1
|
Scoullar MJL, Melepia P, Peach E, Fidelis R, Supsup H, Davidson EM, Boeuf P, Bradshaw CS, Fehler G, Hezeri P, Kabiu D, Elijah A, Siba PM, Kennedy EC, Umbers AJ, Robinson LJ, Vallely AJ, Badman SG, Vallely LM, Fowkes FJI, Morgan CJ, Pomat W, Crabb BS, Beeson JG. Mycoplasma genitalium in pregnancy, including specific co-infections, is associated with lower birthweight: A prospective cohort study. MED 2024:S2666-6340(24)00211-3. [PMID: 38870930 DOI: 10.1016/j.medj.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 03/26/2024] [Accepted: 05/15/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Mycoplasma genitalium infection in pregnancy is increasingly reported at similar frequencies to other sexually transmitted infections (STIs). Knowledge on its contribution to adverse pregnancy outcomes is very limited, especially relative to other STIs or bacterial vaginosis (BV). Whether M. genitalium influences birthweight remains unanswered. METHODS Associations between birthweight and M. genitalium and other STIs (Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis) and BV in pregnancy were examined in 416 maternal-newborn pairs from a prospective cohort study in Papua New Guinea. FINDINGS Compared to uninfected women, M. genitalium (-166.9 g, 95% confidence interval [CI]: -324.2 to -9.7 g, p = 0.038) and N. gonorrhoeae (-274.7 g, 95% CI: -561.9 to 12.5 g, p = 0.061) infections were associated with lower birthweight in an adjusted analysis. The association for C. trachomatis was less clear, and T. vaginalis and BV were not associated with lower birthweight. STI prevalence was high for M. genitalium (13.9%), N. gonorrhoeae (5.0%), and C. trachomatis (20.0%); co-infections were frequent. Larger effect sizes on birthweight occurred with co-infections of M. genitalium, N. gonorrhoeae, and/or C. trachomatis. CONCLUSION M. genitalium is a potential contributor to lower birthweight, and co-infections appear to have a greater negative impact on birthweight. Trials examining the impact of early diagnosis and treatment of M. genitalium and other STIs in pregnancy and preconception are urgently needed. FUNDING Funding was received from philanthropic grants, the National Health and Medical Research Council, and the Burnet Institute. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Collapse
Affiliation(s)
| | | | | | | | - Hadlee Supsup
- East New Britain Provincial Health Authority, Kokopo, Papua New Guinea
| | - Eliza M Davidson
- Burnet Institute, Melbourne, VIC, Australia; University of Melbourne, Melbourne, Australia
| | | | - Catriona S Bradshaw
- University of Melbourne, Melbourne, Australia; Melbourne Sexual Health Centre, Alfred Hospital, Melbourne, VIC, Australia; Monash University, Clayton, VIC, Australia
| | - Glenda Fehler
- Melbourne Sexual Health Centre, Alfred Hospital, Melbourne, VIC, Australia
| | | | | | - Arthur Elijah
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | - Peter M Siba
- Center for Health Research and Diagnostics, Divine Word University, Madang, Papua New Guinea
| | - Elissa C Kennedy
- Burnet Institute, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | | | - Leanne J Robinson
- Burnet Institute, Melbourne, VIC, Australia; University of Melbourne, Melbourne, Australia; Monash University, Clayton, VIC, Australia; Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Andrew J Vallely
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea; The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - Steven G Badman
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - Lisa M Vallely
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - Freya J I Fowkes
- Burnet Institute, Melbourne, VIC, Australia; University of Melbourne, Melbourne, Australia; Monash University, Clayton, VIC, Australia
| | - Christopher J Morgan
- Burnet Institute, Melbourne, VIC, Australia; University of Melbourne, Melbourne, Australia; Jhpiego, a Johns Hopkins University affiliate, Baltimore, MD, USA
| | - William Pomat
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Brendan S Crabb
- Burnet Institute, Melbourne, VIC, Australia; University of Melbourne, Melbourne, Australia; Monash University, Clayton, VIC, Australia
| | - James G Beeson
- Burnet Institute, Melbourne, VIC, Australia; University of Melbourne, Melbourne, Australia; Monash University, Clayton, VIC, Australia.
| |
Collapse
|
2
|
Lara-Escandell M, Gamberini C, Juliana NC, Al-Nasiry S, Morré SA, Ambrosino E. The association between non-viral sexually transmitted infections and pregnancy outcome in Latin America and the Caribbean: A systematic review. Heliyon 2024; 10:e23338. [PMID: 38187347 PMCID: PMC10767377 DOI: 10.1016/j.heliyon.2023.e23338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction Non-viral sexually transmitted infections are known to be associated with adverse pregnancy outcomes. For these pathogens, standard antenatal screening is not broadly performed in Latin America and the Caribbean. The aim of this study was to comprehensively review the association of non-viral sexually transmitted infections and neonatal outcomes among pregnant women in the region. Methods Four databases (PubMed, Embase, SciELO and LILACS) were examined to identify eligible studies published up to September 2022. English or Spanish cross-sectional, case-control and cohort studies assessing the association of non-viral sexually transmitted infections and adverse pregnancy outcomes were evaluated. Articles were firstly screened by means of title and abstract. Potential articles were fully read and assessed for inclusion according to the eligibility criteria. Snowballing search was performed by screening of bibliographies of the chosen potentially relevant papers. Risk of bias within studies was assessed using the Joanna Briggs Institute reviewer's manual. Results A selection of 10 out of 9772 search records from five Latin America and the Caribbean countries were included. Six studies associated Treponema pallidum infection with preterm birth (1/6), history of previous spontaneous abortion (2/6), fetal and infant death (1/6), low birth weight (1/6) and funisitis of the umbilical cord (1/6). Three studies associated Chlamydia trachomatis infection with preterm birth (2/3), ectopic pregnancy (1/3) and respiratory symptoms on the newborn (1/3). One study associated Mycoplasma genitalium infection with preterm birth. Conclusion This review provides evidence on the association of non-viral sexually transmitted infections with adverse pregnancy outcomes. Further investigation is needed to establish more associations between non-viral sexually transmitted infections and pregnancy outcome, especially for Mycoplasma genitalium, Trichomonas vaginalis and Neisseria gonorrhoeae. Overall, this review calls for more research for public health interventions to promote screening of non-viral sexually transmitted infections during pregnancy, among high-risk population groups of pregnant women living in the region.
Collapse
Affiliation(s)
- Maria Lara-Escandell
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, 6229 ER Maastricht, the Netherlands
| | - Carlotta Gamberini
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, 6229 ER Maastricht, the Netherlands
| | - Naomi C.A. Juliana
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, 6229 ER Maastricht, the Netherlands
| | - Salwan Al-Nasiry
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, 6229 ER Maastricht, the Netherlands
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Servaas A. Morré
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, 6229 ER Maastricht, the Netherlands
- Department of Molecular and Cellular Engineering, Jacob Institute of Biotechnology and Bioengineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Allahabad 211007, UP, India
- Dutch Chlamydia Trachomatis Reference Laboratory on Behalf of the Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, 3721 MA Bilthoven, the Netherlands
| | - Elena Ambrosino
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, 6229 ER Maastricht, the Netherlands
| |
Collapse
|
3
|
Wilson AN, Melepia P, Suruka R, Hezeri P, Kabiu D, Babona D, Wapi P, Morgan A, Vogel JP, Beeson J, Morgan C, Kelly-Hanku A, Scoullar MJL, Nosi S, Vallely LM, Kennedy E, Bohren MA, Homer CSE. Community perspectives and experiences of quality maternal and newborn care in East New Britain, Papua New Guinea. BMC Health Serv Res 2023; 23:780. [PMID: 37474934 PMCID: PMC10360243 DOI: 10.1186/s12913-023-09723-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 06/16/2023] [Indexed: 07/22/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Alyce N Wilson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.
- School of Population and Global Health, Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia.
| | - Pele Melepia
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Healthy Mothers, Healthy Babies, Burnet Institute, Kokopo, Papua New Guinea
| | - Rose Suruka
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Healthy Mothers, Healthy Babies, Burnet Institute, Kokopo, Papua New Guinea
| | - Priscah Hezeri
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Healthy Mothers, Healthy Babies, Burnet Institute, Kokopo, Papua New Guinea
| | - Dukduk Kabiu
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Healthy Mothers, Healthy Babies, Burnet Institute, Kokopo, Papua New Guinea
| | | | - Pinip Wapi
- Nonga General Hospital, Rabaul, Papua New Guinea
| | - Alison Morgan
- Global Financing Facility, World Bank, Washington, DC, USA
| | - Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - James Beeson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | | | - Angela Kelly-Hanku
- Papua New Guinea Institute for Medical Research, Goroka, Papua New Guinea
- Kirby Institute, University of New South Wales, Kensington, Australia
| | - Michelle J L Scoullar
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Somu Nosi
- Papua New Guinea Institute for Medical Research, Goroka, Papua New Guinea
| | - Lisa M Vallely
- Papua New Guinea Institute for Medical Research, Goroka, Papua New Guinea
- Kirby Institute, University of New South Wales, Kensington, Australia
| | - Elissa Kennedy
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Meghan A Bohren
- Gender and Women's Health Unit, School of Population and Global Health, Centre for Health Equity, University of Melbourne, Melbourne, Australia
| | - Caroline S E Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| |
Collapse
|
4
|
Davidson EM, Scoullar MJL, Peach E, Morgan CJ, Melepia P, Opi DH, Supsup H, Hezeri P, Philip W, Kabiu D, Tokmun K, Suruka R, Fidelis R, Elijah A, Siba PM, Pomat W, Kombut B, Robinson LJ, Crabb BS, Kennedy E, Boeuf P, Simpson JA, Beeson JG, Fowkes FJI. Quantifying differences in iron deficiency-attributable anemia during pregnancy and postpartum. Cell Rep Med 2023:101097. [PMID: 37413986 PMCID: PMC10394161 DOI: 10.1016/j.xcrm.2023.101097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/13/2022] [Accepted: 06/08/2023] [Indexed: 07/08/2023]
Abstract
Pregnant women in resource-limited settings are highly susceptible to anemia and iron deficiency, but the etiology of postpartum anemia remains poorly defined. To inform the optimal timing for anemia interventions, changes in iron deficiency-attributable anemia through pregnancy and postpartum need to be understood. In 699 pregnant Papua New Guinean women attending their first antenatal care appointment and following up at birth and 6 and 12 months postpartum, we undertake logistic mixed-effects modeling to determine the effect of iron deficiency on anemia and population attributable fractions, calculated from odds ratios, to quantify the contribution of iron deficiency to anemia. Anemia is highly prevalent during pregnancy and 12 months postpartum, with iron deficiency increasing the odds of anemia during pregnancy and, to a lesser extent, postpartum. Iron deficiency accounts for ≥72% of anemia during pregnancy and 20%-37% postpartum. Early iron supplementation during and between pregnancies could break the cycle of chronic anemia in women of reproductive age.
Collapse
Affiliation(s)
- Eliza M Davidson
- Burnet Institute, Melbourne, VIC, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Michelle J L Scoullar
- Burnet Institute, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | | | - Christopher J Morgan
- Burnet Institute, Melbourne, VIC, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; John Hopkins Program for International Education in Gynecology and Obstetrics, Baltimore, MD, USA
| | - Pele Melepia
- Burnet Institute, Kokopo, East New Britain, Papua New Guinea
| | - D Herbert Opi
- Burnet Institute, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Department of Immunology, Monash University, Wellington Road, Melbourne, VIC, Australia
| | - Hadlee Supsup
- Burnet Institute, Kokopo, East New Britain, Papua New Guinea; East New Britain Provincial Health Authority, Rabaul, East New Britain, Papua New Guinea
| | - Priscah Hezeri
- Burnet Institute, Kokopo, East New Britain, Papua New Guinea
| | - Wilson Philip
- Burnet Institute, Kokopo, East New Britain, Papua New Guinea
| | - Dukduk Kabiu
- Burnet Institute, Kokopo, East New Britain, Papua New Guinea
| | | | - Rose Suruka
- Burnet Institute, Kokopo, East New Britain, Papua New Guinea
| | - Ruth Fidelis
- Burnet Institute, Kokopo, East New Britain, Papua New Guinea
| | - Arthur Elijah
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | - Peter M Siba
- Centre for Health Research and Diagnostics, Divine Word University, Madang, Papua New Guinea
| | - William Pomat
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Benishar Kombut
- Burnet Institute, Kokopo, East New Britain, Papua New Guinea; Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Leanne J Robinson
- Burnet Institute, Melbourne, VIC, Australia; Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | - Elissa Kennedy
- Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - James G Beeson
- Burnet Institute, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Department of Immunology, Monash University, Wellington Road, Melbourne, VIC, Australia; Department of Microbiology, Monash University, Melbourne, VIC, Australia
| | - Freya J I Fowkes
- Burnet Institute, Melbourne, VIC, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| |
Collapse
|
5
|
Waites KB, Crabb DM, Ratliff AE, Geisler WM, Atkinson TP, Xiao L. Latest Advances in Laboratory Detection of Mycoplasma genitalium. J Clin Microbiol 2023; 61:e0079021. [PMID: 36598247 PMCID: PMC10035321 DOI: 10.1128/jcm.00790-21] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Mycoplasma genitalium is an important sexually transmitted pathogen affecting both men and women. Its extremely slow growth in vitro and very demanding culture requirements necessitate the use of molecular-based diagnostic tests for its detection in clinical specimens. The recent availability of U.S. Food and Drug Administration (FDA)-cleared commercial molecular-based assays has enabled diagnostic testing to become more widely available in the United States and no longer limited to specialized reference laboratories. Advances in the knowledge of the epidemiology and clinical significance of M. genitalium as a human pathogen made possible by the availability of molecular-based testing have led to updated guidelines for diagnostic testing and treatment that have been published in various countries. This review summarizes the importance of M. genitalium as an agent of human disease, explains the necessity of obtaining a microbiological diagnosis, describes currently available diagnostic methods, and discusses how the emergence of antimicrobial resistance has complicated treatment alternatives and influenced the development of diagnostic tests for resistance detection, with an emphasis on developments over the past few years.
Collapse
Affiliation(s)
- Ken B Waites
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Donna M Crabb
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Amy E Ratliff
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - William M Geisler
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - T Prescott Atkinson
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Li Xiao
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
6
|
Eghrari D, Scoullar MJL, Wilson AN, Peach E, Elijah A, Melepia P, SupSup H, Vallely LM, Siba PM, Kennedy EC, Vogel JP, Homer CSE, Robinson LJ, Fowkes FJI, Pomat W, Crabb BS, Beeson JG, Morgan CJ. Low knowledge of newborn danger signs among pregnant women in Papua New Guinea and implications for health seeking behaviour in early infancy - findings from a longitudinal study. BMC Pregnancy Childbirth 2023; 23:71. [PMID: 36703135 PMCID: PMC9878757 DOI: 10.1186/s12884-022-05322-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 12/20/2022] [Indexed: 01/27/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Donya Eghrari
- grid.1056.20000 0001 2224 8486Burnet Institute, Melbourne, Australia ,grid.1008.90000 0001 2179 088XUniversity of Melbourne, Melbourne, Australia
| | - Michelle J. L. Scoullar
- grid.1056.20000 0001 2224 8486Burnet Institute, Melbourne, Australia ,grid.1008.90000 0001 2179 088XUniversity of Melbourne, Melbourne, Australia ,Burnet Institute, Kokopo, Papua New Guinea
| | - Alyce N. Wilson
- grid.1056.20000 0001 2224 8486Burnet Institute, Melbourne, Australia ,grid.1008.90000 0001 2179 088XUniversity of Melbourne, Melbourne, Australia
| | - Elizabeth Peach
- grid.1056.20000 0001 2224 8486Burnet Institute, Melbourne, Australia
| | - Arthur Elijah
- grid.412690.80000 0001 0663 0554University of Papua New Guinea, Port Moresby, Papua New Guinea ,grid.415118.80000 0004 8340 8668Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | | | - Hadlee SupSup
- East New Britain Provincial Health Authority, Kokopo, Papua New Guinea
| | - Lisa M. Vallely
- grid.417153.50000 0001 2288 2831Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea ,grid.1005.40000 0004 4902 0432The Kirby Institute, University of New South Wales, Sydney, Australia ,grid.1011.10000 0004 0474 1797Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - Peter M. Siba
- grid.449086.70000 0001 0581 065XCenter for Health Research and Diagnostics, Divine Word University, Madang, Papua New Guinea
| | - Elissa C. Kennedy
- grid.1056.20000 0001 2224 8486Burnet Institute, Melbourne, Australia ,grid.1002.30000 0004 1936 7857Monash University, Melbourne, Australia ,grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Melbourne, Australia
| | - Joshua P. Vogel
- grid.1056.20000 0001 2224 8486Burnet Institute, Melbourne, Australia ,grid.1008.90000 0001 2179 088XUniversity of Melbourne, Melbourne, Australia
| | - Caroline S. E. Homer
- grid.1056.20000 0001 2224 8486Burnet Institute, Melbourne, Australia ,grid.1008.90000 0001 2179 088XUniversity of Melbourne, Melbourne, Australia
| | - Leanne J. Robinson
- grid.1056.20000 0001 2224 8486Burnet Institute, Melbourne, Australia ,grid.1008.90000 0001 2179 088XUniversity of Melbourne, Melbourne, Australia ,grid.417153.50000 0001 2288 2831Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea ,grid.1002.30000 0004 1936 7857Monash University, Melbourne, Australia
| | - Freya J. I. Fowkes
- grid.1056.20000 0001 2224 8486Burnet Institute, Melbourne, Australia ,grid.1008.90000 0001 2179 088XUniversity of Melbourne, Melbourne, Australia ,grid.1002.30000 0004 1936 7857Monash University, Melbourne, Australia
| | - William Pomat
- grid.417153.50000 0001 2288 2831Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Brendan S. Crabb
- grid.1056.20000 0001 2224 8486Burnet Institute, Melbourne, Australia ,grid.1008.90000 0001 2179 088XUniversity of Melbourne, Melbourne, Australia ,grid.1002.30000 0004 1936 7857Monash University, Melbourne, Australia
| | - James G. Beeson
- grid.1056.20000 0001 2224 8486Burnet Institute, Melbourne, Australia ,grid.1008.90000 0001 2179 088XUniversity of Melbourne, Melbourne, Australia ,grid.1002.30000 0004 1936 7857Monash University, Melbourne, Australia
| | - Christopher J. Morgan
- grid.1056.20000 0001 2224 8486Burnet Institute, Melbourne, Australia ,grid.1008.90000 0001 2179 088XUniversity of Melbourne, Melbourne, Australia ,grid.21107.350000 0001 2171 9311Jhpiego, a Johns Hopkins University Affiliate, Baltimore, USA
| |
Collapse
|
7
|
Tan RKJ, Daskalopoulou M, Thomson-Glover R. Research news in clinical context. Sex Transm Infect 2022. [PMID: 35878929 DOI: 10.1136/sextrans-2021-055337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Rayner K J Tan
- University of North Carolina Project-China, Guangzhou, China .,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | | | - Rebecca Thomson-Glover
- Sexual Health Department, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, UK
| |
Collapse
|
8
|
Wilson AN, Melepia P, Suruka R, Hezeri P, Kabiu D, Babona D, Wapi P, Spotswood N, Bohren MA, Vogel JP, Kelly-Hanku A, Morgan A, Beeson JG, Morgan C, Vallely LM, Waramin EJ, Scoullar MJL, Homer CSE. Quality newborn care in East New Britain, Papua New Guinea: measuring early newborn care practices and identifying opportunities for improvement. BMC Pregnancy Childbirth 2022; 22:462. [PMID: 35650540 PMCID: PMC9157041 DOI: 10.1186/s12884-022-04735-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Renewed attention and investment is needed to improve the quality of care during the early newborn period to address preventable newborn deaths and stillbirths in Papua New Guinea (PNG). We aimed to assess early newborn care practices and identify opportunities for improvement in one province (East New Britain) in PNG. METHODS A mixed-methods study was undertaken in five rural health facilities in the province using a combination of facility audits, labour observations and qualitative interviews with women and maternity providers. Data collection took place between September 2019 and February 2020. Quantitative data were analysed descriptively, whilst qualitative data were analysed using content analysis. Data were triangulated by data source. RESULTS Five facility audits, 30 labour observations (in four of the facilities), and interviews with 13 women and eight health providers were conducted to examine early newborn care practices. We found a perinatal mortality rate of 32.2 perinatal deaths per 1000 total births and several barriers to quality newborn care, including an insufficient workforce, critical infrastructure and utility constraints, and limited availability of essential newborn medicines and equipment. Most newborns received at least one essential newborn care practice in the first hour of life, such as immediate and thorough drying (97%). CONCLUSIONS We observed high rates of essential newborn care practices including immediate skin-to-skin and delayed cord clamping. We also identified multiple barriers to improving the quality of newborn care in East New Britain, PNG. These findings can inform the development of effective interventions to improve the quality of newborn care. Further, this study demonstrates that multi-faceted programs that include increased investment in the health workforce, education and training, and availability of essential equipment, medicines, and supplies are required to improve newborn outcomes.
Collapse
Affiliation(s)
- Alyce N Wilson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia. .,Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Pele Melepia
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.,Healthy Mothers, Healthy Babies, Burnet Institute, Kokopo, Papua New Guinea
| | - Rose Suruka
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.,Healthy Mothers, Healthy Babies, Burnet Institute, Kokopo, Papua New Guinea
| | - Priscah Hezeri
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.,Healthy Mothers, Healthy Babies, Burnet Institute, Kokopo, Papua New Guinea
| | - Dukduk Kabiu
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.,Healthy Mothers, Healthy Babies, Burnet Institute, Kokopo, Papua New Guinea
| | | | - Pinip Wapi
- Nonga General Hospital, Rabaul, Papua New Guinea
| | - Naomi Spotswood
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia.,Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Meghan A Bohren
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.,Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Angela Kelly-Hanku
- Papua New Guinea Institute for Medical Research, Goroka, Papua New Guinea.,Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - Alison Morgan
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Global Financing Facility, World Bank Group, Washington, DC, USA
| | - James G Beeson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Christopher Morgan
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.,Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Jhpiego, the Johns Hopkins University affiliate, Baltimore, USA
| | - Lisa M Vallely
- Papua New Guinea Institute for Medical Research, Goroka, Papua New Guinea.,Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - Edward J Waramin
- Population and Family Health, National Department of Health, Port Moresby, Papua New Guinea
| | - Michelle J L Scoullar
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Caroline S E Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.,School of Population and Global Health, University of Melbourne, Melbourne, Australia
| |
Collapse
|
9
|
Risk Prediction of Ureaplasma urealyticum Affecting Sperm Quality Based on Mathematical Model and Cross-Sectional Study. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2498306. [PMID: 35664640 PMCID: PMC9159871 DOI: 10.1155/2022/2498306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/29/2022] [Indexed: 11/18/2022]
Abstract
Objective. To explore the risk of Ureaplasma urealyticum (UU) affecting sperm quality. Methods. Prospective cross-sectional study was conducted. In total, 340 semen samples were collected. According to whether they were infected with UU, the samples were divided into the UU-positive group (observation group) and UU-negative group (control group). The patients with UU-positive were followed up to obtain treatment and collected the semen again after treatment. The semen characteristics and sperm parameters were detected and compared, and the relationship of UU and the sperm quality was analyzed by mathematical models. Results. There were 104 UU-positive semen samples in all, with an overall infection rate of 30.6%, which was highest in 31 to 40-year-old men, and over 40-year-old men were the lowest. The pH, PR, VCL, VSL, and STR in the observation group were significantly lower than those in the control group (all
), while SV, NP, and WOB were significantly higher (all
). After treatment, the pH, VSL, LIN, WOB, and STR in the observation group were significantly higher than before (all
), while SV and VCL were significantly lower (all
). UU infection was closely correlated with pH, PR, NP, VCL, VSL, WOB, and STR. During the treatment, pH, PR, VSL, WOB, and STR increased, but NP and VCL decreased. 7 major factors that would affect SQ were extracted, of which VAP, LIN, and UU were the first three main factors. The risk of SQ declining after UU infection increased nearly twice with the change of PR and VCL and increased 0.08 times with STR. Conclusion. UU may approximately double the risk of altering the sperm’s curvilinear movement rate and straightness to affect the sperm quality.
Collapse
|
10
|
Frenzer C, Egli-Gany D, Vallely LM, Vallely AJ, Low N. Adverse pregnancy and perinatal outcomes associated with Mycoplasma genitalium: systematic review and meta-analysis. Sex Transm Infect 2022; 98:222-227. [PMID: 35351816 PMCID: PMC9016252 DOI: 10.1136/sextrans-2021-055352] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/22/2022] [Indexed: 12/22/2022] Open
Abstract
Objective To examine associations between Mycoplasma genitalium infection during pregnancy and adverse outcomes. Methods We did a systematic review of observational studies. We searched Medline, EMBASE, the Cochrane Library and CINAHL up to 11 August 2021. Studies were included if they compared preterm birth, spontaneous abortion, premature rupture of membranes, low birth weight or perinatal death between women with and without M. genitalium. Two reviewers independently assessed articles for inclusion and extracted data. We used random-effects meta-analysis to estimate summary ORs and adjusted ORs, with 95% CIs, where appropriate. Risk of bias was assessed using established checklists. Results We identified 116 records and included 10 studies. Women with M. genitalium were more likely to experience preterm birth in univariable analyses (summary unadjusted OR 1.91, 95% CI 1.29 to 2.81, I2=0%, 7 studies). The combined adjusted OR was 2.34 (95% CI 1.17 to 4.71, I2=0%, 2 studies). For spontaneous abortion, the summary unadjusted OR was 1.00 (95% CI 0.53 to 1.89, I2=0%, 6 studies). The adjusted OR in one case–control study was 0.9 (95% CI 0.2 to 3.8). Unadjusted ORs for premature rupture of membranes were 7.62 (95% CI 0.40 to 145.86, 1 study) and for low birth weight 1.07 (95% CI 0.02 to 10.39, 1 study). For perinatal death, the unadjusted OR was 1.07 (95% CI 0.49 to 2.36) in one case–control and 38.42 (95% CI 1.45 to 1021.43) in one cohort study. These two ORs were not combined, owing to heterogeneity. The greatest risk of bias was the failure in most studies to control for confounding. Conclusion M. genitalium might be associated with an increased risk of preterm birth. Further prospective studies, with adequate control for confounding, are needed to understand the role of M. genitalium in adverse pregnancy outcomes. There is insufficient evidence to indicate routine testing and treatment of asymptomatic M. genitalium in pregnancy. PROSPERO registration number CRD42016050962.
Collapse
Affiliation(s)
- Carole Frenzer
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Dianne Egli-Gany
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Lisa M Vallely
- Kirby Institute for Infection and Immunity in Society, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Andrew J Vallely
- Kirby Institute for Infection and Immunity in Society, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands, Papua New Guinea
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| |
Collapse
|
11
|
Wilson AN, Melepia P, Suruka R, Hezeri P, Kabiu D, Babona D, Wapi P, Bohren MA, Vogel JP, Kelly-Hanku A, Morgan A, Beeson JG, Morgan C, Spotswood N, Scoullar MJL, Vallely LM, Homer CSE. Partnership-defined quality approach to companionship during labour and birth in East New Britain, Papua New Guinea: A mixed-methods study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000102. [PMID: 36962285 PMCID: PMC10021905 DOI: 10.1371/journal.pgph.0000102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/23/2022] [Indexed: 11/19/2022]
Abstract
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.
Collapse
Affiliation(s)
- Alyce N Wilson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Pele Melepia
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Healthy Mothers, Healthy Babies, Burnet Institute, Kokopo, Papua New Guinea
| | - Rose Suruka
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Healthy Mothers, Healthy Babies, Burnet Institute, Kokopo, Papua New Guinea
| | - Priscah Hezeri
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Healthy Mothers, Healthy Babies, Burnet Institute, Kokopo, Papua New Guinea
| | - Dukduk Kabiu
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Healthy Mothers, Healthy Babies, Burnet Institute, Kokopo, Papua New Guinea
| | | | - Pinip Wapi
- Nonga General Hospital, Rabaul, Papua New Guinea
| | - Meghan A Bohren
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Angela Kelly-Hanku
- Papua New Guinea Institute for Medical Research, Goroka, Papua New Guinea
- Kirby Institute, University of New South Wales, New South Wales, Australia
| | - Alison Morgan
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Global Financing Facility, World Bank, Washington, DC, United States of America
| | - James G Beeson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Christopher Morgan
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Jhpiego, The Johns Hopkins University affiliate, Baltimore, Maryland, United States of America
| | - Naomi Spotswood
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Paediatrics, Royal Hobart Hospital, Tasmania, Australia
| | - Michelle J L Scoullar
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Lisa M Vallely
- Papua New Guinea Institute for Medical Research, Goroka, Papua New Guinea
- Kirby Institute, University of New South Wales, New South Wales, Australia
| | - Caroline S E Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| |
Collapse
|
12
|
Opi DH, Boyle MJ, McLean ARD, Reiling L, Chan JA, Stanisic DI, Ura A, Mueller I, Fowkes FJI, Rogerson SJ, Beeson JG. Reduced risk of placental parasitemia associated with complement fixation on Plasmodium falciparum by antibodies among pregnant women. BMC Med 2021; 19:201. [PMID: 34425801 PMCID: PMC8383393 DOI: 10.1186/s12916-021-02061-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/13/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The pathogenesis of malaria in pregnancy (MiP) involves accumulation of P. falciparum-infected red blood cells (pRBCs) in the placenta, contributing to poor pregnancy outcomes. Parasite accumulation is primarily mediated by P. falciparum erythrocyte membrane protein 1 (PfEMP1). Magnitude of IgG to pRBCs has been associated with reduced risk of MiP in some studies, but associations have been inconsistent. Further, antibody effector mechanisms are poorly understood, and the role of antibody complement interactions is unknown. METHODS Studying a longitudinal cohort of pregnant women (n=302) from a malaria-endemic province in Papua New Guinea (PNG), we measured the ability of antibodies to fix and activate complement using placental binding pRBCs and PfEMP1 recombinant domains. We determined antibody-mediated complement inhibition of pRBC binding to the placental receptor, chondroitin sulfate A (CSA), and associations with protection against placental parasitemia. RESULTS Some women acquired antibodies that effectively promoted complement fixation on placental-binding pRBCs. Complement fixation correlated with IgG1 and IgG3 antibodies, which dominated the response. There was, however, limited evidence for membrane attack complex activity or pRBC lysis or killing. Importantly, a higher magnitude of complement fixing antibodies was prospectively associated with reduced odds of placental infection at delivery. Using genetically modified P. falciparum and recombinant PfEMP1 domains, we found that complement-fixing antibodies primarily targeted a specific variant of PfEMP1 (known as VAR2CSA). Furthermore, complement enhanced the ability of antibodies to inhibit pRBC binding to CSA, which was primarily mediated by complement C1q protein. CONCLUSIONS These findings provide new insights into mechanisms mediating immunity to MiP and reveal potential new strategies for developing malaria vaccines that harness antibody-complement interactions.
Collapse
Affiliation(s)
- D Herbert Opi
- Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Australia. .,Department of Immunology, Monash University, Melbourne, Australia. .,Department of Medicine at the Doherty Institute, University of Melbourne, Melbourne, Australia.
| | - Michelle J Boyle
- Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Australia.,Human Malaria Immunology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | - Linda Reiling
- Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Jo-Anne Chan
- Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Australia.,Department of Immunology, Monash University, Melbourne, Australia.,Department of Medicine at the Doherty Institute, University of Melbourne, Melbourne, Australia
| | - Danielle I Stanisic
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.,Institute for Glycomics, Griffith University, Southport, Queensland, Australia
| | - Alice Ura
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Ivo Mueller
- Walter and Eliza Hall Institute of Medical Research, Parkville, Australia.,Department of Medical Biology, University of Melbourne, Melbourne, Australia.,Institute Pasteur, Paris, France
| | - Freya J I Fowkes
- Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Australia.,Department of Infectious Diseases, Monash University, Melbourne, Australia.,Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Australia.,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Stephen J Rogerson
- Department of Medicine at the Doherty Institute, University of Melbourne, Melbourne, Australia
| | - James G Beeson
- Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Australia. .,Department of Immunology, Monash University, Melbourne, Australia. .,Department of Medicine at the Doherty Institute, University of Melbourne, Melbourne, Australia. .,Department of Microbiology, Monash University, Clayton, Australia.
| |
Collapse
|