We have recently returned to Sweden from a reconnaissance trip to Port
Moresby, the capital of Papua New Guinea. Our aims are twofold:
1)      To study the effects of urbanization among traditional subsistence
horticulturalists on the incidence and prevalence of cardiovascular disease
(spontaneous sudden death, retrosternal effort angina, aphasia and
hemiparesis) and on cardiovascular risk factor levels.
2)      To facilitate necessary efforts of preventing the emergence of
cardiovascular disease in developing countries.

We are sorry to tell you that stroke is rapidly becoming a major health
problem among urbanized Papuan New Guineans, even more so than myocardial
infarction which is however also coming up [1]. We saw one obvious case of
stropke; hemiplegia and aphasia in a 47 year old smoking male. There are
almost two stroke cases every week at the Port Moresby General Hospital
where the first was reported in the mid 70s (Kevau I, personal
communication). We roughly estimate that the hospital serves some 300
thousand inhabitants.

Thus, history repeats itself; the same pattern was seen in Uganda from the
1940s and onwards when stroke emerged from virtual absence in the 1930s to
similar prevalences as in the West around 1970 [2-4]. This was parallelled
by a dramatic change in diet and lifestyle.

The effect of a paleolithic lifestyle in the prevention of stroke may be
heavily underestimated by the medical community.

1.  Kevau IH. Clinical documentation of twenty cases of acute myocardial
infarction in Papua New Guineans. P N G Med J 1990; 33: 275-80.
2.  Muwazi E. Neurological disease among african natives of Uganda: A
review of 269 cases. East Afr Med J 1944; 2-19.
3.  Hutton PW. Neurological disease in Uganda. East Afr Med J 1956; 33:
209-223.
4.  Billinghurst JR. The pattern of adult neurological admissions to Mulago
hospital, Kampala. East Afr Med J 1970; 47: 653-63.


Staffan Lindeberg and Dan Petersson
Dept of Community Health Sciences, Lund University, Sweden