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The pathway to diagnosis and follow-up care for atrial fibrillation in Sri Lanka: a descriptive longitudinal study

2026-01-01T00:00:00Z

Title: The pathway to diagnosis and follow-up care for atrial fibrillation in Sri Lanka: a descriptive longitudinal study Authors: Antony Sheron, V.; Tiffany, E.G.; Powsiga, U.; Shribavan, K.; Guruparan, M.; Kumaran, S.; Gregory., Y.H.L.; Krishnarajah, N.; Neil Thomas, G.; Rajendra, S.; Balachandran, K.; Semira, M.H. Abstract: Background: Early diagnosis and continuity of care is vital for atrial fibrillation (AF), to reduce stroke ; There is a lack of understanding of when and how AF is being diagnosed and managed the care pathway) in in low- and middle-income countries (LMICs). We aimed to identify the AF care pathway in Northern Province, Sri Lanka and determine how the COVID-19 pandemic impacted the care pathway. Methods: This descriptive longitudinal study utilised two quantitative questionnaires to evaluate the AF pathway: The first questionnaire (baseline) was used to identify where AF was being diagnosed and the second questionnaire (3 months following baseline) was used to identify where and how often AF follow-up care was being received. How the COVID-19 pandemic impacted the care pathway was asked in the second questionnaire. We aimed to recruit 236 adults (≥18 years) with AF from Jaffna Teaching Hospital. Data were collected between October 2020 and June 2021 and analysed using descriptive statistics. Results: 151 participants were recruited (median age 57 years; 70% female). Most participants were diagnosed in the accident & emergency (38%) or inpatient department (26%), followed by an outpatient department (19%) or private facility (16%). Nearly all (97%) participants received follow-up care during the study period, with an average of 1.3 AFrelated healthcare visits per person for a month; most visited an outpatient department (88%). The COVID-19 pandemic negatively impacted 39% of participants’ care: healthcare visits were reduced or, delayed or medications were unattainable, and longer intervals between blood tests were experienced; however, 24% of participants were able to receive their medication by ambulance, public health staff or post during lockdowns. Conclusions: Primary care was not involved in the diagnosis of AF, indicating that most diagnoses occurr after a medical emergency. The frequency of blood tests was lower than the guideline recommendations of one per month which could in-part be due to the adverse impacts of the pandemic. Strengthening primary and community-based care may enable early diagnosis and improve continuity of care during and beyond future healthcare crises.

Cost-effectiveness of three screening strategies for atrial fibrillation in Sri Lanka: a decision-tree modelling analysis using community-based prevalence data

2026-01-01T00:00:00Z

Title: Cost-effectiveness of three screening strategies for atrial fibrillation in Sri Lanka: a decision-tree modelling analysis using community-based prevalence data Authors: Shribavan, K.; Zainab, A.; Tiffany, E.G.; Sheron Antony, V.; Powsiga, U.; Chamira, K.; Balachandran, K.; Neil, T.; Krishnarajah, N.; Gregory, Y.H.L.; Mahesan, G.; Haniffa, R.; Rajendra, S.; Abi, B.; Kumaran, S.; Sue, J. Abstract: Introduction Early diagnosis and treatment of atrial fibrillation (AF) are crucial to reduce AF-related complications and associated healthcare costs. In low-resource settings, digital health technologies could help achieve this; however, costs of different screening strategies are key for policy change. Methods This decision-tree model representing the Sri Lankan public health system perspective used prevalence data from a community-based cross-sectional study of 10 000 individuals aged ≥50 years in Northern Province, Sri Lanka. Participants were screened for AF using AliveCor, a handheld single-lead ECG device. Three screening strategies (systematic, opportunistic and targeted) were compared against each other. The incremental cost-effectiveness ratio (ICER) is presented, representing the incremental total aggregated cost between screening strategies divided by the incremental number of new detected AF cases to generate a cost per additional new AF cases detected for a 1-year time horizon. Results Systematic screening detected 48 new AF cases, and the targeted screening detected 47. Systematic screening was more expensive (Sri Lankan rupees (Rs) 698 422; US$2123) for 10 000 screened individuals compared with targeted screening (Rs 492 002; US$1496) for 7780 screened individuals. Opportunistic screening was the cheapest strategy (Rs 360 617; US$1096) for screening 6556 individuals; however, only 30 new AF cases were identified. The ICER of targeted screening was lower compared with opportunistic screening (Rs 7729; US$23 per additional detected AF case) whereas the ICER of systematic screening compared with opportunistic screening was higher at Rs 18 767 (US$57) per detected AF case. When the systematic screening strategy was compared with targeted screening, the cost per additional detected AF case increased to Rs 206 420 ($628). Conclusion Targeted screening with AliveCor was the most cost-effective strategy. Systematic screening, while having similar effectiveness, was not cost-effective due to the high additional costs to detect just one further case. These findings support integrating targeted screening into Sri Lanka’s primary care pathways.

Visual Outcomes of Cataract Surgery at a Tertiary Care Hospital in Northern Sri Lanka

2026-01-01T00:00:00Z

Title: Visual Outcomes of Cataract Surgery at a Tertiary Care Hospital in Northern Sri Lanka Authors: Malaravan, M.; Kumaran, S.; Kumanan, T.; Aruljenani, K.; Powsiga, U.; Thurga, J. Abstract: Background: Cataract is the leading cause of blindness and visual impairment. Cataract surgery is the most common procedure for restoring vision in individuals with cataracts. It is important to assess the surgical outcomes of cataract surgery to ensure the highest standard of vision restoration, improved patient quality of life, and service delivery. Therefore, the present study aimed to evaluate the visual outcomes of cataract surgery among patients attending the Eye Unit of Teaching Hospital Jaffna, Northern Sri Lanka, at the fourth week follow-up postoperatively. Methods: An institution-based, retrospective analytical study design was conducted among 1,133 patients who underwent cataract surgery using phacoemulsification with intraocular lens implantation. The study participants were selected using a systematic random sampling technique. Data were obtained through a structured data extraction form derived from patients’ medical records and an interviewer-administered questionnaire, and were subsequently analysed using IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States). Proportions, summary statistics, and tables were used to present the findings. Multivariable linear regression was performed to identify associations among the variables. A p‑value of <0.05 was considered indicative of statistical significance. Results: Among 1,133 patients who underwent phacoemulsification with intraocular lens implantation, 1,027 (90.6%) achieved good postoperative visual outcomes of 6/12 or better. The majority, 699 (61.7%), were female, and 800 (70.6%) were aged 60 years and above. The most common systemic comorbidities were hypertension with 386 (34.1%) patients and diabetes mellitus with 350 (30.9%), while 24 (2.1%) of them had pre-existing ocular comorbidities. Patients aged 60 years and above demonstrated significantly less improvement in visual acuity than those aged <60 years (p < 0.001). Diabetes mellitus was independently associated with reduced postoperative visual improvement (p = 0.014), whereas sex and pre-existing ocular comorbidities were not. Conclusion: The visual outcome following cataract surgery exceeds WHO recommendations. In this study, age and diabetes mellitus were associated with postoperative visual outcomes, whereas the presence of other ocular comorbidities and sex were not. Furthermore, this study demonstrates that good postoperative visual outcomes can be achieved with cataract surgery even in resource-constrained settings.

Dissecting autonomy in a resource-constrained setting: adescriptive qualitative study of women’s decisions on thesurgical treatment of early breast cancer in northern Sri Lanka

2025-01-01T00:00:00Z

Title: Dissecting autonomy in a resource-constrained setting: adescriptive qualitative study of women’s decisions on thesurgical treatment of early breast cancer in northern Sri Lanka Authors: Ramya, K.; Gopikha, S.; Dhivya, T.; Chrishanthi, R. Abstract: Breast cancer treatment is a contested space in which therapeutic decisions often collide withwomen’s values and preferences. In northern Sri Lanka, mastectomy remains the mainstay of surgicaltreatment of early breast cancer (EBC) despite evidence of equivalent survival following breast conservingsurgery (BCS) and radiotherapy. This study explores autonomy in decision-making among women with EBCwho were eligible for BCS and underwent mastectomy in northern Sri Lanka. A descriptive qualitative studywas carried out among 15 women referred for adjuvant therapy to Tellippalai Trail Cancer Hospital in Jaffnadistrict after having a mastectomy for EBC. Participants were recruited between January and May 2022 untildata saturation was reached. Data were gathered through semi-structured interviews, which weretranscribed in Tamil, translated into English, coded using QDA Miner Lite software, and analysedthematically. Women’s autonomy in EBC treatment decisions is limited by various factors in northern SriLanka. The hospital setting is not conducive to informed decision-making, and women do not receivesufﬁcient information. Neither survival rates nor risks/beneﬁts of the surgical options are discussed in asystematic way. Although many women appear to be satisﬁed with their involvement in decision-making,their decisions are guided by incomplete information and fears of spread/recurrence communicated bytreating teams. In the absence of policies and protocols to support patient autonomy, women “choose” themore invasive option: mastectomy. While it behoves medical professionals to provide evidence-basedinformation, governments and the global health community must support strengthening healthcare systemsto advance women’s health and rights in lower-resource settings.