Papua New Guinea Institute of Medical Research PNGIMR

Goroka, Papua New Guinea

Papua New Guinea Institute of Medical Research PNGIMR

Goroka, Papua New Guinea
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Barnadas C.,Papua New Guinea Institute of Medical Research PNGIMR | Barnadas C.,Walter and Eliza Hall Institute of Medical Research | Kent D.,Case Western Reserve University | Timinao L.,Papua New Guinea Institute of Medical Research PNGIMR | And 7 more authors.
Malaria Journal | Year: 2011

Background: Reports of severe cases and increasing levels of drug resistance highlight the importance of improved Plasmodium vivax case management. Whereas monitoring P. vivax resistance to anti-malarial drug by in vivo and in vitro tests remain challenging, molecular markers of resistance represent a valuable tool for high-scale analysis and surveillance studies. A new high-throughput assay for detecting the most relevant markers related to P. vivax drug resistance was developed and assessed on Papua New Guinea (PNG) patient isolates. Methods. Pvdhfr, pvdhps and pvmdr1 fragments were amplified by multiplex nested PCR. Then, PCR products were processed through an LDR-FMA (ligase detection reaction - fluorescent microsphere assay). 23 SNPs, including pvdhfr 57-58-61 and 173, pvdhps 382-383, 553, 647 and pvmdr1 976, were simultaneously screened in 366 PNG P. vivax samples. Results: Genotyping was successful in 95.4% of the samples for at least one gene. The coexistence of multiple distinct haplotypes in the parasite population necessitated the introduction of a computer-assisted approach to data analysis. Whereas 73.1% of patients were infected with at least one wild-type genotype at codons 57, 58 and 61 of pvdhfr, a triple mutant genotype was detected in 65.6% of the patients, often associated with the 117T mutation. Only one patient carried the 173L mutation. The mutant 647P pvdhps genotype allele was approaching genetic fixation (99.3%), whereas 35.1% of patients were infected with parasites carrying the pvmdr1 976F mutant allele. Conclusions: The LDR-FMA described here allows a discriminant genotyping of resistance alleles in the pvdhfr, pvdhps, and pvmdr1 genes and can be used in large-scale surveillance studies. © 2011 Barnadas et al; licensee BioMed Central Ltd.


Grant
Agency: European Commission | Branch: FP7 | Program: CP-FP | Phase: HEALTH-2007-2.3.2-4 | Award Amount: 3.93M | Year: 2008

Malaria in pregnancy has been recently prioritised by the EC 7th Framework Program. In response, we propose to carry out a cohort observational study in pregnant women in 5 P. vivax endemic countries, broadly representing most of the worlds infections. The Indian and Papua New Guinean endemic sites are included because of their important contribution to the global burden of vivax malaria; PNG has a high prevalence of asymptomatic P. vivax infections resembling P. falciparum infection in sub-Saharan Africa, and India contributes to nearly 80% of malaria cases in Southeast Asia. In Latin America, 3 countries are selected, Guatemala, Colombia and Brazil. In Guatemala P vivax is responsible for almost all malaria cases, in Colombia and Brazil it co-exists in different proportions with falciparum. Pregnant women will be enrolled at each site during routine antenatal care visits (ANC) and followed-up at the health facility until delivery or end of pregnancy. P. vivax malaria parasitaemia will be assessed at enrolment, at every contact with the health facility and at delivery. In a sub-sample of women, peripheral blood will be taken for immunological/molecular studies, and placental samples will be collected. To assess with precision the prevalence of infection (estimated to be around 4% on average) and to obtain sufficient number of pregnant women with P vivax infection to determine the impact on birthweight, 2000 pregnant women per site will be enrolled. Due to the likely low prevalence of infection in pregnancy, the number of pregnant women with P. vivax per site will probably not be enough to assess specific impact for each site, thus a multicentric study design will be used. Immunological analysis will be performed to unveil whether there are pregnancy-specific immune responses. Phenotypic and genotypic analyses of parasites from the placenta should reveal their adhesive properties and whether the accumulation of infected erythrocytes unique parasite population.


Pulford J.,Papua New Guinea Institute of Medical Research PNGIMR | Pulford J.,University of Queensland | Kurumop S.F.,Papua New Guinea Institute of Medical Research PNGIMR | Ura Y.,Papua New Guinea Institute of Medical Research PNGIMR | And 6 more authors.
Malaria Journal | Year: 2013

Background: This paper reports on the availability of diagnostic tools and recommended anti-malarials in the 12-month period immediately following the implementation of a new national malaria treatment protocol (NMTP) in Papua New Guinea (PNG). Health worker adherence to the new NMTP is also examined and comparisons made with previously reported pre-implementation findings. Methods. A countrywide cross-sectional survey in randomly selected primary health care facilities (n = 88). Data were collected via passive observation of the clinical case management of fever or suspected malaria patients and via an interviewer administered questionnaire completed with the officer in charge of each participating health care facility. Results: Malaria rapid diagnostic tests (RDTs) and the new first-line anti-malarial medication, artemether-lumefantrine (AL), were available in 53.4% and 51.1% of surveyed heath facilities, respectively. However, they were more widely available in the larger health centres as compared to the smaller aid-posts (90.2% vs. 21.3% and 87.8% vs. 19.2%, respectively). Overall, 68.3% of observed fever cases (n = 445) were tested for malaria by RDT and 39% prescribed an anti-malarial, inclusive of 98.2% of RDT positive patients and 19.8% of RDT negative cases. The availability and use of malaria RDTs was greater in the current survey as compared to pre-implementation of the new NMTP (8.9% vs. 53.4% & 16.2% vs. 68.3%, respectively) as was the availability of AL (0% vs. 51.1%). The percentage of fever patients prescribed anti-malarials decreased substantially post implementation of the new NMTP (96.4% vs. 39.0%). Conclusions: PNG has achieved high coverage of malaria RDTs and AL at the health centre level, but these resources have yet to reach the majority of aid-posts. Malaria case management practice has substantially changed in the 12-month period immediately following the new NMTP, although full protocol adherence was rarely observed. © 2013 Pulford et al.; licensee BioMed Central Ltd.


PubMed | Swiss Tropical and Public Health Institute, University of Barcelona and Papua New Guinea Institute of Medical Research PNGIMR
Type: Journal Article | Journal: BMC health services research | Year: 2017

The Papua New Guinea Department of Health recently shifted from a presumptive to a test and treat malaria case management policy. This shift was supported by the widespread introduction of malaria rapid diagnostic tests in health facilities across the country. Health workers received training and job-aids detailing how to conduct and interpret a malaria rapid diagnostic test and how to treat test positive cases; however, little instruction on treating non-malaria febrile cases was provided. Accordingly, this study examined health worker case management of non-malarial febrile patients in the 12-month period immediately following the introduction of the revised malaria case management policy.Data were collected from a country-wide cross-sectional survey of febrile case management at randomly selected health facilities and from longitudinal surveillance at sentinel health facilities. Analysis was restricted to febrile patients who tested negative for malaria infection by rapid diagnostic test (N=303 and 5705 outpatients, respectively).96.8% of non-malarial febrile patients received a diagnosis in the longitudinal sample, compared to 52.4% of the cross-sectional sample. Respiratory tract infections were the most commonly reported diagnoses. Over 90% of patients in both samples were prescribed one or more medications, most commonly an analgesic (71.3 & 72.9% of the longitudinal and cross-sectional samples, respectively), some form of antibiotic (72.7 & 73.4%, respectively) and/or an anthelminthic (17.9 & 16.5%, respectively). Prescribing behaviour was adherent with the recommendations in the standard treatment guidelines in fewer than 20% of cases (longitudinal sample only).Many non-malarial febrile patients are not provided with a diagnosis. When diagnoses are provided they are typically some form of respiratory tract infection. Antibiotics and analgesics are widely prescribed, although medications prescribed rarely adhere to the Papua New Guinea standard treatment guidelines. These findings indicate that Papua New Guinea health workers require support for non-malarial febrile illness case management.


PubMed | Papua New Guinea Institute of Medical Research PNGIMR, Walter and Eliza Hall Institute of Medical Research, University of Western Australia, Swiss Tropical and Public Health Institute and 3 more.
Type: Journal Article | Journal: Antimicrobial agents and chemotherapy | Year: 2014

Intermittent preventive treatment of infants (IPTi) reduces early childhood malaria-related morbidity. While genotypic drug resistance markers have proven useful in predicting the efficacy of antimalarial drugs in case management, there are few equivalent data relating to their protective efficacy when used as IPTi. The present data from an IPTi trial in Papua New Guinea demonstrate how these markers can predict protective efficacy of IPTi for both Plasmodium falciparum and Plasmodium vivax.


PubMed | Royal Melbourne Hospital, University of New South Wales, Papua New Guinea Institute of Medical Research PNGIMR, Walter and Eliza Hall Institute of Medical Research and Burnet Institute
Type: Journal Article | Journal: Sexually transmitted infections | Year: 2015

To determine the prevalence of, and risk factors associated with, Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis infection in pregnant women in Madang, Papua New Guinea (PNG).A cross-sectional survey was conducted among 400 pregnant women presenting to antenatal clinics. Sociodemographic and behavioural data were collected and real-time PCR diagnostic methods were used to detect the presence of chlamydia, gonorrhoea and trichomonas in self-collected vaginal swabs. The relationships between symptoms, sociodemographic and behavioural factors and infection were assessed.The prevalence of C. trachomatis was 11.1%, N. gonorrhoeae was 9.7% and T. vaginalis was 21.3%. One-third of women (33.7%) had at least one infection. The most common symptom was abdominal pain (48.0%), but only abnormal vaginal discharge was consistently associated with infection (p<0.001). Women diagnosed with vaginal discharge syndrome were more likely to have at least one treatable infection (50.0% (47/94) vs 26.8% (68/254), p<0.001), yet 59.1% of women with infection would have been missed by the current clinically-based syndromic diagnosis. Risk factors included having a partner at perceived risk of infection, maternal extramarital intercourse, early sexual debut, lack of formal education, urban residence and smoking. 78.8% of women reported never using condoms.The prevalences of T. vaginalis, C. trachomatis and N. gonorrhoeae were high among pregnant women in coastal PNG. The poor performance of clinically based syndromic diagnosis suggests that alternative strategies are urgently required to improve detection and reduce the burden of sexually transmitted infections and their associated adverse pregnancy outcomes in this population.


Pulford J.,Papua New Guinea Institute of Medical Research PNGIMR | Pulford J.,University of Auckland | Adams P.,University of Auckland | Sheridan J.,University of Auckland
Addiction Research and Theory | Year: 2011

This article presents findings from a study that examined the assistance aspirations of clients attending an outpatient alcohol and other drug (AOD) treatment service. Key research questions were as follows: What type(s) of assistance do clients want? Do assistance aspirations vary by age, gender or ethnicity? and Are assistance aspirations predictive of subsequent attendance duration? The study was set in an outpatient AOD treatment service located in Auckland, New Zealand. Data were collected from two client groups via a questionnaire (n = 109) and a semi-structured interview (n = 12). Questionnaire data were collected following the completion of the first attended appointment. Interview data were completed, on average, after participants had attended two treatment appointments (range 1-3). When asked to indicate the services they would most like to receive, from a list of 10 possible options, questionnaire participants most frequently selected the options 'talk to a professional about an AOD-related problem'- (71%), 'practical strategies for making/maintaining changes to AOD use'- (66%) and 'ongoing support while making/maintaining changes to AOD use'- (61%). These options were also the three most likely to be endorsed as the number one service type wanted. Binary regression analysis identified few between-group differences concerning the frequency with which each option was endorsed. The interview data were consistent with the questionnaire findings suggesting that, irrespective of age, gender, ethnicity and subsequent attendance duration, outpatient AOD treatment clients may share a common set of assistance aspirations at the point of service entry. © 2011 Informa UK Ltd All rights reserved.


Pulford J.,Papua New Guinea Institute of Medical Research PNGIMR | Pulford J.,University of Queensland | Hetzel M.W.,Papua New Guinea Institute of Medical Research PNGIMR | Hetzel M.W.,University of Queensland | And 3 more authors.
Malaria Journal | Year: 2011

Background: A review of the barriers to mosquito net use in malaria-endemic countries has yet to be presented in the published literature despite considerable research interest in this area. This paper partly addresses this gap by reviewing one component of the evidence base; namely, published research pertaining to self-reported reasons for not using a mosquito net among net 'owning' individuals. It was anticipated that the review findings would potentially inform an intervention or range of interventions best suited to promoting greater net use amongst this group. Method. Studies were sought via a search of the Medline database. The key inclusion criteria were: that study participants could be identified as owning a mosquito net or having a mosquito net available for use; that these participants on one or more occasions were identified or self-reported as not using the mosquito net; and that reasons for not using the mosquito net were reported. Studies meeting these criteria were included irrespective of mosquito net type. Results: A total of 22 studies met the inclusion criteria. Discomfort, primarily due to heat, and perceived (low) mosquito density were the most widely identified reason for non-use. Social factors, such as sleeping elsewhere, or not sleeping at all, were also reported across studies as were technical factors related to mosquito net use (i.e. not being able to hang a mosquito net or finding it inconvenient to hang) and the temporary unavailability of a normally available mosquito net (primarily due to someone else using it). However, confidence in the reported findings was substantially undermined by a range of methodological limitations and a dearth of dedicated research investigation. Conclusions: The findings of this review should be considered highly tentative until such time as greater quantities of dedicated, well-designed and reported studies are available in the published literature. The current evidence-base is not sufficient in scope or quality to reliably inform mosquito net promoting interventions or campaigns targeted at individuals who own, but do not (reliably) use, mosquito nets. © 2011 Pulford et al; licensee BioMed Central Ltd.


PubMed | Papua New Guinea Institute of Medical Research PNGIMR
Type: | Journal: Malaria journal | Year: 2013

This paper reports on the availability of diagnostic tools and recommended anti-malarials in the 12-month period immediately following the implementation of a new national malaria treatment protocol (NMTP) in Papua New Guinea (PNG). Health worker adherence to the new NMTP is also examined and comparisons made with previously reported pre-implementation findings.A countrywide cross-sectional survey in randomly selected primary health care facilities (n=88). Data were collected via passive observation of the clinical case management of fever or suspected malaria patients and via an interviewer administered questionnaire completed with the officer in charge of each participating health care facility.Malaria rapid diagnostic tests (RDTs) and the new first-line anti-malarial medication, artemether-lumefantrine (AL), were available in 53.4% and 51.1% of surveyed heath facilities, respectively. However, they were more widely available in the larger health centres as compared to the smaller aid-posts (90.2% vs. 21.3% and 87.8% vs. 19.2%, respectively). Overall, 68.3% of observed fever cases (n=445) were tested for malaria by RDT and 39% prescribed an anti-malarial, inclusive of 98.2% of RDT positive patients and 19.8% of RDT negative cases. The availability and use of malaria RDTs was greater in the current survey as compared to pre-implementation of the new NMTP (8.9% vs. 53.4% & 16.2% vs. 68.3%, respectively) as was the availability of AL (0% vs. 51.1%). The percentage of fever patients prescribed anti-malarials decreased substantially post implementation of the new NMTP (96.4% vs. 39.0%).PNG has achieved high coverage of malaria RDTs and AL at the health centre level, but these resources have yet to reach the majority of aid-posts. Malaria case management practice has substantially changed in the 12-month period immediately following the new NMTP, although full protocol adherence was rarely observed.


PubMed | Papua New Guinea Institute of Medical Research PNGIMR
Type: Journal Article | Journal: PloS one | Year: 2013

The aim of this study is to assess whether a text message reminder service designed to support health worker adherence to a revised malaria treatment protocol is feasible and acceptable in Papua New Guinea (PNG). The study took place in six purposively selected health facilities located in the Eastern Highlands Province (EHP) of PNG. Ten text messages designed to remind participants of key elements of the new NMTP were transmitted to 42 health workers twice over a two week period (two text messages per day, Monday to Friday) via the countrys largest mobile network provider. The feasibility and acceptability of the text message reminder service was assessed by transmission reports, participant diaries and group discussions. Findings indicate that the vast majority of text messages were successfully transmitted, participants had regular mobile phone access and that most text messages were read most of the time and were considered both acceptable and clinically useful. Nevertheless, the study found that PNG health workers may tire of the service if the same messages are repeated too many times and that health workers may be reluctant to utilize more comprehensive, yet complementary, resources. In conclusion, a text message reminder service to support health worker adherence to the new malaria treatment protocol is feasible and acceptable in PNG. A rigorous pragmatic, effectiveness trial would be justified on the basis of these findings.

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