The effect of bacille Calmette-Guérin vaccination at birth on tuberculin skin test reactivity in Ugandan children.

SETTING: In Uganda, bacille-Calmette Guerin (BCG) vaccination coverage at birth is between 82 and 84%. OBJECTIVE: To evaluate the effect of neonatal BCG vaccination on tuberculin skin test positivity in Ugandan children exposed to infectious cases. DESIGN: As part of an ongoing prevalence study of household contacts of new tuberculosis cases, 365 children were evaluated to determine if BCG vaccination at birth had an impact on tuberculin skin testing. The children were classified as contacts (179) and non-contacts (186) depending on the presence of a sputum acid-fast bacilli (AFB) smear-positive adult tuberculosis case in the household. RESULTS: Regardless of prior BCG vaccination, children exposed to a smear-positive adult were more likely to have a positive skin test (purified protein derivative >5mm) (68% versus 36%, P < 0.01). BCG-vaccinated children below 1 year of age without a known household contact with active tuberculosis had a lower frequency of tuberculin skin reactions (29%) compared to their counterparts in the contact households (65%, P = 0.031). CONCLUSION: BCG vaccination at birth had no important effect on the interpretation of the tuberculin skin test reactivity in this group of Ugandan children. The tuberculin skin test remains a valuable tool for the evaluation of household contacts and suspected cases of tuberculosis in BCG-vaccinated children.

Investigation of an outbreak of typhoid fever in two settlements near Port Moresby.

From November 1985 to February 1986 two unplanned settlements near Port Moresby experienced a small person-to-person outbreak of typhoid fever, which included one death. Investigation showed that of the 20 individuals who were diagnosed as either ill, culture positive or a carrier, 15 were related by blood, marriage or through shared living quarters. The remaining 5 lived in the same house, but were not related to the larger group. Drinking water was contaminated with coliforms, but was not implicated. The outbreak resolved with no additional cases after February 1986. Outbreaks of this nature highlight the need for continuing public health education for local health officers in contact tracing, field testing and transportation of specimens, and epidemiological skills in ivestigating person-to-person outbreaks. They also make a strong case for public health laboratories equipped to perform rapid, comprehensive pathological examination of specimens collected during any outbreak of infectious illness.

Schistosomiasis mansoni and paddy-rice growing in Uganda: an emerging new problem.

In Eastern Uganda, paddy-rice growing, which has only become popular in recent years, seems to be associated with the emergence of schistosomiasis mansoni as a new problem in public health. To estimate the magnitude of this problem, a cross-sectional, baseline survey was carried out in six villages of the Kibimba Rice Scheme. The overall prevalence of Schistosoma mansoni infection was found to be 20%. The highest prevalences and intensities of infection were seen in those aged 5-29 years, with more males infected than females. An attempt was then made to identify the important factors in the aetiology of S. mansoni in this area. Odds ratios indicated that working regularly in the rice paddies, fishing with baskets, and being male were statistically associated with an increased risk of S. mansoni infection. It is clear that schistosomiasis mansoni which is emerging as a new health problem in the study area is closely linked to working in the rice paddies. Encouraging the rice farmers to wear knee-high, waterproof boots while in the fields may help control the disease.

Factors affecting the use of immunization among urban settlement dwellers in Papua New Guinea.

This paper examines the importance of selected social factors in the acceptance of childhood immunization in urban settlements in Port Moresby, Papua New Guinea. The study found that the provision of information to mothers on when to start immunization and how often the child should be immunized were key factors in determining immunization status. Maternal education was found to be positively associated with knowledge of immunization, but was not significantly associated with actual immunization practice. Over 70% of the women studied found out when to attend for immunization from the local maternal and child health (MCH) staff, hence emphasizing their importance in disseminating information. If coverage is to be increased further in urban settlements with mobile populations, maximal use must be made of local community organizations to disseminate the key immunization information and for follow-up of newborns and infants new to the community. Efforts to encourage mothers to deliver under supervision should also continue as this is an important point of first contact for immunization.

PIP: A community-based study was carried out between July 30 and August 13, 1990, in order to assess the level of immunization coverage in 11 Port Moresby urban settlements and to examine selected social factors in the completion of the immunization. The population comprised women living in urban settlements with children under the age of 2 years. Multistage sampling was used to select the sample. A sample size of 323 children was derived on an expectation of 70% coverage, with an allowance for 5% error. 345 mothers were interviewed in Melanesian Pidgin by trained interviewers and 345 children were included in the survey. Of the mothers, only 154 had ever attended school and only 128 (37%) had completed more than 4 years of school. Maternal education was positively associated with residence in planned settlements (p 0.01). Only 189 (55%) of mothers were able to explain the preventive effects of immunization. 58% did not know when immunizations should commence and 48% did not know how many times the child should be immunized in the first year of life. When asked what prevented them from attending immunization clinics, lack of money to pay the bus fare was the most common reason given (n = 24), followed by indifference (n = 23) and sickness in the family (n = 8). Longer maternal education was associated with knowledge of when to start childhood immunizations (p 0.001), and of the number of times that children should be immunized (p 0.001). Mothers' education was also associated with the ability of mothers to name the diseases which immunization prevents (p 0.001). Among 232 (79%) of 293 children more than 1 year old, the immunization coverage was 93.5% for bacillus Calmette-Guerin, 85.3% for third dose of tetanus and oral poliomyelitis virus, and 82.8% for measles vaccine. 77.6% of children had received all antigens. The knowledge of mothers of when to start immunization was positively associated with actual immunization practice (p 0.01), as was the knowledge of the number of times that a child should be immunized (p 0.006).

Compound hygiene, presence of standpipe and the risk of childhood diarrhoea in an urban settlement of Papua New Guinea.

Children below five years of age residing in an urban settlement of Papua New Guinea were monitored from May 1987 to July 1988 in an attempt to identify aetiological factors of childhood diarrhoea. Presence of faeces in the compound was associated with a 48% increase (incidence density ratio (IDR) = 1.48, 95% confidence interval (CI): 1.163-1.897) in diarrhoea morbidity whilst the presence of pigs in the compound was associated with a 69% increase (IDR = 1.694, 95% CI:1.317-2.189). The presence of a standpipe in the compound was associated with a reduction in diarrhoea morbidity of 56%. The effect of presence of faeces, animals, and standpipe on the incidence of diarrhoea was not dependent on whether or not mothers were literate. We conclude that any intervention aimed at these factors is likely to reduce diarrhoea morbidity in similar urban ecosystems.

Possible reasons for non-completion of immunization in an urban settlement of Papua New Guinea.

A study to identify possible reasons for non-completion of immunization among children was carried out in an urban settlement of Port Moresby. It was found that the children's mothers lacked basic understanding about immunization and the potential seriousness of immunizable diseases. There was also poor social interaction between health workers and the mothers. It is recommended that emphasis be placed also on the social aspects of immunization if widespread coverage is to be achieved.

PIP: Researchers interviewed 194 mothers of children 1-2 years old in Port Moresby, New Guinea to determine why childhood immunizations are not completed. They also looked at the baby clinic books to see if the children received the completed doses of vaccines. 87% did not know why children should be immunized. Moreover only 13% believed immunizations could prevent disease. Further 86.6% could not list any of the diseases that immunizations target. 11.9% did correctly report measles, tuberculosis, polio, and pertussis, however. On the other hand, 3 (1.5%) mothers incorrectly believed immunizations protect against malaria, diarrhea, and malnutrition. The relationship between lack of knowledge and noncompletion of immunization was not significant, however (p=.07). 76.8% reported very rude behavior on the part of the health staff. 15.5% went so far to say that the health staff often reacted aggressively towards them. Only 7.7% reported kind of behavior. Mothers who perceived health staff attitudes as negative tended not to return to the clinic with their children for the 3rd dose (p=.002). DPT and polio vaccine coverage declined consistently from 94% (1st dose) to 79% (3rd dose). Nevertheless 3rd dose coverage was considered rather high. Since hospital delivery was almost universal in Port Moresby and hospital staff routinely administer the BCG vaccination prior to discharge, BCG coverage was high (96%), however. Emphasis in the national immunization program should be on changing health staff attitudes leading to improvements in the social interaction between patients and health staff.

Low birthweight and acute childhood diarrhoea: evidence of their association in an urban settlement of Papua New Guinea.

Children under 5 years of age residing in an urban settlement of Papua New Guinea were monitored from May 1987 to July 1988 in an attempt to identify aetiological factors of childhood diarrhoea. Low birthweight was found to be strongly associated with diarrhoea (incidence density ratio (IDR) = 1.60, 95% confidence interval (CI) = 1.26-2.03). The low birthweight effect was noticeable to at least 3 years of age. Greater attention should be paid to reducing the incidence of low birthweight, because such a reduction will not only be of benefit in the control of diarrhoea, but will also alleviate other factors which contribute to infant morbidity and mortality.

Transient risk factors for acute childhood diarrhoea in an urban community of Papua New Guinea.

Transient risk factors may play an important role in the aetiology of acute diarrhoea. These factors have not been well elucidated. To assess them, we monitored 479 children below the age of 5 years living in a well-defined urban community in Port Moresby, Papua New Guinea, for one year, using the nested case-control method with density sampling. Comparing the odds ratios, we found that eating food that had been kept for more than 12 h, eating away from home, temporary absence of mother from home for more than one day, and the presence of respiratory infection in the child, were statistically associated with an increased risk of diarrhoea. We conclude that these transient factors must be addressed if effective control of diarrhoea is to be achieved. We believe that further studies will identify the factors more precisely and provide a better understanding of the method we have employed.

Rotavirus from children of an urban settlement of Papua New Guinea.

Rotavirus is a leading cause of severe dehydrating diarrhoea among children admitted to hospitals in Papua New Guinea. A community-based study in an urban settlement of Port Moresby, the capital of Papua New Guinea, revealed that rotavirus was a major cause of diarrhoea, especially of the severe type, in this community. Two serotypes of rotavirus were observed and were explained on the basis of a 'shift and drift' phenomenon, or an introduction of a new strain from outside. Implications for such observations are far reaching in developing countries and it is recommended that intervention strategies other than vaccine development be explored.

The hydrogen sulphide screening test of water quality: its validity compared to a standard multiple-tube technique test.

A study to determine the validity and predictive value of the hydrogen sulphide screening test for water quality compared to a standard multiple-tube technique test was undertaken. The hydrogen sulphide test was found to be highly sensitive and specific with a high predictive value. It is recommended as a screening test for water quality in developing countries where resources are limited. It will be especially useful in monitoring improvement in rural water supplies.

Breast cancer in Papua New Guinea: a survey of 10 years.

A retrospective review of cancer of breast in Papua New Guinean females for a period of 10 years revealed an annual reporting rate of 2.7 per 100,000. It contributed to 4.8% of all malignancies. The islands region has the highest incidence. The most common age group at diagnosis was 40-49 years. Histologically invasive ductal carcinomas formed 66% of the tumours. Resembling the African experience, the incidence of breast carcinoma in Papua New Guinea appears to be low and most patients report quite late.

Carcinoma of liver in Papua New Guinea: an updated review of incidence.

568 cases of primary carcinoma of the liver were recorded as having been histologically diagnosed in Papua New Guinea during a period of 25 years (1962-1986). Though the reported annual incidence rate of 0.9/100,000 population is low, the age incidence pattern suggests that this is a high incidence area. We strongly recommend fine needle aspiration cytology for the diagnosis of primary carcinoma of liver. This will increase the number of confirmed diagnoses in developing countries.

The relationship of mothers' perception of babies' faeces and other factors to childhood diarrhoea in an urban settlement of Papua New Guinea.

Much progress has been made in identifying behavioural factors that play an important role in the aetiology of diarrhoea. This short report represents results from a 1-year prospective community-based study of the aetiology of diarrhoea. It was designed to investigate, among other things, mothers' perceptions of the importance of babies' faeces and other factors in the aetiology of diarrhoea. Children whose mothers did not perceive babies' faeces to be important in causing diarrhoea had a 7.4 times greater risk of getting diarrhoea than those whose mothers recognized the relationship. The risk for contaminated food was 6.8 times greater for those children whose mothers did not recognize its importance. For the rest of the factors, there was no meaningful association. Health education should emphasize the polluting nature of babies' faeces and the need for hand-washing when there has been any contact.

PIP: A 1-year prospective study on the etiology of infantile diarrhea, conducted in an urban settlement in Papua New Guinea, revealed a strong association between mothers' perceptions that feces are polluting and the number of diarrheal episodes. Children whose mothers did not recognize feces as a source of diarrhea were 7.4 times more likely to get diarrhea than those whose mothers were aware of this association. Similarly, those whose mothers did not link contaminated food to diarrhea were 6.8 times more likely to suffer from diarrhea than their counterparts who were knowledgeable about this relationship. There was no significant correlation between the number of diarrhea episodes and the other items--maternal perceptions of the etiologic significance of dirty clothes, food dropped on the ground, cow's milk, and breast milk in diarrhea--about which mothers were questioned. Even when the data were adjusted for the potentially confounding effects of maternal age, education, employment, and socioeconomic status, the associations between feces, contaminated food, and diarrheal incidence remained significant. The highest relative risk (11 times greater) of diarrhea was found among infants of mothers who failed to recognize the etiologic significance of both infants' feces and contaminated food. These findings suggest a need to educate mothers about the importance of handwashing after every contact with their child's feces. Education is also needed on the dangers of eating food that has been dropped on the ground. Of the 479 infants studied, 296 had no episodes of diarrhea during the 1-year study period, 144 had 1 episode, 21 had 2 episodes, 10 had 3 episodes, and 8 had 4 or more episodes.

Knowledge about sexually transmitted diseases shown by people attending the STD Clinic at Port Moresby General Hospital.

PIP: 289 patients at Port Moresby General Hospital's Sexually Transmitted Diseases (STD) Clinic were interviewed over the January-March 1985 period to evaluate the level of knowledge about STDs shown by people attending the clinic. The questionnaire used included open-ended and precoded questions and had been translated into the 2 major languages spoken in this area of Papua New Guinea. The data were processed by the Prime computer using the BMDP statistical package. There were 231 (80%) males and 58 females; their ages ranged from 15-47 years with a mean of 24.8 and a mode of 20 years. The patients came from all provinces except West Sepik and North Solomons. 85% of the patients had heard about gonorrhea, 38% about syphilis, and 11% about donovanosis. Of those who had heard about gonorrhea, only 25 (10%) knew a corresponding local name for gonorrhea. In general, the patients knew the symptoms of gonorrhea but not of syphilis or donovanosis. A large number responded affirmatively that they had ever suffered with, had sex with someone suffering with, or had sex with someone they suspected of having gonorrhea; a few responded affirmatively to these questions in regard to syphilis and donovanosis. There was considerable variation in the replies to the causes of gonorrhea, syphilis, and donovanosis. The older patients with a mean age of 29.7 years tended to believe the cause was sorcery (puripuri); the younger patients did not. Among the 256 patients that responded to the question about what they considered to be the worst consequences of STD, 39% thought it was death. 66% responded that there was no treatment for STD in their local area; 3 identified the use of leaves, bark of trees, and ashes. The plant most commonly mentioned was the "budowai" plant. The study results indicate that even among those individuals who attend a clinic for STDs the knowledge about the major 3 STDs of the country remains limited. Ignorance of causes, symptoms, and complications is common.^ieng