Epidemiologic studies from South Asian countries have reported vitamin D deficiency among all age groups. However, there is very little information on vitamin D levels, especially in the vulnerable populations (pregnant/breast feeding mother and infants) in Sri Lanka. More data on vitamin D status of such populations will be important for policy decisions to be made at a national level. Similarly, it will be valuable for healthcare programs in other countries (e.g., United States, Australia, Europe, and Canada) as Sri Lankans are a fast-growing migrant population to those countries. The purpose of this study was to investigate maternal vitamin D status and its effects on infants in a state sector tertiary care centre in Sri Lanka. This prospective cohort study was conducted on 140 healthy pregnant mothers in the third trimester (mean gestational age 39±1 weeks). Blood was collected for 25(OH)D and parathyroid hormone (PTH). Sun exposure and feeding patterns of the infants were recorded based on maternal reporting. Mean age of the infants at follow-up visit was 36±7 days. Vitamin D (25 (OH)D) deficiency (<25 nmol/L) was observed in 12% pregnant mothers, 5% lactating mothers, and 63% infants. Insufficiency (<50 nmol/L) was found in an additional 51% and 43% in pregnant and lactating mothers and 25% of infants. Mean 25(OH)D was higher in pregnant (46.4±17.5 nmol/L) and lactating (51.9±17.0 nmol/L) mothers than infants (28.1±13.7 nmol/L). Maternal vitamin D level during pregnancy was a significant risk factor (OR: 6.00, 95%CI: 1.522-23.655) for infant deficiency and insufficiency. Sun exposure of infants showed a significant positive correlation with vitamin D level (OR: 3.23, 95%CI: 1.19-8.68). In conclusion, the presence of Vitamin D deficiency/insufficiency is higher in infants compared to pregnant/lactating mothers. Low maternal 25(OH)D during pregnancy was a risk factor for deficiency in infants. Although majority of lactating mothers had sufficient vitamin D, most of their exclusively breastfed offspring were deficient.

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Introduction: Many studies from the Asian region have shown the existence of vitamin D deficiency among pregnant and breast feeding mothers despite abundant sunlight. Yet, we have little information on this topic in Sri Lanka. There are many skeletal and non-skeletal effects of vitamin D deficiency. Objectives: To investigate vitamin D status of pregnant mothers and its effect on growth parameters of the offspring. Method: We recruited 91 mothers who did not receive vitamin D supplementation during their pregnancy. 25(OH) D, parathyroid hormone (PTH), alkaline phosphatase, calcium and inorganic phosphorus levels were measured during the third trimester. Weight, length and head circumference (HC) of the babies were measured at birth and at one month of age. Results: Vitamin D deficiency (<10ng/ml) was present in 18.8% and insufficiency (10-20ng/ml) in 47.5%. This study showed no significant correlation between maternal vitamin-D levels and neonatal anthropometry (height, weight and head circumference). Conclusions: A significant rate of vitamin D deficiency was observed in pregnant mothers. There was no correlation between maternal vitamin-D levels and neonatal anthropometry in this study.

Background Poor compliance with hand hygiene practices among medical students poses a risk for cross-infection. It has become more critical during the COVID-19 pandemic than ever before. This study aimed to determine the knowledge, attitudes, practices of hand hygiene among final-year medical students. It also explored reported hand hygiene behavior before the COVID-19 pandemic and the need for educational strategies to correct the deficiencies. Methods A concurrent mixed-method approach was used. In the quantitative strand, a cross-sectional online survey was carried out via a Google form. Mann-Whitney U test and Chi-squared test were used for comparisons. In the qualitative strand, twelve participants were interviewed, based on a semi-structured interview guide and audio recorded. Transcribed data were evaluated with thematic content analysis. Results A total of 225 final-year medical students were studied in the quantitative strand. Most were females. The mean score for knowledge was 3.35 ± 0.795 out of six. Of them, 31.6 % of participants scored below 3 points (< 50 % of the total). Most (78.9 %) had positive attitudes (score of > 80 %). Only 36.4 % reported “adequate” hand hygiene performance in all eight dimensions of the behavior domain. Noticeably, fewer participants reported to clean their hands after checking blood pressure (55.6 %), and only 66.2 % stated carrying a hand sanitizer in their pocket. Significant correlations were not found between reported behavior and attitudes (p = 0.821) or knowledge (p = 0.794). The qualitative strand with 12 respondents revealed the positive influence of both hierarchical and non-hierarchal role models. Time constraints, skin irritation, and workload pressures were the main barriers. Frequent reminders, supervision, and interactive teaching were suggested as methods to improve hand hygiene compliance. They also stated that increased enthusiasm was noted on hand hygiene during the COVID-19 pandemic compared to the pre-pandemic period. Conclusions Most of the participants had positive attitudes towards hand hygiene. Yet, a considerable gap between attitudes and knowledge and reported hand hygiene behavior was evident. Coupling educational programs that use cognitive and behavioral methods, including role modeling, supervision, and frequent reminders, is recommended to bridge the knowledge-attitude-behavior gap.

Background: Studying medicine is challenging since medical students undergo many stressors during their long course of studying. Moreover, their final year is probably more stressful with more clinical work and stringent assessments. Aim of this study was to assess the prevalence and sources of psychological distress among final year students in University of Sri Jayewardenepura in Sri Lanka with a well validated screening tool. Methods: This is a cross sectional study of 151 medical students evaluating stress through general health questionnaire (GHQ) with 30 items. Comparison was made with another 257 non-medical undergraduates of the same university. Results: More than half of students (59.6%) in our university had psychological distress. When compared medical students (62.9%) are more distressed than non-medical (56.4%) students. Major source of stress for medical students was academic pressure. Conclusions: Final year medical students have significantly high psychological impairment and the main reason reported by students was academic pressure. It warrants implementation of stress management programs and curriculum based interventions to minimize stress.