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Biomedical subjects

F Shann

Publications and source records attributed to F Shann.

121 records · Page 7Linked to original sources
PubMed1979

Port Moresby or the bush?

85% of the population of Papua New Guinea lives in rural areas. Most death in Papua New Guinea occur in rural areas - from diseases that can easily be cured or prevented. We know how to treat them. We have the drugs. But we do not deliver the goods. We do not deliver health services to rural villages. This is the central problem of health care in Papua New Guinea, all else is secondary to it. It is just as important to train Papua New Guinea doctors to tackle the problem of delivering health services to rural areas (public health) as it is to train them in what to deliver (clinical medicine). If we do not deliver rural services, but persist in concentrating on urban curative services, then we will go on being largely irrelevant to the health needs of Papua New Guinea.

Delivery of Health Care↗
PubMed1979

Leukaemoid reaction in Eastern Highlands children.

In the five year period 1973-77, 278 children in Goroka Hospital paediatric ward were found to have a white cell count (W.C.C.) over 30,000/mm3. Of those with a W.C.C. over 40,000/mm3 in 1977 where the outcome was known, 13 of the 17 (76%) died. It is suggested that "leukaemoid reaction" in Highlands children be defined as a total W.C. over 40,000/mm3 that is not due to leukaemia. A leukaemoid reaction is a useful, but grave, prognostic sign. Such children comprise a quarter of all deaths in the Goroka paediatric ward.

Child↗
PubMed1979

Childhood pneumonia at Goroka Hospital.

We have reviewed the clinical presentation of pneumonia to the Goroka paediatric ward. In comparison to survivors, children dying from pneumonia more often (p less than 0.05) had malnutrition (weight-for-age under 80%), anaemia (haemoglobin under 9g%), and a marked leucocytosis (total white cell count over 30,000 cells per c.m.m.). Children dying from pneumonia had been ill for longer and had been given more antibiotics prior to admission. There was no significant difference between children dying from pneumonia and survivors in age distribution, pulse rate, incidence of cardiac failure or duration of stay in hospital. 70% of the children dying from pneumonia at Goroka Hospital are infants under 12 months of age. Pneumococcal vaccine gives a poor antibody response in infants, and overseas studies using lung aspiration suggest that Haemophilus influenzae and Staphylococcus aureus might be causative organisms as well as Streptococcus pneumoniae. A study to determine the aetiology of pneumonia in Highlands children is required to enable a rational choice of routine antibiotic therapy and to plan further research on vaccination against pneumonia.

Age Factors↗
PubMed1979

Metronidazole for chronic diarrhoea in children.

A double blind prospective controlled trial of metronidazole was performed on children admitted to Goroka Hospital with diarrhoea for seven days or more. There was no significant difference in the duration of diarrhoea after treatment began between children given metronidazole (4.3 days) and those given placebo (4.1 days).

Chronic Disease↗
PubMedDate not supplied

Effect of reusing suction catheters on the occurrence of pneumonia in children.

OBJECTIVE: The purpose of this study was to determine whether disposable suction catheters can be reused in the same patient for a 24-hour period without affecting the incidence of pneumonia. DESIGN: The study design was a randomized controlled trial. SETTING: The study was conducted in the pediatric intensive care unit of a tertiary pediatric center. SAMPLE: Subjects included 486 children with an endotracheal tube in place. OUTCOME MEASURES: The development of pneumonia, diagnosed with radiographic and clinical evidence, was the measure. Cost analysis was also undertaken. METHOD: Subjects in the study group (n = 241) were suctioned using the same catheter for a 24-hour period. Those in the control group (n = 245) had a new catheter for each episode of suctioning. RESULTS: Pneumonia developed in 14 members (5.71%) of the control group and in 12 members (4.98%) of the study group, a difference of 0.7% (95% CI, -3.3% to 4.7%). Cost analysis indicated a saving of Aust $4.14 per patient per day. CONCLUSION: Reusing suction catheters for up to 24 hours is both safe and cost-effective.

Adolescent↗
PubMedDate not supplied

Immunization--dramatic new evidence.

The current EPI (Expanded Programme on Immunization) vaccines do not specifically target the organisms that lead to the two main causes of death in children - pneumonia and diarrhoea. This implies that the EPI vaccines will have only a modest effect on total child mortality. However, recent evidence suggests that measles and BCG vaccines dramatically reduce child mortality through nonspecific effects - that is, they reduce mortality from many causes, not just measles and tuberculosis. The combination of BCG at birth and measles vaccine at 6 months probably reduces total mortality to about one-third of its previous level. This means that immunization must now have the very highest priority. If we could improve immunization in Papua New Guinea so that all children received BCG, measles, diphtheria-pertussis-tetanus and polio vaccines, we would reduce child mortality from 120 to approximately 52 per 1000 livebirths - a truly spectacular reduction. The old polysaccharide pneumococcal vaccine is safe and effective and bulk purchases are likely to cost US$1 a dose or less. Further studies are needed of the effects of pneumococcal vaccine. Immunization of mothers and babies might reduce child mortality by 20%, at a cost of only US$83 per life saved. The available evidence suggests that one dose of pneumococcal vaccine given to every Papua New Guinean over 5 years of age every 5 years would save approximately 6600 lives a year and the vaccine would cost only US$121 per life saved. It will not be easy to achieve high immunization rates throughout Papua New Guinea. Vaccines will have to be given the highest possible priority, with curative medical services secondary to immunization. Health workers, government, the general population and overseas donors will have to be convinced of the very great benefits that will come from effective immunization. A sustained education campaign will be needed in addition to the establishment of an effective delivery system. The time has come for a radical shift in emphasis in Papua New Guinea: from hospitalization to immunization.

BCG Vaccine↗