Syphilis serology testing: a comparative study of Abbot Determine, Rapid Plasma Reagin (RPR) card test and Venereal Disease Research Laboratory (VDRL) methods.

Blood from 2100 women attending the antenatal clinic of the Port Moresby General Hospital (PMGH) and the 9 Mile urban clinic of Port Moresby was tested for syphili using the laboratory-based Venereal Disease Research Laboratory (VDRL) syphilis serology test and two clinic-based syphilis tests, Abbot Determine and Abbot Syfacard-RR (Rapid Plasma Reagin (RPR) card test). The Abbot Determine and the Syfacard-R tests were compared with the VDRL test, the gold standard in this study. The validation test results of Determine versus VDRL were as follows: sensitivity 92.0%; specificity 94.6%; the predictive value of a positive test 42.6%; and the predictive value of a negative test 99.6%. The validation tests for RPR versus VDRL were as follows: sensitivity 56.3% specificity 96.5%; predictive value of a positive test 41.2%; and the predictive value of a negative test 98.1%. The RPR test costs 3.5 kina (about one US dollar) a test, the VDRL less than 1 kina a test whilst the Determine test kit costs about 5 kina a test. When laboratory time, salaries and other supplies are costed the Determine test is expected to cost relatively much less. Our recommendation is that the Determine test be made available in areas of the country where VDRL is unavailable or where logistics do not allow for test results to be available early enough to make a difference to the care of th pregnant woman and her fetus.

A survey of under-18 year old and 20-29 year old primigravidae delivered at the Port Moresby General Hospital: a comparative study of their sociodemographic and sexuality characteristics and contraceptive knowledge and experience.

From July 1992 to August 1993, 330 under-18 year old primigravidae (cases) and 330 randomly selected 20-29 year old primigravidae (controls) who were delivered at the Port Moresby General Hospital were sequentially studied, using a standardized, pretested, precoded questionnaire. In stepwise logistic regression analysis, significantly more of the cases had menarche at less than 15 years of age, learned before menarche that sex causes pregnancy, were of highland origin, were unemployed, or had partners who were unemployed; significantly fewer of the cases thought that one sexual act could cause pregnancy, had knowledge of or had ever used a family planning method, or had planned this pregnancy.

PIP: This study aims to identify factors (explanatory variables) which are associated with the risk of an adolescent becoming pregnant. From July 1992 to August 1993, 330 18 year old primigravidas (cases) and 330 randomly selected 20-29 year old primigravidas (controls), who were delivered at the Port Moresby General Hospital in Papua New Guinea, were sequentially studied. Trained research assistants administered a standard, pretested, precoded questionnaire. By using stepwise logistic regression analysis, it was revealed that significantly more of the cases had menarche at 15 years of age (81% vs. 49%), learned before menarche that sex causes pregnancy (51% vs. 32%), were of highland origin, were unemployed, or had partners who were unemployed. Moreover, significantly fewer of the cases thought that one sexual act could cause pregnancy, had knowledge of or had ever used a family planning method, or had planned their pregnancy.

A survey of Papua New Guinean parturients at the Port Moresby General Hospital: family planning.

A survey of 673 consecutive Papua New Guinean parturients at the Port Moresby General Hospital, in May and June 1990, showed that 28% had ever used a family planning (FP) method, chiefly a hormonal method (93% of ever-users). Only seventeen of 239 (7.1%) nulliparae had ever used an FP method, compared with 170 of 434 (39.2%) parous subjects. Education of mother and of husband were independently and significantly associated with FP ever-use. Seventeen (4.9%) of 347 women who had a surviving child, had not breast-fed the child. The interval between the birth of the surviving child and the start of the index pregnancy was significantly associated with the duration of breast-feeding; the longer the duration of breast-feeding, the longer the inter birth interval.

PIP: A 1990 survey of 673 postpartum women at Port Moresby General Hospital in Papua New Guinea found that 27.8% had used a family planning method as a means of delaying or avoiding pregnancy. 92.7% of ever use was with the oral pill or the injectable Depo-Provera. Educational level of the mother or the father was significantly associated with contraceptive usage among multiparous women. Having some education by either spouse was significantly related in the absence of education of the other spouse. The mean years of schooling among family planning users was 14.7 years and significantly different from the 12.7 years for never-users. Parity was also significantly related to ever use of family planning. 31% of 667 respondents reported that the index pregnancy had not been planned. The planned pregnancy was unrelated to maternal or paternal educational status or parity. 122 or 16.5% of those with a planned index birth had used a family planning method prior to conception. 11.3% in the unplanned index birth group had used a contraceptive method prior to the pregnancy; the differences were significant. Longer duration of breast feeding was related to longer birth interval regardless of whether or not contraception was used. Ever use of family planning was significantly higher among those of a mid-high social class than among those in the low social class. 49.1% of the 654 respondents reported no intention to use family planning. 41% planned to use the oral pill or injectables. 0.6% planned to use an IUD, and 8.9% reported plans for a tubal ligation. Of the 58 planning female sterilization, 79.3% (46) had the operation before returning home. The findings reflected the lack of family planning promotion within the larger community among non-pregnant women.

A survey of Papua New Guinean parturients at the Port Moresby General Hospital: sociodemographic and reproductive characteristics.

A survey of 673 consecutive Papua New Guinea parturients carried out at the Port Moresby General Hospital between May and June 1990 showed that socioeconomic and educational factors played a part in predicting perinatal death. Mothers who have previously experienced a perinatal death are more likely to experience a second one.

PIP: During May-June, 1990, physicians surveyed all postpartum women before they were discharged from Port Moresby General Hospitals of Papua New Guinea to determine whether socioeconomic and educational factors contributed to perinatal death as well as to low birth weight. Most of the 673 women were of southern origin (70%), currently married (97.2%), 20-35 years old (79.5%), and had 1-4 children prior to the index birth (57.4%). 4.6% had experienced at least 1 perinatal death before the index infant. The perinatal death rate among the index births (676 births) was 29.6/1000 births (stillbirth rate = 22.2/1000 births and neonatal mortality rate = 7.4/1000). The main cause of perinatal death were antepartum hemorrhage, prematurity and respiratory distress syndrome, syphilis, and placental insufficiency associated with intrauterine growth retardation. The stepwise logistic regression analysis indicated that village/urban slum residence, prenatal care, and previous perinatal death were significantly associated with perinatal death. The odds ratios of village/urban slum residence (p = .001), lack of prenatal care in index pregnancy (p = .002) were 5.13, 4.18, and 5,38, respectively. Predictors of low birth weight were village/urban slum residence (OR = 2.67; p .001), nulliparity before index birth (OR = 2.29; p .001), and previous perinatal death (OR = 2.87; p .05). These findings showed that mothers who have previously suffered from a perinatal death are more likely to again experience a perinatal death.