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.

Child adoption in the Western Highlands Province of Papua New Guinea

@#This study investigated the epidemiology of child adoption in the Western Highlands Province of Papua New Guinea. A prospective case-control study of 100 adopted and 100 control children matched by age and sex was done in 1995. The age at the time of adoption ranged from 7 days to 8 years with 64 being adopted in the neonatal period. 28 were adopted because the biological mother had died, 23 because the adoptive mothers had been unable to bear children and 16 because the biological mother was unmarried or 'too young'. Only 11 adopted children were not blood relatives of the adoptive mother; 10 children had been abandoned and 1 had been bought for cash. 97 adoptive mothers were married. The majority (61%) had no formal education and 95% were not in paid employment. Compared with the mothers of the control children fewer adoptive mothers had received any formal education and more of them smoked cigarettes, drank alcohol or chewed betelnut. Social characteristics of the adoptive fathers were similar to the fathers of the control children. Of the 66 living biological mothers for whom information was available, 39 (59%) were married, 16 (24%) single, 8 (12%) divorced and 3 (5%) widowed. For 21 (32%) of the biological mothers the adopted baby was their first. 19 adopted babies were breastfed, 8 exclusively, 6 with the addition of non-human milk and 5 with additional solid feeds. Two-thirds of the adopted children and only 5 controls were bottle-fed. There were no significant differences in nutritional status between the two groups and immunization status was similar. There was widespread ignorance about legal adoption procedures. Only 8 adoptive mothers had any knowledge of and only 2 had followed formal adoption procedures. In this group of adopted children it appeared that most were well cared for, as their nutritional status and immunization status were similar to non-adopted children. There have, however, been suggestions that adoption is a risk factor for child abuse in Papua New Guinea and adoption has recently been associated with severe malnutrition and mortality in a highlands hospital inpatient population. Information relating to formal adoption processes should be more widely disseminated throughout Papua New Guinean communities to protect the rights of adopted children and their adoptive parents.

The use of the Paediatric Standard Treatment Book by clinic and health centre staff

@#The study assessed the self-reported frequency and quality of use of the Paediatric Standard Treatment Book by staff in urban clinics and rural health centres. 61 of the 88 nursing officers and 44 of the 89 community health workers in 9 urban and 4 rural health settings completed written questionnaires on their use of the Standard Treatment Book. The survey participants were also assessed on the management of three case scenarios of common clinical conditions. Whilst 69% of the participants reported daily use of the book, only 51% indicated that they always followed the guidelines. Performance in the case scenarios was poor. Although 87% made a correct diagnosis in the most straightforward case, only 38% indicated complete treatment and only 36% indicated complete and correct advice. In two more complex scenarios less than 30% of the participants made correct diagnoses and less than 10% indicated complete treatment and advice. 75% of the study group wanted inservice training on the use of the book; the majority of these said that doctors should give this training. 79% thought that the book could be improved. Many of the participants felt that more topics and more flow charts should be included. Whilst nursing officers and community health workers regard the Standard Treatment Book (STB) as important, many do not make optimal use of it. Knowledge of appropriate advice to give parents regarding their child's illness was particularly poor. Given the low scores of health workers on case scenarios involving children with more than one presenting problem, the use of the STB appears to be essential for management of most severely ill children presenting to health facilities in Papua New Guinea. Doctors, especially paediatricians, have an important role to play in stressing the importance of the book, in teaching health workers to use it correctly and in emphasizing an integrated approach to the management of sick children. The study incorporated an assessment of health facility infrastructure and equipment. All facilities needed maintenance work, and more than half had significant deficiencies in equipment and drug availability. Medical staff supervision and support of primary health staff is important and should include increasing and improving the use of the Standard Treatment Book. Such support should also aim to improve the working environment and health facility resources. This would substantially improve the service provided.

A history of surgery for congenital heart disease in Papua New Guinea

@#Cardiothoracic surgery in Papua New Guinea (PNG) was somewhat ad hoc prior to 1956 but later settled into an arrangement in which visiting teams from overseas selected mostly adult patients for a limited range of closed heart operations to be done locally or overseas. In 1978 the late Professor John Biddulph was instrumental in facilitating a more formal arrangement with the Royal Prince Alfred Hospital whereby patients were selected by a visiting cardiologist on an annual basis to be transferred to Sydney for cardiac surgery. This subsequently developed into a predominantly paediatric program based at the Royal Alexandra Hospital for Children in Sydney, which successfully ran until 1992. In 1993 a program began, based at the Sydney Adventist Hospital, in which a voluntary cardiac team has been visiting annually to perform both open and closed heart surgery. This program has proved to be very successful with a high output and a low mortality. Despite this long history of surgery for congenital heart disease in PNG, no definite long-term plans have eventuated. Because the financial situation of the country does not allow for a major cardiothoracic unit, the current arrangement whereby noninvasive investigation and some closed surgery are performed at Port Moresby General Hospital is appropriate for the foreseeable future.