Melbourne School of Population and Global Health - Theses

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End date: 2023 × Start date: 2020 × Subject: Adult mortality × Subject: Papua New Guinea ×

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    Mortality Patterns in Papua New Guinea
    Kitur, Urarang ( 2020)
    Abstract Introduction Little is known about mortality rates and cause of death (COD) patterns in Papua New Guinea (PNG), because there is a lack of high-quality mortality data. The use of demographic and statistical models which use no local data to estimate mortality has created much uncertainty about actual mortality and COD patterns in PNG. This thesis aims to address this knowledge gap by applying novel demographic and statistical methods to available local data to estimate all-cause mortality (adult mortality, child mortality and life expectancy) and COD by sex for PNG and each of its provinces. Methods A range of demographic and statistical methods were used to estimate mortality rates and COD patterns. The adult mortality rate (45q15) was estimated using the orphanhood method applied to data reported in the 2000 and 2011 national censuses. The under-five mortality rate (5q0) was calculated using the maternal age cohort method using summary birth history data from the 2000 and 2011 national censuses. The 45q15 and 5q0 estimates were entered into model life tables to produce estimates of life expectancy at birth. Cause-specific mortality fractions (CSMFs) were calculated as the average of estimates obtained from two methods: the empirical cause method and the expected cause patterns method. A composite index was constructed using the means of education, economic and health access indicators from various data sources to assess the plausibility of mortality and COD estimates. Results The 45q15 for PNG in 2011 was estimated as 269 per 1,000 for males and 237 per 1,000 for females with substantial inter-provincial variations in both sexes. The under-five mortality was estimated as 68 per 1,000 live births for males and 58 per 1,000 live births for females, and life expectancy was 62.0 years for males and 64.3 years for females. Provinces with a low composite index had comparatively high levels of 45q15 and 5q0, and low life expectancy for both sexes. Conversely, provinces with a higher composite index reported lower 45q15 and 5q0, and higher life expectancy. Both Infectious diseases and noncommunicable diseases (NCDs) accounted for 45% of the deaths each, with the former accounting for more than half the deaths in several provinces (e.g. Gulf and Sandaun). Provinces with higher CSMFs from emerging NCDs (e.g. ischaemic heart disease and stroke) were those in which socioeconomic status was comparatively high. Conclusion The major findings of this thesis are that adult mortality in PNG is relatively high compared with other low- and middle-income countries and that provincial variations in all-cause mortality and COD correlate with levels of development as measured by the composite index. The level of epidemiological transition is not uniform across the country with noncommunicable diseases emerging in provinces with higher levels of socioeconomic development. It is recommended that PNG urgently address the major causes of persistently high premature adult and child mortality and strengthen the collection of routine mortality and COD data through verbal autopsies to ensure the availability of reliable and timely data for policymakers to improve PNG’s population health.