Gestational Diabetes in Melanesia and Appropriateness of Current Screening and Diagnostic Tests

Abstract@#In low-resource settings such as Melanesia, gestational diabetes often goes undiagnosed due to many factors, including the unsuitability of current tests. Ideally a gestational diabetes test for low-resource settings should meet criteria related to acceptability, test performance and operational characteristics, with minimal impositions on individual patients or the wider health system. None of the six tests recommended in country-specific gestational diabetes guidelines in Melanesia (2-hour oral glucose tolerance test, glucose challenge test, fasting plasma glucose, random plasma glucose, 2-hour postprandial glucose and glycated haemoglobin) meet criteria related to these attributes. Additionally, each Melanesian country has different, complex algorithms that use multiple tests in different combinations. With a high and increasing burden of diabetes mellitus (and therefore assumed gestational diabetes), Melanesian health practitioners and policymakers should be aware of the limitations of recommended tests for gestational diabetes and be open to alternative technologies that may be more appropriate.

Assessing Preventative Maintenance and Sustainability of Oxygen Concentrators in Health Facilities in Papua New Guinea

@#The lifespan of medical equipment depends on preventative maintenance. Properly functioning oxygen concentrators are the only practical sources of oxygen in many Low & Middle Income Countries and their use reduces mortality in hospitalised children. We provided 82 concentrators with pulse oximeters, split flow meters, oxygen tubing, and an oxygen analyser to 38 health facilities. Training and instructions on how to perform preventative maintenance were provided. The concentrators were monitored for three years after they were installed, by assessing the proportion of concentrators still producing optimal oxygen at greater than 85% purity, the proportion that underwent weekly maintenance checks, and the proportion that were faulty and repaired. A logbook for weekly documentation of performance, maintenance, faults and repairs, was employed. Faults were additionally identified by a biomedical engineer during the visits. Twenty nine oxygen concentrators underwent regular maintenance checks, 25 (86.2%) of which had a median of 30 (IQR: 9 - 65) checks. Twenty-four were functioning well throughout the three years. One concentrator was used for 23,807 hours before requiring repair. Fourteen (24%) of the 58 concentrators used at the start of the programme had problems, two were repaired, and 12 were replaced. Concentrator failure was mostly caused by excessive movement, dust, and leaking in the internal tubing. Routine preventative maintenance, thorough documentation of performance and reporting of problems, and having access to clinicians and a knowledgeable biomedical engineer are essential for oxygen concentrator longevity in health care facilities in low-resource settings.

Inequities and inequalities in health and some Public Health Proposals that may improve inequities and inequalities in accessing Primary Healthcare Services in Papua New Guinea

@#Inequity and inequality in accessing primary healthcare services can be created by systemic and structural barriers in a health system. A recent review of Papua New Guinea’s (PNG) health system revealed that there are inequities and inequalities in primary healthcare service access. This disparity is magnified in the rural and remote regions of the country. One of the main reasons for this has been the chronic shortage in government funding. This paper presents an overview of inequities and inequalities in health and suggests some public health approaches that may improve primary healthcare service access in PNG

Assessment on the effectiveness of communication between Radiographers and Patients during general Radiographic Examinations at Port Moresby General Hospital, Papua New Guinea

@#Patient communication is highly regarded as one of the basis of health care and an important part of practice in the application of radiographic procedures. Good communication is necessary in medical imaging if optimum diagnostic images are to be achieved. This study is a prospective assessment on the effectiveness of communication among radiographers and patients during general radiographic procedures at the Port Moresby General Hospital (PMGH). Questionnaires were administered to 100 patients and 15 radiographers using a quantitative approach for data collection. Informed consent was obtained from each of the participants, after obtaining ethical clearance from the authorities. The responses in the questionnaires were recorded in Excel Spread sheet. The data was statistically analysed using Microsoft Excel 2013. A majority (78%) of the patients reported that there were no communication problems while more than half (57%) expressed satisfaction with the radiographic services that were provided. A majority (67%) of radiographers reported that language barrier was the cause of communication problems during radiographic procedures. The result indicated that although there was communication between radiographers and patients, the most common factor affecting effective communication was language barrier.

Prevalence of syphilis, gonorrhoea and chlamydia in women in Fiji, the Federated States of Micronesia, Papua New Guinea and Samoa, 1995–2017: Spectrum-STI model estimates

Objectives@#To estimate prevalence levels of and time trends for active syphilis, gonorrhoea and chlamydia in women aged 15–49 years in four countries in the Pacific (Fiji, the Federated States of Micronesia [FSM], Papua New Guinea [PNG] and Samoa) to inform surveillance and control strategies for sexually transmitted infections (STIs).@*Methods@#The Spectrum-STI model was fitted to data from prevalence surveys and screenings of adult female populations collected during 1995−2017 and adjusted for diagnostic test performance and to account for undersampled high-risk populations. For chlamydia and gonorrhoea, data were further adjusted for age and differences between urban and rural areas.@*Results@#Prevalence levels were estimated as a percentage (95% confidence interval). In 2017, active syphilis prevalence was estimated in Fiji at 3.89% (2.82 to 5.06), in FSM at 1.48% (0.93 to 2.16), in PNG at 3.91% (1.67 to 7.24) and in Samoa at 0.16% (0.07 to 0.37). For gonorrhoea, the prevalence in Fiji was 1.63% (0.50 to 3.87); in FSM it was 1.59% (0.49 to 3.58); in PNG it was 11.0% (7.25 to 16.1); and in Samoa it was 1.61% (1.17 to 2.19). The prevalence of chlamydia in Fiji was 24.1% (16.5 to 32.7); in FSM it was 23.9% (18.5 to 30.6); in PNG it was 14.8% (7.39 to 24.7); and in Samoa it was 30.6% (26.8 to 35.0). For each specific disease within each country, the 95% confidence intervals overlapped for 2000 and 2017, although in PNG the 2017 estimates for all three STIs were below the 2000 estimates. These patterns were robust in the sen sitivity analyses.@*Discussion@#This study demonstrated a persistently high prevalence of three major bacterial STIs across four countries in WHO’s Western Pacific Region during nearly two decades. Further strengthening of strategies to control and prevent STIs is warranted.

Diarrhoeal disease surveillance in Papua New Guinea: findings and challenges

Abstract@#Diarrhoeal diseases are among the leading causes of morbidity and mortality in the Western Pacific Region. However, data on the major causes of infectious diarrhoea are limited in many countries within the Region, including Papua New Guinea. In 2013–2014, we conducted surveillance for acute diarrhoeal illness in four provinces in Papua New Guinea. One rural health clinic from each province participated in the surveillance activity. Samples were sent to central laboratories and batch analysed for bacterial and viral gastrointestinal pathogens that are commonly associated with diarrhoea. Across the four sites, the most commonly detected pathogens were Shigella spp., Campylobacter spp. and rotavirus. In this paper, we report the results of the surveillance activity and the challenges that we faced. The lessons learnt may be applicable to other parts of the Region with a similar socioeconomic status.

Assessment of Rubrics for Health Science Education at the School of Medicine and Health Sciences, University of Papua New Guinea

@#This study carried out at the University of Papua New Guinea investigates undergraduate medical imaging science (MIS) students’ perceptions of the usefulness of individualised feedback using a rubric. In the first semester of 2017, 15 fourth year students in the research proposal design course were assigned to an assessment rubric, which comprised a detailed description of how their work was to be graded. Students were instructed to submit an initial draft of their writing. Electronic feedback was then provided to support the revision process. The benefits of the rubric and feedback were evaluated at the end of the semester using a paper-based survey, which provided participating students with the opportunity to critically reflect on the learning experience. The majority (93.3%) of the students were satisfied that the feedback on their draft proposal assisted their understanding on research methodology concepts which informed their progress with respect to achieving the assessment learning outcomes. This study has demonstrated that the use of a rubric as a formative assessment tool has had a positive impact on students’ learning experience. Reflection on the results of this study will lead to further refinement of the existing rubric and the development of others.

Spatial distribution of tuberculosis in a rural region of Western Province, Papua New Guinea

Introduction@#There is a high burden of tuberculosis (TB) in the Western Province, Papua New Guinea. This study aims to describe the spatial distribution of TB in the Balimo District Hospital (BDH) catchment area to identify TB patient clusters and factors associated with high rates of TB.@*Methods@#Information about TB patients was obtained from the BDH TB patient register for the period 26 April 2013 to 25 February 2017. The locations of TB patients were mapped, and the spatial scan statistic was used to identify high- and low-rate TB clusters in the BDH catchment area.@*Results@#A total of 1568 patients were mapped with most being from the Balimo Urban (n = 252), Gogodala Rural (n = 1010) and Bamu Rural (n = 295) local level government (LLG) areas. In the Gogodala region (Balimo Urban and Gogodala Rural LLGs), high-rate clusters occurred closer to the town of Balimo, while low-rate clusters were located in more remote regions. In addition, closer proximity to Balimo was a predictor of high-rate clustering.@*Discussion@#There is heterogeneity in the distribution of TB in the Balimo region. Active case-finding activities indicated potential underdiagnosis of TB and the possibility of associated missed diagnoses of TB. The large BDH catchment area emphasizes the importance of the hospital in managing TB in this rural region.

Providers’ perceptions of the key issues affecting the delivery of quality services at a Dental Clinic in Port Moresby, Papua New Guinea: a qualitative descriptive study

@#The aim of this study was to identify factors that affect the dental service delivery in a dental clinic from the context of Papua New Guinean dental providers and to make practical recommendations to improve dental service delivery. This qualitative descriptive study used individual interviews with seven dental providers to identify the factors that were affecting quality dental service delivery in a dental clinic in Papua New Guinea. The factors influencing the quality of dental service fell into three categories and 8 themes. The categories were environmental factors with themes of resources and facilities, leadership and management, partnership development and collaboration; provider-related factors with themes provider competence, provider motivation and satisfaction; and required measures with the themes of a new dental clinic building, renovation of the main clinic area and organizational structure. Quality dental service is achieved when there is a supportive working environment with availability of (new) physical amenities and dental resources, and proper management and organizational structures with supportive visionary leadership. This would encourage teamwork and partnership development internally within the dental team and externally with its stakeholders. Furthermore, it would increase staff motivation and satisfaction internally and partnership development internally within the dental staff and externally with its stakeholders. Consider creating a new dental clinic. Develop a contract between the University and the Hospital to resolve the property ownership issues. Create a clear organizational structure and improve management interaction with clinical staff so that management is supportive. Improve the quality of dental supplies and create an efficient material ordering system. Ensure fairness to staff and respect to procedures are compliantly maintained to encourage teamwork. Reward clinical staff for mentoring and teaching dental students. Create access to continuing professional development for the clinical staff.

Assessment of patients’ knowledge to their dispensed medications at Port Moresby General Hospital, Papua New Guinea

@#Limited information on drug use indicates that medicines are not optimally used. Inadequate knowledge of medication uses may lead to overuse of medicines or patient non-compliance with a medicine regimen, and result in serious outcomes. The aim of this study was to assess the patients’ knowledge on dispensed medications in pharmacy at Port Moresby General Hospital (PMGH). This was a descriptive cross-sectional study utilizing a self-administered questionnaire adapted from the WHO “Guide to Good Prescribing Practical Manual”. The questionnaire sought to elicit major classes of medicines prescribed, knowledge of patients on indications, how to use the medicines, precautions and possible adverse events. A total of 130 patients from PMGH participated in this study. Although majority of patients (94.6%) knew the instructions on the use of the dispensed medicines in terms of route of administration, dosage and frequency of usage; only 74.6% of them knew the duration of medicines use. Further, 19.2% of participants did not know the indications for which their medicines were prescribed. Knowledge on adverse effects was also significantly low i.e 34.7%. Lack of understanding of warnings and precautions was rated at 42.3%. These figures may contribute to poor patient compliance and cause possible harm to the patients. The results demonstrated lack of adequate information given to patients on their prescribed medicines. It is recommended that prescribers be re-trained on the importance of giving adequate information on medications given to patients, particularly to patients with low educational background.

Assessment of aflatoxin M1 in breast milk of lactating mothers in Papua New Guinea

@#Aflatoxin M1 (AFM1) is a secondary metabolite in the breast milk of lactating mothers who consume foodstuffs infected by the fungi Aspergillus flavus and Aspergillus Parasiticus. The concentration of AFM1 in breast milk of lactating mothers is of major public health concern, because it can negatively affect the health of their babies. The major objective of this study was to assess the AFM1 concentration in the breast milk of lactating mothers in Papua New Guinea (PNG). This was a prospective cross-sectional study carried out between 2011 and 2015 in three of the four Regions in PNG: the National Capital District (NCD) in the Southern Region; Eastern Highlands (EHP) and Western Highlands (WHP) provinces in the Highlands Region; and East New Britain (ENB) and Manus provinces in the Islands Region. The Susu Mama, Well-Baby and Paediatric clinics in the General Hospitals in each of the selected provinces in the three regions were the primary sites for this study. A solid phase competitive Enzyme-Linked Immunosorbent Assay (ELISA 96 Microwell plates) was used for the quantification of AFM1 in breast milk from consented lactating mothers. A total of 874 lactating mothers and their babies participated in this study. The mean age of the mothers was 28.0 ±5.5 years. The age range of all the babies was 2 to 6 weeks. 76.1% (665/874) of all breast milk samples analyzed had detectable levels of AFM1. The concentration of AFM1 was above 10.00ppt in 89 (10.2%) of the 874 breast milk samples (which, according to the Australia / New Zealand / Austria safe cut-off limits for AFM1, makes them unsafe for consumption by the babies). The mean AFM1 concentration in the breast milk samples from lactating mothers in EHP (7.99ppt) was higher than that in the samples from the other 4 provinces in the present study. AFM1 concentration was above 10.00ppt in 14 (4.6%) of the 300 breast milk samples from NCD, in 62 (31.0%) of the 200 samples from EHP, in 10 (4.5%) of the 220 samples from ENB and in 3 (3.0%) of the 100 samples from WHP. In order to reduce the AFM1 concentrations in breast milk of lactating mothers, basic nutrition education, aggressive advocacy, social mobilization, awareness campaigns, including communication with all relevant target groups and the relevant policy makers are urgently required.

Historic accounts of Mansonella parasitaemias in the South Pacific and their relevance to lymphatic filariasis elimination efforts today

There are two species of filarial parasites with sheathless microfilariae known to commonly cause parasitaemias in humans: Mansonella perstans and Mansonella ozzardi. In most contemporary accounts of the distribution of these parasites, neither is usually considered to occur anywhere in the Eastern Hemisphere. However, Sir Patrick Manson, who first described both parasite species, recorded the existence of sheathless sharp-tailed Mansonella ozzardi-like parasites occurring in the blood of natives from New Guinea in each and every version of his manual for tropical disease that he wrote before his death in 1922. Manson's reports were based on his own identifications and were made from at least two independent blood sample collections that were taken from the island. Pacific region Mansonella perstans parasitaemias were also later (in 1923) reported to occur in New Guinea and once before this (in 1905) in Fiji. Although Mansonella-parasitaemias are generally regarded as benign, they are thought to be of public health importance because they can affect the epidemiological monitoring of other filarial diseases. In this article, we reviewed the historic literature concerning Pacific-origin Mansonella-parasitaemias in an attempt to explain how, despite repeated reports of Pacific-region Mansonella-parasitaemias, by as early as the 1970s, the WHO had arrived at the present-day view that Wuchereria bancrofti is the only cause of filarial parasitaemias in Papua New Guinea. We have also evaluated the evidence supporting the contemporary existence of Pacific-area parasitaemia-causing Mansonella parasites and assessed the relevance such parasites could have for present-day lymphatic filariasis elimination efforts in the region.

Historic accounts of Mansonella parasitaemias in the South Pacific and their relevance to lymphatic filariasis elimination efforts today

There are two species of filarial parasites with sheathless microfilariae known to commonly cause parasitaemias in humans: Mansonella perstans and Mansonella ozzardi. In most contemporary accounts of the distribution of these parasites, neither is usually considered to occur anywhere in the Eastern Hemisphere. However, Sir Patrick Manson, who first described both parasite species, recorded the existence of sheathless sharp-tailed Mansonella ozzardi-like parasites occurring in the blood of natives from New Guinea in each and every version of his manual for tropical disease that he wrote before his death in 1922. Manson's reports were based on his own identifications and were made from at least two independent blood sample collections that were taken from the island. Pacific region Mansonella perstans parasitaemias were also later (in 1923) reported to occur in New Guinea and once before this (in 1905) in Fiji. Although Mansonella-parasitaemias are generally regarded as benign, they are thought to be of public health importance because they can affect the epidemiological monitoring of other filarial diseases. In this article, we reviewed the historic literature concerning Pacific-origin Mansonella-parasitaemias in an attempt to explain how, despite repeated reports of Pacific-region Mansonella-parasitaemias, by as early as the 1970s, the WHO had arrived at the present-day view that Wuchereria bancrofti is the only cause of filarial parasitaemias in Papua New Guinea. We have also evaluated the evidence supporting the contemporary existence of Pacific-area parasitaemia-causing Mansonella parasites and assessed the relevance such parasites could have for present-day lymphatic filariasis elimination efforts in the region.

Knowledge, attitudes and practices of caregivers of patients with Schizophrenia in Port Moresby, Papua New Guinea

@#The purpose of this study was to investigate the knowledge, attitudes and practices of adult caregivers of schizophrenia patients in Port Moresby, Papua New Guinea. A semi-structured questionnaire was used to obtain the required data from consented caregivers accompanying the schizophrenia patients attending the consultation clinic at Port Moresby General Hospital (PMGH). Focus Group Discussion was held with consented caregivers of schizophrenia patients admitted in the Psychiatric ward of PMGH. A convenient sample of 79 caregivers with patients was selected for this study. Consents were obtained from 40 caregivers, which give a response rate of 50.6%. Most of the caregivers (75.0%) had no prior knowledge about schizophrenia; they became aware about schizophrenia from experience with their patients. The fathers (35.0%) and mothers (22.5%) were the major caregivers for the patients. Most of the caregivers indicated that the health workers did not give them adequate education about schizophrenia. Marijuana (47.5%) and psychosocial problems (45.0%) were the two major causes of schizophrenia indicated by the caregivers. Caregivers considered medical intervention to be the most important, but they also advocated supportive interventions such as church activities and family support. Most of the caregivers accepted their patients as part of the family and considered it their responsibility (52.5%) to care for them, and preferably to administer treatment at home (52.5%); the exception being during severely aggressive episodes. Financial problem was one of the factors that impacted negatively on follow-up of patients. Increased access to services and health education is recommended to further enhance the care of schizophrenia patients in Port Moresby, PNG.

HIV/AIDS atigma: main barrier to VCT and other health services in four suburban villages in National Capital District, Papua New Guinea

The HIV/AIDS stigma, fear and discrimination have been linked with poor participation in Voluntary Counselling and Testing (VCT) programs. Cultural factors, attitudes and behaviours strongly influence the spread of HIV/AIDS and these have been extensively studied in several sub-Sahara African countries. Similar studies in Papua New Guinea are scanty. This study investigates the extents of HIV/AIDS-Stigma, fear, discrimination and other psychological factors as barriers to the access of VCT and other services in four suburban villages in the National Capital District, Papua New Guinea. The study sites were Baruni, Hanuabada, Pari and Kilakila villages. A semi-structured questionnaire comprising of closed and open ended questions was administered to respondents selected randomly. Groups were selected for focus group discussions. Gender stratification was used to ensure that views of both men and women were equally represented. A total of 333 respondents comprising of 166 (49.8%) males, and 167 (50.2 %) females participated in the survey. Self-stigmatization as a major barrier to VCT was indicated by 90.7% of all the respondents. Gender based differences were not statistically significant. Discrimination by relatives and friends was indicated by 74.8% respondents; 79.0% of respondents would discriminate HIV/AIDS-infected people. A total of 42.0% respondents indicated the possibility of rejection from close relationships. The likelihood of dismissal from workplace was indicated by 68.5% of respondents. Lack of support from health providers (67.0%) and fear of HIV test result (61.6%) were other barriers to VCT indicated by respondents. This study recommends the need to heighten awareness of VCT and to eliminate stigma and fear in order to control the HIV/AIDS pandemic.

Knowledge, Attitudes and Practices Relevant to Malaria Control in Remote Island Populations of Manus, Papua New Guinea

A community-based cross-sectional survey of 262 participants in four island communities of Manus, Papua New Guinea was conducted using a structured questionnaire to examine possible factors of malaria prevalence, including education experiences, knowledge, attitudes, and preventive behaviors, in relation to antimalarial antibody titers. Bivariate and multivariate analyses revealed that micro-environmental conditions caused inter-community differences in malaria prevalence. Ninety-nine percent of the subject villagers recognized mosquito bites as a cause of malaria transmission, which explains the high possession rate of bednets. There was a significant correlation between malaria education experience at schools and knowledge (<i>p</i> < 0.01) and between knowledge and bednet use (<i>p</i> < 0.05). However, regular bednet users were only 35% of the total, due primarily to feelings of discomfort, heat, and stuffiness inside the bednet. Villagers’ behavior of consulting an aid post orderly (APO) in case of high fever significantly lowered the titer level (<i>p</i> < 0.05), while their bednet use did not. This unexpected result was attributable to inappropriate bednet use and to daily living patterns, including both subsistence and social activities. We conclude that information regarding lifestyles and attitudes toward bednet use as well as malaria education experience at schools are particularly important for practical malaria prevention.

Using Thyroid Stimulating Hormone (TSH) Levels in Cord Blood to Assess the Iodine Status of Neonates

@#Neonatal Thyroid Stimulating Hormone (TSH) level in blood is one of the indicators recommended for assessing iodine deficiency control programs in a population. This study evaluates the TSH level in cord blood as a way of assessing the iodine status of neonates in the National Capital District, PNG. Assay of TSH in 150 cord sera was by enzyme immunoassay (EIA 96 Microwell plates) using the sensitive EIA kit provided by LiNEAR Chemicals, S.L. The median TSH level in the sera for all the neonates was 2.17mIU/L, the interquartile range (IQR) was 1.53 – 3.48mIU/L. The TSH level in only 2 (1.3%) cord serum samples was greater than 10.0mIU/L. The lower limit (2.5th) and upper limit (99.0th) of the TSH percentile cut-off levels in all the cord sera were 0.76mIU/L and 11.16mIU/L. The median TSH level in the cord sera of the male neonates was 1.98mIU/L and the IQR was 1.55 – 3.38mIU/L. For the female neonates the median TSH level was 2.22mIU/L and the IQR was 1.52 – 3.81mIU/L. The data indicates normal iodine and thyroid status and zero prevalence of congenital hypothyroidism among the neonates in NCD.

Using High Performance Liquid Chromatography to quantitate Artemether and Artesunate anti-malarial tablets in the National Capital District, Papua New Guinea

Malaria is a major public health problem in Papua New Guinea (PNG). The Artemisinin-based combination therapy is widely used as the first-line treatment for malaria in PNG. This study was to assess the quantity of the Artemether and Artesunate ingredients in the antimalarial drugs used for the treatment of malaria in the National Capital District (NCD) PNG. Artemether and Artesunate tablets were purchased from various pharmacies in NCD. Artemether and Artesunate solutions were prepared according to the Standard United States Pharmacopoeial protocol for assay of active ingredients by high performance liquid chromatography (HPLC). The results indicated that the percent Artemether content in the three brands (ART 01, ART 02 and ART 03) of Artemether purchased in the NCD were 93.2%, 87.6% and 89.3% respectively. Four brands (ATS 01/02, ATS 03/04, ATS 05, and ATS 06) of Artesunate were purchased in the NCD. The % Artesunate content in the four brands were 109.0%, 110.0%, 101.2% and 96.2%% respectively. The three Artemether brands (100%) and two (ATS 01/02 and ATS 03/04) of the Artesunate brands (50%) did not satisfy the USP specifications for the amount of active ingredients in the drugs. Our data indicate that poor quality Artemether and Artesunate antimalarial drugs are sold in the National Capital District in PNG. This indicates the urgent need to advocate for more efficient drug monitoring and effective enforcement of regulations that prevents importation of substandard drugs into the NCD.

Impact of HIV/AIDS - stigma and discrimination on the access to VCT and other health services in selected populations of the National Capital District, Papua New Guinea

A number of research findings have linked stigma, discrimination and fear with poor participation in Voluntary Counseling and Testing (VCT) programs. Cultural factors, attitudes and behaviours strongly influence the spread of HIV/AIDS and these have been extensively studied in several sub-Sahara African countries. Treppe and Wambua believed that stigma, silence, discrimination, denial and lack of confidentiality would contribute to an environment of fear that undermines the prevention and treatment efforts, thereby increasing the impact of the HIV pandemic in Papua New Guinea. The objective of this study was to investigate the Impact of HIV/AIDS-Stigma and discrimination on the access to VCT and related services in selected areas of the National Capital District, Papua New Guinea. A semi-structured questionnaire survey comprising of closed and open ended questions was carried out among youths respondents (15-24 years) selected at random, but gender stratified, from two sub-urban areas of the National Capital District, Papua New Guinea. The areas studied were Elevala and Morata 1. Important questions included in the questionnaire aimed at exposing the existence of stigma, fear and discrimination that would occur when close relatives or/and people of the immediate community know about the HIV/AIDS status of individuals, and linked these to impacts on access to VCT and related services. In-depth focus group discussions were also carried out to confirm issues encountered in the quantitative surveys and to disclose other concerns of the community inherent to HIV/AIDS stigma and discrimination. Out of a total of 380 respondents from the areas surveyed, 364 (95.8%) indicated existence of self stigmatization, while 335 (88.2%) showed perceived stigma. The notion of perceived discrimination and discriminating others occurred among 322 (84.7%) and 349 (91.8%) respondents respectively. Both stigma and discrimination were found to impact negatively on VCT and other services; with 255 (67.1%) respondents expressing fear of what to do with HIV positive results, 209 (55%) indicating self withdrawal from normal duties and 15 (3.9%) exhibiting suicidal tendencies in the event where HIV test would reveal positive results. Despite the negative impacts of stigma and discrimination it was reassuring however, to see the majority of respondents; n=347 or 91.3 %) indicating willingness to utilize VCT services, and readiness for HIV testing; n= 266 (70.0%). Focus group discussions showed consistencies in the above findings, but also revealed a strong attitude of abandonment and rejection of an HIV positive person by family members, relatives, friends and workmates. Scepticism whether service providers and caregivers would attend to HIV positive clients politely as they would do with other clients was also highlighted. These results which had little or no significant gender based differences, tended to agree with patterns of studies carried out elsewhere mostly in sub-Saharan African countries. HIV/AIDS - Stigma and discrimination create fear and discouragement as reported by the individuals surveyed, and collectively forms a great barrier in the access to VCT and other related services. Due to the wide diversity in cultural norms in Papua New Guinea, the study should be quickly tested in other areas including rural populations, such that outcomes may be used to complement and strengthen the ongoing government awareness on VCT in the country.

Survey on the current conditions of higher stomatology education in Papua New Guinea / 中华医学教育探索杂志

The paper introduces the survey on the current conditions of higher stomatolo-gy education in Papua New Guinea which locates in the south Pacific and is slow on some as-pects,however it has its own characteristics worth of using for reference.The paper also ana-lyzes the disadvantage of teaching system in China and puts forward some reform consideration based on our real situation.