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Background:
Routine immunization programs face many challenges in settings such as Papua New Guinea with dispersed rural populations, rugged geography and limited resources for transport and health. Low routine coverage contributes to disease outbreaks such as measles and the polio that re-appeared in 2018. We report on an in-depth local assessmen...
Contexts in source publication
Context 1
... surveyed comprised 12 clinics providing immunization services, nine in fixed facilities and three community outreach sites; purposefully chosen as they are all linked to the health institutions providing approximately 80% of maternal and child health care in ENBP [16]. Respondents for interview were chosen to provide a mix of seniority across frontline positions (Table 1). Table 1 summarises the mix of interview, focus group discussion, structured observation and records audit. ...Context 2
... for interview were chosen to provide a mix of seniority across frontline positions (Table 1). Table 1 summarises the mix of interview, focus group discussion, structured observation and records audit. All tools reflected our evaluation framework by incorporating items testing core elements of the SIREP strategy, PNG's national immunization plans [11] and WHO standards for program monitoring [15], refined through consultation with national and provincial health managers. ...Context 3
... were additionally categorised as either local strengths or areas needing improvement, with decisions on this allocation being made by the research team. A comprehensive table of findings and themes is available as Additional file 1, Tables 1 and 2. ...Context 4
... surveyed comprised 12 clinics providing immunization services, nine in fixed facilities and three community outreach sites; purposefully chosen as they are all linked to the health institutions providing approximately 80% of maternal and child health care in ENBP [16]. Respondents for interview were chosen to provide a mix of seniority across frontline positions (Table 1). Table 1 summarises the mix of interview, focus group discussion, structured observation and records audit. ...Context 5
... for interview were chosen to provide a mix of seniority across frontline positions (Table 1). Table 1 summarises the mix of interview, focus group discussion, structured observation and records audit. All tools reflected our evaluation framework by incorporating items testing core elements of the SIREP strategy, PNG's national immunization plans [11] and WHO standards for program monitoring [15], refined through consultation with national and provincial health managers. ...Similar publications
Background:
The global polio eradication initiative has made giant stride by achieving a 99% reduction in Wild poliovirus (WPV) cases, with Nigeria on the verge of being declared polio-free following over 36 months without a WPV. The initiative has provided multiple resources, assets and lessons learnt that could be transitioned to other public he...
Citations
... In a cross-sectional study conducted in East New Britain province, contributing factors for low immunization coverage included a lack of local planning based on locations of child populations, limited intensification of outreach services, incomplete local information and lack of trained human resources. 8 Another study found that there were several barriers to vaccine delivery, including lack of access to health-care services, natural disasters and intertribal conflicts. 9 In 2020, immunization service delivery was negatively affected by the COVID-19 pandemic because the government issued strict movement restrictions that resulted in reduced health clinic attendance and outreach visits by health-care workers. ...
Objective
Routine immunization coverage in Papua New Guinea has decreased in the past 5 years. This persistently low routine immunization coverage has resulted in low population immunity and frequent outbreaks of vaccine-preventable disease across the country. We describe the use of a catch-up programme to improve routine immunization during the coronavirus disease pandemic in Papua New Guinea during 2020–2022.
Methods
In June 2020, 13 provinces of Papua New Guinea were selected to undergo a vaccination catch-up programme, with technical support from the World Health Organization (WHO) and the United Nations Children’s Fund. Twelve provinces received financial and logistic support through the Accelerated Immunization and Health Systems Strengthening programme, and one received support from WHO. All stakeholders were involved in planning and implementing the catch-up programme.
Results
Between July 2020 and June 2022, about 340 health facilities conducted catch-up activities. The highest number of children aged under 1 year were vaccinated in 2022 (n = 33 652 for third dose of pentavalent vaccine). The national coverage of routine immunization (including the catch-up vaccinations) increased between 2019 and 2020 – by 5% for the third dose of pentavalent vaccine, 11% for the measles-rubella vaccine and 16% for the inactivated poliovirus vaccine. The coverage declined slightly in 2021 before increasing again in 2022.
Discussion
The catch-up programme was an instrumental tool to improve routine immunization coverage between 2020 and 2022 and during the pandemic in Papua New Guinea. With appropriate technical and logistic support, including financial and human resources, catch-up programmes can strengthen routine immunization coverage across the country.
... Rates of facility birth are also generally higher in East New Britain at 60%, compared to the national average of 40% [29]. Recent studies in this population have shown high rates of unintended pregnancy and low rates of modern contraceptive use [13], high rates of reproductive tract infections [14], and gaps in childhood immunisation coverage [32]. ...
... This study was conducted in the catchment areas of five health facilities that provide maternity services in East New Britain: a tertiary referral hospital, two rural hospitals, one health centre and one community health post ( Table 1). The PHA nominated these facilities to participate in the study because they collectively provide approximately 70% of the facility-based birthing services in the province, have been involved in previous research [13, 14,32], represent a combination of Government-and faith-based organised services, and capture the referral pathway from a remote community health post to a tertiary referral hospital. ...
Background
Quality maternal and newborn care is essential for improving the health of mothers and babies. Low- and middle-income countries, such as Papua New Guinea (PNG), face many barriers to achieving quality care for all. Efforts to improve the quality of maternal and newborn care must involve community in the design, implementation, and evaluation of initiatives to ensure that interventions are appropriate and relevant for the target community. We aimed to describe community members’ perspectives and experiences of maternal and newborn care, and their ideas for improvement in one province, East New Britain, in PNG.
Methods
We undertook a qualitative descriptive study in partnership with and alongside five local health facilities, health care workers and community members, using a Partnership Defined Quality Approach. We conducted ten focus group discussions with 68 community members (identified through church, market and other community-based groups) in East New Britain PNG to explore perspectives and experiences of maternal and newborn care, identify enablers and barriers to quality care and interventions to improve care. Discussions were transcribed verbatim. A mixed inductive and deductive analysis was conducted including application of the World Health Organisation (WHO) Quality Maternal and Newborn Care framework.
Results
Using the WHO framework, we present the findings in accordance with the five experience of care domains. We found that the community reported multiple challenges in accessing care and facilities were described as under-staffed and under resourced. Community members emphasised the importance of good communication and competent, caring and respectful healthcare workers. Both women and men expressed a strong desire for companionship during labor and birth. Several changes were suggested by the community that could immediately improve the quality of care.
Conclusions
Community perspectives and experiences are critical for informing effective and sustainable interventions to improve the quality of maternal and newborn care and increasing facility-based births in PNG. A greater understanding of the care experience as a key component of quality care is needed and any quality improvement initiatives must include the user experience as a key outcome measure.
... The Healthy Mothers, Healthy Babies (HMHB) [19] research program was established in East New Britain Province (ENBP) in 2015 and consists of several primary studies and implementation projects all working towards identifying determinants of poor maternal and newborn health [20][21][22]. ENB is part of a large island in PNG's north-east, whose population of approximately 400,000 live in a mix of highland and coastal villages, with some small towns [23]. The HMHB Prospective Observational Longitudinal Cohort Study, conducted between March 2015 and December 2018, recruited 699 pregnant women at their first antenatal clinic (ANC) with follow up after childbirth, and again at 1, 6, and 12 months postpartum; data from the first three time points (ANC1, childbirth and 1 month postpartum) were used for this study. ...
Background
Globally, 2.5 million babies die in the first 28 days of life each year with most of these deaths occurring in low- and middle-income countries. Early recognition of newborn danger signs is important in prompting timely care seeking behaviour. Little is known about women’s knowledge of newborn danger signs in Papua New Guinea. This study aims to assess this knowledge gap among a cohort of women in East New Britain Province.
Methods
This study assessed knowledge of newborn danger signs (as defined by the World Health Organization) at three time points from a prospective cohort study of women in East New Britain Province, factors associated with knowledge of danger signs after childbirth were assessed using logistic regression. This study includes quantitative and qualitative interview data from 699 pregnant women enrolled at their first antenatal clinic visit, followed up after childbirth ( n = 638) and again at one-month post-partum ( n = 599).
Results
Knowledge of newborn danger signs was very low. Among the 638 women, only 9.4% knew three newborn danger signs after childbirth and only one knew all four essential danger signs defined by Johns Hopkins University ‘Birth Preparedness and Complication Readiness’ Index. Higher knowledge scores were associated with higher gravidity, income level, partner involvement in antenatal care, and education.
Conclusion
Low levels of knowledge of newborn danger signs among pregnant women are a potential obstacle to timely care-seeking in rural Papua New Guinea. Antenatal and postnatal education, and policies that support enhanced education and decision-making powers for women and their families, are urgently needed.
... There is restrictive outreach, no selective targeting of population concentrations, and minimal systems for tracking and finding under-vaccinated children. Gaps in the provision of education, counselling of families, AEFI readiness, and the checking of vaccines for heat or freezing damage among health workers as only 25% of clinics organise but without the use of pictorial, video, participatory engagement, or give away communication products (Morgan et al., 2020). ...
Papua New Guinea (PNG) has one of the poorest COVID-19 vaccine uptakes, when compared with the global data. It is also deeply rooted in the poor and stagnated performance in the routine immunisation over the decades. The country has demonstrated poor uptake despite the efforts of the government and development partners. Complex political and governance issues are intertwined with poor health infrastructure at the national and sub-national levels, thus hindering COVID-response and vaccination. These issues include a lack of strategic vision and implementation; prevailing vaccine-hesitancy among communities and health workers; strong belief in conspiracy theories and misinformation; inability to reach out to the remote 'media-dark' areas and communities with unwritten languages. Risk Communication and Community Engagement (RCCE) initiative in PNG remains largely restricted to mass media and social media interventions, which have been able to reach only select linguistic communities, whereas the country has more than 800 languages. Observational visits found that the activities were limited to urban settings mostly as there are huge communications challenges. The relevant messages and materials developed and disseminated were found technically compromised in adhering to the protocols of social and behaviour change (SBC), which ought to be based on the primary logic of multiple conceptual frameworks and theoretical underpinnings (Socio-ecological model, Theory of Diffusion of Innovations; Theory of Planned Behaviour; Stages of Change Theory; Health Belief Model and many others). Therefore, PNG is an ideal setting to examine the issues of vaccine hesitancy in the context of missing responses and its linkages with low social media penetration. This article uses a qualitative observational approach to unearth major issues and discuss possible solutions.
... It remains a challenge for healthcare systems in many countries [9]. Some factors that may contribute to low vaccination coverage include a low level of education, negative beliefs, superstitions, a considerable distance from the nearest vaccination facility, and the high cost of traveling to health centers [4,[10][11][12]. ...
... Our findings are in accordance with previous literature data. Morgan and Saweri generally demonstrated a poor state of records of vaccination in Papua New Guinea [10]. The major limitation of our study was reliance on the self-reported vaccination status, deemed less reliable [13]. ...
... Educational institutions should conduct awareness programs and facilitate free vaccination for students [19]. Proper training and education of healthcare workers are crucial [10]. Knowledge about vaccinepreventable diseases is influenced by both level of education and the level of media awareness [26]. ...
Introduction: Vaccinations have a crucial role in the prevention of infectious diseases. Medical students are at high risk of acquiring infectious diseases and transmitting them to vulnerable patients. The success of any vaccination project is closely related to the knowledge and awareness of healthcare workers. The main objective of this study was to assess the vaccination status, knowledge, and attitudes towards vaccination among students being trained at Divine Word University on the Madang campus, Papua New Guinea. Material and methods: A cross-sectional study using a semi-structured questionnaire. Results: Out of 89 participants, there were 67 medical students and 22 non-health sciences students. Only one-third of students provided the book with vaccination records. The self-reported vaccination coverage was low. For measles, it was 42% for health sciences and 20% for non-health sciences students; for tetanus and polio, it was approximately 20% for all students. Only 9% of medical students received vaccination against hepatitis B, while no non-health sciences students were vaccinated. Medical students knew five diseases, other health sciences students knew 4.1 diseases, and non-medical students knew 3.6 diseases that are preventable by vaccination. The knowledge of the preventive role of vaccinations was shallow. Conclusions: The study disclosed not only poor vaccination records but also low awareness and knowledge about vaccinations among students. This poses a risk for future healthcare workers and patients and calls for the improvement of education. Universal precautions, prevention of occupational infections, and optimizing students' vaccination should be taught in the early years at university.
... To ensure the longterm eradication of poliomyelitis in PNG, human and other resources must be directed towards maintaining high vaccination coverage along with ensuring a robust surveillance system is maintained [16]. Tracking unvaccinated people, improving the reach and efficiency of outreach services, and improving staff and community knowledge about vaccination are all areas that have been identified to improve the performance of the national immunization strategy in PNG [22]. ...
Objective: Vaccine-derived poliovirus (VDPV) remains a significant barrier to global poliomyelitis eradication. Following 18 years of polio-free status, an epidemic of circulating VDPV type 1 (cVDPV1) occurred in Papua New Guinea (PNG) in 2018. We describe the epidemiology of the 2018 cVDPV1 epidemic in PNG, and identify risk factors which may aid future policy and control efforts. Methods: Data pertaining to the 2018 PNG epidemic were extracted from EPIWATCH and supplemented with data from other sources, such as the World Health Organization (WHO), and published literature. Descriptive analyses were undertaken, and key risk factors identified. Results: 26 cases of cVDPV1 were confirmed throughout the duration of the epidemic (April to October 2018) in nine provinces. Of the 26 cases, 19 (73%) were males and 7 (27%) were females, and most of the cases (73%) occurred in children under the age of five. Population immunization coverage of three doses of oral polio vaccine (OPV3) was found to fluctuate between 60- 80% between 2000 and 2018. Nonpolio Acute Flaccid Paralysis (NPAFP) surveillance rates were also found to be suboptimal over this period. Discussion: A combination of low routine immunization coverage, lacking supplementary immunization activities, and ineffective surveillance systems, in the context of a struggling health system, culminated in this epidemic. To prevent future poliomyelitis epidemics in PNG, emphasis must be placed on supporting the health system to maintain high vaccination coverage, in conjunction with robust and effective surveillance systems.
... Approximately, 60% of births occur in health facilities, above the PNG national average of 36% [22]. The province is similar to much of PNG in terms of disease profile and geography, including high rates of unintended pregnancy, low rates of contraception use [23], high burden of reproductive infections [24], and gaps in childhood immunization coverage [25]. East New Britain's mountainous interior renders some communities accessible only by walking tracks, and coastal villages generally only accessible by water. ...
Companionship during labour and birth is a critical component of quality maternal and newborn care, resulting in improved care experiences and better birth outcomes. Little is known about the preferences and experiences of companionship in Papua New Guinea (PNG), and how it can be implemented in a culturally appropriate way. The aim of this study was to describe perspectives and experiences of women, their partners and health providers regarding labour and birth companionship, identify enablers and barriers and develop a framework for implementing this intervention in PNG health facilities. A mixed methods study was conducted with five facilities in East New Britain, PNG. Data included 5 facility audits, 30 labour observations and 29 in-depth interviews with women who had recently given birth, partners and maternity care providers. A conceptual framework was developed drawing on existing quality care implementation frameworks. Women and partners wanted companions to be present, whilst health providers had mixed views. Participants described benefits of companionship including encouragement and physical support for women, better communication and advocacy, improved labour outcomes and assistance with workforce issues. Adequate privacy and space constraints were highlighted as key barriers to address. Of the women observed, only 30% of women had a companion present during labour, and 10% had a companion at birth. A conceptual framework was used to highlight the interconnected inputs required at community, facility and provincial health system levels to improve the quality of care. Key elements to address included attitudes towards companionship, the need for education and training and restrictive hospital policies. Supporting women to have their companion of choice present during labour and birth is critical to improving women’s experiences of care and improving the quality of maternal and newborn care. In order to provide companionship during labour and birth in PNG, a complex, intersecting, multi-faceted approach is required.
... PNG introduced the Special Integrated Routine EPI Strengthening Program (SIREP) strategy in 2015 with the support of the WHO and UNICEF to improve its immunization program ( World Health Organization, 2017b ). Notably, improved population-based local planning and stronger community engagement are effective in improving immunization coverage and quality, and it is suggested that SIREP can help strengthen routine immunization programs ( Morgan et al., 2020 ). Besides, the integrated package of services is suggested to contribute to the success in SIAs, and SIAs for measles and rubella can enhance and reinforce routine immunization via a synergistic effect ( Morgan et al., 2020 ;World Health Organization, 2016 ;Wallace et al., 2017 ). ...
... Notably, improved population-based local planning and stronger community engagement are effective in improving immunization coverage and quality, and it is suggested that SIREP can help strengthen routine immunization programs ( Morgan et al., 2020 ). Besides, the integrated package of services is suggested to contribute to the success in SIAs, and SIAs for measles and rubella can enhance and reinforce routine immunization via a synergistic effect ( Morgan et al., 2020 ;World Health Organization, 2016 ;Wallace et al., 2017 ). Because the measles IgG prevalence in the present study was found to be insufficient to eliminate measles, routine immunization needs to be emphasized along with the implementation of SIREP and SIAs with high coverage. ...
Objectives
This study aimed to assess measles and rubella immunity by measuring virus-specific immunoglobulin G (IgG) prevalence among individuals and evaluate the effectiveness of recent supplementary immunization activities (SIAs) by comparing the antibody positivity rates of the SIA target age groups in 2015 with those in 2019 as measles and rubella are endemic in Papua New Guinea.
Methods
A cross-sectional study. The measles- and rubella-specific IgG levels of patients aged ≥1 year at two clinics in East Sepik province, Papua New Guinea were assessed with commercially available virus-specific IgG EIA kits.
Results
In total, 297 people participated in the study and 278 samples with sufficient volume, relevant information, and age inclusion criteria were analyzed. The overall IgG prevalence rates were 62.6% for measles and 82.0% for rubella. The age groups targeted in the 2019 SIAs had a higher IgG prevalence than those targeted in the 2015 SIAs for both the infectious diseases. Moreover, the IgG prevalence for rubella was higher than measles in these groups.
Conclusions
The anti-measles and anti-rubella IgG prevalence in the target groups were lower than those required for herd immunity. The immunization program should be emphasized to eliminate measles and rubella. Further population-based studies are warranted.
... However, studies on immunization coverage in Papua New Guinea are either old (Freeman et al., 1992) or did not thoroughly investigate the factors associated with complete immunization coverage in the country (Samiak & Emeto, 2017;Toikilik et al., 2010). A recent study on strengthening routine immunization in Papua New Guinea identified several strategies to strengthening routine immunization in the country and stressed the need for empirical evidence to unearth some of the factors that influence immunization coverage (Morgan et al., 2020). It is in the light of the gaps in previous studies on immunization in Papua New Guinea that this present study seeks to examine the determinants of complete immunization coverage in Papua New Guinea. ...
Introduction
Vaccination is one of the most cost-effective measures adopted to prevent major deadly childhood diseases globally. Worldwide, the uptake of routine childhood vaccination has the propensity to prevent about 1.5 million annual deaths among children. This study examined the determinants of complete immunization coverage among children aged 12-23 months in Papua New Guinea.
Methods
The study was based on data from the 2016-18 Papua New Guinea Demographic and Health Survey. Information on 709 children aged 12-23 months was extracted from the children’s files. Both bivariate and multivariate analyses were done to assess the factors associated with complete immunisation coverage and statistical significance was pegged at p<0.05.
Results
Complete immunization coverage was 39%. The odds of complete immunization was higher among children whose mothers had primary [AOR=2.272, CI=1.310,3.941], secondary [AOR=2.536, CI=1.303,4.937], and higher levels of education [AOR=2.855, CI=1.051,7.750], compared to children whose mothers had no formal education. Children whose mothers were in the richest wealth quintile [AOR=2.394, CI=1.137,5.038] had higher odds of receiving complete vaccination, compared to those whose mothers were in the poorest wealth quintile. Children whose mothers were married [AOR=1.696, CI=1.113,2.587] had higher odds of receiving complete vaccination, compared to those whose mothers were cohabiting. Finally, children whose mothers attended postnatal check-up visits [AOR=2.366, CI=1.654,3.385] had higher odds of receiving complete vaccination, compared to those whose mothers did not attend postnatal check-up visits.
Conclusion
Complete immunization coverage in Papua New Guinea is relatively low. Mothers’ educational level, wealth quintile, marital status, and postnatal care attendance play significant roles in the complete immunization of children aged 12-23 months in Papua New Guinea. This suggests that interventions such as health education and service expansion on immunization should be implemented, taking into consideration these factors.
Background
In June 2018, a type 1 circulating vaccine-derived poliovirus (cVDPV1) outbreak was declared in Papua New Guinea (PNG), resulting in a total of 26 paralytic confirmed cases. Eight vaccination campaign rounds with bivalent oral poliovirus vaccine (bOPV) were carried out in response. Prevalence of neutralizing polio antibodies in children was assessed two years after the outbreak response was completed.
Methods
We conducted a cross-sectional serological survey among children aged 6 months–10 years selected from six provinces in PNG to evaluate seroprevalence of neutralizing polio antibodies to the three poliovirus serotypes and analyse sociodemographic risk factors.
Findings
We included 984 of 1006 enrolled children in the final analysis. The seroprevalence of neutralizing polio antibodies for serotype 1, 2 and 3 was 98.3% (95% CI: 97.4–98.9), 63.1% (95% CI: 60.1–66.1) and 95.0% (95% CI: 93.6–96.3), respectively. Children <1 year had significantly lower type 1 seroprevalence compared to older children (p < 0.001); there were no significant differences in seroprevalence among provinces.
Interpretation
PNG successfully interrupted transmission of cVDPV1 with several high coverage bOPV campaigns and seroprevalence remained high after two years. The emergence of cVDPV strains underscores the importance of maintaining high levels of routine immunization coverage and effective surveillance systems for early detection.
Funding
10.13039/100004423World Health Organization through a Rotary International IPPC grant.
