COVID-19 is a highly contagious viral illness with a wide spectrum of clinical manifestations ranging from asymptomatic or mild cold like symptoms to a devastating and often fatal respiratory illness. The elderly and those with underlying morbidity are the groups most often, but certainly not exclusively, associated with death from respiratory pathology. COVID-19 respiratory illness usually manifests clinically as pneumonia with predominant imaging findings of an atypical or organized pneumonia. Chest radiography (CXR) helps to assess the progress of the disease. The BRIXIA score based on radiological appearance may be used to determine the severity and clinical outcome of a patient with COVID-19. The aim of this study was to assess the relationship between the BRIXIA score and the clinical outcome of positive COVID-19 patients at Port Moresby General Hospital (PMGH) in Papua New Guinea (PNG). In this descriptive retrospective study conducted at the Radiology Department of the PMGH the records of 129 Polymerise Chain Reaction (PCR) confirmed patients admitted to PMGH between September and December 2021 were examined. The patients were grouped into mild, moderate or severe categories depending on clinical features at the time of diagnosis. There were 89 (69%) males and 40 (31%) females. The mean (SD) age was 52 (12) years, and the median (IQR) was 53 (44-60). Their admission CXRs were given a Brixia score. Mean (SD) Brixia scores for mild (n=24), moderate (n=67) and severe (n=38) were 4.5 (2.5), 8.9 (2.7) and 12.5 (3.5) respectively. The Brixia score was significantly related to the clinical severity, F 55.49, p <0.001. Twenty seven (77%) of the 35 patients who died had comorbidities of whom 21 (78%) were in the clinically severe group. A Brixia score of 9 or more was closely associated with death, p = 0.001, Odds Ratio with 95% Confidence interval (0R) of 3.9 (1.7-9.6). The Brixia CXR severity score is a useful tool in assessing clinical severity and prognosis in patients with COVID 19.

The neonatal mortality rate in Papua New Guinea is high, estimated at 24 per 1000 live births. The neonatal case fatality rate in newborns in provincial and referral hospitals was 5.9% in 2021. Deteriorating newborns can be difficult to identify. This observational study investigated the feasibility of using a neonatal colour coded observation and response chart to identify neonates at risk of deterioration and to promptly escalate care in the Special Care Nursery of Port Moresby General Hospital. The chart was adapted from the Plymouth Hospital Neonatal Early Warning System chart, and was used to collect data over 8 weeks between 1st May and 30th June 2022. One hundred and fifty seven (157) neonates were observed over the 72 hours following admission to the Special Care Nursery. Neonates were grouped into those that had triggers (vital signs that fell in the red zone) and a stable group (who had no observations in the red zone). Of the 157 patients recruited 72 (45.9%) were stable, and 85 (54.1%) had triggers that should prompt a response. Forty seven (55.3%) of the neonates in the trigger group had appropriate interventions. Neonates with observations in the red zone (triggers) were more likely to die in the first 72 hours compared with those with no triggers. Most of the nurse responded positively to the introduction of the chart. Whilst the Neonatal Early warning System is a tool that can be used to identify neonates at risk of clinical deterioration, proper training of its use and knowledge of and appropriate escalation of care are necessary to ensure its benefit

The lifespan of medical equipment depends on preventative maintenance. Properly functioning oxygen concentrators are the only practical sources of oxygen in many Low & Middle Income Countries and their use reduces mortality in hospitalised children. We provided 82 concentrators with pulse oximeters, split flow meters, oxygen tubing, and an oxygen analyser to 38 health facilities. Training and instructions on how to perform preventative maintenance were provided. The concentrators were monitored for three years after they were installed, by assessing the proportion of concentrators still producing optimal oxygen at greater than 85% purity, the proportion that underwent weekly maintenance checks, and the proportion that were faulty and repaired. A logbook for weekly documentation of performance, maintenance, faults and repairs, was employed. Faults were additionally identified by a biomedical engineer during the visits. Twenty nine oxygen concentrators underwent regular maintenance checks, 25 (86.2%) of which had a median of 30 (IQR: 9 - 65) checks. Twenty-four were functioning well throughout the three years. One concentrator was used for 23,807 hours before requiring repair. Fourteen (24%) of the 58 concentrators used at the start of the programme had problems, two were repaired, and 12 were replaced. Concentrator failure was mostly caused by excessive movement, dust, and leaking in the internal tubing. Routine preventative maintenance, thorough documentation of performance and reporting of problems, and having access to clinicians and a knowledgeable biomedical engineer are essential for oxygen concentrator longevity in health care facilities in low-resource settings.

Thiamine deficiency may be associated with severe acute malnutrition (SAM) and contribute to its clinical signs and complications. This hospital-based prospective study aimed to determine if thiamine deficiency is present in children with SAM in Port Moresby General Hospital (PMGH). Convenient sampling was used to select 208 children aged between 2 months and 13 years (median age 15 and IQR 11-32 months) presenting to the Children’s Emergency Department requiring venipuncture for routine testing who had additional blood taken for assay of thiamine levels. Nutritional status was determined using the WHO weight for height (WFH) z-scores. Details of socioeconomic background and diet were recorded. Thiamine levels were determined using enzyme-linked immunosorbent assay (ELISA) test kits. A total of 158 (76%) of the 208 samples were satisfactory for analysis; 86 (54%) from children with normal WFH, 26 (17%) from those with moderate malnutrition and 46 (29%) from those with severe malnutrition. Thiamine levels were normally distributed overall. The mean was 34.18  5.8 ng/ml. This was within the reference level of 16-48ng/ml. There was no statistically significant difference in levels between the normal, moderately and severely malnourished children (33.6  5.6, 35.3  5.7 and 34.4  5.7 ng/ml). The assay of thiamine levels in serum using ELISA is not the best method for determining thiamine deficiency and further studies using whole blood and high-performance liquid chromatography are needed

Breast cancer is now the leading cause of mortality from cancer in Women in Fiji. State of the art diagnostic measures such as MRI, PET scanning and advanced tumour markers are unavailable in many LMIC countries including Fiji, but CT is becoming more widely available. The aim of the study was to determine the association between CT/anatomical staging and prognosis in a resource-limited setting, and its role in planning appropriate treatment strategies. This was a retrospective, analytical study of the data from the Colonial War Memorial Hospital Oncology department tumour register recorded between 2013 and 2018. The mean age of the breast cancer patients with confirmed diagnosis was 54.93 years with SD of 12.4 years. There was a 40% 3 year mortality rate. CT reports were available for 196 patients. Poor prognosis was very closely associated with Tumour size (p=0.002, OR 0.26 (0.10-0.63)), Nodes (p<0.001, OR 0.25 (0.13-0.48.)) and Metastases (p<0.001, OR 0.13 (0.07- 0.25)).The lungs were the most frequent site of metastases. CT staging enables accurate TNM classification, which is closely associated with prognosis. In the absence of advanced cytopathological and imaging modalities CT staging has an important part to play in planning appropriate treatment.

Background: According to the Papua New Guinea (PNG) 2015 Annual Report on Child Morbidity and Mortality, neonatal conditions remained the second leading cause of hospital admission. We aimed to identify the common causes of neonatal admissions and deaths in the Eastern Highlands Provincial Hospital (EHPH) Special Care Nursery, and to identify interventions to improve neonatal outcomes in EHPH. Method: This was a retrospective descriptive study of neonatal admissions over a 5-year period: 2011 to 2015. Data collected from the ward admission register included demographic information, admission diagnoses, outcomes and causes of death where applicable. Results: From 2011 to 2015 there were 5177 neonatal admissions and 504 deaths with an overall case fatality rate of 9.7%. More than one admission diagnosis was recorded for some babies. The leading diagnoses were prolonged rupture of membranes (PROM) (25%), low birthweight (LBW) (20%), neonatal sepsis (NNS) (18%), meconium aspiration syndrome (MAS) (16%) and birth asphyxia (BA) (14%). The leading causes of death by admission diagnosis were LBW (259/1013, 26%), BA (141/746, 19%), MAS (80/852, 9%), NNS (79/915, 9%) and babies born before arrival (BBA) (61/306, 20%). 76% of the admissions were hospital-born babies, but 46% of deaths were in the 24% of babies born outside the hospital. The independent predictors of neonatal death were LBW (odds ratio [OR] 7.31), BA (OR 5.94), health centre birth (OR 3.07) and village birth (OR 2.18). Conclusion: LBW, BA and being born outside of a hospital were the strongest risk factors for neonatal death in the Eastern Highlands during this 5-year period. For PNG to achieve the Sustainable Development Goal of a neonatal mortality rate of 12 per 1000 live births, these 3 areas need to be addressed by multifaceted approaches within and outside the health sector.

SUMMARY BACKGROUND: Forty years after the first postgraduate diplomates (in child health and obstetrics & gynaecology) graduated in 1976 it is appropriate to track the development of postgraduate training and to assess training outcomes. METHODOLOGY: Data were extracted from graduation documents from 1976 and were checked with senior academic staff and with the current postgraduate lists. RESULTS: Postgraduate diploma programs in anaesthesiology, ophthalmology and otorhinolaryngology followed those in child health and obstetrics & gynaecology. The first home-grown specialists in surgery and child health graduated in 1979 and the MMed program is now offered across the spectrum of medical disciplines with the exception of cancer medicine. Of the 344 postgraduate diplomates, a third have been females and 41 (12%) have been Pacific islanders. 166 (48%) have completed MMed and 56 (16%) are currently in the MMed programs. Since 1979, 378 specialists have graduated with the MMed and 3 with the MDS, of whom 21 (6%) have died and 2 have retired on medical grounds. 74 (19%) of the specialists are female and 40 (10%) are Pacific islanders. Of the 322 living Papua New Guinean (PNG) national specialists currently working 70 (22%) are female, 23 (7%) are currently based overseas, 30 (9%) are working in the private sector and 9 (3%) are no longer working in the medical arena. 260 (81%) are in the public sector, 240 (75%) in the clinical area and 20 (6%) in the administrative area. 22 surgical specialists and 1 anaesthesiologist have completed subspecialty training through the Higher Postgraduate Diploma programs. Other disciplines will follow suit. 12 PNG doctors have obtained overseas Fellowships or Membership of their specialty Royal College. Only 3 are currently based in Papua New Guinea. Master’s programs in community health and public health (27 graduates) were introduced in 1987, medical science (16 graduates) in 2006 and pharmacy (3 graduates) in 2012. CONCLUSION: The postgraduate programs at the School of Medicine and Health Sciences of the University of Papua New Guinea have been highly successful in training clinical specialists for Papua New Guinea and Pacific island countries, and in producing a core of the health workforce with Master’s degrees in public health, medical sciences and pharmacy. Loss of the specialist workforce overseas has been relatively small.

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.

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.

This prospective descriptive study aimed to determine the prevalence of chronic suppurative otitis media (CSOM) in children presenting to 5 urban clinics and the Children's Outpatient Department of the Port Moresby General Hospital. 395 children between the ages of 6 months and 12 years were included. 70 (18%) had some form of ear disease. Of the 28 children with CSOM (7%), 18 had unilateral and 10 had bilateral ear pathology. Only 8 of these children presented because of discharging ears. An additional 4 children had dry perforation, 1 had cholesteatoma and 2 had mastoiditis. The high prevalence of CSOM indicates that it is an issue of major public health importance. Risk factors for the development of CSOM were common in the children assessed. Prompt recognition of the problem and management by way of thorough and regular ear wicking should be stressed. Consideration should be given to making ciprofloxacin ear drops available. All clinics should have a functioning auriscope and front-line health workers should be trained to be able to diagnose and treat CSOM. Communities need education about the importance of early diagnosis and management of CSOM.