Epidemiology of malaria in the Papua New Guinean highlands

Abstract

Objectives To conduct an in-depth investigation of the epidemiology of malaria in the Papua New Guinea (PNG) highlands and provide a basis for evidence-based planning and monitoring of intensified malaria control activities. Methods Between December 2000 and July 2005, 153 household-based, rapid malaria population surveys were conducted in 112 villages throughout the central PNG highlands. The presence of malaria infections was determined by light microscopy and risk factors assessed using a structured questionnaire. The combined dataset from all individually published surveys was reanalysed. Results The prevalence of malaria infections in the different surveys ranged from 0.0% to 41.8% (median 4.3%) in non-epidemic surveys and 6.6% to 63.2% (median 21.2%, P<0.001) during epidemics. Plasmodium falciparum was the predominant infection below 1400m and during epidemics, Plasmodium vivax at altitudes >1600m. Outside epidemics, prevalence decreased significantly with altitude, was reduced in people using bed nets [odds ratio (OR)=0.8, P<0.001] but increased in those sleeping in garden houses (OR=1.34, P<0.001) and travelling to highly endemic lowlands (OR=1.80, P<0.001). Below 1400m, malaria was a significant source of febrile illness. At higher altitudes, malaria was only a significant source of febrile illness during epidemic outbreaks, but asymptomatic malaria infections were common in non-epidemic times. Conclusions Malaria is once again endemic throughout the PNG highlands in areas below 1400-1500m of altitude with a significant risk of seasonal malaria outbreaks in most area between 1400-1650m. Ongoing control efforts are likely to result in a substantial reduction in malaria transmission and may even result in local elimination of malaria in higher lying areas. © 2012 Blackwell Publishing Ltd.