BACKGROUND: Open wounds to the head with skull bone depression pose the potential for serious injuries to the brain parenchyma and an increased risk of infection. The treatment of these injuries aims to repair the breached dura as well as remove any nidus for infection. Open wounds to the head due to bullets pose special problems and have a high fatality rate. AIM: To review the presentation, management and outcome of depressed and penetrating open fractures of the skull in Port Moresby. METHOD: All cases seen from 2003 to 2005 were included. All were managed without a CT (computed tomography) scan. Their Glasgow Outcome Scale (GOS) was documented on discharge. RESULTS: There were 340 traumatic brain injury (TBI) cases over a period of 3 years between 2003 and 2005 managed by the Neurosurgery Unit of Port Moresby General Hospital. The open depressed and penetrating skull fractures seen in these cases numbered 46 (14%), of which 42 were males and 4 females. The weapons most commonly used were blunt objects (16), knives (11), guns (6) and axes (4). Gunshots contributed to 4 of the 7 deaths. 4 out of the 7 deaths were due to primary brain injury and 3 were due to infection. CONCLUSION: Open depressed fractures and penetrating injuries form a small but significant group in the management of head injuries. The use of blunt objects, firearms and arrows coupled with increasing urban violence is responsible for most of these injuries. The outcome of patients admitted who are fully conscious is expected to be good. They can be managed by prompt debridement of the wound, elevation of the fracture and removal of fragments as appropriate. However, the mortality rate is high in those with a Glasgow Coma Score of 8 or less on admission, a finding indicative of the severity of brain injury beneath the wound.
penetratin ; g <3> ; Skull ; Physical trauma ; Mores

BACKGROUND: Hydrocephalus is a common neurosurgical problem in Port Moresby General Hospital (PMGH) contributing to 27 (24%) of the 114 neurosurgical operations done in 2003 and 2004. During the same period it was responsible for 25% of the cases seen in the neurosurgery clinic. AIM: To prospectively audit and follow up hydrocephalus cases in PMGH over 2 years from January 2003 to December 2004 and ascertain the causes and the outcome of treatment. METHOD: All cases of hydrocephalus seen in 2003 and 2004 were categorized according to cause. The associated findings on ultrasound scan or CT (computed tomography) scan when available were noted. The subsequent progress was documented with and without treatment for at least 6 months. RESULTS: 61 cases of hydrocephalus were seen for surgical opinion. The age ranged from 4 weeks to 56 years. The commonest age group affected was in the first year of life (61% of cases). There were 34 cases (56%) of congenital hydrocephalus followed by 19 (31%) post meningitis and 8 (13%) due to tumour. There was only one case of myelomeningocele with concomitant hydrocephalus. Ventriculoperitoneal (VP) shunts were inserted in 24 cases. 3 shunts were bypasses from the posterior horn to the cisterna magna, making a total of 27 shunt operations. 9 shunts were performed for post-meningitic hydrocephalus, 15 for congenital stenosis and 3 for a posterior fossa tumour. 24 out of the 27 shunt operations were in children aged <9 months. Post-VP-shunt infection of 2 cases reported within 6 weeks of operation gave an infection rate of 7%. There was cerebrospinal fluid (CSF) leak in 2 cases with Pundez-type shunts. There were 2 shunt blocks needing revision. CONCLUSION: Shunt operations can be done in PMGH with good outcomes. The decision-making about surgery can be made on the basis of the enlarging head and the ultrasound findings.
Hydrocephalus ; Creation of shunt ; seconds ; Surgical aspects ; Mores

Stab wounds are the main cause of large-vessel injuries in the neck and they have a fairly good prognosis when the patient receives expeditious and appropriate management. The objective of this study is to present the experience of managing patients with large-vessel injuries in the neck. A retrospective study was carried out involving 22 cases with vessel injuries in the neck over the past 10 years. Stab wounds accounted for 77% of this series (17 of 22 patients). All 22 cases were treated operatively. The overall survival rate was 95%. One patient died on the operating table because of torrential haemorrhage into the chest. Complications included one thrombosis of the right subclavian artery, and five cases of haemothorax, all of which resolved. Successful salvage of patients with major vessel injuries in the neck depends on familiarity with the anatomy, accurate and timely clinical diagnosis and expedient surgical intervention. Patients with haemodynamic instability, rapidly expanding cervical haematomas or uncontrollable bleeding require immediate operative intervention, forgoing any diagnostic study. Stable patients may undergo radiological studies to detect occult injuries that may result in late morbidity such as false aneurysms and arteriovenous fistulae.
Physical trauma ; Neck ; seconds ; Mores ; Large

The aim of this study was to assess the rate of seatbelt use by drivers and front-seat passengers in Port Moresby, 12 years after the seatbelt legislation in 1993. Before the legislation, the rate of seatbelt usage was only 13.3% for drivers and 11.4% for front-seat passengers. Use of seatbelts was assessed by observers at the main city roundabout. 50% of male drivers, 78% of female drivers, 49% of Papua New Guinean drivers and 69% of expatriate drivers wore seatbelts. Among the young drivers (teenagers aged < 20 years) 55% wore seatbelts. Of the front-seat passengers, 37% of males and 58% of females wore seatbelts. Female drivers and female front-seat passengers were more likely to wear seatbelts than males (OR 2.55 [95% CI 1.53-4.23] and 2.34 [95% CI 1.32-4.14]). The front-seat passengers were more likely to be wearing seatbelts if the drivers wore theirs (OR 2.70 [95% CI 1.60-4.55]). Proportionately more drivers and front-seat passengers were wearing seatbelts than during the pre-legislation period, but more seatbelt education and awareness is needed because of the increasing number of road traffic accidents in Papua New Guinea.
seconds ; Passenger ; legislative ; Papua New Guinea ; Mores

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