Advertisement

Implementing Tuberculosis Control in Papua New Guinea: A Clash of Culture and Science?

Abstract

Tuberculosis (TB) remains a major health problem in Papua New Guinea (PNG) and the Directly Observed Treatment Short course (DOTS) strategy has been adopted as a framework for controlling the disease. We review here the local and cultural factors in PNG that act as barriers to implementing each component of the DOTS program. Political Will is needed to tackle the underlying conditions that lead to squatter settlements, e.g. poverty and unemployment, and to build infrastructure for access to rural populations. Better case detection may be obtained by addressing the cultural beliefs that delay presentation to health facilities, as well as providing ongoing training for laboratory technicians, introducing better sputum microscopy techniques and regular service of radiology equipment. Direct observation of therapy may need to be done using the traditional clan structure, e.g. clan chiefs and extended family system in rural areas. Effective drug supply is provided by the World Health Organisation (WHO) Global Drug Facility (GDF). Monitoring and Evaluation will require innovative approaches; perhaps through financial incentives on completion of the program or texting through the mobile text messaging for reminders. There are unique cultural and local issues that need to be addressed when implementing DOTS strategy in PNG.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 99

This is the net price. Taxes to be calculated in checkout.

References

  1. 1.

    2009 Update tuberculosis facts. World Health Organisation. Stop TB Partnership.

  2. 2.

    Lonnroth, K., Castro, K. G., Chakaya, J. M., Chauhan, L. S., Floyd, K., Glaziou, P., et al. (2010). Tuberculosis control and elimination 2010–2050: Cure, care, and social development. Lancet, 375, 1814–1829.

  3. 3.

    Country Status Report National TB Program. Papua New Guinea 1997–2005. National TB Program Unit, Disease Control Branch, National Department of Health, Papua New Guinea 2006.

  4. 4.

    The Global Fund To Fight AIDS, Tuberculosis and Malaria 2010.

  5. 5.

    Gilpin, C. M., Simpson, G., Vincent, S., O’Brien, T. P., Knight, T. A., Globan, M., Coulter, C., & Konstantinos, A. (2008). Evidence of primary transmission of multi-drug resistant tuberculosis in the Western Province of Papua New Guinea. Medical Journal of Australia, 188(3), 148–152.

  6. 6.

    PNG National AIDS Council Secretariat. UNGASS 2008 Country Progress Report. Papua New Guinea.

  7. 7.

    Gandhi, N. R., Nunn, P., Dheda, K., Schaaf, H. S., Zignol, M., van Soolingen, D., et al. (2010). Multi-drug resistant and extensive drug-resistant tuberculosis: A treat to global control of tuberculosis. Lancet, 375, 1830–1843.

  8. 8.

    Global Plan To Stop TB, 2006–2015/Stop TB Partnership. World Health Organisation 2006.

  9. 9.

    Tuberculosis Report in the Western Pacific Region: 2008 Report. World Health Organisation 2008.

  10. 10.

    Tuberculosis Control in the Western Pacific Region, 2009 Report. WHO Western Pacific Region.

  11. 11.

    Global Fund to Fight AIDS, Tuberculosis and Malaria 2006.

  12. 12.

    Resolution WPR/RC 51.R4. Tuberculosis prevention and control. Report from the fifty-first session of the Regional Committee for the Western Pacific Region, Manila, 2000, September 18–22. Manila: WHO Regional Office for the Western Pacific; 2000.

  13. 13.

    Medium Term Development Goals 2005–2010, PNG Government 2004.

  14. 14.

    National Department of Health Corporate Plan 2009–2013. Reference manual. National Government of Papua New Guinea 2008.

  15. 15.

    Data by Geography Papua New Guinea Summary. Population Reference Bureau 2010.

  16. 16.

    JICA Integrated Community Development Project in the settlement Areas in the National Capital District. 1995–2008 JICA.

  17. 17.

    Payani, H. H. (2000). Selected problems in the Papua New Guinea Public Service. Asian Journal of Public Administration, 22(2), 135–160.

  18. 18.

    Lee, J. (2004). Papua New Guinea transport sector review note: With an emphasis on the Road sector. Government of Papua New Guinea/The World Bank.

  19. 19.

    Harries, A. D., Zachariah, R., Corbett, E. L., Lawn, S. D., Santos-Filho, E., Chimzizi, R., Harrington, M., Maher, D., Williams, B. G., & De Cock, K. M. (2010). The HIV-associated tuberculosis epidemic-when will we act? The Lancet. doi:10.1016/S0140-6736(10)60409-6.

  20. 20.

    ADB Technical Assistance Consultant’s Report. 2007 July TA 4806-PRC. People’s Republic of China: Sustainable Rural Transport Services.

  21. 21.

    ADB Loan. (2008). Community water transport project: Papua New Guinea. Asian Development Bank 2008.

  22. 22.

    Warr, P. (2005). ‘Road development and poverty reduction: The case of Lao PDR.’ ADB Discussion Paper No 25.

  23. 23.

    Henderson, L., & Tulloch, J. (2008). Incentives for retaining and motivating health workers in Pacific and Asian Countries. Human Resource for Health, 6, 18. doi:10.1186/1478-4491-6-18.

  24. 24.

    Sharp, P. T. (1982). Ghosts, witches, sickness and death: The traditional interpretation of injury and disease rural area of Papua New Guinea. Papua and New Guinea Medical Journal, 25(2), 108–115.

  25. 25.

    Lepowsky, M. (1990). Sorcery and penicillin: Treating illness on a Papua New Guinea island. Social Science and Medicine, 30(10), 1049–1063.

  26. 26.

    Department of Health. Rapid Formative Research to Inform Health Promotion for Tuberculosis Program in Papua New Guinea. National Department of Health December 2000.

  27. 27.

    Storla, D. G., Yimer, S., & Bjune, G. A. (2008). A systemic review of delay in the diagnosis and treatment of tuberculosis and coccidiae. Transactions of the Royal Society of Tropical Medicine and Hygiene, 102(6), 520–521.

  28. 28.

    Marais, B. J., Brittle, W., Painczyk, K., Hesseling, A. C., Beyers, N., Wasserman, E., et al. (2008). Use of light-emitting diode fluorescence microscopy to detect acid-fast bacilli in sputum. Clinical Infectious Diseases, 47(2), 203–207.

  29. 29.

    Styblo, K., & Bumgarner, J. R. (1991). Tuberculosis can be controlled with existing technologies: Evidence. Tuberculosis Surveillance Research Unit, Progress Report 1991, pp. 60–72.

  30. 30.

    Dye, C., Garnett, G. P., Sleeman, K., & Williams, B. G. (1998). Prospect for worldwide tuberculosis under WHO DOTS strategy. Directly observed short-course therapy. Lancet, 352(9144), 1886–1891.

  31. 31.

    Dye, C. (2008). Breaking a law. Tuberculosis disobeys Styblo’s rule. Bulletin of WHO, 86, 4. doi:10.2471/BLT.07.049510 PMID: 18235879.

  32. 32.

    Dowdy, W. D., & Chaisson, R. E. (2009). The persistence of tuberculosis in the age of DOTS: Reassessing the effect of case detection. Bulletin of the WHO, 87, 296–304.

  33. 33.

    Bruchfeld, J., Aderaye, G., Palme, I. B., Bjorvatn, B., Kallenius, G., & Lindguist, L. (2000). Sputum concentration improve diagnosis of tuberculosis in a setting with a high prevalence of HIV. Transactions of the Royal Society of Tropical Medicine and Hygiene, 94(6), 677–680.

  34. 34.

    Hanscheid, T. (2008). The future looks bright: Low-cost fluorescent microscopes for detection of Mycobacterium tuberculosis and Coccidiae. Transactions of the Royal Society of Tropical Medicine and Hygiene, 102(6), 520–521.

  35. 35.

    Mizuno, K., Chikamatsu Kaono, A., Azuma, Y., Yamada, Y., & Mitarai, S. (2009). Clinical evaluation of acid-fast smear examination with light emitting diode fluorescent microscopy. Kekkaku, 84(9), 627–629.

  36. 36.

    Wang, J. Y., Lee, L. N., Lai, H. C., Liaw, Y. S., Hsueh, P. R., & Yang, P. C. (2007). Prediction of the tuberculosis reinfection proportion from the local incidence. Journal of Infectious Diseases, 196(2), 281–288.

  37. 37.

    Verver, S., Warren, R. M., Beyers, N., Richardson, M., van der Spuy, G. D., Borgdorff, M. W., et al. (2005). Rate of reinfection tuberculosis after successful treatment is higher than rate of new tuberculosis. American Journal of Respiratory and Critical Care Medicine, 171(12), 1430–1435.

  38. 38.

    Heller, R. F., Gemmell, I., Edwards, R., Buchan, I., Awasthi, S., & Volmink, J. (2006). Prioritising between direct observation of therapy and case-finding intervention for tuberculosis: Use of population impact measures. BMC Medicine, 4, 35.

  39. 39.

    Becerra, M. C., Pachao-Torreblanca, I. F., Bayona, J., Celi, R., Shin, S. S., Kim, J. Y., et al. (2005). Expanding tuberculosis case detection by screening household contacts. Public Health Reports, 120(3), 271–277.

  40. 40.

    Fuimaono, A., & Vince, J. (1997). Screening contacts of children with tuberculosis: An important and worthwhile part of case management. Papua and New Guinea Medical Journal, 40(2), 69–73.

  41. 41.

    Okanurak, K., Kitayaporn, D., & Akarasewi, P. (2008). Factors contributing to treatment success among tuberculosis patients: A prospective cohort study in Bangkok. The International Journal of Tuberculosis and Lung Disease, 12(10), 1160–1165.

  42. 42.

    Okeibunor, J. C., Onyeneho, N. G., Chukwu, J. N., & Post, E. (2006–2007). Barriers to care seeking in directly observed therapy short-course (DOTS) clinics and tuberculosis control in southern Nigeria: A qualitative analysis. International Quarterly of Community Health Education, 27(1), 23–37.

  43. 43.

    Bolger, J., Mandie-Filer, A., & Hauck, V. (2005). Papua New Guinea’s health sector. A review of capacity, change and performance issues. Discussion Paper No 57F. European Centre for Development Policy Management.

  44. 44.

    Volmink, J., & Garner, P. (2007). Directly observed therapy for treating tuberculosis. Cochrane Database of Systemic Reviews 2007. Issue 4. Art. No.:CD003343. doi:10.1002/14651858.CD003343.pub3.

  45. 45.

    Volmink, J., & Garner, P. (1997). Systematic review of randomised controlled trials of strategies to promote adherence to tuberculosis treatment. BMJ, 315(7120), 1403–1406.

  46. 46.

    Davidson, H., Schluger, N. W., Feldman, P. H., Valentine, D. P., Telzak, E. E., & Laufer, F. N. (2000). The effects of increasing incentives on adherence to tuberculosis directly observed therapy. The International Journal of Tuberculosis and Lung Disease, 4(9), 860–865.

  47. 47.

    Newell, J. N., Baral, S. C., Pande, S. B., Bam, D. S., & Malla, P. (2006). Family-member DOTS and community DOTS for tuberculosis control in Nepal: Cluster-randomised controlled trial. Lancet, 367(9514), 903–909.

  48. 48.

    Egwage, S., Mkopi, A., Range, N., Haag-Arbenz, V., Baraka, A., Grewal, P., et al. (2009). Patient-centred tuberculosis treatment delivery under programmatic conditions in Tanzania: A cohort study. BMC Medicine, 7, 80.

  49. 49.

    Oscherwitz, T., Tulsky, J. P., Roger, S., Sciortino, S., Alphers, A., Royce, S., et al. (1997). Detention of persistently nonadherent patient with tuberculosis. JAMA, 278(10), 843–846.

  50. 50.

    Burman, W. J., Cohn, D. L., Rietmeijer, C. A., Judson, F. N., Sbarbaro, J. A., & Reves, R. R. (1997). Short-term incarceration for the management of noncompliance with tuberculosis treatment. Chest, 112(1), 57–62.

  51. 51.

    Mori, T. (2004). Reform of Japan’s NTP and its technical perspectives. Kekkaku, 79(10), 587–604.

  52. 52.

    Rookkapan, K., Chongsuvivatwong, V., Kasiwong, S., Pariyawatee, S., Kasetcharoen, Y., & Pungrassami, P. (2005). Deteriorated tuberculosis drugs, management system problems in lower southern Thailand. The International Journal of Tuberculosis and Lung Disease, 9(6), 654–660.

Download references

Author information

Correspondence to Kindin Ongugo.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Ongugo, K., Hall, J. & Attia, J. Implementing Tuberculosis Control in Papua New Guinea: A Clash of Culture and Science?. J Community Health 36, 423–430 (2011) doi:10.1007/s10900-010-9324-8

Download citation

Keywords

  • Tuberculosis
  • Sorcery
  • Witchdoctor
  • Squatter settlements
  • Rural