title: Epidemic malaria in the highlands of Papua New Guinea.
abstract: 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.
authors.affiliation: Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea. ivo@pngimr.org.pg
authors.forename: Ivo
authors.initials: I
authors.lastname: Mueller
authors.forename: Pioto
authors.initials: P
authors.lastname: Namuigi
authors.forename: Julius
authors.initials: J
authors.lastname: Kundi
authors.forename: Rex
authors.initials: R
authors.lastname: Ivivi
authors.forename: Tony
authors.initials: T
authors.lastname: Tandrapah
authors.forename: Steven
authors.initials: S
authors.lastname: Bjorge
authors.forename: John C
authors.initials: JC
authors.lastname: Reeder
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007223:Infant; D008288:Malaria / Q000453:epidemiology*; D008297:Male; D010219:Papua New Guinea / Q000453:epidemiology; D015995:Prevalence