Quality of Breast Cancer Early Detection Services Conducted by Well Woman Clinics in the District of Gampaha, Sri Lanka

Vithana, Palatiyana Vithanage Sajeewanie Chiranthika,Ariyaratne, M.A.Y.,Jayawardana, P.L. Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.1

Background: Breast cancer is the most common cancer diagnosed in females in Sri Lanka and early detection can lead to reduction in morbidity and mortality. Aim: To evaluate selected aspects of breast cancer early detection services implemented through well woman clinics (WWCs) in the Gampaha District. Methods: The study consisted of two components. A retrospective descriptive arm assessed clinical breast examination (CBE) coverage of target age group women (TGW) of 35-59 years in all the WWCs in Gampaha district over 2003-2007. A cross sectional descriptive study additionally assessed quality of breast cancer early detection services. The Lot Quality Assurance Sampling (LQAS) technique was used to decide on the lot size and threshold values, which were computed as twenty and six clinics. Checklists were employed in assessing coverage, physical facilities and clinic activities. Client satisfaction on WWC services was assessed among 200 TGW attending 20 WWCs using an interviewer-administered questionnaire. Results: CBE coverage in the Gampaha district increased only from 1.1-2.2% over 2003-2007. With regard to physical facilities, the number of clinics that were rated substandard varied between 7-18 (35-90%). The items that were lacking included dust bins, notice boards, stationary, furniture and linen, and cleanliness of outside premises and toilets. With regard to clinic activities, punctuality of staff, late commencement of clinics, provision of health education, supervision, CBE and breast self-examination (BSE) were substandard in 7-20 clinics (35-100%). Client satisfaction for WWC services was 45.2% (IQR: 38.7-54.8%) and only 11% had a score of ${\geq}70%$, the cut off set for satisfaction. Conclusions: Breast cancer early detection service coverage in the Gampaha district remained low (2.2%) in 2007, 11 years after commencing WWCs. All 20 clinics were substandard for overall CBE and BSE.

Qualitative Assessment of Breast Cancer Early Detection Services Provided through Well Woman Clinics in the District of Gampaha in Sri Lanka

Vithana, Palatiyana Vithanage Sajeewanie Chiranthika,Hemachandra, Nilmini Nilangani,Ariyaratne, Yasantha,Jayawardana, Pushpa Lalani Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.12

Background: Breast cancer is the most common cancer diagnosed among women in Sri Lanka. Early detection can lead to reduction in morbidity and mortality. The objective here was to identify perceptions of public health midwives (PHMs) on the importance of early detection of breast cancer and deficiencies of and suggestions on improving existing breast cancer early detection services provided through Well Woman Clinics. Materials and Methods: A qualitative study using four focus group discussions (FGDs) were conducted among 38 PHMs in the Gampaha district in Sri Lanka and the meetings were audio-recorded, transcribed and analyzed using constant comparison and identifying themes and categories. Results: All the PHMs had a firm realization on the need of breast cancer early detection. The four FGDs among PHMs revealed non-availability of guidelines, inadequacy of training, lack of skills and material to provide health education, inability to provide privacy during clinical examination, shortage of stationery, lack of community awareness and motivation. The suggestions for the improvements of the programme identified in FGDs were capacity building of PHMs, making availability of guidelines, rescheduling clinics, improving the supervision, strengthening the monitoring, improving coordination between clinical and preventive sectors, and improving community awareness. Conclusions: Results of the FGDs can provide useful information on components to be improved in breast cancer early detection services. Study recommendations were training programmes at basic and post basic levels on a regular basis and supervision for the sustainance of the breast cancer early detection program.

Effectiveness of an Educational Intervention among Public Health Midwives on Breast Cancer Early Detection in the District of Gampaha, Sri Lanka

Vithana, P.V.S. Chiranthika,Ariyaratne, May,Jayawardana, Pl Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.1

Background: Breast cancer is the commonest cancer among Sri Lankan females, accounting for 26% of the cancer incidence in women. Early detection of breast cancer is conducted by public health midwives (PHMs) in the Well Woman Clinics. The aim of the present study was to determine the effectiveness of an educational intervention on improving knowledge, attitudes and practices (KAP) on breast cancer screening among PHMs in the district of Gampaha. Materials and Methods: Two Medical Officer of Health (MOH) areas in Gampaha district were selected using random sampling as intervention (IG) and control (CG) groups. All the PHMs in the two MOH areas participated in the study, with totals of 38 in IG and 47 in CG. They were exposed to an educational intervention with the objective of using them to subsequently conduct the same among 35-59 year women in the community. Following the intervention, post-intervention assessments were conducted at one month and six months to assess the effectiveness of the intervention. Results: The overall median scores for KAP among PHMs respectively were as follows. Pre-intervention: IG:58%(IQR: 53-69%), 90%(IQR: 70-100%) and 62%(IQR: 57-70%). CG: 64%(IQR: 56-69%), 90%(IQR: 70-90%) and 62%( IQR: 50-77%). Post-intervention: one month, IG:96%(IQR: 93-96%), 100%(IQR: 100-100%), and 85%(IQR: 81-89%). CG:67%(IQR: 60- 73%), 90%(IQR: 80-100%) and 65%(IQR: 50-73%). Post-intervention: six months, IG: 93% (IQR: 91-93%), 100%(IQR: 90-100%), and 81%(IQR: 77-89%). CG: 67%(IQR: 58- 71%), 90%(IQR: 90-100%), and 62%( IQR: 58-73%). All the above post-intervention scores of PHMs in the IG were significantly higher in comparison to CG (p<0.001). Conclusions: This planned educational intervention had a significant impact on improving KAP of PHMs for early detection of breast cancer in the Gampaha district.

Educational Intervention on Breast Cancer Early Detection: Effectiveness among Target Group Women in the District of Gampaha, Sri Lanka

Vithana, PVS Chiranthika,Ariyaratne, MAY,Jayawardana, PL Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.6

Purpose: The present study concerns the effectiveness of an educational intervention for improving knowledge, attitudes and practices (KAP) of breast cancer early detection among target group women (TGW) in the district of Gampaha, Sri Lanka. Materials and Methods: The study was a community-based intervention. Two medical officer of health areas in Gampaha district were selected using random sampling as intervention (IA) and control (CA). Public health midwives (PHMs) in the IA were exposed to the educational intervention first, conducted the same among the TGW through PHMs. KAP was assessed using an interviewer- administrated questionnaire among 260 TGW from each area selected using cluster sampling before and six months after the intervention. Results: The overall median scores for KAP among TGW in IG increased significantly from pre intervention level of 54% (IQR: 46-59%), 50% (IQR: 41-59%), and 0% (IQR: 0-20%) to post intervention level of 77% (IQR: 72-82%), 68% (IQR: 59- 76 %) and 40% (IQR: 20-60%) respectively. In CG, overall median scores for KAP remained almost the same at pre intervention 54% (IQR:44-59%), 50% (IQR:36-59%) and 0% (IQR: 0-20%) and post intervention 54% (IQR:46-59%), 50% (IQR:36-64%) and 0% (IQR: 0-20%) respectively. Conclusions: The educational intervention was found to be effective.

Poultry By-Product Meal as a Potential Protein Source in Broiler Diets with Exogenous Protease Supplementation

Heshani Amalka Vithana,Shemil Priyan Macelline,Shan Randima Nawarathna,Dinesh Darshaka Jayasena,유명환,서은수,Mangala Amarsinghe,Maleeka Nadeemale Nambapana,Jin Ho Cho,허정민 한국가금학회 2023 韓國家禽學會誌 Vol.50 No.1

The objective of this study was to investigate the effect of exogenous protease supplementation in dietsformulated with poultry by-product meal on growth performance, small intestine magnitudes, and meat physiochemicalcharacters in broiler chickens from 21 to 35 days post-hatch. A total of 120, one-day-old "Arbor Acres Plus" broiler chickens(male: female - 50:50) were allocated one of two dietary treatments to give six replicates and ten birds per cage. Two dietarytreatments included a control diet (CON) and a diet supplemented with protease (CON+Pro). At day 35, body weight andfeed intakes were measured to calculate the feed conversion ratio for the entire experiment period. Two birds from each penwere euthanized to measure the relative lengths and relative weights of three small intestine sections and meat samples werecollected for physiochemical characteristic analyses at 35 days post-hatch. Exogenous protease supplementation did notinfluence (P>0.05) growth performance but showed a tendency to improve FCR (P=0.082). Protease supplementation showed a tendency to reduce proximal small intestine length (P=0.091). Broilers offered dietary treatments influenced minced meatcolor where protease supplementation resulted in lower CIE b* (P<0.001) colorimetric value for yellowness and showed a significant trend (P=0.059) on reducing meat redness CIE a*. In conclusion, the addition of exogenous protease to a broilerdiet formulated with poultry by-product meal did not affect the growth performance, small intestine magnitudes, and meatphysiochemical parameters (except CIE b*) in broiler chickens.