Publications

We are pleased to highlight a recent publication by a member of our network in BMJ Paediatrics Open:

“How are young children treated? Multiprovincial patterns of prescribing for children under 5 in Sri Lanka.”

This study provides a comprehensive evaluation of prescribing practices for children under five years of age across multiple provinces in Sri Lanka. Focusing on routine outpatient care, the research examines the types of medicines prescribed, prescribing patterns, and the extent to which these align with established principles of rational drug use. A key strength of the study is its use of WHO prescribing indicators to assess quality of care. It explores critical aspects such as polypharmacy, antibiotic use, and generic prescribing, offering a structured analysis of how young children are managed in real-world clinical settings. By capturing data across diverse geographic regions, the study highlights both consistencies and regional variations in prescribing behaviour.

The findings draw attention to important areas for improvement, particularly around optimising antibiotic stewardship and promoting rational prescribing practices in early childhood. Given the vulnerability of this age group to medication-related harm, the study underscores the need for targeted interventions, guideline reinforcement, and ongoing professional education. This work makes a valuable contribution to the evidence base on paediatric prescribing in low- and middle-income settings and provides practical insights to inform policy and clinical practice in Sri Lanka and similar contexts.

🔗 Read the full article: https://bmjpaedsopen.bmj.com/content/10/1/e004594

A newly published study in BMJ Paediatrics Open has provided critical insights into the patterns and risk factors associated with illicit substance abuse among teenagers in Sri Lanka, highlighting urgent areas for prevention and policy intervention.

The research, led by Kavinda Dayasiri and colleagues, represents one of the few case-control studies in South Asia to examine adolescent substance use through a rigorous analytical framework. The study draws attention to the growing yet under-recognized burden of substance abuse among Sri Lankan youth.

Key Findings

The study identified several behavioural, familial, and environmental factors that significantly increase the likelihood of substance abuse among teenagers. Peer influence emerged as a dominant driver, with adolescents exposed to substance-using social circles showing a markedly higher risk of initiation and continued use. Family dynamics also played a crucial role. Teenagers from households with poor supervision, parental substance use, or strained relationships were found to be particularly vulnerable. Additionally, school disengagement and academic difficulties were strongly associated with substance use behaviours. The research further revealed that many adolescents begin experimenting with substances at a relatively young age, often without adequate awareness of the long-term health and psychosocial consequences. This early initiation increases the risk of dependency, mental health complications, and repeated harmful behaviours.

Implications for Public Health

The authors emphasize that addressing teenage substance abuse requires a multi-layered approach. Strengthening family support systems, improving school engagement, and implementing community-based awareness programmes are identified as key strategies. Importantly, the study calls for targeted interventions that address peer group influences and promote resilience among adolescents. It also highlights the need for better integration of mental health services within adolescent healthcare frameworks. Given Sri Lanka’s evolving social landscape, the findings underscore the importance of early preventive efforts and evidence-based policymaking to mitigate long-term societal and health impacts. 

This study adds valuable regional evidence to the global discourse on adolescent substance abuse, particularly from low- and middle-income settings where data remain limited. By identifying context-specific risk factors, it provides a foundation for culturally relevant interventions and future research.

🔗 Read the full article: https://bmjpaedsopen.bmj.com/content/10/1/e004410

Excited to share our latest publication in PLOS Neglected Tropical Diseases!                                                                                     

This nationwide study explores the knowledge and practices of Public Health Midwives across Sri Lanka in preventing, identifying, and managing paediatric snakebites—an often overlooked yet critical public health issue. Drawing on data from over 1,700 PHMs across all 25 districts, our findings highlight key strengths, gaps, and opportunities to strengthen community-level care and save young lives.

A step forward in improving early response and prevention of paediatric snakebites in resource-limited settings.

🔗 Read the full article: https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014083

We are proud to share that our recent study, “Curiosity, coercion and coping: psychosocial drivers of youth drug use in Sri Lanka,” has been published in BMJ Paediatrics Open (2026;10:e003929). This qualitative research, led by Dr. Kavinda Dayasiri and colleagues from the Universities of Kelaniya and Peradeniya, explored how and why adolescents initiate and continue substance use in Sri Lanka.

Through in-depth interviews with 48 adolescents undergoing rehabilitation, the study identified five key pathways: curiosity-driven initiation, peer modelling, coercion, emotional distress, and continued use for coping or dependency. Importantly, substance use often began in familiar environments such as schools, homes and community spaces, challenging traditional prevention assumptions.

The findings highlight the urgent need for youth-centred, mental health–integrated, and community-based prevention strategies. This publication marks another important milestone for KidsToxLK in advancing evidence-based advocacy for vulnerable children and adolescents in Sri Lanka.

Read the full text at: https://bmjpaedsopen.bmj.com/content/10/1/e003929

Snakebites are a serious health problem in many rural parts of the world. In Sri Lanka, where farms, forests, and villages lie close together, children are often at risk of encountering snakes while playing, helping at home, or walking to school. Because snakebite injuries can be painful and dangerous — especially for children — researchers want to understand how communities can better prevent bites and respond quickly when they happen.

A new study published in PLOS Neglected Tropical Diseases explores an important idea: Can community health workers help keep kids safe from snakebites? Led by Prof. Kavinda Dayasiri and colleagues, this research listened to the voices of Public Health Midwives — healthcare workers who visit families and children regularly in rural Sri Lanka.

Why Talk to Midwives?

Public Health Midwives (PHMs) are trusted members of their communities. They support families with pregnancy care, immunizations, child growth checks, and health education. Because they already visit many homes, the researchers wondered whether PHMs might also be in a good position to teach families about snakebite prevention and early response.

The study involved group discussions with 74 Public Health Midwives from two rural districts that experience a high number of snakebite cases. These midwives shared what they know about snakebites, what challenges they face, and what support they think would help them do this work better.

What Midwives Knew — and What They Didn’t

The midwives were aware that snakebites happen frequently in their communities, especially during farming seasons and when children play outdoors. However, many midwives said they had limited formal training on identifying dangerous snakes, understanding how snake venom affects children differently than adults, or teaching the right steps for first aid.

Some midwives relied on general health knowledge, but felt unsure about exactly how to guide families when a snakebite occurs. This gap in training made some midwives worried that they might not be giving families the most helpful information possible.

In many rural areas, people still follow traditional beliefs or home remedies for treating snakebites. Some families first try herbal treatments, spiritual rituals, or other local practices before going to a medical clinic. While these practices are important parts of culture, the midwives explained that they can sometimes delay proper medical care — especially for children, who can become very sick quickly after a bite. Midwives also mentioned that hard terrain, long distances to health centers, and heavy workloads made it harder for them to add snakebite education to all the other services they already provide.

Ideas for Improving Safety and Education

Despite these challenges, the midwives were positive and creative in their suggestions. They recommended: 

more training on snakebite first aid and child-specific care, educational sessions in schools and villages to teach kids and parents how to avoid snakebites, information that respects local beliefs while clearly explaining when medical help is needed and better support from health systems, such as faster transportation to clinics. These ideas show that midwives want to help keep children safe — and that with the right tools and training, they could play an even stronger role in preventing snakebite harm.

Why This Research Matters for Kids

Children explore, run, climb, and play in places where snakes might hide — like tall grass, piles of wood, or shady corners near homes. Because a child’s body is smaller than an adult’s, snake venom can spread more quickly and lead to serious illness if not treated fast. This new publication highlights an exciting opportunity: strengthening the skills and knowledge of Public Health Midwives could help families prevent snakebites and act quickly when they happen. Early education and better access to care could save lives and protect children in communities where snakebites are common.

Read the full text at: https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0013976

We are delighted to announce the publication of a new research article led by Professor Kavinda Dayasiri, Director of KidsToxLK and Consultant Paediatrician at the Faculty of Medicine, University of Kelaniya, in the Transactions of the Royal Society of Tropical Medicine and Hygiene. The paper, titled “Facing pediatric snakebites unarmed: knowledge gaps and first-aid response challenges among parents in rural Sri Lanka”, was published on 6 February 2026 and highlights critical insights into caregiver preparedness for pediatric snakebite incidents in rural communities.

Pediatric snakebites remain a neglected but serious public health threat in rural Sri Lanka, where children are at high risk due to environmental exposure and limited access to emergency care. In this study, researchers conducted a descriptive cross-sectional survey among 518 parents of children under five years of age from two snakebite-endemic districts — Ampara and Polonnaruwa.

The findings reveal that while nearly all parents (98.3%) were able to identify a common venomous species such as the Indian cobra, awareness of other medically important snakes was much lower. For example, only about one-third recognized Russell’s viper correctly, and many participants misclassified harmless snakes as venomous. Misconceptions about appropriate first-aid care were also common. Importantly, prior first-aid training was associated with better knowledge of snake identification, symptoms of envenoming, and correct pre-hospital care.

The study also found that higher socioeconomic status and higher parental education were linked to better preparedness, while personal or household experience with snakebite did not significantly improve knowledge. Overall, there remains a low level of caregiver readiness to respond safely and effectively to pediatric snakebite events.

Based on these results, the authors emphasise the urgent need for community-based education programmes that strengthen first-aid training and improve awareness among high-risk families. Such interventions, paired with improved access to emergency care, could reduce preventable morbidity and mortality from pediatric snakebites in rural Sri Lanka. This publication reinforces KidsToxLK’s ongoing commitment to advancing research, informing policy, and supporting evidence-based strategies that protect children’s health and safety in Sri Lanka.

Read the full text at: https://academic.oup.com/trstmh/advance-article-abstract/doi/10.1093/trstmh/traf147/8466163?

We are proud to share that Professor Namal Rathnayake has co-authored a new research article in the prestigious journal Transactions of The Royal Society of Tropical Medicine and Hygiene (TRSTMH), published by Oxford Academic and recognised internationally for contributions to tropical and global health research.

This research addresses a significant gap in snakebite medicine, focusing on the long-term health impacts of bites from the hump-nosed pit viper (genus Hypnale), one of the most medically important venomous snakes in Sri Lanka. Unlike many studies that describe the immediate effects of envenoming, this case series follows patients over extended periods, documenting chronic outcomes such as long-term kidney dysfunction, musculoskeletal injuries, and pulmonary sequelae after envenomation. These findings highlight the need for ongoing medical follow-up and support clinicians in recognising and managing delayed complications of snakebite beyond the acute phase.

Importantly, the lack of an effective antivenom for Hypnale bites in the region underscores the urgency of this work and supports calls for improved snakebite treatments and health system responses.

This achievement underscores KidsToxLK’s commitment to high-quality research and capacity building in poison information and management, strengthening clinical decision-making and improving outcomes for children affected by poisoning across diverse settings.

Read the full text at:  https://academic.oup.com/trstmh/advance-article-abstract/doi/10.1093/trstmh/traf148/8457198?redirectedFrom=fulltext

We are pleased to share our latest publication, “Crisis and Care: Global Trends in Pediatric Poisoning First-Aid Practices (2000–2025)”, published in the Journal of Desk Research Review and Analysis (2025).

This scoping review synthesises 25 years of global evidence on pre-hospital first-aid practices following childhood poisoning. It highlights substantial variation in caregiver responses, with harmful practices such as forced emesis and unproven home remedies remaining common, particularly in low- and middle-income settings. The review also demonstrates that targeted educational interventions and accessible poison control services significantly improve appropriate first-aid behaviours. 

These findings strongly support the need for culturally sensitive caregiver education, strengthened poison information systems, and policy-level integration—core priorities aligned with the mission of KidsToxLK.

Read the full text at:  https://jdrra.sljol.info/articles/86/files/69410eb606f48.pdf

A new multicentre case–control study published in BMJ Paediatrics Open—“Psychosocial and contextual risk factors of adolescent deliberate poisoning: a multicentre case–control study in Sri Lanka”, explores the underlying psychosocial and environmental drivers of adolescent self-poisoning.

The study compared adolescents admitted with deliberate poisoning to matched community controls and found that prior mental-health issues, family conflict, parental substance misuse, school disengagement and recent stressful life events significantly increased risk. Easy household access to medicines and agrochemicals was a prominent modifiable factor. Social isolation and lack of adolescent mental-health support services further compounded vulnerability.

The authors call for targeted interventions—limiting access to toxic substances, strengthening school-based mental-health programmes, training frontline workers to identify at-risk youth, and improving referral pathways to care.

This research highlights the urgent need for culturally tailored, multisectoral prevention efforts in Sri Lanka. KidToxLK encourages health professionals, educators and policymakers to translate these findings into practical action to reduce adolescent self-poisoning and improve early support.

Read the full text at:  https://bmjpaedsopen.bmj.com/content/9/1/e003949

A new case report published in the Sri Lanka Journal of Child Health highlights a rare and life-threatening complication of Hottentotta tamulus (white scorpion) envenomation in a 6-year-old boy from Mannar. This is the first documented case in the district and the first Sri Lankan paediatric case presenting with cardiogenic shock following a scorpion sting.

The child developed severe cardiovascular collapse, pulmonary oedema, and myocarditis, requiring intensive care, intubation, and multiple inotropes. Despite the unavailability of antivenom or intravenous prazosin, timely administration of oral prazosin and critical supportive management led to recovery.

This case underscores the emerging threat of scorpion envenomation beyond Jaffna, the potential for severe cardiac complications in children, and the challenges faced in resource-limited rural hospitals.

Read the full text at:  https://sljch.sljol.info/articles/11171/files/68b4568ab429e.pdf

A recent study, “First-aid practices and pre-hospital care in paediatric snakebites”, sheds light on the widespread use of potentially harmful first-aid actions taken before professional medical care begins. 

While many caregivers confidently administer first-aid in emergencies, this research shows that some commonly used methods may actually increase risk rather than reduce harm. The authors analyse which practices are safe, which are potentially detrimental, and the factors that predict when harmful approaches are more likely to be used. 

At KidsToxLK, our mission is to provide accurate, evidence-based guidance on poisoning prevention and management for children. We believe that by understanding and correcting first-aid myths, caregivers across Sri Lanka can respond more safely and effectively in emergencies. 

Read the full text at:  https://pmc.ncbi.nlm.nih.gov/articles/PMC12333078/