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.

Child sexual abuse (CSA) is common throughout the world and has been recognized as a common presentation at the Eastern Highlands Provincial Hospital. The aim of this prospective study was to describe the presentations and outcomes of CSA in the hospital. A structured questionnaire was used to collect data from the guardians of 38 children aged between birth and 15 years presenting with a history of sexual abuse between February and August 2013. Children were followed up at three months to ascertain the presence of sexually transmitted infection and to determine how the issue of abuse was resolved by the family. There were 35 females and 3 males aged between 3 and 15 years with a median age of 5.5 years and interquartile range of 4-9 years. 28 (80%) of the 35 girls had been raped and one of the boys had been anally raped. Over half of the children’s mothers were illiterate and lived a subsistence lifestyle. The perpetrator was known to the subjectin 36 (95%) of the cases. Coercion was used by the perpetrators in 22 cases (58%). Gram stains of vaginal swabs from 28 children showed gonococci in 15 (54%). Compensation payments were used to resolve the issue of abuse in 13 (72%) of 18 cases at 3-month follow up. There has been an increase in the number of children diagnosed with sexual abuse at the Eastern Highlands Provincial Hospital. There is an urgent need for existing child protection laws such as the Lukautim Pikinini Act to be robustly implemented and for the development of Family Welfare Centres to provide a holistic approach to the management and support of victims of CSA and their families.

Approximately half of all childhood mortality in Papua New Guinea (PNG) occurs in the neonatal period – the first 28 days of life. In this 5-year retrospective study, causes of admissions and in-hospital mortality among 2426 neonates admitted to Modilon Hospital’s Special Care Nursery in Madang Province were investigated. The neonatal case fatality rate was 15% (370/2426; absolute range between years 12-22%). Neonatal sepsis/infection (1017, 42%), prematurity (821, 34%) and birth asphyxia/meconium aspiration (396, 16%) were the leading causes of admissions (92% of total neonatal admissions) and deaths (96%). Many deaths were potentially avoidable but were often complicated by multiple contributing factors. To reduce neonatal mortality in PNG, health professionals, the government, policy makers and communities must appreciate that improving new born survival and other neonatal outcomes are a responsibility for all. ].