Divine Word University

Background Tuberculosis (TB) infection prevention and control (TB-IPC) is recommended as an essential public health intervention to control TB transmission worldwide. Nonetheless, merely applying evidence-based prevention and control measures is often inadequate for effective TB prevention and treatment goals. This study examined healthcare workers’ (HCWs’) perceptions of strategies important for TB-IPC in primary healthcare (PHC) settings in Papua New Guinea. Methods Using a nominal group technique, this study sought the views of a diverse range of HCWs (ranging from clinical, IPC personnel to policymakers) from national and subnational levels, and various provinces to prioritise TB-IPC guidelines implementation needs in practice. Group discussions were conducted with 51 HCWs, and encompassed quantitative and qualitative data collection techniques. Nine key strategies drawn from a preceding study and literature review were presented to participating HCWs, and from these, three significant strategies related to TB-IPC policy were identified as key priorities. Results The participants recommended HCWs’ capacity building on TB-IPC policy and strategy, improving PHC infrastructure, and increasing community awareness of TB as the most important strategies to improve TB-IPC practices. Conclusions This study investigated the perceptions of diverse key HCWs of the implementation of TB-IPC guidelines in PHC settings in rural Papua New Guinea. The HCWs identified key strategies needed for effective TB-IPC practice in PHC to prevent TB transmission. This study supports previous recommendations that call for adopting multi-pronged strategies to improve the high TB burden. Key stakeholders’ insights have been shared to inform public health policy and program implementation both locally and as part of the global goals of the TB eradication program.

Many communities refer to sorcery or witchcraft to explain misfortunes such as sickness, death and disability. The effects of these beliefs on public health service delivery have long been overlooked. Beliefs in sorcery and witchcraft are significant challenges for health-care workers to understand to deliver better health outcomes and avoid inadvertently triggering accusations of witchcraft that may lead to violence. This paper examines the impacts of accusations of sorcery and related violence on the provision of health care in Papua New Guinea. The discussion focuses on a workshop held in Papua New Guinea in September 2022 with health extension officers on the topic of health-care delivery and sorcery accusations. The workshop confirmed the challenges that beliefs in sorcery and witchcraft present for health extension officers and suggested several strategies that could be used to navigate them. It identified several possible future measures that those on the front line of community health-care delivery considered most important in responding to the issue. These included educating health-care workers on how to effectively address sorcery beliefs when delivering health care and developing communication techniques on the causes of death and sickness that avoid triggering sorcery accusations. This paper reviews the findings of the workshop in the broader context of the effects of beliefs in witchcraft on public health delivery globally. Because of the close connections between sorcery beliefs and health, equipping health-care workers and field epidemiologists with strategies to address these beliefs effectively is critical to delivering better health care, facilitating timely response to public health events, and helping to prevent violence related to sorcery accusations. This need exists in all countries where sorcery beliefs related to health, illness, disability and death are prevalent.

ABSTRACTPathogen genomic surveillance demands rapid, low-cost genotyping solutions for tracking infections. Here we use single nucleotide polymorphism (SNP) barcodes to generate practical information for malaria surveillance and control. Using 91Plasmodium falciparumgenomes from three provinces of Papua New Guinea (PNG), we assessed SNP panels with different allele frequency characteristics. A 191 ‘local’ SNP barcode captured similar patterns of population structure evident with 5786 ‘whole genome’ SNPs. Geographically informative SNPs (iSNPs,FST>0.05) show increased population clustering whilst randomly selected SNPs (rSNPs) and SNPs with similar allele frequencies (FST<0.05) amongst different countries (universal, uSNPs) or local PNG populations (balanced, bSNPs) indicated little clustering. SNP panels must be validated in local settings to ensure they capture the diversity and population structure of the target population. Applied to 727P. falciparumisolates from 16 provinces of PNG, the full barcode identified variable transmission dynamics, and eight major sub-populations, as well as the source of a malaria outbreak in a low transmission setting.

BackgroundPapua New Guinea (PNG) is one of the 14 countries categorised as having a triple burden of tuberculosis (TB), multidrug-resistant TB (MDR TB), and TB-human immunodeficiency virus (HIV) co-infections. TB infection prevention and control (TB-IPC) guidelines were introduced in 2011 by the National Health Department of PNG. This study assesses the implementation of this policy in a sample of district hospitals in two regions of PNG.MethodsThe implementation of TB-IPC policy was assessed using a survey method based on the World Health Organization (WHO) IPC assessment framework (IPCAF) to implement the WHO’s IPC core components. The study included facility assessment at ten district hospitals and validation observations of TB-IPC practices.ResultsOverall, implementation of IPC and TB-IPC guidelines was inadequate in participating facilities. Though 80% of facilities had an IPC program, many needed more clearly defined IPC objectives, budget allocation, and yearly work plans. In addition, they did not include senior facility managers in the IPC committee. 80% (n = 8 of 10) of hospitals had no IPC training and education; 90% had no IPC committee to support the IPC team; 70% had no surveillance protocols to monitor infections, and only 20% used multimodal strategies for IPC activities. Similarly, 70% of facilities had a TB-IPC program without a proper budget and did not include facility managers in the TB-IPC team; 80% indicated that patient flow poses a risk of TB transmission; 70% had poor ventilation systems; 90% had inadequate isolation rooms; and though 80% have personal protective equipment available, frequent shortages were reported.ConclusionsThe WHO-recommended TB-IPC policy is not effectively implemented in most of the participating district hospitals. Improvements in implementing and disseminating TB-IPC guidelines, monitoring TB-IPC practices, and systematic healthcare worker training are essential to improve TB-IPC guidelines’ operationalisation in health settings to reduce TB prevalence in PNG.

Tuberculosis (TB) remains a major global health challenge, killing millions of people, despite the availability of preventive TB medication. The majority of these infections and deaths occur in low-income countries. Therefore, practical public health strategies are required to reduce the global TB burden in these countries effectively. The purpose of this review was to examine the current evidence of tuberculosis infection control (TBIC) measures in reducing TB transmission and explore the barriers and enablers of TBIC measures in resource-constrained primary healthcare settings. The PRISMA framework was adopted to identify studies that report on the evidence and barriers and facilitators of administrative, environmental and respiratory control measures at healthcare settings in low- and middle-income countries (LMICs). ProQuest, Scopus, ScienceDirect, Embase and PubMed were searched for English language peer-reviewed studies published since the introduction of TBIC guidelines. Studies not relevant to the topic, were not on TBIC measures or were reviews or commentary-style papers were excluded. Included articles were evaluated based on their aim, study design, geography and health settings interventions (TBIC measures), economic setting (ie LMICs) and main findings. Our review of the 15 included studies identified a cough officer screening system, isolation of TB patients, modification of consultation rooms, and opening windows and doors as effective TB prevention measures. Lack of patient education, unsupportive workplace culture, inadequate supply of particulate respirators, insufficient isolation facilities and poor physical infrastructures were identified as barriers to TBIC practices. Triaging TB patients, maintenance of health infrastructure, appropriate use of personal protective equipment (PPE) and healthcare workers (HCWs) training on the correct use of PPE were reported as facilitators of TBIC in primary healthcare facilities. Our review provides consistent evidence of TBIC measures in reducing TB transmission in resource-constrained primary healthcare settings. This review has demonstrated that TB transmission can be successfully controlled using multiple and simple low-cost TBIC measures including administrative, environmental and respiratory controls. Effective implementation of triaging patients with suspected TB alongside maintenance of health infrastructure, appropriate use of PPE and robust HCWs training on TBIC could improve implementation of TBIC measures in primary healthcare settings. Healthcare management should address these areas particularly in rural and remote locations to improve the implementation of TBIC measures in primary healthcare facilities in LMICs.

Papua New Guinea is a Pacific country that remains an enigma to the world at large. Despite massive geographical challenges due to mountainous terrain, remote islands, poverty, and with 80% of the population of over eight million living in rural villages, Papua New Guinea has managed to develop national medical and postgraduate specialty training. The first recorded anaesthetic was administered in Papua New Guinea in 1880 and the first anaesthetist trained in 1968. The University of Papua New Guinea graduated its first diploma in anaesthesia candidate in 1986 and its first master of medicine candidate in anaesthesiology in 1991. As of December 2021, there have been 82 diplomas and 40 masters of medicine awarded. We review the factors and influences bearing on the development of physician anaesthesia training in Papua New Guinea over this period. Many of the people involved have contributed information used in this article.

The most recent estimates, published in 2016, have indicated that around 70% of anaesthesia providers in Papua New Guinea are non-physician anaesthetic providers and that they administer over 90% of anaesthetics, with a significant number unsupervised by a physician anaesthetist. Papua New Guinea has a physician anaesthetist ratio estimated to be 0.25 per 100,000 population, while Australia and New Zealand have a ratio of 19 physician anaesthetists per 100,000, which is 75 times that of Papua New Guinea. To reach a ratio of seven per 100,000, recommended as the minimum acceptable by the Lancet Commission in 2016, there will need to be over 35 practitioners trained per annum until 2030, at a time when the average annual numbers of recent years are less than three physicians and less than five non-physician anaesthetic providers. We review the development of anaesthesia administered by non-physician indigenous staff and the stages of development from heil tultuls, dokta bois, liklik doktas, native medical assistants, aid post orderlies, and Anaesthetic Technical Officers up to the current Anaesthetic Scientific Officers having attained the Diploma in Anaesthetic Science from the University of Papua New Guinea.

Abstract BackgroundThe C580Y mutation in Plasmodium falciparum kelch13 (pfk13) is the most commonly observed variant in artemisinin-resistant isolates in the Greater Mekong Subregion (GMS). Until 2017, it had not been identified outside GMS, except for Guyana. In 2017, we identified three parasites carrying the C580Y mutation in Papua New Guinea (PNG). As the C580Y allele rapidly spread in the GMS, there is concern that this mutant is now spreading in PNG. MethodsIn 2020, we conducted a cross-sectional survey at two clinics in Wewak, PNG. Symptomatic patients infected with P. falciparum were treated with artemether plus lumefantrine following a national treatment policy. Blood samples were obtained before treatment, and polymorphisms in pfk13, pfcrt, and pfmdr1 were determined. Parasite positivity was examined on day 3. ResultsA total of 94 patients were included in this analysis. The prevalence of C580Y was significantly increased (2.2% in 2017, 5.7% in 2018, and 6.4% in 2020; p = 4.2×10-3). A significant upward trend of wild-type prevalence was found for pfcrt (1.9% in 2016 to 46.7% in 2020; p = 8.9×10-16) and pfmdr1 (59.5% in 2016 to 91.4% in 2020; p = 2.3×10-6). Among 26 patients, including three with C580Y infections successfully followed on day 3, none showed positive parasitemia. ConclusionsUnder the conditions of significant increases in pfcrt K76 and pfmdr1 N86 alleles in PNG, the increase in pfk13 C580Y mutants may be a warning indicator of the emergence of parasites resistant to the currently used first-line treatment regimen of artemether plus lumefantrine. Therefore, nationwide surveillance of molecular markers for drug resistance and assessment of its therapeutic effect, are important.

The rapid and aggressive spread of artemisinin-resistant Plasmodium falciparum carrying the C580Y mutation in the kelch13 gene is a growing threat to malaria elimination in Southeast Asia, but there is no evidence of their spread to other regions. We conducted cross-sectional surveys in 2016 and 2017 at two clinics in Wewak, Papua New Guinea (PNG) where we identified three infections caused by C580Y mutants among 239 genotyped clinical samples. One of these mutants exhibited the highest survival rate (6.8%) among all parasites surveyed in ring-stage survival assays (RSA) for artemisinin. Analyses of kelch13 flanking regions, and comparisons of deep sequencing data from 389 clinical samples from PNG, Indonesian Papua and Western Cambodia, suggested an independent origin of the Wewak C580Y mutation, showing that the mutants possess several distinctive genetic features. Identity by descent (IBD) showed that multiple portions of the mutants' genomes share a common origin with parasites found in Indonesian Papua, comprising several mutations within genes previously associated with drug resistance, such as mdr1, ferredoxin, atg18 and pnp. These findings suggest that a P. falciparum lineage circulating on the island of New Guinea has gradually acquired a complex ensemble of variants, including kelch13 C580Y, which have affected the parasites' drug sensitivity. This worrying development reinforces the need for increased surveillance of the evolving parasite populations on the island, to contain the spread of resistance.