Health situation and challenges in Sri Lanka

Abstract

Sri Lanka, an island in the Indian Ocean, is 65 610km2 with a population of 21 million (population density 315/km2). It is a low-middle income country with GDP per capita of USD 4 310. However, due to policies of free education and health, it is ranked 73 (among 188 nations) in the human development index. Sri Lankans have a life expectancy of 76 years and literacy of 92%. Infant mortality is 7.45 deaths/ 1 000 live births and maternal mortality is 30 deaths/100 000 live births, with all deliveries taking place in hospitals. Sri Lanka faces major health challenges in a rapidly ageing population and increasing burden of non-communicable diseases. Cardiovascular disease is the leading cause of death followed by cancer. A third of males smoke and abuse alcohol. Substance abuse is increasing. Snake bite still causes morbidity and mortality. Road accidents have become an important cause of premature deaths. Sri Lanka is at risk for tropical infections which it has been battling in public health campaigns. Some of these have been very successful, with leprosy eliminated as a public health problem in the 1990’s and malaria and lymphatic filariasis in 2016. Rabies will be eliminated as a public health problem in 2020. Tuberculosis remains a challenge with 9 000 new cases annually. However, MDRTB is uncommon. Immunisation coverage is 100% and maternal/neonatal tetanus was eliminated in 2015. Measles, rubella and congenital rubella syndrome are due for elimination in 2020. Sri Lanka has an extremely low prevalence of HIV (<0.1%) and Hepatitis B and C (<2%). Sanitation coverage is 92% and access to safe drinking water 94%. Hepatitis A and enteric fever rates are low. Cholera was last reported in 2003. However, unplanned urbanization has fueled a dengue epidemic. Leptospirosis is increasing in the rice farming areas. Melioidosis has recently been established as endemic in Sri Lanka. Other emerging infections include amoebic liver disease in the North and rickettsial disease and cutaneous leishmaniasis in rural areas. Sri Lanka faces a grave threat in the emergence of antimicrobial resistance. Urgent measures are needed to foster antibiotic stewardship as well as prevent and control infectious diseases.

Keywords

• Health
• Sri Lanka