Parkinson's disease is a chronic debilitating condition, the prevalence of which has not been fully established in Papua New Guinea. We describe a cluster of 9 cases of the disease, restricted to two generations of one family, and the key ideas and beliefs held within the family regarding disease aetiology. Many of the concerns and feelings of guilt expressed by family members were alleviated following supportive listening and culturally appropriate counselling, explanation and advice from trained health professionals assisted by bilingual family facilitators. This is the first time that such a family has been reported in Papua New Guinea and may warrant more detailed assessment. Addressing patient and community perceptions of disease aetiology should be at the heart of health promotion initiatives and counselling.
Cluster Analysis ; Developing Countries ; Female ; Health Knowledge, Attitudes, Practice ; New Guinea ; epidemiology ; Parkinson Disease - diagnosis ; Parkinson Disease - epidemiology*

In many low-resource settings an estimated one-third of all births take place unsupervised with traditional and non-traditional villager birth attendants the only providers of care during pregnancy and childbirth. The training of village birth attendants (VBAs) in Milne Bay Province began in 1991, and has continued during a period of significant shifts in national and international public health policy. As part of a wider provincial-wide review of the VBA program we undertook 6 focus group discussions, 13 in-depth interviews and 8 key informant interviews in three districts in Milne Bay Province in 2014. In this paper we describe the role, responsibilities and function of VBAs, and the challenges facing both VBAs and those involved in their training and in supporting their work in the community. In this setting, VBAs continue to assist women during childbirth, and are frequently having to try and manage difficult obstetric complications with little or no support from their communities or local health facilities. Some VBAs reported being called too late by the community, with insufficient time to refer women on to a health facility, resulting in maternal deaths. Many VBAs continued with their practice, motivated by a heartfelt desire to serve, despite feeling ‘neglected’ and ‘overlooked’, while others continued because of their religious convictions and dedication to help their communities. There is an urgent need to better define what VBAs can and should do in this setting, what communities can realistically expect of their VBAs, and how professional health care workers can work more constructively with this long-standing cadre of lay health workers. There is a need for all health facilities and VBA trainers to support their VBAs, and to fully recognize the often difficult situations VBAs are required to work in while continuing to advocate for supervised, health facility births.

SUMMARY Antenatal care from a trained health care worker provides the opportunity to promote favourable outcomes for both the woman and her unborn infant. The greatest benefit of antenatal care is seen when the first visit is initiated early in the pregnancy and continued with at least four antenatal visits throughout the pregnancy. In Papua New Guinea (PNG), 66% of women attend for antenatal care at least once during their pregnancy and 51% attend four antenatal visits. We conducted a maternal and infant health survey among 482 women in three sites in PNG, Hiri, Karkar and Asaro, to explore uptake and provision of antenatal care from women’s perspectives. Most women attended for antenatal care (95%; 459/482) at least once and 73% (313/431) attended the recommended minimum four antenatal visits. Women in Hiri (77%) and Asaro (78%) were more likely to attend four or more antenatal visits than women in Karkar (66%). No woman in any site reported receiving the full range of antenatal care, as indicated in the PNG national guidelines. Coverage for tetanus toxoid, malaria prophylaxis and provision of iron supplements were similar in all sites. Women in Asaro were more likely to report being advised about a supervised birth (91%) than women in Karkar (86%) or Hiri (68%). Our findings suggest that the opportunity to monitor for risk factors in pregnancy were missed, including the opportunity to provide messages relating to the importance of supervised, health facility births. There is a need for renewed commitment and resources to enable optimal antenatal care to be provided in accordance with established guidelines if PNG is to make significant improvements in maternal and newborn health.

Summary Poor women in remote areas in many countries remain the least likely to receive adequate health care during pregnancy and childbirth for various reasons. In Papua New Guinea (PNG) there is some documentation regarding why women do not attend for supervised births, but less is known about women’s perceptions and experiences of childbirth in the community or about newborn care practices in the first few hours following childbirth. As part of a wider maternal and infant health survey among 482 women in three sites in PNG, in this paper we describe women’s experiences relating to supervised and unsupervised births and newborn care practices. Among respondents, the majority (95%) reported attending for antenatal care at least once during their most recent pregnancy and almost two-thirds (65%) gave birth in a health facility. Among the health facility births, 88% were assisted by a trained health care worker. Among the women who gave birth in the community, 44% chose to do so. Primiparous women, those aged 15-24 years and women with secondary or tertiary education were significantly more likely to give birth in a health facility than multiparous women, those aged more than 24 years and women with none or only primary education. There were 489 live births, 93% of whom were breastfed. Overall 60% of women knew any danger signs in a newborn infant. Fever was the most frequently mentioned danger sign (81%). Knowledge of danger signs was significantly associated with giving birth in a health facility, being multiparous and having secondary education, compared with village birth, being primiparous and having none or only primary education. Our findings highlight the importance of using the opportunity at antenatal clinic to provide women with information and knowledge, not only on the importance of attending for a health facility birth, but also on the importance of planning and seeking transfer to the health facility early.

In Papua New Guinea, village health volunteers (VHVs) work in their communities to support healthy lifestyles. They form an important link between the community and the formal health system. In the Middle and South Fly Districts of Western Province, the VHV Program was implemented as one of the many interventions of the Community Mine Continuation Agreement Middle and South Fly Health Program. For this region of Papua New Guinea, it would be the first time the VHV Program had been implemented. We describe how the VHV Program was implemented and document the perspectives of the VHV Program from the VHVs, their supervising health workers and the communities they serve through focus group discussions and interviews. The qualitative data revealed that some health workers and community members had expectations of the VHVs that differed from their role, particularly in regard to the expectation that VHVs do clinical work. The importance of compensation for VHVs for their time was identified by communities, health workers and the VHVs. VHVs and the community also noted the conflicting demands of the family of the VHV and their work in the community. The final theme identified was about the interaction between the VHV and the formal health system, where VHVs identified needs for access to medical supplies, transport, ongoing training and supervision. These themes are discussed in the context of the international literature and the VHV policy in Papua New Guinea.