Background: According to the Papua New Guinea (PNG) 2015 Annual Report on Child Morbidity and Mortality, neonatal conditions remained the second leading cause of hospital admission. We aimed to identify the common causes of neonatal admissions and deaths in the Eastern Highlands Provincial Hospital (EHPH) Special Care Nursery, and to identify interventions to improve neonatal outcomes in EHPH. Method: This was a retrospective descriptive study of neonatal admissions over a 5-year period: 2011 to 2015. Data collected from the ward admission register included demographic information, admission diagnoses, outcomes and causes of death where applicable. Results: From 2011 to 2015 there were 5177 neonatal admissions and 504 deaths with an overall case fatality rate of 9.7%. More than one admission diagnosis was recorded for some babies. The leading diagnoses were prolonged rupture of membranes (PROM) (25%), low birthweight (LBW) (20%), neonatal sepsis (NNS) (18%), meconium aspiration syndrome (MAS) (16%) and birth asphyxia (BA) (14%). The leading causes of death by admission diagnosis were LBW (259/1013, 26%), BA (141/746, 19%), MAS (80/852, 9%), NNS (79/915, 9%) and babies born before arrival (BBA) (61/306, 20%). 76% of the admissions were hospital-born babies, but 46% of deaths were in the 24% of babies born outside the hospital. The independent predictors of neonatal death were LBW (odds ratio [OR] 7.31), BA (OR 5.94), health centre birth (OR 3.07) and village birth (OR 2.18). Conclusion: LBW, BA and being born outside of a hospital were the strongest risk factors for neonatal death in the Eastern Highlands during this 5-year period. For PNG to achieve the Sustainable Development Goal of a neonatal mortality rate of 12 per 1000 live births, these 3 areas need to be addressed by multifaceted approaches within and outside the health sector.

SUMMARY Patients with a clinical diagnosis of tuberculous lymphadenitis (TBLN) undergoing fine needle aspiration (FNA) biopsy at Port Moresby General Hospital (PMGH) were recruited in a pilot study to compare Xpert® MTB/RIF (Xpert) with microscopy and cytology. From a total of 1080 patients attending the FNA clinic during the study period 107 were recruited, of whom 105 were analysed. Xpert detected Mycobacterium tuberculosis in 65/105 subjects (62%), acid-fast bacilli (AFB) were found in 35/105 (33%) and cytology was positive in 59/105 (56%). 3 of 7 samples unsuitable for microscopy and 9 of the 28 cases (32%) initially classified as non-TBLN were Xpert positive. Xpert was comparable to cytology but more sensitive than microscopy. Xpert also detected multidrug-resistant tuberculosis (MDR-TB) TBLN cases. The results demonstrated that FNA samples are suitable for Xpert analysis at PMGH to diagnose TBLN, which has the added advantage of detecting MDR-TB.

Summary AIMS: This study aimed to evaluate a surveillance system for pigbel (enteritis necroticans), an enteric disease caused by Clostridium perfringens type C beta-toxin. Pigbel was formerly endemic in Papua New Guinea. Surveillance was based on a standardized clinical case definition, plus laboratory confirmation using a new assay for Clostridium enterotoxin that may be identified in intestinal secretions or stool. METHODS: Patients admitted to the Nazarene Hospital in the Jiwaka Province were eligible for inclusion if they had severe abdominal pain of less than 2 weeks’ duration. A standardized case definition of pigbel was used to distinguish cases of acute abdominal pain very likely to be due to pigbel from cases likely to be accounted for by other diagnoses. Children enrolled in the study were tested with a new ELISA (enzyme-linked immunosorbent assay) for Clostridium perfringens beta-toxin. The number and types of samples tested depended on the clinical features and illness severity, and included gastric aspirate, stool and intestinal fluid if surgery was required. RESULTS: Between October 2012 and January 2015 105 patients with acute abdominal pain were admitted. The median age (interquartile range) was 5 (2- 6) years. 48 children met the standardized criteria for the clinical diagnosis of pigbel. 34 of 67 children tested with ELISA fulfilled the criteria for clinical pigbel, of whom 12 tested positive and 22 negative. The sensitivity of the ELISA test against the clinical diagnosis was therefore 35%. The test was positive in 4 children with abdominal pain who did not fulfil all the clinical criteria for pigbel, suggesting that they had a mild form of the disease. There were 4 surgically confirmed patients who were ELISA negative. In total, laboratory or surgically confirmed pigbel was found in 20 patients, but it is likely that there were others with pigbel among the 105 patients with acute abdomen. 5 of the study children died. CONCLUSIONS: The ELISA test for Cl. perfringens beta-toxin can be a useful confirmatory test and can help to validate the clinical impression of pigbel. However, the sensitivity is low, even in children who are likely to have pigbel, and therefore a negative test cannot rule out the diagnosis. Because the differential diagnosis of the clinical features of pigbel is broad, having the combination of clinical and laboratory-based surveillance for pigbel would help monitor the true burden of disease, and could be used to guide public health interventions.

Assessing the prevalence of anaemia, iron deficiency and iron deficiency anaemia among non-pregnant and pregnant women is essential for evidence-based intervention programs. The purpose of this prospective outpatient and community-based cross-sectional study was to assess the prevalence of those conditions among pregnant women resident in the National Capital District (NCD) and attending the Outpatient Antenatal Clinic in Port Moresby General Hospital. Blood samples were collected from 50 non-pregnant and 157 pregnant women who gave consent. HemoCue was used to measure haemoglobin; the serum ferritin, soluble transferrin receptor (sTfR) and C-reactive protein were measured by specialized 96-well enzyme-linked immuno-sorbent assay (ELISA) kits. The ‘sTfR-F index’ was calculated. Mild to moderate anaemia, low serum ferritin and elevated serum sTfR were found in 28% of the non-pregnant women; the sTfR-F index showed that 16% of them had iron deficiency anaemia. Among the pregnant women, 60% had mild to severe anaemia indicating severe public health significance; 48% had low serum ferritin and 38% had elevated serum sTfR; the sTfR-F index showed that 38% of them had iron deficiency anaemia. Mild to severe anaemia was present in 47%, 71% and 62% of the pregnant women in the first, second and third trimesters respectively, while iron deficiency anaemia was present in 20%, 53% and 48% of the pregnant women in the first, second and third trimesters respectively. The sTfR-F index showed that iron deficiency anaemia was present in 36% of primigravida and 40% of multigravida. Social mobilization, intensive and focused education, aggressive awareness campaigns, including all relevant target groups and policy makers, are required to effectively address this major public health issue.

In Papua New Guinea, village health volunteers (VHVs) work in their communities to support healthy lifestyles. They form an important link between the community and the formal health system. In the Middle and South Fly Districts of Western Province, the VHV Program was implemented as one of the many interventions of the Community Mine Continuation Agreement Middle and South Fly Health Program. For this region of Papua New Guinea, it would be the first time the VHV Program had been implemented. We describe how the VHV Program was implemented and document the perspectives of the VHV Program from the VHVs, their supervising health workers and the communities they serve through focus group discussions and interviews. The qualitative data revealed that some health workers and community members had expectations of the VHVs that differed from their role, particularly in regard to the expectation that VHVs do clinical work. The importance of compensation for VHVs for their time was identified by communities, health workers and the VHVs. VHVs and the community also noted the conflicting demands of the family of the VHV and their work in the community. The final theme identified was about the interaction between the VHV and the formal health system, where VHVs identified needs for access to medical supplies, transport, ongoing training and supervision. These themes are discussed in the context of the international literature and the VHV policy in Papua New Guinea.

The pattern of antibiotics prescribed to patients with peripheral lymphadenopathy was assessed and compared with existing standard treatment guidelines (STGs) in Papua New Guinea (PNG). Information was obtained from patients referred to the Port Moresby General Hospital for fine needle aspiration biopsy by interviewing patients and reviewing patients’ clinic attendance record books and referral letters. Of the 107 patients recruited for the study, 51 (48%) were prescribed antibiotics and, of these, prescription data were obtained from 40 (78%). Amoxycillin, which is recommended as a first-line antibiotic for peripheral lymphadenopathy in PNG STGs, was prescribed in only 18/40 patients (45%). There was also high variability in other antibiotic selection, antibiotic combinations and treatment duration. The results highlight a need for ongoing training on rational antibiotic prescribing.

Tuberculosis (TB) continues to be a serious public health problem in Papua New Guinea (PNG). A key element in the prevention and control of TB is for people to have the correct, appropriate and relevant information regarding TB and its prevention and treatment. In PNG, there is no published information about the knowledge of TB among the general population. An understanding of people’s knowledge of various aspects of TB is important in developing interventions to address the burden of TB. This study aimed to assess the knowledge of TB among the local population in PNG. We used a cross-sectional study to understand people’s levels of knowledge regarding TB in three sites in PNG: Hiri, Asaro and Karkar Island. A total of 1034 people aged 15 years and above participated in this study from May to December 2013. Our study showed different levels of TB knowledge between sites 79% of respondents in Hiri, 27% in Asaro and 23% in Karkar correctly identified TB bacteria as the leading cause of TB. The only site at which respondents gave four correct symptoms of TB was Hiri (7%). Coughing out air droplets was identified as the main mode of transmission by 84% of respondents in Hiri, 33% in Asaro and 71% in Karkar. A tiny proportion of the participants in Hiri (4%) knew the three correct ways of TB prevention. Despite the availability of free TB treatment only 45% of respondents in Hiri, 18% in Asaro and 46% in Karkar knew about it. In Hiri, 58% of the participants knew the TB treatment duration of 6-9 months, compared with 36% in Asaro and 33% in Karkar. A health facility was the most common source of TB information in all three sites. Providing accurate and relevant information about TB through public health education strategies is urgently required to help in addressing the current TB crisis

Surgical services in Papua New Guinea (PNG) have seen an increase in admissions of patients with diabetic septic foot (DSF). Perception and beliefs about the causes of foot ulcer in PNG differ from medical evidence and may play a role in foot-related behaviours among DSF patients. This hospital-based prospective case series study examined the reasons for late presentation among 30 DSF patients in Nonga General Hospital from October 2013 to October 2014. Belief in sorcery was the most common cause of late presentation. Those who chose more than one home treatment were the most likely to present late, and those who presented late had a higher chance of getting a lower extremity amputation than those who presented early.

Child adoption is common in Papua New Guinea (PNG), but little is known about current practices. This study describes the adoption and feeding practices among children up to 3 years of age, identified by both community-based and health facility recruitment in the Southern Highlands of PNG over a 6-month period in 2017. 85 adopted children were identified: 61 (72%) had been customarily or informally adopted and 24 babies (28%) had been sold for cash. Most (93%) were adopted at less than 1 year of age, and twothirds in the neonatal period. 73 mothers (86%) had poor knowledge of the adoption laws and processes, and 56 (66%) had poor knowledge of infant feeding practices. 8% had moderate and 9% had severe malnutrition. The common reasons for adoption were: family breakdown because of divorce, separation or the practice of polygamy; mothers who had too many children or wanted to adopt children; teenage pregnancies; and de facto relationships. 56 of the adopted children were weaned before 6 months of age, and 23 before 4 months of age, most onto a diet consisting of a limited range of fruits and vegetables. Ensuring the rights of adopted children to legal protection, optimal nutrition, care and education is essential. Knowledge of and adherence to customary adoption laws, involvement of social welfare, and infant and young child feeding practices all need to be strengthened in communities, especially in the rural areas.

Two rural communities in Papua New Guinea, the Wopkaimin, which experienced massive socioeconomic development through the Ok Tedi Mine Limited (OTML) commencing in 1983, and Mt Obree, which was without any major economic project during that time, were followed annually since 1982. 83 variables including births and deaths were monitored. The crude birth rate (CBR) and infant mortality rate (IMR) were high in both areas at the beginning. IMR decreased significantly among the Wopkaimin only. The Wopkaimin’s CBR increased immediately after mining but declined later, with no significant change in Mt Obree. The influence of various socioeconomic, cultural and environmental factors is discussed. Demographic monitoring at the community level is accurate, economical and reproducible.