BackgroundPopulations of low and middle-income countries are ageing rapidly; there is a need for policies that support an increase in the duration of old age lived in good health. There is growing evidence that social participation protects against morbidity and mortality, but few studies explore patterns of social participation. Analysis of baseline quantitative and qualitative data from a trial of the impact of Elders’ Clubs on health and well-being in the hill country of Sri Lanka provided an opportunity to better understand the extent of, and influences on, social participation among elders.MethodsWe analysed data from 1028 baseline survey respondents and from 12 focus group discussions. Participants were consenting elders, aged over 60 years, living in Tamil tea plantation communities or Sinhala villages in 40 randomly selected local government divisions. We assessed participation in organised social activities using self-reported attendance during the previous year. Multivariable regression analyses were used to explore associations with community and individual factors. The quantitative findings were complemented by thematic analysis of focus group discussion transcripts.ResultsSocial participation in these poor, geographically isolated communities was low: 63% reported ‘no’ or ‘very low’ engagement with organised activities. Plantation community elders reported significantly less participation than village elders. Attendance at religious activities was common and valued. Individual factors with significant positive association with social participation in multivariable analyses were being younger, male, Sinhala, married, employed, and satisfied with one’s health. Domestic work and cultural constraints often prevented older women from attending organised activities.ConclusionsElders likely to benefit most from greater social contact are those most likely to face barriers, including older women, the oldest old, those living alone and those in poor health. Understanding these barriers can inform strategies to overcome them. This might include opportunities for both informal and formal social contact close to elders’ homes, consulting elders, providing childcare, improving physical access, advocating with elders’ families and religious leaders, and encouraging mutual support and inter-generational activities. Influences on social participation are interrelated and vary with the history, culture and community environment. Further study is required in other low and middle-income country contexts.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5482-x) contains supplementary material, which is available to authorized users.

FGDs: focus group discussions; GBD: global burden of disease; NCDs: non-communicable diseases; VI: vision impairment.

Background: It is crucial to understand the differences in dengue seroprevalence rates in different regions in Sri Lanka to understand the burden of infection to plan dengue vaccination programmes. Methods: age stratified seroprevalence rates were assessed in 5208 children, aged 10 to 19 years, in nine districts representing the nine provinces in Sri Lanka. A stratified multi-stage cluster was used to select 146 schools representing each district. Probability proportionate to the size (PPS) sampling technique based on the age distribution of general population and the urbanicity in each district was used to select the number of clusters to be enrolled for the study from each district. Findings: The overall dengue seroprevalence rates in children was 24.8%, with the highest rates reported from Trincomalee (54.3%) and the lowest rates from Badulla (14.2%), which is a high altitude estate area. There was a weak but positive correlation between the dengue antibody positivity rates and age in districts which had seroprevalence rates of >25%, while there was no increase in antibody titres with age in the other districts. While the seroprevalence rates was significantly higher in urban areas (35.8%) compared to rural (23.2%) and estate areas (9.4%), there was no association with seropositivity rates with population density (Spearmans r=- 0.01, p=0.98), in each district. Interpretation: The seroprevalence rates in many districts were <25% and the rates were very different to those reported from Colombo. Therefore, it would be important to take into account these differences when rolling out dengue vaccines in Sri Lanka.

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