Papua New Guinea
Country Summary for DOLF Meeting, October 2010
Lymphatic filariasis (LF) is endemic in 16 of the 21 provinces of Papua New Guinea (PNG). All infections are due to W. bancrofti and transmitted by Anopheles punctulatus and, less frequently, An. koliensis sibling species. More than 1 million persons in PNG are currently infected with W. bancrofti, and >3 million are at risk (total ~6.6 million). Brugia infection has not been described in PNG or the Indonesian province of Papua in the western half of the island of New Guinea.
Lymphatic filariasis is mainly a problem in lowland coastal areas and the many small islands off the main island mass. Malaria infection that includes the four major species of human parasite co-exists in the lowland areas. The level of LF endemicity varies widely, with community mf+ rates ranging from ~10 to >70%. The high end of the range is typified by inland tropical rainforest areas of East and West Sepik Provinces, and the lower end in eastern coastal areas and parts of Milne Bay Province. The map in Figure 1, below, shows the estimated LF endemicity in various provinces of PNG. Darker shading indicates a higher prevalence of infection (Trends Parasitol 2003).
Current Status of LF Elimination:
Leo Makita is the Director of Vector Control in the PNG and is responsible for LF elimination and also charged with LF elimination at a national level. Monies from the Global Fund are currently used to distribute long lasting insecticide treated bed nets (for malaria control), a task that is taking place at a provincial level by Rotary International. Zaixing Zhang is a WHO malaria expert assigned to advise the national government on malaria control and LF elimination. Recent discussions with national leaders indicate the following with respect to LF elimination: 1) Implementation units for MDA are based on districts within each province of the country. Since districts are determined by political boundaries, the population size of various districts may vary considerably; 2) LF is considered endemic in all provinces; 3) There are little to no data to indicate how the level of endemicity varies among districts within a province; 4) Only one province has received any MDA, Milne Bay Province. Three rounds of annual MDA were administered in 2005, 2006 and 2007. The drugs were administered by provincial health care workers grouped who would go from village to village handing out drugs over a period of 3 weeks. Typically drugs would be administered in the morning and evening when people were in the village. Teams would return to an area if there was poor initial coverage within the 3-week period. Drugs were administered based on the national census record from 2000. Department of Health Elimination of Lymphatic Filariasis treatment forms were used to record whether or not an individual actually took DEC/Albendazole. It is standard policy that dosing of DEC is based on weight recorded with a field scale. Presumably drugs were given under direct observation, but how much this was adhered to is unclear. They believe that 80% coverage was achieved; however, this is uncertain since 2000 census records may be outdated. Plans are to complete more rounds of MDA in Milne Bay Province in the near future. There has been no follow-up ICT card testing to evaluate the impact of the MDA; 6) The second province planned for MDA is New Ireland Province.