Human Behavior, Livelihood, and Malaria Transmission in Two Sites of Papua New Guinea.

BACKGROUND: Malaria transmission is currently resurging in Papua New Guinea (PNG). In addition to intervention coverage, social and cultural factors influence changes in epidemiology of malaria in PNG. This study aimed to better understand the role of human behavior in relation to current malaria control efforts. METHODS: A mixed-method design was used in 2 sites in PNG. In-depth interviews, focus group discussions, cross-sectional malaria indicator survey, and population census were implemented. RESULTS: We identified 7 population groups based on demographics and behavioral patterns with potential relevance to Anopheles exposure. People spend a substantial amount of time outdoors or in semiopen structures. Between 4 pm and 8 am, all types of activities across all groups in both study sites may be exposing individuals to mosquito bites; sleeping under a long-lasting insecticidal net was the exception. The later in the night, the more outdoor presence was concentrated in adult men. CONCLUSIONS: Our findings highlight the potential of outdoor exposure to hamper malaria control as people spend a remarkable amount of time outdoors without protection from mosquitoes. To prevent ongoing transmission, targeting of groups, places, and activities with complementary interventions should consider setting-specific human behaviors in addition to epidemiological and entomological data.

Caregivers' acceptance of using artesunate suppositories for treating childhood malaria in Papua New Guinea.

Community-based interventions using artemisinin-derived suppositories may potentially reduce malaria-related childhood mortality. However, their sociocultural acceptability is unknown in Papua New Guinea and a formal examination of caregiver's attitudes to rectal administration was needed to inform effective deployment strategies. Caregivers (n = 131) of children with uncomplicated malaria were questioned on their prior experience with, and attitudes to, rectal administration and then offered artesunate suppositories as treatment of their child. The 29% who refused this alternative were further questioned to determine their reasons for this refusal. Lack of spousal approval and fear of side effects were the most common reasons for refusal. Sixty-six percent of caregivers agreed to self-administer suppositories, which were perceived as effective (99%), safe (96%), and fast-acting (91%), but problematic to administer to a struggling child (56%). Shame, embarrassment, and hygiene were not significant concerns. Acceptability of rectal administration should be relatively high in Papua New Guinea. However, deployment must be accompanied by health education that addresses the practical aspects of administration, is appropriate for the illiterate, and is directed at fathers as well as mothers.

Knowledge, attitudes, and practices concerning malaria in pregnancy: results from a qualitative study in Madang, Papua New Guinea.

BACKGROUND: Malaria is the leading cause of illness and death in Papua New Guinea (PNG). Infection during pregnancy with falciparum or vivax malaria, as occurs in PNG, has health implications for mother and child, causing complications such as maternal anemia, low birth weight and miscarriage. This article explores knowledge, attitudes and practices concerning malaria during pregnancy and it's prevention in Madang, PNG, a high prevalence area. METHODS: As part of a qualitative study in Madang, exploring MiP, participatory techniques (free-listing and sorting) were conducted along with focus group discussions, in-depth interviews (with pregnant women, health staff and other community members) and observations in the local community and health facilities. RESULTS: The main themes explored were attitudes towards and knowledge of MiP, its risks, and prevention. Although there was a general awareness of the term "malaria", it was often conflated with general sickness or with pregnancy-related symptoms. Moreover, many preventive methods for MiP were related to practices of general healthy living. Indeed, varied messages from health staff about the risks of MiP were observed. In addition to ideas about the seriousness and risk of MiP, other factors influenced the uptake of interventions: availability and perceived comfort of sleeping under insecticide-treated mosquito nets were important determinants of usage, and women's heavy workload influenced Chloroquine adherence. CONCLUSION: The non-specific symptoms of MiP and its resultant conflation with symptoms of pregnancy that are perceived as normal have implications for MiP prevention and control. However, in Madang, PNG, this was compounded by the inadequacy of health staff's message about MiP.

Factors affecting attendance at and timing of formal antenatal care: results from a qualitative study in Madang, Papua New Guinea.

BACKGROUND: Appropriate antenatal care (ANC) is key for the health of mother and child. However, in Papua New Guinea (PNG), only a third of women receive any ANC during pregnancy. Drawing on qualitative research, this paper explores the influences on ANC attendance and timing of first visit in the Madang region of Papua New Guinea. METHODS: Data were collected in three sites utilizing several qualitative methods: free-listing and sorting of terms and definitions, focus group discussions, in-depth interviews, observation in health care facilities and case studies of pregnant women. Respondents included pregnant women, their relatives, biomedical and traditional health providers, opinion leaders and community members. RESULTS: Although generally reported to be important, respondents' understanding of the procedures involved in ANC was limited. Factors influencing attendance fell into three main categories: accessibility, attitudes to ANC, and interpersonal issues. Although women saw accessibility (distance and cost) as a barrier, those who lived close to health facilities and could easily afford ANC also demonstrated poor attendance. Attitudes were shaped by previous experiences of ANC, such as waiting times, quality of care, and perceptions of preventative care and medical interventions during pregnancy. Interpersonal factors included relationships with healthcare providers, pregnancy disclosure, and family conflict. A desire to avoid repeat clinic visits, ideas about the strength of the fetus and parity were particularly relevant to the timing of first ANC visit. CONCLUSIONS: This long-term in-depth study (the first of its kind in Madang, PNG) shows how socio-cultural and economic factors influence ANC attendance. These factors must be addressed to encourage timely ANC visits: interventions could focus on ANC delivery in health facilities, for example, by addressing healthcare staff's attitudes towards pregnant women.