Strategic options for syphilis control in Papua New Guinea- impact and cost-effectiveness projections using the syphilis interventions towards elimination (SITE) model.

OBJECTIVES: Papua New Guinea (PNG) has among the highest rates of sexually transmitted infections (STIs) globally and is committed to reducing their incidence. The Syphilis Interventions Towards Elimination (SITE) model was used to explore the expected impact and cost of alternative syphilis intervention scale-up scenarios. METHODS: SITE is a dynamical model of syphilis transmission among adults 15-49 years. Individuals are divided into nine groups based on sexual behaviour and into six stages of infection. The model was calibrated to PNG using data from routine surveillance, bio-behavioural surveys, research studies and program records. Inputs included syphilis prevalence, risk behaviours, intervention coverage and service delivery unit costs. Scenarios compared different interventions (clinical treatment, contact tracing, syphilis screening, and condom promotion) for incidence and cost per infection averted over 2021-2030. RESULTS: Increasing treatment coverage of symptomatic primary/secondary-stage syphilis cases from 25-35% in 2020 to 60% from 2023 onwards reduced estimated incidence over 2021-2030 by 55%, compared to a scenario assuming constant coverage at 2019-2020 levels. The introduction of contact tracing in 2020, assuming 0.4 contacts per symptomatic person treated, reduced incidence over 2021-2030 by 10%. Increasing screening coverage by 20-30 percentage points from the 2019-2020 level reduced incidence over 2021-2030 by 3-16% depending on the target population. Scaling-up clinical, symptom-driven treatment and contact tracing had the lowest cost per infection averted, followed by condom promotion and periodic screening of female sex workers and men who have sex with men. CONCLUSIONS: PNG could considerably reduce its syphilis burden by scaling-up clinical treatment and contact tracing alongside targeted behavioural risk reduction interventions. SITE is a useful tool countries can apply to inform national STI programming and resource allocation.

National health information systems for achieving the Sustainable Development Goals.

OBJECTIVES: Achieving the Sustainable Development Goals will require data-driven public health action. There are limited publications on national health information systems that continuously generate health data. Given the need to develop these systems, we summarised their current status in low-income and middle-income countries. SETTING: The survey team jointly developed a questionnaire covering policy, planning, legislation and organisation of case reporting, patient monitoring and civil registration and vital statistics (CRVS) systems. From January until May 2017, we administered the questionnaire to key informants in 51 Centers for Disease Control country offices. Countries were aggregated for descriptive analyses in Microsoft Excel. RESULTS: Key informants in 15 countries responded to the questionnaire. Several key informants did not answer all questions, leading to different denominators across questions. The Ministry of Health coordinated case reporting, patient monitoring and CRVS systems in 93% (14/15), 93% (13/14) and 53% (8/15) of responding countries, respectively. Domestic financing supported case reporting, patient monitoring and CRVS systems in 86% (12/14), 75% (9/12) and 92% (11/12) of responding countries, respectively. The most common uses for system-generated data were to guide programme response in 100% (15/15) of countries for case reporting, to calculate service coverage in 92% (12/13) of countries for patient monitoring and to estimate the national burden of disease in 83% (10/12) of countries for CRVS. Systems with an electronic component were being used for case reporting, patient monitoring, birth registration and death registration in 87% (13/15), 92% (11/12), 77% (10/13) and 64% (7/11) of responding countries, respectively. CONCLUSIONS: Most responding countries have a solid foundation for policy, planning, legislation and organisation of health information systems. Further evaluation is needed to assess the quality of data generated from systems. Periodic evaluations may be useful in monitoring progress in strengthening and harmonising these systems over time.

Thiamine (vitamin B1) status of boarding school students in the Southern Region of Papua New Guinea.

Thiamine pyrophosphate (TPP) is the major biologically active form of thiamine (vitamin B1). This cross-sectional study assessed whole-blood thiamine pyrophosphate concentration (WBTPPC) in boarding school students in the Southern Region of Papua New Guinea. Sample size for each of the five boarding schools was calculated using the 'proportionate to population size' cluster sampling technique. The 'Clin-Rep' reagent kit was used for the extraction of thiamine pyrophosphate from whole blood. Reverse phase high performance liquid chromatography with post-column derivatization was used to determine the thiamine pyrophosphate concentration. Informed consent was obtained from 468 students, mean age 17.7 +/- 1.5 years. The gender distribution of these students was 274 (58.5%) males and 194 (41.5%) females. The median and interquartile range of WBTPPC for all students was 95.41 microg/l (82.27-113.55). Severe to marginal status of thiamine deficiency was present in 6.4% of all the students. The mean WBTPPC for female students was significantly lower than that for the male students (p < 0.001), with a mean difference of 14.17 microg/l (95% CI of the difference: 9.85-18.50). Severe to marginal status of thiamine deficiency was present in 9.8% of female students and 4.0% of male students. The data strongly support the need for effective implementation and monitoring of food fortification legislation in Papua New Guinea. Withdrawal of fortification or suboptimal thiamine fortification of rice and other cereal products in Papua New Guinea would have serious negative public health implications, especially among students in boarding schools.