Dextrocardia ; epidemiology ; Ductus Arteriosus, Patent ; epidemiology ; Female ; Heart Defects, Congenital ; epidemiology ; Heart Septal Defects, Ventricular ; epidemiology ; Humans ; Infant ; Male ; New Guinea

Community-based rehabilitation for those people with a physical disability is a policy promoted by the World Health Organization. In order to assess whether such a program might be useful to the disabled people of the highlands of Papua New Guinea a survey was conducted which first identified those people with a severe physical disability and then investigated the degree that they were handicapped in terms of their social and physical environment. The survey was performed in the Tari area of the Southern Highlands Province in conjunction with the Papua New Guinea Institute of Medical Research (PNGIMR). By using the PNGIMR demographic surveillance system it was possible to calculate a prevalence level of physical disability (including walking disability, deafness and blindness) of 46 per 10,000 (0.46%). A significant physical disability was identified in 114 people, of whom 54 were given personal interviews to establish their quality of life. The survey found the social and economic situation of disabled people to be generally good although there is a lack of basic material aids for handicapped people. The disabled people and their families do not need extra knowledge about how to care for their disabilities and a formal community-based rehabilitation program would be inappropriate, but they would find mobility aids such as wheelchairs and artificial limbs of enormous help. The regular health care services are widely used although both people with a disability and health service staff are not always aware of the types of treatment which can usefully be provided.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent ; Adult ; Aged ; Altitude ; Attitude to Health ; Child ; Child, Preschool ; Community Health Services ; organization & administration ; utilization ; Disabled Persons ; rehabilitation ; statistics & numerical data ; Female ; Health Priorities ; Health Services Needs and Demand ; Health Services Research ; Humans ; Infant ; Infant, Newborn ; Male ; Middle Aged ; Papua New Guinea ; epidemiology ; Residence Characteristics ; Self-Help Devices ; supply & distribution ; Socioeconomic Factors

Whenever an unexpected neuropsychiatric disorder arises suddenly in a person of good previous mental health after a new drug of any kind has been taken it is reasonable to suspect a drug-induced reaction. The suspected medication should then be stopped. Adverse reactions to drugs are known to account for a considerable amount of neuro-psychiatric disorder, which is likely to increase as new and more potent drugs are introduced into clinical practice.
Humans ; Psychoses, Substance-Induced ; classification

Haematogenous osteomyelitis, especially in its more common chronic stage, is an important cause of morbidity in children in the Southern Highlands Province. Hospital stays are lengthy and the incidence of fractures is high. While awaiting, or in the absence of, culture and sensitivity results, cloxacillin 200 mg/kg/day plus probenecid 40 mg/kg/day is an appropriate first choice antibiotic when it is available. Antibiotic therapy in chronic disease should be limited to the specific settings of associated soft tissue infection; pre- and post-sequestrectomy; and radiological signs of ongoing bone necrosis and systemic signs of active infection. Surgical drainage of subperiosteal pus and possibly the medullary canal is required in all but the very early (less than 48 hours) cases of acute osteomyelitis that sometimes respond to antibiotics alone. Sequestrectomy should be reserved for cases where a sequestrum and adequate involucrum can be seen on X-ray. Effective management of this disease is possible only if ongoing communication exists between hospital-based medical staff and the staff of health centres or subcentres, including the network of aid post orderlies and their supervisors. Since the majority of patients present to facilities other than hospitals, any campaign directed at improving management must involve co-workers in rural areas, namely the health extension officer, nurse and aid post orderly. Only in this way can we hope to achieve earlier appropriate treatment and more systematic long-term follow-up.
Adolescent ; Anti-Bacterial Agents ; administration & dosage ; therapeutic use ; Child ; Child, Preschool ; Chronic Disease ; Hospitals, Rural ; Humans ; Osteomyelitis ; drug therapy ; microbiology ; surgery ; Papua New Guinea ; Rural Health

This cross-sectional study assessed the zinc status of non-pregnant and pregnant women resident in the National Capital District (NCD), Papua New Guinea (PNG). Non-fasting morning blood samples were collected by venipuncture from consented women. Flame atomic absorption spectrometry was used to measure the serum zinc concentration in 27 non-pregnant and 100 pregnant women. C-reactive protein (CRP) in serum was measured by enzyme immunoassay and used to interpret the serum Zn data. For all the non-pregnant women, the median serum zinc concentration was 42.7 mug/dl with an interquartile range (IQR) of 27.6 to 91.2 mug/dl. Zinc deficiency was prevalent among 59% in this group of women. For those with normal CRP the median and IQR serum zinc concentrations were 48.9 mug/dl and 30.2 to 98.7 mug/dl, respectively. The median and IQR for all the pregnant women were 63.8 mug/dl and 40.9 to 93.2 mug/dl, respectively. Prevalence of zinc deficiency was 42% using the cut-off point of 56.0 mug/dl. Of the 100 pregnant women, 16 (16%) were in the first trimester, 51 (51%) in the second trimester and 33 (33%) in the third trimester. The median serum zinc concentrations of pregnant women in the first, second and third trimesters were 87.0 mug/dl, 61.6 mug/dl and 60.8 mug/dl, respectively. Using gestational period-specific cut-off points, zinc deficiency was prevalent among 31%, 39% and 36% of the pregnant women in the first, second and third trimesters, respectively. Our results clearly indicate suboptimal zinc status among non-pregnant and pregnant women in the NCD. According to the International Zinc Nutrition Consultative Group (IZiNCG) criteria, this should be considered as a public health problem among these groups of women in the NCD. To effectively address the issue, social mobilization, intensive education and awareness campaigns, with all relevant target groups and policy makers, are urgently required.
Zinc - deficiency, Pregnant Women

breastfeeding in the first 6 months of life as the proven safest feeding practice, recent studies from Papua New Guinea (PNG) showed that the rate of exclusive breastfeeding was well below the world average. There is a paucity of recent studies on breastfeeding in rural PNG, and this study aimed to identify the knowledge of, attitudes towards and practice of breastfeeding by rural mothers. Methods: A mixed method study using face-to-face interviews based on semi-structured questionnaires was conducted among rural mothers (n = 40) in 2014. Purposive homogeneous sampling was used to select participants. We included mothers in the child-bearing age of 18-40 years who had a child under the age of three years, and who could speak Tok Pisin. Content analysis for qualitative data and descriptive statistics for quantitative data were applied. Results: Despite the fact that most mothers regarded breastfeeding to be a better way of infant feeding than bottle feeding, they did not understand the reasons why. With regard to exclusive breastfeeding for the first 6 months of life our study showed a striking gap between global recommendation and practice. 78% of mothers (n = 31) in our study did not practise exclusive breastfeeding for the first 6 months of their baby’s life. Given that the majority of mothers had not completed grade 8, during which formal education on infant feeding practices is supposed to take place, most of the mothers had missed school education on infant feeding. Conclusion: Knowledge about the importance of exclusive breastfeeding in the first 6 months of life and its practice was very poor. Because promotion of breastfeeding practices in developing countries has been shown to be one of the most cost-effective health interventions, we suggest the introduction of infant feeding teaching in grade 4 in school curricula and the development of community-based educational programs on infant feeding.
Breast feeding, women,

To reduce the incidence of surgical site infection (SSI), perioperative antimicrobial prophylaxis has long been advocated for joint replacement and open reduction with internal fixation of long bones. Increasing health care costs have focused hospital interest on more cost-effective procedures. Although current literature indicates that single-dose antibiotic prophylaxis is comparable to a 3-dose regimen, there are no reports from lowincome countries. The primary aim of this study was to compare the infection rate following open reduction and internal fixation of long-bone fractures in groups with a single dose and 3 doses of prophylactic antibiotic. The secondary aim was to compare the costeffectiveness of both antibiotic regimens. This is a prospective randomized clinical trial (RCT) to compare the incidence of surgical site infection between the patients allocated randomly into two groups with different antibiotic prophylactic regimens: single dose or 3 doses 8 hourly of 1g ceftriaxone administered intravenously. 200 consecutive patients who underwent open reduction and internal fixation (ORIF) for closed long-bone fractures were enrolled in this study. The rate of postoperative SSI was 4.1% in the single-dose group and 2.2% in the 3-dose group; the overall SSI rate was 3.2%. The primary endpoint of this study, which is the incidence of SSI, showed no significant difference between the single-dose and 3-dose prophylactic antibiotic groups. Furthermore, there was no difference between groups regarding the length of hospital stay. Our randomized clinical trial affirmed that single-dose antibiotic prophylaxis in orthopaedic clean operations is not only a cost-saving practice but also is effective for SSI prevention, and should be incorporated in the development of clinical practice guidelines in tropical hospitals.
Clinical Trials as Topic- statistics & ; numerical data,

The Southern Highlands were first discovered and explored by Europeans in the 1930s. The first patrols led by Lloyd Yelland, a medical assistant, assessed the health of the population in the early 1950s. Thereafter, Tari Hospital was built in 1954 and first staffed by medical assistants. The first medical officer, Roger Rodrigue, was not stationed there until 1959. He performed minor operations with local or general anaesthetic using ether. The first surgeon to operate there – Bill Ramsey (1967-1968) – did so under the auspices of the Leprosy Mission. The first nurse was Judith Wilson posted in 1970. By 1972, the hospital had 100 inpatients, saw 50 outpatients a day and had a staff complement of 9 trained nurses and a matron. A research station was set up in the Tari Basin, which eventually came under the Papua New Guinea Institute of Medical Research (PNGIMR) in Goroka. In the 1970s Ian Riley (later a Professor of Public Health) and his wife, an anaesthetist, were based in Tari, studying pneumonia and pneumococcal vaccines, and managed emergency cases including trauma and caesarean sections. Stephen Flew, now a general practitioner in Northern Victoria, was superintendent of the hospital from 1989 to 1993, whilst Tim Dyke FRCS Edin was based at the PNGIMR in Tari. They offered a significant surgical service, again largely based on emergency presentations. Their tenure resulted in a number of publications and conference presentations on surgical topics, largely related to trauma. After Dyke, the hospital had no surgeon until 2007, largely due to political reasons. Médecins Sans Frontières (MSF) were invited to provide surgical services in 2009, and even in 2013 there was still no government-funded surgeon at Tari Hospital. The MSF surgical audit data in 2010-2011 showed that more than 90% of surgical cases seen at Tari Hospital required emergency surgery, most of which resulted from trauma. More than half of the trauma procedures were classified as major.

The zoonotic nematode, Trichinella papuae, was first discovered in wild and domestic pigs in the Bensbach area, Morehead District, Western Province of Papua New Guinea (PNG) in 1988. 15 years later, T. papuae was found in wild pigs and captive crocodiles (Crocodylus porosus) in the Kikori area, Gulf Province of PNG. An overall prevalence of anti-Trichinella IgG was detected in 10% (0.0%-36.7%) of 1536 villagers living in Morehead District by using an ELISA as screening test and a Western blot as confirmatory test. No anti-Trichinella IgG antibodies were detected in 313 villagers living in the Kikori District in spite of the fact that T. papuae was circulating in wild pigs in the district. These results may reflect the different methods of cooking in the two districts. Specific symptoms typical of trichinellosis were not reported by serologically positive persons living in Morehead District, although some non-pathognomonic symptoms, common to trichinellosis and other ailments, were noted. In Thailand, trichinellosis caused by T. papuae was attributed to the custom of eating large quantities of raw pig meat, a food behaviour not found in people living in Morehead and Kikori Districts. This fact probably accounts for the lack of pathognomonic symptoms of trichinellosis in serologically positive people of Morehead District, although they, as well as the Kikori people, occasionally eat tidbits of raw pork sufficient, in the case of the Morehead people, to develop an immune response. The importance of consumer education to eat only thoroughly cooked meat in the localities where T. papuae is circulating is emphasized.