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In the five year period 1973-77, 278 children in Goroka Hospital paediatric ward were found to have a white cell count (W.C.C.) over 30,000/mm3. Of those with a W.C.C. over 40,000/mm3 in 1977 where the outcome was known, 13 of the 17 (76%) died. It is suggested that "leukaemoid reaction" in Highlands children be defined as a total W.C. over 40,000/mm3 that is not due to leukaemia. A leukaemoid reaction is a useful, but grave, prognostic sign. Such children comprise a quarter of all deaths in the Goroka paediatric ward.

Rotavirus infections were detected by electron microscopy examinations in 54 of 66 children (82%) with acute gastroenteritis which necessitated admission to hospital during April to July, 1979, in the Highlands of Papua New Guinea. Longitudinal epidemiological studies may confirm rotavirus infections to be more important aetiolgical agents of childhood gastroenteritis in this region than in many other countries studied to date.

We have reviewed the clinical presentation of pneumonia to the Goroka paediatric ward. In comparison to survivors, children dying from pneumonia more often (p less than 0.05) had malnutrition (weight-for-age under 80%), anaemia (haemoglobin under 9g%), and a marked leucocytosis (total white cell count over 30,000 cells per c.m.m.). Children dying from pneumonia had been ill for longer and had been given more antibiotics prior to admission. There was no significant difference between children dying from pneumonia and survivors in age distribution, pulse rate, incidence of cardiac failure or duration of stay in hospital. 70% of the children dying from pneumonia at Goroka Hospital are infants under 12 months of age. Pneumococcal vaccine gives a poor antibody response in infants, and overseas studies using lung aspiration suggest that Haemophilus influenzae and Staphylococcus aureus might be causative organisms as well as Streptococcus pneumoniae. A study to determine the aetiology of pneumonia in Highlands children is required to enable a rational choice of routine antibiotic therapy and to plan further research on vaccination against pneumonia.