Some general factors to be considered when implementing a program to control pneumonia.
Papua New Guinea medical journal.2010;53(3-4):94-98.
Papua New Guinea medical journal
2002 (v1, n1) to Present ISSN: 1671-8925
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Nontypeable Haemophilus influenzae and childhood pneumonia.
Papua New Guinea medical journal.2010;53(3-4):147-150.
Nontypeable Haemophilus influenzae (NTHi) is a common microbe frequently isolated from the nasopharynx of children. Bacterial pneumonia is a major cause of morbidity and mortality in children less than 5 years of age, with the burden of disease being greatest in developing countries. Determination of the bacterial aetiology of pneumonia is difficult due to sampling constraints. However, with a combination of sampling approaches, trans-thoracic fine-needle aspiration, blood culture and screened sputum, the evidence strongly suggests that NTHi is a significant causative pathogen of pneumonia in young children. However, further studies are required. The development of a new pneumococcal conjugate vaccine containing H. influenzae protein D has the potential to be beneficial against disease caused by NTHi, including pneumonia. With the implementation of this vaccine in many regions of the world where NTHi disease is endemic, it will be critical to introduce surveillance programs wherever it is used.
Pneumonia in Papua New Guinea, from the past to the future.
Papua New Guinea medical journal.2010;53(3-4):99-105.
This paper briefly describes a journey with pneumonia and the pneumococcus that began in partnership with Ian Riley at the Lae Hospital in 1967 and continues 43 years later. It is a journey that signalled the global emergence of penicillin-resistant pneumococci and played an important role in the licensure of pneumococcal polysaccharide vaccine for use in adults around the world. The journey involved many other people whose experience began in Papua New Guinea (PNG), playing lead roles in the global program to reduce pneumonia deaths in developing countries. But none of this has benefitted Papua New Guineans as it could and should have done. In this paper I assert that substantial benefits could now follow from widespread use of the 23-valent polysaccharide vaccine in PNG adults not suffering from HIV and that there is also good scientific reason why children over the age of 9 months should be offered the potential benefits from use of this vaccine that were demonstrated in PNG in the 1980s. Indeed there are very good medical and economic reasons why it should happen.
Papua New Guinea medical journal.2010;53(3-4):126-138.
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.
A review of cancer in Papua New Guinea.
Papua New Guinea medical journal.2010;53(1-2):48-53.
Papua New Guinea medical journal.2011;54(1-2):4-16.
Assessing the vitamin A status among pre-school-age children is essential for evaluating the magnitude and public health status of vitamin A deficiency in a population. This cross-sectional study assessed the vitamin A status of children aged 6 to 59 months resident in the National Capital District (NCD), Papua New Guinea. Children attending the Children's Outpatient Clinic at Port Moresby General Hospital participated in this study. Informed consent was obtained from parents before using blood samples from their children. Assay of plasma retinol was carried out using the 'Clin-Rep' complete kit for assay of vitamins A and E in plasma by high performance liquid chromatography (HPLC). A commercial enzyme immunoassay kit was used to assay C-reactive protein (CRP) in plasma. Of the 132 children in the study 108 (82%) had received vitamin A capsules. The median plasma retinol concentration of the 132 children was 0.98 micromol/l and the interquartile range 0.65-1.38 micromol/l. Of the 132 children, 35 (27%) had a plasma retinol concentration below 0.70 micromol/l. 75 children (57%) had normal plasma CRP levels and in 57 (43%) the CRP levels were elevated. The median plasma retinol concentration of the children with normal plasma CRP was 1.19 micromol/l and the interquartile range 0.93-1.50 micromol/l. The prevalence of vitamin A deficiency (VAD) in the children with normal plasma CRP was 11%, indicating a moderate public health problem. 74 (56%) males and 58 (44%) females were included in the study. The prevalence of VAD in the male and female children with normal plasma CRP was 14% and 8%, respectively, indicating a moderate public health problem among the male children and a mild public health problem among the female children. The prevalence of subclinical (mild to moderate) and marginal VAD among the children with and without elevated CRP strongly suggests the need for continuous monitoring of the vitamin A status of the vulnerable groups in NCD.
C-Reactive Protein/analysis ; Child, Preschool ; Cross-Sectional Studies ; Female ; Humans ; Infant ; Male ; Papua New Guinea/epidemiology ; Prevalence ; Vitamin A/*blood ; Vitamin A Deficiency/*epidemiology
C-Reactive Protein/analysis ; Child, Preschool ; Cross-Sectional Studies ; Female ; Humans ; Infant ; Male ; Papua New Guinea/epidemiology ; Prevalence ; Vitamin A/*blood ; Vitamin A Deficiency/*epidemiology
Papua New Guinea medical journal.2011;54(1-2):23-34.
The relationship between HIV (human immunodeficiency virus), food security and nutrition has become increasingly important to practitioners, policy makers and people living with HIV. In this paper we describe for the first time the connection between HIV and antiretroviral therapies, the extent of nutritional counselling for HIV-positive people and food security in Papua New Guinea (PNG). A total of 374 HIV-positive people who were over the age of 16 and who had been on antiretroviral therapy (ART) for more than two weeks were recruited from six provinces, using a non-probability, convenience sampling methodology. A subsample of 36 participants also completed an in-depth qualitative interview. Participants received nutritional advice when beginning ART which focused on three main domains, of which the first two were the most frequently mentioned: what foods to avoid; what foods to eat; and how frequently to eat. 72% of the sample reported that they had experienced an increase in their appetite. Of those who reported that their appetite had increased on ART 33% reported that they did not have enough food to satisfy hunger. People who lived in the capital city, Port Moresby, within the Southern Region of PNG, had significantly more difficulty with food security than those who lived in other regions of the country. Not having enough food was the third most commonly recorded reason for non-adherence to ART. Responses to the HIV epidemic in Papua New Guinea must also begin to address the phenomenon of food insecurity for people with HIV, in particular those who are receiving antiretroviral therapies and who live in the urban areas.
Adolescent ; Adult ; Aged ; Anti-Retroviral Agents/*therapeutic use ; Appetite/*drug effects ; *Counseling ; Female ; *Food Supply ; HIV Infections/*drug therapy ; Humans ; Male ; *Medication Adherence ; Middle Aged ; Papua New Guinea ; Qualitative Research ; Urban Population ; Young Adult
Adolescent ; Adult ; Aged ; Anti-Retroviral Agents/*therapeutic use ; Appetite/*drug effects ; *Counseling ; Female ; *Food Supply ; HIV Infections/*drug therapy ; Humans ; Male ; *Medication Adherence ; Middle Aged ; Papua New Guinea ; Qualitative Research ; Urban Population ; Young Adult
The epidemiology of malaria in the Papua New Guinea highlands: 7. Southern Highlands Province.
Papua New Guinea medical journal.2011;54(1-2):35-47.
As the last part of a program to survey the extent of malaria transmission in the Papua New Guinea highlands, a series of rapid malaria surveys were conducted in 2003-2004 and 2005 in different parts of Southern Highlands Province. Malaria was found to be highly endemic in Lake Kutubu (prevalence rate (PR): 17-33%), moderate to highly endemic in Erave (PR: 10-31%) and moderately endemic in low-lying parts (< 1500 m) of Poroma and Kagua (PR: 12-17%), but was rare or absent elsewhere. A reported malaria epidemic prior to the 2004 surveys could be confirmed for the Poroma (PR: 26%) but not for the lower Kagua area. In Kutubu/Erave Plasmodium falciparum was the most common cause of infection (42%), followed by P. vivax (39%) and P. malariae (16%). In other areas most infections were due to P. vivax (63%). Most infections were of low density (72% < 500/ microl) and not associated with febrile illness. Overall, malaria was only a significant source of febrile illness when prevalence rates rose above 10%, or in epidemics. However, concurrent parasitaemia led to a significant reduction in haemoglobin (Hb) level (1.2 g/dl, CI95: [1.1-1.4.], p < 0.001) and population mean Hb levels were strongly correlated with overall prevalence of malarial infections (r = -0.79, p < 0.001). Based on the survey results, areas of different malaria epidemiology are delineated and options for control in each area are discussed.
Adolescent ; Adult ; Antimalarials/therapeutic use ; Child ; Child, Preschool ; Endemic Diseases ; *Epidemics ; Female ; Geography, Medical ; Humans ; Malaria/drug therapy/*epidemiology/prevention & control ; Malaria, Falciparum/drug therapy/epidemiology/prevention & control ; Malaria, Vivax/drug therapy/epidemiology/prevention & control ; Male ; Mosquito Nets/utilization ; Papua New Guinea/epidemiology ; Prevalence ; Young Adult
Adolescent ; Adult ; Antimalarials/therapeutic use ; Child ; Child, Preschool ; Endemic Diseases ; *Epidemics ; Female ; Geography, Medical ; Humans ; Malaria/drug therapy/*epidemiology/prevention & control ; Malaria, Falciparum/drug therapy/epidemiology/prevention & control ; Malaria, Vivax/drug therapy/epidemiology/prevention & control ; Male ; Mosquito Nets/utilization ; Papua New Guinea/epidemiology ; Prevalence ; Young Adult
Papua New Guinea medical journal.2011;54(1-2):48-52.
Trauma is a leading cause of admissions to the surgical ward in Papua New Guinea (PNG), accounting for about 35% of cases. Of these, 15% of cases are abdominal injuries, of which 19% are penetrating injuries. Selective surgical management of patients with a low-velocity anterior abdominal wound (AAW) is beneficial in some patients. AIM: To determine if selective surgical management is a viable therapeutic option in PNG. METHODS: A non-random prospective study of consecutive cases was done on 60 patients with an AAW based entirely on clinical symptoms and signs. The outcome measures were length of hospital stay, morbidity and mortality. Data were analysed using SPSS 10.0 for Windows and Microsoft Excel. RESULTS: Immediate laparotomy was done on 24 (40%) of cases and 36 (60%) had nonoperative conservative management, of which 6 (17%) failed and went on to have laparotomy on demand. The average hospital stay was 4 days shorter (p = 0.0001) for the nonoperative group, which had significantly fewer complications (p = 0.01). No deaths were recorded in either of the two groups of patients. CONCLUSION: Selective nonoperative management of stable patients with an AAW with or without omental signs is a safe therapeutic option in PNG.
Abdominal Injuries/complications/mortality/*surgery ; Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Humans ; Laparotomy ; Length of Stay/statistics & numerical data ; Male ; Papua New Guinea ; Patient Selection ; Peritonitis/etiology/*surgery ; Prospective Studies ; Treatment Outcome ; Wounds, Penetrating/complications/mortality/*surgery ; Young Adult
Abdominal Injuries/complications/mortality/*surgery ; Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Humans ; Laparotomy ; Length of Stay/statistics & numerical data ; Male ; Papua New Guinea ; Patient Selection ; Peritonitis/etiology/*surgery ; Prospective Studies ; Treatment Outcome ; Wounds, Penetrating/complications/mortality/*surgery ; Young Adult
Two cases of Peutz-Jeghers syndrome presenting as bowel obstruction from intussusception.
Papua New Guinea medical journal.2011;54(1-2):53-55.
Two unusual cases of small intestinal intussusception presenting as bowel obstruction are presented. They both had freckle-like pigmentation of the perioral area, palms and soles of the feet with intestinal polyps which acted as lead points in the intussusception. Peutz-Jeghers syndrome was diagnosed. This report highlights the high risk of cancer of the intestines and extra-intestinal sites associated with this interesting but rare condition.
Adolescent ; Adult ; Female ; Humans ; Ileal Diseases/*complications ; *Ileocecal Valve ; Intussusception/*etiology ; Male ; Peutz-Jeghers Syndrome/*complications
Adolescent ; Adult ; Female ; Humans ; Ileal Diseases/*complications ; *Ileocecal Valve ; Intussusception/*etiology ; Male ; Peutz-Jeghers Syndrome/*complications
Country
Papua New Guinea
Publisher
The Medical Society of Papua New Guinea
ElectronicLinks
http://www.pngimr.org.pgEditor-in-chief
pngmedj@pngimr.org.pg
Abbreviation
P N G Med J.
Vernacular Journal Title
ISSN
0031-1480
EISSN
Year Approved
2008
Current Indexing Status
Currently Indexed
Start Year
1955
Description
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