Social determinants of injury-attributed mortality in Papua New Guinea: new data from the Comprehensive Health and Epidemiological Surveillance System

Abstract

ObjectiveThis study reported the prevalence and sociodemographic distribution of mortalities attributed to injuries in Papua New Guinea (PNG).SettingAs part of a longitudinal study, mortality data were collected from the population who live in eight surveillance sites of the Comprehensive Health and Epidemiological Surveillance System, established in six major provinces in PNG. Verbal autopsy (VA) interviews were conducted by the surveillance team with close relatives of the deceased, using the WHO 2016 VA instrument from January 2018 to December 2020.Participant and InterventionMortality data from 926 VA interviews were analysed, using the InterVA-5 diagnostic tool to assign specific cause of death (COD). Distributions of injury-attributed mortality were calculated and multinomial logistic regression analyses were conducted to identify sociodemographic factors and provide ORs, 95% CIs of estimates and p values.ResultInjury-attributed deaths accounted for 13% of the total deaths recorded in the surveillance population, with the highest proportion in Madang (22%), followed by Port Moresby and Central Province (13%). Road traffic accidents were the leading COD, accounting for 43% of the total injury-attributed deaths, followed by assaults (25%) and accidental falls (10%). Young adults (aged 15–24 years) accounted the largest proportion of injury-attributed deaths (34%) and were nearly six times more likely to die from injuries than those aged 75+ years (OR: 5.89 (95% CI: 2.18 to 15.9); p<0.001). Males were twice more likely to die from injuries than females (OR: 2.0 (95% CI: 1.19 to 3.36); p=0.009). Another significant sociodemographic factor associated with the increased injury-attributed mortalities included urban versus rural residence (OR: 2.0 (95% CI: 1.01 to 3.99); p=0.048).ConclusionYoung adults, particularly those who live in urban areas, were at the highest risk of dying from injuries. Public health policies and interventions are needed to reduce premature mortality from injuries in PNG.

Non-communicable diseases attributed mortality and associated sociodemographic factors in Papua New Guinea: Evidence from the Comprehensive Health and Epidemiological Surveillance System

“…Aside from asking standard questions about the signs and symptoms the deceased experienced prior to death, an additional data module on the deceased identification information was included in the questionnaire, including household location (GPS data) and individual background information. This information allow linkages between mortality data and other existing data components available from the CHESS database such as morbidity data and household socioeconomic data, to enhance the scope of data for analysing sociodemographic factors associated with NCDs mortality in PNG [18]. VA interviews were conducted by the CHESS demographic team to collect mortality data from the communities from January 2018 to December 2020.…”

“…Finally, multinomial logistic regression (MLR) analyses were conducted to identify sociodemographic factors associated with mortalities from emerging and endemic NCDs. Since social determinants of mortalities from emerging NCDs and endemic NCDs could be different [13,18], analyses were conducted separately for these two categories to predict the risks of dying from these COD categories across sub-populations. Two binary variables (Yes/No) on emerging NCDs and endemic NCDs attributed deaths were created in the dataset.…”

“…The CHESS was granted ethics approvals from Instructional Review Board of PNG Institute of Medical Research (IRB's Approval no. 18.05) and the Medical Research Advisory Committee of Papua New Guinea (MRAC's Approval no. 18.06).…”

“…The increase of cash flow and the local economic growth are thought to contribute to increased access to and consumption of processed foods [32,34]. Children in these sites were reported as consuming high levels of sugar, soft drinks and salty fast foods [35]. Half of the adult population and 25% of adult patients in Central Province were identified as overweight or obese.…”

“…The PNG Government has set a target to reduce premature NCD mortality by 25% from 2010 to 2020 [16]. The increased prevalence of NCD associated risk factors in PNG is likely associated with recent changes in socioeconomic development [17,18]. However, little evidence is available to support this argument.…”