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EPIDEMIC MALARIA IN THE HIGHLANDS OF PAPUA NEW GUINEA

As part of a larger study into the epidemiology of malaria in the highlands of Papua New Guinea, outbreak investigations were carried out at the end of the 2002 rainy season in 11 villages situated between 1,400 and 1,700 meters above sea level that had reported epidemics. Locations and timing of these epidemics corresponded largely to those reported in the pre-control era of the 1960s and 1970s. On average, 28.8% (range = 10.3–63.2%) of people in each of the 11 villages were found to be infected with malaria. Plasmodium falciparum accounted for 59% of all identified infections and P. vivax for 34%. The majority (53%) of infections were symptomatic. Although symptomatic infections were most common in children 2–9 years of age (36%), even in adults a prevalence of 20% was observed. A comparison with earlier non-epidemic data in three of the villages without easy access to health care showed markedly increased levels of morbidity, with 6–10-fold increases in parasite prevalence, a 3-fold increase in both measured and reported fevers, and a 12-fold increase in enlarged spleens. The average hemoglobin levels were reduced by 2.3–3.5 g/dL, with a concurrent increase in moderate to severe anemia (hemoglobin level < 7.5 g/dL) from 0.0–3.3% to 3.8–18.4%. These massive increases in morbidity have devastating impact on the affected communities and highlight that malaria epidemics are a serious and increasing public health problem in the highlands of Papua New Guinea.

Received December 17, 2003. Accepted for publication April 9, 2004.

Acknowledgments: We thank all the villages for their help and participation in the surveys. Special thanks are given to Jerome Whitfield and Gimana Poigeno for help with the field work.

Financial support: This study was supported by the World Health Organization through the Regional Office for the Western Pacific and the Global Roll Back Malaria Initiative.

Authors’ addresses: Ivo Mueller, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea and Tropical Health Program, Australian Centre of Tropical Health and Nutrition, University of Queensland Medical School, Herston, Queensland 4006, Australia, E-mail: ivo{at}pngimr.org.pg. Pioto Namuigi, Rex Ivivi, and John C. Reeder, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea. Julius Kundi, Malaria Surveillance and Control Unit, Goroka, Eastern Highlands Province, Papua New Guinea. Tony Tandrapah, Eastern Highland Division of Health, Goroka, Papua New Guinea. Steven Bjorge, National Department of Health, Waigani, National Capitol District, Papua New Guinea.

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