Epidemiology of tuberculosis in Papua New Guinea: analysis of case notification and treatment-outcome data, 2008–2016

Abstract

Papua New Guinea has strengthened its surveillance system for tuberculosis (TB) under the National TB Program. This paper provides an overview of TB surveillance data at the national and subnational levels from 2008 to 2016.TB case notification has consistently increased since 2008 with 6184 cases (93 per 100 000 population) in 2008 to 28 598 (359 per 100 000 population) in 2014 and has stabilized since 2014 with 28 244 cases (333 per 100 000 population) in 2016. The population-screening rate for TB rose from 0.1% in 2008 to 0.4% in 2016. Notified cases were dominated by extra-pulmonary TB (EP-TB, 42.4% of all cases in 2016). The proportion of pulmonary TB cases with no sputum test results was high with a national average of 26.6%. The regional variation of case notifications was significant: the Southern Region had the highest number and rate of notified TB cases. Of the nationally reported cases, 26.7% occurred in children. Treatment success rates remained low at 73% for bacteriologically confirmed TB and 64% for all forms of TB in 2016, far below the global target of 90%. For all forms of TB, 19% of patients were lost to follow-up from treatment.An analysis of TB data from the national surveillance system has highlighted critical areas for improvement. A low population-screening rate, a high proportion of pulmonary TB cases without sputum test results and a low treatment success rate suggest areas for improvement in the National TB Program. Our additional subnational analysis helps identify geographical and programmatic areas that need strengthening and should be further promoted to guide the programme’s direction in Papua New Guinea.

Challenges in TB diagnosis and treatment: the Kavieng Provincial Hospital experience, Papua New Guinea

“…1 The national surveillance system for TB has been strengthened in PNG since 2008 with an increase in TB case notification each year until 2014. 4 However, the recently reported case detection rate of 333/100 000 for 2016 suggests that many TB patients remain undetected. The case notification rate for New Ireland Province was reported to be 105/100 000, with 26% being new smear-positive TB patients.…”

Implementation of screening and management of household contacts of tuberculosis cases in Daru, Papua New Guinea

“…1 In 2016, PNG reported a total of 28 244 TB case notifications, a rate of 333 per 100 000 population with 26.7% of all notified TB cases occurring in children (aged 15 years). 5 This is substantially higher than the global estimate of 10.6% of all TB cases, and represents ongoing community transmission. 2,5 Of the provinces in PNG, Western Province reported one of the highest TB case notification rates of 674/100 000 in 2016.…”

“…5 This is substantially higher than the global estimate of 10.6% of all TB cases, and represents ongoing community transmission. 2,5 Of the provinces in PNG, Western Province reported one of the highest TB case notification rates of 674/100 000 in 2016. 5 There is a particularly high TB incidence in Daru, the capital of Western Province, which has reported an outbreak of MDR-TB.…”

“…A. Honjepari, 1 S. Madiowi, 1 S. Madjus, 2 C. Burkot, 3 S. Islam, 3 G. Chan, 3 S. S. Majumdar, 3 S. M. Graham 3,4,5 I mproving tuberculosis (TB) case detection and treatment is critical to reducing disease transmission, incidence and mortality. 1 The World Health Organization (WHO) reported that 6.4 million new cases of TB were notified in 2017, but that this represents only 64% of the estimated global incidence.…”

“…2,5 Of the provinces in PNG, Western Province reported one of the highest TB case notification rates of 674/100 000 in 2016. 5 There is a particularly high TB incidence in Daru, the capital of Western Province, which has reported an outbreak of MDR-TB. [6][7][8] The screening of household contacts, particularly contacts of the most infectious TB cases (i.e., bacteriologically confirmed), can further increase case detection, 9 and thereby improve IPT uptake as per international and national TB guidelines to high-risk contacts who do not have active TB.…”