Status of iodine nutrition among school-age children (6 – 12 years) in Morobe and Eastern Highlands Provinces, Papua New Guinea

Insufficient intake of iodine or consumption of foods containing goitrogens can decrease thyroid function leading to multiple physical and mental disorders known collectively as iodine deficiency disorders. Successful implementation of the universal salt iodization strategy, which is the main intervention strategy for the control and elimination of iodine deficiency, requires constant monitoring. Urinary iodine concentration is the recommended biochemical indicator for assessing the iodine status of a population. The present studies were prompted by the apparent lack of published data on the status of iodine nutrition among school-age children in Morobe and Eastern Highlands provinces in Papua New Guinea (PNG). The aims of these studies were to determine the urinary iodine concentration in school-age children (6 – 12 years) as a way of assessing the impact of the salt iodization programs in Morobe and Eastern Highlands Provinces in PNG. These prospective school based cross-sectional studies were carried out in Aseki-Menyamya district Morobe province and Gouno, Mt. Michael Local-Level Government area in Lufa district Eastern Highlands province, PNG. Simple random sampling was used to select primary schools in each district. The iodine content in salt samples was measured using the single wavelength semi-automated WYD Iodine Checker Photometer. Urinary iodine concentration (UIC) was estimated using the Sandell-Kolthoff reaction. In Lufa district, the mean per capita discretionary consumption of salt was 4.7 ± 2.1g per day with a range of 2.1 – 9.6g; the mean iodine content in salt samples from the households was 17.8 ± 4.5ppm; the iodine content was below 15ppm in 23.8% of all the salt samples. For the children in Aseki-Menyamya district, the median UIC was 149.5μg/L, Interquartile Range (IQR) was 70.0 – 300μg/L; the UIC was below 100.0μg/L in 32.9% of the children and 17.9% had UIC below 50μg/L. For children in Gouno Lufa district, the median UIC was 50.0μg/L, IQR was 23.9 – 76.0μg/L, 87.9% had UIC below 100.0μg/L, and 49.2% had UIC below 50.0μg/L. The results indicate that iodine deficiency should be considered a significant public health problem among the school-age children in Gouno Lufa district. Our findings indicate the urgent need for efficient, sustainable, systematic and functional monitoring system to strengthen and improve on the implementation of the USI strategy in both districts.

Vitamin A status of pre-school-age children aged 6 to 59 months in the National Capital District, Papua New Guinea

Assessing the vitamin A status among pre-school-age children is essential for evaluating the magnitude and public health status of vitamin A deficiency in a population. This cross-sectional study assessed the vitamin A status of children aged 6 to 59 months resident in the National Capital District (NCD), Papua New Guinea. Children attending the Children's Outpatient Clinic at Port Moresby General Hospital participated in this study. Informed consent was obtained from parents before using blood samples from their children. Assay of plasma retinol was carried out using the 'Clin-Rep' complete kit for assay of vitamins A and E in plasma by high performance liquid chromatography (HPLC). A commercial enzyme immunoassay kit was used to assay C-reactive protein (CRP) in plasma. Of the 132 children in the study 108 (82%) had received vitamin A capsules. The median plasma retinol concentration of the 132 children was 0.98 micromol/l and the interquartile range 0.65-1.38 micromol/l. Of the 132 children, 35 (27%) had a plasma retinol concentration below 0.70 micromol/l. 75 children (57%) had normal plasma CRP levels and in 57 (43%) the CRP levels were elevated. The median plasma retinol concentration of the children with normal plasma CRP was 1.19 micromol/l and the interquartile range 0.93-1.50 micromol/l. The prevalence of vitamin A deficiency (VAD) in the children with normal plasma CRP was 11%, indicating a moderate public health problem. 74 (56%) males and 58 (44%) females were included in the study. The prevalence of VAD in the male and female children with normal plasma CRP was 14% and 8%, respectively, indicating a moderate public health problem among the male children and a mild public health problem among the female children. The prevalence of subclinical (mild to moderate) and marginal VAD among the children with and without elevated CRP strongly suggests the need for continuous monitoring of the vitamin A status of the vulnerable groups 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.