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.

Artemisinin-naphthoquine combination (ARCO) therapy for uncomplicated falciparum malaria in adults of Papua New Guinea: a preliminary report on safety and efficacy.

BACKGROUND: The use of anti-malarial drug combinations with artemisinin or with one of its derivatives is now widely recommended to overcome drug resistance in falciparum as well as vivax malaria. The fixed oral dose artemisinin-naphthoquine combination (ANQ, ARCO) is a newer artemisinin-based combination (ACT) therapy undergoing clinical assessment. A study was undertaken to assess the safety, efficacy and tolerability of ANQ combination in areas of multi-drug resistance to generate preliminary baseline data in adult population of Papua New Guinea. METHODS: The clinical assessment was an open-labeled, two-arm, randomized study comparing ANQ combination as a single dose regimen and three days regimen (10 mg/kg/day) of chloroquine plus single dose sulphadoxine-pyrimethamine (CQ+SP) for the treatment of uncomplicated falciparum malaria with 28 days follow-up in an adult population. The primary outcome measures for efficacy were day 1, 2, 3 7, 14 and 28-day cure rates. Secondary outcomes included parasite clearance time, fever clearance time, and gametocyte carriage. The main outcome measures for safety were incidences of post-treatment clinical and laboratory adverse events. RESULTS: Between June 2005 and July 2006, 130 patients with confirmed uncomplicated P. falciparum were randomly assigned to receive ANQ and CQ+SP, only 100 patients (51 in ANQ group and 49 in CQ+SP group) were evaluated for clinical and parasitological outcomes. All the patients treated with ANQ and CQ+SP showed adequate clinical and parasitological response with 28 days follow-up. The cure rate for ANQ on day 1, 2, 3, 7, 14, and 28 was 47%, 86%, 92%, 94%, 94% and 94%, respectively. Recrudescence account for 6%; all were cleared on day 21. For CQ+SP treated group the cure rates were 24%, 67%, 82%, 82%, 84% and 88%, respectively. Recrudescence accounted for 10%; all were cleared on day 28 except for one patient. Both regimens were well tolerated with no serious adverse events. The proportion of gametocyte carriers was higher in CQ+SP treated group than ANQ treatment (41% versus 12%; p < 0.05). CONCLUSION: While these data are not themselves sufficient, it strongly suggests that the ANQ combination as a single dose administration is safe and effective for the treatment of uncomplicated P. falciparum malaria in the adult population of Papua New Guinea and deserves further clinical evaluation.

A surveillance information system as a management tool: a report from Papua New Guinea.

To have a very good surveillance system, it is paramount important to have a functional health information system that could be easily used for monitoring and investigation of disease outbreaks. In Papua New Guinea (PNG) a national health information system was developed, trailed and implemented nationwide. Furthermore to have the system working linked to it must be the local health system for sustainability and control. A public health manual for disease surveillance in PNG was developed and is now being used for surveillance. This paper describes how the health information system, particularly surveillance system was developed and implemented on the national scale, how it was integrated with other management information systems and how information has been used to support management decision-making and informed policy decision. It will highlight some of the hurdles that it has encountered while trying to implement the system. PNG has one of the best national health information system as compared to many developing countries but limited information generated from the system. There was also less feedback from all levels of the health sector. We need to improve surveillance on the basic principles of integration, focus, and sharing of work. There must be an appropriate and timely response and feedback. We need to improve on the current system rather than building a new one.

Smoking prevalence among young people in Papua New Guinea.

This study done was done during the 1996/1997-school break in NCD and Manus. There were total of 2000 and 1000 young people were interviewed respectively from NCD and Manus. From the 1150 males and 850 females interviewed in NCD, 115(10%) males and 315(37%) females were non-smokers. There were 138(12%) males and 68(8%) females smoked cigarettes. There were 150(13%) males and 84(10%) females smoked marijuana. Those who smoked marijuana also smoked cigarettes and mutrus. Even though there was higher rate of smokers among males, there is a high rate among female smokers in NCD. There were 163(10%) and 63(7%) smokers for the age group 8-10 yrs in NCD and Manus respectively. For the age group 11-12 there were 186(12%) in NCD and 91(11%) in Manus. In NCD there were 257(16%) smokers and 107(13%) in Manus in the age group of 13-14 yrs. There were 281(18%) and 153(18%) smokers in the age group 15-16 yrs in NCD and Manus respectively. There were 157(37%) of non-smokers in NCD and 28(18%) in Manus did not smoke because of they were told by their teachers on the dangers of tobacco and marijuana smoking. The effort by health workers on health messages on the dangers of smoking tobacco and marijuana did influence 72(17%) non-smokers in NCD and 56(36%) in Manus on young people. Parents and teachers have full responsibility of ensuring that messages on the dangers of tobacco and marijuana smoking aregiven to the young people. Aggressive promotion of cigarette products has influenced smoking and should be stopped.