Papua and New Guinea medical journal
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Comparative Study
Thyroid function in a formerly goitrous community on Karkar Island, Papua New Guinea.
During a survey of noncommunicable disease conducted on Karkar Island, Madang Province in 1986, measures of thyroid function were examined in adult residents of a formerly goitrous village (Gamog) and a neighbouring community (Marup) with no history of iodine deficiency or endemic goitre. In Gamog, almost 20% of males and almost 30% of females had palpable goitre (maximum prevalence at ages 35-54 years) but visible goitres were not encountered. However, thyroid function tests were generally similar in the two groups, suggesting that iodine deficiency is no longer an appreciable problem for adults in Gamog. ⋯ Correction of the iodine deficiency in the Gamog community began with the program of iodized oil injections, which was undertaken in the 1970s. The current lack of iodine deficiency is probably due in the main to dietary change associated with the introduction of the cash economy. This effect may have occurred in many formerly goitrous communities in Papua New Guinea in recent years, although persistence of iodine deficiency in some parts of the country should not be discounted.
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In a retrospective study of 130 out of 141 consecutive cases of antepartum haemorrhage admitted to the Obstetrics Unit of the Port Moresby General Hospital in the three years 1987 to 1989, 33% had abruptio placentae, 48% had placenta praevia and in 19% the cause of the APH could not be determined. Delivery was by caesarean section in 56% of cases compared to a caesarean section rate of 3% for the total obstetric population. Stillbirth rates per 1000 total births were 223 for all the 130 cases, 81 for the praevia group, 488 for the abruptio group and 120 for the indeterminate group. The stillbirth rate for all deliveries in the hospital in the year 1989 was 21.5/1000.
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In 1988 a countrywide study was conducted on the costs of rural health services in Papua New Guinea. 16% of all health centres and subcentres were surveyed. Information was collected on physical facilities, recurrent costs, staff time allocation, service outputs and quality of services. Wide variation was found in the costs of rural health facilities overall, and significant differences were found between the costs and outputs of health centres and subcentres. ⋯ Despite government policy on extension of preventive health care, a strong emphasis was found on curative care. Many facilities were found to have significant excess bed capacity. Recurrent financing for transportation and maintenance was found to be inadequate.
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Systematic observations were made of a small number of aid post orderlies (APOs) managing children with the common but potentially serious symptoms of cough, fever and diarrhoea. On-site performance was evaluated against recommended management guidelines set out in Dr Keith Edwards' Diagnosis and Treatment of Common Childhood Illnesses for APOs. ⋯ Preventive health issues were rarely tackled. Our study reaffirms the need for on-site assessment of the performance of paramedical workers, sets priority demands for continuing education of health workers, and provides a framework for competency-based problem-solving activities within this context.
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Pacific populations have some of the highest prevalences for diabetes in the world. Whilst universal screening for diabetes in pregnancy does yield the best pick-up rate it is not economically feasible in developing countries. ⋯ This study shows genetic origin to be a potent marker for gestational diabetes in a Pacific Island population. It is recommended that in Port Moresby 'at-risk ethnicity' (urban Motuan or Marshall Lagoon origin) be added to the list of indications for antenatal glucose tolerance testing in Papua New Guinean women.