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The change from general nurse education to a nursing diploma in Papua New Guinea.

Papua New Guinea has started to change from a hospital based general nurse training to a competency based, university linked, diploma of nursing training program. This paper looks at the development of nurse education in Papua New Guinea. It also briefly outlines the present and proposed courses. The expected benefits and anticipated problems are then discussed and the paper ends with challenges being faced by those involved in nurse education.

Education, Nursing, Diploma Programs↗

A rapid situation assessment of drug use in Papua New Guinea.

Papua New Guinea (PNG) is an Asia Pacific country that we hear little about in the drug and alcohol area. Recently at the APEC meeting in Chile, the Australian Prime Minister, Mr John Howard, announced that PNG would be one of the countries of focus with regards to public health programs and HIV AIDS assistance by Australia in the future. This is a timely report of a rapid situation assessment (RSA) of drug use and drug-related harm in Papua New Guinea (PNG) conducted in 1998-1999, with comments on developments since that time. The author of this paper, David McDonald, was appointed as the international consultant to work with the PNG National Narcotics Bureau to undertake an assessment of drug use in PNG, and is well-equipped to report on the drug and alcohol situation in that country. The rapid assessment study was conducted to provide up-to-date, factual information about drugs in PNG that could contribute to the development of a national drug strategy for PNG. The focus was on illegal drugs in accordance with the mandates of the auspicing bodies--namely cannabis and home-brewed alcohol. In keeping with the methodology for rapid assessment, the author utilised multiple information sources including published literature, administrative by-product data, case studies, a key informants' study and structured interviews with drug users. It was found that alcohol--both licit and home brew, as well as high potency cannabis, were the major substance problems in PNG. This paper, based on a more detailed report available through the author, provides a snap-shot of substance use problems in PNG. However, the author reports that problems in public sector management within and external to the sponsoring agency, the National Narcotics Bureau, have meant that the proposed national drug control strategy has not yet been developed.

Alcoholism↗

Venereal diseases in the Pacific Islands. Papua New Guinea.

Papua New Guinea, which contains nearly three-quarters of the population of the 20 islands, or island groups, studied by the South Pacific Commission has a commensurate proportion of reported cases of syphilis and gonorrhoea. It is a country with an exceptional interest for the venereologist as it exhibits all the facets of venereal disease problems as experienced the world over. With the opening up of communications syphilis has gained a foothold in what were areas previously endemic with yaws; moreover, some yaws still remains (particularly in the offshore islands)--the two conditions tending to be mutually exclusive. In the area around the capital, Port Moresby, the prevalence of Donovanosis is unparalleled.

Gonorrhea↗

[Papua New Guinea].

Papua New Guinea is an independent country located in Oceania with a population of 4.9 million. Urban development is low and the estimated population density is 9 inhabitants per square kilometre. The terrain is mountainous and accessibility for health care services is difficult in some locations. Medical care facilities are organized in 18 provinces that are divided into 2 to 8 districts in which basic health care and hospital services are delivered through 1765 first aid units, 319 dispensaries, 189 specialized clinics and centers and 19 hospitals. There are no local schools for training medical and paramedical personnel who come from outside the country. Malaria, filariasis, leprosy, tuberculosis, infant diarrheal diseases, viral hepatitis, and envenomation are major public health problems. Buruli ulcer, dengue fever and arboviruses are emerging diseases.

Delivery of Health Care↗

The epidemiology of malaria in Papua New Guinea.

Papua New Guinea (PNG) is a patchwork of different ecological zones, inhabited by human populations of exceptional cultural and linguistic diversity. This results in complex variations in vector ecology and malaria epidemiology. Malaria is the main cause of morbidity in many health facilities in lowland areas, but it is absent in much of the highlands. All four human malaria species occur, but endemicity varies widely, with Plasmodium falciparum locally reaching holo-endemic levels that are rarely found outside sub-Saharan Africa. The high frequency of Plasmodium vivax is an important difference to most African situations. PNG is therefore a prime location for studies of interactions between different parasite species, and of the biology of local human genetic adaptation and its implications for malaria morbidity and mortality.

Animals↗

Current opportunities and future challenges in child health in Papua New Guinea.

Papua New Guinea (PNG) is at a crossroads in child health care. We know how to treat or prevent most of the diseases causing child and maternal mortality, but we are failing to deliver the services to where most of the people are dying. There is much to be learnt from early achievements in the development of health services in PNG. Between the 1950s and 1970s the infant mortality rate fell from 250-500 per 1000 livebirths to 77-100 per 1000 livebirths. This occurred predominantly because of an emphasis on public health programs and cost-effective standard treatment. Now the public health services have deteriorated, vaccine coverage is poor and health workers are not fully using the standard treatment resources available to them. The greatest academic and practical challenges facing medicine in PNG are to implement effective and consistent delivery of vaccines, and nutritional, basic curative and maternal care to remote or impoverished communities. The other unmet prerequisites for improvement in health status are that communities participate in and take some responsibility for their health care needs. There are now unprecedented opportunities for collaboration with international partners, churches, non-government organizations and community groups to achieve these goals. Specific key strategies in child health include the more widespread utilization of the 10-Step Checklist, adoption of some of the World Health Organization Integrated Management of Childhood Illness strategies, increased output of child health nursing training, improving vaccine delivery and cold-chain services, and new immunization strategies for acute respiratory infections. The National Health Plan 2001-2010, launched in August 2000, emphasizes the vital importance of public health; the need for greater access to quality health services; improving clinical skills among health workers at all levels; and cooperation between all interested parties. By 2010 the National Health Plan must be judged not on how good the plan seemed on paper, but on whether there was a measurable reduction in maternal and child mortality over the first decade of this century.

Child↗

Health insurance and medical schemes in Papua New Guinea.

Papua New Guinea (PNG) is an independent nation in the Pacific region. It is located due north of Australia. It is made up of a main island and about 100 smaller islands in the Bismark and Solomon Seas, to the north and east of the main island. The population of PNG is about 4.0 million, the total land area approximately 463,840 sq km and population density 8/square km. Only about 15% of the population is urban, average household size is 5.4 and 45.1% literate. Politically and administratively, it is divided into nineteen provinces and a National Capital District. Since 85% of the population lives in rural areas, the provision of services to the rural areas is constrained by difficult terrain, poor infrastructure and geographic dispersion of the rural population. PNG is a developing Pacific nation with an economy largely based on primary and mining industries. According to the 1993 World Bank estimates, more than 30% of the Gross Domestic Product (GDP) is derived from agriculture. The expenditure on health, as a percentage of the GDP, was 2.8% in 1989, (Table 1). This is low compared to developed nations (ranging from 8% to 14%), but very reasonable compared to the rest of the developing world. Indonesia for example expends 2.7% of GDP on health care. All government expenditures declined sharply in the post 1989 period, including health care expenditures. However, by 1989, the expenditure per capita on health was almost back to 1986 levels. PNG has a small population base relative to the other countries in its World Bank peer group. However, its per capita GDP is reasonable at US$850, the third highest amongst its group and higher than Indonesia, for example, which is US$700/head. Like almost all countries in its gorup, it experienced a negative growth rate over the decade 1980-1991 but kept inflation at a reasonable 5.2% for the same period. On most other indicators PNG fares reasonably well, in comparison with other developing nations (Tables 2 & 3).

Adolescent↗

Acetylator phenotype and short-course chemotherapy for tuberculosis in Papua New Guinea.

In Papua New Guinea the slow acetylator phenotype is unusual and peripheral neuropathy during isoniazid therapy is uncommon. Acetylator status and other factors influencing isoniazid-induced peripheral neuropathy are discussed, and statistics from Papua New Guinea are presented. The relevance of acetylator phenotype to other side-effects of isoniazid is less well defined. Prophylactic pyridoxine supplementation during short-course chemotherapy for tuberculosis is not generally necessary in the daily 'A' regimen, but should be maintained in the twice-weekly (high-dose isoniazid) 'B' regimen for adults and children over 20 kg.

Acetylation↗

Laboratory diagnosis of HIV infection in Papua New Guinea.

In Papua New Guinea, the laboratory diagnosis of HIV infection is based on proof of HIV antibody in the patient's serum. Under the government scheme, the testing is done in 30 laboratories, including the Papua New Guinea HIV Reference Laboratory (NRL), the Red Cross Blood Transfusion Service in Port Moresby, and 19 provincial and 9 district laboratories. An alternative testing strategy was adopted in 1993 based on a WHO recommendation, replacing the classical testing strategy (enzyme immunoassay + Western blot). The alternative testing strategy uses several EIA, rapid or simple HIV antibody assays for the detection and confirmation of the HIV antibody. This approach is faster and cheaper, with the same sensitivity and specificity as the classical testing algorithm. Except for the NRL, the Serodia Fujirebio HIV-1 gelatin particle agglutination assay is used throughout the country as the screening test. The PNG National HIV Reference Laboratory is the only laboratory authorized to perform confirmatory testing and to release positive results. Therefore, all serum samples reactive in the screening assay are sent to the NRL for confirmation by the battery of EIA, rapid or simple assays in accordance with the alternative testing strategy adopted. The paper explains the alternative testing strategy and highlights the principle of each individual test that is employed.

AIDS Serodiagnosis↗

Health research in Papua New Guinea.

The Papua New Guinea Institute of Medical Research (PNGIMR) is one of the most respected health research institutions in the developing world, and its studies of the local health problems of PNG have consistently had international relevance. This article examines the structural and philosophical factors that have enabled the success of the PNGIMR, and presents the PNGIMR approach to research as a potential model for other disease-endemic countries. An overview of PNGIMR research into malaria and filariasis is given with selected examples as an introduction to a Trends in Parasitology series on health research in Papua New Guinea.

Animals↗

Barriers to measles immunization: the beliefs and attitudes of caregivers in Goroka, Eastern Highlands Province, Papua New Guinea.

In Papua New Guinea, measles remains a public health problem and the majority of measles cases occur in non-immunized children. In Goroka, measles vaccine coverage for the 9-month-old group was 44%. The parents or caregivers are important in measles prevention as children's immunization depends on their compliance. This study aimed to determine the factors that hinder caregivers from having their children vaccinated for measles prevention in the Goroka District, Eastern Highlands Province. A cross-sectional study was conducted in July-August 2003, using pre-constructed questionnaires and interviews. There was a total of 120 respondents who were caregivers or parents of children whose ages ranged from 6 to 12 months and who attended health care centres where immunization services were provided. The main reasons for not bringing their children to clinic for immunization were: limited access to health centres, especially to maternal and child health (MCH) clinics; too long a waiting time at the clinic; concern that too many injections were being given to their children; the side-effects of the vaccine; being sent away and asked to come back the next day for immunization; and a bad reception from health workers. Funerals or election-related events in the area also affected the attendance at the clinic. In order to improve the vaccine coverage, the use of a mobile MCH clinic should be re-established. Health workers should utilize the opportunities to pass on necessary information on immunization to caregivers, as well as being mindful to use communication that will prevent misunderstanding by the mothers. It is important for all health workers to recognize that their performance and attitude can greatly improve the overall vaccine coverage in Papua New Guinea.

Adult↗

Prospective study of mortality associated with chronic lung disease and smoking in Papua New Guinea.

In Papua New Guinea a 15-year mortality follow-up was carried out among 2026 highlanders and 1734 coastal dwellers on whom data on respiratory symptoms and signs, and lung function had been obtained by prevalence surveys in 1970/71. Survival status was established in 99%, of whom 9.8% had died, the rate being higher in the highland (12.2%) than in the coastal population (7.0%). All abnormalities indicative of chronic lung disease were associated with increased mortality though this was statistically significant only for chronic shortness of breath (SMR 195) and wheezing (SMR 183) in coastal females. In those aged 25 years or more there was a strong association between reduced lung function (FEV1, FVC, FEV1/FVC%) and mortality, after controlling for age and height. The associations observed were as strong as those reported from prospective studies in developed countries. The most striking difference was that in Papua New Guinea mortality showed no association whatever with tobacco smoking; this may be because the traditional type of tobacco and method of smoking it resembles pipe/cigar smoking in developed countries.

Adolescent↗

Qualitative analysis of the impact of a lymphatic filariasis elimination programme using mass drug administration on Misima Island, Papua New Guinea.

BACKGROUND: Papua New Guinea is the only endemic country in the Western Pacific Region that has not yet introduced a countrywide programme to eliminate lymphatic filariasis. However, on Misima Island in Milne Bay Province, government and private sectors have collaborated to implement a pilot elimination programme. Although interim evaluation indicated that the programme has been parasitologically successful, an appreciation that sustainable health gains depend on understanding and accommodating local beliefs prompted this qualitative study. METHODS: We investigated Misima community members knowledge and attitudes about lymphatic filariasis and the elimination programme. A combination of focus groups and key informant interviews were used to explore participants perceptions of health; knowledge of the aetiology and symptoms of filariasis, elephantiasis and hydrocele; attitudes towards the disease and mass drug distribution; and the social structure and decision-making protocols within the villages. RESULTS: Focus group discussions proved inferior to key informant interviews for gathering rich data. Study participants did not consider lymphatic filariasis ("pom") a major health problem but were generally positive about mass drug administration campaigns. A variety of conditions were frequently and incorrectly attributed to filariasis. Participants expressed the belief that individuals infected with filariasis always had visible manifestations of disease. A common misconception was that taking drugs during campaigns provided long-term immunity against disease. The role of mosquito vectors in transmission was not generally appreciated and certain clinical presentations, particularly hydrocele, were associated with supernatural forces. Multiple adverse events were associated with mass drug administration campaigns and most study participants mentioned community members who did not participate in campaigns. CONCLUSION: Important issues requiring educational intervention and elimination activity modification in the Misima region were identified during this study. Research outcomes should assist Papua New Guinea in developing and implementing a national elimination strategy and inform discussions regarding the appropriateness of current elimination strategies.

Journal Article↗

Protection of breastfeeding in Papua New Guinea.

In Papua New Guinea the bottle-feeding of babies has been increasing, predominantly among unemployed women of low educational status. Many women are unaware of their legal right to have breaks at work for the purpose of breastfeeding, and a high proportion of workplaces have no facilities for mothers who wish to breastfeed their children. The laws on the feeding of infants should be updated and implemented, and an effort is needed to explain the benefits of breastfeeding and the rights of working mothers.

Bottle Feeding↗

Emergence of FY*A(null) in a Plasmodium vivax-endemic region of Papua New Guinea.

In Papua New Guinea (PNG), numerous blood group polymorphisms and hemoglobinopathies characterize the human population. Human genetic polymorphisms of this nature are common in malarious regions, and all four human malaria parasites are holoendemic below 1500 meters in PNG. At this elevation, a prominent condition characterizing Melanesians is alpha(+)-thalassemia. Interestingly, recent epidemiological surveys have demonstrated that alpha(+)-thalassemia is associated with increased susceptibility to uncomplicated malaria among young children. It is further proposed that alpha(+)-thalassemia may facilitate so-called "benign" Plasmodium vivax infection to act later in life as a "natural vaccine" against severe Plasmodium falciparum malaria. Here, in a P. vivax-endemic region of PNG where the resident Abelam-speaking population is characterized by a frequency of alpha(+)-thalassemia >/=0.98, we have discovered the mutation responsible for erythrocyte Duffy antigen-negativity (Fy[a-b-]) on the FY*A allele. In this study population there were 23 heterozygous and no homozygous individuals bearing this new allele (allele frequency, 23/1062 = 0.022). Flow cytometric analysis illustrated a 2-fold difference in erythroid-specific Fy-antigen expression between heterozygous (FY*A/FY*A(null)) and homozygous (FY*A/FY*A) individuals, suggesting a gene-dosage effect. In further comparisons, we observed a higher prevalence of P. vivax infection in FY*A/FY*A (83/508 = 0.163) compared with FY*A/FY*A(null) (2/23 = 0.087) individuals (odds ratio = 2.05, 95% confidence interval = 0.47-8.91). Emergence of FY*A(null) in this population suggests that P. vivax is involved in selection of this erythroid polymorphism. This mutation would ultimately compromise alpha(+)-thalassemia/P. vivax-mediated protection against severe P. falciparum malaria.

Animals↗

Oral health status of teenage schoolchildren in Port Moresby, Papua New Guinea.

In Papua New Guinea the main dental problem has been periodontal disease and related conditions. Dental caries appears to be low in many community groups. The aim of this study was to explore the prevalence of dental caries and the periodontal health status of teenage schoolchildren in Port Moresby. 200 children of mean age 15.4 years were examined from two urban community high schools in Port Moresby. 44% of the children examined were caries-free and the average decayed, missing or filled teeth (DMFT) score was 1.43, while only 2.5% of the children had totally healthy periodontal tissues. 18% of them showed pathological periodontal pockets of 4 or 5mm in depth, the remaining children having either gingival bleeding, calculus or both. The results indicated that this group of children showed a low prevalence of dental caries and a high prevalence of periodontal problems. No cases with deep periodontal pockets of 6mm or more were found.

Adolescent↗

Field trial of a heat-stable measles vaccine in Papua New Guinea.

In Papua New Guinea, consideration has been given to the introduction of measles vaccination, and a trial was conducted to determine the optimum age for vaccination and the suitability of a heat-stable measles vaccine (Rimevax) for countrywide use. As much of the vaccination programme is carried out by MCH teams on foot patrols, the trial was designed to determine immunogenicity of the vaccine after being transported and used for a week in a standard issue vaccine Esky by MCH staff. A study of the relevant literature having indicated 9 months as the probable best minimum age for measles vaccination, younger children were not included. The study was carried out on 313 infants and children aged nine to 24 months. An overall seroconversion rate of 96.6% was achieved using initially potent vaccine kept under field conditions for up to 102h. Ninety-seven percent of the vaccinees less than 11 months and 15 days of age seroconverted, as did all 15 children who were less than 70% of the Harvard standard weight for age. All 35 children who had seroconverted and who were retested six months after vaccination had detectable measles antibodies in their serum. Parental recollection of past measles infection was found unreliable as was reporting of post-vaccination reactions by parental recall since the incidence of reported 'reactions' in initially seronegative and seropositive vaccinees were similar. It is concluded that use of this heat-stable vaccine is possible with existing cold chain facilities in PNG and that infants can be vaccinated from the age of 9 months.

Antibodies, Viral↗