Biography ; Biomedical Research/history* ; Education, Medical/history* ; History, 20th Century ; Papua New Guinea ; Saweri, A.

Poliomyelitis ; Papua New Guinea ; Dreams

Cholera was first detected in Papua New Guinea in July 2009, caused by Vibrio cholerae O1 El Tor serotype Ogawa. By late 2011, 15 500 cases had been reported throughout lowland Papua New Guinea with a case fatality rate of 3.2%. The epidemic has since slowed, with only sporadic cases reported in Western Province and the Autonomous Region of Bougainville (ARB). Accurate and timely diagnosis is a critical element of the public health response to cholera, yet in low-income countries where the burden of cholera is the greatest, diagnostic services are often limited. Here we report on the diagnostic challenges and the logistical factors that impacted on diagnosis during the first reported outbreak of cholera in Papua New Guinea.

We investigated the circulation of avian influenza viruses in poultry populations throughout Papua New Guinea to assess the risk to the poultry industry and human health. Oropharyngeal swabs, cloacal swabs and serum were collected from 537 poultry from 14 provinces of Papua New Guinea over an 11–month period (June 2011 through April 2012). Virological and serological investigations were undertaken to determine the prevalence of avian influenza viruses. Neither influenza A viruses nor antibodies were detected in any of the samples. This study demonstrated that avian influenza viruses were not circulating at detectable levels in poultry populations in Papua New Guinea during the sampling period. However, avian influenza remains a significant risk to Papua New Guinea due to the close proximity of countries having previously reported highly pathogenic avian influenza viruses and the low biosecurity precautions associated with the rearing of most poultry populations in the country.

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 in vitro susceptibility of Plasmodium falciparum to chloroquine (CQ), amodiaquine (AQ), monodesethylamodiaquine (mAQ) and piperaquine (PQP) antimalarial drugs was evaluated in 13 isolates from East New Britain Province of Papua New Guinea (PNG) using a colorimetric Plasmodium lactate dehydrogenase (LDH) assay. Of the 13 isolates assessed, 9 (69%) showed in vitro resistance to CQ with the concentration required to inhibit growth by 50% (IC50) ranging from 25 to 188.8 nM (geometric mean 118.7 nM). All parasites exhibited in vitro susceptibility to AQ, mAQ and PQP with their mean IC50s well below reported threshold values. Significant rank order positive correlations were observed between PQP and CQ (rs = 0.67, p <0.005) suggestive of potential in vitro cross-resistance between these two 4-aminoquinoline drugs. These results demonstrate the suitability of the enzyme-based LDH assay for assessing in vitro P. falciparum susceptibility and highlight the importance of in vitro assessment of antimalarial drugs in PNG in tandem with local therapeutic efficacy studies.

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.

Tuberculosis (TB) continues to be a serious public health problem in Papua New Guinea (PNG). A key element in the prevention and control of TB is for people to have the correct, appropriate and relevant information regarding TB and its prevention and treatment. In PNG, there is no published information about the knowledge of TB among the general population. An understanding of people’s knowledge of various aspects of TB is important in developing interventions to address the burden of TB. This study aimed to assess the knowledge of TB among the local population in PNG. We used a cross-sectional study to understand people’s levels of knowledge regarding TB in three sites in PNG: Hiri, Asaro and Karkar Island. A total of 1034 people aged 15 years and above participated in this study from May to December 2013. Our study showed different levels of TB knowledge between sites 79% of respondents in Hiri, 27% in Asaro and 23% in Karkar correctly identified TB bacteria as the leading cause of TB. The only site at which respondents gave four correct symptoms of TB was Hiri (7%). Coughing out air droplets was identified as the main mode of transmission by 84% of respondents in Hiri, 33% in Asaro and 71% in Karkar. A tiny proportion of the participants in Hiri (4%) knew the three correct ways of TB prevention. Despite the availability of free TB treatment only 45% of respondents in Hiri, 18% in Asaro and 46% in Karkar knew about it. In Hiri, 58% of the participants knew the TB treatment duration of 6-9 months, compared with 36% in Asaro and 33% in Karkar. A health facility was the most common source of TB information in all three sites. Providing accurate and relevant information about TB through public health education strategies is urgently required to help in addressing the current TB crisis