The epidemiological transition in Papua New Guinea: new evidence from verbal autopsy studies.

BACKGROUND: Recent economic growth in Papua New Guinea (PNG) would suggest that the country may be experiencing an epidemiological transition, characterized by a reduction in infectious diseases and a growing burden from non-communicable diseases (NCDs). However, data on cause-specific mortality in PNG are very sparse, and the extent of the transition within the country is poorly understood. METHODS: Mortality surveillance was established in four small populations across PNG: West Hiri in Central Province, Asaro Valley in Eastern Highlands Province, Hides in Hela Province and Karkar Island in Madang Province. Verbal autopsies (VAs) were conducted on all deaths identified, and causes of death were assigned by SmartVA and classified into five broad disease categories: endemic NCDs; emerging NCDs; endemic infections; emerging infections; and injuries. Results from previous PNG VA studies, using different VA methods and spanning the years 1970 to 2001, are also presented here. RESULTS: A total of 868 deaths among adolescents and adults were identified and assigned a cause of death. NCDs made up the majority of all deaths (40.4%), with the endemic NCD of chronic respiratory disease responsible for the largest proportion of deaths (10.5%), followed by the emerging NCD of diabetes (6.2%). Emerging infectious diseases outnumbered endemic infectious diseases (11.9% versus 9.5%). The distribution of causes of death differed across the four sites, with emerging NCDs and emerging infections highest at the site that is most socioeconomically developed, West Hiri. Comparing the 1970-2001 VA series with the present study suggests a large decrease in endemic infections. CONCLUSIONS: Our results indicate immediate priorities for health service planning and for strengthening of vital registration systems, to more usefully serve the needs of health priority setting.

Community response to intermittent preventive treatment of malaria in infants (IPTi) in Papua New Guinea.

BACKGROUND: Building on previous acceptability research undertaken in sub-Saharan Africa this article aims to investigate the acceptability of intermittent preventive treatment of malaria in infants (IPTi) in Papua New Guinea (PNG). METHODS: A questionnaire was administered to mothers whose infants participated in the randomised placebo controlled trial of IPTi. Mothers whose infants participated and who refused to participate in the trial, health workers, community reporters and opinion leaders were interviewed. Men and women from the local community also participated in focus group discussions. RESULTS: Respondents viewed IPTi as acceptable in light of wider concern for infant health and the advantages of trial participation. Mothers reported complying with at-home administration of IPTi due to perceived benefits of IPTi and pressure from health workers. In spite of patchy knowledge, respondents also demonstrated a demand for infant vaccinations and considered non-vaccination to be neglect. There is little evidence that IPTi has negative impacts on attitudes to EPI, EPI adherence or existing malaria prevention practices. CONCLUSION: The degree of similarity between findings from the acceptability studies undertaken in sub-Saharan Africa and PNG allows some generalization relating to the implementation of IPTi outside of Africa: IPTi fits well with local health cultures, appears to be accepted easily and has little impact on attitudes towards EPI or malaria prevention. The study adds to the evidence indicating that IPTi could be rolled out in a range of social and cultural contexts.

Antenatal care in Goroka: issues and perceptions.

The high maternal mortality rate in Papua New Guinea indicates an urgent need for action. One area for examination is antenatal care. From April 2002 to August 2002 a qualitative study was undertaken in order to identify perceptions, beliefs, barriers and strengths relevant to the utilization of antenatal care by women in the urban, periurban and rural communities of Goroka, Papua New Guinea. Interview data about antenatal care utilization were collected from 20 pregnant or parous women and 4 antenatal health care workers and relevant statistics were reviewed. This information was analyzed in order to identify the constraints faced by the users of antenatal care and health care workers providing such services and to make recommendations aimed to improve the utilization and delivery of antenatal care in Goroka. Multiple encouragers and barriers to using antenatal care were identified within the three categories of physical barriers/encouragers, cultural issues and health care system characteristics. The attitude of health care workers and their perceived ill-mannered treatment of women was one of the most significant concerns raised by the women. Nevertheless, all of the women expressed overall satisfaction with the care given. All of the health care workers stated that antenatal care is very important for the health of both the baby and the mother and expressed a desire to improve the level of care. The major constraints faced were staff shortages, limited supplies and broken equipment. There were four key areas of strength: the broad level of coverage, the high regularity of attendance, the women's commitment to antenatal care and the willingness of health care workers to overcome resource difficulties in the provision of care. Recommendations to improve the delivery of antenatal care services and their utilization by women addressed the situation of women and the interactions between women and health care providers, and proposed innovations in the health care system.