Insufficient duration of insecticidal efficacy of Yahe® insecticide-treated nets in Papua New Guinea.

BACKGROUND: Insecticide-treated nets (ITNs) are the backbone of anti-malarial vector control in Papua New Guinea (PNG). Over recent years the quality and performance of ITNs delivered to PNG decreased, which has likely contributed to the stagnation in the malaria control effort in the country. The present study reports results from the first 24 months of a durability study with the ITN product Yahe LN® in PNG. METHODS: The durability study was conducted in four villages on the northern coast of PNG, in an area with high malaria parasite transmission, following WHO-recommended methodology adapted to the local scenario. A cohort of n = 500 individually identifiable Yahe® ITNs was distributed by the PNG National Malaria Control Programme from October to December 2021. Insecticidal efficacy of the ITNs was tested using cone bioassays with fully pyrethroid susceptible Anopheles farauti colony mosquitoes at baseline and at 6 months intervals, alongside evaluation of physical integrity and the proportion of ITNs lost to follow-up. A questionnaire was used to collect information on ITN end user behaviour, such as the frequency of use and washing. The observations from the durability study were augmented with simulated laboratory wash assays. RESULTS: Gradual uptake and replacement of previous campaign nets by the communities was observed, such that at 6 months 45% of all newly distributed nets were in use in their designated households. Insecticidal efficacy of the Yahe® nets, expressed as the percent 24 h mortality in cone bioassays decreased from 91 to 45% within the first 6 months of distribution, even though > 90% of study nets had never been washed. Insecticidal efficacy decreased further to < 20% after 24 months. ITNs accumulated physical damage (holes) at a rate similar to previous studies, and 35% were classified as 'too torn' by proportional hole index after 24 months. ITNs were lost to follow-up such that 61% of cohort nets were still present after 24 months. Laboratory wash assays indicated a rapid reduction in insecticidal performance with each consecutive wash such that average 24 h mortality was below 20% after 10 washes. CONCLUSION: Yahe® ITNs are not performing as per label claim in an area with fully pyrethroid susceptible vectors, and should be investigated more comprehensively and in other settings for compliance with currently recommended durability and efficacy thresholds. The mass distribution of low quality ITN products with variable performance is one of the major ongoing challenges for global malaria control in the last decade.

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.

Evaluation of an obstetric and neonatal care upskilling program for community health workers in Papua New Guinea.

BACKGROUND: 60% of women in Papua New Guinea (PNG) give birth unsupervised and outside of a health facility, contributing to high national maternal and perinatal mortality rates. We evaluated a practical, hospital-based on-the-job training program implemented by local health authorities in PNG between 2013 and 2019 aimed at addressing this challenge by upskilling community health workers (CHWs) to provide quality maternal and newborn care in rural health facilities. METHODS: Two provinces, the Eastern Highlands and Simbu Provinces, were included in the study. In the Eastern Highlands Province, a baseline and end point skills assessment and post-training interviews 12 months after completion of the 2018 training were used to evaluate impacts on CHW knowledge, skills, and self-reported satisfaction with training. Quality and timeliness of referrals was assessed through data from the Eastern Highlands Province referral hospital registers. In Simbu Province, impacts of training on facility births, stillbirths and referrals were evaluated pre- and post-training retrospectively using routine health facility reporting data from 2012 to 2019, and negative binomial regression analysis adjusted for potential confounders and correlation of outcomes within facilities. RESULTS: The average knowledge score increased significantly, from 69.8% (95% CI:66.3-73.2%) at baseline, to 87.8% (95% CI:82.9-92.6%) following training for the 8 CHWs participating in Eastern Highlands Province training. CHWs reported increased confidence in their skills and ability to use referral networks. There were significant increases in referrals to the Eastern Highlands provincial hospital arriving in the second stage of labour but no significant difference in the 5 min Apgar score for children, pre and post training. Data on 11,345 births in participating facilities in Simbu Province showed that the number of births in participating rural health facilities more than doubled compared to prior to training, with the impact increasing over time after training (0-12 months after training: IRR 1.59, 95% CI: 1.04-2.44, p-value 0.033, > 12 months after training: IRR 2.46, 95% CI:1.37-4.41, p-value 0.003). There was no significant change in stillbirth or referral rates. CONCLUSIONS: Our findings showed positive impacts of the upskilling program on CHW knowledge and practice of participants, facility births rates, and appropriateness of referrals, demonstrating its promise as a feasible intervention to improve uptake of maternal and newborn care services in rural and remote, low-resource settings within the resourcing available to local authorities. Larger-scale evaluations of a size adequately powered to ascertain impact of the intervention on stillbirth rates are warranted.

Investigating socio-ecological factors influencing implementation of tuberculosis infection prevention and control in rural Papua New Guinea.

BACKGROUND: Tuberculosis (TB) is a highly transmissible infectious disease killing millions of people yearly, particularly in low-income countries. TB is most likely to be transmitted in healthcare settings with poor infection control practices. Implementing TB infection prevention and control (TB-IPC) is pivotal to preventing TB transmission in healthcare settings. This study investigated diverse stakeholders' perspectives relating to barriers and strategies for TB-IPC in rural hospitals in Papua New Guinea. METHODS: Multiple qualitative case studies were conducted with 32 key stakeholders with experience in TB services. Data collection drew on three primary sources to triangulate data: semi-structured interviews, document reviews and field notes. The data were analyzed using hybrid deductive-inductive thematic analysis. RESULTS: Our results reveal that key stakeholders perceive multiple interdependent factors that affect TB-IPC practice. The key emerging themes include strategic planning for and prioritizing TB-IPC guidelines; governance, leadership and accountability at the provincial level; community attitudes towards TB control; institutional capacity to deliver TB care, healthcare workers' safety, and long-term partnership and integration of TB-IPC programmes into the broad IPC programme. CONCLUSIONS: The evidence suggests that a multi-perspective approach is crucial for TB-IPC guidelines in healthcare institutions. Interventions focusing on addressing health systems strengthening may improve the implementation of TB-IPC guidelines.

Evaluation of a population-wide, systematic screening initiative for tuberculosis on Daru island, Western Province, Papua New Guinea.

BACKGROUND: A population-wide, systematic screening initiative for tuberculosis (TB) was implemented on Daru island in the Western Province of Papua New Guinea, where TB is known to be highly prevalent. The initiative used a mobile van equipped with a digital X-ray device, computer-aided detection (CAD) software to identify TB-related abnormalities on chest radiographs, and GeneXpert machines for follow-on diagnostic testing. We describe the results of the TB screening initiative, evaluate its population-level impact and examine risk factors associated with TB detection. METHODS: Through a retrospective review of screening data, we assessed the effectiveness of the screening by examining the enrolment coverage and the proportion of people with TB among screened subjects. A cascade analysis was performed to illustrate the flow of participants in the screening algorithm. We conducted univariate and multivariate analyses to identify factors associated with TB. Furthermore, we estimated the number of additional cases detected by the project by examining the trend of routine TB case notifications during the intervention period, compared to the historical baseline cases and trend-adjusted expected cases. RESULTS: Of the island's 18,854 residents, 8,085 (42.9%) were enrolled and 7,970 (98.6%) had chest X-ray interpreted by the CAD4TB software. A total of 1,116 (14.0%) participants were considered to have abnormal CXR. A total of 69 Xpert-positive cases were diagnosed, resulting in a detection rate of 853 per 100 000 population screened. 19.4% of people with TB had resistance to rifampicin. People who were in older age groups (aOR 6.6, 95%CI: 1.5-29.1 for the 45-59 age group), were severely underweight (aOR 2.5, 95%CI:1.0-6.1) or underweight (aOR 2.1, 95%CI: 1.1-3.8), lived in households < 5 people (aOR 3.4, 95%CI:1.8-6.6) and had a past history of TB (aOR 2.1, 95%CI: 1.2-3.6) were more likely to have TB. The number of bacteriologically confirmed TB notified during the intervention period was 79.3% and 90.8% higher than baseline notifications and forecasted notifications, respectively. CONCLUSION: The screening project demonstrated its effectiveness with the high Xpert-positive TB prevalence among the participants and by successfully yielding additional cases of bacteriologically confirmed TB including rifampicin-resistant TB. The results and lessons learnt from the project should inform future TB screening initiatives in Papua New Guinea.

Human impacts and Anthropocene environmental change at Lake Kutubu, a Ramsar wetland in Papua New Guinea.

The impacts of human-induced environmental change that characterize the Anthropocene are not felt equally across the globe. In the tropics, the potential for the sudden collapse of ecosystems in response to multiple interacting pressures has been of increasing concern in ecological and conservation research. The tropical ecosystems of Papua New Guinea are areas of diverse rainforest flora and fauna, inhabited by human populations that are equally diverse, both culturally and linguistically. These people and the ecosystems they rely on are being put under increasing pressure from mineral resource extraction, population growth, land clearing, invasive species, and novel pollutants. This study details the last ∼90 y of impacts on ecosystem dynamics in one of the most biologically diverse, yet poorly understood, tropical wetland ecosystems of the region. The lake is listed as a Ramsar wetland of international importance, yet, since initial European contact in the 1930s and the opening of mineral resource extraction facilities in the 1990s, there has been a dramatic increase in deforestation and an influx of people to the area. Using multiproxy paleoenvironmental records from lake sediments, we show how these anthropogenic impacts have transformed Lake Kutubu. The recent collapse of algal communities represents an ecological tipping point that is likely to have ongoing repercussions for this important wetland's ecosystems. We argue that the incorporation of an adequate historical perspective into models for wetland management and conservation is critical in understanding how to mitigate the impacts of ecological catastrophes such as biodiversity loss.

Garnet sand reveals rock recycling processes in the youngest exhumed high- and ultrahigh-pressure terrane on Earth.

Rock recycling within the forearcs of subduction zones involves subduction of sediments and hydrated lithosphere into the upper mantle, exhumation of rocks to the surface, and erosion to form new sediment. The compositions of, and inclusions within detrital minerals revealed by electron microprobe analysis and Raman spectroscopy preserve petrogenetic clues that can be related to transit through the rock cycle. We report the discovery of the ultrahigh-pressure (UHP) indicator mineral coesite as inclusions in detrital garnet from a modern placer deposit in the actively exhuming Late Miocene-Recent high- and ultrahigh-pressure ((U)HP) metamorphic terrane of eastern Papua New Guinea. Garnet compositions indicate the coesite-bearing detrital garnets are sourced from felsic protoliths. Carbonate, graphite, and CO2 inclusions also provide observational constraints for geochemical cycling of carbon and volatiles during subduction. Additional discoveries include polyphase inclusions of metastable polymorphs of SiO2 (cristobalite) and K-feldspar (kokchetavite) that we interpret as rapidly cooled former melt inclusions. Application of elastic thermobarometry on coexisting quartz and zircon inclusions in six detrital garnets indicates elastic equilibration during exhumation at granulite and amphibolite facies conditions. The garnet placer deposit preserves a record of the complete rock cycle, operative on <10-My geologic timescales, including subduction of sedimentary protoliths to UHP conditions, rapid exhumation, surface uplift, and erosion. Detrital garnet geochemistry and inclusion suites from both modern sediments and stratigraphic sections can be used to decipher the petrologic evolution of plate boundary zones and reveal recycling processes throughout Earth's history.

Language and ethnobiological skills decline precipitously in Papua New Guinea, the world's most linguistically diverse nation.

Papua New Guinea is home to >10% of the world's languages and rich and varied biocultural knowledge, but the future of this diversity remains unclear. We measured language skills of 6,190 students speaking 392 languages (5.5% of the global total) and modeled their future trends using individual-level variables characterizing family language use, socioeconomic conditions, students' skills, and language traits. This approach showed that only 58% of the students, compared to 91% of their parents, were fluent in indigenous languages, while the trends in key drivers of language skills (language use at home, proportion of mixed-language families, urbanization, students' traditional skills) predicted accelerating decline of fluency to an estimated 26% in the next generation of students. Ethnobiological knowledge declined in close parallel with language skills. Varied medicinal plant uses known to the students speaking indigenous languages are replaced by a few, mostly nonnative species for the students speaking English or Tok Pisin, the national lingua franca. Most (88%) students want to teach indigenous language to their children. While crucial for keeping languages alive, this intention faces powerful external pressures as key factors (education, cash economy, road networks, and urbanization) associated with language attrition are valued in contemporary society.

Intimate partner violence as a determinant of pregnancy termination among women in unions: evidence from the 2016-2018 Papua New Guinea Demographic and Health Survey.

There is a demonstrated link between intimate partner violence (IPV) and pregnancy termination, and this association has received much attention in developed settings. Despite the high prevalence of IPV in Papua New Guinea (PNG), little is known about the association between these experiences and pregnancy termination. This study examined the association between IPV and pregnancy termination in PNG. The present study used population-based data from the PNG's first Demographic and Health Survey (DHS) conducted in 2016-2018. The analysis involved women aged 15-49 years who were in intimate unions (married or co-habiting). We used binary logistic regression modelling to analyse the association between IPV and pregnancy termination. Results were reported as crude odds ratios (cOR) and adjusted odds ratios (aOR) with 95% confidence intervals (CIs). Overall, 6.3% of women involved in this study had ever terminated a pregnancy, and 6 in 10 women (61.5%) reported having experienced IPV in the last 12 months preceding the survey. Of those women who experienced IPV, 7.4% had ever terminated a pregnancy. Women who had experienced IPV had a 1.75 higher odds of reporting pregnancy termination (cOR: 1.75; 95% CI: 1.29-2.37) than women who did not experience IPV. After controlling for theoretically and empirically relevant socio-demographic and economic factors, IPV remained a strong and significant determinant of pregnancy termination (aOR: 1.67, 95% CI: 1.22-2.30). The strong association between IPV and pregnancy termination among women in intimate unions in PNG calls for targeted policies and interventions that address the high prevalence of IPV. The provision of comprehensive sexual reproductive health, public education, and awareness creation on the consequences of IPV, regular assessment, and referral to appropriate services for IPV may reduce the incidence of pregnancy termination in PNG.

Collaborative governance in a primary health care partnership in Papua New Guinea.

INTRODUCTION: Collaboration in primary health care is recommended to achieve global health goals. Public-private partnerships (PPP) are one means of collaboration. Our study examined collaboration in a case study PPP for primary health care in Western Province, Papua New Guinea (PNG). METHODS: Interviews with key informants involved in the PPP were conducted and key programme documents were reviewed. Data were coded and deductively analysed using the collaborative governance model developed by Emerson, Nabatchi and Balogh. RESULTS: The key features of the case study PPP that were highlighted by the collaborative governance model were: identification of partners, trust, procedural arrangements, and leadership. DISCUSSION: We identified four lessons of significance in the practical establishment and implementation of a partnership in a complex and challenging setting such as PNG: the need to (i) prioritise in-person collaboration and communication, (ii) engage dynamic individuals to lead the partnership, (iii) encourage relationships across all sectors and actors, and (iv) remain flexible and adapt to local cultural and context. CONCLUSION: Collaborative governance offers a practical framework to understand, assess and strengthen collaboration in multi-stakeholder partnerships in the health sector.

Antibody to Plasmodium falciparum Variant Surface Antigens, var Gene Transcription, and ABO Blood Group in Children With Severe or Uncomplicated Malaria.

BACKGROUND: Antibodies to variant surface antigens (VSAs) such as Plasmodium falciparum erythrocyte membrane protein 1 (PfEMP1) may vary with malaria severity. The influence of ABO blood group on antibody development is not understood. METHODS: Immunoglobulin G antibodies to VSAs in Papua New Guinean children with severe (n = 41) or uncomplicated (n = 30) malaria were measured by flow cytometry using homologous P falciparum isolates. Isolates were incubated with ABO-matched homologous and heterologous acute and convalescent plasma. RNA was used to assess var gene transcription. RESULTS: Antibodies to homologous, but not heterologous, isolates were boosted in convalescence. The relationship between antibody and severity varied by blood group. Antibodies to VSAs were similar in severe and uncomplicated malaria at presentation, higher in severe than uncomplicated malaria in convalescence, and higher in children with blood group O than other children. Six var gene transcripts best distinguished severe from uncomplicated malaria, including UpsA and 2 CIDRα1 domains. CONCLUSIONS: ABO blood group may influence antibody acquisition to VSAs and susceptibility to severe malaria. Children in Papua New Guinea showed little evidence of acquisition of cross-reactive antibodies following malaria. Var gene transcripts in Papua New Guinean children with severe malaria were similar to those reported from Africa.

Rapid Serologic Test for Diagnosis of Yaws in Patients with Suspicious Skin Ulcers.

The Chembio DPP (Dual Path Platform) Syphilis Screen & Confirm kit (https://chembio.com) is a rapid serologic test that can be used to diagnose yaws. We evaluated its capacity to detect patients with ulcers that tested PCR positive for Treponema pallidum subsp. pertenue. DPP detected 84% of ulcers that were positive by PCR.

First insight into oral microbiome diversity in Papua New Guineans reveals a specific regional signature.

The oral microbiota is a highly complex and diversified part of the human microbiome. Being located at the interface between the human body and the exterior environment, this microbiota can deepen our understanding of the environmental impacts on the global status of human health. This research topic has been well addressed in Westernized populations, but these populations only represent a fraction of human diversity. Papua New Guinea hosts very diverse environments and one of the most unique human biological diversities worldwide. In this study we performed the first known characterization of the oral microbiome in 85 Papua New Guinean individuals living in different environments, using a qualitative and quantitative approach. We found a significant geographical structure of the Papua New Guineans oral microbiome, especially in the groups most isolated from urban spaces. In comparison to other global populations, two bacterial genera related to iron absorption were significantly more abundant in Papua New Guineans and Aboriginal Australians, which suggests a shared oral microbiome signature. Further studies will be needed to confirm and explore this possible regional-specific oral microbiome profile.

Exposure to interparental violence and intimate partner violence among women in Papua New Guinea.

INTRODUCTION: Evidence suggests that childhood exposure to interparental violence increases the risk of intimate partner violence (IPV) experience or perpetration in adolescence or adulthood. However, it is unclear if exposure to interparental violence increases the risk of IPV among women in Papua New Guinea. This study, therefore, seeks to fill this gap in the literature by examining the association between childhood exposure to interparental violence and IPV among women in Papua New Guinea. METHODS: We used data from the most recent 2016-18 Papua New Guinea Demographic and Health Survey. We included 3,512 women in our analyses. Past-year experience of IPV was the outcome variable in this study. Exposure to interparental violence was the key explanatory variable. We used a multilevel binary logistic regression to examine the association between exposure to interparental violence and IPV. RESULTS: We found a higher probability of experiencing IPV among women exposed to interparental violence [aOR = 1.45, 95% CI = 1.13, 1.86] relative to women who were not exposed. Furthermore, we found that women living in rural areas had a lower likelihood of IPV experience [aOR = O.50, 95% CI = 0.32, 0.80] compared to those in urban settings. Finally, a greater odd of IPV experience was found among women staying in the Highlands Region [aOR = 1.44, 95% CI = 1.06, 1.96] compared to those staying in the Southern Region. CONCLUSION: Exposure to interparental violence was found to be significantly associated with IPV among women in Papua New Guinea. The findings of this study suggest the need for proven operational strategies to reduce IPV, such as improving anti-IPV laws in Papua New Guinea. We recommend the development and implementation of intercession strategies to reduce the experience and justification of violence among women exposed to interparental violence. In addition, health professionals should implement counseling and health education initiatives to tackle the consequences of IPV on women's well-being.

Exposure to interparental violence and justification of intimate partner violence among women in Papua New Guinea.

BACKGROUND: Previous studies have demonstrated that exposure to interparental violence is associated with intimate partner violence justification in a variety of contexts. In this study, we examined the association between exposure to interparental violence and justification of intimate partner violence among women in Papua New Guinea. METHODS: We used data from the 2016-18 Papua New Guinea Demographic and Health Survey. We included 2839 women of reproductive age (15-49 years) in a sexual union (married and cohabiting) in the study. We used a multivariable binary multilevel regression analysis to examine the association between interparental violence and justification of intimate partner violence. We presented the results of the regression analysis using crude odds ratio (cOR) and adjusted odds ratios (aORs), with their 95% confidence intervals (CIs). RESULTS: Women exposed to interparental violence were 1.26 (95%CI = 1.05, 1.53) times more likely to justify intimate partner violence than those who were not exposed. Women who resided in the Highlands (aOR = 2.50, 95%CI = 1.78, 3.51), Momase (aOR = 1.96, 95%CI = 1.40, 2.75), and Islands (aOR = 1.42, 95%CI = 1.01, 1.99) were more likely to justify intimate partner violence compared to those in the Southern region. Women who were exposed to one (aOR = 1.38, 95%CI = 1.06, 1.82) mass media were more likely to justify intimate partner violence compared to those who had no exposure to mass media. On the other hand, women aged 25-34 years (aOR = 0.66, 95%CI = 0.48, 0.91) and 35-49 years (aOR = 0.66, 95%CI = 0.44, 0.97) were less likely to justify intimate partner violence compared to those aged 15-24 years. CONCLUSIONS: Our study has shown that exposure to interparental violence is a predictor of intimate partner violence justification. This study suggests the need for conscious and continuous efforts to identify and assist women who have been exposed to interparental violence to help prevent its transition to later life. Policies and interventions should be developed and implemented to curtail children's exposure to domestic violence in their households. Also, laws and policies need to condemn any violence and demystify community justification and acceptance of intimate partner violence, taking into consideration the significant sociodemographic characteristics of the women highlighted in the study.

"This is really something: same place, same day result, same day treatment" women's experiences of testing positive for HPV and receiving same-day treatment in Papua New Guinea: an interpretative phenomenological analysis.

INTRODUCTION: Human papillomavirus (HPV) testing is transforming cervical screening globally. The World Health Organization (WHO) now recommends same-day HPV screen-and-treat for primary cervical screening in low- and middle-income countries (LMIC) but there is a lack of evidence on women's lived experience of testing positive for oncogenic HPV and receiving same-day treatment. This study aimed to address this knowledge gap among women participating in a same-day HPV screen-and-treat (HPV S&T) program in Papua New Guinea. METHODS: As part of a larger qualitative study, this paper explores the lived experiences of 26 women who tested positive for oncogenic HPV and were treated the same day. We analysed the data using the interpretative phenomenological analysis method. All data were managed using Nvivo 12.5. RESULTS: The interpretative phenomenological analysis led to three superordinate themes: 1) facing and alleviating initial worries, (2) transforming the disclosure process, and (3) connecting to their faith. Women's experiences of the same day HPV screen-and-treat were framed by initial emotional reactions to their positive HPV test result, and having access to treatment on the same day, which helped address their worries and fears, and transformed their experience of disclosing their test result and subsequent treatment to family and friends. CONCLUSION: This study shows that, while women experience similar initial emotional reactions, undergoing same day treatment quickly resolved the women's worries, making this program highly acceptable. Overall, women's engagement in the program confirmed its high acceptability and cultural congruence, leaving women feeling empowered and hopeful about their future, and the future of all Papua New Guinea women.

Factors influencing maternal healthcare utilization in Papua New Guinea: Andersen's behaviour model.

BACKGROUND: Papua New Guinea (PNG) has recorded the highest maternal mortality ratio in the Western Pacific Region and faces major challenges in achieving SDG 3. Antenatal care (ANC), skilled birth attendant (SBA) and postnatal care (PNC) services are critical components of maternal healthcare services (MHS) for reducing maternal mortality and promoting maternal health in PNG. The study sought to assess the prevalence and determinants of ANC, SBA and PNC services amongst women in PNG. METHODS: The study was conducted using the 2016-2018 Papua New Guinea Demographic and Health Survey. A total of 5248 reproductive-age women were considered as the analytical sample. The outcome variables were utilisation of ANC, SBA and PNC services. Chi-square test, multivariable logistic regression and dominance analysis were conducted. Statistical significance was set at p < 0.05. RESULTS: The prevalence rates of ANC, SBA and PNC services were 52.3%, 58.7% and 26.6%, respectively. Women's employment, education, media exposure, distance to health facility, household wealth, region, residence and parity were determinants of MHS utilisation. ANC, SBA and PNC services utilisation were all primarily influenced by enabling factors, followed by predisposing and need factors. CONCLUSIONS: This study demonstrated that enabling factors such as media exposure, distance to health facility, household wealth, region and residence have the greatest impact on MHS utilisation, followed by predisposing (working, education) and need factors (parity). Therefore, enabling factors should be prioritised when developing maternal health programmes and policies. For example, transport and health infrastructure should be strengthened and women's education and vocational training should be increased, especially in Highlands region, Momase region and rural areas, to increase the utilisation of MHS.

Historical epidemics of scrub typhus in Queensland and Papua New Guinea.

Undifferentiated febrile diseases (e.g., Mossman fever) from northern Queensland were eventually partially attributed to mite-transmitted rickettsial infections known as scrub typhus or tsutsugamushi fever. Scrub typhus became a major medical threat to military operations in Papua New Guinea during the Second World War and killed more Australian soldiers than malaria in the pre-antibiotic era. Further investigations showed scrub typhus to be an occupational disease of rural workers in north Queensland especially around Cairns and Innisfail. Occasional small epidemics of scrub typhus still occur during military exercises in Queensland, but as scrub typhus is not a reportable disease, its presence in the civilian community is largely unknown. Increased use of serological testing in patients with fever and rash illnesses after exposure in northern Queensland is likely to show that scrub typhus is a modern infection that remains treatable with antibiotics once it is identified.

Socioeconomic inequality in teenage pregnancy in Papua New Guinea: a decomposition analysis.

BACKGROUND: Teenage pregnancy is a global public health issue, and it poses a serious threat to the health and socioeconomic status of mothers and their newborn children. Although Papua New Guinea has recorded one of the highest teenage pregnancy rates among Asia-Pacific countries, few studies have conducted research on the related inequality in the country. Therefore, this study aimed to assess socioeconomic inequality in teenage pregnancy and its contributing factors in Papua New Guinea. METHODS: Data for this cross-sectional study were obtained from the 2016-2018 Papua New Guinea Demographic and Health Survey. The analytical sample consisted of 2,864 girls aged 15-19 years. We employed Erreygers normalized concentration index (ECI) and concentration curves to measure and depict socioeconomic inequality in teenage pregnancy. Decomposition analysis was likewise performed to identify the contributions of determinants to the observed inequality. RESULTS: Weighted ECI for teenage pregnancy was - 0.0582 (P < 0.001), thereby indicating that teenage pregnancy in Papua New Guinea is disproportionately concentrated among poor girls. Decomposition analysis suggested that education level (65.2%), wealth index (55.2%), early sexual debut (25.1%), region (8.5%), and sex of household head (4.1%) are the main determinants explaining the pro-poor socioeconomic inequality in teenage pregnancy. CONCLUSIONS: A pro-poor socioeconomic inequality of teenage pregnancy was present in Papua New Guinea. This inequality may be alleviated by such interventions as ensuring that teenage girls receive education; implementing poverty alleviation projects, eliminating child, early, and forced marriages; strengthening promotion for household head to support teenagers in accessing sexual and reproductive health education; improving geographical accessibility to health facilities on contraceptive services, and taking necessary precautions and responses to sexual misconduct.

Community perspectives and experiences of quality maternal and newborn care in East New Britain, Papua New Guinea.

BACKGROUND: Quality maternal and newborn care is essential for improving the health of mothers and babies. Low- and middle-income countries, such as Papua New Guinea (PNG), face many barriers to achieving quality care for all. Efforts to improve the quality of maternal and newborn care must involve community in the design, implementation, and evaluation of initiatives to ensure that interventions are appropriate and relevant for the target community. We aimed to describe community members' perspectives and experiences of maternal and newborn care, and their ideas for improvement in one province, East New Britain, in PNG. METHODS: We undertook a qualitative descriptive study in partnership with and alongside five local health facilities, health care workers and community members, using a Partnership Defined Quality Approach. We conducted ten focus group discussions with 68 community members (identified through church, market and other community-based groups) in East New Britain PNG to explore perspectives and experiences of maternal and newborn care, identify enablers and barriers to quality care and interventions to improve care. Discussions were transcribed verbatim. A mixed inductive and deductive analysis was conducted including application of the World Health Organisation (WHO) Quality Maternal and Newborn Care framework. RESULTS: Using the WHO framework, we present the findings in accordance with the five experience of care domains. We found that the community reported multiple challenges in accessing care and facilities were described as under-staffed and under resourced. Community members emphasised the importance of good communication and competent, caring and respectful healthcare workers. Both women and men expressed a strong desire for companionship during labor and birth. Several changes were suggested by the community that could immediately improve the quality of care. CONCLUSIONS: Community perspectives and experiences are critical for informing effective and sustainable interventions to improve the quality of maternal and newborn care and increasing facility-based births in PNG. A greater understanding of the care experience as a key component of quality care is needed and any quality improvement initiatives must include the user experience as a key outcome measure.

Improving the care provided to, and experienced by, women and their families during pregnancy and childbirth is important for improving the health of mothers and babies. Community members should be involved in thinking about appropriate ways to improve care. Papua New Guinea (PNG) is a country in the Pacific which faces multiple challenges to improving care during pregnancy and birth. We aimed to understand what community members think about care provided and experienced during labour and birth in East New Britain, a rural province of PNG. We worked with five health facilities, health workers and community members in East New Britain to develop a qualitative research project. We carried out 10 focus group discussions with community members in East New Britain to understand what the provision and experience of care was like during labour and birth, and ways that it could be improved. We found that community members identified multiple challenges in getting to facilities and many facilities were found to have not enough supplies, equipment, or staff. Community members wanted staff that were good at their work but also caring and respectful. Women wanted to have support people present during labour and birth and many men wanted to be present too. Our results show that it is important to understand what the community thinks about the quality of care during labour and birth and this information is helpful to design effective activities to improve the care provided and experienced.