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This paper presents findings from a qualitative study that sought to identify the ways in which affected individuals or their caregivers respond to a suspected malaria infection and to illuminate the rationale underlying the decision-making process. In-depth interviews (IDIs) were conducted with a sub-sample (n = 44) of participants in a country-wide household survey who reported experiencing, or caring for someone who experienced, a suspected malaria infection in the two weeks before the survey. All IDIs were completed between March and July 2011. Analysis was informed by a general inductive methodology. The most commonly reported response involved the use of antimalarial medication and some form of traditional remedy prepared in the home. Reported treatment responses were frequently consistent with a stepped-care approach to disease management, the first step of which was characterized by convenience and was often relatively generic in nature. Seeking assistance from a formal health care provider was the exception amongst study participants, with fewer than half attending a health facility during the target illness episode. A number of barriers to health service access were reported; however, a range of other factors contributed to the decision not to seek formal health care such as perceived severity of illness, positive past experiences using home-based treatments and the aforementioned preference for utilizing convenient 'treatment' options in the first instance. Traditional healers were rarely considered an appropriate treatment option for malaria.

BACKGROUND: Malaria is the leading cause of illness and death in Papua New Guinea (PNG). Infection during pregnancy with falciparum or vivax malaria, as occurs in PNG, has health implications for mother and child, causing complications such as maternal anemia, low birth weight and miscarriage. This article explores knowledge, attitudes and practices concerning malaria during pregnancy and it's prevention in Madang, PNG, a high prevalence area. METHODS: As part of a qualitative study in Madang, exploring MiP, participatory techniques (free-listing and sorting) were conducted along with focus group discussions, in-depth interviews (with pregnant women, health staff and other community members) and observations in the local community and health facilities. RESULTS: The main themes explored were attitudes towards and knowledge of MiP, its risks, and prevention. Although there was a general awareness of the term "malaria", it was often conflated with general sickness or with pregnancy-related symptoms. Moreover, many preventive methods for MiP were related to practices of general healthy living. Indeed, varied messages from health staff about the risks of MiP were observed. In addition to ideas about the seriousness and risk of MiP, other factors influenced the uptake of interventions: availability and perceived comfort of sleeping under insecticide-treated mosquito nets were important determinants of usage, and women's heavy workload influenced Chloroquine adherence. CONCLUSION: The non-specific symptoms of MiP and its resultant conflation with symptoms of pregnancy that are perceived as normal have implications for MiP prevention and control. However, in Madang, PNG, this was compounded by the inadequacy of health staff's message about MiP.

This paper presents findings from a qualitative study designed to explore the reasons why some Papua New Guineans who own mosquito nets choose not to use them, whether on a regular or episodic basis. In-depth interviews (IDIs) were conducted with a sub-sample (n = 44) of participants in a country wide household survey who reported owning or having access to a mosquito net, but not having slept under a mosquito net the night prior to survey. All IDIs were completed between December 2010 and June 2011. Analysis was informed by a general inductive methodology. Multiple impediments to regular mosquito net use were identified by study participants, although all were broadly grouped into the inter-related categories of net-, environmental- or human-factors. Indifference emerged as the most influential impediment towards regular net use presenting as a general attitudinal context in which a majority of participant responses were grounded. A lack of knowledge regarding malaria transmission pathways or the utility of mosquito nets did not appear to underlie this indifference. Rather, the indifference appeared to be rooted in a lack of fear of malaria infection cultivated through lived experience. A wide range of interventions could potentially promote greater mosquito net use amongst this population. However, the basis of any intervention strategy, given the pervasive indifferent attitude towards regular mosquito net use, should be to render individual mosquito net use as easy and as convenient as possible and to promote complementary malaria control strategies where appropriate.

Background: Appropriate antenatal care (ANC) is key for the health of mother and child. However, in Papua New Guinea (PNG), only a third of women receive any ANC during pregnancy. Drawing on qualitative research, this paper explores the influences on ANC attendance and timing of first visit in the Madang region of Papua New Guinea.Methods: Data were collected in three sites utilizing several qualitative methods: free-listing and sorting of terms and definitions, focus group discussions, in-depth interviews, observation in health care facilities and case studies of pregnant women. Respondents included pregnant women, their relatives, biomedical and traditional health providers, opinion leaders and community members.Results: Although generally reported to be important, respondents’ understanding of the procedures involved in ANC was limited. Factors influencing attendance fell into three main categories: accessibility, attitudes to ANC, and interpersonal issues. Although women saw accessibility (distance and cost) as a barrier, those who lived close to health facilities and could easily afford ANC also demonstrated poor attendance. Attitudes were shaped by previous experiences of ANC, such as waiting times, quality of care, and perceptions of preventative care and medical interventions during pregnancy. Interpersonal factors included relationships with healthcare providers, pregnancy disclosure, and family conflict. A desire to avoid repeat clinic visits, ideas about the strength of the fetus and parity were particularly relevant to the timing of first ANC visit.Conclusions: This long-term in-depth study (the first of its kind in Madang, PNG) shows how socio-cultural and economic factors influence ANC attendance. These factors must be addressed to encourage timely ANC visits: interventions could focus on ANC delivery in health facilities, for example, by addressing healthcare staff’s attitudes towards pregnant women.