The epidemiology of malaria in Papua New Guinea

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Abstract

Papua New Guinea (PNG) is a patchwork of different ecological zones, inhabited by human populations of exceptional cultural and linguistic diversity. This results in complex variations in vector ecology and malaria epidemiology. Malaria is the main cause of morbidity in many health facilities in lowland areas, but it is absent in much of the highlands. All four human malaria species occur, but endemicity varies widely, with Plasmodium falciparum locally reaching holo-endemic levels that are rarely found outside sub-Saharan Africa. The high frequency of Plasmodium vivax is an important difference to most African situations. PNG is therefore a prime location for studies of interactions between different parasite species, and of the biology of local human genetic adaptation and its implications for malaria morbidity and mortality.

Section snippets

Endemicity of malaria in PNG

The main climatic determinant of malaria endemicity in PNG is temperature, and because the country is located close to the equator, temperatures do not show much seasonal variation and depend mainly on altitude. The human population is concentrated in the highland areas at >1300–1500 m and in the coastal lowlands at <600 m altitude [6] with very sparse habitation in intermediate zones (Table 1). Until recently, the highland areas, with the exception of lower-lying inter-montane valleys, were

Species composition and history of malaria control

The two main species of human malaria in PNG are P. falciparum and P. vivax. The distribution of P. malariae is patchy. In parts of East Sepik Province, the overall prevalence of P. malariae reaches 13%; although it has been little studied, it might have important health effects both as a cause of chronic morbidity and (possibly) by stimulating cross-protection against other pathogens [20]. Plasmodium ovale is found only occasionally.

The species composition is very much related to the history

Clinical epidemiology

Malaria is the most frequent outpatient diagnosis (annual incidence of 303 per 1000 people at risk) and the second leading case of admissions (834 per 100 000 individuals) in health facilities in many endemic areas. This high incidence occurs despite the fact that most of the population of malaria-endemic areas in PNG have some degree of immunity, and so malaria

Vector taxonomy and ecology

The principal malaria vectors in PNG are members of the Anopheles punctulatus group of mosquitoes. Before 1993, only three members of this group were known from PNG, Anopheles farauti, Anopheles koliensis and Anopheles punctulatus 4, 39, 40, 41. It was believed that these could be distinguished morphologically. In addition, there are several morphologically distinct minor vectors including Anopheles bancroftii, Anopheles longirostris and Anopheles karwari [18].

Allozyme analysis and PCR

Conclusions

The studies carried out at the Papua New Guinea Institute of Medical Research (PNGIMR) on the epidemiology of malaria have aimed at an integrated understanding of the ecology of malaria and have attempted to move as quickly as possible to the evaluation of appropriate interventions. An integrated programme studies the biology and molecular analysis of the parasite; the genetics, immune responses and behaviour of the host; human infection and disease; the genetics and behaviour of the mosquito

Acknowledgements

We thank the people of PNG and, in particular, the staff of the PNGIMR for their tremendous contributions to the various studies cited in this paper. We are grateful to Dan Anderegg for his assistance with graphics, and to the Swiss National Science Foundation for their support of I.M.

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