Infection with human immunodeficiency virus, herpes simplex virus type 2, and human herpes virus 8 in remote villages of southwestern Papua New Guinea.

To investigate the spread of human immunodeficiency virus (HIV) and other sexually transmitted viruses, two serosurveys (the first in 1999 among 56 adults and the second in 2001 among 351 adults) were conducted in remote villages of the southwestern part of Papua New Guinea. Only one individual was positive for antibodies to HIV. In 2001, the seroprevalence of human herpes virus 8 (HHV-8) was 32.2%, and the seroprevalence of herpes simplex virus type 2 (HSV-2) was 27.4%. Both prevalence rates increased with age, and were lower in the villages near the Bensbach River. The seropositivity of HSV-2 was independently correlated with HHV-8 infection. Our data show that the inhabitants of the southwestern region of Papua New Guinea currently experience an extremely low circulation of HIV. However, the high prevalence of infectious agents that can be sexually transmitted, such as HSV-2 and to a lesser extent HHV-8, indicates the presence of behavioral patterns that may facilitate the spread of HIV in this area of currently low endemicity.

Human herpesvirus-8 and other viral infections, Papua New Guinea.

We studied residents of remote villages and the capital (Port Moresby) of Papua New Guinea to determine the distribution of human herpesvirus-8 (HHV-8) infection. Our data suggest that HHV-8 has been endemic on the island for a long time and that the epidemiologic pattern of HHV-8 is more similar to that of herpes simplex virus-2 than hepatitis C virus.

Focus of human trichinellosis in Papua New Guinea.

Human trichinellosis and teniasis (Taenia solium) are meat-borne helminthic infections with a wide distribution throughout the world. However, there is little information on the prevalence of these infections in Papua New Guinea. In 1999, serum samples were collected from 97 people in 6 villages in the remote Bensbach area of Papua New Guinea. Enzyme-linked immunosorbent assay and Western blot analyses were used to detect anti-Trichinella immunoglobulin (Ig) G and anti-cysticercus IgG in this population. The prevalence of Trichinella antibodies among inhabitants of the Bensbach area was 28.9% (28 of 97; 67.8% in men), suggesting a high consumption of poorly cooked meat. The higher prevalence of infection for Trichinella in men compared with women may be explained by the inclination of men to eat undercooked pork while hunting. All serum samples were negative for cysticercus antibodies. This is to our knowledge the first serosurvey showing anti-Trichinella antibodies in a human population living in Papua New Guinea (Australian region).

Current opportunities and future challenges in child health in Papua New Guinea.

Papua New Guinea (PNG) is at a crossroads in child health care. We know how to treat or prevent most of the diseases causing child and maternal mortality, but we are failing to deliver the services to where most of the people are dying. There is much to be learnt from early achievements in the development of health services in PNG. Between the 1950s and 1970s the infant mortality rate fell from 250-500 per 1000 livebirths to 77-100 per 1000 livebirths. This occurred predominantly because of an emphasis on public health programs and cost-effective standard treatment. Now the public health services have deteriorated, vaccine coverage is poor and health workers are not fully using the standard treatment resources available to them. The greatest academic and practical challenges facing medicine in PNG are to implement effective and consistent delivery of vaccines, and nutritional, basic curative and maternal care to remote or impoverished communities. The other unmet prerequisites for improvement in health status are that communities participate in and take some responsibility for their health care needs. There are now unprecedented opportunities for collaboration with international partners, churches, non-government organizations and community groups to achieve these goals. Specific key strategies in child health include the more widespread utilization of the 10-Step Checklist, adoption of some of the World Health Organization Integrated Management of Childhood Illness strategies, increased output of child health nursing training, improving vaccine delivery and cold-chain services, and new immunization strategies for acute respiratory infections. The National Health Plan 2001-2010, launched in August 2000, emphasizes the vital importance of public health; the need for greater access to quality health services; improving clinical skills among health workers at all levels; and cooperation between all interested parties. By 2010 the National Health Plan must be judged not on how good the plan seemed on paper, but on whether there was a measurable reduction in maternal and child mortality over the first decade of this century.

Protection of breastfeeding in Papua New Guinea.

In Papua New Guinea the bottle-feeding of babies has been increasing, predominantly among unemployed women of low educational status. Many women are unaware of their legal right to have breaks at work for the purpose of breastfeeding, and a high proportion of workplaces have no facilities for mothers who wish to breastfeed their children. The laws on the feeding of infants should be updated and implemented, and an effort is needed to explain the benefits of breastfeeding and the rights of working mothers.

PIP: Among women leaving hospital after delivery in Port Moresby, Papua New Guinea, the proportion feeding their babies artificially increased from 6% in 1964 to 22% in 1974. However, bottle-feeding was known by health personnel to have devastating effects upon children's health. A 1976 survey conducted in 5 suburbs of the city found that a third of babies were artificially fed, of whom 69% were malnourished, compared to only 26% of breast-fed children similarly malnourished. Papua New Guinea's Baby Feed Supplies (Control) Act 1977 was issued to keep parents from obtaining feeding bottles except from registered pharmacists upon presentation of a prescription issued by a registered health worker. The Act also prohibits the advertising of breast milk substitutes. A 1979 survey in 4 of the 5 suburbs covered in 1976 found that only 11% of babies were being bottle-fed, indicating a positive short-term effect of the Act. Current policy favors exclusive breast-feeding for the first 4-6 months of a baby's life, no bottle-feeding in maternity or pediatric facilities, and active discouragement of such feeding. A 1995 multicenter infant feeding survey which collected feeding data on 1822 infants under age 2 years found that breast milk substitutes or other fluids were given to 1133 children, with bottles readily attained without prescription. Bottle-feeding was common in all of the provincial centers studied, with the highest prevalence being 35% in the Western Highlands Province. The prevalence of bottle-feeding was positively correlated with the level of mother's education and her work status as a paid employee. 72% of the bottle-feeding mothers knew that such feeding practice can cause diarrhea, almost two-thirds of the working women were unaware that they were legally entitled to 2 half-hour breast-feeding breaks daily, and the existence of child care facilities at the workplace was reported by less than 5% of interviewees.

Infant feeding practices in Papua New Guinea.

Concern about a possibly increasing prevalence of bottle-feeding led in 1995 to an Infant Feeding Survey of 1822 mothers attending urban health facilities. Infant feeding practices including feeding of colostrum, exclusive breastfeeding, weaning practices and bottle-feeding were assessed. This revealed that 28.8% of mothers had not given colostrum to their babies, that 43.5% of 3-month-old babies were exclusively breastfed, and that solids were introduced before 4 months of age in over half of the study population. Bottle-feeding was used by 20% of the study population. Feeding practices differed in women of Highlands and of Coastal origin. The findings emphasize the need to strengthen health education programmes which take into account the mothers' different cultural backgrounds. The issue of breast-feeding by mothers in paid employment needs to be addressed.

PIP: Recognizing the many benefits of breast-feeding, the government of Papua New Guinea (PNG) legislated to protect the practice 4 years before the introduction of the World Health Organization Code of Marketing restricting access to bottle feeding supplies. While exclusive breast-feeding for 4-6 months is recommended policy, it was noticed that many mothers introduce solids and fluids other than breast milk much earlier. In 1995, the Pediatric Society of PNG conducted a feeding survey to assess the prevalence of bottle feeding and review the effects of the imposed legislation. Infant feeding practices, including the feeding of colostrum, exclusive breast-feeding, weaning practices, and bottle feeding were assessed among 1822 mothers of children under age 2 years attending urban health facilities. 28.8% of the mothers had not given colostrum to their babies, 43.5% of 3-month old babies were exclusively breast-fed, and solids were introduced before age 4 months in more than half of the study population. 20% of the study population bottle fed. The prevalence of exclusive breast-feeding among employed Highlands women was lower than among employed Coastal women, but the difference was not statistically significant. Study findings point to the need to strengthen health education programs which take into account mothers' different cultural backgrounds. The issue of breast-feeding by mothers in paid employment also needs to be addressed.

Assessment of HIV/AIDS knowledge, attitudes and behaviour of high school students in Papua New Guinea.

OBJECTIVE: To assess the knowledge, attitudes and behaviour of high school students (grade 10) with regard to HIV infection and AIDS. METHODS: A self-administered questionnaire survey was carried out in 21 high schools in 6 different provinces. The questionnaire was anonymous and contained questions about HIV transmission, preventive measures, attitudes towards HIV infection and a few questions about personal sexual behaviour. PRELIMINARY RESULTS: A total of 1811 students completed the questionnaire. 46% were female. The average age was 17 years. Over 98% knew what AIDS and HIV were. 97% knew that HIV was sexually transmitted, but many misconceptions existed: one-third thought that HIV was transmitted by mosquitoes, 7% that HIV-infected persons were a danger in the classroom. 72% knew that using a condom at every sexual encounter was a way of protection from HIV infection. Approximately 25% reported to have had sexual contacts, and of 15-year-old students 14% were sexually active. Although STD/AIDS education is part of the curriculum for grade 8 the principals of the majority of the schools reported that no formal teaching was done. DISCUSSION: Although the majority of students knew that HIV is sexually transmitted, basic knowledge about STDs is lacking and is not taught as part of the curriculum in most of the schools. Teaching about STDs and HIV needs to be enforced and safe sexual practices need to be discussed with the students.

Persistent diarrhoea in children admitted to Port Moresby General Hospital.

A retrospective study of the records of children admitted to Port Moresby General Hospital with diarrhoea during 1992 and 1993 was carried out to determine the morbidity, mortality and risk factors associated with persistent diarrhoea. 858 admissions of children under five years of age who had diarrhoea were identified from the ward admission registers, and case records for 724 were studied. Persistent diarrhoea occurred in 20%, and nearly half of these were in the 12-23 months age group. Children with persistent diarrhoea had a case fatality rate of 4.9%. Seasonality was similar for both persistent and non-persistent diarrhoea. In the crude analysis children of 12 months and older had a greater risk of developing persistent diarrhoea than those less than 12 months (odds ratio for children 12-23 months was 2.0 and for children 24-59 months 1.7; confidence intervals were 1.2-3.1 and 1.0-2.9 respectively); however, this difference was not found after logistic regression analysis. Poor nutritional status was a significant risk factor for persistent diarrhoea and remained so after controlling for confounding variables (odds ratio 2.7; confidence interval 1.8-4.0).

PIP: A retrospective review of the records of 724 children under 5 years of age admitted to Port Moresby General Hospital (Papua New Guinea) in 1992-93 with diarrhea was conducted, with emphasis on risk factors for persistent diarrhea. These cases represented 84% of total under-5 diarrhea admissions during the study period. Of the 720 children for which the duration of diarrhea was recorded, 144 (20%) had persistent diarrhea lasting 14 or more days. 49% of persistent diarrhea cases involved children 12-23 months of age; the largest proportion (40%) of short-term diarrhea cases occurred in infants 0-11 months old. Watery diarrhea, vomiting, cough, and fever were the most common presenting symptoms for diarrhea and acute respiratory tract infection was the most frequent cause of co-morbidity. Seasonal peaks in incidence occurred in May-July and November-January. After adjustment for dehydration-related weight loss, 42% of children with diarrhea were classified as malnourished. The case fatality rate was 4.9% for persistent diarrhea and 3.6% for non-persistent cases. In the univariate analysis, age and nutritional status were the only significant risk factors for persistent diarrhea; sex, past hospital admission, and co-morbidity were only weakly associated with persistent diarrhea. In the logistic regression analysis, only malnutrition remained a significant risk factor (odds ratio, 2.7; 95% confidence interval, 1.8-4.0). It is speculated that malnutrition associated with weaning accounts for the high rate of persistent diarrhea among children 12-23 months of age.

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.