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Drug-induced neuro-psychiatric disorders in medical practice--an overview.

Papua New Guinea medical journal.1989;32(3):219-224.

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

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Management of childhood haematogenous osteomyelitis in a rural Papua New Guinean hospital.

G Van GURP ; R KILA ; T HUTCHINSON

Papua New Guinea medical journal.1989;32(2):117-122.

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

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Congenital heart disease in Papu New Guinean children.

P De BUSE

Papua New Guinea medical journal.1974;17(3):278-281.

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

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Would people with a disability in the highlands benefit from a community-based rehabilitation program?

H van AMSTEL ; T DYKE ; J CROCKER

Papua New Guinea medical journal.1993;36(4):316-319.

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

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Child sexual abuse at Eastern Highlands Provincial Hospital: a prospective descriptive study

Casparia Mond ; Ilomo Hwaihwanje ; John D. Vince

Papua New Guinea medical journal.2016;59(1-2):12-19.

Child sexual abuse (CSA) is common throughout the world and has been recognized as a common presentation at the Eastern Highlands Provincial Hospital. The aim of this prospective study was to describe the presentations and outcomes of CSA in the hospital. A structured questionnaire was used to collect data from the guardians of 38 children aged between birth and 15 years presenting with a history of sexual abuse between February and August 2013. Children were followed up at three months to ascertain the presence of sexually transmitted infection and to determine how the issue of abuse was resolved by the family. There were 35 females and 3 males aged between 3 and 15 years with a median age of 5.5 years and interquartile range of 4-9 years. 28 (80%) of the 35 girls had been raped and one of the boys had been anally raped. Over half of the children’s mothers were illiterate and lived a subsistence lifestyle. The perpetrator was known to the subjectin 36 (95%) of the cases. Coercion was used by the perpetrators in 22 cases (58%). Gram stains of vaginal swabs from 28 children showed gonococci in 15 (54%). Compensation payments were used to resolve the issue of abuse in 13 (72%) of 18 cases at 3-month follow up. There has been an increase in the number of children diagnosed with sexual abuse at the Eastern Highlands Provincial Hospital. There is an urgent need for existing child protection laws such as the Lukautim Pikinini Act to be robustly implemented and for the development of Family Welfare Centres to provide a holistic approach to the management and support of victims of CSA and their families.

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Adolescent health in Papua New Guinea: time for action

Wendy Pameh

Papua New Guinea medical journal.2016;59(1-2):20-22.

The health of adolescents in Papua New Guinea requires urgent attention. At stake is the health and wellbeing of a sizeable proportion of a generation. Adolescence is defined by the World Health Organization as occurring between the ages of 10 and 19 years. For many this can be a time of working through issues and progressing their education to become happy, well-rounded adults. But young people without adequate guidance and education are vulnerable to negative influences and risk-taking, and these can have adverse consequences for health and wellbeing in the short and long term. Many adolescents with chronic mental or physical health currently do not get the services they need. This paper briefly outlines disease burdens for adolescents, and the challenges for health and education services.
Health services administration, Child health services

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Paediatric cancer in Papua New Guinea: moving to the next stage

Gwenda Anga ; John D. Vince

Papua New Guinea medical journal.2016;59(1-2):23-29.

We reviewed the cases of paediatric malignancy at Port Moresby General Hospital (PMGH) over the 18 months between June 2014 and December 2015 and compared diagnoses and outcomes with previously reported data. Children with paediatric cancer account for 0.5- 1% of admissions to the PMGH Paediatric Unit and around 0.4% of admissions to provincial hospitals. Efforts to improve outcome have included establishment of linkages with and practical experience at the Children’s Cancer Centre of the Royal Children’s Hospital in practical supportive care measures established. Potentially curative chemotherapy was started on 26 of the 47 patients in the series, of whom 13 are known to have died. Better outcomes are possible within our setting. We have a paediatrician with considerable and appropriate expertise in paediatric oncology, linked to a centre of excellence in Australia, but we will need a dedicated Paediatric Cancer Unit, separate from the highly infectious paediatric wards and with its own staff. Local community support for such a unit will be required.

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Causes of neonatal admissions and in-hospital mortality at Modilon Hospital, Madang Province: a 5-year retrospective study

Jimmy Aipit ; Ilomo Hwaihwanje ; Naomi Pomat ; John W. Bolnga ; Moses Laman

Papua New Guinea medical journal.2016;59(1-2):30-33.

Approximately half of all childhood mortality in Papua New Guinea (PNG) occurs in the neonatal period – the first 28 days of life. In this 5-year retrospective study, causes of admissions and in-hospital mortality among 2426 neonates admitted to Modilon Hospital’s Special Care Nursery in Madang Province were investigated. The neonatal case fatality rate was 15% (370/2426; absolute range between years 12-22%). Neonatal sepsis/infection (1017, 42%), prematurity (821, 34%) and birth asphyxia/meconium aspiration (396, 16%) were the leading causes of admissions (92% of total neonatal admissions) and deaths (96%). Many deaths were potentially avoidable but were often complicated by multiple contributing factors. To reduce neonatal mortality in PNG, health professionals, the government, policy makers and communities must appreciate that improving new born survival and other neonatal outcomes are a responsibility for all. ].

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Scaling up midwifery in Papua New Guinea: how many lives could be saved?

Caroline S. E. Homer

Papua New Guinea medical journal.2017;60(1-2):5-14.

SUMMARY The impact of increasing the midwifery workforce in developing countries has the potential to markedly improve maternal and neonatal outcomes as increased numbers of women have access to essential interventions. We estimated how many women’s and babies’ lives would be saved in Papua New Guinea if the coverage of midwifery interventions were scaled up.

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Women’s recall of provision of antenatal care in Papua New Guinea: findings of a maternal and infant health survey conducted in three provinces

R. Emori ; A. J. Vallely ; H. Gouda ; P. Siba ; S. Phuanukoonon ; C. S. E. Homer ; L. M. Vallely

Papua New Guinea medical journal.2017;60(1-2):15-26.

SUMMARY Antenatal care from a trained health care worker provides the opportunity to promote favourable outcomes for both the woman and her unborn infant. The greatest benefit of antenatal care is seen when the first visit is initiated early in the pregnancy and continued with at least four antenatal visits throughout the pregnancy. In Papua New Guinea (PNG), 66% of women attend for antenatal care at least once during their pregnancy and 51% attend four antenatal visits. We conducted a maternal and infant health survey among 482 women in three sites in PNG, Hiri, Karkar and Asaro, to explore uptake and provision of antenatal care from women’s perspectives. Most women attended for antenatal care (95%; 459/482) at least once and 73% (313/431) attended the recommended minimum four antenatal visits. Women in Hiri (77%) and Asaro (78%) were more likely to attend four or more antenatal visits than women in Karkar (66%). No woman in any site reported receiving the full range of antenatal care, as indicated in the PNG national guidelines. Coverage for tetanus toxoid, malaria prophylaxis and provision of iron supplements were similar in all sites. Women in Asaro were more likely to report being advised about a supervised birth (91%) than women in Karkar (86%) or Hiri (68%). Our findings suggest that the opportunity to monitor for risk factors in pregnancy were missed, including the opportunity to provide messages relating to the importance of supervised, health facility births. There is a need for renewed commitment and resources to enable optimal antenatal care to be provided in accordance with established guidelines if PNG is to make significant improvements in maternal and newborn health.

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