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Query: UMLS:C0032285 (pneumonia)
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As part of a multi-disciplinary research programme undertaken by the Papua New Guinea Institute of Medical Research near the town of Madang, northern PNG, a three-year study of mortality was conducted in a rural population of approximately 16,500 people. From early 1982 the area was under continuous demographic surveillance which continued for the three years of the study. All deaths which occurred in this period were investigated by interviewing relatives of the deceased and examining any available health service records. Respiratory diseases were the commonest cause of death, with pneumonia accounting for 20% of deaths in children under 10 years of age, and pneumonia and chronic obstructive lung disease (COLD) together accounting for a third of all deaths. Deaths from COLD were more common in the study population than in PNG hospitals and health centres. The proportion of deaths caused by malaria in children under 10 years was estimated to be between 4 and 17%. Mortality rate in the first year of life were determined by following up a cohort of 1015 births occurring in the first 20 months of the study. Of the 1002 live births, 46 died in the first 12 months of life, giving an infant mortality rate of 45.9% live births. Other mortality and demographic rates were consistent with data reported from the 1980 PNG National Census, suggesting that the study population belonged to an advantaged rural area. Demographic features found in this population were a high birth rate, a relatively low crude death rate, and a rate of natural population increase of 2.8% per annum. The methodological difficulties associated with the measurement of malaria mortality have important implications for the evaluation of future malaria vaccines. The methods employed in this study are critically discussed, and recommendations made for future studies.
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PMID:Mortality in a rural area of Madang Province, Papua New Guinea. 260 69

The purpose of this health facility survey was to evaluate how the ARI (Acute Respiratory Infection) Program actually works in an everyday, non-research setting. We surveyed 33 clinics and aid posts, including 223 children with ARI and 104 health workers. In this primary health care setting, health workers diagnosed 37% of ARI cases as pneumonia, compared to 69% in the same children assessed independently by trained ARI surveyors using Papua New Guinea case management, which defines fast breathing as > or = 40 per minute for children 1 month to 5 years of age. Agreement between health workers and surveyors was reasonably good (kappa > or = 0.6) for the history of symptoms, but was poor (kappa < 0.3) for diagnoses, treatments and signs such as respiratory rate (RR) and chest indrawing. Health workers counted the RR in only 14% of cases in the survey. In essence, we found that health workers in Simbu are not practising ARI case management. We conclude that case management guidelines which define fast breathing as a rate of > or = 40 per minute classify too many obviously well children as pneumonia. Furthermore, we encountered difficulties in measuring RR accurately, and documented marked inter-observer variation in this setting. Consequently, we are concerned about the ARI Program's excessive reliance on RR and rigid protocols at the expense of clinical sense. Case management guidelines developed for aid post orderlies or village health workers may need to be modified, or used differently by experienced nurses at health centres, who recognize sick children better than by following a standardized protocol. Despite better overall ARI knowledge and practice by nurses, we could demonstrate an impact of the ARI Training Program only on community health workers (CHWs). In order to improve ARI clinical practice, we recommend that the ARI Program in PNG initiates regular on-site clinical supervision of nurses and CHWs at health centres.
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PMID:Evaluation of the ARI program: a health facility survey in Simbu, Papua, New Guinea. 794 57