Biomedical subjects

T Duke

Publications and source records attributed to T Duke.

59 records · Page 4Linked to original sources

PubMedDate not supplied

Congenital syphilis at Goroka Base Hospital: incidence, clinical features and risk factors for mortality.

A prospective study of all cases of congenitally acquired syphilis diagnosed at Goroka Base Hospital was conducted between January 1998 and December 1999. 67 affected neonates and children were seen, of whom 19 died during the first admission and 3 died during the period of follow-up. Congenital syphilis caused 5.5% of 994 neonatal admissions, but 22% of all neonatal deaths. The major risk factor for death in affected babies was low birthweight. A birthweight of less than 2 kg had an odds ratio for death of 30.0 (95% confidence interval 6.90-131.1). During the time of the study 5385 women attended antenatal care at Goroka Base Hospital, of whom 382 had both positive VDRL and TPHA tests. The incidence of syphilis in women attending antenatal care was 7.1%. Syphilis is a major cause of neonatal mortality and morbidity and a major cause of morbidity among women of childbearing age in the Eastern Highlands Province. Current antenatal screening is inadequate, covering less than 30% of pregnant women. New ways to extend syphilis screening and treatment to all affected pregnant women are urgently required and must be formally assessed.

Birth Weight↗

PubMedDate not supplied

The effect of introduction of minimal standards of neonatal care on in-hospital mortality.

A retrospective study was done to assess the effect on in-hospital neonatal mortality of a series of interventions in neonatal care in the highlands of Papua New Guinea. Between 1995 and 1997, prior to the interventions, the mortality among neonates admitted to the Goroka Hospital Special Care Nursery was 18% and two-thirds of very low birthweight (1-1.5 kg) neonates died. The interventions began in December 1997 and were aimed at reducing mortality among all neonates and particularly among those with very low birthweight. Compared to the 30-month period prior to the interventions, the in-hospital neonatal mortality in the 30-month period after the interventions began was 44% lower (relative risk (RR) 0.56, 95% confidence interval (CI) 0.45-0.69). After adjustment for a higher number of neonates <1500 g in the pre-intervention period, the relative risk was 0.59 (0.48-0.74). The mortality in the intervention phase for very low birthweight babies was 56% lower (RR 0.44, 95% CI 0.30-0.65) and for moderate low birthweight (1.5-2 kg) 50% lower (RR 0.50, 95% CI 0.28-0.90). Mortality was also significantly lower in the intervention phase in neonates with a diagnosis of septicaemia or pneumonia (RR 0.36, 95% CI 0.19-0.67), but there were no differences in mortality from birth asphyxia, meconium aspiration or extremely low birthweight (<1 kg). We estimate that in the 30 months after beginning the interventions 82 neonatal deaths that would previously have occurred were avoided. The costs of the improvements in technology described are estimated at US$445 (K1000) per life saved, but substantial training and improved supervision of staff and other human factors may have been more important than equipment. Apnoea monitors were the single most important technology introduced. A similar evaluation of the effect of minimal standards should be done without the use of incubators and overhead heaters, as these are costly and may be dangerous when used by less experienced operators. The 33 neonatal deaths that we estimate were avoided each year because of the interventions represent less than 10% of all neonatal deaths in the province. Although this study provides justification for increasing the technology for supportive neonatal care and training in medium-sized hospitals in rural areas in developing countries, estimates of cost-effectiveness must be compared with other interventions that will effectively lower neonatal mortality, both in and out of hospitals.

Clinical Protocols↗

PubMedDate not supplied

The role of non-government organizations in supporting and integrating interventions to improve child health.

In Papua New Guinea there are many organizations providing sparsely spread and fragmented health services. Government health facilities are often relatively well functioning in urban and periurban areas, but sporadic or nonexistent in rural areas. In some remote areas churches are the major health service providers. Increasingly other community groups are providing village-based health services. Much financial support is now pledged by major international donors for community-based health services, but few people working at a district or community level have the management skills to access the funds or plan programs effectively, and few of the major donors have any significant presence in rural areas. Such a management skill gap also exists at the level of many provincial health offices and this seriously limits the effectiveness of all major donor projects. There is need for integration of health services to avoid replication and to extend services to areas where no effective services are currently provided. There is also a great need to train people at a community and district level in program planning and management. Non-government organizations (NGOs) working at a district or community level have the potential to bridge this skill gap and to help integrate community-based services with government institutions. This paper reports, as an example, the activities of Save the Children, an international NGO in Papua New Guinea. Essential for the success of community-based health projects is the development of local management skills, reliable funding, integration with established health institutions, objective evaluation and community support. Skilled NGOs working at a community, district or provincial level can have important roles in assisting local people to run effective and sustainable health programs.

Child↗

PubMedDate not supplied

Antibiotic-resistant bacterial sepsis in Papua New Guinea.

Infections due to antibiotic-resistant bacteria, especially gram-negative bacteria, are a common cause of child mortality in Papua New Guinea. Antibiotic-resistant bacteria include the enteric gram-negative bacilli, especially Escherichia coli, Klebsiella and Enterobacter, and Haemophilus influenzae type b, a major respiratory tract pathogen and cause of meningitis. Among these bacteria there is now high-level resistance to standard antibiotics, including chloramphenicol, amoxycillin and cotrimoxazole. Reasons behind the increase in antibiotic-resistant bacterial infections are the widespread unregulated use of antibiotics and the very large burden of bacterial infections. Risk factors for development of resistant enteric gram-negative infections include village births, prolonged hospital stay, kwashiorkor in adopted children and previous treatment with broad-spectrum antibiotics. Cost-effective strategies to combat these pathogens will need to be broad and must focus on reducing the use of antibiotics for trivial illnesses, reducing the need to use antibiotics and reducing the risk factors for resistant bacterial sepsis. There must be stricter regulation of commercial pharmacies, education of health workers on how to avoid inappropriate antibiotic prescribing, a focus on the prevention of pneumonia by immunization with new vaccines, improvements in the quality and uptake of formal maternal care services and public health measures within villages. In addition there is a need for better surveillance for antibiotic-resistant bacteria within hospitals; this will require substantial improvements in laboratory facilities and carefully planned research collaboration. A national committee should be established to advise on these matters and coordinate interventions.

Bacterial Infections↗

PubMedDate not supplied

Control measures and the outcome of the measles epidemic of 1999 in the Eastern Highlands Province.

In the Eastern Highlands Province (EHP) of Papua New Guinea (PNG) measles outbreaks have occurred regularly every 3 to 4 years since 1980. The latest was between September 1998 and March 2000. Between July 1999 and March 2000 314 children with measles were reviewed at Goroka Base Hospital. The majority of these children were very young: 55% were under 1 year and 27% under 6 months. The median age of the measles cases was 11 months (range 10 days to 13 years). 40% of the children had a verifiable history of having received at least one dose of measles vaccine. The majority were vaccinated during the epidemic and included many children who either were below 6 months of age or who developed measles within 2 weeks of vaccination. Measles complications occurred in 82% of the children, the most common being pneumonia. Serious complications, particularly severe pneumonia, were more common among the unvaccinated children than in those who had received at least a single dose of the measles vaccine. No deaths occurred among 82 children who had received measles vaccine more than 2 weeks before the onset of clinical measles, compared with 10 deaths in 206 children who had never been vaccinated against measles or were vaccinated in the 2 weeks before presentation (p=0.067). The overall case fatality was 4%: 14% among the hospital-acquired and 2.5% in community-acquired measles. Improvement in the measles vaccination coverage and supplementary vaccination campaigns are required to prevent measles outbreaks in PNG. Intensified measles vaccination campaigns, such as the one conducted in EHP in 1999, are recommended during epidemics to minimize deaths due to measles and to rapidly control outbreaks. The efficacy of measles vaccination can only be measured in total mortality, not in the prevention of clinical measles.

Adolescent↗