Ajith Alagiyawanna

Introduction: Occupational stress among bus drivers is on the rise in the world. Mental health promotion programs can be effective in managing job stress in occupational groups.Objectives: To assess the effectiveness of a multi-component intervention to manage occupational stress among bus drivers of Sri Lanka Transport Board of Colombo District.Methods: A cluster randomized control trial was performed to assess the effectiveness of the intervention. Drivers were selected by randomization from all 12 depots in Colombo District. The intervention was carried out in six depots and controlled in the other six depots. Both arms consisted of 72 drivers. The mental health promotion-stress management intervention package was delivered for six months. Outcomes were assessed based on pre- and post-test stress levels. Process indicators were also determined to assess the effectiveness of the intervention.Results: All the participants were males. Response rate in the intervention group was 97.2%. Pre-intervention prevalence of occupational stress in the intervention group was 50% (n=36) and it was 58.33% (n=42) in the control group. This difference was not statistically significant (p=0.316). The post-intervention occupational stress level in the intervention group was 40.28% (n=29) and in the control group was 56.94% (n=41). This difference was statistically significant (p=0.045). In the intervention group, twelve drivers with occupational stress shifted to normal stress levels after the intervention, while five drivers who had normal stress levels, developed occupational stress afterwards (6.94%). This difference within the intervention group was not statistically significant (OR=2.4; 95% CI: 0.845, 6.81; p=0.145). Level of satisfaction on the overall programme was stated as excellent by 86% of the drivers in the intervention group.Conclusions & Recommendations: Stress management intervention was effective in reducing occupational stress among drivers. Mental health promotion programs need to be conducted on the recruitment of bus drivers.

Introduction: Complex interventions are widely used in public health practices. Communication for Behavioural Impact (COMBI) is an effective method in planning for dengue control. The aim was to develop an intervention package to change behaviour to prevent dengue in a dengue endemic area of Sri Lanka. Methods: Development of the intervention package was formulated according to two-phases including ‘Theoretical phase’ and ‘Modelling phase’ using a framework. World Health Organization 10 key steps in planning COMBI were followed in order to develop the present intervention package. A Situational-Market-Analysis-for-Communication-Keys (SMACK) was conducted in highest dengue endemic area in Kurunegala district to identify the Specific Behavioural Objectives (SBOO), which was conducted using mixed methodological approach followed by other steps of COMBI planning. Results: The overall goal was to decrease morbidity and mortality due to dengue illness. The SBOO for the plan were to improve the proper waste management practices according to the ‘3R concept’ (Reduce-Reuse-Re-cycling) and to improve the dengue prevention practices by 30 minutes of weekly cleaning. The strategies were to conduct a community empowerment program to improve waste management and weekly practices on dengue prevention by conducting administrative mobilization and public-relationship, public-advocacy, community mobilization, personal selling, advertising, and point of service promotion. The plan was finalized after taking expert opinion with the participation of stakeholders by the management team. Conclusion: Developing a COMBI plan for an area after the identification of SBOO would be feasible to implement in order to empower the community to prevent dengue and improve community health services.

IntroductionStigma and discriminatory behaviours are common during pandemics. Stigma if not mitigated could result in varied negative psychological consequences in those who it is directed towards, as well as his/her associates. ObjectivesThe objective of this study was to assess the dynamics of stigma experienced by ten different categories of people, the places and persons who expressed stigmatising attitudes and behaviours, adherence to COVID-19 related health instructions by the general public, and the aspects of the pandemic that had the most psychological impact in the above-indicated ten categories of people. MethodologyWe conducted a secondary analysis of already available data collected by the Directorate of Mental Health and Health Promotion Bureau of the Ministry of Health to formulate a communication campaign to combat stigma and discrimination during the COVID- 19 pandemic. ResultsOf the 4022 participants, a majority (53.7%) were females, Sinhalese (86.2%) and 17.3% were in the 25-29 year age category. Personnel working in health, security and other essential services and their family members experienced stigma and discrimination from the wider society, neighbours or media. Participants quarantined either at quarantine centres or in their homes, and their family members, also experienced stigma and discrimination. A majority of the general public reported avoiding places where health, security and essential service personnel gathered. Further, a majority of participants reported adhering to the COVID-19 related health instructions. The aspect of the pandemic that had the most psychological impact was the fear of contracting the virus. ConclusionsResults indicated stigma and discrimination towards certain categories of people during the COVID-19 pandemic. It is essential that authorities take action to mitigate such instances, for instance by formulating media guidelines on reporting the pandemic – an action that was implemented subsequent to these study results.

Background: Sri Lankan citizens consume almost double the recommended daily amount of salt. Objective of this study was to assess the knowledge, attitudes and practices related to health effects of dietary salt among adults and adolescents in Sri Lanka to inform a national behavior change communication campaign. Methods: We conducted a descriptive household survey among adults (n=1016) and adolescents (n=505) in 10 districts. An, interviewer administered questionnaire was used for data collection. The approximate amount of dietary salt intake of the individuals was estimated based on household purchases. Findings: The recommended salt limit was identified by 40% of the population. Majority, adults (90.8%) and adolescents (86.1%) knew the adverse health effects of high salt intake. Although household monthly purchase of salt indicated consumption is much higher than recommended, 48.3% of adults and 45.9% of adolescents believed that they consume ‘just the right’ amount. Discretionary salt added to home cooking was a major contributor to intake, with approximately half (50%) adding salt when cooking rice, the staple. For health-related information most preferred (adults - 72%, adolescents – 69%) media is television. Interpretation: The study identified gaps as well strengths in knowledge, attitudes and practices of Sri Lankans related to salt and health and recommends that the communication campaign include specific messaging to address gaps and leveraging on strengths. The survey identified adult females to be a key target group for the campaign and television is recommended as the mode of delivery.

Despite reports that Southeast Asia has one of the highest prevalence for childhood exposure to second hand smoke (SHS), there are limited data on SHS exposure among schoolchildren in individual countries in the region, including Sri Lanka. This study aimed to determine the prevalence and correlates of SHS among schoolchildren in a Medical Officer of Health (MOH) region in the country. We conducted a cross-sectional study, sampling from nice schools in one MOH region following a two-stage cluster sample design and probability proportionate to size sampling techniques. Data were obtained through a self-completed anonymous questionnaire on socio-demographic and health behaviour risk factors. We achieved an 89.5% response rate, corresponding to a total of 311 students in the final sample. The prevalence of exposure to SHS during the previous week was 17.6% at home and 25.7% in enclosed public places. There were no significant differences in exposure to SHS between sexes. Univariable analysis found that the presence of smokers at home and mother’s unemployment status were significantly associated with a higher risk of exposure to SHS at home. These variables remained significant in multivariable analysis. Non-Sinhalese ethnicity and presence of smokers at home were significantly associated with exposure to SHS in public places, in both uni- and multivariable analysis. Unemployment status of mother was also found to be a significant determinant of exposure to SHS in public places in multivariable analysis. Despite numerous antismoking activities and strong antismoking legislation, the prevalence of SHS exposure among schoolchildren is higher in enclosed public places than homes. The implementation and enforcement of antismoking legislation is imperative to tackle this and should be supported by the provision of education for schoolchildren and their families on the health risks of SHS. The high-risk groups identified here could be prioritised for preventive programmes.

Second-hand smoke (SHS) in households remains a serious public health problem in Sri Lanka, partly due to a lack of voluntary prohibitions of tobacco smoking inside houses. Women are especially at risk of being exposed. Effective community based interventions to reduce the SHS in households targeting women is scarce. The objective of this study was to examine the impact of a multi-component intervention on household SHS exposure among Sri Lankan women. Thirty clusters of 25 women (aged 18–65) from 750 households were randomized into the intervention and control groups. Women in the intervention group were exposed to activities which focused on improving knowledge on the health effects of SHS, attitudes towards SHS exposure, right to a smoke-free living and women empowerment against smoking. The duration of the intervention was six months. The comparison group received no intervention. The primary outcome of interest was self-reported SHS exposure in the household within 7 days prior to data collection. The secondary outcomes were exposure in the past 30 days, knowledge of the health risks of exposure, attitudes towards exposure, right to smoke-free living, women empowerment against smoking, and smoking inside the homes. Final assessment was in 329 (89.6%) in the intervention group and 309 (85.8%) in the comparison group. Following the intervention, significantly lower proportion of women in the intervention group as compared to the control group reported SHS exposure in their households within 7-days (9.2% vs. 15.3%, p = 0.02) and 30-days (13.6% vs. 21.6%, p = 0.008) prior to the post survey. As compared to the control group, significantly higher median scores were observed in the intervention group on the knowledge of the health risks of exposure to SHS (p < 0.001), attitudes on exposure to SHS (p = 0.004), right to smoke free living (p = 0.001) and women empowerment (p < 0.001). Multi-component intervention activities were effective in reducing household exposure to SHS among women. Sri Lanka Clinical Trials Registry SLCTR/2014/033.

Governments use fiscal interventions (FIs) on food and beverages to encourage healthy food behaviour and positive health outcomes. The objective of this review was to study the behavioural and health outcomes of implemented food and beverage FIs in the form of taxes and subsidies in countries of different income classifications. The present systematic review was conducted in accordance with Cochrane protocols. The search was carried out on academic and grey literature in English, for studies conducted in different countries on implemented FIs on food and non-alcoholic beverages and health outcomes, with a special focus on the income of those countries. Eighteen studies met the inclusion criteria and 14 were from peer- reviewed journals. Thirteen studies came from high-income (HI) countries, four from upper middle-income (UMI) countries and only one came from a lower middle-income (LMI) country. There were no studies from lower-income (LI) countries. Of these 18 studies; nine focused on taxes, all of which were from HI countries. Evidence suggests that FIs on foods can influence consumption of taxed and subsidized foods and consequently have the potential to improve health. Although this review supports previous findings that FIs can have an impact on healthy food consumption, it also highlights the lack of evidence available from UMI, LMI and LI countries on such interventions. Therefore, evidence from HI countries may not be directly applicable to middle-income and LI countries. Similar research conducted in middle and low income countries will be beneficial in advocating policy makers on the effectiveness of FIs in countering the growing issues of non-communicable diseases in these countries.