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Disease Surveillance Case Reporting Form Disease Surveillance Case Reporting Forms Acute Flaccid Paralysis (AFP)_Case Investigation Form Acute Fever and Rash (AFR)_Case Investigation Form Pertussis Case Investigation Form Tetanus_Case_Investigation_Form Rheumatic Fever Case Reporting Form Public Health Events Case Investigation Form Contacts for Vaccine Preventable Disease Surveillance: Fiona Kupe (Paediatrician NCD): fionankupe@gmail.com Vienna Nonwo (NDOH EPI) nonwovienna@gmail.com Charlotte Kambaie (NDOH Surveillance) kambaiecharlotte9@gmail.com Masa Takamatsu (WHO VDI) takamatsum@who.int

Discover the history of the PNG Paediatric Society and its journey in advancing child health, paediatric care, and medical training in Papua New Guinea. History On the 40th Anniversary of the PNG Paediatric Society, Dr Mobumo Kiromat summarised the history and achievements of the Society. History of the Paediatric Society 40th Anniversary Dr Mobumo Kiromat

Training Tools Training The School of Medicine at the University of Papua New Guinea runs post-graduate training in paediatrics and child health. The training consists of a 1-year Diploma of Child Health (DCH), followed by a 3-year Masters of Medicine in Paediatrics. The DCH can be done from any hospital where there is a paediatrician. The training is a mixture of clinical paediatrics and public health, with a focus on the common causes of disease in PNG children, available treatments and holistic care, determinants of health and illness prevention, and evidence-based health care. Trainees do a research project for both their DCH and Masters. Curriculum: UPNG Post graduate curriculum DCH and MMed in Paediatrics From Pregnancy to Adolescence — We’re Here Every Step of the Way

Annual General Meeting Current Activities The Paediatric Society met in Port Moresby in June 2014 at the Annual Mid-Year Meeting. The National Child Health Plan 2009-2020 was revised and updated. Some of the key points of progress highlighted in the first 5 years of the Plan were Reductions in malaria Vaccines: Hib in 2008 and Pneumococcal Conjugate Vaccine (2014) Slowing of HIV epidemic, introduction of PCR for early infant diagnosis Increased training of paediatricians through the UPNG DCH and Master of Medicine program, and improved paediatrician coverage in provinces Better surveillance and outcome data at hospital level through the Paediatric Hospital Reporting program Introduction of zinc and better coverage of vitamin A Changes beyond the health sector Improved education, some provinces with free education Primary school enrolments up 300,000 It was recognised that there are still gaps Old conditions not solved Tuberculosis HIV Measles Pneumonia Severe malnutrition Dysentery, typhoid The “new morbidities” Developmental disability Long-term implications of chronic illness Adolescent health Cancer, heart disease Obesity Child mental health

Research 2014 Research 2014 2014: Research conducted by the Master of Medicine and Diploma of Child Health post-graduate candidates Dr Stanley Hannup Binax NOW testing in meningitis in Angau Hospital 2014 Dr Michael Landi Malnutrition at PMGH 2014 Dr Betty Antibiotic prescribing in Honiara 2014 Dr Tina Yarong Immunization in Modilon 2014 Dr Margaret Nablu Malnutrition in Angau Hospital 2014 Dr Veronia Kalit Newborn care practices at Nonga 2014

PHR Reports Paediatric Hospital Reporting Annual Child Morbidity and Mortality Reports The National Health Department’s Child Health Advisory Committee has produced an Annual Morbidity & Mortality Report since 2010. These reports summarise paediatric admissions and outcomes in hospitals in PNG. The reports contain important clinical and public health recommendations for improving child health. Disease Surveillance Case Reporting Forms The World Health Organisation declared Papua New Guinea free of polio and leprosy in 2000. However surveillance is still essential for polio and for other diseases. PNG has a program for reporting of acute flaccid paralysis (for polio surveillance), and acute fever and rash (for measles and rubella surveillance). Reporting forms for these and other notifiable diseases can be downloaded here. Reporting of these diseases requires that health workers know how to identify a suggestive clinical syndrome and take the appropriate test to confirm or exclude the diseases under surveillance. PNG also has surveillance for rheumatic fever and rheumatic heart disease, and severe acute watery diarrhoea (to identify cholera outbreaks). Stronger Communities Begin with Healthier Children

Research 2019 Research 2019 Master of Medicine Dr Rupert Marcus Congenital malformations among 1000 consecutive live births in Milne Bay Province Background: Birth defects contribute 7-10% to neonatal mortality, worldwide 2.3 million children survive each year with lifelong disabilities from birth defects and 90% of birth defects occur in developing nations. Data on birth defects from developing countries such as Papua New Guinea are scarce. We describe the profile of birth defects seen in a birth cohort in a provincial hospital in Papua New Guinea. Aim: To describe the specific types of birth defects in the cohort, to identify possible risk factors, and to direct prevention measures. Methods: Between February and August of 2018, one thousand consecutive babies born alive were assessed for birth defects at Milne Bay Provincial Hospital. Cases were identified and described by the use of the World Health Organization Classification of Disease (ICD-9). Controls were compared with cases utilizing pretested questionnaires. Results: In this study the incidence of birth defect was 28/1000 live births. Defects of the nervous system was most common with 17.9% of cases followed by cardiovascular, genitourinary, ENT and musculoskeletal defects which all comprised 14.3% each. Some characteristics were more represented in cases compared to controls, including maternal age <19 years (OR: 11.9), maternal smoking (OR: 3.8) and lack of folate supplements (OR: 3.5), however, in this relatively small sample of birth defects these were not statistically significant. Conclusion: Birth defects will increasingly play a major part in child mortality and morbidity in developing nations such as Papua New Guinea. Strategies in family planning, adolescent health, maternal health care and folate supplementation/fortification appear important in Papua New Guinea. Dr Allanie Rero Child neglect in Modilon Hospital, Madang – incidence and characteristics Neglect is an important form of child maltreatment which can result in death or permanent poor health throughout life. For the purpose of this study, child neglect was defined when a child’s basic developmental and health needs have not been met by acts of omission by parents or guardians, leading to ill health and hospitalization. Between March 2017 and December 2017 there were 231 patients admitted to the Paediatric ward, 91 of whom fulfilled the definition of neglect. From those that had been neglected in some way 30 (33%) of children were adopted compared to 3 (3.3%) of controls, bottle fed 21 (23.1%) compared to (4.4%), unvaccinated 41 (45%) from 17 (18.7%) respectively. Among the children who had been neglected, severe acute malnutrition 42 (46.2%), followed by tuberculosis 26 (28.6%) and acute gastroenteritis 12 (13.2%), were the leading causes of hospital admissions, while malaria, pneumonia and anaemia were the leading causes in the controls. Mortality was high in the neglected group with a case facility rate of 23%, with severe acute malnutrition accounting for 9 of the 21 deaths (43%). Associated with child neglect were financial stress 25 (28%), parental issues 23 (25%), uneducated parents 15 (17%), closely spaced pregnancies 13 (14.3%), domestic violence 4 (4.4%) and a child with disability 3 (3.3%). Diploma of Child Health Dr Dasha Pomat Management of severe pneumonia in Nonga Base Hospital, a systematic audit In PNG pneumonia remains the most common cause of admission in children with CFR of 9.62% in 2018 for severe pneumonia. This systemic audit was aimed at identifying where care is adequate and where it is lacking and needs improvement in the current management practices of severe pneumonia in Nonga General Hospital, East New Britain Province. The objective of the study was to audit the clinical standard of practice of the management of severe pneumonia in children aged 1 month to 59 months, using a proforma checklist of clinical standards outlined by the Paediatric Society of PNG and the WHO. Dr Clyde Kamo Child death audit meetings at Mt Hagen General Hospital – processes and outcomes Auditing is a vital tool to improve quality of any endeavour. Good auditing with regard to death auditing and reviews depends on the availability of updated credible records, a standard widely accepted auditing protocol and the objective to make adjustments and needed changes to ultimately improve patient care. Over 5 months, the paediatric team in Western Highland Provincial Health Authority has been carrying out monthly death reviews based on the WHO death reporting forms with the aim of identifying common avoidable modifiable causes of deaths. Strategies can then be put in place to improve these factors. This paper looks at the effects of establishing a regular death auditing program and the implications it has for the future care of paediatric patients. Dr Maxon Lifigao Congenital syphilis at National Referral Hospital in Honiara, Solomon Islands This presentation discusses the incidence and clinical features of congenital syphilis, and the incidence of mothers who are VDRL positive delivering at the National Referral Hospital in Honiara, Solomon Islands. In Honiara in 2018-19 of 1535 live births: 130 (8.5%) mothers were VDRL positive; 72 babies (4.7%) babies were VDRL positive; 67 (4.3%) babies were TPHA positive; 7 (0.5%) babies had clinical features of congenital syphilis. The rates doesn’t take into account still births, which are likely to have higher VDRL positive rate. Dr Wilma Luan-Kasso Kangaroo Mother Care amongst preterm newborns in Modilon General Hospital, Madang Kangaroo Mother Care (KMC) was introduced to Modilon General Hospital in 2015 but there were many implementation challenges due to limited resources and a limited level of a supportive and enabling environment. Aim: To assess the impact of intermittent KMC on preterm/low birth weight neonates on discharge outcomes. Methods: This prospective observational study included educational sessions for special-care-nursery staff and mothers about KMC. This was followed by an assessment provided on the care of 38 neonates with birth weights between 1200-2000 grams who received intermittent KMC. Results: Overall, 84% were preterm with 83.3% of the newborns delivered at health facilities with hypothermia on admission. KMC hours ranged from 0-8 hours per day. More than half absconded/leaving hospital against medical advice and 72.7% and 41.7% had weight gains of <5 grams/kg/day and 10 grams/kg/day, respectively. Conclusion: Early essential newborn care practices for preterm/low birth weight newborn and an enabling supportive environment and resources for both the health care worker and mother/career would improve the implementation of intermittent KMC.

Paediatric Teaching Resources Paediatric Teaching Resources Below are the links to some good teaching videos about clinical history taking and examination for different systems, and some procedures. They are all freely available from the Internet, and the sources are acknowledged. Thanks to Dr Paulus Ripa and others for finding these. Gastrointestinal assessment https://www.youtube.com/watch?v=932E4B9UApg&t=103s https://www.youtube.com/watch?v=oJ1CsJJHZCQ https://www.youtube.com/watch?v=H0e8XkYe7uQ&t=47s Respiratory assessment https://www.youtube.com/watch?v=gcS7RS8pXqs https://www.youtube.com/watch?v=gcS7RS8pXqs&t=11s https://www.youtube.com/watch?v=rKgbIEPYqQ8&t=44s Cardiovascular assessment https://www.youtube.com/watch?v=Mu0C_of6Aw0 https://www.youtube.com/watch?v=hTClmf8egGM&t=343s https://www.youtube.com/watch?v=y-n6MWmT1YA Neurological assessment https://www.youtube.com/watch?v=_XTY8YYhkGU https://www.youtube.com/watch?v=HDDVqEa_MpY How to perform a lumbar puncture This is an excellent video from Dr Osama Naga on how to safely perform an LP and how to interpret the CSF findings. https://youtu.be/Md4Bp4HD5xE Developmental assessment https://www.youtube.com/watch?v=RfemPAlDzN4 https://www.youtube.com/watch?v=ThNsIohZzAY&t=208s https://www.youtube.com/watch?v=nxvAaQm659M Airway videos by Sydney intensive care ambulance officers (input the same password to watch each video: “AiRblogVideos”) https://sydneyhems.com/airway-registry/cmac-videos/

Research 2016 Research 2016 Dr Villa Watch TB meningitis at Modillon hospital DCH 2016 Dr Anna Toti Infant feeding practices at Nonga Hospital DCH 2016 Dr Francis Pulsan CPAP on severe pneumonia in children and neonates MMed 2016 Dr Thyna Orelly HIV disclosure in children and adolescents MMed 2016

Child Death Review Meetings Child Death Review Meetings Mortality Review Meetings WHO January 2019 This is a description of how to conduct regular child mortality review meetings. The forms below are used for summarising the cases for discussion, identifying diagnoses, and drawing up a plan for actions and recommendations from the meeting. Below is a lecture describing child death review meetings https://youtu.be/Ec51GpWwhtM Death Register Form 01 The Death registrar form is held in the ward, and the names of children who died are recorded. This is so that at the designated time each week that the audit meeting is going to be held, you will have a list of the cases for discussion. This form is taken to the meeting to ensure that all cases, or the selected cases, are discussed. Child Mortality Reporting Form Final Version 2017 02 The Child Mortality Reporting Form is the main form used at the weekly audit meeting to record information about the case. It is best if the person who is coordinating the meeting fill some of the demographic information in before the meeting, so the meeting can focus on discussing the story, and determining if there are any avoidable factors, and what action needs to be taken. Cause of Death Codes 03 The Cause of death codes is a list of standardised diagnoses. These are common in PNG, and all are included in the PHR. This is in an effort to assign an accurate and standardised cause(s) of death. 04 Action Plan Summary Form 04 The Action plan summary form is a summary each week of the meetings resolutions, which should be reviewed at the next and subsequent meetings to determine if the required action was taken. Over time, by filling out this form and reviewing all outstanding actions, it should be possible to determine if progress is being made.

Annual Paediatric Symposium Paediatric Symposium 2019 Paediatric Symposium Below are the program and presentations from the 2019 symposium. Click on the links to download. PNG Paediatric Society Symposium booklet Day 1: Paediatric education and workforce planning Prof Vince Postgraduate training in Child Health 2019 Dr James Amini Paediatric workforce needs Dr Francis Pulsan Does PBL MBBS curriculum prepare RMOs for paediatric practice? Dr Maylin Karko My expereience in Kaviang To see the MMed and DCH trainee research projects, go to Registrars and Research 2019 Day 2: Child heath program areas Dr Mobumo Kiromat and Dr James Amini Key Result Area 4 in the National Health Pplan 2021-2030 Dr James Amini and Prof Duke Revision of the Child Health Plan 2021-2030 Dr Gamini Vali Paediatric HIV update Mr Petrus Kombea Early Infant Diagnosis of HIV Sr Esther Pisaro Prevalence of HIV in HIV-exposed babies at 18 months by PCR Dr Roland Barnabas Early Essential Newborn Care update HEO Monica Poasa Kangaroo Mother Care at Mt Hagen Hospital Dr Mary Paiva Child Abuse and Child Protection In Focus Sr Jean Kupo Child abuse and Family Support Centres in Kundiawa Day 3: Quality improvement and clinical topics Prof Duke Lessons from the PHR 2018 Dr Paulus Ripa and Dr Jonah Kurubi Clinical Governance, mortality reviews and clinical accountability Prof Duke T National Paediatric Quality Improvement program Dr Rhondi Kuana and Dr Doreen Panauwe Bubble CPAP use in Wabag Hospital Dr Kone Sobi Advanced Paediatric Life Support 2022 - June - Paediatric Symposium Mid year meeting: Strategising the implementation of the Child and Adolescent Health Plan 2021-2030 Sogeri June 6-10 In June 6-10 the Paediatric Society of Papua New Guinea met together for the first time in nearly 3 years. The purpose of the meeting was to strategize the implementation of the Child and Adolescent Health Policy and Plan 2021-2030. The program and detailed abstracts, the recommendations, and the presentations can be downloaded below. PNG Paediatric Society mid-year meeting program and abstracts booklet 2022 Recommendations mid-year meeting June 2022 The meeting was attended by 40 paediatricians with diverse experience in clinical and academic paediatrics, public health, and health administration within Provincial Health Authorities. In addition we welcomed other participants: 5 senior child health nurses from Port Moresby General Hospital; 2 health extension officers; and representatives from the National Department of Health, the Society of Obstetrics and Gynaecology, WHO and UNICEF. Day 1 Dr Cornelia Kilalang Child and Adolescent Health Policy and Plan 2021-2030 Prof Trevor Duke Changing nature of child health epidemiology and what it means for paediatrics Dr Dale Frank National Health Plan 2021-2030 in Milne Bay PHA Dr Roland Barnabas High risk newborns and EENC Dr Mary Bagita Perinatal Mortality at the Port Moresby General Hospital Dr Rupert Marcus COVID-19 in children PMGH 2022 Day 2 Dr Moses Laman Malaria and Lymphatic filariasis Dr Diana Olita’a Rheumatic Heart Disease Ms Martha Pogo Measles situation in PNG Dr. Satish Gupta Stategies to improve routine immunization Dr Debra Preventing re-emergence of polio in PNG Dr Garba Safiyanu Going back to Primary Health Care UNICEF Nutrition program Day 3 Ms Modalen Wobiro Social work role in child abuse Dr Allanie Rero Child protection and abuse Dr Beryl Vetuna Services for the disabled child Dr Fiona Kupe Urban child health NCD Dr Gilchrist Oswyn Community paediatrics in Milne Bay Province Dr Mary Paiva Adolescent Health and wellbeing Dr Mary Paiva Social and community child health – the paediatricians role Dr Monica Hagali Mental health in children and adolescents Dr Vila Watch Paediatric palliative care Ms Francesca Vangun Child abuse a social workers perspective Chemotherapy practical demonstration Jayne Harrison Day 4 Mr Edilson Yano Paediatric Hospital Reporting Dr Gwenda Anga Childhood cancer in PNG Dr Rupert Marcus Pediatric critical care in PNG Prof Trevor Duke PHR brief data 2021 Dr James Amini Paediatric workforce projections Prof Vince Postgraduate training Programme in Child Health 1979-2022 Prof Trevor Duke Current paediatric trainees and future needs 2022 Sr Merelyn Pindau Paediatric nursing Dr Doreen Panauwe Child and Adolescent Health programs in Enga 2022 - September - Paediatric Symposium 46th Annual Paediatric Society Symposium Recommendations Links to presentations from the Paediatric Society meeting are below. Dr Cornelia Kilalang National Standards Dr Roland Barnabas EENC Dr Jason Vuvu Nutrition Programs in order to achieve the NHP Dr Diana Olita’a Cardiology Dr Francis Pulsan Standard in Child Health Training Mr Ambrose Kwaramb Paediatric Healthcare Facilities Design Standards Prof T Duke RCTs child health and developing countries 2022

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