The use of complementary and alternative medicine in children admitted to Angau Memorial Hospital, Lae, Papua New Guinea.

There is considerable overlap between traditional medicine (TM) and complementary and alternative medicine (CAM). Although the use of CAM, often regarded as TM, is recognized to be widespread in Papua New Guinea (PNG) there are few if any studies of its use in children. This study assessed the use of CAM in 300 children admitted to the children's wards of Angau Memorial Hospital between April and July in 2010 and the same time period in 2011. 54% of the children had been treated with some form of CAM. The use of CAM did not appear to depend on socioeconomic indices. Children with chronic illness were twice as likely to have received CAM as those with acute illness. 116 (72% of the 161 children who had received CAM and 39% of the total sample) had received alternative medicine prior to commencing conventional treatment. Of these, 72 (62%) used plant-derived medication, 29 (25%) sought spiritual/religious help, 12 (10%) admitted to having accessed the help of sorcerers and 3 had used minerals. 43 (37%) were using some form of CAM whilst in hospital. The commonest reasons for using alternative medicine were previous use with perceived good effect (50, 43%), belief that it was a cure for the disease or symptom (28, 24%) and belief that the disease was due to a nonmedical or spiritual cause (14, 12%). Belief in spiritual or nonmedical causation of illness was strongly associated with delay in accessing conventional treatment. When CAM was used only in the outpatient setting plant-based treatment was more commonly used than mind-body medicine, whereas mind-body medicine--mainly religious activity--was used more commonly in the inpatient setting. CAM was given to 12 of the 35 outpatient user only group because of a perception that conventional treatment was not working whilst 13 carers gave it to assist in healing. The large majority of CAM treatments were free but in two cases (one the use of purported electromagnetic field with Biodisc and one religious activity) the cost had been more than 100 kina. The study demonstrates that the use of CAM for the treatment of childhood illness is common in PNG. Whilst most forms of CAM were in themselves not harmful, potential for harm exists, particularly when its use results in significant delay in accessing conventional treatment.

Aetiology and clinical signs of bacterial meningitis in children admitted to Goroka Base Hospital, Papua New Guinea, 1989-1992.

Children aged 1-59 months admitted to Goroka Base Hospital with signs suggestive of meningitis were recruited to determine what proportion of such children have clinical or bacterial meningitis and to investigate the bacterial aetiology. A laboratory classification of definite, probable, possible, indeterminate and no meningitis was established. Thirty per cent of 697 children had a final clinical diagnosis of meningitis, 12% had culture-proven bacterial meningitis (case fatality rate 34%) and 10% had probable or possible meningitis. Inability to feed, vomiting, drowsiness, "staring eyes" and haemoglobin < 9 g/dl in addition to the classical signs of meningitis were associated with increased mortality. Isolates from cerebrospinal fluid were 62 pneumococci, 22 Haemophilus influenzae type b (Hib) and one Neisseria meningitidis. Including blood culture-proven and antigen-proven Hib disease, Hib and pneumococci accounted for 44% and 46% of bacterial meningitis, respectively, and 23% of pneumococci were intermediately resistant to penicillin. Inability to feed, bulging fontanelle, convulsions in young children, neck stiffness, fever and "staring eyes" were all independently associated with bacterial meningitis. Conjugate Hib vaccine must be given to infants as early as possible. Conjugate pneumococcal vaccines, maternal immunization with 23-valent vaccine and pneumococcal protein vaccines are under investigation for prevention of pneumococcal disease.

Infant feeding practices in Papua New Guinea.

Concern about a possibly increasing prevalence of bottle-feeding led in 1995 to an Infant Feeding Survey of 1822 mothers attending urban health facilities. Infant feeding practices including feeding of colostrum, exclusive breastfeeding, weaning practices and bottle-feeding were assessed. This revealed that 28.8% of mothers had not given colostrum to their babies, that 43.5% of 3-month-old babies were exclusively breastfed, and that solids were introduced before 4 months of age in over half of the study population. Bottle-feeding was used by 20% of the study population. Feeding practices differed in women of Highlands and of Coastal origin. The findings emphasize the need to strengthen health education programmes which take into account the mothers' different cultural backgrounds. The issue of breast-feeding by mothers in paid employment needs to be addressed.

PIP: Recognizing the many benefits of breast-feeding, the government of Papua New Guinea (PNG) legislated to protect the practice 4 years before the introduction of the World Health Organization Code of Marketing restricting access to bottle feeding supplies. While exclusive breast-feeding for 4-6 months is recommended policy, it was noticed that many mothers introduce solids and fluids other than breast milk much earlier. In 1995, the Pediatric Society of PNG conducted a feeding survey to assess the prevalence of bottle feeding and review the effects of the imposed legislation. Infant feeding practices, including the feeding of colostrum, exclusive breast-feeding, weaning practices, and bottle feeding were assessed among 1822 mothers of children under age 2 years attending urban health facilities. 28.8% of the mothers had not given colostrum to their babies, 43.5% of 3-month old babies were exclusively breast-fed, and solids were introduced before age 4 months in more than half of the study population. 20% of the study population bottle fed. The prevalence of exclusive breast-feeding among employed Highlands women was lower than among employed Coastal women, but the difference was not statistically significant. Study findings point to the need to strengthen health education programs which take into account mothers' different cultural backgrounds. The issue of breast-feeding by mothers in paid employment also needs to be addressed.

Assessment of HIV/AIDS knowledge, attitudes and behaviour of high school students in Papua New Guinea.

OBJECTIVE: To assess the knowledge, attitudes and behaviour of high school students (grade 10) with regard to HIV infection and AIDS. METHODS: A self-administered questionnaire survey was carried out in 21 high schools in 6 different provinces. The questionnaire was anonymous and contained questions about HIV transmission, preventive measures, attitudes towards HIV infection and a few questions about personal sexual behaviour. PRELIMINARY RESULTS: A total of 1811 students completed the questionnaire. 46% were female. The average age was 17 years. Over 98% knew what AIDS and HIV were. 97% knew that HIV was sexually transmitted, but many misconceptions existed: one-third thought that HIV was transmitted by mosquitoes, 7% that HIV-infected persons were a danger in the classroom. 72% knew that using a condom at every sexual encounter was a way of protection from HIV infection. Approximately 25% reported to have had sexual contacts, and of 15-year-old students 14% were sexually active. Although STD/AIDS education is part of the curriculum for grade 8 the principals of the majority of the schools reported that no formal teaching was done. DISCUSSION: Although the majority of students knew that HIV is sexually transmitted, basic knowledge about STDs is lacking and is not taught as part of the curriculum in most of the schools. Teaching about STDs and HIV needs to be enforced and safe sexual practices need to be discussed with the students.

Subacute sclerosing panencephalitis (SSPE) in Papua New Guinea: a high incidence in young children.

Eighty-seven cases of subacute sclerosing panencephalitis (SSPE) were diagnosed from September 1988 to April 1991 in Papua New Guinea (PNG), by demonstration of high-titre measles-specific antibodies in cerebrospinal fluid (CSF). For 1990 the annual incidence of SSPE, for the study provinces, was calculated to be 56 cases per million under 20 years of age and it is expected that this figure will be higher in 1991. The mean age of presentation was 4.9 years, with a male to female ratio of 1.8:1. An elevation in the ratio of immunoglobulin G as a percentage of total protein in CSF and an increase in the CSF:serum immunoglobulin G ratio was shown in SSPE patients. The dramatic appearance and high frequency of the disease in PNG might relate to the early age of measles infection encountered in children in this country.