Tuberculosis and HIV/AIDS-Attributed Mortalities and Associated Socioeconomic Demographic Factors in Papua New Guinea: Evidence From the Comprehensive Health and Epidemiological Surveillance System

Background: Tuberculosis (TB) and HIV/AIDS have been recently identified as the leading specific causes of deaths (COD) in Papua New Guinea (PNG). However, little is known about the socioeconomic demographic factors of mortalities attributed to these diseases. Objective: This study examines the socioeconomic and gender inequality in mortality attributed to TB and HIV/AIDS among the population by analyzing the associations of socioeconomic demographic factors of the deceased and CODs in the population in PNG to inform policy. Method: Mortality data from 926 verbal autopsy (VA) interviews were collected from the population living within the catchment areas of the Comprehensive Health and Epidemiological Surveillance System (CHESS), established in five provinces, including Central, Eastern Highlands, East New Britain, East Sepik, Madang and Port Moresby, the National Capital in the period 2018-2020, using the WHO 2016 VA tool. InterVA-5 cause of deaths (COD) diagnostic tool was used to assign possible CODs. Mortality data were linked with household socioeconomic data from CHESS database for analysis of socioeconomic factors associated with mortalities from TB and HIV/AIDS using multinomial logistic regression (MLR) models to provide estimates odds ratios (unadjusted and adjusted ORs) and 95% confidential intervals (CI). Result: TB and HIV/AIDS were the first and the third leading CODs, attributed to 9% and 8% of the total deaths recorded in the population. The prevalence of TB and HIV/AIDS co-morbidities was about 6% of all TB and HIV/AIDS-attributed deaths. Males were more likely to die from TB than females (aOR: 1.2; 95% CI: 0.62-1.83). The population aged 25-34 years had the highest proportion of deaths from TB (20% of deaths in this age group), and the risk of dying from TB in this age group was three folds more than those aged 75+ years (aOR: 2.7; 95% CI: 1.59-19.5). People from middle household wealth quintile had highest proportion of deaths from TB (15% of deaths in this population) and the risk of dying from TB in this quintile was doubled than the richest quintile (aOR: 2.14; 95% CI: 1.30-3.27). Rural population was more likely to die from TB than urban population. The risks of dying from TB were 50% higher in Central and Madang, but 50% lower in POM compared to East New Britain. HIV/AIDS-attributed deaths accounted for 11% of female deaths, compared to 5% of male deaths. Young population aged 25-34 years had the highest proportion of deaths attributed to HIV/AIDS (18%) and the risk of dying from HIV/AIDS in this population was twice higher than those aged 75+ years (aOR: 1.99; 95% CI: 0.77-20.3). HIV/AIDS-attributed deaths accounted for 5% of deaths among children aged 0-4 years. The highest proportion of HIV/AIDS mortality was found among the population from middle household wealth quintile (10% of deaths in this population), and this population was 85% more likely to die from HIV/AIDS than the richest quintile (aOR: 1.85; 95%CI: 0.91-3.21). About 9% of deaths in rural population was due to HIV/AIDS, compared to 6% in urban population. The proportion of people died from HIV/AIDS was highest in EHP (12%), followed by Madang (10%). The risks of dying from HIV/AIDS were higher in EHP and Madang than East New Britain (aOR: 1.3 [95% CI: 0.4-2.5] and aOR: 2.0 [95% CI: 0.8-3.6], respectively). Conclusion: TB and HIV/AIDS were the top leading causes of death in PNG population, and attributed to highest proportions of mortalities among the young people aged 24-35 years, are evidence of failed TB and HIV/AIDS programs. Death of children aged 0-4 years to HIV/AIDS suggested that the prevention of mother-to-child transmission was failed to protect newborns from HIV/AIDS. More targeted public health interventions are needed to reduce premature mortalities from TB and HIV/AIDS among the population in rural areas, particularly those are young females in Madang and EHP, and those are from households with low wealth status. Funding Information: The CHESS was operated with financial supported from the PNG Government through the Department of National Planning and Monitoring (PIP No. 02704). Declaration of Interests: No potential conflict of interest was reported by the authors. Ethics Approval Statement: The CHESS was granted ethics approvals from Institutional Review Board of PNG Institute of Medical Research (IRB’s Approval no. 18.05) and the Medical Research Advisory Committee of Papua New Guinea (MRAC’s Approval no. 18.06). These approvals covered all the data components under the CHESS, including the mortality data which were used in this manuscript. Informed consent was sought from self-identified close relatives of the deceased. They were informed about their right to withdraw from the study at any stage.