Implementation of national tuberculosis infection prevention and control guidelines in rural hospitals, Papua New Guinea

Introduction: Tuberculosis (TB) is a significant public health problem in Papua New Guinea (PNG). Poor infection prevention and control (IPC) measures in healthcare settings may partly contribute to the high burden of TB in PNG. This study examines the implementation of the TB infection prevention and control (TBIPC) policy introduced by the national health department in 2011 in rural hospitals in the Highlands and Momase region of PNG. Method(s): A self-administered structured questionnaire adapted from the WHO TBIPC framework and site observations were undertaken to assess the TBIPC activities. Questionnaires and observation data were analysed using SPSS. Fishers' exact test was performed to determine the similarities and differences in TBIC practices between the health facilities. Significance was assessed at p<=.05. Ethics approval was given by Griffith University Human Research Ethics Committee (GU Ref No: 2021/921). Result(s): Ten of thirteen rural hospitals in the Highlands and Momase region (78%) were surveyed. The majority (N=8,80%) of rural hospitals have inadequate TBIPC programs. Two (20%) facilities have intermediate or advanced TBIPC programs. The facility with advanced TBIPC employed a doctor with public health training. COVID-19 pandemic has provided the impetus to strengthen IPC programs in rural health facilities. Significant differences in TBIPC practices were identified across the two regions (p=0.03). Conclusion(s): Overall, TBIPC guidelines were inadequate in rural hospitals in PNG. The significant differences in TBIPC practices in rural hospitals remain a severe challenge to the TB control efforts. Public health training for health workers could play an important role in IPC programs.Copyright © 2022

Tuberculosis infection prevention and control in rural Papua New Guinea: an evaluation using the infection prevention and control assessment framework.

BACKGROUND: Papua New Guinea (PNG) is one of the 14 countries categorised as having a triple burden of tuberculosis (TB), multidrug-resistant TB (MDR TB), and TB-human immunodeficiency virus (HIV) co-infections. TB infection prevention and control (TB-IPC) guidelines were introduced in 2011 by the National Health Department of PNG. This study assesses the implementation of this policy in a sample of district hospitals in two regions of PNG. METHODS: The implementation of TB-IPC policy was assessed using a survey method based on the World Health Organization (WHO) IPC assessment framework (IPCAF) to implement the WHO's IPC core components. The study included facility assessment at ten district hospitals and validation observations of TB-IPC practices. RESULTS: Overall, implementation of IPC and TB-IPC guidelines was inadequate in participating facilities. Though 80% of facilities had an IPC program, many needed more clearly defined IPC objectives, budget allocation, and yearly work plans. In addition, they did not include senior facility managers in the IPC committee. 80% (n = 8 of 10) of hospitals had no IPC training and education; 90% had no IPC committee to support the IPC team; 70% had no surveillance protocols to monitor infections, and only 20% used multimodal strategies for IPC activities. Similarly, 70% of facilities had a TB-IPC program without a proper budget and did not include facility managers in the TB-IPC team; 80% indicated that patient flow poses a risk of TB transmission; 70% had poor ventilation systems; 90% had inadequate isolation rooms; and though 80% have personal protective equipment available, frequent shortages were reported. CONCLUSIONS: The WHO-recommended TB-IPC policy is not effectively implemented in most of the participating district hospitals. Improvements in implementing and disseminating TB-IPC guidelines, monitoring TB-IPC practices, and systematic healthcare worker training are essential to improve TB-IPC guidelines' operationalisation in health settings to reduce TB prevalence in PNG.

Sociocultural and Behavioral Features of Anticipated COVID-19 Vaccine Acceptance in Papua New Guinea: Protocol for a Mixed Methods Study.

BACKGROUND: COVID-19 was characterized by the World Health Organization (WHO) as a pandemic in 2020. Papua New Guinea (PNG) has remained on high alert ever since, and its National Control Centre continues to coordinate national preparedness and response measures, guided by its Emergency Preparedness and Response Plan for COVID-19. As part of the WHO and the Global Alliance for Vaccines and Immunization's COVID-19 Vaccines Global Access (COVAX) program, PNG received several shipments of COVID-19 vaccine doses. A nationwide vaccine rollout for COVID-19 was initiated in PNG in May 2021. Despite the availability of vaccines and the capacity of health systems to vaccinate frontline workers and community members, including high-risk groups, there are still critical issues related to vaccine safety, confidence, and acceptance to ensure the effectiveness of the COVID-19 vaccination campaign. Evidence from studies on COVID-19 vaccine acceptance and demand in low- and middle-income countries (LMICs) suggests that sociocultural characteristics of the community and the behaviors of different vaccine stakeholders, including vaccine recipients, vaccine providers, and policymakers, determine the effectiveness of vaccination interventions or strategies. OBJECTIVE: This study will examine sociocultural determinants of anticipated acceptance of the COVID-19 vaccine in urban and rural areas of different regions in PNG and health care providers' views on vaccine acceptance. METHODS: The study design uses a mixed methods approach in PNG's coastal and highlands regions. The first research activity will use a qualitative methodology with an epistemological foundation based on constructivism. This design elicits and listens to community members' accounts of ways culture is a rich resource that provides meaning to the COVID-19 pandemic; the design also measures adherence to niupela pasin ("new normal" in Tok Pidgin) and vaccination acceptance. The second activity will be a cross-sectional survey to assess the distribution of features of vaccine acceptance, priorities, and practices. The third activity will be in-depth interviews of health care providers actively involved in either COVID-19 clinical management or public health-related pandemic control activities. RESULTS: The project proposal has been reviewed and approved by the Medical Research Advisory Committee of Papua New Guinea. Qualitative data collection started in December 2022, and the survey will begin in May 2023. The findings will be disseminated to the participating communities later this year, followed by publication. CONCLUSIONS: The proposed research on community views and experiences concerning sociocultural and behavioral features of acceptance of the vaccine will provide a better understanding of communication and education needs for vaccine action for COVID-19 control in PNG and other LMICs. The research also considers the influence of health care providers' and policy makers' roles in the awareness and use of the COVID-19 vaccine. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/44664.

Multimodal learning for emergency department triage implementation: experiences from Papua New Guinea during the COVID-19 pandemic.

Background: Triage implementation in resource-limited emergency departments (EDs) has traditionally relied on intensive in-person training. This study sought to evaluate the impact of a novel digital-based learning strategy focused on the Interagency Integrated Triage Tool, a three-tier triage instrument recommended by the World Health Organization. Methods: A mixed methods study utilising pre-post intervention methods was conducted in two EDs in Papua New Guinea. The primary outcome was the mean change in knowledge before and after completion of a voluntary, multimodal training program, primarily delivered through a digital learning platform accessible via smartphone. Secondary outcomes included the change in confidence to perform selected clinical tasks, and acceptability of the learning methods. Findings: Among 136 eligible ED staff, 91 (66.9%) completed the digital learning program. The mean knowledge score on the post-training exam was 87.5% (SD 10.4), a mean increase of 12.9% (95% CI 10.7-15.1%, p < 0.0001) from the pre-training exam. There were statistically significant improvements in confidence for 13 of 15 clinical tasks, including undertaking a triage assessment and identifying an unwell patient.In an evaluation survey, 100% of 30 respondents agreed or strongly agreed the online learning platform was easy to access, use and navigate, and that the digital teaching methods were appropriate for their learning needs. In qualitative feedback, respondents reported that limited internet access and a lack of dedicated training time were barriers to participation. Interpretation: The use of digital learning to support triage implementation in resource-limited EDs is feasible and effective when accompanied by in-person mentoring. Adequate internet access is an essential pre-requisite. Funding: Development of the Kumul Helt Skul learning platform was undertaken as part of the Clinical Support Program (Phase II), facilitated by Johnstaff International Development on behalf of the Australian Government Department of Foreign Affairs and Trade through the PNG-Australia Partnership. RM is supported by a National Health and Medical Research Council Postgraduate Scholarship and a Monash Graduate Excellence Scholarship, while PC is supported by a Medical Research Future Fund Practitioner Fellowship. Funders had no role in study design, results analysis or manuscript preparation.

Market update: Sixty years of change in Papua New Guineaʼs fresh food marketplaces

Open‐air marketplaces are vital to food security, livelihoods, and the national economy in Papua New Guinea (PNG). Over the past 60 years, rapid growth of urban populations, changes in global commodity prices, and the decline in value of the PNG currency have stimulated demand for domestic fresh food. Selling fresh food in marketplaces has also become an attractive way to earn money for rural producers, whose returns on labour on their export crops have declined, and for urban residents struggling to make a living. This in turn has led to significant changes in PNGʼs marketplaces: spatial and temporal changes, changes in what is bought and sold, changes in who is selling, and changes in how food is transacted. In this paper, we bring together research on PNGʼs marketplaces from between 1961 and 2022 to document these changes and their causes, alongside important continuities, and to examine the implications and substantial gaps in our knowledge.

Establishing a National Emergency Medical Team (EMT) in Papua New Guinea (PNG)

Background/Introduction:Papua New Guinea (PNG) is a Pacific nation of over nine million. It is one of the world’s most diverse nations, with over 800 languages and geographic diversity that includes both tropical islands and highland mountains. Located on the Pacific “ring of fire,” PNG is regularly struck by disasters and outbreaks. The COVID-19 pandemic triggered multiple deployments of international EMTs to PNG, which were coordinated through a national EMT Coordination Cell. To strengthen rapid, national response to future emergencies, the PNG Government through its National Department of Health is now developing the “PNG EMT.”Objectives:To describe the development of the PNG EMT.Method/Description:PNG’s national EMT development was inspired by multiple international EMT deployments, including the 2018 Highlands earthquake and multiple COVID-19 deployments. With support from WHO, PNG’s National Department of Health led EMT coordination efforts in those responses, and recognized the need for similar capabilities to be developed for national response.Results/Outcomes:To develop the PNG EMT, a focal point was appointed, a national technical working group was formed, and SOPs have been drafted with support from WHO and partners. In consultation with PNG and other Pacific EMTs, WHO is procuring a tailored Pacific EMT cache, including items specifically selected for PNG’s diverse geographic and climactic environments. PNG plans to train team members and be ready for self-sufficient national deployments by late 2022.Conclusion:PNG is strengthening readiness for future emergencies by developing a national EMT capable of rapid response to challenging and austere post-disaster environments.

Sharing of Best Practices from an Emergency Medical Team Deployment in Papua New Guinea: Piloting a Health Promotion Program Targeting COVID-19 Vaccine Uptake

Background/Introduction:COVID-19 tremendously affected Papua New Guinea in late 2021, which accompanied by a low vaccination rate (<4%), lead to an International EMT Request for Assistance.Objectives:Study’s aim is to share how UK-Med, a part of the UK EMT, developed best practices related to risk communication and community engagement integration within a COVID-19 emergency response.Method/Description:A participatory health promotion program was piloted in Western Highland Province among 71 health care workers. Training of trainers approach was adopted to build the capacity of health workers in advocating for vaccines uptake. Perception survey was used at the baseline and at the end of the program to assess the knowledge, skills, and attitude of the participants towards COVID-19 vaccine acceptance. A descriptive analysis and paired t-test were used.Results/Outcomes:Health care professionals are not well-equipped with accurate, scientific, and up-to-date information related to COVID-19 vaccines;which leads to increase in concern and fear among them. Health care workers affect community members’ decision to take the COVID-19 vaccine, being viewed as referents within their communities. The paired t-test showed a significant increase in the knowledge, skills, and attitude (P value <.001) of the participants toward COVID-19 vaccines. Participants described being ready to engage community influencers and cascade training to further reach out to community groups.Conclusion:Integrating RCCE within EMT deployments plays a crucial role in leveraging health care capabilities to influence community members and advocate for COVID-19 vaccines uptake;which will ultimately decrease morbidity and mortality. Further research is required to strengthen the role of health promotion in emergencies.

The China Alternative. Changing Regional Order in the Pacific Islands

The presence of China poses a challenge to the dominance of Western powers and their allies, who have set the agenda in the Pacific since the end of the Second World War. [...]today, the region has been characterised by (post-)colonial power structures. In her opening remarks, Dame Meg Taylor clearly states that the Pacific Island states regard the presence of China in the region as a positive development because it gives PIF countries access to markets, technology, financing and infrastructure. The Boe Declaration of the PIF meeting in 2018, which states that "climate change remains the single greatest threat to the livelihoods, security and wellbeing of the peoples of the Pacific" (ix) - is the principal element of efforts by Pacific Island state leaders to implement the "Blue Pacific" concept and stands in stark contrast to the environmental and security policy of PIF member country Australia as well as that of the previous Trump administration. In Australia alone, economic damage caused each year by Beijing's punitive actions in response to bans on Huawei equipment (Australia excludes the Chinese company from the country's 5G roll-out) and COVID-19 demands (Canberra's call for an independent investigation into the origins of the virus) runs into the billions annually.

Stock market prediction by applying big data mining

Purpose: There is a gap in knowledge about the Gulf Cooperation Council (GCC) because most studies are undertaken in countries outside the Gulf region – such as China, India, the US and Taiwan. The stock market contains rich, valuable and considerable data, and these data need careful analysis for good decisions to be made that can lead to increases in the efficiency of a business. Data mining techniques offer data processing tools and applications used to enhance decision-maker decisions. This study aims to predict the Kuwait stock market by applying big data mining. Design/methodology/approach: The methodology used is quantitative techniques, which are mathematical and statistical models that describe a various array of the relationships of variables. Quantitative methods used to predict the direction of the stock market returns by using four techniques were implemented: logistic regression, decision trees, support vector machine and random forest. Findings: The results are all variables statistically significant at the 5% level except gold price and oil price. Also, the variables that do not have an influence on the direction of the rate of return of Boursa Kuwait are money supply and gold price, unlike the Kuwait index, which has the highest coefficient. Furthermore, the height score of the variable that affects the direction of the rate of return is the firms, and the accuracy of the overall performance of the four models is nearly 50%. Research limitations/implications: Some of the limitations identified for this study are as follows: (1) location limitation: Kuwait Stock Exchange;(2) time limitation: the amount of time available to accomplish the study, where the period was completed within the academic year 2019-2020 and the academic year 2020-2021. During 2020, the coronavirus pandemic (COVID-19), which was a major obstacle, occurred during data collection and analysis;(3) data limitation: The Kuwait Stock Exchange data were collected from May 2019 to March 2020, while the factors affecting the stock exchange data were collected in July 2020 due to the corona pandemic. Originality/value: The study used new titles, variables and techniques such as using data mining to predict the Kuwait stock market. There are no adequate studies that predict the stock market by data mining in the GCC, especially in Kuwait. There is a gap in knowledge in the GCC as most studies are in foreign countries, such as China, India, the US and Taiwan. © 2022, Bedour M. Alshammari, Fairouz Aldhmour, Zainab M. AlQenaei and Haidar Almohri.

Seasonal space use and habitat selection in magpie geese: implications for reducing human‐wildlife conflicts

Negative interactions between waterbirds and people are increasing. Waterbirds feeding on agricultural crops cause significant losses to farmers worldwide, but so far most research to address these conflicts has been conducted on migratory species in the temperate northern hemisphere. We investigated the space use and habitat selection of the magpie goose (Anseranas semipalmata), a taxonomically distinct waterbird endemic to Australia and southern Papua New Guinea. In tropical northern Australia, magpie geese are protected but are increasingly persecuted by farmers to protect crops during the late dry–early wet season (~Sep–Jan), a bottleneck of natural resources for waterbirds in the monsoonal tropics. Using satellite telemetry of 38 geese spread across 3 seasons (2016–2017, 2017–2018, 2018–2019), we evaluated daily and seasonal space use, individual site fidelity, and habitat selection to determine the extent of use of agricultural fields by geese, and the spatiotemporal scales at which management should be undertaken. Geese used relatively small daily areas (x̄ = 8.2 km2) consistently throughout the late dry–early wet season, and repeatedly used agricultural fields, forested bushlands, and local wetlands. Geese used comparatively large seasonal areas (x̄ = 219.5 km2) encompassing several agricultural areas, and had a low mean overlap between successive weekly core activity areas, indicating that site fidelity rapidly weakened over time. These results suggest that farm‐scale (<30 ha) management of geese is unlikely to be effective because hazed individuals are likely to be replaced soon afterwards. Instead, our findings suggest that goose management should be coordinated strategically at the local (~1,000 ha), or regional (~100,000 ha) scale. Farm‐level management would likely be more effective if implemented in conjunction with the creation of regional sanctuaries where geese could rest and potentially feed undisturbed away from farms. Our findings can be used by wildlife managers for optimizing the location of such sanctuaries and highlight the necessity for management to be adaptive given the opportunistic nature of the species. [ FROM AUTHOR] Copyright of Journal of Wildlife Management is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

ACORN Papua New Guinea ANGAU Memorial Hospital redevelopment clinical support program (Part 1)

ACORN provided an expert consultancy team known as the Perioperative Clinical Advisory Team (PCAT) to undertake the required work for the key deliverables that were aimed at ensuring a standard of care that will be safe for the patients undergoing surgical procedures provided by Morobe Provincial Health Authority. [...]the governance, operational flows and ORS efficiency are aLL muLtidiscipLinary and require coLLaboration from aLL teams with Leadership from both nursing and medicine to succeed. [...]the primary educational focus was nursing with other deliverables aimed at the muLtidiscipLinary teams. Key deliverables Four key deliverables were identified: 1.Development of a monitoring and evaLuation framework incLuding a governance structure and risk management plan. 2. The PNGPSP incorporates appendices that apply to: * Pre-operative patient checklist * Surgical hand scrubbing procedures (three- and fiveminute) * Surgical hand rubbing procedure * Accountable items count sheet * Papua New Guinea Surgical Safety Checklist * ORS and CSU environmental cleaning audit * Perioperative patient journey audit forms (measured against the standards) * Perioperative safety guidelines (relating to positioning the patient, diathermy safety, pneumatic tourniquet safety, sharps handling and disposal, and specimen coflection) * WHO recommendations for staffing CSU The count sheet and surgical safety checklist can be utilised across all perioperative environments in PNG, therefore, enabling a safe, consistent approach to perioperative documentation.

Journalism education 'truth' challenges An age of growing hate, intolerance and disinformation

This keynote commentary at the 2021 Asian Congress for Media and Communication (ACMC) conference with the theme Change, Adaptation and Culture: Media and Communication in Pandemic Times is addressed through a discussion of three main issues: 1. The COVID-19 Pandemic and how it is being coped with;2. A parallel Infodemic-a crisis of communication, and the surge of 'disinformation' and truth challenges in this 'age of hatred and intolerance';and 3. The global Climate Emergency and the disproportionate impact this is having on the Asia-Pacific region. Finally the author concludes with an overview of some helpful strategics for communicators and educators from his perspective as a journalist and media academic with a mission.

PRIORITY-SETTING FOR EFFECTIVE PANDEMIC PREPAREDNESS: A CASE STUDY OF PRIORITY SETTING FOR COVID-19 IN THE WESTERN PACIFIC REGION

Background There have been divergent approaches used by countries to curb and control the spread, impact and burden of COVID-19. While priority setting - defined as decision- making about the allocation of resources between competing claims of different services, populations and elements of care - is recognized as critical for promoting accountability and transparency in health system planning, its role in supporting rational, equitable and fair pandemic preparedness planning is less well understood. Our multicountry project investigates the effectiveness of priority setting for pandemic preparedness planning. This study aims to describe how priority setting guided the COVID-19 responses implemented in the sub-set of countries in the Western Pacific Region. Methods Guided by the adapted Kapiriri and Martin Framework, we purposively sampled a subset of countries in the WHO Western Pacific Region (WPRO) and undertook a critical document review of national-level pandemic preparedness plans. A pre-specified, validated tool guided data extraction on twenty quality parameters of PS. A critical synthesis was completed. Results Nine plans were included (41% WPRO countries), including: Papua New Guinea, Tonga, Philippines, Fiji, China, Australia, New Zealand, Japan, and Taiwan. There was evidence of strong political will to quickly and effectively combat the pandemic. With 8/9 countries being islands, an emphasis on securing boarders was reflected in the plans. A limited number of quality indicators of effective priority setting were described. Most commonly, plans described resource needs (n=8), stakeholder engagement (n=8), and responsibilities of legitimate institutions (n=7). Consideration of health inequalities, fair financial burden, or public engagement/acceptance of priorities was not evident in any plans. Discussion This project advances understanding of how priority setting has been used in the WPRO region to support COVID-19 responses. It provides a basis for examining the relationship between effective priority setting for pandemic preparedness and country-level outcomes in future work.

Genomic characterisation reveals a dominant lineage of SARS-CoV-2 in Papua New Guinea.

The coronavirus disease pandemic has highlighted the utility of pathogen genomics as a key part of comprehensive public health response to emerging infectious diseases threats, however, the ability to generate, analyse, and respond to pathogen genomic data varies around the world. Papua New Guinea (PNG), which has limited in-country capacity for genomics, has experienced significant outbreaks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with initial genomics data indicating a large proportion of cases were from lineages that are not well defined within the current nomenclature. Through a partnership between in-country public health agencies and academic organisations, industry, and a public health genomics reference laboratory in Australia a system for routine SARS-CoV-2 genomics from PNG was established. Here we aim to characterise and describe the genomics of PNG's second wave and examine the sudden expansion of a lineage that is not well defined but very prevalent in the Western Pacific region. We generated 1797 sequences from cases in PNG and performed phylogenetic and phylodynamic analyses to examine the outbreak and characterise the circulating lineages and clusters present. Our results reveal the rapid expansion of the B.1.466.2 and related lineages within PNG, from multiple introductions into the country. We also highlight the difficulties that unstable lineage assignment causes when using genomics to assist with rapid cluster definitions.

Emergency department triage and COVID-19: Performance of the Interagency Integrated Triage Tool during a pandemic surge in Papua New Guinea.

OBJECTIVE: To determine the sensitivity of the Interagency Integrated Triage Tool to identify severe and critical illness among adult patients with COVID-19. METHODS: A retrospective observational study conducted at Port Moresby General Hospital ED during a three-month Delta surge. RESULTS: Among 387 eligible patients with COVID-19, 63 were diagnosed with severe or critical illness. Forty-seven were allocated a high acuity triage category, equating to a sensitivity of 74.6% (95% CI 62.1-84.7) and a negative predictive value of 92.7% (95% CI 88.4-95.8). CONCLUSION: In a resource-constrained context, the tool demonstrated reasonable sensitivity to detect severe and critical COVID-19, comparable with its reported performance for other urgent conditions.

Pacific Dermatology Training Center-From birth to infancy

The Pacific Dermatology Training Center began its life on February 8th 2019 when it was officially opened by the Hon Minister for Health in Fiji- Hon Ifereimi Waqainabete in Tamavua, Suva, Fiji. This marked a new beginning for Dermatology Services in Fiji-it now has a Training arm that will strengthen Dermatology Services in Fiji and the South Pacific. Following the opening, four young medical officers enrolled through Fiji National University to become the first cohort of the Postgraduate Diploma in Dermatology Programme. While the major disciplines (Internal Medicine, Surgery, Paediatrics, Obstetrics and Gynaecology) have had their postgraduate programme to Masters Level for more than 20 years with the then Fiji School of Medicine, dermatology like many subspecialities was not included. The first dermatology trainees were from Kiribati, Samoa and two from Fiji. The 2019 academic year, although challenging, had four trainees successfully complete the programme through the FNU accredited and supervised programme. Three trainees enrolled in 2020-two Fijians and one from Papua New Guinea, The Covid19 pandemic caused the teaching and assessment to be converted to on-line, in conjunction with clinic participation and supervision. The Fijian trainees were diverted for Covid 19 response. Our PNG student returned home after the first semester, with online teaching and assessment continuing from Fiji and Australia, and the trainee passed the examinations in February 2021. The center continues to survive and three trainees enrolled in 2021 including two Fijian and one Solomon Islander doctors. 2022 will see commencement of the Masters In Medicine (Dermatology) programme and continuation of the Diploma, with 4 students already registering interest. Online teaching will be supplemented by local clinic supervision. The presentation therefore highlights this journey and the players involved behind the scene.

ENT/Audiology Department of Samoa welcomes the introduction of the Pneumococcal Conjugate Vaccine (PCV) into the national childhood immunisation program

The Pacific Island region is estimated to have among the highest levels of otitis media (middle ear infections) and secondary hearing loss in the world [3], and a public health approach has already been advocated for its prevention, early identification, and management in the Pacific Islands [4]. The significant factors contributing to pneumococcal carriage and density continue to be young age, residential location, living with young children, low family income, and symptoms of upper respiratory tract infection [10]. Again, the lesson we can draw from the Papua New Guinean experience is that PCV is but one part of a package of public health care measures: childhood immunisations should not overshadow the role of environmental health measures in reducing the risk of infections. Ear disease, hearing loss, and PCV introduction in Samoa – the way forward At this time, the foreseeable challenge in Samoa is restoring public confidence in childhood immunisations and achieving optimal immunisation coverage rates through health promotion activities [14].

Governance networks in the delivery of public healthcare services in the Pacific: Implementation of the Bougainville Healthy Communities Programme

Networks play a vital role in the delivery of public services, especially in countries where governments are constrained by capacity and funds. This study develops a framework of governance networks based on two dimensions: at the national and community levels, and within the governmental and non‐governmental sectors. Based on the framework, this article analyses the governance networks of the Bougainville Healthy Communities Programme (BHCP) and their nature of integration and collaboration. BHCP mainly operates as a public healthcare advocacy program in Bougainville, an underdeveloped autonomous region of Papua New Guinea. BHCP’s success reveals that the nature of interaction among the various actors is key to making governance networks work. Its experience demonstrates that governance networks are important in the effective delivery of services, particularly in countries where the governments face financial and human resources shortages.

Addressing vaccine hesitancy: survey and experimental evidence from Papua New Guinea

This paper examines the drivers of COVID-19 vaccine hesitancy and tests various means of increasing people's willingness to receive a COVID-19 vaccine. The study draws on data collected through a broadly representative phone survey with 2,533 respondents and an online randomized survey experiment with 2,392 participants in Papua New Guinea. Both surveys show that less than 20 percent of the respondents who were aware a vaccine existed were willing to be vaccinated. The main reason respondents stated for their hesitancy regarding the vaccine was concern about side effects;however, the majority also said health workers could change their mind, particularly if information was communicated in person. The phone survey illustrated that people's level of trust in the vaccine and their beliefs about the behavior of others are strongly associated with their intention to get a COVID-19 vaccine. In contrast, people's concern about COVID-19, most trusted source of information (including social media), and vaccination history were unrelated to their intention to get vaccinated. The online experiment showed that a message that emphasized the relative safety of the vaccine by highlighting that severe side effects are rare, while also emphasizing the dangers of COVID-19, increased intention to get vaccinated by around 50 percent. Collectively, these results suggest that policy makers would be well placed to direct their efforts to boosting the general population's trust that getting vaccinated substantially reduces the risk of severe illness or death from COVID-19.

Estimating Child Mortality at the Sub-national Level in Papua New Guinea: Evidence From the Integrated Health and Demographic Surveillance System.

BACKGROUND: Child mortality is an important indication of an effective public health system. Data sources available for the estimation of child mortality in Papua New Guinea (PNG) are limited. OBJECTIVE: The objective of this study was to provide child mortality estimates at the sub-national level in PNG using new data from the integrated Health and Demographic Surveillance System (iHDSS). METHOD: Using direct estimation and indirect estimation methods, household vital statistics and maternal birth history data were analysed to estimate three key child health indicators: Under 5 Mortality Rate (U5MR), Infant Mortality Rate (IMR) and Neonatal Mortality Rate (NMR) for the period 2014-2017. Differentials of estimates were evaluated by comparing the mean relative differences between the two methods. RESULTS: The direct estimations showed U5MR of 93, IMR of 51 and NMR of 34 per 1000 live births for all the sites in the period 2014-2017. The indirect estimations reported an U5MR of 105 and IMR of 67 per 1000 live births for all the sites in 2014. The mean relative differences in U5MR and IMR estimates between the two methods were 3 and 24 percentage points, respectively. U5MR estimates varied across the surveillance sites, with the highest level observed in Hela Province (136), and followed by Eastern Highlands (122), Madang (105), and Central (42). DISCUSSION: The indirect estimations showed higher estimates for U5MR and IMR than the direct estimations. The differentials between IMR estimates were larger than between U5MR estimates, implying the U5MR estimates are more reliable than IMR estimates. The variations in child mortality estimates between provinces highlight the impact of contextual factors on child mortality. The high U5MR estimates were likely associated with inequality in socioeconomic development, limited access to healthcare services, and a result of the measles outbreaks that occurred in the highlands region from 2014-2017. CONCLUSION: The iHDSS has provided reliable data for the direct and indirect estimations of child mortality at the sub-national level. This data source is complementary to the existing national data sources for monitoring and reporting child mortality in PNG.