No abstract
Child Health Services ; Community Health Services ; Infant ; Infant Mortality ; Nutrition Disorders - mortality ; Papua New Guinea

Haemophilus Infections - mortality ; Immunization Programs - organization & ; administration*

Infections due to antibiotic-resistant bacteria, especially gram-negative bacteria, are a common cause of child mortality in Papua New Guinea. Antibiotic-resistant bacteria include the enteric gram-negative bacilli, especially Escherichia coli, Klebsiella and Enterobacter, and Haemophilus influenzae type b, a major respiratory tract pathogen and cause of meningitis. Among these bacteria there is now high-level resistance to standard antibiotics, including chloramphenicol, amoxycillin and cotrimoxazole. Reasons behind the increase in antibiotic-resistant bacterial infections are the widespread unregulated use of antibiotics and the very large burden of bacterial infections. Risk factors for development of resistant enteric gram-negative infections include village births, prolonged hospital stay, kwashiorkor in adopted children and previous treatment with broad-spectrum antibiotics. Cost-effective strategies to combat these pathogens will need to be broad and must focus on reducing the use of antibiotics for trivial illnesses, reducing the need to use antibiotics and reducing the risk factors for resistant bacterial sepsis. There must be stricter regulation of commercial pharmacies, education of health workers on how to avoid inappropriate antibiotic prescribing, a focus on the prevention of pneumonia by immunization with new vaccines, improvements in the quality and uptake of formal maternal care services and public health measures within villages. In addition there is a need for better surveillance for antibiotic-resistant bacteria within hospitals; this will require substantial improvements in laboratory facilities and carefully planned research collaboration. A national committee should be established to advise on these matters and coordinate interventions.
Bacterial Infections - mortality ; Bacterial Infections - prevention & ; control ; Community Health Workers ; Cross Infection - epidemiology ; Drug Resistance, Microbial ; Health Education ; Infant, Newborn ; Papua New Guinea - epidemiology

Diarrhoea is one of the commonest reasons children require health care in Papua New Guinea (PNG). Acute watery diarrhoea is the commonest form, and is due to viruses. Oral rehydration solution, zinc and continued breastfeeding are highly effective treatments that can be delivered in homes and health facilities. Antibiotics are not useful in acute watery diarrhoea--they make it worse. Deaths from acute watery diarrhoea should be rare if basic curative services are available. Persistent diarrhoea (lasting longer than 14 days) is commonly associated with other co-morbidities, including malnutrition, anaemia, HIV (human immunodeficiency virus) infection, parasite (such as Giardia) or worm infections and environmental enteropathy. Educating parents on handwashing, food preparation, water purification, improvements in sanitation and the home environment, breastfeeding, nutrition and immunization are essential in preventing diarrhoea. Cholera appeared in PNG in 2009, causing over 500 deaths in all age groups. Cholera emerged because of limited access to safe, clean drinking water and poor sanitation. Addressing these will have beneficial effects not only on cholera but also on all causes of diarrhoea and many other common childhood infections.
Anti-Bacterial Agents/therapeutic use ; Child ; Dehydration/prevention & control ; Diarrhea/microbiology/*prevention & control ; Fluid Therapy/methods ; Humans

In Papua New Guinea there are many organizations providing sparsely spread and fragmented health services. Government health facilities are often relatively well functioning in urban and periurban areas, but sporadic or nonexistent in rural areas. In some remote areas churches are the major health service providers. Increasingly other community groups are providing village-based health services. Much financial support is now pledged by major international donors for community-based health services, but few people working at a district or community level have the management skills to access the funds or plan programs effectively, and few of the major donors have any significant presence in rural areas. Such a management skill gap also exists at the level of many provincial health offices and this seriously limits the effectiveness of all major donor projects. There is need for integration of health services to avoid replication and to extend services to areas where no effective services are currently provided. There is also a great need to train people at a community and district level in program planning and management. Non-government organizations (NGOs) working at a district or community level have the potential to bridge this skill gap and to help integrate community-based services with government institutions. This paper reports, as an example, the activities of Save the Children, an international NGO in Papua New Guinea. Essential for the success of community-based health projects is the development of local management skills, reliable funding, integration with established health institutions, objective evaluation and community support. Skilled NGOs working at a community, district or provincial level can have important roles in assisting local people to run effective and sustainable health programs.
Child ; Child Health Services - organization & ; administration ; Child Welfare ; Community Health Planning ; Community Health Workers ; Papua New Guinea

Pigbel remains a likely significant cause of morbidity and mortality in the highlands of Papua New Guinea (PNG), two decades after the administration of pigbel vaccination ceased. There is a need for an effective surveillance program for pigbel to better understand the disease burden and to target communities for preventive strategies. This paper reviews the epidemiology, pathogenesis, recent history and current data on the burden of pigbel in PNG. We propose a surveillance program based on clinical recognition of likely cases and laboratory confirmation using an ELISA assay for Clostridium perfringens type C beta-toxin. Research aimed at validating this approach in the clinical setting is outlined.
Clostridium Infections/epidemiology/*microbiology/*prevention & control ; Clostridium perfringens/pathogenicity ; Enteritis/epidemiology/*microbiology/*prevention & control ; Health Services Needs and Demand ; Humans ; Incidence ; Papua New Guinea/epidemiology ; Population Surveillance

Oxygen therapy is essential in all wards, emergency departments and operating theatres of hospitals at all levels, and oxygen is life-saving. In Papua New Guinea (PNG), an effective oxygen system that improved the detection and treatment of hypoxaemia in provincial and district hospitals reduced death rates from pneumonia in children by as much as 35%. The methods for providing oxygen in PNG are reviewed. A busy provincial hospital will use on average about 38,000 l of oxygen each day. Over 2 years the cost of this amount of oxygen being provided by cylinders (at least K555,000) or an oxygen generator (about K1 million) is significantly more than the cost of setting up and maintaining a comprehensive system of bedside oxygen concentrators (K223,000). A district hospital will use 17,000 l per day. The full costs of this over 2 years are K33,000 if supplied by bedside concentrators, or K333,000 plus transport costs if the oxygen source is cylinders. In provincial and district hospitals bedside oxygen concentrators will be the most cost-effective, simple and reliable sources of oxygen. In large hospitals where there are existing oxygen pipelines, or in newly designed hospitals, an oxygen generator will be effective but currently much more expensive than bedside concentrators that provide the same volume of oxygen generation. There are options for oxygen concentrator use in hospitals and health centres that do not have reliable power. These include battery storage of power or solar power. While these considerably add to the establishment cost when changing from cylinders to concentrators, a battery-powered system should repay its capital costs in less than one year, though this has not yet been proven in the field. Bedside oxygen concentrators are currently the 'best-buy' in supplying oxygen in most hospitals in PNG, where cylinder oxygen is the largest single item in their drug budget. Oxygen concentrators should not be seen as an expensive intervention that has to rely on donor support, but as a cost-saving intervention for all hospitals.

In the Eastern Highlands Province (EHP) of Papua New Guinea (PNG) measles outbreaks have occurred regularly every 3 to 4 years since 1980. The latest was between September 1998 and March 2000. Between July 1999 and March 2000 314 children with measles were reviewed at Goroka Base Hospital. The majority of these children were very young: 55% were under 1 year and 27% under 6 months. The median age of the measles cases was 11 months (range 10 days to 13 years). 40% of the children had a verifiable history of having received at least one dose of measles vaccine. The majority were vaccinated during the epidemic and included many children who either were below 6 months of age or who developed measles within 2 weeks of vaccination. Measles complications occurred in 82% of the children, the most common being pneumonia. Serious complications, particularly severe pneumonia, were more common among the unvaccinated children than in those who had received at least a single dose of the measles vaccine. No deaths occurred among 82 children who had received measles vaccine more than 2 weeks before the onset of clinical measles, compared with 10 deaths in 206 children who had never been vaccinated against measles or were vaccinated in the 2 weeks before presentation (p=0.067). The overall case fatality was 4%: 14% among the hospital-acquired and 2.5% in community-acquired measles. Improvement in the measles vaccination coverage and supplementary vaccination campaigns are required to prevent measles outbreaks in PNG. Intensified measles vaccination campaigns, such as the one conducted in EHP in 1999, are recommended during epidemics to minimize deaths due to measles and to rapidly control outbreaks. The efficacy of measles vaccination can only be measured in total mortality, not in the prevention of clinical measles.
Adolescent ; Child, Preschool ; Disease Outbreaks ; Measles - epidemiology ; Measles - prevention & ; control

Humans ; Informed Consent

Aerospace Medicine ; Emergencies ; Equipment and Supplies ; Ethics, Medical ; First Aid ; Humans ; Physicians ; Professional Competence ; Travel