Stakeholder views on the relationship between human rights and the law in addressing the HIV epidemic in Papua New Guinea.

Community activists, policymakers and researchers have long identified human rights as central to addressing the HIV epidemic. Over the past 10 years, efforts to incorporate human rights into the HIV response have focused on reforming laws which criminalise sex work and male-to-male sex. Laws criminalising sex work and male-to-male sex drive communities underground, making HIV prevention, testing, and treatment efforts more difficult. This article draws on a qualitative study conducted in Papua New Guinea (PNG) which examined stakeholder views on prospects for law reform, the impact of criminal laws on communities, and the role of law reform in addressing the HIV epidemic. While efforts to reform criminal laws related to sex work and male-to-male sex have taken place in PNG, these have been unsuccessful. Stakeholders identified that strategies for addressing criminal laws and the impacts of law reform must be grounded in the PNG context, that there must be material support for community members to engage with criminal laws and human rights, and that dignity rather than HIV should be the justification for law reform.

Plasma adenosine deaminase-1 and -2 activities are lower at birth in Papua New Guinea than in The Gambia but converge over the first weeks of life.

Introduction: Dynamic cellular and molecular adaptations in early life significantly impact health and disease. Upon birth, newborns are immediately challenged by their environment, placing urgent demands on the infant immune system. Adenosine deaminases (ADAs) are enzymatic immune modulators present in two isoforms - ADA-1 and ADA-2. Infants exhibit low ADA activity, resulting in high plasma adenosine concentrations and a consequent anti-inflammatory/anti-Th1 bias. While longitudinal studies of plasma ADA have been conducted in infants in The Gambia (GAM), little is known regarding ADA trajectories in other parts of the world. Methods: Herein, we characterized plasma ADA activity in an infant cohort in Papua New Guinea (PNG; n=83) and compared to ontogeny of ADA activity in a larger cohort in GAM (n=646). Heparinized peripheral blood samples were collected at day of life (DOL) 0, DOL7, DOL30, and DOL128. Plasma ADA-1, ADA-2, and total ADA activities were measured by chromogenic assay. Results: Compared to GAM infants, PNG infants had significantly lower ADA-1 (0.9-fold), ADA-2 (0.42-fold), and total ADA (0.84-fold) activities at birth which converged by DOL30. Discussion: Overall, discovery of a distinct baseline and a consistent pattern of increasing plasma ADA activity in early life in two genetically and geographically distinct populations validates and extends previous findings on the robustness of early life immune ontogeny.

Investigation of factors associated with delayed initiation of breastfeeding in Papua New Guinea: a cross-sectional study.

BACKGROUND: Breastfeeding within the first hour of birth is critical for newborn survival. However, in Papua New Guinea (PNG), about 40% of newborns are not breastfed within the first hour of birth. This study aimed to determine the prevalence and factors associated with delayed initiation of breastfeeding in PNG. METHODS: This study used secondary data from the 2016-2018 PNG Demographic and Health Survey, a nationally representative cross-sectional study. A total weighted sample of 4748 women aged 15-49 were included. Complex samples analysis was performed to determine the direction of association between the independent variables and delayed initiation of breastfeeding. RESULTS: About a quarter (24.6%) of women delayed initiation of breastfeeding. Women with an unplanned pregnancy (adjusted OR (AOR) 1.32; 95% CI 1.03 to 1.68), those who had a caesarean section (AOR 3.16; 95% CI 1.39 to 7.17), those who did not initiate newborn skin-to-skin contact immediately after birth (AOR 1.83; 95% CI 1.41 to 2.38) and those who watched television (AOR 1.39; 95% CI 1.11 to 1.75), and were from the Momase region (AOR 1.31; 95% CI 1.00 to 1.93) had higher odds of delayed breastfeeding initiation. Conversely, the odds of delayed initiation of breastfeeding was lower among women who read a newspaper or magazine (AOR 0.76; 95% CI 0.61 to 0.95), were from the Southern (AOR 0.81; 95% CI 0.56 to 1.15) and Highlands (AOR 0.86; 95% CI 0.58 to 1.29) regions, and gave birth at home or in the village (AOR 0.69; 95% CI 0.49 to 0.96). CONCLUSION: One in four women in this study delayed initiation of breastfeeding until after 1 hour after birth. Interventions to promote optimal breastfeeding require a multi-sectoral approach, as well as bolstering health workers' capacity to encourage and support early initiation of breastfeeding during the antenatal and early postnatal periods.

Wealth-related inequalities in the utilisation of modern contraceptives in Papua New Guinea: evidence from the 2016-2018 Demographic and Health Survey data.

OBJECTIVE: To examine the wealth-related disparities in modern contraceptives use among women in Papua New Guinea. DESIGN: We performed a cross-sectional analysis of the 2016-2018 Papua New Guinea Demographic and Health Survey data. We included 11 618 women of reproductive age in our final analysis. Percentages were used to present the results on utilisation of modern contraceptives. A concentration curve was used to summarise the cumulative use of modern contraceptives by wealth index (ranked into groups: richest, richer, middle, poorer and poorest). We used a decomposition analysis to estimate the contributions of individual factors towards wealth-related inequality in modern contraceptives use. We estimated the slope index of inequality (SII) and the relative index of inequality (RII) in modern contraceptive utilisation to provide summary evidence of inequality. SETTING: Papua New Guinea. PARTICIPANTS: Women aged 15-49 years. OUTCOME MEASURE: Modern contraceptives utilisation. RESULTS: Overall, 27.5% of Papua New Guinea women used modern contraceptives. The concentration curve showed that the use of modern contraceptives was highly concentrated among women of the richest household wealth index as the concentration curve lies below the equality line. The SII (0.210, CI 0.182 to 0.239) indicates that the richest group uses more modern contraceptives. The RII depicts a relative difference of 2.044 between the richest and the poorest women in the use of modern contraceptives. CONCLUSIONS: Our study has shown that modern contraceptives use among women in Papua New Guinea is low. Women from the richest household wealth index group had the highest propensity to use modern contraceptives in comparison with those from poorer homes. The Ministry of Health and other organisations must design and carry out initiatives aimed at enhancing the availability of and use of modern contraceptives among women from less affluent backgrounds.

Birds and bats reduce herbivory damage in Papua New Guinean highland forests.

Insectivorous predators, including birds and bats, play crucial roles in trophic cascades. However, previous research on these cascades has often relied on permanent predator exclosures, which prevent the isolation of specific effects of birds and bats, given their different activity patterns throughout the day. Moreover, limited knowledge exists regarding the variations in individual effects of these predators under different biotic and abiotic conditions, such as changes in elevation. To address these uncertainties, our study aimed to investigate the distinct effects of bats and birds on arthropod densities in foliage and herbivory damage in lowland and highland rainforests of Papua New Guinea (PNG). Predator exclosures were established for one month to exclude diurnal or nocturnal predators across 120 saplings (ca. 2.5-4 m tall) selected from two lowland and two highland forests (i.e., 30 saplings per study site) along the Mt. Wilhelm transect in PNG. Arthropods were collected and measured, and herbivory damage was analyzed at the end of the experiment. Birds significantly reduced arthropod densities by 30%, particularly in arthropods longer than 10 mm, regardless of elevation. Additionally, both birds and bats appeared to mitigate herbivory damage in highland forests, with protected saplings displaying up to 189% more herbivory. Our results support previous studies that have demonstrated the ability of insectivorous predators to reduce leaf damage through the control of arthropods. Furthermore, our approach highlights the importance and necessity of further research on the role of seasons and elevations in trophic cascades.

National Politics' Role in Developing Primary Health Care Policy for Maternal Health in Papua New Guinea: A Qualitative Document Analysis.

Politics is one of the critical factors that influence health policy agendas. However, scholarly efforts, especially in low- and middle-income countries, rarely focus on how politics influence health policy agenda-setting. We conducted a qualitative document review to examine the factors that led to developing the free primary health care policy for maternal health in Papua New Guinea. We also discuss mechanisms through which national politics, as an overriding factor, influenced the development of the policy. The review draws on Kingdon's multiple-stream model for agenda-setting and incorporates theoretical insights from Fox and Reich's framework for analyzing the politics of health reform for universal health coverage in low- and middle-income countries.

Prevalence of pregnancy termination and associated factors among married women in Papua New Guinea: A nationally representative cross-sectional survey.

BACKGROUND: Pregnancy termination or induced abortion is not decriminalized, and access to safe abortion services is largely unavailable in Papua New Guinea (PNG). However, the practice is common throughout the country. This study aimed to estimate the prevalence and determine factors associated with pregnancy termination among married women aged 15-49 years in PNG. METHODS: Secondary data from the 2016-2018 PNG Demographic and Health Survey (PNGDHS) was used. A total weighted sample of 6,288 married women were included. The Complex Sample Analysis method was used to account for the cluster design and sample weight of the study. Chi-square tests and multivariable logistic regression were used to assess factors associated with pregnancy termination. Adjusted odds ratios (aORs) with 95% Confidence Intervals (CIs) were reported. RESULTS: The prevalence of pregnancy termination was 5.3%. Nearly half (45.2%) of all pregnancy terminations occurred in the Highlands region. Women aged 35-44 years (aOR = 8.54; 95% CI: 1.61-45.26), not working (aOR = 6.17; 95% CI: 2.26-16.85), owned a mobile phone (aOR = 3.77; 95% CI: 1.60-8.84), and lived in urban areas (aOR = 5.66; 95% CI: 1.91-16.81) were more likely to terminate a pregnancy. Women who experienced intimate partner violence (IPV) were 2.27 times (aOR = 2.27; 95% CI: 1.17-4.41) more likely to terminate a pregnancy compared to those who did not experience IPV. Women with unplanned pregnancies were 6.23 times (aOR = 6.23; 95% CI: 2.61-14.87) more likely to terminate a pregnancy. Women who knew about modern contraceptive methods and made independent decisions for contraceptive use were 3.38 and 2.54 times (aOR = 3.38; 95% CI: 1.39-8.18 and aOR = 2.54; 95% CI: 1.18-5.45, respectively) more likely to terminate a pregnancy. CONCLUSION: The findings highlight the role of sociodemographic and maternal factors in pregnancy termination among married women in PNG. Efforts aimed at reducing unplanned pregnancies and terminations should focus on comprehensive sexual and reproductive health education and improving easy access to contraceptives for married couples. Post-abortion care should also be integrated into the country's legal framework and added as an important component of existing sexual and reproductive health services.

Exploring the association between multidimensional poverty and antenatal care utilization in two provinces of Papua New Guinea: a cross-sectional study.

BACKGROUND: Although global poverty rates have declined in the last decade, the fall in the Asia-Pacific region has been slow relative to the rest of the world. Poverty continues to be a major cause of poor maternal and newborn health, and a barrier to accessing timely antenatal care. Papua New Guinea has one of the highest poverty rates and some of the worst maternal and neonatal outcomes in the Asia-Pacific region. Few studies have investigated equity in antenatal care utilization in this setting. We explored equity in antenatal care utilization and the determinants of service utilization, which include a measure of multidimensional poverty in Papua New Guinea. METHODS: To explore the association between poverty and antenatal care utilization this study uses data from a ten-cluster randomized controlled trial. The poverty headcount, average poverty gap, adjusted poverty headcount, and multidimensional poverty index of antenatal clinic attendees are derived using the Alkire-Foster method. The distribution of service utilization is explored using the multidimensional poverty index, followed by multivariate regression analyses to evaluate the determinants of service utilization. RESULTS: The poverty headcount was 61.06%, the average poverty gap 47.71%, the adjusted poverty headcount 29.13% and the average multidimensional poverty index was 0.363. Further, antenatal care utilization was regressive with respect to poverty. The regression analyses indicated that older women; being a widow (small number of widows (n = 3) asserts interpreting result with caution); or formally employed increase the likelihood of accessing antenatal care more often in pregnancy. Travelling for over an hour to receive care was negatively associated with utilization. CONCLUSION: This study indicated high levels of multidimensional poverty in PNG and that ANC utilization was regressive; highlighting the need to encourage pregnant women, especially those who are economically more vulnerable to visit clinics regularly throughout pregnancy.

Cost-effectiveness analysis of COVID-19 booster doses and oral antivirals: Case studies in the Indo-Pacific.

BACKGROUND: Decision-makers in middle-income countries need evidence on the cost-effectiveness of COVID-19 booster doses and oral antivirals to appropriately prioritise these healthcare interventions. METHODS: We used a dynamic transmission model to assess the cost-effectiveness of COVID-19 booster doses and oral antivirals in Fiji, Indonesia, Papua New Guinea, and Timor-Leste. We conducted cost-effectiveness analysis from both healthcare and societal perspectives using data collated from publicly available sources. We developed an interactive R Shiny which allows the user to vary key model assumptions, such as the choice of discounting rate, and view how these assumptions affect model results. FINDINGS: Booster doses were cost saving and therefore cost-effective in all four middle-income settings from both healthcare and societal perspectives using 3% discounting. Providing oral antivirals was cost-effective from a healthcare perspective if procured at a low generic price (US$25) or middle-income reference price (US$250); however, their cost-effectiveness was strongly influenced by rates of wastage or misuse, and the ongoing costs of care for patients hospitalised with COVID-19. The cost or wastage of rapid antigen tests did not appear strongly influential over the cost-effectiveness of oral antivirals in any of the four study settings. CONCLUSIONS: Our results support that COVID-19 booster programs are cost-effective in middle-income settings. Oral antivirals demonstrate the potential to be cost-effective if procured at or below a middle-income reference price of US$250 per schedule. Further research should quantify the rates of wastage or misuse of oral COVID-19 antivirals in middle-income settings.

Sorcery and witchcraft beliefs on the front line of public health response in Papua New Guinea and beyond.

Problem: Many communities refer to sorcery or witchcraft to explain misfortunes such as sickness, death and disability. The effects of these beliefs on public health service delivery have long been overlooked. Beliefs in sorcery and witchcraft are significant challenges for health-care workers to understand to deliver better health outcomes and avoid inadvertently triggering accusations of witchcraft that may lead to violence. Context: This paper examines the impacts of accusations of sorcery and related violence on the provision of health care in Papua New Guinea. Action: The discussion focuses on a workshop held in Papua New Guinea in September 2022 with health extension officers on the topic of health-care delivery and sorcery accusations. Lessons learned: The workshop confirmed the challenges that beliefs in sorcery and witchcraft present for health extension officers and suggested several strategies that could be used to navigate them. It identified several possible future measures that those on the front line of community health-care delivery considered most important in responding to the issue. These included educating health-care workers on how to effectively address sorcery beliefs when delivering health care and developing communication techniques on the causes of death and sickness that avoid triggering sorcery accusations. Discussion: This paper reviews the findings of the workshop in the broader context of the effects of beliefs in witchcraft on public health delivery globally. Because of the close connections between sorcery beliefs and health, equipping health-care workers and field epidemiologists with strategies to address these beliefs effectively is critical to delivering better health care, facilitating timely response to public health events, and helping to prevent violence related to sorcery accusations. This need exists in all countries where sorcery beliefs related to health, illness, disability and death are prevalent.

Prevalence and predictors of HIV testing among young men in Papua New Guinea: A cross-sectional analysis of a nationally representative sample.

BACKGROUND: HIV testing is an important component of HIV prevention and serves as a gateway to other HIV-related services. However, the uptake remains suboptimal among young people, particularly in highly prevalent settings such as Papua New Guinea (PNG). This study aimed to assess the prevalence and determine the predictors of HIV testing uptake among young men aged 15-24 years in PNG. METHODS: The 2016-2018 PNG Demographic and Health Survey (DHS) data was used. A total of 1,275 young men aged 15-24 years were included in the final analysis. Descriptive, bivariate, and multivariable logistic regression analyses were performed to determine independent predictors of HIV testing. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. All analyses were adjusted using survey weights to account for unequal sampling probabilities. RESULTS: The overall prevalence of HIV testing among young men was 17.1% (95% CI: 15-19). Of those who were tested for HIV, about one-third (32.9%) had experienced a sexual debut at age <15 years, and 33.9% inconsistently used condoms during sex. In multivariable analysis, men aged 20-24 years (AOR 1.18, 95% CI: 1.00-2.31), who owned mobile phones (AOR 1.43, 95% CI: 1.00-2.55), who were aware that consistent condom use during sex can reduce HIV risk (AOR 2.18, 95% CI: 1.18-4.04), who had paid for sex (AOR 1.75, 95% CI: 1.01-5.83), and who had two or more sexual partners (AOR 1.37, 95% CI: 1.01-3.14) had increased odds of HIV testing. However, decreased odds of HIV testing were found among men who were never married (AOR 0.51, 95% CI: 0.29-0.88), lived in rural areas (AOR 0.54, 95% CI: 0.32-0.92), and consistently used condoms during sex (AOR 0.59, 95% CI: 0.34-1.01). CONCLUSION: The findings show that HIV testing is low among young men in PNG. To increase HIV testing uptake among young men, it is crucial to implement comprehensive youth-friendly HIV/STI education and tailored sensitization programs and enable more accessible and affordable HIV testing services. Also, outreach and community-based testing programs for young men in rural and prioritized areas requiring urgent prevention interventions are feasible options in PNG.

Barriers to the uptake of eye care services: A cross-sectional survey from rural and urban communities.

PURPOSE: To explore the barriers to the uptake of eye care services in urban and rural communities in Papua New Guinea. METHODS: This was a population-based cross-sectional descriptive study and involved multi-stage sampling. Communities were randomly selected from each of the three clusters of Madang District for free eye care outreaches from June to September 2022. A structured questionnaire was used to collect data from the outreach patients. The study excluded attendees who refused to consent. Responses were rated from 1 (not a barrier) to 10 (a very strong barrier). The p-value significance was set at ≤ 0.05. RESULTS: The majority of the 972 participants (60.2%) were from rural communities. The mean age of participants was 40.82 ± 13.14 years. Almost two-thirds of the participants (61.4%) never had an eye examination before this study was conducted. All the participants reported that time constraint, insufficient income, good vision in the fellow eye, not considering their eye conditions as serious issues and cultural beliefs were personal barriers to accessing eye care services. Provider-related challenges included long waiting periods at eye clinics and fear of procedure complications. There were differences in barriers with respect to the participants' demographic clusters. CONCLUSION: There are major personal- and service-related barriers to eye care services in Madang. These barriers could be overcome through strategic human resource development, health education, school screening programs, and establishing eye care centres in the communities to improve the uptake of eye care services in Madang and more widely across the country.

Phylogenetic structure of moth communities (Geometridae, Lepidoptera) along a complete rainforest elevational gradient in Papua New Guinea.

We use community phylogenetics to elucidate the community assembly mechanisms for Geometridae moths (Lepidoptera) collected along a complete rainforest elevational gradient (200-3700 m a.s.l) on Mount Wilhelm in Papua New Guinea. A constrained phylogeny based on COI barcodes for 604 species was used to analyse 1390 species x elevation occurrences at eight elevational sites separated by 500 m elevation increments. We obtained Nearest Relatedness Index (NRI), Nearest Taxon Index (NTI) and Standardised Effect Size of Faith's Phylogenetic Diversity (SES.PD) and regressed these on temperature, plant species richness and predator abundance as key abiotic and biotic predictors. We also quantified beta diversity in the moth communities between elevations using the Phylogenetic Sorensen index. Overall, geometrid communities exhibited phylogenetic clustering, suggesting environmental filters, particularly at higher elevations at and above 2200 m a.s.l and no evidence of overdispersion. NRI, NTI and SES.PD showed no consistent trends with elevation or the studied biotic and abiotic variables. Change in community structure was driven by turnover of phylogenetic beta-diversity, except for the highest 2700-3200 m elevations, which were characterised by nested subsets of lower elevation communities. Overall, the elevational signal of geometrid phylogeny was weak-moderate. Additional insect community phylogeny studies are needed to understand this pattern.

Genetic Signatures of Positive Selection in Human Populations Adapted to High Altitude in Papua New Guinea.

Papua New Guinea (PNG) hosts distinct environments mainly represented by the ecoregions of the Highlands and Lowlands that display increased altitude and a predominance of pathogens, respectively. Since its initial peopling approximately 50,000 years ago, inhabitants of these ecoregions might have differentially adapted to the environmental pressures exerted by each of them. However, the genetic basis of adaptation in populations from these areas remains understudied. Here, we investigated signals of positive selection in 62 highlanders and 43 lowlanders across 14 locations in the main island of PNG using whole-genome genotype data from the Oceanian Genome Variation Project (OGVP) and searched for signals of positive selection through population differentiation and haplotype-based selection scans. Additionally, we performed archaic ancestry estimation to detect selection signals in highlanders within introgressed regions of the genome. Among highland populations we identified candidate genes representing known biomarkers for mountain sickness (SAA4, SAA1, PRDX1, LDHA) as well as candidate genes of the Notch signaling pathway (PSEN1, NUMB, RBPJ, MAML3), a novel proposed pathway for high altitude adaptation in multiple organisms. We also identified candidate genes involved in oxidative stress, inflammation, and angiogenesis, processes inducible by hypoxia, as well as in components of the eye lens and the immune response. In contrast, candidate genes in the lowlands are mainly related to the immune response (HLA-DQB1, HLA-DQA2, TAAR6, TAAR9, TAAR8, RNASE4, RNASE6, ANG). Moreover, we find two candidate regions to be also enriched with archaic introgressed segments, suggesting that archaic admixture has played a role in the local adaptation of PNG populations.

Sequence typing of Haemophilus ducreyi isolated from patients in the Namatanai region of Papua New Guinea: Infections by Class I and Class II strain types differ in ulcer duration and resurgence of infection after azithromycin treatment.

Haemophilus ducreyi (HD) is an important cause of cutaneous ulcers in several endemic regions, including the Western Pacific Region, especially among children. An HD sequence typing on swab samples taken from 1,081 ulcers in the Namatanai district of Papua New Guinea, during the pilot study for treatment of yaws, has been performed using the Grant typing system. Of the 363 samples that tested positive for the 16S rDNA of HD, the dsrA sequences of 270 samples were determined. Altogether they revealed 8 HD strain types circulating in Namatanai, including seven strain types of Class I (I.3, I.4, I.5, I.9, I.10, I.11, I.12) and one strain of Class II (II.3); four Class I types (I.9, I.10, I.11, I.12) were novel. The southern region of Namatanai (Matalai Rural) was identified as the region with the lowest genotype diversity and with most infections caused by HD Class II. The middle and northern subdistricts were affected mainly by HD Class I. Analysis of patient characteristics revealed that Class II HD infections were more often represented by longer-lasting ulcers than Class I HD infections. An increase in the prevalence of the I.10 strain was found after azithromycin administration compared to the untreated population at baseline likely reflecting higher infectivity of HD Class I, and more specifically strain type I.10.

"Pioneers, yes. We all should think that way" Improving Papua New Guinea Cancer Nurses Education through an International Partnership.

OBJECTIVES: First, to understand Papua New Guinea (PNG) oncology nursing issues perceived through the nurses' lens of unmet supportive care needs of people affected by cancer and to identify nurses' self-perceived educational priorities in cancer care. Second, to evaluate the tailored bidirectional learning and knowledge transfer among the participants of the Australia Capital Territory Health and PNG Oncology Nursing Development Program hosted in Australia in June 2023. METHODS: A qualitative descriptive study was conducted. Two focus groups were audio-recorded, transcribed, and analyzed using inductive thematic analysis. Based on PNG oncology nurses' experiences and self-assessed educational needs, the findings were analyzed and presented separately for Time 1 before the PNG Oncology Nursing Development program and Time 2 following the completion of the program. RESULTS: The findings from the Time 1 focus group identified four themes: (1) educational priorities, (2) system-wide challenges, (3) patient unmet care needs, and (4) cultural beliefs. After the completion of the educational program, there were four emergent themes: (1) new educational experiences, (2) learnings into practice, (3) culturally sensitive nursing, and (4) leadership (PNG nursing trailblazers). This study, for the first time, provided the PNG RNs with a "voice," to empower them to take more leading roles in important decision-making regarding care structures and management. CONCLUSION: Policymakers, government officials, and international cancer organizations must continue to work together to support cancer control in PNG in light of the current and projected limited resources and barriers to timely cancer diagnosis and treatment in PNG. IMPLICATIONS FOR NURSING PRACTICE: Through observing and learning from a modern cancer department, PNG oncology nurses have gained insight into what is needed for a safe cancer service for both patients and nurses. Oncology nursing education in PNG needs to be further developed, enhanced, and supported for sustainability of cancer nurses in the long term.

Total adiponectin in indigenous Melanesians on Kitava.

OBJECTIVES: Experimental and small human studies have indicated that high total adiponectin levels have beneficial cardiometabolic effects. In contrast, however, high total adiponectin levels are also associated with higher all-cause and cardiovascular mortality in thoroughly adjusted epidemiological studies. To gain further insight into these seemingly contradictory results, we report results on total adiponectin from the indigenous Melanesian population of Kitava, Trobriand Islands, Papua New Guinea, where an apparent absence of cardiometabolic disease has been previously reported. METHODS: Fasting levels of serum total adiponectin were measured cross-sectionally in ≥40-year-old Kitavans (n = 102) and Swedish controls matched for age and sex (n = 108). Multivariable linear regression was used for the analysis of associations with total adiponectin when controlled for group, sex, smoking, hypertension and/or type 2 diabetes, age, and body mass index. RESULTS: Total adiponectin was lower for Kitavans compared to Swedish controls (Median [Mdn] 4.6 µg/mL, range 1.0-206 µg/mL and Mdn 9.7 µg/mL, range 3.1-104 µg/mL, respectively, r = .64, p < .001). Lower total adiponectin was associated with Kitavan group, male sex (only in Swedish controls), smoking (only in Kitavans and Swedish controls combined), younger age (not in Swedish controls), higher BMI, lower total, low-density lipoprotein, high-density lipoprotein (HDL) (only in Kitavans and Swedish controls combined), and non-HDL cholesterol, and higher anti-PC IgG (only in Kitavans and Swedish controls combined). CONCLUSION: Total adiponectin in Kitavans was significantly lower than in Swedish controls.

Impact on pregnancy outcomes of intermittent preventive treatment with sulfadoxine-pyrimethamine in urban and peri-urban Papua New Guinea: a retrospective cohort study.

BACKGROUND: Intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) reduces malaria-attributable adverse pregnancy outcomes and may also prevent low birth weight (< 2,500 g) through mechanisms independent of malaria. Malaria transmission in Papua New Guinea (PNG) is highly heterogeneous. The impact of IPTp-SP on adverse birth outcomes in settings with little or no malaria transmission, such as PNG's capital city Port Moresby, is unknown. METHODS: A retrospective cohort study was conducted amongst HIV-negative women with a singleton pregnancy who delivered at Port Moresby General Hospital between 18 July and 21 August 2022. The impact of IPTp-SP doses on adverse birth outcomes and anaemia was assessed using logistic and linear regression models, as appropriate. RESULTS: Of 1,140 eligible women amongst 1,228 consecutive births, 1,110 had a live birth with a documented birth weight. A total of 156 women (13.7%) did not receive any IPTp-SP, 347 women (30.4%) received one, 333 (29.2%) received two, and 304 (26.7%) received the recommended ≥ 3 doses of IPTp-SP. A total of 65 of 1,110 liveborn babies (5.9%) had low birth weight and there were 34 perinatal deaths (3.0%). Anaemia (haemoglobin < 100 g/L) was observed in 30.6% (243/793) of women, and 14 (1.2%) had clinical malaria in pregnancy. Compared to women receiving 0-1 dose of IPTp-SP, women receiving ≥ 2 doses had lower odds of LBW (adjusted odds ratio [aOR] 0.50; 95% confidence interval [CI] 0.26, 0.96), preterm birth (aOR 0.58; 95% CI 0.32, 1.04), perinatal death (aOR 0.49; 95% CI 0.18, 1.38), LBW/perinatal death (aOR 0.55; 95% CI 0.27, 1.12), and anaemia (OR 0.50; 95% CI 0.36, 0.69). Women who received 2 doses versus 0-1 had 45% lower odds of LBW (aOR 0.55, 95% CI 0.27, 1.10), and a 16% further (total 61%) reduction with ≥ 3 doses (aOR 0.39, 95% CI 0.14, 1.05). Birth weights for women who received 2 or ≥ 3 doses versus 0-1 were 81 g (95% CI -3, 166) higher, and 151 g (58, 246) higher, respectively. CONCLUSIONS: Provision of IPTp-SP in a low malaria-transmission setting in PNG appears to translate into substantial health benefits, in a dose-response manner, supporting the strengthening IPTp-SP uptake across all transmission settings in PNG.

Highly Diverse Symbiodiniaceae Types Hosted by Corals in a Global Hotspot of Marine Biodiversity.

Symbiotic dinoflagellates in the genus Symbiodiniaceae play vital roles in promoting resilience and increasing stress tolerance in their coral hosts. While much of the world's coral succumb to the stresses associated with increasingly severe and frequent thermal bleaching events, live coral cover in Papua New Guinea (PNG) remains some of the highest reported globally despite the historically warm waters surrounding the country. Yet, in spite of the high coral cover in PNG and the acknowledged roles Symbiodiniaceae play within their hosts, these communities have not been characterized in this global biodiversity hotspot. Using high-throughput sequencing of the ITS2 rDNA gene, we profiled the endosymbionts of four coral species, Diploastrea heliopora, Pachyseris speciosa, Pocillopora acuta, and Porites lutea, across six sites in PNG. Our findings reveal patterns of Cladocopium and Durusdinium dominance similar to other reefs in the Coral Triangle, albeit with much greater intra- and intergenomic variation. Host- and site-specific variations in Symbiodiniaceae type profiles were observed across collection sites, appearing to be driven by environmental conditions. Notably, the extensive intra- and intergenomic variation, coupled with many previously unreported sequences, highlight PNG as a potential hotspot of symbiont diversity. This work represents the first characterization of the coral-symbiont community structure in the PNG marine biodiversity hotspot, serving as a baseline for future studies.

Breastfeeding and Neonatal Age Influence Neutrophil-Driven Ontogeny of Blood Cell Populations in the First Week of Human Life.

The first few days of life are characterized by rapid external and internal changes that require substantial immune system adaptations. Despite growing evidence of the impact of this period on lifelong immune health, this period remains largely uncharted. To identify factors that may impact the trajectory of immune development, we conducted stringently standardized, high-throughput phenotyping of peripheral white blood cell (WBC) populations from 796 newborns across two distinct cohorts (The Gambia, West Africa; Papua New Guinea, Melanesia) in the framework of a Human Immunology Project Consortium (HIPC) study. Samples were collected twice from each newborn during the first week of life, first at Day of Life 0 (at birth) and then subsequently at Day of Life 1, 3, or 7 depending on the randomization group the newborn belongs to. The subsequent analysis was conducted at an unprecedented level of detail using flow cytometry and an unbiased automated gating algorithm. The results showed that WBC composition in peripheral blood changes along patterns highly conserved across populations and environments. Changes across days of life were most pronounced in the innate myeloid compartment. Breastfeeding, and at a smaller scale neonatal vaccination, were associated with changes in peripheral blood neutrophil and monocyte cell counts. Our results suggest a common trajectory of immune development in newborns and possible association with timing of breastfeeding initiation, which may contribute to immune-mediated protection from infection in early life. These data begin to outline a specific window of opportunity for interventions that could deliberately direct WBC composition, and with that, immune trajectory and thus ontogeny in early life. This trial is registered with NCT03246230.