Search

Background Malaria transmission is currently resurging in Papua New Guinea (PNG). In addition to intervention coverage, social and cultural factors influence changes in epidemiology of malaria in PNG. This study aimed to better understand the role of human behavior in relation to current malaria control efforts. Methods A mixed-method design was used in 2 sites in PNG. In-depth interviews, focus group discussions, cross-sectional malaria indicator survey, and population census were implemented. Results We identified 7 population groups based on demographics and behavioral patterns with potential relevance to Anopheles exposure. People spend a substantial amount of time outdoors or in semiopen structures. Between 4 pm and 8 am, all types of activities across all groups in both study sites may be exposing individuals to mosquito bites; sleeping under a long-lasting insecticidal net was the exception. The later in the night, the more outdoor presence was concentrated in adult men. Conclusions Our findings highlight the potential of outdoor exposure to hamper malaria control as people spend a remarkable amount of time outdoors without protection from mosquitoes. To prevent ongoing transmission, targeting of groups, places, and activities with complementary interventions should consider setting-specific human behaviors in addition to epidemiological and entomological data.

ObjectiveTo measure the readiness of health facilities in Papua New Guinea (PNG) to provide obstetric care and other maternal health services.DesignCross-sectional study involving random sample of health centres, district/rural hospitals (levels 3 and 4 facilities) and all upper-level hospitals operational at the time of survey. Structured questionnaires were used to collect data from health facilities.SettingHealth facilities in PNG. Facility administrators and other facility personnel were interviewed. Number of facility personnel interviewed was usually one for health centres and two or more for hospitals.Participants19 upper-level facilities (levels 5–7, provincial, regional and national hospitals) and 60 lower-level facilities (levels 3 and 4, health centres and district/rural hospitals).Outcome measuresFour service-types were used to understand readiness of surveyed health facilities in the provision of maternity care including obstetric care services: (1) facility readiness to provide clinical services; (2) availability of family planning items; (3) availability of maternal and neonatal equipment and materials; and (4) ability to provide emergency obstetric care (EmOC).Results56% of lower-level facilities were not able to provide basic emergency obstetric care (BEmOC). Even among higher-level facilities, 16% were not able to perform one or more of the functions required to be considered a BEmOC provider. 11% of level 3 and 4 health facilities were able to provide comprehensive emergency obstetric care (CEmOC) as compared with 83% of higher-level facilities.ConclusionGiven the high fertility rate and maternal mortality ratio (MMR) in PNG, lack of BEmOC at the first level inpatient service providers is a major concern. To improve access to EmOC, level 3 and 4 facilities should be upgraded to at least BEmOC providers. Significant reduction in MMR will require improved access to CEmOC and optimal geographic location approach can identify facilities to be upgraded.

Background Sub-Saharan Africa (SSA) suffers from a dearth of concrete information on the causes of women’s under-representation in scientific research workforce particularly at higher levels compared with the wealth of information that exists in the global north. The goal of this study was to illuminate familial and socio-cultural drivers that contribute to intersectional gender inequities in scientific career progression in SSA to inform strategies that could promote career equity for African scientific researchers. Methods This study was nested within the context of ‘Developing Excellence in Leadership, Training and Science in Africa’ (DELTAS Africa)—a health-based scientific research capacity strengthening initiative. It adopted an exploratory qualitative cross-sectional study design. In-depth interviews were conducted among 58 (32 Female and 26 Male) trainees/research fellows at various career stages, affiliated to three purposively selected African Research Consortia. The interviews were conducted between May and December 2018 in English. The data were analysed inductively based on emergent themes. Results The study participants were nationals of thirteen SSA countries. More female than male participants had young children. Four themes were identified. They illustrate women’s and men’s characterisation of the normative career pathway and progression requirements which calls for significant ‘time’ commitments (theme 1), and how social power relations of gender within the family and wider society shapes their participation in scientific research activities (theme 2). This culminates in researchers'' differential experiences of navigating between the ‘two different lives’—family and career, and the resultant implications for their career progression and personal well-being (theme 3). Women researchers made different and conscious trade-offs for navigating the ‘two different lives’ by utilising various metaphors such as the ‘biological clock and career clock’, the ‘glass ball and rubber ball’, and the concept of ‘sacrifice’ (theme 4). Conclusions This study is the first of its kind to demonstrate how intersectional gender analysis through use of qualitative research methods may provide novel insights into the hidden familial and socio-cultural drivers of gender inequitable scientific research career progression. It offers important policy and practice measures and approaches for fostering career equity for women and men scientists within research capacity strengthening initiatives in SSA.

Gambiense Human African Trypanosomiasis (g-HAT) is a neglected tropical disease caused by trypanosomes transmitted by tsetse flies. 70% of cases in 2019 (604/863) occurred in the Democratic Republic of Congo (DRC). The national programme for g-HAT elimination in DRC includes a large-scale deployment of Tiny Targets which attract and kill tsetse. This intervention is directed by vector-control specialists with small teams, moving in canoes, deploying Tiny Targets along riverbanks where tsetse concentrate. While the targets are deployed in communal areas, and the method is cheap and easy-to-use, local people have little involvement. This study aimed to evaluate if a community-led vector control programme was feasible in the context of DRC’s g-HAT elimination programme. In 2017, a community-led intervention was implemented in three villages in the Kwilu province of DRC. This intervention was evaluated through an Action Research with qualitative data collected through 21 focus group discussions and 289 hours of observation. Also the geographical location and quality of each Tiny Targets were collected (total number deployed = 2429). This research revealed that community-based approach largely worked: people were motivated and proactive, showed a good application of the acquired knowledge resulting in an effective deployment of Tiny Targets. In addition, our study provided evidence that acceptability of the targets by the community can improve deployment quality by reducing target loss and damage. The approach was feasible in places where canoe-based teams could not reach. Against these advantages, a community-based approach was time-consuming and had to adapt to the seasonal and daily rhythms of the community. A community-based approach for tsetse control is technically feasible and recommended but limits to the speed and scale of the approach restraints its application as a standalone strategy in a large-scale national programme aiming to eliminate g-HAT in a short timeframe., Author summary Sleeping sickness (Human African Trypanosomiasis, HAT) is a neglected disease caused by Trypanosoma brucei gambiense or T.b.rhodesiense both transmitted by tsetse flies. Currently 70% of the global cases of Gambiense HAT (g-HAT) occur in Democratic Republic of Congo (DRC). Over the last 20 years, a national programme of screening and treating humans has driven down the number of cases of g-HAT from >30,000 to

Gambiense human African trypanosomiasis (g-HAT) is the chronic form of sleeping sickness caused by Trypanosoma brucei gambiense in West and Central Africa, while Trypanosoma brucei rhodesiense causes an acute form in eastern Africa. g-HAT is targeted for elimination as a public health problem by 2020 and 0 transmission by 2030 [1,2]. Control of g-HAT is largely based on identification and treatment of infected individuals, supplemented by control of the tsetse fly vectors [3]. There has been growing evidence that when both tsetse control and case identification activities are carried out simultaneously in the same geographies, elimination of the disease is accelerated [4–6]. Here, we describe how the Trypa-NO! Partnership is using novel and classical tools to drive g-HAT elimination in an integrated approach, progress made, lessons learnt, and future directions.

Background Long-lasting insecticidal nets (LLIN), improved diagnosis and artemisinin-based combination therapy (ACT) have reduced malaria prevalence in Papua New Guinea since 2008. Yet, national incidence trends are inconclusive due to confounding effects of the scale-up of rapid diagnostic tests, and inconsistencies in routine reporting. Methods Malaria trends and their association with LLIN and ACT roll-out between 2010 and 2014 in seven sentinel health facilities were analysed. The analysis included 35,329 fever patients. Intervention effects were estimated using regression models. Results Malaria incidence initially ranged from 20 to 115/1000 population; subsequent trends varied by site. Overall, LLIN distributions had a cumulative effect, reducing the number of malaria cases with each round (incidence rate ratio ranging from 0.12 to 0.53 in five sites). No significant reduction was associated with ACT introduction. Plasmodium falciparum remained the dominant parasite in all sentinel health facilities. Resurgence occurred in one site in which a shift to early and outdoor biting of anophelines had previously been documented. Conclusions LLINs, but not ACT, were associated with reductions of malaria cases in a range of settings, but sustainability of the gains appear to depend on local factors. Malaria programmes covering diverse transmission settings such as Papua New Guinea must consider local heterogeneity when choosing interventions and ensure continuous monitoring of trends.

Malaria surveillance and response-systems are essential for identifying the areas most affected by malaria and for targeting interventions and optimising resources. This study aimed to assess whether the visualisation of routinely collected health facility data linked to village of residence provides evidence for targeting control interventions in four sentinel health facilities in Papua New Guinea. A video format was used to visualise the dynamics in case incidence over time and space alongside photographs illustrating the context of the data collection in the study sites. Incidence changes overtime were illustrated in animated maps. Despite limitations, this approach appeared useful in sites with very few remaining cases or with increasingly marked heterogeneity. Villages that could benefit from targeted interventions or investigations were identified.

BackgroundRisk factors for cardiovascular disease (CVD) are negatively correlated with socio-economic status (SES) in high-income countries (HIC) but there has been little research on their distribution by household SES within low-and middle-income countries (LMICs). Considering the limited data from LMICs, this paper examines the association between behavioural and cardiovascular risk factors and household SES in Papua New Guinea (PNG).MethodsReported here are results of 671 participants from the 900 randomly selected adults aged 15-65 years. These adults were recruited from three socioeconomically and geographically diverse surveillance sites (peri-urban community, rural Highland and an Island community) in PNG in 2013-2014. We measured their CVD risk factors (behavioural and metabolic) using a modified WHO STEPS risk factor survey and analysis of blood samples. We assessed SES by education, occupation and creating a household wealth index based on household assets. We calculated risk ratios (RR) and their 95% confidence intervals (CI) using a generalized linear model to assess the associations between risks and SES.FindingsElevated CVD risk factors were common in all SES groups but the CVD metabolic risk factors were most prevalent among homemakers, peri-urban and rural highlands, and the highest (4th and 5th) wealth quintile population. Adults in the highest wealth quintile had high risks of obesity, elevated HbA1c and metabolic syndrome (MetS) that were greater than those in the lowest quintile although those in the highest wealth quintiles were less likely to smoke tobacco. Compared to people from the Island community, peri-urban residents had increased risks of increased waist circumference (WC) (RR: 1.67, 95%CI: 1.21-2.31), hypertension (RR: 2∙29, 95%CI: 1∙89-4.56), high cholesterol (RR: 2∙22, 95%CI: 1∙20-4∙10), high triglycerides (RR: 1∙49, 95%CI: 1∙17-1∙91), elevated HbA1c (RR: 5∙54, 95%CI: 1∙36-21∙56), and Metabolic syndrome (MetS) (RR: 2∙04, 95%CI: 1∙25-3∙32). Similarly, Rural Highland residents had increased risk of obesity (Waist Circumference RR: 1∙70, 95%CI: 1∙21-3∙38, Waist-Hip-Ratio RR:1∙48, 95%CI: 1∙28-1∙70), hypertension (RR: 2∙60, 95%CI: 1∙71-3∙95), high triglycerides (RR: 1∙34, 95%CI: 1∙06-1∙70) and MetS (RR: 1∙88, 95%CI: 1∙12-3∙16) compared to those in the rural Island site.InterpretationCVD risk factors are common in PNG adults but their association with SES varies markedly and by location. Our findings show that all community members are at risk of CVD weather they are part of high or low SES groups. These results support the notion that the association between CVD risk factors and SES differ greatly accordingly to the type of SES measure used, risk factors and the population studied. In addition, our findings contribute further to the limited literature in LMIC. Longitudinal studies are needed to monitor changes in rapidly changing societies such as PNG to inform public health policy for control and prevention of NCDs in the country.

Background This paper examines the impact of the scale-up of malaria rapid diagnostic tests (RDT) on routine clinical diagnosis procedures for febrile illness in primary healthcare settings in Papua New Guinea. Methods Repeat, cross-sectional surveys in randomly selected primary healthcare services were conducted. Surveys included passive observation of consecutive febrile case management cases and were completed immediately prior to RDT scale-up (2011) and at 12- (2012) and 60-months (2016) post scale-up. The frequency with which specified diagnostic questions and procedures were observed to occur, with corresponding 95% CIs, was calculated for febrile patients prescribed anti-malarials pre- and post-RDT scale-up and between febrile patients who tested either negative or positive for malaria infection by RDT (post scale-up only). Results A total of 1809 observations from 120 health facilities were completed across the three survey periods of which 915 (51%) were prescribed an anti-malarial. The mean number of diagnostic questions and procedures asked or performed, leading to anti-malarial prescription, remained consistent pre- and post-RDT scale-up (range 7.4–7.7). However, alterations in diagnostic content were evident with the RDT replacing body temperature as the primary diagnostic procedure performed (observed in 5.3 and 84.4% of cases, respectively, in 2011 vs. 77.9 and 58.2% of cases in 2016). Verbal questioning, especially experience of fever, cough and duration of symptoms, remained the most common feature of a diagnostic examination leading to anti-malarial prescription irrespective of RDT use (observed in 96.1, 86.8 and 84.8% of cases, respectively, in 2011 vs. 97.5, 76.6 and 85.7% of cases in 2016). Diagnostic content did not vary substantially by RDT result. Conclusions Rapid diagnostic tests scale-up has led to a reduction in body temperature measurement. Investigations are very limited when malaria infection is ruled out as a cause of febrile illness by RDT.

Background In 2009, the Papua New Guinea (PNG) Department of Health adopted artemether–lumefantrine (AL) and dihydroartemisinin–piperaquine (DHA-PPQ) as the first- and second-line treatments for uncomplicated malaria, respectively. This study was conducted to assess the efficacy of both drugs following adoption of the new policy. Methods Between June 2012 and September 2014, a therapeutic efficacy study was conducted in East Sepik and Milne Bay Provinces of PNG in accordance with the standard World Health Organization (WHO) protocol for surveillance of anti-malarial drug efficacy. Patients ≥ 6 months of age with microscopy confirmed Plasmodium falciparum or Plasmodium vivax mono-infections were enrolled, treated with AL or DHA-PPQ, and followed up for 42 days. Study endpoints were adequate clinical and parasitological response (ACPR) on days 28 and 42. The in vitro efficacy of anti-malarials and the prevalence of selected molecular markers of resistance were also determined. Results A total of 274 P. falciparum and 70 P. vivax cases were enrolled. The day-42 PCR-corrected ACPR for P. falciparum was 98.1% (104/106) for AL and 100% (135/135) for DHA-PPQ. The day-42 PCR-corrected ACPR for P. vivax was 79.0% (15/19) for AL and 92.3% (36/39) for DHA-PPQ. Day 3 parasite clearance of P. falciparum was 99.2% with AL and 100% with DHA-PPQ. In vitro testing of 96 samples revealed low susceptibility to chloroquine (34% of samples above IC50 threshold) but not to lumefantrine (0%). Molecular markers assessed in a sub-set of the study population indicated high rates of chloroquine resistance in P. falciparum (pfcrt SVMNT: 94.2%, n = 104) and in P. vivax (pvmdr1 Y976F: 64.8%, n = 54). Conclusions AL and DHA-PPQ were efficacious as first- and second-line treatments for uncomplicated malaria in PNG. Continued in vivo efficacy monitoring is warranted considering the threat of resistance to artemisinin and partner drugs in the region and scale-up of artemisinin-based combination therapy in PNG. Electronic supplementary material The online version of this article (10.1186/s12936-018-2494-z) contains supplementary material, which is available to authorized users.

ObjectivesSubstantial development assistance and research funding are invested in health research capacity strengthening (HRCS) interventions in low-income and middle-income countries, yet the effectiveness, impact and value for money of these investments are not well understood. A major constraint to evidence-informed HRCS intervention has been the disparate nature of the research effort to date. This review aims to map and critically analyse the existing HRCS effort to better understand the level, type, cohesion and conceptual sophistication of the current evidence base. The overall goal of this article is to advance the development of a unified, implementation-focused HRCS science.MethodsWe used a scoping review methodology to identify peer-reviewed HRCS literature within the following databases: PubMed, Global Health and Scopus. HRCS publications available in English between the period 2000 and 2016 were included. 1195 articles were retrieved of which 172 met the final inclusion criteria. A priori thematic analysis of all included articles was completed. Content analysis of identified HRCS definitions was conducted.ResultsThe number of HRCS publications increased exponentially between 2000 and 2016. Most publications during this period were perspective, opinion or commentary pieces; however, original research publications were the primary publication type since 2013. Twenty-five different definitions of research capacity strengthening were identified, of which three aligned with current HRCS guidelines.ConclusionsThe review findings indicate that an HRCS research field with a focus on implementation science is emerging, although the conceptual and empirical bases are not yet sufficiently advanced to effectively inform HRCS programme planning. Consolidating an HRCS implementation science therefore presents as a viable option that may accelerate the development of a useful evidence base to inform HRCS programme planning. Identifying an agreed operational definition of HRCS, standardising HRCS-related terminology, developing a needs-based HRCS-specific research agenda and synthesising currently available evidence may be useful first steps.

Papua New Guinea (PNG) is a culturally, environmentally and ethnically diverse country of 7.3 million people experiencing rapid economic development and social change. Such development is typically associated with an increase in non-communicable disease (NCD) risk factors. Aim To establish the prevalence of NCD risk factors in three different regions across PNG in order to guide appropriate prevention and control measures. Methods A cross-sectional survey was undertaken with randomly selected adults (15–65 years), stratified by age and sex recruited from the general population of integrated Health and Demographic Surveillance Sites in West Hiri (periurban), Asaro (rural highland) and Karkar Island (rural island), PNG. A modified WHO STEPS risk factor survey was administered along with anthropometric and biochemical measures on study participants. Results The prevalence of NCD risk factors was markedly different across the three sites. For example, the prevalences of current alcohol consumption at 43% (95% CI 35 to 52), stress at 46% (95% CI 40 to 52), obesity at 22% (95% CI 18 to 28), hypertension at 22% (95% CI 17 to 28), elevated levels of cholesterol at 24% (95% CI 19 to 29) and haemoglobin A1c at 34% (95% CI 29 to 41) were highest in West Hiri relative to the rural areas. However, central obesity at 90% (95% CI 86 to 93) and prehypertension at 55% (95% CI 42 to 62) were most common in Asaro whereas prevalences of smoking, physical inactivity and low high-density lipoprotein-cholesterol levels at 52% (95% CI 45 to 59), 34% (95% CI 26 to 42) and 62% (95% CI 56 to 68), respectively, were highest in Karkar Island. Conclusion Adult residents in the three different communities are at high risk of developing NCDs, especially the West Hiri periurban population. There is an urgent need for appropriate multisectoral preventive interventions and improved health services. Improved monitoring and control of NCD risk factors is also needed in all regions across PNG.

Introduction:The mortality associated with non-communicable diseases has increased significantly in most countries in the World Health Organization Western Pacific Region over the last 20 years, as have the underlying risk factors. This study aimed to collate evidence on the prevalence of four major non-communicable diseases and their risk factors in Papua New Guinea in order to inform appropriate policy for their prevention and management.Methods:We performed a systematic review of Papua New Guinea-based population prevalence studies of cardiovascular diseases, type 2 diabetes mellitus, chronic respiratory diseases, and cancers, as well as non-communicable disease risk factors published before 2016. Five online databases were searched and screened against eligibility criteria according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Results:A total of 57 articles were included in this review, most of which (n = 48) were published prior to 2000. Eleven articles reported on diabetes, six reported on chronic lung disease/asthma, two reported on cardiovascular diseases, and two reported cancer as the primary outcome, while the remaining 36 papers reported non-communicable disease risk factors.Conclusion:This review demonstrated variations in the prevalence of non-communicable diseases (0%–19%) and their risk factors (0%–80.6%) attributed to the lifestyle and genetic diversity of the Papua New Guinea population. There is a strong suggestion that the prevalence of non-communicable diseases (particularly type 2 diabetes mellitus) and key non-communicable disease risk factors (hypertension, overweight, and obesity) has increased, but there is a lack of recent data. As such, there is an urgent need for new and up-to-date data in all areas of Papua New Guinea.

Background 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. Methods 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). Results and Discussion 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). Conclusion 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. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1965-6) contains supplementary material, which is available to authorized users.

Background Behavioural resilience in mosquitoes poses a significant challenge to mosquito control. Although behaviour changes in anopheline vectors have been reported over the last decade, there are no empirical data to suggest they compromise the efficacy of vector control in reducing malaria transmission. Methods In this study, we quantified human exposure to both bites and infective bites of a major malaria vector in Papua New Guinea over the course of four years surrounding a nationwide bednet distribution. We also quantified malaria infection prevalence in the human population during the same time period. Results We observed a shift in mosquito biting to earlier hours of the evening, before individuals are indoors and protected by bednets, followed by a return to pre-intervention biting rates. As a result, net users and non-net users experienced higher levels of transmission than before the intervention. The personal protection provided by a bednet decreased over the study period and was lowest in the adult population, who may be an important reservoir for transmission. Malaria prevalence decreased in only one of three study villages after the distribution. Discussion This study highlights the necessity of validating and deploying vector control measures targeting outdoor exposure to control and eliminate malaria.

This study examined the acceptability, durability and bio-efficacy of pyrethroid-impregnated durable lining (DL) over a three-year period post-installation in residential homes across Papua New Guinea (PNG).; ZeroVector(®) ITPS had previously been installed in 40 homes across four study sites representing a cross section of malaria transmission risk and housing style. Structured questionnaires, DL visual inspections and group interviews (GIs) were completed with household heads at 12- and 36-months post-installation. Three DL samples were collected from all households in which it remained 36-months post-installation to evaluate the bio-efficacy of DL on Anopheles mosquitoes. Bio-efficacy testing followed WHO guidelines for the evaluation of indoor residual spraying.; The DL was still intact in 86 and 39% of study homes at the two time periods, respectively. In homes in which the DL was still intact, 92% of household heads considered the appearance at 12-months post installation to be the same as, or better than, that at installation compared to 59% at 36-months post-installation. GIs at both time points confirmed continuing high acceptance of DL, based in large part of the perceived attractiveness and functionality of the material. However, participants frequently asserted that they, or their family members, had ceased or reduced their use of mosquito nets as a result of the DL installation. A total of 16 houses were sampled for bio-efficacy testing across the 4 study sites at 36-months post-installation. Overall, combining all sites and samples, both knock-down at 30 min and mortality at 24 h were 100%.; The ZeroVector(®) DL installation remained highly acceptable at 36-months post-installation, the material and fixtures proved durable and the efficacy against malaria vectors did not decrease. However, the DL material had been removed from over 50% of the original study homes 3 years post-installation, largely due to deteriorating housing infrastructure. Furthermore, the presence of the DL installation appeared to reduce ITN use among many participating householders. The study findings suggest DL may not be an appropriate vector control method for large-scale use in the contemporary PNG malaria control programme.

Electronic gaming machines (EGMs) have been frequently associated with problem gambling. Little research has compared the relative contribution of casino EGMs versus non-casino EGMs on current problem gambling, after controlling for demographic factors and gambling behaviour. Our exploratory study obtained data from questionnaires administered to a convenient, non-representative New Zealand sample of 138 problem gamblers (66 male, 70 female) and 73 non-problem gamblers (41 male, 32 female) categorized by scores on the Problem Gambling Severity Index (PGSI). Age groups ranged from 20 to 60+ years. Of 11 gambling activities, only gambling on EGMs in casinos and EGMs in pubs and clubs distinguished problem gamblers from non-problem gamblers. There were some significant interactions between marital status and types of gambling activities on problem gambling status. From multivariate logistic regression analysis, gambling on EGMs in pubs and clubs was a stronger, unique predictor of current problem gambling than EGMs in casinos, after controlling for demographic factors and total gambling activities. We suggest directions for future large-scale research and interventions for reducing the harm of gambling on non-casino EGMs.

These findings are from a qualitative study examining clinician experiences of employing the AmpliChip® CYP450 test in psychiatric practice. One hundred tests were made available to secondary care mental health service clinicians commencing patient treatment with risperidone across three District Health Boards within New Zealand. Feedback was sought on clinicians’ ( n = 33) experiences of ordering the test and receiving results, utilization of results, and perceived advantages and disadvantages. Difficulties were reported regarding ordering the test and receiving the results; however, real or perceived advantages of employing the test results in practice were widely reported. Analysis of the ways in which the test results were reportedly utilized revealed that they generally played a supporting role with regard to dosing decisions, rather than being the main influence on clinician behaviour. The test itself, and subsequent results, was viewed as potentially useful in facilitating the development of the doctor–patient relationship. Reported disadvantages of the test included potential over-reliance at the expense of clinical wisdom, cost, and challenges inherent in introducing a new clinical procedure into routine practice. These findings indicate that psychiatric clinicians are receptive to employing this test as a clinical support tool if its implementation is carefully considered and economically justifiable.

This article reviews the evidence in support of current treatment dropout responses designed for use in outpatient, psychosocial-based alcohol and other drug (AOD) treatment settings. A total of 17 publications meeting the inclusion criteria were identified for this review, reporting findings from 19 randomised controlled trials or controlled clinical trials. The methodological quality of these studies was largely sound; however, a lack of contextual information made it difficult to generalise the reported findings across treatment settings and the effectiveness of the reported strategies was modest at best. Future possibilities in dropout response research are subsequently discussed and a novel conceptual framework, termed treatment-fit, is described in detail. It is anticipated that the findings and ideas presented in this article will assist AOD treatment providers formulate an informed response to client dropout. It is also the authors’ intention to promote a fundamental shift in how treatment dropout...

This paper examines the post-treatment support practices, attitudes and preferences of outpatient alcohol and other drug (AOD) treatment staff as well as perceived barriers to implementing a post-treatment support service in an outpatient AOD treatment context. Data were collected via semi-structured interview and group discussion (n = 23). Findings suggest that post-treatment support was rarely provided by participating AOD treatment staff or their respective services. However, there was widespread support for implementing such services, and it was generally believed that implementation would be most successful if: multiple post-treatment support options were made available; if one or more of these options were based on the maintenance of an established client/clinician relationship; and if one of the options involved proactive (service-led) telephone support. A number of barriers to possible implementation were identified, although none were considered insurmountable.

Introduction and Aims. When a client exits an alcohol and other drug (AOD) treatment service against clinical advice, they and their service may incur significant disadvantage. The extent of awareness by both clients and clinicians that treatment would not continue has not been examined. Accordingly, this paper presents findings from a study that sought to identify whether clients and/or their respective clinicians were aware of pending service exit that occurred within the first 2 months of treatment admission. Design and Methods. The study was set in an outpatient AOD treatment service located in Auckland, New Zealand. Data were obtained by structured questionnaire and were reported for a group of clients (n = 49), clinicians (n = 46) and matched client/clinician pairs (n = 36). Results. Overall, clients and clinicians were no more likely to accurately identify pending service exit at a rate greater than would be expected by chance alone. However, clinicians were significantly more likely to identify pending service exit as compared with their respective clients (47% vs. 25%), although a large proportion of both groups expected treatment to continue beyond what proved to be the final treatment appointment (44% and 52%, respectively). Discussion and Conclusions. These findings suggest that service exit that occurs within the first 2 months of treatment admission may be largely unpredictable and that, as a result of this unpredictability, the opportunities for a targeted response may be limited.

Multiple means exist by which gamblers including problem gamblers may be recruited from the general population for research survey purposes. However, there appears to be limited discussion in the published literature about the relative merits of one or other approach. This paper addresses this gap, in part, by reporting the experiences of employing two contrasting approaches to survey recruitment: passive advertisement versus active solicitation outside gambling venues. Fifty participants were recruited by advertisement and 54 by active solicitation. The former group was found to be less ethnically diverse and more likely to be problem gamblers than the latter group which, due to the nature of the recruitment process, showed a more even distribution of ethnicity and PGSI classified risk and problem gambler categories. Results also indicated that recruitment by advertisement was more cost effective for reaching problem gamblers whilst active solicitation was more cost effective for the recruitment of low risk and moderate risk gamblers.

This paper presents reasons for help-seeking data as reported by users of a national gambling helpline (help-seekers, HS, n = 125) as well as data pertaining to perceived reasons for seeking help as reported by gamblers recruited from the general population (non-help-seekers, NHS, n = 104). All data were collected via a structured, multi-modal survey. Participants in both groups considered help-seeking to be motivated by multiple factors (mean of 6.8 and 10.6 responses, respectively). Responses indicative of financial concern were most frequently reported by both HS and NHS participants (82 & 90%, respectively). Over a third of HS participants (35%) also identified financial concern as their primary reason for seeking help and 50% of NHS participants perceived financial concern to be the primary motivator for seeking help in a problem gambling context. Common types of secondary influence (other than financial concern) included psychological distress (HS & NHS participants), problem prevention (HS participants), rational thought (HS participants), physical health issues (HS participants), and relationship issues (NHS participants). The implications for promoting greater or earlier help-seeking activity amongst problem gamblers are discussed.

This paper presents findings from a survey that sought the post-treatment support preferences of a group of outpatient alcohol and other drug treatment clients. The client group (n = 83) were presented with six possible models of post-treatment support and were asked to express their level of interest in using or receiving each model and, if interested, by what means they could best be provided. The six models included a range of pro-active (service initiated) and passive (client initiated) support services, variously accessible by telephone, mail, text-message, computer or in-person. Participants were also afforded an opportunity to identify alternative approaches. The results suggest pro-active telephone- and mail-based approaches to post-treatment support are favoured over passive in-person approaches and that computer and text-message approaches (whether passive or pro-active) may be least favourable in the contemporary environment.

This paper examines the possibility that clinicians working in an alcohol and other drug (AOD) treatment service may lack appreciation of problem improvement in clients who choose to dropout against clinical advice. Underlying this investigation is the belief that if clinicians are indeed unperceptive of problem improvement amongst this population then this may explain why retention based responses to client dropout continue to be promoted, despite evidence to suggest that they are ineffective and/or unnecessary. Outcome data obtained from a sample of 75 AOD treatment clients and their respective clinicians at baseline and 2-month follow-up are reported. Analysis of these data suggest a client/clinician discrepancy in perceived problem improvement was evident in the study setting: clinicians reported significantly less problem improvement in the first 2 months of service attendance as compared to their clients and this discrepancy was most pronounced if the client had dropped out of treatment.

Aim: The present study sought to document client attendance norms at a multi‐site outpatient alcohol and other drug (AOD) treatment service located in Auckland, New Zealand.Method: Service attendance data were retrospectively analysed for two client cohorts: consecutive admissions over the period 1 January 2001 to 31 March 2001 (n = 501) and a sub‐sample of admissions who were entering the treatment service for the first time over the same period (n = 325). Data from the former cohort were analysed over a single episode of care. Data from the latter sample were analysed over a period of five calendar years (1 January 2001 to 31 March 2005).Results: Across a single episode of care, 73% of the respective client cohort exited treatment having attended four or fewer appointments. Furthermore, 61% of these clients exited treatment against clinical advice or prior to completing a scheduled treatment appointment. Only 15% of the ‘new to treatment’ sub‐sample initiated a second episode of care during the next fiv...

Objectives: To assess the population prevalence of malaria in villages across Papua New Guinea (PNG) following the first roll-out of free long-lasting insecticidal nets (LLIN). Methods: Between October 2008 and August 2009, a household survey was conducted in 49 random villages in districts covered by the LLIN distribution campaign. The survey extended to 19 villages in sentinel sites that had not yet been covered by the campaign. In each village, 30 households were randomly sampled, household heads were interviewed and capillary blood samples were collected from all consenting household members for microscopic diagnosis of malaria. Results: Malaria prevalence ranged from 0% to 49.7% with a weighted average of 12.1% (95% CI 9.5, 15.3) in the national sample. More people were infected with Plasmodium falciparum (7.0%; 95% CI 5.4, 9.1) than with P. vivax (3.8%; 95% CI 2.4, 5.7) or P. malariae (0.3%; 95% CI 0.1, 0.6). Parasitaemia was strongly age-dependent with a P. falciparum peak at age 5-9 years and a P. vivax peak at age 1-4 years, yet with differences between geographical regions. Individual LLIN use and high community coverage were associated with reduced odds of infection (OR = 0.64 and 0.07, respectively; both P < 0.001). Splenomegaly in children and anaemia were common morbidities attributable to malaria. Conclusions: Malaria prevalence across PNG is again at levels comparable to the 1970s. The strong association of LLIN use with reduced parasitaemia supports efforts to achieve and maintain high country-wide coverage. P. vivax infections will require special targeted approaches across PNG.

To investigate changes in malaria prevalence in Papua New Guinea after the distribution of long-lasting Insecticide-treated nets, starting in 2004, and the introduction of artemisinin-based combination therapy in 2011.Two malaria surveys were conducted in 2010-2011 and 2013-2014. They included 77 and 92 randomly selected villages, respectively. In each village, all members of 30 randomly selected households gave blood samples and were assessed for malaria infection by light microscopy. In addition, data were obtained from a malaria survey performed in 2008-2009.The prevalence of malaria below 1600 m in altitude decreased from 11.1% (95% confidence interval, CI: 8.5-14.3) in 2008-2009 to 5.1% (95% CI 3.6-7.4) in 2010-2011 and 0.9% (95% CI 0.6-1.5) in 2013-2014. Prevalence decreased with altitude.Large-scale insecticide-treated net distribution was associated with an unprecedented decline in malaria prevalence throughout Papua New Guinea, including epidemic-prone highland areas. The decline was accompanied by broader health benefits, such as decreased morbidity. Better clinical management of nonmalarial fever and research into residual malaria transmission are required.Étudier les changements observés à l'égard de la prévalence du paludisme en Papouasie-Nouvelle-Guinée suite à la distribution, depuis 2004, de moustiquaires imprégnées d'insecticides de longue durée et à l'introduction, depuis 2011, d'une combinaison thérapeutique à base d’artémisinine.Deux enquêtes portant sur le paludisme ont été menées en 2010-2011 et 2013-2014. Elles incluaient respectivement 77 et 92 villages, sélectionnés d'une manière aléatoire. Dans chacun de ces villages, tous les membres de 30 foyers sélectionnés aléatoirement ont donné des échantillons sanguins et été soumis à un test de dépistage de l'infection palustre par microscopie optique. Des données ont par ailleurs été tirées d'une enquête sur le paludisme réalisée en 2008-2009.La prévalence du paludisme à moins de 1600 m d'altitude est passée de 11,1% (intervalle de confiance, IC, à 95%: 8,5–14,3) en 2008–2009 à 5,1% (IC à 95%: 3,6–7,4) en 2010–2011 et 0,9% (IC à 95%: 0,6–1,5) en 2013–2014. La prévalence diminuait avec l'altitude. Plasmodium falciparum n'était pas systématiquement plus courant que P. vivax, mais l'était dans l'ensemble et, dans un premier temps, la prévalence de l'infection à P. vivax a diminué plus lentement que la prévalence de l'infection à P. falciparum. Les infections palustres ont été regroupées par foyers. Contrairement à ce qu'indiquaient les résultats obtenus en 2008-2009, aucune corrélation significative entre l'utilisation d'une moustiquaire et la prévalence n'a été constatée dans le cadre des deux dernières enquêtes. Les prévalences de la fièvre et de la splénomégalie ont également diminué, mais leur corrélation avec l'infection palustre est devenue plus forte.La distribution à grande échelle de moustiquaires imprégnées d'insecticides a été associée à un déclin sans précédent de la prévalence du paludisme dans l'ensemble de la Papouasie-Nouvelle-Guinée, et notamment dans les régions montagneuses sujettes aux épidémies. Ce déclin s'est accompagné d'autres bienfaits sur la santé, et notamment d'une diminution de la morbidité. Il est nécessaire d'améliorer la prise en charge clinique de la fièvre non palustre ainsi que les recherches sur la transmission résiduelle du paludisme.Investigar los cambios en la prevalencia de la malaria en Papua Nueva Guinea tras la distribución de mosquiteros tratados con insecticida de larga duración, a partir de 2004, y la introducción de terapias combinadas basadas en la artemisinina en 2011.Se llevaron a cabo dos encuestas sobre la malaria en 2010–2011 y 2013–2014. Incluían 77 y 92 aldeas seleccionadas al azar, respectivamente. En cada aldea, todos los miembros de 30 hogares seleccionados al azar dieron muestras de sangre y se evaluaron de infección de malaria con microscopio óptico. Además, se obtuvieron datos de la encuesta sobre la malaria realizada en 2008–2009.La prevalencia de la malaria por debajo de 1600 m de altitud descendió del 11.1% (intervalo de confidencia (IC) del 95%: 8.5–14.3) en 2008–2009 al 5.1% (95% IC 3.6–7.4) en 2010–2011 y 0.9% (95% IC 0.6–1.5) en 2013–2014. La prevalencia descendía con la altitud.La distribución de mosquiteros tratados con insecticida a gran escala se asoció con un descenso sin precedentes en la prevalencia de la malaria en toda Papua Nueva Guinea, incluidas las áreas altas con propensión a causar epidemias. El descenso estuvo acompañado de beneficios saludables más amplios, como el descenso de la morbilidad. Se requieren una mejor gestión clínica de la fiebre no relacionada con la malaria y la investigación de la transmisión residual de la malaria.التحقيق في تغيرات انتشار الملاريا في بابوا غينيا الجديدة بعد توزيع الناموسيات المُعالَجة بالمبيد الحشري ذات المفعول الممتد، بدءًا من عام 2004، وطرح العلاج المجمّع المرتكز على مادة الأرتيميسينين في عام 2011.أُجريت دراستان استقصائيتان للملاريا في عامي 2010-2011 و2013-2014. وشملتا 77 و92 قرية تم اختيارها عشوائيًا على التوالي. في كل قرية، قدم جميع أفراد الثلاثين أسرة التي تم اختيارها عشوائيًا عينات من الدم وتم تقييمها بواسطة الفحص المجهري لمعرفة ما إذا كان هناك إصابة بالملاريا. وبالإضافة إلى ذلك، تم الحصول على البيانات من مسح الملاريا الذي تم إجراؤه في الفترة ما بين عامي 2008-2009.انخفض معدل انتشار الملاريا في المناطق التي لا يزيد ارتفاعها عن 1600 متر من‏11.1 % (بنطاق ثقة يبلغ 95‏%: 8.5–14.3) في الفترة ما بين عاميّ 2008–2009 إلى ‏5.1‏% (بنطاق ثقة ‏95‏%: 3.6–7.4) في الفترة ما بين عاميّ 2010–2011، و0.9‏% (بنطاق ثقة 95‏%: 0.6–1.5) في الفترة ما بين عامي 2013–2014، بما يعني انخفاض انتشار المرض مع زيادة الارتفاع. كانت "المتصورة المنجلية" (الملاريا الخبيثة) أكثر شيوعًا من "المتصورة النشيطة" بشكل إجمالي ولكن ليس في كل الأماكن، كما انخفض معدل انتشار الإصابة "بالمتصورة النشيطة" بمعدل أبطأ من الإصابة "بالمتصورة المنجلية". وتم تجميع إصابات الملاريا في الأسر. وفي مقابل النتائج التي تم التوصل إليها في الفترة ما بين عامي 2008-2009، لم يتم العثور على ارتباط كبير بين استخدام الناموسية ومعدل الانتشار في الدراستين الأخيرتين. كما انخفض انتشار الحمى وتضخم الطحال ولكن أصبح ارتباطهما بعدوى الملاريا أقوى.ارتبط توزيع الناموسية المُعالَجة بالمبيد الحشري على نطاق واسع بحدوث انخفاض غير مسبوق في انتشار الملاريا في جميع أنحاء بابوا غينيا الجديدة، بما في ذلك المناطق المرتفعة المعرضة للأوبئة. ورافق هذا الانخفاض فوائد صحية أكثر، مثل انخفاض معدلات الاعتلال. ويلزم توفير إدارة سريرية أفضل للحمى غير الملارية وإجراء الأبحاث حول انتقال الملاريا المتبقية.旨在调查自 2004 年开始分发长效驱虫蚊帐并于 2011 年开始引入青蒿素联合疗法后，新几内亚（旧称巴布亚）疟疾患病率的变化。.在 2010 年至 2011 年和 2013 年至 2014 期间分别进行过两次疟疾调查。这两次调查分别包括了 77 个和 92 个随机选择的村庄。 在每个村庄，30 个随机选择的家庭的所有成员均提供了血液样本，并通过光学显微镜评估疟疾感染情况。 另外，数据还来自于 2008 年至 2009 年进行的疟疾调查。.自 2008 年至 2009 年期间，海拔 1600 米以下的疟疾患病率从 2008 年至 2009 年的 11.1％（95％ 置信区间，CI: 8.5–14.3）降到 2010 年至 2011 年的 5.1%（95% 置信区间，CI：3.6–7.4）并在 2013 年至 2014 年降到 0.9%（95% 置信区间，CI：0.6–1.5)。患病率随着海拔高度下降而降低。 总体而言大规模驱虫蚊帐的普及与新几内亚（旧称巴布亚）疟疾患病率前所未有的下降之间有相关性，包括流行病高发的高海拔地带。 这种下降伴随着范围更广的健康益处，如发病率下降。 需要对非疟疾发烧进行更有效的临床管理和研究，以降低尚有残留的疟疾传播。.Изучить изменения в распространенности малярии в Папуа — Новой Гвинее после внедрения сеток, обработанных инсектицидами длительного действия, с 2004 года и после введения в 2011 году комбинированной терапии на основе артемизинина.В 2010–2011 гг. и 2013–2014 гг. были проведены два обследования на инфицирование малярией. Они включали соответственно 77 и 92 случайно выбранных поселка. В каждом поселке все представители 30 случайно отобранных домохозяйств сдали образцы крови, которые прошли исследование с использованием световой микроскопии на предмет заражения малярией. Кроме того, были получены результаты обследования на малярию, проведенного в 2008–2009 гг.Распространенность малярии на высоте ниже 1600 м над уровнем моря снизилась с 11,1% (95%-й доверительный интервал, ДИ: 8,5–14,3) в 2008–2009 гг. до 5,1% (95%-й ДИ: 3,6–7,4) в 2010–2011 гг. и до 0,9% (95%-й ДИ: 0,6–1,5) в 2013–2014 гг. Распространенность инфекции снижалась по мере роста высоты над уровнем моря. ВозбудительШирокомасштабное распространение использования сеток, обработанных инсектицидами длительного действия, было связано с беспрецедентным снижением распространенности малярии во всей Папуа — Новой Гвинее, включая районы, подверженные эпидемии. Снижение распространенности инфекции сопровождалось более широкими преимуществами для здоровья, такими как снижение заболеваемости. Требуется введение более качественных клинических протоколов ведения и лечения лихорадки, не связанной с малярией, а также проведение исследования оставшихся очагов распространения малярии.

Background: This paper aims to assess the sensitivity and specificity of exit interviews as a measure of malaria case management practice as compared to direct observation. Methods: The malaria case management of 1654 febrile patients attending 110 health facilities from across Papua New Guinea was directly observed by a trained research officer as part of a repeat cross sectional survey. Patient recall of 5 forms of clinical advice and 5 forms of clinical action were then assessed at service exit and statistical analyses on matched observation/exit interview data conducted. Results: The sensitivity of exit interviews with respect to clinical advice ranged from 36.2% to 96.4% and specificity from 53.5% to 98.6%. With respect to clinical actions, sensitivity of the exit interviews ranged from 83.9% to 98.3% and specificity from 70.6% to 98.1%. Conclusion: The exit interview appears to be a valid measure of objective malaria case management practices such as the completion of a diagnostic test or the provision of antimalarial medication, but may be a less valid measure of low frequency, subjective practices such as the provision of malaria prevention advice.

Background Poor-quality life-saving medicines are a major public health threat, particularly in settings with a weak regulatory environment. Insufficient amounts of active pharmaceutical ingredients (API) endanger patient safety and may contribute to the development of drug resistance. In the case of malaria, concerns relate to implications for the efficacy of artemisinin-based combination therapies (ACT). In Papua New Guinea (PNG), Plasmodium falciparum and P. vivax are both endemic and health facilities are the main source of treatment. ACT has been introduced as first-line treatment but other drugs, such as primaquine for the treatment of P. vivax hypnozoites, are widely available. This study investigated the quality of antimalarial drugs and selected antibiotics at all levels of the health facility supply chain in PNG. Methods and Findings Medicines were obtained from randomly sampled health facilities and selected warehouses and hospitals across PNG and analysed for API content using validated high performance liquid chromatography (HPLC). Of 360 tablet/capsule samples from 60 providers, 9.7% (95% CI 6.9, 13.3) contained less, and 0.6% more, API than pharmacopoeial reference ranges, including 29/37 (78.4%) primaquine, 3/70 (4.3%) amodiaquine, and one sample each of quinine, artemether, sulphadoxine-pyrimethamine and amoxicillin. According to the package label, 86.5% of poor-quality samples originated from India. Poor-quality medicines were found in 48.3% of providers at all levels of the supply chain. Drug quality was unrelated to storage conditions. Conclusions This study documents the presence of poor-quality medicines, particularly primaquine, throughout PNG. Primaquine is the only available transmission-blocking antimalarial, likely to become important to prevent the spread of artemisinin-resistant P. falciparum and eliminating P. vivax hypnozoites. The availability of poor-quality medicines reflects the lack of adequate quality control and regulatory mechanisms. Measures to stop the availability of poor-quality medicines should include limiting procurement to WHO prequalified products and implementing routine quality testing.

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 country's 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.

The Papua New Guinea (PNG) Department of Health introduced a 'test and treat' malaria case management protocol in 2011. This study assesses health worker compliance with the test and treat protocol on a wide range of measures, examines self-reported barriers to health worker compliance as well as health worker attitudes towards the test and treat protocol. Data were collected by cross-sectional survey conducted in randomly selected primary health care facilities in 2012 and repeated in 2014. The combined survey data included passive observation of current or recently febrile patients (N = 771) and interviewer administered questionnaires completed with health workers (N = 265). Across the two surveys, 77.6% of patients were tested for malaria infection by rapid diagnostic test (RDT) or microscopy, 65.6% of confirmed malaria cases were prescribed the correct antimalarials and 15.3% of febrile patients who tested negative for malaria infection were incorrectly prescribed an antimalarial. Overall compliance with a strictly defined test and treat protocol was 62.8%. A reluctance to test current/recently febrile patients for malaria infection by RDT or microscopy in the absence of acute malaria symptoms, reserving recommended antimalarials for confirmed malaria cases only and choosing to clinically diagnose a malaria infection, despite a negative RDT result were the most frequently reported barriers to protocol compliance. Attitudinal support for the test and treat protocol, as assessed by a nine-item measure, improved across time. In conclusion, health worker compliance with the full test and treat malaria protocol requires improvement in PNG and additional health worker support will likely be required to achieve this. The broader evidence base would suggest any such support should be delivered over a longer period of time, be multi-dimensional and multi-modal.

Background This study assessed the feasibility and acceptability of utilizing insecticide-treated plastic sheeting (ITPS) as a malaria control intervention in Papua New Guinea (PNG). Methods ZeroVector® ITPS was installed in 40 homes across four study sites representing a cross section of malaria transmission risk and housing style. Structured questionnaires were completed at the time of ITPS installation (n=40) and at four weeks post installation (n=40) with the household head. Similarly, group interviews with the male and/or female household heads were completed at installation (n=5) and four-week follow-up (n=4). Results ZeroVector® ITPS was successfully installed in a range of homes employing traditional and/or modern building materials in PNG. The ITPS installations remained intact over the course of the four-week trial period and were highly acceptable to both male and female household heads. No dissatisfaction with the ITPS product was reported at four-week follow-up; however, the installation process was time consuming, participants reported a reduction in mosquito net use following ITPS installation and many participants expressed concern about the longevity of ITPS over the longer term. Conclusion ZeroVector® ITPS installation is feasible and highly acceptable in a diverse range of PNG contexts and is likely to be favourably received as a vector control intervention if accessible en masse. A longer-term evaluation is required before firm policy or public health decisions can be made regarding the potential application of ITPS in the national malaria control programme. The positive study findings suggest a longer-term evaluation of this promising malaria control intervention warrants consideration.

Background Papua New Guinea (PNG) is a South Pacific island nation with a complex malaria epidemiology. Four malaria species are transmitted by a variety of anopheline vectors filling the diverse ecological niches. Attempts to eliminate malaria in PNG in the 1950s -70s failed largely due to operational difficulties related to the unique implementation environment. Since 2004, the national malaria control program has been supported by two consecutive grants from the Global Fund resulting in the first country-wide free distribution of insecticide treated mosquito nets.

This paper presents findings from a qualitative study designed to explore the reasons why some Papua New Guineans who own mosquito nets choose not to use them, whether on a regular or episodic basis. In-depth interviews (IDIs) were conducted with a sub-sample (n = 44) of participants in a country wide household survey who reported owning or having access to a mosquito net, but not having slept under a mosquito net the night prior to survey. All IDIs were completed between December 2010 and June 2011. Analysis was informed by a general inductive methodology. Multiple impediments to regular mosquito net use were identified by study participants, although all were broadly grouped into the inter-related categories of net-, environmental- or human-factors. Indifference emerged as the most influential impediment towards regular net use presenting as a general attitudinal context in which a majority of participant responses were grounded. A lack of knowledge regarding malaria transmission pathways or the utility of mosquito nets did not appear to underlie this indifference. Rather, the indifference appeared to be rooted in a lack of fear of malaria infection cultivated through lived experience. A wide range of interventions could potentially promote greater mosquito net use amongst this population. However, the basis of any intervention strategy, given the pervasive indifferent attitude towards regular mosquito net use, should be to render individual mosquito net use as easy and as convenient as possible and to promote complementary malaria control strategies where appropriate.