A personal story from a mum told to Professor Caroline Homer AO and Ms Primrose Homiehombo.
Burnet’s innovative research program Healthy Mothers, Healthy Babies (HMHB) comprises a suite of studies that aims to save lives and improve health and wellbeing in Papua New Guinea (PNG).
HMHB is based in Kokopo, East New Britain (ENB) and is a partnership with the East New Britain Provincial Health Authority, PNG Institute of Medical Research (PNGIMR), National Department of Health, University of PNG, Kirby Institute, and local health facilities.
HMHB has made significant progress in understanding the causes of poor maternal and child health, and identifying potential areas for improvement. The first major HMHB Study, a longitudinal study of 700 mothers and their babies, completed follow-up in 2018, and early results have been provided to local communities, health facilities and provincial government.
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Accelerating access to postnatal care and chlorhexidine in PNG
Severe infections in young babies account for one-third of newborn deaths in low- and middle-income countries like PNG. The newly cut umbilical cord is an important entry point for infections. In partnership with the ENB Provincial Health Authority and GSK, we began a trial of a low-cost, non-profit formulation of chlorhexidine, a sterilising antiseptic, for umbilical cord care straight after birth; this has been demonstrated to significantly reduce newborn mortality in many countries in Asia and Africa.
Research conducted by Burnet in ENB also suggested that routine postnatal care service coverage in the first week after birth was low, reaching only 17 per cent of mothers. In response we developed PNG’s first set of targeted postnatal community education materials to help families understand more about how to care for mothers and babies in the first crucial weeks after childbirth.
Outcomes and Impact:
Nurses are educating new parents in postnatal wards before they go home with their new baby, including detailed information on routine care, information about the use of the new GSK chlorhexidine gel for the umbilical cord, as well as danger signs to watch for in themselves and their baby.
Burnet-trained volunteers are visiting new mothers in the home, checking their understanding of postnatal health, use of chlorhexidine, and encouraging them to visit clinics.
A highly sensitive rapid diagnostic test for malaria among pregnant women: An evaluation
A new rapid, point-of-care, Plasmodium falciparum diagnostic test for malaria has been developed that has a 10-fold greater sensitivity to existing tests. But how does it compare with conventional rapid diagnostic tests in the field for detecting malaria in pregnant women in PNG?
Image: Field testing of the highly sensitive rapid diagnostic test for malaria by HMHB’s Ms Kerryanne Tokmun (front) with Ms Dorah Edward, Ms Primrose Homiehombo and a study participant.
“Malaria during pregnancy is really a major public health problem because the malaria parasite can hide in the placenta and so they are often hard to detect,” Burnet’s Associate Professor Leanne Robinson said.
“The mother might not necessarily feel sick but they can have really serious consequences, both for the mother and the baby. These can include maternal anaemia, fetal growth restriction, premature labour, and even death of the mother or the fetus.
“We are screening mothers who attend antenatal clinics in ENB province using this new rapid test, the standard malaria test, as well as several very sensitive laboratory-based assays (analysing a substance to determine its composition or quality), one of which could be conducted in the clinics.”
Preliminary data suggests a moderate burden of malaria (18 per cent) and a substantial burden of anaemia (82 per cent) in pregnant women in the study. This evaluation project is being led by Associate Professor Robinson, in partnership with Dr Moses Laman at the PNGIMR, the ENB provincial government, and Kirby Institute, through funding from the Foundation for Innovative and New Diagnostics (FIND).
Low childhood immunisations – steps to change this
HMHB research into health care services during the first six months after childbirth revealed two significant gaps:
Very low uptake of routine checks after childbirth (postnatal care)
Strengths and weaknesses in the running of childhood immunisation clinics.
We responded to the first issue in the postnatal care and chlorhexidine study. We also found that while staff are providing safe and effective vaccinations, service planning can be improved to reach all children, and some vaccinations (such as those in the second year of life) are not being prioritised.
The 2018 resurgence of polio (now under control) elsewhere in PNG, and the looming threat of more measles outbreaks, shows just how urgent it is to find ways to improve immunisation nationally. Stronger routine programs are the key; but their coverage has been stagnant at sub-standard levels for more than 15 years.
Our findings point to new ways to document where unvaccinated children are, new options for organising outreach clinics, and mechanisms by which polio campaigns can do a better job of strengthening routine immunisation services, even as they respond to the emergency. These findings have been circulated within ENB, presented nationally, and are being published internationally. We are also using these research findings in our development work to strengthen immunisation in other parts of PNG.
The Quality of Pregnancy, Childbirth and Newborn Health Services Study
Earlier HMHB studies have identified a critical need to evaluate the quality of health care provided to women and babies in PNG, and to identify and implement strategies to improve maternal and newborn health outcomes. Internationally, it is recognised that:
– Saving mothers’ and babies’ lives requires quality care that is ‘safe, effective, timely, efficient, equitable and people-centred’
– If the level of care is not considered to be of quality by a community, women are more likely to avoid accessing health services.
“This study will highlight immediate opportunities for improved provision of good-quality maternal and newborn care in partnership with local health managers and health care workers,” a study principal investigator, Burnet’s Dr Alyce Wilson said.
Image: Dr Alyce Wilson (second from left) with Provincial Health Authority staff Ms Claire Pidik (left), Ms Elsie Buka (second from right) and Burnet’s Mr Hadlee Supsup and Ms Pele Melepia.
The collaborative study involves principal investigators from Burnet Institute, PNGIMR, Nonga Hospital and St Mary’s Hospital, ENB. Key partners include the ENB Provincial Health Authority, PNGIMR, National Department of Health, and University of PNG. Funding support has come from Steamships PNG Community Grant, June Canavan Foundation, and the Alastair Lucas Prize for Medical Research.
