Poverty is the driver of TB epidemic in Papua New Guinea.
A significant amount of resources has been and continues to be invested in the effort to control the TB epidemic in Papua New Guinea (PNG). However, we are witnessing very limited impact. This is not to suggest that there are no success stories; indeed, there are some success stories, but they are occurring in isolated pockets. Regrettably, the broader perspective remains unchanged. We are observing the opposite trend, where the situation appears to be stagnant or possibly even worsening. One of the key factors driving TB in PNG, as is the case in areas where TB is endemic, is HIV. The incidence of HIV seems to be on the rise again after years of decline.
I have read and continue to read reports from NGOs and government initiatives aimed at addressing TB. In these reports, I consistently search for one word – POVERTY!
Surprisingly, only a few of these reports place a strong focus on POVERTY, in other words, the social determinants of TB.
This is a graph that is very well known to those working in the TB space.
It is evident from the graph that the decline in the number of people succumbing to TB had begun long before the discovery of TB drugs. What instigated this decline? It was the improvement in housing conditions.
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Present efforts in Papua New Guinea (PNG) are predominantly concentrated on diagnosis and treatment. While this approach can cure existing cases and temporarily halt transmission, it falls short in providing a long-term solution.
Without an enhancement of the social environment in which the patient resides, they remain susceptible to reinfection with TB. Many individuals fail to complete their treatment, resulting in a high number of drug-resistant cases. Why does this occur? It transpires due to financial constraints or other economic factors that lead them to discontinue their medication. Additionally, some may not comprehend or be aware of the significance of completing their treatment, reflecting a lack of health literacy.
Only 20% of TB cases can be effectively managed through diagnosis and treatment. The remaining 80% can be controlled or prevented by addressing the social determinants of health.
The upsurge in TB cases and the challenges in controlling TB in Papua New Guinea directly mirror the escalating poverty levels influenced by the deteriorating social and economic conditions in PNG's villages and communities.
We must channel more resources into combatting the true drivers of TB in PNG by enhancing the social and economic determinants of TB.
Nutrition Support Officer/ Public Health
1 å¹´Social determinants of health such as you mentioned housing or living conditions, health literacy and other socioeconomic factors should be paramount in addressing TB/HIV. Public Health directives in all PHAs should rise up to these challenges, rather than sitting back and watching the curative health teams taking the lead in combating this non improving TB/ HIV trend. Changing the current approach is the way forward.
Medical Doctor at AGI
1 å¹´Dr you are absolutely correct. For too long we have been passively approaching the fight against TB. The escalating DR TB reflex our (PNG NTP and partners) failure.? Yes, we have our success stories, which were isolated and in most cases not reported. Data collection and reporting is still fragmented.? As you pointed out, we need a Very proactive approach to this flight. Housing styles in rural PNG and the peri urban settlements still fuel TB transmission. Over crowding homes with very poorly ventilation is common all over. From Kikori (growing number of?DR TB) travelling to Seberigi you will see some traditional houses build with NO windows, along the river you find very crowded houses and these continuous all the way down to the coastal villages as well.? I hope to see Strictly guided NTP guidelines that will seriously get the partners/NGOs into places/programs where impacts can be done. We have to be more Pro-active.