Linking Longitudinal Morbidity and Mortality Trends in Host Communities to Workplace Disease Control Efforts in the PNG LNG Project

摘要

OBJECTIVE: Longitudinal morbidity and mortality trends are critical key performance indicators that can be utilized by a large oil and gas development project in order to understand evolving patterns of disease present in host communities. These communities typically provide a substantial number of direct and contract workers; hence, monitoring the underlying burden of disease is extremely important. As part of the PNG LNG Project, a systematic longitudinal effort was made to collect a broad range of morbidity and mortality data for those communities directly adjacent to PNG LNG activities. These data were utilized to inform workplace disease monitoring efforts. METHODS: Within the PNG LNG sponsored Partnership in Health Program (PiHP), longitudinal morbidity and mortality data were collected by the PNG Institute for Medical Research (PNGIMR). A consistent and objective set of morbidity and mortality data were obtained from (a) key community health clinics adjacent to major project operations and facilities and (b) via internationally established verbal autopsy techniques. Morbidity and mortality data were reviewed and analyzed semi-annually and utilized to inform workplace disease control efforts. RESULTS: Key findings included, (a) the measured incidence and prevalence rates of pulmonary tuberculosis (TB) were significantly greater than published Ministry of Health and WHO data, (b) laboratory diagnosed rates of malaria were generally less than 2%, a level far below the "clinical malaria" rates published by health authorities, (c) the baseline level of non-HIV sexually transmitted diseases (STIs) in the community was extremely high, approaching 50% for adults; the level of HIV documented in antenatal clinics was low (typically less than 1%) and consistent with background PNG levels in rural settings, (d) levels of metabolic syndrome, hypertension and diabetes were rapidly increasing, particularly in more affluent villages and (e) the level of community accidents and injuries was substantial, particularly in the Hides area where the upstream activities are based. These findings (a) supported the need to develop a comprehensive workforce tuberculosis surveillance program, (b) reinforced the need to make malaria management decisions based on laboratory proven data, (c) indicated that providing workplace information, education and communication regarding STIs was warranted in addition to easy and free workplace access to condoms was appropriate (d) reinforced the benefit of the "Culture of Health Program" currently being developed across the company workforce and (e) indicated that home/village accidents and injuries were a rising problem. NOVEL/ADDITIONAL INFORMATION: Understanding and monitoring the disease trends in proximate communities provides unique insight into the workforce and provides an opportunity to tailor and target programs that will directly enhance workplace health and safety. The PNG LNG Project developed a unique longitudinal morbidity and mortality surveillance system that objectively informs both workplace and community health efforts.