Papua New Guinea Studies Research Articles

Debating Appropriate Approaches to Violence in Lihir: The Challenges of Addressing Gender Violence in Papua New Guinea

Recent years have seen a proliferation of initiatives aimed at addressing gender violence both at the national and local levels in Papua New Guinea (PNG). Numerous studies in PNG have noted high levels of violence. This paper takes a range of initiatives in the Lihir Islands, New Ireland Province (NIP), as a case study to discuss the challenges of speaking about, creating policy and attempting to manage gender violence. In Lihir there have been marches against violence, business initiatives to combat violence, outreach programs to villages and training programs for individuals and groups. These changes occur locally within the national context of the establishment of the Family Protection Act in 2013 and the Family Violence and Sexual Action Committee in 2000. Despite the seeming groundswell against gender violence in Lihir, the plans and programs are often met with debate about the terms used, the value of programs or events and their appropriateness. Initiatives are critiqued as externally imposed, colonial or inappropriate for the local context which has implications for programs at both local and national levels.

Experiences of studying midwifery in the Eastern Highlands Province of Papua New Guinea

Introduction: Midwives have been shown to be the essential healthworker in improvinghealth formothers andnewborns. Papua New Guinea (PNG) suffers a critical shortage of qualified midwives. Exploring the reasons why people apply to study midwifery may assist future efforts to strengthen the midwifery workforce. Methods: 182midwifery students from four differentmidwifery schools or universities in Papua New Guinea commenced their training in 2012 and 2013. During the course of their studies, students were given a survey to complete regarding many aspects of their midwifery studies. 121 students completed the survey and 118 students gave a response to the question ‘Why did you choose to study midwifery?’ The answers were analysed using thematic analysis. Results: Three themes emerged from the responses: Recognising public need, recognising professional needs and recognising personal needs. The majority (50%) of responses recognised the high maternal mortality in PNG. Several of the students had witnessed maternal deaths and wanted to prevent this in the future. More than one quarter (28%) of respondents saw that their professional skills and knowledge needed to be improved and also cited the extreme shortage of midwives in the country as a motivating factor. A further one fifth (21%) stated that they had experience and interest in working in maternal health, with others in positions of supervision or education without midwifery qualifications. Conclusion: The concern about the number of women dying in PNG was the major single motivating factor for nurses commencingmidwifery studies in PNG. There is an urgent need to trainmore midwives in PNG to face the crisis of maternal deaths. The enthusiasm for saving lives needs to be garnered to improve the development of ‘supermidwives’who canmake vital differences to the lives of mothers and newborns in PNG.

Developing ‘super’ midwives – Motivation to become a midwife in Papua New Guinea

Introduction: Midwives have been shown to be the essential healthworker in improvinghealth formothers andnewborns. Papua New Guinea (PNG) suffers a critical shortage of qualified midwives. Exploring the reasons why people apply to study midwifery may assist future efforts to strengthen the midwifery workforce. Methods: 182midwifery students from four differentmidwifery schools or universities in Papua New Guinea commenced their training in 2012 and 2013. During the course of their studies, students were given a survey to complete regarding many aspects of their midwifery studies. 121 students completed the survey and 118 students gave a response to the question ‘Why did you choose to study midwifery?’ The answers were analysed using thematic analysis. Results: Three themes emerged from the responses: Recognising public need, recognising professional needs and recognising personal needs. The majority (50%) of responses recognised the high maternal mortality in PNG. Several of the students had witnessed maternal deaths and wanted to prevent this in the future. More than one quarter (28%) of respondents saw that their professional skills and knowledge needed to be improved and also cited the extreme shortage of midwives in the country as a motivating factor. A further one fifth (21%) stated that they had experience and interest in working in maternal health, with others in positions of supervision or education without midwifery qualifications. Conclusion: The concern about the number of women dying in PNG was the major single motivating factor for nurses commencingmidwifery studies in PNG. There is an urgent need to trainmore midwives in PNG to face the crisis of maternal deaths. The enthusiasm for saving lives needs to be garnered to improve the development of ‘supermidwives’who canmake vital differences to the lives of mothers and newborns in PNG.

Frequency of the Functionally Relevant Aryl Hydrocarbon Receptor Repressor (AhRR) Pro185Ala SNP in Papua New Guinea

The diverse cultural and social habits of the Papua New Guinea (PNG) population include betel quid chewing and more recently smoking. The formation of DNA adducts from betel quid is mediated by the cytochrome P450 (CYP) enzymes, including CYP1A2. The tobacco smoke compounds can induce CYP1A2. The transcription factor AhR (aryl hydrocarbon receptor) is involved in the regulation of CYP1A2 expression. AhR activity is itself regulated by other transcription factors, including the aryl hydrocarbon receptor repressor (AhRR). The AhRR Pro185Ala (rs2292596; 565C>G) minor allele was recently associated with a lower AhR repressor activity, leading to a higher CYP1A2 inducibility. We investigated AhRR Pro185Ala SNP in the East Sepik populations in PNG and found a high frequency of 53.4% of the minor allele, significantly different from other Asian populations. We can hypothesize that a high frequency of the AhRR SNP can be a risk factor in the incidence of oral cancer and other neoplasias in PNG due to higher inducibility of CYP1A2. The potential role of AhRR pharmacogenetics in the risk of developing cancers associated with betel quid chewing and smoking should be addressed and clarified in future epidemiological studies in PNG.

Filarial Worms Reduce Plasmodium Infectivity in Mosquitoes

BackgroundCo-occurrence of malaria and filarial worm parasites has been reported, but little is known about the interaction between filarial worm and malaria parasites with the same Anopheles vector. Herein, we present data evaluating the interaction between Wuchereria bancrofti and Anopheles punctulatus in Papua New Guinea (PNG). Our field studies in PNG demonstrated that An. punctulatus utilizes the melanization immune response as a natural mechanism of filarial worm resistance against invading W. bancrofti microfilariae. We then conducted laboratory studies utilizing the mosquitoes Armigeres subalbatus and Aedes aegypti and the parasites Brugia malayi, Brugia pahangi, Dirofilaria immitis, and Plasmodium gallinaceum to evaluate the hypothesis that immune activation and/or development by filarial worms negatively impact Plasmodium development in co-infected mosquitoes. Ar. subalbatus used in this study are natural vectors of P. gallinaceum and B. pahangi and they are naturally refractory to B. malayi (melanization-based refractoriness).Methodology/Principal FindingsMosquitoes were dissected and Plasmodium development was analyzed six days after blood feeding on either P. gallinaceum alone or after taking a bloodmeal containing both P. gallinaceum and B. malayi or a bloodmeal containing both P. gallinaceum and B. pahangi. There was a significant reduction in the prevalence and mean intensity of Plasmodium infections in two species of mosquito that had dual infections as compared to those mosquitoes that were infected with Plasmodium alone, and was independent of whether the mosquito had a melanization immune response to the filarial worm or not. However, there was no reduction in Plasmodium development when filarial worms were present in the bloodmeal (D. immitis) but midgut penetration was absent, suggesting that factors associated with penetration of the midgut by filarial worms likely are responsible for the observed reduction in malaria parasite infections.Conclusions/SignificanceThese results could have an impact on vector infection and transmission dynamics in areas where Anopheles transmit both parasites, i.e., the elimination of filarial worms in a co-endemic locale could enhance malaria transmission.

The prevalence of sexually transmitted infections in Papua New Guinea: a systematic review and meta-analysis.

BackgroundThe potential for an expanded HIV epidemic in Papua New Guinea (PNG) demands an effective, evidence-based and locally-appropriate national response. As sexually transmitted infections (STIs) may be important co-factors in HIV transmission nationally, it is timely to conduct a systematic review of STI prevalences to inform national policy on sexual health and HIV/STI prevention.Methodology/Principal FindingsWe undertook a systematic review and meta-analysis of HIV and STI prevalences in PNG, reported in peer-reviewed and non-peer-reviewed publications for the period 1950–2010. Prevalence estimates were stratified by study site (community or clinic-based), geographic area and socio-demographic characteristics. The search strategy identified 105 reports, of which 25 studies (10 community-based; 10 clinic-based; and 5 among self-identified female sex workers) reported STI prevalences and were included in the systematic review. High prevalences of chlamydia, gonorrhoea, syphilis and trichomonas were reported in all settings, particularly among female sex workers, where pooled estimates of 26.1%, 33.6%, 33.1% and 39.3% respectively were observed. Pooled HIV prevalence in community-based studies was 1.8% (95% CI:1.2–2.4) in men; 2.6% (95% CI:1.7–3.5) in women; and 11.8% (95% CI:5.8–17.7) among female sex workers.Conclusions/SignificanceThe epidemiology of STIs and HIV in PNG shows considerable heterogeneity by geographical setting and sexual risk group. Prevalences from community-based studies in PNG were higher than in many other countries in the Asia-Pacific. A renewed focus on national STI/HIV surveillance priorities and systems for routine and periodic data collection will be essential to building effective culturally-relevant behavioural and biomedical STI/HIV prevention programs in PNG.

Application of Respondent Driven Sampling to Collect Baseline Data on FSWs and MSM for HIV Risk Reduction Interventions in Two Urban Centres in Papua New Guinea

The need to obtain unbiased information among hard–to-reach and hidden populations for behavioural and biological surveillance, epidemiological studies, and intervention program evaluations has led researchers to search for a suitable sampling method. One method that has been tested among IDU and MSM recently is respondent-driven sampling (RDS). We used RDS to conduct a behavioural survey among FSWs and MSM in two urban centres in Papua New Guinea (PNG). In this paper we present the lessons learned implementing RDS in a developing country setting. We also present comparisons of RDSAT-adjusted versus unadjusted crude estimates of some key socio-demographic indicators as well as comparisons between the estimates from RDS and a hypothetical time–location sample (TLS). Overall, the use of RDS among the MSM and FSWs in PNG had numerous advantages in terms of collecting a required sample size in a short time period, minimizing costs and maximising security for staff and respondents. Although there were a few problems these were easily remedied and we would recommend RDS for other similar studies in PNG and other developing countries.