Research 2020 Research 2020 Master of Medicine Dr Edwina Baleo. Parents’ perspectives of adolescent sexual reproductive health in Port Moresby A study of parental perception on adolescent sexual reproductive health in Port Moresby, Papua New Guinea. The study demonstrated that there is a need for parental support in improving adolescent sexual reproductive health of young people, as revealed by lack of awareness of adolescent sexuality rights, poor knowledge depth and communication capacity among parents interviewed. While parents were aware that adolescence was an important stage in a child’s life, during which guidance in decision making relating to sexuality is paramount, their depth of understanding of the aspects of sexuality that require attention in a child’s life were limited, including an obligation to ensure contraceptives are encouraged and made available to their children. Most parents based their preventative measures on messages of abstinence which has shown to be an ineffective preventative method. Hence there is a need for comprehensive sexual and reproductive health education amongst parents and adolescents in Port Moresby. Dr Ian Kintwa. Factors associated with mortality in children with acute malnutrition at the Mt Hagen General Hospital in 2019 A prospective study of 150 children with severe malnutrition, investigating clinical and laboratory risk factors for death, measurable at the time of presentation. Children with a capillary refill greater than 3 seconds, tachypnoea, hypoxaemia, reduced conscious level and dysnatraemia (hypernatremia or hyponatremia) were significantly more likely to die. 13 children had prolonged capillary refill the odds ratio for death was 9. 18 children had hypoxaemia and the odds ratio for death was 30. 20 children had a GCS<13 and the odds ratio for death was 56. 28 children had dysnatraemia and the odds ratio for death was 4. To reduce acute malnutrition mortality, children presenting with capillary refill greater than 3 seconds, hypoxaemia, reduced conscious level or dysnatraemia should be identified promptly and given special attention. Clinical and laboratory features of children with malnutrition in Mt Hagen MMed 2020 Dr Violet Nigiria. “Tied for life”: Children with thalassaemia receiving blood transfusions in Port Moresby in 2020 A descriptive longitudinal-qualitative review of thalassaemia patients receiving blood transfusions in Port Moresby general Hospital in Papua New Guinea was carried out. 21 patients who were receiving blood transfusions and their parents were interviewed. There are important impacts of thalassemia on quality of life, as seen in school attendances and self-perception to illnesses. The genuine sacrifices and burden faced by the family were substantial. Issues faced by these families included their knowledge of thalassaemia, end of life discussions, parental concerns, family coping strategies and aspects of positivity about their illness. Most children were from southern coasts of Papua New Guinea. The affected families sacrificed a lot and migrated near hospitals that have blood bank services. Regular blood transfusions had increased the patient’s life span, however this can be improved further by regular monitoring of post-transfusion haemoglobin to maintain a hyper-transfusion state, combined with the introduction of chelation agent. Papua New Guinea need to develop prevention strategies of any birth defects by having the health policy makers aware of the global and local toll of birth defects with associated disabilities and family burdens and develop a genetic screening services for selected birth defects in hospitals, for risk assessment, genetic counselling and education of the family so reliable database for the country can be collected. Finally, provision of holistic and comprehensive care for patients and families with thalassaemia is essential including other children with birth defects. Thalassaemia in children at Port Moresby Hospital MMed 2020 Dr Joseph Ande. Approach to the diagnosis of tuberculosis meningitis in children admitted to the Port Moresby General Hospital In Papua New Guinea childhood TB is a large burden and contributes substantially to child mortality, malnutrition and impaired neurological and cognitive development. Diagnosing tuberculous (TB) meningitis or central nervous system TB in low resource setting is very challenging. The study assessed the current practice of diagnosing children admitted to Port Moresby General Hospital in 2020. 50 children who were admitted with a diagnosis of CNS TB with no underlying prior cerebral lesions were enrolled in this study. The data were collected by interviewing the parents or guardians and from the admission charts. The median age was 45 months. The CSF microscopy result showed the typical picture of CNS TB or TB Meningitis with a very high lymphocytes with very high protein and normal glucose. More than 50% of the population studied had chest x-ray changes suggestive of TB. Gene x-pert detected more mycobacterium TB in CSF more than other samples collected for testing. Based on these results a standardised algorithm in diagnosing TBM in PNG can be designed to further improve detection, management and prevent comorbidities and deaths relating to TBM. Diagnosis of tuberculous meningitis in children MMed 2020 Diploma of Child Health Dr Thomas Johns. The prevalence and risk factors for malnutrition in children attending outpatient clinics in Goroka town In this study, amongst children attending urban clinics in Goroka, 14% had malnutrition. The risk factors associated with malnutrition were; village delivery and residence in a rural area. Other characteristics linked to higher probability of malnutrition were among children who resided in a settlement area, were being raised by a single parent, were adopted, lived in homes where the primary water source was from river supply, and partially vaccinated child and introduction of first feed less than 6 months. However these were not significant. Improvements to reducing rates of malnutrition can be achieved greatest through changes in socioeconomic status of women, ensuring children have a supervised delivery in a health facility where they are provided adequate counselling for basic nutrition amongst other necessary basic health advice, improving accessibility of primary health care to women and children has the potential to reduce the rates of malnutrition that we see in the province and the nation as a whole. Malnutrition in urban clinics in Goroka DCH 2020 Dr Tracey Jeff. The severity and duration of hypoxemia in children with pneumonia in Mount Hagen Hospital Pneumonia and bronchiolitis are the commonest cause of admission to the paediatric ward in Mt Hagen General Hospital associated with hypoxemia for the patients aged 1 month to 5 years. Many patients with pneumonia and bronchiolitis patients presenting with hypoxaemia seem to require longer hospital stay being on oxygen, and this is more commonly seen in the highlands. This study aimed to determine the time taken for hypoxaemia to resolve in children aged 1 month to 5 years, with pneumonia or bronchiolitis at Mount Hagen Hospital Western Highlands Province, Papua New Guinea, and to study the factors predicting prolonged hypoxaemia (SpO2<90% for more than 7 days) and the effect of comorbidities. Among 152 patients, 70 had clinical pneumonia, 20 had clinical bronchiolitis, and the rest had acute lower respiratory infection indistinguishable between pneumonia and bronchiolitis. The median SpO2 in air on admission was 78% (IQR 66-83%). The median days to resolution of hypoxemia was 2.5 days (IQR 1.5 to 5 days), 19.1% still required oxygen at 7 days, and hypoxaemia in all patients had resolved by 18 days. Hypoxaemia was more likely to be prolonged for those with underlying comorbidities. Most children who have just pneumonia or bronchiolitis do not require prolonged hospital stay for supplemental oxygen, while some do but their hypoxaemia resolves within 3 weeks. Better understanding of associated comorbidities and their management will help improve education on the use of oxygen therapy, understand disease progression and complexity and improve management of children with hypoxaemia. Severity and duration of hypoxaemia in children with pneumonia in Mt Hagen DCH 2020 Dr Vanessa Binene. Oxygen saturation reference values measured by pulse oximetry among children living at high altitude in Wabag The use of pulse oximetry is now common in most clinical settings throughout PNG, and it is recognized as a fifth vital sign. The purpose of this research was to determine a reference value of healthy individuals from the age of 1 to 60 months living in Wabag District at about 2300m above sea level, and to determine any factors that can contribute to a lower oxygen saturation in children living that this altitude. There were 266 subjects analysed, the data were normally distributed. The lowest measured SpO2 was 82% and the highest 99% with a mean of 94.8% (SD 2.8%). The 95% CI was 94.5% to 95.1%. Younger children had a lower mean SpO2 than older children living at this altitude, which suggests physiological adaptation to altitude over time, even beyond infancy. Sleep had a lowering effect on arterial oxygen saturation, and babies in bilums whether awake or asleep had lower SpO2 compared to other children. While the clinical significance of this is uncertain, certain young babies may be more at risk of hypoxia and adverse events if asleep in a bilum, and if parents also smoke, and this requires further research. Normal oxygen saturations in children in Enga DCH 2020 Dr Ruth Jaye. Bacteria causing intravenous cannula-related thrombophlebitis and fever, and antibiotic resistance patterns, among paediatric patients at Angau Hospital Thrombophlebitis and fever secondary to the use of intravenous cannula (IVC) is a common occurrence in children at Angau Hospital, and might be a cause of nosocomial infection and avoidable morbidity and mortality. This study was done to identify the causative organisms by doing cultures on IVC tips and identifying the antibiotic sensitivity and resistance of bacteria isolated. The study included children who had IVC during their hospital admission. All IVC tips were collected using a sterile procedure (wearing sterile gloves, sterile scissors to cut the cannula tip, and transport media). Cultures were done on all IVC tips and antibiotic sensitivities done on all isolates. The organisms in the IVC tips that are responsible for causing thrombophlebitis were identified, Gram negative bacteria were most common, especially Escherichia coli and Klebsiella species. These bacteria were resistant to many standard antibiotics.

Research 2015 Research 2015 Dr Edwinah Baleo Improving Severe Acute Malnutrition Care in Buka Dr Ian Kintwa PPTCT in Mt Hagen Dr Mathilda Alloich Birth Asphyxia in Vanimo Dr Mispah Mukap Severe Pneumonia in Kundiawa Dr Paul Wari PPTCT and EID of HIV in Goroka Dr Rosemary Kipalan TB and HIV at Angau Hospital Dr Rupert Marcus Infant Feeding Enga Dr Sharon Kasa Tom GerneXpert in TB diagnosis at PMGH

Photo Gallery Photo Gallery A Voice for Children’s Health in Papua New Guinea

CME 2021 2021 The following are lecture notes on paediatric topics in the DCH and MMed 2021 1 Covid-19 update 2 Pneumonia and bronchiolitis 3 Fever in children 4 Anaemia in children 5 Failure to thrive 6 Vaccines 7 Common paediatric problems I 8 Meningitis and encephalitis in children 9 Oxygen therapy for the Pandemic 10 Fluid and electrolyte management in paediatrics 11 Neonatology – Preterm and low birth weight infants 12 Neonatal infections 13 Endocrine problems in children 14 Paediatric Cancer 15 Intensive management of common paediatric problems 16 Intensive management of common paediatric problems II 17 Paediatric Hospital Reporting Program 18 Common paediatric problems II 19 Soil transmitted helminths in children 20 Cardiac disease in children 21 Cardiac disease in children 22 Common paediatric medical and surgical problems 23 Epilepsy in children 24 Common paediatric medical and surgical problems 25 COVID Delta variant and multisystem inflammatory illness 26 Common kidney diseases in children 27 HIV in children and adolescents 28 Basic research methods how to design a research project 29 CPAP 30 Jaundice and liver disease in children 31 Dengue in children 32 Diagnosis of tuberculosis in children 33 Treatment of COVID infections in children and adolescents

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

Research 2013 Research 2013 2013: Research conducted by the Master of Medicine and Diploma of Child Health post-graduate trainees Dr Mary Paiva Spirometry values in PNG children Dr Doreen Panuawe Child Adoption in Port Moresby 2013 Dr Bardley Ludawane Rheumatic Fever in Honiara Solomon Islands 2013 Dr Janella Solomon Dengue in Children in the Solomon Islands 2013 Dr Winnie Sadua Prevention of parent to child HIV transmission Alotau 2013 Dr Steven Lumasa TB in Honiara Solomon Islands Dr Casparia Mond Child Sexual Abuse in Goroka, Eastern Highlands 2013 Dr Fiona Kupe Rotavirus at PMGH 2013 Dr Thyna Orelly Rheumatic Heart Disease at PMGH 2013 Dr Gamini Vali Rubella in Port Moresby Dr Jimmy Aipit Meningitis in Madang 2013

Contact Contact Get in Touch For information about the website or to report errors, please contact us. First name* Last name* Email* Subject Type Your Message Here Send Quality Care Starts With Informed Practice

Research 2023 Research 2023 Content will be available soon.

Research 2021 Research 2021 Diploma of Child Health Dr Geraldine Lagani Paediatric referrals from Gerehu Hospital Dr Shedrick Wadigi Child injuries in Angau Hospital Dr Dorothy Namba Antibiotic audit in Mt Hagen Master of Medicine Dr Mathilda Aloich Polio vaccine in Sandaun Province Dr Tina Yarong Knowledge and Perceptions of HIV among parents in Port Moresby Dr Andree Zumanu Intravenous cannula complications in children at Port Moresby Hospital Dr Anna Toti Birth defects in Rabaul Dr Winnie Sadua Thiamine status of malnourished children in Port Moresby

CME Continuing Medical Education Q&A 2018 2017 2016 2015 Because Every Child Counts

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 2017 Research 2017 Diploma of Child Health Andree Zamunu Antibiotics for the common cold in Popendetta DCH 2017 In Popendetta, antibiotic prescribing for children with a common cold or minor upper respiratory tract infection was common, occurring in 82% of 108 cases. Children under the age of 1 year, and those with symptoms longer than 5 days were more likely to be inappropriately prescribed antibiotics. When health workers prescribed antibiotics for the common cold they were less likely to give basic symptomatic advice. Annette Garae The spectrum of paediatric cardiac disease in Vanuatu DCH 2017 In Vanuatu, 212 children with congenital (166) and rheumatic heart disease (44) were identified between 2010 and 2016. Through a collaboration with New Zealand 61 children underwent surgery in Auckland, with 60 survivors. 20% of the 212 children were on conservative care, many because of inoperable severe pulmonary hypertension from left to right shunts. 12% of the 212 had been lost to follow-up. Justin Kali Adoption and Feeding Practices among children in Southern Highlands DCH 2017 In Mendi Hospital and rural health facilities in Southern Highlands, 85 adopted children were identified. 61 were subject of customary adoption, 24 infants were bought, and there were no legal adoptions. Most mothers had no knowledge of legal adoption practices, or of appropriate infant feeding practices, and 53 (62%) were adopted in the neonatal period. Nearly half of the adoptive mothers had no formal education. Merlisa Birth asphyxia in Goroka DCH 2017 In Goroka over 6 months 52 babies with birth asphyxia were identified, with an incidence of 2.4%. They had a case fatality rate of 23%. 67% were delivered by midwives and in 58% of cases no partograph was used. The major predictor of death was a low Apgar score at 5 minutes (Apgar of 5 or less). Rachel Masta Malnutrition in Kimbe DCH 2017 In Kimbe, the parents of 20 children with severe malnutrition were interviewed to explore the diversity of the diet given to their children. While most children ate carbohydrates and vitamin A containing food daily, more than half of these children did not have a daily source of protein or other vitamins, and more than half did not have a weekly source of calcium in their diets. Rhondi Kauna Oral Rehydration and outpatient treatment of moderate dehydration DCH 2017 Among 129 children with gastroenteritis and moderate dehydration monitored in the children’s emergency department at PMGH, 63 tolerated oral rehydration and zinc well, taking 25ml/kg of ORS over 2¼ hour of observation without vomiting. All these children recovered with home treatment, and 97% of mothers understood how to give ORS. Of the 66 children who did not tolerate ORS under observation in the CED, all improved with half-strength Darrow’s solution. Outpatient management of children with gastroenteritis and moderate dehydration is safe as long as appropriate safeguards are in place: particularly that the family can access the hospital 24 hours a day, the child has 2-4 hours of observation in ED and tolerates 25-40ml/kg ORS and oral zinc without vomiting, parent education is provided on danger signs and when to return, and the child can be reviewed on day 2. Venao Seta Bempu bracelet and hypothermia DCH 2017 Among 97 low birth weight babies monitored with the new Bempu wrist bracelet, which is designed to detect neonatal hypothermia, 6 hourly temperatures were taken by thermometer 1491 times. On 124 occasions the babies temperature was measured by thermometer as <36 C. On 102 of these 124 occasions that the neonate had hypothermia the Bempu bracelet had an orange alarm, with a sensitivity (true positive) rate of 82%. All the Bempu bracelets lasted the expected life of 4 weeks, there was a high alert for hypothermia and prompt actions, including swaddling and skin-to-skin warming. Illiterate mothers were able to recognise hypothermia with use of band. The study is ongoing. Master of Medicine Diana Olita’a Minimal antibiotics in PROM MMed 2017 Among 133 well babies born at term after prolonged rupture of membranes, with a minimal or no antibiotic treatment approach, any signs of sepsis occurred in only 10 (7.5%) in the first week of life, and an additional 3 between 8 and 28 days. There was only one case of proven bacteraemia, and no deaths. Most of the suspected sepsis cases were a transient fever or skin pustules. Minimal use of antibiotics in PROM in well term babies is safe as long as safeguards are in place to monitor for signs of sepsis. In this study nearly 90% of newborns avoided antibiotic exposure and went home at 48-72 hours. This approach can protect against adverse consequences of antibiotics, including overgrowth with resistant organisms and wheezing. Janella Solomon Malnutrition in Honiara MMed 2017 At the National Referral Hospital in Honiara, 62 of 144 children admitted in a 3 month period had some degree of malnutrition. Of the 62, 27% had severe acute malnutrition, 30% had moderate acute malnutrition, 18% had chronic severe malnutrition and 16% had moderate chronic malnutrition. Only 4 children with malnutrition died (CFR 6.5%), after a major campaign to improve the management of malnutrition at NRH, with training, guidelines, monitoring and audit. Kunera Kiromat JE virus and quality of care for children with encephalopathy in PMGH MMed 2017 Among 97 children with febrile encephalopathy, 5 had Japanese encephalitis, 5 had Dengue, 6 had meningitis due to Streptococcus pneumonia, 1 had meningitis due to Haemophilus influenzae, 6 had malaria, and 19 had suspected tuberculous meningitis. Many aspects of supportive care for children with febrile encephalopathy were frequently not done, including monitoring of blood pressure, blood glucose, anticonvulsant therapy, pupillary assessment and recording, and head elevation to reduce intracranial pressure and prevent aspiration. Other aspects of supportive care were done in more than half the cases, but there was still scope to improve on oxygen administration, Glasgow Coma Score monitoring, recording weight, basic vital signs and providing enteral nutrition. Rose Morre Outpatient treatment of moderate peumonia MMed 2017 Among 120 children assessed as having moderate pneumonia at PMGH, outpatient treatment was successful in 92%. 3 patients were recognised as having clinical signs of severe pneumonia on day 1, and admitted. 117 were treated as outpatients with a single dose of benzylpenicillin, followed by oral amoxicillin for 5 days. Three children were admitted on day 2 with signs of severe pneumonia, and on day 6, 2 children were admitted for non-pneumonia causes. In total 15 children were lost to follow-up. 97 children were cured by day 6. There were no deaths. This study shows that outpatient treatment of moderate pneumonia is safe and effective, as long as safeguards are in place. These include: excluding high risk patients (HIV, neonates), checking for danger signs and hypoxaemia using pulse oximetry, a protocol for education of mothers, including teaching about danger signs and when to return (use structured teaching materials and video), and follow-up and reassessment if a child is not improving to detect undiagnosed conditions which may look like moderate pneumonia (TB, congenital heart disease, HIV). Steven Lumasa PHR in Honiara MMed 2017 Using the Paediatric Hospital Reporting Program as a tool, the case mix and epidemiology of children admitted to Honiara National Referral Hospital was identified. The study identified the more complex diagnoses not summarised in the summary sheet of the PHR, including the different types of TB, the types of cancer, the different types of neonatal sepsis and congenital malformations, and the comorbidities associated with severe malnutrition (anaemia, infectious complications, and underlying chronic conditions). Key findings included: 25% of all admissions were readmissions, suggesting many children have chronic conditions; the highest CFR was for sepsis in older children (63% died); and just over half the childhood cancers did not receive a proper diagnosis of the cancer type. Temane Korowi Neonatal epidemiology in Goroka MMed 2017 In a retrospective study describing 5 years of neonatal admissions at Goroka General Hospital, there were over 5176 admissions, of which 82% were born in hospital, 4% in health centres and 14% at home. The overall neonatal mortality rates was 9.7%, and annual CFRs were 8.07% to 13.1%. The highest causes of mortality were low birth weight, birth asphyxia and meconium aspiration syndrome, and neonatal sepsis. In a multivariate regression the significant independent predictors of neonatal death were LBW, health centre birth and village birth. Babies born in HCs and in villages who are referred to EHPH have higher mortality rates than hospital delivered babies who are admitted to NNU, partly because of referral bias (sicker babies are referred). Bardley Ludawane RHD in Solomon Islands MMed 2017 In a qualitative study of children and adolescents with Rheumatic Heart Disease, the understanding of RDH was explored. Many adolescents knew that RHD affected their heart, and that they needed regular injections, but knowledge among affected patients was often limited. Parents of these children knew they had some sort heart problem, and thought that treatment would make their child better. They showed a sense of trust in doctors, and had a fear of their child missing injections. Because of recent adverse events related to benzathine penicillin injection, and difficulties with syringes being obstructed by powder if not shaken adequately, some clinic health workers were reluctant to give injections. This is a challenge for the RHD program in Solomon.