Assessment of anaemia and iron status among pregnant women in the National Capital District, Papua New Guinea

@#Assessing the prevalence of anaemia, iron deficiency and iron deficiency anaemia among non-pregnant and pregnant women is essential for evidence-based intervention programs. The purpose of this prospective outpatient and community-based cross-sectional study was to assess the prevalence of those conditions among pregnant women resident in the National Capital District (NCD) and attending the Outpatient Antenatal Clinic in Port Moresby General Hospital. Blood samples were collected from 50 non-pregnant and 157 pregnant women who gave consent. HemoCue was used to measure haemoglobin; the serum ferritin, soluble transferrin receptor (sTfR) and C-reactive protein were measured by specialized 96-well enzyme-linked immuno-sorbent assay (ELISA) kits. The ‘sTfR-F index’ was calculated. Mild to moderate anaemia, low serum ferritin and elevated serum sTfR were found in 28% of the non-pregnant women; the sTfR-F index showed that 16% of them had iron deficiency anaemia. Among the pregnant women, 60% had mild to severe anaemia indicating severe public health significance; 48% had low serum ferritin and 38% had elevated serum sTfR; the sTfR-F index showed that 38% of them had iron deficiency anaemia. Mild to severe anaemia was present in 47%, 71% and 62% of the pregnant women in the first, second and third trimesters respectively, while iron deficiency anaemia was present in 20%, 53% and 48% of the pregnant women in the first, second and third trimesters respectively. The sTfR-F index showed that iron deficiency anaemia was present in 36% of primigravida and 40% of multigravida. Social mobilization, intensive and focused education, aggressive awareness campaigns, including all relevant target groups and policy makers, are required to effectively address this major public health issue.

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.

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.