No abstract

A case-control study of environmental and behavioural risk factors for childhood diarrhoea was conducted in Kurunegala district, Sri Lanka. From five hospitals, 2458 children aged less than 5 years and suffering from diarrhoea were recruited as clinic cases, and a further 4140 reporting with complaints other than diarrhoea were recruited as clinic controls. Community-based cross-sectional surveys were also conducted in three of the five areas served by these hospitals, and from these a further 1659 children were recruited as community controls. Children from households where excreta were reported to be disposed of in a latrine were less likely to have diarrhoea than children whose families improperly disposed of excreta. The results obtained from comparisons of cases with clinic controls (adjusted odds ratio [OR] 1.42, 95% confidence interval [CI] : 1.01-1.98), and of cases with community controls (OR 1.35, 95% CI : 0.85-2.13) were in agreement, suggesting that no important selection bias operated on this association. If the observed proportion (91%) of improper excreta disposal among the population could be reduced to 50%, 12% of childhood diarrhoea episodes would be prevented. Although latrine ownership may be a necessary condition for safe excreta disposal behaviour, diarrhoeal morbidity may only be reduced in Sri Lanka if behavioural changes take place concomitant with the construction of sanitation facilities.

This survey examined 59,158 children from 87 schools in 17 out of 24 districts in Sri Lanka for goitre. The overall prevalence rate was 18.8%: 23.2% for girls and 14.0% for boys. Prevalence in districts varied from 30.2% in Kalutara to 6.5% in Matale. It was higher in rural than urban areas, and in inland than coastal areas. The sex ratio of prevalence rates was directly related and the ratio of palpable to visible goitre was inversely related to the severity of the endemic. It is suggested that for a rapid epidemiological assessment when the latter ratio is less than four, it is indicative of endemicity for public health purposes and calls for intervention. The iodination of salt is both practical and feasible in Sri Lanka.

A total of 13,566 school girls from 17 districts in Sri Lanka recalled their date of menarche for a study on the prevalence of goitre. Seventy-four percent (10,036) did not have any signs of goitre, and the recalled mean age of menarche for this group was 13.6 years. This figure was significantly lower than the mean age of 13.9 years observed in the goitrous group. The mean age was lowest for thyroid grade 0 and highest for thyroid grades 1b and above. The mean age in high prevalence areas was significantly higher both among goitrous and nongoitrous groups, and in different areas of prevalence the mean age was higher among the goitrous than the nongoitrous. These findings strongly suggest a delay in sexual maturation among girls living in endemic goitre areas and among girls with evidence of goitre.

The prevalence of goiter in a rural community was determined in a defined geographical area, namely, the Hindagala Community Health Project (HCHP). In this area which is divided into six Public Health Midwife (PHM) areas, the mean altitude varies from 450 to 775 meters. The house-to-house goiter survey conducted by the trained field health staff covered 70% of the population. The total goiter prevalence was 7% while the prevalence of visible goiter was 2.8%. The goiter prevalence was higher in the females than in the males at all age groups. Among males, the prevalence was highest in the school-going age group 6-18 years, while among females the highest prevalence was in the early childbearing period of 19-34 years. Further, an increasing trend in the prevalence was observed with increase in mean altitude of the PHM area. Correlation between community prevalence and age-sex specific prevalence gave the best relationship with the 6-18 year age group and a regression equation to predict the community prevalence from the prevalence in the school-going age group is presented.