Village rural water supplies in the Western Highlands Province of Papua New Guinea

The 1980's have been declared the "International Water Supply and Sanitation Decade". The Papua New Guinea (PNG) Government has committed itself to spending K2.5 million between 1982-1985 on rural water supplies. The experience for such a programme in the Western Highlands is reviewed. Between 1975 and June 1981 there were 101 installation, 69 of which were inspected. Of these, 40.6% were working. Within one year 40% had broken down; after 4 years, 90% had broken down. Contributing factors to break downs were; the use of a cheap and inefficient hand pump on wells; use of plastic rather than metal pipes in reticulated water supplies; weaknesses in the design of reticulated supplies; and difficulties with regular maintenance. It is recommended that the government take steps to solve these problems before it commits itself to a significantly increased expenditure on rural water supplies.     

Maternal death in Papua New Guinea, 1984-1986

The life-time risk of maternal death in the developing world is about 500 times that for women in developed countries. This disparity is wider than for any other public health statistic. The causes of 304 maternal deaths occurring in the period 1984-1986 are reported; this most likely represents only 10% of the total occurring in Papua New Guinea. The maternal mortality rate is estimated at 7/1000 for the period. Figures for Simbu Province are given in more detail than are available for other parts of Papua New Guinea.     

Wuchereria bancrofti infection and disease in a rural area of Papua New Guinea

The relation between infection and disease in lymphatic filariasis is still imperfectly understood. This paper presents baseline data on microfilaraemia, oedema and acute episodes from a drug trial against bancroftian filariasis in Papua New Guinea. Among 2,187 people with data on these manifestations, 1,144 were microfilaraemic, 78 had leg oedema, 356 had acute episodes and 919 were negative for all three. All possible combinations of the three manifestations were observed. The relationships between microfilaraemia and disease are found to be time-dependent. Microfilaraemia is a positive risk factor for leg oedema at lower ages, but a negative one at higher ages. Acute disease over a whole year is found to be positively associated with a point estimate of microfilaraemia. However, when considering incidence within a month of the time of the blood sample, a curvilinear relationship is found and people with low but positive microfilarial counts have the lowest incidence. Possible explanations for these findings are discussed.     

The cost of rural health services in Papua New Guinea.

In 1988 a countrywide study was conducted on the costs of rural health services in Papua New Guinea. 16% of all health centres and subcentres were surveyed. Information was collected on physical facilities, recurrent costs, staff time allocation, service outputs and quality of services. Wide variation was found in the costs of rural health facilities overall, and significant differences were found between the costs and outputs of health centres and subcentres. Average levels of service output were found to be similar at church and government facilities but average levels of utilization by the population were higher at church facilities. Despite government policy on extension of preventive health care, a strong emphasis was found on curative care. Many facilities were found to have significant excess bed capacity. Recurrent financing for transportation and maintenance was found to be inadequate.     

Diarrhoea morbidity in children in the Asaro Valley, Eastern Highlands Province, Papua New Guinea

A morbidity study of diarrhoea covering 1926 children aged less than 5 years was carried out in Goroka town and the Lowa and Asaro Census Divisions, Eastern Highlands Province between 1986 and 1989. The study involved weekly demographic surveillance of the total population and morbidity surveillance of children by lay reporters who enquired about the presence or absence on any of the preceding 8 days of a range of symptoms associated with diarrhoeal and respiratory diseases. A three-day symptom-free period was used to define distinct episodes of diarrhoea. The average number of episodes/child-year for all children in the study population was 3.0. Boys suffered a significantly higher incidence of diarrhoea under 48 months of age than girls (4.4 episodes compared to 3.6/child-year). Incidence was highest among those aged 6-17 months (5.5/child-year) with a rapid decline after age 35 months. Incidence of diarrhoea was highest in the more remote Asaro Census Division and was higher in periurban areas than in Goroka town. Incidence also varied significantly between villages, some villages experiencing up to 10 times the incidence of diarrhoea found in Goroka town. The incidence of diarrhoea was significantly higher in January than at other times of year. Duration of diarrhoea varied with age, the longest duration being an average of 4.7 days in the 12-17 months age group. In order to reduce diarrhoea morbidity, it is necessary to improve access to water, encourage improved hygiene practices and breastfeeding and warn people about the risks of sleeping with pigs.     

The epidemiology of malaria in the Papua New Guinea highlands: 1. Western Highlands Province

Despite a resurgence of malaria in many Papua New Guinea highlands and highlands fringe areas after the cessation of control activities in the early 1980s the malaria situation in these areas has received little attention. A series of cross-sectional surveys were therefore carried out to provide accurate and up-to-date information on the prevalence of malaria and the risk of epidemics and to propose adequate malaria control strategies. Studies in 24 villages in Western Highlands Province found the prevalence of malarial infections to be strongly correlated with altitude, ranging from 1.6% at altitudes of 1500-1800 m to over 30% in villages below 900 m. Malaria outbreaks were observed at the end of the rainy season. All four human malaria species were present with P. falciparum infections clearly dominating. The relative importance of P. vivax increased with altitude, while both P. malariae and P. ovale were rare. Many infections were of low density. While malaria is an important source of febrile illness in endemic areas below 1500 m altitude, only few observed or reported fevers are due to malarial infections in higher, nonendemic areas. Rates of enlarged spleens, mean haemoglobin levels and the prevalence of anaemia (Hb <7.5 g/dl) were strongly linked to the level of malaria found in each community and were associated with both altitude and concurrent malarial infection. Based on the survey results, areas of different malaria epidemiology are delineated and options for control in each area are discussed.     

The epidemiology of malaria in the Papua New Guinea highlands: 2. Eastern Highlands Province

The epidemiology of malaria in Eastern Highlands Province (EHP) is characterized by generally very low-level or no local malaria transmission but a considerable risk of epidemics. In non-epidemic situations, parasite prevalence was under 5% in all but one area, Lufa Valley, where P. vivax was the most common parasite (prevalence rate of 58%). During epidemics, however, 23% (range 8-63%) of people were infected, with P. falciparum the predominant parasite. Mixed infections were very common (12%) but P. malariae and P. ovale were rare. Outside epidemics, malaria was only a minor source of febrile illness and enlarged spleens and anaemia (haemoglobin level < 7.5 g/dl) were virtually absent. However, epidemics were associated with a high incidence of relatively severe morbidity, both in terms of fevers and moderate to severe anaemia. Epidemic prevention, surveillance and response therefore are priorities in malaria control in EHP.     

Cannabis in Papua New Guinea

Cannabis is the most commonly used illicit drug in Papua New Guinea (PNG). Data on the epidemiology and history of cannabis in PNG are presented. The adverse health consequences of cannabis smoking and treatment options for cannabis dependence are discussed. It is recommended that a range of strategies are urgently required in PNG to prevent adverse physical and mental health consequences associated with cannabis smoking.     

Training appropriate laboratory workers for rural health centres in Papua New Guinea

Many rural health centres in developing countries continue to treat patients without the help of any laboratory tests. The result is often inaccurate diagnosis, wasteful use of multiple drugs, and increasing drug resistance of pathogens. It is unlikely that there will ever be sufficient funds to employ a full-time laboratory worker at each of the many small remote health centres in Papua New Guinea. It is also doubtful whether staff and health extension officers who run such centres have the appropriate knowledge to adequately utilize full-time laboratory personnel. It is feasible, however, to train selected health workers in courses of three to four months' duration to perform a few simple laboratory tests part-time, in addition to their clinical duties. Suitable tests are those where the result does not require skilled interpretation. For most such tests, the result is the diagnosis. After the clinical staff have received the laboratory diagnosis, they are free to decide whether it fits the clinical picture. If so, they can then find the appropriate treatment to prescribe in standard treatment books. The present paper describes the experience in setting up and operating laboratory training for health centre staff in Milne Bay Province, Papua New Guinea. Costs and initial results of the program are discussed.