The epidemiology of tuberculosis in the rural Balimo region of Papua New Guinea

Diefenbach-Elstob, Tanya; Graves, Patricia M.; Dowi, Robert; Gula, Bisato; Plummer, David; McBryde, Emma S.; Pelowa, Daniel; Siba, Peter; Pomat, William; Warner, Jeffrey

doi:10.1111/tmi.13118

Cited by 10 publications

(17 citation statements)

References 17 publications

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“…7,11 One finding that is consistent among the limited amount of published literature on TB in PNG is the high rate of EPTB relative to other settings. 1,3,7,11 Detailed investigation to determine whether this phenomenon represents inappropriate diagnosis or if the clinical manifestations of TB in PNG are different to other settings has not been undertaken. Since 2013, the WHO has recommended that all presumptive EPTB cases undergo Xpert testing.…”

Section: S40mentioning

confidence: 66%

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A retrospective study of tuberculosis outcomes in Gulf Province, Papua New Guinea

Moses

Main

Commons

et al. 2019

public health action

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Setting: Gulf Province, a rural area of mainland Papua New Guinea, is known to have one of the highest burdens of tuberculosis (TB) in the country. Objectives: To describe the characteristics and outcomes of TB patients registered for first-line treatment in Kerema General Hospital in Gulf Province between January and December 2016. Design: This was a retrospective cohort study using routinely collected programme data. Results: Of 347 cases with a recorded TB site, 54% were male and 32% were aged 15 years. No human immunodeficiency virus (HIV) status was recorded for 51% of cases. TB was bacteriologically confirmed in 23% of cases. Among the cohort, there were 145 extrapulmonary TB cases (42%); the site of disease was unknown in 56% of these cases. Of the 297 cases with treatment outcome evaluated, 56% had a favourable outcome and 26% were lost to follow-up. On multivariable analysis, extrapulmonary TB (adjusted OR [aOR] 0.51, 95%CI 0.30-0.88, P = 0.02) and bacteriologically confirmed TB (aOR 0.40, 95%CI 0.21-0.77, P  0.01) were associated with decreased odds of an unfavourable treatment outcome. Conclusion: The study findings highlight the need to improve TB diagnosis, access to HIV testing, treatment adherence, patient support and the quality of TB programme data in Gulf Province.

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Section: S40mentioning

confidence: 66%

“…The high rate of childhood TB reported in this study is consistent with previous reports in PNG. 3,7,11 Children are estimated to account for approximately 10-20% of all TB cases globally. 13 The high proportion of children with TB found in our study could be due to overdiagnosis or may be a true indication of the burden of TB disease in children.…”

Section: S40mentioning

confidence: 99%

A retrospective study of tuberculosis outcomes in Gulf Province, Papua New Guinea

Moses

Main

Commons

et al. 2019

public health action

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“…However, the hospital has been without a physician for many years, and staffed by health extension officers and nurses. At the hospital, diagnosis of TB relies on clinical presentation and smear microscopy results, and is based on the PNG National Tuberculosis Management Protocol [24,26,27]. The hospital laboratory does not have the capacity for culture or Xpert MTB/RIF-based diagnosis of TB.…”

Section: Study Population and Methodsmentioning

confidence: 99%

“…The Balimo region in the Middle Fly District of Western Province is known to have a high burden of TB [24], with limited diagnostic facilities and smear microscopy being the only laboratory-based method of TB diagnosis available at Balimo District Hospital (BDH). Given the TB epidemic in Western Province, combined with limited data from areas outside the provincial capital, the aim of this study was to characterise the extent and type of molecular DR-TB in the remote Balimo region.…”

Section: Introductionmentioning

confidence: 99%

Molecular Evidence of Drug-Resistant Tuberculosis in the Balimo Region of Papua New Guinea

et al. 2019

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Papua New Guinea (PNG) has a high burden of tuberculosis (TB), including drug-resistant TB (DR-TB). DR-TB has been identified in patients in Western Province, although there has been limited study outside the provincial capital of Daru. This study focuses on the Balimo region of Western Province, aiming to identify the proportion of DR-TB, and characterise Mycobacterium tuberculosis (MTB) drug resistance-associated gene mutations. Sputum samples were investigated for MTB infection using published molecular methods. DNA from MTB-positive samples was amplified and sequenced, targeting the rpoB and katG genes to identify mutations associated with rifampicin and isoniazid resistance respectively. A total of 240 sputum samples were collected at Balimo District Hospital (BDH). Of these, 86 were classified as positive based on the results of the molecular assays. For samples where rpoB sequencing was successful, 10.0% (5/50, 95% CI 4.4–21.4%) were considered rifampicin-resistant through detection of drug resistance-associated mutations. We have identified high rates of presumptive DR-TB in the Balimo region of Western Province, PNG. These results emphasise the importance of further surveillance, and strengthening of diagnostic and treatment services at BDH and throughout Western Province, to facilitate detection and treatment of DR-TB, and limit transmission in this setting.

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“…This area is hereafter referred to as the “Balimo/Bamu region”. BDH does not have facilities for performing Mtb culture and is not equipped with a GeneXpert (Cepheid) instrument, so TB diagnosis relies primarily on clinical presentation and direct sputum smear microscopy, based on the PNG National Tuberculosis Management Protocol 13–15 . DNA extracted from Ziehl-Neelsen (ZN) stained sputum smears has already proven useful in molecularly confirming the microscopy diagnosis of TB in this region of PNG 14 , and spoligotyping has been undertaken successfully on DNA extracted from cultures 10,16 , from decontaminated sputa 17 , as well as from ZN-stained sputum smears 18–21 .…”

Section: Introductionmentioning

confidence: 99%

Diversity of Mycobacterium tuberculosis in the Middle Fly District of Western Province, Papua New Guinea: microbead-based spoligotyping using DNA from Ziehl-Neelsen-stained microscopy preparations

Guernier

Diefenbach-Elstob

Klotoe

et al. 2019

Sci Rep

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Tuberculosis remains the world’s leading cause of death from an infectious agent, and is a serious health problem in Papua New Guinea (PNG) with an estimated 36,000 new cases each year. This study describes the genetic diversity of Mycobacterium tuberculosis among tuberculosis patients in the Balimo/Bamu region in the Middle Fly District of Western Province in PNG, and investigates rifampicin resistance-associated mutations. Archived Ziehl-Neelsen-stained sputum smears were used to conduct microbead-based spoligotyping and assess genotypic resistance. Among the 162 samples included, 80 (49.4%) generated spoligotyping patterns (n = 23), belonging predominantly to the L2 Lineage (44%) and the L4 Lineage (30%). This is consistent with what has been found in other PNG regions geographically distant from Middle Fly District of Western Province, but is different from neighbouring South-East Asian countries. Rifampicin resistance was identified in 7.8% of the successfully sequenced samples, with all resistant samples belonging to the L2/Beijing Lineage. A high prevalence of mixed L2/L4 profiles was suggestive of polyclonal infection in the region, although this would need to be confirmed. The method described here could be a game-changer in resource-limited countries where large numbers of archived smear slides could be used for retrospective (and prospective) studies of M. tuberculosis genetic epidemiology.

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The epidemiology of tuberculosis in the rural Balimo region of Papua New Guinea

Cited by 10 publications

References 17 publications

A retrospective study of tuberculosis outcomes in Gulf Province, Papua New Guinea

A retrospective study of tuberculosis outcomes in Gulf Province, Papua New Guinea

Molecular Evidence of Drug-Resistant Tuberculosis in the Balimo Region of Papua New Guinea

Diversity of Mycobacterium tuberculosis in the Middle Fly District of Western Province, Papua New Guinea: microbead-based spoligotyping using DNA from Ziehl-Neelsen-stained microscopy preparations

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