transmission ; Parents ; Papua New Guinea ; HIV ; Child

Blood from 2100 women attending the antenatal clinic of the Port Moresby General Hospital (PMGH) and the 9 Mile urban clinic of Port Moresby was tested for syphili using the laboratory-based Venereal Disease Research Laboratory (VDRL) syphilis serology test and two clinic-based syphilis tests, Abbot Determine and Abbot Syfacard-RR (Rapid Plasma Reagin (RPR) card test). The Abbot Determine and the Syfacard-R tests were compared with the VDRL test, the gold standard in this study. The validation test results of Determine versus VDRL were as follows: sensitivity 92.0%; specificity 94.6%; the predictive value of a positive test 42.6%; and the predictive value of a negative test 99.6%. The validation tests for RPR versus VDRL were as follows: sensitivity 56.3% specificity 96.5%; predictive value of a positive test 41.2%; and the predictive value of a negative test 98.1%. The RPR test costs 3.5 kina (about one US dollar) a test, the VDRL less than 1 kina a test whilst the Determine test kit costs about 5 kina a test. When laboratory time, salaries and other supplies are costed the Determine test is expected to cost relatively much less. Our recommendation is that the Determine test be made available in areas of the country where VDRL is unavailable or where logistics do not allow for test results to be available early enough to make a difference to the care of th pregnant woman and her fetus.
VDRL test ; Rapid plasma reagin ; predictive ; Clinic ; Rapid

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

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

Besides young children, pregnant women are at high risk of malaria in highly endemic countries. This paper reviews evidence from studies conducted in Papua New Guinea (PNG) in the last 20 years on the burden and prevention of malaria in pregnancy and highlights gaps in our knowledge of malaria in pregnancy in PNG. Overall, primigravidae were found to be at higher risk than multigravidae, with up to 40% of primigravidae but only 10-25% of multigravidae infected with Plasmodium falciparum at delivery. Such infections were found to be associated with a 128-145 g decrease in birthweight. Mean birthweights reported between 1980 and 2003 range from 2.58 to 2.72 kg in primigravidae and 2.84 to 3.09 kg in multigravidae, with 21% to 48% and 9% to 19% of babies born to primigravidae and multigravidae, respectively, of low birthweight (<2500 g). The negative impact of malaria in pregnancy is compounded by relatively low rates of antenatal coverage. The current PNG national treatment policy which prescribes a treatment course of first-line antimalarial treatment (currently chloroquine and sulphadoxine-pyrimethamine) at first antenatal clinic contact, followed by weekly chloroquine prophylaxis and iron and folate supplementation, may no longer be effective given the high levels of resistance to chloroquine in PNG and poor compliance. In order to reduce the burden of malaria in pregnancy in PNG, alternative methods of control such as insecticide-treated nets and intermittent preventive treatment in pregnancy (IPTp), as well as improved modes of delivery of maternal health interventions, are urgently needed.
Malaria ; Pregnancy ; therapeutic aspects ; Review [Publication Type] ; Human Females