Background Ending preventable maternal deaths remains a global priority and in the later stages of obstetric transition, identifying the social determinants of maternal health outcomes is essential to address stagnating maternal mortality rates. Countries would hardly achieve the Sustainable Development Goal (SGD) targets on maternal health, unless the complex and context-specific socio-economic aetiologies associated with maternal mental health and suicide are identified. The Rajarata Pregnancy Cohort (RaPCo) is a prospective cohort study, designed to explore the interactions between social determinants and maternal mental health in determining pregnancy and new-born outcomes. Methods The study will recruit all eligible pregnant women in the maternal care programme of Anuradhapura district, Sri Lanka from July to September 2019. The estimated sample size is 2400. We will assess the socio-demographic and economic status, social capital, gender-based violence and mental health, including a clinical examination and biochemical investigations during the first trimester. Participants will undergo four follow-ups at 2nd and 3rd trimesters, at delivery and in early postpartum. The new-borns will be followed up at birth, neonatal period, at 6 six months and at 1 year. Pregnancy and child outcome data will be collected using direct contact. Qualitative studies will be carried out to understand the complex social factors and behavioural dimensions related to abortion, antenatal depression, maternal deaths and near misses. Discussion This is the first reported maternal cohort in Sri Lanka focusing on social determinants and mental health. As a country in stage four of obstetric transition, these findings will provide generalizable evidence on achieving SGD targets in low- and middle-income countries. The study will be conducted in a district with multi-cultural, multi-ethnic and diverse community characteristics; thus, will enable the evidence generated to be applied in many different contexts. The study also possesses the strength of using direct participant contact, data collection, measurement, examination and biochemical testing to minimise errors in routinely collected data. The RaPCo study will be able to generate evidence to strengthen policies to further reduce maternal deaths in the local, regional and global contexts particularly focusing on social factors and mental health, which are not optimally addressed in the global agenda.
Introduction Rice is the most important crop cultivated in Sri Lanka and rice milling is the largest agro-based industry in the country. Objectives To compare lung functions of rice millers and controls with predicted normal values for Sinhalese and to determine the effects of rice husk dust on lung functions of rice millers in relation to length (years) of exposure. Methods Rice millers (male: 84, female: 84) and controls (male: 84, female: 84) were selected and matched for determinants of lung functions. Data were collected via a validated questionnaire and spirometry. Observed mean lung functions were compared with lung function norms published for non-smoking Sinhalese. Results Most of the male millers and controls were smokers while none of the females were. All mean lung functions tested FVC, FEV1, PEFR and FEF25-75%, were significantly lower than the predicted values among male millers. While some lung functions were significantly reduced in female millers and male controls, all were comparable with predicted values in female controls. Duration of employment in rice mills was significantly and inversely related to FVC and FEV1 of millers. Conclusions Observed deficiencies in lung functions of rice millers were probably caused by occupational exposure to rice husk dust and tobacco smoke. The cumulative effect of the two were found to be more harmful than each alone. Wearing face masks, worker education and adequate ventilation in mills are recommended. Advantages of cessation of smoking should be further stressed to communities of lower socioeconomic and educational backgrounds.
Background Fat in certain body compartments has a significant contribution to dyslipidemia. Objective The objective was to determine the fat distribution in various body compartments among management assistants (clerks: sedentary occupational group), from the Anuradhapura Municipal Council area, Sri Lanka and to estimate their lipid profiles for any correlation with fat distribution. Methods In this descriptive cross-sectional study [n=78; males=15(mean age=38(11) years); females=63 (mean age=39(9) years)], weight, height, waist and hip circumferences were measured using standard WHO methods. Body fat was measured using 8 electrode bio impedance analyzer system (HBF375 Karada Scan, Japan). Lipid profile was estimated using colorimetric assay kit methods. Results According to the BMI, 57% of females were obese and 13% were overweight, and 67% of males were obese and 20% were overweight. Abdominal obesity [WC>90cm males; >80cm females] was present in 73% of males and 81% of females. Based on total BF% (males>25%; females>35%-obese), 73% males and 65% females were obese. Twenty nine percent of females and 73% of males had a high visceral fat percentage (>10%). This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY) Among the females, 68%, 17%, 92% and among males, 73%, 27%, 80% had hypercholesterolaemia, hypertriglyceridemia and high LDL levels, respectively. Low HDL levels were observed in 47% of males and 68% of females. Conicity index (CI) and body adiposity index (BAI) were at high risk level in 93% of males and 75% of females and 27% of males and 56% of females, respectively. Conclusion The prevalence of overweight and obesity was high among the individuals of the study group and a majority were unaware that they were dyslipidemic.
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