Coping with Drought in Rural Papua New Guinea: A Western Highlands Case Study

The short- and long-term effects of climate change on Papua New Guinea’s agricultural sector have generated significant debate in recent times. Current literature demonstrates that different population groups have differing levels of vulnerability and resilience to the flow-on effects of climate change, particularly drought. Yet different schools of thought on the country’s food security and effects on livelihoods persist. This article draws on evidence from research conducted in the Western Highlands of Papua New Guinea as part of a bigger economic empowerment project to illustrate the vulnerabilities of one community of rural semisubsistence farmers to drought-induced food insecurity. It examines responses to drought, identifies modes of resilience, and discusses the implications for future actions.     

Iodine deficiency in Papua New Guinea (sub-clinical iodine deficiency and salt iodization in the highlands of Papua New Guinea)

Data on the status about iodine nutrition in children in Papua New Guinea (PNG) are scarce. This study attempts to determine the mean daily per capita consumption of salt, the iodine content of salt in the households and retail shops and the urinary iodine concentration in children (6-12 years) in Hella Region, Southern Highland Province (SHP), PNG. The mean daily consumption of salt was 2.62 +/- 1.29 g. The iodine content of salt was >30 p.p.m. in 95 per cent of households and 100 per cent of retail shops. The median urinary iodine concentration of 48.0 mg/l for all the children indicates moderate iodine deficiency. The median urinary iodine concentrations for the male (67.0 mg/l) and female (44.0 mg/l) children indicate mild and moderate iodine deficiency, respectively. 68.42 per cent of the male and 81.82 per cent of the female children have urinary iodine concentration <100 mg/l, indicating that iodine deficiency is a potential public health problem in the Hella region. These results indicate a need for further assessment of the implementation of the universal salt iodization strategy for the elimination of iodine deficiency in the SHP, PNG.     

Measles in Papua New Guinea: An age-specific serological survey

We aimed to determine the proportion of the population in Madang (Papua New Guinea) immune to measles infection by age groups, with respect to immunization status and study location, using dried blood sampling technology. We performed a prospective cross-sectional sero-survey. Population immunity against measles was sub-optimal (77%) and reported measles vaccine coverage in children <10 years of age was low (41%). The urban population was more susceptible to measles infection, compared with the rural population (66% vs 79% immune, aOR = 0.6, p = 0.05). Sero-conversion and long term protection rates appeared to be higher when at least one dose of vaccine was provided at or after 12 months of age (84% vs 59%, aOR = 4.3, p = 0.004). Such a dose is, however, not currently prescribed by the national immunization schedule.     

Subsistence agriculture and child growth in Papua New Guinea

Spatial statistical analyses of child anthropometric data were undertaken to assess the influence of systems of subsistence agriculture, in terms of staple foods and cash crops cultivated, on patterns of child growth in Papua New Guinea. These agricultural data explained between a quarter and half of the geographical variation in anthropometric growth indicators. Accounting for differences in altitude, relief and rainfall patterns, though explaining additional geographical variation, did not improve the predictions. Child growth was better in agriculture systems with cassava and sweet potato as staple crops, but worse in systems where banana, sago and taro were staple crops. Both the cultivation of all major cash crops, and sales of fish and food crops improved child growth. More intensive agricultural systems were associated with larger children indicating that the nutritional status of children benefited from intensification as well as from the introduction of cash crops into traditional subsistence systems.     

The challenges in developing a mathematics curriculum for training elementary teachers in Papua New Guinea

As Papua New Guinea undergoes a period of major education reform that includes the establishment of an elementary education programme, the development of an elementary teacher education curriculum is proving to be a challenging task. As a background this paper provides contextual information about the elementary education programme and highlights some of the challenges facing those who are developing and implementing elementary mathematics curricula, including teacher trainers and trainee teachers.     

Missed opportunities to prevent mother-to-child transmission in Papua New Guinea: results from a retrospective cohort of HIV-exposed infants

Human immunodeficiency virus (HIV) diagnosis in infants born to seropositive mothers is one of the challenges of HIV epidemics in children. No data are currently available on the risk of HIV positivity among children who are exposed to HIV through their parents in Papua New Guinea (PNG). The primary aim of this study was to measure the prevalence of HIV infection among infants born to HIV-infected mothers who attended antenatal clinic of PNG General Hospital. We also determined the factors associated with mother-to-child transmission (MTCT) and hypothetically estimated their population-level impacts. Study population was determined by reviewing the Papua New Guinea General Hospital paediatric clinic HIV registry books and antenatal hospital charts. Univariable and multivariable logistic regression models were used to determine the risk factors associated with the HIV seropositivity of the infants. We also assessed their individual and combined population-level impacts to prevent MTCT using novel statistical method. A total of 58 (38.16%) children tested were HIV-positive. Mothers’ timing of diagnosis and lack of antiretroviral prophylaxis or highly active antiretroviral (HAART) use were significantly correlated with infants’ HIV status and accounted for more than 80% of all the MTCT cases, while 36% (95% confidence interval (CI): 21–54%) and 79% (95% CI: 69–87%) of the transmissions were attributed to the intrapartum and postpartum diagnoses, respectively; their combined impact was estimated to be 86% (95% CI: 82–89%). Current study provided evidence that almost 100% of the MTCT cases would have been prevented if (1) women were diagnosed antenatally, and (2) appropriate treatments (including antiretroviral prophylaxis or HAART) were provided for the mothers and infants without a delay.     

The challenges in developing a mathematics curriculum for training elementary teachers in Papua New Guinea

As Papua New Guinea undergoes a period of major education reform that includes the establishment of an elementary education programme, the development of an elementary teacher education curriculum is proving to be a challenging task. As a background this paper provides contextual information about the elementary education programme and highlights some of the challenges facing those who are developing and implementing elementary mathematics curricula, including teacher trainers and trainee teachers.     

Ambiguous bodies,uncertain diseases: knowledge of cervical cancer in Papua New Guinea

Objectives: Within their local realities, people experience and interpret disease in diverse ways that do not necessarily correlate or converge with Western biomedical interventions. In the high cervical cancer burden setting of Papua New Guinea, understanding how people experience and interpret cervical cancer is necessary for effective intervention. Drawing on work by Street on the production of unstable biomedical knowledge, we explored how ambiguity and uncertainty, coupled with cultural taboos and linguistic limitations, affect what and how people ‘know’ about women’s reproductive organs and their associated disease.

Design: A qualitative research approach was used to explore and understand how people in PNG articulate matters of health and disease as they relate to cervical cancer and HPV infection. Specifically, how unstable biomedical knowledge is produced and sustained. We employed a mixed-methods approach in collecting data from 208 (147 women) participants between 2011 and 2012 across 3 provinces in PNG.

Results: We found that knowledge and awareness about cervical cancer were poor. Five thematic areas emerged in our analysis, which included the gendered knowledge of women’s reproductive health, the burden of cervical cancer in the community and the role (or limitation) of language. We further identified four ways in which ambiguity and uncertainty operate on both sociocultural and biological levels, and in the intersection between to produce unstable biomedical knowledge. These included poor knowledge of where the cervix is located and the uncertainty or unreliability of (lay) diagnoses of disease.

Conclusion: Local understandings of cervical cancer reflected the limitations of Tok Pisin as a lingua franca as well as the wider uncertain biomedical environment where diagnoses are assembled and shared. There is a clear need to improve understanding of the female reproductive organs in order that people, women in particular, can be better informed about cervical cancer and ultimately better receptive to intervention strategies.     

Early childhood care and education in a changing world: building on village life in Papua New Guinea

In Papua New Guinea, the early childhood care and education of young children is largely a parental and community responsibility. Like many other village-based societies, including those found throughout Africa, Asia and the South Pacific, more than 80% of Papua New Guinean children grow up in subsistence farming and fishing tribal villages. In these settings, children participate in work and village activities and gradually develop the skills and knowledge they need to become competent adult members of their community. In providing a snapshot of the lives of two young Papua New Guinean children, this paper is a contribution to the ongoing discussion about effective early childhood care and education (ECCE) programmes in developing nations. The story of Taita and Oini is used to illustrate how the events and settings that are part of children's daily lives need to be considered and understood before ECCE interventions are attempted or policy developed.     

Early childhood care and education in a changing world: building on village life in Papua New Guinea

In Papua New Guinea, the early childhood care and education of young children is largely a parental and community responsibility. Like many other village‐based societies, including those found throughout Africa, Asia and the South Pacific, more than 80% of Papua New Guinean children grow up in subsistence farming and fishing tribal villages. In these settings, children participate in work and village activities and gradually develop the skills and knowledge they need to become competent adult members of their community. In providing a snapshot of the lives of two young Papua New Guinean children, this paper is a contribution to the ongoing discussion about effective early childhood care and education (ECCE) programmes in developing nations. The story of Taita and Oini is used to illustrate how the events and settings that are part of children’s daily lives need to be considered and understood before ECCE interventions are attempted or policy developed.     

Travel time to health facilities in Papua New Guinea: Implications for coverage and equity in child vaccinations

With infant and child mortality rates that are among the highest in the Pacific region, and basic vaccination coverage rates that are 39% among children 12–23 months, increased coverage of vaccines is a high priority investment for Papua New Guinea (PNG). Using recently gathered household survey data for PNG, this paper contributes to the evidence-base for enhancing investments in frontline facilities by examining the implications of travel time to health facilities for basic vaccination coverage among children in PNG. We find that vaccination coverage rates among children 12–23 months old in PNG are decreasing in distance to healthcare facilities; and this holds whether the outcome is receipt of basic vaccinations (BCG; 3 dose pentavalent; OPV3; Measles), or basic vaccinations-plus (basic vaccinations + Hepatitis B + PCV3). We also find that travel time to health facilities lowers vaccination rates among children 12–23 months old in poor households to a greater extent than for children from richer households. Thus, enhanced geographical access to and resourcing of frontline facilities is likely to expand not only immunization coverage, lower mortality and increase aggregate economic gains, but also improve the distribution of immunization coverage in PNG across socioeconomic groups.     

Management support for provinces: A programme for developing provincial health management capabilities in Papua New Guinea

The decentralization of key health functions in Papua New Guinea in 1983, after a lengthy period of centralized control, highlighted the need to develop and strengthen planning and management capabilities at the intermediate level. This article describes the development of an interactive management support programme, combining regular on-site consultation with in-service training, to improve health planning, supervision and information system development at the provincial level in Papua New Guinea.     

Outbreak of Chikungunya Virus Infection,Vanimo, Papua New Guinea

In June 2012, health authorities in Papua New Guinea detected an increase in febrile illnesses in Vanimo. Chikungunya virus of the Eastern/Central/Southern African genotype harboring the E1:A226V mutation was identified. This ongoing outbreak has spread to ≥8 other provinces and has had a harmful effect on public health.     

Melioidosis in a rural community of Western Province, Papua New Guinea

A prospective study was conducted to determine the significance of melioidosis in the Balimo district of Western Province, Papua New Guinea. During 1998, after the establishment of laboratory procedures and increasing local clinical awareness, the disease was found in 1.8% (95% CI 0.37-5.1%) of individuals presenting with fever refractory to standard treatment. The clinical incidence was 20.0 per 100,000 population (95% CI 12.2-30.9). The median age of culture-confirmed cases was 9.5 years (interquartile range 8.3-14.8 years). The seroprevalence of 747 community children in the region tested was 8.2% (95% CI 6.2-10.4%). Most individuals presented during the rainy season with a febrile disease refractory to standard treatment, sometimes mimicking tuberculosis. Some family clustering was apparent. All patients with bacteraemic melioidosis died, but treatment with the available conventional therapies of chloramphenicol, co-trimoxazole or doxycycline resulted in survival and cure in six patients with subacute/localised melioidosis. Further studies are needed to ascertain the local epidemiology and why children appear particularly at risk, as well as to establish the true extent of melioidosis in Papua New Guinea.     

Microbial and metal water quality in rain catchments compared with traditional drinking water sources in the East Sepik Province, Papua New Guinea

In Papua New Guinea, a significant portion of morbidity and mortality is attributed to water-borne diseases. To reduce incidence of disease, communities and non-governmental organizations have installed rain catchments to provide drinking water of improved quality. However, little work has been done to determine whether these rain catchments provide drinking water of better quality than traditional drinking water sources, and if morbidity is decreased in villages with rain catchments. The specific aim of this study was to evaluate the quality of water produced by rain catchments in comparison with traditional drinking water sources in rural villages in the East Sepik Province. Fifty-four water sources in 22 villages were evaluated for enterococci and Escherichia coli densities as well as 14 health-relevant metals. In addition, we examined how the prevalence of diarrhoeal illness in villages relates to the type of primary drinking water source. The majority of tested metals were below World Health Organization safety limits. Catchment water sources had lower enterococci and E. coli than other water sources. Individuals in villages using Sepik River water as their primary water source had significantly higher incidence of diarrhoea than those primarily using other water sources (streams, dug wells and catchments).     

Muscle cell injury, haemolysis and dark urine in children with falciparum malaria in Papua New Guinea

During a prospective study of red cell variants and severe malaria in children, a surprising observation was the occurrence of dark urine. Children were grouped according to urine findings: 22 had dark urine that contained a haem protein (Group I), 93 had urine of normal colour that contained a haem protein (Group II) and 236 had normal urine (Group III). To investigate the cause of dark urine, haemolysis and muscle cell injury were assessed. Intravascular haemolysis was greater in Group I than in Groups II and III. However, anaemia was more severe in Group III and is likely to have resulted mainly from extravascular haemolysis. Median plasma myoglobin concentrations were greater in Groups I and II than Group III (P = 0.00060). Plasma myoglobin was greater in children with cerebral malaria, hyperlactataemia and those who died but was not associated with acidosis. Urine myoglobin was greater in Group I than Groups II and III (P = 0.00054). It is likely that both haemoglobin and myoglobin contributed to dark urine. The association between muscle cell injury and coma suggests sequestration of parasitized red cells as a common underlying pathology. In malaria, hyperlactataemia may result directly from breakdown of muscle protein as well as tissue hypoxia.