Study purpose The aim of this study was to determine the fractional exhaled nitric oxide (FeNO) levels, exhaled breath carbon monoxide (eCO) levels, blood pressure, blood lipid levels between smokers and non-smokers and to determine the association of smoking intensity with the above parameters. Methods This descriptive study was conducted in selected periurban areas of the Colombo District, Sri Lanka. Adult male current tobacco smokers (n=360), aged between 21 and 60 years were studied and compared with anthropometrically matched male non-smokers (n=180). Data were collected by interviewer-administered questionnaire, clinical assessment and measurement of FeNO by FENO monitor and eCO bySmokerlyser. Results Smokers had significantly lower mean FeNO levels and higher mean eCO values compared with non-smokers. Presentation of palpitations was higher among the smokers and a significantly positive correlation was identified between palpitations and eCO levels. There was a significantly positive correlation between the systolic blood pressure of smokers with the duration of smoking (DS), Brinkman Index (BI), Body Mass Index (BMI) and there was a significantly negative correlation with FeNO levels. The mean arterial pressure was positively correlated with the DS, BI and BMI. There was a significantly negative correlation between FeNO and the number of cigarettes smoked per day, DS and BI of smokers. Significantly higher total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), very LDL-C, TC: HDL ratio and low high density lipoprotein cholesterol (HDL-C) level was observed among smokers compared with the non-smokers. Conclusions Tobacco smoking was found to impact blood pressure and serum lipid levels thus enhancing the cardiovascular risk among smokers. The levels of eCO and FeNO are useful biomarkers for determining the intensity of smoking. The results indicate the necessity for urgent measures to stop cigarette smoking in Sri Lanka.

A Primary Healthcare-System-Strengthening Project (PSSP) is implemented by the Ministry of Health, Sri Lanka, with funding support from the World Bank for providing quality care through primary medical care institutions (PMCIs). We used an explanatory mixed-methods study to assess progress and challenges in human resources, drug availability, laboratory services and the health management information system (HMIS) at PMCIs. We conducted a checklist-based assessment followed by in-depth interviews of healthcare workers in one PMCI each in all nine provinces. All PMCIs had medical/nursing officers, but data entry operators (44%) and laboratory technicians (33%) were mostly not available. Existing staff were assigned additional responsibilities in PSSP, decreasing their motivation and efficiency. While 11/18 (61%) essential drugs were available in all PMCIs, buffer stocks were not maintained in >50% due to poor supply chain management and storage infrastructure. Only 6/14 (43%) essential laboratory investigations were available in >50% of PMCIs, non-availability was due to shortages of reagents/consumables and lack of sample collection–transportation system. The HMIS was installed in PMCIs but its usage was sub-optimal due to perceived lack of utility, few trained operators and poor internet connectivity. The PSSP needs to address these bottlenecks as a priority to ensure sustainability and successful scale-up.

The Primary Healthcare System Strengthening Project in Sri Lanka focuses on improving noncommunicable disease (NCD) care provision at primary medical care institutions (PMCIs). We conducted an explanatory mixed-methods study to assess completeness of screening for NCD risk, linkage to care, and outcomes of diabetes/hypertension care at nine selected PMCIs, as well as to understand reasons for gaps. Against a screening coverage target of 50% among individuals aged ≥ 35 years, PMCIs achieved 23.3% (95% CI: 23.0–23.6%) because of a lack of perceived need for screening among the public and COVID-19-related service disruptions. Results of investigations and details of further referral were not documented in almost half of those screened. Post screening, 45% of those eligible for follow-up NCD care were registered at medical clinics. Lack of robust recording/tracking mechanisms and preference for private providers contributed to post-screening attrition. Follow-up biochemical investigations for monitoring complications were not conducted in more than 50% of diabetes/hypertension patients due to nonprescription of investigations by healthcare providers and poor uptake among patients because of nonavailability of investigations at PMCI, requiring them to avail services from the private sector, incurring out-of-pocket expenditure. Primary care strengthening needs to address these challenges to ensure successful integration of NCD care within PMCIs.

Gender norms practiced by respective societies increase the risk of violence by men against women. To date, there is a dearth of research evidence on changing gender norms through health promotion approaches around the globe, including in Sri Lanka. This study provides an evaluation of effectiveness of a health promotion intervention in changing the acceptance of gender norms among women. A quasi-experimental study was conducted in two rural villages in Anuradhapura district in Sri Lanka including women who have a child under five years of age. One village was allocated to receive an intervention developed based on a health promotion approach and the other village was a control. A community based mechanism to question selected gender norms among women was developed as the intervention. The pre- and post-intervention assessments of the level of acceptance of gender norms were done using an interviewer administered questionnaire and by using focus group discussions. Following the intervention, acceptances of prominent gender norms were changed significantly among the women receiving the intervention method. The control group showed no changes towards the acceptance of gender norms during this period. Women in the intervention group had higher levels of self-reported positive behavior changes and greater understanding of gender concepts compared to the control group. The acceptance of gender norms among women in rural villages in Sri Lanka can be changed by a community based intervention targeting gender norms.

Introduction: Tobacco smoking is the single most preventable cause of death worldwide and a major risk factor for several non-communicable diseases. Tobacco smoking has both acute and chronic effects on hematological parameters. The study aims to assess the effects of smoking intensity on...

Objective: To assess community awareness of cutaneous leishmaniasis (CL) in a disease-endemic district in Sri Lanka. Design: Population-based cross-sectional study. Setting: This study was conducted in selected 158 Grama Niladhari divisions covering all the 22 Divisional Secretariat areas of the Anuradhapura district, Sri Lanka. Sampling technique and participants: A probability sample of households was selected using multistage cluster sampling. Adults (≥18 years) who resided permanently in the Anuradhapura district during the data collection period were eligible, and individuals who could not comprehend or respond to the questions were excluded. The primary or secondary healthcare-related decision-maker of 1555 households participated in the study, in which 1479 (95.1%) were Sinhalese in ethnicity, including 1157 (74.4%) females. Primary and secondary outcome measures: The primary outcome measure was ‘CL awareness,’ operationalised by awareness of the disease name, transmission mode and the primary disease characteristic based on a systematic expert consensus approach. Secondary outcome measures included awareness and perceptions of CL curability, treatment centres and perceived susceptibility. Results: Only 3.6% (n=56) demonstrated CL awareness based on the definition. We observed low disease awareness even among people who claimed having CL or previously had the disease (n=6, 27.3%). While 1065 (68.5%) had heard the correct name (‘leishmaniasis’) or the local name ( ‘wæli mæssāgē leḍē’ ) for the disease, only 224 (21.0%) out of that knew the mode of transmission and 128 (12.0%) the chronic nature of CL skin lesions, respectively. Among the respondents with CL awareness (n=56), 42 (75.0%), 54 (96.4%) and 44 (88.0%) perceived CL as curable, were aware of treatment centres and expressed self-perceived susceptibility, respectively. Despite 423 (46.4%) who claimed to know more beyond the disease name, only 35 (8.3%) demonstrated actual CL awareness. Conclusion: Findings highlight significantly low CL awareness in the disease-endemic Anuradhapura district, and we recommend developing evidence-based, context-specific public health interventions targeting CL awareness gaps.