Papua New Guinea Malaria Indicator Survey 2022-2023: final report on malaria prevention, infection prevalence, and treatment seeking

Background Malaria remains a prevalent issue across Papua New Guinea (PNG), with the exception of its highland regions, where the cooler climate at altitudes above 1600 meters inhibits consistent transmission. The National Malaria Strategic Plan (NMSP) for 2021-2025 has set forth an ambitious goal to eliminate malaria from PNG by 2030. To achieve this, the NMSP outlines objectives to decrease the overall malaria burden by 63% and cut malaria-related deaths by 90% by the year 2025. Since 2004, the PNG National Malaria Control Programme (NMCP), with financial support from The Global Fund to Fight AIDS, Tuberculosis and Malaria, has been actively distributing long-lasting insecticidal nets (LLINs) across the nation. From the latter part of 2011, the program has also expanded the availability of malaria rapid diagnostic tests (mRDTs) and artemisinin-based combination therapies (ACTs) in healthcare facilities. Furthermore, the NMCP has initiated home-based management of malaria in select regions, complemented by behavior change campaigns to bolster the adoption of both preventive measures and treatment solutions. Methods As part of the ongoing thorough assessment of the NMCP, the Papua New Guinea Institute of Medical Research (PNGIMR) undertook a nationwide Malaria Indicator Survey (MIS) from September 2022 to August 2023. This survey aimed to evaluate the reach of malaria control measures and the incidence of malaria infections on both national and regional scales. Conducted across 114 villages in all provinces, the survey encompassed 3,029 households, involving a total of 15,435 participants. For the purpose of diagnosing malaria, 12,849 capillary blood samples were collected and analyzed using mRDT and light microscopy techniques. Results Across PNG, 58% (95% CI 53.8, 62) of all households owned at least one LLIN, 46.1% (95% CI 41.4, 50.7) of the population had access to a LLIN and 30.7% (95% CI 26.1, 35.8) of household members slept under a LLIN the night before the survey. Among children