BackgroundSuicide only present the tip of the iceberg of maternal mental health issues. Only a fraction of pregnant women with suicidal ideation proceeds to intentional self-harm (ISH) and even a smaller proportion are fatal. The purpose of the present study was to determine the prevalence of depression, suicidal ideation (present and past) and history of ISH among pregnant mothers in rural Sri Lanka.MethodsWe have conducted a hospital based cross sectional study in the third largest hospital in Sri Lanka and an another tertiary care center. Pregnant women admitted to hospital at term were included as study participants. The Edinburgh Postpartum Depression Scale (EPDS), a self-administered questionnaire for demographic and clinical data and a data extraction sheet to get pregnancy related data from the pregnancy record was used.ResultsThe study sample consisted of 475 pregnant women in their third trimester. For the tenth question of EPDS “the thought of harming myself has occurred to me during last seven days” was answered as “yes quite a lot” by four (0.8%), “yes sometimes” by eleven (2.3%) and hardly ever by 13 (2.7%). Two additional pregnant women reported that they had suicidal ideation during the early part of the current pregnancy period though they are not having it now. Four (0.8%) pregnant women reported having a history of ISH during the current pregnancy. History of ISH prior to this pregnancy was reported by eight women and five of them were reported to hospitals, while others were managed at home. Of the 475 pregnant females included in the study, 126 (26.5%) had an EPDS score more than nine, showing probable anxiety and depression. Pregnant women who had primary/post-primary or tertiary education compared to those who were in-between those two categories were at higher risk of high EPDS score with a OR of 1.94 (95% CI 1.1–3.3). Reported suicidal ideation prior to pregnancy was also associated with high EPDS with a OR of 6.4 (95% CI 2.3–17.5).ConclusionsBased on our data, we conservatively estimate around 500 pregnant women each year having suicidal ideation and, 130 ISH annually in Anuradhapura, which should be considered as a high priority for an urgent intervention.

BackgroundSri Lanka was the first country in the Southeast Asian region to achieve its measles elimination goal in 2011. In 2012, the measles immunization schedule changed from a measles vaccine at 9 months to a measles, mumps and rubella vaccine at 12 months. However in 2013, Sri Lanka reported its worst recent outbreak of measles. This study investigated a part of this outbreak in order to describe its epidemiology.MethodsA prospective study was carried out at the university medical unit of the Teaching Hospital, Anuradhapura (THA), the third largest hospital in Sri Lanka, from October 2013 until March 2014. An epidemiological profile of patients was constructed, case confirmation was done on all suspected cases and the basic demographic details of these suspected cases were obtained from the available records.ResultsFrom January 2013 to March 2014, 101 measles suspects were admitted to the THA. Until June 2013, all suspected cases were aged below 12 months of age. During the study period (15 months), the total number of patients aged below 9 months, 9 to 12 months, 1 to 11 years, 12–29 years and over 29 years were 10 (9.9 %), 11 (10.9 %), 6 (5.9 %), 37 (36.6 %) and 36 (35.6 %), respectively (data missing-1). Out of the 33 patients clinically suspected, 32 tested positive for measles. Common clinical features included: fever (n = 33, 100 %), maculopapular rash (n = 33), conjunctivitis (n = 31), posterior cervical lymphadenopathy (n = 23) and Koplik’s spots (n = 8). Features suggestive of pneumonia were observed among 30 (90.9 %) patients and 26 (78.8 %) had diarrhoea. Two patients (6.1 %) who developed severe pneumonia received care at an intensive care unit due to respiratory difficulties. Out of 33 patients, 15 (45.5 %) had prior immunization for measles, two (6.1 %) reported that they never had a measles immunization and 16 (48.5 %) were unsure about their immunization status. Out of those who reported they were previously immunized, 11 (73.3 %) belonged to the age group of 12–29 years.ConclusionBecause the first cases of this outbreak were infants, an increase in susceptible infants due to the change in the vaccine schedule could partly explain the outbreak.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-015-0084-7) contains supplementary material, which is available to authorized users.

Plain English SummaryMental disturbances are common during pregnancy. Most of the time, these are normal.However, these disturbances may become serious and lead to self-harm and suicide. In this study, we estimated the proportion of pregnant women who had depression and idea of self-harming during pregnancy.Respondents were pregnant women admitted to two large hospitals for the childbirth.They answered a list o questions about the thought of self-harm and attempts of self-harm during the present as well as past pregnancies.Respondents included 475 pregnant women. Of them, 3.1% reported that "the thought of self-harming has occurred to them during last seven days quite a lot (0.8%) or sometimes"(2.3%). Four (0.8%) pregnant women reported that they actually did it to some extent. Of the 475 pregnant women included in the study, 126 (26.5%) had symptoms of anxiety/depression. Level of education seemed to have an association with anxiety and depression. When women reported that they had thought of self-harm prior to pregnancy, they were about 6.4 times more likely to have depression/anxiety during the pregnancy.Adding a simple screening question (as we used in this study) during the initial pregnancy assessment to detect history of suicidal thoughts will be helpful in identification of highrisk mothers for depression and suicide.Reported suicidal ideation prior to pregnancy had a OR of 6.4 (95% CI 2.3-17.5). ConclusionsBased on our data, we conservatively estimate around 3000 ISH annually in Sri Lanka, which should be considered as a high priority for an urgent intervention.

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BackgroundMeasles vaccine was introduced to the expanded program of immunization