New STI affecting pregnant women in Papua New Guinea

Healthy Mothers, Healthy Babies, a Burnet flagship research program, is addressing significant health challenges faced by women and young children in Papua New Guinea (PNG).

Two recent Burnet-led studies highlight the magnitude of the problems experienced by pregnant women in PNG, and the critical importance of ongoing support at a time when the country's health system is being stretched to breaking point by COVID-19.

Amid, and despite, the COVID-19 pandemic, Burnet’s Healthy Mothers, Healthy Babies (HMHB) team is continuing its outstanding work to address the underlying causes for the appalling level of death and disease among women and children in PNG.

Already faced with one of the world's highest maternal mortality rates – 80 times worse than Australia’s – the country is grappling with rising COVID-19 cases, and the burden of needing to reallocate resources from their battle against debilitating infectious disease burdens, such as tuberculosis and malaria.

Two Burnet-led studies in East New Britain province were conducted in-country before the recent COVID-19 infections affected the area.

Here's what they found.

New, undiagnosed & untreated infections

The first study, led by Dr Michelle Scoullar, has revealed extreme rates of reproductive tract infections (RTIs) and sexually transmitted infections (STIs) in pregnant women, and identified the high burden of a new STI – Mycoplasma genitalium – that has not been previously identified in PNG.

Published in the journal Emerging Infectious Diseases, the study of 699 pregnant women in East New Britain Province found 74 per cent had at least one RTI at the time of their first antenatal visit for pregnancy care, and 37 per cent had at least one curable STI.

Significantly, the research team also found that the current recommended clinical management, based on the presence or absence of specific symptoms, is allowing most infections to go undetected and untreated with serious consequences.

“This study shows there’s a huge number of undiagnosed and untreated RTIs in the community,” Dr Scoullar, HMHB Principal Investigator, said.

In pregnant women, RTIs can cause miscarriage, stillbirth, premature birth or neonatal death, as well as serious neonatal conditions such as blindness, congenital malformations and lifelong disability.

“In Papua New Guinea and many countries globally, treatment of these infections based on the presence or absence of symptoms is common because access to diagnostic services is limited. Our findings show this approach is, unfortunately, missing the majority of infection.”

Dr Scoullar said improved access to affordable and accurate rapid diagnostics or point-of-care tests would lead to more accessible and effective treatment, resulting in improved sexual and reproductive health and better pregnancy outcomes.

More unintended pregnancies, less family planning

A companion study, led by Dr Liz Peach, HMHB Research Project Manager, Burnet Institute, identified high rates of unintended pregnancy and very low use of modern family planning methods among 699 pregnant women attending their first antenatal clinic visit in PNG’s East New Britain province.

Published in the journal Scientific Reports, the study identified an urgent need for gender inclusive, context-specific family planning approaches at individual, family and community levels.

The study found that:

• more than half (55 per cent) of the women reported their pregnancy as unintended
• few (18 per cent) reported ever having used a modern family planning method, and knowledge of the different methods available was low
• single, separated or divorced women had almost tenfold the odds of unintended pregnancy than women who were married or cohabiting with their male partner; however, the great majority of unintended pregnancies were in women with partners
• involvement of male partners in antenatal care was associated with reduced unintended pregnancy and improves family planning use.

“The findings highlight an urgent need for targeted services and strategies to improve family planning knowledge, uptake and access, and male partner involvement, to reduce unintended pregnancies and their complications,” Dr Peach said.

“Unintended pregnancies expose women to serious risks during pregnancy and childbirth. It also leads to inadequate birth spacing and pregnancies in high-risk groups, which can have negative consequences for mother and baby.”

Supervising author, Professor James Beeson, said personal, male partner and community beliefs, attitudes and norms, including objections to the use of family planning and fear of side effects, were reported by women as factors that discourage seeking and using family planning.

“This highlights the potential benefits of including men in all public health strategies, including tailored information broadcast on radio and television, to increase uptake, accessibility and demand for family planning.”

Learn more about HMHB