Assessment of anaemia and iron status among pregnant women in the National Capital District, Papua New Guinea

@#Assessing the prevalence of anaemia, iron deficiency and iron deficiency anaemia among non-pregnant and pregnant women is essential for evidence-based intervention programs. The purpose of this prospective outpatient and community-based cross-sectional study was to assess the prevalence of those conditions among pregnant women resident in the National Capital District (NCD) and attending the Outpatient Antenatal Clinic in Port Moresby General Hospital. Blood samples were collected from 50 non-pregnant and 157 pregnant women who gave consent. HemoCue was used to measure haemoglobin; the serum ferritin, soluble transferrin receptor (sTfR) and C-reactive protein were measured by specialized 96-well enzyme-linked immuno-sorbent assay (ELISA) kits. The ‘sTfR-F index’ was calculated. Mild to moderate anaemia, low serum ferritin and elevated serum sTfR were found in 28% of the non-pregnant women; the sTfR-F index showed that 16% of them had iron deficiency anaemia. Among the pregnant women, 60% had mild to severe anaemia indicating severe public health significance; 48% had low serum ferritin and 38% had elevated serum sTfR; the sTfR-F index showed that 38% of them had iron deficiency anaemia. Mild to severe anaemia was present in 47%, 71% and 62% of the pregnant women in the first, second and third trimesters respectively, while iron deficiency anaemia was present in 20%, 53% and 48% of the pregnant women in the first, second and third trimesters respectively. The sTfR-F index showed that iron deficiency anaemia was present in 36% of primigravida and 40% of multigravida. Social mobilization, intensive and focused education, aggressive awareness campaigns, including all relevant target groups and policy makers, are required to effectively address this major public health issue.

Assessment of zinc status of women resident in the National Capital District, Papua New Guinea

@#This cross-sectional study assessed the zinc status of non-pregnant and pregnant women resident in the National Capital District (NCD), Papua New Guinea (PNG). Non-fasting morning blood samples were collected by venipuncture from consented women. Flame atomic absorption spectrometry was used to measure the serum zinc concentration in 27 non-pregnant and 100 pregnant women. C-reactive protein (CRP) in serum was measured by enzyme immunoassay and used to interpret the serum Zn data. For all the non-pregnant women, the median serum zinc concentration was 42.7 mug/dl with an interquartile range (IQR) of 27.6 to 91.2 mug/dl. Zinc deficiency was prevalent among 59% in this group of women. For those with normal CRP the median and IQR serum zinc concentrations were 48.9 mug/dl and 30.2 to 98.7 mug/dl, respectively. The median and IQR for all the pregnant women were 63.8 mug/dl and 40.9 to 93.2 mug/dl, respectively. Prevalence of zinc deficiency was 42% using the cut-off point of 56.0 mug/dl. Of the 100 pregnant women, 16 (16%) were in the first trimester, 51 (51%) in the second trimester and 33 (33%) in the third trimester. The median serum zinc concentrations of pregnant women in the first, second and third trimesters were 87.0 mug/dl, 61.6 mug/dl and 60.8 mug/dl, respectively. Using gestational period-specific cut-off points, zinc deficiency was prevalent among 31%, 39% and 36% of the pregnant women in the first, second and third trimesters, respectively. Our results clearly indicate suboptimal zinc status among non-pregnant and pregnant women in the NCD. According to the International Zinc Nutrition Consultative Group (IZiNCG) criteria, this should be considered as a public health problem among these groups of women in the NCD. To effectively address the issue, social mobilization, intensive education and awareness campaigns, with all relevant target groups and policy makers, are urgently required.

A case-control study of VDRL-positive antenatal clinic attenders at the Port Moresby General Hospital Antenatal Clinic and Labour Ward to determine outcomes, sociodemographic features and associated risk factors

Between June 2001 and December 2002, 152 antenatal patients at Port Moresby General Hospital who were Venereal Disease Research Laboratory (VDRL) serology positive and 150 unselected antenatal patients who tested negative were studied to determine the gestational age at which the tests were performed, the time it took for results to become available, the proportion of patients who received treatment, the sociodemographic characteristics associated with VDRL positivity and the effect of VDRL positivity on maternal and perinatal outcomes. The prevalence rate of VDRL positive among antenatal clinic attenders in Port Moresby at that time was 4.4%. Of the 152 VDRL-positive patients in this study 97% were also Treponema pallidum haemagglutination (TPHA) positive. Significantly more of the positive patients were of highlands origin, lived in settlements, had previous marriages, had lower parities, delivered preterm babies, had stillbirths, had growth-restricted babies and had babies with lower Apgar scores at both 1 and 5 minutes. The mean birthweight was significantly lower among the positive patients. Significantly more of the positive patients were married to spouses with occupations which were regarded as 'risky' for sexually transmitted infections. There was no difference between the two groups with respect to patient's education, marital status, husband's education, gestational age at delivery and the number of days the baby spent in the Special Care Unit. The study concluded that the current antenatal screening does not provide adequate coverage for our patients. If the current availability of clinic-based strip tests provided by a non-government organization can be continued by the Ministry of Health we should be able to overcome this problem.

Syphilis serology testing: a comparative study of Abbot Determine, Rapid Plasma Reagin (RPR) card test and Venereal Disease Research Laboratory (VDRL) methods

Blood from 2100 women attending the antenatal clinic of the Port Moresby General Hospital (PMGH) and the 9 Mile urban clinic of Port Moresby was tested for syphili using the laboratory-based Venereal Disease Research Laboratory (VDRL) syphilis serology test and two clinic-based syphilis tests, Abbot Determine and Abbot Syfacard-RR (Rapid Plasma Reagin (RPR) card test). The Abbot Determine and the Syfacard-R tests were compared with the VDRL test, the gold standard in this study. The validation test results of Determine versus VDRL were as follows: sensitivity 92.0%; specificity 94.6%; the predictive value of a positive test 42.6%; and the predictive value of a negative test 99.6%. The validation tests for RPR versus VDRL were as follows: sensitivity 56.3% specificity 96.5%; predictive value of a positive test 41.2%; and the predictive value of a negative test 98.1%. The RPR test costs 3.5 kina (about one US dollar) a test, the VDRL less than 1 kina a test whilst the Determine test kit costs about 5 kina a test. When laboratory time, salaries and other supplies are costed the Determine test is expected to cost relatively much less. Our recommendation is that the Determine test be made available in areas of the country where VDRL is unavailable or where logistics do not allow for test results to be available early enough to make a difference to the care of th pregnant woman and her fetus.

Awareness of and attitudes towards HIV among pregnant women at the Antenatal Clinic, Port Moresby General Hospital

BACKGROUND: The prevalence of HIV (human immunodeficiency virus) among pregnant women in Port Moresby has increased tenfold, from 0.08% in 1994 to 0.8% in 2002. To stop a further epidemic spread as seen in sub-Saharan Africa it is urgent to identify and intervene to reduce risk behaviours. In order to do so it is important to evaluate current awareness of and attitude towards HIV. METHODS: Interviews with 122 pregnant women were conducted at the Antenatal Clinic, Port Moresby General Hospital, Papua New Guinea. We assessed the women's HIV awareness and relate the results to education and socioeconomic factors. RESULTS: 4 out of 122 women did not know about HIV. 97% knew that HIV is spread by sexual contacts, 96% knew about mother-to-child transmission and 69% knew about infection through breastfeeding. However, there were many misconceptions; 36% believed that HIV can be spread by mosquitoes and 17% believed that caring for an AIDS (acquired immune deficiency syndrome) patient is a risk. Among the women with no education or primary school education only, 51% knew for sure that HIV is not spread by caring for an AIDS patient, compared to 86% for the women with higher education. 47% of the women received their first information about HIV through the media. CONCLUSIONS: The AIDS campaigns have been successful in making almost all the women aware of HIV as a sexually transmitted disease. However, the high frequency of misconceptions makes it probable that patients are stigmatized. This is particularly true for the lower educated women. To more effectively fight the HIV epidemic it is important to improve the general level of education of both men and women, to encourage women to be more in charge of their own sexuality and to increase their status in society. It is also important to make men aware of their responsibility to practise safe sex.

Reporting of lactation and normal menstrual information by Papua New Guinean women

@#As part of a survey of 600 women enrolled in a study of postpartum progesterone-only contraception (400 women who opted to use progesterone-only contraception and 200 controls) participants were asked about menstrual history and lactation experience. The mean longest menstrual cycle duration was found to be 29.5+/-SD3.5 days and the mean shortest cycle duration was 26.6+/-SD2.8 days. The mean duration of menstrual bleeding was 3.75+/-SD1.16 days. Few women reported menstrual period problems such as dysmenorrhoea (6.5%) and menorrhagia with clots (0.7%). However, 3% of the women reported irregular cycles with intervals of longer than 1 month. Overall the women reported breastfeeding their previous baby for a mean duration of 14 months. The group of women electing to use hormonal contraception reported that they had breastfed their last baby for 13.5+/-SD7.5 months while control women had done so for 14.1+/-SD9.4 months. The longest mean duration that women reported to have breastfed a previous infant was 19.5+/-SD9.6 months in the hormonal contraception group and 19.1+/-SD8.6 months in the control group.

A survey of pregnant women with tuberculosis at the Port Moresby General Hospital

@#From March 1995 to February 1998, 110 patients diagnosed with tuberculosis (TB) in pregnancy or the puerperium at the Port Moresby General Hospital (PMGH) were surveyed. 96% were diagnosed as a result of the symptoms of tuberculosis, 4% through contact tracing. 11 of 40 patients who first attended antenatal clinic in the second trimester were not diagnosed until after delivery. The mean birthweight of term infants of TB patients was significantly less than term infants in a previous survey at PMGH. 45% of babies were growth restricted. With increasing duration of treatment, both increasing maternal weight gain in pregnancy and higher mean birthweight were found. Maternal and perinatal mortality were high in the study patients. There were 6 maternal deaths and a perinatal mortality rate of 137/1000. The majority of maternal and fetal losses occurred in patients who had pulmonary, miliary and meningeal TB. Improvement in the detection of tuberculosis in antenatal patients and the introduction of adequate treatment before delivery should prevent maternal deaths and perinatal morbidity and mortality.

Familial ovarian cancer: report of ovarian carcinoma in three sisters

@#This is a report of ovarian carcinoma occurring in two sisters diagnosed almost at the same time, prompting prophylactic oophorectomy in a third sister. Histology of the overtly normal ovary in the third sister showed a focus of ovarian cancer. Discussion and a review of the literature suggest that any program designed to reduce the incidence of late-stage ovarian carcinoma should include the surveillance of family members of the index case, including the performance of prophylactic oophorectomy in the unaffected members of the family after they have completed their families.

A case-control study of Singleton low birthweight babies at the Port Moresby General Hospital

@#A retrospective study of 432 consecutive singleton low birthweight babies and 432 unmatched controls was carried out at the Port Moresby General Hospital from January to December 1988. Of the 432 low birthweight babies 65% were preterm, 27% were light for gestational age, 6% were both preterm and light for gestational age and 2.5% could not be classified. The results of the analysis showed low birthweight to be significantly associated with the past delivery of a low birthweight infant, very young and elderly mothers, lack of antenatal care, poor family planning, hypertensive disease in pregnancy and intrauterine death. This study reveals that maternal education and improved antenatal care and family planning would ultimately reduce the incidence of low birthweight babies and perinatal mortality in Papua New Guinea.

A retrospective survey of patients with one previous caesarean section delivered at the Port Moresby General Hospital: a comparative study of those delivered vaginally and those delivered by repeat caesarean section

@#We studied 510 patients in a retrospective, nonrandomized, comparative survey of vaginal births and repeat caesarean section after one primary caesarean section at the Port Moresby General Hospital. 478 (94%) were allowed a trial of scar (TOS). The most common indications for elective caesarean section in the other 32 patients were cephalopelvic disproportion (CPD) 31%, contracted pelvis 19% and preeclampsia 12.5%. In 41% of patients TOS was terminated by emergency caesarean section. Logistic regression analysis showed that the following were significantly associated with repeat caesarean section after TOS: parity of one, no vaginal birth after the primary caesarean section, narrow obstetric conjugate, birthweight of 2500 g or greater, short stature, high level of the head at admission to the labour ward and region of origin.

A case-control study of primary caesarean section at the Port Moresby General Hospital, Papua New Guinea, to identify epidemiological predictors of abnominal delivery

@#A retrospective study of 274 consecutive primary caesarean sections and 274 unmatched controls was carried out at Port Moresby General Hospital from January to December 1992. The primary caesarean section rate was 3.5%. Stepwise logistic regression analysis showed that primary caesarean section was significantly associated with maternal height of less than 150 cm; nulliparity; symphysis-fundal height of more than 38 cm at admission in labour; cervical dilatation of less than 4 cm at admission in labour; and the level of fetal head at admission in labour of 3/5 or higher.

A case of factor V deficiency presenting as menorrhagia

@#Factor V deficiency is a rare hereditary disorder. We report a patient with factor V deficiency who presented with menorrhagia and pelvic haematoma. The Haematology Department at the Royal Brisbane Hospital performed the definitive factor assays leading to the diagnosis. The challenges of her management were obtaining adequate supplies of factor V and her socioeconomic circumstances. The main future challenge will be the supervision of her pregnancies.

A survey of under-18 year old and 20-29 year old primigravidae delivered at the Port Moresby General Hospital: a comparative study of their sociodemographic and sexuality characteristics and contraceptive knowledge and experience

@# From July 1992 to August 1993, 330 under-18 year old primigravidae (cases) and 330 randomly selected 20-29 year old primigravidae (controls) who were delivered at the Port Moresby General Hospital were sequentially studied, using a standardized, pretested, precoded questionnaire. In stepwise logistic regression analysis, significantly more of the cases had menarche at less than 15 years of age, learned before menarche that sex causes pregnancy, were of highland origin, were unemployed, or had partners who were unemployed; significantly fewer of the cases thought that one sexual act could cause pregnancy, had knowledge of or had ever used a family planning method, or had planned this pregnancy. PIP: This study aims to identify factors (explanatory variables) which are associated with the risk of an adolescent becoming pregnant. From July 1992 to August 1993, 330 18 year old primigravidas (cases) and 330 randomly selected 20-29 year old primigravidas (controls), who were delivered at the Port Moresby General Hospital in Papua New Guinea, were sequentially studied. Trained research assistants administered a standard, pretested, precoded questionnaire. By using stepwise logistic regression analysis, it was revealed that significantly more of the cases had menarche at 15 years of age (81% vs. 49%), learned before menarche that sex causes pregnancy (51% vs. 32%), were of highland origin, were unemployed, or had partners who were unemployed. Moreover, significantly fewer of the cases thought that one sexual act could cause pregnancy, had knowledge of or had ever used a family planning method, or had planned their pregnancy.