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SummaryRationale: The haemoglobin concentration (Fib) has limitations in the diagnosis of iron deficiency in pregnancy.Objective: The objective of this study was to assess the validity of the accepted cut off points of the other commonly measured haematological indices in either detecting or excluding iron deficiency as determined by the serum ferritin (SF) assay. Design:A cross sectional study was carried out on two groups of women in the second and third trimesters of pregnancy.Setting: University Antenatal Clinic, Faculty of Medicine and Kyoto Medical Centre Galle. Method:The Hb, haematocrit (Hct), mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemo globin concentration (MCHC) and red blood cell count (RBCC) were estimated by an automated haematology analyser and compared with the SF levels measured by immunoradiometric assay, in 156 women in the second trimester (T 2 ) and 47 women in the third trimester (T } ) of pregnancy. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy and the Kappa statistic were calculated for the accepted cut off points for diagnosis of anaemia, for each haematological index, using a SF<12/ig/L as the diagnostic criterion for iron deficiency. Results:The Hct, MCV and MCHC had a high specificity (96-100%) but a very low sensitivity (10-38%). Only the MCH had a high sensitivity (92% in T 2 ,86% in T 3 ) but it had a low specificity (21-24%). The MCHC had the best accuracy (71% in T3) but its accuracy in T 2 was only 64%. Only the MCHC in T 3 showed some agreement with SF (Kappa 0.41, p=0.00). Conclusion:A single haematological index per se has a poor ability of detecting or excluding iron deficiency in pregnancy. Although the best index is the MCHC, its accuracy is only 64% in the second trimester. Therefore several indices should be evaluated before deciding on a diagnosis of iron deficiency and subsequent supplementation or therapy during pregnancy.

Introduction: Maternal competencies among mothers with infants at early infancy are sparsely described in the literature. This study explores the dimensions of competencies among mothers with infants at early infancy in the Sri Lankan context. Methods: An exploratory qualitative study was conducted using focus group discussions with mothers, fathers, and grandparents of infants aged up to 6 months and in-depth interviews with health personnel providing maternal and child health services for these mothers and infants. The Framework approach for qualitative data analysis was used to identify dimensions of parenting competencies in mothers at early infancy. Results: Five dimensions of maternal parenting competencies were identified i.e.; feeding the infant, maintaining hygiene, dealing with crying, dealing with illnesses and recognizing the normal growth and development. Conclusions: The findings can be used to develop culturally specific tools to assess the level of parenting competencies in mothers and to design maternal educational interventions to reinforce their parenting skills.

Introduction: Chronic lymphoedema (CL) of lymphatic filariasis causes severe psychosocial burdens (PSB) to its victims. Currently-established scales to measure PSB of CL are not culturally adaptable to Sri Lankan patients. In this study, we developed and assessed the psychometric properties of a disease-specific questionnaire (15 item PSB-CL). Methods and Results: A detailed literature search was done to identify scales related to PSB of CL patients. Questions were developed through collected expressions from semi-structured interviews with 46 CL patients. A response scale was developed from the collected pool of possible responses, and they were scored using a visual analogue scale. Face and content validity were carried out using an initial questionnaire (31 questions). They were reduced to 27 by removing unclear, ambiguous, double-stranded ones and those with value-laden words. This new questionnaire was administrated on 92 patients by a group of doctors for item reduction by the analysis of internal consistency (Cronbach’s alpha > 0.7) and factor analysis (Principal Component Analysis; Eigenvalues > 1). After the patient survey and factor analysis, the final questionnaire PSB-CL was formed with 15 questions that had four subscales (factors), physical, social, fear and humiliation. Patients (n=92) reported quite a large percentage (42% - 69%) of problems under each dimension. Conclusion: The scale to measure the psychosocial burden of chronic lymphoedema in lymphatic filariasis patients in Sri Lanka. Further validation of the tool is needed.