Low birthweight at a Papua New Guinea highlands hospital.

A prospective case-control study involving 75 low birthweight (LBW) babies and 224 controls was carried out at the Mount Hagen General Hospital over a period of 7 months, from June to December 1997. Identified risk factors for LBW in this population included maternal age (age less than 22 years or over 35 years, p = 0.03), a birth interval of less than 2 years (p = 0.006), no antenatal booking (p = <0.005), low attendance at antenatal clinic (p = <0.005), fever during pregnancy (p = <0.005), PET (p = 0.05), APH (p = <0.015), and maternal smoking during pregnancy (p = 0.008). Other well-established risk factors for LBW, i.e. small stature, low body mass index (BMI), haemoglobin less than 8 g/dl, and low educational attainment, appeared to be more frequent in the mothers of the LBW babies than the controls but differences did not reach statistical significance. The results suggest the need for improved provision of, and efforts to increase the use of, antenatal and family planning services. The results also provide clear evidence of the deleterious effects of smoking during pregnancy in a developing country.

Child adoption in the Western Highlands Province of Papua New Guinea.

This study investigated the epidemiology of child adoption in the Western Highlands Province of Papua New Guinea. A prospective case-control study of 100 adopted and 100 control children matched by age and sex was done in 1995. The age at the time of adoption ranged from 7 days to 8 years with 64 being adopted in the neonatal period. 28 were adopted because the biological mother had died, 23 because the adoptive mothers had been unable to bear children and 16 because the biological mother was unmarried or 'too young'. Only 11 adopted children were not blood relatives of the adoptive mother; 10 children had been abandoned and 1 had been bought for cash. 97 adoptive mothers were married. The majority (61%) had no formal education and 95% were not in paid employment. Compared with the mothers of the control children fewer adoptive mothers had received any formal education and more of them smoked cigarettes, drank alcohol or chewed betelnut. Social characteristics of the adoptive fathers were similar to the fathers of the control children. Of the 66 living biological mothers for whom information was available, 39 (59%) were married, 16 (24%) single, 8 (12%) divorced and 3 (5%) widowed. For 21 (32%) of the biological mothers the adopted baby was their first. 19 adopted babies were breastfed, 8 exclusively, 6 with the addition of non-human milk and 5 with additional solid feeds. Two-thirds of the adopted children and only 5 controls were bottle-fed. There were no significant differences in nutritional status between the two groups and immunization status was similar. There was widespread ignorance about legal adoption procedures. Only 8 adoptive mothers had any knowledge of and only 2 had followed formal adoption procedures. In this group of adopted children it appeared that most were well cared for, as their nutritional status and immunization status were similar to non-adopted children. There have, however, been suggestions that adoption is a risk factor for child abuse in Papua New Guinea and adoption has recently been associated with severe malnutrition and mortality in a highlands hospital inpatient population. Information relating to formal adoption processes should be more widely disseminated throughout Papua New Guinean communities to protect the rights of adopted children and their adoptive parents.