PapersConclusions The prevalence of the selected cardiovascular risk factors is common in the adult Sri Lankan population surveyed. Regional differences exist in the prevalence of these risk factors. The prevalence of high level of risk factors requires urgent public health action. AbstractObjective To determine the prevalence of selected cardiovascular risk factors in adult Sri Lankan population in four provinces.Design Cross-sectional, based on a stratified cluster sampling method.Settings Four provinces, namely the Western, North Central, Southern and Uva.Patients Six thousand and forty seven participants (2692 men) between the age of 30 and 65 years were surveyed.Measurements Risk factors measured included height, weight, waist and hip circumference. Waist to hip ratio and body mass index were calculated, and overweight (23 kg/m 2 ) and obesity (≥25 kg/m 2 ) determined. Hypertension (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg or use of antihypertensive medications), and diabetes mellitus (fasting serum plasma glucose level ≥ 7 mmol/L or use of antidiabetic medications) and impaired fasting glycaemia (≥ 6.1 to < 7 mmol/L) were also determined.Results The prevalence of hypertension as defined was 18.8% (CI 14.5-23.1) for men and 19.3% for women. The prevalence of diabetes was 14.2% (CI 11.9-16.5) for men and 13.5% (CI 6.9-20.1) for women while impaired fasting glycaemia was 14.2% for men and 14.1% for women. The mean body mass index was 21.5 kg/m 2 (SD = 3.7) in men. It was lower than that in women, 23.3 kg/m 2 (SD = 4.5). The prevalence of obesity was 20.3% in men and 36.5 % in women.Regional differences were seen in the mean fasting blood glucose and prevalence of diabetes, and mean BMI and prevalence of obesity were highest in Western province. Mean blood pressure and prevalence of hypertension were highest in the Uva Province. Southern Province had the lowest prevalence of hypertension and diabetes, and North Central Province had lowest anthropometric measures of obesity.

Background : Sexual harassment occurs within the nursing profession globally, challenging the health and safety of nurses and the quality and efficiency of health systems. In Sri Lanka, no studies have explored this issue in the health sector; however, female employees face sexual harassment in other workplace settings. Objective : To explore female nurses’ perceptions of workplace sexual harassment in a large state hospital in Sri Lanka. Methods : This is a qualitative study conducted in an urban, mainly Buddhist and Singhalese context. We invited all female senior and ward nurses working in the hospital to participate in the study. We conducted individual in-depth interviews with four senior nurses and focus group discussions with 29 nurses in three groups. Results : The nurses described a variety of perceived forms of sexual harassment in the hospital. They discussed patient-perpetrated incidents as the most threatening and the clearest to identify compared with incidents involving doctors and other co-workers. There was significant ambiguity regarding sexual consent and coercion in relationships between female nurses and male doctors, which were described as holding potential for exploitation or harassment. The nurses reported that typical reactions to sexual harassment were passive. Alternatively, they described encountering inaction or victim blaming when they attempted to formally report incidents. They perceived that workplace sexual harassment has contributed to negative societal attitudes about the nursing profession and discussed various informal strategies, such as working in teams, to protect themselves from sexual harassment in the hospital. Conclusions : Sexual harassment was a perceived workplace concern for nurses in this hospital. To develop effective local prevention and intervention responses, further research is required to determine the magnitude of the problem and explore differences in responses to and consequences of sexual harassment based on perpetrator type and intent, and personal vulnerabilities of the victims, among other factors.

Obstetric violence refers to the mistreatment of women in pregnancy and childbirth care by their health providers. It is linked to poor quality of care, lack of trust in health systems, and adverse maternal and neonatal outcomes. Evidence of interventions to reduce and prevent obstetric violence is limited. We developed a training intervention using a participatory theatre technique called Forum Play inspired by the Theatre of the Oppressed for health providers in Sri Lanka. This paper assesses the potential of the training method to increase staff awareness of obstetric violence and promote taking action to reduce or prevent it. We conducted four workshops with 20 physicians and 30 nurses working in three hospitals in Colombo, Sri Lanka. Participants completed a questionnaire before and three-to-four months after the intervention. At follow-up, participants more often reported that they had been involved in situations of obstetric violence, indicating new knowledge of the phenomenon and/or an increase in their ability to conceptualise it. The intervention appears promising for improving the abilities of health care providers to recognise obstetric violence, the first step in counteracting it. The study demonstrates the value of developing further studies to assess the longitudinal impacts of theatre-based training interventions to reduce obstetric violence and, ultimately, improve patient care.

Introduction The prevalence and survival of colorectal cancer in Sri Lankans has not been previously reported. We did a retrospective and a prospective survey, in the region of North Colombo, Sri Lanka between 1992 and 2004. The aim was to study cancer burden, sites of colorectal cancer and survival after surgery. Patients and methods The records of 175 patients with colorectal cancer between 1992 and 1997 in the selected region of were analysed retrospectively. A prospective study was performed in 220 new patients with colorectal cancer between 1996 and 2004. Data evaluated were demographics, tumour stage and survival. Results Between 1992 and 1997 the crude annual incidence of colorectal cancer was 1.9 per 100 000, which increased over the years. The current national crude annual incidence is 3.2 per 100 000 in women and 4.9 in men. Median age at presentation was 60 years with similar prevalence of cancer in men and women. In the entire group, 28% of cancers were in those less than 50 years old. Survival at 2 and 5 years was 69% and 52%. The majority of cancer related deaths were within the first 2 years after surgery. Conclusion The burden of colorectal cancer in Sri Lanka is on the rise. Up to a third of cancers occur in those under 50 years, and the majority of cancers are in the rectum or rectosigmoid region. Flexible sigmoidoscopy offers a useful screening tool.

The phenomenon of obstetric violence has been documented widely in maternity care settings worldwide, with scholars arguing that it is a persistent, common, but preventable impediment to attaining dignified health care. However, gaps remain in understanding local expressions of the phenomenon, associations with other types of violence against women, and implications for women’s trust and confidence in health providers and services. We focused on these issues in this cross-sectional study of 1314 women in Sri Lanka’s Colombo district. Specifically, in this study, we used Sinhalese and Tamil translations of the NorVold Abuse Questionnaire and the Abuse Assessment Screen to measure prevalence of women’s experiences with obstetric violence in maternity care and lifetime and pregnancy-specific domestic violence. Then, the results were interpreted by considering the women’s sociodemographic characteristics, such as age, ethnicity, and family income, to reveal previously undocumented associations between obstetric and domestic violence during pregnancy, as well as other factors associated with experiencing obstetric violence. We argue that obstetric violence is prevalent in government-sector (public) maternity care facilities in the Colombo district and is associated with young age, lower family income, non-majority ethnicity, and rural residency. Significantly, this study sheds light on a serious concern that has been underexamined, wherein women who report experiencing obstetric violence are also less likely to be asked by a health care provider about domestic violence experiences. Further research at the clinical level needs to focus on appropriate training and interventions to ensure women’s safety and cultivate relationships between patients and health care providers characterized by trust, confidence, and respect.

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BackgroundAlthough violence against women (VAW) is a global public health issue, its importance as a health issue is often unrecognized in legal and health policy documents. This paper uses Sri Lanka as a case study to explore the factors influencing the national policy response to VAW, particularly by the health sector.MethodsA document based health policy analysis was conducted to examine current policy responses to VAW in Sri Lanka using the Shiffman and Smith (2007) policy analysis framework.ResultsThe findings suggest that the networks and influences of various actors in Sri Lanka, and their ideas used to frame the issue of VAW, have been particularly important in shaping the nature of the policy response to date. The Ministry of Women and Child Affairs led the national response on VAW, but suffered from limited financial and political support. Results also suggest that there was low engagement by the health sector in the initial policy response to VAW in Sri Lanka, which focused primarily on criminal legislation, following global influences. Furthermore, a lack of empirical data on VAW has impeded its promotion as a health policy issue, despite financial support from international organisations enabling an initial health systems response by the Ministry of Health. Until a legal framework was established (2005), the political context provided limited opportunities for VAW to also be construed as a health issue. It was only then that the Ministry of Health got legitimacy to institutionalise VAW services.ConclusionNearly a decade later, a change in government has led to a new national plan on VAW, giving a clear role to the health sector in the fight against VAW. High-level political will, criminalisation of violence, coalesced women’s groups advocating for legislative change, prevalence data, and financial support from influential institutions are all critical elements helping frame violence as a national public health issue.

SUMMARY Analysis of nine randomised controlled trials of prophylactic vitamin E supplementation in very low‐birthweight infants (< 1500g) showed no statistically significant reduction in the incidence of acute retinopathy of prematurity. There was a significant reduction (49 per cent) in the incidence of intraventricular haemorrhage, but no clear evidence for a corresponding reduction in intracerebral haemorrhage and no reduction in the incidence of haemorrhage confined to the germinal matrix. By combining the estimated reduction with the known incidence of long‐term neurological disability associated with intracranial haemorrhage alone, it was shown that only 1·5 per cent (point estimate) and not more than about 4 per cent of all very low‐birthweight infants are likely to benefit from routine vitamin E supplementation. In view of this, and data suggesting toxicity of vitamin E at concentrations close to those considered therapeutic, the routine use of vitamin E in very low‐birthweight infants is not justified on present evidence. Only large randomised trials can establish whether currently used vitamin E preparations do more good than harm. RÉSUMÉ L'adminstration de principe de vitamine E chez le nourrisson de très faible poids de naissance est‐elle justifiée? L'analyse de neufs essais contrôlés randomisés d'un ajout prophylactique de vitamine E chez les nourrissons de très faible poids de naissance (1500 g) n'a pas montré de réduction statistiquement significative de la rétinopathie aigue chez le prématuré. Une réduction significative (49 pour cent) de l'incidence de l'hémorragie ventriculaire a été notée, mais pas d'évidence nette d'une réduction correspondante de l'hémorragie intra‐cérébrale et aucune réduction de l'incidence de l'hémorragie limitée à la couche germinative. En combinant la réduction estimée avec l'incidence connue des déficiences neurologiques à long terme associée à l'hémorragie intracranienne isolée, il a été montré que seulement, 1,5 pour cent (estimation) et sûrement pas plus de 4 pour cent de tous les nourissons de très faible poids de naissance peuvent bénéficier de l'apport supplémentaire de vitamine E. Tenant compte de ces données et de celles qui suggèrent une toxicité de la vitamine E aux concentrations proches de celles utilisées, l'utilisation de routine de la vitamine E chez les nourrissons de très faible poids de naissance, ne parait pas à ce jour justifiée. Seuls des essais largement distribués pourraient établir si la vitamine E couramment utilisée fait plus de bien que de mal. ZUSAMMENFASSUNG Ist eine Routinetherapie mit Vitamin E bei sehr untergewichtigen Neugeborenen gerechtfertigt? Die Analyse von neun randomisierten, kontrollierten Untersuchungen einer prophylaktischen Vitamin E Behandlung bei sehr untergewichtigen Neugeborenen (1500g) zeigte keinen statistisch signifikanten Rückgang der akuten Retinopathie bei Frühgeborenen. Es gab einen statistisch signifikanten Rückgang (49 Prozent) der intraventrikulären Blutungen, jedoch keinen eindeutigen Hinweis für einen entsprech...