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.

Lessons from the first 6 years of an intervention-based field epidemiology training programme in Papua New Guinea, 2013-2018.

Papua New Guinea (PNG) faces a critical shortage of human resources to address pressing public health challenges arising from an increasing burden of communicable and non-communicable diseases. PNG is an independent State in the Pacific and home to 8.2 million people. Resource and infrastructure constraints due to the country's challenging geography have made it difficult and expensive to deliver health services and implement health programmes. The National Department of Health and its partners developed a field epidemiology training programme of Papua New Guinea (FETPNG) to strengthen the country's public health workforce. The training programme covers field epidemiology competencies and includes the design, implementation and evaluation of evidence-based interventions by Fellows. From 2013 to 2018, FETPNG graduated 81 field epidemiologists. Most FETPNG graduates (84%) were from provincial or district health departments or organisations. Many of their intervention projects resulted in successful public health outcomes with tangible local impacts. Health challenges addressed included reducing the burden of multi-drug resistant-tuberculosis (TB), increasing immunisation coverage, screening and treating HIV/TB patients, and improving reproductive health outcomes. FETPNG Fellows and graduates have also evaluated disease surveillance systems and investigated disease outbreaks. Early and unwavering national ownership of FETPNG created a sustainable programme fitting the needs of this low-resource country. A focus on designing and implementing effective public health interventions not only provides useful skills to Fellows but also contributes to real-time, tangible and meaningful improvements in the health of the population. The graduates of FETPNG now provide a critical mass of public health practitioners across the country. Their skills in responding to outbreaks and public health emergencies, in collecting, analysing and interpreting data, and in designing, implementing and evaluating public health interventions continues to advance public health in PNG.

Spatio-temporal epidemiology of the cholera outbreak in Papua New Guinea, 2009-2011.

BACKGROUND: Cholera continues to be a devastating disease in many developing countries where inadequate safe water supply and poor sanitation facilitate spread. From July 2009 until late 2011 Papua New Guinea experienced the first outbreak of cholera recorded in the country, resulting in >15,500 cases and >500 deaths. METHODS: Using the national cholera database, we analysed the spatio-temporal distribution and clustering of the Papua New Guinea cholera outbreak. The Kulldorff space-time permutation scan statistic, contained in the software package SatScan v9.2 was used to describe the first 8 weeks of the outbreak in Morobe Province before cholera cases spread throughout other regions of the country. Data were aggregated at the provincial level to describe the spread of the disease to other affected provinces. RESULTS: Spatio-temporal and cluster analyses revealed that the outbreak was characterized by three distinct phases punctuated by explosive propagation of cases when the outbreak spread to a new region. The lack of road networks across most of Papua New Guinea is likely to have had a major influence on the slow spread of the disease during this outbreak. CONCLUSIONS: Identification of high risk areas and the likely mode of spread can guide government health authorities to formulate public health strategies to mitigate the spread of the disease through education campaigns, vaccination, increased surveillance in targeted areas and interventions to improve water, sanitation and hygiene.

Event-based surveillance in Papua New Guinea: strengthening an International Health Regulations (2005) core capacity.

Under the International Health Regulations (2005), Member States are required to develop capacity in event-based surveillance (EBS). The Papua New Guinea National Department of Health established an EBS system during the influenza pandemic in August 2009. We review its performance from August 2009 to November 2012, sharing lessons that may be useful to other low-resource public health practitioners working in surveillance. We examined the EBS system's event reporting, event verification and response. Characteristics examined included type of event, source of information, timeliness, nature of response and outcome. Sixty-one records were identified. The median delay between onset of the event and date of reporting was 10 days. The largest proportion of reports (39%) came from Provincial Health Offices, followed by direct reports from clinical staff (25%) and reports in the media (11%). Most (84%) of the events were substantiated to be true public health events, and 56% were investigated by the Provincial Health Office alone. A confirmed or probable etiology could not be determined in 69% of true events. EBS is a simple strategy that forms a cornerstone of public health surveillance and response particularly in low-resource settings such as Papua New Guinea. There is a need to reinforce reporting pathways, improve timeliness of reporting, expand sources of information, improve feedback and improve diagnostic support capacity. For it to be successful, EBS should be closely tied to response.

Mobile phone-based syndromic surveillance system, Papua New Guinea.

The health care system in Papua New Guinea is fragile, and surveillance systems infrequently meet international standards. To strengthen outbreak identification, health authorities piloted a mobile phone-based syndromic surveillance system and used established frameworks to evaluate whether the system was meeting objectives. Stakeholder experience was investigated by using standardized questionnaires and focus groups. Nine sites reported data that included 7 outbreaks and 92 cases of acute watery diarrhea. The new system was more timely (2.4 vs. 84 days), complete (70% vs. 40%), and sensitive (95% vs. 26%) than existing systems. The system was simple, stable, useful, and acceptable; however, feedback and subnational involvement were weak. A simple syndromic surveillance system implemented in a fragile state enabled more timely, complete, and sensitive data reporting for disease risk assessment. Feedback and provincial involvement require improvement. Use of mobile phone technology might improve the timeliness and efficiency of public health surveillance.

Outbreak of chikungunya virus infection, Vanimo, Papua New Guinea.

In June 2012, health authorities in Papua New Guinea detected an increase in febrile illnesses in Vanimo. Chikungunya virus of the Eastern/Central/Southern African genotype harboring the E1:A226V mutation was identified. This ongoing outbreak has spread to ≥8 other provinces and has had a harmful effect on public health.

Vibrio cholerae antimicrobial drug resistance, Papua New Guinea, 2009–2011

Cholera is an acute infectious disease caused by Vibrio cholerae . The disease occurs in a variety of forms ranging from sporadic cases to outbreaks that may transition to endemic disease. While cholera case management focuses on early, rapid rehydration, antimicrobial therapy can reduce the volume of diarrhoea, duration of carriage and symptoms and is frequently recommended for patients with severe dehydration.

Event-based surveillance in Papua New Guinea: strengthening an International Health Regulations (2005) core capacity

Under the International Health Regulations (2005), Member States are required to develop capacity in event-based surveillance (EBS). The Papua New Guinea National Department of Health established an EBS system during the influenza pandemic in August 2009. We review its performance from August 2009 to November 2012, sharing lessons that may be useful to other low-resource public health practitioners working in surveillance. We examined the EBS system’s event reporting, event verification and response. Characteristics examined included type of event, source of information, timeliness, nature of response and outcome. Sixty-one records were identified. The median delay between onset of the event and date of reporting was 10 days. The largest proportion of reports (39%) came from Provincial Health Offices, followed by direct reports from clinical staff (25%) and reports in the media (11%). Most (84%) of the events were substantiated to be true public health events, and 56% were investigated by the Provincial Health Office alone. A confirmed or probable etiology could not be determined in 69% of true events. EBS is a simple strategy that forms a cornerstone of public health surveillance and response particularly in low-resource settings such as Papua New Guinea. There is a need to reinforce reporting pathways, improve timeliness of reporting, expand sources of information, improve feedback and improve diagnostic support capacity. For it to be successful, EBS should be closely tied to response.

Clonal origins of Vibrio cholerae O1 El Tor strains, Papua New Guinea, 2009-2011.

We used multilocus sequence typing and variable number tandem repeat analysis to determine the clonal origins of Vibrio cholerae O1 El Tor strains from an outbreak of cholera that began in 2009 in Papua New Guinea. The epidemic is ongoing, and transmission risk is elevated within the Pacific region.