Prevalence of non-communicable diseases and their risk factors in Papua New Guinea: A systematic review

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

Effectiveness of Artemether/Lumefantrine for the Treatment of Uncomplicated Plasmodium vivax and P. falciparum Malaria in Young Children in Papua New Guinea

This study shows that artemether/lumefantrine provides a rapid clinical response against both Plasmodium falciparum and Plasmodium vivax clinical malaria, but is associated with a high rate of P. vivax recurrent clinical episodes due to relapsing infections from long-lasting hypnozoite

Rapid Diagnostic Test-Based Management of Malaria: An Effectiveness Study in Papua New Guinean Infants With Plasmodium falciparum and Plasmodium vivax Malaria

This study shows that treatment for malaria based exclusively on rapid diagnostic test results is safe and feasible even in infants living in areas with moderate to high endemicity for both Plasmodium falciparum and Plasmodium vivax infection

Blood-Stage Parasitaemia and Age Determine Plasmodium falciparum and P. vivax Gametocytaemia in Papua New Guinea

A better understanding of human-to-mosquito transmission is crucial to control malaria. In order to assess factors associated with gametocyte carriage, 2083 samples were collected in a cross-sectional survey in Papua New Guinea. Plasmodium species were detected by light microscopy and qPCR and gametocytes by detection of pfs25 and pvs25 mRNA transcripts by reverse-transcriptase PCR (qRT-PCR). The parasite prevalence by PCR was 18.5% for Plasmodium falciparum and 13.0% for P. vivax. 52.5% of all infections were submicroscopic. Gametocytes were detected in 60% of P. falciparum-positive and 51% of P. vivax-positive samples. Each 10-fold increase in parasite density led to a 1.8-fold and 3.3-fold increase in the odds of carrying P. falciparum and P. vivax gametocytes. Thus the proportion of gametocyte positive and gametocyte densities was highest in young children carrying high asexual parasite densities and in symptomatic individuals. Dilution series of gametocytes allowed absolute quantification of gametocyte densities by qRT-PCR and showed that pvs25 expression is 10-20 fold lower than pfs25 expression. Between 2006 and 2010 parasite prevalence in the study site has decreased by half. 90% of the remaining infections were asymptomatic and likely constitute an important reservoir of transmission. However, mean gametocyte densities were low (approx. 1-2 gametocyte/muL) and it remains to be determined to what extent low-density gametocyte positive individuals are infective to mosquitos

Prevalence of non-communicable disease risk factors in three sites across Papua New Guinea: a cross-sectional study

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.To establish the prevalence of NCD risk factors in three different regions across PNG in order to guide appropriate prevention and control measures.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.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.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

Intermittent Preventive Treatment for Malaria in Papua New Guinean Infants Exposed to Plasmodium falciparum and P. vivax: A Randomized Controlled Trial

A three-arm randomized trial conducted among infants in Papua New Guinea estimates the preventive effect against malaria episodes of intermittent preventive treatment, in an area where children are exposed to both falciparum and vivax malaria

A survey of non-communicable disease and the associated risk factors in three different study sites in Papua New Guinea

© 2020 Patricia RarauIntroduction Non-Communicable Diseases (NCDs) are the leading cause of death and morbidity throughout the world, with the greatest burden in low- and middle-income countries (LMICs). Of the estimated 17.9 million CVD deaths in 2016, more than 10 million occurred in LMIC countries. Coronary heart disease and stroke were the two major causes contributing to these deaths. Papua New Guinea (PNG) is categorized as a lower-middle-income country according to World Bank criteria and it is experiencing rapid economic growth as a result of large-scale mineral and gas resource developments. These economic changes are contributing to epidemiological transitions associated with rapid lifestyle changes that, in turn, are leading to increases in cardiovascular diseases and diabetes. NCDs and associated risk factors have not been well investigated in PNG, however, several small studies conducted over the past 40 years have been suggestive of increasing prevalence of NCDs and their associated risk factors (Chapter 3). The aim of this research is to establish an up-to-date NCD risk factor prevalence data enabling a better understanding of the differences in these risk factors in relation to socio-economic status in three locations in PNG. The present study was undertaken during the construction phase of a large-scale gas development which was projected to more than double the gross domestic product (GDP) of PNG. The study was designed to provide baseline prevalence data on NCD risk factors in the initial years of a gas project impact site (West Hiri) and in two non-project impact sites (Asaro and Karkar Island). It was also anticipated that the study findings would provide up-to-date NCD risk factor prevalence data to help the national government plan services and develop cost-effective interventions. This thesis describes the methods used and presents the initial findings for NCD risk factors in a survey of three different socio-demographic populations of PNG. Methods The analysis of the data presented in the results sections of this thesis was based on the NCD Risk factor survey. The survey was a cross-sectional study of the prevalence of NCD risk factors across three different sites namely West Hiri in Central province, Asaro in Eastern Highlands province and Karkar Island in Madang province. A modified questionnaire based on the WHO STEPwise instrument was used for data collection. In addition, physical measurement and biochemical samples were collected from participants (Chapter 4). Results A total of 785 participants participated in the survey. The prevalence of NCD risk factors varied markedly different across the three sites. The metabolic risk factors such as obesity, elevated blood pressure, increased total cholesterol and HbA1c levels were higher in West Hiri compared to the other two sites (Chapter 5). Further analysis of the data was done to investigate the association between socio-economic status (SES), and the CVD risk factors. Findings show that elevated CVD risk factors were common among all SES groups, but metabolic risk factors were more prevalent among homemakers, peri-urban West Hiri and Asaro and among the highest quintile groups. Adults in the peri-urban West Hiri had higher risk of obesity, hypertension, abnormal lipids and elevated HbA1c. Similarly, Asaro adults had increased risk of central obesity, hypertension, elevated triglycerides and MetS compared to the residents of rural Karkar Island (Chapter 6). Conclusion The research reported in this thesis adds to our understanding of the associations between SES and CVD risk factors in a LMIC like PNG. Data from high income countries show a negative correlation with socio-economic status, however findings from our study showed the association between CVD risk factors and SES varied greatly depending on the type of SES measure used. Understanding these associations is important to inform the government to develop appropriate and effective prevention and control strategies. With this information at hand, the government would be able to make informed decisions and prioritize its prevention and control strategies targeting high risk populations or settings in the country

Use of antibiotics within the IMCI guidelines in outpatient settings in Papua New Guinean children : an observational and effectiveness study

There is a need to investigate the effectiveness and appropriateness of antibiotics prescription within the Integrated Management of Childhood Illness (IMCI) strategy in the context of routine outpatient clinics.; Making use of a passive case detection system established for a malaria prevention trial in outpatient clinics in Papua New Guinea, the appropriateness and effectiveness of the use of antibiotics within the IMCI was assessed in 1605 young children. Main outcomes were prescription of antibiotics and re-attendances within 14 days for mild pneumonia, mild diarrhoea and uncomplicated malaria whether they were managed with or without antibiotics (proxy of effectiveness). Appropriateness was assessed for both mild and severe cases, while effectiveness was assessed only for mild diseases.; A total of 6975 illness episodes out of 8944 fulfilled inclusion criteria (no previous attendance >14 days+full medical records). Clinical incidence rates (episodes/child/year; 95% CI) were 0.85 (0.81-0.90) for pneumonia, 0.62 (0.58-0.66) for malaria and 0.72 (0.65-0.93) for diarrhoea. Fifty three percent of 6975 sick children were treated with antibiotics, 11% were not treated with antibiotics when they should have been and in 29% antibiotics were prescribed when they should not have been. Re-attendance rates within 14 days following clinical diagnosis of mild pneumonia were 9% (126/1401) when managed with antibiotics compared to 8% (56/701) when managed without (adjusted Hazard Ratio (aHR) = 1.00 (0.57-1.76), p = 0.98). Rates for mild diarrhoea were 8% (73/874) and 9% (79/866) respectively (aHR = 0.8 (0.42-1.57), p = 0.53).; Non-adherence to IMCI recommendations for prescription of antibiotics is common in routine settings in Papua New Guinea. Although recommended, the use of antibiotics in young children with mild pneumonia as defined by IMCI criteria did not impact on their outcome. Better tools and new strategies for the identification of bacterial infections that require antibiotics are urgently needed

Reduced risk of Plasmodium vivax malaria in Papua New Guinean children with Southeast Asian ovalocytosis in two cohorts and a case-control study

BACKGROUND: The erythrocyte polymorphism, Southeast Asian ovalocytosis (SAO) (which results from a 27-base pair deletion in the erythrocyte band 3 gene, SLC4A1Delta27) protects against cerebral malaria caused by Plasmodium falciparum; however, it is unknown whether this polymorphism also protects against P. vivax infection and disease. METHODS AND FINDINGS: The association between SAO and P. vivax infection was examined through genotyping of 1,975 children enrolled in three independent epidemiological studies conducted in the Madang area of Papua New Guinea. SAO was associated with a statistically significant 46% reduction in the incidence of clinical P. vivax episodes (adjusted incidence rate ratio [IRR] = 0.54, 95% CI 0.40-0.72, p>0.0001) in a cohort of infants aged 3-21 months and a significant 52% reduction in P. vivax (blood-stage) reinfection diagnosed by PCR (95% CI 22-71, p = 0.003) and 55% by light microscopy (95% CI 13-77, p = 0.014), respectively, in a cohort of children aged 5-14 years. SAO was also associated with a reduction in risk of P. vivax parasitaemia in children 3-21 months (1,111/microl versus 636/microl, p = 0.011) and prevalence of P. vivax infections in children 15-21 months (odds ratio [OR] = 0.39, 95% CI 0.23-0.67, p = 0.001). In a case-control study of children aged 0.5-10 years, no child with SAO was found among 27 cases with severe P. vivax or mixed P. falciparum/P. vivax malaria (OR = 0, 95% CI 0-1.56, p = 0.11). SAO was associated with protection against severe P. falciparum malaria (OR = 0.38, 95% CI 0.15-0.87, p = 0.014) but no effect was seen on either the risk of acquiring blood-stage infections or uncomplicated episodes with P. falciparum. Although Duffy antigen receptor expression and function were not affected on SAO erythrocytes compared to non-SAO children, high level (<90% binding inhibition) P. vivax Duffy binding protein-specific binding inhibitory antibodies were observed significantly more often in sera from SAO than non-SAO children (SAO, 22.2%; non-SAO, 6.7%; p = 0.008). CONCLUSIONS: In three independent studies, we observed strong associations between SAO and protection against P. vivax malaria by a mechanism that is independent of the Duffy antigen. P. vivax malaria may have contributed to shaping the unique host genetic adaptations to malaria in Asian and Oceanic populations. Please see later in the article for the Editors' Summar