1. 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

3. Country

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

5. 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%

7. EPIDEMIOLOGY OF TB IN PNG

8. DOTS coverage

9. 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

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

11. 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

12. Treatment results
Report is cohort based, i.e. it reviews the patient that were notified 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-

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

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

15. 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

16. 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 Department of Health, PNG

17. 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.

18. 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

19. 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

20. 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.

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