Linking Longitudinal Morbidity and Mortality Trends in Host Communities to Workplace Disease Control Efforts

Objective
Longitudinal morbidity and mortality trends are critical key performance indicators that can be used by large oil- and gas-development projects 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 Papua New Guinea (PNG) Liquefied Natural Gas (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 used to inform workplace disease-monitoring efforts.

Methods
Within the PNG-LNG-sponsored Partnership in Health Program, longitudinal morbidity and mortality data were collected by the PNG Institute for Medical Research. A consistent and objective set of morbidity and mortality data were obtained from key community health clinics adjacent to major project operations and facilities and through internationally established verbal autopsy techniques. Morbidity and mortality data were reviewed and analyzed semiannually and used to inform workplace disease-control efforts.

Results
Key findings included the following:

  • The measured incidence and prevalence rates of pulmonary tuberculosis were significantly greater than published Ministry of Health and World Health Organization data.
  • Laboratory-diagnosed rates of malaria were generally less than 2%, a level far below the “clinical malaria” rates published by health authorities.
  • The baseline level of non-HIV sexually transmitted infections (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.
  • Levels of metabolic syndrome, hypertension, and diabetes were rapidly increasing, particularly in more-affluent villages.
  • The level of community accidents and injuries was substantial, particularly in the Hides area where the upstream activities are based.
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These findings

  • Supported the need to develop a comprehensive workforce tuberculosis surveillance program
  • Reinforced the need to make malaria-management decisions based on laboratory-proven data
  • Indicated that providing workplace information, education, and communication regarding STIs was warranted and easy and free workplace access to condoms was appropriate
  • Reinforced the benefit of the Culture of Health Program currently being developed across the company workforce
  • 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.

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