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Chen J, Davies A, Tran P, Gronau R, Rangan A, Allman-Farinelli M, Porykali S, Oge R, Porykali B. Health and Nutrition Promotion Programs in Papua New Guinea: A Scoping Review. Nutrients 2024; 16:1999. [PMID: 38999748 PMCID: PMC11243307 DOI: 10.3390/nu16131999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/04/2024] [Accepted: 06/20/2024] [Indexed: 07/14/2024] Open
Abstract
There is a rising prevalence of non-communicable diseases (NCDs) in Papua New Guinea (PNG), adding to the disease burden from communicable infectious diseases and thus increasing the burden on the healthcare system in a low-resource setting. The aim of this review was to identify health and nutrition promotion programs conducted in PNG and the enablers and barriers to these programs. Four electronic databases and grey literature were searched. Two reviewers completed screening and data extraction. This review included 23 papers evaluating 22 health and nutrition promotion programs, which focused on the Ottawa Charter action areas of developing personal skills (12 programs), reorienting health services (12 programs) and strengthening community action (6 programs). Nineteen programs targeted communicable diseases; two addressed NCDs, and one addressed health services. Enablers of health promotion programs in PNG included community involvement, cultural appropriateness, strong leadership, and the use of mobile health technologies for the decentralisation of health services. Barriers included limited resources and funding and a lack of central leadership to drive ongoing implementation. There is an urgent need for health and nutrition promotion programs targeting NCDs and their modifiable risk factors, as well as longitudinal study designs for the evaluation of long-term impact and program sustainability.
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Affiliation(s)
- Juliana Chen
- Discipline of Nutrition and Dietetics, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
| | - Alyse Davies
- Discipline of Nutrition and Dietetics, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
| | - Phyllis Tran
- Discipline of Nutrition and Dietetics, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
| | - Ryley Gronau
- Discipline of Nutrition and Dietetics, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
| | - Anna Rangan
- Discipline of Nutrition and Dietetics, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
| | - Margaret Allman-Farinelli
- Discipline of Nutrition and Dietetics, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
| | - Shelina Porykali
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD 4222, Australia
| | - Robin Oge
- National Capital District Provincial Health Authority, Port Moresby 121, Papua New Guinea
| | - Bobby Porykali
- Aboriginal and Torres Strait Islander Health Program, George Institute for Global Health, Sydney, NSW 2000, Australia
- Faculty of Medicine, School of Population Health, University of New South Wales, Sydney, NSW 2052, Australia
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Vignali A, Elmore U, Guarneri G, De Ruvo V, Parise P, Rosati R. Enhanced recovery after surgery in colon and rectal surgery: identification of predictive variables of failure in a monocentric series including 733 patients. Updates Surg 2020; 73:111-121. [PMID: 32638264 DOI: 10.1007/s13304-020-00848-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 07/01/2020] [Indexed: 12/18/2022]
Abstract
To identify factors associated with early deviation and delayed discharge within an Enhanced Recovery after Surgery (ERAS) pathway. This is a retrospective review of prospectively collected data of consecutive patients who underwent laparoscopic or open colorectal surgery and managed with a standardized ERAS pathway between April 2015 and October 2018. ERAS items were assessed within 48 h after surgery. Patients with early complications were excluded. The influence of factors on length of stay was calculated by univariate and multivariate analysis. A binary logistic regression was used to model a predicting score. Seven hundred and thirty-three patients met the inclusion criteria. Multivariate analysis showed that age ≥ 75 years (P = 0.02), ASA score ≥ 3 (P = 0.03), open surgery or conversion to open (P = 0.001), non-compliance with the intra-operative balanced fluid therapy (P = 0.049), failure to early removal of the urinary catheter (P = 0.001), to discontinue IV fluid (P = 0.02) and to early mobilization (P = 0.001) were independently associated with ERAS failure. The generated score had a specificity of 84% and a positive predictive value of 72%. Patients who would have a length of stay longer than the median for each surgical procedure were properly identified (Area under ROC Curve = 0.753, P < 0.001). The delayed discharge could be predicted at 48 h from the intervention. The ability of the model to weight the specific role of each statistically significant variable might be a useful tool to identify the most frail patients.
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Affiliation(s)
- Andrea Vignali
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, San Raffaele Hospital, San Raffaele Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy. .,Vita-Salute San Raffaele University, Milan, Italy.
| | - Ugo Elmore
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, San Raffaele Hospital, San Raffaele Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy
| | - Giovanni Guarneri
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, San Raffaele Hospital, San Raffaele Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy
| | - Valentino De Ruvo
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, San Raffaele Hospital, San Raffaele Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy
| | - Paolo Parise
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, San Raffaele Hospital, San Raffaele Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, San Raffaele Hospital, San Raffaele Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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Masefield SC, Megaw A, Barlow M, White PCL, Altink H, Grugel J. Repurposing NGO data for better research outcomes: a scoping review of the use and secondary analysis of NGO data in health policy and systems research. Health Res Policy Syst 2020; 18:63. [PMID: 32513183 PMCID: PMC7278191 DOI: 10.1186/s12961-020-00577-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 05/19/2020] [Indexed: 11/26/2022] Open
Abstract
Background Non-governmental organisations (NGOs) collect and generate vast amounts of potentially rich data, most of which are not used for research purposes. Secondary analysis of NGO data (their use and analysis in a study for which they were not originally collected) presents an important but largely unrealised opportunity to provide new research insights in critical areas, including the evaluation of health policy and programmes. Methods A scoping review of the published literature was performed to identify the extent to which secondary analysis of NGO data has been used in health policy and systems research (HPSR). A tiered analytical approach provided a comprehensive overview and descriptive analyses of the studies that (1) used data produced or collected by or about NGOs; (2) performed secondary analysis of the NGO data (beyond the use of an NGO report as a supporting reference); and (3) analysed NGO-collected clinical data. Results Of the 156 studies that performed secondary analysis of NGO-produced or collected data, 64% (n = 100) used NGO-produced reports (mostly to a limited extent, as a contextual reference or to critique NGO activities) and 8% (n = 13) analysed NGO-collected clinical data. Of these studies, 55% (n = 86) investigated service delivery research topics and 48% (n = 51) were undertaken in developing countries and 17% (n = 27) in both developing and developed countries. NGOs were authors or co-authors of 26% of the studies. NGO-collected clinical data enabled HPSR within marginalised groups (e.g. migrants, people in conflict-affected areas), albeit with some limitations such as inconsistent and missing data. Conclusion We found evidence that NGO-collected and produced data are most commonly perceived as a source of supporting evidence for HPSR and not as primary source data. However, these data can facilitate research in under-researched marginalised groups and in contexts that are hard to reach by academics such as conflict-affected areas. NGO–academic collaboration could help address issues of NGO data quality to facilitate their more widespread use in research. The use of NGO data use could enable relevant and timely research in the areas of programme evaluation and health policy and advocacy to improve health and reduce health inequalities, especially in marginalised groups and developing countries.
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Affiliation(s)
- Sarah C Masefield
- Department of Health Sciences, University of York, York, YO10 5DD, United Kingdom. .,Interdisciplinary Global Development Centre, University of York, York, YO10 5DD, United Kingdom.
| | - Alice Megaw
- Interdisciplinary Global Development Centre, University of York, York, YO10 5DD, United Kingdom
| | - Matt Barlow
- Interdisciplinary Global Development Centre, University of York, York, YO10 5DD, United Kingdom.,Department of Politics, University of York, York, YO10 5DD, United Kingdom
| | - Piran C L White
- Interdisciplinary Global Development Centre, University of York, York, YO10 5DD, United Kingdom.,Department of Environment and Geography, University of York, York, YO10 5NG, United Kingdom
| | - Henrice Altink
- Interdisciplinary Global Development Centre, University of York, York, YO10 5DD, United Kingdom.,Department of History, University of York, York, YO10 5NH, United Kingdom
| | - Jean Grugel
- Interdisciplinary Global Development Centre, University of York, York, YO10 5DD, United Kingdom.,Department of Politics, University of York, York, YO10 5DD, United Kingdom
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Manineng CM, MacLaren D, Baigry M, Trowalle E, Muller R, Vallely A, Gesch P, Hombhanje F, McBride WJ. Re-establishing safer medical-circumcision-integrated initiation ceremonies for HIV prevention in a rural setting in Papua New Guinea. A multi-method acceptability study. PLoS One 2017; 12:e0187577. [PMID: 29117244 PMCID: PMC5678725 DOI: 10.1371/journal.pone.0187577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 10/23/2017] [Indexed: 12/14/2022] Open
Abstract
Background Efforts to stem the spread of Human Immunodeficiency Virus (HIV) in Papua New Guinea (PNG) are hampered by multiple interrelated factors including limited health services, extreme diversities in culture and language and highly prevalent gender inequity, domestic violence and poverty. In the rural district of Yangoru-Saussia, a revival of previously ceased male initiation ceremonies (MICs) is being considered for a comprehensive approach to HIV prevention. In this study, we explore the local acceptability of this undertaking including replacing traditional penile cutting practices with medical male circumcision (MMC). Methods A multi-method study comprising three phases. Phase one, focus group discussions with male elders to explore locally appropriate approaches to HIV prevention; Phase two, interviews and a cross-sectional survey with community men and women to assess views on MICs that include MMC for HIV prevention; Phase three, interviews with cultural leaders and a cross sectional survey to assess the acceptability of replacing traditional penile bleeding with MMC. Results Cultural leaders expressed that re-establishing MICs was locally appropriate for HIV prevention given the focus on character building and cultural preservation. Most surveyed participants (81.5%) supported re-establishing MICs and 92.2% supported adapting MICs with MMC. Changes to penile bleeding emerged as a contentious and contested issue given its cultural significance in symbolizing initiates’ transition from childhood to adulthood. Participants were concerned about potential clash with modern education, introduced religious beliefs and limited government support in leadership and funding. Conclusions Most people in this study in Yangoru-Saussia support re-establishing MICs and replacing traditional penile bleeding with MMC. This culturally-sensitive alignment of MMC (and HIV prevention) with revived MICs responds to a national health priority in PNG and acts as an example of providing culturally-sensitive male circumcision for HIV prevention recommended by WHO/UNAIDS. However, the implementation of this undertaking will require considerable effort, especially when modern pursuits in education and religion must be factored and when there is expectation for local authorities to lead and provide funding.
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Affiliation(s)
- Clement Morris Manineng
- College of Medicine and Dentistry, James Cook University, Queensland, Australia
- Faculty of Medicine and Health Sciences, Divine Word University, Madang, Papua New Guinea
- * E-mail:
| | - David MacLaren
- College of Medicine and Dentistry, James Cook University, Queensland, Australia
| | - Maggie Baigry
- Faculty of Medicine and Health Sciences, Divine Word University, Madang, Papua New Guinea
| | - Emil Trowalle
- East Sepik Provincial AIDS Committee, Wewak, Papua New Guinea
| | - Reinhold Muller
- College of Medicine and Dentistry, James Cook University, Queensland, Australia
| | - Andrew Vallely
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Patrick Gesch
- Faculty of Medicine and Health Sciences, Divine Word University, Madang, Papua New Guinea
| | - Francis Hombhanje
- Faculty of Medicine and Health Sciences, Divine Word University, Madang, Papua New Guinea
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Vallely A, Ryan CE, Allen J, Sauk JC, Simbiken CS, Wapling J, Kaima P, Kombati Z, Law G, Fehler G, Murray JM, Siba P, Kaldor JM. High prevalence and incidence of HIV, sexually transmissible infections and penile foreskin cutting among sexual health clinic attendees in Papua New Guinea. Sex Health 2014; 11:58-66. [PMID: 24618046 DOI: 10.1071/sh13197] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 02/02/2014] [Indexed: 11/23/2022]
Abstract
UNLABELLED Background Papua New Guinea (PNG) has one of the highest prevalences of HIV and sexually transmissible infections (STIs) in the Asia-Pacific region, and one of the highest burdens of maternal syphilis and cervical cancer globally. Despite this disease burden, only limited clinical research in sexual and reproductive health has been conducted in PNG. METHODS A longitudinal clinical cohort study was conducted at two sexual health clinics. Participants completed a behavioural interview, clinical assessment and genital examination at baseline, and at 12, 24 and 50 weeks, including specimen collection for STI diagnostics. RESULTS In total, 154 people attended a screening visit. Reattendance at 12, 24 and 50-weeks was 87%, 78% and 80% respectively. At baseline, HIV prevalence was 3.3%; chlamydia (Chlamydia trachomatis), 29.2%; gonorrhoea (Neisseria gonorrhoeae), 22.1%; Trichomonas vaginalis 15.6%; herpes simplex type-2 (HSV-2), 46.1%; active syphilis, 11.7%. Multiple infections were common particularly among women. The incidence of chlamydia was 27 per 100 person-years (PY); gonorrhoea, 15 out of 100 PY; T. vaginalis, 29 out of 100 PY; HSV-2, 12 out of 100 PY; syphilis, 8 out of 100 PY. No incident HIV cases were recorded. At baseline, 39% of men in Mt Hagen and 65% in Port Moresby had a penile foreskin cut, with a dorsal slit being the most common. Two men underwent penile cutting during the follow-up period. CONCLUSIONS The prevalence and incidence of STIs, HIV and penile cutting were high among sexual health clinic attendees. High retention figures suggest that this population may be suitable for future interventions research and clinical trials.
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Affiliation(s)
- Andrew Vallely
- The Kirby Institute, University of New South Wales, Darlinghurst, NSW 2010, Australia
| | - Claire E Ryan
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Joyce Allen
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Joyce C Sauk
- National Capital District Department of Health, Port Moresby, Papua New Guinea
| | - Cassey S Simbiken
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Johanna Wapling
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Petronia Kaima
- Mount Hagen General Hospital, Mount Hagen, Papua New Guinea
| | - Zure Kombati
- Mount Hagen General Hospital, Mount Hagen, Papua New Guinea
| | - Greg Law
- National Department of Health, Port Moresby, Papua New Guinea
| | - Glenda Fehler
- Melbourne Sexual Health Centre, 580 Swanston Street, Carlton, Vic. 3053, Australia
| | - John M Murray
- School of Mathematics and Statistics, University of New South Wales, Sydney, NSW 2052, Australia
| | - Peter Siba
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - John M Kaldor
- The Kirby Institute, University of New South Wales, Darlinghurst, NSW 2010, Australia
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Tynan A, Vallely A, Kelly A, Kupul M, Naketrumb R, Aeno H, Siba P, Kaldor JM, Hill PS. Building social currency with foreskin cuts: a coping mechanism of Papua New Guinea health workers and the implications for new programmes. Health Policy Plan 2013; 29:902-11. [PMID: 24105013 DOI: 10.1093/heapol/czt072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recent research as part of a multi-disciplinary investigation on the acceptability and impact of male circumcision for HIV prevention in Papua New Guinea (PNG) has shown that health workers (HWs) undertake unauthorized forms of penile cutting practices in public health facilities or in community settings, at times within a traditional context. Participation in these activities shares common features with coping mechanisms, strategies used by HWs to alleviate the burden of unsatisfactory living and working conditions. Coping mechanisms, however, are typically described as motivated by economic advantage, but in PNG evidence exists that the behaviours of HWs are also influenced by opportunities for social capital. METHODS Twenty-five in-depth interviews (IDIs) were completed with a variety of HWs from 2009 until 2011 and were triangulated with findings from 45 focus group discussions and 82 IDIs completed with community members as part of a wider qualitative study. Thematic analysis examined HW participation in unauthorized penile cutting services. RESULTS The emergence of unauthorized practices as a coping mechanism in PNG is compelled by mutual obligations and social capital arising from community recognition and satisfaction of moral, professional and cultural obligations. Using the example of unauthorized penile cutting practices amongst HWs in PNG, the research shows that although economic gains are not explicitly derived, evidence exists that they meet other community and socio cultural responsibilities forming a social currency within local traditional economies. CONCLUSIONS Coping mechanisms create an opportunity to extend the boundaries of a health system at the discretion of the HW. Fragile health systems create opportunities for coping mechanisms to become institutionalized, pre-empting appropriate policy development or regulation in the introduction of new programmes. In order to ensure the success of new programmes, the existence of such practices and their potential implications must be addressed within programme design, and in implementation and regulation.
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Affiliation(s)
- Anna Tynan
- Australian Centre for International & Tropical Health, School of Population Health, The University of Queensland, Herston Road, Herston, Queensland 4006, Australia, Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka Eastern Highlands Province 441, Papua New Guinea, Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, New South Wales 2034, Australia and International HIV Research Group, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - Andrew Vallely
- Australian Centre for International & Tropical Health, School of Population Health, The University of Queensland, Herston Road, Herston, Queensland 4006, Australia, Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka Eastern Highlands Province 441, Papua New Guinea, Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, New South Wales 2034, Australia and International HIV Research Group, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia Australian Centre for International & Tropical Health, School of Population Health, The University of Queensland, Herston Road, Herston, Queensland 4006, Australia, Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka Eastern Highlands Province 441, Papua New Guinea, Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, New South Wales 2034, Australia and International HIV Research Group, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - Angela Kelly
- Australian Centre for International & Tropical Health, School of Population Health, The University of Queensland, Herston Road, Herston, Queensland 4006, Australia, Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka Eastern Highlands Province 441, Papua New Guinea, Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, New South Wales 2034, Australia and International HIV Research Group, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia Australian Centre for International & Tropical Health, School of Population Health, The University of Queensland, Herston Road, Herston, Queensland 4006, Australia, Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka Eastern Highlands Province 441, Papua New Guinea, Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, New South Wales 2034, Australia and International HIV Research Group, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - Martha Kupul
- Australian Centre for International & Tropical Health, School of Population Health, The University of Queensland, Herston Road, Herston, Queensland 4006, Australia, Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka Eastern Highlands Province 441, Papua New Guinea, Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, New South Wales 2034, Australia and International HIV Research Group, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - Richard Naketrumb
- Australian Centre for International & Tropical Health, School of Population Health, The University of Queensland, Herston Road, Herston, Queensland 4006, Australia, Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka Eastern Highlands Province 441, Papua New Guinea, Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, New South Wales 2034, Australia and International HIV Research Group, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - Herick Aeno
- Australian Centre for International & Tropical Health, School of Population Health, The University of Queensland, Herston Road, Herston, Queensland 4006, Australia, Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka Eastern Highlands Province 441, Papua New Guinea, Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, New South Wales 2034, Australia and International HIV Research Group, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - Peter Siba
- Australian Centre for International & Tropical Health, School of Population Health, The University of Queensland, Herston Road, Herston, Queensland 4006, Australia, Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka Eastern Highlands Province 441, Papua New Guinea, Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, New South Wales 2034, Australia and International HIV Research Group, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - John M Kaldor
- Australian Centre for International & Tropical Health, School of Population Health, The University of Queensland, Herston Road, Herston, Queensland 4006, Australia, Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka Eastern Highlands Province 441, Papua New Guinea, Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, New South Wales 2034, Australia and International HIV Research Group, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - Peter S Hill
- Australian Centre for International & Tropical Health, School of Population Health, The University of Queensland, Herston Road, Herston, Queensland 4006, Australia, Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka Eastern Highlands Province 441, Papua New Guinea, Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, New South Wales 2034, Australia and International HIV Research Group, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
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Tynan A, Hill PS, Kelly A, Kupul M, Aeno H, Naketrumb R, Siba P, Kaldor J, Vallely A. Listening to diverse community voices: the tensions of responding to community expectations in developing a male circumcision program for HIV prevention in Papua New Guinea. BMC Public Health 2013; 13:749. [PMID: 23941536 PMCID: PMC3751450 DOI: 10.1186/1471-2458-13-749] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 08/06/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The success of health programs is influenced not only by their acceptability but also their ability to meet and respond to community expectations of service delivery. The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) have recommended medical male circumcision (MC) as an essential component of comprehensive HIV prevention programs in high burden settings. This study investigated community-level perceptions of MC for HIV prevention in Papua New Guinea (PNG), a setting where diverse traditional and contemporary forms of penile foreskin cutting practices have been described. METHODS A multi-method qualitative study was undertaken in four provinces in two stages from 2009 to 2011. A total of 82 in-depth interviews, and 45 focus group discussions were completed during Stage 1. Stage 2 incorporated eight participatory workshops that were an integral part of the research dissemination process to communities. The workshops also provided opportunity to review key themes and consolidate earlier findings as part of the research process. Qualitative data analysis used a grounded theory approach and was facilitated using qualitative data management software. RESULTS A number of diverse considerations for the delivery of MC for HIV prevention in PNG were described, with conflicting views both between and within communities. Key issues included: location of the service, service provider, age eligibility, type of cut, community awareness and potential shame amongst youth. Key to developing appropriate health service delivery models was an appreciation of the differences in expectations and traditions of unique cultural groups in PNG. Establishing strong community coalitions, raising awareness and building trust were seen as integral to success. CONCLUSIONS Difficulties exist in the implementation of new programs in a pluralistic society such as PNG, particularly if tensions arise between biomedical knowledge and medico-legal requirements, compared to existing socio-cultural interests. Community participatory approaches offer important opportunities to explore and design culturally safe, specific and accessible programs.
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Affiliation(s)
- Anna Tynan
- Australian Centre for International & Tropical Health, School of Population Health, University of Queensland Herston Road, Herston, 4006 Queensland, Australia
| | - Peter S Hill
- Australian Centre for International & Tropical Health, School of Population Health, University of Queensland Herston Road, Herston, 4006 Queensland, Australia
| | - Angela Kelly
- Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research (PNG IMR), Eastern Highlands Province 441, P.O. Box 60, Goroka, Papua New Guinea
- International HIV Research Group, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Martha Kupul
- International HIV Research Group, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Herick Aeno
- International HIV Research Group, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Richard Naketrumb
- International HIV Research Group, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Peter Siba
- Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research (PNG IMR), Eastern Highlands Province 441, P.O. Box 60, Goroka, Papua New Guinea
| | - John Kaldor
- Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, 2034 New South Wales, Australia
| | - Andrew Vallely
- Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research (PNG IMR), Eastern Highlands Province 441, P.O. Box 60, Goroka, Papua New Guinea
- Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, 2034 New South Wales, Australia
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Tynan A, Vallely A, Kelly A, Kupul M, Neo J, Naketrumb R, Aeno H, Law G, Milan J, Siba P, Kaldor J, Hill PS. Sociocultural and individual determinants for motivation of sexual and reproductive health workers in Papua New Guinea and their implications for male circumcision as an HIV prevention strategy. HUMAN RESOURCES FOR HEALTH 2013; 11:7. [PMID: 23418879 PMCID: PMC3602021 DOI: 10.1186/1478-4491-11-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 01/28/2013] [Indexed: 06/01/2023]
Abstract
BACKGROUND The motivation of health workers (HWs) to deliver services in developing countries has been described as a critical factor in the success of health systems in implementing programmes. How the sociocultural context of Papua New Guinea (PNG) affects the values, motivation and actions of HWs involved in sexual and reproductive health services is important for policy development and programme planning. With interest in male circumcision (MC) as an HIV prevention option in PNG, this study explored the perceptions and motivations of HWs involved in sexual and reproductive health services in PNG, examining their implications for the possible future roll out of a national MC programme. METHODS A multi-method qualitative study was conducted with HWs across a range of health care professions working in sexual health facilities. A total of 29 in-depth interviews and one focus group discussion were completed. Qualitative thematic analysis of the transcripts and field notes was undertaken using a social constructivist approach and complemented by documentary organizational, programme and policy analysis. RESULTS AND DISCUSSIONS Introduction of new health programmes, such as a MC programme for HIV prevention, are likely to impact upon one or more of the many motivational determinants. Social-cultural and individual factors influencing HW motivation to be involved in sexual and reproductive health services in PNG included community expectation and concern, sense of accomplishment and religious conviction. Strong links to community responsibility outweighed organizational ties. Faced with an often dysfunctional work environment, HWs perceived themselves as responsible to compensate for the failed health system. The impact of community influence and expectation needs to be considered when introducing a MC programme, particularly to communities in PNG where penile foreskin cutting is a common and accepted practice. CONCLUSIONS The potential contribution to the success of a MC programme that HWs may have means that taking into account the differing needs of communities as well as the motivational influences on HWs that exist within the sociocultural environment is important. These findings will assist not only in programme planning for MC, but also in the expansion of other existing sexual and reproductive health services.
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Affiliation(s)
- Anna Tynan
- Australian Centre for International & Tropical Health, School of Population Health, University of Queensland, Herston Road, Herston, Queensland, 4006, Australia
| | - Andrew Vallely
- Public Health Interventions Research Group, Kirby Institute, University of New South Wales, Cliffbrook Campus, 45 Beach Street, Coogee, New South Wales, 2034, Australia
- Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, P.O. Box 60, Goroka, Eastern Highlands Province, 441, Papua New Guinea
| | - Angela Kelly
- Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, P.O. Box 60, Goroka, Eastern Highlands Province, 441, Papua New Guinea
- International HIV Research Group, School of Public Health and Community Medicine, University of New South Wales, High Street, Kensington, 2052, Australia
| | - Martha Kupul
- Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, P.O. Box 60, Goroka, Eastern Highlands Province, 441, Papua New Guinea
| | - James Neo
- Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, P.O. Box 60, Goroka, Eastern Highlands Province, 441, Papua New Guinea
| | - Richard Naketrumb
- Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, P.O. Box 60, Goroka, Eastern Highlands Province, 441, Papua New Guinea
| | - Herick Aeno
- Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, P.O. Box 60, Goroka, Eastern Highlands Province, 441, Papua New Guinea
| | - Greg Law
- Sexual Health and Disease Control Branch, National Department of Health, P.O. Box 807, Waigani, National Capital District, 131, Papua New Guinea
| | - John Milan
- Sexual Health and Disease Control Branch, National Department of Health, P.O. Box 807, Waigani, National Capital District, 131, Papua New Guinea
| | - Peter Siba
- Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, P.O. Box 60, Goroka, Eastern Highlands Province, 441, Papua New Guinea
| | - John Kaldor
- Public Health Interventions Research Group, Kirby Institute, University of New South Wales, Cliffbrook Campus, 45 Beach Street, Coogee, New South Wales, 2034, Australia
| | - Peter S Hill
- Australian Centre for International & Tropical Health, School of Population Health, University of Queensland, Herston Road, Herston, Queensland, 4006, Australia
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Vallely A, Fitzgerald L, Fiya V, Aeno H, Kelly A, Sauk J, Kupul M, Neo J, Millan J, Siba P, Kaldor JM. Intravaginal practices and microbicide acceptability in Papua New Guinea: implications for HIV prevention in a moderate-prevalence setting. BMC Res Notes 2012; 5:613. [PMID: 23116431 PMCID: PMC3599571 DOI: 10.1186/1756-0500-5-613] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 10/18/2012] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The acceptability of female-controlled biomedical prevention technologies has not been established in Papua New Guinea, the only country in the Pacific region experiencing a generalised, moderate-prevalence HIV epidemic. Socio-cultural factors likely to impact on future product uptake and effectiveness, such as women's ability to negotiate safer sexual choices, and intravaginal hygiene and menstrual practices (IVP), remain unclear in this setting. METHODS A mixed-method qualitative study was conducted among women and men attending a sexual health clinic in Port Moresby. During in-depth interviews, participants used copies of a hand-drawn template to indicate how they wash/clean the vulva and/or vagina. Interviewers pre-filled commercially available vaginal applicators with 2-3mL KY Jelly® to create a surrogate vaginal microbicide product, which was demonstrated to study participants. RESULTS A total of 28 IDIs were conducted (women=16; men=12). A diverse range of IVP were reported. The majority of women described washing the vulva only with soap and water as part of their daily routine; in preparation for sex; and following sexual intercourse. Several women described cleaning inside the vagina using fingers and soap at these same times. Others reported cleaning inside the vagina using a hose connected to a tap; using vaginal inserts, such as crushed garlic; customary menstrual 'steaming' practices; and the use of material fragments, cloth and newspaper to absorb menstrual blood. Unprotected sex during menstruation was common. The majority of both women and men said that they would use a vaginal microbicide gel for HIV/STI protection, should a safe and effective product become available. Microbicide use was considered most appropriate in 'high-risk' situations, such as sex with non-regular, transactional or commercial partners. Most women felt confident that they would be able to negotiate vaginal microbicide use with male sexual partners but if necessary would be prepared to use product covertly. CONCLUSIONS Notional acceptability of a vaginal microbicide gel for HIV/STI prevention was high among both women and men. IVP were diverse in nature, socio-cultural dimensions and motivators. These factors are likely to impact on the future acceptability and uptake of vaginal microbicides and other biomedical HIV prevention technologies in this setting.
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Affiliation(s)
- Andrew Vallely
- The Kirby Institute, The University of New South Wales, Sydney, NSW, 2052, Australia.
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Kelly A, Kupul M, Fitzgerald L, Aeno H, Neo J, Naketrumb R, Siba P, Kaldor JM, Vallely A. "Now we are in a different time; various bad diseases have come." Understanding men's acceptability of male circumcision for HIV prevention in a moderate prevalence setting. BMC Public Health 2012; 12:67. [PMID: 22264256 PMCID: PMC3298502 DOI: 10.1186/1471-2458-12-67] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 01/22/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Adult male surgical circumcision (MC) has been shown to reduce HIV acquisition in men and is recommended by the WHO for inclusion in comprehensive national HIV prevention programs in high prevalence settings. Only limited research to date has been conducted in countries experiencing moderate burden epidemics, where the acceptability, operational feasibility and potential epidemiological impact of MC remain unclear. METHODS A multi-method qualitative research study was conducted at four sites in Papua New Guinea (PNG), with 24 focus group discussions and 65 in-depth interviews carried out among 276 men. RESULTS The majority of men were in favour of MC being introduced for HIV prevention in PNG and considered improved genital hygiene, enhanced sexual pleasure and culturally appropriateness key factors in the acceptability of a future intervention. A minority of men were against the introduction of MC, primarily due to concerns regarding sexual risk compensation and that the intervention went against prevailing cultural and religious beliefs. CONCLUSION This is one of the first community-based MC acceptability studies conducted in a moderate prevalence setting outside of Africa. Research findings from this study suggest that a future MC program for HIV prevention would be widely accepted by men in PNG.
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Affiliation(s)
- Angela Kelly
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka EHP 441, Papua New Guinea
- International HIV Research Group, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Martha Kupul
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka EHP 441, Papua New Guinea
| | - Lisa Fitzgerald
- School of Population Health, University of Queensland, Brisbane, Australia
| | - Herick Aeno
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka EHP 441, Papua New Guinea
| | - James Neo
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka EHP 441, Papua New Guinea
| | - Richard Naketrumb
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka EHP 441, Papua New Guinea
| | - Peter Siba
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka EHP 441, Papua New Guinea
| | - John M Kaldor
- Kirby Institute (formerly the National Centre in HIV Epidemiology and Clinical Research), University of New South Wales, Sydney, Australia
| | - Andrew Vallely
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka EHP 441, Papua New Guinea
- Kirby Institute (formerly the National Centre in HIV Epidemiology and Clinical Research), University of New South Wales, Sydney, Australia
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