BackgroundFurther research gaps exist in relation to the promotion of breastfeeding. Robust scientific evidence obtained by a meta-analysis would provide objectively summarized data while enabling the assessment of consistency of findings. This review includes the first documented meta-analysis done on the effectiveness of targeting fathers for promoting breastfeeding (BF). Assessments have been done for a primary outcome and for six more secondary outcomes.MethodsPubMed, EMBASE, Google Scholar, CENTRAL databases and unpublished researches were searched. Selections of randomized-controlled trials and quasi-experimental studies were done in three rounds. Heterogeneity and potential publication bias were assessed. Eight studies were included in meta-analysis and others in narrative synthesis of the outcomes. Pooling was done with the Mental- Haenszel method using risk ratio (RR). Summary-of-Findings table was composed by Review-Manager (version 5.3) and GRADEproGDT applications. Subsequent sensitivity analysis was done.ResultsSelected eight interventional studies included 1852 families. Exclusive BF at six months was significantly higher (RR = 2.04, CI = 1.58–2.65) in the intervention groups. The RR at 4 months was 1.52 (CI = 1.14 to 2.03). Risk of full-formula-feeding (RR = 0.69, CI = 0.52–0.93) and the occurrence of lactation-related problems were lower in the intervention groups (RR = 0.24, CI = 0.10–0.57). More likelihood of rendering support in BF-related issues was seen in intervention groups (RR = 1.43, CI = 1.22–1.68). Increase of maternal knowledge and favorable attitudes on BF were higher in the intervention groups (P ≤; 0.001). The quality of evidence according to GRADE was “low” (for one outcome), “moderate” (for four outcomes), and “high” (for two outcomes).ConclusionsTargeting fathers in promotion of BF has provided favorable results for all seven outcomes with satisfactory quality of evidence.This review was registered in the PROSPERO-registry (ID: 2017-CRD42017076163) prior to its commencement.

BackgroundGlobally, non-communicable diseases (NCD) are the leading cause of death and more than 40% of NCD deaths are premature occurring before the age of 70 years. In 2012, World Health Assembly declared its commitment to reduce premature NCD mortality by 25% from 2010 to 2025. The trend of premature NCD deaths in Sri Lanka has not been assessed and thus this study was done to assess it between 2001 to 2010.MethodsDeaths due to cardiovascular diseases, cancers, chronic respiratory diseases and diabetes were studied. Premature NCD mortality was assessed using unconditional probability of dying (UPoD) due to NCDs among those aged 30 to 70 years. Number of relevant premature NCD deaths that occurred in each 5-year age interval and the respective mid-year population was used to calculate UPoD.ResultsDuring the period of 2001 to 2010, premature NCD mortality in Sri Lanka increased from 15·8% to 19·1% and males showed higher mortality compared to females throughout the period. Highest mortality was due to cardiovascular diseases followed by cancer and diabetes and all three showed an increasing trend. Chronic respiratory diseases showed an increase until 2004 and dropped thereafter. Among the four NCDs, diabetes revealed the most marked increasing trend in premature mortality during this period.ConclusionsThe data revealed an increasing trend of premature NCD mortality in Sri Lanka between 2001 and 2010 although it has a relatively lower premature NCD mortality rate in the South-East Asian Region. Therefore, reducing premature NCD mortality by 25% from 2010 to 2025 is likely to be a rather challenging task in Sri Lanka and policy level changes need to be taken to achieve this target.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5503-9) contains supplementary material, which is available to authorized users.

Introduction: Food label is the main medium of communication between manufacturer, distributor and consumer. It is regulated via law enforcing officers. Objectives:To identify the attitudes of manufacturers /distributors, law enforcing officers and consumers towards the Sri Lankan labelling regulation, its implementation and practical difficulties Methods: A qualitative study conducted through focus group discussions (FGD); two FGDs for 14 manufacturers/distributors, three for 23 law enforcing officers and another two for 19 consumers. Participants were selected by convenience sampling. A semi-structured guide was used to collect data. Ideas generated were thematically analysed.Results: Manufacturers/distributors perceived labelling regulations as useful. The colour code for sugar level and the expiry date were the main interests of consumers. Consumers believed that the labels do not always provide correct information. Consumers were not satisfied on the implementation of labelling regulations, location of the label and the expiry date. Law enforcing officers admitted that they give minimum priority to labelling regulations due to inadequate knowledge, competence and legal support. They further expressed uncertainty on authority over Ayurveda foods. Conclusions & Recommendations:Consumers and law enforcing officers were of the opinion that labelling regulations are poorly implemented. The legal definition of 'food' has failed to exclude or include Ayurveda food precisely, therefore explicit exclusion is necessary. Both manufacturers / distributors and law enforcing officers need to be provided with training on regulations as they admitted that their existing knowledge and competency are poor.

Background: With demographic and epidemiological transitions, the burden of chronic non-communicable diseases (NCDs) is rising in Sri Lanka. Chronic obstructive pulmonary disease (COPD) is one main chronic NCD, the exacerbations of which are known to worsen the quality of life (QOL). Documented literature on the QOL of COPD patients is not commonly found in Sri Lanka and rarer on its exacerbations. Objective: To describe the QOL and its associated factors among patients with COPD before and after an exacerbation in Western Province of Sri Lanka Methods: A longitudinal study with two waves of data collection was done in 13 government hospitals among 289 participants in 2015. The study population included patients admitted to hospital with an exacerbation of COPD. Sample size was calculated to estimate the expected QOL in numerical scale with reference to documented global literature. The pre-exacerbation and post-discharge one month QOL was assessed using SF-36 generic QOL tool. Bivariate analysis was done followed by multivariate analysis. Results: In seven domains, there was a significant decline in QOL from pre-exacerbation to one month postdischarge (p<0.05). Further, pre-exacerbation QOL significantly correlated with post-discharge QOL in relation to five domains. Age (two domains), income (seven domains) and health infrastructure (seven domains) were significantly associated with their pre-exacerbation QOL. Younger age, higher income and better health-infrastructure are associated with relatively higher baseline. Older age, higher monthly income, better health infrastructure and less severity of the exacerbation were independent predictors of reduced QOL following an exacerbation. Conclusions: The QOL among COPD patients was relatively low compared to patients with other chronic NCDs such as myocardial infarction and stroke. The QOL in relation to several aspects worsened with exacerbations. Post-discharge QOL can be predicted with pre-exacerbation QOL for five domains of QOL.

Introduction: The main legislation governing food labelling in Sri Lanka is the Food Act which is implemented by health authorities. Food labels provide information to help consumers make healthier and safe food choices. Objectives: To assess the compliance of health and nutrition claims of labels of non-alcoholic beverages with food labelling regulation Methods: A descriptive cross-sectional study was carried out in all 18 supermarkets in the Kandy Municipal Council Area. Non-alcoholic beverages were assessed. A judgmentally validated pre-tested checklist containing provisions of the labelling regulation was used as the study instrument. Data collection was done by four trained data collectors. Results: Of the 214 beverages assessed, 5.1% (n=11) did not have the common name in two languages. Claims or pictures to the effect that the beverage is recommended by medical practitioners or a professional association was present in 8.1% (n=19). Of the 56 milk products and health drinks, 8.9% (n=5) made claims that dietary fats benefit heart patients. Claim of food being an aid for slimming or weight reduction was found in 14% (n=9) of the 64 milk products, health drinks and green tea surveyed. Of the 36 beverages which made special claims, 30 (83%) did not have declarations that the natural food items also have the same characteristic. Conclusions: Labels of considerable proportions of beverages contravene the provisions of the food labelling regulation, indicating the importance of proper implementation of the regulation.

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Background Treatment default in leprosy leads to progression of the disease and to disabilities. A defaulter is an individual who fails to complete treatment within a prescribed time frame. Defaulters can act as a source of infection in the community. Therefore, identifying factors contributing to defaulting will be essential to revise existing control strategies. Methods We conducted a hospital-based unmatched case-control study from March to October 2018 to assess the factors associated with treatment defaulting among adult leprosy patients in the Western province, Sri Lanka. Defaulting cases were true defaulters, and defaulters who have restarted treatment and control cases were patients on regular treatment. Defaulting cases were selected using the Clinic Leprosy Register, and three controls per case were selected by a consecutive sampling method. Data collection was carried out at households and clinics using an intervieweradministered questionnaire. Multivariate analysis using logistic regression was carried out to identify the risk of each significant factor in the bivariate analysis for defaulting, adjusted for all confounders. Results The study was conducted among 98 defaulting cases and 294 control cases. The following risk factors were identified in the logistic regression analysis; age less than 60 years (adjusted OR = 3.2, 95% CI: 1.55-6.64, P < 0.05), poor knowledge about the disease (adjusted OR = 9.6, 95% CI: 4.96-18.55, p < 0.001), normal treatment duration (Paucibacillary 6 months; Multibacillary 12 months therapy) (adjusted OR = 4.0, 95% CI: 1.82-9.02, p < 0.001), and poor caregiver support (adjusted OR = 7.8, 95% CI: 3.97-15.46, p < 0.001). Conclusions Age less than 60 years, inadequate knowledge about the disease, normal treatment duration, and poor caregiver support were found to be factors associated with defaulting. Patients and caregivers should be educated to continue treatment and provided a travelling allowance for the needy to encourage clinic attendance.