Therapeutic efficacy of chloroquine or amodiaquine in combination with sulfadoxine-pyrimethamine for uncomplicated falciparum malaria in Papua New Guinea.

Resistance of Plasmodium falciparum to chloroquine is widespread in Papua New Guinea. At a meeting in Port Moresby in October 1997, it was decided to explore a possible change of the current first-line treatment of uncomplicated malaria with chloroquine alone (amodiaquine for children under five years) to chloroquine or amodiaquine in combination with sulfadoxine-pyrimethamine (S-P). To assess the therapeutic efficacy of the new drug combination in Papua New Guinea, a study was carried out in 1998-1999 at five hospital outpatient departments. From the 513 patients enrolled for the study, 95 defaulted from follow-up. Of the remaining 418, 399 (95.5%) had an adequate clinical response (ACR). Out of the 19 patients who did not have an ACR, 3 (0.7% of the total) developed severe signs in the first 24 hours and were treated in hospital; they were regarded as early treatment failures. The remaining 16 did not complete the study on the basis of various exclusion criteria but were not excluded from the analysis. From these results it was concluded that the combination was effective and a decision was taken in May 2000 to introduce the two-drug combination regimens as the standard first-line treatment of uncomplicated malaria, including falciparum malaria, in Papua New Guinea.

Systemic lupus erythematosus in children: a case report and review.

A 12-year-old Papua New Guinean female presented initially with nonspecific clinical symptoms, fever of unknown origin and anaemia. She subsequently developed multisystem disease involving the respiratory, gastrointestinal, central nervous, musculoskeletal and cutaneous systems. She was diagnosed to have systemic lupus erythromatosus (SLE) and started on treatment. Unfortunately the patient defaulted from follow-up after treatment, which covered seven months only, to present with acute respiratory distress from which she died within 24 hours. A relevant literature review with the clinical features of systemic lupus erythematosus in children is described.

Child adoption in the Western Highlands Province of Papua New Guinea.

This study investigated the epidemiology of child adoption in the Western Highlands Province of Papua New Guinea. A prospective case-control study of 100 adopted and 100 control children matched by age and sex was done in 1995. The age at the time of adoption ranged from 7 days to 8 years with 64 being adopted in the neonatal period. 28 were adopted because the biological mother had died, 23 because the adoptive mothers had been unable to bear children and 16 because the biological mother was unmarried or 'too young'. Only 11 adopted children were not blood relatives of the adoptive mother; 10 children had been abandoned and 1 had been bought for cash. 97 adoptive mothers were married. The majority (61%) had no formal education and 95% were not in paid employment. Compared with the mothers of the control children fewer adoptive mothers had received any formal education and more of them smoked cigarettes, drank alcohol or chewed betelnut. Social characteristics of the adoptive fathers were similar to the fathers of the control children. Of the 66 living biological mothers for whom information was available, 39 (59%) were married, 16 (24%) single, 8 (12%) divorced and 3 (5%) widowed. For 21 (32%) of the biological mothers the adopted baby was their first. 19 adopted babies were breastfed, 8 exclusively, 6 with the addition of non-human milk and 5 with additional solid feeds. Two-thirds of the adopted children and only 5 controls were bottle-fed. There were no significant differences in nutritional status between the two groups and immunization status was similar. There was widespread ignorance about legal adoption procedures. Only 8 adoptive mothers had any knowledge of and only 2 had followed formal adoption procedures. In this group of adopted children it appeared that most were well cared for, as their nutritional status and immunization status were similar to non-adopted children. There have, however, been suggestions that adoption is a risk factor for child abuse in Papua New Guinea and adoption has recently been associated with severe malnutrition and mortality in a highlands hospital inpatient population. Information relating to formal adoption processes should be more widely disseminated throughout Papua New Guinean communities to protect the rights of adopted children and their adoptive parents.

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.

Pneumoperitoneum in a five-day-old baby: a case report.

A five-day-old male was admitted to Mt Hagen Hospital with a history of vomiting, fever and rapidly progressive abdominal distension of one-day duration. Urgent abdominal X-ray revealed pneumoperitoneum. Laparotomy revealed a malrotation of the intestine with jejunal perforation. The baby died postoperatively, 21 hours after admission. The importance of plain abdominal X-rays and reliance on 'classical' plain film radiographic signs is highlighted.

Influence of maternal bio-social factors on birthweight

Influence of maternal bio-social factors; including age; pre-pregnancy weight/height; social class; birth-order; birth-spacing; educational level and use of antenatal-care facilities; on birthweights of 1;238 singletons was studied over a period of six months at three hospitals in Ibadan. There was a significant (p0.001) influence on birthweight by the age of the mother; such that teenage mothers gave birth to lighter babies than older mothers. The study also revealed that the most appropriate period in life for a woman to have normal size babies was between 25 and 29 years of age. There was a significant difference (p0.05) between the mean birthweight of babies delivered by mothers weighing less than 70kg and those whose weights were 70kg and above