Abstract
BackgroundLong-lasting insecticidal nets (LLIN), improved diagnosis and artemisinin-based combination therapy (ACT) have reduced malaria prevalence in Papua New Guinea since 2008. Yet, national incidence trends are inconclusive due to confounding effects of the scale-up of rapid diagnostic tests, and inconsistencies in routine reporting.MethodsMalaria trends and their association with LLIN and ACT roll-out between 2010 and 2014 in seven sentinel health facilities were analysed. The analysis included 35,329 fever patients. Intervention effects were estimated using regression models.ResultsMalaria incidence initially ranged from 20 to 115/1000 population; subsequent trends varied by site. Overall, LLIN distributions had a cumulative effect, reducing the number of malaria cases with each round (incidence rate ratio ranging from 0.12 to 0.53 in five sites). No significant reduction was associated with ACT introduction. Plasmodium falciparum remained the dominant parasite in all sentinel health facilities. Resurgence occurred in one site in which a shift to early and outdoor biting of anophelines had previously been documented.ConclusionsLLINs, but not ACT, were associated with reductions of malaria cases in a range of settings, but sustainability of the gains appear to depend on local factors. Malaria programmes covering diverse transmission settings such as Papua New Guinea must consider local heterogeneity when choosing interventions and ensure continuous monitoring of trends.
Highlights
Introduction of artemisinin-based combination therapy (ACT)incidence rate ratio (IRR)Balimo East Cape Karimui Dreikikir Sausi Arawa Lemakot 1.32E−09 (0.00, –) (0.47, 3.14) (0.20, 1.41) (0.18, 0.64) (0.79, 2.85) (0.06, 0.58) (0.03, 0.43) (0.32, 2.80)
Long-lasting insecticidal nets (LLIN), but not ACT, were associated with reductions of malaria cases in a range of settings, but sustain‐ ability of the gains appear to depend on local factors
Malaria in Papua New Guinea (PNG) was described by Koch in 1900 [1, 2] and to date malaria transmission remains endemic in PNG especially in areas below 1400 m altitude [3, 4]
Summary
Long-lasting insecticidal nets (LLIN), improved diagnosis and artemisinin-based combination therapy (ACT) have reduced malaria prevalence in Papua New Guinea since 2008. In the 1950s to 1980s, PNG had joined efforts of the Global Malaria Eradication Programme with spraying of dichlorodiphenyltrichloroethane (DDT) and mass drug administration (primarily chloroquine) [6]. The NMCP has promoted: (1) the country-wide free distribution of longlasting insecticidal nets (LLIN); (2) behaviour change campaigns; and, (3) the scaling-up of parasitological diagnosis by rapid diagnostic test (RDT) or microscopy, together with the introduction of artemisinin-based combination therapy (ACT), artemetherlumefantrine [7]
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