BACKGROUND: Papua New Guinea (PNG) introduced a revised national malaria treatment protocol (NMTP) in late 2011. Successful implementation of the revised protocol requires all health facilities in PNG to have reliable access to microscopy or malaria rapid diagnostic kits as well as a reliable supply of all recommended first-line medications. This paper presents findings from a study that sought to assess the availability of microscopy, malaria rapid diagnostic kits and recommended first-line antimalarial medication in Papua New Guinean health facilities across the country before the introduction of the revised treatment protocol. METHODS: A country-wide cross-sectional survey of 79 randomly selected health centres, health subcentres and aid posts. Data were collected via an interviewer-administered questionnaire completed with the officer in charge of participating health facilities. RESULTS: Overall, 15% of surveyed health facilities had unexpired rapid diagnostic test (RDT) in stock or working microscopy available. A recommended first-line antimalarial for uncomplicated malaria was available in 85% of health facilities. The preferred first-line antimalarial combination for treating severe malaria was present in 42% of health facilities, although 68% had the capacity to provide either the preferred or recommended substitute first-line medication for severe malaria. The total number of health workers employed in the 79 surveyed health facilities was 443, only 3 of whom were medical doctors. CONCLUSIONS: Our findings indicate that diagnostic capacity was low in Papua New Guinean health facilities before the introduction of the new NMTP and that access to recommended first-line antimalarial medication was variable. Substantial improvements in diagnostic capacity and antimalarial procurement and distribution will need to be made if the revised protocol is to be adhered to.
Antimalarials/*therapeutic use ; Clinical Protocols ; *Health Policy ; *Health Services Accessibility ; Humans ; Malaria/*drug therapy ; Papua New Guinea

Tumor necrosis factor (TNF) antagonists are highly effective treatments for psoriasis. These agents provide the opportunity to improve disease activity and achieve clinical remission. Despite its efficacy, long-term use of biologics is associated with high financial costs and possibly life-threatening adverse events. Recently, there has been an increasing interest in discontinuing TNF antagonists in patients with psoriasis who have achieved a positive clinical response. However, there is a paucity of data and clinical guidelines concerning the cessation TNF antagonists in psoriasis treatment. Several factors, including cost, subsequent treatment efficacy, relative risks, and tolerability, should be considered before the decision is made to discontinue TNF antagonists. Well-designed clinical trials are necessary to identify factors that may trigger disease exacerbation after medication discontinuation in order to recognize the potential disadvantages of discontinuing treatment in patients who are previously successfully managed on TNF antagonists.
Biological Products ; Disease Progression ; Humans ; Psoriasis ; Treatment Outcome ; Tumor Necrosis Factor-alpha

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.

Infants in Papua New Guinea (PNG) are at a high risk of invasive pneumococcal disease, and a substantial burden of this falls on children less than six months old. PNG is planning to introduce a pneumococcal conjugate vaccine for infants in the near future, but to make the maximum impact neonatal immunization will have to be considered. To provide evidence on safety and immunogenicity for neonatal and early infant immunization, we undertook an open randomized controlled trial of 7-valent pneumococcal conjugate vaccine (7vPCV). 318 children received 7vPCV at ages 0, 1 and 2 months or at 1, 2 and 3 months or not at all. All children received 23-valent pneumococcal polysaccharide vaccine at age 9 months. This was a large and complex trial: village reporters visited participants weekly during the first year and fortnightly for a further 6 months and nurses monitored self-reported morbidity and collected many thousands of biological samples. The study team was remarkably successful in achieving the study aims, with 18-month follow-up completed on 77% of enrolled children and over 80% of scheduled samples collected. While the results of the trial will be reported elsewhere, this paper discusses the design of the study and dissects out some of the main reasons for its successful completion. Strong community engagement was an essential factor in success and the principles of equitable partnership and service provision led to a strong research partnership. A two-stage consent process, comprising primary assent followed by later informed consent, led to a high drop-out before initial enrolment, but an outstanding retention of those enrolled in the study. We conclude that factors such as strong community participation, reciprocity and a good relationship between the study team and participants are just as important as the technical elements of laboratory testing and data handling in ensuring the success of a vaccine trial in PNG.