Biomedical subjects
Publications and source records attributed to M P Senanayake.
Two patients with homozygous beta thalassaemia complicated by cerebral thrombosis are reported. An alteration in coagulability due to a sudden increase in haematocrit and platelets was the probable cause in one patient. Although the other patient had many complications of thalassaemia, the cause for cerebral thrombosis was not identifiable.
OBJECTIVES: To describe the problems faced by children during separation from their imprisoned mothers, and evaluate the health of children who accompanied their mothers into prison. DESIGN: A prospective observational study. SETTING: Welikada Prison, Colombo, Sri Lanka. METHODS: 200 randomly selected mothers who had left their children at home were interviewed using a questionnaire. During a period of 8 months 30 children living with their mothers in prison underwent physical and developmental examination and tuberculin testing. The living conditions within the prison were evaluated. RESULTS: During 18 months from January 1999, 4089 women were imprisoned. 88% were remanded, 20% awaited trial for more than one year in prison. 2416 were mothers. 1411 had at least one child under 12 years of age. The 200 mothers interviewed had 262 children under 12 years at home. Their care arrangements were: a relative (69%), father (16%), older sibling (4%), religious organisation (2.7%), neighbour (1.3%). None had received social services support. 70 children accompanied mothers into prison. In the 30 children followed up regularly 23% had scabies, 10% pediculosis, and 7% impetigo. No severe malnutrition was found and screening for tuberculosis was negative. 70% were breastfed. The child-friendly dormitory was inadequate to accommodate all children. CONCLUSION: Care arrangements and schooling were affected and no counselling services were provided during the imprisoned mothers' absence. The children within the prison enjoyed close bonds with the mothers and their physical needs were met. The child's best interest had not always been considered by court when deciding on custody during the mothers' imprisonment.
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OBJECTIVES: To study the prevalence of exclusive breast feeding and the reasons for water supplementation, and investigate whether water is necessary in the humid climate of Colombo. SETTING: Well baby clinic in De Soysa Maternity Hospital for Women, Colombo. SUBJECTS: 200 breast fed infants born in a baby friendly hospital between the ages of 1 and 4 months. METHODS: The study sample was randomly selected. Sick infants and those of working mothers were excluded. The mothers' knowledge of feeding practices was recorded in an interviewer administered questionnaire. The infants' weights, lengths and rectal temperatures were measured and the osmolality of urine estimated. The room temperature and relative humidity were recorded on each day of study. The data were analysed using the Chi-Square statistical test. RESULTS: 69% of mothers introduced supplementary fluids within the first 4 months, because of advice from grandmothers or relatives, thirst, hiccups or constipation. 45% had introduced water with "rathakalkaya", a fluid traditionally given to infants in Sri Lanka. 90% of mothers had attended antenatal clinics in the De Soysa Hospital for Women. 70% of mothers who gave supplementary fluids were aware of the importance of exclusive breast feeding. The range of urine osomolalities of exclusively breast fed infants was 60 to 204 mosmol/kg. There were no significant differences in core temperatures and number of times urine was voided daily, or urine osmolalities, between exclusively breast fed and fluids-supplemented group of infants. CONCLUSIONS: Despite delivery in a baby friendly hospital a majority of mothers supplemented breast milk with water or other fluids during the first 4 months. The advice of grandmothers had a significant influence on early feeding practices. Exclusively breast fed infants were found to maintain water homeostasis under the hot, humid climatic conditions of this study.
INTRODUCTION: Short stature is common in thalassaemia major. Hypothyroidism resulting from haemosiderosis has been implicated, but this complication has not been investigated in Sri Lanka. OBJECTIVES: To estimate the thyroid hormone level of patients with thalassaemia major and correlate height with age, iron status and thyroid hormone level. SETTING: University Unit, Lady Ridgeway Hospital, Colombo. DESIGN: A cross-sectional comparative study. METHODS: 33 patients with thalassemia major (19 males) aged 2 years 6 months to 23 years were studied. 21 healthy age and sex matched subjects from the same neighbourhood as the patients served as controls. Anthropometric measurements, skeletal maturity, serum ferritin and thyroid hormone levels were estimated. RESULTS: The height centiles and height standard deviation scores (SDS) were significantly lower in the patient group. Skeletal maturation was delayed by more than 1 year in 69% of patients. Undernutrition was not seen. The height SDS showed significant reduction with age (r = -0.5, 95% confidence limit -0.72 to -0.18) and with elevated serum ferritin levels (r = -0.8, 95% confidence limit = -0.9 to 0.62). Serum ferritin levels were elevated in the entire patient group with 70% being heavily iron overloaded (serum ferritin > 7000 ng/ml). The thyroxine (T4) levels were within the normal range in all 33 patients. The TSH levels were normal in 32 patients. The patient too had a normal T4 level. The control group had TSH levels comparable with the patients. CONCLUSION: Hypothyroidism was not present in our iron overloaded thalassaemic patients. The thyroid hormone levels were similar in patients with mild and heavy iron overload. We conclude that routine surveillance for hypothyroidism is unnecessary in thalassaemia major. Other causes for delayed skeletal maturation and short stature need investigation.
OBJECTIVE: To study the background, life styles, health and prevalence of abuse of street children in Colombo. STUDY SAMPLE: 50 street children receiving temporary day care or night shelter from community service centres were serially recruited. DESIGN: A retrospective descriptive survey. Demographic, experiential and clinical data were collected by an interviewer, based on a semistructured questionnaire, followed by physical examination and laboratory investigation. RESULTS: The children were aged between 4 and 17 years. (Mean 10.5 years.) 64% were males and 18% belonged to ethnic minorities. The majority (84%) had family ties. Family disintegration was mentioned as the cause for life on the streets by 36%. Child labour was reported in 38%. 16% admitted to being sexually abused. 20% were tobacco smokers. Respiratory and skin infections, and injuries incurred in road traffic accidents were the main causes of morbidity. CONCLUSION: Street children in Colombo are an abused and exploited group. Road traffic accidents, and physical and sexual abuse are the main hazards of the street they are exposed to.
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OBJECTIVE: To investigate the maternal comprehension of two different growth charts and to identify the group of mothers with poor comprehension. DESIGN: An experimental prospective study. SETTING: A child welfare clinic at the De Soysa Hospital for Women, Colombo, Sri Lanka. SUBJECTS: 932 mothers were studied regarding their interpretation of the type of growth chart their infants had been allocated. A total of 413 mothers interpreted the 'road-to-health' chart and 519 mothers interpreted the revised chart. A validated scoring system was used to assess comprehension. The two groups of mothers were comparable. RESULTS: 62.4% (324) mothers who interpreted the revised chart had good comprehension. Only 20.6% (85) mothers had similar comprehension with the road-to-health chart. Education up to or beyond grade 8 in school significantly improved comprehension. CONCLUSION: The design of the growth chart has a powerful effect on maternal comprehension of growth patterns. Length of schooling rather than literacy alone is a marker of a comprehending mother. The policy implications of these findings are that governments and agencies may need to redesign parent held growth charts to achieve better comprehension by mothers.
OBJECTIVE: To study the integrity of EPI vaccine storage during interruptions to the power supply. SETTING: Health centres in Colombo District. METHOD: An interviewer-administered questionnaire was used to collect information on staff compliance with regulations of the expanded program of immunisation (EPI) and alternative facilities available for refrigeration during power failure. The refrigerator and storage conditions were inspected. The stored vaccines were tagged with thermosensitive cold chain monitors, which were read on revisiting the clinic 14 days later. During the study period, power cuts of 2 hours' duration were in force daily. A control study was carried out when there was no interruption to power supply. RESULTS: Diphtheria-pertussis-tetanus (DPT) and measles vaccines had been exposed to temperatures outside the prescribed range during power cuts. Oral polio vaccine had adequate storage with power cuts of 2 hours' duration. CONCLUSION: Alternative facilities for vaccine storage during power cuts were not available and the potency of DPT and measles vaccines were compromised with interruptions to power of 2 hours' duration or more.
OBJECTIVES: To study the practices of health personnel regarding vaccine storage and the integrity of the cold chain, during storage, in immunisation clinics. DESIGN: A cross-sectional descriptive survey based on a postal questionnaire and an observational study of the cold chain during storage of a randomly selected sample. SETTING: Colombo District. PARTICIPANTS: 10 health centres, 13 Colombo Municipal Council Clinics, 26 general practices receiving vaccines from health centres, 13 private hospitals and 10 state-run hospitals. METHOD: A pretested postal questionnaire collected information on storage conditions and compliance with EPI requirements. The sub-sample in which the temperatures were monitored consisted of 33% of the total. The study was carried out in 1995-1996, when there was an uninterrupted power supply. OUTCOME MEASURES: Responses to the postal questionnaires and the colour changes recorded in thermosensitive WHO cold chain monitors. RESULTS: The response rate to the postal questionnaire was 87.5%. All 63 respondents stored vaccines in refrigerators worked by electricity. Information regarding refrigerators showed 46% to be less than 5 years old and 17% were more than 15 years old. 97% of refrigerators had good door seals. Regular defrosting was claimed by 79% of clinics and 81% had a named person responsible for vaccine storage. Only 57% had thermometers available and temperatures were monitored daily in only 40% of clinics. 76% of refrigerators were used for purposes other than storage of vaccines. Colour changes were noted in 2 out of 22 cold chain monitors.