Strengthening disease surveillance in Papua New Guinea

Papua New Guinea is a fragile state, where the health system faces significant constraints and surveillance systems infrequently meet international standards. The country is striving to achieve the minimum requirements in disease surveillance in line with the International Health Regulations (IHR 2005). This research has shown that Papua New Guinea is a high risk setting for emerging and re-emerging infections, for unusual combinations of outbreaks and clinical syndromes, and for outbreaks in remote locations which are difficult to detect in a timely way. These studies characterise some of the acute public health events affecting Papua New Guinea during the research period, including the first report of cholera, concurrent outbreaks of shigellosis and influenza as well as cholera and peripheral neuropathy among vulnerable populations. The lack of human resources for health makes timely outbreak detection and response a major challenge. A simple mobile phone based syndromic surveillance system was successfully implemented in this fragile state. The system met some of its objectives by enabling timely, complete and sensitive reporting of data for risk assessment. In fragile states, mobile phone technology may improve the timeliness and efficiency of disease surveillance and corresponding disease control. The findings from this series of studies can inform emerging infectious disease policy and practice. Further work is required to strengthen and expand the syndromic surveillance system as well as the event based surveillance systems. Data contained within this thesis is useful for Papua New Guinea and other fragile states that are striving to achieve the minimum core requirements under the IHR