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

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

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

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.

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

Research 2018 Research 2018 Diploma of Child Health Benjamin Daur Outcomes of paediatric cancer in PNG DCH 2018 At Port Moresby General Hospital, between 2016 and 2018, 61 children with cancer were diagnosed. The mean time of diagnosis from first symptoms was 8 months, and the mean time from presentation to diagnosis was 9 days. Compared with earlier studies from 1998-2001 there has been an increase in retinoblastoma diagnoses and a decrease in the number of children diagnosed with lymphoma. The late presentation is a concern, and messages need to get out to health workers about the signs that could indicate childhood cancer: severe pallor, a lump, swelling of the abdomen, easy bleeding and progressive malnutrition. For retinoblastoma the early signs are leukocoria (white pupillary reflex), strabismus (squint) and eye inflammation or swelling which does not resolve with antibiotics. Heagi Lovai Waiting times in children’s emergency department PMGH DCH 2018 At Port Moresby General Hospital Children’s Emergency Department waiting times for 164 patients was assessed. A 5-tier Australasian Triage classification is used, but there is not consistency of classification between health care workers. Average overall waiting time was 119 mins; 96% of patients in category 1 (the most severe) and category 2 waited longer than specified by the Australasian Triage criteria. There is a need to use a Triage classification system that is easy to understand, such as WHO’s triage system (Emergency signs, Priority signs, or none of the above), and a need to improve staffing in the children’s emergency department, including more nurses and specialist paediatric cover to support the registrars. Rose Hosea Care seeking Behaviour in Mendi DCH 2018 In Mendi, care seeking behaviour of the parents of 100 children requiring admission with pneumonia (53), diarrhoea (43) or both (4) was assessed. 70% of the patients were infants. Many parents sought hospital treatment more than 24 hours after onset of illness despite residing within an hour of the hospital. Most parents who delayed care did so thinking that the symptoms were not serious, and waited at home for them to subside. The presence of more than one symptom of illness seemed to be a motivating factor to seek care, parents understanding that this indicates increased severity of illness. Some parents had false beliefs about the cause of diarrhoea, believing it was normal phase in child development, rather than an infection or illness. Gordon Pukai RCT of Nebulised saline in bronchioitis DCH 2018 In a randomised trial in the Port Moresby General Hospital Emergency Department, children under 2 years of age with clinical bronchiolitis were given either nebulisation with normal saline (x 3 over 4 hours) in addition to standard treatment (oxygen if SpO2<90%, antibiotics, minimal handling), or standard treatment alone. A change in Respiratory Distress Score, hypoxaemia and admission were the main outcomes. The 2 groups were similar to begin with in terms of RDS and oxygen saturation. There was a significant difference in the change in RDS at 4 hours between the 2 groups. Among the 100 that received nebulised Normal saline, the mean RDS fell by 3.41 (95% CI 3.0-3.8), whereas in the Standard group the RDS fell by only 1.96 (95% CI 1.5-2.4). P-value <0.0001. There was a significant difference in the change in SpO2 between the 2 groups. Among the 99 children who received standard therapy the SpO2 increased by 4% (95% CI 2.8-5.2) to a mean SpO2 of 87.5% at 4 hours, and among the 100 who received normal saline the SpO2 increased by 7% (6.0-7.9) to a mean SpO2 of 90.7% at 4 hours. There was a significantly higher discharge rate in those who received Normal saline. 58 of 100 (58%) were discharged, whereas only 24 of 99 (24.2%) who received Standard care were discharged (p<0.001). Master of Medicine Maylin Kariko Follow-up of LBW babies at PMGH MMed 2018 A follow-up study was conducted for 81 low birth weight babies recruited from the Special Care Nursery at Port Moresby General Hospital. The mean birth weight was 1495 g, and the mean gestational age was 34 weeks, meaning these LBW babies were significantly small for gestational age, as well as being preterm. The median length of stay was 19 days, and the discharge weight was 1.54kg. There were 16 known deaths: 13 while in hospital and 3 after discharge. Many infants were lost to follow up. 39 were followed up at a median of 9 months chronological age. The majority of these babies followed up were well nourished with a weight-for-length z-score of -0.3, and most had good head growth (40th centile). 47% had some degree of gross motor developmental delay, although it is too early to be sure. 15 (38%) were admitted to the children’s ward during the period of follow-up, mostly for respiratory and gastrointestinal infections, which highlights the increased vulnerability to community acquired infections in this population. Paul Wari Early infant diagnosis of HIV at PMGH MMed 2018 A descriptive study was done to assess the outcomes of children exposed to HIV in the Prevention of Parent to Child Transmission Programme at the Well Baby Clinic, of Port Moresby General Hospital. 135 children were followed. All received zidovudine for the first 6 weeks of life, and 118 received nevirapine. 58 were exclusively breast fed, 25 formula fed, 40 mixed fed, and in 12 the feeding method was unascertained. 95 received isoniazid prophylactic therapy. 14 (10%) had a positive HIV-PCR test at 6-8 weeks of age. Two thirds (90/135) did not have any follow-up testing at 6 or 18 months and nearly 2/3 were lost to follow-up by 18 months (85/135). 6 were known to have died. There has been a deterioration in PPTCT and HIV services for children since the loss of funding and coordination by the CHAI PNG, leading to high rates of loss to follow up and inadequate testing being done. Vela Solomon MDR TB at PMGH MMed 2018 50 children with multi-drug resistant TB were described at Port Moresby General Hospital. The numbers of children diagnosed from 2004 have increased each year. These children came from National Capital District, Central and Gulf Provinces, and Daru. 38 (76%) had previously undergone treatment for drug-sensitive TB, and 31 had completed this treatment. A contact source for drug-resistant TB was identified in 25 children, and in 10 children the contact was the child’s mother. The median length of illness until diagnosis was 7 months, but many children had received multiple courses of DS TB and other treatments, either complete or partial. 35 children had confirmation of rifampicin resistance on GeneXpert testing, and 15 were diagnosed on clinical grounds alone. 16 were TB culture positive, and drug resistance patterns were identified in 15 of these. Veronica Kalit Rheumatic Heart Disease study MMed 2018 48 children with rheumatic heart disease (RHD) were involved in a longitudinal cohort study, using quantitative and qualitative methods to understand their and their family’s perceptions of their condition, and secondary prophylaxis. These children had quite severe RHD, with 31 having moderate-severe mitral regurgitation, 20 having moderate-severe aortic regurgitation, and 31 on anti-heart failure medications. There were 4 deaths in the follow-up period, including 2 sudden deaths immediately after injections of benzathine penicillin in children with severe heart failure. The deaths lead to a change in secondary prophylaxis at Port Moresby General Hospital: from predominantly benzathine penicillin to daily oral penicillin V. Elizabeth Longa Anaemia in children in Kimbe MMed 2018 In Kimbe 214 children with anaemia (median Hb 6.72 g/dL) were studied. 14 children had a history of chronic illness, including pulmonary tuberculosis (6 cases previously diagnosed), HIV, hypothyroidism and cerebral palsy (1 each). Rapid diagnostic tests for malaria were done in 213 children: 133 were negative, 33 were positive for plasmodium falciparum, 43 were mixed, and 4 were plasmodium vivax 179 children were followed up and had a repeat Hb 5 months after first presentation. The mean change in Hb for the 179 children was 4.07 (SD 2.51) g/dL. Five children died from malignancies (AML and retinoblastoma), severe malaria, HIV and severe malnutrition and meningitis. The mortality rate for severe anaemia can be low if Standard Treatment is followed and comorbidities are identified and treated. Casparia Mond Epilepsy in children in NCD MMed 2018 47 children with epilepsy were studied over nearly 2 years at Port Moresby General Hospital, the median age of the children was 6.5 years. 21 (45%) had normal development, and 26 (55%) had some developmental delay. Most children had generalised tonic-clonic seizures or complex partial seizures. Over 20 months of close follow up and adjustment of medications the proportion of children with good control (less than 4 seizures per month) increased (73% at baseline and 92% good control at 20 months), and the proportion with very poor control decreased. Frequent stock-outs of phenobarbitone, lack of reliable availability of alternative anti-epileptic drugs (sodium valproate, carbamazepine, phenytoin), and financial challenges faced by parents effected the child’s seizure control. For the children with epilepsy stigma and discrimination affected the quality of their lives, but many had strong ambitions to do well in school and get good jobs in the future.

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

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

Research 2024 Research 2024 Below are the research presentations by the 2024 DCH and MMed II registrars. They cover a wide variety of relevant topics, including unvaccinated children, adoption, abdominal tuberculosis, neonatal outcomes in the provinces, pulmonary hypertension of the newborn, thalassaemia, retinoblastoma, severe pneumonia, bronchiectasis, and quality improvement through mortality auditing and having a quality improvement team. DCH 2024 Elaine Waine Challenges in the management of β-thalassemia major ESPH DCH 2024 Elina Kuri Unvaccinated children at Mt Hagen Hospital DCH 2024 Ernestine Gugu Neonatal Admissions to Kavieng DCH 2024 Melisha Barr Adoption a social contributor to malnutrition in Kundiawa DCH 2024 Sylvia Orapa TB Abdomen in Children PMGH 2024 Thomas Du Retinoblastoma DCH 2024 MMed 2024 Vanessa Binene Bronchiectasis MMed 2024 Dasha Namor-Pomat Management of Severe Pneumonia in Children at Rabaul MMed 2024 Mathew Sandakabatu Quality improvement team and mortality auditing in Honiara MMed 2024 Merlisa Kuama Persistent Pulmonary Hypertension of the Newborn MMed

Registrars Registrars MMED and Diploma of Child Health Program Post-graduate paediatric training for doctors is conducted by the School of Medicine and Health Sciences at the University of PNG. Doctors who have completed 2 years post-residency (working as a service registrar) begin by doing a one-year Diploma of Child Health (DCH). This can be done from any hospital in the country that has a paediatrician who can provide supervision. The Master of Medicine in paediatrics is a 4 year course, in addition to the DCH year, during which trainees work as paediatric registrars. The course includes the Part I examination process, one year of a research project, and at least one year working at Port Moresby General Hospital. More details on the Diploma of Child Health and the Master of Medicine can be downloaded at: UPNG Post graduate curriculum DCH and MMed in Paediatrics Keep a log book of your training Paediatric cases log-book 2021 This log-book is designed to be used throughout the 5 years of paediatric training, commencing in the DCH year. Trainees should record details of procedures learnt and practiced, cases managed, courses attended, and research projects. Along with the curriculum, the log-book can guide trainees in the skills and knowledge required to be a paediatrician in PNG. Supervisors should review this log-book as part of regular supervision. How to do a DCH and MMed project and write a minor thesis How to do a research project and write a minor thesis ADC 2018 This paper describes the steps in conducting a Diploma or Masters research project and writing up a project report (a minor thesis). Read it before you start! Epidemiology and practical research methods course slides 2020 A series of 5 lectures: teaching slides on basic epidemiology, research methods and statistical tests Clinical practice for paediatric exams How to do a long case 2019 Paediatric Lectures 2021 Lectures Weekly Paediatric Lecture 1 Covid-19 update Feb 1 2021 Weekly Paediatric Lecture 2 Pneumonia and bronchiolitis Feb 8 2021 Weekly Paediatric Lecture 3 Fever in children Feb 15 2021 Weekly Paediatric Lecture 4 Anaemia in children February 22 2021 2020 Lectures Lecture 1 Covid-19 and children May 2 2020 Lecture 2 HIV in children May 11 2020 Lecture 3 Dengue in children May 18 2020 Lecture 4 Meningitis and encephalitis in children May 25 2020 Lecture 5 Common kidney diseases in children June 1 2020 Lecture 6 Anaemia in children June 10 2020 Lecture 7 Paediatric oncology June 22 2020 Lecture 8 Epilepsy in children July 6 2020 Lecture 9 Child health epidemiology in PNG July 13 2020 Lecture 10 Congenital heart disease July 20 2020 Lecture 11 Congenital heart disease II July 27 2020 Lecture 12 Diagnosis of tuberculosis in children August 3 2020 Lecture 13 Management of CNS TB and TB-related chronic lung disease August 11 2020 Lecture 14 Fluid and electrolyte management in children August 17 2020 Lecture 15 Antibiotics and antibiotic resistance in children August 24 2020 Lecture 16 Neglected Tropical Diseases in children August 31 2020 Lecture 17 Endocrine problems in children September 7 2020 Lecture 18 Failure to thrive in infants and children September 14 2020 Lecture 19 Paediatric mortality auditing September 21 2020 Lecture 20 Neonatal problems September 28 2020 Lecture 21 Neurological examination of children October 12 2020 Lecture 22 Jaundice and liver disease in children October 19 2020 Your Care Today Shapes Their Tomorrow

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.

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