine the proportion of leptospirosis in an OPD setting in a regional public hospital in Sri Lanka to provide further estimation of disease burden. Methods: This study was conducted in the OPD of the Rathnapura Provincial General Hospital from August to September 2017. Suspected leptospirosis patients were recruited based on standardized criteria and tested using the microscopic agglutination test and quantitative polymerase chain reaction. The number of OPD patients was compared with the reported patient numbers with leptospirosis from the hospital during the same period as the denominator, and the 95% confidence interval was calculated for the proportions using Poisson distribution. Results: During the study period, of 2,960 fever patients presenting to the OPD, 33 (1.1%) were suspected to have leptospirosis; 8/33 suspected (22.3%) cases were confirmed as being due to leptospirosis. There were 82 notifications of leptospirosis cases from hospital inpatients during the same period, none from the OPD. The total missing proportion from the surveillance system was 28.6% (95% CI, 19.4-40.4%). Among OPD patients, 12 (36.4%) had been given antibiotics from a primary care center prior to the OPD visit. No OPD patient was admitted to the hospital for inward care. Conclusions: More than 25% of cases of leptospirosis were not identified because they were not sick enough to be admitted nor subjected to routine leptospirosis diagnostic testing.These data have public health implications if the sources of leptospirosis transmission are to be controlled.
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Affiliation(s)
- Janith Warnasekara
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, 50008, Sri Lanka
| | - Parami Aberathna
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, 50008, Sri Lanka.,Department of Family Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, 50008, Sri Lanka
| | | | - Joseph Vinetz
- Section of Infectious Diseases, Department of Internal Medicine, School of Medicine, Yale University, New Haven, 208022, USA
| | - Suneth Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, 50008, Sri Lanka
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Rajapakse Mudiyanselage SIR, Amarasiri L, Yasaratne D, Warnasekara J, Agampodi S. Prevalence and factors associated with severe asthma among preschool children of rural Sri Lanka. Epidemiology 2020. [DOI: 10.1183/13993003.congress-2020.2607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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25
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Agampodi TC, Wickramasinghe ND, Prasanna RIR, Irangani MKL, Banda JMS, Jayathilake PMB, Hettiarachchi A, Amarasinghe G, Jayasinghe I, Koralagedara I, Gunarathne SP, Wickramage S, Warnasekara J, Lokunarangoda N, Mendis V, Dissanayaka AK, Premadasa J, Hettigama N, Koralagedara D, Weerasinghe M, Malawanage K, Jayakodi H, Wickramasinghe A, Agampodi SB. The Rajarata Pregnancy Cohort (RaPCo): study protocol. BMC Pregnancy Childbirth 2020; 20:374. [PMID: 32586287 PMCID: PMC7318435 DOI: 10.1186/s12884-020-03056-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 06/15/2020] [Indexed: 01/14/2023] Open
Abstract
Background Ending preventable maternal deaths remains a global priority and in the later stages of obstetric transition, identifying the social determinants of maternal health outcomes is essential to address stagnating maternal mortality rates. Countries would hardly achieve the Sustainable Development Goal (SGD) targets on maternal health, unless the complex and context-specific socio-economic aetiologies associated with maternal mental health and suicide are identified. The Rajarata Pregnancy Cohort (RaPCo) is a prospective cohort study, designed to explore the interactions between social determinants and maternal mental health in determining pregnancy and new-born outcomes. Methods The study will recruit all eligible pregnant women in the maternal care programme of Anuradhapura district, Sri Lanka from July to September 2019. The estimated sample size is 2400. We will assess the socio-demographic and economic status, social capital, gender-based violence and mental health, including a clinical examination and biochemical investigations during the first trimester. Participants will undergo four follow-ups at 2nd and 3rd trimesters, at delivery and in early postpartum. The new-borns will be followed up at birth, neonatal period, at 6 six months and at 1 year. Pregnancy and child outcome data will be collected using direct contact. Qualitative studies will be carried out to understand the complex social factors and behavioural dimensions related to abortion, antenatal depression, maternal deaths and near misses. Discussion This is the first reported maternal cohort in Sri Lanka focusing on social determinants and mental health. As a country in stage four of obstetric transition, these findings will provide generalizable evidence on achieving SGD targets in low- and middle-income countries. The study will be conducted in a district with multi-cultural, multi-ethnic and diverse community characteristics; thus, will enable the evidence generated to be applied in many different contexts. The study also possesses the strength of using direct participant contact, data collection, measurement, examination and biochemical testing to minimise errors in routinely collected data. The RaPCo study will be able to generate evidence to strengthen policies to further reduce maternal deaths in the local, regional and global contexts particularly focusing on social factors and mental health, which are not optimally addressed in the global agenda.
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Affiliation(s)
- Thilini Chanchala Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka.
| | - Nuwan Darshana Wickramasinghe
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Rampathige Indika Ruwan Prasanna
- Department of Social Sciences, Faculty of Social Sciences and humanities, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | | | | | | | - Ayesh Hettiarachchi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Gayani Amarasinghe
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Imasha Jayasinghe
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Iresha Koralagedara
- Department of Anatomy, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Sajaan Praveena Gunarathne
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Sujanthi Wickramage
- Department of Physiology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Janith Warnasekara
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Niroshan Lokunarangoda
- Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Vasana Mendis
- Department of Pathology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Ajith Kumara Dissanayaka
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | | | - Nandana Hettigama
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | | | - Manjula Weerasinghe
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | | | - Hemali Jayakodi
- Provincial Director of Health Services Office, Anuradhapura, Sri Lanka
| | - Anuprabha Wickramasinghe
- Department of Psychiatry, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Suneth Buddhika Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
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Jayasinghe I, Hettiarachchi A, Koralegedara I, Amarasinghe G, Agampodi T, Dissanayake K, Warnasekara J, Wickramasinghe N, Abeyrathne P, Agampodi S. Female Obesity: An Emerging Threat in Sri Lanka. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa063_043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
Emerging body of evidence clearly shows a transgenerational effect of obesity. The maternal health programme in low- and middle-income countries are typically focusing on undernutrition, while the burden of overweight and obesity are mostly overlooked. The objective of this study was to evaluate the burden of malnutrition in a cohort of pregnant mothers in Sri Lanka.
Methods
A cross sectional analysis was conducted as a part of an ongoing cohort of all pregnant women registered in the public health system and having a period of gestation less than 12 weeks in Anuradhapura district, Sri Lanka were recruited over three months period during 2019. Clinical and anthropometric assessments were done in 240 dedicated clinics.
Results
Total of 3190 mothers were recruited with full anthropometric profile with mean age of 28.3 years (SD 5.6). Prevalence of overweight, obesity grade I, II and III according to Asian cut off limits were 15.3% (n = 520), 31.4%(n = 1065), 1.5% (n = 51) and 2% (n = 7) respectively. Prevalence of underweight was only 15.9%. Waist circumference >80 cm was reported among 1189 (35%) mothers. A marked spatial distribution of obesity was observed with ranging from 23% to 46%. As a more important and unbiased factor in the first trimester of pregnancy, we looked at the predictors of WC >80. After the adjustment for POA and age, living environment variables indicating higher level of financial status such as using electricity as main cooking fuel (OR 2.276), having a wooden floor (OR 1.688), floor tiles (OR 1.377), three-wheeler (OR 1.22) or other vehicle ownership (OR 1.287) were associated with central obesity. Higher education level of women and lower educational level of husband were also identified as predictors. Women from moor ethnic group were also at a higher risk compared to others.
Conclusions
Context specific strategies are required to tackle the double burden of malnutrition and the observed gross micro geographical variation in obesity needs further studies.
Funding Sources
Accelerating Higher Education Expansion And Development (AHEAD) Operation.
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Affiliation(s)
| | | | | | | | | | | | - Janith Warnasekara
- Department of Community Medicine, Faculty of Medicine And Allied Sciences, Rajarata University of Sri Lanka
| | | | | | - Suneth Agampodi
- Department of Community Medicine, Faculty of Medicine And Allied Sciences, Rajarata University of Sri Lanka
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Agampodi T, Dharmasoma N, Dissanayaka T, Koralagedara I, Warnasekara J, Pérez-Escamilla R, Agampodi S. Strengths and Barriers in Achieving “Green Status” of Breastfeeding; The Story of Frontline Health Care Workers in Sri Lanka. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa043_002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
The achievements in breastfeeding in Sri Lanka are due to multiple factors and the work of frontline health care workers: public health midwives (PHMs) was crucial. Objective of this study is to explore the strengths and constraints of PHMs in optimizing breastfeeding practices in the Sri Lankan community.
Methods
We conducted a series of focus group discussions with PHMs in three different areas in Anuradhapura district Sri Lanka. Transcribed data were analyzed thematically to identify the types of strengths and constraints.
Results
Thirty six PHMs participated in the focus groups conducted. The well-established public health system that introduces and reinforce knowledge and skills on breastfeeding assured that mothers will adhere to the current recommendations on EBF. PHMs agreed on the support given by the hospital labor room, theatres and Lactation Management Center on early initiation and EBF. However, emphasis on attachment to breast rather than discharging a newborn on cup feeding was mentioned. PHMs devotion on establishing proper breastfeeding during the early postpartum home visits, the respect and acceptance of PHM by the mother and the community and the knowledge and skills they possess on breastfeeding counseling were highlighted. Irrational prescription of formula by medical practitioners, negative verbal comments by in-laws and unfavorable attitudes of mothers of high social class were seen as social obstacles to promote EBF. The PHMs seem to work with many barriers which could compromise care provision for mothers and children. Inability to attend for the home visit early due to scheduled work, the increased time needed to spent to counsel mothers and subsequent restriction of the daily duties, high population density and having to cover the vacant areas through out, excessive documentation work were problems needed to be addressed with regard to service enhancement.
Conclusions
The PHMs role is inevitable and Sri Lanka needs to enhance and facilitate service provision of grass root level health workers to optimize promotion, protection and support for EBF.
Funding Sources
No funding source.
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Affiliation(s)
- Thilini Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka
| | - Neerodha Dharmasoma
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka
| | - Thushari Dissanayaka
- Department of Community Medicine, Faculty of Mediine and Allied Sciences, Rajarata University of Sri Lanka
| | - Iresha Koralagedara
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka
| | - Janith Warnasekara
- Department of Community Medicine, Faculty of Medicine And Allied Sciences, Rajarata University of Sri Lanka
| | | | - Suneth Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka
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Agampodi T, Dharmasoma N, Dissanayaka T, Koralagedara I, Warnasekara J, Agampodi S, Pérez-Escamilla R. Sri Lanka; The First Ever Only “Green Nation” in the World for Breastfeeding; Yet Lessons to Learn Through Exploring Maternal Perspectives. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa054_001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
Sri Lanka has been awarded the first-ever ‘Green’ breastfeeding (BF) nation status by the World Breastfeeding Trends Initiative (WBTi) in January 2020. Our objective was to explore the maternal perceptions of unrevealed barriers for the provision of promotion, protection and support of optimal exclusive breast feeding (EBF) up to six months.
Methods
We used in-depth interviews with 16 mothers with infants completed six months, who had been unable to practice EBF, attending six child-welfare clinics in Anuradhapura, Sri Lanka. Initial thematic analysis built upon force field and social learning theories were conducted to identify the barriers for optimal EBF practices during the first six months life.
Results
Main challenges to EBF were notably clustered at three occasions over the six months and first during the first 2–3 days after the delivery. Factors related to child birth influencing self-efficacy and confidence on establishing breastfeeding included cesarean section, pain and poor positioning due to pain, exhaustion, and perceived “inadequate milk”. Suboptimal policies on ward environment and practice of health staff that could lead to maternal worry and maternal stress related to demand for EBF were also identified as key barriers. Despite the early challenges, mothers who interrupted EBF within the first few days, desired to go back to EBF and was able to do so. The second occasion of cessation of EBF occurred around 2–3 weeks postpartum by introducing water or infant formula. These mothers lacked family support for BF leading to physical and mental exhaustion. Additionally, the mother's perception that “healthy infants should be chubby” also led to introduction of infant formula. On-demand feeding was reported to be a challenge due to misconceptions such as feeding according to a time table. Working mother reported ending EBF between 4 and 5 months, and they lacked self-efficacy, resulting from the lack of enabling environments and social support to express and continue only breast milk.
Conclusions
Although Sri Lanka has attained the “green” breastfeeding top status, interventions are needed to better the support the BF needs of mothers after cesarean section and to practice on-demand feeding and to improve the support for mothers that are employed in order to optimize EBF until completion of six months.
Funding Sources
No funding source.
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Affiliation(s)
- Thilini Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka
| | - Neerodha Dharmasoma
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka
| | - Thushari Dissanayaka
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka
| | - Iresha Koralagedara
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka
| | - Janith Warnasekara
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka
| | - Suneth Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka
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Senevirathna I, Jayasundara D, Lefler JP, Chaiboonm KL, Warnasekara J, Agampodi S, Matthias MA, Vinetz JM. Complete Genome Sequence of Leptospira interrogans Strains FMAS_KW1, FMAS_KW2 and FMAS_AW1 Isolated from Leptospirosis Patients from Karawanalla and Awissawella, Sri Lanka. J Genomics 2020; 8:49-52. [PMID: 32494307 PMCID: PMC7256012 DOI: 10.7150/jgen.43953] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 03/23/2020] [Indexed: 12/24/2022] Open
Abstract
Leptospirosis is an important cause of acute undifferentiated fever and complex multisystem febrile diseases in the tropics and subtropics. Understanding the evolution of Leptospira especially as related to the clinical pathogenesis of leptospirosis is facilitated by systematic comparative genomic analysis of human-infecting isolates. Here, we announce the complete genome sequences of three Leptospira strains that were isolated from blood of humans with undifferentiated fever in Sri Lanka.
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Affiliation(s)
- Indika Senevirathna
- Leptospirosis Research Laboratory, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka.,Department of Biochemistry, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka
| | - Dinesha Jayasundara
- Leptospirosis Research Laboratory, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka.,Department of Microbiology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka
| | - Joshua P Lefler
- Department of Medicine. Division of Infectious Diseases, University of California, San Diego. California, United States of America
| | - Kira L Chaiboonm
- Department of Microbiology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka
| | - Janith Warnasekara
- Leptospirosis Research Laboratory, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka.,Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka
| | - Suneth Agampodi
- Leptospirosis Research Laboratory, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka.,Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka.,Section of Infectious Disease, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Michael A Matthias
- Section of Infectious Disease, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Joseph M Vinetz
- Section of Infectious Disease, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
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Agampodi S, Warnasekara J, Jayasundara D, Senawirathna I, Gamage C, Kularatne S, Siribaddana S, Maththias M, Vinetz J. Study protocol: characterising the clinical, epidemiological and aetiological aspects of leptospirosis in Sri Lanka: a hospital based clinico-epidemiological study. BMJ Open 2019; 9:e027850. [PMID: 31511281 PMCID: PMC6738675 DOI: 10.1136/bmjopen-2018-027850] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 07/11/2019] [Accepted: 08/19/2019] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Sri Lanka has one of the highest incidences of leptospirosis worldwide. We hypothesised that different geographical locations and patient context will have a distinct molecular epidemiology of leptospirosis, based on microgeographical characteristics related to regiona-specific Leptospira predominance. Our objective is to characterise the clinical, epidemiological and molecular aspects of leptospirosis in Sri Lanka to understand disease progression, risk factors and obtain isolates of Leptospira. METHODS AND ANALYSIS We designed a multicentre prospective study in Sri Lanka to recruit undifferentiated febrile patients and conduct follow-ups during hospital stays. Patients will be recruited from outpatient departments and medical wards. This study will be conducted at two main sites (Anuradhapura and Peradeniya) and several additional sites (Awissawella, Ratnapura and Polonnaruwa). Blood and urine will be collected from patients on the day of admission to the ward or presentation to the outpatient department. Bedside inoculation of 2-4 drops of venous blood will be performed with Ellinghausen-McCullough-Johnson-Harris (EMJH) semisolid media supplemented with antibiotics. Regionally optimised microscopic agglutination test, culture and qPCR-evidence will be performed to confirm the presence of Leptospira in blood which in turn will confirm the presence of disease. Whole genome sequencing will be carried out for all isolates recovered from patients. Multilocus sequence typing (MLST) will be used for the genotyping of new isolates. Sri Lankan isolates will be identified using three published MLST schemes for Leptospira. ETHICS AND DISSEMINATION Ethical clearance for the study was obtained from Ethics Review Committees (ERC), Medicine and Allied Sciences (FMAS), Rajarata University of Sri Lanka (RUSL) and University of Peradeniya. All genomic data generated through this project will be available at GenBank. Anonymised data will be deposited at the ERC, FMAS, RUSL.
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Affiliation(s)
- Suneth Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Janith Warnasekara
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Dinesha Jayasundara
- Department of Microbiology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Indika Senawirathna
- Department of Biochemistry, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Chandika Gamage
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Senanayake Kularatne
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Sisira Siribaddana
- Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | | | - Joseph Vinetz
- Yale University School of Medicine, New Haven, Connecticut, USA
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Schønning MH, Phelps MD, Warnasekara J, Agampodi SB, Furu P. Correction to: A Case-Control Study of Environmental and Occupational Risks of Leptospirosis in Sri Lanka. Ecohealth 2019; 16:544. [PMID: 31713741 DOI: 10.1007/s10393-019-01455-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The original version of this article unfortunately contained a mistake in one of the co-author's family name. The correct name should be Janith Warnasekara instead of Janith Warnasuriya. The original article has been corrected.
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Affiliation(s)
- Marie Hellung Schønning
- Global Health Section, Department of Public Health, University of Copenhagen, Oster Farimagsgade 5, 1014, Copenhagen K, Denmark
| | - Matthew David Phelps
- Global Health Section, Department of Public Health, University of Copenhagen, Oster Farimagsgade 5, 1014, Copenhagen K, Denmark
| | - Janith Warnasekara
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Suneth B Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Peter Furu
- Global Health Section, Department of Public Health, University of Copenhagen, Oster Farimagsgade 5, 1014, Copenhagen K, Denmark.
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Schønning MH, Phelps MD, Warnasekara J, Agampodi SB, Furu P. A Case-Control Study of Environmental and Occupational Risks of Leptospirosis in Sri Lanka. Ecohealth 2019; 16:534-543. [PMID: 31664587 DOI: 10.1007/s10393-019-01448-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 08/07/2019] [Indexed: 06/10/2023]
Abstract
Sri Lanka has one of the highest incidences of human leptospirosis worldwide. Outbreaks of this zoonotic infection are related to the monsoons and flooding. The study investigates risk factors associated with environmental, animal and occupational exposure while acknowledging the potential bias due to hanta viral infections in the study samples. Data were obtained from structured interviews with 483 patients (276 cases and 207 controls). Risk exposures were studied for the entire population and for two stratified occupational groups: non-paddy workers and paddy workers. A higher odds ratio (OR) of leptospirosis transmission for paddy workers was observed compared to non-paddy workers (OR 1.905, 95% CI 1.274-2.856). Rat exposure was not associated with a significant higher risk for any of the groups. Instead, cattle and household animals seemed to be important for transmission of leptospirosis to humans, especially among non-paddy workers (OR 10.655, 95% CI 1.213-93.582). Leptospirosis in paddy workers was associated with environmental factors linked to contamination and wetness in paddy fields. Interestingly, abandoned paddy fields were found to have a protective effect against transmission to paddy workers (OR 0.421, 95% CI 0.237-0.748). Keeping animals on these dryer fields may act as a boundary for contamination of paddy fields with infectious animal urine. This finding may be considered as a public health intervention targeting leptospirosis among paddy workers.
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Affiliation(s)
- Marie Hellung Schønning
- Global Health Section, Department of Public Health, University of Copenhagen, Oster Farimagsgade 5, 1014, Copenhagen K, Denmark
| | - Matthew David Phelps
- Global Health Section, Department of Public Health, University of Copenhagen, Oster Farimagsgade 5, 1014, Copenhagen K, Denmark
| | - Janith Warnasekara
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Suneth B Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Peter Furu
- Global Health Section, Department of Public Health, University of Copenhagen, Oster Farimagsgade 5, 1014, Copenhagen K, Denmark.
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Warnasekara J, Koralegedara I, Agampodi S. Estimating the burden of leptospirosis in Sri Lanka; a systematic review. BMC Infect Dis 2019; 19:119. [PMID: 30727968 PMCID: PMC6364467 DOI: 10.1186/s12879-018-3655-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 12/21/2018] [Indexed: 12/18/2022] Open
Abstract
Background Although the assessment of disease burden should be a priority for allocating resources, leptospirosis is grossly underestimated despite its true burden in Sri Lanka. This study aimed to assess the morbidity and mortality of leptospirosis based on routine surveillance data, hospital reported data and scientific publications from Sri Lanka. Method A systematic review was carried out, and Pub Med, MEDLINE®, BIOSIS Previews, Zoological Record, Web of Science Core Collection, Current Contents Connect, KCI-Korean Journal Database, BIOSIS Citation Index, Data Citation Index, SciELO Citation Index and Google Scholar databases were searched. Quarterly epidemiological bulletin (QEB), indoor morbidity & mortality returns (IMMR) and hand searches of local literature were performed in local libraries. Forty-two relevant full texts, 32 QEBs, and 8 IMMR were included in the full text review. Adjustments were made for under diagnosis, underreporting and chance variability. Results The estimated annual caseload of leptospirosis in Sri Lanka from 2008 to 2015, was 10,423, and the cumulative annual incidence of leptospirosis that required hospitalization was 52.1 (95% CI 51.7–52.6) per 100,000 people. The estimated number of annual deaths due to leptospirosis was approximately 730 (95% CI 542–980), with an estimated pooled case fatality ratio of 7.0% (95% CI 5.2–9.4). The most common organs involved were the kidney, liver and heart, with median rates of 48.7, 30, and 14.2%, respectively. Conclusion Our systematic review shows gross underestimation of the true leptospirosis burden in the national statistics of Sri Lanka, and the hospitalization rates estimated in our study were compatible with the total burden estimate of 300·6 (95% CI 96·54–604·23) per 100,000 people published previously. Electronic supplementary material The online version of this article (10.1186/s12879-018-3655-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Janith Warnasekara
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008, Sri Lanka.
| | - Iresha Koralegedara
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008, Sri Lanka
| | - Suneth Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008, Sri Lanka
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