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Publisher : QUEST Publication, Ghatkopar, Mumbai 400 086

The book “Disease, Treatment and Health behaviour in Srilanka” is well written with balanced statement of facts based on well organised and well conducted survey work comprising different cross sections of people in Srilanka.

Chapter 1 : Highlights achieving low levels of mortality with only moderate expenditure on health. Low level of mortality comparable with countries like Thailand having nearly 3 times percapita income and Malaysia having nearly five times the percapita income compared to Srilanka has been mentioned. It has been emphasized that in addition to health care facilities available in Srilanka number of socio economic factors including literacy particularly education of women, old culture including autonomy of women for health care of the family are contributory factors for rapid decline in mortality rate since middle of twentieth century.

Chapter 2 : Deals with present health services in Srilanka, how the three major types e.g. Western, ayurvedic and supernatural health services available have been used to tackle the growing health need of population belonging to different religious groups, Buddhists, Hindus, Muslims and Christians representing all the three classes rich, middle class and poor.

Chapter 3 : Describes the survey methodology and areas of study, a well designed, multipurpose demographic study, gathering health and mortality related informations based on two sets of data (i) Srilankan demographic change project (SLDCP) dealing with demographic survey of various districts and (ii) Srilankan demographic health survey (SLDHS) dealing with health related behaviour. It is interesting to note that nearly 50% of population of Srilanka including more of well to do people reside in the western district of Srilanka which includes the main city of Colombo.

Srilanka’s health care system is unique in the sense that it is the amalgamation of deshi chikitsa, the ayurveda along with other traditional remedies and the modern system of medicine. Because of higher education and existing social culture people in general particularly the women are cooperative and come forward to respond to questionnaires of the survey personnel including revealing of unrespectable behaviour e.g. premarital pregnancy which is accepted by the society in a particular district.

Chapter 4 : Based on SLDCP data, common disease pattern in Srilanka and types of health facilities employed have been focussed in this chapter. While people extensively use the widely available modern medicine, traditional forms of treatment are used for some illnesses for which people believe them to be particularly appropriate and to restore the balance of humours after taking modern medication. Although modern medical facilities are widely used particularly so by poor people because it is readily available and free of cost, ayurveda is most popular particularly for illnesses for which no permanent cure is available; for example, chronic rheumatism and culturally defined mental illnesses such as demonic possession.

Ayurvedic herbal medicines are often self - administered and used as a preliminary treatment before professional advice is sought. Magico-religious cures are also used for comparatively rare psychological conditions which though serious are not in general life threatening. Nevertheless the analysis shows that primary form of treatment is modern either free hospital treatment or private fee paid medicine. However, ayurvedic medicine is preferred by older people and especially the Simhalese. Young Muslim and Tamil children mostly receive Magico-religious cures, and though very expensive Exorcism ceremonies are mainly practised by Sinhalese. People in general use modern treatment first even though they believe it causes side-effects. Indeed, many Srilankans regard modern and traditional medicine as complementary.

Chapter 5 : Based on SLDCP and SLDHS studies this chapter deals with preventive health care in women and children which is commendable. Study shows that infant, child and maternal mortality levels in Srilanka are very low compared to those in many developing countries in Asia, Africa and Latin America. One thing that was emphasised and important interms of preventive health care is female autonomy in Srilanka particularly in the majority Sinhalese women. Other factors which are complementary are the high level of education, availability of free health care services and improved transport facilities existing in Srilanka.

Chapter 6 : This chapter deals with changing reproductive and child health care behaviour showing overall maternal and child health behaviour in favour of better health. Breast feeding, immunization and old women’s responses on health behaviour are the contributing factors.

Chapter 7 : Makes the concluding remarks emphasizing that Srilanka is well known for unusually rapid mortality decline that started during the middle of last century. At present Srilanka has the lowest levels of infant and child mortality and the highest expectation of life at birth of both males and females in South Asia, a record better than most in the generally wealthier south east Asian region. On the whole this study has demonstrated importance of the contribution of health behaviour in understanding changes in mortality and more generally in the health of Srilankan society.

Comments : It is a case study of health transition showing how various factors affecting health behaviour, including notions of health and treatment, education, female status and decision making within the family combine to influence the use of available health services.

Director; Bombay Hospital,Medical Resarch Centre.

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