In view of the dearth of information relating to antibiotic resistance in community- and hospital-acquired bacterial infections in Papua New Guinea (PNG), we carried out a prospective, hospital-based observational study of surgical patients between October 2008 and October 2009. In a sample of 115 patients (median age 30 years; 55% males) suspected of having a bloodstream infection, blood cultures were positive in 11 (10%) and a significant pathogen was isolated in 9 (8%). Staphylococcus aureus was isolated in 4 patients (44%) and 3 were methicillin resistant; all these isolates were considered community acquired because cultures were performed within 48 hours of admission. Of the remaining 5 isolates, 4 were Gram-negative organisms with at least intermediate resistance to chloramphenicol that were grown from blood taken > 48 hours post-admission and thus considered nosocomially acquired. These data suggest two distinct patterns of bacterial infection in PNG surgical inpatients that have implications for national antibiotic prescription guidelines.

The World Health Organization (WHO) recommends that parasitological confirmation of clinical malaria diagnosis be performed before antimalarial treatment is administered. Malaria rapid diagnostic tests (RDTs) represent a valuable tool for prompt and efficient diagnosis of malaria in settings where microscopic diagnosis is unavailable or unreliable. Concerns remain, however, that Plasmodium falciparum polymorphisms in the genes coding the antigens detected by RDT could impact on RDT performance. Using field isolates of Plasmodium falciparum, we aimed to characterize genetic variability in histidine-rich proteins 2 and 3 (PfHRP-2 and PfHRP-3), aldolase (ALD) and Plasmodium lactate dehydrogenase (pLDH) genes and to evaluate their impact on the performance of RDT. Pfhrp-2, Pfhrp-3, aldolase and pldh were amplified using polymerase chain reaction (PCR) and sequenced. Genetic variation was observed in pfhrp-2 and pfhrp-3 genes while aldolase and pldh showed high levels of conservation. These findings suggest that RDTs based on pLDH and ALD are reliable in the study settings where there is intense diversity or polymorphisms of histidine-rich protein (HRP). Nevertheless, there is no evidence from this study to suggest that RDTs based on the detection of PfHRP-2 and PfHRP-3 have lower sensitivity in Papua New Guinea (PNG). The results observed in this study will be used to inform the PNG National Department of Health on the continued usage of pLDH/ HRP-2 RDT for malaria diagnosis in PNG.

In recent years, there have been increased efforts to reduce the high maternal mortality ratio (MMR) in Papua New Guinea. This retrospective study conducted at Modilon Hospital in Papua New Guinea documented maternal and perinatal mortality over the 6 years from 2009 to 2014. In-hospital maternal mortality, though still high, significantly declined by over 50% from 24/2598 (924 per 100,000) in 2009 to 12/3217 (373 per 100,000) in 2014 (p <0.001) while stillbirth rates and early neonatal death rates remained unchanged. There is a need for an approach with interventions aimed at reducing both maternal and perinatal mortality. While monitoring and auditing of maternal deaths should be possible throughout the entire country, in settings where there is limited capacity to monitor population-based perinatal and neonatal mortality, an emphasis on improved data quality as part of hospital-and health centre-based surveillance can provide important information.

Approximately half of all childhood mortality in Papua New Guinea (PNG) occurs in the neonatal period – the first 28 days of life. In this 5-year retrospective study, causes of admissions and in-hospital mortality among 2426 neonates admitted to Modilon Hospital’s Special Care Nursery in Madang Province were investigated. The neonatal case fatality rate was 15% (370/2426; absolute range between years 12-22%). Neonatal sepsis/infection (1017, 42%), prematurity (821, 34%) and birth asphyxia/meconium aspiration (396, 16%) were the leading causes of admissions (92% of total neonatal admissions) and deaths (96%). Many deaths were potentially avoidable but were often complicated by multiple contributing factors. To reduce neonatal mortality in PNG, health professionals, the government, policy makers and communities must appreciate that improving new born survival and other neonatal outcomes are a responsibility for all. ].