Effect of low cost public health staff training on exclusive breastfeeding

Objective  To assess the effectiveness and feasibility of on the job staff training and supportive supervision to improve six months Exclusive Breastfeeding (EBF). Methods  A longitudinal study was conducted in a public health field practice area-Sri Lanka in 2006–2007. Three breastfeeding counseling sessions were conducted for public health midwives. Supportive supervision and on the job training were done by two public health physicians. Pre and post intervention independent cross sectional studies were conducted to assess the effectiveness of the programme. The study sample consisted of mother-infant pairs where infants were aging 6 to 12 months, attending child welfare clinics. Primary outcome measure was the proportion of infants who received EBF up to 6 months. Logistic regressing model was used for analysis of predictors of EBF. Results  Study sample consisted of 336 mother-infant pairs (pre 139, post 197). Proportion of mothers who breastfed their infants exclusively for six months improved from 19% to 70% after the intervention. The median duration of EBF increased from 4 months to 6 months (inter-quartile range 2–6 and 5–6 months respectively). Unconfounded effect of intervention on 6 months EBF in logistic regression model was highly significant (OR=13.67. p<0.001). Intervention significantly reduced the bottle feeding rate (OR=0.212, p<0.001) but not formula feeding (OR=1.146. p=0.642). Of potential predictors assessed. Sinhalese mothers than Muslim mothers (OR=3.37, p<0.001) and employed mothers compared to housewives (OR=4.45. p=0.014) were more likely to breastfeed their infants upto six months. Parity, maternal education and maternal age were not significantly associated with six months EBF. Conclusions  The existing public health infrastructure can be used effectively to improve six months EBF in places where the care is given primarily by public health system.     

Cold autoimmune haemolytic anaemia secondary to Epstein Barr virus infection presenting with peripheral gangrene; case report

Hump-nosed pit viper (Genus Hypnale) is a medically important venomous snake in Sri Lanka and Southwestern India which causes significant morbidity and mortality. Envenoming of this snake results in hemostastic dysfunction, thrombotic microangiopathy, acute kidney injury and death. This case describes an authenticated first case of ischemic stroke in a 65?year old male following envenoming by H.hypnale in Sri Lanka.     

Tetanus following ocular wooden foreign body in incompletely vaccinated patient: a case report

Tetanus is now encountered rarely in clinical practice. There were no reported cases of tetanus due to ocular injuries in Sri Lanka. We report of a case of tetanus following an ocular injury which can be at least partly attributed to the disruption of immunization programmes due to political unrest. A 13 year-old Sri Lankan Tamil schoolgirl who had a splinter prick injury to left orbit was treated for intraorbital abscess and orbital cellulites. She developed clinical tetanus while on intravenous antibiotics. Following intensive care and ventilatory support she achieved an uncomplicated recovery. Ocular injury is a rare cause of tetanus worldwide. Adequate debridement of orbital soft tissue injuries can be difficult and demanding. Even in countries with high immunization coverage, tetanus can still occur due to lapses in immunization with conflict and war.     

Mediastinal impalement with a fibreglass sheet

Mediastinal impalement injuries are uncommon and often fatal. There have been very few reported cases of survival following mediastinal impalement. Patients who present with these injuries always undergo operative intervention regardless of their underlying haemodynamic status or associated injuries. We herein present a case of mediastinal impalement injury, where a sheet of fibreglass had fractured the manubrium and entered thffige anterior mediastinum with no associated great vessel injury. The fibreglass sheet was removed via a partial sternotomy and the patient made an uneventful postoperative recovery.