Exploring Tuberculosis Riskscapes in a Papua New Guinean ‘Hotspot’

Abstract

This article explores socio-spatial dimensions of risk and how they can enhance understanding of a high burden tuberculosis (TB) context in the South Fly District of Papua New Guinea. We report on select findings from a qualitative study that included 128 semi-structured in-depth interviews and 10 focus group discussions with a wide range of South Fly District community members. Using the conceptual framework of ‘riskscapes’ to examine emic perspectives on risk, space and practice, we map key elements of TB riskscapes on Daru Island, South Fly District, along with solutions for navigating through these riskscapes. Overcrowding, lack of water, sanitation and hygiene, as well as food insecurity and undernutrition, were identified as common elements within participants’ riskscapes, that compounded upon each other to create the perception of an assemblage of risk favourable to TB transmission.

Evaluation of a population-wide, systematic screening initiative for tuberculosis on Daru island, Western Province, Papua New Guinea

“…In this study, smaller household size was associated with a three-fold increase in the odds of TB. This is contrary to the literature, where crowding is a consistent risk factor for TB [ 22 ] and it is a known problem in Daru [ 23 ]. This could be explained if people living in larger households may spend less time in their homes, avoiding crowded conditions.…”

Contact screening and management in a high-transmission MDR-TB setting in Papua New Guinea: Progress, challenges and future directions

“…Daru, and South Fly District have significant particular challenges in the social determinants of health which contribute to increased risk of TB transmission, with one of the highest measures of household poverty in the region, low levels of health literacy overcrowding food insecurity and low access to health services due to service availability, remoteness and lack of trust ( 7) (8). The TB program has had a concerted focus on community engagement, health promotion and patient-centred services.…”

“…In 2014, the PNG National Department of Health and Western Provincial Health Authority (WPHA) initiated an emergency response to MDR-TB, which has resulted in the stabilisation of TB notifications, improved treatment outcomes and a reduction in TB-related mortality (5,6). A description of the geographical, social and demographic context in Daru, which is located in the transboundary region between PNG and the Australian Torres Strait, has been detailed elsewhere (7,8).…”