Community screening for high blood pressure among adults in urban and rural Papua New Guinea

This is a cross-sectional study conducted intermittently in Port Moresby, the National Capital District of Papua New Guinea, from 1996 to 1997; Mt Obree in Central Province in October 2000; Upper Strickland River in April 2001; and the Balopa Islands in Manus Province in December 2002. The aim of the study was to determine the prevalence of high blood pressure and identify possible risk factors for hypertension in the 'healthy' population in Port Moresby and the three rural communities. There were 1491 subjects surveyed, 704 males and 787 females. Their ages ranged from 20 to 84 years. Just over 6% of subjects were aged 65 years and above. There were 205 (14%) smokers and 340 (23%) betelnut chewers. The Central (rural) subjects were generally younger with the lowest mean systolic and diastolic blood pressures and lowest body mass index (BMI) in both males and females (no overweight or obesity). In Central and Strickland the mean systolic (SBP) and diastolic (DBP) blood pressures were lower and remained the same in all age groups, then in females decreased with age after 55 years. The Manus (rural) subjects were older with higher mean systolic and diastolic blood pressures and higher mean BMI, surprisingly similar to the urban population of Port Moresby. The mean systolic blood pressures in Port Moresby and Manus increased with age in both sexes, while the mean diastolic pressure remained the same in all age groups in females and decreased after the age of 50 years. The prevalence of systolic hypertension among men and women was higher in Manus than in urban Port Moresby and, among the female subjects, Manus had the highest at 31%, while Central recorded the lowest for both males and females. The mean systolic blood pressures of betelnut chewers in Port Moresby, Manus and Central were lower (by 1-9 mmHg) but higher--in males only--in Strickland. The mean diastolic blood pressures of betelnut chewers were lower in all study sites. Both high BMI (overweight and obesity) and older age were significantly associated with high systolic blood pressure but betelnut chewing was significantly associated with lower mean SBP (p < 0.001), a protective effect against systolic hypertension.     

Acute erosive gastritis in Port Moresby

A retrospective analysis of 50 cases of haematemesis and melaena during the period from June 1978 to July 1983 at Port Moresby General Hospital (PMGH) was undertaken to establish the cause, clinical profile and prognosis of this problem. Acute erosive gastritis is the commonest cause of acute gastro-intestinal bleeding found in this study. The significance of its occurrence, age and sex distribution, associated aetiological factors and management are discussed.     

Oral health status of teenage schoolchildren in Port Moresby, Papua New Guinea.

In Papua New Guinea the main dental problem has been periodontal disease and related conditions. Dental caries appears to be low in many community groups. The aim of this study was to explore the prevalence of dental caries and the periodontal health status of teenage schoolchildren in Port Moresby. 200 children of mean age 15.4 years were examined from two urban community high schools in Port Moresby. 44% of the children examined were caries-free and the average decayed, missing or filled teeth (DMFT) score was 1.43, while only 2.5% of the children had totally healthy periodontal tissues. 18% of them showed pathological periodontal pockets of 4 or 5mm in depth, the remaining children having either gingival bleeding, calculus or both. The results indicated that this group of children showed a low prevalence of dental caries and a high prevalence of periodontal problems. No cases with deep periodontal pockets of 6mm or more were found.     

Survey of rickettsial antibodies at two local sites and review of rickettsiosis in Papua New Guinea

The status of rickettsial infection in Papua New Guinea (PNG) is unknown although several reports of typhus-like illnesses infecting predominantly white settlers and the Allied troops during World War 2 were published between 1930 and 1945. We performed a serological survey for evidence of rickettsial infection by measuring rickettsia-specific antibody levels in the blood of 191 non-randomly selected Papua New Guineans living in Port Moresby (n=93) and in the highland villages of Samberigi (n=98). Antibodies were measured by a microimmunofluorescence method using a panel of rickettsial antigens of a number of species and strains. In addition, we have reviewed the current status of rickettsiosis in PNG. Overall, we were able to demonstrate significant titres of antibodies to two groups of rickettsiae, the scrub typhus group (STG) and the spotted fever group (SFG). All positive individuals (7/191) were residents of Port Moresby. None from the highlands showed any significant levels of antibodies to rickettsiae. The strains detected within each group were Gilliam and Karp for STG and, for SFG, Rickettsia honei, R. conorii, R. sibirica, R. rickettsii, R. australis and R. akari. No significant antibody titres to typhus group infection were detected in either Port Moresby or highland volunteers. These findings were not surprising given previous reports of typhus-like illnesses and favourable environmental characteristics for rickettsiae in some parts of PNG. Until a definite status of this disease is known, we suggest that rickettsial infection be included as a differential diagnosis for patients presenting with acute febrile illness in Port Moresby and surrounding areas.     

Neonatal jaundice and glucose-6-phosphate dehydrogenase deficiency in Papua New Guinea.

Of 50 jaundiced neonatal patients studied at the Port Moresby General Hospital, 11 (22%) were found to be glucose-6-phosphate dehydrogenase-deficient. No apparent exogenous precipitating causes for the jaundice were noted. Serum bilirubin levels exceeded 20 mg/100 ml in seven of these glucose-6-phosphate dehydrogenase-deficient infants, and exchange transfusions were required for three subjects. Glucose-6-phosphate dehydrogenase deficiency must be considered in the differential diagnosis of neonatal jaundice in Papua New Guinea.     

Isolation of Haemophilus ducreyi from a chancroid in Papua New Guinea

Haemophilus ducreyi was isolated from a patient who presented with a genital ulcer at the Port Moresby Clinic for Sexually Transmitted Diseases. This provides documentation for the occurrence of chancroid in Papua New Guinea. The differentiation of this disease from donovanosis is discussed.     

Sexual abuse of children presenting to the Children's outpatient Department of Port Moresby General Hospital

Over a one-year period in the Children's Outpatient Department of Port Moresby General Hospital 23 cases of child sexual abuse were diagnosed. 20 (87%) were female. The perpetrator was known to be a male relative or acquaintance in 14 (61%) cases. The patients presented either with a history or overt signs of sexual abuse. With increasing awareness of child sexual abuse as a significant problem in paediatrics there will be an increase in the frequency of diagnosis of this condition in Papua New Guinea.     

Perinatal outcome and associated factors of persistent breech presentation at the Port Moresby General Hospital,Papua New Guinea

A study of 502 singleton persistent breech presentations and 502 controls of cephalic presentations during labour, at the Port Moresby General Hospital, was carried out from January 1988 to July 1993. In 76 (15%) of the cases, at least one attempt was made at external cephalic version. Backward logistic regression analysis showed that Momase or Islands region ethnicity, previous breech delivery, lack of antenatal care, preterm delivery, low birthweight and congenital anomalies were significantly associated with persistent breech delivery. The perinatal outcome of babies with breech presentation was worse than among babies with cephalic presentation.     

Perinatal mortality at the Port Moresby General Hospital and St. Therese's Maternity Hospital 1972

A study was made of the 67 still-births and the 58 neonatal deaths that occurred among the 3,516 viable infants (birth weight 1,000 g. or more) that were born to public patients of the obstetric units of Port Moresby General Hospital and St. Therese's Maternity Hospital during the year 1972. The combined stillbirth and neonatal mortality rate was 35.5 per 1,000 births. The adverse effects of lack of antenatal care, delivery outside hospital, high parity, maternal anaemia, mulitple pregnancy, and low birth weight are demonstrated. Low birth weight (1,000 to 2,200 g.) of unknown cause accounted for 24.0 per cent of the deaths. In 16,8 per cent of cases the birth weight was more than 2,200 g. and the cause of death was unknown. Birth trauma accounted for 19.2 per cent of the deaths, congenital malformation for 11.2 per cent, antepartum haemorrhage for 11.2 per cent, toxaemia for 10.4 per cent, and maternal disease for 3.2 per cent. There were miscellaneous causes in 4.0 per cent of cases. Approximately 75 per cent of the deaths were considered to be the result of unfavourable factors in the mother's environment. Approximately 14 per cent were primarily the result of obstetric complications and might have been avoided by a higher standard of obstetric care. Improving the standard of obstetric care that is presently available in Port Moresby would probably reduce the perinatal mortality rate by not more than 5 per 1,000.     

Superiority of traditional village diet and lifestyle in minimizing cardiovascular disease risk in Papua New Guineans

In the traditional society of Papua New Guinea (PNG) atherosclerotic cardiovascular diseases (CVD) are rare. However, among the urban population reports of cases of atheroma-related CVD are increasing. The purpose of this study was therefore to compare the CVD risk factors in a homogeneous population of the Southern Highlands Province living in both rural and urban areas differing only in their diet and lifestyle. A total of 221 Samberigi people over the age of 25 years were selected for the survey. These included 123 individuals from remote villages of Samberigi and 98 of their relatives who had lived in Port Moresby city continuously for a minimum of 5 years. The anthropometric measurements, blood lipid, blood glucose and glycosylated haemoglobin (HbA1c) levels were measured and compared. The rural diets were mainly of vegetarian type, limited in variety and low in fat and protein content. In the urban subjects, the typical meal comprised refined foods with high fat and protein content. The urban men and women had significantly (p < 0.05) greater body weight, body mass index (BMI), and waist and hip circumferences than their rural counterparts. In Port Moresby, 57% of the men and 67% of the women were overweight or obese compared to 28% of their rural counterparts. Similarly, the mean plasma total cholesterol, low-density lipoprotein cholesterol (LDLC), high-density lipoprotein cholesterol (HDLC), fasting blood glucose and HbA1c were significantly higher in the urban group. However, no significant differences were demonstrated for waist to hip ratio, LDLC/HDLC ratio and lipoprotein (a) levels between the two groups. The total cholesterol, LDLC and HbA1c were positively associated with age and BMI in both rural and urban locations. In conclusion, there were significant increases in CVD risk factors in the urban population compared to the rural residents. This was predominantly due to the adoption of a western lifestyle and diet as people moved from rural villages to the city of Port Moresby.     

Evaluation of thyroid stimulating hormone (TSH) alone as a first-line thyroid function test (TFT) in Papua New Guinea

In the Port Moresby General Hospital, the Chemical Pathology Department assays both thyroid stimulating hormone (TSH) and free thyroxine (FT4) on all requests for a thyroid function test (TFT). The cost of assaying both tests is obviously higher than either test alone. In order to minimize the cost of a TFT we aimed to determine if TSH or FT4 alone as a first-line test would be adequate in assessing the thyroid hormone status of patients. We analyzed TFT records from January 1996 to May 2000 in the Port Moresby General Hospital. A total of 3089 TSH and 2867 FT4 were assayed at an annual reagent cost of Papua New Guinea kina 14,500. When TSH alone is used as a first-line test at the Port Moresby General Hospital, the biochemical status of 95% of patients will be appropriately categorized as euthyroidism, hypothyroidism or hyperthyroidism with only 5% discrepant (ie, normal TSH with abnormal FT4) results. In contrast, using FT4 alone as a first-line test correctly classifies only 84% of TFTs. Euthyroid status is observed in 50% of patients and FT4 assays on these samples will be excluded appropriately if a TSH-only protocol is adopted. Furthermore, we will save a quarter of the yearly cost of TFTs on reagents alone by performing TSH only. We conclude that TSH alone is an adequate first-line thyroid function test in Papua New Guinea and when it is normal no further FT4 test is necessary unless clinically indicated.     

A case-control study of primary caesarean section at the Port Moresby General Hospital, Papua New Guinea, to identify epidemiological predictors of abdominal delivery

A retrospective study of 274 consecutive primary caesarean sections and 274 unmatched controls was carried out at Port Moresby General Hospital from January to December 1992. The primary caesarean section rate was 3.5%. Stepwise logistic regression analysis showed that primary caesarean section was significantly associated with maternal height of less than 150 cm; nulliparity; symphysis-fundal height of more than 38 cm at admission in labour; cervical dilatation of less than 4 cm at admission in labour; and the level of fetal head at admission in labour of 3/5 or higher.     

Review of surgical mortality

An analysis of surgical deaths over a seven-year period (1975-1981) at Port Moresby General Hospital is reported. Malignancy is the leading cause of death, followed by trauma. Hepatoma appears to be the commonest malignancy. 52% of septicaemic deaths occurred due to abdominal sepsis arising mainly due to delayed presentation of acute abdominal catastrophes. A plea for a separate Burns Unit is made, to reduce deaths from burn sepsis.     

A paediatric observation ward

The paediatric ward and paediatric outpatients at Port Moresby General Hospital have become increasingly crowded during the past few years. 15% of paediatric admissions stayed less than 24 hours, which meant that much work was done unnecessarily on these patients who would be better regarded as outpatients. A paediatric observation ward was opened in September 1982 to help overcome these problems. An analysis of the 2132 admissions to the observation ward during 1983 showed that 89% of the children were later sent home without requiring hospital admission.     

Survey of neonatal jaundice in Port Moresby

Neonatal jaundice is a common problem in Port Moresby. A survey was carried out on 50 consecutive jaundiced neonates in an attempt to delineate the causes of severe neonatal jaundice (bilirubin 15 mg. % or more). ABO blood group incompatibility, G-6-P-D deficiency and infection accounted for 62% of cases while no cause could be found in 38% of cases. Low birth weight, multiple births, male sex, asphyxia, delivery occuring outside the hospital, and vacuum extraction were associated more commonly with jaundiced neonates than with the controls. There was a statistically significant association between the use of promethazine in the mother during and after labour and jaundice in the newborn. The association between the use of sulphonamides in the mother after delivery and neonatal jaundice was suggestive but not statistically significant.     

Ovarian tumours in Papua New Guinea: relative frequency and histological features

An analysis has been made of 447 ovarian tumours submitted for histological examination to the Department of Pathology, Port Moresby General Hospital, for the period 1978-1982. Ovarian tumours constituted 8% of all tumours submitted during this period. Of the ovarian tumours submitted 75% were benign. The ovarian tumours presented a wide range of histological features, which were analysed according to the accepted international classification.     

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.     

Surgical wound infection in a developing country-Papua New Guinea

The results are presented of a survey of surgical wound infection in the Port Moresby General Hospital. The rate of infection in operations where it was anticipated that there was not a high probability of infection was 10 per cent. This is discussed in terms of world figures. It is concluded that the infection rate is reasonable under the circumstances which apply in such countries. Reference is made to particular factors of importance in preventing wound infection.     

A study of the correlation of prostatic pathology and serum prostate-specific antigen (PSA) levels: a perspective from Papua New Guinea

A review of serum prostate-specific antigen (PSA) values from January 1994 to May 1997 and their correlation with the histopathology of prostate specimens was carried out in the Department of Pathology, Port Moresby General Hospital. The study has shown that this biochemical investigation has not been properly used for the maximum benefit of the patient population. Remedial measures are suggested to improve the sensitivity and specificity of PSA in a setting with limited resources.