Evaluation of risks of tuberculosis in Western Province Papua New Guinea

Tuberculosis in Western Province: tuberculosis (TB) is the major contributor to the infectious diseases burden in Western Province and indeed all of PNG. On my mission, TB was the principal diagnosis in almost all admitted medical patients. Malaria and HIV are also concerns in the Western Province but currently generate a much lower burden in terms of deaths, morbidity, hospitalisations, utilisation of healthcare and cost of treatment. After reviewing five TB registers (two in North Fly, two in Middle Fly and one in South Fly (Daru Hospital)), I estimated that the registered incidence of TB in Western Province is around 500 per 100,000 people per annum, much higher than the national reported rate of 300 and the PNG National Department of Health estimate for Western Province of 150 per 100,000. My estimated rate for Western Province is almost double the overall TB incidence in the WHO-defined African region and similar to rates in Mozambique and Cambodia. Nevertheless, the true incidence of TB is likely to be even higher due to poor access to healthcare and poor rural health services in the region, leading to under-reporting. Under-reporting is likely to be responsible for the unusual case mix in many parts of the region (large number of extra-pulmonary to pulmonary cases, more women than men reported, late presentation of TB), suggesting much TB is missed by registers. Greater outreach into rural areas will provide more robust estimates of TB incidence