The clinical diagnosis and treatment of important childhood diseases in rural Papua New Guinea

This study used multiple standardized instruments to evaluate the quality of the clinical management of the common childhood diseases in rural Papua New Guinea. The findings indicate major inadequacies in the quality of history taking, examination, record keeping, diagnosis and treatment of the common causes of childhood morbidity and mortality. To improve case management by health workers in rural clinical situations everything possible must be done to make good clinical management easy and practical. This should involve provision of practical reinforcing tools, training and supervision which target rural health workers as valuable human resources, and community education which maximizes the contribution that community members can make to early diagnosis and good management.     

Head injuries in Papua New Guinea

Human calcitonin (hCT) has been reported to have a less hypocalcemizing effect on rats and to have a lower binding affinity for the receptor of mouse osteoclasts than salmon CT(sCT). In this study we comparatively examined the effect of hCT and sCT on osteoclastic bone-resorbing activity of unfractionated cells obtained from human giant cell tumor of bone and from rabbit and mouse long bones. We found that hCT had the same inhibitory effect as sCT on the bone-resorbing activity of human and rabbit osteoclastic cells, but a different one on that of mouse cells. These results indicate that the activity of drugs should be assayed using human cells if possible.     

Chloroquine-resistant Plasmodium vivax in Papua New Guinea

An Australian expatriate on regular weekly antimalarial prophylaxis with chloroquine base and Maloprim developed symptomatic Plasmodium vivax infection which failed to respond adequately to 600 mg of chloroquine base. More ominously, a resident of the Highlands region of Papua New Guinea contracted vivax malaria which failed to be cleared by 2400 mg chloroquine base administered over 4 d. Both patients had achieved appropriate blood and plasma concentrations of chloroquine after treatment. Chloroquine-resistant P. vivax is now a clinical fact in Papua New Guinea.     

Health insurance and medical schemes in Papua New Guinea

Papua New Guinea (PNG) is an independent nation in the Pacific region. It is located due north of Australia. It is made up of a main island and about 100 smaller islands in the Bismark and Solomon Seas, to the north and east of the main island. The population of PNG is about 4.0 million, the total land area approximately 463,840 sq km and population density 8/square km. Only about 15% of the population is urban, average household size is 5.4 and 45.1% literate. Politically and administratively, it is divided into nineteen provinces and a National Capital District. Since 85% of the population lives in rural areas, the provision of services to the rural areas is constrained by difficult terrain, poor infrastructure and geographic dispersion of the rural population. PNG is a developing Pacific nation with an economy largely based on primary and mining industries. According to the 1993 World Bank estimates, more than 30% of the Gross Domestic Product (GDP) is derived from agriculture. The expenditure on health, as a percentage of the GDP, was 2.8% in 1989, (Table 1). This is low compared to developed nations (ranging from 8% to 14%), but very reasonable compared to the rest of the developing world. Indonesia for example expends 2.7% of GDP on health care. All government expenditures declined sharply in the post 1989 period, including health care expenditures. However, by 1989, the expenditure per capita on health was almost back to 1986 levels. PNG has a small population base relative to the other countries in its World Bank peer group. However, its per capita GDP is reasonable at US$850, the third highest amongst its group and higher than Indonesia, for example, which is US$700/head. Like almost all countries in its gorup, it experienced a negative growth rate over the decade 1980-1991 but kept inflation at a reasonable 5.2% for the same period. On most other indicators PNG fares reasonably well, in comparison with other developing nations (Tables 2 & 3).     

Immunology and growth faltering of Anga children, Papua New Guinea: preliminary work

BACKGROUND: Between 1985 and 1989, only one centre in Sweden combined preoperative radiotherapy with total mesorectal excision (TME) in the primary treatment of rectal cancer. The aim of this study was to investigate whether this change in primary treatment had an impact on the outcome. METHOD: The survival rate of 94,262 patients with colorectal cancer from the total Swedish population between 1960 and 1989 was analysed. RESULTS: A continuous improvement in relative survival rate occurred during the first year of follow-up for both colonic and rectal cancer. Some improvement was also seen during follow-up years 2-5, but this was much more pronounced during the last period (1985-1989) for rectal cancer in the county of Uppsala. The improvement was particularly marked during follow-up years 3-5. CONCLUSION: There are strong indications from this study that altered primary treatment for rectal cancer results in improved long-term survival.     

The management of cryptococcal meningitis in Papua New Guinea

The efficacy of tacrine for treatment of Alzheimer's has been demonstrated in several clinical trials but has not been assessed in cases complicated by medical and psychiatric comorbidities. Additionally, the benefit-risk ratio of tacrine is small, so it is best administered with carefully developed guidelines that specify this ratio for patients and families. On the basis of guidelines developed for the Johns Hopkins Dementia Research Clinic, tacrine treatment was offered to 162 patients with probable Alzheimer's. Only 35 accepted, and only 22 continued on tacrine beyond 3 months. The latter group declined by 1.36 points over 1 year on the Mini-Mental State Examination, significantly less than expected. The authors conclude that, if used in the context of clinical guidelines, tacrine is an effective treatment for Alzheimer's.     

The effect of distance from home on attendance at a small rural health centre in Papua New Guinea

BACKGROUND: The willingness of patients in the rural tropics to seek medical care at primary health care facilities is influenced by the distance they have to travel, but few studies have tried to estimate these distance effects. METHODS: Distance decay effects in attendance rates were estimated from a database of 4348 attendances at a rural health centre in Papua New Guinea, linked to demographic and house position data for the catchment population. Small-scale spatial patterns and differences between diagnoses, age groups and gender are described. RESULTS: Attendance decreased markedly with distance both overall (50% decrease at 3.5 km) and for patients with malaria or acute respiratory infections. This decrease was non-linear (on log scale) with distance. Although constant over time, there were big differences in this distance effect among age and gender groups: Female patients showed less distance decay in adolescents and adults, but higher in the infant group. Spatial patterns accounted for 32% of the variation in age- and gender-specific attendance rates. Of the spatial effects more than 50% were due to distance effects. CONCLUSIONS: Distance effects were similar in magnitude to those reported elsewhere, suggesting that distance effects may be generalizable to many parts of the rural tropics. The non-linearity of distance decay implies that a bell-shaped demand function should be used in health planning.     

Papua New Guinea students' perceptions of mathematics lecturers.

51 Papua New Guinea undergraduate mathematics students evaluated the performance of their mathematics lecturers by completing a survey previously used with US and Australian students (H. W. Marsh, 1981). Facets in the survey included enthusiasm, organization, group interaction, individual rapport, examinations, assignments, workload, breadth of coverage, and learning value. Results show that Ss in the present study differed from Western students in their perception of what is required in a lecturer's performance. These Ss from a developing country did not distinguish between the quality of organization of the lecture and the rapport created between lecturer and Ss, as did students from developed countries. It is suggested that lecturers in developing countries should be person-oriented to be effective. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The future of surgery in Papua New Guinea and the South Pacific

Surgery in the South Pacific is different in many respects from surgery in Australia and New Zealand. It is primarily the surgery of trauma, infection, advanced malignancy, hollow-tube obstruction and congenital abnormalities. Specific tropical infections such as tuberculosis, typhoid, pigbel and amoebiasis occur regularly but constitute only a small proportion of all cases. The patients tend to be young, rural and poor, and often present late because access to surgical services is limited. The treatment patients receive is also compromised by a lack of resources--the result of underfunding and inefficient administration. Standards for appropriate surgical practice should be determined in-country and based at least on surgical audit and clinical studies. Even though Western diseases are emerging in the tropics, the best management may sometimes be different. Training of national surgeons is a priority if a sustainable surgical service is to be established. Such training is more effectively carried out in the home country, or at least in one with similar pathology and problems, rather than overseas. Project aid should support these schemes and encourage regional co-operation through the Fiji and Papua New Guinea medical schools. There remains an important role for visiting surgical specialists, but they need to ensure that they transfer skills and encourage the professional development of promising local doctors rather than simply focusing on treating patients.     

Cryptococcal meningitis in children in Papua New Guinea: a reminder

This report describes a case of fibromyalgia developing following a workplace injury, but in which the issues of compensation and work disability were not relevant. A previously healthy 37-year-old woman developed back and groin pain after lifting a heavy box. Over the next months, pain and allodynia gradually spread over her body, and headaches, sleep disturbance, paresthesias, and bowel symptoms developed for the first time. The pain was constant and severe, invading and interfering with every area of daily function. Surprisingly, no previous case reports or definition of post-traumatic fibromyalgia could be found. This case report, narrated by the patient, suggests that there is such an entity as post-traumatic fibromyalgia, and that central nervous system plasticity plays a central role.     

Respiratory abnormalities and ventilatory capacity in a Papua New Guinea Island community

Several molecular forms of human glucose-6-phosphate dehydrogenase (D-glucose-6-phosphate:NADP+ 1-oxidoreductase, EC 1.1.1.49) corresponding to different stages of post-synthetic modifications have been purified from human leukocytes. The various enzyme forms were different in their specific activity, their kinetic properties and their isoelectrofusing pattern. The molecular weight of the subunits of the different forms was not modified. The changes in the electrofocusing pattern were not due to modifications of the N-terminal ends, the oxidation of thiol groups or the non-covalent fixation of an acid molecule upon the enzyme. Carboxypeptidase B cleaved a C-terminal lysine from the different enzyme forms and shifted the isoelectric point of the different enzyme active bands towards the acid pH. The different enzyme forms studied here seemed to result from the action upon 'native glucose-6-phosphate dehydrogenase' of 'modifying factors' especially abundant in some leukemic granulocytes. The modifying factors did not seem to be consumed during the 'modification' of glucose-6-phosphate dehydrogenase. Moreover, the storage for one year of unmodified enzyme resulted in changes in its electrofocusing pattern similar to those quickly induced by the 'modifying factors'. Consequently it appears that the modifying factors are catalysts of the modification of special residues of glucose-6-phosphate dehydrogenase. The hypothesis that this modification involves the deamination of asparagine or glutamine residues is put forward.     

Prosocial reasoning among children and adults in a Papua New Guinea society.

N. Eisenberg's (1982) prosocial moral reasoning interview, adapted to the setting, was administered to members of the small-scale, traditional, collectivistically oriented Maisin society of New Guinea. The sample consisted of 69 elementary school children (mean age range 8–13 yrs), 8 adolescents (aged 14–20 yrs), and 24 adults (aged 24–60 yrs). Results indicate that no new reasoning categories were used by the Ss. Children and adults used physical-needs-oriented reasoning most frequently. Adults used significantly more psychological-needs-oriented reasoning than did younger Ss. It is suggested that Maisin prosocial reasoning develops toward empathic concern for others but not toward concern with one's own internal states as motivators of behavior or toward generalized notions of society. Developmental patterns suggest that initial exposure to Western schooling is associated with an increase in hedonistic reasoning and a decrease in needs-oriented reasoning, although this trend appears to reverse after Grade 3. The internal organization of Maisin prosocial reasoning as well as the specific reasoning categories used by the Maisin are congruent with the nature of their society. Results of the study support the idea that moral reasoning patterns develop as adaptive responses to actual circumstances of social living. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quality of health services in Papua New Guinea: what do we know?

The discussion of quality issues in Papua New Guinea requires that attention be focused on what is known about the actual quality of the health care provided in Papua New Guinea. Since 1987 there has been increasing evidence that there are serious deficits in the quality of care in rural areas and that there are similar problems in the country's hospitals. This paper summarizes what is known and discusses the implications for the development of quality assurance activities in Papua New Guinea. The paper concludes that many of the deficiencies observed are amenable to improvement through simple and inexpensive means and that with sustained commitment, improvements are achievable.