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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 Research Below are summaries of the latest research on child and adolescent health in developing countries: evidence derived from all the randomized trials. The aim is to make this information widely available to paediatricians, child health nurses, midwives, researchers, students and administrators in places where up-to-date health information is hard to find. We hope it will be helpful in reviewing treatment guidelines and clinical and public health approaches, and in teaching about paediatrics and evidence-based medicine. RCTs in child and adolescent health in developing countries 2023-2024 RCTs in child and adolescent health in developing countries 2022-2023 RCTs in child and adolescent health in developing countries 2021-2022 RCTs in child and adolescent health in developing countries 2020-2021 RCTs in child and adolescent health in developing countries 2018-2019 RCTs in child and adolescent health in developing countries 2017-2018 RCTs in child and adolescent health in developing countries 2016-2017 RCTs in child and adolescent health in developing countries 2015-2016 RCTs in child health in developing countries 2014-2015 RCTs in child health in developing countries 2013-2014 RCTs in child health in developing countries 2012-2013 RCTs in child health in developing countries 2011-2012 RCTs in child health in developing countries 2010-2011 RCTs in child health in developing countries 2009-2010 RCTs in child health in developing countries 2008-2009 RCTs in child health in developing countries 2007-2008 RCTs in child health in developing countries 2006-2007 RCTs in child health in developing countries 2005-2006 RCTs in child health in developing countries 2004-2005 RCTs in child health in developing countries 2003-2004 RCTs in child health in developing countries 2002-2003 Healthy Beginnings. Strong Futures.

Health Policies Child Health Policies Child and Adolescent Health Plan 2021-2030 In June 2022 the 3rd edition of the Child and Adolescent Health Plan was launched by the Paediatric Society of Papua New Guinea and partners, in a meeting in Sogeri. The plan outlines the priority areas and activities in line with the National Health Plan 2021-02030, and adds practical detail. The Child and Adolescent Health Plan is for use by paediatricians and Provincial Health Authorities (PHAs) to guide their annual activity plans; and to inform health workers, the community and the Government’s partners about child and adolescent health needs and approaches being adopted. The Plan is in line with the WHO Child and Adolescent Health Redesign, and includes a life-course approach, more emphasis on preventative health, school health, adolescent health, community and social paediatrics, mental health, and chronic diseases. The Plan also updates the program recommendations on HIV, TB, pneumonia, malaria, diarrhoea, and newborn care. PNG Child and Adolescent Health Policy and Plan 2021-2030 WHO Standards for Care of Children and Adolescents in Health Facilities In 2018 WHO published standards for paediatric care in hospitals. These standards are universal and holistic. They include clinical standards aligned to WHO guidelines, and go beyond this to require child- and family-centred care, better environments to care for children, and attention to prevention of disease and protection of children’s rights. WHO Standards for Improving Quality of Health Care for Children and Adolescents 2018 School Health Policy School Health Policy 2016 Child Protection Legislation Lukautim Pikinini (Child) Act 2009 International Code of Marketing of Breast Milk Substitutes International code of marketing of breast milk substitutes WHO 1981 The World Health Assembly Code was ratified by the PNG parliament in the Infant Feeding Act, whereby the sale of feeding bottles, cups, teats and dummies is strictly controlled, and there is a ban on advertising these products as well as breastmilk substitutes. Adolescent Health Policy Youth and adolescent health policy 2014 Nurturing Children, Supporting Families, Empowering Professionals

Hospital Reporting Program Hospital Reporting Program Click here to download and install PHRV12.5 on the desktop Steps to install PHRV12.5 1. Download PHRV12.5.zip 2. Go to the downloads folder and find PHRV12.zip and extract it into the computer (Please use 7ZIP to extract the file to the computer . ) 3. Go inside the PHRV12.5 folder and find PHRV12.5.exe. 4. Double click on PHRV12.5.exe and follow the installation prompts. Paediatric data form PHR 12.5 Neonatal data form PHR 12.5 Maternal and Newborn data form PHR 12.

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 2022 Research 2022 Diploma of Child Health Feasibility of using a Neonatal Early Warning System in Neonates, in Port Moresby General Hospital Special Care Nursery. Dr Roy Iga Neonatal Early Warning Systems DCH 2022 Introduction Worldwide there are about 2.4 million babies that die before the 28 days of life. In Papua New Guinea, case fatality rate for neonates is 5.9% in 2021. As part of improving, quality care for neonates, recommendations were made to use color coded observational charts to assist in providing care for sick children. Even though, In Papua New Guinea there is a color-coded chart formulated and used for children, there are none specifically tailored for neonates. This study seeks to investigate the feasibility of using a Neonatal Early Warning System (NEWS) to identify neonates at risk and to promptly escalate care. Method An observational study was conducted to find out if a NEWS can be used to identify neonates at risk by using current vital observation techniques of nurses in PMGH, SCN. A color-coded observation chart was adapted from the Plymouth Hospital Neonatal Early Warning System chart, and used to collect data over an 8-week period (01 May 2022 to 30 June 2022). 157 patients were recruited in the study and followed up in the first 72 hours of life. Neonates were grouped into two groups, those that have triggers (had vitals that fell in the red zone) and stable group (had vitals that did not fall in the red zone). Results Of the 157 patients recruited 45.86% (n=72) were stable, and 54.14% (n=85) had triggers, that prompt a response. In the group that had triggers 55.29% (n=55) had appropriate interventions done, whilst 44.71% (n=38) did not have the appropriate intervention. It was also found that neonates that had fall in the red zone (triggers) were more likely to die in the first 72 hours of life as compared to neonates who did not have triggers. Conclusion NEWS is a tool that can be used to identify neonates at risk for unfavorable outcomes, however there has to be proper training of its use and knowledge of escalation of care, before implementing it in SCN. A qualitative study on the need for age-appropriate adolescent health care in Alotau Provincial Hospital Dr Leilani Suwari Adolescent health needs in Milne Bay Province DCH 2022 Introduction The adolescent population makes up 22.7% of the total population of Papua New Guinea (PNG). The lack of appropriate health and social services for adolescents in PNG, results in their marginalization. The care of sick adolescents admitted to hospitals in Papua New Guinea should be shared between the paediatric and adult medical units. The current cut-off age for admission to a paediatric ward is 12 years old while the adult wards admit 18 years and above. The management of chronic cases such as congenital or acquired heart problems, epilepsy, cerebral palsy, and multiple congenital abnormalities in this age gap is also an issue. There is currently no allocated ward space and appropriate facilities for sick adolescents in hospitals within PNG. Alotau Provincial Hospital, is no exception to this fact. Hospitals in PNG should support appropriate clinical care of sick adolescents by the introduction of an adolescent unit. This study aims to explore the perceptions of adolescents towards the quality of health care received, in Alotau Provincial Hospital. Methodology A qualitative-observational study was carried out from 26/04/22 – 11/08/22, amongst all adolescents (persons aged 10 – 19 years) admitted to a ward, or receiving out-patient care in Alotau Provincial Hospital, i.e. Paediatric Ward, Paediatric Consultation Clinic, Paediatric TB Clinic, Internal Medicine Ward, Surgical Ward, Obstetrics & Gynaecology Ward, and Antenatal Clinic. Data was collected via semi-structured interviews with participants of the study; and contextual data, obtained from their medical charts. Data analysis was done using the method of Thematic data analysis. Informed verbal consent was obtained from each participant and guardian – of children < 18 years of age; at the beginning of the interviews. Results A total of 57 adolescents were interviewed, 32 adolescents had a negative first impression of the hospital; whilst 25 of them felt the opposite way. 46 adolescents preferred an adolescent-friendly setting, as opposed to their current setting (n = 11); stating that it would allow for positive peer-interaction (n=14), improve their experience in the hospital (n=33), and improve the quality of health care received (n=2). Conclusion This study shows that adolescents are able to perceive the need for adolescent-friendly health services and advocate for improvement in the quality of health care received Master of Medicine Re-presentation of neonatal sepsis to the children’s ward in Port Moresby General Hospital Dr Venao Seta Neonatal Sepsis in PMGH MMed 2022 Introduction This study investigated the incidence of admissions of neonatal sepsis to the wards and further expanded on trying to identify what the common reasons of these presentations were. The study was conducted from November 2021 to April 2022. It was instigated by an observation where there was a rise in admissions of neonates following delivery at the PMGH. This study aimed to find the incidence of NNS admissions to the wards in PMGH. 2) To identify main admitting diagnosis of NNS. Methods Full admissions and consents were done for any neonate admitted via the Childrens’ Emergency Department. Data was collected using a data collection form that attained information on antenatal and delivery history; details of care at home; reason for current presentation and findings of examinations that may suggest sources of infection. Patient outcomes (discharge/died) were included. Results A total of 132 children were recruited to this study. 3 died (CFR 2.2%) whilst the rest recovered and discharged (n=129). The incidence in this study was about 2%. The main reasons for admissions to the wards were due to pneumonia (69), skin sepsis (28), cord sepsis (15), presumed sepsis (14) and abscesses (3). We saw more children with late onset sepsis (n=108) Most of the mothers were booked and were delivered at PMGH (n=120). Conclusions The incidence rate of 2% may not be entirely reflective of the true picture of NNS within the hospital due to the small sample size. Pneumonia was still a leading cause of admission in this study. This is also true for admissions in the older paediatric population as indicated in the Child Health Mortality report for 2021. Most of these presentations were of late onset sepsis; this finding reflects conditions and care of the newborn at home. A visit to individual households would have added more value to this study. We recommend the following: 1) A similar study be done nation-wide with more emphasis on risk factors of neonatal sepsis at the household and community level. This would provide a preventative approach to reducing neonatal sepsis at household and community levels thus reducing late onset sepsis to a certain degree. 2) There should be more emphasis for staff to advocate on KMC and essential early newborn care as in this study we identified that only 3% (n=4) out of the 132 recruited were told about and practised KMC. Survey of paediatric palliative care at Port Moresby General Hospital Dr Villa Watch Paediatric Palliative Care MMed 2022 Paediatric palliative care as defined by the World Health Organization involves the child’s body, mind, and spirit, but also involves supporting the family. Palliative Care starts from diagnosis and continues whether child is receiving curative treatment or not. As clinicians, identifying and relieving the child’s physical, psychosocial, and spiritual distress is imperative. This study aims to identify the characteristics of children admitted to the Paediatric Ward of the Port Moresby General Hospital with palliative care needs and how parents and health care workers view the palliative care services provided to these children. Data will be collected from the child’s admission chart and will be analysed using frequency and percentages while in-depth interviews will be carried out on parents and health care workers using semi-structured questionnaires which will be analysed using thematic analysis. The results will be useful in improving palliative care for children admitted with life-threatening and life-limiting illnesses in our setting. A cohort of children with HIV in Papua New Guinea during an era of anti-retroviral transition. Dr Gordon Pukai HIV and ART in children MMed 2022 Introduction 2019-2021 was an era of transition of anti-retroviral therapy from non-nucleoside reverse transcriptase inhibitor (NNRTI) based therapy to the new dolutegravir (DTG) based treatment. This study was conducted to observe the difference in the clinical and virological outcomes in the children with the new DTG and Lopinavir-ritonavir (LPVr) regimes as compared to their previous NNRTI-based ART regimens at Port Moresby General Hospital. Methods The participants were 60 children living with HIV who were followed at the Well Baby Clinic at PMGH. A survey form was filled included infants and children less than 18 years old. Results At enrollment in the study, 25 children had moderate malnutrition; 27 children had severe malnutrition; only 8 were well nourished. Fifty-three of the 60 were on an NNRTI based regimen. 2 were on a triple-NRTI based regimen, and 5 were on a lopinavir-ritonavir based regimen. 52 children underwent viral load testing and 37 had viral load levels >1000 copies per ml. Only 15 had adequate viral suppression with viral load <1000 copies per ml. Thirty-nine children out of 60 had clinical failure as defined by WHO. Of the 37 who had viral load >1000, all had evidence of clinical failure. Of the 54 children tested post change to the new ART regimen, 49 (90.7%) had viral load levels <1000. 5 had viral load >1000. 41 children had a reduction in their viral load after changing treatment, 1 had an increase, and in 5 the viral load was unchanged. Conclusion The DTG- based regimen provides adequate reconstitution of immunity, an effective reduction in the viral load and good clinical improvement. The outcome of low birth weight babies in Vanuatu Dr Annette Garai Low birth weight babies in Vanuatu MMed 2022 Background Low birth babies (LBW) are a fragile cohort. Medical technology has increased survival of these babies. In Vanuatu, improving their outcomes and survival is a significant health challenge. The objective of this study was to prospectively document the outcomes of LBW babies admitted to Special Care Nursery (SCN). Recording the mother’s experiences of caring for a LBW baby was a secondary objective. Methods This is a prospective descriptive cohort study compromising of 49 recruits weighing less than 2.5kg from April to August 2019. Patients were followed up at six and twelve months post discharge and their outcomes recorded. A qualitative study was conducted to identify experiences and challenges the mothers faced in caring for a LBW baby. Results Thirty-nine babies followed up. Thirty-four patients gained good weight in their first six months of life. At 12 months post discharge, 19 babies had pallor, 17 had normal head ultrasound scan, and 1 baby had retinal detachment. Most babies achieved their developmental milestones by 12 months. Mothers identified stress as a common risk factor for their premature delivery. Conclusions This study outlined the outcomes of LBW babies in Vanuatu and highlighted issues of concerns by their mothers. It is vital that all LBW babies are followed up well after discharge from SCN. Equally important is the support for mothers of LBW babies to achieve better outcomes. Procedural sedation for paediatric CT scans Dr Benji Daur Sedation for CT scans in children MMed 2022 Introduction Computerized Topography (CT) scans have been an important diagnostic tool since its introduction in the 1970s. The success of Paediatric CT scans are complicated by anxious uncooperative children and the administration of sedation has proven beneficial in improving success of completing the procedure. The primary aim of this study is to evaluate the safety and effectiveness of procedural sedation protocols provided by paediatric clinicians who are not trained anaesthetists for Paediatric CT scans in Port Moresby General Hospital (PMGH). Secondary aims include identifying complications and factors that could influence success of oral chloral hydrate and intravenous diazepam. Methods A prospective observational analysis of procedural sedations for CT scans between September 2020 to June 2021. Port Moresby General Hospital CT scan room. Results 99 sedation events were included in this cohort. 49 patients received oral chloral hydrate and 50 received intravenous diazepam prior to the procedure. 11 failed sedations occurred most noticeable from the diazepam group (Fisher’s exact p=0.008). Complications included vomiting (3) and over-sedation (4) in the chloral hydrate group. Significant factors that influence success include the drug used and ASA of patient prior to study. Conclusions This study has proven that paediatric clinical staff can provide safe and effective procedural sedation for children who require CT scans in hospital with oral chloral hydrate and intravenous diazepam. Children and adolescents admitted with Covid-19 infection at the Port Moresby General Hospital Dr Justin Kali Covid-19 in children and adolescents MMed 2022 Introduction COVID-19 is a global pandemic which has infected and killed millions of people throughout the world. Healthcare systems have faced are lot of challenges in fighting this disease and scientists are conducting studies to investigate this killer disease. Numerous case reports and studies have been done on the clinical characteristics, outcomes, and treatment of COVID-19 however the studies done in children are limited. There is no study on COVID-19 in children in Papua New Guinea. The aim of this study is to describe the clinical characteristics and outcomes of children and adolescents admitted with a positive test of COVID-19 at the Port Moresby General Hospital. Method This study is a retrospective descriptive study of children and adolescence admitted to the Port Moresby General Hospital who has tested positive for Covid-19 over a period of 6 months. The study mainly looked at their clinical characteristics and outcomes. Data was extracted from (1) PMGH laboratory COVID-19 data and (2) Admission charts according to a modified form derived from case information forms (CIF). Results Sixty patients tested positive for COVID-19 during the 6 months and were sick enough to be admitted to the paediatric isolation wards. The median age was 17 months. The most common symptoms were fever in 53 (18.5%), cough 47(16.4%), poor feeding 44 (15.3%) and dyspnoea 39 (13.6%). The most common clinical signs on examination were chest indrawing 35 (44.9%), nasal flaring/grunting 19 (24.4%) and pallor 15 (19.2%). Five (6.4%) had reduced level of consciousness and 2 (2.6%) had signs of shock. Clinical diagnosis saw nearly half of the patients admitted for COVID-19 pneumonia alone 28 (46.7%) and the other 33 (55.2%) was COVID-19 with other diagnosis. Twenty-eight (46.7%) of the COVID-19 patients had comorbidities. Most COVID-19 cases were mild 45 (75.0%) and 5 (8.3%) had severe COVID-19. 50 (83.3%) patients received empirical antibiotics and systemic corticosteroids. Eleven patients died (case fatality rate 18.3%), 4 (6.7%) absconded and 4 (6.7%) left hospital at their own risk. Of the 11 children that died, all had COVID-19 pneumonia, 1 (1.7%) also had multisystem inflammatory syndrome and 3 children (5.1%) had significant comorbidities that contributed to their deaths. Conclusions The clinical characteristics of children infected with COVID-19 were similar to other studies done in other countries. Most of the COVID-19 cases were mild. Children with comorbidities infected with COVID-19 have increased risk of mortality.

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.

Guidelines Treatment Guidelines PNG Standard Treatment for Common Illnesses in Children The PNG Standard Treatment manual for common illnesses in children has been continuously in print since 1975, and is now in its 10th Edition. It is one of the longest running clinical guidelines in the world. Members of the Paediatric Society revise and update the manual every 5 years, drawing on international and local evidence and experience. PNG Standard Treatment Book for Children 10th Edition 2016 WHO Pocket Book of Hospital Care for Children The Pocket Book of Hospital Care for Children is a clinical guideline used in provincial and district hospital for hospital management of serious illness. The second edition was published in 2013. There is a 4-day training course that teaches staff how to use the guidelines in clinical practice. The Paediatric Society is active in training health workers in many provinces. Training is linked to other measures to improve quality of care. Hospital Care for Children Paediatrics for Doctors in PNG Paediatrics for Doctors in PNG was originally written in the 1980s by Frank Shann and Professor John Biddulph. The book was revised in 2000 by Prof John Vince and Prof Frank Shann. It contains guidance on practical procedures and the treatment of many common conditions. Download Paediatrics for Doctors Child Health for Nurses and HEOs This third edition of the text-book on child health for nursing and HEO schools and reference for nurses looking after children was completed in 2022. Child Health for Nurses and HEOs in Papua New Guinea 3th Edition March 2022 PNG Standard Treatment Manual for Obstetrics and Gynaecology These guidelines have been produced since 1986 by the O&G Society, with input from the Society of Midwives. The latest edition, edited by Professor Glen Mola, contains many updates on new treatments, and new diagnostics, including ultrasound. PNG Standard Treatment Manual for Obstetrics and Gynaecology 7th Edition 2018 Oxygen Therapy Guidelines WHO Oxygen therapy for children 2016 Bubble-CPAP guidelines 2017 Child Health Record Book Every new baby in PNG should have a Child Health Record Book (Baby Book) for recording vaccines, weight, any illnesses and how they are treated. This is a very important book, and should be kept in a safe place and brought to the clinic at every visit. The Baby Book also contains information for parents on feeding, what signs of illness to look out for, and family planning. Weight charts are essential for growth monitoring, you can download these below. Baby Book Girls Baby Book Boys Monitoring Growth and Nutrition Weight for age chart Girls 0-5 years Weight for age chart Boys 0-5 years For older children monitoring growth is also important, especially in children with a chronic illness. Below are the WHO body mass index charts for females and males aged 5-19 years. Body mass index charts 5-19 years WHO Mid upper arm circumference (MUAC) is a useful screening test for malnutrition. The chart below shows reference ranges for different ages, so MUAC can be useful from infants to adolescents and adults. This chart was designed by the University of Rochester, adapted from WHO guidelines. Malnutrition – Guidelines and Tools for Management In this section there are tools to guide management of children with severe and moderate malnutrition. The case fatality rate for severe malnutrition in PNG hospitals was 18-20%, but this has now been reduced with a systematic approach. Our target is to eliminate all preventable deaths and have the case fatality rate for severe malnutrition well under 10%. Severe acute malnutrition PNG guidelines 2018 Management of severe malnutrition wall poster F75 and F100 Milk feeding chart Recipes for home-made F75 and F100 Inpatient Weight Chart Severe Malnutrition monthly recording form Nutrition Education Resources Frangipani Friendly Clinic Healthy Plate Poster Pasifika Plates Recipe Book HIV Treatment Guidelines These guidelines highlight the importance of using new combination ART, given the high rates of resistance to non-nucleoside reverse transcriptase inhibitors (NNRTI). All children should be transitioned or commenced on Dolutegravir (DTG) based therapy: Abacavir (ABC), Lamivudine (3TC) and DTG as 1st line treatment – see UPDATE Summary below. For adolescents over 30kg, the preferred 1st line regimen is Tenofovir (TDF) + 3TC + DTG. The new guidelines also highlights the need for regular viral load monitoring and clinical assessment to detect treatment failure. PNG HIV care and treatment guidelines 2019 UPDATE Memo from NDoH on DTG-based therapy for children Nov 2021 UPDATE Summary of ABC 3TC DTG therapy for children and adolescents Nov 2021 Instructional video: How to Administer Lopinavir/Ritonavir Pellets to Children with HIV Nurse Abigael Wanyana from Gertrudes Children’s Hospital in Kenya shows clearly how to give Lopinavir/ritonavir (LPV/r) pellets to children. LPV/r is part of second-line therapy for children and adolescents, and is bitter tasting, so mixing with expressed breast milk makes it palatable. WHO Guideline on Management of Tuberculosis in Children and Adolescents (2024) WHO Management of tuberculosis in children and adolescents Module 5 2024 This comprehensive WHO guideline covers all aspects of TB diagnosis, treatment, prevention and prophylaxis. WHO Treatment Guidelines for Multi-Drug-Resistant Tuberculosis (2019) WHO guidance on MDR Tuberculosis 2019 The MDR regimen depends on the drugs you have available and how unwell the child is. See pages 96-99 of this WHO guideline on MDR, it contains the medication doses and weight bands for children. Look at the charts, and in general choose 1-2 drugs from each class (A, B, C), until you have at 4-5 drugs. For example: A: Levofloxacin B: Cycloserine C: Ethionamide and pyrazinamide and para-amino-salicylic acid (PAS) Avoid injectable aminoglycosides (kanamycin / amikacin) if bedaquiline or delamanid are available, to avoid IM injections and serious side-effects, especially deafness which occurs in 20% of children on long-term aminoglycosides. Child Protection, Maltreatment and Gender-Based Violence Child maltreatment clinical handbook WHO 2022 Child protection resources Sexual and gender-based violence clinical guideline 2021 1-Tok-Kaunselin Helpim Lain Service Provider Directory 2017 Paediatric Cancer Protocols Click here for more details of the PNG paediatric cancer protocols, developed by Dr Gwenda Anga. Evidence-Based Care. Lifelong Impact.

Hospital Care for Children Hospital Care for Children Hospital Care for Children: Education Modules Below are modules for the WHO Hospital Care for Children course which teaches health workers how to use the guidelines in everyday clinical practice. The course teaches the 10 Stages of Management of all sick children: Triage, Emergency treatment, History and examination, Laboratory investigations, Main diagnosis and other diagnoses, Treatment, Supportive care, Monitoring, Discharge planning, and Follow-up. The course can be done as a 4½ day workshop, or a module each week for 10 weeks. It can be done in groups as a workshop or individually for self-learning as part of Continuing Medical Education for nurses and doctors. Practice using the guidelines in the wards is an essential part of learning. The course material were last updated in February 2023. Hospital Care for Children course timetable 2022 Overview and introduction (2026) Chapter 3. Early Essential Newborn Care (2023) Chapter 3. Low birth weight (2026) Chapter 3. Neonatal infections (2026) Chapter 3. Birth asphyxia and resuscitation (2023) Chapter 4. Cough and difficult breathing II complex case (2026) Chapter 4. Cough and difficult breathing I Chapter 4. Chronic cough and fever (2025) https://ea8e41db-a279-4a00-b75a-4ac937e24937.usrfiles.com/ugd/ea8e41_761b3ba26aa94ca798af0d6e3dae3240.ppt Chapter 4. Oxygen therapy for children (2023) Chapter 5. Diarrhoea and severe dehydration (2023) Chapter 5. Diarrhoea and dehydration II Chapter 6. Fever in an infant (2024) Chapter 6. Fever, convulsions and coma Chapter 6. Fever and joint pains (2026) Chapter 7. Malnutrition (2023) Chapter 8. Children with HIV (2026) Chapter 9. Trauma (2025) Chapter 9. Burns Chronic illnesses in children (2023) Prevention of infections (2022) Vaccine preventable disease surveillance (2026)

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

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

2022 - Weekly Paediatric Lectures 2022 – Weekly Paediatric Lectures Paediatric training overview and how to learn https://youtu.be/MzbUAiWAopo This teaching session focuses on the many ways we can learn paediatrics and child health, so that trainees can make the most of the learning opportunities, and include them into a learning plan for 2022 and beyond. COVID in 2022 and the other side of the pandemic https://youtu.be/WAP7soFUK6g This session covers where COVID is up to in 2022. We discuss the SARS Co-V-2 variant Omicron and its effect on children. We know a lot about this in the last months from what has happened in South Africa and other heavily affected countries. We need to understand the ways in which COVID in 2022 is different from 2021 and 2020, and what it means for paediatrics (mostly it will be good news!) In addition to vaccines, what other therapies are useful in COVID? Type 1 Diabetes in children https://youtu.be/44Iaw79ktZU In the past type 1 diabetes was rare in children in the Pacific, but it is now increasingly, as it is in all countries around the world. Children with diabetes need careful management of their initial presentation – usually ketoacidosis, and they need careful transition to chronic long-term treatment. There is a lot to think about when we are looking after a child with diabetes, but if we manage all issues then these children can have a very good outcome. In this session we cover all stages of management and describe the complications and pitfalls to avoid. Meningitis and encephalitis in children https://youtu.be/Z3q85tj5zVw This teaching session covers meningitis and encephalitis, and other causes of acute febrile encephalopathy. We cover diagnosis and treatment, including basic measures to prevent secondary brain injury – we will go through all the causes and how to prevent them. To care for such patients, we need to understand the rationale for using certain antibiotics in meningitis, antimalarial therapy in cerebral malaria, and how to monitor children properly to prevent secondary brain injury. We also cover identification and treatment of complications (such as cerebral abscess) and when to suspect other causes (tuberculosis, cryptococcosis, non-infective causes). Pneumonia and bronchiolitis https://youtu.be/UIEIiCBlSdI Pneumonia is the most common cause of child morbidity and mortality, and it is both simple and complicated. Treatment guidelines outline a Standard treatment approach for simple pneumonia, but many cases are complicated, and we need early recognition of such cases. We need to improve risk assessment for children with pneumonia, and this involves early recognition of risk factors. If we recognise these risks early, we can put in place measures to achieve a better outcome. These risks include hypoxaemia, WHO emergency signs, malnutrition, chronic comorbidity, neonates, special x-ray changes, and sometimes other laboratory tests. We need to identify complicated cases of pneumonia, especially empyema, and lung abscess, and cases that will not be treated with standard antibiotic therapy, including tuberculosis or Staph pneumonia. There are ways to do this, and we discuss in this teaching session. Antibiotics and antibiotic resistance https://youtu.be/LCL5wJEFeEo Antibiotics treat bacterial infections, but in the last 25 years bacteria causing common infections are becoming resistant to many antibiotics, in Papua New Guinea and in all countries. We need to understand the mechanisms of antibiotic resistance, the different types of resistance in different bacteria, and the options of treatment. Standard Treatment is still effective first line treatment for most common infections, but we need ways to identify clinically and with simple tests the patients most at risk of antibiotic resistance. We can put in place steps to limit antibiotic resistance in our hospitals and paediatric wards, this is called antibiotic stewardship, and we discuss the ways to do this. Epilepsy in children https://youtu.be/rhiUQQFbpCI Epilepsy is common in children, as high as 1-4% in some communities. We need to know how to diagnose epilepsy, an understanding of the types of childhood epilepsy, the anti-epileptic medications, why to choose certain drugs, their complications, what to do if one drug is not working, and the overall goals of care for children with epilepsy. Most children and adolescents with epilepsy can have a good outcome if they and their families are cared for in a holistic way. Fluid and electrolyte management https://youtu.be/6i37wZV1SVo In this session we cover the essentials of fluid and electrolyte management in children, including the type and volume of fluid to use, the dangers of low sodium containing intravenous fluids formerly commonly used in paediatrics, the risks of hyponatraemia and hypernatraemia and how to treat, the importance of clinical monitoring of oedema and dehydration, and how to calculate fluid replacement in a child with severe dehydration, including the deficit, maintenance, and ongoing losses. Neurological examination of children https://youtu.be/QN5vHMKXzMw In this session we go through the neurological examination of children and describe a practical approach to making clinical diagnoses – by first asking “where is the lesion”, to locate the neurological abnormality, and afterwards ask “what is the lesion”. With history and neurological and general examination, many clinical diagnoses can be made. Vaccines and vaccine preventable diseases https://youtu.be/SSBU5XcrHqo This session covers the basic information paediatric trainees need to know about vaccines and the diseases they prevent, the history of the expanded programme of immunisation (EPI), the different types of vaccines, and the recent changes to the vaccine schedule. This will help you become familiar with the current EPI schedule, and vaccine terminology, for example what live attenuated, inactivated, recombinant, conjugate, and adjuvant mean. We also cover the science of why measles outbreaks occur, and the reasons for recent polio and pertussis outbreaks in PNG. Failure to thrive https://youtu.be/II2C6KV2BPs Failure to thrive is a common paediatric presentation. It is not just malnutrition but encompasses the developmental impact of poor nutrition. Failure to thrive is often a combination of inadequate energy (calorie) or protein intake, inadequate absorption of nutrients in the gut, increased energy utilisation, underlying infectious or genetic condition, psychosocial and environmental factors. It is important to understand each component to manage these children properly. We will discuss the assessment of a child with failure to thrive, the stages of management of severe malnutrition according to WHO and Standard Treatment guidelines, and how to identify and manage refeeding syndrome, which can cause patients to deteriorate after recommencing feeds. Neonatology I: care of the very low birth weight baby https://youtu.be/LV-tib4RQJg In this teaching session we cover definitions of low birth weight and prematurity, gestational age assessment, multi-system complications of prematurity, respiratory complications and care for the developing lungs, nutrition and growth monitoring, gastrointestinal complications, retinopathy, anaemia, hospital discharge criteria and follow-up of very low birth weight babies. Neonatology II – infections https://youtu.be/rzlfrFFdyNc In this session we cover all common neonatal infections: bacterial, viral, including intrauterine, and post-natally acquired infections in newborns. Paediatric mortality and morbidity audit meetings https://youtu.be/ROiuFhpnPpQ Auditing of child deaths allows the identification areas that can be addressed to improve quality of care. About 50% of child deaths have at least one modifiable or preventable factor: in the community, in primary health care, or in hospitals. Audit is an important process, but it must be non-blameful, open to and supportive of all staff, and educational. This teaching session goes through how to run M&M meetings, and the importance of follow-up after such meetings by a quality improvement team to put changes in place. All hospitals should do regular audit, and paediatric trainees need to learn how to conduct these meetings. Cardiac disease in children I https://youtu.be/Iw7pDHKo_BE In this first of two sessions on paediatric cardiology, we will discuss the causes of heart failure at different ages, especially focus on acyanotic congenital heart disease, and the most common left to right shunts (ASD, VSD, PDA). We will go through how to assess cardiac function clinically, and how to integrate the history (age of presentation, severity, symptoms, associated features), the examination finding, the chest x-ray and ECG to make the diagnosis 90% of cases. We will cover the basics of echocardiography, but very often we can make a working diagnosis on clinical grounds and with proper interpretation of x-ray and ECG. Cardiac disease in children II – cyanotic CHD and pulmonary hypertension https://youtu.be/Hm5TyQ8GmwI In this session we will discuss cyanotic congenital heart disease (CHD), its different presentations in the newborn period, infancy, and older childhood. We will discuss how to manage the cyanosed neonate, who might have CHD, but also might have other conditions, such as persistent pulmonary hypertension of the newborn (PPHN), sepsis, or congenital lung disease. We will also discuss acquired pulmonary hypertension that arises due to chronic lung disease, severe pneumonia, high altitude, and nutritional issues, especially a problem in the highlands. In this session you will learn the ECG and x-ray changes of common forms of cyanotic CHD and pulmonary hypertension, so the diagnoses can be made using clinical features and basic investigations. Renal disease in children https://www.youtube.com/watch?v=utB37NOvkbA We cover nephrotic syndrome, post Streptococcal glomerulonephritis and congenital renal diseases that can lead to chronic renal failure. We also cover acute renal failure and its management, nephrotoxic drugs and management of complications, particularly hypertension. Adolescent health Part 1: https://youtu.be/styx0_YSIyA Part 2: https://youtu.be/REIx6UKoAhg This teaching session in 2 parts, by Dr Mary Paiva covers the main issues in adolescent health. Adolescent health is increasingly important in PNG, and paediatricians need a good understanding of the neurobiology, the neurodevelopmental transition and vulnerabilities of adolescence, the factors that influence health seeking behaviours of adolescents, and their health concerns, including sexual health, mental health, substance use, nutrition, and particular issues for adolescents with chronic diseases. Dr Paiva discusses the roles of health services for adolescents in hospitals and in the community, in prevention, education and treatment. Anaemia in children Video links (in 2 parts): https://youtu.be/Ra_eq54-7TY https://youtu.be/h8mQbv1bH1Q In 2021 anaemia was reported in at least 7% of all paediatric hospital admissions, the case fatality rate was 12%, and anaemia was a comorbidity in at least 17% of all child deaths. Anaemia increases the risks of infection, poor growth and development. In this session we will cover the common causes of anaemia in children, especially iron deficiency and nutritional anaemia. We will discuss how to assess the child with pallor, how to distinguish based on clinical features and an analysis of the FBC the different causes of anaemia. We will cover iron physiology, anaemia of malaria, anaemia due to haemolysis and anaemia due to bone marrow failure, and Thalassaemia. We will also discuss nutritional treatment of anaemia, safe use of iron, and indications for blood transfusion. Soil transmitted helminths in children Video link https://youtu.be/OyGiBaejNjQ WHO identifies soil-transmitted helminths as among the neglected tropical diseases (NTD). Many children in PNG are affected by these infestations, including from Ascaris, Human hookworm, Cutaneous larva migrans (dog hookworm), Whipworm, and Strongyloides. This session will discuss sources, lifecycles, clinical features, and treatment of these infections, which cause a lot of morbidity and nutritional problems in children. Trainees need a good understanding of the basics of helminth infections, as they are often truly neglected in our management of patients. Liver disease in children Video link: https://youtu.be/geKKZWi3VgA Liver disease is more common than may think, being caused by a variety of conditions directly affecting the liver, and systemic infections where liver dysfunction is a part of it. Liver disease can be a part of virus, bacterial and parasitic infections, cancer, and drug side effects. Paediatricians need to have a good understanding of liver anatomy and physiology, the different functions of the liver, the production and excretion of bile, and the significance of different tests of liver function. In this teaching session we discuss the differences between physiological and pathological jaundice in newborns, thresholds for phototherapy, the various forms of congenital liver disease such as biliary atresia and neonatal hepatitis. We also cover liver disease in older children, where we need to distinguish acute from chronic liver disease and recognise the effect of drugs on liver function. We can diagnose most liver diseases with a good history, clinical examination, and an understanding of the basic LFTs. Although there is often no specific treatment that can be given to children with liver disease, many types of liver disease resolve with time, and there are important ways to support such patients to give their liver the best chance of recovery. Paediatric x-rays Video link: https://youtu.be/xBNqltqj8P4 In this teaching session we will go through a series of x-rays to show common problems in seriously ill children and learn how to relate the changes you see on x-rays to the clinical picture and pathophysiology. So many diagnoses can be made by linking these things together (clinical, x-ray, pathophysiology). In the DCH and MMed exams you will need to be interpreting x-rays, so watch the session if you can. Management of critical illnesses in children I Video link: https://youtu.be/WGJ7G7tV5Aw In this session we will go through some common scenarios in the management of common severe illness in children, including severe acute respiratory distress, upper airway obstruction in infants, and sudden cardiac arrest in a previously well adolescent. We can use clinical signs and basic test to differentiate the causes of these clinical syndromes: for example, differentiating when severe respiratory distress is due to pneumonia or airways disease, and then considering the different causes of airways disease at different ages. This type of deductive reasoning allows for specific treatment that addresses the underlying pathophysiology, at the end we discuss a framework for thinking about children with critical illness on ward rounds. Common critical illness in children II Video link: https://youtu.be/4bZt2AkEIKc In this second teaching session on the management of critical illness in children we discuss a few case scenarios and how to approach them, including unusual causes of respiratory distress, the causes and management of shock in a child with Hirschsprung disease, and basic neuroprotection for children with meningitis or encephalitis. Differentiating causes of acute illness, understanding the pathophysiology, providing supportive care and monitoring, and giving time are all important for critically ill patients to recover. How to write a minor thesis Video link: https://youtu.be/KXavdZfRCrg In this teaching session, we cover the next step of how to write a thesis. Includes developing a spreadsheet, ensuring it is analysable, and how to construct and write a thesis. There are many things you can do to make the process easier, and that help you learn about doing research. HIV in children and adolescents YouTube recording did not work In this session we discuss all things related to HIV management. The diagnosis, types of anti-retroviral drugs, mechanisms of drug resistance, and the new recommendations for ART dolutegravir-based therapy. We also discuss chronic care for children and adolescents with HIV, which involves a lot more than ART, including consideration of nutrition, gastrointestinal, lung, cardiovascular, renal and bone health, development, and neurological issues. Care of children and adolescents with HIV also requires improving mental health, self-esteem, and school participation. Paediatric cancer YouTube video link is at: https://youtu.be/5ZxQQr-QsOg These 2 sessions on common cancers affecting children in PNG give an overview, covering acute leukaemia, lymphoma, retinoblastoma, chest tumours, and abdominal tumours. We discussed the diagnosis using important clinical signs, basic laboratory investigations, imaging cancer using ultrasound and CT, and cover treatments of the commonest cancers and their complications, and the management of common cancer emergencies. Acute kidney failure and encephalopathy case discussion Video link: https://youtu.be/dVusXDFI05c This session highlights the many cases of acute renal failure and encephalopathy in children in Indonesia. Dr Nina Putri, paediatrician from Jakarta presents a typical case, and other specialists from Indonesia also provide input. We discuss the likely causes, which include diethylene glycol contamination of cough and cold medicines, or a post-COVID complication that severely affects the kidneys. We discuss similar outbreaks in other countries from contaminated medicines including recently in Gambia, and previously in India, Bangladesh, Nigeria, South Africa, treatment options for acute renal failure, public health measures, and the reasons why some remedies have been contaminated in the manufacturing process.