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.

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.

COVID-19 in Pakistan and Papua New Guinea: reflections on mass testing and challenges.

The 2020 COVID-19 pandemic continues during 2021. Some countries are revisiting their containment measures to be eased or re-imposed after massive testing programs. Yet is testing itself a solution? Testing may be an important containment step, yet in low-income countries (LICs), it may be substantially challenging to carry out. This is because the situation in LICs is complexified by inadequate and corrupt economic, political, and healthcare systems in which testing is often beyond reach. Focusing on Pakistan and Papua New Guinea (PNG), we contend that the sparse number of recorded COVID-19 infections may demonstrate that both countries lack the required resources to conduct effective testing and deal with the pandemic. To appropriately tackle the pandemic, such countries need focus on implementing the measures they can and on public education about how viruses work and why it is so important to seek to contain their spread. Furthermore, we invite thorough studies to examine and analyze massive testing from various perspectives.

Point-of-care testing and treatment of sexually transmitted and genital infections during pregnancy in Papua New Guinea (WANTAIM trial): protocol for an economic evaluation alongside a cluster-randomised trial.

INTRODUCTION: Left untreated, sexually transmitted and genital infections (henceforth STIs) in pregnancy can lead to serious adverse outcomes for mother and child. Papua New Guinea (PNG) has among the highest prevalence of curable STIs including syphilis, chlamydia, gonorrhoea, trichomoniasis and bacterial vaginosis, and high neonatal mortality rates. Diagnosis and treatment of these STIs in PNG rely on syndromic management. Advances in STI diagnostics through point-of-care (PoC) testing using GeneXpert technology hold promise for resource-constrained countries such as PNG. This paper describes the planned economic evaluation of a cluster-randomised cross-over trial comparing antenatal PoC testing and immediate treatment of curable STIs with standard antenatal care in two provinces in PNG. METHODS AND ANALYSIS: Cost-effectiveness of the PoC intervention compared with standard antenatal care will be assessed prospectively over the trial period (2017-2021) from societal and provider perspectives. Incremental cost-effectiveness ratios will be calculated for the primary health outcome, a composite measure of the proportion of either preterm birth and/or low birth weight; for life years saved; for disability-adjusted life years averted; and for non-health benefits (financial risk protection and improved health equity). Scenario analyses will be conducted to identify scale-up options, and budget impact analysis will be undertaken to understand short-term financial impacts of intervention adoption on the national budget. Deterministic and probabilistic sensitivity analysis will be conducted to account for uncertainty in key model inputs. ETHICS AND DISSEMINATION: This study has ethical approval from the Institutional Review Board of the PNG Institute of Medical Research; the Medical Research Advisory Committee of the PNG National Department of Health; the Human Research Ethics Committee of the University of New South Wales; and the Research Ethics Committee of the London School of Hygiene and Tropical Medicine. Findings will be disseminated through national stakeholder meetings, conferences, peer-reviewed publications and policy briefs. TRIAL REGISTRATION NUMBER: ISRCTN37134032.

Barriers and enablers experienced by health care workers in swabbing for COVID-19 in Papua New Guinea: A multi-methods cross-sectional study.

OBJECTIVE: We aimed to identify the barriers and enablers that Health Care Workers (HCWs) in Papua New Guinea experienced in swabbing for COVID-19. METHODS: We conducted a cross-sectional multi-methods study: a qualitative scoping exercise and a telephone survey. The target population was COVID-19-trained HCWs from all provinces of Papua New Guinea. A descriptive analysis of survey responses was conducted alongside a rapid qualitative analysis of interviews and open-ended survey questions. RESULTS: Four thematic areas were identified: human resources, logistics, HCW attitudes and community attitudes. The survey response rate was 70.3% (407/579). Commonly reported barriers to COVID-19 swabbing were insufficient staff trained (74.0%, n = 301), inadequate staffing in general (64.9%, n = 264), insufficient supply of personal protective equipment (60.9%, n = 248) and no cold chain to store swabs (57.5%, n = 234). Commonly reported enablers to swabbing were community awareness and risk communication (80.8%, n = 329), consistent and sufficient supplies of personal protective equipment (67.8%, n = 276), increased surge workforce (63.9%, n = 260) and having a fridge to store swabs (59.7%, n = 243). CONCLUSIONS: A comprehensive community and HCW engagement strategy combined with innovations to improve the supply chain are needed to increase COVID-19 swabbing in Papua New Guinea to reach national testing targets. Investments in increasing numbers of frontline workforce, consistent supplies of PPE, swabs, transport medium, cold boxes and ability to make ice packs, in addtion to establishing regular tranport of specimens from the facility to the testing site will strengthen the supply chain. Innovations are needed to address these issues.

Transforming the health information system using mobile and geographic information technologies, Papua New Guinea.

In the context of declining economic growth, now exacerbated by the coronavirus disease 2019 pandemic, Papua New Guinea is increasing the efficiency of its health systems to overcome difficulties in reaching global health and development targets. Before 2015, the national health information system was fragmented, underfunded, of limited utility and accessed infrequently by health authorities. We built an electronic system that integrated mobile technologies and geographic information system data sets of every house, village and health facility in the country. We piloted the system in 184 health facilities across five provinces between 2015 and 2016. By the end of 2020, the system's mobile tablets were rolled out to 473 facilities in 13 provinces, while the online platform was available in health authorities of all 22 provinces, including church health services. Fractured data siloes of legacy health programmes have been integrated and a platform for civil registration systems established. We discuss how mobile technologies and geographic information systems have transformed health information systems in Papua New Guinea over the past 6 years by increasing the timeliness, completeness, quality, accessibility, flexibility, acceptability and utility of national health data. To achieve this transformation, we highlight the importance of considering the benefits of mobile tools and using rich geographic information systems data sets for health workers in primary care in addition to the needs of public health authorities.

Dans un contexte de déclin de la croissance économique, exacerbé par la pandémie de maladie à coronavirus, la Papouasie-Nouvelle-Guinée a décidé d'augmenter l'efficacité de ses systèmes sanitaires afin de surmonter les difficultés à atteindre les objectifs globaux en matière de santé et de développement. Avant 2015, le système d'information sanitaire national était fragmenté, sous-financé, peu utile et rarement consulté par les autorités sanitaires. Nous avons donc conçu un système électronique intégrant des technologies mobiles et des ensembles de données géographiques provenant de chaque ménage, de chaque village et de chaque établissement de soins du pays. Entre 2015 et 2016, nous avons piloté le système dans 184 établissements de soins répartis sur cinq provinces. Fin 2020, les tablettes mobiles du système ont été distribuées dans 473 établissements de 13 provinces, tandis que les autorités sanitaires des 22 provinces du pays, y compris les services sanitaires confessionnels, ont pu accéder à la plateforme en ligne. Les silos de données fragmentées des programmes de santé antérieurs y ont été incorporés et une plateforme destinée aux registres d'état civil a été créée. Le présent document se penche sur la manière dont les technologies d'information mobiles et géographiques ont transformé les systèmes d'information sanitaire en Papouasie-Nouvelle-Guinée ces six dernières années en améliorant la ponctualité, l'exhaustivité, la qualité, l'accessibilité, la flexibilité, la recevabilité et l'utilité des données nationales sur la santé. Pour réaliser cette transformation, il est à nos yeux essentiel de tenir compte des avantages que représentent les outils mobiles, et de tirer profit des vastes ensembles de données géographiques non seulement pour les travailleurs des soins de santé primaires, mais aussi pour les besoins des autorités de santé publique.

En el contexto de un crecimiento económico en declive, agravado ahora por la pandemia de la enfermedad por coronavirus, Papúa Nueva Guinea está aumentando la eficiencia de sus sistemas sanitarios para superar las dificultades para alcanzar los objetivos globales de salud y desarrollo. Antes de 2015, el sistema nacional de información sanitaria estaba fragmentado, carecía de fondos suficientes, su utilidad era limitada y las autoridades sanitarias accedían a él con poca frecuencia. Construimos un sistema electrónico que integraba tecnologías móviles y conjuntos de datos del sistema de información geográfica de cada casa, pueblo y centro de salud del país. Entre 2015 y 2016 pusimos a prueba el sistema en 184 centros de salud de cinco provincias. A finales de 2020, las tabletas móviles del sistema se implementaron en 473 centros de 13 provincias, mientras que la plataforma en línea estaba disponible en las autoridades sanitarias de las 22 provincias, incluidos los servicios de salud de las iglesias. Se han integrado los silos de datos fracturados de los programas sanitarios heredados y se ha establecido una plataforma para los sistemas de registro civil. Exponemos cómo las tecnologías móviles y los sistemas de información geográfica han transformado los sistemas de información sanitaria en Papúa Nueva Guinea en los últimos seis años, aumentando la puntualidad, la exhaustividad, la calidad, la accesibilidad, la flexibilidad, la aceptabilidad y la utilidad de los datos sanitarios nacionales. Para lograr esta transformación, destacamos la importancia de tener en cuenta los beneficios de las herramientas móviles y de utilizar conjuntos de datos ricos en sistemas de información geográfica para los trabajadores sanitarios de la atención primaria, además de las necesidades de las autoridades sanitarias públicas.

A comparison of non-magnetic and magnetic beads for measuring IgG antibodies against Plasmodium vivax antigens in a multiplexed bead-based assay using Luminex technology (Bio-Plex 200 or MAGPIX).

Multiplexed bead-based assays that use Luminex® xMAP® technology have become popular for measuring antibodies against proteins of interest in many fields, including malaria and more recently SARS-CoV-2/COVID-19. There are currently two formats that are widely used: non-magnetic beads or magnetic beads. Data are lacking regarding the comparability of results obtained using these two types of beads, and for assays run on different instruments. Whilst non-magnetic beads can only be run on flow-based instruments (such as the Luminex® 100/200™ or Bio-Plex® 200), magnetic beads can be run on both these and the newer MAGPIX® instruments. In this study we utilized a panel of purified recombinant Plasmodium vivax proteins and samples from malaria-endemic areas to measure P. vivax-specific IgG responses using different combinations of beads and instruments. We directly compared: i) non-magnetic versus magnetic beads run on a Bio-Plex® 200, ii) magnetic beads run on the Bio-Plex® 200 versus MAGPIX® and iii) non-magnetic beads run on a Bio-Plex® 200 versus magnetic beads run on the MAGPIX®. We also performed an external comparison of our optimized assay. We observed that IgG antibody responses, measured against our panel of P. vivax proteins, were moderately-strongly correlated in all three of our comparisons (pearson r>0.5 for 18/19 proteins), however higher amounts of protein were required for coupling to magnetic beads. Our external comparison indicated that results generated in different laboratories using the same coupled beads are also highly comparable (pearson r>0.7), particularly if a reference standard curve is used.

Association between the spread of COVID-19 and weather-climatic parameters.

OBJECTIVE: To explore whether the climate has played a role in the COVID-19 outbreak, we compared virus lethality in countries closer to the Equator with others. Lethality in European territories and in territories of some nations with a non-temperate climate was also compared. MATERIALS AND METHODS: Lethality was calculated as the rate of deaths in a determinate moment from the outbreak of the pandemic out of the total of identified positives for COVID-19 in a given area/nation, based on the COVID-John Hopkins University website. Lethality of countries located within the 5th parallels North/South on 6 April and 6 May 2020, was compared with that of all the other countries. Lethality in the European areas of The Netherlands, France and the United Kingdom was also compared to the territories of the same nations in areas with a non-temperate climate. RESULTS: A lower lethality rate of COVID-19 was found in Equatorial countries both on April 6 (OR=0.72 CI 95% 0.66-0.80) and on May 6 (OR=0.48, CI 95% 0.47-0.51), with a strengthening over time of the protective effect. A trend of higher risk in European vs. non-temperate areas was found on April 6, but a clear difference was evident one month later: France (OR=0.13, CI 95% 0.10-0.18), The Netherlands (OR=0.5, CI 95% 0.3-0.9) and the UK (OR=0.2, CI 95% 0.01-0.51). This result does not seem to be totally related to the differences in age distribution of different sites. CONCLUSIONS: The study does not seem to exclude that the lethality of COVID-19 may be climate sensitive. Future studies will have to confirm these clues, due to potential confounding factors, such as pollution, population age, and exposure to malaria.