Thirty years of the Paediatric Standard Treatment Book

The publication of the 8th edition of the Paediatric Standard Treatment Book 30 years after the first edition was introduced in 1975 provided an opportunity to examine the changes in the book's content and composition that have occurred over time. A detailed analysis of all editions of the book was made. The 8th edition is bigger, contains more clinical and guidance topics, and is undoubtedly more complex than the first. Health workers of different levels of training undoubtedly value the book, but there is evidence that it is frequently not used appropriately. The books form an important historical record of the changes in treatment of various clinical conditions that have been driven by alterations in antimicrobial susceptibility and by the emergence of evidence for efficacy. The current book is intricately linked with the Integrated Management of Childhood Illness and the treatments it contains are based on best evidence and practicality. Whilst there are challenges in ensuring that the information in the standard treatment book is accessible, practical and up to date, the book will continue to provide the basis for treatment of the common conditions presenting in children in the future.

Mortality in children admitted to Port Moresby General Hospital: how can we improve our hospital outcomes?

A detailed audit, part retrospective and part prospective, of deaths occurring in children admitted to the children's wards of the Port Moresby General Hospital over a 12-month period was made. 238 children died out of the 4898 admitted, an overall case fatality rate of 4.9%, with a monthly range of 3.7%-9.6%. The proportion of deaths approximated the proportion of admissions in each age group. 92% of the children had a weight of less than 80% of the standard weight for age and 30% weighed less than 60% of the standard weight for age. 24 (11%) of the deaths occurred within the first 6 hours of admission, 39 (17%) within the first 12 hours and 58 (26%) within the first 24 hours. 89 children (40%) died more than one week after admission. Pneumonia, meningitis, measles and septicaemia were the four leading certified causes of death and paediatric AIDS was the fifth. Less than half of the deceased children were appropriately immunized for their age. 27 deaths (12%) were assessed as preventable. 150 (67%) were classified as from treatable causes but unavoidable, 18 (8%) from untreatable causes, 22 (10%) of undetermined cause and 34 (15%) avoidable. The factors associated with avoidable deaths were delayed treatment (20 children), inadequate treatment (8 children), incorrect treatment (1 child) and others (5 children). Infant and child mortality could be reduced by general measures such as improving community nutrition and immunization status and improving care-seeking behaviour. Hospital-related measures to reduce mortality include improving the accuracy and effectiveness of triage and provision of adequate staffing levels and bed space. Periodic in-depth audit is necessary to assess quality of patient care, to identify problems and to point towards their solution. Accurate recordkeeping is essential for appropriate audit and planning.