Child abuse in Papua New Guinea.

This paper is a report on two children who suffered severe abuse including sexual abuse who were referred to the Port Moresby General Hospital for consultation and treatment. Two case reports are discussed on the basis of literature review of Child Abuse in Papua New Guinea. This is followed by conclusion and recommendations for preventing child abuse in Papua New Guinea.

Health insurance and medical schemes in Papua New Guinea.

Papua New Guinea (PNG) is an independent nation in the Pacific region. It is located due north of Australia. It is made up of a main island and about 100 smaller islands in the Bismark and Solomon Seas, to the north and east of the main island. The population of PNG is about 4.0 million, the total land area approximately 463,840 sq km and population density 8/square km. Only about 15% of the population is urban, average household size is 5.4 and 45.1% literate. Politically and administratively, it is divided into nineteen provinces and a National Capital District. Since 85% of the population lives in rural areas, the provision of services to the rural areas is constrained by difficult terrain, poor infrastructure and geographic dispersion of the rural population. PNG is a developing Pacific nation with an economy largely based on primary and mining industries. According to the 1993 World Bank estimates, more than 30% of the Gross Domestic Product (GDP) is derived from agriculture. The expenditure on health, as a percentage of the GDP, was 2.8% in 1989, (Table 1). This is low compared to developed nations (ranging from 8% to 14%), but very reasonable compared to the rest of the developing world. Indonesia for example expends 2.7% of GDP on health care. All government expenditures declined sharply in the post 1989 period, including health care expenditures. However, by 1989, the expenditure per capita on health was almost back to 1986 levels. PNG has a small population base relative to the other countries in its World Bank peer group. However, its per capita GDP is reasonable at US$850, the third highest amongst its group and higher than Indonesia, for example, which is US$700/head. Like almost all countries in its gorup, it experienced a negative growth rate over the decade 1980-1991 but kept inflation at a reasonable 5.2% for the same period. On most other indicators PNG fares reasonably well, in comparison with other developing nations (Tables 2 & 3).

Childhood epilepsy in Papua New Guinea.

A prospective study of 40 children with epilepsy was carried out between June 1990 and August 1991 at Port Moresby General Hospital. Half of the children had yet to start school. Significant features in their past medical histories were acute meningitis (38%), tuberculous meningitis (10%), febrile convulsions (10%) and head trauma (5%). Most cases had grand mal epilepsy (80%). The majority of the children with epilepsy (90%) were treated with a single drug, which was usually phenobarbitone. 22% had received more than one drug, but not simultaneously. Significant side-effects requiring change of treatment occurred in 10%. Disturbed behaviour was reported in 55% and 22% had a poor social outcome. 45% had complete control of fits clinically. This study showed that in Port Moresby acute meningitis is a significant cause of epilepsy in young children, the majority of whom present with grand mal epilepsy, which is usually controlled by phenobarbitone, a readily available and cheap drug and still a useful anticonvulsant in the developing world.