Port Moresby General Hospital Research Articles

Description of Bacterial RNA Transcripts Detected in Mycobacterium tuberculosis - Infected Cells from Peripheral Human Granulomas using Single Cell RNA Sequencing.

Mycobacterium tuberculosis (Mtb) remains a global human health threat and a significant cause of human morbidity and mortality. We document here the capture of Mtb transcripts in libraries designed to amplify eukaryotic mRNA. These reads are often considered spurious or nuisance and are rarely investigated. Because of early literature suggesting the possible presence of polyadenylated transcripts in Mtb RNA, we included the H37Rv Mtb reference genome when assembling scRNA seq libraries from fine needle aspirate samples from patients presenting at the TB clinic, Port Moresby General Hospital, Papua New Guinea. We used 10X Genomics single-cell RNA sequencing transcriptomics pipeline, which initiates mRNA amplification with poly-T primers on ~30-micron beads designed to capture, in this case, human mRNA associated with individual cells in the clinical samples. Utilizing the 10X Genomics Cell Ranger tool to align sequencing reads, we consistently detected bacterial small and large ribosomal subunit RNA sequences (rrs and rrl, respectively) and other bacterial gene transcripts in the cell culture and patient samples. We interpret Mtb reads associated with the host cell's unique molecular identifier (UMI) and transcriptome to indicate infection of that individual host cell. The Mtb transcripts detected showed frequent sequence variation from the reference genome, with greater than 90% of the rrs or rrl reads from many clinical samples having at least 1 sequence difference compared to the H37Rv reference genome. The data presented includes only bacterial sequences from patients with TB infections that were confirmed by the hospital pathology lab using acid-fast microscopy and/or GeneXpert analysis. The repeated, non-random nature of the sequence variations detected in Mtb rrs and rrl transcripts from multiple patients, suggests that, even though this appears to be a stochastic process, there is possibly some selective pressure that limits the types and locations of sequence variation allowed. The variation does not appear to be entirely artefactual, and it is hypothesized that it could represent an additional mechanism of adaptation to enhance bacterial fitness against host defenses or chemotherapy.

Impact on pregnancy outcomes of intermittent preventive treatment with sulfadoxine-pyrimethamine in urban and peri-urban Papua New Guinea: a retrospective cohort study

BackgroundIntermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) reduces malaria-attributable adverse pregnancy outcomes and may also prevent low birth weight (< 2,500 g) through mechanisms independent of malaria. Malaria transmission in Papua New Guinea (PNG) is highly heterogeneous. The impact of IPTp-SP on adverse birth outcomes in settings with little or no malaria transmission, such as PNG’s capital city Port Moresby, is unknown.MethodsA retrospective cohort study was conducted amongst HIV-negative women with a singleton pregnancy who delivered at Port Moresby General Hospital between 18 July and 21 August 2022. The impact of IPTp-SP doses on adverse birth outcomes and anaemia was assessed using logistic and linear regression models, as appropriate.ResultsOf 1,140 eligible women amongst 1,228 consecutive births, 1,110 had a live birth with a documented birth weight. A total of 156 women (13.7%) did not receive any IPTp-SP, 347 women (30.4%) received one, 333 (29.2%) received two, and 304 (26.7%) received the recommended ≥ 3 doses of IPTp-SP. A total of 65 of 1,110 liveborn babies (5.9%) had low birth weight and there were 34 perinatal deaths (3.0%). Anaemia (haemoglobin < 100 g/L) was observed in 30.6% (243/793) of women, and 14 (1.2%) had clinical malaria in pregnancy.Compared to women receiving 0–1 dose of IPTp-SP, women receiving ≥ 2 doses had lower odds of LBW (adjusted odds ratio [aOR] 0.50; 95% confidence interval [CI] 0.26, 0.96), preterm birth (aOR 0.58; 95% CI 0.32, 1.04), perinatal death (aOR 0.49; 95% CI 0.18, 1.38), LBW/perinatal death (aOR 0.55; 95% CI 0.27, 1.12), and anaemia (OR 0.50; 95% CI 0.36, 0.69). Women who received 2 doses versus 0–1 had 45% lower odds of LBW (aOR 0.55, 95% CI 0.27, 1.10), and a 16% further (total 61%) reduction with ≥ 3 doses (aOR 0.39, 95% CI 0.14, 1.05). Birth weights for women who received 2 or ≥ 3 doses versus 0–1 were 81 g (95% CI −3, 166) higher, and 151 g (58, 246) higher, respectively.ConclusionsProvision of IPTp-SP in a low malaria-transmission setting in PNG appears to translate into substantial health benefits, in a dose–response manner, supporting the strengthening IPTp-SP uptake across all transmission settings in PNG.

Healthcare-associated infections and antimicrobial use at a major referral hospital in Papua New Guinea: a point prevalence survey

Healthcare-associated infections (HAI) and antimicrobial use (AMU) are drivers for antimicrobial resistance, and robust data are required to inform interventions and track changes. We aimed to estimate the prevalence of HAI and AMU at Port Moresby General Hospital (PMGH), the largest hospital in Papua New Guinea. We did a point prevalence survey (PPS) on HAI and AMU at PMGH in May 2023 using the European Centre for Disease Prevention and Control (ECDC) PPS protocol. We included all critical care patients and randomly sampled half of the patients in other acute-care wards. We calculated weighted HAI and AMU prevalence estimates to account for this sampling strategy. Weighted HAI estimates were also calculated for an expanded definition that included physician diagnosis. Of 361 patients surveyed in 18 wards, the ECDC protocol identified 28 HAIs in 26 patients, resulting in a weighted HAI prevalence of 6.7% (95% CI: 4.6, 9.8). Surgical site infections (9/28, 32%) were the most common HAI. When adding physician diagnosis to the ECDC definitions, more skin and soft tissue, respiratory, and bloodstream HAIs were detected, and the weighted HAI prevalence was 12.4% (95% CI: 9.4, 16.3). The prevalence of AMU was 66.5% (95%CI: 61.3, 71.2), and 73.2% (263/359) of antibiotics were from the World Health Organization Access group. This is the first reported hospital PPS of HAI and AMU in Papua New Guinea. These results can be used to prioritise interventions, and as a baseline against which future point prevalence surveys can be compared. Australian Government Department of Foreign Affairs and Trade and Therapeutic Guidelines Limited Australia.

The identification of WHO emergency signs in children by nurses at triage in an emergency department

ABSTRACT Background The World Health Organization recommends the use of a three-tier triage system to recognise a sick child in low- and middle-income countries. The three tiers are based on standardised emergency and priority signs. No studies have evaluated the prevalence or reliable detection of these emergency signs. Aims To determine the prevalence of WHO emergency signs and the underlying causes, and to determine whether nurses could reliably detect these signs in children presenting to the emergency department at Port Moresby General Hospital in Papua New Guinea. Methods A prospective study measured inter-rater agreement between nurses at triage and a blinded second assessor trained in paediatrics. Results The prevalence of emergency signs was 16.7%: 32 of 192 children had these signs at presentation; 18 (9.4%) had severe respiratory distress; 10 (5.2%) had severe dehydration; and 3 (1.6%) had convulsions. There was an acceptable inter-rater agreement between nurses and doctors (Cohen’s Kappa score >0.4) for some signs: subcostal recession, intercostal recession, nasal flaring, lethargy, weak volume pulses, convulsions, sunken eyes and a poor conscious state. Obstructed breathing, cyanosis, tracheal tug and cold hands and feet were less commonly detected and had poor inter-rater agreement (Kappa score <0.4). Conclusions Effective screening at triage can enable prompt emergency treatment by nurses and can help focus doctors’ attention on children who require it most. There is a need for additional training in the identification of some emergency signs. Abbreviations CED: children’s emergency department; ETAT: emergency triage assessment and treatment; HCC: Hospital Care for Children; PMGH: Port Moresby General Hospital; PNG: Papua New Guinea; WHO: World Health Organization

Children with palliative care needs in Papua New Guinea, and perspectives from their parents and health care workers: a qualitative study

IntroductionThe World Health Organisation defines paediatric palliative care (PPC) as caring for the child’s body, mind, and spirit, and giving support to the family. In life-limiting conditions it is important that palliative support can be provided even when curative attempts are being utilised. In Papua New Guinea, as in other low- and middle-income countries there is a lack of services and training on PPC. This study aims to describe the characteristics of children with palliative care needs and to assess the perspectives of their parents and health care workers.MethodsA descriptive qualitative study was carried out over 5 months in 2022 at the Port Moresby General Hospital children’s wards. Clinical information was gathered from the admission charts of children with life threatening and life limiting conditions and a recorded interview was carried out with the children’s parents. A focus group interview with 10 experienced nurses caring for these children was video recorded. The recorded interviews were subjected to thematic analysis.ResultsTwenty children and their parents were included in this study. Nine had a cancer diagnosis and 11 had a chronic progressive condition. The common clinical characteristics of children with palliative care needs were pain (n = 9) and shortness of breath (n = 9), and most children had more than one symptom. Several themes were identified in the parent interviews. Most parents could not name their child’s diagnosis, but they were able to correctly describe their child’s condition using their own terms. Most parents felt involved in their child’s management and were satisfied with the care provided. Parents were psychologically affected by their child’s situation but were hopeful that God and the medicines would heal their child. Ten nurses were involved in a focus-group interview. Most nurses’ understanding of palliative care was from experience not from formal training, but most felt confident in identifying the physical, emotional, and spiritual needs of the children. Understanding of analgesia was limited, as was the availability of appropriate medications included in the WHO Analgesic Ladder.ConclusionThere is a need for a systematic approach to palliative care in Papua New Guinea. Palliative care can be integrated into an overall approach to quality of paediatric care. It is relevant to a broad section of children with severe chronic or malignant conditions and can be carried out with limited resources. It does require some resources, further training and education, and increased provision of basic drugs for symptom control.

A study comparing the WHO C-Model caesarean section rates and observed caesarean section rates at Port Moresby General Hospital, Papua New Guinea.

Worldwide, there is an increase in caesarean deliveries. Ideal caesarean section (CS) rates continue to be a matter for debate. The World Health Organization (WHO) C-Model, is a mathematical modelling tool to assist health facilities estimate expected CS rates based on the quality middle income facilities practice. To compare WHO C-Model derived CS rates with actual CS rates at Port Moresby General Hospital. Clinical and obstetric data for women who delivered during a fourmonths period was used to calculate CS probability using the WHO C-Model online calculator. Comparisons of CS rates were made for the entire cohort, as well as for each Robson Classification group to assess whether there was either 'under' or 'overusage' of CS according to the C-Model estimates. The actual CS rate of 5.5% (246/4437) was lower than the mean C-Model rate of 8%. The C-Model rate equates to an almost 45% increase in CS rates or an additional 111 caesarean deliveries be done during the fourmonths study period. The WHO C-Model had good predictability among most of the low-risk Robson groups that accounted for just over 80% of the study population. The suggested additional 111 caesarean deliveries needed to be performed among high-risk Robson groups represented 15% of the study population. Local hospital protocols pertaining to management of both low- and high-risk cases are credited for keeping CS rates to a minimum. A lower threshold for CS in Robson groups two and four could have led to better perinatal outcomes.

A cross-sectional study of factors associated with immediate postpartum uptake of contraceptive implants in Papua New Guinea

ObjectivesIn 2016 the Port Moresby General Hospital in Papua New Guinea introduced a midwife led postpartum contraception service to educate patients and provide contraceptive implants. This study examines the factors that were associated with immediate postpartum uptake of the implants. Study DesignWe conducted a cross-sectional study of patients on the hospital postnatal ward who gave birth between March 2017 and January 2018. Patients aged 16–45 who had a vaginal birth with a singleton, live baby not requiring admission to the special care nursery were eligible for inclusion and invited to complete a survey prior to discharge. ResultsOf 2082 patients approached, all consented to participate in the survey. Of those completing the survey, 531 (25.5%) chose to have the contraceptive implant provided immediately postpartum. Excluding patients who chose tubal ligation (n = 330), in multivariable analysis, higher odds of implant uptake was associated with no prior contraception use compared to prior use (aOR 1.38; 95% CI 1.07 –1.77), unplanned pregnancy compared to planned (aOR 1.37, 95% CI 1.07–1.79), and having received antenatal education about the implant compared to no information (AOR 1.65, 95% CI 1.23–2.10). ConclusionsAntenatal education about the contraceptive implant impacted on likelihood of immediate postpartum method uptake. Patients who had no prior use of contraception and those with unplanned pregnancies were also more likely to request the implants, suggesting that the midwife-led postpartum service is successfully reaching patients with a previous unmet need for contraception. ImplicationsThis study demonstrates successful delivery of a postpartum implant program in a setting where community access to contraception is limited. Antenatal information and education can support implant uptake and that the program provides the opportunity for birth spacing and limiting in patients with a previous unmet need.

Emergency department triage and COVID‐19: Performance of the Interagency Integrated Triage Tool during a pandemic surge in Papua New Guinea

ObjectiveTo determine the sensitivity of the Interagency Integrated Triage Tool to identify severe and critical illness among adult patients with COVID‐19.MethodsA retrospective observational study conducted at Port Moresby General Hospital ED during a three‐month Delta surge.ResultsAmong 387 eligible patients with COVID‐19, 63 were diagnosed with severe or critical illness. Forty‐seven were allocated a high acuity triage category, equating to a sensitivity of 74.6% (95% CI 62.1–84.7) and a negative predictive value of 92.7% (95% CI 88.4–95.8).ConclusionIn a resource‐constrained context, the tool demonstrated reasonable sensitivity to detect severe and critical COVID‐19, comparable with its reported performance for other urgent conditions.

Pericardial Disease and Pericardiocentesis in Adult Patients in Port Moresby General Hospital Papua New Guinea

Papua New Guinea (PNG) remains categorised as a Mycobacterium tuberculosis (MTB) endemic country [1]. Pericardiocentesis is recommended for patients with pericardial effusion in whom MTB is suspected, along with those with indications for therapeutics drainage [2]. This study aimed to report the incidence of TB pericardial effusion on GeneXpert [3] in patients living in Port Moresby.

Analysis of Clinical Characteristics and Prognosis of Traumatic Brain Injury in Papua New Guinea.

Objective To evaluate the clinical characteristics and prognosis of TBI patients from 2016 to 2019 admitted to Port Moresby General Hospital (PMGH) of Papua New Guinea (PNG) and compare the results with previous researches to analyze current clinical characteristics and prognosis. Methods A retrospective study was performed on 389 TBI patients in Port Moresby General Hospital (PMGH) over a 48-month period (from January 2016 to December 2019). The clinical and radiographic data were collected. Patients were followed up for at least 3 months, and outcomes were assessed using the Glasgow Outcome Scale (GOS). Univariate and multivariate logistic regressions were performed to analyze the prognosis and intracranial infection of patients, as well as the effect of surgery on the prognosis of TBI patients. Results The average age of the 389 TBI patients was 24.9 years old, and the most common age was 18-40 years old, accounting for 55.5%. The proportion of male patients was 79.4%, and the proportion of juvenile patients (≤18 years) was 30.8%. The most primary cause of injury was fighting and brawling (38.0%). At admission, patients had an average GCS score of 9.1, and patients with severe TBI accounted for 46.8%. Overall, 32.1% of the patients had a good prognosis, with a mortality rate of 13.9% (54 cases). Analyzing the relationship between surgical treatment and prognosis in 303 patients with moderate or severe TBI, there was no statistical significance. Univariate and logistic regression analyses for poor prognosis included gender, GCS, multiple injuries, Rotterdam CT scores, and intracranial infection. Univariate and logistic regression analyses for intracranial infection included GCS, open brain trauma, and postoperative drainage time. Conclusion Despite there has been a secular trend towards reduced incidence of TBI, the prognosis of moderate or severe TBI patients who received surgery showed no significant improvement, indicating that PNG, as a backward developing country, faced a huge problem in TBI prevention and control.

Induced abortion in Papua-New Guinea: Experience and opinions of health professionals.

Papua-New Guinea (PNG) has one of the highest maternal mortality rates in the world; complications due to unsafe abortion are an important cause. Abortion laws are restrictive, and safe, induced abortions are unavailable to the majority of women, while unsafe abortions are known to be practised throughout the country. The topic of abortion is stigmatised, for women and health professionals. To conduct a study of PNG health professionals' experience of induced abortion and their views on the provision of safe, accessible abortion services for PNG women. A questionnaire developed from similar surveys conducted in Australia and New Zealand was distributed in 2017 to doctors working in provincial hospitals of the public health system; in 2020, the questionnaire was distributed to doctors and nursing staff in Port Moresby General Hospital, and to medical, nursing and health sciences students in the University of Papua-New Guinea. Significant numbers of senior medical officers and nurses reported experience of women presenting following unsafe induced abortion. There was wide variation across all respondents with regard to accurate knowledge of PNG's abortion laws, and to views on the provision of safe accessible abortion services in the country's public health system. Abortion training for service providers and provision of primary care services are necessary to ensure that PNG women have equitable access to abortion care instead of seeking out untrained providers or attempting self-abortion. Innovative approaches also need to be adopted to complement family planning efforts in PNG.

A review of mammographic image quality in Papua New Guinea.

IntroductionTo report for the first time the image quality of mammograms performed in Papua New Guinea (PNG) using the Perfect, Good, Moderate, Inadequate (PGMI) image evaluation system (IES); and to benchmark the image quality against BreastScreen Australia (BSA) National Accreditation Standards (NAS).MethodsA retrospective image quality analysis of the de‐identified mammograms of 102 women imaged at the Port Moresby General Hospital (PMGH) was undertaken using the PGMI IES. Each craniocaudal (CC) and mediolateral oblique (MLO) image was assigned a grade and the reasons for the grade recorded. Age was recorded in years. Simple frequency analysis was undertaken and comparison with BSA NAS 2.4 was made.ResultsWomen were aged between 25 and 74 years. There were 111 CC views and 109 MLO views. The most frequent individual grade for the CC view was G (83.8%) and for the MLO view M (72.48%); and for a routine series (four images), P and G combined (14.8%). Non‐visualisation of the IMA (28%), nipple not in profile (26%) and short length of pectoral muscle (12%) were the most cited reasons for assigning an M grade.ConclusionThe reported image quality is not commensurate with that required by BSA (P and G > 50%) and while common positioning errors can be rectified through education and training, it is also important to recognise the complex challenges faced by PNG radiographers in obtaining mammographic images that extend beyond education and training and reflect the emerging nature of the modality as well as wider health, economic and other issues. This work raises the need for national standards, dedicated equipment, and radiographer education to best serve the women of PNG.

Incidence of complications of peripheral intravenous cannula use in children admitted to Port Moresby general hospital: A prospective, observational study

Peripheral intravenous cannulas (PIVCs) are used for administration of medications and fluids in sick children but their use can result in complications. This prospective study was conducted from June to October 2020 at Port Moresby General Hospital in Papua New Guinea. Children who were admitted to the paediatric wards requiring PIVC insertion were regularly monitored to check for complications. Three hundred and thirty PIVCs were inserted in 104 paediatric patients. Eighty six (83%) of the 104 children had at least one PIVC complication which occurred in 220 (67%) of the 330 PIVCs assessed. Tissue infiltration was the commonest complication, occurring in 60% of the PIVCs, followed by phlebitis (29%), cannula obstruction (6%) and leaking (4%). Skin ulceration occurred in 1%. Larger gauge cannulas were more than twice as likely to be associated with complications as smaller gauge cannulas and administration of both medications and fluids more likely to result in complications than administration of medications alone. The incidence of PIVC complications of 83% by patient and 67% by cannula is of major concern. Staff should be aware of the risks associated with PIVC, ensure that PIVS are carefully inserted and stabilized and regularly monitored to prevent, detect and manage complications appropriately.

Living with thalassaemia in Papua New Guinea, the experience of children, adolescents and their families.

Thalassaemia, the commonest genetic blood disorder in Papua New Guinea (PNG) presents daunting challenges for the affected children, their parents and families, and the health system. We aimed to describe the quality of life of affected children and adolescents and the experience of and difficulties faced by their parents in the setting of a tertiary referral hospital in PNG. A mixed-methods longitudinal study involving baseline questionnaire, then serial interviews with parents, children and adolescents living with β-thalassaemia attending Port Moresby General Hospital. Twenty-one patients and their families were interviewed over a 6-month period. Most families originated outside the National Capital District and had migrated to be near the Port Moresby General Hospital and its blood bank services. Thirteen patients had at least one affected sibling and four families had experienced the death of at least one other affected child. No child was receiving chelating agents, and most had clinical evidence of iron overload. There were important impacts of thalassemia on quality of life, including very poor school attendance and some aspects of children's self-perception. Families faced significant burdens and made genuine sacrifices to care for their children. Regular blood transfusions increase the life-span of children with thalassaemia but there is a need to achieve a hyper-transfusion regimen coupled with chelation therapy. As for all chronic illness, a focused and holistic approach is needed to improve the quality of life for affected children and their families.

Relationship between Leadership Style and Hospital Employee Engagement in Papua New Guinea

Engagement, an important concept in the determination of overall employee output, has become an important factor within the healthcare sector, and in light of various challenges facing employees, such as high workloads and long working hours, engagement also plays a significant role in ensuring improved healthcare output. Meanwhile, leadership, which plays a major role in guiding and influencing employees toward goal achievement, is the driving force behind employee engagement. Accordingly, the purpose of this study was to examine the nature of the relationship between three different leadership techniques—transformational, transactional and passive avoidant—and employee engagement in the Papua New Guinea (PNG) healthcare sector. Research has shown that transactional and transformational leadership have the highest level of impact on employee engagement as a result of the role leaders play in the inspiration and stimulation of employees. The methodology applied to examine this statement involved a random selection of 84 health employees from three PNG hospitals: ANGAU Memorial Provincial Hospital, Mount Hagen General Hospital and Port Moresby General Hospital. A correlation analysis of the quantitative research methodology was then applied to evaluate the relationship between key variables in the collected data. A final analysis of results revealed that, within the PNG healthcare sector, transformational and transactional leadership both have a positive relationship with employee engagement, while passive avoidant leadership has a negative relationship with employee engagement.

Treatment Under the Spotlight and Kanguru Mother Care for Body Temperature among Premature Newborn

The purpose of this study was to find out how the comparison between kangaroo cares methods and treatments under the spotlight to control the body temperature of premature infants in the perinatology room port moresby general hospital, papua new guinea. This type of research is an experiment with a posttest only control design. The results obtained Mann-Whitney value of 0.589, which means the value of p-value&gt; rather than α (0.05). Conclusion, there was no significant difference between the control group (under the spotlight treatment) and the intervention group (kangaroo maintenance method).&#x0D; &#x0D; Keywords: Kangaroo Mother Care, Premature newborn, Spotlights

Public/Private Partnership Improves Healthcare Outcomes in Papua New Guinea

This article, written by JPT Technology Editor Chris Carpenter, contains highlights of paper SPE 199373, “A Public/Private Partnership To Improve Healthcare Outcomes in Papua New Guinea,” by Henry Welch, Texas Children’s Hospital, Nirven Kumar, ExxonMobil, and Michael Mizwa, Texas Children’s Hospital, et al., prepared for the 2020 SPE International Conference and Exhibition on Health, Safety, Environment, and Sustainability, originally scheduled to be held in Bogota, Colombia, 28-30 July. The paper has not been peer reviewed. Papua New Guinea (PNG) ranks 157th out of 187 countries on the United Nations (UN) Human Development Index, with extremely high under-5 mortality (5.4% of children will die before the age of 5). In 2013, ExxonMobil PNG (EMPNG) facilitated a public/private partnership (PPP) to improve healthcare education at the University of Papua New Guinea (UPNG) and clinical management in child health at Port Moresby General Hospital and other PNG facilities, as well as strengthen public health capacity. The complete paper reviews the aspects and results of this program. Introduction PNG is one of the more diverse countries in the world, geographically, biologically, linguistically, and culturally. Communicable diseases are a recognized problem in PNG, with pneumonia, diarrhea, tuberculosis (TB), malaria, newborn infections, and other communicable diseases being responsible for 62% of deaths nationwide. Malnutrition remains a significant contributor to morbidity, mortality, and national economic loss. PNG has the fourth highest rate of stunting in the world because of chronic malnutrition - 48% of children experience this deficiency. Malnutrition also contributes to nearly 30% of hospital deaths of children. In recent years, TB, including drug-resistant TB, has emerged as a public health crisis in PNG. With 432 cases per 100,000 population annually, PNG has the sixth highest incidence rate of TB cases worldwide. Twenty-six percent of these TB cases occur in children, which represents the highest such percentage in the world. An adequate number of well-trained healthcare workers is essential to address these issues as well as other health priorities in PNG. The country suffers from a severe shortage of doctors, with 0.05 physicians per 1,000 population. By comparison, neighboring Australia has 3.52 doctors per 1,000 population. Additionally, while the national government is recommending at least 300 new doctors to be trained per year, only one medical school, The University of Papua New Guinea School of Medicine and Health Sciences (UPNG-SMHS) exists; it produces approximately 50 doctors per year. To build healthcare capacity, a needs assessment was conducted. Historically short-term expatriate secondments of faculty to UPNG were 1-3 months and, while beneficial, were unable to provide consistent teaching rotations. Barriers to long-term secondments to UPNG included locating suitable candidates, logistical and safety issues, isolationism, and an extremely high cost of living for expatriates in Port Moresby.

An outbreak of dengue fever in children in the National Capital District of Papua New Guinea in 2016

ABSTRACT Background The first documented outbreak of dengue which included cases with haemorrhage occurred in Papua New Guinea in 2016. Aim To document the presentation and outcome of children with dengue in Port Moresby. Methods This prospective cross-sectional descriptive study was conducted in Port Moresby General Hospital during a 6-month period from 6 January to 6 July 2016. Altogether, 165 children aged 1–14 years who met the WHO criteria for probable dengue were assessed and treated. Clinical features, presence of warning signs and signs of severe dengue, date of onset, management and outcome were recorded. Blood specimens were collected for serological testing and full blood count. Results The median age was 6 years (interquartile range 3–8). Eighty-eight (53%) children had no warning signs and were managed as outpatients. Of the 165 patients, 42 (25%) had abdominal pain, 28 (17%) had bleeding and 3 (2%) had clinical evidence of fluid accumulation. The median (IQR) lowest platelet count in those tested was 34 × 109/L (22–54). Two children were transfused with packed red blood cells and one received a platelet transfusion. No child developed dengue shock and none died. Non-structural protein 1 (NS1) and dengue IgM were positive in 122/144 (85%) and 36/111 (32%) of blood samples, respectively. 150/151 blood samples tested for dengue were positive on one or more tests. Conclusion There is the potential for future outbreaks of increased severity in Papua New Guinea. Surveillance, mosquito reduction initiatives and health education programmes are needed to reduce the impact of future outbreaks.

Nebulised normal saline in moderate acute bronchiolitis and pneumonia in a low- to middle-income country: a randomised trial in Papua New Guinea

ABSTRACT Background Acute lower respiratory tract infections are the commonest cause of hospitalisation in young children and supportive care remains the cornerstone of management. A randomised open trial was undertaken at the Port Moresby General Hospital Children’s Emergency Department (CED) to determine whether nebulised normal saline had beneficial effects. Methods Children <2 years of age presenting with a clinical diagnosis of moderate acute bronchiolitis or moderate pneumonia were randomised to receive standard care alone or with nebulised normal saline administered hourly. The outcomes were the difference in respiratory distress scores (RDS) and oxygen saturation between 0 and 4 hours, and admission rates. Results A total of 199 patients participated; 100 patients were randomised to normal saline and 99 to standard care. At 4 hours there was a significant difference in the change of the respiratory distress scores: mean RDS reduced by 3.41 (95% CI 3.0–3.8) in the normal saline group, and for the standard group, the RDS reduced by 1.96 (95% CI 1.5–2.4, p < 0.0001). In those receiving normal saline oxygen saturation measured by pulse oximetry (SpO2) increased by a mean of 7% (95% CI 6.0–7.9) to 90.7% at 4 hours. For those receiving standard care, the SpO2 increased by a mean of 4% (95% CI 2.8–5.2) to 87.5% at 4 hours (p < 0.001). Of 100 patients, 58 (58%) in the normal saline group and 24 of 99 (24.2%) in the standard arm were discharged from the Children’s Emergency Department (p < 0.001). Conclusions This study supports the use of nebulised normal saline in the treatment of moderate acute bronchiolitis or pneumonia in an emergency department setting in a low- to middle-income country. Abbreviations ALRI, acute lower respiratory infection; CED, Children’s Emergency Department; NaCl, sodium chloride; PMGH, Port Moresby General Hospital; PNG, Papua New Guinea; RDS, respiratory distress score; SpO2, oxygen saturation by pulse oximetry.

Outcomes in children treated for tuberculosis with the new dispersible fixed-dose combinations in Port Moresby.

The new child-friendly fixed dose combinations (FDCs) were introduced at Port Moresby General Hospital, Papua New Guinea, in 2016 for the first-line treatment of children (aged <15 years) with tuberculosis (TB) who weighed <25 kg. To describe the characteristics and outcomes for children treated with the new FDCs, and to identify risk factors for unfavourable treatment outcomes. This was a retrospective cohort study of all children treated for TB with the FDCs from August 2016 to August 2017. Of 713 children included, 488 (68%) were diagnosed with pulmonary TB. Only 6 (0.8%) TB cases were bacteriologically confirmed and human immunodeficiency virus (HIV) status was known in 50%. Treatment outcomes were favourable in 425 (60%) children. Of 288 children with unfavourable outcomes, there were 242 (84%) with loss to follow-up (LTFU) and 25 (8.4%) were known to have died. Children who were severely underweight (weight-for-age Z score <-3) on presentation were at greater risk of LTFU compared to children of normal weight on multivariable analysis (aRR 1.3, 95%CI 1.0-1.6, P < 0.05). Alternative models of care to decrease LTFU during treatment are needed, including integration with nutritional support. Improving diagnosis through microbiological confirmation of TB and HIV are major challenges to be addressed.