Supervised and unsupervised birth and early newborn care practices in Papua New Guinea: findings of a maternal and infant health survey conducted in three provinces

@#Summary Poor women in remote areas in many countries remain the least likely to receive adequate health care during pregnancy and childbirth for various reasons. In Papua New Guinea (PNG) there is some documentation regarding why women do not attend for supervised births, but less is known about women’s perceptions and experiences of childbirth in the community or about newborn care practices in the first few hours following childbirth. As part of a wider maternal and infant health survey among 482 women in three sites in PNG, in this paper we describe women’s experiences relating to supervised and unsupervised births and newborn care practices. Among respondents, the majority (95%) reported attending for antenatal care at least once during their most recent pregnancy and almost two-thirds (65%) gave birth in a health facility. Among the health facility births, 88% were assisted by a trained health care worker. Among the women who gave birth in the community, 44% chose to do so. Primiparous women, those aged 15-24 years and women with secondary or tertiary education were significantly more likely to give birth in a health facility than multiparous women, those aged more than 24 years and women with none or only primary education. There were 489 live births, 93% of whom were breastfed. Overall 60% of women knew any danger signs in a newborn infant. Fever was the most frequently mentioned danger sign (81%). Knowledge of danger signs was significantly associated with giving birth in a health facility, being multiparous and having secondary education, compared with village birth, being primiparous and having none or only primary education. Our findings highlight the importance of using the opportunity at antenatal clinic to provide women with information and knowledge, not only on the importance of attending for a health facility birth, but also on the importance of planning and seeking transfer to the health facility early.@*@#

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.

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 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.

HIV infections in obstetrics and gynaecology

@#Thirteen women were discovered to be positive for human immunodeficiency virus (HIV) infection during pregnancy at the Port Moresby General Hospital from 1988 to 1995; of these, eight were diagnosed in the first half of 1995. Risk testing for HIV status is unlikely to discover more than 20% of HIV-positive antenatal patients because risk factors target intravenous drug users and the sexual behaviour of men. Pregnancy does not seem to have a major impact on the progress of HIV disease, but could be detrimental particularly in the later stages of the disease. Especially in developing countries, where HIV-positive patients are more likely to be of poor nutritional status and burdened with a number of other infections, there is a higher risk of preterm labour, small-for-dates babies and chorioamnionitis in pregnancy. The risk of vertical transmission is increased when viral loads are high, the general maternal condition is poor and delivery is preterm. Rates in Papua New Guinea appear to be following the higher rates which have been reported from Africa. Gynaecological conditions found in association with HIV infection, including pelvic inflammatory disease, vulvovaginal candidiasis and cervical neoplasia, may be resistant to treatment and tend to recur. Contraception for HIV-positive women may be more important to them than prevention of viral transmission; Depo-Provera and tubal ligation have special benefits in this regard. HIV infection in association with psychiatric disturbance might be an indication for termination of pregnancy. PIP: Risk testing for HIV serostatus is unlikely to detect more than 20% of HIV-positive pregnant women. Of the 11 pregnant women discovered to be HIV-infected at Port Moresby General Hospital in Papua New Guinea in 1994-95, only four had more than two sexual partners since 1992 and none was an intravenous drug user. The deleterious effect of pregnancy on HIV disease progression appears to be small but variable, with more serious effects in the later stages of disease. The risk of vertical transmission increases when viral loads are high, the general maternal condition is poor, and delivery is preterm. In developing countries, where HIV-infected pregnant women are likely to be malnourished and to have concomitant infections such as malaria and tuberculosis, the risks of preterm labor, small-for-gestational age infants, and chorioamnionitis are increased. HIV-related gynecologic conditions such as pelvic inflammatory disease, vulvovaginal candidiasis, and cervical neoplasia may be resistant to treatment and tend to recur. Pregnancy prevention through effective contraceptive methods such as Depo-Provera and tubal ligation may be more important to HIV-infected women than prevention of viral transmission, especially when both partners are seropositive.