Papua and New Guinea medical journal最新文献

Background: There are many benefits to involving expectant fathers in maternal and newborn health, including reducing vulnerability to HIV (human immunodeficiency virus) and sexually transmitted infections (STIs). Women are at risk of HIV infection and other STIs during pregnancy and breastfeeding and in Papua New Guinea (PNG) a number of complex factors interact to enhance this vulnerability. PNG health policies do support men's involvement in maternal and newborn health, but currently there is limited understanding of appropriate or effective ways by which this could be achieved.

Aims: The aims of this research were to gather information to inform strategies to enable the greater involvement of men in maternal and newborn health services and to explore the factors that contribute to STI and HIV vulnerability among pregnant women in East New Britain Province.

Methods: Between June 2011 and February 2012 we conducted a total of 14 focus group discussions with pregnant women, expectant fathers, older men and older women. Ten in-depth interviews were conducted with health workers and staff within the provincial administration.

Key findings: Expectant fathers were concerned for the health of their wife and baby both during and after pregnancy. They had many questions about pregnancy, childbirth and the care of their baby and were eager for information. Protecting their family is viewed as an important role for men and could be a useful way of engaging with them. Misconceptions about the safety of sex during pregnancy are one reason that couples are often sexually abstinent for long periods. This may contribute to the likelihood that either partner will seek sex outside marriage during pregnancy or postpartum, and increase a pregnant woman's risk of contracting STIs and HIV. We heard that it is common for men as well as women to have extramarital sex at this time. Currently, male involvement in maternal and child health care is uncommon and community attitudes are mixed. Some significant barriers to involving men relate to traditional customs and feelings of shame and embarrassment. Others can be attributed to health service factors, such as a lack of privacy and the attitudes of health care workers. Various community channels for reaching expectant fathers were suggested.

The findings of a seroepidemiological study into the prevalence of Toxoplasma gondii infection amongst normal blood donors and patients infected with HIV (human immunodeficiency virus) are presented. Of the total 301 participants, 181 were HIV antibody positive and 120 blood donors were HIV antibody negative. We used a prevalidated questionnaire, enzyme-linked immunosorbent assay (ELISA) and the Epi Info version 3.2 software plus SPSS version 10 for data analysis. The results showed an overall antibody prevalence rate of 53% in the population and a significantly higher infection rate amongst HIV-positive patients: odds ratio 2.14 (95% CI 1.30-3.53), p = 0.001. The study further showed that exposure to cats and highlands origin were independent risk factors. This study has demonstrated that in light of the current HIV/AIDS (acquired immune deficiency syndrome) epidemic, opportunistic infections such as toxoplasmosis will be a cause of considerable morbidity and mortality. It is therefore important that clinicians and public health practitioners fit these findings into overall management strategies to help control toxoplasmosis.

In view of the dearth of information relating to antibiotic resistance in community- and hospital-acquired bacterial infections in Papua New Guinea (PNG), we carried out a prospective, hospital-based observational study of surgical patients between October 2008 and October 2009. In a sample of 115 patients (median age 30 years; 55% males) suspected of having a bloodstream infection, blood cultures were positive in 11 (10%) and a significant pathogen was isolated in 9 (8%). Staphylococcus aureus was isolated in 4 patients (44%) and 3 were methicillin resistant; all these isolates were considered community acquired because cultures were performed within 48 hours of admission. Of the remaining 5 isolates, 4 were Gram-negative organisms with at least intermediate resistance to chloramphenicol that were grown from blood taken > 48 hours post-admission and thus considered nosocomially acquired. These data suggest two distinct patterns of bacterial infection in PNG surgical inpatients that have implications for national antibiotic prescription guidelines.

We report on the results of a retrospective audit of airway management in patients presenting to the Port Moresby General Hospital from 1998 to 2009. Safe and secure airway management can be challenging in the operating room during head and neck surgery. These challenges continue into the postoperative period and can present significant issues to intensive care staff. This series includes many patients with upper airway and upper gastrointestinal malignancy, head and neck trauma, head and neck infections, thyroid pathology and cleft palate. This series highlights the importance of anticipating the possibility of difficult airway preoperatively and modifying the airway management appropriately. We consider that all members of the operating team including surgeons, anaesthetists, intensive care physicians and nursing staff should cooperate and communicate effectively to optimize outcomes for these potentially difficult cases. A proposed airway management algorithm is presented to guide surgical teams performing head and neck surgery in Papua New Guinea and similar regions.

Arboviruses (arthropod-borne viruses) are important emerging pathogens in many tropical and developing countries of the world. The Southeast Asian and Western Pacific regions have recently experienced large outbreaks of dengue, Japanese encephalitis and chikungunya fever. In Papua New Guinea (PNG) serological surveys and mosquito isolation experiments suggest that arboviruses are prevalent throughout the country. However, the lack of surveillance and clinical reporting means that the distribution and prevalence of these diseases is unknown. In this paper we review the most important arboviruses with regard to human health in the PNG region.

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.

This descriptive questionnaire-based study carried out between 16 June and 30 September 2010 aimed to assess the knowledge among doctors at Port Moresby General Hospital of basic life support and cardiopulmonary resuscitation (CPR) for children and adults, based on Australian Resuscitation Council Guidelines. 87 (81%) of 107 questionnaires were returned from 15 consultants (17% of respondents), 51 registrars (59%)--of whom 39 (45%) were in training--and 21 resident medical officers (24%). The respondents were based in internal medicine, surgery, emergency medicine, anaesthetics, obstetrics and gynaecology, paediatrics and smaller disciplines (ear, nose and throat, ophthalmology, intensive care, radiology, psychiatry and pathology). Knowledge of CPR in this study population was uneven and overall inadequate. Only 51 respondents (59%) knew that basic CPR was a priority over intubation. 72 (83%) knew the correct compression: ventilation ratio for children but only 38 (44%) knew this for adults. 33 (38%) knew the correct compression rate for children and 29 (33%) for adults. 40 (46%) knew the correct compression depth for children and 35 (40%) for adults. 60 (69%) knew the sites for defibrillator pads. Knowledge of types of defibrillator and shockable rhythms was poor: 21 (24%) gave two correct arrhythmias for defibrillation and 44 (51%) gave one. Medical officers in training appeared to have better knowledge than their colleagues in postgraduate training programs. As a group, doctors working in emergency medicine, anaesthetics and intensive care had better knowledge of adult resuscitation than their counterparts in the other adult disciplines and had similar knowledge of paediatric resuscitation to that of their paediatric counterparts, although overall knowledge was incomplete in all groups. Basic life support (BLS) and advanced life support (ALS) flow charts for both children and adults should be highly visible throughout the hospital and there is a need for regular training in CPR.

The East New Britain Sexual Health Improvement Project (ENBSHIP) partners with the East New Britain Provincial Health Office. The project supports initiatives at the provincial, district and community levels to strengthen health services and expand the community response to sexually transmitted infections (STIs). Community mobilization is based on a lengthy engagement process with local leadership structures at district, local level government and village levels. At the village level, ENBSHIP works through community activators called 'stret tokers' [straight talkers]. These individuals are selected by their communities and trained to raise awareness of sexually transmitted infections and build a bridge between communities and health services. Training includes simple, gender-sensitive community development principles and basic information about STI transmission and prevention. 'Stret tokers' are supported to understand the complex issues that underpin STI transmission and treatment-seeking behaviour, and to mobilize their communities to respond to these issues. ENBSHIP has highlighted the value of taking sexual health promotion to the village level while also strengthening health services. The initiative has been met with great enthusiasm and has received excellent support from host communities. At the same time there have been many challenges and lessons learned of potential value to other community-based initiatives in Papua New Guinea.

Maternal health across Papua New Guinea (PNG) is of extreme public health concern. In response, the National Department of Health explicitly prioritized improving maternal, neonatal and child health services, envisaging increased collaboration between the formal health system and community-based initiatives as one method for achieving this. This study examined the patterns of formal and non-formal service utilization during pregnancy and childbirth in one province. We analysed the activity database of the East Sepik Women and Children's Health Project's Village Health Volunteer (VHV) program, an informal health service in East Sepik Province of PNG, estimating VHV activity and coverage for two maternal health care services (first antenatal care visit and VHV-attended deliveries) and comparing these to the volume and estimated coverage of these services delivered by the formal health system in East Sepik over the years 2007 to 2010. We found a significant increase in women's utilization of VHVs for first antenatal care and for an attended delivery. Reported coverage of these services delivered by the formal health service declined or at best remained static over the same time period. Our data cannot illuminate the causes of an apparent and highly concerning decline in health facility usage for assisted delivery, nor the reasons for increased usage of VHVs. The factors contributing to these trends in service provision require urgent study, to improve our understanding of the drivers of utilization of critical maternal health services. Our study demonstrates that VHVs deliver a substantial proportion of maternal health services in East Sepik. This finding alone highlights the importance of considering this cadre when planning health service improvements and suggests that a national VHV policy that builds on the work of the National Health Plan in defining the most appropriate role for VHVs in maternal health care is long overdue.

Cervical cancer is one of the most common cancers among women worldwide and is a leading cause of cancer death in Papua New Guinea (PNG). It is well established that persistent infection with high-risk types of human papillomavirus (HPV) is necessary for the development of cervical cancer. The recent licensing of two vaccines for the prevention of the two most common high-risk HPV types has prompted renewed interest in the prevention of cervical cancer and HPV in PNG. This review aims to assess and compare available technologies suitable for the epidemiological surveillance of HPV in PNG. Data from the surveillance exercise will provide critical information to the National Department of Health to make an informed decision regarding the introduction of a preventive HPV vaccine.