Between June 2001 and December 2002, 152 antenatal patients at Port Moresby General Hospital who were Venereal Disease Research Laboratory (VDRL) serology positive and 150 unselected antenatal patients who tested negative were studied to determine the gestational age at which the tests were performed, the time it took for results to become available, the proportion of patients who received treatment, the sociodemographic characteristics associated with VDRL positivity and the effect of VDRL positivity on maternal and perinatal outcomes. The prevalence rate of VDRL positive among antenatal clinic attenders in Port Moresby at that time was 4.4%. Of the 152 VDRL-positive patients in this study 97% were also Treponema pallidum haemagglutination (TPHA) positive. Significantly more of the positive patients were of highlands origin, lived in settlements, had previous marriages, had lower parities, delivered preterm babies, had stillbirths, had growth-restricted babies and had babies with lower Apgar scores at both 1 and 5 minutes. The mean birthweight was significantly lower among the positive patients. Significantly more of the positive patients were married to spouses with occupations which were regarded as 'risky' for sexually transmitted infections. There was no difference between the two groups with respect to patient's education, marital status, husband's education, gestational age at delivery and the number of days the baby spent in the Special Care Unit. The study concluded that the current antenatal screening does not provide adequate coverage for our patients. If the current availability of clinic-based strip tests provided by a non-government organization can be continued by the Ministry of Health we should be able to overcome this problem.
VDRL test ; Clinic ; Mores ; seconds ; Port - alcoholic beverage

This paper outlines the principles of the management of different spinal diseases. In Port Moresby General Hospital between 2004 and 2006 there were 41 spinal injuries, 36 cases of spinal tuberculosis (8 of whom were operated on), 3 non-tuberculous infections and 11 degenerative conditions. The incidence of spinal dysraphism is low in Papua New Guinea with only 5 cases recorded in Port Moresby over the 3-year period. Identification and assessment of spinal pathology were sometimes limited by a lack of radiological investigation and often the resources were not available for optimal treatment. 8 cases with myelopathy had no definitive diagnosis made.
Pathology processes ; Papua New Guinea ; Mores ; Port - alcoholic beverage ; Vertebral column

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: 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

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

This is a cross-sectional study conducted in Port Moresby and 3 rural areas of Papua New Guinea from 1999 to 2002. These areas were selected because of their specific characteristics such as modernity, geographical location and remoteness. The aim of the study was to compare the body mass index (BMI) of selected urban and rural populations. When age was standardized, in urban and periurban populations, the mean BMI increased with age to about 40 years, plateaued and then decreased in older age. The BMI was higher in Port Moresby than in the other study areas: many people in Port Moresby were overweight (40%) and obese (21%), and by gender, 26% of females and 16% of males were obese. In Manus, the prevalence of overweight and obesity was 36% and 18% respectively. In both Port Moresby and Manus, more women than men were obese. Obesity was not a problem in rural areas of Strickland and Central Province. In rural Central Province 52% of subjects had a BMI < 20 kg/m2. Obesity is becoming a public health problem in the urban areas. The high prevalence of overweight and obesity corresponds with the high intake of refined carbohydrates and fatty foods in urban and periurban areas. It will be necessary to carry out health awareness and education on the risk factors associated with obesity in the urban and periurban areas and promote healthy environments: healthy foods should be available and affordable, and the accessibility and safety of exercise and walking tracks must be supported by the community and government agencies.
Obesity ; Body Mass Index ; seconds ; Papua New Guinea ; 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 is a cross-sectional study conducted intermittently in Port Moresby, the National Capital District of Papua New Guinea, from 1996 to 1997; Mt Obree in Central Province in October 2000; Upper Strickland River in April 2001; and the Balopa Islands in Manus Province in December 2002. The aim of the study was to determine the prevalence of high blood pressure and identify possible risk factors for hypertension in the 'healthy' population in Port Moresby and the three rural communities. There were 1491 subjects surveyed, 704 males and 787 females. Their ages ranged from 20 to 84 years. Just over 6% of subjects were aged 65 years and above. There were 205 (14%) smokers and 340 (23%) betelnut chewers. The Central (rural) subjects were generally younger with the lowest mean systolic and diastolic blood pressures and lowest body mass index (BMI) in both males and females (no overweight or obesity). In Central and Strickland the mean systolic (SBP) and diastolic (DBP) blood pressures were lower and remained the same in all age groups, then in females decreased with age after 55 years. The Manus (rural) subjects were older with higher mean systolic and diastolic blood pressures and higher mean BMI, surprisingly similar to the urban population of Port Moresby. The mean systolic blood pressures in Port Moresby and Manus increased with age in both sexes, while the mean diastolic pressure remained the same in all age groups in females and decreased after the age of 50 years. The prevalence of systolic hypertension among men and women was higher in Manus than in urban Port Moresby and, among the female subjects, Manus had the highest at 31%, while Central recorded the lowest for both males and females. The mean systolic blood pressures of betelnut chewers in Port Moresby, Manus and Central were lower (by 1-9 mmHg) but higher--in males only--in Strickland. The mean diastolic blood pressures of betelnut chewers were lower in all study sites. Both high BMI (overweight and obesity) and older age were significantly associated with high systolic blood pressure but betelnut chewing was significantly associated with lower mean SBP (p < 0.001), a protective effect against systolic hypertension.
seconds ; Blood Pressure ; Mores ; Port - alcoholic beverage ; Hand

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