BackgroundThere is substantial evidence of poor dispensing practices with inadequate packaging and labelling of medicines, and limited advice on their usage in low and middle-income countries (LMICs). We examined the labelling and packaging of medicines identified during a survey of 1322 households in six regions of Sri Lanka between 2010 and 2013 conducted using the World Health Organization (WHO) methodology for household surveys. We compared medicines obtained from public and private sources and asked interviewees if they understood how to take the medicines.MethodsPackaging was considered adequate when the primary package was an envelope or closable container holding only one medicine. Adequate labels were legible and included medicine name, dose and expiration date. Interviewers assessed whether respondents knew how to take the medicines.ResultsOf 1322 households, 1253 households (94.8%) had at least one medicine; 84% were classified as western medicines and 16% traditional medicines. Of 5756 western medicines identified, 82.1% were adequately packaged, 43.3% adequately labelled and 41.4% both adequately packaged and labelled. Participants stated that they understood the label and knew how to take 96% of the medicines. Private medicine sources had more adequately packaged medicines than public sources (87.7% vs 73.5%; OR 2.58, 95% CI 2.23, 2.99) and more adequately labelled medicines (52.2% vs 27.4%; OR 2.90, 95% CI 2.57, 3.26).ConclusionsInadequate packaging and labelling of medicines remain a concern in Sri Lanka. Commitment to Good Pharmacy Practices, investments in staff education and training and adequate dispensing resources (containers and labels), particularly in the public sector, are needed to address sub-optimal dispensing practices. Ageing populations with more chronic diseases requiring polypharmacy and complex medicine regimens increase the need for appropriately packaged and labelled medicines.Electronic supplementary materialThe online version of this article (doi:10.1186/s40545-016-0091-5) contains supplementary material, which is available to authorized users.

PPOS-Sinhala is stable, sufficiently valid and reliable to evaluate patient centeredness among Sinhala speaking health care professionals and patients. Lower internal consistency is found for a few items in the instrument which requires further development. PPOS scores and their correlates for this Sri Lankan population were more similar to that found in other populations in this region than for scores and correlates found in the US.

Background The World Health Organization (WHO) has currently detected five Variants of Concern of SARS-CoV-2 having the WHO labels of ‘Alpha’, ‘Beta’, ‘Gamma’, ‘Delta’ and ‘Omicron’. We aimed to assess and compare the transmissibility of the five VOCs in terms of basic reproduction number, time-varying reproduction number and growth rate. Methods Publicly available data on the number of analyzed sequences over two-week windows for each country were extracted from covariants.org and GISAID initiative database. The ten countries which reported the highest number of analyzed sequences for each of the five variants were included in the final dataset and was analyzed using R language. The epidemic curves for each variant were estimated utilizing the two-weekly discretized incidence data using local regression (LOESS) models. The basic reproduction number was estimated with the exponential growth rate method. The time-varying reproduction number was calculated for the estimated epidemic curves by the ratio of the number of new infections generated at time step t to the total infectiousness of infected individuals at time t, using the EpiEstim package. Results The highest R0 for the variants Alpha (1.22), Beta (1.19), Gamma (1.21), Delta (1.38) and Omicron (1.90) were reported from Japan, Belgium, the United States, France and South Africa, respectively. Nine out of ten epidemic curves with the highest estimated growth rates and reproduction numbers were due to the Omicron variant indicating the highest transmissibility. Conclusions The transmissibility was highest in the omicron variant followed by Delta, Alpha, Gamma and Beta respectively.

Rationale and aims: Contextual factors are increasingly recognized as having a significant influence on clinical-decision-making. Contextual influences however, are considered ‘less scientific’ or ‘non-clinical’ in the eyes of practicing clinicians, making it a sensitive issue for discussion.  Therefore, exploring these contextual influences can be challenging. Methods which can circumvent this challenge are required to evaluate clinical decision making at natural settings. This paper reports on the development of an innovative research method to address this challenge of exploring contextual influences and similar sensitive and complex clinical practice issues.  Method: The researchers conducted a field research to test an interview based method which was termed as ‘Clinician Recalled Vignette (CRV) Method’. Based on reflections on the field research experience this preliminary method was refined to develop an innovative method which is potentially capable of eliciting sensitive and complex clinical practice issues. Results: Reflections on field test data provided preliminary evidence on the usefulness of the CRV method and limitations. The method that was refined, in response to limitations, focused on key decision points relevant to the clinical vignettes recalled by clinicians, and included a mechanism to identify how contextual factors influence these key decision points. This innovative method was termed ‘Vignette-based Decision Point Analysis’. Conclusions: The innovative method discussed in this paper will assist other researchers in conceptualising and conducting research projects to explore sensitive and complex clinical practice issues in natural settings.

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