Sociocultural barriers to access and utilization of birth delivery services in a rural area of Papua New Guinea

@#A cross-sectional descriptive study using qualitative and quantitative methods was carried out in November 2012 to determine the reasons for the very low facility delivery rate in the Imbongu District of the Southern Highlands Province. 300 women of childbearing age (15-45 years) who had delivered either in Imbongu District health facilities or villages within the previous 24 months were interviewed using a structured questionnaire. Two focus groups with women and one focus group with the officers in charge of health facilities were held. The women who delivered at health facilities were more likely to have been educated to primary school level and above, to be less than 36 years of age, to have attended antenatal clinic and to have had the support of their male partner or male relative than the women who delivered in the village. Customary beliefs, run-down health facilities, poor staff attitude and concerns over the possibility of a male birth attendant were major reasons for women avoiding facility delivery. If maternal mortality rates are to fall in the district, urgent attention is needed to make the health facilities more attractive and user-friendly, and to find other ways of persuading mothers to deliver in them.

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.