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

Malaria is a life-threatening disease caused by protozoan Plasmodium species. Plasmodium falciparum is the deadliest species. Reducing and eliminating malaria burden are linked to most of the Sustainable Development Goals (SDG), central to SDG3 targeting the end of malaria by 2030. This study was aimed at assessing the Management of malaria and prevalence of P. falciparum kelch-13 among febrile patients in selected Government Hospitals in Nigeria. Malaria patients (399) attending outpatient clinics of the Hospitals between August, 2019 and January, 2021, were enlisted in the study, following ethical approval and informed consents. Blood (5mL) was collected from patients for microscopic and molecular investigation of malaria parasite. DNA extraction, PCR amplification, BLAST, and alignment were performed. Plasmodium resistance to Artemether/lumefantrine was determined by PCR amplification of extracted DNA using Kelch-13 gene primer. Data obtained were subjected to One-way Analysis of Variance and Linear Regression. The VapA gene primer amplified 55 (68.75%) out of the 80 DNA extracts tested. Twenty-five strains of P. falciparum belonging to 3 clades phylogenetically were identified and they showed evolutionary relationships with others. Plasmodium falciparum resistant Kelch-13 gene was detected in 70% of the isolates. This study observed a high prevalence of resistant gene to ACT drugs in the study area. Monitoring the effectiveness of ACTs must be done routinely to ensure timely changes in National treatment policies.

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.

Transfusion Transmissible Infections (TTI) in blood donors continue to be a threat to recipients, therefore, to increase accessibility to infection-free donor blood, voluntary non-remunerated donation has been recommended. This was a retrospective observational study aimed at establishing a data base for transfusion transmissible infections in family replacement and voluntary donors at the Alotau Provincial Health Authority (PHA) Blood Bank Service using donor data recorded from 2015 to 2018. Statistical significance was determined using the chi-square test with p-values of <0.05 considered significant. Ethical clearance was approved by the School of Medicine and Health Sciences Research Ethics Committee. Consent to collect data from the Alotau PHA Blood Transfusion Service and the Blood Bank Laboratory was granted on the 17/06/2019 reference #: RCO1/6/19. A total of 2852 blood donors were analyzed, of which 90% (n=2567) were males and 10% (n=285) were females. Of these, 69% (n=1959) were Family-Replacement-Donors (FRDs) and 31% (n=893) were Voluntary Donors (VDs). Donations by FRDs increased with increasing years from 2015 to 2017 and declined slightly by 1% in 2018. The complete opposite was observed in VDs. TTIs were higher in FRDs than in VDs (20.1% vs 16.8%, p=0.04), in single infections, (18.6% vs 15.2%, p=0.03), infection with HBV (9.9% vs 7.2%, p=0.02), and in those aged over 45 years (2.7% vs 0.1%, p=<0.01). The differences were statistically significant. TTI was significantly higher in male FRDs than VDs (19.1 vs 14.3, p=0.00) and in females, it was significantly higher in VDs than in FRDs (2.5% vs 1.0%, p=0.00). TTIs were significantly high in older male FRDs which seem to indicate that the primary route of transmission in this setting could be mostly sexual. This calls for establishment of effective educational awareness about risk factors in the older population, and promotion of voluntary non-remunerated donations in this setting.

The strategy of fortifying food grade salt with iodine has been globally successful in increasing iodine intake and significantly reducing the prevalence of iodine deficiency. In addition, the consumption of salt through processed foods is increasing in many countries. The major objectives of the current study were to assess the iodine nutritional status among school children, the availability and awareness of iodized salt, the use of salty condiments and flavorings in households in a remote Zia community. This was a school and community based prospective cross-sectional study carried out in February 2020. The study population included 6 to 12 years old school children in five schools in Zia. Simple random sampling was used to select the children. Salt samples were collected from randomly selected households in the community. Discretionary salt intake was also assessed in a sub-set of households. The size of the thyroid gland of the children was assessed by a single specialist endocrinologist using the standardized procedure for palpation and grading, after which a single urine sample was collected from the children after obtaining informed consent from their parents. A pre-tested questionnaire was used to assess the awareness and use of iodized salt in the households. The iodine content in salt samples was measured using the single wavelength semi-automated WYD Iodine Checker Photometer. The urinary iodine concentration (UIC) was measured by isotopic dilution, using 129I as a spike. The 127I/129I ratio was measured by Inductively Coupled Plasma Mass Spectrometry (ICPMS) (quadrupole ICP-MS iCap). The volume of urine required per run was 0.3ml. The mean iodine content of the salt samples from the Households was 31.7 ± 5.9mg/kg. The daily per capita discretionary intake of salt was 5.7 ± 2.2g. The calculated per capita discretionary intake of iodine was 126.5 ± 48.8μg per day. The Median UIC among the children was 147.5μg/L, which indicates normal iodine status at the time of this study. A total of 44.5% of all the children had palpable goiter (grade 1). This may indicate long-standing prevalence of mild status of iodine deficiency. Majority of the households (93.9%) used Maggi Kakaruk stock cubes to make their food salty compared to 90.9% that used salt. Instant noodles/2-minute noodles are the best wheat based alternative processed foods that should be fortified with iodine. Salt and Maggi Kakaruk stock cubes are the two optimal food vehicles for fortification with iodine in this remote community.

Venous thromboembolism (VTE) is one of the significant causes of morbidity and mortality for hospital inpatients. The use of VTE prophylaxis in high-risk patients admitted under Geriatric Medicine in RIPAS Hospital, Brunei was evaluated. The electronic medical records of all patients admitted under Geriatric Medicine between 1st February 2022 and 28th February 2022 were reviewed. For these patients, the risk of developing VTE, bleeding risk and whether they were prescribed VTE prophylaxis were assessed. There were 34 patients identified, of which 20 (58.8%) were female. Median age was 81 years, ranging from 64 to 93 years. There were 13 (38.2%) COVID-positive patients, of which 9 (69.2%) were considered high VTE risk. Among these 9 patients, 4 (44.4%) were low bleed risk; of these 4 patients only two were prescribed VTE prophylaxis. Among the 21 non-COVID patients, 17 (80.9%) were high VTE risk. There were 11 (64.7%) with low bleed risk among the 17 patients in the group. Of the 11 patients only 3 (27.3%) were prescribed VTE prophylaxis. The use of VTE prophylaxis among Geriatric Medicine inpatients could be improved. Use of the VTE prophylaxis protocol should be emphasised to clinicians and re-audited to ensure compliance

The COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2, has had a profound impact on the world. At the time of writing this article, almost 760 million cases have been confirmed globally with over 6.5 million deaths recorded. Africa had lower numbers of confirmed cases and deaths as compared to other regions despite initial fears of the devastating effect that the pandemic would have on the vulnerable continent. Many theories exist to explain why this was so. However, low testing rates, amidst other factors, have raised concerns about the possible underestimation of the impact of the Covid-19 pandemic in Africa.

This paper describes the Geriatrics services in the hospital and community in Brunei and the impact of the COVID-19 pandemic. Due to the need for clinical staff to assess and manage COVID-19 cases at the national isolation centre and to assist with contact tracing, outpatient services were suspended. Patients had to be contacted regarding clinic cancellations and ensure they had adequate medications. There was an increase in phone-call consultations and virtual clinics were introduced. Home based nursing patients had the interval of routine nasogastric and indwelling urinary catheter changes extended. Data on the pandemic effects on Geriatric services including outpatient clinics, home visits, phone-call and virtual consultations, admissions to hospital and the home-based nursing case load after the pandemic are shown. After the pandemic, there is a need to strengthen measures to prevent pressure injuries and delirium, improve patient self-management of chronic conditions and manage the physical and mental health sequalae of the pandemic such as frailty and depression.

The coronavirus disease 2019 (COVID-19) pandemic has uncovered the need for health systems to be strengthened in order to be able to respond quickly to any potential future outbreaks. In response, the Pacific Syndromic Surveillance System (PSSS) is currently being used by many countries within the Pacific Islands for tracking and addressing infectious disease outbreaks, including COVID-19. To maximise its usefulness as an early warning system, investments must be made in strengthening data quality, data sharing, health facility capacity, technology, and ongoing evaluation of surveillance systems. Doing so will ensure that the PSSS and other surveillance systems can remain effective tools for monitoring and respond to infectious disease outbreaks in the Pacific Islands

COVID-19, a highly contagious and deadly virus rapidly swept across the world from the year 2019 to 2020 killing more than two million people. Due to the magnitude of affect the virus was having, governments were forced into taking measures that required isolation of the infected from the unaffected, as mitigation to halt the spread. This brought about the “COVID-19 Lockdown”. Though the Pacific Island Countries (PICs) were with one of the least numbers of COVID-19 cases, similar measures were implemented as measure to prevent the virus from entering the countries. Like other countries, PICs like Fiji had a lockdown and this affected the lifestyles of the people. Amidst the lockdown, there was a rise in domestic violence cases. The literature review was done using databases; Medline, ProQuest, Embase, and Scopus. The research was done by using the relevant keywords in the field of COVID-19 which was aimed specifically on domestic violence during the pandemic. Moreover, local, and international publications, like media reports and published reports were also used. Upon carrying out this research it could be stated that there was a rise in the number of domestic violence cases in the wake of the COVID-19 pandemic lockdown. The literature review was aimed at identifying the consequences of COVID-19 and why it triggered a spike in domestic violence cases. The study concluded that the psychological impacts, and socio-economic state created as the result of the lockdown was the main contributing factor which gives rise to substance abuse, depression, which collectively lead to violence