Zinc status of children aged 12 to 59 months resident in the National Capital District, Papua New Guinea

@#Zinc deficiency is a major public health problem in some resource-limited countries. This study assesses the zinc status of 90 pre-school-age children, aged 12 to 59 months, resident in the National Capital District (NCD), Papua New Guinea. Children attending the Children's Outpatient Clinic at Port Moresby General Hospital participated in this cross-sectional study. Informed consent was obtained from parents before using blood samples from their children. Flame atomic absorption spectrometry was used to measure the serum zinc concentration. C-reactive protein (CRP) in serum was measured by enzyme immunoassay and used to interpret the serum zinc data. The median serum zinc concentration for all the children was 83.6 μg/dl and the interquartile range was 64.6-103.7 μg/dl. The prevalence of serum zinc deficiency (Zn <65.0 μg/dl) among all the children was 26%; and 42% had elevated serum CRP level. Serum zinc deficiency was present among 31% and 20% of the children in the 12 to 24 months and over 24 months age groups respectively. The prevalence of serum zinc deficiency among the male and female children was 28% and 25% respectively. The high prevalence of zinc deficiency among the children may be caused by the high rate of subclinical infection and low bioavailability of absorbable zinc in the popular foodstuffs that they are consuming. The prevalence of zinc deficiency among the children with and without elevated serum CRP strongly suggests the need for continuous monitoring of the zinc status of pre-school-age children in the NCD

The use of blood and blood products in the Paediatric Unit of Port Moresby General Hospital

@#This prospective descriptive study aimed to document the use and the quality of delivery of blood products in paediatric patients at the Port Moresby General Hospital. Paediatric patients transfused in the Paediatric Ward, the Special Care Nursery, the general Intensive Care Unit, the full Nursing Care Ward and the Children's Outpatient Department were included. 555 transfusion requests were dispensed from the blood bank to paediatric patients during the six months from the end of February to August 2012. Detailed information about age, sex, diagnosis, indication for transfusion and whether or not this followed standard indications, timeliness of transfusion and the quality of the transfusion procedure was recorded for a convenience sample of 64 patients, 37 males and 27 females, with a median age of 33 months and an interquartile range of 9-72 months. The most common indication for transfusion was infection-related anaemia. 50% of patients transfused did not meet standard indications for this intervention. In 86% of cases there was a delay in blood transfusion, blood shortage being an important contributing factor. Adequate monitoring of transfusion occurred in only 20% of the patients. No major adverse reactions were reported. It is highly recommended that a blood transfusion checklist be designed to improve the quality of blood transfusion practices and monitoring. Clinicians need to improve their prescribing of blood in accordance with established guidelines.

The Binax NOW 'Streptococcus pneumoniae' test for the diagnosis of pneumococcal meningitis in children

@#Background: Identifying the causes of childhood meningitis is difficult. Conventional diagnostic tests (culture, bacterial latex and Gram staining) have limitations, especially in settings where many children receive antibiotics prior to presentation. A point-of-care test called Binax NOW detects meningitis due to 'Streptococcus pneumoniae' in 15 minutes and is not affected by pre-test antibiotic use. <br /><br /> Methods: A prospective study was conducted among children with suspected bacterial meningitis at Angau Memorial General Hospital to evaluate the usefulness of the Binax NOW 'S. pneumoniae' test in comparison with conventional tests: cerebrospinal fluid (CSF) bacterial culture, Gram stain and latex agglutination. Latex antigen testing was done for 'S. pneumoniae, Haemophilus influenzae and Neisseria meningitidis'. We analysed the CSF of all children who had a lumbar puncture done for clinical suspicion of meningitis. FINDINGS: 132 children were enrolled in the study, of which 3 were excluded because of insufficient CSF sample to do the Binax NOW test. 5 CSFs were culture positive, all for 'S. pneumoniae'. 13 (10%) of 129 CSF specimens had organisms seen with Gram staining; 7 had Gram-positive cocci and 6 showed Gram-negative bacteria. Latex antigens were positive in 20 cases: for S. pneumoniae (11), 'H. influenzae' (8), 'N. meningitidis' (1). Using the 3 conventional tests combined (culture, Gram stain and antigens) 14 cases of 'S. pneumoniae' meningitis were detected. Binax NOW was positive for 'S. pneumoniae' in 19 cases (15% of meningitis cases): the 14 samples positive by conventional methods and a further 5 cases that were not detected by conventional methods. <br /><br /> Conclusion: The Binax NOW test increases the diagnostic yield for pneumococcal meningitis on CSF. This may be important in surveillance for the effectiveness of pneumococcal conjugate vaccine introduced in Papua New Guinea (PNG) in 2014, and in clinical diagnosis. 'H. influenzae' is rarely identified on culture in PNG provincial hospital laboratories, so latex antigen testing is still needed for the accurate diagnosis of 'Haemophilus' meningitis and monitoring of the effectiveness of 'Haemophilus influenzae' type b vaccine.

The prevalence of chronic suppurative otitis media in children in Port Moresby public clinics

@#This prospective descriptive study aimed to determine the prevalence of chronic suppurative otitis media (CSOM) in children presenting to 5 urban clinics and the Children's Outpatient Department of the Port Moresby General Hospital. 395 children between the ages of 6 months and 12 years were included. 70 (18%) had some form of ear disease. Of the 28 children with CSOM (7%), 18 had unilateral and 10 had bilateral ear pathology. Only 8 of these children presented because of discharging ears. An additional 4 children had dry perforation, 1 had cholesteatoma and 2 had mastoiditis. The high prevalence of CSOM indicates that it is an issue of major public health importance. Risk factors for the development of CSOM were common in the children assessed. Prompt recognition of the problem and management by way of thorough and regular ear wicking should be stressed. Consideration should be given to making ciprofloxacin ear drops available. All clinics should have a functioning auriscope and front-line health workers should be trained to be able to diagnose and treat CSOM. Communities need education about the importance of early diagnosis and management of CSOM.