Pneumonia in Goilala.

The clinical syndrome of pneumonia in adults in Port Moresby, the capital city of Papua New Guinea, has changed from the 1970s to the present. The severe lobar pneumonia commonly diagnosed in young adult men, characteristically from Goilala and living in settlements in Port Moresby, is no longer seen. Today pneumonia in adults is likely to be milder and bronchopneumonic in type. Possible explanations for the change include changes in immunity and in the bacteria found in the environment and carried in the nasopharynx of recent immigrants to the city. A change in treatment-seeking behaviour together with the wide availability of oral antibiotics is considered to be the most likely cause of the altered clinical syndrome that we have observed.

Artemisinin-naphthoquine combination (ARCO) therapy for uncomplicated falciparum malaria in adults of Papua New Guinea: a preliminary report on safety and efficacy.

BACKGROUND: The use of anti-malarial drug combinations with artemisinin or with one of its derivatives is now widely recommended to overcome drug resistance in falciparum as well as vivax malaria. The fixed oral dose artemisinin-naphthoquine combination (ANQ, ARCO) is a newer artemisinin-based combination (ACT) therapy undergoing clinical assessment. A study was undertaken to assess the safety, efficacy and tolerability of ANQ combination in areas of multi-drug resistance to generate preliminary baseline data in adult population of Papua New Guinea. METHODS: The clinical assessment was an open-labeled, two-arm, randomized study comparing ANQ combination as a single dose regimen and three days regimen (10 mg/kg/day) of chloroquine plus single dose sulphadoxine-pyrimethamine (CQ+SP) for the treatment of uncomplicated falciparum malaria with 28 days follow-up in an adult population. The primary outcome measures for efficacy were day 1, 2, 3 7, 14 and 28-day cure rates. Secondary outcomes included parasite clearance time, fever clearance time, and gametocyte carriage. The main outcome measures for safety were incidences of post-treatment clinical and laboratory adverse events. RESULTS: Between June 2005 and July 2006, 130 patients with confirmed uncomplicated P. falciparum were randomly assigned to receive ANQ and CQ+SP, only 100 patients (51 in ANQ group and 49 in CQ+SP group) were evaluated for clinical and parasitological outcomes. All the patients treated with ANQ and CQ+SP showed adequate clinical and parasitological response with 28 days follow-up. The cure rate for ANQ on day 1, 2, 3, 7, 14, and 28 was 47%, 86%, 92%, 94%, 94% and 94%, respectively. Recrudescence account for 6%; all were cleared on day 21. For CQ+SP treated group the cure rates were 24%, 67%, 82%, 82%, 84% and 88%, respectively. Recrudescence accounted for 10%; all were cleared on day 28 except for one patient. Both regimens were well tolerated with no serious adverse events. The proportion of gametocyte carriers was higher in CQ+SP treated group than ANQ treatment (41% versus 12%; p < 0.05). CONCLUSION: While these data are not themselves sufficient, it strongly suggests that the ANQ combination as a single dose administration is safe and effective for the treatment of uncomplicated P. falciparum malaria in the adult population of Papua New Guinea and deserves further clinical evaluation.

Thiamine (vitamin B1) status of boarding school students in the Southern Region of Papua New Guinea.

Thiamine pyrophosphate (TPP) is the major biologically active form of thiamine (vitamin B1). This cross-sectional study assessed whole-blood thiamine pyrophosphate concentration (WBTPPC) in boarding school students in the Southern Region of Papua New Guinea. Sample size for each of the five boarding schools was calculated using the 'proportionate to population size' cluster sampling technique. The 'Clin-Rep' reagent kit was used for the extraction of thiamine pyrophosphate from whole blood. Reverse phase high performance liquid chromatography with post-column derivatization was used to determine the thiamine pyrophosphate concentration. Informed consent was obtained from 468 students, mean age 17.7 +/- 1.5 years. The gender distribution of these students was 274 (58.5%) males and 194 (41.5%) females. The median and interquartile range of WBTPPC for all students was 95.41 microg/l (82.27-113.55). Severe to marginal status of thiamine deficiency was present in 6.4% of all the students. The mean WBTPPC for female students was significantly lower than that for the male students (p < 0.001), with a mean difference of 14.17 microg/l (95% CI of the difference: 9.85-18.50). Severe to marginal status of thiamine deficiency was present in 9.8% of female students and 4.0% of male students. The data strongly support the need for effective implementation and monitoring of food fortification legislation in Papua New Guinea. Withdrawal of fortification or suboptimal thiamine fortification of rice and other cereal products in Papua New Guinea would have serious negative public health implications, especially among students in boarding schools.