Mortality in a rural area of Madang Province, Papua New Guinea

As part of a multi-disciplinary research programme undertaken by the Papua New Guinea Institute of Medical Research near the town of Madang, northern PNG, a three-year study of mortality was conducted in a rural population of approximately 16,500 people. From early 1982 the area was under continuous demographic surveillance which continued for the three years of the study. All deaths which occurred in this period were investigated by interviewing relatives of the deceased and examining any available health service records. Respiratory diseases were the commonest cause of death, with pneumonia accounting for 20% of deaths in children under 10 years of age, and pneumonia and chronic obstructive lung disease (COLD) together accounting for a third of all deaths. Deaths from COLD were more common in the study population than in PNG hospitals and health centres. The proportion of deaths caused by malaria in children under 10 years was estimated to be between 4 and 17%. Mortality rate in the first year of life were determined by following up a cohort of 1015 births occurring in the first 20 months of the study. Of the 1002 live births, 46 died in the first 12 months of life, giving an infant mortality rate of 45.9% live births. Other mortality and demographic rates were consistent with data reported from the 1980 PNG National Census, suggesting that the study population belonged to an advantaged rural area. Demographic features found in this population were a high birth rate, a relatively low crude death rate, and a rate of natural population increase of 2.8% per annum. The methodological difficulties associated with the measurement of malaria mortality have important implications for the evaluation of future malaria vaccines. The methods employed in this study are critically discussed, and recommendations made for future studies.