BackgroundThe Ottawa Charter defines Health Promotion as the 'process of enabling people to increase control over, and to improve, their health'. The National Health Promotion Policy recognizes health promotion as an efficient and cost effective approach to promote health in Sri Lanka. The Public Health Midwife (PHM) is the grass root level health worker responsible for promoting the health of communities in Sri Lanka. Their knowledge regarding health promotion has not been assessed. The main aim of this study was to describe their knowledge on health promotion and associated factors. Methods A cross sectional descriptive study was conducted among all PHMM (N=364) in the Kandy District who were eligible, using a self-administered questionnaire. Level of knowledge was based on scores obtained for responses to close ended questions and case scenarios. Results Knowledge on health promotion was 'poor' among 238 (65.4%). Incorrect labeling of other activities as activities using a health promotion approach was common 257(70.6%). Training programmes 285(73.9%) were the commonest source of knowledge while 95(26%) were never trained on health promotion approach during their career. The factors that were significantly associated with a level of 'good' knowledge on health promotion in multivariate analysis were; experience in the public health field less than 20 years (p=0.012), participating in training programmes on health promotion (p=0.03) and experience in implementing health promotion programmes (p=0.04). Conclusions The study concludes that PHMM in the Kandy District have a 'poor' level of knowledge on health promotion and recommends increasing training opportunities and improving opportunities for application to improve the situation.

Objective: To evaluate the effectiveness of a 'health promotional' intervention by lay people in changing determinants of low birth weight, when added to the existing package of antenatal care provision. Method: A quasi-experimental study design was used. An intervention was carried out among 403 pregnant women and their partners. Intervention group (IG) was recruited from participants registered to routine field antenatal services in the Anuradhapura district. A comparison group (CG) of 403 pregnant women and their partners was recruited from an adjacent district. Both groups were recruited in the first trimester of pregnancy. The intervention was based on health promotion principles and used a model previously piloted in Sri Lanka. Data from the Child Health Development Record (CHDR) available at the health clinic were used to determine birth weights. Results: Significant improvements were seen in the IG, compared to the CG, in the care given to the pregnant mothers by their families, and level of control over identified determinants of low birth weight (LBW). The prevalence of LBW in the IG was 10.0% and in the CG 19.2%. (X 2 =12.465; p<0.001) with an adjusted OR of 0.5 (95% CI; 0.2-0.8) and mean birth weight in the IG 2987g and in the CG 2772.4g (t=6.934; df=726; p<0.001).

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