Background: The determination of behaviours that lead to noncommunicable diseases (NCDs), such as high dietary salt intake, are multifactorial. The prevention of NCDs, including the promotion of healthy dietary choice, including low salt intake, therefore requires multisectoral working. Although the need of a multisectoral approach to risk factor modification has been globally accepted, there is minimal evidence for its application in the real world.Methods: This quasi-experimental trial was designed to study the impact of a community led multisectoral approach to integrate nutrition prevention into the development agenda, in two districts in Sri Lanka, a lower-middle income country undergoing a phase of rapid socioeconomic development.Results: Results from logistic regression found that those living in the district (Ampara) that identified salt intake as a health issue had significantly higher odds (OR =1.4; 95% CI =1.1, 1.9) of high salt consumption (>5 grams/day) at baseline compared to control areas (Kurunegala), in multivariable models. Postintervention, individuals in this district had lower odds (OR =0.6; 95% CI =0.4, 0.9) of consuming high levels of salt in all models, including multivariable models whilst controlling for baseline high salt consumption. Conclusions:The findings from this study demonstrate the positive impact in improved diet, in reduced salt consumption, through a community led multisectoral intervention, in areas in which the community identified high salt consumption as a health issue. These findings demonstrate that multisectoral approaches can be effective in the real world setting and highlight the need to engage with many stakeholders, including targeted communities throughout their development and implementation.

Objective: To evaluate the feasibility of performing the single stage primary laparoscopic pullthrough (PLPP) surgery for Hirschprung disease (HD) to avoid the morbidity associated with traditional staged multiple surgery. Method: PLPP was performed on 12 patients with histologically diagnosed, uncomplicated HD below the age of 4 years since April 2010. Adequate bowel preparation was achieved prior to surgery. Four-port video laparoscopy was performed. The transition zone was identified with biopsies and confirmed with frozen section. Colon and rectum were mobilized close to its wall up to the pelvic floor. Rectal prolapse was induced intussuceptically and the rectum transected 2cm above the dentate line. Colon was pulled down through anus and divided at biopsy site level. Colo-anal anastomosis was performed over a rectal tube. Results: A noteworthy improvement of bowel habits and general well being was expressed by parents during follow-up assessment. Early results from our study, as well as the long-midterm results from elsewhere in the world, suggest that the PLPP is superior to the traditional staged procedure. Conclusion: PLPP is a better, safer and more effective approach of treating HD.

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