This descriptive study was conducted in the Diabetes Clinic of the Port Moresby General Hospital for 6 months, from July to December 2002. The aim was to document the usage and effects of betelnut chewing in diabetic patients. 210 patients were randomly selected from the list of patients in the appointment book, using a random number table. Betelnut chewing caused hyperglycaemia and diabetes mellitus in animal models. It was significantly associated with high fasting capillary blood glucose and was an independent risk factor for type 2 diabetes mellitus. In this study, the majority of patients with diabetes were in the older age group (> or = 45 years) and many of them were overweight or obese. The majority of patients had lived in the city of Port Moresby for many years before their diagnosis. 74% of diabetic patients chewed betelnut before their diagnosis and had continued the habit while undergoing treatment for diabetes. The majority (80%) of patients had poor glycaemic control as indicated by the high mean of their most recent blood glucose, which was 13.0 mmol/l in male and 13.1 mmol/l in female patients; these levels were not much lower than those at diagnosis. The mean follow-up of patients in the clinic was 6.2 years. On the balance of evidence, betelnut is a contributing factor to the poor glycaemic control in diabetic patients attending Port Moresby General Hospital.
Mores ; Port - alcoholic beverage ; Financially poor ; control ; Mastication

BACKGROUND: The prevalence of HIV (human immunodeficiency virus) among pregnant women in Port Moresby has increased tenfold, from 0.08% in 1994 to 0.8% in 2002. To stop a further epidemic spread as seen in sub-Saharan Africa it is urgent to identify and intervene to reduce risk behaviours. In order to do so it is important to evaluate current awareness of and attitude towards HIV. METHODS: Interviews with 122 pregnant women were conducted at the Antenatal Clinic, Port Moresby General Hospital, Papua New Guinea. We assessed the women's HIV awareness and relate the results to education and socioeconomic factors. RESULTS: 4 out of 122 women did not know about HIV. 97% knew that HIV is spread by sexual contacts, 96% knew about mother-to-child transmission and 69% knew about infection through breastfeeding. However, there were many misconceptions; 36% believed that HIV can be spread by mosquitoes and 17% believed that caring for an AIDS (acquired immune deficiency syndrome) patient is a risk. Among the women with no education or primary school education only, 51% knew for sure that HIV is not spread by caring for an AIDS patient, compared to 86% for the women with higher education. 47% of the women received their first information about HIV through the media. CONCLUSIONS: The AIDS campaigns have been successful in making almost all the women aware of HIV as a sexually transmitted disease. However, the high frequency of misconceptions makes it probable that patients are stigmatized. This is particularly true for the lower educated women. To more effectively fight the HIV epidemic it is important to improve the general level of education of both men and women, to encourage women to be more in charge of their own sexuality and to increase their status in society. It is also important to make men aware of their responsibility to practise safe sex.
Human Females ; HIV ; Mores ; Port - alcoholic beverage ; educational

Yaws is a re-emerging disease in Papua New Guinea. A resurgence of yaws is documented in the periurban settlements around Port Moresby. A total of 494 cases were identified from April 2000 to September 2001. The age distribution ranged from 2 years to adult (median 9 years). Presenting symptoms were adequately recorded in 286 cases (58%). Of these, 42% presented with raised painless sores, 47% with bone/joint symptoms only and 11% with both sores and bone/joint symptoms. Children in communities with a suspected high prevalence were surveyed and examined for presence of primary yaws sores. 33 out of 227 children examined (15%) had evidence of primary yaws sores. Initial control measures have been case-finding and treatment of contacts, but in areas of known high prevalence mass treatment is planned.
Yaws ; Mores ; Port - alcoholic beverage ; Papua New Guinea ; joint symptom

BACKGROUND: Traumatic brain injury (TBI) has been responsible for 25-30% of surgical deaths in Port Moresby General Hospital (PMGH) over the last 30 years despite being responsible for only 5% of the admissions. AIM: To document the epidemiology of TBI over a period of two years from 2003 to 2004 and compare this to the previous two decades in PMGH and elsewhere. The treatment and outcome of TBI cases are analyzed. METHODS: All TBI cases were included from January 2003 to December 2004. The Glasgow Coma Score (GCS) and Glasgow Outcome Scale (GOS) were documented at admission and discharge. These cases were followed up in the outpatient department for at least 6 months. RESULTS: There were 262 cases of TBI admitted between January 2003 and December 2004. There were 31 deaths during this period. 28 deaths were in the severe TBI category (GCS 3-8) and 3 in the moderate category (GCS 9-12). CONCLUSION: The case fatality rate of severe TBI has been reduced from 60% to just below 30% over the period of 2 years. The formation of a single unit managing TBI over two years may be one factor contributing to this improvement. Interpersonal violence has replaced motor vehicle accidents as the leading cause of death from TBI.
Traumatic brain injuries ; Mores ; Port - alcoholic beverage ; Hospitals, General ; trends

A detailed audit, part retrospective and part prospective, of deaths occurring in children admitted to the children's wards of the Port Moresby General Hospital over a 12-month period was made. 238 children died out of the 4898 admitted, an overall case fatality rate of 4.9%, with a monthly range of 3.7%-9.6%. The proportion of deaths approximated the proportion of admissions in each age group. 92% of the children had a weight of less than 80% of the standard weight for age and 30% weighed less than 60% of the standard weight for age. 24 (11%) of the deaths occurred within the first 6 hours of admission, 39 (17%) within the first 12 hours and 58 (26%) within the first 24 hours. 89 children (40%) died more than one week after admission. Pneumonia, meningitis, measles and septicaemia were the four leading certified causes of death and paediatric AIDS was the fifth. Less than half of the deceased children were appropriately immunized for their age. 27 deaths (12%) were assessed as preventable. 150 (67%) were classified as from treatable causes but unavoidable, 18 (8%) from untreatable causes, 22 (10%) of undetermined cause and 34 (15%) avoidable. The factors associated with avoidable deaths were delayed treatment (20 children), inadequate treatment (8 children), incorrect treatment (1 child) and others (5 children). Infant and child mortality could be reduced by general measures such as improving community nutrition and immunization status and improving care-seeking behaviour. Hospital-related measures to reduce mortality include improving the accuracy and effectiveness of triage and provision of adequate staffing levels and bed space. Periodic in-depth audit is necessary to assess quality of patient care, to identify problems and to point towards their solution. Accurate recordkeeping is essential for appropriate audit and planning.
Child ; Mores ; Port - alcoholic beverage ; Weight ; therapeutic aspects

The status of rickettsial infection in Papua New Guinea (PNG) is unknown although several reports of typhus-like illnesses infecting predominantly white settlers and the Allied troops during World War 2 were published between 1930 and 1945. We performed a serological survey for evidence of rickettsial infection by measuring rickettsia-specific antibody levels in the blood of 191 non-randomly selected Papua New Guineans living in Port Moresby (n=93) and in the highland villages of Samberigi (n=98). Antibodies were measured by a microimmunofluorescence method using a panel of rickettsial antigens of a number of species and strains. In addition, we have reviewed the current status of rickettsiosis in PNG. Overall, we were able to demonstrate significant titres of antibodies to two groups of rickettsiae, the scrub typhus group (STG) and the spotted fever group (SFG). All positive individuals (7/191) were residents of Port Moresby. None from the highlands showed any significant levels of antibodies to rickettsiae. The strains detected within each group were Gilliam and Karp for STG and, for SFG, Rickettsia honei, R. conorii, R. sibirica, R. rickettsii, R. australis and R. akari. No significant antibody titres to typhus group infection were detected in either Port Moresby or highland volunteers. These findings were not surprising given previous reports of typhus-like illnesses and favourable environmental characteristics for rickettsiae in some parts of PNG. Until a definite status of this disease is known, we suggest that rickettsial infection be included as a differential diagnosis for patients presenting with acute febrile illness in Port Moresby and surrounding areas.
rickettsial ; Antibodies ; Upper case are ; Mores ; Port - alcoholic beverage

This is a cross-sectional study conducted intermittently in Port Moresby, the National Capital District of Papua New Guinea, from 1996 to 1997; Mt Obree in Central Province in October 2000; Upper Strickland River in April 2001; and the Balopa Islands in Manus Province in December 2002. The aim of the study was to determine the prevalence of high blood pressure and identify possible risk factors for hypertension in the 'healthy' population in Port Moresby and the three rural communities. There were 1491 subjects surveyed, 704 males and 787 females. Their ages ranged from 20 to 84 years. Just over 6% of subjects were aged 65 years and above. There were 205 (14%) smokers and 340 (23%) betelnut chewers. The Central (rural) subjects were generally younger with the lowest mean systolic and diastolic blood pressures and lowest body mass index (BMI) in both males and females (no overweight or obesity). In Central and Strickland the mean systolic (SBP) and diastolic (DBP) blood pressures were lower and remained the same in all age groups, then in females decreased with age after 55 years. The Manus (rural) subjects were older with higher mean systolic and diastolic blood pressures and higher mean BMI, surprisingly similar to the urban population of Port Moresby. The mean systolic blood pressures in Port Moresby and Manus increased with age in both sexes, while the mean diastolic pressure remained the same in all age groups in females and decreased after the age of 50 years. The prevalence of systolic hypertension among men and women was higher in Manus than in urban Port Moresby and, among the female subjects, Manus had the highest at 31%, while Central recorded the lowest for both males and females. The mean systolic blood pressures of betelnut chewers in Port Moresby, Manus and Central were lower (by 1-9 mmHg) but higher--in males only--in Strickland. The mean diastolic blood pressures of betelnut chewers were lower in all study sites. Both high BMI (overweight and obesity) and older age were significantly associated with high systolic blood pressure but betelnut chewing was significantly associated with lower mean SBP (p < 0.001), a protective effect against systolic hypertension.
seconds ; Blood Pressure ; Mores ; Port - alcoholic beverage ; Hand

From June 1998 to December 1999, mothers of 150 babies who died in the early neonatal period and 150 controls whose babies did not die were studied. In multiple logistic regression analysis the following variables were positively associated with early neonatal deaths: lack of antenatal attendance, thick meconium staining of the liquor, male sex, very low birthweight and delivery at gestational age less than 34 weeks. Maternal betelnut chewing was negatively associated with neonatal deaths. When babies with birthweight below 1000 g were excluded, the following variables were associated with early neonatal deaths: unmarried status, thick meconium staining of the liquor and gestational age below 34 weeks. The negative association with betelnut chewing persisted. The main causes of early neonatal deaths were respiratory distress syndrome, septicaemia, birth asphyxia, meconium aspiration syndrome and congenital abnormalities. Avoidable factors in these deaths were associated with the patient (53%), the labour ward (28%), the antenatal clinic (9%), the postnatal ward (8%) and the special care nursery (2%).
Neon ; Meconium ; Mores ; Betal nut ; Port - alcoholic beverage

Between June 2001 and December 2002, 152 antenatal patients at Port Moresby General Hospital who were Venereal Disease Research Laboratory (VDRL) serology positive and 150 unselected antenatal patients who tested negative were studied to determine the gestational age at which the tests were performed, the time it took for results to become available, the proportion of patients who received treatment, the sociodemographic characteristics associated with VDRL positivity and the effect of VDRL positivity on maternal and perinatal outcomes. The prevalence rate of VDRL positive among antenatal clinic attenders in Port Moresby at that time was 4.4%. Of the 152 VDRL-positive patients in this study 97% were also Treponema pallidum haemagglutination (TPHA) positive. Significantly more of the positive patients were of highlands origin, lived in settlements, had previous marriages, had lower parities, delivered preterm babies, had stillbirths, had growth-restricted babies and had babies with lower Apgar scores at both 1 and 5 minutes. The mean birthweight was significantly lower among the positive patients. Significantly more of the positive patients were married to spouses with occupations which were regarded as 'risky' for sexually transmitted infections. There was no difference between the two groups with respect to patient's education, marital status, husband's education, gestational age at delivery and the number of days the baby spent in the Special Care Unit. The study concluded that the current antenatal screening does not provide adequate coverage for our patients. If the current availability of clinic-based strip tests provided by a non-government organization can be continued by the Ministry of Health we should be able to overcome this problem.
VDRL test ; Clinic ; Mores ; seconds ; Port - alcoholic beverage

This paper outlines the principles of the management of different spinal diseases. In Port Moresby General Hospital between 2004 and 2006 there were 41 spinal injuries, 36 cases of spinal tuberculosis (8 of whom were operated on), 3 non-tuberculous infections and 11 degenerative conditions. The incidence of spinal dysraphism is low in Papua New Guinea with only 5 cases recorded in Port Moresby over the 3-year period. Identification and assessment of spinal pathology were sometimes limited by a lack of radiological investigation and often the resources were not available for optimal treatment. 8 cases with myelopathy had no definitive diagnosis made.
Pathology processes ; Papua New Guinea ; Mores ; Port - alcoholic beverage ; Vertebral column