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Training Tools Training The School of Medicine at the University of Papua New Guinea runs post-graduate training in paediatrics and child health. The training consists of a 1-year Diploma of Child Health (DCH), followed by a 3-year Masters of Medicine in Paediatrics. The DCH can be done from any hospital where there is a paediatrician. The training is a mixture of clinical paediatrics and public health, with a focus on the common causes of disease in PNG children, available treatments and holistic care, determinants of health and illness prevention, and evidence-based health care. Trainees do a research project for both their DCH and Masters. Curriculum: UPNG Post graduate curriculum DCH and MMed in Paediatrics From Pregnancy to Adolescence — We’re Here Every Step of the Way

Annual General Meeting Current Activities The Paediatric Society met in Port Moresby in June 2014 at the Annual Mid-Year Meeting. The National Child Health Plan 2009-2020 was revised and updated. Some of the key points of progress highlighted in the first 5 years of the Plan were Reductions in malaria Vaccines: Hib in 2008 and Pneumococcal Conjugate Vaccine (2014) Slowing of HIV epidemic, introduction of PCR for early infant diagnosis Increased training of paediatricians through the UPNG DCH and Master of Medicine program, and improved paediatrician coverage in provinces Better surveillance and outcome data at hospital level through the Paediatric Hospital Reporting program Introduction of zinc and better coverage of vitamin A Changes beyond the health sector Improved education, some provinces with free education Primary school enrolments up 300,000 It was recognised that there are still gaps Old conditions not solved Tuberculosis HIV Measles Pneumonia Severe malnutrition Dysentery, typhoid The “new morbidities” Developmental disability Long-term implications of chronic illness Adolescent health Cancer, heart disease Obesity Child mental health

Research 2014 Research 2014 2014: Research conducted by the Master of Medicine and Diploma of Child Health post-graduate candidates Dr Stanley Hannup Binax NOW testing in meningitis in Angau Hospital 2014 Dr Michael Landi Malnutrition at PMGH 2014 Dr Betty Antibiotic prescribing in Honiara 2014 Dr Tina Yarong Immunization in Modilon 2014 Dr Margaret Nablu Malnutrition in Angau Hospital 2014 Dr Veronia Kalit Newborn care practices at Nonga 2014

PHR Reports Paediatric Hospital Reporting Annual Child Morbidity and Mortality Reports The National Health Department’s Child Health Advisory Committee has produced an Annual Morbidity & Mortality Report since 2010. These reports summarise paediatric admissions and outcomes in hospitals in PNG. The reports contain important clinical and public health recommendations for improving child health. Disease Surveillance Case Reporting Forms The World Health Organisation declared Papua New Guinea free of polio and leprosy in 2000. However surveillance is still essential for polio and for other diseases. PNG has a program for reporting of acute flaccid paralysis (for polio surveillance), and acute fever and rash (for measles and rubella surveillance). Reporting forms for these and other notifiable diseases can be downloaded here. Reporting of these diseases requires that health workers know how to identify a suggestive clinical syndrome and take the appropriate test to confirm or exclude the diseases under surveillance. PNG also has surveillance for rheumatic fever and rheumatic heart disease, and severe acute watery diarrhoea (to identify cholera outbreaks). Stronger Communities Begin with Healthier Children

Research 2019 Research 2019 Master of Medicine Dr Rupert Marcus Congenital malformations among 1000 consecutive live births in Milne Bay Province Background: Birth defects contribute 7-10% to neonatal mortality, worldwide 2.3 million children survive each year with lifelong disabilities from birth defects and 90% of birth defects occur in developing nations. Data on birth defects from developing countries such as Papua New Guinea are scarce. We describe the profile of birth defects seen in a birth cohort in a provincial hospital in Papua New Guinea. Aim: To describe the specific types of birth defects in the cohort, to identify possible risk factors, and to direct prevention measures. Methods: Between February and August of 2018, one thousand consecutive babies born alive were assessed for birth defects at Milne Bay Provincial Hospital. Cases were identified and described by the use of the World Health Organization Classification of Disease (ICD-9). Controls were compared with cases utilizing pretested questionnaires. Results: In this study the incidence of birth defect was 28/1000 live births. Defects of the nervous system was most common with 17.9% of cases followed by cardiovascular, genitourinary, ENT and musculoskeletal defects which all comprised 14.3% each. Some characteristics were more represented in cases compared to controls, including maternal age <19 years (OR: 11.9), maternal smoking (OR: 3.8) and lack of folate supplements (OR: 3.5), however, in this relatively small sample of birth defects these were not statistically significant. Conclusion: Birth defects will increasingly play a major part in child mortality and morbidity in developing nations such as Papua New Guinea. Strategies in family planning, adolescent health, maternal health care and folate supplementation/fortification appear important in Papua New Guinea. Dr Allanie Rero Child neglect in Modilon Hospital, Madang – incidence and characteristics Neglect is an important form of child maltreatment which can result in death or permanent poor health throughout life. For the purpose of this study, child neglect was defined when a child’s basic developmental and health needs have not been met by acts of omission by parents or guardians, leading to ill health and hospitalization. Between March 2017 and December 2017 there were 231 patients admitted to the Paediatric ward, 91 of whom fulfilled the definition of neglect. From those that had been neglected in some way 30 (33%) of children were adopted compared to 3 (3.3%) of controls, bottle fed 21 (23.1%) compared to (4.4%), unvaccinated 41 (45%) from 17 (18.7%) respectively. Among the children who had been neglected, severe acute malnutrition 42 (46.2%), followed by tuberculosis 26 (28.6%) and acute gastroenteritis 12 (13.2%), were the leading causes of hospital admissions, while malaria, pneumonia and anaemia were the leading causes in the controls. Mortality was high in the neglected group with a case facility rate of 23%, with severe acute malnutrition accounting for 9 of the 21 deaths (43%). Associated with child neglect were financial stress 25 (28%), parental issues 23 (25%), uneducated parents 15 (17%), closely spaced pregnancies 13 (14.3%), domestic violence 4 (4.4%) and a child with disability 3 (3.3%). Diploma of Child Health Dr Dasha Pomat Management of severe pneumonia in Nonga Base Hospital, a systematic audit In PNG pneumonia remains the most common cause of admission in children with CFR of 9.62% in 2018 for severe pneumonia. This systemic audit was aimed at identifying where care is adequate and where it is lacking and needs improvement in the current management practices of severe pneumonia in Nonga General Hospital, East New Britain Province. The objective of the study was to audit the clinical standard of practice of the management of severe pneumonia in children aged 1 month to 59 months, using a proforma checklist of clinical standards outlined by the Paediatric Society of PNG and the WHO. Dr Clyde Kamo Child death audit meetings at Mt Hagen General Hospital – processes and outcomes Auditing is a vital tool to improve quality of any endeavour. Good auditing with regard to death auditing and reviews depends on the availability of updated credible records, a standard widely accepted auditing protocol and the objective to make adjustments and needed changes to ultimately improve patient care. Over 5 months, the paediatric team in Western Highland Provincial Health Authority has been carrying out monthly death reviews based on the WHO death reporting forms with the aim of identifying common avoidable modifiable causes of deaths. Strategies can then be put in place to improve these factors. This paper looks at the effects of establishing a regular death auditing program and the implications it has for the future care of paediatric patients. Dr Maxon Lifigao Congenital syphilis at National Referral Hospital in Honiara, Solomon Islands This presentation discusses the incidence and clinical features of congenital syphilis, and the incidence of mothers who are VDRL positive delivering at the National Referral Hospital in Honiara, Solomon Islands. In Honiara in 2018-19 of 1535 live births: 130 (8.5%) mothers were VDRL positive; 72 babies (4.7%) babies were VDRL positive; 67 (4.3%) babies were TPHA positive; 7 (0.5%) babies had clinical features of congenital syphilis. The rates doesn’t take into account still births, which are likely to have higher VDRL positive rate. Dr Wilma Luan-Kasso Kangaroo Mother Care amongst preterm newborns in Modilon General Hospital, Madang Kangaroo Mother Care (KMC) was introduced to Modilon General Hospital in 2015 but there were many implementation challenges due to limited resources and a limited level of a supportive and enabling environment. Aim: To assess the impact of intermittent KMC on preterm/low birth weight neonates on discharge outcomes. Methods: This prospective observational study included educational sessions for special-care-nursery staff and mothers about KMC. This was followed by an assessment provided on the care of 38 neonates with birth weights between 1200-2000 grams who received intermittent KMC. Results: Overall, 84% were preterm with 83.3% of the newborns delivered at health facilities with hypothermia on admission. KMC hours ranged from 0-8 hours per day. More than half absconded/leaving hospital against medical advice and 72.7% and 41.7% had weight gains of <5 grams/kg/day and 10 grams/kg/day, respectively. Conclusion: Early essential newborn care practices for preterm/low birth weight newborn and an enabling supportive environment and resources for both the health care worker and mother/career would improve the implementation of intermittent KMC.

Paediatric Teaching Resources Paediatric Teaching Resources Below are the links to some good teaching videos about clinical history taking and examination for different systems, and some procedures. They are all freely available from the Internet, and the sources are acknowledged. Thanks to Dr Paulus Ripa and others for finding these. Gastrointestinal assessment https://www.youtube.com/watch?v=932E4B9UApg&t=103s https://www.youtube.com/watch?v=oJ1CsJJHZCQ https://www.youtube.com/watch?v=H0e8XkYe7uQ&t=47s Respiratory assessment https://www.youtube.com/watch?v=gcS7RS8pXqs https://www.youtube.com/watch?v=gcS7RS8pXqs&t=11s https://www.youtube.com/watch?v=rKgbIEPYqQ8&t=44s Cardiovascular assessment https://www.youtube.com/watch?v=Mu0C_of6Aw0 https://www.youtube.com/watch?v=hTClmf8egGM&t=343s https://www.youtube.com/watch?v=y-n6MWmT1YA Neurological assessment https://www.youtube.com/watch?v=_XTY8YYhkGU https://www.youtube.com/watch?v=HDDVqEa_MpY How to perform a lumbar puncture This is an excellent video from Dr Osama Naga on how to safely perform an LP and how to interpret the CSF findings. https://youtu.be/Md4Bp4HD5xE Developmental assessment https://www.youtube.com/watch?v=RfemPAlDzN4 https://www.youtube.com/watch?v=ThNsIohZzAY&t=208s https://www.youtube.com/watch?v=nxvAaQm659M Airway videos by Sydney intensive care ambulance officers (input the same password to watch each video: “AiRblogVideos”) https://sydneyhems.com/airway-registry/cmac-videos/

CME Continuing Medical Education Q&A 2018 2017 2016 2015 Because Every Child Counts

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Disease Surveillance Case Reporting Form Disease Surveillance Case Reporting Forms Acute Flaccid Paralysis (AFP)_Case Investigation Form Acute Fever and Rash (AFR)_Case Investigation Form Pertussis Case Investigation Form Tetanus_Case_Investigation_Form Rheumatic Fever Case Reporting Form Public Health Events Case Investigation Form Contacts for Vaccine Preventable Disease Surveillance: Fiona Kupe (Paediatrician NCD): fionankupe@gmail.com Vienna Nonwo (NDOH EPI) nonwovienna@gmail.com Charlotte Kambaie (NDOH Surveillance) kambaiecharlotte9@gmail.com Masa Takamatsu (WHO VDI) takamatsum@who.int

Discover the history of the PNG Paediatric Society and its journey in advancing child health, paediatric care, and medical training in Papua New Guinea. History On the 40th Anniversary of the PNG Paediatric Society, Dr Mobumo Kiromat summarised the history and achievements of the Society. History of the Paediatric Society 40th Anniversary Dr Mobumo Kiromat

Research Research Below are summaries of the latest research on child and adolescent health in developing countries: evidence derived from all the randomized trials. The aim is to make this information widely available to paediatricians, child health nurses, midwives, researchers, students and administrators in places where up-to-date health information is hard to find. We hope it will be helpful in reviewing treatment guidelines and clinical and public health approaches, and in teaching about paediatrics and evidence-based medicine. RCTs in child and adolescent health in developing countries 2023-2024 RCTs in child and adolescent health in developing countries 2022-2023 RCTs in child and adolescent health in developing countries 2021-2022 RCTs in child and adolescent health in developing countries 2020-2021 RCTs in child and adolescent health in developing countries 2018-2019 RCTs in child and adolescent health in developing countries 2017-2018 RCTs in child and adolescent health in developing countries 2016-2017 RCTs in child and adolescent health in developing countries 2015-2016 RCTs in child health in developing countries 2014-2015 RCTs in child health in developing countries 2013-2014 RCTs in child health in developing countries 2012-2013 RCTs in child health in developing countries 2011-2012 RCTs in child health in developing countries 2010-2011 RCTs in child health in developing countries 2009-2010 RCTs in child health in developing countries 2008-2009 RCTs in child health in developing countries 2007-2008 RCTs in child health in developing countries 2006-2007 RCTs in child health in developing countries 2005-2006 RCTs in child health in developing countries 2004-2005 RCTs in child health in developing countries 2003-2004 RCTs in child health in developing countries 2002-2003 Healthy Beginnings. Strong Futures.

Health Policies Child Health Policies Child and Adolescent Health Plan 2021-2030 In June 2022 the 3rd edition of the Child and Adolescent Health Plan was launched by the Paediatric Society of Papua New Guinea and partners, in a meeting in Sogeri. The plan outlines the priority areas and activities in line with the National Health Plan 2021-02030, and adds practical detail. The Child and Adolescent Health Plan is for use by paediatricians and Provincial Health Authorities (PHAs) to guide their annual activity plans; and to inform health workers, the community and the Government’s partners about child and adolescent health needs and approaches being adopted. The Plan is in line with the WHO Child and Adolescent Health Redesign, and includes a life-course approach, more emphasis on preventative health, school health, adolescent health, community and social paediatrics, mental health, and chronic diseases. The Plan also updates the program recommendations on HIV, TB, pneumonia, malaria, diarrhoea, and newborn care. PNG Child and Adolescent Health Policy and Plan 2021-2030 WHO Standards for Care of Children and Adolescents in Health Facilities In 2018 WHO published standards for paediatric care in hospitals. These standards are universal and holistic. They include clinical standards aligned to WHO guidelines, and go beyond this to require child- and family-centred care, better environments to care for children, and attention to prevention of disease and protection of children’s rights. WHO Standards for Improving Quality of Health Care for Children and Adolescents 2018 School Health Policy School Health Policy 2016 Child Protection Legislation Lukautim Pikinini (Child) Act 2009 International Code of Marketing of Breast Milk Substitutes International code of marketing of breast milk substitutes WHO 1981 The World Health Assembly Code was ratified by the PNG parliament in the Infant Feeding Act, whereby the sale of feeding bottles, cups, teats and dummies is strictly controlled, and there is a ban on advertising these products as well as breastmilk substitutes. Adolescent Health Policy Youth and adolescent health policy 2014 Nurturing Children, Supporting Families, Empowering Professionals