Background: Medical ethics deals with the ethical obligations of doctors to their patients, colleagues and society. The annual reports of Sri Lanka Medical Council indicate that the number of complaints against doctors has increased over the years. We aimed to assess the level of knowledge, attitude and practice regarding medical ethics among doctors in three teaching hospitals in Sri Lanka. Methods: A hospital-based cross-sectional study was conducted among doctors (n = 313) using a pre-tested selfadministered, anonymous questionnaire. Chi Squared test, and ANOVA test were used to identify the significance of association between level of knowledge and selected factors. Results: Most doctors (81.2%) had a poor level of knowledge on medical ethics, with postgraduate trainees showing significantly (p = 0.023, Chi square) higher level of knowledge. The average knowledge on medical ethics among doctors was significantly different between the three hospitals (p = 0.008, ANOVA). Over 95% had a favourable attitude towards gaining knowledge and advocated the need for training. The majority (69.3%) indicated awareness of unethical practices. 24.6% of respondents stated that they get a chaperone 'sometimes' during patient examination while 3.5% never do. The majority (54%) responded that they never accept gifts from pharmaceutical companies in recognition of their prescribing pattern. 12-41% of doctors participated in the study acknowledged that they 'sometime' engaged in unethical practices related to prescribing drugs, accepting gifts from pharmaceutical companies and when obtaining leave. Conclusion: Most doctors had a poor level of knowledge of medical ethics. Postgraduate trainees had a higher level of knowledge than other doctors. The majority showed a favourable attitude towards gaining knowledge and the need of training. Regular in-service training on medical ethics for doctors would help to improve their knowledge on medical ethics, as well as attitudes and ethical conduct.

Background The basic reproduction number (R0) is the number of cases directly caused by an infected individual throughout his infectious period. R0 is used to determine the ability of a disease to spread within a given population. The reproduction number (R) represents the transmissibility of a disease. Objectives We aimed to calculate the R0 of Coronavirus disease-2019 (COVID-19) in Sri Lanka and to describe the variation of R, with its implications to the prevention and control of the disease. Methods Data was obtained from daily situation reports of the Epidemiology Unit, Sri Lanka and a compartmental model was used to calculate the R0 using estimated model parameters. This value was corroborated by using two more methods, the exponential growth rate method and maximum likelihood method to obtain a better estimate for R0. The variation of R was illustrated using a Bayesian statistical inference-based method. Results The R0 calculated by the first model was 1.02 [confidence interval (CI) of 0.75–1.29] with a root mean squared error of 7.72. The exponential growth rate method and the maximum likelihood estimation method yielded an R0 of 0.93 (CI of 0.77–1.10) and a R0 of 1.23 (CI of 0.94–1.57) respectively. The variation of R ranged from 0.69 to 2.20. Conclusion The estimated R0 for COVID-19 in Sri Lanka, calculated by three different methods, falls between 0.93 and 1.23, and the transmissibility R has reduced, indicating that measures implemented have achieved a good control of disease.

Background: Majority of the maternal and neonatal adverse events take place during the postnatal period. Provision of high-quality care during this period can minimize these events. Assessment of mothers’ perceptions of the quality of care received by them provides valuable feedback to improve the care and ultimately outcomes. Methods: A cross sectional survey was conducted in specialized institutions of Colombo district, Sri Lanka, to assess the maternal perceptions of the quality of regular postnatal care and its correlations, using an interviewer administered questionnaire. The questionnaire contained 23 items distributed under three main domains: technical and information domain, interpersonal care domain and ward facilities and cleanliness domain. Each item was given a score from 1 to 5 and total scores were calculated for the total questionnaire and for each domain. Descriptive statistics were used to assess the perceptions and multivariate analysis was conducted to assess the significant correlates of positive perceptions. Results: The median score obtained for the questionnaire was 108, (Inter Quartile Range 96-114). The median scores of the technical care and information domain, interpersonal care domain and ward facilities and cleanliness domain were 43 (IQR 38-45), 33 (IQR 30-35) and 32 (IQR 28-35) respectively. Attending teaching/ specialized hospitals (1.6, p<0.001), 20-35 age group (aOR=1.8, p=0.024), and services such as initiation of breast feeding within one hour of delivery (2.1, p=0.009), pain relief during episiotomy suturing (2.2, p<0.001), practicing Kangaroo Mother Care (1.4, p=0.035), receiving health advices by doctors or midwives (2.1, p<0.001) were significant correlates of positive perceptions. Conclusions: Majority of mothers had favourable perceptions of the quality of care received by them. However, the ward facilities and environment domain has obtained lower ratings compared to technical and interpersonal care domains. Several services were significantly associated with favourable perceptions. Authorities should consider these findings when attempting to improve care quality. Further, this assessment should be carried out regularly to obtain more current data. Key words: Client perceptions, Postnatal care, Quality of care, Client perceived care, institutional postnatal care

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: Postnatal period is an important period during which both mother and the newborn adjust to the new environment. High quality services should be provided during this period in order to prevent adverse health outcomes. Patients' perception of the care received by them is considered an important attribute in the assessment and improvement of quality of health care. However, this should be assessed using a valid and reliable instrument. Objectives: To assess the psychometric properties of a newly developed instrument to assess the mothers' perception of the quality of institutional postnatal care in Sri Lanka Methods: The instrument was validated among 200 mothers who had undergone normal vaginal delivery in Colombo North Teaching Hospital and were in the immediate postnatal period. The factor structure of the instrument, its internal consistency and test retest reliability were assessed as main outcomes. Results: Following exploratory factor analysis, the instrument consisted of 23 items. Three main domains identified were interpersonal care, technical care and information, and ward facilities and cleanliness. The threefactor model identified was able to explain 58.9% of the total variance of the scale. The Cronbach's alpha value for the total scale was 0.94. The Spearman's rank correlation coefficient value for the test retest reliability was 0.94. Conclusions: The instrument developed for assessment of maternal perception of the quality of postnatal care reported satisfactory level of validity and reliability, thus recommended to be used for improving care provision.