PNG has worst health status

 ACCORDING to the World Health Organisation (WHO), PNG has the worst health status in the Pacific region.

It ranks 153rd of 187 countries on the UN’s Human Development Index, worse than Bangladesh and Myanmar. Australia ranks 2nd. 

Health outcomes have stalled over the last quarter century and PNG is unlikely to reach any of the UN’s Millennium Development Goals.

For a population nearing 7 million, PNG has less than 400 doctors of which only 51 work outside Port Moresby, despite 87% of people living in rural areas. That’s one doctor per 17,068 people, compared to one per 302 in Australia.

There’s also a critical shortage of health workers – just 0.58 per 1,000 people, compared to WHO’s standards which specify 2.5:1,000 simply to maintain primary care. 

Not surprisingly, PNG ranks in the bottom 15 countries in Save the Children’s Health Workers Reach Index.

Some of the most troubling health statistics include :

• Maternal mortality: PNG’s maternal mortality ratio is worse than India’s, with almost half of all women giving birth without the assistance of a doctor or midwife;
• Infant mortality: 5.5% of babies will die before age two (UNDP);
• Communicable diseases: Tuberculosis, malaria and other communicable diseases cause 62% of deaths nationwide;
• Water-borne diseases: Only 33% of rural people have access to clean water, a major factor in the 2009 cholera outbreak that affected 14,000 people, while diarrhoea is the seventh bigger killer.

PNG’s leading causes of mortality and morbidity

• Mortality: Perinatal conditions, pneumonia, malaria, TB, meningitis, heart diseases, diarrhoea, diseases of the digestive system; and,
• Morbidity (inpatient care): TB, normal deliveries, pneumonia, malaria, perinatal conditions, direct obstetric causes, diarrhoea, diseases of the digestive system, open wounds and injury to blood vessels, anaemia.

Maternal health

Women in PNG are particularly disadvantaged, as evidenced by poor maternal health and lack of access to family planning. 

The maternal mortality ratio is 733 per 100,000 (twice what is was in 2006).

Doctors and other health professionals from the PNG National Department of Health, Population Services International and more estimate that at least five women die in childbirth every day.

• 60% of women do not give birth at a health facility or hospital;
• 53% of pregnant women do not receive any care by trained health personnel;
• 26% of women use contraception;
• 15% of a woman’s lifetime is estimated to be affected by some form of disability;
• 10% of all deaths in PNG are due to perinatal conditions; and,
• 4.6 is the average number of children per woman.

Babies and children

Children are five times more likely to die in countries hit by a health worker crisis, and PNG is no exception. 

In 2005, 14,000 of 15,000 child deaths in the Pacific region occurred in PNG (UNICEF). 

Pneumonia and diarrhoea, together with underlying malnutrition, are the most important causes of post-neonatal death in young children in PNG.

• 74.7 deaths per 1,000 live births in children under five (in 2010, 551 child deaths overall due to acute respiratory infections and 173 due to diarrhoeal diseases);
• 56.7 deaths per 1000 live births in infants under one;
• 29.10 deaths per 1,000 live births in newborns;
• 31% of children aged 0-5 are stunted;
• 28% of children considered moderately to severely malnourished; and,
• 9.4% of newborns weigh less than 2500 grams at birth. 

Malaria

Malaria is endemic in every province, with an average of 1.5-1.8 million suspected cases of malaria seen at health care facilities annually.

• #1 cause of all outpatient visits (2008);
• #3 cause of death (2008), with a mortality rate of 9.7 per 100,000 population;
• #4 cause of hospital admissions (2008); and,
• Only 60% of young children with fever receive appropriate treatment with anti-malarials.

Tuberculosis

TB a major public health concern in PNG, with an estimated 33% of new and retreatment cases being multi-drug resistant strains (2008). Directly Observed Treatment Short-course (DOTS) was introduced in 1997, but reaches 9 of 29 provinces.

• 337:100,000 prevalence rate;
• 42% increase in cases over the past 10 years;
• 26:100,000 mortality rate;
• #2 cause of in-patient bed occupancy in hospitals in 2008; and,
• TB poses a serious threat to HIV positive people (TB-HIV co infection).

HIV and AIDS

HIV has been endemic in PNG since 2003, with over 34,000 people infected. 

According to The Medical Journal of Australia, AIDS related death is the leading cause of death in adult patients at Port Moresby General Hospital (2003).

• 3% (est.) of sexually active adults in Port Moresby are HIV positive;
• 0.9% national prevalence rate in 2009 down from 1.5% in 2007;
• 0.6% to 3.7% prevalence rate amongst pregnant women attending antenatal clinics; and,
• High incidence of sexual assaults on women contributes to their risk of catching HIV or another sexually transmitted infection (STI).

Filariasis (elephantiasis)

Filariasis is endemic to PNG, however, the extent of the problem is unknown. Mass Drug Administration to Eliminate Lymphatic Filariasis was conducted in only a few provinces due to insufficient funding and has now been taken over with DEC salt trials in selected provinces.

In the Pacific region, PNG represents 70% of the total population at risk of being infected with filariasis.

Leprosy

Leprosy has re-emerged in five provinces including National Capital District, Central, Gulf, Western and West Sepik. 

The Leprosy Mission International estimates there are over 1,000 cases nationwide.

Health and sanitation

In 2009 PNG was affected by a cholera outbreak that spread across eight provinces with approximately 14,000 cases reported.

• 33% of people in rural areas use an improved water drinking source;
• 40% of people nationwide use an improved water drinking source; and,
• 41% of people in rural areas use an improved sanitation facility.

Non communicable diseases

The incidence of non-communicable diseases in PNG is rising, creating the double burden observed in most developing countries.

This includes tobacco and alcohol related illnesses, diabetes and hypertension, and cancer (especially oral cancer caused by chewing betel and tobacco, and cervical cancer which claimed the lives of 900 women in 2011). – Australian Doctors International website