2.1. Study area

The pilot project for this study was approved by the PNG Ministry of Health (Registration Number: 20170330). Three rounds of MDA with the AP program were initiated via the grid-based management model in the Trobriand Islands from March to June 2018. The study profile is shown in Fig. 1. The Trobriand Islands were categorized into two groups in this study based on their geographical location: the main island (Kiriwina) and the outer islands (Vakuta, Kitava, Kaduaga, and Simsimla) (Fig. 2).

Study profile *AP, artemisinin-piperaquine; MDA, mass drug administration.

Geographic information of the Trobriand islands.

Trobriand Islands cover 450 km² of coral atolls off the East Coast of New Guinea. Kiriwina island, located in the Trobriand Islands center, is the main island home to most of the population. This island is surrounded by the outer islands of Vakuta, Kitava, Kaduaga, and Simsimla (Wikipedia, n.d.). The rainy season in this area lasts from November to March, with the rest of the year being dry. According to a WHO report, the main malaria vectors in PNG are Anopheles punctulatus, Anopheles farauti, and Anopheles koliensis (World Health Organization, n.d.).

Kiriwina Rural is a long and narrow island with an area of 290.5 km². According to the 2011 census, 36,721 people were living in 7,005 households distributed across 33 villages (National Statistical Office, 2011).