National Capital District Research Articles

Stratification of malaria incidence in Papua New Guinea (2011-2019): Contribution towards a sub-national control policy.

Malaria risk in Papua New Guinea (PNG) is highly heterogeneous, between and within geographical regions, which is operationally challenging for control. To enhance targeting of malaria interventions in PNG, we investigated risk factors and stratified malaria incidence at the level of health facility catchment areas. Catchment areas and populations of 808 health facilities were delineated using a travel-time accessibility approach and linked to reported malaria cases (2011-2019). Zonal statistics tools were used to calculate average altitude and air temperature in catchment areas before they were spatially joined with incidence rates. In addition, empirical Bayesian kriging (EBK) was employed to interpolate incidence risk strata across PNG. Malaria annual incidence rates are, on average, 186.3 per 1000 population in catchment areas up to 600 m, dropped to 98.8 at (800-1400) m, and to 24.1 cases above 1400 m altitude. In areas above the two altitudinal thresholds 600m and 1400m, the average annual temperature drops below 22°C and 17°C, respectively. EBK models show very low- to low-risk strata (<100 cases per 1000) in the Highlands, National Capital District and Bougainville. In contrast, patches of high-risk (>200 per 1000) strata are modelled mainly in Momase and Islands Regions. Besides, strata with moderate risk (100-200) predominate throughout the coastal areas. While 35.7% of the PNG population (estimated 3.33 million in 2019) lives in places at high or moderate risk of malaria, 52.2% (estimated 4.88 million) resides in very low-risk areas. In five provinces, relatively large proportions of populations (> 50%) inhabit high-risk areas: New Ireland, East and West New Britain, Sandaun and Milne Bay. Incidence maps show a contrast in malaria risk between coastal and inland areas influenced by altitude. However, the risk is highly variable in low-lying areas. Malaria interventions should be guided by sub-national risk levels in PNG.

Evolution and spread of a highly drug resistant strain of Mycobacterium tuberculosis in Papua New Guinea.

BackgroundMolecular mechanisms determining the transmission and prevalence of drug resistant tuberculosis (DR-TB) in Papua New Guinea (PNG) are poorly understood. We used genomic and drug susceptibility data to explore the evolutionary history, temporal acquisition of resistance and transmission dynamics of DR-TB across PNG.MethodsWe performed whole genome sequencing on isolates from Central Public Health Laboratory, PNG, collected 2017–2019. Data analysis was done on a composite dataset that also included 100 genomes previously sequenced from Daru, PNG (2012–2015).ResultsSampled isolates represented 14 of the 22 PNG provinces, the majority (66/94; 70%) came from the National Capital District (NCD). In the composite dataset, 91% of strains were Beijing 2.2.1.1, identified in 13 provinces. Phylogenetic tree of Beijing strains revealed two clades, Daru dominant clade (A) and NCD dominant clade (B). Multi-drug resistance (MDR) was repeatedly and independently acquired, with the first MDR cases in both clades noted to have emerged in the early 1990s, while fluoroquinolone resistance emerged in 2009 (95% highest posterior density 2000–2016). We identified the presence of a frameshift mutation within Rv0678 (p.Asp47fs) which has been suggested to confer resistance to bedaquiline, despite no known exposure to the drug. Overall genomic clustering was significantly associated with rpoC compensatory and inhA promoter mutations (p < 0.001), with high percentage of most genomic clusters (12/14) identified in NCD, reflecting its role as a potential national amplifier.ConclusionsThe acquisition and evolution of drug resistance among the major clades of Beijing strain threaten the success of DR-TB treatment in PNG. With continued transmission of this strain in PNG, genotypic drug resistance surveillance using whole genome sequencing is essential for improved public health response to outbreaks. With occurrence of resistance to newer drugs such as bedaquiline, knowledge of full drug resistance profiles will be important for optimal treatment selection.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12879-022-07414-2.

Cocoa suitability mapping using multi-criteria decision making: An agile step towards soil security

Cocoa production is impacted by major resource constraints, such as the soil's capability, and in some areas, by unreliable access to markets. A multifaceted approach that employs both biophysical and socio-economic conditions is developed here for mapping areas that are suitable for cocoa production in Papua New Guinea (PNG). This manuscript presents a case study of using multi-criteria decision making by the Analytic Hierarchy Process for mapping the fundamental criteria for cocoa suitability. The results show that temperature, precipitation and soil reveal sections within Western, Gulf and Central (along the west coast joining to National Capital District) province that have very low suitability for cocoa production. In our analysis, precipitation, soil, slope and road, were ranked as the four most important criteria. Additionally, we included stream networks because they may help irrigation and allow cocoa transport via water (e.g. Manus Island). Comparing an already existing cocoa suitability map for PNG to the one created in this study, we found some similarities. For example, the Central, Gulf, and Western (Fly) areas are either unsuitable for cocoa production or have very low potential, and exceptional areas around Rabaul and Kokopo in East New Britain, Popendetta, and Bouganiville were identified. Some new areas suitable for cocoa production in East Sepik, East New Britain, and a major stretch within West New Britain may show low to moderate suitability. The most important finding is the potential to grow cocoa in the highlands, especially, Chimbu (Simbu), Eastern Highlands, Enga, Hela, Jiwaka regions. We found that currently the majority of farmers are growing cocoa in highly suitable areas (76% in class 4, 20%in class 3 and 4% in class 5). The inclusion of slope and roads impacts the impact of flooding conditions and the amount of work and ease of access to markets as important indicators of the connection farmers make between soil suitability and their decision to grow cocoa. This is an agile step towards linking biomass production to soil capability, and connectivity, allowing cocoa suitable areas selection and the production of ‘living maps’ that continually evolve as more empirical data becomes available. This can be an essential connectivity tool for practitioners to evaluate the potential geographic range for cocoa production.

Prevalence of Substandard Amoxicillin Oral Dosage Forms in the National Capital District of Papua New Guinea.

.Antibiotics are commonly reported as being substandard or falsified in low- to middle-income countries, having potential to contribute to the development of antimicrobial resistance and drug-resistant infections. Amoxicillin, used to treat a number of infections and listed by the WHO as an essential medicine, presented as a good drug candidate for this study. We aimed to measure the prevalence of substandard and falsified amoxicillin oral products (tablets, capsules, and suspensions) in the National Capital District of Papua New Guinea (PNG). These oral products were surveyed in 2018 and 2019 from retail pharmacies, private and public health facilities, and the Area Medical Store, representing more than 90% of licensed medicine outlets. The product packaging was visually inspected, and the samples were analyzed for amoxicillin content using a validated high-performance liquid chromatography method. Although no falsified products were identified, 15% of the 190 products analyzed contained substandard amounts of amoxicillin. Quality varied with the dosage form (P = 0.002), with capsules exhibiting the lowest incidence of substandard content (4% in 2019) and tablets collected in 2018 experiencing the highest failure rate (50%). Suspension (40%) quality was compromised by failure to achieve homogeneity on reconstitution. A higher incidence of substandard content (P = 0.002) was associated with one major retail group. Routine testing of medicines by resource-poor countries is often unachievable, leading to the circulation of poor quality drugs, which is a global public health concern. Our study highlighted that substandard amoxicillin oral products are indeed prevalent in the NCD of PNG.

Living with thalassaemia in Papua New Guinea, the experience of children, adolescents and their families.

Thalassaemia, the commonest genetic blood disorder in Papua New Guinea (PNG) presents daunting challenges for the affected children, their parents and families, and the health system. We aimed to describe the quality of life of affected children and adolescents and the experience of and difficulties faced by their parents in the setting of a tertiary referral hospital in PNG. A mixed-methods longitudinal study involving baseline questionnaire, then serial interviews with parents, children and adolescents living with β-thalassaemia attending Port Moresby General Hospital. Twenty-one patients and their families were interviewed over a 6-month period. Most families originated outside the National Capital District and had migrated to be near the Port Moresby General Hospital and its blood bank services. Thirteen patients had at least one affected sibling and four families had experienced the death of at least one other affected child. No child was receiving chelating agents, and most had clinical evidence of iron overload. There were important impacts of thalassemia on quality of life, including very poor school attendance and some aspects of children's self-perception. Families faced significant burdens and made genuine sacrifices to care for their children. Regular blood transfusions increase the life-span of children with thalassaemia but there is a need to achieve a hyper-transfusion regimen coupled with chelation therapy. As for all chronic illness, a focused and holistic approach is needed to improve the quality of life for affected children and their families.

\u2018Making of a Strong Woman\u2019: a constructivist grounded theory of the experiences of young women around menarche in Papua New Guinea

BackgroundMenarche, the first menstruation, is a significant developmental milestone for females. In Papua New Guinea (PNG), menarche is an important socio-cultural event marking transition from girlhood to womanhood. PNG is a culturally and linguistically diverse nation, with wide-ranging socio-cultural beliefs and practices around menarche. This study explored post-menarcheal women’s understanding about body changes and menarche, preparation for menarche, and related cultural beliefs and practices at menarche.MethodsA constructivist grounded theory study was conducted with 98 female participants who originated from four PNG provinces: Eastern Highlands Province; East Sepik Province; Milne Bay Province; and National Capital District. The participants were purposively and theoretically sampled, with 10 focus group discussions and six individual interviews conducted using a semi-structured interview guide for data collection. Focus group discussions and interviews were voice recorded and transcribed. Data were inductively analyzed using initial, intermediate and advanced coding, memos and constant comparative methods to develop a theoretical model that explains women’s experiences at menarche. Interview participants also identified actions required to improve future experiences of girls at menarche in PNG.ResultsA grounded theory comprising the core category of ‘Making of a Strong Woman’ and four interconnecting categories (‘Having Baby Sense’; ‘Beginning of Learning’; ‘Intensifying Learning’; and ‘Achieving Womanhood’) was constructed. ‘Urban’ and ‘Rural’ represented both geographical and socio-cultural intervening conditions that influence the experiences of girls at menarche. Experiences of young women at menarche were rooted in socio-cultural beliefs and practices. Women reported being physically and emotionally distressed and unprepared at onset of menarche. Mothers were considered important support, however, their ability to adequately prepare their daughters is limited by shame and secrecy. Despite these limitations, cultural practices at menarche provided an opportunity for intensive preparation of girls for womanhood.ConclusionLimited pre-menarcheal awareness of the meaning of body changes and menarche of girls was linked to culture of shame and secrecy about open discussion on sexuality. However, traditional cultural practices provide an opportunity for collective support and focused learning for girls. Findings from this study have implications for broader sexual and reproductive health education programs in addressing menstrual health and hygiene in PNG, and the Pacific.

An outbreak of dengue fever in children in the National Capital District of Papua New Guinea in 2016

ABSTRACT Background The first documented outbreak of dengue which included cases with haemorrhage occurred in Papua New Guinea in 2016. Aim To document the presentation and outcome of children with dengue in Port Moresby. Methods This prospective cross-sectional descriptive study was conducted in Port Moresby General Hospital during a 6-month period from 6 January to 6 July 2016. Altogether, 165 children aged 1–14 years who met the WHO criteria for probable dengue were assessed and treated. Clinical features, presence of warning signs and signs of severe dengue, date of onset, management and outcome were recorded. Blood specimens were collected for serological testing and full blood count. Results The median age was 6 years (interquartile range 3–8). Eighty-eight (53%) children had no warning signs and were managed as outpatients. Of the 165 patients, 42 (25%) had abdominal pain, 28 (17%) had bleeding and 3 (2%) had clinical evidence of fluid accumulation. The median (IQR) lowest platelet count in those tested was 34 × 109/L (22–54). Two children were transfused with packed red blood cells and one received a platelet transfusion. No child developed dengue shock and none died. Non-structural protein 1 (NS1) and dengue IgM were positive in 122/144 (85%) and 36/111 (32%) of blood samples, respectively. 150/151 blood samples tested for dengue were positive on one or more tests. Conclusion There is the potential for future outbreaks of increased severity in Papua New Guinea. Surveillance, mosquito reduction initiatives and health education programmes are needed to reduce the impact of future outbreaks.

Estimating the pattern of causes of death in Papua New Guinea

BackgroundPapua New Guinea (PNG) is a diverse country with high mortality and evidence of increased prevalence of non-communicable diseases (NCDs), but there is no reliable cause of death (COD) data because civil registration is insufficient and routine health data comprise only a small proportion of deaths. This study aims to estimate cause-specific mortality fractions (CSMFs) for five broad groups of causes (endemic infections, emerging infections, endemic NCDs, emerging NCDs and injuries), by sex for each of PNG’s provinces.MethodsCSMFs are calculated as the average of estimates obtained from: (1) Empirical cause method: Utilising available Verbal Autopsy (VA) data and Discharge Health Information System (DHIS) data, and applying statistical models of community versus facility CODs; and (2) Expected cause patterns method: Utilising existing estimates of mortality levels in each province and statistical models of the relationship between all-cause and cause-specific mortality using Global Burden of Disease (GBD) data.ResultsAn estimated 41% of male and 49% of female deaths in PNG are due to infectious, maternal (female only), neonatal and nutritional causes. Furthermore, 45% of male and 42% of female deaths arise from NCDs. Infectious diseases, maternal, neonatal and nutritional conditions account for more than half the deaths in a number of provinces, including lower socioeconomic status provinces of Gulf and Sandaun, while provinces with higher CSMFs from emerging NCDs (e.g. ischemic heart disease, stroke) tend to be those where socioeconomic status is comparatively high (e.g. National Capital District, Western Highlands Province, Manus Province, New Ireland Province and East New Britain Province). Provinces with the highest estimated proportion of deaths from emerging infectious diseases are readily accessible by road and have the highest rates of sexually transmitted infections (STIs), while provinces with the highest CSMFs from endemic infectious, maternal, neonatal and nutritional causes are geographically isolated, have high malaria and high all-cause mortality.ConclusionsInfectious, maternal, neonatal and nutritional causes continue to be an important COD in PNG, and are likely to be higher than what is estimated by the GBD. Nonetheless, there is evidence of the emergence of NCDs in provinces with higher socioeconomic status. The introduction of routine VA for non-facility deaths should improve COD data quality to support health policy and planning to control both infectious and NCDs.

Drug-resistant tuberculosis diagnosis since Xpert® MTB/RIF introduction in Papua New Guinea, 2012-2017.

Xpert® MTB/RIF was introduced in Papua New Guinea in 2012 for the diagnosis of tuberculosis (TB) and of rifampicin-resistant TB (RR-TB), a marker of multi-drug-resistant TB (MDR-TB). To assess the concordance of Xpert with phenotypic drug susceptibility testing (DST) performed at the supranational reference laboratory and to describe the patterns of drug-resistant TB observed. This was a retrospective descriptive study of laboratory data collected from April 2012 to December 2017. In 69 months, 1408 specimens with Xpert results were sent for mycobacterial culture and DST; Mycobacterium tuberculosis was cultured from 63% (884/1408) and DST was completed in 99.4%. The concordance between Xpert and culture for M. tuberculosis detection was 98.6%. Of 760 RR-TB cases, 98.7% were detected using Xpert; 98.5% of 620 MDR-TB cases were identified using phenotypic DST. Phenotypic resistance to second-line drugs was detected in 59.4% (522/879) of specimens tested, including 29 with fluoroquinolone resistance; the majority were from the National Capital District and Daru Island. The high concordance between phenotypic DST and Xpert in identifying RR-TB cases supports the scale-up of initial Xpert testing in settings with high rates of drug resistance. However, rapid DST in addition to the detection of RR-TB is required.

Estimating Adult Mortality in Papua New Guinea, 2011

BackgroundMortality in Papua New Guinea (PNG) is poorly measured because routine reporting of deaths is incomplete and inaccurate. This study provides the first estimates in the academic literature of adult mortality (45q15) in PNG by province and sex. These results are compared to a Composite Index of provincial socio-economic factors and health access.MethodsAdult mortality estimates (45q15) by province and sex were derived using the orphanhood method from data reported in the 2000 and 2011 national censuses. Male adult mortality was adjusted based on the estimated incompleteness of mortality reporting. The Composite Index was developed using the mean of education, economic and health access indicators from various data sources.ResultsAdult mortality for PNG in 2011 was estimated as 269 per 1000 for males and 237 for females. It ranged from 197 in Simbu to 356 in Sandaun province among men, and from 164 in Western Highlands to 326 in Gulf province among women. Provinces with a low Composite Index (Sandaun, Gulf, Enga and Southern Highlands) had comparatively high levels of adult mortality for both sexes, while provinces with a higher Composite Index (National Capital District and Manus) reported lower adult mortality.ConclusionsAdult mortality in PNG remains high compared with other developing countries. Provincial variations in mortality correlate with the Composite Index. Health and development policy in PNG needs to urgently address the main causes of persistent high premature adult mortality, particularly in less developed provinces.

Rapid assessment of avoidable blindness and diabetic retinopathy in people aged 50 years and older in the NationalCapitalDistrict of PapuaNewGuinea.

To conduct an assessment of avoidable blindness, diabetes mellitus and diabetic retinopathy (DR) in adults aged 50 years and older in the National Capital District (NCD) region of Papua New Guinea (PNG). A cross-sectional population-based survey was performed for which 25 clusters of 50 people aged≥50 years were randomly selected from the NCD region. The standardised rapid assessment of avoidable blindness (RAAB) with diabetic retinopathy (+DR) methodology was used. Blindness was defined as presenting visual acuity<3/60 in the better eye. Participants were classified as having diabetes if they were known to have diabetes or if their random blood glucose level was≥200 mg/dL. Dilated fundus examination and Scottish DR grading were performed. In total, 1192 out of 1250 eligible participants (95.4%) were examined. Of these, 7.8% had known or newly diagnosed diabetes. Seventy-one percent of participants with known diabetes had a blood glucose level≥200 mg/dL, and 82.9% had never had an ophthalmological examination for DR. Prevalence of DR and/or maculopathy was 46.4%. The age-adjusted and sex-adjusted prevalence of diabetes was estimated at 8.1% (95%CI5.7% to 10.4%) in the population aged 50 years or older in the NCD region of PNG. Prevalence of diabetes in adults aged 50 years and older was lower than reported elsewhere in the region, and lower than other RAAB+DR surveys. Despite this, the prevalence of DR is high compared with other RAAB+DR surveys and demonstrates the need for increased awareness and accessibility to eye services for people with diabetes.

Rapid assessment of avoidable blindness in Papua New Guinea: a nationwide survey

ObjectiveTo estimate the prevalence and main causes of blindness and vision impairment in people aged 50 years and older in Papua New Guinea (PNG).DesignNational cross-sectional population-based survey in National Capital...

Can public works programs reduce youth crime? Evidence from Papua New Guinea\u2019s Urban Youth Employment Project

Crime rates in Papua New Guinea’s capital city of Port Moresby are among the highest in the world. Few youth work, and good jobs are scarce. In 2013, the National Capital District Commission partnered with the World Bank to implement the Urban Youth Employment Project. The project offers out-of-school and out-of-work youth 2 months of public works employment or, for academically qualified candidates, 6 months of classroom and on-the-job training. This paper presents difference-in-differences estimates of project impacts on participants’ social and criminal behavior, 12 to 18 months after completion. The control group consists of observably similar youth living in areas not served by the program. Project participants became less likely to hang out with friends at night, have a best friend involved in crime, and have friends involved in fights or robberies. The program also increased subsequent employment rates and significantly reduced aggressive behavior and gratuitous property damage. However, there is little robust evidence that the program reduced participants’ engagement in or exposure to crime. The study concludes that the program had strong and healthy effects on participants’ peer group and behavior, but more limited effects on the socio-economic causes of crime.

Responses of fruit flies (Diptera: Tephritidae) to new attractants in Papua New Guinea

AbstractMale fruit fly attractants – cue‐lure and methyl eugenol (ME) – have been used successfully for decades in the monitoring and control of species of Dacini (Dacinae) fruit flies (Bactrocera, Zeugodacus and Dacus). However, many species, including several pests, are non‐responsive to these lures. Field tests of new compounds are therefore worthwhile, particularly in areas of high species diversity where multiple species attractions can provide additional information on lure function. Recent field tests of new male attractants (isoeugenol, dihydroeugenol, methyl‐isoeugenol and zingerone) and food‐ and host‐based lures (cucumber volatile blend and Cera Trap®) in Australia resulted in discoveries of lure responses for ‘non‐responsive’ species. In this study, these new lures were field tested for the first time in Papua New Guinea (PNG) for attractiveness to ‘non‐responsive’ species, including the guava pest Bactrocera obliqua and cucurbit pests Zeugodacus atrisetosus and Z. decipiens. Testing was conducted in the National Capital District (NCD) and Kerevat on the island province of East New Britain. Of the ‘non‐responsive’ pest species, B. obliqua was trapped three times at isoeugenol and once at methyl‐isoeugenol. This is the first record of B. obliqua responding to male lures. Zeugodacus decipiens was significantly attracted to Cera Trap. Five undescribed species responded to zingerone and one to the eugenol analogues. The ME‐responsive B. musae and B. umbrosa responded differently to the three eugenol analogues in Kerevat and NCD, with both species responding more strongly to methyl‐isoeugenol in NCD, although their response to ME was similar in both locations. Intraspecific differences in lure response were also noted between this study and that recorded previously in other countries. The cue‐responsive B. frauenfeldi, B. neohumeralis and Dacus axanus were previously trapped at zingerone in Australia, and the ME‐responsive B. dorsalis was trapped at zingerone in Malaysia, but these species, while caught at their respective lures, were not recorded at zingerone in this study. The findings from this study have implications for quarantine monitoring for the ‘non‐responsive’ B. obliqua and Z. decipiens in Australia, highlight that there may be intraspecific variation in male lure response and provide further information on these novel male lures' activity.

DETECTION OF THE GUAM BIOTYPE (CRB-G) ORYCTES RHINOCEROS LINNEAUS (COLEOPTERA: SCARABAEIDAE) IN PORT MORESBY, PAPUA NEW GUINEA

Oryctes rhinoceros L. is an important pest of coconuts and oil palm. The damage to palms is primarily caused by adult beetles. They either cut through the frond butts or bore through the palm bases with their forelegs and feed on the inner soft tissues. A strain of Oryctes NudiVirus (Rhabdionvirus oryctes) was identified from Malaysia in the 1960s and used effectively for classical biological control of the pest. However, in 2007 a more destructive population of the beetle was found in Guam. Molecular analysis confirmed its genotype to be different from that of the common population and also to be resistant against NudiVirus infection. The new population has subsequently been referred to as the Guam biotype (CRB-G) whilst the common type has been referred to as the Samoan/Pacific biotype (CRB-SIP). In 2010, similar damage was noted on coconuts in Port Moresby, National Capital District, Papua New Guinea. Sympatric occurrence of both CRB-G and CRB-S in National Capital District with no NudiVirus infection on CRB-G has been confirmed. CRB-G has been found to be less responsive to the aggregation pheromone (ethyl 4-methyloctanoate) used for monitoring and control of 0. rhinoceros. Only CRB-S is found in East New Britain, New Ireland and West New Britain with NudiVirus infection. Widespread severe damage was observed in National Capital District and Central Province, whilst severe damage in New Ireland, East New Britain and West New Britain were localised in areas with readily available breeding sites. Light damages were noted in some areas of Milne Bay, Northern and West New Britain Provinces, but most areas were free of damage. The results are discussed in relation to the impact CRB-G is likely to have on the palm industries in Papua New Guinea if no effective control options are put in place. Keywords: Coconut, oil palm, biological control, Rhabdionvirus oryctes, defoliation.

Population-Based Trachoma Mapping in Six Evaluation Units of Papua New Guinea

ABSTRACTPurpose: We sought to determine the prevalence of trachomatous inflammation – follicular (TF) in children aged 1–9 years, and trachomatous trichiasis (TT) in those aged ≥15 years, in suspected trachoma-endemic areas of Papua New Guinea (PNG).Methods: We carried out six population-based prevalence surveys using the protocol developed as part of the Global Trachoma Mapping Project.Results: A total of 19,013 individuals were sampled for inclusion, with 15,641 (82.3%) consenting to participate. Four evaluation units had prevalences of TF in children ≥10%, above which threshold the World Health Organization (WHO) recommends mass drug administration (MDA) of azithromycin for at least three years; Western Province (South Fly/Daru) 11.2% (95% confidence interval, CI, 6.9–17.0%), Southern Highlands (East) 12.2% (95% CI 9.6–15.0%), Southern Highlands (West) 11.7% (95% CI 8.5–15.3%), and West New Britain 11.4% (95% CI 8.7–13.9%). TF prevalence was 5.0–9.9% in Madang (9.4%, 95% CI 6.1–13.0%) and National Capital District (6.0%. 95% CI 3.2–9.1%) where consideration of a single round of MDA is warranted. Cases of TT were not found outside West New Britain, in which four cases were seen, generating an estimated population-level prevalence of TT in adults of 0.10% (95% CI 0.00–0.40%) for West New Britain, below the WHO elimination threshold of 0.2% of those aged ≥15 years.Conclusion: Trachoma is a public health issue in PNG. However, other than in West New Britain, there are few data to support the idea that trachoma is a cause of blindness in PNG. Further research is needed to understand the stimulus for the active trachoma phenotype in these populations.

The Burden of Drug-Resistant Tuberculosis in Papua New Guinea: Results of a Large Population-Based Survey.

BackgroundReliable estimates of the burden of multidrug-resistant tuberculosis (MDR-TB) are crucial for effective control and prevention of tuberculosis (TB). Papua New Guinea (PNG) is a high TB burden country with limited information on the magnitude of the MDR-TB problem.MethodsA cross-sectional study was conducted in four PNG provinces: Madang, Morobe, National Capital District and Western Province. Patient sputum samples were tested for rifampicin resistance by the Xpert MTB/RIF assay and those showing the presence of resistance underwent phenotypic susceptibility testing to first- and second-line anti-TB drugs including streptomycin, isoniazid, rifampicin, ethambutol, pyrazinamide, ofloxacin, amikacin, kanamycin and capreomycin.ResultsAmong 1,182 TB patients enrolled in the study, MDR-TB was detected in 20 new (2.7%; 95% confidence intervals [CI] 1.1–4.3%) and 24 previously treated (19.1%; 95%CI: 8.5–29.8%) TB cases. No case of extensively drug-resistant TB (XDR-TB) was detected. Thirty percent (6/20) of new and 33.3% (8/24) of previously treated cases with MDR-TB were detected in a single cluster in Western Province.ConclusionIn PNG the proportion of MDR-TB in new cases is slightly lower than the regional average of 4.4% (95%CI: 2.6–6.3%). A large proportion of MDR-TB cases were identified from a single hospital in Western Province, suggesting that the prevalence of MDR-TB across the country is heterogeneous. Future surveys should further explore this finding. The survey also helped strengthening the use of smear microscopy and Xpert MTB/RIF testing as diagnostic tools for TB in the country.

Changes in consumer behavior as a result of the Home Appliance Eco-Point System: an analysis based on micro data from the Family Income and Expenditure Survey

The Home Appliance Eco-Point System refers to the project executed by the Japanese government from May 2009 to March 2011. The system, while showing signs of slowing down in the latter half of the implementation period, has, to a certain extent, facilitated a demand-promoting effect. Those effects are relatively large, particularly in regions outside the greater national capital district and in households with senior citizens. It can be attributed to the Eco-Point system that “electrical appliances became widespread in those households that had rarely made an effort to save on energy consumption”. Moreover, it can be inferred that the Eco-Point system enhanced the relative utility levels for refrigerators in households in major cities, and for air conditioners and televisions in households with elderly members in small cities. Thus, when implementing environmental policy, we believe that the policy effects can be made more impactful by reasonably determining the household types to target for each good, by setting the subsidy rates according to the differences in the targeted households, and by considering the desirable method of the information provision policy.

Evaluation of short-rotation coppicing fuelwood production systems for Papua New Guinea

A 2 year short-rotation coppicing (SRC) fuelwood production system was evaluated, at 2 tree densities (3333 and 6666 trees ha−1) for the Western Highlands Province (WHP) and National Capital District (NCD) of Papua New Guinea. Of the 10 species tested, the best production of firewood was from Eucalyptus grandis and Eucalyptus robusta in WHP and Eucalyptus tereticornis in the NCD, with values of 2.97 m3, 2.55 m3, and 0.92 m3 for a 500 m2 woodlot respectively at the denser spacing. E. grandis and E. robusta produced best tree form in WHP while Eucalyptus pellita produced best form in NCD. Best coppice performance was observed in E. robusta in WHP and E. tereticornis in NCD. The burning characteristics of SRC firewood and charcoal were also assessed, as well as how SRC firewood will appeal to consumers. In the highlands SRC firewood and charcoal yield higher estimated returns to labour (USD20.00 and USD11.16 person−1day−1) compared with main alternative crops of sweet potato and coffee (USD9.77 and USD6.98 person−1day−1 respectively). SRC pole production has a low return to labour (USD7.44 person−1day−1) but could complement SRC production as part of a thinning regime. The main limitation in promulgating SRC systems could be market acceptance and finding a small-business model that integrates well with the indigenous non-market economy. The poor growth rates around the NCD due to limiting biophysical conditions make a 2 year rotation cycle unfeasible.

At Risk: The Relationship between Experiences of Child Sexual Abuse and Women's HIV Status in Papua New Guinea

Child sexual abuse in Papua New Guinea is a human rights issue as well as an indicator of HIV risk in women. This study aimed to develop knowledge about the link between violence experienced by women and their HIV status. The study used a mixed method approach to collect quantitative and qualitative data through structured interviews with a sample of 415 women across four provinces of Papua New Guinea: National Capital District, Western Highlands, Western, and Morobe. Participants were asked about violence they had experienced as children and in their adult relationships and the impact of the violence. The quantitative data was analyzed using SPSS, and qualitative data was coded using a thematic approach. Child sexual abuse was reported by 27.5% of the sample (n = 114). Women reporting child sexual abuse were more likely to live in violent relationships, be HIV positive, and have a higher number of sexual partners.