Childhood pneumonia and meningitis in the Eastern Highlands Province, Papua New Guinea in the era of conjugate vaccines: study methods and challenges

Background: Pneumonia and meningitis are common causes of severe childhood illness in Papua New Guinea (PNG). The etiology of both clinical conditions in PNG has not been recently assessed. Changes in lifestyle, provision and access to healthcare, antimicrobial utilization and resistance, and the national childhood vaccination schedule necessitate reassessment. Methods: A prospective case-control study was undertaken, enrolling children <5 years of age to determine the contemporary etiology of clinically defined moderate or severe pneumonia or suspected meningitis. Cases were identified following presentation for inpatient or outpatient care in Goroka town, the major population centre in the Eastern Highlands Province. Following enrolment, routine diagnostic specimens including blood, nasopharyngeal swabs, urine and (if required) cerebrospinal fluid, were obtained. Cases residing within one hour’s drive of Goroka were followed up, and recruitment of healthy contemporaneous controls was undertaken in the cases’ communities. Results: 998 cases and 978 controls were enrolled over 3 years. This included 784 cases (78.6%) with moderate pneumonia, 187 (18.7%) with severe pneumonia and 75 (7.5%) with suspected meningitis, of whom 48 (4.8%) had concurrent pneumonia. The median age of cases was 7.8 months (Interquartile range [IQR] 3.9–14.3), significantly lower than community controls, which was 20.8 months (IQR 8.2–36.4). Half the cases were admitted to hospital (500/998; 50.1%). Recruitment of cases and controls and successful collection of diagnostic specimens improved throughout the study, with blood volume increasing and rates of blood culture contamination decreasing. The overall case fatality rate was 18/998 (1.8%). Of cases eligible for follow-up, outcome data was available from 76.7%. Low but increasing coverage of Haemophilus influenzae type B conjugate vaccines on the national schedule was observed during the study period: three dose DTPw-HepB-Hib coverage in children >3 months increased from 14.9 to 43.0% and 29.0 to 47.7% in cases and controls (both p < 0.001). Despite inclusion in the national immunization program in 2014, 2015 PCV13 three-dose coverage in cases and controls >3 months was only 4.0 and 6.5%. Conclusions: Recruitment of large numbers of pediatric pneumonia and meningitis cases and community controls in a third-world setting presents unique challenges. Successful enrolment of 998 cases and 978 controls with comprehensive clinical data, biological specimens and follow up was achieved. Increased vaccine coverage remains an ongoing health priority

Operationalisation of Mild Cognitive Impairment: A Graphical Approach

A new online tool allows mapping of the different classifications of mild cognitive impairment

Portuguese category norms for children

This study presents Portuguese category norms for children of three different age groups: preschoolers (3- to 4-year-olds), second graders (7- to 8-year-olds), and preadolescents (11- to 12-year-olds). Three hundred Portuguese children (100 in each group) completed an exemplar-generation task. Preschoolers generated exemplars for 13 categories, second graders generated exemplars for 17 categories, and preadolescents generated exemplars for 21 categories. For each group, responses within each category were organized according to frequency of production in order to derive exemplar-production norms for sets of tested categories. The results also included information about the number of responses and exemplars, idiosyncratic and inappropriate responses, and commonality and diversity indexes for all the categories. A comparison of these children’s norms with the Portuguese adult norms was also presented. The full set of norms may be downloaded from www.psychonomic.org/archive

Backpackers—What is the Peak Experience?

This section is denoted to research reports, notes, conference resumes and other significant research events. Two copies of write-ups, not exceeding 3,000 words, may be mailed to the Section Editor, Associate Professor David A. Fennell, Brock University, St. Catharines, Ontario, Canada L2S 3A1; e-mail. [email protected]. In all cases, one copy of the report should be mailed to the Chief Editor, TRR. This paper reports findings from interviews with 69 respondents representing about 15 percent of the backpackers staying in the Waikato, New Zealand, during the survey period. The research method included both quantitative and qualitative methods and analysed what backpackers perceived as their most memorable experiences. The findings suggest these include themes of difference, uniqueness, bonding with special others, a sense of achievement and the ‘adrenalin high’. While about 70 percent of such experiences related to commercial adventure products, other activities, often in a natural setting, were important. The data were analysed using thematic analysis and perceptual mapping

Clinical predictors of hypoxic pneumonia in children from the Eastern Highlands Province, Papua New Guinea: secondary analysis of two prospective observational studiesResearch in context

Summary: Background: Pneumonia is the leading cause of death in young children globally and is prevalent in the Papua New Guinea highlands. We investigated clinical predictors of hypoxic pneumonia to inform local treatment guidelines in this resource-limited setting. Methods: Between 2013 and 2020, two consecutive prospective observational studies were undertaken enrolling children 0–4 years presenting with pneumonia to health-care facilities in Goroka Town, Eastern Highlands Province. Logistic regression models were developed to identify clinical predictors of hypoxic pneumonia (oxygen saturation <90% on presentation). Model performance was compared against established criteria to identify severe pneumonia. Findings: There were 2067 cases of pneumonia; hypoxaemia was detected in 36.1%. The strongest independent predictors of hypoxic pneumonia were central cyanosis on examination (adjusted odds ratio [aOR] 5.14; 95% CI 3.47–7.60), reduced breath sounds (aOR 2.92; 95% CI 2.30–3.71), and nasal flaring or grunting (aOR 2.34; 95% CI 1.62–3.38). While the model developed to predict hypoxic pneumonia outperformed established pneumonia severity criteria, it was not sensitive enough to be clinically useful at this time. Interpretation: Given signs and symptoms are unable to accurately detect hypoxia, all health care facilities should be equipped with pulse oximeters. However, for the health care worker without access to pulse oximetry, consideration of central cyanosis, reduced breath sounds, nasal flaring or grunting, age-specific tachycardia, wheezing, parent-reported drowsiness, or bronchial breathing as suggestive of hypoxaemic pneumonia, and thus severe disease, may prove useful in guiding management, hospital referral and use of oxygen therapy. Funding: Funded by Pfizer Global and the Bill &amp; Melinda Gates Foundation