Community & Family Medicine

A Descriptive Study of the Pattern of Refractive Errors, Amblyopia Burden, and Effective Refractive Error Coverage Among Children Attending a Tertiary Hospital in Northern Sri Lanka

Thu, 01 Jan 2026 00:00:00 GMT

A Descriptive Study of the Pattern of Refractive Errors, Amblyopia Burden, and Effective Refractive Error Coverage Among Children Attending a Tertiary Hospital in Northern Sri Lanka Malaravan, M.; Thurga, J.; Kumanan, T.; Kumaran, S.; Powsiga, U.; Jathusha, K.; Aruljenani, K. Background: Visual impairment affects children's learning, development, and quality of life. Refractive errors (REs) are the most prevalent form of VI among ocular conditions, especially in children. They often begin in childhood and can progress significantly if left uncorrected, leading to complications such as amblyopia or long-term visual disability. Thus, this study was conducted to describe the patterns of REs, examine demographic and behavioral characteristics, and assess the burden of amblyopia and effective RE coverage among schoolchildren with REs attending the Ophthalmology Unit of Teaching Hospital Jaffna, Sri Lanka. Methodology: This hospital-based prospective cross-sectional study was conducted at the Ophthalmology Unit of Teaching Hospital Jaffna. Data were collected over two months among schoolchildren aged 6-18 years with REs. A total of 253 participants were recruited using systematic random sampling. Data on demographic factors, family history, outdoor activities, screen exposure, spectacle use, visual acuity, and RE patterns were collected using an interviewer-administered questionnaire and medical records from routine eye examinations. Visual assessments and refraction were performed according to standard ophthalmic procedures. Data were analyzed using IBM SPSS Statistics version 25.0 (IBM Corp., Armonk, NY, USA) with descriptive statistics. Results: A total of 253 schoolchildren with REs were included, with a mean age of 11.7±3.6 years; 138 (54.5%) were female. Astigmatism was the most common RE (118, 46.6%), followed by myopic astigmatism (66, 26.1%) and myopia (58, 22.9%). A family history of RE was present in 33.2% (n=84) of participants. The effective RE coverage was 18.6%. Among children previously prescribed spectacles, only 47 (33.3%) were current users, with lack of information (58, 61.7%) and affordability (20, 21.3%) being the main barriers to spectacle use. Amblyopia was present in 152 (60.1%) participants and was most common among children with hyperopic astigmatism (5, 100%) and hyperopia (5, 83.3%). Discussion: Astigmatism was the most common RE among children attending a tertiary eye care center in Northern Sri Lanka, followed by myopic astigmatism and myopia. A high burden of amblyopia and very low effective RE coverage were observed, indicating inadequate utilization of refractive services despite spectacle prescriptions; the high amblyopia burden likely reflects the tertiary referral-based study population rather than the general community. Lack of information and affordability were the main barriers to spectacle use. These findings highlight the need to strengthen early vision screening, improve awareness of spectacle compliance, and enhance access to affordable eye care services for children in Northern Sri Lanka. Conclusion: As the first hospital-based evidence of its kind from Northern Sri Lanka, these findings provide a starting point for local eye care planning while highlighting the broader need for community-based research to establish the true population burden. Strengthening screening pathways, support for spectacle compliance, and the affordability of eye care should be prioritized as immediate steps toward reducing preventable childhood VI in this region.

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

Thu, 01 Jan 2026 00:00:00 GMT

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

Thu, 01 Jan 2026 00:00:00 GMT

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

Thu, 01 Jan 2026 00:00:00 GMT

Visual Outcomes of Cataract Surgery at a Tertiary Care Hospital in Northern Sri Lanka Malaravan, M.; Kumaran, S.; Kumanan, T.; Aruljenani, K.; Powsiga, U.; Thurga, J. 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.