Demography and the epidemiology of disease in Papua New Guinea.

Papua New Guinea (PNG) remains a predominantly rural society. Declining mortality but only slow decline in fertility has led to an average annual growth rate of the order of 2.8%. If fertility continues to decline slowly, the population will reach 10 million soon after 2029; with an accelerated decline the population will be about 8.9 million persons in 2029. Wide differentials in mortality among provinces indicate considerable variation in mortality change. Infectious diseases which dominate the cause structure of mortality should be susceptible to health service intervention. Prerequisites are an appropriate mix of interventions, high levels of coverage, and high-quality monitoring and surveillance. It is critical that these unsolved disease problems be fully addressed as the combination of increasing urbanization, the AIDS (acquired immune deficiency syndrome) epidemic and an increasing prevalence of non-communicable diseases will place upward pressure on mortality rates. For the purposes of monitoring mortality change health services need access to methods for the calculation of mortality rates which have been validated in populations in PNG. Perhaps the most fundamental task of health services is to prevent unnecessary deaths. This article focuses on levels of mortality and the cause structure of mortality. It examines the relationship between health service interventions and mortality decline in PNG.