A cohort of 1711 children born in Tari, Southern Highlands Province, Papua New Guinea was followed to determine the effect of birthweight on total and cause-specific mortality at varying ages during infancy. Mean birthweight was 3.04 kg, males were significantly heavier than females and first offspring significantly lighter than other offspring. Children weighing < or = 2.5 kg at birth accounted for 15% of all births and 32% of all deaths and were 2.7 times more likely to die in infancy than heavier children. Infant mortality was negatively associated with birthweight (p < 0.001). Mortality was very high among children with birthweight < or = 2 kg and was lowest in the 3.1-3.5 kg birthweight category. Pneumonia mortality declined with increasing birthweight in the 1-5 month age group, but in the 6-11 month age group the risk of death from pneumonia was the same among children with birthweight > 3.5 kg as those with birthweight < or = 2.5 kg. While control of infectious diseases will have a marked impact on infant mortality in the short term, longer-term interventions aimed at improving socioeconomic status are needed to improve nutritional status of both adults and children (including birthweight) and hence sustain the lower mortality levels achieved in young children. PIP: Birth weight is an important determinant of infant mortality in both developed and developing countries, with low birth weight associated with a high risk of neonatal death and an increased risk of death during the postneonatal period. 1711 children born in Tari, Southern Highlands Province, Papua New Guinea, were followed to assess the effect of birth weight upon total and cause-specific mortality at varying ages during infancy. The infants were of mean birth weight 3.04 kg, with males significantly heavier than females and first offspring significantly lighter than other offspring. Children weighing 2.5 kg or less at birth accounted for 15% of all births and 32% of all deaths, and were 2.7 times more likely to die in infancy than heavier children. Infant mortality was negatively associated with birth weight. For example, mortality was very high among children with birth weight of 2 kg or less and lowest among those of birth weight 3.1-3.5 kg. Pneumonia mortality declined with increasing birth weight at ages 1-5 months. However, in the 6-11 month age group, the risk of death from pneumonia was the same among children with birth weight of greater than 3.5 kg as it was among those with birth weight of 2.5 kg or less. Controlling infectious diseases will have a major impact upon infant mortality in the short-term, but longer-term interventions designed to improve socioeconomic status are needed to improve the nutritional status of both adults and children and thereby sustain the lower mortality levels achieved in young children.
Cause of Death ; Cohort Studies ; Female ; Humans ; Infant ; Male ; Papua New Guinea - epidemiology ; Pneumonia - mortality ; Proportional Hazards Models ; Rural Population

Humans ; Papua New Guinea/epidemiology ; Pneumonia/*epidemiology/microbiology/prevention & control

Although acupuncture theory is a fundamental part of the Huangdi Neijing, the clinical application of the needle therapy in ancient China was always a limited one. From early times there have been warnings that acupuncture might do harm. In books like Zhang Zhongjing's Shanghanlun it plays only a marginal role. Among the 400 emperors in Chinese history, acupuncture was hardly ever applied. After Xu Dachun called acupuncture a "lost tradition" in 1757, the abolition of acupuncture and moxibustion from the Imperial Medical Academy in 1822 was a radical, but consequent act. When traditional Chinese medicine was revived after 1954, the "New Acupuncture" was completely different from what it had been in ancient China. The conclusion, however, is a positive one: The best time acupuncture ever had was not the Song dynasty or Yuan dynasty, but is now - and the future of acupuncture does not lie in old scripts, but in ourselves.
Acupuncture Therapy ; history ; Books ; history ; China ; History, 17th Century ; History, 18th Century ; History, 19th Century ; History, 20th Century ; Humans ; Medicine, Chinese Traditional ; history

From 1985 to 1987, Streptococcus pneumoniae isolates were collected from children under 5 years of age in the Asaro Valley, Papua New Guinea as part of a study on bacterial colonization and respiratory tract infections. Data on serogroup and colony morphology were collected to survey serogroups and associated colony morphologies present in the area and to assess whether colony morphology can be indicative of serogroup. In total, 5989 colonies were examined; serogroups 6, 10, 14, 15, 19, 23, 33, 34, 35 and nonserotypeable strains were the most common and accounted for 77% of all the colonies, with serogroups 6, 19 and 23 accounting for 48%. The majority of colonies displayed the typical draughtsman morphology, though serogroup 10 and non-serotypeable isolates most often displayed a raised colony morphology. Of the 15 mucoid colonies identified 73% were serotype 3, though only 29% of serotype 3 isolates were mucoid. Thus colony morphology is of limited value in identifying the pneumococcal serogroup/serotype apart from mucoid colonies, which are likely to be serotype 3.

To determine the effect of moderate altitude on arterial oxygen saturation (SaO2), pulse oximetry was performed on 302 children aged <3 months attending a clinic in Goroka, Eastern Highlands Province (1584 metres above sea level) for minor ailments or immunization. Respiratory and heart rates were also measured. The overall mean SaO2 was 96%. Comparison between log-transformed means showed that SaO2 was significantly lower in the first month of life than later (p=0.04). 6% of SaO2 values were <92%, which is a practical cut-off for normal SaO2 in this population of highland children aged <3 months. Mean respiratory and heart rates were 50/minute and 145/minute, respectively. After adjusting for age, respiratory rate increased significantly as SaO2 declined (p=0.002). We have thus defined reference values for SaO2, respiratory rate and heart rate in healthy young infants residing in the highlands of Papua New Guinea. Further investigation is needed to determine whether SaO2 is lower in babies when they are asleep and to define reference values for older children in the highlands.
Heart Rate - physiology ; Infant, Newborn ; Linear Models ; Oximetry ; Oxygen - blood ; Papua New Guinea - epidemiology ; Respiration

A morbidity study of diarrhoea covering 1926 children aged less than 5 years was carried out in Goroka town and the Lowa and Asaro Census Divisions, Eastern Highlands Province between 1986 and 1989. The study involved weekly demographic surveillance of the total population and morbidity surveillance of children by lay reporters who enquired about the presence or absence on any of the preceding 8 days of a range of symptoms associated with diarrhoeal and respiratory diseases. A three-day symptom-free period was used to define distinct episodes of diarrhoea. The average number of episodes/child-year for all children in the study population was 3.0. Boys suffered a significantly higher incidence of diarrhoea under 48 months of age than girls (4.4 episodes compared to 3.6/child-year). Incidence was highest among those aged 6-17 months (5.5/child-year) with a rapid decline after age 35 months. Incidence of diarrhoea was highest in the more remote Asaro Census Division and was higher in periurban areas than in Goroka town. Incidence also varied significantly between villages, some villages experiencing up to 10 times the incidence of diarrhoea found in Goroka town. The incidence of diarrhoea was significantly higher in January than at other times of year. Duration of diarrhoea varied with age, the longest duration being an average of 4.7 days in the 12-17 months age group. In order to reduce diarrhoea morbidity, it is necessary to improve access to water, encourage improved hygiene practices and breastfeeding and warn people about the risks of sleeping with pigs. PIP: A morbidity study of diarrhea covering 1926 children aged less than 5 years was carried out in Goroka town and the Lowa and Asaro Census Divisions, Eastern Highlands Province between 1986 and 1989. The study involved weekly demographic surveillance of the total population and morbidity surveillance of children by lay reporters who enquired about the presence or absence on any of the preceding 8 days of a range of symptoms associated with diarrheal and respiratory diseases. A 3-day symptom-free period was used to define distinct episodes of diarrhea. The average number of episodes/child-year for all children in the study population was 3.0. Boys suffered a significantly higher incidence of diarrhea under 48 months of age than girls (4.4 episodes/child-year compared to 3.6 episodes/child-year). Incidence was highest among those aged 6-17 months (5.5 episodes/child-year) with a rapid decline after age 35 months. Incidence of diarrhea was highest in the more remote Asaro Census Division and was higher in periurban areas than in Goroka town. Incidence also varied significantly between villages, some villages experiencing up to 10 times the incidence of diarrhea found in Goroka town. The incidence of diarrhea was significantly higher in January than at other times of year. Duration of diarrhea varied with age, the longest duration being an average of 4.7 days in the 12-17 months age group. In order to reduce diarrhea morbidity, it is necessary to improve access to water, encourage improved hygiene practices and breastfeeding and warn people about the risks of sleeping with pigs.
Age Distribution ; Child, Preschool ; Diarrhea - epidemiology ; Female ; Health Surveys ; Papua New Guinea - epidemiology

Between 1980 and 1989 we carried out fortnightly demographic surveillance in a random sample of people living in Goroka town, periurban areas and rural areas in the Lowa and Asaro Census Divisions, all within 1 1/2 hours' drive of the town in the Asaro Valley, Eastern Highlands Province. Cause of death was determined by verbal autopsy supplemented by any available health service information. Crude death and birth rates were 10 and 32 per 1000 person-years, respectively, in 59,906 person-years at risk. The standardized mortality ratio increased with increasing distance from town. Life expectancy at birth was 57 years for males and 55 years for females. The stillbirth rate was 19 per 1000 births, neonatal and infant mortality 21 and 60 per 1000 livebirths, respectively, and 1-4-year mortality 9 per 1000 person-years. Maternal mortality was 3 per 1000 births. Neonatal and infant mortality were respectively 7 and 3 times as high in Asaro Census Division as in Goroka town. Acute lower respiratory tract infections accounted for 22% of all deaths, chronic obstructive lung disease 10%, trauma 8% and gastroenteritis/dysentery 7%. 76% of deaths occurred at home and 44% of people who died had no treatment during their terminal illness. Health services were used most frequently by urban dwellers and by the young. To reduce mortality, a political commitment to provide functioning health services in rural areas is needed; regular supervision of health staff, ensuring the safety of staff and their families, availability of antibiotics as near people's homes as possible and regular mobile maternal and child health clinics are essential. Health education should include recognition of signs of severe disease and the importance of seeking treatment early. In view of high maternal and neonatal mortality, user fees should be waived for pregnant women.
Adult ; Age Distribution ; Cause of Death ; Health Services - statistics & ; numerical data ; Mortality - trends ; New Guinea - epidemiology

Effects of diets on hepatic aflatoxin B1 (AFB1)- DNA binding and AFB1-induced glutathione S- transferase placental (GST-P) form positive hepatic foci have been examined in young male Fischer rats. Animals were fed either AIN-76A or Purina Chow (PC) diet for 1 wk before AFB1- DNA binding studies in vivo and in vitro. Animals were injected i.p. with AFB1 (1 mg/kg body wt) and 3 days later were given either AIN-76A or PC diet with or without 0.1% phenobarbital (PB) in their drinking water. All animals were sacrificed 10 wks after AFB1 dosing for analysis of AFB1-induced GST-P positive hepatic foci by immunochemistry. Two h after i.p. injection of AFB1, hepatic AFB1-DNA binding in AIN-76A fed rats was twice as much as those in PC fed animals without affecting GSH levels. There was no significant effect of diet on either cytochrome P-450 content, GSH levels or microsomal cytochrome P-450 mediated AFB1-DNA binding to exogenous DNA. There was a 40% increase in cytosolic GSH S-transferase activity with 1-chloro-2,4-dinitrobenzene as a substrate in PC fed animals compared to those given AIN- 76A diet. The number and area of AFB1-induced GST-P positive hepatic foci were twice and fivefold as much in AIN-76A fed compared to those in PC fed rats. The number of AFB1-induced GST-P positive foci was increased 5-10 fold in the presence of PB in both groups. In summary, the present data indicate that feeding of PC diet compared to AIN-76A diet inhibits the initiation phase whereas AIN-76A stimulates the promotion phase of AFB1 hepatocarcinogenesis in rats by inhibiting AFB1-DNA binding and increasing AFB1-induced hepatic foci respectively.
Aflatoxin B1/metabolism/*pharmacology ; Animals ; Cell Transformation, Neoplastic ; Cytochrome P-450 Enzyme System/metabolism ; DNA/*metabolism ; *Diet ; Glutathione Transferase/analysis/*metabolism ; Hepatocytes/drug effects/*enzymology ; Liver Neoplasms/*etiology ; Microsomes, Liver/enzymology ; Rats ; Research Support, U.S. Gov't, P.H.S.

PURPOSE: We examined the prevalence of anemia, annual screening for anemia, and treatment of anemia with iron among children with inflammatory bowel disease (IBD). METHODS: A retrospective study of U.S. pediatric patients with IBD was performed in the MarketScan commercial claims database from 2010–2014. Children (ages 1–21) with at least two inpatient or outpatient encounters for IBD who had available lab and pharmacy data were included in the cohort. Anemia was defined using World Health Organization criteria. We used logistic regression to determine differences in screening, incident anemia, and treatment based on age at first IBD encounter and sex. RESULTS: The cohort (n=2,446) included 1,560 Crohn's disease (CD) and 886 ulcerative colitis (UC). Approximately, 85% of CD and 81% of UC were screened for anemia. Among those screened, 51% with CD and 43% with UC had anemia. Only 24% of anemia patients with CD and 20% with UC were tested for iron deficiency; 85% were iron deficient. Intravenous (IV) iron was used to treat 4% of CD and 4% UC patients overall and 8% of those with anemia. CONCLUSION: At least 80% of children with IBD were screened for anemia, although most did not receive follow-up tests for iron deficiency. The 43%–50% prevalence of anemia was consistent with prior studies. Under-treatment with IV iron points to a potential target for quality improvement.
Anemia ; Child ; Cohort Studies ; Colitis, Ulcerative ; Crohn Disease ; Follow-Up Studies ; Humans ; Inflammatory Bowel Diseases ; Inpatients ; Iron ; Logistic Models ; Mass Screening ; Outpatients ; Pharmacy ; Prevalence ; Quality Improvement ; Retrospective Studies ; United States ; World Health Organization

Infants in Papua New Guinea (PNG) are at a high risk of invasive pneumococcal disease, and a substantial burden of this falls on children less than six months old. PNG is planning to introduce a pneumococcal conjugate vaccine for infants in the near future, but to make the maximum impact neonatal immunization will have to be considered. To provide evidence on safety and immunogenicity for neonatal and early infant immunization, we undertook an open randomized controlled trial of 7-valent pneumococcal conjugate vaccine (7vPCV). 318 children received 7vPCV at ages 0, 1 and 2 months or at 1, 2 and 3 months or not at all. All children received 23-valent pneumococcal polysaccharide vaccine at age 9 months. This was a large and complex trial: village reporters visited participants weekly during the first year and fortnightly for a further 6 months and nurses monitored self-reported morbidity and collected many thousands of biological samples. The study team was remarkably successful in achieving the study aims, with 18-month follow-up completed on 77% of enrolled children and over 80% of scheduled samples collected. While the results of the trial will be reported elsewhere, this paper discusses the design of the study and dissects out some of the main reasons for its successful completion. Strong community engagement was an essential factor in success and the principles of equitable partnership and service provision led to a strong research partnership. A two-stage consent process, comprising primary assent followed by later informed consent, led to a high drop-out before initial enrolment, but an outstanding retention of those enrolled in the study. We conclude that factors such as strong community participation, reciprocity and a good relationship between the study team and participants are just as important as the technical elements of laboratory testing and data handling in ensuring the success of a vaccine trial in PNG.