Dr. Joseph Bana-Koiri Dr. Gilbert Hiawalyer Papua New Guinea Workshop on Surveillance and Epidemiology of Tuberculosis in the Western Pacific Region, Manila, Philippines,4-7 May 2004 Dr. Joseph Bana-Koiri Dr. Gilbert Hiawalyer Papua New Guinea

Country

Population 5.1 Million(2,000 Census) Melanesian & Polynesian 85% Rural Languages: 817 3 Official-English,Pidgin & Motu

Health Indicators of PNG Leading Causes of Death Life expectancy 54(2000) IMR 64 per 1000 births(2000) MMR 370 per 100,000 births(1996-DHS) TFR 4.7 Growth rate 2.3% Literacy rate 45%

EPIDEMIOLOGY OF TB IN PNG

DOTS coverage

Case-detection Target: minimum 70% of estimate Estimate: 115 new PTB+ cases / 100,000 / year Estimate is based on surveys, previous reporting, other countries, extrapolation DOTS case notification rate: number of new PTB+ cases notified / estimate

Notification Rates (status on 15 March 2004) 2001 2002 2003 TB07 expected 18 162 214 TB07 submitted 18 (100%) 160 (99%) 149 (70%) TB08 expected 8 TB08 submitted 8 (100%) 16 (89%) 90 (56%)

DOTS case-notification Number of new PTB+ cases notified in 2003: 859 for 5.1 million or 17/100,000 DOTS case notification rate: 17/115 or 15% for new smear-positive cases The true figure is higher as reporting is not complete

Treatment results Report is cohort based, i.e. it reviews the patient that were notified 12-15 months earlier. Possible outcomes: cured, treatment completed, died, failure, defaulter, transfer out, not evaluated Rates are calculated as: Number cured / number notified one year ago Separate analysis for new PTB+, new PTB-, relapse PTB+ and other PTB+ No evaluation of EPTB, retreatment PTB-

Treatment Results: new P+TB (status on 15 March 2004) Cohort: 403 452 934

Treatment Results: new P-TB (status on 15 March 2004) Cohort: 1064 1505 2057

Treatment outcomes (percents) 1998 1999 2000 2001 2002 Cured Completed 21 25.5 32.9 29.8 36.5 Defaulted Failed 1.9 2.5 3.3 3 3.1 Died Transferred out 2.9 2.6 2.1 2.4 4 Non evaluated

Incidence of HIV at Antenatal, TB and STI Clinic Site No. of Patients Screened No. of Sero-Conversion Prevalence Rate(%) Port Moresby   Antenatal 1187 16 1.35 STI Clinic 335 27 8.06 TB Clinic 300 57 19.00 Goroka 451 4 0.89 315 5 1.59 Mt. Hagen 19 6.33 Lae 480 12 2.50 Daru 150 1 0.66   Source: HIV/AIDS Quarterly Report, Sept. 2003-Department of Health, PNG

NHIS REPORTING RATE It is possible that inconsistencies may arise with data used for analysis at province level and those at national level (for example, if reports are not forwarded, or errors in data entry are not identified). Provinces are urged to collate and undertake their own analysis; however, the national level report will be extracted from the Nation Department of Health. Failure to submit reports will limit the ability of the national report to accurately provide the picture of provincial performance. The higher the report returns, the more likely is the national report likely to reflect the actual situation. Accordingly, health centre, district and province staff are encouraged to enter their data and forward reports with a high level of efficiency and quality. The NHIS return rates below show that overall, the national report is drawn from reports form only 89% of health facilities, and in some province, a quarter of the facility reports are not available.

Surveys No Prevalence Survey Done No Tuberculin Survey No skills and personnel to do it No financial backing Logistic is difficult Government Reforms make it difficult No Tuberculin Survey

Monitoring of TB situation (DOTS) Each diagnosed case is registered – TB04 Each registered case is reported – TB07 Each reported case is analysed at the end of treatment (cohort) – TB08 TB is the only disease for which individual case-monitoring is systematically done

DOTS coverage: target 100% by 2007 Coverage refers to population covered A district or province is considered as DOTS covered when, after a formal training, one health facility in the district/province is submitting a TB07 report Number of health facilities reporting: 58 Number of districts reporting: 25 (28%) with 30% of pop. Number of provinces reporting: 9 (45%) with 46% of pop.

THANK YOU VERY MUCH EVERYONE FOR EVERY THING YOU HAVE DONE TO MAKE THIS WORKSHOP A VERY SUCCESSFUL ONE